Second Quarter 2010

A Message from the Vice President of Clinical Effectiveness and Medical Affairs

insurance coverage will expand dramatically. Like throwing a rock into a still pool, the It is estimated that 32 million of the nation’s ripple effect of reform will not 49 million uninsured will be required in 2014 be fully understood for some time. As to take on health insurance. There will be a always, I suggest working together for the sliding scale of cost for the working poor/ best interest of those who entrust their underinsured and the poorest will be added to lives to us. the rolls of Medicaid. The insurance industry will benefit from the addition of more people According to Dictionary.com, the definition to the insured pool, but there will be strict of the word entitlement is: regulations regarding excluding people with pre-existing conditions or capping benefits. 1.The act of entitling 2.The state of being entitled Experts feel that health care costs will 3.The right to guaranteed benefits certainly go up under the new program. under a government program, as The Rand Corporation (think tank) estimates Social Security or unemployment David Boss, M.D. that costs in the U.S. will go up 2% more compensation. than the current rate of increase. The “Entitlement” Congressional Budget Office (CBO) In light of definition #2 above, I think that estimates that “Obamacare” will cost the The B-52s said it best in the 1980 hit We Americans are standing on the brink federal government approximately $940 song, Private Idaho: “Get out of the state of the most important entitlement program billion over the next decade. Of that, some you’re in!” in our nation’s history. I believe that in $400 billion will be spent on the subsidies for the end it will dwarf the impact of the insurance coverage and $500 billion on Medicare and Medicaid programs of the increased Medicaid spending. 1960s. After President Obama’s health Annual Doctor’s Outing legislation was passed, a number of There are other moving parts to be people asked me what I thought about it. I considered. We are now seeing the leading The Annual Patrick J. Dwyer Medical Staff honestly told them that I don’t understand edge of the Baby Boomer generation begin Outing will be held on Thursday, May 27. it fully and we may not understand all of to consume a lot of health care resources. Lunch will be served at the Manasquan its ramifications for decades to come. This will only get worse over the next twenty River Golf Club at noon with activities to years. Also, as more Americans get start at 1:00 p.m. If you have not done so, There are two components of the reform insurance, the previously uninsured that please send in your registration form and package. The first portion was signed by were receiving just-in-time care from the check in order to reserve your spot. the President on March 23 and includes will move into the a number of flaws and plenty of pork physician’s office for care. Do we have barrel additions that were added to enough physicians now or in the future to Orthopedic Fair is June 8 appease special interest groups. The care for them? Finally, it has been observed second part is a bill referred to as a that when large populations of people have Ocean Medical Center will host the “Movin’ “reconciliation” bill intended to fix some of avoided routine health care services due to and Groovin’ Orthopedic Fair” on Tuesday, the problems in the first bill. Not a very lack of coverage and then become insured, June 8, from 9:30 a.m. – 1:00 p.m. The good start. there is a deluge of newly diagnosed (and event is open to the community and often chronic, fatal, and expensive) illnesses includes free health screenings for foot, The short answer to the question of what that are identified. Are these costs in the balance, bone density, and BMI; physician health care reform will do is that health CBO estimates? lectures; and fitness demonstrations. Doctors’ Notes — Second Quarter 2010

Welcome New Physicians NOTE: • Staph aureus by PNA FISH will not determine

Randi Katz, D.O. Hematology/ susceptibility status, MSSA vs. MRSA (new added PCR Kenneth D. Nahum, D.O. Hematology/Oncology technology released in April will make the differentiation). Michael E. Schimler, M.D. Emergency Medicine • If only one positive blood culture bottle (from a set) is identified as Staph coagulase negative by PNA FISH, a comment will appear stating that it is a possible skin contaminate.

