Marys Medicine

03nov

LEGAL REPORT continued that best serves the needs of their communities, even ifthat means that certain specialists may not be available at It remains to be seen how the new
certain times. In such situations, hospitals are required to EMTALA regulations will affect
have a plan to deal with patients who need specializedcare. In particular, CMS clarified that exempting senior physicians and the effect is likely to
medical staff physicians from on-call coverage is not a vary based upon medical specialty
violation of EMTALA as long as the exemption does not affect patient care adversely. The final rule also allowsphysicians to perform elective surgery while on-call or tobe on call at more than one hospital.
capacity at multiple hospitals at the same time, rather Physician assistants and advance practice nurses can than limiting them to one hospital in the community.
be used by on-call specialists to respond to emergencies The ruling will also allow patients to schedule elective on a case-by-case basis under the direction of the special- surgery on a more timely basis, rather than having to ist, but only with the consent of the emergency room wait while that physician serves in an on-call capacity." However, the new EMTALA regulations have sparked some concerns that specialists will entirely Effect Of the new EMTALA regulations
abandon emergency departments. In particular, the The American Medical Association has applauded American College of Emergency Physicians (ACEP), the final rule, stating that it will "provide patients with while supporting many of the clarifications, has stated continued access to physician services in an on-call that the new regulations may add to the existing special-ist shortage. According to the ACEP, the final rules couldleave only a few hospitals in each community withmedical specialists, which would lead emergency patientsto flood their emergency departments. ACEP PresidentGeorge Molson, MD, states "It could result in conflictsbetween hospitals over who will provide specialty careand result in delayed care or more transfers of patients." Other physician groups, however, maintain that many specialists have already been forced into providingsimultaneous call services in their communities. Suchgroups believe that the rules will encourage certainspecialists to make their services available to morehospitals and, therefore, to more patients.
It remains to be seen how the new EMTALA regula- tions will affect physicians, and the effect is likely to varybased upon medical specialty and geography. What isclear is that hospitals and physicians will have to worktogether in order to develop adequate emergency depart-ment coverage under this new regulatory framework.
Only through such cooperation will appropriate cover-age be provided to the communities they serve.
Ms. Hershey is an associate with the Pittsburgh office of Fox RothschildLLP, which serves as counsel to the Allegheny County Medical Society.
She can be reached at [email protected]. Mr. Maruca is apartner with the firm and can be reached at (412) 394-5575 [email protected]. The Bulletin u 535 Hospitality Houses: Caring for
Patients and Their Families
ELIZABETH L. FULTON With Pittsburgh on the forefront of medical ments, designed for specialized, long-term housing, advances and treatments, people are coming opened next door to the original house. Ronald to the city to receive medical care from all McDonald House of Pittsburgh serves approximately over the country and the world. Many of them have 800 families a year. To be eligible to stay there, a family financial problems from extraordinary medical expenses must have a child 21 years old or younger who will be a that preclude staying at a hotel while they receive the patient at an area hospital, and the family's home must treatment they need.
be at least 40 miles away. The family also must have a Hospital hospitality houses are an inexpensive home- referral from the hospital, a physician or a social worker away-from-home for seriously ill patients and their verifying that the family has a child in treatment. About families who come from far distances to seek medical 95 percent of patients staying at the Pittsburgh house are care. It all began in 1972 with a hospital hospitality receiving treatment at Children's Hospital of Pittsburgh.
house in Buffalo, New York. The house was purchased For a small fee that may be reduced or waived for by Cyril and Claudia Garvey of Sharon, whose son had those unable to afford the full amount, the Ronald died of leukemia. As a memorial to their son, the house McDonald House provides private bedrooms, kitchens, was named "Kevin Guest House." laundry facilities, Internet access and playrooms. The The Ronald McDonald Houses, serving families of house also offers free daily food supplies such as milk, seriously ill children, are the most well known of hospi- eggs, orange juice, coffee and non-perishables. The tality houses. The story of Ronald McDonald Houses patient will also receive a gift of a brand-new toy, book begins in 1973 when the three-year-old daughter of or video, and some children may even be lucky enough Philadelphia Eagles tight-end, Fred Hill, was diagnosed to meet Ronald McDonald himself as he makes appear- with leukemia. While his daughter was receiving treat- ances at the houses.
ment, Hill and his wife noticed that many families, In addition to Ronald McDonald Houses, many including his own, ended up sleeping in hospital chairs non-profit agencies run hospitality houses throughout and eating vending machine meals. With the help of the country. Locally, Family House Inc. has three resi- Hill's teammates, a pediatric oncologist from Children's dences, two in Oakland and one in Shadyside, and Hospital of Philadelphia and several Philadelphia Allegheny General Hospital offers lodging through its McDonald's restaurants, the first Ronald McDonald Visitor Center.
House opened in Philadelphia in 1974 and became the Family House Inc., one of the largest hospital model for hospitality houses all over the country and the hospitality houses in the country serving about 7,200 patients a year, was founded in 1983 and serves any A Ronald McDonald House opened in the family who comes to Pittsburgh seeking medical care Shadyside section of Pittsburgh in 1979 near Children's from UPMC hospitals, VA Medical Center in Oakland, Hospital. In 1994, the Ronald McDonald House apart- Children's Hospital and Western Pennsylvania Hospital.
536 u The Bulletin FEATURE continued “It’s a gift finding this place (Family
House) and getting your life back
together and knowing you can live a
normal life again.”
—Anthony “T.R.” Russo
Family House also handles some of the overflow fromRonald McDonald House of Pittsburgh.
Carey Miller, director of development and public relations at Family House, explains some of the qualifi-cations for a family to stay at one of the residences. "Thefamily must be from at least 50 miles away to qualify,but we look at it on a case-by-case basis." she says,explaining that there have been families from Butler thathave stayed at Family House. "There are limited rooms,so we prioritize according to the severity of the illness."Also, patients who receive treatment on an outpatientbasis, such as transplant patients, get priority over Family House at Pittsburgh's Shadyside location has 44 family suites.
families of patients. Family House provides a total of115 guest rooms and averages 96 percent occupancy Oakland. Miller explains, though, that Family House over the course of a week. "Many nights, we are forced will usually try to have the family pay something. "Even to turn people away. However, we usually can accommo- as little as $10," she says. This gives the family the sense date our overflow in a few days time, and we have of ownership.
agreements with some local hotels for discounted rates There are several benefits to patients and patients' when available," Miller says. "We are keeping a close families who are staying in a hospitality house. "It's watch on the number of requests, averaging over 1,000 a comforting to the patient that family is nearby," Miller month, for future planning." says. "Studies have shown that families that are well- Each guest room provides a private bath, television rested give better support to the patient," she says. "And and telephone. In addition to guest rooms, Family the patient knows their loved ones are being taken care House also has suites that provide a family room area with a sofabed. Says Miller, "It feels most like a bed and Anthony "T.R." Russo of Boston, Massachusetts, breakfast." She adds that each residence has a communal and Kevin Hornbeck of Michigan are both transplant kitchen where each family has its own shelf in the patients staying at the Shadyside Family House.
refrigerator and cupboard. Also available at the resi- Russo was diagnosed with Crohn's disease 20 years dences are living rooms, television lounges, libraries, ago and, due to a surgical mistake, his small intestine Internet access and laundry facilities. Some residences was damaged. Not being able to eat solid food, he lived also have patios and exercise rooms.
on total parenteral nutrition (TPN) for a few years.
