East Tennessee Medical News November 2015

FOCUS TOPICS SENIOR HEALTH ENVIRONMENTAL HEALTH/MEDICINE

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PHYSICIAN SPOTLIGHT PAGE 4

Dr. James Lacey TRI CITIES

PHYSICIAN SPOTLIGHT PAGE 9

Dr. Alexei Gonzalez ON ROUNDS

Enjoying East Tennessee Fantasy Of Trees Although decorations have been out in the stores for weeks, November usually marks the beginning of the Christmas season. Some hold tightly waiting for the first of December to decorate. Either way, November allows ideas to flourish, especially for the Christmas tree ... 5

Tennessee Health Care Hall of Fame Inducts Inaugural Members On Oct. 12, the Tennessee Health Care Hall of Fame inducted its inaugural class at a gala luncheon celebration at Belmont University’s Curb Event Center ... 6

ONLINE: EASTTN MEDICAL NEWS.COM

Get Educated About Nonemergency Medical Transportation

By DENNIS ROWE

An ambulance, while very visible as an emergency vehicle, also is used to transport patients to and from medical facilities and hospitals. Patients who require these scheduled services often have questions about the level of response needed and coverage of transport. Physicians can be a resource for patients by knowing the answers.

One of the most common questions is whether or not the transport will be covered by insurance or Medicare. That can be a complicated answer. Typically, insurance or Medicare covers all or part of medical ground transportation to hospitals or medical facilities if the transport is determined to be medically reasonable and necessary and the destination of the transport is the nearest facility that can appropriately treat the patient.

For nonemergency transports, medical necessity is critical to reimbursement for an ambulance transport and must be documented by a physician with a Physi(CONTINUED ON PAGE 8)

Priority Ambulance paramedics transport a senior to a medical facility for treatment during a scheduled nonemergency ambulance trip.

Outside Influences

Improving the Environment to Improve Health

By CINDy SANDERS

By mandate and practical necessity, healthcare professionals are lifelong learners.

Whether at the starting point of undergraduate or graduate education or further along in careers and looking to hone skills, a wide array of resources exist to help providers be better prepared to deliver effective, efficient care.

A number of national organizations are looking ahead to assess the way professional teams will need to interact within the delivery system of the future to dispense the highest quality of care, along with ways to help communities and patients take a more interactive role in managing their health.

AMA Expanding Med Ed Initiative

Less than two years after the American Medical Association (AMA) launched an (CONTINUED ON PAGE 8)

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East Tennessee Children’s Hospital Pediatric Gastroenterology, Hepatology & Nutrition Services

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HealthcareLeader

Bridging The Gaps

Front Line Experience Serves Erlanger’s Robert Brooks Well As COO

By JOHN SEWELL

The hospital business is serious business. Hospitals are in the business of saving, elongating, and elevating the quality of human lives.

Still, there is often a disconnect between the administrators who chart debits and credits, tally ledgers and manage personnel and the physicians, nurses, technicians and staff who tirelessly walk the hospital’s labyrinthine halls, and serve the patients. In other words, the administrators are the somewhat disengaged, budget balancing number-crunchers, while the healthcare providers deal with the very real, very personal, very human health crises of the patients—and never the twain shall meet.

Erlanger Health System’s Executive Vice President and Chief Operating Officer Robert Brooks is bridging these gaps.

The recent recipient of Modern Healthcare magazine’s Up-And-Comers award began his healthcare career decades ago—working on the front lines, as it were.

“I actually started out doing patient care as a paramedic and a registered nurse,” said Brooks. “I have a Bachelor’s

degree in nursing. I worked as a critical care and emergency room trauma nurse for a while. And then I flew as a flight nurse for an air medical program in Pittsburg called STAT Medivac for around five years. Then I started to do some business development for UPMC, the University of Pittsburg Medical Center. And I began to really get involved in the business side of healthcare versus patient care. So I

went back to college and got an MBA and started working in administration, which I’ve been doing for about 15 years now.”

Brooks’ background on the front lines of medicine has served him well. Having the experience of ascending through the ranks of the healthcare world from a trauma nurse to the top tier administration of a cutting-edge hospital system enables Brooks’ “big picture” understanding of the healthcare environment—not only from a business perspective, but from the perspective of a healthcare provider and patient.

As COO for Erlanger, Brooks has around 5,300 employees under his purview. Clearly, this is a challenging and burdensome task. Still, the ever optimistic and forward-thinking Brooks finds inspiration in his job.

“We have a lot of projects going on,” enthused Brooks. “The biggest thing is we’re doing a $15 million expansion at our East Hospital in East Brainerd. We’re adding 68 beds to that facility as well as operating rooms and a cardiac cath lab.

So we really have a full-service hospital in the East Chattanooga market.”

Brooks explained that the Chatta-

nooga Healthcare market is deceptively large, hence the expansion. The Brainerd facility will provide easier access to top quality healthcare for a somewhat underserved Chattanooga area population.

“When you look at Hamilton County, most of the population growth is happening in the eastern part of the county,” said Brooks. “And there’s no hospital out there. All three of the Chattanooga hospitals are downtown. Brainerd is only about 10 miles away from downtown. But if traffic is bad, it can take as long as 40 minutes to get downtown. So having those healthcare facilities right there in the community brings the care right where people are choosing to live.

“Erlanger is unique in that we’re the only area provider of several very high level tertiary care services: we’re the only level one adult trauma center, we’re the only children’s hospital, we’re the only pediatric level one trauma center, and we have the only comprehensive stroke center,” Brooks continued. “We cover a large area—not only Hamilton County, but actually 15 other counties. So all of the tertiary care services in the Chattanooga (CONTINUED ON PAGE 10)

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LegalMatters

BY IAN P. HENNESSEY, LONDON & AMBURN, P.C.

Cybersecurity And Patient Privacy

Available Umbrellas For Falling Skies (Part III of III) The following article is the third in a three-part series, which will educate you about emerging issues in cybersecurity and recommend ways to protect your practice.

By now, you have likely read about the potential legal consequences to your practice posed by cybersecurity threats in Part I and Part II of this series.

These risks can lead to massive government fines and even lawsuits by the affected patients. In response to these growing risk factors, insurance companies recently began to offer certain coverage for cybersecurity liability. For more information about these policies, we reached out to several insurance industry insiders who are active in providing coverage to physicians and physician groups in East Tennessee.

What Is Typically Covered Under A Cybersecurity Insurance Policy?

According to those we contacted, cyber-liability insurance is designed to cover damages and liability associated

with cyber events, damage associated with intangible electronic information or computer software, and data breaches. A typical cybersecurity policy might include coverage for privacy breach response, privacy regulatory defense and penalties, network assets, multimedia, and cyber-extortion/cyber-terrorism.

Coverage for privacy breach response commonly covers an insured’s reasonable expenses necessary to respond to a privacy breach, including reasonable legal, credit monitoring and postage expenses incurred. Privacy regulatory defense coverage typically includes legal defense costs as well as coverage for regulatory fines and penalties up to certain limits. Network asset coverage usually applies to reasonable and necessary expenses required to recover and replace data that is compromised, damaged, lost, or corrupted due to accidental damage or operational mistakes. Multimedia coverage, on the other hand, applies to third-party claims alleging copyright or trademark infringement, defamation,

advertising, plagiarism, and other injuries, both in online and offline media.

