The Leg.Up
Local, state and national news of interest to the
physician community
January 27, 2016 First Zika Virus Case in Virginia; Physicians Alerted
A Virginia woman contracted the Zika virus while traveling out of the
country, the Times­Dispatch reports today. "The woman lives in the
northwest region of the state... Lab testing completed Monday
confirmed the woman was infected."
State health officials, citing patient privacy rules, would not say if the
woman showed any symptoms or if she was pregnant. Once considered
a relatively rare and minor virus, Zika is "now thought to be responsible
for a huge increase in the number of children in Brazil born with
underdeveloped heads." Because mosquitoes aren't active
in Virginia during the winter,
officials said there's little risk of
the virus spreading in the Old
Dominion. But they "want doctors
to be on alert for possible cases
among returning travelers," the
TD reports.
"We are facilitating testing," said
Dr. Laurie Forlano, state
epidemiologist at the Department Feeding time for mosquito blamed for
of Health. "We are encouraging
spread of virus providers to report suspected
cases as we would with any reportable condition."
She noted, however, that "most of these cases are asymptomatic," with
80 percent of individuals infected exhibiting no symptoms whatsoever.
"The focus for us right now is on this pregnant woman population, but
not limited to that population."
Zika cases also have been reported in Texas, Florida and Arkansas.
Public health officials are "scrambling to respond to the crisis," the TD
reports, urging "doctors to test newborns who show signs of the Zika
virus." New CDC guidelines "have special application in parts of the
country where mosquitoes are active all year," such as Florida, Texas
and other parts of the Deep South.
Meanwhile, Virginia Health Commissioner Dr. Marissa Levine told
the TD: "Pregnant women are strongly encouraged to consider
postponing travel to Zika­affected countries while pregnant."
The most common symptoms of the virus are fever, rash, joint pain and
conjunctivitis. There's no Zika vacccine, though some drug companies
are considering trying to develop one (read more below). Over the weekend, the government of El Salvador advised women in the
country not to get pregnant until 2018, prompting this question from
The New York Times: "When in human history has an epidemic become
so alarming that a nation feels compelled to urge its people not to have
children for two years?"
The virus has rattled Latin America and the Caribbean, particularly
Brazil, "where more than a million people have been infected and nearly
4,000 children have been born with microcephaly, a rare condition in
which babies have unusually small heads," the Times reports.
Women in Brazil and Colombia have also been asked to avoid
pregnancy, according to news reports.
Click here to read an update from
Dr. Levine as she joined the federal Centers for Disease
Control and Prevention in suggesting postponement of all
travels to Zika­infected areas of the world.
Click here to check the CDC's travel notices.
The virus is transmitted by the Aedes aegypti mosquito,
which is also known to carry the dengue, yellow fever and
Marissa
Chikungunya viruses, Reuter reports.
Levine, MD,
MPH, FAAFP Zika "is expected to spread to the United States and most
of the Americas, the World Health Organization said Monday," reports
USA Today.
The outbreak is especially concerning in Brazil because of this summer's
Olympic Games in Rio de Janeiro. The government said those sites will
undergo daily inspections to prevent the virus from spreading. Meanwhile, GlaxoSmithKline Plc is concluding feasibility studies
evaluating whether its vaccine technology is suitable for the Zika virus,
reports Reuters.
RAM's White Coat Brigade: Making the Public Personal
As a group of RAM physicians engaged in a frank, give­and­take
with state Sen. Donald McEachin, the Henrico­based legislator
paused for a moment at the mention of a familiar doctor's name
that came up during Tuesday's White Coat Day at the General
Assembly. "I'm feeling warm and fuzzy," McEachin said of a doctor who
practices with Dr. Mark Monahan at Virginia Urology. "He's my
doctor! Tell him to put on his white coat and come down here!"
The old adage ­ "all politics is local" ­ was clearly evident as
Academy members and guests connected with key Richmond­area
legislators at our first White Coat Day in conjunction with the
Medical Society of Virginia (read below about our next
opportunity to meet with legislators on February 9!)
McEachin, for his part, was pointed in his questioning on a number
of Certificate of Public Need (COPN) bills. He voiced arguments
against phasing out the program, as Del. John M. O'Bannon III
(R­Henrico) has proposed and RAM backs along with the MSV.
