Orlando Medical News October 2013

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Amitra Caines, MD

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Reducing StressOrlando practitioner talks candidly about rising anxiety level among healthcare providers ... 4

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(CONTINUED ON PAGE 8)

By LyNNE JETER

Mimi Guarneri, MD, FACC, and fellow founding members of the American Board of Inte-grative Medicine (ABIOM) spent the lingering days of summer putting the fi nal touches on a new board certifi cation examination for a specialty that’s garnering national attention.

“Creation of integrative medicine as a specialty by the American Board of Physician Specialties (ABPS) guarantees excellence in the fi eld and assures consumers of healthcare the practitioner they’re seeing has reached a high standard of practice,” said Guarneri, board-certifi ed

Recognizing Integrative Medicine as a SpecialtyABIOM fi nalizes board certifi cation exam

By LyNNE JETER

WINTER GARDEN –Florida Hospital leaders celebrated an-other milestone last month: breaking ground on Adventist Health System’s ninth campus in Metro Orlando.

The event offi cially launched construction of the Winter Garden Health Campus. The fi rst phase consists of a three-story, 75,000-square-foot building with a stand-alone emergency depart-

ment staffed around the clock by emergency room physicians who provide clinical expertise to Florida Hospital’s emergency rooms in Orange, Osceola and Seminole counties. The complex, slated to open next winter, will also include an outpatient imaging center and a multispecialty clinic with multiple physician practices.

“We’re very excited to be a part of this rapidly growing community of Winter Garden,” said Florida Hospital CEO


Another Backyard ExpansionFlorida Hospital continues to strengthen local footprint, breaks ground in Winter Garden

Dr. Mimi Guarneri

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PhysicianSpotlight

By JEFF WEBB

MAITLAND - When interventional cardiologist Amitra Caines says “I come from a medically oriented family,” it’s an understatement.

Her mom has a PhD in medical soci-ology and was a university professor; her dad has a PhD in clinical biochemistry and works for biomedical companies; one sister is a nurse practitioner; and another sister is a fourth-year medical school in-tern. Extend the familial radius a little and Caines’ medical roots include an uncle who is a pathologist; another uncle and a cousin who are orthopedic surgeons; a cousin who is a radiologist; a cousin who is a nurse; and a cousin who is a phar-macist.

They all saw each other at a family gathering earlier this summer, Caines said; the topic of medicine never came up. “We don’t get to see each other all that often, so we have plenty of other things to catch up on,” said the 36-year-old who in June opened her practice, Cardiovascu-lar Clinic of Orlando, which is actually in neighboring Maitland.

Caines said she is seeing a diverse population of patients “ages 19 to 99,” and takes “a special interest in women’s cardiovascular health. I think I am in a unique position to provide that” care. “I am the only black female cardiologist in the Orlando area, and also one of only two female interventional cardiologists in the Orlando area,” she said.

“I think women are a little bit more comfortable opening up to me and talk-ing about their various symptoms because I have a little more insight into the female experience,” said Caines. “In terms of cardiovascular health women often pres-ent with symptoms that are atypical to what males present with. For instance, with MIs (myocardial infarctions) men will more typically present with a crush-ing chest pain, or radiating pain in the left extremities. Women often have more dis-creet symptoms – heartburn, mild pain in the stomach, shortness of breath and an-gina,” she explained. “So you just have to be a little more aware that (women) may not present like the cardiology textbooks tell you.”

Caines continued: “A good portion of the population is surprised when they hear about these differences. What I im-press upon them when I give talks is that when they have symptoms they should come in to make sure it is not something more serious. Some people think that ‘If I’m not doubled over in pain and I don’t have (severe) chest pain, then I don’t have coronary disease.’ That is not always the case,” she said.

Regardless of gender, “I find treating complex cardiac cases and forming rela-

tionships with my patients very reward-ing,” said Caines, who knew she was going to be a doctor by the time she was 10 or 11. Moreover, an early fascination with how the heart functions guided her toward the specialty before she even started univer-sity. She was born and raised in Canada and lived there until her late teens, when the family moved to upstate New York.

Caines returned to Canada to earn her undergraduate degree in biochemistry at McMaster University in Hamilton, On-tario. “Then I moved back to the U.S. to begin my medical training,” she said. That included attending medical school at Case Western Reserve University in Cleveland, Ohio, followed by an internal medicine residency at the University of Illinois at Chicago. Then, in 2005, Caines accepted a three-year general cardiology fellowship at the University of Florida Jacksonville, which was followed by a one-year inter-ventional cardiology fellowship, also at UF Jacksonville.

Caines then spent almost three years practicing at the Florida Cardiovascular Association in Titusville, but eventually followed through on her dream of going out on her own and her desire to live in a more metropolitan area. “I’m more of a city person,” said Caines. “I scouted out Orlando and so far it’s going great and I really love working for myself.”

Her practice includes an office man-ager who is a medical assistant and a part-time medical assistant. Caines said she already is looking to expand. “I would like to put a satellite office on the north side of Orlando. I’ve also considered the Lake Nona area,” which is where her parents have retired, she said.

Caines said she does most of her car-dio-interventional procedures at Florida Hospital South and Florida Hospital Al-tamonte, and a lesser amount at Orlando Regional Medical Center. Most of her pa-tients are referrals from other physicians who appreciate her approach to patient

care, she said. “One thing I am known for is spending so much time with my pa-tients, explaining to them what’s going on, why they are in the hospital, how we are treating them, and what the next step is,” said Caines.

That self-assessment was backed up by Vanessa Williams, MD, who met Caines when she was practicing in Ti-tusville. “I met Amitra on my first day at Parrish Medical Center and we worked together for about two-and-a-half years,” said Williams, an anesthesiologist who re-ferred patients to Caines.

“I had patients who went through anesthesia and they came through on the other side with chest pains or diffi-culty breathing or other subtle changes. (Caines) was the person I tended to call most frequently for a variety of reasons. Number one, she is always available for her patients. Number two, she is ex-tremely thorough with her workup. She makes note of their complaints. She is very knowledgeable and she also is very caring and understanding,” said Williams. “She talks to them, not down at them. She ex-plains things to them in language they can

understand. She’s quite at good at that,” Williams said.