PNA FISH® Testing of Positive Blood Cultures

PNA FISH testing of positive blood cultures is now available at Naso/Orogastric Tube Placement Confirmation Meridian Health. The PNA FISH diagnostic platform provides definitive species identification of pathogens on the same day One of the worst case scenarios in naso/orogastric tube that primary blood cultures have turned positive. The PNA management is misplaced tubes in the lungs. Pulmonary FISH Test will be performed on all positive blood cultures damage varies depending upon the amount, osmolality, and when the Gram stains are reported as “Gram-Positive Cocci pH of the aspirated material, but can be severe. in Clusters” or “Gram Negative Bacilli.” For your convenience, identification results are available at 1:00 p.m. and 7:00 p.m., The Medical Executive Committees of University Monday through Friday. Results are also available at 5:00 p.m. Medical Center, Ocean Medical Center, and Riverview Medical on weekends and holidays. Center have approved the following: • All gastric tube placements for instillation of medications, Effective implementation of PNA FISH via coordinated efforts fluids, or feeding will be confirmed by ABDOMINAL can result in many great benefits: (SINGLE VIEW) X-RAY. If at any time, a tube originally • Improved patient safety placed for decompression becomes a vehicle for • Early notification of bacteremia with Staph aureus instillation of medications, fluids or feeding, an should lead to earlier appropriate and effective ABDOMINAL (SINGLE VIEW) X-RAY must be obtained. antibiotic therapy. When a naso/orogastric tube is ordered, the nurse is • Decreased antimicrobial use and early permitted to also order this X-ray by policy for those discontinuation of unnecessary antibiotics in patients where the tube is used for instillation of cases where only one set of blood cultures grew medications, fluids, or feeding. Coagulase Negative Staphylococcus. • Auscultation and fluid aspiration checks are • Identification of Pseudomonas aeroginosa in a unreliable methods of checking for tube placement. blood culture will prompt care givers to use antipseudomonal agents earlier in a patient’s course • Ongoing tube confirmation is done by observing for signs of treatment. of tube migration or misplacement. The tube’s exit site • Potential to decrease mortality in some situations. must be marked on the tube at the location of the nares or • Decreased length of stay mouth with a permanent non-black marker, or wrap tape • Significant cost savings at that area with an X to mark the spot. If the position of • Development of new therapeutic guidelines this mark changes, the location of the tube is in question and the physician should be contacted for a possible need The Lab has fully validated the S. aureus/Coagulase Negative of a repeat X-ray. Staph and the E.coli/Pseudomonas aeroginosa PNA FISH. • Patients at risk for pulmonary placement are those This validation is 100% sensitive and specific for identification who are coughing, comatose, intubated, pulling on the of Staphylococcus aureus and coagulase-negative staph as tube, require suctioning, have a decreased level of well as E.coli and Pseudomonas aeroginosa. consciousness, or a diminished cough/gag reflex.

PNA FISH results will be viewed in the clinical system results • If gastric tube is inserted for decompression, the tube display under MICROBIOLOGY (LIFETIME). There are four may be placed to gravity or suction as per M.D. order, possible PNA FISH Test results as follows: without the need for X-ray confirmation of placement. • CULTURE E. coli by PNA FISH • CULTURE Pseudomonas aeroginosa by PNA FISH • CULTURE Staph aureus by PNA FISH • CULTURE Staph coagulase negative by PNA FISH Doctors’ Notes — Second Quarter 2010

2010 Clinical Excellence Committee Initiatives

For 2010, the system-wide Clinical Excellence Committee (CEC), which welcomed new member clinicians from Southern Ocean County Hospital for 2010, has developed a work plan for the following areas of focus:

Infection Control/Antibiotic Stewardship: The CMS concept that nosocomial infections are “never events” has led to many improvements in actual care. As the number of C. diff cases related to handwashing decreases, cases remain related to antibiotic overuse. A larger problem is the emergence of resistant organisms limiting our armamentarium. The program endorsed by the CEC in 2009 needs continued oversight and evaluation. The Joint Commission continues to promote aggressive approaches to infection control and antibiotic stewardship in their surveys and National Patient Safety Goals.

CHF/Readmissions: A pilot project has just begun at Ocean Medical Center. This is the single largest admitting diagnosis across the system, and health care reform will focus on the issue of readmissions. Best practice guidelines for evaluation, treatment, and follow- up will be reviewed, disseminated, and monitored for outcomes in conjunction with Case Management and the Clinical Excellence Committee.

Blood Management: Meridian Health is committed to a culture of excellence within a collaborative environment and actively seeks innovative solutions, technologies, and partnerships to help ensure the communities we serve have the best health care experience possible. Another example of this approach is through the recent partnership with Strategic Healthcare Group, a physician-led blood management consulting company who will work with us to assess our current blood management process and develop new practices to help ensure blood utilization is maximized within our system. Strategic Healthcare Group conducted their onsite assessments during the second half of February.

Our have done a tremendous job managing our blood utilization; however, with a heightened focus on transfusion safety, the efficient use of resources, and improving the clinical effectiveness of blood transfusion, the time is now to raise the bar and develop a stronger blood management initiative for Meridian Health. Over the next few months, information will be communicated about the assessments and what changes Meridian will implement to ensure we all do our part to help manage blood usage more efficiently.

