The Journal of the Medical Association of Georgia by PubMan, Inc.

Vol. 106, Issue 4, 2017

2017 HOUSE OF DELEGATES Frank McDonald, M.D., M.B.A. President

2018 General Assembly preview 2017 MAG award & student abstract winners The latest on opioid prescribing from GCMB A physicianâ&#x20AC;&#x2122;s duty to non-patients

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FOCUS ON HELPING OT H E R S. “It was the first note I ever got in crayon. ‘Thank you for making my daddy feel better.’ I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.”

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TABLE OF CONTENTS VOLUME 106, ISSUE 4

IN EVERY ISSUE

FEATURES

3 President’s Message

7 HOD survey results

4 Editor’s Message

8 Highlights from the 163rd House of Delegates

6 Executive Director’s Message 34 Medical Ethics

14 2017 MAG award recipients

36 Opinion: Health Care in America

17 2017 MAG Life members

39 Georgia Composite Medical Board: Opioid prescribing

18 2017 HOD attendees

40 Legal: A physician’s duty to non-patients 46 Patient Safety

20 Key 2016 HOD resolutions update 22 2017 medical student abstract winners

48 County, Member & Specialty News 26 Key 2017 bills summary 30 2018 General Assembly preview 51 Perspective 52 Prescription for Life

32 Practice Models – Concierge Medicine 44 Specialty Feature – Cardiology

PRESIDENT’S MESSAGE

House of Delegates Inaugural Address Frank McDonald, M.D., M.B.A.

fmcdonald@icloud.com

The following is an abbreviated version of the speech that Dr. McDonald gave when he was installed as MAG’s president during the House of Delegates meeting in October.

would like to express my sincere thanks to my predecessor, Dr. Steve Walsh. Under his leadership, MAG defeated key legislation that would have harmed our patients and our profession in significant ways. It is an honor to be MAG’s 163rd president. In the last nine years, we have elected a woman, an African-American, and a physician of East Indian decent. I am proud to serve an organization whose leadership reflects the diversity of its membership. My sincere thanks to my family and friends, especially my wife, Shantha. She inspires me, and my success is the result of her boundless enthusiasm, encouragement, and support. At the age of 30, I entered the University of Mississippi Medical School. Following a neurology rotation in my fourth year, I took a neurology elective in Dublin, Ireland. After working as an emergency physician in rural Mississippi, I returned to the University of Mississippi to complete my residency in neurology. Later, I completed the Executive MBA program at the Goizueta Business School at Emory. I consequently had a great understanding of health care economics, but I faced a decision: Walk away from clinical medicine or become part of the solution. That’s when I discovered the value of organized medicine. I joined Hall County Medical Society and became a MAG delegate. I served as MAG’s vice speaker for six years, I graduated from the Georgia Physicians Leadership Academy, and I served a two-year term as MAG’s speaker. The upheaval we have in our health care system is attributable to money. Health care spending in the U.S. is the world’s highest at $3.2 trillion a year. It consumed nearly 18 percent of our GDP in 2015, despite the Affordable Care Act. That’s nearly $10,000 per person per year. Thirty-seven percent of all health care costs are paid by the government through Medicare and Medicaid, while another 33 percent are paid by private insurance – most of which is provided by employers. As insurance premiums rise, American businesses become less competitive. Programs like the SGR, MIPS, and PQRS were created to reduce health care costs, but that hasn’t happened. In 2015, health care spending in the U.S. increased by about six percent, yet payments to physicians decreased by about

one percent. So the overall health care pie is growing while our slice is getting smaller, a trend that will continue – change notwithstanding. Physician burnout is a huge problem, too. We are working longer hours for less pay. We are also losing our autonomy to insurers and government bureaucrats. The best way to control health care costs is to empower physicians with more authority, but we have failed to deliver our messages in a clear and effective way. MAG fights to get insurers to pay physicians according to the terms of their contracts. It has taken steps to protect patients by keeping less qualified health care professionals from practicing medicine. And MAG has intervened when legislators have created problems instead of solutions. Rather than simply comply with regulations that are aimed at reducing health care costs, we need to design cost-saving solutions that are so clear and compelling that lawmakers won’t have any choice but to adopt them. Instead of letting hospital systems treat us like cogs, we must become vocal champions for new and innovative health care delivery solutions that empower physicians and patients – and we need to insist that physicians retain control as the leaders of every health care team. MAG is essential because it gives the medical profession the critical mass it needs to effect change. During my term as president, MAG will pursue legislation that will address the “surprise insurance coverage gap” and that will simplify and streamline the processes for prior authorization and step therapy. MAG will also promote legislation requiring insurers to provide better coverage to reduce opioid abuse – as well as reducing distracted driving. MAG will continue to shine a light on the health insurance industry’s harmful policies – including one by Anthem to review claims for ER care on a retrospective basis. MAG will also keep working with its allies to reduce the burden associated with the maintenance of certification process. Finally, MAG will maintain its efforts to ensure that health insurance networks in the state are adequate. www.mag.org 3

EDITOR’S MESSAGE

The Medical Association of Georgia 1849 The Exchange, Suite 200 Atlanta, Georgia 30339 800.282.0224 www.mag.org MAG’s Mission To enhance patient care and the health of the public by advancing the art and science of medicine and by representing physicians and patients in the policy-making process. Editor Stanley W. Sherman, M.D. Executive Director Donald J. Palmisano Jr. Publisher PubMan, Inc. Richard Goldman, rgoldman@pubman.net 404.255.5603, ext. 1 Editorial Board Jay S. Coffsky, M.D., Decatur Mark C. Hanly, M.D., Brunswick Mark Murphy, M.D., Savannah Barry D. Silverman, M.D., Atlanta Joseph S. Wilson Jr., M.D., Atlanta Michael Zoller, M.D., Savannah MAG Executive Committee Frank McDonald, M.D., President Rutledge Forney, M.D., President-elect Steven M. Walsh, M.D., Immediate Past President Lisa Perry-Gilkes, M.D., First Vice President Despina D. Dalton, M.D., Second Vice President Frederick C. Flandry, M.D., Chair, Board of Directors Steven M. Huffman, M.D., Vice Chair, Board of Directors Edmund R. Donoghue Jr., M.D., Speaker James Barber, M.D., Vice Speaker Andrew B. Reisman, M.D., Secretary Thomas E. Emerson, M.D., Treasurer S. William Clark III, M.D., Chair, AMA Delegation W. Scott Bohlke, M.D., Chair, Council on Legislation Advertising PubMan, Inc. 404.255.5603 or 800.875.0778 Fax 404.255.0212 Brian Botkin, bbotkin@pubman.net

HOD – Time to expand our list of legislative priorities?

Stanley W. Sherman, M.D.

n a survey of the delegates who attended the HOD meeting in October, 79 percent felt that state legislative advocacy was MAG’s most valuable program. At this meeting, we discuss resolutions that involve the major concerns of our members. This year’s resolutions included: promoting detoxification units, safe cannabis use, drop boxes to destroy unneeded prescription drugs, and a ban on indoor smoking. We also advocated: eliminating the “donut hole” in Medicare D, paying for screening colonoscopies, promoting more affordable prescription drug costs and preventing price gouging to strengthen Medicaid, promoting payment for dementia therapy, promoting skin cancer prevention, to allow billing for behavioral therapy for autistic children, and promoting education about choice of Medicare plans. We had resolutions: promoting the National Board of Physicians and Surgeons rather than MOC, addressing MAG’s position on CON, having alternative options to malpractice litigation, joining the Interstate Medical Licensure Compact, using drones to deliver medical supplies during emergencies, licensing surgical assistants, and supporting the CDC’s meningitis vaccine recommendations. I think we can all agree that these resolutions are important for our patients and our practices. We are trained as physicians to seek the cause of an illness and treat it, not to simply treat the symptoms of an illness. At least some of our resolutions stem from our present ailing health care system. So far, our legislators have not been able to agree on a “cure.” How about our national problems with crime? Some criminals may be a product of poverty and exposure to criminal activity in their neighborhoods. We know that nearly 57 percent of criminals will repeat crimes within one year of prison release, 68 percent will be re-arrested within three years, and 76 percent will be re-arrested within five years. Recidivism is particularly high in when it comes to property crimes, drug offenses, and violent crimes. Would not dealing with this make us all safer?

The Journal of the Medical Association of Georgia (ISSN 0025-7028) is the quarterly journal of the Medical Association of Georgia, 1849 The Exchange, Suite 200, Atlanta, Georgia 30339.

How about the problems of homelessness? Serious mental illness is felt to be the third largest cause of homelessness. Even after we have spent millions of dollars repairing Interstate 85 after a homeless person set the fire that destroyed it, we have no approach to “curing” this problem. When we bring up social problems to our legislators – who are presumably elected to deal with societal concerns – they want to help but do not know where to start. When asked about this, a legislator told me, “You give us a solution, and we will consider it.”

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Should physicians, representing about 0.3 percent of the population, try to cure society’s problems? Remember that five physicians signed our Declaration of Independence. That was nine percent of the 56 signers whose leadership and vision started this country. We physicians should continue this historical leadership in the issues which currently face our society.

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I do not have an answer to the above societal problems, but, like what we all do daily, we can study, educate, and promote cures to our legislators. I once asked a psychiatrist why an incarcerated patient who had a mental illness was deemed mentally stable and discharged – only later to commit murder. His response was that the patient was evaluated within a very structured environment of incarceration,

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4 MAG Journal

and once they were released into our free, unstructured environment, they became totally decompensated. Knowing this and the aforementioned recidivism rates, can we, having given up some of our rights to remain safe from terrorism, demand that criminals remain structured and watched for years? Could reformed criminals be trusted to watch over and follow newly released prisoners? Can society insist that a child born to a mother in poverty get support from the biological father and grandparents? Would this help? Would agricultural farms for criminals, the impoverished, and the homeless, with perhaps self-supporting work and structure, help? Can we start to discuss, study, and debate these issues to give to our legislators to debate? The problem that physicians should be focused on – our health care system –is addressed in the second half of an editorial by Dr. Minor that appears in this edition of the Journal (with part one having appeared in the last issue). Perhaps his solutions would be as successful in passing our HOD as the recent attempts in Washington were – but could we agree on some of them and revise others so that we have something to send to our legislators that WE helped formulate, rather than being handed our future from those who know little about patient care? Is it time for a MAG task force on this? While the MAG Foundation has sought to help society with ‘Project DAN’ (Deaths Avoided by Naloxone), prescription drug abuse, and distracted driving, perhaps its ‘Think About It’ campaign should be expanded to include all of us working together to cure societal ills.

This issue of the Journal is focused on our HOD meeting, our MAG award and student abstract contest winners, and state legislation. Dr. Barry Silverman and Dr. David Rodriguez address the concierge medicine practice model. Drs. Dan DeLoach and John Antalis give us a Composite Medical Board update on the state’s opioid-prescribing rules and regulations. Dan Huff, Esq., explains the legal implications of the physician-patient relationship. Dr. John Cantwell concludes his wonderful three-part historical perspective on the cardiac physical exam – keeping in mind that we encourage you to submit articles about your specialty as well. MagMutual warns against billing under another provider’s number. Dr. Richard Elliott has become a professor emeritus, and his “last ethics lesson” is indeed his last Journal contribution after 10 wonderful years. I hope that you, like I, have learned much from him – he will be greatly missed. While we all thank him for his many contributions, we especially thank him for recruiting Dr. David Baxter to take over this column. Our sincere thanks, Dr. Elliott! This issue concludes with Drs. Mark Murphy and Jay Coffsky recounting some poignant memories. We hope that all of our readers made wonderful memories over the holidays. Best wishes for a happy and healthy New Year to you and yours.

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www.mag.org 5

EXECUTIVE DIRECTOR’S MESSAGE

Here’s to 2017 (and beyond) Donald J. Palmisano Jr. dpalmisano@mag.org

would like to express my heartfelt thanks to the physicians and sponsors and other allied stakeholders who attended the Medical Association of Georgia’s (MAG) House of Delegates meeting in Savannah in October. For me, the key takeaway was that MAG enjoyed another unprecedented year of growth and success in 2017.

primary care and OB-GYN codes. Finally, MAG achieved its number one objective for the 2017 General Assembly when H.B. 165 went into effect on July 1 – prohibiting MOC from being used to require as a condition of licensure or to be employed by a state medical facility or for the purpose of licensure, insurance panels or malpractice insurance.

We owe MAG’s outgoing President Steve Walsh, M.D., a round of applause and a debt of gratitude for his leadership and the countless hours that he spent away from home (and his wife, Jane) while he was representing MAG members at the state and national levels.

Note, too, that MAG’s 2017 advocacy efforts weren’t limited to the state legislative arena. Arm-in-arm with Hal Lawrence, M.D., with the American College of Obstetrics and Gynecologists, MAG led a multi-state and national medical society effort to discuss physicians’ concerns surrounding MOC with the American Board of Medical Specialties (ABMS). I am optimistic that we can effect change in the MOC arena based on our interaction with ABMS – and I encourage you to monitor MAG’s communications for developments on this front.

Dr. Walsh was a fixture at the State Capitol – testifying on important legislation, including the surprise health insurance coverage gap (i.e., which is the result of out-of-network care that is provided in ER settings), opioid abuse, the prescription drug monitoring program (PDMP), and scope of practice (e.g., opposing a measure to allow optometrists to make injections in or near a patient’s eye). What’s more, Dr. Walsh was the leading proponent for HealtheParadigm – a health IT solution that enables physicians to generate sophisticated patient data reports that they can use to improve patient outcomes and fulfill the new quality-based payer metrics. Serving as MAG’s president requires an extraordinary amount of time and effort, and Dr. Walsh exceeded our expectations in every way. MAG has nearly 8,000 members, and we actually saw a slight increase in the dues-paying membership category in the last year. With the support of a lot of our physician leaders, I am also proud to report that we met a MAG Board of Directors mandate to build a $200,000 surplus for the eighth straight year. MAG has zero long term debt, and we are closing in on our goal of a full year’s worth of cash reserves. We are also making great strides in fulfilling the MAG Foundation’s longterm financial obligations. MAG solidified its reputation as the leading advocate for physicians in Georgia with another successful legislative session in 2017. MAG convinced lawmakers to oppose a bill that would have fined and jailed physicians for failing to check the PDMP. MAG also promoted ways to close the aforementioned surprise insurance gap. MAG supported a FY 2018 budget that includes $38 million to increase pay for certain Medicaid 6 MAG Journal

And since 2011, we have expanded the number of “lightertouch” ways MAG members have to participate in MAG’s process. In addition to our traditional leadership meetings (e.g., Executive Committee, Board of Directors, House of Delegates), MAG now offers a ‘Summer Legislative Education Seminar,’ a ‘Physicians Day at the Capitol,’ a GAMPAC ‘Washington DC Fly-In,’ and a dinner with elected officials during the legislative session. I would also like to stress that MAG members are now getting a bigger bang for their membership dollar. Since 2011, MAG and its subsidiaries have added a number of valueadded programs – including HealtheParadigm, the MAG Medical Reserve Corps, the ‘Think About It’ campaign to reduce prescription drug abuse, the ‘Make Georgia HandsFree’ campaign to reduce distracted driving, the ‘Top Docs Radio’ program, and a 401(k) plan for member physicians and their practices. Finally, I would be remiss if I did not point out that we have achieved this growth and success while MAG’s staff levels have remained flat. I️ cannot say enough about MAG’s staff when it comes to their passion and the time and effort they put into helping MAG achieve its goals and objectives (i.e., protecting you and your profession and your patients). If you played a role in MAG’s success in 2017, thank you – and here’s to more of the same kind of growth and success in 2018.

2017 HOUSE OF DELEGATES

HOD meeting survey highlights

he delegates who attended the Medical Association of Georgia’s (MAG) House of Delegates meeting in Savannah in October were surveyed on an array of important issues. The following is a summary of the survey results…

32% said they plan to submit their Medicare Merit-based Incentive Payment System (MIPS) information for 2017 (i.e., for the 2019 payment year), while 23% said they plan to but weren’t yet ready. 7% said they refused to participate in MIPS.

33% see the federal government as the biggest threat to the medical profession. Other threats include the erosion of private practice at 21%, the erosion of scope of practice at 21%, other third-party payers at 17%, and medical malpractice at 5%.

36% gave state lawmakers a “C” grade for health care, while 26% gave them a “B,” 20% gave them a “D,” 17% gave them a “F,” and 2% gave them an “A.”

41% feel “somewhat positive” about the state of the medical profession, while 40% are “somewhat negative,” 12% are “very negative,” and 7% are “very positive.” 56% said they are in private practice. 79% believe that state legislation is MAG’s most valuable advocacy program. That was followed by public health at 10%, federal legislation at 5%, third party payer at 5%, and legal at 2%. 41% said opposing a bill requiring physicians to participate in every plan that was offered by their hospital was MAG’s greatest achievement during the 2017 legislative session. That was followed by supporting better pay for Medicaid primary care and OB-GYN physicians (23%), supporting a bill to preempt MOC requirements (20%), and opposing a bill that would have reduced pay for outof-network ER care (17%). 58% said they have registered with Georgia’s Prescription Drug Monitoring Program (PDMP), while another 27% said they would by the January 1, 2018 deadline. 6% said they will not register with the PDMP. 63% said they understand Georgia’s PDMP requirements. 31% believe Georgia’s PDMP is an important tool to fight prescription drug abuse but that it doesn’t work well, 30% said it is an important tool to fight prescription drug abuse, and 22% it’s a burden that doesn’t work well. 52% were familiar with Georgia’s new three-hour opioid prescribing CME requirement. 24% said prescribing practices are the biggest reason for opioid abuse. That was followed by “pill mills” at 21%, pharmaceutical industry marketing at 13%, regulations (e.g., Medicare patient satisfaction surveys) at 9%, insurers unwillingness to cover more expensive but less addictive options at 6%, and the lack of insurance (i.e., other forms of care) at 1%. 53% said lawmakers should keep trying to repeal the Affordable Care Act.

86% gave federal lawmakers an “F” for health care, while 11% gave them a “D.” Less than 1% gave federal lawmakers an “A” or “B” grade combined. 61% said Georgia should seek a Medicaid waiver to care for low-income patients, while 14% said it should not. 41% said they use their mobile phone while they are driving “sometimes,” 14% said they do so all the time, 42% said they do so but only on a hands-free basis, and 3% said they never do so. 75% believe physicians overprescribe antibiotics. 4% said they are using HealtheParadigm, while another 4% said they have plan to do so. 36% said they might, while 29% said they weren’t familiar with HealtheParadigm. 64% said they live a healthy lifestyle At 26% a piece, delegates said the lack of transparency and prior authorization are today’s biggest payer problems. Those were followed by narrowing health insurance networks at 19%, EHR/HIT adoption at 10%, and network selection/deselection and step therapy at 4% each. When it comes to how much time they personally spend on the prior authorization process, 15% said 6-10%, 7% said 1115%, 5% said 16-20%, and 6% said more than 20%. When it comes to how much time their practice staff spends on the prior authorization process, 20% said more than 20%, 13% said 16-20%, 18% said 11-15%, 13% said 6-10%, and 8% said less than 5%. When it comes to the most favorable payers/insurer, Medicare ranked the highest at 22%. That was followed by Blue Cross Blue Shield at 10%, Aetna at 6%, UnitedHealthcare at 5%, Humana at 4%, and Medicaid at 2%. When it comes to the most unfavorable payers/insurers, Medicaid led the way at 28%. That was followed by Blue Cross Blue Shield at 25%, Humana at 12%, UnitedHealthcare at 10%, Medicare at 5%, and Aetna at 4%. Finally, 55% said they believe the U.S. has world’s best health care system. www.mag.org 7

HIGHLIGHTS FROM THE 163RD HOUSE OF DELEGATES MEETING The Medical Association of Georgia (MAG) recently held high-level leadership meetings at the Hyatt Regency Savannah, including the Board of Directors (BOD) on October 20 and the House of Delegates (HOD) on October 21-22. The following is a summary of the key developments that took place at those meetings.

Key accomplishments On his final day in office, MAG President Steven M. Walsh, M.D., gave a report to the HOD that highlighted some of MAG’s key accomplishments during his one-year term. He noted that… • During the 2017 legislative session, MAG was the leading advocate for a maintenance of certification (MOC) bill that was introduced by Rep. Betty Price, M.D. Having passed, H.B. 165 will preempt the state’s medical practice act from being used to require MOC for a physician to be employed by a state medical facility or for the purposes of licensure or insurance panels or obtaining malpractice insurance. • MAG convinced lawmakers to amend legislation that would have subjected physicians who fail to use the state’s prescription drug monitoring program (PDMP) to fines and criminal penalties. Given MAG’s intervention on H.B. 249, physicians will be able to allow two members of their practice staff to check the PDMP on their behalf. And thanks to MAG, this legislation was also amended to increase the number of exemptions that will be permitted. MAG also played a pivotal role in getting the bill’s effective date delayed until 2018 so the state can address the PDMP’s operational problems. • Physicians in the state should be pleased with MAG’s efforts to lobby for Medicaid pay that’s reasonable and sustainable – as lawmakers passed a FY 2018 budget that includes $38 million 8 MAG Journal

to increase pay for certain Medicaid primary care and OB-GYN codes. Of that, $6.5 million will be used to resolve physician location and attestation issues that MAG brought to the attention of the Georgia Department of Community Health. • MAG successfully opposed several onerous health insurance bills. Had it passed, H.B. 71 would have required physicians to participate in every health insurance plan that is offered by any hospital where they have privileges. And had it passed, S.B. 8 would have established an inadequate and unsustainable payment system for physicians who provide out-of-network care in emergency settings. • MAG opposed Anthem’s new retrospective ER policy. This includes writing op-eds and working with the Georgia Office of Insurance. • MAG called for legislation to reduce distracted driving in the state in 2017. While a bill did not ultimately pass during this year’s General Assembly, lawmakers did form a committee to study this issue before next year’s legislative session – and MAG serves on that committee. MAG also kept its eye on other important legislation in 2017, including bills that were related to physician autonomy and scope of practice. • MAG has maintained a strong relationship with key stakeholders, including the Georgia Office of Insurance, the Georgia Department of Public Health, the Georgia Composite Medical Board, and the pharmacy and dental boards.

• Nearly 100 physicians and 30 lawmakers attended the ‘Physicians’ Day at the Capitol’ event in January, while more than 80 physicians and 25 legislators discussed key issues like health insurance, opioid abuse, the PDMP, and patient safety during MAG’s 'Legislative Education Seminar' in June. • MAG staff continues to serve on key payer advisory committees, and MAG has helped numerous practices resolve claims problems with both public and private payers in 2017. • MAG has monitored lawsuits that are related to certificate of need and health insurance and other important issues. • MAG continues to promote HealtheParadigm, a health IT solution that features unique data analytics dashboards that enable physicians and hospitals in the state to share real-time patient information. • MAG has sponsored its ‘Top Docs Radio’ program twice a month. It has now reached more than 30,000 listeners – addressing important issues like state legislation, MACRA and MIPS, health insurance, antibiotics, developments in cancer care, prescription drug abuse, and distracted driving. • MAG updated its website. In addition to a cost savings of about $2,500 a year, mag.org is now more secure and mobile-friendly and easier to navigate. • MAG accredits 38 CME providers and the health care programs for 52 correctional facilities. • With nearly 150 physician members and more than 300 members in all, the MAG Medical Reserve Corps held training events in Atlanta and Savannah in February and March. It also participated in Georgia’s first ‘Vigilant Guard’ training exercise in March. Plus the MAG MRC is promoting the American College of Surgeons ‘Stop the Bleed’ campaign, and it recruited physicians to man shelters across the state during Hurricane Irma in September. • The MAG Institute for Excellence in Medicine continues to build MAG’s brand with educational projects and grants that are designed to enhance patient safety and clinical outcomes. Led by Manoj Shah, M.D., the institute’s board is evaluating some new and exciting ways to help patients and physicians in Georgia. In addition, the MAG Institute now houses the MAG MRC and HealtheParadigm. During his report, MAG Executive Director Donald J. Palmisano Jr. noted that, “MAG’s finances and membership are in a very sound position, and the organization continues to expand its offering of value-added programs and events, including a number of exclusive GAMPAC events, the Legislative Education Seminar, patient safety campaigns that address opioid abuse and distracted driving, a new and improved 401(k) plan, a cuttingedge health IT solution (HealtheParadigm), the Medical Reserve Corps, and our 'Top Docs Radio' show.” Key resolutions The HOD considered 100 items of business, including resolutions that called for MAG to... Adopt the L.E.A.D.S. (Lead, Engage, Advocate, Develop, Serve) medical student program to 1) increase education in organized medicine and advocacy amongst medical students across the state and 2) provide opportunities for engagement in organized medicine and advocacy without creating additional financial burdens or distractions from student education and training (401F.17). Adopted.

Outgoing MAG President Steven M. Walsh, M.D., puts the president’s pin on incoming MAG President Frank McDonald, M.D.

