RAISING THE BAR
A wSsLlEeTt tTeErR fFoOr RO M r aEnDgI C e ARL eSgTiAoFnFa lO M e dR iAcNaGl ECRe En G t eI Or ’NsA M e dE iDcI aC lA LS tCaEfNf T E|R V o l u m e 1S UNMuMmEbRe r2 011 6 A NNEeW F O L M
Physicians Honored
Orange Regional hosted its 2016 Physician Recognition Reception on May 6 at the West Hills Country Club. Orange Regional’s Medical Staff was honored for its dedication to delivering quality healthcare to the community. This year, special recognition was given to physician honorees Elliot Mayefsky, MD, FACS of Horizon Family Medical Group, PC and Phillip Massengill, MD of ENT and Allergy Associates, LLP for their outstanding leadership and medical achievements.
General Surgeon, Dr. Mayefsky was presented with the 2016 Lifetime Achievement Award. This award is given to physicians who have continually improved the level of patient care, whose professional body of work has served to elevate their profession and who, through personal example, have earned the respect of their peers and the community. Dr. Mayefsky joined the Medical Staff at Orange Regional’s Horton Campus in May 1982 and currently serves as the Director of the Surgical Residency program and Surgical Clerkship Director for Touro College. Otolaryngologist, Dr. Massengill was the recipient of the 2016 Leadership Award. This award recognizes involvement in the development of new or enhanced medical programs,
L to R: Elliot Mayefsky, MD, FACS and Phillip Massengill, MD, FACS
promotion of staff education within the physician’s field and professional excellence. Dr. Massengill joined the Medical Staff at Orange Regional’s Horton Campus in June 2006 and served as past Chair of the Otolaryngology department. He currently serves as Vice President of the Medical Staff.
This year the Medical Staff Services Department recognized Family Medicine practitioner, Francis Imbarrato, MD of Horizon Family Medical Group, PC for 30 years of service. Dr. Imbarrato was featured in the Winter/Spring 2012 issue of Raising the Bar, which highlighted his work as a Christian missionary physician for almost 13 years.
Francis Imbarrato, MD
In This Issue
3 Medical Staff Update 5 Scenes from the Physician Recognition Dinner 6 Medical Education Update A member of the Greater Hudson Valley Health System
Welcome New Practitioners December 2015 – March 2016
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CHIEF MEDICAL OFFICER
The Zone The weather is changing for the better and the golfers are out swinging away. This makes you feel more alive and I see a little spring in everyone’s step. Athletes are said to be “in the zone” when everything during the game slows down in their mind and whatever they are doing becomes seemingly effortless. We marvel at their brilliance in sports. Consider for a moment our doctors in the emergency room, operating room, on the floors, in the ICU – presented with a patient in distress – the calmness with which they respond; the efficiency with which they perform their life saving procedures is nothing short of fantastic. They are “in the zone” and when you think about it, it’s much more remarkable than hitting a big shot in a game. So take a step back, take pride in what you do every day – and continue to be prepared for the unexpected. There will always be another game – there might not always be another moment for a patient.
Achuthan, Vindya
Medicine
Brooks, Hannah L.
Surgery
Choi, Lisa Eunju
Orthopedics
Davidson, Dennis
Pediatrics
Deol, Ajit
Surgery
Dimov, Nikolay
Pathology
Heublum-Colton, Rona R.
Medicine
Khan, Saqiba
Emergency Medicine
Lam, Hao
Family Medicine
Lee, Annie
Medicine
Lovig, Leif Cameron
Pediatrics
Malhotra, Sandeep
Surgery
Nerkar, Sanjay D.
Medicine
O’Brien, Michael Robert
Medicine
Paralkar, Mayur Ajit
Medicine
Perez, Elynor Giannin
Orthopedics
Rosenfeld, Lonny
Orthopedics
Sachdeva, Amrita
Medicine
Schwartz, Shimon
Psychiatry
Sharma, Rita
Medicine
Stockl, Thomas Jerome
Pathology
Wood, Katherine Delia
Orthopedics
Regards,
Jim Oxley, DO Chief Medical Officer
Medical Staff Meeting Schedule
The 2016 Medical Staff meeting schedule is now available on the Orange Regional Medical Center website and can be accessed by visiting www.ormc.org/medicalstaff.
