Liability premium P increases may offer opportunities for change

_________________________________________________________________FEATURES

Surgeon takes flight to deliver improved sight worldwide 12Walter J. Kahn, MD, FACS

Surgeons pocket PDAs to end paper chase: Part II 17Karen Sandrick

Liability premium increases may offeropportunities for change 22Christian Shalgian

Governors’ committee deals with range of risks 25Donald E. Fry, MD, FACS

A summary of the Ethics and Philosophy Lecture:Surgery—Is it an impairing profession? 29

Statement on bicycle safety andthe promotion of bicycle helmet use 30

DEPARTMENTS

From my perspectiveEditorial by Thomas R. Russell, MD, FACS, ACS Executive Director 3FYI: STAT 5

Dateline: Washington 6Division of Advocacy and Health Policy

What surgeons should know about... 8OSHA regulation of blood-borne pathogensAdrienne Roberts

Keeping current 32What’s new in ACS Surgery: Principles and PracticeErin Michael Kelly

February 2002Volume 87, Number 2

Stephen J. RegnierEditor

Linn MeyerDirector of

Communications

Diane S. SchneidmanSenior Editor

Tina WoelkeGraphic Design Specialist

Alden H. Harken,MD, FACS

Charles D. Mabry,MD, FACS

Jack W. McAninch,MD, FACS

Editorial Advisors

Tina WoelkeFront cover design

Tina WoelkeBack cover design

About the cover...

For the last 20 years,ORBIS, a not-for-profit orga-nization based in New York,NY, has been flying ophthal-mologists to developing landsto treat blind and nearlyblind patients and to trainsurgeons and other healthcare professionals in the pro-vision of advanced oph-thalmic services. In “Sur-geon takes flight to deliverimproved sight worldwide,”p. 12, Walter J. Kahn, MD,FACS, discusses his experi-ences as a volunteer forORBIS.

NEWS

Dr. Harken named to ACS executive staff 332001 Australia-New Zealand Chapter Travelling Fellowship 34William M. Kuzon, Jr., MD, PhD, FACS

2002 Trauma Motion Picture Session: Call for videotapes 36

Surgeons targeted for identity theft 38

State issues database now online 38

Highlights of the Board of Regents meeting,October 5-7, 12, 2001 39John P. Lynch

Chapter news 46Rhonda Peebles

Bulletin of the AmericanCollege of Surgeons (ISSN0002-8045) is publishedmonthly by the American Col-lege of Surgeons, 633 N. SaintClair St., Chicago, IL 60611. Itis distributed without charge toFellows, to Associate Fellows,to participants in the Candi-date Group of the AmericanCollege of Surgeons, and tomedical libraries. Periodicalspostage paid at Chicago, IL,and additional mailing offices.POSTMASTER: Send ad-dress changes to Bulletin of theAmerican College of Surgeons,633 N. Saint Clair St., Chicago,IL 60611-3211.

The American College ofSurgeons’ headquarters is lo-cated at 633 N. Saint Clair St.,Chicago, IL 60611-3211; tel.312/202-5000, fax: 312/202-5001; e-mail: [email protected]; Web site: www.facs.org.Washington, DC, office is lo-cated at 1640 Wisconsin Ave.,NW, Washington, DC 20007;tel. 202/337-2701, fax 202/337-4271.

Unless specifically statedotherwise, the opinions ex-pressed and statementsmade in this publication re-flect the authors’ personalobservations and do not im-ply endorsement by nor offi-cial policy of the AmericanCollege of Surgeons.

©2002 by the American Col-lege of Surgeons, all rights re-served. Contents may not be re-produced, stored in a retrievalsystem, or transmitted in anyform by any means withoutprior written permission of thepublisher.

Library of Congress number45-49454. Printed in the USA.Publications Agreement No.1564382.

VOLUME 87, NUMBER 2, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS

2

Officers and staff of the American College of Surgeons

Officers

R. Scott Jones, MD, FACS, Charlottesville, VAPresident

Kathryn D. Anderson, MD, FACS, Los Angeles, CAFirst Vice-President

Claude H. Organ, Jr., MD, FACS, Oakland, CASecond Vice-President

John O. Gage, MD, FACS, Pensacola, FLSecretary

John L. Cameron, MD, FACS, Baltimore, MDTreasurer

Thomas R. Russell, MD, FACS, Chicago, ILExecutive Director

Gay L. Vincent, CPA, Chicago, ILComptroller

Officers-Elect (take office October 2002)

C. James Carrico, MD, FACS, Dallas, TXPresident

Richard R. Sabo, MD, FACS, Bozeman, MTFirst Vice-President

Amilu S. Rothhammer, MD, FACS, Colorado Springs, COSecond Vice-President

Board of Regents

Edward R. Laws, Jr., MD, FACS, Charlottesville, VAChair*

Jonathan L. Meakins, MD, FACS, Montreal, PQVice-Chair*

Barbara L. Bass, MD, FACS, Baltimore, MDL. D. Britt, MD, FACS, Norfolk, VAWilliam H. Coles, MD, FACS, New Orleans, LAPaul E. Collicott, MD, FACS, Chicago, ILEdward M. Copeland III, MD, FACS, Gainesville, FLA. Brent Eastman, MD, FACS, La Jolla, CARichard J. Finley, MD, FACS, Vancouver, BCJosef E. Fischer, MD, FACS, Boston, MAAlden H. Harken, MD, FACS, Denver, CO*Gerald B. Healy, MD, FACS, Boston, MA*R. Scott Jones, MD, FACS, Charlottesville, VA*Margaret F. Longo, MD, FACS, Hot Springs, ARJack W. McAninch, MD, FACS, San Francisco, CA*Mary H. McGrath, MD, FACS, Maywood, ILJohn T. Preskitt, MD, FACS, Dallas, TXRonald E. Rosenthal, MD, FACS, Wayland, MAMaurice J. Webb, MD, FACS, Rochester, MN

*Executive Committee

Board of Governors/Executive Committee

J. Patrick O’Leary, MD, FACS, New Orleans, LAChair

Sylvia D. Campbell, MD, FACS, Tampa, FLVice-Chair

Timothy C. Fabian, MD, FACS, Memphis, TNSecretary

Julie A. Freischlag, MD, FACS, Los Angeles, CA

Steven W. Guyton, MD, FACS, Seattle, WARene Lafreniere, MD, FACS, Calgary, ABCourtney M. Townsend, Jr., MD, FACS, Galveston, TX

Advisory Council to the Board of Regents(Past-Presidents)

W. Gerald Austen, MD, FACS, Boston, MAHenry T. Bahnson, MD, FACS, Pittsburgh, PAOliver H. Beahrs, MD, FACS, Rochester, MNJohn M. Beal, MD, FACS, Valdosta, GAHarvey W. Bender, Jr., MD, FACS, Nashville, TNGeorge R. Dunlop, MD, FACS, Worcester, MAC. Rollins Hanlon, MD, FACS, Chicago,ILJames D. Hardy, MD, FACS, Madison, MSM. J. Jurkiewicz, MD, FACS, Atlanta, GALaSalle D. Leffall, Jr., MD, FACS, Washington, DCWilliam P. Longmire, Jr., MD, FACS, Los Angeles, CALloyd D. MacLean, MD, FACS, Montreal, PQWilliam H. Muller, Jr., MD, FACS, Charlottesville, VADavid G. Murray, MD, FACS, Syracuse, NYDavid C. Sabiston, Jr., MD, FACS, Durham, NCSeymour I. Schwartz, MD, FACS, Rochester, NYGeorge F. Sheldon, MD, FACS, Chapel Hill, NCG. Tom Shires, MD, FACS, Las Vegas, NVFrank C. Spencer, MD, FACS, New York, NYRalph A. Straffon, MD, FACS, Shaker Heights, OHJames C. Thompson, MD, FACS, Galveston, TX

Executive Staff

Executive Director: Thomas R. Russell, MD, FACSDivision of Advocacy and Health Policy:

Cynthia A. Brown, DirectorAmerican College of Surgeons Oncology Group:

Samuel A. Wells, Jr., MD, FACS, Group ChairCommunications: Linn Meyer, DirectorDivision of Education:

Ajit K. Sachdeva, MD, FACS, FRCSC, DirectorExecutive Services: Barbara L. Dean, DirectorFinance and Facilities: Gay L. Vincent, CPA, DirectorHuman Resources: Jean DeYoung, DirectorInformation Services: Howard Tanzman, DirectorJournal of the American College of Surgeons:

Wendy Cowles Husser, Executive EditorDivision of Member Services:

Paul E. Collicott, MD, FACS, DirectorDivision of Research and Optimal Patient Care:

Alden H. Harken, MD, FACS, Interim DirectorCancer:David P. Winchester, MD, FACS, Medical DirectorOffice of Evidence-Based Surgery:Margaret Mooney, MD, Interim DirectorTrauma:David B. Hoyt, MD, FACS, Medical Director

Executive Consultant:C. Rollins Hanlon, MD, FACS

FEBRUARY 2002 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS

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From myperspective

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As the nation becomes more economicallyand emotionally stable after the eventsof last year, resolution of health care is-sues will once again occupy a prominent

spot on the agendas of federal policymakers, medi-cal organizations, and other stakeholders in thesystem. Topics that undoubtedly will be debatedinclude health insurance reform, quality of care,and financial strains on surgeons and physicians.

Health insurance reformThe continuing controversies related to health

insurance reform have, of course, been driven inlarge part by the ongoing escalation of health carecosts. For example, it has been estimated that em-ployers that provide medical benefits to their em-ployees experienced an 11.2 percent increase inassociated costs per worker last year. Employersanticipate that those expenses will go up another13 percent in the year 2002. Further, the nation’shealth care expenditures now total more than $1trillion a year, and, according to recent governmentprojections, health care spending in the U.S. willdouble over the next decade to $2.6 trillion, withemployers covering most of the expenses. Despitethese alarming economic numbers, huge numbersof people in this country have no insurance what-soever, partly because many small businesses can-not afford to provide health insurance benefits fortheir workers.

Other factors will undoubtedly fuel the healthinsurance reform debate in the future. I wouldpoint out the fact that one of the major health in-surance companies, Aetna Inc., recently laid offone-sixth of its workforce due to languishing en-rollment and expectations of losing more subscrib-ers as it raises rates and eliminates unprofitableplans.

While most players certainly can agree on theprinciples of insurance system reform, it is verydifficult to arrive at any sort of consensus as tohow to take these ideas and convert them into real,concrete changes in the system. Indeed, what is aclear-cut, positive solution to one stakeholder be-comes the bête noir of the next. For instance, mostpeople and organizations agree that the health in-surance system should be reformed to ensure medi-cal coverage for all Americans, regardless of eco-nomic status. How to achieve that goal, however,is the source of endless debate. Do we establish a

single-payor system, expand and improve managedcare organizations, or offer vouchers so that peoplecan buy their own health insurance policies? Whowill benefit most from implementation of any ofthese methods?

Presently, coalitions representing large purchas-ers of health care are gathering and developingnovel suggestions on ways to improve their abilityto offer health insurance coverage. These groupsand the corporations they represent have been con-tinually alarmed by the escalating costs and areattempting to come up with appropriate solutionsto the issue. Some businesses, for instances, areoffering their employees “defined contribution”benefit plans. Under this strategy, employers pro-vide a set amount of money for each employee’shealth benefits, and the employee decides whichtype of plan to purchase using the allowance. Dis-cussion of these and other proposals have been andwill continue to be prevalent for the foreseeablefuture.

