Save the Date / July 10, 2017

a quarterly publication of the Maine Medical Association january/february/march 2017

Maine Medical Association Mission: support Maine physicians, advance the quality of medicine in Maine, promote the health of all Maine citizens.

Prescribing for Pain Limitations Continuing to Challenge Will you be ready to meet Patients and Prescribers Maine’s e-prescribing Maine’s landmark law limiting opioid prescriptions and rule changes as routine technical rules. Emergency

mandating PMP checks and electronic prescribing routine technical rules are effective for up to 90 days. mandate by July 1, 2017? continues to present challenges to patients who are Emergency substantive rules may be effective for up to See article on page 7. over the daily dosage limits and to prescribers who are 12 months or until the Legislature has completed review trying to sort out fact from fiction relative to the law and of the rules. In its communication dated January 1, 2017 the emergency rule published by HHS on Jan. 2, 2017. to prescribers, the Department announced its intention Maine Quality Counts Maine State Health Officer Christopher Pezzullo, D.O. to “engage in a single rule-making which will make By Dr. Erik Steele, Interim Executive Director also has communicated to prescribers stating that the permanent the emergency technical rule provisions state will not enforce the mandatory PMP checks (by and which will also provisionally adopt the emergency Overcoming the Opioid reporting violations to the appropriate licensing boards) major substantive rule provisions, which will then be Epidemic is the Work of until March 1 and will not enforce dosage limitations submitted to the Maine Legislature for its review.” In All of Us prior to Oct. 1, 2017. MMA had requested a grace period other words, MMA and other advocacy organizations, in order for prescribers and patients to be educated on patients and prescribers will have at least three Peter was a patient of mine the emergency rule and also to accommodate for the opportunities to provide input into the rule and the law. to whom I prescribed opioids conversion of the PMP to a new vendor which took First is the opportunity to provide comments orally or in intermittently for several years. place on Dec. 20, 2016. The conversion to the new writing at or following the rule-making hearing February I remember to this day how platform resulted in all delegates having to re-register 13th at 9:00am at the Augusta Armory. Second is the shocked I was to finally discover that he was not only in the system, a process that also required approval by opportunity to testify at the Legislative hearing on the pathologically hooked on opioids, but was so hooked the prescriber. proposed final rules and the third is an opportunity to he was stealing money to buy them on the street. Even testify on one or more of the many bills that have been more shocking to me, was that a patient I liked and The emergency rule did provide three important submitted to this session of the legislature proposing to respected, an upstanding member of the community, additional exceptions to the law but also attempts amend Chapter 488. There will also be hearings on the had been deceiving me. to limit the exemptions previously granted by the proposed amendments to Joint Rule 21 by the licensing legislature in the original legislation (PL 2016, Chapter boards. In some cases, the proposed amendments to Well intentioned as I was, I did my part contributing to 488). The additional exemptions are: the Chapter 21 rule goes further than the statute and Peter’s opioid use disorder (OUD), and by extension the rules in mandating certain prescribing practices and my part in contributing to Maine’s opioid use disorder 1. A pregnant individual with a pre-existing universal precautions. epidemic. I was not aware enough that every patient prescription for opioids in excess of 100 Morphine I prescribed opioids to even once had a real risk of Milligram Equivalent aggregate daily limit. This Watch the MMA Weekly Update, e-mailed each developing OUD. I was too easy to convince that every exemption applies only during the duration of the Monday, for timely information on the dates of these patient’s pain needed eradication, and that opioids were pregnancy. hearings. If you are not receiving the Weekly Update the best tool for doing that. I was intent on reducing 2. Acute pain for an individual with an existing opioid and would like to do so, communicate with Lisa Martin the painful suffering of my patients, and too unaware prescription for chronic pain. In such situations the in the MMA membership office (622-3374 ext. 221 or of the suffering that might develop if my pills were acute pain must be postoperative or new onset. e-mail [email protected]). used inappropriately. I failed to see that our efforts in The seven day prescription limit applies. healthcare to be more effective in treating pain – efforts 3. Individuals pursuing an active taper of opioid MMA attorneys have provided over forty CME promoted on a national level by healthcare regulators medications, with a maximum taper period of six presentations on Chapter 488 and the associated rules and pain experts – was ‘opioid-dependent’ itself, and months, after which time the opioid limitations will since May, 2016. If you would like a presentation at your would come back to haunt us all. apply, unless one of the additional exceptions in practice site, your medical staff or medical specialty this subsection apply. society, contact Gail Begin at [email protected] For these and other reasons, I contributed my small or EVP Gordon Smith, Esq., at 622-3374 ext. 212 or stream of unnecessary opioid pills to thousands of other The emergency rule attempts to limit the statutory e-mail to [email protected]. Many of these such streams from physician offices, hospitals, and exemptions by limiting the exception for active and presentations are supported through a contract with emergency departments across Maine. Together we aftercare cancer treatment to six months post remission. MaineCare and a grant through the Maine Health created the flood of opioids that has now engulfed us, MMA does not believe that this limitation is lawful in that Access Foundation so there is no cost to the attendees. kills more Mainers each year than car crashes, wreaks the rule-making provision authorized OUD-induced havoc in homes and communities, and the Department “to establish reasonable has made Maine a national showcase for the opioid exceptions to prescriber limits” not to tsunami. limit those exceptions already granted by the law. There are several other Having helped make this mess, I now need to help fix provisions in the emergency rule it, by starting a different small stream. As I go back into that MMA will be seeking changes to, family practice in Maine, I will take my 8 hour course and including the requirement to add the do other work to be able to prescribe suboxone therapy ICD-10 diagnosis code to each script – one part of Medically Assisted Therapy (MAT) for OUD, over 100MME, mandatory reporting and provide treatment for as many as I and my practice of unlawful scripts to the PMP can capably manage. I will begin screening for OUD coordinator and the broad definition among my patients, and treating or referring those who of “dispenser” which threatens to make need help. I will dramatically change my approach to each prescriber who also dispenses a the treatment of pain, avoiding use of opioids wherever mandatory reporter to the PMP. possible, weaning patients off opioids wherever I can, and partnering with other healthcare providers and Maine law designates the PMP state government in meticulous management of opioid regulations as major substantive rules, prescribing. That all amounts to a big, challenging pain requiring legislative approval. However, Lani Graham, M.D., a member of the prevention/harm reduction task in my practice, but I don’t think any of us who helped Chapter 488 assigned some of the force of the Maine Opiate Collaborative speaks at January 18 community get Maine and its people into this opioid mess can, in forum in Augusta. good conscience, do anything less.

