East TN Medical News May 2013

By ciNdy SaNdErS

What if the standard treatment approach was the wrong one? In the case of several autoimmune disorders, it’s a theory that is gaining traction bolstered by recent research fi ndings.

Stephen A. Paget, MD, FACP, FACR, MACR, physician-in-chief emeritus at the Hospital for Special Surgery in New York City, has spent his career researching and treat-ing a range of infl ammatory and autoimmune disorders. The rheumatologist, who is

also a professor of Medicine and Rheumatic Disease at the Weill Med- i -cal College of Cornell University, said the potential exists for a paradigm shift in how clinicians view and treat some disorders including reactive arthritis, Whipple’s disease and persistent Lyme disease.

Paget said the accepted concept has been “that in a genetically predisposed person, with some type of environmental trigger … probably virus or bacteria … they develop disease.” Although the initiation was from a microorganism, he continued, the conventional wisdom has been that the self-perpetuation of symptoms is due to the body’s subsequent response. “What you were left with was an infl ammatory problem that was no longer tied to the previous organism,” Paget explained.

A good example would be persistent Lyme disease. The infectious trigger is the Borrelia burdorferi, a bacterial

Malcolm Foster, MD

PAGE 3

PHYSICIAN SPOTLIGHT

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Healthcare Leader: New TMA President Dr. Chris Young Pushes Doctors to Become Advocates for Care

For most of his career, Chris Young, MD, has been putting people to sleep. These days, he wants them awake, and listening, as he advocates for Tennessee doctors and medical professionals ... 4

Wine 201Headaches from Wine - Is it the Sulfi tes?

Some people claim to get headaches from only one glass of wine. Surely it’s not a hangover from one glass. Is it due to sulfi tes, an allergy, or dehydration? ... 6

Special Advertising

Constipation ... 9

FOCUS TOPICS AUTOIMMUNE DISORDERS MARKETING/COMMUNICATIONS

(CONTINUED ON PAGE 10)

The Move from Social Media Marketing to Social Business Strategies

423-929-2111 • www.JohnsonCityEye.comJohn Johnson, MD Alan McCartt, MD Michael Shahbazi, MD Amy Young, MD Randal Rabon, MD Jeff Carlsen, MD James Battle, MD Calvin Miller, MD Peter Lemkin, OD

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Unconventional WisdomRethinking the approach to some autoimmune disorders


Dr. Stephen A. Paget

By ciNdy SaNdErS

Earlier this year, Andrew Dixon, senior vice president of marketing and opera-tions with Igloo Software and the former chief marketing offi cer for Microsoft

Canada, was invited to Dallas to share insights on how healthcare organi-zations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit.

At the core of a social business strategy is the desire to deepen connec-tions, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities

might be other practitioners, researchers, payers, staff, and … of course … patients.

“Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.”

One of the fi rst steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in

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PhysicianSpotlight

By Brad Lifford

As an interventional cardi-ologist and clinical researcher at Tennova’s Turkey Creek Medical Center, Malcolm Fos-ter, MD, is accustomed to seek-ing the latest advancements that could be a breakthrough for patients. But to see a new procedure he performed be-come the subject of a major network drama ... that’s an-other thing altogether.

The show is about doctors, but Foster said he doesn’t typi-cally watched Grey’s Anatomy. He made an exception for this episode, however.

“They featured the Para-chute device for one of their patients; it was a patient with congestive heart failure,” Fos-ter said, “so, yes, I did watch it that night.”

Where Grey’s Anatomy was realistic fiction, Foster’s experi-ence was wholly real.

The TV drama came on the heels of Foster implant-ing the Parachute device into device into the heart of a Sevierville man with CHF. Foster, who practices with East Tennessee Heart Consultants, performed the proce-dure at the Tennova Heart Institute in a little over an hour and with minimal inva-sion.

The patient, Gregg Fruchtnicht, ben-efited from the fact that Foster and ET Heart Consultants are on the leading edge of heart care. When Fruchtnicht under-went the procedure on Feb. 6, he became the first patient in Tennessee – and only the third in the nation – to participate in the Parachute IV clinical trial.

Manufactured by California-based CardioKinetix, Inc., the Parachute Ven-tricular Partitioning Device possesses a name that reflects its form and function to the letter. When implanted in the heart, the device very much resembles a de-ployed parachute, and it is employed to as a means of partitioning off damaged heart muscle from the functional segment.

Inserted by catheter through the femoral artery, the Parachute essentially remolds the enlarged heart muscle to im-prove its function, Foster explained. The Parachute is designed for implantation into the left ventricle, which is frequently enlarged in patients with heart failure. The condition leads to a decrease in car-diac output and can result in shortness of breath, one of the most pervasive symp-toms for those with heart failure.

Foster said that the procedure for Fruchtnicht went “extremely well,” and that he was encouraged by a nearly im-mediate improvement in the patient’s breathing. And Fruchtnicht, for his part, was hopeful not only for himself but also

other men and women who share his pre-dicament.

“I can climb stairs now without be-coming completely winded – something I could not do before this procedure,” Fruchtnicht said. “It’s gratifying to be a part of something that may become a standard treatment for others like me.”

The randomized Parachute clini-cal trial will measure mortality, hospital-ization for worsening heart failure and functional outcomes, along with other measures. Foster is encouraged that the procedure could be a difference maker.

“When we place the Para-chute device,” Foster said, “we can change the geometry of the heart and reduce the ventricu-lar volume by about 30 per-cent and improve the pumping function of the heart. With that first implant, we’ve already seen significant improvement not only in his breathing but also his exercise level. It’s an investigational device, so we’re still in the process of evaluating its safety and benefits.”

It’s not possible to over-state the burden that conges-tive heart failure places on those who suffer from it or its impact on the healthcare sys-tem. More than six million Americans are affected by heart failure, and the heart’s

inability to supply sufficient blood flow to the body can be debilitating or fatal. It also consumes a huge share of healthcare resources.

“Congestive heart failure is the No. 1 admitting diagnosis for hospitals all across the county, at least for Medicare patients,” Foster said. “It’s a serious con-dition, a chronic condition, and we don’t have a cure. And patients with CHF have so many readmissions – we have a diffi-cult time keeping them out of the hospital. Another issue is that it’s becoming more and more common with our aging popu-

lation.”Coronary artery bypass surgery is a

possible treatment for some patients—Fruchtnicht had had five bypasses prior to Foster implanting the Parachute de-vice—and even heart transplant is another option. But with the latter in particular, Foster said, the number of patients who would be candidates is limited.

“There is the possibility of transplant, but it really only applies to a small percent-age of patients,” Foster said. “There are only so many hearts available (for trans-plant), and that number hasn’t changed over time.”

The Parachute device does show early promise, and Foster points to an-other device that he and colleagues turn to, with heart transplant being a remote option for most patients. A left ventricular assist device, or LVAD for short, is a sort of mechanical heart which can’t replace the organ, but can augment the function of a heart that has severe dysfunction.

“It’s basically a mechanical pump,” Foster said, “that’s surgically implanted inside the heart. For patients with end-stage heart disease, the LVAD has proved to be as good or better when compared to transplants; it’s at least had results compa-rable to transplants. We’ve had patients of ours who receive LVADs, who used to be patients who would have regular readmis-sions to the hospital, and now those pa-tients are literally playing golf and farming and leading very active lives.”

Foster and his colleagues at East Ten-nessee Heart Consultants will continue to search for the latest treatment modali-ties for patients, hence, his participation in the Parachute IV trial. That only the third procedure was performed in Knox-

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During a procedure at Turkey Creek Medical Center, Malcolm Foster, MD, inserts the Parachute IV through the artery of patient Gregg Fruchtnicht who suffers with CHF (Congestive Heart Failure).



