ACMS Bulletin July 2022 by TEAM

Bulletin Allegheny County Medical Society

July 2022

Great Expectations Making a Book

Neurosurgical expertise for patients. When your patients need the best possible specialty care, AHN has physicians with world-class expertise — like our new neurosurgeon. Dr. Shepard provides cutting-edge surgical options for patients, to ensure the best possible outcomes.

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Allegheny County Medical Society

Bulletin July 2022 / Vol. 112 No. 7

Opinion

Departments

Articles

Editorial ....................................5 POS Meetings ........................14 Materia Medica .......................30 • Treating Insulin-Induced • Summer’s Bounty Society News .........................15 Hypoglycemia with Confidence: Deval (Reshma) Paranjpe, MD, MBA, FACS

Editorial ...................................7 • Great Expectations Anna Evans Phillips, MD, MS

• Welcome to the ACMS Team!

Society News .........................16 • In Memoriam—H. Jordan Garber, MD

Dasiglucagon (Zegalogue®) Karen M. Fancher, PharmD, BCOP

Legal Summary .....................34 • Private Equity Deals Offer Both Potential Significant Return and Significant Challenges

ACMS Bylaws ........................17 Editorial ....................................9 • Making a Book 2022 ACMS Meeting and Activity Schedule....................38 Election Form 2023 ...............39 Richard H. Daffner, MD, FACR

On the cover

Ohiopyle

Elias Hilal, MD Dr. Hilal specializes in Head and Neck Surgery

Bulletin Medical Editor Deval (Reshma) Paranjpe (reshma_paranjpe@hotmail.com) Associate Editors 2022 Executive Committee and Board of Directors

PAMED DISTRICT TRUSTEE

President Peter G. Ellis President-elect Matthew B. Straka Vice President Raymond E. Pontzer Secretary Mark A. Goodman Treasurer Keith T. Kanel Board Chair Patricia L. Bononi

COMMITTEES

G. Alan Yeasted

Bylaws Raymond E. Pontzer Finance Keith T. Kanel Membership Matthew B. Straka Nominating Raymond E. Pontzer

Douglas F. Clough (dclough@acms.org) Richard H. Daffner (rdaffner@acms.org) Kristen M. Ehrenberger (kehrenberger@acms.org) Anthony L. Kovatch (mkovatch@comcast.net) Joseph C. Paviglianiti (jcpmd@pedstrab.com) Anna Evans Phillips (evansac3@upmc.edu) Andrea G. Witlin (agwmfm@gmail.com)

DIRECTORS 2022 William F. Coppula Micah A. Jacobs G. Alan Yeasted Alexander Yu 2023 Steven Evans Bruce A. MacLeod Amelia A. Pare Adele L. Towers 2024 Douglas F. Clough Kirsten D. Lin Jan B. Madison Raymond J. Pan PEER REVIEW BOARD 2022 Niravkumar Barot Kimberly A. Hennon 2023 Lauren C. Rossman Angela M. Stupi 2024 Marilyn Daroski David J. Levenson

ADMINISTRATIVE STAFF

ACMS ALLIANCE

Executive Director Sara Hussey (shussey@acms.org)

Co-Presidents Patty Barnett Barbara Wible

Governance Administrator Dorothy Hostovich (dhostovich@acms.org)

Recording Secretary Justina Purpura

Vice President - Member and Association Services Nadine M. Popovich (npopovich@acms.org) Manager - Member and Association Services Eileen Taylor (etaylor@acms.org)

Director of Publications Cindy Warren (cwarren@pamedsoc.org)

Corresponding Secretary Doris Delserone Treasurer Sandra Da Costa Assistant Treasurers Liz Blume Kate Fitting

EDITORIAL/ADVERTISING OFFICES: Bulletin of the Allegheny County Medical Society, 850 Ridge Avenue, Pittsburgh, PA 15212; (412) 321-5030; fax (412) 321-5323. USPS #072920. PUBLISHER: Allegheny County Medical Society at above address. The Bulletin of the Allegheny County Medical Society is presented as a report in accordance with ACMS Bylaws. The Bulletin of the Allegheny County Medical Society welcomes contributions from readers, physicians, medical students, members of allied professions, spouses, etc. Items may be letters, informal clinical reports, editorials, or articles. Contributions are received with the understanding that they are not under simultaneous consideration by another publication. Issued the third Saturday of each month. Deadline for submission of copy is the SECOND Monday preceding publication date. Periodical postage paid at Pittsburgh, PA. Bulletin of the Allegheny County Medical Society reserves the right to edit all reader contributions for brevity, clarity and length as well as to reject any subject material submitted. The opinions expressed in the Editorials and other opinion pieces are those of the writer and do not necessarily reflect the official policy of the Allegheny County Medical Society, the institution with which the author is affiliated, or the opinion of the Editorial Board. Advertisements do not imply sponsorship by or endorsement of the ACMS, except where noted. Publisher reserves the right to exclude any advertisement which in its opinion does not conform to the standards of the publication. The acceptance of advertising in this publication in no way constitutes approval or endorsement of products or services by the Allegheny County Medical Society of any company or its products. Annual subscriptions: $60

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Editorial

Summer’s Bounty Deval (Reshma) Paranjpe, MD, MBA, FACS

he middle of summer calls for dining al fresco and discovering new places and revisiting old favorites. Here are some in-depth reviews of some joyous places you should try around town in your summer travels. Café Zinho 238 Spahr Street (near the corner of Ellsworth) 412-363-1500 Wed-Sat 5pm-10pm, Closed Sun-Tues Reservations recommended I broke my in-person dining fast at Café Zinho in late spring when al fresco dining opened. Café Zinho was the natural place to go. The isolation of the pandemic led many people to develop or rekindle friendships through social media, and one of those beautiful pandemic links for me has been Chef Toni Pais. I knew Toni from his beautiful Tiffany blue Portugese restaurant downtown called Café Zao, nearly 2 decades ago when I moved back to Pittsburgh after fellowship and was exploring the dining scene downtown. He was always so kind and gracious, and taught me about port and Portuguese dishes. I’d treat myself to dinner at the bar now and then because I hadn’t made many friends in those days, and some days Toni would be behind the bar and we’d chat. I knew he was a

ACMS Bulletin / July 2022

legend, of course, world-renowned and a Pittsburgh icon. His famed restaurant Baum Vivant was the longstanding epitome of fine dining in Pittsburgh when I was a resident and couldn’t afford it. (Back in those days getting an invite to a pharma dinner at Baum Vivant was a ticket to paradise for a mere trainee.) So, to be on the receiving end of culinary and bartending pearls from such a master, generously dispensed over a beautiful supper at the bar…I literally ate it up. Fast forward a few years; Toni began to notice uncontrollable shaking of his left arm and was diagnosed with early-stage Parkinson’s disease. He started medical therapy and went back to work, but the symptoms proved to be more than pharmaceuticals alone could control. He was deemed a good candidate for DBS (deep brain stimulation) and underwent electrode placement within the MRI scanner while sedated. A month later, the patient-adjustable pulse generator by his clavicle was activated; he immediately enjoyed significant improvement and was able to work and enjoy life again and titrate pulses to his symptoms. I made an early reservation to avoid the rush and had dinner at one of Café Zinho’s charming sidewalk tables on a late spring afternoon with a cool breeze blowing. What did I want to order from this exquisite menu? I asked Toni to choose for me. Chef’s choice of rich

roasted tomato bisque, his signature Portugese fisherman’s stew and an incredibly indulgent chocolate mousse reminded me that there’s still plenty of joy to be found in life. Toni even joined me briefly before the rush started, like the old days, and we talked about Pittsburgh, food, and his miraculous recovery and his road forward. He’s grateful for everything, makes the most of every day, and celebrates his loyal staff daily. Toni’s creative process is very much like that of Michelangelo, who saw his David trapped in the block of marble, waiting to be freed. Toni can taste the finished dish in his imagination before he sculpts it out of the finest ingredients and brings it to dazzling life. Try his delicious upscale European/Mediterranean creations and his newest one, which I’m honored to say was born out of our conversation that day: Goan Fish Curry. Inspired by the famous style of fish curry from Goa (an old Portugese colony in India), you’ll not find it in any other restaurant in Pittsburgh. Please go dine at Café Zinho and say hello to Toni Pais, a longstanding Pittsburgh treasure, culinary maestro and medical miracle. Cash or check only, ATM on premises. BYOB, upscale, reservations recommended. Continued on Page 6

Editorial From Page 5

Tepache 926 Sheraton Drive, Mars PA 16046 724-553-5307 Open daily M-Th 11AM-10PM, Fri-Sat 11AM-11PM, Sun 11AM-9PM Named for the famed Southern Mexican fermented pineapple drink, Tepache is sheer perfection in the North Hills. Located off Route 19 at the Cranberry border, Tepache features fresh, authentic and fantastically tasty Mexican delicacies and drinks at a spacious interior/bar and a covered outdoor patio. The owners are brothers from Jalisco and the chefs are from Yucatan and Baja California. The entire service team is gracious, committed and professional. The eponymous tepache is featured in margarita, mojito and mezcal cocktail format on the drinks menu along with a dizzying array of margaritas, mojitos, cocktails, micheladas, and beers (as well as nonalcoholic options) to sip as you survey the menu. Start with the excellent freshly made tortilla chips, which set the tone for the meal—you’ll know you’re in for something special. Then opt for the flaming queso fundido because who can resist the spectacle of a tableside tequila flambée? The taste is sublime and sophisticated, but it’s Cheese on Fire, after all. Instant childlike grins appear on all witnesses. Spread some joy. The menu is a rich and varied treat. I can safely say that it will take me all summer and fall to eat my way through it. The fact that this process will happen is a foregone conclusion. You can find everything from elotes (Mexican street corn) and tamales to jackfruit tacos, pozole verde (hominy and chicken stew), specialty brussel sprouts, 6

squash blossom quesadillas, arroz con pollo and Birria tacos. The expected list of tacos, enchiladas, burritos, chimichangas, fajitas and salads exists but with a delightful and authentic variety of preparations for each format—it’s a tour of Mexico with selections from the Yucatan and Jalisco among other areas. You really can’t go wrong with any of them. Try my favorite so far--the brilliant Choripollo—seasoned marinated chicken topped with chorizo and cheese sauce, served on a nopal (prickly pear) cactus slice with a grilled poblano pepper, beans, and rice for accompaniment. Cap it all off with a lovely selection of desserts including Crepas de Naranja (crepes flambéed with orange liqueur, drizzled in caramel and served with ice cream), elote flan, tres leches cake, and a churro platter. Seriously, why are you still sitting here reading? Reservations, walk in seating, delivery, and pickup options available. Children’s menu, Happy Hour (4-6pm weekdays), specialty margaritas of the day and weekend brunch. KIIN Lao and Thai Eatery 5846 Forbes Avenue 2nd floor, Pittsburgh PA 15217 (Squirrel Hill, old Bangkok Balcony) 412-521-0728 Closed Tuesday; open Wed-Mon 11AM-10 PM. Summer’s heat invites light yet satisfying and cooling foods. Enter KIIN Lao and Thai Eatery, created by the owners of the former Bangkok Balcony in that famous space. The menu explores a range of Lao, Isan, and Thai cuisine and is both delicious (to this reviewer) and authentic (to other reviewers who hail from these areas). The Thai portion of the menu features dishes familiar to most Pittsburghers

(pad thai and other noodle dishes, green curry, pineapple curry, crab fried rice) but also beloved specialties seen in more traditional Thai restaurants on the West Coast and indeed in Thailand. These include pink noodle soup, pink noodles, pad gra prow, and boat noodles, among others. Lao, Isan and Thai cuisines are related yet distinct, and KIIN offers a window to all of them. Try the Sai Oua, a traditional spicy pork and lemongrass/ ginger/dill/peanut sausage served with a fermented soy-pineapple sauce, or the Naem Khao (crispy coconut rice salad with choice of protein). You must try one of the three refreshing green papaya salads (one of which is naturally gluten free and vegan). Try the Laab (larb), another refreshing dish of minced spiced protein mixed with fragrant herbs, scallions, lime juice and fish sauce and served with sticky rice. Or for a deep dive, try the Mok (your choice of seafood steamed in a banana leaf with red curry and bright accompaniments) or Kua Mee (wok rice noodles with fish sauce caramel, egg, tomato, bean sprout and lime with your choice of protein). I asked my college and medical school friend Andy Shen, now a foodie and an Emergency Medicine doc in LA, to suggest menu items to try. His suggestions (all listed above) followed his initial assessment after reading the menu: “This place looks legit.” After trying it, I can tell you that it is indeed legit delicious, and unlike any other Thai restaurant I’ve tried in the area. Worth a visit, especially on a hot summer day with good company. Mid-afternoon if you want the place to yourself; takeout available. After your meal, take a stroll down Forbes Avenue, listen to the sweet breezes in the trees and remember that summer is one definition of pure joy. Enjoy. www.acms.org

