SEPTEMBER 2015 | VOLUME 100 NUMBER 9 | AMERICAN COLLEGE OF SURGEONS Bulletin Contents

FEATURES ACS advocates on behalf of trauma patients: An update 9 Tara Leystra Ackerman, MPH

Changes on the horizon for global services payment 14 Vinita M. Ollapally, JD

The Mayne legacy: A look back at an influential charter member of the ACS 18 Sarah B. Klein and William F. Sasser, MD, FACS

Dr. Beverley Ketel: Surgeon who brought transplant surgery to Peoria, IL, reflects on a fulfilling career 22 Karen Sisulak Binder

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COLUMNS NEWS James Haug, Past-Director, ACS Socioeconomic Affairs Looking forward 7 Included with this month’s Department, dies 50 Bulletin: Compendium on David B. Hoyt, MD, FACS Diane Schneidman improving survivability from mass ACS Clinical Research Program: casualty events 34 Dr. Judson Graves Randolph, Biomarker-driven adjuvant targeted John A. Weigelt, MD, DVM, FACS, pediatric surgeon, leaves therapy for NSCLC—the ALCHEMIST lasting legacy 52 trials 25 chosen as 2015 Distinguished Service Award recipient 35 Kurt D. Newman, MD, FACS, and Geoffrey R. Oxnard, MD; Colleen Mary Fallat, MD, FACS Watt; Dennis Wigle, MD, FACS; and Official notice: Annual Business Judy C. Boughey, MD, FACS Meeting of Members, American Tour the cemetery where ACS College of Surgeons 37 leaders are buried: Visit Archives From the Archives: American Fellows honored for volunteerism 39 booth for information 54 surgical history: Finding a home at Adam Carey the Clinical Congress 28 Andrea L. Musolf, MBA LaMar S. McGinnis, Jr., MD, FACS, Bleeding control spotlighted Members in the news 56 and Norman H. Rich, MD, FACS at new ACS Theater Sessions at ACS in the news 58 Clinical Congress 43 A look at The Joint Commission: Register for ACS TQIP Conference, 2 | Safety culture is a great fit ACS Foundation presents two November 15−17, in for the OR 30 distinguished awards at Nashville, TN 60 2015 Clinical Congress 45 Carlos A. Pellegrini, MD, FACS, Report on ACSPA/ACS activities, FRCSI(Hon) Renewed Excelsior Surgical Society June 2015 62 hosts first meeting at 2015 ACS Fabrizio Michelassi, MD, FACS NTDB data points: Kickback 32 Clinical Congress 48 Richard J. Fantus, MD, FACS ACS CoC bestows National MEETINGS CALENDAR Achievement Award on 21 cancer care facilities 49 Calendar of events 72

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V100 No 9 BULLETIN American College of Surgeons The American College of Surgeons is dedicated CLINICAL CONGRESS to improving the care of the surgical patient and to safeguarding standards of care in an 2015 optimal and ethical practice environment. OCTOBER 4–8

EDITOR-IN-CHIEF Letters to the Editor McCORMICK PLACE | CHICAGO, IL Diane Schneidman should be sent with the writer’s DIRECTOR, DIVISION OF name, address, INTEGRATED COMMUNICATIONS e-mail address, and Lynn Kahn daytime telephone SENIOR EDITOR number via e-mail to Tony Peregrin dschneidman@facs. org, or via mail to EDITORIAL & PRODUCTION ASSISTANT Diane S. Schneidman, Matthew Fox Editor-in-Chief, Bulletin, American CONTRIBUTING EDITOR College of Surgeons, Jeannie Glickson 633 N. Saint Clair St., SENIOR GRAPHIC DESIGNER/ Chicago, IL 60611. PRODUCTION MANAGER Letters may be edited Tina Woelke for length or clarity. Permission to publish EDITORIAL ADVISORS letters is assumed Charles D. Mabry, MD, FACS unless the author Leigh A. Neumayer, MD, FACS indicates otherwise. Marshall Z. Schwartz, MD, FACS Mark C. Weissler, MD, FACS

FRONT COVER DESIGN Tina Woelke

Bulletin of the American College of Surgeons (ISSN 0002-8045) is published monthly by the American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It is distributed without charge to Fellows, Associate Fellows, Resident and Medical Student Members, Affiliate Members, and to medical libraries and allied health personnel. Periodicals postage paid at Chicago, IL, and additional mailing offices. POSTMASTER: Send address changes to Bulletin of the American College of Surgeons, 3251 Riverport Lane, Maryland Heights, MO 63043. Canadian Publications Mail Agreement No. 40035010. Canada returns to: Station A, PO Box 54, Windsor, ON N9A 6J5. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211; tel. 312-202‑5000; toll-free: 800-621-4111; e-mail: [email protected]; website: facs.org. Washington, Achieving Your Personal Best: DC, Office is located at 20 F Street N.W. Suite 1000, Washington, DC. 20001-6701; tel. 202‑337-2701; website: www.tmiva.net/20fstreetcc/home. Improvement Based on Evidence Unless specifically stated otherwise, the opinions expressed and statements made in this publication reflect the authors’ personal observations and do not imply endorsement by nor official policy of the American College of Surgeons. ©2015 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmitted in any form by any means without prior written permission of the publisher. Library of Congress number 45-49454. Printed in the USA. Publications Agreement No. 1564382. Officers and Staff of the American College of Surgeons

Gerald M. Fried, MD, AMERICAN COLLEGE OF FACS, FRCSC Advisory Council SURGEONS FOUNDATION Officers Montreal, QC Martin H. Wojcik Executive Director Andrew L. Warshaw, MD, FACS James W. Gigantelli, MD, FACS to the Board Boston, MA Omaha, NE of Regents ALLIANCE/AMERICAN PRESIDENT COLLEGE OF SURGEONS Carlos A. Pellegrini, MD, FACS B. J. Hancock, MD, FACS, FRCSC (Past-Presidents) CLINICAL RESEARCH Seattle, WA Winnipeg, MB PROGRAM IMMEDIATE PAST-PRESIDENT Enrique Hernandez, MD, FACS Kathryn D. Anderson, MD, FACS Kelly Hunt, MD, FACS Chair Jay L. Grosfeld, MD, FACS Philadelphia, PA Eastvale, CA Indianapolis, IN Lenworth M. Jacobs, Jr., MD, FACS W. Gerald Austen, MD, FACS CONVENTION AND MEETINGS FIRST VICE-PRESIDENT Hartford, CT Boston, MA Felix Niespodziewanski Kenneth L. Mattox, MD, FACS L. Scott Levin, MD, FACS L. D. Britt, MD, MPH, Director Houston, TX Philadelphia, PA FACS, FCCM DIVISION OF EDUCATION SECOND VICE-PRESIDENT Norfolk, VA *Mark A. Malangoni, MD, FACS Ajit K. Sachdeva, MD, Edward E. Cornwell III, Philadelphia, PA John L. Cameron, MD, FACS FACS, FRCSC MD, FACS, FCCM Baltimore, MD Director *Raymond F. Morgan, MD, FACS Washington, DC EXECUTIVE SERVICES SECRETARY Charlottesville, VA Edward M. Copeland III, MD, FACS Gainesville, FL Jane J. Lee-Kwon, MPS William G. Cioffi, Jr., MD, FACS Leigh A. Neumayer, MD, FACS Director, Executive Operations Providence, RI Tucson, AZ A. Brent Eastman, MD, FACS Rancho Santa Fe, CA Maxine Rogers TREASURER Marshall Z. Schwartz, MD, FACS Director, Leadership Operations David B. Hoyt, MD, FACS Philadelphia, PA Gerald B. Healy, MD, FACS Wellesley, MA FINANCE AND FACILITIES Chicago, IL Howard M. Snyder III, MD, FACS EXECUTIVE DIRECTOR Gay L. Vincent, CPA Philadelphia, PA R. Scott Jones, MD, FACS Director Charlottesville, VA Gay L. Vincent, CPA Beth H. Sutton, MD, FACS 4 | Chicago, IL HUMAN RESOURCES Wichita Falls, TX Edward R. Laws, MD, FACS AND OPERATIONS CHIEF FINANCIAL OFFICER Boston, MA *Andrew L. Warshaw, MD, FACS Michelle McGovern Boston, MA LaSalle D. Leffall, Jr., MD, FACS Director Washington, DC Officers-Elect Steven D. Wexner, MD, FACS INFORMATION TECHNOLOGY Weston, FL LaMar S. McGinnis, Jr., MD, FACS Howard Tanzman Atlanta, GA (take office October 2015) *Michael J. Zinner, MD, FACS Director Boston, MA David G. Murray, MD, FACS DIVISION OF INTEGRATED J. David Richardson, MD, FACS Syracuse, NY COMMUNICATIONS Louisville, KY Lynn Kahn PRESIDENT-ELECT *Executive Committee Patricia J. Numann, MD, FACS Syracuse, NY Director Ronald V. Maier, MD, FACS Carlos A. Pellegrini, MD, FACS JOURNAL OF THE AMERICAN Seattle, WA COLLEGE OF SURGEONS FIRST VICE-PRESIDENT-ELECT Board of Seattle, WA Timothy J. Eberlein, MD, FACS Walter J. Pories, MD, FACS Governors/ Richard R. Sabo, MD, FACS Editor-in-Chief Greenville, NC Bozeman, MT SECOND VICE- Executive DIVISION OF MEMBER SERVICES PRESIDENT-ELECT Seymour I. Schwartz, MD, FACS Patricia L. Turner, MD, FACS Committee Rochester, NY Director Fabrizio Michelassi, MD, FACS Frank C. Spencer, MD, FACS M. Margaret Knudson, MD, FACS Board of Regents New York, NY New York, NY Medical Director, Military Health CHAIR Systems Strategic Partnership *Mark C. Weissler, MD, FACS Karen Brasel, MD, FACS Girma Tefera, MD, FACS Chapel Hill, NC Portland, OR CHAIR VICE-CHAIR Executive Staff Director, Operation Giving Back *Valerie W. Rusch, MD, FACS James C. Denneny III, MD, FACS EXECUTIVE DIRECTOR PERFORMANCE IMPROVEMENT New York, NY Alexandria, VA David B. Hoyt, MD, FACS Will Chapleau, RN, EMT-P Director VICE-CHAIR SECRETARY DIVISION OF ADVOCACY John L. D. Atkinson, MD, FACS Kevin E. Behrns, MD, FACS AND HEALTH POLICY DIVISION OF RESEARCH AND Rochester, MN Gainesville, FL Frank G. Opelka, MD, FACS OPTIMAL PATIENT CARE Medical Director, Quality Clifford Y. Ko, MD, MS, FACS Margaret M. Dunn, MD, FACS Diana L. Farmer, MD, FACS and Health Policy Director Dayton, OH Sacramento, CA Patrick V. Bailey, MD, FACS Cancer: James K. Elsey, MD, FACS Steven C. Stain, MD, FACS Medical Director, Advocacy David P. Winchester, MD, FACS Atlanta, GA Albany, NY Christian Shalgian Medical Director Henri R. Ford, MD, FACS Joseph J. Tepas III, MD, FACS Director Los Angeles, CA Jacksonville, FL Trauma: Michael F. Rotondo, MD, FACS Julie A. Freischlag, MD, FACS Medical Director Sacramento, CA

V100 No 9 BULLETIN American College of Surgeons Author bios*

*Titles and locations current at the time articles were submitted for publication.

a b c

d e f g | 5

h i j

MS. ACKERMAN (a) is State Affairs DR. FALLAT (e) is professor of surgery and DR. McGINNIS (h) is senior medical Associate, American College of chief, division of pediatric surgery, University consultant and advisor, American Cancer Surgeons (ACS) Division of Advocacy of Louisville School of Medicine, KY; and Society, and adjunct clinical professor and Health Policy, Washington, DC. pediatric surgeon, department of surgery, of surgery, Emory University, Atlanta, Kosair Children’s Hospital, Louisville. GA. He is Past-President of both the ACS MS. BINDER (b) is a freelance and the American Cancer Society. journalist based in Carbondale, IL. DR. FANTUS (f) is vice-chairman, department of surgery; medical director, DR. MICHELASSI (i) is the Lewis Atterbury DR. BOUGHEY (c) is professor of surgery trauma services; and chief, section of Stimson Professor and chairman, department and vice-chair of research, department surgical critical care, Advocate Illinois of surgery, Weill Cornell Medical College; of surgery, Mayo Clinic, Rochester, MN. Masonic Medical Center. He is clinical and surgeon-in-chief, New York-Presbyterian/ She is Chair, ACS Clinical Research professor of surgery, University of Illinois Weill Cornell Medical Center, NY. He Program Education Committee. College of Medicine, Chicago, and Past- is Chair, ACS Board of Governors. MR. CAREY Chair, ad hoc Trauma Registry Advisory (d) is the ACS Archivist, Committee, ACS Committee on Trauma. MS. MUSOLF (j) is Communications Division of Member Services, Chicago, IL. Assistant, ACS Division of Integrated MS. KLEIN (g) is Director, Donor Communications, Chicago, IL. Relations and Communications, ACS Foundation, Chicago, IL. continued on next page

SEPT 2015 BULLETIN American College of Surgeons Author bios continued

k l m

n o p 6 |

q r s

DR. NEWMAN (k) is a pediatric DR. PELLEGRINI (n) is The Henry N. MS. SCHNEIDMAN (q) is Editor-in-Chief, surgeon and president and chief Harkins Professor and Chair, department of Bulletin of the American College of Surgeons, ACS executive officer, Children’s National surgery, University of Washington, Seattle, Division of Integrated Communications. Health System, Washington, DC. and Immediate Past-President of the ACS. MS. WATT (r) is senior protocol MS. OLLAPALLY (l) is Regulatory DR. RICH (o) is a vascular surgeon and coordinator, Alliance for Clinical Affairs Manager, ACS Division of professor of military medicine, Uniformed Trials in Oncology, Chicago. Advocacy and Health Policy. Services University of the Health Sciences, Bethesda, MD, and director DR. WIGLE (s) is professor of surgery and DR. OXNARD (m) is a thoracic of the Vietnam Veterans Registry. chair, division of thoracic surgery, department oncologist, Dana-Farber Cancer Institute, of surgery, Mayo Clinic, Rochester. and assistant professor of medicine, DR. SASSER (p) is adjunct professor Harvard Medical School, Boston, MA. of surgery, St. Louis University School of Medicine, MO, and an ACS Foundation board member.

V100 No 9 BULLETIN American College of Surgeons EXECUTIVE DIRECTOR’S REPORT

Looking forward

by David B. Hoyt, MD, FACS

s I write this column, the American College investigators, while the Video-Based Education Ses- of Surgeons’ (ACS) staff and volunteers are sions will showcase emerging surgical procedures. Aputting the finishing touches on the program Clinical Congress attendees who are interested in for this year’s Clinical Congress, October 4–8, at learning about leading-edge issues in a less formal McCormick Place, Chicago, IL. This year’s program, setting are encouraged to attend Meet-the-Expert as usual, is replete with many excellent hands-on skills Luncheons and Town Hall Meetings. Continuing and didactic Postgraduate Courses, informative Panel Medical Education credits are available for most of Sessions, and opportunities to share and discuss scien- these sessions, and Self-Assessment credit is avail- tific advances in surgery. In addition, we have added able for participation in many Postgraduate Courses, some member engagement activities that promise to Panel Sessions, and Video-Based Education Sessions. make this Clinical Congress particularly memorable and enjoyable, and we will take some time to recap the year’s successes. Member engagement In addition to these wonderful educational programs, this year the ACS is offering three new opportuni- Educational programming ties for attendees to meet and network in fun and As always, Clinical Congress 2015 will provide the innovative ways. best surgical education and training opportunities First, Clinical Congress attendees will have the | 7 for surgeons, surgery residents, medical stu- opportunity to start their day off right with compli- dents, and other members of the operating room mentary early-morning yoga and Zumba classes. Yoga team—all in one place. The theme of this year’s will be offered 6:00–7:00 am Monday, October 5, and Clinical Congress—Achieving Your Personal Best: Zumba will be offered 5:30–6:30 am Tuesday, Octo- Improvement Based on Evidence—was selected by ber 6. Both classes will take place at the headquarters ACS President Andrew L. Warshaw, MD, FACS, hotel—the Hilton Chicago. Classes are appropriate FRCSEd(Hon). for all ability levels, and water, yoga mats, and towels The Program Committee, chaired by Valerie W. will be provided. Advance registration is required due Rusch, MD, FACS, along with the ACS Division of to space limitations. (To register, go to www.facs.org/ Education, under the leadership of Ajit K. Sachdeva, clincon2015/register.) MD, FACS, FRCSC, have developed an outstanding You’re sure to work up an appetite after a couple program. The 2015 Scientific Program has again been of days of attending yoga, Zumba, and going from arranged in key thematic tracks covering both clini- meeting to meeting in the convention center. Plan to cal and nonclinical topics and should be of interest join ACS leaders and staff for ACS Taste of the City to surgeons in every specialty. More than 120 Panel 5:00–7:00 pm Wednesday, October 7, at McCormick Sessions will be presented, along with 11 Named Place. This special event will showcase the diversity Lectures by distinguished experts in their respective of Chicago’s dining scene and will feature music and fields. Didactic/Experiential and Surgical Skills Post- other entertainment activities. To encourage a more graduate Courses will enable attendees to develop relaxed environment after a full day of educational advanced knowledge and techniques that they can programming, we encourage you to dress casually apply in their practices as they strive to deliver opti- and bring your friends and family. mal care to their patients. Lastly, those of you who are part of the selfie craze This year’s Clinical Congress places increased on social media will want to participate in the ACS emphasis on the science of surgery. As such, we have Selfie Scavenger Hunt and show the surgical com- developed a Scientific Forum that will include surgi- munity all that the Clinical Congress has to offer. cal research presentations by residents and surgical There will be a raffle of up to three iPad Minis for

SEPT 2015 BULLETIN American College of Surgeons EXECUTIVE DIRECTOR’S REPORT

This year’s Clinical Congress places increased emphasis on the science of surgery. As such, we have developed a Scientific Forum that will include surgical research presentations by residents and surgical investigators, while the Video-Based Education Sessions will showcase emerging surgical procedures.

those attendees who take and post the most selfies on and Quality Award from The Joint Commission and Twitter. Selfies from the list below should be tweeted the National Quality Forum during the meeting using the Clinical Congress Twit- ter account at #CC15selfie: • The ongoing success of the ACS Accredited Educa- tion Institutes (AEI) and our plans to launch an AEI • With a new Initiate/Fellow (include images of name tour in January to educate policymakers about the badges) value of ACS accreditation of simulation and surgical • With an International Member (include images of research programs name badges) • With a Regent (include images of name badges) • The development of new learning management soft- • With an Officer (include images of name badges) ware • With a Governor (include images of name badges) • In front of McCormick Place • The utility of the ACS Surgeon Specific Registry in • In the ACS Resource Center complying with Centers for Medicare & Medicaid reg- • In front of a poster at the Poster Session ulatory mandates • With a member of the ACS staff (include images of 8 | name badges) • Our role in the repeal of the sustainable growth rate • With a medical student (include images of name badges) formula used to calculate Medicare payment and the • With a resident/fellow (include images of name development of a new value-based reimbursement sys- badges) tem, and the tools surgeons can use to ensure the sus- • With someone who went to your medical school tainability of their practices under this new paradigm • With someone who trained at your program • At the Opening Ceremony • At the Convocation See you in October • At the ACS Taste of the City event Remember, this is your meeting. The College’s staff • With an exhibitor in their booth (include images of and volunteers continue to look for ways to make the name badges) Clinical Congress more engaging and educational for surgeons of all specialties and at every stage of their career. Let us know how we can help you to make Celebrating our success the most of your time in Chicago. We look forward to Also be sure to attend this year’s Opening Ceremony seeing you at Clinical Congress 2015. ♦ 8:00–9:00 am Monday, October 5, at McCormick Place West. During this important event, we will introduce the six new Honorary Fellows, the recipi- ent of the Distinguished Service Award, ACS Officers, Regents, Past-Presidents, and special invited guests. In addition, we will recognize some of the College’s most significant achievements from the last year and reveal plans for the future. Examples include the following:

• The ACS National Surgical Quality Improvement Pro- If you have comments or suggestions about this or other issues, please gram receiving the John M. Eisenberg Patient Safety send them to Dr. Hoyt at [email protected].

