FCS
Spring 2014
THE MAGAZINE
Brad & Terri Prechtl
Navigating the Road to Success
INSIDE
Foundation events » Dr. Ralph Gousse » Spotlight on Diane Cope » Radar Screen Spring 2014
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FCS The Magazine
editor's
FCS THE MAGAZINE
letter
Message from
spring 2014
contents
Scott Tetreault Dear Colleagues,
Physician leadership President
William N. Harwin, M.D. 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 OfficeR
Sharon Dill
Vice President of Revenue Cycle
Sarah Cevallos
Vice President of Clinic Financial Services
Christina Sievert
Our firm’s growth philosophy, set in motion 30 years ago by our founder, Dr. William Harwin, has allowed Florida Cancer Specialists & Research Institute to become one of the largest and most successful cancer medical practices in the country. Today, we have 80 offices throughout the state with 170 physicians and support personnel who are actively working under one brand and bringing cuttingedge cancer care to thousands of patients each year. Our successful growth pattern will hopefully continue with another few mergers and acquisitions in 2014 and our goal of expanding outside Florida in the foreseeable future. Any office opening is hectic, but the difficulties multiply when the staff and doctors are also merging with FCS. Not only does the name change, but just about everything else does too — all at once. And, by the way, every single patient appointment and treatment must continue on schedule as if nothing is changing. In this issue, we take you to meet Dr. Ralph Gousse, who has dedicated himself and his family to helping the folks of Haiti rebuild their lives. Our ARNP in this issue is Diane Cope, who works in Ft. Myers. Diane is an author on the American Society of Clinical Oncology Guidelines for central venous catheters and serves in several other leadership positions. We are grateful to her for letting us get a sense of her life outside the office. On the cover, you see Brad Prechtl and his lovely wife, Terri. We are proud of them both, and I know you will enjoy your time with them in these pages. There’s more, so have fun. It is said that in the world of business the only thing one can count on is change, and if your business is not growing it is shrinking. We believe this, and we have our eyes on a bright horizon for FCS. As always, any ideas, pictures, contributions … etc., are always welcome. All the best!
Senior Management Jeff Esham Jeremy Behling Jeffrey Rubin Ray Bailey Lois Brown Rich dyson Michael essik Inga Gonzalez Katie Goodman, RN, BSN, CCRP Sue Kearney lois poel Denice Veatch Samantha Watkins
Scott Tetreault, Editor, FCS The Magazine
in this issue
Departments 7 Foundation Events 12 Insurance Tips 14 The Radar Screen 15 How We Roll Legal Estate/ 22 Asset Protection
Designed and produced by
Tallahassee, FLorida
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Spotlight
16 Doctor Spotlight: Ralph Gousse Haitian Humanitarian Paying It Forward
18 Nurse Spotlight: Diane Cope
Writing the Book on Nursing
20 Research Spotlight: Drug Development Unit Offering Access to Significant Clinic Research Therapies
Industry Recognition Money Management for Doctors Humor
Features 4 Profile: Brad and Terri Prechtl
Navigating the Road to Success Spring 2014
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Profile
Brad and Terri Prechtl Navigating the Road to Success Together By Zandra Wolfgram
T
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“ We are not making widgets. This affects people’s lives each and every day.”
he first thing to understand about success is it’s not always a straight road,” says Terri Prechtl with a soft laugh. “As a couple we have gone in circles, back and forth, up and down.” Terri, 47, is a former nurse and the wife of Florida Cancer Specialists & Research Institute (FCS) CEO Brad Prechtl. And, according to her executive and careerminded husband, her unwavering support as a partner has been key to his success. During a time of tumultuous change in the health care — Brad prechtl industry, 49-year-old Brad Prechtl has propelled FCS through the most explosive growth in the company’s 30year history. A native of western Pennsylvania, Prechtl comes with a winning business background in finance and operations management. Since he was recruited in 2009, FCS has tripled the number of physicians in its network, expanded its footprint, developed better-equipped labs and deepened research efforts. Today, FCS is the nation’s largest privately owned, independent medical oncology practice with 2,000 employees, 81 locations, 170 physicians who serve upwards of 40,000 new patients each year throughout Florida. The rapid expansion is part of a long-term strategy to maintain FCS’ competitive advantage so the company can continue to realize its mission of providing world-class cancer care in communitybased settings close to home. “We grew the size of the organization to protect and deliver the best in treatment, quality and outcomes for our patients. Size brings leverage to nearly every aspect of our business, from negotiating with insurance carriers to reducing expenses,” Brad says. “There are definite advantages to being large, debt free and run extremely well. This ensures that our patients have access to the best in research, clinical trials, laboratory, medications and so much more.” Keeping a company humming requires a steady hand at the helm. “He’s like a duck,” Terri Prechtl quips with a hint of a Texas accent. “His feet may be going 90 mph under the water, but he’s totally calm.” Brad has seen to it that FCS develops the best practices and strong operational infrastructure to ensure it always “hits on all eight cylinders,” but the real strength that sets this industry leader apart is not found on any spreadsheet. It’s the people that make all the difference. And for Brad, who admits to having high expectations, their contributions do not go unnoticed. “I worked in oncology prior to coming to FCS. In fact, I’ve worked for our competition. The passion and overall commitment at FCS is at a level I haven’t seen before.”
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Photo by Scott Holstein
Avid Pittsburgh Steelers football fans, Brad and Terri Prechtl apply team-oriented principles to all aspects of their life together.
