Final jan feb 2016

Bulletin

Editors: Karen Snow, M.D. | Erica Huffman, Executive Director

www.escambiacms.org

JANUARY/FEBRUARY 2016 VOLUME 46, NO. 1

PRESIDENT’S MESSAGE Why the Medical Society?

It is with great excitement and a little bit of apprehension (mostly about writing these articles) that I start my term as this year’s president of the Medical Society. I love how our medical Society has grown over the last few years and the increased involvement from our members. I am often asked by non-members, “Why join the Medical Society?”, and by new and current members, “Why stay?”. So I started thinking about why I joined the Medical Society, and why I’m still here.

I joined the ECMS shortly after I moved to Pensacola and started working at the Medical Center Clinic. While I’d like to say that I joined the medical Society so I could become politically involved and effect change locally and at the state level, I actually joined so I could meet other physicians and generate some referrals. While this may seem somewhat self serving, I think it is a great benefit of the Medical Society; to connect with other local physicians, put a name to the face, and become known within the medical community. For physicians new to the area I can think of no better venue for such an opportunity.

As my practice grew and I established a good referral base, I found that I still continued to go to meetings regularly. Now days many of us primarily have office based specialties, where it can sometimes be difficult to see and speak to our colleagues who we do not directly work with. At meetings, I found I enjoyed seeing and talking to friends with whom I share patients as well as similar interests. Sometimes in our busy lives, it is not always the easiest thing to take the extra time to see and talk to everyone.

Over the last few years I’ve found myself (along with many of my colleagues) becoming upset

CONTENTS about many the new laws and regulations that affect us daily. I’ve seen the advent of meaningful use, the affordable care act, PQRS, endless prior authorizations, onerous maintenance of certification, and nurses who wish to replace us. I started to realize that while complaining is cathartic, it just wasn’t enough. That is when I realized I needed to become more involved with the Medical Society at the level of the board and also more involved with the Florida Medical Association. I’ve seen our local Medical Society effect real policy at the state level, and while slow, sometimes frustrating and often painful, I feel we can make a real change.

So whatever your reason for joining the Medical Society, whether it be to drum up business, keep in touch with old friends, be the next political medical powerhouse, or just come by for the free food and drinks, I hope you enjoy your connection with our organization. For those that have been with us encourage you to become more involved and help us all make real change in Escambia and Santa Rosa Counties, as well as the state of Florida.

If you have any suggestions to improve or enhance our Society, please feel free to let me know as we’re always open to new ideas. This is our Medical Society and it is great, but we should always focus on the future, and on how we can all make it better together.

Page 3 - Announcements Page 4 - Membership Page 6 - Practice Mgmt.

Page 10 - Medical/Legal Page 14 - Foundation Page 15 - In the Community

SAVE THE DATE Tuesday, March 15, 2016 5:30pm General Membership Meeting Post-Legislative Session Overview Thursday, April 14, 2016 Pensacola Wahoos Game Time: TBD General Membership Meeting Doctors Day Celebration Thursday, May 5, 2016 | Hilton Garden Inn Airport Boulevard | 5:30p General Membership Meeting Mini Health Vendor Fair & physician speed networking event Founded in 1873

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8880 University Pkwy., Suite B Pensacola, FL 32514 Ph: 850-478-0706 x2 Fx: 850-474-9783 Email: info@escambiacms.org www.escambiacms.org

E.C.M.S. Bulletin

The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.

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Vision for the Bulletin:

Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond.

A powerful instrument to attract and induct members to organized medicine.

Mission:

The mission of the Escambia County Medical Society is to promote the art and science of medicine in order to improve the health of our community. | Tradition – Honoring the history of medical care in Escambia and Santa Rosa counties. | Service – Serving the needs of our community through the service of our members in the practice of medicine. | Leadership – Meeting the challenges of the future and safeguarding our community’s health through organized collaboration on the local, state, and national level.

Ad placement Contact Erica Huffman at 478-0706 x2 Ad rates 1/2 page: $350 · 1/4 page: $200 · 1/8 page: $150

Announcements 2016 Executive Committee 2016 E.C.M.S. President: “I joined E.C.M.S. because it gives me the opportunity to meet community physicians and work with them to improve the quality of healthcare in Pensacola.” - Brian Kirby, M.D. 2016 E.C.M.S. President- Elect: “I decided to join E.C.M.S. to get involved with issues that face us in the medical community in order to make positive changes by working together. It has been a great opportunity to meet other local physicians that I wouldn’t normally have a chance to meet (put a face with a name).” - Hillary Hultstrand, M.D.