V100 No 9 BULLETIN American College of Surgeons ACS ADVOCATES FOR TRAUMA PATIENTS

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ACS advocates on behalf of trauma patients: An update

by Tara Leystra Ackerman, MPH

SEPT 2015 BULLETIN American College of Surgeons ACS ADVOCATES FOR TRAUMA PATIENTS

HIGHLIGHTS Distracted driving The most ubiquitous type of injury prevention legisla- • Describes state-level legislative activity tion recently considered in the state legislatures seeks regarding injury prevention and to discourage distracted driving. Most states restrict trauma system development the use of cell phones and other handheld devices • Updates on distracted driving and motorcycle while driving. In all, 14 states (California, Connecticut, helmet safety mandates are summarized Delaware, Hawaii, Illinois, Maryland, Nevada, New • Discusses the AMA HOD annual meeting, which Hampshire, New Jersey, New York, Oregon, Vermont, focused on resolutions related to gun safety and Washington, and West Virginia), and the District of protective headgear for female lacrosse players Columbia and Puerto Rico, have prohibited drivers from using handheld devices; however, most states have specifically banned texting while driving with tate legislatures regularly address issues related either a primary or secondary enforcement mechanism. to the provision of trauma care and injury pre- A primary enforcement mechanism means that an offi- Svention. The U.S. Congress has also historically cer can ticket the driver for the offense without any played a role in trauma system development and fund- other traffic violation taking place, whereas a second- 10 | ing, but federal lawmakers recently have experienced ary enforcement mechanism means an officer can only difficulty passing system development legislation and issue a ticket if a driver has been pulled over for another appropriating money for trauma, leaving it to state violation, such as driving erratically. Only two states, legislatures to identify funding sources and to design Montana and Arizona, allow texting while driving. and implement their own trauma systems. This year, the lawmakers at the state level considered The American College of Surgeons (ACS) actively legislation that would update current distracted driving monitors state legislative activity. In 2015, for example, statutes to address advances in technology. Utah is one ACS State Affairs staff has reviewed approximately 200 of the few states that attempted to weaken its law by pieces of trauma-related legislation. Most of these bills altering its ban on texting while driving to allow one- pertained to injury prevention efforts, but some were button dialing on cell phones with voice commands and related to trauma system development and funding. In similar one-button commands for music or other apps. addition, the American Medical Association’s (AMA) However, that legislation failed to advance. House of Delegates (HOD), which includes an ACS del- egation, took a close look at trauma prevention during Motorcycle helmet mandates its annual meeting in June. A number of resolutions In a number of states, legislators attempted but ulti- were put forth calling for the AMA to weigh in on mately failed to change current laws related to injury prevention policy. mandatory helmet use. In Iowa, H.F. 267 would have This article examines the trauma-related issues con- mandated that motorcycle operators and passengers sidered in state legislatures and by the AMA HOD over wear a safety helmet. In New Mexico, two bills were the last year. introduced that would have placed new requirements on motorcycle operators. One bill, S.B. 327, would have implemented a universal helmet requirement. Injury prevention The other bill, S.B. 308, would have instituted a helmet State legislatures debated a significant amount of legis- requirement, although under the proposed law opera- lation aimed at injury prevention in 2015, including laws tors would have been permitted to ride helmetless if pertaining to distracted driving, motorcycle helmet they were older than 18 years of age and if they had pur- use, gun control, and vulnerable users of roadways. chased a validating sticker for $692. The fees collected

V100 No 9 BULLETIN American College of Surgeons ACS ADVOCATES FOR TRAUMA PATIENTS

would have gone to the Trauma System Fund, the Brain certification, and in Georgia, school districts are now Injury Services Fund, and the Fatal-Injury Diagnosis prohibited from regulating gun possession on school and Reporting Fund. Similar legislation, S.B. 356, was grounds as mandated by H.B. 492. Texas will now introduced in West Virginia. This bill would have pro- allow concealed carry permit holders to carry loaded vided an exemption from wearing helmets for operators firearms openly in public as well as allowing permit who meet certain safety requirements and have at least holders to carry firearms on college and university $10,000 in medical coverage, including coverage for campuses with some regulation permitted by local motorcycle accidents. school officials. In Tennessee, separate pieces of legislation were Oregon enacted S.B. 941, which requires back- considered that would loosen helmet restrictions. S.B. ground checks on unlicensed gun purchasers in the 925/H.B. 700 would have exempted motorcycle driv- state. In Nevada, S.B. 240 was signed into law, prohib- ers and passengers older than 21 years of age from the iting mentally ill convicts from owning a gun. The helmet requirement if those individuals were covered law also removes Nevada’s $35 fee for background by health or medical insurance other than the state- checks for private gun sales, criminalizes the practice funded TennCare program. This legislation advanced of buying a gun for another person, and strengthens through the committee process but ultimately failed reporting requirements on criminal history and mental to pass. It will, however, carry over to next year’s leg- illness. Also in Nevada, S.B. 175, mentioned previously, | 11 islative session. Another bill of a much more limited prohibits individuals convicted of a domestic violence scope, S.B. 469, was signed into law in Tennessee. This misdemeanor from owning or possessing a firearm. new law allows for a helmet wearing exemption for Alabama, Delaware, Louisiana, Oregon, South Car- persons riding in a funeral procession, memorial ride olina, and Washington State all passed legislation under a police escort, or body escort. making it more difficult for individuals charged with Nebraska bill L.B. 31 would have repealed the state’s domestic violence to possess firearms. mandatory helmet law completely, and in Washington, S.B. 5198 would have removed the mandatory helmet Safe travels for vulnerable users requirement for individuals older than age 18. Both bills An emerging issue in the state legislatures in recent received public hearings, but neither advanced further. years has focused on improving safety for so-called vulnerable users on roadways. Vulnerable users are Gun control typically defined as pedestrians or individuals using Gun control continues to be a hot topic in the state bicycles, skateboards, roller skates, inline skates, and legislatures. Dozens of bills were considered on issues other nonmotorized modes of transportation. These ranging from private sale background checks to bills differ by state but usually require increased pen- permit-less concealed carry of guns. Kansas, Maine, alties when a vulnerable user is injured or killed by a and Mississippi all passed bills allowing for concealed motor vehicle. These penalties include increased fines, guns to be carried in public without a permit. Nevada license suspension, community service, or mandatory passed a bill (S.B. 175) that expands the state’s stand- traffic courses. A total of 12 states (Colorado, Delaware, your-ground statute, which protects individuals who Hawaii, Illinois, Louisiana, Maryland, Mississippi, decide not to retreat when defending a motor vehicle Nevada, New York, Oregon, Tennessee, and Wash- and recognizes out-of-state conceal and carry permits. ington) have already adopted some sort of vulnerable H.B. 2014 was signed into law in Oklahoma, which user protections. An additional eight states (Arizona, allows a school district to permit school personnel to Delaware, Florida, Maine, Massachusetts, New Hamp- carry loaded firearms on the grounds of public elemen- shire, Utah, and Vermont) considered bills this year, tary and secondary schools if they obtain reserve officer but only Utah enacted legislation.

SEPT 2015 BULLETIN American College of Surgeons ACS ADVOCATES FOR TRAUMA PATIENTS

In 2015, ACS State Affairs staff has reviewed approximately 200 pieces of trauma-related legislation. Most of these bills were related to injury prevention efforts, but some were related to trauma system development and funding.

Trauma system funding and development would be administered within the Ohio Department Minimal activity in the state legislatures pertained of Health, would comprise 19 members appointed by to trauma system development and funding, as most the Governor, the Speaker of the House, and the Presi- state budgets are still recovering from the recession dent of the Senate. The board would be responsible for and some are still facing budget deficits. In addition, operating the state trauma registry, seeking and dis- many states have trauma systems in place with at least tributing grants, and developing a statewide system some available funding. Nonetheless, a few state legis- for improving the quality of trauma and rehabilitative latures did consider changes to their trauma systems care. At least three of the Ohio Trauma Board mem- or are trying to identify new funding sources. State bers would be trauma surgeons. The Ohio Chapter of lawmakers took unique approaches to reforming the ACS would be required to submit nominations for these systems, especially with respect to establish- two of the positions. ing funding. In addition, H.B. 261 also would add new designa- In Texas, legislation to repeal the Driver Respon- tion standards, such as participation in statewide and sibility Program, which provides funding for the regional injury prevention activities and submission state trauma system, did not pass this session. S.B. 93 of more timely data to the registry. Furthermore, the received unexpected support in the legislature and bill would require the Department of Health to hire an 12 | was passed by the Senate, but the House did not act executive director and chief medical director. The ACS before the session ended. The Driver Responsibility would still verify trauma centers, but additional stan- Program imposes surcharges on drivers who receive dards would be added for centers to gain verification. citations for traffic violations. As originally written, Currently, the trauma system in Ohio is funded solely S.B. 93 would have repealed the Driver Responsibility through fees assessed on trauma hospitals, and this legis- Program entirely, but the amended bill left the pro- lation does not address that issue. One suggested means gram intact. The amended legislation, however, also of addressing the funding situation would require hos- removed a provision that would suspend the driver’s pitals to contribute at least some of the revenue needed licenses of those individuals who fail to pay the fine. to make the proposed changes in the legislation. Ohio’s License suspension is the main enforcement mecha- original trauma law was passed in 2000. nism for the program; if eliminated, it would have led A bill introduced this year in Indiana would have to a significant decrease in funding for trauma care in provided some funding for the statewide trauma the state. The ACS actively opposed the bill and will system. Although funds have been authorized for continue to counter efforts to cut trauma funding when the trauma system through the Spinal Cord and Brain the Texas legislature reconvenes in 2017. Injury Fund that became effective through legislation Legislation was introduced in Nevada that would passed eight years ago, no actual funding is provided have required the Department of Health and Human for trauma system development and infrastructure Services to develop a standardized system for the col- support. The bill introduced this year, H.B. 1404, lection of information for the state trauma registry. would have used speed cameras to identify drivers The bill, S.B. 189, also would have created the Fund for speeding through construction or school zones or the State Trauma Registry, which would have required illegally passing a school bus and would have imposed automobile and home insurers to charge an annual $1 a fine with a ticket sent through the mail. Half of fee to fund the development of this system. The bill the funds received from these fines would have been did not make it out of committee. directed to the Spinal Cord and Brain Injury Fund, In Ohio, H.B. 261 was introduced to create a new specifically for use in developing a statewide trauma Ohio Trauma Board and to make other changes to hospital network. The bill failed in the Committee its trauma system. The Ohio Trauma Board, which on Roads and Transportation.

V100 No 9 BULLETIN American College of Surgeons ACS ADVOCATES FOR TRAUMA PATIENTS

In addition, significant behind-the-scenes work is Another resolution that garnered some attention occurring in some states to gain support for trauma dealt with the use of restraint systems for children on system development. As a result, increased legislative commercial airline flights. There was mixed testimony activity is expected to occur next year. on the resolution, which recognized the need to keep children safe on flights but acknowledged the logistical challenges. The delegates adopted a policy, which calls AMA HOD activities on the AMA to support the use of restraint systems for In the course of its annual meetings, the AMA HOD children on flights and for public education about the typically considers a number of resolutions pertaining use of the devices. The resolution also recommends to trauma care. This year’s meeting was no exception. that the AMA work with relevant federal and inter- Reference Committee D, which considers resolutions national agencies to establish criteria for appropriate focused on public health, reviewed a number of reso- child restraint systems. lutions centered on injury prevention. The AMA also considered and adopted an amend- One of the more hotly debated resolutions cen- ment to its current policy on distracted driving. The tered on mandatory protective headgear/helmets for amendment added in language about the dangers of female lacrosse players in order to prevent concus- using headphones/earbuds while driving and while sions. U.S. Lacrosse, the national governing body of partaking in outdoor activities such as biking, jog- | 13 the sport, currently opposes mandatory helmet use ging, rollerblading, walking, and skateboarding. The for female players but is debating whether to change amendment directs the AMA to support education policy. Some delegates argued that the AMA should about these dangers, as well as the addition of warn- wait until U.S. Lacrosse has ruled before getting ing labels indicating the dangers of using handheld involved. After hearing significant testimony in favor devices with headphones/earbuds. The ACS supported of the resolution, the AMA adopted the new policy the resolutions on increasing toy gun safety, concussion and will advocate for protective headgear for female and youth sports, and mandating support of protective lacrosse players. headgear in lacrosse. In another effort to prevent youth concussions, the AMA adopted a policy to promote requirements for youth sports participants who are suspected of having Learn more a concussion. Specifically, these requirements man- ACS staff members work closely with the Committee date the suspension of these athletes from all forms on Trauma to review trauma-related policies and to of the activity until written approval is provided by take a position on them as appropriate. The College a physician or designated member of the care team. also builds relationships with individual members and The AMA also regularly considers resolutions State Chairs of the Committee on Trauma to ensure dealing with gun safety. At this year’s meeting, the proper coordination of state legislative advocacy. House of Delegates adopted a resolution directing If you have questions or would like more informa- the AMA to encourage toy gun manufacturers to tion about the ACS state legislative activities, contact take additional steps to further differentiate toy guns Tara Leystra Ackerman or Justin Rosen, State Affairs from real guns. Currently, makers of toy guns add an Associates, at [email protected]. If you have any orange tip to their products to distinguish them from questions or would like more information regarding actual weapons. The resolution that was adopted was the work of the ACS delegation to the AMA HOD, amended from its original version, which would have contact Jon Sutton, Manager, State Affairs, at jsutton@ required the AMA to support legislation strengthen- facs.org or 202-672-1526. ♦ ing current laws on the manufacturing of toy guns.

SEPT 2015 BULLETIN American College of Surgeons GLOBAL PAYMENTS

Changes on the horizon for global services payment 14 |

by Vinita M. Ollapally, JD

HIGHLIGHTS lthough an immediate overhaul of the global • Provides details on the averted CMS policy services reimbursement mechanism has that would have transitioned 10- and 90- Abeen averted, significant modifications that day global payment codes to 0-day codes will affect all surgeons are on the horizon for the coming years. • Describes the College’s role in encouraging Congress to intervene Global codes include necessary services normally provided by a surgeon before, during, and after a sur- • Forecasts the future of the issue gical procedure. Global codes are classified as 0-day, and its impact on surgery 10-day, or 90-day based on the number of postopera- tive days that will be covered for specific procedures. Approximately 4,200 of the more than 9,900 Current Procedural Terminology (CPT) codes are categorized as either 10- or 90-day global codes.* This article describes policies by which the Cen- ters for Medicare & Medicaid Services (CMS) would have transitioned all 10- and 90-day global codes to 0-day; the congressional action that prohibited the agency from implementing those policies; the

*All specific references to CPT (Current Procedural Terminology) codes and descriptions are © 2014 American Medical Association. All rights re- served. CPT and CodeManager are registered trademarks of the Ameri- can Medical Association.

V100 No 9 BULLETIN American College of Surgeons GLOBAL PAYMENTS

Although initially it appeared that this proposal could benefit surgeons given that they would be able to bill separately for each follow-up visit, analysis by the ACS GSCRC showed that this policy would result in a decrease in payments to surgeons.

legislation that replaced those policies and will revise global payments in the coming years; and the American Col- lege of Surgeons’ (ACS) advocacy efforts.

CMS’ proposal Representative Bucshon In July 2014, CMS proposed to transi- tion all 10- and 90-day global codes to comments on legislation 0-day global codes in 2017 and 2018, to stop conversion to respectively. Under this proposal, medically reasonable and necessary 0-day codes visits would have been billed sepa- Representative Bucshon | 15 rately during the preoperative and “As one of a small number of physicians in Congress, I’m happy to postoperative periods outside the day of the surgical procedure. CMS’ ratio- have played a part in putting an end to the flawed SGR policy. As nale behind this policy was concern a part of that package—and through the work of my physician that the current valuation methodol- colleagues and the ACS—we were able to stop a proposed CMS rule ogy for global codes is problematic, in to convert all 10- and 90-day global procedures to 0-day global that it is based on assumptions about procedures that would have dramatically increased administrative the resources used in furnishing a costs on physicians, taking away from their ability to care for typical case for each individual service rather than actual data on the cost of patients. This change would have also increased the financial furnishing services. CMS also ques- burden on patients, forcing them to pay more out-of-pocket and tioned whether the values included in discouraging them from seeking critical follow-up care. By preserving the postoperative global codes reflect global payments, we keep the focus on patient care in an effort to the care actually furnished during that lower hospital readmissions, improve the quality of care, increase period. CMS’ proposal did not include patient satisfaction, and prevent medical errors. I’m proud I was able a methodology for making this transi- tion, nor did it provide an analysis of to work with my Democratic colleague and fellow physician Rep. Ami its impact on surgical patients or the Bera (D-CA) to get this provision included in the SGR reform package, surgeons who care for them. and I’m thankful that the ACS partnered with us to get this done.” Although initially it appeared that this proposal could benefit surgeons, given that they would be able to bill separately for each follow-up visit, an analysis by the ACS General Surgery Coding and Reimbursement Commit- tee (GSCRC) showed that this policy

SEPT 2015 BULLETIN American College of Surgeons GLOBAL PAYMENTS

would result in a decrease in payments to surgeons. Congress intervenes This reimbursement reduction is attributable to sepa- In parallel with its regulatory efforts, the College’s rately reportable evaluation and management (E/M) legislative and political team spent several months codes being reimbursed at a lower rate than the E/M working to bring about a legislative solution to the codes included in the value of global codes. Further- problems associated with CMS’ proposal to eliminate more, the separately reportable E/M services would 10- and 90-day global codes. During Congress’ lame- not cover the practice expenses and liability costs duck session following the November 2014 election, a associated with postoperative visits. In addition, some coalition of surgical groups led by the College provided postoperative work now included in 10- and 90-day legislative language to lawmakers for inclusion in the global surgical packages is unreportable through E/M catchall omnibus spending bill. The language would codes; thus, depending on the methodology that CMS have precluded CMS from moving forward with its would have used, surgeons might not have been paid plan to transition 10- and 90-day global codes to 0-day 16 | for some follow-up care. global codes. However, despite strong support from a Based on these findings, in September 2014 the group of physicians in the House of Representatives ACS submitted a detailed comment letter to CMS known as the congressional Doctors Caucus and other describing these and other reasons why the agency representatives, the language was omitted from the should refrain from implementing the policy. In the final legislation. letter, the College stated that CMS first should com- When Congress reconvened in January, the Col- plete a comprehensive analysis of the effect the policy lege redoubled its efforts to ensure this policy was not would have on surgical patients and on access to sur- permitted to take effect. Reps. Larry Bucshon, MD, gical care, and develop a methodology for making FACS (R-IN), and Ami Bera, MD (D-CA), drafted a the transition to 0-day global codes. Without a letter to House Speaker John Boehner (R-OH) and transparent methodology, it would be impossible Minority Leader Nancy Pelosi (D-CA), urging them for stakeholders to provide cogent feedback to CMS to take action to nullify CMS’ plan. Dr. Bucshon, a on the validity and viability of its proposed policy. cardiothoracic surgeon, and Dr. Bera, a family physi- Despite these and other efforts by the ACS regula- cian, worked to encourage other House members to tory staff to counter the policy, in November 2014, sign on to the letter, making sure the issue rose to a CMS finalized the policy to transition 10- and 90-day priority level in Congress (see sidebar, page 15). The global codes to 0-day. letter ultimately garnered strong support. Due to the Before finalization of this policy, the ACS GSCRC hard work and determination of surgical champions in also embarked on an extensive data analysis and mod- Congress, this issue remained on the table throughout eling project to estimate the impact of a transition to negotiations on the bipartisan Medicare reform legis- 0-day global codes. The findings from this project were lation, and was included in the final package that was used to support recommendations to CMS on how to passed by overwhelming margins in the House and develop a fair and accurate methodology for transi- Senate. This significant legislative victory was made tioning to 0-day global codes if the agency intended to possible through the continuous efforts of Drs. Bucshon move forward. GSCRC and ACS staff presented these and Bera and other members of the Doctors Caucus, recommendations to CMS in meetings with senior CMS including Reps. Tom Price, MD, FACS (R-GA); Dan officials in February and April 2015. Benishek, MD, FACS (R-MI); and Charles Boustany,

V100 No 9 BULLETIN American College of Surgeons GLOBAL PAYMENTS

The hard-fought victory for both the repeal of the SGR and blocking the implementation of the global services transition policy was achieved through the advocacy efforts of the ACS and other medical associations, Fellows’ participation in meetings with lawmakers, and thousands of letters and calls to Capitol Hill.

MD, FACS (R-LA); as well as Phil Roe, MD (R-TN), required to collect data on global services starting chairman. The ACS’ advocacy efforts were ultimately no later than January 1, 2017, and use those data to successful when President Barack Obama signed the revise global services starting in 2019. Medicare Access and Children’s Health Insurance Pro- The ACS will continue working to influence the gram Reauthorization Act of 2015 (MACRA) into law implementation of this new global payments policy. on April 16. This law not only repealed the sustainable Efforts will include developing recommendations growth rate (SGR) formula used to calculate Medicare for CMS on the methodology for collecting data, as physician payments, but it also prevented CMS from the methodology used by CMS is directly relevant to implementing the policy to transition 10- and 90-day the type of data that will be gathered. The ACS will global codes to 0-day. then put forth recommendations on how these data With MACRA in place, beginning on or before Janu- should be used to revalue global surgical services in ary 1, 2017, CMS is required to collect the data needed 2019. The ACS GSCRC will continue to collaborate to value surgical services from a representative sample and build on its relationship with CMS to ensure that | 17 of physicians. These data must include information on the agency implements the MACRA-mandated revi- the number and level of medical visits furnished during sions to global services in a fair and accurate manner. the global period and on other appropriate items and More information about CMS’ sidelined proposal services related to surgery furnished during the global to transition global payments and the revisions man- period. MACRA also allows 5 percent of the surgical dated under MACRA is available on the ACS website payments to be withheld until these data are reported at www.facs.org/advocacy/regulatory/medicare-a-b/ at the end of the global period and grants authority global-codes. ♦ to discontinue the reporting requirement if sufficient information can be derived from Qualified Clinical Data Registries, surgical logs, electronic health records, or other sources. Beginning in 2019, CMS must use these and possibly other data that the agency might identify to improve the accuracy of the valuation of surgical services. The hard-fought victory for both the repeal of the SGR and blocking the implementation of the global services transition policy was achieved through the advo- cacy efforts of the ACS and other medical associations, Fellows’ participation in meetings with lawmakers, and thousands of letters and calls to Capitol Hill.