The rates to stay in a room at one of the Family "Unfortunately, that does a number on your liver in a lot House residences are inexpensive, but for those families of cases," he says. "The TPN was so taxing on my liver that may be unable to afford it, social workers will work that my liver went, and so it was my choice whether we with them to see if they qualify for help through the would figure out something else to do or look into a Family Assistance Fund which is offered at the houses in continued on page 538 The Bulletin u 537 FEATURE continued from page 537 possible transplant of his small intestine after his liverfailed. Hornbeck was given eight months to live beforecoming to Pittsburgh, where his surgeon told him it (atransplant) could be done without liver failure. "I hadthe worst attitude, and I was down. I was 118 pounds—all right, Mom and Dad, you want to transplant me, let'stransplant me," he said. His parents told him he had todo it, and he knew they were right, but he came toPittsburgh just to satisfy everyone else. "Then when Icame here (Family House), I met T.R. and all thesepeople who just finished having this done who arearound my age," Hornbeck says.
"That's the only reason why I'm here. I thought I'd be here and be the only sick one. Everybody else wouldbe cured." He was wrong and learned that many wanted Kevin Hornbeck (left) and Anthony "T.R." Russo, recent resi-
dents at Family House, hang out in the facility's library.
to help him. "I didn't approach them; you just don'twhen you get to that point. You pull yourself back.
transplant." A gastroenterologist in Boston gave him You're just kind of a loner," Hornbeck says. "They came information on the Starzl Transplantation Institute at to me. Someone called me on the phone before I even UPMC, which brought him to Pittsburgh for a five- got here." He says when he got to the house people organ transplant. The doctor also suggested Family approached him in the living room and began talking to him. Hornbeck then felt comfortable to ask them "It's a gift finding this place and getting your life questions about their transplant operations. "Now I'm back together and knowing you can live a normal life doing that for people who come here," he says.
again," Russo says. "Then there are things like getting Even Hornbeck's sister became a believer. His sister, down here, where to stay, tying in the transplant with a nurse, and brother-in-law, a doctor, had discouraged support groups, meeting people; and that's where Family him from coming to Pittsburgh for the transplant. She House comes in." Russo enjoys the supportive environ- was visiting when he got the call for the transplant. "Two ment at Family House. "No one could relate to what I people with transplants.came up to my room. I was was going through; my best friends, my closest family scared. I wouldn't get off the couch; I was scared to could sympathize and see the wounds and the ostomy death. And those guys came up to my room and said, bags and tons of medicine and all the supplies, but they ‘Come on. It's going to be all right.' I get down to the couldn't really relate to me," he says. "And here it was door and everybody's at the door seeing me off and like walking into this place where, instead of me being everything," he says. "It was just amazing. And my sister the outsider, it's the patients who are almost normal. You went back home. She met everybody here and said, ‘I meet all these people who are just like you, have experi- enced the same things that you have and know what you Russo believes there is an innate feeling among are talking about firsthand." Russo also likes that his transplant patients that they should give back. He came mother is taken care of when he is in the hospital.
from Boston earlier in the year to help with the Family "There are so many people around to give her support, House benefit polo match, and Miller explains that which is just as important in the family scheme," he says.
many do come back from long distances just to volun- Hornbeck knows that Family House was the reason teer. Many also come back just to visit.
he came to Pittsburgh for his transplant. He was diag- According to Miller, people from all over the coun- nosed about 20 years ago with pseudo-abdominal try and every part of the world have stayed at Family obstruction and was on TPN for six years. He was told House. Russo says, "One of our friends is kind of plot- there was nothing that could be done for him except a ting the states where we all are on a map so we can really 538 u The Bulletin FEATURE continued look it up, our support system, and see how it's grown are people out there dying everyday, and they don't even and see how many friends we have across the country." come here. I didn't want to come here. I live seven hours After explaining the friendships he's made living in a away," he says. "People from West Virginia don't even hospitality house, Hornbeck says, "In a hotel that know about this place.These places need to be talked wouldn't have happened. It wouldn't have happened in about on T.V. and bulletins on everything, on the news the hospital because you're sick in the hospital. You're or whatever is out there." just laying there. Here you get down here (the common Local hospital hospitality houses include: Family area), you get some air, you talk to people, which makes House Inc., (412) 647-7777; Ronald McDonald House you a thousand times better." He adds, "I was scared to of Pittsburgh, (412) 362-3400; and the Visitor Center death to come out of the hospital. I was in the intensive of Allegheny General Hospital, (412) 359-1200.
care unit for 28 days. Two days out, they sent me here.
My mom was like, ‘No way.' And I was like, ‘Uh-uh.' Ms. Fulton is communications assistant for the Allegheny County You know, because I've got all this stuff hooked up to Medical Society. She can be reached at [email protected]. me. And I came down here and everybody was helping." Kay Bebenek, manager of the Shadyside Family House, says hospitality houses can shorten the length of Family House Inc.: www.familyhouse.org stay at a hospital for many patients, but it can be a National Association of Hospital Hospitality Houses: www.nahhh.org Ronald McDonald House Charities: www.rmhc.com Catch-22 situation. "As far as managed care is Ronald McDonald House Charities of Pittsburgh: www.rmhcpgh.org concerned.they feel they can discharge the patientsright to us that aren't well enough to go back home," shesays. Bebenek adds that all patients must have a caregiverstaying with them because Family House does notprovide medical care.
Better emotional support from family and staying in a caring environment greatly help patients in the recov-ery process. Financially, hospitality houses contribute tolower healthcare costs to patients and their families.
They give a low-cost option of lodging to many familieswho otherwise may have to stay in expensive hotelrooms or sleep in hospital waiting rooms. Also, forpatients who require outpatient care or need accommo-dations before and after surgery, hospitality houses offeran inexpensive place to stay. But it still costs money. "Ireally think they need to do something about gettinghousing like this covered by insurance," Russo says. "It's$45 a night to stay here, so it adds up, especially whenyou don't know how long you're going to be here.
There's got to be something that can be done aboutthat." Hornbeck believes more people should know about hospital hospitality houses and that there should bemore houses around the country. "There are tons ofpeople who can donate, and physicians that can help getthese places built," he says. Hornbeck also believes morepeople should know about transplantation in conjunc-tion with the hospitality houses in Pittsburgh. "There The Bulletin u 539 PRACTICE MANAGEMENT Reducing Errors in
Ambulatory Care
KAREN K. DAVIS Not many studies have looked at ambulatory care Graham Center study, 83 percent of the errors reported or primary care to find out what errors are were process errors and 13 percent of the errors reported common to those settings. A newly published were knowledge errors. (The other four percent of study does, though. A Preliminary Taxonomy of Medical reported errors were not considered errors by the re- Errors in Family Practice, published by the Robert searchers, and therefore were left out of the taxonomy.)1 Graham Center for Policy Studies in Family Practice and The main categories of process errors were: Primary Care, Washington, D.C., lists the results of an • administrative failures (information missing or mis- effort to discover common errors that occur in ambula- filed, problem with patient "flow," message improperly tory primary care.
handled, appointment error); The Graham Center study selected a group of • error when ordering, obtaining results of or notifying approximately 50 board-certified family physicians from patients about lab work, diagnostic imaging or other across the United States and asked them to report on errors in their practices. The physicians were told to • error when ordering medications or implementing observe their practices in all locations—office, clinic, medication orders; nursing home, hospital and patient home—and to • error in communicating with the patient or with report anything that made them think, "that should not another healthcare provider; and happen in my practice, and I don't want it to happen • payment processing error.
again."* Physicians reported the first 10 errors in their The main categories of knowledge errors were im- practices after a specified start date.
proper performance of a clinical task, wrong diagnosis The researchers then analyzed the error reports and and wrong treatment decision.
established a taxonomy classifying the errors. The Researchers pointed out that one way the family taxonomy distinguishes two main kinds of errors: practice study differed from studies of inpatient care process errors and knowledge/skill errors. Process errors errors was that most of the mistakes in this study were are administrative-type errors that could be addressed from process problems rather than clinical problems.
and reduced by establishing different office procedures.
