TRIAD Autumn 2019 Issue by Michigan Osteopathic Association

The Award-Winning Journal of the Michigan Osteopathic Association A U T U M N 2019

15th Annual

MOA AUTUMN SCIENTIFIC CONVENTION November 8-10, 2019 Grand Rapids, MI

MICHIGAN MOA OSTEOPATHIC ASSOCIATION

w w w. D O M O A . o r g

michiganosteopathic

MichiganDOs

m i c h i g a n - o s t e o p a t h i c- a s s o c i a t i o n

PAT I E N T C A R E QUALITY OUTCOMES

FOCUS ON WHAT MATTERS MOST WITH COVERYS. Quality outcomes for better patient care are more easily achieved when distractions are reduced. At Coverys, we illuminate unforeseen risks so you can focus on patient satisfaction and reduce exposure to malpractice claims. As a premier provider of medical liability insurance, Coverys’ data insights and risk recommendations will help you provide optimal healthcare outcomes that you can see clearly. Very clearly. To learn more, visit Coverys.com or call our East Lansing office at 800.313.5888, and select option 3 to speak with a representative.

Medical Lia b i l i ty In s u ra n c e • B u s i n e s s A n a l y t i c s • R i s k M a n a g e m e n t • E d u c a t i o n COPYRIGHTED. Insurance products issued by ProSelect® Insurance Company and Preferred Professional Insurance Company®

CONTENTS MICHIGAN OSTEOPATHIC ASSOCIATION

15th Annual Autumn

Join us in Grand Rapids this Fall!

SCIENTIFIC CONVENTION www.moa.org/autumn2019

November 8-10, 2019 Amway Grand Plaza, Grand Rapids, MI 24-26 AOA Category 1-A credits anticipated.

In Every Issue 07 President’s Page 16 Coverys 24 Healthcare Partners

FEATURES 8

Q & A with Richard Koss, DO, C-SPOMM, C-ACOFP

MOA Autumn Convention: Session Highlights

Behavioral Health Risks in Surgical Environments

Contributed by Coverys

Fifteen Lawyers from Kerr Russell Named Among “The Best Lawyers in America”

Marie's Story

Contributed by Origami

MOA and Tri-County Component Societies Host Legislative Huddle

of Michigan

27 Advertiser Index

MICHIGAN MOA OSTEOPATHIC ASSOCIATION 3

Fulford Legacy Conference ))

Michigan Osteopathic Association

Michigan Osteopathic Association 2445 Woodlake Circle, Okemos, MI 48864 domoa.org | P 517-347-1555 | F 517-347-1566

BAS I C PE RC US S I O N C OUR S E

Friday, Nov. 22 - Sunday, Nov. 24, 2019 Conference Fulford Legacy Sheraton Detroit) )Novi Hotel (Ballrooms A-B)

BAS IC PE RCUS SI ON C OUR SE

)

21111 Haggerty Road, Novi, MI 48375

November 22 - 24, 2019 Sheraton Detroit Novi Hotel 23 AOA Category 1-A credits anticipated. This course describes the power of healing concepts which expand on the Association Agenda &Michigan registration atOsteopathic www.domoa.org/fulford teachings of Andrew T. Still, DO. Instructed by Richard W. Koss, DO, Michigan Osteopathic Association 2445 Woodlake Circle, Okemos, MI 48864 who first domoa.org | P 517-347-1555 | F 517-347-1566attended Dr. Fulford’s percussion course in 1987 before completing his residency in Osteopathic Manipulative Medicine 23 NMM-Specific at A.T. Still University-Kirksville College of Osteopathic AOA Category 1-A Credits Medicine (ATSU-KCOM), Missouri.

Legacy The basic percussion “hammer”Conference course Dr. Koss worked alongside Dr. Fulford to design and teach Fulford ))

)

BA S I C on PE C U S S I& Oosteopathic N C O U R S Ethe Basic and Advanced Percussion Hammer courses for over is based theRphilosophy eight years up to his passing in 1997. Since then, Dr. Koss November 22 - 24, principles practiced by 2019 Robert C. Fulford, DO, has lead trainings internationally on Fulford’s philosophy of Sheraton Hotel authorDetroit of “TouchNovi of Life: The Healing osteopathic healing and the use of the Fulford Percussor. 23 AOA Category 1-A credits anticipated. Power of the Naturalat Life Force” and Prerequisites: Agenda & registration www.domoa.org/fulford ”Are We on the Path?”

Attendees must have completed a 40-hour introductory cranial course taught by an Osteopathic Practitioner so that they have developed the hand sensitivity and anatomical understanding necessary to successfully understand the course materials.