SCIP: The constant addition of publicly monitored new indicators and need for incremental improvement continue to make this an important project. The Department of Health and Senior Services, The Joint Commission, and the Centers for Medicare & Medicaid Services are expanding the number of measures to be publically reported.

As reported in the last issue of this publication, starting with January 2010 discharges, hospitals are required to submit Inpatient Quality Data on two new Surgical Care Improvement (SCIP) measures: Perioperative Temperature Management (all surgeries), and Postoperative Urinary Catheter Removal on Post Operative Day 1 (POD 1) or Day 2 (POD 2). The Clinical Excellence Committee will work to develop standard approaches to compliance.

Palliative Care/End of Life: The PCC and Board of Trustees have heard often of the Dartmouth Atlas Study which notes that ranks highest in the cost and quantity of care at the end of life. While the causes are multi-factorial and not entirely under physician control, it is clear that health care systems and medical staffs both play a roll in controlling those costs. A CMS demonstration project will likely begin at Jersey Shore initially, and will then rollout across the system to test the concept that physicians need to be reimbursed if they are to ever have the time for the sensitive and complex family discussions that will help patients delineate their care decisions. This new committee would help oversee the further development of existing programs, and the roll out of new ones.

ICU: This standing subcommittee has much important work to do in the areas of Sepsis protocols, Central line bacteremia, and allows for the healthy exchange of new approaches across the system.

Each of these involve a strategic initiative in areas where the utilization of evidence-based care has the potential to improve quality, increase patient satisfaction, and contribute to better outcomes for all of our patients. Doctors’ Notes — Second Quarter 2010 Important SCIP Information for ALL PHYSICIANS Community Day Set for May 22 Regarding Care of a Surgical Patient Bring the family out for a day of fun on Saturday, May 22 As physicians and specialists are under increasing scrutiny for Ocean Medical Center’s annual Community Day activities. by regulatory and insurance agencies with respect to certain The morning starts with a 5K Run/Walk at 8:30 a.m. Great key quality indicators, it is critical that all physicians remain prizes will be offered for top winners, as well as random informed of national quality initiatives and documentation drawings for all race participants. Kids’ races will be at requirements. 9:30 a.m., and the fun goes on until noon with free food, entertainment, rides, games, and screenings. The event takes place on the grass lawn in front of the Medical Center. In the surgical care improvement project (SCIP), surgeons are accountable for certain elements of care, however the data reflecting their care can be positively or negatively impacted by medical decisions and orders provided by non- Sleep Center Specialized Services surgical physicians. The effects of sleep disorders range from irritating to life If you are a non-surgeon involved in the medical care of a threatening. Sleep disorders can contribute to high blood surgical patient, here are four key focus areas that you need to pressure and heart disease, and negatively influence remember as you contribute to the care of this patient type: aspects of a patient’s personal life. If left untreated, certain sleep disorders can have harmful effects on the brain, heart, • Antibiotics: Document your reason for ordering any and lungs. antibiotics (i.e., “Antibiotic X ordered for suspected In addition to traditional sleep studies, Ocean’s Sleep Center infection”). provides the following specialized services that may be of • Beta Blockers: If the patient was on a beta blocker benefit to your patients: at home prior to arrival then a beta blocker must be administered during the perioperative period. If you Pediatric: Studies show that children with sleep disorders are determine that the beta blocker is not needed, more likely to have behavioral issues, and that treatment can document the reason for not administering the beta lead to significant improvement in school performance. Pregnancy: The physical, psychological, and hormonal blocker in the perioperative period (i.e., “Beta blocker changes that occur during pregnancy can affect sleeping not administered during the perioperative period habits, and even produce snoring, fatigue, and sleep apnea. because patient is hemodynamically unstable”). The Pre-Operative Evaluation: Sleep testing observes breathing perioperative period is the period 24 hours prior to patterns and checks for possible airway-related problems that surgical incision and ends a maximum of 6 hours may affect surgery and recovery outcomes. after arrival to PACU. • Urinary Catheters: Review Foley’s for necessity. For more information about Ocean’s Sleep Center, call 1.800.753.3779. If the catheter needs to be continued past post-

operative day 2 (POD2), document the reason by the

end of POD 2. (i.e., “Maintain Foley for strict I&O,” “Continue catheter until patient is ambulatory”). New Differential Parameter