The future for global surgical services As the law currently states, CMS is prohibited from implementing its policy to transition 10- and 90-day global codes to 0-day global codes, but the agency is

SEPT 2015 BULLETIN American College of Surgeons DR. MAYNE’S LEGACY

18 |

The Mayne legacy: A look back at an influential charter member of the ACS

by Sarah B. Klein and William F. Sasser, MD, FACS

V100 No 9 BULLETIN American College of Surgeons DR. MAYNE’S LEGACY

ngineer, surgeon, health care advocate, entre- Surgical career preneur—Earl Hugh Mayne, MD, FACS, could Using his training in civil engineering, Dr. Mayne Eonly dream of earning these titles as a young worked as a bridge builder along the Ohio River to boy growing up on a small farm near Mason City, save enough money to attend medical school, intent IA. He eventually attained these professional goals on becoming a practicing surgeon. Along the way, through hard work, education, and business acumen. he met the vivacious Isabella “Maud” Rittenhouse of But one of Dr. Mayne’s most striking achievements Cairo, IL, whose lively journals kept from her girl- was in philanthropy—he established the Mayne Edu- hood through marriage were published in 1939 and cational Fund in 1944, thus becoming the first Fellow became a bestselling book, Maud. They later married to provide a legacy gift for the educational mission of and had three daughters. Mrs. Mayne was an accom- the American College of Surgeons (ACS). plished artist, graduating from the St. Louis School of Fine Art, Washington University, MO, in 1887. Dr. Mayne earned enough money to study at the Iowa roots Bellevue Hospital Medical College, New York, NY, Born on October 19, 1866, Dr. Mayne was the where he completed his course work in the spring | 19 youngest of eight children. According to the Mayne of 1893. After a trip abroad to Italy and other parts Educational Fund archives, it was “in a sturdy home of Europe, Dr. Mayne hung his physician’s shingle atmosphere of a large family and an efficiently run in Bath Beach, a suburb of Brooklyn, NY, and had farm that Dr. Mayne learned the value of industry, his first patient call in April 1894. In a letter to Maud self-reliance, and self-respect.” He also had the good later that year, he wrote that his practice income had fortune in his formative high school years to come grown to $484 per month and that he was “making under the influence of Carrie Lane, the young princi- as many as 26 patient visits per day, barely sleep- pal of the Mason City High School, who encouraged ing.”* His practice soon expanded, and he went from Dr. Mayne to continue his academic pursuits beyond making his rounds on a bicycle to a steam-powered high school. Ms. Lane, better known as Carrie Chap- Locomobile that he purchased in 1902. man Catt, eventually became a familiar leader in the In 1915, Dr. Mayne was admitted to the ACS as American women’s suffrage movement. a charter member and was later elected to serve on With money he earned by raising cattle and with a its Board of Governors. Throughout his career, Dr. county scholarship, Dr. Mayne completed civil engi- Mayne campaigned for health care advances, often neering courses at the University of Iowa, Iowa City. ignoring prejudices against modern medicine. For As an undergraduate student, he waited tables and example, he was a pioneer in the use of diphtheria cut cordwood for professors to pay the wages of a antitoxin during a time that the disease had a 40 per- hired man who took his place on the family farm. cent mortality rate. Although his primary studies were in engineering, Dr. and Mrs. Mayne also gave back to the com- Dr. Mayne began adding elective classes in medicine munity in their adopted home state of New York. and observing operations. A few fainting spells in his He was a founder of the Bay Ridge Hospital and for early viewings of surgery did not diminish his new- many years was the president of the institution’s found passion to become a surgeon. board of directors, as well as president of the Bay Ridge Medical Society. He had many interests in real *Rittenhouse IM. Maud. Strout RL, ed. New York, NY: The Macmillian estate and was a director of the Atlantic Gulf and Company; 1939. continued on page 21

SEPT 2015 BULLETIN American College of Surgeons DR. MAYNE’S LEGACY

MAYNE HERITAGE SOCIETY MEMBERS (AS OF JUNE 2015) †Dr. William W. Allen LaMar and Julia McGinnis Kathryn and French Anderson †Dr. Mary L. McKenzie Anonymous The Estate of Harold H. Metz, MD, FACS Dr. and Mrs. H. Randolph Bailey †Dr. Alvin W. Mooney Charles and Carol Balch Dr. William R. Muir Dr. William A. Bernie Dr. and Mrs. Henry A. Norum James G. and Cynthia G. Chandler Dr. Frank G. Opelka Dr. and Mrs. Neil C. Clements Dr.† and Mrs. Frank T. Padberg, Sr. Dr. Amalia L. Cochran †Dr. Frederick W. Plugge IV Dr. Benjamin L. Crue, Jr. Dr. and Mrs. Stuart M. Poticha Dr. and Mrs. Martin L. Dalton, Jr. Dr. and Mrs. Richard B. Reiling Gary S. Flom, MD, FACS, FAAP Danny and Paula Robinette Dr. and Mrs. Henry Gans Antonio and Vivian Robles Dr. and Mrs. David E. Grambort Dr. and Mrs. Martin C. Robson †Dr. Wilfred Guerra Drs. Thomas R.† and Nona C. Russell 20 | Dr. and Mrs. Peter S. Hedberg Dr. and Mrs. Russell L. R. Ryan Dr.† and Mrs. Robert W. Hobson II Dr. and Mrs. William F. Sasser Dr. Robert T. J. Holl-Allen Dr. and Mrs. Paul R. Schloerb Mary and John Iacuzzo, MD, FACS Drs. Pamela P. Scott and Dr. and Mrs. Paul H. Jordan, Jr. Razaullah A. Khwaja † †Dr. and Mrs. M. J. Jurkiewicz Dr. and Mrs. Andrew G. Sharf The Estate of Samuel Kantor, MD, FACS William Sternfeld, MD, FACS The Estate of Harry E. Keig, MD, FACS Dr. Amilu Stewart Dr. and Mrs. Norman M. Kenyon Dr. Hugh H. Trout III † †Dr. William W. Kridelbaugh Dr. and Mrs. Irving W. Varley † Yeu-Tsu Margaret Lee, MD, FACS Dr. Arie D. Verhagen † Dr. and Mrs. LaSalle D. Leffall, Jr. Dr. and Mrs. Alexander J. Walt Dr.† and Mrs. Joseph H. Lesser Dr. and Mrs. W. Merle Warman Dr. and Mrs.† Eric T. Lincke Dr. and Mrs. Andrew L. Warshaw Dr. and Mrs. Richard A. Lynn The Estate of Claude E. Welch, MD, FACS Dr. Marcel C. C. Machado Dr. and Mrs. David P. Winchester † Dr. and Mrs. James V. Maloney, Jr. Dr. A. Stark Wolkoff † †Dr. Hector and Mrs. Ruth Marin Dr. and Mrs. Scott W. Woods Richard W. and Pennie B. Martin †Deceased The Estate of Earl H. Mayne, MD, FACS

V100 No 9 BULLETIN American College of Surgeons DR. MAYNE’S LEGACY

Throughout his career, Dr. Mayne campaigned for health care advances, often ignoring prejudices against modern medicine. For example, he was a pioneer in the use of diphtheria antitoxin during a time that the disease had a 40 percent mortality rate.

Pacific Company. Mrs. Mayne volunteered and was Regents. Dr. Mayne’s extraordinary generosity and active in the women’s suffrage movement. foresight to create a legacy gift are remarkable and have led to the development of resources that will enable the College to meaningfully support the edu- Philanthropic leadership cational and lifelong learning pursuits of Fellows. | 21 Dr. Mayne is perhaps best remembered among mem- bers of the ACS and in the philanthropy community for the contributions that he has made, including gifts The Mayne Heritage Society that extended well beyond his lifetime. In honorable In 1994, the Board of Regents honored Dr. Mayne by recognition for the role that education had on his naming the ACS Foundation’s planned giving pro- professional success, he established the Mayne Edu- gram the Mayne Heritage Society to recognize his cational Fund in 1944 to help deserving young men leadership in philanthropy. Members of the society and women have access to educational opportunities. are those who have followed Dr. Mayne’s example He directed that this charitable trust be dissolved 50 and have generously included the College in their years later, at which time the corpus and all other future philanthropic plans. No single gift is the same, accumulated income would be paid to the ACS. With as donation amounts and gift formats vary. However, an initial contribution of $64,000 in the Mayne Edu- all of these philanthropic efforts share a common goal cational Fund trust, the College ultimately received of supporting the College’s educational mission for a sum of more than $1 million in 1994. Dr. Mayne future generations through forward-thinking donors also bequeathed an outright sum of $5,000 to the Col- who have the opportunity to give to the area of their lege upon his death in 1949, the equivalent of nearly choice (see the list of Mayne Heritate Society mem- $50,000 today. bers, page 20). The first distribution of the Mayne Educational If you are interested in learning more about Mayne Fund, in conjunction with the Robert Wood Johnson Heritage Society membership, contact the ACS Foun- Foundation, supported the work of Clinical Scholars dation at 312-202-5338, or visit plannedgiving.facs.org. ♦ within the ACS Division of Research and Optimal Patient Care. Future distributions from the fund will soon be used to advance other educational opportu- nities for ACS Fellows and Affiliate Members. Per Dr. Mayne’s directive in his will, the determined usage will be at the behest of the College’s Board of

SEPT 2015 BULLETIN American College of Surgeons TRANSPLANT SURGEON REFLECTS

Dr. Beverley Ketel: Surgeon who brought transplant surgery to Peoria, IL, reflects on a fulfilling career

Dr. Ketel (left) honored at her retirement from her career as a transplant surgeon. At the podium is Karen Welborn, MSN, manager, transplant services, OSF Saint Francis Medical Center.

22 | by Karen Sisulak Binder ne of the first events Beverley L. Ketel, MD, FACS, attended following her retirement this spring was the dedication of Oa new memorial at Rutherford Park near the OSF (Order of Saint Francis) Saint Francis Medical Center, Peoria, IL. This space is filled with flowers, shrubs, and other carefully curated flora, planted in recognition of all the tissue and organ donors that have helped the Level I trauma and tertiary care center become the top donor hospital in Illinois. Tucked between all the tributes was another thank you, this one honoring Dr. Ketel for her work as a transplantation surgeon, 1984–1990 and 2002–2015, with the medical center and the Gift of Hope Organ & Tissue Donor Network. The inscribed paver stone was placed in the garden and reads: “Dr. Beverley Ketel—33 years of dedication to donation & transplantation.” During the 12-year gap in her service at Saint Francis, she served as chief of transplantation at the University of Arkansas-Little Rock and remained there until her children had grown and moved out of the house.

Making dreams come true “She actually had a better feel for what was needed more than the typical transplantation surgeon,” said Jerry Anderson, chief execu- tive officer of the Gift of Hope from 1987 to 2013. “When I first met Beverley, she was running her own organ donation organization. That certainly speaks to her as an advocate for patients.” Hospital archives note the tandem successes shared by the hos- pital and Dr. Ketel since she joined the staff in 1984, particularly in

V100 No 9 BULLETIN American College of Surgeons TRANSPLANT SURGEON REFLECTS

July of that year, when she started the hospital’s kidney an infectious disease specialist. The couple speculated transplant program. With this act, she made “a medi- on whether it was possible to match at the same hos- cal dream a reality,” as noted by an article published in pital for their residency training. They did—both at the hospital’s history retrospective publication. U of C—and then started thinking about taking their The next milestone for Dr. Ketel and the medical relationship to the next level. center occurred on July 14, 1985, when she performed “I thought at one point we should keep our mar- the first kidney transplant in the Peoria area. This 5.5- riage secret,” she said. “There were questions whether hour operation was the first in what would become an a wife could devote herself to her husband, a family, estimated 3,700 procedures completed at the Peoria and medicine. It was unproven ground. I felt a little facility by 2014. Dr. Ketel would again make history under the microscope during my five-year residency.” at the medical center by performing the first pancreas She asked a physician mentor if he thought it would and kidney-pancreas transplant surgeries in Septem- be all right to marry. He endorsed the union, and her ber 2002. She assisted in another landmark procedure first two of three children were born during her trans- in 2011 by performing the center’s 1,000th transplant. plant fellowship. “Then I started to apply for jobs. It felt like no one wanted to hire me because I was a woman with a | 23 Overcoming obstacles young family,” she said. Her husband’s family was from Many health care professionals would consider these the Kansas City, MO, area, so she settled for a general benchmarks to be extraordinary achievements for a surgery position that did not include transplantation at regional hospital in a rural setting, let alone to occur the University of Missouri School of Medicine, Kansas largely under the leadership of a woman surgeon in City. But eventually she would receive an opportune the 1980s. Currently boasting 850 physicians and 6,500 phone call. employees, OSF Saint Francis also is a member of the Administrators at OSF Saint Francis wanted the Gift of Hope Organ & Tissue Donor Network (origi- facility to be one of the nation’s first regional hospi- nally the Regional Organ Bank of Illinois). It was in tals with a transplant program, and they reached out central Illinois that Dr. Ketel found the ideal setting for to Dr. Ketel to see if she would lead the program. She a young woman surgeon launching her career. accepted eagerly but with some concerns. U.S. medical culture in the 1980s could be intimi- “I was excited, but it was also a little frightening as a dating, “especially for a petite woman in a world most young surgeon,” she said. “Once I came back to Peoria, certainly dominated by men,” Dr. Ketel said. “That I never sensed a problem with me being a woman. The just meant that I had to work harder, and that’s exactly culture changed very quickly in the mid- to late 1980s. what I did.” It was strictly professional.” Dr. Ketel was raised in Eugene, OR, before attend- ing the University of Chicago Medical School, IL. When she applied at the institution, university admin- Transplantation history istrators were actively recruiting medical students From a technical standpoint, Dr. Ketel said, kidney specifically from small and rural towns. “I was one of transplantation has changed little over the last few a dozen admitted in a grassroots talent search,” she decades, but transplantation drugs have certainly recalled. “There was a fear that we would not be able evolved. The transplantation success rate was to compete with the other students. We all did well.” 50 percent in 1984; today, it is 91 percent to 92 per- In her second year of medical school at the Univer- cent. This drastic improvement can be attributed to sity of Chicago (U of C), she met her husband, Richard, the advent of medicines that help control the immune

SEPT 2015 BULLETIN American College of Surgeons TRANSPLANT SURGEON REFLECTS

From a technical standpoint, Dr. Ketel said, kidney transplantation has changed little over the last few decades, but transplantation drugs have certainly evolved. The transplantation success rate was 50 percent in 1984; today, it is 91 percent to 92 percent.

system, particularly the anti-rejection drug cyclospo- services to more than 693,000 patients in 2014, and rin, as well as antibiotics and sophisticated diagnostic its patient base draws from within 250 miles of equipment such as computed tomography and mag- Peoria, as well as a three-state region (Illinois, Mis- netic resonance imaging. souri, and Iowa) for its specialized services, including In addition to immunosuppressants and advances the transplant program, according to the OSF Saint in diagnostic technology, requirements mandating Francis’s 2014 annual report.* OSF Saint Francis Medi- hospital affiliation with organ recovery programs cal Center, Peoria, is the largest of the health care have boosted the transplantation success rate. “Saint system’s institutions and is host to the Children’s Hos- Francis embraced organ donation and has been a lead- pital of Illinois, OSF Heart Hospital, and the Illinois ing donor hospital for decades—and that’s all because Neurological Institute and is a major teaching affili- of our community,” she said. “Since the beginning of ate of the University of Illinois College of Medicine our donation program, our community has responded at Peoria. well. In fact, their response was so great that our hos- pital has consistently been the top donation hospital, and continues to hold this honor.” A new beginning 24 | Dr. Ketel’s hands-on experience organizing Now, at age 66, Dr. Ketel is carefully considering the medical center’s first donor donation program her “next career.” She knows that she wants to stay afforded her the experience and skill set necessary to in Peoria and help disenfranchised elderly patients work with the Gift of Hope board. “She could look at secure needed medical attention. “It won’t be medi- things from a much higher level. She wanted to help cal, but it will be social work. I have not completely everyone, not just her patients. As a result, Saint Fran- decided yet. I’m just going to play this summer and cis has been consistently the top one or two donor then make a decision.” hospital [according to data collected through the Gift Her husband also is retired, and their three adult of Hope Network], and I think a lot of credit goes to children are launching their own careers: a daughter her steady force,” Mr. Anderson said. as a pediatric internal medicine physician; a son as an Dr. Ketel also enjoyed the status of practicing in attorney; and another son as a database developer. Midwestern medical circles. With Chicago and its Since she left Saint Francis in April, there’s been renowned medical institutions less than two hours a noticeable lack of stress, a byproduct of no longer away, she was pitted into “deep competition and the dealing with “all of the life and death decisions you prestige that comes with it.” have to make every day [in the profession],” she noted. The Saint Francis transplantation program seemed Yet, Dr. Ketel said it’s “hard not to miss surgery. to grow and evolve all on its own, according to There are a lot of articles out there about the general Dr. Ketel. “I didn’t realize how poised the commu- unhappiness of surgeons because it can be a hard life. nity was for this program. We never had to work hard I have worked a lot of hours, and with my husband to make this work.” Dr. Ketel further explained that being a doctor, he has, too. [But] I think if you ask the hospital’s staff and physicians all readily adopted my children, they were all right with everything. and promoted the transplantation practices required This has been the most rewarding career for me. I to successfully run the program. can’t imagine anything else for me that would be as The OSF Saint Francis health care system as a satisfying. I’ve been very happy.” ♦ whole has grown as well. It provided health care *OSF Saint Francis. Annual Report. Available at: annualreport.osfhealth- care.org/. Accessed July 23, 2015.

V100 No 9 BULLETIN American College of Surgeons ACS CLINICAL RESEARCH PROGRAM

Biomarker-driven adjuvant targeted therapy for NSCLC— the ALCHEMIST trials

by Geoffrey R. Oxnard, MD; Colleen Watt; Dennis Wigle, MD, FACS; and Judy C. Boughey, MD, FACS

It has become clear that umor genotyping has one way to achieve durable had an enormous impact Previous studies Ton the management of Though widely used and disease control for advanced advanced non-small cell lung extremely effective, these potent NSCLC, with minimal cancer (NSCLC). Today, tumor targeted agents are not part of genotyping for epidermal growth our curative management of | 25 toxicity, is to identify a gene factor receptor (EGFR) mutations NSCLC. Several randomized and anaplastic lymphoma kinase studies have investigated the target and to treat it with (ALK) gene rearrangements is role of EGFR TKIs in resected a potent targeted agent. widely accepted as a standard of NSCLC, but none have studied care for advanced non-squamous these agents specifically in the NSCLC in order to identify group known to gain the most patients for treatment with EGFR benefit—cancers harboring tyrosine kinase inhibitors (TKIs), EGFR mutations. The BR.19 trial such as erlotinib, or ALK TKIs, randomized 503 patients with such as crizotinib. Furthermore, resected NSCLC to gefitinib genotyping to identify other versus placebo; however, only 15 rare but targetable genotypes of those patients were identified (such as ROS1 rearrangements, as having EGFR mutations.* The BRAF V600E mutations, and so Randomized Double-blind Trial on) is increasingly performed. in Adjuvant NSCLC with Tarceva It has become clear that one (RADIANT) trial randomized way to achieve durable disease 973 patients with resected control for advanced NSCLC, NSCLC positive for EGFR by with minimal toxicity, is to immunohistochemistry or identify a gene target and to treat fluorescence in situ hybridization it with a potent targeted agent. to erlotinib versus placebo, and 161 of those had EGFR *Goss GD, O’Callaghan C, Lorimer I, et mutations—disease-free survival al. Gefitinib versus placebo in completely (DFS) was more favorable in the resected non–small-cell lung cancer: Results of the NCIC CTG BR19 study. erlotinib arm (HR 0.6), but no J Clin Oncol. 2013;31(27):3320-3326. difference in overall survival

