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VOLUME 95* NUMBER 7 JULY 1992

Medical Technology andb Maternal-Fetal Conflicts An Ethicist's View

ONTENTS

JULY 1992 VOLUME 95

NUMBER 7

Medical Ethics and Maternal-Fetal Conflicts

A medical ethicist offers guide- lines for physicians in dealing with medical decisions, new technologies, and the age-old maternal-fetal dilemma.

Cover photo by Blair Seitz®, Harrisburg

Clarifying Concurrent Care

Concurrent care policy is the source of much confusion and exasperation in Pennsylvania.

This article seeks to clarify the process for a better under- standing by physicians.

Health Views from the House

In this final of three conversations with members of the state’s legisla- ture, a representative of the House dis- cusses medical issues and the political process.

Representative Elinor Z. Taylor

Living Wills

The follow-up article on living wills slated for this issue of Pennsylvania Medicine has been delayed until September. At that time, look for an analysis of the Pennsylvania Durable Power of Attorney Act.

PENNSYLVANIA MEDICINE (ISSN 0031-4595) is published monthly by the Pennsylvania Medical Society, 777 East Park Drive, Harrisburg, PA 1 71 1 1 .

SUBSCRIPTIONS: $20 per year — United States and Canada; $30 — all others. Single issues $3.00 per copy prepaid; special issues cost more.

POSTMASTER: Send address changes to PENNSYLVANIA MEDICINE, 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105-8820. Second class postage paid at Harrisburg, PA 17105.

Medigram hhhhmhh

4 Late news at press time

Issues of Interest

1 2 Medical Ethics — Medical ethics and maternal-fetal conflicts — James F. Drane, PhD

18 Legislative Profil e — Health views from the House— Maria T. Montesano

2 1 Government— Funds cut in budget, GA health package offered/ Support sought for liability reform bill/PHC4 postpones report release/New law expands HCFA 1 500 use by insurers

22 Regulations— PennDOT publishes amendments to licensing regulations— Susan M. Weber, Esq.

24 Medical Economics— Clarifying concur- rent care— Dennis L. Olmstead

26 Medical Economics— Medicare conversion factor split for 1 993/Blue Shield, Society answer RBRVS questions

28 Policy Briefs— Actions of the Board of Trustees, May 13, 1992

30 Public Health— Society co-sponsors ani- mal research workshop/First rural health conference held

32 Practice Management— Office over head: recognizing hidden costs —The Health Care Group

34 Peer Review— Possible changes in store for PRO program —Donald E. Harrop, MD

Opinion

6 Editorial— AIDS: startling statistics call for strong actions

8 President's Page— Notes from the Road

10 Letters to the Editor— Vaccine pamphlet supplement released

48 Discharge Summary— A refreshing view: the Oath of Hippocrates— Leslie E. Morris, MD

Departmen ts

36 Newsfronts— Graduation stats up five percent from 1 991 /"Women in Medicine" month: September/Philadelphia county president elected/LCMS offers second mini-internship/Mercer county physicians address state officials/ Societies computerize speaker program/Coalition honors state businesses/ Society receives dues rebate from AMA/ Seminars to address loss prevention

41 Advertisers' Index

41 Obituaries

42 Medical Abstracts

43 New Members

44 Newsmakers

45 Classified Advertising

2

PENNSYLVANIA MEDICINE

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WORKERS' COMP BILL AMENDED, MEDICAL LANGUAGE UNTOUCHED:

The state Senate on June 30 passed (30-18) an amended version of House Bill 2140, addressing workers’ compensation reform. The bill’s medical language — limiting medical payments to 120 percent of the Medicare allowance for 1992 and offering an annual update beginning in 1993 equal to the percentage change in the statewide average weekly wage — was comparable to the previous Senate-passed version. Since the Senate vote occurred during a House recess, the House will not consider the bill until it reconvenes September 21. The Senate procedural maneuvers avoided a conference committee on the bill.

HOUSE COMMITTEE APPROVES CERTIFICATE OF NEED LEGISLATION: The

House Health and Welfare Committee in late June voted 13-10 in support of House Bill 1982, which modifies Pennsylvania’s Certificate of Need (CON) program. The program could sunset December 31, 1992, a move the State Society supports because improvement in quality of care and limiting increased health care costs, with few exceptions, have not resulted from the program as intended. The Society's Board in May adopted a recommendation advocating assurance of quality through appropriate licensure standards, but Society lobbyists are working with key legislators in an attempt to amend the bill should it pass.

HOUSE PASSES MAMMOGRAPHY BILL: Pennsylvania’s House of Representatives, just prior to recess on June 30, passed (196-1) Senate Bill 1939, the Mammography Quality Assurance Act. The bill — introduced by Senator Allyson Schwartz (D-Philadelphia), and supported by the Society and the Pennsylvania Radiological Association — establishes standards for mammography services. The Senate unanimously passed the bill on May 19, at which time it was amended to utilize federal Medicare standards in lieu of those set by the American College of Radiology. At press time, the bill was back in the Senate for concurrence on the House amendments, and action was pending.

SOCIETY MEMBERS ELECTED TO AMA POSTS: Pennsylvanians will play an increasingly prominent role in organized medicine at the national level with the election of three State Society members to posts at the American Medical Association (AMA): Society President Robert N. Moyers, MD, a Meadville family physician, was elected to a three-year term on the Council on Medical Education; Lee H. McCormick, MD, a Pittsburgh family physician, was elected to a two-year term as chairman of the governing council of the AMA's Hospital Medical Staff Section; and Maria Simbra, who just completed her third year at the University of Pittsburgh School of Medicine, was elected to a one-year term as chairman of the governing council of the AMA's Medical Student Section. Elections were held in conjunction with the AMA’s annual meeting in June.

CONCERN ABOUT PHYSICIAN LIABILITY UNDER ADA EXPRESSED:

Several State Society members have expressed concern about their liability under the Americans With Disabilities Act (ADA) when they perform physicial examinations at an employer's request. In particular, they are concerned about the inclusion in their reports of information with respect to medical history or previous workers’ compensation claims. According to an attorney from the Equal Employment Opportunity Commission (EEOC), a physician who performs examinations in a "medically ethical manner" should not be exposed to liability for a report and advice given to an employer. The ADA prohibits the employer from making employment decisions based on a person's handicap or disability and requires the employer to segregate medical information from general personnel records. It appears, at the present time, that physicians' liability under the ADA is primarily focused on their role as employers and the accessibility of their offices to the public.

PENNSYLVANIA MEDICINE 777 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820 Telephone (717) 558-7750 Fax (717) 558-7840

PUBLICATION COMMITTEE

John W. Mills, MD, Chairman Mark V. Caliendo George R. Fisher III, MD Daniel S. Henriksen, MD Ferdinand L. Soisson Jr., MD

STAFF

Medical Editor:

John W. Mills, MD

Managing Editor:

Elaine S. Herrmann

Assistant Managing Editor:

Maria T. Montesano

Art Director:

Donna R. Jones

Production Assistant:

Stacy J. Bolden

Advertising Representative:

Gordon V. Hamilton

Advertising Assistant:

Lori Rusinko

Pharmaceutical Advertising Representative: Karl S. Messerrly (203) 661-9702

PENNSYLVANIA MEDICINE, estab- lished in 1897, is the official publication of the Pennsylvania Medical Society. All edito- rial and advertising correspondence should be directed to the Managing Editor.

All material subject to this copyright may be photocopied only for noncommercial scien- tific or educational purposes. The opinions of authors do not necessarily represent the policy of the publisher. The appearance of advertising does not guarantee or endorse the claims of the advertisers.

The publisher reserves the right to refuse any advertisement. All advertising is subject to ap- proval. Advertiser and agency warrant that they are authorized and entitled to advertise copy furnished; and hereby agree to indemni- fy and hold the publisher harmless against all claims, demands, damages, liabilities, and costs including counsel fees, arising out of or in any way caused by or connected with the printing and publishing of the advertising copy furnished by the advertiser.

Copyright 1992:

Pennsylvania Medical Society.

4

PENNSYLVANIA MEDICINE

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Editorial M

AIDS: Startling Statistics Call for Strong Actions

John W. Mills, MD Medical editor

“If we continue to pussyfoot around this epidemic , we will be consumed by it. ”

A public service message on TV recently pointedly announced that one in 250 Americans are infected with HIV. There fol- lowed a toll-free number for "information on how to pre- vent HIV infection.”

That statistic boggled my mind: one in 250 Americans infected with HIV? Is this true? In a recent editorial I questioned whether the Centers for Disease Control (CDC) is telling the truth about HIV; now I question it even more. I recalled Mark Twain’s comment, "Statistics and more statistics and damn lies.” But this startling statistic, true or not, pulled me toward several realizations.

The new regulations from the Occupa- tional Safety and Health Administration (OSHA) on controlling bloodborne pathogens in medical facilities have jump-started physicians and their office staffs into compliance under the threat of severe fines. As I said in a recent editori- al, I think the regulations are probably a good thing — though perhaps misdirected.

That misdirection is the problem. The federal regulators have missed the boat with their emphasis so far; past efforts in the right direction have not been carried through. Former Surgeon General C. Ev- erett Koop sent an HIV informational fly- er to each American household several years ago. It was a well-intentioned effort which should have been continued on a periodic basis with new information and updated statistics. This would have been a very positive way to disseminate HIV trends and keep the spector of HIV before the American public so that we could be- gin to really understand the seriousness of this scourge.

Instead, federal efforts turned toward us — the medical community.

Most physicians would argue for HIV infection to be treated as an infectious disease, reportable at once with immedi- ate follow-up of patient contacts. Unfor- tunately, the legal morass in this country, spurred on by AIDS activists, have made this deadly disease a political football. Even with the increasingly alarming spread to the heterosexual population and to teenagers, we are afraid or blinded by the threat of legal actions to call a spade a spade.

Physicians know that, regardless of OSHA’s newest regulations, the threat of spreading HIV infection from within our offices is a miniscule risk.

Rather, the federal regulations need to acknowledge the actual modes of infection and get tough about dealing with them.

It is a sexually transmitted disease as well as an illicit drug user's disease. It should be immediately reportable with follow-up with patient contacts.

If we continue to pussyfoot around this epidemic, we will be consumed by it.

Education is our other tool. We need widespread sex education, including in- formation on HIV and other sexually transmitted diseases. This should be mandatory in the schools starting in the elementary grades and continuing through college. We can't afford not to spend this effort to protect our young cit- izens from themselves.

Some might blame our dilemma on the breakdown of morality in this country. They’re not entirely wrong, in my view: the sexual revolution of the 1960s was part of that breakdown. Couple this with the in- creasing loss of the family unit, and you have the seeds of destruction. But when the rights of some threaten the health of a nation, it’s time for action. The common good should be the legal precedent here.

PENNSYLVANIA MEDICINE

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President'sPageM

Notes from the Road

Robert N. Moyers , MD

“Physicians should be players, because we know the business of medicine as well as the art of providing effective medical care . ”

Feeling a little like a traveling preacher intent on spreading the word, I rolled out on my first hos- pital medical staff visit to Bryn Mawr in late January. My truck odometer read 80,000 miles. More than two dozen visits later, it reads 120,000 miles. Many more miles are rep- resented in plane flights and in the com- pany of Society staff as a tired and grate- ful passenger.

By the time my presidency is over, I will have spoken personally to hundreds of physicians, averaging two visits a week to county medical societies and hospital medical staff meetings. That’s in addition to many, many visits to Harrisburg to talk to groups ranging from the foundrymen to legislators, and several trips to Wash- ington. It’s been a privilege. It’s been a challenge. But it’s just a beginning.

It’s been my longtime goal to reach out to our colleagues who are not members and give them the very compelling rea- sons to join us in our efforts. We know there are a number of external forces that are affecting the way we practice medicine. Two key forces are governmen- tal regulation and legislative activity. We in the Society, and I as president, recog- nize the feelings of concern, frustration, anger, and disillusionment that these forces elicit in physicians.

If we as a profession want to do some- thing about these negative forces, we need to become more effective and influential. We must unify in the only association that serves us all regardless of specialty, the Pennsylvania Medical Society.

But unity is not enough. There is little value in a society that functions only as a loose association of political observers or bystanders. The State Society needs not only more members, but more member involvement. Many are active; many more must be, particularly in the legislative process and in devising ways in which we can have an impact on that process.

I’ve put a lot of rubber to the road to take this message to physicians. There’s

no way around it. Each of us must devote a bit of time to addressing the issues of the day. We must learn to communicate bet- ter with our legislators.

My travels throughout the state have re- inforced my belief that physicians do not have to be victims of this whole process. We do need to get a better grasp on how to deal with the legislative process effec- tively and strengthen our ability to influ- ence legislation. This is especially critical as the nation and its individual states struggle with health care reform. Physi- cians should be players, because we know the business of medicine as well as the art of providing effective medical care.

When physicians’ input is lost, our health care system is vulnerable to special interest groups who may want only to con- trol costs by sacrificing quality, and to the quick fix that can become the long-term boondoggle. We can play a more aggres- sive role in this whole process, or we can become victims of others’ decisions, mere purveyors of care at the control of others.

My visits to hospital medical staff sec- tions, in addition to the regular visits to county medical societies, are part of an initial effort to achieve greater unity. Many physicians tell me they want to see more regular outreach programs at the lo- cal level.

This certainly reinforces my impres- sion that the Society needs a greater pres- ence on the front lines of the medical care delivery system. It’s important that mem- bers and non-members have the opportu- nity to meet and talk to Society leadership and staff. We must be more than just names and faces in Harrisburg. Physi- cians need to see that there really are peo- ple who are concerned about working to solve our mutual problems.

I’m more determined than ever to see how we can be more helpful in rebuilding our sense of professionalism, improving our scope of influence, and expanding our role as patient advocates. I’m confident that more leaders and members will join me, on the road again....

8

PENNSYLVANIA MEDICINE

ETTERS TO THE EDITOR

VACCINE PAMPHLET SUPPLEMENT RELEASED

In mid-March 1992, the Pennsylvania Department of Health sent to each Pennsylvania Medical Society member (who was likely to administer childhood vaccines) a camera-ready copy of three different Vaccine Information Pamphlets (VIPs) developed by the Centers for Disease Control (CDC). The VIPs— for use with DTP, OPV, and MMR vaccines — would satisfy a provision of the National Childhood Vaccine Injury Act (Public Law 99-660).

Because of the recent licensure of the acellular pertussis vaccine, a supplement was developed for the VIP that is used with DTP vaccine. This VIP Supplement must be inserted into the DTP pamphlet, if the DTP vaccine being used by the health care provider was purchased using the federal vaccine contract. Even though few physicians would be required to use the supplement, many are using the VIPs developed by the CDC and, therefore, are encouraged, but not required, to use the supplements when they administer any DTP vaccine.

Enclosed is a copy of the VIP supplement. In communications with Society members, it might be helpful for them to know about this. Thank you for your assistance.

Robert E. Longenecker Immunization Program Coordinator Pennsylvania Department of Health Harrisburg

Editor’s Note: At right is a reprint of the supplement which physicians may copy, cut, and insert into DTP pamphlets as needed. The State Society, in an early June news release, expressed some concern with the CDC pamphlets: “A major concern is that [the government’s] effort to provide so much detail, on what for most families has been routine preventive health care, cart backfire, actually scaring parents away from having their children immunized, ” warned Society President Robert N. Moyers, MD, a family physician. Also, May’s American Academy of Pediatrics “AAP News” reports that many parents refuse to read the booklets, and many who do “are frightened. ” The distribution of the information specified by the National Childhood

Vaccine Injury Act should be in addition to routine pre-immunization counseling, according to State Society advisors. Physicians should talk to parents and legal guardians about their understanding of the information in the brochures, and should document the patient record that the information was distributed as required.

Dr. Moyers noted that the CDC brochure writers tried to make the

information as readily understandable as possible, and the information on what to look for in shot reactions and certain risk factors may be useful to some parents. But he emphasized the importance of physician communication when administering vaccinations.

SUPPLEMENT

WHAT YOU NEED TO KNOW ABOUT THE ACELLULAR PERTUSSIS VACCINE

After the 1991 pamphlet Diphtheria, Tetanus, and Pertussis: What You Need to Know was prepared, a new pertussis vaccine became available for the fourth and fifth shots against diphtheria, tetanus, and pertussis. This sheet provides up-to-date information about the new vaccine. You should read this sheet after you have read the pamphlet.

WHAT IS THE NEW VACCINE?

DTP vaccine is usually given 5 times before a child reaches age 7 years. Until now, pertussis vaccine nas been made from killed whole pertussis cells and mixed with diphtheria and tetanus vaccines to make the whole-cell DTP shot. The new acellular pertussis vaccine, DTaP, is made of only a few parts of the pertussis cell and is also combined with diphtheria and tetanus vaccines.

WHEN SHOULD IT BE USED?

The fourth and fifth shots of the DTP vaccine series are usually given to children 15-18 months old and 4-6 years old. The DTaP vaccine can be used only for the fourth and fifth shots. Testing is now in progress to show that DTaP is safe and effective for the first three doses. Until these studies are completed, this vaccine cannot be considered for use for the first three doses of the vaccine series. Whole-cell DTP vaccine should still always be used for the first three shots, and can still be used for the fourth and fifth DTP shots, although most experts will prefer to use DTaP vaccine. Compared with the DTP vaccine, after DTaP shots fewer children will be cranky or drowsy, have fever, or have soreness or swelling where the shot was given. Convulsions that occur after receiving DTP vaccine are usually caused by fever. With DTaP, there is less chance of fever, so convulsions probably occur less often. Experts do not know whether unusual, more serious problems which have been reported after DTP vaccine (mentioned in the pamphlet) happen less often after DTaP shots than after DTP shots.

WHEN SHOULD THE VACCINE NOT BE GIVEN?

If the health care provider determines that a whole-cell DTP should not be given, DTaP also should not be given. In that case, the child should usually get DT vaccine instead.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control Atlanta, Georgia 30333

DTaP 3/25/92

10

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Medical Ethics and Maternal-Fetal

Conflicts

James F. Drone, PhD

“The impact of maternal behavior dangerous to the fetus is only beginning to be understood . ”

Dr. Drane was Russell B. Roth professor of medical ethics at Edinboro University of Pennsylvania. He retired in December 1991.

As ethical issues are raised by more and more aspects of medical practice, medical ethics becomes an ever more complex and confusing enterprise, presenting yet anoth- er phvsician dilemma. This article offers guidelines for individual physicians and hospital ethics committees in dealing with medical ethics and maternal-fetal conflicts.

o most lay persons, the term "medical ethics” suggests that there is one right (ethical) answer to every question which experts in the field can provide. However, many different answers are pro- posed to all the important questions, and experts prefer to outline options rather than presume to give answers.

Despite an absence of unanimity about answers to particular problems, there are areas in modern medical ethics in which broad agreement exists. One can speak of a main-line, medical ethics agreement on death and dying issues, as opposed to a re- fractory and troublesome division on questions related to the beginning of life. The abortion controversy, for example, drags on in the courts, the legislature, the hospitals, and even in the streets. On one side of the dividing line, answers are based on women’s freedom and privacy rights; the other side decides right and wrong based on the principles of sanctity and right to life.

Understanding the conflict

Abortion for some is a paradigm example of maternal-fetal conflict, and new medi- cal technologies are expanding this con- flict. area. Even when pregnant women de- cide not to abort, but to carry a pregnancy to term, conflict possibilities between them and their fetuses emerge with every new technology. Sonograms, amniocen- tesis, chorion villus sampling, fetal thera- pies, and even fetal surgeries all raise the possibility of disagreement between what a woman might want for herself and what doctors believe to be best for her develop-

ing life. The fetus has become “a patient” as a result of technological advances, and this change of language and status sets up conflict possibilities with the maternal pa- tient. Potential areas of conflict have also been expanded by changes in the lifestyles of many women. Most pregnant women go to great lengths to do everything beneficial for their babies. Not only do they abstain from legal and illegal drugs, but they even submit to painful procedures if the fetus will benefit. Recently, however, this tradi- tional, moral characteristic of western so- ciety has weakened.

Thirty-seven thousand babies are bom each year in the U.S to mothers who have used illegal drugs. In a Florida county (Pinellas), 3.4 percent of pregnant women used cocaine during pregnancy. Further- more, alcohol use by mothers causes ab- normalities and growth retardation in one of every 1 ,000 U.S. births, and fetal al- cohol syndrome now is the leading cause of mental retardation. Also, 1.5 percent of New York City newborns are HIV posi- tive, usually because their mothers en- gaged in high-risk behaviors.

The impact of maternal behavior dan- gerous to the fetus is only beginning to be understood. Sometimes a fetus survives the worst uterine environment with only limited damage. But as the number of severely handicapped babies mounts, the ethical issues associated with the begin- ning of life force themselves into the pub- lic and professional consciousness.

In American culture, the individual’s right to make personal life choices is a ba- sic one. Applied to the medical setting, this translates into a right to consent or refuse consent to treatment, and even a right to accept or to ignore medical advice. Once pregnant, however, the exercise of these typical American rights affects another human being: a child-to-be. Freely making one’s own decisions, without interference from state or medical authorities, sudden ly may mean endangering a fetus’s life. The rights of pregnant women cart quick- ly become pitted against the interests, if not the rights, of their fetuses.

12

PENNSYLVANIA MEDICINE

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□

“Can the fetus , too , be considered a patient toward whom the doctor has professional obligations?”

Resolving the conflict

The resolution of ethical dilemmas in- volving rights conflicts can be handled by the courts, but few believe that courts are the proper place for such problems. They can also be addressed by hospital ethics committees, which attempt to provide help while keeping the decision making within the doctor-patient relationship. In any case, either judges or hospital com- mittees, including doctors, patients, and other medical professionals, will be ad- dressing medical ethics with their preg- nant patients — engaging in applied phi- losophy for which they may be well prepared, but not necessarily so. Profes- sional medical associations are more and more frequently trying to provide ethical guidelines to prevent the worst ethical er- rors. And, of course, the American courts have developed their own corpus of liter- ature on medical ethics.

The court in Roe v. Wade left open the possibility of government exercising some degree of control over a pregnant woman’s behavior. Since that case, however, the ar- eas of potential maternal-fetal conflict have expanded, and older Supreme Court ethics are hardly adequate to address the many new situations in which a mother’s behavior can be harmful to the life she car- ries. The medical ethics provided by law in effect are deficient, and other sources must be found to develop defensible ethical guidelines and policies.

The new conflict areas can seriously af- fect the doctor-patient relationship. Tra- ditional medical codes were developed under different situations and either do not fit or provide little guidance for these new problems. According to tradition, the mother is the physician’s patient and he owes her care, support, and confidential- ity. But what do doctors do when medical care and direction are ignored? Can the fetus, too, be considered a patient toward whom the doctor has professional obliga- tions? What is the extent of physician re- sponsibility toward a fetus in situations involving harmful maternal behavior or a maternal medical decision which harms or creates risk for the fetus?

The American Academy of Pediatrics (AAP) Committee on Bioethics has pro- vided general ethical directives for physi- cians facing these problems. In general, AAP advises respect for the American principle of individual autonomy, so that when a procedure beneficial to the fetus is opposed by the mother, the physician should honor the mother’s refusal, even if the fetus will be harmed as a result.

Only in the following situations, accord- ing to AAP, may a physician consider chal- lenging a woman’s decision out of concern for benefit to her fetus: 1 ) when the fetus will suffer irrevocable harm without the treatment; 2) when the treatment is clear- ly indicated and likely to be effective; and 3 ) when the risk to the woman is low. 1 If all three conditions are present and the moth- er refuses, then the academy advises con- sultation with a hospital ethics committee. Turning to the courts is not recommended, except as a last resort; physicians are en- couraged to handle medical ethical dilem- mas within the clinical setting rather than turning clinical problems over to lawyers for solution.

The American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics provides similar ethical directives for situations in which the mother’s lifestyle or refusal of diagnostic/therapeu- tic procedures endangers her fetus. ACOG advocates education of the mother to fol- low doctor’s orders but condemns the use of coercion because of its bad effect on the doctor-patient relationship. Like their pe- diatrician colleagues, when education doesn’t work, ACOG suggests turning to a hospital ethics committee and avoiding the courts.

Developing ethical directives

Virtually everyone agrees that medical practice and hospital policy should not be dictated by the courts. The reason is clear: the culture of law is different from the cul- ture of medicine, and physicians are much better off developing ethical directives that reflect the culture and ethics of medicine. Defensible medical ethics has to be ade- quate to clinical realities; court-dictated ethics rarely seem to be so. Besides, courts have provided very conflicting signals on cases of maternal-fetal conflict. Some courts have sentenced women to jail for be- havior harmful to fetuses,2 while others have overturned the use of legal force against maternal decisions thought to be threatening to fetal life.

Most famous among cases involving conflicts of interest between pregnant women and their fetuses is the Angela Carter case. Twenty-six-and-a-half weeks pregnant, she entered the hospital dying of metastatic cancer. She had to be so heavily sedated that her competency was severely compromised. Never was she able to carry on a reasoned discussion about her situation or that of her fetus. First she seemed to want to do what she could to improve the baby’s chances, then

14

PENNSYLVANIA MEDICINE

she seemed less clearly committed. Her mother had no such ambivalence — she did not want the baby.

Doctors, as often happens, were caught in the middle and decided to inform ad- ministrators about what was happening. The administrators, in turn, asked the court for a declaratory judgement. Judge Sullivan found it was “not clear what her intent was” and ordered a caesarean sec- tion performed. The baby lived only a few hours, and the mother died two days lat- er. The ACLU entered at this point, and an appeal was initiated. In a sharply worded reversal of the trial court decision, the District of Columbia Court of Appeals ruled that “in virtually all cases the ques- tion of what is to be done is to be decided by the Patient — the pregnant woman — on behalf of herself and her fetus.”3 Subse- quently, the family sued George Washing- ton Medical Center for malpractice and civil rights violations.

In November 1990 the family and hos- pital settled out-of-court. The family ac- cepted an undisclosed payment and an agreement to adopt a policy written by the hospital ethics committee which requires difficult decisions involving severely ill pregnant women and their fetuses to be made by each woman, her family, and her doctors, and not by the courts.

The George Washington Medical Center Ethics Committee policy is comprehensive and can serve as a guide for other hospi- tals. Its objective is to keep difficult deci- sions within the doctor-patient-family re- lationship. Ordinarily, consultation with the ethics committee is optional, but this policy requires that the ethics committee be consulted if a woman’s preference is be- ing overridden or before any court actions are initiated. The hospital policy reflects the need to balance the interests of the pregnant woman and the fetus. Process is important to guarantee that everyone in- volved understands the issues. If a mater- nal-fetal conflict cannot be resolved by committee involvement, either the patient may leave the hospital, or the hospital may withdraw from the case. According to the policy, a patient advocate will also be made available to help patients and their surro- gates clarify complex issues and under- stand where help is available.

Consulting hospital ethics committees

The hospital ethics committee, of course, is always available for advice. In many court cases, hospital policies, and ethical statements by professional organizations, the hospital ethics committee is recom-

mended as the first resource when conflict develops. But where does an ethics com- mittee’s expertise come from? What are the ethics of the hospital ethics committee, especially in disputed areas where the whole society, including the hospital com- munity, is split?

A hospital ethics committee can provide help in conflict resolution, but only if it is well-trained and has worked to develop policy guidelines which reflect basic ethi- cal principles and the mission statement of the hospital. As things now stand, one hos- pital ethics committee may provide advice and develop policies different from those of a neighboring institution.

Most everyone agrees that it is not good for medicine or society that life and death decisions depend upon where a patient happens to be treated. A hospital ethics committee then cannot simply apply either a pro-life or a pro-choice perspective. Solv- ing problems created by a conflict between two interests or principles by opting for one over the other is sometimes inevitable and often-times appropriate at the person- al level. But a hospital ethics committee, even in its case consultations, enters the area of policy; and policy involves a bal- ancing of interests and principles, rather than simply choosing one over the other.

Different hospital committees may pro- vide different advice on similar cases, but basic directives and committee methodol- ogy for coming to conclusions should be somewhat uniform. And every committee should try to balance legitimate interests in conflict situations. The life of the fetus and the freedom of the mother must both be taken into account, and the same is true of society’s interests.

Balancing interests

Medical professionals have interests too, as do health care institutions, that also need balancing. Institutional policy will be influenced by a particular committee’s make-up and the hospital mission/philos- ophy, but committees which stamp out ethical judgements from a single ethical perspective are likely to be a waste of time. Given the importance of balance, it is not advisable, even in Catholic institu- tions, to discount a woman’s competent decision. In practice, ignoring women's interests makes very bad hospital policy, both ethically and legally. Reasonable and defensible policy must take the law into consideration without having ethics dic- tated by law or collapsed into law.

Pennsylvania’s recently passed living will law (Senate Bill 3, now Act 24) pro-

JULY 1992

15

YOCON*

YOHIMBINE HCI

motes and defends individual patient de- cision making, and requires respect for patient decisions to refuse life-sustaining treatments in terminal and comatose sit- uations. But an exception is made in the case of a pregnant woman. Life-sustaining treatments, including nutrition and hydra- tion, must be provided even against a preg- nant woman’s wishes, as expressed in a liv- ing will, unless the interventions will not contribute to a live birth or will cause harm and pain to the pregnant woman.

Even with such a law in place, an ethics committee has to carry out careful as- sessments of medical facts and patient in- terests including the fetal patient before providing advice and mediation. Howev- er, many hospitals have no committee trained to do this delicate work and have no guiding policies for conflict situations.

What is an individual physician prac- ticing in a particular hospital to do when society is so split and the hospital has no policy? Prudential counsel would suggest the following:

• Discuss your own professional values or ethical beliefs with patients whom you think might be involved in behavior harmful to their fetuses.

• Be careful about overreacting when patients do not follow orders — it could signal a personal hang-up.

• Be very clear (e.g., draw pictures) about the effects of harmful behaviors on mother and fetus.

• Evaluate the patient’s competence, and make a note of this in her file.

• Recognize that in this culture, patient autonomy — in situations involving op- tions and/or conflicts of goods — is a firm- ly established value which must play a role in ethical decision making.

References

1. American Academy of Pediatrics Committee on Bioethics: Fetal therapy: ethical considerations. Peds 81(6):898-899, 1988.

2. Florida, Seminole County, Circuit Court, Crim- inal Division. Florida v. Johnson (Case no. E-89-890- CFA), July 13, 1989.

3. In re A.C. 573 A. 2d 1235; D.C. Court of Appeals, 1990.

Description: Yohimbine is a 3a-15a-20B-17a-hydroxy Yohimbine-16a-car- boxylic acid methyl ester. The alkaloid is found in Rubaceae and related trees. Also in Rauwolfia Serpentina (L) Benth. Yohimbine is an indolalkylamine alkaloid with chemical similarity to reserpine. it is a crystalline powder, odorless. Each compressed tablet contains (1/12 gr.) 5.4 mg of Yohimbine Hydrochloride.

Action: Yohimbine blocks presynaptic alpha-2 adrenergic receptors. Its action on peripheral blood vessels resembles that of reserpine, though it is weaker and of short duration. Yohimbine’s peripheral autonomic nervous system effect is to increase parasympathetic (cholinergic) and decrease sympathetic (adrenergic) activity. It is to be noted that in male sexual performance, erection is linked to cholinergic activity and to alpha-2 ad- renergic blockade which may theoretically result in increased penile inflow, decreased penile outflow or both.

Yohimbine exerts a stimulating action on the mood and may increase anxiety. Such actions have not been adequately studied or related to dosage although they appear to require high doses of the drug . Yohimbine has a mild anti-diuretic action, probably via stimulation of hypothalmic centers and release of posterior pituitary hormone.

Reportedly, Yohimbine exerts no significant influence on cardiac stimula- tion and other effects mediated by B-adrenergic receptors, its effect on blood pressure, if any, would be to lower it; however no adequate studies are at hand to quantitate this effect in terms of Yohimbine dosage.

Indications: Yocon ■ is indicated as a sympathicolytlc and mydriatric. It may have activity as an aphrodisiac.

Contraindications: Renal diseases, and patient s sensitive to the drug. In view of the limited and inadequate information at hand, no precise tabulation can be offered of additional contraindications.

Warning: Generally, this drug is not proposed for use in females and certainly must not be used during pregnancy. Neither is this drug proposed for use in pediatric, geriatric or cardio-renal patients with gastric or duodenal ulcer history. Nor should it be used in conjunction with mood-modifying drugs such as antidepressants, or in psychiatric patients in general.

Adverse Reactions: Yohimbine readily penetrates the (CNS) and produces a complex pattern of responses in lower doses than required to produce periph- eral a-adrenergic blockade. These include, anti-diuresis, a general picture of central excitation including elevation of blood pressure and heart rate, in- creased motor activity, irritability and tremor. Sweating, nausea and vomiting are common after parenteral administration of the drug.12 Also dizziness, headache, skin flushing reported when used orally.1-3 Dosage and Administration: Experimental dosage reported in treatment of erectile impotence. 1 -3,4 i tablet (5.4 mg) 3 times a day, to adult males taken orally. Occasional side effects reported with this dosage are nausea, dizziness or nervousness. In the event of side effects dosage to be reduced to % tablet 3 times a day, followed by gradual increases to 1 tablet 3 times a day. Reported therapy not more than 10 weeks.3 How Supplied: Oral tablets of Yocon* 1/12 gr. 5.4 mg in

AVAILABLE AT PHARMACIES NATIONWIDE

bottles of 100's NDC 53159-001-01 and 1000's NDC 53159-001-10.

References:

1. A. Morales et al.. New England Journal of Medi- cine: 1221 . November 12, 1981 .

2. Goodman, Gilman — The Pharmacological basis of Therapeutics 6th ed., p 176-188.

McMillan December Rev. 1/85.

3. Weekly Urological Clinical letter, 27:2, July 4,

1983.

4. A. Morales etal., The Journal of Urology 128:

45-47, 1982.

Rev. 1/85

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PENNSYLVANIA MEDICINE

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Legislative P rofileM

Health Views from the House

Maria T. Montesano Assistant Managing Editor

Representative Taylor is a Re- publican representing Pennsyl- vania's 1 56th District, Chester County. She is currently serving her eighth term in the House, and is minority chairman of the Health and Welfare Committee and a member of the Education Committee.

This interview was conducted by Miss Montesano, in cooperation with the State Society’s Department of Governmental Affairs Division of Legislative Affairs, Larry L. Light, director.

In this final of three conversations with members of Pennsylvania's legislature, Representative Elinor Z. Taylor talks about living wills, cost containment, health care access, and physician involvement in the political process.

Question: As Republican chairman of the House Health and Welfare Committee, you were involved in passage of the living will bill. What were your thoughts are on that bill?

Representative Taylor: The bill was ex- tremely important to senior citizens. They had been looking to the legislature for some assurance, some control during the death process, so that it could occur with dignity. Certainly, we in the House had fooled around with this for a long time, but I can’t tell you how pleased I am to see that Pennsylvania does have a living will law.

I had an amendment added to the leg- islation for protection of the emergency medical community. Emergency medical personnel are committed to keeping a person alive. That’s what their certifica- tion requires them to do. So, my portion of the bill says that if you have a living will, you should register it with the local emergency medical service. That way, if you require an ambulance in the last hours, the emergency personnel could be directed not to keep life going, but to hon- or the person’s will.

Question: But overall, you were pleased with the passage?

Representative Taylor: Yes, I was.

Question: I remember seeing you quoted in the newspaper as saying, “This has been held up for quite some time now — let's get it moving. ”

Representative Taylor: Yes, I did. I said that, and if you recall, that was when there was a controversy between the Sen- ate and the House. You can’t let pride of authorship interfere with a piece of legis- lation that is this important.

Question: Moving on, what is your re- sponse to this statement: Medical liability reform must be included in any health care cost containment reform.

Representative Taylor: Well, if we are going to really look at health care costs, we are going to have to put in some lia- bility reform. For example, we would have to limit awards for payments. Also, we would have to set a definition for mal- practice and require the plaintiff to prove incompetence, malfesion, unethical be- havior on the part of the doctor, rather than require the doctor to prove that what was done was correct.

It would appear to me that a portion of the "Greenwood proposal” [the Health Reform Act of 1992] is a limiting of physi- cian liability by having patients consent in writing to major invasive procedures. When a patient agrees to a procedure, it would be presumed that the doctor is act- ing in accordance with accepted medical practice. And one step further, that medi- cal treatment could not be conditioned on a patient who would refuse to sign an agreement. Those are two elements that have to be in any health care cost con- tainment that we hope to have.

Question: Speaking about cost contain- ment, do you think the Certificate of Need (CON) process has been a viable means to control health care costs and expansion?

Representative Taylor: I’m not sure what the answer to that is. In 1979 we passed Act 48, which is the Health Care Facilities Act. In 1980 I think health care costs — if we’re going to tie CON to them — were about eight percent of the gross na- tional product. That has risen today to 14 percent. And with some economic predic- tions that I saw, it will rise again — to 20 percent — by the year 2000. ..I don’t know whether it’s working or not. I think that the idea could work. ..that probably it hasn't worked because of some medical ramifications, not necessarily at the state level, but at the local level.

The health care industry itself has not shown noticeable restraint in capital ex-

18

PENNSYLVANIA MEDICINE

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pansion and the management of services. For example, within a 30 mile radius of Harrisburg, we have six open-heart surgery units. If CON were working, pos- sibly that wouldn’t be true. But I will also say that CON cannot be solely responsible without the involvement of other issues, such as liability, if we are going to be suc- cessful in containing health care costs.

Question: You introduced legislation for rural and family physician incentives. Could you talk a little about that ?

Representative Taylor: First of all, I in- troduced three bills. House Bill 729 — in- troduced early in the session — would have set up an opportunity for health demonstration projects throughout the Commonwealth for primary care, inpa- tient health care, managed care, and a Medical Assistance buy-in. That bill was voted out of the Insurance Committee early in 1991, came to the floor of the House, and is now in Appropriations be- cause it had a fiscal note of $4 million — $ 1 million for each project, the idea being, let’s see how a pilot project might work.

I also introduced House Bill 530, which addressed the key barrier to rural health care: access. We simply don’t have enough physicians, especially family physicians, to serve rural areas. The bill addressed the problem by trying to attract new physicians, awarding $100,000 to the medical school with the most innovative project to increase the number of family practitioners. Also, that bill would have provided loans to graduates of Pennsylva- nia’s medical schools in the amount of $30,000 per year for each year of practice in a medically underserved area.

