UCF Lake Nona Medical Center - Expanding Access to Care in Orlando's Medical City - Florida MD
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MARCH 2021 • COVERING THE I-4 CORRIDOR
UCF Lake Nona Medical Center
Expanding Access to Care in Orlando’s
Medical City
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Spring 2021
contents MARCH 2021
COVERING THE I-4 CORRIDOR
4 COVER STORY
After breaking ground in 2018, UCF Lake Nona Medical Center opened to the public
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER
this month, providing full-service healthcare to Lake Nona and surrounding communities
in southeast Orlando and Osceola County. Located at 6700 Lake Nona Blvd., adjacent
to the UCF College of Medicine in Orlando’s Medical City, Lake Nona’s new hospital
provides 24/7 emergency care and an array of inpatient and outpatient hospital services
and is expected to serve more than 17,000 patients in its first year.
The establishment of the new hospital was a $175 million investment toward creating
an immediate access point to acute inpatient care for adults. Previously, that level of care
was only available in the Lake Nona area for children (at Nemours Children’s Hospital)
and veterans (at Orlando VA Medical Center at Lake Nona). Now, adults of all ages have
immediate, convenient access to a full-service hospital featuring 64 inpatient beds, a 20-
bed emergency department, four operating rooms, a cardiac catheterization lab, compre-
hensive imaging and laboratory services, and six private birthing suites.
ON THE COVER: UCF Lake Nona Medical
Center
3 CANNABIS USE DOES NOT
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER
DIMINISH COGNITION IN
OLDER ADULTS
10 YOUR PATIENT IS NOT
HAPPY WITH THEIR KNEE
OR HIP REPLACEMENT.
WHAT’S NEXT?
DEPARTMENTS
2 FROM THE PUBLISHER
7 DERMATOLOGY
8 HEALTHCARE LAW
12 PHARMACY UPDATE
15 MARKETING YOUR PRACTICE
FLORIDA MD - MARCH 2021 1
FROM THE PUBLISHER
I am pleased to bring you another issue of Florida MD. Sometimes a patient may have the
opportunity to participate in a clinical trial. Sometimes a patient may need specialized treatment
that is not available in Central Florida. And sometimes there’s no money for that patient to get
to those places. Fortunately there is Angel Flight Southeast to get those patients where they need to
go. I asked them to tell us about their organization and how you, as physicians, can help. Please join
me in supporting this truly wonderful organization.
Best regards,
Donald B. Rauhofer
Publisher
ANGELS ON EARTH HELP PATIENTS GET TO LIFESAVING MEDICAL TREATMENT
Everyone knows angels have wings! But did you know in Florida and many parts of the nation they have engines
and tails with dedicated volunteers who donate lifesaving services every day? Leesburg, Fla.-based Angel Flight
Southeast is a network of approximately 650 pilots who volunteer their time, personal airplanes and fuel to help
passengers get to far-from-home medical care. A member of the national Air Charity Network, Angel Flight
Southeast has been flying passengers since 1993.
Almost all of its passengers are chronic-needs patients who require multiple, sometimes 25-50 treatments.
Passengers may be participating in clinical trials, may require post-transplant medical attention or are getting
specialized treatment that is not available near home. Each passenger is vetted to confirm medical and financial
need and is often referred to Angel Flight Southeast by medical personnel and social workers.
Angel Flight Southeast “Care Traffic Controllers” arrange flights 24 hours a day, 365 days a year. In the event of
a transplant procedure, the Care Traffic Controllers have precious minutes to reach out to its list of volunteer pilots
who have agreed to be prepared on a moment’s notice to fly a patient to receive his or her potentially lifesaving
organ.
The organization is completely funded through donations by individuals and organizations. A typical Angel
Flight Southeast pilot donates $400 to $500 in services-per-trip. In fact, Angel Flight Southeast has earned the
Independent Charities of America Seal of Approval as a good steward of the funds it generates from the public.
Each $1 donated generates more than $10 worth of contributed services by Angel Flight Southeast.
The charity always seeks prospective passengers, volunteer pilots and donations. For additional information,
please visit https://www.angelflightse.org or call 1-888-744.8263.
Publisher: Donald Rauhofer
ADVERTISE IN FLORIDA MD PREMIUM REPRINTS Photographer: Donald Rauhofer / Florida MD
For more information on advertising Reprints of cover articles or feature Contributing Writers: John “Lucky” Meisenheimer,
in Florida MD, call Publisher Donald stories in Florida MD are ideal for MD, Sonda Eunus, MHA, Julie Tyk, JD, Michael
Rauhofer at promoting your company, practice, Patterson NHA, OTR/L, CEAS, George J. Haidukewych,
MD, Juan Lopez, Pharm D, John Meisenheimer, VII
(407) 417-7400, services and medical products. Increase
Art Director/Designer: Ana Espinosa
fax (407) 977-7773 or your brand exposure with high quality,
Florida MD is published by Sea Notes Media,LLC, P.O. Box 621856,
info@floridamd 4-color reprints to use as brochure Oviedo, FL 32762. Call (407) 417-7400 for more information.
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pieces, and trade show handouts. Call
Although every precaution is taken to ensure accuracy of published
Email press releases and all other Florida MD for printing estimates. materials, Florida MD cannot be held responsible for opinions
related information to: expressed or facts expressed by its authors. Copyright 2021, Sea Notes
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2 FLORIDA MD - MARCH 2021
Cannabis Use Does Not Diminish Cognition
in Older Adults
By Michael Patterson, NHA, OTR/L, CEAS
Based on a recent review of applicable studies published in the a Endocannabinoid system (ECS), we are
journal: Archives of Clinical Neuropsychology, Cannabis exposure naturally are predisposed to accept can-
appears to have no significant adverse impact on the cognitive nabis as a medicine. Therefore, I expect
function of older adults. A link to the article is below: more and more Seniors globally will begin
to use cannabis as a medicine to decrease
Effects of Cannabis Use on Cognitive Function in Healthy Ag-
symptoms of many diseases, decrease use of other prescription
ing: A Systematic Scoping Review | Archives of Clinical Neuropsy-
drugs due to no longer needing them, and to not have harsh side
chology | Oxford Academic (oup.com)
effects from certain prescription drugs, and for a better quality of
Adults over 50 years old represent the fastest-growing population life.
