OPIOIDS :
Carol C. Dorey Real Estate, Inc.
Holmquist Farm
Picturesque Bucks County is an idyllic backdrop for this rural estate set on 12 private acres with heated in-ground saltwater infinity pool, pickleball court & long distance views. 5 beds, 5 baths, separate 2-bed guest quarters. Offered for $6,400,000
Spring Hill
Sequestered on 90 acres, this beautiful barn renovation offers re-imagined spaces & stunning new architectural details. The heated pool, spa & pool house are dramatically positioned amidst the serene views. Offered for $4,500,000
Foxfield
Newly completed renovation & additions impress with subtle sophistication. Nestled in the center of its 4.6 acres, the pool & bluestone patio beckon you to enjoy one of Saucon Valley’s finest retreats. Offered for $4,500,000
Pine Run Farm
A verdant 2+ acre parcel is the setting for this stone home & PA bank barn. A 2014 addition, office & living space in the barn, along with fenced gardens and a koi pond, complete this extraordinary residence. Offered for $1,650,000
Cortland
Abundant curb appeal, stylish amenities and a lovely 2021 renovation are the hallmarks of this exceptional home. The park-like 4.6 acreage includes an inground pool with sunset vistas. Offered for $1,595,000
Saucon Valley Road
This mid-century modern home has an updated design & a family friendly interior. Nestled on almost 2 acres, the captivating architectural design has been updated with energy efficient technology. Offered for $965,000
LEHIGH COUNTY MEDICAL SOCIETY
P.O. Box 8, East Texas, PA 18046 610-437-2288 | lcmedsoc.org
2024 LCMS BOARD OF DIRECTORS* Chaminie Wheeler, DO President
Kimberly Fugok, DO President Elect
Mary Stock, MD Vice President
Oscar A. Morffi, MD Treasurer
Charles J. Scagliotti, MD, FACS Secretary
Rajender S. Totlani, MD Immediate Past President
*effective February 1, 2024 - for two-year terms
CENSORS
Howard E. Hudson, Jr., MD
Edward F. Guarino, MD
TRUSTEES
Wayne E. Dubov, MD
Kenneth J. Toff, DO Alissa Romano, DO
EDITOR
David Griffiths Executive Officer The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the Lehigh County Medical Society. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.
DANNYʼS RIDE IS CHANGING LIVES, one ride at a time By Nancy Knoebel, Founder and President
How We Got Here, Where We Are Now, Where Things Are Going By Dr. Juan Lopez Tiboni, Dr. Joseph Dorazio, Dr. Barbara Westerhaus, Catherine Abrams
PATIENTS CAN REDUCE the Risks of Complications After Surgery
YOU CAN USE ORGANIZED Medicine as a Vehicle for Change
Lehigh County Health & Medicine is published by Hoffmann Publishing Group, Inc. Sinking Spring, PA | HoffmannPublishing.com | (610) 685.0914 FOR ADVERTISING INFO CONTACT: Tracy Hoffmann, Tracy@hoffmannpublishing.com, 610.685.0914 x201
Welcome to our fall issue of the Lehigh County Medical Society magazine, Lehigh County Health & Medicine. It seems each year the first signs of fall come earlier. Now you can have your pumpkin spice drink while still on the beach and prior to the start of school! We are happy to make this magazine available to you, and look forward to your responses, ideas, and contributions.
We hope you’ll agree there are some great articles in this edition. One such article highlights Danny’s Ride, a nonprofit that provides free transportation to recovery services for people living with substance abuse disorders. In a study that showed 21.6 million Americans needed treatment for a substance abuse disorder, only 2.3 million of those individuals received care. Read on to learn how Danny’s Ride is trying to help.
Many physicians are asking questions regarding the new law, HB 1633. The governor signed the bill into law on July 17. Please see the Legislative Update. We hope this will answer some of your questions and we are working to provide more information soon.
One of our goals is to offer you insightful information, helpful statistics, and tips and tools to consider using in your own lives and practices. Please see the article “Erasing the Stigma of Mental Health Support for Health Care Professionals.” In today’s general population, conversations on mental health have become more common although likely still not enough. However, when it comes to the mental health of those working in the healthcare profession, we have work to do to ease the stigma.
We hope you enjoy this and past issues as we add to the conversation about how medicine and wellness can help us form strong communities in Lehigh County. If you are interested in back issues, or just want to read Lehigh County Health & Medicine online, please visit our website at https://lcmedsoc.org/our-publication. Thank you for reading.
DANNY’S RIDE IS CHANGING LIVES,
one ride at a time.
NANCY KNOEBEL, FOUNDER AND PRESIDENT
Research on transportation as a barrier to substance use disorder (SUD) recovery resources is consistent. Transportation to services that support recovery is regularly identified as a significant barrier – particularly outside the major metro areas that offer more public transportation options. Danny’s Ride was established as a nonprofit in 2020 to address this barrier. Based in the Lehigh Valley, Pennsylvania, Danny’s Ride harnesses the power of Uber and Lyft to get people with SUDs to treatment, medical care, employment, legal system meetings, AA, NA and other support meetings, and more. Removing the transportation barrier has a tremendous impact on those receiving services. Our services are currently available in many communities throughout Pennsylvania, and beyond. As of June 30, 2024, we provided more than 22,000 rides to nearly 2,500 individuals.
A significant health crisis in the US and beyond, SUD impacts millions of individuals, as well as their families, employers, and communities. In 2022, 48.7 million people aged 12 or older in the United States (17.3%) had an SUD in the past year. Recovery is complicated and difficult, and possible, but people normally need to be able to access a broad range of resources to succeed.
National Institute on Drug Abuse (NIDA) statistics compiled over a 12-month period show that 21.6 million Americans needed treatment for an SUD but only 2.3 million received care. NEMT (Non-Emergency Medical Transport) improves the likelihood of success. One survey found that on average, those attending 16.4 treatments a month with NEMT would expect to attend only 4.3 treatments monthly without it.
A study by the Robert Wood Johnson Foundation found that more than one in five adults with limited public transit access forgo health care because of transportation barriers.
Lack of transportation has been identified by the World Health Organization (WHO) as a critical determinant of health for individuals in recovery from SUDs.
In addition to the logistical challenges caused by transportation-related barriers to access, SUD carries a significant stigma, often leading to feelings of shame and isolation for those struggling with it. We aim to change this by emphasizing that SUD is an illness, not a moral failure. When a Danny’s Ride vehicle arrives at the home of an individual living with SUD, who cannot access other forms of transportation, it sends a powerful message – “you matter.”
DANNY’S RIDE WORKS.
Our mission: to honor Danny’s legacy of compassion and generosity by providing free rides to recovery services for people living with substance use disorder.
Our vision: transportation is available to all who seek to access services, programs and resources in support of their SUD recovery journey.