House Bill 530 was prepared as an amendment to House Bill 2594 [the Rural and Inner-City Health Care Bill] which was moved from the committee in April. House Bill 529, which was the companion bill, would have awarded scholarships to students in state medical schools. In ex- change, students would serve one year in a rural area, and student loans would be repaid at the rate of $25,000 per year. Oth- er bills are also being reviewed in com- mittee.

Question: What do you think is the most significant medical issue facing Pennsylva- nians today?

Representative Taylor: The number one problem is really two-fold: how do people access health care, and how do we pay for it?

We live in a society which considers it- self civilized; yet, it doesn’t take care of the

weakest — the young and the elderly... Ev- erybody would like to see health care spread so everyone has equal access, but health care is expensive. You only have to spend a few days in a hospital to know how expensive it is. I think to control it, we need to concentrate on a wellness pro- gram, to concentrate on immunization. It is less costly to work in those areas.

Also, if you were to ask me what else would guide my thinking in the area of health care cost containment, I would stress — and I am stressing to the [House Health and Welfare] committee — quality. You can have access, you can have af- fordability, and then you can have poor quality of medical care. I believe we have quality health care. The question is: How can we spread that quality so everyone can access and afford the program?

Question: Speaking of the House Health and Welfare Committee, in what direction would you like to go in addressing those is- sues? You talked a little bit about wellness and immunization — what other ideas do you have?

Representative Taylor: The committee doesn’t have the privilege of beginning with a blank page and saying, “This is what the committee would like to offer in the field of health care costs.” We can only look at what has been introduced: we can look at Tom Gannon’s bill that creates af- fordable insurance for small business, and we looked at Bill DeWeese’s bill that spoke to immunization.

The one thing that I haven’t talked about is that the committee is looking very, very carefully at the issue of long- term care. While we have been bragging about our quality of health care in the United States, we have enabled people to live longer. And when people live longer, we get into [increased demands on] health care. The committee at present is looking at what is out there, and attempt- ing to take the very best pieces of legisla- tion and umbrella them into a package.

Question: What is your view on how physicians can best get involved in the po- litical process?

Representative Taylor: While I don’t think it’s their primary responsibility, I suppose there is more doctors can do to be involved.. .To tell you the truth, I don’t want my surgeon to be running around to political meetings. However, I do want him to have an avenue to express himself and to have input, and I want him to make sure he advises me about the problems that are out there.

20

PENNSYLVANIA MEDICINE

OVERNMENT

FUNDS CUT IN BUDGET,

GA PACKAGE OFFERED

The governor’s proposed budget annually affects the medical community in a number of ways through financial activity in the state's medical and health care programs. With the 1992-93 budget, physicians’ and medical students’ eyes are focused on proposed cuts to medical school funding and the introduction of a general assistance (GA) basic benefits package.

Medical school funding

Available funding for non-state- related medical schools in 1991-92 totaled $135 million. For 1992-93 the governor’s original budget cut all such funding and proposed a 3.5 percent cut for state-related universities for the remainder of 1991 -92 and an additional 3.5 percent for 1992-93. Funding proposed for state-related schools for 1992-93 totals $531 million, with $23.6 million slated for medical programs.

Senate Republicans in early June passed an amended House budget bill which calls for a 1 .2 percent increase in overall spending for the state, but $25 million less that the governor’s original proposal. Included in the amended proposal is funding for all Pennsylvania medical schools.

For state-related schools, Senate Republicans agreed with the governor’s 3.5 percent cut over what was approved for 1992-93. They did not, however, agree to the second proposed 3.5 percent cut in the 1991- 92 fiscal year. For non-state-related schools, Senate Republicans approved funding at 90 percent of the 1991-92 budget plan. Movement on the issue by House Democrats had not occurred as of this printing.

GA basic benefits package

The Pennsylvania Medical Society, at the request of the Pennsylvania Department of Public Welfare (DPW), has commented on DPW’s basic health care package for general assistance recipients. The package was proposed as part of the 1 992-93 budget.

Intended to save more than $50 million for Pennsylvania, the package includes a range of covered services, such as hospital care, physician and clinic services, select medications, medical rehabilitation hospital care, day surgery, emergency care, drug

and alcohol care, psychiatric care, laboratory and x-ray services, medical supplies, limited home health and hospice care, ambulatory services, and an HMO/HIO option.

Though implementation of the program was expected by July 1 , in mid-June the department was still accepting comments and readjusting the plan, and could not pinpoint in what range actual savings would fall.

SUPPORT SOUGHT FOR LIABILITY REFORM BILL

A State Society proposal which would amend the state’s medical malpractice act and addresses a series of underlying liability reform issues has been shared with potential sponsors in both the Senate and House. The Society maintains medical liability reform as a high priority.

Included in the proposal are both technical corrections and broader modifications of current law. Proposed amendments redefine informed consent, eliminate duplicative payments for the same injury, limit punitive damages in some instances, provide for installment or periodic payments for “future damage” awards of more than $200,000, and provide for arbitration agreements between patients and providers. Other provisions address statutes of limitations, “expert" witness qualifications, frivolous lawsuits, expansion of coverage, and risk management.

About 25 states already limit malpractice awards, and more than 30 have been trying to implement reforms since 1986, according to the Risk Management Foundation of the Harvard Medical Institutions, Inc. In Pennsylvania, two other related bills are in the works. The first, to be introduced by Representative Leo Trich (D-Washington), addresses parameters like those adopted in Maine. The second, Senate Bill 1728 introduced by Senator James Greenwood (R-Bucks), addresses health care cost containment and devotes a full section to medical liability reform. Several of the Society’s provisions are addressed in Senator Greenwood’s bill.

The Society is examining Senator Greenwood's and Representative's Trich's proposals, and following leads on other possible ties to proposed legislation. Additionally,

the Society will continue to seek support for its proposal.

PHC4 POSTPONES REPORT RELEASE

Because of the many issues raised in comments to the Pennsylvania Health Care Cost Containment Council’s (PHC4’s) proposed research plan for the 1990 Hospital and Physician Report for Coronary Artery Bypass Graft Surgery, the release of the report will be delayed until fall.

In the interim, the newly constituted PHC4 Technical Advisory Group and MediQual are reviewing the plan and comments. Recommendations are due back to PHC4 for review and action this month.

Current plans indicate that the report draff will be circulated to involved hospitals, physician groups, and physicians for review and comment in September. The release of the final report to the public may be in October. A number of significant concerns about the report — raised by the State Society’s Task Force on Health Care Cost Containment and the Joint Committee on Health Care Data of the Society, the Pennsylvania Osteopathic Medicine Association, and the Hospital Association of Pennsylvania — remain unresolved at this time.

John A. Malcolm Jr., MD Chairman, Task Force on Health Care Cost Containment Pennsylvania Medical Society

NEW LAW EXPANDS HCFA 1500 USE BY INSURERS

A new law in effect June 2 expands the requirement that the HCFA 1500 form be used by commercial insurance companies. The legislation, formerly Senate Bill 969 and now known as Act 13, was written to ease physician “red tape.”

The idea for the bill developed from a conversation between Joseph M. Clark, MD, a diagnostic radiologist in Lebanon, and state Senator David J. Brightbill (R- Lebanon); their cooperative efforts led to passage. Referring to Dr. Clark, Senator Brightbill said, “This shows that a single individual who recognizes a legitimate problem can have an impact.”

The bill was originally introduced and passed by the Senate last year; it passed the House earlier this year.

JULY 1992

21

EGULATIONS

PennDOT Publishes Amendments To Licensing Regulations

The Pennsylvania Department of Transportation (PennDOT) recently published amendments to regulations with respect to physical and mental criteria relating to the issuance of drivers’ licenses. While the amendments do not alter the current mandate that physicians must report to PennDOT certain conditions which may interfere with a person’s ability to drive, physicians should be familiar with the regulations and the effect that the listed conditions have on the likelihood that an individual will be able to obtain a drivers’ license.

The regulatory standards are divided into three sections: 1) visual standards, 2) seizure disorder standards, and 3) other physical and mental standards. For ease of discussion, each section will be addressed separately in the following analysis.

Visual standards

The PennDOT regulations provide that a person with visual acuity of at least 20/40 may drive without corrective lenses, such as glasses or contact lenses. However, if acuity is less than 20/40 in one eye, the weaker eye must be corrected. The amendments include a waiver from the corrective lenses requirement for those whose combined vision of more than 20/40 would not improve after cotrection of the weaker ( less than 20/40 ) eye, as recommended by a licensed optometrist or opthalmologist.

In general, a person with visual acuity of less than 20/40 must wear corrective lenses. At the far end of the spectrum, a person with visual acuity of less than 20/100 combined corrected acuity may not drive under any circumstances. This standard is an improvement, however, since previous regulations had prohibited driving by those with combined corrected visual acuity of less than 20/70.

Persons who have combined visual acuity of less than 20/40 may drive under certain circumstances. For example, if a person’s acuity cannot be corrected to 20/40, he or she may drive in daylight hours providing that acuity is corrected to at least 20/60,

or that a licensed optometrist or ophthalmologist using equipment to properly measure acuity states that combined corrected acuity is between 20/70 and 20/60.

PennDOT has adopted new criteria for those whose corrected combined vision falls between 20/100 and 20/70. PennDOT may issue a restricted license upon recommendation of a licensed optometrist or ophthalmologist who has proper diagnostic equipment, wider certain circumstances.

The applicant must pass a complete vision examination on an annual basis. Upon application, the person must pass a driving exam. If the restricted license is granted, the person will be prohibited from driving on roads with speed limits greater than 45 miles per hour, will be limited to driving passenger vehicles which weigh less than 10,000 pounds, and may not drive motorcycles. Further, PennDOT may limit the person’s driving to a specific geographic area.

In addition, PennDOT will conduct a review of the person’s accident and driving violation history on an annual basis. PennDOT may revoke the restricted license if the person holding the license is “involved in an at-fault accident” or is convicted of two violations within a one-year period. The regulations do not specifically define what is meant by either an “at-fault accident,” or two violations “within a one-year period.” However, in order to provide for maximum flexibility, it is likely that PennDOT will utilize the concept of a "rolling” 12-month period for its determinations.

Other visual standards require a combined horizontal field of vision of 140 degrees or better, with allowances for "normal blind spots.” Persons with vision in only one eye are required to use mirrors to provide a rear view of at least 200 feet. And finally, the use of “corrective lenses” for acuity purposes does not include the use of telescopic lenses.

Seizure disorder standards

Previously, people who experienced seizures could not drive until they

Susan M. Weber, Esq.

had been seizure-free for one year; those between the ages of 16 and 18 who were applying for their first driver’s license must have been seizure-free for two years. The amendments require a seizure-free period of only six months and make no distinctions between teens and adults. Persons experiencing “auras only" have no driving restrictions under the amendments. An “aura” is defined as “an epileptic seizure which does not cause a change in a person’s ability to think clearly or interfere with the mechanical or sensory ability to operate a motor vehicle.”

The six months’ freedom from seizure requirement may be waived in certain circumstances, based upon recommendation from any licensed physician; previously, only a neurologist or neurosurgeon could make this recommendation. The requirement can be waived providing that seizures occur only noctumally or immediately after awakening; this pattern must be determined over a period of the two preceding years with or without the benefit of medication.

A second situation in which the requirement could be waived involves a "specific prolonged aura accompanied by sufficient warning” established over the preceding two years, with or without the benefit of medication. While “aura” has been defined in the regulations, no time limitations are defined by the terms "prolonged” and "sufficient.”

A third situation in which the requirement could be waived includes those instances in which a person had previously been seizure-free for six months but experienced seizures during prescribed medication dosage alterations or supervised withdrawal from medication. The waiver would be granted only upon return to dosages at which seizures had been controlled.

The seizure-free period could also be waived if a person had previously met the six-month requirement but subsequently experienced seizures as a result of a “nonrecurring transient illness, metabolic imbalance, or nonrecurring trauma.”

A specific section of the regulations addresses the physician’s

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PENNSYLVANIA MEDICINE

responsibility for reporting to PennDOT information about persons who have experienced even a single seizure while under the physician’s care. PennDOT may, pursuant to the physician’s report, require the person to undergo a medical examination.

Other physical/mental standards

The regulatory amendments make significant changes in that they disqualify certain people from driving by administrative fiat, which decision had previously been left to the physician's discretion. For example, the regulations prohibit driving by those with “unstable or brittle diabetes or hypoglycemia” unless they are free from syncopal episodes related to the condition for a six- month period. Similarly, the regulations prohibit driving by those with cerebrovascular insufficiency or cardiovascular disease which has resulted in syncope, loss of consciousness, dizziness, paralysis, or loss of certain visual fields within the previous six months. In addition, the driving ban extends to those who experience episodes of loss of consciousness with unknown etiology or types not listed unless

they have been symptom-free for a period of one year.

The amendments provide for disqualification of drivers based on recommendation from the provider, defined as “a person authorized to diagnose or treat disorders or disabilities covered in this chapter, including but not limited to, licensed physicians, podiatrists, psychologists, and osteopathic physicians.”

In the recommendation, the provider would advise PennDOT that the condition is “likely to impair the ability to control and safely perform motor functions” essential in driving. A laundry list accompanies the description of the recommendation, which includes physical disabilities or conditions such as loss or permanent impairment of a limb or part of a limb, neuromuscular diseases, orthopedic conditions, mental deficiency or mental retardation, or cerebrovascular insufficiency or cardiovascular disease which has, in the previous six months, caused symptoms which would impair driving abilities.

The list also includes mental or emotional disorders, or chronic alcohol abuse or use of drugs which

results in inattentiveness, despondency, aggressiveness, or lack of concern for personal safety or the safety of others. The regulations prohibit reporting, however, with respect to any person participating in a drug or alcohol rehabilitation program which is federally funded.

In addition, PennDOT may require special driver-competency examinations for those who have physical disabilities which inhibit motor control.

Physicians should bear in mind that the PennDOT reporting requirements are not new. They have only been refined by the Medical Advisory Board, which was established in 1976 when Pennsylvania became one of the few states to require physician reporting of driver qualifications. Only about six states currently require this type ol physician reporting.

Editor’s Note: Physicians from the Allegheny County Medical Society (ACMS) were instrumental in having the amendments formulated by the state’s Medical Advisory Board.

Ms. Weber is assistant general counsel for the Pennsylvania Medical Society.

Physiatrist

Allied Services Rehabilitation Hospital is a progressive 98- bed C ARF and JC AHO accredited facility , with a comprehensive offering of rehabilitation disciplines and state-of-the-art equipment Our inpatient and outpatient programs treat an array of neurological and orthopedic diagnoses including spinal cord injury, CVA, amputees, arthritis and pediatrics.

We are seeking a board eligible or board certified physiatrist to further develop our expanding inpatient and outpatient programs. Competitive compensation, excellent benefits and relocation costs offered.

Scranton is situated at the foot of the scenic Pocono Mountain region and offers its residents a variety of educational, cultural and recreational opportunities, a low cost of living and proximity to New York City and Philadelphia. For information, send curriculum vitae to Janet Shinney , assistant directorofhuman resources, or call 717-348-1454 or 800-368- 3910.

Allied

Services

Rehabilitation Hospital

475 Morgan Highway • P.O. Box 1103* Scranton, PA 1 8501 Allied Services is an Equal Opportunity Employer

The First Annual

Dr. J.H. McClelland Distinguished Lecture Series

Carcinoma of the Breast:

Concepts in Prevention, Detection & Treatment

• September 9, 1992 •

The Westin William Penn Hotel Pittsburgh, PA

Sponsored by Shadyside Hospital Department of Surgery and Office of Continuing Medical Education

Shadyside Hospital Is accredited by the Accreditation CouncS for Continuing Medical Education to sponsor continuing medical education for physicians. The Shadyside Hospital Office of Continuing Medical Education designates this program for 6 credit hours In Category I of the Physician's Recognition Award of the American Medical Association.

For more Information, please contact Shadyside Hospital, Office of Continuing Medical Education 5230 Centre Avenue, Pittsburgh, PA 15232, (412) 623-2393.

I

JULY 1992

23

Medical Economics M

Clarifying

Concurrent Care

Dennis L. Olmstead

Proposed AMA Resolution

The Pennsylvania delega- tion to the AMA House of Delegates introduced a concurrent care resolu- tion at the AMA’s annual meeting in June. If adopt- ed as proposed, the reso- lution would direct:

• that the AMA use all appropriate resources to accomplish uniformity among carriers in the ap- plication of concurrent care payment policies in the Medicare program,

• that the AMA use all appropriate resources to allow physicians to be identified by their special- ty as reported to the carri- er rather than an arbitrary definition established by a carrier for the purpose of concurrent care payment policy, and

• that a report of these activities be brought to the AMA House of Dele- gates in December 1992.

Mr. Olmstead is the State Society’s director of medical economics.

Pennsylvania Blue Shield's concurrent care policy for both the Medicare program and its private business is the source of much confusion and exasperation among physi- cians, especially with regard to medical- medical concurrent care. This article seeks to clarify the process for better under- standing by physicians.

Concurrent care is defined by Pennsylvania Blue Shield (PBS) as care provided to an inpatient of a hospital or skilled nursing facility by more than one doctor simultaneously, during a speci- fied period of time. Usually, concurrent care is provided when: 1 ) two or more sep- arate conditions require the services of two or more doctors; or 2) the severity of a single condition requires the services of two or more doctors for proper patient management.

As a first step in Blue Shield’s concur- rent care review process, as with all claims processed by PBS, services must be deemed “medically necessary.” To be considered such, the claim must demon- strate an active symptomatology or evi- dence of the disease, injury, or defect; and the need for services must be document- ed in the patient’s records. If no identifi- able relationship between the reported service and the diagnosis or symptoms is reported, payment will be denied.

Concurrent care claims must then be processed through concurrent care system edits, which screen by diagnosis code(s) and physician specialty. If a claim "fails” the edit process, e.g., the diagnosis code(s) used does not sufficiently support the need for the specialist or sub-specialist, the claim is rejected. Prepayment develop- ment for concurrent care, for the most part, does not exist. In other words, if the claim fails the system edits, PBS rejects it rather than sending a development letter to the provider. Under the Medicare pro- gram, however, prepayment development does occur on non-assigned claims where the denial is based upon medical necessity. PBS policy states that the medical ne-

cessity for concurrent care is based on the patient's condition. It is therefore impor- tant that the claim form contain either the specific ICD-9 diagnosis code(s) that re- flects the nature of the patient’s condition, or the reason the physician is treating the patient. Additional documentation, such as hospital records, may be submitted with the claim to further explain the pa- tient’s condition and justify the medical necessity of the service. The records should also document the primary care physician’s request for the consultant to see the patient and the seriousness of the patient’s condition. The necessity of each physician’s skills will be evaluated based on the ICD-9 code and/or this additional documentation.

Submission of medical records with the claim will delay initial claims processing and payment because the medical records must be reviewed. Ultimately though, if the claim fails the system edits, the sub- mission of medical records with the ini- tial claim filing would expedite payment, since records would eventually have to be sent to Blue Shield to justify the service under the postpayment review process.

Thus, the physician has a decision to make. If he or she believes the ICD-9 di- agnosis code(s) stands on its own to justi- fy the medical care rendered by specialty, the physician may not need to submit the records. If he or she does not believe that the ICD-9 code supports the concurrent medical care provided, the physician may need to send the medical records with the initial claim.

In addition to the diagnosis and/or medical records sent for the patient, PBS reviews physician specialty in determin- ing medical necessity. Similar specialties simultaneously providing medical care may cause the physician’s claim to be re- jected. For example, PBS considers the following specialties the same as or com- parable to “internal medicine” when eval- uating the medical care provided to the patient: cardiology, endocrinology, fami- ly practice, general practice, preventive medicine, pulmonary disease, and

24

PENNSYLVANIA MEDICINE

rheumatology. Blue Shield non-Medicare business also considers pediatrics and pe- diatric cardiology as the same specialty for purposes of concurrent care.

The Health Care Financing Administra- tion (HCFA) has stated that while it is not unusual for concurrent care to be per- formed by physicians in different speciali- ties or sub-specialties, the need for such care would not be considered medically necessary in many cases. HCFA believes that these physicians generally possess the same skills and knowledge necessary to treat the patient. HCFA also acknowl- edges, however, that there are valid cir- cumstances in which a patient may require the services of two “like” physicians, i.e., when one physician has limited his/her practice to some unusual aspect of a spe- cialty.

Payment guidelines

PBS medical policy payment guidelines are established according to the type of concurrent care rendered. The guidelines for medical-medical concurrent care are:

• Under some circumstances, concur- rent care services are not required on a

daily basis for the entire hospitalization.

• The admitting doctor should be re- sponsible for primary care and be paid for medical care, unless the patient is trans- ferred to the consultant.

• Generally, PBS does not pay for the concurrent treatment of: 1 ) two or more separate conditions by physicians of the same specialty, 2) the same condition by physicians of the same speciality; or 3 ) the same condition by physicians not of the same specialty. In each case, Blue Shield’s definition of “specialty" is assumed.

Advice for physicians

To avoid rejection of concurrent care claims and/or a request for additional documentation, physicians should:

• insure that the proper ICD-9 diagno- sis code(s) specific to the degree of sever- ity of the patient’s condition being treat- ed is used when billing;

• insure that PBS has on file the physi- cian’s correct specialty designation; and

• append a “22” unusual services mod- ifier to the procedure code billed, and at- tach hospital records which justify the medical necessity of services being billed.

Typifying Conditions for Which Concurrent Care Services May Be Eligible

The following is a partial listing of conditions identi- fied by Pennsylvania Blue Shield as typifying conditions for which concurrent care services may be eligible: Blood and blood-forming organs; malignancies Anemia (aplastic, Cooleys hemolytic, sickle cell, hy- poplastic); hemophilia; Hodgkins disease; leukemia; lymphoma; multiple myeloma

Integumentary

Bums; scleroderma; erythema gangrenosum

Cardiovascular

Atrial fibrillation; cardiac arrest; cardiac arrhythmias; cardiac surgery; congestive heart failure; cor pulmonale; myocardial infarction; shock; hypertension, severe; thrombosis, acute

Gastrointestinal

Hepatitis; ulcer (gastric, duodenal, enteric); pancreatitis; cirrhosis; inflammatory enteritis, colitis, or enterocolitis

Genito-urinary

Acute renal insufficiency; chronic renal disease; urinary hemorrhage; eclampsia, pre-eclampsia; urinary tract in- fection with septicemia

Acute infectious diseases

Acquired Immune Deficiency Syndrome (AIDS); AIDS- Related Complex (ARC); infectious mononucleosis; tu- berculosis, active; sarcoidosis; septicemia or viremia

Metobolism and endocrine system

Acute anaphylaxis; diabetes mellitus, uncontrolled and/or insulin dependent; adrenal failure; hyper- parathyroidism; heat stroke

Musculoskeletal

Arthritis; myopathies; osteomyelitis; Paget’s disease, com- plicated

Nervous

Drug intoxication; cerebral vascular accident; coma; meningitis; multiple sclerosis; Parkinson’s disease; head injury; encephalitis

Respiratory

Abscess of lung; pneumonia; bronchial asthma (acute); cystic fibrosis; pulmonary edema; respiratory arrest; res- piratory insufficiency and/or failure; chronic obstructive pulmonary lung disease

Miscellaneous injury and poisoning

Compressed air sickness; drowning; electric shock; poi- soning (chemicals, drugs, heavy metals, toxic gases)

Psychiatric

Psychosis, acute

Fora complete listing of conditions, contact the Society's Department of Medical Economics at 1-800-228-7823.

JULY 1992

25

EPICAL ECONOMICS

MEDICARE CONVERSION FACTOR SPLIT FOR 1993

The Department of Health and Human Services (HHS) in late May recommended a two-part Medicare physician payment schedule conversion factor update for 1993. HHS Secretary Louis W. Sullivan, MD, also presented the Medicare Volume Performance Standard (MVPS) for fiscal year 1993, as well as potential program directions for congressional and public consideration.

The two-part update will be applied on a service-specific basis as follows: for surgical services, the recommended update is 2.6 percent; and for non-surgical services, the recommended update is 0.3 percent. The recommendation is based on an update equal to the projected Medicare Economic Index (MEI): 2.2 percent, plus or minus the percentage points by which the MVPS was exceeded or was less than the actual rate of increase for surgical and nonsurgical services for the fiscal year 1991. MVPS figures recommended by HHS were 6 percent for surgical services and 7.9 percent for nonsurgical services.

Modifications being considered for 1994 include:

• a single MVPS and conversion factor update;

• acceleration of the payment schedule transition;

• a separate MVPS for primary care services;

• a restructuring of graduate medical education payment to favor primary care and to non-hospital- based, ambulatory residency training sites; and

• increased emphasis on primary care in Public Health Services programs.

The Americal Medical Association (AMA) has previously argued that multiple conversion factor updates are inconsistent with the resource based relative value scale (RBRVS) and should not have been recommended. Currently, the AMA is reviewing Dr. Sullivan’s full report, and still believes that important elements of RBRVS require correction and refinement.

BLUE SHIELD, SOCIETY ANSWER RBRVS QUESTIONS

A number of general questions regarding Medicare coding, payment

policies, audits, etc., were raised by physicians at the regional resource based relative value scale (RBRVS) seminars sponsored by the State Society. Questions were mailed directly to Medicare via special question forms handed out at the seminars.

What follows is a sampling of questions from those seminars and their corresponding answers, compiled by Pennsylvania Blue Shield Medicare representatives and amended in italics by the Society’s Council on Medical Economics staff. The Society will publish additional questions and answers on Medicare payment reform in the future.

How do I bill for a hospital admission associated with an office visit on the same day?

When the patient is admitted to the hospital in the course of an encounter in the physician’s office, all evaluation and management (E/M) services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed in the other site of service, as well as in the inpatient setting.

Sendees such as diagnostic tests, pathology studies, and radiologic studies — peifonned in any place of sendee — should be reimbursed in addition to the E/M services rendered that day.

If an evaluation (99201-99215, 99241-99273) involves an endoscopic procedure (31250-31375) to complete the evaluation, are both procedures or just one billed? If only one, which? Separate payment will be made for an office visit (99201-99215) and an endoscopy on the same day if a separate, readily identifiable service was provided. If you are providing a service beyond recordkeeping, counseling, prescribing recovery therapy, etc., you may bill an office visit with modifier ‘‘25,” in addition to the endoscopy.

The consultation codes, 99241- 99273, may be billed when you have been asked by another physician to render your expert opinion of the patient’s problem. As the consultant, you must prepare a written report back to the requesting physician. Therefore, a consultation and an endoscopy may also be performed on the same day.

By definition, a histoiy and physical

are recognized as separate and identifiable services. Therefore, a visit comprising a histoiy and physical could be reimbursed in addition to the endoscopy using modifier “25” with the visit code. Additional documentation does not need to be submitted with modifier “25" billings.

Will Medicare pay for the administration of an injection on the same day as an office visit?

Payment for the administration of a therapeutic injection will not be made when the injection is performed in conjunction with an office visit on the same day. Payment will be made for the visit and the cost of the drug. The appropriate level of E/M service should be reported in addition to the appropriate code for the drug. The administration service is considered to be part of the office visit. Injection administration (procedure codes 90782-90784,

90788, and 90799) will be paid when billed independently, i.e., no E/M service is rendered on that day. In this case, one of the administration codes listed above should be billed in conjunction with the appropriate code for the drug.

Payment can be made for visits, the administration of the drug, and the cost of the drug for chemotherapy injections. Payment can also be made for the cost of the drug, the arthrocentesis injection, and a visit on the same day, if the visit was for a separate and identifiable service, such as a histoiy and physical to determine that arthrocentesis was needed.

Can physicians now bill patients for telephone calls made to patients regarding their care or problem since the last office visit?

Although Current Procedural Technology (CPT) has codes for telephone calls, Medicare will not make separate payment for them. Medicare’s policy is that telephone calls are part of the physician work in the visit or service, and the payment for the visit or service encompasses the payment for the telephone call.

How can electrocardiograms (EKGs) be billed when they are interpreted in the hospital by a physician who has not seen the patient?

The Omnibus Budget Reconciliation Act (OBRA) of 1990 precludes separate payment for the

26

PENNSYLVANIA MEDICINE

interpretation of an EKG. Thus, by law, payment may not be made for the interpretation of an EKG that is ordered or performed in conjunction with a visit or consultation. Additional relative value units (RVUs) were added to the visit and consult codes to account for physician work in performing this service. The interpretation of this legislation by the Health Care Financing Administration (HCFA) does not recognize payment for the interpretation of an EKG by a physician who performed the interpretation but did not order the test.

Payment is still permitted for the technical component billings of EKGs, as well as the professional interpretation of specialized EKGs, such as hotter moniters.

If a 99291 is billed on a given day, can you also bill for additional time spent for Swan Ganz catheter insertion, arterial line insertion, or ventilator management?

Critical care (99291) reported on the same day as ventilatory assistance (94656-94662) will be combined and paid at the fee for 99291. The insertion of a swan ganz catheter or an arterial line will also be included in

the critical care code. Critical care codes are intended to include all critical care services, performed during the critical care period, that require the constant attention of the physician.

Procedures which are not directly attendant to critical care management (e.g., setting of fractures, bladder tap) are not included in the critical care code and should be reported separately.

Other sendees which can be billed in addition to critical care include the suturing of lacerations, lumbar punctures, peritoneal lavage, and the reduction of joint dislocations.

The Impaired Professionals Program

1-800-345-7345

(Complete Confidentiality)

HAMPTON

HOSPITAL

P.O. Box 7000, Rancocas Road Rancocas, NJ 08073

JULY 1992

27

Actions of the Board of Trustees , May 13 , 1992

OFFICIAL HEALTH CARE REFORM POLICY ADOPTED

The Board amended and adopted a health care reform policy statement and goals recommended by the State Society’s Committee on Long Range Assessment (see below).

The position statement sets forth broad criteria necessary for any meaningful reform movement, rather than advocating specific proposals. The statement has been designated as policy to be used to respond to media, to evaluate the merits of reform plans advocated by others,

and to develop the Society’s own health care reform proposal.

CERTIFICATE OF NEED POSITION STATED

The State Society’s Board of Trustees, at its May meeting, adopted a position statement on Certificate of Need (CON) recommended by the Hospital Medical Staff Section (HMSS). Pennsylvania’s CON program is scheduled to sunset December 31, 1992; however, a modified CON program is proposed in House Bill 1982.

Past Society policy supported a "free and competitive health care market’’ relative to CON. The HMSS recommendation adopted in May continues to support that position and advocates assurance of quality through appropriate licensure standards.

SOCIETY SEEKING CLAIMS DATA STANDARDS

At the recommendation of the Council on Medical Economics and the direction of its Board, the State Society will seek to have

PENNSYLVANIA MEDICAL SOCIETY HEALTH CARE REFORM POLICY

The goal of the physician is to prevent illness and treat injury or disease in the most skilled and professional manner. The Pennsylvania Medical Society believes physicians must always place the welfare of their patients first, ahead of personal interests.

Our nation has the expertise and technology to provide the finest quality health care in the world, and the strengths of our existing system should be preserved. However, the Pennsylvania Medical Society recognizes that reform is needed to address the imperfections of the health care system — including rising costs and the absence of health insurance coverage for millions of our citizens. Therefore, in the best interest of the public's health, physicians must be committed to reform and to playing an active role in the process.

Goals

Universal access: The Society believes all people should be able to obtain basic health services. To facilitate access to basic health care, financial resources must be made available. At the same time, geographic, social and cultural barriers, and other impediments to health care access must be overcome.

Quality: The Society is committed to the highest possible quality in health care services and supports ongoing efforts to improve health care techniques and technology. The current high standard of quality must be protected throughout the process of reform — cost containment should not sacrifice quality.

Cost containment: Escalating health care costs must be curbed through measures which target the causes. The Society believes health system reforms should reduce administrative burdens on physicians and other providers, attack inefficiencies in the delivery system, address overutilization, and eliminate excessive charges and cost shifting. Reforms should stress the cost savings inherent in prevention and early detection of disease. Most importantly, the health care consumer should be an active participant in the economic decisions affecting health care.

Practice parameters: The Society supports the proper development of practice parameters, which are guidelines to assist physicians in clinical decision making. They provide a means to improve quality and assure appropriate utilization of health care services.

Health insurance reform: The Society believes reforms of the existing health care insurance system are necessary to ensure the availability of basic health care coverage for all people. Shortcomings to be addressed include restrictive eligibility criteria, such as pre-existing condition exclusions; the demise of community rating, which drives up the cost of coverage; and the lack of portability — workers’ inability to take their health care coverage with them when changing jobs.

Public health initiatives: Health system reform is only one component of what is necessary to achieve the major public health goals of our nation. The Society believes it is absolutely vital that efforts be increased to promote healthy lifestyles and positive changes in community attitudes. Physicians must foster a commitment within the community to improving public health education and resolving chronic economic and social problems which lead to violence, substance abuse, and other unhealthy lifestyles.

Tort reform: Billions of dollars are spent each year on "defensive medicine” — tests and procedures conducted to protect medical providers against potential lawsuits. The Society believes an efficient and fair medical liability system should be developed to reduce cost-shifting, help control health care cost inflation, and protect quality.

Basic freedoms: The Society believes that both patients and providers must be assured basic health care freedoms, limited only by the delivery systems they choose: the public must be assured of the right to select their physician and their hospital; physicians and other health care providers must be assured the autonomy to select the location of their practices and their method of reimbursement. Individuals should be free to purchase additional health care services and coverage with their own resources.

Prioritization: Health care services should be ranked, or prioritized, according to some agreed-upon criteria in order to assure the most efficient distribution of resources. This belief comes as recognition that society may be unable or unwilling to expend the resources necessary to provide every available health care sendee. The Society also believes that this process of prioritization should be achieved through consensus of health care consumers, payors, and providers, with the role of physicians being to provide medical information necessary for informed choices. Any subsequent restriction of resources allocated for medical services through rationing should be determined by society as a whole with full understanding of the consequences of the choices made.*

Medical research and education: The Society believes that medical education and research must be promoted and supported to assure continued improvement in quality and efficiency.

* Definitions:

Prioritization — A listing of services according to an agreed- upon set of criteria.

Rationing — Determining which services will be made available.

28

PENNSYLVANIA MEDICINE

Pennsylvania’s Medical Assistance (MA) program use the standard claims data elements used by Medicare.

Most health insurors, including Medicare, Blue Shield, and the majority of commercial carriers, use the HCFA 1500 claim form. However, Pennsylvania’s MA program requires information specific only to the MA program. A unique claim form, the MA319, was developed in the early 1980s, with input from the State Society, to gather this data.

Because the MA319 includes nuances not present in the HCFA 1500, many claims are returned to providers due to incomplete or incorrect information. Returned claim forms are one of many ‘‘hassles’’ associated with participating in MA, according to members. A 22-page “crosswalk” was developed by MA to use in conjunction with the HCFA 1 500 form, but its use is not practical, according to the Society.

BOARD ENDORSES MBNA CREDIT CARD PROGRAM

The Society’s Board of Trustees, at the recommendation of the Council on Medical Practice, endorsed the MBNA America affinity credit card program to be offered as an added member benefit. The program offers one of the

highest credit limits available in the country, access to 24-hour service, and a special business card for professional use.

Credit lines offered by MBNA range from $3,500 to $50,000. Other benefits include travel/accident insurance ranging from $300,000 to $1 million, and lost-luggage reimbursement up to $3,000. The card’s annual fee will be waived in the first year of card ownership. In subsequent years, the annual fee will be waived when card charges exceed specified amounts.

All members will receive a credit card application in the mail by September. For additional information at that time, call the Society’s Department of Practice Services at 1-800-228-7823.

JUDICIAL COUNCIL NOMINATIONS APPROVED

The Board approved four nominations for a one-year term on the Judicial Council to fill the vacancy created by the death of D. Ernest Witt, MD. Nominated are: Henry H. Fetterman, MD, Lehigh County; Donald E. Harrop, MD, Chester County; David L. Miller, MD, Clarion County; and alternate, Joseph N. Demko, MD, Lackawanna County. Dr. Harrop was appointed to the position until the election in October.

Also, the following two additional nominations for the Judicial Council were approved to fill the vacancy created by the expiration of the term of Kenneth L. Cooper, MD,

Lycoming County, in October: Thomas J. Kardish, MD, Bucks County; and Charles A. Lauback Jr., MD, Montour County.

SOCIETY OPPOSING HOUSE BILL 1516

At the recommendation of the Interspecialty Section and bv direction of the Board of Trustees, the State Society will oppose in its current form House Bill 1516, which amends the HMO Act and regulates health maintenance organization (HMO) functions with regard to dnig and alcohol treatment.

The Society expressed concerns that the bill:

• does not allow HMOs to credential qualified physicians to treat drug and alcohol abuse patients,

• includes qualifying criteria to permit individuals certified in "any three-year program or equivalent life experience” to treat drag and alcohol abuse patients, and

• does not include a qualified psychiatrist on the proposed Grievance Committee.

NO IX HI GRIND.

Our occurrence policy has been the industry standard for nearly a century. But some doctors want a claims- made policy. So we have it available. At the Medical Protective Company, we have no ax to grind. You can choose from a variety of programs, both occurrence and claims-made, that offer greater flexibility and savings. The choice is yours. Call us today.

at

Allentown, William Waldron, Robert L. Ignasiak, (215) 395-8888; Pittsburgh, Donald C. Hoffman, R. Grant Stewart, David M Gusic, (412) 531-4226; Camp Hill, Sidney B. Elston, Jr., Paul M. Fischerkeller, (717) 737-9900; Plymouth Meeting, Eugene P Ziemba, William J. Carey, Robert J. Zucosky, James I. Frazer, Jr., (215) 825-6800

JULY 1992

29

SOCIETY CO SPONSORS ANIMAL RESEARCH WORKSHOP

The Pennsylvania Medical Society, along with the AMA and the Pennsylvania Society for Biomedical Research (PSBR), co-sponsored “Medical Progress — A Miracle at Risk,” a one-day workshop in May addressing the importance of animals to medical research. More than 65 physicians, residents, medical students, basic science faculty, lab animal technicians, veterinarians, and researchers attended the workshop, held in Hershey.