Editorial

GREAT EXPECTATIONS Anna Evans Phillips, MD, MS

igital rectal exams cannot be performed via telemedicine. Nor can subtle palpation of a fluctuant or indurated wound site, or auscultation of the pitch of bowel sounds. Telemedicine is not the same as an in-person visit. I have had patients take telemedicine visits with me from their kitchen island, their living room, their back yard, their basement, their garage, and multiple individuals have done so from their car in the parking lot at their workplace. Patients have done their video visits while conference calls at work are held on mute, multi-tasking during their work-at-home days. They have taken telemedicine visits while grocery shopping, even while walking their dog. A diabetic patient of mine with bad vascular disease took his while chain-smoking cigarettes and drinking Mountain Dew. The coronavirus pandemic has pushed physicians to their limits in recent months and sometimes beyond, creating a sea of need into which many doctors have waded, armed with optimism, altruism, and perseverance. The expectation that physicians can and will rise to any occasion to meet a challenge where their talents might be of use continues to exist. And yet neither the challenges

nor the expectations have abated in the two-plus years we have faced the pandemic. The growth of telemedicine represents just one of the ways in which new demands are made of physicians, but our system has not yet caught up to acknowledging and accounting for what this means for clinical medicine moving forward. In recent months, the coronavirus pandemic has touched all of us: rules for entering grocery stores, sending children to school, attending a concert, have all changed…then changed again. Our expectations of how we fly in airplanes, how we shop for groceries and clothing and household goods, and how we stay in touch with our family members have changed during this time. Our expectation for what it means to receive high-quality health care from a physician, however, has not. Healthcare workers – specifically physicians—have been tasked with continuing on during the pandemic. There is no coronavirus exception for the measurement of the number of cases I start on time – despite the fact that there is additional personal protective equipment to don and added complexity for every aspect of the morning routine from daycare drop off to entering the hospital. There is no coronavirus exception for the

calculation of my adenoma detection rate that is performed to identify my skill as a colonoscopist, despite some patients delaying colonoscopy during the past two years to avoid healthcare environments. There is no forgiveness for the delay in a cancer diagnosis despite patients requesting telemedicine visits in place of in-person exams. There is nothing new with physicians stepping up when all else fails; but there’s been almost no time to reflect on how this duty and honor has been affected by the pandemic. The rise of telemedicine has facilitated access to health care and specialist care in an unprecedented fashion that in some ways has been a huge gain for the system. For those physicians in specialties with high demand, this represents a new expectation of availability and flexibility that may not be deliverable at the rate or quality at which it is desired. For a person with an anal cancer, a wound infection, or a distended abdomen, who prefers to have a video chat instead of driving to the office, their reticence to present in-person often results in diagnostic uncertainty and additional delay. They are often unwilling or unable to adequately show the area of concern via video that could have been examined in the privacy of the Continued on Page 8

ACMS Bulletin / July2022

Editorial From Page 7

office by the consulting physician. Patients and health care systems both are looking for shortcuts, but no good ones exist if high quality health care is the goal. In these situations, it requires a physician with a broad differential diagnosis, who can deftly navigate the logistics of video meetings (including patient instruction and guidance), or the complex scheduling systems necessary to perform high volumes of diagnostic testing that must be done in person to answer questions not solvable via video. And yet, medicine remains a calling for many of us who have stayed in our positions throughout this time. Most physicians do not enter the profession expecting their job to be easy, their days to be predictable, or the demands from patients or employers to be easy to meet. The profession is one that demands constant and unrelenting compassion from individuals who must be ready to serve the needs of those who come to them. With whatever energies remain to each of us after this grueling time, we must remember

to turn to our inner sense of creativity, ingenuity, inventiveness, and our reserves of kindness to focus on what matters most: the treatment of patients in our care.

During the pandemic, the health care problems I frequently diagnose and treat continued to happen despite the spread of coronavirus.

outcomes were the same, there was something lost for me with a video visit. As we grapple with how to make the pandemic a part of our lives and not a hold on them, I suspect these deeply human interactions will remain the foundation for meeting the great expectations we have for patientcentered health care.

People continued to develop colon cancers, pancreas cancers, and devastating pancreatitis at rates similar to before the pandemic. There were several patients who braved the hospital to present in-person for our visits. These in-person visits provided some of the most profound connection I have ever felt with patients. Though the care may not have differed at all, from those individuals I saw in-person, I have received notes, messages, and in-person thanks for the care and work that was done on their behalf during that time. Even if clinical

Become an ACMS Media Contact We are fortunate to have over 2,000 local physicians, residents, and students as part of the ACMS membership. We are grateful for the range of expertise that exists within our membership community and we want to help you share that expertise with the community! Join the Media List here! 8

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Editorial

Making A Book Richard H. Daffner, MD, FACR

have been privileged, in my long academic career, to have written nine textbooks. Four were fresh works1-4; the other five were revisions. I am also honored that my books have been translated into Greek, German, Spanish, and Portuguese. So, I’m often asked, “How much work is it?” The answer is, “A lot” for the first editions, and after 1997 the revisions were easier. And so, for those curious what goes into producing a book, I offer what follows.

Concept There are two ways one obtains a contract to prepare a manuscript for a publisher. The most common scenario occurs when a prospective author has an original idea and contacts the publisher with his/her proposal. In this situation, the author must sell the idea for the book by answering two important questions: Why is this book different from what is already out there? And what is the potential market for this book? The publisher will send a prospective author a questionnaire asking these questions and others on the details. The second route is an invitation from the publisher (“We would like you to write…”). I have had experiences with both routes. My first book, Case Studies in Radiology1 was the result ACMS Bulletin / July 2022

of a direct invitation. I was a resident at the time and had been writing a monthly column entitled “X-ray Consultation” for The New Physician, a publication of the American Medical Student’s Association (AMSA). The journal’s goal is to provide medical students with the tools they need for success in their classrooms and beyond as they begin taking care of patients. At the time (1972), the journal’s editor, Dr. Terry Carden, was a beginning resident in my radiology program at Duke University. Terry was an older resident whose undergraduate degree was in journalism. Terry told me that my monthly columns, which presented unknown cases for the reader to diagnose using radiologic studies, followed by a discussion of the findings, was one of the most popular sections of the journal. He suggested we write a book on case studies in collaboration with our mentor, Dr. John Gehweiler, an established author5, 6. My second book, Introduction to Clinical Radiology2 was the result of my approaching a publisher. My first post-residency job was on faculty at the University of Louisville School of Medicine where I gave the medical students a series of lectures on basic radiology. The only competition was the classic Fundamentals of Radiology by Lucy Squire7. Her approach was to

describe the appearances of different types of pathology as seen on various radiographic studies. My approach was clinically oriented around three aspects: Technical Considerations, Anatomic Considerations, and Pathologic Considerations. In addition, I included the physical foundations of diagnostic imaging as well as a discussion of radiographic contrast material. The book was successful and underwent four revisions under the title of Clinical Radiology: The Essentials, of which the last edition8 had a co-editor (Dr. Matthew Hartman) and most of the chapters had coauthors to reflect the state-of-the-art. My third book, Imaging of Vertebral Trauma9 was the result of an invitation from my colleague, the late Dr. Morrie Kricun, who was the editor for the Clinical Diagnostic Imaging series, published by Aspen. Interestingly, each of the two subsequent revisions was by a different publisher, reflecting consolidation of the industry.

Mechanics The mechanics of book publishing are routine for both scientific and non-scientific books. The publisher wants to know how long the book will be (number of pages), the number of illustrations and artwork, and the number of tables. Will any of the illustrations be in color? Prior to

Continued on Page 10

Editorial From Page 9

electronic publishing, color illustrations drove the production costs up. Now, they are used routinely. For the last edition of Clinical Radiology8, the publisher colorized almost all of my black and white artwork (fig. 1). A timeline is also agreed upon where the author agrees to have submitted everything to the publisher by a certain date. Fig. 1. Moth-eaten bone destruction.

Following the contract signing, the author will prepare the manuscript and obtain all necessary artwork, tables, illustrations, and permissions for any borrowed material. Once the manuscript is submitted, it will undergo editorial review. It may also undergo peer review. The edited manuscript will be returned to the author, often with editorial questions to be answered. The author will then make additional changes and approve the edited work. Prior to the electronic age, once the edited manuscript had been accepted, galley proofs showing the manuscript set in type were sent to the author for approval and/or amending. Finally, page proofs showing the final layout of how the material will look in the book are sent for approval.

Illustrations and Tables Most medical books have plenty of illustrations. It is important for the author to prepare a list of illustrations and tables for each chapter. If the book is a revision, the author should note those illustrations to be kept from the previous edition and those that will be new on a worksheet (fig. 2). Tables are handled the same way. Fig. 2. Sample of a chapter illustration list used for a revision. Parentheses indicate that the old illustration is still being considered for reuse.

A. B & W illustration used in previous editions2,4.

B. Original color artwork, from which fig. 1A was derived, used in 4th edition8. Note how much the color adds. 10

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Editorial How Technology Changed Publication Prior to 1997, manuscripts were dictated to a secretary or typed by the author. If the authors were fortunate, the typing was done on a word processor or a typewriter with memory. Revisions were similarly retyped. Illustrations were generally 5x7 glossy prints. The smart author always obtained at least four prints of each illustration for safety. Arrows and/ or letters and numbers were of the press-on variety, which always carried the risk of misplacement or ruining of a print with the stylus used to apply them. Completed manuscripts were sent to the publisher by “snail mail” (USPS), by FedEx or UPS, or hand carried by the author for delivery. Composing and production of galleys and page proofs were handset. Again, “snail mail” was used for each interaction between the author and the publisher at each step in the process. The average production time was between 15 and 24 months. After 1997, the benefits of the electronic age improved matters significantly. All communication was via e-mail. Manuscripts were prepared using MS Word® or voice recognition computer programs. Illustrations were also electronic products, with the TIFF format preferred. Arrows and text could be added using a photo processing program such as Adobe Photoshop®. All material was submitted electronically. Editing was done directly from the manuscript and composing was done directly from the edited manuscript. There was no longer a need for galleys; page proofs

ACMS Bulletin / July 2022

were sent in PDF format. And, most importantly, the overall production time was reduced to nine months. The electronic age and globalization also assured that book publishing would be an international endeavor. For example, the current edition of Clinical Radiology8 saw its authors from the U.S., the publisher from the Netherlands, the copy editors from India, and the printers from China. Quite a change from the “good old days.” So, do you want to write a book? Yes, it’s a lot of work, but the results are rewarding. And, once you’ve done it, subsequent works (revisions or new books) are much easier.

References: 1. Daffner RH, Gehweiler JA Jr., Carden TS Jr. Case Studies In Radiology, Appleton-Century-Crofts, New York, 1975. 2. Daffner RH: Introduction to Clinical Radiology. A Correlative Approach to Diagnostic Imaging, C.V. Mosby, St. Louis, 1978. 3. Daffner RH: Imaging of Vertebral Trauma. Aspen Publishers, Baltimore, 1988.

4. Daffner RH:Clinical Radiology: The Essentials. Williams & Wilkins, Baltimore, 1993. 5. Becker RF, Wilson JSW, Gehweiler JA. The Anatomical Basis of Medical Practice. Williams & Wilkins, Baltimore 1971. 6. Gehweiler JA, Jr, Osborne RL, Becker RF. The Radiology of Vertebral Trauma. W. B. Saunders, Philadelphia, 1980. 7. Squire LF. Fundamentals of Radiology. Harvard University Press. Cambridge, 1975. 8. Daffner RH, Hartman MS. Clinical Radiology: The Essentials, 4th ed. Wolters Kluwer, Philadelphia, 2014. 9. Daffner RH. Imaging of Vertebral Trauma. Aspen Publishers, Rockville MD, 1988 Dr. Daffner is a retired radiologist, who practiced at Allegheny General Hospital for over 30 years. He is Emeritus Clinical Professor of Radiology at Temple University School of Medicine. The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

suppressed or was forbidden.2 As long as the humor, in this case name-

to us, they are still our fellow human beings.

their relation to the unconscious New York: W. W. Norton, 1960 (Original work published 1905).

