The Leg.Up Local, state and national news of interest to the physician community
October 25, 2017
Gillespie/Northam Race in National Spotlight
Amid conflicting poll data, Virginia's gubernatorial election on Nov. 7 is drawing national attention, including a Democratic National Committee meeting that had "one worry on every activist's mind: We'd better not lose the Virginia's race," reports The Washington Post.
The Post notes that "it's a surprising case of the jitters over a place that hasn't elected a Republican to statewide office in eight years - and that voted resoundingly against Donald Trump last year.
"But nationally, Democrats haven't won a marquee race since losing the presidency. They lag Republicans in fundraising. A loss for Lt. Gov. Ralph Northam against Republican Ed Gillespie on Nov. 7 could stir doubts about message and strategy just as the party is gearing up Northam (l) and Gillespie: Too close nationally for next year's all- to call? important midterm elections."
One Democratic official called Virginia "Ground Zero. All eyes are on us."
Defeat in Virginia could "prompt another brawl between progressive activists" who aren't thrilled by Northam and the party's establishment that backed him over the more progressively-minded Tom Perriello."
A Northam loss "would set the stage for more infighting in 2018," says the Post.
In an effort to counter the national GOP's wide lead in fund raising over the Democrats, "A group looking to turn out key Democratic- leaning demographics plans to spend just over $1 million in Virginia," reports Politico. "Some Democrats have worried about the low-key, genial Northam's ability to excite the progressive base."
Today's Post profiled Northam as a doctor and politician -- and how he sometimes struggles with the dual roles in his race with Gillespie, who the Post called "a much more polished politician."
Click here for an article about a push against Northam by Americans for Prosperity, "the heart of the billionaire Koch Brothers' conservative political network." The Koch-backed group plans to spend at least $1 million on mailers and digital ads targeting Northam's record, reports The Washington Post.
A Roanoke Times editorial notes how polls have been "all over the place, ranging from Democrat Ralph Northam with a lead of 14 percentage points in the Quinnipiac Poll to Republican Ed Gillespie with a lead of 1 percentage point in the Monmouth Poll. Lots of others were in between."
How can the polls be so different?
"The answer is they are all based on different assumptions about what the electorate who show up at the polls on Nov 7 will look like," the Roanoke paper opines.
Quinnipiac assumes the Democrats - eager to send an anti-Trump message -- "will outnumber Republicans by 10 percent," leading to a double-digit lead, while "Monmouth assumes Republicans will outnumber Democrats by 2 percent, which inevitably leads to the slight Gillespie lead."
If other off-year elections in Virginia are a guide, the paper expects "better news for Republicans than for Democrats." Click here to find out why.
Meanwhile, in a local General Assembly race, Del. John M. O'Bannon III is facing his first opponent in eight years, the Times-Dispatch reports.
O'Bannon, a neurologist for HCA Hospitals and a former RAM president, "faces a spirited challenge by Debra Professor Rodman (l) challenging Dr. H. Rodman, an associate O'Bannon college professor who won the Democratic nomination in June in a field of four candidates calling for change."
Congratulations to . . .
Congratulations are in order for a number of RAM Members who participated in the Medical Society of Virginia's Annual Meeting in Norfolk, Virginia this past weekend as well as our District. Dr. Richard A. Szucs, former RAM president and current chair of Honoring Choices Virginia Advisory Board was elected Vice- President of the Medical Society of Virginia this past weekend. Dr. Szucs is an exceptional leader and will guide MSV in the coming years with courage, grace and purpose. In addition to Dr. Szucs serving as MSV's Vice-President, Drs. John Butterworth and Peter Zedler will serve as Directors from District 3 and Dr. Clifford Deal will serve as our Associate Director. Dr. Mark Hylton has also been elected to serve as the MSV Dr. Szucs being recognized Resident Board Member. as MSV's next Vice President
We hope you'll make plans now to attend next year's MSV Annual Meeting --- October 19-21, 2018 at the Hotel Roanoke --- and be there to watch Dr. Szucs' inauguration!
The Academy would also like to congratulate Dr. Cliff Deal on his recognition as founder of MSV's Student Section which celebrated its 20th anniversary this year! In 1997, Dr. Deal spearheaded the effort to create MSV's Medical Student Section (MSS) and has continued to provide support, leadership and mentorship to the MSS. This section has played a vital role in MSV's legislative advocacy efforts and numerous medical students from MSV's MSS have been elected to AMA regional and national positions. Thank you, Dr. Deal, for your dedication to Virginia Medical Students! Dr. Deal being recognized for his role in forming the Medical Student Section And once again, MSV District 3/Richmond Academy of Medicine received the MSVPAC District Achievement Award. This award was presented to the physicians of MSV District 3 for raising the highest total contributions to MSVPAC - over $50,000. The physicians of MSV District 3 continue to demonstrate leadership through their enormously successful fundraising efforts on behalf of the MSVPAC.