There is a growing help for those on the challenging save the date / July 10, 2017 front lines of MAT; health systems across Maine have geared up substantial efforts to support their physicians, MMA's 14th Annual Benefit Golf Tournament nurse practitioners, and other caregivers in this work. Augusta Country Club, Manchester, ME The Maine Medical Association, Maine Quality Counts, Contact Lisa Martin at 622-3374 ext. 221 or [email protected] Maine state government, the Maine Health Access for more details, including sponsorship opportunities. Continued on Page 3

Check out the inserts with this issue including the mma Upcoming Happenings, Golf Flyer, and June 17, 2017 Program.

A Message for Physicians and Physician Assistants of Maine president’s corner By Stephanie Podolski, MPH, MSPA, PA-C, President of By Charles Pattavina, M.D., President, Maine Medical Association the Maine Association of Physician Assistants Rambling Thoughts lost three of five people taking call in one subspecialty, so I am writing to you today as on Professionalism we have 22 days uncovered by that specialty in January. President of the Maine Asso- And this is a specialty we don’t call very often! ciation of Physician Assistants A couple of weeks ago I was (MEAPA), but also as your col- working in the E.D. alongside A subspecialist from the Augusta area recently wrote league and friend. As an or- my esteemed colleague, this to me: “Just saw a young kid about 10 years old ganization, MEAPA would like Scott Thomas, D.O., and from Addison because Tufts [same specialty] resident to thank our collaborating we found ourselves talking called me and I, while on call, agreed to see the patient and supervising physicians for about some rewarding col- so they would not have to go to Boston for a [non- their continued dedication to legial experiences we have operative surgical problem]. The resident had called our profession. Our unified teams have allowed us to recently had with a couple of consultant cardiologists at [my colleagues] in Ellsworth and Bangor-- no one on provide excellent patient centered, quality care with a very large hospital in Portland - and what real profes- call. Now there are five [of my colleagues] inE llsworth expanded access to our rural and aging communi- sionals they are. It occurred to me - and I did remark to and another eight in the Bangor area. If each one simply ties in Maine. During a changing and truly dynamic Scott - that I thought I might have known the father of took one week out of 13 that would do it but no [one healthcare environment, it is crucial for us to continue one of them during my internship year in Framingham. is willing].” I call that specialist from Augusta a “real to work hard to provide the best care for our patient The father was a highly regarded primary care internist doctor”. populations, while keeping our larger public health is- (who might also have been an office cardiologist) – a sues in our sights. As you all know, we are currently in real professional, a gentleman and a role model and I On one hand, this bothers me as an emergency physician the trenches of an opiate epidemic. However, over the recalled he had a son who was a brand-new cardiologist because I see the people in their hour of need when last year the Comprehensive Addiction and Recovery at the time. they have to travel far (Boston sometimes) because no Act (CARA) of 2016 passed the U.S. House and Senate, specialist here is willing to take care of them. It also amending federal law to permit PAs to become waiv- Fast forward to the week between Christmas and simply bothers me as a physician. I’m not advocating ered to prescribe Buprenorphine for opiate addiction. New Year’s and in the middle of a particularly rough we outlaw capitalism and I’m certainly not looking to The inclusion of PAs in CARA expands our ability as day, I found myself on the phone with that particular compromise other people’s wellness, but we have skills a medical community to provide more treatment op- cardiologist and had the opportunity to ask if his father (and yes, we took an oath) to take care of people and we tions to Americans suffering from addiction. was the gentlemanly internist I knew from training. didn’t complain or refuse the money when the general Indeed he was, and the pleasant conversation we had public subsidized our medical educations. The public Additionally, I write to remind you that there have been – including the part about the patient – really made my probably has the reasonable expectation that we will many changes in Physician Assistant regulations, laws, day and I went home with a smile on my face. I only take care of them some day. and principles of practice over the last year. The Maine regret that I didn’t tell the cardiologist that we thought Joint Chapter 2 Rules, which went into effect January 1, he was quite a gentleman professional too. Our patients really do appreciate the things we do for 2017, unite PA licensure and supervisory criteria under them, but they can never appreciate care they never got the Maine Board of Licensure in Medicine and Maine A few days later I was working with Scott again and from doctors who didn’t respond to help them. And when Board of Osteopathic Licensure. MEAPA Board of discussing how it is we could impart those qualities of they have to go to Boston for care that a neighbor could Directors has created a Joint Chapter 2 “compliance” courtesy and patient-focus from lady and gentlemen have provided here, is it not understandable that they rubric for your use. This document has also received professionals to other colleagues – and hoping we might actually be angry when they Google a specialty approval from both licensing boards and has been lived up to that standard ourselves. Scott has served and see just how many of their neighbors in the needed mailed to all Maine PAs. All practicing PA’s and Primary on the osteopathic licensure board for years, so this is specialty could have taken care of them? I think some Supervising Physicians (PSPs) must read the rubric and of particular interest to him as well. Your MMA board introspection by our medical profession is needed here. the Chapter 2 Rule. Plans of supervision should be is discussing professionalism and we would appreciate Perhaps my own specialty of emergency medicine has reviewed and rewritten by PA/PSP teams as soon as your input. lulled specialists into a kind of complacency. Perhaps possible to comply with the rules as they stand now. some new thinking such as regional call panels may be If you would like access to an electronic copy of this We have another problem brewing that has been appropriate, but it is not acceptable to have no one on document, please see the contact below. growing faster in other parts of the country, but is call in the whole state for emergencies. beginning to rear its ugly head in Maine. Certain surgical I welcome your comments, feedback and criticisms. There are more opportunities on the horizon for PAs (and medical and radiological) specialties/subspecialties Please feel free to reach me at 207-907-3350 or by and physicians to continue to work collaboratively are developing their own hospitals or procedure centers email to [email protected]. and I hope to inspire physicians of the Maine to and declining to serve on hospital staffs. My hospital just reach out to our leadership community at MEAPA for further engagement. Please consider joining us at our upcoming Annual Winter CME Conference at Keeping the game fair... Your Maine medicine Sunday River from February 8-11, 2017. For more information, including registration, see our website at is getting hit from all angles. www.mainepa.com. You need to stay focused and on point — If you have additional questions, comments or confident in your coverage. concerns, please feel free to reach out to me directly at [email protected]. Get help protecting your practice, with resources that make important decisions easier.