How it works: Danny’s Ride uses Lyft and Uber to provide rides to individuals living with substance use disorder, to help them get to programs, services and resources that support recovery. Wherever communities are served by Lyft and Uber, Danny’s Ride can help. Our partnership with Roundtrip, a ride booking technology company, makes it fast and simple to set up rides. Riders don’t arrange their own rides – they are arranged for by staff at our many partner organizations who know their clients and their needs. It is a streamlined process that results in Ubers and Lyfts coming to the doors of people who need rides, on schedule, and taking them where they need to go.
We currently work with over 30 partners, including county Drug & Alcohol departments, a sheriff’s department, private organizations serving unhoused persons, veterans, outpatient services, and workforce development; as well as two Pennsylvania county treatment court programs.
HOW WE KNOW IT’S WORKING:
The data demonstrate tremendous impact and make it clear that an investment in transportation is a game changer. The cost is a fraction of the cost of the current investment in recovery services in our country. Add to that increased employment, decreased incarceration, lower family stress, supporting parental sobriety, preserving or restoring child custody (among others) and it becomes crystal clear that transportation represents a synergistic boon to recovery. And Danny’s Ride has proven there’s a way to make it happen.
continued on next page
RIDERS SAY IT BEST:
“Taking the bus with my 2-year-old son is tough – sometimes taking the bus can be too much for him. Being in a calmer environment is very helpful, as is getting to my destination without having to stress myself out about how I’m going to get there on time.”
“Danny’s Ride helped me attend NA meetings when I moved to Allentown and helped me make it to and from work and interviews.”
(without Danny’s Ride) “I would never have been able to make it to work and back!”
“Danny’s Ride helped me secure employment, thus I was able to buy a car.”
“I didn't have to walk in the cold and snow which is a big support for me as I have a lot of physical issues.”
“Danny’s Ride has been the best thing in the world. Before it was very nerve-racking trying to find a ride. I have no license and I live 40 minutes away from the testing facility. I would constantly worry about going back to jail if I couldn’t make it to a test. Having Danny’s Ride has been a huge benefit. I would not have been able to complete the treatment court program without Danny’s Ride being available to me.”
“Danny’s Ride made it easier for me to save money, which allowed me to catch up on bills, pay for activities for my children to enjoy and pay my court costs and supervision fees. It made it easy for me to be able to get to therapy, random urines and judicial reviews. Being able to utilize Danny’s Ride helped take some of the stress away when facing the question: “How am I going to get to that place?”
Statistics – as of 6/30/2024:
A recent riders survey confirms that we are making a huge difference in the lives of those receiving rides through the program. 98% said that Danny’s Ride helped them, and 89% rated Danny’s Ride 5 out of 5 when asked to rate how helpful it was.
A full 86.5% would not have been able to get to their appointment without Danny’s Ride.
The open-ended questions reveal that the impact on riders is extensive and broad. They noted things like maintaining and regaining child custody, not having to take small children on the bus, getting to work and job interviews, earning enough to buy a car, complying with court requirements and staying out of jail.
80% had no other option besides Danny’s Ride, and the 20% who said they did have an option, none were very good, such as walking long distances, finding a bike to ride, imposing on a tentative support system, or long and difficult bus rides, often with small children in tow.
A different survey was sent to those who received rides through the Northampton and Chester County treatment courts. Over 90% report that it helped people achieve and maintain sobriety. 71% are saving money needed for day-to-day expenses for themselves and their families.
61% said they would not have met mandated requirements, or at least, they
AA/NA/Other
Inpatient Treatment
were unsure how they would have done so. 57% report avoiding program extension for missing mandated requirements, and the same number report being able to avoid people unhealthy to their recovery, by not having to scrounge for a ride.
Chester County’s data shows that the rate of missed appointments following the inception of Danny’s Ride fell by 50%. This translates to fewer fines and faster progress in meeting the court requirements, helping people get back to their lives, families, and jobs.
A targeted survey for those who received rides through the pilot program Danny’s Ride established with Pro-A’s workforce support program revealed that 62% said they would not have been able to get to work without Danny’s Ride. Individuals who received rides obtained employment 33% of the time; only 9% of those who did not get rides did so.
Danny’s Ride can help wherever Lyft and Uber operate. We have shown that by investing a fraction of the cost of the tremendous resources that have been made available to people in recovery, we can effectively resolve the barrier so many face, the lack of access to transportation.
206,472 miles driven
Nancy Knoebel lives in Bethlehem, PA. She lost her son Danny Teichman in 2016 after he used kratom to manage the impact of withdrawal from suboxone, which he was taking as part of his recovery from opioid addiction. She founded Danny’s Ride in 2020 to honor Danny’s legacy of generosity and kindness. Nancy has more than 20 years of nonprofit leadership, and is the former CEO of Easterseals Eastern PA. She spent several years in healthcare consulting after receiving an MBA from Wharton early in her career.
LEGISLATIVE UPDATE: WILL THE NEW PA NONCOMPETE LAW COMPETE WITH THE FEDERAL RULE?
STEVEN T. BOELL, SBOELL@FLBLAW.COM, 610-797-9000, EXT. 330
As one of the senior members in Fitzpatrick Lentz & Bubba's Healthcare Group, Mr. Boell regularly represents health systems, practices, physicians, and others in a wide array of matters including compliance, M&A, land development, employment agreements, and more.
As noted in the summer issue, Pennsylvania House Bill (HB) 1633 or the “Fair Contracting for Health Care Practitioners Act” was approved by the PA House Health Committee. Likely, as the issue went to print, Governor Josh Shapiro signed the bill into law on July 17. What does this new law mean for health care practitioners in the Commonwealth, and how will this be impacted by the Federal Trade Commission’s rule on banning noncompete agreements across all industries?
OVERVIEW OF HB 1633
Beginning January 1, 2025, certain noncompete agreements will no longer be enforceable. This law extends to health care practitioners – medical doctors, doctors of osteopathy, nurse anesthetists, nurse practitioners, and physician assistants – and applies only to new agreements entered into with employers after this date.
Additionally, employers will be required to notify patients when their health care practitioner has left their practice:
• Within ninety days of departure
• How patients can transfer their records, and
• If they choose, they may be assigned to a new health care practitioner at the practice
Of course, there are exceptions to HB 1633, giving provisions to employers, including:
• Length – employers can enforce agreements if they last no more than one year and the practitioner was not dismissed
• Recovery of expenses - an employer may seek to recoup “reasonable expenses” from the practitioner within the three years prior to separation, including those “related to relocation, training and establishment of a patient base”
FTC NONCOMPETE BAN
Scheduled to take effect on September 4, a Federal Trade Commission (FTC) rule bans noncompete agreements in most employment contexts and rescinds most existing noncompetes. However, on August 20, a federal judge ruled the ban violates the Administrative Procedure Act and exceeds the agency’s statutory authority, specifically citing the ban was “unreasonably overbroad without a reasonable explanation.” The August 20 ruling will likely be appealed and is possibly headed to the United States Supreme Court.
