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 770.855.3608

Editorial Board Sara Acree, M.D. John S. Antalis, M.D. Mark G. Hanly, M.D. John S. Harvey, M.D. William Kanich, M.D. Frank McDonald, M.D. Mark E. Murphy, M.D. Barry D. Silverman, M.D. Michael Zoller, M.D.

MAG Executive Committee Andrew B. Reisman, M.D., President Lisa Perry-Gilkes, M.D., President-elect Rutledge Forney, M.D., Immediate Past President Thekkepat G. Sekhar, M.D., First Vice President James L. Smith Jr., 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 W. Barber, M.D., Vice Speaker Debi D. Dalton, M.D., Secretary Thomas 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. Brian Botkin, bbotkin@pubman.net 678.643.7250

Subscriptions Members $40 per year or non-members $60 per year. Foreign $200 per year (U.S. currency only). 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. Periodicals postage paid at Atlanta, Georgia, and additional mailing offices. The articles published in the Journal of the Medical Association of Georgia represent the opinions of the authors and do not necessarily reflect the official policy of the Medical Association of Georgia. Publication of an advertisement is not to be considered an endorsement or approval by MAG of the product or service involved. Postmaster Send address changes to the Journal of the Medical Association of Georgia,1849 The Exchange, Suite 200, Atlanta, Georgia 30339.

Established in 1911, the Journal of the Medical Association of Georgia is owned and published by the Medical Association 4 MAG Journal of Georgia. © 2017.

EDITOR’S MESSAGE

The coronavirus pandemic war

Stanley W. Sherman, M.D.

Given the fact that, at the time of this writing, there is little else in the news than the current coronavirus pandemic, it is only appropriate for me to write about this unfortunate subject. I also would not want to miss the opportunity to say how grateful and proud I am of all of my colleagues who in any way care for COVID-19 patients. They brave the risks to themselves and their families to treat them. Because of these efforts, the public is appreciating, respecting, and honoring the medical profession. Perhaps not unlike Pearl Harbor, we had a surprise attack that woke up our country and led us to join in the war against a powerful foe. I recently, however, read the Winter 2019 Emory Health Digest with the cover article entitled ‘CONTAGION – Flu is coming.’ The article asked if we are ready for the next pandemic. The article recounted that when a new strain of the flu appears, it is so different than previous strains that people have no immunity to it. The 1918 H1N1 Spanish flu pandemic infected a third of the world’s population, killing an estimated 50 million to 100 million people. Since then, the 1957 Asian flu pandemic death toll was 1.5 million to 2 million, the Hong Kong flu of 1968 was one million, while the Swine flu in 2009 had an estimated death toll of 284,000 people. A normal flu season claims between 12,000 and 56,000 lives in the United States. The 2018 flu season, however, was the deadliest in 40 years, killing an estimated 80,000 Americans, including 180 children. The article stated that “the demand for hospital beds and services quickly outstripped supply. Grady Memorial Hospital converted waiting rooms into inpatient units, rented ‘mobile ERs’ for the parking lot, and asked staff to work overtime.” Although this article dealt with potential ways to deal with another influenza virus pandemic, what was written and predicted is exactly what we have had to do to deal with during this similar SARS-CoV-2 (COVID-19) virus infection. As of June 23, this virus has caused more than 120,000 deaths in the U.S. with, unfortunately, many more to come. This is an even higher mortality rate than most influenza strains. The article goes on to quote infectious disease experts who met for a Rollins School of Public Health/CDC Conference in 2018 – the 100-year anniversary of the 1918 pandemic – to discuss pandemic preparedness. They noted that the majority of our critical medical supplies are not made in the U.S., that federal funding for emergency preparedness was 30 percent lower, and hospital preparedness was 50 percent lower than it was in 2003. This status quo was felt to be unacceptable. Clearly, these experts thought preparedness requires better support yearly, not just in response to a pandemic crisis. Since the COVID-19 outbreak began, the stock market has been crashing and unemployment claims are at a historical level. The appropriate legislative action to support our people and businesses through our “shelter in place” and business closings has caused the largest budget deficit since World War II. Do any of us believe that more spending yearly on pandemic preparedness can cost anywhere near what COVID-19 has cost us? I do not want to point any fingers at anyone for not realizing the cost of human life, suffering, and devastation our economy