SEPT 2015 BULLETIN American College of Surgeons ACS CLINICAL RESEARCH PROGRAM

FIGURE 1. ALCHEMIST SCHEMA

was evident.† One single-arm to design a clinical trial survival in resected NSCLC, study, the SELECT trial, studied platform that would facilitate and (2) to perform advanced 26 | adjuvant erlotinib in resected definitive studies of adjuvant genomics on a large cohort EGFR-mutant NSCLC and found targeted therapies in biomarker- of resected NSCLCs and to it to be a feasible therapy, with selected NSCLC patients. correlate these findings with 40 percent of patients requiring This platform was named detailed clinical annotation. a dose reduction and 69 percent ALCHEMIST—Adjuvant Lung of patients completing more Cancer Enrichment Marker than 22 months of treatment Identification and Sequencing How to get involved (of the 24 months intended). Trials. The ALCHEMIST with ALCHEMIST The two-year DFS rate was 89 program comprises three Surgical involvement is percent, which was better than studies at present: one overall critical to the success of the expected for resected NSCLC.‡ screening study (A151216) to ALCHEMIST screening study. Given that adjuvant TKI perform tumor genotyping This study has two aims: (1) in genotype-defined NSCLC and collect tissue and data for to perform EGFR and ALK populations is feasible and correlative studies, and two genotyping, which may lead to may improve outcomes, treatment trials that randomize enrollment in the ALCHEMIST- the National Clinical Trials EGFR-mutant NSCLC EGFR and ALCHEMIST-ALK Network and National Cancer (A081105) or ALK-rearranged studies; and (2) to collect high- Institute (NCI) joined together NSCLC (E4512) to two years quality formalin-fixed, paraffin- of adjuvant TKI (erlotinib for embedded tissue to allow †Shepherd FA, Alkorti NK, Eberhardt WEE, et al. Adjuvant erlotinib (E) versus placebo EGFR, crizotinib for ALK) advanced genomics at the NCI. (P) in non-small cell lung cancer (NSCLC) versus placebo (see Figure 1, Patients may provide consent for patients (pts) with tumors carrying EGFR- this page). The effort balances the screening trial at any time sensitizing mutations from the RADIANT trial. J Clin Oncol. 2014;32:5s (suppl; abstr 7513.) an important clinical aim and in their care (before or after ‡Pennell NA, Neal JW, Chaft JE, et al. an important translational operation, or during adjuvant SELECT: A multicenter phase II trial of research goal: (1) to study chemotherapy or radiation), adjuvant erlotinib in resected early-stage EGFR mutation-positive NSCLC. J Clin whether adjuvant targeted so long as the patients remain Oncol. 2014;32:5s, (suppl; abstr 7514). therapies can improve overall in-window for treatment on

V100 No 9 BULLETIN American College of Surgeons ACS CLINICAL RESEARCH PROGRAM

TABLE 1. ELIGIBILITY WINDOWS FOR ALCHEMIST TRIALS

Eligibility window for Eligibility window for Adjuvant treatment given ALCHEMIST-screening ALCHEMIST-EGFR or -ALK

No adjuvant therapy 75 days after surgery 90 days after surgery

Adjuvant chemotherapy only 165 days after surgery 180 days after surgery

Adjuvant chemotherapy 225 days after surgery 240 days after surgery and radiation

the two treatment trials (see results are returned directly receive any therapy at time of Table 1, this page). Ideally, to the site within 14 business recurrence, including crossing patients should be enrolled days; however, the advanced over from placebo to TKI. before resection so that an extra genomics at the NCI is tumor block can be collected considered investigational. for the study, ensuring adequate Thus, while these data will be Future directions tissue for clinical genotyping shared publicly when analysis The ALCHEMIST platform and advanced genomics. The is completed, they will not be is intended to allow room eligible patient population provided to sites for clinical use. for growth in the number for ALCHEMIST screening Surgeons and medical of adjuvant treatment trials is patients with resectable or oncologists both will enroll supported by the screening | 27 resected NSCLC, node-positive patients in the screening protocol. At present, an (IIA-IIIA) or high-risk node- study, and medical oncologists additional treatment trial negative disease (IB with will enroll eligible EGFR- or is in development to study size ≥ 4cm), non-squamous ALK-positive patients in the adjuvant therapy with a histology, who did not receive two treatment trials. Both PD1 inhibitor, which also neoadjuvant therapy. trials will accept patients will involve expanding the For patients enrolled who have completed standard ALCHEMIST screening study postoperatively, sites may adjuvant therapy. Adjuvant to include squamous NSCLC. either submit a tumor block chemotherapy and/or radiation The surgeons involved in or a combination of standard therapy is permissible but not the study anticipate that the slides and thick-cut “scrolls” required prior to enrollment effort will continue to grow for analysis. All patients also in the treatment trial. Both in the future to accommodate must have a tube of blood treatment studies are placebo- emerging agents. In this way, collected and complete an controlled trials that study two the ALCHEMIST trial offers an epidemiological questionnaire. years of adjuvant TKI versus infrastructure that can answer Those patients who are two years of placebo. Because a range of scientific questions ineligible for the EGFR or ALK U.S. medical oncologists are over the coming years, all treatment trials are followed experienced with the two with the aim of improving the on the ALCHEMIST screening targeted therapies being studied overall treatment of resected study every six months for five (erlotinib for EGFR, crizotinib and potentially curable NSCLC. years. If a biopsy is performed for ALK), it is expected that For more information about at the time of recurrence, a toxicity and compliance will not ALCHEMIST, contact Colleen portion of this sample should be major issues. The primary Watt from the Alliance for be submitted to the NCI for endpoint of both studies is Clinical Trials in Oncology further genomics. Importantly, an improvement in overall at [email protected]. ♦ the EGFR and ALK genotyping survival; patients are allowed to

SEPT 2015 BULLETIN American College of Surgeons FROM THE ARCHIVES

American surgical history: Finding a home at the Clinical Congress

by LaMar S. McGinnis, Jr., MD, FACS, and Norman H. Rich, MD, FACS

n 2014, a newly formed group President John Cameron, MD, Dr. Cameron moved on to at the American College of FACS; Professional Organizations the evolution of the surgical ISurgeons (ACS) began to find and Their Impact on American training program developed by its place. Driven by a consensus Surgery, presented by ACS William Halsted, MD, FACS, that our rich surgical heritage Distinguished Service Award at The Johns Hopkins School was not only reflective of our past recipient David Nahrwold, MD, of Medicine, Baltimore, MD, but could also serve as a guide FACS; What Surgeons Learn as the model that profoundly to our future, the members of from Wars, presented by Basil changed and improved surgical this group felt it was imperative Pruitt, MD, FACS; and A Fruitful training over the 20th century. that the College begin to collect, Partnership: Surgeons and Dr. Cameron then pointed to collate, reflect upon, and highlight Technology, presented by Mark modifications of the model that how surgeons and surgery Talamini, MD, FACS. These were implemented at other have evolved, believing that distinguished experts impressed institutions, such as the move 28 | awareness of this history adds the large audience assembled on from a pyramidal to a rectangular richness to our daily lives. the afternoon of October 28, 2014, program led by Edward Churchill, One of the ACS Surgical in San Francisco, CA. A video MD, FACS, at Massachusetts History Group’s (ACSSHG) initial of the session is available at the General Hospital, Boston. goals was to make surgical history Archives & History/Films section In addition, Dr. Cameron an integral part of the Clinical of the ACS website at www.facs.org/ commented on the 21st century use Congress. We were pleased about-acs/archives/collections/films. of fellowships following residency that the 2014 Clinical Congress training, describing them as Program Committee accepted our representative of a transition to a proposal for a Panel Session titled The evolution of training more disease-oriented approach Factors Shaping Surgery during Dr. Cameron opened the session to surgical training. He closed the 20th Century—the Inaugural by explaining that surgical by noting that the progression Session of the ACSSHG, and education and training have of responsibility in surgical we are equally grateful that the evolved to create generations of training and an ever-increasing Program Committee has agreed to highly skilled surgeons who are focus on science are perhaps the present a second panel discussion able to care for evermore complex greatest influences on American on this subject at the upcoming patient cases. He provided an surgery in the 20th century. Clinical Congress in Chicago, IL. overview of Civil War surgery, focusing on John Shaw Billings, MD (essentially untrained as a Profound impact of Overview of 2014 program surgeon), and the enormity of his professional organizations Recognizing the enormity of exploits as an innovator in surgery. Dr. Nahrwold spoke of the impact the forces at play over the last He then used the famous Thomas that professional organizations century, we thought this inaugural Eakins paintings of the Gross have had over this last century venture should focus on four Clinic and of the Agnew Clinic to of surgical progress, particularly principal topics: The Training of a exemplify and to contrast progress on ethical and moral standards Surgeon, presented by ACS Past- in the training of surgeons. and on professionalism. The

V100 No 9 BULLETIN American College of Surgeons FROM THE ARCHIVES

[W]e now look forward to the 2015 Clinical Congress and another ACSSHG Panel Session, Factors Shaping Surgery over the 20th Century II, which builds on last year’s theme....

formation of the American care, infection control, triage and experience of George Berci, Medical Association in 1847, the transport, shock management/ MD, FACS, who collaborated founding of the American Surgical resuscitation, blood transfusion, personally with Karl Storz, to Association in 1880 and the ACS in surgical technology, the evolution illustrate his point. According to 1913, the first surgical examining of certain surgical specialties, burn Dr. Talamini, Dr. Berci believes board (the American Board of management, hemorrhage control, that in a physician/industry Ophthalmology) in 1913, and the data collection and analysis, and partnership, there needs to be American Board of Surgery in so on, have all advanced through complete trust on both sides, 1937, along with many others, the laboratory of war. From (all creative freedom, the ability to represented a remarkable change MD, FACS) John M. T. Finney respectfully disagree and debate in the climate of surgical practice. through Fred W. Rankin, I. S. details, and an understanding Dr. Nahrwold further Ravdin, Champ Lyons, Curtis P. that the goal of the alliance is the remarked on the major influence Artz, and Frank C. Spencer, and creation of a better instrument of the organized medical staff at many others, advances in surgical or service—not making money. hospitals, beginning in 1917 with care have always accelerated Dr. Talamini then guided us the first standards for hospitals during war, with resultant major from the first Bovie to the Argon promulgated by the ACS. The impact on decreasing morbidity beam and gave us an appreciation evolution of the Clinical Congress, and mortality. These advances for the ups and downs that along with other professional in surgical care ultimately are have occurred along the way. | 29 association meetings and their passed on to civilian patients. publications—all with a primary focus on education—have been More to come this year of inestimable benefit to the Advances in technology With the remarkable success of field. Therefore, professional We all benefit daily from the inaugural panel in 2014, we organizations have not only the marvels of technology. now look forward to the 2015 benefitted surgeons, but also their Dr. Talamini addressed the subject Clinical Congress and another patients and society as a whole. in his presentation on A Fruitful ACSSHG Panel Session, Factors Standard setting and professional Partnership: Surgeons and Shaping Surgery over the 20th education were and remain Technology, depicting the often Century II, which builds on last the primary strengths of our tenuous relationship between year’s theme and will include organizations, serving to bind us technology and hesitant surgeons the following presentations: together as surgical professionals. that ultimately results in benefits Imaging: A Radiology and Surgery for our patients. Dr. Talamini Synergism (Barry Katzen, MD); provided an overview of some of Infection Control to Purge the War and medicine the major technological changes Scourge of Sepsis (Hiram Polk, Opening with a quotation from that have occurred over time, Jr., MD, FACS); Cardiovascular Hippocrates, “he/she who wishes including better visualization of Surgery: The Heart of the Matter to be a surgeon should go to the operative field, dramatically (Alden Harken, MD, FACS); and war,” Dr. Pruitt then explained improved instrumentation, Transplantation: Surgical Use of the remarkable advances in heightened ability to control Used Parts (Nancy Asher, MD). surgery that have resulted from hemorrhage, enhanced ability The ACSSHG welcomes experiences in wartime, pointing to join tissues, and so on. your presence and participation out that our nation was involved in He discussed the important at this event on Wednesday, some type of military conflict for relationship between industry October 7, 2015, at the Clinical most of the 20th century. Wound and the surgeon and used the Congress meeting in Chicago. ♦

SEPT 2015 BULLETIN American College of Surgeons A LOOK AT THE JOINT COMMISSION

Safety culture is a great fit for the OR

by Carlos A. Pellegrini, MD, FACS, FRCSI(Hon)

magine a scenario in which safe practices should be instilled someone on the operating Creating a culture of safety in all employees “and is spurred 30 | Iroom (OR) team is about According to an article by Mark by implementing standards to make a mistake while R. Chassin, MD, MPP, MPH, for invoking disciplinary performing a surgical procedure, FACP, president and chief procedures that apply to all and no one speaks up. This executive officer of The Joint staff, regardless of seniority is an undesirable situation Commission, and Jerod M. Loeb, or professional credentials.… that often results from the PhD, titled “High-reliability Becoming much safer requires hierarchical OR structure health care: Getting there caregivers’ willingness that has developed over the from here,” one of the methods and ability to recognize years. Under those conditions, that health care institutions and report close calls and individuals are unlikely to can use to attain levels of unsafe conditions, combined raise concerns for fear of quality and safety similar to with an organizational disturbing or even offending other industries that strive to capacity to act effectively the most senior member of the achieve zero harm includes on this report to eliminate team. Safety experts in other establishing a safety culture.* the risks they embody.” areas have recognized that The authors write that “a hierarchy trumps safety and culture of safety that fully that improvements of safety supports high reliability Flattening the hierarchy require elimination of this has three central attributes: and communicating intimidating structure, as well as trust, report, and improve.” I believe surgeons should encouragement of all members Furthermore, “maintaining trust champion these concepts in of the team “to speak up.” also requires the organization the OR. From my perspective, to hold employees accountable two elements are vital to *Chassin MR, Loeb JM. High-reliability for adhering to safety creating a culture of safety. health care: Getting there from here. protocols and procedures.” The first is to establish a Milbank Quarterly. 2013;91(33):459-490. In the article, Dr. Chassin nonthreatening environment— Available at: www.jointcommission.org/ high-reliability_health_care_getting_ and Dr. Loeb also state that one that not only invites team there_from_here/. Accessed July 23, 2015. accountability for adhering to members to question the

V100 No 9 BULLETIN American College of Surgeons A LOOK AT THE JOINT COMMISSION

The most senior surgeon in the OR should create the right environment by elevating everyone and empowering team members to speak up, which is essential to building a team. The best way to achieve this goal is to ensure that everyone feels that the patient’s welfare is the central focus.

processes being used but also multiple monitors in the OR about unrelated matters or does away with the traditional and everyone can follow the allowing our minds to drift. hierarchy that has been present procedure, I want all members Constant communication | 31 in the OR for many years. of the team to be involved and about what we are doing The most senior surgeon to feel empowered to challenge keeps us focused and alert. in the OR should create the me or to ask a question if they A culture of safety increases right environment by elevating see something they do not the chance of safely completing everyone and empowering team understand. I tell them the an operation. Surgeons should members to speak up, which best way to do that is to ask me use their influence to create is essential to building a team. any time they find me doing such an environment in their The best way to achieve this something they don’t follow. ORs. The right climate will goal is to ensure that everyone There are only two reasons for improve the quality of surgical feels that the patient’s welfare is team members to have these care, enhance the well-being the central focus. Applying this questions: either they do not of the members of the surgical technique will allow everyone understand, which gives me the team, and result in better on the team to focus on desired opportunity to teach them; or outcomes for patients. ♦ outcomes, rather than on the what I am doing is incorrect, in hierarchy. Each member of the which case they can make me team should feel that his or her more alert to a potential error. Disclaimer impressions and thoughts count. After eliminating the The thoughts and opinions When I am working in the hierarchy, the other vital expressed in this column are solely OR, I tell my assistants and the element in OR safety is those of Dr. Pellegrini and do not scrub nurse that I would like adequate communication. necessarily represent the official them to follow every step of Communication in the OR views of The Joint Commission or the operation, and make sure I should be active, constant, the American College of Surgeons. don’t make any mistakes. Such a focused on what is being done, statement is usually met with a and always with an emphasis little smile, as if I did not mean on what is best for the patient— it. But at a time when we use we should never be talking

SEPT 2015 BULLETIN American College of Surgeons NTDB DATA POINTS

Kickback

by Richard J. Fantus, MD, FACS

here are several definitions records were searched using of the word “kickback,” History of the chain saw the International Classification Tand most of them have The first use of a chain handsaw of Diseases, Ninth Revision, negative connotations. The was recorded in 1785 in John Clinical Modification diagnoses Merriam-Webster online Aitken’s Principles of Midwifery codes. Specifically searched dictionary defines kickback or Puerperal Medicine, in which were records that contained as (1) a sharp violent reaction, a fine serrated chain was the following external cause and (2) a return of a part of a described as having been used of injury code (E-code): E920.1 sum received often because to remove diseased bone.3 In (injuries from chain saw). A of confidential agreement or 1926, Andreas Stihl patented a total of 5,570 records were coercion.1 Kickback, in fact, 116-pound electric chain saw found, of which 4,701 contained has several meanings—the that required two people to a discharge status, including Urban Dictionary, an online operate. Near the end of World 4,612 patients discharged to 32 | resource for pop culture terms War II, chain saws were still home, 58 to acute care/rehab, and phrases, defines the term heavy and required two people and 21 sent to skilled nursing as “a get-together consisting to operate. In 1949, McCulloch facilities; 10 died. Of these of close friends, [involving] Motors Corp. debuted the patients, 97 percent were male, partying and drinking.”2 There world’s lightest chain saw at on average 45.5 years of age, is also a legal definition for only 25 pounds. In 1973, the had an average hospital length kickback—specifically, the Husqvarna company created of stay of 2.5 days, an intensive federal law that prohibits health the automatic chain break, care unit length of stay of 2.7 care providers and suppliers a safety device consisting of days, an average injury severity from giving or receiving a lever that stops the chain score of 4.5, and were on the “remuneration” for the after kickback, preventing ventilator for an average of referral of patients or services injury to the operator.3 2.6 days. Injury location was covered by most government- available for 4,635, and most run health programs, such occurrences took place at as Medicare and Medicaid. Chain saw injuries home (65 percent), followed In addition to these more According to the Centers for by industry (28 percent) figurative meanings, kickback Disease Control and Prevention, (see Figure 1, page 33). can refer to the physical approximately 36,000 people reaction that results from a are treated annually in hospital sudden, powerful force, such as emergency departments Wear the right gear the recoil from using a firearm for injuries resulting from The chain saw is one of the or from starting an unsteadied use of a chain saw.4 most versatile power tools one power tool. One such popular To examine the occurrence can own; however, it cuts both tool is the chain saw, with of chain saw-related injuries flesh and wood with equal ease. which the term kickback in the National Trauma Data Several safety measures should describes the unexpected Bank® (NTDB®) research dataset be taken to avoid injury while upward motion of the guide bar. for 2013, admissions medical operating a chain saw. First,

V100 No 9 BULLETIN American College of Surgeons NTDB DATA POINTS

FIGURE 1. LOCATION OF INJURY

| 33 operate, adjust, and maintain quality-programs/trauma/ntdb. In REFERENCES the chain saw according to addition, information is available 1. Kickback. 2015. Merriam-Webster.com. the manufacturer’s direction. on the website regarding how Available at: www.merriam-webster. Properly sharpen and oil chain to obtain NTDB data for more com/dictionary/kickback. Accessed June 29, 2015. saw blades, and choose the detailed study. To submit your 2. Kickback. UrbanDictionary.com. proper size saw for the job. trauma center’s data, contact Available at: www.urbandictionary. Wear the appropriate protective Melanie L. Neal, Manager, com/define.php?term=KB. Accessed equipment when operating a NTDB, at [email protected]. June 29, 2015. chain saw, including helmets, 3. Green A. A brief history of the chain saw. PopularMechanics.com. face shields, safety glasses, October 12, 2012. Available at: www. hearing protection, cut-resistant Acknowledgement popularmechanics.com/home/tools/ gloves and chaps, along with Statistical support for this article reviews/a8162/a-brief-history-of-the- boots above the ankle. has been provided by Chrystal chain-saw-13626055/. Accessed June 30, Observe the above safety Caden-Price, Data Analyst, NTDB. 2015. 4. Preventing chain saw injuries during recommendations so that tree removal after a disaster. Centers when you are done, you for Disease Control and Prevention. can kick back with your Available at: http://emergency.cdc. friends and family and enjoy gov/disasters/chainsaws.asp. Accessed the work that you did. June 30, 2015. Throughout the year, we will be highlighting NTDB data through brief monthly reports in the Bulletin. The NTDB Annual Report 2014 is available as a PDF file at www.facs.org/

SEPT 2015 BULLETIN American College of Surgeons NEWS

SEPTEMBER 2015 | VOLUME 100 NUMBER 1S | AMERICAN COLLEGE OF SURGEONS Bulletin See Something, Included with this month’s Bulletin: Do Something: Compendium on improving survivability from Improving Survival mass casualty events Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium

Mailing with this month’s Bulletin The committee was founded The individuals, agencies, and of the American College of Surgeons by the ACS in collaboration is Strategies to Enhance Survival in with the medical community organizations that dedicated Active Shooter and Intentional Mass and representatives from the considerable time and Casualty Events: A Compendium. federal government, the National This document is being distributed Security Council, the U.S. expertise to the development to a wide audience, including not military, the Federal Bureau of of this compendium...hope only members and staff of the Investigation, and governmental that the lifesaving techniques 34 | American College of Surgeons and nongovernmental (ACS), but also employees of emergency medical response described in the articles will federal agencies and stakeholders organizations, among others, help to ensure that when interested in improving the and has met regularly in public’s ability to respond at the Hartford, CT. In addition to the bystanders see something scene of active shooter and mass Hartford Consensus reports, the where lives are at stake, casualty events. It was developed compendium contains statements under the guidance and leadership from government leaders and they can do something to of ACS Regent Lenworth M. individuals who have contributed improve survivability. Jacobs, Jr., MD, MPH, FACS, in to the committee’s efforts. response to a Presidential Policy The individuals, agencies, Directive aimed at strengthening and organizations that dedicated the security and resilience of the considerable time and expertise U.S. at a time when active shooter to the development of this and mass casualty incidents are compendium anticipate that occurring all too frequently. this document will assist in The compendium contains achieving the President Policy Hartford Consensus reports that Directive of strengthening have been published previously the security and resilience of in the Bulletin and the Journal of U.S. citizens when these tragic the American College of Surgeons. incidents occur. They also hope These reports represent the that the lifesaving techniques deliberations of the Joint described in the articles will help Committee to Create a National to ensure that when bystanders Policy to Enhance Survivability see something where lives are from Intentional Mass Casualty at stake, they can do something and Active Shooter Events. to improve survivability. ♦