A special thanks goes out to all RAM physicians who attended the MSV Annual Dr. Bear accepting the Meeting on behalf of the Academy, on MSVPAC District Achievement Award behalf of their specialty societies, or as an MSV designated delegate, especially our first time Delegates Drs. Quinn Lippman, Susan Miller, Dishant Shah, and Bruce Silverman. All of our delegates worked to pass resolutions addressing improving obesity Medicare & insurance coverage, improving step therapy in Virginia, improving prior-authorization laws in Virginia, improving tobacco control and working to identify policy changes to require health plans participating in the Commonwealth of Virginia State Benefits Program to also provide individual coverage for the public at large in the regions in which they participate.
CLICK HERE to see our delegates at work (and play) at this year's MSV Annual Meeting
What Do Patients Really Want? Be prepared to laugh and learn at RAM's Nov. 14th dinner program
It's no secret that patients are more tech savvy and informed than ever before. And they will leave you for your competitor. In a heartbeat. But what do they really expect from their healthcare experience? The answer is (SPOILER ALERT!): more than just medical treatment.
But the good news is that the things patients expect and want most from you are often easy to give, if we make them a priority in our organizations. Don't miss this dinner program where GeGe Beall, MS, FACHE, owner of Engaged @ Work will reveal what YOU as a physician can - and should - be doing to make your practice the obvious choice for patients!
Join us on Tuesday, November 14th at the
University of Richmond Jepson Alumni GeGe Beall, MS, FACHE Center. Cocktails at 5:30 p.m., dinner at 6:15 p.m. and the presentation at 7:00 p.m. FREE to you as a member benefit! Guests welcome for $40 guest fee.
While you're here, get your HEAD SHOT taken for FREE! Professional photographer Jay Paul will be ready to take the PERFECT shot that you can use for your ONLINE PROFILES and for our upcoming RAM Online Member Directory! Don't miss this rare FREE opportunity!
or email Lara at [email protected] or call her at 804-622-8137
Attend an Upcoming Legislator Meet & Greet
Please join us on Thursday, Nov. 30 or Thursday, Dec. 7 for one of our annual legislator meet and greets. Get to know your elected officials! Come out and enjoy light refreshments and a discussion of physicians' concerns. We want to see you there!
THURSDAY, NOVEMBER 30 7:00 - 8:00 a.m. St. Francis Medical Center Assisi Conference Room 13710 St. Francis Boulevard Midlothian, Virginia 23114
Come hear from Senator Siobhan Dunnavant and Delegates Riley Ingram, John O'Bannon and Lee Ware.
THURSDAY, DECEMBER 7 6:00 - 7:00 p.m. Virginia Eye Institute St. Francis Huguenot Bridge Medical Center 400 Westhampton Station Building B Richmond, VA 23226 Virginia Eye Institute
Meet with Delegates Betsy Carr, Delores McQuinn, John O'Bannon and Chris Peace.
Click here to sign up for the 11/30/17 Meet & Greet at St. Francis Medical Center from 7-8 a.m.
Click here to sign up for the 12/7/17 Meet & Greet at Virginia Eye Institute from 6-7 p.m.
or email Lara Knowles at [email protected] to register!
VOTE NOW!
Cast your vote NOW in the RAM Board of Trustee Elections!
The electronic polls are open until 11:59 p.m. on November 13. Click below to vote for President, Treasurer, Secretary and Trustee positions for the 2018-19 term. You will be prompted to Log In to vote. If you have not created a password (or don't remember) click "password" and follow the prompts.
Vote NOW by clicking here!
High Cost of Opioid Epidemic: "Dozens Die. Hundreds are being revived"
Click here to read an in-depth report in last Sunday's Times-Dispatch on the high price being exacted daily by the opioid epidemic. Statewide, ODs now kill more people than gun shots or car wrecks.
"There have been 19 a week on average this year in the city, where ambulance crews are on pace to treat 40 percent more overdoses than last year and more than twice as many as in 2015," the TD reports.