is experiencing, since this virus is to blame. My greatest fear, however, is that we learn nothing and go back to not preparing for the next pandemic – which WILL OCCUR. In the midst of so much loss, we also mourn the passing of Roy Vandiver, M.D., who died of cancer on April 15. A born leader, Roy chaired the surgery department and was chief of staff at DeKalb Medical Center, as well as a member of the DeKalb Hospital Authority. He was president of the DeKalb Medical Society (DMS), chairman of the Georgia Neurosurgical Society, and president of MAG (1993-1994). To my knowledge, he was the only Georgia physician to serve as chairman of the board of the AMA PAC (2000- 2002). Many also knew Roy in his second career as chairman of MagMutual Insurance Company, where he maintained both support and much welcomed involvement in both DMS and MAG. I was proud to call Roy both a friend and a mentor. A gifted neurosurgeon at DeKalb Medical, now Emory Decatur, he made a house call to see me when I ruptured a lumbar disc, and soon after operated to relieve my constant pain and inability to walk. I have been able to dance ever since, thanks to his wonderful care! We all send condolences to Maureen, his loving wife of 58 years and a past MAG Auxiliary president, and the rest of the family. We thank him for a lifetime of service – he will be missed. This issue of the Journal features an article on the differences between allopathic and osteopathic medical training. Representing the GCMB, John Antalis, M.D., reviews a physician’s responsibilities for patient medical records. Our MagMutual article deals with legal and regulatory risks of locum tenens doctors. Our Mercer ethics article that was written by Christopher Issenock discusses the determination of a decision-making capacity in a schizophrenic patient. Susan Blank, M.D., discusses naloxone prescribing for patients who are taking opioids. MAG President Andrew Reisman, M.D., and MAG CEO Donald Palmisano join us all in thanking the MAG MRC and all others who have volunteered to treat COVID-19 patients, and review MAG’s successful efforts to help us practice through this pandemic. Dan Huff, Esq., discusses one of these efforts – emergency immunity from liability. Keisha Callins, M.D., discusses another important effort – MAG’s Physician Resilience Task Force, which is developing resources to help us cope with this crisis. Sen. Kay Kirkpatrick, M.D., generously shares her personal experiences as both a physician and a state senator, surviving this infection. Finally, Mark Murphy, M.D., reminds us as we all struggle personally and financially through this pandemic that we must remember we are all in this together and should appreciate our blessings compared to those many less fortunate. Please stay safe and enjoy this unusual summer with your families.

MAG member weighs in on ethics article with letter to the editor

Dear editor, have made the decision to have unprotected sexual relations The article ‘The need to preserve the crucial link between free speech and patient care’ by Mercer University medical student Leah Gober [that appeared in the 1Q, 2020 Journal] is not an “ethics” subject, but more of a political nature with her opinions attached. As such, this should have more properly been published in the MAG Journal as a “letter to the editor.” The subject of women’s health care, including birth control and abortions, is a topic rife with controversy, both in whether and/or have otherwise become pregnant, those rights might be abrogated by the creation of new life. Government intrusion into the physician-patient relationship has become an important roadblock over the past 50 years to the provision of ethical, let alone beneficial, medical care for our patients. The subject in Ms. Gober’s article is one that should be presented as a matter of opinion, not medical fact, and it should be identified by the Journal as such. or not these services should be provided by government with Roger A. Meyer, M.D., FACS tax moneys, health insurance coverage, or if they should be Greensboro provided at all. Supporters of “women’s rights” are advocating for a special group that might enjoy rights and privileges under the law which causes them to be treated differently, not the intent of our country’s Founding Fathers in their construction of our Constitution. Women, as do all U.S. citizens, have certain inalienable rights to “control their bodies.” However, once they Editor’s note: Dr. Meyer was responding to the “ethics” column that appeared in the 1Q, 2020 Journal. The Journal’s ethics columns are submitted to J. David Baxter, M.D., FACP, who is an associate dean at the Mercer University School of Medicine. MAG members can contact Dr. Baxter at baxter_jd@mercer.edu.

MAG introduces health insurance plan for member practices

The Medical Association of Georgia (MAG) has introduced the Alpharetta-based Decisely Insurance Services administers the ‘MAG Association Healthcare Solutions Plan’ – which is expected MAG Association Healthcare Solutions Plan, which is available to deliver savings of up to 20 percent compared to standard small to MAG member practices that enroll five or more full-time group plans, although savings will vary for each practice. physicians and practice staff – keeping in mind that every The MAG Association Healthcare Solutions Plan features… • Medical, dental and vision plans from Humana®. • Customized plans, deductibles, co-pays, and cost-sharing. • HR technology and support that make benefits administration less time-consuming. • Humana’s Go365 wellness program, which rewards individuals for making healthy choices and can save practices even more physician at the practice must be a MAG member for the practice to qualify for the plan. Decisely also offers “competitive prices [for health, dental and vision insurance plans] from Aetna and Cigna for practices with two to four employees.” Go to magbenefitscenter.decisely.com or contact Ryan Larosa at rlarosa@mag.org for details. in premium credits. www.mag.org 5