FCS
Winter 2014
THE MAGAZINE
My Heart Is In It
Why Dr. William Harwin founded Florida Cancer Specialists Research Institute INSIDE
RX TO GO » DR. MARY LI » THE VILLAGES » TRACEY CURTIS ARNP » IRAs » LAUGHTER Winter 2014
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editor's
letter
FCS THE MAGAZINE PHYSICIAN LEADERSHIP PRESIDENT
WILLIAM N. HARWIN, M.D.
Message from
Scott Tetreault A few months ago I was perusing the month-end business reports. Data is a wonderful thing. Given enough time and energy, I could plow through those pages and probably figure out each partner’s work style in tremendous detail. The numbers could tell me what they do and how they do it. But the numbers can’t even begin to tell me who they are. Heck, I have partners now, I am embarrassed to say, who I could run into at Publix and not even know we work for the same company. We’ve gotten big — very big. But the glue that will bind us together through time is not just our shared commitment to providing excellent care close to home. We will be a team only if we know each other. This first volume of FCS The Magazine is the first step on that journey. Our goal here is pretty simple: Bring to life the people and places that make up Florida Cancer Specialists. To give dimension to those faceless names on those email streams. So please enjoy the inaugural issue as we profile our “fearless leader,” take you to The Villages and down to Rx To Go. And stay tuned, we may be coming to your corner of FCS soon. All the best,
Scott Tetreault, Editor, FCS the Magazine
ASSISTANT MANAGING PARTNER, DIRECTOR, EXECUTIVE BOARD
STEPHEN V. ORMAN, M.D. MEDICAL DIRECTOR
MARK S. RUBIN, M.D. SCIENTIFIC DIRECTOR OF CLINICAL RESEARCH, DIRECTOR, DRUG DEVELOPMENT PROGRAM
LOWELL L. HART, M.D.
DIRECTOR OF RESEARCH OPERATIONS
ROBERT C. WHORF, M.D.
EXECUTIVE MANAGEMENT CHIEF EXECUTIVE OFFICER
BRAD PRECHTL
CHIEF OPERATING OFFICER
TODD SCHONHERZ GENERAL COUNSEL
TOM CLARK
CHIEF MARKETING & SALES OFFICER
SHELLY GLENN
CHIEF HUMAN RESOURCES OFFICE
SHARON DILL
VICE PRESIDENT OF REVENUE CYCLE
SARAH CEVALLOS
VICE PRESIDENT OF CLINIC FINANCIAL SERVICES
CHRISTINA SIEVERT
SR. VICE PRESIDENT OF OPERATIONAL TRANSITIONS
TIM BOOZAN, RN
SENIOR MANAGEMENT JEFF ESHAM JEREMY BEHLING LOIS POEL JEFFREY RUBIN RAY BAILEY LOIS BROWN JOHN DODD INGA GONZALEZ KATIE GOODMAN, RN, BSN, CCRP SUE KEARNEY DENICE VEATCH SAMANTHA WATKINS
DESIGNED AND PRODUCED BY
TALLAHASSEE, FLORIDA
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SCOTT HOLSTEIN
contents
in this issue
DEPARTMENTS 6 12 13 24 25 26 26
Foundation Events The Radar Screen How We Roll Legal Estate/ Asset Protection Q&A Money Management for Doctors Humor Bragging Rights
SPOTLIGHT
18 Doctor Spotlight: MARY LI Dr. Mary Li wanted to make a difference. She meets cancer head-on and hand-inhand with her patients.
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Nurse Spotlight: TRACEY CURTIS Tracey Curtis, ARNP likes working on all kinds of cancer and not getting pigeonholed. “It keeps my mind sharp,” she says.
FEATURES 4 Profile: DR. WILLIAM HARWIN
Dr. William Harwin talks about why he founded FCS, the need for quality care and why he wants to make a difference.
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RX TO GO FCS’ retail pharmacy helps patients with quick results at affordable prices.
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Office Spotlight: THE VILLAGES “This isn’t your run-of-the-mill doctor’s office,” says Office Manager Donna Swearingen of the compassionate care that patients receive while being close to home, family and friends.
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PROFILE
Dr. William Harwin, a cycling enthusiast, on the porch of his Fort Myers condominium overlooking the Caloosahatchee River.
Fighting For A Cancer Cure Why Dr. William Harwin’s heart is in it BY GINA DAVIDSON
M
any years ago while hiking with a tour group through Denali National Park in Alaska, Dr. William Harwin was approached by a fellow traveler who had overheard his last name mentioned in the crowd. The stranger asked if he was any relation to Marty Harwin. The two men were more than 3,000 miles from the small town of Westbury, N.Y., where Harwin had grown up and his father had been a pediatrician for more than 40 years. As a child, he’d grown accustomed to everyone in town knowing his dad, but here? What were the odds?