Work with appropriate state agencies and affected stakeholders to promote the creation of detoxification units in medical centers or other appropriate health care facilities to detoxify the patients and transfer them to appropriate rehabilitation facilities (601S.17). Adopted. Oppose the expansion of the legalization of non-standard and non-FDA approved cannabis for medical use in Georgia and educate physicians and other clinicians on the risks of artisanal cannabis products lacking FDA approval and call for the Georgia AMA Delegation to submit a resolution calling for AMA to work with the National Institutes of Health to ease some of the barriers to medical research regarding chemical components of marijuana (e.g., cannabidiol) that show great promise (602S.17). Adopted. Work with the Georgia Board of Pharmacy to 1) revise applicable regulations to ensure the safe, convenient placement of [prescription] drug disposal drop boxes in neighborhood retail pharmacies or other appropriate locations and 2) facilitate changes to its policy (480-50-.02) to allow the efficient destruction of these drugs by local law enforcement officials. And if the Georgia Board of Pharmacy is unable to update its policies on the destruction of [prescription] drugs, support legislation to establish state law ensuring the safe, convenient placement of [prescription] drug disposal drop boxes in neighborhood retail pharmacies or other appropriate locations (603S.17). Adopted. Encourage Georgia’s medical societies to develop drug [abuse] prevention presentations for middle and high school-aged students and facilitate the incorporation of these presentations into school curriculums (604S.17). Adopted. Call for all commercial health insurance plans that are offered in Georgia to 1) voluntarily waive all cost-sharing associated with screening colonoscopies and 2) specify that a colonoscopy, following a positive stool-based test that is part of the screening continuum, also be included in the waiver and 3) educate their provider network and members regarding this policy change. In addition, call for insurance companies that offer Medicare Advantage product lines in Georgia to 1) voluntarily waive co-pays for polyp removal discovered during a colonoscopy screening by reclassifying polypectomy as screening, not therapeutic and 2) voluntarily waive costs if the polyp leads to a biopsy by reclassifying the biopsy test as screening, not (continued on page 10)

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therapeutic and 3) waive all cost-sharing associated with positive stool tests that require a follow up colonoscopy, defining it as part of the screening continuum (102A.17). Adopted. Call for Georgia’s AMA Delegation to submit a resolution calling for the development of a model national policy to support the voluntarily removal of all cost-sharing associated with screening colonoscopies in all commercial and Medicare Advantage product lines consistent with the policies that are outlined in 102A.17 and that AMA be an advocate for the adoption of these policies (103A.17). Adopted. Oppose any federal legislation that would block grant or cap Medicaid funding to the states and work to maintain and strengthen the viability of the Georgia Medicaid program and oppose any state legislative or other efforts to curtail or diminish the program (104A.17). Referred to the BOD. Be an advocate for amending the state’s Maintenance of Certification (MOC) law to change its verbiage from “employment in state medical facilities” back to the original “for physician staff membership,” thereby covering all physicians in Georgia (301C.17). Adopted. Reaffirm its policy and position to remain neutral on issues regarding Certificate of Need (302C.17). Referred to the BOD for a report at the 2018 HOD. Support legislation calling for Georgia to become a member of the Interstate Medical Licensure Compact (304C.17). Adopted. Support the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ evidencebased meningococcal vaccination recommendations for children, adolescents, and adults (309C.17). Adopted. Contact MAG’s Kimberly Ramseur at kramseur@mag.org with questions related to HOD resolutions.

2017-2018 MAG Executive Committee Frank McDonald Jr., M.D. Gainesville, neurology President

Andrew B. Reisman, M.D. Oakwood, family medicine Secretary

Rutledge Forney, M.D. Atlanta, dermatology President-elect

Thomas E. Emerson, M.D. Marietta, urology Treasurer

Steven M. Walsh, M.D. Roswell, anesthesiology Immediate Past President

Edmund R. Donoghue Jr., M.D. Savannah, pathology Speaker of the House

Lisa Perry-Gilkes, M.D. Atlanta, ENT First Vice President

James W. Barber, M.D. Douglas, orthopedic surgery Vice Speaker of the House

Despina Dalton, M.D. Atlanta, pediatric emergency medicine Second Vice President

W. Scott Bohlke, M.D. Statesboro, family medicine Chair, Council on Legislation

Frederick C. Flandry, M.D. Columbus, orthopedic surgery Chair, Board of Directors

S. William Clark III, M.D. Waycross, ophthalmology Chair, Georgia AMA Delegation

Mark Huffman, M.D. Marietta, anesthesiology Vice Chair, Board of Directors

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Election results The following officers were elected for 2017-2018... President Frank McDonald, M.D., Gainesville, neurology President-elect Rutledge Forney, M.D., Atlanta, dermatology First Vice President Lisa Perry-Gilkes, M.D., Atlanta, ENT Second Vice President Debi Dalton, M.D., Atlanta, pediatric emergency medicine Secretary Andrew Reisman, M.D., Gainesville, family medicine Treasurer Tom Emerson, M.D., Marietta, urology AMA Delegate William Clark, M.D., Waycross, ophthalmology AMA Delegate Mike Greene, M.D., Macon, family medicine AMA Delegate Sandra Reed, M.D., Atlanta, OB-GYN AMA Delegate Billie Luke Jackson, M.D., Macon, dermatology AMA Alternate Delegate Gary Richter, M.D., Atlanta, gastroenterology AMA Alternate Delegate John Goldman, M.D., Atlanta, rheumatology AMA Alternate Delegate Ali Rahimi, M.D., Atlanta, cardiology Judicial Council member Chris Hackney, M.D., Roswell, anesthesiology The physicians who were elected to the BOD at the district and county levels included... District Rod Duraski, M.D. (Alternate Director, 6) John Antalis, M.D. (Director, 7) David Bosshardt, M.D. (Alternate Director, 7) Sudhakar Jonnalagadda, M.D. (Director, 8) Keith Johnson, M.D. (Alternate Director, 8)

2017 MAG HOD Sponsors MagMutual www.magmutual.com

Hanger Clinic www.hangerclinic.com

Angel Flight Soars www.angelflightsoars.org

HealtheParadigm www.healtheparadigm.org

ACG Wealth www.acgwealth.com

LegalShield www.legalshield.com/info/ gamedical

Appriss Health appriss.com CareSource www.caresource.com Compass PTN compassptn.qualitrac.com CopernicusMD www.coperinusmd.com GAMPAC www.mag.org/gampac Georgia Drug Card www.georgiadrugcard.com GaHIN www.gahin.org

MAG Alliance www.mag.org/alliance MAG Foundation www.mag.org/magf MAG Medical Reserve Corps www.mag.org/mrc MCG Alumni Association www.gru.edu/mcg Peach State Health Plan www.pshpgeorgia.com Privia Medical Group www.priviahealth.com SunTrust Medical Specialty Group www.suntrust.com

Richard Wherry, M.D. (Director, 9) Stephen Jarrard, M.D. (Alternate Director, 9) County Robert Jones, M.D. (Director, Bibb) Sid Moore, M.D. (Alternate Director, Bibb) Allen Garrison, M.D. (Alternate Director, Bibb) Mark Huffman, M.D. (Director, Cobb) Debi Dalton, M.D. (Alternate Director, Cobb) Andrew Herrin, M.D. (Director, Crawford Long) Ryan Katz, M.D. (Alternate Director, Crawford Long) Karen Lovett, M.D. (Director, Dougherty) Karl Schultz Jr., M.D. (Director, Hall) Abhishek Gaur, M.D. (Alternate Director, Hall) Quentin Pirkle Jr., M.D. (Director, MAA) Charles Wilmer, M.D. (Director, MAA) Tom Bat, M.D. (Alternate Director, MAA) Deborah Ann Martin, M.D. (Alternate Director, MAA) Albert Johary, M.D. (Alternate Director, MAA) John Cowan, M.D. (Director, Rome) William Gilbert, M.D. (Alternate Director, Rome)

Go to www.mag.org/img for additional information or contact Renai Lilly at rlilly@mag.org or 678.303.9263 to join MAG’s IMG Section. Resident Physician & Fellows Section

Chair Zach Lopater, M.D. Vice Chair Tracy Henry, M.D.

MAG’s Resident Physician & Fellows Section (RPFS) elected its officers for the year, including Chair Shoheb Ali, M.D., Vice Chair Brandon Kirshner, M.D., Secretary Kilby Osborn, M.D., and Treasurer Maegan Lazaga, M.D. Dr. Ali reports that, “The 2017 MAG HOD included an active and energetic resident physician section meeting. One of the goals we established a year ago was to expand resident physicians’ representation in the policy-making process. The HOD served as a unifying platform for residents throughout Georgia to form a web of interconnection. The RPFS now has physicians from Atlanta, Lawrenceville, Decatur, Macon, and Augusta.” He also notes that, “We are building a foundation for the next generation of physicians in Georgia to become more engaged and connected with one another. With this network, we become more united, and physicians can collectively work towards improving health care practices that improve the health of the community.” Dr. Ali adds that, “The goals of the RPFS include amplifying the efforts of its members, connecting with other members throughout the state, expanding its network of resident physicians, improving health care policy and practices in the state, and improving Georgia’s health care system. The RPFS consists of a statewide network of active resident physicians who are in constant communication. We hope to practice more efficient medicine, as well as create a ‘bottom-up, organic’ approach to policy change.” Finally, he says that, “One of our longer-term goals is to expand the RPFS network to non-health care professionals, including lawyers, entrepreneurs, politicians, economists, students, and other professionals – allowing the efficient and effective improvement in the access and delivery of health care in Georgia.” Go to www.mag.org/rpfs for additional information or contact Renai Lilly at rlilly@mag.org or 678.303.9263 to join MAG’s RPFS Section.

Medical Student Section

Young Physician Section

Chair Hannah Childs Vice Chair Naureen Mullani

MAG’s Young Physician Section (YPS) elected its officers for the year, including Chair Zachary Lopater, M.D., Vice Chair Tracey Henry, M.D., Secretary & Treasurer Amin Yehya, M.D., MAG HOD Delegate Manuel Rodriguez, D.O., MAG HOD Alternate Delegate & Member-At-Large Sara Acree, M.D., and AMA Delegate Shamie Das, M.D. Dr. Lopater reports that YPS will focus on building better networks in Georgia. He explains that, “A lot of physicians who have recently moved to the state have told us that they value social and networking events, so we will focus on that and increasing MAG’s membership and becoming more involved in MAG as a section.” Dr. Henry adds that. “The section’s strategic goals for the year will include building awareness, outreach, and developing leadership and advocacy opportunities for the busy, early-career physician. It is imperative for our non-member peers understand

IMG Section Chair Ayman Rihawi, M.D. Vice Chair Masoumeh Ghaffari, M.D. Resident Section Chair Shoheb Ali, M.D. Vice Chair Brandon Kirshner, M.D. Young Physician Section

International Medical Graduate Section MAG’s International Medical Student Graduate (IMG) Section elected its officers for the year, including Chair Ayman Rihawi, M.D., Vice Chair Masoumeh Ghaffari, M.D., MAG Delegate T. Sekhar, M.D., MAG Alternate Delegate Dilipkumar Patel, M.D., Secretary Sudha Tata, M.D., Treasurer Rani Swaroopa Reddy, M.D., and members at large Arvind Gupta Valdosta, M.D., and Leiv Takle Jr., M.D. “The majority of the IMG meeting was spent discussing ways to expand the number of residency slots that are available in Georgia,” says Manoj Shah, M.D., a member of the IMG Board. “We also decided that that IMG should identify clinical observeship positions and research opportunities for IMG with medical practices and hospitals.”

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the benefits associated with being a MAG member and the YPS Section – and we will reach out to young physicians across the state in every practice setting, including academics, private practice, and rural areas.” Go to www.mag.org/yps for additional information or contact Renai Lilly at rlilly@mag.org or 678.303.9263 to join MAG’s RPFS Section. Medical Student Section The 2017-2018 MAG Medical Student Section (MSS) officers will include Chair Hannah Childs (MCG/Athens), Vice Chair Naureen Mullani (MCG/AU), Secretary Hannah Harrison (MCG/Athens), Treasurer Nathan Mickinac (MCG/ Southeast), MAG Delegate David Yashar (MCG/AU), MAG Alternate Delegate Alexandra Thomson (MCG/Athens), and Officer-At-Large Benjamin Wilson (MCG/AU). “The MAG MSS goals for the year will include expanding the ‘Generation Rx’ program that was developed by the Richmond County Medical Society to address the dangers associated with prescription drug in elementary and middle and high schools in the state,” reports Childs. “We will also take steps to improve communications within the medical student community in the state, we will establish primary contacts at every medical school in the state, and we will develop resources – including videos and brochures – that we can use to increase MAG and MSS membership.” It is also worth notion that MSS Immediate Past Chair Ebony Caldwell gave an update on the aforementioned, MSSsponsored L.E.A.D.S. resolution (that passed the next day) when the MSS met during the HOD. Go to www.mag.org/mss for additional information or contact Renai Lilly at rlilly@mag.org or 678.303.9263 to join MAG’s MSS. Medical Student Abstract Competition MAG held an abstract competition for MAG member students during the HOD, which included four categories – including basic science/bench work, clinical research, public health, and case studies. It also featured a “Best Pitch Competition,” whereby the student had 45 seconds to give their best “pitch” to a panel of physician judges. The contest was open to every student in every class in every medical school in the state. The winners included… Sunny Patel (MCG/AU) Basic Science Katherine Rhoades (Mercer) Case Report Jason Moraczewski (MCG/AU) Clinical Science Salima Makhani (Mercer) Public Health Hyunjin Song (MCG/AU) Best Pitch Go to page 22 for details on the winning abstracts. Dignitaries Among the dignitaries who attended the 2017 HOD were AMPAC Board Member Stephen Imbeau, M.D., AMA 12 MAG Journal

Immediate Past Chair of the Board of Trustees Patrice Harris, M.D., North Carolina Medical Society President John Reynolds, M.D., South Carolina Medical Society President Richard Osman, M.D., Georgia Reps. Stacey Abrams, Sharon Cooper, Mark Newton, M.D., Betty Price, M.D., and Bob Trammell, Georgia Sens. Kay Kirkpatrick, M.D., and Chuck Hufstetler, former HHS Sec. Tom Price, M.D., and U.S. Reps. Buddy Carter and Drew Ferguson from Georgia, Rep. Neal Dunn, M.D., from Florida, and Rep. Roger Marshall, M.D., from Kansas. GAMPAC GAMPAC Chair Michelle Zeanah, M.D., reports that GAMPAC raised nearly $120,000 to elect pro-physician candidates in the state during the HOD meeting. She also notes that more than 120 GAMPAC members attended an exclusive lunch program that GAMPAC hosted for its members on October 21 that included a health care panel that featured U.S. Reps. Buddy Carter and Drew Ferguson from Georgia, Rep. Neal Dunn, M.D., from Florida, and Rep. Roger Marshall, M.D., from Kansas. “It was a really interesting and informative program,” says Dr. Zeanah. “These four lawmakers offered a real-world look at where we are and where we are going from a health care reform perspective at the federal level.” Contact Bethany Sherrer at bsherrer@mag.org or 678.303.9273 or go to www.mag.org/gampac to join GAMPAC. MAG Foundation MAG Foundation President Jack M. Chapman Jr., M.D., gave updates on several key programs, including the ‘Think About It’ campaign to reduce prescription drug abuse and the Georgia Physicians Leadership Academy (GPLA). Dr. Chapman said that the ‘Think About It’ campaign is now focused on physician outreach and education (e.g., promoting good prescribing practices), looking for ways to collaborate with allied stakeholders (e.g., federal, state, regional and local agencies, private and not-for-profit organizations, and academic institutions), and encouraging physicians to use Georgia’s Prescription Drug Monitoring Program. Dr. Chapman also noted that, “Project DAN has also been a huge success, as the MAG Foundation – with the support of the Northeast Georgia Medical Center Foundation – has provided first responders in 53 counties throughout Georgia with more than 5,000 doses of naloxone – resulting in more than 60 lives saved.” He added that GPLA’s 10th class is underway. The MAG Foundation program now has more than 120 graduates, including former MAG presidents W. Scott Bohlke, M.D., Manoj Shah, M.D., and Steve Walsh, M.D. – as well as MAG’s 2017-2018 president, Frank McDonald, M.D. Dr. Chapman thanked and applauded the GPLA Steering Committee – which includes Chair John Sy, M.D., and Vice Chair Stephen Jarrard, M.D. – for its efforts. Finally, Dr. Chapman announced that the MAG Foundation had teamed up with the Medical Association of Atlanta and the MAG Alliance to create the ‘Make Georgia Hands-Free’ campaign to reduce distracted driving in the state – with plans to launch the effort with a town hall that will take place in Atlanta on

December 2 and a social media campaign that will get underway shortly thereafter. In addition to Dr. Chapman, the MAG Foundation’s Board of Trustees includes Vice President John S. Antalis, M.D., Secretary/Treasurer Steven M. Walsh, M.D., W. Scott Bohlke, M.D., Ali Rahimi, M.D., Anurag Sahu, M.D., and William E. Silver, M.D. Contact Lori Cassity Murphy at 678.303.9282 or lmurphy@mag. org or go to www.mag.org/magf for additional information or to support the MAG Foundation with a tax-deductible donation. MAG Alliance During his report, MAG Alliance President Dave Street stressed that the MAG Alliance “wants to continue to be a network of support for physician families in Georgia.” Street said that, “For the rest for 2017 and 2018, the MAG Alliance will be focused on increasing its membership, communicating with spouses of Georgia physicians in a variety of ways, advocating on behalf of Georgia physicians on key legislative issues, and being involved in health and service projects with MAG that impact the health of Georgia citizens.” Georgia physician’s spouses can go to www.magalliance.org to join the MAG Alliance for $25 for 2018 or for additional information. MagMutual luncheon Gold-level HOD sponsor MagMutual Insurance Company hosted a delegates’ luncheon that featured a keynote ‘Victories in Patient Safety’ presentation by Bill Kanich, M.D., J.D., the chief medical officer of MagMutual’s Patient Safety Institute. Dr. Kanich noted that, “Several government and private groups were developing programs to identify and reduce medical errors… [and that] medical professional liability providers, like MagMutual, are in a unique position to both gather and disseminate data on medical errors.” He said that MagMutual’s programs “foster an environment of patient safety, including live educational programs, online resources, and point-of-care decision tools (e.g., ‘UpToDate’).” Dr. Kanich also stressed that, “MagMutual values its partnership with the Medical Association of Georgia, which continue to work in tandem to further the interests of physicians and patients in Georgia through their work on legislative issues, educational programs, and public health initiatives.” He concluded his remarks by stressing that, “MagMutual would continue to strengthen its partnership with MAG to address key patient safety issues, including physician burnout, telemedicine, and the physician shortage.” CME More than 50 physicians took advantage of a free CME activity that the Medical College of Georgia Alumni Association sponsored that featured David C. Hess, M.D., the dean of the Medical College of Georgia at Augusta University. He gave a ‘What doesn’t kill you makes you stronger’ presentation that addressed 1) how physical exercise reduces stroke and heart attack and dementia and 2) how exercise mimetics can be used to help for patients who are unable or unwilling to exercise and 3) ischemic conditioning.

Contact MAG Director of Education Andrew Baumann at abaumann@mag.org with questions related to CME. Delegates’ survey In a survey that was sent to HOD delegates after the meeting... • 79% rated the meeting as excellent, while 21% said it was good. • 100% said there was a good mix of meetings and free/social time, while 97% felt the meeting was "just right" when it came to its duration. • 62% rated the Hyatt Regency Savannah as an excellent venue, while 24% said it was good. • 86% said the meeting was interesting and informative, while 14% said it was informative but boring. • 97% believe “everyone had an opportunity to express their opinion.” • 100% said they had enough information and staff support. • 67% liked MAG’s HOD meeting app, while 28% said they did not use it. MAG Board actions During its meeting on October 20, MAG’s Board of Directors… • Approved MAG’s priorities for the 2018 state legislative session (see the article on page 30 for details). • Approved a recommendation to transfer the platform that is used for the MAG MEP 401(k) Plan that ACG Wealth manages from Transamerica to BlueStar Retirement to streamline the plan’s administrative process, provide more investment options, eliminate annual audits for plans that have more than 100 participants, and reduce the fiduciary liability for MAG and the plan’s participating practices. • Elected Fred Flandry, M.D., and Mark Huffman, M.D., to serve as its chair and vice chair for the next year. • Appointed the Journal of the Medical Association of Georgia’s Editorial Board for 2017-2018, including Editor Stanley Sherman, M.D. Laura McCrary, the senior vice president of KaMMCO Health Solutions and the executive director of the Kansas Health Information Network, gave a free CME presentation that was designed to “provide physicians and clinicians with the knowledge to drive quality improvements and transform health care through the application of meaningful data analytics for quality reporting, population health management, risk management, and clinical effectiveness.” Contact MAG Executive Director Donald J. Palmisano Jr. at dpalmisano@mag.org with questions related to the BOD meeting. Go to www.mag.org/HOD for additional information on the 2017 HOD meeting, including the policies that were reaffirmed or revised, the reference committee reports, and the actions of the BOD and the Executive Committee. Also go to www.mag.org/HOD to see 2017 HOD meeting photos. Contact Renai Lilly at 678.303.9263 or rlilly@mag.org with any questions related to the 2017 HOD meeting.¨

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2017 MAG AWARD RECIPIENTS

Lamartine Hardman Cup BARRY SILVERMAN, M.D.

arry Silverman, M.D., was honored with the Lamartine Hardman Cup during a ceremony that took place in conjunction with the Medical Association of Georgia’s (MAG) 163nd House of Delegates meeting in Savannah on October 21. The MAG award is given to a physician who has solved an outstanding problem in public health or made a discovery in surgery or medicine or a contribution to the science of medicine. In nominating him for the award, Medical Association of Atlanta (MAA) Executive Director David Waldrep pointed out that, “Dr. Silverman recognized early on in his career that medical associations were a critical safeguard to protect and preserve patient care and the practice of medicine. He has always understood that organizations like MAG and MAA result in better patient care and a better practice environment.” In practice for more than 40 years, Dr. Silverman is a board-certified cardiologist with the Northside Heart practice in Atlanta. He specializes in non-invasive cardiology and pacemaker implantations.

Having arrived in Atlanta in 1973, Dr. Silverman is one of the physicians who is credited with establishing a medical education program at Northside Hospital. He was Northside’s chief of cardiology and director of internal medicine education. Dr. Silverman taught at the Emory University School of Medicine on a full-time basis for six years, and he has been teaching medical students, PA students, residents, and cardiac fellows at Northside and Grady for 44 years. In addition to MAG and MAA, Dr. Silverman has been an active member of the American Medical Association, the American College of Physicians (ACP), the American Heart Association (AHA), and the American College of Cardiology (ACC). Dr. Silverman is credited with planning numerous physician education conferences in Georgia for both ACP and ACC. It is also worth noting that he served as the chair of AHA’s CPR Taskforce – and he was one of the first physicians to teach advanced cardiac life support in the state. Dr. Silverman is a long-time member of the

Barry Silverman, M.D.

Editorial Board for the Journal of the Medical Association of Georgia, and he served as the editor of MAA’s Atlanta Medicine magazine for 20 years. His interests include “the doctor-patient relationship, improving physicians’ ‘bedside manners,’ and the bedside cardiac exam.” Dr. Silverman has a medical degree from Ohio State University. Dr. Silverman and his wife, Martha Silverman, live in Atlanta. They have three children and three grandchildren. The award was named for Lamartine Hardman, M.D., who was Georgia’s governor from 1927 to 1931 and who was a successful physician, entrepreneur, and farmer from Jackson County.

Physician’s Award for Community Service E.D. DELOACH, M.D., FACS

avannah plastic surgeon E.D. DeLoach, M.D., FACS, received the Physician’s Award for Community Service during a ceremony that took place in conjunction with the Medical Association of Georgia’s (MAG) 163rd House of Delegates meeting in Savannah on October 21. The MAG award recognizes physicians who demonstrate a love for the community outside the regular scope of practice. Dr. DeLoach has been applauded for founding the ‘Health Care Heroes’ awards program, which is sponsored by the Georgia Medical Society (GMS). This honors individuals who improve health care in Savannah on an annual basis. In his nomination letter, GMS President Joshua T. McKenzie, M.D., stressed that, “Dr. DeLoach is very dedicated to honoring our ‘Health Care Heroes’ for what they do to make Savannah a 14 MAG Journal

healthier community. He designed this program, and it has been a great success. And the entire health care community in Savannah consequently has a better, closer working relationship.” Dr. DeLoach has participated in medical mission trips to the north-central mountains of Nicaragua – the poorest area of the second poorest country in the western hemisphere – that have been sponsored by John 3:16 Medical Ministries, Inc. since 2004. And in 2010, Dr. DeLoach and his wife, Cam DeLoach, formed a separate John 3:16 Ministries non-profit group to provide basic primary care and surgical services for the people who live in the region. The DeLoachs now go on two medical missions to Nicaragua each year. It is also worth noting that Dr. DeLoach is one of the founders of the Growing Healthy Program in the Chatham County

E.D. DeLoach, M.D. (on the left) receives the Medical Association of Georgia’s Physician’s Award for Community Service from outgoing MAG President Steven M. Walsh, M.D.