2016 E.C.M.S. VicePresident: “I decided that if I didn’t get involved in organized medicine, someone else, usually a non-physician, would make rules that affect my practice of medicine. The Escambia County Medical Society is the right organization to advocate for physician/patient issues. It’s also a lot of fun!” - Ellen W. McKnight, M.D. 2016 ECMS Secretary/ Treasurer: “With all of the evolving changes in healthcare it is important for doctors to stay current and stand together for what is best for their patients.” Karen Snow, M.D.

Save the Date On Saturday, January 30, 2016 ECMS will host our Annual Inaugural Ball in conjunction with our donor gala at the Pensacola Yacht Club.

The donations on this evening will benefit the Escambia/Santa Rosa County Medical Society Scholarship Endowment Fund which benefits students from the Florida State University College of Medicine Pensacola Campus. Fourth year medical students who receive the ECMS Michael Redmond Scholarship must demonstrate an interest in returning to Northwest Florida to practice medicine after completing their residency training.

2016 Inaugural Ball | President-Elect Brian Kirby, M.D. View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.

Saturday, January 30, 2016 | Pensacola Yacht Club

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

3 | ECMS

GO SENIORS! The ECMS Foundation’s goal is to meet the needs of underserved populations.

The goal of this voucher program is to keep our vulnerable elderly population consistently receiving care when they need it and helping physicians’ better treat a population with limited resources.

Criteria: 60 years or older Have a healthcare transportation need Visit your doctor’s office Each patient is eligible for two vouchers per visit Call Erica Huffman for more information 850-478-0706 x2

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Membership 2016 Calendar of Events Saturday, January 30, 2016 | Pensacola Yacht Club | 6:00pm cocktail hour 2016 Inaugural Ball President-Elect Brian Kirby, M.D. $65/per person | Black Tie Optional Attire Tuesday, March 15, 2016 | Location: Hilton Garden Inn Airport Boulevard | 5:30pm General Membership Meeting Post-Legislative Session Overview Thursday, April 14, 2016 |Pensacola Wahoos Game | Time: TBD General Membership Meeting Doctors Day Celebration Thursday, May 5, 2016 | Hilton Garden Inn Airport Boulevard | 5:30p General Membership Meeting Mini Health Vendor Fair & physician speed networking event Tuesday, August 9, 2016 | Location: V.Paul’s Italian Ristorante| 5:30p General Membership Meeting - Young Physicians Section Meeting Topic: “Direct Patient Care” Sunday, September 25, 2016 | Time: TBD Women in Medicine Brunch – Painting October 2016 | Location: TBD | 5:30p General Membership Meeting Topic: TBD November 12, 2016 | Location: Hilton Garden Inn Airport Boulevard | AM start time General Membership Meeting - FALL CME CONFERENCE Topics: TBD Calendar is subject to change please visit our website for updates www.escambiacms.org

2016 MEMBERSHIP DUES Early County Dues: October 1 - DECEMBER 31, 2015 County Dues: JANUARY 1, 2016 ECMS Annual Pictorial Directory Published in April. Please pay your dues before March 1st to be included in the next edition of the ECMS Annual Pictorial Directory.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

5 | ECMS

Practice Management INFORMED CONSENT: SUBSTANCE AND SIGNATURE For decades, consent documents protected physicians against any legal recourse a dissatisfied patient might pursue.

Times have changed. Modern medicine requires a more complex and complete acknowledgment of both the patient’s and the physician’s rights and responsibilities to each other. According to the Physician Insurers Association of America data, almost 6 percent of claims arise from lack of consent.

True informed consent is a process of managing a patient’s expectations; it is not just a signature on a document.

Achieving an accurate diagnosis requires the patient to provide accurate information to the physician. The physician must then provide sufficient information to the patient so that a reasonable and informed decision regarding a treatment plan can be made. This physician responsibility cannot be delegated.

A successful exchange of information between the doctor and the patient accomplishes two things. First, when the physician explains diagnoses, treatments, expected outcomes, and potential risks to the patient, it demonstrates that the physician recognizes the patient’s rights and will remain responsive to them. Second, it shifts the decision-making responsibility from the physician alone to a mutual responsibility of both physician and patient. Informed consent should protect and inform both the patient and the doctor.

