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TOLEDOMEDICINEThe Journal of The Academy of Medicine of Toledo & Lucas County

Spring 2017 Volume 108/Number 2

4428 Secor Rd. Toledo, OH 43623419.473.3200 Fax 419.475.6744

Academy Foundation FundThe Academy of Medicine Foundation Fund has been helping worthwhile organizations and programs since 1957. Major donations have been for scholarships for medical students at The University of Toledo College of Medicine, American Cancer Society, CareNet, Cherry Street Mission, COSI, Great Lakes Student Health Conference, Habitat for Humanity, Hospice, Junior League of Toledo, Mobile Meals of Toledo, Toledo~Lucas County Health Department, MCO Community Health Clinic, Mildred Bayer Clinic, TelMed, Northwest Ohio Health Planning, Ohio Physicians Effectiveness Program, Tsunami relief effort, WGTE-TV and others.

For the past several years the primary source of income for the Foundation Fund has been from interest and dividends. In 2010 all of the Toledo area hospital medical staffs made very important contributions to keep the Foundation Fund afloat. Sincere thanks to the hospital medical staffs. There have been very few mem-bers making donations to the Foundation fund in lieu of holiday cards and virtually no contributions from the membership in memory of their deceased colleagues and loved ones.

The Foundation Fund continues in great need of contributions to continue to help these worthwhile projects and fund new projects. Please consider listing The Academy Foundation Fund for contributions in lieu of flow-ers when a colleague or loved one passes away, remember the Foundation Fund when you wish to com-memorate a deceased colleague and watch for the notice in an upcoming Communique’ for holiday greet-ings to your colleagues. All contributions to the Foundation fund are deductible as charitable contributions.

Thank You!




Thank You!

16 TOLEDOMEDICINE www.toledoacademyofmedicine.org Spring 2017

including our ProMedica partners in the Academic Affiliation, excellent department chairs and program directors, engaged GME staff and others. These students are excited to be here, and we are thrilled to have them.

Ryan Johnston, one of our fourth-year students, summed up the excitement on Match Day when he said, “My wife im-mediately started crying and I couldn’t stop smiling because this was our No. 1 choice. We’re both from Northwest Ohio and want to stay home. Plus, the Academic Affiliation with ProMedica benefits the specialty of emergency medicine because of high patient volumes, different acuities and presentations of illnesses at Toledo Hospital. I think that is going to lead to extensive learning. I’m excited to see what the future holds for the Academic Affiliation.”

Jennifer Amsdell, another fourth-year medical student who matched in neurol-ogy, said, “The wait was nerve-wracking, but I am so happy I matched with my top choice. I wanted to stay because of the faculty in neurology. I’ve been able to spend a lot of time with them in rotations and during research projects. They are amazing mentors and teachers.”

Why is this match important? We know that approximately 70 percent of residents establish their practice in the community where they complete their terminal train-ing. For years we’ve seen that some of the most talented physicians trained here and stayed here. As practicing physicians, we can help increase this number with a com-mitment to the next generation of doctors learning in our community.

Graduation will follow closely and we will celebrate with our students the next step in their medical careers. They’re full of hope for their future and so should we. Welcome them to this noble profession, support their education and mentor them for professional growth. We all have a role in securing the future of medical care for the community we serve. Let’s all celebrate a smashingly successful match for our community.

— Christopher J. Cooper, MD

(Dean’s Report continued from page 12)

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Spring 2017 TOLEDOMEDICINE 1

In My Opinion President’s Page

4th District Councilor’s ReportApplause, Applause

Membership Memo UTCOM Report

Around Town

Send information to: TOLEDOMEDICINE The Academy of Medicine, 4428 Secor Road Toledo, Ohio 43623 Ph. 419.473.3200 Fx. 419.475.6744 [email protected]

www.toledoacademyofmedicine.org

Officers

PresidentJoDee E. Ahrens, MD

[email protected]

President-ElectChristopher A. Bates, MD

[email protected]

Vice PresidentRichard L. Munk, [email protected]

SecretaryTimothy M. Husted, [email protected]

TreasurerWilliam C. Sternfeld, MD

[email protected]

Immediate Past PresidentBennett S. Romanoff, MD

[email protected]

Editorial Board

EditorS. Amjad Hussain, MD

[email protected]

Ted E. Barber, MD, [email protected]

Stephen P. Bazeley, [email protected]

Gerald W. Marsa, [email protected]

James G. Ravin, [email protected]

J. Gregory Rosenthal, [email protected]

Stephen J. Rubin, [email protected]

StaffExecutive DirectorLee F. Wealton, MPH

[email protected]

Managing EditorJohanna D. Begeman, JD

[email protected]

Advertising ManagerJanice M. Schutt

[email protected]

C O V E R S T O R Y

Alliance President Denise Colturi

TOLEDOMEDICINE is an official publication of The Academy of Medicine of Toledo and Lucas County

All statements or comments in TOLEDOMEDICINE are the statements or opinions of the writers and not necessarily the opinion of The Academy of Medicine of Toledo and Lucas County. The Academy of Medicine does not necessarily endorse the advertisements in TOLEDOMEDICINE.

Published quarterly during February, May, August and November. Subscription rate $20 per year. Contributions to TOLEDOMEDICINE are due before the first of the month preceding publication.

Spring 2017

Volume 108

No. 2TOLEDOMEDICINE09

F E A T U R E S

D E P A R T M E N T S

02040508081212

07

On the cover:

Gloria Steinem: Return of a NativeJames G. Ravin, MD

Denise Colturi, Alliance President

10Book Review:The Art and Science of Happiness

in Body, Mind and Soul Written by Om P. Sharma, MD

Review by S. Amjad Hussain, MD


Why is the Cost of Medical Care So High?by Ted E. Barber, MD, MBA

In My Opinion

Full Disclosure: I have been a mem-ber of The Toledo Clinic, Inc. for the entire time I have been in practice in Toledo, Ohio.

Recently a close acquaintance of mine called to say he needed a CT of the abdomen and pelvis. His PCP is a member of a large local vertically integrated group and my friend had been referred to the large vertically integrated group’s radiological ser-vices to have the study performed. When he enquired about the cost for the test, he was told that his deduct-ible would be just shy of $1000. He further enquired about the entire cost of the test and was met with a ques-tion of theirs, “Why would you want to know that? Your insurer is picking up the balance." He persisted because he still wanted to know and was told that the entire cost of the test was just under $6000. He called me to see if I could help him find a way to have it done for less. I called down to the radiology department of The Toledo Clinic and learned that he could have the test done there for just under $600 and his out-of-pocket portion would be just under $100. Naturally he met some resistance from the large verti-cally integrated system and had to jump through several hoops in order to get the discounted price for the test.

It got me thinking. Why does medi-cine cost so much and what can be done about it? Back to the large vertically integrated group for start-ers. In theory, vertical integration is where a large corporate structure oversees “soup to nuts” provision of health care services. The integra-

tion is supposed to manage care and provide efficiencies that control costs and promote quality. In my opin-ion, the vertical integration drives down competition and allows the few remaining large players to price services according to what they can get away with, not what the market can bear. Vertical integration means the dollars come in and they never leave.

We can blame our government in part for the rising costs. CMS sets the pric-es for services the government will pay for through their Medicare and Medicaid benefits. It is capricious, arbitrary, and rarely has any justifica-tion. If I do an extensive EMG in the hospital, it can take over an hour and I will be paid less than $12. I can do a study that is not half as involved, in my office, spend two-thirds less time and get paid ten times as much. Insurers fall in line and use the gov-ernment pricing as a benchmark for their own pricing.

A recent WSJ editorial confirmed what I had long suspected regarding pricing of pharmaceuticals. Con-sumers in the United States bear the entire costs of research and devel-opment. Foreign countries demand steep discounts in order for the medi-cations to be imported to their coun-tries. Pharmaceutical companies ac-cede to the demands because half a loaf is better than none. So we have the absurd situation where our pa-tients in Toledo get on a bus to Wind-sor, pay a Canadian doctor to copy their American prescription, then go to a Canadian pharmacy to recoup the foreign discount.

In my estimation, not all cost escala-tion is necessarily untoward. Think of the advances in medicines, tech-niques, devices, and training that have occurred in recent memory. Those come at a cost, but are worth it when consideration of suffering avoided, lives saved, and productiv-ity returned to society are tallied.

But let us consider the costs of litiga-tion to our medical fisc. Last year an estimated $55.6 Billion was factored into total health care spending. Sure, that was only 2.4% of the nation’s total health care bill, but as the late Senator Everett Dirksen noted, “a billion here and a billion there and pretty soon you’re talkin’ real mon-ey”. Tort reform on a national scale remains an elusive pipe dream and will remain so as long as plaintiff at-torneys continue to contribute expo-nentially more to political campaigns than physicians.

On more than one occasion, from more than one source, I have seen a curve with supply of physicians and a separate curve showing the supply of health care administrators plot-ted along the ordinate, in numbers of each, plotted against time on the abscissa (1970 – present). The curve of physicians rises modestly (1-2 percent per year) and the supply of administrators rises exponentially. Those people expect to get paid (and in the case of insurance executives, paid extremely well indeed).

Everybody wants quality health care. Everybody wants someone else (gov-ernment, employer, high net worth individuals’ tax dollars) to pay for it.

14 TOLEDOMEDICINE www.toledoacademyofmedicine.org Spring 2017 Spring 2017 TOLEDOMEDICINE 15

to You.” We celebrated the service of all of our Medical Staff as well as that of our nation’s Armed Forces. The en-tertainment was a USO Show complete with Bob Hope (played by Bob Hope look-alike Lynn Roberts) and the An-drews Sisters (played by the Ladies for Liberty). Dinner and the drinks were not served in canteen cups, as I had requested, but on the fine china and glass ware of the Hilton Garden Inn at Levis Commons. And, once again the chef and the wait staff contributed to a wonderful evening.

At St. Luke’s Hospital, everyone is col-laborating in helping to prepare our new Cerner EHR. We are about 8 ½ months since the effective date of the divestiture from ProMedica. We continue to benefit from their transition services as, one by one, we are replacing old systems with our own and hiring a host of new or returning support staff to implement all of these changes. Our Medical Staff is heavily engaged with all aspects of this revitalization of St. Luke’s Hospital to become, once again, the best darned community hospital in all of Northwest Ohio. I think that we have to give a lot of credit and thanks to the administra-tion and to our Board of Trustees, as we doctors and nurses have continued to render top notch care for our patients, despite rooms and OR’s being booked to near capacity.

Two of our physicians have stepped up to major leadership roles. Dr. Mary Pellioni has agreed to take on the role of Chief Medical Informatics Officer. This is a position which is badly needed during this time of total makeover of our Infor-mation Technology. Dr. Lalaine Mattison has been asked to create a whole new position as Medical Director of Quality and Care Continuum. Her mandate is to do everything that you would think that the title would imply and then a whole lot more.

On the outpatient side, we continue to grow our WellCare Physician Group. Most of us have recently gone live with our EHR conversion from Allscripts to e-ClinicalWorks. Living continues to be good at the intersection of I-75 and I-80/90 or as we say at our corner of healthy and happy.