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Profile
We grew the size of the organization to protect and deliver the best in treatment, quality and outcomes for our patients. Size brings leverage to nearly every aspect of our business, from negotiating with insurance carriers to reducing expenses.” — Brad Prechtl
Warm and engaging, with hazel eyes and an easy smile, Brad is quick to point out “that any accomplishments realized during my tenure are a result of a true team effort. It takes strong administrative support, buyin from our board and leadership from our president and managing partner, Bill Harwin.” Harwin, who says he and Prechtl are “great complements to one another” in terms of what they bring to the company, is happy to give credit where it is due. “Brad’s impact on FCS has been extraordinary. Having him aboard as CEO has led to the biggest single reason for our growth for the last five years. He’s tireless, hardworking and extremely bright. We wanted to find a nice person who would create the right culture for the company, and he is just the executive we were looking for.” Collaboration and team are centric to FCS culture. And the stakes are high. “We are not making widgets. This affects people’s lives each and every day,” Brad reminds. That’s precisely why this executive makes sure that every staffer knows they are key to the company’s success. “At each employee orientation, I ask everyone to bring their A-game and a great attitude every day,” he says. “It’s a total team effort, from physicians, nurses and lab techs to financial counselors and folks in billing — everyone affects patient care.” Great caregiving demands special traits. Brad gets a chance to see these qualities first-hand when he makes his rounds of the 81 sites across the state, which he tries to do a couple of times a year. “It takes compassion and commitment to deliver the best care and service. You can teach someone who says they can’t do something, but you can do nothing with people who say they won’t. At FCS, everyone has a cando attitude.” Though the Prechtls have been connected to cancer for years through their respective jobs, when Terri’s father died within six months of being diagnosed with leukemia last year, it obviously became painfully personal. “The irony is even though my husband
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works in cancer care 24/7, you can have a Teflon coating only so long without it impacting you personally. When someone you love has cancer, this changes the way you think. It has personalized everything for me,” Terri says. For Terri, reaching out to FCS not only provided her much-needed support and information, it gave her perspective. “It’s inspiring, not only how many are dealing with cancer but how many are surviving and just how far treatment has come,” she says. It’s common practice at FCS for doctors to share their personal cell phone numbers with patients, and Brad is no different. He has an “open communication-open door policy” and makes himself available 24/7. He recognizes that he sets the tone for the company, but he hopes he doesn’t ask any more than he would be willing to do himself. That said, he tries to recognize everyone’s need for a work-life balance, including his own. “When I am with my family, I stay focused on them and try not to be distracted. It’s a challenge, but they understand that I have to be accessible to be successful, too,” he says. Having a balanced life means being active. Brad spends a lot of his time volunteering with Big Brothers/Big Sisters, chairing the FCS Foundation and serving on the board for the Jack & Jill Late Stage Cancer Foundation, while Terri volunteers at the local Humane Society. When they do have free time, the dynamic duo enjoys cheering on the Pittsburgh Steelers, Tampa Bay Bucs, Rays and Lightning at local games, golfing, being active in their church and grilling out with family and friends. Terri and their four children, who range from age 15 to 22, embrace Brad’s job role at FCS as a family commitment. “We are blessed and fortunate,” Terri says. “It’s because of Brad’s job that we get to enjoy many good things in life. Sure, sometimes it requires some sacrifices, but ultimately this is not just his project, his passion and his legacy — it’s ours, too. We’re all in it together.”
foundation
events
Celebrity Bartending Jan 15, 2014 ďƒŠ
The Celebrity Bartending event was held at the Frigates Waterfront Bar & Grill in North Palm Beach. The event benefitted the Sari Asher Center for Integrative Care. FCS physicians Dr. Robert Green and Dr. Daniel Spitz bartended at the event.
Gentle Yoga 2013 ďƒŠ
Andrea Bolivar, office manager at the Highland Office, enjoying the gentle yoga class as part of the Integrative Oncology Program.
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foundation
events
Race for the Cure Jan. 25, 2014 ďƒŠ
The Susan G. Komen Race for the Cure was held January 25, 2014 in West Palm Beach. Runners included Regional Director Lois Brown, Dr. Marilyn Raymond and Connie Tuller.
Cooking Class Jan. 30, 2014 ďƒ¨
On January 30, certified nutritionist, Adrienne Falcone Godsell, taught patients, caregivers and staff members how to prepare healthy meals using organic ingredients at the Highland Office in Largo.
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foundation
events
30th Anniversary Celebration Feb. 26, 2014 ďƒŠ
Florida Cancer Specialists & Research Institute is in the midst of its 30th anniversary celebrations with various events held at FCS offices around the state.
City of Clearwater Multiple Myeloma Awareness Month Proclamation Feb. 20, 2014 ďƒŠ
Dr. Jose Alemar and the Tampa/St. Pete Multiple Myeloma Support Group attend the Feb. 20th Clearwater Commission meeting where the City of Clearwater presented a proclamation declaring March 2014 Multiple Myeloma Awareness Month. Dr. Alemar is pictured with the Tampa/St. Pete Multiple Myeloma Support Group. A few of the individuals pictured are FCS patients. Dr. Alemar is seen shaking hands with City of Clearwater officials. Spring 2014
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foundation
events
Run Amuck with the Duck Mar. 8, 2014 ďƒŠ
The 5th annual Run Amuck with the Duck 5K benefits the Bonnie J. Addario Lung Cancer Foundation and was held on Saturday, March 8, 2014. This event raises much-needed funds for the patient services and clinical research projects of the Bonnie J. Addario Lung Cancer Foundation, while providing fun, family-friendly activities, including a kid's dash, music, 5K event awards and more.
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FCS The Magazine
arts and
culture
Art 2013 ďƒŠ
Collection of photos from Dr. Richard Buck from his travels around the world.
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insurance
tips
Lawrence D. Share President
The Lawrence D. Share Company has been built with the same characteristics as successful members of the medical profession — professionalism, respect and personal care. A long-standing commitment to building relationships with our clients has been the determining factor in our success. For the past 40 years, we have provided quality insurance coverage tailored specifically to members of the medical profession. Lawrence D. Share Company representatives are top producers with many highly rated companies that offer solid insurance products that provide protection designed for your needs. Today, more than 5,000 physicians and health care professionals throughout the United States depend on us for comprehensive insurance and solid financial products.
Lawrence D. Share Company, Inc. 1200 South Pine Island Road, #400 Plantation, FL 33324 800-329-5011 | LDShare.com info@LDShare.com
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FCS The Magazine
Lawrence D. Share Company, Inc.