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“ ‘That’s my dad,’ I told him, and he proceeded to tell me about a time when he was a boy, terribly sick, and stuck in his house during a snowstorm. ‘Your dad followed a snow blower all the way to my door,’ he told me, ‘He inspired me to become a doctor.’ ” Turns out the men had that in common, too. “I remember going to house calls with him as a young child of six or seven,” says Harwin, a practicing oncologist and the president and managing partner of Florida Cancer Specialists (FCS). He would wait patiently in the car during his father’s visits, and then afterward get to talk with him about the world of medicine. “I was always interested in what he did,” Harwin says. His father, in turn, was pleased his son chose to study medicine. “In my sophomore year (at Baylor College of Medicine in Houston), I became interested in oncology,” he says. “I chose it as an elective rotation, and once I was there, I knew what I wanted to do.” After receiving his medical degree from Baylor, he completed his internship and residency in internal medicine and a fellowship in hematology and medical oncology at the University of Miami. It was during his time at UM that he met his wife, Marilyn, a CT technologist. They married in 1984, just before Harwin opened his own practice. “We started with a $70,000 line of credit,” he says. “And Marilyn was the first employee.” She ran the office until later deciding to stay home to raise their four children. Harwin began merging with other practices in the area. “We formed a group in Fort Myers, and then the group expanded into other areas of
Florida,” he says, noting it made sense to merge with other oncologists. He envisioned a network of doctors who could help each other learn and grow while minimizing overhead expenses. Twelve years into his practice, his chosen profession took a personal turn when Marilyn was diagnosed with breast cancer. She was 37 years old. “Had we known then what we know now,” he says, “she might have been cured.” Instead, the Harwins spent more than 10 years battling the insidious disease they had helped so many others fight. Marilyn underwent a lumpectomy, radiation, recurrence, a mastectomy and a variety of
PHOTOS BY SCOTT HOLSTEIN
chemotherapy treatments before finally succumbing to the disease on Dec. 1, 2006. “I’m more huggy with patients now,” says Harwin, “more affectionate than I was before.” Living through her illness, he says, has given him an appreciation for the spouses in that position, mostly for the husbands who are in the process of dealing with a wife’s cancer. “Waiting for results and reading the CT scans was the worst,” he says. “It was traumatic.” And being an oncologist made it even tougher. “I always had to be the one to give her the bad news.” Today, he honors Marilyn’s memory and continues to fight for a cure by participating in
various fundraising events. Three times he has taken on the Pan Mass Challenge, an annual bike-a-thon of nearly 200 miles that raises money for breast cancer research at the Dana Farber Cancer Institute in Boston. And he has raised more than $38,000 for the Dolphin Cycling Challenge, a two-day tri-county event that raises funds for research at the Sylvester Comprehensive Cancer Center. Through FCS, he says, “I’d like to get everyone to accomplish the same goals: provide high quality care and drive our business forward. We are a cohesive group, and it’s important we remain a cohesive group. There will be lots of challenges in health care, and
I look forward to leading our group through those challenges.” Harwin is also currently looking to expand the business beyond Florida. But at the center of things are the patients he works with every day. “Always make sure the stethoscope is on the patient,” he says his father would tell him, by which he meant to make sure you have personal interaction and a genuine connection with each person you see. “We’re very involved with our patients and their families,” he says. “We provide the support and education and whatever they need to get through the cancer experience. I love this business. My heart is in it.”
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foundation
events
Tampa Bay Buccaneers’ Inaugural Treasure Chests 5K Run/Walk
OCT. 13, 2013 More than 1,300 runners and walkers participated and the event culminated in the Buccaneers announcing a $30,000 donation that will benefit equally the American Cancer Society, Florida Cancer Specialists Foundation and Moffitt Cancer Center. Over 30 FCS staff and their family members participated in the run/walk — some even winning medals. The Treasure Chests 5K was part of a weekend full of activities aimed at raising awareness of the issue of breast cancer and funds to help find a cure for the disease. FCS was the sponsor of the breast cancer awareness game (TB Bucs vs. Philadelphia Eagles), where over 100 FCS nurses and breast cancer survivors’ children ran on the field pre-game carrying Buccaneers flags. The Buccaneers military suite hosted breast cancer survivors who have served in our armed forces.
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foundation
events
Pitch for Pink JULY 9, 2013
FCS was a Grand Slam Sponsor of this minor league Clearwater Thrashers game to raise money and awareness for breast cancer. Over 50 staff members and physicians attended the game.
Purple Strides NOV. 23, 2013
As a Platinum Sponsor, FCS helped support over 10 FCS attendees in this walk/run — and Dr. Jose Alemar kindly provided the T-shirts.
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Making Strides Against Breast Cancer OCT. 2013 ďƒŤ
Throughout Florida, FCS sponsors many of the American Cancer Society’s Making Strides Against Breast Cancer (MSABC) October events, supporting the mission to fight breast cancer. FCS staff members, Dr. Gregoire Bergier rallied within the FCS communities served to join the fight.
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Thanksgiving Comes Early for Cancer Patients & Families NOV. 20, 2013 ďƒŠ
More than 300 cancer patients and their family members, including Dr. David Wright, attended an early Thanksgiving dinner. The event was hosted by the physicians and staff of Florida Cancer Specialists & Research Institute (FCS) and held at the Tampa Cancer Center. The Tampa Bay Bucs’ Mason Foster and Adam Hayward served food and greeted patients and their family members.
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foundation
events
The Angry Open Golf Tournament OCT. 17, 2013
Dr. Andrew Hano and others participated in this fundraiser for melanoma. This foundation and event was started by an FCS employee.
Stories worth telling. Lives worth
living... 7 PINELLAS CO. LOCATIONS
Dr. J. Andrew Peterson
se Dr. Jo
r
Alema
lemar is “Dr. A The tic. s ta n fa gement encoura he has e p o and h e pulled s. given m gh the u nd word me thro es. He is beyo uldn’t m wo tough ti r. Alemar, I lly saved a tD Withou ght now. He re ri be here ” HARBOR my life. S, PALM MING
“I chose Dr. Peterson because I asked all the nurses that I knew who was the best doctor to go to. One worked person knew a nurse who a with him and said that he was to his great doctor and very nice ’.” patients. I said ‘that’s my guy —
THERESA HESTON, PINELLAS
PARK
Clearwater 303 Pinellas St. Suite 230 Clearwater, FL 33756 (727) 442.4188
Dr. Joseph R.
“My husband and I decided to na me our younger so n Mace because we had so muc h support and compassion fro m Dr. Mace fo years ago, whe ur n I went thro ugh my cancer treatm ent. Dr. Mace will always be a pa rt of our lives .” — DESIREE M ARLOWE, ST . PETERSBURG
Clearwater 303 Pinellas St. Suite 330 Clearwater, FL 33756 (727) 447.8100 Clearwater 3280 McMullen Booth Rd. Suite 200 Clearwater, FL 33761 (727) 216.1141 Largo 8787 Bryan Dairy Rd. Suite 210 Largo, FL 33777 (727) 397.9641 Largo 100 Highland Ave. Largo, FL 33770 (727) 683.2900
LA C — NO
UM
St. Petersburg 1615 Pasadena Ave. S. Suite 400 St. Petersburg, FL 33707 (727) 341.1316
Watch the videos of our stories…
Go to the links below to view: flcancer.com/alemar flcancer.com/peterson flcancer.com/mace
Mace
FLCancer.com
St. Petersburg 1201 Fifth Ave. N. Suite 505 St. Petersburg, FL 33705 (727) 821.0017
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what's on your radar?
