Oklahoma County Medical Society March April Bulletin

OKLAHOMA COUNTY MEDICAL SOCIETY

‌ FOR OUTSTANDING RESPONSE FOLLOWING THE MURRAH BUILDING BOMBING The American Medical Association presented its Medal of Valor to the Oklahoma County Medical Society for outstanding response following the bombing.

It marked only the fifth time in its history the award has been presented. It is the only time the medal has been presented to a group of medical professionals rather than a single individual.

MARCH/APRIL 2015

THE BULLETIN March/April Volume 88 Number 2 313 North East 50th Street, Suite 2 Oklahoma City, OK 73105-1830 phone: 405-702-0500 fax: 405-702-0501 email: ocms@o-c-m-s.org

www.o-c-m-s.org Ideas and opinions expressed in editorials and feature articles are those of their authors and do not necessarily express the official opinion of the Oklahoma County Medical Society.

OFFICERS C. Douglas Folger, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . President Don L. Wilber, MD . . . . . . . . . . . . . . . . . . . . . . . . . President-Elect David L. Holden, MD . . . . . . . . . . . . . . . . . . . . . . . Vice-President Sam S. Dahr, MD . . . . . . . . . . . . . . . . . . . . . . Secretary-Treasurer

BOARD OF DIRECTORS Joseph C. Broome, MD Louis M. Chambers, MD Renée Grau, MD Julie Strebel Hager, MD Jason S. Lees, MD J. Samuel Little, MD

R. Kevin Moore, MD Don P. Murray, MD James A. Totoro, MD Baolien Tu, MD Duc M. Tu, MD Lisa J. Wasemiller-Smith, MD

BOARD OF CENSORS Thomas H. Flesher, III, MD Julie Strebel Hager, MD Tomás P. Owens, MD

EXECUTIVE OFFICE Jana Timberlake . . . . . . . . . . . . . . . . . . . . . . . . Executive Director Tracy Senat . . . . . . . . . . . . . . . . . . . . . . . . . . . . Associate Director,

Managing Editor of The Bulletin

Six Annual Publications • Circulation 1500

TABLE OF CONTENTS About the cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OCMS Inaugural 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Welcome New Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 In Memory of Dr. Tony Czerwinski . . . . . . . . . . . . . . . . . . . . . . 13 Law & Medicine: Medical Marijuana . . . . . . . . . . . . . . . . . . . . . 14 Doctor of the Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Member News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 The Pearl: Deativating ICDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 House of Delegates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Remembering Old Wesley Hospital . . . . . . . . . . . . . . . . . . . . . . 22 Dirctor’s Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Poet’s Spot: Pansies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Commonly Reported Diseases for 2014 . . . . . . . . . . . . . . . . . . . 30 CME Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Professional Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

THANK YOU TO OUR 2015 SPONSORS! QUAIL CREEK BANK

GOLD BRONZE

Deaconess Hospital McBride Orthopedic Hospital Mercy Hospital Midwest Regional Medical Center Oklahoma Blood Institute

Eldona Wright . . . . . . . . . . . . . . . . . . . . . Membership Coordinator

Orthopedic Associates

EDITORIAL

PLICO

James W. Hampton, MD Editor-in-Chief William P. Truels, MD Associate Editor

THANK YOU TO OUR ADVERTISERS! Baker Asset Management LLC

OSMA Health

Johnny B. Roy, MD Associate Editor

Frontier Hospice

OU College of Medicine Continuing Professional Development

S. Sandy Sanbar, MD, PhD, JD, FCLM Assistant Editor - Law and Medicine

Laser Partners of Oklahoma

Graphic Design - BCreative

Integris Hospice

Wilshire-Pennington

OK Allergy & Asthma Clinic

2015 March/April | The Bulletin

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Pre-Conference - 14TH

Annual Geriatric Medicine Update

Monday, May 4, 2015 AND

18th Annual Primary Care Update Tuesday-Saturday, May 5 - 9, 2015 Reed Conference Center, Midwest City, OK Attend one day or all six days and receive up to 61.25 AMA PRA Category 1 Credits™.

Optional morning and evening workshops also are available.

2015 Update - Special Features: MONDAY, MAY 4

KEYNOTE SPEAKER Aimee Garcia, M.D. “Pressure Ulcers” AND “Diabetic Foot” KEYNOTE SPEAKER

Mark Supiano, M.D.

TUESDAY, MAY 5

FRIDAY, MAY 8

LUNCH SPEAKER Alina Istrate, M.A. “Oklahoma Prescription Monitoring Program”

KEYNOTE SPEAKER

WEDNESDAY, MAY 6

SATURDAY, MAY 9

Cynthia ScheidemanMiller, M.H.S.A.

Mark Doescher, M.D.

LUNCH SPEAKER

David Lee Gordon, M.D. “Stroke Update” AND “Migraine Headache”

KEYNOTE SPEAKER

“Hypertension in the Older Patient” AND “Hospital Elder Life Program (HELP) for Prevention of Delirium”

“Coordination, Transition & “Telemedicine: Reimbursement Communication between PCP and the Oncology Team” and New Regulations”

TUESDAY, MAY 5

THURSDAY, MAY 7

KEYNOTE SPEAKER Aimee Garcia, M.D. “Dermatologic Issues in the Elderly” KEYNOTE SPEAKER

KEYNOTE SPEAKER

Robin Germany, M.D. “Congestive Heart Failure” AND “Cardiovascular Disease and Sleep Apnea”

LUNCH SPEAKER

Chaplain Danny Cavett, M.L.S.

“The Spirituality of Pain”

Early-Bird

RATES

Register by 4/13/15

PRE-CONFERE NCE th

14 Geriat Medicine U ric pdate

May 4, 2015

LUNCH SPEAKER “Removing Chaos from Clinical Lyle Kelsey, M.B.A. “Linking Physician Regulations Care” AND “Patient-Family to Patient Safety” Centered Care”

Michael Nelson, M.D.

