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CURRENT
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lULY 1990
rOLUME 93, NUMBER 7
Pennsylvania Medicine UCSF LIBRARY Received on: 08-08-90
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Medicine'
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.>»7V THIS ISSUE
8 Medical graduating classes smaller again this year Pennsylvania schools surveyed
1 8 Bridges to span medicine’s choices profile of PMS resident trustee Carl A. Sirio, MD
28 Nobel Conference: a report
autonomy in American medical ethics
34 Free and discounted care by physicians PMS indigent care survey
Celebrate freedom!
Photography by Blair Seitz®, Harrisburg
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Dr. Stephen Dunn on the difference between the old St Christopher’s Hospital for Children and the new St Christopher’s Hospital for Children.
“With our June 9 move to our new loca- tion at Erie Avenue at Front Street in North- east Philadelphia,
I’ve been asked to compare the ‘Old’ St. Christopher’s to the ‘New’ St. Christopher’s. But that’s like compar- pig apples to oranges.
“As the director of St. Christopher’s Pediatric Transplant Institute, I serve with a distinguished group of colleagues, all of whom hold fuH-time faculty positions at Temple University School of Medicine. The resultiug mteUectual, clinical and research capabilities have enabled St. Chris- topher’s to provide a truly extraordinary cali- ber of pediatric care.
“And although the ‘New’ St. Christo- pher’s has many changes, that Mgh level of care won’t change.
“With 183 beds (up from 146), the new facility is brighter, roomier, more open, with everything under one roof-and a helipad on top. Our Intensive
Care, Cardiac, Neonatal, Bum and Special Care Units will be expanded. More operating suites have also been added, with two designed spe- cifically for transplant procedures. Patient rooms are either private or semi-private (with private bath), and have been designed to allow parents to spend the night beside their chil- dren. The new location also has an 850-car gar- age and is convenient to both 1-95 and Route 1 .
“The net result: the tremendous medical resources of the ‘Old’ St. Christopher’s will now be available to a greater number of area physi- cians and their patients.
“So, even though St. Christopher’s quality of care will be as high as ever, the difference between our old location and our new, state-of- the-art facility couldn’t be greater. It’s Eke apples and oranges.”
/^STCHRISIOPHER’S
HOSPITAL FOR CHILDREN
' Erie Avenue at Front Street Philadelphia, PA 19134 215-427-5000
PENNSYLVANIA MEDICINE
JULY1990
PENNSYLVANIA MEDICINE
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PENNSYLVANIA MEDICINE, established in 1897, is the official publication of the Pennsylvania Medical Society. All editorial and advertising correspondence should be directed to the Managing Editor,
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1990: Pennsylvania Medical Society.
■ ABLE
■of contents
NEWSFRONTS
4 Medigram— /afe news at press time
8 Number of new physicians continues to shrink— med/cay schools report statistics
9 HCFA adopts new PRO definitions— “m/smanagemenf” replaced by new term
9 New pediatric AIDS clinic for
famiWes— Philadelphia area will benefit 10 Penn publishes medical school
history— distinguished careers highlighted 12 Penn professorship honors Dr.
Erdman— contributions memorialized 1 4 Group practice annual meeting in Florida— convenes September 4-7
PRESIDENT’S PAGE
6 Bad guys: not so bad— J. Joseph
Danyo— becoming heroes in health cost fray
EDITORIAL
16 From inkblots to art therapy— Fred B. Rogers— /i/sfo/y of art therapy
PMS PROFILE
18 Building bridges to span medicine’s choices— Elaine S. Herrmann— pro/iVe of Carl A. Sirio, PMS trustee
SPECIAL FEATURE
24 County society tries: reach out and touch someone— Mark W. Shulkin— p/?onaf/?on brings out physicians’ styles
32 State system of discipline for lawyers and judges— Kym Liebler— report from Pennsylvania Bar Association
IN MY OPINION
28 Nobel Conference: a report— Robert F. Drane— autonomy in American medicaU ethics ■
FINANCIAL MANAGEMENT I
31 After estate planning— William T. I Tsiouris, Esq.— important steps when wi is completed
CAPITOL COMMENTARY
34 Free and discounted care by physicians— PMS Indigent Care Survey— significant data collected
CORRESPONDENCE
40 Obituaries remind how fleeting is
time— Donald E. Harrup— remember/ngl an old friend I
40 Society president writes on Medicare— J.
Joseph Danyo— response to Senator H Heinz ■
41 Physician payment under I
Medicare— George Ross Fisher— broader aspects of cost reduction
AIDSPEAK TO AIDSENSE
44 The natural course of HIV
infections— George J. Pazin— disease progression analyzed
DEPARTMENTS
20 New members 22 Physicians in the news 38 Obituaries 48 Classified advertising 52 Advertisers’ index
36 Tips for surviving peer review— Rocco DeMasi— steps to keep handy
38 Physician pioneer honored in Clearfield County— Elaine S. Herrmann— co/or/u/ historical figure remembered
2
PENNSYLVANIA MEDICINE • JULY 1990
YOCON*
YOHIMBINE HCI
Description: Yohimbine is a 3a-15a-20B-17a-hydroxy Yohimbine-16a-car- boxylic acid methyl ester. The alkaloid is found in Rubame and related trees. Also in Rauwolfia Serpentina (L) Benth. Yohimbine is an indolalkylamlne 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 (alrenergic) activity. It is to be noted that in male sexual performance, erection is linked to cholinergic activity and to alpha-2 ad- renergic blockade whidt may titeoretically result in increased penile inflow, decreased penile outflow or toth.
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 dosK of the drug . Yohimbine has a mild anti-diuretic action, probably via stimulation of hypothalmic centers and release of posterior pituitary hormone .
Reportally, Yohimbine exerts no significant influence on cardiac stimula- tion and other ^ects mediated by B-adrenergic receptors, its effect on blood pressure, if any, would be to lower it; however noatequate studies are at hand to quantitide this effect in terms of Yohimbine dos^.
Indications: Yocon® is indicated as a sympathicolytic and mydriatric. It may hinre activity as an aphrodisiac.
ContraindiGations: Renal diseases,- and patient's sensitive to the dmg. In view of the limited and inadequate information at hand, tK> precise tabulation can be o^^ of additkmal contraindications .
Wamiim: G^rally, this drug is not proposed for use htfemales and certainly must not be used during pregnancy. Neither is this drag proposed for use in pediatric, geriatrfc or cardio-renal patients with gsBtric or duodenal ulcer history. Nor should It be used in conjunction with mood-modifying drugs such as antidepressants, or in psydttatric patients in general.
Mvarse Reactions: Yohimbine readi^ penetrates the (CNS) and produces a complex pattern of responses in lower doses than required to produce periph- eral a-»tref»fgic blockade. These include, anti-diuresis, a general picture of central excitation including elevation of blood pressure and heart rate, in- creased motor activity, irritabili^ and tremor. Sweating, nausea and vomiting are common after parenteral administration of ttie drug. ’'2 Also dizziness, headache, skin flushing reported when used orally.^ -^
Dosage and Adminisiratlon: Experimental dosr^ reported in treatment of
erectile impotence. ’ '3.4 i tablet (6.4 mg) 3 times a day, to adult males taken
orily. Occasional side effects reported with this dos^ are nausea, dizziness
or nervousness. In the event of side effects dosage to be r«luwd to Vt tablets
times a day, followed gradual increases to 1 tabtet 3 times a day. Reported
therapy not more than 10 weeks.3
How Sailed; Oral tablets of Yoam® 1/1 2 gr. 5.4 mg in
bottles of 1f»’s NOG 53159-001-01 and 1000's NDC
53159-001-10.
References:
1. A,4i4orales et al. , New England Journal of Medi-
cine: 1221 . November 12. 1981 . '
2. Goodman, Gilman — The Pharmacotogical basis | of Therapeutics etti ed.,p. 176-188,
McMillan December Rev. 1/85.
3. Weekly Ufological Clinical Wer, 27:2, July 4,
1983.
4. A. Morates « al. , The Journal of Urology 128:
45-47, 1982.
Rev. 1/85
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SENATE PASSES BILL ON MEDICARE FEES
SOCIETY SUPPORTS CHANGES IN MEDICAL LICENSE FEES
SUPPORT GROWS FOR LIVING WILL LAW
AUGUST DATE ANNOUNCED FOR COMMUNICATIONS PLAN
JUDICIAL DISCIPLINE SYSTEM MAY CHANGE
AMA BOARD NAMES DR. TODD EXECUTIVE VICE PRESIDENT
BLUE SHIELD'S OASIS SYSTEM IS TOLL-FREE
The Health Care Practitioners’ Fee Control Act, formerly called the “Medicare Over- charge Measure,” is expected to be signed by the governor. The measure, which would prohibit physicians from balance billing of Medicare patients in Pennsylvania, passed on June 26 by a 44-6 vote in the Senate. The House, which passed the measure a year ago, concurred in Senate amendments by a 165-32 vote on June 30. Through the Society’s lobbying efforts, a vital amendment which prohibits us- ing violations of the act to impose penalties against physicians’ hcenses was retained. j
The PMS Board acted Jime 5 to support the State Board of Medicine’s proposed fee increases for biennial registrations and some medical hcenses. The State Board seeks to raise the initial apphcation fees for graduate and unrestricted hcenses to $80 for foreign medical school graduates, and to raise the biennial registration for unrestricted hcenses to $80 for ah physicians, both domestic and foreign graduated
The U.S. Supreme Court’s recent ruling in the Nancy Cruzan case, that state govern-] ments can prevent physicians and family members from removing patients’ hfe-| support equipment, highhghts the importance of hving wiUs. Long a strong sup-1 porter of the hving wih concept, the Society’s board has caUed for declaration by] Governor Casey of a “hving wih day,” cutd has encouraged county societies to pro-* mote the hving wih concept in Pennsylvania. Pennsylvania is one of only nine state^l that have no right-to-die legislation, either curbing or forbidding the withdrawal! of hfe-support equipment.
The Society’s Long-Range Strategy and Communications Committee wih complete ! its action plan for projects and staffing to strengthen Society communications by^ August 14. The plan whl consider the results of focus groups held in 1989-90, the 1988 Forbes Communications Audit, and the 1989 membership survey. The plan wih address member commtmications, pubhcations, news media relations, and pubhc relations.
Nearing passage as the legislature moved toward the summer recess is a measure to change Pennsylvania’s judicial discipline system. Three pending bihs, S.B. 1,'* S.B. 595, and H.B. 539, are simhar. They would; separate the investigative function* of the disciplinary system from the adjudicatory; provide for both legal professionals' and lay persons to serve on the investigative and adjudicatory bodies; provide' respondent judges fuh discovery and a fair opportunity to prepare for adjudicatory hearings before a court of record, whose proceedings would be pubhc; and re-] quire the adjudicatory coiurt to prove any charges by clear and convincing evidence, versus the current method requiring proof beyond reasonable doubt.® See the related article on page 32. |
The AMA’s Board of Trustees has selected James S. Todd, MD, as executive vice president designate, pending agreement of final terms. Dr. Todd has been the AMA’s acting executive vice president since February 9, 1990, when he replaced the retiring James H. Sammons, MD. He left his general surgery practice in Ridgewood, NJ, in 1985 to serve as senior deputy executive vice president of the AMA. He was an AMA trustee from 1980 to 1984.
Pennsylvania Blue Shield has announced that toll-free phone service is now available ^ for the Office Assistance Information System (OASIS), a computerized voice^ response system that provides information about patients covered under medical- surgical, dental and vision programs. Touch-tone telephones can access enroll- ment, benefits, and service restrictions. Participating providers can also access' status of claim information. The toll-free OASIS number is: 1 -800-4-0 ASIS-4 (or 1-800-462-7474). [l
PENNSYLVANIA MEDICINE • JULY 1990
Thomas Scott Bertholon-Rowland Account Executive
People Helping People.
People Helping People. . . For more than 30 years the Pennsylvania Medical Society and Bertholon-Rowland have worked together to design and provide high quality, economical insurance programs for members, their families and employees.
I have a strong commitment to continue this service. My goal is to offer products that are competitive and comprehensive while providing prompt, personal, professional service.
Our administrative personnel supporting our products and sales are equally committed to serving you. We are always pleased to answer your questions and meet your insurance needs. For information about PMS sponsored insurance programs please call me at our Media, PA office, (800) 556-2500. Or, if you live in Western PA, call our Pittsburgh office at (800) 327-1550 and ask for Cindy Miller or Michele Urbano.
Name
Please send me information on PMS sponsored insurance coverage:
□ Life Insurance
□ Disability Income
Address Medical Insurance
□ Personal Umbrella
□ Accidental Death
. □ Overhead Expenses
Date of Birth ^ Property Contents
Bertholon-Rowland
Phone
Insurance Development Group P.O. Box 77 201 Caste Center
Media, PA 19063 Pittsburgh, PA 15236
(800) 556-2500 (800) 327-1550
BR #1993 Thomas Scott Cindy Miller or Michele Urbano
J. Joseph Danyo, MD
B
'AD GUYS: NOT SO BAD
Increasingly frustrated doctors raise an oft-repeated question: “When did we become the bad guys?” A corollary is, “ Why are we the bad guys?”
The questions go to the heart of the hecdth care delivery system. Numerous articles have dwelled on costs, value, quality, over-utilization, and “solutions.” The debate on healthcare costs and access goes back 100 years in this country.
In vogue now is the notion that 12 percent of the gross national product is the magic threshold for health expendi- tures, beyond which bad things will happen to the economy. Further, doc- tors are held responsible for all the costs.
Today the administrative costs of health care consume 5.5 percent of the GNP— close to 50 percent of total healthcare costs. The paper game is the most rapidly growing sector of health costs.
The perception is everywhere that doctors no longer occupy as high a rung on the ladder of society. That is, physicians think that society feels that way: Doctors are the captain of the health ship; ergo, they have ultimate responsibility.
We should acknowledge that percep- tion as valid and use the notion as a plus. Right now our greatest strength lies in weakness. Society wants us to do something about costs; not all the other contributors— us!
Our problem has been that we physi- cians have not recognized our own power to affect the debate and the
6 PENNSYLVANIA MEDICINE • JULY 1990
rules. We need to shake the collective mentality that we cire powerless, hap- less, and defeatist. Eastern European- style revolution needs to touch us. To reverse the momentum toward subju- gation and deprofessionalization, a big job needs to be done. It goes like this:
The American Medical Association, our partner, must deliver a stronger message to the public and to doctors on what it will not accept.
Next, PMS must continue to man the fronts in the manner that has devel- oped of late. Our stance on the Penn- sylvania Health Care Cost Containment Council; taking public our legal chal- lenge to the governor’s auto insurance bill; our positions on residency training funding, generic drugs, and AIDS— all are strong and have gained medicine new respect from the public. This is just the beginning.
The PMS position on the cost con- tainment council deserves particular comment. Here we threw down the gauntlet to business and government by stating in no uncertain terms that the Council’s profligate behavior actu- ally thwcirts cost containment. We cannot sit by while the Council squan- ders tens of millions of dollcirs pursuing illusory figures and expects doctors to swallow that and persist in efforts to contain costs.
Thirdly, the medical schools must come out of their slumber and be seen. Forget the town and gown stuff; we call on the academicians to get their hands calloused in the fray. They have much to contribute. There is support at the top; now the faculties must follow.
County societies must gecU" up two notches. How? Identify social/health issues and form coalitions. Be a force in local elections, especially those involving the legislature, and formalize an ongoing program to educate busi- ness and carriers about the health care system. We cannot forego communicat- ing our side.
Finally, members at IcU'ge must ad- dress the daily hassles by pressing all insurance carriers and patients about their contributions to the system. Grade them on performance and compliance. Be assertive in this regard. Each time you are Ccilled upon to do more for less, think of the administrative costs of health care and their contribution to the totcil picture.
Remember, we cU"e perceived as controlling and directing costs. Now it is time to tell them why.
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UMBER OF NEW PHYSICIANS CONHNUES TO SHRINK
Continuing the nationwide trend, fewer new medical degrees were awarded in the Commonwealth this year than last. A total of 1,182 medical degrees from the state’s seven medical schools and one osteopathic medical school were conferred, 27 less than last year. In 1989, 45 fewer new doctors were graduated than in 1988.
The percentage of women medical school graduates (34 percent of the total class) in the state remained steady this year, at 423, even though the total number of graduates declined.
Hahnemann University
Anthony S. Fauci, MD, director of the National Institute of Allergy and Infec- tious Diseases, delivered the com- mencement address to 149 medical school graduates from Hahnemann University School of Medicine in cere- monies June 1 at the Academy of Music. There were 50 women in the school’s 143rd graduating class.
Dr. Fauci became director of NIAID in 1984, and also serves as associate director of NIH for research on the acquired immunodeficiency syndrome (AIDS) and as director, NIH, Office of AIDS Research. Most recently. Dr. Fauci demonstrated the precise nature of the immune defect in AIDS.
Among other awards, citations of emeriti were given to Joseph Gambes- cia, MD, professor of medicine, and
George Teplick, MD, professor of diag- nostic radiology.
Hershey Medical Center
Founder’s Hall on the campus of the Milton Hershey School was the site of May graduation ceremonies for the PennState University College of Medi- cine. Samuel Shem, MD, PhD, author, playwright, and instructor in psychiatry at Harvard Medical School, delivered the commencement address.
Among 79 graduates at the school,
23 were women and 56 men.
Jefferson Medical College
Graduates of Jefferson Medical College of Thomas Jefferson University heard U.S. Secretary of Health and Human Services Louis W. Sullivan, MD, issue a challenge to be “renaissance health care professionals for the 21st century” in his June 8 commencement address. Dr. Sullivan was presented an honorary degree of doctor of humane letters from Jefferson.
University President Lewis W. Blue- mle conferred doctor of medicine degrees on 201 Jefferson graduates; 73 women and 128 men. Bruce E. Jarrell, MD, professor of surgery and director of Jefferson’s division of transplantation surgery, was the grand marshal for the Jefferson Medical College/College of Graduate Studies commencement.
In his address. Dr. Sullivan empha- sized the need for physicians to de- velop a broader range of skills and talents to accommodate the expanding demands of American health care. He called for an increased awareness of the discrepancy between the issues of run-away health costs and major access to care in the U.S.
Medical College of Pennsylvania
A total of 1 1 1 students— 64 women and 47 men— were awarded medical degrees by the Medical College of Pennsylvania on May 19 at the Acad- emy of Music. Five members of the MCP class of 1990 were awarded com- bined undergraduate/MD degrees through a joint six-year program with Lehigh University while two AB/MD degrees were awarded through a pro-
8
PENNSYLVANIA MEDICINE • JULY 1990
gram with Bryn Mawr College.
Samuel Shem, MD, PhD, practicing psychiatrist and instructor in psychiatry at Harvard Medical School, delivered the commencement address on “How to Stay Human in Medicine.”
MCP conferred honorary degrees on Lewis Bluemle Jr., MD, retiring presi- dent of Thomas Jefferson University; Nancy Gary, MD, dean of Albany Medi- cal College in New York; Peter Likins, PhD, president of Lehigh University,
I and Peter Nero, music director and
i conductor of the Philly Pops Orchestra.
I Special citations were presented to seven female physicians, graduates of the 18-member MCP class of 1940, returning for their 50th reunion. D. Walter Cohen, DDS, president of MCP, presided at commencement.
! Philadelphia College of Osteopathic Medicine
Philadelphia College of Osteopathic Medicine (PCOM) graduated 198 osteo- pathic physicians, including 138 men and 60 women, on June 3 at the Acad- emy of Music. Leonard H. Finkelstein, DO, MSc, PACOS, president and chair- man of the board of trustees, conferred the degrees.
During the ceremony, Galen S.
Young Sr., DO, FAAO, FACOS, was installed as chancellor of the college, the second person ever to hold that position. An emeritus member of PCOM’s Board of Trustees, Dr. Young also served as professor and chairman of the Department of Surgery. He is a member of PCOM’s class of 1935.
Temple University
On May 24, Temple University School of Medicine conferred medical degrees on 172 students at the Academy of Music. There were 112 men and 60 women graduates. \Yilliam E. Barry,
MD, associate dean for curriculum, was the commencement speaker.
University of Pennsylvania
The University of Pennsylvania School of Medicine graduated 150 students on May 14. The 59 women and 91 men received their degrees at Irvine Audito- rium on the Penn Campus. Commence-
ment speaker was Diane K. Jorkasky, MD, clinical associate professor of medicine at the school.
University of Pittsburgh
Carnegie Music Hall, Pittsburgh, was the site of the University of Pittsburgh’s May 21 graduation ceremony for the School of Medicine. Of the 122 persons receiving medical degrees, 83 are men. Kenneth Schuit, MD, PhD, associate professor of pediatrics, was the com- mencement speaker.
Hcfa adopts new
PRO DEFINITIONS
As a result of concerns expressed by numerous sources including Peer Re- view Organizations (PROs), hospitals, individual physicians, and medical organizations, a change was made by the Health Caire Financing Administra- tion (HCFA) in its definition of the
AMA President Alan R. Nelson, MD, presented Pennsylvania’s Membership Award to Gordon K. McLeod, MD, during the AMA’s National Leadership Conference. The AMA gives the award annually to state societies which exceed previous year membership totals. The State Society has received the award each of the past 11 years, since the award’s inception.
quality severity levels used by PROs. Previously, the definitions of each of the three quality severity levels con- tained the term “medical mismanage- ment.” That term has now been re- placed by “confirmed quality problem.” This revision, said Donald E. Harrop, MD, president of the Keystone Peer Review Organization, will now be reflected in all KePRO final quality letters. Therefore, all such letters will contain one of the following definitions:
• Confirmed quality problem with significant adverse effects on the pa- tient (Level 111).
• Confirmed quality problem with the potential for significant adverse effects on the patient (Level 11).
• Confirmed quality problem without the potential for significant adverse effects on the patient (Level 1).
New pediatric aids
CLINICS FOR FAMILIES
A new Pediatric AIDS Comprehensive Program, funded through a private- public partnership, will address the needs of children and families with AIDS in the Philadelphia area.
Rorer Group Inc., a Fort Washington- based pharmaceutical company, is donating $1 million over five years to underwrite the health care services component of the program. Two family AIDS clinics will be developed, located at St. Christopher’s Hospital for Chil- dren and Children’s Hospital of Phila- delphia.
The program, geared to help families with both symptomatic and asympto- matic HIV-infected members, includes family centered health care, case man- agement and centralized services. Family AIDS clinics will provide a family-centered approach to the treat- ment of HIV-infected children and families throughout the Delaware Val- ley and southern New Jersey. The clinics are designed to keep families intact and assist them in coping with the devastating effects of the disease. Services will include medical care, transportation, case management, lay
home visitors, emergency aid, foster care, counseling, community education and prevention efforts.
In addition to Rorer, Pew Charitable Trusts, the Commonwealth, and other city and state health care and social service organizations will help fund and develop the program. The Pew Charitable Trusts, a national philan- thropy based in Philadelphia, is provid- ing a two-year grant of $800,000 for program support, and is considering a $1.6 million, four-year commitment.
The state is providing $250,000 for program case management, and the federal Department of Health and Human Services has been asked to provide $712,000 of first-year funding.
Approximately 40 children in the Delaware Valley have died of HIV infection since the onset of the pediat- ric AIDS epidemic, estimated to have started in 1983. The number of HIV-infected children under care at the city’s two children’s hospitals has dou- bled from a year ago with more than 170 HIV-affected children currently under care. National estimates indicate there are five to 10 HIV-infected chil- dren for every reported case of pediat- ric AIDS. It is expected that approxi- mately 430 families affected by AIDS will be enrolled in the program through 1993, representing nearly 2,000 individual family members.
The program will be administered initially by the Family Planning Council of Southeastern Pennsylvania, guided by a community advisory board repre- senting many of the participating or- ganizations and funding parties. Each clinic will provide a full complement of staff, including a physician, an ob/gyn, a social worker, a nurse, and a commu- nity volunteer to care for the children while the parents are receiving care. Several city district health centers will also expand existing health services to include prenatal testing and counseling. A special emergency fund will provide essential goods and services such as diapers, in-home medical equipment, clothing, and utility payments, needed to keep families functioning and to- gether.
10
Ama address, phones
CHANGE AUGUST 27
The staff of the American Medical Association will begin moving on Au- gust 16 into leased space in a new headquarters building in Chicago.
When the move is complete on August 27, the AMA’s mailing address changes to 515 North State Street, Chicago 60610. The general office phone num- ber becomes (312) 464-5000.
In 1985-86, the AMA undertook an extensive study to help the association decide what to do about its aging head- quarters building, which was becoming increasingly more expensive to operate and maintain. The original building dates back to 1902, and there were several additions over the years.
The decision to become the prime tenant in a developer’s larger office building was found to be the fiscally sound solution.
Penn publishes
MEDICAL SCHOOL HISTORY
Innovation and Tradition at the Univer- sity of Pennsylvania: An Anecdotal Journey has been published in con- junction with the 225th anniversary of the University of Pennsylvania School of Medicine. The book traces the school’s growth from a couple of courses at the College of Philadelphia to its present day importance in Ameri- can medical education.
Author David Y. Cooper II, MD, professor of surgical research, has pursued his interest in the school’s history since his student days there. Co-author Marshall A. Ledger, PhD, editor of Penn Magazine, helped coor- dinate the reams of historical anecdotes and data garnered by Cooper.
The book centers on the faculty members and physicians who made indelible contributions not only to the school but also to biomedical science. Highlights include the remarkable contributions to medicine made by such school faculty as Benjamin Rush, Caspar Wistar, Joseph Leidy, Simon Flexner, Isador Ravdin, and Britton Chance. The book was published by Univerisity of Pennsylvania Press, May 1990.
Publication of another book, a picto-
PENNSYLVANIA MEDICINE • JULY 1990
rial history of medicine in Philadelphia, is also planned in conjunction with the medical school’s anniversary this year.
Dr. LUDWIG TO HEAD PSYCHIATRIC SOCIETY
Karl D. Ludwig, MD, Pittsburgh, was inducted as president of the Psychiatric Physicians of Pennsylvania and Penn- sylvania Psychiatric Society. He has been director since 1981 of inpatient and emergency psychiatry at Sewickley Valley Hospital.
Dr. Ludwig will preside over the activities of the 2,000-member associa- tion, which has a record of active participation in medical, education, and | governmental affairs relating to the |
treatment of the mentally ill.
Dr. Ludwig previously was superin- tendent of Dixmont State Hospital in Sewickley. Before returning to the Pittsburgh area, where he received his . medical degree in 1960, he practiced ] psychiatry in the Philadelphia area. His positions there included senior staff psychiatrist, research psychiatrist, and director. Alcoholism Program, at ,
Friends Hospital; consultant to the U.S. Veterans Administration Hospital, Coatesville; and chief of outpatient services, clinical director, and director of psychiatric consultation at Northeast Community Center for Mental Health/ Mental Retardation.
Geriatric manual
PUBLISHED BY MERCK
The Merck Manual of Geriatrics, a medical handbook covering virtually all aspects of disease and the clinical and social management of elderly patients, is now available from Merck & Co., Inc. Merck also publishes the widely-known medical text, Merck Manual.
According to co-editors William B. Abrams, MD and Robert Berkow, MD, both of Philadelphia, a primary objec- tive of The Merck Manual of Geriatrics is to help elevate the quality of geriat- ric care. Dr. Abrams is executive direc- tor of scientific development at Merck Sharp & Dohme Research Laboratories, a division of Merck & Co., Inc. Dr. Berkow is senior director of medical
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The Merck Manual of Geriatrics is published on a nonprofit basis as a service to the medical community by Merck & Co., Inc. The price is $20 per copy.
Penn professorship
TO HONOR DR. ERDMAN
The University of Pennsylvania School of Medicine has established an en- dowed professorship in memory of William J. Erdman, 11, MD, its late chairman of physical medicine and rehabilitation. Dr. Erdman retired in 1987 and died September 27, 1989.
Dr. Erdman was a graduate of the University of Pennsylvania School of Medicine and served his residency at
the Hospital of the University of Penn- sylvania in the Department of Physical Medicine and Rehabilitation under the chairmanship of George Morris Piersol, MD, a pioneer in the field. At age 32, Dr. Erdman succeeded Dr. Piersol as professor and chairman of the depart- ment, a position he held for 34 years. He also served as assistant dean of the medical school from 1960 to 1978.
Dr. Erdman served for many years in the American Medical Association’s House of Delegates as the delegate from the American Academy of Physi- cal Medicine and Rehabilitation. The academy honored him in 1982 with its Distinguished Clinician Award.
Contributions may be made to the Erdman Fund, established with contri- butions from Dr. Erdman ’s patients and former residents. Contact Anita Hen- derson, Medical Center Development, 209 Blockley Hall, University of Penn- sylvania Medical Center, 3400 Spruce Street, Philadelphia, Pa., 19104-6205.
Nih warns against
EXPOSURE TO SUN
With the sunlit days of summer ap- proaching, the National Institutes of Health (NIH) recommends Americans be cautious in their exposure to natural and artifical ultraviolet radiation (UVR). According to a NIH consensus state- ment, “Any sunburn or suntan is visible evidence of injury to the skin. The long-term consequences of UVR expo-
A HELPING HAND FOR THE TROUBLED PHYSICIAN
Alcoholism. Drug abuse. Mental and physical disability. The problems of aging. All take their toll on the medical community.
But there’s help — through the Physicians’ Health Programs of the Educational and Scientific Trust of the Pennsylvania Medical Society. The program offers peer support . . . referral to professional treatment agencies . . . and compassionate follow-up throughout the rehabilitation process. All efforts are voluntary and strictly confidential.
Write Physicians’ Health Programs, The Educational and Scientific Trust of the Pennsylvania Medical Society, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.
If you need help — or know someone who does— call the Physicians’ Health Programs Hotline: (717) 558-7817. Learn more about the Physicians’ Health Programs.
12 PENNSYLVANIA MEDICINE • JULY 1990
sure include development of skin can- cers and premature aging of the skin.’
The NIG notes that the average American’s exposure to UVR hcis in- creased considerably due to changing lifestyles; more outdoor recreational activities, more emphcisis on tanning, scantier clothing, and a population shi^ to the sun belt. It targets tanning par- lors as especially dangerous to the women, adolescents and young adults who most commonly frequent them. The NIH calls for public education about the hcizards of tanning parlors and for better regulation of these facili ties.
Because one-half of a person’s life- time exposure to UVR occurs by age 18, the NIH recommends exposure be minimized by modifying schedules for outdoor activities at schools, camps, day care centers, and beaches. “If exposure during peak times, between 10:00 a.m. and 3:00 p.m., could be minimized, significant reduction in the number of nonmelanoma skin cancers would certainly occur.”
The report was prepared by mem- bers of the National Institute of Arthri- tis and Musculoskeletal and Skin Dis- eases, and the Office of Medical Applications of Research of NIH. Free copies may be obtained from William H. Hall, Director of Communications, Office of Medical Applications Re- search, NIH, Building 1, Room 259, Bethesda, MD, 20892.
MCP STUDIES JOB-RELATED ILLNESS WITHIN STATE
To help combat what the American Public Health Association says is an “epidemic” of occupational disease and injury in the U.S., the Medical College of Pennsylvania (MCP) is evaluating th^ extent of the problem in Pennsylvania!
The study is funded by a four-month service contract awarded to MCP by the state Department of Heailth. MCP, an affiliate of Allegheny Health Ser- vices, Pittsburgh, will be the leading contractor of a consortium whose goal is to recommend ways to improve the recognition, prevention and treatment of occupationally related illness and injury in the state.
Eddy A. Bresnitz, MD, MS, acting chairman of the Department of Com- munity and Preventive Medicine and director of the Division of Occupational! and Environmental Health at MCP, is I
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the study’s project manager. Other principal investigators of the consor- tium arrangement include Michael Hodgson, MD, director of the Univer- sity of Pittsburgh’s occupational and environmental medicine program; Howard Frumkin, MD, assistant profes- sor of medicine. University of Pennsyl- vania; Carolyn Needleman, PhD, direc- tor of Bryn Mawr College’s occupational health program; David Neumark, PhD, assistant professor of economics. University of Pennsylvania; and Harriet Rubenstein, JD, assistant director of MCP’s division of occupa- tional and environmental health.
According to Dr. Bresnitz, “Pennsyl- vania carries a large and costly part of the nation’s public health burden from occupational hazards.”.
Group practice annual
MEETING IN FLORIDA
The American Group Practice Associa-
tion will hold its 41st annual confer- ence in Orlando, Florida, September 4- 7, 1990. The theme of the conference is “In search of quality,” with course topics that address defining, delivering, and measuring quality. Also within that topic will be discussions of national health insurance models and new state initiatives.
Among the speakers at the confer- ence are Kermit B. Knudsen, MD,
AGFA president from Temple, Texas; William S. Kissick, MD, PhD, professor of health care systems, the Wharton School, University of Pennsylvania; Leland R. Kaiser, PhD, president, Kaiser & Associates, Brighton, Colorado; and Donald W. Fisher, PhD, CAE, executive vice president and chief executive officer of AGPA.
Meetings of the Family Practice Council and Occupational Medicine Section will be held on Wednesday, September 5 of the conference, along with workshops by clinic size.
Concurrent forums will be held cov- ering governance issues, ethical issues review, computer information systems, the role and responsibilities of the medical professional with blood borne diseases, the National Practitioner Data Bank, physician payment reform, eval- uating and managing the quality of inpatient medical care, measuring quality and outcomes in the group practice outpatient setting, and practice guidelines.
An aerial view of the newly acquired facility of the Medical College of Pennsylvania. On a nearby 15-acre site, it will house research and edcuation activities.
Medical college of pa
EXPANDS PHILLY CAMPUS
The Medical College of Pennsylvania (MCP) has announced the acquisition of a 15-acre property at 2900 Queen I Lane, Philadelphia. Currently, MCP has two campuses— one at 3300 Henry Avenue in the East Falls section of Philadelphia and the Allegheny Campus located at Allegheny General Hospital in Pittsburgh. The additional campus is designated for research and educational programs.
According to MCP President D. Walter Cohen, DDS, “The opportunity to purchase the Queen Lane property will enable us to realize our long-range plans from a different perspective and provide us with the opportunity to add new facilities for student and faculty amenities.”
The Queen Lane property was formerly headquarters of the Lutheran Church of America. The property’s existing facility also will provide 180,000 square feet of additional office space for the institution’s programs and services. The Henry Avenue Campus will be designated principally for clinical care. MCP plans to renovate the radiology area as well as a space for comprehensive outpatient services.
The move into Queen Lane Campus,^ which has 317 parking spaces and is within walking distance of the Henry Avenue Campus, is expected to begin by early summer.
Pathologists book
INTEGRATES ADVANCES
In his new book. Current Surgical Pathology, Michael J. Warhol, MD, attempts to integrate the information produced by the recent technological explosion in the field of pathology. Dr. Warhol is chairman of pathology at Pennsylvania Hospital, and also serves as clinical professor of pathology and laboratory medicine at the University of Pennsylvania School of Medicine.
The book, written for practicing pathologists and physicians-in-training, serves as an introduction and guide to using new technology in diagnostic surgical pathology. It covers such tech- nologies as DNA analysis, electron microscopy and immunocytochemistry.