• VTE Prophylaxis: Remember, surgery patients The laboratory now reports out a 6th fraction in the CBC must receive appropriate VTE prophylaxis within differential. The 6th part is referred to as Immature 24 hours prior to surgery to 24 hours after surgery. Granulocytes. This fraction consists of Metamyelocytes, Mechanical (SCDs) and pharmacologic prophylaxis Myelocytes, and Promyelocytes. The addition of this new must be ordered as appropriate. If one of these is parameter is possible due to an upgrade of our hematology contraindicated, document reason within 24 hours analyzers with new technology. after surgery. The reference ranges are as follows: If you have any questions regarding the SCIP requirements, Immature Granulocyte percent: 0.0-0.02 please contact Kirsten Zabilowicz, R.N., Performance Immature Granulocyte absolute: 0.00-0.01 Improvement Coordinator in the Ocean Medical Center Outcomes Department at internal ext. 4786. If you have any questions, please call Dr. Rangwala at

732.840.3218. Doctors’ Notes — Second Quarter 2010 Ocean Recognized for Organ and Practicing along side Dr. Khademi and Dr. Uustal are two Tissue Donation physiatrists new to the Shore Rehabilitation Institute team, Jennifer Scheick, M.D., and Talya Kianti Fleming, M.D. In New Jersey Organ and Tissue Sharing Network recognized addition to providing inpatient care and consulting services, Ocean Medical Center for outstanding achievement in the field Dr. Scheick and Dr. Fleming both provide outpatient care of organ and tissue donation for reaching the national for musculoskeletal and neurological disorders and perform benchmark goal for having 75% or higher conversion rate EMGs. Additionally, they both specialize in spasticity for 2009. management, including botox injections, nerve blocks, and intrathecal baclofen pump management. This achievement is a direct result of team member and physician support and dedication to help the thousands of Shore Rehabilitation Institute holds weekly prosthetic and individuals on the waiting list. During a recent recognition orthotic clinics. During these clinics, Dr. Uustal and his team ceremony, Ocean’s team was acknowledged for, “…your evaluate patients for the first time or will assist a patient who advocacy of donation with your professional colleagues, your is having an issue with their current device. Clinics are held by appointment. For further information, please call 732.836.4640. collaboration in the donation process, and the care you provide our donors and their families. Your compassion and expertise have touched the lives of not only the patients and families in your care, but also the lives of the recipients who Professional Achievements and received their precious gifts.” Accomplishments Needed

Last issue we informed you of the pending update project to Bedside Barcode Medication Administration the Echo credentialing system. That time is now upon us. If Now at Ocean you haven’t already, you will soon be receiving a printout of your current profile with the opportunity to update and add The new barcode scanning technology for medication information on yourself, your practice, and the things that administration was successfully implemented on 5 South in interest you most. Your updated profile information will be March, and then on 5 West in April. Implementation went so featured in new printed directories and an enhanced online well on the first two nursing units that it will go house-wide at directory and profiles to be introduced later this year. Ocean in June. In addition, we are looking for information about your Medication Administration Check, or “MAK,” is a patient safety professional achievements and accomplishments such as: initiative that closes the loop in medication administration. The process begins with CPOE, then verification by the • Were you a featured speaker at a conference or pharmacist, to security of medications in the MedSelect lecture series? machines, and now to bedside barcoding administration. • Have you recently been published in any medical journals or trade magazines? • Have you participated in an overseas medical mission or pro bono work in underserved communities? Nationally Recognized Physiatrist Now • Are you/have you been involved in any clinical trials/ Practicing at Shore Rehabilitation Institute investigational studies? • Have you been elected or served on the board or Shore Rehabilitation Institute, located in Brick, is excited to leadership committee of local or national medical welcome Heikki Uustal, M.D. Dr. Uustal received his medical societies, trade associations, or commissions? degree from the University of Vermont and has been board • Have you received any honors, awards, and/or certified in Physical Medicine and Rehabilitation since 1988. recognition? In his role at Shore Rehabilitation Institute, Dr. Uustal’s primary focus is on prosthetics and orthotics. We would like this information from you so that it can be featured in publications, physician and consumer directories, Nationally recognized in his field, Dr. Uustal joined Shore and multimedia events and celebrations of physicians Rehabilitation Institute from Meridian Health partner, JFK throughout 2010. Please take a few moments when you receive Johnson Rehabilitation Institute in Edison, where he currently the form to fill it out and return it to your Med Staff office for serves as attending physiatrist and director of the Prosthetics processing. If you have any questions, please contact Mike and Orthotics team. Valentino in Communications at 732.751.7538.