Public School system, an effort that teaches children how to live a healthier lifestyle. This program now covers 23 elementary schools in Chatham County, teaching thousands of children every year. Dr. DeLoach has been in a number of leadership roles at MAG since 1980, including serving as its president in 2010-2011. Dr. DeLoach has a medical degree from the Medical College of Georgia in Augusta. The DeLoachs live in Savannah. They have three children and two grandchildren.

Jack A. Raines Humanitarian Award TERESA E. CLARK, M.D.

eresa E. Clark, M.D., was honored with the Jack A. Raines Humanitarian Award during a ceremony that took place in conjunction with the Medical Association of Georgia’s (MAG) 163rd House of Delegates meeting in Savannah on October 21. The MAG award is given to a physician for their outstanding humanitarian contributions beyond the normal practice of medicine. In nominating Dr. Clark for the award, Sandra Fryhofer, M.D., emphasized that, “Dr. Clark has always loved her patients. She is a champion for the elderly, the disabled, and the underserved.” Dr. Fryhofer added that, “Dr. Clark’s community service goes back to her early years in practice. While many doctors went on vacation in their free time, Dr. Clark spent her free time volunteering her time and services to others.” Early in her career, Dr. Clark cared for the homeless as volunteer at the Techwood

Baptist Center, the Medical Association of Atlanta Homeless Clinic, and the Georgia Nurses’ Foundation Homeless Clinic. In practice for nearly 40 years, Dr. Clark has also been involved with the Baptist MedicalDental Fellowship and its ministries. She is a Baptist Mobile Health Ministry founder, an immediate past president, and a member of its Board of Directors. Dr. Fryhofer explains that, “What began as a converted Blue Bird school bus serving migrant and/or indigent patients is now two working dental mobile vans, each with three working dental chairs, serving needy patients state-wide.” It is also worth noting that Dr. Clark has participated in medical missions to Liberia (before Ebola), Haiti (after the earthquake), Honduras (this summer with first-year medical students from the Mercer University School of Medicine), and Ghana – where she has provided care at a bush hospital on multiple occasions, with plans to do so again early next year.

Teresa E. Clark, M.D., receives the Medical Association of Georgia’s Jack A. Raines Humanitarian Award from outgoing MAG President Steven M. Walsh, M.D.

Upon “retiring” from her practice at Piedmont Hospital in Atlanta in 2016, Dr. Clark became a volunteer physician at the Good Samaritan Health Center of Gwinnett – becoming its unpaid medical director early in 2017. Dr. Clark has a medical degree from the Vanderbilt University School of Medicine in Nashville. Dr. Clark and her husband, Michael Fowler, live in Buford. They have one daughter, a student at the Mercer University School of Medicine.

Joseph P. Bailey Jr., M.D., Physician Distinguished Service Award PATRICE A. HARRIS, M.D.

atrice A. Harris, M.D., received the Joseph P. Bailey Jr., M.D., Physician Distinguished Service Award during a ceremony that took place in conjunction with the Medical Association of Georgia’s (MAG) 163nd House of Delegates meeting in Savannah on October 21. The MAG award is given to a physician for distinguished and meritorious service that reflects credit and honor on MAG. In nominating the Atlanta psychiatrist for the award, Medical Association of Atlanta (MAA) Executive Director David Waldrep emphasized that, “Dr. Harris has been an advocate for patients and physicians as a delegate to and Chair of the Board of the American Medical Association (AMA) and as a member of the Medical Association of Georgia’s Council on Legislation.” Dr. Harris has made significant contributions as “a private practice physician, a public health administrator

(in Fulton County), a patient advocate, and a medical society lobbyist.” She currently serves as the immediate past chair of AMA’s Board of Trustees. In addition to holding numerous positions at MAG and AMA, Dr. Harris served as the president of the Georgia Psychiatric Physicians Association. It is also worth noting that she was a founding co-chair of that organization’s political action committee. Dr. Harris is a national authority on the opioid epidemic, health care reform, health care financing, insurance reform, health care disparities, juvenile law, children’s mental health, and addiction. She has also been a leading advocate in the fight against child abuse and neglect. Dr. Harris has appeared on a number of local and national television and radio shows, including CNN and The Today Show on NBC.

Patrice A. Harris, M.D., receives the Medical Association of Georgia’s Joseph P. Bailey Jr., M.D., Physician Distinguished Service Award from outgoing MAG President Steven M. Walsh, M.D.

Dr. Harris is now in private practice and consults on health service delivery and emerging trends in practice and health policy. She also serves as an adjunct professor in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine in Atlanta. Dr. Harris has a medical degree from the West Virginia University School of Medicine – and she was inducted into the West Virginia University Academy of Distinguished Alumni in 2007. www.mag.org 15

Donna Glass Non-Physician Distinguished Service Award DALLAS F. GAY

allas F. Gay was honored with the Medical Association of Georgia’s (MAG) Donna Glass Non-Physician Distinguished Service Award during a ceremony that took place in conjunction with the MAG’s 163rd House of Delegates meeting in Savannah on October 21. The MAG award honors non-physicians for their contributions to the advancement and support of medicine.

In his nomination letter, Hall County Medical Society member Jack M. Chapman Jr., M.D., stated that, “Dallas Gay is one of the primary architects of the Medical Association of Georgia Foundation’s ‘Think About It’ campaign to reduce prescription drug abuse – raising some $400,000, including a personal donation of $10,000.” Dr. Chapman added that, “In his role as the ‘Think About It’ campaign chair community co-chair, Mr. Gay has been

a tireless advocate for raising awareness with key stakeholders across the state. In addition to garnering widespread media coverage for the ‘Think About It’ campaign, Mr. Gay has made a countless number of presentations in Georgia.” It is also worth noting that Gay – who lost his grandson, Jeffrey, to prescription drug abuse in 2012 – helped the MAG Foundation secure more than $280,000 from the Northeast Medical Center Foundation to fund ‘Project DAN’ (Deaths Avoided by Naloxone), which has funded more than 5,000 doses of naloxone for first responders and which has been credited with saving at least 60 lives. And Dr. Chapman pointed out that, “Dallas led the effort to create the training program and educational resources for law enforcement officers and other first responders on how to administer naloxone.

Dallas F. Gay

Dr. Chapman concluded that, “Mr. Gay has spent an enormous amount of time and personal resources to combat the prescription drug abuse epidemic in Georgia. The residents of Hall County and other parts of the state are consequently living better and safer lives.” Gay is the chairman of the board of Protein Products in Gainesville. Gay and his wife, Bobbie Gay, live in Gainesville. They have two children and four grandchildren.

MAG honors lawmakers with ‘Friend of Medicine’ award The Medical Association of Georgia (MAG) recently honored four state legislators with its ‘1849 Friend of Medicine Award’ to recognize them for their efforts during the General Assembly in 2017. This includes… • Rep. Sharon Cooper (R-Marietta), the chair of the House Health & Human Services Committee (HHS), who was a “tireless champion” for the medical profession on several key fronts, including out-ofnetwork billing, scope of practice, and opioid abuse.

Dr. McDonald also stresses that, “This is the kind of action-oriented leadership we need to ensure that Georgians have access to the physicians they need in every specialty and locale. These lawmakers have earned their pro-patient and pro-physician reputations.”

• Rep. Betty Price, M.D. (R-Roswell), who introduced a landmark bill, H.B. 165, that ensures that maintenance of certification cannot be used as a condition of licensure. • Sen. Chuck Hufstetler (R-Rome), who was a leading advocate for physicians on out-of-network billing and the state’s Prescription Drug Monitoring Program (PDMP). • Sen. Ben Watson, M.D. (R-Savannah), a member of the Senate HHS who also led the pro-physician charge on out-of-network billing and PDMP legislation. “These four legislators deserve our thanks and admiration,” says MAG President Frank McDonald, M.D., M.B.A. “They have proven that they are true advocates for the medical profession, and the state’s practice environment and overall health care system are in a far better place as a result of their efforts.”

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From the left are Sens. Ben Watson, M.D., and Chuck Hofstetler, GAMPAC Vice Chair James Smith, M.D., and Reps. Sharon Cooper and Betty Price, M.D.

2017 LIFE MEMBERS

“Life members” are physicians who are 70 years or older who have been an active, dues-paying member of a state medical society or in a branch of the armed services for at least 25 consecutive years – including at least two years with MAG. Life members are not required to pay MAG dues or assessments. They will continue to receive the MAG ‘Journal’ on a complimentary basis. Oscar E. Aguero Sr., M.D. Alfredo Alarcon, M.D. Marshall Bonner Allen Jr., M.D. Barbara J. Allen-Dalrymple, M.D. Joseph M. Almand Jr., M.D. John H. Angell, M.D. Murray C. Arkin, M.D. Gerson Harvey Aronovitz, M.D. Cirilo A. Aseron Jr., M.D. Harold Asher, M.D. George Jeff Austin Jr., M.D. Philip Bates Bailey, M.D. Henry Faver Ball, M.D. Crawford F. Barnett Jr., M.D. William Lawrence Barnwell, M.D. Albert Barrocas, M.D. John Gilbert Bates, M.D. William Ward Baxley Jr., M.D. Ernest W. Beasley Jr., M.D. James Louis Becton, M.D. James A. Bedingfield, M.D. Fred M. Bell Jr., M.D. William H. Benson Jr., M.D. William Henry Biggers, M.D. Jack K. Bleich, M.D. William F. Bloom, M.D. Jerry Arvin Boatwright, M.D. H. William Bondurant, M.D. James Larry Boss, M.D. Franklyn P. Bousquet Jr., M.D. Robert L. Brand III, M.D. Donald L. Branyon Jr., M.D. Farrell Hobbs Braziel, M.D. Harry Harris Brill Jr., M.D. Avery B. Brinkley, M.D. John B. Brinson Jr., M.D. William P. Brooks, M.D. Juanita A. Brooks-Warren, M.D. Leonard Brown, M.D. Nelson H. Brown, M.D. Gwynne T. Brunt Jr., M.D. John Knox Burns III, M.D. Charles George Burton, M.D. Dwana Marie Bush, M.D. Leon Hays Bush, M.D. William H. Cabaniss Jr., M.D. Louis G. Cacchioli, M.D. Daniel Bennett Caplan, M.D. Gerald E. Caplan, M.D. M. Gary Carter, M.D. George C. Cauble, M.D. Rives Coleman Chalmers, M.D. Arthur Bleakley Chandler Sr., M.D. Jay S. Coffsky, M.D. Marvyn Donald Cohen, M.D. Paul Gary Cohen, M.D. Richard William Cohen, M.D. Sheldon B. Cohen, M.D. Terrence J. Cook, M.D. Rawser Paul Crank Jr., M.D. Laurence Tarver Crimmins, M.D. John M. Crymes, M.D. Ernest F. Daniel Jr., M.D. Waverly Berkley Dashiell, M.D. Alfred L. Davis Jr., M.D. Henry Gordon Davis Jr., M.D. John Lorraine Davis III, M.D.

Marion Bedford Davis Jr., M.D. Jose Arturo Delgado, M.D. Keith A. Dimond, M.D. Robert S. Donner, M.D. Roy Gordon Duncan, M.D. William Robert Dunn, M.D. Louis Dupont, M.D. Thomas Earl Dupree, M.D. Lawrence L. Durisch Jr., M.D. Harmer Oran Eason Jr., M.D. Anthony Ekwenchi, M.D. Lois Taylor Ellison, M.D. Bruce A. Elrod, M.D. Harold S. Engler, M.D. David Allan Epstein, M.D. William G. Erickson, M.D. Richard C. Estes, M.D. John G. Etheridge, M.D. James Patrick Evans, M.D. William B. Fackler Jr., M.D. Alva Humphrey Faulkner, M.D. Elaine B. Feldman, M.D. David Earl Field, M.D. Elliott Ronald Finger, M.D. Waldo Emerson Floyd Jr., M.D. Harry Robert Foster Jr., M.D. Julia Graydon Wood Foster, M.D. Milton Frank III, M.D. Milton H. Freedman, M.D. Charles Freeman Jr., M.D. Ronald A. Freeman, M.D. Thomas Rumph Freeman, M.D. William H. Galloway, M.D. Cyler D. Garner, M.D. Glen Earl Garrison, M.D. Brinton Bizzelle Gay Jr., M.D. William N. Gee Jr., M.D. Charles Braselton Gillespie, M.D. Joe I. Gillespie, M.D. Bruce M. Gillett, M.D. Kenneth S. Gimbel, M.D. Martin Irving Goldstein, M.D. George Robert Gottlieb, M.D. William J. Gower, M.D. David Howard Greenwald, M.D. Herbert S. Greenwald Jr., M.D. Joseph W. Griffin Jr., M.D. Arvind Gupta, M.D. Jerold Alan Haber, M.D. Maxwell F. Hall Jr., M.D. Newell M. Hamilton, M.D. John H. Harbour, M.D. William R. Hardcastle, M.D. Billy Star Hardman, M.D. William J. Hardman, M.D. William Alton Hays Jr., M.D. John Phinazee Heard, M.D. Edgar Randolph Hensley, M.D. Pascual Herrera, M.D. Eugene Van Landingham Herrin, M.D. Theodore Hersh, M.D. John Bunn Hill Jr., M.D. Joseph H. Hilsman, M.D. Edward David Himot, M.D. Jack Walter Hirsch, M.D. Frank Hoffman, M.D. Bernard C. Holland, M.D.

Emory Willie Holloway Jr., M.D. Noel Holtz, M.D. Henry Lee Howard Jr., M.D. Douglas Crawford Huber, M.D. John L. Hughes, M.D. Wayne Gary Hulsey, M.D. Arthur Lee Humphries Jr., M.D. Dirk Erik Huttenbach, M.D. Steve Kyousick Hwang, M.D. Menard C. Ihnen, M.D. Ervine P. Inglis Jr., M.D. John S. Inman Jr., M.D. Anthony Frank Isele, M.D. Sidney Isenberg, M.D. Bethanne Foley Jenks, M.D. C. Emory Johnson Jr., M.D. Charles Garden Johnson, M.D. Jimpsey Burke Johnson, M.D. Thomas Devann Johnson, M.D. George Richard Jones, M.D. William Ellis Josey, M.D. Julio Jove, M.D. Zeynep Karasu, M.D. Ferdinand Vogt Kay, M.D. Craig Todd Kerins, M.D. James Lon King Jr., M.D. William R. King Jr., M.D. James Leroy Kirkpatrick, M.D. Luella V. Klein, M.D. Alex Z. Klopman, M.D. William Jay Klopstock, M.D. Robert Anthony Kral, M.D. Constantine Peter Lampros, M.D. Charles A. Lanford Sr., M.D. James Franklin Langford, M.D. Bob G. Lanier, M.D. Walter Edward Lee Jr., M.D. Ted Flournoy Leigh, M.D. Bernard Lerman, M.D. Michael K. Levine, M.D. Craig S. Lichtenwalner, M.D. Paul Harvey Liebman, M.D. William D. Logan Jr., M.D. William Trent Lucas, M.D. Robert Mainor, M.D. David S. Mann, M.D. Frank Rambo Mann Jr., M.D. James Hunt Manning, M.D. Thomas Windrow Marks, M.D. Steven I. Marlowe, M.D. Louie F. Woodward Marshall, M.D. Alberto Carlos Martinez, M.D. Jose Ramon Martinez, M.D. Charles Bush May, M.D. Stephen C. May Jr., M.D. Alva L. Mayes Jr., M.D. Milton Mazo, M.D. Ray Harold McCard, M.D. John Marshall McCoy, M.D. Fayette M. McElhannon Jr., M.D. Joe Lewis McLendon, M.D. John W. McLeod, M.D. Noah D. Meadows Jr., M.D. William Hugh Meeks Sr., M.D. Jack F. Menendez, M.D. Harvey Ernest Merlin, M.D. Charles Aloysius Meyer Jr., M.D.

Roger Albert Meyer, M.D. Carey A. Mickel Jr., M.D. Jacqueline White Miller, M.D. Byron D. Minor, M.D. Victor Augustus Moore Jr., M.D. Russell Ray Moores, M.D. Hugo A. Sanchez Moreno, M.D. Harvey Vaughan Morgan, M.D. Jacob Moshev, M.D. Benjamin F. Moss Jr., M.D. Steven A. Muller, M.D. Darrell W. Murray, M.D. Hamil Murray, M.D. Dearing A. Nash, M.D. Puthugramam K. Natrajan, M.D. John Bruce Neeld Jr., M.D. Maury C. Newton Jr., M.D. William Lanier Nicholson, M.D. James Lawton O’Quinn, M.D. Benjamin Boyd Okel, M.D. William W. Orr Sr., M.D. William W. Osborne, M.D. John Anthony Page, M.D. Joseph L. Parker, M.D. Prentiss E. Parker Jr., M.D. Jesse Lyle Parrott, M.D. Thomas Corley Paschal, M.D. Robert Marion Patton, M.D. Peter Michael Payne, M.D. Jesse R. Peel, M.D. William J. Pendergrast Sr., M.D. James Chandler Pope, M.D. Stuart Holmes Prather Jr., M.D. Carol Graham Pryor, M.D. Dent W. Purcell, M.D. Norman B. Pursley, M.D. Harold Smith Ramos, M.D. Alfred Henry Randall Jr., M.D. Albert A. Rayle Jr., M.D. Charles Joseph Rey Jr., M.D. Donald Wallace Rhame, M.D. Sterling H. Richardson, M.D. Henry C. Ricks Jr., M.D. Wells Riley, M.D. Robert Arthur Robbins, M.D. Michael F. Roberts Jr., M.D. Phillip Lee Roberts, M.D. Ralph Donald Roberts, M.D. Harvey B. Roddenberry, M.D. Howard Stephen Rosing, M.D. Julius Thornton Rucker Jr., M.D. Edward Kinzel Russell, M.D. Ferrol Aubrey Sams Jr., M.D. Gerald E. Sanders, M.D. John Keith Schellack, M.D. Philip Thomas Schley, M.D. Elbert William Schmitt Jr., M.D. Carl C. Schuessler, M.D. Robert Ira Schwartz, M.D. George P. Sessions, M.D. Narendra K. Shah, M.D. Kailash B. Sharma, M.D. Edwin C. Shepherd, M.D. Eloise Baim Sherman, M.D. Barry David Silverman, M.D. Charles M. Silverstein, M.D. Robert Webb Simmons, M.D.

William Crawford Simmons, M.D. Howel William Slaughter Jr., M.D. Hugh F. Smisson Jr., M.D. Charles Walter Smith, M.D. Chester M. Smith Jr., M.D. James Leon Smith, M.D. Luther J. Smith II, M.D. Patton Paul Smith, M.D. Samuel Raymond Smith, M.D. William Hill Somers, M.D. John Aziz Souma, M.D. Stephen Danny Spain, M.D. Jacob Aaron Spanier, M.D. Raymond F. Spanjer, M.D. Oscar Smith Spivey, M.D. Irving Teague Staley, M.D. Franklin Julian Star, M.D. Michael Stebler, M.D. Dan Bryan Stephens, M.D. Elma Mera Steves, M.D. Robert L. Stump Jr., M.D. Yung-Fong Sung, M.D. Panagiotis N. Symbas, M.D. David E. Tanner, M.D. Robert Pierpont Taylor, M.D. David C. Thibodeaux, M.D. Donald Ray Thomas, M.D. William Robert Thompson, M.D. William A. Threlkeld, M.D. John Nicholas Tiliacos, M.D. Ralph A. Tillman, M.D. William Clyde Tippins Jr., M.D. Robert P. Tucker, M.D. Mildred Virginia Tuggle, M.D. William Darrell Tumlin, M.D. David Allen Turner, M.D. Carroll S. Tuten, M.D. Karl Henry Ullman, M.D. Charles R. Underwood, M.D. Charles Bell Upshaw Jr., M.D. Roy W. Vandiver, M.D. Edgar Allen Vaughan, M.D. Abraham S. Velkoff, M.D. Irving Victor, M.D. John Seth Wade, M.D. Edward Jones Waits, M.D. Charles Osborne Walker Jr., M.D. Richard Storer Ward, M.D. John D. Watson Jr., M.D. Paul Daniel Webster III, M.D. Paul Austin Whitlock Jr., M.D. Stewart Earle Wiegand, M.D. Christopher James Wilke, M.D. Howard J. Williams Jr., M.D. William T. Williams, M.D. John Page Wilson, M.D. Joseph Sealy Wilson Sr., M.D. Roy Witherington, M.D. Homer Patrick Wood, M.D. Robert Warner Wood, M.D. Thomas Earl Wyatt, M.D. Owen K. Youles Jr., M.D. Frank Yu, M.D. Joseph Robert Zanga, M.D. Henry John Zielinski, M.D. Arnold Zweig, M.D.

www.mag.org 17

2017 HOUSE OF DELEGATES ATTENDEES

NAME

REPRESENTING

NAME

REPRESENTING

Sara Cuadra Acree, M.D.

Cobb CMS

David Lee Edwards, M.D.

Cobb CMS

Mohammad Naif Al-Shroof, M.D.

Peachbelt CMS

Thomas Edward Emerson, M.D.

Cobb CMS

Oluranti Adeleke Aladesanmi, M.D.

MAA

Frederick Charles Flandry, M.D.

Muscogee CMS

Vinita Marie Alexander, M.D.

MAA

Jay W. Floyd, M.D.

Georgia Academy of Family Physicians

Ahmed Naser Ali, M.D.

MAA

Donald Lowell Fordham, M.D.

Georgia Academy of Family Physicians

Shoheb Ali, M.D.

Resident Physician & Fellows Section

Rutledge Forney, M.D.

MAA

John S. Antalis, M.D.

Whitfield/Murray CMS

Sandra Adamson Fryhofer, M.D.

MAA

Joseph P. Bailey Jr., M.D.

Richmond CMS

Allen Gene Garrison, M.D.

Bibb CMS

James William Barber, M.D.

Georgia Orthopaedic Society

Masoumeh Ghaffari, M.D.

Cobb CMS

David Geoffrey Barnes, M.D.

Muscogee CMS

Jonathan Gibson, M.D.

MAA

Maria Hernandez Bartlett, M.D.

Bibb CMS

John Abner Goldman, M.D.

MAA

Thomas Edward Bat, M.D.

MAA

Michael E. Greene, M.D.

Bibb CMS

Essene Bell, M.D.

MAA

Joseph W. Griffin Jr., M.D.

Richmond CMS

Adam Eric Berman, M.D.

Richmond CMS

Patrick Raschiotto Hall, M.D.

MAA

Deepti Bhasin, M.D.

Peachbelt CMS

Thomas Lamb Haltom, M.D.

Cobb CMS

Patrick Leroy Blohm, M.D.

Georgia MS

Magdi M. Hanafi, M.D.

MAA

W. Scott Bohlke, M.D.

Ogeechee River MS

William R. Hardcastle, M.D.

DeKalb CMS

Michael Jay Borkat, M.D.

Muscogee CMS

John S. Harvey, M.D.

MAA

Gary Robert Botstein, M.D.

DeKalb CMS

Jill P. Hauenstein, M.D.

Richmond CMS

John O. Bowden, M.D.

East Metro MS

Tracey Lynn Henry, M.D.

MAA

Kenneth Myron Braunstein, M.D.

MAA

Brian Edward Hill, M.D.

MAA

William P. Brooks, M.D.

Bibb CMS

Michael C. Hilton, M.D.

MAA

Vernon Thomas Bryant, M.D.

Georgia MS

Mal Hollander

Laurens CMS

Brett H. Cannon, M.D.

Cobb CMS

Sandra L. Hollander, M.D.

Laurens CMS

Dimitri C. Cassimatis, M.D.

MAA

Steven Mark Huffman, M.D.

Cobb CMS

Jack M. Chapman Jr., M.D.

Hall CMS

Nikki Hughes, M.D.

MAA

Anthony Bernard Chappell, M.D.

Ogeechee River MS

Dirk Erik Huttenbach, M.D.

Cobb CMS

Hannah Childs

Medical Student Section

Mark Craton Hutto, M.D.

MAA

Hersh Chopra, M.D.

Cobb CMS

Ann O. Igbre, M.D.

MAA

S. William Clark III, M.D.

Okefenokee CMS

Billie Luke Jackson, M.D.

Bibb CMS

Ruth Cline, M.D.

Georgia OBGyn Society

Deborah Ann Jensen Taylor, M.D.

Cobb CMS

Michael J. Cohen, M.D.

Richmond CMS

Clarence Joe, M.D.

Richmond CMS

Richard William Cohen, M.D.

Cobb CMS

Albert Farah Johary, M.D.

MAA

Ca Rita Connor

Georgia MS

John Alexander Johnson, M.D.

MAA

Melissa Connor

DeKalb & Hall CMS

Robert C. Jones, M.D.

Bibb CMS

Terrence J. Cook, M.D.

Richmond CMS

Drazen Marijan Jukic, M.D.