14
PENNSYLVANIA MEDICINE • JULY 1990
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Dr. Rogers is professor of family practice and community health at Temple University School of Medicine. Philadelphia.
From inkblots to art therapy; What an interesting meander for eye, hand, and brain! Hermann Rorschach, Swiss de- viser of the inkblot personality assess- ment test bearing his name, was a pupil of psychiatrist Carl G. Jung while in med- ical school at Zurich.' Concerning such projective techniques Dr. Jung later wrote as follows;
All attempts at characterology have stcirted from the outside world; astrol- ogy, in ancient times, turned even to stellar space in order to determine those lines of fate whose beginnings cire contained in man himself. To the same class of interpretations from out- ward signs belong palmistry. Gall’s phrenology, Lavater’s study of physi- ognomy, and more recently, graphol- ogy, Kretschmer’s physiological study of types and Rorschach’s klexographic method. . . . Merely to establish the fact that certain people have this or that appearance is of no significance if it does not allow us to infer a psychic correlative. . . . The body means as lit- tle to us without the psyche as the lat- ter without the body."
Dr. Rorschach was associate director of the mental hospital in Herisau, Switz- erland, when he died on April 2, 1922, at the age of 37, nine months after the publication of his Psychodiagnostik, which contained 10 plates showing sym- metrical blots (German klex = blot) of ink— five achromatic and five
chromatic— for use in psychological test- ing. Rorschach also had instituted a vig- orous arts therapy program at the hospi- tal where he worked. In 1932, Hans
Binder introduced the concept of c/j/arc-| scuro in the testing technique and thor-ii oughly analyzed the psychological sub-?' strata of the experiment." In recent^ years, psychologist Zygmunt A. Pio-[’ trowski (1904-1985), of Hahnemannjl University, extended and improved the I' use of Rorschach and related tests, as ex-i plained in his book Perceptanalysisf (1957).^ These projection procedures are designed to reveal basic mental conflicts)’ and personality trends. Responses to a ^ series of techniques, when properly in-jr terpreted, can lead to revealing informa-|i tion concerning personality makeup. If am indebted to Dr. Bradley B. Ridge, a ) psychologist now practicing in San Fran-| cisco, for administrating and interpreting! a personal Rorschach test. The interpre-f tive skill required is truly artistic. 'rhis|i experience led me to appreciate the im-|) portance of Dr. Piotrowski’s teaching at ; Hahnemann University, where the firstll master of arts degree program in art I therapy in the U.S. originated."
Almost from the moment children are'i able to draw shapes in outline form they 8 begin to combine these forms into de-i» signs. In the beginning the designs are simple. The favorite subject of people is people. And so it is with children and their art. As soon as they are able, at about age four, children begin to draw the human figure. The practice of art therapy in Europe and America uses this skill to help reveal and rehabilitate per- turbed persons of all ages. Its role in th« treatment of hospitalized patients is more than recreational. Art therapy has been increasingly accepted within the! field of psychotherapy as effective, ever if supplementary, in the restoring o emotional composure. It helps patients especially those who have difficultj communicating their feelings, gain in sights through the use of self expression." In the words of poet Willian Blake, “Art is the Tree of Life.”
Art therapy in the United States date: back to the pioneering work of Margare Naumburg at the progressive Walder School (1914) in New York City. Havinr been psychoanalyzed by Dr. Beatrice Mj Hinkle, the ecirliest translator of Jung’: writings into English, Naumburg brough a psychoanalytic viewpoint to creativib in art. She later was active in the Wash ington (D.C.) School of Psychiatry am was instrumental in the formation of th( American Journal of Art Therapy (1962] The human potential movement in psy chology combined with a holistic healti concept coincided with the organizatioi of the American Art Therapy Associa
16
PENNSYLVANIA MEDICINE • JULY 1990
ion in 1970. Salient books published iuring the following year included Edith j'amer’s Art as Therapy with Children jid Robert S. McCully’s Rorschach The- ory and Symbolism. Dr. Muriel M. Gar- liner, psychiatrist and philanthropist, vrote a cogent introduction to the ormer, and Dr. Zygmunt Piotrowski, a jcid foreword to the latter.
The following decade brought numer- »us publications in the field of art ther- ipy. For example, Harriet Wadeson’s Art Psychotherapy (1980) provided a bal- inced perspective on the discipline. In it he wrote: “1 see psychotherapy as pri- ncirily an educational process to help leople with problems in living rather han as a treatment for a disease.”’ This ipproach was echoed in other writings, ncluding Judith A. Rubin’s book Ap- )roaches to Art Therapy (1987). Helen B. Landgarten’s volume Family Art Therapy (1987) helped widen the base of |he profession.®
I In Europe, Antonia Wolff, a Swiss col- league of C. G. Jung, and Dr. H. Godwin Baynes, an English co-worker, used art Inodcilities in psychotherapy early in this tentury. Their protegee, Irene Cham-
pernowne, extended the use of art ther- apy at Withymead, a sanatorium located near Exeter in Devon, England. Her pu- pil, psychiatrist Anthony Stevens, wrote a charming account of this healing com- munity (1986).“ Two years earlier, Tessa Dailey’s Art as Therapy had been pub- lished in London; in 1987, she edited an- other significant book. Images of Art Therapy Among other writings on the subject, in Florence, Italy, Dr. Roberto Assagioli’s treatise. Psychosynthesis, saw mankind tending naturally toward har- mony within itself and the world. His opinion on art as therapy:
In works of art there is much more than mere aesthetic value; they consti- tute living forces, almost living enti- ties, embodying a power which has suggestive and creative effects. . . . The influence of color as a therapeutic agent is becoming increasingly recog- nized. . . . The individual constitution and temperament of the patient is also an important factor. . . . This is a con- sideration which therapists should keep in mind— not to become too much interested and side-tracked by the technique, by theoretical interest.
by the ideal of perfection, but to re- main close to the immediate practical and humanitarian purpose of the ther- apy, to make the patient whole."’
Art therapy, useful as an adjunct to the
promotion and restoration of health, has
earned a definite place in the modern
medical arena.
References
1. EHenberger, Henri. The Life and Work of Hermann Ror- schach (1884-1922). Bull. Menninger Clin. 18:173-219. Sept. 1954.
2. Jung CG. Modern Man in Search of a Soul. New York, Har- court Brace and Co.. 1933, p. 75.
3. Mens W. Principles and Practice of the Rorschach Person- ality Test, ed. 2. Philadelphia and London. J. B. Lippincott Company, 1950, pp. 7, 41.
4. Piotrowski ZA. Perceptanalysis: A fundamentally re- worked, expanded and systematized Rorschach method. New York, The Macmillan Company, 1957.
5. Wadeson, Harriet. Art Psychotherapy. New York, .lohn Wiley & Sons. 1980, p. xi.
6. Rubin JA. Approaches to Art Therapy: Theory and Tech- nique. New York, Brunner/Mazel, Publishers. 1987.
7. Wadeson, p. 23.
8. Landgarten HB. Family Art Psychotherapy: A Clinical Guide and Casebook. New York. Brunner/Mazel. Pub- lishers. 1987.
9. Stevens, Anthony. Withymead: A Jungian Community for the Healing Arts. London, Coventure Ltd., 1986.
10. Assagioli, Roberto. Psychosynthesis: A Manual of Princi- ples and Techniques. New York, Penguin Books. 1976, pp. 190-191, 283. 286.
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PHYSICIANS SERVICES DIVISION
h
^JUflDING H BRIDGES TO I SPAN MEDIG/NES I GHOICES
Elaine S. Herrmann
For Carl A. Sirio, MD, resident physician representative to the PMS Board of Trustees, leadership in organized medi- cine is an integral part of his career plan. “1 enjoy involvement in organized medi- cine for two reasons: first, my major pro- fessional goal is to participate in the in- terface between medicine and the rest of society. Second, 1 want to maintain aca- demic ties while practicing good, old- fashioned internal medicine.”
He has been active in PMS and AMA since he began his internship at Hershey Medical Center of PennState University in 1984. He has been a delegate to the AMA Resident Physician Section (RPS) since 1984, and served as an AMA resi- dent physician section representative on the National Board of Medical Exam- iners in 1986. At the state level, he has served on the Governing Council of the State Society RPS and as a delegate to the PMS House of Delegates since 1984. He also served on the PMS Commission on Manpower for four years. While at Hershey, he was a representative to the Strategic Planning Retreat at Milton S. Hershey Medical Center, and media par- ticipant and TV spokesman for the State Society’s AIDS Awareness Program.
Dr. Sirio, internist, forsees increasing polarization in the medical community. To achieve his clinical and career goals, he has focused his training on honing skills that will enable him to bridge the widening fissures he detects— between
hospital staff physicians and private practice physicians; between physician groups and solo practitioners; between generalists and specialists; between cure-J at-any-cost procedures and a balance of morality and medicine; and between the academic community and the clinical I one. Skill in the political, social, and eco-’^ nomic spheres of medicine will help him r grasp and predict developments, andJC participate in shaping them.
After attending Columbia University { for his undergraduate degree, he re- ' ceived his medical degree in 1984 from | the University of Medicine and Dentistry u of New Jersey of Rutgers University. Fol- j lowing his residency at Hershey, he | spent one year earning a master’s de- 1 gree in public health administration t from Columbia University. J
Presently completing a fellowship ini critical care medicine at The National In- 1 stitutes of Health in Washington, DC, Dr. ^ Sirio says his interest in the fellowship 1 came from two different perspectives: ' clinical and career. “There’s a high likeli- j hood that American medicine will de- ' velop a European flavor to it, in that there will be a more clearly defined set of hospital physicians and a more clearly , defined set of outpatient physicians. As a ' general internist. I’d really like to be able ! to bridge that gap between primary care ! and hospital based internal medicine. 1 | thought critical care was one good way : to do that." He says critical care allows . him to focus on the whole patient, as op- [ posed to concentrating on one organ ■ system as a specialist. He can also main- tain his commitment to internal medi- cine while practicing hospital-based medicine. He is currently participating in research on outcome and delivery of services in intensive care units with Wil- liam Knaus, MD, of George Washington University.
“My long view is to try to be a spokes- man for the profession,” he says. “If I’m going to be a true spokesman for advo- cating appropriate use of technology, 1 felt 1 ought to have the training and ex- pertise." He hopes to be part of the forces creating sound health care policy based on good medical decisions and sci- entific data, rather than decisions swept along by ill-considered political or eco- nomic pressures.
Involvement in AMA and PMS not only offers a source of current political and social information, but also a valu- able opportunity to interact with and in- fluence colleagues, he says. “The expo- sure to the variety of perspectives within medicine— various speciality orienta-
ls PENNSYLVANIA MEDICINE • JULY 1990
tions, from a hospital radiologist to a ru- ral family practictioner— is a tremendous resource,” he says.
Sparking involvement
Dr. Sirio says that the first goal of the Resident Physician Section is to get the word out that the section exists. “We be- lieve very strongly that we have a real contribution to make,” he says. An ac- tive series of orientation programs around the state, plus a quarterly resi- dent newsletter, help spur membership growth. But, as with other sectors of or- ganized medicine, apathy is the greatest challenge.
“Many residents and fellows don’t get as involved as 1 would like to see them, in large part because there are so many other pressures on their time,” he says. “But if you think the issues are impor- tant, you have to carve out a little piece of the day to stand up and be counted.” He says that it is important for all physi- cians in training to bring the perspective of youth to organized medicine. Resi- dents and fellows face, or will face, much the same issues as older physi- cians, but may not be as aware of the complexity behind the issues. “For ex- ample, many residents don’t have a clear idea of where their salaries and other support monies come from,” he says. Nevertheless, what happens to Medicare and Medicaid may have a di- rect affect on a hospital’s ability to sup- port its housestaff.
One direction which Dr. Sirio believes resident physicians, as well as other sec- tors of organized medicine should take, is to help interest and educate young physicians in primary Ccire. Professional opportunities in this area abound nation- wide, but many positions go unfilled. Re- search is needed into the reasons for this deficit. Dr. Sirio says. Educational debt load and the resulting need for success- ful practices are often cited as steering young physicians away from primary Ccire and toward specialties. But this may not be as critical as other lifestyle issues influencing young physicians. “Primary care positions are available from main- line Philadelphia to rural coal country in Pennsylvania; residents need to be made more aware of the rewards of primary care,” Dr. Sirio says.
The availability of role models for young physicians may also be an impor- tant determinant of caireer choices. Dia- logue between the practicing commu- nity and the academic community should be a continuing goal of not only the resident section but also of the State
Society, he says. Residents’ and students’ role models cu'e more likely to be sub- specialists at teaching institutions rather than physicians delivering quality pri- mary care. “Students and housestaff need a more rounded and balanced ex- perience. Many residents came to medi- cal school with the notion of becoming family or primary care doctors. Some- where in the transition from college graduate to medical school graduate, that gets lost,” Dr. Sirio says.
A sense of despair at seldom being able to control one’s daily activities may be the source of a growing trend of young physicians to choose group prac- tice and practice situations with manage- able schedules, he says. Young physi- cians view traditional fee-for-service solo practices as wrought with financial and paperwork burdens. “There aren’t a lot of people willing to take on that kind of risk,” Dr. Sirio says.
A resident’s wish list
He says that at the top of his list of priori- ties for change is “the need for govern- ment and industry to better understand what they are purchasing through the third party payer system; and to under- stand what effective and quality health care truly means.” There are reasonable
questions to be asked, he says: Why is it that we spend more per capita and more in percentage of our gross national prod- uct on health care, and yet have infant mortality statistics that range near the lowest rather than the best in the indus- trial world? Why is our life expectancy lower than that of people in Europe or Japan? “I think it may be a matter of re- focusing some priorities in health care,” he says.
Our system of allocating health care resources will change; We may adopt some features of the Canadian or Euro- pean systems, but will also maintain dis- tinctly American features, Dr. Sirio be- lieves. “1 think our society is too pluralistic; patients will want to maintain some sort of control on their freedom to choose between health care options. We’re more likely to have a smorgas- bord of choices for patients to choose from.”
Personal choices
Within a year. Dr. Sirio will complete his fellowship and reach another major de- cision point in his career. He says he en- joyed the rural atmosphere at Hershey, and he and his wife Annette place Penn- sylvania at the top of their list of practice locations.
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ALLEGHENY COUNTY
Gail C. Anderson, MD, Radiologic Oncology 812 Grandview Ave,. #3-C, Pittsburgh 15211 Christ A. BaJouris, MD, Ophthalmology 650 Smithfield St.. Ste. 1110. Pittsburgh 15222 David L. Blinn, MD, Internal Medicine 7310 Beacon Hill Dr, Pittsburgh 15221 Mehboob K. Chaudhry, MD, Pulmonary Diseases 1321 5th Ave., Mckeesport 15132 Robert V Cummings, MD, Ob/Gyn 4800 Friendship Ave.. Pittsburgh 15224 Scott D. Gleditsch, MD, Psychiatry 1254 Greystone Dr, Pittsburgh 15241 Sophie Gomez, MD, Internal Medicine 1901 Teal Trale Dr. Pittsburgh 15236 Robert E. Hunt, MD, Cardiovascular Diseases 222 Lexington Ave.. Aspinwall 15215 Robert G. Liss, MD, Orthopedic Surg.
3471 5th St.. Pittsburgh 15213 Mary C. Martini, MD, Dermatology 28026 Route 19. Evans City 16033 Melvin I. Roat, MD, Ophthalmology The Eye & Ear Institute. 203 Lothrop St,, Pittsburgh 15213 W. Parke Thrush, MD, Diagnostic Radiology Rte. 6, Box 73A, Morgantown. WV 26505 Mary J. Torchia, MD, Anesthesiology 133 Woodhaven Ln., Pittsburgh 15237 Jeffrey D. Towers, MD, Radiology 905 E. End Ave., Pittsburgh 15221 Devin J. Troyer, MD, Physical Medicine/Rehabilitation St. Francis Med. Ctr. 45th St,. Pittsburgh 1.5201
BUCKS COUNTY
Brett M. Harrison, MD, Gen. Surg.
Franklin & Wood Sts., Doylestown 18901
BUTLER COUNTY
David L. Swenson, MD, Internal Medicine 325 W Jefferson St.. #12, Butler 16001
CAMBRIA COUNTY
Fikry F. Hanna, MD, Pathology 313 Tioga St., Johnstown 15905 Martin H. Max, MD, Gen. Surg. c/o Duke, 1111 Franklin St., Johnstown 15905
CARBON COUNTY
Rondi T. Adi, MD, Family Practice 325-K Skyline Dr, RD 4, Slatington 18080
CENTRE COUNTY
Melanie M. Chaputa-Cherry, MD, Ob/Gyn 251 Easterly Pkwy., State College 16801
CLEARFIELD COUNTY
Mark A. Piasio, MD, Orthopedic Surg.
807 Turnpike Ave., Ste. 140, Clearfield 16830
CLINTON COUNTY
Francis T. Daly Jr., MD, Internal Medicine PO Box 181. Mill Hall 17751 Henry T. Dietrich, MD, Family Practice PO Box 181, Mill Hall 17751
CRAWFORD COUNTY
Anne G. Larochelle, MD, Endocrinology 1510 Windham Ln,. Wheaton. MD 20902 Gerald E. Larochelle Jr., MD, Rheumatology 1510 Windham Ln,, Wheaton. MD 20902
DAUPHIN COUNTY
Christopher J. Berg, MD, Gen. Surg.
843-B Rhue Haus Ln., Hummelstown 17036 Susan K. Disanto, MD, Pathology 5901 J. K. Dr. Harrisburg 17112 Nancy J. Huerter, MD, Child Psychiatry M.S. Hershey Med. Ctr, Dept, of Psychiatry. Hershey 17033 Thomas E. Young, MD, Internal Medicine
86 Lakepoint Dr. Harrisburg 17111
DELAWARE COUNTY
Mark J, Marciano, MD, Internal Medicine
87 S. Lansdowne. Lansdowne 19023
ERIE COUNTY
Anthony Mattis, MD, Emergency Medicine 700 Peach St., Ste. 201. Erie 16501
GREENE COUNTY
Martha R. Noflzger, MD, Family Practice SE Greene Community Health Ctr, Greensboro 15338
LACKAWANNA COUNTY
Bruce R. Culp, MD, Family Practice 251 East Grove St., Clarks Summit 1841 1 Michael J. Rainey, DO, Psychiatry 2630 Birney Ave., Scranton 18505 Gary W. Ross, MD, Pathology 441 Wyoming Ave.. Scranton 18509
LANCASTER COUNTY
Kenneth R. Arthur, MD, Plastic Surg.
554 N. Duke St., Lancaster 17602
LEHIGH COUNTY
Brian P. Murphy, MD, Urological Surg.
1210 S. Cedar Crest Blvd.. Allentown 18104
LUZERNE COUNTY
Stanley T. Bohinski, DO, Family Practice 540 Pierce St., Kingston 18704
LYCOMING COUNTY
Thomas B. Antonetti, MD, Family Practice 505 Hawthorne Ave., Williamsport 17701
MONTGOMERY COUNTY Andrew G. Gerson, MD, Ob/Gyn 353 Lankenau Med. Bldg., Philadelphia 19151 Jacqueline S. Gomberg, MD, Radiology 135 Cynwyd Rd., Bala Cynwyd 19004 Janice A. D. Jacques, MD, Anesthesiology 211 S. 4th St., North Wales 19454 Seth I. Rosenberg, MD, Otolaryngology 138 Montrose Ave., #12, Rosemont 19010 Andrew M. Star, MD, Orthopedic Surg.
1327 Old York Rd., Abington 19001
MONTOUR COUNTY
Cathleen Doman, DO, Pediatrics 17 Meadow Ln., Danville 17821 Douglas E. Roeshot, MD, Orthopedic Surg.
N. Academy Ave., Danville 17822 Glenn A. Stayer, MD, Child Neurology 7 Cotswoid, Danville 17821
NORTHAMPTON COUNTY
Stuart M. Boreen, MD, Anesthesiology 806 Orlando Rd., Cherry Hill, NJ 08034 Hung X. Phan, MD, Internal Medicine 745 Delaware Ave., Bethlehem 18015 Karen M. Sciascia, DO, Ob/Gyn 830 Ostrum St.. Bethlehem Stre 18015 Debra L. Seoane, MD, Gen. Surg.
2040 Lehigh St,, Ste. 103, Easton 18042
PHILADELPHIA COUNTY
Francisco Badosa, MD, Gen. Surg.
5401 Old York Rd,. Ste. 505, Philadelphia 19141 Keith D. Calligaro, MD, Vascular Surg.
700 Spruce St., Ste, 101, Philadelphia 19106 Harry A. Doyle, MD, Psychiatry 230 S. 22nd St.. Philadelphia 19103 Keivan H. Fatolomi, MD, Gen. Practice 10825 E. Keswick Rd., #46, Philadelphia 19154 Jill A. Foster, MD
1624 Locust St., Ste. 400, Philadelphia 19103 Barry S. Friter, MD, Dermatology 10125 Verree Rd,. Ste. 303. Philadelphia 19116 Brenda B. Hoffman, MD, Internal Medicine Graduate Hosp.. Philadelphia 19146 Chamg-Ming Huang, MD, Pathology 11th & Walnut Sts., Philadelphia 19107 Yasin N. Khan, MD, Anesthesiology 217 Preston Rd.. Flourtown 19031 Charles D. Kurth, MD, Anesthesiology Children's Hosp., Dept, of Anesthesiology. Philadelphia 19104
Margaret M. Lamanna, MD, Nuclear Medicine 200 Locust St.. #9-H. Philadelphia 19106 Elihu J. Ledesma, MD, Gen. Surg.
330 S. 9th St.. Philadelphia 19107 Bruce J. Lehrman, MD, Diagnostic Radiology 2158 Benson St., Philadelphia 19152 Lori A. Lemer, MD, Psychiatry 3761 Lankenau Rd., Philadelphia 19131 Anne C. Mack, MD, Physical Medicine/Rehabilitation 6 Franklin Plz,. Philadelphia 19102 Nicholas J. Mandalakas, MD, Cardiovascular Diseases 360 Delmar St., Philadelphia 19128
Michael J. Martinelli Jr., MD, Internal Medicine 2 Independence PI.. #508. Philadelphia 19106 Sandy D. Melnick, MD, Psychiatry 1017 Melrose Ave., Melrose Park 19126 Minaxi H. Pansuria, MD, Family Practice 2601 Andrew Rd.. Broomall 19008 Srinivason R. P^uThasarathy, MD, Physical Medicine/Rehabilitation
226 W Rittenhouse Sq., #2201, Philadelphia 19103 Neil S. Schwalb, MD, Psychiatry Friends Hosp., Philadelphia 19124 Sharon R. Segal, DO. Radiology 396 Ballytore Cir. Wynnewood 19096 Adriana M. Selvaggio, MD, Internal Medicine 5KRB Unit Presbyterian Hosp., 51 N. 39th St.. Philadelphia 19104
Mara Shlimovich, MD, Psychiatry 9884 Wisteria St.. Philadelphia 19115 Neil T. Streisfeld, MD, Endocrinology 555 City Line Ave.. Ste. 500. Bala Cynwyd 19004 Tien P. Wong, MD, Ophthalmology nil Spruce St.. #104, Philadelphia 19107 Jorge J. Yunis, MD, Pathology 911 Summit Rd.. Penn Valley 19072 J. Matthew Sleeth, MD, Family Practice 95 Leonard Ave., Washington 15301
WASHINGTON COUNTY
Brian D. Allen, MD, Family Practice 107 Donna Dr., PO Box 97. Rosepine. LA 70659
YORK COUNTY
Cheryl D. Burk, MD, Internal Medicine 2-J Alexander Chase. Sparks 21152 Judith E. Diffenderfer, DO, Family Practice 112 George St., Hanover 17331 Wayne C. Herrick, MD, Orthopedic Surg.
80 Wyntre Brook Dr. York 17403 Alexander D. Kofinas, MD, Orthopedic Surg.
1001 S. George St., York 17405 David A. Stone, MD, Internal Medicine 1735-F Yorktowne Dr. York 17404
STUDENTS
Barbara J. Aimino, 325 N. 15th St,. #1404, Philadelphia
19102
Mazen Anbari, 552 Cathedral Rd.. Philadelphia 19128 Norifusa J. Anegawa, Box 165, Univ. of PA Med. School.
Med. Education Bldg.. Philadelphia 19104 Shanawar Ansari, 1000 Walnut St.. #907, Philadelphia 19107
Sanjay Banerji, 3190 Chaucer Ln.. Bethlehem 18017 Robert T. Brautigam, 246 N. Third St., #2-A, Philadelphia
19106
Cynthia Cheng, 1000 Walnut St.. Orlowitz 603, Philadelphia
19107
Gerard J. Diefes, 2020 Race St.. #1-F, Philadelphia 19103 Daniel C. Fisher, 3024 W Queen St.. #A1B, Philadelphia 19129
Susan G. Goldman, 1 16 S. 11th St., 3rd Floor. Philadelphia 19107
Robert H. Hall, 3940 Stevenson St., Philadelphia 191 14 E. Kai Hansen, 1703 Wallace St.. #201, Philadelphia 19130 Aphrodite M. Henderson, 8210 York Rd.. Elkins Park 19117
Karl W. Holtzer, 950 Walnut St.. #419. Philadelphia 19107 JilUan S. Imagire, 4526 Osage Ave.. #A-2, Philadelphia 19143
Karen M. Kelly, University Manor East. #68. Hershey 17033 John A. Kline Jr, 409 S. Iseninger St.. Philadelphia 19147 Philip D. Kousoubris, 950 Walnut St., #205, Philadelphia 19107
Elizabeth B. Lange, University Manor East. #195, Hershey
17033
Susan M. Lemer, 2400 Chestnut St.. #305, Philadelphia
19103
Scott A. Lynch, 401 Amberson Ave., #251. Pittsburgh 15232 Joseph J. Mannella, 318 Clay Ave,, Mt. Pleasant 15666 Darlene W, Millman, 1918 Wightman St., Pittsburgh 15217 Jason C. Mills, Univ. of PA. 34th & Spruce Sts.. Box 272, Philadelphia 19104
Kamaldeep S. Momi, 201 S. 1 1th St., #502, Philadelphia 19107
Patrick L. Okane, 622 Gerritt St., Philadelphia 19147 Minesh C. Patel, 950 Walnut St.. 417 Barringer. Philadelphia 19107
Renee E. Phelps, 201 Division St.. Hummelstown 17036 Christopher R. Post, 199 University Manor Ela.st. Hershey 17033
Nila Sandhu, 794 Depot Ln.. Quakertown 18951 Adam R. Silverman, 126 Cedar Ave,, Hershey 17033 Sean P. Timey, 317 S. 1 1th St., Philadelphia 19107 Kenneth K. Wang, 3650 Chestnut St.. Box 0454, Philadelphia
19104
20
PENNSYLVANIA MEDICINE • JULY 1990
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Dyspnea . . . chronic productive cough ... or wheezing in patients too young for smoker’s emphysema or chronic bronchitis could be due to an inherited deficiency of alpha^ -antitrypsin (AAT).^ Associated with panacinar emphysema, AAT deficiency may be fatal.
An estimated 40,000 Americans have AAT deficiency.^ Smoking hastens the progress of the disease.
AAT deficiency is easy to diagnose. A simple blood test can show serum concentrations of AAT <35% of expected values.
Do you have patients with AAT deficiency in your practice? For more information about specific therapy for emphysema caused by AAT deficiency, please call
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1, Brantly ML, Paul LD. Miller BH. et al: Clinical features and history of the destructive lung disease associated with alpha-1 -antitrypsin deficiency of adults with pulmonary symptoms. Am Rev Respir Dis 1988:138:327-336.
2. Wewers MD, Casolaro MA, Sellers SE, et al: Replacement therapy for alpha, -antitrypsin deficiency associated with emphysema. N Engl J Med 1987:316:1055-1062.
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Stephen D. Silberstein, MD, chief, De- partment of Neurology, Germantown Hospital and Medical Center, was elected president of the Philadelphia Neurologi- cal Society. He had served as vice- president.
John Neely, MD, prediatric oncologist, Penn State’s Milton S. Hershey Medical Center, presented cancer drug research findings at the American Society of Clini- cal Oncology scientific meeting in Wash- ington, DC. Dr. Neely, associate profes- sor of pediatrics, described how cancer becomes resistant to one of the most commonly used drugs in chemotherapy, cyclophosphamide.
David B. Soil, MD, FACS, spoke at the International Congress of Ophthalmol- ogy in Singapore. He is chairman of the departments of ophthalmology at Frankford and Rolling Hill Hospitals.
Mary Ann E. Keenan, MD, was ap- pointed chairman of orthopedics at Al- bert Einstein Medical Center, Philadel- phia. Dr. Keenan is trained in the rare specialty of surgically correcting spastic deformities of the arms and legs.
PMS President J. Joseph Danyo, MD,
represented physicians on a panel of health care experts examining the health care process from the perspective of the patient. Sponsored by the Lancas- ter County Business Group, “Money, Mir- acles, and Mayhem,” also included em- ployer, extended health care facility, government, labor, managed health care, medical insurance, policy makers, and primary care facility representa- tives.
Meiriell Jessup, MD, has been named director of the Heart Failure Unit at the Philadelphia Heart Institute, a compre- hensive CcU'diovascular center at Presby- terian Medical Center. Dr. Jessup was di- rector of the Heart Failure and Transplantation Center at Temple Uni- versity Hospital and associate professor of medicine at Temple University School of Medicine.
William G. Hendren, MD, cardiac sur-
geon, formerly of the Cleveland Clinic Foundation, joined the cardiovasculeir di- vision of the DepcU'tment of Surgery at Presbyterian Medical Center of Philadel- phia on July 1. Dr. Hendren also joins the faculty of the Philadelphia Heart In- stitute.
William N. Kelley, MD, received the American College of Physicians’ 1990 John Phillips Memorial Award for distin- guished contributions in clinical medi- cine. Dr. Kelley became executive vice president of the University of Pennsylva- nia, chief executive officer of Penn’s Medical Center, and dean of the School of Medicine in October 1989. Formerly, he was chairman of the Department of Internal Medicine at the University of Michigan Medical Center, Ann Arbor.
Margaret Gray Wood, MD, emeritus professor and former acting chairman of dermatology at the University of Penn- sylvania Medical Center, was awarded the Rose Hirshler Awcird for significant contributions to medicine and dermatol- ogy. The award, presented annually by the Women’s Dermatologic Society, is in honor of Dr. Rose Hirshler, the first known female dermatologist in the U. S.
SHADYSIDE
HOSPITAL
BASIC & ADVANCED GYNECOLOGIC LASER COURSE
Shadyside Hospital
Department of Obstetrics and Gynecology
September 20-22, 1990
The course includes didactic lectures, videotapes and hands-on experience providing each participant with the knowledge, understanding and certification to confidently use the laser in all clinical settings. Each course participant will be involved in extensive laboratory workshops using COj, KTP, YAG and Argon lasers.
18 Hours Category I AM A Credit and 18 Cognats ACOG
Course limited to 30 participants.
Course Directors: Amir Ansari, MD, John Marlow, MD,
Harry Reich, MD, and 9 additional faculty members
For information contact: Ms. Kathleen Baker, Course Coordinator Shadyside Hospital - East Wing 510 S. Aiken Avenue, Suite 312
Pittsburgh, PA 15232 Telephone 412-622-1710
22
PENNSYLVANIA MEDICINE • JULY 1990
Check our fine print.
You don’t need to look deep to find out what sets PMSLIC apart from our competitors in the professional liability field. It’s clear on page 1 of our annual financial statement, filed with the state Insurance Department.
Our chief distinction: Physician control.
At PMSLIC, key decisions are made not by hide- bound managers . . . not by profit-motivated investors . . . but by dedicated, practicing physicians. Their leadership and direct participation on our Board and committees guarantee that the medical perspective
dominates in our underwriting and rating decisions, risk management initiatives, and claims handling processes.
The result is a company that cares— about your views, your needs, and the long-term health of medical practice in Pennsylvania.
Can your liability carrier make that claim? If not, call PMSLIC, toll-free, at 1-800-445-1212.
We’ll send you some “fine print’’ you’ll be glad to read.
I:
■✓0MV7Y SOCIETY H TRIES REACH OUT I AND TOUCH
Mark W. Shulkin, MD
“There are as many different doctor phonathon styles as there are different doctor personalities," commented a psy- chiatrist while eavesdropping on fellow directors during a membership phonathon. At the May meeting of the Delaware County Medical Society’s Board of Directors, county physicians participated in this unusual event.
The board squeezed its May business meeting down to a half hour so they could put 90 minutes into phoning reluc- tant colleagues, who hadn’t yet paid their annual dues. They also contacted a number of prospective new members.
Bell Telephone installed seven new phone lines in the society’s office suite just for the occasion. Why shouldn’t they have? They charged a whole month’s
phone rate for each line, though the lines were only used for 90 minutes. Plus installation.
Not to worry. The AMA picked up the tab and even sent staff from Chicago to help “prep.” The staff kept a running tally on a score board to spur the doctors on. Seven doctors made the evening phone calls but there were eight differ- ent styles. One doctor even had two per- sonalities.
Humble: “Sorry to bother you. 1 could call back later. Well, I’d like to ask you to | come back into the fold so our political | voice doesn’t seem somewhat compro- 1 mised."
Persuasive: “Look, even Congress is not perfect, but you don’t secede from the Union. We’ll send you a packet. You have to hang up? Call me tomorrow so we can talk about it some more.”
“My partner is the greatest non-joiner in the world but even he’s willing to pay for this kind of support. Where else can you put $1,000 and get that much for it?” Direct: “What could we do to influence you to be a member? Did you know that last year PMS saved doctors enough on the CAT Fund alone to pay their dues for four and one-half years?”
Sympathetic: “I’m sure your office ex- penses are astronomical. Yeah, I under- stand. I’m in the same boat myself, just stcirting a new practice, but the AMA is doing things to help us!”
Helpful: “How are you doing? I see you belong to the AMA but not the county medical society. Any reason for that? What are your feelings? Well I can get you in for one-half price if this is your first year. It’s only $240 for one-half year;
I think you can swing that.”
Good Natured: “Ha-Ha! I’m calling you
Dr. Shulkin is clinical director of adult services, Department of Psychiatry, at the Mount Sinai Hospital in Philadelphia and editor of The Bulletin of the Delaware County Medical Society. "The Investigative Reporter" is a monthly feature in The Bulletin.
24
CALLS
COMPLETED
SCOREBOARD
PROBABLE POSSIBLE
UNLIKELY
NO
Humble
6
3
1
1
2
Persuasive
7
3
2
0
2
Good Natured
6
3
1
1
1
Relevant
9
6
1
0
3
Direct
9
3
4
0
2
Sympathetic
7
1
3
0
3
Helpful
7
4
1
0
2
Enthusiastic
7
3
2
0
2
PENNSYLVANIA MEDICINE • JULY 1990
for a consultation today instead of you calling me for one. 1 need your money or 1 can’t get sent to Hawaii for confer- ences. You don’t have to pay it all at once. We take Visa, MasterCard, and American Express. Union members’ dues are over $1,000 and doctors make more than they do. You can afford it.”
