East Tn Medical News December 2015

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PHYSICIAN SPOTLIGHT PAGE 2

Dwan Perry, DO TRI CITIES

PHYSICIAN SPOTLIGHT PAGE 7

McKenzie Calhoun,

PharmD

ON ROUNDS TETs and TAPTs A Pathway to Asset Protection for the Healthcare Industry in Tennessee There are many reasons people are interested in asset protection.

One of the most common areas of asset protection is bloodline — protecting assets for a spouse, children and grandchildren ... 4

Surgical Treatment of Thyroid Diseases Thyroid disease is very common. In fact, according to the National Institutes of Health, thyroid issues affect an estimated 27 million Americans.

My partner, Surgical Oncologist Dr. Troy Kimsey, and I see a large number of thyroid patients in our practice at Premier Surgical Associates in Knoxville ... 8

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Statin Therapy Benefits Patients with Highest Genetic Risk of Heart Attack Multi-institutional Study Focuses on Using Genetics to Identify At-Risk Patients

By LyNNE JETER

Widely-used statin therapy provides the most benefit to patients with the highest genetic risk of heart attack, according to Nathan O. Stitziel, MD, PhD, a cardiologist and human geneticist at Washington University in St. Louis, and co-author of a study published earlier this year that’s receiving national buzz.

“There’s no ongoing study in the same realm, concerning statins and genetic risk,” said Stitziel. “Interestngly, the study isn’t so much about statins, but rather the use of genetics as a method for identifying patients at risk and those who could potentially benefit from primary prevention therapy. It just turns out that statins are the best means we have as a way to reduce heart attacks.”

(CONTINUED ON PAGE 6)

Retirement Funding Strategies for High Income Earners

By CINDy SANDERS

T or F: For 2015 and 2016, everyone can contribute up to $18,000 to their 401K, and those aged 50 or older can contribute up to $24,000. FALSE “In a lot of cases, we see situations where the (401K) plans are not designed in a way where more highly compensated individuals can take full advantage of the benefits,” said Steven Glasgow, a senior vice president with Avondale Partners’ Wealth & Asset Management Group, which serves clients across the country.

When 401K plans were being created, Glasgow continued, they were designed with certain tests in place to ensure a company’s plan didn’t intentionally discriminate against employees at lower income levels. “If they have a population of employees who are not contributing enough as a percentage of their total income, then you have a testing issue,” Glasgow said, adding that (CONTINUED ºON PAGE 6)

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PhysicianSpotlight

A Sporting Chance

Osteopathy Interest Leads Doctor Into Sports Medicine Career

By JOE MORRIS

A career in medicine was something Dwan Perry, DO, wanted early on. Choosing a particular path, however, took a little bit longer. But once he heard about, and begin to learn, osteopathic medicine, he knew he’d found his niche.

“My sister, who had applied to medical school, told me about osteopathic medicine and suggested I look into it,” Perry said. “It involved extra training with your hands, and seemed to be a more immersive and manipulative medicine, and that had interested her. I like the philosophy as well, so once I was in medical school, it just kind of took off from there.”

Perry, who now is director of sports medicine, assistant professor of physical medicine and rehabilitation, and assistant professor of sports medicine at Lincoln Memorial University’s DeBusk College of Osteopathic Medicine, attended medical school at the West Virginia School of Osteopathic Medicine in Lewisburg, W. Va. He followed that up with an internship at Westchester General Hospital in Miami, and then held a residency at the Univer-

sity of Kentucky, as well as a sports medicine fellowship at Virginia Tech.

“In osteopathy, one thinks of the body as a unit, and then explores how the structure and function of the body interplay and rely on each other,” Perry said.

“The body can actually heal itself when

given the chance, and if you put all those aspects together you can come up with a good, rational medical plan. That remains very interesting to me because it comes down to what a lot of people describe as a holistic approach. I really like considering all parts of what is going on with a patient, rather than just one particular issue.”

That eventually took him into sports medicine, although early on he didn’t think that would be his career path despite a solid interest.

“I never really looked at sports medicine because when I first began medical school, the way to become a sports medicine doctor was to become an orthopedic surgeon,” he said. “In my fourth year of medical school, a friend of mine was doing a residency and he recommended I look at physiatry, or rehabilitation medicine, because that had a sports medicine avenue.

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DECEMBER 2015

I looked at that, and it fit in with the osteopathic approach of taking care of the whole person, not just the disease, and also had a lot of rehab elements to it. I really set my sights on that, and the opportunities that followed really matched up.”

While at Virginia Tech, he would perform osteopathic manipulation on athletes before big games, and so he got a firsthand look at how he could improve their lives.

Now, as he works with student athletes and community members at LMU’s University Medical Clinic, he builds on that background as he finds more opportunities than ever to put what he loves about his specialty to work.

“I would say that we’re doing 80 percent of our work with athletes, and the rest will be community patients, so I get to work in the training room setting and then the clinic,” he explained. “We see the student population in both settings, which is really good for me because I get a lot of variety.”

His work consists of a lot of sprains and strains, but underneath those headings come a lot of different conditions.

“Different sports have different injuries, but there’s a biomedical aspect to all of it,” Perry said. “Overhead athletes, like volleyball and baseball players, have a lot more rotator cuff problems, while soccer players and lower-extremity athletes have hip flexor sprains, knee and ligament issues, and ankle problems. But they’re all moving around, and so the goal is to get them back to where they can do that.”

Having such a wide variety of patients allows him to explore new treatment methodologies, some of which aren’t available LMU — yet.

“We do a lot of the classic RICE method: rest, ice, compression, and elevation,” he said. “But there are a lot of new treatments coming out that involve stem cells and platelet rich plasma, as well as regenerative medicine such as prolotherapy. Some professional athletes are going to Germany and getting the platelet rich plasma treatment, and when our students see that on ESPN, they want to know more. I want to know more, too, so we’re all pushing to find out what new methods are available, and what’s right for us and our programs.”

In the meantime, he said, he’ll still handle the aches, pains, and strains, while helping the whole person heal.

“If I could get us a plasma machine I would do that, certainly, and I want to explore more of what’s going on with manual medicine and concussion treatments,” he said. “There’s so much that can be done in osteopathy, and I have a lot of questions all the time. It’s a very interesting field, and we’re doing great work here.”