Why you should consider adding Group Long Term Disability to your Insurance Portfolio. As a physician you have invested a considerable amount of time and resources to train for your career. If your ability to practice hematology oncology becomes limited by a disability, you may find that your individual disability income insurance does not provide enough of a benefit to offset the loss of income you may suffer from an extended disability. Typically individual carriers issue coverage that protects only a portion of your pre-disability earnings up to a maximum amount. Most physicians have maximized their individual disability income coverage and may not realize that they are eligible to have additional benefits if the corporation that they are affiliated with offers group disability. By supplementing your current coverage with group long term disability insurance you can obtain additional protection and more fully protect your income. There are several advantages to group long term disability insurance. For example, group long term disability benefits are available on a guaranteed issue basis. Group disability policies often have fewer underwriting restrictions than individual disability policies. That’s because the risk of disability is borne by the group rather than by an individual. A fairly large group will include mostly individuals who are good insurance risks, as well as a few individuals who are poor insurance risks. Even though individuals enrolling in a group disability plan will not have to pass a physical exam, they will have only a limited time to enroll in the group sponsored plan without evidence of insurability. This helps to prevent individuals with health problems from enrolling after they have discovered that they have a medical problem. Another big advantage of group disability insurance is that premiums are typically lower than premiums for individual disability insurance policies, because it’s more cost effective to underwrite insurance for a group than for individuals. The premium is usually the same for all eligible participants. Also, if premiums are paid individually or with post tax dollars, the benefits will be tax free. Finally, because the marketplace for group disability insurance is so competitive, policies are available with very rich benefits including protection for partial disabilities and coverage in your own medical specialty. Insuring your income is one of the most important aspects of your financial plan. Be sure that your income is adequately protected today.
Individual Disability Insurance Business Overhead Expense Group Disability Insurance Group Health Insurance Variable Life Insurance Universal Life Insurance Term Life Insurance Long Term Care Medical Malpractice Insurance Legal Defense Insurance
Lawrence D. Share Company, Inc. & Professional Casualty Corporation 1200 South Pine Island Road, Suite 400 Plantation, FL 33324 www.ldshare.com www.professionalcasualtycorp.com Phone: (954) 473-5011Toll Free: (800) 329-5011Fax: (954) 472-3982 Spring 2014
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the radar
screen
What’s on Your Radar?
By Scott Tetreault
For Breast Cancer in Older Women, Skip the XRT At San Antonio Breast, the PRIME II study was presented that asked the question: Can women age 65 years and older, after lumpectomy for an ER positive, lymph node negative breast cancer (3cm or less), just skip radiation and only be treated with good surgery and Arimidex? The answer is yes, for the English authors anyway. They say that this has already changed practice in the United Kingdom. You’ll have to look at the details and decide if the answer is yes for your individual patients.
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Finally, a Good Strategy for Small HER2 Positive Tumors We scratch our heads and twist ourselves in knots over those women with small lymph node negative but HER2 positive tumors. We “feel” they need chemo along with their Herceptin, but very few studies have included women with tumors less than one or two centimeters. Do you sentence them to Adriamycin and all of its potential long-term side effects? Eric Winer and his team knew that a placebo trial in HER2 positive disease was out of the question, so they designed, conducted and then presented the APT trial of weekly Taxol times 12 with one year of Herceptin in node-negative, HER2 positive women with tumors three centimeters or less. They did great, with 99 percent disease free at three years and very little toxicity. This is now considered a very reasonable adjuvant option in these women.
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Confused about Lynch Syndrome Testing? Join the club. This is an important “new” wave in cancer, and very few of us have a mastery of the full algorithm for testing, which can include both phenotype and genotype tumor testing in addition to germline genetic testing of the patient. Dr. Doug Hartman at the University of Pittsburgh says it is actually pretty easy. Everyone with Stage IV colon cancer should have their tumor tested by the most sensitive method: MSI polymerase chain reaction (MSI-PCR) along with DNA mismatch
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repair protein IHC. At Pitt, they adopted “universal screening” this year based on their large prospective study (Journal of Human Pathology, Sept. 2013). Age, tumor location and Microsatellite instability testing are all just not good enough. You’ll miss one in five Lynch patients, and that’s too many. GBM responds to Valcyte GBM is awful. Glaciers move faster than GBM scientists. But in a letter to the New England Journal, the Swedes stirred up a hornet’s nest by concluding that in their 42 cases of GBM the anti-CMV drug Valcyte, when given for six months, increased the life expectancy of these folks from only one year to two years. That qualifies as “awesome” in this tragic disease. In 250 cases they examined before the study, they found only one patient who was CMV negative. So this may join Kaposi’s Sarcoma and cervical cancer as neoplasms caused by an infectious disease.
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So She is JAK2 Negative? Maybe We Can Explain… The patient with obvious myeloproliferative disorder but negative JAK2 testing is a puzzle. But the geniuses in Cambridge, England, think they can explain this in the majority of patients. They found
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that 84 percent of these folks had a somatic mutation in the CALR gene. Soon, we will include this testing when we don’t see a JAK2 mutation. (NEJM, Dec.19th, 2013) Bump Fists, Don’t Shake Hands I live with a germophobe, so this caught my eye. Researchers from the West Virginia School of Medicine did a cute experiment. They had docs go through the hospital, at first shaking hands and then fist bumping. Shaking hands resulted in tons more nasty germs (common sense). But, get this, even after washing the handshakes resulted in 84 percent higher colony counts. Fist bump your friends in the hospital. Your family will thank you.
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Coke? Pepsi? Endometrial Cancer? A huge, 20,00 women study conducted at the University of Minnesota showed, pretty convincingly, that higher consumption of sugary drinks (like Coke, Pepsi, Hawaiian Punch, lemonade, 7Up) resulted in a 78 percent increase in endometrial cancer in post-menopausal women. The slope of the curve is near one — the more you drink, the higher your risk.