Relevant: “1 read your letter of resig- nation in which you question the AMA’s position on a specific issue. I’m very sympathetic to your point of view and 1 wondered if you had any further thoughts about it. 1 understand your feel- ings. People like us need to continue our memberships and speak with a unified voice to change the AMA’s position.”
Enthusiastic: “Phonathons are a lot of fun. I’d like to do it again tomorrow. It’s only costing me $2.50 a day to belong to three organizations. What a bargciin!”
It was fascinating to listen to six or seven simultaneous conversations. The room was a-buzz. Messages were left on machines and with answering services. A couple of poor souls were being paged at their hospitals.
The directors scribbled notes for im-
Careful record was kept on a “Scoreboard” of the Delaware County Medical Society’s progress during the membership phonathon. Each phoning physicians’ efforts were tallied on calls completed, and probable, possible, unlikely and “no” responses.
mediate follow-up mailings or call-backs. Some were giving out their office num- bers and promising to “do lunch.”
During the next two days the DCMS staff coordinated repeat billings and indi- vidual memorandums to each physician who had been called. They included the current “benefits propaganda” and appli- cations for many prospective members.
The eight different styles seemed equally successful. Take a look at the scoreboard and see if you don’t agree. At the end of the session, it looked as though there would be a growth yeeir rather than a horrendous fallout as the result of AMA unification.
How many checks did the DCMS re- ceive because of the phonathon? Don’t ask! It’s not important! The doctors reached out to touch someone, not to put the touch on them. They initiated a dialogue with some of the 50 percent of American physicians who do not pres- ently support organized medicine. That dialogue should be a continuing one.
It needs to be Humble but Persuasive, Good Natured but Relevant, Direct but Sympathetic, Helpful and Enthusiastic.
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James F. Drane, PhD
Dr. Drane is Russell B. Roth Professor of Clinical Medical Ethics at Edinboro University of Pennsylvania. As an interna- tionally known bioethicist, be was profiled in the November 1989 issue of this publication.
Currently he is a resident ethicist with the Pan American Health Organization, working to develop ethics committees in Latin America.
OBEL CONFERENCE: A REPORT
The opening of the Third International Nobel Conference on Ethics in Medicine reminded me of Sunday Mass. Not ex- actly what I had expected in Sweden, where Lutheranism is the state religion and the culture today is thoroughly secu- lar. Conference participants were ad- vised to be 15 minutes early for the opening session at Huddinge Hospital, an enormous, modern, high-tech medi- cal center, 30 minutes by train from downtown Stockholm. Promptly at 9 a.m. the main doors opened for a pro- cession of well-dressed men followed by a woman dressed in cardinal purple. She carried a bouquet of yellow roses, a striking combination. All present stood to greet Queen Silvia of Sweden as she moved down the isle to her place in the first row. As she was seated and we sat, the “liturgy of the word” began.
The director of the Nobel Commission welcomed us to the conference and spoke about the commission’s interest in ethics and medical ethics. Next the queen spoke, as a mother and represen- tative of her people, in flawless and ac- centless English. Her theme was protect- ing the integrity of patients, whom she felt were increasingly threatened in to- day's high-tech medical care institutions. After she spoke, the queen remained to listen to several papers on “Integrity and Autonomy,” the first of which was deliv- ered by Edmund Pellegrino, MD, direc- tor of the Kennedy Institute of Ethics at Georgetown University, Washington, D.C.
Dr. Pellegrino’s thesis, which set the conference’s tone, critiqued the role of autonomy in American medical ethics. The American emphasis on autonomy, he argued, is exaggerated, minimalistic.
legalistic, individualistic, and often dis- ruptive in the clinical setting. The under- lying assumption by proponents of American-style autonomy is that the rights of the individual are inviolably above those of the doctor and the com- munity. Such a view undermines trust in the physician, ignores the rights of the community, and most damagingly, ig- nores both the reality of illness and the healing character of the doctor-patient relationship.
Dr. Pellegrino strongly emphasized the need for patient respect and partici- pation in medical decision making, but he also insisted that physicians have rights and duties that entitle them to re- spect. Physicians’ ethical commitments cannot be made subservient to an exag- gerated patient autonomy. Patients can- not, for example, require doctors to per- form abortions or euthanasias. While no added powers or privileges are due phy- sicians, they do have added responsibili- ties derived from a fiduciary relationship with patients. Any adequate code of medical ethics must take this reality into consideration.
Integrity, Dr. Pellegrino said, would be a sound basic principle for ethical deci- sions in medicine. Integrity applies equally as a moral directive to patients and physicians. Respect for a person’s in- tegrity requires balancing the physical, psychological, and spiritual dimensions of the person. Physical integrity refers to the body’s proper physiological function- ing, which is undermined by serious ill- ness. Psychological integrity implies the self which is alienated from the body in illness. Spiritual integrity encompasses the values both of the physician and the patient. Physicians are committed more to patient integrity than to the narrower value of individual autonomy, and pa- tients have an obligation to respect the integrity of their physician. Because it is more central to the doctor-patient rela- tionship, integrity is a better guiding principle for medical ethics than patient autonomy and is more readily recog- nized as such by non-American cultures.
The integrity principle applies to issues such as a donor’s body integrity in trans- plantations. AIDS has called attention to the integrity both of victims and the community, which also requires respect, security, and protection. Integrity is a central issue in research, where viola- tion possibilities are a constant concern. The same is true of modern gene tech- nology where both individual and spe- cies integrity is rooted in the very being of a person, cannot be lost, has no de-
28 PENNSYLVANIA MEDICINE • JULY 1990
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grees, and cannot be subjected to substi- tution. For all these reasons, integrity is preferable to autonomy as the founda- tion value in medical ethics.
The atmosphere of an international meeting demonstrates the need for broad transcultural ethical standards. High-tech medical procedures which give rise to modern ethical dilemmas are world-wide, and so too must be ethical standards guaranteeing their humane use. The international focus of the con- ference was repeatedly revealed in at- tempts to develop concrete ethical pa- tient protections across cultural lines. Common elements of environment, cul- ture, and medicine force us to search for ethical standards that are more than re- flections of a particular people. The American emphasis on individual pa- tient autonomy, however, is considered too narrow and one-sided to serve as a foundation for international medical eth- ics. Integrity comes closer to fulfilling that need.
A challenge to autonomy
The conference’s celebration of commu- nality and transcultural ethical agree- ment came to a shocking halt when Daniel Callahan, PhD, delivered his pa- per on “Age and Other Limits in Health Care.” While he continued the critique of individual autonomy as a viable founda- tion for medical ethics, the integrity or autonomy discussion was lost in the midst of his much more emotional argu- ment about limiting patients' rights to expensive high-tech medicine after they reach a certain age. Suddenly, the con- ference descended from a relatively pure metaphysical atmosphere of princi- ples and turned into an only slightly re- strained dog fight about social ethics and medical treatment for the elderly.
Dr. Callahan outlined his now famous thesis that a combination of aging popu- lation and constant medical progress very soon will pose a challenge to fair allocation of health care resources. To- gether, the two factors will increase the cost of health care beyond what even an affluent society can afford. Because the greatest expenses will come from caring for the elderly, we need to begin think-
30
ing now, he said, about setting priorities and limits. Cost cutting alone cannot deal with the oncoming crisis. The American emphasis on autonomy and individual decisions makes the only via- ble solutions more difficult to implement. Societally-mandated standards of age and outcome assessment will be re- quired. Such a change necessitates a move away from individualism toward social values; from individual autonomy to a social ethic.
The very mention of age as an agreed- upon objective standard for limiting cer- tain kinds of health care expenditures caused an emotional audience response that frequently was unfair to Dr. Calla- han. His thesis of age-based rationing was not unnuanced, but the emotional responses to it certainly were. His chal- lenge to participants to re-think the meaning of growing old and dying was apparently a very threatening task. Many conference participants felt more comfortable with rhetorical statements about discrimination against the elderly, or about how being old is like being young, or about the need for more pub- lic programs for extending the length and advancing the quality of life. The idea of up-front, institutionalized ration- ing violated accepted beliefs about medi- cal care delivery in first world nations. Dr. Callahan defended strong advocacy of improved care for the elderly in the sense of chronic and palliative care. What he argued against were continued improvements and entitlements to life- prolonging treatments after a certain age. He had no objections to treatments and expenditures which either control chronic symptoms or improve the qual- ity of life. It was the use of high-cost, high-tech, life extending procedures which do neither that he thought should be eliminated.
Nevertheless, during the discussion the polite atmosphere of earlier sessions degenerated into something akin to an old-fashioned back alley brawl. When Dr. Callahan was labeled callous, uncar- ing, and unjust, the ordinarily cool, ana- lytic philosopher took off the gloves to defend himself. All the points raised by critics from the audience had already been addressed in his tightly argued arti- cles and books,' and comparisons be- tween his ideas and Nazi solutions did little to advance rational discussion. Gra- tuitous rhetoric compared the tyranny of younger majorities in democratic coun- tries to totalitarian regimes and warned of frightening dangers for the weak and aged. Ominous social predictions stood
in shcirp contrast to what had been a growing consensus about guidelines and standcu-ds of right and wrong in health Ccire. His suggestion that an aged-based cut-off for life extending treatments be balanced by an enriched understanding of the meaning of being old and an ex- tended societal role for the elderly as conservators of the past and teachers of youth, fell on deaf ears. While confer- ence participants continued to agree about the need for international guide- lines and standcirds based on something more objective than autonomy, age as a social standard was not well received.
Movement beyond an individualistic, autonomy-based morality, toward a more balanced social ethic with respect for individuals, seems well-established. Steps already are being taken in that di- rection in Scandinavian countries. Utili- tarian thinkers at the conference said they accept deontological individual safeguards against obvious injustice. There were signs also of a growing transcultural agreement, at least about guiding principles for public health pol- icy, if not about more concrete, practical measures.
Philosophically, the conference partici- pants seemed to be moving toward agreed upon principles for just allocation of scarce medical resources. In the real world, however, even among sophisti- cated academicians, the debate quickly slips into bare knuckle interactions over which concrete norms or laws will be applied. Limits obviously have to be set in accordance with principles of social justice, but where principles meet af- fected persons, heated disagreement still arises.
The issue of clinical freedom
The following morning, another assault was mounted on the autonomy princi- ple, this time from the perspective of physician-based demands for clinical freedom. The socially authorized aim of the doctor-patient relationship is to im- prove the patient’s condition, cure the patient, relieve pain, overcome dysfunc- tion, and prevent untimely death. Time and again the point was made that the principles of medical ethics cannot im- pede these goals. In situations where medical goals conflict with patient au- tonomy, a shared responsibility is more appropriate than a single individualistic patient right.
Sir Raymond Hoffenberg, president of the Royal College of Physicians, London, argued that the threat of malpractice liti- gation has forced physicians to adopt de-
PENNSYLVANIA MEDICINE • JULY 1990
fensive styles of practice which are costly to society and do not advance pa- tient interests. Clinical freedom for phy- sicians, he said, must be protected or ev- eryone suffers. Many specialties important to patients and to society are being abandoned because of legal entan- glements. The greatest threat to sound medical ethics today, he said, comes from economic restraints on clinical freedom. Increasingly, physicians are called upon to ration resources, creating a conflict between duties to patients and duties to government (or employing in- stitution). More and more guidelines are being imposed on medical practice, seri- ously limiting physicians’ freedom to manage patients. Sir Hoffenberg pro- posed that physicians become more in- volved in discussions of medical ethics, designing their own ethical standards of good clinical care.
The emerging theme of the conference— critiques of American-style autonomy— was reiterated by many
r\FTER ESTATE PLANNING
William T. Tsiouris, Esq.
The completion of a person’s estate plan, whether carried out by a will or a deed of trust, does not signify the end of the process. At that time, and subject to peri- odic revision, the individual should ad- dress the task of providing his fiduciaries
William T. Tsiouris is associated with Kalogredis Law Associates Ltd. of Wayne, PA. He deals primarily with estate planning matters.
speakers who insisted that the autonomy/paternalism dialectic is sim- ply an insufficient framework for build- ing medical ethics. The ideals of social justice, integrity, and clinical freedom were emphasized in contrast to an au- tonomy based ethic. A repeated consen- sus of the meeting was that unless more consideration is given to societal issues, patient choices will be reduced to the point that individual autonomy will have almost no meaning.
The United States is clearly the world leader in medical ethics and is far ahead both in breadth and depth of work in this field. But the technologies which gave rise to modern medical ethics are now world-wide, and diseases like AIDS raise the same ethical concerns every- where. Certainly, ethical approaches re- flecting cultural influences exist, but an international bioethics community is also developing. International meetings such as this conference take place more frequently. Policy developments are
and family with the basic information necessciry to carry out the estate plan upon that person’s death. A great deal of trouble and, in most instances, expense will be avoided if the fiduciary has data which enables him to carry out his du- ties in an expeditious manner.
The alternative is to have the fiduciary conduct a search at a time when the family and heirs are in a highly dis- traught state of mind. That type of situa- tion can be avoided by having the indi- vidual prepare a detailed statement or letter which gives the fiduciary a fairly complete picture of the individual’s fi- nancial affairs as well as such prefer- ences as, for example, those concerning burial instructions and division of per- sonal effects.
The statement or letter should include the following subject matters:
1. Listing of assets, which should be currently valued, and which should indi- cate the location of each such asset.
2. Listing of significant debts includ- ing maturity, installment payment amounts and location of underlying debt instruments.
3. Name, address, and telephone number of family attorney and accoun- tant, including preference, if any, as to retention of both or either.
4. Burial directions and location of deed to burial plot.
5. Specific location of safe deposit
shared across national borders. There is growing interest in the development of an internationally uniform response to major problems in bioethics.
Once this broader perspective be- comes a more conscious consideration, American bioethicists should move away from the almost single-minded fo- cus on individual rights and liberties that has characterized their work. This will not be easy. The present struggle in the Soviet Union and Eastern Europe to shift away from broad social values to indi- vidualistic ones illustrates the problem. It will be interesting to see how flexible Americans are in moving in the opposite direction.
Reference
1. Callahan, Daniel: ‘ Vilal Distinctions, Mortal Questions.' Commonweal, July 15, 1988, pp. 397-404; see also Daniel Callahan, "Elderly Health Care: There Ought to Be a Limit." U.S. Catholic. July 1988, pp. 13ff.; see also Daniel Callahan, Setting Limits: Medical Goals in an Aging Society, New York; Simon and Schuster, 1988; and Daniel Callahan, What Kind of Life: The Limits of Medical Progress. New York: Simon and Schuster. 1989,
box, if any, location of key to box, and names of registered owners.
6. Inventory of safe deposit box.
7. If personal items are left to a group of heirs as determined by execu- tors, some preference as to major items should be set forth.
8. Employment benefits including any contracts, or if none, company pol- icy as to accrued vacation pay and death benefits. List name of person handling these matters at place of employment.
9. If minor children are involved, di- rections to guardian concerning educa- tion and rearing of minor children should be set forth.
10. If the individual owns unique as- sets, directions concerning valuation and disposition should be set forth.
11. If the individual owns assets which are not marketable, the individ- ual’s particular insight and attitudes with respect to those assets should be set forth.
An additional advantage to the preparation of the above statement or letter will be to discipline the individual in his lifetime to assemble his records in an understandable and logical fashion— this process gives rise to living as well as post-death benefits. An investment of some additional time after execution of a will or deed of trust will pay consider- able dividends to a person’s family and heirs.
5,
TATE SYSTEM OFDISCIPUNE FDR LAWYERS AND JUDGES
Kym Liebier
Kym Liebier is a publications staff writer for Pennsylvania Lawyer, the monthly publica- tion of the Pennsylvania Bar Association.
Despite criticism leveled at the confiden- tiality of Pennsylvania’s legal and judicial disciplinary systems, the Disciplinary Board of the Supreme Court of Pennsyl- vania remains in the forefront of na- tional recognition as a model system widely followed by other states.
Pennsylvania lawyers are obligated by their profession to adhere to the New Rules of Professional Conduct, which re- quire attorneys to act professionally in their roles as representatives of clients, officers of the legal system, and public citizens. The rules also serve as a frame of reference to solve professional ethical dilemmas that arise when a lawyer’s var- ied responsibilities conflict. Disciplinary action is sought or taken when members of the legal profession are guilty of mis- conduct and, as a consequence, jeopar- dize the integrity of the legal system and the public’s faith in that system.
Ultimate authority over Pennsylvania lawyers and judges rests with the Penn- sylvania Supreme Court. Unlike the ma- jority of professions, which are regulated by government-appointed boards or commissions, the legal profession is largely self-governing.
The Disciplinary Board and the Judi- cial Inquiry and Review Board (JIRB) are both under the purview of the Supreme Court of Pennsylvania and are the two agencies charged with policing the legal profession. Both adhere to strict confi- dentiality during the disciplining of law-
yers and judges. To ensure public confi- dence in the court system, both agencies are forbidden to disclose any informa- tion about an investigation until they have determined that misconduct has in fact occurred, and until they recom- mend formal discipline to the Supreme Court.
Lawyer discipline
The Disciplinary Board, a 17-year-old entity made up of 11 lawyers and two lay members, is assigned the task of monitoring the conduct of Pennsylvania lawyers.
According to the Disciplinary Board’s 1989 Annual Report to the Supreme Court, the most common causes of disci- pline continue to be conversion and commingling of client funds and neglect of legal matters that may or may not in- clude deception and misrepresentation to the client. Recent reports indicate that other causes for lawyer discipline in- clude neglecting to sue on behalf of a cli- ent, failing to file appeals, and crimincd misconduct such as drug pushing, racke- teering, mail fraud, and income tax eva- sion.
Disciplinary action can take many forms, only one of which is disbarment. Other types of discipline consist of infor- mal admonitions by disciplinary counsel, a private reprimand by the disciplinary board, public censure by the state Su- preme Court, or suspension. Only a frac- tion of lawyers that appear before the disciplinary board are disbarred. In addi- tion, informal admonitions and private reprimands comprise 70 percent of the punishment meted out to lawyers.
Disciplinary Board procedures
The Disciplinary Board handles and in- vestigates approximately 275 complaints a month. Typically, disciplinary proce- dures are prompted by a written com- plaint filed with the board. In some in- stances, however, the board itself initiates investigations into a lawyer’s conduct. After a complaint is filed, a staff member reviews it to determine whether probable cause for discipline exists. If the complaint warrants further investigation, a written report is submit- ted to a reviewing member of one of Pennsylvania’s 42 hearing committees.
It is up to the reviewing member— one of 108 lawyers selected to serve on a voluntary basis— to decide whether the case should either be referred to discipli- nary counsel for a formal hearing before a three-lawyer hearing committee, or whether an informal admonition or pri-
32 PENNSYLVANIA MEDICINE • JULY 1990
vate reprimand from the bocird is appro- priate discipline.
Disciplinary hearings are held after the reviewing member determines that probable cause for discipline of a more serious nature exists and approves the prosecution of formal charges. The disci- plinary hearings operate in much the same way as a court trial; however, they are not open to the public.
Following testimony before a hearing committee, a report is sent to the Disci- plinary Board, which then decides if the complaint should be dismissed or if disci- pline is warranted. The matter is consid- ered closed if the discipline is less than disbarment, suspension, or public cen- sure.
Public censure, suspension or disbar- ment can be ordered only by the Su- preme Court. Not until the Supreme Court directs such discipline does the matter become public information.
Voluntary disbarment
Voluntary disbarment, under which a lawyer agrees to stop practicing law in return for the Disciplinary Board’s keep- ing his wrongdoing private, constitutes the majority of disbarments. The details on involuntciry disbarments, however, are available to the public. Twenty-nine lawyers were disbarred last year, accord- ing to the Disciplinciry Board’s annual re- port. Three of the disbarments were the result of formal proceedings undertaken by the board.
Voluntary disbarment is not a painless process. The lawyer must sign a verified statement that his action is voluntary and that the material facts contained in a complaint against him are true. The law- yer must also inform his clients that he has terminated his practice. All disbar- ments are effective for at least five years and can only be lifted by the state Su- preme Court.
Another function of the Disciplinary Board is to review petitions for reinstate- ment filed by lawyers who have been suspended or disbarred. The petitions in- clude a lengthy questionnaire, and re- quire participation in a hearing to dem- onstrate that the petitioner has the moral qualifications and is learned in the law. The disbarred or suspended lawyer must prove that his reinstatement will not be adverse to the public interest and will not reflect poorly on the reputation of the bar.
The judiciary
While the lawyer’s disciplinary process has maintained a low profile, the proce-
dures implemented to monitor Pennsyl- vania’s judiciary have received consider- able media attention during the last decade. The JIRB is the agency of the Pennsylvania Supreme Court responsi- ble for overseeing the judiciary. Al- though sometimes criticized for its ineffi- cacy, the nine-member board last year recommended to the Supreme Court the removal of 15 Philadelphia judges charged with accepting cash gifts from the Roofer’s Union.
Five judges, two lawyers and two lay members sit on the JIRB. Like the Disci- plinary Board, much of its proceedings are confidential. Although the board cannot dole out punishment, it has the authority to determine if ethical miscon- duct has occurred and to recommend appropriate discipline to the Supreme Court. Until the JIRB submits its report to the Supreme Court, nothing about the investigation is public record.
Each case of alleged judicial miscon- duct is explored during a six-step pro- cess. The first phase involves a review of either a complaint received from an out- side source or initial information gath- ered by the board for an internal investi- gation. At this point, the case may be dismissed if it is determined that the mat- ter is frivolous or not within the jurisdic- tion of the board. The second phase en- tails a brief preliminary investigation after which the case may be dismissed if it is found to be without merit. The third phase is the initiation of an investigation. At this point, the judge under investiga- tion is informed that such an investiga- tion is under way.
The filing of formal charges and the ensuing hearing concerning the charges constitutes the fourth phase of JIRB pro- cedures. Fifth, the board informs the judge charged with misconduct of its ulti- mate finding. The sixth and final phase involves relaying the board’s recommen- dations to the Supreme Court. After the JIRB presents its report to the Supreme Court, the public is privy to the details of the judicial investigation.
Confidentiality debate
The confidentiality rule is controversial. It came under fire in 1983 when the ma- jority of the JIRB voted to keep confiden- tial the testimony of a 28-month investi- gation into the conduct of Supreme Court Justice Rolf Larsen. The Philadel- phia Inquirer obtained a copy of the tes- timony and printed extensive excerpts of the proceedings.
According to critics of the disciplinary system, the policy undermines, rather
than strengthens, the very objective it was designed to guarantee. Proponents of the confidentiality clause say it pro- tects judges who are subjected to groundless or frivolous complaints. Ap- proximately 75 percent of the 400 com- plaints the JIRB receives annually are found to be without merit. There are 1,100 judges, district justices and senior judges in Pennsylvania.
The JIRB dismisses about half of the remaining 25 percent of the cases opened to formal investigation. Over the last three years, the board has taken for- mal action in about 15 percent of its cases.
Judicial reform legislation
Reforming the manner in which Penn- sylvania judges are disciplined is an ini- tiative of the Pennsylvania Bar Associa- tion. Two bills that would amend the state constitution to provide for a two- tiered system of judicial discipline have passed the Senate and are now in the House Judiciary Committee. S.B. 1 and S.B. 595 call for the establishment of a Judicial Conduct Board/Board of Com- plaints that would investigate complaints and could order a hearing based on probable cause before a Judicial Con- duct Board/Conduct of the Judiciary.
Momentum for judicial reform has picked up following the March resigna- tion of former Superior Court Judge Ed- mund B. Spaeth Jr. from his post as chairman of JIRB. In his resignation let- ter, Judge Spaeth said, “. . .the structure of the board is so fundamentally flawed that the board cannot fulfill the responsi- bilities entrusted to it.”
In reply. Governor Robert P. Casey stated his support for judicial reform and noted “public disclosure of substantial charges against judges is absolutely es- sential to maintaining public confidence in the board’s ability to deal with ethical violations.”
Change is on the horizon. If S.B. 1 or S.B. 595 pass the General Assembly this June, and the same measure is passed again in the 1991-92 legislative session, Pennsylvanians will have an opportunity to vote on a constitutional amendment referendum placed before them during an election occurring as early as May 1991. If that happens, a constitutional change could be in effect as early as Jan- uary ^1992.
For years, the legal community has lobbied for judicial reform. It appears their efforts have not been in vain as state leaders, legislators and the public finally address the issue.
CAPITAL COMMENTARY
amount of free and discounted ceu-e pro- vided by doctors. The data from both surveys are consistent. The principal findings are:
I
■ REE AND H DISCOUNTED CARE I BY PHYSICIANS
As the Commonwealth’s economy changes, questions arise about the num- ber of Pennsylvanians without health in- surance. Related to this is the willingness of physicians to give free and discounted care to patients in financial need. In the spring of 1988 and again in the fall of 1989 the Pennsylvania Medical Society conducted two surveys to track the
1. The vast majority of physicians (94 percent of respondents) offer signif- icant amounts of free and dis- counted care.
2. The average physician provides ap- proximately 900 free or discounted visits per year. This represents about 16 percent of all visits (1988 American Medical Association sur- vey of physicians in Pennsylvania).
3. The average annual dollar value of these visits, as reported by a physi- cian in the survey, is $33,237.
4. Projected to the approximately 25,000 practicing physicians in Pennsylvania, the survey shows that more than $830 million in free and discounted care is provided each year by Pennsylvania doctors. (Range = $576 million to $ I bil- lion).
Survey findings
The elderly benefit most from free and
These are the findings of a RMS Indigent Care Survey conducted May-July, 1989.
Table 5
Physician Respondent Profile
Age
Sample
Population
Difference
Less than 35
12%
25%
- 13%
35-44 Years
30%
31%
- 1%
45-54 Years
24%
19%
-r5%
55-64 Years
21%
15%
+ 6%
65 and Over
12%
10%
-t-2%
Sex
Male
91%
86%
-1-5%
Female
9%
14%
-5%
Specialty
General IM
9%
13%
-4%
FP/GP
29%
16%
+ 13%
Pediatrics
6%
6%
NA
OB/GYN
6%
6%
NA
Other Medical
22%
40%
-18%
Orthopedic
Surgery
8%
4%
+ 4%
Other Surgery
20%
16%
+ 4%
Type of Practice
Solo
60%
46%
+ 14%
Group
38%
54%
- 16%
34
PENNSYLVANIA MEDICINE • JULY 1990
discounted care. Physicians provide the greatest number of free or discounted visits to Medicare patients. For the aver- age physician respondent, this amounts to 342 visits per year, with 87 percent of those visits resulting in a discount to the patient. The total annual dollar value of these discounts per doctor is $11,891.
Insured patients receive free and dis- counted care. The typical physician in the survey provides 257 free or dis- counted visits to patients who have health insurance. Most of the benefits to these patients come in the form of dis- counts (75 percent). For doctors in the survey, the annual average dollar value of this free and discounted care to in- sured patients is $11,088.
Welfare eligible patients receive addi- tional free and discounted care. A major- ity of physicians not only serve Medical Assistance patients but often provide some of that care free. Frequently they absorb discounts over and beyond those built into the program.
The average physician in the survey provides 247 visits to Medical Assistance patients per year in which a deductible is not collected or in which a service is pro- vided which is not billed to the Depart- ment of Public Welfare (DPW). Nearly half of the doctors responding to the sur- vey (48 percent) give some free care to Medical Assistance patients.
Most doctors give some free care to self pay patients. More than half of the doctors responding (58 percent) give free care to uninsured patients. And al- most half (47 percent) give discounts to uninsured patients.
When physicians treat patients with- out insurance, or as termed in the sur- vey, “self pay,” the majority of the care given switches from discounted to free. In the survey, on an annual basis, 57 per- cent of the dollar value of care given to the uninsured was free care. Forty three percent was discounted care.
Summary
Most doctors in the state voluntarily pro- vide free or discounted care to patients. Based on the survey, a typical doctor, who sees Medicare, Medicaid, commer- cial insured, and uninsured patients, pro- vides 950 free or discounted visits a year
or approximately three per day.
Design of the study
To ensure a high level of validity, this study was designed to collect actual, rather than estimated free or discounted care figures from physicians. To this end, physicians who agreed to participate were asked to record dollar values of free or discounted care for each of the three months of the study. Separate cate- gories were provided for free care ver- sus discounted care in each of the follow- ing classifications: Medicare patients; Medical Assistance (MA) patients; Pa- tients with commercial insurance (in- cluding Blue Shield); and self-pay pa- tients.
Corresponding patient visit data was collected for each of these categories. The data collected over three months was then aggregated and multiplied by four to provide a projection of the an- nual amount.
Respondents were instructed:
• NOT to provide figures for other members of their group.
• NOT to list discounts which are pro- vided to Medicare, MA or an insurance carrier as part of an agreement.
• NOT to list care which is provided as professional courtesy.
Respondents were asked to provide figures only for themselves and only for those amounts remaining after reim- bursement from the insurance carrier. They were asked to call the PMS contact person if they had questions about the proper way to fill out the survey ques-
tionnaire. In addition, the responses were carefully screened to eliminate in- appropriate responses, such as figures reported for a group practice rather than an individual or unusually large dollar amounts reported.
Statistical significance of results
In a sample of the size used in the PMS study, a difference of plus or minus 9 percent would be considered statistically significant. Using this figure, a judge- ment can be made as to whether the sample of respondents is biased, or if the sample can be used to produce estimates of the amount of free or discounted care given by the entire physician population in the Commonwealth. Like most mail- out surveys, this survey contains a cer- tain amount of response bias, but with few exceptions, the survey sample is representative of the physician popula- tion in terms of age, sex, specialty, and type of practice. Certain differences exist between the profile of respondents and that of the entire physician population. Those drawing conclusions from this data are alerted to this.
One major bias— a lack of response by physicians who give little or no free or discounted care— was avoided by urging these physicians to participate in the sur- vey, and they did so. With one exception (“Other Medical”), the survey profile matches the profile of the population of physicians in the Commonwealth. Table 5 provides a detailed profile of physician respondents versus the physician popu- lation in Pennsylvania.
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SURVIVING PEER REVIEW
Rocco DeMasi, MD
Dr. DeMasi is a member of the Department of Medicine. Divi- sion of Rheumatology, at York Hospital. York.
Physicians often feel as if they are watching the blank screen of the Health Care Financing Administration’s (HCFA) regulation making apparatus, waiting for the new book of rules to appear. Well, it’s here; and it is called “The Third Scope of Work.” This sets forth the new obliga- tions that the Peer Review Organiza- tions (PRO) must fulfill.
Earlier PRO activities stressed utiliza- tion review and cost containment;
1. detection of, and denial of payment for, unnecessary admissions and un- necessary care;
2. review of cost outliers and day outli- ers;
3. DRG validations;
4. review for medical necessity of transfers from one prospective pay- ment system hospital to another;
5. review of readmissions occurring within 31 days of discharge;
6. scrutiny of specific DRGs;
7. checks of random samples of Medi- care admissions;
8. discharge planning, 'etc.
Added to and expanding these tasks will be 100 percent pre-procedure re- view for carotid endarterectomies, cata- ract extractions, and eight other proce- dures (no matter if done on an in-patient or out-patient basis) selected by the PROS from a list supplied by HCFA. Ke- PRO’s selections include several cardio- vascular procedures (pacemaker inser- tions, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, complex periph- eral revascularization), orthopedic pro- cedures (major joint replacement, and laminectomy), hysterectomy, and pro- statectomy.
Under the new scope of work, greater emphasis is to be placed on the quality of care given to the patient, not only in and by the hospital and physician, but also by ambulatory surgical centers, home health care agencies, skilled nurs- ing facilities, and hospital ambulatory care facilities.
Once a chart is selected for review, it must undergo scrutiny to make sure that the admission was necessary; that the quality of care rendered was satisfac- tory; that the principal diagnosis was
36 PENNSYLVANIA MEDICINE • JULY 1990
proper; and that discharge planning was adequate to continue the patient’s care and avoid readmission. By understand- ing the various aspects of this process, physicians can decrease the number of PRO letters they receive.
Determining admission
How necessary is it for the patient to be admitted to the hospital to care for the particular problem? Most times the an- swer is very obvious, especially in the case of serious or life-threatening illness. But what about the elective admission? Could the diagnostic evaluation have been performed on an out-patient basis without jeopardizing the patient’s health or well-being? Notice that inconvenience to the patient is not part of the question. Very often the patient’s social problems and circumstances pressure the physi- cian into deciding to hospitalize for care. Difficult emotional factors come into play in making the choice. Now the doc- tor must take the time to explore all ave- nues available for patient evaluation in the least costly setting and become fa- miliar with the out-patient diagnostic fa- cilities, home health care agency ser- vices, and ambulatory surgery centers. The patient and the family need to be informed of the various options open to them so that they can participate in the care rendered. When adequate out- patient services are not available physi- cians must assist their hospitals and com- munities in establishing the needed facilities.
If, after considering all of this, the phy- sician feels that as much as possible has been done in the ambulatory setting, the efforts must be documented legibly in the patient’s hospital record. Without this substantiation, the chart reviewer is at a disadvantage. Not knowing the patient’s social and medical environment, the re- viewer must make a decision on neces- sity of admission based on general medi- cal principles. That judgment cannot weigh all of the mitigating circumstances that went into an attending physician’s decision. Documentation is vital. The old adage, “if it isn’t in the chart it doesn’t exist,” will be followed.
Pre-admission planning
Once the patient is in the hospital, care given to him must reflect the severity of illness for which in-patient status is deemed necessary. Pre-admission plan- ning, then, is important. Document the diagnostic and/or therapeutic approach you plan to take as part of your history and physical examination. Make sure
that your clinical impressions are consis- tent with the history and physical find- ings. If the care plan is one that can be carried out in a less expensive setting, or if clinical findings do not support your diagnostic impression, reconsider hospi- talization.
Another factor which will take on greater significance in the “Third Scope of Work” is discharge planning. Dis- charge planning must begin as soon as the decision to admit the patient is made. Physicians should add the head- ing “Discharge Plan” to their H&P, along with Chief Complaint, History of Present Illness, etc. Just as we use our diagnostic impressions to guide our approach to solving the problem, so should we use our discharge plan. Too often physicians find themselves with a clinically stable patient ready to leave the hospital, but no place to go.
The patient’s family and the institu- tion’s social service department must be made a part of the patient’s Ccire process from the beginning. Documentation of dischcirge planning efforts, and antici- pated out-patient management are ex- tremely important. Your notes should in- dicate the timing of post discharge follow-up, the problems to be assessed, and the proposed approach to these problems. Documentation of this kind in the hospital chart, substantiated and con- firmed by the out-patient record, will go far to discount claims of “premature dis- chcirge.”
Inherently linked with the “premature discharge” designation is the condition of a patient during the 24 hours prior to dismissal from the hospital. HCFA policy lists several factors to which reviewers must pay attention as indicators of possi- ble premature discharge. Abnormal lab- oratory studies, blood pressure readings outside of certain limits, temperature ele- vation, postoperative bleeding or evi- dence of wound infection (e.g. drainage) within 24 hours of discharge can lead to quality review problems. It is to the phy- sician’s advantage to review all of the pa- tient’s record a few days before antici- pated discharge. This includes notes by nurses and any ancillary health care pro- viders who contribute to the chart. Doc- ument and explain any discrepancies that exist in the record. Evaluate and ex- plain any abnormalities in the labora- tory or x-ray data. Treat any instabilities found which may indicate the patient is not ready to leave the hospital. Make sure all pending laboratory information is checked. Cultures and other diagnostic tests that come back positive after the
patient goes home raise red flags to re- viewers, unless documentation is present showing that return of the infor- mation is awaited, and a possible thera- peutic approach is proposed.
