Physician-Pilots Responded WHEN DISASTER STRUCK

VOL. 40 NO. 4

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Physicians Bulletin • July/August 2019 3 Boys Town Pediatric Neuroscience

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FEATURES 24 24 COLLABORATIVE EFFORT 15 NMA MESSAGE ADDRESSING MATERNAL Prioritizing Member MORTALITY RATES Engagement, Communication 26 SPREAD THE WORD: 17 RISK MANAGEMENT MOMS’ PODCASTS TOUCH ON Considerations for Law TRENDING MEDICAL TOPICS Enforcement Interactions 28 PDMP DATA SHARING: 19 YOUNG PHYSICIAN 26 NEBRASKA JOINS THE CROWD Defining an Early Career Physician 30 PHYSICIAN-PILOTS 21 LEGAL COLUMN RESPONDED WHEN Responding to Family Members’ DISASTER STRUCK Requests for a Deceased Patient’s Medical Records

30 DEPARTMENTS FINANCIAL COLUMN 23 Plan Now for a Cash Influx 9 COMING EVENTS 33 MOMS EVENT RECAP 11 EDITOR’S DESK The Many Faces of MOMS 34 MEMBER NEWS Membership 35 NEW MEMBERS 12 MEDICAL MUSINGS 36 CAMPUS & HEALTH 13 MOMS LEADERSHIP SYSTEMS UPDATES Thank You to Those Who Inspire

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Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2015. No whole JOIN US AS WE DIG DEEP INTO HIPAA LAW AND HOW IT or part of contents herein may be reproduced without prior APPLIES TO YOUR OFFICE ON A DAY-TO-DAY BASIS! permission of Omaha Magazine or the Metro Omaha Medical Society, excepting individually copyrighted articles and photo- Earn 2 Ethics CEU’s While you update your HIPAA Knowledge Base graphs. Unsolicited manuscripts are accepted, however, no responsibility will be assumed for such solicitations. Omaha Maga- zine and the Metro Omaha Medical Society in no way endorse discoveringhipaa.com any opinions or statements in this publication except those ac- curately reflecting official MOMS actions. Steps Minutes Life Changed Forever

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3/2017 Physicians Bulletin • July/August 2019 COMING EVENTS 9 Coming EVENTS

PLEASE REGISTER FOR EVENTS ONLINE AT OMAHAMEDICAL.COM/EVENTS OR CALL THE MOMS OFFICE AT (402) 393-1415

AUG RETIRED PHYSICIANS AUG EARLY CAREER PHYSICIAN 07 27 WEDNESDAY, AUG. 7 | 10:00 A.M. HAPPY HOUR METRO OMAHA MEDICAL SOCIETY BOARDROOM TUESDAY, AUG. 27 | 5:30 - 8:30 P.M. 7906 DAVENPORT ST. RAILCAR MODERN AMERICAN KITCHEN Robert Devin, M.D. will present “An Update on 1814 N. 144TH ST. Omaha-area Emergency Services and Facilities.” Come network with your fellow early career physicians! Appetizers and first drink on us! AUG POLICYMAKER & PHYSICIAN 16 MEET & GREET RECEPTION SEPT NMA ANNUAL MEETING & FRIDAY, AUG. 16 | 6:00 - 8:30 P.M. 06 HOUSE OF DELEGATES MIDTOWN CROSSING CLUB ROOM FRIDAY, SEPT. 6 200 S. 31ST AVE. - NINTH FLOOR EMBASSY SUITES HOTEL - LINCOLN, NE (SOUTH ENTRANCE NEXT TO PRAIRIE LIFE) 1040 P ST., LINCOLN, NE 68508 A unique opportunity for Nebraska lawmakers and Visit nebmed.org for complete details. candidates to meet with our member physicians to explore the rapidly changing health care environment and its impact on the health of our community. OCT WOMEN IN MEDICINE: 16 AXE THROWING AUG WEDNESDAY, OCT. 16 | 5:30 - 8:30 P.M. 19-22 COMMUNITY INTERNSHIP SHADOWING MONDAY - THURSDAY, AUG. 19-22 FLYING TIMBER - 1507 FARNAM ST. BANQUET THURSDAY EVENING, AUG. 22

Physicians Bulletin • July/August 2019 EDITOR’S DESK 11

Using web-based cameras, we watched Improvement Collaborative, is working THE MANY as the river began to rise, fluctuating by to improve care of Nebraska mothers and as much as 6 feet over a 20-minute period. babies. While the team consists of phy- FACES OF MOMS The river eventually flowed across the sicians from many hospital systems, the road that separated our cabin from the Physicians Bulletin would like to share MEMBERSHIP Platte River, stopping within inches of some words from one of our members, our garage. We watched via our webcam Dr. Bonebrake. I think it is important for as the road maintenance people, along these statewide collaboratives to occur to with a group of home owner volunteers, improve care for all people who live in the arrived and worked to keep the Platte State of Nebraska, and I am pleased that from destroying our lake community. The one of our members has agreed to tell the effort included 140 loads of aggregate, a story of this collaborative. road grader, a bulldozer and countless hours of volunteers, sometimes risking In addition, we are sharing information their own safety to save our lake commu- about the work the administrative team at AUDREY PAULMAN, M.D. nity and our cabin. Metro Omaha Medical Society has done Editor to provide educational materials in an Physicians Bulletin My story has a good ending. With time, up-to-date format. Podcasts are educa- hat do flying doctors, people the river went down. While there were tional materials that can be delivered dur- W caring for babies and their mothers, cabins with damage, the lake community, ing a morning or evening commute, and podcasts and prescription drug monitor- including our cabin, was saved. We had the information is provided by members ing have in common? an outstanding outcome—no lives lost, of MOMS, so those who listen to the no injuries, and no catastrophic prop- podcasts may get to know some of the The cover story for this edition of the erty loss. Individuals came together and local experts. To learn more about the Physicians Bulletin is about the Fremont worked as a team. People I don’t know new Health 101 podcast series, see the flood. While Nebraska experienced put themselves in harm’s way to keep the feature article on page 26 of this issue. flooding earlier this year that has been flooding from destroying my home. It was described as historical, for me, the flood- overwhelming. And, finally, as a state, we are addressing was much more personal. My family ing the opioid crisis. For those of us has owned a cabin along the Platte River The floods came so quickly that people practicing in Omaha, we have been for nearly 25 years. Each year, we wait for did not have time to evacuate. Friends of unable to share prescription drug infor- the spring thaw, when ice clears out of the mine were trapped in Omaha, while their mation to and from the state of Iowa. This Platte River. We had heard that the ice was children were trapped in Fremont. Individ- will change in a few months, a change that unusually thick this last winter, and so we uals came together and worked as a team MOMS wants you to know about, and so were anticipating the risk of flooding, but to help. People were told to just “show up” we interviewed an expert in the change. we were not prepared for the degree of at the airport in Fremont and they would flooding that followed. be placed on one of the flights. Supplies And so, what do flying doctors, caring were flown into Fremont, and people were for babies and their mothers, podcasts, We watched the forecasts as the flood- shuttled in and out of the city. and prescription drug monitoring have ing was predicted, changing from an advi- in common? They are all groups that are sory to a watch, and then from a flood I am the grateful recipient of help dur- members of MOMS or provide services watch to a flood warning. With our cabin ing the Nebraska flooding. I am thank- to MOMS members, who are working to sitting right at the level of the flood plain, ful that there are people who know what make life better for people. it looked like we were doomed. On a to do, and, without explicit direct orders Wednesday afternoon, I went and moved from anyone, they do it. In this edition, While Physicians Bulletin is distributed items of sentimental or monetary value we are sharing the story of two of free of charge to all of the metro-Omaha up to the second floor, or out of the cabin MOMS member physicians who stepped area physicians, the physicians featured entirely, hopefully, for safe-keeping. After up and helped. are all members of MOMS. If you would photographing everything, we told law like information about being a member enforcement officers all our phone num- Other teams are working to make of MOMS, we can have someone reach bers and notified them that the cabin Nebraska safer. Quality improvement out to you. If you have a story you would would not be occupied. My husband and initiatives to reduce maternal mortality like to see featured, please contact I emotionally prepared to lose the cabin are occurring across the entire State of Laura Polak at MOMS, (402) 393-1415 or to the flood. Nebraska. A collaborative team, work- [email protected]. ing as the Nebraska Perinatal Quality 12 MEDICAL MUSINGS

MEDICAL MUSINGS STRATEGIC PARTNERS Each issue of the Physicians Bulletin, we will post a prompt or question to which MOMS members may respond. Check our The Metro Omaha Medical Society Strategic next issue as we share some of the responses we receive. Partners offer a variety of expertise, products and services to assist physicians and practices in addressing their needs and achieving success.