RRRRResolution of health careesolution of health careesolution of health careesolution of health careesolution of health careissues will once again occupy aissues will once again occupy aissues will once again occupy aissues will once again occupy aissues will once again occupy aprominent spot on the agendasprominent spot on the agendasprominent spot on the agendasprominent spot on the agendasprominent spot on the agendasof federal policymakof federal policymakof federal policymakof federal policymakof federal policymakers, medicalers, medicalers, medicalers, medicalers, medicalorganizations, and other stakorganizations, and other stakorganizations, and other stakorganizations, and other stakorganizations, and other stake-e-e-e-e-holders in the systemholders in the systemholders in the systemholders in the systemholders in the system.


4

Quality issuesThere will also be increasing pressure on all sur-

geons, health care practitioners, hospitals, andother providers to make certain that their inter-ventions and actions are based on solid medicaland surgical evidence. Some stakeholders, such asthe Leapfrog Group, even call for differentiatingamong providers on the basis of some sort of anevaluation system, so that the purchasers of healthcare can make better choices about where to sendpatients for treatment. Other organizations aredemanding better use of information systems andtechnology with the ultimate aim of someday hav-ing medical records that are completely electronicand hopefully decreasing medical errors so thatpatient safety can be improved. Additionally, thereare growing expectations that federal agencies andhealth care organizations will establish guidelinesfor treating specific diseases and conditions,thereby enabling physicians and providers to es-tablish best practices.

Finally, many stakeholders believe that healthcare consumers should become more engaged inenhancing the quality of their health care, not onlyin their day-to-day living habits, but also in theway they select their health plans and their pro-viders. Engagement of the public in their ownhealth care is certainly a laudable goal, but it isalso perhaps the most difficult to realize.

Financial strainsAnother problem that has become endemic to the

U.S. health care system is the ever-heightening fi-nancial burdens that physicians and other provid-ers are expected to bear.

For example, physicians are paying highermalpractice insurance premiums because juryawards have risen to an average of $3.49 mil-lion each. These hefty awards are, in turn, driv-ing some malpractice carriers out of business.This past December, St. Paul Companies, thenation’s major medical liability carrier, an-nounced that it would exit the medical malprac-tice field and would no longer offer new policiesbecause of mounting losses from medical mal-practice. Meanwhile, physicians, hospitals, andothers are expected to shoulder the costs throughhigher premiums. And the increased costs ofpremiums, unfortunately, are too often passedon to employers and consumers, adding approxi-

mately one percentage point to health care in-flation.

In addition, reimbursement issues continue toplague the health care system. The Centers forMedicare & Medicaid Services (CMS) recently an-nounced a delay in payment for hospital servicesand that the conversion factor that is used to cal-culate payments to physicians who provide Medi-care services will decrease by 5.4 percent this year.This reduction brings payment per relative valueunit down from $38.26 to $36.19 this year. As Inoted in a previous column on this topic, the CMScut the conversion factor because, under legisla-tion that was enacted during the previous Admin-istration, the annual conversion factor update isbased on a “sustainable growth rate,” which is tiedto the business cycle rather than to health carecosts (Bulletin, December 2001, p. 3). There clearlyis a major flaw in the system under which CMSworks and compensates providers.

These types of financial strains must be eased aspart of any effort to reform the nation’s health caresystem, so that the practice of surgery and medi-cine remains attractive to those surgeons and phy-sicians who are committed to providing excellentcare.

What we’re doingHow these problems will be resolved remains to

be seen. I can assure all of you that the AmericanCollege of Surgeons will be closely monitoring allof these issues and will respond appropriately, ei-ther independently or as part of coalitions withother organizations. Clearly, surgeons and otherhealth care practitioners have frequently been ne-glected in the national debates over health carereform. We will make certain that our membersare appropriately represented as the controversiesunfold and issues of concern to Fellows are dis-cussed.

If you have comments or suggestions about this orother issues, please send them to Dr. Russell [email protected].

Thomas R. Russell, MD, FACS


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The College’s Health Policy Steering Committee met in Wash-ington, DC, on January 13 to discuss action on the Medicare paymentupdate, the looming liability insurance crisis, and the need to assume ahigher profile on the national bioterrorism readiness effort. The com-mittee reviewed the College’s continuing dialogues with private sectororganizations such as the National Quality Forum and employer pur-chasers like the Leapfrog Group, as well as alliances that will supportand advance the College’s positions on socioeconomic and clinical is-sues. Other topics covered included support for state advocacy effortsto strengthen scope of practice, surgery’s response to the nursing short-age, and determining the net impact of the direct medical educationpayment system by the Medicare Payment Advisory Committee.

The American College of Surgeons will hold its 30th Annual SpringMeeting April 14-17 at the Hyatt Regency San Diego. A major focus ofthe meeting, which is dedicated to addressing the interests and needs ofthe practicing general surgeon, will be the Assembly for General Sur-geons, a “town-hall” session on “The Twenty-First Century Health CareSystem.” Other highlights will include postgraduate courses on hands-onskills, coding, and informatics; the Excelsior Surgical Society/Edward D.Churchill Lecture; and several general panel presentations. The ProgramPlanner for the Spring Meeting will be mailed this month. Online regis-tration is available at http://www.facs.org/2002springmeeting/index.html.For further information, contact [email protected].

John T. Preskitt, MD, FACS, and Frank G. Opelka, MD, FACS, recentlyrepresented the College at the first meeting of the CPT Editorial PanelEvaluation and Management (E&M) Workgroup of the AmericanMedical Association. The workgroup will evaluate current levels of E&Mcodes to ensure that they clearly and effectively describe what physi-cians do (functionality) and improve physicians’ ability to accuratelyuse the codes in submitting claims (utility).

The American Society of Colon and Rectal Surgeons (ASCRS) ismaking a Webcast of more than 30 hours of scientific material pre-sented at its 2001 annual meeting available at no cost to visitors to itsWeb site. Simply log onto http://www.fascrs.org and access the link onthe homepage to broaden your knowledge of diseases of the colon andrectum and use these online programs for your teaching activities.

The General Surgery Coding and Reimbursement Committeemet on January 11 to provide input regarding CPT codes, the activitiesof the American Medical Association/Specialty Society Relative ValueUpdate Committee (RUC) and the Practice Expense Advisory Commit-tee (PEAC), and problems regarding the Medicare fee schedule. Theyalso provided detailed recommendations on practice management edu-cation for ACS Fellows. John O. Gage, MD, FACS, and Charles D. Mabry,MD, FACS, will be meeting with the RUC and PEAC as representativesof general surgery to ensure that reimbursement codes reflect both thework done and appropriate practice management costs.

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DatelineWashingtonprepared by the Division of Advocacy and Health Policy


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Congress adjourned for the year on December 20 without taking ac-tion on S. 1707/H.R. 3351, the Medicare Physician Payment FairnessAct. This legislation, introduced by Sens. Jim Jeffords (I-VT) and JohnBreaux (D-LA), and by Reps. Michael Bilirakis (R-FL) and SherrodBrown (D-OH), would have shaved 4.8 percentage points off the 5.4percent across-the-board reduction in Medicare physician payments thattook effect in January 2002.

Beginning January 1, the Medicare fee schedule conversion factorwas set at approximately $36.20, down from $38.26 in 2001. The lossoccurred despite a broad-reaching grassroots lobbying campaign in-volving the College’s active participation, which generated support frommajorities in both the Senate and House. The payment reduction oc-curred because of major flaws in the formula that is used to calculateMedicare physician payments.

During the last days of its first session, the 107th Congress approved$3.5 million in fiscal year (FY) 2002 funding for the Trauma Care Sys-tems Planning and Development Act (Title XII of the Public HealthService Act), which provides federal grants to assist states in planning,developing, and coordinating statewide trauma systems. The traumacare program funding was included as part of a larger spending bill forthe Departments of Health and Human Services, Labor, and Educa-tion.

For FY 2001, Congress had approved $3 million for the trauma pro-gram, most of which has been used by the Health Resources and ServicesAdministration (HRSA) to conduct a state-by-state needs assessment oftrauma system capabilities around the country. Trauma funding advo-cates anticipate that the results of the study, expected shortly, will clearlyillustrate the patchwork nature of the nation’s trauma care network andbolster the argument for significantly increased program funding.

The College is taking initial steps toward persuading Congress to re-authorize the program for an additional four years. It also is workingwith Congress to address trauma care system needs as part of new ef-forts to improve the nation’s preparedness to respond to acts ofbioterrorism. H.R. 3448, the Public Health Security and BioterrorismResponse Act of 2001, recently passed by the House, includes a provi-sion that would authorize increased funding to “develop and imple-ment the trauma care component of the State plan for the provision ofemergency medical services.” A Senate-passed bioterrorism packagedoes not include this provision. Legislators hope to resolve differencesbetween the two bills as soon as possible.

On December 20, the Senate passed by unanimous consent a bill in-troduced earlier in the day by Sen. Barbara Mikulski (D-MD) that isintended to address the nation’s current nursing shortage. The NurseReinvestment Act, S. 1864, combines two proposals passed by the Sen-ate Health, Education, Labor, and Pensions Committee on Novem-ber 1—S. 721, originally sponsored by Senator Mikulski and Sen. Tim

Congress failsto halt Medicarepay cut

Trauma fundingincreases in 2002

Congress passesnursing shortagebills


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Hutchinson (R-AR), and S. 1597, sponsored by Sens. John F. Kerry (D-MA) and James Jeffords (I-VT).

The Senate-passed legislation would create nursing scholarship pro-grams to cover tuition, school expenses, and a $400 monthly stipendfor students who commit to serve at least two years in geographic areaswith a critical shortage of nurses. It would also provide scholarshipsfor graduate-level education in exchange for service teaching at an ac-credited school of nursing.

In addition, the Senate bill calls for creating a public awareness cam-paign to promote nursing as a career and for establishing a nationalcommission to study and make recommendations on solutions to thenursing shortage. Grant programs would also be established to improveworkplace conditions for nurses and create nurse retention and out-reach programs. Finally, the measure calls for “career ladder” programsto encourage additional training and advancement within the profes-sion.

The House introduced and passed similar but less sweeping legisla-tion on December 20. Also titled the Nurse Reinvestment Act, H.R.3487 was introduced by Rep. Michael Bilirakis (R-FL). Differences be-tween the two bills will need to be resolved by a House-Senate confer-ence committee.

According to a report issued by the Centers for Medicare & MedicaidServices (CMS) on January 8, health care spending in the U.S. rose to$1.3 trillion in 2000, a 6.9 percent increase over the previous year. Theincrease for 2000 was notably higher than the 5.7 percent growth rateexperienced in 1999 and was the highest annual increase recorded since1993, when spending rose by 7.4 percent. CMS economists said the in-crease primarily reflected a rise in economy-wide inflation.

Health care spending averaged $4,637 per person in 2000, comparedto $4,377 in 1999. Spending for prescription drugs once again led thepace of growth in 2000, although at a slower rate than recent years.Drug spending increased by 17.3 percent to a total of $121.8 billion in2000, compared with a 19.2 percent increase to a total of $103.9 billionin 1999.

Spending for Medicare, the federal program for senior citizens anddisabled individuals, was $224 billion in 2000, an increase of 5.6 per-cent for the year. Medicare accounted for 38 percent of public spendingon health care and 17 percent of overall health spending. Increases inMedicare spending were attributed largely to changes in provider pay-ments, including those enacted in the Balanced Budget Refinement Actof 1999.

Federal and state spending for Medicaid totaled nearly $202 billionin 2000, an increase of 8.3 percent from 1999. Federal and state spend-ing for the State Children’s Health Insurance Program was $2.8 bil-lion in 2000, a 55 percent increase from the 1999 level.

The growth in expenditures in 1999 and 2000 slightly outpaced growthin gross domestic product. The share of GDP spent on health care in-creased from 13.1 percent in 1999 to 13.2 percent in 2000.

