April 3, 2015
Inside MUsC
PresenTer
7
Faculty member impresses at national meeting.
PrOviding COMfOrT
8
MUSC chaplain publishes book about her calling.
2 Applause 5
Meet Dana
11 1,000th Patient T h e C aTa ly s T Online http://www. musc.edu/ catalyst
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 33, No. 31
Rx Warning: possible mitochondrial toxicity Watchdog group advocates for sterner warnings on antioboiotics Levaquin, Cipro By J. Ryne Danielson Public Relations
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hen Raja Fayad, M.D., was murdered on the campus of the University of South Carolina this past February, he was working on something big, something Charles Bennett, M.D., Ph.D., hopes will be part of his legacy. Bennett is the SmartState endowed chair for medication safety and efficacy at the South Carolina College of Pharmacy, a partnership between USC and MUSC. Bennett also runs one of the largest and most successful pharmaceutical watchdog groups in the country, the Southern Network on Adverse Reactions — SONAR. In June and September 2014, SONAR filed two citizen petitions with the Food and Drug Administration regarding fluoroquinolones, a class of drug that includes the powerful antibiotics levofloxacin and ciprofloxacin — Levaquin and Cipro. Bennett wants “possible mitochondrial toxicity” and “serious psychiatric events” added to the drugs’ black box Bennett labels — the most prominent warning label required by the FDA. SONAR has gathered testimony from hundreds of patients who have experienced muscle weakness, chronic fatigue, cardiomyopathy, hearing loss, developmental disorders, severe depression or nerve damage after taking Levaquin and related drugs. A recent report from the FDA’s Office of Safety and Epidemiology has also linked neurodegenerative diseases like Parkinson’s, Alzheimer’s and amyotrophic lateral sclerosis (ALS) to quinolones and the mitochondrial toxicity reported by some patients after taking them. The problem: most patients – even most doctors
photo by Sarah Pack, Public Relations Powerful antibiotics Levaquin and Cipro, as well as other members of the flouroquinolone family, may be responsible for dangerous but unacknowledged side effects, including mitochondrial toxicity syndrome, a disruption of cellular function which causes severe nerve damage. – don’t know these side effects exist. On top of that, the most common use of the drugs is off-label, that is, for uses other than those explicitly approved by the FDA. Bennett gave an example: “A patient goes to see their doctor on a Friday afternoon because they don’t feel well. What we should do is watch that patient closely, see if they really have an infection; they probably don’t. The patient hates that. On the other hand, give them a prescription for Levaquin and they think, ‘my doctor's taking good care of me.’” The drugs are often prescribed, Bennett said, to placate patients — and doctors themselves. “The antibiotics are viewed as harmless and effective,” Bennett said. “So, why not write the prescription?” But, he stressed, the risk-benefit profile of quionolones, like all medications, is favorable only when the drugs are administered according to FDA–approved indications. Pharmaceutical companies are not allowed to market their drugs off–label, but doctors are allowed to prescribe drugs, including quinolones, for off–label use. Seventy–five percent of all prescriptions are written off-label, Bennett said. This presents problems when doctors are not fully aware of the possible side effects
READ THE CATALYST ONLINE - http://www.musc.edu/catalyst
See Wathdog on page 6
2 The CaTalysT, April 3, 2015
Applause Program The following MUSC employees received recognition through the Applause Program for going the extra mile: Medical Center
Brandi Olsen, Vol. Guest Services; Sharon Bond, Women’s Health; Gretchen Hahn, Prenatal Health; John Parlor, Vol. Guest Services; Justin Ravenel, ART Vol. Guest services; Jacqueline Heyward, PAS Admissions; Valencia Brown, Venipuncture; Ana Rosa Virella, Ambulatory Care Women’s Services; Debbie Capeda, Revenue Cycle; Sherrel Singleton, Women’s Care Services (Anetpartum); Earlease Capers, 5W Labor and Delivery; Ashley Pratt, Antepratum; Michael Andaya, Vol. Guest Services; Jennifer Mikoll, Hematology Oncology; Phyillis Kinloch, Physicians Administration; Jennifer Carullo, ART Ambulatory Care; Amanda Myers, Revenue Cycle; Collin Quashie, Ambulatory Care/Pt Transportation; Brittany Lewis, 6 West; Lorraine Haas, Meduflex Team; Wendy C Williams, 10West; Laurie Moultrie, Meduflex Team; Vanessa Jackson, Plant Maintenance; Mar-Yam Mcfadden, Radiology; Alberta Williams, Registeration Admin; Michelle Turner, Ambulatory Care; Chelsie Oster, Financial Services; Cassandra Dickerson, Revenue Cycle; Metz Sulyma, 10West; Michelle Barnett, Radiology; Kevin Marcum, Clinical Neurophysiology; Sheila Byas, Revenue Cycle; Tara Hall, 8West Med Surgery; Michael Swaney, Radiology; Brittany Ravenell, 9West Neurology; Geraldine Torres, Interpreter Services; William Williams, Floor Technician; Deborah Bellinger, Radiology; Shnek Gaillard, ART Lab Services; Lisk Kirkman, DDC; Evelyn Polite, ART Surgery;
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723
Editor: Cindy Abole
catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu Dawn Brazell, brazell@musc.edu J. Ryne Danielson, daniejer@musc.edu Helen Adams, adamshel@musc.edu Sarah Pack, packsa@musc.edu Jeff Watkins, watkinsj@musc.edu
Roberta Lockwood, Antepartum; Melvina Matthews, EVS; Lisa Carraher, Antepartum; Allison Ciarella, Autospy Pathology; Jenna Delany, STNICU; Tyler Hunter, STICU; Monterris Junes, Outpatient Registration; Meggan Deveaux, ED Technician (PICO Intern); Chlorice Hergatt, Labor and Delivery; Karen Mcwhite, Vol. Guest Services; Sarah Justiss, Peds Procedure; Dale Donnelly, Endoscopy; Bernadette Mazzoli, Women’s Services; Heather Cornwell, Medical Intensive Care Unit; Monica Wigfall, Postpartum 5 East; Leola Wright, Meduflex team (Patient Companion); Dionne Boone, Phlebotomy; Morgan Dipasquale, Neurophysiology; Jie Zhang, Neurophysiology; Queenester Bowens, Respiratory Therapy; Phyllis LaBoard, UIM; Donna Williams, STICU; Deborah Oliver, Peds Gastro; Suzette Jeffcoat, HVC Prep and Recovery; Consonia Brown, STNICU; Lucinda Magwood, MICU; Carlton Jenkins, Parking Management; Lori Morris, 9West (Neuro); Jeff Etheridge, Neuropsysiology; Taylor Roberts, 9 West (Neuro); Jessica LaChance, 9West (Neuro); Colleen Jones, 9West (Neuro); Linda Vodzak, Neuropsysiology; Sandra Fokes, Antepartum; Tiwanna Gibbs, EVS; Angela Chisolm, Endoscopy/ GI; Bret Johnson, ART 4E; Karen Loury, Peds Intermediate Care; Cynthia Corson, Peds Subspeciality; Patty Thompson, PICU; Kristen Mclure, PICU; Casey Howett, Ambulatory Care/ Women’s Services; Anna Powell, Ob/GYN; Rene Mallari, MICU; Terrance Jennings, Engineering and Facilities; Kayla Lobaugh, Ultrasound Genetics; Isiah White, Engineering and Facilities (Physical Plant); Roberta Campbell, Meduflex Team; and The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.