The Irwin H. Brown Office of Continuing Professional Development @OUMedEd #APCU2015

Get clinical u Care, Deliriu pdates on HTN, Woun d m, Osteoporosi Dementia, Diabetes, s, an d Med Managemen t in your old ication er patients

The University of Oklahoma College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Oklahoma College of Medicine designates this live activity for a maximum of 61.25 AMA PRA Category 1 Credits™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity. For accommodations on the basis of disability, call: (405) 271-2350. The University of Oklahoma is an Equal Opportunity Institution. www.ou.edu/eoo

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ABOUT THE COVER

W

here were you on April 19, 1995? Most people in Oklahoma and around the country have that date etched in their memory, when 168 people were killed by a terrorist bombing that destroyed the Alfred P. Murrah Federal Building in downtown. Our healthcare providers and many others responded with bravery and compassion and resilience, leaving a lasting legacy known as the Oklahoma Standard. This April is the 20th anniversary of the bombing, which will be remembered in many ways throughout the community.

In recognition of the efforts of our entire medical community, in 1996 the Oklahoma County Medical Society was awarded the Medal of Valor by the American Medical Association. This medal is given to those who demonstrate courage under extraordinary situations. At that time, the medal had been awarded only four times, and the OCMS medal is still the only one that has been given to a group instead of an individual. The medal, seen on the cover, now sits on permanent display in the Oklahoma City Memorial Museum.

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2015 March/April | The Bulletin

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PRESIDENT’S PAGE

By C. Douglas Folger, MD

Each year there are certain dates on the calendar that elicit significant emotions, positive or negative, in each of us.

For me, one of those days is April 19.

T

his year, April 19 signifies the 20th anniversary of the tragic bombing of the Alfred P. Murrah Federal Building in downtown Oklahoma City. I can still remember that infamous day as if it were yesterday.

In 1995, I was Vice President for Medical Affairs at Presbyterian Hospital, located at the corner of NE 13th and Lincoln Blvd. in Oklahoma City. On the morning of April 19 at a couple of minutes past 9 a.m., as I was walking through the threshold of my office on the ground floor of the northwest corner of the hospital, there was a massive explosion that bowed the plate glass window looking out to the west and caused my knees to buckle. I thought something had exploded in the building just above the executive suite. That proved, however, not to be the case.

I ran out into the common area of the suite where several of my colleagues and I were all wondering what in the world had happened. Within a few minutes, we learned that there had been a terrible explosion downtown, and that a large building had

been destroyed. We later learned that this explosion was an act of terrorism perpetrated by a misguided man who was angry with our government. Looking toward downtown, we could see a dark cloud of smoke rising in the sky. We were also able to hear sirens from emergency responders.

In anticipation of probable heavy casualties of the blast, we instituted our disaster plan, and within a matter of minutes, numerous physicians, nurses, and other hospital personnel began showing up and reporting to their assigned work areas. Within the first hour after the explosion, 50 people were rescued; and within the first couple of hours, slightly over 200 victims/patients were transported from an on-site triage center to nearby hospitals. Many of the rescued victims had severe life-threatening injuries.

By the end of the first day, roughly 300 survivors had been transported to the surrounding hospitals.

St. Anthony, Presbyterian, University, and Children’s Continues on page 7 …

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6 The Bulletin | 2015 March/April

PRESIDENT’S PAGE Continued from page 5 … hospitals received the bulk of the injured. As I recall, we received over 70 injured at Presbyterian, and St. Anthony received well over 100 injured.

Very sadly, the last survivor was rescued at 7 p.m. on the day of the blast. The outpouring of love and compassion and concern for the injured and their families was remarkable. I can remember the sadness that came over us when it became clear that we were unlikely to receive any more survivors.

The next couple of weeks were dedicated to work at the bombing site to search for possible survivors and to recover the dead. The performance of the early responders including EMSA, police, firefighters, medical volunteers and local civilian volunteers was remarkable. The support of local, state, and federal government and their agencies was swift and strong.

National humanitarian aid came quickly to support the rescue workers. Hundreds of local citizens donated blood to support the injured. The combined effort and remarkable teamwork of all involved in the response to the bombing was truly monumental, and serves as a model to the rest of the country of how people coming together can successfully deal with tragedy.

In the end, 168 people, including 19 children, lost their lives in the Murrah Building bombing.

Almost 700 people were injured. The people of Oklahoma City, Oklahoma and America did not

want what happened that terrible day to be forgotten.

They started leaving tokens of their remembrance, condolence, and support on a chain link fence surrounding the bombing site.

It became clear that not only we, but our nation, supported the creation of a permanent National Memorial to honor and “…remember those who were killed, those who survived, and those changed forever…” by the tragedy. On April 19, 2000, after 5 years of planning and help from the local, state, and federal governments, as well as private donors, President Bill Clinton joined thousands of people at the bombing site to dedicate the Oklahoma City National Memorial. On President’s Day, Feb. 19, 2001, President George W. Bush dedicated the Memorial Museum.

Over the past 20 years, I continue to be occasionally drawn to the Oklahoma City National Memorial. I always take a seat on the north side of the memorial below the site of the Survivor Tree. As I peer across the Reflecting Pool to the 168 empty chairs, I experience the same emotions. I am angry about the violence perpetrated on innocent people; I am saddened to tears about the senseless loss of life and severe injuries that occurred here; and yet, I am optimistic and hopeful for the goodness and kindness of so many people in our city, our state, and our nation.

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This year’s Memorial Marathon will be April 26, 2015 – for race details: http://okcmarathon.com 2015 March/April | The Bulletin

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OCMS INAUGURAL 2015 OCMS 2015 President C. Douglas Folger, MD

C. Douglas Folger, MD, took over as 2015 OCMS President at the annual presidential inaugural dinner in January at the Oklahoma City Golf & Country Club. Julie Strebel Hager, MD, was the outgoing president.

The evening included: • Recognition of the 2015 Rhinehart Award winner Larry A. Bookman, MD, for his work with, among others, the Oklahoma Blood Institute and the OCMS Leadership Academy, and • Recognition of Class V of the OCMS Leadership Academy.

Below: Outgoing president Julie Strebel Hager, MD, presents the gavel to the 2015 OCMS President C. Douglas Folger, MD. Above, Left to right: OCMS 2015 President C. Douglas Folger, MD; Past President Julie Strebel Hager, MD; and President-Elect Don L. Wilber, MD.