Ian S. Elliot, MDThe Toledo Clinic

The Toledo Clinic and the Central Michigan University (CMU) Col-

lege of Medicine are beginning a new partnership in 2017 to expand medical student education. As part of the CMU College of Medicine’s Comprehensive Community Clerkship (CCC) program, medical students will serve six-month rotations with established primary care physicians in NW Ohio. “We are very excited by this type of modern ‘ap-prenticeship’ in which medical students can see and work in a thriving practice and determine how private community medicine best suits their future needs,” states Henry Naddaf, MD, of The Toledo Clinic. With the recent closures of established primary care training programs in NW Ohio, The Toledo Clinic has found it imperative to establish and accentuate the training and placement of future family physicians to meet the needs of the community. The CMU College of Medicine offers a new academic partner whose very charter is designed to pro-mote community-focused primary care. “Many of our well-established family physicians are excited by the prospect of working with medical students,” said Ian Elliot, MD, President of The Toledo Clinic. “Some of these family physicians might be three to five years from retirement and would have a lot to offer a new physician.” The Toledo Clinic is an independent partnership of over 180 physicians and 70 additional medical providers. It has had a long and successful history in the training of medical students and residents. As “community educators,” The Toledo Clinic allows students to see how private practice can thrive in the era of corporate medicine.

The CMU College of Medicine is the nation’s 137th medical school. Its mis-sion is to prepare physicians focused on improving access to high-quality health care in Michigan with an emphasis on rural and medically underserved regions. The College will celebrate the graduation of its first class of students in May 2017.

Thomas A Schwann, MDThe University of Toledo Medical Center

Like much of the health care industry, The University of Toledo Medical

Center has experienced a season of change and is setting a course for the future. After a thorough review over the past year, University leadership announced that the medical center would continue to operate as a teach-ing hospital, serving the South Toledo community.

While UTMC has always been a source of care for complex cases, our physi-cians and staff are equally committed to the more routine health care needs of the community. Going forward we will continue to build robust primary care and behavioral health options at UTMC to meet the evolving needs of the Toledo community, as well as to ensure strong medical education programs in those specialties.

The University also announced a per-manent leader for the medical center, naming Dan Barbee CEO. Dan has nearly 25 years of combined clinical and health care management experience. Prior to being named CEO, he served as UTMC’s chief operating officer and vice president of clinical services. Dan joined the medical center in 2011 as chief nursing officer and associate execu-tive director. Importantly, Dan has the trust and confidence of the physicians and staff at UTMC. We’re glad to have him at the helm, and together with our faculty and University leadership we’re looking forward to a strong future with continued dedication to caring for our community and achieving our tripartite mission of outstanding clinical care, education and academic activity.


ing between team members to ensure that safety practices remain the priority while providing care. In addition, a team of leaders at Pro-Medica Bay Park Hospital is designated to evaluate each reported error and evaluate for the level of harm to our pa-tients. By paying attention to the detail in the cases and providing the necessary education or training needed to reduce the harm in the future, ProMedica Bay Park Hospital has decreased the serious safety event rate by 83% over the last two years! This journey is dynamic and endless in that our goal is zero events of harm. We are continuously establish-ing safety as our highest priority across the system.

Henry H. Naddaf, MDProMedica Flower Hospital

ProMedica Flower Hospital has received the 2017 Distinguished

Hospital Award for Clinical Excellence™ from Healthgrades, the leading online resource for comprehensive information about physicians and hospitals. The distinction places Flower Hospital in the top 5% for clinical excellence among more than 4,500 hospitals nationwide. Flower Hospital is one of 258 recipients of the Distinguished Hospital Award for Clinical Excellence™, standing out among the rest for overall clinical excel-lence across a broad spectrum of care.

The staff and physicians at ProMedica Flower Hospital are extremely honored to earn this achievement that demon-strates the high level of care we provide to our patients. We will continue to put our patients first and always provide excellent care.

In addition to our Healthgrades rec-ognition, ProMedica Cancer Institute recently received a successful re-accred-itation through the American College of Surgeons Commission on Cancer. The North Central Region, which includes Flower Hospital, Toledo Hospital, Toledo Children’s Hospital and Bixby Hospital, received the “ Accreditation with Commendation Award” and the “Outstanding Achievement Award”.

(from page 13)

Also, the radiation program at Flower Hospital recently completed a survey through the American College of Radiol-ogy. While the final report is pending, the surveyors were very complementary of the clinical expertise, physicians and staff. To recognize our exceptional medical staff at ProMedica Flower Hospital, the 2017 Medical Staff dinner was held on March 10 at Sylvania Country Club. The event was a great success, as medical staff members were honored for their dedication and service. Colleagues were able to connect outside of the work envi-ronment to further build relationships. It was an honor to serve the ProMedica Flower Hospital Medical Staff as Chief of Staff. Please welcome our incoming Chief of Staff Dr. Timothy Husted.

Howard M. Stein, MDProMedica Toledo Children’s Hospital

ProMedica Toledo Children’s Hospi-tal has joined the Ohio Children’s

Hospital Solutions for Patient Safety in an effort to eliminate serious safety events on our pediatric wards. The Situ-ational Awareness initiative can prevent harm in vulnerable patients through pre-emptive detection and mitigation of untoward events.

The Situational Awareness team is comprised of the Pediatric Critical Care Physician (the safety officer of the day), the Pediatric Hospitalist, key nursing and respiratory staff from the Pediatric Intensive Care Unit and general ward. They meet every morning and evening to discuss high risk patients, known as “watchers”. These “watchers” can be identified by any healthcare team member or family member based on either pre-determined triggers (transfer out of PICU, high risk diagnosis, high risk therapy) or non-specific concerns. Potential complications and action plans are reviewed by the Situational Awareness team and updated in the electronic medical record for all caregiv-ers to access.

Deteriorations in the patient’s condi-tion are reported to the primary service and covering physician who activate

the action plan. If the patient does not improve with the therapy, the Safety Of-ficer of the Day is notified for additional interventions or transfer to the Pediatric Intensive Care Unit. The presence of the Safety Officer of the Day reinforces the culture of safety at TCH by providing a contact person for staff and family when clinical concerns arise. The im-plantation of this system has increased collaboration between all members of the healthcare team and increased our collective vigilance of the most vulner-able children in the hospital.

Thank you to Susan Tourner, MD, for composing this update.

Peter F. Klein, MDProMedica Toledo Hospital

ProMedica Toledo Hospital has been recognized as one of America’s 100

Best Hospitals Award™ from Health-grades, the leading online resource for comprehensive information about physi-cians and hospitals. For the third year in a row, ProMedica Toledo Hospital is among the top 2% of more than 4,500 hospitals nationwide for its clinical excellence. It is an honor to be recognized as one of America’s best hospitals for the third consecutive year. Our staff, providers and physicians are committed to pro-vide the highest level of care to every patient and visitor who comes through our doors. Healthgrades determines America’s 100 Best Hospitals Award recipients by analyzing objective performance data such as risk-adjusted mortality and in-hospital complications among Medi-care patients. During the 2017 study period (2013 – 2015), award recipients showed superior performance in clini-cal outcomes for patients across at least 21 of 32 of the most common inpatient conditions and procedures.

Timothy J. Mattison, MDSt. Luke’s Hospital

We celebrated our Annual Medi-cal Staff Dinner and Meeting the

evening of Saturday March 4th. The theme of this year’s Gala was “A Salute


If you think a single party payer is the answer, I would cite two exam-ples of why that doesn’t work. When I lived in the United Kingdom in the late ‘80’s, my gardener needed a her-nia operation. He waited five years, but eventually he did have it. More recently, there is the case of the poor soul from Toronto. He had an MI and died on the Ohio Turnpike as he drove himself from Canada to Cleve-land to have his cardiac bypass sur-gery done at the Cleveland Clinic, as he was told he would have to wait a year to have it in Toronto.

I am old enough to remember when we physicians actually had some dis-cretionary ability to price our servic-es. Our group would charge wealthy patients a bit more, and less well-off patients a bit less. Indigent patients we treated for free. Now I can’t even forgive the co-pay of a physician col-league without incurring the wrath of the insurers.

In my opinion, the problem lies in the inelasticity of pricing. Central control almost never works. Prices for our services are set in Washing-ton, DC and attempt to be fair. Rural physicians get paid a bit more. Phy-sicians who practice in high cost en-vironments (think New York or LA) get paid a bit more. But whatever happened to supply and demand? I contend that price would come down and quality would go up if only we were forced to compete for the pa-tient’s hard earned healthcare dollar. Think about it. You want your hip re-placement done at the Mayo Clinic? Fine, be prepared to wait six months and shell out a 50% premium for the

privilege. Meanwhile, young Eager Orthopedist, MD just down the street will do it tomorrow for 50% less.

Obviously, there needs to be a safety net for the needy, but competition al-most always causes quality to rise and price to settle at some rational level. I realize I am swimming against the tide and may not even espouse the prevailing attitude, but nothing else is working, and what do I tell my friend who needs the CT scan?


JoDee E. Ahrens, MD

President’s Page

How Far We’ve Come

57.5% of women com-pleting residency be-tween 2004 and 2013 remained practicing in the state where they trained, compared to 49.1% of men. Thus, again proving that you are likely to stay in the area where you did your residency training.

“There are three classes of human beings: men, women and women physicians.” Sir William Osler.

What would he think today of the changes in medicine and the number of women in our

profession?

He was, as you know, a founding father of Johns Hopkins School of Medicine. Reviewing the web site Hopkins.org tells the interesting sto-ry of the school’s beginnings.

Their medical school would not have been possible without the fundraising and help of several feminists. These women were wealthy daughters of the original university trustees.

Once it became clear that there were not enough funds to open the school or build the building, Martha Carey Thomas, Mary Elizabeth Garrett, Mary Gwinn and Elizabeth King volunteered to raise $500,000 for the project. Their one condition was that the school admit women as well as men. The women also proposed strict entrance requirements of both male and female applicants: proof of a bachelor’s degree, proficiency in German, French and Latin, as well as a strong science background in chem-istry, biology and physics. After per-suading the men, including Sir Osler, the money was raised and the school was established. Dr. Osler is said to have joked with the other professors that it was good that they got in as professors as they would not have qualified as applicants.

These women sowed seeds which took many years to grow, but they have become a reality. Now close to half of the new physicians of today are women.

One hundred and sixty-six years after the first female physician in America, Elizabeth Blackwell, was awarded her medical degree at Geneva Medi-cal College in upstate New York, gen-der equality in the awarding of medi-cal degrees is approaching. AAMC 2015 lists 8907 medical degrees were presented to women and 9798 medi-cal degrees to men. Data reviewed

also show 2416 women received doc-tor of osteopathy degrees while 2907 men received that degree.

There are also statistics that women tend to choose more of the primary care specialties, which are under served. A review of the AMA Wire article of February 18, 2015 by Lyn-da Vassar presented some of these statistics. Her article was based on a 2013 study from the Journal of the American College of Surgeons which found women make up 58% of Fam-ily Medicine residents, 75% of Pe-diatrics residents, 85% of Ob-Gyn residents and 75% of Psychiatry resi-dents. Whereas 75% of Radiology

residents were male, 54% of Internal Medicine residents were male and 62% of Emergency Medicine resi-dents were male. Women remained under represented in the surgical specialties and cardiology.

This study also noted that 57.5% of women completing residency be-tween 2004 and 2013 remained prac-ticing in the state where they trained, compared to 49.1% of men. Thus, again proving that you are likely to stay in the area where you did your residency training.

Gender differences are more striking in academic medicine. Veena Dubal wrote an article in The Clayman Insti-tute for Gender Research, January 15, 2015, that only thirteen percent of department chairs in academic medi-cine were women at the time. That Stanford group felt the “motherhood penalty” played a role in this in that women with children generally are viewed as less committed to their ca-reers than their childless colleagues. It was also felt that the sixty-five hour average work week coupled with work life balances contributed to this disparity. In the article, Stanford noted the issue and voiced their com-mitment to working on changing this environment. Hopefully, this dispar-ity has been noted in other academic centers and will be addressed going forward.

Since the days of Sir Osler women have made huge strides in our pro-fession.

There is no turning back now. To Dr. Osler we can paraphrase the Chinese proverb and say, “Sir William, Today in medicine women hold up half the sky”.