Adam Miller, 6 West University Melissa (Missy) Behling, College of Dental Medicine/Dental Faculty Practice; Mary (Mimi) Bongiorno, Clinical Effec-
tiveness and Patient Safety; Melissa Glover-Johnson, Employee Health Services; Christine Talbot-Bond, College of Medicine Dean’s Office; Ernest Thomas, Internal Audit; and Sara Thigpen, College of Dental Medicine/Oral Rehabilitation
ART nurse advocates, wins DAISY The February DAISY (Disease Attacking the Immune System) award winner is Christine Puskar, R.N., who works in the Cardiac Acute Care Unit, 5East at Ashley River Tower. Puskar was nominated by Eileen Sandlin, R.N., a fellow cardiac acute care nurse in the department. Below is her nomination: “While working on a Saturday afternoon, nurse Christine Puskar received a phone call from a family member of a patient whom she had discharged the day before. The patient had Puskar & her been sent home Family on prescription Nexium and when she was attempting to fill the prescription, the family member discovered that the co-pay for this drug was going to be $500. Throughout their conversation, Christine discovered that the patient’s prescription for 100mg of Spironolactone also had a very high co-pay. While at the patient’s local pharmacy, Christine asked to speak to the pharmacist for clarification. While talking to the pharmacist, Christine pulled up the list of $4 medications and discovered that 50mg Spironolactone was on the list. She learned that the prescribed strength of Nexium could be obtained by taking a higher dose of over–the–counter Nexium. Christine then located the physician who had discharged the patient and had a discussion with him. The physician initially pushed back about changing the prescribed medications, but with Christine’s explanation, he understood patient situation as she would be unable to fill her prescriptions at all without
the dosage adjustment. The physician agreed to calling in a modification to the prescriptions. Christine next called the patient’s family to explain the changes to the prescriptions. She provided detailed instructions about how they would take the medications, and reinforced that the medications were on the $4 Rx list. Christine went on to emphasize the importance of taking these pills, and that not filling them would likely result in a return trip to the hospital. The family agreed that they would pay for the prescriptions when organized the way Christine had worked it out for them. Christine then went the final step and called the pharmacist to personally discuss the changes to the prescriptions and explain why we made the modifications. I was so extremely impressed by Christine’s advocacy for her patient. She went above and beyond her role in ensuring that her patient would be successful post-hospitalization. With the knowledge she had, she orchestrated a solution to what could have been a potential deal-breaker for this patient’s recovery. Christine’s actions that day likely prevented a re-hospitalization for her patient, and certainly demonstrated MUSC Excellence. Each month, MUSC nurses are honored with the DAISY Award for Extraordinary Nurses. It is part of the DAISY Foundation’s program recognizing the efforts that nurses contribute daily in their jobs around the country. The award recognizes outstanding nurses in more than 1,800 health care providers in the U.S. and 14 other countries. Nominations can be submitted by anyone — patients, visitors, physicians nurses and MUSC staff. To nominate a nurse, visit http://www. musc.edu/medcenter/formsToolbox/ DaisyAward/form.htm.
The CaTalysT, April 3, 2015 3
MUSC recognized in the state for recycling, waste reduction Staff Report MUSC was among five South Carolina businesses that were recognized for their exemplary recycling efforts by the S.C. Smart Business Recycling Program and Green Hospitality Program, according to the state’s Department of Health and Environmental Control. MUSC was recognized for collecting more than 1,235 tons of material from 130 buildings. Specifically, MUSC doctors, nurses, lab staff and others worked together to recycle more than five tons of radiology film and medical products. MUSC tracks its recycling efforts using bar-coded recycling bins and increased its recycling rate of plastic, glass and metal by 32 percent. “The 2015 winners demonstrate how businesses and organizations can improve their bottom line while also conserving resources and protecting the environment,” said DHEC Environmental Affairs director Elizabeth Dieck. “Their dedicated efforts help strengthen South Carolina’s economy by creating recycling businesses and jobs.” MUSC chief facilities officer Greg Weigle praised sustainability manager Christine von Kolnitz Cooley and MUSC’s Sustainability and Recycling Program team for their hard work and efforts. “I appreciate the efforts Christine and her team have made to increase recycling on the MUSC campus. It’s both the right
thing to do and good business sense. I also appreciate the support of our campus community to enable us to reduce our waste stream,” he said. Other businesses recognized include Charleston Water System; Caterpillar Inc. of Newberry; Gravatt Camp and Conference Center in Aiken; and Sea Pines Resort in Hilton Head. The S.C. Smart Business Recycling Program and Green Hospitality Program offer free, confidential, non-regulatory services including site visits, technical assistance, market research and workshops. For information, visit www.scdhec.gov/smartbusiness or www.scdhec.gov/greenhospitality.