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HealthcareLeader

The Patient Comes First

Patient Experience Paramount For Premier Surgical Director of Surgical Services

By KIMBERLY O’NEAL

There have been a lot of sleepless nights in the past year for Steve Ross, RN, Director of Surgical Services for Premier Surgical Associates. Ross has been heavily involved in the planning and construction details of Premier Surgical’s new officebased procedure center on Papermill Drive in west Knoxville. It’s a new, expanded facility that houses Premier Vascular Access & Imaging Center, Premier Vein Clinics, Premier Prosthetic Center, and Premier Hemorrhoid Treatment Center.

“I wake up at night thinking about patient flow,” admitted Ross. “I wonder: how will the patients perceive the staff, the equipment, and the care they receive here? Their perception and experience are so important.”

For Ross, his involvement in the planning of the new facility is the culmination of nearly 30 years in healthcare.

He was first trained in safety and first aid while serving as a military policeman and S.W.A.T. Team member in the U.S. Army. When Ross left the military, he worked as a Highway Patrolman in northern California for 14 years, investigating

traffic accidents for many of those years.

“We were trained as EMTs and were usually the first ones on a crash scene. So, we often treated patients in the field,” explained Ross.

In 2001, Ross and his family relocated to Knoxville to be near his wife’s family. It was only natural that he earned his Registered Nurse certification while working in the Heart Cath Lab at what was then St. Mary’s Hospital and Parkwest Medical Center.

“It was rewarding to see the difference you were making for patients,” said Ross.

“Someone would come in with an active heart attack, and you are part of the team that immediately treats that person and saves their life.”

That appreciation for a team approach continued to come into play as Ross joined Premier Surgical Associates in 2007 to manage the group’s new freestanding Vascular Access and Imaging Center.

“When I started at Premier, I wrote a letter to the staff explaining that our goal is to concentrate on each and every patient.

I don’t care what they look like, what their social economic status is – I want that patient to be treated better than I treat my own family,” said Ross.

As the Premier Vascular Access & Imaging Center grew to include additional specialties and 65 clinical and clerical staff and 15 physicians, Ross continues focus on the individual patient experience.

“I may sound cliché, but I tell every person who applies for a job here that our care and relationship with the patient comes first. From the front desk, to the nurse, to the physician - we are all part of a team working to make each patient feel comfortable, welcome, and valued as an individual.”

Now, as Ross heads up the recent relocation and expansion of Premier Surgical’s new Papermill Drive facility, he’s excited about what the future brings.

“Our new facility is a great opportunity to offer improved access and care to patients in East Tennessee. Our team is ready to give every patient the best care and experience possible.”

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LegalMatters

BY CHAD W. WHITFIELD

TETs and TAPTs

A Pathway to Asset Protection for the Healthcare Industry in Tennessee There are many reasons people are interested in asset protection.

One of the most common areas of asset protection is bloodline — protecting assets for a spouse, children and grandchildren.

Additionally, given our litigious society, individuals who work in the healthcare industry must particularly be proactive in protecting their assets.

Tenants by the Entirety Tennessee law allows a married couple to own assets as Tenants by the Entirety (TBE). From a legal viewpoint, the marital unit owns the entire property. This simply means that neither

spouse can transfer his or her interest in TBE property without the consent of the other spouse. Why is this important?

There is an advantage to owning assets (home, investments, etc.) as TBE property as opposed to other forms of ownership. Since the marital unit owns the property and neither spouse can convey the property without the other, the creditors of an individual spouse cannot attach and sell the TBE property. Only creditors of both spouses may attach and sell the interest in the property.

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In addition, upon the death of one spouse, the deceased spouse’s individual creditors cannot reach the TBE property because the creditors have no right to the property.

Unfortunately, after the death of the surviving spouse, his or her individual creditors can now reach the property. However, in Tennessee, we now have a new estate planning tool — the Tenants by the Entirety Trust (TET).

Recent changes in Tennessee law now allow the use of two types of trusts, which provide additional valuable tools for asset protection.

Tenants by the Entirety Trust In a TET, just like property held as TBE, assets will pass free from the individual creditors of the first spouse to die. However, under a TET, joint creditors and creditors of the surviving spouse may only potentially attach assets held in a TET “to the extent that the surviving spouse remains a beneficiary of the TET” and retains certain powers in an individual capacity.

In other words, the new law indicates that, upon the first spouse’s death, some or all of the assets held by a TET could convert to an irrevocable spendthrift trust for the benefit of the surviving spouse. This means a portion of the assets inside the TET would be free from the creditors of the surviving spouse. Further, utilizing a TET can protect assets in the event the surviving spouse remarries or is involved in a lawsuit. This was not previously allowed under Tennessee law.

Since the statute allowing for the creation of a TET is riddled with intricacies, each step in creating and funding a TET must be carefully followed in order to achieve the full benefit of protection. Obviously, this trust is only appropriate for longtime, happily married couples who plan to remain married.

Tennessee Asset Protection Trusts (TAPTs) In recent years, Tennessee has enacted new laws allowing an individual to create a Tennessee Asset Protection Trust (TAPT). For more than 200 years in our country, these types of trusts were not allowed. Now, however, asset protection trusts are allowed in 16 states, and Tennessee currently ranks third among those states for the best asset protection laws.

Essentially, a TAPT is an irrevocable trust that protects your assets and allows you or your family to benefit from the trust resources. Under the new law,

an individual can transfer assets (real estate, investments, interest in a family or closely held business) into a TAPT and continue to benefit from the trust, while enjoying exemption from claims of creditors and predators.

TAPTs offer exceptional creditor protection, providing a mere twoyear statute of limitations from future creditors. To illustrate this point, let’s say that on May 5, 2013, Dr. Smith transferred an investment account into a TAPT and is subsequently sued in December 2015 by patient/creditor A. Assuming that Dr. Smith is in full compliance with the TAPT law, the assets owned by the TAPT would be sheltered from the claims of patient/creditor A. A beneficiary of a TAPT who was married before the creation and funding of the TAPT may be responsible for alimony and child support. However, the statute does not provide for any other “exception creditors.” This limited list of “exception creditors” helps make Tennessee one of the best states in which to create an asset protection trust.

An individual who creates a TAPT is known as the Grantor. Under Tennessee law, the Grantor maintains certain rights and control over the TAPT, while enjoying the asset protection benefit of the TAPT. Some of the rights a Grantor is allowed to retain without jeopardizing creditor protection include: The right to be a beneficiary; The right to live in a home owned by the trust; and The right to direct investments of trust assets.

In order to qualify for creditor protection, a TAPT must satisfy certain legal elements, such as the appointment of a “qualified trustee” and governance

by Tennessee law. Additionally, the trust must be irrevocable.

