IN THE NEWS

Dr. David Satcher: From Alabama Farm to the Surgeon General’s Office

BY MARY KORR RIMJ MANAGING EDITOR

PROVIDENCE – Prior to delivering the an- then on, I told everyone I was going to nual Dr. and Mrs. Frederick W. Barnes, be doctor like Dr. Jackson. I was as cer- Jr. Lecture in Public Health at Brown tain of that as I have been of anything University on April 18th, former U.S. in my life. Surgeon General David Satcher dis- The leadership of cussed his path to becoming a physician and Benjamin Elijah Mays [president with the Rhode Island Medical Journal, of Morehouse College 1940–1967] also and his views on medicine and health played a major role in my development

care today. and getting into medical school. But I NIH Born in March 1941 to Wilmer and was first motivated by that near-death BRIEF BIO Anna Satcher, Dr. Satcher’s journey be- experience. DAVID SATCHER, MD, PhD gan on the family’s rural Alabama farm when he was two years old and gravely Q. What lessons have stayed with Graduated ill with whooping cough. The town you from your boyhood days on Morehouse College in (1963) hospital was segregated and did not the farm? Case Western Reserve in Cleveland, admit black children. His father sought A. Our dad taught us to work in the MD, PhD (1970) the help of the only black physician in field and a lot of other lessons about life Positions the vicinity of Anniston, Alabama, who that are still with me. He always said if President, came out to the farm to tend the toddler. you’re not careful, the person who beats in Nashville (1982–1993) His prognosis was dire. you out in the morning will beat you out Director of the CDC (1993–1998) in life. I still get up at 5 a.m. to exercise Appointed by President Clinton as Q. Who has inspired you the most before work. 16th U.S. Surgeon General & Asstistant in your life? When it came time for me to go to Secretary for Health in Dept. of Health A. I should start with Dr. Fred Jackson, Morehouse College in Atlanta, I remem- and Human Services (1998-2002) who came out to the farm on his day off ber standing at the bus stop with my President, Morehouse School of Medicine when I was two years old and very sick dad. I was feeling kind of sorry for him. (2004-‘06) with whooping cough and pneumonia. He never finished first grade. As the bus Current He told my parents I wasn’t going to pulled up, he said to me: ‘Son, I want Founder & Director, The Satcher Health live out the week, but he did everything you to promise me something. Where Leadership Institute and Center of he could and showed them how to care you are going you will meet people with Excellence on Health Disparities, for me. When I stopped breathing, my more than you, and you will meet people Morehouse School of Medicine mother breathed for me. with less than you. Promise me you will Poussaint-Satcher-Cosby Chair in Mental I often heard that story from my treat everyone with respect.’ It’s the best Health, Morehouse School of Medicine mother. And the one thing I wanted to advice in life I’ve ever been given. do was to meet Dr. Jackson. My parents And on February 13 of this year, I promised me when I was six years old acknowledged the 100th anniversary of they would take me to meet him, but the birth of Anna Curry, the 16th of 17 that year he died of a stroke at 54. From children. She was my mother. She has a

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ideal to capture…It is not a disgrace not Q. What is your assessment of the to reach the stars, but it is a disgrace to Affordable Care Act (ACA) thus far? have no stars to reach for.’ A. I would have liked universal access as part of ACA. I think one of the best Q. In your exemplary career in investments we could make as a country medicine and public health, you is that everyone has access to health care have been closely associated with as early as possible. Not only will we two of the three outstanding Ameri- save unnecessary pain and suffering, but can medical schools associated his- we will save money and time. torically with an African-American But I think it went further than ever heritage (Morehouse and Meharry). before in terms of access and quality. I The erstwhile racial barriers in think it incentivizes primary care, quali- other American medical schools ty care, and reduces costs. The ACA said have diminished. Do you see a you are going to be paid for the quality. I continuing role for the historically think that’s a major step forward. black medical schools (including And all indications are that the ACA Howard), in the future? will dramatically reduce the cost of A. Meharry has been around for a long healthcare. It takes time for prevention time, since 1876, and for a hundred to work but in time we can prevent years it educated about half the black many of the chronic diseases we are pay- physicians in the South. During that ing for; 75 percent of costs go period, its graduates went on to practice for chronic diseases that are preventable.