Examples of Reduce and Reuse at MUSC
photo provided
Susatinability manager Christine von Kolnitz Coonley, left, accepts two plaques presented by S.C. DHEC’s Stacey Washington for MUSC’s Outstanding Waste Reduction and Recycling Program.
q Epic online patient record stores all patient information online. No paper is used in this process. q My-fax is a fax system that uses no paper. Medical faxes are sent to this unique system. q MUSC’s Urban Farm composts on-site utilizing all reusable containers, paper and plastic bags. q Water bottle filling stations help users avoid the use and waste of plastic water bottles. q Two reusable office supply exchange rooms collect donations for reuse: three-ring binders, printer cartridges, binder clips, hanging file folders, etc.
New area code prompts 10-digit dialing need to dial 9 followed by the 10-digit local number, or 9 followed by 1+ area code + telephone number for long distance calls. Calls within MUSC to 792 or 876 numbers will continue to use the 5-digit extension to extension dialing. This new overlay will not affect current telephone numbers and area codes. Everyone is reminded to make the necessary adjustments to accommodate this new dialing procedure by setting and reprogramming equipment such as fax machines, alarms, Internet dial-up numbers, security systems, speed dialing, call forwarding settings, voicemail services and similar functions. Employees also should check their websites, business cards and stationery, contact lists, etc. Information on updating abbreviated dial buttons on your MUSC phone can be found on the University Communications website at https:// sp.musc.edu/ocio-is/infrastructure/uct on the Basic Phone Information and Instructions page. For more information, contact University Communications at 792-9980 or email uctdir@musc.edu.
COLLEGE ADVISING • Find right college “fit” • Financial aid solutions • Summer Enrichment plans
• Private school placement • Learning support programs • Emotional growth schools
Call Chip And Claire Law, IECA Certified Educational Planners
843-278-1271
www.eduave.com claire@eduave.com chip@eduave.com
IP03-1286710
The Tri-county area and coastal area of South Carolina are adding a new area code to its existing 843 overlay for telephone numbers. The new area code overlay is 854 and will serve communities in the Charleston, Hilton Head Island, Myrtle Beach and Florence region. Beginning immediately, callers on MUSC’s campus should begin using 10-digit dialing (area code + telephone number) for local calls. Calls made using seven-digit dialing will still be accepted until Sept. 19. After Sept. 19, calls made without using 10-digit dialing will not be completed and a recording will instruct the user to hang up and dial again. When calling from MUSC, users will
4 The CaTalysT, April 3, 2015
Student dentists teach oral disease, preventative care By KelCy huDDle MUSC Chapter, American Association of Women Dentists, James B. Edwards College of Dental Medicine
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or the first time, the MUSC chapter of American Association of Women Dentists had the opportunity to teach and interact with residents of the Florence Crittenton home in Charleston. Florence Crittenton Program of South Carolina sponsors a residential home that houses pregnant teens and young adults ages 10 to 21, where they receive comprehensive care ranging from academic education to prenatal care and life skill instruction. In February, six AAWD students visited the home and taught proper oral hygiene, nutrition, and basic elements of tooth structure at the facility. The group split up into teams of two, manning three rotating stations to facilitate interactive lessons. Dental students Rebecca Harrison and Kinsley Johnson gave a nutrition lesson on the amount of sugar contained within drinks such as orange juice, Gatorade and soft drinks and asked the ladies of Florence Crittenton to guess the amount of sugar in each drink. “It was definitely eye opening,” said one of the participants. Following AAWD students Sarah Carlisle and Laura Kuhne used an egg to illustrate the effects of different liquids on tooth enamel, submerging an egg in Coca-Cola, a fluoride mouth rinse and vinegar. Meanwhile, students Hannah Rustin and I gave a lesson on oral hygiene for both mother and baby, emphasizing
Dental students Hannah Rustin and Kelcy Huddle demonstrate proper oral care.
photos provided AAWD students Sarah Carlisle and Laura Kuhne demonstrate how tooth enamel erodes with regular use of products while visting the Florence Crittenton Home in Charleston.
“I am so happy that they were able to spend time with these young women teaching them about oral health both for themselves and for their babies.”
Dr. Elizabeth Pilcher the importance of proper oral care when the baby is born, and establishing a dental home by 12 months of age. The interactive day ended with a distribution of “goodie bags” that contained samples of toothpaste, toothbrushes, mouth rinses and floss, which the ladies were extremely thankful to receive. Students also enjoyed the experience and hope it was the start of routine visits to the Florence Crittenton facility. Elizabeth S. Pilcher, DMD, associate dean for institutional effectiveness and AAWD faculty advisor, has enjoyed working with the women dental students on this project and other efforts. “I am very proud of the College of Dental Medicine’s AAWD chapter. They are energetic and committed to improving the lives of others,” she said. “Their work with the Florence Crittendon program is a good example of this. I am so happy that they were able to spend time with these young women teaching them about oral health both for themselves and for their babies.”
The CaTalysT, April 3, 2015 5
Meet Dana
t
West Ashley Rental
1014 RIVERSHORE ROAD, CHARLESTON, 29492 $649,900, LISTING MLS# 15007011
How I’m changing what’s possible at MUSC I believe in MUSC’s mission and vision and am inspired by our direction for the future. I use my personal inspiration to motivate others to join the Excellence journey.
4 bedroom 2.5 bath big back yard! 1910 Ashley Hall Road $2,300 per month
Call 843-810-8275
Call Ed for more info:
843.270.0292
IP02-1304182
Department Department of Ophthalmology, Storm Eye Institute
L o c a t e d j u s t 6 m i l e s f ro m M U S C
IP07-1303374
Dana Millet
Beautiful Lowcountry home in the waterfront community of Beresford Creek Landing with resort style amenities! The open floor plan features two story ceilings in the great room, master suite on the first floor, two large guest suites with private baths, and an inviting game room/media room/4th bedroom on the ground level with full bath and its own access! The huge space on the ground floor has all the room you need for a pool table, home theater, or separate suite. Beresford Creek Landing amenities include a private boat landing, junior Olympic pool, clubhouse, play park, and tennis and volleyball courts.
How long at MUSC Five months
Hometown Kingwood, West Virginia Reason I became a nurse It happened by accident. I couldn’t decide what to study in college. My grandmother Beryl begged me to apply to nursing school. Later, I fell in love with the profession. What makes me a Magnet nurse The values that I hold dear are integrity, being a lifelong learner, seeking excellence and mastery and connecting to patients and co-workers.