of people who use cannabis. Given healthy aging and cannabis use
are associated with cognitive decline, it is important to establish the
effects of cannabis and cognition on healthy aging. Michael Patterson NHA, OTR/L, CEAS is CEO of US
Cannabis Pharmaceutical Research and Development
A team of researchers with the University of California at San LLC. (uscprd.com). Mr. Patterson is a healthcare executive
Diego reviewed human studies and animal trials specific to the po- with over 25 years experience in the following areas: Can-
tential impact of cannabis on cognition. For the analysis, research- nabis-Hemp investment, Law, Regulation, Compliance,
ers analyzed six databases (PubMed, EMBASE, PsycINFO, Web Operations, and Management, Skilled Nursing, Phar-
of Science, Family and Society Studies Worldwide and CINAHL) macy, Laboratory, Assisted Living, Home Healthcare, and
and discovered over 1,000 relevant studies as of September 2019. Healthcare Analytics. Michael is a subject matter expert in
In the human trials, cannabis exposure revealed “predominantly the Global Cannabis and Hemp Industry with Gerson Leh-
null findings” in adults ages 50 and older. In animal models, canna- rman Group (glg.it) and Guidepoint. Mr. Patterson is an
binoid dosing was associated with “improved cognition” with small editorial board member of the American Journal of Medi-
amounts of THC and more potent amount of THC as well. The cal Cannabis, licensed Nursing Home Administrator, and
authors suggested to use caution in interpreting the studies’ results licensed Occupational Therapist in 4 states..
because of their limited number and heterogeneity.
However, the authors concluded, “This systematic scoping re-
view examined current research on the relationship between can-
Sea Notes
nabis use and cognitive function in healthy aging and provides a
starting point for future research.” “Ultimately, given the recent
increase in cannabis use among older adults, future human research
Photography
should examine the relationship between both early and later-life
cannabis use on cognitive function within more homogenous, old-
er adult samples of people who use cannabis.”
ANALYSIS
As more Seniors look to cannabis as a medicine to help with
Donald Rauhofer – Photographer
multiple ailments, it is important for us to use as much research Head Shots • Brochures • Meetings
and data as possible to assist this demographic in feeling comfort-
able using an all-natural medicine in proper dosages to have a con-
Events • Portraits • Arcitectural
4O7-417-74OO
sistent result. In the largest medical cannabis market in the world
(Florida-almost 500,000 patients), the average age of patient is 52
years old. The number of patients in Florida is increasing by 5,000
each week!
The average Senior Citizen in the United States takes 13 pre-
scription medicines per day. From my experience in working in
the US post-acute healthcare system for over 20 years (Nursing
Homes, Rehabilitation centers, Pharmacies, Laboratories), I saw
first-hand how over medication can be just as detrimental to health www.floridamd.com
as not being treated for an ailment. With our bodies containing
FLORIDA MD - MARCH 2021 3
COVER STORY
UCF Lake Nona Medical Center –
Expanding Access to Care in Orlando’s
Medical City
By Staff Writer
After breaking ground in 2018, UCF Lake Nona
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER:
Medical Center opened to the public this month,
providing full-service healthcare to Lake Nona and
surrounding communities in southeast Orlando
and Osceola County. Located at 6700 Lake Nona
Blvd., adjacent to the UCF College of Medicine in
Orlando’s Medical City, Lake Nona’s new hospi-
tal provides 24/7 emergency care and an array of
inpatient and outpatient hospital services and is
expected to serve more than 17,000 patients in its
first year.
The establishment of the new hospital was a
$175 million investment toward creating an imme-
UCF Lake Nona Medical Center’s Family Birthing Unit features six private birthing
diate access point to acute inpatient care for adults. suites, offering all the medical technology mom and baby may need for a safe deliv-
Previously, that level of care was only available ery – including a dedicated operating room for C-sections. Each suite is comfortably
in the Lake Nona area for children (at Nemours furnished with space for a guest to stay overnight. The hospital supports each mom’s
Children’s Hospital) and veterans (at Orlando VA birth plan and preferences, and provides a nurturing environment to support the
family in bonding with baby following delivery, including rooming in, skin-to-skin care
Medical Center at Lake Nona). Now, adults of all immediately following birth and personalized breastfeeding instruction.
ages have immediate, convenient access to a full-
realization of a vision that will impact the community for years
service hospital featuring 64 inpatient beds, a 20-bed emergency
to come,” said Wendy H. Brandon, FACHE, Chief Executive
department, four operating rooms, a cardiac catheterization lab,
Officer. “With the rapid growth in Lake Nona, this community
comprehensive imaging and laboratory services, and six private
needed a hospital close to home. Our team looks forward to
birthing suites.
working with our medical staff to deliver innovative, patient-
“The grand opening of UCF Lake Nona Medical Center is the centered care to every patient and support Lake Nona’s com-
mitment to health and
UCF Lake Nona Medical Center
well-being.”
Established in one
of the state’s fast-
growing regions, UCF
Lake Nona Medical
Center was strategi-
cally designed and
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER:
planned for with
the future in mind –
meaning the hospital
intends to grow with
the community. Cur-
rently, the facility has
64 inpatient beds. The
facility’s shell space has
immediate capacity to
grow to 80 beds, and
the hospital and cam-
pus are designed to
grow to 500 beds, as
4 FLORIDA MD - MARCH 2021
COVER STORY
needed. Looking ahead, Bran-
don expects the hospital’s first
targets for expansion to be in-
patient beds, as well as the ER,
Family Birthing Unit and oper-
ating rooms. Since the hospital
was designed to accommodate
expansion in these areas, such
additions would be completed
without disruption to current
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER
services or care.