Similar to HB 1633, the FTC ban also includes exceptions, most notably for senior executives earning above $151,164 (annually) and in policymaking roles. Nonprofits – which includes many of PA’s health care organizations – are arguably outside of FTC’s jurisdiction, but the FTC has stated it will review whether a 503(c) tax-exempt organization is truly engaged in business only for charitable purposes and directs its proceeds to public, rather than private, interests. Lastly, the new rule does not apply to noncompetes entered into by a person pursuant to the sale of a business.
WILL THE FTC BAN IMPACT PA’S FAIR CONTRACTING FOR HEALTH CARE PRACTITIONERS ACT?
For decades, health care noncompete clauses have been viewed as a way for hospitals and
health networks to ensure the continuity of their workforce and discourage employees from leaving employment.
If the FTC noncompete ban doesn’t stand, Pennsylvania’s Fair Contracting for Health Care Practitioners Act will likely stand as is.
However, if the FTC ban somehow does withstand legal challenges, it would extend to health care practitioners, striking down the new one-year noncompete allowance and banning noncompetes subject to the exclusions in place.
LEGAL GUIDANCE AMIDST OVERLAPPING LEGAL STATUTES
Both employers and health care practitioners in PA should be prepared to make adjustments with the passing of HB 1633 as we head into 2025 and the implications of the FTC noncompete ban, which remains up in the air.
The ban on noncompete agreements exceeding one year represents a major shift in PA’s health care employment landscape. By adapting to these changes proactively, both employers and employees can navigate the new legal environment effectively and continue to thrive in the evolving healthcare sector.
Legal counsel will be crucial in navigating these adjustments to ensure compliance and minimize risks. Health care practitioners can also leverage legal support in negotiating future employment contracts, now with potential enhanced leverage without a noncompete.
OPIOIDS :
How We Got Here, Where We Are Now, Where Things are Going
CONTRIBUTING:
DR. JUAN LOPEZ TIBONI – INTERNAL MEDICINE RESIDENT, PENNSYLVANIA HOSPITAL
DR. JOSEPH DORAZIO – TOXICOLOGY AND ADDICTION
MEDICINE, COOPER UNIVERSITY HEALTH SYSTEM, FORMERLY OF TEMPLE UNIVERSITY
DR. BARBARA WESTERHAUS –PRIMARY CARE PHYSICIAN AND DIRECTOR OF J EDWIN WOOD CLINIC, FORMERLY WORKING FOR PHILADELPHIA’S AMBULATORY HEALTH CENTERS
CATHERINE ABRAMS – PROGRAM COORDINATOR, SUBSTANCE USE RESPONSE, GUIDANCE, AND EDUCATION (SURGE) GROUP OF THE HEALTH FEDERATION OF PHILADELPHIA
Philadelphia is a city known for many things: the cheesesteak, the Eagles, the Mummers, and now, Fentanyl. In 2022, 1171 people died in the city from an opioid overdose1. ‘Philly Dope’, as many patients call it, is unlike other opioids used throughout the United States. Evolving exponentially in its potency out of the not-so-secret open air opioid markets in the city, many patients and providers find themselves in uncharted territory in the struggle against opioid addiction. This new frontier has brought many shifts in addiction medicine practice during the last decade. With the help of some of those breaking new frontiers, Philadelphia Medicine Magazine brings you an update on how we got here, where we are now, and where things are going.
OPIOIDS IN THE UNITED STATES
From 1999-2021, 645,000 people died from an opioid overdose in the United States2. In Philadelphia in 2022 alone, 1171 people lost their lives to opioids1, not to mention the immeasurable healthcare utilization and disability burden among those who live with opioid dependence. In Philadelphia in 2012, the number of opioid deaths was 413, close to a third of what it is now.
HOW DID WE WIND UP HERE?
In order to understand this question, one has to first understand that Opioids and the United States have long been intertwined. This is not the first wave of opioid abuse in American history. Opioid dependence dates back first to the Civil War, and the same fields of combat where many soldiers lost their lives where wives and daughters grew poppies for opium. In the years that followed, ‘Soldiers disease’, a complex syndrome of pain and trauma in veterans, contributed to the uptake of opium and morphine as a substance of abuse, particularly in the South3. 1920s and ’30s also saw the rise of heroin in urbanized centres, percolating most notably in the Jazz scenes of John Coltrane and Charlie Parker of the northeast where ‘junkies’ stole discarded materials to sell for scrap to feed their addiction4. Some baseline abuse of heroin remained thereafter, but it didn’t rise to national prominence again until the Vietnam war; at one time it was estimated that up to 20% of US soldiers had some form of heroin dependence. Notably, despite fears, not many of them remained addicted once returning to the US to a change in scenery and social supports. Still, heroin didn’t just disappear at the end of the Vietnam war, and up until the 1990s, nearly all of the heroin use was in urban centers, not widespread throughout America from coast to coast at the level it is now. So what changed?
THE ARRIVAL OF OXYCONTIN
In 1996, the arrival of OxyContin was promised to be the solution to uncontrolled pain. Purdue Pharmaceuticals, a drug company based out of Connecticut, advertised it to physicians as a wonder-drug with less than 1% potential for addiction. This lack of addictive potency was attributed to its sustained release formulation of the previous availably Oxycodone, that prevented users from getting a true opioid high. Purdue, keen on selling their new drug, launched a targeted marketing strategy at primary care doctors in small, working class towns with high chronic pain burden tied to coal mining throughout the Appalachians. They specifically targeted states with less stringent prescription controls for Schedule II drugs5, while simultaneously lobbying heavily for changes in medical practices to more aggressively treat pain through back door funding to groups like the American Pain Society6. Due largely to their efforts, these medications started being prescribed with little reservation in large quantities. Over the span of a few years, it became apparent that the pill was menacingly addictive to those with chronic pain. Additionally, recreational users and prescription abusers alike realised that by crushing the pill, or sucking down the external coating, the continuous release mechanism could be circumvented to produce more euphoric effects. This made prescription Oxy abuse commonplace throughout the northeast in small suburban towns all through the late nineties into the mid-2000s7, before the wave of abuse spread outwards into urban centers, the Great Lakes, and throughout to the West Coast. Purdue Pharmaceuticals ultimately plead guilty to its role in the current day opioid crisis, first with a 600-million-dollar settlement in 2007 which has since spiralled into an ongoing 6-billion-dollar Supreme Court bankruptcy deal8. This relationship with Oxy set the stage for the current opioid crisis nationwide.
continued on next page
HEROIN AND FENTANYL IN PHILADELPHIA
Anecdotal evidence in Philadelphia will tell you that most of our patients suffering from opioid addiction started on prescription pills. To that point, a data review of American heroin users published in 2015 showed that 80% start on prescription opioid tablets, commonly sourced from prescriptions written for themselves or friends and family9
As part of the 2007 settlement from Purdue, OxyContin was reformulated in 2010. This made accessing and abusing prescription Oxy more difficult, leading users in the city to heroin as it was cheaper and enabled them to better satisfy their withdrawal symptoms and cravings. A quote from a heroin user in the 2018 book Dopesick articulates this transition: ‘If you tried to crunch ’em, they’d gel up on you. You couldn’t even snort ’em, let alone shoot ’em. After that, the pills either went dry or were just too expensive to get. And everybody who used to deal pills starting dealing heroin instead4.’ Over time, the heroin supply on the east coast, funneled through the ports of Philly and Baltimore, was replaced by the exponentially more potent fentanyl produced overseas. The compound is stronger, more addicting, and far more lethal than heroin, which has been largely responsible for the increasing rate of opioid overdoses. ‘I miss heroin,’ I had a patient tell me once in the emergency department. ‘It’s all gone now. Fentanyl is the only thing out there and I hate it.’