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Notes from the EVP By Gordon H. Smith, Esq., Executive Vice President, Maine Medical Association

It is my pleasure to wish all honor to be asked by legislative leaders year after year to MMA members, their families make available a physician to handle any medical issues and their staffs a Happy New that arise. MMA and our partner the Maine Osteopathic Year. All of us here at the Association need to be able to fill the Doctor of the Day MMA wish you all the best slot every day. Please help us by volunteering. We will for 2017. For healthcare, enjoy spending time with you, and your family, if you it will be quite a year, with bring them along to the State House. Also plan on many challenges in both joining us at the State House on May 31 for Physicians’ Augusta and Washington. Day at the Legislature. At MMA, we will do all that is possible to advocate for actions consistent with our 2016 was a good year for MMA in many ways. We 30 Association Drive, P.O. Box 190 mission. We will advocate for healthcare coverage for increased membership to record levels, met the budget Manchester, Maine 04351 everyone in Maine. We will work to improve the quality and improved upon it and continued our work on the of care and to reduce the cost and for the improvement opioid/heroin crisis. I thank our active and engaged (t) 207-622-3374 of public health. None of this will be easy, but we are leadership including the officers and the board for (f) 207-622-3332 not easily deterred. It is important work and it is work leading us through a great year. And I want to thank our [email protected] worth doing. Please help us by becoming active in amazing staff which is both experienced and dedicated. www.mainemed.com your professional society. It may be a cliche now, but We are a good team. May 2017, despite posing its many together we are stronger and physicians must stick challenges, be an even better year for MMA which will together if they are to be successful. celebrate its 164th year on April 28. Newsletter Editor Richard A. Evans, M.D. As we begin another long legislative session, we will be I close on a personal note. On December 20 my wife (t) 207-564-0715 (f) 207-564-0717 at the State House everyday to represent your interests. Janet and I were blessed with our second grandchild. [email protected] As I write this article, we just concluded the first weekly There is simply nothing in life that compares to holding legislative conference call. For the next 20 weeks or a newborn infant in that crook in your arm where they PRESIDENT more, MMA members both as individual physicians and so naturally fit. Colby Smith Conopka was just the most Charles F. Pattavina, M.D. as representatives of various specialties, will join together perfect Christmas present. Thank you to daughter Devon (t) 207-907-3450 (f) 207-907-3355 to review legislative proposals impacting on physicians, and husband Mark for making this possible. We were [email protected] patients and public health and to determine the position able to take big brother Quinn, age 3, to meet his baby MMA will take. It is a very democratic process. Increase brother. It was a special time and I am very grateful. I PRESIDENT-ELECT your engagement with MMA by joining the call and/or by hope you had a special holiday as well. Happy New Year. serving as Doctor of the Day at the State House. It is an Jabbar Fazeli, M.D. (t) 207-780-6565 (f) 207-878-6565 [email protected] Overcoming the Opioid Epidemic... continued from page 1 Foundation, and many other organizations across the every practice has them) and a few more patients in their Executive Vice President state are contributing educational, financial, legal, communities who do not have access to primary care. Gordon H. Smith, Esq. organizational, and other support. Some organizations Every practice that fails to do that leaves their population with more expertise and resources are building hubs of of patients who needs MAT to some other practice to (t) 207-622-3374 ext. 212 (f) 207-622-3332 advanced OUD management to which smaller practices provide, potentially overwhelming those practices that [email protected] and organizations can turn for expert consultation and step forward. other assistance. We all could do more, we all could do Information in this newsletter is intended to better, but what we are doing means that physicians and The people to whom I and others must offer this provide information and guidance, not legal others who take on the obligation of providing MAT will treatment for OUD are, in fact, us; they are our family advice. Since exact language and definitions feel less alone and more supported than many of them members, some of our physician and other caregiver of key terms are critical to understanding the have in the past. colleagues, our community members, our children’s requirements of legislation, rules or laws, we friends in school, the people who build our bridges and encourage you to read each carefully. Articles To that can be added the help of knowing that we serve us food. They are the ones dying in Maine at the submitted to Maine Medicine represent the are helping reduce the suffering of our patients and rate of one per day, and the grief their deaths bring is a views of the author only and do not necessarily their families; MAT providers I speak with talk of how cry for help to us all. represent MMA policy. challenging this work can be, but also of how rewarding it can be to help turn around the lives being ruined by OUD. It took years for Maine to get into this mess, and it will take Maine years to get out of it. But a concerted effort, Others must join this effort if they have not already improved and sustained over the long haul, will turn back Thanks to 2017 Sustaining Members done so. Every hospital that employs physicians must this tide. The scale of the effort needs to increase rapidly Thank you to the following individuals and practices support those physicians to add to the MAT stream. – we should be establishing a statewide goal that every who have shown support for the MMA’s long-term Every physician who prescribes opioids on a regular community in Maine has adequate MAT access by the end growth by renewing at an additional sustaining basis must do his or her part; at a minimum fastidiously of some finite date – perhaps the end of 2018? The clock membership level. prescribe – and not prescribe - opioids in a responsible is ticking on our efforts, and it is a terrible human clock; Stephen Babirak, MD Central Maine Orthopaedics manner, screen for OUD and refer those who need it, every second it ticks tells another story of the misery that Maroulla Gleaton, MD InterMed, P.A. and follow the state prescribing regulations, etc. Ideally, OUD brings all it touches, and every 24 hours it tolls the Jerald Hurdle, DO Kennebec Anesthesia Associates every primary care practice should develop enough MAT death of another one of us from OUD. We cannot move Jo Linder, MD MidCoast Hospital capacity to be able to care for its patients with OUD (and quickly enough. Michael Szela, MD Spectrum Medical Group

Down East Community Hospital is seeking quality focused Board Certified Physicians to join our Family Mandated Prescriber Opioid Education Medicine Practice in Machias, Maine. We welcome Fami- ly Practice & Internal Medicine Physicians with experi- MICIS, a program of the Maine Medical Association, ence to share as well as new graduates looking to start provides evidenceͲbased prescribing education. In their career. We offer comprehensive benefits, aggressive 2017, MICIS will focus exclusively on education Dr. Frederick Goggans and Sen. Dave Miramant incentive plans, and a flexible workweek. required by Maine’s new opioid law. Sen. Dave Miramant, D-Camden, welcomed Dr. Frederick  Free 30 minute to 3 hour presentations available Goggans, of Camden, to the Maine Senate as the “Doctor of  “Blitz” didactics, multiͲmedia components, caseͲ the Day” Jan. 11 at the State House in Augusta. based studies and small group discussions “It was an honor to have Dr. Goggans as a guest in the Senate,”  Experienced, expert faculty said Sen. Miramant, in a news release. “Our community in Cam-  Content created by practicing clinicians den is lucky to have someone with such strong credentials.”  Compassionate, patientͲcentered perspective Goggans is the Medical Director at Borden Cottage in Camden.  Educational credits applied for He oversees a team of professionals providing residential treatment for patients with substance use disorders, many of whom present with co-occurring psychiatric disorders. For more information, contact Susan Kring Miramant is serving his second term in the Maine Senate rep- at [email protected] or 480Ͳ4190. resenting District 12, which includes all of Knox County except Visit our website for details: www.DECH.org www.mainemed.com/MICIS the town of Washington.