TOWNAROUND

Toledo by successfully recruiting five additional radiologists to Toledo. This collaboration will help streamline our radiology service, enhance turnaround times and provide a better experience for not only our patients but also our physicians.

Rajender K. Ahuja, MDMercy Health — St. Charles Hospital

With the goal of making access easier for our patients, Mercy Health has

transitioned our Urgent Care facilities into Walk-In Family Medicine, start-ing with the one adjacent to the Mercy Health – St. Charles Hospital campus. Mercy Health – Oregon Walk-In Family Medicine offers evening and weekend hours and is open to the whole com-munity for fast, convenient care with the patient’s out-of-pocket cost being a simple office visit co-pay. We’re pleased to be offering this service to the patients of the Oregon community.

I would like to commend the St. Charles team for receiving excellent patient satisfaction scores in the Emergency Department and Ambulatory Surgery. Both areas exceeds their goals and so showed the dedication of the physicians and staff to ensuring that the patient is put first. The leadership teams in these areas are to be recognized for setting a solid foundation to start the year.

Earlier this year, the St. Charles team went live on CarePath systems for revenue cycle/patient accounts, Stork, OpTime, and new patient placement programming. The command center for the go-live for the entire Toledo region of Mercy Health was stationed at St. Charles. By connecting every point of the patient journey through one integrated system, Mercy Health will experience less possibilities of interface errors ul-timately aiding in our ability to provide world-class experiences. The team is adapting well to the new system.

Finally, I’d like to recognize the Mercy Health – St. Charles Mission Services Committee, who satisfied visitors’ sweet tooth and helped the homeless dur-ing Valentine’s Day, when they raised money to purchase emergency Mylar blankets through a cookie sale in the cafeteria. The team sold cookies dur-ing the lunch hours, collected financial donations and raised enough money to purchase 240 blankets. These blankets were made available to homeless pa-tients in need.

Randall W. King, MDMercy Health — St. Vincent Medical Center

Mercy Health – St. Vincent Medical Center made a significant invest-

ment in equipment and technology recently to ensure that we continue to offer patients world-class treatment and care.

St. Vincent expanded its surgery capa-bilities after acquiring a new DaVinci® Xi robot. With the additional robot, St. Vincent now has two DaVinci® Xi’s and one DaVinci® Si, helping to increase access for our patients and improve effi-ciencies for our surgeons. Mercy Health remains the first to bring robotic surgery to northwest Ohio, and this investment further reinforces our commitment to providing the most advanced technol-ogy for better patient outcomes.

Another addition comes in the form of an intraoperative Body Tom CT scan-ner, thanks to the generous donation of the Mercy Health – Foundation. This scanner will allow for more complex brain and spine cases to be completed right here in Toledo. The Body Tom has cranial and spinal navigation that offers real-time imaging during surgery. The intraoperative CT promotes safer surgi-cal processes with the ability to watch for bleeds in real time before closing the incision, show hematomas intraopera-tively, check fluid in brain ventricles,

confirm functional placements for shunts and external ventricular drains, and avoid wrong-site surgeries all in real time.

Finally, the recent installation of a new GE 450W Wide Bore MRI means that St. Vincent now provides a wide-bore gantry to better accommodate patients as well as minimizing the sense of claus-trophobia some patients experience.

I am also proud to share that the Oc-cupational Health team at St. Vincent will provide healthcare for employees of The City of Toledo after being awarded a two-year contract. The physicians in the Occupational Medicine program focus on the health of workers in our community, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures.

Manish M. Thusay, MDProMedica Bay Park Hospital

The physicians and staff at ProMedica Bay Park Hospital are proud to

efficiently serve the complex medical needs of our community, and to further our Mission of improving the health and wellbeing of those we serve.

During the summer of 2014, all Pro-Medica Bay Park Hospital employees and providers went through error pre-vention training. The purpose of the training sessions was to teach employees about ProMedica’s safety journey to become a highly reliable organization. The training provided tools necessary to assist in reducing errors that can lead to patient harm. This program is enriched by having safety coaches in each department of the hospital. The purpose of a safety coach is to provide a peer-to-peer train-

(continued on page 14)


UTCOM Report

Dean’s

ReportThe University of Toledo College Of Medicine TOWNAROUND

Around Town

R. W. Mills, MD Mercy Health — Children’s Hospital

Mercy Health – Children’s Hospital will once again be home to pedi-

atric residents in its emergency rooms, clinics and on the inpatient units with the start of a new pediatric residency program.

Beginning July 1, four first-year pediatric residents will begin their training with Mercy Health physicians and special-ists. This is the 12th medical residency or fellowship program offered at Mercy Health. The program is accredited by the Accreditation Council for Gradu-ate Medical Education (ACGME). By the year 2019, there will be a total of 12 pediatric residents at Mercy Health, four in each residency year.

The American College of Surgeons, recently re-verified Mercy Health - St. Vincent as a Level 1 Trauma Center and Mercy Health – Children’s Hospital as a Level 2 Trauma Center for pediatric care. This is the first time that we have received a separate certification in pedi-atric trauma care and further formalizes our expertise and skill in trauma care for both adults and children. While we have always cared for pediatric trauma patients, the designation is indicative of Mercy Health’s commitment to our pediatric population and to providing a team of specialists to care for them. Congratulations to the entire Mercy Health – Children’s team for achieving this level.

Mercy Children’s Hospital Pulmonary and Sleep Center was chosen as one of three sites statewide to receive an Ohio Department of Health grant focusing on Asthma. The program, led by Ramalinga Reddy, MD, was chosen because it excels in both quality of care and community outreach. The multidisciplinary team approach to asthma care has led this program to one of the lowest hospital-ization rates and hospital length of stay in the state. The grant will help us pro-

vide The American Lung Association’s Open Airways For Schools® program to students and faculty in central city schools.

Shakil A. Khan, MDMercy Health — St. Anne Hospital

The transformation to Mercy Health continues and new signage is now

in place across the Toledo region. As the largest health system in Ohio with fa-cilities across the state and in Kentucky, Mercy Health delivers world-class care to thousands of patients each day. Mercy Health – St. Anne Hospital was the first of the local hospitals to receive all of its new signs and so visibly connected our team to fellow physicians and staff in eight regions with one united purpose – to help our patients be well in mind, body and spirit.

Individually, St. Anne has been work-ing very deliberately on delivering world-class patient experience and has seen the results in recent Press Ganey results. This initiative began in 2015 in the inpatient units and based on suc-cesses and learnings, a program was rolled out in the Emergency Department last year. These efforts have resulted in St. Anne being placed in the top 20 percent of hospitals nationally in Press Ganey scores as more than 80 percent of respondents gave our team a “top box” score. Congratulations to the en-tire St. Anne team for continuing to put patients first.

Recently, Mercy Health formally an-nounced our partnership with Colum-bus Radiology, which currently serves more than 65 sites in Ohio, including 19 hospitals and eight health systems. As part of this partnership, Mercy Health radiologists seamlessly transitioned employment to CR. The same radiolo-gists who currently provide service to Mercy Health onsite now will continue to do so with the added support of CR, which has shown its commitment to

This winter I wrote about the importance of recruiting nationally prominent

faculty and researchers to northwest Ohio and the success we’ve had in that endeavor as part of The University of Toledo College of Medicine and Life Science’s Academic Affiliation with ProMedica. Equally im-portant for us is the goal of attracting medical students, residents and fellows to the region and retaining those physicians in northwest Ohio as they complete their terminal training.

Top students and residents want to be at the very best place to learn and prepare for their careers. They are attracted to faculty who are leading experts in their field, the chance to learn about complex cases and procedures, access to top facilities, and the opportunity to participate in clinical research providing new and better treat-ments and outcomes for patients. At The University of Toledo College of Medicine, we are building a system of medical educa-tion with ProMedica that embraces these opportunities and are actively recruiting the students, residents and fellows that will thrive in this environment.

Our office of admissions received in excess of 4,000 medical student applications for admission and interviewed more than 500 prospective students for the 175 open seats for the incoming class. This competitive field ensures that we can select a class of medical students that are serious about their education and are looking to build long-term professional relationships that will continue throughout their careers.

It also is critically important that students have exceptional opportunities for a resi-dency here in Toledo. This year our goal was to increase the number of UT medical students who stay in Toledo for residency. Match Day 2017 revealed that we didn’t meet the goal, we far exceeded it. This next year 30 UT students will stay at UT for residency training. This compares to nine a year ago and eight in 2015. There are many factors contributing to this success,

(Dean’s Report continued on Page 16)


Fourth District Councilor’s Report

Ohio Physicians: Top 7 Issues to Watch in 2017

Anthony J. Armstrong, MD

It is already clear that 2017 will be a big year for health care. This year, health care transformation will

continue to take shape, building upon change brought on by prior legisla-tion, past and emerging major initia-tives, and last year’s elections. There is going to be a lot of activity in the world of health care, but amongst the multitudes of issues out there, some major themes are emerging. These are the issues that will top the agenda for the Ohio State Medical Association (OSMA) this year:

1.) Price Transparency

In late December, the OSMA, with the Ohio Hospital Association, filed a law-suit against the state of Ohio, to tempo-rarily halt the effective date (01/01/17) of a flawed health care price transpar-ency law. This law was inserted into an unrelated bill, and passed without any stakeholder involvement or public hearings. By delaying the law’s imple-mentation, the OSMA and OHA saved practices from a major administrative burden and disruption in patient care. The law is intended to offer patients a clear understanding of their financial obligations before receiving medical services, but the OSMA and OHA con-tend the wording of the new law makes it an unworkable mandate on physi-cians and health systems and a threat to efficient medical care for patients.

Now, the OSMA and other associa-tions can continue the dialogue with lawmakers and other interested parties to create a price transparency law that benefits all. The judge overseeing the suit has extended a preliminary injunc-

tion hearing until March 17. The origi-nal hearing date was set for Jan. 20, a day before a temporary order halting the new statute was set to expire.

The extension of the hearing means the law cannot be implemented or en-forced in the interim. The delay gives the legislature – including the law’s primary sponsor, state Rep. Jim Butler, R-Oakwood – and hospital and physi-cian advocates time to work on revis-ing the wording in an attempt to make the law more reasonably applicable.

2.) Health Insurance

• The OSMA supported a bill in 2016 calling for major step therapy re-form by establishing new requirements for the step therapy protocols required by health insurers, and the Medicaid program. This legislation, to be rein-troduced this year, would require these organizations to create and implement clinical review criteria upon which step therapy protocols are to be based, and to develop a process through which patients and their health care provid-ers can request an exemption from the protocols, should the patient’s indi-vidual health circumstances warrant an exemption in order to serve the pa-tient’s best interest.

This would help to ensure that patients in circumstances in which is it advis-able are able to receive exemptions from step therapy protocols. Failure to secure an exemption when neces-sary can result in disease progression, which can mean increased health care expense and decreased quality of life. The patient’s health and financial bur-den should be the first and foremost priority in the treatment process. The OSMA has been actively supporting this legislation because it represents a step forward in ensuring that step ther-

apy works for patients more efficiently, and that patients in circumstances in which is it advisable are able to receive an exemption from the step therapy protocols required by health plan is-suers. With patients’ health at stake, physicians and other providers need to be able to obtain this exemption and move forward with appropriate treat-ment of the patient’s condition with as little hassle as possible.

• The future of the Affordable Care Act (ACA) is uncertain. The OSMA will monitor any changes to the ACA and any other health care reform President Trump and Congressional Republicans try to implement in the coming year.

• The OSMA will also continue to advocate for the ACA expansion of Medicaid in Ohio. Under Medicaid ex-pansion, more than 500,000 Ohioans have been able to access health cover-age and uncompensated care has sig-nificantly decreased.