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ACMS Bulletin / July 2022

Pittsburgh Ophthalmology Society Announces 2022-2023 Monthly and Annual Meetings Dates Marshall Stafford, MD, President of the Pittsburgh Ophthalmology Society (POS), is pleased to announce the 2022-2023 POS Monthly Meeting Series and Annual Meeting dates. A total of six meetings are scheduled, beginning September, and concluding with the Annual meeting in March 2023. The POS will host the monthly meetings as “in person” meetings in the Ohio Room at the Rivers Casino (777 Casino Dr, Pgh, PA 15212). The venue is centrally located on the North Side and offers free parking. Valet parking is also available for a small fee. The ballroom, located on the 2nd level is a non-smoking facility and provides ample social distancing space.

The November 3 program will be the only meeting held at the Babb Insurance Building (850 Ridge Ave, Pgh, PA 15212). More details will be provided on the November meeting notice and registration site. Registration begins at 4:00 pm with the first lecture to commence at 4:30 pm. The agenda includes a Resident Case presentation. We are pleased to announce the Resident presenters for the series. All are second-year Residents at the University of Pittsburgh Eye Center: Sonny Caplash, MD; Timothy Chen, MD; Jonathan Peterson, MD; Matthew Sommers, MD; and Bushra Usmani, MD.

Members will receive registration information, including the link to register, 1 month prior from the date of each meeting. Registration is required (no walk-ins, please) and will be handled online only. At the time of print, guest faculty for all meetings are in the process of being confirmed. Please visit the POS website www.pghoph.org periodically for updates on guest faculty and presentation details, as well as registration information. Contact administrator, Nadine Popovich, to confirm the status of your membership or to inquire about the upcoming program. She can be reached by email: npopovich@acms. org or by phone: 412-321-5030.

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Society News

Welcome to the ACMS Team! Eileen Taylor

Eileen Taylor

The Allegheny County Medical Society is pleased to welcome Eileen Taylor to our team as of July 1, 2022. Eileen joins ACMS as the new Manager of Member and Association services. In her new role, Eileen will manage several of the specialty associations that are within the ACMS umbrella including the American College of Surgeons Southwestern Pennsylvania Chapter and the Pennsylvania Geriatrics Society Western Division. Additionally, Eileen will help support ACMS membership initiatives and programming. Before coming to the ACMS, Eileen was previously the Program Coordinator at the University of Pittsburgh, Division of Geriatric Medicine where she coordinated

the Geriatrics Area of Concentration program for medical students as well as the Clinical Update in Geriatric Medicine. Additionally, she oversaw the procurement of supplies and equipment for the Division’s research studies as well as the Pepper Center research, developmental, and pilot projects and performed monthly reconciliation and annual budget of the Division’s operating and unrestricted accounts. Eileen completed her master’s degree in Public Policy and Management at the University of Pittsburgh, and we are excited to have her insight and expertise in that area. When she’s not working, Eileen enjoys reading, dancing, walking her dog, and spending time with family. Eileen can be reached at etaylor@ acms.org or 412-321-5030 x105.

Thank you for your membership in the Allegheny County Medical Society The ACMS Membership Committee appreciates your support. Your membership strengthens the society and helps protect our patients.

ACMS Bulletin / July 2022

Please make your medical society stronger by encouraging your colleagues to become members of the ACMS. For information, call the membership department at (412) 321-5030, ext. 109, or email acms@acms.org

Society News

In Memoriam

H. Jordan Garber, MD 1954-2022

H. Jordan Garber, MD

Dr. Harold Jordan Garber, 67, of Sewickley, passed away after two years of fighting cancer Tuesday, June 14, 2022. Dr. Garber was born in Queens, NY. He graduated from Yale University in 1976 and worked at Yale Psychiatric Hospital, where he set his path to medicine and went on to graduate cum laude from Loyola Medical School in Chicago in 1982. He did his internship and residency at Massachusetts General Hospital in Boston, and postdoctoral research in brain imaging at the UCLA Neuropsychiatric Institute. From 1996 to 2012, he was selected each year by fellow physicians as one of “The Best Doctors in America: Northeast Region” (Woodward/White). Dr. Garber was a fixture of the medical community in Pittsburgh, having worked at many institutions in the area and serving on executive and IRB committees. He joined ACMS in 1994 and served as a delegate to the Pennsylvania Medical Society for many years. In addition, he was author of numerous research publications. His most recent work was at Encompass Health Rehabilitation Hospital of Sewickley (previously HealthSouth), beginning in 2010. Dr. Garber was an avid jogger and ran several marathons, including the Boston Marathon. He loved the outdoors, hiking and camping with his family and dog. He was a lifelong golfer and a strong proponent of golf course etiquette. Throughout everything, he was known for his sense of humor. In recent years, he rediscovered his love of creative writing, authoring two screenplays. Dr. Garber is survived by his wife, Randi Morgan, son, Max Garber, and brother, Henry (Carol) Garber, of Long Island, N.Y.

Thank you for your membership in the Allegheny County Medical Society The ACMS Membership Committee appreciates your support. Your membership strengthens the society and helps protect our patients. 16

www.acms.org

ACMS Bylaws BULLETIN NOTICE RECOMMENDATION OF CHANGES BYLAWS COMMITTEE

The Executive Committee had charged the Bylaws Committee to review certain items within the Bylaws and correct outdated language. These items were reviewed by the Bylaws Committee on May 3, 2022, and recommended for approval at the Board of Directors meeting on May 10, 2022. Bylaws changes must be read at two consecutive Board of Director meetings and published in the ACMS Bulletin before final approval. The Bylaws Committee recommends the following updates and changes to the ACMS Bylaws: 1. Update language:  Remove “ex-officio members of all committees with right to vote.”  Remove line “Treasurer to present to the Board of Directors a monthly report of receipts and expenditures, be bonded in such sums as shall be directed by the Board of Directors.”  Change Chief Executive Officer to Executive Director.  Remove “all officers are ex-officio members of all committees with the right to vote.”  Remove “The President may also appoint, subject to the approval of the Board of Directors, a Director representing Medical Students and a Director representing Residents with right to vote.” 2. Officer / Committee Appointments  Treasurer will chair Finance Committee, with right to vote.  Secretary will chair ByLaws Committee, with right to vote.  President Elect will chair Nominating Committee, with right to vote.  Eliminate the Vice President office.  Secretary to assume President Elect if vacant position.  If vacancy for Secretary or Treasurer, President could appoint replacement.  Medical student and Residents are welcome to attend Board meetings as non-voting members. 3. Revise Peer Review Board  Change the Peer Review Board to consist of the three immediate past presidents, the most recent to chair. If any of the three immediate past presidents are not available, the succession line of previous past presidents will be contacted until the Peer Review Board consists of three members. 

When a complaint is received at the Society office, it is the discretion of the Secretary to determine if it requires referral to the Peer Review Board.  Any questions regarding the above-noted changes can be directed to the Bylaws Committee through the Society office. [dhostovich@acms.org  412-321-5030].

ACMS Bulletin / July 2022

ACMS Bylaws LINE NUMBER REFERRENCED IN BYLAWS 256

Eliminate Vice President – see Line 394

258

Students and Residents should not be voting members of the board. See line 440.

278

Peer Review – see Line 632.

287 294

Secretary to assume President elect if vacant position. . If a vacancy for Secretary or Treasurer, the President can appoint a successor.

378

Remove line “ex officio member of all committees with the right to vote” for all officers.

387

President Elect to chair Nominating Committee.

394

Eliminate Vice President position.

413

Secretary shall chair Bylaws Committee.

422

Remove “Treasurer to present to the Board of Directors a monthly report of receipts and expenditures, be bonded in such sums as shall be directed by the Board of Directors.”

424

Treasurer shall chair the Finance Committee.

440

Resident & Students – remove as voting members of the Board. They are invited to participate.

511

Change Chief Executive Officer to Executive Director.

636

Update Peer Review. The Peer Review to consist of the three immediate past presidents, most recent to chair. • If any of the three immediate past presidents are not available, the succession line of previous past presidents will be contacted until the Peer Review Board consists of three members. • When a complaint is received at the Society office, it is the discretion of the Secretary to determine if it requires referral to the Peer Review Board.

663

See Attached Redlined Bylaws Red Line = Deletions ADDITIONS/NEW LANGUAGE

www.acms.org

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ACMS Bulletin / July 2022

The name of this organization shall be Allegheny County Medical Society.

ARTICLE I

Rights and Privileges of Membership including Voting Rights

Admission to Membership

Membership Categories

A. Full Active: Persons who hold the degree of Doctor of Medicine or Osteopathy or the equivalent from a recognized accredited medical school, and who hold or are eligible to hold an unrestricted license to practice

Active Member:

Section 3.

To be a member of this Society an individual must be a physician, in training to be a physician, or a student in an accredited school of medicine or osteopathic medicine. The term, physician, means a person who has received formal and recognized training in the art and science of medicine and is qualified to acquire an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania.

Section 2.

Members of this Society shall have all the rights and privileges of membership except as otherwise provided in these Bylaws. No member of this Society of any class shall have any direct vote in the affairs of this Society except as to such matters, if any, where such vote is required by the laws of the Commonwealth of Pennsylvania.

Section 1.

MEMBERSHIP

ARTICLE III

The purposes of this Society shall be to extend medical knowledge and advance medical science; to elevate the standard of medical practice; to promote friendly interactions among physicians; to uphold the ethics and dignity of the medical profession; and may unite with similar societies of other counties to form the Pennsylvania Medical Society; to enlighten and direct public opinion in regard to the problems of public health, and any other problems relating to the practice of medicine so that the profession shall become more useful to the public in the prevention and management of disease and in prolonging and adding comfort to life.

PURPOSES

ARTICLE II

Section2. This society shall have all of the powers usual and incident to organizations of like character which are permitted by the laws and customs of the Commonwealth of Pennsylvania and necessary or appropriate to the fulfillment of its purpose.

Section 1.

NAME

SAMUEL D. FOSTER, Recorder

Recorded in the office for the recording of deeds, etc., in and for said County on the 26 day of April 1919, in charter Book, Vol. 67, page 701. Witness my hand and seal of said office the day and year aforesaid.

ACMS BYLAWS

(https://www.acms.org/bylaws)

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A member admitted by transfer shall not be subject to a membership fee and shall pay no annual dues for the current year provided that he or she has paid the dues to his or her previous society for the current year. A member admitted by transfer from another Pennsylvania County shall be subject to all special assessments that are in effect at the time of his or her admission to membership in this Society.

B. C.

A. Dues for each category of membership shall be designated each year by the Board of Directors upon recommendation of the Finance Committee as stated in Article IV, Section 2.

Fees and Dues

Fiscal Year

ARTICLE IV

Annual Dues

New Membership

Special Assessments Special assessments may be made by the membership at a Business Meeting of the Society provided that previous notice of the proposal has been published in the BULLETIN of the Allegheny County Medical Society for two successive issues prior to the meeting. The assessment and the amount of the assessment for each class of membership shall be determined by a majority of the Active members of the Society in good standing present at the meeting. This assessment shall be uniform within each category of membership.

Section 4.

The dues for the current year of new members shall be pro-rated on a monthly basis for the current fiscal year.

Section 3.

Notice of dues payable January 1 of the next year shall be mailed to the address of record before November 15 of the current year.

Prior to the end of the fiscal year and upon recommendation of the Finance Committee, the Board of Directors shall approve the amount of dues for each category of membership for the following year.

Money for the purposes of the Society shall be raised by annual assessment payable by each member.

Section 2.

The fiscal year of this Society shall begin January 1 and end December 31.

Section 1.

FEES, DUES AND ASSESSMENTS

A physician residing in a community immediately adjacent to Allegheny County may choose to apply for membership in the Allegheny County Medical Society when it is more convenient for the member to attend meetings and take an active part in this Society than in the medical society of their home county.