www.mainemed.com Page 3

MMA happenings public health spotlight All meetings take place at the MMA office, 30 Association Drive, Manchester, ME unless By James Maier, MD, DLFAPA, Member of the MMA Public Health Committee and MAPP otherwise noted. Marijuana Risks symptoms including paranoid delusions and occasional February 8 and Mental Illness hallucinations had been controlled with treatment in 4:00pm – 6:00pm the PIER program traveled to Amsterdam where he MMA Public Health Committee in Youth smoked large quantities of readily available marijuana. Despite continuing to take antipsychotic medication, his March 8 As Maine approaches imple- former psychotic symptoms re-emerged with greater 4:00pm – 6:00pm mentation of the recreation- severity, terrifying him that he would never return to his MMA Board of Directors al marijuana referendum, normal level of mental functioning. Fortunately, after he controversy continues about stopped daily use of marijuana, his psychotic symptoms March 14 possible risks attendant on disappeared. 4:00pm – 6:00pm wider availability. Many of these have been fiercely de- MMA Committee on Physician Quality bated for years, e.g., whether marijuana use is a “gateway” If greater numbers of young people in Maine use leading to use of other, more harmful substances. Oth- marijuana or THC-containing products daily, whether by April 12 er concerns have emerged more recently. Media stories smoking or by ingestion, they could essentially become 4:00pm – 6:00pm highlighting the poisonings of children in Colorado by part of a public health experiment in reverse: exposing a MMA Public Health Committee ingestion of THC-laced gummy bears have led some large population to a particular risk factor with potentially municipalities to draft ordinances pre-emptively ban- serious consequences (even for relatively few vulnerable May 5 ning sales of such products. However, if experience with individuals) and waiting to see which unlucky “subjects” 8:00am – 5:00pm attempting to limit the availability of alcohol to adults is get in serious trouble. This population at risk may be Medical Professionals Conference: any indication, it’s likely that despite attempts to restrict expanding, according to a recent study in Psychiatric Health, Wellbeing & Awareness at Holiday Inn use by young people, legalization may make THC-con- Services reporting data from 5 large U.S. healthcare by the Bay, Portland, ME taining products more widely available to children and systems over a period from 2007 to 2013. The rate of adolescents. A recent study cited in JAMA Pediatrics initial presentation of psychotic symptoms in 15-19 year May 9 stated that usage in 8th and 10th graders in Washington olds averaged nearly 1% each year. 4:00pm – 6:00pm state has increased (2% and 4% respectively) following MMA Committee on Physician Quality marijuana legalization in 2012, with rates of perceived While there are compelling arguments on both sides of the harmfulness of marijuana dropping by 14% and 16% in legalization question, awareness of this lesser known but May 22 these age groups. more serious consequence can lead to earlier detection 6:00pm and referral to specialized intervention. Regrettably, the Washington County Listening Session One largely unrecognized risk of heavy daily exposure potential demand for the specialized multidisciplinary at Helen’s Restaurant, Machias, ME to THC-containing products in adolescence is the early intervention programs which are the most potential of “unmasking” or accelerating the emergence successful in addressing first episode psychotic illness May 31 of major mental illness. The experience of researchers in is already exceeding capacity nationwide, according 8:00am – 4:00pm Portland’s PIER program and at other “early intervention” to Dr. John Kane, Chair of the Psychiatry Department Physicians’ Day at the Legislature sites around the world attempting to prevent or merely at Hofstra North Shore LIJ School of Medicine. Maine State House, Augusta, ME attenuate or delay the emergence of schizophrenia, cannot afford to terminate federal funding earmarked bipolar disorder or other psychotic illness confirms this for the PIER program, risking aggravating the existing June 7 danger for the small number of adolescents at higher shortage of badly needed treatment programs for a 4:00pm – 6:00pm risk of developing one of these serious and potentially vulnerable population at a critical time. MMA Board of Directors disabling disorders. A family history of more serious mental illnesses may be a clue to vulnerability in a young person, There will be a program on Maine’s Marijuana Law and June 14 but often there is no way to predict which individuals are its Impact on Youth taking place on Saturday, March 4:00pm – 6:00pm at greater risk for the emergence of paranoid thinking 4, 2017 from 4:00pm – 6:30pm at Sunday River Ski MMA Public Health Committee or disturbances of perception and mood which may Resort in Newry, ME. For more information and to evolve, in the worst cases, to become lifelong mental register, contact Dee Kerry at 207-480-4185 or dkerry@ June 17 illness. One young man whose “prodromal” psychotic mainemed.com. 8:00am – 4:00pm Challenges to Professionalism in a Time of Change Conference at Sheraton, Portsmouth, NH

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Legislative Update specialty society By Andrew MacLean, Esq., Deputy Executive Vice President, Maine Medical Association meetings