We encourage you to talk with our FROM LAST ISSUE: Strategic Partners when making decisions for “Tell us about a connection you made thanks yourself or your practice. to MOMS (personal, business, etc.)”

RESPONSES PLATINUM PARTNER “I have made new friends and renewed old friendships among Omaha physicians via the MOMS DocBuild program. This program has also allowed me to meet and interact with individuals in other professions (i.e. construction) and has led me to develop some new skills. These interactions would not have happened without the DocBuild program.” — Paul Paulman, M.D. GOLD PARTNERS

“MESS Club Show. A tenor from Creighton. An anesthesiologist from Immanuel, an Orthopedist from Methodist and an ophthalmologist from Clarkson that would never have met if not for the MESS Club Show. We became friends and have sung together for two decades. Couldn’t have done better than that. Thanks my friends—Drs. Laurel Preheim, Chris Link, and Chet Waters.” SILVER PARTNERS — William Schlichtemeier, M.D.

NEXT QUESTION: What mobile apps do you use BRONZE PARTNERS in practice?

For more information on our Strategic Partners ANSWER ONLINE AT visit OmahaMedical.com OmahaMedical.com/Medical-Musings Physicians Bulletin • July/August 2019 MOMS LEADERSHIP 13

MOMS members who said yes and gave THANK YOU TO their time and efforts to make this happen. “For all the leaders We’re already thinking of more topics we THOSE WHO want to record. at MOMS, who sit on INSPIRE a committee, serve I also want to tell you about a small on the Board, and group of people who have earned their MBA as recipients of the Canedy spread the word of Scholarship from the Clarkson Foundation. how important it They’ve benefitted from the experience is for the voices of and want to nurture the next generation of physician leaders. Their motivation to physicians to be heard use their talents to benefit the greater in the conversations Omaha medical community is admirable. I about health care, am excited to see what they accomplish in CAROL WANG the coming years and encourage anyone we couldn’t do this Executive Director interested in a master’s degree in health without you.” Metro Omaha Medical Society care management to consider applying for — CAROL WANG this scholarship. ratitude. It’s a word I see time and Gtime again in reference to stories, This is the time of year when MOMS strategies and studies about burnout members craft resolutions to help shape For all the leaders at MOMS, who sit and stress. Even Oprah advocates daily policy priorities of the Nebraska Medical on a committee, serve on the Board, and gratitude journaling as a means to keep Association and beyond. We all owe these spread the word of how important it is focused on what’s important and what’s thoughtful colleagues our appreciation for the voices of physicians to be heard good in life. for trying to solve problems that affect in the conversations about health care, the care of patients in our community and we couldn’t do this without you. Finally, It’s in that vein that I thought I would the practice of medicine. I am humbled thank you, to our members for cheerlead- shine the spotlight on some of the phy- every year by the number of physicians ing MOMS and for being on this journey sicians who inspire me or deserve the who volunteer their time and their efforts with us. Your work caring for patients gratitude of all of us for making a positive to testify for state lawmakers, write let- and our community motivates us to work impact in our community. ters in support or opposition of an issue harder and make you proud. and allow community leaders to shadow I start with something that will have them as part of the MOMS Community debuted by the time you get this issue in Internship Program. your hands: Health 101, our podcast that features conversations about health top- MOMS would not be able to advocate, ics that we hope will help patients be their create educational materials and work on best advocates and showcase our mem- initiatives like wellness and health literacy ber physicians’ expertise. At a time when if it weren’t for an incredibly dedicated there is so much misinformation, this is and hard-working staff. They make our an opportunity for us to be a resource for day-to-day operations possible and are our community and beyond. I hope you’ll always trying to answer the needs of phy- download the episodes from wherever you sicians. I cannot even begin to express my get your podcasts, refer patients to it and appreciation to them for the million things support this effort. I am so thankful to the they do to keep us operating.

Physicians Bulletin • July/August 2019 NMA MESSAGE 15

Membership engagement is a vital com- PRIORITIZING “Membership ponent to the success of the NMA, and we engagement is a are working diligently to ensure that we MEMBER provide a variety of opportunities for mem- vital component to bers to engage and be part of the organi- ENGAGEMENT, the success of the zation. “Alone, we can do so little; together COMMUNICATION NMA, and we are we can do so much.” (Helen Keller) working diligently Speaking of ways to get involved, the to ensure that we NMA Annual Membership meeting is provide a variety of quickly approaching. This year’s meeting will be held on Sept. 6 at the Embassy opportunities for Suites in Lincoln. The day will begin with members to engage the NMA Board of Directors meeting in and be part of the the morning followed by lunch that will include a presentation by medical stu- organization.” dents and also an overview on the NMA AMY REYNOLDSON — AMY REYNOLDSON mobile application. The afternoon edu- Executive Vice President cational session will focus on physician Nebraska Medical Association burnout and will be led by Gail Gazelle, Given that we are immersed in the digi- M.D. Dr. Gazelle is an associate scien- his year is moving quickly, and the tal era, the NMA will continue to transition tist at Brigham and Women’s Hospital at TNebraska Medical Association is work- to digital communications, including the Harvard Medical School, author and physi- ing hard to implement several items from NMA Advocate, our quarterly magazine. cian leadership coach. our strategic plan, as well as tend to day-to- During our planning phase, we had great day tasks to ensure that we are providing input on ways to address this challenge Following the education session, the the best service to our membership. and after some discussion with our mem- NMA House of Delegates business meet- bers we have decided to branch out and ing will take place. We encourage all In January, members of the NMA Board develop our own mobile application. members to attend and engage in cur- of Directors and representatives from rent items that will be discussed. This is MOMS and Lancaster County Medical The NMA will launch its own mobile a great opportunity to network with oth- Society (LCMS) participated in a strategic application allowing members to connect ers and learn about the NMA’s priority planning meeting. In summary, the meet- with the latest association news, events items for the coming year. We will then ing was very productive and instrumen- and advocacy efforts, as well as allow mem- transition into the evening events begin- tal in identifying areas of opportunity and bers networking opportunities. The mobile ning with a cocktail hour followed by our strengths within the organization. Over application will also serve as a platform inaugural dinner where Todd Hlavaty, the last eight months, the NMA staff has for NMA staff to organize events and pro- M.D., will be installed as our 2019-20 pres- been focused on the implementation of vide detailed content on trainings, confer- ident. Dr. Hlavaty is a radiation oncolo- new efforts and enhancing existing ones. ences and other events, engage effectively gist practicing at Great Plains Health with members such as taking a poll on our Callahan Cancer Center in North Platte, One of the priority areas identified was position with legislative items, and collect Neb., who has been involved with the membership engagement. We have also input and guidance on projects. The NMA Lincoln County Medical Society and an identified that effectively reaching our mobile application will be available on IOS active member of the NMA for 23 years. members to keep them engaged is becom- and Android platforms in late August. We Dr. Hlavaty has served in various capaci- ing more difficult. We currently rely heav- encourage you to get on and check it out. ties within the NMA including Nebraska ily on communicating to our members Just search for “Nebraska Medical Associa- Medical Foundation, BOD, PAC BOD, through email, perhaps it is a direct email tion” in the Apple and Play Store. Professional Liability Committee, communicating specific timely information Commission on Legislation and Govern- or it is our bi-monthly electronic newslet- The NMA is also in the process of mental Affairs, Health Care Reform Task ter. Although many of us have at least one expanding opportunities to for member Force, and Bioterrorism Task Force. email account, unfortunately it does not involvement. Efforts include recording mean that we read everything we receive. a radio announcement that focuses on a You can register for the NMA Annual topic in their area of practice, organizing Membership Meeting online at www. small groups to focus on specific advo- nebmed.org or by calling the NMA cacy efforts, developing and partnering at (402) 474-4472. We look forward to on CME opportunities, and engaging in seeing you on Sept. 6. the physician leadership academy. Dr. Melanie Ortleb is a board-certified dermatologist with a new practice in West Omaha. She is accepting new patients and practices all aspects of dermatology. moddermatology.com

