Memorial Day Honoring All the Men and Women Who Have Selflessly Served Our Country
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May 2019
®
The Official Publication of the Dade County Medical Association
Memorial Day
Honoring All the Men and Women Who
Have Selflessly Served Our Country
DCMA Presidential Inauguration
Join the Dade County Medical Association at our Presidential Inauguration on June 29, 2019 – invitations
are in the mail, or call the DCMA for tickets and/or sponsorship opportunities – 305 324-8717.
P
lease join Antonio Mesa, D.O. and the
Dade County Medical Association, on
his inauguration as the 109th President
of the Association.
This prestigious event will take place on
Saturday, June 29, 2019 – 7:00 p.m.-11:00
p.m. at the Douglas Entrance, a place where
old-world charm and elegance come
together. This historic landmark was built
in 1927, and its original gateway marks the
northeast entrance to George E. Merricks,
“City Beautiful,” Coral Gables. On Sep-
tember 22, 1972, it was listed on the U.S.
National Register of Historic Places. Douglas
Entrance is located at 800 Douglas Road,
Miami, Florida.
The Douglas Entrance
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MESSAGE from your PRESIDENT:
The Unfairness of the
Physician Peer Review
Barbara Montford, MD the punishment: explusion from the Women physicians are increasing in governing committees with company
President, Dade County Medical Association medical staff. If not, the decision has numbers but the workplace has not men and women, physicians who are not
to be to fight. God is intentional. He yet adapted to their different attitudes, that busy and may have a financial stake
knows what tasks will call our names work habits and work styles. Much in supporting the hospital at all costs. I
M
y aunt, who was my other and which ones will not raise any flags of what women physicians do can be am encouraging my colleagues that each
mom, died in March of this for us. Our tasks are uniquely designed misinterpreted and they can become easy year we need to be certain to run and elect
year. During the week leading for us. I have always been motivated by targets for disciplinary action. Linda physicians who have our best interest at
up to her funeral services, I received a unfairness. I am not a silent sufferer. Brodsky, M.D. listed several questions heart. This involves providing the extra
call from the chief medical officer at My father always told us that our good in her blog to alert physicians that they support to that physician during their
one of my hospitals. He stated that my name is the only thing we have. If it can be on the pathway to being labeled a service time. We should no longer let
reappointment application had been took all of his money to defend his disruptive physician. These questions are: hospitals treat us like indentured servants.
denied by the parent hospital even good name, he would do so. I thought 1. Do you speak your mind when you We should not work for their hospitals
though it had been approved by my God’s timing was a mistake; how can are concerned about quality of care? for free. Most of the bylaws have built in
actual hospital. While I was trying to deal I handle the grief of my aunt/mom’s 2. Do you give directions in an that ER coverage is a necessity of having
with the grief of the loss of my aunt, I had death and the hospital’s decision. God authoritative way? privileges. I also believe the bylaws
three days to make a decision whether remains intentional. I was the recipient 3. Do you command a large practice should state that whenever a quality issue
to resign or attend the medical executive of God’s message through two of God’s which is the envy of others with whom is raised and noted in our record, we
committee meeting at the parent hospital. servants that weekend. The minister you compete? should be apprised. I hope this helps.”
If the medical executive committee who delivered the eulogy that Saturday 4. Do you ever question the hospital June Colman, M.D.
upheld the decision of the credentialing stated that God has three different sets administration about procedures and Doctor Colman offers the following
committee I would be reported to the of angels to fight our battles. I called on policies? suggestions to physicians:
National Practitioner Data Bank. all three that Monday as I went before 5. Do you ever go against the tide “1. Submit a written response to any
I was overwhelmed. the medical executive committee. My of opinion about the clinical care of items which appear in your hospital
I know the Lord said that He will never pastor deliveed a message that Sunday patients? personnel records.
give us more than we can bear, but I just essentially reaffirming the message that You should have answered yes to all of 2. Keep a personal record at home of
knew He had to have me confused with if God is for us who can be against us. I these questions, but bear in mind that all personnel reports.
some other individiual down the street. girded myself with that message as I sat you may be placing yourself in line for 3. Schedule an annual meeting with
I had recently gone through the peer before the committee. increased scrutiny from your hospital. the hospital chief medical officer and
review and appeal process with one of One of my three projects for my In closing I would like to share with my review your personnel file. Discuss any
my other hospitals. My appeal had been installation year was the creation of colleagues this testimony. items and devise a mutual response to
successful but the process was emotionally a house staff manual to empower After I had gone through a successful items with a scheduled follow up to assess
brutal. It is terrible to be in a room of physicians to more effectively defend appeal of the hospital peer review process, progress.
your peers who are saying you are the their good name against the hospital I was asked by my book club sister to 4. Submit a written report to your
worst doctor in the history of medicine. peer review process. My sub committee speak to one of her college roommates. file with a copy to yourself and your
Even though these same doctors had is chaired by DCMA President-elect, The friend was an obstetrician in the department chair.”
been saying for 20 years that you were Doctor Antonio Mesa and we are Houston area who was being blackballed I would like to remind us to always
the cat’s meow. Needless to say I was not actively moving forward to complete by her hospital. She had been in practice keep in mind that at the end of the day,
looking to go through the turmoil again. this task. As I noted in my inaugural for more than twenty years and had hospitals as well as ourselves, have the
I asked for guidance from the chair of the address, the hospital peer review process recently been escorted out of the hospital same mutual mission: the privilege of
credentialing committee of my hospital. has become more malignant and unfair by security at the request of the hospital care of our patients.