She and Caines both love to travel and have taken several vacations together, Williams said. She also was quick to praise Caines’ skills in the kitchen. “She loves to watch (Food Network television) and then try weird things. Most of the time they come out pretty good,” Williams laughed.

Caines said she especially enjoys cooking West Indian food because of her heritage. Her parents are natives of Trini-dad and Tobago and she has inherited their palate. Her favorite is roti, she said. “It’s like a tortilla wrapped around curry chicken.” But when she wants to impress friends at her Baldwin Park home, Caines cooks Italian. “Veal and sausage with bolognese sauce I make completely from scratch,” she said.

At home or at work, Caines said one tenet encircles both her professional and personal lives. “My faith in Christ influ-ences me in terms of compassion and trying to conduct business and medicine in an honest way. … It gives everyone a lot more patience and a lot more confi-dence,” she said.

Amitra Caines, MDCardiovascular Clinic of Orlando


By LyNNE JETER

Last month, An Obituary for the American Middle Class revealed the social class that once helped the U.S. economy prosper is on the verge of collapse, precipi-tated by the devastating toll of the housing market downfall and exacerbated by the credit crisis.

So what does that mean for doctors, who are also practicing medicine in the midst of the greatest transformative change in healthcare?

“We’re feeling it,” said Eudene Harry, MD, medical director of Oasis Wellness & Rejuvenation Center in Orlando, and au-thor of the recently released book, Anxiety 101: The Holistic Approach to Managing Your Anxiety and Taking Back Your Life. “We’re expected to be stoic. After all, we’re medical professionals! But the truth of the matter is, we can be just as susceptible to the negative impact of stress as our patients. If you’re in a place of exhaustion, stress and anxiety, it becomes particularly challenging to provide the best service.” So physician heal thyself so you can better help others to heal may be a more apt statement.

What are your thoughts on the elephant in the room nobody wants to discuss, namely the possible

destruction of the middle class? It means a lot of people have frayed

nerves. If this author is referring to the mid-dle class as the backbone of our economy, then what happens when anything loses its support? It collapses and everything it sup-ported collapses as well. So I would say no one is exempt from the anticipatory stress response to an impending loss of the ability

to support themselves and their loved ones. Whether this collapse actually takes place, the anticipation of such an event is just as stressful as the event itself. By the way, if you ask most healthcare providers, they’d say they’re defi nitely in the middle class. Many are feeling the same uncertainties about the ability to be able to provide and maintain.

With physicians adapting to signifi cant changes in the healthcare industry, how’s the anxiety level?

Medical professionals are under a sig-nifi cant amount of stress. We’re expected to be healthcare providers for others, but we really don’t have a place to take care of our-selves. We’re not immune to it; we’re more in the thick of it. Caregivers tend to be rela-tively more stressed than average individu-als, and medical professionals are the classic caregivers. Now we’re being asked to fulfi ll additional requirements with no additional time. The stress factor is going even higher!

What led you to focus on anxiety and stress in your practice?

Many moons ago, when I defi nitely started recognizing that I was becoming excessively stressed, I veered my interests in a different direction. I also started to recog-nize what was going on with my colleagues, and we’d discuss it. Our main question was: Why isn’t anybody talking about this? That gave me an overwhelming passion and a drive to start the conversation.

Where can physicians turn to discuss their rising anxiety level?

Unfortunately, nothing’s established unless it’s a program geared to helping phy-sicians who are at a crisis level. In general, we as healthcare providers must stop treat-ing our health so callously. We cannot on one hand lecture our patients about low-ering their stress levels, while remaining ignorant about ours. There’s a continuum (concerning stress) that should be recog-nized earlier, so we can intervene earlier, so we don’t get to a crisis point. I would love to see more programs created with that very goal in mind: preventing us from getting to a crisis level. Like my grandmother used to say, ‘an ounce of prevention is worth more than an entire pound of cure.’ If we think we’re exempt as healthcare professionals, we’re really operating under a misconcep-tion.

Has the change from production- to value-based medicine been a silver lining for doctors who have been working diligently to meet production quotas?

In the ideal world, it would seem it’s changing from production to value. But in speaking with my colleagues, they’re not seeing it that way. They still feel the pres-sure of production, but now also other mandates. I don’t hear them talking about slowing down production and focusing on value. That would be a whole different sce-nario.

When does pressure start for rising physicians?

It starts building in college, but esca-lates in medical school. Picture this: we have a person who wants to serve human-ity. Attending medical school is not an in-expensive venture and many of us may not have the money set aside to go to school so we borrow. If we’re going into the medi-cal profession at a signifi cant cost, what is the guarantee at the end of it? You’re not only competing for a limited amount of slots, which is stressful in and of itself, but you’re also thinking ahead. For example, if I go through medical school and I don’t get a residency slot, I’ve already invested a lot of time, energy and fi nancial resources. Then what? We have huge expectations and often times limited control of the out-come. It’s a set up for feeling overwhelmed. Then you can see the downside. Generally, medical students have the drive to succeed, are very competitive and will work hard to get to that light at the end of the tunnel. But what if you get to that light and all you fi nd is debt and uncertainty? Imagine those thoughts going through your head, along with the academic pressures of having to be the best. Now, imagine not having the re-sources available to help you cope with the rising pressure. When you’re driven with-out supportive resources, then it becomes a problem.

If you could offer one change to better handle stress, what would it be?

Paying attention to sleep quality (see sidebar) makes a signifi cant difference. It may seem too simplistic, but sometimes we’re so tired that it’s easy to overlook.

Reducing StressOrlando practitioner talks candidly about rising anxiety level among healthcare providers

Improving Sleep Quality

1. Give your body the routine it craves: go to bed at the same time every night.

2. Lose the soda, not the sleep. Try not to drink caffeinated beverages after 2 p.m.

3. Get to the gym early to get to sleep early. Exercising too close to bedtime may interrupt the sleep cycle.

4. Enjoy happy hour, but avoid alcohol intake at night. A nightcap usually has the adverse effect.

5. Create a relaxing routine before bedtime.

6. Listen to soothing music or sounds to “calm the savage beast” within.

7. Avoid distracting or stimulating sounds; they’re the enemy of sleep.

8. Leave your “sanctuary” if unable to fall asleep, until you’re tired enough to return to bed.

SOURCE: Anxiety 101: The Holistic Approach to Managing Your Anxiety and Taking Back Your Life, by Eudene Harry, MD.