Lunch Buffet:
BOGO Monday – Thursday Come experience our newly expanded lunch buffet and healthier options menu.
(not valid with any other discounts) Expires 4/30/15.
IP07-1303058
Children and their names Husband, Damian (also a nurse working at the IOP); daughter, Brooke; son, Jack; and a cat named Magic
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WaTChDog
Continued from Page One
associated with the drugs they are prescribing, which is why Bennett believes getting a black box warning is so important. Bennett is clear: He doesn’t want the drugs banned. Levaquin and Cipro are important drugs, especially in clinical oncology where they are used to treat infections in patients undergoing chemotherapy. “Every drug has side effects,”Bennett said. “If the drug has a favorable risk-benefit profile, then it should be on the market.” For mitochondrial toxicity syndrome, Bennett believes, the risk could be mitigated with a simple genetic test. But, before this test can be developed, the risks must be acknowledged. SONAR is the only pharmaceutical watchdog group that focuses on drugs used in the treatment of cancer. “We have a niche that nobody else in the country can be in,” Bennett said. “The science is too hard. You have to understand oncology.” Bennett does. He is an oncologist. It is this clinical training that sets him apart in his field. Being a clinician, focusing on pharmaceutical safety, he believes, is very different from being a statistician, looking for safety signals. Rather than combing large databases for adverse drug reactions, like most watchdogs, Bennett goes directly to the patients themselves. SONAR is a fitting acronym for Bennett’s group. “SONAR listens to people who have been harmed by an adverse drug reaction," he said. “We give patients a voice.” He continued, “If a patient takes a drug and experiences a terrible side effect, what could they do? What could they do? They’d be upset, I know that. But, what could an ordinary citizen do? “One option might be to call their doctor. What would the doctor say? ‘That’s a terrible thing that’s happened to you, I’ll put it in your notes.’ The patient wouldn’t feel very good about that. “So, they’d say, ‘Let me call the FDA,’ and they’ll call up some number in Washington. They’re put through a series of push-ones and push-twos, until they get to a person that says, ‘That’s a terrible thing that’s happened to you, please send us a two-page report.’ “The FDA gets more than 250,000 such reports every year. The patient would be filed away and never even get a thank-you note. “Then the patient might call the drug company. One can imagine how that would go. The drug company will have a drug safety representative who is required to file a report with the FDA within 15 days. They’ll say, ‘That’s a terrible thing,’ and file their report. But, at the end of the day, the patient is back at square one. “A final option,” Bennett said, “is SONAR.” Bennett’s group has personally collected hundreds of patients’ stories from across the country, in addition to the more than 130,000 adverse event reports for quinolones that have been filed with the FDA. “Levaquin, Cipro — these are billion–dollar drugs,” Bennett said. “But the FDA has the authority and
photo provided Dr. Raja Fayad, killed last February in a shooting on USC’s Columbia campus, was working to prove a link between Levaquin and and MTS. His paper is still under review.
“Levaquin, Cipro — these are billiondollar drugs, but the FDA has the authority and responsibility to ensure they’re labeled correctly.” Dr. Charles Bennett
responsibility to ensure they’re labeled correctly.” Before Fayad was killed, he was engaged in documenting these side effects in a preclinical setting, adding empirical evidence to a surfeit of anecdotal accounts. Fayad’s paper, submitted last summer, has been under review for eight months. This is an unusually long time, Bennett said, saying it amounted to a “pocket veto.” Since Fayad is no longer able to fight for his work, Bennett is stepping in. “I spoke with the editor and said I need this paper adjudicated – it’s an important piece of Raja’s legacy,” Bennett explained. “I received a commitment that the adjudication will happen.” Bennett said the pushback from drug companies has been “unbelievable.” The companies he has taken on have a market capitalization in excess of $700 trillion; their products are worth hundreds of billions of dollars. “You can’t do what I do and think the drug companies don’t notice you,” he said. “Wyeth, Celegene, Eli Lilly, Novartis, Roche, Genentech, even General Electric — you can’t find a major drug company that SONAR hasn’t found an issue with.”
Bennett’s work with erythropoietin and darbepeotin, to cite one example, led to a 90 percent decrease in annual sales of these drugs in the cancer setting - from $6 billion to less than $1 billion. Bennett said many things can happen when one finds themselves on the wrong end of a powerful corporation: “Sometimes you find that you’re not invited to conferences you used to be invited to. You’re kicked off committees. Sometimes they send private investigators after you. “They’ve looked at everything I’ve ever done in my life,” Bennett said. “At the end of the day, most people would not do my work. It’s far too dangerous.” Bennett’s grants have been repeatedly and aggressively audited. “I am pleased that after careful review,” he said, “they did not identify a single dollar that I had misspent over a 27 year academic career. There has been a concerted effort to shut my program down, but it is not shut down. We will be heard.” Pushback doesn’t just come from drug companies, Bennett said, but from the FDA itself. After filing a Freedom of Information Act request with the FDA, Bennett discovered the agency’s own safety experts had investigated reports related to fluoroquinolones and found evidence of the same side effects SONAR found. SONAR’s citizen petitions request that the FDA include its own safety panel’s findings in the drugs’ package inserts. The FDA has indicated they have received the citizen petitions, and they are under review, but no action has been taken to date. “The FDA is not in the business of pushing back very hard against the drug companies,” Bennett said. “The FDA’s client is the pharmaceutical industry.” Bennett explained: “If you’re an underpaid government employee, working at the FDA — you maybe have a good heart — but if you decide you want a better paying job, what do you do? You take a job with the pharmaceutical industry. If your resume shows you’ve been leading the charge to remove drugs from the market, the only place that resume is going is in the garbage.” Bennett said the current method for determining the severity and rarity of side effects in off–label uses of medications is unacceptable. For one, he said, it is very expensive to get a drug approved for a specific use. This is why so many prescriptions are written off–label to begin with. “It costs about $800 million to do the appropriate testing to support a new indication for a drug. Many drug companies say, ‘Look, we’ve got a small number of labeled indications that we can live with — we’ll let the market take care of the rest.’” How could a drug be around for 20 years and these side effects remain undocumented? Bennett said this failure reveals “not just a chip in the armor — the armor has fallen off. And this is not the only drug like this — I’ve investigated 50 drugs like this.” Over the past few months, Bennett has met with 10 U.S. Senators and two Congressmen, including