When the attestation statement on the front of the patient’s chart is signed, the physician is specifying the principal diag- nosis for which the hospital is to be paid under the prospective payment system. By definition, this diagnosis is “that con- dition which after study is determined chiefly responsible for occasioning the admission of the patient to the hospital.” It may not be the reason why the patient stayed in the hospital for a prolonged pe- riod of time. It may not be the most seri- ous illness the patient had. It is the rea- son why the doctor thought the person had to be taken care of as an in-patient. Confusion may occur when determining the final diagnosis to be used to catego- rize the patient’s Diagnosis Related Group (DRG). The definition of “principal diagnosis” is the test that must be ap- plied. If there is concern or disagree- ment as to what is correct, the physician should consult with the hospital’s direc- tor of quality assurance, utilization re- view or the medical records librarian. They may be able to assist.
Some physicians feel that peer review
is a game in which the rules keep chang- ing. It may seem that way at times, but the good news is that the rules are avail- able to you from the PRO, and your hos- pital’s PRO contact person. Get to know them. Better still, take part in the review process by assisting your peer review or- ganization. Spend some time reviewing your colleagues’ charts. It is a sure bet that your record keeping will improve, and reviews of your records will go more smoothly. Then you will be able to complain legitimately should you get one of those “denial letters.”
1 have said nothing about the various sanction procedures mandated by HCFA. They will never be used against the vast majority of doctors. We should not practice to avoid sanctions. Learning the methods used by the PRO will help physicians to minimize the bureaucratic nuisances that use so much of our time in dealing with the “red tape machine.” Most doctors want to, and do, practice good quality, cost effective medicine. Looking for the “bad apple” in the medi- cal barrel should not be the only reason for peer review. Peer review can help all of us to practice better. It should help teach us improved ways to fulfill our role as physician to our patients and our communities.
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HYSICIAN PIONEER HONORED IN CLEARFIELD COUNTY
On a windy day in April 1990, more than 1 70 years after his death, a group of Dr. Samuel Coleman’s peers gathered in a Clearfield County cemetary to honor
his name. He was Clearfield County’s first physician, and members of the Clearfield County Medical Society joined with other community groups to restore a century-old monument to Dr. Coleman which had been damaged by vandals.
The monument, erected by the county society in 1888, was moved to a more accessible location and fitted with a new bronze plaque for the re-dedication. Be- cause Dr. Coleman was the first settler in the small agricultural community of Grampian, members of the Clearfield and Curwensville Masonic Lodge Teams and Clearfield County Historical Society joined the physicians for the dedication.
Dr. Coleman might have been amazed to see the large gathering of dignified of- ficials and physicians braving the April winds of rural Pennsylvania to remem- ber his name. He did not court imortal- lity. From the colorful bits and pieces of his personal history which remain, it seems he was a “taciturn,” reclusive fig-
• Denotes PMS membership at time of death. Oliver E. Mattas Sr., Altoona Jefferson Medical College. 1930; age 85. died April 14. 1990. Dr. Mattas was a urologist. •
Carl B. Myers, Bridgeville Jefferson Medical College, 1953; age 63, died May 14, 1990. Dr. Myers was a family practi- tioner. •
Harry M. Persing Jr., Altoona University of Pennsylvania School of Medicine, 19.34; age 80, died April 29, 1990. Dr. Persing was an ophthalmologist. •
Edward Shubert, Erie
State University of New York at Buffalo School of Medicine, 1939; age 84, died May 18, 1990. Dr. Shubert was an anesthesiologist. •
John J. Snyder, Harrisburg University of Pennsylvania School of Medicine, 1939; age 75, died May 13, 1990. Dr. Snyder was a family practitioner. •
Morris W. Stroud 111, West Chester University of Pennsylvania School of Medicine, 1939; age 76, died April 30, 1990. Dr. Stroud spe- cialized in preventive medicine. •
Earl R. Widter, Milroy
Temple University School of Medicine, 1952; age 72, died April 4, 1990. Dr. Walter was a general practitioner. •
Kenneth R. Weston, Breinigsville Hahnemann University School of Medicine, 1931; age 85, died May 12, 1990. Dr. Weston was an orthopedic surgeon. •
Alfred A. Grilli, Pittsburgh Philadelphia College of Osteopathic Medicine, 1948; age 67, died May 7, 1990. Dr. Grilli was a surgeon.
Mary C. McCormick Jayashekaramurthy,
Philadelphia
Medical College of Pennsylvania, 1960; age 55, died April 15, 1990, Dr. Jayashekaramurthy was a pathologist.
Charles W. Schertz, Pittsburgh Boston University School of Medicine, 1978; age 36, died March 27, 1990. Dr. Schertz was an an- esthesiologist.
CORRECTION
An error occiu'rcd in an obituary on page 52 of the June, 1990 issue of Penn- .sylvania Medicine. Dr. Benjamin A. Gross of Philadelphia practices der- matology in that city. The deceased Dr. Benjamin Gross, of Cherry Hill, New Jersey, died on April 8, 1990.
38
PENNSYLVANIA MEDICINE • JULY 1990
ure, who settled in the wilderness of western Pennsylvania not solely to ex- tend medical services into the frontier, but also to escape a mysterious past.
A Scottish nobleman?
County histories written some 60 years after Colemans 1819 death say, “Of his early history nothing is known.” They record only that he was born in Scotland in 1772, emigrated to America and in 1805 became the second doctor to settle in Willicunsport. Rumor had it that he was “the son of an English nobleman, who, for some reason, did not acknowl- edge his paternity, but who provided the means to ensure him a superior educa- tion and maintenance.” People said he never spoke of his birth place or parent- age.
He acquired “considerable reputation” as a physician in Williamsport, where he practiced for several years. While they thought him eccentric, local folk remem- bered he had a “wcU'm heart.”
But he was quick to leave that com- munity when a friend offered him 300 acres amidst a 40,000-acre wilderness tract in the still-unsettle Pennsylvania frontier. The owners’s only condition for the property was that he relocate there. “Not liking the practice of medicine,” lo- cal history says, Dr. Coleman poled a keel boat up river, landing at McClure, two and a half miles above Curwens- ville. He and his company cut a four- mile road through the wilderness to his acreage, and built a rough log hut cov- ered with chestnut bark. He called his new home Grampian Hills, after his na- tive Scottish highlands. Scotland must have seemed far away: like other early pioneers, he used tin cups for drinking and wood chips for plates, cleaning the plates by hewing them off with an ax.
Dr. Coleman set about the hard labor of clearing and working his lands, living alone except for, the record shows, the company of several slaves. Whether be- cause of frontier stoicism or Dr. Cole- man’s peculiar character, he tended sur- rounding settler’s sicknesses “only when his services were deemed indispens- able,” travelling his 70-mile wide prac- tice territory by horseback.
While making his rounds, he at first
found some of the local settlers a bit rough-hewn for his taste: “In the earlier part of his career, he was never known to use profane language and invariably reproved the use of it by others.”
He never took a wife, living a solitary rural life, “indisposed to take anyone into his confidence.” Others put their confidence in him, however, as he served as the second treasurer of Clear- field County. Eventually, the husband and wife who had first asked him to move into the area took up residence with him and cared for his estate, which he willed to them upon his death.
He died on his farm at the early age of 40, cause unrecorded. He asked to be buried “in the middle of a large field, habited in his best suit of clothes, includ- ing hat, boots and spurs, without a stone to mark his resting place and where the
plow might ever after move over his re- mains.” His last wishes were granted. His grave is on a farmland hilltop, inaccessi- ble to the general public.
While language and culture have changed, sentiments have not. Apprecia- tion for Dr. Coleman’s contributions were expressed at the 1887 dedication of the original monument to Dr. Cole- man by Davis A. Hogue, MD, of Altoona, in a poem: “These modest doctors, then excuse/Much on them may depend, /If they should court their latent muse/Old Homer’s fame would end./ We’ve met today to honor one, /physician, pioneer;/who though, alas, his race has run,/His memory we revere.” At the 1990 re-dedication, Betty Cottle, MD, PMS Sixth District trustee, said simply, “His first goal was to render service to his fellow man.”
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Obituaries remind
HOW FLEETING IS TIME
I couldn’t help thinking when 1 read the Obituaries in the May 1990 Penn- sylvania Medicine, (I’m old enough that I read it carefully) “How fleeting time is!”
My old friend Cyrus B. Stease had died. Cy had been a trustee from the Ninth District and chairman of the society’s board of trustees. How well I remember his wisdom and patience in trying times.
Could we somehow give him an extra special note or two someplace? He deserves it.
Donald E. Harrop, MD
Dr. Harrop, a past president of PMS. is presi- dent of the Keystone Peer Review Organiza- tion. The managing editor notes other deaths of leaders in medicine in the first half of 1990 included Drs. Harold G. Scheie, Samuel B. Hadden, and William J. Erdman. It is regret- ted that time and space considerations permit only the brief notices of deaths now pub- lished, even though their lives were those of
giants.
Society president
WRITES ON MEDICARE
In response to a letter from Senator John Heinz, I took the opportunity to share these thoughts with him on the pro- posed Medicare budget cuts.
Dear Senator Heinz:
We share your concerns over the cuts in the Part B area; nevertheless, we real- ize the difficult task before the Finance Committee. We hope that the following comments will be helpful in your delib- erations and carefully considered.
Federal health policy has zig-zagged the past few years. Solutions offered have proved to be problems. The reim- bursement system is a shambles; over- regulation is rampant. Physicians are
40
confused, angry, and distrustful of the federal government’s continued at- tempts to cut the reimbursement system even though the (RBRVS) Resource Based Relative Value Scale is on the hori- zon.
To many physicians the Medicare sys- tem has become an adversary. Conse- quently, Medicare beneficiaries are af- fected. For example, some doctors have given up nursing home visits because of Medicare prohibitions on care. Also, the intensity of hospital services has in- creased because the PRO mechanism is unforgiving with respect to readmissions and has induced physicians to change in- hospital practice.
The following comments on the pro- posed cuts reflect the position of physi- cians in Pennsylvania.
• Freeze the customary and prevailing charge updates for non-primary care services.
Comments: PMS can support an in- crease in the Medical Economic Index for all physicians as intended in the Medicare Law. Physicians will not sup- port any freeze that singles out physi- cians. The Society believes that physi- cians in Pennsylvania are at the point where they will change their practice behavior because of inadequate pay- ment for services and increased “hassle factor.”
• Reduce physician payments for over- valued procedures.
Comments: The Society has serious reservations about the OBRA 89 reduc- tions and questions who determined what procedures were overvalued and what methods were used to determine values. Organized medicine has sup- ported the implementation of a fee schedule based on RBRVS. There should be a moratorium on any further reduc- tions until this has had a chance to func- tion.
• Reduce physician payments for over- valued localities.
Comments: The proposals for reduc- tion of physician payments for overval- ued localities are not reasonable. This history of payment reductions was one of the reasons for Congressional support for the implementation of the RBRVS system. Additional cuts, especially with RBRVS implementation in the near fu- ture, would be arbitrary and short- sighted. These cuts eliminate the re- sources that would be available to provide for increased reimbursement for undervalued services and undervalued geographic areas.
• Reduce radiology and anesthesiology
PENNSYLVANIA MEDICINE • JULY 1990
fees.
Comments: The Society believes that payments for these services are best de- termined through RBRVS. We further note that there is significant difference in anesthesia care provided by an anesthe- siologist and an anesthetist, and strongly oppose basing payment for this care at a single rate.
• Reduce surgical global fees.
Comments: While some abuses may
occur in the use of surgical assistants, the proposal would jeopardize the quality of care that a Medicare beneficiary may re- ceive. This is especially important with procedures requiring more than one physician, including team procedures and operations when multiple proce- dures are being performed. Current law prohibits reimbursement for an assistant in a teaching hospital when a resident is available, and mandates prior approval for an assistant at cataract surgery and other selected procedures. This proposal seeks to eliminate reimbursement in most cases for medically necessary assis- tance. Furthermore, a reduction in surgi- cal global reimbursements at this time is inconsistent with the transition to RBRVS.
• Expand and make permanent the phase-in of fee increases for new physi- cians.
Comments: The Society’s position is that physicians’ fees should be the same for physicians fully qualified to perform treatment and there should not be a two- tiered payment system. We continue to believe that in an indemnity system schedules should not differentiate based on years in practice. This proposal also discriminates against young physicians whose costs and educational debt load are substantially higher than those of other physicians.
• Reduce the amount paid for radiology and diagnostic tests.
Comments: The use of caps and me- dian national charges to establish pay- ment levels is inappropriate as no con- sideration is given to the actual cost of providing the services in various locali- ties. The Pennsylvania Radiological Soci- ety believes that radiologists already have taken a larger share of cuts than other specialists. Additionally, because of comparability in Pennsylvania, radiol- ogists received a 15 percent cut which is significantly greater than the 3 percent proposed under law. Medicare provi- sions do not address self-referral. It should be pointed out that 38 percent of all outpatient imaging procedures are being done by non-radiologists. There
must be some control in this area. The specicilty society recommends a support- ive role to decrease utilization and sup- port appropriate utilization of high tech- nology. Because radiologists do not order procedures, cutting the fees is not a deterrent. Standards of care being de- veloped by the specialty address this is- sue.
• Reduce payments for clinical labora- tory services.
Comments: The use of the national “median” to establish payment levels in areas of high labor and other costs is in- equitable. The payment level would be adjusted downward automatically with no consideration of the actual cost of providing the tests.
• Provide prior authorization authority to carriers.
Comments: This proposal would result in duplication of effort in that the Peer Review Organization now carries out prior authorization. Giving such au- thority to the CcU"rier, which in most cir- cumstances lacks medical expertise, would result in increased administrative burden, duplicative effort, and an addi- tional layer of review by untrained per- sonnel. So far, data show that the prior authorization program has picked up only a few procedures that lacked criter- ia for surgery at the time of submission of the request. The data demonstrate that physicians are doing an excellent job in screening and that the “unneces- sary surgery” tag is vastly overstated.
• Permit a hospital to advertise itself as a “Medicare participating physician medi- cal staff hospital. ”
Comments: Permitting hospitals to advertise in this fashion will create a strong incentive for the hospital to pres- sure the medical staff to do something they choose not to do, thereby disrupt- ing the harmonious working relationship necessary for high quality care. The Medicare participating physician pro- gram would be more offensive under this proposal than it is currently in that all physicians in the respective special- ties would be required to abide by the decision of the majority to “participate.” Participating doctors are actually penal- ized financially by the MediccU"e system. If an3dhing, the reverse should be true.
Thank you for the opportunity to com- ment.
J. Joseph Danyo, MD
The writer of the letter to Senator Heinz is president of the Pennsylvania Medical Society and an orthopedic surgeon in York.
Physician payment
UNDER MEDICARE
This statement responds to a call for public testimony on proposed cuts in Medicare spending. Others have cor- rectly testified that spending cuts of the size proposed will severely threaten the workability of the relative value study program which Congress enacted last year, even before it is tested. These com- ments, however, are directed toward some broader aspects of the cost- reduction process.
Dividing the Cuts Between Medicare A and Medicare B. There had been gen- eral anticipation that Medicare cuts would be apportioned between the two segments of the program in rough rela- tion to their size. However, comments from the chair dwelt on the idea that Medicare A had increased only .4 per- cent while Pcu-t B spending increased 8 percent— with the implication that per- haps hospitals should be treated more generously to reward abstemious behav- ior, while physicians deserve to be
treated more harshly because of profli- gacy. Alternative interpretations are cer- tainly possible, including the possibility that the compressibility of a program is related to the amount of water it con- tains.
Dr. Gail Wilensky, new as head of the Health Care Financing Administration, might be asked to check out a remark recently made by HCFAs Philadelphia regional administrator. Payments to hos- pitals by the program are now more than 50 percent based on cost- reimbursement. Most people are sur- prised to learn this, since there is general misconception that hospitals are entirely paid by the DRG prospective pricing methodology. A mixed methodology permits no one to conclude safely that the incentives of the DRG system are de- terminative of spending results. A mixed methodology creates a powerful incen- tive to shift costs to the cost-plus half of it, while extracting profits from the pro- spective prices. Not only is this likely to occur in the attribution of indirect over- head, but shifting also occurs in the in- gredients of the health care process. Tests and procedures formerly thought
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normal within the hospitalization are in- creasingly performed pre- and post- hos- pitalization, thereby making the DRG payment more profitable, and shifting the program attribution from Part A to Part B. It would be a supreme irony to discover from future HCFA data (now lagging several years behind) that a sub- stantial portion of the 8 percent increase in Part B is attributable to hospitals rather than physicians. Allowing a pro- gram as large as this one to run so far ahead of its data analysis is cause for great dismay.
The Source of Volume Increases. The primitive state of HCFA data analysis permits assertions to be voiced without fear of quick contradiction. It does seem to make mathematical sense that total program costs could only rise because of rising volume of items, since prices of items have been frozen for several years. To the extent new procedures make up the postulated volume incre- ment, almost no one would wish to con- strain them, since new “miracle” treat- ments have typically overcome strenuous efforts of the Food and Drug Administration or peer reviewed jour- nals to evaluate them. As such, they have survived the most rigorous out- comes analysis. Obsolete treatments should, of course, be eliminated forth- with, but it is unrealistic to suppose that obsolete procedures are increasing 8 percent a year. Therefore, Congress must face the uncomfortable idea of sub- stantially reducing the volume of estab- lished, traditional, procedures and prac- tices. Neither the patients nor the practitioners are likely to treat this idea warmly.
Physicians have not provoked volume increases— Congress has provoked vol- ume increases, by relentless attrition of deductibles, copayments and balance billing. All of the foregoing introduce volume restraints through patient finan- cial participation in the cost of care. Re- cent Congressional cost-escalating activ- ity has centered on coerced assignment of claims, where it is easy to demon- strate a statistical relation between volume-increase and elimination of bal- ance billing. After all, it makes little dif-
ference whether the patient pays $75 as a deductible, or pays $75 as a balance- bill. If the president and Congress wish to reduce the government cost of Medi- care, as distinguished from merely wish- ing to make budgetary expenditure cuts, a rise in the deductibles is long overdue and mandatory assignment is highly counter-productive. Limiting the Medi- care pain to the patient-participation ap- proach for a single year would have the salutory effect of establishing a clear demonstration of the effectiveness of pa- tient co-payment as a volume restraint. And meanwhile it could achieve the nec- essary budget-balancing without under- mining the RVS system before it starts.
Administrative Reform. Recent events in central and eastern Europe have dem- onstrated how futile it is to run massive enterprises with centralized micro- management. As regulation fails, it esca- lates to tyranny; tyranny then destroys the enterprise. Proposals like the recent one from the Institute of Medicine to add $600 million to the PRO program, which evoked sympathetic echoes at the hear- ing, are difficult to relate to the subject of cost cutting.
Having said that, there are still a num- ber of available ways of reducing the very large administrative costs of the control apparatus to be found in the last few Omnibus Reconciliation Acts. Elec- tronic claims processing, electronic funds flow, cross-over billing, piggy- backing of claims are merely a few ex- amples of techniques presently available but untried as the fiscal intermediaries contend with mountains of paper. The development of a computerized claim process which includes physicians within the electronic environment would have far more beneficial effect than merely reducing everyone’s admin- istrative costs. If physicians, for what- ever reason, buy and learn to use com- puters the subsequent scientific spill-over would position this committee as a ma- jor contributor to better and more abun- dant high quality medical care.
Reversing Financial Disincentives for Preventative Medicine. No one at the hearing mentioned the possibility that national investment in preventive medi- cine or promotion of more healthful pub- lic lifestyles might have long-term bene- fit for the federal budget. Perhaps that was an oversight, or perhaps there is enough general sophistication to recog- nize that federal programs presently cre- ate a strong disincentive for such an ap- proach. If people live longer, it is necessary to make Social Security pay-
ments for a longer period. If they re- cover from one illness, they inevitably live on to develop another one at Medi- care expense. What we have here is a monstrous incentive system, which amounts to presenting Congress with the dilemma of bankrupting the govern- ment whenever it seeks to improve pub- lic health.
The most facile way of reversing this disincentive is to substitute a prefunded system for the present pay-as-you-go ap- proach. That is to say, the power of com- pound interest accumulation could pro- vide revenue, increasing with increased longevity, to match the heightened ex- penditures which likewise adhere to lon- gevity improvement. Senator Moynihan has alerted everyone to some problems inherent in “overfunding” a pay-as-you- go system, which 1 will not address be- yond observing that devolving the sys- tems to private IRAs would seem a readily available remedy. Practical solu- tions to pre-funding complexities will likely emerge quickly once the urgent need is acknowledged.
Summary. This letter supports ideas which others introduced into the hear- ing: (1) The HCFA data system does not permit the conclusions which have been based on it, particularly that some physi- cians deserve harsher budget cuts than the rest of the system; (2) Disruption of the RVS system so soon would be counter-productive; and (3) Administra- tive streamlining of the program is badly needed.
The main thrust of this testimony is that line-item budget cuts, whether tar- geted or across-the-board, are not the best way to save money in the Medicare program. (4) Rather, a serious reapplica- tion of patient financial restaints (whether deductibles, copayments or balance-billing) should be attempted. (5) The payment system should actually re- ceive an investment to enlarge the com- puter environment to include physicians’ offices, for reduced cost in future years. (6) The funding system should be redi- rected so the power of compound inter- est can take advantage of improved lon- gevity, rather than putting Congress in the present deplorable position of con- demning longevity because it costs so much.
George Ross Fisher, MD
Dr. Fisher, an internist who practices in Philadelphia, is trustee representing the First
District and a member of the Pennsylvania
Delegation to the AMA. He is the author of
the book, "The Hospital that Ate Chicago."
42 PENNSYLVANIA MEDICINE • JULY 1990
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TRANSFORMING
AIDSPEAK
INTO AIDSENSE
I
■ HE NATURAL COURSE OF INFECTIONS
George J. Pazin, MD
Except for an understanding of transmis- sion or acquisition of human immunode- ficiency virus (HIV), knowledge of the natural history of HIV infections offers the greatest appreciation for the signifi- cance of being infected. With an over- view of the natural course of HIV infec- tion, observers have a foundation on which to build knowledge of this most important infection.
In general, the natural course of infec- tion with HIV can be divided into four parts: 1) acquisition of tbe virus, 2) initial infection, 3) subclinical asymptomatic in- fection and 4) symptomatic disease. The latter is manifested as mild to moderate constitutional signs or symptoms re- ferred to as AIDS-related complex (ARC) or clinically more significant disease which meets the criteria of acquired im- munodeficiency syndrome (AIDS).
Acquisition
The acquisition phase of HIV infection was discussed in greater detail in install- ments four through eight of this series. In installment four, I pointed out that ac- quisition of infection with HIV involves 1) susceptibility of the uninfected person— basically always present, 2) ex- posure to the virus— necessary for infec- tion, but not sufficient for infection in it- self and 3) inoculation of the virus into the body or onto a mucosal membrane— accomplished by risky be- haviors such as unprotected sexual inti- macy, needlesharing, and the like. Since 1 wrote the fourth installment, 1 have
added an additional component to my transmission-acquisition concept. The fourth element is attachment to a viral receptor which in the case of HIV is a structure on the cell membrane of, helper lymphocytes called the CD4 re- ceptor.
Why bother to add the element of at- tachment to the CD4 receptor to my transmission-acquisition concept? Be- cause the requirement for attachment to a CD4 receptor— which seems to be present only on a limited number of cells in the body, e.g. CD4 lymphocytes, mac- rophages, monocytes, tissue macro- phages (langerhans cells), central ner- vous system glial cells and supposedly eosinophils— helps explain the low con- tagiousness of HIV Since the number of cells containing CD4 receptors on the surface is limited, the requirement for at- tachment to a CD4 receptor makes ac- quisition of HIV infection a somewhat chance occurrence; in fact, a relatively low probability event, but one which is very serious and dangerous if it occurs. I emphasize that, rather than a break in the skin or a lesion on a mucosal mem- brane, attachment to a receptor which has limited availability is the reason spread of HIV is a low probability, rela- tively inefficient process— thank good- ness.
It is fortunate that transmission or ac- quisition of HIV are relatively low proba- bility events. But it is important to ac-
knowledge and emphasize that spread
Acquisition
Susceptibility (everyone, anytime)
Exposure to human
immunodeficiency
LOW
virus (HIV)
probability,
+
but 1
Innoculation into
HIGHLY '
body via risky
dangerous
behaviors
-1-
Attachment to CD4 receptors
event
Contagiousness :
44
PENNSYLVANIA MEDICINE • JULY 1990
|Df HIV is a chance event that is “all-or- aone” and “only takes once.”
Infection
Assuming that a susceptible person— and we’re all susceptible— has been exposed to HIV; the risky behavior has led to the virus being inoculated into the person; cind the virus has by chance attached to a CD4 receptor, then a “TAKE” has oc- cured and the person has been infected. The first phase of the infection process is totcdly inapparent. The virus is taken into the cell where it is uncoated. The genetic material from the virus is then reverse copied into DNA, genetic mate- rial which is randomly incorporated or “integrated” into the DNA or genetic ma- terial of the infected cell of the newly- infected person. Once the viral-coded DNA has been integrated into the cellu- lar DNA, the cell, and in turn the person, becomes infected for life.
Some portion, about 50-85 percent, of HIV-infected persons, will experience a non-specific viral syndrome about 2-3 weeks after the infection is acquired. By this I mean that the newly infected per- son may develop fever, myalgias (mus- cle aches), malaise (a tired “sick” feeling), lymphadenopathy (swollen lymph glands) and perhaps a rash or diarrhea. This non-specific viral syndrome sub- sides naturally in 3-6 weeks. Although some newly infected persons experience the non-specific viral syndrome, which seems like many other viral illnesses.
many newly infected persons do not re- call a viral syndrome. Thus, the newly acquired lifelong infection may be to- tally inapparent. All HIV-infected per- sons remain infectious to intimate con- tacts and needlesharing contacts throughout their lives.
Usually within six weeks to three months of acquisition of infection with Hiy the newly infected person will de- velop antibodies to HIV A few persons may require up to six months or more to develop antibodies to HIV but this is the exception rather than the rule. A pcU'tic- ularly astute physician can use the devel- opment of antibodies to HIV to differen- tiate infection with HIV from other non-specific viral syndromes. Note that development of antibodies does not oc- cur in response to mere exposure to HIV but requires infection. Of course, the HIV-infected person continues to be po- tentially infectious to intimate contacts and needlesharing contacts.
Subclinical phase
After the initial infection occurs, which may be inapparent, unrecognized or manifested as a non-specific viral syn- drome, and antibodies have developed, the infection naturally enters a subclini- cal phase in which the HIV-infected per- son shows no signs or symptoms of in- fection, i.e. is asymptomatic. The HIV-infected asymptomatic person con- tinues to show HIV present in peripheral blood mononuclear cells circulating in
the blood, as well as in the plasma. Therefore, despite seeming well from a clinical standpoint, the HIV-infected per- son must be considered infectious to inti- mate or needlesharing contacts.
Duration of this subclinical asympto- matic phase varies from person to per- son. The most frequent question asked by HIV-infected persons is, “Will 1 de- velop AIDS and how long will it take?” My best answer to this critical question is: Nothing much happens for 1-2 years, then about 6 percent of HIV-infected per- sons progress on to AIDS each year thereafter.
Common sense says that the HIV- infected persons should maintain sensi- ble health measures such as a balanced diet, adequate exercise, rest, and reason- able stress reduction, but the benefits of these reasonable health measure should not be exaggerated lest HIV-infected per- sons blame themselves if their infection progresses to a symptomatic phase. Now that early intervention therapy during the subclinical asymptomatic phase has been demonstrated to delay progression to symptomatic phases, (reduces pro- gression by approximately 50 percent and in turn delays progression for about 6-7 months) it is recommended that CD4 lymphocyte counts be obtained pe- riodically as a guide to when zidovudine (formerly known as AZT) should be insti- tuted. Early intervention therapy will be discussed in detail in subsequent install- ments of this series.
THE NATURAL COURSE OF HIV INFECTION
Infection
Inapparent
Subclinical
1-2% progression
Disease
Constitutional
“TAKE”
or
CD4 decreases
signs & symptoms
Unrecognized
over 2 years then
1 00 per year
Latent
or
Asymptomatic
(50-200/year)
“Opportunistic”
integrated
Non-specific
4-6% progression
infections and/or
“provirus”
viral syndrome
tumors
stage
(at 2-3 weeks,
per year thereafter
detected by
for 2-6 weeks)
Direct viral
Wasting
PCR
Development of
Infection
ZDV delays
injury
Neurological disease
antibodies to HIV at 6-12 weeks,
progression
Saroreversion
Latent “provirus”
rarely 6 mo. ±
(1 per 250)
stage (PCR +)
? +/-?
+ HIV in blood cells and plasma
-*-+++++
-1-+++++
Progression to AIDS
At least two processes are occurring dur- ing the asymptomatic subclinical phase which account for eventual progression to AIDS. One mechanism of progression to AIDS is a gradual, progressive decline in the number of CD4 lymphocytes, which are central players in the cell- mediated immune system. When the function of the cell-mediated immune system declines sufficiently, certain in- ternal infections which had been under control reactivate. These cause the “op- portunistic” infections which character- ize AIDS. Tumors, under the circum- stances also considered “opportunistic,” may also develop.
The second mechanism of disease pro- duction during the asymtomatic phase is a more direct injury seemingly due to the human immunodeficiency virus it- self.
The last phase of HIV infection is com- posed of the constitutional signs and symptoms which we call AIDS-related complex (ARC), or the opportunistic in- fections and tumors, wasting or neuro- logical disease which we call AIDS. It must be emphasized that a formal diag- nosis of AIDS is not an immediate death sentence. Whereas previously the life- span after diagnosis of AIDS was often 1-2 yecirs, improved management of op- portunistic infections has resulted in a modest, but limited, improvement in prognosis.
The figure also refers to the observa- tion that one HIV-infected person per 250— actually four in 1,000 asymptoma- tic infected persons— have reverted to negativity on blood testing. Although these four men also had negative cul- tures for HIV they remained positive for
latent “provirus” on polymerase chain reaction (PCR) testing. The eventual out- come for these rare persons is uncertain at this time.
In summary, the natural course of in- fection with HIV consists of acquisition, which is the result of susceptibility of the person; exposure to the virus; inocula- tion into the body via risky behavior; and chance attachment to a cell having the CD4 receptor. Once infection has oc- curred, the virus remains in the body for the remainder of the infected person’s life. After a transient, non-specific, viral- like syndrome, the infection enters an I asymptomatic subclinical phase during | which the cell-mediated immune system is damaged, or the virus injures the cen- i tral nervous system, or causes striking , weight loss called wasting. Despite treat- I ment, the disease seems invariably to i lead to the person’s eventual demise, i While the course of the infection is gen- j erally slow, from a couple to 1 0 or more ! years, that is a relatively short timespan ' when dealing with young adults. ‘
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46
PENNSYLVANIA MEDICINE • JULY 1990
Axm
nizatidine
Because safety
cannot be taken for granted
in H2-antagonist therapy
Minimal potential for drug interactions
Unlike cimetidine and ranitidine,^ Axid does not inhibit the cytochrome P-450 metabolizing enzyme system.^
Swift and effective H2-antagonist therapy
■ Most patients experience pain relief with the first dose^
■ Heals duodena! ulcer rapidly and effectively^^
■ Dosage for adults with active duodena! ulcer is 300 mg once nightly (150 mg b.i.d. is also available)
References
7. USP D! Update. September/ October 1988. p 120.
2. Br J dm Pharmacol 1985:20:710-713.
3. Data on file. Lilly Research Laboratories.
4. Scand J Gastroenterol 1987:22(supp! 1361:61-70.
5. Am J Gastroenterol 1 989:84:769-774.
AXID®
nizatidine capsules
Brief Summary. Consult the package literature for complete information.
Indications and Usage: 1./lc0Ve duodena/ u/cer-for up to eight weeks ot treatment Most patients heal within lour weeks.
2. Maintenance therapy -tor heaied duodenal ulcer patients at a reduced dosage ot 150 mg h.s. The consequences ot therapy with /txid tor longer than one year are not known.
Contraindication: Known hypersensitivity to the drug. Use with caution in patients with hypersensitivity to other H2-receptor antagonists. Precautions: General- 1. Symptomatic response to nizatidine therapy does not preclude the presence ot gastric malignancy.
2. Dosage should be reduced in patients with moderate to severe renal insufficiency.
3. In patients with normal renal tunction and uncomplicated hepatic dysfunction, the disposition of nizabdine is similar to that in normal subjects.
Laboratory Tests-False-positive tests for urobilinogen with Multistix® may occur during therapy.
Drug Interactions -tio interacbons have been observed with theophyl- line, chlordiazepoxide, lorazepam, lidocaine, phenytoin, and warfarin. Ttxid does not inhibit the cytochrome P-450 enzyme system; therefore, drug interactions mediated by inhibition of hepabc metabolism are not expected to occur. In pabents given very high rioses (3,900 mg) of aspirin daily, increased serum salicylate levels were seen when nizabdine, 150 mg b.i.d., was administered concurrently.
Carcinogenesis, Mutagenesis, Impairment of Fertility -It two-year oral carcinogenicity study in rats with doses as high as 500 mg/kg/day (about 80 times the recommended daily therapeutic dose) showed no evidence ot a carcinogenic effect There was a dose-related increase in bre density of enterochromaffin-like (ECL) cells in the gastric oxynbc mucosa. In a two-year study in mice, there was no evidence of a carcinogenic effect in male mice, although hyperplasbc nodules of the liver were increased in the high-dose males as compared with placebo. Female mice given the high dose of Axid (2,000 mg/kg/day, about 330 times the human dose) showed marginally statistically signiticant increases in hepabc carcinoma and hepatic nodular hyperplasia with no numerical increase seen in any of the other dose groups. The rate ot hepatic carcinoma in the high-dose animals was within the historical conbol limits seen for the strain ot mice used. The female mice were given a dose larger than the maximum tolerated dose, as indicated by excessive (30%) weight decrement as compared with concurrent conbols and evidence of mild liver injury (transaminase elevations). The oaurrence of a marginal finding at high dose only in animals given Axid* (nizabdine, Lilly)
an excessive and somewhat hepatotoxic dose, with no evidence ot a carcinogenic ebect in rats, male mice, and female mice (given up to 360 mg/kg/day, about 60 times the human dose), and a negative mutagenicity battery are not considered evidence of a carcinogenic potential tor Axid.
/txid was not mutagenic in a battery of tests performed to evaluate its potenbal genebc toxicity, including bacterial mutation tests, unscheduled DNA synthesis, sister chromatid exchange, mouse lymphoma assay, chromosome aberration tests, and a micronucleus test
In a two-generation, perinatal and postnatal ferblity study in rats, doses of nizabdine up to 650 mg/kg/day produced no adverse effects on the reproducbve performance of parental animals or their progeny.