In addition to expanded ac-
cess to care, the new hospital
will also provide innovative
treatments not previously avail-
able in the area, like incisionless
brain surgery to treat patients
with essential tremors. The
hospital also features the latest
technology to support superior
quality care and patient safety,
including systems to provide
enhanced security, communica- UCF Lake Nona Medical Center was thoughtfully designed to create a space that is warm and invit-
ing, putting patients at ease with purposeful color choices, calming patterns, comfortable furniture and
tion and experience. Examples functional spaces. The lobby atrium features a gift shop, a quiet room and café complete with outdoor
include an interactive nurse call dining. Complimentary Wi-Fi service is available throughout the facility so guests can be notified by text
system that alerts care teams when their loved one or a team member is ready for them. Located next door to the University of Central
of patient needs in real-time, a Florida’s College of Medicine, some design and architectural elements are repeated as a symbolism of
the unique partnership between UCF College of Medicine and HCA Healthcare.
real time location system which
pinpoints equipment, staff and
patient location throughout the hospital, smart hospital beds that collect patient data and communicate with patients in up to six dif-
ferent languages, and electronic information displays in each room, which communicate important information such as a patient’s care
team, diet, activity schedule and the names and times of team members entering the room.
The community will also benefit from the hospital’s tremendous financial impact on the area’s economy. The new facility employs
more than 370 staff members. In addition,
UCF Lake Nona Medical Center features a full range of imaging technology for both inpatients more than 330 physicians have joined the
and outpatients, including 64-slice Computed Tomography (CT), MRI, nuclear medicine, ultra- UCF Lake Nona Medical Center medi-
sound, X-ray, 3-D mammography, DEXA scan and interventional radiology. cal staff, including specialists in primary
care, cardiology, colorectal surgery, gen-
eral surgery, gastroenterology, orthopedic
surgery, pulmonology, nephrology, OB/
GYN, gynecologic oncology, infectious
disease, nephrology, neurology, neurosur-
gery, spine and urology. UCF Lake Nona
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER
Medical Center is projected to contribute
$1.4 million in local and state taxes and
provide an estimated $13.8 million for
charity and uncompensated care in its
first year.
Thanks to a unique partnership be-
tween HCA Healthcare and the Univer-
sity of Central Florida Academic Health,
UCF Lake Nona Medical Center will
support community needs and boost the
local economy – while simultaneously
investing in tomorrow’s healthcare prac-
FLORIDA MD - MARCH 2021 5
COVER STORY
health and well-being of our communities,” said Brandon.
“We want our community to know they can trust UCF Lake
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER
Nona Medical Center to provide safe care, whether it is in a
medical emergency, a planned medical or surgical procedure
or welcoming a new baby to their family.”
UCF Lake Nona Medical Center opened its doors to the
community Monday, March 1, hosting a virtual grand open-
ing celebration that morning featuring HCA Healthcare
and UCF leadership, hospital team members and commu-
nity leaders. A recording of the program is available at UCF
Lake Nona Medical Center’s Facebook page. To learn more,
please visit www.ucflakenonamedicalcenter.com.
The hospital invested in the latest technology to support superior quality
care and patient safety for its new facility. Every patient room features a
smart bed that weighs the patient and collects other important data, noti-
fies care teams of patient movement to help avoid falls, and communicates
with patients in up to six different languages. Each room is also equipped
with an electronic white board, which communicates a patient’s diet, activ-
ity schedule and the names of team members entering the room in real time. 6700 LAKE NONA BOULEVARD
Through the integration of cutting-edge technologies like these, the hospital
can ensure higher levels of patient care, safety and satisfaction. ORLANDO, FL 32827 • 689-216-8000
UCFLAKENONAMEDICALCENTER.COM
titioners. These future healthcare professionals will benefit from
the depth and breadth of the HCA Healthcare network, tapping
PHOTO: PROVIDED BY UCF LAKE NONA MEDICAL CENTER
into its extensive clinical knowledge and innovative operating
strategies.
“In addition to providing convenient access to outstanding
healthcare services in Lake Nona, this hospital will also provide
important educational opportunities for tomorrow’s physicians
and support the work of our UCF researchers and scientists from
across the country seeking innovative treatments and cures,” said
Dr. Deborah C. German, Vice President for Health Affairs and
Dean of the College of Medicine at University of Central Flori-
da. “UCF Lake Nona Medical Center is the next step in creating
a healthcare hub that will increase economic development and
improve health for all.”
UCF Lake Nona Medical Center’s rehabilitation technology includes a
Designed with education spaces and technology throughout, car transfer simulator, which allows patients to practice getting in and
the new hospital creates an ideal learning environment for fu- out of a vehicle during therapy sessions.
ture physicians, as well as UCF nursing, social work, pharmacy
and physical therapy students and more. These students will UCF LAKE NONA MEDICAL CENTER SERVICES:
be learning not only from the UCF Lake Nona Medical Cen-
ter physicians but will also be supported by hospital colleagues CARDIOLOGY NEPHROLOGY
committed to elevating the standards of care in the Lake Nona COLORECTAL SURGERY NEUROHEALTH SCIENCES
community. UCF Lake Nona Medical Center has also partnered
with community physicians, as well as UCF College of Medicine 24/7 EMERGENCY CARE ORTHOPEDICS
physicians and researchers, who share a commitment to develop- GASTROENTEROLOGY PULMONOLOGY
ing excellent caregivers and finding cures.
GENERAL SURGERY ROBOTIC SURGERY
As the hospital’s leadership team celebrated their grand open- GYNOCOLOGIC ONCOLOGY SPINE CARE
ing milestone this month, they also acknowledged the unique
challenges of opening a hospital during the ongoing pandemic IMAGING UROLOGY
– something they’re well-equipped to handle. INFECTIOUS DISEASE WOMEN’S CARE
“As we’ve seen even more so over this past year, access to qual- MATERNITY
ity healthcare and leading medical experts is paramount to the
6 FLORIDA MD - MARCH 2021
DERMATOLOGY
Things That May Look Malignant But Are Not
By John “Lucky” Meisenheimer, MD and John Meisenheimer, VII
The rate of the number of skin biopsies performed each year nation-
ally has increased by about 6% a year for the last ten years or so. Part
of this increase appears to be due to physician extenders biopsying
more lesions. The good news is that although there may be more un-
necessary biopsies, we have also had an increase in early detection of
PHOTO: JOHN MEISENHEIMER, VII
melanoma in situ, so overall, we are still saving lives. The difficulty is
that there are many benign lesions to the untrained eye that look sus-
picious for skin cancer. Often, for a trained dermatologist, it is simple
to tell benign from malignant lesions. Still, in some cases, it is far more problematic, and a
biopsy is needed to make sure you are not missing something important.