Above: Emcee Thomas H. Flesher, III, MD, presents the President’s Plaque to outgoing president Julie Strebel Hager, MD. 8 The Bulletin | 2015 March/April

Above: OCMS Executive Officers (left to right): Don L. Wilber, MD, President-Elect; Sam S. Dahr, MD, Secretary/Treasurer; Julie Strebel Hager, MD, Past President; C. Douglas Folger, MD, 2015 President; and David L. Holden, MD, Vice President.

Above: Julie Strebel Hager, MD, presents the Rhinehart Community Service Award to Larry A. Bookman, MD. Below: Attending the inaugural to help recognize Larry A. Bookman, MD, as the 2015 recipient of the Don F. Rhinehart, MD, Medical Service Award is Melba Rhinehart and their grandson, Evan Vincent. Dr. Rhinehart launched the development of the Oklahoma Blood Institute; Dr. Bookman is an OBI board member.

Above: Members of the OCMS Leadership Academy Class V: Bottom row left to right: Joshua Carey, MD; Aubrey Kavanaugh, MD; Sarah Yoakam, MD; Natasha Neumann; and Jason Breed, MD. Top row left to right: Doug Beacham, DO, and Michael Holzer, MD.

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WELCOME NEW MEMBERS!

Mark Andrew Fine, MD Julie Lees, MD

Melanie Pearce, DO

Jeffrey Sparling, MD

Joel Thomas, MD

Bryan VanZandt, MD

Rachel M. Tay, MD, is a board-certified general surgeon in Oklahoma City. She completed medical school at the University of Virginia, and an internship and residency at Baylor University Medical Center in general surgery.

Mark Andrew Fine, MD, is a board-certified anesthesiologist in Oklahoma City. He completed medical school at the OU School of Medicine, a residency at OU Health Sciences Center in anesthesiology, and a fellowship at the Texas Heart Institute in cardiothoracic anesthesiology.

Joel R. Thomas, MD, is a board-certified diagnostic radiologist in Oklahoma City. He completed medical school at the OU School of Medicine, an internship at the OU Health Sciences Center in diagnostic radiology, and a fellowship at the Mayo Clinic in neuroradiology.

Julie W. Lees, MD, is a board-certified pediatrician in Oklahoma City. She completed medical school at the OU College of Medicine, and an internship and residency at OU Health Sciences Center in pediatrics.

Melanie R. Pearce, DO, is a board-certified diagnostic radiologist in Oklahoma City. She completed medical school at the Kansas City University of Medicine and Bioscience, and an internship at the OU Health Sciences Center in diagnostic radiology.

Bryan L. VanZandt, MD, is a board-certified vascular and interventional radiologist in Oklahoma City. He completed medical school at the OU School of Medicine, an internship at Baylor College of Medicine in diagnostic radiology, and a fellowship at Brown College of Medicine in vascular and interventional radiology.

Jeffrey M. Sparling, MD, is a board-certified interventional cardiologist in Oklahoma City. He completed medical school at the OU School of Medicine, an internship and residency at OU Internal Medicine, and fellowships at OU in cardiovascular disease and at Brigham & Women’s Hospital in Boston in interventional cardiology.

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Rachel Tay, MD

LOOK FOR THE OCMS ENEWS IN YOUR EMAIL! It’s a monthly email newsletter that we send to all of our members with news and information. It’s short and easy to read, just right for our busy members. It is distributed in the middle of the month, so if you don’t remember seeing it, please check in your spam email folder!

Changed Your Email Address?

New Mailing Address?

Let us know so we can keep you updated!

Email: ewright@o-c-m-s.org Call: 702-0500

100%

PHYSICIAN OWNED

2015 March/April | The Bulletin

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In Memory of

Dr. Tony Czerwinski

By J. Christopher Carey, MD, PhD, FACS Tony Czerwinski, MD

R

ecently we lost a pedagogue of medicine in the passing of Dr. Tony Czerwinski.

My first contact with him was as a second-year medical student when he was my mentor in the course of clinical medicine, in which we learned the art of the history and physical (a lost skill with the advent of technology).

He was an imposing figure, was gruff in his manner, but he was extremely knowledgeable, skilled, and he showed a great deal of compassion and love for not only his patients but also his students. This remained constant throughout his life. Although I was intimidated by him at this early stage, little did I realize that our careers would cross again and I grew to understand and appreciate him.

Tony came to South Community Hospital in 1982.

In those early years, the ‘employment model’ was just beginning. Although given many opportunities to be employed, Tony remained a fierce stalwart of being an independent physician through his career. He was the longest running president of the medical staff during the tumultuous years of the transition to Integris Southwest Medical Center. We shared many patients and he remained a teacher and example for me and my colleagues throughout his career.

He seemed to attract the sickest patients. He showed a great deal of compassion no matter how challenging or their payor source. He was hard on his consultants but he was harder on himself when something went awry. He was always available, took very little time off, and he returned his pages within minutes. As many of us told our wives or significant others, if we were sick we want Tony to manage our care.

His thoroughness, knowledge, compassion and availability were respected by us all.

Tony could never say “good-bye.” He simply hung up the phone when he was finished. He could not say good-bye to Integris Southwest Medical Center; he could not say good-bye to his fellow physicians; but more importantly, he could not say good-bye to his patients. He simply passed away in his office.

I was fortunate to be one of his ‘kids’ and I, as well as many others, have been blessed by the privilege of having been mentored by him. He was certainly an example of what a physician should be.

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LAW AND MEDICINE

LEGAL ASPECTS OF

MEDICAL MARIJUANA Compiled by S. Sandy Sanbar, MD, PhD, JD

M

edical marijuana is a hotly debated issue. The use, possession, and/ or cultivation of marijuana for medical purposes are referred to as “medical marijuana” (AKA medicinal cannabis), which is the same as standard marijuana.

Both federal and state laws make it a crime to use, grow, sell, or possess marijuana.

The federal Controlled Substances Act classifies marijuana as a “Schedule I drug,” thus having the potential for abuse, no currently accepted medical use in treatment in the U.S., and lacks accepted safety for use of the drug under medical supervision.