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16 Physicians Bulletin • July/August 2019 Physicians Bulletin • July/August 2019 RISK MANAGEMENT 17

information in electronic form in connec- • Share your side of the situation. Explain CONSIDERATIONS tion with a transaction covered under the your understanding of the situation and HIPAA regulations.1 the laws (HIPAA, etc.) that govern your FOR LAW actions of what you can and can’t do. PROTECTED HEALTH INFORMATION ENFORCEMENT (PHI): includes individually identifiable • When trying to decide which federal health information transmitted or main- or state law applies, the more restric- INTERACTIONS tained in electronic media or any other tive one will likely apply. In general, form or medium.1 Individually identifiable if there is a state or federal law that is health information is information created more restrictive than HIPAA (more pro- or received by a health care provider that tective of a patient’s privacy), providers identifies the individual and relates to are required to comply with the more the past, present, or future physical/men- restrictive law. tal health or condition of an individual; the provision of health care to the indi- • Document the details. Obtain any doc- vidual; or payment for the provision of umentation or statements from the health care to the individual.1 person requesting protected health JEAN MARTIN, M.D., J.D. information (PHI) when these docu- COPIC Legal Department WHO IS CONSIDERED A LAW ENFORCE- ments or statements are relied upon to MENT OFFICIAL?: As outlined in the make the disclosure.4 ealth care providers may experience HIPAA Privacy Rule, a law enforcement Hinteractions with law enforcement official means an officer or employee of • Respect law enforcement and the chal- personnel that create uncertainty around any agency or authority within the U.S., lenges they are dealing with. Do not their responsibilities to patients, includ- who is empowered by law to: (1) Investi- physically interfere with law enforce- ing the duty to protect patients’ privacy. gate or conduct an official inquiry into a ment officials or provide them false or Law enforcement personnel are tasked potential violation of law; or (2) Prosecute misleading information. with ensuring public safety and conduct- or otherwise conduct a criminal, civil, or ing criminal investigations. administrative proceeding arising from • Don’t provide more information than an alleged violation of law.2 what is necessary. Unless disclosures When these duties intersect as they made to law enforcement are required relate to patients in the health care sys- Law enforcement officials include by law, they should be held to the “mini- tem, providers should understand how (but are not limited to): mum necessary” standard. This means that to meet their obligations while respect- • Police officers and state troopers when using or disclosing PHI, the HIPAA- ing the requests of law enforcement per- • Sheriffs and sheriffs’ deputies covered entity or provider must make rea- sonnel. Situations that providers may • District attorneys sonable efforts to limit PHI to the minimum encounter with law enforcement include • DEA and FBI special agents necessary to accomplish the purpose of treating a gunshot wound, reporting • ICE officers the use, disclosure, or request.5 A provider child abuse or neglect, possible threats may rely upon the representations of a law to public safety, and if there is a crime The default position under HIPAA is enforcement official that the information on the premises of a medical facil- that PHI cannot be disclosed without requested is the minimum necessary for ity or practice. the patient’s authorization, but there the stated purpose.6 are some exceptions relevant to law PROTECTED HEALTH INFORMATION enforcement, including where reporting More details regarding disclosures for UNDER HIPAA: Before disclosing is required by state law. law enforcement purposes under HIPAA patient information to law enforcement, can be found at: www.hhs.gov/hipaa/for- a provider should consider whether it KEY CONSIDERATIONS FOR ANY LAW professionals/faq/disclosures-for-law- is protected under the federal Health ENFORCEMENT INTERACTION: enforcement-purposes/index.html Insurance Portability and Accountability • Don’t be afraid to ask for identification. Act (HIPAA) rules, which provide privacy Have they properly identified them- 145 C.F.R. § 160.103 2 protections for individually identifiable selves? If the law enforcement offi- 45 C.F.R. § 164.103 345 C.F.R. § 164.514(h)(1)(i) health information held by health care cial is not known to the provider, the 445 C.F.R. § 164.514(h)(1)(ii) providers and their business associates. provider must verify the identity and 545 C.F.R. § 164.502(b) 6 HIPAA “covered entities” include health authority of the person.3 Processes 45 C.F.R. § 164.514(d)(3)(iii)(A) care providers who transmit any health should be in place for in-person, phone, and email interactions. Thanks Omaha for over 30 Years!

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18 Physicians Bulletin • July/August 2019 Physicians Bulletin • July/August 2019 YOUNG PHYSICIAN 19

In order to identify strategic priorities DEFINING AN for our committee this year, we sent out “As early career an online survey to all MOMS ECPs. We EARLY CAREER asked about the types and frequency of physicians, we face PHYSICIAN events ECPs would be most interested in unique challenges in attending and the topics that would be entering the health most helpful to address in these events. The top two priorities identified by care workforce. Still ECPs were professional networking and experiencing the social connection. excitement of a new

You spoke and we listened! We held our physician, we are ECP kickoff event on May 7 at Vis Major, eager to roll up our a local brewery, with MOMS generously sleeves and get our providing the first drink for all attendees. ALËNA A. BALASANOVA, M.D. The aims of our Early Career Physician/ hands dirty.” Chair, Early Career Physicians Committee New Member Mixer were to increase — ALËNA A. BALASANOVA, M.D. Metro Omaha Medical Society ECP engagement and recruitment. ECPs were encouraged to bring a physician col- s we begin a new academic year this league who is not a member of MOMS to As early career physicians, we face AJuly, we welcome a new cohort of learn about the benefits of this organiza- unique challenges in entering the health medical students, residents and fellows. tion and potentially become a member. care workforce. Still experiencing the However, something we do not often think excitement of a new physician, we are about is that with each year a new cadre We asked our esteemed colleagues eager to roll up our sleeves and get our of freshly minted doctors also enter the and seasoned MOMS members to attend hands dirty. We are looking to innovate health care workforce as attending phy- and offer remarks on their experiences and disrupt the status quo while main- sicians. Every organization has its own with organized medicine and the value taining high quality, excellent care for definition of exactly what constitutes an of the collective physician voice in advo- our patients. We are looking to learn ECP. Here at MOMS, ECPs are residents, cating on behalf of our patients and the from the experience of our senior mentors fellows and physicians in their first five medical profession. We were pleased while also challenging long held beliefs years of practice and there is no age limit, to have immediate past president for which new data and research is avail- because many specialists do not finish Laurel Prestridge, M.D.; current president, able. We are looking to trade medical training until their mid-30s or later. Lindsay Northam, M.D.; and president- folklore for evidence-based medicine. elect John Peters, M.D.; all in attendance. I am honored to be your new ECP chair We learned about the different ways in Looking ahead, we are planning our and am proud to represent the interests which organized medicine can contribute second event, a social networking mixer, of early career physicians in the Metro to an ECP’s career trajectory. In addition on August 27 from 5:30 - 7:30 P.M. at Omaha Medical Society. I am excited to professional networking and social Railcar at 1814 N. 144 Street. In the mean- about our committee’s collective enthu- engagement, MOMS can offer a platform time, if any ECP would like to offer input siasm for increasing the presence and vis- for advocacy, community engagement, on the direction of our ECP committee ibility of ECPs in MOMS and the greater leadership development, identification and how we can best represent and serve Omaha medical community. Our commit- of mentors and connecting with research your needs, I encourage you to please let tee represents a wide variety of physician opportunities. Hearing how these expe- us know by reaching out to Halie Smith at practices—from academic faculty and rienced physicians have benefitted from [email protected]. employed physicians to solo private prac- MOMS was both enlightening and moti- tice—which is a reflection of the diversity vating for many of us ECPs and we are of medical practice in our community. grateful to all three for contributing their enthusiasm to this event. YOU ARE SPECIALIZED. MOMS PODCAST SERIES LAUNCHING IN AUGUST SO ARE WE.