• “Surprise non-coverage” can occur when a patient utilizes an in-network hospital but receives services from an out-of-network provider, mak-ing the patient’s out-of-pocket costs higher than expected. Lawmakers are being called on to address the issue. The OSMA will work to hold insur-ers accountable by requiring they have adequate networks so as to avoid sur-prise non-coverage. We will also work to safeguard patients by requiring in-surers to base their payments to non-participating providers on a UCR rate using out-of-network charge data from an independent source.

3.) Scope of Practice

• Legislation that would have

Article first appeared in Ohio Medicine magazine, 2017 – Issue 1. Republished with permission by the Ohio State Medi-cal Association.


allowed CRNAs to select, order and administer drugs, and to direct certain other personnel to administer drugs or perform clinical support functions was introduced in 2016. Opposition from the OSMA, the Ohio Society of Anes-thesiologists, and other groups due to concerns about patient safety and CRNA training limitations stopped the bill from passing; however, the effort is expected to be picked back up in 2017. The OSMA will be ready to continue to push back against this legislative ef-fort.

• Last year, the OSMA and the Ohio Psychiatric Physicians Associa-tion fought a bill seeking to authorize certain psychologists to prescribe psy-chotropic drugs for the treatment of drug addiction and mental illness. It is the position of the OSMA that psy-chologists do not possess the proper training and education to prescribe drugs to patients, and that the required training for psychologists to prescribe proposed by the bill is inadequate. The OSMA will continue to work hard on this issue, as this bill is also expected to be reintroduced in 2017.

• A bill also expected to resur-face this year would permit physical therapists to evaluate, diagnose, and determine a treatment plan for a pa-tient, as well as order tests and imag-ing. Under current law, a PT can assess, but not diagnose a patient’s condition. The OSMA is strongly opposed to this legislation, as it is the OSMA’s stance that allowing PTs to diagnose without the medical education and training of a physician would negatively impact patient care.

4.) Medical Liability/Tort Reform

Ohio has some of the most effective tort reform laws in the nation, but the OSMA believes our state can do even better. Several hearings have laid the groundwork for the Medical Malprac-tice Litigation Improvements Act, an OSMA-backed bill that aims to fix im-portant gaps in existing law with 10 specific provisions, strengthening tort reform and protecting Ohio physicians

from frivolous lawsuits. This legisla-tion will be a top OSMA priority in 2017. For more information about the specific provisions this legislation will contain, visit: OSMA.org/TortReform.

5.) Prescription Drug Issues

• Prescription drug costs will continue to be a major issue nationally and in Ohio. A ballot measure to limit prescription drug costs for government-sponsored health coverage to no more than what the Veterans Administration pays for similar drugs is expected to be on the ballot in November 2017.

• The OSMA continues to ad-dress the opioid epidemic in Ohio with Smart Rx, a statewide educational cam-paign about responsible opioid pre-scribing. The OSMA has also launched the Be Smart campaign, providing ad-ditional resources to physicians to edu-cate and increase awareness among patients about opioids and the risk of addiction and abuse. Advocating for more focus on addiction treatment and insurance coverage of alternative treat-ments for pain will be a priority for the OSMA in 2017.

6.) Regulatory Issues

• The Medical Board suggested removal of the “one-bite” rule which allows a physician to confidentially seek treatment for substance abuse or impairments one time without report-ing to the Board. The OSMA and other medical groups successfully defended the “one-bite” rule in 2016 and will work to strengthen this protection in 2017.

• Non-compete clauses may be beneficial for employers, but these clauses potentially hurt employed physicians. The Legislature is likely to investigate how these restrictive agree-ments may place undue burdens on physicians leaving employment and potentially impact access to care for patients.

7.) Public Health

• The OSMA continues to moni-tor the implementation of Ohio’s Medical Marijuana law, and will keep all members updated on any develop-ments. State regulators have said that it may take between 12 and 24 months before the rules and regulations are complete. For more information, visit: medicalmarijuana.ohio.gov/.

• Ohio must reassess GME fund-ing to ensure Ohio’s future physicians are well-trained to treat Ohio’s patients. During the last budget process, the OSMA participated in the GME Study Committee, and a report was submit-ted to the Governor, Ohio legislators, and the Joint Medicaid Oversight Com-mittee with suggested changes to GME fund allocation.

For more on the OSMA’s continuous advocacy efforts, visit osma.org/advo-cacy.


have to retreat to a mountain cave to achieve that goal.

While in the initial chapters Dr. Shar-ma introduces the main theme of the book in broad religious, philosophical and historic sweeps, he succumbs at the end to a cookbook approach. To-wards the end of the book he lists 111 items under the heading of ABC’s of Happiness. It is a helpful guide, but would probably require a fulltime ef-fort to modify one’s behavior to at-tain fulfillment. It would have been more insightful if Dr. Sharma had also talked about his personal journey to achieve happiness and contentment in life.

Dr. Sharma is a retired surgeon who has had a fulfilling career as a general and trauma surgeon. With his keenly observant eye he must have seen many unhappy persons and quite a few hap-py ones as well. Anecdotal snapshots of his observations would have added to the already rich texture of the book.

Dr. Sharma has put in a Herculean effort in writing this book. There are pearls and nuggets scattered throughout, but it requires careful and thoughtful study, not unlike reading a complicated textbook or a philosophi-cal treatise. The book does not lend it-self to an afternoon of fast or leisure reading.

Post script: The author informed me that he has made some changes in the new revised edition. He has added a chapter on prayers and has included prayer practices in Juda-ism and Islam. In addition, food guidelines and some updated scientific advances in the field have also been included.

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Dr. Om Parkash Sharma has written an impressive book on a difficult subject. He has

delved deep into the history, philoso-phy and religion in an effort to find and define happiness.

The art and science of happiness is a tricky subject. Through the ages, wise men, rishis, sages and pundits have tried to define happiness and with some rare exceptions, have always come up short. Unlike a well-worn and unambiguous recipe, most of them point to a general direction. In as complex a creature as man, such sim-plifications do show the way but often fail to lead the seeker to the final des-tination.

To Dr. Sharma, the state of happiness is a frame of mind that can be achieved by exploring the inner self in the light of religions and various philosophies. He borrows heavily from his own an-cient religion of Hinduism and tries to synthesize the ancient teachings with philosophies of the West. For exam-ple, he quotes (among other sources) the Upanishads (6th century BCE), Vedas (3rd century BCE) and Bhaga-vad Gita (8th century CE) to make his point. He emphasizes that the eternal truths expressed in those texts can help one reach true contentment and happiness.

The result, however, is that with so much information and rather profuse sprinklings of quotes throughout the book, a picture does emerge, but it is not very clear and crisp.

The author dwells at some length on the physiology of happiness. He quotes

studies done at UCLA that pinpoint vari-ous neurotrans-mitters that are closely associ-ated with happi-ness. In particu-lar, he mentions hypocretin, a neurotransmit-ter peptide and Melanin-Con-centrating- hor-mone. Could it be, and the question begs for an answer, that in future we may have a pill that changes our biochemi-cal balance in such a way to make us happy and content? Not unlike the chemical boost one might con-sider for erectile dysfunction or depression.

But then that would be akin to a quick fix. Life is more compli-cated and does not lend itself to quick fixes that are permanent. The wise men and philosophers em-phasize introspection, meditation and contemplation to boost our biochemi-cal balance in such a way that happi-

ness and contentment is achieved as a byproduct of the process and thus becomes part of life. Dr. Sharma sug-gests that we have the tools at our dis-posal in everyday life and we don’t

The Art and Science of Happiness in Body, Mind and Soul

Book Review by S. Amjad Hussain, MD

The Art and Science of Happinessin Body, Mind and Soul

By Om P SharmaCreateSpace Independent Publishing Platform

ISBN 153006256XAvailable on Amazon

Amazon $7.99eKindle $0.99


Gloria Steinem: Return of the NativeBy James G. Ravin, MD

Feature

About a year ago Gloria Steinem (1934- ) returned to the city of her birth and her parents’ birth to

speak before a sellout crowd at the Masonic Auditorium. Although she now lives in the upper east side of New York, she still con-siders Toledo home. (The Blade, Nov. 15, 2015) Both her parents graduated from The University of Toledo and were very active in campus affairs. Her mother worked for The Blade as a society news and feature writer. Her pa-ternal grandmother was the first woman to be on the Toledo school board and was an important suf-fragette locally and nationally. It may be difficult to believe that this witty and charming feminist and social activist is now in her ninth decade. Although she has spent most of her life travelling and is constantly giving talks, she said speaking before an audience always gives her some anxious moments.

Gloria attended Waite High School for three years but moved to Washington DC, where her sis-ter lived, for her last year in high school. She had a “Hollywood” vision of school, dreamed of becoming a dancer and may-be, eventually a Rockette on stage in New York City. She told a reporter for the New Yorker (October 19, 2015) “I imagined my-self, with some impracticality, as danc-ing my way out of Toledo.” She went to Smith College, where her older sister had gone, and graduated with Phi Beta Kap-pa honors. Although her father always loved her dearly, she said he gave new meaning to the term financially irrespon-sible, which made an exclusive eastern college something of a stretch.

While she was a senior in college, Ches-ter Bowles, who was soon to become the

Ambassador to India, spoke at Smith and was so astonished by the students there that he donated his lecture fee for fellow-

ships to two graduating students, and Gloria received one of them. She spent her time there inspiring women with what they could achieve. She travelled on “rickety buses and third-class wom-en-only carriages of local trains, leaving behind all my possessions except a cup, a comb, and the sari I had on.” After re-turning to the US she was employed by the Independent Research Service, work-ing to send non-communist students to the World Youth Festival. Only later did she learn it was funded by the CIA.

She looked for a job in New York as a writer for magazines or newspapers. An editor at Life magazine rejected her, say-ing they needed a reporter, not a pretty

girl. In 1963 Show magazine had her go undercover as a Playboy Bunny. The ex-pose she wrote jump-started her career.

Soon she became involved in the women’s movement. A new maga-zine, New York, invited her to join its editorial board. While sharing a taxi with two well-known writ-ers, one said “every year there’s a pretty girl who comes to New York and pretends to be a writer. Well, Gloria is this year’s pretty girl.” Even though she was cover-ing politics and became interested in the feminist movement, other writers advised her not to become involved with those “crazy wom-en.” Instead, she became one of the earliest mainstream writers on the subject. In 1971 a 40-page preview version of what was to become Ms. magazine was published as a sup-plement to the year-end issue of New York magazine and included Gloria’s article entitled “On Sister-hood.” The issue quickly sold out and Ms. had half a million subscrib-ers within a few years. The maga-zine is now a monthly, with little advertising, so that today competi-tors such as Cosmopolitan have

taken over much of its audience, which gives credence to the aphorism that the pioneers take the arrows and the settlers get the territory.

Gloria has branched out into issues of national politics, Native Americans, Chi-canas, African-Americans, gay rights, sexual mutilation, and prostitution. She says her travels have convinced her that ordinary people are smart, smart people are ordinary, decisions are best made by the people affected by them, and human beings have an almost in-finite capacity for adapting to expecta-tions. (Steinem, G. My Life on the Road. NY: Random House, 2015, 39)


MembershipMemo

The following physicians were approved for Associate membership in The Academy of Medicine.

Applause, Applause

MembershipMemoApplauseApplause

Gretchen E. Tietjen, MD, UT chair of neurology, has been recognized national-ly for her research in neurology, focused on migraines and headache pain. She is a recipient of the Stroke Innovation Award from Stroke, the medical journal of the American Heart Association, and the Seymour Solomon Research Lecture Award.