In 2005, the federal Supreme Court stated in Gonzales v. Raich1 that it is illegal to use, sell or possess marijuana, even for medical use.

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In October 2009, the Obama administration sent a memo to federal prosecutors encouraging them not to prosecute people who distribute marijuana for medical purposes in accordance with state law. In late August 2013, the U.S. Department of Justice announced an update to their marijuana enforcement policy.2 The statement reads that while marijuana remains illegal federally, the US Department of Justice expects states like Colorado and Washington to create “strong, state-based enforcement efforts … and will defer the right to challenge their legalization laws at this time.”

In contrast, some health advocates and other drug legalization groups would like to legalize the medical use of marijuana, on the

grounds that the drug is a valuable aid in the treatment of a wide range of medical conditions, including select patients with terminal illness, epilepsy, AIDS, glaucoma, and cancer, often for pain relief.

As of November 2014, a total of 23 states, the District of Columbia and Guam now allow for comprehensive public medical marijuana and cannabis programs.3 These states have removed criminal penalties from doctors who prescribe the drug or from patients who use it within the bounds set by state law.

The law allows the possession and cultivation of marijuana for medical purposes under specific provisions. States may require written documentation from a person’s doctor affirming that the person suffers from a debilitating condition and might benefit from the medical use of marijuana. People may be required in some states to present this documentation, or “marijuana ID card,” prior to an arrest.

Violators of medical marijuana laws may be penalized by prison time, fines, or both. States that have not legalized medical use of marijuana treat the

charges as general misdemeanor or felony drug charges. States that have decriminalized medical marijuana often treat marijuana offenses as minor civil infractions.

In December 2014, Oklahoma State Attorney General Scott Pruitt and Nebraska Attorney General Bruning announced their states’ lawsuit in federal court against Colorado over marijuana legalization, in an effort to stop the commercial production and sale of marijuana.4 There has been an increase in drugs smuggled to Tulsa County, and its department’s drug task force seized a load of THCinfused “edibles” similar to the popular Gummy Bears candy.

Smoked marijuana has less serious adverse effects than THC-infused “edibles.” When marijuana is smoked in small amounts or used in a vaporizer, and the effects titrated to euphoria, serious adverse effects will be quite infrequent. Use of high dose of marijuana can produce anxiety and panic attacks. Psychotic breaks may occur mostly after oral ingestion. Why? THC (tetrahydrocannabinol) is metabolized more extensively by the oral route, leading to the synthesis of a much larger amount of 11-OH-THC than is generally formed following smoking. Blood levels of the psychopharmacologically active 11-OH-THC metabolite can combine its psychotropic effects with those of THC to produce a more robust psychotropic effect in the CNS. Continues on page 16 …

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LAW AND MEDICINE

Continued from page 15 …

Thus, marijuana treats pose hidden dangers.5 • In 2014, a 19-year-old student ate a marijuanalaced cookie and shortly thereafter began rambling incoherently and subsequently jumped to his death from the balcony of a Denver hotel. The Denver coroner listed marijuana intoxication as a significant factor in his death, and reported that he had a blood level of 7.2 ng/ml, (equivalent to 14 ng/ml plasma concentration), a concentration that would be found approximately 2 hours after smoking a 3.55% THC marijuana cigarette.

• In early September, five high school students in the San Francisco area, ages 14-16, became ill after eating brownies that had been laced with marijuana.

Three developed nausea and vomiting and two became unconscious and were hospitalized. The brownies were sold to the students by a classmate. 6 1 http://caselaw.lp.findlaw.com/scripts/getcase. pl?court=us&vol=000&invol=03-1454 2 http://www.justice.gov/opa/pr/justice-department-announcesupdate-marijuana-enforcement-policy 3 http://www.ncsl.org/research/health/state-medical-marijuanalaws.aspx. See also, http://healthcare.findlaw.com/patient-rights/ medical-marijuana-laws-by-state.html 4 http://www.huffingtonpost.com/2014/12/18/lawsuit-coloradomarijuana_n_6350162.html 5 Marijuana treats pose hidden dangers. Trevor Hughes. USA Today Weekend, 1A-2A, May 9-11, 2014.

6 Benjamin, DM. Toxic Ingestions of Marijuana (THC), presented at the second international conference on Neu Psyco 2014, Nov. 18th, 2014, Havana, Cuba.

• Another case involved a man who developed hallucinations and rambling speech after eating marijuana candy with concomitant ingestion of an unidentified prescription medication. In the midst of an apparent psychotic break, he fatally shot his wife while she was calling 911 for help.

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Gary B. Anderson, M.D. John W. Anderson, M.D. Jack J. Beller, M.D. Steven P. Brantley, M.D. Stephen R. Davenport, M.D. Joel M. Davis, M.D. David J. Flesher, M.D. Thomas H. Flesher III, M.D. Greg E. Halko, M.D. Michael E. Kiehn, M.D. Andrew B. Parkinson, M.D. Richard A. Ruffin, M.D.

The surgeons at Orthopedic Associates are board certified or board eligible by the American Board of Orthopaedic Surgery.

NW 50th & Hefner Parkway • Oklahoma City • 405.947.0911 • 888.947.0911 • www.okortho.com 16 The Bulletin | 2015 March/April

DOCTOR OF THE DAY APRIL SIGN FOR DOCTOR OF THE DAY UP AT CAPITOL Each year the Oklahoma State Medical Association provides a physician for each day of the state legislative session. This program is called Doctor of the Day, and the physician for that day handles minor medical situations (think aspirin and Band-Aids). The physician also is introduced in both the House and the Senate chambers as sessions open.

OCMS is responsible for providing physicians during the month of April. If you are interested in serving one day during the month of April, please contact Eldona Wright at OCMS, 702-0500, or email: ewright@o-c-m-s.org.

Fast.

MEMBER NEWS Congratulations to Jason Breed, MD, for being named the 2014 Physician of the Year at Integris Canadian Valley Hospital. He also was selected to receive the T.J. Lowery Humanitarian Award from the Yukon Chamber of Commerce. Dr. Breed completed medical school at the OU School of Medicine and completed his residency at the Integris Baptist Great Plains Family Medicine Residency Program.