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HealthcareLeader

New TMA President Dr. Chris Young Pushes Doctors to Become Advocates for Care

By JoE MorriS

For most of his ca-reer, Chris Young, MD, has been putting people to sleep. These days, he wants them awake, and listening, as he ad-vocates for Tennessee doctors and medical professionals.

As the newly inau-gurated, 159th president of the Tennessee Medi-cal Association (TMA), Young will oversee the organization, while also serving as its public face. That means he’ll be speaking on behalf of almost 8,000 physicians, a job the board-certified anes-thesiologist takes very seriously.

“We are the largest physicians’ or-ganization in Tennessee, and one that’s composed of local medical societies and physicians at large,” said Young, who practices at Erlanger Medical Center with Anesthesiology Consultants Ex-change. “We are the voice of medicine in Tennessee, and so I think we can have an enormous amount of influence on how healthcare is delivered in Tennessee.”

Healthcare has always loomed large in Young’s life. After growing up in Knoxville and working at what is now Fort Sanders Regional Medical Center, Young developed an interest in medicine. His father was a surgeon, and so he knew what to expect once he finished medical school at Georgetown University School of Medicine. Eventually, he found his way to anesthesiology, and after residency and

a teaching stint at SUNY Health Science Center in Syracuse, NY, he made his way back to Tennes-see.

“I like it [anesthe-siology] because it’s just remarkable that we can give people drugs and make them invincible to dramatic invasions of the human body,” he explained. “And then we wake them up, and they are fine. It’s something of a miracle. And it’s just the same for local anesthesia,

where we render a portion of the nervous system insensible for a temporary period of time. Being able to relieve pain in that way is something that is very appealing to me.” Another aspect of anesthesiology that ap-peals is that while it’s very procedure ori-ented, often he is dealing with critically ill people, and there’s a fairly fast pace no matter what’s going on.

“I get to see all kinds of patients, from children to the elderly, as well as people who are very sick to women who are having babies, so it’s a wide spectrum,” he said. “That’s very appealing as well.” He’d never gotten heavily involved in practice administration, but did start to become more involved in the business side of medicine thanks to his involvement and leadership within the Tennessee Society of Anesthesiologists, and the legislative con-ferences that entailed.

“I learned a lot about the interac-tion of government and medicine on the national level, and when I became that

society’s president, I became even more aware of those interactions,” he said. “In 2007, I was elected to the board of trustees for the TMA, and began to understand that even though physicians are special-ized, the similarities between us are far greater than our differences. The issues that confront us are virtually all the same.” He found working with physicians from all around the state quite gratifying, and just as he was finishing his board term, the Affordable Care Act was being debated in Congress. That meant changes, and so he opted to stay involved.

“It was clear that whatever happened, there would be dramatic changes, and be-cause I had a history of building relation-ships and advocacy, I thought I might as well be in the middle of it,” Young said.

The legislative and legal journey of the ACA has meant that a lot of local actions were put on hold, but now that implementation is taking place, it’s more important than ever for physicians to make sure they know what’s going on, and how they can benefit, he explained.

“This is just the beginning of reform,” Young predicted. “We face enormous challenges. We have a country that’s get-ting older; baby boomers are going onto the Medicare rolls at the rate of 10,000 a day. Our healthcare system is too ex-pensive. On the one hand, we have the tremendous ability to bring incredible technology to healthcare, to practice in in-credibly sophisticated ways. On the other hand, we have large populations that still lack even the most basic healthcare. Trying to bridge that gap in a way that provides quality care, at a lower cost, and includes access for everyone, is a difficult

problem.”But even with that said, he feels that

physicians will rise to the challenge, and do what they’ve always done when it comes to putting patients first.

“There are opportunities now for physicians to step up and lead,” he said. “I think we’ve been reluctant to do that sometimes because, frankly, doctors are busy. We’re taking care of patients. But that means sometimes we haven’t been as involved in government relations, or the healthcare industry, as we should be. We have to get more involved now so that we can make sure we get the cost of health-care down, but also make sure that the quality is still there.”

That’ll mean everything from offer-ing input on any Medicare, of TennCare, expansion, Young said, adding that “doc-tors continue to see the problems of people that don’t have any access to healthcare at all, and they usually have advanced cases of chronic illnesses that were treatable if we’d gotten to them earlier.”

In the end, he says, “We’re going to take care of everybody eventually, so we want to do that as well as we can. My goal is to get more doctors to believe that they really can make a difference, and that they can do so in the public arena.”

ville might come as a surprise to some, but when one considers the robust research program at Foster’s practice, it should come as no surprise at all.

Foster is principal investigator for a research program that began 12 years ago and has grown immensely ever since.

“We started in 2001, and since that time we’ve done dozens of clinical trials,” Foster said. “We do pharmaceutical and device trials, with an emphasis on device trials, and we’ve had very good success over the years. We know our physicians and our (trial) coordinators, and we’ve been very successful at finding patients and doing a very thorough job, and fol-lowing through on research protocols with a high level of compliance and a high level of success.

“There’s a relatively small commu-nity of people in the research world, and in the beginning of our program, we were often seeking out trials that would be ap-propriate for our patients. Now we have the luxury that we have a lot of trials com-ing to us, hoping that we’ll be a trial site for them, and we try to pick and choose the trials that will be most appropriate for us and our patients.”

Physician Spotlight: Malcolm Foster, continued from page 3


LegalMatters

Where’s the Beef? Physician Advertising and Non-Compete Clauses

BY J. DAVID WATKINS

Since the landmark Tennessee Su-preme Court decision in Murfreesboro Medial Clinic, P.A. v. Udom, the law governing covenants not to compete in Tennessee has been in a state of flux. In Udom, the Supreme Court ruled that restrictive covenants limiting a physician’s right to prac-tice medicine were void against public policy, and therefore, unenforceable. Since that time, however, the Tennessee General As-sembly has adopted, and sev-eral times amended, a statute that allows for the enforcement of non-com-pete clauses in physicians’ employment agreements with certain geographic and time restrictions. While this statute opens the door for the enforcement of cove-nants not to compete, it is still important to carefully interpret the actual language of the non-compete clause in an employ-ment agreement, as some forms of com-petition might still be permitted.

Where the solicitation of a prac-tice’s patients is prohibited, what forms of advertisement are consid-ered “solicitations”?

Many restrictive covenants in physi-

cians’ contracts come in the form of a clause that prohibits the physician from soliciting the practice’s patients. This is called a non-solicitation provision. This type of language raises the question of what sort of advertisement is permissi-ble without violating the restrictive cov-enant. In Rogers v. Hall, the Tennessee Court of Appeals addressed whether a newspaper advertisement containing a dentist’s name and contact information constituted solicitation in violation of the non-compete agreement with his former employer. The court ruled that this advertisement was not a solicitation,

and stated that holding that such “ad-vertising efforts consti-

tuted ‘solicitation’ or ‘contact’ would un-reasonably encroach”

on the provider’s right to practice his profes-

sion. Applying this reason-ing, the use of non-directed ad-

vertisements, such as billboards and newspaper advertisements merely containing a physician’s name do not constitute a “solicitation,” and

would not violate a non-compete provision that only bars the solicita-

tion of patients. With that said, the Rogers case also

demonstrates that non-compete agree-ments that prohibit patient solicitation will be enforced with respect to some advertisements. In Rogers, the former provider also sent out mailers contain-ing the phrase “you might be a former patient” and stating that he had moved to a different practice location. Accord-ing to the court, this phrase alone ren-dered the mailer an improper “solicita-tion” in violation of the non-compete agreement. This case demonstrates that a provider may advertise even in the face of a non-compete agreement

that prohibits the solicitation of a prac-tice’s patients. Nevertheless, a physician must be cautious to avoid violating a non-compete provision by carefully re-viewing the actual language in his or her employment agreement.