St. John's Parish CMS

Loy Dekle Cowart III, M.D.

Georgia Academy of Family Physicians

Craig Todd Kerins, M.D.

Richmond CMS

Bret Cameron Crumpton, D.O.

Muscogee CMS

Faria Memnun Khan, M.D.

MAA

Charles Edward Curry Jr., M.D.

MAA

Sen. Kay Kirkpatrick, M.D.

MAA

Luke J. Curtsinger, M.D.

Georgia MS

Brett Alan Krummert, M.D.

Hall CMS

Despina Demestihas Dalton, M.D.

Cobb CMS

Maegan Garcia Lazaga, M.D.

Resident Physician & Fellows Section

Fred Lester Daniel, M.D.

Georgia MS

Florence Ruth LeCraw, M.D.

MAA

Shamie Das, M.D.

MAA

Katarina Gabrielle Lequeux-Nalovic, M.D.

Georgia Society of Dermatology

Aaron H. Davidson, M.D.

Ogeechee River MS

Brian Allen Levitt, M.D.

DeKalb CMS

Kelly Michelle DeGraffenreid, M.D.

MAA

E. Daniel DeLoach, M.D.

Georgia MS

Jay Leonard Lichtenfeld, M.D.

American College of Physicians, Georgia Chapter

Robert Charles Dinsmore, M.D.

Georgia Society of Plastic Surgeons

Travis Lindley

Ammar Divan, M.D.

MAA

Georgia Society of Ophthalmology & Georgia Psychiatric Physicians Association

Michael Francis Doherty, M.D.

MAA

Thomas Blaise Lintner, M.D.

Cobb CMS

Edmund Roche Donoghue Jr., M.D.

Georgia MS

Edward Allan Lloyd, M.D.

Cobb CMS

Donnie P. Dunagan, M.D.

Richmond CMS

Zachary David Lopater, M.D.

Bibb CMS

Rod Michael Duraski, M.D.

Troup CMS

Daniel Candelario Lopez, M.D.

MAA

Stanley H. Dysart III, M.D.

Cobb CMS

Teresa Ann Luhrs, M.D.

Bibb CMS

James Davant Majors, M.D.

Muscogee CMS

18 MAG Journal

NAME

REPRESENTING

NAME

REPRESENTING

Edward M. Marchan, M.D.

Young Physicians Section

Manuel Damian Rodriguez, D.O.

Young Physician Section

William Parker Marks Jr., M.D.

Cherokee-Pickens CMS

John James Rogers, M.D.

Bibb CMS

Dale Mathews

Bibb CMS

John Frederick Salazar, M.D.

Richmond CMS

Joy A. Maxey, M.D.

DeKalb CMS

Karl Daniel Schultz Jr., M.D.

Hall CMS

Howard Michael Maziar, M.D.

Georgia Psychiatric Physicians Assoc.

Al Scott Jr., M.D.

DeKalb CMS

Barbara Harvey McCollum, M.D.

Thomas Area CMS

Manoj H. Shah, M.D.

Peachbelt CMS

E. Frank McDonald Jr., M.D.

Hall CMS

Shefali Navin Shah, M.D.

MAA

Stacie McGahee

Muscogee CMS

Issam John Shaker, M.D.

Bibb CMS

Joshua Terry Mckenzie, M.D.

Georgia MS

Neha Sharma, M.D.

MAA

Lionel Dain Meadows, M.D.

Jackson/Banks CMS

Stanley W. Sherman, M.D.

DeKalb CMS

Charles Aloysius Meyer Jr., M.D.

Richmond CMS

Jay Vikram Shukla, M.D.

MAA

William Charles Miller Jr., M.D.

Coffee CMS

Donald Carl Siegel, M.D.

DeKalb CMS

Adrienne Denise Mims, M.D.

MAA

Anna Skold, M.D.

MAA

Fonda Ann Mitchell, M.D.

MAA

James Lofton Smith Jr., M.D.

Georgia College of Emergency Physicians

Gerald Edward Moody, M.D.

Georgia Society of Anesthesiologists

Kenneth Lamar Smith, M.D.

Muscogee CMS

Malcolm Sid Moore Jr., M.D.

Bibb CMS

Karunaker Reddy Sripathi, M.D.

Peachbelt CMS

Walter Joseph Moore, M.D.

American College of Physicians, Georgia Chapter

Gary Wayne Stewart, M.D.

Georgia Orthopaedic Society

Terence Lee Moraczewski, M.D.

MAA

Jeffrey Craig Stone, M.D.

Cobb CMS

Daniel Ashley Mullis, M.D.

Hall CMS

Elizabeth Ann Street, M.D.

Cobb CMS

Rana Kay Munna, M.D.

Bibb CMS

Roland S. Summers, M.D.

Georgia MS

Kevin Tawn Napier, M.D.

Spalding CMS

Johnny Liu Sy, D.O.

Georgia College of Emergency Physicians

Puthugramam Krishnansarma Natrajan, M.D.

Richmond CMS

Leiv M. Takle Jr., M.D.

IMG Section

David Steven Oliver, M.D.

Georgia MS

James Mason Tallman, M.D.

Cobb CMS

Richard Arthur Olson, M.D.

North Georgia Mountains CMS

Jeffrey L. Tharp, M.D.

Cobb CMS

Gerardo Parada, M.D.

Cobb CMS

Norman Bryant Thomson III, M.D.

Richmond CMS

Kunj Patel, M.D.

MAA

Earl Harold Thurmond Jr., M.D.

MAA

Lisa Christanne Perry-Gilkes, M.D.

MAA

Joanne Thurston

Cobb CMS

Belkis Pimentel-Vera, M.D.

MAA

Leah Casey Tobin, M.D.

MAA

Quentin Roosevelt Pirkle Jr., M.D.

MAA

Arthur Joseph Torsiglieri, M.D.

Georgia Society of Otolaryngology

Mary Cathrene Pitcher, M.D.

Cobb CMS

Jennifer Tucker, M.D.

Georgia Orthopaedic Society

Samuel Casey Pitts, D.O.

Muscogee CMS

Roy W. Vandiver, M.D.

DeKalb CMS

Alan L. Plummer, M.D.

MAA

Jacob Varghese, M.D.

MAA

Ramana Puppala, M.D.

Jackson-Banks CMS

David Waldrep

MAA

George Clark Pursley, M.D.

Richmond CMS

Daniel Walton

Richmond & Muscogee CMS

Ali Rahimi, M.D.

MAA

Clyde Watkins Jr., M.D.

American College of Physicians, Georgia Chapter

Willie Frank Rainey Jr., M.D.

MAA

Jennifer Leigh Whaley, M.D.

MAA

Darl Wayne Rantz, M.D.

Bibb CMS

Martha Mary Wilber, M.D.

MAA

Sandra B. Reed, M.D.

DeKalb CMS

Michael James Wilkowski, M.D.

Georgia MS

Garland Ashley Register Jr., M.D.

Thomas Area CMS

William Frank Willett III, M.D.

Muscogee CMS

Andrew B. Reisman, M.D.

Hall CMS

Charles Inman Wilmer, M.D.

MAA

Deborah Kay Richardson, M.D.

Richmond CMS

William Hayes Wilson, M.D.

MAA

Gary C. Richter, M.D.

MAA

Margaret Wong, M.D.

Georgia Society of Ophthalmology

Randy Frank Rizor, M.D.

MAA

Amin A. Yehya, M.D.

MAA

Carla Delle Roberts, M.D.

Georgia OBGyn Society

Michelle Reynolds Zeanah, M.D.

Ogeechee River MS

John Eric Roddenberry, M.D.

Bibb CMS

www.mag.org 19

KEY 2016 HOD RESOLUTIONS UPDATE

The following is an update on the status of key actions from the 2016 House of Delegates meeting…

Action

Status

Support efforts to allow intranasal naloxone to be dispensed on an over-the-counter basis using standing orders or collaborative practice agreements in a manner that is consistent with state law.

MAG adopted a policy to support over-thecounter dispensing of intranasal naloxone through standing orders or collaborative practice agreements in a manner consistent with state law – and a bill that allows this to occur (S.B. 121) was signed into law in Georgia in 2017.

Encourage policymakers to pursue the extensive application of needle and syringe exchange and distribution programs and the modification of restrictive laws and regulations that are related to the sale and possession of needles and syringes to maximize the availability of sterile syringes and needles while ensuring that physicians continue to be reimbursed for medically-necessary needles and syringes.

MAG supported H.B. 161, which was consistent with MAG policy, though the bill did not pass. MAG also updated its policy to allow physicians to be allowed to prescribe syringes and needles to patients who have an injection drug addiction – in conjunction with addiction counseling – to help prevent the transmission of contagious diseases.

Support the introduction and adoption of legislation that prohibits the use of Maintenance of Certification (MOC) as a condition of medical licensure or as a prerequisite for hospital or staff privileges, employment in state medical facilities, reimbursement from third parties, or malpractice insurance.

MAG supported a bill (H.B. 165) that was signed into law that will prevent the state’s Medical Practice Act from being used to require MOC as a condition of licensure or requiring MOC to be employed by a state medical facility or for insurance panels or malpractice insurance.

Work with the Specialty Tiers Coalition of Georgia to develop step therapy legislation.

MAG supported a step therapy bill (H.B. 519) that did not pass.

Support a Medicaid waiver to close the health insurance coverage gap in Georgia in a fiscally responsible and sustainable way.

MAG adopted a policy to support a Medicaid waiver to reduce the number of uninsured in Georgia in a fiscally responsible and sustainable way and that meets the needs of patients and physicians. This includes, but is not limited to, ensuring 1) that patients receive proven, cost-effective care that is not impeded by unnecessary barriers to enrollment or unaffordable cost-sharing and 2) parity for every physician service covered by the Medicare fee schedule.

Advocate to allow international medical school graduates who are not included in the statutes of the Georgia Composite Medical Board (GCMB) to apply for an unrestricted medical license following the completion of the second year of their residency program.

MAG, the Georgia Academy of Family Physicians, and GCMB developed a plan to contact international medical schools. MAG consequently sent letters asking the schools to apply for accreditation in Georgia.

20 MAG Journal

Action

Status

Continue to support the American Medical Association (AMA) in its MACRA advocacy efforts with the Center for Medicare & Medicaid Services and continue to convey information, education, educational and technical support opportunities to its members in a timely and regular fashion.

AMA/MAG/MAA/Cobb/DeKalb held a joint MACRA meeting in December. MAG continues to support and promote the AMA’s MACRA advocacy and education and outreach efforts. MAG developed a page on its website that is dedicated to MACRA issues. MAG continues to disseminate information on MACRA to its members via its monthly newsletter, the Journal, the ‘Top Docs Radio’ show, etc. And MAG has held monthly MACRA meetings in concert with county medical societies in the state.

Encourage AMA to develop model legislation to limit cell phone use to a hands-free basis while driving and establish a public safety awareness initiative and enter into partnerships with community organizations to better educate the public on the dangers associated with distracted driving.

The Georgia delegation submitted a resolution (220) to AMA’s HOD that addressed distracted driving that was adopted during AMA’s interim meeting in 2016. The Georgia House of Representatives passed a resolution resulting in a distracted driving study committee, which met during the summer months in 2017. MAG sponsored a ‘Top Docs Radio’ show on distracted driving. And the MAG Foundation, Medical Association of Atlanta, and MAG Alliance recently kicked-off the ‘Make Georgia Hands-Free’ campaign.

Submit a resolution to AMA that calls for it to investigate the feasibility of purchasing medications that are in short supply in the U.S. from other countries with FDA guidance on a temporary basis until U.S. availability improves; advocate to permit temporary prescription drug compounding to take place in the U.S. with FDA’s guidance until the medications that are in short supply are readily available in the U.S.; advocate to allow increased competition in the marketing of medications; advocate for participative pricing; advocate for accountability for outcomes; and advocate for increased regulation of the generic drug market.

The Georgia delegation submitted a resolution (817) to AMA’s HOD that addressed these provisions during AMA’s 2016 interim meeting. The resolution did not pass, but the AMA HOD did adopt several key provisions (D-100.983, H-120.934, H-120.945, D 120.949, H-110.987, H-110.989, H-155.962, and H-110.988.); go to http://www.mag.org/ama for details.

Submit a resolution to AMA urging it to call for legislation that would eliminate a physician’s costs associated with recovering patient health care records from a previous EMR vendor.

The Georgia delegation submitted this resolution during AMA’s 2016 interim meeting, though the HOD reaffirmed AMA’s existing policy in lieu of passing the measure.

www.mag.org 21

2017 MEDICAL STUDENT ABSTRACT WINNERS

Best pitch – 1st place "VPS35 and Hydrocephalus of the Developing Mouse Brain"

HYUNJIN SONG Medical College of Georgia at Augusta University

ydrocephalus is a condition in which the ventricles enlarge due to abnormal cerebrospinal fluid production or drainage. It is one of the most common birth defects as well as a co-morbid factor in neurodegenerative diseases like Alzheimer’s disease (AD), one of the 10 leading causes of death in the U.S. Deficiency in VPS35, a component of a retromer complex that returns transmembrane proteins from endosomes to the trans-Golgi network, is a risk factor for pathogenesis of AD and Parkinson’s disease (PD). This study aims to investigate a possible link between neurodegeneration and hydrocephalus by studying VPS35-deficient mouse models. Mice with conditional knockout (CKO) of the Vps35 gene in EMX1-Cre+ cells (Vps35f/f; EMX1-Cre) showed a significant decrease in body weight from p19 onwards compared to same-aged control mice. Longitudinal MRI studies at p14 and p23 found that the mutant mice developed larger ventricles, especially the lateral ventricle, but a smaller cerebral aqueduct. Confocal microscopy analysis of immunostained brain

sections with anti-S100b (a marker for ventricular ependymal cells) and anti-acetylated tubulin (a marker for cilia) antibodies showed marked reductions in both ependymal cells and their cilia in the mutant brain. These results suggest that VPS35 deficiency in EMX1Cre+ cells contribute to the formation of hydrocephalus, possibly through two mechanisms: disruption of CSF maintenance due to denudation of the ependymal and cilia layer, and constriction of the aqueduct leading to CSF flow blockage. In our future studies, we will investigate the mechanism behind the denudation of the ependymal and cilia layer and determine whether the increased intracranial pressure from hydrocephalus is linked to cortical neurodegeneration, which may ultimately build towards future treatments for both neurodegenerative disease as well as hydrocephalus.

Case Report – 1st place "A Case of Infectious Endocarditis Presenting with Acute Bilateral Vision Loss"

KATHERINE RHOADES Mercer University School of Medicine

nfectious endocarditis is often a diagnostic challenge since many presenting symptoms are non-specific. Our case report details a unique example of infectious endocarditis in an afebrile patient. The patient was a 20-year-old male who presented to the ED with a sudden onset of blindness. The vision loss began with blurry vision, which progressed to complete bilateral vision loss. Other associated symptoms included a headache without neck pain, toe pain due to a suspected insect bite, and mild abdominal pain. The patient was recently treated with Levaquin for suspected pneumonia five days earlier due to a subjective fever, shortness of breath, cough, and headache. Further questioning revealed a recent history of IV drug use. Physical exam was within normal limits except for a negative confrontation eye exam and red/purple discoloration on the left fourth metatarsal and left lateral foot without any appreciable bite marks. No abnormalities were found on non-contrast CT scan or chest X-ray. Lumber puncture showed mild CSF pleocytosis. Neurology suspected possible occipital lobe infarcts or a seizure. In the ED, the patient developed severe sepsis and was admitted to the ICU while we awaited results of further testing with echocardiography, MRI, and EEG. An MRI 22 MAG Journal

revealed multiple small nodular foci of abnormal signal and restricted diffusion scattered throughout the brain reflecting multiple small septic emboli. A transesophageal echocardiography showed mild mitral regurgitation, a small vegetation on aortic valve, and mild aortic regurgitation. Blood cultures were positive for Staphylococcus aureus and we were able to diagnose the patient with infective endocarditis. Interestingly, the EEG showed non-specific diffuse slowing and could not definitively rule out a seizure. We hypothesize that our patient’s vision loss was due to septic emboli precipitating a seizure in the occipital lobe since the emboli on MRI were not large enough to cause complete bilateral vision loss. We believe this phenomenon can be compared to a Todd’s paralysis in the occipital lobe. Within two days, the patient’s vision returned to baseline. Treatment included aortic valve replacement, patch repair of an aortic root abscess, and long-term IV antibiotics.

Clinical Science – 1st place ‘"The Role of Post-Traumatic Stress Disorder (PTSD) in Intensifying the Effects of Nightmares, Insomnia, Depression, and Suicide"

JASON MORACZEWSKI Medical College of Georgia at Augusta University

ost-traumatic stress disorder (PTSD) is psychiatric disorder that develops in certain individuals who have experienced or witnessed a terrifying event. Patients with PTSD re-experience the traumatic incident through nightmares and this causes clinically significant distress in social areas of functioning, and nightmares are an independent risk factor for suicide. While major depressive disorder (MDD), suicide, nightmares, and insomnia have been shown to be comorbidities of PTSD, research in the field has not discerned whether or not PTSD provides additional burden over-and-above having MDD alone. This project sought to investigate if PTSD is a risk factor for increasing severity of depression symptoms, suicidal ideation, nightmare intensity, and insomnia intensity among patients with MDD. A total of 103 patients were recruited from three clinical sites and after a one-week baseline, participants were prescribed 20 mg of fluoxetine for eight weeks. Participants were then randomized to receive either zolpidem 6.25 mg

or placebo 15 minutes before bedtime. Suicidal ideation and severity of depression, insomnia, and nightmares were measured at baseline. Comparison of symptom severity between the participants with versus without PTSD at baseline was accomplished with two-sample t-tests and linear regression modeling. The results of the two-sample t-tests revealed that patients with PTSD at baseline did not have a greater degree of suicidality, depression, or insomnia than those without PTSD. However, participants with PTSD reported a greater degree of nightmare intensity, confirming previous findings. PTSD does not appear to play a role in intensifying the severity of depression, suicidality, and insomnia, but it does appear enhance the intensity of nightmares. Further reports from this study and related studies will show how the treatment of insomnia and nightmares modulate the risk of suicide.

Basic Science – 1st place "Ex vivo Priming of Melanoma-specific Lymphocytes in IL-7 and IL-15 Yields Self-renewable CD8+ T cells with Potent In vivo Anti-tumor Efficacy"

SUNNY PATEL Medical College of Georgia at Augusta University

doptive T cell therapy (ACT) is an emerging immunotherapy that can potentially induce objective clinical responses in patients with metastatic solid tumors. The goal of this treatment modality is to utilize a patient’s own T cells to fight cancer. In order to foster enough T cell soldiers to control and excise tumor growth, immunoregulatory growth cytokines must be utilized to induce the proliferation and differentiation of tumor-specific T cells ex vivo. Current ACT-based immunotherapies employ interleukin-2 (IL-2) to activate and expand cells. Yet, recent literature has proposed that regimens involving IL-2 priming may not be optimal. Other strategies to optimize ex vivo cultures have been investigated. Cytokines IL-7 and IL-15 have been described to induce the formation of memory T cells that confer superior antitumor immunity once transferred in vivo compared to cells with the effector phenotype. However, antitumor efficacy of IL7/15- or IL-2-primed T cells in an orthotopic tumor model has not been evaluated before. This study compares and elucidates the two priming methods, analyzing cytokine effect upon T cell expansion, differentiation, and fitness to unveil a more effective process for augmenting cancer treatment. We hypothesized that IL-7/15 is

superior to IL-2 to generate T cells for ACT. Utilizing wildtype murine models, tumor antigen-sensitized splenic lymphocytes were harvested and expanded in culture with either IL-2 or IL-7/15. In vitro cell expansion, phenotype, and function were compared for T cells grown in the independent cytokine regimens. ACT was then administered against mice bearing subcutaneous orthotopic melanoma. Cell expansion was significantly higher in T cells activated with IL-7/15 compared with IL-2. IL-7/15 treatment groups consisted of a higher proportion of CD44+CD62L+ central memory T cells and secreted significantly more IL-2 against the target antigen than IL-2-activated T cells. While IL-7/15-primed T cells were less-differentiated, they still maintained comparable cytotoxicity and IFN release responses. Transferred IL-7/15 T cells also significantly delayed tumor growth and improved survival. Given IL-7/15’s ability to produce tumorspecific T cells with higher self-renewal capacity and greater antitumor efficacy, we conclude that co-administration of IL-7/15 is superior for priming T cells utilized in ACT. www.mag.org 23

Public Health – 1st place "Cognitive Impairment and Overall Survival in Frail Surgical Patients"

SALIMA MAKHANI Mercer University School of Medicine

railty demonstrates a phenotype of decreased physiologic reserve, leaving those affected more susceptible to poor outcomes. The concepts of frailty, as modeled by the Fried criteria, focuses primarily on the physical domain. The purpose of this study was to assess the additive value of cognitive function with existing frailty criteria to predict poor postoperative outcomes in a large multidisciplinary cohort of patients undergoing major surgery.

This was a prospective cohort study of patients who were 18 years or older who were undergoing major surgery at Emory University Hospital. Baseline assessment included demographics, laboratory values, and traditional surgical risk assessments, and several health confounders. A four-level composite frailty scoring system was created via the combination of the Fried Frailty score and the Clock Draw Test to measure pre-operative frailty and cognitive impairment, respectively. The primary outcome of interest was overall survival, which was defined as months from date of surgery to date of death or last follow-up. This study included 330 patients undergoing major surgery, with a mean age of 58 years, and a total of 53 patient deaths occurring over a four-year follow-up. One hundred sixty-eight patients (50.9%) were non-frail with a normal clock draw score; 96 (29.1%) as non-frail with cognitive impairment, 40 (12.2%) as physically

frail without cognitive impairment, and 26 (7.9%) as frail with cognitive impairment. Among the Robust cohort, 20 out of 168 patients (11.9%) died, and among those who were both physically frail and cognitively impaired, 11 out of 26 patients (42.3%) died. Multivariable analysis demonstrated that the physically frail and cognitively impaired cohort to have a 3.92% higher risk of death (CI 1.66 9.26) compared to the cohort of robust patients (p = 0.002). Kaplan-Meier survival curves reveal an overall difference in long-term survival (log-rank p < 0.0001), driven mainly by the high risk of mortality among patients with both physical frailty and cognitive impairment. Our study suggest that the combined frailty and cognitive assessment score has powerful potential to predict adult patients at higher risk of postoperative survival, while independent assessment of cognitive impairment alone does not. Thus, the addition of cognitive assessment to physical frailty measure can improve preoperative decision making and possibly early intervention.

More than 20 medical students from around the state took part in an abstract competition that the Medical Association of Georgia (MAG) hosted during its House of Delegates meeting in Savannah in October. The competition was open to every MAG member student. The contest had four categories, including basic science/bench work, clinical research, public health, and case studies. The students were also given the opportunity to participate in a ‘Best Pitch Competition,’ where they were given 45 seconds to make a “pitch” to a panel of physician judges. The winner of this competition was Hyunjin Song from Medical College of Georgia at Augusta University.

24 MAG Journal

HealtheParadigm is the statewide, physician-led health information exchange delivered in partnership with the Medical Association of Georgia.

This health information network allows connected physicians, hospitals, and other providers to share patient information, employ powerful analytic tools designed to help improve clinical outcomes, reduce inefficiencies, and positively impact patient safety. To learn more about HealtheParadigm please call 877.921.7196 or visit www.HealtheParadigm.com.