CMS says healthcare spendingincreased in 2002


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A s mandated by the Needlestick Safety andPrevention Act signed into law in 2000,changes were made to the Occupational

Safety and Health Administration’s (OSHA’s)blood-borne pathogens standard. These changes,which became effective April 18, 2001, are in-tended to further protect health care workersand others in the medical community from ex-posure to blood-borne diseases, such as HIV andhepatitis, by imposing additional employee pro-tection requirements on hospitals and privatephysician offices. The following questions and an-swers highlight some of the key requirements inthe regulations from the surgeon’s perspective.

When was the blood-borne patho-gens standard first issued?

The standard was released on Decem-ber 6, 1991, based on OSHA’s conclu-

sion that employees face a significant health riskas a result of occupational exposure to blood andother potentially infectious materials. The origi-nal standard became effective on March 6, 1992.

Who is covered by OSHA’s blood-borne pathogens standard?

The standard applies to any person whomay be exposed to blood or to other po-

tentially infectious material containing blood-borne pathogens in the workplace. In the stan-dard, OSHA defines occupational exposure as any“reasonably anticipated skin, eye, mucous mem-brane, or parenteral contact with blood or other

potentially infectious materials that may resultfrom the performance of the employee’s duties.”

How did the Needlestick Safety andPrevention Act affect the OSHA

blood-borne pathogens standard?

The law revised the blood-borne patho-gens standard to incorporate a broader

range of engineering controls, encourage im-proved documentation, and provide greater em-ployee involvement in developing workplace con-trols. More specifically, the law directed OSHA to:

1. Include new examples in the definition of en-gineering controls.

2. Require that exposure control plans reflectchanges in technology that eliminate or reduce ex-posure to blood-borne pathogens.

3. Require employers to document annually inthe exposure control plans consideration andimplementation of safer medical devices.

4. Require that employers solicit input fromnonmanagerial employees responsible for directpatient care in the identification, evaluation, andselection of engineering and work practice con-trols.

5. Document this input in the exposure controlplan.

6. Require employers to establish and maintaina log of percutaneous injuries from contaminatedsharps.

How do the current and previousdefinitions of engineering controls

differ?

What surgeonsshould know about ...

OSHA regulation ofblood-borne pathogensby Adrienne Roberts, Government Affairs Associate, Division of Advocacy and Health Policy

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The new definition includes more ex-amples of engineering controls. Previ-

ously, they were defined as “controls (for ex-ample, sharps disposal containers, self-sheath-ing needles) that isolate or remove the blood-borne pathogens hazard from the workplace.”The revised standard definition of engineeringcontrols is much broader and includes “sharps dis-posal containers, self-sheathing needles, safermedical devices, such as sharps with engineeredsharps injury protections and needleless systems.”

What must employers do to complywith the new exposure control plan

regulations?

The new standard mandates that employ-ers “document annually in the exposure

control plans consideration and implementationof safer medical devices” and consult with “non-managerial employees responsible for direct pa-tient care in the identification, evaluation, andselection of engineering and work practice con-trols.” In an effort to include everyone in thehealth care community (physicians, nurses, as-sistants, and so forth) who is responsible for pa-tient care, employers must consult with all per-sonnel about the consideration and implemen-tation of potentially safer instruments. This con-sultation must be included in the exposure con-trol plan.

What are employers required to doto comply with the new sharps in-

jury log requirements?

The new record-keeping rule, effectiveJanuary 1, 2002, requires employers to

log all percutaneous injuries and any related ill-nesses involving exposure to blood and other po-tentially infectious materials (OPIM). Work-re-lated needlesticks and cuts from sharp objectsthat are contaminated with another person’sblood or OPIM must be recorded in the log asan injury; however, for privacy reasons, theemployee’s name should be omitted. If the em-ployee is later diagnosed with an infectiousblood-borne disease, the identity of the diseasemust be entered and the classification must bechanged to an illness. If an employee is splashedor exposed to blood or OPIM without being cutor punctured, the incident must be recorded inthe log only if the exposure results in the diag-nosis of a blood-borne illness.

Have studies been conducted to ex-amine the potential costs of these

changes?

The GAO released a study last Novem-ber entitled Occupational Safety: Se-

lected Cost and Benefit Implications ofNeedlestick Prevention Devices for Hospitals(#GAO-01-60R). It reports that “analysis ofavailable data on the costs and preventabilityof needlestick injuries shows that the adoptionof needles with safety features may be justifi-able based solely on decreased initial treatmentcosts.” Also noted, “Needles with safety featuresmay also reduce liability and worker’s compen-sation costs to hospitals when health care work-

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ers acquire diseases after a needlestick injury.”For a copy of the response, please visit http://www.gao.gov.

What about physicians who have es-tablished an independent practice, as

opposed to those employed at a hospital?What is the difference between physiciansas employers versus as employees?

In applying the provisions of the standardin situations involving physicians, the sta-

tus of the physician is important. Physicians maybe employers or employees. Physicians who areunincorporated sole proprietors or members of abona fide partnership are employers and may becited for violations of the standards if they em-ploy at least one individual (such as a technicianor secretary). Such physician-employers may becited if they create or control blood-borne patho-gens hazards that expose their employees at hos-pitals or other sites where they have staff privi-leges in accordance with the multi-employersworksite guidelines of compliance directive CPL2-0.124, Multi-Employer Citation Policy.

However, because physicians in these situa-tions are not themselves employees, citationsmay not be based on their exposure to the haz-ards of blood-borne diseases. In other words, de-pending on the circumstances, surgeons whoemploy a nurse to assist in procedures at a hos-pital at which they have privileges could be citedfor actions that directly result in a nurse’s ex-posure to a blood-borne pathogens. On the otherhand, depending on the circumstances, such ahospital cannot be cited for the surgeon’s expo-sure, if he or she is directly at fault.

Physicians may be employed by a hospital oranother health care facility or may be membersof a professional corporation that provides theirservices to a hospital and conduct some of theiractivities at hospital sites where they have staff

privileges. In general, professional corporationsare the employers of their physician-members andmust comply with the following standard provi-sions: hepatitis B vaccination, postexposure evalu-ation and follow-up, record keeping, and generictraining provisions with respect to these physi-cians when they work at host employer sites. Thehospital where these physician-members havestaff privileges is not responsible for the aboveprovisions but, in appropriate circumstances(for instance, not having a sharps bucket in anoperating room), may be cited under other pro-visions of the standard in accordance with themulti-employer worksite guidelines of CPL 2-0.124.

A number of states already haveneedlestick laws on the books; do

these new requirements affect those laws?

OSHA’s revised blood-borne pathogensstandard has raised questions about the

status of those state laws. It has been establishedthat the standard does preempt state laws “relat-ing to issues in the private sector on which fed-eral OSHA has promulgated occupational safetyand health standards, such as the blood-bornepathogens standard, regardless of whether the re-quirements are more or less stringent.” Preemp-tion is a complex legal matter that can only befinally resolved by the courts when raised by anaffected party. OSHA does not take any formal le-gal or other action with regard to preemption ofstate activities. However, in general, the follow-ing principles apply:

1. States with plans. All OSHA-approved stateplans are required to incorporate “at least as ef-fective” needlestick protection for private sectorand public sector (state and local government)employment, either through a standard or a stateneedlestick prevention law administered under theplan. To avoid the preemptive effect, state

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needlestick prevention laws applicable to the pri-vate sector must be administered under the stateplan.

2. States without plans. State needlestick lawsand/or regulations in these states would not beaffected by the preemptive effect of the federalblood-borne pathogens standard to the extentthat they regulate the occupational safety andhealth conditions of public sector (state and lo-cal government) employment. However, statelaws or programs that regulate private sectoractivities addressed by the federal blood-bornepathogens standard, absent an OSHA-approvedstate plan, would be subject to challenge as pre-empted.

Where can a copy of the updatedblood-borne pathogens standard and

the accompanying compliance directive beobtained?

For a copy of the standard, go to http://w w w. o s h a - s l c . g o v / O s h S t d _ d a t a /

1910_1030.html. The compliance directive, En-forcement Procedures for the Occupational Expo-sure to Bloodborne Pathogens (# CPL 2-2.69) es-tablish policies and provides clarification to en-sure uniform inspection procedures are followedwhen conducting inspections to enforce theblood-borne pathogens standard. Reviewing thisdocument is the best way to determine if youare complying with the standard’s requirements.It can be found on the Internet at http://www.osha-slc.gov/OshDoc/Directive_data/CPL_2-2_69.html.

How can I get more informationabout compliance?

More information can be obtained by con-tacting OSHA on the Internet at http://

www.osha.gov.A.Q.

A.

Q.

Bibliography

General Accounting Office: Occupational Safety: Se-lected Cost and Benefit Implications of NeedlestickPrevention Devices for Hospitals, #GAO-01-60R.Web site: www.gao.gov.

Occupational Safety and Health Administration: En-forcement Procedures for the Occupational Exposureto Bloodborne Pathogens, # CPL 2-2.69. Web site:http://www.osha-slc.gov/OshDoc/Directive_data/CPL_2-2_69.html.

Occupational Safety and Health Administration: Occu-pational Exposure to Bloodborne Pathogens Stan-dard, #1910.1030. Web site: http://www.osha-slc.gov/OshStd_data/1910_1030.html.

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12

Surgeon takes flightto deliver improvedsight worldwide

Surgeon takes flightto deliver improvedsight worldwide

by Wby Wby Wby Wby Walter J. Kahn, MD, Falter J. Kahn, MD, Falter J. Kahn, MD, Falter J. Kahn, MD, Falter J. Kahn, MD, FAAAAACS,CS,CS,CS,CS,Red Bank, NJRed Bank, NJRed Bank, NJRed Bank, NJRed Bank, NJ

by Wby Wby Wby Wby Walter J. Kahn, MD, Falter J. Kahn, MD, Falter J. Kahn, MD, Falter J. Kahn, MD, Falter J. Kahn, MD, FAAAAACS,CS,CS,CS,CS,Red Bank, NJRed Bank, NJRed Bank, NJRed Bank, NJRed Bank, NJ


13

Iam in the back of a DC-10 in the CentralAsian city of Tashkent, Uzbekistan. Theweather is good, but the flight crew is miss-ing, and I am very concerned. We are not in

the air, and the plane is securely parked, so mycause for worry is not travel-related. Rather, I amthinking about the safety of a patient and whetherthe students aboard the plane understand what ishappening. I am suturing a new cornea in place,and the procedure is being televised to the front ofthe plane, a 48-seat classroom. Questions aboundfrom the observers and from my assistant, a localophthalmologist.

This description is typical of the experiences Ihave had during the course of my 17 years of vol-unteering for an organization known as ORBIS.

What is ORBIS?ORBIS is a not-for-profit humanitarian organi-

zation dedicated to saving sight worldwide throughhealth education and hands-on training for oph-thalmologists, nurses, and allied health practitio-ners.

David Paton, MD, FACS, a Houston ophthal-mologist, conceived the idea of an airborne oph-thalmological teaching hospital in the mid-1970s.He wanted to bring American skills and expertisein ophthalmology to help personnel in developingcountries. Dr. Paton’s father was R. Townley Paton,MD, a prominent ophthalmologist and founder, in1944, of the world’s first eye bank, in New York,NY.

ORBIS was founded in 1982 with a grant fromUSAID and a DC-8, donated by United Airlines(the plane was extensively modified, and is nowon display at the China Musem of Aerospace inBeijing). Since then, ORBIS has carried out morethan 440 programs, both on and off the plane, in80 countries and has trained more than 50,000 oph-thalmologists, nurses, biomedical engineers, andrelated health care workers who, in turn, providetreatment and training in underserved countries.ORBIS is headquartered in New York, NY, and hasinternational affiliates in Canada, Hong Kong, En-gland, and France.