He said he could not make that decision toward physicians. As more and more administrator. She had a patient waiting
for me but he would evaluate the situation physicians are no longer self employed, to deliver in that very same hospital. The BIBLIOGRAPHY
from a purely financial view point. How this unfairness will increase. hospital system has a very large footprint 1. Center for Peer Review Justice
much of my practice income was derived The hospital peer review process in the Houston area and she is still website.
from said hospital? is integral in improving the care of battling. She is now working as an office 2. Clinical Peer Review in the United
Unfortunately – or fortunately – I have our patients and the expertise of our based gynecologist as she has not been States: History, legal development
never based my life decisions on purely physicians. We are all challenged to able to continue as an obstetrician. She and subsequent abuse. World J.
financial terms. My first barameter is ensure that the process does not become made the following recommendations to Gastroenterology. 2014 Jun7 20(21);
always what would the Lord have me do. a Sham Peer Review process. The improve the peer review process. 6357-6353.
The messae was not so clear. Center for Peer Review Justice states “I have no problem with you sharing 3. How do you know if you’re a
My second barometer is whether my that the process is routinely used by my story. One of the problems I see disruptive physician? Linda Brodsky,
decision is based on fear; the fear of being hospital corporations and is currently at is that many of the more empathetic M.D. Physician. Dec. 12, 2012.
reported to the National Practitioner epidemic proportions. physicians are very busy so tend to www.kevinmd.com/blog/2012/2013
Data Bank. If so, discard that decision. There are few studies documenting shy away from hospital committee disruptive physician.
The Lord did not give us a spirit of fear racism in medicine and they are almost appointments. Early in my career I 4. Doctors Face Racism in Medicine/
but rather of sound mind. If God is for always focused on racism directed sat on the MEC and headed various MD Magazine. Heidi Moawad, M.D.
us, who can be against us. toward patients rather than racism committees but as the demands of an Nov. 20, 2016.
My final barometer is to look at the toward doctors. The racism can come extraordinary practice called, I let these 5. Ethics:Peer Review and Due Process.
facts as if they pertained to another from other physicians, administrators, things fall by the wayside. I find here www:ama.ass.org/delivering-care/ethics/
physician. Do the actions warrant ancillary staff and patients. that the administration will stack their peer review-due process.
MIAMI MEDICINE May 2019 3
Physician Leadership Academy of South Florida
Session 5 Developing and Promoting Resilience for You and Your Team’s Health workshop took place on Saturday, April 13, 2019 at Kaiser Univer-
sity in Fort Lauderdale.
The presenters at the workshop included, Sarah Steele, Nicki Klevos, M.D., and PBCMS Past President, Shawn Baca, M.D.
The Academy is sponsored by the Palm Beach County Medical Society, the Broward County Medical Association, and the Dade County Medical
Association. The Physician Leadership Academy is supported by a grant from The Physicians Foundation.
DCMA Community Outreach Committee
North Miami Police Department Training Sessions
The Dade County Medical Association (DCMA) Community Outreach Committee delivered the
fourth in a serious of training sessions to the North Miami Police Department. This is part of the
DCMA on-going alliance with the North Miami Police Department to provide tools and strate-
gies for police officers to deploy when they encounter behavioral issues in the field. Doctor Del-
vena Thomas, Board Certified Psychiatrist, continues to volunteer her time to these educational
sessions. Twenty (20) police officers attended the training. The program is scheduled to conclude
in June 2019. DCMA continues to research the potential for this initiative to be replicated in
other Police Departments within Miami-Dade County.
When Treating Children,
Avoid These Risks
Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company
A
study of malpractice claims against physicians in 52 family member and provider. Inadequate patient assessments were
specialties who treat children reveals that while there are closely linked to incorrect diagnoses. Incomplete communication
common elements in allegations, the types of problems between patients or family members and providers affected
experienced by pediatric patients—and that lead to malpractice clinicians’ ability to make correct diagnoses.
claims—change as they age.
Risk Mitigation Strategies
The Doctors Company studied 1,215 claims (written demands The following strategies can assist physicians in preventing some
for payment) filed on behalf of pediatric patients that closed of the concerns identified in this study:
from 2008 through 2017.
The study focused on four groups: neonate (less than one For Neonates
month old), first year (one month through 11 months), 1. Become familiar with the National Institute of Child Health
child (one through nine years), and teenager (10 through 17 and Human Development nomenclature. Physicians and nurses
years). It included all claims and lawsuits except dental claims, should participate together in regular fetal monitoring learning
regardless of how the cases were resolved (denied, settled, or activities.
judgment at trial). 2. Respond without delay when a nurse requests a physician
assessment.
Claim and Lawsuit Payments 3. Conduct drills to ensure 30-minute response times for
Of the claims, 446 (37 percent) resulted in a payment to the emergency cesarean section deliveries and carry out simulations of
claimant. The mean indemnity payment was $630,456, and low-frequency/high-severity obstetric emergencies.
the mean expense was $157,592. The median indemnity payment was $250,000, 4. Estimate and document fetal weight when considering vacuum-assisted vaginal
and the median expense to defend these claims was $99,984. delivery. Plan the exit strategy, such as calling the cesarean section team in advance
in case the extraction is unsuccessful.
Neonates had the highest mean indemnity ($936,843) and median indemnity
payment ($300,000). The mean expense paid to defend these cases was also the For Children Ages One Month to 17 Years
highest ($187,117), as was the median expense paid ($119,311). 1. Ensure quality documentation. Documentation is essential for coordinating
quality care and defending a claim that may not be filed until years after the alleged
The median number may be a more accurate representation of the amount of
injury.
indemnity in paid claims. The median eliminates the impact of very high or very
2. Conduct careful reevaluations when patients return with the same or worsening
low indemnity amounts, giving a better idea of a typical value.
symptoms. If no new information comes to light, consider a second opinion or
The patients represented in these claims and lawsuits were treated by a variety of referral to a specialist.
specialties. Obstetricians were most frequently involved with neonatal patients. 3. Ensure an adequate exchange of information. Utilize translations services if
Pediatricians, orthopedic surgeons, emergency medicine physicians, and family communication is difficult.