Donna A. Woodson, MD, was re-elected President of the Toledo-Lucas County Board of Health.

Mohammad M. El Sayyad, MD5705 Monclova Rd.Family Medicine

American University of Beirut. Family Practice residency at the American Univer-sity of Beirut and St. Luke’s Hospital.

James Lyions, MD6005 Monclova Rd.Orthopedic Surgery

Wright State University. Orthopedic Sur-gery residency at The University of Toledo Medical Center.

Richard B. Markwood, DO1103 Village Square Dr.Obstetrics/Gynecology

Kirksville College of Osteopathic Medicine. Rotating internship and Obstetrics and Gy-necology residency at Mt. Clemens General Hospital.

Nitisha Mutgi, MD1103 Village Square Dr.Obstetrics/Gynecology

Marshall University School of Medicine. Obstetrics and Gynecology residency at Marshall University Hospitals.

Douglas E. Olson, MD6005 Monclova Rd.Orthopedic Surgery

University of Cincinnati. Orthopedic Sur-gery residency at The University of Toledo Medical Center.

Kenneth H. Power, MD5705 Monclova Rd.Family Medicine

Memorial University of Newfoundland, St. John, NF, Canada. Family Practice residen-cy at Memorial University of Newfound-land.

LaKeya C. Russell, MD1103 Village Square Dr.Obstetrics/Gynecology

Wayne State University. Obstetrics and Gy-necology residency at St. John Hospital and Medical Center.

Lauren E. Scott, DO1103 Village Square Dr.Obstetrics/Gynecology

Lincoln Memorial University Debusk Col-lege of Osteopathic Medicine. Obstetrics and Gynecology residency at William Beaumont Hospital.

Shannon R. Sutherland, DO1103 Village Square Dr.Obstetrics/Gynecology

West Virginia School of Osteopathic Medi-cine. Rotating internship and Obstetrics and Gynecology residency at Mercy Health Partners/St. Vincent.


Together We Can Do So Much

Cover Story

Denise Colturi

It is an honor and a privilege to serve as president of The Academy of Medicine of Toledo and Lucas

County Alliance for 2017-2018. I have a great team of dedicated and enthusi-astic board members and chairpersons. President Elect: Lynn Cooper; Vice Presi-dent: Cindy Hoeflinger; Treasurer: Lisa Husted; Assistant Treasurer: Kiran Rai; Recording Secretary: Bev Hartwig and Corresponding Secretary: Anjali Gupta. Together we have planned a great year of fun and exciting activities for you.

I would like to warmly thank Immediate Past Co-Presidents Lela Rashid and Jan Colville and their board for an excellent job well done. Their hard work has paid off for a most memorable year filled with activities and our 75th Anniversary Cel-ebration.

I became a registered nurse in 1975 and during training said “I would never marry a doctor, they are always at the hospital.” Well never say never! I have been married to Dr. Thomas Colturi for 43 years. We have four beautiful chil-dren all born in different states as we moved around for his training. Amy (36) married to Christopher Penna with 2 daughters, Para (5) and Carmella (2) whom I love to spoil; Julie (34); Jason (32) married to Breena Ferguson; and David (28). All live in Chicago, except David, who is in L.A. Needless to say we spend many weekends driving to Chicago. As a nurse I worked in the area of Oncology for 25 years in Toledo, Ohio; Rochester, New York; Dallas, Texas and Ann Arbor, Michigan. I then stayed at home with our children to become active in their sports and school activities and volunteer in the community. The kids would often say I was a “professional volunteer”.

My goals this year are simple: continue to recruit new members and stay involved supporting our community needs. Some

of our projects and activities we have been involved in are Mobile Meals, Ron-ald McDonald House meal preparation, Read For Literacy Spelling Bee, Save A Shelter, Mom’s House, Bethany House and UTCOM Scholarships, to name a few. A project I would like to promote and support is the P.E.A.C.E. Project (cov-ering bullying, signs & symptoms of self-harm and suicide, the signs & symptoms of drug use and the danger it presents), started by Mr. Bill Geha, Prevention & Intervention Coordinator for Sylvania & Springfield Schools. He gave a wonder-ful presentation at our February General Membership Luncheon, highlighting the drug & heroine epidemic in our commu-nity.

If you are not a member yet, please con-sider joining the Alliance. If you are a member ask a friend to join and help us support one or more of our health pro-motion projects or our Gourmet Lunch groups, Bridge group, Euchre night or start a new group. These are fun and educating.

As our OSMA-Alliance President, Kris Firth states “We’re Better Together”. I look forward to working with our talent-ed members and meeting the challenges of the coming year. We really are better together and can do so much. Here’s to a great year.

—Denise

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Dr. Om Parkash Sharma has written an impressive book on a difficult subject. He has

delved deep into the history, philoso-phy and religion in an effort to find and define happiness.

The art and science of happiness is a tricky subject. Through the ages, wise men, rishis, sages and pundits have tried to define happiness and with some rare exceptions, have always come up short. Unlike a well-worn and unambiguous recipe, most of them point to a general direction. In as complex a creature as man, such sim-plifications do show the way but often fail to lead the seeker to the final des-tination.

To Dr. Sharma, the state of happiness is a frame of mind that can be achieved by exploring the inner self in the light of religions and various philosophies. He borrows heavily from his own an-cient religion of Hinduism and tries to synthesize the ancient teachings with philosophies of the West. For exam-ple, he quotes (among other sources) the Upanishads (6th century BCE), Vedas (3rd century BCE) and Bhaga-vad Gita (8th century CE) to make his point. He emphasizes that the eternal truths expressed in those texts can help one reach true contentment and happiness.

The result, however, is that with so much information and rather profuse sprinklings of quotes throughout the book, a picture does emerge, but it is not very clear and crisp.

The author dwells at some length on the physiology of happiness. He quotes

studies done at UCLA that pinpoint vari-ous neurotrans-mitters that are closely associ-ated with happi-ness. In particu-lar, he mentions hypocretin, a neurotransmit-ter peptide and Melanin-Con-centrating- hor-mone. Could it be, and the question begs for an answer, that in future we may have a pill that changes our biochemi-cal balance in such a way to make us happy and content? Not unlike the chemical boost one might con-sider for erectile dysfunction or depression.

But then that would be akin to a quick fix. Life is more compli-cated and does not lend itself to quick fixes that are permanent. The wise men and philosophers em-phasize introspection, meditation and contemplation to boost our biochemi-cal balance in such a way that happi-

ness and contentment is achieved as a byproduct of the process and thus becomes part of life. Dr. Sharma sug-gests that we have the tools at our dis-posal in everyday life and we don’t

The Art and Science of Happiness in Body, Mind and Soul

Book Review by S. Amjad Hussain, MD

The Art and Science of Happinessin Body, Mind and Soul

By Om P SharmaCreateSpace Independent Publishing Platform

ISBN 153006256XAvailable on Amazon

Amazon $7.99eKindle $0.99


Gloria Steinem: Return of the NativeBy James G. Ravin, MD

Feature

About a year ago Gloria Steinem (1934- ) returned to the city of her birth and her parents’ birth to

speak before a sellout crowd at the Masonic Auditorium. Although she now lives in the upper east side of New York, she still con-siders Toledo home. (The Blade, Nov. 15, 2015) Both her parents graduated from The University of Toledo and were very active in campus affairs. Her mother worked for The Blade as a society news and feature writer. Her pa-ternal grandmother was the first woman to be on the Toledo school board and was an important suf-fragette locally and nationally. It may be difficult to believe that this witty and charming feminist and social activist is now in her ninth decade. Although she has spent most of her life travelling and is constantly giving talks, she said speaking before an audience always gives her some anxious moments.

Gloria attended Waite High School for three years but moved to Washington DC, where her sis-ter lived, for her last year in high school. She had a “Hollywood” vision of school, dreamed of becoming a dancer and may-be, eventually a Rockette on stage in New York City. She told a reporter for the New Yorker (October 19, 2015) “I imagined my-self, with some impracticality, as danc-ing my way out of Toledo.” She went to Smith College, where her older sister had gone, and graduated with Phi Beta Kap-pa honors. Although her father always loved her dearly, she said he gave new meaning to the term financially irrespon-sible, which made an exclusive eastern college something of a stretch.

While she was a senior in college, Ches-ter Bowles, who was soon to become the

Ambassador to India, spoke at Smith and was so astonished by the students there that he donated his lecture fee for fellow-

ships to two graduating students, and Gloria received one of them. She spent her time there inspiring women with what they could achieve. She travelled on “rickety buses and third-class wom-en-only carriages of local trains, leaving behind all my possessions except a cup, a comb, and the sari I had on.” After re-turning to the US she was employed by the Independent Research Service, work-ing to send non-communist students to the World Youth Festival. Only later did she learn it was funded by the CIA.

She looked for a job in New York as a writer for magazines or newspapers. An editor at Life magazine rejected her, say-ing they needed a reporter, not a pretty

girl. In 1963 Show magazine had her go undercover as a Playboy Bunny. The ex-pose she wrote jump-started her career.

Soon she became involved in the women’s movement. A new maga-zine, New York, invited her to join its editorial board. While sharing a taxi with two well-known writ-ers, one said “every year there’s a pretty girl who comes to New York and pretends to be a writer. Well, Gloria is this year’s pretty girl.” Even though she was cover-ing politics and became interested in the feminist movement, other writers advised her not to become involved with those “crazy wom-en.” Instead, she became one of the earliest mainstream writers on the subject. In 1971 a 40-page preview version of what was to become Ms. magazine was published as a sup-plement to the year-end issue of New York magazine and included Gloria’s article entitled “On Sister-hood.” The issue quickly sold out and Ms. had half a million subscrib-ers within a few years. The maga-zine is now a monthly, with little advertising, so that today competi-tors such as Cosmopolitan have

taken over much of its audience, which gives credence to the aphorism that the pioneers take the arrows and the settlers get the territory.

Gloria has branched out into issues of national politics, Native Americans, Chi-canas, African-Americans, gay rights, sexual mutilation, and prostitution. She says her travels have convinced her that ordinary people are smart, smart people are ordinary, decisions are best made by the people affected by them, and human beings have an almost in-finite capacity for adapting to expecta-tions. (Steinem, G. My Life on the Road. NY: Random House, 2015, 39)


allowed CRNAs to select, order and administer drugs, and to direct certain other personnel to administer drugs or perform clinical support functions was introduced in 2016. Opposition from the OSMA, the Ohio Society of Anes-thesiologists, and other groups due to concerns about patient safety and CRNA training limitations stopped the bill from passing; however, the effort is expected to be picked back up in 2017. The OSMA will be ready to continue to push back against this legislative ef-fort.

• Last year, the OSMA and the Ohio Psychiatric Physicians Associa-tion fought a bill seeking to authorize certain psychologists to prescribe psy-chotropic drugs for the treatment of drug addiction and mental illness. It is the position of the OSMA that psy-chologists do not possess the proper training and education to prescribe drugs to patients, and that the required training for psychologists to prescribe proposed by the bill is inadequate. The OSMA will continue to work hard on this issue, as this bill is also expected to be reintroduced in 2017.

• A bill also expected to resur-face this year would permit physical therapists to evaluate, diagnose, and determine a treatment plan for a pa-tient, as well as order tests and imag-ing. Under current law, a PT can assess, but not diagnose a patient’s condition. The OSMA is strongly opposed to this legislation, as it is the OSMA’s stance that allowing PTs to diagnose without the medical education and training of a physician would negatively impact patient care.