ConclusionWhen a physician leaves a medical

practice, the wording of his or her em-ployment agreement can have a pro-found and lasting effect on the future of both the physician and the practice he or she is leaving. While non-compete agreements are now enforceable under Tennessee law, the presence of such a provision in an employment agreement does not necessarily close the door on all competitive activity. As such, physi-cians and physician practices should give careful consideration to the language contained in a non-compete agreement in order to protect the interests of both parties.

J. David Watkins is an attorney practicing at London & Amburn, P.C. He focuses his practice in medical malpractice defense, health law, and general business and corporate matters. For more information, you can contact Mr. Watkins at [email protected]. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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Katie, a healthcare senior, works directly with medical practices to enhance the overall levels of efficiency and profitability. With ten years of experience, she has extensive experience in operational and revenue cycle assessments, EMR/PM consulting, fee schedule analysis and needs assessments. Katie is active in Healthcare Information and Management Systems Society (HIMSS) and Knoxville Area Medical Group Management Association (KAMGMA), and enjoys biking, listening to local music and spending time with her family. She appreciates the outdoors and is often outside playing with her two dogs.

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Wine 201Headaches from Wine - Is it the Sulfites?

Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at [email protected] or visit his website at www.winetasteathome.com.

By rick JELovSEk cSW, fWS

Some people claim to get headaches from only one glass of wine. Surely it’s not a hangover from one glass. Is it due to sul-fites, an allergy, or dehydration? The an-swer is complex, but wine headaches are most likely due to biogenic amines, mostly histamine and tyramine. These are natu-rally occurring substances in many wines to which some people are quite sensitive. In addition, there may be proteins in wine that produce an allergic response. In this case, a wine drinker’s own body produces the histamine.

Histamine causes brain blood vessels to dilate. This results in both non-migraine and migraine headaches. In the skin, it can produce hives or a nettle rash. It also causes mucous secretion (nasal stuffiness), bowel smooth muscle contraction (diarrhea, heartburn), blood pressure changes, and sometimes heart beat irregularities. The histamine symptoms can be experienced fairly quickly within an hour or delayed 10 hours or more. Add this to dehydration or low blood sugar and one cannot tell a de-layed histamine response from a hangover.

Within the wine industry, studies have shown that the major source of these bio-genic amines is not from the primary yeast fermentation, but rather from secondary events such as wine spoilage bacteria like lactobacillus and pediococcus, natural or induced bacterial malolactic fermentation, and from the barrel aging process. This lat-ter cause is also from spoilage bacterial in the nooks and crannies of previously used wine barrels. That is why red wines, most of which undergo malolactic fermentation and ageing in barrels rather than stainless steel, are the most frequently cited source of wine headaches.

The reason why most people who drink red wines do not get these headaches is not entirely clear. The usual answer, from physicians who have studied this problem, is that most people do not have a “hista-mine intolerance.” They are not lacking in either of two gastrointestinal enzymes—his-tamine N-methyl transferase (HMT) and diamine oxidase (DAO) that are necessary to metabolize ingested histamine. They say that those who suffer the most headaches from wine have low levels of these enzymes. These individuals are also sensitive to other fermented products such as aged cheese, vinegar, sauerkraut, pickles, and soy sauce. However, most often the problem is just too much histamine from the winemaking pro-cess. In fact, the European union is consid-ering regulations to limit histamine levels to less than 10 mg/liter for any wine exported to Europe.

What about sulfites?Almost everyone who gets headaches

from minimal amounts of wine mistakenly blames them on added sulfites. While sulfite forms free sulfur dioxide (SO2) which can produce allergic reactions, when it does, it almost always produces respiratory symp-toms such as wheezing or an asthma attack, skin rash or itching, and, rarely, a severe swelling of the tongue and larynx leading to shock. An allergy to sulfites RARELY

produces headaches. Less than 1% of the population will have any allergic sulfite re-action. The most common reaction people have to excess SO2 in wine, is sneezing, or nasal membrane burning when they first smell a wine. On the other hand, people with a history of asthma are more prone to asthma flare-ups in reaction to SO2 (1 in 10 to 1 in 20).

Sulfites naturally occur in grapes. But they are also added during the winemaking process to preserve wine. They convert to sulfur dioxide (SO2), which is a strong an-tioxidant. Wine with free SO2 binds any excess oxygen. It keeps white wine from turning deep yellow and red wines from turning brown. One winemaker states, “Without sulfites, a wine has no shelf life.” In fact, most people are not aware that sulfites can be added to “organic” wine, i.e., certifying agencies consider them an “organic” compound, and most organic and biodynamic wines have added sulfites. While a very few wineries produce wines with “no added sulfites”, it is unlikely that there will be many commercial examples in the near future because wineries can-not take a chance on having thousands of bottles of wine spoil.

During early fermentation and aging, winemakers try to keep the free SO2 at about 80-100 parts per million (ppm) for white wines and about 50 ppm for red wines because red wines have more natu-ral anti-oxidants than white wines do. Each time they move or pour the wine from one container to another, more oxygen is intro-duced, and free SO2 is bound, lowering the parts per million. Thus, sulfites are usually added more than once from fermentation to bottling. It might be common at bottling for a red wine to have 35 ppm, but by the time that bottle is a few weeks old, the free SO2 will be down to 25 ppm from combin-ing with the oxygen left in the neck of the bottle.

In the U.S., wines that have more than 10 parts per million (ppm) of free SO2 must be labeled as “containing sulfites.” Europe has no such labeling laws. When visitors to Europe return to the U.S. claiming they had no wine headaches from sulfite free wines produced there, they are just being fooled because the bottle label does not say that the wine contains sulfites. The best way to lower the sulfite level is to aerate the wine as you pour it into a glass. The oxygen in the air combines with SO2 to bind sulfur and decrease or eliminate any reactions to the sulfur. Aeration also releases some of the flavors of the wine, so I recommend ei-ther using an aerator or splashing the wine into the center of the glass as you pour. Some wine loving, sulfite-hating compul-sives have even coined the term “super aeration” for wines poured into a blender prior to drinking!

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Enjoying East TennesseeCycling Championships in Chattanooga

By LEiGH aNNE W. HoovEr

Whether it’s for the health benefits, social interaction, or environmental con-cerns, cycling is a growing activity enjoyed by many. For others, it can also be an en-tertaining spectator sport.

Listed as one of “America’s Top 50 Bike Friendly Cities” by Bicycling Maga-zine, it’s not surprising that Chattanooga will be the site of the USA Cycling Road and Time Trial National Championships May 25th-27th. In fact, Chattanooga will be the host city through 2015.

Sponsored by Volkswagen of Amer-

ica, Inc., the USA Cycling National Championship event will traverse all throughout downtown and up to Lookout Mountain in a weekend of activity.

“Several governing bodies with the US Olympic Committee have a national championship…,” said Chris Aronhalt, managing partner with Medalist Sports. “This is the Olympic sport of cycling, and it is for the professional level only, which is the ‘cream of the crop’ for males and females.”

According to Aronhalt, the national event originally began in Philadelphia, where it was held for over 20 years be-

fore being moved to Greenville, S.C., and Chattanooga, Tenn., has been awarded the championship for the next three years.