The 30-Minutes-or-Less E.R. Service Pledge.

We understand that life is too short for you to spend hours in an E.R. waiting room. And we know that in an emergency, minutes really do matter. So our entire team is committed to working diligently to have you initially seen by a clinical professional* in 30 minutes or less. We want to help you spend less time waiting, and more time getting better. Learn more at DeaconessOKC.com.

*Clinical professional is defined as a physician, physician assistant or nurse practitioner. If you are experiencing a medical emergency, call 911.

Deaconess Hospital is directly or indirectly owned by a partnership that proudly includes physician owners, including certain members of the hospital’s medical staff.

2015 March/April | The Bulletin 81957_DEAC_ERpldg_7x4_3875c.indd 1

12/9/14 4:45 PM

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THE

PEARL DEACTIVATING IMPLANTABLE CARDIAC DEVICES: Ethical and Legal Aspects

By S. Sandy Sanbar, MD, PhD, JD

O

n Dec. 28, 2014, a patient celebrated her 89th birthday with her daughter, who is the patient’s health care proxy, and her granddaughter. The patient has had a pacemaker for a sick sinus syndrome for over five years. She has been bedfast for about three years.

She is blind. She is often mentally confused and has hallucinations. She is extremely weak and emaciated.

She is edentulous and unable to eat enough food. She has difficulty moving her painful joints, is on hospice care and has recurrent lower urinary tract infections, which are very painful.

Implantable cardiac devices, including pacemaker (PM), implantable cardioverter-defibrillator (ICD) and left ventricular assist device (LVAD) have greatly improved the treatment of patients with certain cardiac disorders over the past decades. Some patients with implantable cardiac devices will be expected to reach a point when they become physically debilitated and emaciated, emotionally distraught, and at times

18 The Bulletin | 2015 March/April

financially drained. These patients, or their surrogates, may ask the attending physician and/or other members of the health care team to deactivate the implanted cardiac device.

A number of organizations have addressed this dilemma, including the Heart Rhythm Society, the American College of Cardiology, American Geriatrics Society, American Academy of Hospice and Palliative Medicine, American Health Association, European Heart Rhythm Association, the Hospice and Palliative Nurses Association, and the European Heart Rhythm Association. The emerging consensus statement by these organizations is as follows: In the United States, under the liberty protections of the 14th Amendment Due Process provisions, and based on the ethical principle of autonomy and the legal doctrine of informed consent, an adult with present decision-making capacity has the right to choose or refuse medical interventions, or to request the withdrawal of any medical intervention, regardless

of his/her medical condition and regardless of whether death will result from the refusal or withdrawal.

Adults should be afforded a presumption of adequate decision-making capacity. This presumption may be overcome or rebutted when necessary to best serve the ethical principles of beneficence (doing good) and non-maleficence (avoiding harm) by protecting a decisionally incapacitated person from avoidable injury.

Where the patient currently lacks sufficient cognitive and emotional ability to make and express his or her own autonomous choice, the right to assert a medical decision may be exercised by a surrogate decision-maker acting on the patient’s behalf.

One should determine if the patient has a valid advance medical directive, and a proxy instrument such as a durable or enduring power of attorney for health care, in which the patient appoints another person to act as the decision-making agent.

There is no relevant legal or ethical difference between a patient or surrogate refusing a medical intervention in the first place and requesting, at a later time, the withdrawal of that intervention which is already in place, such as a cardiac device or any other form of life-sustaining medical intervention. The patient or surrogate may choose either.

Some physicians draw operational distinctions among different treatment modalities, and between foregoing a medical intervention at the outset and discontinuing an intervention that is already in progress. Such distinctions have no reasonable legal

or ethical basis. However, no physician should be compelled by the state to carry out an act such as deactivating a patient’s implantable cardiac device, even when the act is totally permissible legally, if the physician’s participation would violate the physician’s personal ethical values and conscience. In this situation, the physician may not unilaterally terminate an existing professional relationship with a patient who continues to need care, thereby abandoning the patient without access to appropriate medical services. Instead, the physician should notifying the patient of the ethical conflict and the physician’s intent to terminate the relationship, and to make reasonable efforts to refer the patient to another adequate source of care that will honor the patient’s or surrogate’s wishes.

Finally, with respect to device deactivation, institutional providers should formulate and have readily available formal policies and procedures regarding relevant implementation logistics. They should also conduct regular continuing education activities to assure that the institutional policies and procedures are carried out competently and consistently.

The clinical encounter surrounding the device deactivation, including the communication process, action rationale, and conduct undertaken, must be documented in a complete, timely, and accurate manner, directly in the patient’s medical record. Documentation is a key to avoid civil, and possibly criminal, liability issues.

THE

BULLETIN

2015 March/April | The Bulletin

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HOUSE OF DELEGATES OSMA Annual Meeting April 17-18

The Oklahoma State Medical Association will host its annual meeting and House of Delegates April 17-18, 2015, in Oklahoma City at OSMA headquarters.The OCMS Delegate Caucus was held March 5, 2015, in preparation for the House of Delegates meeting. For more information, please visit www.okmed.org or call (405) 601-9571.

Friday, April 17

Saturday, April 18

• 9 am to noon: CME presentation “Prescription Monitoring Program: What Physicians Need to Know” • 1 pm: OSMA Board of Trustees Meeting • 6 pm: CME Wine & Cheese Reception • 7 pm: Dinner and CME: – Desmond Mason will speak on “The Stress of the Game” – Jay Wilkinson will speak on “Winning the Wilkinson Way”

• 8:30 am: OCMS, TCMS and Rural Physician Caucuses meet • 10 am: House of Delegates • 6 pm: Inaugural Reception, Oklahoma City Golf & Country Club • 7 pm: OSMA/OSMAA Inaugural Dinner and Awards Ceremony

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Remembering

OLD WESLEY HOSPITAL

By David William Foerster, MD

22 The Bulletin | 2015 March/April

T

he year was 1959 and I was finishing my year of surgical internship at the University Hospitals. I had signed on for three years of general surgery, which was a prerequisite before proceeding with two years of plastic surgery training. I wanted to make the general surgery years as productive as possible and work directly with talent surgeons (rather than residents), therefore I requested and was granted a one-year rotation to Wesley Hospital, a teaching facility aligned with the university. Wesley was headed by Austin Bell, MD, a superb general surgeon and, as the only surgical resident there, I would be worked as his primary assistant. As it turned out, I was also allowed to work with several other fine surgeons in other specialties and was allowed to have primary care of

occasional indigent patients that Wesley cared for under its teaching program.