CORRINE GIORDANI, BROWN PUBLIC HEALTH PROGRAM CORRINE GIORDANI, BROWN PUBLIC HEALTH in underserved communities, mostly If we can promote prevention not in primary care. In addition to race only in the doctor’s office but also in lot to do with who I am. She died on the it took on another role; its graduates the community, I think we are going to day in 1993 it was announced I was to worked where they were most needed, see a reduction in costs. become director of the CDC. She lived much more than other medical schools. long enough to know that. Morehouse, founded later, also assumed Q. Some public health actions on this role. That has nothing to do with the local and national level are con- Q. You mentioned Benjamin Elijah race. It has more to do with what the troversial, such as Mayor Michael Mays. Can you share a recollection country needs. Bloomberg’s recent efforts in New about him from your undergraduate Today, Morehouse is integrated. Our York City to try and curb the sale days at Morehouse? faculty and students are diverse. We of large sodas. What role should A. Dr. Mays challenged students, and were ranked No. 1 in the country last the Surgeon General’s office play Martin Luther King, Jr. [1948 Morehouse year for our social mission. It is No. 1 for in issues such as this to achieve a graduate] was one of them, to excel medical schools when it comes to grad- healthier populace? in academics and in life. Some of his uating under-represented minorities, to A. Washington D.C. is a different words of wisdom: ‘It must be borne in sending its graduates into underserved town when it comes to politics. Every mind that the tragedy in life doesn’t lie communities, and for its graduates going Surgeon General has to work with an in not reaching your goal. The tragedy into primary care. We need more prima- administration, and Congress, but so far, lies in having no goal to reach…It isn’t a ry care, and more diversity in medicine for the most part, that has not stopped calamity to die with dreams unfulfilled, and medical education. As long as we the Surgeon General from leading. The but it is a calamity not to dream…It is are leading in that area there is a critical Surgeon General has to be able to have not a disaster to be unable to capture role for us. a bully pulpit. It was Surgeon General your ideal, but it is a disaster to have no who called attention to

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smoking as a problem in health in 1964. needle exchange. The science said that our graduates are going into primary care We have now halved the number of needle exchange was effective is halting is that many see medicine as a business. smokers in this country in 50 years. And the spread of HIV. But President Clinton We have created the kind of environ- Dr. C. Everett Koop and his response to refused to support legislation making ment where a lot of our graduates feel HIV/AIDS in the early days is another needle exchange legal. His reality was compelled to go into specialties where example of the relevance of the office that Congress was not ready to lift you can make the most money. And of the Surgeon General in this country. the ban on federal funding for needle they have the burden of debt. When I was the Surgeon General we exchange programs. But the role of the I like the national health service called attention to obesity. We are be- scientist is to state the science. They were corps, but as you know it has been cut ginning to see a reversal of that trend. In not listening to the available science. back. What I would like to see is the na- Mississippi, which has the highest rate When I was in office, they threatened tional service aligned with community of childhood obesity, it has decreased to take all the money away from the centers where young doctors can prac- more than 10 percent. So that means a Surgeon General’s office. I didn’t listen tice with the benefit of debt forgiveness. lot of lives are going to be saved if that to that threat. But the offices of the But I think the mission of medicine trend continues. Surgeon General and the CDC are not is to serve. From the beginning health I also focused attention on mental always at liberty to do what they would care has been about serving and that’s health when I was in office. Since that want to do because they are dependent why it’s called health care. I don’t know time we have a parity of access to mental on Congress for funding. any other area where the word ‘care’ is a health services, and mental health ser- part of the name. You don’t say business vices has been integrated into the ACA. Q. What are your thoughts on care or law care. We are about caring for But within the political context, the corporatization of medicine? people who need us. I still think most when I was in office I ran into conflict A. Corporatization is an issue in medi- medical students go to medical school with President Clinton when it came to cine. One of the reasons that so few of with the idea of serving. v

Highlights of lecture During the Dr. and Mrs. Frederick W. Barnes, Jr. Lecture in Public Health, speaker Dr. David Satcher made the following remarks:

On smoking: “50 years ago, when the first Surgeon General’s report came out on smoking and health, 60 percent of doctors were smokers. When you went to a medical meeting you could hardly see the screen for the smoke. Today, only 3 percent of doctors smoke…nevertheless, I see smoking today as a pediatric disease.”

On public health: “Public health is what we do collectively as a society to ensure the conditions in which people can be healthy…The science of public health is very challenging and critical. It is the credibility of that science that translates into the Surgeon General’s reports and eventual public policy.”

On the future of public health: “We can’t leave the emergence of public health leaders to chance alone.”

ALAN SHAN, COURTESY OF BROWN DAILY HERALD OF BROWN DAILY ALAN SHAN, COURTESY On the gap between science and policy: “We are struggling with that now as Dr. David Satcher was the keynote speaker during Brown’s it relates to gun violence. You need the science, and you need advocacy at Program in Public Health’s annual research day. It was also the community level to transform science into policy. The lobbyists bring in sponsored by The Alpert Medical School and co-sponsored by the money. The community against gun violence has to hang in there.” the Dept. of Health and the R.I. Public Health Association.