Introductory remarks were offered by Jerod M. Loeb, PhD, AMA assistant vice president of science and technology, and Robert N. Moyers, MD, State Society president. Karen A. Gorell, MSW, AMA project manager of the Group on Science and Technology, overviewed the goals of the workshop, which were to encourage practicing physicians to speak out on the issue, and to build grassroots support for the use of animals in research. Dr. Loeb then presented "The Price of Ignorance: Medical Progress vs. Animal Activism.”

Several other national and local leaders also participated in the program. C. McCollister Evarts, MD, senior vice president for health affairs and dean of the College of Medicine at Penn State’s Milton S. Hershey Medical Center, moderated a panel discussion entitled, "What Are We Up Against?” During the discussion, three panelists offered case studies: Richard Van Sluyters, OD, PhD, professor of optometry and chair of the Animal Care and Use Committee at the University of California, Berkeley, offered the targeted researcher perspective;

Steve Carroll, executive director for incurably ill For Animal Research (iiFAR), offered the patient research advocate perspective; and Deborah S. Saline, director of public relations at the Hershey Medical Center, talked about animal activism and the Hershey facility.

In the afternoon, participants learned how to handle "tough questions” about the issue. Craig G. May, senior public information officer for the AMA, and Bruce Dan, senior editor of the Journal of the American Medical Association and anchor of "Medical Rounds” on

American Medical Television, CNBC, discussed how to address emotionally charged topics and presented examples of situations where difficult questions are posed by biased or badgering individuals. Wiley R. McKellar, editorial writer for The Patriot News, Harrisburg, also provided a media perspective of animal-based research in Pennsylvania.

Another panel closed out the afternoon with "Personal Strategies — What Can I Do?” Moderated by Norman Wilkinson, PhD, PSBR executive director, the session included presentations by: Cooper Schenck, grassroots strategist at E. Bruce Harrison Company, Washington, D.C., on how to build an effective grassroots network;

Craig B. Wisman, MD, cardiovascular and thoracic surgeon at the Hershey Medical Center, on educating patients about the role animals play in their medical care; and Ms. Gorell explaining the elements of a resource kit given to each participant to assist them in understanding the issues associated with the use of animals in medical research.

The AMA’s resource kit contains materials for use in outreach activities, including such tools as a backgrounder on the animal "rights” movement, sample speeches with accompanying slides, a 10-minute videotape exploring the issues, sample written materials, and other

Karen A. Gorell, MSW, AMA project manag- er of the Group on Science and Technology, was one of several national and local speak- ers at "Medical Progress — A Miracle at Risk," a workshop, co-sponsored by the State Soci- ety, addressing the importance of animals to medical research.

resources to enable physicians to better inform patients. Also available to participants were a series of brochures from the conference’s sponsoring organizations and the Pennsylvania Department of Health.

FIRST RURAL HEALTH CONFERENCE HELD

The State Society participated in the first annual Pennsylvania Rural Health Conference, sponsored by the Pennsylvania Office of Rural Health (PORH) of The Pennsylvania State University. The conference, held in May in Harrisburg, brought together policymakers, health professionals, and educators to exchange information and ideas about the quality and delivery of rural health care in Pennsylvania.

Acting Secretary of Health Allan Noonan, MD, MPH, presented the keynote address. He listed several rural health priorities, including:

• rebuilding the health professional shortage area (HPSA) designation process;

• coordinating with Pennsylvania’s medical schools to use their graduates in rural areas within the state, rather than exporting them to other states;

• developing school-based health clinics;

• instituting “one-stop shopping” for health care needs;

• improving migrant health services;

• improving data collection;

• educating the rural population on health matters;

• strengthening the state’s ability to assess the impact of toxic waste; and

• re-examining the Emergency Medical System.

The remainder of the conference focused on mental health and technology transfer, and several speakers outlined successful programs and projects at work in the rural areas of Pennsylvania and neighboring states.

The State Society supported this first annual conference through a financial contribution.

Robert J. Lilley, the Society’s assistant director of educational and scientific affairs, contributed to this page.

30

PENNSYLVANIA MEDICINE

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RACTICE MANAGEMENT

Office Overhead: Recognizing Hidden Costs

Physicians are accustomed to turning to traditional strategies to increase their gross income, such as maximizing reimbursement, increasing patient base, and reducing overhead. Of these, reducing overhead often seems to offer the least savings, as a few percentage points here and there would probably have little effect on a practice’s bottom line.

The new Medicare fee schedule has changed that thinking. As reimbursement dollars shrink, two key management issues are moving to the forefront in every practice: cost containment and time efficiency. Regardless of practice size or mix of services, physicians should review expenses line-by-line. In the new reimbursement climate, it is essential to ask if each expense item really contributes to productivity — and those that do not should be trimmed.

A word of caution in undertaking this process: don’t begin by firing or laying off employees unless the practice is clearly overstaffed. Personnel are the most valuable asset, albeit the biggest operating expense. Many practices react to economic pressures by eliminating some of these major expenses, when, in fact, such actions often result in decreased efficiency and in patient dissatisfaction, both of which will have a negative effect on income. Practices should review personnel costs, but should not focus entirely on payroll to save dollars.

The following is a list of cost- saving ideas that have proved helpful to many practices. Some represent big savings; others will have a smaller impact. Physicians should remember, however, that in today’s environment cost efficiency is key. Given that, every dollar helps.

Personnel costs

• Review and rewrite job descriptions, assuring that higher- paid workers are not doing lower-paid work, such as filing, opening mail, and making bank runs.

• Limit the number of RNs on hand at any time, using them only for tasks requiring their training.

• Cross-train staff to fill in for temporary vacancies, vacations, and illnesses, thus avoiding temporary help and “floater” employees.

• Avoid overtime work by keeping office hours on time and staggering staff work schedules.

• Recruit, train, motivate, and supervise effectively to keep turnover — a very costly item — at a minimum.

• Develop pre-printed forms and standard form letters for insurance correspondence, patient recall, and records transfer to minimize secretarial time.

• Move payroll to an "outside” payroll service, thus reducing manager/bookkeeping/accounting time demands.

• In larger practices, develop salary grades to help monitor increases.

• Consider job-sharing positions that use part-time employees to staff full-time hours. Practices can attract good, experienced employees; gain flexibility during vacation time; and save on benefits, depending on the hours worked.

• "Flex-time” can also attract good candidates looking for non-traditional hours and can be a "benefit” to existing employees if used correctly.

Occupancy costs

• If more office space is needed, hire top-notch designers or architects with medical practice expertise to design for maximum efficiency.

• Schedule office hours so each exam room is used for as many sessions as possible, avoiding underutilized days, nights, and weekends.

• Sublet excess office space — especially for days, nights, and weekends — when not in use.

• Negotiate more demanding terms with the landlord, including repainting, carpet replacement, and limited rent escalation clauses.

Supplies

• Negotiate for a year’s requirements of supply items at competitively bid prices, making sure to reopen the process each year.

The Health Care Group

• Avoid "panic ordering” at high prices by having a perpetual inventory system.

• Plan purchases by a yearly budget process, limiting purchases beyond the budgeted level.

• Purchase minor supplies (pens, pencils, paper products, etc.) through mail order houses, typically less expensive for generic items.

• Limit the number of people involved in the purchasing process.

Equipment

• Be critical as to whether maintenance/service contracts are needed for fairly simple items (e.g., a telephone system).

• Avoid wedding one equipment brand or distributor, retaining the ability to negotiate price and terms.

• Evaluate lease vs. purchase options.

Telephone

• Monitor phone bills, especially long distance, to see if all calls are justified.

• Consider alternative long- distance services, but keep reviewing the costs after switching — sometimes promised savings fail to appear.

• Have only the number of phone lines needed, possibly restricting some to incoming calls and dedicating others as “outgoing” lines.

Legal and accounting

• Move routine accounting functions in house, and onto a computer if possible, to reduce the need for the work of independent CPAs.

• Negotiate legal and accounting fees, obtaining advance agreement on fees and time deadlines for specific undertakings.

• Shop around for competent, lower-priced retirement plan administrative services.

Billing and collection

• Shop for computer supplies, pegboard systems, pre-printed fee slips, etc.: a regular vendor may make undue profits.

• Negotiate collection agency fees, possibly switching to a collection

32

PENNSYLVANIA MEDICINE

letter service which doesn’t charge on a percentage basis. Using two agencies often gives a practice a bargaining chip.

• In computerized practices, use electronic claims submission whenever possible in order to turn money around quickly. Investigate “linking” with the hospital admissions office for data retrieval, as well as lab and x-ray data.

Lab fees

• Be critical about using hospital labs. If their charges are higher, hospital lab use reduces the practice profit margin on self-pay and commercial insurance patients.

• Recognize that volume discounts may be available from outside labs.

Fringe benefits

• Drop key-man and buy-out life and disability insurance that should not be needed in properly structured inter-physician practice arrangements.

• Increase the deductible and co- pay elements of health insurance, and shop for changed health insurance (possibly even HMO coverage) every three years.

• Drop group term-life insurance. It’s now an expensive way to provide some coverage for physician-owners.

• Eliminate staff fringe benefits which are not really important to employees. “Cafeteria” plans (which include dependent care plans and medical expense reimbursement plans) and “40 1 (k)” retirement plans may produce savings.

Physician-level "perks"

• Have one person coordinate all ordering of professional books and journal subscriptions, avoiding duplication among group members.

• Choose practice-paid, vacation- oriented professional meetings carefully. Even if tax-deductible, they are still costly.

Miscellaneous items

• Computerize scheduling to better develop scheduling plans and increase efficiency.

• Computerize recall.

• Evaluate the tasks involved in seeing patients, and try to identify which tasks typically performed by physicians can be delegated to other staff members. Be sure physician time is not spent doing tasks someone else could do, such as making phone calls to check on test results.

These are just a few of the overhead costs that a physician may find hiding out in a practice. Reduce the costs, and let the savings boost the practice’s income.

The contributing authors, Patricia M. Salmon and Edward L. Grab, are consultants with The Health Care

Group, a medical practice management consulting firm based in Plymouth Meeting.

Copyright 1992: The Health Care Group

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33

Peer Review ■

Possible Changes in Store for PRO

Program

Donald I. Harrop, MD

“We are hoping for some compromises and more opportunity for

negotiation before all these plans are finalized. ”

Dr. Harrop is president of the Keystone Peer Review Organization.

Some drastic changes in the peer review organization (PRO) program have been proposed by the Health Care Financing Administration in recent months. Some or them are good, but, as we see them, some could cause problems for PROs, hospitals, and physicians.

As this is being written, I know that much of what is now con- sidered as the plan for the fu- ture of the peer review organi- zation (PRO) program will change more than once before this gets published. Nevertheless, I will at- tempt to comment on how I view the prospects for the program in relation to the proposed changes.

Most government programs of this type have a life expectancy of about 10 years. There is no particular reason for this that I’ve ever heard of, but there are historical examples. For instance, the predecessors to the PROs were professional standards review organizations (PSROs). The PSROs were created by law in October 1972, re- ceived their first funding in mid- 1974, and were replaced by the PROs in 1984. The PRO law was part of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982. At that time, the changes from PSRO to PRO were really quite dramatic.

Single-state PROs replaced what were numerous PSROs around the country. There were 28 PSRO areas in California, 17 in New York, and 12 in Pennsylvania. The nature of the organizations also changed from strictly educational to somewhat punitive, and this is believed to have been caused by the Health Care Fi- nancing Administration's (HCFA's) fear that the newly enacted Prospective Pay- ment System using DRGs would allow too much possibility for “gaming the system.”

Here we are, 10 years after enactment of the PRO law, and HCFA is busy propos- ing new directions for what will be the fourth PRO Scope of Work. Their basic premises were fine. They named this new direction the Health Care Quality Im-

provement Initiative (HCQII) and an- nounced that the thrust of the PRO pro- gram will become educational rather than punitive. The intent is to move away from individual case review to a broader review by analysis of patterns and outcomes of care. But, other proposed changes leave much to be desired. For example, last September’s article in this column dis- cussed the Uniform Clinical Data Set (UCDS).

This is the new data-collection and case- finding system which is comprised of a standard set of clinical data elements, based on algorithms that function to pro- vide decisions on which cases should be re- ferred to physicians for review. HCFA has proposed creation of five regional organi- zations called clinical data abstraction cen- ters (CDAC) which would do all of the med- ical record abstraction using the UCDS. Those records requiring physician review would be sent back to the PRO for review.

The number of reasons why we think this system is poorly conceived will not fit in this article. However, here are just a few: it threatens patient, physician, and provider confidentiality since medical records will be mailed all over the coun- try to CDACs which will not necessarily be PROs; because of the time it takes for UCDS abstraction of a record and the cost involved, the sample sizes for review have been drastically reduced which will allow egregious departures from acceptable care to go unnoticed; and the UCDS has not been tested sufficiently to allow for such a sudden and dramatic departure from traditional PRO review.

Although the PRO community is con- cerned about a number of such issues, they are not against change and do sup- port the underlying direction HCFA is at- tempting to take. We are hoping for some compromises and more opportunity for negotiation before all these plans are fi- nalized. It seems as though we have gone full circle since 1972 and are starting around again. We will try to keep you posted as new developments occur.

34

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Graduation Stats Up Five Percent From 1991

For the first time in several years, Pennsylvania’s medical schools graduated a greater number of physicians than in prior years. The total number of men and women who received MD and DO degrees from the state’s eight schools in 1992 is 1,225, a five percent increase from last year’s figure of 1,166.

Estimated percentages of men versus women graduates have remained constant from last year, at 65 percent and 35 percent respectively. The percentage of women graduates varied by school, from a low of 24 percent at the University of Pittsburgh School of Medicine to a high of 49 percent at the Medical College of Pennsylvania.

A number of nationally known leaders spoke at the graduations, which were held between May 16 and June 5, and several honorary degrees and special honors were also presented.

Hahnemann University

Louis W. Sullivan, MD, secretary of the U.S. Department of Health and Human Services, and former Middle East hostage Joseph Cicippio received honorary degrees and spoke at Hahnemann's graduation on May 29 at the Academy of Music, Philadelphia. Dr. Sullivan received a doctorate of science and Cicippio received a doctorate of humane

letters. Hahnemann confered the degree of doctor of medicine on 163 men and women.

Hershey Medical Center

AMA Executive Vice President James S. Todd, MD, presented the address to medical graduates of Penn Slate’s College of Medicine at The Milton S. Hershey Medical Center. The ceremony was held on May 1 7 at Founder’s Hall on the campus of the Milton Hershey School.

Among the college’s 93 graduates were 37 women and 56 men. The number of graduates was up from 1991 by 35 percent; last year, 69 students graduated.

Jefferson Medical College

Michael N. Castle, governor of Delaware, received an honorary degree at Thomas Jefferson University’s 168th commencement exercises on June 5 at the Academy of Music, Philadelphia.

Castle received the honorary doctor of letters degree for his efforts to broaden the delivery of health care services. Also honored with a doctor of science degree was Alfred G. Knudson Jr., MD, PhD, a renowned cancer researcher.

A total of 152 men and 59 women received MDs during the ceremony, an increase from last year’s total of 209 graduates.

Medical College of Pennsylvania

The Medical College of Pennsylvania honored 1 1 1 medical gradutates at its 140th Commencement on May 16 at the Academy of Music, Philadelphia. Oliver Sacks, MD, the neurologist who wrote the book, Awakenings, received an honorary degree. Also honored were Rosemary Anne Stevens, MPH, PhD, dean of the College of Arts and Sciences and professor of history and sociology of science at the University of Pennsylvania, and Gail H. Foster, a longtime member of the college’s National Board and president of the National Foundation for Women’s Health.

Nancy Gary, MD, senior medical advisor to the administrator of the Health Care Financing Administration, was the graduation speaker. Dr. Gary spoke about quality care and health care costs.

Also this year, the college noted the twentieth anniversary of its first male graduates — four of them — in 1972. The class of 1992 had 57 male graduates.

Philadelphia College of Osteopathic Medicine

U.S. Senator Arlen Specter received an honorary doctor of laws degree and delivered the commencement address May 31 during the 101st graduation of the Philadelphia College of Osteopathic Medicine (PCOM), the nation’s largest osteopathic medical college. Also honored as professor emeritus at the exercises — held at the Academy of Music — was Henry A. D’Alonzo, DO, MSc, FACOS, a distinguished surgeon and educator, and a 1 95 1 PCOM graduate.

Of the 1 12 men and 84 women in the class of 1992, 75 percent were Pennsylvania residents, and 25 percent were from nine other states. The graduates represented 1 04 undergraduate colleges and universities, and 15 class members hold advanced degrees.

Temple University

During graduation ceremonies on May 21, Temple University School of Medicine graduated 171 physicians, a 7.5 percent increase from last year’s total of 159. Ceremonies were held at the Academy of Music, Philadelphia. Kenneth R. Curdy, PhD, professor of microbiology and immunology at Temple, presented the commencement address.

MEDICAL SCHOOLS AND "THE OATH"

The original Oath of Hippocrates, set forth in 400 B.C., is no longer in use today in any of Pennsylvania’s eight medical schools. Instead, the schools’ medical graduates recite a “modem” version of the oath, if they recite one at all.

Common sense will tell you what might be offensive in the original version of the oath: references to “my own brothers” and “my own sons” may be considered sexist, and passages relating to not performing abortions bring up moralistic issues.

In order to allow for the changes in the medical community in the past 23 centuries, many of Pennsylvania’s medical schools allow students to vote each year for the version of the oath

they wish to recite. This year, seven of the eight graduating classes recited seven different versions of the "modem” oath, and one class opted not to recite the oath as part of its ceremony.

Among the "modem” versions used were the “Geneva” version written by the World Medical Association in 1948, the osteopathic oath, several versions written throughout the 1980s, and one version formulated by one of the graduating classes of 1992.

For a view of what the Oath of Hippocrates means to one Pennsylvania physician, see page 48.

Maria T. Montesano Assistant Managing Editor

36

PENNSYLVANIA MEDICINE

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University of Pennsylvania

The Irvine Auditorium on the campus of the University of Pennsylvania was the site of commencement exercises on May 17 for the school’s medical graduating class. Of the 148 graduates, 100 were men and 48 were women.

Dr. Bernadine P. Healy, director of the National Institutes of Health, presented the graduation address entitled, "The Path is Made By Walking.” In her comments, Dr. Healy discussed medicine as a healing art.

University of Pittsburgh

The University of Pittsburgh School of Medicine graduated 132 physicians on May 18. Among the graduates were 101 men and 31 women. Henry Bahnson, MD, of Pitt’s Department of Surgery, spoke during the event, held at Carnegie Music Hall, Oakland.

"WOMEN IN MEDICINE" MONTH: SEPTEMBER

The Pennsylvania Medical Society is planning a series of activities in September as part of "Women in Medicine” month, designated by the American Medical Association and the American Hospital Association. Activities will focus on the status of women physicians and medical students, reflect how far women have come since entering the profession in the mid- 1800s, and recognize women’s accomplishments.

Highlighting the Society’s efforts is an exhibit on the history of women in medicine, which includes a series of photographs from years gone by of women at work in the medical field. The exhibit will include informational publications for public interest and will travel around the state.

The Society is developing special recruitment materials and a fact sheet for physicians to copy and distribute in their offices. Also a proclamation will be requested from the governor. Watch for materials and information about September’s activities in July and August. For additional information, call the Society’s Department of Public Affairs at 1-800-228-7823.

Editor’s note: Pennsylvania Medicine is planning to include related articles in its September issue. The editors would like to hear from women

physicians and students about what it is like to be female in the field of medicine. The magazine offers a number of departments in which to include comments. The copy deadline for the September issue is August 1; all submissions are welcomed.

County News

PHILADELPHIA COUNTY PRESIDENT ELECTED

Richard M. Gash, MD, has been elected to succeed Donald Kaye, MD, as president of the Philadelphia County Medical Society (PCMS) for a one-year term. Dr. Gash is medical director of the Police and Fire Medical Association of Philadelphia,

clinical assistant professor of surgery at Temple University School of Medicine, and maintains a consultative practice in general surgery.

A graduate of the University of Pittsburgh School of Medicine, Dr. Gash served as a captain in the U.S. Army Medical Corps. Following his residency, he was an active attending in surgery at Albert Einstein Medical Center in Philadelphia, Rolling Hill Hospital in Elkins Park, and Uawndale Community Hospital in Philadelphia. He has been involved in organized medicine on a county and state level throughout his career, including as a delegate from Philadelphia County to the State Society since 1974. Dr. Gash is secretary of the Keystone Peer Review Organization, where he holds a number of other positions, and he serves on the board of the Florida Peer Review Organization.

Succeeding Dr. Gash as president elect is William S. Frankl, MD. The following have been elected to other PCMS offices: Thomas G. Garbuzda, MD, vice president; Ronald J.

Carlucci, MD, secretary; and James L. Cristol, MD, treasurer.

LCMS OFFERS SECOND MINI-INTERNSHIP

Six community leaders participated in the second Lackawanna County Medical Society (LCMS) Mini-

Dr. Gash

Internship Program, May 14-15, 1992. Among the participants was Senator Robert Mellow, who said, "The knowledge and insight gained from my experience is something that will benefit me in my legislative duties in dealing with health care issues.”

Other community leaders involved in the program included representatives from labor and industry, welfare, community service, and banking, as well as an attorney. Each was invited to spend four half- day sessions with physicians at work. The program ended Friday evening with a dinner for the 22 participating physicians and interns to discuss their two-day experiences.

Senator Mellow said the experience gave him "a great realization as to the workings of our hospitals and more importantly the men and women who provide health care services to our people.” He added, "The experience of the two days with the doctors I was assigned to gave me a greater appreciation for the length of day the doctors work. It also demonstrated the personal concern and relationship the physicians had with their patients.”

As for the future of the program, Eric Blomain, MD, LCMS president, said it will be repeated in October, and a member from the American Association of Retired Persons (AARP) is already scheduled to participate. For additional information about the success and workings of the program, contact Pat Martin, LCMS executive director, at (717) 344-3616.

MERCER COUNTY PHYSICIANS ADDRESS STATE OFFICIALS

Nearly 30 Mercer County physicians met with state health care officials in May during a “Capitol for a Day” visit to Sharon. The program of visits, sponsored by Governor Robert P. Casey, has brought state officials to various cities throughout the state to discuss priorities and concerns with local leaders.

Allan Noonan, MD, Pennsylvania’s secretary of health, and Cynthia Maleski, the state’s acting insurance commissioner, heard the Mercer County physicians’ views on such issues as increasing governmental hassles and regulations directed toward physicians, private insurers’ plans, decreased Medicare reimbursement, the Auto Insurance

38

PENNSYLVANIA MEDICINE

Dr. Giordano

Reform Act, AIDS testing, and implementation of the Health Care Cost Containment Council’s physician- and hospital-specific outcome data.

The physicians aired specific complaints about reimbursement of physicians’ medical services for automobile accidents. State insurance department regional representatives said that the payment regulations were not promulgated until November 1, 1991, and payments were based on the conclusion of the Peer Review Organization’s claim evaluations. Upon being instructed that their

“trade groups” must present their positions to the insurance department, the physicians told Ms. Maleski that

innumerable complaints had already been filed by

individual physicians and the State Society.

The Mercer County physicians discussed the onerous responsibilities placed on physicians by Pennsylvania’s AIDS Confidentiality of HIV-Related Information Act, and the resulting decline in patient testing. Conflicts between Pennsylvania law and new federal regulations regarding bloodbome pathogens were discussed, specifically regarding regulations which allow physicians to test themselves and their personnel, as well as their patients.

Also aired were the physicians’ views on the encumbrances associated with Medicaid and Medicare and the acceleration of limiting medical care resulting from the Health Care Practitioners’ Medicare Fee Control Act and the federal Resource Based Relative Value Scale. The physicians noted that Pennsylvania is equated with Massachusetts as the most restrictive state in which to practice medicine.

Further meetings were planned with the secretary of health, and regional insurance department representatives have already contacted the physicians about the Auto Insurance Reform Act.

Joseph A. Giordano, MD Sharon

SOCIETIES COMPUTERIZE SPEAKER PROGRAM

The Communications Committee of the Allegheny County Medical Society (ACMS), assisted by the State Society, has developed a Speakers Bureau Utilization computer program to organize and ease the county society’s operations in providing speakers to the community upon request.

Linked to the State Society’s membership files, the program automatically makes additions and corrections, eliminating file maintenance by the county. The program is also set up to: identify bureau participants by specialty, location, and speaking topics; track who has been contacted and their responses to county speaking requests; and quickly and easily compile reports of bureau activity on a monthly and yearly basis.

Other county societies interested in more “user” information about the program should call Lyn Riley,

ACMS director of communications, at (412) 321-5030.

COALITION HONORS STATE BUSINESSES

Twenty-two Pennsylvania businesses were honored June 3 for their non- smoking policies in the workplace by officials of the Pennsylvania Department of Health and the Coalition for a Tobacco-Free Pennsylvania. The coalition is comprised of the State Society and a number of other state agencies and organizations.

Representatives of the businesses received a certificate from the Society and a plaque from the coalition distinguishing their company as a recipient of the “Pennsylvania Smoke-Free 2000 Business Award.” To qualify, businesses must be smoke free, permitting no smoking indoors by anyone on the premises, and should have a related written policy in effect for at least six months. Items such as employee incentives for those who quit smoking, smoking-cessation programs, and other employee relations/communications activities are also considered.

Honorees in the medical field included: Capital Blue Cross, Harrisburg; McWilliams Pharmacy, Danville; Family Health Council, Pittsburgh; Mary Ellen Convalescent Home, Hellertown; and Merck & Co.,

Inc./Merck Manufacturing Division, Danville.

AMA News

SOCIETY RECEIVES DUES REBATE FROM AMA

The State Society has received $ 1 1 1 ,6 1 0.84 from the American Medical Association (AMA) for 1992 dues rebate. The total is $6,668.29 more than received in 1991.

In keeping with Society policy,

50 percent of the rebate will be distributed in the near future to county medical societies. Seventy- five percent of the CMS share is for AMA dues reported by January 15, twenty-five percent for AMA dues reported between January 1 6 and February 15, and five percent for AMA dues reported between February 16 and March 15.

SEMINARS TO ADDRESS LOSS PREVENTION

The Pennsylvania Medical Society Liability Insurance Company (PMSLIC) will present loss prevention seminars at six sites around the state this fall. The seminar program, “Curing and Caring,” addresses how to deal with difficult patients and is designed for all physicians regardless of specialty.

"Curing and Caring” will focus on physician-patient relationships using both a lecture and workshop approach. Stephen E. Prather, MD, a practicing obstetrician and gynecologist from Utah, will lead the program.

Following the seminar, attendees should be able to communicate more effectively with difficult patients, describe optimal use of the consultation process, and develop a communication and teamwork plan to deal with angry and dissatisfied patients.

Two sessions — one in the morning and one in the afternoon — will be offered at each site. Locations and dates are:

September 23:

Sheraton East, Harrisburg September 30:

Bel Aire Hotel, Erie October 1:

Westin William Penn, Pittsburgh October 20:

The Woodlands, WilkesBarre/

Scranton

JULY 1992

39

EWSFRONTS

November 4:

Warwick Hotel, Philadelphia November 5:

The Holiday Inn, King of Prussia

PMSLIC is offering a 10 percent discount on 1993 premiums to all seminar participants. For PMSLIC- insured physicians, the discount will automatically be deducted from quarterly premium billings; other physicians who attend will receive a coupon for the same discount if they obtain their professional liability insurance from PMSLIC. Please note: a $300 minimum and $ 1 ,000 maximum apply to the discount program.

For additional information on credits and the program, or for registration information, call PMSLIC’s Risk Management Departmental 1 -800-445- 1212.

FACILITIES ENTER AFFILIATION AGREEMENT

Muhlenberg College, Lehigh Valley Hospital, and Hahnemann University School of Medicine have entered into a new affiliation agreement which establishes a program designed to link the undergraduate and medical school education programs of Muhlenberg premedical students.

Under terms of the agreement, qualified Muhlenberg College students may be admitted to the program when admitted to the college or during their first, second, or third years of study. Students admitted to the program, to begin this fall, are guaranteed admission to Hahnemann upon meeting required Scholastic Aptitude Test (SAT) scores and grade-point-average standards, and completing a pre-professional internship and their undergraduate degree requirements.

Students in the program may take part in research studies and other educational enrichment experiences at the participating institutions. Also as part of the agreement, Lehigh Valley Hospital will annually award a scholarship to a maximum of six students in the program.

DRUG MISUSE-PREVENTION MESSAGE DELIVERED

Senior volunteers are delivering a medicine misuse-prevention message to the nation’s elderly under provisions of a newly announced partnership involving the National

Council on Patient Information and Education (NCPIE) and ACTION, the federal domestic volunteer agency — both headquartered in Washington, DC. The project is funded by a $29,000 ACTION grant.

Citing studies that 243,000 senior citizens are hospitalized each year because of adverse reactions to prescriptions or over-the-counter drugs, the effort will dispense information kits to more than 750 local projects of the Retired Senior Volunteer Program (RSVP), federally administered by ACTION and made up of more than 427,000 volunteers age 60 and older.

The kits, produced by NCPIE and containing information about medicines and the uses of drugs, will urge seniors to deposit their prescriptions and over-the-counter drugs in brown bags, and seek advice from pharmacists and other medical professionals at community medicine review clinics or other events sponsored by participating RSVP projects. The project was developed in conjunction with Older American Month, observed in May.

QUARTERLY REPORTS FROM KEPR0 OVERSEERS

The House of Delegates, through Resolution 86-44 (Amended), has mandated the Society to provide regular reports on Keystone Peer Review Organization (KePRO) findings.

The following report from the Ad Hoc Committee on KePRO Oversight covers the period January 1 through March 31, 1992. It shows the number of Medicare discharges, cases

reviewed by KePRO physician reviewers, pending denials issued, final denials issued, and DRG changes made by KePRO.

KePRO Data for All Pennsylvania Hospitals 01/01/92 - 03/31/92

Medicare Discharges *222,781 Cases Reviewed 39,774

Admission Denials 701

Administrative Denials 156

Total Denials 857

DRG Changes 1,301

PPS Hospitals Under IR 2

Generic Screen Failures 32,272

Pending Quality Problems 5,670

Confirmed Quality Problems 265

* Reflects total discharges received by KePRO for the reporting quarter.

TECHNOLOGY TO BOOST CLINICAL CAPABILITIES

A “new generation” of magnetic resonance imaging technology has been approved for purchase by officials at MRI OF YORK, a joint venture between York Hospital and Memorial Hospital.

Developed by GE Medical Systems, Milwaukee, Wisconsin, the new technology, called "multicoil array,” will reduce imaging time when integrated with the computerized system in place at the imaging center.

Applications of the technology include male and female pelvic anatomy, the abdomen, and the spine. MRI OF YORK will be the only imaging facility in this region implementing the new technology, according to a representative of GE.

FYI: C0ST-0F-PRACTICE STATS OFFERED

Physician income continues to be a topic of great interest throughout the United States, but the reality of the price of maintaining a practice is often unseen by the general public. The following statistics, offered by AMA Communications Services, address a number of topics which may be of interest to physicians:

• According to the AMA’s Center for Health Policy Research, physician net income after expenses comprises approximately 1 3 percent of overall health care expenditures.

• These days, physicians are working an average of 60 hours per

week — 100 more hours per year than they worked in the early 1980s.

• Average office expenses in 1983 amounted to $85,400; today a physician averages over $150,000 in office expenses.

• The price of medical supplies alone has doubled since 1982.

• The price of malpractice insurance has more than doubled since 1983. While the average obstetrician pays $34,000 per year for professional liability insurance, there are obstetricians in some high-cost states who pay upwards of $100,000 for such premiums.

40

PENNSYLVANIA MEDICINE

ADVERTISERS' INDEX

Allied Services 23

Medical Personnel Pool 46

Princeton Insurance Co. 17

Bertholon Rowland Agencies 35

Medical Protective Co. 29

Sentient Systems 1 1

Dodson Insurance Group 3

Palisades Pharmaceuticals 16

Shadyside Hospital 23

Educational & Scientific Trust 41

PAMPAC 19

Shadyside Hospital 37

Eli Lilly & Company 31

Pennsylvania Blue Shield 13

University of Maryland 45

Fulton, Longshore & Associates 45

Physicians Insurance Co. 9

U S. Air Force 37

Hampton Hospital 27

PMS Liability Insurance Co. 1

U.S. Army Reserve 47

Hoffman La Roche Covers 3, 4

PMS Liability Insurance Co. 5

Valley Medical Management, Inc. Cover 2

Medical Inter-Ins. Exchange of NJ 7

Postgraduate Medicine 33

BITUARIES

Robert E. Allen, Mount Carmel Jefferson Medical College, 1927; age 93, died April 14, 1992. Dr. Allen was a gen- eral practitioner.*

Charles W. Delp, Saint Clair Temple University School of Medicine, 1924; age 92, died April 8, 1992. Dr. Delp was a family practitioner.*

Max Harris, Berwyn University of Vermont College of Medicine, 1940; age 76, died March 3, 1992. Dr. Harris was a pediatrician.*

John J. Kelly Jr., Wynnewood Jefferson Medical College, 1954; age 63, died May 10, 1992. Dr. Kelly was a cardi- ologist.*

Henry G. McKeown, Xenia, Ohio Hahnemann University School of Medicine, 1932; age 83, died March 28, 1992. Dr. McKeown was an internist.*

David S. Pollack, Roaring Spring Hahnemann University School of Medicine, 1974; age 43, died April 22, 1 992. Dr. Pollack was a general surgeon.*

Edward A. Troncelliti, Media Jefferson Medical College, 1942; age 76, died April 13, 1992. Dr. Troncelliti was a pediatrician.*

James B. Gregg, Chambersburg Kirskville College of Osteopathic Medicine, 1951; age 70, died April 1, 1992.

John M. Riva, Philadelphia Tufts University School of Medicine, 1978; age 39, died March 22, 1992. Dr. Riva was a gynecological oncologist.

•Denotes membership in the Pennsylva- nia Medical Society at the time of death.

The Educational and Scientific Trust of the Pennsylvania Medical Society provides you with a way to make a significant statement honoring the memory of and paying tribute to your colleagues who are deceased. Send your tax-deductible memorial gift to The Ed- ucational and Scientific Trust of the Penn- sylvania Medical Society, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.

Seven Out of Ten Americans

Have Not Made a Will! Are You One of Them?

It's hard to believe but true. Most Americans die without a will. If you should die without a will. Commonwealth laws, through a tedious and impersonal process, will determine how your assets will be distributed.

Considering the courts' record in health care, you can imagine the legal process involved in settling your estate. In all probabil- ity your survivors will pay the maximum estate taxes.

To understand how important a will and linked trust instru- ments are to your estate, call Bob Lamb at the Trust and ask for the free pamphlet:

"What Difference Does A Will Make?"

Dial toll free: 1-800-228-7823

P. S. When you call, you’ll also receive the free booklet,

"I Have Put My House In Order," a personal asset directory to make your executor's job easier.

EDUCATIONAL ^SCIENTIFIC TRUST

of the Pennsylvania Medical Society

777 East Park Drive, Harrisburg, PA 17105

JULY 1992

41

EPICAL ABSTRACTS

MANIFESTATION OF ACROMEGALY: A CASE REPORT

TRIGEMINAL NEURALGIA AS A

Larry N. Merkle, MD, FACP; Brian W. Little, MD, PhD; Robert A. Morrow,

MD; Gerald Pvtlewski, DO

OBJECTIVE: Trigeminal neuralgia is one of the most painful disorders known in medicine, and neurologists and neurosurgeons frequently make a strong effort in a search for identifiable and treatable causes of this facial pain syndrome. This paper was compiled as a case report of a patient with trigeminal neuralgia and acromegaly.

METHODS: A 66-year-old female was diagnosed as having acromegaly from

a growth hormone secreting pituitary microadenoma with associated trigeminal neuralgia. Acromegaly was suspected because of suggestive clinical features and confirmed by endocrine testing. The patient eventually underwent transphenoidal pituitary exploration. Pituitary replacement therapy in the form of cortisone acetate 37.5 mg daily was required following surgery, as well as continuation of a previous physiological thyroid replacement.

RESULTS: The patient’s post-operative course was relatively uneventful, and

the surgery resulted in complete remission of her facial pain.

CONCLUSION: When usual causes have been excluded, acromegaly should be added to the list of potential treatable causes of refractory trigeminal neuralgia.

For additional information or a copy of the complete study, contact Larry N. Merkle, MD, FACP, at the Lehigh Valley Flospital Department of Medicine, (215) 402-8200.

CLINICAL USE OF AMBULATORY BLOOD PRESSURE RECORDING:

Alan P. Shapiro, MD; Daniel J. Glunk, MD; Bruce Barnhill, BS

OBJECTIVE; Variability of blood pressure determinations has long been recognized and results in considerable difficulty in evaluation of hypertensive patients. This study was conducted to evaluate the problems and value of routine clinical use of ambulatory indirect recorders in an outpatient setting in a hypertension practice.

METHODS: Using the Spacelabs 90202 monitor, 200 ambulatory blood pressure recordings (ABPRs) were obtained in 179 patients over a period

of 25 months; 21 of the 200 determinations were duplicates in the same patients after a change in therapy. Data were fed into a computer programmed by Spacelabs software to compute averages.

RESULTS: Of the 200 determinations attempted, successful records were obtained in 197 (98 percent). Blood pressure and heart rate outcomes were compared in regard to various means, and several calculations were made from the computed averages.

CONCLUSION: Several insights were gained from use of APBR in the

VALUE IN PATIENT CARE

clinical care of hypertensive patients. The current "state-of-the-art” instrumentation is reliable, accurate, reasonably trouble-free, and acceptable to patients. It provides a day-long measure of blood pressure which possibly has prognostic and diagnostic implications, may provide a prediction of the course of the patient, and offers guidance to the understanding and adjustment of pharmacologic therapy.

For additional information or a copy of the complete study, contact Alvin P. Shapiro, MD, at the Sliadyside Hospital Department of Medicine, (412) 623- 2465.

HEMODYNAMIC PATTERNS ASSOCIATED WITH INFARCTED BOWEL

Mark Gannon, MD; Robert Weaver, AS; Matthew Indeck, MD; J. Robert Bums, MD; Sheldon Brotman, MD; Joseph L. Smith, MD

OBJECTIVE: Bowel infarction remains a diagnostic dilemma and therefore leads to increased mortality and morbidity. This study was conducted to review a series of intensive care unit patients with infarcted bowel in an attempt to characterize their hemodynamic profiles.