Litigation often results from a discrepancy between the patient’s expectations and the outcome of treatment. Informed consent cannot completely eliminate malpractice claims, but an established rapport between the patient and the physician based on solid exchanges of information can prevent patient disappointment from ripening into a claim. The informed consent process is not limited to surgical procedures; it is also appropriate for comprehensive medical treatment plans.

Physician-Patient Dialogue When discussing diagnoses, treatment plans, risks, and expected outcomes with the patient, use medically correct wording and names, but avoid medical terminology. If there are alternative treatment options, discuss them in detail. Also, outline the recovery process and the expected short- and long-term effect on the patient.

Identify any uncertainty and risk involved with a specific treatment plan, including the probability factors, if possible.

Discuss reasonable assumptions the patient may make about the treatment plan. Whenever possible, supply reading materials and the consent form document for the patient to take home and discuss with his or her family.

Encourage questions. Questions provide a better understanding of the patient’s comprehension of the information and facilitate the dialogue between the patient and the physician. Where time permits, consider scheduling a second visit with the patient to review the consent form, clarify expectations, and ensure patient comprehension of the proposed treatment— especially with elective surgery procedures.

Documentation Documentation is another key component of the informed consent process that cannot be fully delegated to a nurse or other member of the healthcare team. If the doctor-patient discussion proceeds successfully and the patient requests treatment, the doctor is required in some jurisdictions to write a note in the patient’s record. Additionally, the consent document must include the patient’s name, doctor’s name, diagnosis, proposed treatment plan, alternatives, potential risks, complications, and benefits.

To some extent, physicians who use an informed consent document can protect themselves further by including a statement to the effect that the form only covers information that applies generally and that the physician has personally discussed specific factors with the patient. The consent document must be signed and dated by the patient (or the patient’s legal guardian or representative). Many consent forms also require a physician signature.

We offer more than 100 sample forms in our informed consent resource center at www.thedoctors.com/consent. The information in the consent forms is for reference purposes only. The sample documents provide a general guideline, not a statement of standard of care. The documents should be edited and amended to reflect the policy requirements of the physician’s practice site(s) and the legal requirements of the individual state.

Each sample consent form includes statements to be signed by the patient and the physician. The patient attests that he or she understands the information in the treatment agreement. The physician attests that he or she has answered all questions fully and believes that the patient/legal representative fully understands the information. This statement helps avoid any claim that the patient did not understand the information.

Informed Consent in Special Situations The informed consent process for same-day surgery patients may occur in the physician’s office before scheduling the ECMS | 6

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Practice Management procedure. That will allow the patient time to think through the information, ask questions, and make an informed decision.

Hospitalized patients must be informed as far in advance of the procedure as practicable. If time permits in an emergency where the patient is unable to provide consent, the physician must contact a legally authorized representative to obtain an informed consent. If the nature of the emergency does not permit time to contact a legally authorized representative, consent is implied. Consent may be waived under emergent conditions that threaten life, limb, eyes, and the central nervous system.

If the patient is incompetent or otherwise cannot consent, the physician is legally bound to obtain informed consent from the incompetent patient’s authorized representative, except in an emergency. This type of consent should be thoroughly documented in the medical record.

Additional Tips and Suggestions • •

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Develop and use procedure-specific forms that are signed by the patient when the informed consent discussion takes place.

Obtaining consent from the patient after a sedative or sleep-inducing medication is administered is not recommended.

However, when there is a change in the patient’s condition that requires a change in treatment, consent should be secured from the patient. The facts and conditions surrounding the need for the revised consent should be thoroughly documented in the medical record.

Additions or corrections to the consent form must be dated, timed, and signed by the person making the additions or corrections.

Any member of the healthcare team may sign as a witness to the patient’s signature, although this serves only to verify that it was the patient who signed the form. The witness does not obtain consent or verify the patient’s competency to give consent.

A patient’s questions or obvious lack of understanding about the procedure should be referred to the attending physician as soon as possible.

Translate consent forms to the most common non-English language that you encounter in your practice, and verify that the form is translated correctly.

Patient Safety Measures Every physician should develop his or her own style and system for the informed consent process, making it easier to avoid omissions and—more importantly—ensuring consistency of application.

Do not speed through the process. Give the patient and the family time to absorb and comprehend the information.

Preprinted materials are extremely helpful for patient understanding and will serve as a trigger for other questions.