Doctors’ Notes — Second Quarter 2010 Calling All Artists! Dr. Kerr attended New York Medical College before residency in Internal Medicine at Rhode Island Hospital. He went on to a It is time for the Ninth Annual Meridian Health Medical and fellowship in Pulmonary Medicine at the Albert Einstein College Dental Staff Art and Photography Exhibition. We are pleased of Medicine. He has practiced Pulmonary and Critical Care to announce that Residents and Fellows affiliated with Medicine at Ocean Medical Center since May of 1988. Meridian Health will also be eligible to exhibit this year. The exhibit will run from June 7, 2010 through July 16, 2010 and Congratulations Dr. Kerr on your outstanding achievement. will be held in the North/South Concourse at Jersey Shore

University Medical Center. The opening night of the exhibit will be held on June 7, at 6:00 p.m. in the Kurr Atrium at Meridian KidViews Makes Its Debut Jersey Shore and we will be honored to have Arthur Topilow, M.D., and his jazz group performing. Meridian is pleased to announce we are expanding our free health education resources for our communities with the If you have any questions or would like to request a introduction of Meridian KidViews, a new quarterly publication registration packet, please contact: dedicated to health information for families that focuses on • Cynthia Allen, manager of Physician Services at Jersey children’s health topics, including asthma, safety, neonatal Shore, at 732.776.4689 or [email protected] care, and much more for parents. • Richard Rhee, M.D., chairman of the Ninth Annual Meridian Health Medical and Dental Staff Art and “The magazine incorporates both the Meridian Health and the Photography Exhibition, at 732.775.2400 or K. Hovnanian Children's Hospital at Jersey Shore University 732.890.8925 Medical Center brands, and provides the opportunity to further communicate the benefits and features of Meridian Pediatric

Network, our network of 300 community pediatricians, Richard J. Scott, M.D., Receives Board obstetricians, and family practitioners working side-by-side Certification in Medical Management with the region's largest group of pediatric sub-specialists,” says Ryan Younger, marketing manager for the Meridian The Certifying Commission in Medical Management Pediatric Network. (CCMM) recently designated Richard J. Scott, M.D., senior vice president of Clinical Effectiveness and Medical Affairs Meridian KidViews includes: for Meridian Health, as a Certified Physician Executive (CPE). • A "Meridian Moms" feature that provides content for CCMM awarded Dr. Scott the status of Certified Physician moms-to-be or moms that already have children Executive for his educational achievements, demonstrated • An engaging "In the News" section with health news stature as a physician, and experience in the field of relevant to the reader and her family, with a focus on OB medical management. • A "just-for-kids" KidMazing layout featuring the Pawsitive Action Team, tips for children on how to become The CPE designation indicates that a physician has achieved healthier, fun recipes kids can make with their parents, superior levels of professional excellence and management and contests education, while also demonstrating effective knowledge and leadership skills. The Certifying Commission in Medical If you’d like to receive Meridian KidViews, visit Management currently lists more than 1,000 Certified www.KHovnanianChildrensHospital.com to join our Physician Executives. mailing list today.

Congratulations to Brian Kerr, M.D., FACP Prescription Benefit Information and Your Meridian Team Member Patients Brian Kerr, M.D., FACP, has been elected to Fellowship in the American College of Physicians (ACP). Fellowship in the If you have patients who are covered under Meridian’s Health ACP is an honor achieved by those recognized by their peers Benefits, this information on our 2010 Health Plan changes may for personal integrity, superior competence in internal be of interest to you. medicine, professional accomplishment, and demonstrated scholarship. Fellowship may be achieved through academic Meridian’s 2010 Health Benefits offer a $0 co-pay for generic publishing, pursuing advanced degrees, activity within the maintenance medications, when filled through the Meridian ACP, or seniority within the profession and specialty. Ambulatory Pharmacy. Your Meridian patients who take a Doctors’ Notes — Second Quarter 2010

Brand Name drug to control high blood pressure, cholesterol, the Meridian patient care continuum. If you want more etc. may benefit from a discussion with you about whether a information on access to patient information across the generic or therapeutic equivalent might be appropriate to help continuum, please call our IT Customer Support Line at them control their medical condition and their out-of-pocket ext. 3333 (internal) or 732.776.3333. prescription expenses.