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GENERAL ASSEMBLY

Key 2017 bills The following is a summary of the key bills that Georgia lawmakers considered in 2017 that were related to the Medical Association of Georgia’s legislative priorities… Out-of-network billing & network adequacy H.B. 71 would have required physicians and health centers to disclose certain information to patients about the providers they expect to use and the fees they typically charge before any services are rendered, and it would have required physicians to participate in every health insurance plan that is offered by any hospital where they have privileges. Did not pass. S.B. 8 would have created a payment system for out-ofnetwork care in emergency care settings and prohibited balance billing. Did not pass. S.B. 277 would have addressed the surprise health insurance “coverage gap” in emergency care settings. It would have set the payment methodology for out-of-network emergency care at the 80th percentile of the ‘FAIR Health’ database. Did not pass. Medicaid payment parity Lawmakers passed a FY 2018 budget that includes $38 million to increase pay for certain Medicaid primary care and OB-GYN codes; $6.5 million of that will be used to resolve physician “location” and “attestation” issues. Maintenance of Certification (MOC) H.B. 165 prevents the state’s Medical Practice Act from being used to require Maintenance of Certification (MOC) as a condition of licensure or to require MOC to be employed by a state medical facility or for the purposes of licensure, insurance panels, or malpractice insurance. Passed. Patient Safety H.B. 249 1) codified an executive order that Georgia Gov. Nathan Deal issued in 2016 that made naloxone available on an over-the-counter basis and 2) requires prescription drug dispensers to update the state’s Prescription Drug Monitoring Program (PDMP) every 24 hours (as opposed to the current seven-day requirement) and 3) requires prescribers to check the PDMP every time they prescribe a Schedule II drug beginning in 2018 and to document the information in the patient’s medical record. H.B. 249 also establishes a way for non-licensed practice staff (up to two per prescriber) to become authorized delegates to access the PDMP, an it requires prescribers to provide their patients with information on the addictive risks associated with the drugs they prescribe in oral or written form. Passed. S.B. 153 allows optometrists to inject pharmaceutical agents around a patient’s eye. Exceptions include sub-tenon, retrobulbar, peribulbar, facial nerve block, subconjunctival anesthetic, dermal filler, intravenous, intramuscular, intraorbital 26 MAG Journal

nerve block, intraocular, and botulinum toxin injections. The optometrist has to obtain a certificate that shows that they have successfully completed an “injectables” training program of at least 30 hours that is sponsored by a school or college of optometry that is credentialed by the U.S. Department of Education and the Council on Postsecondary Accreditation or that they are enrolled in such a program. They also have to be under the direct supervision of a board-certified ophthalmologist. Passed. H.B. 163 would have required drivers who make phone calls while operating a motor vehicle to do so on a hands-free basis, certain exceptions (e.g., 911 calls) notwithstanding. Did not pass. H.R. 282 created a House study committee on distracted driving. Passed. Other Key Senate Bills S.B. 4 would have created the ‘Georgia Mental Health Treatment Task Force’ to recommend ways to improve the state’s mental health care system. Did not pass. S.B. 12 would have allowed dental hygienists to provide certain services to patients in certain settings under the general supervision of a dentist, and it would have established definitions for “direct” and “general” supervision. Did not pass. S.B. 16 modified the state’s medical cannabis law. It left the THC at the current 5.0 percent level and added six qualifying conditions, including 1) “severe” autism for people who are under the age of 18 and 2) autism for people who are 18 or older and 3) severe or end-stage cases of Alzheimer’s disease and 4) AIDS or peripheral neuropathy and 5) severe Tourette’s syndrome and 6) any case of epidermolysis bullosa. S.B. 16 also made the low-THC cannabinoid oil available to people who are in hospice programs. Passed. S.B. 40 would have allowed emergency medical services personnel to transport a person exhibiting signs of mental illness directly to the emergency department rather than waiting for a crime to occur and taking the person to jail. Did not pass. S.B. 41 created a state licensure system for durable medical equipment suppliers and gave the Georgia Board of Pharmacy authority over these licensees, though health care practitioners and others are exempt. Passed. S.B. 47 allows a visiting sports team’s physicians and trainers to provide care in Georgia without the need to be licensed in the state. Passed. S.B. 50 would have allowed physicians to enter into direct primary care agreements without being subject to insurance regulations. Did not pass.

S.B. 52 removed the sunset provision from the state law that allows licensed professional counselors to be authorized to conduct emergency examinations on individuals who are mentally ill or drug- or alcohol-dependent. Passed. S.B 55 would have allowed a competent adult or their agent to execute a psychiatric advance directive that includes their mental health care information and care preferences. Did not pass. S.B. 56 would have established standards, criteria, and disclosure requirements for profiling programs that compare, rate, rank, measure, tier, or classify a physician’s or a physician group’s performance, quality, or cost of care against objective or subjective standards or the practice of other physicians. Did not pass. S.B. 70 extended Georgia’s Medicaid provider fee (aka the “bed tax”) until June 30, 2020. Passed.

S.B. 123 would have changed destination cancer hospital regulations by 1) eliminating the “bed cap” and 2) eliminating the cap on the number of in-state patients they can treat and 3) subjecting these facilities to the same certificate of need (CON) process as other comparably-sized hospitals in the state. Did not pass. S.B. 125 allows physician assistants to write hydrocodone prescriptions of up to five days if this prescriptive authority is included in their job description. Passed, but vetoed by governor. S.B. 138 would have replaced the state’s medical malpractice litigation system with a patient compensation system and a patient compensation board. Did not pass.

S.B. 96 allows physician assistants, nurse practitioners, and registered nurses to pronounce an organ donor’s death in hospice settings. Passed.

S.B. 157 would have exempted multi-specialty ambulatory surgery centers (ASC) that aren’t in “rural restriction areas” and that meet several requirements – including being the sole ASC owned by a multi-specialty group practice or a practice with 25 members or more that has been operating for more than five years and cares for Medicaid patients – from the state’s CON requirements. Did not pass.

S.B. 102 created a three-tier cardiac care center designation system that is similar to the one that’s used for stroke and trauma hospitals in the state. It also allows registered nurses and licensed practical nurses to be licensed in more than one state, though the scope of the care they are allowed to provide will be determined by the state where the patient receives the care. Passed.

S.B. 158 would have allowed one freestanding emergency service in every county in the state. It also included CON exemptions for “expenditures related to the increase of more than 10 percent in the number of inpatient beds and certain multi-specialty ambulatory surgical centers not located in rural restriction areas.” Did not pass.

S.B. 103 authorizes the commissioner of the Georgia Department of Community Health to investigate pharmacy benefits managers (PBM), it places certain restrictions on PBM (e.g., prohibiting them from requiring patients to use mail order pharmacies), and it allows pharmacists and pharmacies to have more freedom in their interactions with patients (e.g., ability to deliver prescriptions). Passed.

S.B. 164 would have limited copays, coinsurance, and deductibles for physical therapy, occupational therapy, and chiropractic visits to what patients pay for primary care visits. Did not pass.

S.B. 88 was a comprehensive regulatory and licensing framework for narcotic treatment programs. Passed.

S.B. 106 defines when certified registered nurse anesthetists (CRNA) can provide medical treatment and services in a licensed pain management clinic when a licensed provider is not physically present. It also requires the supervising physician to examine the patient before the CRNA is allowed to write any orders for treatment. S.B. 106 also instituted patient notification and consent requirements (i.e., addressing the nature of the treatment, the risk associated with the treatment, and that a physician might not be on-site). Passed. S.B. 109 authorized a licensure compact for Emergency Medical Services personnel. Passed. S.B. 121 made naloxone available on an over-the-counter basis under a standing order by the state health officer, it reclassified naloxone as a Schedule V controlled substance, and it requires the state health officer to be licensed to practice medicine in Georgia. Passed.

S.B. 166 would have created an interstate licensure compact for nurses who meet certain qualifications and who have not been convicted of certain crimes. Did not pass. S.B. 180 1) requires rural hospitals to report payments to consultants to qualify for the state’s tax credit for rural hospitals and 2) increases the amount of tax-deductible donations individuals and married couples can make to rural hospitals and 3) allows IRS “S” corporation-eligible members to make tax-deductible donations to rural hospitals. Passed. S.B. 193 eliminates a requirement for women to be “medically indigent” to receive services from the state’s ‘Positive Alternatives for Pregnancy and Parenting Grant Program.’ It also prohibits the program’s contract management agencies from “referring, encouraging or affirmatively counseling” a person to have an abortion unless their physician diagnoses them with a condition that makes the procedure necessary to prevent the person’s death. Passed. S.B. 200 requires insurers to cover prescriptions that are written for less than 30 days at a “prorated daily cost-sharing www.mag.org 27

rate” when it is in the best interest of the patient or when it is for the purpose of synchronizing the insured patient’s medications for chronic conditions. Passed.

H.B. 36 would have allowed optometrists to make injections and perform other delicate procedures in and around a patient’s eye or eyelid. Did not pass.

S.B. 201 requires employers to allow employees to use sick leave to care for immediate family members. Passed.

H.B. 54 would have required “rural hospitals to report payments made to third parties to solicit, administer, or manage the donations [they receive]” to qualify for the state’s rural hospital tax credit and would have also changed the amount that can be claimed as a deduction in certain cases. Did not pass.

S.B. 206 requires health insurers to cover billed charges of up to one hearing aid per impaired ear not to exceed $3,000 per hearing aid every 48 months for covered patients who are 18 or younger. Passed. S.B. 220 would have repealed legislation that was enacted in 2016 that limited a physician’s ability to advertise and publicize their medical specialty certification to specific certification boards. Did not pass. S.B. 221 would have expanded 1) the number of medications that optometrists are allowed to prescribe and 2) the pharmaceutical agents optometrists are allowed to administer around the eye – exceptions notwithstanding. Did not pass.

H.B. 55 would have limited the number of consecutive years an individual can serve on a professional licensing board. Did not pass. H.B. 65 would have added six conditions to the state’s ‘Low THC Oil Patient Registry’ – including Tourette’s syndrome, autism spectrum disorder, intractable pain (i.e., severe, debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months, post-traumatic stress disorder), Alzheimer’s disease, human immunodeficiency virus, and acquired immune deficiency syndrome. Did not pass.

S.B. 241 would have moved the administration of the Georgia PDMP from the Georgia Drugs and Narcotics Agency to the Georgia Department of Public Health. The bill had been amended to create a disposal program for controlled substances in hospice programs. Did not pass, although it was attached to a bill (H.B. 249) that did pass.

H.B. 149 would have established regulations for trauma scene cleanup services. Did not pass.

S.B. 242 increased the number of advanced practice registered nurses (APRN) that a physician can delegate their authority to from four to eight – including no more than four at any single point in time. It also added county and municipal emergency medical services that have a full-time medical director to the list of organizations that are exempt from limiting the number of APRN their physicians can supervise. Passed.

H.B. 157 amended a law (H.B. 1043) allowing physicians who are in a specialty or subspecialty to advertise a board certification that is similar in scope and complexity (i.e., training, documentation, and clinical requirements) to the certifications that are offered by the Accreditation Council for Graduate Medical Education and the Bureau of Osteopathic Specialists of the American Osteopathic Association. Passed.

S.R. 13 recognized MAG Foundation ‘Think About It’ campaign Community Co-chair Dallas Gay for his efforts to reduce prescription drug abuse in the state. Adopted. S.R. 18 recognized January 12 as ‘Addiction Recovery Awareness Day’ in Georgia. Adopted.

H.B. 161 would have allowed harm reduction organizations (i.e., focused on “reducing the harm associated with the use of psychoactive drugs in people unable or unwilling to stop”) to sell, lend, rent, lease, give, exchange or otherwise distribute a syringe or needle. Did not pass.

S.R. 188 formed a Senate study committee to evaluate at barriers to access to adequate health care in Georgia, with an emphasis on the role of advanced practice registered nurses. Passed.

H.B. 206 prevents scrivener (i.e., person who writes a document for another person) errors from being deemed fraud or as a basis to recoup payment for medical assistance provided. Passed.

Other Key House Bills

H.B 213 would have made the sale, manufacture, delivery or possession of more than four grams of fentanyl a “felony offense of trafficking in illegal drugs.” Did not pass.

H.B. 7 would have required drivers who make phone calls to do so on a hands-free basis. Did not pass. H.B. 30 would have re-classified the synthetic opioid known as ‘U-4770’ [3,4-dichloro-N-(2-(dimethylamino)cyclohexyl)-Nmethylbenzamide] as a Schedule I drug. Did not pass. H.B. 35 would have required pharmacy benefit managers to confirm their receipt of prior approval requests for prescription drugs within 48 hours. Did not pass.

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H.B. 154 authorizes dental hygienists to provide certain services under general supervision to patients in certain settings (e.g., schools, nursing homes, rural health clinics, and long-term care facilities). Passed.

H.B. 231, the annual update to ensure that the state’s drug schedule is aligned with the federal government’s drug schedule. Passed. H.B. 276 allows the commissioner of the Georgia Department of Community Health to promulgate rules that are related to the oversight of pharmacy benefit managers (PBM) and investigate them for violations. It also prevents a PBM/insurer from requiring the use of a mail-order pharmacy or from requiring a covered individual to pay a different copay for using

their pharmacy of choice, it prohibits PBM from prohibiting pharmacies from disseminating information about prescription drug alternatives or delivery services, and it places other limits on PBM that are related to “financial maneuvers.” Passed.

H.R. 36 was a constitutional amendment that would have allowed the growth and sale of medical cannabis in Georgia. Did not pass.

H.B. 299 would have 1) removed certain CON equipment from the CON review process and 2) added freestanding emergency departments to the list facilities that are exempt from the CON process and 3) deleted references to the “Health Strategies Council” and 4) exempted capital expenditures from the CON process. Did not pass.

H.R. 340 urged the U.S. Congress to consider passing legislation to address hemp and marijuana, including rescheduling. Adopted.

H.B. 360 would have allowed antibiotic drugs to be prescribed or dispensed to the sexual partner or partners of a patient who is diagnosed with chlamydia or gonorrhea without the need for a physical examination. Did not pass, though it was attached to a bill (S.B. 193) that did pass. H.B. 400 would have limited opioid prescriptions to seven days with no refills and would have required prescribers to accept unused medications. Did not pass. H.B. 402 would have created an interstate licensure compact for nurses (RN and LPN) who meet certain qualifications and who have not been convicted of certain crimes. Did not pass. H.B. 416 would have allowed optometrists to administer pharmaceutical agents that are related to the diagnosis or treatment of diseases and conditions of the eye and adnexa oculi by injection – with exceptions. Did not pass. H.B. 426 would have 1) increased the number of advanced practice registered nurses (APRN) a physician can delegate their authority to from four to eight – including no more than four at any single point in time and 2) added county and municipal emergency medical services with a full-time medical director to the list of organizations that are exempt from limiting the number of APRN their physicians can supervise. Did not pass. H.B. 427 added dentists, physician assistants, and APRN to the list of practitioners who are eligible for the service cancelable loan program that is administered by the Georgia Board for Physician Workforce. Passed. H.B. 464 would have gradually reduced the “out-of-state” and “bed cap” requirements for destination cancer hospitals. Did not pass. H.B. 517 would have required diagnostic imaging equipment to be registered with the Georgia Department of Community Health. Did not pass. H.B. 519 would have required health benefits plans to use certain clinical review criteria to establish step therapy protocols – as well as establishing a step therapy override process. Did not pass.

H.R. 240 created a House study committee on Georgian’s barriers to access to adequate health care. Passed.

H.R. 431 would have created a House study committee to evaluate the effects of any new federal (i.e., the Trump administration’s) health care policies on Georgia. Did not pass. H.R. 446 would have created a House study committee on heat-related injuries, cardiac injuries, and other sports-related injuries. Did not pass. H.R. 464 would have created a House study committee to evaluate the state’s preparedness for infectious disease outbreaks (e.g., Zika) and develop legislation to increase the state’s readiness for any such outbreaks. Did not pass. H.R. 627 would have created a House study committee on funding mechanisms for mental health and substance abuse treatment – with a focus on non-profit institutions. Did not pass. H.R. 745 would have created a House study committee to address the surprise health insurance gap that leads to balance billing in emergency care settings. Did not pass.¨ Editor’s note: Go to www.mag.org/governmentrelations for a more comprehensive summary of these bills, including MAG’s positions.

Protecting your patients, your profession & your future GAMPAC is your peace of mind. Joining MAG’s non-partisan political action committee is the best and easiest way to elect pro-physician candidates in Georgia. Go to mag.org/affiliates/gampac to join GAMPAC today.

H.B. 527 would have allowed podiatrists to jointly own a professional corporation with physicians. Did not pass. H.R. 11 recognized MAG President Steven M. Walsh, M.D., as MAG’s ‘Doctor of the Day’ at the Capitol on January 11 and thanked him for his contributions to the state. Adopted.

Paid for by GAMPAC

www.mag.org 29

GENERAL ASSEMBLY

MAG ready for ‘job one’ in 2018

eeping in mind that nearly 80 percent of the delegates who took a survey during the Medical Association of Georgia’s (MAG) House of Delegates (HOD) meeting in Savannah in October said that state legislative advocacy is the program they value the most, MAG has spent a considerable amount of time and effort preparing for the 2018 legislative session.

“There is no doubt that MAG creates a lot of value for physicians across every specialty and practice setting with a full array of programs, but there is a strong consensus that the work we do at the state Capitol is job one,” explains W. Scott Bohlke, M.D., the new chair of MAG’s Council on Legislation (COL). The Brooklet family physician reports that, “MAG enjoyed a lot of success in 2017, which is remarkable when you consider that it was one of the most challenging and contentious sessions in recent history. We were fending off attacks against the medical profession that were coming in just about every direction.” Dr. Bohlke also notes that, “Our W. Scott Bohlke, M.D. hope is that this year’s General Assembly will be somewhat more subdued, but we haven’t taken anything for granted, and we have spent a lot of time delivering our messages, participating in study committees, and building and reinforcing relationships with lawmakers and other key stakeholders.” He adds that, “We sincerely hope that we will be able to spend less time on defense in 2018, and we are especially excited about promoting several key patient safety measures – including a bill to reduce distracted driving.” MAG’s 2017 Legislative Successes MAG Government Relations Director Derek Norton says that MAG’s top legislative successes in 2017 included… 30 MAG Journal

• H.B. 165, which will prevent the state’s Medical Practice Act from being used to require Maintenance of Certification (MOC) as a condition of licensure or to require MOC to be employed by a state medical facility or for the purposes of licensure, insurance panels, or malpractice insurance. • H.B. 249, which will codify an executive order to make naloxone available on an over-the-counter basis, require prescription drug dispensers to update the state’s Prescription Drug Monitoring Program (PDMP) every 24 hours, and require prescribers to check the PDMP every time they prescribe a Schedule II drug or a benzodiazepine beginning in 2018. In addition, MAG successfully thwarted efforts to impose criminal penalties on physicians who don’t check the PDMP database and requiring physicians to check the PDMP before they prescribe schedule II, III, IV or V drugs. Norton says that there were several

Derek Norton noteworthy bills that did not pass in

2017 as well, including… • H.B. 71, which would have required physicians to participate in every health insurance plan that is offered by any hospital where they have privileges. • S.B. 8, which would have established an unsustainable payment system for physicians who provide care in emergency care settings on an out-of-network basis. • S.B. 277, which was model legislation that MAG and other physician groups developed to address the surprise health insurance coverage gap and end the need for balance billing for out-of-network care in emergency care settings.

In the grassroots arena, Dr. Bohlke reports that more than 100 physicians and 30 lawmakers attended the ‘Physicians’ Day at the Capitol’ event in January, while 80 physicians and 25 legislators addressed key issues like health insurance, opioid abuse, the PDMP, and patient safety at MAG’s ‘Legislative Education Seminar’ in July. MAG’s 2018 Legislative Priorities MAG’s legislative priorities for the 2018 General Assembly will include… Health Insurance

• Developing a solution for the “surprise health insurance coverage gap.” • Streamlining and improving the prior authorization process. • Promoting more and better health insurance coverage options for pain therapy. • Ensuring patients have access to every physician insurers advertise as “in-network” for the duration of the contract year to ensure the continuity of care. • Requiring insurers to be transparent about how they develop their networks, their standards of participation, and the process they use to select and de-select physicians for their networks. • Allowing patients to make their own health care decisions based on the best treatment options, their medical history, and the advice they receive from their physician rather than an insurer’s step therapy protocols. Patient Safety

• Working with allied stakeholders (e.g., MagMutual) on key patient safety initiatives, including distracted driving. Medicaid

• Exploring a waiver option to access federal funds to expand the state’s Medicaid program. Scope of Practice

• Addressing scope of practice issues that undermine patient safety. MAG’s legislative agenda is developed by the COL, which includes physicians from a wide range of specialties and practice settings with input from specialty societies in the state. The aforementioned priorities were approved by MAG’s Board of Directors and the HOD. Norton also stresses that MAG’s Government Relations team has distributed a number of GAMPAC checks to prophysician candidates in the state in 2017. Georgia’s legislative session will get underway on Monday, January 8, and it is expected to conclude by the end of March. Contact Norton at dnorton@mag.org or 678.303.9280 with questions related to MAG’s legislative priorities or the 2018 General Assembly.¨

Save January 31 for the 2018 ‘white coat’ event MAG is encouraging physicians to make plans to attend the 2018 ‘Physicians’ Day at the Capitol,’ which will take place from 8 a.m. to 2 p.m. on Wednesday, January 31. Contact Liz Bullock at ebullock@mag.org or 678.303.9271 with questions and to RSVP.

Support the candidates who support your profession GAMPAC is MAG’s non-partisan political action committee. It supports state-level candidates who support the medical profession in Georgia. Go to www.mag.org/gampac or contact Bethany Sherrer at bsherrer@mag.org or 678.303.9273 with questions and to join GAMPAC.

Save June 1-3 for MAG’s 2018 ‘Legislative Education Seminar” MAG is encouraging its members to save June 1-3 for MAG’s 2018 ‘Legislative Education Seminar,’ which will take place at the Brasstown Valley Resort in Young Harris. More than 50 physicians and 22 state leaders attended the meeting in 2017. Monitor www.mag.org for details – and contact Derek Norton at dnorton@mag.org or 678.303.9280 with questions.

Make a difference as a ‘MAG Doctor of the Day’ volunteer MAG is calling on physicians in every specialty to serve as a ‘MAG Doctor of the Day’ volunteer during the 2018 legislative session, which will run from January 8 to the end of March. MAG Doctor of the Day volunteers provide free minor medical care for legislators and their staff in the Medical Aid Station at the state Capitol in Atlanta. The ‘MAG Doctor of the Day’ is introduced in the House and Senate chambers at the beginning of each legislative day. They also get their picture taken with Gov. Nathan Deal – depending on his availability. Contact Liz Bullock at ebullock@mag.org or 678.303.9271 to sign up to be a 'MAG Doctor of the Day.'

Follow MAG 24/7 Whether you’re using a laptop computer or a tablet or a handheld device, you can always get the latest legislative news in Georgia by following MAG on Twitter at www. twitter.com/MAG1849 and on Facebook at www.facebook. com/MAG1849.

MAG’s Government Relations team Derek Norton, Director dnorton@mag.org or 678.303.9280 Bethany Sherrer, GAMPAC Manager & Government Relations Associate bsherrer@mag.org or 678.303.9273 Liz Bullock, Administrative Assistant ebullock@mag.org or 678.303.9271

www.mag.org 31

PRACTICE MODELS

Concierge medicine: Back to the future By Barry Silverman, M.D.

n the past decade, there has been tremendous growth in the variety of practice models that physicians employ. This has been driven by the economics of medicine, insurance companies and managed care, EMR requirements and other government regulations, student debt, and generational changes. The Journal’s Editorial Board asked some physicians in the state to write about the practice model they employ. We asked them to consider… • When you went into medicine, what were your interests, how did you visualize your future, and have you achieved your goals? • Did you choose your practice model based on financial considerations? • Do you feel like you are in control of your schedule? Is the amount of time you are on call a major problem? Is the number of patients you see reasonable? • Do you feel like you are truly responsible for your patients’ care? • How much time do you spend managing your practice? Does your perspective matter when it comes to practice management decisions? Does practice staff answer to you or management? How good is the patient scheduling process at your practice? • Are you able to generate enough income to meet your overhead expenses? • Do you handle patient management? Do you have your own nurse? Does your nurse(s) handle phone calls, patient concerns, prescriptions, etc.? • How much time off do you have? How many hours do you work? Do you work a lot of hours because you love working or does the practice control your schedule? • Do you believe that you are earning an income that is commensurate with your skill set and experience? • Have you experienced burnout, and how enthusiastic are you about medicine compared to when you graduated from medical school? 32 MAG Journal

The following is the third in a series of perspectives that will appear in the Journal. It was written by David F. Rodriguez, M.D., FACP, with Sandy Springs Internal Medicine. Concierge Medicine

I joined Sandy Springs Internal Medicine (SSIM) in 1990 when Grattan C. “Chip” Woodson Jr., M.D., retired. Dr. Woodson founded SSIM in 1954, and he was a medical trailblazer who mentored me on my path to becoming a practicing internal medicine physician. I had just completed more than a decade at Emory University – earning undergraduate and medical degrees and culminating with the completion of an internship and residency in internal medicine. My father was a general surgeon and my mother was a registered nurse. They ran a solo, private medical practice for more than 35 years. My interest in medicine began early in life, as I witnessed the personal satisfaction that my parents experienced caring for their grateful patients who were more like family members, neighbors, and friends than anonymous individuals. As Francis W. Peabody said at the end of a lecture that was entitled 'The Care of the Patient' that he gave to Harvard students on October 21, 1915, “For the secret of the care of the patient is in caring for the patient.” I learned this at an early age. I always envisioned practicing medicine in a private practice like my parents. I like the idea of being self-employed, being my own boss, and reaping the benefits that come with ownership. This has come to fruition at SSIM. At SSIM, physicians are able to control their work and vacation schedules, and we get to implement our own time management strategies. We signed our first managed care contract in 1992. After many years of struggling with high-volume managed care issues – and after deciding not to hire physician assistants or nurse practitioners to help handle increasing patient care volume – all seven of SSIM’s physicians elected to transition to our current concierge medical practice model in 2005. Our practices, our lives (personally and professionally), and our patients’ lives have consequently changed tremendously and for the better. Our practice size went from approximately 3,000 patients per physician to no more than 600 patients per physician. Appointment durations went from five to 15

minutes to 30 minutes for return appointments and from 30 minutes to an hour to 75 minutes for comprehensive history and physical examinations. Patients were guaranteed same day or next day appointments for urgent concerns. Patient and physician satisfaction soared. Physician careers were revitalized, and thoughts of early retirement were put on hold as the practice of medicine became fulfilling and fun again. This is how medicine was practiced in the 1950s and 1960s – when patients and physicians had ample time to interact with each other. There are numerous benefits to the concierge medical practice model. We have daily practice management lunch meetings as a group that are organized by our practice administrator, who is appointed by the physicians. Overhead is more easily controlled, allowing for adequate resources to implement up-to-date electronic medical records (EMR). As a result, we have successfully completed every federal EMR ‘meaningful’ use target and requirement. We continue to meet and exceed these quality benchmarks. Our practice design allows each physician to handle most patient care directly with the assistance of a scheduler/

appointment assistant and a credentialed medical assistant. At our practice, every physician takes afterhours calls for their own patients. This is mutually beneficial for patients and physicians, and it allows for more personalized care and more accurate decision making. In today’s environment, I would not have it any other way. The future of internal medicine and primary care will depend on new, young talent. We need more primary care physicians, and one way to encourage the best students to pursue careers in primary care is to educate them on and mentor them in concierge medical practices. We have mentored many students (high school, undergraduate and graduate) at SSIM in the past and we will continue to do so in the future.¨ In addition to being MAG members, Drs. Rodriguez and Silverman are members of the Medical Association of Atlanta. MAG members who would like to share their practice model experience in the Journal should contact Dr. Silverman at mssbds@gmail.com.