The Richmond region "trails only Roanoke for the highest rate of emergency room visits for opioid overdoses in Virginia over the past five months," with Henrico County seeing a 37.5 percent increase between 2016 and 2017, and Hanover's rate increasing by a 66.7 percent clip. The city of Richmond's rate increased by a lesser amount (20 percent), but it continues to lead the region in overall ODs (306 cases last year).
Click here to read about the only "silver lining" in the story - the increasing use of naloxone (Narcan) to prevent deaths. So, for example, "the number of nonfatal overdoses is up more than 25 percent in the Richmond region compared with last year."
But the epidemic has strained the resources of local jails and state morgues which have seen "an influx of bodies in need of processing."
Don't Blame Docs for Opioid Crisis: How Congress Called Off DEA's Watchdogs
For years, Big Pharma has put much of the blame for the nation's opioid crisis on doctors for allegedly overprescribing their pain pills.
But a recent investigative project by CBS' "60 Minutes" and The Washington Post shows otherwise - and in fact, clearly traces the Big Money by Big Pharma going into the very open pockets of several prominent members of Congress, including Utah's powerful Sen. Orrin Hatch who received $177,000. Click here for the full report.
"In April 2016, at the height of the deadliest drug epidemic in U.S. history, Congress effectively stripped the Drug Enforcement Administration of its most potent weapon against drug companies suspected of spilling prescription narcotics onto the nation's streets," the Post reports.
"By then, the opioid war had claimed 200,000 lives, more than three times the number of U.S. military deaths in the Vietnam War. Overdose deaths continue to rise. There is no end in sight."
The investigative article details how "a handful of members of Congress, allied with the nation's major drug distributors, prevailed upon the DEA and the Justice Department to agree to a more industry-friendly law, undermining efforts to stanch the flow of pain pills."
Big Pharma spent millions lobbying Congress, including more than $100,000 given to Rep. Tom Marino, a Pennsylvania Republican who became President Trump's nominee to become the next drug czar.
That soon changed after Mr. Trump announced that Marino had withdrawn as the administration's nominee, reports Politico.
Meanwhile, Sen. Claire McCakill (D-Mo.) said she would introduce legislation to repeal the 2016 law that hampered the DEA's ability to regulate opioid distributors it suspects of misconduct, reports STAT News.
Click here to read more about how the drug-makers managed to call off the dogs from the DEA and continue to wield a big leash around Washington.
Bon Secours New Surgical Program Reduces Opiod Use
Click here to read about a successful program at Bon Secours Richmond Health System's St. Mary's Hospital that reduces the time patients stay in the hospital after surgery, making them "less likely to use opioids for their post- surgical pain."
Since August, 2016, St. Mary's Enhanced Recovery Program has changed the protocols for patients receiving open and laparoscopic colorectal surgery.
According to St. Mary's, the more than 100 patients involved have experienced an 80 percent reduction in post-operative opioid use.
The new protocol includes allowing clear liquids up to two hours before and after surgery, a diet that minimizes IV fluids, tubes and drains, and using fewer narcotics and more non-opioid painkillers.
RAM Still Jamming After (nearly) 200 Years!
Click here for the Fall 2018 edition of Ramifications.
President Dr. Harry Bear reminds us of why the Academy continues to grow within three years of its bicentennial celebration in 2020.
"At a time when most local and regional medical societies are in decline or have become extinct, RAM has continued to flourish and get stronger," he writes.
"With nearly 2,500 active members, our continued viability is due in part to partnership with the area's three major health systems - VCU Health, Bon Secours Richmond and HCA Virginia - along with other practice groups that Dr. Bear (right) with his support us with dues for their employed energetic mentor, Dr. physicians. In return, RAM strives - in the Walter Lawrence words of our mission statement - to be 'the patient's advocate, the physician's ally, and the community's partner.'"
You'll find a number of informative and thought-provoking articles, including Dr. Isaac Wornom on "Medicine as Magic: How patients perceive what we do for them;" Executive Director Jim Beckner on "Our Legacy of Healing;" Drs. Mark Monahan and Harry Gewanter on the importance of legislative advocacy, "Speak Up or Forever Hold Your Peace;" and "Healing Patients' Bodies, Physicians' Souls."
In addition, Dr. Judy Chin reflects on the 20th anniversary of Women in Focus; Dr. Janet Eddy writes about how climate change is affecting her patients in Richmond, plus much more, even an article on the legalities of "Workplace Body Art."
Just click here to enjoy it all!
Dr. Chin on Women in Focus 2.0!