The ORBIS teaching facility is currently a DC-10 that was purchased for ORBIS in the early 1990s

by A.L. Ueltschi (who founded Flight Safety Inter-national and who started his career as the personalpilot of Pan Am founder Juan Trippe), Y.C. Ho (aHong Kong businessman), and an anonymous do-nor. The DC-10 houses a state-of-the-art operat-ing room staffed by trained nurses and anesthesi-ologists, and also contains a fully staffed recoveryroom, laser facility, conference room, audio-visualequipment, satellite communications center, sur-gical instrument room, and a sterilization facilitywith its own water-purification system.

The work that ORBIS does is very important.Blindness is a problem of unreasonable propor-tions: more than 180 million people in the worldare blind, severely visually impaired, or otherwise

The ORBIS aircraft in flight.

Floor-plan of the ORBIS DC-10 aircraft.

Opposite page: The author, Dr. Kahn, with a patient infront of the ORBIS aircraft.


14

at risk of losing their sight. The real tragedy ofblindness is that about 80 percent of the peoplewho are blind could be cured if they had access tothe preventive and surgical techniques routinelypracticed in the U.S. and other developed countries.

The heart of ORBIS is the DC-10 “flying eyehospital.” The aircraft spends 90 percent of its timein developing countries, home to most of theworld’s blind people. These countries generallylack education in eye care and supplies, and sufferfrom restrictive government policies and culturalattitudes inhibiting the use of eye banks.

Each mission carried out by ORBIS is tailoredto a particular region by an advance team, whichcoordinates with the host country months beforewe arrive. A follow-up team monitors the status ofthe patients after we leave.

My experience I became involved with ORBIS in 1984, and my

first mission was to Ouagadougou, Burkina Faso,in West Africa. Since then, I have participated in10 missions in countries that include the Philip-pines, Haiti, India, China, Mongolia, Latvia, and

most recently (18 months ago) Uzbekistan. I en-joy taking a break in my practice, having the op-portunity to contribute to the world’s health, andgetting to see parts of the world I normally wouldnever visit.

On these excursions, I typically have been partof a two-to-three-person group of visiting faculty,my specialty being cornea and cataract surgery.Other subspecialists represented in ORBIS includeretina, glaucoma, pediatric, and oculoplastic sur-geons. Each of us spends one intense week per yeardemonstrating surgery and giving lectures on oph-thalmic procedures.

Our first day is spent at the host hospital, screen-ing patients for surgery. Even though the patientsare “prescreened” by the host physicians, the lineof people waiting for treatment may wind aroundthe block in 120-degree heat, each person desiringto be treated in that big plane from the sky. Thepressure during the selection process can be veryemotional. Some patients wear their World War IImedals or cite other significant facts about them-selves in hopes of gaining favor. One patient Itreated in Uzbekistan was a retired general and

Dr. Kahn teaching in the DC-10 classroom. Peripheral wet lab classroom in the DC-10.


15

another was an ophthalmologist. We select the fiveor six cases per day with teaching potential as thetop priority and need as secondary. Then, the an-esthesiologist evaluates the surgical risk for theselected cases.

The 25-member medical team is truly interna-tional, with representatives from the U.S., Canada,the Philippines, Great Britain, Ireland, India, Pa-kistan, Bulgaria, China, Iraq, and other parts ofthe world. The visiting surgical faculty are also in-ternational but predominantly American. Theflight crew generally is composed of retired volun-teers, who fly the plane every three weeks, thendepart for home.

Everything is well coordinated by the frontteam—the one based in the country that we arevisiting. The coordinating team determines theneeds and wants of the host country, such aswhether local health care practitioners are mostinterested in learning about corneal transplantsor retina repair. Each country presents its ownspecial challenges. Some illnesses are prevalent incertain countries but have been virtually elimi-nated from the rest of the world. Onchoceriasis

(river blindness), for instance, is a scourge in WestAfrica. Other countries pose unique situations forthose of us from the West because of their culturaland religious views. Uzbekistan is a former Sovietrepublic that received its independence in 1991.The population is 60 to 70 percent Muslim but notvery religious. Nonetheless, Muslim faith prohib-its eye banks, so on this trip, we had to bring do-nor corneas from the U.S.

Each mission is truly fascinating, because we getright in the middle of the action as soon as we ar-rive. The ORBIS DC-10 is parked on a ramp areain the airport where it is accessible to the surgeonsand their patients. (The plane uses its auxiliarypower unit to provide needed electrical energy andair conditioning.) Generally, we are met by a crewmember who escorts us to our hotel, where we par-ticipate in an orientation conference during whichwe discuss the local needs and the strengths andweaknesses of the area.

The program starts in the following morning.We leave the hotel, usually with a police escort,promptly at 7:00 am and start the operations at8:00 am, continuing nonstop until about 6:00 pm.

The DC-10 operating room. The DC-10 recovery room.


16

All procedures are performed in slow motion withlots of interaction by the assistants and video au-dience. There are more than 20 video screensthroughout the plane. At times, we also demon-strate at the local hospital to make the surgeonscomfortable in their own setting with their equip-ment. In addition each of us gives 10-12 lecturesduring the week.

On most missions we train a few hundred oph-thalmologists. They and the patients continuallyexpress their gratitude in countless ways. We arewell received by the host doctors and governmentofficials.

I have found the most difficult part is doing in-tricate surgery that is videotaped live while fight-ing jet lag. Jet lag is a problem because you are ona predetermined schedule with no time for a cat-nap. By the end of the week, we are really physi-cally and emotionally washed out.

Dr. Kahn is in private ophthalmic practice in Red Bank,NJ, and is a private pilot.

Memorable experiencesThe 10 trips that I have taken through ORBIS

have supplied me with indelible memories. I havemet a number of prominent figures, includingMother Teresa, on our trip to Calcutta, India. Usu-ally the president of the country or a designee willvisit the plane. Shortly after we returned homeafter our work in Burkina Faso, we learned thatthe president, who had paid us a visit, was assassi-nated. No wonder there was an 11:00 pm curfewwith shots fired at 11:01!

My wife, Susan, has accompanied me on severalmissions and has kept herself well-occupied hand-ing out candy and magnifying glasses to the chil-dren and taking photos. We usually spend a fewdays after the work week seeing some of the sights,which are always fascinating. In Uzbekistan, thechair of my four-hospital-system board, an attor-ney, came along and enjoyed seeing a different sideof medicine. He did help when we almost got ar-rested in the subway in Tashkent; the policethought we were taking pictures, which is forbid-den there because the subway serves as a defenseshelter for the city. They are very worried aboutMuslim fundamentalists.

Nonetheless, Uzbekistan is a captivating coun-try. It was part of the old silk route and encom-passes the beautiful, historic Muslim cities ofBukhara and Samarkand, the latter of which isbeing restored. Tamerlane is the local hero to thisday. In Tashkent, statues of Lenin have all beenreplaced with statues of Tamerlane.

Meanwhile, the people of Mongolia continue toidolize Genghis Khan. In the city Ulan Bator, onedrinks Genghis Khan beer or Genghis Khan vodkawhile staying at the Genghis Khan Hotel.

Why do I look forward to these missions? Well,they give me a chance to do some good and offer asense of adventure. And, it’s a relief to practicemedicine using U.S. standards but without worryabout government restrictions, payment policies,CPT codes, and the threat of litigation. My involve-ment with ORBIS makes me feel appreciated, andI get to be a real doctor again.

For more information about ORBIS, visit theorganization’s Web site at www.orbis.org.

In the first day of post-op in Uzbekistan: The patientwas blind in both eyes due to opaque corneas andcataracts. A “triple procedure” (combined cornealtransplant, cataract extraction, and lens implant) wasperformed on one eye. This was the first time she hadbeen able to see in years, and she is so happy that she iscrying.

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SurgeonsSurgeonsSurgeonsSurgeonsSurgeonspocket PDAspocket PDAspocket PDAspocket PDAspocket PDAs

to endto endto endto endto endpaper chasepaper chasepaper chasepaper chasepaper chase

Part IIPart IIPart IIPart IIPart II

by Karen Sandrick,by Karen Sandrick,by Karen Sandrick,by Karen Sandrick,by Karen Sandrick,

Chicago, ILChicago, ILChicago, ILChicago, ILChicago, IL


17


18

Neurosurgeon David W. Lowry, MD, FACS,started using a personal data assistant(PDA) when he was a surgical resident in1997 just because he was tired of trying to

fit an unwieldy daily planner into the pocket ofhis lab coat. Now in a busy neurosurgical prac-tice in Grand Rapids, MI, he’s turning to thedevice not only to keep his calendar and addressbook but also to generate postoperative notesand orders at the bedside and to organize infor-mation about surgical cases. A huge utility, hesays, is the ability to tap into up-to-date drugtreatment data with an electronic prescriptiondrug reference program. “It’s better than havinga drug reference book in private practice,” he said.

Like standard drug prescribing texts, theqRxTM program from ePocrates, Inc., San Carlos,CA, lists all medications that have been ap-proved by the U.S. Food and Drug Administra-tion. But rather than having to wait until thenext edition of the Physician’s Desk Reference(PDR) comes out, Dr. Lowry receives regularupdates about the latest additions to the lists ofavailable medications. Instead of having tothumb through page after page of the PDR, Dr.Lowry can get the details about a specific drug—whether he needs the pediatric or adult dosingschedule, mechanisms of action, or side effects—in a matter of seconds. He also can check onknown drug interactions for up to 30 differentmedications—an invaluable option for surgicalspecialists who see patients with concomitantchronic diseases, he says. “If you have a patientcoming in the office who’s already taking 10drugs and you’re going to be adding another, youcan give the patient and the referring physiciana bit of a heads up about the potential problemsthat may occur,” he said.

In the not-too-distant future, Dr. Lowry ex-pects his PDA to be linked with surgical hand-books and online journals, clinical practice al-gorithms and guidelines, prescription pads, andother patient care applications. “I can very eas-ily envision having a commonly used handbookon a hand-held computer, so I’ll have informa-tion available to me whether I’m in the office orthe hospital or somewhere else. I can see an in-frared port at a nurses’ station that surgeonscan interact with to transmit medication ordersdirectly to the pharmacy,” he said.

“Companies are already working on applica-tions for handling clinical utilities throughhand-helds right at the point-of-care, where in-dividual patient care decisions are made,” Dr.Lowry notes.

Not just a notebookNot just a notebookNot just a notebookNot just a notebookNot just a notebookHand-held personal computers are ready-

made vehicles for point-of-care record-keeping.PDAs also serve as convenient calculators, withprograms that analyze arterial blood gas values;compute intravenous doses of medications fortreating myocardial infarction, arrhythmia, andstrokes; diagram the extent of burn wounds anddetermine the corresponding fluid requirementsfor a patient; and perform statistical exercisessuch as the chi square, Student and Fischer test,and so on.

PDAs are not merely handy notebooks orscratchpads, however. The devices organize in-formation into databases, so quick memos abouta patient, including name, date and type of sur-gery, and diagnosis, transform into a data sourcethat can be searched by patient or by surgicalproblem. PDAs also can coalesce individualitems of information about the type, nature, andlocation of a disease or condition, the charac-teristics of the patients who suffer from it, andthe treatment options for addressing it and theirsuccess rates, so they can be analyzed to iden-tify trends and begin documenting outcomes.

Also, as vehicles for evidence-based medicine,PDAs have great potential for eliminating er-rors, reducing variation in surgical practice, andimproving patient care.

Currently, surgeons have access to software forhand-held computers that brings clinical text-books, journal abstracts, dictionaries, meetingabstracts, and practice guidelines to their fin-gertips.