An asset protection plan works best when it is developed and funded before a creditor/predator event occurs. Clearly, Tennessee is a leader in the area of asset protection. Proactive planning can result in the protection of hard-earned assets and ensure that desired beneficiaries receive their intended inheritance.

Chad Whitfield is an attorney with the law firm of Hunter, Smith & Davis, LLP. He has 19 years of estateplanning experience, including estate administration, asset protection, and succession planning. Licensed in Tennessee, Florida, and in the United States Tax Court, Mr. Whitfield has been a featured speaker throughout the Southeast on various estate planning topics. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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Enjoying East Tennessee Christmas Underground at Ruby Falls

By LEIGH ANNE W. HOOVER

Whether it’s at the mall, a large department store, or just about anywhere nowadays, a visit with Santa is often part of the holidays. Capturing the treasured photo and sharing an item or two from the Christmas list is special for any child. As adults, we love it, too! We still have keepsake annual photos taken with the jolly ‘ole fellow when our children were little, and they always bring back special memories.

Years ago, the local television station, WSPA-TV 7 in Spartanburg, South Carolina, featured “A Visit with Santa” weekday afternoons during December. It was fun watching the local program and seeing friends.

When my brothers and I actually got to be on the show, it was a really big deal. Seeing Santa on a television set simply seemed unrivaled.

Years later, he began visiting other unusual places. Today, Santa has even gone underground in a cave!

Celebrating its second year at Ruby Falls in Chattanooga, Tenn., Christmas Underground is truly a unique experience for all children and kids at heart of all ages to visit Santa.

“We wanted to create a Christmas

tradition,” explained Ruby Falls Special Events Coordinator, Hollie Baranick. “We decided to create a story, and it became an adventure with sort of a secret passage to see Santa.”

According to Baranick, the separate part of the cave used for Christmas Underground begins with happy miners searching for “Joystone,” which is a precious gem mined to use and spread the joy and magic of Christmas throughout the world.

Visitors can interact with the happy miners, complete with mining carts and glowing gems along the way, and learn about the joystone.

One of the best parts about this Christmas adventure is there are good temperatures, around 60 degrees, year-round underground.

The experience can also be enjoyed during the day because it is always illuminated underground.

After visiting the mine, visitors work their way through an area referred to the icy part of the cave, which is actually like a small Christmas village, where they will see the Northern Lights leading to the ice cave secret passage to see Santa.

“Everyone enjoys the fact we take the time to interact and talk to the kids,” said Baranick. “It’s a self-guided tour. Everyone can walk at your own pace, but if you just want to see Santa, you do not have to stay behind them.”

Once a child sees Santa, where a professional photograph will be taken and available for purchase following the visit, children can do hands-on activities.

“We set up little activities,” said Baranick. “There’s a wishing well, where they can make their own Christmas wish, they can pan for their own joystone, test joystones…, and actually crack one open to see what it looks like inside.”

Each participant will leave Christmas Underground with his or her very own

joystone.

“The really neat thing about our attraction is most places can’t open until it gets dark,” and at that point, the kids are ready for bed,” explained Baranick. “But, we’re in a cave, it’s dark anyway, and that way, we can stay open during the day.”

Christmas Underground is open Thursday – Sunday from 10:00 a.m. until 8:00 p.m. beginning December 3rd. The week of Christmas, it’s open December 22nd and 23rd from 3:00 until 8:00 p.m.

Known as one of the “Southeast’s favorite destinations,” Ruby Falls has been a tourist destination since opening to the public in 1930. There are special ticket prices for those wishing to see Christmas Underground and also experience Ruby Falls.

For additional information about this special event at Ruby Falls, be sure to visit http://www.rubyfalls.com/ruby-fallschristmas-underground also visit www. rubyfalls.com.

Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. With a Bachelor of Arts degree in secondary education/ English and a minor in general communications, Hoover has worked for over 30 years in the media. She is the author of several books, including well-known children’s book The Santa Train Tradition, and two adult Christian books. You may contact her at hoover@ chartertn.net or https://www.facebook. com/LeighAnneWHoover

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Statin Therapy. continued from page 1

Retirement Funding, continued from page 1

The research team included investigators studying 49,000 patients across five studies at Brigham and Women’s Hospital, Harvard Medical School, Massachusetts General Hospital and Washington University. Using a relatively straightforward genetic analysis, the team assessed heart attack risk independently of traditional risk factors – age, sex, cholesterol levels, smoking history, and family history – and whether the Dr. Nathan O. Stitziel patient has diabetes. They discovered that individuals in the high genetic risk category have a 70 percent higher risk of heart attacks, compared with those at lowest genetic risk. They also pointed out that statin therapy results in a 13 percent reduction in risk in the low genetic-risk group, a 29 percent reduction in the intermediate group, and a 48 percent reduction in the high-risk group.

Results of the 2015 published study, “Genetic Risk, Coronary Heart Disease Events, and the Clinical Benefit of Statin Therapy: An Analysis of Primary and Secondary Prevention Trials,” differ from past research, which has consistently shown that statins provide about the same relative risk reduction — 30-45 percent, depending on dosage — across all categories of patients, said Stitziel.

could block higher earners from being allowed to fully contribute. “It’s an incentive to design plans to encourage participation by the non-highly compensated employees, and if they don’t do so, it limits the ability of everyone else to use the plan.”

Typically, administrators will run yearend test calculations to ascertain whether the plan met its threshold or whether highly compensated employees have contributed too much. If some employees are found to have excess contributions, Glasgow said, “then they have to file an amended tax return and take the money back out. That’s never a happy moment for anybody.”

Study Specifics

Investigators analyzed each patient’s DNA code for the 27 genome positions and risk of coronary heart disease to calculate the genetic-risk score.

Individually, many genome locations are linked to a minor increase in risk while the high-risk letter may be quite common, explained Stitziel.

“For example, a T instead of a G in a particular spot may be associated with a 6 percent increase in risk, and that T may be present in 70 percent of the population,” he explained. “But combined, the

risk score appears to become a clinically meaningful measure of coronary heart disease risk.”

Stitziel pointed out the 27 markers do not change with age or lifestyle. Theoretically, a person at high risk of developing coronary heart disease could be identified early, before traditional measures of the disease would be detected with a doctor’s physical exam or routine blood work.

Too Liberal?

The multi-institutional study has spurred national debate over the “liberal prescribing” of statin drugs. Two years ago, the American College of Cardiology (ACC) and the American Heart Association (AHA) changed the guidelines for statin therapy, dramatically increasing the number of patients recommended to take it.