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Lars Houmann. “We want to strengthen our presence in this community as a trusted healthcare partner that brings greater access to care close to home.”

Winter Garden Mayor John Rees was pleased that Florida Hospital selected the city located 14 miles west of downtown Or-lando as the site for its newest fa-cility, not only for the number of high-paying jobs it will bring to the community, but also how its presence will “make Winter Gar-den more attractive as a place that others will want to live, work and play.”

The historic event comes 10 months after Winter Garden commis-sioners unanimously approved the trans-formation of 58 acres located between Daniels Road and State Road 535 into a medical campus near the Winter Garden Village at Fowler Grove. The two parcels

of land include a 24-acre horse farm and a 34-acre empty site that recently had 350 townhomes on the drawing board.

Slight Stumbling BlockCity commissioners balked at the

ambitious plan originally set forth by the not-for-profi t organization. A proposed seven-story hospital on the city’s south side site would have been mired in legal ob-stacles, including opposition from home-owners in neighboring gated communities – Stonecrest, Bay Isle and Country Lake Estates – and the time-consuming hurdle of convincing state authorities of the need for more in-patient beds. Even though Florida Hospital will start with three sto-ries at the Winter Garden campus, it may eventually include seven stories.

“I hope years from now, people will look at that hospital and say we did the right thing,” Rees said last December, not-ing the potential height of 131 feet.

Borron Owen, an attorney repre-

senting Florida Hospital said at the Winter Garden zoning-board meeting late last year, said experi-ence “teaches us that when we get to more than 40 beds per fl oor, it becomes entirely ineffi cient and it becomes almost unmanageable to provide the superior level of health-care that we strive to provide.”

Owen added that patient beds could be limited to fi ve stories, with additional levels needed for surgi-cal suites, labs, and administra-tive offi ces, and pointed out that a hospital-commissioned study by two University of Central Florida professors determined that Florida Hospital’s more ambitious Winter

Garden plan would pump $3.5 billion into the local economy for 15 years, and would employ about 1,200.

Homeowners, who successfully fought mall developers who planned to build big-box stores and a movie theater close to their neighborhoods, emphasized how a seven-story hospital would impede their view and also complained about po-tential noise from a helipad.

Market ComparisonFor decades, the local community has

been served by Health Central Hospital in nearby Ocoee, which operated indepen-dently until Orlando Health acquired the 171-bed medical center in April 2012 for roughly $180 million. Orlando Health, also a not-for-profi t system, has added clinical programs for cardiac and stroke care, and has partnered with MD An-derson Cancer Center Orlando to bring cancer-treatment services into west Or-ange County.

At the groundbreaking event, Florida Hospital offi cials also revealed the new leader of the Winter Garden Health Cam-pus: Amanda Maggard, who has been part of the Florida Hospital team for nearly a decade, most recently as assistant admin-istrator at the healthcare system’s Winter Park Memorial Hospital.

“I’m excited to be a part of the process from the early stages, as the fi rst shovels go into the ground,” said Maggard, assistant vice president of West Orange development. “We’ll build a team of healthcare profession-als and a facility (for which) the community of Winter Garden can be proud.”

Another Backyard Expansion, continued from page 1

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By LyNNE JETER

DAYTONA—On a crisp weekend in mid-September, two patients and their families at the new $12.8 million Halifax Health Brooks Rehabilitation-Center for Inpatient Rehabilitation in Day-tona were bustling around effi-ciency apartments, working on newly reacquired skills to allow them independence before being discharged.

“It’s a safe way for our pa-tients to practice skills such as cooking, working at a computer, or anything else that’s part of their daily routine,” said Lydia Hendrix, director of the new cen-ter, about the two ADL (activities of daily living) suites that help distinguish the comprehensive rehabilitation facility. “It’s also very unique. Many rehabilitation facilities don’t have the benefit of those (ADL) rooms to allow fami-lies to work together.”

The new destination rehabilitation fa-cility located just outside Daytona opened Sept. 1, marking the first full-fledged partnership between Halifax Health and Brooks Rehabilitation.

“The great reputation Brooks Re-habilitation has is a wonderful match for the level of care provided and the mission at Halifax Health,” said Hendrix, of the healthcare provider’s programmatic re-

habilitation approach, which involves at least three hours of individual therapy daily. “For example, for specific diagnoses such as a traumatic brain injury (TBI), we have an entire team of specially trained therapists and nurses versus a general compre-hensive rehabilitation center.”

The new 40-bed center was three years in the making, with a pause to acquire the Certificate of Need (CON). Despite opposi-tion, the companies successfully showed the projected increase in population growth of more than 10 percent by 2016 in Volusia and Flagler counties, with at least one-third age 65 and older. Also, sporting events and tour-ism attractions such as NAS-CAR events and annual Bike Week and Biketoberfest ampli-fied the local need for “a variety of rehab challenges,” said Caro-lyn Geis, MD, medical director of the center.

The inpatient facility, featuring 20 private rooms each located on the 8th and 9th floors of Fountain Tower, comple-ments Brooks’ long-standing outpatient center for residents of Volusia and Flagler

counties with conditions such as stroke, TBI, spinal cord injuries, post-polio and multiple sclerosis.

Hendrix was brought on six months ago, and immediately hired a nurse man-ager and a therapy manager, who began hiring the first wave service team. When at capacity, the center will employ more than 120.

“Brooks has never had a rehabilita-tion unit within a hospital setting,” she said. “It’s working beautifully. Patients tell us their families are thrilled with their care.”

The amenities always induce patient chatter: a therapeutic recreation and game room, two high-tech gymnasiums, a court-yard with different surfaces for specialized wheelchair learning, a putting green, and outdoor grilling. Flat screen TVs, free WiFi and common areas for dining and socializing make families comfortable in the learning environment.