Early Bird registration until Nov. 1 at www.domoa.org/fulford

Credit card payment taken by phone, fax or online. Checks accepted by mail, made payable to MOA.

PREREQUISITES: By registering, I certify that I have or will have completed required courses (described on reverse) before the conference _____ Initial Speakers: FRIDAY 8 AM 6 PM

Richard W. Koss, DO, C-SPOMM, C-ACOFP Name ________________________________________________________________________________ AOA Number __________________________________ SATURDAY 8 AM - 6 PM (to appear on badge) William H. Stager, DO, MS, MPH, FAAFP, FAAMA, SUNDAY 7:45 AM - 3 PM FAAO, FACOFPEmail dist. address ____________________________________________________________ Phone Number _________________________________________________

PAYMENT:

OPTION 1 - Credit card

MasterCard

Visa

Discover

OPTION 2 - Check #_____________ Made payable to MOA

Cancellation Policy: Requests for refunds by October 31, 2019 and will entitle registrant to a full refund less a $200 fee.

Early Bird registration until Nov. 1 at www.domoa.org/fulford

Name on credit card ____________________________________________________________

Credit card payment taken by phone, fax or online. Checks accepted by mail, made payable to MOA. Credit card number _________________________________________________________________Exp. date ______ /_______ CVV code _______________ Billing Address ____________________________________________________________ Cityrequired ________________________________ State________ Zip _______________ PREREQUISITES: By registering, I certify that I have or will have completed courses (described on reverse) before the conference _____ Initial

Travel & Lodging: Name ________________________________________________________________________________ AOA Number __________________________________

For out-of-state travel, closest airport: Sheraton Detroit (to appear on Novi badge)Hotel Detroit Metropolitan Wayne County Airport (DTW) 21111 Haggerty Rd, Novi, MI 48375 Phone Number _________________________________________________ Email address ____________________________________________________________ 18.6 miles from Sheraton, transportation not included Reservations: $93/room + tax if made by Oct. 22 - Call 248-349-4000 Call hotel to coordinate special assistance (wheelchair access, accommodations, etc.) PAYMENT: OPTION 1 - Credit card MasterCard Visa Discover OPTION 2 - Check #_____________ Made payable to MOA Statement of Accreditation: The Michigan Osteopathic Association (MOA) is accredited by the American Osteopathic Association (AOA) to provide osteopathic Cancellation Policy: Requests for refunds by October 31, 2019 and will entitle registrant to a full refund less a $200 fee. continuing medical education for physicians. MOA designates this program for a maximum of 23 AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.

Name on credit card ____________________________________________________________

Credit card number _________________________________________________________________Exp. date ______ /_______ CVV code _______________ 4

T R I A D | A U T U M N 2019

Billing Address ____________________________________________________________ City ________________________________ State________ Zip _______________

T R I A D | A U T U M N 2019

MEMORANDUM TO: Members of the House Committee on Oversight FROM: Kris Nicholoff, Director DATE: September 12, 2019 ________________________________________________________________________________________ The Michigan Department of Health and Human Services is currently investigating six cases of lung infections that are related to the use of e-cigarettes/vaping. The Michigan Osteopathic Association opposes tobacco use among all segments of the public, but the rise of use in vaping is a threat to public health, particularly to younger users. Vaping-related illnesses have afflicted more than 450 patients and have been linked to six fatalities nationwide. The American Osteopathic Association, the Centers for Disease Control and Prevention and a host of other organizations are speaking out against the products and have urged residents not to use ecigarette products in light of this health emergency. President Donald Trump has announced that his administration is planning a federal ban on non-tobacco flavored vaping products. Manufacturers of vaping/e-cigarette nicotine delivery devices are targeting children and young adults with flavors like “jelly bean, “bubble gum,” and “Lucky Charms,” that mask the tobacco flavor and present their own health issues with chemicals that have been approved by the FDA as a food additive, but can cause harm when heated and inhaled. The devices themselves are designed to be covert, disguised as flash drives, watches, pens and other common items that make it extremely difficult for parents to recognize as a nicotine product. The Michigan Osteopathic Association strongly supports Gov. Gretchen Whitmer’s recognition of ecigarettes/vaping devices and contents as a public health emergency. We consider the actions she has taken as a great first step. The vaping industry continues to use their influence to fight for market share, particularly among teens and young adults. We call on our Michigan Legislature to pass comprehensive laws that can help stop the spread of these devices and the diseases they can cause, especially among the most vulnerable segment of our population— our children. Sincerely,

Kris T. Nicholoff, Executive Director Michigan Osteopathic Association T R I A D | A U T U M N 2019

Q & A with RICHARD KOSS, DO, C-SPOMM, C-ACOFP When did you first begin training with Dr. Fulford? I met Dr. Fulford in 1987 when I was a resident in Kirksville Missouri, ATSU. I took two courses from Dr. Fulford and in 1989 I was able to table train for a third course.