the radar screen
New Stuff, Old Stuff Looked at in a New Way and Interesting News from the Oncology Wires BY SCOTT TETREAULT
AML TREATMENT FROM HOME Conventional wisdom says you have to keep your new AML patients locked up for a month during induction. Not so fast, says Dr. Roland Walter and his team at Fred Hutchinson in Seattle. They challenged this decades old dogma and handpicked 15 patients to be discharged right after seven plus three. They needed a stable loving housemate, close residence and they needed to “get it” and be strictly compliant. Visits were three times a week in the clinic with PRN transfusions to follow. All 15 did well; 13 of them had to be readmitted for a day or so for either febrile neutropenia or nausea and vomiting, but there were no deaths or major issues or ICU admissions. Costs were, of course, much lower and QOL was much higher. The authors point out the complete lack of any data on this approach and appropriately suggest further study. (Clinical Advances in Hematology & Oncology. Vol 11; Issue 9, Sept 2013.)
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‘BONE PET’ BETTER THAN BONE MARROW A very interesting study was just reported in the Journal of Nuclear Medicine (AKA The Journal of Unclear Medicine) — about 139 patients with DLCL who underwent BOTH bone marrow biopsies and F-18 Fluoride PET. If the PET showed uptake in a bony area, that area was biopsied directly. PET was much more sensitive at identifying areas of true bone marrow
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involvement (sensitivity 94 percent to 24 percent). This definitely impacted treatment plans, as you can imagine. Someday, say the authors, Bone PET may replace bone marrow biopsy as the staging study of choice.
SAY WHAT? So, you have an older patient with local but muscle-invasive bladder cancer. He’s not a cisplatinum candidate. How do you radio-sensitize him? Ronald Chen (UNC Tarheels) and his team tackled this question in the August 2013 issue of Journal of the National Comprehensive Cancer Network. It might surprise you that they felt it necessary to clearly state: “Carboplatinum© has NO proven effectiveness in this setting … ” Rather, they suggest you use 5-FU plus Mitomycin C (based on the BC2001 trial) or, as an alternative, single agent Gemzar.
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HELP IS ON THE WAY If you’ve ever had the pleasure of a stat consult (at 10 p.m., of course) for a “Pradaxa© disaster,” you’ll be happy to know that Boehringer Ingelheim, the maker of Pradaxa, is fairly far along in the development of BI655075. This is an antibody which can serve as an antidote to Pradaxa. Thank heavens.
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cultured pearls
how we roll
Tips, Pearls and Words of Wisdom from FCS Doctors and Staff
1. EASING FEARS To help put patients at ease regarding clinical trials, Lowell Hart, MD tells them about his own experience in a clinical trial as a little boy. His mother put him on the randomized trial of the Salk polio vaccine. Of course, this was successful. Mrs. Hart believed in medical progress through high-quality clinical trials and so does her son.
SUGGESTIONS
Scott Tetreault MD (send suggestions for “Pearls” to stetreault@ flcancer.com)
2. GOOD ANALOGY Adjuvant treatment can be a hard concept for patients to grasp. This is especially true when their surgeon tells them that they “got it all,” and they are given the good news of clean scans. Scott Lunin, MD analogizes the absence of radiographically visible micromets to a ball point pen placed on a weight scale at Publix. Everyone shops at Publix at some point and everyone steps on that big green scale occasionally. The scale doesn’t register the weight of a single pen, only 30 or 40 pens would make the needle move.
3. THE RIGHT WORD Joel Grossman, MD declines to use the word “refuse.” Patients these days often peruse their medical records, and many physicians use the word “refuse” when referring to interventions that the patient doesn’t want. If a person refuses a reasonable suggestion, then it implies that they are difficult and stubborn. The word “declines” sounds so much better when read by the patient and his or her family, and it conveys the same message.
Fighting Cancer is hard enough. It’s not necessary to leave Hernando County for state-of-the-art radiation treatment. Too often, fighting cancer turns into life on the road — traveling to this treatment or that specialist or the next procedure. Whether it’s cross-country or across the state, extra miles add extra stress. Fortunately, Florida Cancer Specialists is conveniently located, close to home, right here in Hernando County. With the same expertise you find at national cancer centers – and as a preferred clinical trial site among leading researchers – Florida Cancer Specialists stays at the forefront of effective treatment options, including radiation oncology. Our focus on patient convenience means that everything is under one roof. And we’re committed to caring in a way that makes any medicine work harder.
Sawsan G. Bishay, MD Radiation Oncologist
Larry Gandle, MD Radiation Oncologist
Dr. Bishay and Dr. Gandle are board certified in radiation oncology and internal medicine. Both have over 20 years experience.