One company creating such software isEurekah.com, a division of the biological sci-ences book publisher Landes Bioscience,Georgetown, TX. Eurekah.com is working withthe department of surgery at NorthwesternUniversity School of Medicine, Chicago, IL, toprovide an electronic handbook of surgical pro-cedures complete with line anatomical drawingsand lists of indications, operative principles,preoperative and postoperative considerations,


19

and possible complications. Eurekah.com soft-ware also will allow surgeons to superimpose onstandard anatomical drawings depictions oftheir approaches to surgical procedures and todownload searchable databases of algorithms forassessing symptoms, managing diseases, andmeeting best practice standards of care devel-oped by subspecialists in major academic medi-cal centers.

JournalToGo from HealthTech Solutions, St.Louis, MO, automatically delivers selected jour-nal abstracts and other medical news to PDAswhenever they are hot synched with a surgeon’smain computer system. Taber’s Cyclopedic Medi-cal Dictionary from F.A. Davis, Philadelphia, PA,has 56,000 online definitions that can be re-trieved with the touch of a stylus on the face ofa PDA.

Electronic abstracts from medical conferencesare being provided by organizations such as theCongress of Neurological Surgeons, anddownloadable clinical practice guidelines and al-gorithms are available from professional soci-eties, expert panels, and other sources, such asthe Advanced Cardiac Life Support (ACLS) al-gorithms, which display treatment alternativesfor monomorphic and polymorphic ventriculartachycardia and other cardiac emergencies in-stantaneously on PDA screens.

“One side of hand-held computing people findindispensable to patient care is applications thatbring medical knowledge base to the bedside,”said David Krusch, MD, FACS, Chair of theCollege’s Committee on Informatics and direc-tor of the University of Rochester MedicalCenter’s Informatics Division in Rochester, MN.“You’ve taken your reference material out of thelibrary, to the computer workstation, and havefinally put it in your pocket.”1

Photographic databasesPhotographic databasesPhotographic databasesPhotographic databasesPhotographic databasesSome surgeons are creating their own PDA

utilities. Sidney F. Miller, MD, FACS, professorof surgery at Wright State University and di-rector of the Miami Valley Hospital RegionalAdult Burn Center, Dayton, OH, attaches a digi-tal camera to his PDA to record, at least on aweekly basis, the appearance of burn wounds.

Dr. Miller explains that most burn centershave switched to digital pictures of wounds be-

cause they are easier to store than 35mm slides.The photography department at Miami ValleyHospital Regional Adult Burn Center makes 3x 3O glossies from digital images that are placedon the patient’s chart or stores the images inthe central computer. Surgeons consequentlycan get a quick overview of patients’ progressimmediately before seeing them simply by call-ing up the images on the terminal at a nurses’station. “The digitized images are helpful forconsultants, who can’t always be there when apatient’s dressings are coming off. But they needto have some idea of what the patient’s burnwounds looked like, so they look at the digitalimages that were taken over the last however-many weeks the patient has been in the hospi-tal,” Dr. Miller said.

The digital images also provide a visual recordfor rotating surgical residents. “Some patientshave been in the hospital four, five, or six weeksbefore residents come on the service. The digitalphotographs let the residents see what patientslooked like on admission and get a feel for howwell they are progressing,” Dr. Miller observed.

What Dr. Miller adds to the digital photographyprogram at the Miami Valley Hospital RegionalAdult Burn Center is his PDA. He links a small,lightweight, inexpensive (less than $100) digitalcamera to his hand-held computer, carries it to theclinic, the hospital room, and the OR, and cap-tures high-quality pictures of burn wounds thatcan be transmitted directly to his computer sys-tem, saved for educational purposes, and enteredinto the burn registry when he hot synchs thehand-held at the end of the day.

And he doesn’t have to worry about losing anyof the pictures or other data. A few months ago,he dropped his PDA and had to replace it with anew one. When he hot synched the new devicewith his computer system, he was able to com-pletely restore his address lists, memos, docu-ments, and burn care database in three or fourminutes. “It would have been a lot harder toreestablish that information if I’d kept it in alittle book and lost that book,” he said.

Reducing errorsReducing errorsReducing errorsReducing errorsReducing errorsOne of the greatest potential uses of PDAs,

many proponents say, is to decrease errors, par-ticularly in prescribing medications. According


20

concluded a survey of 870physicians who used the qRxhand-held computer drug ref-erence guide by Brigham andWomen’s Hospital, Boston,MA. The survey, which waspresented at the annual meet-ing of the American MedicalInformatics Association in No-vember 2000, showed that 81percent of the physicians feltthey were making better deci-sions about medications, and80 percent were better in-formed about medications.Forty-six percent of physiciansreported that the hand-helddrug reference guide influ-enced three or more of theirdrug decisions every week, and50 percent said it prevented atleast one adverse drug event aweek.3

PDA programs that createand transmit electronic pre-scriptions to pharmacies, suchas those from ePhysician, Inc.,Mountain View, CA, AllscriptsHealthcare Solutions, Inc.,Libertyville, IL, PocketscriptInc., Cincinnati, OH, andiScribe, Redwood City, CA, alsoprevent drug mix-ups due tohandwriting errors. In anec-dotal studies conducted by theconsulting firm Accenture,Boston, MA, PDA electronicprescription services cut thenumber of calls from pharma-cists to physicians for clarifi-

Accenturewww.accenture.com617/454-4000

Allscripts HealthcareSolutionswww.allscripts.com800/654-0889

DigitalAssistwww.digitalassist.net

ePhysicianwww.ePhysician.com650/314-2000

ePocrates, Inc.www.ePocrates.com650/592-7900

ePhysicianwww.ePhysician.com650/314-2000

Eurekah.comwww.Eurekah.com512/863-7762

F.A. Daviswww.fadavis.com800/523-4049

Companies offering PDACompanies offering PDACompanies offering PDACompanies offering PDACompanies offering PDAsoftware packages for surgeonssoftware packages for surgeonssoftware packages for surgeonssoftware packages for surgeonssoftware packages for surgeons

HealthTech Solutionswww.htsolutions.com314/994-3030

iScribewww.iscribe.com650/381-2155

MDeverywhere, Inc.www.mdeverywhere.com919/484-9002

Medical ChartWriterwww.chartwriter.com

Pocket Medwww.pocketmed.org434/825-0099

Pocket Patient Billinghttp://pocketpa.imrac.com

Pocketscriptwww.pocketscript.com

Skyscape.comwww.skyscape.com978/562-5555

to the widely quoted 1999 Institute of Medicinereport, at least 44,000 patients in the U.S. dieevery year because of preventable medical er-rors, including approximately 7,000 who die ofmistakes related to ordering and dispensingmedications.2

PDA-based drug information guides may pre-vent medication errors by increasing clinicians’knowledge about available drugs and improv-ing their selection of appropriate medications,

cation of a medication order by 20 percent.4

Electronic drug reference programs are help-ful for surgeons, who tend to prescribe a smallnumber of specific drugs or drug classes and con-sequently have to look up information about un-familiar medications, said Barklie Zimmerman,MD, FACS, a vascular surgeon from Richmond,VA. Although the PDR is the primary referencefor determining dosage patterns, indications, po-tential adverse effects, and drug interactions, it


21

often provides more data than surgeons need,and it is not always current.

However, the ePocrates qRx program for PDAsis updated every day by an editorial board ofphysicians, and it includes the name, class, in-dications, dosage, known drug interactions, ad-verse events, the mechanism of action, retailprice, and package/tablet description of a drug.Other drug-related software for PDAs, such asiFACTs (Drug Interaction Facts) fromSkyscape.com, Hudson, MA, provides informa-tion about drug-drug and drug-food interactionsfor more than 2,700 brand name and genericmedications in 70 therapeutic classes. The JohnsHopkins Antibiotic Guide from Johns HopkinsMedical Center, Baltimore, MD, and qIDTM, alsofrom ePocrates, identify the proper antibiotic fora specific diagnosis and infecting pathogen.

Such programs give surgeons rapid access tocomprehensive, current information aboutmedications from a manageable, portable con-tainer. As plastic surgeon Roger Simpson, MD,from Garden City, NY, said, “If I’m in the officeor at the bedside, and a patient or another phy-sician asks about a specific medication, and Idon’t know the dosages, within 20 seconds I canget the dose ranges and contraindications. If apatient is on multiple medications and theremay be a problem with a drug interaction, I geta ‘doc alert’ message as soon as I open the PDA.If patients ask whether they can take an anti-inflammatory when they’re also taking asthmamedications, I can pull out the PDA and look upcontraindications and sensitivities.”

If infectious disease specialists are recom-mending unusual antibiotics, Dr. Simpsondoesn’t have to take the time to research themall. “I can’t believe it, but I can get all that in-formation and keep it in my pocket.”

Nonetheless, many surgeons have yet to dis-cover the advantages of using PDAs within theirpractices. Most physicians, as well as the facili-ties at which they work, still use laptops anddesktops to access Web portals, update records,and send e-mail messages. “The lowest commondenominator is an Internet connection and abrowser. Everyone has that,” Dr. Krusch said.“The next logical leap is porting part of that,taking segments of the functionality of the Web,and applying it to the hand-held device.”1

This article was generated through efforts of theBoard of Regents’ Committee on Informatics. Mem-bers of the committee believe that this and other ar-ticles published in the Bulletin will serve to alert Fel-lows of the College to and inform them about trends ininformation technology that will help them simplify theadministrative burdens of surgical practice, heightentheir use of online and other innovative approaches toCME, and enhance their ability to improve patient care.

References

1. Hutchins J: Help is at hand. Rochester Bus J, Spe-cial Report, January 4, 2002.

2. Institute of Medicine: To Err Is Human: Buildinga Safer Health System. Washington, DC: NationalAcademy of Science, 1999.

3. Rothschild JM, Lee TH, Horsky J, et al: “Surveyof Physicians’ Experience Using a Handheld DrugReference Guide.” Presented at the annual meet-ing of the American Medical Informatics Associa-tion, November 5, 2000, Los Angeles, CA.

4. Briggs B: Getting around with hand-helds. HealthData Mgmt, September 2001.

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Liability premium

increases may offer

opportunities for change

Physicians across the country have seendramatic increases in their 2001 and 2002malpractice premiums. For some sur-geons, these are the first substantial rate

hikes in quite a few years.Recent national news reports have speculated

that the surge in malpractice insurance premi-ums could lead to a crisis in the availability ofhealth care services. What is being done to stemthis tide? Is this a problem that each state shouldattempt to solve on its own? Or is this a nationalproblem that should be addressed by the federalgovernment?

Malpractice premiums risingSome physicians are now having trouble ob-

taining medical malpractice insurance, andthose surgeons who are fortunate enough to findit are often charged rates that are substantiallyhigher than in previous years.