Robert C. Fulford, DO

What initially attracted you to the philosophies of Dr. Fulford and begin assisting in teaching with him? My entire view and understanding of osteopathy was radically changed when I witnessed the miraculous results that doctor Fulford was able to achieve in treating patients and adults. One of the first cases I witnessed was a 1 ½ year old toddler who’s left lower leg had turned in so much since birth that the outside edge of his left shoe was worn. The treatment he was receiving was monthly serial casting to turn the foot straight. I tried to treat the child, but the child would not sit still. Dr. Fulford was in town and I

“Anyone who has had the experience to study with, to be treated by, or have him (Dr. Fulford) treat your patient, will say that they were never the same after that experience.”

T R I A D | A U T U M N 2019

asked him if he would treat the youngster. The amazing thing is that the child climbed up on the treatment table and was quiet for 15 minutes while Dr. Fulford used the percussion hammer on him. More importantly was that when the child got down off the table, he ran down the hall on his toes with both feet facing forwards! After this experience I knew I had to study Dr. Fulford’s osteopathic principles and practices.

How long have you been training others in Fulford’s methods? I began by assisting Dr. Fulford in 1990, working with him until his passing in 1997. During these years I assisted Dr. Fulford teaching 22 basic courses and 15 advanced courses.

Dr. Fulford has inspired so many other physicians, can you elaborate on why DO’s and MD’s have embraced his methods? Anyone who has had the experience to study with, to be treated by, or have him treat your patient, will say that they were never the same after that experience. Andrew Weil, MD, wrote about Dr. Fulford in four of his books. There was an entire chapter on Dr. Fulford and Dr. Weil’s book “Spontaneous Healing.” Dr. Weil made a short documentary of Dr. Fulford that is on YouTube today. It captures the amazing result of a challenging diagnosis that is still difficult to treat even today and cured it with just one treatment. Many MD’s and DO’s who have studied Dr. Fulford remark that their practice has been forever changed for the better.

You have spent decades teaching the Fulford Percussion Hammer course, have you expanded on the original concepts? The original course with Dr. Fulford was two days. It was an intense tutorial, jam-packed with information that goes back to Dr. A.T. Still. I feel Dr. Fulford is the 20th century’s embodiment of Dr. Still’s osteopathy. His osteopathic approach still is well ahead of our time producing better results than even modern allopathic or osteopathic medicine. Remember, he used no drugs or surgery. He only used his hands and vibrating machine to assist his hands. The current course has been expanded to three days to give the student the scientific information needed, the palpatory skills necessary, and treatment experiences to understand the osteopathic practices of Dr. Fulford.

What can physicians look forward to learning in the course? The basic course design is to introduce the participant to Dr. Fulford and his timeless principles of healing as founded by Dr. A.T. Still. We will present information and palpatory skills not taught currently in CME courses

or even in the undergraduate OPP coursework. By the end of the threeday course the participant will have an excellent grasp of the use of the percussion hammer as an adjunct to their osteopathic treatment armamentarium. The course will teach another way to evaluate the patient and provide guided table training time to get the basic concepts across by utilizing the percussion hammer.

Our country is realizing the devastating effects of the opioid epidemic. Can the principals you advance in the course help manage chronic pain? Absolutely! Many patients seeking osteopathic medicine are looking for alternatives to the current chronic pain treatment protocols. This course will provide information and treatment strategies to work with even the most complicated cases without the use of drugs.

You teach all over the world. How are Dr. Fulford’s principals received in other cultures? We just returned from teaching two courses in Japan. Osteopathic medicine, and especially Dr. Fulford principals, are highly revered in all of the countries where I have taught. We

have already been invited back for two advanced courses in Japan in 2021. We also have taught in Rome and Pescara Italy as well as Heiden, Switzerland. Next year we will be teaching in Brazil, France, and Switzerland. In 2021 we will be introducing Dr. Fulford‘s work in St. Petersburg, Russia. Everywhere Dr. Fulford is introduced is an exciting experience as they truly embrace his teachings and apply it in their practices with amazing results.