Finally, cyber-extortion/cyber-terrorism coverage relates to extortion monies as a direct threat of cyber-extortion threat and loss of business income and interruption expenses as a result of a cyber-terrorism attack.

What Types of Activities Are Not Typically Covered?

While typical cyber liability policies are quite broad in nature, there are several exclusions. Such exclusions often include intentional, fraudulent, or malicious acts, willful violations of the law, loss of future revenue, and reputational damage. Those we contacted agreed that every policy is different and careful attention to policy exclusions is advisable.

Why Is It Important For Providers To Obtain This Coverage?

Those we spoke with agreed: everyone in healthcare is at risk simply

because of the kind of information being handled daily, which includes personal financial information and personal health information, as well as the way this information is delivered.

Therefore, they agreed, any practice entity that handles, collects, or stores confidential information and relies upon technology to any extent for the operation of its business should have cybersecurity insurance. “It’s no longer ‘if’ but ‘when,’” was a common refrain among those we contacted. Any type of breach, whether accidental or intentional, may lead to an expensive response. Such events can lead not only to public embarrassment, but also to financial ruin for an unprepared or under-insured small to mid-size or even large practice.

How Did Cybersecurity Insurance Policies Come About?

In many cases, some basic cybersecurity coverage was included as an (CONTINUED ON PAGE 8)

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Knoxville/Chattanooga

PhysicianSpotlight

From Bedside To Boardroom

UTMC’s First-Ever CMO Creates Hybrid Position To Serve Patients And Doctors

By JOE MORRIS

As a rule, doctors are not easily fooled. And if they are, it usually doesn’t last long before the truth comes out. But when Dr. James Lacey’s staff got him to attend a recent meeting of the Tennessee Hospital Association (THA), what happened next was very much unexpected.

“They lied to me to get me to go,” said Lacey, who is senior vice president and chief medical officer at the University of Tennessee Medical Center (UTMC), of the meeting where he was honored for his lifetime of healthcare work. “It came as a complete surprise. I’m certainly honored, but as I said then, I don’t want to take credit for doing something wonderful all by myself; we work as a team here, and so I accepted on behalf of all the fantastic people that I work with, and our leadership team at the medical center.”

In fact, once he starts talking about the UT team, it’s hard to get him back to his own career.

“I’ve never asked for help with a patient and not gotten it,” he said. “Everyone here really steps up. I work in a great

medical community where there are lots of good hearts, and highly skilled people who are willing to use their God-given blessings and talents to help others.”

He certainly can speak with familiarity about the university. He holds an undergraduate degree in nuclear engineering, and earned his medical degree from the University of Tennessee College

of Medicine. He is a practicing general internist, and as the UTMC’s first chief medical officer, has created a hybrid positon that allows him to still see patients.

“The deal I have with our CEO and our senior management team is that if a patient need comes up, I may have to skip a meeting we have,” Lacey said. “Patients always take priority for us, and for me. I’m very blessed in that they have supported me in that.”

He wanted to keep his practice going for many reasons, he adds.

“There were a lot of practical reasons, the first one being that I wanted to have a good working relationship with all our physicians,” he explained. “As CMO, the big focus of my work is supporting our doctors; that’s the reason I’m here. I also need to be able to understand the work they are doing, and the challenges they are experiencing, so I need to be out there.

I don’t know a better way of doing that than continuing to practice myself. If I’m going to understand how our system can be improved, then I need to be working within it so I can get the feedback from staff, doctors and my own patients. It gives

me insights I wouldn’t have, otherwise.”

Lacey, who plans to retire in 2016, is quick to point out that this arrangement may not be suitable for his successor.

“The job evolved as I wanted it to, since I am the first CMO,” he said. “But the next one may not wish to practice medicine, and I think as the job continues to grow its demands will be such that doing so may not be practical.”

But for him, that hands-on approach defines not just his work at UTMC, but the work he’s done in the larger community. He helped create the Knoxville Area Project Access, where he has served as medical director since its 2006 founding. To date, the program has provided more than $65 million in free healthcare to uninsured Knoxville-area residents. He also has served on the Governor’s Task Force on Health and Wellness, which is focused on improving Tennessee’s health rankings. And he also has served as cochairman of the East Tennessee Quality Alliance, where he has overseen the training of Rapid Response Teams for every Knoxville-area hospital; develop(CONTINUED ON PAGE 10)

Food Allergy Facts

BY YOUHANNA AL-TAWIL, M.D.

Food allergy is an immune reaction to food. It affects an estimated 6 to 8 percent of children and approximately 4 percent of adults. There has been a significant increase in the prevalence of allergic disorder in the past two decades. This could be related to a complex gene-environment interaction.

It is easy to confuse food allergy with food intolerance; both are hypersensitivities to food and can cause similar symptoms. Food intolerance however, is less serious, and is not an immune response. It is usually related to lactose intolerance, monosodium glutamate, which is used to enhance food flavor, contamination with microbes or toxins, or the pharmacologic activity of food.

We are gaining increasing understanding of the pathophysiology of food allergic disorder. There is well-recognized acute allergic reactions and anaphylaxis triggered by lgE antibody0mediated response to food protein, and increasing recognition of cell-mediated disorder such as eosinophilic gastroenteropathies and food-induced enterocolitis.

Food antigens may provide respiratory, skin, or gastrointestinal symptoms. Behavior manifestations (ADD, ADHD, autistic behavior, etc.) have been described, but are controversial. GI manifestations include nausea, vomiting, GER, eosinophilic esophagitis, abdominal pain, diarrhea, constipation, and GI bleeding.

In children, approximately 90 percent of all allergic reactions to food are caused by 8 primary foods including: mild, eggs, peanuts, tree nuts, fish, soy, wheat and shellfish.

Diagnosis Diagnostic workup begins with a detailed history and physical examination. Food allergy is suspected when the above-mentioned symptoms occur with introduction to specific food. Food intolerance of non-allergic mechanisms should be ruled out first.

Elimination diets are the gold standard for diagnosis of food allergy. Suspected foods should be avoided for a minimum of two to four weeks.

Skin prick test or radioallergosorbent test (RAST) can be useful in determining an IgE allergic reaction in the case of food allergy. Limitations of these tests include: high sensitivity (generally >90%) but only moderately specific (-50%). These tests are most useful when the index of suspicion is high based on a detailed history.

Treatment The only proven effective treatment for a food allergy is an elimination diet. It might take a few days to several weeks before most gastrointestinal manifestations resolve. A child with severe and life-threatening IgE-mediated reactions needs injectable epinephrine and an antihistamine.

At least 30 percent of infants with cow’s mild allergy also have allergy to soy protein.

Generally, these infants improve with protein hydrolysate formula. When cow’s milk is reintroduced, it should be offered in small amounts (one teaspoon or less), then progressively increased amounts over several days as tolerated.

Eighty-five percent of infants with non-IgE-mediated food allergy recover by three years of age. While symptoms from IgE-mediated allergy to peanuts, tree nuts, and fish might not resolve, thus allergy referral is indicated.

Allergy and intolerance to a variety of foods are common problems in childhood and can present with a wide range of clinical manifestations. Diagnosis can be a challenge, and presently elimination diet is the only good treatment. Future management of food allergies requires better testing and new, novel therapies. Until then, cooperative management of the child’s food allergies between his/her pediatrician or primary care physician, allergist, dietician, and GI physician can help the child live a healthy and happy life.