In my practice, I never tell a patient, we will “closely watch” something suspicious to see if it
Abscess – not an ulcerated squamous looks worse in 6 months. I have had patients on their visits with me point out lesions that their
cell carcinoma. health care provider is “following” as it appeared a little suspicious to them. If it is question-
able, then it needs to be biopsied, period, now, not in 6 months when it has had a chance to
grow. You only follow lesions that don’t look suspicious. If I am at all suspicious, and of course,
being a dermatologist, I have the advantage of intuitive expertise, I will biopsy, and I like other
dermatologists have a high rate of success in finding the spots that do need biopsying.
There are times that I will biopsy a spot just because I have an inkling of a thought that
there might be something going on; this is the intuitive expertise kicking in again. Sometimes
PHOTO: JOHN MEISENHEIMER, VII
I biopsy lesions because it is a CTA (Cover Thy Ass) moment. Although I know deep in my
heart that the spot is benign, it sure looks funky, and I want to make sure I have not made
a mistake. Better to biopsy and prove yourself wrong
than trying to explain to the jury why not biopsying
the malignancy that appeared benign, was the correct
choice, good luck with that challenge.
Hidrocystoma - not Merkel cell carci- What about a growth that looks completely benign,
noma.
but you are mistaken? If I feel that there is nothing
clinically wrong with a lesion, I will explain to the
patient, “if it should change or become symptomatic,
PHOTO: JOHN MEISENHEIMER, VII
then come back in for a recheck, do not wait for your
six or twelve months follow up.” If you don’t give the
patients this bit of sage advice, then you will invari-
ably see the following scenario happen.” A patient calls
PHOTO: JOHN MEISENHEIMER, VII
three years after his last exam. “Doc, I had a spot you
said was okay, but it started growing about a week af-
ter I saw you. I didn’t do anything as you said it was
okay. It’s now about the size of a golf ball, do you think Chondrodermatitis – not Squamous
I need to come in, it’s been three years now and still cell carcinoma.
growing, what do you think?”
Herpes – not Basal cell carcinoma. Benign appearing lesions that, in reality, have gone to
PHOTO: JOHN MEISENHEIMER, VII
the dark side will eventually evolve. The patient will be
the first to notice this happening, and they need to know you take changes seriously, even if it
occurs days or weeks after their exam. Return checks on sudden changes in benign-appearing
growths are your security net for wolves hiding under sheepskins.
Lucky Meisenheimer, M.D. is a board-certified dermatologist specializing in Mohs Sur-
gery. He is the director of the Meisenheimer Clinic – Dermatology and Mohs Surgery.
John Meisenheimer, VII is a medical student at USF. Pyogenic Granuloma – not
Metastatic carcinoma.
FLORIDA MD - MARCH 2021 7
HEALTHCARE LAW
Understanding Exculpatory Clauses
By Julie A. Tyk, JD
An exculpatory clause purports to deny an injured party the The Fifth District reversed, find-
right to recover damages from a person negligently causing his ing the lower court erred in denying
injury. Cain v. Banka, 932 So. 2d 575 (Fla. 5th DCA 2006). GKTW’s motion for summary judg-
They are disfavored in the law because they relieve one party of ment because the release signed by
the obligation to use due care and shift the risk of injury to the the Sanislos was unambiguous and
party who is probably least equipped to take the necessary pre- did not contravene public policy. It
cautions to avoid injury and bear the risk of loss. Applegate v. ruled the exculpatory clause barred the negligence action despite
Cable Water Ski, L.C., 974 So. 2d 1112, 1114 (Fla. 5th DCA the lack of a specific reference to “negligence” or “negligent acts”
2008). Such clauses are strictly construed against the party seek- in the exculpatory clause.
ing to be relieved of liability. Sunny Isles Marina, Inc. v. Adulami,
The Fifth District reasoned that exculpatory clauses are ef-
706 So. 2d 920 (Fla. 3d DCA 1998). Thus, exculpatory clauses
fective if the wording of the exculpatory clause is clear and un-
are enforceable, only where, and to the extent, that the intention
derstandable so that an ordinary and knowledgeable person would
to be relieved from liability is made clear and unequivocal. Tat-
know what he or she is contracting away, and that the court had
man v. Space Coast Kennel Club, Inc., 27 So. 3d 108, 110 (Fla. 5th
previously rejected “‘the need for express language referring to
DCA 2009). The wording must be so clear and understandable
release of the defendant for “negligence” or “negligent acts” in
that “an ordinary and knowledgeable person will know what he is
order to render a release effective to bar a negligence action.’ ” On
contracting away.” Id. (quoting Gayon v. Bally’s Total Fitness Corp.,
the public policy argument, the Court said the relative bargain-
802 So. 2d 420 (Fla. 3d DCA 2001).
ing power of the parties should not be considered because it was
The seminal Florida case on exculpatory clauses is the Florida outside of the public utility or public function context and the
Supreme Court case of Sanislo v. Give Kids The World, Inc., 157 Sanislos were not required to request a vacation with GKTW or
So. 3d 256 (Fla. 2015). Give Kids the World, Inc. (“GKTW”) go on the vacation. Id.
provided free vacations to seriously ill children and their families.