Section 7. Choice of Membership

A physician applying for membership as a transferee from any other county medical society shall contact either the member’s original component society, the component society into whose jurisdiction the member moves, or the State Society with all pertinent information. The procedure for election to membership shall be the same as set forth in these bylaws. Annual dues shall be prorated making due allowance for dues previously paid by the transferee during the fiscal year.

ACMS Bylaws

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Rejection of Application

Section 6.

Transfer of Membership to the Allegheny County Medical Society

The Secretary shall immediately return the entrance fee and dues to any candidate who has not been accepted for membership. An applicant who has been rejected may not have his or her name presented again within twelve months.

Section 5.

Applications shall be reviewed pursuant to guidelines of the Society to determine whether the applicant meets the qualifications for membership.

Application for membership shall be made to the Secretary of the Society. The applicant shall return to the Secretary the properly executed application form and the required dues.

Procedure for Application and Election to Membership

The Board of Directors may designate other categories of membership which shall not have the right to vote or hold office.

Other Member Categories

An Emeritus member shall be an Active member who has been a member of this Society. A member in this status shall not be engaged in the practice of medicine. They may vote, hold office and serve on any committee.

Retired Member

Any physician who is engaged in professional activities related to the active practice of medicine, but who is not engaged in active practice within Allegheny County. A supporter member may not vote or hold office. A supporter member may serve as a member of any workgroup or committee.

Supporter Member

A. A physician not engaged in active practice may be an affiliate member of this Society and remain as such providing the individual is one of the following: (1) a physician who is a member of a national medical society of a foreign country; (2) an American physician who is engaged in missionary or philanthropic labors who may or may not have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania; (3) a fulltime teacher of medicine or of the arts and sciences allied to medicine who does not have a license to practice medicine and surgery in the Commonwealth of Pennsylvania; (4) a physician who is engaged in research or administrative medicine in Pennsylvania who does not have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania; (5) a physician who is retired from active practice (6) a physician who resides in a state other than Pennsylvania and concurrently maintains active membership in another state medical society.

Associate Member

Medical students enrolled in a medical school approved by this Society are eligible for active membership in this Society. Such students are entitled to all rights and privileges of membership. Medical Students may not vote or hold office except for the member appointed to the Board of Directors.

Section 4.

Residents and fellows serving in residency or fellowship programs approved by this Society are eligible for active membership in this Society. Upon admission to membership, such members shall have the right to vote and hold office in this Society.

medicine and surgery in Pennsylvania, are eligible for active membership in this Society. Upon admission to membership, such members shall have the right to vote and hold office in this Society.

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Reinstatement After Suspension

Reinstatement of a Terminated Membership

Inability to Pay

No Refund of Dues or Assessments

Security of Membership

ARTICLE V

Resignation

Section 3.

Transfer of Residence

Resignation from membership must be presented by the Secretary for action by the Board of Directors.

Section 2.

A member shall retain their membership as long as they comply with the provisions of the Charter and Bylaws of the Society.

Section 1.

TENURE OF MEMBERSHIP

In the event of termination of membership for any cause except transfer, there will be no refund of dues or assessments.

Section 9.

Application for omission or reduction of dues is effective for one year only but may be renewed if warranted. During the year, the member is entitled to all the rights and privileges of the individual’s class of membership in the Allegheny County Medical Society.

In the event a member of this Society is unable to pay dues and/or assessments, the Executive Committee of the Board of Directors is empowered to act upon a petition presented directly or through associates for the omissions of dues. The name of the member shall not be made known to the Society membership.

Section 8.

A member whose membership has been terminated for nonpayment of dues may be reinstated before the end of the fiscal year after payment of the member’s dues. A member whose membership has been terminated for nonpayment of dues and who has not sought reinstatement during the fiscal year in which his or her membership was terminated, may make formal application for membership as in Article III, Section 4.

Section 7.

A member who has been suspended for cause other than nonpayment of dues shall be required to continue the payment of annual dues and assessments without any reduction whatsoever during the period of suspension.

A member suspended for nonpayment of dues may be reinstated after payment of the dues for the current year. The member shall be notified that his or her rights and privileges begin as of the date of reinstatement but are not retroactive to January 1.

Section 6.

A member whose annual dues are not paid prior to the date determined by the Board of Directors shall be delinquent and shall not be in good standing in this Society. No delinquent member shall be entitled to exercise any of the rights and privileges of membership in this Society during the period of delinquency. Notice shall be sent to each delinquent member promptly noting the delinquency and the date upon which membership will be terminated unless membership dues are paid.

Section 5.

ACMS Bylaws

www.acms.org

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ACMS Bulletin / July 2022

Reinstatement

A member desiring readmission to the Society after resignation may apply for new membership as provided in Article III.

A member who has been expelled due to the revocation of such member’s license may apply for readmission to membership as a new member as described in Article III, Section 4, upon reinstatement of such member’s license.

Numbers of Officers and Delegates

Term of Office

Members of the Board of Directors at-large shall be elected for a term of three years. Five Directors shall be elected each year. No Director may serve more than two consecutive full terms.

The President, President-Elect, Vice President, Secretary and Treasurer shall be elected to serve for one year. The President, President-Elect and Vice President shall not be eligible to serve for two consecutive terms. The Secretary and Treasurer are eligible to serve for no more than three consecutive terms.

Section 2.

The officers shall assume their duties on January 1 of the year following election.

Delegates and Alternate Delegates to the Pennsylvania Medical Society shall be elected in the proportion as dictated by Pennsylvania Medical Society Bylaws.

The officers of this Society shall be a President, a President-Elect, a Vice President, a Secretary, a Treasurer and a Board of fifteen Directors elected by the membership-at-large. The President may also appoint, subject to the approval of the Board of Directors, a Director representing Medical Students and a Director representing Residents.

Section 1.

ARTICLE VI

A member who transfers back to Allegheny County from another component society may apply for reinstatement as provided in Article III, Section 6.

OFFICERS AND DELEGATES

A member whose membership has been terminated for non-payment of dues may apply for reinstatement as provided in Article III.

A former member of the Society may be reinstated.

Section 5.

A member who has failed to pay his or her dues by April 1 of the current year shall automatically have his or her membership terminated as of the date he or she no longer qualify for membership. His or her record shall bear the notation “membership terminated for non-payment of dues” and the Pennsylvania Medical Society shall be so notified.

Failure to Pay Dues

A member moving to another state may receive upon request a letter of recommendation.

Section 4.

A member in good standing who moves to another county in Pennsylvania shall have his or her membership transferred to the component society into whose jurisdiction he or she moves in accordance with the bylaws of the Pennsylvania Medical Society.

A. A member who no longer resides or practices in Allegheny County automatically terminates his or her membership in the Allegheny County Medical Society as of the date he or she no longer qualifies for membership.

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Mark the ballot for the designated number of Officers and Delegates in each category. A vote may be made for a candidate for any office whose name does not appear on the official ballot by writing his or her name in the appropriate space. The results of the election shall be reported to the President and to the Secretary. The candidate receiving the plurality of votes shall fill the office. The Delegates and Alternate Delegates shall be listed in order of the votes received. Delegates and Alternate Delegates shall be elected as shall be necessary to complete the full number of Delegates to which the Society is entitled. Those candidates receiving the highest number of votes shall be considered elected until all places are filled.

President

In the absence of the Treasurer, the President shall be empowered to sign duly authorized warrants dispensing funds.

The President shall: preside at the meetings of the Society; shall perform such other duties as parliamentary usage and these Bylaws require. The President shall be a member of the Board of Directors with the right to vote and an ex-officio member of all committees with the right to vote. The President shall appoint all committees of the Society as provided in these ByLaws.

Section 1.

DUTIES OF EXECUTIVE OFFICERS

ARTICLE VIII

Publication of election results – The results of the election shall be published in the first issue of the BULLETIN of the Allegheny County Medical Society following the election.

Resolution of a tie vote – In the event of a tie between candidates for election to any office, the Board of Directors shall select the candidate to fill the office.

4. 5.

No member may cast more than one vote for any candidate for any elective office.

In the event of an increase in the number of authorized Delegates, the President shall appoint such additional Delegates as may be required. The appointments shall be made first from the list of candidates unsuccessful in the preceding election in order of the number of votes received. Additional appointments shall then be made from the list of Alternate Delegates in the order of the votes received. The list of the Alternate Delegates shall then be supplemented by appointment from the Society at-large. In the event of a reduction in the number of authorized Delegates, the appropriate number of Delegates shall be removed from the list of those elected beginning with the Delegate who received the smallest number of votes and continuing in order until the proper number of Delegates has been secured. The list of Alternate Delegates shall be reduced in a comparable manner.

The voting shall be by secret ballot. Voting may be conducted by mail or electronic means. The polls will close at 12:00 p.m. ten days after balloting begins or the next regular business day.

Manner of Elections

Section 5.

All nominations for Officers and Delegates shall be made prior to October 1 and shall be distributed to the members of the Allegheny County Medical Society prior to the distribution of the ballots.

Section 4.

A Nominating Committee of five to seven members, appointed by the President and confirmed by the Board of Directors, will present a slate of candidates by September 1. The Committee may nominate more than the required number of candidates. Additional nominations of candidates may be made in writing prior to October 1. Nominations made in writing shall contain the written permission of the nominees.

ACMS Bylaws

Reinstatement

A member desiring readmission to the Society after resignation may apply for new membership as provided in Article III.

Numbers of Officers and Delegates

Term of Office

Members of the Board of Directors at-large shall be elected for a term of three years. Five Directors shall be elected each year. No Director may serve more than two consecutive full terms.

Section 2.

The officers shall assume their duties on January 1 of the year following election.

Delegates and Alternate Delegates to the Pennsylvania Medical Society shall be elected in the proportion as dictated by Pennsylvania Medical Society Bylaws.

Section 1.

ARTICLE VI

A member who transfers back to Allegheny County from another component society may apply for reinstatement as provided in Article III, Section 6.

OFFICERS AND DELEGATES

A member whose membership has been terminated for non-payment of dues may apply for reinstatement as provided in Article III.

A former member of the Society may be reinstated.

Section 5.

Failure to Pay Dues

A member moving to another state may receive upon request a letter of recommendation.

Section 4.

President

In the absence of the Treasurer, the President shall be empowered to sign duly authorized warrants dispensing funds.

Section 1.

ARTICLE VIII

Publication of election results – The results of the election shall be published in the first issue of the BULLETIN of the Allegheny County Medical Society following the election.

DUTIES OF EXECUTIVE OFFICERS

Resolution of a tie vote – In the event of a tie between candidates for election to any office, the Board of Directors shall select the candidate to fill the office.

No member may cast more than one vote for any candidate for any elective office.

The results of the election shall be reported to the President and to the Secretary. The candidate receiving the plurality of votes shall fill the office. The Delegates and Alternate Delegates shall be listed in order of the votes received. Delegates and Alternate Delegates shall be elected as shall be necessary to complete the full number of Delegates to which the Society is entitled. Those candidates receiving the highest number of votes shall be considered elected until all places are filled.

Manner of Elections

The voting shall be by secret ballot. Voting may be conducted by mail or electronic means. The polls will close at 12:00 p.m. ten days after balloting begins or the next regular business day.

Section 5.

All nominations for Officers and Delegates shall be made prior to October 1 and shall be distributed to the members of the Allegheny County Medical Society prior to the distribution of the ballots.

Section 4.

ACMS Bylaws

www.acms.org

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Organization

ACMS Bulletin / July 2022

Meetings

Duties

The Board of Directors shall have the authority to declare any office vacant if: a member fails to accept the office; neglects to perform the duties of the office; or the office becomes vacant. A successor shall be appointed by the Board of Directors to serve until the next annual election, except as provided elsewhere in these ByLaws.

BULLETIN of the Allegheny County Medical Society

(1) The Board of Directors shall appoint the medical editor for a term of three years upon the recommendation of the Executive Committee. This appointment shall be subject to yearly confirmation at the January meeting of the Board of Directors.

A. Medical Editor

The Board shall provide for and supervise the publication of the BULLETIN of the Allegheny County Medical Society. The Board shall determine the editorial policy and supervise the contents of the publication.

Section 6.

Fifty percent plus one of the voting members of the Board of Directors shall constitute a quorum.

Quorum

The Board of Directors shall elect, suspend, terminate membership and reinstate members of the Society in accordance with the provisions of these ByLaws.

Section 5.

D. The Board of Directors shall receive and approve or disapprove recommendations for action by the Peer Review Board. It shall implement such decisions forthwith.