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Enjoying East Tennessee Fantasy Of Trees By: LEIGH ANNE W. HOOVER

Although decorations have been out in the stores for weeks, November usually marks the beginning of the Christmas season.

Some hold tightly waiting for the first of December to decorate.

Either way, November allows ideas to flourish, especially for the Christmas tree.

Growing up, the Christmas tree was never up before Thanksgiving. However, it was always decorated before my December 10th birthday. Ornaments were usually favors for my birthday parties, and one was always saved for our tree. Over the years, we had the traditional tree with multi-colored lights and even the popular aluminum tree with all red ornaments in the 1960s as a second tree.

When our, now adult, children were born, my mother gave them their own miniature artificial tree for their rooms. Our daughter loved teddy bears, and her tree has a bear theme. Her brother’s is decorated with Santa ornaments. Both are sweet reminders of their late grandmother.

My sister-in-law started their Hallmark ornament collections.

Our daughter had a Barbie ornament tree, and her brother’s was a tree of sports standouts and Batman figurines.

Today, our family tree is decorated with all white lights and traditional ornaments, but you will still find special ornaments, including Batman and the Little Mermaid, somewhere on its branches.

Whether you are decorating a tree for your own home or awaiting the lighting of the Rockefeller Center Christmas Tree in New York City, everything you ever imagined in a Christmas tree can be glimpsed and enjoyed at the 31st annual Fantasy of Trees benefiting the East Tennessee Children’s Hospital in Knoxville.

For five days, Nov. 25th-29th, 2015, the Knoxville Convention Center will be transformed into a Christmas wonderland celebrating this year’s theme, “An East Tennessee Christmas,” and there will be something for the entire family to enjoy.

Last year, Fantasy of Trees raised more than $340 thousand, which was a record. Annual purchases for Children’s Hospital are based on dollars raised.

In 2014, children in East Tennessee, and surrounding states, made more than 142,000 visits to the Children’s Hospital.

More than 66,000 of those visits were to the Emergency Department.

“Proceeds from this year’s Fantasy of Trees will be used to update existing equipment and purchase new equipment for our Emergency Department, includeasttnmedicalnews

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ing new patient monitors and a centralized monitoring station,” explained Erica Estep, East Tennessee Children’s Hospital public relations manager. “The new technology will help clinical staff monitor patients more closely by displaying vital signs in the nurses’ station.”

Another equipment item, Kidspace Game System, is also high on the list.

Although video equipment may seem unusual for emergencies, Estep has a personal connection.

“Children’s Hospital experts understand that healing requires more than medicine alone. That’s why the hospital will also purchase a new Kidspace Game System to make a child’s stay in the hospital more comfortable,” said Estep.

Following a soccer ball blow to the face, which embedded braces in her 12-year-old son’s lip, Estep found herself in the emergency facility of Children’s Hospital with her own family member.

“They brought an iPad into the room,” said Estep. “While the nurse practitioner was numbing his lip, he and a child life specialist played a video game

as a distraction. After he was numb, and they had already removed his lip from his braces, my son asked me when they were going to do it.”

Estep did not disclose to the attending physician or nurses her role with the hospital until the end, and what she observed was expert care with compassionate attention to detail in action.

“At Children’s Hospital, we think about everything—the whole child.

When we think about healing them, it’s not just medicine because we know kids are different, and they need to be treated differently. They’re not little adults, so the fact they’re buying a game system really hit home with me.”

Fantasy of Tress was established in 1984, and the first show was three days in 1985 with live trees. This proved somewhat messy and difficult to manage.

Today, artificial trees are purchased by Children’s Hospital in varying sizes and designers donate the decorating. An architect creates the floor design for tree and decoration placement Visitors can purchase the lighted and decorated trees for their homes or businesses, and they can either be picked up or delivered following the event. According to Estep, all ornaments are secured and wired into place, and no tree goes unused.

“We deliver it straight to your door…,” said Estep. “We have a bag that we literally lift up, cover the tree, tie it at the top, put it on a truck, deliver it to your door, unbag it, plug it in to make sure it works, and fluff it. It’s a fully decorated Christmas tree in your home. Trees that do not sell are donated to organizations in the community.”

Throughout the Knoxville Conven-

tion Center, visitors of the Fantasy of Trees will also be able to purchase unique gift items. There is even a secret Santa shop, where children can visit with an allotted amount of money and be supervised to make their gift purchases for relatives.

There are 18 popular craft events and activities for children, including a carousel ride.

One activity is a special clinic where a child can purchase a teddy bear and get first aid supplies for his or ger bear based on how the child says it feels. It’s also an opportunity to share safety tips, such as wearing a bike helmet.

Another popular activity is the keepsake thumbprint wooden ornament, and this has been part of Fantasy of Trees since its beginning.

“A group of volunteers cut out these wood ornaments… It’s a different shape each year, and they paint it just a little around the edges,” explained Estep. “This year it’s a Santa head… They have the children put ink on their thumb, and they put a thumbprint and date on it.

Estep says parents who did this as a child are now bringing their own children to continue the thumbprint ornament tradition for their trees.

The event has remained successful through the hard work of volunteers and the selfless contributions of donors. Many, many volunteers are involved in making the Fantasy of Trees come to life. From planning and preparation, to working throughout the week, their efforts are truly appreciated.

In keeping with this year’s theme, the focal point of the event will also feature a life-size Three Bears Cabin with elements of the Smoky Mountains included. There will also be a gingerbread village, and scheduled holiday musical entertainment throughout the week will enhance your holiday sensory experience.

For her, Estep says a favorite part of the event is recapturing the magic of Christmas seen and enjoyed by the children.

“It’s a holiday tradition,” said Estep.

“It’s the kickoff to the holiday season for families.”

For additional information about Fantasy of Trees, visit http://www.fantasyoftrees.org/ 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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Tennessee Health Care Hall of Fame Inducts Inaugural Members On Oct. 12, the Tennessee Health Care Hall of Fame inducted its inaugural class at a gala luncheon celebration at Belmont University’s Curb Event Center.

Hosted by Susan Dentzer, senior policy adviser for the Robert Wood Johnson Foundation, the event paid homage to eight pioneers who have shaped the health and healthcare industry of Tennessee and the nation.

The Tennessee Health Care Hall of Fame was created by Belmont University and Belmont’s McWhorter Society with the support of the Nashville Health Care Council, a founding partner. Grand sponsors for the 2015 event were Community Health Systems and Hospital Corporation of America. Other sponsors included Acadia Healthcare, BlueCross BlueShield of Tennessee, FirstBank, JourneyPure, MedCare Investment Funds, Meharry Medical College, AmSurg, Foundations Recovery Network, LifePoint Health, Medical News, NashvillePost, and PYA. For more information, go online to tnhealthcarehall.com.

Thomas F. Frist Sr., MD

Committed Physician, Savvy Businessman

A native of Meridian, Miss., Thomas Frist, Sr. attended the University of Mississippi, where he started a transportation company that eventually employed 17 other students, the first evidence of his entrepreneurial spirit. But Frist’s passion lay in caring for people, shaped from his early experiences working as an orderly at Meridian’s local hospital. Frist studied medicine at Vanderbilt University School of Medicine and completed his residency at the University of Iowa.

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ity care, the bottom line would take care of itself. That emphasis on patient care permeated every decision he made while leading HCA and remains a centerpiece of the company’s culture today.