V100 No 9 BULLETIN American College of Surgeons NEWS

John A. Weigelt, MD, DVM, FACS, chosen as 2015 Distinguished Service Award recipient

In acknowledgement of his have positively impacted the Comprehensive General Surgery commitment to the American practices of numerous surgeons,” Review Course since its beginning College of Surgeons (ACS) and according to the award citation. in 2010. Additionally, he has been his accomplishments in the field a member of the Committee on of surgery, John A. Weigelt, MD, Education and the Committee DVM, FACS, has been selected to Leadership in the ACS on Video-Based Education since receive this year’s Distinguished In his more than 30 years as a 2002, as well as a member of Service Award (DSA). An ACS Fellow, Dr. Weigelt has been a the Committee on Medical Fellow since 1982, Dr. Weigelt member of and held leadership Motion Pictures (2002–2004). | 35 is the Milt & Lidy Lunda/ roles in a range of ACS programs Dr. Weigelt also has been a Charles Aprahamian Professor and committees. He has been a part of state-level ACS activities, of Trauma Surgery; professor member of the ACS Committee becoming a member of the North and chief, division of trauma on Trauma (COT) since 1992 Texas Chapter in 1983 and serving and critical care; and associate and, in that time, served as COT as Chair, North Texas Chapter dean for quality, Medical Chair (1994–1998) and COT COT, and Council Member, College of Wisconsin (MCW), Membership Committee Chair North Texas Chapter (both Milwaukee. He also is a general (1998–2004). He also was chief, 1983–1989). He has also been a surgeon and medical director COT Region 6 (1989–1992). He member of the ACS Chapters of clinical quality at Froedtert has been on the National Faculty in Minnesota and Wisconsin. Memorial Lutheran Hospital. of the Advanced Trauma Life The DSA is the ACS’ highest Support® program since 1983. honor and will be presented Dr. Weigelt has been deeply Accomplished surgeon at the 2015 Clinical Congress involved in many of the College’s and educator Convocation ceremony, Sunday, educational programs. He began Dr. Weigelt’s involvement in the October 4, in Chicago, IL. serving as an author of the Surgical College’s educational programs The Board of Regents of the Education and Self-Assessment and committees is representative ACS is presenting the DSA to Program (SESAP®) during of his dedication to surgical Dr. Weigelt “in appreciation of his SESAP VII, joined the Advisory education and practice. He joined continuous and devoted service as Committee during SESAP IX, and the faculty of the MCW in 1999 a Fellow of the American College has served as Medical Director of and, in addition to his previously of Surgeons” and “in recognition SESAP since 2001. He helped to noted professorships and position of his superb skills in synthesizing start the General Surgery Review as chief of the division of trauma and applying surgical knowledge course at the Clinical Congress and critical care, he has been a and conveying effectively in 2007 and has functioned as member of MCW’s Residency critical concepts to learners that Course Director of the lauded Education and Evaluation

SEPT 2015 BULLETIN American College of Surgeons NEWS

The Board of Regents of the ACS is presenting the DSA to Dr. Weigelt “in appreciation of his continuous and devoted service as a Fellow of the American College of Surgeons” and “in recognition of his superb skills in synthesizing and applying surgical knowledge and conveying effectively critical concepts to learners that have positively impacted the practices of numerous surgeons,” according to the award citation.

Committee (1999–2010); Executive Care Excellence by the board of member of many other honorary Committee (2001–present); directors of Froedtert Hospital. and professional societies, Peer Review Committee (2004– Dr. Weigelt has been including the Society of Critical present); Society of Teaching recognized as a premier surgical Care Medicine; Southwestern Scholars (member, 2006–present educator. In his tenure as Surgical Congress; American and chair in 2007), among many professor at the University of Association for the Surgery others. He remains a practicing Minnesota (1992–1999), he was of Trauma; Western Surgical general surgeon with specialty twice awarded the Wangensteen Association (past-vice-president); interest in trauma and critical Award for Excellence in Teaching American Trauma Society; care at Froedtert, where he chairs (1993, 1999). In 2002, he was Parkland Surgical Society the trauma committee (1999– awarded the Association for (founding member); American present) and the joint quality Surgical Education Outstanding Medical Association; Société 36 | committee (2004–2015). Earlier Teacher Award. And since joining Internationale de Chirurgie, faculty appointments include MCW, he has twice been awarded U.S. Chapter; Central Surgical positions at University of Texas the Teacher of the Year Award Association; American Surgical (UT), Dallas; Parkland Memorial (2004, 2010). In 2013, he was Association; Society of American Hospital, Dallas; Dallas Veterans honored by being elected one of Gastrointestinal and Endoscopic Medical Center; Presbyterian the Giants of General Surgery by Surgeons; Association Hospital, Dallas; St. Paul Medical UT Southwestern and Parkland of Program Directors in Center, MN; Zale-Lipshy Foundation, recognizing his Surgery; and Association University Hospital, Dallas; excellence and dedication to for Surgical Education. University of Minnesota, St. teaching. Dr. Weigelt also has Dr. Weigelt has presented Paul; Regions Hospital, St. Paul; mentored 88 medical students, more than 150 local, regional, Gillette Children’s Hospital, residents, fellows, and faculty and national lectures in his St. Paul; North Memorial Medical in his career, and served as career, as well as 20 lectures on Center, Minneapolis, MN; program director for surgical the international stage, ranging Fairview University Medical critical care at UT Southwestern in location from Istanbul, Center, Minneapolis; Regina and University of Minnesota Turkey, to Beijing, China. He has Medical Center, Hastings, MN; and as general surgery residency served as faculty for more than and Osceola Medical Center, program director at MCW. 130 postgraduate courses and WI. While at UT Southwestern symposiums throughout the U.S. Medical Center, Dallas, his clinical Dr. Weigelt’s research activities were acknowledged Other contributions to the field interests include surgical by the Weigelt-Wallace Award Beyond his previously noted roles infections, clinical outcomes, in 1991, which was established with the ACS, Dr. Weigelt has and educational approaches to to recognize clinical excellence been an active contributor to training surgeons. Over the and dedication to patient care. In the broader field of surgery. In course of his career, Dr. Weigelt 2012, he was awarded the Thomas addition to his Fellowship in the has been awarded 19 research L. Smallwood Award for Patient ACS, Dr. Weigelt is or has been a grants. His most recent research

V100 No 9 BULLETIN American College of Surgeons NEWS

Dr. Weigelt’s involvement in the College’s educational programs and committees is representative of his dedication to surgical education and practice.

interests focus on quality of care College. Additionally, he has or associate editor of more issues, working closely with served on the editorial boards than 60 entries in SRGS. the Wisconsin Collaborative of the Journal of Trauma, the Pan Dr. Weigelt graduated from for Healthcare Quality. American Journal of Trauma, the Michigan State University, He is editor-in-chief of the Journal of Critical Care Medicine, Lansing, with a bachelor of Journal of Surgical Education and and Advances in Therapy. science degree, and earned of the audio Practical Reviews He is a reviewer for Critical his doctor of veterinary in General Surgery. He was the Care Medicine, Surgery, and medicine degree from the same editor of the Journal of Surgical previously reviewed Archives institution. He completed his Outcomes, 2002–2007. He was of Surgery (now Journal of the medical degree at MCW, and an associate editor with Selected Americian Medical Association his internship and residency Readings in General Surgery Surgery). As a contributor, he at UT Southwestern. He (SRGS) when it was published has published more than 150 completed his master’s in | 37 at UT Southwestern Medical medical journal articles, written hospital administration Center (1989–1996) prior to more than 50 book chapters, at the University of the program’s transfer to the and has been a contributing Wisconsin-Madison. ♦

Official notice: Annual Business Meeting of Members, American College of Surgeons

In accordance with Article I, Section 6, of the officials will be presented. Items of general Bylaws, the Annual Business Meeting of Members interest to the Members will also be presented. of the American College of Surgeons (ACS) is Members are respectfully urged to be present.  called for 4:15 pm, the afternoon of Wednesday, October 7, 2015, at McCormick Place, Chicago, IL. Edward E. Cornwell III, MD, FACS This session constitutes the Annual Business Secretary Meeting of Members, at which time ACS Officers American College of Surgeons and Governors will be elected and reports from September 1, 2015

SEPT 2015 BULLETIN American College of Surgeons CLINICAL CONGRESS 2015 WEBCASTS

Don’t miss out on the sessions you want to attend—even if they’re scheduled at the same time. Webcast sessions are available on your computer, tablet, or mobile device anytime, anywhere. Maximize your learning opportunities and earn CME credit and claim self-assessment credit when it’s convenient for you.

Practicing Surgeons Special preregistration prices available now! Webcast Packages Choose one of the three webcast packages below: Earn CME credit and claim self-assessment credit for 2015 Complete Package each webcast. Receive Access all 118 webcast sessions from Clinical Congress 2015 and MP3 audio a CME certificate with recordings of all Named Lectures and most Panel Sessions. More than 175 CME self-assessment credit upon credits and 175 self-assessment credits are available for practicing surgeons. successful completion of For Practicing Surgeons* For Residents viewing the webcast and completing the posttest. Member Non-Member Member Non-Member $475 $525 $175 $225

Resident Webcast 2015 Webcast Package Packages Access all 118 webcast sessions from Clinical Congress 2015. View webcasts on For Practicing Surgeons* For Residents demand. Individualize Member Non-Member Member Non-Member your education. Receive a $375 $425 $125 $175 certificate of completion. Pick 25 of 2015 Select 25 of the 118 webcast sessions from Clinical Congress 2015. For Practicing Surgeons* For Residents Member Non-Member Member Non-Member $225 $275 $75 $125 *Practicing surgeons may earn CME credit and claim self-assessment credit. For more information, visit www.facs.org/education/resources/elearning/webcasts or contact Olivier Petinaux at 866-475-4696 or [email protected].

AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION Blended Surgical Education and Training for Life

CC2015 Webcast Ad for Bulletin.indd 1 4/21/2015 9:52:01 AM NEWS

Fellows honored for volunteerism

by Andrea L. Musolf, MBA

The Board of Governors’ Reports of the 2015 ACS/Pfizer to Kenya with BethanyKids, a (B/G) Surgical Volunteerism Volunteerism and Humanitarian faith-based organization devoted | 39 and Humanitarian Awards Award Winners, Monday, to the holistic care of children Workgroup has announced the October 5, 9:45 am–12:15 pm, at with surgical conditions and recipients of the 2015 American McCormick Place, Chicago, IL. disabilities. With only seven College of Surgeons (ACS)/Pfizer beds available for children with Surgical Humanitarian Award pediatric surgical conditions and Surgical Volunteerism Surgical Humanitarian Award upon his arrival, Dr. Poenaru Awards. As in previous years, the The ACS/Pfizer Surgical co-founded BethanyKids at Workgroup received exceptional Humanitarian Award recognizes Kijabe Hospital (BKKH), a nominations, reflecting the Fellows who have dedicated 67-bed pediatric surgery unit remarkable commitment of much of their careers to ensuring with 15 outpatient clinic ACS Fellows to providing care that underserved populations sites across Kenya, several to underserved populations. have access to surgical care and surgical trainees, specialty The extraordinary have done so without expecting nurses, and rehabilitation contributions of the award commensurate compensation. therapists. He ran multiple recipients are summarized in Dan Poenaru, MD, FACS, pediatric surgical missions in this article and will be formally a pediatric surgeon from Somaliland and bimonthly recognized at the 2015 Clinical Montreal, QC, will receive the clinics in Dadaab, Kenya. Congress in Chicago, IL, during Surgical Humanitarian Award Realizing his general and the annual B/G reception and for starting East Africa’s first pediatric surgical training was dinner, on Tuesday, October pediatric surgical fellowship insufficient to meet the demands 6, at the Hilton Chicago and for educating and training of his new environment, Hotel. Clinical Congress pediatric surgeons in Africa. Dr. Poenaru sought additional attendees are invited to hear Dr. Poenaru made a life- training and recruited volunteer the honorees speak at a Panel changing decision to end his full- surgeons from North America. Session, Humanitarian Surgical time academic pediatric surgical Not wanting to turn patients Outreach at Home and Abroad: practice to move from Canada away, he scrubbed in with these

SEPT 2015 BULLETIN American College of Surgeons NEWS

Dr. Poenaru seeing patients in Dadaab. Dr. Poenaru (left) operating in Borama, Somaliland, with Dr. Hassan, who was an intern from Amoud Medical School, and surgeon Aiah Lebbie, MD, a BethanyKids fellow at the time.

recruits to learn techniques in of the new operative block surgeon, Massachusetts General pediatric urology, neurosurgery, at Kijabe Hospital, an 80-bed Hospital (MGH), Boston, MA, and plastic surgery. Soon children’s center expected to will receive the International becoming aware of the open in 2016, and an upcoming Surgical Volunteerism Award limitations of surgical practice 15-bed inpatient unit at the for working with not-for- and training in resource-limited Mbarara University Teaching profit organizations and settings, Dr. Poenaru established Hospital (MUTH) in Uganda. the U.S. National Disaster 40 | a pediatric surgery fellowship As clinical director of Medical System to provide program in conjunction with BethanyKids, Dr. Poenaru surgical care during the Pan-African Academy of oversees the activities of all humanitarian emergencies Christian Surgeons (PAACS). In six African sites. He is closely throughout the world. partnership with the College of involved with the local surgeons Dr. Briggs founded the Surgeons of East, Central, and and staff, regularly visiting the International Trauma and Southern Africa (COSECSA), he sites to assist in their operation. Disaster Institute at MGH as an was able to attain accreditation For the last three years he educational resource in trauma for this fellowship program, has also been involved in a and disaster medicine to aid making it the first certification new undergraduate medical the many countries that have in pediatric surgery available program in Addis Ababa, little or no organized systems in the region. The COSECSA Ethiopia, where he acts as for disaster preparedness and graduates, coming from several part-time academic dean. response. She developed and African countries, established participated in numerous satellite BethanyKids sites international train-the-trainer in Madagascar, Ethiopia, Surgical Volunteerism Awards courses for multidisciplinary Uganda, and Sierra Leone. The ACS/Pfizer Surgical medical providers, which are Dr. Poenaru remained a Volunteerism Award recognizes provided at no cost. The second strong advocate for increased ACS Fellows and members who edition of the Advanced Disaster resources for children’s are committed to giving back Medical Response Manual for surgeries in Africa through to society though significant Providers was recently developed his research into the global contributions to surgical care and edited by Dr. Briggs with burden of pediatric surgery, as volunteers. This year, three the MGH department of surgery at conferences, and through awards will be granted to and the Harvard Program in educational and promotional the following individuals. Global Surgery; at present, it is materials. His fundraising efforts Susan Miller Briggs, MD, MPH, being translated into multiple contributed to the construction FACS, a trauma and general languages. The first edition

V100 No 9 BULLETIN American College of Surgeons NEWS

Dr. Briggs (right) at the ATLS Course for the Rwanda Surgical Dr. Briggs working with the U.S. Disaster Medical Society/Massachusetts General Hospital International Team, Deployable Field Hospital, Port-au- Trauma and Disaster Institute, Kigali, Rwanda, 2011. Prince, Haiti, after the 2010 earthquake. was translated into eight rehabilitation medicine in videoconferencing capabilities, languages, including Chinese, conjunction with not-for-profit and an electronic library that Arabic, Japanese, and Spanish. and international medical uses the Health InterNetwork In collaboration with the organizations. These programs Access to Research Initiative American Refugee Committee provide in-country training of (HINARI). The Initiate-Build- and as a founding member personnel, provision of medical Operate-Transfer (IBOT) of the Durant Fellowship for equipment, and collaborative model designed by Dr. Latifi Refugee Medicine, Dr. Briggs exchange programs. Dr. Briggs and his collaborators ensures | 41 served as a mentor to many of is an associate professor of the program’s sustainability the recipients, both at MGH and surgery and affiliate faculty and has been successfully in refugee camps throughout in global surgery, Harvard replicated in Albania and Cabo the world. Her involvement Medical School, Boston. Verde, Africa, and is currently with Project Hope and the U.S. Rifat Latifi, MD, FACS, a present in 44 hospitals. government included organizing trauma and general surgeon Being the founder and and leading volunteer disaster from Tucson, AZ, will receive president of the not-for-profit medical teams to respond to the International Surgical International Virtual e-Hospital many international emergencies, Volunteerism Award for helping (IVeH), Dr. Latifi was able including earthquake disasters to establish telemedicine to introduce telemedicine, in El Salvador, Armenia, Iran, and e-health programs in telehealth, virtual educational China, and Haiti, as well as a underdeveloped countries, programs, and seminars train disaster in Ufa, Russia. especially those recovering though the IVeH network to Dr. Briggs also worked with from conflict and in need fulfill the need for continuing not-for-profit organizations to of major rebuilding of their medical education (CME). develop programs addressing health care systems. The telemedicine centers gender-based violence, income Dr. Latifi’s telemedicine can be used for disaster generation, and austere program began in Kosovo, preparedness to educate medical care in low- and where the medical medical staff and improve middle-income countries. infrastructure was destroyed educational capacities as an Dr. Briggs worked as a during the war of 1999. He e-learning platform. Dr. Latifi consultant in trauma and and his collaborators built a and his team trained both disaster medicine following state-of-the-art telemedicine physicians and administrators humanitarian disasters, program that included to operate these systems. helping to develop sustainable technical infrastructure, Dr. Latifi is professor of programs in trauma care and virtual education programs, surgery, University of Arizona,

SEPT 2015 BULLETIN American College of Surgeons NEWS

Dr. Latifi (right) at a meeting with Maria Cristina Fontes Lima, MD, Minister of Health of the Republic of Cape Verde.

Dr. Latifi (center, back row) with medical students from the University of Kosova, Pristina.

Tucson, and is an active member supplies to underdeveloped The survey was designed of the American Telemedicine countries around the world. In to determine how people Association, vice-president of three years, the organization accessed water and how this the International Society for grew to 100 students from six contributed to sanitation habits Telemedicine and e-Health, and and is currently one of the and nutritional status. She Chair of the Health Information largest and most active global also assisted in and advocated Technology Committee of health undergraduate groups for the creation of the first 42 | the ACS. In addition, he is an on campus. In collaboration Global Health Center at Penn advisor to the Multinational with Health in Action, a State University, Hershey. Telemedicine for Disaster medical student group from In Kigali, Rwanda, Management for the North the University of Michigan, Dr. Murthy designed and Atlantic Treaty Organization, Dr. Murthy led a group of implemented a clinical breast and he previously served on undergraduate engineer, public exam training course for the advisory board of the health, and medical students surgical, internal medicine, and European Space Agency. to apply health education obstetrics and gynecology (OB/ Shilpa Shree Murthy, programs and discover GYN) residents and medical MD, MPH, a PGY-4 general innovative ways to develop a students at the University of surgery resident at Indiana clean water system for several Rwanda. She taught more than University, Bloomington, will villages outside San Cristóbal, 230 students how to evaluate receive the Surgical Resident Dominican Republic. Dr. and examine patients presenting Volunteerism Award for Murthy also co-founded a with a breast complaint. She developing the Clinical Breast chapter of Unite for Sight, a used a low-fidelity breast Exam Simulation Training not-for-profit organization that simulation model created by Course to provide care and provides free vision screenings. a local women’s cooperative, education in Rwanda, Africa. Before graduating from Ineza, to provide care to While attending the Pennsylvania State University impoverished women who University of Michigan, Ann College of Medicine, Hershey, survived the Rwanda genocide. Arbor, Dr. Murthy founded the in 2010, Dr. Murthy traveled Dr. Murthy also developed the Global Medical Relief Program to Malawi, Africa, with the curriculum and coordinated in 2002, one of the first William Jefferson Clinton an ultrasound-guided breast undergraduate global health Foundation in 2007. There core needle biopsy course for programs at the university. she trained local women to surgery and OB/GYN residents. This program raised funds deliver a health survey to In collaboration with Rwanda’s that were used to send medical more than 450 households. Ministry of Health, Partners in

V100 No 9 BULLETIN American College of Surgeons NEWS

Dr. Murthy (left) with Robert Riviello MD, FACS Dr. Murthy (left) and the Ineza Cooperative with a low-fidelity breast model. (center), and a local surgeon in Rwanda.