See Wathdog on page 9
The CaTalysT, April 3, 2015 7
Chief quality officer shares ‘Just Culture’ highlights By MiKie hayes Public Relations
S
ay there is an employee of 25 years who’s had a truly exemplary career. He dedicates himself to the organization, is liked and respected by colleagues and superiors. He always comes through, never grumbles, supports teammates, volunteers for extra duties when others need help. But one day, while on duty in the hospital at 3 a.m., he finds himself experiencing medical symptoms his doctor had warned him to be on the lookout for. Recalling his doctor’s instructions to have a particular test done ASAP if he ever had those symptoms, he sprang into action. But rather than telling a supervisor or bothering a colleague during the wee hours of the morning, he proceeds to perform the diagnostic test on himself. Obviously this scenario is fraught with all sorts of bad endings. But, for a quarter of a century before that experience, the man had a spotless record. And, in the middle of that night, he believed he was following his doctor’s orders. He thought he was taking initiative. He certainly didn’t want to inconvenience people who were likely sound asleep. So what should his managers have done: Fire him on his first offense? Call no harm, no foul and look the other way since he was so well liked and again, no one, and nothing, was any worse for the wear? Slap him on the hand and say, “Don’t let it happen again?” It’s these types of thought–provoking, yet challenging, situations that quality officers face every day. Some are egregious, others may seem fairly benign, but all offer an opportunity to educate. It’s that premise that underscores the principles of a relatively new way of dealing with organizational safety issues called Just Culture. According to MUSC CEO Patrick Cawley, M.D., Just Culture is an approach to dealing with human behavior that balances accountability with the recognition that all humans can and will make mistakes. The example of the above employee
served as just one of many types of scenarios that Danielle Scheurer, M.D., MUSC chief quality officer, used to bring home her point about Just Culture during the presentation she made to hundreds of colleagues at the 2015 American College of Medical Quality (ACMQ) annual conference held March 26 through 28. “Together We Will” was both the title of the conference, as well as the tone of the presentations at the meeting. As health care professionals work together to ensure patients are put first in all aspects of their care, quality officers and their teams have some of the toughest jobs as they strive to integrate practical systems aimed at fair and effective reporting practices and appropriate course correction into the organization’s ethos. Scheurer and fellow medical quality expert, Peter Pronovost, M.D., Ph.D., from Johns Hopkins University School of Medicine, were Friday’s keynote speakers. Through numerous relevant examples, Scheurer’s presentation, “Just Culture,” educated her peers about how this method could help organizations improve safety outcomes as well as employee engagement. As she explained to the audience that consisted of participants attending the meeting and others who were watching it streaming live from the conference in Alexandria, Virginia, Just Culture strikes a balance between the extremes of a punitive culture of blame and a blame– free culture. Historically, based on the belief that individual workers were solely accountable for patient outcomes, regardless of a flawed process or deficiencies in the system, perfect performance was expected and believed to be achievable through training and the threat of disciplinary action. However, because of fear of being fired or other types of retribution, errors and hazards weren’t being reported, instead remaining hidden. Not only was that dangerous for patient care, it prevented opportunities to bring awareness to potential risks or implement changes to improve care. An overly-punitive culture ultimately led way to a blame-free model, where
photo provided
Dr. Danielle Scheurer, keynote speaker at the 2015 American College of Medical Quality annual meeting, fields questions after her ‘Just Culture’ presentation. people who meant well were given the benefit of the doubt and excuses were often made for bad behavior and critical mistakes. This approach was equally ineffective. “A Just Culture,” Scheurer said, “creates a fair and safe environment where all employees feel at ease to report problems, including errors and mistakes. The Just Culture algorithm has been helping organizations be ‘just’ with their employees. Let’s face it, we all make mistakes. This approach helps us understand our behavioral choices and judge behaviors, not outcomes. It also allows for an investigation of events so we can best determine whether behavioral choices need to be managed or if processes and systems need to be addressed and changed.” In every work place, each person has his or her job or set of duties to perform. According to the principles of Just Culture, there are behaviors that can impact the performance of those duties, including human error, at-risk behavior and intolerable behavior; each, too, has a corresponding response. It is important to note that the response is not based on
the severity of the event outcome. Most everyone at some point in their careers has inadvertently made a mistake or done something other than what should have been done: an accident, an oversight, a slip–up. When there is no malice or intention involved, the prescription for human error is to console that employee and make sure they are properly trained to reduce the risk of it happening again. People may also have participated in what can be described as at–risk behavior at some time in their careers, which is defined as making a behavioral choice that increased risk where risk is not recognized or is mistakenly believed to be justified. “In essence,” Scheurer said, “you knew you were doing it, but you thought the risk was reasonable or your actions justified.” Perhaps that person cut corners, left out steps they thought were unnecessary or in some cases just didn’t know — perhaps it wasn’t part of his or her training. As Scheurer said, “You can’t hold people accountable for what they weren’t aware of.” This type of
See Culture on page 9
8 The CaTalysT, April 3, 2015