According to the Medical Liability Monitor,one malpractice insurer charged Philadelphia,PA, general surgeons $35,523 for medical mal-practice insurance coverage in 2001. This rep-resented a 69 percent increase over the 2000rates. While Pennsylvania physicians have seensome of the highest percentage increases, theyare not alone. In Los Angeles, CA, medical mal-practice insurance for a general surgeon thatcost $35,110 in 2000 rose to $42,181 in 2001—a20 percent increase.1

These alarming rate hikes are not limited tolarge cities. In Portland, OR, general surgeonssaw their malpractice premiums increase by asmuch as 55 percent. In Charleston, WV, generalsurgeons experienced premium increases of upto 32 percent.1

Of course, general surgery is not the only af-fected specialty. Obstetrician-gynecologists andemergency physicians have also seen large in-creases in their malpractice insurance rates, ashave other specialists who traditionally have notbeen considered members of the high-risk insur-ance classes. For example, some internists inChicago, IL, saw their malpractice insurancepremiums rise by as much as 17 percent lastyear.1

While specific data are not yet available for2002 premiums, surgeons have reported in-creases at even higher rates.

by Christian Shalgian,

Senior Government Affairs Associate,

Division of Advocacy and Health Policy


23

Carriers leave the businessThe rising cost of offering medical malpractice

insurance has not only led to large rate hikes, buthas also prompted some companies to leave themedical malpractice insurance market. The great-est impact on physicians may be felt by the depar-ture of St. Paul Companies from the market. OnDecember 12, 2001, St. Paul, the second largestmedical malpractice insurer in the country, an-nounced that it would withdraw from the medicalmalpractice business. According to St. Paul, “Thecompany is forecasting that medical malpracticewill generate a 2001 underwriting loss of approxi-mately $940 million.”2

Physicians change practicesThe combination of rising insurance costs and

decreasing insurance availability is reportedlycausing some physicians to retire early, relocate,or drastically change their practices. The Wash-ington Post, for example, recently ran a storyabout physicians in Mississippi who are beingforced to drop obstetrics from their practicesbecause of prohibitive increases in their mal-practice insurance costs.3 It also has been re-ported that a group practice in Delaware County,PA, will no longer perform surgery or taketrauma call because they can’t afford the mal-practice insurance. One could speculate that thecombination of a resurgent malpractice pre-mium crisis and the continuing downward spi-ral in payments for key surgical services willlead to a proliferation of stories like these.

National tort reformTo help control the premium increases, the Col-

lege has been urging Congress to pass a series ofmedical liability reforms. In fact, six times in thepast 10 years, the U.S. House of Representativeshas passed these reforms as provisions of otherhealth care-related bills. The efforts to pass na-tional medical liability reform has not found asmuch support in the Senate, however, where noreforms have been passed to date.

Most recently, the issue of medical liability re-form was brought before the House in the sum-mer of 2001, during debate on the Patients’ Bill ofRights (PBR). The leading PBR proposal con-tained provisions that would allow patients to suetheir health plans in certain circumstances. While

this provision was controversial, it led to a com-promise that included a cap on noneconomic dam-ages for lawsuits brought against health plans. TheCollege and other leading health care groups sub-sequently argued that a cap on health plan liabil-ity would lead to situations where physicians wereleft with the “deep pockets.” To alleviate this in-equity, Rep. Bill Thomas (R-CA) introduced anamendment that included all of the medical liabil-ity reforms the College supports. Unfortunately,the amendment failed by a vote of 207 to 221.

In addition to the Thomas amendment, legisla-tion on this topic has been introduced by Reps.Jim Greenwood (R-PA) and Patrick Toomey (R-PA). Legislation to put in place needed medicalliability reforms also has been introduced by Sen.Mitch McConnell (R-KY).

State tort reformStates have had varying degrees of success in

passing medical liability reforms. For some, legis-lative victories have been tempered by rulingsfrom state supreme courts that have found somemedical liability reform laws unconstitutional.

In 1975, the California legislature passed a se-ries of tort reforms that are known collectively asthe Medical Injury Compensation Reform Act (MI-CRA). These reforms included a $250,000 cap onnoneconomic damages, modifications to the col-lateral source rule, mandatory periodic paymentsof future damages, and a sliding scale for plaintiffattorneys’ contingency fees. MICRA has been chal-lenged a number of times, and in each case theCalifornia State Supreme Court has upheld thelaw.

Other states have not fared as well, however. Forexample, the Ohio legislature passed a series ofmedical liability reforms that were later found tobe unconstitutional by the state’s Supreme Court.

Supporters of medical liability reform have beenunable to convince the Pennsylvania legislature toplace a cap on noneconomic damages, which manybelieve is the crucial aspect of liability reform.Since the 1970s, that state has had a mandatoryprofessional liability catastrophe fund. All Penn-sylvania physicians pay into this fund, which isused to pay awards and claims that are not cov-ered entirely by malpractice insurance. Due to therecent increases in jury awards, however, largeshortfalls threaten the fund.


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Some liability analysts describe West Virginiaas “Tort Hell.”4 Because of the growing medicalmalpractice crisis in that state, the governor re-cently called the legislature into a special sessionin an effort to find a solution to the problem. Thelegislature passed a series of short-term solutions,but was unable to address the long-range impli-cations of the issue and is expected to consider avariety of potential solutions in 2002.

Other dimensionsRising malpractice premiums are due at least

in part to the large jury awards in many medicalmalpractice cases. According to Jury Verdict Re-search, the median award in a medical malprac-tice case has risen by 113 percent since 1994.5 Thisincrease stands in stark contrast to the change inthe consumer price index, which has risen approxi-mately 20 percent in the same time period.6 Anold problem, it has been speculated that the esca-lation in awards has only been made worse by thesize of the awards granted in tobacco lawsuits inrecent years.

At the same time that malpractice-related costsare rising, payments to physicians that are in-tended to reimburse them for these costs have notkept up. The Medicare physician fee schedule,which serves as the foundation for reimbursementrates under both public and private health plans,includes three components: physician work, prac-

tice expenses, and malpractice expenses. The foun-dation of the entire fee schedule is the principlethat physician reimbursement should be based onthe relative amount of resources required fromthem to provide each service.

The malpractice expense component representsthe smallest fee schedule component, however, ac-counting for approximately 2 to 3 percent of theaverage service payment. The relative “weight”given to this component has in fact decreased since1999, when it accounted for 5 percent of paymentson average. This increase is small compared to in-creasing malpractice insurance premiums, whichin many instances have been much gone up bymore than 5 percent. Despite this rising cost tophysicians, Congress has not allocated any newfunds to fairly compensate them for this expense.

Where do we go from here?Across the country, medical malpractice costs are

skyrocketing and physicians are being forced toreact. It is clear that efforts are needed at boththe national and the state levels. It also is clearthat creative thinking is necessary and a varietyof solutions beyond the tort reforms that physi-cians have been promoting for many years willneed to be developed. ACS leaders, including theRegental Committee on Patient Safety and Pro-fessional Liability and the Board of Governors’Committee on Physician Competency and Liabil-ity, are committed to this task, and the College con-tinues to work with surgical specialty societies andthrough state and national coalitions to addressthis growing concern.

References

1. Trends in 2000 rates for physicians’ medical pro-fessional liability insurance. Med Liab Monitor, Sep-tember 2001.

2. St. Paul Companies press release, December 12,2001.

3. Porretto, J: Costs lead rural doctors to drop obstet-rics. Washington Post, A04, November 23, 2001.

4. Nordlinger, J: Welcome to “Tort Hell.” NationalReview, August 20, 2001, 28-30.

5. Jury Verdict Research news release, January 30,2001.

6. Bureau of Labor Statistics press release, Decem-ber 14, 2001.

Medical liability reformssupported by the College

1. Capping noneconomic damage awards,preferably at $250,000.

2. Modifying the collateral source rule to re-duce the total awards by amounts from othersources, such as health insurance companies.

3. Shortening the statute of limitations for fil-ing claims.

4. Limiting attorneys’ contingency fees.5. Eliminating joint and several liability, so a

physician who is only partly at fault for an in-jury cannot be held liable for paying the entirejudgment.

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by Donald E. Fry, MD, FACS, Albuquerque, NM

Governors’ committee

deals with range of risks

Editor’s note: This article is the fifth in a seriesof articles that highlight the work of the commit-tees of the Board of Governors (B/G). It focuses onthe Committee on Blood-Borne Infection and Envi-ronmental Risk.

T he spread of lethal pathogens has been an is-sue of concern to all surgeons throughout thehistory of our profession. For the last few de-cades, physicians have been particularly con-

cerned about the possible transmission of HIV,hepatitis B and C, and, most recently, diseases thatcould be spread through chemical or biologicalwarfare. The College’s activities related to moni-toring and managing these types of conditions fallunder the purview of a group of surgeons nowknown as the Governors’ Committee on Blood-Borne Infection and Environmental Risk.

The panel originally was simply a subcommit-tee of the B/G Committee on Surgical Practice inHospitals—the Subcommittee on AIDS. As thegroup quickly demonstrated its capacity to study

issues and offer solid proposals for managing them,the Board of Governors agreed to make it a stand-ing committee of the Board of Governors in 1992,and it became the Governors’ Committee on AIDS.

The committee soon started to study and com-ment on the transmission of other infectious dis-eases, and in 1994, we became the Governors’ Com-mittee on Blood-Borne Pathogens. To reflect anever-broadening scope of topics, in 2001, we at-tained our current moniker.

This article summarizes what the Committee onBlood-Borne Infection and Environmental Risk,in its various manifestations, has done to date andwhat we plan to accomplish in the future.

BackgroundIn 1981, the first AIDS-related deaths in the U.S.

were reported. Throughout the 1980s, surgeons’concerns about HIV infection remained promi-nent. Blood was handled with suspicion, surgicalteam members were apprehensive about treatinghigh-risk patients, and the public was concerned


26

about possible HIV exposure in health care facili-ties. Hence, in 1989, at the request of the B/G Com-mittee on Surgical Practice in Hospitals, the Boardof Governors called upon the College to adopt aposition on testing for HIV infection. In consider-ing the Board of Governors’ request, the Board ofRegents recommended the formation of a Subcom-mittee on AIDS that would report to the B/G Com-mittee on Surgical Practice in Hospitals. The sub-committee became active in 1990 and was chargedwith studying, providing educational materials,and developing proposals regarding future Collegeactivity related to the AIDS issue.1

The subcommittee, initially chaired by LaMarS. McGinnis, Jr., MD, FACS, was an active one rightfrom the start. In 1991, the subcommittee devel-oped the College’s Statement on the Surgeon andHIV Infection, which was approved by the Boardof Regents in October 1991 and issued in Decem-ber. The statement indicated that: (1) surgeonshave the same ethical obligation to treat patientswith HIV as they have for other patients; (2) sur-geons should use scientifically accepted methodsof infection prevention; (3) because there had beenno documented instances of a surgeon transmit-ting HIV to a patient, HIV-infected surgeons maycontinue to practice and perform invasive proce-dures unless there is clear evidence that a surgeonis not meeting basic infection control standards oris incapable of providing care; and (4) relevantCollege committees should continue to consider theconcerns of HIV-infected surgeons and their fami-lies.2

The document was updated several years later,and the revised text was published in the Febru-ary 1998 Bulletin. In this updated statement, theCollege noted that the risk of transmission fromsurgeon to patient and from patient to surgeonremained extremely low. Even so, the federal gov-ernment continues to expect surgeons to followguidelines that are costly and inappropriate in thesurgical environment. The College also reiteratedits belief that “enforcing a high standard of infec-tion control and universal precautions remains thebest strategy for protecting patients from acciden-tal exposure,” as well as its four points set forth inthe original Statement on the Surgeon and HIVInfection.3

Additionally, each year since 1991, we have spon-sored a session during the Clinical Congress. Top-

ics that have been addressed during these programsinclude: AIDS and the Surgical Team, Transmis-sion of Blood-Borne Disease in the Care of Patients:Current Perspectives; Prevention and Treatmentof HIV and Hepatitis B and C in the Surgeon andthe Health Care Worker; and Surgical Aspects ofthe Patient with HIV: Etiology, Diagnosis, andTreatment.

Also since 1991, we have maintained a strongrelationship with the Centers for Disease Control(CDC). We forged this alliance to ensure that sur-geons would be able to offer their input on issuesrelated to HIV and other blood-borne infectionsbefore policies are made. In 1994, under the chair-manship of Robert S. Rhodes, MD, FACS, the com-mittee assisted the College in developing a jointconference with the CDC titled Prevention ofTransmission of Blood-Borne Pathogens in Sur-gery and Obstetrics. More than 200 individualsattended the meeting, which was described in con-siderable detail in the May 1994 Bulletin.