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20 Physicians Bulletin • July/August 2019 Physicians Bulletin • July/August 2019 LEGAL COLUMN 21

tative” (the term used in HIPAA) may request to obtain the deceased patient’s records. RESPONDING and receive copies of those records and is LB1103 would have allowed family mem- generally treated as standing in the patient’s bers a way to access their deceased relative’s TO FAMILY shoes. However, the power of attorney or medical records without needing to open an other authority that grants such person legal estate and be appointed as its executor or MEMBERS’ status as the patient’s personal representative administrator. REQUESTS FOR does not extend beyond the patient’s death – it dies with the patient. Who, then, may serve However, LB1103 was never brought to a A DECEASED as the deceased patient’s personal represen- vote and, thus, never became Nebraska law. tative to request his or her medical records? Accordingly, it remains the case that family PATIENT’S members are not, as a matter of Nebraska HIPAA continues to apply with respect to a law, automatically granted any legal author- MEDICAL patient’s health information for 50 years after ity to act as personal representatives of a his or her death and, as a general rule, takes deceased relative for purposes of HIPAA. RECORDS precedence over state laws governing the In other words, merely being a close fam- release of medical records. In some instances, ily member of the deceased patient does however, HIPAA actually relies on state law. not entitle such person to have access to, or Whether a deceased patient’s medical receive copies of, the deceased patient’s records may be lawfully disclosed to a family medical records in Nebraska. member is one such instance. In recognition of the difficulty family mem- Under HIPAA, an executor or administrator bers often have in obtaining access to health of the individual’s estate or other person who information of a deceased relative because JOSEPH E. HUIGENS, J.D. has legal authority to act on behalf of the indi- they do not qualify as a “personal represen- Member of the Health Law Practice Group vidual or estate must be treated as a personal tative,” the U.S. Department of Health and Koley Jessen, P.C., L.L.O. representative of the deceased individual, but Human Services revised HIPAA to allow cer- Attorneys at Law even then only with respect to health informa- tain persons to receive a limited amount of tion that is directly relevant to that person’s health information of the deceased patient. f you are the administrator for a group prac- representation and responsibilities. Thus, if a Specifically, a covered entity may (but is not Itice, a nursing home, a surgery center, an family member of the deceased patient is nei- required to) disclose to a family member, imaging center or another health care facility, ther an executor nor an administrator of the other relative, or close personal friend of the you probably have had to respond to requests decedent’s estate, then, in order to access the patient, who was involved in his or her care for a deceased patient’s medical records from patient’s records, he or she must have legal or payment for his or her health care prior to a surviving family member. Maybe mom died authority to act on behalf of the decedent. the patient’s death, health information of the from an inheritable disease and her adult Whether a family member has such legal deceased individual to the extent such infor- daughter would like to see mom’s medical authority is a matter of state (not federal) law. mation is relevant to that person’s involve- records to understand more about her own ment, unless doing so would be inconsistent risk of developing the same condition. Per- Under Nebraska law, a “patient request” with any prior expressed preference of the haps dad died soon after undergoing treat- for medical records includes a request by the individual that is known to the covered entity. ment and now son is asking to get copies of patient’s guardian or “authorized representa- dad’s records. Possibly, even, parents of a tive.” However, Nebraska law does not offer As explained by the department, this pro- deceased adult patient are asking for cop- any indication of who constitutes an “autho- vision ensures that family members can find ies of their child’s medical records. There are rized representative” other than in the context out about the circumstances surrounding any number of reasons family members may of a duly appointed executor or administrator the death of a love one, unless the individ- want copies of a deceased relative’s medical of the estate. Indeed, at least one proposed ual, prior to death, objected to such informa- records. It is not an uncommon request, and (but never passed) legislative bill acknowl- tion being shared with the family member. providers often want to allow family members edges this gap in Nebraska law. Of course, this begs the question: what was access to their loved one’s records, but pro- the family member’s involvement? Along viders also want (and need) to comply with In 2012, Legislative Bill 1103 (LB1103) was those lines, the department was careful to the Health Insurance Portability and Account- introduced to revise the definition of “patient note that providers generally should not ability Act of 1996 (HIPAA). How HIPAA and request” to expressly include the request share details of the patient’s past, unrelated Nebraska law treat this issue may surprise you. of “a family member of a deceased patient.” health information. It is worth noting that LB1103 thus confirmed that Nebraska law is this provision does not give health care pro- State and federal data privacy laws, such silent as to whether the spouse, parent, child, viders carte blanche to disclose a deceased as HIPAA, are implicated whenever a request or sibling of a deceased patient has any legal patient’s medical records to his/her family is made to obtain medical records. With few authority, in the absence of being appointed members. When in doubt, providers should exceptions, the patient’s “personal represen- as the executor or administrator of the estate, consult an attorney. Access to 35 specialties and 135 experts just one call away

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Call (844) 851-1515 to refer a patient today. Physicians Bulletin • July/August 2019 FINANCIAL COLUMN 23

CREATE A CASH FLOW PLAN: Once PLAN NOW FOR “Understanding timeframes have been established and and evaluating the a market assessment has occurred, cash A CASH INFLUX flow needs should be analyzed to deter- different personal and mine if there is a gap or an income-to- professional areas expense deficit. If there is, asset allocation that may be affected inside current portfolios becomes even more important, as there will be a need by a liquidity event is to narrow the gap of the savings deficit extremely important, without eroding the portfolio’s principal. as individuals will For example, if an individual is mak- have many financial ing an annual salary of $300,000, a goal KEVIN MALONE decisions to make once might be to replace that money with Private Banking Client Manager the event occurs.” the interest gained from the portfolio UMB Bank as opposed to taking direct withdraw- — KEVIN MALONE als. Using $5,000,000 as an example of any occurrences during a physi- total retirement savings, this $300,000 Mcian’s career can result in an influx perhaps consider playing a lesser role in income could be replaced with a 6% port- of income—often referred to as liquidity their practice? Do they want to venture folio return, whereas a 4% return would events. Whether it’s selling a practice, into an entirely new profession or fully offer $200,000 of annual interest income. bringing on new partners, establishing retire? Understanding where they are Advisers can provide recommendations a new contract that will drive revenue, or currently and where they want to be 12 and options on how to achieve these transitioning from being a career prac- months or more from now will help pro- goals, while continuing to position the titioner into partial or full retirement, vide a framework for strategic planning portfolio for long-term needs as well. these are all significant milestone events and making the best decisions. that require careful planning. EVALUATE ANCILLARY BENEFITS: Next, UNDERSTAND MARKET REALITIES AND individuals need to evaluate if other ben- Understanding and evaluating the dif- EVALUATE OPPORTUNITIES: The market efits are affected by the liquidity event. ferent personal and professional areas has changed dramatically over the past Items such as health care, life insurance that may be affected by a liquidity event several years, and while the U.S. economy and savings vehicles are oftentimes is extremely important, as individuals will remains strong, volatility is expected to tied to employment and either cease or have many financial decisions to make persist for the foreseeable future. That need to transition when the individual once the event occurs. Those plans does not mean we can bury our heads in finally parts from the group benefits plan. should reflect career aspirations, current the sand. Working with a professional to Advisors can help identify areas to review economic and market conditions, a real- identify investment opportunities that and provide recommendations on the istic budget, and benefits considerations are not directly correlated to the stock best ways to proceed based on the per- like health insurance. market and provide the opportunity to sonal, strategic plan. hedge against market swings has been an CAREER PLANNING IS CRUCIAL: In many attractive option for many and a comple- Liquidity events can provide physi- cases, these types of liquidity events may ment to core portfolio holdings. Under- cians with a variety of exciting opportu- present the opportunity to re-evaluate standing current market conditions and nities, but those come with challenges as career plans. If this is the case, physi- how they will likely affect an individual’s well. Taking the time to evaluate and plan cians need to know what their personal investments is critical. Portfolios should how to proceed, both personally and short- and long-term career goals are. reflect the risk tolerance and life stage of professionally, is extremely important. Are they going to take some time off? that individual. A trusted advisor can work with individu- Do they want to reduce their hours or als to navigate these different areas so they can help ensure desired outcomes are realized. 24 FEATURE

Collaborative Effort ADDRESSING MATERNAL MORTALITY RATES

ruth be told, said Robert Bonebrake, The need for action TM.D., the rise in maternal mortality rates in the United States could be attrib- to stymie increasing uted, in part, to contentment. maternal mortality

“To be honest, there was a sense of rates came after what ‘we’re the United States; we’re the best’— Dr. Bonebrake called a sense of complacency.” “one of the biggest public Dr. Bonebrake, who specializes in health success stories.” maternal-fetal medicine at Methodist Women’s Hospital, serves as co-medical ers at risk of death or injury. The first of director of a collaborative aimed at stop- the 11 protocols focuses on hypertension ping that trend which, he said, started in pregnancy. Others address blood clots, about 30 years ago. hemorrhage and deep vein thrombosis.