Working with Dr. Bell was a wonderful experience. He was the quintessential Southern gentleman cut in the mold of a surgical Robert E. Lee. Not only was he adroit and skillful in the OR but he was worshipped by his patients and staff. Unlike too many physicians who stood at the foot of the patient’s bed with chart in hand, Dr. Bell went directly to the patient and touched them in a caring way: a pat on the forehead or shoulder or a gentle squeeze of their hand, asking how they were doing and reassuring them that he had their best interest at heart. This was something I never forgot and incorporated it into my own practice throughout the years.

It was also my privilege to occasionally work with A.C. “Ace” Lyle, MD, a very talented neurosurgeon.

Dr. Lyle was left-handed and I recalled one time when the scrub nurse inadvertently handed his closing suture threaded for a right-handed surgeon. Without missing a heartbeat, he began his repair right-handed with great aplomb so as not to embarrass the young nurse! Very few could have done this so well.

Oklahoma City was blessed with many fine neurosurgeons at this time, including Harry Wilkins, MD (the father of Oklahoma neurosurgery), Jess Hermann, MD, Bob Rutledge, MD, and others.

Continues on page 24 …

2015 March/April | The Bulletin

23

WESLEY HOSPITAL

I also enjoyed working from time to time with Robert Holt, MD, orthopedic surgeon per excellence. He pinned several hips together and I got to pin one myself from the indigent service. Dr. Holt had a great deal of confidence in me and when a young man with a traumatic loss of his ring finger was admitted to the service ward, he asked me what I was planning. I told him that I could trim and close the finger stump or narrow the metacarpal ray and give him a four-fingered hand without a stump. The patient preferred the latter procedure. (Mickey Mouse also has four-fingered hands, of which most people are unaware).

Dr. Holt agreed and mentioned that I should use a drain. I had never seen or done such a procedure but had studied the technique. Fortuitously everything worked as planned and after releasing the tourniquet there was very little bleeding that was easily controlled. So I elected to avoid the drain and get a nice smooth skin closure.

24 The Bulletin | 2015 March/April

Continued from page 23 …

The next day Dr. Holt accompanied me on my rounds to see my patient. I proudly removed the dressings and everything looked great. In a booming voice, Dr. Holt exclaimed, “Where is the drain?” In a meek voice, I replied that I didn’t feel it was necessary.

We then proceeded out of the patient’s earshot and I got a five-minute verbal lashing about my failure to follow instructions! Happily the patient healed nicely with no complications, but I learned a valuable lesson: DO WHAT YOUR MENTOR TELLS YOU TO DO!!!

I have never forgotten that lesson!

The year was now 1960 and two of the Wesley staff surgeons, Drs. Munnell and Gatchel, decided to get into the latest thoracic advancement, namely open heart surgery. As the surgery resident, I was made part of the team and for several months we worked with animal subjects getting down the pump techniques, etc. By June we were ready to begin human surgery.

At this time, the recovery room concept was not in effect and patients were simply transferred back to their rooms after surgery. Therefore, it was decided

that the open heart patients should remain in the OR overnight and be closely monitored by a nurse. The surgical resident was also to spend the night in the OR with the patient (a cot was provided so I could get a few winks).

I seriously doubt if something dire were to have happened, I would have any idea as to what to do! Blessedly, the three patients done in June survived their valve replacements (arterial bypass was yet to be) and so ended my nightly vigils and open heart experience before returning to the University Hospitals.

Although I never worked with Jack Hough, MD, he returned to Wesley while I was there after spending three months at the Mayo Clinic observing stapes mobilization procedures and then began doing such at Wesley. Dr. Hough was a natural

surgeon and had learned his ENT skills while serving in the Army during WWII. He was another of the great surgeons working at Wesley and, as we now know, established his own institution at the Baptist (Integris) Medical Center and became famous for his innovative techniques and procedures.

Wesley Hospital eventually morphed into the Presbyterian Medical Center and the Oklahoma City Clinic moved to the new hospital in the Health Sciences Center. There are only a few of us that still remember old Wesley Hospital and its virtuoso staff of exceptional surgeons. It was a great chapter in the history of Oklahoma City medicine! “The old order changeth yielding place to the new” and the new has much to do to match the old.

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DIRECTOR’S DIALOGUE

By JanaTimberlake, Executive Director

“Leaders make things possible.

Exceptional leaders make them inevitable.” ~Lance Morrow

I

have had the privilege of working for many leaders since beginning my work at the Oklahoma County Medical Society. While their leadership styles have differed, each has been effective in his or her own way. The first Society president who really got my attention was Dr. Irwin H. Brown, a general surgeon. I was a part-time employee at the time who often attended membership meetings. At his first membership meeting as president, Dr. Brown shot a starter’s pistol instead of using the gavel to begin the meeting! Yes, he got everyone’s attention.

It is fun to walk down memory lane for the past 30 years while remembering something special about each president. They each donated an incredible amount of time and expertise to the Society, and we are grateful for their commitment to the organization.

One of the Society’s past leaders, Dr. Jay Cannon, received the Dean’s Award for Distinguished Medical Service at this year’s Evening of Excellence. As I sat in the audience during his introduction, I thought about what made him an exemplary leader, especially in the development of the community-wide emergency call rotation system. Was it his demeanor? Was it the respect and trust of his fellow colleagues? Was he in the right place at the right time?

To be truthful, it is probably all of the above. But what I believe makes a good leader begins with the inner core of the person. Before I had the opportunity to really get to know him, everyone – and I mean everyone – had only kind words when referring to Dr. Cannon. Once he started up the leadership ladder at the Society and I was given the opportunity to see his leadership skills, I soon understood what they meant.