Life on the road is no way to start a journey you never would have chosen. Florida Cancer Specialists makes it a short trip to the best possible outcome. BROOKSVILLE LOCATION 7154 Medical Center Drive Spring Hill, FL 34608 (352) 596.1926
FLCancer.com Winter 2014
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FEATURE
Rx To Go:
Helping to Extend Lives BY GINA DAVIDSON
W
SCOTT HOLSTEIN
hen it comes to compliments, you couldn’t ask for a more meaningful one than that given to Rx To Go’s pharmacy team by cancer patient Bruce Ott: “They’ve helped me extend my life,” he says. Shortly after Ott was diagnosed with prostate cancer in January 2013, he learned the shockingly high cost of the oral oncology medications prescribed to him. “Just one of them was $4,500 a month,” he says. He was unsure how he would be able get the medications he needed, and then he met with Dr. William Harwin, the founder of Florida Cancer Specialists and the force behind the development of the group’s retail pharmacy. Ott says Dr. Harwin immediately put him at ease. “He told me, ‘You have a tough case, but we’re going to do whatever we can.’ ” “We’ll do whatever we can” seems to be the standard operating procedure of Rx To Go’s team of professionals who are working every day to secure medication for the more than 3,000 Florida cancer patients they serve at any one time. They are committed to getting the medications to the patients as quickly as possible and at an affordable price –– sometimes even for free. “We’re going to get coverage for them –– whether they are underinsured or not insured,” says Director of Pharmacy Ray Bailey, who leads the group along with Pharmacy Manager Kathy Hogan, RPh and Finance Manager Jackie Jimenez-Capote. “We want to be a clearinghouse for all the oral chemotherapy medications,” says Bailey. “We can’t fill all the prescriptions, but we can process any prescription and can cut down
(a patient’s) time in gaining access by doing things centrally.” From the pharmacy’s beginning in 2007, Dr. Harwin says that has been the goal. “I started the pharmacy because we saw it as an important business to get involved in,” he says, “to make it easier for physicians to get patients the medications they need as soon as possible. We can provide the support needed to buy the drugs. And because we have all the medical records, we can provide a great service to our patients.” That service includes proper patient intake, financial consulting, prior authorizations, educating patients on the medications prescribed and following up to maintain compliance. Lisa Flores, a pharmacy technician, is often an initial point-of-service. “I let them know
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SCOTT HOLSTEIN
FEATURE
who we are, and what we’re going to do for them,” she says. She and her team check patients’ prescription information and refer them to other departments as needed. “We try to navigate that to the best of our ability for the patient,” she says. “We don’t want it to be their burden.” When patients can’t afford the medications prescribed, they are referred to financial counselors who work with them to find solutions based on their needs. During the past four years, Bailey says they have learned how to dig up resources, and that many of the expenses are largely paid for by not-forprofit specialty foundations. “It was a matter of knowing how to access the various resources,” he says, “which includes co-pay assistance. In community pharmacies, the rate is 50%. Our rate is in the high 90s. We can get them all help. The prescriptions we don’t fill are only because the patients choose not to take them. They go to hospice, and that’s fine. It’s their choice.” Those who are interested in seeking medication can learn about their options.
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SCOTT HOLSTEIN
Director of Pharmacy Ray Bailey and his team of professionals are the heart of Rx To Go, Florida Cancer Specialists’ retail pharmacy. Their job: Get medication to patients as quickly as possible and at an affordable price.
Patients are called if anything seems amiss. “It’s hard,” says Patt Smith, a financial counselor. “(The “They can see how often the patients are getting refills,” says Dr. patient) just got the bad news that they have cancer, and then Hart. “They’re good at letting us know if there’s a problem. That’s very they find out what the medication is going to cost. Many of important, because these are cancer drugs.” them (first) decide that they won’t get the medication. They’re Dr. Robert Green, a FCS hematologist/ shocked and overwhelmed. We let oncologist in West Palm Beach, also sees great them know we’re here to help and to benefits in his practice being part of FCS and give them assistance. We try to tell Rx To Go. them right away, ‘We understand, and “(The pharmacy) has been great for our we’re going to help you get through physicians, staff and most importantly for our this and get you what you need.’ ” patients,” he says. “The process from ordering When a prior authorization is in OncoEMR to the delivering of the drug needed, Rx To Go has a distinct to the patient is seamless. I’m incredibly advantage over regular retail impressed by not only the efficiency of the pharmacies: access to the patients’ pharmacy staff, but the dedication they show medical records. This speeds up the in helping educate the patients and finding process considerably. financial assistance for patients with copays or “It can usually be determined within helping when their drug is not covered.” 24–72 hours,” says Donna Robichaud, And they can send the medications a nurse on the prior-authorization anywhere in Florida. That is a huge plus for team. “Most are determined that same cancer patient David Boyd, who last year day. If everything is in place, and I at the age of 65, was looking forward to can get all the answers I need for that traveling during his retirement. After a visit to drug, I can get the approval by phone. his hematologist in Virginia, he and his wife Many times (patients) can get their left their home state to spend the winter in medications within two to three days.” Florida. They had just passed the Florida state At other pharmacies, she’s heard prior line when he got the news over the phone. authorization can take weeks. “I was diagnosed with Stage 2 Multiple Not only is this service quick, it’s Myeloma and was told I should begin convenient for the doctors and their staff. receiving treatment immediately,” he says. “They handle everything,” says Not knowing where to turn, the Boyds made Dr. Lowell Hart, a FCS hematologist/ their way to Tampa and found FCS. oncologist in Fort Myers, Fla. “I don’t “They handled everything,” he says, “which have to have my nurses do all the work was a wonderful thing for me because we while we’re trying to see patients. were already living full time in our motor That’s a tremendous benefit.” home. Starting with Dr. David Wright in Other significant benefits, says Dr. Tampa, we were able to go to clinics around Hart, include the education patients the state. Being able to (get) infusions (at receive from the pharmacists, the other clinics) allowed me to continue to live convenience of having the medications the life of a somewhat healthy person. They’ve sent directly to their homes and made everything easier and have been a huge the pharmacy staff monitoring help in allowing me the freedom to continue compliance. traveling.” “Our pharmacists follow up with Boyd and his wife hope to eventually travel them if it’s the first time they’re taking out west. the medications,” says Lucy Draheim, — DR. ROBERT GREEN, INTERNAL And Ott –– who recently called out-of-thea pharmacy technician. “They go over MEDICINE AND ONCOLOGY blue to thank FCS for helping him with his the specifics of the medication, the prostate cancer –– just got married. “Now I side effects and the drug interactions.” get to spend time with my family,” he says. “I Dr. Natasha Khrystolubova, one of couldn’t be more pleased or thankful.” those pharmacists, agrees. “Our goal,” she says, “is to educate the Doing whatever they can every day to serve the FCS patients unites patient about the drug. They’re really scared and anxious, and we this team of professionals in a way few other endeavors could. And it want to be gentle with them. They’re so nervous about meds and brings rewards far greater than any paycheck. what their reaction to them will be. We call them every month “They couldn’t be kinder or more helpful,” says Ott. “If it wasn’t for asking about side effects, refills and more. We make them feel (them) I know I wouldn’t be here.” comfortable, like part of a family.”
(The pharmacy) has been great for our physicians, staff and most importantly for our patients. The process from ordering in OncoEMR to the delivering of the drug to the patient is seamless. I’m incredibly impressed by not only the efficiency of the pharmacy staff, but the dedication they show in helping educate the patients and finding financial assistance for patients with copays or helping when their drug is not covered.”