Health, and the University of boards at university hospitals she can continue her work in Rwanda, Dr. Murthy was a key and further supported breast medical education and improve leader in planning and executing training programs throughout access to quality surgical cancer Rwanda’s inaugural national the country, and procurement care in the most disenfranchised breast cancer symposium. This of breast core needle biopsies. patient populations. ♦ program led to the creation Dr. Murthy plans to pursue of multidisciplinary tumor an academic career where | 43

Bleeding control spotlighted at new ACS Theater Sessions at Clinical Congress

A new bleeding control (B-Con) course has Congress, October 4–8, in Chicago, IL. This been developed in response to the call from session, which will be presented twice during the American College of Surgeons (ACS)- the Clinical Congress (2:00–2:25 pm, Monday, led Hartford Consensus for direct training October 5, and 11:15–11:40 am, Wednesday, of lay personnel (immediate responders) in October 7) is a preview of the 2.5 hour course external hemorrhage control (see compendium that meets the requirements of basic training enclosed with this month’s Bulletin). The U.S. in hemorrhage control. Course participants Department of Homeland Security and the U.S. will learn fundamental lifesaving medical Department of Health and Human Services interventions, including bleeding control with a also have been involved in these efforts to tourniquet, bleeding control with gauze packets increase collaboration between tactical law and topical hemostatic agents, and opening an enforcement, non-tactical law enforcement, airway properly to allow the victim to breathe. fire service, and emergency medical services The B-Con course PowerPoint presentation personnel (professional first responders) when can be accessed via the ACS website at www.facs. responding to the scene of a casualty incident. org/quality-programs/trauma/education/affiliate. ♦ The new B-Con course will be spotlighted at the ACS Theater at the ACS Clinical

SEPT 2015 BULLETIN American College of Surgeons ® SELECTED READINGS in GENERAL SURGERY

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* The American College of Surgeons (ACS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing Subscribe today! medical education for physicians. The ACS designates this enduring material for a maximum of 80 AMA PRA Category 1 Credits™ annually. Physicians www.facs.org/publications/srgs should claim only the credit commensurate with the extent of their or call 800-631-0033 participation in the activity.

AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION Blended Surgical Education and Training for Life

2014 SRGS Bulletin Ad_NOV2014.indd 1 10/7/2014 9:22:38 AM NEWS

ACS Foundation presents two distinguished awards at 2015 Clinical Congress

Dr. and Mrs. Robinette Dr. Rich | 45

The American College of Surgery Fund. Both initiatives Surgeons (ACS) Foundation The Robinette’s outstanding align closely with Dr. Robinette’s Board of Directors will philanthropy work as a surgeon in a small present the longstanding The 2015 Distinguished community and his commitment Distinguished Philanthropist Philanthropist Award will be to providing the best care Award and a new Distinguished presented to Dr. Robinette and and service to his patients. Organization Award at the 2015 Paula Robinette of Fairbanks, “Paula and I can think of Clinical Congress. This year’s AK, in recognition of their few other organizations that recipient of the Distinguished philanthropic endeavors and deserve our strong support,” Philanthropist Award will be service to the surgical Dr. Robinette said. “We see Danny R. Robinette, MD, FACS, and profession, the medical many things the College is doing, his wife, Paula. The Foundation community, and the ACS. thanks to philanthropy, that Board will present the newly Through their membership in are improving the education established Distinguished the Fellows Leadership Society, and training of young surgeons. Organization Award to the the ACS major donor recognition A gift to the ACS Foundation Norman M. Rich Department of program, and the Mayne Heritage is a gift to future surgical Surgery at Uniformed Services Society—the ACS planned patients and their surgeons.” University of the Health Sciences giving program—Dr. and Mrs. Dr. Robinette is medical (USUHS), Bethesda, MD. Robinette are helping to ensure director, Surgery Center of Both awards will be presented that the College remains a strong Fairbanks, and clinical assistant at the Foundation’s annual advocate for future surgeons. professor, department of surgery, Donor Recognition Luncheon, Their 1913 Legacy Campaign gift University of Washington, Monday, October 5, at the Hyatt will support the Codman Quality Seattle. He attended the Regency McCormick Place. and Safety Fund and the Rural University of Louisville Medical

SEPT 2015 BULLETIN American College of Surgeons NEWS

The ACS Foundation promotes voluntary philanthropy from Fellows and friends to support the College’s goals for improving surgical patient care and ensuring the professional standing of surgeons wherever they practice.

School, KY, and completed Through the advocacy of Forces. USUHS is located in his residency at Wright State retired U.S. Army Colonel Bethesda, MD, on the grounds University, Dayton, OH. Norman M. Rich, MD, FACS, of the Naval Support Activity Mrs. Robinette graduated from MC, DMCC, the Leonard Bethesda, near the Walter Reed Morehead State University, KY. Heaton and David Packard National Military Medical Center. Dr. Robinette’s voluntarism Professor at USUHS, the Uniform Before this funding activities within the ACS Services University Surgical partnership was established, the include service as Alaska Associates Military Professor of ACS and USUHS were longtime Chapter President, Alaska Surgery Fund was established informal collaborators and have Commission on Cancer in 2011 and is administrated by shared several volunteer leaders, State Chair, ACS Governor, ACS. This fund will be used including the late Oliver H. member of the Board of the to improve surgical care for Beahrs, MD, FACS, and the late ACS Professional Association’s current and former members George F. Sheldon, MD, FACS, 46 | political action committee of the U.S. Armed Forces and both Past-Presidents of the ACS. (ACSPA-SurgeonsPAC), and ACS their families and to ensure Dr. Rich will accept the Foundation committee member. the professional standing of award, in his words, “on behalf Danny and Paula Robinette surgeons in the military and of the thousands of individuals are the 25th recipients of the public health services. who have contributed to Foundation’s Distinguished Congress established USUHS our collective efforts over Philanthropist Award. The award as part of the Uniformed Services the past nearly 50 years.” recognizes individuals who Health Professions Revitalization The ACS Foundation promotes have demonstrated exemplary Act, which President Richard voluntary philanthropy from commitment to philanthropy and M. Nixon signed into law on Fellows and friends to support to the ACS mission. In addition to September 21, 1972. It was created the College’s goals for improving their philanthropic support of the to fill a void that existed in surgical patient care and ensuring ACS, they contribute to several hospitals and clinics, on military the professional standing of not-for-profit organizations bases and battlefields, and other surgeons wherever they practice. within the Fairbanks community. places where service members For more information on the needed—and deserved— Foundation and the awards, visit specially trained physicians the ACS Foundation’s website at First Distinguished to care for their wounds. www.facs.org/acsfoundation. ♦ Organization Award The mission of USUHS is This year, the ACS Foundation to educate, train, and prepare Board of Directors will also uniformed services health present the first Distinguished professionals, officers, and leaders Organization Award to the to directly support the military Norman M. Rich Department health system, the National of Surgery at USUHS in honor Security and National Defense of its generous philanthropic Strategies of the U.S., and the partnership with the College. readiness of the U.S. Armed

V100 No 9 BULLETIN American College of Surgeons CLINICAL CONGRESS

Same great meeting, exciting new locations In the coming years, the American College of Surgeons Clinical Congress will be held in two brand-new cities.

PLAN NOW TO ATTEND!

New CHICAGO, IL WASHINGTON, DC SAN DIEGO, CA October 4–8, 2015 October 16–20, 2016 October 22–26, 2017

New BOSTON, MA SAN FRANCISCO, CA October 21–25, 2018 October 27–31, 2019

2015 New Locations Ad_06-29-15_OCTBULL.indd 1 6/29/2015 12:17:27 PM NEWS

The original Excelsior Surgical Society in Rome, 1945. Dr. DeBakey is on the far right. (Photo courtesy of Lieutenant Colonel Charles G. Rob of the Royal Army Medical Corps (UK), who is leaning on one of the pillars.)

Renewed Excelsior Surgical Society hosts first meeting at 2015 ACS Clinical Congress 48 |

With the experiences from the MD, FACS. The first meeting • U.S. Army Colonel Mary J. most recent conflicts in the took place at the Excelsior Hotel Edwards, MD, FACS, a pediatric Middle East and the renewed in Rome, Italy. The last official surgeon at San Antonio interest in combat casualty care, meeting of the Society convened Military Medical Center, TX there is a strong desire among in 1986 at the ACS Clinical military surgeons who are Congress in New Orleans, LA. • U.S. Air Force Colonel Gregory members of the American College This first meeting of the York, MD, FACS, commander of Surgeons (ACS) to resurrect the revitalized society will focus on of the 51st Medical Group, Excelsior Surgical Society and to the theme The Way Forward. 51st Fighter Wing, Osan Air make the College its official home. The program has been organized Base, Republic of Korea The newly reformed Excelsior by U.S. Navy Commander Surgical Society will meet from Gordon Wisbach, MD, FACS, • U.S. Navy Captain Craig 7:30 am to 12:45 pm, Sunday, director of minimally invasive, Shepps, MD, FACS, a general October 4, at the Hilton Chicago, bariatric, and robotic surgery, surgeon at Naval Medical IL, International Ballroom South, and vice-chairman, department Center, Jacksonville, FL Second Floor, in conjunction with of surgery, Naval Medical Center the ACS Clinical Congress 2015. San Diego, CA; and U.S. Army • C. William Schwab, MD, FACS, The original Excelsior Surgical Commander Yong Choi, MD, FRCS, professor of surgery, Society was founded in 1945 by FACS, chief, laparoscopic surgery, University of Pennsylvania; a group of American surgeons Eisenhower Army Medical director, University of who had served during World Center, Fort Gordon, GA. Pennsylvania Trauma Network; War II. Among the founders Surgical consultants who will and director, fellowship were Edward D. Churchill, MD, speak on the state of U.S. military program in trauma surgery FACS, and Michael E. DeBakey, surgical communities include: and critical care, University of

V100 No 9 BULLETIN American College of Surgeons NEWS

This first meeting of the revitalized society will focus on the theme The Way Forward.

Pennsylvania, Philadelphia, of Defense for Health Affairs, Trauma’s Region 13 (Military will deliver the Army Major U.S. Department of Defense, Region) Resident Paper John P. Pryor Lecture, Training will discuss the Military Competition, as well as in an of a Combat Surgeon. Health Service Strategic interactive panel discussion Partnership with the ACS. on the way forward for the In addition, Jonathan Woodson, Attendees will be able to Excelsior Surgical Society. ♦ MD, FACS, Assistant Secretary participate in the Committee on

ACS CoC bestows National Achievement Award on 21 cancer care facilities The Commission on Cancer (CoC) of the of four cancer program activity areas: cancer American College of Surgeons (ACS) has granted committee leadership, cancer data management, its mid-year 2015 Outstanding Achievement clinical services, and quality improvement. Award to 21 accredited cancer programs The programs were further evaluated on seven throughout the U.S. Award criteria were commendation standards. To be eligible, all award | 49 based on qualitative and quantitative surveys recipients must have received commendation conducted during the first half of 2015. ratings in all seven commendation standards, For a list of these award-winning cancer in addition to receiving a compliance rating programs, go to www.facs.org/quality-programs/ for each of the 27 other standards. cancer/accredited/about/outstanding/2015. “More and more, we’re finding that patients The award raises the bar on quality cancer care, and their families want to know how the health with the ultimate goal of increasing awareness about care institutions in their communities compare quality care choices among cancer patients and their with one another,” said Daniel P. McKellar, MD, loved ones. In addition, the award is intended to: FACS, Chair of the CoC. “They want access to information in terms of who’s providing the best • Recognize cancer programs that achieve excellence quality of care, and they want to know about in providing quality care to cancer patients overall patient outcomes. I’d like to think that this recognition program assumes a small but • Motivate other cancer programs to work vital role in helping patients and families make toward improving their level of care informed decisions on their cancer care.” The 21 award-winning, cancer-care programs • Facilitate dialogue between award recipients and represent approximately 11 percent of programs health care professionals at other cancer facilities surveyed January 1−June 30 by the CoC in for the purpose of sharing best practices 2015. “These 21 cancer programs currently represent the best of the best when it comes • Encourage honorees to serve as quality- to cancer care,” added Dr. McKellar. “Each of care resources to other cancer programs these facilities is not just meeting nationally recognized standards for the delivery of quality Cancer programs were evaluated on 34 cancer care but is actually exceeding them.” ♦ program standards categorized within one

SEPT 2015 BULLETIN American College of Surgeons NEWS

James Haug, Past-Director, ACS Socioeconomic Affairs Department, dies

by Diane Schneidman

James N. ”Jim” Haug, Past-Director, health care data, summaries sense of what the College could American College of Surgeons of pertinent federal legislation, accomplish in Washington, Dr. (ACS) Socioeconomic Affairs and ACS position statements. Austen noted, adding, “He was Department (now the Division In March 1979, the ACS opened very practical, but also quite of Advocacy and Health Policy), its Washington, DC, office. Under passionate about the American died at his home in Lena, IL, Mr. Haug’s direction, the office College of Surgeons. “ June 18, at age 78. Fellows and was charged with maintaining John O. Gage, MD, FACS, staff who worked with Mr. Haug liaison with congressional staff, Past-Chair of the ACS Board remember him as a dedicated government agencies, and of Governors Committee on professional who delighted in medical and surgical societies. Socioeconomic Issues, Past-Chair fostering the careers of the people The Washington Office also of the General Surgery Coding who worked for him and in developed a pool of key contacts and Reimbursement Committee, 50 | spending time with his family. to offer advice and congressional and Distinguished Service Award “Jim was a complex testimony on relevant issues. As recipient, recalls that when the character,” said Cynthia A. the government continued to College sent him and other ACS Brown, Past-Director, ACS play an increasingly prominent leaders to the first meeting of Division of Advoacy and Health role in surgical practice in the the AMA Relative Value Scale Policy, now vice-president, 1980s and 1990s, the Washington Update Committee, they were government affairs, American Office staff expanded to include ill-prepared. However, they also Medical Association (AMA). several registered lobbyists. saw an opportunity to have “He could be adversarial but “Jim was an idea man and an impact on the committee’s was extraordinarily supportive was always looking for ways decisions. With that, “Jim of his staff and his family. Some to improve efforts to enhance got us staff—Pat Parks [then- might say he was a little ‘old the College’s reputation in Manager of the Socioeconomic school,’ but then he was always Washington, DC, and in Affairs Department] and her looking for new and better the medical community at staff—to give us background ways of doing things. He was large,” said Linn Meyer, Past- information and to work an early promoter of women Director of the ACS Division with us at the meetings.” and took great joy in growing of Integrated Communications and arranging strawflowers.” and now Executive Consultant to the College. Mentor W. Gerald Austen, MD, FACS, “Jim knew people well,” Dr. Gage Idea man ACS Past-President, Past-Chair added. He was adept at appointing Mr. Haug began working at of the ACS Board of Regents, and people to the roles for which they the College in December 1974. Past-Chair of the Health Policy were best-suited and cultivated One of the first activities he and Reimbursement Committee, a hard-working, loyal staff. led was the development of remembers Mr. Haug as “very “I was the first person that the ACS Socioeconomic Factbook enjoyable to work with and Jim hired when he started the for Surgery, which contained very intelligent.” He had a great department in 1974. At the

V100 No 9 BULLETIN American College of Surgeons NEWS

“Jim was an idea man and was always looking for ways to improve efforts to enhance the College’s reputation in Washington, DC, and in the medical community at large.” —Ms. Meyer

time, I thought I was going to affairs, American Association of Jim how much he loved and write the great American novel, Neurological Surgeons/Congress admired his wife, Norma, and but Jim was very pragmatic. of Neurological Surgeons. “He his three sons, Doug, Curt, He told me that if I worked was a great boss for working and Matt,” Ms. Meyer said. hard, I could have a gratifying parents and ahead of his time as a Having served in the U.S. Air career in this field. He was champion for work/life balance, Force from 1955 to 1957, stationed right,” said Rebecca M. Maron, although he may have bristled at in Okinawa, Japan, Mr. Haug also CAE, now executive director, the ‘politically correct’ term.” was fiercely loyal to the military Society for Vascular Surgery. and the people who defend our “Always his authentic, nation. After retiring from the straightforward, and candid self, Dedication to family ACS in 1998, Mr. Haug was active Jim was genuinely interested and country in the Veterans of Foreign Wars in all of his employees— Mr. Haug’s commitment to post in Freeport, IL, and on professionally and personally,” the College and his team was Lena’s economic development noted Catherine Jeakle Hill, exceeded only by the pride and and planning committee. He also who worked in the ACS love he exuded when talking found time to pursue his other Washington Office and now about his family. “It was more passions—including golf, cards, | 51 is senior manager, regulatory than clear to anyone who knew yard work, and coin collecting. ♦

A PUBLICATION OF THE AMERICAN COLLEGE OF SURGEONS PROFESSIONAL ASSOCIATION (ACSPA)

Influencing THE ACS Health Policy in Washington ADVOCATE and the States Each month, rely on the ACS advocacy e-newsletter:  To keep you informed  To learn the College’s position on pertinent issues  To see how your involvement can make a difference.

Downloadable from most digital communications devices Visit www.facs.org/publications/newsletters/acs-advocate

Advocacy Summit • AMA House of Delegates/Surgical Caucus • Cancer • Chapter Advocacy • Training • Coding • Electronic Health Records • e-Prescribing • Grassroots Efforts • Health Information Technology • Legislative Action Center • Legislative Advocacy • Liability • Lobby Day Grant Program • Medicaid • Medicare • Medicare Physician Payment • Pediatric Issues • Physician Quality Reporting • Political Action Committee (SurgeonsPAC) • Quality and Patient Safety • Relative Value Update Committee (RUC) • Socioeconomics • Surgery State Legislative Action Center (SSLAC) • Surgical Quality Alliance • Trauma and EMS • Workforce

ACS Advocate Half Page for Bulletin_2_6_15.indd 1 2/6/2015 11:47:38 AM SEPT 2015 BULLETIN American College of Surgeons NEWS

Dr. Judson Graves Randolph, pediatric surgeon, leaves lasting legacy

by Kurt D. Newman, MD, FACS, and Mary Fallat, MD, FACS

Judson Graves Randolph, MD, FACS, Center in Washington DC, a pediatric surgeons. The a Past-Member of the American post he held for nearly 30 years. Children’s National Medical College of Surgeons (ACS) Board Center program became the of Governors, died May 17, 2015, 13th when Dr. Randolph at his home in Nashville, TN. He Champion for pediatric recruited John Lilly, MD, FACS, was 87 years old. The surgical surgical education to come to Washington to community, and particularly Dr. Randolph was the first train. Dr. Randolph was on the the pediatric surgery family, full-time pediatric surgeon committee that successfully lost a true friend, colleague, in Washington, DC, and he approached the American Board and mentor with his passing. achieved the rank of professor of Surgery to obtain specialty of surgery and pediatrics at board certification, resulting George Washington University. in the Certificate of Special Nashville roots Dr. Randolph was adored by Competence in Pediatric Surgery. 52 | Dr. Randolph was born July 19, his patients and families and Furthermore, Dr. Randolph 1927. He grew up in Nashville, played an active role in the care was the first pediatric surgeon where he attended Hillsboro of complicated patient cases well to represent the specialty of High School and was an Eagle into their adulthood. He was one pediatric surgery as a director on Scout. He served in the U.S. of the first pediatric surgeons to the American Board of Surgery Navy, 1945–1946, aboard the focus on children’s burn care, and (1973–1979). He, along with USS Alabama. He returned to was a leader in the advancement Harvey Beardmore, MD, FACS, of Nashville, where he graduated of surgical care of children with McGill University, Montreal, QC, from Vanderbilt University cancer. He was also well known and Marc Rowe, MD, FACS, of in 1950 and from Vanderbilt for his creativity in the care of Children’s Hospital of Pittsburgh, Medical School in 1953. In his children with complex anomalies. developed the first written professional life, Dr. Randolph Dr. Randolph provided examination in pediatric surgery. trained in general surgery at significant leadership in the Massachusetts General developing the specialty of Hospital, Boston. He trained pediatric surgery in the U.S. Leader of organizations in pediatric surgery at the Along with William Clatworthy, Dr. Randolph was a long-term Boston Children’s Hospital MD, who chaired a newly Fellow of the American College under the tutelage of Robert formed education committee of Surgeons. He served as Gross, MD, FACS, whom within the surgical section of the President of the Metropolitan Dr. Randolph considered an American Academy of Pediatrics, Washington, DC, Chapter esteemed mentor. He remained Dr. Randolph was instrumental in (1981–1983) and as a Governor in Boston on the faculty of establishing the requirements for (1971–1974). He also served on Harvard Medical School at the two-year training program the Medical Student Education Boston Children’s until 1963, for pediatric surgery in the U.S. Committee (1978–1988). when he accepted the position and Canada in the late 1960s. He valued his membership in as surgeon-in-chief of the At the time, only 12 programs the ACS and enjoyed participating Children’s National Medical in North America were training in ACS meetings and presenting

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It was a source of great satisfaction to Dr. Randolph that he trained more than 40 of the finest pediatric surgeons in this country and abroad, many of whom have become chiefs and training program directors.

papers for discussion. While in that he trained more than 40 he was elected to the Nashville Washington, Dr. Randolph served of the finest pediatric surgeons Public Schools Hall of Fame. as President of the Washington in this country and abroad, Dr. Randolph’s wife of Academy of Surgery, Chairman many of whom have become nearly 50 years, Comfort of the Surgical Section of the chiefs and training program Adams Randolph, died in 2001. American Academy of Pediatrics, directors. ACS Past-President Dr. Randolph is survived by his and President of the American Kathryn D. Anderson, MD, five children: Somers of Santa Pediatric Surgical Association. He FACS, for example, was one of Fe, NM; Garrett of Belfast, was a member of the American his trainees and then partner. ME; Judson Jr. (Catherine) of Surgical Association and the Dr. Randolph always enjoyed Seattle, WA; Adam of Sewanee, Southern Surgical Association. quoting Dr. Gross: “A good pupil TN; and Comfort (Bradford He was awarded the will always outshine his teacher.” Belbas) of Edina, MN; and Ladd Gold Medal by the Dr. Randolph was a member his eight grandchildren. American Academy of of the Board of Trust of Two memorial services for Pediatrics for his surgical Vanderbilt University from 1981 Dr. Randolph were held—the service to children and the to 2004, at which time he became first on July 25 in Nashville, Distinguished Graduate Medal an emeritus member. He was and the second on August 22 in by Vanderbilt Medical School. active in Leadership Nashville, Washington, DC—to celebrate | 53 It was a source of great an independent executive his personal and professional satisfaction to Dr. Randolph leadership program, and in 2007 life there for 30 years. ♦

AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION AMERICAN COLLEGE OF SURGEONS Blended Surgical Education and Training for Life DIVISION OF EDUCATION

“Your Lung Operation” provides patients with the knowledge and training to support full participation and optimal recovery. Safety measures such as site marking, ID band checks, and pneumonia prevention strategies are demonstrated to support the surgeon and health care professional in meeting all CMS and Joint Commission guidelines YOUR LUNG for safe surgical procedures and optimal recovery. OPERATION The program is free to members and contains: Education for a Better Recovery ● A 20-page booklet and 30-minute DVD with information on preoperative prep, cancer staging, procedure overview, potential risks, discharge, and home care. ● Information sheets, including lung images, medication lists, exercise and pulmonary rehab activity guides, quit smoking resources, and survivorship plans. PARTNERS IN YOUR SURGICAL CARE© ● Additional resources, including a patient evaluation form. ● For nonmembers, this program can be purchased individually, or bulk pricing is available. ● Hospital broadcast rights are also available for purchase. To order, visit www.facs.org/education/patient-education.