Assessing the patient’s level of understanding is the step just before documenting the process. One way of doing this is to ask the patient to repeat back to you his or her understanding of the information you have communicated. This will increase the likelihood that you will be able to manage the patient’s expectations effectively. ______________________________________________________________________________________

By Robert Morton, ARM, CPHRM, Director, Department of Patient Safety, The Doctors Company. ______________________________________________________________________________________ Reprinted with permission. ©2015 The Doctors Company (www.thedoctors.com).

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

7 | ECMS

Practice Management MANAGING YOUR CYBER RISK As a physician it is your job to ensure that your patients’ protected health information is safeguarded. Cyber attacks against hospitals and medical practices are on the rise, and it’s more important than ever for physicians to take the necessary precautions to protect their practice.

Five Tips for Protecting Patient Data 1. Internet access should be provided through a quality router/firewall.

2. Ensure all computer operating systems are patched on a monthly basis. These patches fix bugs and close security gaps.

3. Use an anti-virus program. Though the program is not an absolute solution to keeping others from accessing your information, it is an important element of any comprehensive security system.

4. Any site, program, or computer that requires a password should be given a strong and unique password.

5. Consider using contracted IT support to ensure that all elements of security are in place and functioning properly.

Five Security Components for Managing Your Risk 1. Physical Safeguards – to protect your facilities, computer equipment, and portable devices you should consider alarm systems, locked offices, and screen shields.

2. Administrative Safeguards – Hire a security officer, provide workforce training and oversight, control access to information, and perform periodic security reassessments.

3. Technical Safeguards – Implement controls on access to EHRs by requiring passwords and having different access levels.

Utilize audit logs to monitor users and other EHR activities. Install measures that keep electronic patient data from being improperly changed and perform data back-ups regularly. Secure electronic exchange of patient information by performing virus checks and keeping data encrypted.

4. Policies and Procedures – Having written policies and procedures will help assure HIPAA security compliance, proper documentation, and good security measures. Written protocols on authorized users and record retention are also a good measure.

5. Organizational Requirements – Ensure the practice has breach notification and associated policies as well as business associate agreements.

Cloud Storage vs. HIPAA Compliant Hosting Cloud – When using cloud storage software for patient information, the data center is the only piece of equipment that is located off site. The information that is stored in the cloud can be accessed anywhere. When in transit to, and at rest in the cloud, data must be encrypted. The cloud storage service chosen must support the data in an encrypted state to be considered HIPAA compliant.

Compliant Hosting – This is a server-based solution and is required when a medical practice chooses not to house the hardware or data locally. Webserver, application server, and database sever are all located in the data center of a HIPAA compliant hosting provider. This service includes firewall, web or application server, and database server.

After choosing the right data storage method, utilize the aforementioned tips to help protect your medical practice from being exposed to a cyber attack. Though these tips and practices may help to minimize your risk, they do not entirely eliminate it. To protect your practice against the damages attributed to a cyber breach, consider talking to your medical malpractice carrier about cyber liability coverage.

Works Cited Cowperthwaite, Eric. (2014, July 23). 6 steps for reducing cyber risk. http://www.medicalpracticeinsider.com/best-practices/6steps-reducing-cyber-risk HealthIT.gov. 10 Best Practices for the Small Health Care Environment. http://www.healthit.gov/providers-professionals/ cybersecurity Pollard, David. 2013, July 30. HIPAA Cloud Storage vs. HIPAA Compliant Hosting- Key Differences. http://www.connectria. com/blog/the-difference-between-hipaa-compliant-hosting-and-hipaa-cloud-storageindex-php/ Taitsman, M.D., J.D. Julie K. Grimm, M.P.A Chrisi Macrinca, and Agrawal, M.D. Shantanu. 2013, March 14. Protecting Patient Privacy and Data Security. http://www.nejm.org/doi/full/10.1056/NEJMp1215258

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Medical/Legal SYSTEM DANGERS: HOW EHRS CAN CONTRIBUTE TO MEDICAL MALPRACTICE CLAIMS

by David B. Troxel, MD, Medical Director, The Doctors Company

Shortly after electronic health records (EHRs) began to be widely adopted, The Doctors Company and other medical professional liability insurers became aware of their potential liability risks. We anticipated that EHRs would become a contributing factor in medical liability claims.

However, due to the three- to four-year lag time between an adverse event and a claim being filed, EHR-related claims have only recently begun to appear. In 2013, The Doctors Company began coding closed claims using 15 EHR contributing factor codes (for system and user factors) developed by CRICO Strategies and back-coded all claims to 2007.