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cultured pearls
how we roll
Inside the Mind of Morris This month we take you inside the mind of Dr. Daniel Morris for some of his tips and techniques for navigating the difficult world of cancer communication. Suggestions
Scott Tetreault, MD (send suggestions for “Pearls” to stetreault@ flcancer.com)
1. If a patient says something mean to their spouse, I might say, “That is not like to you speak in that fashion,” (even if it is), to try to neutralize the situation. 2. I don’t tell people they have “nonsmall cell lung cancer.” People don’t want to know what they don’t have; they want to know what they do have. I will tell the person they have carcinoma of the lung and this can be alk positive or negative or egfr positive or negative, etc., etc., or this can be squamous or adeno, etc., etc., etc. 3. If I am asked a difficult question, I might say, “I realize that this answer is not as precise as you were
wanting, however, I think it is the best answer that can be given.” 4. If I think a patient is only going to live a few weeks to a few months, I might say, “I don’t know if it is 10 days or 100 days, however, I want you to enjoy every one of them as much as possible.” 5. When a patient feels he or she has been given a better prognosis (by another doctor) than is the case, I might say, “Doctors are sometimes taught to communicate ambiguously and with optimism, either in their words or their approach, to try and give encouragement, so I can understand why you might have gotten the impression … ”
6. If a patient really understands and verbalizes what I am saying, I might say, “You listen much better than my own family.” 7. If a patient asks a question that I cannot answer exactly, I might say, “I may not have answered your question exactly, however, I think I made an important point. Thank you for hearing me out.” 8. If I have to bring up a difficult subject, I might say, “This is not easy to talk about.” 9. Sometimes if the question is sort of tangential but somehow relevant, I might say to a patient, “Let me rephrase the question.”
TRUE Warrior R FLO
ANCER SPECIALISTS SALU I DA C TES
A
Karen Warmack is not only ghting her own personal battle with cancer, but is speaking out on behalf of others battling the disease. She recently testied in support of “The Cancer Treatment Fairness Act” before Florida lawmakers. Her testimony led to the enactment of the law.
Florida Cancer Specialists Medical Oncologists Scott Tetreault, MD • Viralkumar Bhanderi, MD • Paresh Patel, MD Tallahassee Location 1600 Phillips Road, Suite 300 Tallahassee, FL 32308 | (850) 877-8166
Tallahassee North Location 2626 Care Drive, Suite 200 Tallahassee, FL 32308 | (850) 219-5830
FLCancer.com
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doctor Spotlight
Haitian Humanitarian Paying It Forward … Back Home
By Zandra Wolfgram
R
alph Gousse, M.D., grew up in Haiti surrounded by aunts who worked as doctor and lab technologists in Port-au-Prince. His father worked for Reynolds Aluminum, which mined bauxite (a metal used to make aluminum foil) in the port town of Miragoane at an annual rate of 600,000 tons from the 1960s into the 1980s. During that time the town flourished and enjoyed community amenities — including a 10-bed hospital that provided free health care to locals. While pursuing his medical degree 60 miles away in Port-au-Prince, Gousse moonlighted at the small charity hospital during his vacations. But in 1982, Reynolds abandoned its mines and turned the operation of the medical clinic over to the Haitian government. That same year Gousse graduated from medical school and immigrated to the United States. When he returned to his homeland after completing his fellowship at Mount Sinai Medical Center in New York (he is a board certified internist, oncologist and hematologist), he came back “shocked to find a hospital without electricity, air conditioning, running water and, ironically, no surgical aluminum.” He banded with his brother, Ronald, and friend, Henri Jabon, to form a non-profit organization called Haiti Help Med Plus Inc. (HHMP) and set out to improve basic living conditions of his hometown, starting with saving the hometown hospital that was so seminal during his early days in medicine. After 10 years in operation, to say Gousse has made an impact with Haiti Help Med Plus is like saying the 2010 Haiti earthquake was a small tremor. With Gousse at the helm, HHMP has a long list of meaningful sustainable improvements, including refurbishing and increasing the size of the hospital, launching a roving mobile clinic, building 18 new homes for the poorest of the poor, establishing water collection systems, constructing outhouses, improving farming techniques, creating new crops, educating the youth and more. The intangible and invisible impact goes even deeper. Beyond basic essentials for living, Gousse’s non-stop efforts have filled thousands of
Haiti Trip November 2012
people living in these impoverished villages with pride and hope. “It’s all about changing the quality of life,” Gousse says. “We are helping to change how they live, and it is making people happy.” Gousse volunteers his time to travel to Haiti three to four times a year, but it’s never been an individual effort. In addition to medical colleagues, his wife, Ninotte, and their three children (Melissa, Ranley and Ryan) have joined the cause and become deeply engaged in the community. The children, in turn, bring their friends, too. Ninotte began by bringing shoes to the villagers. Ranley and Ryan, who are runners and summer counselors at Brevard Distant Runners Camp in Brevard, N.C., collect them. Over the past two years they estimate they have fitted children with upwards of 250 pair of shoes. And this year plans are in the works for completion of a twostory community center to help better educate the children. Ninotte plans to teach sewing, crafts and cooking. Computer skills also will be offered. The plan is that proceeds from handicrafts sold in the U.S. will come back directly into the pockets of the villagers. Gousse has amassed many memories and compelling stories over the past decade, but one family of a father, mother and their six children aged 7 to 17 is extra special to him. “They were crowded in a one-room home with a holey tin roof. Two chickens were laying eggs in the corner and there was no outhouse,” Gousse recalls. Today, thanks — William Penn to the Gousses and HHMP, the family lives in a three-room house that boasts a solid concrete roof and an outhouse. They operate a rain collection water system that enables them to sell water to other villagers. “When we first met them they could not read. We got them a private teacher and now the oldest is learning electricity as a trade. It’s wonderful to see,” Gousse says. And the experience has been a life lesson for the Gousse children as well. “My mother always taught me to give to others. I want my children to understand this, and I want them to know where they come from,” Gousse says.