Pregnancy-Teratogenic Efiects- Pregnancy Category C-Oral repro- ducbon studies in rats at doses up to 300 times the human dose and in Dutch Belted rabbits at doses up to 55 bmes the human dose revealed no evidence ot impaired fertility or teratogenic effect but, at a dose equivalent to 300 times the human dose, heated rabbits had abortions, decreased number of live fetuses, and depressed fetal weights. On intra- venous adminisbation to pregnant New Zealand White rabbits, nizabdine at 20 mg/kg produced cardiac enlargement coarctabon of the aorbc arch, and cutaneous edema in one fetus, and at 50 mg/kg, it produced ventricular anomaly, distended abdomen, spina bifida, hydrocephaly, and enlarged heart in one fetus. There are, however, no adequate and well-conbolled studies in pregnant women, it is also not known whether nizatidine can cause fetal harm when administered to a pregnant woman or can affect reproducbon capacity. Nizabdine should be used during pregnancy only if the potential benefit justifies the potential risk to the tebJS.
Nursing Mothers -Studies in lactating women have shown that 0.1% of an oral dose is secreted in human milk in proporbon to plasma concentrabons. Because of growth depression in pups reared by beated lactating rats, a decision should be made whebrer to discontinue nursing or the drug, taking into account the importance of the drug to ffie mother.
Pediatric t/se-Satety and eftecbveness in children have not been established.
Use in Bderly Patients-Heaiing rates in elderly pabents were similar to those in younger age groups as were the rates of adverse evenfs and laboratory test abnormalibes. Age alone may not be an important factor in the disposition of nizatidine. Elderly patients may have reduced renal tuncbon.
Adverse Reactions: Clinical trials of varying durabons included almost 5,000 pabents. Among ffie more common adverse events in domesbc placebo-conbolled bials of over 1,900 nizabdine patients and over 1,300 on placebo, sweabng (1% vs 0.2%), urbcaria (0.5% vs <0.01%), and somnolence (2.4% vs 1.3%) were significantly more common with nizabdine. It was not possible to determine whether a vahety of less common evenfs was due to ffie drug.
/txid® (nizabdine. Lilly)
//epa(/e- Hepatocellular injury (elevated liver enzyme tests or alkaline phosphatase) possibly or probably related to nizatidine occurred in some pabents. In some cases, there was marked elevabon (>500 lU/L) in SCOT or SGPT and, in a single instance, SGPT was >2,000 lU/L. The incidence of elevated liver enzymes overall and elevabons of up to three bmes ffie upper limit of normal, however, did not significanby diber from thaf in placebo patients. Hepatitis and jaundice have been reported. All abnormairties were reversible after discontinuabon of Axid.
Cardiovascular -in clinical pharmacology sfudies, short episodes of asymptomatic ventricular tachycardia occurred in two individuals administered Axid and in three unbeated subjects.
CA/S-Rare cases of reversible mental confusion have been reported.
Endocrine-Ctmical pharmacology studies and conbolled clinical bials showed no evidence of aniiandrogenic activity due to nizatidine. Impotence and decreased libido were reported with equal frequency by patients on nizatidine and those on placebo. GynecomasUa has been reported rarely.
Hematologic-Fatai thrombocytopenia was reported in a patient beated with nizatidine and another H2-receptor anffigonisL This pabent had previously experienced thrombocydopenia while taking other drugs. Rare cases of thrombocytopenic purpura have been reported.
Integumental -Sweating and urticaria were reported significantly more bequenby in nizatidine- bran in placebo-beated pabents Rash and extoliabve dermatibs were also reported.
Hypersensitivity -As wiffi other H,-receptor antagonists, rare cases of anaphylaxis following nizatidine administration have been reported. Because cross-sensitivity among this class has been observed, Hj-receptor antagonists should not be administered to ffiose with a history of hyper- sensibvity fo these agents. Rare episodes of hypersensibvity reacbons (eg, bronchospasm, laryngeal edema, rash, and eosinophilia) have been reported.
0//rer-Hyperuricemia unassociated wiffi gout or nephrolithiasis was reported. Eosinophilia, (ever, and nausea related to nizabdine have been reported.
Overdosage: Overdoses of Axid have been reported rarely. If overdosage occurs, acbvated charcoal, emesis, or lavage should be considered along wiffi clinical monitoring and supportive therapy. Renal dialysis (or four to six hours increased plasma clearance by approximately 84%.
PV 2098 AMP [091289]
Addibonal intormabon available to the profession on request Eli Lilly and Company Indianapolis, Indiana 46285
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Axid® (nizabdine, Lilly)
PHYSICIANS WANTED Emergency physician — Full-time oppor- tunities in the PA, NY, and NJ area. Must be experienced. Board eligibility and ACLS certification preferred. Salary range $80,000 plus malpractice insurance and benefits. Part-time positions also available. Send CV to AES, Inc., Box 2510, Wilkes- Barre, PA 18703; or call (717) 825-2500 col- lect.
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, Philadel- phia, PA 19113.
Family practice opportunities — Muncy Valley Hospital is seeking four individuals to establish practices in surrounding rural communities. Competitive, flexible financial
assistance opportunities available. If inter- ested, call George J. Geib, (717) 546-8282.
Pennsylvania, western. 400-bed teach- ing hospital designated Level II Trauma Center seeking career emergency physi- cian, preferably board certified/prepared in emergency medicine. Sophisticated emer- gency care with nearly 30,000 visits per year, resident teaching and a busy hospital- based paramedic program. Excellent com- pensation for qualified physician. 70 miles east of Pittsburgh. Call or send CV to Rich- ard M. McDowell, MD, FACEP, Department of Emergency Medicine, Conemaugh Valley Memorial Hospital, Johnstown, PA 15905, (814) 533-9769.
General/Vascular surgeon — BE/BC, im- mediate opening in prestigious private prac- tice, rapid growth opportunity in north cen- tral Pennsylvania. Send CV to Box 323, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.
Board Certified FP seeking BC/BE FP
or IM to join busy practice in a growing uni- versity town in central Pennsylvania. Excel- lent opportunity-competitive salary-no OB. Inquiries to Lewisburg Family Practice, 55 N. 5th St., Lewisburg, PA 17837.
Wanted: Family practice specialist or Board-eligible to join four-person group in south-central Pennsylvania. No obstetrics. Salary negotiable. Write Box 296, Pennsyl-
vania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.
Camp physicians — Camp CHEN-A- WANDA, fine northeast Pennsylvania co-ed sleepaway camp. One or two weeks avail- able in August. Excellent living accomoda- tions for physician and family. Combine va- cation with little work. Three RNs on duty. Call (717) 756-2016.
Radiologist — Full or P/T for out-patient imaging center, suburbs of Phila. CT experi- ence necessary. MRI experience desirable. Call Judy Weiss (215) 752-8080.
Emergency medicine positions avail- able — Suburban Philadelphia emergency department group seeking emergency de- partment physician for open position and also locum tenens for summer of ’90. Can- didate must be BC/BP in emergency medi- cine, internal medicine or surgery, and certi- fied in ACLS/ATLS. Contact John D. Gorry, MD, FACEP, Chairman, Department of Emergency Medicine, Crozer-Chester Med- ical Center, 15th and Upland Ave., Chester, PA 19013, (215) 874-8177.
Williamsport — Solo psychiatrist with ac- tive general practice really needs an associ- ate. Two hospitals with psychiatric units. The city is located in a peaceful rural area
EMERGENCY DEPARTMENT PHYSICIAN
JEANES HOSPITAL, a 218-bed suburban community general hospital, has immediate opening for a career-oriented Emergency Physician to complement a small stable group. Our modern facility handles 18,000 vis- its per year. Applicant must be PA licensed. ACLS, ATLS and have previous Emergency Dept, experience. Viable candidate should be board certified in emergency medicine, fam- ily medicine, internal medicineorsurgery. We offer competitive compensation and benefits package including malpractice. Send CV to, or contact:
Karen Sharrar, MD Chairperson
Dept, of Emergency Medicine
JEANES HOSPITAL
7600 Central Ave. Phila., PA 19111 (215) 728-2170
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
JPHYSICIAN )
Emergency Medicine
FIRSTCARE Medical Treatment Center is a quality service of the Capital Health System. At our Seidle Memorial Hospital location, we need the services of a board-eligible or certified Physician on the 3-llpm shift.
Candidates should have experience in Emergency Medicine, Family Medicine or Internal Medicine.
To pursue this full-time position offering a salary commensurate with experience and generous benefits, please send c.v. noting salary requirements in complete confidence to: Kenneth Cardlin, M.D., Medical Director — FIRSTCARE, SEIDLE MEMORIAL HOSPITAL,
132 S. Filbert St., Mechanicsburg, PA 17055.
Extensive Care.
Intensive Pride.
GAPHAL.
48
PENNSYLVANIA MEDICINE • JULY 1990
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
Dermatology
Coastal New Jersey
$600,000
Family Practice
Northern Delaware
$200,000
Family Practice
Central PA
$190,000
Internal Medicine
Northern Jersey
$375,000
OB/GYN
New Jersey
$300,000
Ophthalmology
West Texas
$400,000
Ophthalmology
Philadelphia
$1,000,000
Ophthalmology
Michigan
$800,000
Ophthalmology
New York City
$450,000
Ophthalmology
Florida
$450,000
Radiology
South Jersey
$850,000
For additional Information, please contact: Ed Strogen, FULTON, LONGSHORE & ASSOCIATES, INC., 527 Plymouth Rd., Suite 410, Plymouth Meeting, PA 19462 (215) 834-6780, (800) 346-8397.
Ed Strogen
Fulton, Longshore & Associates 527 Plymouth Road, Suite 410 Plymouth Meeting, PA 19462 (215) 834-6780
SUPERIOR OFFICE EQUIPMENT
For The Medical Profession
Hill Adjustable Exam Table
from $2085
CLINTON cabinets
CLINTON Epic $965 P.T equipment
INTERSTAT
P.O. Box 135
Malvern, PA 19355 U.S.A. (215) 644-3742
GET MORE FOR YOUR RESIDENCY.
Become an Air Force sponsored resident and remain in your training program while you enjoy the pay and benefits of an Air Force officer. Then serve two years as an Air Force physician or spe- cialist...enjoying a great start without the financial/administrative burden of start- ing a practice. Find out how to qualify for Air Force residency. Call
USAF Health Professions 1-800-423-USAF
with 100,000 population served. Hunting, fishing, water sports. Excellent public schools and churches. Terms of association negotiable. Please give me a call (collect) (717) 323-4677. Dr. Williams.
Pocono Mountains, NE Pennsylvania —
Extremely busy family practice seeking BC/ BE FP. Active hospital practice, peds but no OB. Good terms, excellent opportunity for potential partnership. Beautiful recreational area with close proximity to cultural events. Please respond to: Monroe Family Practice Associates, 1803 W. Main St., Stroudsburg, PA 18360, (717) 421-0170.
Northeastern Pennsylvania — Multispe- cialty group practice is seeking BC/BE phy- sicians with background in: Family practice, family practice with obstetrics, gynecology — office and surgical, anesthesi- ology, urology, non-invasive cardiology. We are located in a beautiful rural area of Penn- sylvania that has recently experienced an industrial buildup and community growth. Send CV to Box 335, Pennsylvania Medi- cine, 777 East Park Dr., P.O. Box 8820, Har- risburg, PA 17105-8820.
Philadelphia, PA area — Part-time or full- time position available for FP or IM in mod- ern urgicare center. Excellent salary w/ in- centive bonus plus benefit package. Reply Box 336, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.
Internist — BE/BC needed to join 5- physician internal medicine group in Carlisle — south central Pennsylvania, with ready access to Washington, Baltimore and Philadelphia. College town with excellent schools; good place to raise family. Com- petitive salary with complete benefit pack- age and opportunity for partnership. Send CV to Box 338, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.
Position avaiiable — Full-time associate/ assistant faculty director wanted for active fully accredited 5-5-5 residency program with full residency compliment. Position available July 1, 1990. Salary negotiable. Benefits. CV required. Respond to: Robin Staebler, MD, Saint Joseph Hospital, Fam- ily Practice Residency Program, 200 N. 13th St., Ste. 100, Reading, PA 19604; (215) 378-2080.
Emergency medicine — Career ER phy- sician wanted to join stable 8-physician 19- year-old group. Require BE/BC, ACLS certi-
so
fication, and U.S. graduate. Full service, modern 370-bed hospital and ER. All medi- cal specialties, family practice residency, and paramedic training school. Treating 46,000 plus patients per year. Fee for ser- vice with minimum guarantee and generous benefit package. Excellent housing and schools in the heart of Pennsylvania wilder- ness recreation land. Contact: J.G. English, MD, 777 Rural Ave., Williamsport, PA 17701. (717) 321-2000.
OB/GYN New York — 32-member multi- specialty group in Long Island, New York, adding third member to its department of obstetrics and gynecology. First year, 6- figure salary, four weeks vacation, other benefits. Call Wanda Parker, Senior Associ- ate, E.G. Todd Associates, Inc., 535 Fifth Ave., Suite 1100, New York, NY 10017. Toll Free (800) 221-4762. Collect (212) 599- 6200.
Beaver, Pennsylvania — Seeking direc- tor, assistant director, full-time and part-time emergency physicians for 475-bed Level II facility. Double and triple coverage provided during peak periods. Outstanding compen- sation and paid malpractice insurance. Ben- efits available to full-time staff. Board eligi- bility or certification in emergency medicine or primary care specialty, and ACLS re- quired. Contact: Karen Remai, Emergency Consultants, Inc., 2240 S. Airport Rd., Room 27, Traverse City, Ml 49684; 1-800- 253-1795 or in Michigan 1-800-632-3496.
Ohio — Emergency physician $50-$65 per hour. ACLS certification required. ATLS pre- ferred. Primary care experience a plus. Ex- cellent medical staff backup for major medical/surgical emergencies. Moderate volume ER. Double coverage during peak periods. Benefits include four weeks vaca- tion, incentive bonus during the 1st year, paid malpractice and an incentive plan. Contact: Emergency Consultants, Inc., 2240 S. Airport Rd., Room 27, Traverse City, Ml 49684; 1-800-253-1795 or in Michi- gan 1-800-632-3496.
Pediatrician — Nonprofit, ambulatory, community health center seeks a pediatri- cian with a commitment to serving under- privileged communities. Applicants must be board eligible or board certified. Send re- sume to: Personnel Department, Charter Oak Terrace/Rice Heights Health Center, 81 Overlook Terrace, Hartford, CT 06106. EOE.
Medical Director — Nonprofit, ambula- tory, community health center seeks an ex- perienced primary care physician with a commitment to serving underprivileged communities. Family practice and internal medicine specialists are preferred. Appli- cants must be board eligible or board certi- fied, and possess strong management and organizational skills. Send resume to: Per- sonnel Department, Charter Oak Terrace/
PENNSYLVANIA MEDICINE • JULY 1990
Rice Heights Health Center, 81 Overlook Terrace, Hartford, CT 06106. EOE.
Physiatrist — Established part-time prac-] tice with excellent growth potential in' hospital-owned corporate medicine/' rehabilitation/fitness facility in major metro- 1 politan area. Active occupational/industrial ^ referral program with in-house physical ' therapy and rehabilitation departments. Board certified or eligible required. Send CV to Box 339, Pennsylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, i PA 17105-8820.
Medical Director — Full-time appointment for Board Certified internist or family prac- tice physician able to lead an established corporate medicine program through growth phase. Responsibilities include re- fining and oversight of expanding employee • wellness/fitness programs, physical therapy and corporate health accounts. Practice lo- cated in the heart of corporate Pittsburgh. Send CV in confidence to Box 340, Penn- sylvania Medicine, 777 East Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820.
Ob/Gyn — Established multi-specialty medical group providing care to a pre-paid and growing fee-for-service patient base seeks BC/BE ob/gyn physicians for Phila- delphia office. Teaching opportunities and faculty appointments available. Excellent salary, benefits, and paid malpractice. Send CV to Betty Goldberg, Suite 300, 9600 Roosevelt Blvd., Philadelphia, PA 19115.
Family practitioner-opportunity — Ex- panding northeast Ohio multi-specialty j group has an opportunity for a family practi- 1 tioner. The Ashtabula Clinic offers good ■ compensation and earning potential within the professional and financial support of a multi-specialty group. The Ashtabula area, located on the shores of Lake Erie, com- bines the advantage of a small town, with easy access to the major metropolitan cen- ters of Cleveland and Erie, PA. For addi- tional information call or write: Ashtabula j Clinic, Inc., 430 W. 25th St., Ashtabula, OH ], 44004 ATTN: Jim Graeca, Administrator; ( (216) 992-4422. i
Emergency medicine — Elkins Park, PA. Two staff physicians needed in full service community hospital. Annual ED volume: 13,000. Spectrum offers a competitive reim- bursement fee, occurrence malpractice in- j surance, CME allowance and relocation as- sistance. Contact Jean McGinty, Spectrum Emergency Care, Inc., P.O. Box 27352, St. j Louis, MO 63141, 1-800-325-3982, ext. j 3017.
Internal medicine group looking for { new associate. Five man group looking for 6th partner. Serving two local hospitals with new office building. Non-invasive cardiology , a plus. Potential for by-in. Send CV to: ' MRA, 205 E. Laurel Blvd., Pottsville, PA ■ 17901. I
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
Join four full-time Board Certified EM physicians in our 120-bed community hos- pital located 30 minutes south of Pittsburgh, PA. Applicant must be Residency Trained or Board Certified emergency medicine. Dept, is exceptionally well equipped, progressive and has a volume of 21,000 acute patient visits per year, all of whom are treated by the emergency physicians. 12 hour shifts with 8 hour double coverage. All emergency physicians are Board certified or Residency trained emergency medicine. Attractive compensation. Contact K. David Mosienko, MD, FACER Director, Canonsburg General Hospital, Route 519, Canonsburg, PA 15317. (412) 745-3077 or (412) 941-2895.
POSITIONS WANTED
Seeking position in gastroenterology/ internal medicine. Available now. Board cer- tified in internal medicine. Board eligible in gastroenterology. British and U.S. trained. Licensed in Pennsylvania. Contact S. P. Na- than, South Baltimore General Hospital, 3001 S. Hanover Street, Baltimore, MD 21230. (301) 355-5502.
Board prepared emergency physician
recently relocated in Scranton. ATLS and ACLS instructor certified. Available for part- time/full-time ER or urgent care position. Call (717) 344-4439.
Bertholon Rowland Agencies 5 Capital Health System 48 Cutter Biological 21 Dodson Insurance Group 51 Eli Lilly Company 47 Fulton, Longshore & Associates 49 Graduate Health System 41 ICN Pharmaceuticals 29 Interstat 49 Jeanes Hospital 48 Jefferson Surgery Center 13 Medical Directors Advancements Council 39
Medical Personnel Pool 19
Medical Protective Co. 43
NYU Post Graduate Medical School— 25
52
MiSCELLANEOUS
Professionai office suite in northeast Philadelphia. Private entrance, located in apartment bldg. One block from shopping and transportation. Will renovate to suit ten- ant. Call (201) 944-8700 or (215) 744-8271.
Medicai transcribing services available from Durborow Transcribing Services, 6035 Devonshire Rd., Harrisburg, PA 17112. Transcription by cassette and phone avail- able. For information call (717) 652-5091.
Very iucrative Cherry Hili practice (inter- nal and family medicine) available. Send confidential CV to Box 318, Pennsylvania Medicine, 777 East Park Dr., PO. Box 8820, Harrisburg, PA 17105-8820.
Practice wanted — Experienced family physician 15 years in practice, wants to buy general/family medicine practice in Chester, Montgomery, Philadelphia, Delaware, or Lancaster counties. Please call (215) 495- 5414.
Physicians — Urgent mobile insurance ex- ams. Highest $$$ pay. F/T, P/T, IM, FP, GP. (215) 563-3970.
Pieasant country practice in rural com- munity in south central PA. Spacious new building with lower level rented to radiology, physical therapy, and orthopedics. Reason- able on call schedule with other solo practi- tioners. An abundance of new equipment. Lease/buy options available. Send inquiry to Box 337, Pennsylvania Medicine, 777 East Park Dr., PO. Box 8820, Harrisburg, PA 17105-8820.
For saie — GE x-ray unit DXR single phase with Konica QX-60A processor set. Good
Orion Systems 23 Palisades Pharmaceuticals 23 Pennsylvania Blue Shield 26-27 Physician Support Systems 11 Physicians' Health Programs 12 Physicians Insurance Co. 15 PMS Liability Insurance Company 3 Roche Laboratories Covers 3, 4 Rocky Mountain Safaris 25 Shadyside Hospital 22 Shared Medical Systems 17 Specialized Computer Systems 37 St. Christopher’s Hospital 1 U.S. Air Force 49 U.S. Army Reserve 46 Wasserott’s 7
PENNSYLVANIA MEDICINE • JULY 1990
working condition. Call (717) 646-1616, PO. Box 219, Route 940, Blakeslee, PA 18610.j
For sale — Kodak Ektachem DT 60 Ana- lyzer $3,000. Nova Gelltrak Hematology An- alyzer (RBC, Hct, HGB, MCV, WBC) $3,000 or $5,500 for both. Used one year. Originally' purchased for $10,500. Please call (215) 495-5414 Phoenixville, PA.
Practice available — Family practice available in Aliquippa, Beaver County, Lo- cated 15 minutes from Pittsburgh Airport and 25 minutes from downtown Pittsburgh. Practice has been in same location for 34 years, very active and constantly obtaining new patients. Close to two hospitals in Ali- quippa and Beaver, practice includes two adjacent lots, building and 1 1/2 stall ga- rage. Average gross income for past three years is over 250K. Contact: Harold D. Thomas, Jr., MD, 2113 Irwin St., Aliquippa, PA 15001. i
One story modern brick medical office buiiding — Prime northeast Philadelphia location. 8,000 sq. ft. with parking; space available immediately; good income from existing tenants; perfect for group; present owners (internist/radiologist) will remain as tenants if desirable. No money needed. Contact: HAY Investment Co. (215) 742- 4740.
Lab eiectroiytes — Beckman E4A ma- chine, sodium, potassium, C02, chloride, complete with rapid kit, currently in use. Best offer accepted call (717) 346-5228.
For saie — Laboratory equipment. Abbott Vision chemistry analyzer and Coulter CBC- 5 hematology analyzer. Excellent condition. Call (717) 455-7677.
Toshiba Uitrasound for sale, including: 5 MHZ Abdominal Probe, Transrectal Probe for Prostatic Ultrasound, camera for record- ing, 9" T.V. monitor with cables, V.C.R., and mobile unit. Price $12,000. Please call (215) 259-3434.
Classified Advertising
Rates: $30 per insertion ($25 for PMS mem- bers) for the first 30 words or part thereof; 80 cents for each additional word; $5 per in- sertion 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 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 num- bers forbid disclosure of their identity. Writ- ten inquiries are forwarded to such adver- tisers, but no information can be revealed by the publisher.
Word Count: Count as one word all single words, two initials of a name, single num- bers or groups of numbers, hyphenated words, and abbreviations.
For the brain/bowel conflict of IBS*
specify Adjunctive
i}
t>A..
specify
Adjunctive
Antianxiety
Antisecretoiy
Antispasmodic
Each capsule contains 5 mg chlordiazepoxide HCl and 2.5 mg cUdinium bromide.
Please consult complete prescribing information, a summary of which follows:
*
Indications: Based on a review of this drug by the National Academy of Sciences— National Research Council and/or other information, FDA has classified the indications as follows: "Possibly” effective: as adjunctive therapy in the treatment of peptic ulcer and in the treatment of the irritable bowel S5m- drome (irritable colon, spastic colon, mucous colitis) and acute enterocolitis.
Final classification of the less-than-effective indications requires further investigation.
Contraindications: Glaucoma; prostatic hypertrophy, benign bladder neck obstruction; hypersensitivity to chlordiazepoxide HCl and/or clidinium Br.
Warnings: Caution patients about possible combined effects with alcohol and other CNS depressants, and against hazardous occu- pations requiring complete mental alertness (e.g., operating machinery, driving).
Usage in Pregnancy: Use of minor tranquilizers during first trimester should almost always be avoided because of increased risk of congenital malformations as sug- gested in several studies. Consider possibility of preg- nancy when instituting therapy. Advise patients to discuss therapy if they intend to or do become pregnant.
As with aU anticholinergics, inhibition of lactation may occur. Withdrawal symptoms of the barbiturate type have occurred after discontinuation of benzodiazepines (see Drug Abuse and Dependence).
Precautions: In elderly and debilitated, limit dosage to smallest effective amount to preclude ataxia, oversedation, confusion (no more than 2 capsules/day initially; increase gradually as needed and tolerated). Though generally not recommended, if combination therapy with other psychotropics seems indicated, carefully con- sider pharmacology of agents, particularly potentiating drugs such
as MAO inhibitors, phenothiazines. Observe usual precautions in presence of impaired renal or hepatic function. Paradoxical reac- tions reported in psychiatric patients. Employ usual precautions in treating anxiety states with evidence of impending depression; suicidal tendencies may be present and protective measures nec- essary. Variable effects on blood coagulation reported very rarely in patients receiving the drug and oral anticoagulants; causal rela- tionship not established. Inform patients to consult physician before increasing dose or abruptly discontinuing this drug. Adverse Reactions: No side effects or manifestations not seen with either compound alone reported with Librax. When chlordi- azepoxide HCl is used alone, drowsiness, ataxia, confusion may occur, especially in elderly and debilitated; avoidable in most cases by proper dosage adjustment, but also occasionally observed at lower dosage ranges. Syncope reported in a few instances. Also encountered: isolated instances of skin eruptions, edema, minor menstrual irregularities, nausea and constipation, extrapyramidal symptoms, increased and decreased libido— all infrequent, gener- ally controlled with dosage reduction; changes in EEG patterns may appear during and after treatment; blood dyscrasias (includ- ing agranulocytosis), jaundice, hepatic dysfunction reported occa- sionally with clilordiazepoxide HCl, making periodic blood counts and fiver function tests advisable during protracted therapy. Adverse effects reported vwth Librax typical of anticholinergic agents, i.e., dr5mess of mouth, blurring of vision, urinary hesitancy, constipation. Constipation has occurred most often when Librax therapy is combined with other spasmolytics and/or low residue diets.
Drug Abuse and Dependence: Withdrawal symptoms similar to those noted with barbiturates and alcohol have occurred following abrupt discontinuance of chlordiazepoxide; more severe seen after excessive doses over extended periods; milder after taking contin- uously at therapeutic levels for several months. After extended therapy, avoid abrupt discontinuation and taper dosage. Carefully supervise addiction-prone individuals because of predisposition to habituation and dependence.
P.l. 0288
Roche Products Roche Products Inc.
Manati, Puerto Rico 00701
PA
1
In IBS,* when it's brain versus bowel,
Tb insist on the brand, be siire to write "Brand Necessary" or "Brand Medically Necessary" on your prescription.
ITS TIME FOR THE
In irritable bowel syndrome,* intestinal discomfort will often erupt in tandem with anxiety— launching a cycle of brain/bowel conflict. Make peace with Librax. Because of possible CNS effects, caution patients about activities requiring complete mental alertness.
* Librax has been evaluated as possibly effective as adjunctive therapy in the treatment of peptic ulcer and IBS.
Specify Adjunctive
Each capsule contains 5 mg chlordiazepox ide HCl and 2.5 mg clidinium bromide.
Copyright © 1990 by Roche Products Inc. All rights reserved.
Please see summary of prescribing information on adjacent page.
Journals
W1
PE
385K
Pennsylvania Medicine UCSF LIBRARY Received on: 09-10-90
AUGUST 1990 VOLUME 93, NUMBER 8
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Pennsylvania
Medicine
J^EMBERSHIP
DIRECTORY
1990-91
Boating on Blue Marsh Lake, Berks County
Photography by Blair Seitz®, Harrisburg
Take a break from your routine. Learn to jump out of an airplane in airborne school. Survive Field Survival Training with a Special Forces unit. Or put your skills and endurance to the test in a Combat Casualty Care Course.
The Army Preserve can take you abroad. And to the forefront of medicine, where you’ll experience the kinds of training and education
environments that only the Reserve can offer.
Your commitment? Sixteen hours a month. Fourteen days a year. Less, in some cases, should your civilian practice demand it.
Find out more about how we operate. And in exchange for your skills, live the adventure of your life.
Call L800-USA-ARMYext.431 today.
ARMY RESERVE MEDICINE. BE ALLYOU CAN BE
PENNLine
Physician to physician
Toll-free.
1-800-635-7780
When it’s a ® tough call, we’re on the line
PENNLine
Today, communication among physi- cians is as essential as the dialogue between doctor and patient.
Now, one toll-free call gives physicians access to consultations with Penn physi- cians. Plus, PENNLine provides access to the latest research, clinical findings and protocols for patient management.
So, when it’s a tough call, we’re on the line.
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(In Philadelphia, 349-5958)
UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER
PENNSYLVANIA MEDICINE
AUGUST 1990
PENNSYLVANIA MEDICINE
111 East Park Drive RO. Box 8820 Harrisburg, PA 17105-8820 Telephone (717) 558-7750 Fax (717) 558-7830
PUBUCATION COMMITTEE
Frederick G. Brown, MD, Chairman, Danville George Ross Fisher, MD, Philadelphia John W. Mills, MD, Indiana Steven F. Nemerson, Hershey Ferdinand L. Soisson Jr., MD, Johnstown
STAFF
Frederick G. Brown, MD, Medical Editor Mary L. Uehlein, Managing Editor Elaine S. Herrmann, Assistant Managing Editor
Gordon V Hamilton, Advertising Representative
Lon Rusinko, Advertising Assistant
PENNSYLVANIA MEDICINE, established in 1897, is the official publication of the Pennsylvania Medical Society. All editorial and advertising correspondence should be directed to the Managing Editor.
All material subject to this copyright may be photocopied only for noncommercial scientific 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 advertise copy furnished; and hereby agree to indemnify 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.
PENNSYLVANIA MEDICINE (ISSN 0031-4595) Is published monthly by the Pennsylvania Medical Society, 111 East Park Drive, Harrisburg, PA 17111.
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, 111 East Park Drive, PO. Box 8820, Harrisburg, PA 17105-8820. Second class postage paid at Harrisburg, PA 17105.
® 1990: Pennsylvania Medical Society.
T
ABLE
OF CONTENTS
CALL TO MEETING
18 Official Call — 1990 House of Delegates
MEDICAL SOCIETY OFFICERS
34 Pennsylvania Medical Society 36 County Medical Societies 46 Medical Specialty Societies
HEALTH CARE INFORMATION
52 Washington Information 54 Pennsylvania Health Agencies
MEMBERSHIP DIRECTORY 1990-91
69 Member Specialty Codes and Statistics 71 Membership by County 173 Membership Alphabetically
DEPARTMENTS
52 Advertisers Index 62 Classified Advertising
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2
PENNSYLVANIA MEDICINE * AUGUST 1990
Dr. Sarah Long weighs the difference between the old and the new St Christopher’s Hospital for Children.
“Twenty years ago, I began my medi- cal career as an intern at St. Christopher’s. Today, I am Chief of the Infectious Diseases Section at St. Chris- topher’s. Life has changed.
“And St. Chris- topher’s has changed. We’ve just moved to Erie Avenue at Front Street near North- east Philadelphia. Back when I did my residency at St. Christopher’s, we were practicing 20th century medicine and doing it weU.
Now, at the new St. Christopher’s, we’re offering the latest in leading edge medi- cine, in a facility that win carry us weU into the 21st century.
“Our state-of- the-art hospital now has 183 beds, with bright and spacious private or semi- private rooms with private baths. Our Intensive Care, Car- diac, Neonatal, Bum and Special Care Units
have expanded, and more operating suites have been added.
“Now our spe- cial kind of care can be extended to more children, with more convenience to their families. Our new location is very acces- sible to Route 1 and 1-95, making it easy for family and friends to visit and offer their support. Our rooms have been designed to allow parents to spend the night beside their children. Being a parent myself, I know how important it is to be close to your children when they are iQ.
“There’s a place for history. At the ‘old’ St. Christo- pher’s, we were living it. At the ‘new’ St. Christopher’s, we’re making it. The differ- ence is like apples and oranges.”
^SrCHRISIDPHEirS
HOSPITAL FOR CHILDREN
Erie Avenue at Front Street Philadelphia, PA 19134 215-427-5000
GEISINGER CLINIC
1990-1991 Continuing Education Programs
Advanced Trauma Life Support Provider Course (ATLS)
Friday & Saturday, September 7 & 8, 1990
Basic Life Support Instructor Course
Tuesday, September 18, 1990 Hotel Magee, Bloomsburg
Cardiology in the 90’s
Wednesday, September 19, 1990
7th Annual Neuro-Ophthalmology Seminar
Wednesday, September 26, 1990 Danville Days Inn
Rehabilitation of the Trauma Patient
Friday, September 28, 1990
Poison Update
Wednesday, October 3, 1990
Advanced Cardiac Life Support Instructor Course
Friday & Saturday, October 5 & 6, 1990
Diabetes Update: 1990
Wednesday, October 10, 1990 Danville Days Inn
4th Annual Horizons in Cardiac Rehabilitation
Friday, October 12, 1990
Advanced Cardiac Life Support Provider Course
Friday, Saturday, Sunday, October 19-21, 1990
Advanced Cardiac Life Support Recertification Course
Saturday, November 3, 1990
Pediatric Update: Advances in Medical and Surgical Management of Children with Chronic Diseases
Thursday, November 8, 1990 Mountain Laurel Resort, White Haven, PA
Advanced Trauma Life Support Provider Course
Friday & Saturday, November 9 & 10, 1990
Update in Rheumatology
Wednesday, November 14, 1990
Pediatric Advanced Life Support Provider Course
Thursday & Friday, November 15 & 16, or November 29 & 30, 1990
Advanced Trauma Life Support Instructor Course
Friday, Saturday & Sunday, December 7-9, 1990
Advanced Trauma Life Support Provider Course (ATLS)
Friday & Saturday, January 11 & 12, 1991
Winter Update in Gastroenterology
Tuesday, Wednesday, Thursday, January 22-24, 1991 Seven Springs Resort, Champion
Advanced Cardiac Life Support Instructor Course
Friday & Saturday, February 1 & 2, 1991
16th Annual Concepts in Clinical Practice
Saturday & Sunday, February 9 & 10, 1991 Location to be announced
Advanced Cardiac Life Support Provider Course
Friday, Saturday, Sunday, February 22-24, 1991
Emergency Medicine Update
Wednesday, February 27, 1991
Contemporary Issues in Internal Medicine
Wednesday, March 6, 1991
Advanced Traumas Life Support Provider Course (ATLS)
Friday & Saturday, March 8 & 9, 1991
ENT for the Family Practitioner
Wednesday, March 13, 1991
Advanced Cardiac Life Support Recertification Course
Saturday, March 16, 1991
Family Practice Update: ’91
Wednesday, March 20, 1991
Dermatology Update
Wednesday, April 3, 1991
Pediatric Advanced Life Support Provider Course
Thursday & Friday, April 4 & 5, or April 18 & 19, 1991
Acute & Chronic Lung Infections: Diagnosis & Management
Wednesday, April 10, 1991
Symposium in Obstetrics & Gynecology
Wednesday, April 17, 1991
Neuro-Imaging Update
Saturday, April 20, 1991 Danville Days Inn
Impotence: Evaluation & Treatment Options
Wednesday, April 24, 1991
6th Annual Sight Loss Support Group Meeting
Wednesday, May 1, 1991 Danville Days Inn
Ischemic Hypertension & Renal Failure: Current Concepts
Wednesday, May 8, 1991
5th Annual Symposium in Clinical Medicine
Tuesday-Friday, June 18-21, 1991 Hilton Head Island, South Carolina
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.
