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Norman McCoomer, MDPain Management460 Lanier Rd Ste 206256-464-7855David Cole, MDAerospace Medicine4100 Goss Rd256-876-0517Brenda Peak, DOFamily Medicine532 Madison Street256-489-2238Jitesh Kar, MDNeurology201 Governors Dr Ste 420256-881-4112John Panico, MDAnesthesiology303 Williams Ave Ste 129256-469-7895Daniel Fox, MDInternal Medicine201 Sivley Rd Ste 500256-265-3880Medical StudentsCourtney CulbreathKatie Tucker

UAB IM ResidentsAli Alhusseini, MDSawsan Alkurabi, MDAmir Azarbal, MD Swetha Bheemanathni, MDMounika Boyeinpally, MDAartee Deshpande, MDAshokkumar Gaba, MDCesar Garcia, MDAnshum Goel, MDEsmeralda Gutierrez-Asis, MDJacob Tyler Hughes, MDAshley Jackson, MDDurga Jonnalagadda, MDZainab Kakakhel, MDRajashekar Kumar, MDJyothika Mamadgi, MDSara Ocheltree, MDImran Osmani, MDNeha Patil, MDMohammed Raja, MDAbdur Raziq, MDMorgan Scully, MDNemil Shah, MDVineet Veitla, MD

The Madison County Medical Society has been organized to serve its members as an advocate for the physician/patient relationship, and to promote and preserve the highest standards of professional, educational, and moral conduct.

OUR MISSION

Winter 2015

Welcome

MCMS Quarterly Newsletter

THE

Change seems to happen at a faster pace each year. As physicians, we have been prepared for new advances in medical knowledge since we began our practices. We anticipated these changes and understood that this type of change was part of the practice of medicine.

The changes affecting our practices now have a different character - more administrative and clerical than clinical. We have burdens in almost every direction

we turn - new EHR requirements, ICD-10, Obamacare, RCOs, and RAC audits to name a few. It has changed the nature of practice in the community.

We are often left burdened, behind, and overwhelmed. Our workload goes up but our bottom line decreases. Where does this end? Some of our colleagues retired early and many chose the security of a hospital based practice. Many have developed a quiet anxiety about the unknown future.

How do we prepare for the unknown?

Since what we do not know may scare us, I think we should concentrate on what we do know well. Each other.

There has been a slow division of responsibility among physicians over the last few years. More physicians have decided to stay solely in the hospital or in the clinic and few actively do both.

This has been an understandable result of economic realities and lifestyle choices. The unintended consequence has been a slow, but steady widening of the distance between physicians. But this is not an insurmountable distance. While we may practice in different settings, we still have common goals and beliefs that bind us together in caring for both the sick and healthy in our community.

Our Board will focus on physician-physician communication and physician-community education this year. We hope you will join us as we try to promote and preserve communication as a cornerstone to improve quality of care of all our patients in Madison County.

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Name: Debbie Kolb, MDSpecialty: Family Medicine

Practice Name: Madison Family Medicine

2015 Executive Board

PRESIDENT: Amit Arora, MD VICE PRESIDENT: James Gilbert, MDSECRETARY/TREASURER: Debbie Kolb, MD

Board of TrusteesWilliam Brix, MD / James Byrd, MD / Michael Conrad, MD

Deason Dunagan, MD / Tobin Fisher, MD / Daniel Fox, MD Sharon Gardepe, MD / Akram Haggag, MD / Heather Haley, DO

Erik Henninger, DO / Scott Lynn, MD / Dawn Mancuso, MD Philip McGee, MD / Alan McCrory, MD / Brad Rice, MD / Sherrie Squyres, MD

Paul Tabereaux, MD / Alex Talalight, MD / Tarak Vasavada, MD Ex Officios

COUNTY DISASTER LIAISON: John Higginbotham, MD / Norman Sabio, MD MASA FIFTH DISTRICT CENSOR: Dan Gifford, MD / MASA PLACE 2 CENSOR: Tim Stewart, MD

REDSTONE ARSENAL LIAISON: David Cole, MD IM RESIDENT REP: Ashley Jackson, MD / FP RESIDENT REP: Tate Hinkle, MD MEDICAL STUDENT: Courtney Culbreath / NAMRC DIRECTOR: Brooke Rawlins