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www.mag.org 33

MEDICAL ETHICS

The last ethics lesson By Richard L. Elliott, M.D., PhD, FAPA, professor emeritus, medical ethics, Mercer University School of Medicine

en years ago, Dr. Stanley Sherman gave me an opportunity to edit a column on medical ethics for the Journal of the Medical Association of Georgia. I have been grateful for this privilege, and have enjoyed it immensely. I wrote this, my last column, to express my thanks and to highlight a few key lessons that I have learned along the way from my colleagues, students and you – the Journal reader. The most important lesson that I have taken from this experience is that medical ethics always comes back to clinical medicine. At the Mercer University School of Medicine (MUSM), we have a ‘Rule #1’ in ethics – which is to be a doctor first. This means that whenever an ethical or legal issue arises, we have a duty to go back and ask how well we understand the given clinical situation. Many times, a clinical reevaluation leads to the resolution of an “ethical” or “legal” issue. For example, it is not unusual for a patient to refuse a particular recommended medical procedure. Their decision is often related to the way the procedure was presented rather than the procedure itself. The patient might feel like they did not receive an adequate explanation of the procedure or that their questions and concerns were not adequately addressed. Or, maybe they just didn’t like the doctor’s style. We’ve all had these kind of patient encounters, so when the ethicist examines the patient to determine their “competence” (i.e., capacity) to refuse the proposed procedure, what often happens is that the clarification of the patient’s concerns leads to an opportunity for the attending physician to redress the issues and the patient either consents to the original procedure or to an acceptable alternative. Thus our ‘Rule #1’ is a reminder that when a legal or ethical question is raised, we should force ourselves to go back to what we know clinically and consider asking for a consultation to see if there are other clinical approaches or alternatives.

Another lesson that I have learned from my Journal experience is that while medical ethics is centered on the patient’s interests, those are not the only interests to be taken into consideration. For example, when a patient expresses a wish to “have everything done” to save their life but then becomes unresponsive (e.g., is in a PVS or coma), what duty does the physician have? How do we respect the patient’s wishes and, at the same time, respect ‘Rule #1’ to practice good medicine, knowing the intervention will likely be clinically futile? 34 MAG Journal

Richard L. Elliott, M.D. Are we obligated to fulfill the patient’s wishes even though they were likely unable to appreciate the current situation when they asked that "everything be done?” Probably not, as there are other important stakeholders involved. The family may experience prolonged grief and caregiver fatigue during the time, often months or years, when futile clinical physiological support is provided. The hospital may be unable to provide clinically useful care to other patients if resources are consumed on futile care. The profession suffers when physicians are forced to provide care they know to be futile. And the state’s interests should be considered when futile care drains financial resources. However, state interests should not regularly become a paramount concern, as they did when Texas ordered a brain-dead woman to be maintained on a ventilator over her previously stated objections and the objections of her husband. But in many cases, the state’s interests should also not be ignored. Thus, with many potential interests that need to be considered in complex cases, there is much to be gained from an ethics conference, when perspectives from other stakeholders can be brought out and weighed. The third discovery I have made is the importance of learning and teaching the relevant aspects of the law. Medical ethics is sometimes taught primarily as a philosophy course, focusing on ethical principles. And while I do not mean to disparage philosophy, physicians are usually forced to be pragmatic in their approach to ethical issues. This often means understanding the legal constraints and requirements that are relevant to a particular situation. While it may be philosophically interesting to discuss the differences between deontological and utilitarian perspectives, doctors need to know what to do, and the law often informs our choices. So while it may be important for doctors to understand the ethical basis for confidentiality, they also need to know at a practical level how to respond to a subpoena, how to respond to family members in an emergency, and how to respond when a patient may be presenting a risk to a third party. In the same vein, doctors – especially ones who practice in Georgia – need to understand the legal meaning of informed consent and when the doctrine of informed consent applies in Georgia and its limitations in special situations such as in emergencies and when treating minors. There are many other times when a practicing physician’s knowledge of the law and the legal system are important, and an ethics course may be the best time to introduce these ideas – as many important

ethical cases arise out of legal decisions (e.g., Quinlan, Cruzan, Tarasoff ). We don’t have to pretend to be training lawyers to introduce physicians to key concepts in medical ethics that can be used in practical ways. Fourth, ethics has underscored for me the importance of understanding a patient, their family, and their doctor’s potential cultural differences. For example, in some cultures it is not the patient who makes health care decisions, but another family member or a senior member of the community who decides. While it would be unethical for a community elder to make a patient’s medical decisions in Western medicine, that is not the case in every culture. Perhaps the most influential book that I have read on this topic is The Spirit Catches You and You Fall Down by Anne Fadiman – and it is a book that I recommend for every medical student. Fifth, while we try to get as much information as possible before we make a recommendation about a difficult ethical decision, we always face time and other resource constraints. This means that we necessarily make imperfect decisions. It is humbling, just as in the rest of medicine, to look back on cases and ask what decisions we would have made if we had only had a bit more information. I try to keep in mind that the clinician who is involved in any case that I am reviewing from an ethics or legal standpoint was often working with less or imperfect information than I retrospectively have at my disposal. Any sense of superiority that I feel is unjustified and borders on arrogance. Physicians do the best they can with the information and resources they have, often under less-thanfavorable conditions, so we need to be charitable when we judge their decisions in hindsight. Sixth, the best ethical decisions are empathically connected to the parties involved, including patients, families, doctors, administrators and, yes, even lawyers. This sounds trivial, but I

have to remind myself to look for ways to be empathic when my sympathies are strained. For example, a mother is involved in a motor vehicle accident that kills her young daughter. The mother has a severe brain injury, is put on a ventilator, is indigent, and was intoxicated at the time of the accident – with a blood alcohol level three times the legal limit. The ethics team is consulted regarding the decision to keep the patient on a ventilator. Team members are angry because the patient was intoxicated, and some suggest that she should not benefit from further care at state expense given her irresponsible actions and self-induced impairment. It is hard to try to be simultaneously empathic at these times, both to the mother and to other members of the ethics team, but that is our challenge and our duty. Finally, I have discovered the great value of talking with other physicians about ethics cases. Their clinical, ethical, and legal perspectives have been both insightful and rewarding. It has been a pleasure to work with Dr. Sherman and MAG staffers Tom Kornegay, Angela Boltz and Mandi Milligan, whose feedback and suggestions have always resulted in a better column. It has also been a tremendous pleasure working with medical students and my colleagues to identify topics that are suitable for this column and that I hope ultimately effects change and results in a stronger profession and better patient care. Finally, I am especially thankful to the readers of the Journal for their thoughtful and invaluable feedback. It is now time to turn the duty of writing this column on medical ethics over to a valued colleague, Dr. David Baxter, an internist and associate dean for academic affairs at MUSM. Best wishes to him and to all whom he invites into this space.¨ Special thanks to Dr. Elliott for 10 years of contributions to the Journal. Please see Dr. Sherman’s remarks on page 5. Contact Dr. Elliott at elliott_rl@mercer.edu.

Physicians Foundation debunks myths surrounding physician income The following are a few key excerpts from a blog that was written by Walker Ray, M.D., the president of the Physicians Foundation, and Tim Norbeck, the CEO of the Physicians Foundation, that appeared on Forbes’ website. It seems that whenever there is a discussion of health care costs in America, at least one critic pops up-usually more than one-who carps about physician fees-income-earnings, etc. and how they greatly impact rising health care costs. They do not, and it is a false narrative to claim that they do, but critics continue to throw the charges out there in the expectation that some will stick. Several years ago, Princeton Professor Uwe Reinhardt wrote an article for the New York Times on rising health care costs in America. He was surprised when several readers criticized him for not even mentioning physician incomes as one of the factors. Reinhardt responded with an extensive letter to the editor. He said that instead of comparing “the incomes of American physicians with those earned by doctors in other countries, a more relevant benchmark would seem to be the earnings of the American talent pool from which American doctors must be recruited.” The total amount Americans pay their physicians, as Reinhardt reminds us,

represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by physician practice expenses, including “malpractice premiums, but excluding the amortization of college and medical school debt.” Even if physicians all took a pay cut of 20 percent, the savings would amount to a minuscule two percent of our health bill. Add in the challenge of practicing medicine in the most litigious country on the planet, and the resulting psychological angst and demands for perfection need also to be weighed when considering physician compensation. According to Investor’s Business Daily, “Health spending in the U.S. accounts for more than 17 percent of GDP. Among industrialized nations, the next closest is Sweden, where health care spending is 12 percent. The U.S. is a very rich country...Americans spend more on just about everything than any other country in the world (e.g., advertising, national defense, communications technology, leisure activities). Furthermore, the country also gives far more on average to charity than any other nation in the world. Does that mean the U.S. spends too much on charity?”  Go to https://www.mag.org/debunkingmyths to read the blog.

www.mag.org 35

OPINION

The Emperor’s Clothes (Part II) By Minor C. Vernon, M.D. Minor C. Vernon, M.D. The following is the second of a two-part series on health care.

f our health care system is broken or at least on life support, and if the ACA was not the answer, what are some possible solutions? The first possible solution might be rationing of health care. In his book, Pricing Life, Peter Ubel writes at length about the failed rationing experiment in Oregon in the 1990s. Oregon realized the health care cost problem then. They decided the state would pay for the top 754 diagnosis codes used under Medicaid. But they soon realized how many problems were inherent in this plan. When a bone marrow transplant on a seven-year-old with leukemia was denied, the rationing program was doomed to fail. In the U.S., people demanded “fairness” regardless of outcome. They demanded equity, not efficiency. Most felt that treatment should be withheld only if the patient volunteered.1 Because most Americans will not accept it, rationing is not an answer, even though it makes a lot of sense. The second possible health care fix is to limit overuse services. In The New Yorker, Atul Gawande compares health care in El Paso and McAllen, Texas. These are two very similar towns in terms of size and similar demographics of obesity, smoking, and alcohol consumption. In McAllen in 2006, Medicare spent $15,000 per enrollee, almost twice the national average and roughly twice what was spent per enrollee in its sister city, El Paso. In McAllen, Medicare spent $3,000 per person, more than the average person earned. Economists Baker and Chandra found, when looking at McAllen, that the more Medicare spent in a given state, the lower that state’s quality ranking tended to be. Four states – Louisiana, Texas, California, and Florida – had the highest levels of spending, yet were near the bottom of ranking of quality of patient care. Dr. Elliott Fisher studied the issue and found that patients in high cost areas receive less preventative care such as vaccines and are less likely to have a primary care physician. This all leads to poor outcomes but at higher costs. In an odd way, it is reassuring to find evidence that less spending can yield better health results. More spending yields more waste. We would do well to form a National Institute for Healthcare Delivery, bringing 36 MAG Journal

together clinicians, hospitals, insurers, employers and citizens to assess regularly the quality, use, and cost of care as well as make clear recommendations for local systems. This must be part of any effective plan.2 The third solution would include looking at services to certain patients whom Gawande refers to as “Hot Spotters.” These are heavy users of the health care system including those with asthma, migraine headaches, and other chronic conditions. Many of these people cycle in and out of hospitals incurring the highest health care costs. They tended to receive the worst care. It was found in this study that 1 percent of patients in a certain poor area of Camden, New Jersey received 30 percent of its health care costs. Another study out of California showed a community where 5 percent of health care patients accounted for 60 percent of the spending. It was found in both studies that many with chronic illnesses were not using preventative medications appropriately, thus having to utilize the expensive emergency rooms and hospitals much more. An asthmatic, not using a preventative inhaler, will often appear in the emergency room with its expensive services. To deal with this, Massachusetts General Hospital began a program designed by a physician. In this program, social workers and nurses were assigned to each of the “hot spotters.” Nurses saw the patients for longer visits, made surveillance phone calls, and in consultation with doctors, tried to recognize and address small problems before they became bigger problems resulting in expensive hospital visits. Health care costs are enormous, but it we can identify the “hot spotters” and deal with their problems efficiently and promptly, many dollars can be saved.3 The fourth solution focuses on the end of life, when many health care costs are incurred. Twenty-five percent of Medicare spending is for the five percent of patients who are in their final year of life, and most of that expense is in the last few months of life yielding little benefit for great monetary costs. Our medical system is excellent at trying to stave off expensive surgery, chemotherapy, and ICU days before death. As death approaches, however, very few

medical people know when to stop treatments. Demagogues shout in protest about rationing and “death panels” (Thank you, Sarah Palin). Many blame insurance companies for these high costs. If patients and families paid the bills themselves, many expensive therapies would come down in price, be stopped, or never get started. We need to grapple with our failure to deal with expensive end of life decisions. Patients, families, and doctors are unprepared for their final stages of life. Consider La Crosse, Wisconsin, whose residents have unusually low end of life costs. In 1991, local medical leaders in La Crosse headed a systematic campaign to get physicians and patients to discuss end of life wishes. Within a few years it became routine for all patients admitted to a hospital, nursing home, or assisted living facility to complete a form with four basic questions: 1. Do you want to be resuscitated if your heart stops? 2. Do you want aggressive treatment such as intubation and mechanical ventilation? 3. Do you want antibiotics? 4. Do you want tube or intravenous feeding if you cannot eat on your own? Within five years, 85 percent of La Crosse residents who died had these advanced directives, up from 15 percent. There are few end of life answers set in stone. There will always be nuances and complexities, but with advanced directives, at least these conversations have taken place before arrival in an intensive care unit or nursing home. This helps the patient focus at a time when he or she is lucid on what they truly desire, thus helping the family carry out the patient’s true last wishes in a dignified manner. The family members push their own individual agendas, often with family conflict. Often the medical community is less than effective in helping the family to make these decisions, sometimes counter to what the patient really wanted.4 The fifth solution has to be getting control of insurance costs. It is truly frightening what the average American will pay to insure his cars, home, life, and possible disability, yet his health insurance may cost double all those other coverages combined. This is clearly a travesty. Health insurance was originally designed to spread risk of catastrophic health costs for a few to many. It was not designed to cover every cost of every patient. As the money in premiums skyrocketed and financial people got involved, things changed. How a single insurance can cost so much more than all others combined is truly a conundrum. Health care insurance costs clearly drive up prices for all other goods and services and put the U.S. at a poor competitive disadvantage compared to the rest of the world. This cost conundrum is compounded by the fact that the majority of health care costs happen when people

are over the age of 65, when most costs are covered by the government. This is greatly adding to our national debt and screams for true health care reform, not the band aid we received in 2010. The last component of solutions includes extending Medicare to the entire population, irrespective of age. We must deal with the current Medicare policy that allows wide latitude to physicians in prescribing treatments for eligible patients. Payments should be refused if quality of service cannot be demonstrated. That is, some type of preset benchmark is needed that shows significant improvement in morbidity and mortality, not just some vague improvement metric supplied by lobbyists for drug companies. The extension of Medicare could be financed by a small income tax levy of one to one and a half percent per year, which would be much cheaper than the 10 to 30 percent increase that many employers are currently facing. This would be a very basic coverage for all, incorporating many of the solutions mentioned earlier in this paper; including things like having a triage nurse in the emergency room. This nurse would have true control over who does or does not get seen in an expensive emergency room versus referral to a clinic the next day to be seen by a much cheaper physician extender. Anyone desiring more complete coverage of services would buy this through an insurance company as is currently done with Medicare policies like Medicare Advantage (obviously dovetailing with current government supplied Medicare.) If insurance policies like Medicare Advantage work, then extending the basic policy to all Americans should work. Private insurance companies do a much better job at auditing cases and controlling costs than government; therefore, private companies should partner with the government. Smart people with no political agendas will be needed to make this happen. The aforementioned Health Alliance would be a good start. It is clear that for a number of reasons, our health care system is broken. Due to different motivations an adequate fix was not obtained. Obamacare was touted as “the answer.” In reality, it did a few good things, but also greatly increased costs for many while only insuring about half of the uninsured. The burden for paying for Obamacare will clearly fall to the middle class who will also see unpayable deductibles as things continue to progress. Anyone who attempts to navigate the system will see how difficult and costly it will be. Due to greed of the drug and insurance companies in concert with our incompetent Washington government, we have arrived at this point. Insurance and drug lobbyists feed the insatiable appetite of Washington. This has led to where we are today. As T.D. Reid points out in his book, Healing of America, the complications created by our for-profit system add tremendous costs to health care.5 Unlike other countries, the United States doesn’t manage prices.6 www.mag.org 37

True health care reform will be tedious, painful to most, and disruptive to our system of free trade. With something so essential to everyone, and whose costs continue to spiral out of control, it may be time to carve out health care to a truly nationalized system (with much help from the private insurance sector if they wish to remain in business.) This new system would have to start with a National Healthcare Alliance as mentioned earlier. It would include Washington bureaucrats (shudder), doctors, insurance companies, drug companies, and private citizens (from both sides of the halls of Congress.) This Alliance would have to deal with overuse outliers like McAllen, Texas. It must have an increase in social programs to direct heavy users to more appropriate care and out of emergency rooms. Reform must deal with many end of life expenses. All who enter a hospital and certainly all who apply for Medicare and Medicaid will be required to answer the four end of life questions mentioned earlier as to health care decisions. There will have to be some semblance of national or perhaps regional fee schedules. A recent survey showed a huge fee swing for the same procedure or treatment, in the same city. It was shown that a knee replacement in Atlanta, Georgia can cost as little as $5,000 to as much as $35,000.7 It is “un-American” to recommend price fixing in the U.S., but the unexplained fee swings must be managed and drug costs in this country must be lowered.

health care system is broken in terms of quality and cost. It will take drastic measures to fix the system. This must be done as health care is making our economy, and all of us, sick!!8 ¨

The Emperor needs better, more affordable clothes just as America needs better, more affordable health care. Our

Editor’s note: Dr. Vernon’s views do not necessarily reflect MAG’s views or policies. MAG did not edit nor verify this article’s facts or assumptions. MAG members who would like to respond to this article are encouraged to submit a letter to the editor or an article to Tom Kornegay at tkornegay@mag.org. All submissions are subject to editorial review. Dr. Vernon is a pediatrician who has been in private practice for nearly 40 years. He served as the president of the Bibb County Medical Society in 1991. Dr. Vernon has served as a delegate at MAG’s annual House of Delegates meeting for more than 20 years. He is the treasurer of the Georgia Academy of Pediatrics. It is also worth noting that he has two children who are in the medical profession. References 1. 2. 3. 4. 5. 6. 7.

Pricing Life by Peter Ubel “The Cost Conundrum” The New Yorker, Atul Gawande, June 2009 “The Hot Spotters” by Atul Gawande, The New Yorker, January 2011 “Letting Go”, The New Yorker, Atul Gawande, August 2010 Healing of America by T.D. Reid “Places for Better and Cheaper HealthCare”, by Quealy & Sanger Katz, The New York Times, December 15, 2010 “Why we must ration healthcare”, The New York Times, July 19, 2009 Marc Treadwell

MCMS honors Dr. John Watson for contributions to profession The Muscogee County Medical Society (MCMS) recently honored John D. Watson, Jr., M.D., with the society’s first John D. Watson, Jr., M.D., Outstanding Service Award. The award will be given on an annual basis and was named after Dr. Watson, a long-time MCMS member. “Dr. Watson has demonstrated a tireless commitment and dedication to organized medicine on both the local and state levels,” explains MCMS President W. Frank Willett, III, M.D. “It was a distinct privilege to present Dr. Watson with the inaugural award during our meeting on September 28.” Dr. Willett adds that, “Dr. Watson has been a fixture in our medical community since 1967. He has served in nearly every capacity in our society, from MAG delegate to president. He served as the president of the Medical Association of Georgia, and he was an AMA delegate.” Dr. Watson was the chair and CEO of the MAG Foundation for 20 years, he was the president of the 38 MAG Journal

Georgia Radiologic Society, and he was the president of the American College of Nuclear Medicine. Dr. Willett concludes that, “Dr. Watson embodies the very essence of this award, which recognizes him for his exemplary service to the medical community and his commitment to the practice of medicine in Muscogee County and the Columbus area.”

Dr. John Watson (on the left) receiving the MCMS ‘Outstanding Service Award’ from MCMS President Dr. Frank Willett.

GCMB UPDATE

The latest on opioid prescribing By E.D. DeLoach, M.D., chair, and John S. Antalis, M.D., immediate past chair, Georgia Composite Medical Board

n July, the Georgia Composite Medical Board changed its leadership – with Dan DeLoach, M.D., being elected chair, John Marshall, M.D., being elected vice chair, and John Antalis, M.D., becoming immediate past chair. The Board also appointed LaSharn Hughes to serve as its interim executive director. The Board usually meets on the first Thursday of each month. Other than confidential application reviews and enforcement/ disciplinary actions, the meetings are open to the public. The Board’s Rules Committee meetings are also open to the public, and the Board encourages interested parties to attend these meetings to help shape the rules and regulations for the practice of medicine. Information on the Board’s meeting dates, rules, FAQ, and other news can be found on its website at www.medicalboard.ga.gov. With the opioid abuse crisis in mind, the Board has been busy writing rules to enact the laws that were passed during the 2017 General Assembly. These rules will hopefully help physicians gain a better understanding of the impact of opioid abuse and the consequences associated with overprescribing. Also note that the Board has been working with the Georgia Department of Public Health to provide physicians with information on good prescribing practices. The Board is stressing that every physician who holds a medical license with an active Georgia DEA license must visit www. dph.georgia.gov/pdmp and enroll as a Georgia Prescription Drug Monitoring Program (PDMP) user by January 1, 2018. Prescribers who obtain a DEA license after January 1, 2018 must enroll with the PDMP within 30 days of obtaining that DEA license to prescribe controlled substances in Georgia. At its October meeting, the Board voted to post the requirements in the new rule 'Prescription Drug Monitoring Program' (36037), which can be found at www.medicalboard.ga.gov. The Board also adopted Rule 360-15-.01(3), which requires physicians (not resident physicians) who maintain an active DEA license and prescribe controlled substances to complete at least three hours of AMA/AOA PRA Category 1 CME that is designed specifically to address controlled substance prescribing practices by your next renewal date. The completion of this requirement may count as three hours toward the physician’s CME license renewal requirement. Note, too, that any controlled substances prescribing guidelines coursework that has been taken since

E.D. DeLoach, M.D.