“Before we opened, Halifax Health was referring long-term rehab patients to Brooks Rehabilitation 90 miles away in Jacksonville and sometimes to the Shep-herd Center in Atlanta, which is 400 miles away. It’s not acceptable to send patients so far away from family and friends when that type of support is so crucial to a pa-

Rehabilitation Taken to a Higher LevelPartnership brings increased efficiency and quality



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in cardiology, internal medicine, nuclear medicine and holistic medicine.

ABPS, the fi rst multi-specialty certi-fying body to offer physician certifi cation in integrative medicine, is the offi cial cer-tifying body of the American Association of Physician Specialists (AAPS) and one of three national certifying organizations of MDs and DOs in 26 recognized medi-cal specialties. The ABPS has led industry response to trends in urgent care, disaster medicine, hospital medicine and family medicine obstetrics.

Andrew Weil, MD, said the forma-tion of ABOIM – one of 18 ABPS boards – marks an important milestone in the

development in the fi eld of integrative medicine.

“Finally, there’s a way for qualifi ed physicians to present themselves as experts in offering competent integrative care to patients,” said Weil, who helped establish integrative medicine as a specialty.

Of the other two national certifying organizations, the American Board of Medical Specialties (ABMS) represents the largest national organization certify-ing MDs and DOs. The American Osteo-pathic Association Bureau of Osteopathic Specialists (AOABOS) certifi es DOs only.

“Integrative medicine focuses on get-ting to the underlying cause of disease and

implementing personalized programs that help people achieve optimal health,” said Guarneri. “In conventional medicine, we’re taught to make a diagnosis and pre-scribe a treatment. In integrative medi-cine, we look for the underlying cause of the problem or health challenge. For ex-ample, in conventional medicine, we may diagnose diabetes and prescribe a medica-tion. In integrative medicine, we look at what a person is eating (to determine if) they’re defi cient in micronutrients linked to diabetes. If they’re physically fi t, are they exposed to toxins? Are they under stress? All of these can cause diabetes. We may prescribe medicine, but we also look to correct the underlying cause. We treat the whole person – body, mind and spirit – and we look at an individual’s relation-ships to family, community and planet.”

ABOIM and the Consortium of Academic Health Centers for Integrative Medicine defi ne integrative medicine as “the practice of medicine that reaffi rms the importance of the relationship be-tween practitioner and patient, focuses on the whole person, is informed by evi-dence, and makes use of all appropriate therapeutic approaches, healthcare pro-fessionals, and disciplines to achieve opti-mal health and healing.”

Guarneri, founder of the Scripps Center for Integrative Medicine in La Jolla, Calif., and president of the Ameri-can Board of Integrative Holistic Medi-cine (ABIHM), pointed out that as a cardiologist, her goal is to also reverse the patient’s health challenges.

“Integrative medi-cine provides me the tools that weren’t available in my conventional med-ical training,” she said. “As a cardi-ologist, I’m well versed in the role of medication, sur-gery and stenting for treatment of cardio-vascular disease. But, it’s my training in integrative medicine that’s taught me the principles of nutrition, the evidenced-based use of natural supplements, and the role of the mind-body connection. Inte-grative medicine allows me to complete

the circle of care.”Eudene Harry, MD, medical director

of Oasis Wellness & Rejuvenation Center in Orlando, was thrilled to learn about the new board certifi cation in integrative

medicine.“It’s very good that inte-

grative medicine is being acknowledged as a spe-

cialty,” said Harry. “The message is: let’s not be exclu-sive. Let’s be inclu-sive. Let’s look at all evidence-based material and treat it equally.”

Harry, who specializes in both

holistic and emer-gency medicine, said integrative medicine

allows “more focus on in-formation-gathering.”

“That’s going to be helpful,” she said. “Medications don’t address the issue that’s driving the patient to the doctor’s offi ce.”

Recognizing Integrative Medicine as a Specialty, continued from page 1

The 14th annual Science & Clinical Application of Integrative Holistic Medicine will be held Nov. 3-7 at the Vinoy Renaissance St. Petersburg Resort in St. Petersburg. The 2013 conference, Transform Your Practice & The Future of Medicine, is sponsored by the Scripps Center for Integrative Medicine and the American Board of Integrative Holistic Medicine.

Scripps Center founder Mimi Guarneri, MD, FACC, will launch the conference with a Nov. 2 event with “Bringing Integrative Medicine to Your Practice and Health Care System.”

The American Association of Physician Specialists (AAPS) and the American Board of Physician Specialties (ABPS) will host an exhibit promoting the new medical specialty board certifi cation.

Calling Florida HomeThe American Association of Physician Specialists (AAPS) and the American Board

of Physician Specialties (ABPS), one of three national multi-specialty organizations nationwide, got its start in the Midwest, made a stop in the Deep South, and landed permanently in Tampa.

Established in 1950 in Joplin, Mo., the national organization began certifying physicians in 1960.

After being headquartered in Atlanta, the AAPS and ABPS relocated to Tampa in August 2007.

“ABPS relocated to Tampa because of easy access for physicians due to our very close proximity to TIA and I-275/I-75,” said ABPS CEO William J. Carbone. “Moreover, the building presented a good future ROI for the association and its members. In addition, the quality of life and decrease in signifi cant traffi c – as was the case in Atlanta – offered a refreshing respite for staff. Being located between two large counties and the closeness of I-275 offered a valuable incentive in recruiting staff.”

Integrative Medicine Board Certifi cation 4-1-1

ABOIM certifi cation is available to both allopathic and osteopathic physicians in the United States and Canada who are practicing integrative medicine and have completed a residency training program approved by the Accreditation Council of Graduate Medical Education (ACGME), American Osteopathic Association (AOA), Royal College of Physicians and Surgeons of Canada (RCPSC), or College of Family Physicians of Canada (CFPC).

Complete eligibility requirements are available online.Qualifi ed physicians interested in becoming board certifi ed in integrative

medicine may submit an application by Dec. 1; the initial exam will take place next May. Applications are available online at www.aapsus.org and may be obtained by contacting the ABPS Certifi cation Department at (813) 433-2277.