Meridian 2010 Health Benefits also require maintenance Ocean Celebrates National Doctors’ Day medications to be filled through the Meridian Ambulatory Pharmacy or through ExpressScripts Mail Order Delivery On Tuesday, March 30, Ocean celebrated National Doctors’ Service. Maintenance medications may no longer be obtained Day. If you have not picked up your Doctors’ Day gift, please through a local retail pharmacy. come by the Medical Staff Office. If you are participating in the outing, you may find the gift useful. Your Meridian patients on maintenance medications will be requesting a prescription for a 90-day supply. This plan design As part of the National Doctors’ Day celebration, the Medical change not only helps Meridian control the rate of increase in Staff presented five nurses with the 2nd Annual Nurse of the our health benefit spending, but also helps our team members Year Award. The nurses nominated were recognized as reduce their out-of-pocket prescription costs. When filling a demonstrating the highest standards of the nursing profession, 90-day supply, the team member pays only the cost for a promoting collaboration and collegiality among the members of 60-day supply, and receives the remaining 30 days without the interdisciplinary team, demonstrating commitment and a cost. And as mentioned previously, filling a prescription for a caring attitude toward patients, and contributing to a positive generic drug at the Meridian Ambulatory Pharmacy will be free work environment for physicians at Ocean. Recipients of the for our Meridian plan members. 2010 Nurses of the Year Awards were Nancy Bersey, R.N. (ICU), Nancy Bradshaw, R.N., (Case Management), Kathleen Thank you for the care and attention you provide to our team Ingrassia, R.N., (Radiology), Michele O’Connor, R.N., (4 North), members, and for your support in helping to reduce their costs and Linda Wrigley, R.N., (4 West). for their prescription medication.

Team Effort Even in the Air Access to Patient Information Across the Meridian Continuum The pilots and flight attendants on a flight from Ireland to New York were happy to have some of Ocean’s physicians on Did you know that physicians can access information on board when an extremely ill passenger lost consciousness. An patients across Meridian using their link to Soarian? hour-and-a-half into a flight over the Atlantic Ocean, Joseph Albanese, D.O., and James Clarke, M.D., responded to an Today, physicians can access information on patients seen at overhead announcement for medical assistance. Jersey Shore, Riverview, Ocean, Shore Rehab, and Riverview Rehab. In the future, we plan to expand that access to Luck was with the airline, as a group of 15 doctors happened information to include other Meridian hospitals, long-term to be on the flight – several of whom were from Ocean Medical care facilities, and physician offices via our planned Health Center. The doctors were part of a group of 23 friends and Information Exchange (more on that next time). colleagues who had just completed what has become an annual trip to Ireland for the past 18 years. All physicians have access to Soarian from their Master screen using the option Go To Soarian. In Soarian, physicians The doctors determined that the unconscious woman was can easily view their census or group census. What you may severely dehydrated, her pulse was racing, and she had low not know is that physicians can search across facilities to blood pressure. After talking to her husband, they learned that access information as needed. For example, a patient comes she had been vomiting for the past 48 hours, having been to your office who has previously been seen at one of our struck by a severe gastrointestinal bug. The airline had a Meridian facilities. You can review that patient’s record (results medical case, so the doctors were able to start an IV and treat from both inpatient and outpatient visits) in Soarian even if the the woman. For the remainder of the six-hour flight, the doctors patient has not been a patient at the Meridian hospital where took shifts sitting by the patient’s side, monitoring the IV drip as you work. the plane’s altitude and pressure changed, and ensured that she was stable the rest of the way home. By the end of 2010, our Meridian Health Information Exchange will begin expanding access to information across Great job to all who were involved with this amazing act of caring! Doctors’ Notes — Second Quarter 2010 Happy Anniversary!