One initiative that emanated from the joint con-ference was the College’s Statement on the Sur-geon and Hepatitis B Infection. The College de-cided it was important to focus on HBV in recog-nition of the fact that “surgeons are at consider-able risk for occupational infection from HBV.” Thestatement was published in the May 1995 issue ofthe Bulletin. The committee updated the statementin 1997 to include information about the risks oftransmitting and recommendations for controllingHCV. The updated document was renamed simplythe Statement on the Surgeon and Hepatitis andwas published in the April 1999 issue of the Bulletin.

Recent activityI have served on the committee literally since its

inception, first as an ex officio, then as a Governorappointee, and, since October 2000, as Chair. Soonafter I became Chair, we changed the name of thepanel to the Governors’ Committee on Blood-Borne Infection and Environmental Risk. Thename change reflects our belief that blood-bornerisks in the operating room remain of consider-able concern to surgeons and other health carepractitioners. Also of great interest over the lastfew years to several members of the committee,including Kenneth L. Mattox, MD, FACS, Maj. Gen.John Sutherland Parker, MD, FACS, and myself,however, has been the potential use of chemical,


27

biological, and nuclear weapons for the purposesof mass destruction. By adding the phrase “envi-ronmental risk” to our title, we have demonstratedthat our mission has expanded to encompass thedevelopment of suggestions on how to deal withthese threats to surgeons and their patients.

In light of the terrorist attacks on the U.S. onSeptember 11, 2001, disseminating informationregarding unconventional weaponry has now be-come an even higher priority for the committeeand the College in general. We really want to serveas a vehicle for motivating Fellows to become ac-tively involved in overcoming the effects of terror-ism at the local level.

During the 2001 Clinical Congress, I participatedin a special session on Unconventional Civilian

Disasters: What the Surgeon Should Know withDavid B. Hoyt, MD, FACS, Chair of the College’sCommittee on Trauma. During the program, I pre-sented information substantiating and summariz-ing the College’s Statement on UnconventionalActs of Civilian Terrorism. The committee craftedthis document, which was subsequently approvedby the Board of Governors and the Regents andpublished in the November 2001 Bulletin.

In the statement, we noted that there are threemajor categories of unconventional acts of civil-ian terrorism (ACTs), including: nuclear/radiationevents, such as nuclear detonation, radioactiveexplosions, and dissemination of radioactively con-taminated food and water; chemical events, suchas dispersion of cyanide, sarin, and so on; and bio-

Donald E. Fry, MD, FACS, ChairGeneral surgery, Albuquerque, [email protected]

Michael Belkin, MD, FACSVascular surgery, Boston, [email protected]

Donald K. Brief, MD, FACSGeneral surgery, Millburn, NJ

Daniel T. Dempsey, MD, FACSGeneral surgery, Philadelphia, [email protected]

Ronald M. Ferguson, MD, FACSGeneral surgery, Columbus, OH

Stanley R. Klein, MD, FACSVascular surgery, Torrance, [email protected]

Kenneth L. Mattox, MD, FACSThoracic surgery, Houston, [email protected]

John E. Moenning, MD, FACGeneral surgery, Punta Gorda, FL

Governors’ Committee on Blood-Borne Infection and Environmental Risk

David S. Mulder, MD, FACSThoracic surgery, Montreal, [email protected]

Denise Marie Anne Ouellette, MD, FACSGeneral surgery, Montreal, PQ

Maj. Gen. John Sutherland Parker, MD, FACSThoracic surgery, Frederick, [email protected]

Edward J. Quebbeman, MD, FACSGeneral surgery, Milwaukee, WI

Maj. Gen. Leonard M. Randolph, Jr., MD, FACSGeneral surgery, Washington, [email protected]

William P. Schecter, MD, FACSGeneral surgery, San Francisco, [email protected]

William T. Stubenbord, MD, FACSGeneral surgery, New York, NY

Laurence John Tuner, MB, BS, FACSGeneral surgery, New Westminster, [email protected]


28

logical events, including the spread of anthrax,brucellosis, and cholera.

The statement makes clear that it is of the ut-most importance that surgeons develop a new levelof knowledge so they can care for patients who arecasualties of these actions. Specifically, we recom-mend that: (1) Fellows of the College actively par-ticipate in local and regional disaster-planning; (2)Fellows attain extensive education and training inthe pathogenesis, diagnosis, prevention, and treat-ment of the likely agents of unconventional ACTs;(3) Fellows educate other health care practitionersand the nonmedical community about the effectsof ACTs and how to treat them; (4) the College ac-cept a policy of universal standards for respond-ing to all potential terrorist activity; and (5) theCollege develop formal relations with disaster plan-ning and response units.

The statement is just the first in what we antici-pate will be a long line of informational materialsthat we will prepare on this subject. This year, forexample, we plan to publish an article in the Jour-nal of the American College of Surgeons on the ef-fects of chemical and biological agents. Addition-ally, we are preparing a program in conjunctionwith the ACS Committee on Trauma on Weaponsof Mass Destruction in a Civilian Setting for pre-sentation at this year’s Clinical Congress.

In addition, the committee is working on anemerging issue—nosocomial transmission of prion,the infectious agent that causes mad cow disease.Over 250 patients have contracted nosocomialprion infection from the receipt of neurografts, orfrom contaminated surgical instruments that hadpreviously been used on patients subsequentlyshown to have prion infection. We have discoveredthat there is a risk of transmission from surgicalinstruments, even when appropriate sterilizationhas been used. In some cases, the instruments mayneed to be destroyed. This growing problem raisessome very interesting issues for all surgeons, andthe committee plans to publish an article regard-ing the transmission of prion disease in the Jour-nal of the American College of Surgeons later thisyear.

Of course, we continue to pay close attention toHIV and hepatitis infection among health careworkers and to update the College on its transmis-sion. Between October 2000 and October 2001,there were seven additional possible cases of HIV

transmission among health care workers and nonew documented cases. No documented transmis-sions occurred among surgeons, and no transmis-sions occurred from solid needle injury since theonset of the HIV epidemic in the U.S. With regardto hepatitis, there were no new cohorts of HBVtransmission from surgeon to patient and one re-ported cohort of HCV transmission from a gyne-cologic surgeon.

ConclusionThe B/G Committee on Blood-Borne Infection

and Environmental Risk has consistently foreseenissues that are likely to be of concern to surgeonsand responded in a timely and an appropriatemanner. It’s very exciting to be part of a commit-tee that is carrying out many innovative activitiesand that has the potential to do some good bothfor surgeons and the patients for whom they care.

I would like to gratefully acknowledge the con-tributions of all the committee members (see ros-ter, p. 27). We all look forward to carrying out ourcurrent mission and to helping the College meetfuture challenges.

References

1. McGinnis L: Governors’ Committee on AIDS to ex-amine concerns of the surgical community. Bull AmColl Surg, 75(7):6-8, 1990.

2. American College of Surgeons: Statement on thesurgeon and HIV infection. Bull Am Coll Surg,76(12):28-31, 1991.

3. American College of Surgeons: Statement on thesurgeon and HIV infection. Bull Am Coll Surg,83(2):27-29, 1998.

Dr. Fry is professor ofsurgery and chairman

of the department ofsurgery at the Univer-sity of New Mexico. He

also is Chair of theACS Governors’

Committee on Blood-Borne Infection and

Environmental Risk.

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Editor’s note: The following is a summary ofthe Ethics and Philosophy Lecture delivered byThomas J. Krizek, MD, FACS, during the 2001Clinical Congress in New Orleans, LA. Dr. Krizekis professor of religious studies and professor ofsurgery and medicine (ethics) at the University ofSouth Florida, Tampa. The text of Dr. Krizek’s pre-sentation will appear in its entirety in the March2002 issue of the Journal of the American Collegeof Surgeons.

Dr. Krizek posed the question, “Surgery: Is itan impairing profession?” during the Ethicsand Philosophy Lecture at the 2001 ClinicalCongress. To this query he responded, “I be-

lieve we may be an impairing profession, but wedon’t have to be.”

The evidence that surgery may be an impairingprofession can be found in data indicating that therates of alcoholism, drug addiction, emotional dis-ease, and divorce are all higher among surgeonsthan the rest of society. Dr. Krizek, a recoveringalcoholic, defined impairment among surgeons asbeing “no longer capable of performing in a pro-fessionally safe fashion.”

Dr. Krizek said that the profession of surgery andsurgical training programs must change in orderto reduce the risk of impairment. Particularly im-portant, he said, are changes in the educationalprocess, because it is during training that surgeonsdevelop both good and bad habits.

Dr. Krizek offered 10 observations on what fac-tors involved in the surgical training process areimpairing. They are as follows:

1. The length of training is too long. Dr. Krizekadded that all surgical trainees must complete pro-grams of predetermined duration, but what theylearn may vary. “The constant is time, and the vari-able is quality,” he said. “We have the wrong con-stant and the wrong variable.” Further, he notedthat more and more surgeons are retiring in their50s because of the pressures associated with theprofession. Because surgeons don’t complete theirtraining until they are in their mid-30s, they can

only practice for about 20 years. If the length oftraining were reduced, residents could look forwardto longer and more productive careers.

2. The financial sacrifice is too great. He saidresidents should earn a living wage and pay tu-ition. If they earned a reasonable amount of moneyduring their residencies, they would be more likelyto “give back” to the system that trained them af-ter their practices get off the ground and shouldbe expected to do so.

3. The hours of work are too many. Work hoursshould be devoted primarily to learning. Unfortu-nately, surgical residents are currently admired andrewarded for simply working longer hours.

4. Sleep deprivation is dangerous. He noted thatlack of sleep distorts thinking and is incompatiblewith learning.

5. Surgery is emotionally draining. “Socially vir-tuous professions use up emotion,” Dr. Krizek said.Residents are often the ones who must explain tofamily members why a patient died during an op-eration. “Residents nurture. Who nurtures them?”he noted.

6. There is a “tragic need to suppress emotions.”Residents are taught to “suppress secrets, hidegrief, and deal with challenges to honesty and in-tegrity,” he said.

7. Fragmentation of surgeons begins early. Resi-dents are segregated on the basis of the specialtythey choose, and these divisions continue through-out their careers.

8. Mistakes are not handled appropriately. Theyusually are handled with silence, disapproval, oraccusations of liability.

9. Impairment may be behavioral, the result ofinjury, or the product of chemical dependency. It isimportant that surgeons reach out to impairedresidents and colleagues. “Why should we do it?”he asked. “Because they can’t do it alone.”

10. If the training process is changed, the pro-fession will reap rewards. “The seeds of impair-ment are planted during residency,” Dr. Krizekadded. What fruit those seeds will bear is up to theprofession, he concluded.

A summary of the Ethics and Philosophy Lecture

S U R G E R YIs it an impairing profession?

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Statement on bicycle safety andthe promotion of bicycle helmet use

At its October 2001 meeting, the Board of Regentsapproved the following statement, which was devel-oped by the Subcommittee on Injury Prevention andControl of the College�s Committee on Trauma.

The American College of Surgeons and itsCommittee on Trauma recognize the im-

portance of injury prevention in the spectrumof care of the trauma patient, especially withregard to the prevention of traumatic brain in-jury. Cycling remains an important means oftransportation and recreation; however, thebicycle rider can be at significant risk of seri-ous injury.

The College recognizes the following facts:� Approximately 800 people die and 17,000

are hospitalized in the U.S. due to bicycle-re-lated injuries. Bicycle crashes are the fourthlargest contributor to childhood injury costs andquality-of-life losses.

� Bicycle injuries account for the largestnumber of sports-related injuries treated inemergency departments.

� Bicycle helmets can reduce the risk of headinjury by 85 percent. Bicyclists hospitalized withhead injury are 20 times more likely to die thanthose without head injury.

� 98 percent of bicyclists killed were notwearing a helmet at the time of injury. Helmetuse is estimated to prevent 75 percent of cy-cling deaths.