“The new AHA/ACC guidelines could put half of all adults in this country on statins for life … totally absurd,” wrote David Williams, MD, in “Statins: Separating Fact from Fiction” in a 2014 edition of Alternatives.

Stitziel acknowledged the ongoing debate over which individuals should be allocated statin therapy to prevent a first heart attack. “Some have said we should be treating more people,” he said, “while others say we need to treat fewer.”

That’s where precision medicine comes into play, Stitziel emphasized.

“It’s another approach to identify people at high risk and preferentially prescribe statin therapy to those individuals,” he said. “Genetics appears to be one way to identify high-risk patients.”

Unfortunately, this particular genetic analysis isn’t yet available to patients.

“More research is needed to validate the findings before such a test could be developed for clinical use,” said Stitziel.

“The bigger issue behind it is that insurers would need to start paying, and obviously that takes lots of decisions beyond my world of research.”

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Avoiding the Amended Tax Return

Glasgow, who has 20 years of experience working with individual and institutional investors, focuses his expertise in the areas of defined contribution plans, defined benefit plans, endowments and foundations. He said there are ways to address the funding issue and help high income individuals adequately save for retirement.

The first option, he noted, is to change the plan design so that it becomes more generous for non-highly compensated individuals. Switching to a safe harbor plan allows companies to eliminate testing.

However, it does cost more from the company, health system or practice perspective.

“So it raises the question, ‘does it make more sense to increase your benefit plan?’

Most often, the answer is ‘yes.’” Glasgow said. He added a qualified financial advisor could put pencil to paper to help an employer weigh the costs and benefits of such a plan. In addition to some longterm financial advantages to the decision, Glasgow added a richer benefit plan could also help attract and retain talent in a competitive marketplace.

“The other thing you can do in some cases … not all … is to put a non-qualified plan in place to supplement the 401K,” he continued. “It’s a plan specifically designed for highly compensated people.”

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In this scenario, the higher income earner could take excess contributions and put the money in the non-qualified plan.

In fact, it can be set up so that excess contributions automatically spill over into the non-qualified plan, eliminating the need to file an amended tax return. In addition, the company is free to add ‘bells and whistles’ such as contributing on an employees’ behalf to sweeten the pot.

“It can be structured in a lot of ways,” noted Glasgow, “but it’s not governed by the Department of Labor and ERISA law like your 401K is.”

The downside of that is money in a non-qualified plan is an asset on the corporate balance sheet. If creditors come after the company or health system, money in the non-qualified plan is fair game so employees could lose their contributions.

“That can’t happen in a 401K,” Glasgow stressed. “It’s absolutely free and clear from the company balance sheet.”

Profit Sharing

“With a physician practice, you have an interesting situation where you have a high concentration of high income earners,” Glasgow said.

In the case of professional services groups – which could include attorneys and accounts, in addition to physicians – Glasgow said it’s common to have a profit sharing plan as the second part of the overall retirement benefit. In combination with a 401K plan, individuals could defer up to $53,000 in income (for 2015 and 2016) to lessen their current tax burden.

“For those profit sharing plans to pass muster, the owners actually have to contribute additional money on behalf of the non-highly compensated employees,” Glasgow added, noting hourly employees must have access to the profit sharing plan, as well.

Defined Benefit

“If you really want to turbo charge your contributions, there is something called a cash balance defined benefit plan,” Glasgow said. “In this case, in addition to the $53,000 you’ve already put away (through 401K and profit sharing), you could … depending on your age and income … put away an additional $294,000 pre-tax.”

The closer to retirement, the more an individual is allowed to contribute. Glasgow said it isn’t unusual to see a 68-year-old put in the max amount. “You can use this as a way to manage your adjusted gross income,” he pointed out, adding minimizing tax liability and building a nest egg is often more important than take-home pay as retirement nears. Like a 401K, the cash balance defined plan is very safe and is kept in a segregated trust governed by ERISA laws.

While this plan could work for any size practice, Glasgow said it is particularly interesting for larger practices. “It’s worth exploring and having a conversation about,” he noted. However, Glasgow cautioned, setting it up is tricky so those considering the option should consult with a qualified financial advisor. easttnmedicalnews

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Tri Cities

PhysicianSpotlight

Professional Courtesy

Pharmacist Works To Blend The Profession Into All Areas Of Healthcare that she can hands-on help treat some-

at conventions,” she said. “It’s so impor-

one’s diabetes, for example, while also

tant to advocate for clinical pharmacy,

Most kindergarten students

working with their primary care phy-

which is such a huge–and growing—

don’t announce that they plan a

sician to craft an ongoing care plan.

area. We have worked on legislation such

career in clinical pharmacy, but

At the same time, she can work with

as a collaborative practice act, which

McKenzie Calhoun, PharmD, may

pharmacy students, med students, and

lets pharmacists go into a collaborative

have been getting a little coaching

residents as she interacts with the pa-

agreement with doctors to provide clini-

on the side.

tient and physician.

cal service and help them manage pa-

By JOE MORRIS

“My dad is a pharmacist, so

“I love the teachabilty of the new

tients with different chronic diseases.”

I grew up around it,” said Cal-

physicians and pharmacists because

It’s another way to advocate for the

houn, who is assistant professor

they are sponges and are so much fun

concept of interprofessional healthcare,

in the Department of Pharmacy

to work with,” Calhoun said. “In my

which Calhoun said she sees becoming

Practice at the Bill Gatton Col-

job, I get to do so much more than just

much more commonplace in the next few

lege of Pharmacy at East Tennes-

help manage someone’s condition.

years.

see State University (ETSU). “I

We are very interprofessional here,

“Pharmacists and other healthcare

heard my dad say that’s what he

so I’m working with the students, a

providers have always had great relation-

was, so that is what I was deter-

clinical psychologist, a licensed clini-

ships, but now those are really expand-

mined to be – even though at that

cal social worker, and a great nursing

ing,” she explained. “For a long time, all

age I had no idea what it meant.”

staff. We’ve created this amazing in-

areas of healthcare were really siloed, or

Happily for her, she was drawn to math

of residency in ambulatory care with an

terprofessional space, which I think is the

at least viewed that way. Now those barri-

and science as she moved through her

emphasis in academia and family medi-

way of the future in terms of how medicine

ers are coming down. I’m seeing patients

school years, and eventually did un-

cine at ETSU. By the time she was done,

is practiced. Everyone is doing what they

in a family medicine practice, there are

dergraduate work at the University of

she began describing herself as a family

do best, and that means the patient wins.”

pharmacists who are on rounding teams

Tennessee and ETSU. She considered

medicine clinical pharmacist.