medicine physicians were most frequently named as defendants for children older 4. Provide parents with information to help them recognize when a sick child
than one month. requires emergency care. Train office staff to recognize the types of concerns raised
by parents during phone calls that should prompt immediate assessment and
The top 10 physician specialties named as defendants were: obstetrics (24%), treatment.
pediatrics (15%), orthopedics (7%), emergency medicine (6%), family medicine
(6%), radiology (3%), general surgery (3%), anesthesiology (3%), otolaryngology Conclusion
(3%), and psychiatry (2%). These specialties represented 72 percent of all the This study showed that neonates and infants in their first year of life were more
claims. vulnerable than older children. Children less than one year of age experienced high-
Allegations severity injuries at almost twice the rate of children older than one year. Neonates
Diagnosis-related allegations were the most common allegation in all but the may experience complications due to difficult labor and delivery. They also face
neonate age group. Patients older than neonates experienced diagnosis-related congenital conditions that may not be readily diagnosed and treated.
claims in 34 to 44 percent of all claims and lawsuits. Children older than one year experienced more injuries from trauma,
The most common allegation for neonates was obstetrics-related treatment for communicable disease, and malignancies. Teenagers experienced trauma and illness,
injuries that occurred during labor and delivery (63 percent). and teenaged females may also face the dangers of pregnancy and childbirth.
This wide spectrum of development adds to the challenges of diagnosing and
Factors Contributing to Patient Injury treating pediatric patients and shows that clinicians need the assistance of reliable
To prevent injuries, it is essential to understand the factors that contributed systems to help prevent these errors.
to patient harm. Categories of contributing factors include clinical judgment,
technical skill, patient behaviors, communication, clinical symptoms, clinical These issues and additional data are addressed in more detail at thedoctors.com/
environments, and documentation. Physician experts identified factors that childmedmalstudy.
contributed to patient harm and evaluated each claim to determine whether the
standard of care was met. --------------------------
The guidelines suggested here are not rules, do not constitute legal advice,
The most common factor contributing to injury in neonates was selection and and do not ensure a successful outcome. The ultimate decision regarding the
management of therapy. This issue refers to decisions about vaginal birth versus appropriateness of any treatment must be made by each healthcare provider
cesarean section. Other factors included patient assessment issues and lack of considering the circumstances of the individual situation and in accordance with
communication among providers. the laws of the jurisdiction in which the care is rendered.
The most common factors contributing to patient harm for age groups other than
neonates were patient assessment issues and communication between the patient or Reprinted with permission. ©2019 The Doctors Company (thedoctors.com).
MIAMI MEDICINE May 2019 5
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You’ve worked hard for your money.
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Using our Confident Retirement®approach,
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chikezie.r.esiobu@ampf.com
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The Confident Retirement approach is not a guarantee of future financial results. Investment advisory products and services are made
available through Ameriprise Financial Services, Inc., a registered investment adviser.
© 2019 Ameriprise Financial, Inc. All rights reserved. (04/19)
Trade Tensions and Your Portfolio:
What You Need to Know
A
prominent economic story of the dependent on imports than it is on exports.
past year has been the growing The last time the U.S. ran a trade surplus
tide of trade disputes across the was in 1975. Since then, the trade deficit
globe. The U.S is at the center of has risen significantly, peaking in 2006 at
it – most notably with China – which means $761 billion (according to the U.S. Census
investors are often subject to daily headlines Bureau’s Economic Indicator Division),
debating possible implications for global before dropping and remaining fairly
markets and the economy. But are there consistently between $500 and $600 billion.
reasons for investors to be concerned?
The short answer is that trade tensions are nothing new, and our
Should you be concerned about tariffs?
Fast forward to today, where we find ourselves at another crossroad
country has dealt with the impacts of international negotiations many with trade. Take for example the recent implementation of tariffs on
times over. Yet, as trade becomes increasingly global, its important for a variety of international products. These tariffs are aimed, in part, to
investors to understand the current environment and what may be help domestic industries that are losing business to lower-cost goods
ahead for the markets. from overseas – a similar goal of past tariffs. Whether these industries
Let’s dive into this more, starting with a quick history lesson to provide and their workers will benefit over the long run remains in question.
some perspective on today’s trade environment. There are other factors that bear watching. The primary concern for
investors is whether tariffs will create negative economic consequences
Trade issues are nothing new for the targeted industries, the U.S. or global economy. Recently,
Challenges with trading partners for our nation go back to its trade tensions have had an impact on investor sentiment, with more
founding. The Boston Tea Party of 1773 was a protest against taxes people becoming cautious about the state of the global economy. In
imposed by Britain on a number of products used by colonists. many instances, trade disputes can be a contributing factor to market
Fast forward to when the U.S. economy struggled during the Great volatility. This is because markets do not like the uncertainly that
Depression of the 1930s, and Congress imposed the Smoot-Hawley happens when global powers are negotiating.
Tariff. That legislation was designed to protect American jobs, raising So, what does all this trade history mean for investors? The key
duties on over 20,000 imported goods. Many of the targeted countries takeaway is to keep an eye on trade developments and to not overreact
countered with retaliatory tariffs. As a result, trade activity dropped to daily headlines. Remember that trade policies are just one of many
dramatically, contributing to global economic turmoil. factors likely to impact the economy and markets. Maintaining a
The U.S. economy picked up with the onset of World Word II and diversified portfolio – that is reflective of the level of risk you are
emerged as a dominant force in global trade. However, in the years that willing to accept to reach your own financial goals – is one of the best
followed the war, Europe and Japan rebuilt their economies and by the defenses to all types of market uncertainty.