Legislative Update: the Maine Legislature’s web site here: http://legislature. February 16, 2017 128th Maine maine.gov/lio/bill-requests/9317. The public generally Maine Medical Association– Manchester, ME doesn’t know the details of these LRs until they are – 6:00pm – 8:00pm Legislature Begins printed and referred to committee as LDs or “Legislative Maine Association of Psychiatric Physicians Work of First Documents.” Executive Council Meeting Regular Session Another significant task of every new legislature is to Contact: Dianna Poulin at 207-480-4194 or [email protected] The 186 members of the consider a new two-year or “biennial” state budget. In accordance with his constitutional obligation, Governor 128th Maine Legislature were February 25-26, 2017 seated in early December LePage submitted his budget proposal for the 2018-2019 2016 and began the work of their First Regular Session on state fiscal year biennium on Friday, January 6th. You can Sugarloaf Mountain Hotel & Conference Center Wednesday, January 4, 2017. The work of this legislature find the Governor’s proposed budget documents on the – Carrabassett Valley, ME coincides with the last two years of the Administration web at: http://www.maine.gov/budget/. The legislature’s Maine Society of Anesthesiologists Annual Winter of Paul R. LePage (R). The 128th Legislature continues consideration of the biennial budget usually occupies Business Meeting the partisan division in the legislature from the 127th much of the First Regular Session and public hearings on Contact: Anna Bragdon at 207-441-5989 or Legislature with Republicans controlling the Senate by the health and social service portion of the biennial budget [email protected] a slim margin of 18 Republicans, 17 Democrats and the are likely to take place some time in February. Democrats controlling the House by a 77 Democrats, 71 March 8, 2017 Republicans, and 3 unenrolled members margin. The The MMA encourages you to introduce yourself to your Grand Summit Hotel – Sugarloaf, ME – 6:00pm 128th Maine Legislature includes three returning physician two members of the legislature, if you do not know them Maine Chapter of the American College of already. You can find your legislator using this tool on the members: Sen. Geoffrey Gratwick, M.D. (D-Penobscot), Emergency Physicians Chapter Meeting Maine Legislature’s web site: http://legislature.maine. Rep. Patricia Hymanson, M.D. (D-York), and Rep. Heidi (Held in conjunction with the Emergency gov/house/townlist.htm. If you have any questions Brooks, M.D. (D-Lewiston). The Senate President is Sen. Medicine Winter Symposium) Michael Thibodeau (R-Winterport), the Senate Majority about your legislators, please contact the MMA staff. Leader is Sen. Garrett Mason (R-Androscoggin), and Contact: Maureen Elwell at 207-512-6108 or [email protected] the Assistant Majority Leader is Sen. Andre Cushing During the legislative session, the MMA staff provides links (R-Penobscot). The Senate Minority Leader is Sen. Troy to bills for review and comment, updates on the legislature’s March 17-19, 2017 Jackson (D-Aroostook) and the Assistant Senate Majority work, and calls-to-action through our weekly electronic Leader is Sen. Nate Libby (D-Androscoggin). The newsletter, Maine Medicine Weekly Update. Also, the Sugarloaf Mountain Hotel and Conference Center Speaker of the House is Rep. Sara Gideon (D-Freeport), MMA Legislative Committee holds a weekly conference – Carrabassett Valley, ME the House Majority Leader is Rep. Erin Herbig (D-Belfast), call to review bills and brief members on legislative action. ME Section of the American Congress of and the Assistant House Majority Leader is Rep. Jared The conference call information is published each week in Obstetricians and Gynecologists Winter Meeting Golden (D-Lewiston). The House Minority Leader is Rep. the Maine Medicine Weekly Update. Look for these calls and Symposium Kenneth Fredette (R-Newport) and the Assistant House to begin again in mid-January 2017. Finally, we are always Contact: Dianna Poulin at 207-480-4194 or Minority Leader is Rep. Ellie Espling (R-New Gloucester). recruiting volunteers for MMA’s Doctor of the Day Program [email protected] The 128th Legislature is scheduled to conclude its First at the State House. This is an excellent opportunity to Regular Session by Wednesday, June 21, 2017. participate in MMA’s state legislative advocacy. Find out March 29-April 1, 2017 more about the program on the MMA web site: https:// Hilton Garden Inn – Freeport, ME SAVE THE DATE: Physicians’ Day at the Legislature is www.mainemed.com/advocacy-policy/doctor-day- 25th Annual Family Medicine Update & Wednesday, May 31, 2017 – please plan to join us at the program-maine-legislature. Annual Meeting State House! To find more information about the MMA’s advocacy Visit www.maineafp.org for brochure and The First Regular Session of each legislature begins activities, visit the Legislative & Regulatory Advocacy registration. relatively slowly as it takes some time for the Senate and section of the MMA web site, www.mainemed.com/ Contact: Deborah Halbach at 207-938-5005 or House Republican and Democratic caucuses and the legislation/index.php. You will find more information [email protected] joint standing committees of the legislature to organize. about the Maine Legislature, including schedules, During the first session, legislators can submit any committee assignments, legislator contact information, April 25, 2017 number of bills and legislators have filed approximately audio coverage of legislative work, and newly enacted Maine Medical Association– Manchester, ME 1800 bills by the December 30, 2016 cloture deadline. laws on the web at: http://legislature.maine.gov/. – 5:30pm – 8:30pm The Governor can submit bills at any time and legislators Maine Chapter of the American Academy of can submit “after deadline” bills upon approval by the The MMA welcomes your participation in our legislative Pediatrics Board Meeting Legislative Council, the 10 members comprising the advocacy activities. For more information, please contact Contact: Dee Kerry at 207-480-4185 or leadership of the legislature. You can find the lists of Andrew MacLean, Deputy EVP & General Counsel, at [email protected] bill requests (LRs) by subject matter and by sponsor on [email protected]. April 27, 2017 Hilton Garden Inn – Freeport, ME – 5:30pm – 6:00pm The “TIGER” Returns of this uncontrolled epidemic. It is little wonder Maine Association of Psychiatric Physicians By Richard C. Dillihunt, M.D., Retired Surgeon, that we need to explore and utilize every avenue Executive Council Meeting Portland, Maine available to overcome this domestic problem, and bring the opioid epidemic under control. When we Contact: Dianna Poulin at 207-480-4194 or DECADES AGO while I was in surgical training in realize that fentanyl is manufactured in China and [email protected] New York, heroin was a terrible problem, a real Mexico, and enters the US easily via borders that are tiger in New York City and now its back, worse wide open to its importation including from China to April 27-28, 2017 than ever. Maine`s annual opioid deaths now Canada to the U.S. Do we realize that a huge supply Hilton Garden Inn – Freeport, ME of fentanyl can reach us through birthday cards? approach 400 as jails overflow and treatment and 11th Annual Spring Meeting & Program of Maine rehabilitation programs are inadequate in bed Association of Psychiatric Physicians numbers and funding, despite terrific work by Have we thus done all we can? No Way. We have Topic: Current Advances in Psychiatry police to accomplish results in this area. Federal and not done much at all to educate the young people State governments have joined in serious efforts to of America to never start taking opioids. That a first Contact: Dianna Poulin at 207-480-4194 or control this epidemic and bring funds forward in try of an opioid may be their last. That late teens [email protected] what is now obviously a domestic war. through twenties is an age of unreasonable reason, and virtually nobody can beat “The Tiger” alone. May 6-7, 2017 Only now is the critical role and scope our profession Sable Oaks Marriott – Portland, ME – 8am – 4pm has played in aiding and abetting the spread of this Maine Chapter of the American Academy of epidemic becoming apparent, with many accidental Education of Millenials is Pediatrics Spring Conference addictions attributable to faulty prescribing of a Critical Need Contact: Dee Kerry at 207-480-4185 or opioids. Likewise, the very deep involvement of the [email protected] drug industry in overproduction and overzealous Bethany is a fictional 19 year old first- pushing of such drugs to market for profit motives is time user tempted to try heroin by addicts May 12, 2017 showing some transparency. who are skilled at making the experience Brunswick Hotel & Tavern, Brunswick, ME appear attractive and safe, fueling their own Our Governor has chipped in by insisting that more 12:00pm – 5:00pm addiction. Her story is designed to deter DEA professional agents be added to the roster to Maine Society of Eye Physicians and Surgeons temptation and emphasize the real danger increase the forces of interdiction. Our Attorney Spring Educational Program & Business Meeting and vivid results an overdose can cause, General has also been a strong voice in spreading the even with a first time experience. B ethany’s Contact: Shirley Goggin 207-445-2260 or word regarding the horrendous exponential growth story is available on the MMA website at [email protected] www.mainemed.com.