MUSC chaplain finds her calling in writing books By DaWn BRazell Public Relations Early in training to be a chaplain, Stacy Sergent’s goal was simple— to remain upright and not embarrass herself. Given she had a hard time getting through an episode of “Grey’s Anatomy” without feeling a bit squeamish, she knew the clinical pastoral education residency might not go well. “I thought, ‘Dear God, please don’t let me pass out or throw up,’” she said of her first ventures into emergency room settings as she explored whether being a chaplain was the right calling for her. “I found I enjoyed it, though, and actually was good at it.” That is one of many revelations that she captures in her debut book, “Being Called Chaplain — How I lost my name and (eventually) found my faith,” a memoir that captures her spiritual coming-of-age journey. Born and raised in the mountains of Harlan, Kentucky, Sergent’s family was not religious. She also chose a denomination, Baptist, where not all are fond of female pastors, so it hasn’t been the easiest of journeys finding her authentic calling and owning the title of being a chaplain, she said. Her book explores how she has made peace with a calling that requires her to comfort people, yet be comfortable that she doesn’t have all the answers to the questions that illness and grief bring up in patients’ lives. “The big moments of people’s lives happen here. People often are in crises when they come here. It’s life and death stuff. It strips all the petty stuff away. When you’re facing the death or illness of someone you love, it’s a holy moment because I believe God draws near to us.” The hardest part of writing the book is how vulnerable and exposed it has made her feel, she said. Sergent, 37, details stories of her mother who had some cycles of depression that led to her being hospitalized. Her family was not sure how to handle it, and no one spoke of it. “I realized how important it is to give people an outlet to talk about what is happening to them because the silence was what was so hurtful to me as a kid. That imposed silence - I know
the damage it does when you keep everything inside and try to pretend that everything’s OK,” she said. “As a chaplain, I try to encourage them to be honest with what they are feeling.” Encouraging people to be honest helps dispel the shame that can exist for a variety of reasons, whether families are dealing with strained relationships or issues of grief and faith, she said. “Shame thrives in the dark, but when you bring it into the light, then that takes away the power and allows us to heal from those things.” Sergent said she started writing because she needed to. It was like therapy for her, and it was her way of working through a crisis of faith that happened shortly after she came to MUSC in 2008 and had to work through the loss of two people important to her. One was the death of a pediatric patient, who had won over her heart. His death felt like a loss of hope to her, as did the unexpected loss of her close friend and divinity school professor, Dr. Daniel E. Goodman, who died at age 40. Sergent said her heart and faith felt broken, and she sat down to write a letter to her former professor to cope with her grief. “In a world where a perfectly healthy 40-year-old saint could drop dead without warning, nothing made sense at all. I wanted to give up, on ministry, on God, on everything. But as I wrote him the letter, I realized that the best way to honor his memory and his investment in me as his student was to try to piece my faith back together.” Sergent began pouring out her heart and soul into her writing and, at the end of it all, she found she had a book. In the book, she weaves together how her faith has deepened, capturing in the process snapshots of the spiritual journeys of patients and staff at MUSC involved in how the life-and-death stories play out each day. (Sergent was careful to change names and identities to preserve confidentiality.) The name of her book — “Being Called Chaplain” — comes from her adjustment to being known as simply chaplain now rather than Stacy or Sergent. “The book is all about identity — finding out who I am, and being a
photo by Sarah Pack, Public Relations MUSC Chaplain Stacy Sergent finds writing books turns out to be good therapy in finding her calling. Sergent, seated left, at her book launch March 1 at the Charleston Museum, said the hardest part of writing her book was opening up and being vulnerable. photo provided
chaplain is a huge part of that. I really struggled in the beginning with people calling me chaplain and then me feeling like a fraud because I knew I was questioning what I believe, so reconciling those two things was really tough. That’s why I wrote the book. Being a chaplain doesn’t mean you have all the answers. It means being OK with the questions. It’s important to me to be real and vulnerable.” Sergent has another book in the works. She’s the only minister in her family and the only one who goes to church. “The second book is more about me trying to find love in the sense of romantic love but also love of myself – trying to make peace with who I am. I think all of us struggle with liking all of who we are and then in my family,
finding my identity and loving each other even though we don’t necessarily understand each other.” Part of the journey also is letting go of roles that don’t serve well, she said. For example, health professionals and chaplains sometimes feel so powerless in being able to help patients who are ill, but they all can’t be fixed and healed. Sergent found she needed to set better boundaries so she wasn’t bringing home the sadness from the patients she was encountering. She describes a ritual in her book that she uses where she goes to a chapel where there’s a prayer journal. She writes out the best possible ending she can for the people involved as if she were omnipotent. She then places her
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behavior is met with coaching. Reckless behavior is something altogether different, as it is a behavioral choice that increases risk, and despite the recognition of the increased risk, the choice is made to consciously disregard the unjustifiable risk and take the action anyway. In this scenario, if someone has knowingly behaved in an unsafe, reckless or irresponsible manner, they should be punished. Scheurer explained to the audience that employees must be inspired to make things better, to achieve better outcomes. Just Culture, she said, helps by defining the institution’s vision and mission. “When employees onboard at MUSC, we tell them, ‘You’re here to get your work done in a way that says you are here to make MUSC a better place tomorrow.’ They should always strive to do the right thing; they will always get a pass if they did the right thing.” Just Culture is not just about safety issues, it’s also about personal conduct. Scheurer recounted an experience in her own home that had the audience laughing. Her husband told her he was tired of their dark brown couch. With an active son and a dog that is a part of the family, Scheurer was convinced the family should keep their dark couch. One day when Scheurer came home from work, there was a new light blue couch in the living room. She told him, “There’s a reason we had a dark brown couch. We eat dinner on the couch and the dog breaks the rules.” He assured her there were new house rules: No one would wear shoes or eat on it. “Not a week later,” she shared, “sure enough my son was eating in the living room, on the new couch. So I used my algorithm. Eating in the living room is a behavior. Is it risky? Did he forget the new rule? Is it reckless? Had he perhaps seen his dad do it? Do I console him, coach him or send him to his room? Well, his dad had been eating pizza on the couch just three
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Republican Senators Tim Scott and Lindsey Graham of South Carolina and Democratic Congressman James Clyburn, who represents South Carolina’s 6th Congressional District. He has also made numerous media appearances in support of his petition. But, Bennett stressed, he is not an advocate. He is a scientist. “Scientists need a seat at the table,” Bennett said. “And so do these patients. They need a voice.” Bennett said he is proud that MUSC and USC have stood by his controversial work and that this work has helped save so many lives. He is pleased that the NIH and the American Cancer Society have long supported his drug safety research.