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DOCTOR SPOTLIGHT
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Dr. Mary Li, MD, PhD Brooksville To her, patients are a virtue
BY ZANDRA WOLFGRAM
M
ary Li’s parents worked full time, so like many young There should be no surprises. I believe it’s really helpful to know what Chinese girls in Tianjin she spent a lot of time with her is coming so they can handle it,” she says. grandparents. Li was just 11 years old when her beloved Li’s passion for medicine has not come without personal sacrifice. grandfather was diagnosed with lung cancer. He lost She did not take a day off for the first five years of her practice for his battle with cancer just a few months later. This terrible first-time fear her patients would need something while she was out. And she experience took a toll on the entire family, admits she may not have as much one-onbut it also emboldened young Li, who made one time with her 12-year-old son as other the decision as a 12 year old to become a moms might. Still, Li sees her calling to doctor to “help other people who have to medicine as something bigger than herself. go through this.” “I have been highly trained over 30 years, Li’s compassion, drive and commitment I want to use all of my knowledge to help have not waned in more than three decades. people,” she says. She held steadfast to her dream to dedicate And that she has done. She threw a big her life to medicine and earned a full baby shower for a male patient in his 20s scholarship to the University of Louisville, with testicular cancer. The niece of a patient where she earned her medical and Ph.D. from years back hugged her in the middle degrees and completed her residency. Today, of JCPenney and told her how much she she is a respected oncologist, hematologist meant to her ailing uncle. An inspiring and clinical pharmacologist with 16 years 85-year-old female patient now insists she in the field (12 in private practice). She will return for a third trip to China, with Li makes rounds at three hospitals in Hernando in tow! And Li can tell many more stories County (Spring Hill, Oak Hill and about the patients who continue to inspire Brooksville), seeing around 30 patients a day and motivate her. “I love my job and my — DR. MARY LI, MD, PHD, BROOKSVILLE as part of her duties on the oncology team patients, and I look forward to going to at Florida Cancer Specialists. This year, her work every morning and starting another patients nominated her for the Leukemia & new day,” she says. Lymphoma’s Society’s prestigious Woman of the Year honor. Luckily for Li and her patients, she has found more balance in her Though she experienced many different areas during her residency, life these days. A lifelong sprinter, Li, 46, is an avid outdoor enthusiast Li has never second-guessed her choices and is exactly where she who takes full advantage of living on the Gulf of Mexico by spending wants to be. “Cancer patients are the best! They are sick but brave, her leisure time boating, scuba diving, kite surfing and sailing. “It’s my and they need our help the most,” she says. “And perhaps that is why passion,” she says. “It’s so peaceful and quiet, and you can see dolphin!” it is the most rewarding.” Though she tries to live a balanced life, her patients will always come Cancer has become an ugly word that many only utter in hushed first. “My patients are everything to me,” she says just moments before tones. Though it is difficult to deal with the disease on a daily basis, offering her personal cell phone to a breast cancer survivor. “Call me Li uses her sunny disposition and no-holds-barred approach to meet anytime at all with questions. I am your consultant now,” she tells the it head-on, hand-in-hand with her patients. “I am honest with them. caller. Before hanging up, she adds, “Congratulations, I am proud of I tell them the stage, type, the average survival rate, what clinical trials you. You did it!” are available and what my experience is with what they are facing. And the same can be said of Li’s childhood dream to make a difference.
Cancer patients are the best! They are sick but brave, and they need our help the most. And perhaps that is why it is the most rewarding.”
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NURSE SPOTLIGHT
Living in the Moment with Tracey Curtis, ARNP
BY ZANDRA WOLFGRAM
I
n an industry full of dynamic change, Florida Cancer Specialists at the hospital of course, but I also like seeing stable patients at the clinic (FCS) Advanced Registered Nurse PractitionerTracey Curtis, AR who are doing well.” NP finds comfort in the constancy of keeping things on an The vast array of cancers and blood disorders this practice treats is even keel. Her three-member team in the Gainesville office another aspect of nursing that Curtis relishes. “I like caring for all kinds has tried different approaches to how they administer health care, of cancer and not being pigeon-holed. It keeps my mind sharp,” she says. but they always revert to what works best: a core Curtis went into health care team giving compassionate care consistently because she always wanted to to the same patients. “In our FCS office, each help people. She began on a physician has a group of patients. The patients pre-med track at the University get to know you and trust you, and it works well of Florida, but opted for a for us,” she says. Master of Science in nursing Unlike some practices, the clinic also has found to enjoy “banker’s hours.” success in partnering its nurses with a specific Though she works a few more physician. So for nearly a decade, Curtis — a hours than most bankers, she native of Pennsylvania who has lived in Florida doesn’t regret her decision. for 20 years — has been paired with Dr. Lucio Her job at FCS is the first and Gordan. Working side by side every day has only job she’s ever had. “There enabled them to develop a deep bond of trust is great camaraderie here. based on mutual respect. The second I walked in I was “We are like brother and sister. We are able to treated like family. It felt right, say what we think, especially with each other,” and 10 years later I still feel the she says. Having a familial relationship means same. You don’t find that too patients receive consistent quality care. “We often,” she says. don’t have to worry about who we are working Colleagues describe with. We can be ourselves and focus on the care 40-year-old Curtis as we are giving.” enthusiastic. She clears her Curtis begins a typical day around 7:30 head by hitting the open a.m. by making hospital rounds on four to road on her motorcycle and — TRACEY CURTIS, ARNP six patients. She pulls records to determine going off-road on her dirt the course of care and consults Gordon only bike and expends some of if it’s something she feels she can’t handle her “hyperactive energy” by herself. “He’s a very collaborative physician. He asks what I think regularly competing in triathlons and marathons. As is the case with and respects what I have to say, which isn’t always the case for most things for Curtis, she aims to strike a balance. “Exercise for me is extenders,” she says. more about the mind, body and spirit versus being a health nut. I still By 8:30 a.m. the team reports to the FCS clinic to see some of nearly like my cake and ice cream, too,” she says with a laugh. three dozen current patients. The last appointment is around 3:45 Though she readily admits nursing is a fulfilling career if you go into it p.m., and after making notes in patients’ files, Curtis wraps up her day for the right reasons, don’t ask this caregiver for a five-year plan. “I never anywhere between 6 p.m. and 8 p.m. was one who had one of those. I didn’t see the need to look so far ahead, I Breaking up the day keeps things interesting for this nurse. “I like guess.” Like her cancer patients, Tracey Curtis, ARNP is happy where she that we see patients on rounds and in the clinic. The acuity is different is — living in the moment.