Philly dope is now more concentrated with fentanyl than ever before, with conservative estimates that one bag of fentanyl contains the equivalent of 50-100mg of PO oxycodone. ‘There is objectively more fentanyl per bag now than there was before, and this makes controlling withdrawal more difficult. We are talking about patients taking the equivalent of 150 to 200mg of IV hydromorphone daily,’ said Dr. Joseph D’Orazio, an emergency medicine trained toxicologist and addictions medicine physician formerly of Temple and now at Cooper. ‘We also have counterfeit opioids in the city that are made outside the US and channeled in through the typical drug smuggling routes. Patients think they are buying prescription caliber opioids which are actually counterfeit fentanyl and xylazine pressed into what looks like an Oxycodone 30mg IR tablet,’ he pointed out.
Increasing concentrations of fentanyl are a large contributor to the rise in mortality from overdoses, but so are other compounds now entering the drug supply. ‘90% of the fentanyl on the street in Philadelphia now contains Xylazine (an animal tranquilizer that has euphoric properties but is also more addicting),’ Dr. D’Orazio told us. Xylazine, or “tranq,” is not typically used alone but has become a common additive to bags of heroin and fentanyl in the Northeast. It has similar sedative properties to benzodiazepines but behaves somewhat differently, especially when injected, causing necrotic wounds on a scale that hadn’t been seen with injection drug use behaviour of the past. ‘The necrotic wounds you see with Xylazine. We don’t really know why it causes such severe wounds. There are hypotheses out there that there are caustic effects of the compounds or vasoconstriction
mediated effects. More research needs to be done,’ Dr. D’Orazio said. Furthermore, higher potency opioids are already starting to emerge in the drug supply in the form of Nitazines, a new synthetic opioid ten times more potent than fentanyl identified in some autopsy cases since 202110. Physicians on the frontlines of opioid and xylazine-induced toxicity are facing new challenges, and the field of addictions overall has changed massively to try and improve outcomes over the last ten years.
HOSPITAL MANAGEMENT OF WITHDRAWAL
We asked Dr. D’Orazio how management has shifted for hospitalized patients with addiction. ‘The major innovation or thinking change in the last decade is giving opioids to patients suffering with opioid use disorder,’ he said. This may seem counter-intuitive, but one has to consider how these cases unfold in the hospital. ‘Patients would come in with cellulitis or a local abscess at a wound site, get seen in the ED, admitted, and then barely get one or two doses of antibiotics before they’d leave to get opioids on the street to self-treat their withdrawal because we stood firm on not ‘indulging their addiction’. They would enter and leave through this revolving door: a cellulitis would become a bacteremia and then an endocarditis, an abscess would become an osteomyelitis; all because none of the medical complications were being appropriately managed up-front due to uncontrolled withdrawal,’ I had a hospitalist at Pennsylvania Hospital tell me once. Dr. D’Orazio echoed how our practice now better helps to address medical issues before they spiral; ‘Ten years ago patients had one option and that was to taper and not get opioids.’ Another consideration is that our objective in the hospital should not necessarily be to get people off of opioids, but treat their medical complications first. ‘Not every patient is looking for abstinence or to stop using drugs, and these patients still deserve care the same way that other patients coming in with a medical condition will still get care if they decline certain other elements of care,’ Dr. D’Orazio explained. If anything, trying to get patients off of opioids when they are not interested only places them at greater risk of overdose when they return to the community with a lowered opioid tolerance and use the same doses they did before admission.
Still though, administering opioids for withdrawal is not as easy as it sounds. The ever-changing potency, and new substances entering circulation, means that physicians and hospitals need to be willing to adapt on a year to year basis, making treatment nuances fluid. ‘Ten years ago when we gave patients 30mg of methadone for their injection heroin use, that was more than enough to control their symptoms but now that’s not going to touch them. The doses we are able to give in the hospital will just pale in comparison (to how much they get on the street). We have to administer such high numbers that it makes people nervous,’ Dr. D’Orazio noted. This is where multidisciplinary collaboration through nursing, pharmacy, medical, and administrative staff becomes imperative for patients to get effective management.
‘(Temple University Hospital) will administer patients 100mg of extended release q8 for patients that are using a bundle of fentanyl
a day, but that’s not a practice that developed overnight. It took us a lot of steps and collaboration over several years to get there,’ Dr. D’Orazio said.
For those that are interested in recovery, groundwork is made in the hospital with the end goal of seeing them long term in the outpatient setting. ‘We try to catch them in a good therapeutic moment to show patients that there are good options for recovery and recovery is not so bad. The recovery numbers for patients coming to the hospital for care of medical complications will never be as good as someone who walks into a clinic off the street. But the goal is to get these patients in the clinic,’ Dr. D’Orazio said.
OUTPATIENT MANAGEMENT
Transitioning out of the hospital and into the clinic is a different arena entirely making its own advances, and it starts with a frameshift in our approach. ‘We need to start thinking about opioid use disorder as a chronic medical disease like hypertension, diabetes, or asthma. With patients who have been injecting opioids for years, it is often a lifelong disease. We are not ‘curing this disease’ the same way that we are not ‘curing diabetes’ in most patients. Nobody has decided to have this problem the same way that patients don’t decide to have cardiovascular disease. It
is contributed to by both genetic and environmental factors. We don’t end addiction, we manage opioid use disorder the same way that we manage diabetes or hypertension,’ Dr. D’Orazio said. Furthermore, we shouldn’t have punitive expectations to setbacks, and instead approach the disease more like we do other chronic diseases influenced by lifestyle. ‘If your diabetes patient comes in and on this day their sugar is high, we work with them and assess their social determinants of health to find out what is their barrier to getting good diabetes control. Just like other diseases, there are some that get prescribed a medication and hit the ground running and there are others who have comorbid psychiatric conditions convoluting their management that benefit from counseling. This is a stigmatized disorder as many people continue to think that substance use is a moral failure,’ Dr. D’Orazio pointed out.