1970s emerged as trading powerhouses. This transformation in many
ways set the stage for increased global trade as we know it today. ______________
Trade has become increasingly global C. Reginald Esiobu, MBA, CFP®, is a Financial Advisor and Certified
In recent decades, a driving force behind increased international Financial PlannerTM practitioner with Ameriprise Financial Services,
trade was the belief that benefits would extend to more people across Inc. in Fort Lauderdale, Florida. He specializes in fee-based financial
the world. Landmark treaties, like the North American Free Trade planning and asset management strategies and has been in practice for
Agreement (NAFTA) established in 1994 between the U.S, Canada over 20 years.
and Mexico, highlighted an extended period of open borders for the Contact him at:
movement of goods and services. The European Union (created in 950 South Pine Island Road, Suite A-150, Fort Lauderdale, FL 33324;
1993) represents another form of trade agreement, reducing barriers to O: 954.727.8363 F: 954.719.4017 M: 954.243.4337;
the movement of goods. Email: chikezie.r.esiobu@ampf.com; and
Yet a common concern with many treaties is the belief that they Website: ameripriseadvisors.com/chikezie.r.esiobu.
benefit some industries while leaving people in others behind. For Investment advisory products and services are made available through
example, many U.S. farmers benefit from agricultural exports to other Ameriprise Financial Services, Inc., a registered investment adviser.
countries, and the U.S. generally has a trade surplus when it comes to
services it supplies internationally. On the flip side, in the 1970s for Ameriprise Financial Services, Inc. Member FINRA and SIPC.
instance, Japan’s automobile industry rose, while U.S. car companies © 2018 Ameriprise Financial, Inc. All rights reserved.
struggled. We’ve seen similar trends with industries like textiles and
steel manufacturers.
The current trade deficit shows that the U.S. economy is more
MIAMI MEDICINE May 2019 7
__A D V E R T O R I A L__
UM Miller School of Medicine
Receives Full Accreditation for Eight-Year Cycle
T he University of
Miami Miller School
of Medicine has received
approved the plans, and the
Miller School was granted
full accreditation. The next
areas that we are going to
continue to work vigorously
to enhance and improve.”
medical school curriculum.
The self-study process
initiated this renewal and it
full accreditation for an evaluation will be during began before the first LCME
eight-year cycle from the the 2024-25 academic year. The initiatives that were visit. The next generation
Liaison Committee on born of or strengthened by medical education task
Medical Education (LCME). “The LCME praised the the study process include: force now consists of several
outstanding work that planning teams imagining
“This was a three and a half was done by our team,” • The school’s enhanced what teaching and learning
year effort, with teams of said Henri R. Ford, M.D., partnership with should look like in the future.
faculty and students putting M.H.A., dean and chief students through
their heart and soul into academic officer. “And now ongoing transparency Construction of a new
the process,” said Laurence our full accreditation is a and communication has medical education building
B. Gardner, M.D., executive milestone to be celebrated.” accelerated the work of is critical to fully revamping
dean for education and the Learner Mistreatment the curriculum for the
policy. The teams conducted Alex J. Mechaber, M.D., Council, which has physicians of the future.
a fact-finding self-study of senior associate dean representation from
the Miller School before for undergraduate all areas of the school Dean Ford expects the school
the first site visit by the education, was one of the and meets monthly. to have made significant
LCME accreditation team leaders responsible for progress on construction
of medical school leaders the plan and he is central • The Office of Academic of the new Miller School of
in February 2017. to moving it forward. Accreditation was formed Medicine Center for Medical
to lead and monitor the Education by the time a
After that site visit, the “This was an important ongoing progress in the status update is due to the
LCME raised some concerns process that allowed the areas the LCME pointed LCME in August 2021.
that they said needed school to reflect on what we out. Michael A. Kolber, M.D.,
increased monitoring and do well and what we don’t the faculty accreditation
plans for improvement. do well to improve on those lead for the entire process,
A group of Miller School areas and ultimately make is director of the office. For more information about
faculty members developed us a better school,” Mechaber the University of Miami
detailed plans to address said. “While we are elated • “The biggest initiative of Miller School of Medicine,
the concerns, the LCME by the findings, there are them all” is the renewal of the visit Med.Miami.edu.
Health Care Provider Liability
By Bill Gompers
Insurance Primer
H
ealthcare providers, by the or private information. Coverages can
nature of their business, always include crisis management, multimedia
face liability risks. Although liability, and security and privacy liability.
many of these risks can be Coverage can also protect you with regards
lessened through implementation of risk- to privacy regulatory defense and penalties
management practices, they can rarely be as well as privacy breach and network
eliminated. Thus, it is prudent to implement asset protection. Cyber extortion and
a liability-insurance program that addresses cyber terrorism coverages are also desirable
the healthcare provider’s needs and ensures attributes of many policies.
your peace of mind should the unexpected event(s) occur.
Regulatory Liability Insurance: In today’s rapidly changing
The following is a listing of the liability coverages that comprise the regulatory environment many operators are choosing this coverage
inventory selected by many healthcare providers: to provide reimbursements for regulatory fines, penalties, claims
expenses, and shadow-audit expenses resulting from regulatory
• Professional Liability Insurance (Medical Malpractice) proceedings. Desirable policies include coverage for allegations of
• Commercial General Liability Insurance billing errors resulting from ZPIC, RAC, and other similar audits;
• Workers’ Compensation Insurance fines and penalties; as well as defense of EMTALA and STARK
• Cyber Liability Insurance violations.