“The community [of Chattanooga] was very proactive in approaching USA Cycling when the event was up for bid,” said Aronhalt. “Without question, being a cycling friendly community that under-stands and supports cycling was a great first step, and the terrain of Lookout Mountain literally in your backyard cre-ates that championship course.”

In addition to being the first time for the event to be held in the city, Chatta-nooga also marks a first for women com-peting in a national cycling championship.

For each discipline, including the time trials and the road race, there will be one male and one female winner. Al-though the majority of the athletes will compete in both, Aronhalt compares the weekend to track and field events where athletes compete in specific specialties.

The individual time trial competi-tions, where the women and men will race against the clock on a flat road course lo-cated near the actual Volkswagen factory, will kick-off the holiday weekend of com-petition on Saturday.

The inaugural women’s event will begin in the morning and be followed by the men’s time trial competition in the af-ternoon. Following a rolling terrain with limited turns, cyclists will complete 19 miles, which includes two out-and-back runs.

On Monday, Memorial Day brings the second part of the competition, which is the traditional road race and an all-day event. Women cyclists, including over 80 professionals, will compete in the morn-ing, and a group of around 100 profes-sional men will race in the afternoon.

Although the national event does not serve as the only selection for the Olym-pics, it is considered part of the criteria. The weekend also carries a tremendous amount of pride connected to winning.

“It’s a really big deal to be called the ‘national champion’ because they receive a special jersey with the stars and strips design that they will wear throughout the entire year in competitions all over the world,” said Aronhalt. “Wherever there is a professional event, the winner will be

called up to the line and recognized as the USA National Champion.”

During the road race, cyclists travel in groups, and spectators can glimpse ath-letes multiple times during the approxi-mate four and a half hours. The women’s event begins in the morning and covers 63.7 miles, and the men’s championship will follow in the afternoon and be decided over 102.7 miles.

“With the start and finish located in downtown Chattanooga and going throughout all of the unique parts of down-town and traveling up Lookout Mountain for a total of five times, the road race is definitely ‘spectator friendly,’” explained Aronhalt.“Spectators can actually be at the start line, and then make their way up Lookout Mountain to get in position. Cy-clists pass about every 40 minutes.”

Although the road race begins with around 100 riders, typically only about 30 will finish in a national championship event, which exemplifies the competitive nature of the contest.

During the festivities of Memorial Day, visitors can enjoy all that Chat-tanooga has to offer and also personally experience the pride of a world-class na-tional sporting event. In addition to the many restaurants and attractions down-town, there will also be a sponsor event expo that will feature interactive exhibits.

“You can also come and go and min-gle…,” explained Aronhalt. “And, unlike football, basketball or baseball, profes-sional cycling is totally free to the specta-tor.”

For additional information on the USA Cycling Road and Time Trial Na-tional Championships, visit http://www.usacycling.org/2013/pro-road-time-trial-nationals , and for Chattanooga tourism information see http://www.chattanooga-fun.com/

Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at [email protected].


Living and Dying in Brick City

by Sampson Davis (with Lisa Frazier Page

c.2013, Spiegel & Grau; $25.00 / $29.95 Canada, 245 pages

By accident or design, you’ve been in the wrong place at the wrong time, but somehow remained unscathed: the almost-hazard while driving, the near-miss at work, the moment you caught yourself just in time from falling.

Things could’ve been worse – much worse - but you dodged a bullet.

So, did it make your heart pound, or did it change your life? For author Samp-son Davis, it was the latter because, as you’ll see in his new memoir Living and Dy-ing in Brick City (with Lisa Frazier Page), the bullets were sometimes real.

Sampson Davis hid his intelligence from his friends.

He was an A-student and had, in fact, landed a college scholarship and was on his way to becoming a doctor. But since it wasn’t cool to be intelligent, he hid his smarts until he did something dumb: at age seventeen-and-a-half, he gave in to the streets, participated in a robbery, and was caught.

Because he was a juvenile with no pri-or record, he got off easy with scholarship intact, but it was a sobering wake-up call. Grateful for a second chance, Davis buck-led down and went to med school.

When given the chance to intern in the emergency department at Newark’s Beth Israel Hospital, Davis seized it. He wanted to do something good for his com-munity and working at the hospital where he drew his first breath seemed extraordi-narily right.

Time and again, Davis discovered to his dismay that he knew the people who lay on the tables in front of him; gunshot victims, domestic violence survivors, ad-dicts, smokers, the sexually active, and the mentally ill.

He knew them – or he knew he might’ve been one of them, if not for a youthful near-miss and a bullet dodged.

Readers are treated to a heart-racing memoir filled with guns, blood, violence, and life’s unfairness. Rising above all that, though, is author Sampson Davis’ amaz-ingly powerful sense of gratitude: he fully realized that he could very well have been a man on a gurney, rather than the man caring for the man on the gurney.

But that’s not all. At the end of many chapters, Davis

offers brief, helpful information and stats on STDs, heart attacks, AIDS, domestic violence, and other issues of particular in-terest to African Americans and inner-city residents. This information and the accom-panying stories pretty much glued me to my chair.

As memoirs go, this one’s a stunner and if you’re a medical professional, fan of medi-dramas, or if you just want a fast-paced book to read, don’t miss it. Grab Liv-ing and Dying in Brick City… and fire away.

My Parent Has Cancer and It Really Sucks

by Maya Silver & Marc Silver;

c.2013, Sourcebooks; $14.99 / $16.99 Canada, 262 pages

When you read My Parent Has Cancer and It Really Sucks by Maya Silver & Marc Silver, you’ll see that an angry outburst – among other things – is perfectly normal.

Almost 3 million American teens live with a parent who’s dealt with cancer.

Families experience a lot of changes. Someone may be asked to pick up some extra chores. Mom or Dad might be too tired to do the things they used to do. School might seem different, and friends may say stupid things. Adapting to these changes will be easier if the lines of paren-tal communication are kept wide open for a few months.

Also, in the effort to get an ailing par-ent back to health, teens need to take care of themselves, too. They should learn to speak up, ask for help if they need it, and learn to deal with stress. They can talk to a trusted teacher or adult and ask friends to listen. They should stay optimistic, but be realistic. And remember to pat them-selves on the back now and then because, no matter how it all turns out, they’re a sur-vivor, too.

So they’ve heard the diagnosis, they’re terrified, sad, and worried. My Par-ent Has Cancer and It Really Sucks can help teens cope.

Father-daughter authors Marc Silver & Maya Silver have both watched a loved one battle cancer, so they’re very quali-fied to offer a solid POV. They do it along with words of wisdom from other teens, clergymen, doctors and therapists and, for further help, they include a chapter for parents of their teen readers. I tried, but I couldn’t think of one cancer-related thing that Silver & Silver didn’t cover, which makes this teen how-to so comprehensive that the only question you’ll have left to ask is: where has a book like this been all these years?

While it’s meant for 12-to-17-year-olds, I think this book will work for newly-coping college-age kids, too. It’s some-thing you hope you’ll never need – but if you do, My Parent Has Cancer and It Really Sucks… definitely doesn’t.

theLiteraryExaminerBY TERRI SCHLICHENMEYER

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.

ConstipationBy M. Samer Ammar,

MD, FAAP, FAGA

What I am about to share with you would not be anything you don’t already know. I am just going to stress a few facts about constipation.

Constipation, defined as a delay or difficulty in defecation present for two or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. Overall, behind infancy, less than three bowel movements a week and/or painful defecation is generally an accepted definition of constipation.

A normal pattern of stool evacuation is felt to be a sign of health in children of all ages. Especially during the first months of life, parents pay close attention to the frequency and the characteristics of their children’s defecation. Any deviation from what is felt to be normal for children by any family member may trigger a call to the nurse or a visit to the pediatrician. Thus, it is not surprising that approximately 3% of general pediatric outpatient visits, and up to 25% of pediatric gastroenterology consultations, are related to a complaint of defecation disorder.