Funeral Directors/ MSV Upgrading E-Death Registry
The Medical Society of Virginia and the Virginia Funeral Directors Association are working together to improve Virginia's Electronic Death Registration System (EDRS) that can be used by physicians and funeral directors alike.
"No longer do the funeral directors have to chase down the physician to get a signature," writes one physician in a joint newsletter. "They can sign from anywhere... The beach, the office, or any other place of their choosing."
After the system's start in 2014, the two groups have been "moving the needle in a positive direction," working out some early glitches.
Click here for help from the Virginia Department of Health.
Dr. Elliott on Operating in South Sudan
Click here for an excellent column by Dr. David Elliott, a RAM speaker, contributor to Ramifications and a dedicated member of Doctors Without Borders.
On his third day in war-riddled South Sudan, Dr. Elliott begins with his arrival in the capital city of Juba where he found A five-year-old girl who had arm patients "lobbying to be next amputated. (photo courtesy of up for an operation, as they Times-Dispatch) had been languishing for more than a week with pain and infection - casualties of the recent upsurge in violence in the long-running civil war in South Sudan."
Click here for an earlier article by Dr. Elliott in the Fall 2016 edition of Ramifications (page 12): "The surgeon becomes a thief."
Virginia Braces for CHIP's End
After weeks of foot-dragging in Congress, state Medicaid officials have started "unwinding a program that insures 65,000 children and 1,100 pregnant women in the state," reports the Times-Dispatch.
In this report on the lapse in federal funding for the Children's Health Insurance Program (CHIP), the TD reports that the state Department of Medical Assistance Services (DMAS) "has to be ready by the beginning of December so it can give families at least 60 days notice that their children will no longer be covered by the program when money runs out at the end of January."
"Congress is acting as if it's just a matter of when the money runs out, and they're not acknowledging the work and the investment that states have to make in trying to do this in the least chaotic way possible," said Linda Nablo, DMAS' chief deputy director.
Click here to read more about what's at stake and would happen to women and children if they lost the medical coverage.
Gov. Terry McAuliffe jumped into the fray, saying this week that he'd like to get the General Assembly to reconsider its position against Medicaid expansion in Virginia. Click here.
RAM Family Farm Fun on Facebook!
Maybe YOU were there, or maybe not, but either way, click here to see our recent fun at RAM's second annual Fall Family Event at Lloyd Family Farms!
And mark your calendar for our Winter Family Event on Sunday, December 3 from 5 - 8 PM at Lewis Ginter's GardenFest of Lights.
CLICK HERE to Dr. Sylvia Gonsahn- RSVP. Bollie & friend!
Study: Global Pollution Takes Huge Toll on Health
From dirty air in India and China to tainted water in sub-Saharan Africa, pollution around the globe now contributes to an estimated 9 million deaths annually - or roughly one in six - according to a new study in Lancet.
"If accurate," reports The Washington Post, "that means pollution kills three times more people each year than HIV/AIDS, tuberculosis and malaria combined, with most of those deaths in poor and developing countries.
"And the warming of the Earth's climate is likely to fuel more deaths in the absence of international action," said former EPA administrator, Gina McCarthy who wasn't involved in the study.
The findings are consistent with the views expressed by RAM member Dr. Janet Eddy in her article in the latest edition of Ramifications, "The human face of climate change." (page 12). Click here!
Dr. Eddy, Medical Director of Bon Secours Care-A-Van, Dr. Eddy notes that "while reasonable people can disagree on whether human activities are causing the climate to change, the fact remains that change is occurring and it is taking a toll on our health."
To cite just one example: "Spring arrives about a week earlier than it did in the late 1980s," she writes, which in turns "lengthens the tree pollen season" - bad news for everyone, but especially allergy and asthma sufferers." Check out her tips for what physicians can do!
Why Maintaining Board Certification Really Matters
If you've ever wondered why it's important not to lapse in board certification, click here to read about 15 Nebraska women who have filed lawsuits alleging medical malpractice by an Omaha doctor and his cosmetic surgery clinic.
According to Omaha.com, the lawsuits claim the "women suffered scarring, disfigurement and pain as a result of the actions of Dr. Gerard J. Stanley Jr. and his Sculpt Contemporary Cosmetic Surgery in Omaha."
The legal claims allege that Stanley "held himself out to them as a 'board-certified' surgeon qualified to perform cosmetic and plastic surgery."
But, according to the news report, "Stanley is board-certified in family medicine," not in cosmetic or plastic surgery.
Click here to learn more, including the contention by the physician's attorney that the legal claims were generated by a disgruntled employee who'd been fired.