Without someone like him, the mechanics of creating and overseeing the metro call system would have been much more difficult. Yes, there are many others who contributed to the system’s success, but nothing could have been achieved without a good leader.

A little history... In the fall of 2003, Oklahoma’s only Level I trauma center threatened to downgrade its trauma care capabilities because of inadequate funding levels and because the center was overwhelmed with Priority 2 and 3 patients. Meetings were held at the Oklahoma County Medical Society to examine statistics and look for solutions, and the group met with specialists throughout Oklahoma County to begin discussing the creation of a community wide on-call system that would allow the Level I Trauma Center to focus on Priority 1 patients while other hospitals in the urban area served as designated on-call receiving Continues on page 28 …

2015 March/April | The Bulletin

27

DIRECTOR’S DIALOGUE Continued from page 27 …

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facilities with appropriate on-call specialists. And, Dr. Jay Cannon was appointed chair of the committee to oversee the system.

Holding our breath, the first schedule was adopted and put into place in May 2004. Several revisions were made to each schedule at the beginning. Over the years, there have been tweaks here and there to adjust the system and a few of the original hospitals no longer participate, but it continues to operate today under the supervision of the RTAB Trauma Rotation Subcommittee with Dr. Cannon still at the helm. The Society continues to publish the call schedules, and anyone can access the most up-to-date schedules on the OCMS website.

So, on a Thursday night in January while at the Evening of Excellence, I was so proud to hear the applause at his introduction. Everyone else soon learned why Dr. Cannon is so exceptional and why the rotational call system’s success was inevitable!!

Happy Spring...

Jana Timberlake, Executive Director THE

BULLETIN

Won an Award?

LET US KNOW! Email: tsenat@o-c-m-s.org Or call: 702-0500

Midwest Regional Medical Center is directly or indirectly owned by a partnership that proudly includes physician owners, including certain members of the hospital’s medical staff.

28 The Bulletin | 2015 March/April 81021_MIDW_Hospital_3_375x9c.indd 1

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Pansies

Carefully, I made their beds Where now they sleep Each dawn I find their lips Among the purple smiles Love-crimsoned, warm, and deep

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Each eve I whisper tales Into their auburn ears Each night they flock Into my dreams like sheep.

Pansies Sly butterflies Wild with rainbow dust Songs, passion-winged And poems lewd with lust

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2015 March/April | The Bulletin

29

COMMONLY REPORTED DISEASES FOR 2014 Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

E. coli 0157:H7

2

0

0

0

0

1

0

0

0

0

0

1

Ehrlichiosis

0

0

0

0

1

2

3

0

1

0

0

0

Haemophilus influenzae Type B

0

0

0

0

0

0

0

0

0

0

0

0

Haemophilus influenzae Invasive

1

2

3

1

4

0

2

0

0

1

1

2

Hepatitis A

1

0

0

0

0

0

0

0

0

0

0

0

By Month

Hepatitis B

9

7

12

5

8

6

6

12

4

12

9

14

Hepatitis C

22

14

12

10

16

13

12

21

20

29

24

10

Lyme disease

0

0

0

0

0

0

0

1

0

1

0

1

Malaria

0

0

0

0

0

0

1

1

0

0

0

0

Measles

0

0

0

0

0

0

0

0

0

0

0

0

Mumps

0

0

0

0

1

0

0

0

1

0

0

0

Neisseria meningitidis

0

0

0

0

1

0

0

0

0

0

0

0

Pertussis

0

2

1

1

2

1

5

1

0

2

2

1

Strep pneumo invasive, children <5yr

1

1

0

0

1

1

0

0

0

1

0

1

Rocky Mtn. Spotted Fever

0

1

0

1

8

9

4

1

2

0

2

0

Salmonellosis

12

6

4

5

8

19

18

17

10

12

10

8

Shigellosis

4

0

1

2

1

3

0

9

2

2

1

7

Tuberculosis ATS Class II (+PPD only)

0

0

0

0

0

0

0

0

0

0

0

0

Tuberculosis ATS Class III (new active cases)

0

0

0

0

0

0

0

0

0

0

0

0

Tularemia

0

0

0

0

0

1

0

0

0

0

0

0

Typhoid Fever

0

0

0

0

0

0

0

0

0

0

0

0

RARELY REPORTED DISEASES/CONDITIONS: West Nile Virus Fever

0

0

0

0

0

0

0

1

0

0

0

0

Pediatric influenza Death

0

0

0

0

0

0

0

0

0

0

0

1

152

43

16

11

0

0

1

0

1

4

5

106

Influenza, Novel virus

0

0

0

0

0

0

0

0

0

0

0

0

Strep A Invasive

0

0

0

0

1

1

0

0

0

0

0

0

Legionella

0

0

0

0

2

0

1

1

2

1

0

0

Rubella

0

0

0

0

0

0

0

0

0

0

0

1

Listeriosis

0

0

0

0

0

0

0

0

0

0

1

0

Yersinia (not plague)

0

0

0

0

0

1

0

0

0

1

0

0

Dengue fever

0

0

0

0

0

0

0

0

0

0

0

0

Influenza, Hospitalized or Death

YTD totals are updated quarterly to reflect cases that have a reporting delay due to laboratory confirmation or symptom assessment. * Over reported (includes acute and chronic) ***Beginning in June 2012 medical health record was transitioned to the electronic format PHIDDO. Data for newly identified infections is not available at this time. OSDH is being consulted on obtaining data.