In most children, constipation is functional, that is, without objective evidence of a pathological condition. The most common cause of functional constipation is the voluntary withholding of feces by a child who wishes to avoid an unpleasant defecation. Many events can lead to painful defecation including toilet training, changes in routine or diet, stressful events, intercurrent illness, unavailability of toilets, or postponing defecation because the child is too busy. These can lead to prolong fecal stasis in the colon with reabsorption of fluids and increase in the size and consistency of the stools.

Few constipated patients have an underlying medical problem(s). Hirschsprung disease is the most common cause of lower intestinal obstruction in neonates and is a possible, but rare, cause of intractable constipation in toddlers and school-age children. It is characterized by a lack of ganglion cells, usually segmental, but can be diffused in the myenteric and submucous plexuses of the large bowel. Other possible etiologies of defecation disorder may include a food allergy, including allergy to gluten, gluten enteropathy,

and partial bowel obstruction related to different pathology of gastrointestinal diseases, including inflammatory bowel diseases and post surgical management of digestive or non-digestive diseases. Failure to respond to conventional therapy is the most warranted reason for a pediatric gastroenterology referral. Other reasons for a referral include fever, abdominal distension, anorexia, vomiting, weight loss or poor weight gain, or bloody stool. A complete physical examination is most helpful in approaching patients with defecation disorder. A digital rectal examination can aid in the differential diagnosis of constipation. It is an underused tool in routine practice. Based on the most likely suspected cause of the differential diagnosis list, work-up may be warranted. That may include, but is not limited to, a radiographic study(s).

With only a few exceptions, the treatment for constipation is usually not surgical. Understanding the true etiology underlying the cause of the defecation disorder is the first step to a better outcome. Medication use may not be sufficient. Behavioral modification is proven to be effective, yet may not be for long term; and the benefit of biofeedback therapy is controversial.

It is estimated that one fourth of children with functional constipation may continue to experience symptoms related to defecation disorder at adult age. Older age at onset, longer delay between onset of symptoms and referral to a specialized pediatric gastrointestinal clinic, and lower defecation frequency at presentation were related to poor clinical outcomes at adult age.

Our GIforKids specialty clinic is staffed with dedicated physicians, mid-level providers, nutritionists, nurses, and a psychologist who provide comprehensive care for patients and their family.

M. Samer Ammar, MD, FAAP, FAGA is a board-certified pediatric gastroenterologist who practices with GI for Kids, PLLC, in Knoxville, Tenn. He completed his Hepatology & Nutrition Fellowship in 2002 at the James Whitcomb Riley Hospital for Children in Indianapolis, Indiana. Prior to coming to Knoxville, he practiced in Grand Rapids, Michigan.

www.giforkids.com • 865.546.3998


species of the spirochete class, which is transmitted to humans through a tick bite. Skin rash in a bull’s-eye pattern (erythema migrans), fever, fatigue, chills and headaches are among early symptoms. Later symptoms could involve the joints, heart or central nervous system. For most, a prescribed course of oral or intravenous antibiotics takes care of the infection and symptoms. However, in some patients, synovial inflammation persists even after the bacteria have been nearly or totally eradicated. This has given rise to the belief that in predisposed patients, the initial Lyme disease triggers an ongoing autoimmune disorder.

In his 2012 paper, “The Microbiome, Autoimmunity and Arthritis: Cause and Effect: An Historical Perspective,” which was published in Transactions of the American Clinical and Climatological As-sociation, Paget noted that for more than 100 years, there has been “tantalizing but often inconclusive evidence” about the role of microorganisms in autoimmune diseases. He wrote, “Current therapy focuses on the pathogenesis rather than the etiology of these disorders. In order to rein in the overactive immune system we believe to be causing the disease, we employ immunosuppressive drugs, an act that would be counterintuitive if infection were the root cause of the problem.”

A small but intriguing study out of the Division of Rheumatology at the Univer-sity of South Florida College of Medicine published in the journal Arthritis Rheum in May 2010, found a six-month combi-nation antibiotic regimen was effective in treating patients with the autoimmune condition Chlamydia-induced reactive arthritis. In the nine-month, prospec-tive, double-blind, triple-placebo trial, researchers assessed a six-month course of combination antibiotics with a primary end point of the number of patients who improved by 20 percent or more in at least four of six variables without worsening in

any variable. At month six, the authors found

significantly more patients in the active treatment group became negative for C trachomatis or C pneumonia. The pri-mary end point was achieved in 63 per-cent of patients in the active arm of the trial, with 22 percent of those patients believing their disease had gone into com-plete remission. No patient in the placebo group achieved remission.

Pointing to this study, Paget noted that one of the failures of antibiotic regi-mens in the past in treating autoimmune disorders might be the duration of the therapy. “If you give long courses of anti-bodies, you may very well calm the prob-lem down,” he said. However, he noted, physicians currently switch to steroids, T-cell inhibitors, and other immunosup-pressive drugs to ameliorate the ongoing inflammatory issue after treating the trig-gering microorganism with antibiotics or antivirals for a relatively short course,

“It may very well be we have to im-prove the immune system response instead of suppress it, and that’s the interesting twist,” Paget continued. If the root cause of an autoimmune condition is infection, “You’d want the army active,” he said of augmenting the immune system.

While much more research must be done, Paget said mounting evidence of the important connection between micro-organisms and a number of autoimmune disorders provides ‘food for thought’ when it comes to the best course of action for treating these conditions and could ul-timately portend a paradigm shift in the delivery of care.

“In some of these, the organism is slow, smoldering … but still there in a low-grade way that is triggering the inflamma-tory response. We have to be appreciative of the fact that we want to do the best thing for our patients … but what we’re doing (now) may be the worst thing,” he concluded.

Unconventional Wisdom, continued from page 1

the marketplace,” Dixon explained. “So-cial business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.”

He continued, “The most popular tool being used today to do that is email, but email was never intended to be a col-laborative tool.”

In a typical scenario, he continued, one person would email an attached doc-ument to 10 people for comments and input, which leads to 10 different docu-ments with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years.

To address this issue, social business software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping indi-viduals connected to their social network, which is a sophisticated online commu-nity.

The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other.

“Fast forward to where we are today, and what we really have are health net-works. They really are communities, but they’ve introduced much richer commu-nication and collaboration tools,” Dixon continued. He noted tools like microblog-ging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social

business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.

Creating Engaged Communities

Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social busi-ness model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate dis-cussions.

“It’s open communication, but at the same time, you introduce controls,” he ex-plained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online commu-nity far exceeds what you could ever get from an in-person visit.” That element also allows physicians to disseminate mes-sages about wellness and disease manage-ment to large, targeted populations, which will be increasingly important in new ac-countable care delivery models.

For physicians, the community set-ting lets providers who might not be geo-graphically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The or-ganization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said.

Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level provid-ers and practice managers. Internally, an intranet community allows for easy com-munication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.

Security“Security has to be built in as a core

set of requirements in any social busi-ness tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social business tool provider makes sense.”

He added, “Any enterprise-class so-cial business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”

Avoiding Information Overload

Dixon said email is in danger of be-coming less and less useful because of in-formation overload. The same caveat also applies to information imparted through social business tools. “If you don’t imple-ment properly, you risk making that prob-lem worse,” he said.

However, social business tools can be offered in a very targeted manner through channels. Individuals choose which chan-nels are of interest to them and subscribe. Drilling down even further, there are gen-erally options within the channel to refine what information the subscriber receives and how.