• Regulatory Liability Insurance
• Employee Benefits Liability Insurance Employee Benefits Liability Insurance: Covers an insured
• Employment Practices Liability Insurance in the event of a claim that arises out of errors and/or omissions in the
administration of a benefit plan. These can include failing to advise
Below is a brief description of these liability coverages: an employee of a benefit program; failure to enroll, terminate, or
cancel an employee in the plan; and administering improper advice in
Professional Liability Insurance (Medical Malpractice): regards to the benefits. Employee benefits programs can include group
Provides indemnity and expense protection for errors and omissions life insurance, group health insurance, profit-sharing plans, employee
emanating from professional mistakes. These include professional stock plans, workers’ compensation, unemployment insurance, and
negligence, provision of services that are below the prevailing standard COBRA.
of care, and misrepresentation. Policy terms and conditions are not
standardized and must be reviewed closely. Some key components to Employment Practices Liability Insurance: Protects your
look for are incident-sensitive trigger, defense outside limits, prior-acts business against the high cost of lawsuits due to discrimination,
coverage, and coverage for ancillary personnel and medical-director harassment, wrongful termination, and other potential charges
duties. stemming from employment practices. This coverage can cover your
business from the cost of legal defense, settlements, and other court
Commercial General Liability Insurance: Provides fees when faced with an allegation of violating a person’s or group’s
indemnity and expense protection for incidents, including third civil rights or failing to provide a fair, acceptable environment for
parties, arising from negligence causing bodily injuries, property them to complete their work.
damage, and personal injuries that your business caused. This includes
slips and falls and loss of or damage to property. Navigating the various types of coverages can be a challenge. Avoiding
potential gaps and needless overlapping can be crucial to your
Workers’ Compensation Insurance: Covers medical and operations and bottom line. Thus, professional guidance is often the
rehabilitation costs and lost wages for employees injured at work. best route to take, by conducting a review of all alternatives with your
Florida, along with most states (with a few exceptions), essentially liability-insurance consultant.
requires employers to purchase an insurance policy to handle their
statutory obligations to workers who are injured or made ill due to a ______________
workplace exposure. Typically, workers’ compensation covers medical Bill Gompers is a medical malpractice insurance specialist with Danna-
expenses, lost earnings, disability payments, funeral expenses, and Gracey, a state-wide independent insurance agency dedicated solely
legal fees. to insurance coverage placement for Florida’s doctors and healthcare
providers, including medical malpractice, workers’ compensation, and
Cyber Liability Insurance: Offers financial protection when physician and employee benefits. To contact him call (888) 777-7173, or
a data breach, theft of data, or cyber-attack compromises valuable e-mail bill@dannagracey.com.
MIAMI MEDICINE May 2019 9
Isn’t it time for an independent expert
opinion on your malpractice insurance
coverage?
Not all policies are created equally. There are many factors to consider
when shopping for your malpractice insurance – proper liability limits,
tails, triggers, retroactive coverage, regulatory and cyber protection,
purchasing programs... the options are daunting, and the wrong fit can
be disastrous to your practice.
As independent agents specializing in malpractice insurance placement,
we are strong enough within the malpractice insurance marketplace to
fully and competently negotiate the best coverage and pricing for you
with the top insurers in the state.
Call Bill Gompers of Danna-Gracey at 888.777.7173 for a no-obligation
assessment of your current malpractice insurance policy. Your practice is
worth it.
888.777.7173 • bill@dannagracey.com • www.dannagracey.com
Serving physicians insurance
needs by the creation and
preservation of wealth
Specializing in:
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Established in 1978
Endorsed by:
Jeff D. Hackmeier & Associates, Inc.
www.hackmeierinsurance.comLooking To Expand Your Practice?
Maybe Medical Marijuana Makes Sense.
efficacy of cannabis. This is due, nonmalignant pain associated with a decisions (“sticky patients”) is critical.
Stephen H. Siegel, Esq. Cynthia Barnett in large part, to the classification qualifying condition. For this reason Medical practices have to recognize that
Hibnick, Esq.
of cannabis as a Schedule I drug. alone, the number of patients seeking their patients are also customers.
There have been studies in Europe this treatment, and the number of Patients no longer are passive
and Israel, however, that support physicians who are permitted to observers of their medical conditions.
the use of cannabis to improve authorize it, are predicted to continue Many patients will decide to try
AUTHORS patients’ conditions. See, e.g.
Epidemiological Characteristics,
to increase greatly.
In addition to offering another
medical marijuana. They will either
seek a QCP on their own or ask their
Stephen H. Siegel, Esq. Safety and Efficacy of Medical treatment modality, including current physicians for referrals.
shs@lubellrosen.com Cannabis in the Elderly, European cannabis within the scope of a In order to develop and maintain
Cynthia Barnett Hibnick, Esq. Journal of Internal Medicine, physician’s practice helps minimize the “sticky patients”, physicians should
March 2918, Volume 49, pp 44-50; likelihood of patients either seeking offer patients as many medical
cbh@lubellrosen.com https://www.ejinme.com/article/ care elsewhere or disrupting their services as they require from one
S0953-6205(18)30019-0/fulltext; treatment. From a clinical perspective, source (of course, assuming that
CBD-enriched Medical Cannabis it is preferable for both patient and source is appropriately medically
F
for Intractable Pediatric Epilepsy: physician for the patient to seek qualified to provide such services).
lorida physicians are feeling The Current Israeli Experience, care from the minimum number of Accordingly, physicians can minimize
the squeeze of declining Seizure, Volume 35, February providers necessary to address his or the likelihood of patients looking
reimbursements, increasing 2016, pp 41-44, https://www. her medical and psychological needs. elsewhere for a QOP, or asking
managed care requirements, sciencedirect.com/science/article/pii/ A physician who is also a QOP helps their physicians for a referral to a
and loosening physician-patient S1059131116000054. promote better coordination of a QOP, thereby losing some or all
relationships. For some of these Moreover, anecdotal evidence patient’s care. their business. Becoming a QOP
physicians, expanding the scope of suggests that, at a minimum, using Medicine is also a business, not only strengthens the “stickiness”
their practices by adding certification cannabis can alleviate a patient’s and there are economic reasons for of current patients, it may attract
of patients for medical marijuana chronic pain, seizures, nausea from considering adding cannabis to the additional patients whose physicians
(“cannabis”) use is a strategy worth chemotherapy, etc. scope of a medical practice. Many have not adopted this business
considering. Physicians who serve as Florida law recognizes that physicians’ incomes from providing model.
the primary care provider (“PCP”) cannabis has value in treating a traditional clinical services are flat, at For both clinical and economic
for some or all of their patients, as wide range of patients. The Florida best. A physician’s ability to increase his reasons (as well as a minimal capital
well as those serving in a number of Legislature identified thirteen (13) or her rates, negotiate more favorable investment), becoming a QOP is an
specialties, have become Qualified “qualifying medical conditions” in the managed care contracts, provide more attractive option for many physicians.