Also, there were fewer medication errors in the family Knowledge or skill errors result when a physician, nurse practice study than in those undertaken in hospital or other healthcare worker lacks the clinical information settings. Although the data discussed in this article come needed to properly diagnose or treat a patient. In the from family practice analyses, the risk reduction ideas in 540 u The Bulletin

the following discussion can be applied to other ambula-tory clinical practices.
Ideas for reducing process problems
The majority of errors identified in the Graham Center study were administrative errors. Therefore, it iswise for practices to try to keep the best possible track ofadministrative processes. From a legal standpoint, thephysician employers of a medical practice bear theultimate responsibility for the actions of all the people inthe office. Some tips to reduce process problems are: Make a notebook of office policies. Delineating specific procedures—for releasing medical records, filing andpulling patients' charts, taking messages, triaging calls,scheduling appointments, directing patients through theoffice, documenting phone calls, refilling prescriptions,and the like—will help to ensure that administrativetasks are done in a consistent way.
Hire competent staff. Physicians can cut risks in administrative processes by paying attention to hiring.
When hiring office personnel, you should look forapplicants who have appropriate technical training and Sale or Lease—Available 2004
ability for the positions they will fill, and should furtherassess the qualified applicants to find those who havegood "people" skills.
Formally orient new staff. When new office personnel start their employment at the practice, they shouldcomplete an orientation program during which theoffice administrative policies are explained and demon-strated to them.
Discuss administrative issues. Set up a method that allows staff to have occasional discussions about policies and procedures. This could be done periodically at 250 Clever Road, Robinson Twp., PA (12 miles to CBD & 3 miles to The Pointe) administrative staff meetings, for example. The discus- sions could focus on a review of certain procedures or on identifying problems with certain procedures.
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patients are expected to take responsibility for their ownhealth care, a review of legal cases shows that courts Utilities: Water, sewer, gas, electric
expect physicians to play a part in ensuring the patient Parking: 100 spaces (room for expansion)
gets appropriate care. Doctors' medical training gives them a better understanding of the consequences of 120-bed residential care facility (Citizens Care, Inc.) various treatment options as well as the consequences of ROY F. JOHNS, ASSOCIATES
delaying treatment. Therefore, a physician is expected to Contact: Ron Willis at (412) 264-8383
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continued on page 543 The Bulletin u 541 PhysiciansPMSLIC was established twenty-five years ago by physicians for physicians.
Our concern for health-care professionals practicing in Pennsylvania extends beyond writing policies. Our defense of good medicine is vigorous.
Risk management activities are tightly integrated with underwriting standards.
We lobby persistently for meaningful medical liability reform. While malpractice carriers falter and fail, PMSLIC is taking actions today to maintain a stable source of professional liability insurance for Pennsylvania physicians for the future.
An advocate for meaningful medical liability reform Founding partner of Citizens Allied for Pennsylvania Patients (CAPP) Endorsed by the Pennsylvania Medical Society Owned by NORCAL Mutual Insurance Company — formed and owned by physicians Rated B++ (Very Good) by A.M. Best Company physician owned, physician directed P.O. Box 8375777 East Park DriveHarrisburg, PA 17105-8375 Currently accepting applications only from physicians joining insured practices.
542 u The Bulletin PRACTICE MANAGEMENT continued from page 541 When there are test results to report to the Ideas for reducing knowledge problems
patient, the physician is expected to The second category of errors make sure the patient knows what identified in the Graham Center these results are, how they relate to his study can be characterized as knowl- or her condition, and what is likely to edge errors. Knowledge errors can happen depending on the course of lead to wrong decisions, wrong action the patient decides to take.
diagnoses, problems using equip- There are a number of ways to set ment, problems executing tasks and up a system for determining whether inaccurate X-ray or test interpreta- or not a patient has had a test or tion. Some general tips to reduce followed through with some other knowledge errors are: recommended action. Some offices use a • Stay within a regular scope of logbook, some a tickler file, some a follow-up appointment, and some a computerized system to track • Keep up with changes and advances in your specialty.
patient compliance with recommendations for tests and • Monitor the allied health providers in your practice.
consults. Any system is appropriate as long as it provides • Hone your history-taking skills by reading literature in a way to assure that the follow-up action is taken and as your field, attending continuing education programs, long as it guards against having issues "fall through the getting patients to focus on their most important or bothersome symptoms, asking open-ended questions Focus on communication with patients. Communica- to facilitate patients' descriptions of symptoms, con- tion is highly important in medical practice. Studies centrating on improving listening skills, and trying not have shown that, if communication is lacking, patients to interrupt the patient's initial statement.
are more likely to perceive a problem with the quality of • Continue diagnostic pursuit until you have a diagnosis care and are also more likely to sue physicians. Some of for a patient's symptoms rather than using a "rule-out" the following techniques may help you develop better diagnosis that is never confirmed. If you use empirical rapport with patients: treatment, you should follow the patient closely and • Make eye contact.
re-evaluate symptoms if they continue.
• Express compassion.
• Solicit feedback with open-ended questions.
You can reduce the chances that mistakes will occur • Ask the patient to summarize information back to you in your practice by examining its processes and looking to check his or her understanding of it.
for weaknesses. Data from the Graham Center study • Ask patients about their willingness and ability to point to some types of errors that have been identified in follow their treatment plans.
ambulatory care practices. Checking to see if these types Communicate effectively with other care providers. It is of errors could happen in your practice and revising your essential that all the providers involved in a patient's processes in vulnerable areas will increase your capacity care—the referring physician and all the consultants— to protect your patients from harm and will reduce your understand who will be primarily responsible for the liability risk.
patient's care. Coordinating care can get complicatedwhen multiple specialists are involved in one patient's Ms. Davis is a risk management researcher and project manager for care. All physicians must keep abreast of who the other Pennsylvania Medical Society Liability Insurance Company (PMSLIC). involved physicians are and what treatments they are You can call her at (800) 445-1212 or e-mail [email protected]. rendering. A break in professional-to-professionalcommunication can translate into a misunderstanding about therapy that could jeopardize a patient's well 1Dovey SM, Meyers DS, Phillips RL, et al. A preliminary taxonomy of medical errors in family practice. Quality and Safety in Health Care. The Bulletin u 543

Sometimes the most dazzling gifts aren’t ones that sparkle.
This holiday season give the gift that will make someone’s life a little brighter.
Created, funded and administered by physicians since 1960, the ACMS Foundation has given more than $1 million back to the community to help people of all backgrounds live better, healthier lives. Last year the ACMS Foundation contributed to or sponsored the following organizations and activities. This year, give a gift that may help to brighten the lives of others. All contributions are tax-deductible.
WILL ALREAD
• Achieva: Individual Public Service Award • Healthy 4 Life Initiative • Allegheny County Respite Care Coalition, Inc.
• Medical Student Award (3) • Carnegie Science Center USE RED SPO
• CCAC Education Foundation • Nazareth Housing Service: Senior • Children’s Hospital of Pittsburgh Foundation: Homeowner Assistance Program Sickle Cell Camp Escape 2003 • Pittsburgh International Science and • Family Medicine Education Consortium Technology Festival (2) • Girls’ Hope of Pittsburgh, Inc.