Another way that Calhoun likes to

in hospitals, and there are pharmacists in

becoming a community pharmacist, but

“That’s what led me to this place,”

plug in is through her professional asso-

long-term care facilities and community

the ability to combine an academic career

Calhoun said of the Gatton College of

ciations. She recently was named as chair

health centers. I’m so lucky that I get to

along with interactions with physicians

Pharmacy. “Although, I will admit that

of the Tennessee Society of Pharmacists,

be in a place where I am seeing all that, as

and patients had a stronger appeal.

my grandmother is still a bit confused.

which is part of the Tennessee Pharma-

well as getting to work with students and

She asks me if there’s a pharmacy in the

cists Association, an organization where

residents. The new payment models and

office!”

she has deep roots.

practice models that are being developed

She completed her first year of postgraduate residency in pharmacy practice at the Veterans Affairs Tennessee Valley

Working in an academic clinical

“I’ve been involved with the TPA

give all of us the opportunity to work to-

Healthcare System (TVHS) in Nashville,

pharmacy setting, in this case, the ETSU

since I was a student, and because of my

gether, and for the patients to continue to

and then followed that with a second year

Family Physicians of Kingsport, means

dad, I was part of the TPA Kids’ Club

be at the center of all we are doing.”

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ClincallySpeaking

BY MICHAEL D. KROPILAK, MD, FACS, PREMIER SURGICAL ASSOCIATES

Surgical Treatment of Thyroid Diseases Thyroid disease is very common. In fact, according to the National Institutes of Health, thyroid issues affect an estimated 27 million Americans. My partner, Surgical Oncologist Dr. Troy Kimsey, and I see a large number of thyroid patients in our practice at Premier Surgical Associates in Knoxville.

Fortunately, thyroid disorders are often usually treatable through medication therapy or surgical options. For those patients who do require surgery, we offer a team approach on many of the larger, extensive cases involving lymph node dissection of one or more groups of lymph nodes, or lateral neck dissections.

The thyroid is a butterfly-shaped endocrine gland, about the size of an orange slice, located below the Adam’s apple. The main job is controlling the body’s metabolism – your energy level, body temperature, heart rate and food metabolism. The thyroid takes iodine from the diet and converts it into thyroid hormone.

Thyroid conditions that may necessitate surgical treatment can be generally broken down into four main categories: diseases of thyroid function

(hyper and hypothyroidism); thyroid nodules; multinodular goiters; and cancer.

The autoimmune disorder, Grave’s Disease, is one of the most common causes of hyperthyroidism, an overactive thyroid gland. Hyperthyroidism may also be related to a toxic multinodular goiter or toxic nodule. Patients may elect to have radioactive iodine ablation (RAI) to gradually shrink or destroy part or all of the thyroid gland.

Several reasons a thyroidectomy may be recommended for hyperthyroidism: a large goiter, nodules at risk for cancer, a pregnant patient or one who wishes to become pregnant within a year of treatment, Ocular Grave’s Disease, a need to quickly control the hyperthyroidism, an iodine allergy, a patient less than 15-years old, or the patient’s preference. With the total removal of the thyroid the patient must take medication for the rest of his or her life to replace the lost hormones.

With hypothyroidism, an underactive thyroid gland, surgery may be recommended for patients suffering from an autoimmune disease where the body attacks specific parts of itself,

such as Hashimoto’s Thyroiditis or Lymphocytic Thyroiditis.

Thyroid nodules are very common, especially in women, with women having a 60% chance of developing a nodule by age 60. Nodules may not have any symptoms and are often discovered through an exam or routine imaging. Most nodules are benign, with only 5-10% being cancerous. If a nodule is greater than 1cm or causing symptoms such as difficulty breathing or swallowing, or a visible lump in the neck, it should be worked up and may need surgery. The patient’s risk of cancer should also be considered: Is there a family history of cancer? Radiation exposure to the head and neck? Is the patient younger than age 20 or older than 70? Male? Is the nodule hard?

Are lymph nodes enlarged? And, is the patient’s voice hoarse?

Thyroidectomy may be performed for a simple or multinodular goiter that may be toxic or nontoxic. While most goiters are asymptomatic, if they are large enough, they may cause compression symptoms. In this case thyroidectomy is often indicated. A total thyroid removal is usually recommended if the

goiter grows quickly, there is concern for cancer, it is substernal (growing in the upper chest), or cosmetically unappealing.

With an estimated 30,000 cases a year, thyroid cancer is relatively rare.

Thyroid cancer is very treatable and usually cured with surgery or other appropriate therapy. It is seldom fatal and has a less than a 1% mortality rate.

While treatment may include radioactive iodine treatment, radiation therapy, and chemotherapy, in most cases patients will undergo surgery to remove part or all of the thyroid gland.

Evaluating a thyroid disease patient’s indications for surgical treatment is a collaborative effort involving the patient, their endocrinologist and surgeon. We work together to determine a course of treatment that best addresses that patient’s specific thyroid condition and needs.

Michael D. Kropliak, MD, FACS, is Board Certified in General and Vascular Surgery and completed Fellowship training in Vascular Surgery at the Cleveland Clinic. He performs general, vascular, and endocrine procedures at Premier Surgical’s Fort Sanders Regional location in Knoxville.

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DECEMBER 2015

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The Literary Examiner

BY TERRI SCHLICHENMEYER

The Laws of Medicine

by Siddhartha Mukherjee; c.2015, TED Books; $16.99 / $19.99 Canada, 76 pages Rules are rules.

Break them and there are consequences. Bend them, though, and that’s okay; everybody knows there are exceptions to every rule.

So could those exceptions actually define rules more clearly?

And, as Siddhartha Mukherjee asks in The Laws of Medicine, is medicine, with its oddities, as a rule then, a science?

Not long ago, as an overworked, sleep-deprived medical resident, Siddhartha Mukherjee stumbled across a book – the only book he read that year – called The Youngest Science. Written in the late 1930s by a Harvard graduate, it was a biography of a doctor-in-the-making, as well as an unintentional look at progress.

“We tend to forget that much of ‘modern medicine’ is, in fact, surprisingly modern,” says Mukherjee, and this book proved it. It also made him think about the way medicine is perceived and how there are “spaces that live between facts,” i.e., we sometimes don’t know what we don’t know. For example, during medical school, Mukherjee says “The information that was missing was what to do with information…”

Science, he points out, has laws, defined as universal “statements of truth based on repeated experimental observations.” In science, if A happens, then B. With that in mind, and remembering that there are unknowns and near-constant outlying occurrences in medicine, could medicine be called a “science”?