Ordering Physicians (“QOPs”). They statutory framework regulating medical services, or leverage his or her practice Achieving this designation adds both
have recognized the value of cannabis marijuana in Florida: has been largely exhausted. another treatment modality and a new
for treating their Qualified Patients’ - Cancer; Regardless of how a physician is revenue stream. Working with legal and
(“QPs’”) medical issues. PCPs and - Epilepsy; reimbursed, a loyal and stable base other advisors, every Florida PCP, and
certain specialty physicians should - Glaucoma; of patients is necessary to succeed physicians in specialties who treat the
evaluate whether becoming a QOP - HIV/AIDS; economically. Developing patients who conditions listed above, should evaluate
makes sense to meet the needs of their - Post-traumatic stress disorder look to their physicians for guidance whether becoming a QOP fits into, and
patient populations. (PTSD); and direction in making clinical will enhance, his or her practice.
In Florida, the Office of Medical - Amyotrophic lateral sclerosis
Marijuana Use (“OMMU”) regulates (ALS);
access to cannabis. As of April 12, - Chron’s disease;
2019, OMMU had issued active ID - Parkinson’s disease; Mr. Siegel and Ms. Hibnick are Partners in the Coral Gables office of Lubell
cards to 207,869 Floridians as QPs. In - Multiple sclerosis (MS); | Rosen, a full-service law firm that focuses on serving the legal needs of the
contrast, a little more than one year - Medical conditions of the same healthcare community.
ago, on March 16, 2018, there were kind or class as or comparable to Mr. Siegel’s legal practice involves guiding physicians and other healthcare
only 88,154 active ID cards issued to the others listed; providers through the often confusing regulatory requirements that must
QPs. During this same time period, - A terminal condition diagnosed be satisfied in structuring business arrangements and defending those
the number of QOPs has grown from by a physician other than the arrangements when challenged by a government agency or private party.
1,225 to 2,182. The tremendous QOP; and Mr. Siegel is Board Certified in Health Law by The Florida Bar. He also
growth of both QPs and QOPs, 136% - Chronic nonmalignant pain is certified by the HCCB in Healthcare Compliance and Healthcare
and 78%, respectively, reflects both caused by a qualifying condition Privacy Compliance. He is a member of Lubell | Rosen’s Health Law
the public’s growing awareness of or that originates from a qualifying and CannabisLAW Groups. He can be reached at 305.298.8640 or shs@
cannabis and the medical community’s medical condition and persists lubellrosen.com.
acceptance of cannabis for treating beyond the usual course of that
certain medical and psychological qualifying medical condition. Ms. Hibnick is a civil trial attorney with over 35 years of legal experience
conditions. who is AV-Preeminent rated by Martindale-Hubbell®. Her practice is largely
In addition to growing acceptance, Qualified Ordering Physicians, devoted to representing health care providers and affiliated entities in health
there are both clinical and economic both primary care physicians and care litigation, peer review defense, qui tam and health care fraud defense,
reasons why PCPs, as well as many specialists, often treat patients who regulatory and administrative defense involving Florida Department of
other physician specialists, should suffer from one or more of these Health (DOH) and the Agency for Health Care Administration (AHCA).
consider expanding their practices to medical conditions. For example, Ms. Hibnick also regularly assists clients with audits and other disputes with
include cannabis referrals. the patient population of a PCP third-party payors. She is a member of the firm’s Health Law Group and
It must be acknowledged that (certainly in south Florida) is likely also chairs Lubell | Rosen’s CannabisLAW Group . She can be reached at
there is a dearth of clinical and to include individuals suffering from 305.671.7771 or cbh@lubellrosen.com.
epidemiological studies performed cancer, glaucoma, Chron’s disease,
in the United States concerning the multiple sclerosis, and chronic
MIAMI MEDICINE May 2019 11Routine HIV Testing:
Critical for Prevention
Routine HIV testing, or testing done as part of early before symptoms develop. Overall, the with men in health-care settings. MMWR.
a health care visit regardless of risk, is standard costs of screening for HIV are minor in relation • Sexual partners of people living with HIV September 2006;55(RR-14);1-17.
of care. Florida’s statutes have removed previous to the anticipated benefits for both providers • Those starting a new sexual relationship https://www.cdc.gov/mmwr/preview/
barriers such as need for written consent and and patients. • Those with recent sexually transmitted mmwrhtml/rr5514a1.htm. Accessed
pre-test counseling, in order to facilitate testing. Routine HIV testing in health care infections December 14, 2018.
Providers are encouraged to test all of their settings and targeted testing in non-health care • Those with multiple sexual partners
U.S. Preventive Services Task
patients for HIV at least once. Providers are settings are part of the four key components • Those who report inconsistent condom
Force. Screening for HIV- Current
also asked to engage those who test negative to reduce HIV infections designated by the use
Recommendations. https://www.
but are at increased risk for HIV in enhanced Florida Department of Health. Testing is also It is important to remember that although
uspreventiveservicestaskforce.
prevention strategies including frequent testing critical to two other key components: rapid there is no cure, HIV is a manageable infection.
org/Page/Name/uspstf-a-and-b-
for HIV and sexually transmitted infections, engagement with initiation of antiretroviral Current medicines are extremely effective and
recommendations/. Accessed December
provision of condoms, and biomedical medications for those who are diagnosed with help people live longer healthier lives.