Any member of the Board of Directors or of the standing committees of the Board not attending three consecutive meetings without due cause shall automatically forfeit the office or committee appointment and the vacancy shall be filled by the Board of Directors to serve until the next regular election.

A. The Board of Directors shall have charge of the general business of the Society and shall have full authority to act upon all matters within the jurisdiction of the Society, except as otherwise provided in these ByLaws.

Section 4.

The Board of Directors shall meet at least four times each year and as necessary. Special meetings of the Board of Directors may be called by the President at any time or upon written request of the majority of the Board. The notice convening a special meeting must state the purpose of the meeting; other matters may be considered only by unanimous vote.

Section 3.

The President-Elect shall serve as Parliamentarian of the Board of Directors. The Secretary of the Society shall serve as Clerk of the Board of Directors and shall keep its record including a register of attendance at its meetings.

The Immediate Past President shall: assume the position of Chair of the Board of Directors at its January meeting. In the absence of the Immediate Past President, the President shall serve as Chair of the Board.

Section 2.

The Board of Directors shall consist of the President, President-Elect, the immediate Past President, Vice President, Treasurer, Secretary, fifteen Directors elected by the Society at-large, a Director representing Medical Students, a Director representing Residents. RESIDENT AND STUDENT REPRESENTATIVES MAY BE INVITED TO ATTEND THE BOARD OF DIRECTORS MEETINGS, WITHOUT THE RIGHT TO VOTE.

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Official Notices

Office of the Society

Executive Director / Chief Executive Officer

Standing Committees of the Board

The ByLaws Committee shall consist of the Vice President SECRETARY and two other members of the Board appointed by the President and confirmed by the Board of Directors. All recommendations for changes in the ByLaws submitted by Officers or members of the Society shall be referred to this Committee for study and recommendation

A. The Finance Committee shall consist of the Executive Committee and three Directors appointed by the President and confirmed by the Board of Directors. It shall have supervision of the funds of the Society. It shall prepare an annual budget and submit it for the Board of Directors no later than November 1, including the recommended amount of dues for each category of membership for the next fiscal year. It shall authorize the payment of bills of an emergency nature and shall recommend the investment of Society funds when requested to do so by the Board of Directors. This Committee shall audit annually the accounts of all the Officers and committees that receive or disburse funds of this Society and shall be authorized to employ a professional accountant for assistance in such audit.

The Executive Committee shall consist of the President, President-Elect, Immediate Past President, Vice President, Secretary and Treasurer. The function of the Committee shall be to regulate the work in the Executive Office of the Society, to the end that the wishes of the Board of Directors are carried out and that the work of the standing and special committees is facilitated. It shall also be a duty of this THE EXECUTIVE Committee to recognize and permanently record the services of the chair and members of all committees from year to year.

The Board of Directors shall have the following Standing Committees:

Section 9.

The Executive Committee shall specify and supervise the duties of the Executive Director / Chief Executive Officer. The Executive Director / Chief Executive Officer shall make monthly reports to the Executive Committee which shall be submitted to the Board of Directors as part of the report of the Executive Committee.

The Executive Director / Chief Executive Officer shall: be in charge of the administrative staff, including appropriate personnel to staff the Society’s publications, and subject to the limitations of the appropriations authorized by the Board; have full authority to engage administrative personnel, to assign their duties and to adjust their salaries with such job classifications and salary scales as may be approved by the Board of Directors.

Section 8.

The Board of Directors shall provide an office for the Society and shall employ an Executive Director / Chief Executive Officer.

Section 7.

The proceedings of this Society, and those of the Board of Directors, after approval by the Board for publication, shall be published as soon as practicable in the BULLETIN of the Allegheny County Medical Society. Authorized notices of this Society shall be official when published therein. Any paper, communication, or transaction may be published in whole, or in part, excepting official notices and proposals to amend the ByLaws which must be published in full.

The Medical Editor and the Associate Editors shall constitute the Editorial Board and shall be responsible to the Board of Directors for the editorial policy of the BULLETIN of the Allegheny County Medical Society. The Medical Editor shall serve as Chair of the Editorial Board.

(2) The Medical Editor shall recommend Associate Editors to the Board of Directors for appointment for a term of two years. There shall be a total of eight Associate Editors, four to be appointed each year by the Board of Directors. An Associate Editor may serve three consecutive terms.

ACMS Bylaws

546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600

A special committee may have a budget as shall be determined annually by the Board of Directors.

Expenditures

The Board of Directors shall adopt an annual budget prepared by the Finance Committee showing the proposed allotment of funds in the various categories of authorized expenditures.

Section 1.

Composition and Election

DELEGATION TO THE PENNSYLVANIA MEDICAL SOCIETY

ARTICLE X

A board member or officer of the Society shall not be personally liable for money damages as such for any action taken or failure to take action as a director or officer unless the member’s or officer’s action constitutes self-dealing, willful misconduct or recklessness, or unless liability is imposed pursuant to criminal statute or for payment of taxes. The Board of Directors may provide for indemnification of Board members and officers to the extent allowed by law.

Liability of Board Members and Officers

No expenditure may be made in excess of the amount specified for that purpose by the Board of Directors.

Section 12.

D. Special appropriations may be authorized in accordance with specific resolutions of the Board of Directors.

The Board of Directors shall designate the amounts of the honoraria for the Medical Editor of the BULLETIN of the Allegheny County Medical Society and the salary of the Executive Director / Chief Executive Officer.

A. All motions for expenditures of the monies of this Society shall originate in the Board 0f Directors.

Section 11.

The Chair of each special committee shall submit to the Board of Directors for its last meeting of the fiscal year a written report summarizing the activities of the committee during the year and recommendation for the continuation or dissolution of the committee.

The Chair of a committee which is entitled to a budget shall certify all charges made against the budget before payment is made. No expenses beyond the limit of the allotted budget may be incurred without specific authorization of the Board of Directors. The Chair of a committee which is entitled to a budget shall submit a request for an annual budget to the Chair of the Finance Committee on or before September 1 of each year. Sufficient detail must be provided to permit adequate analysis for the request for funds.

All special committees shall be terminated as of December 31 each year. The Board of Directors at its last meeting of the fiscal year shall reinstate or discontinue the individual special committees in accordance with the current needs of the Society.

A. The Chair and members of such committees shall be appointed from the membership at-large by the President.

The Board of Directors shall have the authority to constitute such special committees as may be required to accomplish the purposes of the Society.

Special Committees of the Board

The Nominating Committee shall be appointed as described in Article VIII, Section 3.

Section 10.

to the Board of Directors. It shall be the duty of this Committee to re-examine the ByLaws as necessary and to recommend to the Board of Directors such revisions as may be indicated.

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Meetings

Duties

Report

Composition and Election

No member of the Peer Review Board shall be a member of the Board of Directors of the Allegheny County Medical Society.

The members of the Peer Review Board are not eligible to serve more than one term.

The Peer Review Board shall consist of six members, two to be elected annually for a term of three years THREE OF THE IMMEDIATE PAST PRESIDENTS, THE MOST RECENT TO CHAIR. IF ANY OF THE THREE IMMEDIAE PAST PRESIDENTS ARE NOT AVAILABLE, THE SUCCESSION LINE OF PREVIOUS PAST PRESIDENTS WILL BE CONTACTED UNTIL THE PEER REVIEW BOARD CONSISTS OF THREE MEMBERS.

ARTICLE XI

Meetings

It shall have access to legal counsel.

Section 3.

The Peer Review Board shall have the right, subject to the limitations of these ByLaws, to adopt reasonable rules and regulations.

Section 2. Organization 1. Each member shall serve as Chair for six months in the last year of his or her term.

Section 1.

PEER REVIEW BOARD

The Chair of the Delegation shall submit a report in writing to the Board of Directors following the Annual meeting. This report shall summarize the important actions of the Delegation at the Annual Meeting of the Pennsylvania Medical Society.

Section 5.

The Delegation to the Pennsylvania Medical Society has the responsibility of representing the members of the Allegheny County Medical Society to the House of Delegates of the Pennsylvania Medical Society. It shall have the further duty of presenting to the House of Delegates the resolution(s) presented to it by the Board of Directors of the Allegheny County Medical Society.

Section 4.

Meetings of the Allegheny County Delegation shall be held each year at the call of the Chair of the Delegation of the Allegheny County Medical Society or upon request by five members of the Delegation.

Section 3.

The Delegation shall elect its own Chair and Vice Chair annually. The Delegation shall have the right, subject to the limitations of these bylaws, to adopt reasonable rules and regulations except that the majority may not rule that unit voting must be followed.

Section 2.

The Delegation of the Allegheny County Medical Society to the Pennsylvania Medical Society shall consist of the number of Delegates and/or Alternates appropriate for the number of Active members in the Allegheny County Medical Society. The Delegates shall be elected for a term of two years, one half of the number being elected each year. The elected Delegates shall take office as of January of the year following their election.

ACMS Bylaws

www.acms.org

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ACMS Bulletin / July 2022

The Peer Review Board shall investigate written allegations of ethical violations or unprofessional conduct on the part of a member of the Allegheny County Medical Society made by a physician or physicians.

The Peer Review Board shall investigate written allegations made by a physician or physicians that a member of the Allegheny County Medical Society has acted in a manner which discredits the members of the society.

It shall have the duty, at its discretion, to investigate general professional conditions and all matters pertaining to the relations of physicians to one another and to the public and to make such recommendations to the Board of Directors as it deems necessary.

It shall review all applications for reinstatement of membership described in Article IV, Section 7, and make appropriate recommendations to the Board of Directors.

It shall have jurisdiction on all questions of medical ethics and of interpretation of the bylaws of this Society.

It shall investigate all disputed elections. It shall consider and report to the Board of Directors upon any matter referred to it in writing by the Board of Directors or by a petition signed by ten Active members of the Society.

Responsibility of the Society

Records

Annual Report

The Chair shall submit an annual report to the Board of Directors. The Board of Directors shall determine the publication of this report.

Section 9.

The records of the Peer Review Board shall remain in the custody of the Society. They shall be retained for three years and then destroyed.

Section 8.

The Society shall assume all responsibility for the actions of the Peer Review Board.

Section 7.

Decisions and recommendations of the Peer Review Board shall be made to the Board of Directors for consideration and action at the next Board meeting. Implementation procedures shall start within thirty days of the action of the Board of Directors.

Decisions

The Peer Review Board is authorized to summon any member of the Society to appear before it and, having been summoned and failing to appear, such member shall be held in contempt and shall be reported to the Society with the recommendation that the member be reprimanded, suspended or expelled.

Section 6.

The Peer Review Board is authorized to recommend that disciplinary action be taken by the Board of Directors.

Authority

WHEN A DISPUTE IS RECEIVED AT THE SOCIETY OFFICE, IT IS THE DISCRETION OF THE SECRETARY TO DETERMINE IF IT REQUIRES REFERRAL TO THE PEER REVIEW BOARD.

Section 5.

The Peer Review Board shall assist in the settlement of disputes between members of the Allegheny County Medical Society.

Duties

Section 4.

Meetings of the Peer Review Board shall be held at the discretion of the Chair.

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General Rules for All Disciplinary Proceedings

Conduct of a Hearing

(5) Presentation of the charges shall be made by the Chair of the Peer Review Board or a representative who is also a member of the Peer Review Board.

(4) The presence of a majority of the members of the Board of Directors shall constitute a valid meeting.

(3) The Secretary of the Society shall make a record of the hearing.

(2) The Chair of the Board of Directors shall serve as the presiding officer with the right to vote in case of an indecisive vote.

(1) All hearings on disciplinary matters shall be conducted before the Board of Directors in a meeting especially convened for the purpose, which is composed of the President, President-Elect, Vice President, Secretary, Treasurer, Immediate Past President, and voting members of the Board of Directors. The members of the Peer Review Board shall be requested to attend but shall not have the right to vote. Voting members are the named officers and members of the Board of Directors.

Section 4.

All rules and regulations shall apply equally to all classes of membership.

A written copy of the charge or charges shall be sent to the member concerned by certified mail, to the address which appears on the Society records, at least thirty days prior to the date of a hearing. The date and place of the hearing shall be set forth thereon.

All disciplinary proceedings against a member shall be ordered by the Board of Directors after investigation and recommendation by the Peer Review Board. The charge or charges upon which the proceeding is based shall be in writing and in sufficient detail to enable the member to properly defend the charges

Section 3.