• Providence Corrections, Inc.
• Greater Pittsburgh Council of • Rx Council of W. Pennsylvania Boy Scouts of America: • Salvation Army: Scouting for Youths at Community Health Service Award • The Albert Schweitzer Fellowship: 2003- • The Foundation of the Pennsylvania Medical Foundation, Inc.
544 u The Bulletin Diabetes and Depression in
Southwestern Pennsylvania
TANIA LYON, PHDNAIDIA GRUNDEN Coalition partners in the Pittsburgh PRHI partners looked for ways to get timely Regional Healthcare Initiative information into physicians' hands through a (PRHI) are targeting depression secure internet-based connection. The result- and diabetes in our region. What's the ing model, called the Pittsburgh Health connection between these two seemingly Information Network (or PHIN—pro- unrelated conditions? Both are chronic nounced "fin"), is similar to models in diseases, usually in outpatients. Both Utah (UHIN), Delaware (DHIN) and affect a large and increasing percent- Santa Barbara County, California age of the population in Southwestern Pennsylvania. And both are widely undertreated.
The Diabetes and Depression Working Groups are It takes a village: collaboration
working to improve care among all populations illus- PRHI partners addressing this challenge included all trated in the above pyramid (Figure 1). The group four of Pittsburgh's commercial health plans, all three of decided to concentrate on people in the third tier: Pittsburgh's Medicaid health plans, and Pittsburgh's two patients who have been diagnosed with depression or largest commercial labs. Together with numerous diabetes, and are under a physician's care—before healthcare professionals, they proposed to create a database to gather relevant claims data from health plans The hypothesis: When practitioners and patients and results from lab tests and combine them into a have up-to-the-minute patient information when and simple, one-page document for each patient. This where needed, complications and unnecessary hospital- information could then be pulled by the physician at the izations related to depression and diabetes could be point of care through a secure Internet connection.
Information where, when needed
How it works now
The data could generate a list of chronic disease Currently, physician offices have to collect their own patients or an individual patient history of basic care data on diabetic and depressed patients, which arrive at received for diabetes or depression. This will: different times from many sources (commercial health • allow physicians to keep better track of their patients plans, Medicare, Medicaid and multiple laboratories).
through the list/registry function; The paper reports must then be filed in time for a • create opportunities to engage in better preventive care; patient visit, at which time the patient learns the results.
• help reinforce a minimum standard of care that has The current system's inefficiencies conspire against been established for depression and diabetes through physicians' ability to provide proper care to every pa- evidence-based, nationally recognized measures; and tient, every time.
continued on page 546 The Bulletin u 545 SPECIAL REPORT continued from page 545 • allow patients to access their data as a step toward cians are already liable for providing a minimum stan- becoming more educated and active in their own dard of care. PHIN is designed to help them provide disease management.
that care more easily and effectively.
The technical team addressed questions like these: Challenging what's possible
• How will we handle data transmission? PRHI partners studied ways to make the informa- • Can data be posted quickly enough to be useful to tion readily available securely online. Questions and perceived problems abounded. What entity could act as • Can the QIO handle varying patient identifier systems a neutral, trusted repository for this information? Under from different organizations? strict new HIPAA guidelines, would such a data resource • How can the QIO ensure that only physician practices be legal? Could it be confidential enough, yet allow that have a relationship with a patient can access that physicians and patients appropriate access? Could itwork technically, and still be easy to use? Neutral repository: Quality Insights
PRHI discovered a powerful partner in "Quality Insights," our regional Quality Improvement Organiza-tion (QIO) reporting to the federal Center for Medicareand Medicaid Services (CMS). It brings considerabledata management experience and infrastructure to bearon this project as part of its own mandate to improvecare for diabetes. The QIO will act as a neutral platformfor collecting and collating data from all other sources.
See Figure 2 on right.
Legal and technical challenges
With PHIN, claims data from health plans and lab values from diagnostic To systematically address the daunting legal and labs flow into the QIO database. These data can help physicians by providing the following information about the patients in their practice: technical concerns, PRHI formed two task forces madeup of representatives from health plans, labs, the QIO • Lists of all diabetic and/or depressed patients and physician practices. The legal team tackled such • Aggregate reports, allowing physicians to benchmark against regional • What kind of business agreement can be used? • For diabetic patients: • Will physicians' current privacy statements for patients * Dates of last visit need to be modified? * Dates, values of hgb A1C tests * Dates, values of lipid profiles Under what conditions can data be shared across * Dates of dilated retinal exams multiple physicians? • For depressed patients: • What are the parameters for sharing mental health * Dates of follow-up visits data? Are extra safeguards needed? * Dates when prescriptions for antidepressant medications are filled or refilled Will physicians be liable for using PHIN data? Con- The QIO will add Medicare data and build a comprehensive regional versely, if the PHIN database creates a new standard of database. Rather than pushing yet another report to the physician’s desk, care, will physicians be liable for not using it? physicians could draw data as needed through a website.
Perhaps the legal team's most surprising finding was ALL information will be available in a common format—no matter which the extent to which the dreaded HIPAA regulations plan or lab it came from.
actually help efforts like PHIN. HIPAA has actually And it’s two-way: physicians can amend and update data so it becomes reduced liability by establishing clear standards of more accurate with each use.
protection and an industry standard of due care. Physi- Patients will also have access to their own data.
546 u The Bulletin Group Purchasing Program
Endorsed by the Allegheny County Medical Society • How will patient history follow a patient across Mike Gomber, Area Vice President
(412) 580-7900 Toll Free(800) 472-2791
Partner institutions conducted research that helped to navigate these challenges as well.
If you would like a copy of the summary document, Improving Care for People with Diabetes and Depression, A combined 310 years of Physician Healthcare Service call Tania Lyon, PRHI's chronic disease coordinator, at and solution experience in Pittsburgh. That means we (412) 535-0292, ext. 107, or e-mail [email protected].
have the knowledge base to provide the best in medical Pilot testing begins
solution and service! Eleven physicians have agreed to act as a pilot group to test the database in its initial phases. A dozen major 22,000 square foot Pittsburgh warehouse means a Pittsburgh employers, offering health coverage to 90,000 commitment to our community to provide the best employees and dependents, are encouraging physiciansin their health plans to use this resource.
service, solutions, quality and price to your practice.
In addition, because both depression and diabetes disproportionately affect lower-income and certain racial Our factory-trained, locally certified service technicians groups, we are recruiting the participation of physicians provide expert service for your equipment, translating to serving those populations (i.e., via Medicaid health plans less down time.
and physician groups like the Gateway Medical Society).
Some commercial health plans have developed their own programs to improve the care of patients in their Consultant services to analyze your product use and systems (i.e., our partner Highmark's Smart Registry).
provide cost containment and produce standardization.
This project helps to ensure that all patients, no matter That means significant savings to reduce medical supply what their coverage, can have their chronic disease data and utilization costs with our customized programs.
made easily available to their physicians for improved care.
What if this works?
Physicians well know how to treat diabetes and Distributor of Choice (DOC) program provides depression effectively. Yet our region suffers excruciat- continual maintenance and calibration of diagnostic ingly high rates of almost always preventable complica- equipment (scale, BP, otoscope, ophthmoscope) and tions. If PHIN can be made to work, getting physicians sharp surgical instruments—accurate results for your and patients up-to-the-minute healthcare information, diagnostic and surgical procedures.
proper care can be given to every patient at every visit.