PHOTO BY SCOTT HOLSTEIN
There is great camaraderie here. The second I walked in I was treated like family. It felt right, and 10 years later I still feel the same. You don’t find that too often.”
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OFFICE SPOTLIGHT
It Takes The Villages
Making a difference with personalized care
A
BY ZANDRA WOLFGRAM
success of any medical practice always comes back to patient satisfaction. Cherie fter losing her mother to breast cancer in 1993, cancer care became highly personal Cooke, a female breast cancer patient in her 60s, is just one of many residents of to Donna Swearingen, a 12-year health care The Villages who raves about her FCS experience. “The staff, the treatment and administrator and office manager for The the convenience to my home — just five minutes by golf cart — made it the best Villages East office in Lady Lake, Fla. “I think about my decision I ever made for my health,” Cooke says. mom and try to give the type of care I Over the years, Cooke — would want for her,” she says. who is celebrating her 10“Every time I’ve ever hired anyone year anniversary as a cancer for a hands-on role at The Villages, survivor this year — has I let them know, ‘This isn’t your runreferred at least 12 of her of-the-mill doctor office,’ ” explains friends to her oncologist, Dr. Swearingen says. “It takes a very Hussein. “I am really crazy special person, someone with empathy, about him. He’s not just a compassion and the ability to relate to doctor; he’s a kind and caring and understand what the patients are human being. He makes you going through. It takes someone who feel as though you are his only has that special something. And I think patient,” she says. I have that staff at The Villages.” At Villages East there is a This particular office of Florida palpable personal connection Cancer Specialists (FCS) is nestled in between the staff and their 80 a vibrant five-mile adult community to 120 daily patients, most of in central Florida called The Villages. whom are known on a firstBeing located within what Forbes name basis. “Donna was the magazine calls “the No. 1 fastest first person I spoke to after — CHERIE COOKE, a female breast cancer patient growing small town in America,” makes this particular FCS practice perfectly situated to meet the increased demands of this growing retirement community in Lake, Sumter and South Marion counties, where the average age is in the 60s. Before they even enter, patients are put at ease with beautiful Spanish-style architecture and the shade of lush, Sago palms. The cherry wood furniture, gold and green hued walls and lovely landscape paintings inside the reception area create a soothing atmosphere. But as everyone knows, a medical facility is just bricks and mortar. The true heart of this FCS office lies within the skilled, personable and capable team of just over 20 staff led by four experienced specialized physicians and five registered nurses. At Villages East, the focus is clear: The patient comes first. “It’s exciting to work as an oncologist because of two words: personalized care,” noted Dr. Maen Hussein. “We treat everyone as an individual. Each treatment plan only fits that person, because everyone is different.” Consistently positive patient evaluations suggest these Florida Cancer Specialists are on the right track. Referrals are on the rise, too, and that means growth. Just this year Villages East increased from 18 to 25 chemotherapy chairs in the new wing of the Sharon Morse Moffitt Cancer Center. Growth is great, but the most important measure of
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FCS The Magazine
PHOTOS BY SCOTT HOLSTEIN
The staff, the treatment and the convenience to my home — just five minutes by golf cart — made it the best decision I ever made for my health.
Donna Swearingen
learning my diagnosis, and she was a total sweetheart. I will never forget how kind and encouraging she was. She will always hold a special place in my heart,” Cooke confesses. The steady stream of notecards, goodies and small gifts are tokens of appreciation from the happy patients who are grateful to be much VILLAGES EAST more than a 1400 N. US Highway 441 N. case file number. The Sharon Morse Building “Our most (#500), Suite 552 important goal Lady Lake, Fla. 32159 is to help make our patients feel comfortable and have confidence. Cancer treatment is a journey, and we are here to be their companions through it,” Hussein says. Patient care from this FCS wellness team extends beyond its warm walls. This office has become an integral part of the fabric of the Lady Lake community. A Leukemia & Lymphoma Society support group meets at the center on a monthly basis. Staff physicians give informative wellness talks and cancerthemed lectures throughout the community on a year-round basis. Each fall the office gears up to “give cancer the boot” by sponsoring the Cattle Barons’ Ball, an annual event to raise funds for the American Cancer Society. And when summer approaches, the entire Villages East staff looks forward to rallying cancer support during Relay for Life — and it doesn’t go unnoticed. “Our patients love seeing us active and engaged in the community. They see us and tell us that means a lot to them for us to show our support. They say it shows we care. And we do,” Swearingen says. Winter 2014
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legal estate/assett
protection
Florida Third Party Trusts and Protection from Creditors of Beneficiaries
A
BY DOUGLAS KNISKERN, J.D, LL.M,
third party trust (“TPT”) is one of the better asset protection devices available in Florida. As with many asset protection devices, the circumstances must be right, but when the stars line up correctly, a TPT can substantially protect the trust assets from the claims of creditors of a trust beneficiary. So what is a TPT? It actually is a traditional form of trust with origins in the fifteenth and sixteenth century English Common Law--with some modern wrinkles. To form a TPT, a third party, called the “grantor,” creates an irrevocable trust and transfers his or her assets to a trustee, to be held for the benefit of one or more beneficiaries. The trustee is appointed under the terms of a trust agreement that also provides the instructions for the trustee to follow in administering the trust, and, particularly, in providing benefits from the trust assets to the beneficiary. The trustee holds bare legal title to the trust assets with powers and duties with respect to the assets (e.g. the power to sell trust assets and reinvest the sale proceeds, the duty to insure the assets and to account to the beneficiary). Many of the trustee’s powers and duties are set forth in state law, but they can also be set forth in, and even modified by, the trust agreement. The beneficiary has the beneficial title to the assets (also referred to as the “equitable title”) and, with limited exceptions, has no power, individually, to deal with the trust assets, but receives benefits from the trust assets as set forth in the dispositive provisions of the trust. The key to protection of trust assets from the creditors of the beneficiary is that the beneficiary does not have the power to unilaterally withdraw the trust assets from the trust and make it his or her own. If a beneficiary were allowed to do so, the asset protection would be lost under Florida law. The beneficiary’s power to withdraw effectively removes the split between legal and equitable title, because they would merge into one person, the beneficiary, giving him or her both the benefits of the assets and the full power to deal with the assets. The assets would then subject to the claims of the beneficiary’s creditors. Another key to protecting the trust assets