Have a Question? Need Info?
The Medical Staff Services Department can help For assistance with initial credentialing, contact Deborah Lasch at 845-333-1110. For assistance with re-appointment credentialing, contact Kathy Mikulski at 845-333-1108. For general assistance, contact Alicia Remey at 845-333-1106. 2
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Medical Staff Update
The state of healthcare has created tremendous pressures on physicians as they try to balance providing exceptional care, running a business and having a personal life. Medical practice appears to be amongst the most regulated careers with private, state and federal mandates constantly challenging physicians to do more with less. As such, it is imperative physicians police themselves rather than have a bureaucratic regulator with minimal medical knowledge perform such a function. The Orange Regional physician leadership team, through the Medical Executive Committee (MEC) and its subcommittee, the Physician’s Excellence Committee (PEC) take medical staff conduct seriously. Nader Okby, MD President of A formalized policy exists that provides guidance in dealing with medical staff conduct issues. Orange Regional Medical Misconduct manifests in many ways ranging from inappropriate language and disruptive behavior to Center’s Medical physical altercations. In all circumstances, collegial intervention is the initial step and ultimate goal of Executive Committee resolving disputes. In severe cases, varying levels of disciplinary actions may be required. However, the aim is not to be punitive, but rather to provide counsel. The overwhelming majority of misconduct issues is successfully resolved within the sphere of medical staff governance and rarely requires intervention of outside regulatory bodies. We should all be proud that physician leadership and the medical staff hold themselves up to high standards of excellence and professionalism. What we expect of others is something we should expect of ourselves. The Orange Regional Medical Center Medical Staff has also been engaged in medical student and resident teaching, functioning as strictly voluntary preceptors. Physicians have been spending additional time in the hospital and in private offices imparting their knowledge to students and residents in training. Most recently, the Orange Regional medical staff through the MEC has pledged a significant amount of medical staff monetary funds to the Orange Regional Foundation targeted for teaching and educational activities. In an era of increased pressures, this voluntary commitment to the education of future physicians is commendable.
Stroke Gold Plus Quality Achievement Award
Orange Regional’s Neuroscience Program Coordinator, Teressa Bianchi, RN, MSN, TNCC and Stroke Center Medical Director, Dr. Olga Fishman.
Orange Regional received the American Heart Association/American Stroke Association’s Get With The Guidelines®Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite. The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.
To qualify for the Target: Stroke Honor Roll Elite, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. Orange Regional earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. RAISING THE BAR
Orange Regional Achieves HIMSS Stage 7
Orange Regional has been awarded with the highest designation, Stage 7, for implementing an electronic medical record (EMR) system to improve patient safety and quality of care. The Healthcare Information and Management Systems Society (HIMSS) awarded Orange Regional with Stage 7, the highest level on HIMSS Analytics’ EMR adoption model which is used to track EMR progress at hospitals and health systems. During the fourth quarter of 2015, only 4.2 percent of the more than 5,400 U.S. hospitals received the Stage 7 Award. ORMC is one of only three hospitals in New York State to achieve HIMSS Stage 7 joining NYU Langone and the Hospital for Joint Diseases.
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FOUNDATION UPDATE We recently launched The Future Is Orange, a campaign that I think really positions the hospital for great things. I am pleased to report that the Medical Staff made a recent commitment to the campaign, but I believe we need to also make a personal commitment to support this exciting campaign. It includes a fundraising component for academic medicine, something you know is very dear to my heart. Our plan is to raise $500,000 and create an endowment that will assist both preceptors and medical students while we shift from a community hospital to a teaching medical center.
Ronald Israelski, MD
I think the fund will be best managed by the doctors in our medical education program and am supported in this position by the hospital and our Foundation. This is an important step in our journey to become the hospital that provides the very best training for our residents, medical students, our CME programs, and you, our seasoned physicians.