This Surgical Patient Education Program is a collaborative by the American College of Surgeons with the Society of Thoracic Surgery, the American Association for Thoracic Surgery, the Association of periOperative Registered Nurses, and the Commission on Cancer.

THIS PROGRAM IS FUNDED IN PART BY A GRANT FROM ETHICON ENDO-SURGERY.

YourLungOp_Half Horizontal_Bulletin_2_6_15.indd 1 2/6/2015 11:19:34 AM SEPT 2015 BULLETIN American College of Surgeons NEWS

Tour the cemetery where ACS leaders are buried: Visit Archives booth for information

by Adam Carey

With Chicago, IL, hosting this year’s Clinical Congress, the ACS Archives invites Fellows and their colleagues and families to visit one of the city’s unique attractions—Graceland Cemetery. Known as “the cemetery of architects” for housing the burial sites of some of the visionaries whose buildings have defined Chicago’s skyline for generations, Graceland is also the final resting place of ACS Founder Franklin H. Martin, MD, FACS. Dr. Martin is buried with his wife, Isabelle, and her parents, Dr. and Mrs. John Hollister. 54 | The park-like Graceland Cemetery was reimagined by noted landscape architect Ossian Simonds in the 1880s, featuring plants and trees native to Chicagoland. Resting atop the flat plains and gentle hills are some of the most spectacular grave markers in Chicago, including the Graves Family’s Eternal Silence, by sculptor Lorado Taft, and Marshall Field’s Memory, The Martin family headstone by sculptor Daniel Chester French. In additional to Dr. Martin, Graceland is the final resting place of Daniel Hale Williams, MD, FACS, the first African- American Fellow of the College, and Lucius Fisher, president of the Union Bag & Paper Company. Mr. Fisher was the last owner of the Nickerson Mansion before it became the College’s first headquarters. Graceland Cemetery is open every day, 8:00 am–4:00 pm, and is located at 4001 N. Clark Street. If you are interested in planning a self-guided tour of the Graceland Cemetery or in seeing Dr. Williams’ headstone artifacts owned by Dr. Martin, visit the Archives booth in the ACS Resource Center in McCormick Place West, Hall F2, at this year’s Clinical Congress. ♦

V100 No 9 BULLETIN American College of Surgeons CLINICAL CONGRESS 2015 October 4–8, 2015 | McCormick Place | Chicago, IL

Join Us in the Windy City for Education, Networking, and Fun!

This year’s Clinical Congress is taking place in Chicago, IL— a location sure to provide a much-needed break from your busy schedule and offer many exciting options for the whole family to enjoy. In addition to five days of outstanding education and networking opportunities, a number of fun activities have been planned during this year’s meeting. Relax after a day of sessions and enjoy one of these tours and events.

Sunday, 10/04, 2:00 pm ST03 White Sox vs. Detroit Tigers Price per person: $85

Monday, 10/05, 5:00–10:30 pm ST08 Second City and Chicago Deep Dish Pizza Price per person: $135

Tuesday, 10/06, 7:30 pm ST13 Broadway in Chicago: A Gentleman’s Guide to Love & Murder Price per person: $125 (tickets only)

Wednesday, 10/07, 1:00–5:00 pm ST15 Bottle and Bottega Price per person: $140

PLAN NOW TO JOIN US. REGISTER TODAY! facs.org/clincon2015

Achieving Your Personal Best: Improvement Based on Evidence

CC2015 Social Program Ad_08-17-15_SeptBULL.indd 1 8/17/2015 1:46:50 PM NEWS

Members in the news

Dr. Cervantes Dr. Fairman Dr. Perler

56 | surgery and endovascular therapy dozen vascular surgery leaders Jorge Cervantes, MD, FACS(Hon), and has a dual faculty appointment and will oversee four governing of Mexico City, Mexico, as the Clyde F. Barker–William councils, 26 committees, and was recognized in June by Maul Measey Professor in Surgery 400 volunteer members. the Colegio Domincano de and a professor in radiology. Circujanos as an honorary In addition, Dr. Fairman’s Peter S. Richman, MD, FACS, a member during the Latin research has been pivotal to general surgeon in Mission Hills, American Congress of Surgery key clinical trials and lifesaving CA, was installed as 2015–2016 in Punta Cana, Dominican improvements in stent technology. president of the Los Angeles Republic. Dr. Cervantes, County Medical Association former president of FELAC Bruce A. Perler, MD, MBA, FACS, (LACMA) at a reception and (Federacion Latinoamericana the Julius H. Jacobson II, MD, dinner June 24. LACMA is de Cirugia), also is an Honorary Professor of Vascular Surgery, a professional association Member of the International Johns Hopkins University representing Los Angeles Society of Surgery/Société School of Medicine, Baltimore, County physicians from every Internationale de Chirurgie. MD, was elected president of medical specialty and practice. the SVS at the society’s annual Dr. Richman serves on the Ronald M. Fairman, MD, FACS, meeting. Dr. Perler is also vice- Community Board of Directors Hospital of the University of chair, clinical operations and for Facey Medical Foundation Pennsylvania, Philadelphia, was financial affairs, department and Providence Health Services elected president-elect of the of surgery, and chief emeritus, and is a trustee of the California Society for Vascular Surgery division of vascular surgery and Medical Association. (SVS) at the society’s 2015 annual endovascular therapy, Johns meeting in June. Dr. Fairman has Hopkins Hospital. As president of Barry J. Silverman, MD, FACS, a multidimensional practice at the the 5,300-member organization, an orthopaedic surgeon in University of Pennsylvania’s Penn Dr. Perler will chair a board Aventura, FL, and his wife Judy, Medicine. He is chief of vascular of directors of more than two earlier this year received the

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Dr. Richman

Dr. and Ms. Silverman

Nova Southeastern University of service. Dr. Silverman is a screening program for Miami- President’s Excellence in retired physician whose early Dade County Public Schools, Community Service Award. The work with the U.S. Army during served as chair and medical award recognizes professional the Vietnam War inspired him adviser to the Easter Seals of engagement by members of the to pursue a life of community South Florida, and founded South Florida community and service. In the past 40 years, he Camp Yofi, a camp for children encourages the ongoing pursuit has helped create the scoliosis with autism and their families. ♦

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SEPT 2015 BULLETIN American College of Surgeons NEWS

ACS in the

Editor’s note: Media around the Anesthesiologists have been world, including social media, Cutting junior doctors’ issuing warnings about phones frequently report on American hours may not lower risk in the OR and calling for clear College of Surgeons (ACS) activities. of surgical deaths rules on whether and how they Following are brief excerpts from Reuters, July 30, 2015 can be used. Many raised red news stories published from June “Over the past decade, flags about the potential for and July 2015 that mention key ACS concern for patient safety and noise or distraction, while some programs and initiatives, including the wellbeing of doctors in also pointed to the possible research findings that appear in training, known as residents, challenge of infection control.” 58 | the Journal of the American College has driven reductions in of Surgeons. To access the news work hours and more rest items in their entirety, visit the between shifts for residents. Surgeons to review online ACS Newsroom at www. “But these changes have profusion of quality facs.org/media/acs-in-the-news. in turn raised questions about improvement initiatives whether more frequent handoffs Modern Healthcare, July 11, 2015 of patient care from one clinician “These various initiatives will to the next might lead to be discussed at the American mistakes, said lead study author College of Surgeons’ annual Dr. Ravi Rajaram, a researcher National Surgical Quality at the American College of Improvement Program meeting Surgeons and Northwestern July 25–28 in Chicago[, IL]. About University’s Feinberg School 1,400 are expected to attend the of Medicine in Chicago.” conference, which will include sessions focused on value- and evidence-based care, the demand Do cellphones belong in for greater teamwork in surgical the operating room? care, and process improvement. Washington Post, July 13, 2015 “While he’s supportive of the “Such incidents are why CMS’ efforts to boost quality, physicians and medical groups Dr. Frank Opelka [MD, FACS], including the American College [M]edical [D]irector for [Q]uality of Surgeons, the American and [H]ealth [P]olicy for the Academy of Orthopaedic American College of Surgeons, Surgeons and doctors who strikes a cautious note. There published an April paper are risks about going down the for the American Society of wrong paths, he said. ‘Then

V100 No 9 BULLETIN American College of Surgeons NEWS

it’s hard to recover. The pros was from the database of the practice guidelines and provide a are that we are moving forward American College of Surgeons source of institutional knowledge trying to match advances in National Surgical Quality to inform future operations. medicine with potential business Improvement Program.” The agency shares a strategic systems. The simple con is partnership with the American that it’s hard to know which College of Surgeons, or ACS, one is going to work and do “Navigators” for cancer patients: Committee on Trauma and the they work in every market.’” A nice perk or something more? Defense Health Agency, DHA, Washington Post, July 3, 2015 to ensure all surgeries, including “The programs have been trauma surgeries, in civilian Resident work-hour restrictions proliferating; since [January] and military environments don’t help patient outcomes 1, they have been required are registered. JTS has also | 59 FierceHealthcare, July 8, 2015 for cancer centers seeking partnered with United Kingdom “Although restrictions on accreditation by the American medical officers to establish the number of hours resident College of Surgeons. data sharing agreements.” physicians work are meant to “The idea was pioneered in reduce medical errors, the work- 1990 by Harold P. Freeman, a hour limits do not improve doctor at Harlem Hospital who Walking could lower fatigue in patient safety, according to a realized that his largely poor cancer patients, study shows study published in the Journal of and uninsured patients were not Huffington Post, June 22, 2015 the American College of Surgeons.” receiving quality cancer care “The new research shows that because they often got lost in the an activity as simple as walking disjointed system. The programs could help to lessen this fatigue. When new doctors ‘train’ spread to cancer centers across The study, published in the Journal during surgery, risks the United States, as well as some of the American College of Surgeons don’t rise: Study treatment facilities for a small included 102 people who had U.S. News & World Report, number of other diseases.” just had surgery done for their July 6, 2015 pancreatic or periampullary “Researchers found that cancers. Eighty-five percent of residents are supervised and their Trauma registry yields them reported having fatigue assistance doesn’t increase the significant increase in at a moderate to severe level.” risk for complications or death. traumatic injury survival rates “To see if there was any basis U.S. Army, June 23, 2015 for the concern, the researchers “JTS [Joint Trauma System] Breast-conserving Tx keeps looked at results of more is one of five directorates at growing, but disparities persist than 16,000 brain and spine USAISR [U.S Army Institute of MedPage Today, June 21, 2015 surgeries performed between Surgical Research]. Its additional “The [ACS] National Cancer 2006 and 2012. The information responsibility is to write clinical Data Base (NCDB) includes

SEPT 2015 BULLETIN American College of Surgeons NEWS

facility-level data (such as cancer cases in the United type of practice), in addition More women with breast States, the study authors said.” to clinical variables and cancer choose lumpectomy demographics, providing a CBS News, June 18, 2015 basis for revisiting the issue of “The new study draws from Surgery may boost survival in practice-related disparities and a database that’s more complete certain advanced lung cancers their influence on use of BCT than those used in other research, HealthDay, June 4, 2015 [breast conserving therapy]. [Dr. Isabelle] Bedrosian said. Her “In their research, [Dr. Varun] “Investigators reviewed team looked at data on women Puri and his colleagues evaluated NCDB records for women with treated for early stage breast data from the National Cancer newly diagnosed T1-2 breast cancer between 1998 and 2011. All Database on almost 9,200 patients cancer during 1998 to 2011. The were entered into the National with stage 3b non-small cell resulting data encompassed Cancer Data Base, sponsored lung cancer who underwent 727,927 patients. The principal by the American College of a combination of treatments objective was to identify factors Surgeons and the American between 1998 and 2010.” ♦ associated with an increased or Cancer Society. It captures about decreased likelihood of BCT.” 70 percent of newly diagnosed 60 |

Register for ACS TQIP Conference, November 15−17, in Nashville, TN The sixth annual Trauma Quality Improvement registrar and abstractor concerns, matters Program (TQIP®) Scientific Meeting and Training that relate to the trauma medical director, and will take place November 15−17, at the Omni trauma program manager-focused issues will Nashville Hotel, TN. Register online for the enhance the learning experience and instruct meeting by October 22 at www.acstqip.org. participants about their role on the TQIP team. The meeting will convene trauma medical Conference topics of note for 2015 will directors, program managers, abstractors, and include the integration of Verification, TQIP, registrars from participating and prospective and Performance Improvement Programs, TQIP hospitals. The program will begin with as well as Pediatrics. The TQIP project a half-day preconference session on the basics team will present best practice guidelines of the TQIP program, intended for new TQIP on care of the orthopaedic patient, followed centers, new staff at existing centers, and by a discussion by a panel of experts. participants in need of a TQIP refresher. Visit the TQIP annual meeting website at At the conference, representatives from www.facs.org/quality-programs/trauma/tqip/ trauma centers will lead a number of sessions meeting, to view the conference schedule to highlight how they are using TQIP and and obtain information about lodging and convey to attendees the benefits of TQIP transportation, the keynote speaker, and a participation. Breakout sessions focused on social outing to the Grand Ole Opry. ♦

V100 No 9 BULLETIN American College of Surgeons ACS MULTIMEDIA ATLAS OF SURGERY VOLUMES The ACS Multimedia Atlas of Surgery presents step-by-step guides to both open and laparoscopic surgical procedures for liver, hernia, pancreas, and colorectal. Each book comes with a DVD of narrated surgical video. Online access to volumes is also available. Each volume is authored by a leading surgeon in the field and is peer-reviewed by the editors. The books include medical illustrations and tips to prevent errors.

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AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION Blended Surgical Education and Training for Life NEWS

Report on ACSPA/ACS activities, June 2015

by Fabrizio Michelassi, MD, FACS

The Board of Directors of the and SurgeonsPAC staff led a in coordination with the RAS American College of Surgeons discussion on the importance committee and Dr. Gavitt. Professional Association (ACSPA) of surgical advocacy and and the Board of Regents (B/R) of political engagement. Attendees the American College of Surgeons networked and learned more ACS (ACS) met June 5–6 at the about political advocacy. The Board of Regents (B/R) College’s headquarters in Chicago, SurgeonsPAC launched its approved the addition of IL. The following is a summary first PAC Captain Program on two new Regents’ seats for of their discussions and actions. May 26. This six-week, peer- representatives of specialties to-peer campaign, aimed at that are certified under the disseminating SurgeonsPAC’s auspices of the American ACSPA message to a broader Board of Surgery (ABS). The At the time of the meeting, the audience, ended in early July. B/R will, therefore, have 14 American College of Surgeons More than 40 PAC Captains instead of 12 members from 62 | Professional Association’s political participated in the program the ABS community, plus action committee (ACSPA- launch. These PAC Captains an additional nine members SurgeonsPAC) has raised $267,483 will remain our “champions” from each specialty board. in both personal and corporate in the states, working to The subspecialties recognized funds from 825 members of the increase the SurgeonsPAC by the ABS include: College and staff; the average membership base throughout contribution is $324. Of the the 2015–2016 election cycle. • Burn and critical care surgery total raised, $248,414 is personal The 2015 goals of the (hard) dollars and $19,069 is ACSPA-SurgeonsPAC include: • Gastrointestinal surgery corporate (soft) dollars. During the 2015–2016 • Launch additional peer-to-peer • General surgery election cycle, SurgeonsPAC focused solicitations, focused has disbursed $198,000 to 42 on lapsed and low donors, as • Pediatric surgery candidates, leadership PACs, well as surgeons who have not and party committees. Of contributed, using Health Policy • Surgical oncology the amount given, 66 percent and Advocacy Councilors and went to Republicans and other SurgeonsPAC advocates. • Transplantation 34 percent to Democrats. In March, the SurgeonsPAC • Increase awareness of PAC • Trauma sponsored a “Pizza and Politics” efforts to achieve a market reception in conjunction with share goal of 10 percent. • Vascular surgery the 2015 Residents as Teachers and Leaders Course. Brian • Increase RAS-ACS SurgeonsPAC One new position will be Gavitt, MD, the Resident and involvement throughout the filled in 2015, and the other Associate Society of the American country with a goal of 100 percent in 2016. The Nominating College of Surgeons (RAS-ACS) participation. Efforts and related Committee of the Board of PAC Board Representative, events would be carried out Governors will convene this

V100 No 9 BULLETIN American College of Surgeons NEWS

fall to select the nominee for certification requirement for cannot certify that the patient the 2015 pending vacancy. admitting physicians while will be in the hospital for less maintaining the long-enforced than 96 hours could result in an 96-hour average stay requirement. EMTALA violation for the CAH. Advocacy and Health Policy The College has endorsed In addition, if a CAH performs The ACS Division of Advocacy the Critical Access Hospital surgeries on non-Medicare and Health Policy (DAHP) Relief Act (H.R.169/S.258). patients that commonly result continues to support surgeons’ in patient stays of longer than interests at the federal and CAH 96-hour rule and EMTALA 96 hours, even if the patient state levels, advocating on ACS staff received questions does not have an EMC (and the following issues. from rural surgeons regarding thus there are no EMTALA compliance with the 96-hour implications), transferring The Critical Access Hospital rule in emergency cases as the patient because of the 96- Relief Act (96-hour rule) it related to the Emergency hour rule could jeopardize the The Centers for Medicare Medical Treatment and Labor CAH’s Medicare status because | 63 & Medicaid Services (CMS) Act (EMTALA). To help resolve of a potential violation of the recently indicated it would these issues, the ACS scheduled a CAH’s Medicare Conditions begin enforcing a long forgotten call with experts from CMS to (a) of Participation, sometimes regulation requiring that ensure that they understood that resulting in the CAH not being physicians who admit patients to their regulations were in conflict paid for an expensive surgery Critical Access Hospitals (CAHs) with the reality of practice performed there. Importantly, certify that it is reasonable in the rural setting and (b) to the 96-hour certification criteria to anticipate that each will highlight that the regulations for relates to the CAH payment and be discharged or transferred which the agency is responsible does not prohibit surgeons from within 96 hours. Previously, could be forcing CAHs to submitting claims to Medicare CAHs operated under a similar provide care to Medicare for professional services. but separate condition of patients without payment. Given this response from participation that required patient CMS confirmed the outcomes CMS, the best remedy for this stays to be less than 96 hours on created by the two regulations situation is passage of the Critical average. CMS’ recent action will (the 96-hour rule and EMTALA) Access Hospital Relief Act of prevent surgeons from being taken together. Specifically, CMS 2015. The bill, introduced in the able to admit many patients for stated that if a CAH has the Senate as S. 258 and in the House procedures routinely performed capability to perform surgeries as H.R. 169, removes the 96- in CAHs and will force many that would result in a patient stay hour certification requirement, rural patients to travel further of longer than 96 hours, and if the which would alleviate the from home for treatment. patient requires that operation problems rural surgeons have To address the issue, Rep. in order to be stabilized, then expressed. The ACS strongly Adrian Smith (R-NE) and Sens. transferring a patient with an supports this legislation and Pat Roberts (R-KS) and Jon emergency medical condition has included it in our legislative Tester (D-MT) have introduced (EMC) to a different facility agenda at the annual Advocacy legislation to eliminate the simply because a physician Summit for the past two years.