We found that EHR-related claims frequency is increasing. Twenty-six such claims closed in the first two quarters of 2014, 28 claims closed in 2013, 22 closed in 2012, 19 closed in 2011, and two closed between 2007 and 2010. These 97 EHR-related claims that closed from January 2007 through June 2014 are the subject of this analysis.

EHR-related factors contributed to 0.9 percent of all claims closed by The Doctors Company from January 2007 through June 2014. User factors contributed to 64 percent of these EHR-related claims, and system factors contributed to 42 percent.

Analysis of EHR Claims The following tables and representative claims illustrate how EHR system and user factors contributed to the 97 closed claims.

Some claims contained more than one contributing factor.

EHR System Factors: Technology, Design, and Security Issues 10% Failure of system design 9% Electronic systems/technology failure 7% Lack of EHR alert/alarm/decision support 6% System failure—electronic data routing 4% Insufficient scope/area for documentation 3% Fragmented EHR Claim: Lack of EHR Drug Alert A dialysis patient transferred to a skilled nursing facility. There was an active hospital transfer order for Lovenox. A physician evaluated the patient on admission but made no comment about the Lovenox order. During the first dialysis treatment, there was active bleeding at the fistula site. Heparin (anticoagulant) had not been given. Nursing did not inform the physician of the bleeding.

During the second dialysis treatment, there was uncontrolled bleeding from the fistula. The patient exsanguinated and expired.

Experts were critical that there was no EHR High-Risk Medication Alert.

Claim: Insufficient Area for Documentation; Drop-Down Menu A female had a bladder sling inserted for urinary incontinence. Her surgeon was assisted by a proctor surgeon who was representing the product manufacturer and training the patient’s surgeon on the procedure. The patient was informed that another physician would be assisting. In the recovery room, there was blood in the Foley catheter, so the patient was returned to surgery. The bladder had been punctured by the sling. The proctor had approved the sling’s placement. The circulating nurse did not document the proctor’s presence in the OR due to lack of an option in the EHR drop-down menu. There was no space for a free-text narrative to document that the patient was informed of the proctor’s presence.

EHR User Factors: EHR-Related Issues Attributable to Users 16% Incorrect information in the EHR 15% Hybrid health records/EHR conversion 13% Prepopulating/copy and paste 7% EHR training/education 7% EHR user error (other than data entry) 3% EHR alert issues/fatigue 1% EHR/CPOE workarounds Claim: Incorrect Information in EHR A patient was seen by her cardiologist for hypertension. In the written medical record, her blood pressure medication had been increased to 25 mg once a day. Office staff entered the order into the EHR as twice a day. The prescription was filled. The patient missed her follow-up appointment. Seven months later, she went to the ER with numbness and weakness. Her potassium level was low. The cardiologist corrected the prescription error and gave her potassium.

ECMS ECMS || 10 10

ESCAMBIA ESCAMBIA COUNTY COUNTY MEDICAL MEDICAL SOCIETY SOCIETY IN IN CONJUNCTION CONJUNCTION WITH WITH SANTA SANTA ROSA ROSA COUNTY COUNTY

Medical/Legal Claim: Copy and Paste A toddler was taken to a country where tuberculosis was prevalent. After the trip, he presented with fever, rash, and fussiness.

The physician considered bug bite or flu and treated the child with fluids, antibiotics, and flu meds. His office EHR progress note indicated there was no tuberculosis exposure. The physician copied and pasted this information during subsequent office visits with no revision to note travel to a country with tuberculosis. Two weeks later, the child was diagnosed in the ER with tuberculous meningitis. He had permanent and severe cognitive defects.

Analysis of Location, Specialty, and Top Allegations We also analyzed the 97 EHR claims to determine where the claim events occurred, which specialties were involved, and the most common allegations. The following outline our findings.