I expect to pass through life but once. If therefore, there be any kindness I can show, or any good thing I can do to any fellow being, let me do it now, and not defer or neglect it, as I shall not pass this way again.”
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FCS The Magazine
Dr. Ralph Gousse
Ralph Gousse, M.D.
Scott Holstein
With a full-time medical career with Florida Cancer Specialists and Research Institute (FCS), practicing out of the Altamonte Springs location, and family of five to balance, traveling to a foreign country to lend aid may seem taxing. But for this hardworking 57-year-old it has the opposite effect. “When I go to Haiti I don’t feel as tired as I do at the end of a typical day. When I am there, I feel I have a new life,” he says. But operating an international charity hasn’t been without its challenges. When Gousse visits he is inundated with villagers eager to unburden their problems. Now that 18 new homes have been built, impatient villages eager to have one of their own have worn a path to Gousse’s doorstep. “That’s the worst part of it,” he says. As challenging as it can be, this nurturing native is still motivated to give back to Haiti for what it has given him. “I owe it to the country and the people. I have been so fortunate to get a good education and
to be able to come to America,” he says. The future is busy and bright for HHMP. Plans are in the works for further education in reforestation, goat farming and the development of coffee crops. And this year, one 26-year-old Haitian farmer will travel to the United States, sponsored by HHMP, on a special visa to be trained in beekeeping. “The idea is to teach them to fish, not to give them a fish,” Gousse says. It has been a challenge to introduce new ideas to some tentative adult Haitians, but HHMP’s founder is inspired by the attitude of the young. “In the kids I see how much they are willing to change … to learn,” he says. What’s next? “Teaching them honesty and respect of themselves and others, respect of their environment,” Gousse says. After all, “they are the leaders of tomorrow.” Haiti Help Med Plus operates on charitable donations. For more information on how you can help, visit haitihelpmed.org. Spring 2014
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Nurse Spotlight
Diane Cope
Writing the Book on Nursing
D
iane Cope has spent more than half of her 54 years in a classroom. And with a PhD, ARNP, BC, AOCNP, it was certainly time well spent for this Ohio-born oncology nurse practitioner marking 18 years with Florida Cancer Specialists and Research Institute (FCS) this year. This dedicated, goal-oriented vanguard has developed curriculum and taught college level courses, served in various editorial roles with the Oncology Nursing Society and authored award-winning medical journals. Still, this 33-year nursing veteran, who works at the Fort Myers-Summerlin location, would rather be sitting by a cancer patient’s bedside than anywhere else. “I could never think of not working in oncology. It’s the patients. They make it very rewarding,” Diane Cope said. If hard pressed, Cope — who loves reading bestsellers and spending free time with her husband, Steve, her 12-year-old son, Adam, and their two dogs — can envision a back-up career as a pastry chef. After all, baking is creative and relaxing for this high-energy caregiver. But don’t expect this nurse to don a chef hat any time soon. She enjoys the many others she wears on a daily basis. In fact, Cope loves everything about health care, which she began soaking in while working part time in hospitals during college. The experience only helped to deepen her passion for nursing, which she describes as both “an art and a science.” Cope admits that early in her nurse practitioner career, which began in the — Diane Cope mid-1990s, “the book on oncology nursing practices” was not quite written. Educational programs for nurse practitioners were just beginning. No one really knew how a nurse’s role should be defined. So, as is the way for this hands-on health care pro, she led the way by setting the example. “It was all very grassroots. I was just a nurse practitioner showing what I was capable of doing,” she says. She balanced the demands and needs of five physicians (today she is dedicated to just one, William N. Harwin, M.D., the president of FCS), wrote her own job description and essentially penned the rules and regulations that would help define the role of nursing for all of FCS. But her drive didn’t stop there. Today she is chair of the FCS clinical directions team, which develops the policies practiced across all 81 FCS sites. Physician-president Harwin, who has worked directly with Cope for 18 years, says her contributions to FCS are significant on
By Zandra Wolfgram
many levels. “She’s been a terrific person to work with as a nurse practitioner; she has been a tremendous help to my practice, and she is a role model for other physician extenders in our practice and my career.” In the end, whether it’s speaking (she has 47 prepared presentations), writing (she’s published 74 medical and nursing abstracts and articles) or simply making her rounds, Cope prefers to keep her compass focused on the patients. “They are really warriors, and it’s rewarding to be working with them as they are going through their journey,” she says. The job is not suited to everyone. Cope says empathy is a key trait for nurses. That and having the drive and motivation to “take an extra step” for whatever a patient may need. Cope hasn’t learned everything in the classroom. Her father died after battling prostate cancer, and in 1996 her sister-inlaw died of breast cancer at 36. Since her masters and doctoral research was focused on breast cancer, she was certainly able to share her knowledge, but it was seeing the severe stress her family endured that gave her a greater understanding of the real needs of caregivers. Today, she makes a point of drawing on that personal experience and when she gives talks and presentations to her peers around the globe (recently she presented on six different topics as a guest speaker at an oncology nursing conference in Singapore), she urges them to do the same. “I suggest we stop a moment and ask the caregiver how they are doing. They are also in the room with the patient. It just takes one second to ask, ‘And how are you doing today?’” Being attentive is another quality that makes Cope a natural at nursing. When she and other colleagues realized how minimal was the amount of literature available on geriatric oncology, it inspired Cope to put her writing and editing talents to work. She co-authored two books on the subject: “Evidence Based Approach to the Care of the Older Adult with Cancer” (2006) and “Care of the Older Adult with Cancer in the Ambulatory Setting” (2012). They join a long list of medical books, abstracts and articles Cope has penned during her career. The teacher in her figures the more knowledgeable caregivers are, the more the patients benefit. “The more education and support we have for them, the better we can allay their fear and let them focus on their priorities — understanding the facts and their options.”
Photo by Scott Holstein
I could never think of not working in oncology. It’s the patients. They make it very rewarding.”