Thomas F. Frist Jr., MD Physician, Philanthropist, Entrepreneur

In 1935, he opened a medical practice in Nashville. During World War II, Frist served in the U.S. Army Medical Corps as the chief of medical services for a 1,000-bed hospital. Discharged as a major at the war’s end, he returned to his Nashville medical practice. In 1957, he was appointed to the American Medical Association Committee on Aging and subsequently established the Tennessee Commission on Aging.

During this time, Frist envisioned creating a hospital where patients came first and where funding was not dependent upon government sources. This dream led him to set up Park View Hospital with several other medical professionals and businessmen. The success of Park View served as the seed of inspiration for Frist, his son Thomas Frist Jr., MD, and friend Jack C. Massey to form Hospital Corp. of America in 1968. Frist served as chief medical officer and chairman of the board for HCA. One of his most important contributions to HCA was its patient-first culture.

Frist, who is the namesake for the HCA Frist Humanitarian Award, believed that if the company focused on giving qual-

A Nashville native, Thomas “Tommy” Frist, Jr., MD is a graduate of Nashville’s Montgomery Bell Academy and Vanderbilt University. An entrepreneur at heart, Frist created a collegiate advertising company and earned his pilot license while at Vanderbilt University. In 1965, he graduated from the Washington University School of Medicine in St. Louis and then returned to Vanderbilt University for his surgical residency.

His residency was interrupted by a two-year term as a flight surgeon at Robins Air Force Base in Georgia during the Vietnam War. While in the military, Frist had an idea for a company that would bring hospitals together to share resources. In 1968, Frist, along with his father and Jack C. Massey, formed Hospital Corp. of America. As one of the nation’s first investor-owned hospital companies, HCA modernized the way healthcare was delivered in the United States.

Frist served HCA in various leadership roles including as president, CEO and chairman. He remained on the board of directors of HCA until 2009 and currently serves as chairman emeritus.

Philanthropy has always been central to Frist’s life. His board activities have included The Frist Center, Harvard Business School Board of Dean’s Advisors,

Montgomery Bell Academy, the Nashville Health Care Council, Vanderbilt University and both the national and local United Way. Frist also has been the recipient of a number of awards, including the United Way’s “Lifetime Achievement Award” and the Nashville Business Journal’s “Best in Business Lifetime Achievement Award.”

He is quick to credit his success to his wife, Patricia (Trish), for her support and encouragement throughout the years.

Frist credits his wife with keeping him grounded on their first priority — their three children — while building HCA into the company it is today.

Ernest Goodpasture, MD

Pathologist, Passionate Educator, Public Servant

Born in 1886 near Clarksville, Ernest Goodpasture was a 1907 graduate of Vanderbilt University. After obtaining his undergraduate degree, Goodpasture attended Johns Hopkins Medical School and served as a faculty member at Johns Hopkins and Harvard Medical Schools.

In 1924, he was invited to join the new Vanderbilt School of Medicine as the Department of Pathology’s first chairman.

Returning to his home state, he spent the majority of his career in Tennessee at Vanderbilt before taking the position of scientific director of the Armed Forces Institute of Pathology in 1955.

While at Vanderbilt, Goodpasture served as associate dean and dean of the medical school, but his passions were research and teaching. His scientific accomplishments led to his recognition as one (CONTINUED ON PAGE 7)

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of the world’s foremost pathologists. His interest in infectious agents and viruses led to the development of the chick embryo technique used for the cultivation and study of a number of viruses. This work provided the foundation for the successful development and improvement of vaccines against yellow fever, typhus and influenza, saving thousands of lives.

In recognition of his scientific work, Goodpasture received honorary degrees from Yale University, the University of Chicago and Washington University. He was elected as a member of the National Academy of Sciences and the American Philosophical Society, among others.

Goodpasture was awarded the Association of American Physicians’ Kober Award, the American Public Health Association’s Sedgwick Medal, the Association of Pathologists’ Gold Headed Cane, and was nominated for the Nobel Prize in Physiology and Medicine.

Jack C. Massey Pharmacist, Philanthropist, Investor

Georgia native and University of Florida alumnus, Jack Massey began his career as a pharmacist and small business owner. Relocating to Tennessee, he built a long career steeped in healthcare, business and investment.

After selling his chain of six drug stores, the entrepreneur founded Massey Surgical Supply Co. in the 1930s and supplied area hospitals and doctors with medical equipment. In the 1940s, Nashville’s Protestant Hospital was experiencing significant financial challenges that would likely lead to the facility’s closure. Understanding the importance of the hospital to the area, Massey and the Rev. James Sullivan presented a plan to save the hospital to the Tennessee Baptist Convention. In 1948, the hospital was renamed Mid-State Baptist Hospital, and Massey served as a trustee for two decades, 12 as chair.

During his successful career, Massey also entered the food industry as owner of Kentucky Fried Chicken and later at the helm of Winner’s Corporation, one of the largest franchisees of Wendy’s restaurants.

In 1968, Massey and the Frists co-founded HCA, an organization that would become the country’s largest for-profit owner and operator of hospitals.

Passionate about his work and contributions to society, Massey’s career was built on the belief that operations, convenience and service can always be improved. Throughout his career, he was quick to comment on the joy he found from learning and accomplishing those improvements. “Lots of people have more than I do, but not many have as much fun. The fun is in the accomplishing,” he stated.

His desire to share his ideals and perspective with future generations led to his deep commitment to Belmont University, which included helping to build a nationally recognized business school, now known as the Jack C. Massey College of Business. easttnmedicalnews

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R. Clayton McWhorter

Clinician, Businessman, Mentor

Creating a career as both a healthcare clinician and businessman, Clayton McWhorter began making an impact on the healthcare industry as a pharmacist after graduating from Samford University.

Recognizing he could expand services to patients by moving into the business side of healthcare, McWhorter became a hospital administrator, honing his leadership and management skills. Working his way through the ranks at HCA, McWhorter became president and chief operating officer of the hospital giant. He then participated in the formation of HealthTrust Inc., where he served as chairman, president and CEO until the company merged with Columbia/HCA in 1995.

McWhorter served on the Columbia/ HCA board until May 2000, including a stint as chairman.

In 1996, McWhorter founded Clayton Associates, a firm created to invest in and advise entrepreneurs within the healthcare industry. In 2008, he founded PharmMD, served as chairman, and currently serves on its board. He also is a member the Harpeth Capital Advisory Board.

Committed to philanthropy and his community, McWhorter and his family have greatly contributed to education in Nashville and beyond through the creation of the McWhorter School of Pharmacy at Samford and Belmont’s McWhorter Hall and McWhorter Society. Throughout his career, McWhorter has also been involved with a number of community organizations including, the American Cancer Society, the YWCA, and the Middle Tennessee Council of the Boy Scouts of America, among others. McWhorter is the recipient of many awards in recognition of his community service, including the United Way’s Tocqueville Award and the Joe Kraft Humanitarian Award.

McWhorter has mentored countless leaders throughout his career and continues to offer his four guiding principles to all mentees: “Be prepared. Find a mentor and be a mentor. Act like an owner. Give back.”

David Satcher, MD, PhD Advocate, Public Servant, Lifelong Educator

Known as a dedicated physician-scientist, David Satcher, MD, PhD, has devoted his career to advocating for the health and safety of all Americans by tackling issues not previously addressed nationally – including obesity, health disparities among minority populations, and mental illness.