Board of CensorsJeremy Russell, MD / Irma de Leon, MD / Amit Arora, MD / James Gilbert, MD / Debbie Kolb, MD

MCMS Administrative StaffEXECUTIVE DIRECTOR: Laura Moss / ADMIN ASSISTANT/ MEMBERSHIP: Amy McDonald

What do you like best about your current practice? I love the independence of private practice. Although the current issue of Medical Economics has it right when it says you must learn to be a “mixed martial arts champion in practice management.” That is exactly what I am learning to do with the help of my fellow Society members. The supportive nature of the MCMS has been invaluable. I am blessed to be one of many second generation physicians in the local medical community, and I am grateful to my colleagues who helped me build my practice nearly fifteen years ago when I returned home. (Although it was difficult to maintain a professional demeanor when one patient I had referred out told me “The doctor said he remembered little Debbie Booher when she was running around in diapers!”)

What advice would you give to someone just entering the profession of medicine? I have always believed the old adage “If you love what you do, you’ll never work a day in your life.” Don’t be dissuaded by the evolving nature of healthcare. I always left the politics to my husband, but I wanted to have a seat at the table and help influence where things are heading to help my patients. As I continue to educate myself on the issues, I appreciate how welcoming and supportive my colleagues have been. There is a need for all types of providers, but we physicians are a unique bunch and we MUST stick together. I appreciate how phenomenal the Alliance has been in facilitating that.

Who or what has had the most influence on your professional career? I could not do what I do without my amazing family. My husband, Chris, retired from the US Coast Guard when we moved here and not only serves as the Practice Administrator (monitoring ARs and making COSTCO runs!) but holds down the fort with our three boys when I am working late or have a meeting. My parents and sisters have always been so supportive and encouraging and are a phone call away when we need help. This is a team sport.

Tell us about yourself – anything you’d like to share…As the only girl in my house I have learned to embrace testosterone! Our boys (Peter-12, James-9, Joshua-9) are all about tent camping with Dad, but Mom is only good for three nights in a row, tops! Every summer we pack up and drive somewhere new for an adventure. We have camped in Redwood NP, Grand Canyon NP, Grand Tetons NP, Yellowstone NP, Glacier NP and Banff. I did successfully negotiate for a spa day at the Fairmont in Lake Louise at the end of our most recent trip. I also enjoy reading, scrapbooking, and sport shooting at Cavern Cove Rimfire.

Member SPOTLIGHT

Member Spotlight2Annual Session3NAMRC/MCMA 4 Practice Management5Rx Theft and Forgery6New Physicians Reception6-7

Inside LOOK

Your BOARD MCMS extends

our sympathy to the family of

Dr. Richard A Brown

Jan. 7, 1941 - Jan. 4, 2014

hDonations in memory of

Richard’s life can be made to

communityfoundationhsv.org,

donor advised fund,

Richard Brown Fund.

This fund was established to

support medical care,

education, and research.

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Dr. Sherrie Squyres enlightened many as she told of Dr. Knight’s impressive history and instru-mental role in developing the pediatric ICU in Huntsville after repeatedly seeing “sick babies being transferred to Birmingham.” Dr. Squyres noted that “before our community was fortunate to recruit

pediatric subspecialists, we had Patrice Knight.” Dr. Knight also taught for many years at UAB Huntsville’s Medical School sharing her talents with countless students and residents.

Congratulations to both of these deserving recipients!

Thank you Dr. Jeremy Russell for your leadership in 2013-14 &welcome Dr. Amit Arora as our

2015-2016 President!

Thank you 2014 Board of Trustees for your dedication, support and time given to serve the MCMS Membership!

Drs. James Gilbert, Amit Arora & Jeremy Russell 2014 MCMS Executive Board

GeorgeE. Knox, Sr., MD

In December, MCMS had the pleasure of presenting Outstanding Contribution to

Medicine Awards to two physicians. Retired Internist Dr. George Knox joined

MCMS in 1967 after completing his Internal Medicine Residency as well as fellowships

in Cardiology and Nephrology. He was introduced by Dr. Debbie Kolb who shared stories of his

meticulous patient histories, renowned diagnostic acumen, and great intelligence.