In affirming the Fifth District’s decision, the Supreme Court
When applying for the vacation, the Sanislos executed a “wish
wrote that the conflict for the Court’s resolution was “whether
request” form that contained a waiver of liability, also known as
an exculpatory clause is ambiguous and thus ineffective to bar a
an exculpatory clause. When the parents arrived at the resort vil-
negligence action due to the absence of express language releas-
lage they again signed a liability release form, also an exculpatory
ing a party from its own negligence or negligent acts.” Id. at 260.
clause. The language of the exculpatory clause is reprinted below
for reference: The Florida Supreme Court wrote:
I/we hereby release Give Kids the World, Inc. and all of its .... we are reluctant to hold that all exculpatory clauses that are
agents, officers, directors, servants, and employees from any li- devoid of the terms “negligence” or “negligent acts” are ineffective
ability whatsoever in connection with the preparation, execu- to bar a negligence action despite otherwise clear and unambigu-
tion, and fulfillment of said wish, on behalf of ourselves, the ous language indicating an intent to be relieved from liability in
above named wish child and all other participants. The scope such circumstances. Application of such a bright-line and rigid
of this release shall include, but not be limited to, damages or rule would tend to not effectuate the intent of the parties and
losses or injuries encountered in connection with transporta- render such contracts otherwise meaningless.
tion, food, lodging, medical concerns (physical and emotional), Id. at 270.
entertainment, photographs and physical injury of any kind....
The Court found that the GKTW liability release form re-
I/we further agree to hold harmless and to release Give Kids leased GKTW and all of its agents, officers, directors, servants
the World, Inc. from and against any and all claims and causes of and employees from “any liability whatsoever in connection with
action of every kind arising from any and all physical or emotional the preparation, execution and fulfillment of said wish…” The
injuries and/or damages which may happen to me/us.... release then provided that the scope of the agreement included
Sanislo at 258-259. “damages or losses or injuries encountered in connection with
transportation, food, lodging, medical concerns (physical and
While participating in a horse-drawn wagon ride, a rear pneu-
emotional), entertainment, photographs and physical injury of
matic lift designed to allow those in wheelchairs to participate
any kind . . . .” The Court found that the release clearly conveyed
failed, and Ms. Sanislo was injured. The Sanislos brought suit and
that GKTW would be released from any liability, including negli-
GKTW filed a motion for summary judgment arguing that the
gence, for damages, losses, or injuries due to transportation, food,
signed releases precluded an action for negligence. The Sanislos
lodging, entertainment and photographs. Id.
filed a motion for partial summary judgment against GKTW’s
affirmative defense of release. The trial court granted the San- The determination of whether an exculpatory clause is en-
islo’s motion and denied GKTW’s motion. The jury found for forceable will be determined by the Judge, as the enforceability of
the Sanislos and GKTW appealed. Id. a pre-injury release is a question of law. The enforceability there-
8 FLORIDA MD - MARCH 2021HEALTHCARE LAW
fore, will depend on the Judge assigned to the matter. Physicians should not assume that because a patient signed a liability release form
the patient does not have a viable cause of action. Physicians should consult with an experienced attorney who can examine the facts of
the case and help you determine the best path forward. The Health Care Practice Group at Pearson Doyle Mohre and Pastis, LLP is com-
mitted to assisting Clients in navigating and defending medical malpractice claims. For more information and assistance, please contact
David Doyle and Julie Tyk at Pearson Doyle Mohre & Pastis, LLP.
Julie A. Tyk, JD, is a Partner with Pearson Doyle Mohre & Pastis, LLP. Julie concentrates her practice in medical
practice defense litigation, insurance defense litigation and health care law. She has represented physicians, hospitals,
ambulatory surgical centers, nurses and other health care providers across the state of Florida. She may be contacted by
calling (407) 951-8523; jtyk@pdmplaw.com.
FLORIDA MD - MARCH 2021 9Your Patient Is Not Happy with Their Knee or
Hip Replacement. What’s Next?
By George J. Haidukewych, MD
According to the Agency for Healthcare Research and Quality, knee or hip replacement.
more than 790,000 knee and 450,000 hip replacements are
Sometimes patients have unrealistic
performed in the United States each year. While these numbers
expectations of their replacement, because
declined somewhat over the past year due to obvious reasons
of what they’ve been told or seen on TV
and events related to the pandemic, experts project a significant
or social media. Expecting the joint to
upward trend in medically indicated joint replacement surgeries
be normal versus artificial is a common source of dissatisfaction.
over the next 10 years.
They may not follow proper rehab or activity levels. These patients
More than 85-90 percent of patients who undergo total knee require a comprehensive evaluation of their overall fitness level,
or hip arthroplasty (TKA/THA) surgery experience a favorable including other joints like the shoulders and ankles. Patients need
outcome, with a decrease in pain, an increase in mobility and an to focus on total body fitness and understand what a replacement
overall improved quality of life. And with advances in technology, joint can and cannot do.
patients can expect their replacement joint to function well for An overall aging population, a rise in the prevalence of risk
20 years or longer. But not all joint replacement surgeries are factors such as obesity, and the popularity of maintaining active
successful. Complications and failures can occur, and patients lifestyles not only contribute to the increasing number of joint
who expected dramatic pain relief and function after a knee or replacement surgeries, but also the inevitable consequential
hip replacement may present with persistent pain, as well as increase in complications or failed joint replacements. We also
considerable frustration and unhappiness. have seen an increasing number of joint replacements in a younger
About a third of patients will still have some aches and pains patient population whose active lifestyles place added stress and
following knee or hip replacement. Early problems can be due wear on their original and replacement joints. With normal use
to technical factors involving the surgery, inadequate rehab, or and activity, every joint replacement implant begins to wear over
more serious problems such as infection or loosening. Problems time, and excessive activity or weight may increase the rate of this
can also occur years after surgery as the ceramics and plastics start normal wear, causing the replacement joint to loosen and become
to wear through. A joint replacement that had previously been painful.
functioning well for several years can suddenly start hurting or Evaluation by an orthopedic specialist may determine that a
swelling. painful knee or hip replacement does need any further surgical
The most common complaints following TKA include swelling, intervention. It may simply be something that indicates additional
activity-related pain and mechanical symptoms, like a crunching physical therapy, weight loss or activity modification. But there
behind the kneecap and even clicking when the patient walks. is an increasing number of patients who will require a joint
With THA, common painful symptoms include persistent pain replacement revision (redo).
around the tendon or bursa on the side of the hip. WHEN IS REVISION SURGERY NECESSARY?