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Research Spotlight
Drug Development Unit Sarasota, FL
By Katie Goodman, RN, BSN, CCRP, Director of Clinical Research
M
y earliest days of working at FCS began in the summer of 2001 after relocating to Sarasota from fast-paced Atlanta, Ga., to become one of the first FCS Research Coordinators supporting enrollment and management of research patients in our clinics. The next eight years are now a blur of FDA approvals, Avastin, Adjuvant Herceptin, Oxaliplatin, Alimta — all of which I take pride in having supported through clinical trials that were conducted at FCS. Now, as we enter into a very exciting era of molecular profiling and further advancing targeted agents and immunotherapy, we are perfectly positioned to provide access to the most exciting therapies within our clinical research program. Our program includes access to Phase I trials in specialty units called Drug Development Units (DDU). Phase II/III trials are also available throughout FCS. The DDU in Sarasota was the result of over 15 years of successful participation in countless Phase II/III clinical trials. This was a path paved by Dr. Lowell Hart, FCS’ scientific director in Fort Myers. The DDU program is where FCS proudly provides access to the newest drugs which may become the next best treatment for a wide range of cancer diagnoses. The menu of trials offered in the Sarasota DDU, led by Dr. Manish Patel, and the Fort Myers DDU, led by Dr. Hart, involve Phase I trials and unique Phase II trials. Their primary objective is often to enroll smaller numbers of patients, determine proper dose levels and tumor responses in a wide range of cancers. Compared to the past, many of the Phase I trials have restrictions on the number of prior lines of therapy received and involve many patients in disease-specific expansion cohorts. These trials involve combination therapies with either FDA approved drugs or heavily researched drugs. Trials are clearly moving quickly from Phase I/II trials to Phase III trials. Once a patient is referred to the DDU, Dr. Patel and the team of research staff begin their evaluation and determine if (and strategize when) a trial may become available. One enrollment challenge in Phase 1 research is that there are carefully managed cohorts of patients within each trial. Cohorts may enroll only three patients at a time. Cases are discussed on weekly teleconference calls where all participating research teams report on their patient experiences. Many DDU trials involve a few long days in the unit that include serial blood draws to assess drug levels/biomarkers as well as various other assessments (i.e., EKGs, physical exams and eye exams). DDU patients are generally healthy and in good physical condition. Study budgets may include a hotel stay for patients that travel long distances for busy treatment days. If you would like to refer a patient to the DDU, please contact the DDU team at DDU@flcancer.com.
Highlighted Investigational Product MPDL3280A MPDL3280A is an antibody that targets Programmed Death-Ligand 1 (PD-L1). There is a strong correlation between PD-L1 expression and prognosis in cancer. Blockade of the interaction between PD-L1 on tumor cells and PD-1 on immune cells (T cells) is expected to reverse T cell suppression within tumors, thereby promoting effective anti-tumor immune responses. The response data seen in various clinical trials with PD-1 and PD-L1 inhibitors for Melanoma, NSCLC and Renal cell CA are encouraging. Active FCS Clinical Trials with a PDL-1 inhibitor
In the DDU:
MEL 41 — PD-L1 inhibitor + Vemurafenib (Zelboraf) for 1st line metastatic BRAF V600-mutation positive Melanoma RM 312 — PD-L1 inhibitor for 2nd line metastatic NSCLC
In various FCS Clinics: LUN 250 and LUN 258 PD-L1 inhibitor in NSCLC
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legal estate/assett
protection
Five Simple Rules for Becoming a Successful Real Estate Investor BY JOE MANAUSA, MBA
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Determine A Goal Before You Invest When I meet with most investors for the first time, I ask them to tell me their desired rate of return, or return on investment (ROI). Hardly without fail, the answer I receive is “as much as possible.” This is the type of answer that tells me that I am not dealing with somebody who is ready to invest in real estate. If you are going to be investing in real estate, then it is safe to assume that you will be moving your money from an existing investment in order to facilitate this new venture. Your money was already yielding some rate of return (whether positive or negative) and one would think your desire to invest in real estate would be based upon either enhancing your rate of return or doing something to balance your entire investment portfolio. I believe real estate investing requires a higher level of involvement than do most other investments, so the investor should demand a higher rate of return in real estate than he or she could get elsewhere (mutual funds, bonds, stocks, etc.). An ROI goal should consider all other opportunities the investor has, and it should be realistic and rewarding. Don’t just pluck a number out of a hat. Set a target that, once achieved, will confirm that your real estate investment strategy beat all other valid investment opportunities.
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Select A Team Of Advisors The very best reason to become a real estate investor is because you can be an expert of sorts, just by paying attention to what is happening in the community in which you live. But even with
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here are no guarantees when you decide to invest your money (in anything), but there are some safeguards that one can take before taking the plunge into real estate investing. We all know somebody who lost a fortune when the housing market collapsed in 2006, but many were able to withstand the market cycle changes and are flourishing today. For active investors, those that get highly involved with their investment activities, the real estate market offers significant opportunities and handsome returns. But what about the passive investor? What about those people with money to invest for an above market return, who have no desire to treat investing as a day-to-day endeavor? If you fall into that latter category, then follow these five simple rules to becoming a successful real estate investor.