This “doctor’s doctor” was honored for possessing many outstanding qualities that helped him deliver

unparalleled patient care throughout his career. Before recently retiring, Dr. Patrice Knight, MCMS member since 1990 and past MCMS Board Member, practiced as a pediatrician

with a fellowship in neonatology.

PatriceKnight, MD

Holiday CheerEmbassy Suites

Tuesday, December 2nd6 - 9 pm

Madison County Medical Society General Membership Meeting

Sponsored by Crestwood Medical Center, ProAssurance, and Renasant Bank

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The mission of the North Alabama Medical Reserve Corps is to recruit and train medical and non-medical volunteers to supplement existing community organizations in preparing for and responding

to an emergency or disaster and to provide community education in disease awareness and prevention during non-crises times.

NAMRC STAFFDIRECTOR: Brooke Rawlinswww.northalabamamrc.com

UPCOMING EVENTVolunteer OrientationJanuary 15, 20156 p.m. until 8 p.m.320 Fountain CircleHuntsville, AL

Ashley ClarkMCMA President 2014-15

Have you heard we are hosting the AMAA’s Southern Regional meeting January 22-25th? AMASA and MCMA are excited to host

physician families from across the south here in Huntsville. We’d like to recognize MASA for their generous support with a

$5,000 sponsorship, as well as, Pro Assurance, AMASA, AMA Alliance and MCMA for each granting us a $1,000 sponsorship.

This meeting would not be possible without our generous partners.It’s not too late! We have over 40 people registered and still have room

for more. AMA Alliance President, Sarah Sanders and SMA Alliance President, Karen Morris will be in attendance, as well as many of our

alliance friends from across the south. Whether this is your first alliance event or your tenth, you will walk away with some useful information.

We will have an informative Tech Toys demonstration, as well as, a financial consultant warning us of the pitfalls to avoid in investing.

There is something for everyone.We will host a Welcome Reception on Thursday, January 22nd at the

Huntsville Museum of Art. We would love to have a great turnout from our local medical families for this event. For registration and conference

information, visit the Alliance page on the MCMS website. We hope you’ll consider attending both the Welcome Reception

and the Conference. Partial registration is available for those who might only be able to attend one day.

MCMA had over 70 guests attend our annual Christmas Coffee in early December. Our lovely hostess, Linda Akenhead, did not

disappoint in providing a warm and festive setting in her home. In the spirit of the season, the Alliance gave $1,000 to

Huntsville Hospital Foundation’s Mobile Medical Unit, $1,100 to the Huntsville Madison County Senior Center for their Health Room and

$2,000 to the North Alabama Medical Reserve Corps. Our members also donated blankets and coats for the NAMRC to hand out

when doing health programs and clinics this winter. Our October business meeting was short and sweet,

so we could have time for a great presentation at the InBloom Studio. Members enjoyed a great lunch from the

Chicken Salad Chick provided by our friends at Servis1st Bank. We had two members attend the Southern Medical Association Alliance

annual meeting this fall. MCMA was awarded first place in Medical Heritage for our Past President’s Brunch- Celebrating 80 Years of MCMA

and our Health Project at the Huntsville Madison County Senior Center. We received a cash award of $250 for our Medical Heritage project, too.

This year marks the 90th year of the SMAA, so we had many history lessons and celebrations of accomplishments over the years.

SMAA founded Doctor’s Day on March 30, 1933 in Widner, Georgia.

The Alliance is grateful to the Society, it’s members, board of trustees and staff for all the support you’ve given us in 2014. We want to congratulate Dr. Amit Arora along with the 2015 Board of Trustees. We look forward to working together in

the coming year.

In October and November, the NAMRC teamed up withHuntsville Hospital and the North Alabama Community Careto offer free flu shots in Madison County. NAMRC volunteers helped administer more than 1,500 shots.

The NAMRC is grateful for the ongoing support from the

Madison County MediCal Alliance. The MCMA generously awarded the

NAMRC with a $2,000 grant. These funds will benefit

the health outreach initiatives in 2015.

1,500

Thankyou!