14, 2018.
interventions including pre-exposure HIV, and provision of PrEP for those who
What is PrEP and Where is it Available?
prophylaxis (PrEP). are HIV negative but have risk for infection. University of South Florida. A
PrEP, when people who do not have HIV
In spite of ongoing prevention efforts HIV testing is central to treatment, and to Provider’s Guide to Reimbursement
but who are at substantial risk of infection
and advances in treatment, HIV remains a prevention. and sustainability for HIV Testing
take medication to prevent HIV, can be
significant public health concern throughout in Florida healthcare facilities.2015
HIV Testing Law Basics highly effective. PrEP, in combination with
the United States (US) and in Florida, the state http://usfcenter.org/prevention/
Prevention counseling is no longer required HIV testing, testing for sexually transmitted
with the highest number of HIV diagnoses wp-content/uploads/2015/10/
before HIV testing in health care settings. infections, and provision of condoms, should be
in 2017. The Centers for Disease Control HIVTestingSustainabilityGuide.pdf.
Patients must be notified that HIV testing is discussed with all people who are at increased
and Prevention (CDC) estimate that, of the Accessed December 14, 2018.
planned and have the opportunity to opt-out risk for HIV infection after receipt of a negative
approximately 107,000 people living with
of testing. This notification may occur in a test. Currently, there is only one FDA- World Health Organization. Dr
HIV in Florida, 15.6% do not know they
number of ways including verbally or by the approved medication for PrEP: the single tablet Gottfried Hirnschall. Striving for zero
are infected. The CDC also estimates that
distribution of written materials. A facility combination of two antiretroviral medications discrimination in health care. March
people who were not aware of their infection
may include a notification of HIV testing in (tenofovir and emtricitabine) with the brand 2016. http://www.who.int/mediacentre/
transmitted 33% of all new HIV infections.
general consent to medical treatment. If testing name Truvada. Provision of PrEP requires commentaries/zero-discrimination-day/
In July 2015 Florida law was changed to
is declined, this decision should be documented baseline testing for HIV, sexually transmitted en/. Accessed December 14, 2018.
no longer require written informed consent for
and providers are encouraged to address the infections, viral hepatitis, and monitoring of
HIV testing in certain settings (section 381.004, 2-1-1 Big Bend. Florida HIV/AIDS
reasons for declining. serum creatinine. PrEP can be provided through
Florida Statutes). Florida allows and encourages Hotline. http://www.211bigbend.org/
a number of venues including primary care,
the implementation of opt-out HIV testing Why Conduct/Get Testing? flhivaidshotline. Accessed December
sexually transmitted infection clinics, family
within these settings. This means that as long as From a provider’s perspective, the testing 8, 2018.
planning clinics, and other venues.
an authorized healthcare facility gives a patient laws remove time spent acquiring written
the opportunity to “opt-out” of testing, e.g. by consent, conducting prevention counseling, Who should take PrEP? Health Resources and Services
displaying signage which asserts that the facility and conducting HIV risk assessments. HIV CDC guidelines suggest that PrEP be discussed Administration. Get HIV Care and
conducts routinized HIV testing for all of their can be reliably detected with rapid tests, which with people without HIV who are at increased Treatment. https://hab.hrsa.gov/get-
patients, the facility can test any patient who are inexpensive, and noninvasive. Testing risk of infection from sex or injection drug care/get-hiv-care. Reviewed October
does not explicitly state that they do not want to can also be incorporated into routine blood use. Federal guidelines recommend that PrEP 2016. Accessed December 8, 2018..
be tested for HIV. Florida legislation describes work planned as part of a health care visit. is considered for people who are HIV-negative Florida Department of Health. AIDS
facilities that are authorized to implement the Although not required, HIV counseling and and who are: Prevention. http://www.floridahealth.
“opt-out” strategy as any; hospital; urgent care risk assessment are billable actions during • Men who have sex with men gov/%5C/diseases-and-conditions/
clinic; substance abuse treatment center; primary an office visit, and thus can be a source of • Sexual partners of people living with HIV aids/prevention/index.html. Accessed
care clinic; community clinic; blood bank; revenue. Under the Affordable Care Act (ACA), • Exchanging sex for drugs money or other December 8, 2018.
mobile medical clinic; or correctional health care Medicare, Medicaid, and private insurance are items
facility. either required or incentivized to cover “A” • Engaging in sex with multiple sexual Florida Department of Health. PrEP
Decreasing requirements for and “B” grade services. HIV screening has an partners Plan of Action Toolkit. http://escambia.
documentation, including HIV testing as “A” rating from the U.S. Preventive Services • Using condoms inconsistently floridahealth.gov/programs-and-
a normal part of health care is meant to Task Force and should be a covered service by • Injection drug users services/clinical-and-nutrition-services/
facilitate routinized testing, decrease the stigma Medicare, Medicaid, and ACA-qualified health community-clinical-health/hiv-aids/_
associated with HIV testing, and increase Please see below a list of resources which further documents/prep-toolkitfinal-03-29-16.
plans. Although most HIV testing services
the number of individuals who are aware of explain/assist with the implementation of HIV pdf Updated March 2016. Accessed
will be covered, it is important to refer to each
their HIV status. These factors are crucial to testing, PrEP programs, linkage to HIV care, December 8, 2018.
individual health plan to verify reimbursement
reducing new HIV cases in Florida. However, and HIV prevention in general.
coverage. Florida Department of Health.
three critical first steps must be made in order Our program is designed to increase
Who should be tested for HIV? Testing and Counseling. http://
to achieve these goals; 1) increasing awareness information and provide resources to Florida
The short answer is everyone. The CDC www.floridahealth.gov/diseases-and-
among health care providers about the current providers regarding HIV prevention. For more
recommends that everyone between the ages conditions/aids/prevention/testing-
Florida testing laws, 2) increasing awareness of information regarding our services and for
of 13 and 64 is tested for HIV at least once in counseling.html. Accessed December
the importance of routine HIV testing, and 3) testing & PrEP resources for your practice,
their lifetime. This recommendation is similar 8, 2018.