John Antalis, M.D.

a physician’s license “in the previous renewal cycle” will count toward this requirement. Given the rapidly-changing legislative and regulatory environments, opioid prescribing has undergone some tremendous changes. Increasing numbers of physicians have discontinued prescribing opioid analgesics for their patients given their concerns surrounding abuse and overprescribing. Many pain management clinics are consequently becoming overwhelmed with new high-opioid-needs patients. These patients are being transferred to “pain management” care settings for their chronic medication needs. The receiving pain management physician’s challenges and concerns include humanely preventing patient withdrawal, obtaining necessary medical records, outlining a slowly tapering medication regimen to bring the medication regimen to within the provider's prescribing “comfort zone,” and exploring alternative non-opioid pain control treatments. The Board believes that a team-based approach, in which the primary care physician provides a more comprehensive history of the referred patient to the pain physician, is the best approach to ensure the highest quality care. The Board plans to create suggested guidelines (i.e., a good process) for referring these patients to the pain management physician. And in other important news, the Board recently celebrated the five-year anniversary of the Georgia Physician Health Program (PHP), which supports physicians and physician assistants with confidential care. The Board encourages physicians who have wellness (i.e., drug or alcohol) issues to go to www.gaphp.org or to send an email webinquiry@gaphp.org or call 678.825.3764 to seek help; doing so could help them avoid becoming subjected to the Board’s disciplinary process. Any and all treatment that a physician receives from the PHP is 100 percent confidential. Physicians should also encourage any fellow physicians who they feel need help to reach out to the PHP. The members of the Board are genuinely interested in your comments and concerns, which will be addressed by the executive director during its monthly meetings. Physicians should forward their comments or concerns to LaSharn Hughes at lhughes@dch.ga.gov. Dr. DeLoach is a member of the Georgia Medical Society, and he served as MAG’s president in 2010-2011. Dr. Antalis is a member of the Whitfield-Murray County Medical Society, and he was MAG’s president in 2004-2005. www.mag.org 39

LEGAL

Are you my patient? By Daniel J. Huff, Esq., partner, Huff, Powell & Bailey, LLC

hysician obligations and duties are to their patients. In most cases, it is not difficult to determine who your patients are: They present to your office or hospital and you willingly agree to treat them. There are some situations, however, when it is more difficult to determine whether a physician-patient relationship exists, and that leaves physicians asking what legal duty they have to a potential patient. Initiating a patient-physician relationship The physician-patient relationship is a consensual transaction that establishes a legal duty.1 A consensual relationship is one “where the patient knowingly seeks the assistance of the physician and the physician knowingly accepts him as a patient.”2 The critical element in the formation of a physician-patient relationship, like any contractual arrangement, is the mutual consent of the parties to enter into such a relationship. Only when the patient consents to being examined or treated by the physician and the physician agrees to examine, treat or accept the individual as their patient does the physician-patient relationship exist. This is the conventional physician-patient relationship. The concept of duty is especially important in the legal arena. A duty requires a physician to treat a patient with the degree of care and skill that is ordinarily professed by physicians who are generally in the same or similar circumstances (i.e., the “standard of care”). Duty is one of the four elements of a medical malpractice claim in Georgia. If there is no physician-patient relationship, and therefore no duty, a physician cannot be held responsible for malpractice. Scenarios that do not establish a relationship Georgia courts have provided some guidance regarding the formation of a physician-patient relationship. Failure to consent to the relationship by a patient or representative

If there is no mutual consent between the patient and physician, no relationship has been formed. For example, if a patient does not rely on physician’s advice during a telephone call, no consensual physician-patient relationship is formed.3 A patient’s incapacity may also render it impossible for them to consent to a physician-patient relationship as long as the physician’s actions do not imply that they consented to such relationship.4 On-call physicians, insurance reviews, and curbside consults No physician-patient relationship is created when an anonymous physician evaluates a patient’s medical records for the purposes of Medicaid coverage.5 The same is true for an independent medical exam, or IME, because the review is typically for the benefit of the third-party insurance company. A physician’s on-call status, alone, is not typically enough to support an implied consent on behalf of the physician to a physician-patient relationship.6

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Curbside consultations – when a physician conducts a patient evaluation for a third party or as a professional courtesy for a colleague – typically do not establish a duty. The main “on-call physician” case is called Tomeh. The Georgia court of Appeals determined that no physician-patient relationship was created simply because a physician’s name appeared in the plaintiff ’s medical records. The physician in this case, Dr. Mohammad Tomeh, never provided any medical care to the plaintiff or her child – but he was named in a lawsuit. The court determined that when a doctor agrees to be on-call and make themselves available to be consulted regarding a patient’s condition, that fact alone does not indicate that the doctor has agreed to establish a doctorpatient relationship with any patient who presents themselves to the hospital for diagnosis and treatment. The Court of Appeals discussed “curbside consults” in Minster v. Pohl. In that case, a decedent’s family filed suit against a hospital, nurses, and Dr. Stephen Pohl – alleging they were negligent in failing to diagnose a pneumothorax that ultimately led to the patient’s death.7 The patient was admitted for surgery and subsequently developed respiratory problems, so both a breathing tube and nasogastric tube were inserted. A nurse who re-inserted the tubes after the decedent pulled them out asked Dr. Pohl, an emergency room physician, to view an x-ray to check the placement of the tubes. Dr. Pohl viewed the x-ray and observed that the tubes were placed incorrectly, but he did not see evidence of pneumothorax that allegedly led to the decedent’s death. The Court of Appeals held that no physician-patient relationship existed between Dr. Pohl and the decedent because he viewed the x-ray as a courtesy to the nurse, and the patient never consented to form a physician-patient relationship. The court refused to accept the plaintiff ’s argument that despite the absence of a consensual physician-patient relationship, a duty arose out of Dr. Pohl’s mere employment as an emergency room physician. There are situations, however, when a physician-patient relationship may arise during a “curbside consultation.” In a 2014 case, Smith v. Rodillo, the Court of Appeals found that a urologist did have a relationship with a patient when he was asked by an emergency room nurse to insert a catheter.8 The urologist received a description of a patient’s condition and history and then asked a nurse to order a PSA test, which he then reviewed. The Court of Appeals found that he had taken steps to accept the patient as his own and enter orders on that patient. The bottom line is that the determination of a physician-patient relationship in curbside situations is very fact-specific. Good Samaritan Law Georgia law protects physicians who provide care to accident or emergency victims and provides that no liability may attach to (continued on page 42)

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www.mag.org 41

(continued from page 40)

physicians who act to protect persons who are injured in these situations. Georgia Code § 51-1-29 states that any physician who in good faith renders emergency care at the scene of an accident or emergency to the victims thereof for no charge shall not be liable for any civil damages as a result of any action towards the injured party. There also exists protection under O.C.G.A. § 51-1-29.1 for physicians who provide free services for or at the request of a hospital, public school, nonprofit organization, or an agency of the state or one of its political subdivisions or provides such professional services to a person at the request of such an organization. In these situations, which can only occur without the expectation of payment, liability can only be found if it is determined that the physician has committed gross negligence or willful or wanton misconduct – which is a very difficult standard to prove. Other obligations to third parties Another question that often arises is what duty, if any, physicians owe to third parties arising from their patient-physician relationship? These questions typically occur in psychiatric cases or when a patient is given mood-altering medication prior to discharge from a facility and then later injures a third party. Georgia courts have considered two theories that may create a duty on the part of a physician to someone other than her patient. Under these theories, a physician could owe a duty to a third party – someone other than her patient – because of 1) some special factors that exist in the physician’s relationship with the patient or 2) some special obligation that the physician has to the class of persons that includes the injured third party.

recognition of a “special relationship” between the medical care provider and the injured person. The Court of Appeals has refused to create a broad duty to the general public akin to the duty of a government entity charged with protecting public safety (i.e., the public duty doctrine)13 or similar to “the duty of a health care provider to the public at large is similar to the duty imposed on providers of alcohol” (i.e., Dram Shop laws). Termination and abandonment When a patient-physician relationship is established, the physician has an ethical and legal duty to continue care and not to abandon the patient. Of course, a relationship must be consensual, and a physician generally has the right to terminate the doctor-patient relationship. And except for rare circumstances involving patient transfers and emergency care, a physician may refuse to accept a new patient. Before a physician terminates a patient relationship, they should take steps to ensure that the patient is not abandoned. Before they terminate the relationship, the physician must 1) ensure that the patient is in a stable condition and 2) offer to provide the patient with emergency medical care for at least 30 days and offer to assist the patient with the continuity of their care and transfer their medical records to their new physician in writing. Also keep in mind that EMTALA requires patients who present to an emergency room be treated. Generally, the physician-patient relationship is terminated if the patient does not seek treatment for two years – although a physician must maintain the patient’s medical records for 10 years. Conclusion

The good news is that Georgia courts have expressed a welljustified reluctance to broaden a physician’s duties beyond the physician-patient relationship. The Court of Appeals has stated that expanding a physician’s duty to encompass the protection and well-being of members of the public at large in many cases would impose an obligation that would be inconsistent with the physician’s duty to his patient and, it follows, inconsistent with public policy.9 Similarly, the Court of Appeals has determined that “a doctor, like any actor, generally has no duty to exercise control over third persons to prevent them from harming others.”10

The patient-physician relationship is consensual, and in most non-emergency situations the physician has the right to decline to enter into a relationship. As noted, situations may arise where a relationship may be created if a physician does not explicitly agree to treat a patient. In these situations, it is important to clearly communicate with others involved in the patient care and to clarify your acceptance or denial of the patient to avoid any confusion. Georgia law protects physicians who provide care in true emergency situations, and you should feel comfortable assisting patients who are in those situations.¨

Under Georgia law, a physician could have a duty to persons other than their patient – albeit under very narrow circumstances.11 Specifically, the plaintiff must show that the physician 1) had “control” over the party who caused harm (typically the patient) and 2) “foreseeability” that the patient was likely to cause harm to others. Under this novel theory, the breach of the duty is the failure to exercise that control with such reasonable care as to prevent that harm.

Huff is with the Atlanta law firm of Huff, Powell & Bailey, LLC. He defends civil lawsuits on behalf of hospitals, physicians, product manufacturers, businesses, corporations, and other professionals. Huff and the firm try several jury trials each year. Contact Huff at dhuff@ huffpowellbailey.com.

“Control” is defined as the legal authority to restrain the patient and prevent them from leaving the premises of the facility. No control is found in situations involving the treatment of voluntary outpatients.12 The second prong of this test is “foreseeability.” Georgia courts have required a high degree of foreseeability-overt acts or threats that would make it obvious to the physician that the patient might harm others-before imposing a duty to protect third parties. In similar cases, injured third parties have attempted to impose liability on the treating medical personnel by arguing for the

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Paid editorial submission

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Tomeh v. Bohannon, 329 Ga. App. 596, 598-99 (2014). Anderson v. Houser, 240 Ga. App. 613, 615 (1999). Clanton v. Von Haam, 177 Ga. App. 694, 696 (1986). Minster v. Pohl, 206 Ga. App. 617, 618 (1992). Dawson v. Fulton-DeKalb Hospital Authority, 227 Ga. App. 715, 718 (1997). Anderson v. Houser, 240 Ga. App. at 617-18 (1999). 206 Ga. App. at 617-618. Smith v. Rodillo, 330 Ga. App. 365, 765 S.E.2d 432 (2014). Shortnacy v. North Atlanta Internal Medicine, P.C., 252 Ga. App. 321, 327 (2001). Gilhuly v. Dockery, 273 Ga. App. 418, 419 (2005). Bradley Center v. Wessner, 250 Ga. 199 (1982). Keppler v. Brunson, 205 Ga. App. at 33 (1992). Shortnacy, 252 Ga. App. at 326.

MAG CEO runs 100 miles to raise $21,000 for ‘Hands-Free’ campaign

he Medical Association of Georgia’s (MAG) executive director and CEO, Donald J. Palmisano Jr., raised more than $21,000 for a new ‘Make Georgia HandsFree’ campaign to reduce distracted driving when he completed the 100-mile ‘Javelina Jundred’ trail run in Arizona in October. “I want to express my sincere thanks to the individuals and organizations who supported me in this effort,” says Palmisano. “We surpassed our fundraising goal by more than $6,000, and 100 percent of the funds that we raised will be used to educate the public on the dangers associated with distracted driving.” Jack M. Chapman Jr., M.D., the president of the MAG Foundation’s Board of Trustees, thanked and applauded Palmisano and his sponsors, emphasizing that, “This fundraiser will provide some significant and much-needed resources to get the new campaign up and running.” Medical Association of Atlanta (MAA) member Charles Wilmer, M.D., added that, “MAA is proud of its association with Donald Palmisano, and we genuinely appreciate his efforts to raise such a large sum of money to support our new campaign and for helping us shine a light on a serious patient safety issue – keeping in mind that distracted driving is just as dangerous, if not more so, than drunk driving.” The MAG Foundation, MAA, and the MAG Alliance launched the ‘Make Georgia Hands-Free’ campaign to reduce distracted driving in Georgia with a town hall that took place in Atlanta on December 2 that featured Joel Feldman – a nationally-recognized driving safety advocate who is with the

‘End Distracted Driving Campaign’ – and Rep. John Carson, who is the chair of the Georgia House Study Committee on Distracted Driving. “The AAA Foundation for Traffic Safety reports that distracted driving is responsible for about 16 percent of all fatal crashes in the U.S., which translates into some 5,000 deaths per year,” says Ali Rahimi, M.D., another MAA member who serves on the MAG Foundation’s Board of Directors. “Distracted driving has evolved into a very real and dangerous patient safety threat.” “The town hall’s primary purpose was to begin to raise awareness,” says Dr. Rahimi. “It is imperative to change our social mindset and place the same kind of emphasis on distracted driving that we do on drinking and driving because it can result in the same devastating injuries and loss of life.” MAG Alliance President Dave Street agrees, stressing that, “The exponential increase in the use of smart phones and other mobile devices in recent years has created an environment whereby drivers are often engaged in tasks that draw their attention away from operating their motor vehicle, resulting in an increase in accidents. The MAG Alliance believes that a combination of awareness and legislation is needed to educate and instruct the public on the proper and legal use of smart phones while driving.” Go to www.mag.org/makegahandsfree for additional information or to support the ‘Make Georgia Hands-Free’ campaign with a tax-deductible donation.

DONORS Adrienne Mims, M.D. Alan Plummer, M.D. Albert F. Johary, M.D. Ali Rahimi, M.D. Andrew Baumann Andrew Reisman, M.D. Antonio Rios, M.D. Benita Bowers Brett Cannon, M.D. Bryan Markowitz Carlo A. Musso, M.D. Charles Miller, M.D. Charles Wilmer, M.D. Darrin Hubbard David S. Ryan, M.D. Dennis White Despina Dalton, M.D. Donald Palmisano Sr., M.D. Donna Glass Elizabeth Bullock Fay Ames Fulton Fonda Mitchell, M.D. Fred D. Jones Gerald Moody, M.D. Howard Maziar, M.D.

Indran Indrakrishnan, M.D. Jack M. Chapman Jr., M.D. Jennifer Ammon Jennifer Robinson, M.D. John S. Antalis, M.D. Joseph B. Reynolds, M.D. Joseph T. Schifilliti, M.D. K. Edward Shanbacker Karl D. Schultz Jr., M.D. Drs. Leonard and Sandra Lichtenfeld Karlene Boswell, M.D. Katarina Lequeux Nalovic, M.D. Kelly Kenny Kevin McGill, M.D. Kimble Ross Larry Bartel, M.D. MAG Alliance Mark Kishel, M.D. Martha Wilber, M.D. Matt Lyon, M.D. Melissa Lundberg Michael Doherty, M.D. Michele Kimball Nudelman and Associates

Richard W. Cohen, M.D. Robert McMillan Robert Schreiner, M.D. Robert Seligson, M.D. Rutledge Forney, M.D. Sandra Fryhofer, M.D. Sareeta Parker, M.D. Sen. Kay Kirkpatrick, M.D. W. Scott Bohlke, M.D. Sid Moore, M.D.

Stanley W. Sherman, M.D. Steve Levine Steve Mitchell Steven Walsh, M.D. Steven Wertheim, M.D. Susan Phenning-Rice Thomas Bat, M.D. Tom Kornegay Travis Lindley Vinamra Bhasin, DMD

SPECIALTY NEWS

The doctors who have contributed to the cardiac physical exam (Part III) By John Davis Cantwell, M.D., MACP, FACC The following is the final part of a three-part series. 1900s

Bernard Marfan (1858-1942) was the son of a general practitioner, became a founder of pediatrics in France, and occupied the first chair of pediatrics in Paris. In 1896, he presented the case of a four-year-old girl, Gabrielle, to the Medical Society of Paris – noting her disproportionately long limbs and asthenic physique. Six years later, the patient was restudied by two other physicians who used new radiographic techniques. They determined that she may have just had congenital contractural arachnodactyly with flexion deformities of the digits. Nonetheless, what we now call Marfan's syndrome is a definite entity. In fact, all taller Georgia Tech athletes are screened for it, as it is a contraindication to vigorous exercise because of the risk of a thoracic aortic rupture or dissection.

John Davis Cantwell, M.D.

thrombolytic therapy and angioplasty/stents are now common-place therapy for acute heart attacks. Sir William Osler (1849-1919) was hailed as one of the world's greatest physicians at the time of his death. Numerous physical findings bear his eponym, including the painful “Osler's nodes” seen in infectious endocarditis, telangiectatic skin lesions in Osler-WeberRendu disease (hereditary telangiectasia), and the Osler maneuver to diagnose pseudohypertension in oldsters. In the latter, the blood pressure cuff is inflated above the “systolic” blood pressure and locked. The brachial or radial artery is then palpated. If the artery is still palpable – despite being pulseless – it could reflect an exaggerated high blood pressure reading due to stiff arteries.

Heinrich Quincke (1843-1922) was the son of a prominent German physician, and he studied under noted teachers, including Virchow and Helmholtz. He described angioneurotic edema (“Quincke’s edema”). Uvular angioedema is also referred to as “Quincke’s disease.” He is best known to cardiologists for identifying the exaggerated capillary pulsations in the nail beds of patients who have aortic regurgitation. The latter is not felt to be a significant indicator of the severity of regurgitation.

Nicolai Korotkoff (1874-1920) was the son of a Russian merchant, and he became interested in vascular injuries while serving as a physician in the war against Japan in 1904. Recalling the teachings of the surgeon Nikolai Pirogoff – who described “murmurs” over vascular tumors and arteriovenous fistulae during auscultation – Korotkoff discovered the combined use of the blood pressure cuff and the stethoscope to determine the systolic and diastolic blood pressures. He received such little recognition for his discovery that his son had no idea that his father made the discovery, even though he was a medical student.

James B. Herrick (1861-1954) was in the class behind my grandfather at Rush Medical School in Chicago. In 1910, he examined a black male who had anemia, muscle and joint pains, and unusual red blood cells in sickle form. Two years later, he presented his classic paper on coronary thrombosis as the cause of heart attacks to the Association of American Physicians. As Herrick recalled, “When I rose to read my paper I was elated, for I knew I had a substantial contribution to make. It fell flat as a pancake.” In 1918, Herrick and Fred Smith published an article on using the relatively new EKG machine to diagnose coronary thrombosis.

Henry Plummer (1874-1936) was a brilliant clinician, profound thinker, and mechanical genius at the Mayo Clinic. He published just a few papers in his career, but virtually all of those are considered classics. Hyperthyroidism resulting from a toxic multinodular goiter is called “Plummer’s disease.” Plummer’s nails are spoon-shaped, seen in iron deficiency. “Plummer’s sign” is the inability to walk up steps due to muscle weakness, and it is seen in Graves’ disease and other forms of hyperthyroidism. The Plummer-Vinson syndrome involves iron deficiency anemia, dysphagia, esophageal webs or stenosis, and atrophic glossitis.

Even in the 1960s and 1970s, some pathologists believed that the coronary clot was a post-mortem event. Herrick's original precepts have since been well-documented, and

Myron Prinzmetal (1908-1987) was a multitalented physician, an excellent violinist, a Shakespearean scholar, and a collector of rare medical books and paintings. In

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1959, he made a preliminary report on a variant form of angina pectoris. Its major features included 1) chest pain occurring during rest or during usual activity and 2) longer duration (up to 20 minutes) and more severe than the typical anginal pain and 3) cyclic pain (occurring around the same time each day) and 4) prompt relief with nitroglycerin and 5) elevation of the ST segment during pain with often associated arrhythmias. The disorder, which is now known as “Prinzmetal's variant angina,” is due to coronary vasospasm that can occur in an otherwise normal artery or one with varying degrees of atherosclerosis. Paul Dudley White (1886-1973) was considered “the father of American cardiology.” Cardiologist to President Dwight Eisenhower, single author of a major textbook of cardiology, dedicated physician, and international lecturer, he inspired literally hundreds of cardiologists and future cardiologists through his words and deeds. In medical school, many of us learned about the Lee-White clotting test that he helped develop. In 1928, he saw a college swimmer with paroxysmal tachycardia and an unusual looking EKG. Putting this case together with several others – including patients of Louis Wolff and John Parkinson – the concept of the Wolff-Parkinson-White syndrome evolved, which is a condition that can be cured, if symptomatic, with radiofrequency techniques. Dr. White once formed an expedition to record the heart rate of a whale using a tiny harpoon with an EKG tip. The venture was unsuccessful, but the effort typified the various interests of this amazing cardiologist – one who promoted the virtues of physical fitness throughout most of his life. Sam Levine (1891-1966) was a native of Poland and attended Harvard College and Medical School. In 1917, he volunteered for World War I and was assigned to the British Medical Corps, where he met regularly with medical giants like Osler, Sir James MacKenzie, and Sir Thomas Lewis. Dr. Levine had compiled 145 cases of coronary thrombosis by 1929, calling attention to a then relatively new disease that is so common today. The author and co-author of several important cardiology texts, including Clinical Heart Disease and Clinical Auscultation of the Heart, he codescribed the current grading of systolic heart murmurs (on a 1-6 basis). He was also an early advocate for getting patients out of bed early after heart attacks when most physicians were keeping such patients at bed rest for several weeks. I should note that a sign he described – a patient's use of a clenched fist to describe chest pain – has not been shown to be a reliable clue as to the cause of the pain in my own experience. Dr. Levine was paged one night while he was at an opera (he was in a coat with tails and a top hat) to see a patient with paroxysmal atrial tachycardia. He appeared

at the patient’s bedside, massaged her carotid artery, and terminated the tachycardia. The next morning, the patient told her regular physician that a “magician” had cured her the night before. Levine died of gastric cancer at age 75. Engraved on his tombstone were the simple, but powerful words: “Above all else, the crown of a good name.” John B. Barlow (1924-2008) was born in Cape Town, South Africa, and educated in Johannesburg, where he practiced for more than 35 years. His patients ranged “from the underprivileged black children of Soweto to former South African President Nelson Mandela.” In 1963, Barlow published his paper on mid-systolic clicks and late systolic murmurs – demonstrating that it was “associated with billowing (prolapse) of the mitral valve leaflets and mitral regurgitation, respectively.” The Barlow syndrome was subsequently recognized world-wide and is “the most common valve disorder in the world.” J. Willis Hurst (1920-2011) was Paul Dudley White's last cardiology fellow at the Massachusetts General Hospital. Like his mentor, Dr. Hurst went on to serve as the cardiologist to President Lyndon Johnson, he was the editor of a major textbook on cardiology, an international leader, and a renowned teacher. He was so impressive that when he was a visiting professor at the Ohio State Medical Center, a student, Mark Silverman, chose to train under him. Dr. Silverman became a dedicated teacher of the cardiovascular examination – eventually co-authoring a book with Dr. Hurst entitled Clinical Skills for Adult Primary Care. Drs. Hurst and Silverman published classic articles on clues from inspection of the hands that can lead to cardiac diagnoses. Included was the Holt-Oram syndrome, wherein the thumb resembles a finger and the patient might also have an atrial septal defect. While still teaching into his 80s, Dr. Hurst was once asked by a young house officer how much longer he was going to work. “As long as my memory is better than yours,” was his reply. Summary

We are greatly indebted to many physicians over the past several centuries who have contributed to our understanding of the basic cardiac evaluation. In this article, I salute the late Mark E. Silverman, M.D., who was a passionate student of medical history and a gifted teacher of the cardiac examination throughout his career.¨ Dr. Cantwell is a cardiologist with the Piedmont Heart Institute in Atlanta, and he is a member of MAG and the Medical Association of Atlanta. www.mag.org 45

PATIENT SAFETY

Billing under another’s provider number can land a physician in hot water By Emma Cecil, senior regulatory attorney, MagMutual

n August 28, 2017, a physician in Oklahoma agreed to pay the U.S. government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services that he did not provide or supervise. According to the government, the physician allowed a company that employed him – and in which he had an ownership interest – to use his National Provider Identifier (NPI) numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he left the company and deactivated his NPIs associated with the company, he reactivated those NPIs so the company could use them to bill Medicare for services he did not perform or supervise. This case is another example of the very real risk associated with billing services that are provided to federal health program beneficiaries under another provider’s name and NPI number. In 2011, the University of North Texas Health Science Center agreed to pay $859,500 for allegedly violating the Civil Monetary Penalties Law (CMPL) by submitting claims for physicians’ services provided to Medicare and Medicaid beneficiaries using the NPI numbers of 103 physicians who neither provided nor personally supervised the services rendered. Other examples include the Towson University Speech Language & Hearing Center, which paid $10,000 under the CMPL for submitting claims for audiology services with an NPI that did not correctly identify the provider who actually rendered those audiology services; a family practice physician who paid $133,880 under the CMPL for submitting claims to Medicare for nurse practitioner services as if he had personally performed the services; a hospital that paid $706,090 for violating the CMPL by submitting claims for physicians’ services provided by a doctor to Medicare beneficiaries using the provider identification numbers of another doctor, who did not furnish the services; and a medical school practice that paid $138,321 for allegedly violating the CMPL by submitting claims for physicians’ services provided by physicians to Medicare beneficiaries using the NPI numbers of two physicians who did not furnish the services.