METHODS: Between December 1984 and May 1987, hemodynamic data for 27 patients with a diagnosis of ischemia or infarcted bowel, confirmed

by either surgical pathology specimen or autopsy, were reviewed. A thermodilution pulmonary artery catheter was used to monitor pressures and oxygenation, and various data were then calculated using standard formulas.

RESULTS: Data from 1 6 patients were excluded because of infection, myocardial infarction, or ischemia, and/or insufficient data. The remaining 1 1 patients demonstrated hemodynamic profiles with sharply defined high and low functional patterns similar to those described for septic shock.

CONCLUSION: The lowest functional group had the highest mortality rate. This observation is consistent with human septic shock experience and animal models of mesenteric ischemia. This might suggest that translocation of bacteria or their products across the injured bowel wall may be the most likely reason for the similarity of findings.

For additional information or a complete copy of the study, contact Joseph L. Smith, MD, at the Geisinger Medical Center Department of Critical Care Medicine, (717) 271-6211.

The editors of Pennsylvania Medicine encourage submission of scientific articles for publication consideration; however, abstracts of those articles not published in full are printed as a reference for readers. Please send submissions to: Medical Editor, Pennsylvania Medicine, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 1 7105-8820. Full scientific articles are published at the discretion of the medical editor as consistent with the editorial schedule and are subject to revision.

42

PENNSYLVANIA MEDICINE

EW MEMBERS

ADAMS

Joel I. Levine, MD, Radiologic Oncology, 54 Lvnn Ct., McSherrvstown 17344, 717-633-6966

ALLEGHENY

Michael D. Ames, MD, Diagnostic Radiology, 561 1 Elmer St., #302, Pittsburgh 15232, 412- 361-1961

Timothy R. Billiar, MD, Gen. Surg., 497 Scaife Hall. Pittsburgh 15261,412-648-9900 V. Alin Botoman, MD, Gastroenterology, Allegheny Gastro Assocs., 490 E. North Ave., Pittsburgh 15212, 412-321-0808 Frank S. Darras, MD, Urological Surg., 5820 Elmer St., Pittsburgh 15232, 412-661-6567 Jay N. Dolitsky, MD, Otolaryngology, 5719 Hobart St., Pittsburgh 15217, 412-521-5874 Jeffrey L. Garland, MD, Infectious Diseases, Univ. of Pittsburgh, 440 Scaife Hall, Pittsburgh

15213.412- 648-9350

Jaffrey Hashimie, MD, Psychiatry, 1612 E. Hemlock Dr., Allison Park 15101, 412-487-8387 Krishan G. Kalra, MD, Cardiovascular Diseases, 634-C Glen Scott Dr., Glenshaw

15116.412- 486-6309

Dana J. Keys-Frezzell, MD, Internal Med.,

1836 Village Green Dr., Clairton 15025, 412- 655-8302

George W. Lovett, MD, Occupational Med., PPG Industries Inc., 1 PPG PI., Pittsburgh 15272, 412-434-31 1 I

Elaine A. Montouris, MD, Internal Med., Gateway Towers, #26-N, Pittsburgh 15222, 412- 642-4299

Scott M. Naum, DO, Internal Med., 63 York Dr., Pittsburgh 15214, 412-931-9499 Tina P. Nowak, MD, Anesthesiology, 4417 Jefferson Ave., Munhall 15120, 412-462-5648 Anne M. ProuLx, DO, Family Practice, 6941 Meade St., Pittsburgh 15208, 412-661-2240 Amos Ritter, MD, Family Practice, 6647 Dalzell PI.. Pittsburgh 15217. 412-422-3887 Thomas K. Rosvanis, MD, Urological Surg., 2566 Haymaker Rd., Ste. 206, Monroeville 15146, 412-372-6330

Wade R. Smith, MD, Orthopedic Surg., 919 Savannah Ave., Pittsburgh 15221,412-647-2323 Stuart G. Tauberg, MD, Cardiovascular Diseases, 901 S. Trenton Ave., Pittsburgh 15221, 412-244-9105

Robert L. Volosky, MD, Infectious Diseases, 476 Haverhill Rd., Pittsburgh 15228, 412-561- 2936

David A. Weidman, MD, Neurology, 220 Mevran Ave., Pittsburgh 15213, 412-681-2000 Fehmida Zahabi-Unwala, MD, Internal Med., 636 Maryland Ave., #1, Pittsburgh 15232, 412- 361-5162

BERKS

Ron D. Nutting, MD, Thoracic Surg., 5848 S. Lisbon Way, Aurora, CO 80015, 303-690-9105 Margaret A. Reiley, DO, Pediatrics. 1258 Penn Ave., Wvomissing 19610, 215-374-4491 Rebecca L. Reiner, MD, Pediatrics, 4593 Lakeside S., Columbus, OH 43232, 614-864-3252

BLAIR

Robert D. Bieser, DO, Family Practice, 510 Howard Ave., Bldg. F, Altoona 16601, 814-946- 2020

Charles M. Narrow, MD, Physical Med. /Rehab., 13805 Castle Blvd., #23, Silver Spring, MD 20904, 301-890-0144

BUCKS

Robert L. Berk, MD, Ob/Gvn, 9 Wellhaven Cir., Owings Mills, MD 21 117, 301-356-8162 Thomas A. Filipowicz, MD, Emergency Med., 704 Remington Ct., Chalfont 18914, 215-822- 2463

Faisal N. Masud, MD, Anesthesiology, 2517

Dunks Ferrv Rd. , #B20 1 , Bensalem 1 9020, 2 1 5- 639-1093

Michael L. Murray, DO, Gen. Practice, 592 Heatons Mill Dr., Langhorne 19047, 215-757- 9577

BUTLER

Elaine C. Dischman, MD, Family Practice. 1 1 1 Buttercup Dr., Mars 16046. 412-772-1742

CAMBRIA

Ronald F. Maceyko, MD, De rmatologv, 209 Delta Dr., Johnstown 15904, 814-266-3078 Roberto Ortiz, MD, Internal Med., 638 Luzerne St., 3rd FI., Johnstown 15905, 814-535-3414

CARBON

Joseph A. Zacher, MD, Radiology, 179 Riverview Ave., North Arlington, NJ 07032

CHESTER

Fred A. Cox, DO, Pediatrics, 928 Benge Rd., Hockessin, DE 19707, 302-239-5695 Francesco D’Urso, MD, Pediatrics, 4335 W. Lincoln Hwy., Downingtown 19335, 215-269- 9966

Arthur B. Flodess, MD, Cardiovascular Diseases, 3456 E. Lincoln Hwy., Thomdale 19372, 215-384-2211

Lisa B. Johnson, MD, Internal Med., 600 E. Marshall St., Ste. 102, West Chester 19380, 215- 696-3431

Robert S. Porter, MD, Emergency Medicine, 258 Fagan S. Ln., West Grove 19390, 215-869- 8811

Barbara J. Walter, MD, Gen. Surg., 213 Reeceville Rd., Ste. 34, Coatesville 19320, 215- 383-5610

Kenneth A. Witterholt, MD, Gen. Surg., 520 Maple Ave., Ste. 4, West Chester 19380, 215- 436-6696

DAUPHIN

David Calcagno, MD, Vascular Surg., 3800 Reservoir Rd., Washington, DC 20007, 202-687- 2255

Francis J. Janton III, MD, Neurology, 208 Lowther St.. Lemovne 17043, 717-774-2202

DELAWARE

Richard F. Chalfin, MD, Internal Med., Drexelbrook 4-3, Bloomfield Ave., Drexel Hill 19026, 215-623-8970

Andrew R. Conn, MD, Gastroenterology, 1000 Conestoga Rd., #A201 , Rosemont 19010, 215- 525-1682

Hoa T. Dang, MD, Internal Med., 7140 Chestnut St., Upper Darby 19082, 215-352-4428 Harpreet S. Grewal, MD, Gen. Surg., 319 Springhouse Rd., #102, Allentown 18104, 215- 395-8107

Daniel A. Smolen, DO, Gen. Practice, 1440 Conchester Hwy., Boothwvn 19061, 215-358- 3920

FAYETTE

Kuk S. Lee, MD, Physical Med./Rehab., Rehabilitation Ctr., 6-8 N. Gallatin Ave., Uniontown 15401, 412-438-9222

JEFFERSON

Guy H. Gerhart, MD, Internal Med., Dubois Regional Med. Ctr. East, Dubois 15801, 814- 371-1480

John W. Thompson, MD, Diagnostic Radiology, 1047 Treasure Lake, Dubois 15801, 814-371-4091

LANCASTER

Carrie L. Bolander, DO, Ob/Gvn, 1934 William Penn Way, Lancaster 17601 , 717-299-2339

LEHIGH

Elizabeth Goff, MD, Pediatrics, PO Box 371,

Ridley Park 19078, 215-521-6827

Robert A. Malta, DO, Family Practice, 827 W.

Wyoming St., Allentown 18103, 215-435-8643

Neil W. Stoddard, MD, Internal Med., 821

Delaware Ave., 3rd Fl„ Bethlehem 18015, 215-

868-4550

Jonathan M. Szenics, MD, Occupational Med.,

1 Braintree Ct., Flemington, NJ 08822, 609-788- 9593

LUZERNE

Manuel A. Fonseca, DO, Family Practice, 540 Pierce St., Kingston 18704, 717-288-7451 David R. Shober, DO, Family Practice, 540 Pierce St., Kingston 18704, 717-288-7451

LYCOMING

Raj J. Patel, MD, Internal Med., 1 16 Kerr Ave., Jersey Shore 17740, 717-398-1800 Thomas E. Wallace, MD, Familv Practice, 1824 E. 3rd St., Williamsport 17701, 717-322-4422

MIFFLIN/JUNIATA

Jose R. Fernandez, MD, Ob/Gvn, 2217 Buttonwood Cir., Harrisburg 17110, 717-540- 6845

MONTGOMERY

John J. Kelly, MD, Infectious Diseases, Abington Memorial Hosp., 1200 York Rd., Abington 19001 , 215-576-2608 Stephen F. Lewis, MD, Neurology, 445 Zeedont St., Jenkintown 19046, 215-885-5065 Rocco J. Santarelli, DO, Pulmonary Diseases, 781 Edge Hill Rd., Glenside 19038, 215-576-1813

NORTHAMPTON

Robert S. Gayner, MD, Nephrology, 4000 Gypsy Ln., #626, Philadelphia 19144, 215-438-8495 '

NORTHUMBERLAND

Marie T. Brislin, DO, Pediatrics, RR 6, Box 78, Danville 17821 , 717-275-4685

PHILADELPHIA

Diane L. Barskv, MD, Pediatrics, 521 Broad Acres Rd., Penn Valley 19072, 215-668-4978 Glen W. Berger, MD, Internal Med., Cooper River Pi/.., #809 S., Pennsauken, NJ 08109, 609- 665-6694

David A. Cautilli, MD, Orthopedic Surg., 4000 Gypsy Ln., #705, Philadelphia 19144, 215-843- 7163'

Joseph R. Codispoti, MD, Internal Med.,

13001 Worthington Rd., Philadelphia 19116, 215-676-6941

Alice W. Flagg, MD, 910 Roumfort Rd., Philadelphia 19150, 215-247-4541 Michael A. Golden, MD, Vascular Surg., 3400 Spruce St., Philadelphia 19104, 215-662-7831 Russell H. Harris, MD, Emergency Med., 792 N. Croskey St., Philadelphia 19130, 215-236-9087 Margaret M. Johnson, MD, Internal Med., 722 Lombard St., Philadelphia 19147, 215-829-9809 Paul K. Kaiser, MD, Neurology, 206-A Wavne Ave., Narberth 19072, 215-660^9918 Richard B. Kanoff, DO, Neurological Surg., GSB Building, Ste. SI 4, Bala CvnCwd 19004, 215-667-0659

William D. Keen Jr., MD, Cardiovascular Diseases, 264-36 Iven Ave., St. Davids 19087, 215-293-0692

Ali N. Khan, MD, Internal Med., 2209 N. Front St., Philadelphia 19133, 215-634-1 102 Stephen E. Levick, MD, Psychiatry, io Avon Rd., Narberth 19072, 215-667-4901 Lawrence L. Livomese Jr., MD, Infectious Diseases, Lankenau Medical Bldg., Ste. 46, Wynnewood 19096, 215-896-0210 Craig H. Marcus, MD, Ophthalmology, 200 Locust St., Philadelphia 19106, 215-625-3578 Kevin P. Marzo, MD, Cardiovascular Diseases, 2414 Linden Dr., Havertown 19083, 215-789- 9307

JULY 1992

43

EWSMAKERS

Robert L. Lasher, MD, a surgeon from Erie and the State Society’s Eighth District Trustee, spoke in late May before the Republican Policy Committee Task Force on Health Insurance. Dr. Lasher presented the Society’s comments on House Bill 2294, a small-business health insurance reform proposal.

Lee H. McCormick, MD, Pittsburgh family practitioner and chairman of the State Society’s Task Force on Dmg Abuse, has been appointed to the American Medical Association (AMA) Advisory Committee on Child Abuse.

Abram M. Hostetter, MD, Hershey, was honored in May by the Mental Health Association in Cumberland, Dauphin, and Perry counties for his many accomplish- ments in the field of psychiatry.

Rocio Neil, MD, has been appointed executive director of the Montgomery County Emergency Service, Norristown.

Rex Newton, MD, emeritus chief of the Department of Physical Medicine and Rehabilitation at Harmarville Rehabilitation Center, Indiana Township, was honored by the Pittsburgh Physiatric Society and the Harmarville facility for his teaching and lifelong contribution to the field

of physical medicine and rehabiliation.

Gilbert A. Friday Jr., MD, professor of pediatrics at the University of Pittsburgh School of Medicine, has been elected chairman of the board of Pennsylvania Blue Shield.

Norman M. Krause, MD, specialist in orthopedic surgery and sports medicine, was elected medical staff president at the Greater Pittsburgh Rehab Hospital.

Two faculty physicians at the University of Pennsylvania Medical Center — Robert Austrian, MD, John Herr Musser professor and chairman emeritus of research medicine, and Clyde Barker, MD, John Rhea Barton professor of surgery, Donald Guthrie professor of surgery, director of surgical research, and chairman of surgery — were elected into the Institute of Medicine of the National Academy of Sciences.

Marvin Steinberg, MD, director of the Joint Reconstruction Center at the Hospital of the University of Pennsylvania and professor of orthopedic surgery at the University of Pennsylvania Medical School, moderated “Avascular Necrosis of the Hip” at the Combined Meeting of the American Orthopedic Association and the English Speaking World in Toronto, Canada, in June.

Loren H. Crabtree, MD, vice president of clinical affairs of the Westmeade Center, Wyndmoor, and Robert Garfield, MD, medical director of the center, were

interviewed during a live taping of a local radio program, "Family Matters.” Examining the issues surrounding stigma and alternatives to traditional psychiatric care was the topic of the program, and Drs. Crabtree and Garfield answered questions about the benefits of the alternatives to psychiatric hospitalization.

John V. White, MD, associate professor of surgery and director of surgical research, Temple University Hospital, was awarded the 1992 Dr. Samuel D. Gross Prize by the

Philadelphia Academy of Surgery for his work on the cause of abdominal aortic aneurysms.

Stephen S. Silberstein, MD, FACP,

chief of neurology and co-director of the Comprehensive Headache Center at the Germantown Hospital and Medical Center in Philadelphia, recently edited and authored a special headache supplement to Neurology, the official journal of the American Academy of Neurology. The supplement was entitled, “Intractable Headache: Inpatient and Outpatient Treatment Strategies.” Also, Elliot A. Schulman, MD, co- director of the center, served as a contributing author to the supplement.

Judith L. Swain, MD, Herbert C. Rorer professor of medical services and professor of human genetics at the University of Pennsylvania School of Medicine in Philadelphia, and chief of the Cardiovascular Division of the Hospital of the University of Pennsylvania, will serve as principal investigator for a grant from Bristol-Myers Squibb to support breakthrough research on how the heart muscle develops.

Ronald B. Herberman, MD,

director of the Pittsburgh Cancer Institute, received the Institute for Advanced Studies in Immunology and Aging 1992 Lifetime Science Award in recognition of his "insightful” work in the field.

State Society President Elect Donald G. Ferguson, MD (left), and Allegheny County Medical Society Past President Richard E. Deitrick, MD (right), were among 29 physician volunteers who answered viewers' questions on breast cancer detection and treatment during The Breast Test, a community outreach project airing on WQED-TV in Pittsburgh.

Dr. Hostetter

44

PENNSYLVANIA MEDICINE

L455/F/EP ADVERTISING

PHYSICIANS WANTED

ER physicians — Full-time/part-time posi- tions available NJ, PA, NY. Emergency medicine experience preferred. Guaranteed compensation and paid malpractice. For more information call (215) 521-5100 (within PA), 1-800-TRAUMA6 (outside PA), or send CV to Trauma Service Group PC, Scott Plaza, Building Two, Suite 114, Philadelphia, PA 19113.

Western Pennsylvania — Board Certified or prepared emergency physicians needed for staffing a community hospital emergency de- partment near the Ohio/Pennsylvania border. Please send CV to P.O. Box 99431 , Pitts- burgh, PA 15233-0431.

Pennsylvania — Physician group seeks full- time and part-time physicians for an emer- gency department of community hospitals in central and western Pennsylvania. Please send resume to P.O. Box 99431, Pittsburgh, PA 15233-0431.

General internist — Immediate opening available for dynamic BC/BE physician to join well-established internal medicine practice in southwestern Pennsylvania. Salary $1 00,000. Benefit package $1 0,000. Pension plans. Future partnership option. In-house laboratory and x-ray facilities. Excellent op- portunity. Reply Box 345, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Flarrisburg, PA 17105-8820.

Pocono Mts. area — Northeast Pennsylvania busy family practice looking for BE/BC family practitioner. No Ob; active hospital practice; partnership possibilities. Skiing, boating, hik- ing within 5 miles. 90 minutes from Manhattan and Philadelphia. Please send CV to: Monroe Family Practice Assoc., 1803 W. Main, Stroudsburg, PA 18360; (717) 421-0170.

Surgery — The Department of Surgery at a progressive, academic urban medical center in the northeast seeking aggressive, well- trained chief of vascular surgery and a gener- al surgeon with certificate in critical care to de- velop a practice and play an important role in the education and training of medical students and surgical residents. Hospital will provide at- tractive package and incentives and will assist with practice development. Medical school faculty appointment commensurate with qual- ifications. Box 362, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Immediate position — Part-time BC/BE in- ternist. Southwestern Pennsylvania (suburb of Pittsburgh); ideal position for female physi- cian desiring to raise a family and practice medicine. Modern new facility, x-ray, lab. Salary negotiable. Box 366, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Seeking associate for busy family prac- tice in western Pennsylvania area. Salary

and benefits guaranteed with full partnership available in one year. Transportation and ac- commodations paid for meeting. Contact Chris at (412) 758-7524 or reply to U.G. Kim, MD, P.O. Box 868, Ellwood City, PA 16117.

Wanted — Family physician needed for busy broadbased group practice 35 minutes north of Pittsburgh. Practice includes obstetrics, nursing home work, house calls, and assist- ing in surgery. Contact: Family Medical Care Associates (412) 681-5170.

General Internist — Excellent opportunity (Full or Part-time). Immediate opening for in- dustrious, personable, compassionate BC- BE physician to join a well established inter- nal medicine practice in greater Harrisburg area. In house laboratory and x-ray facilities. Special skills helpful but not necessary. Re- ply to: Box 372, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Community Hospital, N.E. Philadelphia —

2 locations. Seeks general radiologist, mam- mo, ultrasound, cat scan, nuc. med. Knowl- edge of angio helpful but not necessary. 2 positions: full & part-time. Send resume & date available to: Ann Gabriel, MBA, P.O. Box 21911, Philadelphia, PA 19124.

General surgeon BE/BC to join large solo sur- gical practice. Salary $140,000 with early part- nership. Send CV to Box 376, Pennsylvania

TOPICS IN PULMONARY MEDICINE

This course will review new treatment advances and controversies relevant to common pulmonary problems encountered in the daily practice of medicine.

September 12-13, 1992

Baltimore Marriott Inner Harbor Oriole Park at Camden Yards Baltimore, Maryland

8.3 credit hours in Category 1 Program of Continuing Education University of Maryland School of Medicine

For additional information or to receive a brochure, please contact: Larry R. Sauder, University of Mary- land School of Medicine, Division of Pulmonary & Critical Care, 10 South Pine Street, MSTF 800, Bal- timore, MD 21201, (410) 328-4497, FAX (410) 328-8162.

Medical Practice Sales and Appraisals

Fulton, Longshore & Associates is a leader in the appraisal and sale of medical practices.

Listed below are several of the practices which are currently for sale:

SPECIALTY

LOCATION

ANNUAL

REVENUE

Cardiology

Philadelphia

$

285,000

Dermatology

Coastal New Jersey

$

700,000

Family Practice

Northern Delaware

$

250,000

Gynecology

Philadelphia

$

340,000

Internal Medicine

Central Pennsylvania

$

900,000

Ophthalmology

D.C. Area

$

600,000

Ophthalmology

Michigan

$

700,000

Ophthalmology

New Jersey

$

300,000

Ophthalmology

North Virginia

$1,000,000

Ophthalmology

Ohio

$1,500,000

Ophthalmology

Charlotte, NC

$

600,000

Pediatrics

Central New Jersey

$

210,000

Pediatrics

Lehigh Valley, PA

$

250,000

Psychiatry

Tennessee

$

525,000

For additional information, please contact:

Ed Strogen

Fulton. Longshore & Associates 527 Plymouth Road. Suite 410 Plymouth Meeting, PA 19462 (215)834-6780

JULY 1992

45

IASSIFIED ADVERTISING

Medicine, 111 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.

General internist, or pulmonary, cardiology or other subspecialty-BE/BC to join 5-physi- cian group in Carlisle, south central Pennsyl- vania. Close to Washington, Baltimore, Philadelphia. College town with progressive hospital, excellent schools, good place to raise family. Competitive salary with com- plete benefit package, opportunity for part- nership. Send CV to Box 374, Pennsylvania Medicine, 111 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.

Full-time emergency room position avail- able in a 400-bed suburban hospital with 48,000 visits. Board certified/eligible in emer- gency medicine or other specialty with emer- gency room experience. Excellent salary/ben- efit package with partnership potential. Contact Clarke Hankey, MD, Emergency De- partment, St. Clair Hospital, 1000 Bower Hill Road, Pittsburgh, PA 15243 (412) 561-4900.

Family Practitioner — Excellent opportunity. Full-time. Immediate opening for industrious, personable, compassionate physician look- ing to start practice in growing community. Respond to: Gilbert E. Pittenger, R.D.#1 , Box 91, New Ringgold, PA 17960.

Erie, Pennsylvania — A 560+ bed referral center is seeking a full-time B/C physician in emergency medicine. 36,000 annual visits. Excellent salary and benefit package. Con- tact: Phylliss Gibson, Hamot Medical Center, 201 State St., Erie, PA 16550, (800) 937- 9133, extension 7047.

Woman general surgeon seeks an associ- ate to join her in an active breast clinic. Must be BC/BE in general surgery. Salary, health insurance, malpractice insurance, profit shar- ing. Good opportunity for recent graduate. Reply to: Johnstown Screening & Diagnostic Breast Center, 1111 Franklin St., Suite 030, Johnstown, PA 15905.

Pittsburgh, Pennsylvania — An excellent opportunity to join a three man IM/CD group practice. We are looking for a second internist to provide general medicine services to our patients. We are a two office/two hospital practice. Salary/benefits/profit sharing lead- ing to partnership. We are top admitters at both facilities (390 and 340 beds). If you are interested in a progressive, lucrative and challenging practice in one of “America’s Most Liveable Cities,” please call or write Medicine and Cardiology Associates, Ste. 240, 211 N. Whitfield St., Pittsburgh, PA 15206; (800) 438-2476.

Southwestern, Pennsylvania Family Prac- tice— BE-BC FP to join busy solo practition- er. Located in a beautiful semi-rural commu- nity 25 minutes from one of “Americas Most Liveable Cities,” Pittsburgh, PA. Affiliate with a 400+ bed teaching hospital. This practice boasts a beautiful new facility and provides opportunities to practice obstetrics and be in- volved in resident education. Competitive salary and benefit package leading to part- nership. For more information, send CV to Daniel Stern and Associates, 21 1 N. Whitfield St., Pittsburgh, PA 15206; or fax to 412-363- 6032; or call 1 -800-438-2476.

Group and HMO practice opportunities —

Eastern Pennsylvania, Maryland, Ob/GYN, FP, PEDS, various specialties, confidentiality protected. Call Albert Yannelii, Yannelli Ran- dolph & Co., 994 Old Eagle School Rd., Ste. 1020, Wayne, PA 19087; (215) 964-1616.

Pittsburgh, Pennsylvania — Penn Group Medical Association (PGMA), a multi-special- ty group practice affiliated with the largest HMO in Pittsburgh, is seeking BE/BC physi- cian in: family practice, internal medicine, pe- diatrics, ob/gyn, and psychiatry. We are for- mally affiliated with major teaching hospitals and leading community hospitals in Pittsburgh. PGMA serves eight ambulatory care centers, all conveniently located near cultural, educa- tional, recreational, and corporate activities. Excellent salary, fringe benefits, and incen- tives. For confidential consideration contact: Angela Lascola, HealthAmerica, 5 Gateway Center, Pittsburgh, PA 15222 or call collect (412) 553-7502.

Pennsylvania — Excellent opportunity for BC/BE internist/pulmonologist to associate with fellow internist/pulmonologist in a very active practice. Procedures include bron- choscopy, Swan Ganz, pacemakers, arterial lines, ventilator management, etc. This is an excellent place to raise your children and to also be five minutes from a “state of the art” hospital staffed by similar BC/BE physicians in all specialties. Send resume with full CV to: William H. Fee Jr., MD, FACP, 150 Prospect Ave., Franklin, PA 16323; (814) 437-3761.

Radiologist — Established northeastern Pennsylvania radiology practice seeking a fifth radiologist for hospital and private prac- tice. Applicant should have experience in CT, MRI, ultrasound, mammography, nuclear medicine, angiography and interventional ra- diology. Potential for partnership. Candidate should be Board Certified/Board Eligible and licensed in Pennsylvania. Terrific area for family life, quality schools, recreational and civic activities. Address inquiries and current curriculum vitae to Box 381, Pennsylvania Medicine, 111 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Board Certified/Eligible Internist — Salary commensurate with experience and qualifica- tions. Recurring bonus available. Federal mal- practice insurance; 30 days paid vacation; 15

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PENNSYLVANIA MEDICINE

days sick leave per year; CME leave and reimbursement; Feder- al retirement plan with tax de- ferred savings plan and match- ing government contributions. Health and life insurance. Con- tact Personnel Service, James E. Van Zandt VA Medical Cen- ter, Altoona, PA 16602-4377, (814) 943-8164, ext. 7039. Equal Opportunity Employer.

AESA is seeking qualified physicians to develop an emer- gency department group at Ha- zleton St. Joseph Medical Cen- ter, a 1 90-bed facility with 1 9,000 annual visits. Excellent compen- sation package. Scenic location with access to the Pocono Mountains, Philadelphia and NYC. 1-800-779-1427.

Montana Clinic — Seeking a FP/GP for a unique primary care practice. Outstanding hospital and community support. Guar- anteed income and excellent benefit package. Call or send CV to: FHS, Utah, Butte, MT 59701 ; 406-494-1448.

Physicians, Full and P/T — FP,

General Internists. Modern medi- cal center located in the Lehigh Valley. Early financed buy in. Write: P.O. Box 4283, Bethle- hem, PA 18018-0283.

POSITIONS WANTED

Seeking position in gastroen- terology/internal medicine.

Available now. Board certified in internal medicine. Board eligible in gastroenterology. British and U.S. trained. Licensed in Penn- sylvania. Contact S.P. Nathan, South Baltimore General Hospi- tal, 3001 S. Hanover St., Balti- more, MD 21230. (301) 355- 5502.

Physician Practice Manager —

Experienced health care admin- istrator seeks challenging posi- tion. Proven skills in: administration/planning/fiscal management, innovative prob- lem solving, leadership, market- ing, effective communication. Please send inquiries to: Box 379, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Stat Med USA— BC, MD, mem- ber of Pennsylvania Med-ical Society, offering short-term cov- erage FP/GP & clinics. Available on short notice. Call 717-642- 6355 or FAX 717-642-6942.

MD seeks ciinical/physician assistant position in PA, VA, WV, or New England. Reply to POB 2325, Spartanburg, SC 29304.

Professional office suite in northeast Philadelphia. Private entrance, located in apartment bldg. One block from shopping and transportation. Will renovate to suit tenant. Call (201) 944- 8700 or (215) 744-8271.

Northeastern Pennsylva-nia —

Take over established family practice. Doctor to retire. In home office. Family oriented communities on the beautiful Delaware River at the PA/NY border in fastest growing county in Pennsylvania. Nearby consul- tants in all fields. Quality lifestyle/recreational amenities. Unique opportunity for guaran- teed income, paid malpractice insurance, and other incentives. Contact physician after 6:00 (717) 559-7400.

For Sale — Established pediatric practice in the western suburbs of Philadelphia. Fully equipped. 1,600 patients. Doctor retiring. Box 377, Pennsylvania Medicine,

777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105- 8820.

Otolaryngologist needed to share space with ophthalmolo- gist with multiple offices in Pitts- burgh and suburbs. Flexible terms and ready market. Call (412) 837-4232.

Partners, Investors being sought by business with medical and safety product opportunities. One is unique device for han- dling needles. Market potential for this product alone exceeds $100 million. Call 717-774-6053.

Medical Office — Fully equipped rental. Northeast Philadelphia. 215-725-8114.

Financing Unsecured — Up to

$60K. No placement fees or pre- payment penalties. Competitive rates, rapid processing, best in- terest only payment option. Equipment leasing - Answer in 12-72 hours, no upside limit, sin- gle or master lease. Warranty extension, new practices eligi- ble. Call 800-331-4951 ext. 511, 9-5 EST.

Lease or Sale — Established, fully equipped and staffed mod- ern medical facility with ongoing

family practice, industrial medicine, and emergency medicine. Ideally located in the Lehigh Valley. Financing ar- rangements available. Write: P.O. Box 4283, Bethlehem, PA 18018-0283.

CLASSIFIED ADVERTISING

Rates: $38 per insertion ($25 for PMS members) for the first 30 words or part thereof; $1.30 for each additional word; $6 per insertion for a box number. Payment should be in advance. No agency commission is paid on classi- fied advertising.

Submissions: Copy must be submitted in writing to Penn- sylvania Medicine, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820. For more information, call (717) 558-7750.

Box Numbers: Advertisers using box numbers forbid dis- closure of their identity. Writ- ten inquiries are forwarded to such advertisers, but no in- formation can be revealed by the publisher.

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47

Discharge Summary ■

A Refreshing View: The Oath of Hippocrates

SS3SBR&i| Apollo die phiisjnavi ajooAcsailxpjas awoiwcakJi awp^ilheal

xvjd xll rhe 50DS xud ^oddcssc? chxc accordiuj; co mu xbilicq xud 11105:05 — mevic ) a’iU keep chis Oxch xud chis SCI pill AC lOU-X'W'VlWV^.'VX'N.

(» >o Reckon him uiho cxu^lic me chis Clue equally t>car co me as mq par- cucs, co shxue niq subsrxuce- toicJi him mo uelieue his necessities 1 p Rcquiueo co look upon his off- SPR1145 iu che sxme pooriuj, as mq oum bRodieus xud co ccacIi chan cins xuc ip cheq unsh co IcxRW IC7 unchoLic pee 011 scipulxcioio; xuci chxc bi| puccCpc Icccurc arid eoeuq ochcR mooe op iuscrucciou 1 mill linpxnc x knoiulcojc op che due. co mq otxivi sous xuo chose op mq cexcheus xud co Disciples bouuo 5q x sapulxciou xud oxch xccordiuj; co che Ixm op meoiciue buc co uoue ochens.ic t 7 — r / — r e cfZjt, mill pollorn cJixc sqscem op negi meu mhich xccoudiu^ co mq xbilicq xud juDjemeuc, 7 cousioeR poRche- beuepic op mq pxcieucs XUD xbsrxiu Pnom mhxceucR isoelecCRious xud mischievous. I mill 5m e uo DCXDlq rre oiciue co xuqouC ip xskep. uor sug- gest: xuq sucli couusel xud iu lika mxuuCR ) mill uoc 511’e co xmomxu xpessxRq co pRoouce xbonctou

'HSJich puRicq xud rnich holiuess I mill pxss mq lipe xud puxccise mq OLrc 1 mill uoc cue poisous Ixbour- luguuoeu die scoue buciuitl Icxuer' dus co be ooue bq in cu mho arc prac- ciciouCRS op chis moRk. •' ^ '"3j&

>co mhxceoeR housesi euceu. 1 mill

^50 7UC0 chem poR che bcuepic op die Sick xud mill xbscxju FRom eueuq DoluucxRq xcc of misclnep xuo COR- Rupciow xud puuchCR pRom che seou cciou op pemxlcs or mxles op pRCCmen xud slxves

”9®hxreiJeu iu couuccciou a>ich mq pROFessiouxl pRxccice or uoc iucou uecciou mich ic 1 see ouhcxu iu che lipe op meu, mhich oujhc uoc co bc spo keu op xbuoxD 1 mill uoc Divulge xs ceckouiug chxr xU. such shoulo be — kepc secuec

'T.Uhile i counuuC co keep) chis Oxch uuuiolxcED mxq ic be gRxucCD to me- co euioq lipe-xuo che pnxccice of che arc Respecceo bq xll meu iu xll ermes1 Buc shoulo 1 cues pass xud uiolxce — ’ chis Oxch. mxq che RevCRSC be mq loer

HfflfeeE

fi’*-im| f »chc* ivteh love iLJMX if H

I was first exposed to the Oath of Hip- pocrates when I was a callow medi- cal student in Trinity College, Dublin, in 1934. The oath was taste- fully hung in the vestibule of the School of Anatomy. On the first reading, I thought the oath was pompous. Next year when I began to see patients, I read the document again. This time I was transformed by the magic of its message and read the oath several times each year.

When I graduated in 1 939, there was no ceremonial reading of the oath. This did not bother me at all — I had the Oath of Hippocrates in my heart forever. Now, thanks to the generosity of my lovely daughter Sarah, I have a beautiful Hippo- cratic Oath [at left] hanging in my con- sulting room.

Hippocrates (460-377 B.C.) was the fa- ther of modern medicine. His principles of medical science were laid down 400 years before the birth of Christ, yet they formed the basis for the medical theory developed in the 1800s. The oath named for him gave the medical profession a sense of duty to mankind which it never lost — graduating medical students still take the oath.1

What is so amazing to me is the com- prehensive content of this oath written 2,400 years ago.

It starts off: According to my ability and judgment, / will keep this oath and stipula- tion— to reckon him who taught me this Art equally dear to me as my parents; to share my substance with him, and to re- lieve his necessities if required.

I will impart a knowledge of the Art to my sons and those of my teachers. Little did he know that 24 centuries later the daughters would also acquire the art and would be- come outstanding physicians and sur- geons.

I will follow that system of regimen which according to my ability and judg- ment, I consider for the benefit of my pa- tients, and abstain from whatever is delete- rious and mischievous.

I will not give to a woman a pessary to produce an abortion. I would hazard a

Leslie l. Morris, MD

guess that in ancient times, abortion had a mortality of 50 to 60 percent, at least. This may be the reason that Hippocrates avoided the procedure. I wonder, if he was confronted with a 14-year-old girl, pregnant from rape, whether he would deny her an abortion.

I will not cut persons laboring under the stone but will leave this to men who are practitioners of this work. Obviously he is warning students not to practice surgery without adequate training. Hippocrates also practiced surgery. He reduced dislo- cations of joints and set fractures; he bored holes in the skull to relieve pressure caused by brain tumors and other disorders.2

In whatever house / enter, I will go into them for the sick and will abstain from ev- ery voluntary act of mischief and corrup- tion; and further from the seduction of fe- males or males, of freemen and slaves.

Whatever I see or hear in the life of men which ought not to be spoken of abroad, I will not divulge as reckoning that all such should be kept secret.

This great document ends with a warn- ing: While I continue to keep the Oath un- violated may it be granted me to enjoy life and the practice of the Art, and respected by all men in all times!

But should / trespass and violate this Oath, may the reverse be my lot!

References

1. World Book Encyclopedia. 8:266, 1960.

2. World Book Encyclopedia. 8:227, 1960.

Reprinted by permission from the Bul- letin of the Allegheny County Medical Soci- ety, March 28, 1992.

Leslie E. Morris, MD, is clinical associate professor of medicine at the Universi- ty of Pittsburgh School of Medicine. He was chief of the Peripheral Vascular Clinic, Montefiore Hospital, for 16 years (1966-1982).

48

PENNSYLVANIA MEDICINE

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“Nearly 3A of the malpractice lawsuits that doctors lose reflect poor.patient communica- tion,” according to a recent article in the Wall Street Journal (March 17, 1992). Did you know something as simple as empathy could help protect you against medical malpractice litigation?

Curing and Caring -a half- day seminar sponsored by PMSLIC- addresses this vital component of medical care and how it could make a differ- ence in your own practice.

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Curing and Caring will be presented at the following locations, with a morning and afternoon session at each:

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For registration information contact the PMSLIC Risk Management Department at 800-445-1212 (PA) or 717-558-7500

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EMPATHY.