Satcher earned both his medical degree and doctorate from Case West-

ern Reserve University. In 1982, he was named president and CEO for Meharry Medical College, where he oversaw the merger of Hubbard Hospital and Metro Nashville Hospital, changing the provision of healthcare for Nashville’s underserved populations. During his tenure at Meharry, he also led the plan for academic renewal, which included a national fundraising campaign and the rebuilding of faculty.

Satcher would then go on to serve at a national level. He has held the positions of director of the Centers for Disease Control and Prevention, the 16th Surgeon General of the United States, and the 10th Assistant Secretary for Health in the Department of Health and Human Services. He currently serves as director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

Throughout, Satcher has received a number of top awards, including the Ronald Davis Special Recognition Award from the American College of Preventative Medicine, the Jimmy and Rosalynn Carter Award for Humanitarian Contributions to the Health of Humankind from the National Foundation of Infectious Diseases, and the designations of Nashvillian and Tennessean of the Year. Satcher has also received more than 50 honorary degrees from universities and colleges and has written a clinical guide on multicultural medicine.

Committed to making public health work for all people, Satcher believes in the power of strong leadership. He noted, “Ethical leaders are needed who will take on the problems of poverty, racism and lack of access to healthcare.”

Mildred Stahlman, MD Pioneer, Scholar, Educator

The mother of modern neonatology, Mildred Stahlman, MD, is a native Tennessean and longtime Vanderbilt student, educator, researcher and physician.

Graduating from Ward-Belmont College for Women, she matriculated to Vanderbilt University in 1943 and graduated with honors from the Vanderbilt School of Medicine in 1946 as one of only four women in a class of 50. She completed internships in Cleveland and Boston, a residency year in Chicago, and a research fellowship in Sweden.

Returning home to Tennessee, Stahlman then embarked on a 60-plus year career at Vanderbilt. Throughout her work as an instructor, professor and practitioner of pediatrics and neonatology, Stahlman had more than 150 peer-reviewed publications and assisted in the training of more than 80 post-doctoral fellows from approximately 20 countries. More than just a mentor, Stahlman welcomed the fellows to her log cabin and farm for holidays where they rode horses, swam in the creek and became part of her extended family.

During her career, Stahlman revo-

lutionized the care of high-risk newborns by creating the world’s first modern neonatal intensive care unit in 1961. She also promoted what was at the time a novel concept of regionalized neonatal critical care and helped establish the first Angel Transport Mobile Intensive Care Unit.

Her tireless work on behalf of children and the profession was recognized in 1987 by the American Academy of Pediatrics with the Virginia Apgar Award and in 1996 by the American Pediatric Society’s John Howland Award. She was also named the Vanderbilt Medical Alumni Association’s Distinguished Alumna in 2002 and the University’s Distinguished Alumna in 2004. A newsletter from the institution quoted Stahlman saying, “Medicine is more than a profession — it is my calling.”

Danny Thomas

Entertainer, Humanitarian, Child Advocate

A radio, film and television entertainer and producer, Danny Thomas was born in Michigan in 1912 to Lebanese immigrants.

Before he became a star, Thomas was a struggling actor who needed money to pay for the delivery of his newborn daughter, Marlo. Placing his last $7 in the collection box at church, he quickly realized what he’d done and prayed for a way to pay the looming hospital bills. The next day, he won a small part that paid 10 times what he had just donated.

While still trying to take his career to the next level, Thomas again found himself at church praying for guidance.

He made a vow to St. Jude, the patron saint of hopeless causes, saying, “Give me a sign that I am going in the right direction, and someday I’ll build a shrine in your name.”

As Thomas’ career took off, he remembered his promise. He began raising money for his vision and joined with local business leaders in Memphis to create a groundbreaking research and treatment hospital devoted to curing catastrophic diseases in children. Opening in 1962, St. Jude has treated children from all 50 states and all over the world and continues to lead the charge in finding ways to defeat childhood cancer and other life-threatening diseases.

To this day, the hospital stands by Thomas’ founding promises that no family pays St. Jude for treatment, travel, housing or food and that St. Jude freely shares its discoveries to impact the lives of children across the world.

Throughout his life, Thomas was recognized with many awards, including receiving a Knight Commander of the Order of the Holy Sepulchre by Pope Paul VI, the Congressional Gold Medal, induction in the Television Hall of Fame and a posthumous receipt of the Bob Hope Humanitarian Award.

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Get Educated About Nonemergency Medical Transportation, continued from page 1 cian’s Certification Statement. Medical necessity means that the ambulance transport could not have been accomplished by other means, such as a wheelchair van, without endangering patient health. This rule applies whether or not the other means of transportation is actually available. Some insurance providers and Medicare plans require that medical necessity is documented by a physician before the transport occurs, so it’s best to check with the individual plan before scheduling transport, if possible.

To definitively determine if transportation will be covered, patients should directly contact Medicare or their insurance company with specific details of the procedure prior to transport. Medicare provides extensive information about requirements and coverage on its website at www.medicare.gov.

Coverage of ambulance transport by private insurance plans varies widely with each individual carrier. Some insurance providers require that the ambulance service be in-network. A separate pre-certification process also can be a requirement for both private insurance and Medicare advantage plans. There could be a deductible and/or co-pay for the patient. The best course of action is for the patient to check with the insurance provider before scheduling nonemergency medical transport.

Another factor to be determined is what level of transport a patient needs.

Medical transport varies based on the patient’s condition and the equipment needed to safely transport that patient. The levels of care, staffing and medical equipment affect the cost of the transport, so it’s important to ensure that patients have the appropriate level of care to meet their medical needs.

The first level of ambulance transport is basic life support (BLS), which includes a minimum of two state-licensed emergency medical technicians (EMTs) and an automatic external defibrillator on the ambulance. This is appropriate when the patient requires medical monitoring, oxygen administration or oral suctioning.

An advanced life support (ALS) ambulance is equipped for more extensive medical monitoring, including EKG monitoring, advance airway management or medical administration. These ambulances have at least one paramedic on a two-member team.

Critical care ambulances are the highest level of medical transport and act as a mobile intensive care unit. These ambulances often are used for transportation between hospitals and medical facilities for specialized treatment or procedures. The ambulances are staffed with paramedics trained in critical care and capable of administering

medication via pump or ventilator.

Patients also may require a bariatric ambulance, which is equipped with wider stretchers and ramps to hold patients more than 300 pounds.

Identifying the correct level of ambulance service is more cost-efficient for the patient and allows the proper reimbursement claims to be submitted to Medicare or private insurance.

Another crucial choice is the ambulance service itself. When you call 911, the officially contracted ambulance service for that city or county automatically is dispatched. However, with pre-scheduled nonemergency transport, you have options for which company to use – and they are not all the same.

Medical transport operators must be qualified and have documentation for Medicare transportation. The provider must follow all state and local laws regarding emergency medical services licensing and certification and vehicles must be staffed and equipped to respond to medical emergencies. Selecting a reputable ambulance service licensed by the state of Tennessee, such as Priority Ambulance, will ensure that this requirement is fulfilled. State licensure certifies that all vehicles have been regularly inspected and that all personnel are licensed medical professionals.

When all baseline criteria are met, customer service and comfort also vary between companies. Priority Ambulance, which provides service to Knox, Loudon and Blount counties, sets itself apart by offering state-of-the-art Mercedes-Benz ambulances. The ambulances are the best available on the market with stabilizers to reduce motion in the back of the vehicle for nonemergency transport. The company also uses top-quality, hypoallergenic blankets and pillows, instead of paper coverings.