Below is a listing of physicians who are celebrating anniversary dates at Ocean Medical Center in 2010. Congratulations to you all! 5 Years Cauvin, Leslie R., D.O. 03/22/2005 Internal Medicine Chiu, Kenny, M.D. 06/28/2005 Internal Medicine; Gastroenterology Clark, Greg D., DPM 11/22/2005 Podiatry Diratzouian, Hasmik, M.D. 08/23/2005 Radiation Oncology Jain, Keshani, M.D. 06/28/2005 Internal Medicine; Nephrology Katt, Brian M., M.D. 06/28/2005 ; Orthopedics Hand Kaufman, Matthew R., M.D. 08/23/2005 Plastic Surgery; Otolaryngology Klebacher, Ronald J., D.O. 06/28/2005 Emergency Medicine Leitner, Robyn R., M.D. 08/23/2005 Urology Milazzo, Vincent J., M.D. 06/28/2005 General Surgery; General Morgan, Darlene M., M.D. 01/25/2005 Obstetrics/Gynecology Nguyen, Hoan-Vu T., M.D. 09/27/2005 Orthopedic Surgery O’Connor, Patrick J., Jr., D.O. 07/26/2005 Radiology Pinnelas, David J., M.D. 09/27/2005 Cardiovascular Diseases; Interventional Cardiology Purgavie, Kimberly A., D.O. 09/27/2005 Physical Med & Rehab Rushford, Steven G., M.D. 12/20/2005 Salloum, Didi A., M.D. 10/25/2005 Obstetrics/Gynecology 10 Years Babayev, Lily L., M.D. 12/19/2000 Internal Medicine Collado, Maria R., M.D. 10/24/2000 Pediatrics Dukuly, Zwannah, M.D. 04/25/2000 Pathology-Anatomic & Clinical; Cytopathology Erler, Brian S., M.D. 10/24/2000 Pathology-Anatomic & Clinical; Cytopathology Gallardo, Mary Rose, M.D. 08/22/2000 Pediatrics Godek, Christopher P., M.D. 09/26/2000 Plastic Surgery Govil, Sushama C., M.D. 10/24/2000 Pathology-Anatomic & Clinical; Hematopathology Hasan, Bassam I., M.D. 09/26/2000 Internal Medicine; Infectious Disease Leschhorn, Edwin C., M.D. 04/25/2000 Pathology-Anatomic & Clinical Lozowski, Thomas E., D.O. 07/25/2000 Family Practice Masud, Avais, M.D. 07/25/2000 Nephrology; Critical Care Medicine Minassian, Haig, M.D. 04/25/2000 Pathology-Anatomic & Clinical; Cytopathology Pagano, Ann Marie, M.D. 09/26/2000 Obstetrics/Gynecology Reid, Kenneth M., M.D. 11/28/2000 Anesthesiology Stillo, Joseph V., M.D. 06/27/2000 Physical Med & Rehab; Spinal Cord Injury Medicine Talamayan, Randy, M.D. 09/26/2000 Internal Medicine; Pediatrics Tolerico, Christopher S., M.D. 09/26/2000 Emergency Medicine Doctors’ Notes — Second Quarter 2010 Happy Anniversary! (cont.)

15 Years Albanese, Joseph J., D.O. 07/28/1995 Internal Medicine; Nephrology

Bhagat, Sanjay, M.D. 09/26/1995 Internal Medicine; Gastroenterology Cameron, James D., M.D. 04/28/1995 Emergency Medicine Escandon, Sandra L., M.D. 08/28/1995 Neurology Gonzales, Santos O., M.D. 09/26/1995 Emergency Medicine Hackett, Thomas E., D.O. 07/25/1995 Obstetrics/Gynecology; Gynecologic Oncology Haimowitz, Ira, D.O. 10/22/1995 Pediatrics Lahoti, Chitra, M.D. 07/05/1995 Pathology-Anatomic & Clinical Law, William A., M.D. 09/26/1995 Orthopedic Surgery Noris, Gary L., M.D. 04/06/1995 Emergency Medicine Partyka, Bronislaw, M.D. 05/04/1995 Internal Medicine; Emergency Medicine Patel, Rajendra K., M.D. 04/06/1995 Emergency Medicine Reyes, Prudencio C., M.D. 11/29/1995 Emergency Medicine Rothberg, Michael S., M.D. 07/25/1995 Internal Medicine Shanik, Robert, M.D. 10/30/1995 Pediatrics Sweeney, Robert L., D.O. 04/06/1995 Emergency Medicine; Pediatric Emergency Medicine Weintraub, Steve L., D.O. 04/25/1995 Family Practice, Internal Medicine; Sports Medicine Weiss, Maurice D., M.D. 10/30/1995 Cardiovascular Diseases; Interventional Cardiology

20 Years Clarke, James, M.D. 08/28/1990 Family Practice Filardo, Josephine, M.D. 06/28/1990 Obstetrics/Gynecology Fitzpatrick, John E., M.D. 05/23/1990 Psychiatry and Neurology Lister, Mark A., M.D. 06/26/1990 Ophthalmology Nahm, Choong S., M.D. 09/30/1990 Otolaryngology; Plastic Surgery Head & Neck Rivera, Loyda I., M.D. 06/26/1990 Pediatrics; Pediatric Cardiology Saez-Lacy, Deborah, M.D. 08/28/1990 Obstetrics/Gynecology Verma, Anjali, M.D. 09/25/1990 Pediatrics; Neonatal-Perinatal Med

25 Years Cryan, Jeffrey M., M.D. 08/31/1985 Internal Medicine; Gastroenterology Gilson, Paul J., M.D. 06/25/1985 Neurology Green, Stuart, M.D. 04/30/1985 Ophthalmology Indahl, Kenneth G., DPM 04/30/1985 Podiatric Surgery Kate, V. P., M.D. 04/23/1985 Internal Medicine; Cardiovascular Diseases Lygas, Theodore B., M.D. 10/12/1985 General Surgery; Breast Surgery Potulski, Frederick J., M.D. 09/24/1985 Internal Medicine; Pulmonology Doctors’ Notes — Second Quarter 2010 Happy Anniversary! (cont.)