The medical tools at our disposal continue to evolve as well. Methadone maintenance therapy, once the standard, is now just one of many different medications for opioid use disorder (MOUD). Catherine Abrams, Program Coordinator of the Substance Use Response, Guidance, and Education team of the Health Federation of Philadelphia, offers training for providers who are interested in learning how to prescribe buprenorphine and she walked us through the different tools. Buprenorphine is a continued on next page
partial opioid agonist with stronger affinity to the opioid receptor than opioids of abuse. Buprenorphine is available as a sublingual strip called Suboxone or as a long-acting injection (Sublocade and Brixadi). ‘The newest player is Brixadi, a differently formulated injectable buprenorphine recently approved by the FDA, and a lot of people are very excited about it,’ she told us. Learning how to prescribe these agents is relatively easy through groups like the Health Federation of Philadelphia. They provide free training for interested physicians and bi-monthly meetings for providers to come together and discuss specific challenges. Their goal is to get more physicians comfortable with prescribing these medications to help reduce the overall burden in the city.
Dr. Barbara Westerhaus, a primary care physician and medical director of the J Edwin Wood Clinic at the University of Pennsylvania, has experience in treating this population and rallying other physicians to join the fray. For many years she worked at the City Health Centers integrating MOUD into her primary care practice. ‘This is a medical condition that we have to manage, and until we accept that, it remains stigmatized. We view this as a primary care problem. Primary care doctors can’t just say ‘I am not treating Covid or diabetes,’ and the same goes for opioid use disorder. A primary care doctor should never be turning away a patient for lack of knowledge with substances like suboxone. I just don’t think we can say no at this point with so many people dying every year,’ she told us. This primary care-based model seems to be the new way forward. ‘We would advise against isolating into suboxone ‘clinics’ and instead integrate this with primary care,’ Catherine Abrams said. Likewise is the sentiment from Dr. D’Orazio. ‘Primary care physicians are perfectly aligned with treating substance use disorder. They have all of the skills to manage it, and as long as we think about it as a chronic medical disease they are best equipped. Just look at how PCPs manage HIV now; that has been a big frameshift that we could apply to primary care similarly. There are also levels where it gets out of the realm of a PCP and has to go to a specialist the same as diabetes or cardiovascular disease.’
HARM REDUCTION AND COMMUNITY SUPPORT
MOUD is only one element of opioid use management, however, with a new focus shifting towards harm reduction as a more important principle to reduce human suffering. ‘When we talk about harm reduction, we mean reducing the risk for infection, transitioning from injection to other methods, clean needles, alcohol swabs. I have to say over the last decade physicians have become more comfortable with these conversations and realising that by having these discussions we are not condoning drug use but helping people in this situation,’ Dr. D’Orazio
said. This is where non-medical groups in the community play a large role, not just in the Kensington area but throughout the city. Groups like Narcotics Anonymous, the Savage Sisters (who run several recovery houses and outreach events handing out hot meals, clean needles and wound care packs), Unity Recovery (who provide naloxone training and recovery counseling services), and Prevention Point Philadelphia (who started as a needle exchange service in the 1990s and now include homeless and behavioral health services as well as HIV, hepatitis, and PrEP clinics). ‘Our big objective has been to promote harm reduction strategies which have been missing for a long time. Access to adequate housing, prevention of peri-natal mortality, HIV transmission reduction, reducing streetside births and vertical transmission of syphilis, are all crucial elements in the fight,’ said Catherine Abrams.
Other medical outreach groups go directly into the community and bring the medical services there, although uptake tends to be more difficult long term. ‘These patients (treated by the mobile vans acutely) often get referred to City Heath for long-term care and follow up isn’t great, but sometimes just part of the cycle of recovery. If for every ten of these patients only one or two make it in, that’s okay,’ Dr. Westerhaus told us.
MANY BARRIERS REMAIN SYSTEMIC
Despite all of the progress, it’s clear that the problem continues to worsen with escalating rates of opioid-related mortality and morbidity, and the reasons are multi-faceted. For one, the fragmented nature of US healthcare is such that it prevents one body from coordinating the effort in a large city like Philadelphia. ‘We have four different health systems all with different approaches to pain management and the treatment of addiction,’ Catherine Abrams told us. This patchwork also means that no single actor takes responsibility for gaps or deficiencies, as evidenced by the holes left from the closing of two large hospitals in the last decade. ‘Losing Hahnemann and the conversion of Mercy Hospital to the Penn network led to a big gap and new turbulence for many of these patients,’ Catherine Abrams said. Dr. Westerhaus agrees the system is not conducive to effective efforts. ‘The city is fairly disjointed with this,’ she told us. ‘This is starting to get better now since it’s starting to be spearheaded more by the academic centers and they are starting to talk to each other a little bit more instead of saying ‘we do it this way and you do it that way’ trying to come up with a best practice. Then we have groups like Prevention Point who do a lot of work but aren’t necessarily tied to an academic center or the city.’ Likewise, at the level of the municipality, we have different structures engaged in different elements of addressing the crisis with no true central coordination to reduce redundancy, optimize, or even ensure congruence
between them. ‘The City has an ambulatory health branch and also a public health branch involved in this, and at times they have difficulty staying abreast of what exactly the other one is doing,’ Dr. Westerhaus said.
One other barrier is that opioid use disorder requires patience and time investment from providers, and a lot of these principles of harm reduction are new age. ‘We simply don’t have enough providers in the city,’ she said. ‘Not every physician is in the know, and patients oftentimes have to get lucky for someone to open the door for them to get good care. Patients shouldn’t have to get lucky to get a provider on a given day that knows what to do for your problem and what direction to point you,’ Catherine Abrams said. This lack of provider comfort applies both in the hospital and in the clinic as Dr. Westerhaus pointed out. ‘Clinics aren’t forcing physicians to treat opioid use. The City Health Centers are a primary care service that provides MOUD to patients regardless of their insurance status as well as drug coverage assistance. They are not Suboxone clinics, so one of the caveats is that in order to get Suboxone with the City, they have to become your PCP. If a patient wants to keep their PCP but can’t MOUD from them, they are stuck. Part of the question over the last five to ten years is why, why aren’t people doing it? I think the biggest obstacle is time. Physicians just don’t have the time, you don’t have the luxury to spend 30 minutes with a patient every week.’ There is a large gap in number of providers willing to treat this condition and how many patients stand to benefit.
Also is the reality that fundamentally this is not a profitable disease to treat. The patients most in need of care are on Medicaid or uninsured. Patient outcomes are also generally fairly poor, especially when we consider days of stay as the benchmark for quality care. A patient that stays longer as an inpatient to start on MOUD or to see their medical problem appropriately treated before discharge winds up costing hospitals more. Dr. D’Orazio agrees. ‘Our health systems are not incentivized to provide good care for patients with substance abuse disorder. We create unnecessary barriers and the access to care is a high bar. If we had more providers, more access to outpatient clinics, or specialty training for ancillary staff within the hospitals things could be very different.’
WHERE CAN I START AS A PHYSICIAN IN THE CITY?