www.mainemed.com Page 5

Medical professionals health program

Though the Medical Professionals Health Program Myth: MPHP services are only for professionals with (MPHP) has been in existence and serving physicians substance use illnesses. for 30 years, the nature of addiction and mental health Fact: Within the last five years, MPHP has developed a illness have meant that many may be unaware of the life- behavioral health track for professionals who struggle saving and life-changing services available. On this 30th professionally and personally but are not diagnosed with year, the MPHP is committed to working to celebrate the a substance use illness. It was a logical extension of our hard work of those who have contributed to building a services since many medical professionals with substance strong assistance program and the many physicians and use illnesses also have untreated mental health disorders other medical professionals who are living strong healthy like depression, bi-polar disorder, anxiety or PTSD. The lives and serving our communities safely and effectively evaluators, psychiatrists and therapists used by MPHP Jo Linder, M.D., and Robert Bing-You, M.D. welcome the class of 2020 as a result of their own commitment to treatment and participants are adept at identifying and helping medical Tufts University School of Medicine – sobriety. professionals with mental health disorders. MMC Program Class of 2020 Myth: The MPHP is an arm of Maine’s licensing boards. Myth: Referring a colleague is a betrayal of trust and Kaitlyn Bergeron – Shapleigh, ME – Northeastern Fact: The MPHP is an alternative reporting program for professionalism. University – Donald & Nancy Morse Endowed health professionals who might otherwise be reported Fact: Being appropriately treated for mental health and Scholarship Fund to a licensing board. It is a program of the Maine Medical substance use illness is a gift. Substance use illnesses and Mark Broadwin – Concord, MA – Colby College Association that contracts with the Maine licensing mental health illnesses are often progressive. Allowing boards to assist with treatment and provide monitoring a colleague’s illness or distress to remain untreated Corinne Carland – Shapleigh, ME – Massachusetts services to licensed professionals. In this way, MPHP or be self-treated can result in profoundly greater Institute of Technology – Curran Family Endowed is an alternative to discipline, offering physicians and consequences at a later date. Many who come to the Scholarship Fund physician assistants an opportunity to get treatment MPHP for services feel that they have suffered the effects Elena Cravens – Winterport, ME – Wellesley College – services in lieu of legal and/or licensure action by the of their illness too long and are relieved to finally have Richard & Rakia Hatch Endowed Scholarship Fund board. appropriate treatment. This delayed referral is a pattern we are hoping to change in the coming years. Michael Delucia – Norwich, VT – Middlebury College Myth: The actions of the MPHP are as much a form of Eli Dibner-Dunlap – Cleveland, OH – Skidmore College discipline as board action. Gabrielle Donahue – Cape Elizabeth, ME – Fact: The objectives of MPHP are to help medical Colby College – MMC General Scholarship Fund professionals with their goals of getting well and returning to active practice. Monitoring agreements Jessica Evans – Van Buren, ME – Bowdoin College – with the MPHP are rigorous and demanding which may Doctors for Maine’s Future Program at times feel punitive. There are however, distinctive James Finney – Kingston, NH – Dartmouth College differences. Sydney Ford – Brunswick, ME – University of • Each MPHP requirement is uniquely designed to St. Andrews, Scotland address the medical professional’s medical and Jodi Forward – Sherborn, MA – Colgate University clinical addiction and mental health needs, resulting in reduced incidents of relapse among participating Eliot Gagne – Gorham, ME – University of Maine – professionals John C. Dalco, M.D. House in Manchester, Maine. Richard & Rakia Hatch Endowed Scholarship Fund • The toxicology testing objectively documents the The work we do is saving lives, but we need the assistance Laura Getchell – Raymond, ME – Wesleyan University – participant’s sobriety of all medical professionals to ensure that intervention Suffolk Endowed Scholarship Fund • The collateral reporting is important documentation takes place early in the disease process. Healthcare of the participant’s wellness efforts from different Alexandra Grzywna – Framingham, MA – Wellesley supports appropriate treatment opportunities and perspectives College medical professionals who return to work following • Participants who engage with MPHP and are intervention are treated with support and compassion. Ben Guido – Montville, ME – Colby College compliant with MPHP requirements are able to

William Hirschfeld – Hopkinton, NH – Dartmouth College maintain confidentiality, avoiding board action and To learn more about the MPHP, please visit our website discipline. Samuel Lloyd – Yarmouth, ME – Boston College at www.mainemphp.org or call us at 207-623-9266. William Long – Littleton, CO – Regis University