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Although these cases involve penalties under the CMPL, the Oklahoma physician’s settlement makes it clear that more significant False Claims Act liability is a very real risk for providers who bill under the incorrect NPI. As a reminder, services provided to Medicare beneficiaries should always be billed under the name and NPI of the provider who actually performed the services, and billing under one physician’s NPI for services that are provided by another physician or non-physician provider may be viewed as fraudulent since there is little doubt that the identity of the person performing the service would be material to the government’s decision to pay the claim. An exception to this general rule is when services that are provided by non-physician practitioners to Medicare beneficiaries are billed “incident-to” a physician’s services. While CMS has acknowledged that a physician’s services may be billed incident-to another physician’s services as long as all of the incident-to requirements – including direct supervision – are satisfied, this practice is not favored and should be used sparingly. CMS has observed that billing a physician incident-to another physician is only warranted in rare circumstances. Importantly, the incident-to rules are a Medicare invention and may not apply outside the context of Medicare billing. Many, if not most, commercial plans specifically prohibit the practice of billing the services of one provider under the name and NPI of another provider and explicitly require that all services be billed under the name of the rendering provider. Providers billing private payors must therefore review their provider contracts and health plan rules to determine whether billing the services of one provider under the name and NPI of another provider is allowed – and if so, under what circumstances – or whether it’s forbidden. If it is prohibited, billing under another provider’s name and NPI could result in criminal liability under the federal health care fraud statute, which makes it a crime to knowingly and willfully execute, or attempt to execute, a scheme or artifice to obtain by means of false or fraudulent pretenses, representations, or promises, money or property owned by any health care benefit program in connection

with the delivery of or payment for health care benefits, items, or services. Key takeaway

Practices that are under pressure to pay non-credentialed physicians should think long and hard about billing the non-credentialed physician’s services under a credentialed physician’s NPI. Doing so without strictly complying with all of CMS’s stringent incident-to requirements, or in violation of private payor contracts, can spell big trouble – including penalties under the CMPL, treble damages under the False Claims Act, and even criminal liability under the federal health care fraud statute.¨

The information that is presented in this article is intended to serve as general information of interest for physicians and other health care professionals. The recommendations and advice that is published herein do not reflect or establish a standard of care and do not establish rules for the practice of medicine. The publication of this information is not intended as an offer to insure such conditions or exposures or to indicate that MagMutual Insurance Company will underwrite such risks for the reader. Our liability is limited to the specific written terms and conditions of actual insurance policies issued. MAG members who have questions about the Medicare incident-to billing requirements or billing for non-credentialed providers can call Emma Cecil at 404.842.4670.

MAG groups & MAA host town hall on distracted driving The Medical Association of Atlanta (MAA), the MAG Foundation, and the MAG Alliance hosted a free ‘Distracted Driving Educational Forum’ that took place at Emory University in Atlanta in December. “The AAA Foundation for Traffic Safety reports that distracted driving is responsible for about 16 percent of all fatal crashes in the U.S., which translates into some 5,000 deaths per year,” says Ali Rahimi, M.D., an MAA member who serves on the MAG Foundation’s Board of Directors. “Distracted driving has evolved into a very real and dangerous patient safety threat.” The town hall featured Joel Feldman – a nationallyrecognized driving safety advocate who is with the ‘End Distracted Driving Campaign’ – and Rep. John Carson, who is the chair of the Georgia House Study Committee on Distracted Driving. “The town hall’s primary purpose was to begin to raise awareness,” explains Dr. Rahimi. “It is imperative to

change our social mindset and place the same kind of emphasis on distracted driving that we do on drinking and driving because it can result in the same devastating injuries and loss of life.” MAG Alliance President Dave Street agrees, stressing that, “The exponential increase in the use of smart phones and other mobile devices in recent years has created an environment whereby drivers are often engaged in tasks that draw their attention away from operating their motor vehicle, resulting in an increase in accidents. The MAG Alliance believes that a combination of awareness and legislation is needed to educate and instruct the public on the proper and legal use of smart phones while driving.” MAA, the MAG Foundation and the MAG Alliance recently launched the ‘Make Georgia Hands-Free’ campaign to highlight the dangers associated with distracted driving. Go to www.mag.org/makegahandsfree for additional information on the campaign.

On hand for the distracted driving forum that took place in Atlanta in December were, from the left, MAA Executive Director David Waldrep, MAG Executive Director Donald J. Palmisano Jr., Georgia Rep. John Carson, ‘A Second Later’ founder Molly Welch, Casey Feldman Memorial Foundation founder Joel Feldman, Injury Prevention Research Center at the Emory School of Medicine Task Force member Jonathan Rupp, Emory Healthcare Interim President Ira Horowitz, M.D., MAA President-elect Charles Wilmer, M.D., and MAG Foundation Board of Trustees member Ali Rahimi, M.D.

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COUNTY, MEMBER & SPECIALTY NEWS

COUNTY MEDICAL SOCIETY NEWS Bibb County Medical Society

by Dale Mathews, Executive Director The Bibb County Medical Society (BCMS) held a family picnic in September. BCMS President Eric Roddenbery, M.D., reports that, “Dr. Charles Ogburn and his wife, Susan Ogburn, graciously allowed us to use their lakeside area for the event – which featured a giant waterslide, a combo climber, and wading pools for the children.” In addition to new and existing BCMS members and their family members, local legislators and a group of students from the Mercer University School of Medicine attended the event. Northwestern Mutual helped sponsor the function. Go to www.bibbphysicians. org or contact Dale Mathews at bibbphysicians@gmail.com for information on BCMS.

From the left are Dr. Cameka Scarborough, Dr. Rana Munna, BCMS President Dr. Eric Roddenberry, Joseph Egloff, and Stephen Scarborough at the BCMS picnic in September.

DeKalb Medical Society

by Hank Holderfield, Executive Director The DeKalb Medical Society (DMS) hosted its annual ‘All 48 MAG Journal

Politics are Local’ meeting in September. The dignitaries who attended the event include Georgia Sens. Emmanuel Jones, Fran Millar, Tonya Anderson, Gloria Butler, and Gail Davenport, and Georgia Reps. Mary Margaret Oliver, Megan Hanson, Billy Mitchell, and Doreen Carter. MAG Government Relations Director Derek Norton previewed of the 2018 legislative session. DMS is encouraging its members to make plans to attend its annual meeting and 25th Physicians’ Care Clinic (PCC) anniversary celebration at the Druid Hills Golf Club on February 10. DMS will also present its Judy and Bob McMahan Citizenship Award during the event. DMS founded the non-profit PCC in 1992. The PCC provides primary health care to low income and uninsured county residents who do not have access to medical treatment except through hospital emergency room visits. PCC receives nearly $1 million in donations each year, including the clinic space, administrative offices, professional medical services, and pharmaceuticals. Go to www.dekmedsoc. org or contact Melissa Connor at mconnor@pami.org for information on DMS. Georgia Medical Society

by Ca Rita Connor, Executive Director The Georgia Medical Society (GMS) sponsored its 30th ‘Super Meeting’ – which includes St. Joseph’s/ Candler and Memorial University Medical Center staff and GMS members – in September. The event

featured a keynote ‘Patient care without oppressive government control’ talk by former American Medical Association and World Medical Association President Donald J. Palmisano, M.D., J.D., FACS. GMS recently announced its Healthcare Heroes Awards recipients for the year. In the ‘Health Care Innovation’ category, this included the Adolescent and Young Adult Oncology Program at Memorial University Medical Center; the iROUND Program at St. Joseph’s/ Candler; and Morningstar Cultural Arts Group President Carol Greenberg. The ‘Health Care Education’ category winners included Diane Youmans, MSN, R.N., who is the coordinator of the Perinatal Bereavement Program at Memorial University Medical Center; the African American Health Information and Resource Center, Healthy Kids Cooking Camps at St. Joseph’s/Candler; and the Get Your Rear in Gear 5K Walk/Run at St. Joseph’s/ Candler. The ‘Community Outreach’ category winners included the Mercy Volunteer Program at St. Joseph’s/ Candler; the Angels of Mercy-Danny’s Brown Box Campaign at St. Joseph’s/ Candler; and Mark Roberson, The Rivers Christmas Wish, iHeart Radio. The winners in the ‘Institutions/ Organizations’ category included St. Joseph’s/ Candler Volunteer Services; the Cardiovascular Stepdown Unit at Memorial University Medical Center; and Jackie Rabinowitz, the chair of the Memorial Foundation’s Kids Only Capital Campaign. The ‘Allied Health Professionals’

From the left are GMS President Dr. Joshua McKenzie, GMS Board member Dr. Michael Zoller, MAG CEO Donald J Palmisano Jr., and former AMA President Dr. Donald J. Palmisano, and former MAG President Dr. Roland Summers at the GMS Super Meeting in September.

category honorees included Susan Howell, the director of the Magnet Program at St. Joseph’s/Candler; Sister Grace Agate, RSM, the workplace spirituality coordinator at St. Joseph’s/Candler; and Sara Breyfogle, a boardcertified music therapist at Hospice Savannah, Inc. Paul F. Jurgensen, M.D. (posthumously) and Carl L. Rosengart, M.D., won GMS Physicians Lifetime Achievement awards. Contact Ca Rita Connor at gamedsoc@bellsouth.net with questions related to GMS. Hall County Medical Society

by Hank Holderfield, Executive Director The Hall County Medical Society (HCMS) held its fall meeting in October. The ‘ACOs, CINs, HP2: How do these letters impact your practice?’ program featured several prominent speakers, including Mimi Collins, the CEO of the Longstreet Clinic, PC, Lewis G. Smith Jr., the president of system and acute and postacute operations at Northeast Georgia Medical Center, Antonio Rios, M.D., with the Northeast Georgia Physicians Group, and Bill Beyer, the CEO of the Northeast Georgia Diagnostic Clinic. Meeting

sponsors included MagMutual and Open MRI and Imaging of NE Georgia. Contact Melissa Connor at mconnor@pami. org with questions related to HCMS. Muscogee County Medical Society

by Dan Walton, Executive Director The Muscogee County Medical Society (MCMS) held its annual ‘Fall Beer Tasting’ in September. More than 75 MCMS members and guests were on hand for the event, which featured food and beer pairings from Chef Jamie Keating. Sponsors included Columbus Bank & Trust, the Columbus Diagnostic Center, and Columbus Hospice. The MCMS officers for 2018-2019 will include President Tim Villegas, M.D., Presidentelect Bret Crumpton, D.O., and Secretary/Treasurer Michael Borkat, M.D. MCMS sent a full delegation of eight members to MAG’s House of Delegates meeting in Savannah in October. The recipient of the MCMS Endowment Scholarship at Columbus State University for 2017-2018 is Jared Bies. Go to www.muscogeemedical. org or call 706.322.1254 for additional information or to join MCMS. Richmond County Medical Society

by Dan Walton, Executive Secretary Joseph Griffin, M.D., gave a closed claim review presentation that was sponsored by MagMutual during the Richmond County Medical Society’s (RCMS) meeting in September. RCMS

sent 18 delegates to MAG’s House of Delegates meeting in Savannah in October. RCMS also hosted a meeting that featured a talk on synthetic opioids by William Jacobs, M.D., in October. RCMS’s November meeting included a “Red Meat Allergy: Would You ‘Steak’ Your Reputation on the Diagnosis” lecture by Donnie Dunagan, M.D. And RCMS hosted a food drive to collect non-perishable items for the Golden Harvest Food Bank in Augusta during the fourth quarter of the year.” Go to www.rcmsga.org or call 706.733.1561 for additional information or to join RCMS.

Academy graduate. Jyoti Sharma, M.D., made the Atlanta Business Chronicle’s ’40 Under 40’ list in November. Dr. Sharma is a cardiologist who helped found the Women’s Heart Program at the Piedmont Heart Institute. The list honors “community leaders” who are under 40 years old “whom are both accomplished professionals who develop and grow their businesses and organizations [and who are] committed to creating a better tomorrow for their fellow Atlantans.”

MEMBER NEWS

Georgia Academy of Family Physicians

John Rogers, M.D., FACEP – the co-chair of the Emergency Department at Coliseum Northside Hospital in Macon – was recently elected to be the president-elect of the American College of Emergency Physicians (ACEP), which means he will serve as ACEP’s president in 20182019. In addition to serving as a delegate at this year’s MAG House of Delegates meeting, Dr. Rogers has been the chair of the Emergency Medicine Foundation and the president of the Georgia College of Emergency Physicians. It is also worth noting that Dr. Rogers is a MAG Foundation’s Georgia Physicians Leadership

From the left are Georgia AMA Delegation Chair Dr. William Clark, ACEP Presidentelect Dr. John Rogers, and AMA Alternate Delegate Dr. Jack Chapman at the AMA meeting in November.

SPECIALTY SOCIETY NEWS

By Tenesha Wallace, Manager of Communications and Public Health The Georgia Academy of Family Physicians (GAFP) honored five of its members with awards during the organization’s ‘Annual Scientific Assembly’ in Atlanta in October. Samuel “Le” Church, M.D., of Hiawassee received GAFP’s Family Physician of the Year Award. Dr. Church has cared for patients in a rural setting for the majority of his 17-year career. He serves on numerous community boards, he is a volunteer physician for public school sports teams, and he is the medical director of a child advocacy and domestic violence prevention program. John Bucholtz, D.O., of Columbus won GAFP’s Family Medicine Educator of the Year Award, which honors a member who is “dedicated to teaching, mentoring and educating to help advance the specialty of family medicine.”

Dr. Bucholtz has been with the Columbus Family Medicine Residency Program for over 25 years, and he serves as its director of medical education. Chetan Patel, M.D., of Columbus won GAFP’s Resident of the Year Award, which recognizes a resident who “exhibits dedication to family medicine through their leadership and involvement in their residency program and in the community.” Mary Keith, M.D., of Savannah was honored with the GAFP Keith Ellis Resident Award. Dr. Keith served as the chief resident of the Savannah Family Medicine Residency Program, and she was one of the first medical students in the Family Medicine Accelerated Track at the Mercer University School of Medicine. Jonathan Lynch, M.D., received GAFP’s Georgia Department of Public Health Award for Family Physicians. GAFP and the Georgia Department of Public Health give this award to a physician who has “supported Georgia’s mothers and children above and beyond the routine scope of family medicine.” Dr. Lynch has practiced family medicine, including obstetrics and gynecology, in Cairo for nine years. Go to www.gafp. org for information on Georgia Academy. Georgia Association of Pathologists

by Dan Walton, Executive Director The Georgia Association of Pathologists’ (GAP) officers for the year will include President Kailash Sharma, M.D., Vice President Matthew Fries, M.D., Secretary/Treasurer Dean Joelson, M.D., and members at-large Pat Godbey, www.mag.org 49

M.D., Marla Franks, M.D., and Ted Wright, M.D. Note, too, that Dr. Godbey was recently elected to be the president-elect of the College of American Pathologists. Contact Stacie McGahee at 706.738.3119 or smcgahee@ medicalbureau.net or go to www.gapathology.org for information on GAP or to join GAP or renew your GAP membership. Georgia Chapter of the American College of Cardiology

by Hank Holderfield, Executive Director More than 150 cardiologists and guests attended the Georgia Chapter of the American College of Cardiology’s (GAACC) ‘Scientific Meeting’ in November. The event featured talks by ACC President Mary Norine Walsh, M.D., James Min, M.D., from The Dalio Institute for Cardiovascular Imaging at New YorkPresbyterian Hospital and Weill Cornell Medicine in New York, JoAnn Lindenfeld, M.D., from

Vanderbilt University, Joann Lindenfield, M.D., from the University of Colorado, and Michael Reardon, M.D., from Houston Methodist Hospital. Attendees also heard a talk on leadership by author and former Navy Seal Rorke Denver. And the “fellows” took on the “faculty” in a game of ‘Cardiology Jeopardy.’ The meeting focused on four key areas, including ‘Controversial Topics in the Management of Coronary Artery Disease,’ ‘The New Age of Heart Failure,’ ‘Novel Valvular Concepts,’ and ‘The Athlete’s Heart.’ Jerre F. Lutz, M.D., FACC, was honored with GAACC’s Lifetime Achievement Award. Contact Melissa Connor at mconnor@ pami.org or go to www.accga. org for additional information. Georgia Chapter of the American Academy of Pediatrics

by Kasha Askew, Director of Membership & Education The Georgia Chapter of the American Academy of Pediatrics held its fall

Wishing you a

Happy New Year from the

Medical Association of Georgia

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CME meeting – ‘Pediatrics on the Parkway’ – in November. Rebecca Reamy, M.D., was the program chair. The meeting featured pre-conference seminars on mental health, coding and practice management, hospital medicine, and MOC/injury prevention. The Chapter’s philanthropic arm, the Pediatric Foundation of Georgia, celebrated its 20th anniversary during the meeting. And the Chapter has plans to unveil webinars on mental health, PCMH, and nutrition in the near future. Go to www.gaaap.org or call 404.881.5091 for additional information on the Chapter’s events and webinars. Georgia Gastroenterologic and Endoscopic Society

by Dan Walton, Executive Director The Georgia Gastroenterologic and Endoscopic Society (GGES) hosted its annual meeting in September. Seven physicians gave lectures on a variety of gastro and endo-

based topics. Anas Raed, M.D., was the recipient of the GGES Resident Research Award, and he gave a presentation on his research. Paul Reynolds, M.D., Evan Brady, M.D., and Rushikesh Shah, M.D., were also recognized for their abstract and poster submissions. Contact Stacie McGahee at 706.738.3119 or smcgahee@ medicalbureau.net for additional information or to join GGES. Please submit your Georgia county medical society, member or specialty society news to Tom Kornegay at tkornegay@mag.org. Also contact Kornegay with any corrections, which will run in the next edition of the Journal. The Journal reserves the right to edit submissions for length and clarity. Bolding recognizes the physicians who are active MAG members at the time the Journal was prepared. Go to www.mag.org/membership to join MAG.

PERSPECTIVE

Christmas redemption By Mark Murphy, M.D.

met Joe Williams on a bitterly cold Christmas Eve in North Carolina more than 25 years ago. Joe is dead now, but I carry a part of him with me wherever I go. Sunset came suddenly, plunging the world into a frozen darkness so dense that it sucked the light from a starless sky. And then the snowfall began – a few scattered flurries at first, but clumps of snow came soon enough, swirling into my headlights and blinding me. The night nearly began with disaster. As I drove to Raleigh, a homeless man materialized on the roadside. A Russian-style cap was pulled tightly over his head. His coat flapped about him in the bitter wind. Gnarled hands gripped a battered cardboard sign that simply said, “God bless.” I swerved sharply, never slowing down, my tires skidding in the frozen slush. “Idiot!” I said. Thirty minutes later, I parked my car at Wake Medical Center, steeling myself for the dreaded Christmas shift. Snowstorms and holidays are a bad combination for trauma centers – and the ER, as expected, was a mess. I grabbed the first chart in the rack. It was Joe Williams’ chart. That chart would change my life. Joe was sitting in the darkness. The tip of a lit cigarette glowed a dull red, like some dim tobacco-scented star from an unhealthy part of the universe. Great, I thought. Another street person looking for a warm place to sleep. “You can’t smoke in here,” I said, flicking on the balky fluorescent lights overhead. “Sorry, doc,” Joe croaked, stubbing the butt out. “Bad habit.” Joe reeked of tobacco and B.O. Tufts of salt-and-pepper hair peeked out from the edges of his stained knit cap. “What brings you in tonight?” I asked. “A cough.” “But you’re a smoker. Smokers do that.” “It’s worse,” he said. “Look here.” Joe pulled off his cap and extracted a tattered piece of paper. It was a wedding announcement. A beautiful dark-haired bride peered out from the newsprint. “My little girl,” he said. “You see what it says there? ‘Daughter of Mary and Joe Williams,’ it says. When I first saw it, I thought about cleanin’ myself up and goin’ to the wedding, as a surprise. But then I realized I shouldn’t go. I might ruin things for her.”

Mark Murphy, M.D. His voice clotted up. “So when my cough got worse, I came here instead. To get checked out.” Joe was not what he seemed to be. He’d once owned a lumber supply business. He married and fathered two children. But he started drinking, got into debt and his business failed. One day, he decided that he was too much of a burden on his family and walked out. Now sober, he worked in Raleigh’s homeless shelter – earning a little money and a warm place to sleep at night. But shame had kept him homeless, and homelessness had kept him alone. I ordered a chest X-ray and went about my business in the ER. After about an hour, the films returned, confirming my worst fears. Joe had lung cancer. “How long have I got?” he asked. “I don’t know,” I said. He stared off into nowhere. “My life’s been a waste,” he whispered. I didn’t know what to say. What I did know was that I was ashamed. I had unfairly judged a man without really knowing him. Joe Williams was an honorable man – and now he was dying, desperately alone and so very, very sad. I drove home after my shift ended the next morning. Looking around our warm, brightly-decorated home, I kissed my wife, hugged my son and made a decision. A day or so later, I walked into Joe’s hospital room. He was reading a magazine, oxygen tubing in his nose. “Mornin’ doc,” he said, smiling. “Good morning, Mr. Williams. You up for a visitor or two?” “More of them medical students? Sure. Bring ‘em in.” Behind me, a dark-haired young woman and her infant son stepped into the doorway. She was hesitant, biting her lip. “Dad?” she said, her eyes filled with tears. “Merry Christmas, Joe,” I said quietly, closing the door. I went home that night chastened, reminded of the true meaning of Christmas. More than anything, Christmas is a season of love and forgiveness. Joe Williams died soon afterwards. Though not a man of many material possessions, he died rich in the spirit. I have no doubt that Joe’s last Christmas was his best. www.mag.org 51

PRESCRIPTION FOR LIFE

Thanks for the memories

Jay Coffsky, M.D.

s we conclude another holiday season, I believe it’s appropriate to remember that we are all surrounded by some great memories. I know that I have shared some of mine with you in the past, so please bear with me if some of the following sounds familiar. When you went on a date in the 1950s and 60s, you borrowed the family car – and for six bucks you could get two gallons of gas, two movie tickets and popcorn, and hamburgers, fries, and cokes at the drive-in after the movie. The boy called the girl, and they always paid for the entire date. Unfortunately, my first date with Sandy did not go well. We went to a movie, had dinner, and ended up back at her house. We were holding hands on the couch when her parents drove up. I jumped into a nearby chair and sat on, and crushed, her glasses. I thought, “I better get out of here.” I quickly introduced myself to her parents and, as I was leaving, managed to back into their car. Some years later, I went to medical school and experienced the thrill of graduating and becoming a doctor. I felt like I just won the Heisman Trophy. I also recall the ear-to-ear smiles on the faces of my fellow graduates. Sadly, 47 of the 86 members of that class are now deceased. I remember my first day as a real doctor like it was yesterday. Back then, ER visits were emergencies and doctors still made house calls. The only enemy was disease. We didn’t have to worry about litigation or public scorn. We belonged to a great and honorable society. These days, the enemy includes insurers, the government, and sometimes even our colleagues. My proudest moment as a doctor was being part of a team that included a neurosurgeon, a thoracic surgeon, and a general surgeon that was treating a criminal who had been shot at 2 a.m. Our only remuneration was compassion and upholding the honor of our profession. My most fearful experience was caring for servicemen who had been burned by a partially-exploded phosphorus flare when I was a medical officer in the Air Force. My hardest moment as a doctor was telling my wife, Sandy, and our kids that her CT showed she had lung cancer.

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Over the past 60 years, there have been many highs and some lows. Of course, the highs fade away much quicker than the lows. And if you have never been sued, you probably have not been practicing long enough. I remember a colleague telling me that the major difference between a good doctor and a bad doctor is that the good doctor makes a lot less mistakes than the bad doctor, but now good doctors get sued. Even when a lawsuit is resolved, it never really goes away. I have been with the same hospital for 50 years. I have administered 50,000 barium enemas, 250,000 mammograms, and 600,000 chest x-rays. I served my country during the Vietnam War, and I have been with Sandy for 58 years. I have seen the introduction of major advances in medical care, including simple x-rays and ultrasounds, nuclear medicine, mammography, CT and MRI scanning, computers, workstations, and interventional procedures. And I can remember, with pleasure, working with the hundreds of physicians, nurses, technologists, support personal, and hospital employees to make our patients better. I served on the hospital governing board, I was the president of our radiology group, and I was the chief of staff of our hospital complex. Unfortunately, I have also seen a disturbing transition take place. These days, it seems like doctors treat organ systems – livers, lungs, hearts, kidneys, and brains – rather than the total patient. I have always considered being a doctor a privilege, and I have tried to represent my profession with honor and dignity. I have never considered myself better that anyone else or special, just very fortunate. And I always tried to treat everyone – be it a patient or a co-worker – like I treat the members of my family. The day I stop practicing medicine will be a sad one, indeed. I still have the fire, but life’s more practical obstacles seem to be getting in the way with greater regularity. The moral of this story is to never forget that you are on an awesome and beautiful journey – so don’t take any day for granted and make sure you fill your scrap book full of wonderful memories. Dr. Coffsky and his wife, Sandy, have been married for 58 years and have three children, eight grandchildren, and a greatgrandchild. He is in his 50th year at DeKalb Medical. You can email Dr. Coffsky at m3wejr@bellsouth.net.

800-282-4882

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NCI Designated Comprehensive Cancer Center