From this starting point, Pittsburgh can become the OUR MISSION is to serve each
Perfect Care Zone, where 100 percent of diabetic and customer as if he or she were the only depressed patients routinely receive the care they need.
customer by providing each office with Southwestern Pennsylvania could become the first placein the country to virtually eliminate the complications of the best healthcare services and diabetes and depression—a development that would solutions for quality patient care.
have national implications.
We value your partnership in helping us to serve you. Thank you, physicians, administrators and Ms. Lyon is chronic care coordinator for the Pittsburgh Regional office staff, for directing and advising us on medical Healthcare Initiative and Ms. Grunden is the organization's communi- supply products, services and costs.
cations director. Both can be reached at (412) 535-0292. Visitwww.prhi.org for additional information. The Bulletin u 547 TIMOTHY F. MURPHY In the past, most Americans have taken for granted to limit venue shopping, especially in the Philadelphia easy access to quality health care. Now, however, area. We also passed Act 13, which allowed for propor- there is unease about our healthcare system. The tional liability, collateral receipt and distributed pay- ranks of the uninsured are growing, there are double ments. Because many cases were filed before these bills digit increases in health insurance costs, seniors are took effect, it is too early to document whether or not worried about the high cost of prescription drugs and this legislation has made a substantive difference. It may physicians have yet to see the effects of changes in the take years to see a reduction in high payouts to plaintiffs medical liability system. Even in the midst of the War and subsequently a reduction in insurance costs.
Against Terror and economic concerns, there is a com- Earlier this year, the U.S. House of Representatives mitment to change. Reform of this system has become a passed H.R. 5 to implement reform. This legislation top priority of Congress and President Bush.
would ensure speedy resolution of claims, establish fair As one of the few healthcare professionals in Con- accountability by weighing the degree of fault, provide gress, I have used my experience of working at local maximum patient recovery by ensuring attorneys do not hospitals and the input of my fellow healthcare profes- misdirect awards, fully compensate for patient injuries sionals to explain to my colleagues in great detail the and put reasonable time limits on punitive, non-eco- struggles of healthcare providers. What follows is a brief nomic damages by ensuring the punishment fit the update on the status of two of the most pressing pieces offense. The key to H.R. 5 is a $250,000 cap on puni- of federal health care legislation in the works: medical tive awards. The bill is currently in the Senate for con- liability reform and the addition of a prescription drug sideration and, at the time of this article, this cap on benefit to Medicare.
non-economic damages remains a fundamental area ofdispute.
Medical Liability Reform
In the meantime, there is a concern on the federal The high cost of medical liability insurance is level about the growing exodus of physicians from states forcing physicians, especially those in high-risk fields, to with high insurance rates. A recent report from the flee Pennsylvania. Graduates of our medical schools and General Accounting Office (GAO) disputed the exist- residency programs are choosing not to remain. Physi- ence of a causal link between escalating premiums and cians are unwilling or unable to pay exorbitant insurance patients' access to health care. The goal of the study was costs and have relocated to states with reformed systems.
to determine if fewer people were able to access insur- Some blame physician error for the high costs due and ance in five of the states (Pennsylvania among them) seek to block changes to the system in order to protect a deemed to be "in a crisis" by the American Medical patient's right to sue for damages. Others see the system as broken and in need of major reform.
The GAO study determined that, although some While I was serving as a state senator, we took several people were having difficulty accessing care, these steps to help. The Pennsylvania legislature passed a bill 548 u The Bulletin SPECIAL REPORT continued be deducted to further wrap around the Medicareprogram to further reduce out-of-pocket expenses. In The ranks of the uninsured are
addition, I am working to ensure that Medicare reforms growing, there are double digit
would stabilize fair reimbursement rates for physicians increases in health insurance costs,
and hospitals.
seniors are worried about the high
At the time this article was written, work was con- tinuing in the Senate and House on Medicare reform.
cost of prescription drugs and
Differences on level of coverage and out-of-pocket physicians have yet to see the
expenses are currently being worked out in conference.
effects of changes in the medical
There has been real progress on medical liability and Medicare reform. This is in no small part a result of theinvolvement of the healthcare community. I thank the incidences tended to occur largely in rural areas where many who have advised me on the current state of affairs problems were either long-term or traditional. This and on concerns particular to their practice. Your feed- report used only anecdotal information such as inter- back and comments are an invaluable part of this histori- views with hospitals and practices, and selective investi- cal movement for reform. We are close, but there is more gation of certain medical fields. Only two Pennsylvania work to be done.
settings were studied, and the number of available Congressman Murphy represents the 18th District in the United States physicians was based on a count of existing licenses.
House of Representatives. He can be reached at (412) 344-5583 or License statistics are largely skewed because they count residents, retirees, academic physicians, and physicianswho are licensed here but practice out of state. Thereport's dismissal of rural access problems suggests insensitivity to rural populations. (Pennsylvania has thecountry's highest rural population.) The study concluded that there is no physician shortage in Pennsylvania. Ihave challenged the GAO report and explained tocolleagues that its conclusions are invalid. This illustrates Getting your claims out is easy. Having the need to stay on top of this issue as it works its way the time to follow up is tough, espe- out of the Senate.
cially if your biller is pulled for patient care, scheduling, or whatever.
In June of 2003, the House of Representatives At FENNER, our billers are devoted passed H.R. 1 (Medicare Prescription Drug and Mod- 100% to managing accounts and fol- ernization Act) by a vote of 216-215. This legislation lowing up on difficult claims.
would amend the Social Security Act to provide forvoluntary prescription drug coverage under the Medicare If you think it’s time to outsource your program, modernize the Medicare program and allow adeduction to individuals for amounts contributed to billing, call us at 412-788-8007 or visit health savings security accounts and health savings I am working to ensure that a federal prescription drug plan would complement Pennsylvania's PACE and One Penn Center West PACENET programs. Since Medicare would cover Pittsburgh, PA 15276 much of what PACE covers, Pennsylvania would seehundreds of millions of dollars in savings, which could The Bulletin u 549 Smoking Cessation Efforts
in Allegheny County
LINDA DUCHAK Tobacco Free Allegheny (TFA), a new non-profit At the heart of all strategies to reduce the burden of organization supported by the Allegheny County mortality, morbidity and disability associated with Health Department, has taken advantage of the tobacco use is maintaining an understanding of the body of knowledge, scientific evidence and experience of substantial and expanding body of scientific knowledge other states in constructing a comprehensive, coordi- about the health consequences of tobacco use. Thou- nated tobacco control program in Allegheny County sands of studies detail its overwhelming health conse- that is sustainable and accountable. Funded through the quences, and a succession of U.S. surgeons general have Master Settlement Agreement of 1998 between 46 states reviewed and summarized the health effects associated and the tobacco industry, TFA joins the Pennsylvania with smoking and other forms of tobacco use. Past Department of Health in efforts to create an environ- decades of research have indicated that single-focus ment where it is uncommon to see, use or be negatively efforts (e.g. media campaigns, school programs) produce impacted by tobacco use.
little long-term change in the prevalence of tobacco use.