The top priorities are getting patients safely to their destination and treating them compassionately during the transport. At Priority Ambulance, the patient comes first and that means providing the highest-quality of medical care from EMTs and paramedics, as well as providing a comfortable experience during the trip.

When a patient needs nonemergency medical transport, there are options and factors to consider before choosing a service and scheduling transport. Patients and their families should contact their insurance provider or Medicare to determine if transport will be covered, obtain physician documentation of medical necessity, research levels of ambulance service and select a licensed ambulance provider. Knowing the right questions to ask is critical to getting the care needed at the lowest possible cost.

country and look forward to growing the community of innovation that we’ve created with new ideas and fresh perspectives from additional medical schools.”

egies.

A conference roundup will be posted after the event, and past educational conference summaries are available online through the Education Center tab at hcea-info.org. In addition, the website’s Resources tab includes links to publications, educational tools, and the organization’s Learning Center Network.

Outside Influences, continued from page 1 initiative to reshape medical education in America, the national organization has announced funding for up to 20 additional medical schools to join the AMA’s Accelerating Change in the Medical Education Consortium.

The consortium was originally created in 2013 with an $11 million grant initiative to 11 of the country’s top medical schools. Each of the participants is looking at innovating curriculum redesign to better prepare medical students to deliver care in today’s evolving healthcare landscape.

At the Indiana University School of Medicine, leaders have created a virtual healthcare system (vHS) and are using a teaching electronic medic record to ensure competencies in system-, team- and population-based healthcare, as well as clinical decision-making. At Vanderbilt University Medical Center, the new curriculum looks to create master adaptive learners who will engage in self-assessment and adapt to change throughout their medical career. The Vanderbilt program is also embedding students in the healthcare workplace from the earliest phases of undergraduate medical education. A synopsis of all 11 current programs is available at changemeded.org.

“In such a short amount of time, our consortium schools have made impressive strides toward creating the medical school of the future. Many of the schools have already implemented new curriculum models that are supporting innovative training for 7,000 medical students who will one day care for more than 12.2 million patients each year,” said AMA President Steven J. Stack, MD. 8

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NOVEMBER 2015

He continued, “It is because of this tremendous progress that we’ve decided to collaborate with more medical schools and continue on the path to spreading innovation across the entire medical education system to close the gaps that exist between the way physicians are educated and how healthcare will be delivered in the future.”

As part of this second phase of the Accelerating Change in Medical Education initiative, the AMA is calling on medical schools to build upon and implement the education models created by the 11 founding consortium schools, as well as offer unique projects that can be shared with medical schools nationwide. A national advisory panel is currently reviewing grant proposals, which were due last month. Proposals are being evaluated with an eye toward: • Developing flexible, competencybased pathways, • Teaching and/or assessing new content in healthcare delivery science, • Working with healthcare delivery systems in novel ways, • Making technology work to support learning and assessment, • Envisioning the master adaptive learner, and • Shaping tomorrow’s leaders.

“Bringing systemic change to our medical education system as we know it will require many more partners and many more schools,” said AMA Group Vice President for Medical Education Susan E. Skochelak, MD, MPH. “We are excited about the high level of interest that we’re seeing from medical schools for changing and enhancing medical education in our

AACN Futures Task Force

Last year, the American Association of Colleges of Nursing established the Futures Task Force with a broad charge to develop recommendations to ensure the nursing workforce meets future demands, and that the national organization stays at the forefront of innovation in nursing education.

The final report will be presented at the AACN’s fall meeting on Monday, Oct. 26. For information on the findings, visit the organization’s website at aacn.nche. edu.

HCEA

The Health Care Education Association (HCEA) – a multi-disciplinary organization of professional healthcare educators who look to improve outcomes through evidence-based education for patients, families, staff and the community – is prepping for the organization’s 2015 conference Oct. 15-17 in Indianapolis.

“Education on the Fast Track: Transforming the Patient Experience” will focus on patient engagement and the ways in which educators and healthcare workers impact the healthcare experience. Among the 21 breakout sessions at the biannual meeting are discussions on generational diversity and teaching adolescents how to evaluate health information, explaining numbers and risk with patients, working with the LGBT community, and several sessions emphasizing health literacy strat-

Cybersecurity, continued from page 7 endorsement or rider to an individual physician or practice’s insurance coverage. Due to increased risk factors (including potential penalties), carriers recently started offering an option to purchase higher limits.

Conclusion Over the past decade, the rise in the use of electronic data in the practice of healthcare has coincided with an enhanced regulatory environment.

As the stakes continue to rise – both in terms of cybersecurity and the consequences of breach – the insurance industry has responded by offering new products with increased coverage. In a not too distant future, cybersecurity insurance policies may be as fundamental to a medical practice as malpractice insurance policies are today.

Ian P. Hennessey is an attorney with London Amburn, a law firm based in Knoxville, Tennessee, which represents providers in the area of healthcare law, including regulatory, compliance, HIPAA, malpractice and nursing home defense, employment, mergers

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Tri Cities

PhysicianSpotlight

Itching To Find Solutions

Academic Allergist Blends Classroom And Practice Time To Help Patients

By JOE MORRIS

Even though appendicitis doesn’t itch or involve a runny nose, a bout of it drew a young Alexei Gonzalez toward a career in medicine, and eventually a specialization in allergy and immunology treatment and research.

Gonzalez, who is a graduate of Anahuac University Medical School in Mexico City, recalls well that illness, and how the process of getting treated. It drives him today, he said.

“It took eight hours to diagnose me, and I realized how important it was to treat people as quickly as you can, because that was a long time when you are not feeling good,” he said. “I became interested in how medicine worked, and how important it was to examine the person very thoroughly to diagnose what might be wrong. I wanted to be in internal medicine, because I thought they were the smartest doctors in the whole hospital. I wanted to be one of them when I grew up! But when I got to medical school, I found that immunology came very easily to me, and so I chose that area of expertise.

Following medical school, he came to the United States and completed an internship and residency in internal medicine at the Cleveland Clinic Foundation, as well as a fellowship in allergy and clinical immunology there. He is certified by the American Board of Internal Medicine, and is a Certified Clinical Research Professional. He now is an assistant professor of medicine at East Tennessee State University’s Quillen College

of Medicine, where his areas of research include drug allergy, anaphylaxis, perioperative anaphylaxis and chronic urticaria. In 2014, he received the Clemens Von Pirquet award for best research from the College of Allergy, Asthma and Immunology.

He practices with Quillen ETSU Physicians, where he says his research informs his treatment of patients, and vice versa.

“I have patients whose issues are all across the board,” he explained. “We have a lot of allergic rhinitis here due to the high pollen count, and also see a lot of asthma. And then we have a lot of drug allergy complaints, specifically penicillin allergies. We are able to help

a lot of people, because they come in thinking they are having an allergic reaction to penicillin or another drug when in fact it’s just a rash or viral issue. There are tests we can run to be certain of that, which is one of the great things we offer at Quillen.”

To that end, he and fellow researchers are now seeking approval for a project that would study any kind of allergic reaction to medicine, and would utilize ETSU’s medical facilities throughout Johnson City.

“We want to look at any kind of immediate reaction, such as an immediate rash following a dosage of penicillin, or a more delayed reaction from sulpha antibiotics,” Gonzalez said. “We would obtain blood sample from people with those reactions, and then figure out what the causes are. We hope to collaborate with other medical professionals in the state on this because it’s a program that could have very far-reaching results.”