This is an important time in the history of Orange Regional Medical Center. A strong medical education program will make us all better practitioners. So I am asking you to support this effort at any level you can. Every gift large and small counts and moves us forward. Thank you for your consideration. There are many naming opportunities also available. Please feel free to call Bill Dauster, Foundation President, at 845-333-2333 with any questions. Thank you for your consideration. All my best wishes,
Ron Israelski, MD, Director of Academic Affairs
TEE TIME!
2016 Golf and Tennis Classic Committee
Jake Kriney and Eric Savacool were Co-Chairs of the 2016 Golf and Tennis Classic. Renowned as one of the region’s finest golf outings, the 25th annual Classic raised over $250,000 to benefit The Future Is Orange Capital Campaign at Orange Regional. The widely popular event, with the addition of a tennis tournament this year, was held at West Hills Country Club, in Middletown and Stony Ford Golf Course, in Montgomery. The spectacular occasion concluded with a celebratory dinner and awards ceremony at West Hills Country Club. All golfers received a delicious breakfast, a golf cart, full lunch and an appreciation gift, as well as a tremendous golfers’ hour and buffet dinner at the awards ceremony. For more information on how to make a donation to the Foundation or The Future Is Orange Campaign, call the Orange Regional Foundation office at 845-333-2223 or visit www.ormc.org/foundation. 4
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Recognizing Our Physicians The 2016 Physician Recognition Reception was held on May 6 at the West Hills Country in Middletown. Our Medical Staff was honored for its dedication to delivering quality healthcare to the community. Here are some scenes from the event.
RAISING THE BAR
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MEDICAL EDUCATION UPDATE Touro opened its Middletown campus in 2014 at the former Horton Hospital building, and admits nearly 300 students each year. The college also offers a program in interdisciplinary biological and physical sciences. In addition to our medical student programs, Orange Regional inaugurated its first residency in Family Medicine in 2014 as well, welcoming its first two residents – one from Chester and the other from Long Island – who began their three-year residency. A medical residency is a stage of graduate medical training or education. A resident is a physician who practices medicine usually in a hospital or clinic under the direct or indirect supervision of an attending physician.
Orange Regional’s Medical Residency Program continues to expand by leaps and bounds. This year, we received 600 applications for our programs and interviewed 300 for 27 available spots. The relationship cultivated by Orange Regional and Touro College of Osteopathic Medicine has yielded positive results in attracting medical students to the area and availing them to the residencies that Orange Regional offers. Our proximity to Touro College makes us the closest Academic Teaching Center for Osteopathic students in this area. Our location facilitates a relationship with the college that behooves our residents by having Osteopathic Manipulative Medicine lectures accessible to them at the college every month. Orange Regional also has access to their library resources and their cadaver labs and simulation labs.
Four additional residencies have been added including Emergency Medicine, Psychiatry , a traditional rotating internship (1 year) and Internal Medicine. Orange Regional strives to be unlike every other residency program. We remain open to new ideas and new ways of doing things. The Graduate Medical Education at Orange Regional should not be separated by specialties at all times. For example, all residents can attend any lecture in any program that they wish to. This sets us apart from some residency programs that like to keep their programs separate. While our residency programs are compartmental, it is our practice to encourage all our residents to interact with one another. For more information about the Residency Program, please contact Administrative Director of Medical Education, Jenny Vosganian-Clancy, at 333-1138 or jclancy@ormc.org.
First graduate of Medical Education Department
“Dr. Jason Taniguchi has successfully completed his Osteopathic Transitional Rotating internship. Dr. Taniguchi has all the qualities of an excellent physician. He is kind, patient, intelligent and introspective. In addition, he is humble and will do an excellent job at continuing to educate himself as his career progresses in the future. Dr. Taniguchi from day one impressed me as a conscientious, mature, and humble physician. Dr. Taniguchi is committed to patient care, and dedicated to fostering his own growth in knowledge and skills. Congratulations to our first graduate of the ORMC Medical Education Department.”