The Nebraska Perinatal Quality The need for action to stymie increas- Improvement Collaborative, which ing maternal mortality rates came after includes all the birthing hospitals in what Dr. Bonebrake called “one of the Nebraska, is providing step-by-step, evi- biggest public health success stories.” In dence-based protocols geared toward the 1700s and 1800s, he said, maternal helping health care providers recognize mortality rates were approximately 1,000 and address conditions that can put moth- deaths in 100,000 live births. Thanks to Physicians Bulletin • July/August 2019

Dr. Bonebrake irrespective of the duration of pregnancy, which, after such expulsion or extraction, emphasized that the breathes, or shows any other evidence of collaborative is truly that. life such as beating of the heart, pulsation “This is not associated of the umbilical cord, or definite movement of voluntary muscles, whether or not the with one person or one umbilical cord has been cut or the placenta institution. It is for the is attached. Heartbeats are to be distinguished from transient cardiac contractions; state of Nebraska for respirations are to be distinguished from the people of Nebraska.” fleeting respiratory efforts or gasps.” The — ROBERT BONEBRAKE, M.D. Bonebrake Dr. Bonebrake emphasized that the col- File laborative is truly that. “This is not associ- germ therapy antibiotics in the mid-1800s and ated with one person or one institution. It Hometown the onset of maternal care in the 1950s, the is for the state of Nebraska for the people St. Joseph, Missouri rate dropped to 6 in every 100,000 live births. of Nebraska.” Undergraduate Degree No longer. One tally ranks Nebraska in the The 11 protocols were developed by the Creighton University upper one-half of states, at No. 19, with 16.8 Alliance for Innovation on Maternal Health, in mathematics maternal deaths per 100,000 live births—num- or AIM. The maternal safety bundles, Medical Degree bers that are slightly better than the U.S. aver- developed by AIM and encouraged by the Creighton University age. Nationally, according to the Centers for Nebraska Perinatal Quality Improvement Medical Center Disease Control and Prevention, the United Collaborative, represent best practices for States has the highest maternal mortality rate maternity care and are endorsed by national Residency among the world’s top 50 developed nations— multidisciplinary organizations. The bun- CUMC in obstetrics and gynecology and the country’s rate is one of three—along dles, in addition to focusing on obstetrical with Afghanistan and Sudan—that is rising. hemorrhage, severe hypertension/pre- Fellowship eclampsia, and the prevention of venous University of California “What’s happened in the past 30 years?” Dr. thromboembolism, focus on such topics as: Irvine in maternal- Bonebrake asked. “If I knew that answer…Most fetal medicine people think there are many different factors • Reduction of Low Risk Primary Cesarean Specialty and not a single prong.” Births/Support for Intended Vaginal Birth Maternal-fetal medicine • Reduction of Peripartum Racial Disparities Institution He then lists three possible explanations Methodist for the increase: social determinants of health, • Postpartum care access and standards Women’s Hospital increased risk factors and access to care. Dr. Bonebrake noted the bundles may Hobbies Dr. Bonebrake also cites confusion about take a health institution two to three years Spending time with family and friends definitions relating to maternal mortality and to fully implement. “To implement one bun- inconsistency when collecting and reporting dle is an enormous undertaking and entails Family health statistics as contributing to the increase an entire hospital—from physicians, patients, Wife, Katie Bonebrake; mortality rates. ancillary staff and administration.” daughters, Emma Sudyka and Abby Bonebrake; and sons, Some definitions: According to the Centers A revamped Nebraska Maternal Mortality Ben, Sam, Tommy for Disease Control and Prevention, a preg- Review Committee will review progress and Jack Bonebrake nancy-related death is defined as the “death of and recommend next steps. Patience is Why He a woman while pregnant or within 1 year of key, he said. Joined MOMS the end of a pregnancy—regardless of the out- “To have the potential come, duration or site of the pregnancy—from “We may not be able to immediately for helping sustain any cause related to or aggravated by the preg- quantify results—other than to quantify the profession of nancy or its management, but not from acci- that the state is vested in this and hospitals medicine because it is going to be sustained dental or incidental causes.” A live birth refers are vested.” through collegiality to “the complete expulsion or extraction from and collaboration its mother of a product of human conception, between physicians.” 26 FEATURE

SPREAD THE WORD: MOMS’ Podcasts Touch on Trending Medical Topics

Jeffrey Ebel, D.O.

t’s all about improving health literacy. public become more informed about Health literacy had long been an issue IAnd, at the same time, sharing the exper- issues that affect their health and well- that the MOMS Board has wanted to tise of MOMS’ member-physicians. being by tapping into the expertise of address because according to the National MOMS members. These are topics that Assessment of Adult Literacy, nearly nine in When physicians are speaking with their have value for patients and even for physi- ten adults may not have the skills to man- patients, giving a diagnosis that is tough cians who want to hear the latest in an area age their own health. Low understanding to hear, or recommendations for treat- they may not practice in. leads to poor health outcomes and less ment, how do you know if your patients preventive care. understand what you’re talking about and have enough information to make informed decisions? It is at the very crux of health literacy and the reasoning why MOMS will Kirsten Leu, M.D. begin airing podcasts on medical topics to try to help be part of the solution.

For her part Jill Hanson, M.D., looked to dispel some misconceptions people have about allergies and weigh in about why they seem to be more common these days.

Dr. Hanson, an allergist at Boys Town National Research Hospital, is part of a series of six podcasts created by MOMS that will be released in August.

The purpose of the podcasts—called Health 101—is educational, said MOMS executive director, Carol Wang: Help the Physicians Bulletin • July/August 2019

“Health literacy is not only important, it is necessary. It allows patients and their families to be involved in their healthcare and actively participate in medical decisions, advocacy for themselves and treatment plans.” — TINA SCOTT-MORDHORST, M.D.

“Attorneys are reaching out to potential clients. Real estate agents,” she said. “Experts are sharing content and the public Carol Wang, MOMS executive director, discusses breast cancer with Kirsten Leu, M.D., as is responding.” producers Pat Safford and Jill Thomas of Parkville Media look on. She said a six-week series should serve as a good test for MOMS about how the “As a pediatrician, I want only the best and its potential symptoms of an upset content is received. “You need at least six care and outcomes for my patients. Immu- stomach, diarrhea and abdominal pain—is weeks of consistent product so the audi- nizations play a large role in children’s different than a true wheat allergy—which ence can start relying on you and you get health and are easy, affordable and acces- can lead to a life-threatening reaction, a feel for your listenership.” Wang added: sible to all children,” remarked Tina Scott- Dr. Hanson said. “Six is the right number to see if this reso- Mordhorst, a pediatrician who addresses nates with people. We get to put our toe the issue of vaccines in one episode. She Wang said MOMS leadership deter- in the water.” wanted a chance to have an in-depth dis- mined the initial six topics by asking phy- cussion about the science behind vaccines sicians what patients were discussing The podcasts will be available through and what families should be considering with them. Then, they determined who such platforms as iTunes, Spotify and when they think through their decisions would be best to serve as the experts. Google Play. about whether or not to immunize. Wang, a former TV news anchor, leads the discussions. Dr. Jeffrey Ebel, a sports medicine physi- It’s exactly what MOMS wanted the pod- cian, who took part in the concussion podcasts to do in the sphere of health educa- In addition to allergies and vaccines, cast believes that if patients listen to the tion and the medium was a good fit because other topics in the series are: concussions, information presented, there can be a posi- it allowed for longer length segments. breast cancer, skin, and diets/weight loss. tive impact to their health. “I also believe it helps with compliance when treating MOMS considered television and MOMS turned to Parkville Media to cre- patients, because when they understand radio before deciding to create the ate the podcasts and help market them. the ‘why’ behind their diagnosis and treat- podcast series. Each podcast runs from 20 to 40 minutes. ment then often the patient will do their part in helping treat the issue to get bet- “Podcasts are important. They allow us Why that time span? “Twenty minutes is ter faster.” to have conversations with our member- a good length,” said Jill Thomas, Parkville physicians and give the public something Media co-owner. “Omaha drive time is 20 Scott-Mordhurst is excited to share the to think about,” Wang said. minutes or a bit longer.” podcasts and see what they can do to improve her patients’ grasp of medical Dr. Hanson hopes the podcasts will Thomas and Parkville Media co-owner knowledge. “Health literacy is not only answer some of those frequently asked Pat Safford previously hosted a morning important, it is necessary. It allows patients questions and increase understanding. radio show on Sweet 98.5. Thomas said and their families to be involved in their For example, she clarifies the difference physicians aren’t the only ones sharing healthcare and actively participate in med- between allergies and sensitivities, which content through podcasts, which have ical decisions, advocacy for themselves and often are confused. A gluten sensitivity— gained in popularity the past three years. treatment plans.”