The Pennsylvania Medical Society may assume jurisdiction, in accordance with its bylaws, with the consent of the Board of Directors of the Allegheny County Medical Society. The American Medical Association may assume jurisdiction if the accused member is also a member of the American Medical Association, in accordance with its bylaws, with the consent of the Board of Directors of the Allegheny County Medical Society.

The Allegheny County Medical Society holds primary jurisdiction in all matters pertaining to the discipline of a member.

Section 2. Jurisdiction

(1) Conviction for a statutory offense against the State or Federal Government; (2) Revocation of license to practice medicine; (3) Violations of the bylaws of this Society; (4) Violations of the Principles of Medical Ethics of the American Medical Association; (5) Conduct or actions which tend to bring discredit on the membership of the Allegheny County Medical Society, including ethical violations and unprofessional conduct as determined by the Peer Review Board; (6) Failure by a member to notify the Society of a change in the status of such member license to practice medicine.

The following causes may be considered sufficient for the initiation of disciplinary action against a member of the Society.

Section 1.

CHARGES AND DISCIPLINE

ARTICLE XII

ACMS Bylaws

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Penalties

In the absence of an appeal, the effective date of the decision shall be thirty days after the date of notification of the member by certified mail as in Paragraph 1.

The penalty imposed shall be that penalty recommended by the Board of Directors following disciplinary proceedings in accordance with this Article, except that any member whose license to practice medicine is suspended or revoked by the Pennsylvania State Board of Medicine shall be automatically expelled from membership in the Society unless such suspension or revocation is being appealed. If such suspension or revocation is being appealed, such member shall be automatically suspended from membership in the Society until all appeals have been exhausted. Upon a final appellate decision affirming the suspension or revocation of a member’s license to practice medicine, such member shall be automatically expelled from membership in the Society. Upon a final appellate decision reinstating such a member’s license, such member shall be automatically reinstated as a member in good standing of the Society.

The decision of the Board of Directors shall be sent by the Secretary to the member concerned in writing by certified mail within forty-eight hours of the meeting.

Effective Date of Decisions

Section 7.

Appeals

(4) When the effective date of a disciplinary action has been determined, the Secretary shall notify the member concerned, and the Secretary of the Pennsylvania Medical Society.

(3) In the event of an appeal from the decision of the Board of Directors, the effective date shall be determined by the Board of Directors of the Society after the disposition of the appeal or the expiration of the appeal period.

(2)

Section 6.

In the event of a conviction the penalty may be (1) reprimand, (2) suspension, or (3) expulsion. ‘Reprimand’ shall he interpreted to mean an admonishment to the accused to change the member’s conduct in order that the member may not bring unfavorable criticism upon the medical profession or the individual. ‘Suspension’ shall be interpreted to mean to cause a temporary loss of all rights and privileges of membership. Said suspension shall not be deemed to affect the continuity of membership of said member for purposes of the member becoming other than an Active member. Dues are payable during a suspension. ‘Expulsion’ shall be interpreted to mean an involuntary termination of membership.

Section 5.

(12) In the event of a conviction, a two-thirds vote of the members of the Committee present shall determine the penalty.

(11) A majority vote of the members of the Board of Directors present shall be necessary for a conviction.

(10) The Board of Directors shall not be bound by the rules of evidence used in courts and may receive such oral or written evidence as in their judgment will best and most fairly present the relevant facts.

(9) Members who are not specifically designated by the Peer Review Board or by the defense shall be granted the privilege of the floor only at the discretion of the presiding officer and only for the purpose of presenting pertinent facts not otherwise available.

(8) The hearing shall be open to all Active members of the Society. No other persons except designated employees of the Allegheny County Medical Society may be present.

(7) A hearing may be conducted in the event of the voluntary absence of the defendant. In this event, the defense presented by the defendant’s chosen or assigned colleagues, as described in Section 6, shall be considered adequate.

(6) The defense may be made by one or two Active members of the Society who have been selected by the defendant.

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Business Meetings

Annual Installation of Officers

Special Meetings

Quorum

Vote by Mail

ARTICLE XIV

A vote may be authorized by the Board of Directors upon a written petition signed by fifty Active members.

When a matter is, in the opinion of the Board of Directors, of sufficient gravity, the Board of Directors may authorize a poll of the membership by mail or electronic ballot as permitted by Pennsylvania law to confirm or reject the decision of the Board of Directors. A recorded negative vote of 51 percent of the membership entitled to vote (regardless of the number of votes cast) shall be required to reject a decision of the Board of Directors. Ballots must be returned within two weeks.

Section 5.

In the absence of a quorum, a special meeting of the Board of Directors shall be convened forthwith. This meeting of the Board of Directors shall have the authority to transact all the specified business of the Society including the nominations and elections required by the bylaws of the Society. Matters transacted at this special meeting of the Board of Directors shall be regarded as approved by the membership of the Society. For this special meeting of the Board of Directors, 75 percent of the members of the Board of Directors shall constitute a quorum.

Fifty Active members present shall constitute a quorum for a Business or Special Meeting.

Section 4.

A Special Meeting of the Society may be called by the President, as directed by the Board of Directors, or upon the written request of fifty Active members. Notice of the meeting shall be provided to all members prior to the meeting, or by electronic communication. The notice shall state the purpose of the meeting. Other matters may be considered at a Special Meeting only by the unanimous consent of those members present.

Section 3.

Officers shall assume office January 1 of each year.

Section 2.

Regular Business Meetings of the Society shall be held when convened by the Board of Directors.

Section 1.

MEETINGS

ARTICLE XIII

A member who has been expelled may apply for an initial membership as provided in Article IV, Section 7, after the expiration of two years.

A member who has been suspended may apply for reinstatement as provided in Article IV, Section 7.

Section 8.

(2) In the event that the defendant is also a member of the American Medical Association, an appeal from the Judicial Council of the Pennsylvania Medical Society to the Judicial Council of the American Medical Association may be made as described in the bylaws of the Pennsylvania Medical Society and the ByLaws of the American Medical Association.

(1) A defendant shall have the right of appeal from the decision of the Board of Directors to the Pennsylvania Medical Society within thirty days of his or her notification.

ACMS Bylaws

www.acms.org

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Standing Committees

ACMS Bulletin / July 2022

Appointment

Organization

Finances

Meetings

Reports

Notices

Seal

Section 3.

Execution of Documents

The seal of this Society shall contain the following: In the center a Caduceus surrounded by a circle containing the words. “Organized 1865 Incorporated January 30th 1892” and an outside circle containing the words: “Allegheny County Medical Society, Pennsylvania.”

Section 2.

The term “notice” as used in these bylaws shall mean a communication written, printed, or published in the BULLETIN of the Allegheny County Medical Society which is sent to the last recorded address of a member.

Section 1.

MISCELLANEOUS

ARTICLE XV

The Chair of each Committee shall submit a written report to the Board of Directors as necessary, or upon request of the Board.

Section 6.

A committee shall meet at the call of the Chair. The presence of a majority of the members of a committee shall constitute a quorum. A report of these meetings shall be submitted to the Board of Directors when action is required.

Section 5.

A Committee may have a budget as will be determined annually by the Board of Directors. No expenses beyond the limit of the allotted budget may be incurred without the specific authorization of the Board of Directors.

Section 4.

The Chair and members of each committee shall be appointed yearly by the President-Elect as described in Article IX, Section 2. The committee shall make its own rules provided that these rules are not in conflict with the ByLaws of the Society.

Section 3.

The President, President-Elect, Vice President, Secretary and Treasurer of the Allegheny County Medical Society are exofficio members of all Standing Committees with the right to vote.

Appointments to a Committee shall be for a term of one year.

Section 2.

The President, with the approval of the Board of Directors, shall create ad hoc committees for a term of one year. The Board of Directors may also instruct the President to appoint specific committees.

Number

Standing Committees shall be: Executive, Finance, Nominating and Bylaws.

Section 1.

STANDING AND OTHER COMMITTEES

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Supercedence

Affiliations

Legal Counsel

Right to Petition

Right to Receive and Administer Special Funds

Honorary Members of Committees

Section 12.

Rule of Order

The Board of Directors is authorized to appoint non-members of the Allegheny County Medical Society to Honorary membership on special committees when it is deemed in the best interest of the Society.

Section 11.

The Board of Directors is authorized to accept in the name of the Allegheny County Medical Society specific funds and bequests consistent with purposes of this Society and to administer such funds in accordance with the terms set forth.

Section 10.

Members of the Allegheny County Medical Society shall have the right to petition the Board of Directors on any matters dealing with the operation of the County Society. A petition shall be in writing, addressed to the Secretary of the Society and signed by one or more Active members of the Society. It shall state clearly and succinctly the matter for consideration. This petition shall be considered at the next regular meeting of the Board of Directors at which time the petitioner is entitled to a personal appearance on behalf of the petition. At the discretion of the Board of Directors, such a petition may be presented at the next regular Business Meeting of the Society.

Section 9.

The Board of Directors is authorized to appoint legal counsel and may pay such counsel an annual retainer fee. The counsel shall consider all matters formally referred to them by the Board of Directors, the Executive Committee, and the Peer Review Board.

Section 8.

The Board of Directors is authorized to engage jointly with other organizations in enterprises, which in the opinion of the Board of Directors, will help promote the purposes of this Society as described in Article II.

The Board of Directors is authorized to affiliate by acquiring membership and paying required dues in local, state or national organizations, which in the opinion of the Board of Directors, will help in the promotion of the purposes of this Society as described in Article II.

Section 7.

All bylaws previously adopted are hereby repealed and any rules, standing resolutions or decisions of the Chair previously rendered, which may in any manner interfere with the intent and purpose of the ByLaws or are inconsistent therewith, are hereby repealed and declared to be invalid.

Section 6.

The proposal shall be referred to the Bylaws Committee for examination and recommendation to the Board of Directors. If approved by the Board of Directors, the proposal shall be published in full together with the names of the proposers in the BULLETIN of the Allegheny County Medical Society which immediately precedes the Business Meeting at which the amendment is to be considered.

A proposal to amend any Portion, Section or Article of the bylaws may be initiated by a petition submitted to the Secretary in writing and signed by twenty-five (25) Active members or by action of the Board of Directors.

Section 4.

The President shall execute on behalf of the Society under its seal any bond, deeds, mortgages, or other contracts approved by the Board of Directors or the membership at a regular or special Business meeting.

ACMS Bylaws

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APPROVED AND ACCEPTED: ACMS Board of Directors September 20, 2005

APPROVED AND ACCEPTED: ACMS Board of Directors December 5, 2017

APPROVED AND ACCEPTED ACMS Board of Directors September 11, 2018

APPROVED AND ACCEPTED ACMS Board of Directors September 10, 2019



2021 Allegheny County Medical Society 850 Ridge Avenue Pittsburgh, PA 15212 412-321-5030  acms@acms.org

These changes were read for the first time at The May 10, 2022 Board of Directors Meeting

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The most recent version of Robert’s Rules of Order, shall determine all points of order not provided for in these bylaws.

ACMS Bylaws

www.acms.org

SAVE THE DATE! MPHC 2022, a premier educational event for medical practice administrators and their office personnel, provides a robust engagement opportunity to discuss the challenges facing medicine and to leave with innovative strategies to improve practices!

Conference Highlights include:  Conference Kickoff and Closing Keynote: by Jordan Corcoran, CEO & Creator: ListenLucy.org - Don’t miss this timely presentation on mental health in the workplace. Jordan candidly discusses her battle with mental illness in a relatable, honest, and informal way. Attendees will come away with self-care and coping techniques to share with staff.  Legislative and Regulatory Update: presented by a Pennsylvania Medical Society Advocacy team staff member, you’ll receive exclusive insight following the 2022 midterm elections.  Idea Exchange! Connect with your colleagues to share professional experiences and solutions to your most challenging professional issues.  Payor Help Support Desk: an exclusive opportunity to meet with insurance payors to discuss your practice's pain points. Time slots must be reserved and open only to MPHC 2022 attendees.