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Alpert Graduate Leaves Campus with MD and Medical App Start-Up

MARY KORR RIMJ MANAGING EDITOR

Q. You are graduating from Alpert in the RISD Museum of Art. In medical Medical School in May. Where will school, I thought that there must be a you continue your medical training more creative solution to disseminating and do you have an idea of what all the medical knowledge that is locked field you will practice in? up in journal articles. It seems like these A. I’m excited to say that after grad- articles could only be accessed through uating I will be starting work as an the memories of attending physicians emergency medicine resident physician who read them when they were orig- at Albany Medical Center. I plan to inally published, or through the inev- continue to grow Jolis Biotech. I feel like itable paywalls which pop up on the there is a great deal more we can accom- screen when a diligent medical student plish to facilitate evidence- based deci- attempts to read them. There had to be sion-making and empowering patients. a better way. In a conversation on this As a fledgling tech start-up, we always subject with the wonderful Dr. Joseph welcome support and input from others. Rabatin, he suggested I make an app to manage sensitivity and specificity data. Q. Medical students are pretty The idea stuck. With the encouragement busy. What made you take the and guidance of Dr. Kenneth Williams, PROVIDENCE – This month former U.S. leap from inspiration to actuality – I was on my way to finding better ways Army paratrooper Timothy Jolis will developing medical apps and of getting data to doctors and patients. graduate from the Alpert Medical School setting up a company? of Brown University with more than a A. I like to think of creativity as an Q. Who were your collaborators hundred other students. essential part of my life. I’m a prolific and what roles did they have? While studying at Brown, he not only reader; I design my own basic oncology A. I founded Jolis Biotech in 2012. I earned his medical degree, but also experiments, and I love spending time manage the business, invent apps, create started up a biotech company to devel- medical content and provide “vision.” op and market his medical apps, Jolis Waihong Chung is an MD/PhD Biotech, which are available for iPhone, student at the Alpert Medical School. iPad, and Android devices for 99 cents. His research is focused on hepatitis B The start-up was inspired by a hospital and liver cancer. In his free time, he physician, and came to fruition with does computer programming and is a the collaboration of friends and peers at generalized very smart guy. He plans Brown and the Rhode Island School of on being both a practicing physician Design (RISD). and scientist. For Jolis Biotech, he does In an interview with the Rhode Island programming and data management.

Medical Journal, he spoke of his app OF TIM JOLIS PHOTOS: COURTESY And Ivy Bradley, a graduating RISD avocation. illustration student, does interface design and illustration for Jolis Biotech.

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Q. What has been your best- selling app? A. So far, Jolis Biotech has created four apps. Some are made for patients, some for nurses, and some for physicians. My best selling app for medical people is called Sensitivity & Specificity. It’s very simple. It allows you to look up the sensitivity and specificity of hundreds of tests. Every value is linked to the journal article from which it came. These data are normally difficult to find, even for the most common tests. Having them readily accessible allows physicians to make side-by-side comparisons of tests. This encourages evidence-based decision-making. It also helps prevent unnecessary testing.

Q. When you develop/design an Q. When you use your apps during Q. Other than your own apps, how app, is it patented or copyright- your clinical rotations does it con- many medical apps do you have on protected? What is the process fuse the older physicians or are your own phone/tablet? What’s your for doing this? they pretty savvy about using favorite as a medical student? A. Part of dealing with Apple is realizing information technology? A. Other than my own apps, I have five that they are all-powerful. If you spend A. I’ve found that the more experienced other medical apps. I think my favorite $20,000 building an app, they can decide physicians are actually very receptive to is the one built by the U.S. Preventive not to allow you to list it in their store these new tools. They’ve been adapting Services Task Force called AHRQ ePSS. for any reason they like. While this does to changing fields their entire lives. It allows you to stay current with ever pose a challenge, their power reassures Also, most of them are fellow tinkerers, changing recommendations for disease users that the apps they sell work. Ap- with a lot of lab experience, who get prevention. I also enjoy Diagnosaurus, ple’s power also allows them to protect as excited as I do about the process of which helps you build differentials. v app makers from people infringing on experimentation and invention. their intellectual property. They even have a dedicated website that allows you to report intellectual property violations. That being said, some app developers take extra steps to protect themselves by filing patent applications.