What do you find most rewarding when teaching the Fulford course? To make these complex healing principles of osteopathy understandable, and have the participants attain the skills necessary to fulfill their innermost desire to heal the sick and infirmed, is what keeps me going! It is especially rewarding when I get feedback from former attendees on the incredible results they encountered with their patients. I know they experienced what I experienced when I began working with Dr. Fulford. And I know his knowledge made an impact that will last a lifetime!

See page 4 for information on the Fulford Legacy Conference.

Robert Fulford, DO and the Philosopher Physician Robert Fulford, DO (1905-1997) was an important figure in late twentieth-century osteopathy. Trained at the Kansas City School of Osteopathy and Surgery, he was a strong believer in the "triune" nature of man—physical, mental, and spiritual—and the importance of diagnosing and treating the whole person, not just the physical symptoms. Dr. Fulford's career was a testament to this ideal, what A.T. Still called the philosopher physician. In the mid-1940s he studied cranial osteopathy with William Garner Sutherland and became a lifelong member (and one-time president) of The Cranial Academy. During the course of a practice that spanned six decades he explored a wide spectrum of scientific and philosophical ideas about the basis and mechanics of life. Nothing was off limits—field theory, Aryuvedic medicine, biomagnetics, psychological and subtle energy medicine, crystals. Always he followed Sutherland's advice to "dig on," integrating whatever was useful into the practice of what he termed "twenty-first century medicine.

T R I A D | A U T U M N 2019

MICHIGAN OSTEOPATHIC ASSOCIATION

15th Annual Autumn

SCIENTIFIC CONVENTION

Friday, Nov. 8 – Sunday, Nov. 10, 2019 Registration: www.domoa.org/gr2019 Amway Grand Plaza: 187 Monroe Ave. NW, Grand Rapids, MI 49503 Hotel reservations: Call 616-774-2000 or visit www.DOMOA.org/amway Agenda: www.moaautumn.com What to do in Grand Rapids? www.experiencegr.com/moa2019

24-26 AOA Category 1-A Credits anticipated The Michigan Osteopathic Association is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The Michigan Osteopathic Association designates the Autumn Scientific Convention for a maximum of 24-26 AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.

PHYSICIAN WELLNESS CENTER at Autumn Convention O S T E O PAT H I C M A N I P U LAT I V E T R E AT M E N T

Educational Experience

YO G A S E S S I O N S

Guided Relaxation & Meditation

R E LA X & R E J U V I N AT E

Saturday, 8 am - 3 pm

Thank you to our partners who make the PWC possible!

Diamond Sponsor Diamond Diamond Sponsor Sponsor Diamond Diamond Sponsor Sponsor Strategic Partners Partners Strategic Partners Strategic Strategic Strategic Partners Partners

TRIAD

| A U T U M N 2019

For full agenda, visit www.MOAautumn.com

FRIDAY SESSION HIGHLIGHTS

9 AM – 6:15 PM • AMBASSADOR EAST • 9 CME CREDITS

11 AM - 12 PM

1 - 2 PM

Integrative Lifestyle Medicine: Cardiology Update Joel Kahn, MD, FACC The Kahn Center for Cardiac Longevity in Bingham Farms, Michigan, is one of the world’s premier cardiac clinics. Joel Kahn, MD, and his team offer advanced care using a direct patient model — you have exclusive access to Dr. Kahn, longer and more thorough consultations, and access to the most advanced preventive screenings.

Infectious Disease Hot Topic Anthony Ognjan, DO, FACP

12 - 1 PM

CME & Brown Bag Lunch: Violence in the Workplace Morris Cotton, CPP, Beaumont Deputy Director Security Pre-register $25 per lunch. You do not have to purchase a lunch to attend lecture.

One of the clinic’s sought-after services is a one-on-one thorough evaluation with Dr. Kahn. It’s called the Ultimate Heart Check Up. Additional services at the clinic include Carotid Intimal Medial Thickness (CIMT) ultrasounds, EndoPat artery health screenings, advanced labs, calcium scores, genetic testing, and nutrition counseling. Driven by a passion to help people live as long as possible, Dr. Kahn is an ardent believer in educating his patients to become “Young at Heart by Design,” his proven program to help men and women live younger, feel younger, and stay younger.

5:15 - 6:15 PM

Addressing ACES in Primary Care Mark Sloane, DO

Preventing Workplace Violence in Healthcare Workers in hospitals, nursing homes, and other healthcare settings face significant risks of workplace violence. Many factors contribute to this risk, including working directly with people who have a history of violence or who may be delirious or under the influence of drugs. From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in healthcare than in private industry on average. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined. A written program for workplace violence prevention, incorporated into an organization’s overall safety and health program, offers an effective approach to reduce or eliminate the risk of violence in the workplace. The building blocks for developing an effective workplace violence prevention program include: • • • • •

Management commitment and employee participation, Worksite analysis, Hazard prevention and control, Safety and health training, and Recordkeeping and program evaluation.