30 The Bulletin | 2015 March/April

CME INFORMATION DEACONNESS HOSPITAL Contact: Emily McEwen

CME Coordinator

Medical Library Phone: 604-4523

OKLAHOMA ACADEMY OF FAMILY PHYSICIANS CHOICE CME PROGRAM Contact: Samantha Elliott

Director of Membership Phone: 842-0484 Email: elliott@okafp.org

INTEGRIS BAPTIST MEDICAL CENTER Contact: Marilyn Fick

Medical Education Phone: 949-3284

INTEGRIS SOUTHWEST MEDICAL CENTER Contact: Marilyn Fick

CME Coordinator

Website: www.okafp.org

OUHSC-IRWIN H. BROWN OFFICE OF CONTINUING PROFESSIONAL DEVELOPMENT Contact: Susie Dealy or

Myrna Rae Page Phone: 271-2350

Phone: 949-3284

Check the homepage for the latest CME offerings: http://cme.ouhsc.edu

MERCY HOPITAL OKC

ST. ANTHONY HOSPITAL

Contact: May Harshburger

CME Coordinator

Contact: Susan Moore

CME Coordinator

Phone: 752-3390

Phone: 272-6748

MIDWEST REGIONAL MEDICAL CENTER

ORTHOPAEDIC & RECONSTRUCTION RESEARCH FOUNDATION

Contact: Carolyn Hill

Medical Staff

Services Coordinator Phone: 610-8011

Contact: Kristi Kenney

CME Program Director or Tiffany Sullivan

Executive Director Phone: 631-2601 2015 March/April | The Bulletin

31

PROFESSIONAL REGISTRY Physicians interested in advertising in the Professional Registry should contact the Executive Office at 702-0500.

ALLERGY OKLAHOMA ALLERGY & ASTHMA CLINIC, INC. Warren V. Filley, M.D. * James R. Claflin, M.D. * Patricia I. Overhulser, M.D * Dean A. Atkinson, M.D. * Richard T. Hatch, M.D. * Shahan A. Stutes, M.D. * Gregory M. Metz, M.D. * Laura K. Chong, M.D. * Florina Neagu, M.D. * Diplomate, American Board of Allergy and Immunology â&#x201E;˘

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ENDOCRINOLOGY DIABETES & METABOLISM MODHI GUDE, M.D., MRCP (UK), FACP, FACE

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South Office: 1552 S.W. 44th Oklahoma City, OK 73119 405-681-1100 North Office: 6001 N.W. 120th Ct. #6 Oklahoma City, OK 73162 405-728-7329

Practice limited to Endocrinology, Diabetes and Thyroid only.

NEUROSURGERY OU NEUROSURGERY The University of Oklahoma Health Sciences Center Department of Neurosurgery Timothy B. Mapstone, M.D. Mary Kay Gumerlock, M.D. Craig H. Rabb, M.D. Naina L. Gross, M.D. Michael D. Martin, M.D. William B. Schueler, M.D. Michael Sughrue, M.D.

Gamma Knife Radiosurgery Cerebrovascular Surgery Pediatric Neurosurgery Spine Surgery Skull Base Surgery Neurosurgical Chemotherapy Carotid Artery Surgery Tethered Spinal Cord-Repair Chiari Malformation-Surgery

To schedule an appointment call

405-271-4912 Harold Hamm Oklahoma Diabetes Center 1000 N. Lincoln Blvd., Suite 400 Oklahoma City, OK 73104

PAIN MANAGEMENT AVANI P. SHETH, M.D. Diplomate of American Board of Anesthesiology Diplomate of American Academy of Pain Management

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Diagnostic thyroid fine needle aspiration biopsy.

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32 The Bulletin | 2015 March/April

Let us know so we can keep you updated!

Email: ewright@o-c-m-s.org / Call: 702-0500

PLASTIC SURGERY

UROLOGY

OU PHYSICIANS PLASTIC SURGERY

Urologists

Kamal T. Sawan, M.D. Christian El Amm, M.D. Suhair Maqusi, M.D. Adult Clinic Location OU Physicians Building 825 N.E. 10th St., Suite 1700 Oklahoma City, OK 73104

To schedule an appointment for Adult Services call

405-271-4864

Adult Services Facelifts Endoscopic Brow Lifts Nose Reshaping Eyelid Surgery Liposuction Breast Augmentation Breast Reconstruction Breast Reduction TummyTuck Skin Rejuvenation

Laser Hair Removal Botox & Fillers Body Contouring After Weight Loss Birth Defects Hand Surgery - Dr. Maqusi Microsurgery Burn Reconstruction Skin Cancer Excision MOHs Reconstruction

at

Medicine

Adult Urology

Michael S. Cookson, MD, Chairman Urology Department, Urologic Oncology/Robotics Ash Bowen, MD, General/Oncology/Robotics Daniel Culkin, MD, Men’s Health/Stones/Oncology Jonathan Heinlen, MD, Urologic Oncology/Robotics Joel Slaton, MD, Urologic Oncology Kelly Stratton, MD, Urologic Oncology/Robotics Gennady Slobodov, MD, Male/Female/Reconstructive/ Incontinence/Neurogenic Bladder Puneet Sindhwani, MD, Male Infertility/Transplantation

OU Physicians: Adult Urology 405-271-6452 Edmond 405-340-1279 Stephenson Cancer Center 405-271-4088

Pediatric Urology Brad Kropp, MD, Pediatric Urology

Pediatric Clinic Location OU Children’s Physicians Building 1200 N. Phillips Ave., 2nd Floor Suite 2700 Oklahoma City, OK 73104

Dominic Frimberger, MD Pediatric Urology/Reconstructive Surgery/Spina Bifida

405-271-4357

William Reiner, MD, Child/Adolescent Psychiatry

To schedule an appointment for Pediatric Services call Pediatric Services Secondary Burn Reconstruction Cleft Lip & Palate Congenital Nevi Craniosynostosis

Craniofacial Syndromes Hemangiomas Traumatic Defects Vascular Lesions

RADIOLOGY JOANN D. HABERMAN, M.D.

Breast Cancer Screening Center of Oklahoma Mammography - Screen/Film Breast Ultrasound

6307 Waterford Blvd., Suite 100 Oklahoma City, OK 73118 405-607-6359 Fax 405-607-8256

Blake Palmer, MD Pediatric Urology/Robotics

OU Children’s Physicians: Urology 405-271-2006 Edmond 405-340-1279

LOOK FOR THE OCMS ENEWS IN YOUR EMAIL! It’s a monthly email newsletter that we send to all of our members with news and information. It’s short and easy to read, just right for our busy members. It is distributed in the middle of the month, so if you don’t remember seeing it, please check in your spam email folder!

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OKLAHOMA CITY, OK

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