your localized knowledge, you will also need to put your trust in other people. In order to minimize your exposure within your real estate investment strategy, I strongly recommend assembling a team of people that you will turn to for advice, service and assistance. At a minimum, this team should include: •R eal Estate Agent — Your real estate agent should be your investment counselor and assist you in finding the right properties for your portfolio. Work with somebody who has numerous real estate investments and who can demonstrate a solid grasp of the numbers. Most agents are not qualified to help you, but everyone will try. If you want long-term success, make sure you pick the right agent. •P roperty Manager — A property manager is going to be the person who will safeguard your investment and help you squeeze the return from your investment. The process of choosing a property manager should not be made lightly. Most likely, your real estate agent will know a very good property manager in the area. I would recommend you interview some recommended managers and pick the one that you think will give you and your properties adequate attention. •R eal Estate Attorney — If you own property long enough, you will be faced with situations that require legal assistance. It is far wiser to have somebody in mind to handle these issues before you face them. Ask your property manager and real estate agent for recommendations for a highly skilled real estate attorney. Do not make the mistake of using an attorney who does not specialize in real estate, as it will cost you greatly. •M ortgage Broker (Loan Originator) — In
order to maintain the highest possible ROI, you most likely will be using leverage in your real estate investment strategy. Therefore, ensuring that you get the best mortgage interest terms when you borrow money for your real estate acquisition is important enough that you should hand select the mortgage broker that you will use when you buy each investment. Again, turn to your real estate agent for recommendations on the best mortgage originator with whom to work. • Accountant (with strong real estate background) — It’s not about making money, it’s about keeping it! Most accountants have specializations, so make sure the one you work with can demonstrate that she or he knows a lot about real estate. Reducing taxes helps increase your ROI, so a skilled accountant is an important player that will help you execute your real estate investment strategy.
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Choose Your Desired Market Niche Much of the real estate investment marketing on the Internet promotes buying properties “where the best returns can be found.” If you are a large, institutional investor with a solid staff, this might be the best solution for you. But if you are a small investor with less than $5million in real estate holdings, I would urge you to establish an area of operations that exists close to where you live (or spend a lot of your time). Some of the most obvious signs of opportunity can be found in your everyday routine, and living in your investment area will make you an informed investor. Think about how little you know about some of the companies that you’ve invested with in the stock market, and yet you
legal estate/assett
protection
are practically an “insider” when it comes to what is going on in your local community. You have opinions and thoughts about different parts of town and different neighborhoods, so use this to your advantage and only buy properties in areas that have longevity and a very stable, predictable future.
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Understand Real Estate Market Cycles Buy low and sell high, right? This simple concept is the foundation of investing in any type of commodity. No matter how complex somebody tries to make real estate investing appear, you only need to remember to sell for a higher price than you paid. And wouldn’t it be nice if you knew when the “buy low” times were, as well as the timing for “sell high?” Both of these are actually possible if you know how to forecast real estate market cycle opportunities. To do so, you must pay attention to several different factors in your local housing market. Real estate market cycles are created by the imbalance that occurs between supply and demand, just like in any other type of market. When supply is too low for demand, values rise and producers enter the market with more product. As competition and supply among producers (home builders and developers) increases and outpaces demand, pricing pressures increase and values drop. Producers
reduce production until demand returns to outpace supply. Because there are many players in the real estate market, producers miscalculate the current and future rate of demand. These miscalculations lead the market to the cycles of over-supply and under-supply, and this is why selecting the right real estate agent is so important. Choose somebody who regularly tracks and reports supply and demand in your market of choice, and you will be able to forecast and utilize housing market cycle changes to your advantage.
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Hedge Against Mistakes With Replacement Cost Analysis One way to evaluate a real estate purchase is by using the “cost approach.” This method looks at the replacement cost to produce the property if it were needed. [IMPORTANT NOTE: Cost approach has no bearing on market value if supply and demand are in an imbalance.] Cost is important to know because over the long haul the market is always seeking “cost” as the normalized value level. When supply drops and prices rise to and above cost, producers bring more homes to the market to sell at a profit. When supply rises and homes cannot be built and sold at a profit, producers quit building homes. Simple. Just like other markets where supply and demand create market cycles.
So understanding cost, real estate investors know when to buy real estate and when to sell real estate. When properties are selling below what it costs to replace them, there is great upside potential if one considers the local market viable for the long-term. Investors can grow their portfolio carefully, selecting properties below the cost to replace and ones that have the highest probability of long-term positive cash flows. When properties are selling at or near cost, it is a great time to hold real estate and enjoy the benefit of growing cash flows. This is the reason that real estate is a long-term investment, because properties appreciate at a rate that usually beats inflation, thus a position in real estate provides not only cash flow benefits but also the potential for long-term equity growth. When properties are selling well above cost (which happens very rarely), the market goes into a production frenzy such as we saw in 2004 through 2006. People couldn’t build homes quick enough for the misunderstood demand in the market. This is a good time to sell, should it ever happen again. While there are no guarantees offered to an investor in any market, the prudent real estate investor can safely pursue a long-range rate of return. By following these five simple rules for real estate investing, maybe it is time for you to consider joining the group of investors who demand a higher return on investment.
Joe Manausa, MBA, Century 21 Manausa and Associates, www.manausa.com | Tel 850.386.2001 | info@manausa.com Joe is a 22-plus year veteran of real estate brokerage in the State of Florida and has owned and managed his own company since 1992. He is a daily blogger with content that focuses on real estate analytics and providing his clients with a tactical advantage in today's challenging market.
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industry
recognition
Florida Cancer Specialists Announces Nominees for Leukemia & Lymphoma Society’s Man/Woman of the Year By Florida Cancer Specialists & Research institute
F
lorida Cancer Specialists & Research Institute (FCS) is pleased to announce that Drs. Gregoire Bergier, Jennifer Cultrera, Shachar Peles and Chief Marketing & Sales Officer Shelly Glenn have been nominated by several local Florida chapters of the Leukemia & Lymphoma Society (LLS) as Man/Woman of the Year for 2014. After an intensive nominating and vetting process, these four outstanding community leaders accepted the challenge to engage in a spirited competition to raise funds for blood cancer research and earn the coveted title of “Man/Woman of the Year.” “As a medical oncologist and hematologist,” Dr. Gregoire Bergier said, “I have great respect for the Leukemia & Lymphoma Society. This organization funds critical research that translates into improved therapies and survival rates. In addition, they lessen the burden for our patients and families through education, financial assistance, and through their partnership with my team, in the desire to make a difference in the lives of those living with hematologic malignancies." Nominated by the Suncoast Chapter of LLS, Dr. Bergier practices in Largo and Clearwater, Fla. Dr. Jennifer Cultrera was nominated by the LLS Greater Orlando Chapter and practices in Inverness, Leesburg and The Villages. Dr. Cultrera said, “I am thrilled to be a part of this amazing program. I know that my efforts will help fund the therapies and treatments that help save lives today, and I encourage all my friends, colleagues, patients and caregivers to get involved. All donations are greatly appreciated and are tax deductible.” Dr. Shachar Peles added, “The Man/Woman of the Year Program not only supports blood cancer research but also patient services, advocacy, public and professional education, and community services as well. It is an honor to be nominated by an organization that contributes so much to blood cancer research.” Dr. Peles was nominated by the West Palm Beach Chapter of LLS and practices in West Palm Beach and Atlantis, Fla. To vote for any of the FCS nominees, visit the Leukemia & Lymphoma Society Man & Woman of the Year website and type in the name of the candidate. Doing so will take you to the nominee’s personal web page, where you may donate to the Leukemia & Lymphoma Society. Every dollar donated counts as one vote for that candidate.