T R I A D | A U T U M N 2019

A violence prevention program focuses on developing processes and procedures appropriate for the workplace in question. Specifically, a workplace’s violence prevention program should have clear goals and objectives for preventing workplace violence, be suitable for the size and complexity of operations and be adaptable to specific situations and specific facilities or units. The components are interdependent and require regular reassessment and adjustment to respond to changes occurring within an organization, such as expanding a facility or changes in managers, clients, or procedures. And, as with any occupational safety and health program, it should be evaluated and reassessed on a regular basis. Those developing a workplace violence prevention program should also check for applicable state requirements. Several states have passed legislation and developed requirements that address workplace violence. Source: United States Department of Labor – Occupational Safety and Health Administration

For full agenda, visit www.MOAautumn.com

Adverse Childhood Experiences

Source: Centers for Disease Control and Prevention; cdc.gov

Adverse Childhood Experiences (ACEs) is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18. ACEs have been linked to risky health behaviors, chronic health conditions, low life potential, and early death. As the number of ACEs increases, so does the risk for these outcomes. The presence of ACEs does not mean that a child will experience poor outcomes. However, children’s positive experiences or protective factors can prevent children from experiencing adversity and can protect against many of the negative health and life outcomes even after adversity has occurred.

SATURDAY SESSION HIGHLIGHTS

7 AM – 6:30 PM • AMBASSADOR EAST • 9.5 CME CREDITS 7 - 8:30 AM

TMJ Syndrome & OMT

7:30 - 11:30 AM • VANDENBERG ROOM CONCURRENT SESSION

Mary Goldman, DO

Women’s Health Workshop

Mary Goldman, DO, graduated from Michigan State University from the College of Osteopathic Medicine in 1980 and again in 2014 with an M.A. in Health Professions Education. She practiced primary care from 1980 to 2018, at which time her practice turned to Osteopathic Manipulative Medicine. Her current practice is divided between Ascension Genesys, Grand Blanc, MI, as an OMT instructor and Osteopathic Healthcare Associates in Utica, MI. Dr. Goldman often lectures and treats at state conferences, with some history of teaching at the ACOFP national board reviews (no longer allowed since becoming an ABOFP Practical Board Examiner).

Moderators:

She continues to study Traditional Osteopathy and has completed twelve full seminars in Biodynamics, as well as continued study of Biomechanical OMT. Dr. Goldman is the Chair of the ACOFP e-Learning Committee and participates in other ACOFP Osteopathic Principles and Practice committees. She co-authored a chapter in the Somatic Dysfunction in Osteopathic Family Medicine, Second Edition.

All speakers on this panel are currently employed at Metro Health | University of Michigan Health

• Craig Glines, DO, MSBA, FACOOG, MOA President • Jeffrey Postlewaite, DO, MBA

Topics: Vaginitis, Abnormal Uterine Bleeding, STI"s: Screening & Treatment, Q&A

Speakers: • Steven Lown, DO, FACOOG • Stephanie Getz, DO, FACOOG • David Boes, DO, FACOOG • Kelly Hansul, DO, FACOOG

T R I A D | A U T U M N 2019

For full agenda, visit www.MOAautumn.com

SATURDAY - CONTINUED

8 AM -12 PM

SRE Competition Judging & Awards domoa.org/sre The MOA will once again host a Scientific Research Exhibit (SRE) at the 2019 Autumn Scientific Convention. These competitions provide osteopathic medical students, residents, fellows and attending level physicians an opportunity to present their medical and scientific research to our profession. The SRE event demonstrates the very best of what osteopathic medicine is and reaffirms the profession’s commitment to the advancement of science in osteopathic medicine.

12 -1 PM

Saturday Luncheon Product Theater by Novo Nordisk Does not qualify for CME (pre-register at booth.)