That kind of effort is why he came to ETSU in the first place, and it’s what drives him both in the lab and the practice, he said.

“I really do have the best of both worlds, in that I have a great practice and I can do research,” Gonzalez said. “I like to help people through research, where we can advance science and solve problems.

I also love it in the practice, when we see someone who’s having a reaction, and I can help them through a different treatment. Having the clinical and academic settings, and being able to combine the experiences from each, is really something I

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enjoy.”

He also likes teaching residents, and working with them as they build their own clinical experience.

“I like to work with them as they come through our practice, and I am glad that we are working with them so they develop expertise in allergy and clinical immunology work,” he said. “I hope at some point we can begin to work with pediatric interns as well, so that we can expand what we are doing here into the treatment of both pediatric and adult patients.”

In fact, he notes, there is a great need for more pediatric allergy and immunology specialists in the area, and so he has begun to see younger patients in addition to his current roster of adults.

“It’s going to take a while to build that area up, but I have worked with pediatric patients in the past, and so I wanted to begin to see a few now,” he said. “It’s another situation where I can learn from them, and then take what I am seeing and try to find solutions through research.”

Gonzalez also hopes to spend more time working on chronic idiopathic urticarial, or rashes that last longer than six weeks.

“People have been looking their whole lives for a cause, and we haven’t’ found one yet, so there’s definitely room to work there,” he said. “But that’s just one area of many where there’s always work to be done. Drug allergies are so important, and we can really make advances here. I’m at a great place to do that, because we have tremendous resources here. There was a definite need for an academic allergist in this area, and I am very glad to have come here and fill that position.”

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Bridging The Gaps, continued from page 2 area are done at Erlanger.”

The ever-busy Brooks said that maintaining work/life balance isn’t always easy. With his wife Jeannine, Brooks is the proud parent of four boys—well, four young men; Connor (11), Cody (16), Kasey (23) and Kyle (25).

“I have four boys that actually like me, which is good,” said Brooks, laughing. “So I do want to be home with them from time to time. You know, it’s actually something that you have to prepare for—to actually schedule. I mean, I can literally work all day at the hospital and then be out with physicians and regional partners at dinner meetings every night.

So you either make time for yourself or get burned out.

“But it can be difficult,” Brooks continued. “I mean, we [at Erlanger] never close.”

And then, of course, there are difficulties on the job. Brooks said that his foremost challenge is keeping up with ever-evolving payment reforms.

“We don’t know what tomorrow may hold for hospitals trying to get paid for what they do,” explained Brooks. “Healthcare is unique because it’s the only business in the world where you don’t just take the cost of doing business and then mark it up five or ten percent to make a profit.

We’re basically told by insurers and the government what services we’re going to get paid for. And there are some services that we lose money on. So it’s a challenge figuring out how to provide those services for people that really need them but can’t pay—while at the same time being able to

reinvest in the organization.”

Still, Brooks said that he is greatly satisfied by serving the community and knowing that he really makes a difference.

“We get letters from patients and families just letting us know how we helped them in their hour of need—and that’s very gratifying,” said Brooks, excitedly. “Especially in the children’s hospital, when you see a child that has been ill or injured and they’re getting better, that’s definitely rewarding. We see patients that are on the brink of life or death. And knowing we’re able to provide those services regardless of someone’s ability to pay is a great feeling. Erlanger is the public safety net hospital in Chattanooga. We take care of absolutely everyone.”

For Brooks, understanding how healthcare works from a variety of perspectives is the enabling X-factor that makes everything work. And this all ties back to his early, hands-on experience as a trauma nurse, on the front lines.

“It’s very important for me to still be out there [in the hospital] and to understand how the experience is for our patients and how the work environment is for our staff. I think I’ve been very fortunate to come from a healthcare background and to be able to understand what those physicians and nurses and staff are going through. Because you really have to understand how the care is delivered in order to change how it is delivered. So as I try to affect changes here in our healthcare environment, I am doing it also knowing how it’s going to affect those people doing the care at the bedside.”

From Bedside To Boardroom ing education and protocols that led to a 36 percent drop in ventilator associated pneumonia; protocols to reduce the impact of MRSA; and a five-county school hand washing campaign.

Suffice it to say that the honors and awards list is a long one. But for Dr. Lacey, the work will always be about the patients, and now he includes physicians in his care overview as well.

“I can speak about what our patient need, but I also want to make sure that we are working to create a system which minimizes the chronic stress that our phy-

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NOVEMBER 2015

sicians and other caregivers experience,” he said. “Healthcare is a team, and we need to think about how we evolve systems to enhance patient outcomes, which is our No. 1 priority, but also create systems that help the people who are providing the care.”

He points to the Medscape 2015 Physician Lifestyle Report, which showed a high level of burnout, to make his point.

“When you have a scale of one to seven, and the average is around four, that’s a meaningful number,” he said. “I am working with our team here to look at how we can ameliorate burnout in the way our system is designed. We want to give our healthcare professionals the tools to help them what they do best, and shield them from the chronic stress brought on by all the changes in healthcare now. We hope to have a lot of that work done by my retirement next spring.”

Even so, he added, he’ll still keep an oar in the water.

“As long as my brain and body allow it, I’ll probably be doing something in healthcare,” he said. “That may be at the bedside, or in some other capacity, but I have a number of passions to pursue that are in medicine, and so I’ll be looking at those. We have a lot of challenges, and I want to do what I can to make sure we are thinking about the individuals involved, not just the big picture.”

GrandRounds UT Medical Center Names New Vice President Of Facility Operations KNOXVILLE — Tim Jacoby recently joined The University of Tennessee Medical Center as vice president of Facility Operations. In this role, Jacoby will have responsibility for various areas in the facility operations and planning division.

Tim Jacoby Prior to joining the medical center, Jacoby had been consulting with healthcare organizations in facility planning and engineering. Previously, he worked for nine years with Rady Children’s Hospital of California.

Jacoby holds a Bachelor of Science Degree from the University of the State of New York with a concentration in nuclear engineering. Much of his early training came from his 24 years in the United States Navy. He is a Certified Healthcare Environmental Manager and is certified by the Design Build Institute of America.

Zeyl Joins Wellmont CVA Heart Institute As Cardiothoracic Surgeon At Holston Valley KINGSPORT – Thomas Zeyl, MD, has held a longtime interest in cardiothoracic surgery, a passion that expanded when he watched a beloved family member successfully undergo an operation that increased his quality of life.

Now, Zeyl is help- Dr. Thomas Zeyl ing transform lives in the surgical suite at Holston Valley Medical Center and in patient consult rooms at The Heart Center on Meadowview Parkway. He recently joined the Wellmont CVA Heart Institute after completing his cardiothoracic surgery residency in Florida.

Zeyl conducts a variety of heart procedures, including bypass and valve surgeries, and many of them are performed open-heart. In other cases, he can use a more minimally invasive approach, a style he likes because of its reduced complexity and increased comfort for the patient.

Through his training, Zeyl developed a special interest in aortic surgeries, including the surgical treatment of aortic aneurysms and aortic dissections. Zeyl also has expertise in the diagnosis and treatment of lung cancer and other lung diseases. As he considered options for establishing his practice, Dr. Zeyl liked what he saw when he visited Wellmont Health System.