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U.S. Emergency Care Costs May Be 2X Previous Estimates Analysis published by Drs. Lee, Zink

BY DAVID ORENSTEIN BROWN UNIVERSITY SCIENCE NEWS OFFICER

PROVIDENCE – Alternately praised in the aftermath of horrible tragedies as a heroic service and lamented in policy debates as an expensive safety net for people with- out primary care, emergency medicine is often a hot topic. Despite that impor- tance, an analysis published online April 26 in the Annals of Emergency Medicine finds that national expenditures on emer- gency care are likely significantly higher than previously thought. “The ER has become increasingly important as a place where people go for acute unscheduled care, however there has been little rigorous analysis of its cost structure,” said paper lead author Dr. Michael Lee, assistant professor of emer- PHOTO BY FRANK MULLIN/BROWN UNIVERSITY gency medicine in the Warren Alpert Dr. Michael Lee Medical School and a physician at Rhode Island Hospital and The Miriam Hospital. emergency care in 2010, or 1.9 percent of total health care spending. Dr. Lee, who had a prior career in eco- the nation’s total health care expenditures Much of the debate in the academic nomics and finance before training in of $2.6 trillion. literature around the expense of ED care emergency medicine, co-wrote the anal- But Dr. Lee and his co-authors point has to do with whether the bulk of costs ysis with Dr. Brian Zink, professor and out, based on data from other studies, are fixed (e.g., expensive equipment and chair of the Department of Emergency that MEPS undercounts the number of continuous staffing) or marginal (e.g., Medicine at the Alpert Medical School, ED visits and the number of ED patients flexible staff time, expendable supplies). and Dr. Jeremiah Schuur, assistant pro- who are admitted to hospitals. Adjusting According to Dr. Lee, the cost structure fessor at Harvard Medical School and di- for those discrepancies using data from a of the ED remains poorly understood and rector of quality and patient safety for the variety of other published sources, the au- is significantly more complex than what Department of Emergency Medicine at thors estimate that ED costs are between is modeled in existing studies. the Brigham and Women’s Hospital. 4.9 percent to 5.8 percent of total health As with assessments of total costs, the The challenge of properly account- care spending. authors report, the studies vary widely ing for the costs of emergency care, Dr. The authors went beyond national data even after adjusting for inflation. Across Lee said, becomes crucial as health care sets, including the National Emergency four major studies over the last three de- financing moves from a fee-for-service Department Sample, to review ED spend- cades, the average cost per patient of an model to bundled payments for patient ing data from a different source: a major ED visit in 2010 dollars ranged from only populations or episodes of care. national private insurer. The data includ- $134 to more than $1,000, Dr. Lee and ed charges from doctors and hospitals for colleagues found. Meanwhile, the mar- Clarifying costs imaging, testing, and other procedures. ginal cost of an ED visit (factoring out the The analysis first examines current esti- But again there were accounting differ- fixed costs), ranged from $150 to $638. mates of aggregate spending on emergen- ences between admitted and discharged cy department (ED) care. The Agency for patients and a need to account fully for Alternative accounting Healthcare Research and Quality’s Med- spending from Medicare and Medicaid. The authors instead argue for an account- ical Expenditure Panel Survey (MEPS) The authors’ estimate based on this data ing based approach to ED costs using a estimates $48.3 billion of spending on is ED spending that is 6.2 to 10 percent of methodology known as “Time-Driven

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Activity Based Costing (ABC),” which emergency medicine. accounting for nearly half of all admis- has been applied to health care by Robert The authors acknowledge that an out- sions, emergency medicine should be Kaplan and Michael Porter, professors at come of their analysis reporting higher expected to represent a large share of the Harvard Business School. overall costs for emergency care, may in- health care spending.” The method maps all clinical, adminis- vite further criticism that the expense of And Dr. Lee cautions, based on other trative, and diagnostic steps in a patient emergency care represents unnecessary, studies, that efforts by private and gov- encounter and assigns costs to each ac- inefficient care. ernment payers to divert ER care may not tivity, explicitly accounting for the time “However, we offer a more sanguine lead to large aggregate savings. spent on each task. interpretation — the high share of spend- “Diverting nonemergency care may ABC accounting might provide a more ing affirms the importance of emergency simply shift costs onto primary care offices realistic and transparent measure of ED medicine within the health care system,” and clinics which may not have the infra- costs, Dr. Lee said, because the empha- they wrote. “With 130 million visits, structure to accommodate a large volume sis on time is particularly relevant for 28 percent of all acute care visits, and of unscheduled care,” Dr. Lee said. v

Linakis, DeSpirito receive $3.2M grant to study teen alcohol use Hasbro Children’s Hospital is one of 16 study sites