Micah Ludwig – Waldoboro, ME – Bowdoin College – Frederick Aronson, MD Steven Feder, DO Charles Pattavina, MD Doctors for Maine’s Future Program MMA Annual Appeal William Atlee, MD Richard Flowerdew, MD Lewis Phillips, MD Owen Maguire – Amherst, MA – Northeastern University Warren Baldwin, MD Jacob Gerritsen, MD Lawrence Piazza, MD Thank you to the Jeffrey Barkin, MD Angela Gilladoga, MD James Pringle, DO Anna Martens – Scarborough, ME – Muhlenberg College Peter Bates, MD Edward Gilmore, MD Jane Pringle, MD – Burke Family Endowed Scholarship Fund following individuals who contributed to Ari Berman, MD Maroulla Gleaton, MD David Rawcliffe, DO Hannah Martin – Yarmouth, ME – Swarthmore College – MMA’s Annual Appeal. Douglas Boyink, MD Scott Hanson, MD John Ribadeneyra, MD Women’s Board Endowed Scholarship Fund Contributors chose Tom Brewster, MD Richard Hobbs, MD Lisa Ryan, DO Lauren McAllister – Bethel, ME – Bates College – what they wanted their Irwin Brodsky, MD Richard Jennings, MD Robert Schlager, MD Cecilia Caldwell, MD Robert Keller, MD Charles Smith, MD Bingham Scholarship Fund contribution to go John Carrier, MD John Kilgallen, MD Gordon Smith, Esq Parker Merrill – Brunswick, ME – University of Virginia – towards (MMA Long Judith Chamberlain, MD Nicholas Knowland, MD Sam Solish, MD Dean L. Fisher Scholarship Fund Term Development, Edmund Claxton, MD Robert Kramer, MD Gordon Somerville, MD Robert Michaud – Limington, ME – Saint Joseph’s MMA Building, MMET Jerome Collins, MD George Lawson, MD Alice Spindler, MD College of Maine – Boulos Asset Management General Education, Mark Cooper, MD Rejean Lebel, MD Carole St. Pierre-Engels, MD Scholarship Fund MMET Scholarships, Richard Dillihunt, MD Jo Linder, MD Richard Swett, MD Antigone Mitchell – Candia, NH – Bowdoin College or MMEF Loans). Mary Dycio, MD John MacDonald, MD Michael Szela, MD Contributions totaled Richard Entel, MD Bruce Malmer, MD Stephen Zanella, DO Grace Mueller – Edwardsville, IL – University of $9,194 for 2016. John Erickson, MD Daniel Oppenheim, MD Kate Zimmerman, DO Southern Maine Kelsey-An O’Neil – Cumberland, ME – University of Southern Maine – Dean L. Fisher Scholarship Fund Jacqueline Ordemann – Groton, MA – Bates College Physician – Monmouth please e-mail your resume to Laurie Kane-Lewis, CEO. ([email protected]) EEO Brianna Philbrick – Brewer, ME – Boston College – DFD Russell Medical Centers (DFDRMC) oper- Doctors for Maine’s Future Program Requirements: Current Maine license. Profi- ates three community health centers in central ciency with electronic medical records. James Poulin – Lewiston, ME – University of Maine – Maine. We are seeking a full time Physician, for Marjorie Higbee Saunders, RN, BSN & Henry W. Saunders our Monmouth location. Benefits: Excellent benefit package: medical, Endowed Scholarship Fund dental, life, 401(k), flexible spending accounts Our three health centers serve a multicultural, Samuel Poulin – Readfield, ME – Colby College – Medical and a generous paid time-off plan. Salary is rural population of about 10,000 patients and Mutual Insurance Co. of Maine Scholarship Fund commensurate with experience; there is also have a family practice focus serving pediatrics an incentive plan and a CME reimbursement. Zachary Radford – Tuftonboro, NH – Bates College to geriatrics. We have excellent clinical support Sheila Rajan – Orrington, ME – Colby College – Tower staff. Society Endowed Scholarship Fund This position requires a high degree of flexibili- John Royal, II – Ellsworth, ME – University of Maine – ty, good clinical skills and commitment to team MMC General Scholarship Fund work and open lines of communication. It is a Nabil Saleem – Alpharetta, GA – Bates College full-time at 4 days per week.

Jennifer Scontras – Saco, ME – Brandeis University – This position combines making a difference in www.dfdrussell.org MMC General Scholarship Fund patients’ lives with a family-friendly work life, www.dfdrussell.org

Page 6 Maine Medicine Medical Mutual Insurance Company of Maine Risk Management Practice Tip

Medication Reconciliation: A Risk Management Process for Avoiding Adverse Drug Events Medication reconciliation is a formal process of 2. Adopt a standardized format for reconciling 6. Provide access to drug information. obtaining a complete and accurate list of each patient’s medications. home medications including name, dosage, frequency, a. Patient identification. 7. Provide orientation and ongoing education to all and route. The list is then used to guide drug choice b. Allergy verification. healthcare providers. throughout the health care system and is included in the c. Preparer/verifier’s signature. electronic health record (EHR) or paper chart. Medication d. Physician signature. 8. Develop strategies to educate patients/families in reconciliation involves comparing the patient’s current e. List each medication. monitoring medications and maintaining accurate list of medications against the physician’s medication • Dosage. medication lists. Require return demonstration and orders for that patient at all transitions in care, e.g., • Frequency. document. Document changes and provide patient admission, unit transfer or inter-hospital transfer, step- • Date/time of last dose. with a copy of his or her current medication list. down care transfer, or discharge to home. • Compliance with prescribed dosages and frequency. 9. Review the process for quality improvement. Suggested Implementation Steps for the Medication f. Other data. a. Review a random sample of medical records each Reconciliation Process • Person providing information. month. • Patient weight. b. Encourage reporting of errors identified through 1. Develop policies, protocols, and procedures which • Pharmacy contact. the reconciliation process. address the following: • Over-the-counter medications and herbals. c. Develop a strategy to share the results of the a. Development of a patient home medication list. • Compromising conditions. process. b. Comparison of the home medication list to the • Pregnancy/breast feeding. current list of physician orders. 10. Other considerations for successful c. Prohibition of “blanket orders.” “Blanket orders” are 3. Assure primary responsibility for reconciling implementation: general prescriber directions that do not provide medications is assigned to a healthcare professional a. Involve the facility where the patient resides, e.g., specific information about the medication therapy with sufficient expertise. LTC, SNF, assisted living, ind0ependent living. prescribed, e.g., “continue previous medications,” “resume postoperative orders.” Orders previously 4. Assure the medication reconciliation list is easily Medical Mutual Insurance Company of Maine’s “Practice Tips” written must be written out in their entirety. accessible within the patient’s EHR, or paper chart are offered as reference information only and are not intended d. Identification of timeframes for completing the and that reconciliation of medication occurs. to establish practice standards or serve as legal advice. MMIC medication reconciliation process. recommends you obtain a legal opinion from a qualified attorney for any specific application to your practice. e. Identification and resolution of high-risk situations. 5. Documentation expectations. • Patients on high-risk medications. a. Educate the patient when new and unfamiliar • Patients on greater than five medications. medications are prescribed. Encourage feedback • Specific interventions for elderly or compromised from the patient and require a return demonstration patients. of instructions to assure patient understanding. • Review of discrepancies in medication orders. Document the elements of this encounter in the • Need for specialist consult. record.