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Medical Identity Theft, Too Easy to Commit


By DANIEL ANDREWS

Medical identity theft can have devastating consequences. Just ask Anndorie Sachs, a Salt Lake City mother of four who got a call from the Utah Division of Child and Family Services in April of 2007, in-forming her that agents were on their way to remove her four young children from her home as the result of a stolen driver’s license.

It usually takes a jolt like that opening sentence to get most people to take iden-tity theft seriously. In the medical profes-sion, where the HIPAA rules have long been in effect and are applied rigorously by most practices and practitioners, the significance of identity theft can be even slower to sink in. It would be helpful, at this point, to make a clear distinction be-tween lost data and identity theft. Every commercial entity (business, non-profit, educational institution, or other) that has, holds, or collects personal data has a moral and legal obligation to protect that data. Once Personally Identifying Infor-mation (PII) has been obtained by some-one with ill intent, identity fraud of various types can be perpetrated upon the victim. One type of fraud is medical identity theft, which can have far-reaching and serious consequences that most victims don’t an-ticipate. Medical professionals have long protected the medical details of patients’ treatments and conditions; however, pre-venting imposters from getting treatment, prescriptions, or medical devices requires a significant shift in awareness and meth-ods. This is complicated somewhat by the fact that now practically ALL data is con-sidered private and protected – something as simple as a name, address, and phone number all as part of one record need to be secured, whether or not medical infor-mation is attached. The point, in short, is that medical identity theft is not a HIPAA issue, and to the degree that HIPAA com-pliance is in place has really no bearing on the issues surrounding medical identity theft.

The Poneman Institute, in a study directly detailing the effects of medical identity theft, found that roughly 5.8 per-cent of American adults had been victims. Almost half of those (48 percent) lost their medical coverage as a result of the fraud. The direct economic impact, on average, was in excess of $20,000; that’s money paid by the victims for treatments and de-vices that they never received, attorney’s fees to fight the errors, and more. The indirect impact is impossible to measure; since many employers now want details of credit histories (which can be impacted by unpaid medical bills) and medical histo-ries, how many people are NOT getting

hired simply because they are the victims of fraud?

Let’s return to the case of Anndorie Sachs. Her driver’s li-cense was used (with-

out alteration, it should be noted) by a pregnant

woman with a

methamphetamine habit, Dorothy Bell Moran. Ms. Moran was checked into not one, but two different hospitals using the stolen ID; she gave birth to a pre-mature baby at University Hospital in Salt Lake City. Knowing that giving birth to a chemically-dependent baby constitutes child abuse in every state in the U.S., Ms. Moran walked out of the front door of the hospital and left the infant behind. Natu-rally, an investigation ensued, and using

the information on the driver’s license that had been supplied at the registration desk, Utah DCFS mistakenly concluded that Ms. Sachs was a criminal, and a danger to her other children. Although that element of the crime was eventually resolved, Ms. Sachs is left with a particularly disturbing residual effect: since it has been deter-mined that the treatment received by the criminal is now a part of Anndorie’s medi-


tient’s full rehabilitation recovery,” said Hendrix. “It was a loop that had to be closed to give patients the best possible outcomes.”

Stroke comprises roughly one in four neuro rehabilitation admissions, accord-ing to national averages. Orthopedic re-habilitation cases such as amputees, hip fractures or trauma comprise approxi-mately 12 percent of admissions.

“This is a high level of care, not something that you’d find in a nursing home or other general rehab setting,” said Hendrix. “More than 50 percent of patient treatment is performed by reha-bilitation professionals other than nurs-ing staff, with it conducted away from the bedside. It’s a rigorous program that will eventually lead to a patient and caregiver moving into our ADL suite, preparing for a return home.”

The average length of stay in an in-patient rehabilitation setting is typically 15.5 days, varying widely based on di-agnosis and injury. Average stays range

from 10 days for a joint replacement to 25 days for a spinal cord injury.

With these statistics in mind, the re-habilitation design team configured each floor of the center for ease and functional-ity, including common areas for congre-gate activities. Neurological patients are located on the eighth floor, orthopedic patients on the ninth floor.

Advanced rehabilitation equipment includes the most updated functional electrical stimulation, wireless systems and nerve stimulators for motor skills, such as Restorative Therapy’s RT300 electrical stimulation cycle for patients with multiple sclerosis, stroke, spinal cord injury or TBI. It uses functional electri-cal stimulation (FES) to stimulate up to 10 muscle groups in either the arms or legs for neuromuscular reeducation. Pa-tients and therapists work together on the

RT 300 cycle, mapping points of muscle fatigue for measurement and documen-tation. The new center also features a Bioness H200 Wireless Hand Rehabilita-tion System, a lightweight device that also incorporates the use of FES.

Expanding the services to include the inpatient rehabilitation component was a natural progression of providing compre-hensive care for patients with catastrophic injuries, said Geis, who initiated the de-velopment of the outpatient neuro reha-bilitation program 14 years ago.

“My role is to guide the team through the rehabilitation process and to ensure that all services integrate smoothly in order to allow patients to achieve their highest level of independence,” said Geis. “Medical safety and quality outcomes are my overarching goals. To assure these are met, our team of physicians, nurses, specialists in physical, occupational and speech therapy, psychologists, dieticians, and case managers meet weekly to address each individual patient’s progress and set patient goals for the following week. This is a fully integrated team approach that’s proven to produce the results for patients that we require. It also ensures every pa-tient will participate in their own care in order to build on gains leading to the best quality of life we can achieve.”

cal file, she cannot see her own records lest the privacy rights of Ms. Moran be vio-lated. As frustrating as that obviously is, those in the medical profession will rec-ognize that an inaccurate medical history file can actually be deadly.

Is the answer simply to check for a photo ID when a potential patient checks in? The scope of the solutions and ap-proaches that need to be considered, practice by practice, is too large and two “personalized” to be treated as a “one-size-fits-all” issue. But, it should be noted, that with $20 and two or three weeks of patience, any one at all can purchase a “novelty ID” that looks exactly like a state-issued driver’s license, with whatever picture and identifying details the buyer cares to supply. Take into consideration the fact that a patient’s medical insurance policy number is linked to his/her SSN, and that an SSN is linked to a driver’s license, and it becomes easy to see that medical identity theft is a relatively easy crime to commit. When the victims come looking for someone to blame, will it be YOUR practice named in the lawsuit?