PROVIDENCE – Hasbro Children’s Hospital emergency medicine physician James Linakis, MD, PhD, was recently awarded a five- year, $3.2 million grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (NIH) to validate a more efficient test to screen teenagers for future alcohol abuse and other risk behaviors. Dr. Linakis will be joined on the multi-site study by co-principal investiga- tor Anthony Spirito, PhD. The project, titled “Teen Alcohol Screening in the Pediatric Emergency Care Applied Research Network (PECARN),” will utilize 16 children’s hospital sites to determine if the NIAAA two-question screen is an efficient and valid alcohol screening in- strument among U.S. pediatric emergency department patients compared to the previously utilized more lengthy questionnaires. HASBRO “We know that the younger an individual starts to drink, the Dr. James Linakis is an associate Anthony Spirito, PhD, co-inves- higher their risk for developing alcohol related issues later in life. professor of emergency medicine tigator, is professor of psychiatry We need to find the best way to catch this early,” said Dr. Linakis. and pediatrics at The Alpert Med- and human behavior at The Over the past few years, the NIAAA has focused on the im- ical School and associate director Warren Alpert Medical School. portance of screening adolescents for alcohol problems, but of pediatric emergency medicine the only screening tools have been relatively lengthy. A basic, at Hasbro Children’s Hospital. two-question screening questionnaire was created that the NIAAA hopes will be predictive of both current and future Researchers will then contact 1,000 of those teens and screen alcohol problems in adolescents. It asks: them again. 1.) Do you drink alcohol? How much? “We want to see if the shorter survey can just as effective- 2.) Do you have friends who drink alcohol? ly predict risky behaviors, both current and future,” said Dr. “This two-question screening is based on established litera- Linakis. “When we follow up we will also be able to see if the ture, but it has never been validated. The NIAAA is asking for PE- questionnaire predicted drug abuse or risky behaviors, not just CARN hospital sites to test the two-question screener, so we can alcohol use.” make sure that the screening system works,” said Dr. Linakis. After the study is complete, Dr. Linakis’ team and the NIH Adolescents ages 12 to 17, who are being treated in the hope to use this data to help develop an intervention for ado- emergency room, will be randomly selected to take part in the lescents who drink alcohol and display other unsafe behaviors. questionnaire. They will be asked these questions, along with “The study, the data it finds, and the future intervention pro- a series of others to compare them with longer questionnaires. gram will be extremely helpful for anyone who takes care of The goal is to screen 5,000 teens over three-and-a-half years. kids in a primary care setting,” he said. v

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Health Insurance RI Foundation awards Taylor Innovation Fellowship to ‘defeat Hep C’ Commissioner Koller Will receive up to $300,000 over the next three years leaving post PROVIDENCE – Lynn E. Taylor, MD, an HIV and viral Accepts post as head of hepatitis specialist, primary care physician and director of the HIV/Viral Hepatitis Coinfection Program at The health policy foundation Miriam Hospital, is one of two recipients of the 2013 PROVIDENCE – Gov. Lincoln Chafee Rhode Island Innovation Fellowship, an annual program announced on April 18 that Health in its second year designed to stimulate solutions by Insurance Commissioner Christopher Rhode Islanders to Rhode Island challenges. She is the F. Koller will be stepping down to be- first physician to be selected. come president of the Milbank Me- The Fellowship provides two individuals with up to morial Fund, a national health policy $300,000 over three years to develop, test, and imple- foundation based in New York City. LIFESPAN ment innovative ideas that have the potential to dramat- Koller will leave his post following ically improve any area of life in Rhode Island. the current rate factor review process, Dr. Taylor’s project, Rhode Island Defeats Hep C, aims to make Rhode Island the first expected to be concluded at the end of state to eradicate the Hepatitis C virus infection (HCV). She calls HCV a “time bomb June 2013. in Rhode Island” and says the epidemic will peak in the state over the next two de- “This is a tremendous opportunity cades unless dramatic action is taken. With the medical community now on the verge for Commissioner Koller, and I want of a radical, “game-changing” shift in HCV therapy, Dr. Taylor says the cure rate can to sincerely thank him for his service potentially be 100 percent. to our state in this critically import- She proposed a comprehensive plan that includes several steps: awareness, rapid ant area over the past decade,” Gov. testing, linkage to care, building infrastructure for a sustainable model and evaluation. Chafee said. “We appreciate his hard “At no other time in history have we had such opportunity to eradicate this harmful, work and leadership – both locally costly epidemic,” she said. and nationally – in implementing Dr. Lynae Brayboy, a fellow in obstetrics and gynecology, who proposed a smart- systemic reforms to improve health phone app with sexual health information for girls, was a finalist for the awards.v insurance in Rhode Island. I am committed to identifying a succes- sor who will continue the excellent work of the Office and the Executive Committee for Health Care Reform.” Rhode Island Hospital adds MRI unit to ER Koller was appointed as the coun- PROVIDENCE – Rhode Island Hospital try’s first and only Health Insurance is expanding its emergency department Commissioner in January of 2005. In services with the addition of a magnetic this role, he has developed a compre- resonance imaging (MRI) unit. In doing hensive commercial health insurance this, Rhode Island Hospital becomes one rate review process, established and of just a few hospitals in the country, and enforced expectations of commercial the first in New England, to make MRI insurer efforts to reduce the underly- available in the emergency department. ing costs of medical care, established Prior to the launch of this unit, emer- the nationally recognized Chronic gency department patients requiring an Care Sustainability Initiative focused MRI had to be taken through the hos- on improving primary care, and led pital to the Grosvenor building, often the initial state applications for the In- requiring travel through high-volume LIFESPAN surance Exchange planning grants. v patient areas. “The emergency department at Rhode Island Hospital is essentially a hospital with- in a hospital,” said John Cronan, MD, chief of the department of diagnostic imaging at Rhode Island Hospital. “Any diagnostic imaging test that a patient needs while in our emergency department – X-ray, ultrasound, CT scan, MRI – it can all be done right there in the ER. We are among the first in the country to bring this sophisticated technology to the emergency room patient.” v