WHAT DO YOU DO IF YOUR PATIENT Revision, or redo, surgery is a complex procedure that involves
EXPERIENCES PERSISTENT PAIN AFTER JOINT removing and replacing the original joint implant, usually due to
REPLACEMENT SURGERY? a complication from the initial replacement.
Sorting out what is a normal discomfort for a prosthetic joint Overall, complication rates following TKA or THA surgery are
and what is a more serious problem is not always straightforward. low. Serious complications, such as a joint infection, occur in fewer
What may seem like a minor ache or pain could be a sign of a than 1-2 percent of patients. Instability can occur in 2-3 percent
more serious underlying problem. Problems such as instability or of knee replacements, and 2-3 percent of hip replacements can
loosening of the knee or hip, or even more unusual problems like have a dislocation or similar problem. These percentages are small,
corrosion or metal sensitivity, can be easily misdiagnosed; ruling but given the large number of surgeries performed, it adds up to a
out infection and instability is critical. significant number of people experiencing undue discomfort and
pain.
The optimal plan of care for those patients who continue to
experience ongoing joint pain after TKA or THA is an evaluation Typically, more women than men undergo knee replacement,
referral with an orthopedic specialist. Specialized tertiary referral with hip replacements being about even between men and women.
centers like Orlando Health Jewett Orthopedic Institute offer Overall, men place more wear on replacement joints than women,
expert specialist care and advanced technology, including due both to more body weight and slightly more activity, resulting
leading-edge imaging, such as MRI scanning with metal artifacts in a slightly higher need for revision surgery.
suppression, to diagnose reasons for persistent symptoms after a Data from Medicare shows that the average rate of revision
10 FLORIDA MD - MARCH 2021surgery within 90 days is 0.2 percent but increases to 3.7 percent within 18 months. These are usually due to infection or mechanical
complications of the implant. While surgical techniques and implant designs and materials continue to advance, implant surfaces can
wear down and the components can loosen over time. Research suggests that long-term wear and loosening affects 6 percent of people
after 5 years and 12-15 percent after 10 years.
Only a handful of centers in Florida specialize in diagnosing and treating conditions associated with problematic joint replacements.
Specialists with the Orlando Health Jewett Orthopedic Institute perform hundreds of successful revisions of knee and hip replacements
every year for patients throughout Florida and the Southeast.
These complex, long procedures can be challenging and require multidisciplinary and subspecialty care, including infectious disease
experts and plastic surgeons, as well as advanced surgical, intensive care, recovery and rehabilitation facilities that provide a higher level
of care. Backed by all the resources of the Orlando Health system, Orlando Health Jewett Orthopedic Institute offers this advanced level
of care. And, expected to be completed in 2023, a new, state-of-the-art orthopedic complex on Orlando Health’s downtown Orlando
campus will usher in the next generation of orthopedic care.
Ultimately, the basic message for your
patients is “Don’t give up hope!” An
orthopedic surgeon who specializes in
complex knee and hip revision work can
provide a comprehensive evaluation to
determine how to best correct a persistent
joint replacement problem.
Internationally recognized for
joint replacement surgery and
trauma, George J. Haidukewych,
MD, serves as Orlando Health’s
director of orthopedic trauma and
chief of complex joint replacement,
practicing at the Orlando Health
Jewett Orthopedic Institute. Dr.
Haidukewych specializes in total
hip and total knee replacements
as well as orthopedic trauma. He
brings extensive experience in the
management of failed and infected
total hip and total knee replacements
and in reconstruction of the joints
after trauma. Up to half of his
practice is dedicated to solving these
challenging problems from around
the Southeast. Dr. Haidukewych
completed his residency training
at the Mayo Clinic in Rochester,
Minnesota, as well as a fellowship at
Florida Orthopaedic Institute in the
Tampa Bay area.
Check out our newly
redesigned website at
www.floridamd.com!
FLORIDA MD - MARCH 2021 11PHARMACY UPDATE COVER STORY
Nature-Throid® & WP Thyroid® Recall
By Juan Lopez, PharmD, FAPC
Having difficulties filling your prescription thyroid therapy ners may consider if appropriate. NP
for Nature-Throid® or WP Thyroid®? Thyroid® and Armour Thyroid® are
RLC Labs, the manufacturer of Nature-Throid® and WP Thy- standardized using a different thyroid
roid® products, announced that it is voluntarily recalling all unex- USP quantity as compared to Nature-
pired lots of Nature-Throid® and WP Thyroid® to the consumer Throid® and WP Thyroid® (60mg vs.
level. See RLC Labs’ September 2, 2020 statement below: 65mg). To facilitate patients convert-
ing between these different products,
“RLC Labs, Inc. is voluntarily recalling a total of 483 lots of Na- the amount of therapy as grains (gr.) (i.e. ¼ grain, ½ grain, 1 grain,
ture-Throid® and WP Thyroid® in all strengths, all counts of product etc.) can be used to express the strength of the patient’s thyroid
within current expiry to the consumer level. The products are being therapy and ensure the patient receives the same amount of T3 and
recalled because testing of samples from six (6) lots by the U.S. Food T4 supplementation.
and Drug Administration found the samples to be sub potent. The
product may have as low as 87% of the labeled amount of Liothyro- Patients suffering from hypothyroidism symptoms may be sen-
nine (T3) or Levothyroxine(T4). sitive to particular fillers commonly found in medications. Each
brand of thyroid medication uses different fillers during the manu-
Risk Statement: Patients being treated for hypothyroidism (un- facturing process. Pharmacists can review inactive ingredients of
deractive thyroid), who receive sub potent Nature-Throid® or WP each formulation with patients to help determine tolerability.