2:15 - 3:15 PM • AMBASSADOR EAST

Expanding the Osteopathic Concept for Personal and Professional Health Amelia Bueche, DO Through her work as residency program director in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine in Muskegon, Michigan, leader of an integrative medicine practice in Traverse City, Michigan, private practice in Ashland, Oregon and as a member of the Osteopathic Health Policy Fellowship Class of 2020, Amelia Bueche, D.O. has devoted her career to patient care, education, leadership and collaboration. Recognizing the need for connection among colleagues, support for students and improved access to true care of health for all, Dr. Bueche launched This Osteopathic Life in February 2019. Dedicated to expanding the understanding and application of osteopathic philosophy to serve as guiding principles for a cultural revolution grounded in love and humanity, This Osteopathic Life offers opportunity for education, engagement and empowerment. This Osteopathic Life is for everyone and for everything - recognizing our common unity, capacity for self-healing and the relationship of structure and function as opportunity to facilitate healing, health and humanity in all aspects of life. 14

T R I A D | A U T U M N 2019

SUNDAY SESSION HIGHLIGHTS 7 AM - 1:30 PM • AMBASSADOR EAST • 5.5 CREDITS 7:30 - 8:30 AM

Human Trafficking Fact or Myth Jodi Flanders, DO, FACOFP (Meets Michigan LARA one-time requirement) 8:30 AM - 10:30 AM & 11 AM - 12 PM

Pain & Symptom Management

(Meets Michigan LARA 3 hour requirement)

Topics: Medical Marijuana as a Tool for Pain Management, Hemp Sourced CBD, Update on Marijuana Use Disorder, Addiction Treatment in Jail, Criminal Justice & Telemedicine Speakers: • David Best, DO • Ryan Christensen, DO • William Morrone, DO • Edward Rosik, DO, MPH

12 - 1:30 PM

Topics in LGBTQ+ Health Jessica Heselschwerdt, MD Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals. Source: Office of Disease Prevention & Health Promotion; healthypeople.gov

PROGRAM CONCLUDES AT 1:30 PM

T R I A D | A U T U M N 2019

BEHAVIORAL HEALTH RISKS IN SURGICAL ENVIRONMENTS By Solveig Dittman, RN, BA, BSN, CPHRM, Coverys Senior Risk Specialist

t’s estimated that more than 26 percent of Americans ages 18 and up suffer from

a diagnosable behavioral health disorder. That’s about one in every four adults. These behavioral health issues are increasingly finding their way into surgery units across the nation. In our last article, we talked about maximizing safety and minimizing exposures when managing behavioral health patients in an emergency department. Today, we’re discussing how to manage behavioral health issues in surgical environments. Many of the inherent risks are the same, including inadequate assessment of behavioral health and psychiatric patients, threat to safety of staff and other patients, training deficiencies, and staffing shortages. Most of the same strategies for ensuring safety and minimizing these risks in emergency departments also apply to surgical units. But there are some nuances to consider for the surgical process.

T R I A D | A U T U M N 2019

Behavioral health risks can occur during different stages of the surgical process. Issues may arise at any time: before, during, or after surgery.

Admittance and pre-op. The preoperative assessment of various neurochemical, behavioral, cognitive, and emotional factors is even more critical when evaluating patients with a behavioral health issue. It’s crucial for physicians and nurses to be able to recognize patients with behavioral health issues including psychosis, substance abuse and withdrawal, delirium, anxiety, aggression, bipolar disorder, or suicidal behavior. If family members are involved, make sure to use their input to gain insight into the patient’s medical and psychiatric history. During surgery. It’s vital to monitor patients carefully. Care providers must have complete information about any psychiatric treatment regimen the patient has been undergoing, and any prescriptions the patient is taking to avoid drug interactions during surgery. Post-op. Patients with mental health issues often develop changes in behavior, psychomotor agitation,

delirium, or other cognitive disorders following surgery. These complications can slow the patient’s surgical recovery and minimize the effects of medical treatment.

Disruptions in routine can contribute to behavioral health risks. Especially for individuals already suffering from mental health disorders, a disruption in routine can exacerbate problems. Unfortunately, the surgical process essentially guarantees that daily routines will be significantly altered. This can put a great deal of emotional strain on patients, and it may contribute to a rise in behavioral health risks. Patients must be monitored for any changes in behavior, and systems must exist to respond to agitated patients effectively. Research published in the Western Journal of Emergency Medicine, Verbal De-Escalation of the Agitated Patient, shows that while many facilities focus on restraints and medications, verbal de-escalation techniques provide positive outcomes in many situations.

Common complications spur changes in behavior. Complications from the surgery itself may lead to additional risks. Patients may experience common complications, such as fever and infection after surgery. In some cases, this can contribute to delirium. Postoperative delirium is especially common among elderly patients. Delirious patients may experience emotional changes, becoming angry, paranoid, or depressed when they had previously been calm and cooperative. Staff must be trained on identifying vulnerable individuals, monitoring patients for behavior health disturbances, and responding in ways that de-escalate the situation.