So where can the curious and motivated PCP go to learn about how to help the cause? Philadelphia Medicine Magazine compiled the following list of resources for both patients and providers:
For Physicians
• SAMHSA - federal group that lets you look up a provider that prescribes suboxone anywhere in the US. Also provides links for practitioners to be trained in suboxone prescription. https://www.samhsa.gov/
• UCSF clinical substance use warm line - if you are in a bind with a patient in front of you wanting to start care. https:// nccc.ucsf.edu/clinical-resources/substance-use-resources/
• Substance Use Response, Guidance, and Education (SURGE) - provide free training and support resources for physicians to start treating OUD with MOUD https://surge. healthfederation.org/
For Patients
• Care connect warmline - provides short prescriptions for substance use and is navigator to help patients estabilish care 484 278 1679 https://penncamp.org/get-help/
• Ophelia group - telemedicine suboxone https://ophelia.com
Active Non-profits:
• Savage Sisters - https://savagesisters.org/
• Unity Recovery - https://unityrecovery.org/
• Prevention Point - https://ppponline.org/
References
1. Health PDo. Unintentional Drug Overdose Fatalities in Philadelphia, 2022. 2023.
2. Prevention CfDCa. Understanding the Opioid Overdose Epidemic. 2023.
3. Booth M. Opium: A history: St. Martin’s Griffin; 2013.
4. Macy B. Dopesick: Dealers, doctors and the drug company that addicted America: Bloomsbury Publishing; 2018.
5. Alpert A, Evans WN, Lieber EMJ, Powell D. Origins of the Opioid Crisis and its Enduring Impacts*. The Quarterly Journal of Economics. 2021;137(2):1139-79.
6. Fauber J, Gabler E. Doctors with links to drug companies influence treatment guidelines. Milwaukee Journal Sentinel. Retrieved February. 2012;21:2022.
7. Office USGA. Prescription drugs OxyContin abuse and diversion and efforts to address the problem: report to congressional requesters: DIANE Publishing; 2003.
8. Delouya S. SCOTUS to scrutinize controversial opioid crisis settlement that would give Sackler family immunity. ABC7 Chicago. 2023.
9. Muhuri PK, Gfroerer JC, Davies MC. CBHSQ data review. Center for Behavioral Health Statistics and Quality, SAMHSA. 2013;1:17.
10. Pergolizzi Jr J, Raffa R, LeQuang JAK, Breve F, Varrassi G. Old Drugs and New Challenges: A Narrative Review of Nitazenes. Cureus. 2023;15(6).
This article was originally published in the Spring 2024 issue of Philadelphia Medicine.
ERASING THE STIGMA OF MENTAL HEALTH SUPPORT FOR HEALTH CARE PROFESSIONALS
VERONIKA WHEADON, BSN, RN
In the realm of health care, where the focus is primarily on healing and caring for others, there exists a troubling contradiction: a pervasive stigma surrounding mental health support for those within the profession. With the stressors in health care at an all-time high, the need for mental health services is more critical than ever. It may be hard to imagine that those same providers struggle with identical mental health issues that their patients are experiencing, but the statistics are starting to show otherwise.
STIGMA: A MAJOR STUMBLING BLOCK
Most people, including health care providers, find it difficult to discuss serious issues affecting their mental health. This topic is almost entirely avoided in health care circles. A recent study found that 93% of health care workers reported feeling stressed. A staggering 86% reported experiencing anxiety, 77% reported frustration, 75% reported exhaustion and burnout and 75% stated they felt overwhelmed. Yet, in
this same group, only 13% sought formal support services for their reported anxiety, frustration, and burnout.
When nearly 100% of health care workers admit to feeling stressed, overwhelmed, and burnt out, what is holding them back from taking the next step? Arguably, it is the profound stigma that is associated with “needing help.”
Although conversations about mental health are more common in the general population today, when it comes to health care professionals, stigma is still difficult to break through. One factor that contributes to this is the idea that seeking psychological support is associated with weakness or serious mental illness. Health care professionals feel the burden and pressure to act and convey strength and confidence to fulfill their roles successfully.
Additionally, there is a pressure to conform to the cultural norms of working in health
care, which often ask providers to sacrifice their well-being for the sake of their work and the welfare of their patients.
However, the biggest irony here is that ignoring the well-being of the providers will have implications on patient care. Unaddressed mental health issues can lead to more issues, including decreased job satisfaction, lower energy, and decreased mental acuity, which can compromise the care a patient is receiving.
FINDING SOLUTIONS THROUGH CONFIDENTIAL SERVICES
Heather Wilson is the executive director of the Pennsylvania Medical Society Foundation. A hallmark program of the Foundation is the Pennsylvania Physician’s Health Program (PA PHP). The mission of the PA PHP is to “promote early identification and facilitate rehabilitation of physicians and other eligible health care professionals and trainees with concerns relating to substance use disorders, mental health disorders and/or behavioral concern,” she says.
For nearly 40 years, PA PHP has been a confidential mental health resource for health care professionals of all types. The services provided by the program are screening, referral for evaluation, coordination of treatment, monitoring, and advocacy.
At the initial screening process, staff will identify areas for referral that the client may need. This allows for the most appropriate resources to be offered for that person’s particular needs. Following the referral, an independent assessment is conducted by an appropriate professional. If treatment is indicated, the PA PHP staff will aid the participant in finding the best treatment option.
Types of treatments and services that the organization has helped their clients obtain span from detoxification to intensive outpatient programs to inpatient hospitalizations. During the treatment journey, PA PHP staff will work with the facility or provider to follow progress and offer additional support or resources.
But the health program does not stop there. The staff at PA PHP will work with the provider to create a monitoring agreement that is designed for each individual but can include ongoing therapy, peer monitoring, Mutual Help Meeting attendance, and routine calls to check in. According to Wilson, this monitoring is critical and it offers a consistent “support [for] our participants through the twists and turns” of the recovery journey.
The case manager working with a participant is a trusted ally rooting for the participant as they recover. They are working behind the scenes throughout the whole process as an advocate, providing progress reports on the client’s behalf to appointed parties, which often dictates their ability to continue practicing in the future.
Wilson’s work for the PA Physicians Health Program has exposed her to the acute need to address physician mental health. She has also found that the high stress of health care, the burden of making critical errors that can
impact patient outcomes, time spent away from family, and lack of relaxation are all triggers for mental health decline. More recently, with COVID and a mass exodus from health care, there have been shortages in the workforce and a “depersonalization of the physician-patient experience” that have also contributed to job dissatisfaction.
According to Heather Wilson, the various stressors and burdens of physicians have taken a severe toll. She notes that the program has discovered that unfortunately “many physicians have lost their joy in the practice of medicine,” which has significantly contributed to their need for professional help.
POSITIVE FRUITS
Despite the pervasive issue of stigma, the PA Physician Health Program has been growing. They have broadened their clientele to include physicians, physician assistants, all licensed dental professionals, podiatrists, veterinarians, and trainees of these professions. Most recently, they added pharmacists and student pharmacists to that list. Last year, in 2023, they received a total of 228 referrals and signed 116 agreements for peer assistance monitoring.
During their impact survey, 90% of the respondents stated they were satisfied or extremely satisfied with their experiences working with the organization. It is a testament to the healing that can take place for those who seek help.