If so, he says, it’s a “soft science,” and he offers three laws of his own making.

“A strong intuition is much more powerful than a weak test,” he says, which is what he learned when one of his patients appeared to be dying, and diagnosis was elusive. That law, he says, is all about a “probability game.”

“Normals’ teach us rules; ‘outliers’ teach us laws,” he says, referring to outliers-as-clarity for general assumptions in treatment.

And, because doctors are mortals who contend with 1,000 years of medical knowledge, “For every perfect medical experiment, there is a perfect human bias.”

Tests have “evolved,” but humans make the final decision.

Look again at the page count for this book. With merely 76 of them, you might assume that you could read this skinny TED book in an hour, tops, right?

Not so. The Laws of Medicine is easttnmedicalnews

.com

filled with ideas that practically command you to stop and consider before proceeding another page. It’s also going to make you re-think a lot of what you know about healthcare because, as brief as he is in word, author Siddhartha Mukherjee’s thoughts run deep. He uses anecdotal evidence (words that doctors hate to hear, incidentally) to illustrate his uncertainty about medicine as science, and though he never seems to come to a solid conclusion, readers will surely forgive him that due to what he presents.

The audience for this book, I think, is mainly professionals, but laypeople with the interest and patience to tease out its meaning will likewise get a lot out of it. And if that’s you, then The Laws of Medicine is quite arresting.

Cook County ICU: 30 Years of Unforgettable Patients and Odd Cases

by Cory Franklin, MD; c.2015, Academy Chicago; $16.95 / $19.95 Canada, 223 pages “What’s wrong with me?”

That’s a common question when your head hurts, your stomach loop-deloops, your tongue’s disorganized, and you present yourself at the hospital. You need to know what’s wrong so you can feel all right again, and your doctor may have the answer. But as you’ll see in the new book, Cook County ICU by Cory Franklin, MD, it might take some sleuthing.

As the son of an attending physician at Cook County Hospital in Chicago , Cory Franklin grew up with a comfortable familiarity for the facility. It was natural, then, that he would become a physician at that hospital’s ICU, once he became a doctor himself – but first, Franklin worked at and learned at other hospitals around the country, and he collected stories…

Every doctor, it seems, gets a share of unusual cases, and since becoming a doctor in the late 1970s, Franklin ’s no exception. He was on the ICU team when the “first reported case of iodine toxicity from topical absorption” was found. He once declared a patient dead, only to learn moments later that the ECG machine was broken. He keenly recalls the gang leader he cared for, and how the swaggering twenty-something man was really a little boy, down deep.

“Stories of life and death make for a constant source of drama,” Franklin says, and he has those, too: he writes of poisons ingested and suicides thwarted, Munchau-

sen’s Syndrome cases solved, and Kings, Princesses, and Dukes in Cook County.

Oh, and Elvis is very definitely dead.

Medicine is usually a serious thing to practice, though there’s humor in many situations. Franklin writes of hospital hijinks, pre-internet practical jokes, and things that make ER staff laugh. He once kept a very old secret for a very elderly war veteran, and he explains what happens when everyday items are found where they shouldn’t be.

And having cared for the famous and not-so-famous, Franklin says that “Some… names and their stories still resonate decades later.” He writes about his first AIDS patients, and a toothless laborer he’ll “never forget.” And he knows how ethics can be tested when a patient is a killer.

Why do we feel so not-ourselves when we go to a hospital? Why shouldn’t you schedule elective surgery in mid-November? Author Cory Franklin, MD, knows why – and his explanations are only a tiny

bit of what you’ll read inside Cook County ICU. Never stuffy and only just a little squirmy, Franklin takes readers on an interesting case-walk around one Chicago hospital, from the ssshhhhhhh of the automatic doors to the dimly-lit morgue, focusing on the ER and ICU. On this tour, we get a peek at some of the most notable patients and illnesses that Franklin and his colleagues have tackled, we see medical mystery-solving in action, and we get advice. I loved that.

For readers who enjoy true-medicine stories, this is one of those reward-yourself kinds of books filled with anecdotes you’ll eat up. It’s compelling, comic, and constantly addicting so, for you, missing Cook County ICU would be very wrong.

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.

Keep your finger on the pulse of East TN’s healthcare industry.

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GrandRounds Covenant Health Executives Honored At THA Annual Meeting KNOXVILLE—Two Covenant Health executives were honored for professional achievements at the Tennessee Hospital Association’s 77th annual meeting held in Nashville in October.

Jim VanderSteeg, Covenant Health executive vice president and chief operating officer, received a Senior-Level Healthcare Executive Regent’s Award from the American College of Healthcare Executives. The award recognizes ACHE members who Jim VanderSteeg are experienced in the field and have made significant contributions to the advancement of healthcare management excellence and the achievement of ACHE’s goals.

VanderSteeg also is a member of the Healthcare Advisory Board and the Institute for Healthcare Improvement and has been with Covenant Health since 2007.

Janice McKinley, Covenant Health chief nursing officer and senior vice president of quality, received the Executive Nurse of Distinction Award honoring excellence in patient care and nursing leadership during her career. The award included recogni- Janice McKinley tion for her dedication to nursing education and preparing nurses to meet the challenges of the future.

She is a member of the American Organization of Nurse Executives and a fellow in the American College of Healthcare Executives, and has received the ACHE Senior-Level Healthcare Executive Regent’s Award and Distinguished Service Award.

McKinley has received the Dr. Sylvia E. Hart Distinguished Alumni Award from the University of Tennessee College of Nursing. She serves as chairman of the College of Nursing’s advisory board.

Albea Joins TN Brain And Spine West KNOXVILLE—Jeffrey Albea, MD, board-certified neurosurgeon, has joined TN Brain and Spine West and the medical staff of Parkwest Medical Center.

His clinical expertise and interests include minimally invasive spine surgery, artificial disc replacement, Dr. Jeffrey Albea tumors of the brain and spine, and complex spinal conditions and procedures.

Albea has practiced at WNC Spine Surgery, Haywood Regional Medical Center, Clyde, North Carolina, and the NeuroMedical Center in Baton Rouge, Louisiana. He earned his medical degree at LSU Medical School in New Orleans. He completed his residency in neurological surgery at Vanderbilt University in Nashville.

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DECEMBER 2015

Albea is a member of the American Association of Neurological Surgeons, Congress of Neurological Surgeons, American Association of Neurological Surgeons – Tumor Section, American Medical Association, and the North American Spine Association.