Physicians Bulletin • July/August 2019 FEATURE 29

PDMP DATA SHARING: Nebraska Joins the Crowd

ebraska soon will be one of many “We’re far and above • Users can choose the states they want Nwhen it comes to sharing information included in their drug information with other state prescription drug moni- ahead of any state searches. Health care providers likely toring programs. with our innovative wouldn’t want to include all 50 states, but might look at, for example, those State lawmakers earlier this year passed approach to collecting that border Nebraska. Legislative Bill 556, introduced by Omaha all prescription drug State Sen. Sara Howard, which allows for information. Now, we’re “A patient may be obtaining prescrip- interstate data sharing with other state tions for legitimate—or other—purposes prescription drug monitoring programs. at the table with every and this allows providers to see that infor- Gov. Ricketts signed the legislation, which other state in performing mation and make better informed deci- carried an emergency clause, making it sions,” he said. This allows clinicians to effective immediately. interstate data sharing.” have a more comprehensive picture of the — KEVIN BORCHER patient’s prescription history to reduce It’s now Kevin Borcher’s job, in collab- duplicative or unnecessary medications oration with state partners, to oversee Borcher’s reference is to Nebraska’s and improve patient safety. the evolution of the Prescription Drug stand-alone status as the only state in the Monitoring Program from an inward focus country that requires dispensers, such as Borcher wants physicians to know about to an outward one. Borcher, who serves as pharmacists and physicians with a phar- coming regulations and restrictions that director of Nebraska PDMP (Prescription macy license, to report all dispensed pre- may impact their practices: Drug Monitoring Program), said Wyoming scription drugs, including controlled and and California will be the two remaining non-controlled substances, such as cho- • In January 2020, federal regulations that states that don’t share prescription drug lesterol and anti-diabetic medications. affect Medicare will require prescrib- information with their peers. ers to check the PDMP before prescrib- The benefits of Nebraska removing the ing opioids electronically in order to Launched in 2017, enhancements to data-sharing restriction begin with health meet the requirement of the Medicare Nebraska’s Prescription Drug Monitoring care providers having more information Promoting Interoperability Measure, Program, or PDMP, provided a stand-alone at their disposal to make better informed formerly known as “meaningful use.” medication query platform that is inte- decisions regarding their patients’ care. grated into the Nebraska Health Informa- • In 2021, Medicaid will require its tion Initiative. Two key components of the program, providers to check the PDMP when according to Borcher, are: prescribing controlled substances to The only problem, according to Borcher, Medicaid beneficiaries. was that the legislation didn’t allow for • The PDMP may be integrated into elec- information exchange among states. tronic health records (EHR). As the cli- Although Nebraska played catch-up Howard’s bill changed all that, he said, with nician selects their patient in the EHR, with sharing prescription data with other implementation slated for early fall 2019. they can click a button or tab to view state prescription drug monitoring pro- the patient’s PDMP profile. This saves grams, the state has the attention of its “I don’t think it was an intentional restric- providers from having to log into a sep- peers regarding how it requires dispens- tion,” he said. “We’re far and above ahead arate system. “The PDMP will be avail- ers to report all the medications they dis- of any state with our innovative approach able with just a couple of clicks.” pense. Maryland introduced legislation to collecting all prescription drug infor- last year that would replicate Nebraska’s mation. Now, we’re at the table with mandatory reporting. Another five states every other state in performing interstate have approached Nebraska about its data sharing.” model, he said. PHYSICIAN-PILOTS RESPONDED WHEN DISASTER STRUCK

Matt Bogard, M.D. Physicians Bulletin • July/August 2019 COVER FEATURE 31

ne was a Marine on leave, who wanted love—and helping others at the same time was Oto see his family. Another was an emer- an added bonus. They said they hoped their gency room physician, who needed to get to efforts helped diminish the perception that work. Then, there were the Omaha high school pursuing a passion in aviation is limited to a students, who had attended a Boys and Girls few. Finally, they reinforced the important role Club event at Midland University. that community airports serve.

When flood waters abruptly cut off access “Small towns in Nebraska and all around the to Fremont in March, Drs. Jonathan Fuller and country have airports that no one knows about,” Matt Bogard answered the call to transport Dr. Fuller said. “These airports serve a great people—who needed to get in and out of the role. Fremont received a strong message just The Dodge County community. They ferried pas- how valuable these airports are.” Bogard sengers in their planes to and from Fremont’s File airport to the Millard Airport. They also brought Added Dr. Bogard: “People don’t have an supplies into Fremont. appreciation how an airport supports the Hometown town. Crop dusters use the airports. Visiting Rural Douglas County “It was less than a 10-minute flight (each way),” physicians and critical medications are flown Undergraduate Dr. Bogard explained, “but it was exciting. Lots in. Business coming and going that drives Degree of air traffic. National Guard helicopters were the economy.” Creighton University in out. The State Patrol aircraft were out moni- health administration toring compromised roads. The lay of the land Dr. Fuller said he started flying after finishing and policy looked quite different with all the flooding.” his residency. With four years of military ser- Medical Degree vice to follow, Dr. Fuller continued flying while University of Nebraska Drs. Bogard and Fuller recalled that they attending officer’s training in San Antonio. Medical Center would load up at one location (passengers, He temporarily stopped flying after being supplies and sometimes both), make the quick assigned to Germany, only to discover his base Residency UNMC in family flight to the other location, land, load up, and had an aero club. He earned his license and medicine take off. Repeat. spent his free time flying around Europe. Specialty Dr. Bogard, an emergency medicine physi- “It was a great way to travel. It made the Emergency medicine cian who has flown since his undergraduate distances much shorter.” Institution days, said he had heard that some of his pilot CHI Health friends were volunteering their time and planes He now flies at least once a week, about 250 Missouri Valley and to transport flood victims in and out of Fremont. hours a year. He later earned his commercial OrthoNebraska “I called the airport and they told me they pilot’s license, followed by his air transport Hobbies absolutely needed any help they could get.” license. In 2016, he bought his own plane, a Aviation, bicycling, TBM 850 built in France. “As much as I fly, I boating Dr. Fuller, an orthopedic spine surgeon who needed access to my own plane.” served four years in the U.S. Air Force as a gen- Family Wife, Amanda eral orthopedist, had flown Angel Flights (free Now, he flies when he has clinic in western Bogard; daughters, air transportation for people who need to travel Nebraska communities. He also has flown Sadie and Lucy to receive lifesaving medical treatment, but patients—through Angel Flights—to clinics in lack the means) and heard from the organiza- other states. Why He Joined MOMS tion’s coordinator that pilots were needed to “MOMS is an excellent help flood victims. “I was glad to help. It was Dr. Fuller said flying brings a sense of sat- vehicle to connect and very satisfying.” isfaction—feeling fulfilled by knowing he’s engage with the local mastered something technical. He used the medical community Said Dr. Bogard: “I’d be happy to pitch in example of taking pride in driving a car well. as well as advocate for the future of our and help again.” “It’s the same pleasure derived—controlling collective practices.” a plane well, maintaining altitude. It’s very The opportunity to help people facing rewarding to do something well.” disaster was the compelling reason to assist, Drs. Bogard and Fuller said. But in a way, they CONT. PAGE 32 confessed, they were merely doing what they 32 COVER FEATURE

The Fuller File

Hometown New Canaan, Connecticut

Undergraduate Degree Columbia College in Jonathan Fuller, M.D. New York City in german literature