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Atty. Gen. Kilmartin OKs Westerly Hospital sale OB/GYN Associates Joins to Lawrence + Memorial Corp. Lifespan’s Women’s Medicine

PROVIDENCE – R.I. Attorney General Peter F. Kilmartin announced April 17th that Collaborative he has approved, with conditions, the proposed sale of Westerly Hospital and affili- PROVIDENCE – Lifespan’s Women’s Medi- ated entities to Lawrence + Memorial Corporation (L+M), pursuant to the expedited cine Collaborative has announced a new review process of the Hospital Conversions Act. partnership with OB/GYN Associates, The closing date of the $69.1 million sale will happen before June 1. On June 1, Inc., one of the state’s largest obstetrics the hospital will close its maternity services. The hospital has been in receivership and gynecology practices with locations since December 2011. throughout Rhode Island and Massachu- “This is the first time we have reviewed a hospital conversion under the expe- setts. The partnership is expected to be dited review process, reducing the number of days for review from 120 to 90. All finalized in August. parties recognize the critically important role Westerly Hospital plays in providing “This affiliation with Lifespan’s Wom- quality healthcare to the residents of the area and as an important economic engine en’s Medicine Collaborative will give our for the region,” said Kilmartin. patients more options, while not dimin- “There are currently three hospital conversions before this office in various ishing our presence at Women & Infants’ stages. The Office is always mindful, in our role as a regulator, to the balance Hospital, especially as our patients will need to protect the interests of the community, the employees and the state with continue to deliver their babies at Wom- the economic realities of the rapidly-changing and highly competitive healthcare en & Infants Hospital,” said John Bert, marketplace,” added Kilmartin. v MD, of OB/GYN Associates. v

Grape Street Orthopedic joins Southcoast Physicians Group Hillside, S. County family

NEW BEDFORD, MASS. – Grape Street Orthopedic has joined Southcoast Physicians practices join Coastal Group. The orthopedic practice includes Harry Von Ertfelda, MD, and Gilbert L. PROVIDENCE – Hillside Family and Com- Shapiro, MD, FACS. It will now be recognized as Southcoast Physicians Group munity Medicine in Pawtucket and Orthopedics. v South County Family Medicine, Narra- gansett signed agreements in April to join Coastal Medical. The Coastal Hillside Family Medicine physicians are Christopher Campanile, MD; Hana Hagos, MD; Barbara Jablow, MD; Christine Kennedy, MD; Cristina Mitchell, MD; Kenneth Sperber, MD, and Carla Garcia-Benoit, NP. Coastal Narragansett Family Medicine is a four-physician practice comprised of Catherine DeGood, DO; Dariusz Kos- trzewa, MD; Eileen Gonzalez, MD, and Michael Gonzalez, MD. Coastal Medical is Rhode Island’s first Medicare Shared Savings ACO. It pro- vides predominantly primary care, along

SOUTHCOAST with some specialty services, to 130,000 Harry Von Ertfelda, MD Gilbert L. Shapiro, MD patients in 20 medical offices across Rhode Island. Coastal also owns state- wide laboratories, an imaging center and a medical billing company. v

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Study examines public health implications of lack of methadone treatment in prisons

PROVIDENCE – Methadone treatment for opioid dependence that is routinely stopped remains widely unavailable behind bars in the , upon incarceration. “Giv- and many inmates are forced to discontinue this evidence-based en that opioid dependence therapy, which lessens painful withdrawal symptoms. Now a causes major health and new study by researchers from the Center for Prisoner Health social issues, these cor- and Human Rights, a collaboration of The Miriam Hospital and rectional policies have Brown University, offers some insight on the consequences of serious implications,” these mandatory withdrawal policies. he said. According to their research, recently published online by Additionally, metha- the Journal of Substance Abuse Treatment, nearly half of the done therapy has been opioid-dependent individuals who participated in the study shown to reduce the risk say concerns with forced methadone withdrawal discouraged of criminal activity, re- them from seeking methadone therapy in the community after lapse, infectious disease their release. transmission (including