Locations Where EHR Claim Events Occurred 43% Hospital clinic/doctor’s office 12% Ambulatory/day surgery 10% Patient’s room 9% Operating room 7% Emergency room 5% Labor and delivery 4% Radiology/imaging 2% Dentistry/oral surgery 1% each Pathology, ICU, neonatal ICU, radiation therapy, and special procedures EHR Claim Events by Specialty 20% Internal medicine specialties—cardiology/hospitalist/oncology/GI 16% Primary care—family/internal medicine 15% Obstetrics/gynecology 14% Surgical specialties (other than cardiac surgery) 7% Nursing 5% Radiology 4% each Anesthesiology and general surgery 2% each Pediatrics, emergency medicine, psychiatry, and orthopedics 1% Pathology Top Allegations in EHR Claims 27% Diagnosis-related (failure, delay, wrong) 19% Medication-related: 7% Ordering wrong medication 5% Ordering wrong dose 7% Improper medication management Recap of the Reported Risks of EHRs The 2011 Institute of Medicine report, Health IT and Patient Safety: Building Safer Systems for Better Care, concluded that the information needed to analyze and assess health IT (HIT) safety and use was not available and that our understanding of the benefits and risks of EHRs was anecdotal. The report recommended creating a government agency that would systematically and uniformly collect data to investigate harm and safety events related to HIT. The Office of the National Coordinator for Health Information Technology is now developing a plan to create a Health IT Safety Center.

-------------------Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety.

David B. Troxel, MD, is medical director of The Doctors Company. Dr. Troxel is clinical professor emeritus, School of Public Health at the University of California at Berkeley. He is past president of the American Board of Pathology and the California Society of Pathologists.

ESCAMBIA ESCAMBIA COUNTY COUNTY MEDICAL MEDICAL SOCIETY SOCIETY IN IN CONJUNCTION CONJUNCTION WITH WITH SANTA SANTA ROSA ROSA COUNTY COUNTY

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Medical/Legal WHAT PHYSICIANS AND MEDICAL STAFF NEED TO KNOW ABOUT DEPENDENCY AND INDEMNITY COMPENSATION FOR VETERANS AND THEIR FAMILIES We really don’t need a specific day to remember and honor those in our military service who made the sacrifices to protect the freedoms we all enjoy today. These brave men and women have served our great nation with honor and distinction. After serving their country, veterans often develop disabilities connected to their time in service What you should be aware of is that, if a veteran received service-connected benefits from the Veterans Administration (VA), these benefits can be passed on to their surviving spouse and dependent children after the veteran dies.

Here are some important terms to be aware of: • VA service-connected disability: a disability resulting from an injury or disease that was incurred in or aggravated (beyond normal progression) during active military service; and, • VA Disability Rating Letter: a document that the VA system uses to identify service-connected disabilities or possible contributing factors to a veteran’s death.

If a service-connected disability was a cause or contributing factor in the veteran’s death, the surviving spouse and dependent children may be eligible for Dependency and Indemnity Compensation (DIC). A death certificate indicating that the cause of death was service-connected is the evidence needed by survivors when applying for DIC benefits; but, unfortunately, this does not always happen.

Consider this real-life example: A veteran was disabled due to heart disease, most likely caused by exposure to Agent Orange in Vietnam. He died ten years ago in another state. The surviving spouse asked at that time if she was eligible for any VA benefits and was told that she was not because the veteran died of a heart attack. As a result, she did not file a claim with the VA. Ten years later, a VA Service Officer (VSO) contacted the doctor, on her behalf, to ask if he would correct the death certificate to show that the heart disease was a contributing factor in the veteran’s death. Unfortunately, the physician refused because the death occurred ten years ago.

The VSO took the file to a doctor in Florida who had served at James Haley VA Hospital in Tampa and was knowledgeable about service connected disabilities. The doctor wrote a letter that stated, “The service connected disability (ischemic heart disease) was absolutely a contributing factor in the veteran’s death”.

A couple of months later the surviving spouse received more than $25,000 retroactively from the VA, and a monthly DIC benefit in excess of $1,000.

Here are some simple steps that a veteran and their family can take to prevent this omission from occurring: • Provide the physician with a copy of the VA Disability Rating Letter so it is in the medical file; this should be done for ALL physicians they see.

• Review the disability with the physician so they are personally familiar with it.

• If the veteran dies, the family should remind the physician and the funeral director that the veteran had service-connected disabilities.

• Maintain the VA Disability Rating Letter in a safe place so it is available whenever it might be needed.

• Florida veterans needing a copy of their VA Disability Rating Letter or other related documents can contact John.

Hinton@va.gov For the physicians, it is important to know: Service-connected disabilities that were a direct or underlying cause of death should be listed in Part l of the Cause of Death section on the death certificate.

• A service-connected disability that may be a significant condition contributing to the death but not resulting in the underlying cause given in Part I, should be listed in Part II of the death certificate.

Together, we can prevent this unnecessary burden being placed on a veteran and their family. By taking these simple steps, we can show our appreciation by helping them get the benefits they deserve.