Withdrawal issues can make behavioral health risks worse. Substance abuse is a widespread problem. According to the National Center for Biotechnology Information,

for every 100,000 individuals, 843.2 will experience alcohol dependency, and 220.4 will experience opioid dependency. Being in the hospital for a prolonged period for surgery can result in withdrawal issues for patients with substance dependency. This may result in a wide range of symptoms, including insomnia, anxiety, nausea, and tremors. A patient does not need to be addicted to illegal drugs for severe symptoms to occur. Alcohol withdrawal, for example, can lead to symptoms including hallucinations and seizures. Some prescription drugs also result in dependency, and if medication is not maintained throughout the surgery process, withdrawal symptoms may occur. Any health issues, including mental health issues, being treated by the prescription medicine may also worsen as a result. The problem of substance abuse is not going to disappear anytime soon, so hospitals must take measures to minimize the harmful impact on the surgical process.

The patient’s use of both street drugs and prescribed medication must be determined, and possible drug interactions that could occur during the surgery process must be anticipated. Patients may attempt to conceal or understate their substance dependency. For this reason, medical staff must be trained in spotting the signs of substance abuse and withdrawal. Withdrawal symptoms won’t present immediately, so continued observation is necessary. If substance abuse is identified, steps must be taken to keep both the patient and the staff safe. For a broader look at how to maximize safety and minimize exposures, see the five key steps in our last behavioral health spotlight article. Surgical facilities concerned with minimizing risk cannot afford to ignore behavioral health matters. At Coverys, we specialize in medical professional liability risk management.

T R I A D | A U T U M N 2019

2020

The Best Lawyers in America

LAWYERS FROM KERR RUSSELL NAMED AMONG “THE BEST LAWYERS IN AMERICA”

ifteen Kerr, Russell and Weber PLC members were recently selected by their peers for inclusion in The Best Lawyers in America© 2020. Kerr Russell also had two members named as Best Lawyers “Lawyer of the Year;” James R. Cambridge was named the Best Lawyers 2020 Corporate Law “Lawyer of the Year” in Detroit, and Joanne Geha Swanson was named the Best Lawyers 2020 Litigation – Antitrust “Lawyer of the Year” in Detroit.

Notably, eleven of the named attorneys have been listed in The Best Lawyers in America© for more than five years. Since it was first published in 1983, Best Lawyers has become universally regarded as the definitive guide to legal excellence and are compiled based on an exhaustive peer-review evaluation. Almost 87,000 industry leading lawyers are eligible to vote, from around the world, and Best Lawyers have received almost 10 million evaluations on the legal abilities of other lawyers based on their specific practice areas around the world. Attorneys from Kerr Russell named among The Best Lawyers in America© 2020 are listed at right:

T R I A D | A U T U M N 2019

• Robert S. Anderson Immigration Law • Jason W. Bank Bankruptcy & Creditor Debtor Rights / Insolvency & Reorganization Law • James R. Cambridge Corporate Law • Michael D. Carrol Construction Law; Litigation – Construction • Mark M. Cunningham Construction Law • Curtis J. DeRoo Employee Benefits (ERISA) Law • John D. Gatti Tax Law • Patrick J. Haddad Health Care Law • Fred K. Herrmann Antitrust Law • Mark C. Knoth Employment Law – Management • Eric I. Lark Corporate Law • Stephen D. McGraw Medical Malpractice Law – Defendants; Personal Injury Litigation – Defendants • Daniel J. Schulte Health Care Law • Joanne Geha Swanson Appellate Practice; Litigation – Antitrust • Kurt R. Vilders Real Estate Law

About Kerr Russell ... Kerr Russell is proud of Detroit. They’re also proud to be one of Detroit’s oldest law firms having been here since 1874. Kerr Russell is driven to deliver results and make a difference. They take on their clients’ perspectives to improve their clients’ lives and businesses. Kerr Russell’s legal solutions are prompt, accurate, economical, and focused on their clients’ needs in almost every area of the legal profession, including business law, labor and employment, immigration, mergers and acquisitions, cybersecurity and data privacy, real estate and construction, health care, medical malpractice, tax, contract negotiation, restructuring, automotive, manufacturing, and commercial litigation. Whereas many lawyers merely interpret the law, Kerr Russell attorneys help make it. They’ve played a role in some of the most significant legal developments in state business and health care law, and their trial lawyers have been involved in many notable commercial cases in Michigan and other jurisdictions. In business and legal circles, Kerr Russell is respected for their high standards, quality work, and professional ethics and integrity. If you would like more information about this topic, please call Rebecca Wenglinski at 313-963-7090, or email rwenglinski@ kerr-russell.com. Detroit Center 500 Woodward Ave., Suite 2500, Detroit MI 48226 Phone: 313.961.0200 Fax: 313.961.0388 Website: kerr-russell.com Columbia Center 201 West Big Beaver Road, Suite 260, Troy, MI 48084 Phone: 248.740.9820 Fax: 248.740.9840 Website: kerr-russell.com Jim Mao Tower 31 F, 88 Century Avenue, Pudong, Shanghai 200120, China Phone: +86.21.28909688 Website: kerr-russell.com.cn T R I A D | A U T U M N 2019

Creating Opportunities. Creating Opportunities. Transforming Lives. Transforming Lives.