“Inmates are aware of these correctional methadone with- LIFESPAN HIV and hepatitis) and drawal policies and know they’ll be forced to undergo this overdose death. painful process again if they are re-arrested. It’s not surprising In the study, Dr. Rich and colleagues surveyed 205 people that many reported that if they were incarcerated and forced in drug treatment in two states – Rhode Island and Massachu- into withdrawal, they would rather withdraw from heroin than setts – that routinely enforce methadone withdrawal in cor- from methadone, because it is over in days rather than weeks or rectional facilities. They found nearly half of all participants longer,” said senior author Josiah D. Rich, MD, MPH, director reported concern regarding forced methadone withdrawal during of the Center for Prisoner Health and Human Rights, which is incarceration. based at The Miriam Hospital, and professor of medicine and “We should examine the impact of incarceration itself, and epidemiology at The Alpert Medical School. what happens behind bars, on public health and public safety He points out that methadone is one of the only medications outcomes, and tailor our policies appropriately,” Dr. Rich said. v

W&I physician awarded $1.6M grant

PROVIDENCE – Kristen A. Matteson, MD, MPH, on a woman’s quality of life, often leading women of the Department of Obstetrics and Gynecolo- to utilize expensive medical resources.” gy at Women & Infants Hospital and assistant There are two commonly prescribed non-surgical professor of obstetrics and gynecology at The treatments for heavy menstrual bleeding – com- Warren Alpert Medical School of Brown Uni- bined oral contraceptives and the levonorgestrel versity, has earned a $1.6 million grant from intrauterine system (the use of an intrauterine de- the Eunice Kennedy Shriver National Institute vice (IUD) with progestogen). However, studies of Child Health and Human Development of comparing these treatments are extremely limited. the National Institutes of Health to study the The primary goal of the study is to determine the effectiveness of two treatments options for relative effectiveness of both treatment options in heavy menstrual bleeding. improving the quality of life in women with heavy WOMEN & INFANTS HOSPITAL WOMEN & INFANTS “Heavy menstrual bleeding is one of the menstrual bleeding. The study will also compare most common gynecologic problems women encounter,” rates of treatment failure (defined as stopping the treatment explained Dr. Matteson. “It is such an important problem to and/or request for surgery). study because heavy menstrual bleeding has a negative impact Enrollment in the study will begin in the fall. v

WWW.RIMED.ORG | RIMJ ARCHIVES | MAY WEBPAGE MAY 2013 RHODE ISLAND MEDICAL JOURNAL 66 IN THE NEWS

Traumatic brain injury in patients Research links with nonepileptic seizures ups risk chemoresponse assays, for psychiatric disorders improved ovarian cancer

PROVIDENCE – A new study by a Rhode Island Hospital survival rates researcher has found that traumatic brain injury (TBI) can sig- PROVIDENCE – A team of re- nificantly increase the odds of having major depression, person- searchers has released results ality impulsivity and post-traumatic stress disorder (PTSD) in from an eight-year study that patients with psychogenic nonepileptic seizures (PNES). The shows improved survival rates paper, by W. Curt LaFrance Jr., for women diagnosed with ovar- MD, MPH, director of neuropsy- ian cancer who undergo cancer chiatry and behavioral neurology, tumor testing to determine the WOMEN & INFANTS HOSPITAL WOMEN & INFANTS was published in the April edition best treatment. of the journal Epilepsia. Part of the team was Richard G. Moore, MD, director of the “Some patients who sustain Center for Biomarkers and Emerging Technologies and a gyne- a TBI develop seizures,” Dr. La- cologic oncologist with the Program in Women’s Oncology at France said. “Very often, these sei- Women & Infants Hospital of Rhode Island. zures are believed to be epileptic “Essentially, we have demonstrated that by using a tissue in nature, and the patient, there- sample from the patient’s tumor and a chemoresponse assay, we fore, is treated for epilepsy. Later are able to determine which treatment may or may not work for the seizures are found to be PNES. her,” Dr. Moore explains of the study, which was presented at a This study demonstrates the prev- recent meeting of the Society of Gynecologic Oncology and in alence of co-morbid mild TBI and the journal Cure. PNES, which could suggest that “This study shows that a woman with recurrent ovarian can- BROWN some patients are being inappro- cer could benefit from having a biopsy and chemosensitivity priately treated for epilepsy with antiepileptic drugs, while not testing. The results from such testing will allow for the identifi- being treated for their actual illness: nonepileptic seizures.” cation of chemotherapeutics that are active against the patient’s The study underscores the importance of identifying and disease and those that are not resulting in decreased toxicity addressing the impact of TBI in patients with seizure disorders from ineffective treatments. Learning that personal directed to ensure appropriate and effective treatment. therapies may improve overall survival for these patients made “Another significant finding from the study was that if a this the first study in two decades to show a significant increase patient had both PNES and TBI, the combination resulted in in survival in recurrent ovarian cancer.” 2.75 odds increase of having PTSD, and triple the odds increase The study, launched in 2004, included 283 women. Of those, of having a history of trauma/abuse,” Dr. LaFrance said. “This 262 had successful biopsies which were tested in vitro, or in finding illustrates the importance of the ‘double hit’ of emo- a test tube. The assay ChemoFx®, by Precision Therapeutics, tional and physical traumatic experiences that may occur with tested up to 15 approved treatment regimens on the samples, abuse and/or a head injury commonly found in the PNES pop- identifying chemotherapy drugs and regimens to which each ulation. This study shows that TBI and PNES are significantly tumor might be sensitive. The study was non-interventional, associated with a cluster of diagnoses including depression and meaning that physicians chose the treatment regimens without PTSD, personality, and/or trauma/abuse history, all of which knowing of the assay results. The researchers then evaluated could have an impact on functioning.” the assay’s result against actual patient outcomes. Mild TBI appears to be a significant risk factor in patients with “The assay identified at least one treatment to which the PNES, and is associated with increased psychiatric co-morbidity, tumor would be sensitive in 52% of patients in the study,” Dr. symptom severity, poor functioning and increased disability. v Moore says. “Overall, median survival was 37.5 months for patients with treatment-sensitive tumors, compared to 23.9 months for intermediate and resistant tumors.” Assay-directed therapy has long been debated among on- cologists, he continues. Such debate provided the impetus for this study. v