Wilson and those working at the PA PHP are trying to expand awareness to encourage physicians and other health professionals “to seek help early and without fear.” Like any health condition, addressing the problem early on can be lifesaving.
“Physicians are human, just like everyone else. They have challenges, and we should not take for granted that during the pandemic many physicians and other health care professionals put their lives at risk on a daily basis,” says Wilson, adding that “the normalization of seeking assistance and reassurance that services are confidential is
a strong step to breaking down the barrier created by a fear of ‘stigma’.”
Health care professionals who may need help or think a colleague would benefit from the services PA PHP provides can call the PA PHP at (866) 747-2255 or (717) 558-7819. They can also email php-foundation@pamedsoc.org.
This article was originally published in the May 2024 issue of Strategies Oncology Magazine: https://bluetoad.com/publication/?m= 60297&i=821873&p=34&ver=html5.
Heather A. Wilson, MSW, CFRE, CAE, has over 35 years of leadership experience in the health and services field. Currently she serves as executive director of the Foundation of the Pennsylvania Medical Society which includes programs including the Physicians’ Health Program and LifeGuard®, a clinical skills assessment program for physicians. Concurrently she serves as deputy executive vice president for the Pennsylvania Medical Society (PAMED). She holds a Master of Social Work Degree from Temple University and is a Certified Fundraising Executive and a Certified Association Executive. Heather is a board member for the Federation of State Physician Health Programs.
How Patients Can Reduce the Risks of Complications After Surgery
AND IMPROVE THEIR RECOVERY
OSVALDO ZUMBA, MD, WELLSPAN SURGICAL SPECIALISTS – EPHRATA
When it comes to any surgery, there is always some level of risk involved.
The particular risks and complications vary with the type of surgery. Your surgeon knows best what the most common of these are and will offer more detailed instructions on how to best reduce your risks for a poor outcome and facilitate a fast and easy recovery.
Surgical complications can include minor issues such as sore throat, fatigue or nausea. They can also be more serious, including wound infections, blood clots, fevers, urinary tract infections, or pneumonia. These are only some of the issues that patients may experience post op.
These complications will increase the amount of time you need to recover and
There are also several things that you can work on with your primary care doctor WEEKS—OR EVEN MONTHS—PRIOR TO YOUR SURGERY to help improve your recovery.
delay the overall benefit you receive from your surgery. Many postoperative problems will be addressed by your physician and medical team on the day of your surgery. Interventions such as antibiotics before surgery, injections to prevent blood clots, and early mobilization right after surgery have been proven to improve recovery. There are also several things that you can work on with your primary care doctor weeks—or even months—prior to your surgery to help improve your recovery:
STOP SMOKING
Multiple studies have shown that stopping smoking or even significantly decreasing the amount of smoking prior to surgery improves outcomes. Compared to nonsmokers, smokers who undergo surgery have been shown to have poor wound healing, increased inflammation, slower recovery, and higher rates of infections after surgery.
Quitting smoking 6-8 weeks prior to surgery has been shown to significantly decrease complication rates. Emphasis has been placed throughout all surgical specialties to help patients quit smoking. Your physician can provide you with multiple resources, including medication and smoking cessation programs, to help you quit.
GET ELEVATED BLOOD SUGAR UNDER CONTROL
Talking with your primary care doctor about addressing uncontrolled blood sugar or better controlling your diabetes is crucial for improving the outcome of your surgery. Poorly controlled blood sugar has been associated with increased post op infections, including wound infections, pneumonia, and even sepsis. Research has also demonstrated that uncontrolled diabetes is associated with delayed recovery and longer hospital stays.
Controlling your blood sugar both prior to and post procedure can also be very difficult as your normal diet may be affected. Some patients may even go several days without eating after surgery, which may require a more complex regimen with constant blood sugar checks and injectable medications. Discuss a plan with your primary care physician or an endocrinologist to manage these issues both pre and post op.
MAKE GOOD NUTRITION A PRIORITY
Proper nutrition is one of the best predictors of surgical outcomes. Patients with poor nutrition prior to surgery have been associated with poor outcomes. Improvement in nutrition has been shown to lower post op complication by up to 50% in some studies. Blood work, as well as screening tools, can be used to determine malnutrition prior to surgery. Nutritional issues can be discussed with your surgeon and evaluated by a nutritionist for optimization prior to surgery. Some patients may even be required to have a procedure to improve nutrition with surgery, which could include placement of a feeding tube or a long-term IV for nutrition through the veins.
However, most patients undergoing surgery do not require a procedure to improve nutrition. Prior to surgery, a well-balanced diet with all key nutrients—including vitamins and the appropriate fats, carbohydrates and proteins—can benefit all patients.
START AN APPROPRIATE EXERCISE PROGRAM
Due to the stress of surgery and weakness that may develop during recovery, starting an exercise program before surgery can be beneficial to many patients. Studies have shown that the preoperative exercise (commonly referred to as “prehabilitation”) has multiple benefits: increases muscle mass, reduces average length of hospital stay,
and decreases the need for post-operative rehabilitation.
Of note, a simple six-week exercise program—that might include resistance training or a basic walking program—has been shown to reduce fatigue after surgery and provide better long-term results compared to postoperative rehabilitation alone. As a result, most hospital systems and surgical groups recommend prehabilitation, especially in deconditioned patients and patients undergoing orthopedic surgery.
MONITOR MEDICATIONS
Review of medications prior to your surgery is important. This will be done at multiple steps prior to surgery and postoperatively as well. As patients age, they are more prone to be vulnerable to side effects (such as delirium and abnormal vital signs) from medications. In addition to prescribed medication, home remedies and vitamins should be reviewed by your medical team as they may cause unintended side effects.
While it is impossible to completely eliminate the potential for complications and postoperative problems, patients can take part in decreasing the risks. If you feel ill right before surgery, have fevers or a chronic cough develop, or any other significant changes in your health status, please notify the surgeon as soon as possible. Sometimes the surgeon may be able to treat and resolve your issue before the date of your surgery. However, sometimes your surgeon may have to postpone your surgery in order for you to have the best results from the procedure and easiest recovery.
This article was originally published in the Summer 2024 issue of Lancaster Physician.
How You Can Use Organized Medicine As a Vehicle for Change
BY WINSLOW W. MURDOCH, M.D., TOTAL ACCESS MEDICAL, LLC
Each individual clinician can amplify their voice and collaborate on solutions by engaging in organized medicine through County, State and Federal organizations. You do not have to be a member of PAMED (Pennsylvania Medical Society) to engage in this process, but if you want to make comments about or be a voting member on adoption of solutions, you need to be enrolled in your County and State Medical Society, or, conversely, ask for the support of a delegate from your County Medical Society to lobby for your hot button issue.
“No added hidden fees for covered screening colonoscopies”
“Need for better patient education from public health in proper use of infant and child car seats,” etc.
Once you have identified and labeled your issue, share it with your County Medical Society executive or board members, and they will run it up the flagpole to see if there is already existing policy with PAMED or the AMA, and provide you with updates of movement around that policy if already adopted and being worked on.