KEYNOTE SPEAKER

REGISTRATION BEGINSAUGUST AUGUST10th 10th REGISTRATION BEGINS

Wednesday, NOVEMBER 16, 2022 The Westin Pittsburgh 1000 Penn Ave Pittsburgh, PA, 15222

Materia Medica

Treating Insulin-Induced Hypoglycemia with Confidence: Dasiglucagon (Zegalogue®) Karen M. Fancher, PharmD, BCOP Type 1 diabetes mellitus (T1DM), once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin.1 When the body does not have enough insulin or cannot use it properly, glucose accumulates in the blood and can result in a variety of shortand long-term health complications.2 Approximately 1.6 million Americans have T1DM, including about 200,000 youth (under 20 years of age) and 1.4 million adults.3 Up to five million people in the United States are expected to have T1DM by 2050, including nearly 600,000 youth. As pancreatic β-cell function declines in patients with T1DM, exogenous insulin is required to achieve glycemic control.4 Administration of exogenous insulin is central to the management of T1DM, but hypoglycemia often occurs; it is estimated that 30-40% of patients with T1DM experience one to three episodes of severe hypoglycemia per year. Severe hypoglycemia requires prompt medical intervention to prevent potentially life-threatening complications such as seizure, loss of consciousness and coma.5 Further, multiple hypoglycemic episodes may have negative longterm consequences on growth and development in pediatric patients.

Patients with T1DM who experience severe hypoglycemia are typically treated with glucagon, a wellestablished first-line treatment.5,6 The American Diabetes Association treatment guidelines recommend that glucagon is prescribed for all individuals at increased risk for clinically significant hypoglycemia, and pediatric guidelines recommend that an unexpired glucagon rescue kit be readily accessible to all patients and their caregivers.5,7,8 However, native glucagon is unstable and rapidly degrades in aqueous solutions, and therefore commercially available glucagon emergency kits contain a lyophilized powdered glucagon that must be reconstituted using multiple complex steps prior to injection. The reconstitution process represents a significant barrier to timely, accurate and effective administration of this emergency product.5,6,9 Therefore, a stable ready-to-use formulation is of great interest.4 Dasiglucagon (Zegalogue®) is a glucagon analogue with improved solubility and stability in aqueous liquid. Dasiglucagon was approved by the United States Food and Drug Administration in March 2021 for the treatment of severe hypoglycemia in adult patients with diabetes and in pediatric patients with diabetes who are six years of age or older.6,10

Dasiglucagon Dasiglucagon is a novel peptide analogue of human glucagon. It acts as a glucagon receptor agonist, increasing the release of glucose from the liver and stimulating glycogen breakdown. This anti-hypoglycemic effect is dependent on hepatic glycogen stores.6,11 Dasiglucagon is comprised of 29 amino acids, with seven substitutions compared to native glucagon.4 The substitutions result in increased solubility and stability while maintaining specificity for the glucagon receptor.6,9 In addition, it has a higher absorption rate and longer plasma elimination half-life than traditional reconstituted glucagon.12

Clinical Studies The efficacy of dasiglucagon for the treatment of severe hypoglycemia in patients with T1DM was demonstrated in a randomized, double-blind, phase III trial.9 In this study, 170 adult patients with T1DM were randomized 2:1:1 to receive subcutaneous dasiglucagon, reference glucagon (GlucaGen®) or placebo during controlled insulininduced hypoglycemia. The primary endpoint was time to plasma glucose recovery, defined as an increase of ≥20 mg/dL from baseline without rescue intravenous glucose. The median time to plasma glucose recovery was 10 www.acms.org

Materia Medica minutes with dasiglucagon compared with 40 minutes for placebo (p < 0.001); the corresponding result with reference glucagon was 12 minutes. After 10 minutes, 65% of patients in the dasiglucagon group had recovered, compared with 49% of patients in the reference glucagon group. After 15 minutes, 99% of dasiglucagon patients had recovered their plasma glucose compared to 2% of placebo patients; this difference was statistically significant (p < 0.001). Similar outcomes were observed at other timepoints, including 10, 20 and 30 minutes after dosing. A second randomized, doubleblind, phase III trial of dasiglucagon was conducted in 45 adult patients with T1DM.13 This study enrolled patients aged 18-70 years with a glycosylated hemoglobin <10% who had been receiving insulin for one year or more. Patients were randomized to dasiglucagon or placebo in a 3:1 ratio, with the primary endpoint of median time to plasma glucose recovery, defined as an increase in plasma glucose of ≥20 mg/dL from baseline after induction of hypoglycemia. The median time to plasma glucose recovery was significantly shorted with dasiglucagon than with placebo (10 minutes vs 35 minutes, p < 0.0001). In addition, significantly more dasiglucagon recipients experience plasma glucose recovery within 10 minutes compared to placebo recipients (62 vs 0%, p ≤ 0.001). The increase in plasma glucose from baseline was also significantly higher with dasiglucagon than with placebo at all time points (p ≤ 0.001). In pediatric patients, dasiglucagon was compared to placebo and reconstituted glucagon in a ACMS Bulletin / July 2022

randomized, controlled, phase III trial.5 In this study, 42 patients aged 6-17 years with T1DM were randomly allocated in a 2:1:1 ratio to dasiglucagon, reconstituted glucagon or placebo during insulin-induced hypoglycemia. The primary endpoint was time to plasma glucose recovery, defined as an increase of ≥20 mg/ dL from baseline without rescue intravenous glucose, in dasiglucagon vs placebo; reconstituted glucagon was used as a reference. The median time to plasma glucose recovery was statistically significantly shorter in the dasiglucagon group compared to the placebo group (10 minutes vs 30 minutes, p < 0.001). The median time to plasma glucose recovery in the reference glucose group was also 10 minutes, but this time did not include the time taken to reconstitute the lyophilized powder. Plasma glucose recovery occurred within 20 minutes in 100% of patients who received dasiglucagon, compared to 18% of patients who received placebo.

Adverse Effects Dasiglucagon was generally well-tolerated in all clinical trials.10 In adults, adverse effects occurring with 12 hours of administration were nausea (57%), vomiting (25%), headache (11%), diarrhea (5%), and injection site pain (2%). In trials in pediatric patients, the most common adverse effects included nausea (65%), vomiting (50%), headache (10%), and injection site pain (5%). However, it should be noted that administration of glucagon products is known to cause nausea and vomiting, so these adverse effects are not surprising. Other adverse

effects that occurred within 12 hours of treatment included hypertension, hypotension, bradycardia, presyncope, palpitations and orthostasis. There were no serious drug-related adverse effects noted in clinical trials, and no adverse effects leading to treatment discontinuation were reported.6 As will all therapeutic peptides, dasiglucagon is potentially immunogenic. In clinical trials, <1% of patients developed treatmentemergent anti-drug antibodies (ADAs). No safety or efficacy concerns were noted in these patients, although it is currently unknown whether these ADAs affect pharmacokinetics, pharmacodynamics, safety and/or efficacy of dasiglucagon.10,12

Practical Considerations Dasiglucagon is available as a solution for subcutaneous injection in a single-use autoinjector or prefilled syringe. 6,10 The recommended dose is 0.6 mg administered into the outer upper arm, lower abdomen, buttock or thigh. If no response is observed after 15 minutes, a second dose of 0.6 mg may be administered from a new device. Dasiglucagon can be stored in the refrigerator for up to three years or can be kept at room temperature between 68o and 77o Fahrenheit for up to one year.10 The product should be stored in the provided protective case and protected from light. The product is provided in a single package that contains two devices of 0.6 mg each; it should be clearly explained to patients and caregivers that the full dose is provided in one device. Continued on Page 32

Materia Medica From Page 31

Future Directions

There are several ongoing clinical Due to dasiglucagon’s effect trials of dasiglucagon in various phases on liver glycogen, patients with and clinical settings:5,15 starvation, adrenal insufficiency, or • A phase III extension study examining chronic hypoglycemia may not have the long-term safety and efficacy of sufficient liver glycogen levels for dasiglucagon in children aged six dasiglucagon to be effective.12 Patients weeks to thirteen years with with these conditions should be congenital hyperinsulinemia who treated with glucose.10,11 Additionally, completed one of two lead-in trials. since glucagon products stimulate the release of catecholamines from tumors, • A phase II/III trial is investigating the dasiglucagon should not be used in efficacy and safety of dasiglucagon patients with pheochromocytomas in children under the age of one year or insulinomas. with congenital hyperinsulinism. Several drug-drug interactions have been noted and may be clinically • A phase II trial is evaluating the efficacy, safety and feasibility of significant.10 Patients taking betalow dose dasiglucagon to prevent or blockers may experience a transient treat episodes of mild hypoglycemia increase in pulse and blood pressure in patients with T1DM who use an when given dasiglucagon; patients insulin pump should be monitored and treated as clinically indicated. Similarly, • Two other phase II trials are patients who are taking warfarin examining the use of dasiglucagon should be frequently monitored, as for the treatment postprandial dasiglucagon may increase warfarin’s hypoglycemia after Roux-en-Y anticoagulant effects. In patients taking gastric bypass surgery. indomethacin, dasiglucagon may lose its ability to raise blood glucose or may even produce hypoglycemia. Careful observation of glucose levels and appropriate intervention is recommended in this scenario. Zealand Pharma ConnectedCare is a commercial patient support program that is available through the product manufacturer.14 The program can assist patients with determining insurance coverage, co-pay savings, and home delivery of the product. The program is available at to both patients and healthcare providers at https://www. zegalogue.com/savings-and-support/ .

Summary Dasiglucagon is a novel peptide analog of human glucagon, which can effectively rescue insulin-induced severe hypoglycemia.12 Three phase III trials have demonstrated the superiority of dasiglucagon over placebo in the time to plasma glucose recovery in adult and pediatric patients with T1DM who experienced hypoglycemia. Although no significant difference existed in the time of plasma glucose recovery for hypoglycemia between dasiglucagon and marketed glucagon in these studies, the readyto-use formulation of dasiglucagon potentially decreases time to blood glucose rescue and likely increases the user or caregiver’s confidence in proper administration.9 Adverse effects are similar between dasiglucagon and marketed glucagon, with the most commonly reported events of gastrointestinal nature and in short duration.4,9 The reliability, safety and convenience of this product represents an advance in the management of patients with T1DM and may result in fewer cases of severe hypoglycemia that require additional medical intervention. Dr. Fancher is an Associate Professor of Pharmacy Practice at Duquesne University School of Pharmacy. She also serves as a Clinical Pharmacy Specialist in Oncology at the University of Pittsburgh Medical Center at Passavant Hospital. She can be reached at fancherk@duq.edu or (412) 396-5485.

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Materia Medica REFERENCES 1. Mayo Clinic. Type 1 diabetes. Available at https://www.mayoclinic. org/diseases-conditions/type-1diabetes/symptoms-causes/syc20353011 . Accessed June 9, 2022. 2. Center for Disease Control and Prevention. Diabetes basics. Available at https://www.cdc. gov/diabetes/basics/index.html . Accessed June 9, 2022. 3. Juvenile Diabetes Research Foundation. Type 1 Diabetes Facts. Available at https://www.jdrf.org/t1dresources/about/facts/ . Accessed June 9, 2022. 4. Li S, Hu Y, Tan X, et al. Evaluating dasiglucagon as a treatment option for hypoglycemia in diabetes. Expert Opin Pharmcother. 2020;21:1311-18. 5. Battelino T, Tehranchi R, Bailey T, et al. Dasiglucagon, a next-generation ready-to-use glucagon analog, for treatment of severe hypoglycemia in children and adolescents with type 1 diabetes: Results of a phase 3, randomized controlled trial. Pediatr Diabetes. 2021;22:734-41.

ACMS Bulletin / July 2022

6. Blair HA. Dasiglucagon: First approval. Drugs. 2021;81:1115-20. 7. American Diabetes Association. Glycemic targets: Standards of medical care in diabetes – 2020. Diabetes Care. 2020;43:S66-76. 8. Abraham MB, Jones TW, Naranjo D, et al. ISPAD clinical practice consensus guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2018;19:178-92. 9. Pieber TR, Aronson R, Hövelmann U, et al. Dasiglucagon: A nextgeneration glucagon analog for rapid and effective treatment of severe hypoglycemia results of phase 3 randomized double-blind clinical trial. Diabetes Care. 2021;44:1361-7. 10. Zegalogue [prescribing information]. Søborg, Denmark: Zealand Pharma A/S, 2021.