For more information, contact the Vital Statistics office at the Florida Department of Health in Escambia at 850.595.6500, option 3.

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

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Foundation THE ESCAMBIA/SANTA ROSA COUNTY MEDICAL SOCIETY SCHOLARSHIP FUND As executive director of the Escambia/Santa Rosa County Medical Society and Medical Society Foundation, I take great pride in helping to ensure the quality of health care providers in our community. While maintaining this high level of quality care today is important, it is vital that we invest our resources in the future so the finest and most advanced medical care remains right here in our neighborhood. I am proud to report that earlier this year the Escambia/Santa Rosa County Medical Society Foundation secured their commitment to our community’s future by pledging $100,000 to the Florida State University College of Medicine Pensacola Regional Campus. We will fulfill this pledge in January, and the funds will reward deserving medical students with scholarships to complete their education and return to the Panhandle to practice medicine after residency. I write you today to ask for your help in bringing our students home.

Rather than establishing its own teaching hospital, the Florida State University College of Medicine partners with existing hospitals, physicians and health care providers across the state to provide its students real-life, hands-on experiences at regional and rural clinical-training sites. As one of these six regional campuses, the Pensacola Regional Campus provides third- and fourth-year students one-onone opportunities with esteemed faculty they wouldn’t receive at a large academic medical center. Learning on the front lines of care, our Pensacola Regional Campus students are uniquely qualified to provide patient-centered care in our community.

Join us in our effort to ensure talented, competent and compassionate individuals become this community’s future physicians. To make a gift to The Escambia/ Santa Rosa County Medical Society Scholarship Fund, please visit give.fsu.edu and designate fund F08088, or contact Cindy Tyler, senior development officer for the FSU College of Medicine, at cindy.tyler@med.fsu.edu or (850) 274-7145. ECMS has already awarded three ECMS Michael Redmond Scholarships from this fund in the years of 2012-2014.

You are an essential part of this medical community and with your support, our community at large will benefit greatly. Thank you in advance for your generosity.

Respectfully,

Erica Huffman Executive Director, Escambia/Santa Rosa County Medical Society

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“I am honored to be the recipient of the 2012 ECMS Scholarship. This will be a tremendous help in covering the cost of tuition for the upcoming academic year. As part of my medical education, I consider what I have learned about organized medicine to be key in my development as a physician. I am excited about working with my local medical society, as well as the FMA and AMA, as I continue my education and remain an active voice in organized medicine as a physician.”

- Laura Davis, 2012 ECMS Michael Redmond, M.D. Scholarship Recipient “I value the opportunity to work so closely with the ECMS board, as a non-voting member, and network with other peers and physicians, as well as learn the problems that face the future of medicine. I look forward to playing a significant part in shaping the future of medicine.”

- Rick Sims, 2013 ECMS Michael Redmond, M.D. Scholarship Recipient “Serving as the Student Representative for the Escambia County Medical Society expanded my knowledge of political, social and economic issues affecting our field. Working with local leaders has been thoroughly educational and entertaining. ECMS board meetings have helped me see firsthand how important physician collaboration is. I admire the board member’s devotion to service and respect for colleagues, despite diverse beliefs on health care reform. The meetings constantly remind me of the integrity and responsibility this profession demands. Moreover, ECMS has reinforced my commitment to improving the delivery of healthcare.”

- Juliana Matthews, 2014 ECMS Michael Redmond, M.D. Scholarship Recipient

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

In the Community SACRED HEART NEWS Sacred Heart One of Nation’s “50 Top Cardiovascular Hospitals”

Sacred Heart Hospital Pensacola has been named the recipient of the Truven Health 50 Top Cardiovascular Hospitals award. The award recognizes Sacred Heart’s top performance in cardiovascular outcomes, clinical processes, extended outcomes, and efficient interventions for heart attack and heart failure – the two most common cardiovascular conditions. For more information on The 50 Top Cardiovascular Hospitals study, visit www.100tophospitals.com

Pediatric Surgeon Welcomed to The Children’s Hospital at Sacred Heart

Pediatric Surgeon Don Nakayama, MD, has joined Sacred Heart Medical Group and will serve The Children’s Hospital at Sacred Heart. Dr. Nakayama is board certified in both pediatric and adult surgery from the American Board of Surgery. He graduated with his bachelor’s degree from Stanford University in California, and he earned his medical degree from the University of California at San Francisco, where he completed his residency in general surgery and a research fellowship in fetal surgery. Dr. Nakayama completed a post-graduate fellowship in pediatric surgery at the Children’s Hospital

of Philadelphia. Dr. Nakayama brings to Pensacola more than 20 years of experience in pediatric surgery. He will join the office of Pediatric Surgeon Dr. Bryan Weidner, Sacred Heart Hospital, 5153 N. Ninth Ave., Suite 307 in Pensacola.