Click here for a Medical Society of Virginia member alert regarding
O'Bannon's HB 193 creating a three­phase process to "sunset"
COPN requirements for medical care.
Our intrepid members ­ undeterred by the cold and the piles of
snow and ice along Broad Street ­ informed legislators about a
plethora of issues ­ from the state's Prescription Monitoring
Program, to the need for legislation to protect young people against
tanning beds, to efforts by nurse practitioners to increase their
scope of practice.
Regarding the COPN bills, McEachin said he's been having a "series
of conversations" with representatives of Virginia hospitals in his
role as chairman of the Virginia Senate Democratic Caucus. "One of
the things they're saying is that you physicians want to cherry pick
services" that pay well, "leaving charity care to the hospitals," he
said. "That is a compelling argument, but I invite you to tell me
how it's wrong."
Dr. Rhoda Mahoney, a RAM board member, was up to the task,
explaining how as a pediatrician she often sees the benefit for her
patients of sending them to more affordable care by specialists who are covered by the COPN. And Dr. Monahan. who serves as Vice President of RAM's board,
informed McEachin that "there are requirements for charity care"
for practitioners with COPNs, "and I don't think anyone is cherry­
picking patients."
At Virginia Urology, for example, Monahan said he could treat
kidney stones for half the cost of sending someone to a hospital for
similar treatment. Other members of the RAM delegation ­ family
practitioner Dr. Patrick Woodward and Brigette Booth,
CEO/Administrator of Virginia Urology ­ provided their own
compelling stories and persuasive data.
As Sen. McEachin shook hands with his departing Academy guests,
he made no promises on how he'd vote. But he clearly left the door
open for future talks. "It's something I'll continue to learn about. I
really am a blank slate on this. Just because I'm a lawyer, I ask
questions."
And the questions ­ and connections ­ were often as deep as the
snow outside. For example, newly­elected Senator Amanda
Chase (R­Chesterfield) said one of her four children is studying at
James Madison University to be a physician's assistant.
"When they were young," Sen. Chase said of her kids, "we visited
the hospital four times a week." Chase, who sits on the Senate's
Education and Health Committee, seemed pleased to receive a
complimentary "check" for more than $32 million ­­ showing the
amount of free charity care Academy members and others have
provided to uninsured people of the Richmond area through Access
Now since 2008. Thanks to the following RAM members and guests who brought
their special talents and energy to White Coat Day: Brigette Booth John F. Butterworth IV, MD
Clifford L. Deal III, MD
Georgean G. deBlois, MD
Egidio del Fabbro, MD
J. Mark Hylton
Karsten F. Konerding, MD
Hazle S. Konerding, MD
Walter Lawrence Jr., MD
Rhoda B. Mahoney, MD
Ibe Mbanu, MD, MBA, MPH
Mark Monahan, MD M. Craig Pinsker, MD
Donald M. Switz, MD
Richard A. Szucs, MD
Ife Torrence, FNP­C
Patrick M. Woodward, MD RAM Members with new Senate member Amanda Chase of
Chesterfield. Snow? What Snow? RAM members and staff wave hello on Broad
Street. New State Senator Siobhan Dunnavant, MD is greeted by new and old
friends from RAM: (l to r) Mark Hylton, Dr. Karsten Konerding, Sen.
Dunnavant, Dr. Hazle Konerding, Dr. Don Switz Please click here for a link to more photographs from
yesterday's lobby day!
Mark your calendars for RAM's Next 2016 White Coat Day: February
9th
Make plans now to attend RAM's next 2016 Lobby Day at the General
Assembly (Tuesday, February
9th). Join your colleagues for
breakfast and a legislative
briefing before meeting with local
legislators and sharing your
valuable input and perspective
with them. WHAT WILL YOU HAVE TO DO?
Take the morning off from
your duties February 9th
(from 8:00 AM to 12:00 PM).
Meet at the Hilton Richmond Downtown (MSV's base of operations
during the General Assembly session) at 8:00 AM
Attend a morning briefing about what's happening on that day at
the General Assembly.
In small groups, visit one or more elected officials (RAM staff will
arrange the meetings and take you there).