Thyroid®, may experience signs and symptoms of hypothyroidism
(underactive thyroid) which may include, fatigue, increased sensi- It is not uncommon that patients who are unable to find their
tivity to cold, constipation, dry skin, puffy face, hair loss, slow heart thyroid medication due to availability issues may have their therapy
rate, depression, swelling of the thyroid gland and/or unexplained changed from desiccated thyroid, which supplies a standardized
weight gain or difficulty losing weight. There is reasonable risk of amount of levothyroxine (T4) and liothyronine (T3), to products
serious injury in newborn infants or pregnant women with hypo- that only supply T3 and/or T4 alone. The only commercially avail-
thyroidism including early miscarriage, fetal hyperthyroidism, and/ able T3/T4 combination tablet not derived from desiccated porcine
or impairments to fetal neural and skeletal development. In elderly thyroid was sold under the brand name Thyrolar (Liotrix). In De-
patients and patients with underlying car-
diac disease toxic cardiac manifestations of
hyperthyroidism may occur, such as cardiac
pain, palpitations or cardiac arrhythmia.
RLC Labs, Inc. has not received any re-
ports of adverse events related to this recall.
Pain Management | HRT
Nature-Throid® and WP Thyroid® (thy- Prescribe topical
roid tablets, USP) are composed of liothy- medications in
ronine and levothyroxine, and are used Topi-CLICK® 140
to treat hypothyroidism (underactive thy-
roid).” 0.50 mL
Patients who are currently taking Na- per
ture-Throid® and WP Thyroid® should not CLICK
discontinue use without contacting their
healthcare provider for further guidance • Accurate, metered dose without losing
and/or a replacement prescription. You prime like pumps
are encouraged to contact your prescribing • Innovative Design is user-friendly for
health care provider to discuss next steps. all patients
The recall of all lots may lead to a sup- • 4Port™ for faster dosing of thicker
ply shortage of this thyroid therapy. In topical medications
2017 patients faced similar shortages of
Request FREE samples for Patient Trials and the International Journal
Nature-Throid® and WP Thyroid® due to
of Pharmaceutical Compounding Peer Reviewed Accuracy Study:
a world-wide shortage of pharmaceutical
www.DoseLogix.com | 877.870.8448 | info.TopiCLICK@teamtech.com
grade Thyroid USP. NP Thyroid® (Acella
Pharmaceuticals) and Armour Thyroid®
(Allergan) are two commercially available
alternatives that patients and their practitio-
| Copyright © 2020, DoseLogix. All rights reserved.
12 FLORIDA MD - MARCH 2021PHARMACY UPDATE
cember 2018, the Food and Drug Administration (FDA) announced the manufacturer made a business decision to discontinue production
of Thyrolar tablets.
PERSONALIZED THYROID REPLACEMENT THERAPY
Pharmacy Specialists can help patients and physicians design appropriate thyroid replacement therapy. We stock the pure chemical forms
of desiccated thyroid (Thyroid USP), levothyroxine (T4) and liothyronine (T3), so that we can create a custom blend of hormones at an
ideal ratio to meet patients’ individual needs and maintain their hormone balance. Desiccated thyroid, levothyroxine or liothyronine can
be compounded as single ingredient or combination capsules designed to release immediately or over a prolonged period of time. When
we compound customized dosages, we have the ability to omit any problem-causing inactive ingredients such as corn, gluten, starch, soy or
animal by-products and substitute with non-reactive fillers.
Commercially available thyroid replacement products may not be the best fit for a patient when:
(1) There is a lack in availability due to drug shortages.
(2) They contain undesirable fillers.
(3) They are only available as immediate-release dosage forms.
(4) Patients require a different strength than what is available.
(5) Patients require a unique ratio of T3 and T4 supplementation.
(6) Patients require non-porcine derived products and would benefit from both T3 and T4 supplementation.
When changing thyroid medications from one manufacturer to another, the dose may need to be optimized to meet individual needs, this
is also true for a compounded personalized thyroid prescription. We can prepare a variety of strengths and combinations of thyroid therapy
providing patients with a larger choice of therapy options. A little more or a little less is no problem based on your symptoms and you
healthcare prescriber’s professional judgment.
Our goal as personalized medicine pharmacists is to meet the individual needs and circumstances of patients and physicians. Without the
ability to create customized thyroid replacement therapy patients may be at risk for suboptimal or nonexistent thyroid therapy while these
medications are in short supply.
REFERENCES AVAILABLE UPON REQUEST.
Juan Lopez, PharmD, FAPC, is a
personalized medicine pharmacist with
Pharmacy Specialists Compounding
Pharmacy in Altamonte Springs, FL.
For more information on how personal-
ized medicine can help you, please call
(407) 260-7002, or email us at Info@
MakeRx.com.
Check out our
newly redesigned
website at
www.floridamd.com!
FLORIDA MD - MARCH 2021 13Your Skin is Your Body’s First Line of Defense
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14 FLORIDA MD - MARCH 2021MARKETING YOUR PRACTICE
Facebook Marketing for Medical Practices
By Sonda Eunus, MHA, CMPE
For a medical practice, as for any business, it is now crucial to • Ask your existing patients to add Face-
have a strong presence on social media platforms. However, it book reviews to your page
is often hard for medical practice leaders to know which social
media platforms to focus on to get the greatest results. Whereas GROW YOUR FACEBOOK
there are multiple great options to choose from, Facebook should AUDIENCE:
always be the #1 platform to start with and to invest the most Here are the best ways to start growing your Facebook audience:
time on.