Tobacco has a long history of use in the United It has been those efforts that combine a number of States, and its serious health effects have been well coordinated, complimentary initiatives addressing the documented during the past half-century. In 1982, multiple issues of tobacco use by a variety of providers Surgeon General C. Everett Koop declared, "Cigarette that have resulted in the strongest, longest-lasting smoking is the chief, single cause of avoidable mortality reductions in tobacco use.
in the U.S. and the most important public health issue Multi-pronged efforts, including the development of of our time." Smoking has been the leading preventable prevention and cessation programs, public information cause of disease and death in this country for more than campaigns, legislative initiatives, advocacy activities and three decades and is responsible for more than 430,000 similar measures have produced results. A wide range of deaths annually, representing nearly one in five deaths.
organizations in the federal sector (e.g., Centers for Efforts to control tobacco use in the U.S. accelerated Disease Control, National Heart, Lung and Blood after the publication of the first surgeon general's Report Institutes), voluntary agencies (e.g., American Cancer on Smoking and Health in 1964. Considerable progress Society, American Lung Association), and others (e.g., has been made in reducing the prevalence of smoking in American Medical Association, Association of State and the U.S. over the past 25 years, during which time there Territorial Health Officers) have allied in efforts to has been a 34 percent reduction in adult smoking.
control tobacco use and its disease ramifications. Evi- Despite the increase in policies regulating smoking, dence has indicated that strengthening existing relation- litigation against the tobacco industry and heightened ships and facilitating cooperative linkages among others public awareness of the negative health consequences of who have not previously worked together foster success tobacco use, cigarette smoking remains firmly en- in tobacco control. In this way, with numerous organiza- trenched in American society today. Although the tions converging on the single issue of reducing tobacco demographics of smokers vary from those nearly 40 use through a wide variety of complementary activities, a years ago at the time of the 1964 report, nearly one- multiplicative effect is possible.
fourth of the population, or 67 million Americans, Tobacco Free Allegheny used a competitive process continues to smoke.
to assign funding that has resulted in the selection of 550 u The Bulletin SPECIAL REPORT continued more than 30 service providers from local hospitals, use tobacco and, if so, encouraging them to quit. Our clinics, faith-based organizations, voluntary health staff can provide information, literature and training by organizations, mental health agencies, universities, calling at (412) 578-7910.
community organizations and athletic organizations thathave implemented programs throughout the county in Linda Duchak is executive director of Tobacco Free Allegheny. She can the priority areas identified by the Centers for Disease be reached at (412) 578-7910. Control in its guideline, Best Practices for Comprehensive Tobacco Control Programs. Community-based, school- based, chronic disease and cessation programs offer an (1)U.S. Dept. of Health & Human Services, The Health Consequences of Smoking: Cancer. A Report of the Surgeon General. DHHS Pub. No (PHS) array of services in the community, including classroom 82-50179. Washington, DC: Government Printing Office, 1982.
instruction using evidence-based curricula, cessation (2) U.S. Department of Health and Human Services. Reducing the Health services for youth and adults, faith-based prevention Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. DHHS Pub. N0. (CDC) 89-8411. Washington, DC: Government activities, peer education, parent education, early detec- Printing Office, 1989.
tion of tobacco-related diseases and continued treatment (3) Redmond, D.E. “Tobacco and Cancer: The First Clinical Report.” New of disease. An initiative to provide pharmacotherapy to England Journal of Medicine 282 (1961): 18-23.
participants of cessation programs has been imple- (4) American Cancer Society. Cancer Facts and Figures–1994. ACS Pub.
mented. All services are provided at no charge to resi- No. ACS 94-375M 5008.94. Atlanta, Ga.: ACS, 1994.
dents of Allegheny County.
(5) Pertschuk, Michael. Strategies for Tobacco Control in the United States.
Advocacy Institute, Washington, DC.
Research is being done to identify issues with dispar- ate populations. Enforcement of youth access restrictionsto tobacco products and clean indoor air regulations isongoing. Concurrently, print and broadcast media isbeing used in countermarketing and advertising efforts.
Ongoing process and outcome evaluation is beingconducted by a team of researchers from the GraduateSchool of Public Health at the University of Pittsburghto determine individual and cumulative program effec-tiveness.
Of particular concern to Allegheny County is the unacceptably high rate of tobacco use during pregnancy(23.6 percent) as reported by the Annie E. Casey Foun-dation. Tobacco Free Allegheny has established outreachto pregnant women as a priority. The current focus of itswebsite (www.tobaccofreeallegheny.org) is on maternalsmoking. In addition to educational programs, cessationservices and print and broadcast media outreach, resi-dents at local hospitals and clinics are being trained toimplement interventions in their practices. Physiciansand their staffs are being trained to implement clinicalpractice guidelines as well as Clean Air for HealthyChildren, an intervention focusing on pregnant womenand mothers of young children.
Tobacco Free Allegheny recognizes the impact of the medical profession in prevention efforts. It is our hopethat every physician in Allegheny County will supportour efforts by asking each patient whether or not they The Bulletin u 551 To Tell the Truth
TIMOTHY LESACA, MD Regarding the issue of disclosure, patients and physicians largely agreed on the concept but disagreed Call us! We'll help you find the answers!" These are the closing words from one of the morememorable television ads for a prominent upon the definition. The patients unanimously wanted malpractice attorney. No doubt when people feel that information regarding an error's cause, consequences and they have been hurt, even before they seek justice or even future prevention. They stated that such disclosurevengeance, they instinctively seek some measure of would enhance their trust in the physicians' honesty and understanding. Knowledge is usually the most powerful would reassure them that they were receiving complete antidote against despair.
information about their overall care. Furthermore, the With this axiom in mind, I read with a sense of patients preferred that such disclosure be provided to enlightenment an article in the February 26, 2003, issue them forthrightly, rather than having to ask their physi- of the Journal of the American Medical Association by cian "numerous questions." They also wanted to know Thomas Gallagher, MD, titled "Patients' and Physicians' that the practitioner and institution regretted what had Attitudes Regarding the Disclosure of Medical Errors." happened and were taking steps to prevent future similar This study, designed as an in-depth exploration of attitudes about the disclosure of medical errors, involved52 patients and 46 doctors in a total of 13 focus groups.
The specific research questions pertained to the attitudes Regarding the issue of disclosure
of patients and physicians about medical error disclosure, (of medical errors), patients and
as well as explored whether physicians disclose theinformation patients desire about medical errors.
physicians largely agreed on the
Much to my surprise, this sample of patients con- concept, but disagreed upon the
ceived of medical errors very broadly. Despite being presented with a standard definition of medical errors,they perceived events such as long waits for routineappointments, non-preventable adverse events such as Many of the physicians, however, were reluctant to drug allergies, and interpersonal issues such as being provide patients with this extent of information. Al- addressed "rudely" by a physician as examples of medical though they endorsed error disclosure in principle, many described specific situations in which they might not I was much less surprised by the physicians' attitudes disclose an error that harmed a patient. Some physicians regarding medical errors. Most of the physicians worried felt that there was no need to disclose an error if the regularly about medical errors; in addition to fear that an harm was "trivial" or if the patient was unaware that the error might harm a patient, they also said that their error had taken place.
worst fears about errors included lawsuits, loss of patient Many of the physicians felt that error disclosure trust, loss of colleagues' respect and diminished self- involved being a "spin doctor," describing the event in confidence. They were also frustrated by the breadth of the most positive light, yet as factually accurate. They what patients considered to be errors and felt that spoke of "choosing their words carefully" when talking patients were often unduly upset about "minor" errors.
with patients about errors. Most often, this careful 552 u The Bulletin PROSPECTIVE continued choice of words involved mentioning the adverse eventbut not explicitly stating that an error had taken place.
The physicians' wariness in telling patients about errors reflected their fear of litigation, as well as a belief thatinformation about an error might "harm the patient."Interestingly, few patients shared this latter concern.