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Bridging Neurology & Psychiatry: Movement Disorders Saturday, October 12, 2013 The Joseph B. Martin Conference Center at Harvard Medical School Boston, Massachusetts

This full day course is aimed at reviewing the interface between neurology and psy- chiatry to enhance the clinician’s ability to recognize and classify movement disorders in psychiatric patients and psychiatric problems in movement This course is designed for neurologists, disorder patients. Behavior problems are the major determinants psychiatrists, primary care physicians, of quality of life in Parkinson’s disease yet they are often not rec- nurses, psychologists, pharmacists, phy- ognized. Similarly, movement disorders caused by antipsychotics sician assistants, social workers, medical frequently go unrecognized. students and fellows. World renowned experts in movement and psychiatric disor- Click to download the Course Program. ders will review drug-induced movement disorders, psychogenic Register Online: http://www.worldwide movement disorders and movement disorders associated with medicalexchange.org/content/movement- primary psychiatric disorders. disorder-course

MAY Innovative Approaches to Medication Management Networking Dinner and Panel Discussion 3rd Annual Rhode Island Stroke Conference May 22, 2013, 5:30pm Keynote Speaker: Mark J. Alberts, MD, FAHA Location: 235 Promenade Street, Suite 500 May 3, 2013, 7:15am Register Crowne Plaza Providence-Warwick Conference Agenda and Registration Information JUNE

Rhode Island Medical Women’s Association Scope of Pain 2013 Annual Meeting & 32nd Anniversary Celebration Safe and Competent Opioid Prescribing Education Wednesday, May 13, 2013 June 8, 2013, 7:30 am–1:30 pm Providence Marriott Hotel, One Orms Street Warren Alpert Medical School 6:30 pm Reception, 7 pm Dinner and Program To register, visit www.scopeofpain.com This meeting is open to medical and non-medical communities.

Collaborative Office Rounds 2012–2013 Series Public Health Grand Rounds Webcast Event (CME credit) (CME credit) May 16, 2013 , 8:30 am–9:30 am Motivational Interviewing for Adolescent Alcohol and Marijuana Use All are welcome to attend sessions at South County Hospital Lessons Learned about Shared Decision Making: and Westerly Hospital or participate online via webcast. The Group Health Story Wednesday, June 12, 2013 Ben Moulton, JD, MPH 7:30 a.m.–9:45 a.m. Dr. Moulton is the senior legal adviser at the Foundation for Informed Medical Decision Making. He provides health law Anthony Spirito, PhD, ABPP oversight and guidance to all foundation activities to support Professor of Psychiatry & Human Behavior sustainable models of health care that include informed medical Director, Division of Clinical Psychology decision making and improved quality of medical decisions. In Warren Alpert Medical School of Brown University addition, Dr. Moulton is an adjunct professor of health law at Webcasted and Live the Boston University Law School and the Harvard School of http://med.brown.edu/cme/brouchure/COR-2013%20Sessions.pdf Public Health. Pre-register online

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