4.) Medical Liability/Tort Reform

Ohio has some of the most effective tort reform laws in the nation, but the OSMA believes our state can do even better. Several hearings have laid the groundwork for the Medical Malprac-tice Litigation Improvements Act, an OSMA-backed bill that aims to fix im-portant gaps in existing law with 10 specific provisions, strengthening tort reform and protecting Ohio physicians

from frivolous lawsuits. This legisla-tion will be a top OSMA priority in 2017. For more information about the specific provisions this legislation will contain, visit: OSMA.org/TortReform.

5.) Prescription Drug Issues

• Prescription drug costs will continue to be a major issue nationally and in Ohio. A ballot measure to limit prescription drug costs for government-sponsored health coverage to no more than what the Veterans Administration pays for similar drugs is expected to be on the ballot in November 2017.

• The OSMA continues to ad-dress the opioid epidemic in Ohio with Smart Rx, a statewide educational cam-paign about responsible opioid pre-scribing. The OSMA has also launched the Be Smart campaign, providing ad-ditional resources to physicians to edu-cate and increase awareness among patients about opioids and the risk of addiction and abuse. Advocating for more focus on addiction treatment and insurance coverage of alternative treat-ments for pain will be a priority for the OSMA in 2017.

6.) Regulatory Issues

• The Medical Board suggested removal of the “one-bite” rule which allows a physician to confidentially seek treatment for substance abuse or impairments one time without report-ing to the Board. The OSMA and other medical groups successfully defended the “one-bite” rule in 2016 and will work to strengthen this protection in 2017.

• Non-compete clauses may be beneficial for employers, but these clauses potentially hurt employed physicians. The Legislature is likely to investigate how these restrictive agree-ments may place undue burdens on physicians leaving employment and potentially impact access to care for patients.

7.) Public Health

• The OSMA continues to moni-tor the implementation of Ohio’s Medical Marijuana law, and will keep all members updated on any develop-ments. State regulators have said that it may take between 12 and 24 months before the rules and regulations are complete. For more information, visit: medicalmarijuana.ohio.gov/.

• Ohio must reassess GME fund-ing to ensure Ohio’s future physicians are well-trained to treat Ohio’s patients. During the last budget process, the OSMA participated in the GME Study Committee, and a report was submit-ted to the Governor, Ohio legislators, and the Joint Medicaid Oversight Com-mittee with suggested changes to GME fund allocation.

For more on the OSMA’s continuous advocacy efforts, visit osma.org/advo-cacy.


have to retreat to a mountain cave to achieve that goal.

While in the initial chapters Dr. Shar-ma introduces the main theme of the book in broad religious, philosophical and historic sweeps, he succumbs at the end to a cookbook approach. To-wards the end of the book he lists 111 items under the heading of ABC’s of Happiness. It is a helpful guide, but would probably require a fulltime ef-fort to modify one’s behavior to at-tain fulfillment. It would have been more insightful if Dr. Sharma had also talked about his personal journey to achieve happiness and contentment in life.

Dr. Sharma is a retired surgeon who has had a fulfilling career as a general and trauma surgeon. With his keenly observant eye he must have seen many unhappy persons and quite a few hap-py ones as well. Anecdotal snapshots of his observations would have added to the already rich texture of the book.

Dr. Sharma has put in a Herculean effort in writing this book. There are pearls and nuggets scattered throughout, but it requires careful and thoughtful study, not unlike reading a complicated textbook or a philosophi-cal treatise. The book does not lend it-self to an afternoon of fast or leisure reading.

Post script: The author informed me that he has made some changes in the new revised edition. He has added a chapter on prayers and has included prayer practices in Juda-ism and Islam. In addition, food guidelines and some updated scientific advances in the field have also been included.

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UTCOM Report

Dean’s

ReportThe University of Toledo College Of Medicine TOWNAROUND

Around Town

R. W. Mills, MD Mercy Health — Children’s Hospital

Mercy Health – Children’s Hospital will once again be home to pedi-

atric residents in its emergency rooms, clinics and on the inpatient units with the start of a new pediatric residency program.

Beginning July 1, four first-year pediatric residents will begin their training with Mercy Health physicians and special-ists. This is the 12th medical residency or fellowship program offered at Mercy Health. The program is accredited by the Accreditation Council for Gradu-ate Medical Education (ACGME). By the year 2019, there will be a total of 12 pediatric residents at Mercy Health, four in each residency year.

The American College of Surgeons, recently re-verified Mercy Health - St. Vincent as a Level 1 Trauma Center and Mercy Health – Children’s Hospital as a Level 2 Trauma Center for pediatric care. This is the first time that we have received a separate certification in pedi-atric trauma care and further formalizes our expertise and skill in trauma care for both adults and children. While we have always cared for pediatric trauma patients, the designation is indicative of Mercy Health’s commitment to our pediatric population and to providing a team of specialists to care for them. Congratulations to the entire Mercy Health – Children’s team for achieving this level.

Mercy Children’s Hospital Pulmonary and Sleep Center was chosen as one of three sites statewide to receive an Ohio Department of Health grant focusing on Asthma. The program, led by Ramalinga Reddy, MD, was chosen because it excels in both quality of care and community outreach. The multidisciplinary team approach to asthma care has led this program to one of the lowest hospital-ization rates and hospital length of stay in the state. The grant will help us pro-

vide The American Lung Association’s Open Airways For Schools® program to students and faculty in central city schools.

Shakil A. Khan, MDMercy Health — St. Anne Hospital

The transformation to Mercy Health continues and new signage is now

in place across the Toledo region. As the largest health system in Ohio with fa-cilities across the state and in Kentucky, Mercy Health delivers world-class care to thousands of patients each day. Mercy Health – St. Anne Hospital was the first of the local hospitals to receive all of its new signs and so visibly connected our team to fellow physicians and staff in eight regions with one united purpose – to help our patients be well in mind, body and spirit.

Individually, St. Anne has been work-ing very deliberately on delivering world-class patient experience and has seen the results in recent Press Ganey results. This initiative began in 2015 in the inpatient units and based on suc-cesses and learnings, a program was rolled out in the Emergency Department last year. These efforts have resulted in St. Anne being placed in the top 20 percent of hospitals nationally in Press Ganey scores as more than 80 percent of respondents gave our team a “top box” score. Congratulations to the en-tire St. Anne team for continuing to put patients first.

Recently, Mercy Health formally an-nounced our partnership with Colum-bus Radiology, which currently serves more than 65 sites in Ohio, including 19 hospitals and eight health systems. As part of this partnership, Mercy Health radiologists seamlessly transitioned employment to CR. The same radiolo-gists who currently provide service to Mercy Health onsite now will continue to do so with the added support of CR, which has shown its commitment to

This winter I wrote about the importance of recruiting nationally prominent

faculty and researchers to northwest Ohio and the success we’ve had in that endeavor as part of The University of Toledo College of Medicine and Life Science’s Academic Affiliation with ProMedica. Equally im-portant for us is the goal of attracting medical students, residents and fellows to the region and retaining those physicians in northwest Ohio as they complete their terminal training.

Top students and residents want to be at the very best place to learn and prepare for their careers. They are attracted to faculty who are leading experts in their field, the chance to learn about complex cases and procedures, access to top facilities, and the opportunity to participate in clinical research providing new and better treat-ments and outcomes for patients. At The University of Toledo College of Medicine, we are building a system of medical educa-tion with ProMedica that embraces these opportunities and are actively recruiting the students, residents and fellows that will thrive in this environment.

Our office of admissions received in excess of 4,000 medical student applications for admission and interviewed more than 500 prospective students for the 175 open seats for the incoming class. This competitive field ensures that we can select a class of medical students that are serious about their education and are looking to build long-term professional relationships that will continue throughout their careers.

It also is critically important that students have exceptional opportunities for a resi-dency here in Toledo. This year our goal was to increase the number of UT medical students who stay in Toledo for residency. Match Day 2017 revealed that we didn’t meet the goal, we far exceeded it. This next year 30 UT students will stay at UT for residency training. This compares to nine a year ago and eight in 2015. There are many factors contributing to this success,

(Dean’s Report continued on Page 16)


Fourth District Councilor’s Report

Ohio Physicians: Top 7 Issues to Watch in 2017

Anthony J. Armstrong, MD

It is already clear that 2017 will be a big year for health care. This year, health care transformation will

continue to take shape, building upon change brought on by prior legisla-tion, past and emerging major initia-tives, and last year’s elections. There is going to be a lot of activity in the world of health care, but amongst the multitudes of issues out there, some major themes are emerging. These are the issues that will top the agenda for the Ohio State Medical Association (OSMA) this year:

1.) Price Transparency

In late December, the OSMA, with the Ohio Hospital Association, filed a law-suit against the state of Ohio, to tempo-rarily halt the effective date (01/01/17) of a flawed health care price transpar-ency law. This law was inserted into an unrelated bill, and passed without any stakeholder involvement or public hearings. By delaying the law’s imple-mentation, the OSMA and OHA saved practices from a major administrative burden and disruption in patient care. The law is intended to offer patients a clear understanding of their financial obligations before receiving medical services, but the OSMA and OHA con-tend the wording of the new law makes it an unworkable mandate on physi-cians and health systems and a threat to efficient medical care for patients.

Now, the OSMA and other associa-tions can continue the dialogue with lawmakers and other interested parties to create a price transparency law that benefits all. The judge overseeing the suit has extended a preliminary injunc-

tion hearing until March 17. The origi-nal hearing date was set for Jan. 20, a day before a temporary order halting the new statute was set to expire.

The extension of the hearing means the law cannot be implemented or en-forced in the interim. The delay gives the legislature – including the law’s primary sponsor, state Rep. Jim Butler, R-Oakwood – and hospital and physi-cian advocates time to work on revis-ing the wording in an attempt to make the law more reasonably applicable.

2.) Health Insurance

• The OSMA supported a bill in 2016 calling for major step therapy re-form by establishing new requirements for the step therapy protocols required by health insurers, and the Medicaid program. This legislation, to be rein-troduced this year, would require these organizations to create and implement clinical review criteria upon which step therapy protocols are to be based, and to develop a process through which patients and their health care provid-ers can request an exemption from the protocols, should the patient’s indi-vidual health circumstances warrant an exemption in order to serve the pa-tient’s best interest.

This would help to ensure that patients in circumstances in which is it advis-able are able to receive exemptions from step therapy protocols. Failure to secure an exemption when neces-sary can result in disease progression, which can mean increased health care expense and decreased quality of life. The patient’s health and financial bur-den should be the first and foremost priority in the treatment process. The OSMA has been actively supporting this legislation because it represents a step forward in ensuring that step ther-

apy works for patients more efficiently, and that patients in circumstances in which is it advisable are able to receive an exemption from the step therapy protocols required by health plan is-suers. With patients’ health at stake, physicians and other providers need to be able to obtain this exemption and move forward with appropriate treat-ment of the patient’s condition with as little hassle as possible.

• The future of the Affordable Care Act (ACA) is uncertain. The OSMA will monitor any changes to the ACA and any other health care reform President Trump and Congressional Republicans try to implement in the coming year.

• The OSMA will also continue to advocate for the ACA expansion of Medicaid in Ohio. Under Medicaid ex-pansion, more than 500,000 Ohioans have been able to access health cover-age and uncompensated care has sig-nificantly decreased.

• “Surprise non-coverage” can occur when a patient utilizes an in-network hospital but receives services from an out-of-network provider, mak-ing the patient’s out-of-pocket costs higher than expected. Lawmakers are being called on to address the issue. The OSMA will work to hold insur-ers accountable by requiring they have adequate networks so as to avoid sur-prise non-coverage. We will also work to safeguard patients by requiring in-surers to base their payments to non-participating providers on a UCR rate using out-of-network charge data from an independent source.

3.) Scope of Practice

• Legislation that would have

Article first appeared in Ohio Medicine magazine, 2017 – Issue 1. Republished with permission by the Ohio State Medi-cal Association.