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Rehabilitation Taken to a Higher Level, continued from page 7

Halifax Health & Brooks RehabilitationHalifax Health originated as a state-funded 125-bed hospital in 1928. During World War II, it was used as a convalescent facility.

In 1947, it was remodeled and returned to the community as an acute care hospital. In 1986, it was designated as the area’s own Level II Trauma Center. Now, it’s the area’s largest healthcare provider with a tertiary and community hospital representing 678 beds and more than 500 physicians in 46 specialties. It also provides psychiatric services, four cancer treatment centers, the area’s largest hospice organization, and a preferred provider organization. In 2006, Halifax Health expanded its services to Port Orange, New Smyrna Beach and other Volusia County communities with the opening of the 80-bed Halifax Health-Medical Center of Port Orange.

Halifax Health, a non-profit health system, is now in the middle of a 10-year master plan that includes The France Tower at Halifax Health Medical Center, a new 10-story inpatient tower and emergency department that opened in 2009.

Brooks Rehabilitation began as Genesis Rehabilitation with a 128-bed rehabilitation hospital in downtown Jacksonville built by St. John’s Cathedral in 1973. The first rehabilitation outpatient center was established in the newly acquired and renovated Memorial Healthcare Plaza in 1993.

(L-R): Dr. Carolyn Geis and Lydia Hendrix

Medical Identity Theft, Too Easy, continued from page 9

Daniel Andrews is president of Solutions on the Spot, consulting and insurance. He is a Certified Identity Theft Risk Management Specialist and has been educating employers and employees about identity-theft issues since 1988. He is qualified to offer guidance and advice across a wide range of industries, and is a sought-after speaker on various aspects of identity theft in a variety of settings. He can be reached at [email protected]


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IN FLORIDA

By LyNNE JETER

While the gap between medical graduates and the number of residency slots nationwide continues to challenge industry leaders, USF Health Morsani Col-lege of Medicine (COM) is bucking the trend. Within the next couple of years, the number of residency slots will nearly double to 1,400.

“We have one of the nation’s largest distributive residency programs, with 730 USF residents at seven sites, and a proposal to add another 700 residents,” former USF Health CEO Stephen Klasko, MD, also former dean of the Morsani COM, said before he left the school last month.

The ambitious plan fi ts the distributive model, al-lowing USF Health Morsani COM the ability to sponsor or participate in residency programs as “civilians,” ex-plained Charles Paidas, MD, vice dean for clinical affairs and GME for the USF Health Morsani COM.

“We’re offering a shopping list of educational and research initiatives that are required for GME certifi ca-tion,” said Paidas, noting that Naples Community Hos-pital is the school’s most recent affi liate addition, and that a pact with other affi liations are in the works.

When Paidas, the plan’s architect, became associate dean for GME in 2009 after fi ve years with the school, the residency program faced governance and operation

issues that required improved oversight. He assembled a strategic committee that

allowed the school to garner im-peccable institutional review

commendations from the Accreditation Council for Graduate Medical Educa-tion (ACGME). In 2011, he was promoted to his

current post.At the suggestion

of USF medical stu-dents, Paidas

also brought t o g e t h e r AAMC ex-

ecutives, GME leaders and medical school deans to the USF

Health GME Summit last year. The well attended event “begs the issue of a replay

this year,” he said. “Our goal was to characterize the state of GME in Florida. For example, the average num-ber of residents per 100,000 population in the U.S. is 35.9. Florida’s at 17.5. That’s a raw data point that tells you we need to double the workforce. That translates to 2,900 residency slots in the state.”

Boosting the number of residency slots also improves the chances of keeping new doctors in Florida.

“Florida had nearly a 59.6 percent retention rate of residents who complete their training and stay here,” noted Paidas. “The mantra around the country is: wher-ever you do your residency – not where you attended medical school – is likely where you’ll practice. USF pushes that to 68 percent.”

Residents Rising Florida Results for National Resident Match Program 2013 Main Residency Match

Bayfront Medical Center, St. Petersburg: 12

Cleveland Clinic Florida, Weston: 18

Florida Hospital-Orlando, Orlando: 36

Florida State University COM, Tallahassee: 22

Halifax Medical Center, Daytona Beach: 10

Jackson Memorial Hospital, Miami: 91

Larkin Community Hospital, South Miami: 8

Mayo School of GME, Jacksonville: 35

Miami Children’s Hospital: 24

Mt Sinai Medical Center, Miami: 29

Orlando Health, Orlando: 62

St. Vincents Medical Center, Jacksonville: 7

Tallahassee Memorial Healthcare, Tallahassee: 11

University of Florida, Jacksonville: 81

University of Florida-Shands Hospital, Gainesville: 143

University of Miami, Atlantis: 30

University of South Florida, Tampa: 128*

West Kendall Baptist Hospital, Miami: 4

Total fi rst-year resident slots: 751.

SOURCE: National Resident Match Program.


VVC takes Vein Care to

impoverished People of

Haiti and the Dominican Republic–Hispaniola

Hispaniola Medical Charity Hispaniola Medical Charity is a non-profit with 501(c)(3) status. Our mission is to provide medical, den-tal and surgical care to impover-ished people of Hispaniola, the is-land comprised of the nations of Haiti and the Dominican Republic. This charity was set up in honor of Dr. Hart’s father, Umbert Hart Sr. MD, who served as a surgeon in the Dominican Republic.

Under the direction of Dr. Hugo Hart, Vascular Vein Centers will be sending a team of healthcare pro-fessionals to treat impoverished patients with chronic venous insufficiency. Vein disease is a chronic disorder in which left untreated can cause pain, swelling, skin changes and ulceration to the lower legs which can be disabling.

This is our 2nd mission trip. Last year we were performed over 56 procedures. With the exception of one person, every patient had open sores and ulcers to their legs.

Lending a helping hand

Please DonateYour contributions will help to pay for

travel, supplies and medications

www.vvcmission.com

By SIMONE VIZCAyA

As a medical professional you have un-doubtedly heard this before: “I didn’t go to the doctor sooner because I didn’t want the doctor to find something wrong with me.”