The patients believed that the way the error was Allegheny County Health Department
disclosed to them directly affected their emotional Selected Reportable Diseases
experience after the error. Many patients said they would Jan-Sept Jan-Dec be less upset if the physician disclosed the error honestly and compassionately and apologized. While some of the Campylobacteriosis . 52 . 97 . 99 physicians agreed that it would be helpful to say that Cryptosporidiosis . 4 . 4 . 3 they too were upset about the error, other physicians in E. coli 0157:H7 . 5 . 9 . 10 the group found this approach to be unprofessional.
Most of the physicians, however, did express a desire to apologize, but worried that an expression of regret might Giardiasis . 26 . 60 . 104 be construed by the patient as an admission of legal Guillain-Barre Syndrome . 2 . 7 . 8 Hepatitis A . 7 . 24 . 55 Physicians' reluctance to discuss the cause and Hepatitis B . 15 . 37 . 49 Hepatitis C . 104 . 220 . * future prevention of errors was particularly troubling to Legionellosis. 32 . 53 . 34 the patients. Furthermore, what some physicians defined Lyme Disease. 12 . 19 . 38 as an appropriate professional demeanor while discussing an error impressed some patients as being cold and Aseptic/Viral Meningitis . 34 . 63 . 68 impersonal, thus creating the mistaken impression that West Nile Meningitis . 1 . 1 . * the physician really did not care about what happened or Bacterial Meningitis: Haemophilus Grp. B . 0 . 2 . 4 was hiding what had actually happened.
Cryptococcal . 1 . 3 . 2 Many current institutional policies about disclosing Staphylococcal . 0 . 0 . 2 medical errors instruct physicians not to discuss why an Streptococcal . 3 . 9 . 5 error happened in a way that could imply fault. It is interesting to note, however, that in this study the Other/Unidentified. 2 . 2 . 7 patient group expressed a desire for disclosure not to Meningococcal Disease . 2 . 12 . 12 Pertussis . 19 . 29 . 26 affix blame, but rather to understand what happened to Salmonellosis . 42 . 80 . 133 them and to know that the institution and individuals Shigellosis . 2 . 6 . 6 involved had learned from the event. Although I believe Tuberculosis . 6 . 21 . 25 that it is naïve to assume that full disclosure of all medical errors with an apology would resolve the preva- lent malpractice and litigation crisis facing us today, it Gonorrhea . 428 . 1,135 . 2,166 Chlamydia . 803 . 2,520 . 4,216 does seem to me that our fear of litigation at times Early Syphilis . 5 . 16 . 13 interferes with our common sense and understanding of Carbon Monoxide Poisoning . 7 . 22 . 71 human nature. Instead, we have patients running tolawyers to find the answers.
Dr. Lesaca is a psychiatrist and serves as contributing editor to the Disease reports may be filed weekdays during regular business hours from 8:30 a.m. to 4:30 p.m. by calling Bulletin. He can be reached at [email protected]. (412) 578-8060. At all other times, please call the Health Department’s 24-hour telephone line (412) 687-2243.
The Bulletin u 553 Medicine and Magic:
Robert C. Cicco, MD
LISA B. PETZEL Robert C. Cicco, MD
He dons a red nose, lots of makeup and a helped to influence his decision to become a physician.
silly hat and leaves loving notes for parents of He decided to pursue neonatology after his first year of sick children to lift their spirits. His job is to residency at Children's Hospital when he rotated to heal sick babies, but neonatologist Robert C. Cicco, Magee Womens Hospital. "It had a nice mix of dealing MD, often uses some of his magic learned at a "clown with many organ systems and dealing with families convention" to apply a different kind of healing for going through a crisis." Dr. Cicco says. "I always liked children, healing that comes from laughter and a positive dealing with kids and kids' issues," he adds.
outlook on life. "I've always been interested in magic," Dr. Cicco's lifelong interest in magic began to he says. "There are things other than just medicine that intensify around the same time the direction for his can affect your health." career began to unfold. Having married after his second Dr. Cicco's alter ego, Bobbles the Clown, does won- year of undergraduate work, he and wife Anita were ders to heal the souls of many a child in the hospital, as expecting their first baby while he worked as a "dorm well as at various settings in the community where he parent." Friends brought him a shoe box of magic stuff for a father's day gift, while they Although Dr. Cicco, assistant bought a changing table for his director of the West Penn Hospital wife on mother's day that year.
neonatal intensive care unit (NICU), His avocation of magic and seems a natural in his professional clowning grew steadily over the role, he did not always dream of years. Dr. Cicco has made as many becoming a physician. As an under- as 20 appearances per year as graduate at Case Western University Bobbles the Clown as part of the majoring in chemistry, he realized volunteer organization, Tri Rivers that a future working as a chemist in Clown Alley, of which he is past a lab "wasn't me," and anyone who president. Bringing humor and fun meets the gregarious physician would into the lives of others has become agree. His sister's husband, obstetri- a family affair for the Ciccos as all cian/gynecologist Richard Deitrick, four of his sons learned to juggle MD, as well as his father, a teacher, Bobbles the Clown
and do some type of clowning. "It 554 u The Bulletin PROFILE continued is so rewarding," he says. His son Brian performs semi-professionally on the weekends.
Although he doesn't regularly appear at the hospital in full clown gear, Dr. Cicco applies some of his "magic"such as making balloon animals or wearing goofy socks,and leaves notes to warm the hearts of parents andchildren at the NICU.
Clowning for people with disabilities, such as those at the Children's Institute, is a volunteer duty he findsvery gratifying and one that has led to more serious workhelping the disabled in the form of advocacy. Dr. Ciccosits on the board of the Metabolic Screening AdvisoryCommittee through the state's Department of Health,and he chairs the state's Bureau of Family Health. In this Dr. Cicco appeared on the Jumbotron at the September 17
Pirates game when he received recognition from Exceptional
role, he advocates a newborn metabolic screening pro- Parent magazine for his advocacy work on behalf of children.
gram to identify problems in newborns in order thatthey can begin treatment. He says such work has helpedPennsylvania hospitals to make it mandatory to screenfor some 40 diseases, when they screened for only twojust 20 years ago. "I work with the department of healthto make sure we're doing it right, make sure it is fundedand the infants can get treated," he says.
Dr. Cicco was recently recognized for such work when he was honored by Exceptional Parent magazineduring the September 17 Pirates game at PNC Park. Therecognition is part of Exceptional Parent's DisabilitiesAwareness Program, and he was honored along with twopeople who have accomplished much despite theirdisabilities. Dr. Cicco says the magazine has been suc-cessful in getting most of the ball clubs around thecountry to support it. "We want them to see that peoplewith disabilities are people," he says.
His partner of 20 years, Alan Lantzy, MD, says Dr.
Dr. Cicco entertaining children in Romania with "pocket magic."
Cicco's advocacy work has made an impact on the carethat babies receive and has helped to improve reimburse- through the Humana Foundation. During these trips he ment rates for pediatricians. "He is a very good advocate works alongside Romanian physicians to improve the for parents at a very critical time in their lives," he says.
care of newborns in hospitals there. During his last trip, Longtime friend and fellow magician, Jim N.
Dr. Cicco thrilled Romanian children with "pocket Tucker, MD, a pediatrician at Children's Community magic," drawing dozens of children to his side. "They Pediatrics, Allegheny, had nothing but praise for Dr.
were so enthralled," he says.
Cicco as well, both as a physician and as a magician. "He Dr. Tucker, who was unaware of Dr. Cicco's trips to is a rare kind of doctor. He has wonderful clinical Romania, says he is not surprised in the least at Dr.
judgment and is wonderful with families," he says.