Endovascular Neurosurgeon Joins Sacred Heart Medical Group

Dr. Lincoln Jimenez, an experienced neurosurgeon with advanced training in vascular neurosurgery, has joined Sacred Heart Medical Group and will practice at Sacred Heart Hospital. Dr. Jimenez has special medical interests in vascular neurosurgery including open and endovascular approaches and treating conditions such as brain aneurisms, ischemic strokes and vascular malformations. Dr. Jimenez also has experience in spine surgery and treats neurologic conditions including herniated discs, nerve root injuries, trigeminal neuralgia, Chiari malformations, brain hemorrhages, brain and spine tumors, and osteoarthritis of the spine. Dr. Jimenez will utilize Sacred Heart Hospital Pensacola’s new biplane technology, which produces highly detailed three-dimensional views of blood vessels leading to the brain and within the brain. Dr. Jimenez is accepting new patients at 5153 N. Ninth Ave., suite 302 in Pensacola.

BAPTIST HEALTH CARE NEWS Baptist Heart & Vascular Institute Completes 50th TAVR Case

Baptist Heart & Vascular Institute introduced Transcatheter Aortic Valve Replacement (TAVR) to the Florida Panhandle in 2014. The team has now successfully in completed more than 50 cases at Baptist Hospital. This revolutionary treatment option is saving lives of patients with severe aortic stenosis who are not candidates for traditional open heart surgery.

The multidisciplinary TAVR team at the Baptist Heart & Vascular Institute is unique to our area due to its size and collaborative experience. Board certified interventional cardiologists partner with a highly skilled cardiothoracic surgeons to complete the procedure using the Edwards SAPIEN Valve — the first transcatheter aortic valve approved by the FDA for use in the U.S.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Baptist Health Care Included on Top 100 List for Orthopedic Programs by Becker’s Hospital Review

Baptist Health Care has been name as one of 100 hospitals and health systems with great orthopedic programs. The list is published annually by the Becker’s Hospital Review and includes national leaders in orthopaedic care.

To develop the list, the Becker’s editorial team examined several ranking and award agencies, including U.S. News & World Report national and regional rankings for orthopaedics, U.S. News’ common care ratings for hip and knee replacement, CareChex rankings for orthopedic care and major orthopedic surgery, Blue Distinction Centers for Knee and Hip Replacement, Healthgrades orthaopedic awards and Magnet designation for nursing excellence.

Baptist includes three hospitals, two medical parks and the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. Andrews Institute was founded

by Baptist and renowned orthopedic surgeon James Andrews, M.D. 15 | ECMS

YOU TEND TO YOUR PATIENTS, WE TEND TO YOUR FINANCIAL WELL-BEING.

Announcing the establishment of a new financial planning and wealth management team that specializes in the unique needs of physicians in the Pensacola area.

With a CERTIFIED FINANCIAL PLANNER™ professional and a team that has 28 years of combined investment industry experience, we have the skills you need to help navigate your financial goals.

OUR TEAM’S EXPERTISE INCLUDES Asset Protection

Estate Planning

Financial Planning

Tax Planning

Retirement Planning

Risk Management

Investment Management

Give us a call and see what a customized plan tailored specifically to you looks like.

We’re also able to create business retirement plans (including 401(k) and defined benefit plans) and succession plans (including buy/sell agreements, key person insurance and other catastrophic risk considerations).

So whether you’re affiliated with a hospital or have your own practice, we have solutions for you.

We know you work long hours and that it’s not always convenient to meet during the business day; therefore, we are happy to meet at a time and location that’s convenient for you. Our technology allows us to meet with you virtually anywhere.

RICK LAMBERT, MBA, CFP® Wealth Strategist rick@ironhorsews.com 3000 Langley Avenue, Suite 200 // Pensacola, FL 32504 O 850.361.4978 // F 850.466.3382 // ironhorsews.com Securities offered through Raymond James Financial Services, Inc., member FINRA/SIPC. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ and federally registered in the U.S., which it awards to individuals who successfully complete CFP Board’s initial and ongoing certification requirements.

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY