the Stethoscope the Stethoscope
September 2019 Issue
Quarterly Newsletter of the Erie County Medical Society
Quarterly Newsletter of the Erie County Medical Society • December 2021
A Message From Your President by Kelli DeSanctis, DO
Kelli DeSanctis, DO President, ECMS Jennifer Redmond Association Executive jredmond@pamedsoc.org Phone: 833-770-1542 1438 West 38th Street Erie, PA 16508 Administrative Office/ Mailing Address: 400 Winding Creek Blvd. Mechanicsburg, PA 17050 eriecountymedicalsociety.org
The opinions expressed in this publication are for general information only and are not intended to provide specific medical, legal or other advice for any individuals. The placement of editorial content, opinions, and paid advertising does not imply endorsement by the Erie County Medical Society.
Hello, my colleagues and friends. It is my privilege to address you for the first time as the 142nd president of the Erie County Medical Society. I would first like to thank outgoing president Dr. Jeffrey McGovern for his unfailingly optimistic, inventive, and resourceful leadership during the past two years. There has not been a time in the past century when a president has had to lead during a worldwide pandemic, and he accomplished this with grace and strong leadership. I am honored and privileged to succeed him. During my presidency, I aim to be a servant to all of you. My goal is to give you a place to turn for camaraderie, advice, and advocacy. I promise to work tirelessly to preserve the nobility and autonomy of our profession, and to protect the rights and interests of physicians, not outside influences. The Erie County Medical Society is a non-partisan place where doctors can join in fellowship to support one another and work toward common goals. It is my privilege to serve as the leader of this organization, and one of my goals is to bring us together as doctors while safeguarding the nobility of our vocation. Another goal of mine is to provide physicians with the tools necessary to navigate the administrative burden of practicing medicine, while still allowing them to do what they do best: treat patients. A large part of my presidency will be comprised of community service and advocacy events, as we are called as doctors to aid those that need us the most in the community. In addition, we will be having many opportunities to socialize and learn amidst our peers, with the next upcoming event being a screening of Do No Harm, a film about the growing tragedy of physician burnout and suicide, followed by a roundtable discussion led by our peers. Please keep an eye on your emails for information about registering for what promises to be an insightful and necessary conversation about this worsening issue. In closing, I want to say that my door is always open, literally, and figuratively. Please do not hesitate to call, email, or text if I can be of assistance at any time. It is my honor and privilege to serve you, and I am ready to lead this organization. Take care, my friends, and be well. Your president, Dr. Kelli DeSanctis (484) 340-0640 Kelli.desanctis@ahn.org
Only One Story John C. Reilly, MD At Christmastime, bustling, chaotic and menacing New York City always manages to invest itself in a generous and peaceful luster. Similarly, the halls of Bellevue, Manhattan’s mammoth Charity Hospital, the “send ‘em to” place for the “tired and poor” of the City, enjoys an incongruous serenity as physical and emotional mayhem seem, on cue, to take a brief holiday. It was such that on a quiet evening, three days before Christmas of 1977, I leisurely headed to the Respiratory Therapy Department on the 17th floor of the hospital for a relaxing holiday get together. I was Chief Resident on the Trauma Service at Bellevue. The view from the break room window was glorious that night – the sharp vertical lines of the skyscrapers and the lights of the city were softened by a light snow. Heavenly Peace for sure. Then my pager went off! “They’re bringing in a young man who jumped off the Observation Deck of the Empire State Building – an apparent suicide attempt—he is alive!” Like the Golden Gate Bridge in San Francisco, the Empire State Building remains an icon of soaring man-made achievement. For the discouraged and disaffected, however, the building may symbolize the taunting bitterness of failure. Since its construction in 1931 more than 30 people have acted upon what Malcolm Gladwell has described as a “particular moment of extreme vulnerability” and made a decision, often without planning, to jump from the 86th floor open Observation Deck. I recall reading that when dropping 1,050 feet from that deck, a body reaches a terminal velocity of 110 miles per hour before impact. No wonder that the physical results of such leaps are gruesome and lethal. I considered this as I sprinted to the stairwell. I raced down the stairs to the first floor, screeching to a halt in the middle of the emergency room, I expected to find a scene of monstrous mutilation. The ER seemed almost empty and exceptionally peaceful, especially so, given my apprehension. Looking around, I noticed a young man, bearded, husky and blank-faced, in the custody of two policemen. He was sitting upright, handcuffed to the rail of a gurney. Aside from a few scratches, he appeared to be uninjured! I thought it wildly improbable that this was the “jumper” but I was advised that it was! As I approached the patient, a policeman related to me all that was known about this fortunate unfortunate fellow. My patient was Thomas Helms, a 26-year-old artist from Hawaii who had arrived in Manhattan one week earlier only to disappear into the ranks of the homeless, living in the subway. He apparently joined an impulse to end his miserable existence with the lethal opportunity presented by the tower that in those days fully dominated the skyline of midtown Manhattan. It was reported in the New York Times that he had purchased a $1.70 ticket to the observation deck, avoided one of several guards and launched himself over the 8 foot spiked fence.
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Around that time, a television engineer working on NBC’s 85th floor control room reported having felt a tap on his shoulder. According to the Times, that technician, William Steckman, turned around and encountering a shivering, disheveled and bloodied young man, asked him how he had gotten into the room. The visitor replied softly, without emotion: “Through the window”! The suicide leap had been foiled by the strong winds that often blow vertically up the waist of the landmark building. The 45 mph updraft is capable of driving any object, including a diving body, directly into the side of the skyscraper. As in two prior suicide attempts (and one other in 1979), the winds had blown Mr. Helms onto a 3-foot ledge on the 85th floor, one story down, where it was determined that he remained unconscious for 30 minutes. When he awoke he let himself in through a vintage 1931 double-hung skyscraper window! The police brought Mr. Helms to Bellevue and after getting my head around his incredible story, I prioritized this care - a detailed trauma assessment followed by an urgent referral to Psychiatry. The Times reporter speculated that when Mr. Helms dragged himself through the window to safety he must have had “second thoughts after the fall.” (It should be noted that on another occasion, a man having vaulted the fence and landed on Mr. Helms’ ledge, leapt again). Regarding the subject of “second thoughts”, Malcolm Gladwell relates the findings of a study that demonstrated that, during the period 1937-1971, of 515 people who tried to jump off of the Golden Gate Bridge but were restrained, only 25 went on to kill themselves “some other way”. For some, it may be that for whatever reason, the impulse to commit suicide wanes. As I think about his holiday reprieve in 1977, I have often wondered what happened to young, distraught Tom Helms. Did he end his life another time by another means? An intense Internet search yielded no more than a simple Death Notice placed by the Ballard Family Mortuary in Hilo, Hawaii. Tom Helms did, indeed die —at age 65 in 2016! In his 1977 Holiday Leap, Tom Helms managed to fall only one story. As he stirred and may have taken one last look at the skyscraper window he may have found his reflected image worthy, after all. I’d like to think that the stories that may have chronicled the remaining 39 years of his life reflected the gift of a split-second irresistible impulse to live that prompted him, on a snow-swept ledge far above the city, to open that window.
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2021 Year-end Legislative Update December 16, 2021
Midway Point 2021-2022 Regular Session of the Pennsylvania General Assembly As we come to a close on the 2021 calendar year, we also reach the midway point of the 2021-2022 regular legislative session of the Pennsylvania General Assembly. 2021 saw a return to a bit of normalcy at the state Capitol amidst the COVID-19 pandemic, but a new normal has certainly arrived. While many legislators are present on session voting days, remote voting is an option that many legislators have decided is the safest way for them to represent their constituents. Many offices, which had previously been easily accessible, are now locked or require advance appointments. Across the country we’re seeing tensions rise in state capitols, and in Washington, over election reforms, mask and vaccine mandates, over-crowded hospitals, and the overall impact COVID-19 has had on businesses and our economy. It has been challenging for all, especially those dedicated to patient care. As we look to 2022, politics may very well trump policy as legislators and legislative candidates eye the May primaries and November General Elections. 2022 also marks the creation of new legislative district maps that could potentially change the composition of the General Assembly and leave some legislators to decide if they should bow out of office or face the harsh reality of running against a colleague. Further, the eyes of the nation have shifted to the Commonwealth as we near a primary election for an open U.S. Senate seat in addition to the election of a new Governor’s. At last count, there are currently ten announced candidates seeking the republican nomination for Governor while Attorney General Josh Shapiro stands as the only democratic candidate. Despite the currently political environment, the Pennsylvania Medical Society (PAMED) continues to work tirelessly to defend the practice of medicine, protect the physician-patient relationship and ensure that we are always mindful of legislation and regulation that could potentially impact the practice of medicine. The pandemic continues to provide policy issues and challenges in addition to the existing priority issues that PAMED advocates on behalf of, which include scope of practice and prior authorization. The first year of the current legislative session provided a few highlights for PAMED. Among these were the enactment of Senate Bill 425 as ACT 61 of 2021. ACT 61 was a PAMED-supported effort to provide a remedy to the Pennsylvania Supreme Court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. PAMED was able to support or provide neutrality on various agreements with Advanced Practice Providers including the passage of Senate Bill 416 (CRNAs) and Senate Bills 397/398 (PAs). Another key issue that saw movement was Senate Bill 225, an extensive effort to reform the prior authorization process. While this effort has a long road ahead, it advanced out of the Senate Banking 400 Winding Creek Blvd. I Mechanicsburg, PA 17050 I www.pamedsoc.org
and Insurance Committee for the first time and there is some level of optimism that it may be taken up before the full Senate early next year. House Bill 681 seeks to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House. Lastly, Senate Bill 705 that seeks to provide legislative framework for the practice of telemedicine has advanced out of the Senate. We have seen this effort reach the Governor’s desk in the past only to see it vetoed. We are hopeful that this effort might reach a compromise in the second year of this session. While these are only a few highlights of the current legislative session, detailed below is a list of other issues that we are actively monitoring along with a brief summary. PAMED continues to engage in a number of legislative issues as well as participating in a large coalition to prevent any changes to the current Pennsylvania Supreme Court Civil Procedure rules regarding venue in medical malpractice professional liability cases. _____________________________________________________________________________ House Bill 245 – (Kaufer) – International Medical Graduates (IMGs). Seeks to modernize the process by which graduates of international medical schools become licensed. Passed the House (201-0) and has advanced out of the Senate Consumer Protection & Prof. Licensure Committee and now awaits action from Senate Appropriations. We anticipate this bill to get to the Governor’s desk in the near future. Senate Bill 705 - (Vogel) - Telemedicine-This legislation was voted favorably out of the Senate (464) and has been referred to the House Insurance Committee. PAMED supports this effort and will work to move this bill through the legislative process once again. Senate Bill 416 - (Gordner) - This legislation officially recognizes certified registered nurse anesthetists (CRNAs) in the Commonwealth of Pennsylvania as well outlining requirements for certification of CRNAs. PAMED followed the anesthesiologists lead in supporting this effort. This legislation has unanimously passed both the Senate (50-0) and the House (201-0). Signed into law as Act 60 of 2021. House Bill 931 - (Toohill) - House Companion legislation. Senate Bill 425 - (Gordner) - Informed Consent-PAMED supported this effort to provide a remedy to a court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. PAMED supported this effort which passed the Senate (500) and the House (201-0). Signed into law as Act 61 of 2021.
400 Winding Creek Blvd. I Mechanicsburg, PA 17050 I www.pamedsoc.org
House Bill 1420 - (Thomas) - Health Care Heroes Act-PAMED supports this effort to establish a public awareness campaign to provide information regarding the programs and services available for first responders, healthcare workers, and other workers suffering from mental health issues related to COVID-19. Having unanimously passed the House (202-0), this bill now awaits a vote in the Senate Health and Human Services Committee. House Bill 1082 - (DelRosso) - PAMED supports this legislation, which establishes an education program for providers on early diagnosis of Alzheimer’s disease and other dementias and incorporates information about the disease into existing public health outreach programs. This bill passed the House (201-1) and is now awaiting final consideration by the full Senate. House Bill 1280 - (Jozwiak) - Patient Test Results-PAMED will be working with the cardiologists to advance this bill through the House after it recently was voted favorably out the House Health Committee. This bill amends the Patient Test Result Information Act in addressing how patients receive notifications after certain tests, etc. Senate Bill 397 – (Pittman) – Physician Assistants (PAs); seeking to help physician assistants work and practice with increased efficiency. The bill allows for modernization for physician assistants to practice while maintaining their role under supervising physicians. This legislation has recently passed the Senate (50-0) and House (200-0); signed into law as Act 78 of 2021. (DO ACT) Senate Bill 398 – (Pittman) –This legislation has passed the Senate (50-0) and House (200-0) and has been signed into law as Act 79 of 2021. (MD ACT) Senate Bill 225 – (Phillips-Hill)- Prior authorization reform bills. There is a large coalition with multiple provider entities and patient advocacy groups seeking to make wholesale changes to the prior authorization process in the Commonwealth. PAMED has played an integral role in developing this legislation and working to advance it. While this legislation will require ongoing efforts to continue to advance it through the legislative process, it was voted out of the Senate Banking and Insurance Committee. PAMED continues to work with a broad coalition to pass this important legislation. House Bill 225 – (Mentzer) – House Companion legislation. Senate Bill 25 - (Bartolotta) – PAMED opposes this legislative effort which seeks to grant CRNPs independent practice authority. PAMED has long opposed these efforts, but last session agreed to listen/negotiate a pilot program where CRNPs would be granted independent practice with specific guidelines and restricts. This bill was recently voted out of the Senate Consumer Protection and
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Prof. Licensure Committee, but it is not anticipated that this bill will advance beyond the Senate in its current form. Likely, any movement on this issue would come in the form of a bill/amendment that starts from the agreed upon pilot program. (HCO2108) – (Hickernell) – Co-sponsorship memo recently introduced to advance the pilot program legislation. House Bill 681 – (Ecker) – PAMED has worked closely with the sponsor of this bill, Rep. Ecker to advance legislation dealing with restrictive covenants in health care practitioner employment contracts. This effort would seek to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House. House Bill 958 – (Zimmerman) – PAMED opposed this effort that would prohibit pediatricians from deciding not to provide care to unvaccinated patients or patients whose parent or legal guardians choose to utilize a vaccination schedule that varies from the vaccination schedule recommended by the CDC. While this bill advanced out of the House Health Committee, PAMED does not believe this effort will advance beyond there. House Bill 1033 - (Rapp) - This bill requires health insurers to cover treatment plans of Lyme disease or related tick-borne illnesses as prescribed by a health care practitioner; issues over what type of treatments could be covered (experimental long-term antibiotic for example). Although PAMED opposed this effort, this legislation has passed the House (136-66) and has been referred to the Senate Banking and Insurance Committee. Senate Bill 621 - (Brooks) - Publishing of vaccine availability by physicians-PAMED opposed this legislation which would require physicians that provide the COVID-19 vaccine to pay for the weekly publication of vaccine data, such as the number of vaccines they have available, in local newspapers. Further, it would require that physicians in private practice vaccinate any individual who shows up even when an established relationship does not exist. This bill failed at the Senate Health and Human Services Committee level and has been referred to the committee by a motion to reconsider. Senate Bill 671 - (Hutchinson) - Retaining Health Care Innovations Act-PAMED opposes this effort to extend the emergency administrative regulation changes granted to health care facilities, practitioners, and providers by Governor Wolf during the COVID-19 pandemic. This bill has advanced out of the Senate Health and Human Services Committee and has been referred to Senate Appropriations.
400 Winding Creek Blvd. I Mechanicsburg, PA 17050 I www.pamedsoc.org
House Bill 1700 – (Sonney) – Disclosure of disingenuous physician complaints-This bill would no longer require physicians to acknowledge the existence of a complaint filed against their medical license if the case were closed without any formal action. PAMED supports this effort and will advocate to advance these bills. This legislation has been referred to the House Professional Licensure Committee. (DO ACT) House Bill 1701 - (Sonney) - (MD ACT) House Bill 192 - (Topper) - Interstate Medical Licensure Compact Act-PAMED supports this effort which would allow Pennsylvania to fully join the Interstate Medical Licensure Compact Act (IMLC). The IMLC provides a streamlined process that allows physicians to become licensed in multiple states with a mission of increasing access to health care. This bill has passed the House (201-0) and now awaits consideration in the Senate Consumer Protection and Prof. Licensure Committee. House Bill 1774 – (Flood) – PAMED support this effort to extend the sunset date for the Achieving Better Care by Monitoring All Prescriptions Program. This bill as signed into law as Act 72 of 2021. House Bill 1319 – (DelRosso) – This legislation is intended to curb the predatory practices of Pharmacy Benefit Managers (PBMs) by targeting the practices being used by them to interfere with the funding stream health centers and 340(b) plans use to fund the care they provide to low-income, uninsured residents. PAMED supports this effort and anticipates a committee vote in House Health during early 2022. House Bill 1440 – (Millard) – PAMED supports this legislation that would establish a Medical Imaging and Radiation Therapy Board of Examiners which would license and establish qualifications for individuals in the Commonwealth of Pennsylvania who perform medical imaging or radiation therapy procedures. The House Professional Licensure Committee held an information hearing on the topic and the bill awaits action by this committee. House Bill 1562 – (Pickett) – PAMED strongly worked to oppose this effort to expand access to the PDMP and as of this time, this legislation has yet to be brought up for a committee vote. It is currently sitting in House Insurance and at this time we do not anticipate movement on this bill that grant private health care insurers access to the PDMP, when they have no enforcement abilities and no compelling rationale as to why they should have access to this hypersensitive information.
400 Winding Creek Blvd. I Mechanicsburg, PA 17050 I www.pamedsoc.org
2021–2023 ECMS Board of Directors Kelli K. DeSanctis, DO County President
Thomas D. Falasca, DO At Large Member
Jeffrey P. McGovern, MD Immediate Past President
Narendra S. Bhagwandien, MD At Large Member
Terence O. Lillis, MD County President Elect
Kirk W. Steehler, DO At Large Member
Amanda Marie Wincik, MD County Treasurer
Laura Gephart, MD At Large Member
Peter S. Lund, MD, FACS AMA Representative
Geoffrey Betz, MD At Large Member
Timothy D. Pelkowski, MD At Large Member
Brendan Dempsey, MD Resident Representative Stefano Castagnola, MD Resident Representative