from the creditors of the beneficiary is a “spendthrift provision“ in the trust. These were originally designed to prevent a beneficiary from being foolish with his or her trust benefits by doing things like pledging benefits to be received in the future in exchange for a loan to be received now. Basically, with a spendthrift provision, the beneficiary cannot “anticipate” a distribution, but must wait until the trustee makes a distribution of trust assets to him or her under the terms of the trust before he or she can enjoy the benefit of the distribution. This also prevents a creditor from bringing collection efforts with respect to the assets until they are actually distributed. Although the beneficiary cannot have unfettered access to the trust assets, he or she can have substantial benefits and be given significant control over the trust as follows: • The beneficiary can be a trustee of the trust and, with appropriate trust language, can even be the sole trustee. • The beneficiary can receive all income of the trust. • The beneficiary can have the right to receive trust principal for his or her support, maintenance, health, education, and reasonable comfort. • The beneficiary, acting as trustee, can make distributions for the support, maintenance, health and education of a family member, so long as such distributions do not satisfy a legal obligation of the beneficiary, such as the duty to support a minor child. • The beneficiary can direct the trustee to distribute principal to anyone except the beneficiary or his or her creditors • At his or her death, the beneficiary can direct the trustee to distribute principal to anyone except the beneficiary’s estate or the creditors of his or her estate. The trust may also provide for an independent co-trustee to serve with the beneficiary when the beneficiary is a trustee. An independent trustee generally is someone who is not the grantor and not related to the beneficiary. The beneficiary can have the power to remove and appoint independent trustees. The advantage of the
independent trustee is that the trust agreement can give him or her the power to make distributions of trust assets to the beneficiary for any reason — not limited by standards like support, health, education and reasonable comfort. This includes the power to distribute the principal outright to the beneficiary, but a creditor of the beneficiary cannot force the independent trustee to make such a distribution. In addition, included under the power to distribute for any reason is the power to “decant” the trust into a newly created trust which can have different provisions than the original trust, with some limitations. The beneficiary’s power to appoint and remove independent trustees who can make distributions for any reason provides substantial control to the beneficiary and flexibility to the trust without degrading the protection of trust assets from the claims of the beneficiary’s creditors. As stated above, TPTs can be used only when the circumstances are right. They are typically used for intra-family transfers and are created by the grantor while alive, or on his or her death. TPTs are frequently created by parents for their children and/or other descendants as a receptacle for assets on parents’ deaths, and they are frequently funded, in whole or in part, by the death benefits from life insurance paid at a parent’s death. They can also be created by one spouse for the benefit of the other. TPTs that protect assets from the beneficiary’s creditors can also be used to generate estate tax, gift tax, generation-skipping transfer tax and income tax benefits for the grantor’s family. Unfortunately, many TPT planning opportunities are missed. The reasons vary. Frequently, the advisors simply do not understand the issues and the opportunities. Sometimes there is a preconceived notion that trusts are rigid, restrictive and tie up assets. Some trusts are all of those, and they should be when the circumstances warrant. But, as discussed above, trusts can also be remarkably flexible devices that can confer benefits and protections on the grantors and can continue to do so for generations.
Douglas Kniskern, J.D, LL.M, Board Certified Wills, Trusts and Estates Attorney, Arnstein & Lehr LLP 10th Floor, 200 East Las Olas Boulevard, Fort Lauderdale, Florida 33301 | Tel. 954.713.7600 | Fax: 954.713.7700 | dkniskern@arnstein.com This article does not constitute legal advice and cannot be relied upon in any specific circumstance. It is intended to provide general information only about technical topics. Any use of the concepts described in this article should be based on indivual facts and circumstances with appropriate legal advice.
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FCS The Magazine
money management
for doctors
HOW TO:
I
Convert Your Workplace Savings to a Roth BY JEFFERSON A. LEDBETTER
f you are like many people, the majority of the money you’ve set aside for retirement is held in your workplace savings plan, such as a 401(k) or 403(b). When the time comes to draw income from this portion of your nest egg, most or all of the distributions from your plan will likely be subject to income tax. There is a growing appreciation for the idea of “tax diversification” in retirement. That means having access to income sources that are subject to different tax treatment. A good tax-diversification strategy includes a “tax-free” category of assets. A Roth IRA, for example, allows money contributed after tax to grow and receive qualified withdrawals tax-free. You are now allowed to make a direct rollover of assets in a workplace plan to a Roth IRA, provided you are eligible to move the money in the first place. You can move money from a workplace plan when you separate from service (either retire or leave the employer), or in the event of death or disability. Depending on your retirement plan, you may also be eligible for so-called “in-service distributions,” allowing you to roll some of your retirement savings out of a plan and into an IRA before you leave your job. As with any rollover from an employer-sponsored plan, the money must move directly from the current plan to the administrator of the account (IRA or other employer’s plan) you are moving it to if you want to avoid unnecessary taxes or penalties. PAY TAXES NOW OR LATER The big question you should ask yourself before converting money to a Roth IRA is whether the benefit of tax-free income later in life is worth the cost of paying taxes now on the converted amount, which is required. All pre-tax contributions and earnings accumulated in your workplace plan that are converted to a Roth IRA are subject to current tax at your ordinary income tax rate(s). Note that not all of the money needs to be converted at one time. To limit current tax liability when executing a direct rollover and conversion to a Roth IRA, you can choose to move just a portion out of the 401(k) and into the Roth in a given year. You should be aware that if the conversion drives your total income to certain levels, higher tax rates may apply and make the conversion more costly. WHEN IT MAKES SENSE Converting workplace plan dollars to a Roth IRA may be most worthwhile if you: • expect to be in a similar or higher tax bracket later in life when you need to make withdrawals • can pay the current tax liability on the converted amount from other available resources without drawing down your retirement savings • want to reduce your exposure to Required Minimum Distributions later in life. Distributions are required to begin after you reach age 70-1/2 from your workplace plan or traditional IRA. Distributions
are never required from Roth IRAs during your lifetime, so you can maximize the tax advantages by keeping money in the account. • are trying to create more flexibility to manage your tax liability in retirement by owning a mix of assets subject to different tax treatment. HOLDING OFF ON A ROTH CONVERSION While the potential of future tax-free income makes a Roth conversion worth considering, it may not always work to your advantage. Situations where you may want to avoid such a conversion include: • if you own company stock in your workplace plan. There is the potential to take advantage of special tax treatment of these assets when you take a lump-sum distribution, move employer securities out of the plan and take direct control of the assets (referred to as Net Unrealized Appreciation rules). Work with your tax adviser to be sure you meet requirements. • if you expect your tax bracket in retirement will be lower than it is today. Then the cost of converting assets and paying tax on the conversion at your current rate may actually cost you more money in the long run. There are a number of factors that go into a Roth conversion decision. Be sure to explore all of your options with guidance from financial and tax professionals to be sure you are doing what’s best for your long-term financial future.