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PMSLIC

(INTENTS

AUGUST 1992 VOLUME 95 • NUMBERS

Call to Meeting

18 Official Call— 1 992 House of Delegates

Medical Society Officers 32 Pennsylvania Medical Society 34 County Medical Societies 43 Medical Specialty Societies

Health Care Information 29 Washington Information 46 Pennsylvania Health Agencies

Membership Directory 1 992 ■ 1 993

56 Member Specialty Codes and Statistics

57 Membership by County 190 Membership Alphabetically

Departments 48 Classified Advertising 50 Advertisers' Index

Covet photo by Blair Seitz®, Harrisburg

PENNSYLVANIA MEDICINE 111 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820 Telephone (717) 558-7750 Fax (717) 558-7840

PUBLICATION COMMITTEE

John W. Mills, MD, Chairman Mark V. Caliendo George R. Fisher III, MD Daniel S. Henriksen, MD Ferdinand L. Soisson Jr., MD

STAFF

Medical Editor:

John W. Mills, MD

Managing Editor:

Elaine S. Herrmann

Assistant Managing Editor: Maria T. Montesano

Production Assistant:

Stacy J. Bolden

Advertising Representative: Gordon V. Hamilton

Advertising Assistant:

Lorraine L. Rusinko

PENNSYLVANIA MEDICINE, estab- lished in 1897, is the official publication of the Pennsylvania Medical Society. All edito- rial and advertising correspondence should be directed to the Managing Editor.

All material subject to this copyright may be photocopied only for noncommercial scien- tific or educational purposes. The opinions of authors do not necessarily represent the policy of the publisher. The appearance of advertising does not guarantee or endorse the claims of the advertisers.

The publisher reserves the right to refuse any advertisement. All advertising is subject to approval. Advertiser and agency warrant that they are authorized and entitled to ad- vertise copy furnished; and hereby agree to indemnify and hold the publisher harmless against all claims, demands, damages, lia- bilities, and costs including counsel fees, arising out of or in any way caused by or connected with the printing and publishing of the advertising copy furnished by the ad- vertiser.

Copyright 1992:

Pennsylvania Medical Society.

PENNSYLVANIA MEDICINE (ISSN 0031 -4595) is published monthly by the Pennsylvania Medical Society, 777 East Park Drive, Harrisburg, PA 1 71 1 1 .

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POSTA^,STER^Send address changes to PENNSYLVANIA MEDICINE, 777 East Park Drive, PO Box 8820, Harrisburg, PA 1 7105-8820. Second class postage paid at risburg, PA 1 71 05. ^ ___ ___ ___ .

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Why? Because by continually making Pennsylvania’s healthcare system more efficient, we help ensure affordable access for more than six million Pennsylvanians.

Taking the physician’s view of practice perfection.

During the past five years, we’ve talked with hundreds of physicians and their office managers to find out how Pennsylvania Blue Shield could become more “practice friendly.” Overall, they wanted us to be more sensitive to their individual practice management needs.

They told us that faster payment was important. But they also wanted more control over how they accessed Blue Shield to get information relevant to their practices.

We listened. Here’s what we did.

• We made preparing and filing claims more con- venient, more than twice as fast.

• We provided immediate confirmation of claims received, with a hard copy follow-up sent through the mail.

• We made access to claims status seamless, fast and precise so that providers could accurately project their cashflow, streamline collec- tions and avoid filing unneces- sary duplicate claims.

• We provided instant access to patient information, includ- ing group number, coverage, eligible dependents, benefits explanations-— and more.

• We made it possible to reconcile accounts and post to accounts receivable in minutes, instead of hours or days.

• And most importantly, we kept the price of par- ticipation at low cost to providers without com- puter automation — at no cost to providers with compatible computer systems.

Support when you need it. Free.

Any electronic system needs expert support. We’ve got it — men and women committed to making Blue Shield responsive to your needs.

Call Kathy Smith: 1.800.992.0246 She’s got great news to share with you and your office manager.

▲ “Why go electronic? The doctor operates in the morning. The claim is entered into the computer and transmitted by evening. Payment arrives 6 days later. ”

— Donna Greytock Baird , MS. Business Administrator Practices of: Michael C. Raklewicz, MD: Daniel T. Davis. MD; and H. Alex Smith. Jr.. MD — Kingston

Go electronic. You’ll never look back.

If you don’t already have a Information entry, process, sort,

computer, you need: prep for mailing or transmission

• IBM/compatible* computer with monochrome monitor. DOS 3.3 or greater.

• Internal modem with MNP protocol.

• 80-column, dot matrix printer.

• Estimated Cost: $1,566. 00

Plus:

• FREE PBS Electronic Services Software Bundle, including Paperless Claims Express and Provider Inquiry.

Electronic: 5 minutes

Electronic transmission

vs. mail to Pennsylvania Blue Shield

Electronic: 4. 1 seconds

J

Paper: 2 days

Claims turnaround

• FREE PBS Electronic Services Technical Support.

Electronic: 7 days

*386 processor, 2Mb RAM. 40Mb internal hard drive. This system is more than enough to handle Blue Shield electronic billing. However, you can save hundreds by choos- ing a 286-based computer.

Not sure? Call Electronic Services Technical Support for expert advice.

Paper: 14 days

Pennsylvania

Blue Shield

Electronic Services

ANOT H E R P M S L I C P R O F I L E

“Unfortunately,

he was already sitting in my examining room. This guy was a walking liability suit looking for a victim. He was angry, non-compliant. It was one of those rare, no-win cases and, well, I guess my number was up.

Then I remembered PMSLIC. So I stepped into the next room and gave them a call. They put me in touch with a member of their Risk Management team, who advised me of the relevant legal issues and the implications of each of my alternatives. Right on the spot. As a result, I was able to make the best medical recommendation with

the peace of mind that comes from knowing my legal interests were also protected. I guess that's what it's all about. Peace of mind. The kind you only get from people who really take the time to help. That's excellent service. I'll never change carriers. 99

PMSLIC

Doctor Owned, Doctor Run.

777 East Park Drive Post Office Box 8375 Harrisburg PA 17105-8375 800.445.1212 in PA 717.558.7500

Make life easier for many of your patients

Humulin 70/30. Convenient and simple to administer.

No more mixing. No more mixing errors. All of which makes living with diabetes a little easier for patients. And compliance a lot easier to achieve.

Humulin

70% human insulin isophane suspension 30% human insulin injection (recombinant DNA origin)

Global Excellence in Diabetes Care

Eli Lilly and Company

Indianapolis, Indiana 46285

The patient-friendli / premix

WARNING: Any change of insulin should be made cautiously and only under medical supervision.

HI-7905-B-249327 ©1992. eli lilly and company

ou're on solid ground with the Dodson Plan.

M ore than 75 years ago, Bruce Dodson, Sr. pioneered the concept of the dividend plan for workers' compensation insurance. Dodson Group has been helping businesses like yours save on premium costs ever since.

The Dodson Plan gives you the opportunity to earn a dividend each year, depending on the claim experience of all insured members. We carefully select those who participate, creating the greatest potential for you to save.

Pennsylvania Medical Society endorsed the Dodson Plan in 1973. Since then, participating members have earned a total of $2,309,240 in dividends. Share in the savings!

You're on solid ground with Dodson,

DODSON GROUP 9201 State Line Road Kansas City, MO 64114

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Hahnemann University

Department of Medicine Grand Rounds Wednesdays 8:30 a.m.-9:30 a.m.

SEPTEMBER 1992

September 9, 1992

THE PATIENT WITH HEART DISEASE:

THE IMPORTANCE OF THE INITIAL EXAMINATION J. Willis Hurst, M.D.

Professor of Medicine Department of Medicine (Cardiology)

Emory University Atlanta, GA

September 16, 1992

CRITICAL CARE OF THE IMMUNOSUPPRESSED PATIENT

Harold L. Paz, M.D.

Assistant Professor of Medicine & Anesthesiology Director, Medical Intensive Care Units Hahnemann University

September 23, 1992

RACIAL DIFFERENCES IN CORONARY ARTERY DISEASE AND HYPERTENSION Charles K. Francis, M.D.

Professor of Clinical Medicine Columbia University College of Physicians and Surgeons Chairman, Department of Medicine Harlem Hospital Center, New York, NY

September 30, 1992

HEADLINE NEWS FOR THE INTERNIST:

TOPICS THAT WILL INFLUENCE YOUR CAREER David S. Kountz, M.D.

Assistant Professor of Medicine Codirector, Medical Residency Program Department of Medicine Hahnemann University

OCTOBER 1992

October 7, 1992

Yom Kippur-No Grand Rounds

October 14, 1992

MECHANISMS OF GUT PEPTIDES IN NEUROENDOCRINE DISORDERS Thomas O'Dorislo, M.D.

Professor of Medicine and Physiology Director, Division of Endocrinology Ohio State University, Columbus, Ohio

October 21, 1992

PULMONARY DISEASE Jay N. Nadel, M.D.

Professor of Medicine and Physiology Chief, Section of Pulmonary Diseases Director, Multidisciplinary Training Program in Lung Diseases, C.V.R.I.

University of Califomia/San Francisco San Francisco, CA

October 28, 1 992

NEW APPROACHES TO IDENTIFICATION OF MYOCARDIAL ISCHEMIA Leonard S. Dreifus, M.D.

Professor of Medicine Director, Division of Cardiology Hahnemann University J. Yasha Kresh, Ph D.

Professor and Director Department of Cardiothoracic Surgery and Professor of Medicine Director of Cardiovascular Biophysics and Computing Division of Cardiology Hahnemann University Amir Pelleg, Ph.D.

Associate Professor Division of Cardiology Hahnemann University

NOVEMBER 1992

November 4, 1992

HYPOTHYROIDISM: PATHOGENESIS AND IMMUNE MECHANISMS E. Chester Ridgway, III, M.D.

Professor of Medicine Head, Division of Endocrinology University of Colorado Health Science Center Denver, CO

November 11, 1992

CLINICAL REVIEW OF MORTALITY STUDIES IN CONGESTIVE HEART FAILURE Gary S. Francis, M.D.

Professor of Medicine

Cardiovascular Division

University of Minnesota School of Medicine

Minneapolis, MN

November 18, 1992

MECHANISMS AND NEW STRATEGIES FOR TREATING AUTOIMMUNE DISEASES David Wotsy, M.D.

Associate Professor of Medicine Chief, Rheumatology Division San Francisco VA Medical Center San Francisco, CA

November 25, 1992

Thanksgiving Holidays - No Grand Rounds

DECEMBER 1992

December 2, 1992

ASTHMA BY INGESTION: ASPIRIN, SULFITE, M.S.G., & TARTRAZINE SENSITIVITY Ronald Simon, M.D.

Associate Clinical Professor of Medicine & Pediatrics University of California/San Diego School of Medicine Head, Division of Allergy & Clinical Immunology Scripps Clinic and Research Foundation La Jolla, CA

December 9, 1992

CHOLESTEROL REDUCTION IN PRIMARY PREVENTION: UNANSWERED QUESTIONS AND UNANSWERED ANSWERS Jeremy Swan, M.D., Ph.D.

Professor of Medicine UCLA School of Medicine Los Angeles, CA

December 16, 1992

BREAST CANCER: DIAGNOSIS AND TREATMENT Michael P. Moore, M.D., Ph.D.

Assistant Professor of Surgery Cornell University School of Medicine Sloan-Kattering Cancer Center New York, NY

December 23, 1992

Christmas Holidays - No Ground Rounds

Hahnemann University Department of Medicine Wednesday Medical Seminar Series 8:30 a.m.-3:30 p.m.

September 16, 1992 CRITICAL CARE OF THE IMMUNOSUPPRESSED PATIENT Course Director: Harold L. Paz, M.D.

Guest Faculty: John M. Luce, M.D.

Paul Lankin, M.D.

October 21 , 1 992

PULMONARY MEDICINE

Course Director: Edward S. Schulman, M.D.

Guest Faculty: Jay A. Nadal, M.D.

November 18, 1992

MECHANISMS AND STRATEGIES FOR TREATING AUTOIMMUNE DISEASES Course Director: Richard L. Spielvogel, M.D. Guest Faculty: Alice Gottlieb, MD

Richard P. MacDermott, M.D. David Wotsy, M.D.

December 2, 1992 ASTHMA

Course Director: David M. Lang, M.D.

Guest Faculty: Ronald Simon, M.D.

December 16, 1992

BREAST CANCER:

DIAGNOSIS AND TREATMENT Course Codirectors: Jeffrey Brodsky, M.D.

Pamela Crilley, D.O.

Guest Faculty: Michael P. Moore, M.D., Ph.D.

Seminar Director: Location: For Information:

Allan B. Schwartz, M.D. Classroom C (Alumni Hall) Call the Office of Continuing Education

Professor and Vice Chairman of Medicine 2nd FL New College Building (215) 762-8263

Director, Continuing Medical Education for the Hahnemann University (1 5th Street Entrance)

Department of Medicine 15th and Vine Streets, Philadelphia, PA

As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Hahnemann University designates this continuing medical education activity as Category 1 of the Physician's Recognition Award of the American Medical Association. One credit hour may be claimed for each hour of participation by the individual physician. Conflict of Interest Statement: All faculty participating in continuing medical education programs sponsored by Hahnemann University are expected to disclose to the audience any real or apparent conflict(s) of interest related to the content of their presentation.

Malpractice rates too good to be true usually are.

You may have been told about lower rates offered by insurers new to the Pennsylvania market. Low rates will not benefit you if the company is not around to protect you or your assets if you are sued.

Physicians Insurance Company is an established Pennsylvania carrier who has continued to lower rates while protecting your future:

♦ 10% overall reduction in September 1991

♦ more for physician groups

♦ additional reductions for individuals who are claims free

Artificially low rates are a prescription for disaster., for the physician and the company. When selecting a malpractice carrier you should ask yourself what will happen in the future. Will they automatically surcharge my premium for claims experience? Will their policy provide me with the full Occurrence coverage I have enjoyed with Physicians Insurance Company or are they only providing a form of Claims-Made

coverage — better known as Occurrence Plus or Permanent Protection? Why would a broker recommend this carrier... is the company only trying to buy my business by raising his commission? More importantly, will they be there when I need them?

At Physicians Insurance Company we have always maintained our rates among the lowest and we are committed to keeping this practice intact. When you take an honest look, you can’t do better.

For more information on malpractice rates and coverage, please call or write today.

1

PHYSICIANS

INSURANCE

C 0~M PA\ N Y

800-462-0492 ♦ 215-834-6960 525 Plymouth Road, Suite 315 Plymouth Meeting, PA 19462

PHILADELPHIA HEART INSTITUTE

at Presbyterian Medical Center

I Cardiology Update V

designed for the physician and provides an intensive survey of the current status of clinical cardiology . . .

Wednesday, September 9, 1992 3:00-5:00 PM

Office Cardiology: Bedside Diagnosis of the Cardiac Patient-Part I

Moderator: Bernard L. Segal, M.D.

Patients will be presented with interesting clinical findings. Carotid and jugular venous pulsation will be analyzed. The precordium will be palpated to determine abnormal impulses. Heart sounds and murmurs will be interpreted in light of the patient's symptoms and the clinical findings. Stethophones will be available at each seat so that the audience will be able to hear and interpret these findings.

■ Case Presentations-Marc Tecce, M.D.

■ Panel Discussion-Michael Feldman , M.D., Terry Langer, M.D.,

Marvin Rosner, D. O.

■ CME Credits*

■ No Registration Fee

■ Call for Reservation 662-8627

Scheie Auditorium

Presbyterian Medical Center 39th & Market Streets Philadelphia, Pennsylvania 19104

The Philadelphia Heart Institute at Presbyterian Medical Center is an affiliate of the University of Pennsylvania.

* Presbyterian Medical Center designates this continued medical education activity for 2 credit hours in Category I of the Physicians’ Recognition Award of the American Medical Association and the Pennsylvania Medical Society Membership requirement. Nine sessions, 18 credits.

J

Why buy an office automation system that doesn’t offer a long-term solution?

ACCLAIM™ from Sentient is the total system solution.

A lot of medical practices are planning to invest in an office automation system. But a lot of the systems out there just don’t offer the comprehensive functions and long-term expandability that your practice may need.

IBM® and compatible hardware.

The ACCLAIM system operates on IBM and compatible hardware, so you know you’re getting the quality standard of the industry. And it’s completely expandable, so it can grow as your practice grows.

Long-term support.

ACCLAIM is the system solution that fits your needs today. And Sentient’s software engineers, customer trainers, and telephone support people

are always there to make sure your system fits your needs over the years to come.

Easy to operate.

Even if your staff has no previous computer experience, ACCLAIM is simple to operate effectively and efficiently. Complete training is included in the purchase.

When you’re thinking about office automation, call Sentient first, and find out what ACCLAIM can do for you.

1-800-247-9419

(In the D.C. Metro area call 1-301-929-7600.)

SENTIENT

SYSTEMS

We set the standard in medical computing.

With Princeton, you're in good company.

More than 19,000 medical and health care professionals have chosen Princeton Insurance Company for their professional liability insurance coverage. Here are some reasons why:

• A solid track record.

Princeton has a decade of experience providing profes- sional liability insurance coverage to physicians, and A.M. Best has ranked us (with our parent company) among the 20 largest medical malprac- tice insurers nationwide since 1983.

/

• Financial strength. Our

loss reserves are carried at full value, not discounted in the hope of earning sufficient interest income to pay claims.

We maintain a high quality/low risk investment portfolio, with no junk bonds, no common stock and no real estate specu- lation. And we've earned a claims-paying ability rating of "A" from Standard & Poor's.

• Coverage options. Tail coverage is included in the purchase price of Princeton's innovative Occurrence Plus policy. A standard claims-made policy is also available, and we offer excess liability coverage (limits up to $5 million) to Pennsylvania physicians regardless of which company writes their primary coverage.

• Strong defense against claims. In a typical year, more than 90 percent of the

Princeton-managed cases disposed of by the courts are resolved in the policyholder's favor.

It may be easier than you think to change insurance Compa- nies. Call today to find out more or return the coupon to receive a copy of our brochure, "It's Princeton's Specialty."

Princeton Insurance Company

214 Senate Avenue Suite 710

Camp Hill, PA 17011-2336 (717) 737-0206

Yes! I'd like to learn why doctors are making Princeton their choice for professional liability insurance. Please send me a copy of your "It's Princeton's Specialty" brochure.

Name:

Address:

City: State: Zip:

Telephone: ( )

Clip and mail to:

Princeton Insurance Company, Attn: Communications, 746 Alexander Road, Princeton, NJ 08540-6305.

ENNSYLVANIA MEDICAL SOCIETY PRESIDENTS

The presidents of the Pennsylvania Medical Society, from its beginning to the present, are honored and remembered by this special listing in the Membership Directory.

*1848

Samuel Humes, MD

Lancaster County

*1921

Frank G. Hartman, MD

Lancaster County

*1849

Samuel Jackson, MD

Philadelphia County

*1922

Lawrence Litchfield, MD

Allegheny County

*1850

Wilmer Worthington, MD

Chester County

*1923

Howard C. Frontz, MD

Huntingdon County

*1851

Charles Innes, MD

Northampton County

*1924

J. Norman Henry, MD

Philadelphia County

*1852

Hiram Corson, MD

Montgomery County

*1925

Ira G. Shoemaker, MD

Berks County

*1853

John P. Heister, MD

Berks County

*1926

Harry W. Albertson, MD

Lackawanna County

*1854

Jacob M. Grimmill, MD

Huntingdon County

*1927

Arthur C. Morgan, MD

Philadelphia County

*1855

James S. Carpenter, MD

Schuylkill County

*1928

Thomas C. Simonton, MD

Allegheny County

*1856

Rene La Roche, MD

Philadelphia County

*1929

William T. Sharpless, MD

Chester County

*1857

John L. Atlee, MD

Lancaster County

*1930

Ross V. Patterson, MD

Philadelphia County

*1858

Smith Cunningham, MD

Beaver County

*1931

William H. Mayer, MD

Allegheny County

*1859

D. Francis Condie, MD

Philadelphia County

*1932

Charles Falkowsky Jr., MD

Lackawanna County

*1860-61

Edward Wallace, MD

Berks County

*1933

Donald Guthrie, MD

Bradford County

*1862

George F. Horton, MD

Bradford County

*1934

Moses Behrend, MD

Philadelphia County

*1863

Wilson Jewell, MD

Philadelphia County

*1935

Alexander H. Colwell, MD

Allegheny County

*1864

J. D. Ross, MD

Blair County

*1936

Maxwell Lick, MD

Erie County

*1865

William Anderson, MD

Indiana County

*1937

Frederick J. Bishop MD

Lackawanna County

*1866

James King, MD

Allegheny County

*1938

David W. Thomas, MD

Clinton County

*1867

Traill Green, MD

Northampton County

*1939

Charles H. Henninger, MD

Allegheny County

*1868

John Curwen, MD

Dauphin County

*1940

Francis F. Borzell, MD

Philadelphia County

*1869

William M. Wallace, MD

Erie County

*1941

Lewis T. Buckman, MD

Luzerne County

*1870

Samuel D. Gross, MD

Philadelphia County

*1942

Robert L. Anderson, MD

Allegheny County

*1871

J. S. Crawford, MD

Lycoming County

*1943

Augustus S. Kech, MD

Blair County

*1872

A. M. Pollock, MD

Allegheny County

*1944

William Bates, MD

Philadelphia County

*1873

S. B. Kiefer, MD

Cumberland County

*1945

William L. Estes Jr., MD

Northampton County

*1874

Washington L. Atlee, MD

Philadelphia County

*1946

Howard K. Petry, MD

Dauphin County

*1875

Crawford Irwin, MD

Blair County

*1947

Elmer Hess, MD

Erie. County

*1876

Robert B. Mowry, MD

Allegheny County

*1948

Gilson Colby Engel, MD

Philadelphia County

*1877

D. Hayes Agnew, MD

Philadelphia County

*1949

E. Roger Samuel, MD

Northumberland County

*1878

J. L. Stewart, MD

Erie County

*1950

Harold B. Gardner, MD

Allegheny County

*1879

Andrew Nebinger, MD

Philadelphia County

*1951

Louis W. Jones, MD

Luzerne County

*1880

John T. Carpenter, MD

Schuylkill County

*1952

Theodore R. Fetter, MD

Philadelphia County

*1881

Jacob L. Zeigler, MD

Lancaster County

*1953

James L. Whitehall, MD

Beaver County

*1882

William Varian, MD

Crawford County

*1954

Dudley P. Walker, MD

Northampton County

*1883

Henry H. Smith, MD

Philadelphia County

*1955

Robert L. Schaeffer, MD

Lehigh County

*1884

Ezra P. Allen, MD

Bradford County

*1956

Elmer G. Shelley, MD

Erie County

*1885

E. A. Wood, MD

Allegheny County

*1957

John W. Shirer, MD

Allegheny County

*1886

Rees Davis, MD

Luzerne County

*1958

John T. Farrell Jr., MD

Philadelphia County

*1887

Richard J. Levis, MD

Philadelphia County

1959

Allen W. Cowley, MD

Dauphin County

*1888-89

J. B. Murdoch, MD

Allegheny County

*1960

Thomas W. McCreary, MD

Beaver County

*1890

Alexander Craig, MD

Lancaster County

*1961

Daniel H. Bee, MD

Indiana County

*1891

Samuel L. Kurtz, MD

Berks County

*1962

W. Benson Harer, MD

Delaware County

*1892

Henry L. Orth, MD

Dauphin County

1963

Wilber E. Flannery, MD

Lawrence County

*1893

H. G. McCormick, MD

Lycoming County

*1964

Richard A. Kern, MD

Philadelphia County

*1894

John B. Roberts, MD

Philadelphia County

1965

William B. West, MD

Huntingdon County

*1895

William S. Foster, MD

Allegheny County

*1966

J. Everett McClenahan, MD

Allegheny County

*1896

E. E. Montgomery, MD

Philadelphia County

*1967

John H. Harris, MD

Dauphin County

*1897

W. Murray Weidman, MD

Berks County

1968

George E. Farrar Jr., MD

Philadelphia County

*1898

Webster B. Lowman, MD

Cambria County

1969

William A. Barrett, MD

Allegheny County

*1899

George W. Guthrie, MD

Luzerne County

1970

William A. Limberger, MD

Chester County

*1900

Thomas D. Davis, MD

Allegheny County

1971

George P. Rosemond, MD

Philadelphia County

*1901

Francis P. Ball, MD

Clinton County

1972

Robert S. Sanford, MD

Tioga County

*1902

William M. Welch, MD

Philadelphia County

*1973

Ralph C. Wilde, MD

Allegheny County

*1903

William B. Ulrich, MD

Delaware County

*1974-75

A. Reynolds Crane, MD

Philadelphia County

*1904

Adolph Koenig, MD

Allegheny County

1976

David S. Masland, MD

Cumberland County

*1905

William H. Hartzell, MD

Lehigh County

1977

William J. Kelly, MD

Allegheny County

*1906

Isaac C. Gable, MD

York County

*1978

John V. Blady, MD

Philadelphia County

*1907

William L. Estes, MD

Northampton County

1979

John B. Lovette, MD

Cambria County

*1908

George W. Wagoner, MD

Cambria County

1980

Matthew Marshall Jr., MD

Allegheny County

*1909

Theodore B. Appel, MD

Lancaster County

1981

Leroy A. Gehris, MD

Berks County

*1910

John B. Donaldson, MD

Washington County

1982

Raymond C. Grandon, MD

Dauphin County

*1911

James Tyson, MD

Philadelphia County

1983

Michael P. Levis, MD

Allegheny County

*1912

Lewis H. Taylor, MD

Luzerne County

1984

John Y. Templeton III, MD

Philadelphia County

*1913-14

Edward B. Heckel, MD

Allegheny County

*1985

D. Ernest Witt, MD

Columbia County

*1915

John B. McAlister, MD

Dauphin County

1986

R. William Alexander, MD

Berks County

*1916

Charles A. E. Codmand, MD

Philadelphia County

1987

R. Robert Tyson, MD

Philadelphia County

*1917

Samuel G. Dixon, MD

Philadelphia County

1988

Donald E. Harrop, MD

Chester County

*1917

Walter F. Donaldson, MD

Allegheny County

1989

Gerald L. Andriole, MD

Luzerne County

*1918

Frederick L. Van Sickel, MD

Lackawanna County

1990

J. Joseph Danyo, MD

York County

*1919

Cyrus Lee Stevens, MD

Bradford County

1991

Gordon K. MacLeod, MD

Allegheny County

*1920

Henry D. Jump, MD

Philadelphia County

1992

Robert N. Moyers, MD

Crawford County

‘Deceased

16

PENNSYLVANIA MEDICINE

"The Health Care Group ; the most comprehensive and experienced health care practice management firm in the nation , is unrivalled in its knowledge , experience and breadth of services."

Health Care Group

Meetinghouse Business Center 140 W. Germantown Pike, Suite 200 Plymouth Meeting, PA 19462 (800) 441-0737

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HEALTH CARE LAW ASSOCIATES, P.C.

HEALTH CARE MARKETING ASSOCIATES, LTD.

FFICIAL CALL TO 1 992 MEETING

The 1992 annual meeting of the House of Delegates of the Pennsylvania Medical Society will be called to order at the Adam’s Mark Hotel, Philadelphia, Pennsylvania, on Friday, October 23, at 10:00 a.m. The second session of the House of Delegates is scheduled for Saturday,

October 24, at 1:00 p.m. The third and concluding session of the House of Delegates will be held Sunday, October 25, at 9:30 a.m.

ELECTIONS

In accordance with Chapter XII, Section 1 of the Bylaws of the Pennsylvania Medical Society, the following nominations and/or elections will be in order. Nominations for AMA delegates will be in order at the first session on Friday morning, October 23, 1992, and elections will occur on Saturday morning, October 24, 1992. Nominations for all other offices will be in order at the second session, Saturday afternoon, October 24, 1992, and elections will occur on Sunday morning, October 25, 1992.

General officers to be elected are a vice president, a speaker of the House of Delegates, and a vice speaker of the House of Delegates.

In accordance with Chapter XIV, Section 5 of the Bylaws, elections will be in order for a trustee for the First District to succeed George R. Fisher, in, MD, Philadelphia County, who is eligible for reelection; a trustee for the Third District to succeed John H. Hobart, MD, Lackawanna County, who is not eligible for reelection; a trustee for the Eighth District to succeed Robert L. Lasher, MD, Erie County, who is eligible for reelection; a trustee for the Ninth District to succeed John W. Mills, MD, Indiana County, who is eligible for reelection; a trustee for the Hospital Medical Staff Section to succeed Lee H. McCormick, MD, who is eligible for reelection; a trustee for the Young Physicians Section to succeed Richard J. Greco, MD, who is eligible for reelection; and

a trustee for the Medical Student Section to succeed Mark V. Caliendo, who is eligible for reelection.

If the report of the Board of Trustees regarding restructuring is adopted by the House of Delegates, an election for a trustee for the new Thirteenth District (Allegheny County) for a three-year term will also be in order.

If the proposed Bylaws amendments submitted by David E. Wiley, DO, are adopted which will redistrict Pennsylvania from twelve districts to six districts, elections will be in order for a trustee for the First District for a three-year term and for trustees for new Districts Two through Six, with straws being drawn by the Speaker to determine one, two, and three-year terms.

If the proposed Bylaws amendments submitted by Robert B. Sklaroff, MD, are adopted which would redistrict Pennsylvania from twelve districts to ten districts, Dr. Sklaroff s implementation plan calls for district trustee elections to be held as follows: 1992 — First and new Fourth, Ninth, and Tenth Districts; 1993 — Fifth and new Second and Eighth Districts; 1994 — New Third, Sixth, and Seventh Districts. Reference Committee A will make a recommendation to the House of Delegates on the implementation plan.

In accordance with Chapter X, Section 1 of the Bylaws, elections for delegates and alternate delegates to the American Medical Association are in order. In accordance with Standing Rule Number 1 0 (adopted October 22, 1982), elections for delegates will be held on Saturday morning, October 24, 1992, and elections for alternate delegates will be held on Sunday morning, October 25, 1992.

Delegates whose terms expire December 31, 1992, are:

1 . R. William Alexander, MD (Berks County)

2. Doris G. Bartuska, MD (Philadelphia County)

3. Joseph B. Blood, Jr., MD (Bradford County)

4. Betty L. Cottle, MD (Blair County)

5. James B. Donaldson, MD (Philadelphia County)

6. Victor F. Greco, MD (Luzerne County)

7. Lee H. McCormick, MD (Allegheny County).

8. John S. Parker, MD (Westmoreland County)

9. Howard A. Richter, MD (Delaware County)

10. Roberta L. Schneider, MD (Montgomery County)

1 1 . Donald H. Smith, MD (Northampton County)

12. Vacancy

The Committee to Nominate Delegates and Alternates to the AMA makes the following nominations for twelve (12) delegates for two (2) years commencing January 1, 1993, and expiring December 31, 1994:

1 . R. William Alexander, MD (Berks County)

2. Richard D. Baltz, MD (Dauphin County)

3. Doris G. Bartuska, MD (Philadelphia County)

4. Joseph B. Blood, Jr., MD (Bradford County)

5. George F. Buerger, Jr., MD (Allegheny County)

6. Betty L. Cottle, MD (Blair County)

7. James B. Donaldson, MD (Philadelphia County)

8. Victor F. Greco, MD (Luzerne County)

9. Lee H. McCormick, MD (Allegheny County)

10. John S. Parker, MD (Westmoreland County)

1 1 . Howard A. Richter, MD (Delaware County)

12. Roberta L. Schneider, MD (Montgomery County)

13. Alan H. Schragger, MD (Lehigh County)

14. Donald H. Smith, MD , (Northampton County)

Alternate delegates whose terms expire December 31, 1992, are:

18

PENNSYLVANIA MEDICINE

Magee Rehabilitation Hospital is dedicated to building on strengths for independence by providing the highest quality of care. We offer the following outstanding physical medicine and rehabilitation services:

• Stroke

• Physiatric Consultations

• Industrial Rehabilitation

• Injury Prevention

• Amputation/Orthopaedics

• Neurologic Disorders

Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF).

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MAGEE

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• Spinal Cord Injury

• Brain Injury

• Pain Management

• Vocational Services

• Professional Education

• Outpatient Care

FFICIAL CALL TO 1 992 MEETING

1 . Elias Abrutyn, MD (Philadelphia County)

2. Richard D. Baltz, MD (Dauphin County)

3. James M. Brian (Philadelphia County — Slotted Medical Student Position)

4. Charles J. Cattano, MD (Allegheny County)

5. J. Joseph Danyo, MD (York County)

6. Thomas F. Freenock, Jr., MD (Delaware County — Slotted Resident Physician Position)

7. Joseph F. Girone, MD (Philadelphia County)

8. Robert M. Kemp, MD (Lancaster County)

9. John D. Lane, MD (Bucks County)

10. John A. Malcolm, Jr., MD (Union County)

1 1 . Carl A. Sirio, MD (Dauphin County)

12. Vacancy

The Committee to Nominate Delegates and Alternates to the AMA makes the following nominations for eleven (11) alternate delegates for two (2) year terms commencing January 1, 1993, and expiring December 31, 1994, and one (1) alternate delegate for a one ( 1 ) year term commencing January 1, 1993, and expiring December 31, 1993.

1. Elias Abrutyn, MD (Philadelphia County)

2. Isadora Brodsky, MD (Philadelphia County)

3. Winston M. Bryant, Jr., MD (Philadelphia County)

4. Charles J. Cattano, MD (Allegheny County)

5. J. Joseph Danyo, MD (York County)

6. Robert G. Doe, MD (Lancaster County)

7. Thomas F. Freenock, Jr., MD (Delaware County)

8. Julian Katz, MD (Philadelphia County)

9. Robert M. Kemp, MD (Lancaster County)

10. John D. Lane, MD (Bucks County)

11. John A. Malcolm, Jr., MD (Union County)

12. Carl A. Sirio, MD (Dauphin County)

13. Ferdinand L. Soisson, Jr., MD (Cambria County)

The Committee to Nominate Delegates and Alternates to the AMA makes the following nomination for one slotted position for alternate delegate for a medical student for a one-year term commencing January 1, 1993, and expiring December 31, 1993:

1. James M. Brian (Medical Student Section)

The Committee to Nominate Delegates and Alternates to the AMA makes the following nomination for one slotted position for alternate delegate for a resident physician for a one- year term commencing January 1, 1993, and expiring December 31, 1993:

1 . Michael P. Moulton, MD (Resident Physician Section)'

Also to be elected will be one member to serve on the Committee to Nominate Delegates and Alternates to the AMA. The term of Wilma C.

Light, MD (Westmoreland County) expires; she is eligible for reelection.

In accordance with Chapter - XVII, Section 2 of the Bylaws, the Board of Trustees nominates the following members for two vacancies on the Judicial Council. For the office now held by Kenneth L. Cooper, MD (Lycoming County), who is not eligible for reelection, the Board nominates Betty L. Cottle, MD (Blair County); James L.

Harrison, MD (Lycoming County); and Charles A. Laubach, Jr., MD (Montour County). For a one-year term for the vacancy created by the death of D. Ernest Witt, MD (Columbia County), the Board nominates Henry H. Fetterman, MD (Lehigh County); Donald E. Harrop, MD (Chester County); and David L. Miller, MD (Clarion County).

Set forth below is the text of the proposed bylaws amendments. Deletions from existing bylaws are indicated by brackets; additions are italicized.

SUBJECT ONE

BOARD REDISTRICTING.

(1-A) The Board of Trustees directed the Committee on Bylaws to develop appropriate Bylaws language, for inclusion in the Official Call for consideration by the 1992 House of Delegates, creating a new Thirteenth District consisting of Allegheny County and a Tenth District consisting of Beaver, Lawrence, and Westmoreland Counties.

Chapter XIV - The Board of Trustees

Section 4 - Districts -

For purposes of this Society the counties in the Commonwealth of Pennsylvania shall be divided into the following [twelve] thirteen districts:

First District - Philadelphia County.

Second District - Berks, Bucks, Chester, Delaware, Lehigh, and Montgomery counties.

Third District - Carbon, Lackawanna, Monroe, Northampton, Pike, and Wayne counties.

Fourth District - Columbia, Montour, Northumberland, Schuylkill, and Snyder counties. Fifth District - Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.

Sixth District - Blair, Centre, Clearfield, Huntingdon, Juniata, and Mifflin counties.

Seventh District - Cameron, Clinton, Elk, Lycoming, Potter, Tioga, and Union counties. Eighth District - Crawford, Erie, Forest, Mercer, McKean, and Warren counties.

Ninth District - Armstrong, Butler, Clarion, Indiana, Jefferson, and Venango counties. Tenth District - [Allegheny,] Beaver, Lawrence, and

20

PENNSYLVANIA MEDICINE

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We recognize that continuity of service is the key to earning your confidence... and the referrals, which are the lifeline of our business.

In the area of disability insurance, for example, we have serviced 33 long term claims with 100% satisfac- tion to the physicians involved. And we are organized to assure that you will receive comprehensive policy service throughout your career.

Malachy Whalen's primary function is to understand the long term busi- ness objectives of each practice. . . to be aware of the physicians' short and long term financial goals. . . and to recommend the most effective and most economical insurance cur- rently available.

Peggy McNamee and her staff are responsible for policy execution, keeping beneficiary information and other details up-to-date, paying divi- dends and providing answers about the status of your policies.

Claude Whalen specializes in finan- cial and estate planning. He is licensed in the full line of life and disability insurance as well as being N.A.S.D. licensed for equity sales.

He provides fundamental insurance planning advice as well as an inde- pendent view as a balance to more specialized financial planning.

Clark Whalen has a B. A. in econom- ics and is currently an M.B.A. candi- date. His responsibility is on-going research — tracking changes in insurance products and defining the options that are most appropriate for medical students, residents and prac- ticing physicians.

Continuity of service means that Malachy Whalen and Company will be here to act on your behalf when claims occur. We will file the required documentation and follow- up to assure timely payment .

Malachy Whalen & Company, Inc.

Henry W. Oliver Building • Pittsburgh, PA 15222 (412) 281-4050 • (800) 343-5382 Fax: (412) 261-5955

FFICIAL CALL TO 1 992 MEETING

Westmoreland counties. Eleventh District - Bedford, Cambria, Fayette, Greene, Somerset, and Washington counties.

Twelfth District - Bradford, Luzerne, Sullivan, Susquehanna, and Wyoming counties. Thirteenth District - Allegheny County.

Chapter XIV - The Board of Trustees

Section 6 - Terms. . .

District trustees’ terms shall be so arranged [so that no more than four shall expire at an annual meeting of the House of Delegates] that at two of three annual meetings of the House of Delegates the terms of four members shall expire, and at the remaining annual meeting of the House of Delegates the terms of five members shall expire.