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– Submitted by Cristian Castro-Nunez, D.O; FHM, Program Director, Transitional Rotating Internship
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CONGRATULATIONS Dr. Ofer Jacobowitz, Associate Medical Director of the Center for Sleep Medicine and Associate Editor for the second edition of “Sleep Apnea and Snoring” Elsevier textbook, was a speaker and presenter of original research at the 7th International Surgical Sleep Society (ISSS) SymposiumSurgery Sleep & Breathing, in Sao Paulo, Brazil, April 15-16, 2016. He was also the Keynote Speaker at The Annual Meeting of the Israeli Rhinologic Society, in Kfar Blum, Israel, from May 26-28, 2016.
NEWS BULLETIN Pirozzi N, et al.,
Physicians and Medical Students Co-author Article The article below is the first in a series of three review articles on sepsis. It is a general introduction to sepsis, co-authored with our Emergency Department physicians, Dr. Anuj Vohra and Dr. Trevor Mcginley and Touro medical students Noah Pirozzi, Nima Rejali and Matthew Brennan. To read the article, visit http://goo.gl/ABYWqL
Review Article
Emergency
J Emerg Med
Trauma Surg
Care 2016, 3:
HSOA Journa
Medicine Tr
Sepsis: Epide gy, Pathophysiology, Clmiasolo Biomarkers and Msifanicaagtion, ement
Noah Pirozzi1 , Nim 1 Trevor McGinley2 a Rejali , Matthew Brennan1 , Anuj Vohra2 and Murali G , Krishna2,3* Touro
1
College of Osteo pathic Medicine, Middletown, New Orange Regio York, USA nal Medical Cente r (ORMC) - Midd 3 Division of Pulm letown, New York, onary, Critical USA Care and Sleep al Medical Grou Medicine, Oran p, Middletown, ge RegionNew York, USA 2
rgical Care
significant amo unt of the total number of seps to the general is patients [1]. population, the Similar elderly increases in seps is hospitalization also have experienced dramatic s as shown in recent study has table 2 [3]. A shown that seps more is likely contribu 50% of mortality ted between 30 and had a large and US between 2010 impa and 2012 [4]. With ct on healthcare costs in the the healthcare the growing burd system, there is en of seps is on a strong drive to mechanisms to develop more effic detect and man ient age sepsis patie nts. Sepsis as a
Every physician has been train to recognize ed early in their and manage careers on sepsis. Although the most rese sepsis has been how arched ailments one of in medicine, it deadliest disea also remains ses one of the article, we revie in the face of recent adva nces. In this w the diagnost current Systemic Infla ic and managem mmatory Resp onse Syndrome ent criteria for severe sepsis, septic shock, (SIR S), sepsis, and Multi Orga (MODS). We n Dysfunction then examine Syndrome the implicatio campaign as ns of the “surv well as explo iving sepsis” re the philosoph Therapy (EGD y of Early Goa T) and its role l Directed in the modern sepsis. In addi tion, we soug day managem ht ent to and current avail highlight pote of ntial new biom able therapies arkers in sepsis.
2000 Hospitaliza tion Rate (per 10,00 0)
Primary Dx
Sepsis as any
Abstract
014
l of
auma and Su
11.6
Dx
2008 Hospitaliza tion Rate (per 10,00 0) 24
22.1 Table 1: Seps is 37.7 have more than Hospitalization Trends 2000 -2008: Hospitaliza burden of sepsi doubled from 2000 to 2008 tions for sepsi s on the US healt s demonstrating hcare system the increasing [5]. Age Group 18-64 65-84 85+
2003 Sepsis
Hospitalization Rate (per 10,00 0) 8.3 64.7 177.1
2007 Sepsis
Hospitalization Rate (per 10,00 0) 13 99.8
Table 2: Age 219.7 specific Seps is Hospitaliza rates increased tion Rates in dramatically in USA. Hospitaliza cally in all age groups over the the 5 year span. The rates tion increased dram short 5 year perio atid [3]. Mor
tality