The Bottom LineWith accountable care organizations

and patient-centered models, support-ing patients and colleagues by providing timely, pertinent information in an easily-accessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most pa-tients and keep the most patients … those who don’t will find the opposite.”

The Move from Social Media Marketing, continued from page 1

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Upcoming CME Events in the Greater Chattanooga area

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: May 2, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: May 2, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Fifth Annual Stroke Symposium: Managing the Complex Stroke PatientName of CME provider/sponsor: University of Tennessee Medical Center Brain and Spine Institute and UT Graduate School of MedicineDate: Tuesday, May 7, 2013Time: 7:30 a.m.-5:00 p.m.Place: University of Tennessee Conference Center, Knoxville, TennesseeCredits available: Approved for AMA and AAPA credits and CEUs Information: www.tennessee.edu/cme/Stroke2013Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190Details: The symposium offers presentations by experts addressing care for critically ill cerebrovascular patients and administration of thrombolytics for acute ischemic stroke. Guest speaker is Andrew D. Barreto, M.D., an assistant professor of Neurology at the University of Texas Medical School, Houston, and other speakers represent the specialties of neurology, radiology, anesthesiology, palliative care and pharmacy.



Name of activity: Medicine Grand Rounds: Osteoporosis Update 2013Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: May 14, 2013Times: 8-9 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190



Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: May 23, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, Knoxville

Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190


Name of activity: Medicine Grand Rounds: Peripheral Neuropathy: Clinical Approach and Current ConceptsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: May 28, 2013Times: 8-9 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: May 30, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University

of Tennessee Graduate School of Medicine and Department of SurgeryDate: May 30, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Upcoming CME Events in the Greater Chattanooga area

Name of activity: Family Medicine Update (28th annual)Name of CME provider/sponsor: University of Tennessee College of MedicineDate: June 12-15, 2013 Times: 8:00am-5:00pm on Wednesday-Friday, 8am-12:00pm on SaturdayPlace: The Chattanoogan HotelCredits available: 24 AMA PRA Category 1 Credits™ Information: utcomchatt.org/cmeDetails: General Session Registration fees include: admission to all general sessions; issuance of continuing medical education credit certificates for physicians; light breakfast each day; fresh snacks during breaks; lunch at Broad Street Grille each day; and complimentary Riverbend Festival admission pins for use on a daily checkout basis (while supplies last).

Name of activity: Southeast Wilderness Medicine Conference (9th)Name of CME provider/sponsor: University of Tennessee College of MedicineDate: June 21-26, 2013 Times: Various times each day, depending on involvementPlace: Chattanooga Convention Center Credits available: 45 AMA PRA Category 1 Credits™ Information: utcomchatt.org/cmeDetails: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Tennessee College of Medicine and Still Waters Productions, LLC.

East Tennessee CME Events Editor’s Note: In an effort to provide our readership with the latest professional healthcare news, East Tennessee Medical News is working with area institutions to provide this monthly listing of CME events throughout the East Tennessee region. For more information about each activity, please see the contact information provided for each event.

Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

Time: 11:30 AM until 1:00 PMLocation: Bearden Banquet Hall, 5806 Kingston Pike,

Knoxville, TN 37919Lunch is $10 for regular members.

Come learn and network with peers at our monthly meetings. Topics are available on the website.

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

Time: 11:30 AMLocation: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205

McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confi rmed on

the Friday prior to the meeting.RSVP to Irene Gruter, e-mail: [email protected] or call

622.2872. For more information, visit www.cmgma.net.

3RD THURSDAY 2ND WEDNESDAY

Mark Your CalendarYour local Medical Group Managers Association is Connecting Members and

Building Partnerships. All area Healthcare Managers are invited to attend.


Celebrating the Class of 2013

GrandRounds

MEDICAL MOVER MOMENT9th Annual Denim & Diamonds Fundraiser

Chattanooga phy-sicians and community leaders came together on Feb. 23, 2013, at the Chattanooga Convention Center for an evening of music and food, and a cel-ebration of healing. The Denim and Diamonds fundraiser helps support the Project Access com-munity health partnership and other community health initiatives and is organized by the Chatta-nooga Hamilton-County Medical Society, Medical Foundation of Chattanooga, and Medical Alliance.

Denim & Diamonds: Saturday Night Fever, presented by Dale Buchanan & As-sociates, Kindred Health, and University Surgical Associates celbrated the decade of disco – the 1970s and included dinner, dancing, and live and silent auctions.

Attendees came dressed as their fa-vorite star or icon from the 1970s. Polyes-ter was brought back in style for one night only.

Dr. Peter and Courtney Lund

Tracie & Dr. Chris Lesar.

Expanding Access to Care, Mental Health, Rx Drugs Top Issues at Tennessee Physicians’ Annual Meeting

NASHVILLE – Physicians from across the state gathered in Franklin, Tenn., April 5-7, and considered a number of health policy positions for the Tennessee Medi-cal Association, including support for ex-panding access to healthcare coverage, more funding of mental health screenings and treatment, transparency of patient charges for prescription drugs and hospi-tal services, maternal mortality review, and amending restrictive guidelines for care provided by physicians in training.

Following passionate debate, a res-olution supporting expanded access to care for all Tennesseans was approved by a majority of delegates. The resolu-tion supports expanded access under a three‐year trial program using Medic-aid expansion funds to cover uninsured residents through health exchange pur-chased plans, similar to Gov. Haslam’s proposal, or direct expansion.

The resolution calls for the TMA to continue to support access to affordable healthcare for all Tennesseans as put forth in its previous statement on health reform; to support a three‐year trial to expand access to care using Medicaid expansion funds to either subsidize plans purchased by the uninsured through the federal health insurance exchange or through direct Medicaid expansion; and to insist that the benefits purchased through the exchange remain compara-ble to Medicaid/TennCare benefits.

The TMA House of Delegates held its

session as part of the association’s 178th annual meeting, MedTenn 2013. The event also offered CME and informational sessions on prescription drug abuse and neonatal abstinence syndrome, the men-tal health crisis in Tennessee, the state’s Controlled Substance Monitoring Data-base, which became mandatory for pre-scriber checks for certain pain medicine prescriptions on April 1, health reform, electronic health information exchange and quality incentive programs, ICD-10 coding changes, and more.

RESOLUTIONS OF INTERESTIncreasing Access to Care – The TMA

House of Delegates (HOD) voted to sup-port access to affordable healthcare for all Tennesseans; support a trial for three years to expand access to care by using Medicaid expansion funds either to sub-sidize uninsured residents to purchase health insurance through the federal insurance exchanges or through direct Medicaid expansion; and instructed the Association to make itself fully available to the governor and the state legislature to advocate for healthcare coverage in Tennessee.

• Indigent Care – Delegates reaf-firmed the importance of physicians providing free and reduced-cost care to indigent patients and directed the As-sociation to support and promote such activities.

• Mental Health Screening – Del-egates voted to support efforts for more state and federal money for mental health screenings and treatment in Ten-nessee.


GrandRounds• Maternal Mortality Review – The

HOD voted to support the establishment of a peer review-protected and HIPAA-compliant maternal mortality review process under the auspices of the Ten-nessee Department of Health to review maternal deaths in Tennessee and make recommendations for system changes to improve healthcare services for women in Tennessee.

• Cosmetic Surgery – Delegates passed two resolutions to pursue expan-sion of the definition of the practice of medicine to include any surgical pro-cedure for cosmetic or aesthetic pur-poses; and to support efforts to prevent unlicensed and unsupervised cosmetic surgical procedures through legislative action and enforcement by the Board of Medical Examiners.