Medical Degree Columbia University College FROM PAGE 31 of Physicians and Surgeons Then, there’s just the freedom flying pro- Similar to Dr. Fuller’s analogy of driving a Residency vides. “It’s a different perspective on the car, Dr. Bogard compared flying to taking Dartmouth-Hitchcock Medical Center in world. A sense of freedom it brings—and a long bicycle or motorcycle ride down a Hanover, New Hampshire that a powerful motivator.” highway. “It’s relaxing. Flying gives you the in orthopedics freedom to go where you please.” Dr. Bogard grew up watching planes take Fellowship off and land at the North Omaha Airport. Twin Cities Spine Center in orthopedic spine surgery His first lesson—and a windy day—left him less than convinced that flying was for him. Specialty He decided he would take several more les- YOUR CHANCE Orthopedic spine surgery sons before deciding whether to earn his Institution license. “The next evening was smooth as TO HELP Nebraska Spine and Pain silk. I was absolutely hooked. The bird’s eye The Nebraska Department of Health Center, Nebraska Spine view from 1,000 feet was mesmerizing.” Hospital, Immanuel Campus and Human Services has a State of Nebraska Medical and Health Volunteer He earned his license between his fresh- Hobbies Site, https://volunteers.ne.gov Aviation, trapshooting man and sophomore years of college. Later, friends allowed him to fly their planes for the Family Physicians (and other health care cost of fuel. During residency, he learned Wife, Kyoko Fuller; daughter, providers) may register on this site the owner of a Comanche 250 was ready Rebecca Kingma; and and will be notified during times of to sell. His grandfather had owned one son, Benjamin Fuller emergency for the Nebraska ESAR- and gave the Piper Comanche his highest VHP (Emergency System for Advance Why He recommendation. Joined MOMS Registration of Volunteer Health “I have been involved Professionals) program and the local These days, Dr. Bogard tries to fly every with the Omaha Medical Medical Reserve Corps. Society since I came to week—although finding time with two Omaha 20 years ago. I young daughters at home can be a chal- Registration does not obligate you think it’s a no-brainer to lenge, despite their mutual love of airplanes. be affiliated with your to respond. By registering, you may be He occasionally flies to distant hospitals for local medical society.” contacted about your availability. locums work but doesn’t travel in the plane the way he and his wife used to before start- ing their family. Physicians Bulletin • July/August 2019 MOMS EVENT RECAP 33

EARLY CAREER PHYSICIAN/NEW MEMBER MIXER

1. (From left) Dr. VaKara Meyer Karre, ECP Committee chair, Dr. Alëna Balasanova, Creighton residents, Drs. Around 30 MOMS members and guests gathered at Alex Dragic and Jeannie Ngo Vis Major Brewing Company on May 7 for the first ECP/ New Member event of the year. Remarks were given by ECP Committee chair, Dr. Alëna Balasanova, MOMS 2. (From left) Drs. Jeremy Howe, Alex Dragic, Nikki Gruner, president, Dr. Lindsay Northam, and MOMS executive and Joel Michalski director, Carol Wang.

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MEMBER NETWORKING EVENT - INDOOR ARCHERY

1. Drs. Deb Esser and Michael Visenio aim with perfect form. Around 20 MOMS members and residents tried 2. Drs. Sawsan Abulaimoun and Oleg Militsakh ready their bows. their hand at indoor archery on Tuesday, June 25. The event was held at Full Draw Archery and its long-time owner, Kent, coached the 3. A group of new archers receives instruction. group on proper technique and form. There were many bull’s-eyes and even one split arrow. 4. Residents and established physicians participated in the event. 34 MEMBER NEWS / NEW MEMBERS

MEMBER NEWS NEW MEMBERS

Sawsan Abulaimoun, M.D.* Jyoti Mahapatra, M.D. Internal Medicine Emergency Medicine Creighton Residency Members.MD Janani Baskaran, M.B.B.S.* John Makari, M.D. Internal Medicine Pediatric Urology Creighton Residency Children’s Hospital & Medical Center Angela Beavers, M.D. DRS. O’DELL, PAULMAN Radiology William McDonnell, M.D. Receive UNMC’s Top Nebraska Pediatric Practice, Pediatric Emergency Medicine Educational Award Children’s Hospital & Blue Cross and Blue Medical Center Shield of Nebraska Christie Barnes, M.D. Jeannie Ngo, M.D.* ames O’Dell, M.D., the Stokes Shackleford pro- Otolaryngology, Psychiatry Jfessor and vice chair of UNMC’s Department of Plastic Surgery Head and Neck Creighton Residency Internal Medicine, and Paul Paulman, M.D., professor in UNMC/Nebraska Medicine Antonio Reyes, M.D. the UNMC Department of Family Medicine, were hon- Erin Byrne, M.D. Cardiology ored recently as the Varner Educator Laureates for 2018-19. Emergency Medicine Clarkson Heart Center The Varner Educator Laureate Award recognizes indi- Jayme Dowdall, M.D. Priscila Rodrigues- viduals with sustained achievement in education who Otolaryngology Armijo, M.D.** have significantly improved the UNMC learning environ- UNMC/Nebraska Medicine UNMC Research Fellow ment through the provision of outstanding educational Elizabeth Edney, M.D. Kelly Schroeder, M.D. experiences. Radiology Emergency Medicine UNMC/Nebraska Medicine Venus Vein Clinic Wendy Grant, M.D. Sheilah Snyder, M.D. DR. CAVERZAGIE Transplant Surgery Pediatric Hospitalist Elected to AMA’s UNMC/Nebraska Medicine Children’s Hospital & Medical Center Council on Medical John Hallgren, M.D. Education Family Medicine Charles Stoner, M.D. Mission Direct Primary Care Family Medicine Omaha Family Medicine Stephanie Hartman, M.D. elly Caverzagie, M.D., recently was elected to Internal Medicine Nicholas Townley, M.D. serve for a four-year term on the American Medical K UNMC/Nebraska Medicine Neonatal-Perinatal Medicine Association’s Council on Medical Education. The coun- Creighton University cil recommends educational policies to the AMA House Heather Hergott, D.O. School of Medicine of Delegates and recommends to the AMA Board of Family Medicine Trustees the appointments of representatives to medi- Jennie Edmundson Ana Yuil Valdes, M.D. cal education organizations, accrediting bodies and Memorial Hospital Anatomical & Clinical certification boards. Pathology Terry Huang, M.D. UNMC Pathology Anesthesiology Dr. Caverzagie is associate dean for educational UNMC/Nebraska Medicine strategy at UNMC and vice president for education at Nebraska Medicine. In addition to collaborating with Elizabeth Mahal, M.D. other key organizations in medical education, the Emergency Medicine *Resident council supports the accreditation of medical education UNMC/Nebraska Medicine ** Research Fellow programs and gathers and disseminates medical education data and products/services. Physicians Bulletin • July/August 2019

KIMBERLY MARLEY MOHAN CHRISTNER, M.D. DOYLE, M.D. MYSORE, M.B.B.S.

Medical School Medical School Medical School University of Nebraska Creighton University Armed Forces Medical School of Medicine School of Medicine College (Poona, India)

Residency in pediatrics Residency in psychiatry Residency in pediatrics Children’s Mercy Kansas City McGaw Medical Center at University of Minnesota Northwestern University Hospital & Clinics Specialty pediatrics Fellowship in women’s Fellowship in pediatric mental health critical care Location Brigham and Women’s Hospital Children’s Medical Dundee Pediatrics & Center/UT Southwestern Village Pointe Pediatrics Specialty School of Medicine psychiatry In college, Dr. Christner Specialty competed in the high jump and Location pediatric critical care heptathlon at the University of University of Nebraska Nebraska Lincoln. Her senior year Medical Center Location she won the high jump in the Big Boys Town National Research 12 Conference Championship. Probably the most unique thing Hospital West Campus She still enjoys running and about Dr. Doyle, she says, is likes taking her 2-year old that she is legally blind. She is Dr. Mysore enjoys travelling and daughter for runs in her stroller. able to continue to practice with looks forward to visiting Australia computer accommodations and New Zealand. He and his In residency, she met her and says she is lucky to work in wife, Dr. Chandrika Rizal, have two husband, Amos, playing a supportive environment. children. Their daughter lives in ultimate Frisbee with friends Melbourne, Australia and their from church. He is a great She loves reading (audiobooks, son lives in the Bay Area. cook and helps her relax. of course) and just participated in a book club podcast hosted In medical school and residency, by her brother. She has two she was able to do two medical adorable girls and an awesome rotations in Africa (Liberia and husband. On weekends, they Malawi). She has older twin sisters, like to go for walks and bake. one of whom is deaf, so she grew up learning sign language.