Emergency Medicine: Innovation in Patient Safety
Roneet Lev, MD, FACEP, chief of the emergency medicine department at Scripps Mercy in San Diego, describes changes they made to improve patient safety based on the data and recommendations in The Doctors Company's Emergency Medicine Closed Claims Study.
Click here to view a video about this important work!
First, the study identified the need for rapid recognition of stroke patients and treatment for tissue plasminogen activator (tPA). Dr. Lev's hospital system now takes stroke patients straight to a CAT scan without stopping at an emergency department bed, and the entire stroke team is activated.
Second, many patients are on blood thinners, which can lead to complications in the epidural space with neurological implications. Now any patient on blood thinners is considered a potential risk for bleeding anywhere in the body.
Third, physician assistants and nurse practitioners in emergency medicine settings often handle wound care as an area of risk. Now any wound with a tendon injury has to be explored by a physician before closing the wound.
Fourth, discharge instructions are emphasized to identify the patient's responsibilities.
The Doctors Company is the nation's largest physician-owned malpractice insurance company. Your RAM membership gets you a 5% discount in premiums in addition to receiving financial rewards for practicing good medicine upon your retirement. To learn more, or for a price quote, contact the Academy's endorsed insurance partner - the Medical Society of Virginia Insurance (MSVIA) - at (804) 422-3100.
Virginia in AMA's Study of Anthem-Humana Merger
Click here for a new AMA study of the potential increases in Medicare Advantage premiums if Anthem and Humana merge. Virginia is listed as one of the states that could be hurt by a decrease in competition among insurers, reports HealthDay.com
Charlottesville, Winchester and the Hampton Roads region are cited as regions that could be most hurt by the merger. (The Richmond region was not listed.)
Speaking of Anthem: click here to read about its plans to start its own business to manage prescription drug plans with CVS Health.
"The insurer is in the midst of a bitter legal battle with Express Scripts," reports The New York Times, "its current pharmacy benefits manager, over claims that Anthem has been overcharged."
Anthem hopes to save $4 billion a year after its contract with Express Scripts expires in 2020, "the bulk of which it said would flow to customers in the form of lower drug costs."
Caring for Family Caregivers
Caregivers often find they need help when they are unable to provide care to their loved one or would like to take a break from their caregiving duties. They also may need guidance on choosing those care providers.
For more information, call (800) 552-3402 or visit www.vda.virginia.gov or www.SeniorNavigator.org
Five Things You Can Do to Protect Yourself!
"As physicians," blogs Dr. Nisha Mehta on KevinMD.com, "we're groomed to take care of patients. During training, we don't talk about compensation, work-life balance, or the business of medicine.
"In many ways it's frowned upon, and our hierarchal systems discourage open conversation on these subjects. We also very rarely say 'no' during the course of our training, and this tendency stays with us..."
So if you want to say "yes" to sometimes saying "no," click here!
Peds' New Germ-Control Advice: Parents, Bring Your Own Toys!
As we enter cold and flu season, "Many parents worry about taking children to the doctor's office, and sitting in a waiting room full of sick children," reports The New York Times.
While it's well known that hospitals can be dangerous places for disease transmission, the article notes that most pediatric medical care takes place in the office or the clinic.
On Monday, the American Academy of Pediatrics issued a new policy statement, "Infection Prevention and Control in Pediatric Ambulatory Settings," to help stop the spread of germs in waiting rooms and exam rooms. Click here to read.
Of particular note: "Specific advice for the waiting room includes bringing along a toy from home. Even if they are disinfected daily, as the policy advises, toys that multiple children handle in the waiting room may harbor germs, so the new statement suggests that parents pack their own."
Click here to read about the issue, including this: "There's no good data that says having a 'sick kid waiting room' is going to prevent transmission," said Dr. Mary Anne Jackson, the director of infectious disease and professor of pediatrics at Children's Mercy Hospital in Kansas City, who is a co-author of the policy statement.
Mea Culpa
We draw from a wide range of print, online and medical journals to bring you information we hope is relevant to your practice of medicine.
But as a former reporter, editor and author, I recognize that mistakes do happen. So please contact me if you have any concerns, complaints, or ideas/articles you'd like to share by clicking here or calling 622- 8136.
Click here if you'd like to see some of my books. THANK YOU for being part of the Academy and its continuing conversation about the best practice of medicine.
Click here for past editions of The Leg.Up!
Chip Jones RAM Communications & Marketing Director
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