photo provided
Dr. Prathibha Varkey, from left, president and CEO of Seton Clinical Enterprise in Texas, is the newly installed 2015 ACMQ president and joins Dr. Jim Cross, ACMQ past president and MUSC’s Dr. Mark Lyles, ACMQ president-elect, will serve as president from 2017 to 2019. days earlier, and her son was emulating his dad. So it required training. “In Just Culture, you will find more examples at your own house than at work.” Scheurer’s presentation generated numerous questions from participants about how to integrate Just Culture at their hospitals and what to do under certain circumstances. At the end she told them, “Just culture is not fast or easy. Getting boards to get on board with it can be a tough thing. You have to get people to understand your expectations. Incentivize good behavior, disincentivize bad behavior.” Scheurer, along with MUSC Chief Strategic Officer, Mark Lyles, M.D., were part of the conference faculty. Lyles also served on the 2015 Scientific Program committee, and during the meeting he was installed as
NIH continues to fund the work with a five year R01 grant — of which Bennett is the principal investigator. The American Cancer Society has also awarded Bennett a four-year Institutional Research Grant that facilitates start–up funding for junior cancer researchers on the MUSC and USC campuses. Most importantly, Bennett said, he is committed to helping disseminate Fayad’s work, which “will have important public health benefits for thousands.” “In my life,” he said, “I always wanted to be in a position to make a difference and to save lives through public health and public policy initiatives. I think that’s what I am doing. SONAR has saved tens of thousands of lives and billions of dollars. That’s a good day’s work.”
the organization’s president–elect. Lyles has been very involved in the leadership of ACMQ for several years, having served previously as secretary and vice president of the college. His term as president of the organization will begin in 2017 and run through 2019. Lyles, who kicked off the event with a talk titled, The Politics of Medical Quality, considers this year’s annual meeting a tremendous success and credits outstanding presenters like Scheurer. He said, “Danielle’s talk was the highlight of ACMQ’s annual meeting, Medical Quality 2015. Other speakers discussed and shared their personal and professional thoughts and ideas about how to minimize medical mistakes and improve medical quality. Danielle’s presentation was unique in that it focused on Just Culture and how MUSC and other progressive health care organizations respond appropriately to people who do make mistakes and, importantly, on how to share learned information with other health care providers so the same or similar mistakes won’t be repeated by others in the future. Just Culture is the true foundation for ensuring success in maximizing health care quality and minimizing medical mistakes in all health care settings.” So what ever happened to the 25-year employee? After a full investigation, his behavior was considered reckless. He was shown respect for all his years of good service, but also shown how he exhibited poor judgment and put himself and the institution at risk. Scheurer said, “People often equate punishment with being fired. That is not always the case and not what happened here. “Two of the biggest traps in doing a Just Culture wrong,” Scheurer said “are condoning the ‘severity bias,’ which is when the treatment of the employee is solely based on an outcome, not the employee’s behavior, and prejudging employees as good or bad without going through a Just Culture evaluation. A really good employee can make mistakes or act recklessly, and so can a troubled employee.”
Darkness to Light and MUSC host ‘Happy Valley: Then and Now’ event on April 16 Thursday, April 16 6 to 9 p.m. MUSC’s Drug Discovery Auditorium In honor of April as National Child Abuse Prevention month, Darkness to Light and MUSC will present “Happy Valley: Then and Now” on April 16. This event will examine the Jerry Sandusky scandal at Penn State, the environment that allowed it to happen, and the emotional aftermath felt by the community. The evening will include a screening of the documentary film “Happy Valley,” followed by a panel discussion featuring Dr. Regina Benjamin, 18th U.S. Surgeon General, Joseph V. “Jay” Paterno Jr., son of the late Joe Paterno, Howard W. Long III, president and CEO of the Centre County YMCA; and Cindy McElhinney, director of programs for Darkness to Light. This event is free and open to the public. For information, http://visit www. D2L.org/HappyValley.
10 The CaTalysT, April 3, 2015
MUSC Spring Training workplace makeover challenge
Want to feel healthy and who have 20 percent or active while at work? Ready more of their staff join the to make a lifestyle change and MUSC Wellness Center challenge co–workers to do the will receive the following same? Take the MUSC Spring services, FREE of charge for Training Workplace Makeover all their employees: Challenge. The Office of Health •Live Your Life Healthy Promotion and the Wellness 101: Exercise and Nutrition Center are teaming up to create Intervention healthier work environments •InBody 570 ® Body across the MUSC Campus. Composition Testing Studies suggest that individuals Options are much more successful in •MUSC Employee Susan Johnson adopting healthy habits when Wellness Consultation and they commit to change, share Customized Programs goals with others, create a supportive Take advantage of this limited time environment and are rewarded for offer designed specifically for MUSC progress. Any department interested in employees and schedule your Spring promoting health and wellness among Training Office Makeover today. their staff is encouraged to sign up for this free program. Wellness Events q April Monthly Mindful Challenge: How it works Eat Sustainably. Healthy bodies, healthy q Commit — Schedule your Spring planet — To begin, take the April Training Workplace Makeover session Monthly Mindful Challenge survey at by calling the Wellness Center Trainer http://tinyurl.com/kk186ud. A link to Team at 792-4141 or email Flynn@musc. the final survey will be sent at month’s edu. Consider a time that all staff will be end to those who take the first survey able to participate, such as the first 10 q National Walking Day — noon, April – 20 minutes of the next departmental 8, meet at the Horseshoe. Brief remarks meeting . adn a fun warm up and group walk of q Learn — Fitness experts from the the MUSC Medical Mile in support of a Wellness Center Training Team will healthy lifestyle. Free pedometers, fruit discuss important motivational & and water while supplies last. lifestyle change strategies to empower q MUSC Earth Day — 11 am. to 2 p.m., participants to take the challenge. They at the Horseshoe. See page 12 for an will also introduce a new employee and event layout and details. office challenge campaign, “This is MY q Employee Fitness Series — 12:15 to GYM”. 12:45 p.m. April 15, Greenway Garden q Get Active — Follow WC Training Circuit at the Fitness Park. This full-body Team instructors as they lead staff workout will utilize the outdoor fitness through a short fitness band or stretch equipment. Free day pass to the MUSC workout that can easily be performed at Wellness Center for participants. Email desks and work stations. All participants musc-empwell@musc.edu to register for will receive a copy of the workout and the free class. a free exercise band. In addition, all q Donate a reusable cup anytime attendees will receive a free “Tour between April 1 and April 15. Drop off Pass” to the wellness center to see what at donation bins at the main hospital “This is MY GYM” is all about. When cafeteria or Colbert Education Center/ redeemed at the Wellness Center during Library and nutrition). Sodexo will April or May, employees will receive an sterilize donated cups and make them additional guest pass to share ($15 value) available at both cafeterias on April 22. and a special offer for new employee Take one to use or bring in your own members (50% off enrollment fee, (clean) reusable cup or mug to ART or a “This My Gym” Water bottle and University cafeteria and get a 25 cent Adventure Out T–shirt (free outdoor discount on any fountain soda, tea, fitness classes in city parks) coffee or juice. Drop off cups also at the q Makeover Your Office — Departments April 15 Earth Day event
Health at work
q Farmers Markets — Fresh fruits and vegetables are available from local farmers on Fridays from 7 a.m. to 3:30 p.m. at the Horseshoe.