Geisinger
As an organization accredited by the Pennsylvania Medical Society for its continuing medical education program, the Geisinger Clinic designated these activities as meeting the criteria for Category I credit for the American Medical Association’s Physician’s Recognition Award and the Pennsylvania Medicbl 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.
EXECU-FLOW SYSTEMS, INC.
We could tell you how great we are, but wouldn’t you rather hear it from one of your associates?
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Alfred J. Mauriello II, M.D., F.A.C.S., P.C.
E.N.T., Head & Neck, Facial Plastic Surgery Exton, Pennsylvania
"Excalihur ® Softwwe has greatly reduced the time and effort needed to gather statistics on patient activity, insurances, and procedures. It has given us the ability to generate valuable data and at the same time make things easier for our staff.”
James F. Robertson, M.D., Cardiologist Abington Medical Specialists Abington, Pennsylvania
"While we have been happy with all aspects of our conversion (softw’are, hardware, training, etc.) the one single thing that sets Execu-Flow apart from the others, is their training program and support systems. I can not imagine how we ever managed to survive without you. "
Steven M. LaPorte, M.D., F.A.C.C., P.C.
Primary and Interventional Cardiology
Paoli, Pennsylvania
We are proud to have achieved our leadership position in Practice Management Systems in the tri- state area. Before you begin your search for a reputable computer vendor, talk to us. We can provide you with many other local references, or better yet. . .talk to one of your colleagues.
WE OFFER A 6 MONTH MONEY BACK GUARANTEE For more information call:
(201) 287-9191 Edison, NJ - Corporate Headquarters (215) 941-6667 Plymouth Meeting, PA - Branch Office
The Persmality Disimkr Tieatment Program of Sheppard Pratt Hospital
Very often, specialized inpatient evaluation and treatment is a critical step in the effective care of a borderline patient.
The Personality Disorder Treatment Program at Sheppard Pratt offers a combination of services that may help to untangle difficult clinical ques- tions and facilitate your patient’s continued outpatient treatment.
We offer:
□ Short-term and intermediate-term specialized inpatient treatment
□ Extended-term intensive inpatient treatment
□ Comprehensive diagnostic evaluation
□ Psychotherapy and psychopharmacology consultation
□ Intensive individual and group psychotherapy provided by our staff of psychiatrists and psychologists
□ Long-term treatment planning
If you would like to know more about the Sheppard Pratt approach to the borderline patient and other patients with severe personality disorders, contact the Adult Admissions Office at:
(301)938-3800
feOl North Charles Street 07 J ^
Baltimore, Maryland 21285-5815 ^oheppard rTatt
•L A not for- profit health system
The FHC Pennsj^ania Network.
BO
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ong recognized as a leader in the field of psychiatric and chemical dependency treatment, First Hospital Corporation operates 17 treatment facilities across the country and in the Caribbean, and delivers a standard of care second to none.
In Pennsylvania, the FHC Pennsylvania Network offers individuals and health care providers an entire network of treatment resources. Specialized programs for chil- dren, adolescents, adults, and older adults are available at all levels of care, from out- patient to residential treatment.
In addition to this wide range of services, FHC offers multi-disciplinary treatment methods, which combine the talents and techniques of psychiatrists, psychologists, social workers, and clini- cians. And, with over 15 inpatient and outpatient treatment centers throughout Pennsylvania, the FHC Pennsylvania Network makes quality care accessible from anywhere in the state.
For psychiatric problems and substance abuse, take the effective, comprehensive approach. The FHC Pennsylvania Network.
FHC Penn^lvania Network
Clarion Psychiatric Center, Clarion, (814) 226-9545 • First Hospital Wyoming Valley, Wilkes-Barre, (717) 829-7900 Hickory Ridge Chemical Dependency ^rvices, Bridgeville, (412) 221-3444 • The Horsham Clinic, (215) 643-7800
The Meadows Psychiatric Center, Centre Hall, (814) 364-2161 • Roxbury Treatment Center, Shippensburg, (717) 532-4217
Southwood Psychiatric Hospital, Pittsburgh, (412) 257-2290
PHILADELPHIA HEART INSTITUTE
Presbyterian Medical Center
39th and Market Streets Philadelphia, PA 19104
FIRST ANNUAL SYMPOSIUM
Cardiovascular Disease
State-Of-The-Art 1990
12-13 October 1990 The Rittenhouse Hotel Philadelphia, Pennsylvania
This two-day symposium is designed to give the physician with a busy clinical practice the opportunity to review the field with experts renowned for their contributions to the field. Presentations will focus on the most recent advances in the medical, non-surgical and surgical management of coronary and valvular heart diseases and in the use of state-of-the-art diagnostic procedures.
Course Director, Ami E. Iskandrian, M.D.
Highlights of the Symposium include:
V The Unstable Plaque: Medical Therapy and PTCA
V Expanding Application of Nuclear Cardiology
V New Techniques of Non-Surgical Revascularization
V Left Ventricular Remodelling after Acute Myocardial Infarction
V Optimal Use of Quantitative Doppler Echocardiography The Risk-Benefit Dilemma of Antiarrhythmic Therapy
Co-Sponsored by
The Southeastern Pennsylvania
Affiliate of
The American Heart Association
■ 44 CME Credits
■ Reservations Limited to 200
■ Contact; Ms. Deborah Wal (215) 662-9084
''When lam looking for an institution for the referral of my patients, I look for high quality care, rapid response to my referral request, open communications, and timely reports. That is exactly what I get from Hershey Medical Center.”
Jose R. Acosta, M.D., F.C.C.R Pulmonologist & Critical Care Specialist
"We are workir^ hard to build personal relationships with our referring physicians and to provide them with not only quality patient care, but also service they can depend on.”
David M. Leaman, M.D. Chief, Division of Cardiology
nnState
College of Medicine • University Hospital The Milton S. Hershey Medical Center
August
25
September
14
October 6 - 7
18
November
16
29
December 7- <5
January
24
February
21
March
21
April
25
June 7- 8
28 - 30
23 - 28
27 - 28
For Information
PROGRAM OF CONTINUING EDUCATION UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE Schedule of Courses 1990-1991
FALL - 1990
Menopause: New Insights into Management
Stouffer Harborplace Hotel, Baltimore, Maryland
Current Concepts in Ophthalmology: 10th Annual Clinical Conference
Columbia Inn, Columbia, Maryland
6th Annual Contact Lens Symposium
Stouffer Harborplace Hotel, Baltimore, Maryland
Dean’s Conference Number 1
University of Maryland at Baltimore Campus, Baltimore, Maryland
Sudden Infant Death Syndrome: Progress, Puzzles and Possibilities
Columbia Inn, Columbia, Maryland
Dean’s Conference Number 2: Clinical Medicine for the Community Physician
Cambridge, Maryland
Cancer in the Socioeconomically Disadvantaged: Models for Intervention
Stouffer Harborplace Hotel, Baltimore, Maryland
SPRING - 1991 Conference Number 3
University of Maryland at Baltimore, Baltimore, Maryland
Conference Number 4
University of Maryland at Baltimore, Baltimore, Maryland
Conference Number 5
University of Maryland at Baltimore, Baltimore, Maryland
Conference Number 6: Clinical Medicine for the Community Physician
Hagerstown, Maryland
Current Practical Concepts in Endocrinology & Metabolism
Harbor Court Hotel, Baltimore, Maryland
Dermatology Days
Carousel Hotel, Ocean City, Maryland
17th Annual Family Medicine Review Course
Carousel Hotel, Ocean City, Maryland
10th Annual Update in Obstetrics and Gynecology
Annapolis, Maryland
Contact: Program of Continuing Eklucation, University of Maryland School of Medicine, Room 14-011,
655 W. Baltimore Street, Baltimore, Maryland 21201. 301/328-3956
Dean ’s Dean ’s Dean ’s Dean ’s
Check our fine print.
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You don’t need to look deep to find out what sets PMSLIC apart from our competitors in the professional liability field. It’s clear on page 1 of our annual financial statement, filed with the state Insurance Department.
Our chief distinction: Physician control.
At PMSLIC, key decisions are made not by hide- bound managers . . . not by profit-motivated investors . . . but by dedicated, practicing physicians. Their leadership and direct participation on our Board and committees guarantee that the medical perspective
dominates in our underwriting and rating decisions, risk management initiatives, and claims handling processes.
The result is a company that cares— about your views, your needs, and the long-term health of medical practice in Pennsylvania.
Can your liability carrier make that claim? If not, call PMSLIC, toll-free, at 1-800-445-1212.
We’ll send you some “fine print” you’ll be glad to read.
TAH-LVHC Qp REGIONAL#
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1
■ 91-11 February 9,1991
Second Annual Dermatology Symposium
■ 91-12 February 16, 1991
Psychiatric Symposium
■ 91-01 September 14-15, 1990
Pain Management in the 90s — The Science, The Art, The Program
■ 91-02 September 21, 1990
Third Annual Coagulation Symposium
■ 91-03 September 26, 1990
Third Annual Seminar for Nurses: New Beats in Cardiology
■ 91-04 October 25, 1990
Management of Perinatal Emergencies
■ 91-13 March 9, 1991
Second Annual Symposium in Infectious Diseases
■ 91-14 March 23, 1991
Second Annual Digestive Sciences Symposium: Update on Hepatitis
■ 91-15 April 11, 1991
Pediatric Symposium
■ 91-16 April 19-20, 1991
Sixth Annual Post Graduate Course in Obstetrics and Gynecology
■ 91-05 November 1-2, 1990
Standards for the 90s — Update for Healthcare Protection
■ 91-06 November 17, 1990
The Diabetic Foot
■ 91-07 December 1, 1990
Critical Care Symposium
■ 91-08 December 15, 1990
Assessing Male Fertility
■ 91-09 January 12, 1991
Uses and Limitations of Imaging: CT, MRl, Ultrasound, Radionuclides
■ 91-10 January 26, 1991
Osteoporosis
■ 91-17 May 2, 1991
Eleventh Annual Update in Cardiology
■ 91-18 May 11, 1991
Second Annual Day in Geriatrics
■ 91-19 June 8, 1991
Contemporary Diagnosis and Management of Hypertension
■ 91-20 June 15, 1991
Update in Pulmonary Medicine
The Allentown Hospital—
Lehigh Valley Hospital Center
A HLMlIhl ,|SI
215-776-8322
Name
Address
Telephone ( )
Please send me information on the following symf)osia; (indicate by number)
Please return request to:
Human Resource Development
The Allentown Hospital — Lehigh Valley Hospital Center 1200 S. Cedar Crest Blvd.
P.O. Box 689 Allentown, Pa 18105
Information will be sent approximately two months prior to each symposium. It will contain starting time, registration fee, location, number of credit hours, and types of credit.
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ou’re on solid ground with the Dodson Plan.
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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!
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People Helping People...Our goal is to provide your society members with competitive and comprehensive insurance programs.
Your society has sponsored our agency and insurance products because our research and insurance design provide excellent values for you as Membership Benefits. Whether you have your own independent insurance agent or company representative, we know your society plans are worth your inquiry.
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Bertholon-Rowland
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Box 77 201 Caste Center
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The 1990 annual meeting of the House of Delegates of the Pennsylvania Medi- cal Society will be called to order at the Hershey Lodge and Convention Center, Hershey, Pennsylvania, on Friday, Octo- ber 19, at 10:00 a.m. The second session of the House of Delegates is scheduled for Saturday, October 20, at 1:00 p.m. The third and concluding session of the House of Delegates will be held Sunday, October 21, at 9:30 a.m.
Elections
In accordance with Chapter Xll, Section 1 of the Bylaws of the Pennsylvania Medical Society, the following nomina- tions and/or elections will be in order at the second session, Saturday afternoon, October 20, 1990.
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 Xiy Sec- tion 5 of the Bylaws, elections will be in order for a trustee for the Second District to succeed John W. Lawrence, MD, Dela- ware County, who is eligible for reelec- tion; a trustee for the Fourth District to succeed Frederick G. Brown, MD, Mon- tour County, who is eligible for reelec- tion; a trustee for the Fifth District to suc- ceed Herbert C. Perlman, MD, Cumberland County, who is eligible for reelection; a trustee for the Eleventh Dis- trict to succeed Ferdinand L. Soisson, Jr., MD, Cambria County, who is eligible for reelection; and a trustee for the Medical Student Section to succeed Steven F. Ne- merson, who is eligible for reelection.
In accordance with Chapter X, Section 1 of the Bylaws, elections for delegates and alternate delegates to the American Mediccd Association are in order. In ac- cordance with Standing Rule Number 10 (adopted October 22, 1982), elections for delegates will be held on Saturday after- noon, October 20, 1990, and elections for alternate delegates will be held on Sunday morning, October 21, 1990.
Delegates whose terms expire Decem- ber 31, 1990 cu-e:
1. R. William Alexander, MD (Berks County)
2. Doris G. Bartuska, MD (Philadel-
phia County) I
3. Joseph B. Blood, Jr., MD (Bradford 1
County) ji
4. Betty L. Cottle, MD (Blair County) |
5. James B. Donaldson, MD (Phila- delphia County)
6. Charles A. Heisterkamp, 111, MD (Lancaster County)
7. Lee H. McCormick, MD (Alle-'
gheny County) |
8. Donald E. Parlee, MD (Bucks ^
County) s
9. Howard A. Richter, MD (DelawcU"e * County)
10. Doncdd H. Smith, MD (Northamp- ton County)
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nominations for eleven (11) delegates for two (2) years com- mencing January 1, 1991 and expiring December 31, 1992:
1. R. William Alexander, MD (Berks County)
2. Richard D. Baltz, MD (Dauphin County)
3. Doris G. Bartuska, MD (Philadel- phia County)
4. Joseph B. Blood, Jr., MD (Bradford County)
5. Betty L. Cottle, MD (Blciir County)
6. *J. Joseph Danyo, MD (York
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County)
7. James B. Doncildson, MD (Phila- delphia County)
8. Victor F. Greco, MD (Luzerne County)
9. Charles A. Heisterkamp, 111, MD (Lancaster County)
10. Thomas J. Kardish, MD (Bucks County)
11. Donald Kaye, MD (Philadelphia County)
12. Lee H. McCormick, MD (Alle- gheny County)
13. Donald E. Parlee, MD (Bucks County)
14. Howard A. Richter, MD (Delaware County)
15. Donald H. Smith, MD (Northamp- ton County)
*The Committee does not normally nominate for delegate positions those physicians who have not previously served as alternate delegates; however, in Dr. Danyo’s case, he has attended sev- ered AMA House meetings and has also been seated as an alternate delegate sev- eral times in the past few years when vacancies have occurred.
Alternate delegates whose terms ex- pire December 31, 1990 are:
1. Richard D. Baltz, MD (Dauphin County)
2. Charles J. Cattano, MD (Allegheny County)
3. Donald G. Ferguson, MD (Alle- gheny County)
4. Joseph F. Girone, MD (Philadel- phia County)
5. Victor F. Greco, MD (Luzerne County)
6. Thomas J. Kardish, MD (Bucks County)
7. Donald Kaye, MD (Philadelphia County)
8. Roberta L. Schneider, MD (Mont- gomery County)
9. Carl A. Sirio, MD (Dauphin County)
10. Vacancy
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nominations for ten (10) al- ternate delegates for two (2) year terms commencing January 1, 1991 and expir- ing December 31, 1992:
1. Richard T. Bell, MD (Berks County)
2. Winston M. Bryant, Jr., MD (Phila- delphia County)
3. Charles J. Cattano, MD (Allegheny County)
4. David L. Cohen, MD (York County)
5. Donald G. Ferguson, MD (Alle-
gheny County)
6. Carl A. Frankel, MD (Dauphin County)
7. Joseph F. Girone, MD (Philadel- phia County)
8. Robert M. Kemp, MD (Lancaster County)
9. John A. Malcolm, Jr., MD (Union County)
10. Roberta L. Schneider, MD (Mont- gomery County)
11. Carl A. Sirio, MD (Dauphin County)
12. Chcirles D. Tourtellotte, MD (Phila- delphia County)
13. Thomas J. Weida, MD (Lancaster County)
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nomination for one slotted position for alternate delegate for a med- ical student for a one-year term com- mencing June 1, 1991 and expiring May 31, 1992, as stipulated in the proposed Bylaws language contained in the Offi- cial Call:
1. Kellen K. Kovalovich (Medical Stu- dent Section)
Also to be elected will be two mem- bers to serve on the Committee to Nomi-
nate Delegates and Alternates to the AMA. The term of J. Preston Hoyle, MD, Union County, expires; he is not eligible for reelection. In addition, a vacancy ex- ists on the committee due to the death of Paul J. Poinsard, MD, Philadelphia
County. The Bocird of Trustees, at its May meeting, appointed Wallace G. Mc- Cune, MD, Philadelphia County, to serve on the committee until the 1990 Annual Meeting to fill this vacancy.
In accordance with Chapter XVII, Sec- tion 2 of the Bylaws, the Board of Trust- ees nominates the following members for two vacancies on the Judicial Coun- cil. For the office now held by George P. Rosemond, MD, Philadelphia County, who is not eligible for reelection, the Board nominates Wallace G. McCune, MD, Philadelphia County; Jonathan E. Rhoads, MD, Philadelphia County; and
Show your affiliation with pride
E DUC ATION A L ^SCIENTIFIC TRUST
of the Pennsylvania Medical Society 111 East Park Dnve
P.O. Box 8820 • Hamsburg, PA I7I0.S-8820 717-558-7750
The Pennsylvania Medical Soci- ety is pleased to offer members four distinctive ways to support The Educational and Scientific Trust.
Each item has been tastefully designed, made with quality and reasonably priced. Most impor- tant, a portion of each purchase is used to promote the research and educational endeavors of the Trust.
Order today. And show your affiliation— and sup- port—with pride!
Please send me the following item(s):
Ties ($15 each)
Neck tie Color: Navy/green
Bow tie Navy/tan
Women's tie Navy/maroon
Sport shirts ($30 each)
Navy w/green imprint Size:
White w/blue imprint (Men's S, M, L, XL, XXL)
Certificate frames ($15 plus .90 sales tax each)
Black finish
Walnut finish
Tie/Lapel pins (pewter) ($12 each)
Total enclosed $
Name
Address
Phone
Please make check payable to The Educational and Scientific Trust and mail to:
The Educational and Scientific Trust Pennsylvania Medical Society P.O Box 8820 • Hamsburg, PA 17105-8820
Chcirles E. Schlager, MD, York County. For the office now held by D. Ernest Witt, MD, Columbia County, who is eligi- ble for reelection, the Board nominates William J. Kelly, MD, Allegheny County; Michael P. Levis, MD, Allegheny County; and D. Ernest Witt, Columbia County.
Set forth below is the text of the pro- posed bylaws amendments. Deletions from existing bylaws are indicated by brackets; additions cire itedicized.
SUBJECT ONE
1. Suggested Bylaws Revisions to Bring the Bylaws Up to Date.
(1-A.) Chapter HI— Assessments Section 2. Annual Assessment . . .
The full annual assessment is to be pciid by all members of this Society. Except that:
a. Senior members shall be required to pay 50 percent of the full annued assess- ment. A senior member is an active member of this Society who is 65 yeeirs old or older as of January 1 of the assess- ment yeeir and who hcis been an active member of a constituent association of the American Mediced Association for a [continuous term] total of 30 yecus. . .
(1-B.) Chapter DC— Committees of the
House of Delegates
Section 2. Meeting Committees . . .
b. Rules Committee— This committee shcdl be appointed by the speaker and consist of five delegates who shall serve in this capacity from the time they are appointed until the adjournment of the meeting for which they are appointed.
This committee shall be responsible for proposing necessary or desirable rules of procedure for the orderly trans- action of business at an annual or special meeting of the House of Delegates; the order of business for a specied meeting must include any matter set forth in the Official Call to that meeting.
These rules of procedure shall be des- ignated the Standing Rules.
1. The “Order of Business” for the meeting which shall be adopted as the first order of business by a majority vote of the seated delegates.
2. Standing Rules, which remain in ef- fect unless altered or rescinded by the House of Delegates, may be changed at any session of the meeting by a [two- thirds] majority vote of the seated dele- gates.
3. Standing Rules may not conflict with these bylaws.
(1-C.) Chapter XIV — The Board of
20
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Trustees
Section 14. Quorum— {Seven] A ma- jority of the voting members of the Board of Trustees shall constitute a quo- rum.
(1-D.) Chapter XIX— Special Sections Section 1. Resident Physician Sec- tion
The section shall elect from among its members (a) a governing council consist- ing of a chairman, vice chairman, secre- tary, and seven members-at-large, (b) ten delegates and ten cilternate delegates to the Society’s House of Delegates, and (c) [two] one or more qualified nominees for the position of resident physician trustee to the Society’s Board of Trustees who shall be placed in nomination at the Soci- ety’s House of Delegates by a delegate of the Section. . .
SUBJECT TWO
2. Committee to Nominate Delegates and Alternates to the AMA: The Speaker of the House of Delegates appoint two of
the five members of the Committee to Nominate Delegates and Alternates to the AMA, and the charge of the Nomi- nating Committee be restated, as called for in Report P of the Board of Trustees and approved by the 1989 House of Del- egates.
Chapter XII — Officers Section 7. Duties of Officers. . .
i. The speaker of the House of Delegates:
1. shall preside at all meetings of the House of Delegates or designate the vice speaker to do so, and perform such other duties as may be required by these bylaws;
2. shall appoint the members of the Standing Committee on Bylaws and des- ignate its chairman;
3. shall appoint annually two of the five members of the Committee to Nominate Delegates and Alternates to the Ameri- can Medical Association;
[3] 4. shall appoint committees of the House of Delegates and designate their chairmen;
[4] 5. shall determine the number of ref- erence committees and appoint the members of each;
[5] 6. shall determine the appropriate re- ferral of business items to each reference committee;
[6] 7. shall be ex officio with the right to vote on the Board of Trustees;
[7] 8. shall be ex officio without the right to vote in the House of Delegates, unless there is a tie, when he or she is presid- ing;
[8] 9. may delegate a chairman to pre- side at a meeting of the House of Dele- gates.
Chapter XV— Conunittees, Adminis- trative Councils and Commissions Section 2. Standing Committees. . .
e. Committee to Nominate Delegates and Alternates to the American Medical Association— The Committee to Nomi- nate Delegates and Alternates to the House of Delegates of the American Medical Association shall consist of five members, two members appointed an- nually by the Speaker of the House and three members elected by the House of Delegates, to serve [a term of] three yearfs.] terms, with one of the members being elected each year to maintain con- tinuity. The Speaker will appoint the first two vacancies beginning in 1990; in 1991, the House shall elect for a transi- tion two-year term ending in 1993 and a three-year term ending in 1994. The im- mediate past president and the Chair- man of the Board of Trustees shall serve
inwills Eye Hospital
announces
The Annual Ophthalmology Update for the Primary Care Physician Wednesday, October 10, 1990
Wills Eye Hospital Faculty
Topic
Robert S. Bailey Jr., MD
The Best Way to Remove a Foreign Body; Treatment of Acid, Alkali Burns and Sunlamp Exposure
Owen Belmont, MD
Floaters, Flashes, Blurred Vision and Halos
Michael A. DellaVecchia, MD, PhD
The Patient with the Red Eye
Richard A. Ellis, MD
Cataract Update— 1990
Alan R. Forman, MD
Glaucoma: Simplified Tension Measurement: Estimate Anterior Chamber Depth; Precaution with Systemic Medication
Jonathan Grohsman, MD, PhD
Systemic Effects of Eye Medication; Eye Problems from Systemic Medications
Harold P Roller, MD
Diplopia: Diagnosis and Significance in General Practice
Richard Ellis, MD
Course Director
CME Credits will be distributed.
Further Information:
Department of Continuing Medical
Tuition: $50.00
Education Wills Eye Hospital
To be held at:
9th and Walnut Streets
Wills Eye Hospital
Philadelphia, PA 19107 (215) 928-3378
22
PENNSYLVANIA MEDICINE • AUGUST 1990
Moss Rehabilitation Medicine
A professional corporation striving for excellence in comprehensive medical rehabilitation through
Patient Care • Education • Research
Rehabilitation programs in:
• Amputation
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• Stroke and neurological diseases
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• Acupuncture
• Traumatic brain injury
• Rheumatology
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• Cardiopulmonary diseases
• Oncology
• Acute care rehabilitation
Offices in New Jersey and Pennsylvania (215) 456-9495
Laboratory services in:
• Electromyography
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• Gait and motion analysis
• Exercise physiology
• Prosthetics/orthotics
Teaching affiliations:
• Temple University School of Medicine
• Medical College of Pennsylvania
Herbert Avart DO Nathaniel H. Mayer MD
Brian Emstoff MD Diego Morales MD
Albert Esquenazi MD Jeanne Pelensky MD Lucretia Fitzpatrick MD Jeffrey Perkins MD Robyn Gansner MD Harry Schwartz MD
Gary Goldberg MD Mary L. Smith MD
Anne Idiculla MD Margarita Torres MD
Leonard Kamen DO John Whyte MD, PhD
Judy Kleppel MD Edward Wikoff MD
Gilbert Lafontant MD Susan Zimmerman MD Raymond Lafontant MD
as ex officio members of the Committee without the right to vote. This commit- tee shall select its own chairman annu- ally [immediately upon adjournment of the annual meeting of the House of Dele- gates] at its first meeting following the elections. It shall be the duty of this com- mittee to submit to the House of Dele- gates a list of nominees for delegates and alternates to the House of Delegates of the American Medical Association who cire qualified under the requirements of the American Medical Association to hold such office. In the dischcirge of this responsibility the committee shall for- mally request recommendations of nom- inees from each component society. The committee shall receive a formal presen- tation in a timely manner from the Exec- utive Committee of the Pennsylvania Delegation to the American Medical As- sociation. It shall further be required to publish its list of nominees in the Official
Call to the forthcoming House of Dele- gates meeting wherein the election is to be held. The committee shall also present a report to the House of Dele- gates each year regarding its nomination of delegates and alternates to the Ameri- can Medical Association. Nothing in this section shall be construed as to prohibit nominations from the floor. Service on the Committee to Nominate Delegates and Alternates to the American Medical Association is limited to [two terms] six years.
SUBJECT THREE
3. Merger of Function and Duties of In- terspecialty Committee and Specialty Delegation to PMS House of Delegates, as recommended by the Interspecialty Committee and the Committee on Or- ganization and Operation of the Board, and approved by the Board.
Chapter VIII — House of Delegates Section 3. Composition and Apportionment — The House of Dele- gates shall be composed of voting dele- gates and ex officio persons, a. Voting delegates shall be:. . .
3. A delegate to the Interspecialty Sec- tion from each speciaMy/ subspecialty, recognized by the Pennsylvania Medical
Society, organized in Pennsylvania !' [which is an American Mediccd Associa- 5 tion Board certified specialty;]; such dele- | gate must be an active or associate I member in good stcuiding of this Society. •
Chapter XIV — The Board of Trustees Section 5. Nomination and Election of Trustees. . .
Nominations for the specialty society trustee shall be made by voting mem- bers of the House representing the Inter- specialty Section which is comprised of 1 representatives from each specialty/ I subspecialty, recognized by the Pennsyl- I vania Medical Society, [AMA Bocird cer- tified specialties] organized in Pennsylvania.
Chapter XIX — Special Sections Section 6. Interspecialty Section —
Membership in this section shall consist of representatives of national medical specialty/subspecialty societies in Penn- sylvania.
The section shall elect from among its members a chairman and vice chair- man. When appropriate, the chairman of the section or his designee shall present to the Society’s House of Dele- gates the names of one or more qualified nominees for election to the position of
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PENNSYLVANIA MEDICINE • AUGUST 1990
he Hallmark of Excellence
Continues
The newest addition to The Graduate Hospital’s patient care capabilities is located on the corner of 19th and South Streets and is directly connected to the main hospital by an enclosed bridge across South Street. The 75,000 square foot building houses one of the nation’s most advanced concentrations of diagnostic and therapeutic technology in a facility whose interior design has been carefully crafted to provide the most comforting and comfortable environment possible for patients, staff, and visitors. Services include:
THE CANCER TREATMENT CENTER — A multi-disciplinary team approach to the medical and/or surgical management of all forms of cancer, utilizing:
• Radiation oncology using a Varian computer operated linear accelerator and a General Electric target planning system
• Complete chemotherapy and transfusion services
• On-site pharmaceutical consultation
THE IMAGING CENTER — Advanced, non-invasive diagnostic imaging using the following state-of-the-art technology:
• Two General Electric high field (1.5T) magnetic resonance imagers
• Elscint 2400 Elite computed tomography (CT) scanner
• Two dedicated matmnography rooms
• Diasonics color flow ultrasound unit
• Two standard X-ray rooms with digital and fluoroscopy
NUCLEAR MEDICINE — Contemporary nuclear imaging and treatment, using top-of-the-line General Electric hardware, offering:
• Single photon emission computed tomography
• Whole body bone tmnor imaging
• Thyroid scanning
• Bone densitometry
SAME DAY SURGERY — Four operating and four procedure rooms, each of which is a model of modern technology featuring:
• Baser capability
• Intra-operative X-ray capability
• State-of-the-art video technology
• On-site pathology laboratory
• Ceiling mounted equipment orbiters to enhance sterility and improve patient access
• Warming panels over each recovery bay for improved patient comfort
This addition to The Graduate Hospital’s healthcare delivery system represents a major advancement for patients and referring physicians from the Delaware Valley and beyond.
THE GRADUATE HOSPITAL
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OmCIAt CALL TO 1990 MEETING
specialty trustee who shall be placed in nomination at the Society’s House of Delegates by the chairman of the section or his designee.
Each specialty/subspecialty, recog- nized by the Pennsylvania Medical Soci- ety, shall be entitled to elect one dele- gate and one alternate delegate, who shall be active or associate members of PMS, to this section provided that the so- ciety representing that specialty/ subspecialty establishes to the satisfac- tion of the House of Delegates that it meets the established representation cri- teria.
The regular function of this section shall include, but not be limited to, pro- viding a forum for specialty/subspecialty societies to coordinate their activities with those of the Pennsylvania Medical Society and to make PMS aware of mat- ters of specific interest to the specialty/ subspecialty societies. To carry out these functions, this section shall meet at the time of the annual meeting of the House of Delegates, at all special sessions of the House of Delegates, and at certain regu- lar intervals throughout the year or as may be called by the section chairman. The section shall develop and distribute to the represented specialties/
subspecialties policies and procedures for the conduct of this section, its meet- ings and functions.
SUBJECT FOUR
4. Slotted Alternate Delegate Position on the Pennsylvania Delegation to the AMA, as called for in substitute Resolu- tion 89-65, which was referred to the Board of Trustees by the 1989 House of Delegates and subsequently referred to the Delegation for consideration and recommendation by the Chairman of the Board. The Boaird of Trustees at its June 6 meeting approved the recom- mendation of the Delegation calling for recommendation to the Committee on Bylaws for slotted alternate delegate po- sitions for a student and a resident and that the Medical Student and the Resi- dent Physician Sections each recom- mend nominees for these slotted posi- tions to the PMS Committee to Nominate Delegates and Alternates to the AMA.
Chapter XV — Committees, Adminis- trative Councils and Commissions Section 2. Standing Committees. . .
e. The Committee to Nominate Dele- gates and Alternates to the American Medical Association. . .
It shall be the duty of this committee to submit to the House of Delegates a list of nominees for delegates and alternates to the House of Delegates of the Ameri- can Medical Association who are quali- fied under the requirements of the American Medical Association to hold such office. There shall be one slotted al-
ternate delegate position for a medical student beginning in 1990, and one slot- ted alternate delegate position for a resi- dent physician beginning in 1991. These nominations shall be made by the re- spective special section to this commit- tee. The term of both slotted alternate delegate positions shall begin June I and end on May 31, with a maximum tenure of two years in the slotted position, so long as the resident physician continues to serve in a residency program ap- proved by the Society, and the medical student continues to be enrolled in an approved medical school. In the dis- chcirge of this responsibility the commit- tee shall formally request recommenda- tions of nominees from each component society. It shall further be required to publish its list of nominees in the Official Call to the forthcoming House of Dele- gates meeting wherein the election is to be held. Nothing in this section shall be construed as to prohibit nominations from the floor[.]; provided that only resi- dents or medical students may be nomi- nated for their respective alternate dele- gate positions. .
Chapter XIX— Special Sections Section I. Resident Physician Sec- tion. . .
The section shall elect from among its members (a) a governing council consist- ing of a chairman, vice chairman, secre- tciry, and seven members-at-large, (b) ten delegates and ten alternate delegates to the Society’s House of Delegates, [and] (c) one or more qualified nominees for the position of resident physician trustee to the Society’s Board of Trustees who shall be placed in nomination at the Soci- ety’s House of Delegates by a delegate of the section, and (d) one or more qualified nominees for the slotted alternate dele- gate position to the American Medical Association for recommendation to the Committee to Nominate Delegates and Alternates to the American Medical As- sociation. . .
Chapter XIX — Special Sections Section 3. Medical Student Section. . .
The section shall elect from among its members (a) a governing council consist- ing of a chairman, vice chairman, secre- tary, and five members-at-lcu-ge, (b) eight delegates and eight alternate delegates to the Society’s House of Delegates. Each delegate and corresponding alternate shall represent a different medical school in this Commonwealth and shall be a student at that school. In the event no qualified delegate is available or will-
A HELPING HAND FOR THE TROUBLED PHYSICIAN
Alcoholism. Drug abuse. Mental and physical disability. The problems of aging. All take their toll on the medical community.
But there’s help — through the Physicians’ Health Programs of the Educational and Scientific Trust of the Pennsylvania Medical Society. The program offers peer support . . . referral to professional treatment agencies . . . and compassionate follow-up throughout the rehabilitation process. All efforts are voluntary and strictly confidential.
Write Physicians’ Health Programs, The Educational and Scientific Trust of the Pennsylvania Medical Society, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.
If you need help — or know someone who does— call the Physicians’ Health Programs Hotline: (717) 558-7817. Learn more about the Physicians’ Health Programs.
26
PENNSYLVANIA MEDICINE • AUGUST 1990
One Specialty Deserves Another.
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Your time is valuable. That’s why our Member Service Representatives give your call priority. They’ll answer your questions or fill your requests immediately. Or they’ll connect you with the person at the AMA who can help you quickly. So call now. If you’re looking for a reason, you’ll find it here.