11. Dasiglucagon hydrochloride. Am J Health-System Pharm. 2021;78:1351-3. 12. Xu B, Tang G, Chen Z. Dasiglucagon: an effective medicine for severe hypoglycemia. Eur J Clin Pharmacol. 2021;77:1783-90. 13. Bailey TS, Willard J, Klaff LJ, et al. Dasiglucagon hypopal auto-injector as a fast and effective treatment for severe hypoglycemia: Results of a phase 3 trial. Diabetes. 2020;69(Suppl 1). 14. Zealand Pharma. Convenient access to ZEGALOGUE® (dasiglucagon) injection. Available at https://www.zegalogue.com/ savings-and-support/ . Accessed June 9, 2022. 15. U.S. National Library of Medicine. Clinicaltrials.gov. Available at https://clinicaltrials.gov/ . Accessed June 9, 2022.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

Legal Summary

PRIVATE EQUITY DEALS OFFER BOTH POTENTIAL SIGNIFICANT RETURN AND SIGNIFICANT CHALLENGES Mike Cassidy, Esq., Tucker Arensburg PC If history actually does repeat itself for those who ignore it, then physicians should be cautious about the emerging trend for private equity acquisition of physician practices, because the current private equity resurgence could well be Physician Practice Management Company (PPM) 2.0. One newsletter suggests private equity may be repeating the mistakes of the physician practice management companies of the late 1990s, many of which ended up in litigation and high profile bankruptcies, providing this historical perspective: “With its explosive rise in popularity, the PPM sector alone grew to over 30 publicly traded companies with an aggregate market capitalization in excess of $11 billion at its peak in January 1998. However, by 2002, eight of the 10 largest publicly traded PPMs had declared bankruptcy and many more were ultimately dissolved.” The concept is similar: multiple physician practices, either in a specific area or of a specific specialty, are acquired by non-physician venture or private equity companies, sometimes referred to as “roll-up” transactions, and the structure is fairly standard:

• The practices are acquired with a combination of cash and equity in the private equity vehicle (PEV) • The physicians sign long-term employment contracts • Depending upon state corporate practice of medicine laws, the acquired practices are either operated and managed by the PEV, or execute long-term management agreements The value proposition of these deals, both in the past and present, is the goal of increasing the profitability of the practice through scaling and patient volume, economies of scale for expenses and infrastructure, and more professional management. The fundamental challenge with this concept, especially in regions with either highly concentrated institutional healthcare delivery systems or dominant third party insurers, or a combination thereof, is the difficulty of increasing either patient volume or revenue, since the payment per procedure, other than with cashbased practices, is strictly limited by government and commercial third party insurers. This stress on volume and profitability often leads to either unreasonable productivity

requirements or the transfer of clinical activities to lower cost non-physician practitioners, which could easily impact the physicians’ incentive compensation arrangements, and even base salary. The profitability problems are exacerbated by the challenge of paying the development expenses of these new ventures, paying the new “professional management,” and providing a return for the PEV venture capital investors. If volume and revenue cannot be increased, these costs are simply additional burdens. This model would tend to work better in areas without high concentration of the referral volume control exerted by large systems or the reimbursement control exerted by third party payors.

Evaluating the Offer The basic value comparison for the physicians is to compare the purchase price of the practice (cash, private equity interests, and compensation) to the projected compensation the physicians would have generated had they simply maintained their practices. The challenge is that most of these future variables are contingent; the only fixed value is the cash in the acquisition price. The intangible valuation issue here is the incentive www.acms.org

Legal Summary compensation and a future value of the private equity. Compensation for both the current practice and the PEV practice are projections, within the very important caveat that the physicians will remain in control of their own destiny if they remain in private practice.

Physician Practice Options When viewing this transaction from the perspective of the physicians, another complicating factor is whether the target is a solo physician practice or a physician practice with multiple owners. In the solo situation, the choices are fairly binary and the decisions are in the sole control of the physician. In a multiple physician owner scenario, not only is there an issue of whether all physicians are receiving the same dollar value offer, for either their private practice interest or in the new employment contracts, but there are governance issues associated with multiple owners, as well as the options of the physicians declining to participate to maintain their existing private practice, i.e., are there restrictive covenants, etc.

PEV Physician Employment Contracts The PEV employment contracts are typically long-term contracts, i.e., 5 years or more, because the PEV typically requires this commitment from the physicians to continue to operate the practice. Maintaining the patient referral base is obviously critical to maintaining the long-term revenue of the practice. The employment contracts typically ACMS Bulletin / July 2022

provide a lower-based compensation than the physicians have been accustomed to, which is intended to be offset by the acquisition cash and long-term incentive compensation possibilities, plus the potential upside of the PEV equity. The incentive possibilities obviously depend upon the personal availability and productivity of the physician, i.e., how many WRVUs can reasonably be generated, and how that volume is distributed by the PEV managers among the existing physicians, new physicians, and potentially non-physician practitioners. An essential part of the PEV transaction is usually a non-compete associated both with the sale of the practice and with the employment contracts, and the applicability of those restrictive covenants in the event of mismanagement of the practice is a critical issue.

Management Contracts The long-term management contracts typically provide the professional managers of the PEV the ability to staff the office, equip the facility, hire the staff, schedule the hours, etc. If physician compensation is tied to productivity, then physicians must be aware of the potential complications of being stymied by the management contract, resource restrictions, staff restrictions, etc. Furthermore, the physicians should clearly understand the administrative services to be provided in exchange for the management fee, and the value thereof.

Acquisition Value As mentioned, the acquisition value is usually cash and equity in the PEV, usually split about 80% cash and 20%

equity, but that is also a negotiable item. The acquisition value is usually based upon an EBITDA method, which establishes the earnings history of the practice and multiples that by an acquisition conversion factor, typically referred to as the “multiple.” There are two potential problems here: 1. EBITDA means earnings before income tax, depreciation and amortization. However, physician practices rarely have actual earnings, so EBITDA must be adjusted for FMV physician compensation and normalization of expenses i.e., fringe benefits for in excess of market. 2. The conversion factor is often just a discretionary plugged variable. Finally, another major issue is the future value of the private equity obtained in the transaction. This involves some due diligence with respect to the acquiring company, a review of the documents to determine the future marketability of the private equity stock, restrictions on transfers associated with the maintenance of either the management agreement or the employment contracts, etc. In short, this is usually not a “guaranteed value” so, while it may be an upside, it’s a risky upside.

Conclusion Don’t be seduced by the cash; do your homework, do the math, make an educated decision. TADMS:6055953-2 030205-167727 The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

The Allegheny County Medical Society Foundation 2022 Grant Application window is now open. Applications will be accepted from: July 1, 2022 - September 30, 2022 As the 501(c)3 philanthropic arm of the Allegheny County Medical Society, the Foundation awards grants to support home and community environments that nurture and develop healthy children and families for a healthy Allegheny County. The ACMS Foundation will support organizational-based activities that engage individuals and families in the planning, development, evaluation, and implementation of programs at the community level that assist individuals in creating supportive and healthy home environments. The Foundation believes that all people have the inherent capacity to effect change in their lives and in their communities. The Foundation will support programs that respect and value individuals and their collaborative work to improve healthcare in our community.

Application Details Proposal Review and Timetable: RFP Release Date: July 1, 2022 Proposals Due: September 30, 2022 Funding Decisions: October 25, 2022 Funds Dispersed: November 30, 2022

The following is a list of criteria that will be considered in the review process: * Project will create an impact on communities in Allegheny County, PA. * Project addresses a pressing need or timely issue OR presents a unique approach to addressing an “every day,” ongoing challenge. * Project has potential for broader impact or replication. * Project will respond to the ACMS Foundation Mission: Advancing Wellness by confronting Social Determinants & Health Disparities.

How to Apply To apply for a grant, complete the application form in its entirety. Should you wish to include a formal RFP in addition to the form, you may submit that directly to shussey@acms.org. Grant applications will not be considered complete without a fully completed form. Proposals must be completed and submitted with all required responses and attachments in order to be considered for funding in this grant cycle. If you have questions regarding the application, please contact Sara Hussey, Executive Director at shussey@acms.org.

Download Full List of RFP Criteria

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IN-PERSON TRAINING SATURDAY,

AUGUST

9:00 am to 12:30 pm Babb Insurance Bldg 850 Ridge Ave Pittsburgh PA 15212 ADVANCED REGISTRATION IS REQUIRED

HOW, WHEN & WHY TO REPORT: Mandated Reporter Training for Professionals (Mandated Act 31 Child Abuse Training)

The in-person training program is open to ACMS members and non-members. This 3-hour program meets the requirements for licensure and license renewal. The presenter will be Jacqueline Wilson, PhD, CEO of Three Rivers Adoption Council

Cost is $25 for ACMS members; $50 for non-members with advance registration required for all participants. Registration Includes: ✓ Breakfast & Break Refreshments ✓ Free Parking

Questions? Contact Nadine Popovich

Questions? Contact Nadine Popovich at Npopovich@acms.org npopovich@acms.org 412-321-5030 or to 412.321.5030.

2022 ACMS Meeting & Activity Schedule By Committee Finance Committee

Keith T. Kanel, MD, Chair November 15

August 30

Delegation

Deborah Gentile, MD, Chair August 31 Bruce A. MacLeod, MD, Vice Chair House of Delegates—October 21-22

Board of Directors

Patricia L. Bononi, MD, Chair December 6 MPHC (Management Professionals in Health Care) at the Westin Pittsburgh

September 13 November 16

Meetings begin at 6:00PM. If you are interested in attending any of the meeting, please contact Mrs. Hostovich at 412.321.5030. 38

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ELECTION 2023 The Allegheny County Medical Society is looking for motivated individuals interested in joining our leadership team to develop our Society to meet the future needs of our members and community. ACMS is now seeking candidates for the 2023 ACMS Board of Directors and ACMS Delegates to the Pennsylvania Medical Society and invite your nominations. If you want to make a difference and are interested in participating in ACMS leadership, send in your nomination. If you would like to recommend a colleague, please e-mail [dhostovich@acms.org] or fax this memo back to 412321-5323. Get involved – send in your nominations today. If you have any questions, please contact the Society at 412-321-5030; our staff is eager to assist you. Sincerely,

Mark A. Goodman, MD Mark A. Goodman, MD Secretary

Nominations for 2023 Election [Please Print] I would like to recommend ___________________________________________________________for ________ Board of Directors

________ Delegate.

I am interested in being a candidate for the ACMS: Board of Directors _______ ♦ ♦ ♦

Delegate to the PAMED Society _______

Represents physicians on issues impacting the practice of medicine and makes policy decisions for the Society. Meets four times per year, special meetings as needed. Three-year term: 2023-25. Eligible for reelection.

♦ ♦ ♦

Represents the physicians of Allegheny County in creating statewide policy on issues impacting physicians, patients and the practice of medicine. Meets as necessary prior to attending the House of Delegates in October in Hershey, PA. Two-year term: 2023-24. Eligible for re-election.

Name _______________________________ Phone ________________ Email _____________________________ [Please Print] Please enclose a copy of your CV.

FaxFax the formtoto412-321-5323 412-321-5323 by August thecompleted completed form by Monday, July15, 15, 2022. 2022. Thank you. you. Online form here:Thank https://www.acms.org/nominations

2022 ACMS Bulletin

Photo Contest Please note instructions below for participating in the 2022 ACMS Bulletin Photo Contest: 1 Email your VERTICAL jpg photos with a resolution of 300 dpi or higher to ACMSBulletin@acms.org. Photos should be 8”W x 10”H. No more than three photos may be submitted. 2

You must be an ACMS member physician to submit photos.

3 I nclude the name of the photo (please keep file names short) as well as your name, specialty, address and phone number in the email. 4 You will receive verification that your photo has been received and is eligible to be entered in the contest.

a) Horizontal photos will not be considered. b) Photos with low resolution will not be considered. c) Panoramic shots or photos featuring specifically identifiable individuals, relatives, will not be considered. d) Be aware top third of image will be obstructed by Masthead.

The deadline for submission is Monday, October 3rd, 2022. After this date, a group of individuals selected by the ACMS Board of Directors and ACMS Editorial Board will vote on the top 12 photos.

inners will be announced on the ACMS website, in the Bulletin and via W email. The 1st-place winner’s photo will appear on the January 2023 cover; the remaining winning photos will appear on Bulletin covers throughout the year.

lease continue to check the ACMS website and future issues of the P Bulletin for further updates and reminders.

I f you have any questions, please contact Contact Cindy Warren at ACMSBulletin@acms.org.

ACMS Bulletin July 2022

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