(1-B) David E. Wiley, DO, proposes redistricting Pennsylvania into six trustee districts, each with approximately 3,000 members per district. The proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

[Chapter XIV - The Board of Trustees

Section 4 - Districts -

For purposes of this Society the counties in the Commonwealth of Pennsylvania shall be divided into the following twelve districts:

First District - Philadelphia county.

Second District - Berks, Bucks, Chester, Delaware, Lehigh, and Montgomery counties.

Third District - Carbon,

Lackawanna, Monroe, Northampton, Pike, and Wayne counties.

Fourth District - Columbia, Montour, Northumberland, Schuylkill, and Snyder counties. Fifth District - Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.

Sixth District - Blair, Centre, Clearfield, Huntingdon, Juniata, and Mifflin counties.

Seventh District - Cameron, Clinton, Elk, Lycoming, Potter, Tioga, and Union counties. Eighth District - Crawford, Erie, Forest, Mercer, McKean, and Warren counties.

Ninth District - Armstrong, Butler, Clarion, Indiana, Jefferson, and Venango counties. Tenth District - Allegheny, Beaver, Lawrence, and Westmoreland counties.

Eleventh District - Bedford,

When you refer a patient to D.T. Watson for physical rehabilitation, we take an intensive approach to treat- ment. Providing infants, children and adults with the latest, most sophisti- cated procedures and technology

Our services include everything from the treatment of brain and spinal cord injuries to stroke and general rehabilitation. And each step of the way we keep you advised of your patient’s progress. With your skills and ours, we can render the total care every patient needs to return to a full, productive life.

For further information, call our medical director at 1-800/922-4226.

DT WATSON

Rdhabilitation Hospital

Camp Meeting Road, Sewickley, Pennsylvania 15143

22

PENNSYLVANIA MEDICINE

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FFICIAL CALL TO 1 992 MEETING

Cambria, Fayette, Greene, Somerset, and Washington counties.

Twelfth District - Bradford, Luzerne, Sullivan, Susquehanna, and Wyoming counties.]

Chapter XIV - The Board of Trustees

Section 4 - Districts -

For purposes of this Society, the

counties in the Commonwealth of Pennsylvania shall be divided into the following six districts:

First District - Philadelphia County.

Second District - Berks, Bucks, Chester, Delaware, and Montgomery counties.

Third District - Adams, Blair, Centre, Cumberland, Dauphin,

For nearly 20 years, individual physicians and group prac- tices have relied on our firm for sound financial guidance and productive management counsel. The experienced professionals of the Hagan McClintock Health Care Services Group can help your practice perform more efficiently and profitably through a variety of specialized services.

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Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, and York counties. Fourth District - Armstrong, Beaver, Bedford, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland counties.

Fifth District - Allegheny county. Sixth District - Bradford, Carbon, Clinton, Columbia, Lackawanna, Lehigh, Luzerne, Lycoming, Monroe, Montour, Northampton, Northumberland, Pika, Potter, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, and Wyoming counties.

(1-C) Robert B. Sklaroff, MD proposes redistricting Pennsylvania into ten trustee districts. The proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

[Chapter XIV - The Board of Trustees

Section 4 - Districts -

For purposes of this Society the counties in the Commonwealth of Pennsylvania shall be divided into the following twelve districts:

First District - Philadelphia County.

Second District - Berks, Bucks, Chester, Delaware, Lehigh, and Montgomery counties.

Third District - Carbon, Lackawanna, Monroe, Northampton, Pike, and Wayne counties.

Fourth District - Columbia, Montour, Northumberland, Schuylkill, and Snyder counties. Fifth District - Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.

Sixth District - Blair, Centre, Clearfield, Huntingdon, Juniata,

24

PENNSYLVANIA MEDICINE

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FFICIAL CALL TO 1 992 MEETING

and Mifflin counties.

Seventh District - Cameron, Clinton, Elk, Lycoming, Potter, Tioga, and Union counties.

Eighth District - Crawford, Erie, Forest, Mercer, McKean, and Warren counties.

Ninth District - Armstrong,

Butler, Clarion, Indiana, Jefferson, and Venango counties. Tenth District - Allegheny,

Beaver, Lawrence, and Westmoreland counties.

Eleventh District - Bedford, Cambria, Fayette, Greene, Somerset, and Washington counties.

Twelfth District - Bradford, Luzerne, Sullivan, Susquehanna, and Wyoming counties.]

Chapter XIV - The Board of Trustees

Section 4 - Districts -

For purposes of this Society the counties in the Commonwealth of Pennsylvania shall be divided into the following ten districts:

First District - Philadelphia County.

Second District - Bucks and Montgomery counties.

Third District - Berks, Chester, and Delaware counties.

Fourth District - Carbon, Lackawanna, Lehigh, Monroe, Northampton, Pike, and Wayne counties.

Fifth District - Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.

Sixth District - Blair, Centre, Clearfield, Columbia, Huntingdon, Juniata, Mifflin, Montour, Northumberland, Schuylkill, Snyder, and Union counties. Seventh District - Bradford, Clinton, Luzerne, Lycoming,

Potter, Sullivan, Susquehanna, Tioga, and Wyoming counties. Eighth District - Bedford,

Cambria, Fayette, Greene, Somerset, Washington, and Westmoreland counties.

Ninth District - Allegheny county. Tenth District - Armstrong,

Beaver, Butler, Cameron, Clarion,

Crawford, Elk, Erie, Forest, Indiana, Jefferson, Lawrence, Mercer, McKean, Venango, and Warren counties.

SUBJECT TWO

SOCIETY LEADERSHIP.

(2-A) Dr. David E. Wiley’s proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

Chapter XII - Officers Section 7 - Duties of Officers. . .

а. The president shall:

1 . [be an ex officio member] serve as chairman of the Board of Trustees with the right to vote;

2. be an ex officio member of the House of Delegates without the right to vote;

3. be an ex officio member of all committees and commissions without the right to vote;

4. fill vacancies on administrative councils, commissions, or standing committees according to these bylaws;

5. delegate duties to the president elect, vice president, and the immediate past president;

б. file a report on the term as president with the House of Delegates at its annual meeting; [and]

7. address the House of Delegates at its annual meeting during the opening session; and

8. be an ex officio member of the Committee to Nominate Delegates and Alternates to the American Medical Association without the right to vote. . . .

d. The immediate past president shall:

[ 1 . be an ex officio member of the Board of Trustees with the right to vote;]

[2.] 1. be an ex officio member of the House of Delegates without the right to vote;

[3.] 2. be an ex officio member of the Committee to Nominate Delegates and Alternates to the

American Medical Association without the right to vote; and [4.] 3. perform such duties as may be delegated by the president. . .

Chapter XIV - The Board of Trustees

Section 3 - Composition -

The Board of Trustees shall consist of the president, president elect, the vice president, [the immediate past president,] the speaker of the House of Delegates, the vice speaker of the House of Delegates, ex officio with the right to vote, . . .

Chapter XIV - The Board of Trustees

Section 10 - Board Officers -

At the first meeting of the Board of Trustees after the annual meeting of the House of Delegates, it shall elect, from among the voting trustees, [a chairman,] a vice chairman and a secretary to serve until the next such meeting of the Board and until their successors are elected.

(2-B) Dr. Robert B. Sklaroff s proposed language was submitted with the requisite number of signatures of active or associate members of the Society. /

Chapter XII - Officers Section 7 - Duties of Officers. .

a. The president shall:

1 . be an ex officio member of the Board of Trustees with the right to vote; throughout the year of the term, the president shall either serve as chairperson of the Board of Trustees or shall designate a member of the Board to serve in this capacity. . . .

Chapter XIV - The Board of Trustees

Section 10 - Board Officers -

At the first meeting of the Board of Trustees after the annual meeting of the House of Delegates, it shall elect, from

26

PENNSYLVANIA MEDICINE

among the voting trustees, [a chairman,] a vice [chairman] chairperson and a secretary to serve until the next such meeting of the Board and until their successors are elected. Throughout the year of the term, the president shall either serve as chairperson of the Board of Trustees or shall designate a member of the Board to serve in this capacity.

SUBJECT THREE

SELECTION OF MEMBERS OF SUBSIDIARY BOARDS.

(3-A) Dr. David E. Wiley's proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

Chapter X - Nominations Section 1 - Origin of Nomination . . .

Nominations for directors of any

subsidiary organization owned directly or indirectly by the Society shall be made by the Committee to Nominate Directors of Subsidiaries and published in the Official Call.

Chapter XV - Committees, Administrative Councils and Commissions Section 2 - Standing Committees - This Society shall have the following standing committees:... Committee to Nominate Directors of Subsidiaries. . . g. Committee to Nominate Directors of Subsidiaries. The committee shall consist of five members elected by the House of Delegates to serve a term of three years. It shall be the duty of the committee to submit to the House of Delegates a list of nominees for positions as directors on subsidiary boards owned directly or indirectly in whole or in part by

the Society to which the Society is entitled to appoint directors.

(3-B) Dr. Robert B. Sklaroff s proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

Chapter X - Nominations Section 1 - Origin of Nomination...

Four directors of each subsidiary board shall be elected by the House of Delegates. Two shall be elected each year for two-year terms. No individual may serve more than three successive two-year terms following election by the House of Delegates. (In 1992, two shall be elected for two-year terms and two shall be elected for one-year terms.) Nominations for directors of any subsidiary organization owned directly or indirectly by the Society shall be made by the Committee to Nominate Directors

It's Not By Accident That We See Over 7,000 Children A Year. Usually, It's By Referral

Although it is sometimes an accident that causes a child to need the services offered by the Kennedy Krieger Institute, most often it’s a physician, in a practice like yours, that points the child’s family in the right direction.

The Kennedy Krieger Institute evaluates children and adolescents with disorders of the brain and helps them participate as fully as possible in family, school and community life. The Institute offers inpatient and outpatient hospital services, a school and a host of community programs for children with disabilities.

Our team of dedicated specialists and professionals provides quality services for youngsters of any age with:

• Cerebral Palsy

• Feeding Disorders

• Behavior Problems

• Down Syndrome

• Birth Defects

• Other Special Needs

To make a referral, or to speak with a Referral Specialist, please call:

(410)550-9400 1-800-873-3377 707 North Broadway Baltimore, MD 21 205

• Learning Problems and Disabilities

• Motor and Language Delays

• Mental Retardation

• Head Injury

• Lead Poisoning

Kennedy Krieger Institute

A comprehensive resource for children with disabilities

AUGUST 1992

27

FFICIAL CALL TO 1 992 MEETING

of Subsidiaries and published in the Official Call.

Chapter XV - Committees, Administrative Councils and Commissions Section 2 - Standing Committees - This Society shall have the following standing committees:. . Committee to Nominate Directors of Subsidiaries. . . g. Committee to Nominate Directors of Subsidiaries. The committee shall consist of five members elected by the House of Delegates to serve a term of three years. It shall be the duty of the committee to submit to the House of Delegates a list of nominees for positions as directors on subsidiary boards owned directly or indirectly in whole or in part by the Society to which the Society is entitled to appoint directors.

SUBJECT FOUR

ONE PERSON, ONE JOB RULE. Dr. David E. Wiley’s proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

Chapter V - Separation of Powers

Section 4 - Maintaining Separation of Powers -

To maintain the separation of powers and encourage participation in the Society, [of the three divisions] the following restrictions shall prevail:

a. [A member of this Society, if a voting member of the House of Delegates, may not at the same time serve on the Judicial Council, as a trustee of the Board of Trustees, or as president, immediate past president, president elect, vice president, treasurer, secretary, or speaker or vice speaker of the House of Delegates.

b. A member of this Society may not concurrently hold more than one office of this Society.

c.] A member of the Judicial Council may not at the same time serve as a voting member of the House of Delegates or the Board of Trustees except as provided in Chapter XVII, Section 2, or as president, immediate past president, president elect, vice president, treasurer, or secretary of this Society, or as speaker or vice speaker of the House of Delegates, or as a district censor, or as a member of any council, commission, or administrative committee. A member of the Judicial Council however may be elected or appointed to a council or committee which nominates persons to hold office or receive awards, or which is purely advisory in nature.

A member of this Society may serve concurrently on only one of the following: the Board of Trustees, the delegation to the American Medical Association, or any council committee, or commission of the Society, any Board of Directors on any corporation owned directly or indirectly by the Society or to which the Society may appoint directors directly or indirectly. The boat'd shall be limited to an executive and finance committee composed of its own members.

The board may appoint one, and only one, ex officio member to any council, committee, or task force. Further, the councils, committees, and boards above listed may request a member of another to serve as a consultant without right to vote.

SUBJECT FIVE

VOTING STATUS OF THE SPEAKER AND VICE SPEAKER OF THE HOUSE OF DELEGATES.

Dr. David E. Wiley’s proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

Chapter XII - Officers Section 7 - Duties of Officers.

i. The speaker of the House of Delegates: . . .

6. shall be ex officio without the right to vote on the Board of Trustees; . . .

j. Vice speaker of the House of Delegates: . . .

4. shall be ex officio without the right to vote on the Board of Trustees; . . .

Chapter XIV - The Board of Trustees

Section 3 - Composition -

The Board of Trustees shall consist of the president, president elect, the vice president, and the immediate past president as voting members, and the speaker of the House of Delegates[,] and the vice speaker of the House of Delegates, ex officio without the right to vote, . . .

SUBJECT SIX

CHANGE IN PMS BOARD STRUCTURE TO LIMIT TRUSTEES TO TWO THREE- YEAR TERMS.

Dr. David E. Wiley’s proposed language was submitted with the requisite number of signatures of active or associate members of the Society.

Chapter XTV - The Board of Trustees

Section 6 - Terms. . .

No trustee may serve more than [three] two consecutive terms. A trustee elected to serve an unexpired term shall not be regarded as having served a term unless he has served more than one year. A year is deemed to be the period of time between consecutive annual meetings of the House of Delegates. (A trustee who was serving his third term prior to October 1992 may complete that term.)

28

PENNSYLVANIA MEDICINE

ASHINGTON INFORMATION

General Services Administration

1 8th & F Streets, NW Washington, DC 20405 (202) 708-5082 Bureau of the Census Room 2705, Building 3 Washington, DC 20233 (301) 763-4040 National Technical Information Service 5285 Port Royal Road Springfield, VA 22161 Customer Service (703) 487-4660 Sales Desk 487-4650 Department of Energy Public Information Office 1000 Independence Ave., SW Washington, DC 20585 (202) 586-5000 Department of Labor Public Affairs Office 200 Constitution Ave., NW,

Room SI 032 Washington, DC 20210 (202) 523-7316

Library, Room N2439, 523-6992

Congress

Legislative Information Services

House Annex Bldg. 2,

Room 696

2nd and D Streets, SW Washington, DC 20515 (202) 225-1772 Library of Congress (Scorpio computer access ter- minals)

10 1st St., SE Washington, DC 20540 (202) 707-5522 Consumer Product Safety Commission 5401 W. Bard Avenue Bethesda, MD 20207 (301) 492-5540 U.S. toll-free 1-800-638-2772

Environmental Protection Agency

Office of Public Affairs 401 M Street, SW Washington, DC 20460 (202) 382-4361 Public Information Center (202) 382-2080 Federal Communications Commission Consumer Assistance 1919 M Street, NW Washington, DC 20554 (202) 632-7260 Library, Room 639, 632-7100 Federal Trade Commission Office of Public Affairs 6th and Pennsylvania Ave., NW Washington, DC 20580 (202) 326-2180 Library, Room 630, 326-2395 Public Reference, Room 1 30, (202) 326-2222

Moss Rehabilitation Medicine

A professional corporation striving for excellence in comprehensive medical rehabilitation through

Patient Care • Education • Research

Rehabilitation programs in:

• Amputation

• Musculoskeletal trauma

• Stroke and neurological diseases

• Adult spina bifida

• Physical medicine/ musculoskeletal pain management

• Acupuncture

• Traumatic brain injury

• Rheumatology

• Spinal cord injury

• Cardiopulmonary diseases

• Oncology

Offices in New Jersey and Pennsylvania (215) 456-9495

Tertiary care services in:

• Electromyography

• Motor control analysis

• Evoked potentials

• Gait and motion analysis

• Prosthetics/orthotics

• Independent medical examinations

• Wheelchair clinic

Teaching affiliations:

• Temple University School of Medicine

• Philadelphia College of Osteopathic Medicine

Albert Esquenazi MD Gary Goldberg MD Anne Idiculla MD Leonard Kamen DO Judy Kleppel MD Andrea Laborde MD Raymond Lafontant MD Nathaniel H. Mayer MD John L. Melvin MD

Diego Morales MD Jeanne Pelensky MD Jeffrey Perkins MD David Reinhard MD Harry Schwartz MD L. Matthew Schwartz MD Margarita Torres MD John Whyte MD, PhD Edward Wikoff MD

AUGUST 1992

29

The Commitment to Care Continues

AT HARMARVILLE

For more than 35 years, Harmarville Rehabilitation Center has treated individuals with traumatic injuries and disabling illnesses. Harmarville is a 202-bed, not-for-profit, freestanding rehabilitation hospital.

Our programs include inpatient and outpatient rehabilitation for individuals with:

• Spinal Cord Injury

• Traumatic Brain Injury

• Stroke

• Total Joint Replacement and Fracture

• Arthritis

• Chronic Pain

• Amputations

Our other specialty programs include:

• Geriatric Rehabilitation

• Oncology Rehabilitation

• Center for Motor Control

• Adaptive Driver Education

Harmarville Rehabilitation Center is affiliated with the University of Pittsburgh residency program in Physical Medicine and Rehabilitation and numerous schools of health-related professions.

Harmarville Rehabilitation Center is accredited by:

• Joint Commission for Accreditation of Health Care Organizations

• Commission for Accreditation of Rehabilitation Facilities

Outpatient Center Locations:

• North Shore Pittsburgh, PA

• Main Center Pittsburgh, PA

• Washington, PA

• Cranberry Twp, PA

• Connellsville, PA

• Greensburg, PA

Harmarville

REHABILITATION CENTER

P.O. Box 11460, Guys Run Road • Pittsburgh, Pennsylvania 15238

1-800-624-4673

GEISINGER CLINIC

1992-1993 Continuing Education Programs

Nutrition Support Through the Life Cycle

Hershey Lodge & Convention Center August 20 & 21, 1992

Advanced Cardiac Life Support Renewal Courses

December 5, 1992, February 3 OR May 15, 1993

Pediatric Advanced Life Support Renewal Course

September 9, 1992

9th Annual Neuro-Ophthalmology Seminar

September 9, 1992

Advanced Trauma Life Support Provider Courses (ATLS)

September 1 1 & 1 2 OR November 1 3 & 14, 1 992 January 8 & 9 OR March 12 & 13, 1993

What's New in Gastroenterology?

September 23, 1992

Annual Cardiology Seminar

September 30, 1992

6th Annual Horizons in Cardiac Rehabilitation

October 9, 1992

Pediatric Advanced Life Support Provider Course

October 15 & 16 OR October 29 & 30, 1992 April 15 & 16 OR April 29 & 30, 1993

Diabetes Mellitus Update

Mt. Laurel Resort, White Haven October 21 , 1992

Advanced Cardiac Life Support Instructor Course

October 23 & 24, 1992

Cardiovascular Seminar

November 4, 1992

Pediatric Update

November 12, 1992

Laser Program

December 3, 1992

Topics in the Tropics

St. Thomas, U.S. Virgin Islands December 9-12, 1992

Christmas S.P.I.R.l.T.

Disney Village Resort Lake Buena Vista, FL December 27-30, 1992

Advanced Trauma Life Support Renewal Course

January 27, 1993

18th Annual Concepts in Clinical Practice

Danville Days Inn February 12-14, 1993

Contemporary Issues in Internal Medicine

March 3, 1993

Advanced Cardiac Life Support Provider Course

March 26-28, 1993

Advances in Dermatology

April 7, 1993

Update in Family Practice

Danville Days Inn April 14, 1993

Restrictive Chest & Lung Disease

April 28, 1993

7th Annual Sight Loss Support Group Meeting

Danville Days Inn May 5, 1993

7th Annual Symposium in Clinical Medicine

Hilton Head Island, SC June 21-24, 1993

Please check each specific flyer as it arrives for starting time, location, number of credit hours, and types of credit. Programs may be cancelled due to insufficient registration. If not pre-registered, please call to confirm the program.

As an organization accredited by the Pennsylvania Medical Society for its continuing medical education program, the Geisinger Clinic designates these activities as meeting the criteria for Category I credit for the American Medical Association’s Physician’s Recognition Award and the Pennsylvania Medical Society membership requirement. Please refer to each individual program flyer for registration fees, starting times, and number of credit hours. For further information or for copies of individual programs, call Sharon Hanley, RMP, collect, at 717-271-6692. There is a 24-hour answering service available. You may also write to her at North Academy Avenue, Danville, PA 17822-1350.

Geisinger

AUGUST 1992

31

-

ENNSYLVANIA MEDICAL SOCIETY OFFICIALS

Headquarters Office: 777 East Park Drive, P.0. Box 8820, Harrisburg, PA 17105-8820

Telephone: (71 7) 558-7750 or 1 -800-228-7823

Officers

‘President

Robert N. Moyers, MD

764 Kennedy Street Meadville 16335 (814) 336-5995

‘President-Elect Donald G. Ferguson

1000 Bower Hill Road Pittsburgh 15243 (412) 343-0843

‘Immediate Past President Gordon K. MacLeod, MD

Univ. of Pittsburgh 1 30 DeSoto Street Pittsburgh 15261 (412) 624-3875

‘Vice President Martin A. Murcek, MD

Medical Arts Bldg.

562 Shearer Street, Suite 101-2 Greensburg 15601 (412) 837-4070

‘Secretary

Ferdinand L. Soisson Jr., MD

Suite 101,

East Hills Professional Bldg. 1450 Scalp Avenue Johnstown 15904 (814) 269-2270

‘Speaker

House of Delegates Jonathan E. Rhoads Jr., MD

York Hospital, Dept, of Surgery 1001 South George Street York 17405 (717) 771-2756

‘Vice Speaker House of Delegates Howard A. Richter, MD

655 Lankenau Medical Bldg. Wynnewood 19096 (215) 649-4416

Treasurer and Executive Vice President Roger F. Mecum

777 East Park Drive P.O. Box 8820 Harrisburg 17105-8820 (717) 558-7750

Trustees

* First District — George R. Fisher III, MD, 829 Spruce St., Suite 308, Philadelphia 19107 -(215) 922-5252. Term expires 1992. Philadelphia county.

* Second District — John W. Lawrence, MD, 1078 W. Baltimore Pike, Media 19063 (215)566-4311. Term expires 1993.

Berks, Bucks, Chester, Delaware, Lehigh, and Montgomery counties.

* Third District — John H. Hobart, MD, 2001 Fairview Ave., Easton 18042 - (215) 250- 4865. Term expires 1992. Carbon, Lackawanna, Monroe, Northampton, Pike, and Wayne counties.

* Fourth District — Frederick G. Brown, MD, Geisinger Medical Ctr., Danville 17822 - (717)271-6393. Term expires 1993. Columbia, Montour, Northumberland, Schuylkill, and Snyder counties.

* Fifth District — Herbert C. Perlman, MD, 1104 Fleetwood Dr., Carlisle 17013 - (717) 245-5400. Term expires 1993. Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.

* Sixth District — Edward H. Dench Jr., MD, 945 Outer Dr., State College 16801 - (814) 466-7975. Term expires 1 994. Blair,

Kenneth L. Cooper, MD, Chairman 230 Dunbar Rd.

Williamsport 17701 - (717) 323-3671 (Term expires 1992)

Raymond C. Grandon, MD

131 State St.

Harrisburg 17101 - (717) 234-4187 (Term expires 1994)

John H. Hobart, MD, Chairman John W. Lawrence, MD, Vice Chairman

Centre, Clearfield, Huntingdon, Juniata, and Mifflin counties.

* Seventh District — William R. Beltz, MD, 699 Rural Ave, Williamsport 17701 - (717) 326-4007. Term expires 1994. Cameron, Clinton, Elk, Lycoming, Potter, Tioga, and Union counties.

* Eighth District — Robert L. Lasher, MD, 217 Indiana Dr., Erie 16505 - (814) 455- 5114. Term expires 1992. Crawford, Erie, Forest, McKean, Mercer, and Warren counties.

* Ninth District — John W. Mills, MD, 590 Indian Springs Rd., Indiana 15701 - (412) 349-1203. Term expires 1992. Armstrong, Butler, Clarion, Indiana, Jefferson, and Venango counties.

*Tenth District — John W. Lehman, MD, 1415 Sixth Ave., P.O. Box 816, Beaver Falls 15010 -(412) 843-7812. Term expires 1994. Allegheny, Beaver,

Lawrence, and Westmoreland counties.

* Eleventh District — Ferdinand L. Soisson Jr., MD, Suite 101, East Hills Professional Bldg., 1450 Scalp Ave., Johnstown 15904 - (814)269-2270. Term expires 1993. Bedford, Cambria, Fayette, Greene,

Judicial Council

David W. Clare, MD

577 Briar Cliff Rd.

Pittsburgh 1 5221-3218 - (41 2) 682-251 0 (Term expires 1994)

Donald E. Harrop, MD

130 4th Ave.

Phoenixville 19460 - (609) 492-1656 (Term expires 1992)

Staff Assignment - Kenneth B. Jones, Esq.

Somerset, and Washington counties.

‘Twelfth District — Victor F. Greco, MD, E- Z Acres, RD 1, Drums 18222 - (717) 788- 3225. Term expires 1994. Bradford, Luzerne, Sullivan, Susquehanna, and Wyoming counties.

* Interspecialty Section— James R. Regan, MD, 3222 Green Meadow Dr., Bethlehem 18017 -(215)691-2282. Term expires 1994.

* Resident Physicians Section— Daniel S. Henriksen, MD, 133 Jonathan Way N.,

Red Lion 17356 - (717) 771-2345. Term expires 1 993 (or upon completion of residency).

* Hospital Medical Staff Section — Lee H. McCormick, MD, 2708 Brownsville Rd., Pittsburgh 15227 - (412) 885-6330. Term expires 1992.

* Young Physicians Section — Richard J. Greco, MD, 1639 Pinehurst Ct., Pittsburgh 15237 - (412) 367-3825. Term Expires 1992.

Medical Students Section — Mark V. Caliendo, 2110 Spring St., Philadelphia 19103 - (215) 568-2702. Term expires 1992 (or upon completion of medical school).

‘Voting members of the Board of Trustees

Jonathan E. Rhoads Sr., MD

3400 Spruce St.

Philadelphia 19104 - (215) 662-2008 (Term expires 1993)

Address inquiries to Ferdinand L. Soisson Jr., MD, Judicial Council Secretary, 777 E. Park Dr., P.O. Box 8820, Harrisburg 17105-8820

32

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( partial list)

Technologies in Wound Healing:

A Clinical & Scientific Symposium

Oscar Alvarez, Ph.D., M.D. Gary Grotendorst, Ph.D.

G. Allan Holloway, M.D. David Knighton, M.D. Marvin Levin, M.D.

Terence Ryan, D.M.

John Esterhai, M.D.

George Rodeheaver, Ph.D. Richard Jay, DPM Harold Schoenhaus, DPM Michael S. Weingarten, M.D.

October 1, 2, 3 1992

Hotel Atop the Bellevue Philadelphia

THE GRADUATE HOSPITAL

Dept, of Surgery and the Wound Care Center

For more details, contact:

Kale O'Neill 215-893-7649 The Graduate Hospital Wound Cafe Center

Registration DEADLINE September 16

For Brochure

1800 Lombard St. Ste. 1005 Philadelphia, PA 19146

215-448-1508

OUNTY SOOETY OFFICERS

ADAMS COUNTY

President: David F. Kamsler, MD, 455 S Washington St, Gettysburg 17325, 717- 334-9259

Vice President: Maureen L. Durkin, MD, 149 W Hanover St, Biglerville 17307, 717-677-6124

Secretary-Treasurer: Gill M. Taylor- Tyree, MD, The Gettysburg Hospital, 147 Gettys St, Gettysburg 17325-2500, 717-334-2121

ALLEGHENY COUNTY

President: John A. Burkholder, MD, 490 E North Ave Ste 302, Pittsburgh 15212, 412-323-0363

President Elect: George J. Gemeth, MD, 2400 Ardmore Blvd Ste 200, Pittsburgh 15221, 412-351-3062 Vice President: Lee H. McCormick, MD, 2708 Brownsville Rd, Pittsburgh

15227.412- 885-6330 Treasurer: John S. Oehrle, MD,

Allegheny Valley Hospital, 1301 Carlisle St, Natrona Heights 15065- 1192, 412-226-7076

Secretary: Nancy S. Nieland, MD, 21 1 N Whitfield St, Pittsburgh 15206, 412- 362-5504

Executive Director: John G. Krah, 713 Ridge Ave, Pittsburgh 15212-6098, 412-321-5030

Bulletin Editor: Jack E. Wilberger, MD, 713 Ridge Ave, Pittsburgh 15213, 412- 321-5030

Publication: BULLETIN OF THE ALLEGHENY COUNTY MEDICAL SOCIETY

ARMSTRONG COUNTY

President: Donald W. Minteer, Jr., MD, RD 1, Box 170, Worthington 16262, 412-297-3424

President Elect: David H. Kohl, MD, Medical Arts Bldg, RD 8, Kittanning

16201.412- 543-2505

Vice President: Frederick B. Doerfler, Jr, MD, 206 S Jefferson St, Kittanning

16201. 412- 545-1288 Secretary-Treasurer: Roderick R.

McLeod, MD, 2 1 3 Locust Ln,

Kittanning 16201-2030, 717-586-2011 Executive Secretary: Luann Croyle, 416 Pine Hill Rd, Kittanning 16201-2042, 412-548-1606

BEAVER COUNTY

President: Patrick W. Sturm, MD, 1425 3rd St, Beaver 15009-2427, 412-728- 7820

President Elect: Morry Moskovitz, MD, Sharon PI Prof Bldg, 701 Sharon Rd, Beaver 15009-3133, 412-774-2700 Vice President: Geoffry R. Herald, MD, 1301 Riverside Dr, West Bridgewater 15009, 412-728-8300

Secretary-Treasurer: Jay L. Funkhouser, MD, 721 5th Ave, New Brighton 15066-1836, 412-846-5250 Executive Secretary: Caroline Mills, 650 Corporation St, Ste 303, Beaver 15009-2712, 412-775-3330 Bulletin Editor: James P. McKenna,

MD, 650 Corporation St, Ste 303, Beaver 15009-2712, 412-775-3330 Bulletin Editor: Leslie T. Pallone, DO, 650 Corporation St, Ste 303, Beaver 15009-2712, 412-775-3330

BEDFORD COUNTY

President: Marc J. Finder, MD, West Straub Estates, R R 1, Box 97, Buffalo Mills 15534-9617, 814-733-4543 Vice President: Katherine E.

Erlichman, DO, RR1, Box 378, Everett 15537, 814-623-1969 Secretary-Treasurer: George M. Zubak, MD, 300 N Spring St, Everett 15537- 1011, 814-652-5133

BERKS COUNTY

President: Jeffrey L. Hassel, MD, 640 Walnut St, Ste 305, Reading 19601- 3525,215-376-0353 President Elect: Gary M. Lattin, MD,

222 N 12th St, Reading 19604, 215- 375-4679

Treasurer: Daniel B. Kimball, Jr, MD,

Dir of Medicine, Reading Hosp and Med Ctr, PO Box 16052, Reading 19612-6052,215-378-6133 Secretary: George E. Connerton, MD, Community General Hosp, 145 N 6th

St, Reading, 19601, 215-376-2100, ext 8348

Executive Director: Bruce R. Weidman, 429 Walnut St, Reading 19601-3929, 215-376-1544

Bulletin Editor: Harold I. Farber, MD, 429 Walnut St, Reading 19601-3929, 215-376-1544

Publication: BERKS COUNTY MEDICAL RECORD

BLAIR COUNTY

President: Alan J. Kivitz, MD, 7 1 1 Logan Blvd, Altoona 16602-4165, 814-943- 2088

President Elect: Andrew W. Gurman, MD, 515 26th St, Altoona 16602-2026, 814-942-1166

Vice President: Gregory A. Formanek, MD, 1701 12th Ave, Ste D, Altoona 16601-3106, 814-942-4321

Treasurer: A. Leonard Zimmerman, MD, 501 Howard Ave, Altoona 16601-4809, 814-944-5357

Secretary: S. Victor King, MD, RR 5 Box 287 A, Tyrone 16686-9805, 814-684- 5608

Executive Secretary: Marjorie E.

Harker, 503 E Plank Rd 2nd FI, Altoona 16602-4114, 814-942-8691

Publication: BLAIR COUNTY

MEDICAL SOCIETY - Newsletter

BRADFORD COUNTY

President: Raymond Aldridge, MD, Guthrie Clinic Ltd, Sayre 18840-1699, 717-888-5858

Vice President: Kurt Hahn, MD, Guthrie Clinic Ltd, Sayre 18840-1699, 717- 888-5858

Treasurer: Richard E. Shelling, MD, Guthrie Clinic Ltd, Sayre 18840-1699, 717-888-5858

Secretary: Joseph B. Blood Jr., MD, Guthrie Sq, Sayre 18840-1699, 717- 888-5858

BUCKS COUNTY

President: Edwin W. Shearbum III, MD, 920 Lawn Ave Ste 4, Sellersville 18960-1560, 215-257-4866

President Elect: Joseph F. McGarvey,

Psychopharmacology Update 1992

Child/Adult

Conference location is the Twelve Caesars, Philadelphia, PA

Thursday & Friday October 8 & 9

Credit for AMA & APA Category I

For more information please write to the Conference Coordinator, Continuing Mental Health Education, Medical College of Pennsylvania, 3200 Henry Avenue, Philadelphia, PA 19129. Or call (215) 842-4340.

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UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER

University of Pennsylvania School of Medicine Hospital of the University of Pennsylvania

OLJNTY SOCIETY OFFICERS

MD, 14B Memorial Dr, Doylestown 18901-3511, 215-345-6050 Vice President: Dominic A. Culotta, MD, Box 105, 275 E Street Rd, Feasterville 19053, 215-355-1155 Treasurer: A. James Alderfer, MD, 670 Lawn Ave, Sellersville 18960, 215-257- 0414

Secretary: Donald E. Parlee, MD, 75 Foxcroft Dr, Doylestown 18901-3263, 215-345-2315

Executive Secretary: John S. Detweiler, 200 Apple St, Ste 3, Quakertown 18951-1674, 215-536-8665 Bulletin Editor: John S. Detweiler, 200 Apple St, Ste 3, Quakertown 18951-

1674, 215-536-8665

Publication: NEWS BULLETIN

BUTLER COUNTY

President: Donald C. Fox, MD, 301 N McKean St, Butler 16001-4949, 412- 287-2161

President Elect: Anthony M. Pirrello, Jr, MD 91 1 E Brady St, Butler 16001, 412-283-6666

Secretary: Alfredo J. Garcia, MD, 312 W Jefferson St, Butler 16001-6922, 412- 283-2132

Administrative Secretary: Barbara A. Walls, 541 N Elm St, Butler 16001, 412-285-4882

CAMBRIA COUNTY

President: Magdi S. Azer, MD, 88 Osborne St, Johnstown 15905-4148, 814-535-5541

President Elect: Shiban K. Warikoo,

MD, 1 1 1 1 Franklin St, Johnstown 15905-4330, 814-536-7851

Vice President: Patti Stefanick, DO,

1 1 1 1 Franklin St, Johnstown 15905, 814-539-6765

Treasurer: Thomas J. Strunk, MD, 1301 Menoher Blvd, Johnstown 1 5905- 2003, 814-255-5070

Secretary: Robert J. Swansiger, MD, 609 Somerset Ave, Windber 15963-1330, 814-467-3400

Executive Secretary: Michael P. Kohler, 47 Osborne St, PO Box 36, Johnstown 15907-4147, 814-535-5493

Bulletin Editor: Rudolph Schilli, MD, 350 Southmont Blvd, Johnstown 15905-2818, 814-535-2511

Publication: MEDICAL COMMENT AND PHYSICIANS’ FORUM

CARBON COUNTY

President: Edgardo P. Salazar, MD, 135 Lafayette Ave, Palmerton 1 807 1 , 215- 826-6255

Vice President: Narendra V. Ambani, MD, RD 6, Lehighton, 18235, 215-377- 3252

Secretary-Treasurer: James D. Bohri, MD, 10 Hilton Rd, Schnecksville 18078, 215-799-4524

CENTRE COUNTY

President: Jeffrey H. Baker, MD, 200 Scenery Dr, State College 16801, 814- 237-2137

Vice President: Aaron D. Bleznak, MD, 200 Scenery Dr, State College 16801, 814-231-4560

Treasurer: Stanley P. Mayers, Jr., MD, 648 Wiltshire Dr, State College 16803- 1450, 814-238-4014

Secretary: Jane A. M. Strickler, MD, PO Box 59, Boalsburg 16827-0059, 814- 466-6006

CHESTER COUNTY

President: F. William Maguire, DO, 580 Lancaster Ave, Berwyn 19312, 215- 644-8120

President Elect: Robert O. Satriale, MD, 213 Reeceville Rd, Ste 220A, Coatesville 19320, 215-383-8564

Vice President: Richard F. Satriale, MD, 15 Green St, Downingtown 19355, 215-269-5782

Treasurer: Ralph A. Rossi, Jr, MD, Southern Chester County Med Ctr, 1015 Baltimore Pike, West Grove 19390

Secretary: Robert L. Yoxtheimer, MD, 710 S Main St, Phoenixville 19460- 3844, 215-933-5852

Executive Secretary: Carol Dotts, 580 Lancaster Ave, Berwyn 19312-1664, 215-644-8120

Bulletin Editor: Richard F. Satriale, MD, 2604 Trinity Ct, Chester Springs 19425-8744, 215-363-8479

Publication: CHESTER COUNTY MEDICINE

CLARION COUNTY

President: Jaiveer T. Reddy, MD,

Brookville Hospital, 1 00 Hospital Rd, Brookville 15825-1363, 814-849-8858

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36

PENNSYLVANIA MEDICINE

Rttsburgh Has Some Positive Side Effects On Doctors.