She would describe herself as warm, caring, and knowledgeable. She is passionate about helping families stay healthy and happy. 36 CAMPUS & HEALTH SYSTEMS UPDATE

ADVANCED CARE UNIT OPENS CANCER RESEARCHER’S HOSPITAL RECEIVES AT BOYS TOWN NATIONAL WORK LIVES, LYNCH IBCLC CARE AWARD RESEARCH HOSPITAL— SYNDROME NAMED FOR HIM WEST CAMPUS he man who changed the way the world he International Board of Lactation n June 3, Boys Town National Tlooked at cancer, Dr. Henry T. Lynch, TConsultant Examiners® (IBLCE®) and O Research Hospital officially opened known to many as “the father of hereditary International Lactation Consultant the Advanced Care Unit (ACU). Led by cancer detection and prevention” died Association® (ILCA®) have recognized Pediatric Critical Care Medical Director June 2. He was 91. Methodist Women’s Hospital for excellence Mohan Mysore, M.D., FAAP, FCCM, the Lynch was the founder and director of in lactation care. unit is staffed 24 hours a day, seven days the Hereditary Cancer Center at Creighton, Methodist has received the IBCLC Care a week with board-certified pediatric which opened in 1984, and dedicated his Award, which recognizes facilities that hire specialists, skilled Advanced Practice life to cancer research, especially heredi- International Board Certified Lactation Providers (Nurse Practitioners and PAs), tary cancers. Lynch studied Consultant® (IBCLC®) staff and provide a highly experienced pediatric ICU nurses the cancer histories of more than 3,000 lactation program for breastfeeding fami- and respiratory therapists forming the families in his more than 50-year career lies. In addition, Methodist showed that it core of a multidisciplinary team. tracking the genetic linkages in certain has completed activities that help protect, The secure, six-bed unit offers advanced forms of cancer. promote and support breastfeeding. hospital care for patients recovering from “Dr. Lynch has captained the hereditary Methodist Women’s Hospital is the complex surgeries or illnesses. cancer ship for 50 years, and it is sad to second hospital in Nebraska to receive “We’re excited to offer higher levels of see his journey end,” said Robert Dunlay, the IBCLC award. hospital care for children in the commu- M.D., dean of the School of Medicine. “Our lactation consultants meet with nity,” Dr. Mysore said. “The ACU will be “However, the Henry Lynch Cancer every new mom and make sure this is one able to give children and their families Centers at CHI Health Immanuel Medical area where mom and baby are both feeling incredible care in a healing environment Center and Creighton University-Bergan comfortable. We want them to be at ease and provided by great staff they have come Mercy Medical Center will serve as a plat- when they are with us, but more impor- to associate with Boys Town Hospital.” form that will ensure Henry’s legacy of tantly when they go home. If not, we are The ACU is located at Boys Town excellence in service to others continues always available. Our services don’t end National Research Hospital—West, 14000 here at Creighton.” once you leave the hospital.” said Ronni Boys Town Hospital Road, in Boys Town. Dr. Lynch began studying potential Draper, outreach manager at Methodist hereditary causes of nonpolyposis colon Women’s Hospital cancer in the 1960s, when medical ortho- The Methodist Women’s Hospital doxy said that cancer was not a heredi- campus is a breastfeeding-friendly location tary disease. In 1984, the term “Lynch that promotes the benefits of breastfeed- syndrome” was coined to recognize his ing for mother and baby. Methodist’s 14 contributions in identifying the strain of certified lactation consultants offer inpa- hereditary nonpolyposis colon cancer. tient and outpatient lactation support by His identification of the Lynch syndrome, phone, by email or via one-on-one meet- provided a more accurate prediction of a ings. Support groups are also available, as patient’s risk for the disease, allowing for well as information for breastfeeding moms earlier detection and treatment. returning to work. In addition, Lynch was the first in the IBCLCs focus on preventive care, so they world to discover the hereditary breast- are available during pregnancy to assess ovarian cancer syndrome, a finding that and provide information on how to success- affects countless hereditary breast-ovarian fully initiate breastfeeding. They continue cancer-prone families. This discovery led that assistance after the baby is born by to the identification of BRCA mutations helping families overcome breastfeeding for diagnosis of hereditary breast cancer. challenges, providing accurate information He lectured nationally and internationally, and supporting them as their baby grows. and was widely recognized for his ground- They assist families returning to work or breaking work. school and families facing unusual situations such as breastfeeding more than one baby or nursing a sick or premature infant. They also help train nursing staff to manage basic breastfeeding care.

BONE MARROW DONOR IMPACT ON MEETS RECIPIENT STATE’S ECONOMY TOPS $5 BILLION n important meeting at the Fred & ocated only two miles apart, three orga- APamela Buffett Cancer Center almost L nizations have a more than $5 billion never happened. When Be the Match impact on the state’s economy, according contacted Jacob Oswald of Dubuque, to an independent analysis of the univer- Iowa, he thought it was a prank. sity’s significant and far-reaching impact on “At first I thought they said Match.com,” Nebraska’s growth and prosperity. Oswald said. “I thought my buddies were Those are the findings of Tripp Umbach, playing a joke and I hung up.” a leading national consultant with exper- Luckily, they were persistent. A tise in economic impact studies, regard- 4-month-old baby from Broken Bow, ing the collective impact of UNMC, the Nebraska, needed Oswald’s bone marrow. University of Nebraska at Omaha and That baby, Alle Jilg, now 19 months old, UNMC’s primary clinical partner, Nebraska and her family recently met Oswald in Medicine, with its flagship hospital, person for the first time. Nebraska Medical Center. It started with a fist bump between “These three organizations, along with IN donor and recipient and ended with the entire University of Nebraska system, a lot of smiles, hugs and some happy are an economic powerhouse for the emotional tears. state of Nebraska,” said Jeffrey P. Gold, MEMORIAM “He’s forever a part of our lives—Alle’s M.D., chancellor of both UNMC and UNO. life. He will forever be in our family,” “UNMC, UNO and Nebraska Medicine each Tia Jilg said. are strong contributors to the area’s educa- EDWARD Jilg said her family knew they would tion, research, health care, innovation, and LANGDON, M.D. travel anywhere in the country to meet economic and workforce development. April 5, 1922 – May 27, 2019 Alle’s donor. It turned out he was just According to Tripp Umbach’s findings one state away. (based on data supplied by the university Alle was born with a rare, life-threat- for fiscal year 2017-18): ening condition called severe combined • UNMC/Nebraska Medicine, and its affil- immunodeficiency (SCID), leaving her iates, have a statewide annual economic prone to illness and infection. impact of $4.8 billion and create and “Even a common cold could be fatal,” support 42,132 jobs (13,917 direct jobs). says Mike Jilg, Alle’s father. Together, they generate $165.1 million Tia Jilg spent months in isolation with annually in state and local taxes, and Alle at Nebraska Medical Center before UNMC graduates working throughout the transplant. Nebraska yield $4.4 billion in economic Now, Alle is able to play and explore impact (in 2018 alone). with her big brothers and sisters. She • The Fred & Pamela Buffett Cancer walked in circles in the lobby of the cancer Center at UNMC/Nebraska Medicine center the day of the meeting, wearing a generates $8.5 million in state and local sparkly tutu and a pink T-shirt that read taxes. Completed in 2017, the $330 million “My Donor is Forever my Hero.” investment in research and clinical facilities “She’s got dance recitals and birthday has an annual economic impact of $246.8 parties and sleepovers. She’s got a full life million and creates employment for 2,334 to live,” Oswald said. “And for me to spare Nebraska residents. a three or four-hour procedure for some- “These are significant, and ongoing, one who’s got a lifetime? No brainer. Do contributions to the state,” Dr. Gold said. it. It’s easy.” “And, they show the incredible return we provide for Nebraskans’ investment. We take our responsibility to the state seriously, because we know that when the university is growing, so, too, is the state.” APPLICATION FOR MEMBERSHIP

This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the Nebraska Medical Association (NMA). I understand that my membership will not be activated until this application is approved by the MOMS Membership Committee and I have submitted my membership dues.

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