Allred Joins Cumberland Neurology Group KNOXVILLE—Tom Allred, MD, a board-certified neurologist, has joined Cumberland Neurology Group in Oak Ridge and the medical staff of Methodist Medical Center. He specializes in general neurology, neuromuscular disorders and electrodiag- Dr. Tom Allred nostic testing.

He most recently was staff neurologist at Wenatchee Valley Medical Center in Wenatchee, Washington, where he was a general neurologist and sleep medicine specialist. From 2008 – 2012 he was a staff neurologist and then chief of neurology and sleep lab for the 10th Medical Group at the United States Air Force Academy in Colorado.

Allred received his medical degree from Medical College of Georgia School of Medicine in August. His internal medicine internship and neurology residency were at Walter Reed Army Medical Center National Capitol Consortium. He is a member of the American Academy of Neurology.

Goins Joins Internal Medicine West KNOXVILLE—Andrew Goins, DO, has joined Internal Medicine West. His clinical interests include preventive medicine, diabetes and geriatric care.

Goins received his medical degree from Lincoln Memorial University – DeBusk College of Dr. Andrew Goins Osteopathic Medicine in Harrogate, Tennessee. He completed his residency at the University of Tennessee College of Medicine in Chattanooga.

Goins is a member of the American Osteopathic Association, American Medical Association, Tennessee Osteopathic Medical Association, and American College of Physicians.

Lucas Joins Clinton Family Physicians KNOXVILLE—Brooke Lucas, DO, has joined Clinton Family Physicians and Covenant Health. Her clinical interests include preventive medicine and health and wellness.

Lucas received her medical degree from Lincoln Memorial University Dr. Brooke Lucas – DeBusk College of Osteopathic Medicine in Harrogate, Tennessee. She completed her residency at East Tennessee State University’s family

medicine program in Bristol.

Lucas is a member of the American Academy of Family Physicians and American Osteopathic Association.

Patel Joins Thompson Oncology Group KNOXVILLE—Jashmin Patel, M.D., hematologist/oncologist, has joined Thompson Oncology Group, Thompson Cancer Survival Center, and the medical staff of Fort Sanders Regional Medical Center. Board-certified in internal medicine, Dr. Dr. Jashmin Patel Patel’s clinical interests include colon cancers and other gastrointestinal malignancies, lung cancers, prostate cancers, breast cancers, lymphomas, leukemia, and multiple myeloma.

Patel received her medical degree from University of Tennessee Health Science Center in Memphis. She completed her residency at the University of Alabama, and received her fellowship training through University of Tennessee Health Science Center.

She has received Fellows recognition from the National Comprehensive Cancer Network, and has been extensively involved in research. Dr. Patel also has co-written multiple articles and abstracts related to various types of cancers. She is a member of the American Society of Clinical Oncology, the American Society of Hematology and the American Medical Association.

Troy Rachael Joins Family Clinic Of Oak Ridge KNOXVILLE—S. Troy Rachael, MD, has joined Family Clinic of Oak Ridge as a family medicine physician, caring for the overall health of patients of all ages. He has additional clinical expertise and interest in musculoskeletal issues, Type 2 diabetes, and depression/ Dr. S. Troy Rachael anxiety.

For the past three years Dr. Rachael served as a medical officer in the U.S. Navy for the 8th Marine Regiment at Camp Lejeune, North Carolina. His tour of duty included a six-month combat deployment to Afghanistan, where he helped provide primary care for a base of operations that included more than 2300 Marines, sailors, and Army personnel. He received the Navy and Marine Corps Achievement Medal for his service, mass casualty care, and supervision of 64 corpsmen.

Rachael received his medical degree from Quillen College of Medicine at East Tennessee State University. He completed his residency at Camp Lejeune, where he was named “Resident of the Year” for 2008-09. He received board certification from the American Board of Family Medicine in 2012.

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Become a fan on Facebook, and Follow us on Twitter@EastTNMedNews SOUTHCOMM BUSINESS MEDIA, INC. Chief Executive Officer Chris Ferrell Chief Financial Officer Ed Tearman Chief Operating Officer Blair Johnson Director Of Financial Planning And Analysis Carla Simon Vice President Of Human Resources Ed Wood Vice President of Content Patrick Rains Vice President Of Production Operations Curt Pordes Chief Revenue Officer Dave Carter Director Of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2015 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited.

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GrandRounds Trotter Joins Knoxville Heart Group KNOXVILLE—Christopher Chase Trotter, MD, interventional cardiologist, has joined Knoxville Heart Group and the medical staffs of several Covenant Health hospitals.

Board-certified in cardiology and internal medicine, Dr. Trotter most Dr. Christopher recently practiced with the Chase Trotter Central Texas Veterans Health Administration in Temple, Texas.

Trotter received his medical degree from St. Matthews University School of Medicine in the Grand Cayman Islands, British West Indies. His completed his residency at West Virginia University School of Medicine in Charleston, where he was chief resident in 2011. Dr. Trotter received fellowship training in cardiology and interventional cardiology at the Texas A&M University School of Medicine program at Scott & White in Temple.

Knoxville Heart Group has offices in Knoxville, Harrogate, Jefferson City, Morristown, Sevierville, Seymour, and Tazewell. Dr. Trotter will be on the medical staffs of Fort Sanders Regional Medical Center, Morristown-Hamblen Healthcare System, LeConte Medical Center and Claiborne Medical Center.

CHI Memorial Rees Skillern Cancer Institute Earns National Accreditation With Commendation From The Commission On Cancer Of The American College of Surgeons CHATTANOOGA–The Commission on Cancer (CoC) of the American College of Surgeons (ACoS) has granted threeyear accreditation with commendation to the cancer program at CHI Memorial. To earn voluntary CoC accreditation, a cancer program must meet or exceed 34 CoC quality care standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patient-centered care. Three-year accreditation with commendation is only awarded to a facility that exceeds standard requirements at the time of its triennial survey.

Because it is a CoC-accredited cancer center, CHI Memorial Rees Skillern Cancer Institute takes a multidisciplinary approach to treating cancer as a complex group of diseases. This requires consultation among surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists, and other cancer specialists.

This multidisciplinary partnership results in improved patient care.

The CoC Accreditation Program provides the framework for the CHI Memorial Rees Skillern Cancer Institute to improve its quality of patient care through various cancer-related programs that focus on the full spectrum of cancer care. Those programs include prevention, early diagnosis, cancer staging, optimal treatment,

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rehabilitation, life-long follow-up for recurrent disease and end-of-life care. When patients receive care at a CoC facility, they also have access to information on clinical trials and new treatments, genetic counseling, and patient centered services including psycho-social support, a patient navigation process, and a survivorship care plan that documents the care each patient receives and seeks to improve cancer survivors’ quality of life.