• Health Cost Transparency – Del-egates passed separate resolutions supporting the required posting of pa-tient out‐of‐pocket costs for prescription drugs and hospital charges.

• Medical Education & Physician Involvement – The HOD voted to peti-tion the American Medical Association to work with CMS and other federal au-thorities to remove onerous language from its guidelines on care by physicians in training; and petition the AMA for re-quirements that recognize more accu-rate documentation of care while allow-ing the profession to resume educating its future colleagues in a more cost-effec-tive and efficient manner.

AWARDSThe TMA presented its 2013 annual

awards to the following honorees:• Outstanding Physician: Winston P.

Caine, MD, Chattanooga; Bobby Clark Higgs, MD, Jackson; John Lamb, Sr., MD, Nashville

• Distinguished Service: Marion Dugdale, MD, Memphis; B W. Ruffner, Jr., MD, Signal Mountain

• Community Service: Greater Mem-phis Greenline, Inc., Memphis; Hamilton County Project Access, Chattanooga; Cathy Self, PhD, Baptist Healing Trust, Nashville

NEW OFFICERSIn addition to Dr. Young’s inaugura-

tion as president, the following leaders were installed for 2013-2014:

• Dr. Douglas J. Springer, a King-sport gastroenterologist, will serve as president-elect and on the TMA Board of Trustees.

• Dr. Keith G. Anderson, a German-town cardiologist, was reappointed as chairman of the TMA Board of Trustees.

• Dr. Bob Vegors, a Jackson internal and geriatric medicine specialist, is the new vice-chairman of the TMA Board.

• Dr. James “Pete” Powell, internal medicine and pediatric physician from Franklin, was reappointed as secretary/treasurer for the TMA.

Avon Breast Health Outreach Program Awards Grant for Outreach at the University of Tennessee Medical Center Cancer Institute

KNOXVILLE—The Avon Breast Health Outreach Program has awarded a $60,000 one-year grant to the Breast Health Out-reach Program (BHOP) at The University of Tennessee Medical Center Cancer In-stitute to increase awareness of the life-

saving benefits of early detection of breast cancer. It is the eleventh year that the pro-gram has received funding from the Avon Foundation for Women to support its work on this important health issue, and in rec-ognition of the program’s excellence.

BHOP at UT Medical Center will ed-ucate area women in 21 rural and remote counties in eastern Tennessee and refer them to low-cost or free mammograms and clinical breast exams in their own communities. The vital program will also provide free comprehensive education programs emphasizing the importance of the early detection of breast cancer.

UT’s College of Nursing Helps Launch Leadership Institute

KNOXVILLE—The University of Ten-nessee, Knoxville, College of Nursing is helping to address our state’s most pressing healthcare challenges—access, quality and cost—through the develop-ment of the Tennessee Nursing Institute for Leadership and Policy.

The college is launching the institute on behalf of the Tennessee Action Coali-tion (TAC). The College of Nursing and AARP Tennessee are co-leaders for the TAC.

The institute is made possible

through a two-year $150,000 grant from the Robert Wood Johnson Foundation’s Future of Nursing State Implementation Program and matching funds from sev-eral Tennessee organizations.

The mission of the institute is to equip nurses in Tennessee with the knowledge and skills necessary to trans-form healthcare delivery. It will provide educational programming and training to practicing nurses and other health care professionals across the state. It also will provide expert analysis to promote access to high-quality patient-centered health care in Tennessee.

I don’t just have insurance.

I own the company.

Medical Professional Liability Insurance

Mutual Interests. Mutually Insured.

“ Like me, you’ve probably noticed some professional liability insurance providers recently offering physicians what seem to be lower rates. But when I took a closer look at what they had to offer, I realized they simply couldn’t match SVMIC in terms of value and service. And SVMIC gives me the peace of mind that comes when you’re covered by a company with more than 35 years of service and the financial stability of an “A” (Excellent) rating. At SVMIC, I know it’s not just one person I rely on...there are 165 professionals who work for me. That’s because SVMIC is owned by you, me, and over 14,000 other physicians across the Southeast. So we know our best interests will always come first.”

Gary E. Meredith, M.D.Pediatric Diagnostic Associates

Chattanooga, TNPediatrics

Contact Randy Meador or Susan Decareaux at [email protected] or 1-800-342-2239.

SVMIC is endorsed exclusively by the Tennessee Medical Association and its component societies.

Follow us on Twitter @SVMIC www.svmic.com


American Red Cross accepts $10,000 donation from TeamHealth

KNOXVILLE – The American Red Cross received a $10,000 donation on March 18 from TeamHealth to support its humanitarian services. The check was presented at the TeamHealth offices in Knoxville.

The donation stems from Team-Health’s 2012 holiday card campaign. Recipients of the annual TeamHealth holiday card were directed to a special website, TeamHealthGives.com, where they could vote for an organization to re-ceive a $10,000 donation. The majority of participants cast ballots for the American Red Cross.

The American Red Cross shelters, feeds and provides emotional support to victims of disasters; supplies about 40 per-cent of the nation’s blood; teaches skills that save lives; provides international hu-manitarian aid; and supports military mem-bers and their families. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission.

Helen Ross McNabb Center and YES merger complete

MORRISTOWN—The Helen Ross McNabb Center, Inc. (HRMC) and the Youth Emergency Shelter, Inc. (YES) of Morristown, Tenn. merged operations on April 1.

HRMC will continue to provide emergency shelter care in foster homes or facility-based care, conduct psycho-social assessments and offer community-based casework to divert children from state’s custody and the repetitive need for emergency placement.

HRMC also intends to provide an emergency placement and family pres-ervation continuum for children tempo-rarily removed from their home by law enforcement, the Department of Chil-dren’s Services, or by running away.

Both agencies acknowledge that YES provides valuable services to children

and their families during a time of need. These services are provided with the phi-losophy that every child should have the opportunity to grow up in a nurturing family setting.

Clary Named Winner of 2013 Buscetta Award at Covenant Health

KNOXVILLE—Liz Clary, director of patient care services at Peninsula Hos-pital, is the winner of the 2013 Buscetta Award, given to outstanding Cov-enant Health managers or directors who personify leadership excellence. The award was presented by Covenant Health Presi-dent and CEO Tony Spe-zia.

The award is named for Samuel R. Buscetta, retired executive vice presi-dent for human resources, who was instrumental in launching Covenant Health’s Journey to Excellence initiative. Nominations for the award were submit-ted by Covenant Health’s senior lead-ers and Clary was selected from among seven finalists.

Nominees were evaluated in areas such as quality, service, growth, finance/cost management and developing peo-ple, along with achievements related to systemwide alignment and innovation.

Other Buscetta Award finalists were: • Carol Burns, director, patient regis-

tration and financial services, Fort Sand-ers Regional Medical Center;

• Phil Carney, director of diagnostic services, LeConte Medical Center;

• Dorothy (Bernie) Hurst, director of women’s services, Fort Sanders Regional Medical Center;

• David Newman, director of medi-cal imaging, Methodist Medical Center;

• Stephanie Nichols, director of clin-ical effectiveness, Morristown-Hamblen Healthcare System;

• Jennifer Steely, director of clini-cal services, Patricia Neal Rehabilitation

Center.Jones named ‘CEO of the Year’ of the Tennessee Division

KNOXVILLE—Lance Jones, CEO of Turkey Creek Medical Center, was one of two Eastern Group leaders to be named “CEO of the Year” by Health Manage-ment Associates. Jones was chosen for his out-standing leadership, dedi-cation, and commitment to Turkey Creek Medical Center, its patients and the West Knoxville community.

Jones was chosen by his Division leadership and was recently recognized at a company meeting.