MUSC Wellness Center
q Wu Style Tai Chi — Tai chi is an
ancient Chinese discipline of slow, meditative movements learned in a sequence. Starting April 1 to May 13, Wednesdays at 9 a.m. Visit www.musc. edu/hsc or call 792-5757. For more information, contact johnsusa@musc.eu.
Take the MUSC Culture of Safety Survey From April 6 to April 19, MUSC will be administering the Hospital Survey of Patient Safety Culture, a 42–question survey designed in 2004 by the Agency for Healthcare Research and Quality. This survey will be sent via email to employees who directly care for patients and individuals who support them. Questions are designed for hospitalbased employees working on clinical units, thus not all employees will be asked to complete it. For example, all nurses, respiratory therapists, chaplains and doctors will be asked to take this survey. Pharmacists, lab employees and environmental services staff also are encouraged to complete the survey.
This validated survey has been administered to millions of health care providers in the United States and abroad. MUSC will be utilizing the survey results to benchmark the organization with other hospitals. Surveys are conducted via the vendor patient safety group and are completely confidential. Take the survey at http://www.ahrq. gov/professionals/quality-patient-safety/ patientsafetyculture/index.html. For information, visit http:// mcintranet.musc.edu/quality/ departments/patientsafetyrisk/ PatientSafety/COS/Culture%20Of%20 Safety.
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Gamma Knife celebrates 1,000 patients in five years Staff Report The neurosciences Gamma Knife Center, a service of Hollings Cancer Center, announced the treatment of its 1000th patient March 25. “This milestone in patient care is a special honor for our clinical team and staff,” said Joseph Jenrette, M.D., chairman of the department of radiation oncology and Gamma Knife co–director. “We’ve had the opportunity to help a substantial number of patients who desire or require an alternative to surgery or conventional radiation therapy for brain tumors and functional disorders of the brain.” Gamma Knife is the gold standard in non–invasive treatments of brain tumors and disorders. Gamma Knife radiosurgery is highly precise and usually a one–time treatment completed in a single day. “The aggressive use of Gamma Knife
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has radically improved the prognosis for cancer patients with brain metastases while limiting the collateral damage incurred with other forms of radiation,” said Istvan Takacs, M.D., neurosurgeon and co–director of the Gamma Knife Center. “It is truly a game changer.” The Gamma Knife machine uses 192 separate gamma ray sources — radioactive Cobalt–60 — all focused on a single point three–tenths of a millimeter in diameter — smaller than the point of a pen. “The precision is extraordinary,” Jenrette said. The focal point doesn’t move. Rather, the patient is locked into place and moved around the focal point. “It’s a little bit like moving the deer in front of the rifle,” Takacs explained. Only in this case, the deer is an inoperable tumor. “It used to be that if you had two or three brain metastases, your life expectancy was counted in months,” Takacs said. “You were headed for
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hands over the prayer, closes her eyes and lets go, dropping them into God’s lap. “Being there in chapel and opening my hands over the written prayer, all those physical things remind me of the reality that I’m leaving them in God’s care, which is a whole lot better than what I can offer them.” Sergent said her writing has helped her faith to grow. When she first decided to try to get her story published, her hope was that she could do for others what other spiritual writers have done for her. “There was such power in reading exactly what I needed at exactly the moment I needed it, of feeling that this person I had never met had reached through the page to touch my very soul and let me know I was not alone. If being an author meant the chance to do that for someone else, I thought, it might just be worth all the hard work and stress and rejection that it takes to finally get a book published.” The book, and her blog, also let her share insights from the people who have taught her the most – patients,
photo provided Sergent and her dog, Hurley. particularly children who have taught her the unique beauty of each life. In her Chaplain Jesus Lady blog, Sergent
photo by J. Ryne Danielson, Public Relations MUSC’s 1000th Gamma Knife patient Teresa Mitchel, center, with the the Gamma Knife team including Joshua Hodges, from left, Daniel McDonald, Dr. Joseph Jenrette, Jacqueline Davis, Dr. Istvan Takacs and Lanell Simmons. hospice. Now, we can successfully control multiple brain metastases using Gamma Knife. It has radically increased patient survival. And all of this has been describes what that’s like. “Parents of infants who lived only hours or days will tell me about their child, and every one is special, every one made an impact on their world. Teenagers facing everything from cancer to mental illness have wrestled with the questions of life’s unfairness and God’s goodness as honestly and eloquently as any psalmist. It was a privilege just to sit and listen to each one’s different perspective.” Sergent hopes her book will help others to become more comfortable with the mystery of faith and to understand that it’s fine to ask questions. In the meantime, her job is to just be with them on the journey. “I’ve realized that there are some things that I’m just never going to understand. It’s just feeling like God is there with me and with the patients that I work with in the middle of all the mess. It’s seeing God at work. I believe that God is love – that is one of my favorite verses. Any time I see love between patients and families, that comes out so much even in the middle of the worst possible situations, I believe that’s God right there in the middle of it.”
accomplished on an outpatient basis. We have made a quantum leap in quality of care, while, at the same time, cutting costs. It’s usually the other way around.”
Outstanding Clinician Award nominations being accepted Nominations for the 2015 MUSC Foundation’s Outstanding Clinician Award are being accepted. The award honors full-time faculty who have made outstanding contributions to patient care at MUSC. Currently active clinicians who commit a significant portion of their time caring for patients in ambulatory or inpatient settings are eligible for this award. Nominees should be role models for residents, students and their faculty colleagues. Nomination packets should consist of a full curriculum vitae, three letters of support, with at least one from a peer and a statement (not to exceed 1,000 words) from the nominator. The deadline for nominations is April 24. Nominations may be submitted to Mark Sothmann, Ph.D., 179 Ashley Ave., Colcock Hall, MSC 002, MUSC.
12 The CaTalysT, April 3, 2015
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