30 Years Alcasid, Lino, M.D. 10/28/1980 Radiology DeCotiis, Bruce, M.D. 06/24/1980 Allergy and Immunology, Internal Medicine Shah, Kalpana N., M.D. 08/19/1980 Anesthesiology Shah, Tarun, M.D. 08/01/1980 Pediatrics, Allergy, and Immunology Zaleski, Theodore G., J.D., M.D. 10/14/1980 Orthopedic Surgery 35 Years Rhee, Richard S., M.D. 07/28/1975 Neurology 40 Years Kuflik, Emanuel G., M.D. 10/31/1970 Dermatology

Lung Cancer Conference Now Held Weekly

Ocean’s Lung Cancer Conference has increased its frequency and now meets weekly, every Wednesday from 12:00 p.m. - 1:00 p.m. The multidisciplinary conference discusses patients diagnosed with or with a suspected diagnosis of lung cancer or esophageal cancer. The team reviews the clinical information and studies the cases to develop recommendations for the patient’s treatment plan.

Immediately after the conference, patients may be scheduled to meet with a physician(s) to discuss the recommendations. The recommendations are shared with the referring physician(s). Physicians may request to have their patients’ cases presented at the meeting by calling the Oncology clinical advocate, Joyce Cline-Blasi, at 732.836.4042. Physicians are encouraged to attend and participate in the discussion of their patients and/or as a learning opportunity to get questions answered.

12:00 p.m. – 1:00 p.m.

Wednesday DATE ROOM DATE ROOM May 19 Community Room October 13 CANCELLED May 26 Community Room October 20 Community Room June 2 Community Room October 27 Community Room June 9 Conference Room B November 3 Community Room June 16 Community Room November 10 Conference Room B June 23 Community Room November 17 Community Room June 30 Community Room November 24 CANCELLED July 7 CANCELLED December 1 Community Room July 14 Conference Room B December 8 Conference Room C July 21 Community Room December 15 Community Room July 28 Community Room December 22 Community Room August 4 Community Room December 29 CANCELLED August 11 Conference Room B August 18 Community Room August 25 Community Room Doctors’ Notes — Second Quarter 2010 2010 Tumor Board Conference Schedules

GI General Breast Noon Noon Noon Main Conference Rm Main Conference Rm Main Conference Rm 2nd Monday Last Monday of Month 3rd Monday May 10 May 24 May 17 June 14 June 28 June 21 July 12 July 26 July 19 August 9 August 30 August 16 September 13 September 27 September 20 October 11 October 25 October 18 November 8 November 29 November 15 December 13 December 27 December 20

General and GI Tumor Board Inquiries Contact Arlene Pigan, Ocean Medical Center Cancer Registry, 732.836.4121, or [email protected]

Breast Tumor Board Inquiries Contact Mary Lynn Breslin, Ocean Medical Center Oncology, 732.836.4190, or [email protected]

Tuesday Talks: Grand Rounds Lectures will continue and are held on the first and third Tuesdays of the month, from noon – 1:00 p.m., in East Wing Conference Room A. Lectures will be held during May and June. There will be a summer hiatus during July and August. All are welcome to attend. Contact Susan O’Hara, 732.206.8312, or [email protected].

The Departments of Medicine, OBGYN, and Pediatrics periodically hold Grand Rounds Lectures. Please contact Susan O’Hara, 732.206.8312, [email protected] for dates and times.

All CME activities are subject to cancellation. Please reach out to the contact person to confirm lecture times and dates.

CME Accreditation Statement: Meridian Health is accredited by the Medical Society of New Jersey to provide continuing medical education for physicians.

Disclosure Statement: Meridian Health, in approving activities for AMA PRA Category 1 CreditTM, adheres to the ACCME Standards for Commercial SupportSM. Meridian Health is responsible for every aspect of the activity it certifies. Faculty and planners in a position to control content are expected to disclose relevant financial commercial relationships related to the activity. If a conflict is identified it is Meridian Health’s responsibility to initiate a mechanism to resolve the conflict.