Jones joined Turkey Creek Medical Center in November 2011, when Mercy Health Partners was acquired by Health Management Associates.

Premier Surgical Names New COO

KNOXVILLE—Matthew West has joined Premier Surgical Associates as Chief Operating Officer. West comes to Premier Sur-gical from Carolina Health-care System in Charlotte, North Carolina. There, he served as director of Caro-linas Gastroenterology Centers. Previously, he was an Administrative Resident at Carolinas Medical Center.

West earned his Masters in Sci-ence in Healthcare Administration and a Masters of Business Administration de-gree from the University of Alabama at Birmingham. He completed his under-graduate education at Furman Univer-sity in Greenville, South Carolina.


East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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GrandRounds

Dr. Glen Hall

Dr. Hasmukh Kanabar

Dr. Dianne Petrilla

Name: Virginia Cook

Position: Volunteer at Hutcheson Medical CenterLaunching its monthly volunteer recognition program, Hutcheson

Medical Center, located in Fort Oglethorpe, Ga., named Virginia Cook as its April recipient of the inaugural award. Cook has volunteered at Hutcheson Medical Center for two and a half years in the hospital’s Day Surgery area and was unanimously nominated by the surgery staff.

“Every surgery staff member nominated Virginia as Volunteer of the Month,” stated Chareen Humble, manager of volunteer services at Hutcheson. “Everyone said that she goes above and beyond to help surgery patients and is always asking what more she can do to help”.

As Volunteer of the Month, Cook received a basket with gift certificates from Sears Shoe Store and Battlefield Salon, and gift items from The Hutch Gift Shop. Cook was awarded use of the Volunteer of the Month parking space during April and her name will be added to the recognition plaque by the hospital’s information desk.

(from left to right): Jenny Ackerman, Wanda Buchanan, Tammy Waddle, Virginia Cook, Roger Forgey, Hutcheson CEO, Denise Self, Carol Worley, Chareen Humble, Chris Lundeen, and Amy Bolden.

University Surgical Associates Names New Marketing Manager

CHATTANOOGA – University Surgi-cal Associates’ (USA) CEO, Craig Sarine announced today the hiring of former SunTrust Assistant Vice President and Director of Marketing, Vanessa McNeil Guin as the organization’s new market-ing manager.

Guin is a graduate of the Univer-sity of Tennessee at Chattanooga and has worked for Unum, Siskin Children’s Institute and owned her own marketing consulting firm. Prior to joining USA she worked for SunTrust Bank’s Eastern Ten-nessee Region.

Summit Welcomes Three New Physicians: Hall, Kanabar, Petrilla

KNOXVILLE—Summit Medical Group, the region’s leading primary care organization, recently wel-comed three new physi-cians.

Dr. Glen Hall (former-ly with Statcare Hospital-ist Services) joins Inter-nal Medicine Associates in Powell; Dr. Hasmukh Kanabar joins from Home-town Medical Clinic in Madisonville, and Dr. Di-ane Petrilla joins Statcare Hospitalist Services.

Hall is a native of Morristown, Tennessee and a graduate of the Uni-versity of Tennessee. He originally joined Summit in 2003, serving as a hos-pitalist with Statcare. Dr. Hall is board certified in internal medicine.

Kanabar is board cer-tified in family medicine and a graduate of the Universidad Autonoma de Ciudad Juarez Escuela de Medicina, Instituto de Ciencias Biomedicas. He has been practicing in Madisonville for many years, where he will remain.

Petrilla is a graduate of Georgetown University School of Medicine and pre-viously had a solo family practice in Se-wanee, Tennessee.

LMU-DCOM Announces Class of 2013 Residency Placements

HARROGATE—Approximately 78% of the members of the graduating class at Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) Class of 2013 will enter their first year of residency training in a primary care track residency, including family medicine, internal medicine, pediatrics, OB/GYN, emergency medicine, osteo-pathic manipulative medicine and tran-sitional year/traditional rotating intern-ship. The members of the Class of 2013 will be in 107 different residency pro-grams in 33 states.

LMU-DCOM has placed 100% of its graduating class into postgraduate training programs. Of the graduating class, 61% were placed into osteopathic residency programs. Twenty-eight per-cent accepted residency positions with allopathic programs, and 11% are going

into military programs.LMU-DCOM had the fourth high-

est osteopathic match rate in the coun-try, which is the percentage of a school’s seniors and previous graduates that matched in the osteopathic match as compared to the total number of the school’s eligible participants (including non-participants).

Honorees Announced for Annual Doctors’ Day Salute

CHATTANOOGA -- The Chattanoo-ga-Hamilton County Medical Society, Medical Foundation of Chattanooga, Medical Alliance, and Project Access rec-ognized local physicians by saluting ten honorees for Doctors’ Day Appreciation. The honorees were selected from nomi-nations submitted by local residents.

The ten honorees were:• Tracy Dozier, MD, Academic Inter-

nal Medicine• Annesofie Dubeck, MD, Diagnos-

tic Center• Hunter Jennings, MD, Chattanoo-

ga Surgical Oncology & Associates• Todd Levin, MD, Chattanooga Al-

lergy Clinic• Vicente Mejia, MD, University Sur-

gical Associates• Melissa Phillips, MD, TCFPA Fam-

ily Medical Centers• Philip Pollock, MD, Diagnostic Pa-

thology Services• Marty Scheinberg, MD, Plaza Urol-

ogy• Mark Thel, MD, Chattanooga

Heart Institute• Steven Thomas, MD, Ophthalmol-

ogist Patients submitted almost 70 nomi-

nations of Chattanooga-area physicians this year.

Important Information for People with BlueCross BlueShield of Tennessee Insurance Coverage

8At t e n t i o n

What does the word “transparent” mean to you?

Franklin Woods Community Hospital • Indian Path Medical Center • Johnson City Medical Center Johnson County Community Hospital • Niswonger Children’s Hospital • James H. & Cecile C. Quillen Rehabilitation Hospital

Sycamore Shoals Hospital • Woodridge Hospital • First Assist Urgent Care • Mountain States Medical GroupMedical Center HomeCare and Hospice • Mediserve Medical Equipment • HealthPlus & Pharmacy

www.msha.com/bcbsT

(adjective)visibility or accessibility of information especially concerning business practices

Mountain States Health Alliance is committed to working with BlueCross BlueShield of Tennessee in an attempt to continue participation in their network. BlueCross has set the deadline at June 1 for reaching an agreement, but we have asked BlueCross for a 90-day extension in order to allow enough time to reach that agreement.

There’s no good reason for BlueCross to refuse the extension. In fact, one reason we are currently pressed for time is because the first proposal we received from BlueCross contained an error that would have meant millions of additional dollars for MSHA. Per their request, we granted them a 60-day extension to correct it.

Not only is it important to be trAnspArent, we believe doing the right thing is worth the time. We hope BlueCross will agree.

fAct: MSHA granted BlueCross a 60-day extension when a payment model error was discovered.

fAct: MSHA is again asking BlueCross to extend the contract for the benefit of our patients and our community, so we can come to an agreement.

fAct: The BlueCross CEO has warned subscribers that premiums for individual coverage will increase an average of 30% next year.*

fAct: BlueCross is demanding significant cuts in reimbursement from MSHA.

question: If your health care providers are being paid less and your health insurance premiums are going up, who is benefitting from this arrangement?

Talk to your employer or HR department. Ask them to urge BlueCross to grant the extension.

To learn more, visit www.msha.com/BCBSTN or email us at [email protected].

*Memphis Business Journal, 4/4/13, “Insurance is going to cost more, and BlueCross wants you to know why”

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East TN Medical News May 2013

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