NORTHALABAMA

medicalreservecorps

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Ambulatory Surgery Centers – Be Sure to Assess Your Riskby ProAssurance

Ambulatory surgery centers (ASC) are a great option for patients whose surgical procedures do not require in-hospital stays. And for physicians, they may provide more control over scheduling, delays, limited operating room availability, and the like, according to the Ambulatory Surgery Center Association, concerns that led physicians to develop the model of the ASC.There are many advantages of an ambulatory surgery center (ASC) for patients, such as no overnight stay and potentially less expensive procedures, but performing procedures at an ASC carries some inherent liability for physicians.Each of those centers represents these areas of concern:• Medical staff and facility staff credentialing and competency• Emergency response processes• Risk management/quality improvement/patient safety• Equipment and resources• Discharge planning

Medical staff and facility staff credentialing/competency process: Ensure physicians and other health care providers at the ASC are appropriately credentialed and privileged to perform specific procedures. Policies should be in place to address the qualifications and scope of practice for surgical assistants and other allied health care providers.Additionally, facility staff should be trained to respond to emergencies, such as initiating CPR, ACLS or PALS, and their competency should be assessed at least annually. It’s also a good idea to assess facility staff competency before using new equipment or performing new procedures.

Crisis Situations and Emergency Response: The first step in effectively handling crisis situations is having emergency response procedures in place. Procedures should detail the responsibility of the center and its staff to respond to an emergency, as well as timely transfer of patients to a hospital. For example, a fully stocked emergency crash cart is only as effective as the skills of the people using it. Are staff members properly trained? Is the equipment periodically checked to ensure accessibility and functionality?Additionally, procedures should identify basic requirements for handling emergencies:• Be sure staff members understand their individual responsibilities during an emergency – e.g., who will provide basic life support, which staff member will arrange transport to a hospital, etc.• Paste emergency numbers by telephones and at the nurses’ stations. It’s recommended that all clinical staff have BLS training; periodic re-certification is required.In minor emergencies, patients may refuse transport by ambulance to a hospital or emergency department, or they may refuse to go to the ED at all. In such cases, risk management experts recommend physicians explain the seriousness of the patient’s condition and associated risks of not following medical advice. It is further recommended the discussion be documented in the patient’s medical record.

Equipment/Resources and Discharge PlanningConcerning equipment and resources, risk management experts recommend you assess whether the ASC has adequate resources to care for the patient.For example, do operating rooms contain necessary equipment, such as cardiac monitors, SA02 monitors, resuscitative equipment like defibrillators and suction? It’s a good idea to assess whether the staff is properly trained to use the equipment and resources and whether the ASC has a procedure for updating that training. Also, ensure that equipment is maintained and periodically tested.Resources represent another area of concern. Does the ASC maintain an adequate inventory of supplies, implants, medications, etc., to safely care for patients?Regarding discharge procedures, it’s important to ensure the patient will be adequately monitored following the procedure and/or administration of moderate or deep sedation or anesthesia. Patients should be evaluated by physicians for proper recovery prior to their discharge from the ASC.Experts recommend discharge instructions be reviewed by the patient and/or the responsible adult accompanying the patient, if applicable. Instructions should include information about post-operative conditions that require immediate medical attention, signs and symptoms to report to the physician, medication instructions and potential side effects, as well as follow-up directives.Experts recommend patients be discharged from the post-anesthesia care unit either by a physician or by staff who follow rigorous criteria, such as the Post Anesthesia Discharge Scoring System.ProAssurance insured physicians and their practice managers may contact Risk Resource for prompt answers to liability questions by calling 205-877-5015 or via e-mail at riskadvisor@proassurance.com.

Thanks 2015 ANNUAL SPONSORS

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Sponsored by BlueCreek Investment Partners,