JoDee E. Ahrens, MD

President’s Page

How Far We’ve Come

57.5% of women com-pleting residency be-tween 2004 and 2013 remained practicing in the state where they trained, compared to 49.1% of men. Thus, again proving that you are likely to stay in the area where you did your residency training.

“There are three classes of human beings: men, women and women physicians.” Sir William Osler.

What would he think today of the changes in medicine and the number of women in our

profession?

He was, as you know, a founding father of Johns Hopkins School of Medicine. Reviewing the web site Hopkins.org tells the interesting sto-ry of the school’s beginnings.

Their medical school would not have been possible without the fundraising and help of several feminists. These women were wealthy daughters of the original university trustees.

Once it became clear that there were not enough funds to open the school or build the building, Martha Carey Thomas, Mary Elizabeth Garrett, Mary Gwinn and Elizabeth King volunteered to raise $500,000 for the project. Their one condition was that the school admit women as well as men. The women also proposed strict entrance requirements of both male and female applicants: proof of a bachelor’s degree, proficiency in German, French and Latin, as well as a strong science background in chem-istry, biology and physics. After per-suading the men, including Sir Osler, the money was raised and the school was established. Dr. Osler is said to have joked with the other professors that it was good that they got in as professors as they would not have qualified as applicants.

These women sowed seeds which took many years to grow, but they have become a reality. Now close to half of the new physicians of today are women.

One hundred and sixty-six years after the first female physician in America, Elizabeth Blackwell, was awarded her medical degree at Geneva Medi-cal College in upstate New York, gen-der equality in the awarding of medi-cal degrees is approaching. AAMC 2015 lists 8907 medical degrees were presented to women and 9798 medi-cal degrees to men. Data reviewed

also show 2416 women received doc-tor of osteopathy degrees while 2907 men received that degree.

There are also statistics that women tend to choose more of the primary care specialties, which are under served. A review of the AMA Wire article of February 18, 2015 by Lyn-da Vassar presented some of these statistics. Her article was based on a 2013 study from the Journal of the American College of Surgeons which found women make up 58% of Fam-ily Medicine residents, 75% of Pe-diatrics residents, 85% of Ob-Gyn residents and 75% of Psychiatry resi-dents. Whereas 75% of Radiology

residents were male, 54% of Internal Medicine residents were male and 62% of Emergency Medicine resi-dents were male. Women remained under represented in the surgical specialties and cardiology.

This study also noted that 57.5% of women completing residency be-tween 2004 and 2013 remained prac-ticing in the state where they trained, compared to 49.1% of men. Thus, again proving that you are likely to stay in the area where you did your residency training.

Gender differences are more striking in academic medicine. Veena Dubal wrote an article in The Clayman Insti-tute for Gender Research, January 15, 2015, that only thirteen percent of department chairs in academic medi-cine were women at the time. That Stanford group felt the “motherhood penalty” played a role in this in that women with children generally are viewed as less committed to their ca-reers than their childless colleagues. It was also felt that the sixty-five hour average work week coupled with work life balances contributed to this disparity. In the article, Stanford noted the issue and voiced their com-mitment to working on changing this environment. Hopefully, this dispar-ity has been noted in other academic centers and will be addressed going forward.

Since the days of Sir Osler women have made huge strides in our pro-fession.

There is no turning back now. To Dr. Osler we can paraphrase the Chinese proverb and say, “Sir William, Today in medicine women hold up half the sky”.


TOWNAROUND

Toledo by successfully recruiting five additional radiologists to Toledo. This collaboration will help streamline our radiology service, enhance turnaround times and provide a better experience for not only our patients but also our physicians.

Rajender K. Ahuja, MDMercy Health — St. Charles Hospital

With the goal of making access easier for our patients, Mercy Health has

transitioned our Urgent Care facilities into Walk-In Family Medicine, start-ing with the one adjacent to the Mercy Health – St. Charles Hospital campus. Mercy Health – Oregon Walk-In Family Medicine offers evening and weekend hours and is open to the whole com-munity for fast, convenient care with the patient’s out-of-pocket cost being a simple office visit co-pay. We’re pleased to be offering this service to the patients of the Oregon community.

I would like to commend the St. Charles team for receiving excellent patient satisfaction scores in the Emergency Department and Ambulatory Surgery. Both areas exceeds their goals and so showed the dedication of the physicians and staff to ensuring that the patient is put first. The leadership teams in these areas are to be recognized for setting a solid foundation to start the year.

Earlier this year, the St. Charles team went live on CarePath systems for revenue cycle/patient accounts, Stork, OpTime, and new patient placement programming. The command center for the go-live for the entire Toledo region of Mercy Health was stationed at St. Charles. By connecting every point of the patient journey through one integrated system, Mercy Health will experience less possibilities of interface errors ul-timately aiding in our ability to provide world-class experiences. The team is adapting well to the new system.

Finally, I’d like to recognize the Mercy Health – St. Charles Mission Services Committee, who satisfied visitors’ sweet tooth and helped the homeless dur-ing Valentine’s Day, when they raised money to purchase emergency Mylar blankets through a cookie sale in the cafeteria. The team sold cookies dur-ing the lunch hours, collected financial donations and raised enough money to purchase 240 blankets. These blankets were made available to homeless pa-tients in need.

Randall W. King, MDMercy Health — St. Vincent Medical Center

Mercy Health – St. Vincent Medical Center made a significant invest-

ment in equipment and technology recently to ensure that we continue to offer patients world-class treatment and care.

St. Vincent expanded its surgery capa-bilities after acquiring a new DaVinci® Xi robot. With the additional robot, St. Vincent now has two DaVinci® Xi’s and one DaVinci® Si, helping to increase access for our patients and improve effi-ciencies for our surgeons. Mercy Health remains the first to bring robotic surgery to northwest Ohio, and this investment further reinforces our commitment to providing the most advanced technol-ogy for better patient outcomes.

Another addition comes in the form of an intraoperative Body Tom CT scan-ner, thanks to the generous donation of the Mercy Health – Foundation. This scanner will allow for more complex brain and spine cases to be completed right here in Toledo. The Body Tom has cranial and spinal navigation that offers real-time imaging during surgery. The intraoperative CT promotes safer surgi-cal processes with the ability to watch for bleeds in real time before closing the incision, show hematomas intraopera-tively, check fluid in brain ventricles,

confirm functional placements for shunts and external ventricular drains, and avoid wrong-site surgeries all in real time.

Finally, the recent installation of a new GE 450W Wide Bore MRI means that St. Vincent now provides a wide-bore gantry to better accommodate patients as well as minimizing the sense of claus-trophobia some patients experience.

I am also proud to share that the Oc-cupational Health team at St. Vincent will provide healthcare for employees of The City of Toledo after being awarded a two-year contract. The physicians in the Occupational Medicine program focus on the health of workers in our community, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures.

Manish M. Thusay, MDProMedica Bay Park Hospital

The physicians and staff at ProMedica Bay Park Hospital are proud to

efficiently serve the complex medical needs of our community, and to further our Mission of improving the health and wellbeing of those we serve.

During the summer of 2014, all Pro-Medica Bay Park Hospital employees and providers went through error pre-vention training. The purpose of the training sessions was to teach employees about ProMedica’s safety journey to become a highly reliable organization. The training provided tools necessary to assist in reducing errors that can lead to patient harm. This program is enriched by having safety coaches in each department of the hospital. The purpose of a safety coach is to provide a peer-to-peer train-

(continued on page 14)


ing between team members to ensure that safety practices remain the priority while providing care. In addition, a team of leaders at Pro-Medica Bay Park Hospital is designated to evaluate each reported error and evaluate for the level of harm to our pa-tients. By paying attention to the detail in the cases and providing the necessary education or training needed to reduce the harm in the future, ProMedica Bay Park Hospital has decreased the serious safety event rate by 83% over the last two years! This journey is dynamic and endless in that our goal is zero events of harm. We are continuously establish-ing safety as our highest priority across the system.

Henry H. Naddaf, MDProMedica Flower Hospital

ProMedica Flower Hospital has received the 2017 Distinguished

Hospital Award for Clinical Excellence™ from Healthgrades, the leading online resource for comprehensive information about physicians and hospitals. The distinction places Flower Hospital in the top 5% for clinical excellence among more than 4,500 hospitals nationwide. Flower Hospital is one of 258 recipients of the Distinguished Hospital Award for Clinical Excellence™, standing out among the rest for overall clinical excel-lence across a broad spectrum of care.

The staff and physicians at ProMedica Flower Hospital are extremely honored to earn this achievement that demon-strates the high level of care we provide to our patients. We will continue to put our patients first and always provide excellent care.

In addition to our Healthgrades rec-ognition, ProMedica Cancer Institute recently received a successful re-accred-itation through the American College of Surgeons Commission on Cancer. The North Central Region, which includes Flower Hospital, Toledo Hospital, Toledo Children’s Hospital and Bixby Hospital, received the “ Accreditation with Commendation Award” and the “Outstanding Achievement Award”.

(from page 13)

Also, the radiation program at Flower Hospital recently completed a survey through the American College of Radiol-ogy. While the final report is pending, the surveyors were very complementary of the clinical expertise, physicians and staff. To recognize our exceptional medical staff at ProMedica Flower Hospital, the 2017 Medical Staff dinner was held on March 10 at Sylvania Country Club. The event was a great success, as medical staff members were honored for their dedication and service. Colleagues were able to connect outside of the work envi-ronment to further build relationships. It was an honor to serve the ProMedica Flower Hospital Medical Staff as Chief of Staff. Please welcome our incoming Chief of Staff Dr. Timothy Husted.

Howard M. Stein, MDProMedica Toledo Children’s Hospital

ProMedica Toledo Children’s Hospi-tal has joined the Ohio Children’s

Hospital Solutions for Patient Safety in an effort to eliminate serious safety events on our pediatric wards. The Situ-ational Awareness initiative can prevent harm in vulnerable patients through pre-emptive detection and mitigation of untoward events.

The Situational Awareness team is comprised of the Pediatric Critical Care Physician (the safety officer of the day), the Pediatric Hospitalist, key nursing and respiratory staff from the Pediatric Intensive Care Unit and general ward. They meet every morning and evening to discuss high risk patients, known as “watchers”. These “watchers” can be identified by any healthcare team member or family member based on either pre-determined triggers (transfer out of PICU, high risk diagnosis, high risk therapy) or non-specific concerns. Potential complications and action plans are reviewed by the Situational Awareness team and updated in the electronic medical record for all caregiv-ers to access.

Deteriorations in the patient’s condi-tion are reported to the primary service and covering physician who activate

the action plan. If the patient does not improve with the therapy, the Safety Of-ficer of the Day is notified for additional interventions or transfer to the Pediatric Intensive Care Unit. The presence of the Safety Officer of the Day reinforces the culture of safety at TCH by providing a contact person for staff and family when clinical concerns arise. The im-plantation of this system has increased collaboration between all members of the healthcare team and increased our collective vigilance of the most vulner-able children in the hospital.

Thank you to Susan Tourner, MD, for composing this update.

Peter F. Klein, MDProMedica Toledo Hospital

ProMedica Toledo Hospital has been recognized as one of America’s 100

Best Hospitals Award™ from Health-grades, the leading online resource for comprehensive information about physi-cians and hospitals. For the third year in a row, ProMedica Toledo Hospital is among the top 2% of more than 4,500 hospitals nationwide for its clinical excellence. It is an honor to be recognized as one of America’s best hospitals for the third consecutive year. Our staff, providers and physicians are committed to pro-vide the highest level of care to every patient and visitor who comes through our doors. Healthgrades determines America’s 100 Best Hospitals Award recipients by analyzing objective performance data such as risk-adjusted mortality and in-hospital complications among Medi-care patients. During the 2017 study period (2013 – 2015), award recipients showed superior performance in clini-cal outcomes for patients across at least 21 of 32 of the most common inpatient conditions and procedures.