The kind of side effects that occur when doctors spend some time in Pittsburgh can be really positive. They start developing ideas that lead to the kind of innovations that make medical history. That’s one reason why so many medical societies, groups and associations meet here. And the next time you hold a meeting, symposium or convention in Pittsburgh, you’ll experience those benefits for yourself.

You’ll find first-rate meeting facilities and world-class accommodations at affordable prices. Combined with great ethnic cuisine and activities like exciting performances at Heinz Hall, it leads to astounding results.

To learn more about the positive side effects that we can help make happen during your next event, write to us at Four Gateway Center, Dept. PM3, Pittsburgh, PA 15222. Or call us toll-free at 1-800-366-0093.

GREATER PITTSBURGH CONVENTION

AND VISITORS BUREAU

OUNTY SOCIETY OFFICERS

Vice President: Roger J. Shore, MD, Miller Medical Center, PO Box 40,

New Bethlehem 16242-0040, 814-275- 1600

Secretary-Treasurer: Barry J. Snyder, MD, PO Box 39, New Bethlehem 16242-0039, 814-275-3320 Executive Secretary: Barbara Hibell, PO Box 39, New Bethlehem 16242-0039, 814-275-3320

CLEARFIELD COUNTY

President: Philip A. Pilgram, MD, 3

Medical Center Dr, Philipsburg 16866, 814-342-5402

Vice President: Robert E. Burke, MD, 3 Medical Center Dr, Philipsburg 16866, 814-342-5402

Secretary-Treasurer: William D. Calley, MD, 21 1 N 2nd St, Clearfield 16830- 2538, 814-765-1511

CLINTON COUNTY

President: Veryl F. Frye, MD, PO Box 768, Lock Haven 17745, 717-769-7375 Secretary-Treasurer: Keith I. Adams, MD, 205 N Chestnut St, Mill Hall 17751, 717-748-5601 Administrative Secretary: June L. Houser, 53 W Main St, Lock Haven 17745, 717-748-4063

COLUMBIA COUNTY

President: Ala A. Almashat, MD, 531 E Front St, Berwick 18603-4915, 717- 759-2244

Vice President: William J. Kuprevich, DO, Penn St and Glenn Ave, Bloomsburg 17815, 717-784-8101 Secretary-Treasurer: John E. Widger, MD, 1 S Hospital Dr, Bloomsburg 17815-1476, 717-387-1444 Bulletin Editor: Wilma P. Webster, MD, 159 Clifton Dr, Bloomsburg 17815- 3004, 717-784-9783

Publication: MEDICAL BULLETIN OF THE COLUMBIA COUNTY MEDICAL SOCIETY

CRAWFORD COUNTY

President: Scott H. Bedwell, MD, 505 Poplar St, Meadville 16335-3059, 814- 333-5885

President Elect/Vice President:

Timothy M. Downing, MD, 764 Kennedy St, Meadville 16335-2209, 814-336-6384

Treasurer: Edward J. Owens, DO, 1 18 Railroad St, Cambridge Springs 16403-1060, 814-398-4313 Secretary: Robert N. Moyers, MD, 764 Kennedy St, Meadville 16335-2209, 814-336-5995

CUMBERLAND COUNTY

President: Stephen J. Krebs, MD, 804 Belvedere St, Carlisle 17013, 717-243- 1943

President Elect: William J. West, Sr,

MD, 850 Walnut Bottom Rd, Carlisle 17013, 717-249-2811

Vice President: William J. West, Sr, MD, 850 Walnut Bottom Rd, Carlisle 17013, 717-249-2811 Secretary-Treasurer: David W. Bryant, MD, 850 Walnut Bottom Rd, Carlisle 17013, 717-243-2244

DAUPHIN COUNTY

President: James F. Rich, MD, 355 N 21st St, Camp Hill 17011,717-761- 8331

President Elect: Virginia E. Hall, MD, 645 N 12th St, Lemoyne 17043, 717- 761-8900

1st Vice President: Todd R. Fisher, MD, Fam Med Center of Middletown, 1022 N Union St, Middletown 17057-2198, 717-944-0491

2nd Vice President: Robert F. Siguenza, MD, 245 S 26th St, Camp Hill 17011- 3621,717-761-6049 Secretary-Treasurer: Bradford K.

Strock, MD, Harrisburg Hospital, Harrisburg 17101-2099, 717-231-8310 Executive Secretary: Robert W. Evans, Medical Bureau Bldg, 217 State St, Harrisburg 17101-1187, 717-234-1678

DELAWARE COUNTY

President: Mark W. Shulkin, MD, 105 Mary Watersford Rd, Bala Cynwyd 19004-2020, 215-565-0988 President Elect: Marc I. Surkin, MD,

400 Ballytore Cir, Wynnewood 19096- 2354, 215-896-4545

Vice President: Michael B. Kurtz, MD, Elwyn Institute, Elwyn 19063, 215- 891-2322

Treasurer: Ira H. Weiner, DO, 1216 Montgomery Ave, Narberth 19072, 215-565-4900

Secretary: James A. Morris, Jr., MD, Wynnewood House, 300 E Lancaster Ave #300-304, Wynnewood 19096, 215-642-2002

Executive Director: David McKeighan, State And Sproul Rds, Ste 100, Springfield 19064-2025, 215-328-1184 Bulletin Editor: Mark W. Shulkin, MD, 105 Mary Watersford Rd, Bala Cynwyd 19004-2020, 215-565-0988 Publication: THE BULLETIN OF THE DELAWARE COUNTY MEDICAL SOCIETY

ELK/CAMERON COUNTY

President: Jayant L. Patankar, MD, 129 N. Michael St, Saint Marys 15857, 814-781-3892

President Elect: Roman A. Babin, MD,

1 17 N Michael St, St Marys 15857- 1140, 814-834-7231

Secretary-Treasurer: Starr Kearney, DO, Elk County General Hosp, Ridgway

15853,814-776-6111

ERIE COUNTY

President: Theresa F. Fryer, MD, 300 State St, Ste 204, Erie 16507-1429, 814-452-2218

President Elect: David D. Howell, Jr., MD, 2500 W 12th St, Erie 16505-4508, 814-838-9000

Vice President: Edward T. O’Brien, MD, 2500 W 12th St, Erie 16505, 814-838- 9000

Treasurer: A. T. Roos, MD, 3125 French St, Erie 16504, 814-456-2047 Secretary: Dilip K. Jana, MD, 293 1 Peach St, Erie 16508, 814-456-6258 Executive Secretary: Robert B. Stuart, MD, 3211 Liberty St, Erie 16508-2532, 814-866-6820

Bulletin Editor: John C. Reilly, MD,

3216 State St, Erie 16508-2822, 814- 456-2976

1 blication: THE STETHOSCOPE

FAYETTE COUNTY

President: Lariy J. Papincak, MD, 2 Lydia Dr, Uniontown 15401-8919, 412-430-5027

President Elect: Richard J. Pish, MD, 6 Spring Creek Ln, Uniontown 15401- 8903, 412-439-9200

Vice President: Frank Perrone, MD, RR 1, Box 74A-C, Markleysburg 15459, 412-329-4444, 412-437-8880 Secretary: Gertrude Blumenschein, MD, 30 Delaware Ave, Uniontown 15401, 412-437-1539

Executive Secretary: Anne L. White, 62 Charles St, Uniontown 15401, 412- 437-7565

Bulletin Editor: Anne L. White, 62 Charles St, Uniontown 15401, 412- 437-7565

Publication: NEWSLETTER

FRANKLIN COUNTY

President: James M. Chicklo, MD, 1039 Wayne Ave, Chambersburg 17201- 2993, 717-264-2610

President Elect: David A. Guthrie, MD, 845 Duncan Ave, Chambersburg 17201-1754, 717-263-1697 Vice President: Kenneth W. Rictor, MD, 2573 Black Gap Rd, Chambersburg, 17201-9751,717-267-3606 Secretary-Treasurer: James C. Barton, MD, 4073 Frecon Rd, Chambersburg 17201-9777, 717-264-6185 Bulletin Editor: James C. Barton, MD, 4073 Frecon Rd, Chambersburg 17201-9777, 717-264-6185

GREENE COUNTY

President: Prafullchandra Vora, MD, RR 3, Waynesburg 15370-9803, 412-627- 8131

Vice President: Nathan B. Duer, MD,

Old Glassworks Rd, Greensboro 15338, 412-943-3308 Secretary-Treasurer: Prayun

Chayapruks, MD, 189 E High St, Waynesburg 15370, 412-627-8412

HUNTINGDON COUNTY

President: Frederick L. Jones, MD, 3228 Cold Springs Rd, Huntingdon 16652-

2721.814- 643-5752

Vice President: James B. Hayden, MD, RR 3 Box 148D, Huntingdon 16652- 9803, 814-643-2728

Treasurer: Thomas C. Smith, MD, 50 W 29th St, Huntingdon 16652-2523, 814- 643-5089

Secretary: David S. Miller, MD, 3228 Cold Springs Rd, Huntingdon 16652-

2721.814- 643-1551

INDIANA COUNTY

President: Steven P. Griffin, MD,

Indiana Hospital, Box 788, Indiana 15701, 412-357-7169 President Elect: James E. Bauer, MD, 877 Hospital Dr, Indiana 15701, 412- 465-8900

Vice President: Stella M. Boron, MD, 15 S 8th St, Ste 201, Indiana 15701-2714, 412-349-8311

Treasurer: Peter Drenchko, Jr., MD, 1 19 Professional Bldg, 1265 Wayne Ave, Ste 200, Indiana 15701-3501, 412-463- 0225

Secretary: Daniel J. Bamicle, MD,

Indiana Hospital, Radiology, Box 788, Indiana 15701, 412-357-7128 Executive Secretary: Marianne Gongloff, 590 Indian Springs Rd, Indiana 15701, 412-349-1204

JEFFERSON COUNTY

President: Dennis W. Rhoades, DO, 6 N

38

PENNSYLVANIA MEDICINE

3rd St, ReynoldsviUe 15851-1261, 814- 653-8222

Vice President: Francis P. Badamo, MD, 912 5th Ave, Brockway 15824-1308, 814-268-4843

Secretary-Treasurer: Joseph J. Kemich, MD, Medical Arts Bldg, RR 5, Punxsutawney 15767, 814-938-3310 Bulletin Editor: Dennis W. Rhoades,

DO, 6 N 3rd St, ReynoldsviUe 15851- 1261, 814-653-8222

LACKAWANNA COUNTY

President: Eric W. Blomain, MD, 1 222 Marion St, Dunmore 18509-2458, 717- 347-1712

President Elect: James L. Sundheim, MD, Moses Taylor Hospital, 700 Quincy Ave, Scranton 18510-1798, 717-963-2601

1st Vice President: Theodore W.

Uroskie, MD, 200 Yale Blvd, Clarks Summit 18411-1138, 717-346-7338 2nd Vice President: Joanne S. Zenker, MD, 32 1 Spruce St, Rm 439, Scranton 18503-1444, 717-961-5522 Secretary-Treasurer. Michael J. Gallagher, MD, 746 Jefferson Ave, Scranton 18510-1624, 717-348-7200 Executive Director: Patricia A. Martin, 1416 Monroe Ave, Ste 301, Dunmore 18509-2496, 717-344-3616 Bulletin Editor: Salvatore J. SciaUa, MD, 743 Jefferson Ave, 2nd FI, Scranton 18510-1612, 717-342-3675 Publication: LACKAWANNA MEDICINE

LANCASTER COUNTY

President: Robert G. Doe, MD, 213 Tomahawk Dr E, Conestoga 17516, 717-295-8322

President Elect: Robert S. Mathews, MD, 554 N Duke St, Ste 2, Lancaster 17602, 717-299-3524 Vice President: John H. Garofola, MD, 1525 Ridge Rd, Lancaster 17603, 717- 295-8300

Treasurer: Joseph A. Knepper, MD, 1 1 Holly Dr, Leola 17540-1299, 717-656- 2331

Secretary: Roland A. Loeb, MD, 435 W Chestnut St Box 1708, Lancaster 17603-3441, 717-394-7234 Executive Secretary: Sally J. Sigafoos, 137 E Walnut St, Lancaster 17602- 5110, 717-393-9588 Bulletin Editor: Roland A. Loeb, MD,

435 W Chestnut St Box 1708, Lancaster 17603-3441, 717-394-7234 Publication: LANCASTER MEDICINE

LAWRENCE COUNTY

President: Stuart A. Gardner, MD, 4216 Ellwood Rd, New Castle 16101,412- 924-2635

President Elect: Mohamed K. Tejpar, MD, 1 400 Wilmington Ave, New Castle 16105-2505, 412-658-6583 Vice President: Mohammad Ali, MD,

217 N. Jefferson St, Box 1449, New Castle 16101, 412-658-9721 Secretary-Treasurer: Carlos Flores, MD, 3208 Wilmington Rd, New Castle 16105, 412-658-6450

LEBANON COUNTY

President: James W. Keller, MD, 7 1 1 Poplar St, Lebanon 17042-6756, 717- 270-6625

President Elect: Leonard P. Ferrara,

MD, 711 Popular St, Lebanon 17042-

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6756, 717-272-4500

Vice President: Joseph P. Bering, MD, 618 Cornwall Rd, Lebanon 17042- 7052, 717-270-1949

Treasurer: Joseph M. Clark, MD, 71 1 S 8th St, Lebanon 17042-6721 , 717-273- 9345

Secretary: John J. Messmer, MD, 921 S Forge Rd, PO Box 153, Palmyra 17078-3401, 717-838-6305 Executive Secretary: Susan Foltz, Good Samaritan Hospital, 4th And Walnut Sts, PO Box 1281, Lebanon 17042- 1281, 717-270-7924

LEHIGH COUNTY

President: Carmen G. Montaner, MD, 4308 Boulder Dr, Coopersburg 18036, 215-776-8810

President Elect: Frank J. Altomare Jr., MD, Sacred Heart Hospital, 421 W Chew St, Allentown 18102-3490, 215- 776-4684

Vice President: Michael J. Gordon, MD, 1575 Pond Rd, #203, Allentown 18104, 215-366-7788

Treasurer: Walter J. Finnegan, MD, 40 S Cedar Crest Blvd, Allentown 18104- 5912, 215-433-7589 Secretary: Howard L. Carbaugh, MD,

614 N 6th St, Allentown 18102-1666, 215-432-6032

Executive Secretary: Robert R. Parsons, 1620 W Highland St, Allentown 18102-1033, 215-437-2288 Bulletin Editor: Robert R. Parsons, 1620 W Highland St, Allentown 18102-

1033, 215-437-2288 Publication: THE "DR”

LUZERNE COUNTY

President: Juan D. Gaia, MD, 451 3rd Ave, Kingston 18704-5802, 717-283- 0528

President Elect: Edward A. Lottick, MD, 789 Wyoming Ave, Kingston 18704-

3833. 717- 288-7506

Vice President: David H. Moore, MD,

440 Pierce St, Kingston 18704-5518, 717-283-0655

Treasurer: Martin L. Freifeld, MD,

Nesbitt Medical Arts Bldg, 4 Poplar St, Kingston 18704-3709, 717-288-4800 Secretary: Satish D. Patel, MD, Wilkes Barre General, Radiology Dept,

Wilkes Barre 18764-0001, 717-829- 8111

Executive Director: Duane E. Kersteen, 130 S Franklin St, Wilkes Barre 18701-1101, 717-823-0917 Bulletin Editor: Edward A. Lottick, MD, 789 Wyoming Ave, Kingston 18704- 3833, 717-288-7506 Publication: THE BULLETIN

LYCOMING COUNTY

President: Robert S. Yasui, MD, 1001 Grampian Blvd, Williamsport 17701-

1946.717- 326-5828 President Elect: Terry A. Belles, MD,

145 Shaffer St, Williamsport 17701- 6727, 717-326-2447

Vice President: Judith A. Gouldin, MD, 777 Rural Ave, Williamsport 17701, 717-321-2400

Treasurer: Donald E. Shearer, MD, 217 Broad St, Montoursville 17754-2203, 717-368-8188

Secretary: Aaron J. Kolb, MD, 777 Rural Ave, Williamsport 17701, 717-321- 2000

Executive Director: Paul P. John, 2895 Euclid Ave, Williamsport 17701-6720, 717-323-6432

Bulletin Editor: Paul P. John, 2895 Euclid Ave, Williamsport 17701-6720, 717-323-6432

Publication: LYCOMING MEDICINE

MCKEAN COUNTY

President: Shabir A. Bhayani, MD, 195 Pleasant St, Bradford- 16701-1 081, 814-368-1020

President Elect: Muhammed Sankari, MD, PO Box 735, Bradford 16701- 0735, 814-362-7484

Vice President: Bharat Vakharia, MD, The Community Hospital, Fraley St, Kane 16735, 814-837-8585 Treasurer: Cecilio C. Dee, MD, Bradford Hospital, PO Box 218, Bradford 16701-0218, 814-368-4143 Secretary: Hossain Sarajedini, MD, Bradford Hospital, PO Box 218, Bradford 16701-0218, 814-368-1700

MERCER COUNTY

President: John G. Wassil Jr., MD, 912 E State St, Sharon 16146-3336, 412-346- 6507

President Elect: Arun S. Sawardekar, MD, 635 W Main St, Grove City 16127-1109, 412-455-8044 Vice President: John P. Scullin III, MD, 428 S Main St, Greenville 16125, 412- 588-7250

Secretary-Treasurer: Samuel G.

Woodings, MD, 89 Elm Ave, Sharon 16146, 412-347-7749

MIFFLIN/JUNIATA COUNTY

President: Sally M. Wooten, MD, 27 Sandy Ln, Ste 140, Lewistown 17044-

1318. 717- 242-2711

Vice President: John S. Parry, MD, 4th St at Sandy Ln, Ste 100, Lewistown

17044. 717- 242-7340 Treasurer: William T. Ayoub, MD, 300

Highland Ave, Lewistown 17044-1164, 717-242-4200

Secretary: Kimberly J. Manganaro, MD, 300 Highland Ave, Lewistown 17044- 1171, 717-242-4200

MONROE COUNTY

President: William T. Kesselring Jr., MD, 175 E Brown St, East Stroudsburg 18301-3098,717-421-8526 Vice President: Ian S. Foster, MD, Geisinger Clinic at Shawnee, PO Box 244, Shawnee-on-the-Delaware 18356, 717-421-3900

Secretary-Treasurer: Richard P.

Kennedy, MD, Pocono Hospital, 206 E Brown St, East Stroudsburg 18301- 3006, 717-421-4000

Executive Secretary: Candy K. Forrey, Pocono Hospital, 206 E Brown St, East Stroudsburg 18301-3006, 717- 476-3392

MONTGOMERY COUNTY

President: Roberta L. Schneider, MD,

139 Fembrook Ave, Wyncote 19095-

1506,215-889-6570- President Elect: George R. Green, MD, 1245 Highland Ave, Ste 107, Abington 19002, 215-887-6668 Vice President: Charles Cutler, MD,

1411 Powell St, Norristown 19401, 215-279-8300

Treasurer: H. William Schmidt, MD, 378 Allendale Rd, King of Prussia 19406-

1641, 215-265-2356

Secretary: Robert M. McNamara, MD, 3300 Henry Ave, Philadelphia 19129, 215-842-6548

Executive Director: U. Berkley Ellis, EdD, 1529 DeKalb St, Norristown 19401-3421, 215-277-3690

Bulletin Editor: H. Craig Bell, MD, 1529 DeKalb St, Norristown 19401, 215- 277-3690

Publication: MEDICAL BULLETIN

MONTOUR COUNTY

President: David R. Brill, MD, Geisinger Medical Ctr, Danville 17822-0001, 717-271-6211

President Elect: Norman L. Ekberg,

MD, Geisinger Medical Center, Danville 17822-0001, 717-271-6211

Secretary-Treasurer: John P. Carlson, MD, Geisinger Medical Ctr, Neurology Dept, Danville 17822-0001, 717-271- 6419

NORTHAMPTON COUNTY

President: Robert J. Sallash Jr., MD, 701 Ostrum St, Bethlehem 18015-1013, 215-691-3603

President Elect: Eric Schoeppner, MD, 1346 Northampton St, Easton 18042- 4050, 215-253-7211

Vice President: James D. Balshi, MD,

303 W Broad St, Bethlehem 18018, 215-691-8313

Treasurer: Walter K. Peters, MD, 724 Barrymore Ln, Bethlehem 18017- 2522, 215-694-5881

Secretary: Evan C. Reese Jr., MD, 2005 Fairview Ave, Easton 18042-3915, 215-258-6268

Executive Secretary: William H. Kilpatrick, 788 Redfern Ln,

Bethlehem 18017-1841,215-865-2900

Bulletin Editor: William H. Kilpatrick, 788 Redfern Ln, Bethlehem 18017- 1841, 215-865-2900

Publication: THE BULLETIN

NORTHUMBERLAND COUNTY

President: Thomas J. Heromin, MD, 1 1 Aspen St, Elysburg 17824, 717-672- 9324

President-Elect: Jere L. Wagner, MD, 2 N 8th St, Shamokin 17872, 717-644- 0347

Secretary-Treasurer: Edward V.

Twiggar II, MD, 335 Center St,Shamokin 17872-1120, 717-644- 0494

PERRY COUNTY

President: James J. Marakowski, DO, Perry Health Center, Loysville 17047, 717-789-3553

President Elect: Patrick T. Bolden, MD, Duncannon Family Health Ctr, Box 68, Duncannon 17020, 717-957-3697

Vice President: Byung D. Chang, MD, 48 W Main St, Box 356, New Bloomfield 17068, 717-582-2181

Secretary-Treasurer: Joseph J. Matunis, MD, RR 2 Box 365, Loysville 17047- 9802, 717-789-4277

PHILADELPHIA COUNTY

President: Paul J. Fink, MD, Phila Psychiatric Ctr, 4200 Monument Rd, Philadelphia 19131-1689, 215-667- 3788

President Elect: Donald Kaye, MD, 3300 Henry Ave, Philadelphia 19129-1121, 215-842-6950

40

PENNSYLVANIA MEDICINE

Vice President: Richard M. Gash, MD, 1401 E Redwood Ln, Wyncote 19095- 1905

Treasurer: William S. Frankl, MD, Hahnemann Univ Cardiovascular, Broad And Vine St, Philadelphia 19102, 215-448-8790 Secretary: Norman Makous, MD, 688 S Highland Ave, Merion Station 19066- 1608, 215-829-3456 Executive Director: John Trevi, 2 1 00 Spring Garden St, Philadelphia 19130- 3590, 215-563-5343 Bulletin Editor: William Weiss, MD,

3912 Netherfield Rd, Philadelphia 19129-1014,215-849-4971 Publication: PHILADELPHIA NEWSLETTER

POTTER COUNTY

President: Robert Supinski, MD, Charles Cole Medical Ctr, Rte 6, Coudersport 16915, 814-274-9650 Vice President: Carolyn R. Bengston, MD, Charles Cole Medical Ctr, Rte 6, Coudersport 16915, 814-274-7475 Secretary-Treasurer: George C. Mosch, MD, 207 Cartee St, Box 72, Coudersport 16915, 814-765-1681

SCHUYLKILL COUNTY

President: Samuel C. Slimmer Jr., MD, Pottsville Hosp, Pottsville 17901, 717- 621-5060

President-Elect: A. Mohsen Kholoussy, MD, PO Box 1184, Pottsville, 17901, 717-622-4164

Treasurer: Robert H. Peters, III, MD, 1804 Tall Oaks Rd, Orwigsburg 17961, 717-622-1650

Secretary: Joseph T. Marconis, MD, 1501 Birch Rd, Pottsville 17901, 717-621- 5000

SOMERSET COUNTY

President: George A. Montgomery Jr., MD, 917 W Main St, Somerset 15501- 1213, 814-443-4634

President Elect: Leonardo S. Tensuan, Jr, MD 433 W Main St, Somerset 15501, 814-445-4129

Vice President : Robert V. Jacobs, MD, 203 E Patriot St, Somerset 15501, 814- 445-5167

Secretary-Treasurer: William C. Ryan, MD, 917 W Main St, Somerset 15501- 1213, 814-443-3648

SUSQUEHANNA COUNTY

President: Jan C. Kletter, MD, 1 Grow Ave, Montrose 18801, 717-278-3801

President Elect: Albert M. Bertsch, MD, 3 Grow Ave, Montrose 18801-1103, 717-278-2017

Vice President: Albert M. Bertsch, MD, 3 Grow Ave, Montrose 18801-1103, 717- 278-2017

Secretary-Treasurer: Paul B. Kerr, MD,

1 Grow Ave, Montrose 18801-1103, 717-278-3801

TIOGA COUNTY

President: Edgar Wong, MD, Soldiers and Sailors Mem Hosp, 32 Central Ave, Wellsboro 16901-1840, 717-724- 1631, ext 115

President Elect: Terrence E. Babb, MD, Wellsboro Family Health Ctr, 24 Walnut St, Wellsboro 16901-1526, 717-724-4241

Vice President: Dennis Badman, MD, 24 Walnut St, Wellsboro 16901, 717-724- 424 1

Secretary-Treasurer: David F. Gillum, MD, 135 Main St, Wellsboro 16901- 1415, 717-724-1900 ext 441

UNION COUNTY

President: James W. Morgan Jr., MD, Loan and JPM Rds, RR 5, Box 169, Lewisburg 17837-9391, 717-523-3290

President Elect: Charles E. Heid, MD,

60 S 4th St, Lewisburg 17837, 717- 523-9631

Vice President: John L. Ginsburg, MD, 134 S 16th St, Lewisburg 17837-1657

Treasurer: Russell J. Stankiewicz, MD, 3 Hospital Dr, Lewisburg 17837-9394, 717-524-4405

Secretary: John A. Malcolm Jr., MD, RR 1 Box 310, Sunbury 17801-9612, 717- 286-6553

Executive Director: Paul P. John, 2895 Euclid Ave, Williamsport 17701, 717- 323-6432

VENANGO COUNTY

President: John M. Karian, MD, 150 Prospect Ave, Franklin 16323, 814- 437-3005

President Elect: Stephen Cenedella, MD, 150 Prospect Ave, Franklin 16323, 814-432-4744

Vice President: Robert M. Pilewski, MD, 122 W 1st St, Oil City 16301-2724, 814-676-8571

Secretary-Treasurer: James J. Houser, MD, 150 Prospect Ave, Franklin 16323-2542, 814-437-5776

WARREN COUNTY

President: Dale L. McNett, MD, 1 14 Main Ave, Warren 16365-2119 President Elect: Walter H. Kuhnen, MD, 112 Franklin St, Warren 16365-2631, 814-726-0357

Treasurer: William S. Walters, MD, 381 Pleasant Dr, Warren 16365-3306 Secretary: Ross E. Bryan, Jr, MD, R Rl, Box A1365, 7 Eaton Dr, Clarendon 16313-9801, 814-723-2756 Bulletin Editor: Frank H. Butt Jr., MD, 508 S State St PO Box 55, North Warren 16365-1247, 814-723-7251 Publication: WARREN COUNTY MEDICAL SOCIETY BULLETIN

WASHINGTON COUNTY

President: George C. Schmieler, MD,

The Washington Hospital, 155 Wilson Ave, Washington 15301, 412-223- 3528

President Elect: Michael T. Malayil, MD, 150 W Beau St, Ste 414, Washington 15301-4435,412-225-1120

Vice President: Walter P. Slomiany, MD, 1194 Tidewood Dr, Bethel Park 15102- 1063, 412-587-3472

Secretary-Treasurer: Richard S. Pataki, MD, Washington Hosp, 155 Wilson Ave, Washington 15301, 412-223-3131

Executive Secretary: Coby Bonessi, 218 Washington Trust Bldg, Washington 15301-8210,412-222-1400

Bulletin Editor: Ernest L. Abernathy, MD, 218 Washington Trust Bldg, Washington 15301-2821, 412-222- 1400

Publication: THE MEDICAL BULLETIN OF THE WASHINGTON COUNTY MEDICAL SOCIETY

WAYNE/PIKE COUNTY

President: Jon K. Stemburg, MD, 1500 N Main St, Honesdale 18431-2008, 717- 253-1205

President Elect: George W. Tietjen, MD, 507 High St, Honesdale 18431-1733, 717-253-2620

Secretary-Treasurer: Harry D. Propst, MD, 507 High St, Honesdale 18431-

1733, 717-253-2620

WESTMORELAND COUNTY

President: Gloria J. Watkins, MD, 508 S Church St, Mount Pleasant 15666- 1790, 412-547-1198 President Elect: Gregory D. Grabiak, MD, Central Medical Arts Bldg, Old Rte 30, Greensburg 15601, 412-539- 0505

Vice President: J. Conrad Bures, MD, Latrobe Area Hosp, Pathology Dept, Latrobe 15650, 412-537-1550 Treasurer: William S. Keck, MD, 516 Pellis Rd, Greensburg 15601-4506, 412-834-3730

Secretary: Gloria J. Watkins, MD, 508 S Church St, Mount Pleasant 15666- 1790, 412-547-1198 Executive Director: Richard S. Cole, MD, 207 Coulter Bldg, Greensburg 15601-5405, 412-837-5050 Bulletin Editor: Wilma C. Light, MD, 1100 Ligonier St, Latrobe 15650-1917, 412-539-4551

Publication: WESTMORELAND COUNTY MEDICAL SOCIETY BULLETIN

WYOMING COUNTY

President: Ian A. Kellman, MD, Tyler Memorial Hosp, RR 1, Tunkhannock

18657, 717-836-2161 Secretary-Treasurer: George H. Limpert, MD, PO Box 67, Dimock 18816-0067, 717-278-1981

YORK COUNTY

President: Rocco J. Demasi, MD, 924 Colonial Ave, York 17403-3430, 717- 854-7831

President Elect: Raymond J. Gaspari, MD, 1938 Security Dr, York 17402-

4727, 717-741-3313

Vice President: Richard W. Dabb, MD, 50 Wyntre Brooke Dr, York 17403, 717-741-0877

Treasurer: Samuel S. Laucks II, MD, 1601 S Queen St, York 17403-4630, 717-848-2067

Secretary: Michael J. Prendergast, MD, 25 Monument Rd, Ste 100, York 17403-5049, 717-741-4785

Executive Secretary: Rhonda

Renninger, 1001 S George St, York 17405, 717-843-6744

Bulletin Editor: Roland Friedrich, MD, Apple Hill Medical Ctr, 25 Monument Rd, York 17403-5049, 717-741-2277

Publication: THE BULLETIN

AUGUST 1992

41

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YOHIMBINE HCI

Description: Yohimbine is a 3a-15a-20B-17a-hydroxy Yohimbine-16a-car- boxytic acid methyl ester. The alkaloid is found in Rubaceae and related trees. Also in Rauwolfia Serpentina (L) Benth. Yohimbine is an indolalkylamine alkaloid with chemical similarity to reserpine. It is a crystalline powder, odorless. Each compressed tablet contains (1/12 gr.) 5.4 mg of Yohimbine Hydrochloride.

Action: Yohimbine blocks presynaptic alpha-2 adrenergic action on peripheral blood vessels resembles that of reserpine, weaker and of short duration. Yohimbine’s peripher system effect Is to increase parasympathetic (cholinergic) | sympathetic (adrenergic) activity. It is to be noted that in male performance, erection is linked to cholinergic activity and to alpha renergic blockade which may theoretically result in increased i decreased penile outflow or both .

Yohimbine exerts a stimulating action on the mood and anxiety. Such actions have not been adequately studied or re

although they appear to require high doses of the < anti-diuretic action, probably via stimulation of hy release of posterior f

Reportedly, Yohimbine exerts no significant influence on car tion and other effects mediated by B-adrenbrgic receptor! its ef| pressure, if any, would be to lowers however no adequate studie " I ; effect mterms of Yohimbine dost lions: Yocon * is indicated as a sympathicoly

HH 1 — '-iac.

seases, and patient's se uate information at har

Yohm othalmic centers and

stimu

ton I i are at hand

It may

drug. In i tabulation

itive to f

lean be

I of add

itraindications.

I not proposed for usl nancy. Neither is thisj

t females and certainly I proposed for use in ■tits witb^gastric or duodenal ulcer HStory. ^pr should it be used in conjunction with mood-modifying drugs such as antidepressants or in psychiatric patients in general.

Adverse Reactions: Yohimbine readily penetrates the (CNS) and produces a complex pattern of responses In lower doses than required to produce periph- eral a-adrenergic blockade. These include, anti-diuresis, a general picture of central excitation including elevation of blood pressure and heart rate, in- creased motor activity, irritability and tremor. Sweating, nausea and vomiting are common after parenteral administration of the drug.12 Also dizziness, headache, skin flushing reported when used orally.1’3 Dosage and Administration: Experimental dosage reported in treatment of erectile impotence.1-3-4 1 tablet (5.4 mg) 3 times a day, to adult males taken orally. Occasional side effects reported with this dosage are nausea, dizziness or nervousness. In the event of side effects dosage to be reduced to % tablet 3 times a day, followed by gradual increases to 1 tablet 3 times a day. Reported therapy not more than 10 weeks.3 How Supplied: Oral tablets of Yocon* 1/12 gr. 5.4 mg in

1. A- Morales et al., New England Journal of Medi- cine: 1221. November 12, 1981

2. Goodman, Gilman — The Pharmacological basis of Therapeutics 6th ed,, p. 176-188.

McMillan December Rev 1/85.

3. Weekly Urological Clinical letter, 27:2, July4, 1983.

4. A. Morales et al. , The Journal of Urology 1 28: 45-47, 1982.

Rev. 1/85

bottles of 100's NDC 53159-001-01 and 1000’s NDC 53169-001-10.

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Pennsylvania Allergy Association President: Lawrence A. Caliguiri, MD, 3801 McKnight Road, Pittsburgh, 15237-6437, (412) 681-3333 President Elect: Eric J. Schenkel, MD, 3213 Nazareth Road, Easton, 18042, (215) 252-7388

Secretary: Stephen D. Lockey III, MD, 2445 Marietta Avenue, Lancaster, 17601, (717) 898-1562 Treasurer: Paul M. Mauriello, MD, 1610 Oak Hill Avenue, Suite 141, Hagerstown, MD 21740, (301)790-1482

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Pennsylvania Society of Anesthesiologists President: Donald E. Martin, MD, 19 Gentry Drive, Palmyra, 17078, (717)531-6140

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Executive Secretary: Mrs. Sally A. Nelson, 320 Main street, Johnstown, 15901, (814) 535-6623

Pennsylvania Chapter,

American College of Cardiology President: James H. Gault, MD, 217 Harrisburg Ave., Suite 200, Lancaster, 17603, (717) 397-5484 Vice President: Lee B. Beerman, MD,

129 Richland Lane, Pittsburgh, 15208, (412) 647-5548

Secretary/Treasurer: George R. Moffitt Jr., MD, 1000 North Front Street, Wormleysburg, 17043, (717) 238-1771 Past Governor, E. PA: Alfred A. Bove, MD, PhD, Cardiology Section, Temple Univ. Med. School, Philadelphia, 19140, (215) 221-3346 Past Governor, W. PA: William P. Follansbee, MD, Univ. of Pittsburgh School of Medicine, 376-A Scaife Hall, Pittsburgh, 15261, (412) 647-3435 PMS Administrator: John Jordan

Pennsylvania Society

of Colon/Rectal Surgery President: Pricha Boonswang, MD, 2358 Gruver Avenue, Easton, 18042, (215) 252-2229

President Elect: David Swerdlow, MD, 328 Belleville Avenue, Bloomfield, NJ 07003

Vice President: Robin Rosenberg, MD, 9892 Bustleton Avenue, Suite 206, Moss Plaza, Philadelphia, 19115 Secretary: Stephen Silver, MD, Manoa

Medical Center, 1010 W. Chester Pike, Havertown, 19083, (215) 446-7882 Treasurer Gerald Frost, MD, 15 West Wood Street #404, Norristown, 19401, (215) 279-8686

Historian: Larry L. Sollenberger, MD, Sollenberger C/R Surgery, 1571 N. Front Street, Harrisburg, 17102, (717)232-4567

Pennsylvania Academy of Dermatology President: John A. Zitelli, MD, 347 1 Fifth Ave. Ste. 1011, Pittsburgh, 15213,

(412) 681-9400

Vice President: Robert L. Roschel, MD, 203 North Lime, Lancaster, 17602, (717) 392-6267

Secretary: Warren R. Heymann, MD, 1 Brick Rd., Ste. 206, Marlton, NJ 08053-2146, (609) 596-0111 Treasurer: William K. Sherwin, MD, One Bala Plaza, Ste. 620, Bala Cynwyd, 19004,(215)664-3300

Pennsylvania Chapter, American College of Emergency Physicians President: David M. Siegel, MD, JD,

2008 Garrick Drive, Pittsburgh, 15235, (412)469-5806

President Elect: Richard M. McDowell, MD, Emergency Department, Conemaugh Valley Mem. Hosp, 1086 Franklin Street, Johnstown, 15905, (814) 533-9769

Vice President: Joyce Petrini, MD, 1820 Jody Road, Meadowbrook, 19046, (215) 576-2450

Secretary: Vincent Verdile, MD, 100 Denniston Avenue, #8, Pittsburgh, 15206,(412)578-3170 Treasurer: Russell Bieniek, MD, 1701 Sassafras Street, Erie, 16502,

(814) 870-1010

PMS Administrator: David C. Blunk, Executive Director

Pennsylvania Academy of Family Physicians

President: Louis H. Castor, MD, The Philadelphian, 2401 Penna. Ave., Ste. 9A7, Philadelphia, 19130,

(215) 725-8111

President Elect: Marc J. Schneiderman, MD, Fifth Avenue Medical Assoc.,

Fifth & Mulberry Streets, Coraopolis, 15108,(412)269-0899 Vice President: Thomas J. Weida, MD, 1011 Handsome Place, Lititz, 17543, (717) 627-1214

Treasurer: Robert Robison, MD, 4813 Jonestown Road, Suite 205, Harrisburg, 17109, (717) 657-3030 Executive Vice President: Edward Nielsen, 5600 Derry Street,

Harrisburg, 17111, (717) 564-5365

Pennsylvania Society of Gastroenterology President: Michael M. Geduldig, MD, 4969 Berkley Street, Harrisburg,

17109, (717) 652-5505 President Elect: Harris R. Clearfield,

MD, Hahnemann University, Broad & Vine Sts., MS131, Philadelphia,

19102, (215)448-8101 Secretary: Wayne W. Petemel, MD, 1350 Locust Street, Ste 406, Pittsburgh, 15219, (412) 232-8104 Treasurer: Julian Katz, MD, Two Bala Plaza, Suite IL 22-24, Bala Cynwyd, 19004,(215)664-9700 PMS Administrator: Linda L. Koval

Pennsylvania Society

of Hematology & Oncology President: Ronald N. Rubin, MD, 901 Drexel Lane, Bryn Mawr, 19010 Secretary /Treasurer: Herbert S.