• Invite all your friends to like your new Business page
WHY FACEBOOK SHOULD BE #1 ON YOUR LIST:
• Ask the other page Administrators that you add to invite their
Facebook is currently the largest social media platform, with friends to like your page
2.6 BILLION monthly active users worldwide as of the first
quarter of 2020 – with 1.73 billion of those using Facebook daily • Ask your friends on Facebook to invite their friends to like
(1). Facebook is now the world’s 3rd most-visited website, after your Facebook page
Google and Youtube (2). There are 90 million Facebook Business After you have acquired an initial following by using these
pages (2). This shows that 90 million businesses have found it strategies, you will need to start focusing on more long-term
beneficial to have a Facebook presence. Not only is it important strategies to engage with your existing audience and to grow your
because you are getting additional exposure to Facebook users, following. To do so, you will need to:
but it will also improve your online credibility and boost your • Post quality content regularly, at least once a day – you can
search engine optimization. Social Media accounts show up in use funny (tasteful) memes, motivational quotes, informative
search results when someone searches for your practice – so make articles, etc.
sure that your page is active, that you are sharing valuable con-
tent, and that you have a good amount of page followers for social • Invite the people that engage with the content you share to like
proof that your business is liked and respected in the community. your page, respond to any comments that you receive on your
page
If you are not sure that your target audience is on Facebook,
consider this: 71% of American adults use Facebook, as com- • Use engaging posts to increase engagement, such as contests,
pared to Instagram’s 38%, and Twitter’s 23% (2). The percentages raffles, photo share requests, etc.
of people in specific age ranges that are active on Facebook look • Share blog posts that you write
like this:
• Ask your friends, staff, and business partners to share your
• 18-24: 76% posts
• 25-29: 84%
• Be active in local Facebook groups
• 30-49: 79%
• 50-64: 68% • -Start your own Facebook group
• 65+: 46%
LEVERAGE FACEBOOK GROUPS TO GROW
This is a good audience for any medical practice, as you can YOUR AUDIENCE:
reach both young parents with newborns, older patients, and
anyone in between. There are over 10M+ groups on Facebook, and over 1.4
billion people now use Facebook Groups every month (1). It
OPTIMIZE YOUR FACEBOOK PAGE: is a good idea to start a Facebook group in addition to your
Facebook Business page in order to grow your following and get
To get started, make sure that your Facebook Business page is
more page likes. To grow your group, post valuable resources
optimized. Here are some key steps to focus on:
and information relevant to your target audience – and, every
• You want to add as much information as possible and fill out now and then, make announcements regarding your practice,
all the sections available. new services that you are offering, or other updates. However,
• Upload a clear copy of your logo as your profile picture. make sure that you are not using this group solely to promote
your practice, or you will lose group members. What is great
• Add a nice cover photo – this could be a picture of your clinic, about groups, is that when you share a post in a group, all of
your staff, or another image that is relevant to your clinic and your members get a notification that you have posted in the
your target audience. group. This way, your posts get seen by more people than the
• Make sure that there is a clear way to contact you, visit your posts that you share on your Business page.
website, etc. and add the services that you provide Aside from creating your own Facebook group, make sure that
• Add as many photos as possible, such as pictures of your wait- your page also joins as many relevant local groups as possible.
ing room, exam rooms, doctors, staff, etc. There are groups for everyone, and you need to find the ones that
FLORIDA MD - MARCH 2021 15MARKETING YOUR PRACTICE
will help you gain exposure to your target audience. For example, a pediatric practice can join groups for local moms, or a specialist can
join groups related to a specific ailment that they treat at their clinic.
To summarize, a Facebook presence is important for any medical practice. By utilizing the steps outlined below, you will be on your
way to growing your practice exposure and building up your credibility as an expert in your field.
If you would like to outsource your Social Media Marketing to a team of Marketing experts, Leading Marketing Solutions can help
you bring these strategies to life and grow your audience and social presence for you. Visit www.lms-plus.com for more information.
References:
1. https://zephoria.com/top-15-valuable-facebook-statistics/
2. https://blog.hootsuite.com/facebook-statistics/
3. https://www.websitehostingrating.com/facebook-statistics/
Sonda Eunus is the CEO of Leading Marketing Solutions, a Marketing Agency working with Medical Practices and other
Businesses to help them identify the best marketing strategies for their business, create a strong online presence, and automate
their marketing processes for a better return on their Marketing budget. Learn more about Leading Marketing Solutions at
www.lms-plus.com.
16 FLORIDA MD - MARCH 2021JANUARY – Digestive Disorders
Diabetes
2021
FEBRUARY – Cardiology
EDITORIAL Heart Disease & Stroke
CALENDAR
MARCH – Orthopaedics
Florida MD is a four-color monthly Men’s Health
medical/business magazine for physicians in
the Central Florida market. APRIL – Surgery
Florida MD goes to physicians at their offices, in the Scoliosis
thirteen-county area of Orange, Seminole, Volusia,
Osceola, Polk, Flagler, Lake, Marion, Sumter, Hardee, MAY – Women’s Health
Highlands, Hillsborough and Pasco counties. Cover stories Advances in Cosmetic Surgery
spotlight extraordinary physicians affiliated with local
clinics and hospitals. Special feature stories focus on new JUNE – Allergies
hospital programs or facilities, and other professional
Pulmonary & Sleep Disorders
and healthcare related business topics. Local physician
specialists and other professionals, affiliated with local
businesses and organizations, write all other columns or JULY – Neurology / Neuroscience
articles about their respective specialty or profession. This Advances in Rehabilitation
local informative and interesting format is the main reason
physicians take the time to read Florida MD. AUGUST – Sports Medicine
Robotic Surgery
It is hard to be aware of everything happening in the rapidly
changing medical profession and doctors want to know
more about new medical developments and technology, SEPTEMBER – Pediatrics & Advances in NICUs
procedures, techniques, case studies, research, etc. in Autism
the different specialties. Especially when the information
comes from a local physician specialist who they can OCTOBER – Cancer
call and discuss the column with or refer a patient. They Dermatology
also want to read about wealth management, financial
issues, healthcare law, insurance issues and real estate
NOVEMBER – Urology
opportunities. Again, they prefer it when that information
comes from a local professional they can call and do
Geriatric Medicine / Glaucoma
business with. All advertisers have the opportunity to have
a column or article related to their specialty or profession. DECEMBER – Pain Management
Occupational Therapy
Please call 407.417.7400 for additional materials or information.
FLORIDA MD - MARCH 2021 17Celebrating
YOU on
National
Doctors’
Day
March 30, 2021
Because
you are
incredible.
21-CHN-00952
18You can also read