Huntsville Hospital & Regions Bank

Rx Theft and Forgery: How It Happens and What You Can do About ItBy Jeremy A. Wale, JD, ProAssurance Risk Resource AdvisorPrescription medication abuse is rampant throughout the United States. According to the Centers for Disease Control and Prevention (CDC), 16,500 people died in 2010 from overdoses tied to common narcotic pain relievers.1 In 2009, 15,500 people died from opioid painkiller overdoses, more than deaths from heroin and cocaine combined.2 According to the CDC, approximately 1.4 million ED visits in 2011 were a result of pharmaceuticals misuse and/or abuse.3 Who is stealing prescription drugs?Pharmacists, pharmacy techs, nurses, receptionists, doctors, patients, and even police officers have been caught stealing or forging prescriptions, stealing prescription pads, or stealing prescription medications. It can happen anywhere, by anyone. How does this affect you?Prescription theft or forgery by an employee in your practice may have legal and ethical ramifications for all professionals employed by the practice. If the practice fails to take proper precautions to prevent these actions, an injured person may attempt to sue for negligence. If you have a medical practitioner practicing medicine under the influence of narcotics, there are myriad negative ramifications affecting patient care, patient safety, or staff safety. You may also discover recordkeeping errors or inaccurate medical records. A healthcare provider also may encounter issues with the federal Drug Enforcement Administration (DEA) if there is suspected drug diversion going on in the practice. A DEA investigation could result in suspension or even revocation of a healthcare provider’s DEA license. Prescription theft and/or forgery could lead to loss in business, unhappy staff, increased medical errors, increased malpractice exposure, and more challenging defenses of potential malpractice claims. What can you do?Electronically prescribing medications can help limit the availability of paper prescription pads in your office. Electronic prescriptions also may have the added benefit of preventing pharmacy staff from making alterations to the prescription. One of the best ways to prevent prescription pad theft is to keep them under lock and key. Only trained healthcare providers with prescription-writing authority should have access to prescription pads. It is also a good idea to avoid pre-signing prescription pads. In addition, most states have an electronic drug monitoring program aimed to combat prescription drug abuse. These programs track prescriptions given to each patient. Some states allow practitioners to request a patient’s prescription data to help determine whether the patient may be abusing prescription drugs. If you have a patient displaying possible drug-seeking behavior, you may want to consider obtaining data from your state’s electronic program to help determine if there is an issue. Be sure to check your state’s laws regarding access to this information; you may need to submit a formal request. Some states will not dispense this information to healthcare providers. Maintaining accurate medication lists and limiting refills are also good ways to help determine whether a patient is abusing prescription medications. You may want to consider using NCR (no carbon required) prescription pads so your practice has accurate records of exactly what was prescribed and to whom. Being proactive about the process of prescribing controlled substance will help limit your practice’s susceptibility to prescription theft and/or forgery. “Physicians insured by ProAssurance may contact Risk Resource for prompt answers to liability questions by calling 844.223.9648 or via e-mail at riskadvisor@proassurance.com.”

(Endnotes)1 Koba M. Deadly epidemic: prescription drug overdoses. USA Today. July 28, 2013. http://

www.usatoday.com/story/money/business/2013/07/28/deadly-epidemic-prescription-drug-overdoses/2584117/. Accessed September 3, 2014.

2 Buntin J. America’s biggest drug problem isn’t Heroin, it’s doctors. http://www.governing.com/topics/health-human-services/gov-biggest-drug-problem.html. June, 2014. Accessed September 3, 2014.

3 Prescription drug overdose in the United States: Fact Sheet. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html. Updated July 3, 2014. Accessed September 3, 2014.

Copyright © 2014 ProAssurance CorporationThis article is not intended to provide legal advice, and no attempt is made to suggest more or less appropriate medical conduct.ProAssurance is a national provider of medical professional liability insurance and risk resource services. For more information about the company, visit ProAssurance.com.

Dr. Jeremy and Kerry RussellDrs. Amit and Aruna Arora

Welcome New Physicians to MASA/MCMS and Madison County!

Stephanie Israel, Matthew Israel, Norman McCoomer, David Cole, Beatrize Garcia-Cardona, Shaf Holden, Jitesh Kar, Donald Tighe,

Aaron Hoffman, Ashley Jackson, Brett Davenport, Charisse Jordan, Melissa Layno and Jay Hughey

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Office ManagerRoundtable Meeting

JAN 20The Ledges11:30-1pm

Spring FlingTBD

Governmental Affairs ConferenceFEB 7-10

www.masalink.org/govaffairs

Madison County Medical Society3330 L&N Drive, Suite IHuntsville, AL 35801

Visit us at:www.madisoncountydoctors.org

Send us your news!amymcms@bellsouth.net