Waxman, MD, York & Tabor Roads, Philadelphia, 19141, (215) 456-6940 PMS Administrator: Stacy M. Otstot

Pennsylvania Society of Infectious Diseases President: Robert C. Aber, MD,

Hershey Medical Ctr., Hershey, 17033,(717) 531-8390 Secretary Treasurer: Jerome Santoro, MD, Lankenau Medical Bldg., Suite 310, Philadelphia, 19151

Pennsylvania Society of Internal Medicine President: Howard Fugate Jr., MD, 633 Maple Avenue, DuBois, 18612, (814) 371-4443

President Elect: John H. Moyer, MD, 1090 Miller Road, Palmyra, 17078, (717) 534-2421

Secretary: Jaan Siderov, MD, Geisinger Medical Center, Danville, 17822,

(717) 271-6211

Treasurer: Raymond Gaspari, MD, 1 938 Security Drive, York, 17402,

(717) 741-3313

Executive Director: Mr. John Nikoloff, 128 State Street, P.O. Box 671, Harrisburg, 17108, (717) 234-5351

Pennsylvania Society of Nephrology President: David Knudsen, MD, Hershey Medical Center, Hershey, 17033 Secretary: Gerald B. Martin, MD, 64 S. West Street, Carlisle, 17013,

(717) 245-2291

Treasure n Louis Riley, MD, Temple University Hospital, Broad & Ontario Streets, Philadelphia, 19140

Pennsylvania Neurosurgical Society President: Perry Black, MD, Dept, of Neurosurgery, Mail Stop 407, Hahnemann University, Broad & Vine Streets, Philadelphia, 19102-1192, (215) 448-8072

President Elect: James A. Kenning, MD, 958 County Line Road, Bryn Mawr, 19010-2502, (215) 527-2443 Immediate Past President: John G. Phillips, MD, 5750 Centre Avenue, Suite 400, Pittsburgh, 15206, (412) 363-5900

Secretary/Treasurer: Bruce E.

Northrup, MD, 1025 Walnut Street,

AUGUST 1992

43

jgm

PECIALTY SOCIETY OFFICERS

Philadelphia, 19107, (215) 955-6744 PMS Administrator: John Jordan

Pennsylvania College of Nuclear Medicine President:Walter J. Slizofski, MD, Hahnemann University, 309 Bobst Boulevard, Philadelphia, 19102 President Elect: Vacant Secretary: Perry Smith, MD, 48 Park View Drive, Washington, 15301,

(412) 222-5017

Treasurer: P. Todd Makler, Jr., MD, 960 Meeting House Road, Rydal, 19046, (215)456-6260

Pennsylvania Section of the American College of Obstetricians and Gynecologists Chairman: Vincent A. Pellegrini, MD, Chairman, Pennsylvania Section, 301 South Seventh Avenue, West Reading, 19611, (215) 374-2214

Pennsylvania Academy of Ophthalmology

President: Robert D. Reinecke, MD, 318 South Second Street, Philadelphia, 19106

President Elect: Joseph W. Sassani, MD, Division of Ophthalmology, Hershey Medical Center, Hershey, 17033, (717) 531-8696, (717) 531-5475 (FAX) Secretary/Treasurer: Jane Barton, MD, 92 Tuscarora Street, Harrisburg, 17104,(717) 232-0843 Executive Director: Mr. Alfred K.

Walter, P.O. Box 1325, Reading,

19603, (215) 375-4311 PMS Liaison: Linda L. Koval

Pennsylvania Academy of Otolaryngology, Head and Neck Surgery President: G. William Jaquiss, MD, Manor Oak Village, 1910 Cochran Road, Pittsburgh, 15220,

(412) 921-3363

President Elect: Thomas Kennedy, MD, Geisinger Medical Center, Department of Otolaryngology, Danville, 17821 Treasurer: Alan M. Miller, MD, 306 West Logan Street, Norristown, 19401,

(215) 275-6153

Executive Director: Mr. Alfred K.

Walter, P.O. Box 1325, Reading, 19603,(215) 375-4311 PMS Liaison: Linda L. Koval

Pennsylvania Orthopaedic Society President: Thomas H. Malin, MD, 99 November Drive, Camp Hill, 17011, (717) 761-8644

Immediate Past President: Richard P. Whittaker, MD, 1603 East High Street, Pottstown, 19464,

(215) 327-2400

First Vice President: Arnold T. Berman, MD, 221 North Broad Street, Philadelphia, 19102,

(215) 448-8167

Second Vice President: Harry E. Rubash, MD, 3601 Fifth Avenue, Pittsburgh, 15213, (412) 687-3938

Secretary: Patrick B. Respet, MD, 1730 West Chew Street, Allentown, 18104, (215)433-6045

Treasurer: E. Michael Okin, MD, 9140-A Academy Road, Philadelphia, 19114, (215) 331-6050

PMS Administrator: Linda L. Koval

Pennsylvania Association of Pathologists

President: Stanley Burrows, MD,

Episcopal Hospital, Front and Lehigh Aves., Philadelphia, 19125,

(215) 427-7336

Vice President: Donald Cohen, MD, 539 Boyd Drive, Sharon, 16146, (412)983-3950,

Secretary/Treasurer: Arthur Altman, MD, 3550 Southwood Drive, Easton, 18042-5845, (215) 252-2793 PMS Administrator: John Jordan

Pennsylvania Chapter of the American Academy of Pediatrics President: Barbara Harley, MD, Conemaugh Valley, Memorial Hospital, 1086 Franklin Street, Johnstown, 15905, (814) 533-9104 Vice President: Jerold Aronson, MD, 605 Moreno Road, Narberth, 19072,

(215) 988-1677

Secretary/Treasurer: Bradley Bradford, MD, Mercy Hospital, 1400 Locust Street, Pittsburgh, 15219, (412)232-7388

Chapter Administrator: Suzanne Yunghans, Suite 220, The Dayton Building, 6 1 0 Old Lancaster Road, Bryn Mawr, 19010, (215) 520-9123

Pennsylvania Academy of Physical Medicine and Rehabilitation President: James L. Cosgrove, MD,

North Hills Passavant Hosp, 9100 Babcock Boulevard, Pittsburgh, 15237 President Elect & Vice President: Robert W. Downie, MD, Philadelphia Geriatric Center, 5301 Old York Road, Philadelphia, 19141, (215) 456-2951 Secretary/Treasurer: William F. Bonner, MD, 333 North Oxford Valley Road, Fairless Hills, 19030 Executive Secretary: Mrs. Pat Wyatt,

4 1 7 Hampton Road, King of Prussia, 19406,(215) 278-8460

The Robert H. Ivy Society of Plastic and Reconstructive, Surgeons President: Dennis J. Hurwitz, MD, 347 1 Fifth Avenue, Pittsburgh, 15213,

(412) 683-7766

Vice President: Eric W. Blomain, MD, 1222 Marion Street, Dunmore, 18509, (717) 347-1712

Secretary: Frederick Heckler, MD, 320 E. North Avenue, Pittsburgh, 15212, (412) 359-4352

Treasurer: Bruce E. Genter, MD, 1250 Greenwood Ave., Suite 10,

Jenkintown, 19046, (215) 572-7744

Immediate Past President: Richard W.

Dabb, MD, 50 Wyntre Brooke Drive, York, 17403, (717) 741-0877 PMS Administrator: Stacy M. Otstot

Psychiatric Physicians of Pennsylvania President: Stephen L. Schwartz, MD,

307 Lamplighter Lane, Huntingdon Valley, 19006, (215) 928-6503 President Elect: Marvin Kanefield, DO, Roosevelt Blvd. & Adams Ave., Philadelphia, 19124, (215) 831-4800 Vice President: Michael Vergare, MD, 8860 Germantown Avenue, Philadelphia, 19118, (215)456-7248 Secretary: Thomas L. Horn, MD, 3 Parkway Center East, 2020 Ardmore Blvd., #285, Pittsburgh, 15221,

(412) 351-5540

Treasurer: William R. Dubin, MD, Phila Psychiatric Center, Philadelphia, 19131, (215) 581-3771 Immediate Past President: Lawrence L. Altaker, MD, Polyclinic Medical Cen- ter, 2601 North Third Street, Harris- burg, 17110

Legal Counsel: Michael C. Hemsley, Esquire, Griffith & Burr, PC, 1608 Walnut Street, Philadelphia, 19103, (215) 893-1234

PMS Administrator: Gwen Yackee, Executive Director Philadelphia Psychaitric Society: Barbara Pauly, Executive Director,

2 1 00 Spring Garden Street, Philadelphia, 19130, (215) 665-0849 Pittsburgh Psychiatric Society: Patricia Bogatay, Executive Director, 311 South Craig Street, Pittsburgh, 15213, (412) 681-6944

Pennsylvania Society for Pulmonary Disease President: Richard T. Bell, MD, 301 South Seventh Avenue, West Reading, 19611-1410,(215) 374-4421 Vice President: Robert E. Albertini, MD, Geisinger Medical Center, North Academy Avenue, Danville, 17822, (717) 271-6924

Chapter Administrator: Kathi J.

Wagner, 4807 Jonestown Road, Suite 251, Harrisburg, 17109,

(717) 540-8506

Pennsylvania Radiological Society President: Terence N. Moore, MD,

Lancaster General Hospital, P.O. Box 3555, Lancaster, 17603,

(717) 295-8302

President Elect: Terence N. Moore, MD, Lancaster General Hospital, P.O. Box 3555, Lancaster, 17603,

(717) 295-8302

First Vice President: Michael H. Bleshman, MD, Dept, of Diagnostic Imaging, Phoenixville Hospital, 140 Nutt Road, Phoenixville, 19460,

(215) 983-1117

Second Vice President: David R. Brill, MD, Geisinger Medical Center,

44

PENNSYLVANIA MEDICINE

Danville, 17821, (717) 271-6301 Secretary: Esmond M. Mapp, MD, Dept, of Radiology, Thomas Jefferson Univ. Hosp., 1 1 1 South 1 1th Street, Philadelphia, 19107, (215) 955-6226 Treasurer: William R. Poller, MD, Pittsburgh Radiology Assoc., 3471 Fifth Ave., Ste. 301, Pittsburgh, 15213, (412) 648-6043

Senior Councilor: Joseph H. Rpsen, MD, American College, Jefferson Park Hospital of Radiology, 3905 Ford Road, Philadelphia, 19131 Executive Director: Mr. Thomas Johnson Jr., P.O. Box 175,

Landisville, 17358, (717) 898-6006

Pennsylvania Rheumatology Society President: Robert G. Sanford, MD, 650 Poplar Church Road, Camp Hill,

17011, (717) 761-3505 Secretary/Treasurer: Charles D. Tourtel- lotte, MD, Temple University Health Sciences Center, Philadelphia, 19140- 5192,(215) 221-3606

American College of Surgeons President Central PA: Jonathan E. Rhoads Jr. MD, York Hospital, Department of Surgery, 1001 South George Street, York, 17405,

(717) 771-2756

Vice President: J. Stanley Smith Jr., MD, Hershey Medical Center, Hershey, 17033

Secretary: Gordon Kauffman, MD, Hershey Medical Center, Hershey, 17033 '

President, Eastern PA: Frederick C. Beyer III, MD, Third Floor, 554 N. Duke St., Lancaster, 17602-2225,

(717) 392-4700

Treasurer: Thomas J. Tachovsky, MD,

St. Lukes Hospital, 801 Ostrum St., Bethlehem, 18015, (215) 954-4000

Metro-Phila: Francis Rosato, MD, 1025 Walnut Street, Philadelphia, 19107, . (215) 928-8643

Northwestern PA: E. Lawrence Hanson, MD, 300 State Street, Erie, 16507, (814)455-7542

Southwestern PA: J. William Futrell,

MD, University of PA, 1117 Scaife Hall, Pittsburgh, 15261,

(412) 648-9675

Pennsylvania Association for Thoracic Surgery

President: John L. Pennock, MD, 423 North 21st Street, Camp Hill, 17011, (717) 975-0900

Vice President: Sang B. Park, MD, 490 E. North Ave., Ste. 302, Pittsburgh, 15212, (412) 323-0363

Secretary: Thomas D. Maher, MD, 490 East North Avenue, Suite 302, Pittsburgh, 15212, (412) 323-0363

Treasurer: Manucher FallahNejad, MD, Graduate Hospital, One Graduate Plaza, Philadelphia, 19146

The Urological Association of Pennsylvania

President: Leonard A. Frank, MD, 1313 DeKalb Street, Norristown, 19401, (215) 272-1881

President Elect: Barry S. Shultz, MD, 301 South Seventh Street, West Reading, 19602, (215) 375-4579

Secretary /Treasurer: Marc B. Osias, MD.1313 DeKalb Street, Norristown, 19401, (215) 272-1881

Immediate Past President: Michael J. Prendergast, MD, 25 Monument Road, Ste. 100, York, 17403,

(717) 741-4785

PMS Administrator: John Jordan

Hahnemann University

Department of Anesthesiology and

Office of Continuing Education presents

1 Oth Annual Henry S. Ruth Conference and Lecture

“HEALTH HAZARDS OF THE OPERATING ROOM”

October 3, 1992 Valley Forge Hilton King of Prussia, PA •HIV and the Health Care Worker*

•Hepatitis in the Operating Room*

•Operating Room Pollution*

•Electrical Hazards in the OR*

•Substance Abuse by OR Personnel*

•Work Rest Cycles and Their Importance*

Martin Black, M.D. Jerry Levitt, M.D.

David Henderson. M.D. Fredrick Orkin, M.D.

Jan Horrow, M.D. James Richter. M.D.

Henry Rosenberg, M.D.. Chairman

For information call: 215-762-8263

HAND SURGEON

. . . because we care

Fellowship trained hand surgeon needed for a growing Hand Center in Philadelphia suburbs. Academic affiliation at Thomas Jefferson University.

Send inquiries and CV to:

Marwan A. Wehbe, M.D. PENNSYLVANIA HAND CENTER PO BOX 241 Bryn Mawr, PA 19010

AUGUST 1992

45

ENNSYLVANIA HEALTH AGENCIES

Alcoholism and Addiction Association

500 North Progress Avenue Harrisburg 17109 (717) 657-7084 Debra Beck, President

United Cerebral Palsy of Pennsylvania

1 20 South Street

Harrisburg 17101 (717) 236-1334 Ellen Liversidge, Executive Director

Pennsylvania Association for the Blind

2843 North Front Street Harrisburg 17110 (717) 234-3261 Valerie N. Wiener, Executive Director

March of Dimes State Field Office

1 60 South Progress Avenue Harrisburg 17109 (717) 545-4534 Duane Peters, Executive Director

American Cancer Society

Route 422 and Sipe Ave.

P.O. Box 897

Hershey 17033 (717) 533-6144 Arlene Dembrosky,

Executive Vice President

American Heart Association Pennsylvania Affiliate

1019 Mumma Road P.O. Box 8835

Camp Hill 17011-8835 (717) 975-4800 Theofanis Kotjarapoglus,

Executive Vice President

Kidney Foundation of Western Pennsylvania

130 7th St., Suite 1130 Century Building Pittsburgh 15222 (412) 261-41 15 Ginny Connolly-Manhardt, Acting Executive Director

Kidney Foundation of Southeastern Pennsylvania

325 Chestnut Street, Suite 904 Philadelphia 19106 (215) 923-8611 Prudence Vipiani, Executive Director

Mental Health Association in Pennsylvania

120 South Street

Harrisburg 17101 (717) 236-9363 Susan M. Reider, Executive Director

Pennsylvania Association for Retarded Citizens

123 Forster Street Harrisburg 17102 (717) 234-2621 Linda Drummond,

Public Affairs Coordinator

Pennsylvania Easter Seal Society P.O. Box 497

1 500 Fulling Mill Road Middletown 17057 (717) 939-7801 Karen McHenry Gluntz, Pres. & CEO

American Lung Association of Pennsylvania

4807 Jonestown Road, Suite 251 Harrisburg 17109 (717) 540-8506 Charles J. White, Executive Director

United Way of Pennsylvania

1 7 South Market Square Harrisburg 17101 (717) 238-7365 Deborah Foster, President

Pennsylvania State Board of Medicine

Commonwealth of Pennsylvania Department of State Box 2649

Harrisburg 17105 (717) 783-1400 Joshua Perper, MD

Pennsylvania State Board of Nursing

Commonwealth of Pennsylvania Department of State, Transportation and Safety Building Sixth Floor, Box 2649 Harrisburg 17105 (717) 783-7142 Miriam H. Limo, RN,

Executive Secretary

Pennsylvania State Board of Osteopathic Medicine

Commonwealth of Pennsylvania State Board of Osteopathic Medicine Box 2649

Harrisburg 17105 (717) 783-4858 Linda D. Widdoss,

Administrative Assistant

American Association of Retired Persons

225 Market Street, Suite 502 Harrisburg 17101 (717) 238-2277 Shirley Sharp, State Representative

Pennsylvania Department of Health

P.O. Box 90

Room 802, Health and Welfare Building

Harrisburg 17108 (717) 787-6436 Allan S. Noonan, MD, Secretary

Pennsylvania Cancer Registry

Division of Chronic Diseases Pennsylvania Department of Health P.O. Box 90

Harrisburg 17108 (717) 787-5251 Susan George, Acting Chief of Cancer Control Section

Division of Primary Care & Home Health Services

P.O. Box 90 Room 1032 A, Health

and Welfare Building Harrisburg 17108 (717) 787-2307 Shirely E. Remis, Director

Genetic Counseling and SIDS Program

Division of Maternal and Child Health Pennsylvania Department of Health P.O. Box 90

Health and Welfare Building,

Room 725

Harrisburg 17108 (717) 787-7440 Evelyn S. Bouden, MD,

Division Director

Pennsylvania Department of Public Welfare

Room 333, Health and Welfare Building

Harrisburg 17120 (717) 787-2600 Karen S. Snider, Secretary Includes:

Management Consulting Services 787-4867

Mental Health 787-6443 Mental Retardation 787-3700 Office of Children, Youth & Families 787-4756 Office of Medical Assistance 787-1870

Pennsylvania Department of Environmental Resources

9th Floor, Fulton Building P.O. Box 2063

Harrisburg 17105 (717) 787-2814 Arthur A. Davis, Secretary Includes:

Bureau of Radiation Protection 787-2480

Bureau of Mining & Reclamation 787-5103

Field Operations 787-5028 Bureau of Waste Management 787-9870

Pennsylvania Department of Labor and Industry Labor and Industry Building 7th and Forster Streets Harrisburg 17120 (717) 787-3756 Thomas Foley, Secretary Includes:

Occupational and Industrial Safety 787-3323

Worker’s Compensation 783-5421 Unemployment Compensation Board of Review 787-5122 Vocational Rehabilitation 787-5244

Disability Determination 783-3620

Pennsylvania Department of Agriculture

2301 North Cameron Street

46

PENNSYLVANIA MEDICINE

Harrisburg 1711 0-9408 (717) 787-5085 Boyd E. Wolf, Secretary Includes:

Bureau of Animal Industry 783-5301

Bureau of Plant Industry 787-4843 Bureau of Food and Chemistry 787-4315

Pennsylvania Health Care Association

240 1 Park Drive

Harrisburg 17110 (717) 657-4902 Robert H. Moran,

Executive Vice President

Hospital Association of Pennsylvania

4750 Lindle Road P.O. Box 8600 Harrisburg 17105-8600 (717) 564-9200 John A. Russell, President

Pennsylvania Dental Association

3501 North Front St.

P.O. Box 3341

Harrisburg 17105 (717) 234-5941

Esther F. Richwine,

Executive Director

Pennsylvania League for Nursing

92 Lonely Cottage Dr.

Upper Black Eddy 18972

(215) 847-5396

Paul Piscator, Manager

Pennsylvania Nurses Association

2578 Interstate Dr.

Harrisburg 171 10 (717) 657-1222 (Mailing address: P.O. Box 8525, Harrisburg 17105)

Jessie Igou, RN,

Executive Administrator

Pennsylvania Osteopathic Medical Association

1330 Eisenhower Blvd.

Harrisburg 17111 (717) 939-9318 Mario E. J. Lanni, Executive Director

Pennsylvania Pharmaceutical Association

508 North 3rd Street Harrisburg 17101 (717) 234-6151 Carmen A. DiCello,

Executive Director

Pennsylvania Veterinarian Association P.O. Box 403

Harrisburg 17108 (717) 233-7720 Ray Thompson, Executive Director

Organ and Body Donation Organ Donation:

Eastern and Central Pennsylvania

Delaware Valley Transplant Program

2401 Walnut Street, Suite 404 Philadelphia 19103 Day or Night Call (215) KIDNEY- 1 (543-6391)

Western Pennsylvania

Pittsburgh Transplant Foundation

5743 Center Avenue Pittsburgh 15206

Day or Night Call (412) DONORS-7 (366-6777)

Body Donation:

Humanity Gifts Registry

Suite 1550 1 30 South 9th Street Philadelphia 19107 24-Hour Service (215) 922-4440

1992 ANNUAL MEETING PENNSYLVANIA MEDICAL SOCIETY

HOUSE OF DELEGATES

The House of Delegates of the Pennsylvania Medical Society will convene its annual meet- ing at the Adam's Mark Hotel, Philadelphia, Pennsylvania, on Friday, October 23, 1 992. The second session will convene Saturday, Oc- tober 24, 1 992, and the third session Sunday, October 25, 1 992. Details regarding the start- ing times appear in the Official Call, which be- gins on page 1 8 of this issue of Pennsylvania Medicine.

Resolutions to be considered by the House may be submitted in writing to the Secretary by a delegate acting in his/her own behalf or for the component medical society or special- ty society he/ she represents. If received prior to September 23, 1 992, resolutions will be published in the Official Reports Book.

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Providing management consulting; corporate, estate, and retirement planning; group practice sale and valuation; general practice surveys, (including utilization review, fee schedule analysis, and coding) computerized medical billing, and related services for health care professionals.

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AUGUST 1992

47

IASSIFIED ADVERTISING

PHYSICIANS WANTED

ER physicians — Full-time/part- time positions available NJ, PA, NY. Emergency medicine expe- rience preferred. Guaranteed compensation and paid mal- practice. For more information call (215) 521-5100 (within PA), 1-800-TRAUMA6 (outside PA), or send CV to Trauma Service Group PC, Scott Plaza, Building Two, Suite 114, Philadelphia, PA 19113.

Western Pennsylvania — Board Certified or prepared emergency physicians needed for staffing a community hospital emergency department near the Ohio/Penn- sylvania border. Please send CV to P.O. Box 99431 , Pittsburgh, PA 15233-0431.

Pennsylvania — Physician group seeks full-time and part-time physicians for an emergency de- partment of community hospi- tals in central and western Penn- sylvania. Please send resume to P.O. Box 99431, Pittsburgh, PA 15233-0431.

General internist — Immediate opening available for dynamic BC/BE physician to join well-es- tablished internal medicine prac- tice in southwestern Pennsylva- nia. Salary $100,000. Benefit package $10,000. Pension plans. Future partnership option. In-house laboratory and x-ray fa- cilities. Excellent opportunity. Reply Box 345, PENNSYLVANIA MEDICINE, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Pocono Mts. area — Northeast Pennsylvania busy family prac- tice looking for BE/BC family practitioner. No Ob; active hos- pital practice; partnership possi- bilities. Skiing, boating, hiking within 5 miles. 90 minutes from Manhattan and Philadelphia. Please send CV to: Monroe Family Practice Assoc., 1803 W. Main, Stroudsburg, PA 18360; (717)421-0170.

Immediate position — Part-time BC/BE internist. Southwestern Pennsylvania (suburb of Pitts- burgh); ideal position for female physician desiring to raise a fam- ily and practice medicine. Mod- ern new facility, x-ray, lab. Salary negotiable. Box 366, PENNSYL- VANIA MEDICINE, 777 East Park

Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

Seeking associate for busy family practice in western Pennsylvania area. Salary and benefits guaranteed with full partnership available in one year. Transportation and accommo- dations paid for meeting. Con- tact Chris at (412) 758-7524 or reply to U.G. Kim, MD, P.O. Box 868, Ellwood City, PA 16117.

Wanted — Family physician needed for busy broadbased group practice 35 minutes north of Pittsburgh. Practice includes obstetrics, nursing home work, house calls, and assisting in surgery. Contact: Family Medi- cal Care Associates (412) 681- 5170.

Community Hospital, N.E. Philadelphia — 2 locations. Seeks general radiologist, mam- mo, ultrasound, cat scan, nuc. med. Knowledge of angio helpful but not necessary. 2 positions: full & part-time. Send resume & date available to: Ann Gabriel, MBA, P.O. Box 21911, Philadel- phia, PA 19124.

General surgeon BE/BC to join large solo surgical practice. Salary $140,000 with early part- nership. Send CV to Box 376, PENNSYLVANIA MEDICINE, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105- 8820.

General internist, or pul- monary, cardiology or other subspecialty — BE/BC to join 5- physician group in Carlisle, south central Pennsylvania. Close to Washington, Baltimore, Philadelphia. College town with progressive hospital, excellent schools, good place to raise family. Competitive salary with complete benefit package, op- portunity for partnership. Send CV to Box 374, PENNSYLVANIA MEDICINE, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.

Part-time emergency room position available in a 400-bed suburban hospital with 48,000 visits. Board certified/eligible in emergency medicine or other specialty with emergency room experience. Excellent salary package with partnership poten- tial. Contact Clarke Hankey, MD, Emergency Department, St.

Clair Hospital, 1000 Bower Hill Road, Pittsburgh, PA 15243 (412) 561-4900.

Family Practitioner — Excellent opportunity. Full-time. Immedi- ate opening for industrious, per- sonable, compassionate physi- cian looking to start practice in growing community. Respond to: Gilbert E. Pittenger, R.D.#1, Box 91, New Ringgold, PA 17960.

Woman general surgeon seeks an associate to join her in an active breast clinic. Must be BC/BE in general surgery. Salary, health insurance, mal- practice insurance, profit shar- ing. Good opportunity for recent graduate. Reply to: Johnstown Screening & Diagnostic Breast Center, 1111 Franklin St., Suite 030, Johnstown, PA 15905.

Pittsburgh, Pennsylvania —

Penn Group Medical Association (PGMA), a multi-specialty group practice affiliated with the largest HMO in Pittsburgh, is seeking BE/BC physician in: family practice, internal medicine, pediatrics, ob/gyn, and psychiatry. We are formally affiliated with major teaching hospitals and leading communi- ty hospitals in Pittsburgh. PGMA serves eight ambulatory care centers, all conveniently located near cultural, educational, recre- ational, and corporate activities. Excellent salary, fringe benefits, and incentives. For confidential consideration contact: Angela Lascola, HealthAmerfba, 5 Gate- way Center, Pittsburgh, PA 15222 or call collect (412) 553- 7502.

Radiologist — Established northeastern Pennsylvania radi- ology practice seeking a fifth ra- diologist for hospital and private practice. Applicant should have experience in CT, MRI, ultra- sound, mammography, nuclear medicine, angiography and in- terventional radiology. Potential for partnership. Candidate should be Board Certified/Board Eligible and licensed in Pennsyl- vania. Terrific area for family life, quality schools, recreational and civic activities. Address inquiries and current curriculum vitae to Box 381, PENNSYLVANIA MEDICINE, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.

AESA is seeking qualified physicians to develop an emer- gency department group at Ha- zleton St. Joseph Medical Cen- ter, a 190-bed facility with 19,000 annual visits. Excellent compensation package. Scenic location with access to the Pocono Mountains, Philadelphia and NYC. 1-800-779-1427.

Suburban Columbus, Ohio —

Another FP needed to join 4 oth- ers in a college town. Population 80,000 and expanding. Medical, OB and surgical backup at mod- ern hospital. Columbus & major university medical school 40 minutes. $120,000 + office. Wal- ter F. Smith 800-221-4762.

FP, Perinatal, Peds, Neurolo- gy, Ortho, ID, Urol, OB/GYN.

Local opportunities. Contact Yannelli, Randolph & Co., 994 Old Eagle School Rd., Suite 1020, Wayne, PA 19087; 215- 964-1616.

Primary Care-Part-time —

Evenings or weekend position. Modern immediate care facility. Northeast Philadelphia suburbs. Excellent salary. Contact Dr. Kravitz (215) 638-0666.

Emergency Physicians: direc- tor and staff positions avail- able— Immediate openings exist for a director and staff physi- cians (FT/PT) at Germantown Medical Center, a 280-bed hos- pital located in north Philadel- phia. Germantown is a teaching affiliate of P.C.O.M. Fast-paced ED with 28,000 annual visits. Double coverage during peak hours. 9 and 12 hour shifts. Ap- plicants should be BP/BC in emergency medicine or a prima- ry care specialty, with ED expe- rience and current ACLS/ATLS. Competitive compensation. In- terested candidates should con- tact: Donna Wallace, Emergency Physician Associates, 307 S. Ev- ergreen Ave., Woodbury, NJ 08096, 1 -800-848-EPA-1 .

Emergency Physicians — Posi- tions available 8/1/92 for emer- gency physicians at St. Agnes Medical Center, an impressive 240-bed hospital located in south Philadelphia. 17,400 an- nual visits. Burn Treatment Cen- ter on site. S.A.M.C. is a teach- ing affiliate of P.C.O.M. 12 hour shifts. Applicants should be BP/BC in emergency medicine or a primary care specialty, with

48

PENNSYLVANIA MEDICINE

ED experience and current ACLS, ATLS, PALS/APLS. Com- petitive compensation. Interest- ed candidates should contact: Donna Wallace, Emergency Physician Associates, 307 S. Ev- ergreen Ave., Woodbury, NJ 08096, 1-800-848-EPA-1.

OB/GYN New England — Ocean, Boston, Berkshires. Partnership. Now 250 deliveries plus surgery. 4 OBs coverage. Modern wom- en’s center. 10 percent Medi- caid. Call Walter Smith: 800- 221-4762.

Physicians Wanted — Endocri- nologist, Family Practitioner, Ophthalmologist, Otolaryngolo- gist, Orthopedic Surgeon, Pedi- atrician, Psychiatrist - 20 miles northeast of Pittsburgh. - profes- sional center, Tarentum, PA; (412) 224-4663.

POSITIONS WANTED

Seeking position in gastroen- teroiogy/internal medicine.

Available now. Board certified in internal medicine. Board eligible in gastroenterology. British and U.S. trained. Licensed in Penn- sylvania. Contact S.P. Nathan,

South Baltimore General Hospi- tal, 3001 S. Hanover St., Balti- more, MD 21230. (301) 355- 5502.

Stat Med USA — BC emergency medicine MD, member of Penn- sylvania Medical Society, offer- ing short-term office based FP/GP or clinics. Phone 717- 642-6355 or FAX 71 7-642-6942.

MISCELLANEOUS

Professional office suite in northeast Philadelphia. Private entrance, located in apartment bldg. One block from shopping and transportation. Will renovate to suit tenant. Call (201) 944- 8700 or (21 5) 744-8271.

Northeastern Pennsylvania —

Take over established family practice. Doctor to retire. In home office. Family oriented communities on the beautiful Delaware River at the PA/NY border in fastest growing county in Pennsylvania. Nearby consul- tants in all fields. Quality lifestyle/recreational amenities. Unique opportunity for guaran- teed income, paid malpractice insurance, and other incentives.

Contact physician after 6:00 (717)559-7400.

Otolaryngologist needed to share space with ophthalmolo- gist with multiple offices in Pitts- burgh and suburbs. Flexible terms and ready market. Call (412) 837-4232.

Medical Office — Fully equipped rental. Northeast Philadelphia. 215-725-8114.

Financing Unsecured — Up to

$60K. No placement fees or pre- payment penalties. Competitive rates, rapid processing, best in- terest only payment option. Equipment leasing - Answer in 12-72 hours, no upside limit, sin- gle or master lease. Warranty ex- tension, new practices eligible. Call 800-331-4951 ext. 511, 9-5 EST.

Florida s.e. coast (2 hrg. north of Miami) Young family physician wishes to relocate. Unique op- portunity to assume a busy prac- tice with an excellent reputation. Reply (407) 334-3333 or (407) 286-4588.

CLASSIFIED ADVERTISING

Rates: $38 per insertion ($25 for PMS members) for the first 30 words or part thereof; $1 .30 for each addi- tional word; $6 per insertion for a box number. Payment should be in advance. No agency commission is paid on classified advertising.

Submissions: Copy must be submitted in writing to PENNSYLVANIA MEDI- CINE, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820. For more information, call (717) 558- 7750.

Box Numbers: Advertisers using box numbers forbid disclosure of their identity. Written inquiries are for- warded to such advertisers, but no information can be re- vealed by the publisher.

Word Count: Count as one word all single words, two initials of a name, single numbers or groups of num- bers, hyphenated words, and abbreviations.

You 11 love working with our locum tenens physicians and allied health care professionals.

WE GUARANTEE IT.

CompHealth has thoroughly credenrialed physicians and allied health care providers from more than 40 fields of specialization available to provide locum tenens, or temporary, staffing assistance when and where you need it.

Plus, we have the standards and experience to guarantee your satisfaction each time we place a member of our medical staff in your practice or facility. It’s the closest thing you ’ll find to a risk- free way to cover for absent staff members, "tty out” a potential new recruit, or take care of your patients while you search for a new full-time associate.

Call us today to arrange for quality locum tenens coverage, or to discuss your permanent recruiting needs.

CompHealth

ImNS

-453-3030

:nsive Health Care Staffing

4L /

Salt Lake City # Atlanta ■ Grand Rapids, Mich.

aniel Stern and Associates has been solving medical staffing problems for 21 years. We have served more than 500 clients nationwide.

Our experience can work for you.

Please call for more information about:

▼ Recruiting physicians for Emergency Medicine, PM&R, Primary Care, Private Practice and Medical- Administration.

▼ Consulting services for medical staff planning, medical practice evaluations and medical staff opinion surveys

pp DANIEL STERN S^SAND ASSOCIATES

The Medical Center East Suite 240

211 North Whitfield Street, Pittsburgh, PA 15206

800-438-2476 412-363-6032 FAX 412-363-6032

AUGUST 1992

49

ADVERTISERS' INDEX

Bryn Mawr Rehab 5 Community General Osteopathic Hospital 33 CompHealth 49 CP02, Inc. 42

Daniel Stern & Associates 49 Dodson Insurance Group 10 D.T. Watson Rehabilitation Hospital 22 The Educational & Scientific Trust 50 Eli Lilly & Co. 9 Execu-Flow Systems 53 Fulton, Longshore & Associates 50 Geisinger Clinic 31 Glaxo Covers 3&4 Graduate Health Systems 33 Greater Pittsburg Visitors Bureau and Convention Center 37 Hagan McClintock & Co. 24 Hahnemann University 11, 45 Harmarville Rehab Center 30 Health Care Group 17 Hershey Medical Center 4 Jefferson MRI 39 Kennedy Krieger Institute 27 Magee Rehab Hospital 19

Malachy Whalen & Co. 21

MedCom Resource Corp. 23

Medical College of PA 34

Medical Inter-Ins. Exchange of NJ 25

Medical Personnel Pool 51

Medical Protective Co. 2

Mercy Heart Institute 54

Moss Rehabilitation Medicine 29

OR-D Systems 39

Palisades Pharmaceuticals 42

Pennsylvania Blue Shield 3, 6-7

Pennsylvania Hand Center 45

Philadelphia Heart Institute 13

Physicians Insurance Co. 12

PMS Liability Ins. Co. 1, 8

Princeton Insurance Co. 15

Professional Practice Consulting, Inc. 47

Sentient Systems 14

Shearson Lehman Brothers 53

Sheraton Hotel at Station Square 36

Thomas Johnson Jr & Assoc. 33

University of PA Medical Center 35

U.S. Air Force 35

U.S. Army Reserve 51

Valley Medical Management, Inc. Cover 2

Physicians’

HEALTH • PROGRAMS

Promoting the Well-Being of Pennsylvania Physicians

A confidential program offering peer support, monitoring, and advocacy to physicians who are:

• Dependent on drugs or alcohol

• Undergoing professional stress

• Having difficulty adjusting to retirement

• Experiencing physical/emotional difficulties

If you need help or know someone who does, call the PHP at (800) 228-7823.

Message Line:

(717) 558-7817, 24 hours a day

A service of The Educational and Scientific Trust.

Medical Practice Sales and Appraisals

Fulton, .Longshore & Associates is a leader in the appraisal and sale of medical practices.

Listed below are several of the practices which are currently for sale:

SPECIALTY

LOCATION

ANNUAL

REVENUE

Cardiology

Philadelphia

$

285,000

Dermatology

Coastal New Jersey

$

700,000

Family Practice

Northern Delaware

$

250,000

Family Practice

Philadelphia

$

255,000

Internal Medicine

Central Pennsylvania

$

900,000

Ophthalmology

D.C. Area

$

600,000

Ophthalmology

Michigan

$

700,000

Ophthalmology

New Jersey

$

300,000

Ophthalmology

Ohio

$1

,500,000

Ophthalmology

Charlotte, NC

$

600,000

Pediatrics

Lehigh Valley, PA

$

250,000

Psychiatry

Tennessee

$

525,000

For additional information, please contact:

Ed Strogen

Fulton, Longshore & Associates 527 Plymouth Road, Suite 410 Plymouth Meeting, PA 19462 (215)834-6780

50

PENNSYLVANIA MEDICINE

THE

EDUCATIONAL & SCIENTIFIC TRUST

The Educational and Scientific Trust of the Pennsylvania Medical Society provides you with a way to make a significant statement honoring the memory of and paying tribute to your colleagues who are deceased. Send your tax- deductible memorial gift to:

The Educational and Scientific Trust of the Pennsylvania Medical Society

777 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820.

Do you know someone who needs nursing care in their home ?

We have a special person to take care of your special person.

Are your patients entitled and/or eligible for Medicare benefits? If you are not sure call MEDICAL PERSONNEL POOL and we will

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