Wear a white coat! WHAT WILL RAM/MSV DO FOR YOU?
Arrange transportation from your hospital to the Hilton Richmond
Downtown.
Arrange meetings for small groups of physicians with elected
officials.
Provide you with background information so you can discuss issues
with the elected officials.
Feed you breakfast and lunch.
Lend you a white coat if you don't have one.
Return you to your hospital.
CLICK HERE to sign up for the February 9th White Coat Day or call Lara at 804­622­8137 or email her at lknowles@ramdocs.org to register!
Depression Screening Urged for Maternal Depression
"Women should be screened for
depression during pregnancy and
after giving birth," according to a
new recommendation by the
United States Preventive Services
Task Force, reports The New York
Times.
It was the first time the
government­appointed panel has
Melissa Mead, with two sons, had
recommended such screening for postpartum depression and anxiety.
maternal mental illness. The
(courtesy The New York Times). effort is "expected to galvanize
many more health providers in the wake of new evidence that maternal
mental illness is more common than previously thought" ­ with more
ties to what has been called "postpartum depression," and findings "that
left untreated, these mood disorders can be detrimental to the well­
being of children."
One in seven new mothers are thought to have such symptoms, the
Times reports. The recommendation was part of a broader effort by the
advisory panel to update screening guidelines for depression.
Gun‐Rights v. Gun‐Control in Va. Senate
A Virginia Senate panel last week "scrapped a raft of gun­control bills
while advancing measures intended to expand gun rights," reports The
Washington Post.
Among the legislation was one, proposed by Sen. George L. Parker
(D­Fairfax) that would have created a way for authorities to remove
firearms from people deemed by a Circuit Court judge to be at
"substantial risk" of injury to themselves or others.
"There are people slipping through the cracks who are a danger," said
Lori Haas, a gun­safety activist whose daughter was injured during the
2007 Virginia Tech massacre. "It's not meant to send somebody into
your home unnecessarily."
The Republican­led Senate Courts of Justice Committee easily
defeated the bills and similar measures to tighten gun restrictions,
"sometimes on party­line votes, sometimes with support from a gun­
rights Democrat, Sen. R. Creigh Deeds of rural Bath County."
"Doesn't it bother you that a person's residence could be searched?"
asked Sen. Richard H. Stuart (R­Stafford) in relation to Barker's bill.
Stuart said that he would rather that people suffering from mental
health crises be removed from their homes via a commitment process
rather than having their guns taken from them.
Read more about what's at stake with this issue, both in Virginia and
nationally, including state measures "aimed at expanding gun­rights,"
the Post reports.
Why Some "Roll the Dice" on Health Insurance
The ACA's legal requirements have put a
financial strain on those Americans who can't
pay up to $1,000 a month for employer­based
insurance plans, reports Kaiser Health News. In
response, some workers are cobbling together
short­term coverage that cost less.
One Dallas lab tech worker explained why she
purchased three lower cost policies for herself,
her husband and her two­year­old daughter:
They cost less than half what her employer would have charged for full
family coverage.
She'd rather face stiff federal fines under the ACA "because "when I look
at what I'm saving having a short­term plan versus regular insurance,
it'll balance out."
One insurance expert told Kaiser, "They may be making the best
decision they can for themselves given their financial and health
situation. But it's a big roll of the dice..."
Bon Secours' Fortini: "Medicaid expansion makes sense for
Virginia" Click here to read a column
on Medicaid expansion in
Virginia by Robert J.
Fortini, vice president and
chief clinical officer of Bon
Secours Medical Group,
and by
and by
Len M. Nichols, director of
the Center of Health Policy
Research and Ethics at
George Mason University.
They begin by saying
"opponents never stop
spreading misinformation
about health reform,
especially when the General
Assembly is in town. Luckily,
Bon Secours' Robert Fortini facts are stubborn, and
evidence is pouring in from other states to validate proponents'
claims: Support for Medicaid expansion can be (and should be)
bipartisan."
Medicaid expansion is favored by Senate Democrats and Gov.
McAuliffe ­ and by the Medical Society of Virginia, among
others. But it still faces stiff opposition from the GOP­controlled
state Senate and House of Delegates.
Fortini and Nichols argue that expansion makes sense to improve
the quality of health care, to strengthen local economies, and, of
course, to help Virginia's hospitals.