Zeyl came to Wellmont after completing his cardiothoracic surgery residency at the University of Florida in Gainesville.

He is certified by the American Board of Surgery and has advanced trauma life support and advanced cardiac life support certificates.

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GrandRounds Asbury Place Kingsport Names Dannie Dingus Director Of Nursing KINGSPORT – Asbury Place continuing care retirement communities recently named Dannie Dingus director of nursing for its Kingsport campus.

Dingus has more than 35 years of management, critical care and nursing home experience. He Dannie Dingus came to Asbury Place following a decades-long career with Wellmont Health System’s Holston Valley Medical Center and continues to occasionally work in cardiac care and rehabilitation at the hospital, recognizing that the work positively impacts his ability to perform his job at Asbury Place.

Dingus earned his nursing degree from Walters State Community College and is pursuing a master’s degree in nursing from Vanderbilt University.

MSMG – Family Medicine/ Internal Medicine/Pediatrics Welcomes Kelly McQueen, DO KINGSPORT – Mountain States Medical Group – Family Medicine/Internal Medicine/Pediatrics welcomes Kelly McQueen, DO, to the team.

McQueen is certified by the American Board of Family Medicine in Osteopathic Medicine and is a Dr. Kelly McQueen member of the Tennessee

Academy of Family Physicians. Her training combines today’s medical technology with a “whole body” approach to help her patients obtain a better level of health.

McQueen welcomes patients of all ages, and has a special interest in women’s health and preventive medicine. Dr. McQueen earned her medical degree at Kirksville College of Osteopathic Medicine in Kirksville, Mo., and completed her residency at East Tennessee State University James H. Quillen College of Medicine.

She is passionate about her commitment to medicine.

SVMIC Protects the Most Tennessee Doctors

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KNOXVILLE – Knoxville Dermatology Group, one of the state’s largest private practice groups of board-certified dermatologists, has consolidated two Knoxville medical offices and its MediSpa into a new $6 million expanded facility.

The West Knoxville office at 123 Fox Road was built from the ground up and features more than 28,000-square-feet of state-of-the-art technology and 31 exam rooms. It is also home to the group’s MediSpa, which offers a full range of cosmetic services, soothing therapies and non-surgical rejuvenation procedures.

It also maintains an office in Sevierville.

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The University Of Tennessee Medical Center Welcomes Two NeuroHospitalists

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KINGSPORT — Holston Medical Group (HMG) welcomes Tony Bleckley, PT, to HMG Rehabilitation Services at Medical Plaza, 105 W. Stone Drive, Kingsport.

Bleckley received his Bachelor of Science degree from the University of Tennessee at Chattanooga. Bleckley brings over 20 years of rehabilitation experience to HMG and is a Certified Integrated Manual Therapist.

Protection Is Power

Knoxville Dermatology Group Celebrates New $6 million Facility With Ribbon Cutting Ceremony And Open House

KNOXVILLE — University Neurology, the hospital-based inpatient neurology (neurohospitalist) service, at The University of Tennessee Medical Center recently added two new neurologists to the service, Dr. Li Hua and Dr. Muhammad Masud.

Dr. Li Hua As an integral part of the Comprehensive Stroke Center, University Neurology provides 24/7 inpatient neurology coverage with two neurologists covering day call and a neuDr. Muhammad rologist covering nights, Masud holidays and weekends.

Hua completed her neurology residency at the University of Mississippi Medical Center in Jackson, MS. Masud completed his residency in neurology at the University at Buffalo in Buffalo, NY.

HMG Welcomes Tony Bleckley, PT, To HMG Rehabilitation Services At Medical Plaza

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Physician to Physician

Peripheral Artery Disease

by Dr. Giovanni Ferrante Peripheral artery disease or PAD refers to problems occurring in arteries anywhere except the heart. PAD is one of the major areas vascular specialists are concerned with, using both medical and invasive methods to treat it. Increasingly, our invasive procedures are utilizing nonsurgical, catheter based technologies to reduce the trauma of treatment. We now spend much of our time in the x-ray suite instead of the OR. The arteries are the channels through which blood is pumped from the heart to the organs of the body. Without this blood flow, tissues die– the brain, the heart, the kidneys, and the legs being the most commonly affected. Blood flow can be blocked by plaque composed of cholesterol, calcium, and inflammatory tissue. Sometimes, this plaque can break off and cause blockage in a smaller artery downstream. The symptoms depend on where the blockage is. In the brain, it can cause a stroke. In the heart, a heart attack. In the kidneys, it can cause high blood pressure and kidney failure. In the legs, it can cause muscle pain with walking (claudication) or even gangrene of the toes or foot. Arteries can also develop “aneurysms,” which are areas of weakening and dilation of an artery.

These can rupture and bleed or form blood clots which can travel and cause blockages.

PAD is very common. In fact, all American adults—no matter how healthy—have some arterial plaque.

The severity of the disease is increased by smoking, diabetes, and high blood

pressure and cholesterol, and the Southeast sees a high incidence of these problems. Patient behavior is the root cause of most vascular disease; smoking, overeating, and inactivity are all killers. Physicians have access to very sophisticated tools to treat the complications of vascular disease, but it’s important to understand that these procedures are not treating the disease, merely its complications. The only way to treat the disease, whether it’s venous or arterial, is through behavioral change and sometimes medication.

Arterial Conditions and Their Treatment 1. Stroke Prevention: The carotid arteries carry blood to the brain. Plaque builds up where these arteries branch in the neck. This can break off and travel to the brain, causing strokes. In patients at risk, a duplex ultrasound scan can show plaque. If severe plaque is present, either a stent or surgery can reduce the risk of stroke. Surgery (which can often be done under local anesthesia) seems to be somewhat safer than a stent; therefore, we recommend surgery for most patients with this problem.

2. Aneurysms: These weakened, dilated segments of arteries are most common in the abdominal aorta. The normal aorta is an inch in diameter; if an aneurysm diameter is over 2 inches, it might rupture. This is usually fatal.

Aneurysms can be fixed by replacing the weakened section of the artery either with a fabric-covered stent inserted through catheters placed in the groin arteries, or

with an open operation. The decision as to which type of repair to have depends on the patient’s age and medical condition and personal preference.

3. Lower Extremity Vascular Disease: The most common symptom of atherosclerosis is poor circulation to the legs. This causes “claudication” or pain in the legs with walking. This is not dangerous, but it signals that severe atherosclerosis is present with a risk of stroke or heart attack. If circulation to the legs is very poor, toe ulcers or gangrene may develop. This must be treated immediately with balloons and stents, or with bypass surgery if necessary. Frequently, patients need a combination of both types of treatment to optimize circulation. Follow-up of all types of vascular treatment is very important to catch new problems before they become emergencies. This involves regular testing with ultrasound, or CT scans.

The providers at Johnston Memorial Hospital are fortunate to have a great group of technicians and radiologists who provide high quality vascular studies. We rely on these to make sure our treatment is working and to decide if additional procedures are necessary.

Dr. Giovanni Ferrante, vascular surgeon, received his medical degree from Stanford University School of Medicine in Palo Alto, Calif., and completed a general surgery residency at Stanford University Medical Center. He also completed a fellowship in vascular surgery at University of Massachusetts Medical Center in Worcester, Mass. He is board certified in surgery and vascular surgery, and a member of the Society for Vascular Surgery, the New England Society for Vascular Surgery and is a Fellow of the American College of Surgeons.

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