As a physician in the community, if you are enthusiastic about a hot button issue that is impacting your patients’ care or your practice, you can reach out to your County (CCMS) or State (PAMED) Medical Society member colleagues.
The process is fairly straightforward.
Below is a theoretical attempt at getting collaboration for a hot button issue that you feel passionate about.
Identify your hot button issue in a title:
“Ending prior authorizations of Migraine medications”
If your hot button issue is not something currently in progress, or if you feel that the current level of attention needs to be increased, then, you can work on putting together an actual resolution for your state organization to cocreate, lobby and provide action to the request for change or improvement, assuming it is adopted at the next house of delegates of PAMED in late October.
The next step is to create a list of reasons why this issue is important: for instance, how it is harmful to patients or practice by stating a series of:
“Whereas; Prior authorizations delay needed care”
“Whereas; Insurance benefits for coverage of USPTF screening services should include all fees”
“Whereas; proper infant and child car seat use saves lives”
If you can cite sources or references this is a bonus.
If you can ballpark an estimate for actual cost to implement, that is also a bonus if it applies. PAMED staffing can certainly help in this regard.
The final step is to create a resolution.
A resolution is a stand-alone request for discrete action or several related actions from PAMED or the PAMED delegation to the AMA to collaborate in communicating, organizing, structuring, and ultimately problem solving as per the resolution.
You should use the collective knowledge of your County Medical Society’s executive, as well as the volunteer board members at CCMS, to fine-tune and craft the resolution so that it has the highest likelihood of being adopted at the annual house of delegates of PAMED to become the work of PAMED or AMA in the upcoming year(s). If you are not a member of your County and State Medical Society, you will have to ask a member who is a delegate to the house of delegates of PAMED to sponsor your resolution. Our county board will assist. Conversely, if you are a member of your County and State Medical Society, you may also volunteer to attend remotely or in person the annual House of Delegates in late October as a delegate of your County.
CCMS will then assist you with submitting your resolution for review and comment. PAMED will then assign it to a volunteer PAMED reference committee of 4 or 5 physician peers and administrative support staff at PAMED.
Resolutions proposed are then posted for about 4 weeks to allow comment and discussion on a virtual site for any and all PAMED members who are engaged, allowing a healthy debate about specific resolutions proposed for that year. The smartest person in the room is the collective room, and the Pennsylvania Medical Society (PAMED) is a pretty big room.
All comments are then reviewed by the reference committee, and a recommendation to adopt, modify, send to the Board of Directors at PAMED for further study, for action after study, or not adopt will be made. There is no sausage making at the house of delegates. Resolutions stand or fall on their own merits, though wordsmithing sometimes does come into play.
If you and other PAMED members disagree with the recommendation of the reference committee, further debate and final voting can take place at the House of Delegates meeting in late October.
This article was originally published in the Summer 2024 issue of Chester Medicine.
INNOVATIVE PARTNERSHIP WITH WATSONBATTS SCHOOL OF CONSTRUCTION
The Watson-Batts School of Construction (WBSC), in partnership with St. Luke’s University Health Network, is proud to announce the launch of its first class on September 27, 2024. This groundbreaking program is fully funded by the Watson Organization and represents a dynamic tri-sector partnership involving the private sector, nonprofit sector and government, working collaboratively with the community to improve workforce development and foster economic development.
This initiative is specifically designed to harness the significant growth within the Lehigh Valley, particularly in the commercial construction sectors of medical and educational buildings. The program aims to develop a pipeline of qualified minority contractors and subcontractors who can competitively bid and secure local contracts, thereby addressing the financial disparities that have historically affected these communities.
As a nonprofit organization, St. Luke’s University Health Network conducts Community Health Needs Assessments every three years which is mandated by
the Affordable Care Act. Access to care is a significant issue in our communities. We see the best access among folks who have well-paying jobs with benefits, including insurance. To address the root of the problem, St. Luke’s has been involved with Adolescent Career Mentoring and Workforce Development initiatives for more than 25 years.
“This opportunity for collaboration directly aligns with our vision and mission. Our goal is to create pathways for equity toward measurable health outcomes through advocacy, access, and navigation of resources for partners and underserved communities. We envision a community where everyone has access to exceptional health care built on a foundation of trust and compassion. Ensuring people have jobs and careers with livable wages is vital to this process.”
— Dr. Rajika
E. Reed, Ph.D., MPH, M.Ed., Vice President of St. Luke’s Community Health
"We are excited to initiate this transformative program that does more than just train the next generation of leaders in construction. It actively contributes to the revitalization of communities and fosters economic equity. This pioneering
LCMS NEWS
partnership is set to make a profound impact on the communities that need it most, opening up new opportunities and pathways to generational wealth."
— Dr. Hasshan
Batts
"As a successful young minority business owner, it's crucial for me to give back and invest in the communities we serve. This initiative is more than a business strategy; it's a personal commitment to uplifting the places and people who have shaped our success. By fostering education and opportunities in construction, we're building a foundation for enduring progress and empowerment."
— Ivan Watson
Classes will be held at St. Luke’s Sacred Heart Hospital in Allentown, offering flexible learning opportunities for both youth and small business owners. The WBSC also provides various support mechanisms to ensure students can successfully navigate the challenges of the construction industry.
The program is now accepting applications, and interested candidates are encouraged to apply early due to limited space.
MEMBERS
David Allen, DO
Advanced Heart Failure And Transplant Cardiology
Jesus Juancarlos Alvarado Salinas Medical Student
Oumou Bah, MD
Resident - Obstetrics & Gynecology
Amber C Covington, MD
Obstetrics & Gynecology, St. Lukes Graduate Medical Education
Matin Mohammad, MD
Physical Medicine And Rehabilitation
Courtney Magdalene Moore, MD
Hospitalist - Internal Medicine
Hridayesh Singh Nat, MD Internal Medicine
Bhumika Harshad Patel, DO Internal Medicine
Rita Margaret Pechulis, MD
Pulmonary & Critical Care Medicine (Internal Medicine)
Kanwardeep Singh Sethi, MD Psychiatry
Samantha Alice Shepard, MD
Emergency Medicine
Cheri Alissa Silverstein Fadlon, MD
Cardiovascular Disease (Internal Medicine)
M. Bijoy Thomas, MD
Obstetrics & Gynecology
Bi Liu Yu, DO
Resident - Obstetrics & Gynecology Emergency Medicine
THE REGION’S FIRST & ONLY
MEDICAL SCHOOL
Eva Munshower — Class of 2024 | Schnecksville, PA
Allentown Central Catholic High School Bucknell University
Temple/St. Luke’s 2024 graduate and St. Luke’s general surgery resident Eva Munshower is a longtime resident of Schnecksville and is following in the footsteps of her father, Thomas Munshower, D.O., a SLUHN family medicine physician. “Medicine is my calling and it’s how I want to give back to the community where I grew up,” says Eva. “It will be a gift to practice here at St. Luke’s like my father.”
sluhn.org/SOM