Increasing awareness of enhanced prevention please contact us at 305-243-2584 or Sab321@
strategies, including PrEP, among individuals to screening guidelines for other treatable Health Resources and Services
med.miami.edu.
who are HIV negative and at risk for infection. conditions. However, the frequency of testing Administration. Test and Treat:
From a patient’s perspective, early should increase with a level of risk. For those at Resources: A New Paradigm for Slowing the
detection of HIV can lead to timely initiation higher or ongoing risk for HIV, testing should Florida Department of Health’s resource for Spread of HIV.https://hab.hrsa.gov/
of antiretroviral therapy and viral suppression. be repeated at least annually. More frequent HIV testing and prevention. https://www. sites/default/files/hab/Publications/
Persons who know they are living with HIV testing may be indicated for some individuals testmiami.org/. Accessed December 14, 2018 careactionnewsletter/hab_test_and_
are also less likely to have unprotected sex. In at highest risk. treat_january_careaction_pdf.pdf.
Patients who have increased or ongoing Centers for Disease Control and Prevention.
addition, patients living with HIV have years Revised recommendations for HIV testing Accessed December 9, 2018.
and quality of life to gain if treatment is started risk for HIV include:
• Those who identify as a man who has sex of adults, adolescents, and pregnant women
MIAMI MEDICINE May 2019 13BOARD OF DIRECTORS
President Barbara Montford, M.D. Baptist Health offers more than 280 CME/CE courses each year through its nationally accredited Continuing Medical
(305) 696-0806 Education program. For a complete course listing, go to BaptistHealth.net/CME, or contact the Baptist Health Continuing
Medical Education Department at 786-596-2398, or CME@BaptistHealth.net.
President-Elect Antonio Mesa, D.O.
(305) 670-7650
State of the Science Symposium: Miami Cancer Institute – C Caring for Online Learning Program C Over 160 FREE
Vice President Jorge Marcos, M.D. Critical Care Best Practices, Kids With Cancer Symposiums, CME/CE Courses
(305) 443-2626 10th Annual Second Annual BaptistHealth.net/CMEOnline
Saturday, June 8 Saturday, October 19
Prescribing Controlled Substances
Secretary/Treasurer Rudy Moise, D.O. South Miami Hospital, Victor E. Clarke Miami Cancer Institute Café
Florida Boards of Medicine,
(305) 688-0811 Education MiamiCancerInstitute.com/CaringforKids
Osteopathic Medicine, and Podiatry
Building, Auditorium (6 CME/CE)
Miami Neuro and Miami Neuro Nursing Approved (2 Cat. 1)
Immediate Past President Raul Ravelo, M.D. CriticalCare.BaptistHealth.net
Symposiums, Eighth Annual
(305) 310-7969 FREE online course
Primary Care Focus Symposium, Thursday-Saturday, November 7-9
18th Annual Ritz-Carlton Coconut Grove, Florida Compliance.BaptistHealth.net
North District
Representatives Alix Velar, M.D. Friday-Sunday, July 12-14 MiamiNeuro.BaptistHealth.net
(305) 835-7045 Naples Ritz-Carlton, Florida
Miami Brain Symposiums, Third Annual
Term Expires May 2021 (12 CME/CE)
Saturday, December 6
PrimaryCareFocus.BaptistHealth.net
Ritz-Carlton Coconut Grove, Miami, Florida
Carmel Barrau, M.D. MiamiBrainSymposium.BaptistHealth.net
(305) 836-6221
Term Expires May 2019
Online Learning Program – Over 190 CME/CE Courses, including American Board of Internal Medicine Maintenance
Julie Schwartzbard, M.D. of Certification Courses, Relicensure Courses and Prescribing Controlled Substances.
(305) 933-5993 BaptistHealth.net/CMEOnline
Term Expires May 2019
South District
Representatives Rafael Fernandez, M.D.
(786) 837-8888
Term Expires May 2020
Eugene Eisner, M.D.
(305) 598-2020
Term Expires May 2019
Ruben Ricardo, M.D.
(786) 662-4000
Term Expires May 2019
Jose David Suarez, M.D. List of CME Courses FY 2019
(305) 663-1113
Term Expires May 2020
SAVE THE DATE ONLINE COURSES
At-Large Representatives Jason James, M.D. 2 AMA PRA Category 1 Credits™
(305) 412-6004 Meets Florida Board of Medicine requirements
Term Expires May 2020 Annual Oncology Update 2019: Update & Advances in http://cme.med.miami.edu/online-education
Cancer Therapy • Medical Errors Prevention
Manny Torres, M.D. June 29, 2019 • Domestic Violence Course
(786) 595-8080 Conrad, Ft. Lauderdale, FL
Term Expires May 2020 • HIV/AIDS Update
Advisory Members
Physician Credit: 5.0 AMA PRA Category 1 Credits™
to the DCMA Board Cheryl L. Holder, M.D. FIU
Steven Falcone, M.D. UM
Enrique Fernandez, M.D.
Ross University
Physicians In Training
Representative Nikhil Hitendra Patel, D.O.
Medical Student
Representatives Florida International University
Melissa Smith – Ross University TTo obtain information or to register for upcoming conferences, go to www.cme.med.miami.edu and click on
Meghana Kalavar - UM “Courses” or call the University of Miami Miller School of Medicine Division of Continuing Medical Education
at 305-243-6716 or email at umcme@med.miami.edu.
Executive Director Fraser Cobbe
Managing Director Angel Bosch-De Leon
Miami Medicine is the official publication of the Dade County Medical
Managing Editor Patricia C. Handler
Association (DCMA).
Legal Counsel Jay A. Ziskind, Esq.
Advertising in Miami Medicine does not imply approval or endorsement by the DCMA. Any ads stating approval by the
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