Perfectly reasonable people choose to ignore warning signs in hopes that bad situ-ations will simply rectify themselves. Far too often, these people hear horror stories about how “so and so found a lump and died three days later! Go to the doctor.” Of course, this only causes people to avoid medical attention longer. Nothing makes someone avoid reality more than a scare tactic.

In a society where most people be-lieve that they bring about what they think about, being a professional who specializes in the realities of life isn’t easy. Though we all joke that the two inescapable realities of life are death and taxes, we only seem to plan for one. There is an immediate re-percussion for avoiding paying taxes; there is no immediate repercussion for avoiding funeral planning. That devastating conse-quence falls on the decedent’s family.

Parents who spent their entire lives protecting their children rarely con-nect protection with funeral planning. Yet, parents who have prearranged save their grieving children hours of what can only be described as emotional torment. Though the funeral directors are wonder-fully trained in managing all types of emo-

tions, they must get a job done. A copious amount of information is required to issue a death certificate. As many families learn too late, the information in his or her fam-ily member’s wallet does not satisfy the government’s requirements. Many times the family is sent home to gather more in-formation and return to the funeral home. This adds unnecessary strain in an already difficult situation.

In our industry, we have learned that people should never be responsible for planning the funeral of someone they love. It is emotionally and financially devastat-ing and causes widespread familial chaos. Each and every funeral professional has a story about families torn apart over some minute and seemingly unimportant argu-ment over funeral services. Most people are not rational when mourning the death of a loved one.

As the saying goes: “funerals are for the living not the dead.” Unfortunately, when no prearrangements are made, it is the survivors that live with decisions made in haste and pain. Though life insurance can sometimes take care of the financial burden, it cannot choose a casket, it can-not spend hours searching through records to find information. There is far more to death than dollars, just as there is far more to surgery than paying the bill.

Emotional overspending is our version of a myocardial infarction, preventing it is the key. When a loved one passes (espe-

cially in a sudden tragic event) the family will exhaust every resource available to give the loved one a final farewell worthy of royalty. On several occasions family members admit that the decedent “would have wanted something small and simple” immediately prior to purchasing a twenty thousand dollar casket and catering for 100 guests. In many minds, the amount of money spent is in direct relationship to how much that person was loved. As funeral professionals our main concern is fulfilling the requests of the surviving family mem-bers, but we must admit that it pains us to see a widow max out credit cards to bury a husband who wouldn’t have wanted to leave her with such a financial burden.

Though emotional overspending is trying, family dynamics also create cata-strophic consequences. Most parents can’t imagine intentionally creating a devastat-ing moment for his or her children. Yet not prearranging does just that. It takes an emotional fire and adds gasoline. Nothing rekindles old resentment like losing a par-ent. Siblings who never fought in adult hood can become mortal enemies when mom suddenly passes. There have been cases where lawyers got involved and buri-als were delayed. Unfortunately, funeral professionals are often caught in the cross fire when families fight. This makes the job of carrying out a respectable funeral signifi-cantly more difficult. Sadly, family feuds can last long after mom and dad have been laid to rest.

In order to alleviate the emotional and financial burdens from mourning family members, the funeral industry has shifted its focus from planning funerals at the time of passing to recommending that people prearrange one’s own cemetery and funeral services. Nearly all funeral homes have a free booklet available to the public which guides him or her through the pro-cess. Contained therein is all the informa-tion needed at the time of a passing. These booklets provide a guiding light to navigate through a devastating time. By completing the booklet and prearranging the services, funeral professionals estimate that four or more hours of planning are eliminated at the time of death. By removing this bur-den, mourners are given the opportunity to mourn.

Medical professionals have become very adept at providing bad news. Though telling someone he or she is gravely ill is difficult, being on the receiving end of that information is far worse. Though we know that the ultimate outcome of life is death, when death occurs it is invariably shocking and painful. No one should have to walk into a funeral home and pick out someone’s urn or casket on the worst day of his or her life. No one wants to think about death, unfortunately, that does not prevent it from happening. Plan for death, then go on liv-ing. It won’t hurt a bit.

Plan for Them, Not Yourself

Simone Vizcaya has spent the last two years assisting families with their end of life plans. She spends most of her time providing information through lectures at various venues. Simone is passionate about what she calls, “passing on love to another human being on the worse day of his or her life.”

If you wish to contact Ms. Vizcaya you may do so at [email protected].

GrandRounds

Poinciana Medical Center To Expand Emergency Department

In response to substantial community need for its services, Poinciana Medical Center, an HCA hospital, announced it will expand its Emergency Department to pro-vide patients with improved speed and ser-vice. The expansion will add eight beds and 3,500 square feet to the department – for a total of 20 beds and 14,500 square feet. De-sign is currently underway and construction is slated to begin in mid-2014. The project will likely be complete in approximately six months.

Since its opening in late July, Poinciana Medical Center has broadened healthcare access in Osceola and Polk counties, serv-ing over 3,200 individuals so far. As the hospital’s medical staff began treating a higher-than-expected volume of patients in the Emergency Department, administra-tors evaluated options for ensuring short wait times – ultimately determining that in-creased capacity was needed.

Located at 325 Cypress Parkway in Kis-simmee, the 110,000-square-foot hospital offers a full range of inpatient and outpa-tient acute/emergency care services, includ-ing surgery, laboratory, pharmacy, diagnos-tic imaging and diagnostic cardiac cath-eterization. In addition to the Emergency Department, the facility includes 24 private medical-surgical beds, a six-bed ICU and a helicopter pad for rapid transport of criti-cally ill patients.

Poinciana Medical Center employs ap-proximately 200 full-time staff members. Additionally, the hospital has more than 140 physicians as part of its medical staff.

Leesburg Regional Medical Center Nationally Recognized for Orthopedic Care

Leesburg Regional Medical Center (LRMC) has been named by Healthgrades® as a 5-Star Recipient for Overall Orthopedic Services in 2013 and has been recognized as a 5-Star Recipient for Joint Replacement and Total Knee Replacement in 2011, 2012 and 2013.