Mortality rates for sepsis in recen 40%. The identifica t years have rang tion of the corr ed from 18 to ect microbial strai the proper antib iotic treatment n and initiation Sepsis continue could significa of mor tality in these patie s to be a critic ntly affect the incid of al problem in and mortality nts. ence The high asso regards to mor est incidences ciated with seps in the clinical bidity of mortality are setting. Ranked is morbidity and arisi ng from organisms such as a top caus mortality, seps nosocomial infec as methicillin e of is can be the pathologies and tions by resistant and sens species, pseudom result of a num can greatly com itive staphyloco onas and both ber of plicate the care of the hospital ccus candida and noninfections. Poly of patients in and setting [1]. Desp microbial infec candidal fung out mor ite advances in 28 day in hosp tions are also asso al the treatment of tality rates [6]. ital mortality rates ciated with incre sepsis, still range from ased 15 to 45% [2]. Epidemiology Biomarkers curr ently used in the of septic patients identification and can provide insig Inpatient expe man agem ent nses related to ht into the resp prognosis. Alth the treatment of onse to therapy ough using biom on the rise with sepsis infections and annual costs estim arkers to rule in are identified with strong supp sepsis have not [3]. This places ated to be in exce ort, Lactate level been sepsis as one of ss of $20 billio measurements the most costly n the greatest focus in recent care system. Seps have been burdens on the years and have is rates are on health well with mortality [7]. been shown to the rise (Table population is Lact corr ate levels greater elate at a greater risk 1) [4]. The elder than 4.0 mmo ly been shown to correlate with for the developm sepsis related com l/L have an increase in mor ent of sepsis plications. As and correlation is even stronger tality. In addition, a result this popu if there is a coex this lation makes up *Corresponding autho istence of eleva a with observed hypotension [7]. ted lactate r: Murali G Krishna, Other sources and Sleep Medicine, with 48 hour reso Divis have ion foun of lutio d correlations n of elevated lacta New York, USA, Tel: Orange Regional Medical Cent Pulmonary, Critical Care [8]. te levels and seps +1 9179519661; E-ma er (ORM is prognosis il: murali.krishna.m C), Middletown, Citat d@g
Introduction
Meet Your New Outpatient Physician Liaison
Alexandra Curiale has joined Orange Regional as Outpatient Physician Liaison. Alexandra is experienced in the healthcare industry and most recently worked as manager of Physician Recruitment and Onboarding at Westchester Medical Center. As Outpatient Physician Liaison, Pathophysiolo gy Alexandra develops an effective rapport with physicians and their office staff, markets Orange Regional programs to medical establishments and facilitates patient and community referrals. She serves as a conduit between physicians/physician practices and Medical Center leaders. She holds a Bachelor of Science degree in Management and Marketing from the State University of New York at New Paltz. Alexandra can be reached at 845-695-5833 or acuriale@ormc.org. ion: Piroz mail.com Sepsis: Epidezi N, Rejali N, Brennan M, Vohra A, McGinley T, al. gy, Pathophy Management. Jmiolo (2016) Emerg Med Traumasiology, Classification, Biomet Sepsis and disea arkers and Surg Care 3: 014. se severity depe from the propertie nd on various Received: Dece factors, ranging s of the invading March 07, 2016 mber 8, 2015; Accepted: Febru status of the pathogen to the ary 22, 2016; Publ host [9]. Seve current immune re sepsis can ished: infection and develop can stem from a num following local ber of sites inclu skin, soft tissu e, urinary tract , lungs and is usua ding the abdomen, lly due to a prim ary
RETIREMENTS Orange Regional bids farewell to Dr. Michael Finck and Dr. Samuel Louie who have announced their retirements.
Michael Finck, MD Horizon Family Medical Group RAISING THE BAR
These two physicians have embodied what quality healthcare means for families in the local community over their numerous years of service. It has been an honor and a privilege to have partnered with these committed professionals to work towards improving the health in our community. Thank you and best wishes on your retirements!
Samuel Louie, MD Orange Pathology Associates, P.C. 7
Non Profit US Postage PAID Newburgh, NY Permit No. 39
707 East Main Street Middletown, NY 10940
Culture of Caring Yvon Kernizan is a colleague (on right) who came up from Haiti to pick up almost 500 pairs of shoes donated by Orange Regional nurses and TouroCOM medical students for those who still suffer the effects of the country’s devastating earthquake.
SAVE THE DATES Upcoming Medical Staff Quarterly Meetings 8
Thursday, September 8, 2016 Conference Center Middletown, New York
Thursday, December 8, 2016 West Hills Country Club Middletown, New York
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