Like all CoC-accredited facilities, the CHI Memorial Rees Skillern Cancer Institute maintains a cancer registry and contributes data to the National Cancer Data Base (NCDB), a joint program of the CoC and American Cancer Society (ACS). This nationwide oncology outcomes database is the largest clinical disease registry in the world. Data on all types of cancer are tracked and analyzed through the NCDB and used to explore trends in cancer care.

CoC-accredited cancer centers, in turn, have access to information derived from this type of data analysis, which is used to create national, regional, and state benchmark reports. These reports help CoC facilities with their quality improvement efforts.

ACS estimates more than 1.6 million cases of cancer will be diagnosed in 2013. There are currently more than 1,500 CoC-accredited cancer programs in the U.S. and Puerto Rico, representing 30 percent of all hospitals. CoC-accredited facilities diagnose and/or treat more than 70 percent of all newly diagnosed cancer patients.

When cancer patients choose to seek care locally at a CoC-accredited cancer center, they gain access to comprehensive, state-of-the-art cancer care close to home. The CoC provides the public with information on the resources, services, and cancer treatment experience for each CoC-accredited cancer program through the CoC Hospital Locator at http://www. facs.org/cancerprogram/index.html.

Mountain States Hospitals Receive 22 Quality Awards From Healthgrades JOHNSON CITY—Three Mountain States Health Alliance hospitals – Johnson City Medical Center, Johnston Memorial Hospital and Indian Path Medical Center – have received national recognition from Healthgrades for their high-quality care in several key areas.

Healthgrades is a leading online resource to help consumers make informed decisions in order to find the right doctor, the right hospital, and the right care.

Every year, Healthgrades evaluates hospital performance at nearly 4,500 hospitals nationwide for 33 of the most common inpatient procedures and conditions. New findings and data were recently released on Healthgrades.com and in the Healthgrades 2016 Report to the Nation.

Johnson City (Tenn.) Medical Center was recognized for its cardiac, pulmonary and vascular care, while Indian Path in Kingsport, Tenn., was honored for its

high-quality cardiac, pulmonary, gastrointestinal and critical care. Johnston Memorial, located in Abingdon, Va., earned recognition in orthopedics for providing total knee replacements.

“Our primary focus is providing the best care possible in everything we do,” said Alan Levine, president and CEO of Mountain States. “The people in our hospitals and clinics are committed to providing high-quality care, and they work extremely hard at doing things right.

These folks aren’t working for national recognition, but for the good of their patients. Recognition like this is simply a confirmation that they are consistently providing care that’s among the best of the best in our industry.”

Here’s a list of the Healthgrades recognitions for each hospital: JOHNSON CITY MEDICAL CENTER Best specialty One of Healthgrades America’s 50 Best Hospitals for Vascular Surgery™ in 2016 Cardiac care Healthgrades Cardiac Surgery Excellence Award™ for 2 Years in a Row (20152016) Named Among the Top 10% in the Nation for Cardiac Surgery for 2 Years in a Row (2015-2016) Five-Star Recipient for Coronary Bypass Surgery for 2 Years in a Row (20152016) Pulmonary care Healthgrades Pulmonary Care Excellence Award™ for 5 Years in a Row (20122016) Named Among the Top 10% in the Nation for Overall Pulmonary Services for 5 Years in a Row (2012-2016) Five-Star Recipient for Treatment of Pneumonia for 6 Years in a Row (20112016) Vascular care Recipient of the Healthgrades 2016 Vascular Surgery Excellence Award™ Named Among the Top 5% in the Nation for Vascular Surgery in 2016 Five-Star Recipient for Repair of Abdominal Aorta in 2016 Five-Star Recipient for Carotid Surgery in 2016 Five-Star Recipient for Peripheral Vascular Bypass for 7 Years in a Row (20102016)

INDIAN PATH MEDICAL CENTER Cardiac care Five-Star Recipient for Treatment of Heart Failure for 6 Years in a Row (20112016) Pulmonary care Recipient of the Healthgrades Pulmonary Care Excellence Award™ for 2 Years in a Row (2015-2016) Named Among the Top 5% in the Nation for Overall Pulmonary Services for 2 Years in a Row (2015-2016) Five-Star Recipient for Treatment of Chronic Obstructive Pulmonary Disease for 2 Years in a Row (2015-2016)

Five-Star Recipient for Treatment of Pneumonia for 6 Years in a Row (20112016) Gastrointestinal Five-Star Recipient for Esophageal/ Stomach Surgeries in 2016 Five-Star Recipient for Treatment of GI Bleed in 2016 Critical care Five-Star Recipient for Treatment of Sepsis for 7 Years in a Row (2010-2016) Five-Star Recipient for Treatment of Respiratory Failure for 6 Years in a Row (2011-2016)

JOHNSTON MEMORIAL HOSPITAL Orthopedics Five-Star Recipient for Total Knee Replacement for 4 Years in a Row (2013-2016)

Governor Appoints Erlanger Physician To State Medical Examiner Board CHATTANOOGA – Melanie Blake, MD, MBA, has been appointed to Tennessee’s Board of Medical Examiners by Governor Bill Haslam. Dr. Blake, a physician with Erlanger’s Academic Internal Medicine and Associate Chief Medical Officer for Ambulatory Dr. Melanie Blake Care at Erlanger Health System, will serve on the board for five years.

The board, composed of nine physicians and three health care consumer members from across the state, was created in 1901 to protect the health, safety and welfare of people in Tennessee.

Each member attends bimonthly meetings in Nashville and helps ensureTennessee physicians maintain the highest standard of professional conduct and medical care as required by the state’s laws and regulations.

“As a member of the board, we approve licenses or certificates for physicians who have graduated from approved medical schools and successfully completed adequate training after graduation,” said Dr. Blake. “Licenses are also awarded to physician assistants, athletic trainers and x-ray operators in physician offices. Currently, there are nearly 22,000 licensed medical specialists in Tennessee.”

After graduating from the University of Alabama School of Medicine, Dr. Blake completed her residency at UAB Hospital and remained on faculty there before moving to Chattanooga, Tenn.

As an internal medicine physician and associate chief medical officer, Dr. Blake is involved in projects related to the coordination of patient care, quality and physician leadership.

“I feel very blessed to have this opportunity to serve on the governor’s Board of Medical Examiners and to work with representatives and physicians throughout Tennessee to provide safe and effective care for our patients.”

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