Click here to read more about how President Obama recently
"sweetened the pot" for states that choose to expand Medicaid.
New Guidelines Nudge Docs to Give Patients Access to Medical
Records
New federal guidelines signal a push by the White House to stiffen
patient records regulations, including ending a longstanding policy to
charge a fee for retrieving such data, reports The New York Times.
"The Obama administration is tearing down barriers that make it difficult
for patients to get access to their own medical records, telling doctors
and hospitals that in most cases they must provide copies of these
records within 30 days of receiving a request."
While in theory "patients have
long had a right to obtain copies
of their records," federal officials
recently issued new guidelines
that prohibit doctors and hospitals
to require patients to state a
reason for requesting their records, and cannot deny access out of a
general concern that patients might be upset by the information."
According to "recent studies and our own enforcement experience, far
too often individuals face obstacles to accessing their health
information," said Jocelyn Samuels, director of the Office of Civil Rights
at the Department of Health and Human Services, which enforces
federal healthy privacy standards. "This must change."
Among the other new guidelines, "A health care provider cannot require
patients to pick up their records in person if they ask that the records be
sent by mail or email. A health care provider cannot deny a request for
access to health information because a patient has failed to pay medical
bills."
Regarding fees for records retrieval, "A doctor or a hospital may charge
a fee to cover the cost of copying, but cannot charge for the cost of
searching for data and retrieving it.
Click here to read more about the changes in the HIPAA rules. While
doctors and hospitals are supposed to provide consumers with access to
personal health information within 30 days (and can extend the deadline
by 30 days), the administration is putting the lean on docs and
hospitals, saying "most requests should be fulfilled in fewer than 30
days," the Times reports.
Talking )!@*#! Is Illegal!
If anyone curses in your office (presumably not
including in an exam room!), they may be breaking Virginia law. Click here to find out
why.
Need Hardship Exception to Medicare/Electronic Records
Incentives?
CMS recently issued some guidance for
the Medicare EHR Incentive Program
hardship exception process. Click here to
read more!
Mobile Apps' Liability Risks
With more than 100,000 mobile health
apps now available, physicians now have
to handle an increasing amount of
constant data and patient information
that they did not have in the past. Mobile
apps offer many benefits, but the use of
these apps does not come without
liability risks for doctors.
Click here to read more from The
Doctors Company!
"The Hold": The best way to calm a crying baby in seconds
This video has gone viral: "Dr. Robert Hamilton of
Pacific Ocean Pediatrics shows you how to calm a
crying baby."
One Doc's Crusade for a Better (MOC) Way
Click here for an entertaining, eye­opening and short video by Dr.
Paul Teirstein, a California cardiologist and founder of the new,
alternative board certification group, the National Board of
Physicians and Surgeons.
A RAM member who shared the link calls Dr.
Teirstein "a rare ray of hope and voice of
reason regarding the ever­burgeoning
burden" of ABIM's MOC, and "an example of
professional courage and the power of one."
Dr. Teirstein shows
"the power of one" New Tale Wags Old Dogs
Scientists have long thought
that "man's best friend"
evolved from ancient
wolves.
Click here to read an
entertaining and informative
look that says "this origin
story does not pass muster.
Wolves are hard to tame,
An ancient canine skull is part of
even as puppies, and many
Oxford's research project. researchers find it much
more plausible that dogs, in effect, invented themselves."
Remember this the next time you try that "alpha dog" stuff on
YOUR Fido!
Comments? Criticisms? Witticisms?
We draw from a wide range of print,
online and other sources, including
the shifting realm of social media to
bring you information we hope is
relevant to your practice of medicine.
But as a a former journalist and nonfiction
author, I recognize that mistakes do
happen ­­ especially on deadline! So
please contact me if you have any
concerns, complaints, or articles you'd like to share by clicking here or
calling me at 622­8136.
Click here if you'd like to see some of my other writing. THANK YOU for
being part of the Academy and its continuing conversation about the
practice of medicine.
And check out some back issues.
Chip Jones RAM Communications & Marketing Director The Richmond Academy of Medicine, 2821 Emerywood Pkwy,
Ste 200, Richmond, VA 23294
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