Offering the theregion’s region’sbroadest broadestspectrum spectrumofof Offering neuro-rehabilitationservices. services. neuro-rehabilitation Origami provides comprehensive comprehensiverehabilitation rehabilitationfor foradolescents adolescentsand andadults adults with neurological Origami provides with neurological dysfunction through throughtheir theirresidential, residential,outpatient, outpatient,and andcommunity community based programs. dysfunction based programs. Visit OrigamiRehab.org OrigamiRehab.orgto tolearn learnmore moreabout aboutOrigami’s Origami’sprofessional professional and specialized Visit and specialized services including includingdriver driverrehabilitation, rehabilitation,serial serialcasting, casting,and andvision vision therapy. services therapy.

Info@OrigamiRehab.org Info@OrigamiRehab.org

517-455-0264 517-455-0264

OrigamiRehab.org OrigamiRehab.org

OrigamiRehab OrigamiRehab

T R I A D | A U T U M N 2019

MARIE'S STORY

urvivors of brain injury, their families, and their supporters are facing difficult times, and the fight is far from over. On June 11, 2019, Michigan’s auto no-fault insurance changed forever, threatening the sustainability of brain injury providers like Origami Brain Injury Rehabilitation Center and the longevity of rehab for the catastrophically injured. “Following a brain injury, there are many different things that go into the care of the individual. You are dealing with someone’s whole person and who they are. To meet all of those needs, you have to have a team. It is a common misconception that health insurance covers comprehensive care and that is not the case,” shared Origami’s Director of Rehabilitation, Amanda Carr. Origami’s team sees firsthand the support that auto no-fault benefits provide Michigan families. While the benefits of this law have supported many individuals our team serves, one client story that illustrates the significance of these benefits well is our client, Marie.

is that this kind of injury is like pulling the plug on the person.” When Marie became responsive, her family focused on accessing the resources that Marie would need to recover. “In Marie’s situation, without auto no-fault, she would not have been able to receive the comprehensive rehabilitation services and quality of care that she really deserves,” said Origami’s Director of Rehabilitation, Amanda Carr. When Marie arrived at Origami, she went through a variety of basic cognitive-linguistic assessments and scored in the severe range on each one. “For Marie, being at Origami and getting the services that she needs, allows us to help her progress. Marie has some pretty big personals goals and it is really nice to see her work towards those,” said Marie’s Speech-Language Pathologist, Linda Wells.

“Life benefit with Michigan’s Auto NoFault has allowed us to provide Marie the care she needs, without worry. Policymakers need to step back and realize how much value Michigan’s current benefits provide local families. They can’t put it in the same context as someone who has lived through it,” said Marie’s husband, Dave. Without the expertise of organizations like Origami, people like Marie would not receive the care they deserve to regain a new quality of life. Origami’s President & CEO, Tammy Hannah, calls us all to stand together to do all we can, to ensure survivors of catastrophic auto accidents continue to receive the care they need. Contact Origami at OrigamiRehab.org to learn how you can join this important fight. Origami Brain Injury Rehabilitation Center is a 501(c) (3) nonprofit organization. Origami provides comprehensive rehabilitation for adolescents and adults with neurological dysfunction through their residential, outpatient, and community-based programs. With their compassionate and innovative services, Origami creates opportunities and transforms lives.

At the school bus stop in Haslett, Michigan, Marie and her 13-year-old daughter were struck by a hit and run driver. Marie sustained many severe injuries, including a traumatic brain injury that altered the course of her life. For weeks, Marie was on life support and in a coma. Marie’s husband Dave looks back on the challenging time stating, “For all intents and purposes, she was gone. The truth of the matter T R I A D | A U T U M N 2019

MICHIGAN OSTEOPATHIC ASSOCIATION

121st Annual Spring

SCIENTIFIC CONVENTION

Dynamic speakers, in depth and relevant topics at a nationally accredited program and 750+ physicians in your DO family.

SEE YOU IN SOUTHFIELD

Thursday, May 14 - Sunday, May 17, 2020 32+ AOA Category 1-A Credits Anticipated www.domoa.org/spring