Over 100 Things You Can Do By Calling 1-800-AMA-3211:
1. Check on membership staois
2. Ask about membership benefits
3. Ask about member dikounts
4. Ask about continuing medical education
5. Use AMA library seaidi
6. Express your opinion
7. Register a complaint
8. Resolve a service problem
9. Obtain telephone numbers for state, local and specialty societies
10. Get lekphone numbers fix aOied health oiganizalions
11. Get answers to your questions about mdpractioe
12. Learn about your legal rights
13. Order AMA products
14. Inquire about home health care
15. Request “New Drug Name” reprints
16. Obtain AMA Annual Report
17. Order AMA ConfereiKe Proceedings
18. liKjuire about AMA Cotmcil Reports 19 Le^ about AMA subsidiaries
20. Gain toll-free access to AMA specialists who can answer questions about federal legislation
21. Ask about state legislation
22. Request information about model legislation
23. Ask about physician liability
24. Seek anti-trust information
25. Talk to CPT Coding ^xmlists
26. Learn about the Physician Recognition Award
27. Find out about CME accreditation
28. Irxjuire about peer review organizations
29. Obtain latest iriformation about Resource Based Relative Value Scales
30. Request practice management materials
31. Ask ICD-9 coding questions
32. Get CPT coding publications 33 Order lCD-9 publications
34. Obtain health insuratxe claim forms
35. Order Patient Medication Instruction sheets
36. Get meeting updates during AMA House of Delegates sessions
37. Learn about collective bargaining issues
38. FirKl out about the National Leadership Conference
39. Ask about the National Communications Conference
40. Get information about the Educational Day on Radon
41. Check the Contempo CME Course
42. Learn about Mastering the Accreditation Process
43. Learn about the National Congress on Adolescent Health
44. Discover the AMA HIV Conference
45. Arrange to attend the AMPAC Constituent Skills Workshop
46. Inquire about the AMPAC Campaign Management School
47. Make plans to attend the Human Genome Conference
48. Fmd out about the Committee on Allied Health Education and Accreditation
49. Ask abcxit AMA programs for residents
50. Ask abcxjt AMA programs for medical students
51. Learn abcxrt the AMA program to strengthen America’s healthcare system
52. Gain toll-free access to general member services 53- Ask abcxjt Icxum tenens
54. Use the AMA Recruiting Service
55. Use the Opportunity Placement Register
56. Uncover opportunities with the Practices For Sale service
57. Inquire about the Alternative Careers service
58. Pose (|uestions about accreditation
59. Ask licensure (Questions
60. Contact the AMA Auxiliary
61. Acquire medical econcxnics informatwn
62. Obtain statistical information abcxit physicians
63. Obtain socioecotKimic infomtation ab^ physicians
64. Obtain specialty profile informatkxi
65. Discover important statistics abcxit the physician itiarketplace
66. Refer a colleague for membership cjuestions
67. Ask about AMA representation to the public
68. Ask abcxit AMA representatkxi to the business community
69. Ask abcxit retirement planning
70. Find exit abcxit AMA/Net
71. Leam more abcxit Project USA
72. Ask abcxit AMA-spcxiixed malpractice insurance
73. Contaa the Physician Negotiatkxi Advisory Office
74. Ask abcxit physician ownership c/ health care fadlit^
75. Inqjuire abcxit mental health issues
76. Find exit how to get information about AMA- spcxiscxed investments, credit cards, insurance and financial planning services
77. Ask questkxrs about biotechnology and mciieailar nieclicine
78. Leam abcxit the Campaign Against Cholesterol
79. Contact the Office of Wcxnen in Medicine
80. Reach the Office of Fexeign Medical Graduates
81. Ask for the Office of Employed and Group Practice Physicians
82. Get in touch with the Office of Private Sector Outreach
83. Reejuest the AMA Member Services Guide
84. Inqjuire abcxit Drug Evaluations
85. Ch^ on program listings and times for American Medical Telev^ion
86. Sign up for Practice Management Wcxkshops
87. Lram abcxit ICD-9 Coding Wcxkshops
88. Obtain infcxmatkxi cxi medical ethics and related legal issues
89. Obtain informatkxi abcxit current AMA policies on issues
90. Order bcxiks, pamphlets, other AMA publications
91. Incquire abcxit ycxir JAMA subscriptkxi
92. Find exit abcxit practice developrnent 93- Reejuest free rrorints of articles
94. Access articles from over 4,000 jcximals
95. Ask about AMA representation in Wishingjcxi, D.C
96. Find exit how to get AMA-spcxiscxed rental car discounts
97. Change ycxir address
98. Change ycxir jcximal address 99- Take advantage of the Physician
Placement Register
100. Order fiee AMA publications
101. Register for CPT Coding Wcxkshops
102. Get information abcxit Physicians Trends
103. Ask for ycxir free AMA catalog
104. Your call to the AMA Member Hotline is always free.
The AMA Member Hotline is here to save you time and serve you better. Try it. See how it woiks. And call often.
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If you belong to a unified society, mention it when you call, and you’ll receive special service.
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28
PENNSYLVANIA MEDICINE • AUGUST 1990
Hahnemann University
Department of Medicine
GRAND ROUNDS WEDNESDAYS
SEPTEMBER 1990
September 5, 1990
CORONARY HEART DISEASE AND HOW TO PREVENT IT William Roberts, MD Chief, Pathology Branch NHLBI, NIH
Clinical Professor of Medicine, (Cardiology) and Pathology Georgetown University Washington, D C.
September 12, 1990 DIAGNOSIS OF HIV INFECTION Charles J. Schleupner, MD Associate Professor of Medicine University of Virginia School of Medicine Chief, Infections Diseases Section, VA Medical Center Salem, VA
September 19, 1990 METABOLIC, NEUROLOGIC AND HEMATOLOGIC MANIFESTATIONS OF SPHINGOLIPIDOSIS A. Charles Winkelman, MD Professor of Clinical Neurology Director, Neuro-Ophthalmology Hahnemann University S. Benham Kahn, MD Professor and Vice Chairman Neoplastic Diseases Hahnemann University David A. Wenger, PhD Professor of Medicine, Biochemistry and Molecular Biology Jefferson Medical College Philadelphia, PA
September 26, 1990 CRITICAL CARE MEDICINE: ALVEOLAR EDEMA AND TISSUE OXYGEN TRANSPORT Michael A. Mathay, MD Associate Professor of Medicine and Anesthesia
Director, MICU, UCSF San Francisco, CA David R. Dantzker, MD Professor and Director Pulmonary and Critical Care Medicine University of Texas Medical School Houston, TX
OCTOBER 1990
October 3, 1990
PITUITARY ADENOMAS: DIAGNOSIS AND TREATMENT Peter Snyder, MD Associate Professor of Medicine Division of Endocrinology University of Pennsylvania School of Medicine Philadelphia, PA
October 10, 1990
CHANGING PATTERN OF AIDS AND THE LUNGS
Philip C. Hopewell, MD Professor of Medicine University of California, SF Chief, Chest Service, San Francisco General Hospital
San Francisco, CA
October 17, 1990
DIVISION OF CARDIOLOGY CLINICAL RESEARCH: CARDIAC IMAGING Eric L. Michelson, MD Professor of Medicine Director, Division of Cardiology Hahnemann University
October 24, 1990
CARDIAC REMODELING: CLINICAL IMPLICATIONS AND THERAPEUTIC OPTIONS Gervasio A. Lamas, MD Assistant Professor of Medicine Harvard Medical School Boston, MA
October 31, 1990
DIABETIC NEPHROPATHY Eli A. Friedman, MD Professor of Medicine Chief, Division of Renal Disease SUNY Health Science at Brooklyn Brooklyn, NY
NOVEMBER 1990
November 7, 1990 STEROID ABUSE IN THE ATHLETE Robert Cantu, MD Chairman, Dept, of Surgery Chief Neurosurgery Service Director, Service of Sports Medicine Emerson Hospital Concord, MA
Consultant, Sports Medicine Comm.
USA American Boxing Federation
8:30 a.m.-9:30 a.m. September-December 1990
November 14, 1990
CONTROVERSIES IN NON-CARDIAC CHEST PAIN (Gastro-Esophageal Reflux, Achalasia) Sidney Cohen, MD
Professor and Chairman, Department of Medicine
Temple University School of Medicine Philadelphia, PA
November 21, 1990
DIVISION OF PULMONARY MEDICINE AND CRITICAL CARE Edward Schulman, MD Associate Professor of Medicine Director, Division of Pulmonary and Critical Care Medicine Hahnemann University
November 28, 1990
MEDICAL MANAGEMENT OF DEPRESSION AND ANXIETY Gary Tollefson, MD, PhD Associate Professor of Psychiatry University of Minnesota Minneapolis, MN Jonathan O. Cole, MD Chief, Psychopharmacology Program McLean Hospital Belmont, MA
DECEMBER 1990
December 5, 1990
PTCA VS BYPASS GRAFT SURGERY FOR CORONARY ARTERY DISEASE William S. FrankI, MD
Vischer Professor of Medicine and Chairman, Department of Medicine Director, Likoff Cardiovascular Institute Hahnemann University
December 12, 1990
ABNORMALITIES OF THROMBOSIS AND
THROMBOEMBOLISM
Daniel Deykin, MD
Chief of Medicine, Director, Health Services Research and Development, Boston VA Medical Center Boston, MA
December 19, 1990 AGING OF SKIN Richard L. Speilvogel, MD Professor of Medicine and Dermatology Director, Division of Dermatology Hahnemann University
WEDNESDAY MEDICAL SEMINAR SERIES
September 26, 1990 a.m.-3:30 p.m.
CRITICAL CARE
October 10, 1990 AIDS TREATMENT November 7, 1990 MEDICINE IN ATHLETICS
November 28, 1990 MEDICAL MANAGEMENT OF DEPRESSION AND ANXIETY
December 12, 1990
ABNORMALITIES OF THROMBOSIS AND THROMBOEMBOLISM
Seminar Directors:
William S. FrankI, MD
Professor of Medicine and Chair
Department of Medicine
Allan B. Schwartz, MD
Professor of Medicine
Director, Continuing Medical Education
of the Department of Medicine
Hahnemann University designates this continuing medical education activity for 1 hour-for-hour credit in Category I of the Physician’s Recognition Award of the American Medical Association.
Location:
Classroom C. (Alumni Hall) 2nd Floor New College Bldg. Hahnemann University 15th Street Entrance 15th & Vine Streets Philadelphia, PA
For information call the Office of Continuing Education (215) 448-8263
I
ing to serve as delegate to represent a particular school, then the delegate posi- tion for that school shall be left vacant, (c) one or more qualified nominees for the position of medical student trustee who shall be placed in nomination at the Society’s House of Delegates by a dele- gate of the section, and (d) one or more qualified nominees for the slotted alter- nate delegate position to the American Medical Association for recommenda- tion to the Committee to Nominate Dele- gates and Alternates to the American Medical Association. . .
SUBJECT FIVE
5. Voting Position on the PMS Board of Trustees For a Representative of the Young Physicians Section, as recom- mended by the Philadelphia County Medical Society Young Physicians Sec- tion.
Chapter XIV— 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, one trustee who is an active or associate member in good standing of this Society from each dis- trict, one trustee to represent the AMA Board certified specialties organized in Pennsylvania who is an active or associ- ate member in good standing of this So- ciety and a member of a specialty orga- nized in Pennsylvania which is an AMA Board certified specialty, one trustee to represent resident physicians who is an active member in good standing of this Society and who, at the time of election, is a resident physician member of this Society, one trustee, without the right to vote, who is an active member in good standing of this Society and who, at the time of election, is a mediccil student member of this Society, [and] one trustee to represent hospital medical staffs who is an active or associate member in good standing of this Society and who, at the time of election, is a member of a hospi- tal medical staff in Pennsylvania[.| and one trustee to represent young physi- cians who is an active member in good
30
Standing of this Society and who, at the time of election, is a member of the Young Physicians Section.
Chapter XIV — The Board of Trustees Section 5. Nomination and Election of Trustees— Nomination for a district trustee shall be made by voting mem- bers of the House from the district to be represented. Nominations for the spe- cialty society trustee shall be made by voting members of the House represent- ing the AMA Board certified specialties organized in Pennsylvania. Nominations for resident physician trustee, medical student trustee, [and] hospital medical staff trustee, and young physicians trustee shall be made by seated dele- gates from the resident physician, medi- cal student [or] , hospital medical staff [section,], or young physicians section, as the case may be. Election of all trustees by the House of Delegates is required.
Section 6. Terms — Each trustee, except the resident physician, [and] medical stu- dent, and young physician trustees, shall be elected for a term of three years. The term of the resident physician trustee shall be the lesser of two years or so long as the resident physician trustee con- tinues to serve in a residency program approved by the Society. Provided, how- ever, if the resident trustee cecises to serve in a residency program less than one hundred twenty days before an an- nual meeting of the House then said trustee’s term shall expire at the expira- tion of that annual meeting of the House. The term of the medical student trustee shall be one year with eligibility for re- election so long as the medical student trustee continues to be enrolled in an ap- proved medical school. Provided, how- ever, in the event the medical student trustee discontinues to be enrolled in an approved medical school as a result of graduation from the school, the term of the trustee shall expire at the expiration of the next annual meeting of the House. The term of the young physician trustee shall be one year so long as the young physician trustee is under 40 years of age or in the first five (5) years of profes- sional endeavor after residency and fel- lowship training programs.
SUBJECT SIX
6. Four Bylaws Proposals Regarding the Society’s Subsidiaries, cis Submitted by the Lancaster City and County Medical Society.
(1) On an annual basis, the House of Del- egates will be furnished with a list of all
physicians who receive $1,000 or more from PMS, or from any of its subsidicu-ies, affiliates, etc. This shall include all remu- neration including expenses, travel al- lowances, or in-kind remuneration. The total will be appropriately accounted for by category such as remuneration, travel, etc.
(2) No member of the PMS Board or offi- cer of PMS shall hold a position as a Board member or officer of any subsid- iary organization except that for each and every organization the PMS Board may select an ex-officio member of the subsidiary organization. This member shcill serve without pay or compensation except as provided to any and all other PMS Board members. The member may receive appropriate travel, lodging, and food expenses incurred in fulfilling his/ her duties as an ex-officio member of the subsidiary organization.
(3) The Board and officers of all subsid- iary organizations will be selected by the House of Delegates from a minimal slate of the number to be elected for each po- sition plus one. If three Board members are to be elected, at least four persons will be nominated. For a position such as President, there will be at least two nom- inees. The person elected President will also serve as Chairman of the Bocird of the subsidiary and Chief Operating Offi- cer. The slate will be nominated by a nominating committee composed of five members of the House of Delegates. In addition, nominations for a position may come from the Board of PMS and nomi- nations may be made by any member of the House of Delegates at the time of the meeting held for the election.
(4) Members of the Bocirds of subsidiary organizations will be elected for three year terms. They will serve no more than three consecutive terms and may not be re-elected after serving three con- secutive terms till after a lapse of two years. Any member elected to a pcirtial term which exceeds fifteen months will be considered to have served a full term. The terms of members shall be stag- gered with respect to the year of elec- tion so that approximately one-third of the members are elected each year. At the time this rule is instituted, elected members will draw straws to determine the length of his/her initial term. In the event of a vacancy, the Board of PMS shall appoint a member of PMS who would meet the qucdifications for elec- tion to fill the vacancy until the time of the next election. At that time, if there was cuiy unexpired portion to the term, the House will fill the seat by election.
PENNSYLVANIA MEDICINE • AUGUST 1990
YOCON*
YOHIMBINE HCI
Descriptiofl; Yohimbine is a 3a-15a-20B-17a-hydroxy Yohimbine-1 6a-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 duraUon, 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 toth.
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 sympathicoiytic 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 elevabon of blood pressure and heart rate, in- creased motor activity, irritability and tremor, SweaUng, nausea and vomiting are common after parenteral administration of the drug.^'^ Also dizziness, headache, skin flushing reported when used orally, ^ 3 Dosage and Adminisfration: Experimental dosage reported in treatment of erectile impotence.' '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 Vz tablet 3 times a day, followed by gradual increases to 1 tablet 3 times a day. Reported therapy not more than 10 weeks. ^
How Applied: Oral tablets of Yocon* 1/12 gr. 5,4 mg in bottles of 100’s NOC 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. Moralesetal.,TheJoumalof Urology 128:
45-47, 1982. *
Rev. 1/85
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PENNSYLVANIA
MEDICAL SOCirrY
OPPICIALS
Executive Office:
777 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820
(717) 558-7750 or 1-800-228-7823
•President
J. Joseph Danyo, MD 908 S. George Street York 17403 (717) 848-4800 •President Elect Gordon K. MacLeod, MD Univ. of Pittsburgh
1 30 DeSoto Street Pittsburgh 15261 (412) 624-3875 •Immediate Past President Gerald L. Andriole, MD 219 W. Diamond Avenue Hazleton 18201
(717) 454-4917 •Vice President Robert N. Moyers, MD 764 Kennedy Street Meadville 16335 (814) 336-5995 •Secretary
Ferdinand L. Soisson Jr., MD Suite 304, McAuley Hall 1020 Franklin Street Johnstown 15905 (814) 535-2569
•Speaker, House of Delegates Johnathon E. Rhoads Jr., MD
York Hosp., Dept, of Surgery 1001 S. George Street York 17405 (717) 771-2756
•Vice Speaker, House of Delegates
Howard A. Richter, MD
115 Lankenau Medical Building
Philadelphia 19151
(215) 649-4416
Treasurer and
Executive Vice President
Roger F. Mecum
777 East Park Drive
Harrisburg 17105-8820
(717) 558-7750
Judicial Council Kenneth L. Cooper, MD
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 1991)
George P. Rosemond, MD
3401 N. Broad St., Philadelphia 19140 - (215)
255-2230
(Term expires 1990)
Joseph M. Stowell, MD
501 Howard Ave., Altoona 16601 - (814)
944-6109
(Term expires 1991)
D. Ernest Witt, MD
RD 2, Bloomsburg 17815 - (717) 784-2190 (Term expires 1990)
Address inquiries to Ferdinand L. Soisson Jr.,
MD, Judicial Council Secretary, 777 E. Park Dr., P.O. Box 8820, Harrisburg 17105-8820
Trustees
John H. Hobart, MD, Chairman Martin A. Murcek, MD, Vice Chairman
'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 1990. Berks, Bucks, Chester, Delaware, Lehigh, and Montgomery counties.
'Third District— John H. Hobart, MD, 2001 Fairview Ave., Easton 18042 - (215) 258-9131. Term expires 1992. Carbon, Lackawanna, Monroe, Northampton, Pike, and Wayne counties.
'Fourth District— Frederick G. Brown, MD, Geisinger Med. Ctr., Danville 17822 - (717) 271-6393. Term expires 1990. Columbia, Montour, Northumberland, Schuylkill, and Snyder counties.
'Fifth District — Herbert C. Perlman, MD, 1104 Fleetwood Dr., Carlisle 17013 - (717) 245-5400. Term expires 1990. Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.
'Sixth District— Betty L. Cottle, MD, 25 Sylvan Dr., Hollidaysburg 16648 - (814) 695-0659. Term expires 1991. Blair, Centre, Clearfield, Huntingdon, Juniata, and Mifflin counties. 'Seventh District— Irving Williams III, MD, 1115 Sunset Dr., Lewisburg 17837 - (717) 523-1142. Term expires 1991. Cameron, Clinton, Elk, Lycoming, Potter, Tioga, and Union counties.
'Eighth District— Robert L. Lasher, MD, 316 W. 23rd St., Erie 16502 - (814) 455-9038. 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— Waiter M. Greissinger, MD, 13 Pride St., Pittsburgh 15219 - (412) 232-3555. Term expires 1991. Allegheny, Beaver,
Lawrence, and Westmoreland counties.
'Eleventh District— Ferdinand L. Soisson Jr., MD, Suite 304, McAuley Hall, 1020 Franklin St., Johnstown 15905 - (814) 535-2569. Term expires 1990. Bedford, Cambria, Fayette, Greene, Somerset, and Washington counties.
'Twelfth District— Victor F. Greco, MD, E-Z Acres, R.D. 1, Drums 18222 - (717) 788-3225. Term expires 1991. Bradford, Luzerne, Sullivan, Susquehanna, and Wyoming counties.
'Specialty Societies — Martin A. Murcek, MD, Med. Arts Bldg., 562 Shearer St., Ste. 101-2, Greensburg 15601 - (412) 837-4070. Term expires 1991 .
'Resident Physicians — Carl A. Sirio, MD, 13425 Biddeford Ct., Germantown, MD 20874 - (301) 972-1227. Term expires 1991 (or upon completion of residency).
'Hospital Medical Staff— Lee H. McCormick, MD, 2708 Brownsville Rd., Pittsburgh 15227 - (412) 885-6330. Term expires 1992.
Medical Students— Steven F. Nemerson, 46 University Manor East, Hershey 17033 - (717) 531-8647. Term expires 1990 (or upon completion of medical school).
'Voting members of the Board of Trustees
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PENNSYLVANIA MEDICINE • AUGUST 1990
PROFESSION Af.
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Providing management consulting; corporate and retirement planning; group practice sale and valuation, general practice surveys, and related services for health care professionals.
SUPERIOR OFFICE EQUIPMENT
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ADAMS COUNTY
President:
Secretary/Treasurer: Gill M. Taylor-Tyree, MD, 147 Gettys St., Gettysburg 17325, 717-334- 1733
ALLEGHENY COUNTY
President; George F. Buerger Jr, MD, 3471 Fifth Ave., Ste. 1115, Pittsburgh 15213-3221, 412- 681-4220
President Elect; Stanley M. Marks, MD, 490 E. North Ave., Ste. 208, Pittsburgh 15212, 412- 231-5400
Vice President: John A. Burkholder, MD, 490 E. North Ave., Ste. 302, Pittsburgh 15212, 412- 323-0363
Treasurer: John S. Oehrle, MD, 1301 Carisle St., Natrona Heights 15065, 412-226-7076
Secretary: Lee H. McCormick, MD, 2708 Browns- ville Rd., Pittsburgh 15227, 412-885-6330
Executive Director: John G. Krah, 713 Ridge Ave., Pittsburgh 15212-6098, 412-321-5030
Bulletin Editor: Ralph Gaudio Jr, MD, 713 Ridge Ave., Pittsburgh 15212-6098, 412-321-5030
Publication: BULLETIN OF THE ALLEGHENY COUNTY MEDICAL SOCIETY
ARMSTRONG COUNTY
President: Frederick B. Doerfler Jr, MD, 260 S.
Jefterson St., Kittanning 16201, 412-622-2465 President Elect: Jeffrey W. David, MD, Medical Arts Bldg., RD 8, Kittanning 16201, 412-297- 3424
Vice President: Clifford R. Vogan, MD, Box 168, Cowansville 16218
Treasurer: Paul L. Frederick, MD, Medical Arts Bldg., RD 8, Kittanning 16201 Secretary; Donald W. Minteer Jr, MD, RD 1 , Box 70, Worthington 16262, 412-297-3424 Executive Secretary: Luann Croyle, 416 Pine Hill Rd., Kittanning 16201, 412-548-1606
BEAVER COUNTY
President: David M. Rafalko, MD, 304 Trail Side Dr., Sewickley 15143, 412-741-8734 President Elect: Patrick W. Sturm, MD, 1425 Third St., Beaver 15009, 412-728-7820 Vice President: Morry Moskovitz, MD, 701 Sharon Rd., Beaver 15009, 412-774-2700 Secretary/Treasurer: Jay L. Funkhouser, MD, 721 Fifth Ave., New Brighton 15066, 412-846- 5250
Executive Secretary: Caroline L. Mills, 244 Col- lege Ave., 2nd Floor, Beaver 15009, 412-775- 3330
BEDFORD COUNTY
President; Eric R. Weaverling, MD, Box 123, Fishertown 15539, 814-839-4152 Vice President: James J. Glah, DO, 909 S. Ju- liana St., Bedford 15522, 814-623-5007 Secretary/Treasurer: George M. Zubak, MD, 300 N. Spring St., Everett 15537, 814-652-5133
BERKS COUNTY
President: Donald I. Loder, DO, 143 E. Wall St.,
If you’ve made the decision to move up, our four-day interactional career enhancement program for physicians will help you make the transition to administrative medicine. Adapt practical approaches to organizational chal- lenges to fit your personal leadership style. Learn techniques that will help you control a meeting so goals are accomplished, and how to meet QA and Joint Commission requirements. Prepare to negotiate successfully and respond effectively to confrontation. Career counseling is available upon completion of the program. Class is limited to 24 participants, so call today for more information.
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Leesport 19533, 215-926-2123 ; ;
President Elect: Barton L. Smith, MD, 301 S. ( Seventh Ave., West Reading 19611, 215-374- 1 4401
Treasurer: Jerome I. Marcus, MD, 2001 Wyomissing 19610, 215-378-1900 Secretary: George E. Connerton, MD, 1921 Sturbridge Dr., Wyomissing 19610, 215-777- I 9771
Executive Director: Bruce R. Weidman, 429 Wal- i nut St., Reading 19601, 215-376-1544 «
BLAIR COUNTY 1
President: Joseph M. Stowell, MD, 501 Howard Ave., Altoona 16601, 814-944-6109 President Elect: Anthony J. Maniglia, MD, 702 18th St., Altoona 16602, 814-943-3913 Vice President: Alan J. Kivitz, MD, 711 Logan Blvd., Altoona 16602, 814-943-2088 Secretary: S. Victor King, MD, RD 5, Box 287A, Tyrone 16686, 814-684-5608 Executive Secretary: Marjorie E. Harker, 503 E. Plank Rd., 2nd FI., Altoona 16602, 814-942- 8691
Publication: BLAIR COUNTY MEDICAL
SOCIETY— NEWSLETTER
BRADFORD COUNTY
President: Louis C. Blaum Jr, MD, Guthrie Clinic Ltd., Sayre 18840, 717-888-5858 ;
Vice President: Isaac I. Matta, MD, Guthrie Clinic : Ltd., Sayre 18840, 717-888-5858 Treasurer: Richard E. Shelling, MD, Guthrie Clinic Ltd., Sayre 18840, 717-888-5858 Secretary: Joseph B. Blood Jr, MD, Guthrie Clinic, Guthrie Square, Sayre 18840, 717-888- 5858 ;
I
BUCKS COUNTY
President: Veronica E. Coyne, MD, Landmark ; Bldg. 3rd floor, Clinton & West State Sts., Doy- I lestown 1 890 1 , 2 1 5-348-071 7 >
Secretary: Donald E. Parlee, MD, Doylestown j Hosp., 75 Foxcroft Dr., Doylestown 18901, 215- i 345-2290 j
Executive Secretary: John S. Detweiler, Apple ! Professional Bldg., Second & Apple Sts., Ste. 3, !
Quakertown 18951 , 215-536-8665 |
BUTLER COUNTY 1
President; Swamikkan A. Nallathambi, MD, 131 i E. Cunningham St., Butler 16001, 412-283- !
0212 j
President Elect: Randall M. Saylor, MD, 118 Edgewood Rd., Butler 16001
CAMBRIA COUNTY
President: Stephen T. Bush, MD, 320 Main St., Johnstown 15901, 814-533-0123 President Elect: Sam I. Krinsky, MD, Mercy Hosp., 1020 Franklin St., Johnstown 15905, 814-533-1000
Vice President: David A. Csikos, MD, 609 Somer- set Ave., Windber 15963, 814-467-3400 Treasurer: Thomas J. Strunk, MD, 1301 Meoher Blvd., Johnstown 15905, 814-255-5070 Secretary: Robert J. Swansiger, MD, 609 Somer- set Ave., Windber 15963, 814-467-3400 Executive Secretary; Michael P. Kohler, 47 Os- borne St., PO Box 36, Johnstown 15907, 814- 535-5493
Publication: MEDICAL COMMENT AND PHYSI- CIANS’ FORUM
CARBON COUNTY
President: Edward J. Miller, MD, 204 State Rd., Lehighton 18235, 215-377-6225 Vice President; Rodrigo D. Medina, MD, 336 Kid- die Ln., Walnutport 18088 Secretary/Treasurer: Edgardo P. Salazar, MD,
135 Lafayette Ave., Palmerton 18071, 215-826- 3141
CENTRE COUNTY
President: Stanley J. Yoder, MD, 911 University
Bern Rd.,
36
PENNSYLVANIA MEDICINE • AUGUST 1990
Worker Injury Program
Transitional Living Residence Mild Head Injury Program Neuropsychological Evaluations Support Groups
We provide a full continuum of care for Neurotrauma patients.
• Head Injury
Acute Coma Recovery Ranchos Level I
• Spinal Cord Injury
Inpatient Outpatient Care
RD 1 Box 250 • Reading, PA 19607
(215) 775-8323
Dr., State College 16801, 814-238-9459 President Elect: Edward H. Dench Jr, MD, PO Box 580, Boalsburg 16827 Vice President: Jeffrey H. Baker. MD, 426 S. Al- len St., State College 16801 Treasurer: Stanley Mayers Jr, MD, 648 Wiltshire Dr, State College 16803, 814-238-4014 Secretary: Jane A. M. Strickler, MD, PO Box 59, Boalsburg 16827, 814-234-6137
CHESTER COUNTY
President: Gary J. Levin, MD, 1500 Cardinal Dr, Coatesville 19320, 215-269-9100 President Elect: F. William Maguire, DO, 101 Cope Rd., Kennett Square 19348, 215-869- 3620
Vice President: Robert O. Satriale, MD, 319 N. Woodmont Dr, Downingtown 19335-3253, 215- 647-4018
Secretary: Richard F. Satriale, MD, 2604 Trinity Ct., Chester Springs 19425, 215-363-8479 Treasurer: Robert L. Yoxtheimer, MD, 710 S.
Main St., Phoenixville 19460, 215-933-5852 Executive Secretary: Carol Dotts, 580 Lancaster Ave., Berwyn 19312, 215-644-8120 Publication: CHESTER COUNTY MEDICINE
CLARION COUNTY
President: Ahmad Nabatchi, MD, RD 5, Box 148, Brookville 15825, 814-849-6767 Vice President: Jaiveer T. Reddy, MD, 82 Barnett St.. Brookville 15825, 814-849-8858 Secretary/Treasurer: Barry J. Snyder, PO Box 39, New Bethlehem 16242, 814-275-3320 Executive Secretary: Barbara Hibell, PO Box 39, New Bethlehem 16242, 814-275-3320
CLEARFIELD COUNTY
President: Douglas E. Trent, MD, 323 S. Centre St.. Philipsburg 16866, 814-342-5402 Vice President: Yi H. Kao, MD, 3 Medical Center Dr., Philipsburg 16866, 814-342-5402 Secretary/Treasurer: William D. Calley, MD, 21 1 N. Second St., Clearfield 16830, 814-765-1511
CLINTON COUNTY
President: James M. Andriole, DO, 121 W.
Church St., Lock Haven 17745, 717-748-5656 President Elect: Veryl F. Frye, MD, PO Box 181 Lock Haven 17745, 717-726-3163 Vice President: Steven W. Geise, DO, 200 Wood- ward Ave., Lock Haven 17745, 717-748-6795 Secretary/Treasurer: William C. Long Jr, MD, 53 W. Main St., Lock Haven 17745, 717-748-4063
COLUMBIA COUNTY
President: Ali A. Aliey, MD, 109 Mulberry St., Berwick 18603, 717-759-0351 President Elect: Blairanne H. Revak, MD, Penn & Glenn St., Bloomsburg 17815, 717-784-8101 Secretary/Treasurer: John E. Widger, MD, 1 S.
Hospital Dr., Bloomsburg 17815, 717-387-1444 Bulletin Editor: Wilma P. Webster, MD, 159 Clif- ton Dr., Bloomsburg 17815, 784-4143
Publication: MEDICAL BULLETIN OF THE CO- LUMBIA COUNTY MEDICAL SOCIETY
CRAWFORD COUNTY
President: M. Bruce Dratler, MD, 505 Poplar St., Meadville 16335, 814-336-6157 President Elect: John H. Bailey III, DO, 968 S.
Main St., Meadvilie 16335, 814-336-4652 Secretary: Robert N. Moyers, MD, 764 Kennedy St., Meadville 16335, 814-336-5995 Treasurer: Edward J. Owens, DO, 118 Railroad St., Cambridge Springs 16403, 814-398-4313
CUMBERLAND COUNTY President: Daniel P. Hely, MD, 816 Belvedere St., Carlisle 17013, 717-249-6112 Vice President: Stephen J. Krebs, MD, 804 Bel- vedere St., Carlisle 17013 Secretary/Treasurer: Melvin C. Gitlin, MD, 1113 Sherwood Dr., Carlisle 17013, 717-885-0183
DAUPHIN COUNTY
President: Ira Sackman, MD, 4717 Great Oak Ln., Harrisburg 17110 717-690-0943 President Elect: James F. Rich, MD, 509 Kentwood Dr., Mechanicsburg 17055, 717-761- 1844
Vice President: Richard M. Fencel, MD, 2601 N.
Third St., Harrisburg 17110, 717-238-7621 Secretary/Treasurer: Bradford K. Strock, MD, Harrisburg, Hosp., Harrisburg 17101, 717-231- 8310
Executive Secretary: Robert W. Evans, 217 State St., Med Bureau Bldg., Harrisburg 17101, 717- 234-1678
DELAWARE COUNTY
President: Mandell J. Much, DO, Route 1, Con-
Whether your practice is small or large, SMS has a solution that will perk up your profitability. . .while helping you better deal with new legislation, billing, managed care, productivity, and marketing.
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PHYSICIANS SERVICES DIVISION
38
PENNSYLVANIA MEDICINE • AUGUST 1990
PHILADELPHIA HEART IN
of Presbyterian Medical Center
I Cardiology Update ^
designed for the physician and provides an intensive survey of the current status of clinical cardiology. . .
1990-91
Moderators
Leonard N. Horowitz, M.D. Ami E. Iskandrian, M.D.
Bernard L. Segal, M.D. William J. Untereker, M.D.
5 September 3 October 7 November
5 December 9 January
6 February 6 March
3 April 1 May
Bedside Diagnosis of the Cardiac Patient (with stethophones) The Electrocardiogram (ECG slides discussed)
Recent Advances in the Treatement of Acute Mycardial Infarction Angina Pectoris
Stroke: Diagnosis and Management in the 1990's
Hypertension: 1990's
Women and Heart Disease
The Sudden Death Crisis in America
Geriatric Cardiology
Wednesdays, 3:00 - 5:00 p.m. Case Presentations Reception Following Session
CME Credits No Registration Fee Reservations; (215) 662-8627
Scheie Auditorium
Presbyterian Medical Center 39th & Market Streets Philadelphia, Pennsylvania 19104
cordville 19331, 215-459-3862 President Elect: H. Thomas Dodds, MD, 62 Lankenau Medical Bldg. East, Philadelphia 19151, 215-642-2099
Vice President: Mark W. Shulkin, MD, 105 Mary Watersford Rd., Bala Cynwyd 19004, 215-565- 0988
Secretary: Richard R. Ratner, MD, 100 E. Ches- ter Pike, Ridley Park 19078, 215-521-3333 Executive Director: David McKeighan, State & Sproul Rds., Ste. 100, Springfield 19064, 215- 328-1184
ELK-CAMERON COUNTY President: Emilio G. Flores Jr, MD, Andrew Kaul Memorial Hosp., St Marys 15857, 814-781-1445 Vice President: Larry J. Sarginger, MD 121 E.