Healthgrades assigns hospital 5 stars (better than expected), 3 stars (as expected) or 1 star (worse than expected) based on their performance.

Patients that receive care from a hospital receiving a 5-Star rating have a significantly lower risk of experiencing complications during a hospital stay than if they were treated at a hospital receiving a 1-Star rat-ing. Don Henderson, CEO, said he hopes that this national recognition will help com-munity members considering orthopedic procedures to realize that they have world-class physicians and a caring clinical team at LRMC in their own community.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.


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Health Management Associates Joins the Florida Hospital Association

The Florida Hospital Association (FHA) has announced that Health Man-agement Associates, Inc. (NYSE: HMA) has joined its statewide association of hospitals and health systems. HMA’s Florida network, its largest nationwide, includes 23 general acute care hospitals and a clinical affiliation with UF Health Shands Hospital.

“We are honored to welcome HMA to the Florida Hospital Association,” said FHA President Bruce Rueben. “HMA is a dynamic organization that will strength-en and enhance our efforts to promote safe, effective, affordable care in the state of Florida.”

The Florida Hospital Association serves as a unified voice for the Florida hospital community, advocating on be-half of its hospital and health system members to maintain and improve ac-cess to quality health care for all Florid-ians.

“Our 23 hospitals and 15,000 associ-ates from the western panhandle to Key West are an important voice in Florida, and we are pleased to combine our re-sources with other excellent health sys-tems as we seek to bring awareness to the issues affecting Florida’s health care system and economy,” said Alan Levine,

senior vice president and Florida group president.

FHA’s HMA member hospitals in-clude: Bartow Regional Medical Center, Bayfront Health Brooksville, Bayfront Health Dade City, Bayfront Health Port Charlotte, Bayfront Health Punta Gorda, Bayfront Health Spring Hill, Bayfront Health St. Petersburg, Heart of Florida Regional Medical Center, Highlands Re-gional Medical Center, Lehigh Regional Medical Center, Lower Keys Medical Center, Physicians Regional Medical Center-Collier Blvd., Physicians Regional Medical Center-Pine Ridge, Santa Rosa Medical Center, Sebastian River Medi-cal Center, Seven Rivers Regional Medi-cal Center, Shands Lake Shore Regional Medical Center, Shands Live Oak Re-gional Medical Center, Shands Starke Regional Medical Center, St. Cloud Re-gional Medical Center, Venice Regional Medical Center, Wuesthoff Medical Cen-ter-Melbourne and Wuesthoff Medical Center-Rockledge.

In addition to these hospitals, HMA has entered into letters of intent for the acquisition of Ocala’s Munroe Regional Medical Center in partnership with UF Health Shands Hospital and Bert Fish Medical Center - both of which are cur-rent FHA members and will continue their membership.

Noble Expands into Global Biologics Market with Multisensory Device Training

Noble®, designer and manufac-turer of training devices, is expanding its services to the global biologics mar-ket, offering customized solutions for biopharma drug delivery brands. With the injection market growing 14 percent over that last year, Noble is seeing an in-creased need for training tools to com-plement self-administered injection de-vices, especially for biologics. This trend will continue as submissions of Biologic Licenses Applications (BLA) outnumber those of small molecule drugs. In 2010, the global biologics market was valued at an estimated $149 billion and is ex-pected to reach $239 billion by 2015. In addition, research also shows the global injectable drug delivery technologies market was valued at $22.5 billion in 2012 and is expected to reach $43.3 bil-lion by 2017.

The boom in the biologics and in-jections markets at large has created a need for device training engineers, said Jeff Baker, CEO of Noble. Biologics and injections have a higher efficacy rate but at the same time, come with increased complication and anxiety for the patient, thus reducing adherence and compli-ance.

A study recently published by IMS In-stitute for Healthcare Informatics, found that the billions spent in medication mis-use could prevent millions of hospitaliza-tions, emergency room visits and trips back to the patient’s healthcare provider.

With noncompliance costing the nation hundreds of billions of dollars per year, pharmaceutical brands are increasing in-vestment in patient education tools and device training systems, making self-ad-ministered treatments easier to under-stand for patients.

Low adherence rates are often a re-sult of the increasing role patients are playing in the self-delivery of their treat-ments, like with wet injections, and the lack of simple instructions for use.

Multisensory technologies, such as audio, visual, and tactile feedback, strengthen the resonance and connec-tivity between the patient and the medi-cation, said Baker.

Noble is working with the top brands in the world to implement device train-ing systems to increase patient confi-dence with medications and devices.

Celebration Neurosurgeon Performs World’s First Mazor Robotics Deep Brain Stimulation for Parkinson’s

In August, Nizam Razack, MD, JD performed the world’s first deep brain stimulation (DBS) using Mazor Robotics Renaissance Guidance System at Cel-ebration Health hospital. Dr. Razack per-formed the same procedure later on two more patients with positive results.

DBS is a procedure to surgically im-plant a small battery-operated medical device called a neurostimulator to de-liver electrical stimulation to targeted ar-eas in the brain that control movement. This blocks the abnormal nerve signals that cause the debilitating neurological symptoms of Parkinson’s disease and Essential tremor, such as trembling and slowed movement.

Utilizing Renaissance’s proprietary pre-operative planning software, sur-geons can determine the optimal trajec-tory for implanting the electrodes be-forehand and use the guidance unit to execute the implantation with precision. In Dr. Razack’s cases, Alpha Omega’s microdrive, NeuroDrive™, was used in conjunction with Renaissance to carefully position the electrode in the right area of the brain.

Some 30,000 people with Parkinson’s have undergone DBS according to the Parkinson’s Disease Foundation, and Progress in Brain Research states that there are 8,000 to 10,000 new cases each year worldwide.

Renaissance has also been utilized successfully in 36 brain biopsy proce-dures in Germany. This could be a major application for Mazor Robotics technol-ogy as there are 180,000 new diagnoses of brain tumors each year, according to US News and World Report.

Mazor Robotics plans a wider com-mercial launch for the brain application in early 2014, and to showcase the ap-plication at the American Association of Neurological Surgeons (AANS) meeting in April 2014.

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