Cicco's humanitarian efforts. "He has more zest for life Dr. Cicco's advocacy for children extended beyond than anyone else I know," he says.
the state and even the country four years ago when hebegan an annual trip with his wife Anita to Romania Ms. Petzel is a freelance writer in the Pittsburgh area. The Bulletin u 555 Do What You Do Best.
And we’ll do what we do best. The Allegheny County Medical Society specializes in providing physicians with the best supplies and services at the best prices. And we only contract with those vendors who can meet the unique needs of physicians.
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556 u The Bulletin APPLICATIONS FOR MEMBERSHIP First Year
Bijan Eghtesad, MD, transplant surgery. 6018 Howe Jason J. Lamb, MD, thoracic surgery. 4815 Liberty Street, 15206. Pahlavi University School of Medicine Avenue, Suite 156, 15224. University of Virginia School (Shiraz University), Iran, 1978.
of Medicine, 1996.
Linda M. Farkas, MD, colon and rectal surgery. 5150 David L. Mandell, MD, pediatric otolaryngology. 5858 Centre Avenue, 4th Floor, 15232. Loyola University 1/2 Beacon Street, 15217. University of Maryland Stritch School of Medicine, 1989.
School of Medicine, 1996.
David M. Ferguson, MD, family practice. 6023 Harvard Michael J. Palumbo, MD, allergy and immunology. 180 Square, 15206. University of Pennsylvania School of Fort Couch Road, 15241. Pennsylvania State University, Medicine, 1996.
Jeffrey R. Gingrich, MD, urology. 5200 Centre Avenue, John Pensock, MD, cardiovascular disease. 209 Green 15232. University of Michigan Medical School, 1987.
Court, 15234. Pennsylvania State University, 1995.
Nitin M. Kamat, MD, nephrology. 100 Delafield Road, Joseph Scherer, MD, ophthalmology. 713 Washington Suite 212, 15215. Topiwala National Medical College Road, 15228. Memorial University of Newfoundland, Bombay University, India, 1989.
Faculty of Medicine, Canada, 1999.
Wendy Lemarquand, MD, family practice. 6023 Gerard J. Werries, MD, orthopedic surgery. 9 Blue Harvard Street, 15206. McGill University Faculty of Road, 15076. University of Pittsburgh School of Medi- Medicine, Canada, 1982.
Vered D. Lewy-Weiss, MD, pediatric endocrinology.
405 Jamesborough Drive, 15238. New York Medical Second Year
College, 1993.
Nicolas De La Pena, MD, infectious diseases. 1420 Shawn O. Naseem, MD, internal medicine. 2550 Centre Avenue, 15219. College of Medicine University Mosside Boulevard, 15146. St George's University of Philippines, 1989.
School of Medicine, 1998.
Bradley B. Keller, MD, pediatric cardiology. 2599 Misha L. Pless, MD, neurology. 203 Lothrop Street, Wexford Bayne Road, 15143. Pennsylvania State Univer- 15213. Emory University School of Medicine, 1990.
Stacey H. Popko, MD, internal medicine/pediatrics.
Sarun Suwan, MD, general surgery. 6228 Riverfront 1470 Meadowbrook Drive, 15317. Medical College of Drive, 15238. Temple University School of Medicine, Pennsylvania, 1996.
Richard L. Raszewski, MD, plastic surgery. 620 Yvette L. Taylor, MD, family practice. 6417 Stanton Warrendale Road, 15044. University of Pittsburgh Avenue, 15206. University of Pittsburgh School of School of Medicine, 1986.
Medicine, 1997.
Sonia Saigal Dhawan, MD, internal medicine. 4750 Kevin B. Traub, MD, urology. 580 South Aiken Avenue, Oakhurst Avenue, 15044. Lady Hardinge Medical Suite 610, 15232. New York University School of College, Delhi University, India, 1994.
Medicine, 1996.
Joel S. Schuman, MD, ophthalmology. 203 Lothrop Street, Suite 816, 15212. Mount Sinai School of Medi- Steven R. Abo, MD, gastroenterology. 1515 Shady cine City University of New York, 1984.
Avenue, 15217. Albert Einstein College of Medicine, Robert P. Snyder, DO, internal medicine. 15 Nash Lane, 15090. University of Osteopathic Medicine and Health Bernard J. Costello, MD, craniofacial surgery. 3501 Sciences, 1996.
Terrace Street, Suite G32, 15213. University of Pennsyl- Jeannette E. South-Paul, MD, family practice. 373 vania School of Medicine, 1997.
continued on page 558 The Bulletin u 557 Help Wanted
2 Car Garage. Alexis Fitch, Pru- Clair Hospital. Free parking, dential Preferred Realty 412-877- space available for half days or full days. For additional information hours per week) salaried position contact Shirley at 412-687-2100.
available at CMHC in South O'HARA TOWNSHIP– Hills to provide outpatient psy- $314,900–Brick Colonial with 4 chiatric services to adults. Board bedrooms and 2 1/2 baths in a Certification with DEA # and great O'Hara neighborhood of- FURNISHED MEDICAL OF- fers family room, covered porch Call (412) 321-5030 today FICE–960 Beaver Grade Road, required. To apply send resume and place your ad here! with skylights, new roof and Moon Township. Entrance at to: Human Resources Depart- driveway, and a finished lower street level with own parking lot.
ment, Dept. A, Chartiers MH/ level all in excellent condition.
Reception room, business office, ACMS/box number MR Center, 437 Railroad Street, For more information or a pri- 3 exam rooms, 2 bathrooms, con- Bridgeville, PA 15017. EOE M/ vate showing, please call Bunny sultation room and lab. Some Pittsburgh PA 15212 Wolff or Lucy Oliver at 412-782- utilities included. 412-922-3333.
3700 ext. 238 or 210.
BOARD CERTIFIED PHYSI-CIAN needed to perform outpa- tient aesthetic procedures under Recently renovated 4 bedroom local anesthesia in the South stone Colonial with great curb Hills. Will train. Please call Jerry appeal on 1+ acre of level lawn continued from page 557 at 412-429-1161, ext. 20.
and gardens includes a two storyden and family room, paneled Burrows St, 15213.
Northumberland Street, study, gourmet kitchen, detached ried position available at CMHC garage with space for possible University of Pittsburgh 15217-1238. University of in the South Hills to provide out- home office above. For more in- School of Medicine, 1979.
patient, partial hospitalization Kentucky College of formation or a private showing, and geriatric residential treatment Medicine, 1973.
please call Bunny Wolff or Lucy Diane C. Strollo, MD, psychiatric services to adults for Oliver at 412-782-3700 ext. 238 diagnostic radiology. 3048 vacation coverage. Board certifi- Katherine Leah Wisner, cation with DEA # and White Pine Drive, 15044- MD, psychiatry. 58 6161. Uniformed Services Locksley Drive, 15235.
required. To apply send resume For Lease
University of the Health to: Human Resources Depart- Case Western Reserve FOR LEASE–Monroeville, 2000 ment, Dept. B, Chartiers MH/ Sciences, 1981.
University, 1980.
sq.ft. Medical office in a one MR Center, 437 Railroad Street, story, level entry Medical build- Henkie P. Tan, MD, PhD, Bridgeville, PA 15017. EOE M/ Guy A. Zimbardi, MD, ing. Contact Jeff or Irv Weiner at transplant surgery. MUH Irv Weiner Real Estate. 412-373-8900 N-725, 15213. Loma 4733 Centre Avenue, Linda University School of 15213. Boston University $385,000 SPECTACULAR For Sublease
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