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CANDIDATES
Gregoire Bergier MD
Jennifer Cultrera MD
Shelly Glenn
Shachar Peles MD
Medical Oncologist Suncoast
Chief Marketing & Sales Officer Suncoast
Medical Oncologist Greater Orlando
Medical Oncologist West Palm Beach
money management
for doctors
Celebrating 30 Years! By Florida Cancer Specialists & Research institute
I
n February of 1984, Dr. William Harwin, founder and president of Florida Cancer Specialists & Research Institute (FCS), could only dream of what his small community oncology/hematology practice might one day become. The treatment of cancer at that time was rather primitive compared to modern-day methods. And the trend toward moving patients out of a hospital setting into a community oncology office was just beginning to gain momentum as new, improved and safer chemotherapy drugs were being developed. “In the beginning,” says Dr. Harwin, “when I opened my Fort Myers practice to treat local oncology patients, it was just my wife, Marilyn, and me in the office.” As his original practice quickly grew, Dr. Harwin soon recognized that he and other nearby small, independent hematology/oncology practitioners could help save more cancer patients’ lives if they pooled their resources. Thus, the dream was born. From a single physician’s office, our practice has grown to become the largest independent, privately held hematology/oncology group in the United States. Over the past 30 years, FCS has pioneered the community oncology model and set a benchmark for clinical trial research that rivals many academic medical institutions. As we celebrate our 30th anniversary, we also pay tribute and recognize the more than 1,800 FCS employees who have helped advance the dream of bringing world-class cancer care to communities both large and small, so that patients can be treated close to where they live. Brad Prechtl, CEO of FCS, says, “The relationships with our patients are at the heart of everything we do. Cancer patients rely on our physicians and staff to provide the most advanced treatments in a setting close to their homes so they can have the support of their families and friends. I know that our doctors and our employees throughout FCS often feel that our patients are like an extended family, and they inspire us every day with their courage.” In light of the extraordinary achievements of FCS, it is particularly fitting that the 30th anniversary celebration kicked off publicly during the 2014 Olympics. FCS began airing new TV commercials during the Olympic Opening Ceremonies on NBC stations throughout Florida. The new commercials focus on the millions of patients seen by the practice over the past 30 years and the impact the life stories of these patients have had on physicians, nurses, clinicians and FCS staff members. On Feb. 25, the 30th anniversary was celebrated with a special event held at corporate headquarters in Fort Myers. Several longterm employees were recognized, and Dr. Harwin spoke about the early years of the practice and how the dream continues to evolve and guide the practice in all that we do. If you would like to see a video of the festivities at corporate, you can view it starting in early March by visiting the FCS website. Throughout the year other celebrations are planned in the local offices and for the practice statewide. Every office will be receiving a 30th
Dr. Harwin hugs longtime nurse Mary Iverson Stills in celebration of the company's 30th anniversary.
Anniversary Celebration kit, which contains information on ordering promotional items for your location. In June, we will roll out a special campaign that highlights this special anniversary with activities and messages for each of the 30 days in the month. Look for updates and news throughout the coming months. This is truly a special year for FCS and for all our physicians and employees. All of us can look forward to bringing more advancements and personalized care to our patients across Florida communities as we join the millions worldwide who are committed to ending this disease!
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quotes
humor
Some of our Favorite
Quotes
“Life is not measured by the number of breaths we take, but by the moments that take our breath away,” (Hilary Cooper) and, “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can and wisdom to know the difference.” (Reinhold Niebuhr) — Carly Pabon, ARNP
✚ “Quiet women don’t make history.” (Laurel Thatcher Ulrich) — Sara Beeler, ARNP
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“It’s easy to make a buck. It’s a lot tougher to make a difference.” (Tom Brokaw) Just a good reminder that what we do here is not just a job, we are here to help our patients. — Lisa Sosa, ARNP, Orange City/ Lake Mary
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When I’m talking with cancer patients that have a curative intent, I explain to them this is “a bump in the road that we will get over together.” It makes them feel better, as they are part of a team. — Ann Servies, ARNP
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“God heals, we treat.” — Bonnie Bodin
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“Life is a journey, not a destination.” (Ralph Waldo Emerson) — Joanne Osetsky
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A cancer diagnosis changes everything. Fighting cancer is a long journey. Florida Cancer Specialists Foundation helps make the road a little easier. We deeply care about our patients and their struggles. Florida Cancer Specialists Foundation was created to help patients who need fi nancial assistance while undergoing treatment. The Foundation allows those fighting their battle with cancer to concentrate on recovery rather than their overdue rent, mortgage, electric or water bill. Please visit our website for ways to donate. Florida Cancer Specialists Foundation is a 501(c)(3) non-profit organization.
1600 Phillips Road, Suite 300 | Tallahassee, FL 32308 | (850) 877-8166
Foundation
2626 Care Drive, Suite 200 | Tallahassee, FL 32308 | (850) 219-5830
foundation.flcancer.com