Jeff is a Certified Financial Planner with 25 years of experience. He played both Football and Baseball on scholarship at Florida State and currently advises many medical professionals on financial matters. Jefferson A. Ledbetter, is a Financial Advisor with Ameriprise Financial Services, Inc. in Coral Springs, Florida. He specializes in fee-based financial planning and asset management strategies and has been in practice for 23 years. To contact him/her you may call at 954.575.6250x102 or email at Jefferson.a.ledbetter@ampf.com Our street address is 210 N. University Drive suite #401 Coral Springs, Fl 33071. Ameriprise Financial and its representatives do not provide tax or legal advice. Consult with your tax advisor or attorney regarding specific tax issues. Brokerage, investment and financial advisory services are made available through Ameriprise Financial Services, Inc. Member FINRA and SIPC. © 2013 Ameriprise Financial, Inc. All rights reserved. File # 685417
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jokes & quotes
humor
Laughter is the Best Medicine JOKES
Doctor: You’re in good health. You’ll live to be 80. Patient: But, doctor, I am 80 right now. Doctor: See, what did I tell you?
ACTUAL QUOTES FROM MEDICAL FILES: ✚ Discharge Status: Alive but without permission. ✚ Healthy appearing decrepit 69-year-old male,
mentally alert but forgetful.
The CEO of a large HMO dies and goes to heaven. St. Peter shows him to a lovely villa, wonderful music, great views, full staff of servants, gourmet meals, etc. The CEO says, “This is terrific!” “Don’t get too comfortable,” says St. Peter. “You’re only approved for a three-day stay.”
✚ The patient refused an autopsy. ✚ The patient’s past medical history has been
remarkably insignificant with only a four-pound weight gain in the past three days.
✚ The patient has been depressed ever since she
began seeing me in 1983.
The patient went to his doctor for a checkup, and the doctor wrote out a prescription for him in his usual illegible writing. The patient put it in his pocket, but he forgot to have it filled. Every morning for two years, he showed it to the conductor as a railroad pass. Twice, it got him into the movies, once into the baseball park and once into the symphony. He got a raise at work by showing it as a note from the boss. One day, he mislaid it. His daughter picked it up, played it on the piano and won a scholarship to a conservatory of music.
✚ The patient has left white blood cells at
Sources: Anglefire.com, MedIndia.net, GiggleMed.com, Snopes.com
✚ Patient was alert and unresponsive.
BRAGGING RIGHTS
» FCS’ own Dr. Jennifer Cultrera recently competed in an
Ironman competition in Augusta, Ga. The daylong competition consisted of a 1.1 mile swim in the river, followed by a 56-mile bike ride and then a 13.1 mile run. One of Cultrera’s patients, Gaythee Lumapas, attended the event to cheer her on. She wrote of the experience: “I was so proud to be cheering for her in my neon pink shirt saying, ‘My doctor is an Iron woman!’ I clapped and cheered and screamed and yelled and cried as she crossed the finish line.” Lumapas also said of watching Cultrera compete: “On those difficult days when all my friends and family are at work and I am at home feeling bad, I remember Dr. Cultrera pushing on to finish. I will push on too knowing I am not alone; others will pop up along the way and cheer me on. Just as I have cheered her to finish her Ironman competition, she is cheering me toward a remission of cancer. We celebrate the cure together!”
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FCS The Magazine
another hospital.
✚ Please feed patient only when awake. ✚ He had surgery for an unbiblical hernia. ✚ Patient has two teenage children, but no other
abnormalities.
Winter 2014
27
Over 20 of the most promising new cancer treatments have one thing in common. They were proven in clinical trials at Florida Cancer Specialists. You may have heard of the new immunotherapies and monoclonal antibody treatments for cancer but you might not have realized the critical role played by patients in Florida in FDA approval of those drugs — and many others.
Florida Cancer Specialists Medical Oncologists Paresh Patel, MD • Scott Tetreault, MD • Viralkumar Bhanderi, MD
1600 PHILLIPS ROAD, SUITE 300 | TALLAHASSEE, FL 32308 | (850) 877-8166 2626 CARE DRIVE, SUITE 200 | TALLAHASSEE, FL 32308 | (850) 219-5380
FLCancer.com
28
Proud Sponsor of Florida State Athletics FCS The Magazine
With two cancer centers in Tallahassee and over 70 others in Florida, Florida Cancer Specialists is a preferred clinical trials site and was the recipient of the American Society of Clinical Oncology National Clinical Trials Participation Award. If you ever are faced with cancer, it is good to know you are close to Florida Cancer Specialists. We are on the leading edge of science and hope is the fi rst ingredient in every prescription.