Caution: Entering The Breach Zone© Because so many data breaches originate at the Are You Ready To E-Prescribe? employee’s desktop, training staff in security and Find Out More About DrFirst and By Jane Carpenter, founder of Maine Identity Services, LLC programs to promote awareness can have a profound impact on whether a data breach will occur. You may their E-Prescribing Products After assisting data breach victims for more than a have invested thousands of dollars in technology to decade, we have learned something interesting: There protect the information in your practice, but simply July 1, 2017, is when Maine’s new EPCS (e-prescribing is a human equivalent for the Bermuda Triangle. We’ve controlling the use of a $7 computer accessory may controlled substances) law takes effect for named it “The Breach Zone.©” reduce your risk by as much as 70%. the prescribing of opioids. Despite the limited application of the law, the benefits of e-prescribing This roughly one square meter is the area that includes “Controlling the mouse” also means instituting a culture are significant, which is why MMA encourages our an individual’s eyes and brain, the computer screen and of data security in your organization. This culture members to implement e-prescribing technologies their hand on a mouse when they are seated in front of extends beyond the requirements set by federal and state in their practices now instead of waiting for the a computer. And, as ancient maps proclaimed: Hic sunt regulation. And it also extends beyond the boundaries of legislative deadline. dracones. Here be dragons. your own practice to those businesses that support you. To save you the time of vetting potential vendors In the Breach Zone, unexplained circumstances compel Where do you begin? Here are some statements that and offer you another tangible membership us to re-use the same password we have used on other may help you get started. Think of them as navigational benefit, we have chosen DrFirst as our preferred sites we visit. aids to avoid the Breach Zone. e-prescribing platform and negotiated a generous discount for MMA members. DrFirst offers a superior • Our employees’ understanding of data security is This is the area where, after apparently suspending our clinical workflow that is easy to use and affordable part of their performance evaluation. disbelief, we open attachments of unknown origin. (especially with the discount we have negotiated • We know (by name) who is in our offices at night. for MMA members). Their package includes • We have a policy concerning passwords. Becoming disoriented, we use the office computer to Rcopia® for legend drug e-prescribing, EPCS Gold • We know employees’ password practices. visit social networking websites or bring a computer 2.0SM for controlled substance e-prescribing, and • We know what applications our employees containing private information to our local WI-FI cafe. iPrescribeProSM, an app for mobile e-prescribing. download to their cell phones and tablets. (See informative product brochure inserted in this • We share employee records with third parties for And just as in the Bermuda Triangle, before there is edition of Maine Medicine.) payroll or benefits. time to radio a distress signal, malware has entered the • Our employees never visit other web sites or computer system and data has disappeared from the Aside from legend drug and controlled substance use WI-FI environments when they are using our screen, like airplanes suddenly disappearing from radar. e-prescribing within one workflow, you’ll also get computers. • 24 months of patient medication history In May, the Ponemon Institute released its Sixth Annual Benchmark Study on Privacy and Security of Healthcare Jane Carpenter is the founder of Maine • real-time benefit check (formulary data, Identity Services, LLC, a veteran of Data and the findings are not good news for the medical drug cost, suggestions for cheaper alter- the Maine Attorney General’s Office community. Rather than data becoming more secure and natives) and a member of the FBI-sponsored breaches becoming less frequent, the opposite is true. InfraGard organization. She trains police • clinical alerts (e.g., duplicate therapy and Trafficking in stolen information is a high growth industry personnel and serves on the Advisory allergy warnings) and medical practices are a target-rich environment. Committee of USM’s Statistical Analysis • one-on-one guidance through DEA iden- Center, which informs Maine’s criminal tity proofing and authentication According to statistics from the Identity Theft Resource and juvenile justice systems. Over more Center, the healthcare category accounted for 71% of than a decade, her expertise in identity theft and data breaches • patient adherence monitoring has resulted in new laws assisting victims of the crimes and all compromised records during the first quarter of this • electronic prior authorization year. And employee errors are still the leading cause of her insight is regularly sought by lawmakers as they consider data breaches. proposed identity theft and data breach legislation. For more information, MMA members can visit In addition to Data Breach: Day One©, Carpenter is the author DrFirst’s website at www.drfirst.com/mainemed/ So, what’s the alternative? How do you ensure that of the Identity Theft Help Kit©, the Data Breach Repair Kit© and and/or contact DrFirst’s Eric Landry, a New your organization is navigating safely around the Breach the Police Guide To Identity Theft© which provide assistance Gloucester resident, at 888-481-4303. Zone? The answer is simple: control the mouse. for victims and police and have been accepted by the U.S. Department of Homeland Security as authorized equipment under the Law Enforcement Terrorism Prevention Program.

www.mainemed.com Page 7 PRSRT STD US Postage PUT YOUR MONEY WHERE THE MIRACLES ARE. PAID Permit # 121 Augusta, ME Maine Rx Card is proud to support Children’s Maine Medical Association Miracle Network in helping local kids. A donation will be made to your local CMN hospital each time Visit MaineRxCard.com to 30 Association Drive >> P.O. Box 190 a prescription is processed throughMaine Rx Card. download a free card for Manchester, ME 04351 you and your family.

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Live. Work. Play. In Beautiful Central Maine! Our team is here to keep

SVH is recruiting for a full time Family Medicine physician you and your practice healthy. and Family nurse practitioner. When it comes to providing great care with legal issues regarding Join Sebasticook Valley Family Care, SVH is a 25-bed modern critical access your practice—or personal life—we’re here for you. You can put a modern practice located just off I-95 hospital located in Pittsfield which is your trust in our expertise, experience, and results-oriented focus. in Pittsfield. Be part of a ten member 20 minutes north of Waterville, and 40 We’re here for you when you need help with: collegial medical staff providing primary minutes south of Bangor. The hospital care services in a rural community. serves a population of 30,000 in this central Maine area. SVH offers a wide • Health Law • Estate Planning, Wills & Trusts Work schedule is 4 days per week, range of outpatient services, including • Medical Professional Liability • Family Law with limited telephone call from home. over 20 specialty services. • Medical Professional Licensing • Real Estate Law This position comes with competitive • Medical Credentialing • State & Federal Tax Planning compensation, fringe benefits, assistance with medical education debt, signing/ relocation bonus negotiable.

For more information please contact: Sherry Tardy, PHR, DASPR, at 207-487-4085 Sponsors & Volunteers to more than 25 area nonproﬁ ts or email a CV for review to [email protected]. nhdlaw.com • Portland (207) 774-7000 • Lewiston (207) 777-5200