SEPT 2015 BULLETIN American College of Surgeons NEWS

Cancer Department of Defense (DoD) the Standard of Care Protection At the time of the Board meeting, Health Program, and the Veterans Act. This legislation clarifies the DAHP was working with the Medical and Prosthetics Research that no standard or guideline Commission on Cancer (CoC) Program. Sen. Richard Durbin in federal health programs, to host a congressional briefing (D-IL) introduced companion including Medicare, Medicaid, on June 9. This second briefing legislation, S.289. The College or the Affordable Care Act, hosted by the CoC focused supports these bills, which would may be used to establish the on accreditation. The briefing create a trust fund to support standard of care that a health care featured CoC Chair Daniel a mandatory funding stream professional must provide to a McKellar, MD, FACS, and CoC for this type of research. patient; therefore, these mandates Legislative Committee Chair Reps. Jackie Speier (D-CA) cannot be used as a cause of James Hamilton, MD, FACS, as and Cynthia Lummis (R-WY) action in liability lawsuits. well as a patient treated at a CoC- introduced the Breast Cancer The Saving Lives, Saving Costs accredited facility. The briefing Research Stamp Reauthorization Act was recently reintroduced 64 | was scheduled to complement Act, H.R. 2191, which would by Rep. Andy Barr (R-KY), and the annual One Voice Against extend by four years the U.S. for the first time, a companion Cancer (OVAC) lobby day. Postal Service’s authority to bill was introduced by Sen. John Reps. Charlie Dent (R-PA), issue a fundraising stamp for Barrasso (R-WY). This bill was Joe Courtney (D-CT), Michael breast cancer research. The first introduced last Congress Fitzpatrick (R-PA), and Donald Breast Cancer Research Stamp by Reps. Barr and Ami Bera (D- Payne (D-NJ), introduced the is available for purchase at 11 CA), and combines elements of Removing Barriers to Colorectal cents more than the cost of a pretrial screening panels and Cancer Screening Act, H.R. regular first-class stamp. The safe harbors for adhering to 1220. This bill would correct revenues cover the post office’s practice guidelines to provide an oversight in current law that administrative costs and fund liability protections, promote requires Medicare beneficiaries breast cancer research programs evidence-based medicine, and to make a copayment when a at the NIH and the DoD. Sens. improve patient safety. The colonoscopy also involves a polyp Dianne Feinstein (D-CA) and College worked with the bill’s removal. The College advocated Mike Enzi (R-WY) introduced sponsors to make refinements and for including this legislation the Senate version, S.1170. The improvements, including removal in the 21st Century Cures Act, ACS supports these bills. of a “loser pays” provision. which the House passed soon In December, the DAHP and after the Board meeting. Medical liability reform the ACS Legislative Committee Rep. Anna Eshoo (D-CA) The legislation described in released a new primer, Surgeons introduced the American earlier reports and that repealed and Medical Liability: A Guide to Cures Act (H.R. 2104), which the sustainable growth rate Understanding Medical Liability seeks to expand support for (SGR) formula—the Medicare Reform. This document explores future cancer and other health and Children’s Health Insurance the history and inefficiency of care research at the National Program Reauthorization Act the nation’s medical liability Institutes of Health (NIH), the (MACRA)—also included ACS- system and analyzes both Centers for Disease Control, the supported legislation known as traditional and alternative reform

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proposals. The primer informs to H.R. 648. At press time, centers established through Fellows of ongoing challenges Sen. Patty Murray (D-WA) this initiative. The request was and outlines opportunities for was expected to introduce the sent to the committees from implementation of alternative Senate companion bill to the several members of Congress, reforms that have been proposed trauma centers legislation. In but it is not known if the funds or studied at the local, state, and addition, the ACS is meeting with will be included in the bill. federal levels. This document members of the House and Senate is expected to be followed later Appropriations Committees to Regulatory and policy issues this year by a Surgeon’s Guide to a ask that they include funding The ACS has long highlighted Medical Liability Lawsuit and early for these programs, which have issues related to the Berenson- next year by a Surgeon’s Guide to been unfunded since 2005. Eggers Type of Service (BETOS) Avoiding Medical Liability Litigation. The Coalition for National coding system. CMS and other Trauma Research (CNTR) agencies have used the BETOS Trauma funding advocated for $30 million in coding system primarily to The House Energy and fiscal year (FY) 2016 Defense track resource utilization and | 65 Commerce Committee approved Appropriations to create and to analyze growth in Medicare two pieces of trauma legislation, fund research topics through a expenditures. In recent years, sending them to the full coordinated, multi-institutional, it also has been used to study House for consideration. H.R. clinical research network to the effect of bundled payments, 648, the Trauma Systems and advance military-relevant topics accountable care organizations, Regionalization of Emergency in trauma care and trauma and other alternative payment Care Reauthorization Act, systems that will allow the methodologies. Given increased would reauthorize the trauma Department of Defense to national requirements for the systems planning grants and the maintain the advancements development of new approaches regionalization of emergency and skill sets critical to moving to Medicare payment for provider care pilot projects; H.R. 647, the this area of research forward, services, the BETOS coding Access to Life-Saving Trauma even as combat deployments system could play a larger role in Care for All Americans Act, decrease. The ACS Committee provider reimbursement in the would provide critically needed on Trauma (COT) is a founding future; however, many aspects federal funding to help cover member of CNTR and supports of the BETOS classifications are uncompensated costs in trauma the establishment of a National outdated, inconsistent, or no centers, support core mission Trauma Clinical Research longer optimal. On May 8, the trauma services, provide Program, which would fund ACS submitted a letter to CMS emergency funding to trauma research to improve treatment for with detailed recommendations centers, and address trauma the most deadly and commonly on how to improve and center physician shortages. Both seen battlefield injuries, many modernize the BETOS coding of these bills then passed the full of which also affect civilians. system. The ACS will continue House under suspension rules. Research would be conducted to work with CMS and the AMA On March 17, Sen. Jack through multi-institution Relative Value Scale Update Reed (D-RI) introduced the clinical studies at a network of Committee with the goal of Senate companion bill, S. 763, civilian and military trauma overcoming weaknesses of the

SEPT 2015 BULLETIN American College of Surgeons NEWS

BETOS classification system to at reducing unnecessary In addition, CMS has made develop a more reliable and useful readmissions and the prevalence Quality and Resource Use Reports research and payment policy tool. of hospital-acquired conditions. (QRURs) available to help solo CMS released the Medicare CMS also proposed changes to practitioners and group practices physician fee schedule (MPFS) policy and operational issues understand their performance in proposed rule in early July, with surrounding the potential relation to Medicare’s quality and plans to release the final rule in expansion of its Bundled cost metrics. ACS staff created early November. At press time, Payments for Care Improvement a Web page on QRURs that ACS staff was reviewing the initiative (BPCI), which includes educational material proposed rule and developing links payments for multiple and resources to help Fellows comments based on feedback services. ACS staff submitted access and understand their from the ACS General Surgery comments to CMS in June. report. The ACS and CMS also Coding and Reimbursement CMS released the proposed hosted a webinar, available on Committee and the Performance Outpatient Prospective Payment the ACS QRUR website, on 66 | Measures Committee. System/Ambulatory Surgical how to interpret reports. CMS released its fiscal Center (OPPS/ASC) rule this The Physician Clinical year (FY) 2016 Inpatient summer. The proposed rule Registry Coalition is a group Prospective Payment System would increase Medicare of more than 20 medical (IPPS) proposed rule on April payment for health care services society-sponsored or physician- 17. Under the proposed rule, delivered in most outpatient led registries advocating for average inpatient payments department sites of care by an public policies that facilitate would increase by about 0.3 estimated 2.1 percent for CY 2015. registry development and percent in FY 2016 (October 1, The ACS continues to remove regulatory burdens. 2015–September 30, 2016). This provide educational materials In February 2015, the College update is contingent on hospitals and resources on the Physician worked with the coalition reporting specified quality Quality Reporting System to develop a resource titled data established in the Hospital (PQRS) to Fellows and office staff Guidance on Legal Challenges and Inpatient Quality Reporting through the website, meetings, Regulatory Obligations for Clinical Program. The proposed rule also and publications. The April 2015 Data Registries, which provides includes potential changes to issue of the Bulletin provides an guidance on privacy issues, data programs that apply incentives overview of the PQRS programs ownership, device reporting, and/or penalties to inpatient and College resources that assist liability risk, and legal discovery. hospitals. These include the members in complying with 2015 Hospital Value-Based Purchasing PQRS program requirements.* State Affairs Program and others aimed The PQRS section of the Last year, ACS State Affairs website, www.facs.org/advocacy/ staff assessed which states *Gokak S. Surgeons can avoid PQRS and value-based modifier payment penalties. regulatory/pqrs, is continuously require that insurers provide Bull Am Coll Surg. 2015;100(4):40-44. updated with new information, coverage for bariatric surgery, Available at: bulletin.facs.org/2015/04/ including how to report particularly through the state surgeons-can-avoid-pqrs-and-value- based-modifier-payment-penalties/. measures via claims, registries, health exchanges created in the Accessed August 14, 2015. and electronic health records. ACA. This assessment showed

V100 No 9 BULLETIN American College of Surgeons NEWS

that 28 states do not require have developed an innovative, bariatric surgery coverage, modular Surgery Resident Division of Member Services and that of those states, about Prep Curriculum, which relies The B/R accepted resignations half were states had created heavily on simulation. It is from eight Fellows from exchanges, and about half were currently being pilot tested the following specialties: part of the federal exchange. at 47 institutions across The ACS has been partnering the country with a formal • Neurological surgery (one) with the American Society of launch scheduled for 2016. Metabolic and Bariatric Surgeons The ACS and ASE also have • Obstetrics and Gynecology (two) to address the issue with CMS. developed a Medical Student The popular Chapter Lobby Core Surgery Curriculum, • Ophthalmic surgery (two) Day Grant Program entered a simulation-based modular its fifth year in 2015; a total of curriculum addressing the • Otolaryngology (one) 12 chapters received grants cognitive skills of medical for their lobby days, including students during the core surgery • Plastic and Reconstructive (one) | 67 Alabama, Brooklyn/Long Island, clerkship. The goal is to formally California, Connecticut, Florida, launch the program in 2017. • Urologic (one) Georgia, Indiana, Kansas, The Committee on Ethics Massachusetts, Michigan, continues to pursue projects The B/R also approved a Tennessee, and Virginia. The identified during its 2014 change in status from Active chapters applied various models strategic planning meeting. (dues paying) to Retired to conduct the activities, Specifically, the ACS Division of for 72 Fellows, and from including dinners with legislative Education and MacLean Center Senior (non-dues paying) leaders, receptions for legislators for Clinical Medical Ethics at the to Retired for 12 Fellows, and state Supreme Court University of Chicago, IL, have for a total of 84 Fellows. justices, and briefings and visits established a new Fellowship in The College’s Nigerian with legislators in the capitol. Surgical Ethics, which the B/R Fellows have requested the approved in February 2015. The formation of a Nigeria Chapter. program will prepare surgeons Emmanuel A. Ameh, MB, Division of Education for careers that combine BS, FACS, FWACS, is the The ACS Division of Education clinical surgery with scholarly current Governor for Nigeria. continues to provide learning studies in surgical ethics. Provisional officers include: opportunities to surgeons in Furthermore, the College practice, training, and medical has selected Alberto R. Ferreres, • Stanley N. C. Anyanwu, school and leads several other MD, PhD, MPH, FACS, to MB, BS, FACS, President important activities related serve as Editor of a new book, to surgical education. Ethical Issues in Surgical Care, • Bello Bala Shehu, MB, BS, For example, the ACS, the which will establish boundaries FACS, Vice President Association of Program Directors of the important domains in Surgery, and the Association and organize the essential • Lukman Olajide Abdur-Rahman, of Surgical Educators (ASE) components of surgery ethics. MB, BS, FACS, Treasurer

SEPT 2015 BULLETIN American College of Surgeons NEWS

• Samuel Adesina Ademola, • Essentials: 269 as a PQRS Qualified Clinical MB, BCh, FACS, Secretary Data Registry in March 2015 • Measures (National for the current reporting year. • Adesoji O. Ademuyiwa, MB, Quality Forum-endorsed Kamal M. F. Itani, MD, BS, FACS, Councilor-At-Large measures only): 12 FACS, will again chair the biennial Clinical Trials Methods The Nigeria Chapter is the ACS NSQIP continues to Course, November 6–10, at the College’s 41st international enhance its feedback reports, ACS headquarters in Chicago. chapter, bringing the total specifically the real-time, risk- This five-day intensive course number of chapters to 108, with 67 adjusted reporting capabilities, is based on four successfully domestic (including two Canadian in an effort to improve the conducted and published chapters) and 41 international. relevance of data. As of July 2015, clinical trials, which are used a new Accelerated-on-Demand to teach the methodology of application provides risk- and design and implementation of 68 | Division of Research shrinkage-adjusted rates using a controlled clinical trial. A and Optimal Patient a more accurate and more combination of didactic lectures A total of 630 hospitals participate robust methodology. This new and hands-on breakout sessions in ACS National Surgical Quality application has the same look will be used to apply concepts Improvement Program (NSQIP®); and feel of the old application learned throughout the course, 564 of those sites participate in but reports “rates” rather than including the development adult ACS NSQIP. The Essentials “odds ratios,” providing a of concepts and skills in the option, which is the conventional better application of the data. design, implementation, and sampling frame, has the highest The 2015 ACS NSQIP analysis of randomized clinical enrollment of all the adult National Conference took trials’ funding mechanisms participation options with 269 place July 25–28 at the Hilton and budget development; sites; however, the Procedure Chicago. A major theme at the outcomes (medical and patient- Targeted option, which allows conference’s 10th anniversary centered); and dissemination of hospitals to “target” the sampling was recognition of ACS NSQIP results through publications. to a list of focused procedures of hospitals and providers and The ACS and the Armstrong their choosing, has 233 hospitals their dedication to improving Institute for Patient Safety and is experiencing the highest the care of the surgical patient. and Quality are developing level of growth. The Pediatric At present, 787 health care a surgeon leadership course. option represents slightly more institutions participate in A one-day event was piloted than 10 percent of participation. the Metabolic and Bariatric at the ACS Clinical Congress The following is a Surgery Accreditation and 2014. The course intended breakdown of participating Quality Improvement Program primarily to introduce quality sites by ACS NSQIP option: (MBSAQIP). Of those centers, improvement and data review, 621 are fully accredited, 45 are present engagement strategies • Small and Rural: 41 data collection centers, and and quality improvement 115 are initial applicants. The models, and discuss strategies • Procedure Targeted: 233 MBSAQIP was again selected for overcoming barriers. The

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course will be offered again success with decreasing In addition, One Voice at Clinical Congress 2015. disparities in the quality of Against Cancer Lobby Days rectal cancer care by promoting took place June 8–9. Cancer Programs proper surgical technique, Survey Savvy took place The Commission on Cancer evidence-based treatment, June 18–19 in Chicago with (CoC) engaged in the following and a multidisciplinary approximately 225 participants activities recently: team approach to care. in attendance. Accreditation 101 will be held September • A cumulative total of 1,507 The National Cancer Data 22 in Baltimore, MD. cancer programs in the U.S. and Base (NCDB) Cancer Program The National Accreditation Puerto Rico were accredited Practice Profile Reports (CP3R) Program for Breast Centers has by the CoC. CoC accreditation have been expanded to include verified more than 630 breast encourages hospitals, treatment three new quality measures and centers in the U.S. A total of 28 centers, and other facilities to one replacement quality measure. new programs have been added improve their quality of care Two cervical, one non-small cell in 2015. Reaccreditation rates | 69 through various cancer-related lung, and one rectal measure for 2015 remain at 99 percent. programs and activities. were released in March 2015. Approximately 20 percent of CP3R currently reports 15 quality centers request to be surveyed • A total of 481 cancer program measures across six primary sites. with their CoC program. Plans accreditation surveys were The Quality Integration for expansion to international conducted in 2014. Committee approved nine new sites in 2015 include two quality measures to be added Canadian breast centers and • 33 new cancer programs joined the to the NCDB reporting tools. five centers from the U.K. Accreditation Program in 2014. Three bladder, one pediatric, and The CoC’s Advocacy and five melanoma measures were Outreach Committee was • 75 cancer programs received the proposed and approved. These reorganized to add representation Outstanding Achievement Award. measures were developed in from major breast cancer conjunction with the Society of advocacy groups, including: • 73 percent of CoC-accredited Urologic Oncology/American cancer programs participated in the Urologic Association Pediatric • Young Survivors Coalition Rapid Quality Reporting System. Accreditation Committee, and the Society of Surgical Oncology. • Living Beyond Breast Cancer • CoC leadership and ACS The CoC’s second annual Fellows who are members of legislative briefing, Accreditation • Lymphedema Network Optimizing Surgical Treatment Makes a Difference, took place of Rectal Cancer are developing June 9 and included remarks • Inflammatory Breast Cancer standards and performance from the CoC leadership and Research Foundation measures that will form from the patient perspective the basis of a Rectal Cancer regarding the importance • Susan G. Komen for the Cure Accreditation module. The of receiving care from an work is modeled on European accredited program. • American Cancer Society

SEPT 2015 BULLETIN American College of Surgeons NEWS

international surgeons to visit from the recent months American College of American academic centers include the following: Surgeons Foundation and participate in scholarly The Kenneth L. Mattox programs; development of • “Too few breast cancer International Lectureship and reports and publications patients getting radiation after Scholar Program in Acute Care for presentation at Clinical mastectomy: Study,” U.S. News Surgery (KLM Program) is Congress; and/or a COT- & World Report, discussing an proposed as a joint initiative of the sponsored Mattox Lectureship. article in the April 2015 issue ACS and the COT. The program honors Kenneth L. Mattox, • “Patients bounce back faster MD, FACS, for his national and Journal of the American from surgery with hospitals’ international contributions to College of Surgeons (JACS) new protocol,” Wall Street acute care surgery and his many The JACS continuing medical Journal, also regarding an article decades of ACS leadership. education (CME) website is in JACS’ April 2015 issue 70 | The award also extends the now fully integrated into the ACS vision and the reputation College’s membership database, • “Blood transfusion during flight of COT internationally, while and is easily accessible after login. to trauma center boosts survival: mentoring academic surgeons The new JACS CME platform, Study,” Medline Plus, covering for leadership positions in acute developed by the College’s an article in JACS in May 2015 care surgery. This proposal was Information Technology area, is endorsed unanimously by the mobile-ready for smartphones, • “Worse survival after lung COT Executive Committee. iPads, and tablets. JACS CME is cancer surgery for residents of The ACS COT will confer a quick and convenient way for poor neighborhoods,” Reuters, one or more Mattox awards ACS members to earn credit for discussing an article published each year, contingent on the Maintenance of Certification. online April 15, 2015 ♦ ultimate success of the fund- In the last year, 3,660 seeking effort and investment Fellows earned credit toward return. These awards may be maintenance of certification from granted to surgeons practicing the JACS CME program, with in the U.S. and Canada, as well 84,348 CME credits granted. as to surgeons practicing outside There are now more than North America. The COT, 1,000 followers of @JAmCollSurg in conjunction with the ACS on Twitter—a 50 percent increase Executive Director and B/R, since the beginning of the year. will guide the selection process The app for reading JACS for the Mattox Awards in Acute on smartphones, iPads, and Care Surgery. Responsibilities of tablets has been downloaded the recipient may include travel almost 9,000 times since the to international ACS chapters app launched in October 2014. for scholarly and promotional A few examples of media purposes; travel support to coverage of JACS articles

V100 No 9 BULLETIN American College of Surgeons Save Up to $3,762 on Group Long Term Disability Insurance

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Calendar of events*

*Dates and locations subject to change. For more information on College events, visit www.facs.org/events or http://web2.facs.org/ChapterMeetings.cfm

Minnesota Surgical Society Arizona Chapter SEPTEMBER October 23–24 November 14–15 Duluth, MN Scottsdale, AZ Jacksonville Chapter Contact: Janna Pecquet, Contact: Ross Goldberg, September 1 [email protected], [email protected], Jacksonville, FL www.mnsurgicalsociety.org www.azacs.org Contact: Patti Chapman, [email protected]

Kansas Chapter NOVEMBER DECEMBER September 11–12 Southwestern Overland Park, KS Pennsylvania Chapter Massachusetts Chapters Contact: Denise Lantz, November 4 December 5 [email protected], Pittsburgh, PA Boston, MA www.kansaschapteracs.org Contact: James Ireland, Contact: Crystal Beatrice, [email protected], [email protected], New Mexico Chapter www.acms.org/spec/ACS/index.html www.mcacs.org September 18–19 72 | Albuquerque, NM South Korea Chapter Contact: Gloria Chavez, November 5–7 New Jersey Chapter [email protected] Seoul, South Korea December 5 Contact: Sun-Whe Kim, Iselin, NJ [email protected] Contact: Andrea Donelan, [email protected], OCTOBER Connecticut Chapter www.nj-acs.org Arkansas Chapter November 6 October 17 Farmington, CT Little Rock, AR Contact: Christopher Tasik, Contact: Linda Townsend, [email protected], FUTURE CLINICAL [email protected] www.ctacs.org CONGRESSES Israel Chapter Keystone Chapter October 20–21 November 6 2015 Tel Aviv, Israel Scranton, PA October 4–8 Contact: Mordechai Gutman, Contact: Robb-Ann Cook, Chicago, IL [email protected] [email protected], www.keystonesurgeons.org 2016 Italy Chapter October 16–20 October 21–24 Wisconsin Surgical Society Washington, DC Milan, Italy November 13–14 Contact: Giuseppe Nigri, Kohler, WS 2017 [email protected], Contact: Terry Estness, October 22–26 www.facsitaly.org [email protected], San Diego, CA www.wisurgicalsociety.com

V100 No 9 BULLETIN American College of Surgeons