Arch St., St Marys 15857, 814-834-2850 Secretary/Treasurer: Jayant L. Patankar, MD, 921 Vine Rd. Ext., St Marys 15857, 814-834- 9445
Bulletin Editor: John C. Reilly, MD, 3215 State St., Erie 16508, 814-456-2976
Publication: THE STETHOSCOPE
FAYETTE COUNTY
President: Richard A. Cook, MD, 132 Southwood Dr., Uniontown 15401, 412-437-1539
President Elect: Anthony S. lannamorelli, MD, 6 Spring Creek Ln., Uniontown 15401, 412-439- 9200
Vice President: Larry J. Papincak, MD, Union- town Hosp., 500 W. Berkely St., Uniontown 15401, 412-430-5026
Secretary/Treasurer: Gertrude Blumenschein, MD, PO Box 377, Chalk Hill 15421, 412-437- 1539
Executive Secretary: Anne L. White, PO Box 1212, Uniontown 15401, 412-437-7565
Bulletin Editor: Anne L. White, PO Box 1212, Uniontown 15401, 412-437-7565
Publication: NEWSLETTER
FRANKLIN COUNTY
President: Lawrence J. Boyler, MD, 620 Brum- baugh Ave., Chambersburg 17201, 717-264- 1881
President Elect: Nagib M. Khalifa, MD, 144 S. Eighth St., Chambersburg 17201
Vice President: James M. Chicklo, MD, 1039 Wayne Ave., Chambersburg 17202, 717-264- 2610
Secretary: James C. Barton, MD, 4073 Frecon Rd., Chambersburg 17201, 717-264-6185
HUNTINGDON COUNTY j
President: Frederick L. Jones, MD, 3228 Cold I Springs Rd., Huntingdon 16652, 814-643-5752 “ President Elect: James B. Hayden, MD, 3228 i Cold Springs Rd., Huntingdon 16652, 814-643- j 1414 I
Treasurer: Thomas C. Smith, MD, RD 1, Box j 387C, Huntingdon 16652, 717-275-5460 Secretary: David S. Miller, MD, 3228 Cold j Springs Rd., Huntingdon 16652, 814-643-6462 |
INDIANA COUNTY
President: Minoo D. Karanjia, MD, 1803 Route 422 West, Indiana 15701, 412-349-5440 President Elect: Steven P. Griffin, MD, Indiana Hosp., Indiana 15701, 412-357-7169 Vice President: James E. Bauer, MD, 877 Hospi- tal Dr., Indiana 15701, 412-465-8900 Treasurer: Peter Drenchko Jr, MD, 1265 Wayne Ave., Ste. 200, Indiana 15701, 412-465-6660 Secretary: William G. Evans, MD, 48 Sixth St., Clymer 15728, 412-254-4314
JEFFERSON COUNTY
President: Dennis W. Rhoades, DO, 6 N. Third St., Reynoldsville 15851, 814-653-8222 Vice President: Henry G. DelaTorre, MD, 231 E.
Highland St., Sykesville 15865, 814-894-2448 Secretary/Treasurer: Joseph J. Kernich, MD, Medical Arts Bldg., RD 5, Punxsutawney 15767, 814-938-3310
Bulletin Editor: Dennis W. Rhoades, DO, 6 N. Third St., Reynoldsville 15851, 814-653-8222
ERIE COUNTY
President: Dinesh C. Khera, MD, 238 W. 22nd St., Erie 16502, 814-452-2767 President Elect: A. Craig Brown, MD, 3216 State St., Erie 16508, 814-452-2767 Vice President: Theresa F. Fryer, MD, 300 State St., Erie 16507, 814-452-2218 Treasurer: Dennis M. Scully, MD, 1444 W. 38th St., Erie 16508, 814-868-0943 Secretary: Howard M. Levin, MD, 2626 Sigsbee St., Erie 16508, 814-455-7541 Executive Secretary: Robert B. Stuart, MD, 321 1 Liberty St., Erie 16508, 814-866-6820
GREENE COUNTY
President: Michael T. Czuba, MD, 1150 Seventh Ave., Waynesburg 15370, 412-627-5358
President Elect: Prafullchandra Vora, MD, Way- nesburg Plaza, Waynesburg 15370, 412-627- 8131
Vice President: John W. Reyes, MD, Greene County Memorial Hosp., Waynesburg 15370, 412-627-3101
Secretary/Treasurer: Nathan B. Duer, MD, Old Glassworks Rd., Greensboro 15338, 412-943- 3308
LACKAWANNA COUNTY
President: Harmar D. Brereton, MD, Mercy Hosp., 746 Jefferson Ave., Scranton 18510, 717-348-7200
President Elect: Anthony M. Perry, MD, Medical Arts Bldg., 300 N. Washington Ave., Scranton 18503, 717-343-3570
Vice President: J. Bruce Ruppenthal, MD, 748 Quincy Ave., Scranton 18510, 717-342-5011
Secretary/Treasurer: James L. Sundheim, MD, 700 Quincy Ave., Scranton 18510, 717-963- 2604
MEDICAL OFFICE SYSTEM
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1211 Streets Run Road, Pittsburgh, PA 15236 (412) 885-7100
40
PENNSYLVANIA MEDICINE • AUGUST 1990
DGHER BOTTOM LINE Iflk
The Health Care Group, Inc., is one
of the nation ’s longest established and most comprehensive health care consult- ing groups. Our nationwide practice is dedicated solely to serving health care providers.
Health Care Group
Meetinghouse Business Center 140 W. Germantown Pike, Suite 200 Plymouth Meeting, PA 19462 (215) 828-3888
LOWER STRESS LEVEL
The Health Care Group differs significantly from other consulting organizations by providing a multi-faceted service. Many problems facing physi- cians are comprised of interconnected legal, per- sonnel, marketing and financial elements. We are able to provide more comprehensive and fully rea- soned solutions to problems because of the exper- tise and range of disciplines available within the firm.
LAW
The separate law firm of Beck & Anders Law Associates,
Inc., provides support and advice on day to day and one time legal concerns.
• Professional corporation issues, development, maintenance and liquidation
• Retirement plan design and legal maintenance
• Fringe benefit planning and development
• New doctor arrangements, buy-ins and pay-outs
• Merger, acquisition and practice sale arrangements
• Legal aspects of handling personnel
• Tax and estate planning
• Hospital and medical school departmental arrangements
• Health law matters (third party disputes, antitrust concerns, HMO/PPO arrangements, etc.)
CONSULTING
• Practice management surveys
• Income division and inter-doctor arrangements
• Computer evaluation
• Financial systems analysis (billing, insurance, collections, etc.)
• Practice mergers and group practice development
• Development of traditional and other group arrangements and joint ventures
• Practice valuation and litigation support
PERSONNEL
• New associate feasibility study
• Physician search
• Medical and dental practice brokerage
• Administrator and practice manager recruitment
• Personnel compensation and benefits
• Motivational planning
MARKETING
• Patient information and educational products
• Demographic and competitive analysis
• Marketing and strategic planning
• Office site selection and design criteria
• Long term implementation of marketing goals
MANAGEMENT
• Sustained, on-site facility managers
• Stabilization of practice management
• Staff development
• Temporary management personnel
• CPT coding and ICD-9-CM instruction
Executive Director; W. Richard Kneller, PhD, Comp. HIth. Serv. Ctr. 1416 Monroe Ave., Ste. 301, Dunmore 18509, 717-344-3616 Bulietin Editor: Salvatore J. Scialla, MD, 1416 Monroe Ave., Ste. 301, Dunmore 18509, 717- 344-3616
Publication: LACKAWANNA MEDICINE LANCASTER COUNTY
President: Louis J. Neureuter, MD, 25 E. James St,, Lancaster 17602, 717-397-0555 President Elect: David E. Wiley, DO, 1725 Ore- gon Pk., Lancaster 17601, 717-569-2965 Vice President: Robert G. Doe, MD, 213 Tomo- hawk Dr., Conestoga 17516, 717-852-8985 Treasurer: Joseph A. Knepper, MD, 11 Holly Dr., Leola 17540
Secretary: Roland A. Loeb, MD, 435 W. Chestnut St., Box 1708, Lancaster 17603, 717-394-7234 Executive Secretary: Sally Sigafoos, 137 E. Wal- nut St., Lancaster 17602, 717-393-9588 Bulletin Editor; Roland A. Loeb, MD, 137 E. Wal- nut St., Lancaster 17602, 717-393-9588 Publication: LANCASTER MEDICINE
LAWRENCE COUNTY
President; Chin D. Chung, MD, 2602 Wilmington Rd., New Castle 16105, 412-658-9753 President Elect: Peter J. Mancino, MD, Leawood Dr., RD 3, New Castle 16105, 412-652-9822 Vice President: Stuart A. Gardner, MD, 804 N.
Jefferson St., New Castle 16101, 412-652-3616 Secretary/Treasurer: Timothy M. Heilmann, MD, 150 N. New Castle Rd., New Wilmington 16142, 412-946-3564
LEBANON COUNTY
President: Bruce E. Yeamans, MD, 21 School Ln., Lebanon 17042
President Elect; James W. Keller, MD, 71 1 Poplar St., Lebanon 17042, 717-273-2697 Vice President: James W. Keller, MD, 711 Poplar St., Lebanon 17042, 717-273-2697 Treasurer: Joseph M. Clark, MD, 711 S. Eighth St., Lebanon 17042, 717-273-9345 Secretary: John J. Messmer, MD, 921 S. Forge Rd., Palmyra 17078
LEHIGH COUNTY
President: Walter J. Okunski, MD, 1230 S. Cedar Crest Blvd., Ste. 204, Allentown 18103, 215- 432-1953
President Elect: John J. Stasik Jr, 1275 S. Cedar Crest Blvd., Allentown 18103, 215-433-7571 Vice President: Carmen G. Montaner, MD, RD 3, Box 722, Coopersburg 18036, 215-776-8810 Treasurer; Walter J. Finnegan, MD, 40 S. Cedar Crest Blvd., Allentown 18104, 215-433-7589 Secretary: Howard L. Carbaugh, MD, 614 N.
Sixth St., Allentown 18102, 215-432-6032 Executive Secretary: Robert R. Parsons, 1620 Highland St., Allentown 18102, 215-437-2288 Bulletin Editor; Robert R. Parsons, 1620 High- land St., Allentown 18102, 215-437-2288 Publication: THE “DR”
LUZERNE COUNTY
President: Norina M. D’lorio, MD, 998 Wyoming Ave., Forty Fort 18704, 717-288-6411 President Elect: Juan D. Gaia, MD, 451 Third Ave., Kingston 18704, 717-283-0529 Vice President: Peter G. Decker, MD, 166 Hano-
42
ver St., Ste. 301, Wilkes-Barre 18702, 717-823- 0505
Treasurer: Martin L. Freifeld, MD, 4 Poplar St., Kingston 18704, 717-288-4800 Secretary: David H. Moore, MD, Pierce Med. Bldg., 440 Pierce St., Kingston 18704, 717-283- 0529
Executive Director: Mr. Duane E. Kersteen, 130 S. Franklin St., Wilkes-Barre 18701, 717-823- 0917
Bulletin Editor: Edward Lottick, MD, 130 S.
Franklin St., Wilkes-Barre 18701, 717-823-0917 Publication: THE BULLETIN
LYCOMING COUNTY
President; Thomas S. Forker, MD, PO Box 312, Jersey Shore 17740, 717-398-7660 President Elect: William R. Beltz, MD, 699 Rural Ave., Williamsport 17701, 717-326-4007 Vice President: Robert S. Yasui, MD, 1001 Gram- pian Blvd,, Williamsport 17701 Treasurer: Donald E. Shearer, MD, 217 Broad St., Montoursville 17754, 717-368-8188 Secretary: Terry A. Belles, MD, 145 Shaffer St., Williamsport 17701, 717-326-2447 Executive Director: Paul P. John, 777 Rural Ave., Williamsport 17701, 717-323-6432 Bulletin Editor: Mr. Paul P. John, 777 Rural Ave., Williamsport 17701, 717-323-6432 Publication: LYCOMING MEDICINE
MCKEAN COUNTY
President: Raineldo C. Saquin, MD, 30 Laurel Ave., Kane 16735, 814-837-8585 President Elect: M. Javed Akhtar, MD, 199 Pleas- ant St„ Bradford 16701, 814-362-5503 Vice President: Shabir A. Bhayani, MD, 199 Pleasant St., Bradford 16701, 814-368-1020 Secretary: Hossain Sarajedini, MD, 42 Parkway Ln., Bradford 16701, 814-362-4171 Treasurer; Cecilio C. Dee, MD, Bradford Hosp., 116-156 Interstate Prkway, Bradford 16701, 717-368-4143
MERCER COUNTY
President: David A. Vermeire, MD, 2151 Shenango Vly. Freeway, Hermitage 16148, 412- 342-6200
President Elect: Saad Sakkal, MD, 10 Meadow Ln., Greenville 16135, 412-588-1925 Vice President: John G. Wassil Jr, MD, 735 Koonce Rd., Hermitage 16146 Secretary/Treasurer: Paul J. Dowdell, MD, 90 Shenango St., Greenville 16125, 412-588-4240
MIFFLIN-JUNIATA COUNTY President: James R. Naibert, MD, 3rd St. & High- land Ave., Lewistown 17044, 717-242-2381 Vice President: Sally M. Wooten, MD, 27 Sandy Ln., Ste. 140, Lewistown 17044, 717-242-2700 Treasurer: William T. Ayoub, MD, 3rd St. & High- land Ave,, Lewistown 17044, 717-242-4200 Secretary; Kimberly J. Manganaro, MD, 3rd St. & Highland Ave., Lewistown 17044, 717-242-4200
MONROE COUNTY
President: Richard P. Kennedy, MD. 206 E. Brown St., East Stroudsburg 18301, 717-421- 4000
Vice President: Michael W. Spence, DO, 239 E, Brown St., East Stroudsburg 18301, 717-421- 3872
Secretary/Treasurer: Robert F. G. DeOuevedo, MD, 175 E. Brown St., East Stroudsburg 18301, 717-421-3401
Executive Secretary: Candy Forrey, Pocono Hosp., 206 E. Brown St., East Stroudsburg 18301, 717-476-3392
MONTGOMERY COUNTY President: William W. Lander, MD, 888 Glenbrook Ave., Bryn Mawr 19010, 215-525-6277 President Elect: John E. Devenney, MD, 9501 Wheelpump Ln., Philadelphia 19118
PENNSYLVANIA MEDICINE • AUGUST 1990
Vice President: Roberta L. Schneider, MD, 139 Fernbrook Ave., Wyncote 19095, 215-661-7441 Treasurer: H. William Schmidt, MD, 378 Allendale Rd., King of Prussia 19406 Secretary: H. Craig Bell, MD, 1335 Highland Ave., Abington 19001, 215-886-4000 Executive Director: U. Berkley Ellis, EdD, 1529 DeKalb St., Norristown 19401, 215-277-3690 Bulletin Editor: H. Craig Bell. MD, 1335 Highland Ave., Abington 19001, 215-886-4000 Publication: MEDICAL BULLETIN
MONTOUR COUNTY
President: Robert E, Albertini, MD, Geisinger Medical Center, Danville 17822, 717-271-6924 President Elect; William F. Pharr, MD, Geisinger Medical Center, Danville 17822, 717-271-6367 Secretary/Treasurer: John S. Gerig, MD, Geisinger Medical Center, Danville 17822, 717- 271-8026
NORTHAMPTON COUNTY President; Terry J. Pundiak, MD, 3321 Sherwood Rd., Easton 18042, 215-253-4380 President Elect: Michael A. Abgott, MD, 1232 Stanford Rd., Bethlehem 18018, 215-865-6112 Treasurer: Walter K. Peters, MD, 724 Barrymore Ln., Bethlehem 18017, 215-694-5881 Secretary: Evan C. Reese Jr, MD, 2005 Fairview Ave., Easton 18042, 215-258-6268 Executive Director: William H. Kilpatrick, Execu- tive Secretary, 788 Redfern Ln., Bethlehem 18017,215-865-2900
Bulletin Editor; Mr. William H. Kilpatrick, 788 Re- dfern Ln., Bethlehem 18017, 215-865-2900 Publication: THE BULLETIN
NORTHUMBERLAND COUNTY President: John D. M. Judge, MD, 2 Twig Ln., , Sunbury 1 7801 , 71 7-286-7701 ^
President Elect: Jeffrey M. Greco, MD, 300 S. I Hickory St., Mt Carmel 17851, 717-339-3134 Vice President: Thomas J. Heromin, MD, 11 As- j pen St., Elysburg 17824, 717-672-9324 Secretary/Treasurer: Edward V. Twiggar II, MD, i 325 Center St., Shamokin 17872, 717-644-0494 i Executive Director: Paul P. John, Executive Di- rector, 2895 Euclid Ave., Williamsport 17701, I 717-323-6432 or 323-361 1 (pager) *
PERRY COUNTY
President; James J. Marakowski, DO, Perry Health Ctr., Loysville 17047, 717-789-3553 President Elect: Patrick T. Bolden, MD, Duncan- j non Family Health Ctr., Box 68, Duncannon 17020,717-957-3697 ;
Vice President: i
Secretary/Treasurer: Joseph J. Matunis, MD, RD i 2, Box 365, Loysville 17047, 717-789-3553
PHILADELPHIA COUNTY I
President: Paul J. Fink, MD, Philadelphia Psychi- atric Center, Ford Rd. & Monument Ave., Phila- i delphia19130,21 5-667-3788 President Elect: Donald Kaye, MD, 3300 Henry j Ave., Philadelphia 19129, 215-842-6950 |
Vice President: Richard M. Gash, MD, 1401 Red- | wood Ln., Wyncote 19095, 215-831-4980 i
Treasurer: William S. FrankI, MD, Hahnemann j Univ. Hosp., Broad & Vine Sts., Philadelphia 19102, 215-448-8790 !
Secretary: Norman Makous, MD, 829 Spruce St., Philadelphia 19107, 215-664-0818 Executive Director: John Trevi, Executive Direc- tor, 2100 Spring Garden St., Philadelphia i 19130, 215-563-5343 (FAX 215-563-3627) [
Bulletin Editor; William Weiss, MD, 2100 Spring f Garden St., Philadelphia 19130, 215-563-5343 i Publication: PHILADELPHIA NEWSLETTER
POTTER COUNTY '
President: Michael E. Callahan, DO, RD 1, Box j 203A, Galeton 16922, 814-435-2942 Vice President: Howard J. Miller, MD, RD 3, Box )
Your skills helped a stroke victim survive. Now, your referral can help him learn to live again.
The NeuroScience program at Harmarville Rehabilitation Center could enhance the quality of recovery for your next patient.
If your patient suffers a stroke, neurological or neuromuscular disorder, his or her recovery depends on how well your treatment plans can be carried out by rehabilitation specialists.
At Harmarville, our specially trained doctors, therapists and nurses are on the leading edge of knowledge in rehabilitation and physical medicine.
Which means we can treat medically complex rehabilitation cases early on— so your patient’s full-recovery potential may be realiz,ed.
What’s more, our NeuroScience Program Manager works directly with you, to ensure an appropriate treatment plan for each patient. So you can make every referral with confidence.
And now, we’ve taken our commitment one step further by developing our Resource and Reference Guide, to help simplify the lines of communication between you and our specialists. Our Guide provides in-depth information on our key medical staff and our specific areas of rehabilitation expertise, including our regional network of outpatient rehabilitation centers.
To take a closer look at the expertise of our NeuroScience Program, call JoAnn Nader, Director of Corporate Communications, at 412/826-2722.
© 1989 Harmarville Rehabilitation Center
Or write: P.O. Box 11460, Guys Run Road, Pittsburgh, PA 15238-0460. We’ll send you our Guide right away.
HARMARVILLE
Rehabilitation Center
Harmarville. It’s your reputation behind every referral. We take that seriously.
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 bene- fits? If you are not sure call MEDICAL PERSONNEL POOL and we will help you get the answer. Bear in mind that a person need not be a Social Security recipient or over 65 to receive Medicare services. People who are disabled for 2 years or more are eligible as are people who are in dialysis for 6 months or longer. MEDICAL PERSONNEL POOL pro- vides a full range of HOME HEALTH SERVICES, as well as private duty nursing. We provide most of these services in the home as well as in the hospital and nursing home.
MEDICAL PERSONNEL POOL
• Allentown 434-7277 • Philadelphia 663-0700
Harrisburg 233-2444 • Pittsburgh 683-2227
Lebanon 272-5214 • Reading 372-461 1
Monroeville 824-6730
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THE COMPLETE PRACTICE MANAGEMENT SYSTEM THAT TRULY REFLECTS THE NEEDS OF THE MODERN MEDICAL PRACTICE
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63A, Coudersporf 16915, 814-274-7070 Secretary/Treasurer; George C. Mosch, MD, 207 Cartee St., Box 72, Coudersporf 16915, 814- 274-8450
Vice President: Gloria J. Watkins, MD, 508 S.
Church St., Mt. Pleasant 15666, 412-547-1198 Treasurer: William S. Keck, MD, 516 Pellis Rd., Greensburg 15601, 412-834-3730
SCHUYLKILL COUNTY
President: Carl J, Forster, DO, 211 Timber Rd., Pottsville 17901, 717-622-9508 Vice President: Samuel C. Slimmer Jr, MD, Potts- ville Hosp., Pottsville 17901, 717-621-5060 Treasurer: William J. Gianfagna, MD, 316 Mauch Chunk St., Pottsville 17901, 717-622-2291 Secretary: Richard P. Bindie, MD, 150 Ave. E., Schuylkill Haven 17972, 717-622-6120
SOMERSET COUNTY
President: Jan R. J. deVries, MD, 430 Stonycreek St., Boswell 15531, 814-629-5568 President Elect: Harold S. Hay, MD, 867 W. Main St., Somerset 15501, 814-445-5169 Vice President: George A. Montgomery Jr, MD, 917 W. Main St., Somerset 15501, 814-443- 4634
Secretary/Treasurer: William C. Ryan, MD, 917 W Main St., Somerset 15501, 814-443-3648
SUSQUEHANNA COUNTY President: Jan C. Kletter, MD, Three Grow Ave., Montrose 18801, 717-278-3801 President Elect: Albert M. Bertsch, MD, Three Grow Ave., Montrose 18801 Vice President: Albert M. Bertsch, MD, Three Grow Ave., Montrose 18801 Secretary/Treasurer: John C. Cavender, MD, PO Box 213, Hop Bottom 18824, 717-289-4444
TIOGA COUNTY
President: David M. Cahill, MD, 11 Queen St., Wellsboro 16901, 717-724-2411 President Elect: Edgar Wong, MD, 14 Morris Ln., Wellsboro 16901, 717-724-6122 Vice President: Terrance E, Babb, MD, 24 Walnut St., Wellsboro 16918, 717-724-4241 Secretary/Treasurer: David F. Gillum, MD, 135 Main St., Wellsboro 16901, 717-724-1900, ext 441
UNION COUNTY
President: Jack L. Fairweather, MD, JPM Rd., Le- wisburg Med. Park, Lewisburg 17837, 717-523- 1210
President Elect: James W. Morgan Jr, MD, RD 5, Box 169, Lewisburg 17837, 717-523-3290 Vice President:
Treasurer: John L. Ginsburg, MD, 134 S. 16th St., Lewisburg 17837
Secretary: John A. Malcolm Jr, MD, Evangelical Com. Hosp., One Hospital Dr., Lewisburg 17837, 717-286-6553
Executive Director: Paul P. John, Executive Di- rector, 2895 Euclid Ave., Williamsport 17701, 717-323-6432 or 323-3611 pager)
VENANGO COUNTY
President: David A. Gehring, MD, Polk Center, PO Box 94, Polk 16342, 814-432-3171 President Elect: Gerald W. Kahler, MD, Croner Stone Fam. Prac., Route 322 & 257, Cranberry 16319, 814-677-5800
Vice President: John M. Karian, MD, RD 4, Box 675, Franklin 16323, 814-437-3005 Secretary/Treasurer: James J. Houser, MD, 150 Prospect Ave., Franklin 16323, 814-437-5776
WARREN COUNTY
President: Robert J. Weiss, MD, 103 W. St. Clair St.. Warren 16365, 814-726-2020 President Elect: Fred R. Taylor Jr, MD, 143 Pleasant Dr., Warren 16365, 814-726-3310 Treasurer: Daniel G. Lareau, MD, Warren Hosp.,
44
PENNSYLVANIA MEDICINE • AUGUST 1990
i
, 2 Crescent Dr., Warren 16365, 814-723-3300 ::5ecretary: Thomas E. Carson, MD, 209 N. State I St., PO Box 249, North Warren 16365, 814-723- I 5500, ext. 441
Sulletin Editor: Frank H. Butt Jr, MD, 508 S.
State St., North Warren 16365, 814-723-7251 Publication: WARREN COUNTY MEDICAL SO- CIETY BULLETIN
I Psychotherapy and
SYCHOPHARMACOLOGY: ' UPDATE 1990
WASHINGTON COUNTY
President: Richard S. Pataki, MD, The Washing- ton Hospital, 155 Wilson Ave., Washington 15301, 412-223-3131
President Elect: John F. Weldon, MD, 125 Tower St., Monongahela 15063, 412-258-2000 Secretary/Treasurer: Paul L. Reardon Jr, MD, 380 Wilbert Ave., Washington 15301, 412-223- 8943
Executive Director: Coby Bonessi, Executive Secretary, 218 Washington Trust Bldg., Wash- ington 15301, 412-222-1400 Bulletin Editor: Ernest L. Abernathy, MD, 218 Washington Trust Bldg., Washington 15301, 412-222-1400
Publication: THE MEDICAL BULLETIN
WAYNE/PIKE COUNTY
President: Jon K. Sternburg, MD, 1500 N. Main St., Honesdale 18431
President Elect: George W. Tietjen, MD, 507 High St., Honesdale 18431 Vice President: Stephen D. Wakulchik, MD, 1325 N. Main St., Honesdale 18431, 717-253-1205 Secretary/Treasurer: Harry D. Propst MD, 507 High St., Honesdale 18431, 717-253-2620
WESTMORELAND COUNTY President: Wilma C. Light, MD, 1100 Ligonier St., Latrobe 15650, 412-539-4551 President Elect: Mohammed F. El-Hillal, MD, 101 Lincoln Way West, Jeannette 15644, 412-523- 9952
Secretary: Gloria J. Watkins, MD, 508 S. Church St., Mt. Pleasant 15666, 412-547-1198 Executive Director: Richard S. Cole, MD, Execu- tive Director, 207 Coulter Bldg., Greensburg 15601, 412-837-5050
Bulletin Editor: Ronald S. Berardi, MD, Latrobe Hosp., West Second Ave., Latrobe 15650, 412- 537-1554
Publication: WESTMORELAND COUNTY MEDI- CAL SOCIETY BULLETIN
WYOMING COUNTY
President: Ian A. Kellman, MD, RD 5, 625 Hamp- ton Rd., Shavertown 18708, 717-836-2161 Vice President: Ray L. Landis, MD, Saddle Lake Rd., RD 4, Box 41 2B, Tunkhannock 18657, 717- 945-3071
Secretary/Treasurer: George H. Limpert, MD, PO Box 67, Route 29, Dimock 18816, 717-278- 1981
YORK COUNTY
President: Ronald L. Klimes, MD, Yorkshire Medi- cal Ctr., 3233 Eastern Blvd., York 17402, 717- 755-1480
President Elect: David L. Cohen, MD, Ortho- paedic Assoc, of York County, 80 Wyntre Brooke Dr., York 17403, 717-741-4653 Vice President: Rocco J. DeMasi, MD, 2020 Hol- j lywood Parkway, York 17403,
Treasurer: Samuel S. Laucks II, MD, 1601 S. Queen St., York 17403, 717-848-2067 1 Secretary: Cathy P. Carpenter, MD, Spring Gar- den Family Practice, 924M Colonial Ave., York 17403, 717-845-4846
Executive Director: Rhonda S. Renninger, Exec- ! utive Secretary, 1001 S. George St., York 17405, 717-843-6744
Bulletin Editor: Roland Friedrich, MD, Apple Hill Medical Ctr., 25 Monument Rd., York 17403, 717-741-2277 Publication: BULLETIN
Thursday & Friday
October 4 & 5, 1990
Depression and Personality Disorders
Day 1: The Adult Day 2: The Child
Featured Speakers
Paul Ambrosini, M.D. Emil Coccaro, M.D. Rex Cowdry, M.D. Madeline Gould, M.D.
Thomas Gualtieri, M.D. Bruce Pfohl, M.D. George Simpson, M.D. Program Director
Conference location is the Holiday Inn - City Line, Philadelphia, PA
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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Pennsylvania Allergy Association President: Sandra Gawchik, MD, Rivers Edge, 12-C, 23rd & Cherry Sts., Philadelphia 19103, (215) 439-8171
President Elect: George W. Kern IV, MD, 520 Ma- ple Ave., Ste. One, West Chester 19380 Secretary: Lawrence Caliguiri, MD, 8035 McK- night Rd„ Pittsburgh 15237, (412) 681-3333 Treasurer: Paul M. Mauriello, MD, 1610 Oak Hill Ave., Ste. 141, Hagerstown, MD 21740 PMS Administrator: Marti Evans
Pennsylvania Society of Anesthesiologists President: James Noone, MD, 1039 Lindsay Ln., Rydal 19046
President Elect: Edward H. Dench Jr., MD, P. O. Box 580, Boalsburg 16827
Secretary/Treasurer: John R. Quinn, MD, 320 Main St., Johnstown 15901, (814) 535-6623
Assistant Secretary: Donald E. Martin, MD, 19 Gentry Dr.. Palmyra 17078, (717) 534-6140
Executive Secretary: Mrs. Sally A. Nelson, 320 Main St., Johnstown 15901, (814) 535-6623
PMS Liaison: Donald N. McCoy
Pennsylvania Chapter, American College of Cardiology
President: Alfred A. Bove, MD, Cardiology Sec- tion, Temple Univ. Med. School, Philadelphia 19140, (215) 221-3346
Vice President: William Follansbee, MD, Univ. of Pittsburgh School of Medicine, 376-A Scaife Hall, Pittsburgh 15261, (412) 647-3435
Secretary/Treasurer: George R. Moffitt Jr., MD, 92 Tuscarora St., Harrisburg 17104, (717) 238- 1771
Past Governor, E. PA: William S. FrankI, MD, Li- koff Cardiovascular Inst., Hahnemann Univ. Hosp., 230 N. Broad St., Philadelphia 19102, (215) 448-8790
Past Governor, W. PA: Donald F. Leon, MD, 3800 Reservoir Rd., NW GUH, Washington, DC 20007
PMS Administrator: Linda Unsworth
Pennsylvania Society of Colon/Rectal Surgery President: Alan M. Resnik, MD, 111 S. 11, Ste.
6015, Philadelphia 19107, (215) 735-0357 President Elect: Pricha Boonswang, MD, 2358 Gruver Ave., Easton 18042, (215) 252-2229 Vice President: David Swerdlow, MD, 328 Bel- leville Ave., Bloomfield, NJ 07003 Secretary: Stephen Silver, MD, Manoa Medical Center, 1010 W. Chester Pike, Havertown 19083, (215) 446-7882
Treasurer: Gerald Frost, MD, 15 W. Wood St., #404, Norristown 19401, (215) 279-8686 Historian: Robin Rosenberg, MD, 9892 Bustleton Ave., Ste. 206, Moss Plaza, Philadelphia 19115
Pennsylvania Academy of Dermatology President: Gay D. Dunne, MD, 137 S. Pugh St., State College 16801, (814) 234-3381 Vice President: Ira Berman, MD, Dermatology Associates, 2319 S. George St., (717) 741-4666 Secretary: Robert L. Roschel, MD, 203 N. Lime, Lancaster 17602, (717) 392-6267 Treasurer: John A. Zitelli, MD, 90 Woodland Dr.. Pittsburgh 15228, (412) 681-9400
Pennsylvania Chapter, American College of Emergency Physicians
President: J. Ward Donovan, MD, M. S. Hershey Medical Ctr., Emergency Medicine Division, Hershey 17033, (717) 534-8955 President Elect: David J. Dula, MD, Geisinger Medical Ctr., Danville, PA 17822, (717) 271- 6812
Vice President: David Siegel, MD, JD, 2008 Gar- rick Dr„ Pittsburgh 15235, (412) 731-8523 Secretary: Joyce Petrini, MD, 1820 Jody Rd., Meadowbrook 19001, (215) 576-2450 Treasurer: David A. DeHart, MD, Western PA Hosp., 4800 Friendship Ave., Pittsburgh 15224, (412) 828-1545
PMS Administrator: David C. Blunk, Executive Director
Pennsylvania Academy of Family Physicians President: Jan R. J. deVries, MD, 430 Stonycreek St., Boswell 15531, (814) 629-5612 President Elect: Louis H. Castor, MD, The Phila- delphian, 2401 Penna. Ave., Apt. 9A7, Philadel- phia 19130, (215) 725-8111 Vice President: Marc Schneiderman, MD, Fifth Ave., Medical Assoc., Fifth & Mulberry Sts., Cor- aopolis 15108
Treasurer: Robert Robison, MD, 4813 Jonestown Rd., Ste. 205, Harrisburg 17109 Executive Vice President: Edward Nielsen, 5600 Derry St., Harrisburg 17111, (717) 564-5365
Pennsylvania Society of Gastroenterology President: Morton L. Goldstein, MD, 3362 Fifth Ave., Pittsburgh 15213, (412) 621-2334 President Elect: Michael M. Geduldig, MD, 4969 Berkley St., Harrisburg 17109, (717) 652-5505 Secretary: James F. Young, MD, 601 N. Duke St., Lancaster 17602, (717) 397-1400 Treasurer: Thomas J. Humphries, MD, 6600 Wis- sahickon Ave., Philadelphia 19119, (215) 834- 2624
PMS Administrator: Joanne E. Caulfield
Pennsylvania Society of Hematology & Oncol- ogy
President: Ronald N. Rubin, MD, 901 Drexel Ln., Bryn Mawr 19010
Secretary/Treasurer: Herbert S. Waxman, MD, York & Tabor Rds., Philadelphia 19141 PMS Administrator: Joanne E. Caulfield
Pennsylvania Society of Infectious Diseases President: Robert C. Aber, MD, M S. Hershey Medical Ctr., Hershey 17033, (717) 531-8390 Vice President: Carl Norden, MD, Montefiore Hosp., Dept, of I D., Pittsburgh 15213 Secretary Treasurer: Jerome Santoro, MD, Lankenau Medical Bldg., Ste. 310, Philadelphia 19151
Presenting
THE IMPLICATIONS OF NEW TECHNOLOGY
Featuring
C. Everett Koop, M.D
Former U.S. Surgeon General
Edmund Pellegrino, M.D.
Director, Georgetown University Center for the Advanced Study of Ethics
Uwe Reinhardt, Ph.D.
lames Madison Professor of Political Economics Princeton University
Daniel Maguire, Ph.D.
Professor of Ethics Marquette University
Steven Rosenberg, M.D.
Chief of Surgery, National Cancer Institute National Institutes of Health
A NATIONAL MEDICAL CONFERENCE
September 26-28, 1 990
Celebrating