Timothy J. Mattison, MDSt. Luke’s Hospital

We celebrated our Annual Medi-cal Staff Dinner and Meeting the

evening of Saturday March 4th. The theme of this year’s Gala was “A Salute


If you think a single party payer is the answer, I would cite two exam-ples of why that doesn’t work. When I lived in the United Kingdom in the late ‘80’s, my gardener needed a her-nia operation. He waited five years, but eventually he did have it. More recently, there is the case of the poor soul from Toronto. He had an MI and died on the Ohio Turnpike as he drove himself from Canada to Cleve-land to have his cardiac bypass sur-gery done at the Cleveland Clinic, as he was told he would have to wait a year to have it in Toronto.

I am old enough to remember when we physicians actually had some dis-cretionary ability to price our servic-es. Our group would charge wealthy patients a bit more, and less well-off patients a bit less. Indigent patients we treated for free. Now I can’t even forgive the co-pay of a physician col-league without incurring the wrath of the insurers.

In my opinion, the problem lies in the inelasticity of pricing. Central control almost never works. Prices for our services are set in Washing-ton, DC and attempt to be fair. Rural physicians get paid a bit more. Phy-sicians who practice in high cost en-vironments (think New York or LA) get paid a bit more. But whatever happened to supply and demand? I contend that price would come down and quality would go up if only we were forced to compete for the pa-tient’s hard earned healthcare dollar. Think about it. You want your hip re-placement done at the Mayo Clinic? Fine, be prepared to wait six months and shell out a 50% premium for the

privilege. Meanwhile, young Eager Orthopedist, MD just down the street will do it tomorrow for 50% less.

Obviously, there needs to be a safety net for the needy, but competition al-most always causes quality to rise and price to settle at some rational level. I realize I am swimming against the tide and may not even espouse the prevailing attitude, but nothing else is working, and what do I tell my friend who needs the CT scan?


Why is the Cost of Medical Care So High?by Ted E. Barber, MD, MBA

In My Opinion

Full Disclosure: I have been a mem-ber of The Toledo Clinic, Inc. for the entire time I have been in practice in Toledo, Ohio.

Recently a close acquaintance of mine called to say he needed a CT of the abdomen and pelvis. His PCP is a member of a large local vertically integrated group and my friend had been referred to the large vertically integrated group’s radiological ser-vices to have the study performed. When he enquired about the cost for the test, he was told that his deduct-ible would be just shy of $1000. He further enquired about the entire cost of the test and was met with a ques-tion of theirs, “Why would you want to know that? Your insurer is picking up the balance." He persisted because he still wanted to know and was told that the entire cost of the test was just under $6000. He called me to see if I could help him find a way to have it done for less. I called down to the radiology department of The Toledo Clinic and learned that he could have the test done there for just under $600 and his out-of-pocket portion would be just under $100. Naturally he met some resistance from the large verti-cally integrated system and had to jump through several hoops in order to get the discounted price for the test.

It got me thinking. Why does medi-cine cost so much and what can be done about it? Back to the large vertically integrated group for start-ers. In theory, vertical integration is where a large corporate structure oversees “soup to nuts” provision of health care services. The integra-

tion is supposed to manage care and provide efficiencies that control costs and promote quality. In my opin-ion, the vertical integration drives down competition and allows the few remaining large players to price services according to what they can get away with, not what the market can bear. Vertical integration means the dollars come in and they never leave.

We can blame our government in part for the rising costs. CMS sets the pric-es for services the government will pay for through their Medicare and Medicaid benefits. It is capricious, arbitrary, and rarely has any justifica-tion. If I do an extensive EMG in the hospital, it can take over an hour and I will be paid less than $12. I can do a study that is not half as involved, in my office, spend two-thirds less time and get paid ten times as much. Insurers fall in line and use the gov-ernment pricing as a benchmark for their own pricing.

A recent WSJ editorial confirmed what I had long suspected regarding pricing of pharmaceuticals. Con-sumers in the United States bear the entire costs of research and devel-opment. Foreign countries demand steep discounts in order for the medi-cations to be imported to their coun-tries. Pharmaceutical companies ac-cede to the demands because half a loaf is better than none. So we have the absurd situation where our pa-tients in Toledo get on a bus to Wind-sor, pay a Canadian doctor to copy their American prescription, then go to a Canadian pharmacy to recoup the foreign discount.

In my estimation, not all cost escala-tion is necessarily untoward. Think of the advances in medicines, tech-niques, devices, and training that have occurred in recent memory. Those come at a cost, but are worth it when consideration of suffering avoided, lives saved, and productiv-ity returned to society are tallied.

But let us consider the costs of litiga-tion to our medical fisc. Last year an estimated $55.6 Billion was factored into total health care spending. Sure, that was only 2.4% of the nation’s total health care bill, but as the late Senator Everett Dirksen noted, “a billion here and a billion there and pretty soon you’re talkin’ real mon-ey”. Tort reform on a national scale remains an elusive pipe dream and will remain so as long as plaintiff at-torneys continue to contribute expo-nentially more to political campaigns than physicians.

On more than one occasion, from more than one source, I have seen a curve with supply of physicians and a separate curve showing the supply of health care administrators plot-ted along the ordinate, in numbers of each, plotted against time on the abscissa (1970 – present). The curve of physicians rises modestly (1-2 percent per year) and the supply of administrators rises exponentially. Those people expect to get paid (and in the case of insurance executives, paid extremely well indeed).

Everybody wants quality health care. Everybody wants someone else (gov-ernment, employer, high net worth individuals’ tax dollars) to pay for it.


to You.” We celebrated the service of all of our Medical Staff as well as that of our nation’s Armed Forces. The en-tertainment was a USO Show complete with Bob Hope (played by Bob Hope look-alike Lynn Roberts) and the An-drews Sisters (played by the Ladies for Liberty). Dinner and the drinks were not served in canteen cups, as I had requested, but on the fine china and glass ware of the Hilton Garden Inn at Levis Commons. And, once again the chef and the wait staff contributed to a wonderful evening.

At St. Luke’s Hospital, everyone is col-laborating in helping to prepare our new Cerner EHR. We are about 8 ½ months since the effective date of the divestiture from ProMedica. We continue to benefit from their transition services as, one by one, we are replacing old systems with our own and hiring a host of new or returning support staff to implement all of these changes. Our Medical Staff is heavily engaged with all aspects of this revitalization of St. Luke’s Hospital to become, once again, the best darned community hospital in all of Northwest Ohio. I think that we have to give a lot of credit and thanks to the administra-tion and to our Board of Trustees, as we doctors and nurses have continued to render top notch care for our patients, despite rooms and OR’s being booked to near capacity.

Two of our physicians have stepped up to major leadership roles. Dr. Mary Pellioni has agreed to take on the role of Chief Medical Informatics Officer. This is a position which is badly needed during this time of total makeover of our Infor-mation Technology. Dr. Lalaine Mattison has been asked to create a whole new position as Medical Director of Quality and Care Continuum. Her mandate is to do everything that you would think that the title would imply and then a whole lot more.

On the outpatient side, we continue to grow our WellCare Physician Group. Most of us have recently gone live with our EHR conversion from Allscripts to e-ClinicalWorks. Living continues to be good at the intersection of I-75 and I-80/90 or as we say at our corner of healthy and happy.

Ian S. Elliot, MDThe Toledo Clinic

The Toledo Clinic and the Central Michigan University (CMU) Col-

lege of Medicine are beginning a new partnership in 2017 to expand medical student education. As part of the CMU College of Medicine’s Comprehensive Community Clerkship (CCC) program, medical students will serve six-month rotations with established primary care physicians in NW Ohio. “We are very excited by this type of modern ‘ap-prenticeship’ in which medical students can see and work in a thriving practice and determine how private community medicine best suits their future needs,” states Henry Naddaf, MD, of The Toledo Clinic. With the recent closures of established primary care training programs in NW Ohio, The Toledo Clinic has found it imperative to establish and accentuate the training and placement of future family physicians to meet the needs of the community. The CMU College of Medicine offers a new academic partner whose very charter is designed to pro-mote community-focused primary care. “Many of our well-established family physicians are excited by the prospect of working with medical students,” said Ian Elliot, MD, President of The Toledo Clinic. “Some of these family physicians might be three to five years from retirement and would have a lot to offer a new physician.” The Toledo Clinic is an independent partnership of over 180 physicians and 70 additional medical providers. It has had a long and successful history in the training of medical students and residents. As “community educators,” The Toledo Clinic allows students to see how private practice can thrive in the era of corporate medicine.

The CMU College of Medicine is the nation’s 137th medical school. Its mis-sion is to prepare physicians focused on improving access to high-quality health care in Michigan with an emphasis on rural and medically underserved regions. The College will celebrate the graduation of its first class of students in May 2017.

Thomas A Schwann, MDThe University of Toledo Medical Center

Like much of the health care industry, The University of Toledo Medical

Center has experienced a season of change and is setting a course for the future. After a thorough review over the past year, University leadership announced that the medical center would continue to operate as a teach-ing hospital, serving the South Toledo community.

While UTMC has always been a source of care for complex cases, our physi-cians and staff are equally committed to the more routine health care needs of the community. Going forward we will continue to build robust primary care and behavioral health options at UTMC to meet the evolving needs of the Toledo community, as well as to ensure strong medical education programs in those specialties.

The University also announced a per-manent leader for the medical center, naming Dan Barbee CEO. Dan has nearly 25 years of combined clinical and health care management experience. Prior to being named CEO, he served as UTMC’s chief operating officer and vice president of clinical services. Dan joined the medical center in 2011 as chief nursing officer and associate execu-tive director. Importantly, Dan has the trust and confidence of the physicians and staff at UTMC. We’re glad to have him at the helm, and together with our faculty and University leadership we’re looking forward to a strong future with continued dedication to caring for our community and achieving our tripartite mission of outstanding clinical care, education and academic activity.


including our ProMedica partners in the Academic Affiliation, excellent department chairs and program directors, engaged GME staff and others. These students are excited to be here, and we are thrilled to have them.

Ryan Johnston, one of our fourth-year students, summed up the excitement on Match Day when he said, “My wife im-mediately started crying and I couldn’t stop smiling because this was our No. 1 choice. We’re both from Northwest Ohio and want to stay home. Plus, the Academic Affiliation with ProMedica benefits the specialty of emergency medicine because of high patient volumes, different acuities and presentations of illnesses at Toledo Hospital. I think that is going to lead to extensive learning. I’m excited to see what the future holds for the Academic Affiliation.”

Jennifer Amsdell, another fourth-year medical student who matched in neurol-ogy, said, “The wait was nerve-wracking, but I am so happy I matched with my top choice. I wanted to stay because of the faculty in neurology. I’ve been able to spend a lot of time with them in rotations and during research projects. They are amazing mentors and teachers.”

Why is this match important? We know that approximately 70 percent of residents establish their practice in the community where they complete their terminal train-ing. For years we’ve seen that some of the most talented physicians trained here and stayed here. As practicing physicians, we can help increase this number with a com-mitment to the next generation of doctors learning in our community.

Graduation will follow closely and we will celebrate with our students the next step in their medical careers. They’re full of hope for their future and so should we. Welcome them to this noble profession, support their education and mentor them for professional growth. We all have a role in securing the future of medical care for the community we serve. Let’s all celebrate a smashingly successful match for our community.

— Christopher J. Cooper, MD

(Dean’s Report continued from page 12)

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