� As of November 2000, bicycle-related in-juries and deaths had decreased in the 17 statesthat have youth bicycle helmet laws.

� Helmets can benefit adult riders as wellas children. As more helmet laws target youth,the proportion of adults comprising bicycle fa-talities has risen from 32 percent in 1975 to 71percent in 1999.

� Helmet laws are necessary. Forty-three


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percent of bicyclists report that they never weara helmet, and of those who do, 44 percent re-port that they do so only because a law re-quires it.

Therefore, supported by these and other epi-demiologic and outcomes data, the AmericanCollege of Surgeons supports efforts to pro-mote, enact, and sustain universal bicycle hel-met legislation.

Bibliography

Baker SP, O�Neill B, Ginsburg M, Li G: The Injury Fact Book.Oxford, England: Oxford University Press, 1992: 287-291.

Centers for Disease Control and Prevention: Injury-controlrecommendations: Bicycle helmets. MMWR 44:1-17,Feb. 17, 1995.

Rodgers GB: Bike helmets. Consumer Products Safety Re-view. 4(1); 1-4, 1999.

Shafi S, Gilber, JC, Loghmanee F, et al: Impact of bicyclehelmet safety legislation on children admitted to a re-gional pediatric trauma center. J Pediatr Surg, 33:317-321, 1998.

Thomas S, Acton C, Nixon J, et al: Effectiveness of bicyclehelmets in preventing head injury in children. Brit MedJ, 308:173-176, 1994.

Thompson R, Rivara FP, Thompson DC: A case-control studyof the effectiveness of bicycle helmets. N Eng J Med,320:1361-1367, 1989

Thompson DC, Rivara FP, Thompson R: Effectiveness ofbicycle helmets in preventing head injuries. JAMA, 276:1968-1973, 1996.

Yelon J, Harrigan N, Evans J: Bicycle trauma: A five yearexperience. Am Surg, 61:202-205, 1995.

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Keepingcurrent

What’s new in ACS Surgery:Principles and Practiceby Erin Michael Kelly, New York, NY

Mr. Kelly is editor, What’s New in ACS Surgery: Prin-ciples and Practice, WebMD Reference, New York, NY.

continued on page 38

Monthly updates to the online version of ACSSurgery: Principles and Practice in the physicianportion of the WebMD Web site, www.webmd.com,are also available quarterly through subscriptionto the ACS Surgery CD-ROM, which incorporatesevery online update from the previous threemonths and yearly through subscription to theannual hardcover edition of ACS Surgery: Prin-ciples and Practice, which incorporates everyonline update from the preceding year. To learnmore, visit the ACS Surgery: Principles and Prac-tice page on the ACS Web site, www.facs.org/mem-bers/acs_surgery.html.

Following are highlights of recent additionsto the online version of ACS Surgery: Prin-ciples and Practice, the practicing surgeon’s

first Web-based and only continuously updated sur-gical reference. Chapters may be viewed in theirentirety by visiting the online version of ACS Sur-gery: Principles and Practice found on the physi-cian portion of the WebMD Web site atwww.webmd.com.

VIII. Common Clinical Problems8. Lower Gastrointestinal Bleeding. Michael

Rosen, MD, Jeffrey L. Ponsky, MD, FACS. In thischapter, the authors review the wide array of eti-ologies of lower gastrointestinal bleeding (LGIB),as well as the diagnostic and therapeutic modali-ties available to treat this difficult clinical prob-lem. Tenets of management include initial hemo-dynamic stabilization followed by localization ofthe bleeding site, and then eventual, site-specifictherapeutic intervention. There are many causesof LGIB, and successful localization requires timelyand appropriate use of a variety of diagnostic tests.Diverticular disease is the most common cause ofLGIB and represents 30 to 40 percent of all cases.While arteriovenous malformations are extensively

described in the literature, their actual incidenceas a cause of LGIB is reported at 1 to 4 percent inseveral large series. Other causes of LGIB includeinflammatory bowel disease, benign and malignantneoplasms, ischemia, infectious colitis, anorectaldisease, coagulopathy, NSAIDs use, radiation proc-titis, AIDS, and small bowel disorders. While theultimate decision on what tests to order are basedon the individual case, the authors recommendbeginning the work-up for lower GI bleeding witha colonoscopy when possible. If a source is not iden-tified, then an upper endoscopy should follow. Ifthe source of the bleeding still remains obscure orif massive hemorrhage precludes safe endoscopicexamination, then angiography or nuclear medi-cine scans might be appropriate. Finally, every ef-fort to accurately identify the source of bleedingshould be made before surgical resection. Thera-peutic options for the clinician include endoscopy,angiography, or surgery.

The full text of “Lower Gastrointestinal Bleed-ing” may be viewed at www.webmd.com. Click onACS Surgery: Principles and Practice.

XI. Surgical Techniques1. Gastrointestinal Endoscopy. Alicia Fanning,

MD, Jeffrey L. Ponsky, MD, FACS. Since the be-ginning of the 1970s, flexible endoscopy of the gas-trointestinal (GI) tract has been the dominantmodality for the diagnosis of gastrointestinal dis-ease. Over the same period, developments in tech-nology and methodology have made possible theuse of endoscopy to treat a host of conditions thatonce were considered to be manageable only bymeans of open surgical procedures. The integra-tion of flexible endoscopic techniques into the ar-mamentarium of the GI surgeon permits a moremultidimensional approach to the treatment of


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Collegenews

ACS Executive Director Tho-mas R. Russell, MD, FACS, hasappointed Alden H. Harken,MD, FACS, to the executivestaff of the College as volunteerInterim Director of the Divi-sion of Research and OptimalPatient Care.

As Interim Director of the di-vision, Dr. Harken will overseethe activities of the Office ofEvidence-Based Surgery and ofthe Cancer and Trauma pro-grams of the College. Throughthis division, the College willadvance the practice of surgerythrough research and scholarlyactivities to expand medicalknowledge by: providing op-portunities for scholarshipsand fellowships; education ofsurgeons about funding andresearch-related activities,such as clinical trials and out-comes efforts; and develop-ment of strategies to improvephilanthropic activities.

Dr. Harken is professor inthe department of surgery atthe University of Colorado,Denver. He has been a Regentof the College representingcardiothoracic surgery since1999, and is a member of theBoard of Regents’ ExecutiveCommittee and Fellowship Li-aison and Honors Committees.He is the Regental representa-tive to the Advisory Council forCardiothoracic Surgery andChair of the College’s Scholar-ships and Surgical Researchand Education Committees.Dr. Harken is also an Editorial

Advisor for the Bulletin.A Fellow since 1978, Dr.

Harken has been active in awide range of College activi-ties. He served on the Pre-andPostoperative Care Committee(1982-1985, senior member,1988-1992), the Committee onYoung Surgeons (1983-1986),and the Committee on Con-tinuing Education (1987-1990).

Dr. Harken graduated fromHarvard College in 1963 andobtained his medical degreefrom Case Western ReserveMedical School in 1967. He wasintern (1967-1968), junior resi-dent in surgery (1968-1970),

and senior and chief residentin surgery (1971-1973) at Pe-ter Bent Brigham Hospital,Boston, MA. He served as chiefof cardiovascular physiology atWalter Reed Army Institute ofResearch, Washington, DC,from 1974 to 1976.

Dr. Harken was assistantprofessor, associate professorof surgery, and professor ofsurgery at the University ofPennsylvania, Philadelphia,from 1976 to 1984. He assumedhis duties as professor of sur-gery and chair of the depart-ment of surgery at the Univer-sity of Colorado, Denver, in1983. Since 1984 he has alsoserved as chief of surgery, Uni-versity Hospital, and staff sur-geon at Veterans Administra-tion Hospital, Rose MedicalCenter, The Children’s Hospi-tal, and Denver Health Medi-cal Center—all in Denver, CO.

Dr. Harken has served aspresident of the Association forAcademic Surgery, the Societyof University Surgeons, theColorado Trauma Institute,and as director of the Ameri-can Board of Surgery and theAmerican Board of ThoracicSurgery. He holds membershipon the editorial boards of theJournal of Surgical Research,the Journal of Cardiac Sur-gery, Archives of Surgery, Sur-gery, Shock, and the Journal ofThoracic and CardiothoracicSurgery. He is also an editor ofACS Surgery: Principles andPractice.

Dr. Harken namedto ACS executive staff

Dr. Harken


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It was an honor to be selectedas the 2001 Australia-NewZealand (ANZ) Chapter of theACS Travelling Fellow. My per-sonal academic enrichment asa result of the fellowship hasbeen enormous, and I can onlyhope that I have replied in kindduring my travels in the pastthree months.

Australasian College meetingIn May 2001, I attended the

annual scientific congress of theAustralasian College of Sur-geons in Canberra, ACT. Thisweek-long meeting featured anoutstanding scientific program,generous collegiality, and a busysocial schedule. During themeeting, I delivered the 2001American College of SurgeonsLecture, participated in threeopen panel discussions, spoke atthe annual ANZ ACS Chapterluncheon, and delivered two freecommunications. The titles ofthese panels were:

• An Algorithmic Approachto Facial Palsy.

• International Surgeons’Forum: Surgeons Beyond 2000.

• Facial Paralysis.• Plastic Surgery Education.• Workforce Issues Facing

the Young Plastic Surgeon in theU.S.

• Plastic Surgery Trainingin the U.S. and Canada.

• Trauma Surgeons Arefrom Mars, Reconstructive Sur-geons Are from Venus.

Traveling portionIn July 2001, I returned to

Australia with my family tofulfill the traveling portion ofthe fellowship. We arrived inMelbourne on July 10. Thenext day, I visited Mr. FelixBehan and the house staff at theWestern Hospital in Melbourne.Mr. Behan had generously ar-ranged an outpatient clinic forme to examine patients who hadundergone reconstructions withhis fasciocutaneous island flaptechnique. We made wardrounds at the hospital, and I ob-served an intraoral reconstruc-

tion in the operating theater. Ialso had an opportunity to visitMr. Behan’s private office, andI read and edited a manuscripton his fasciocutaneous flap tech-nique that he is submitting forpublication.

The next morning I was for-tunate enough to attend wardrounds at the Royal MelbourneHospital with Mr. BruceJohnstone and Mr. G. Ian Tay-lor. After a teaching session withresidents and attendings whereI spoke on facial reanimation, Iattended outpatient clinic withthe plastic surgery staff. I wasalso able to spend several hourswith Mr. Taylor in his researchsuite where we had a lively ex-change of ideas.

In the afternoon on July 12, Ivisited St. Vincent’s Hospital inMelbourne where I observed Mr.Wayne Morrison perform a mi-crosurgical nasal reconstruc-tion. I was then able to attendtheir plastic surgery outpatientclinic and to participate in wardrounds at St. Vincent’s PublicHospital. I enjoyed a tour of theresearch facilities at the Ber-nard O’Brien Institute of Micro-surgery, hosted by Mr. Morrison.At the institute, I delivered a lec-ture on tissue engineering toattendings and residents fromseveral Melbourne hospitals. Asa result of my visit, it is likelythat Mr. Morrison and I will be-gin a research collaboration inthe area of tissue engineering.

2001 Australia-New Zealand ChapterTravelling Fellowshipby William M. Kuzon, Jr., MD, PhD, FACS, Ann Arbor, MI

Dr. Kuzon


35

Next, I visited the RoyalChildren’s Hospital, Melbourne,with Mr. Christopher Coombsserving as my host. I was ableto participate in a micro-neu-rovascular gracilis transfer forthe reanimation of the face of achild with Mobius syndromethat Mr. Coombs performed onthat day. As a result of our com-mon interest in facial reanima-tion, Chris and I will be coau-thoring a review paper on thistopic for an upcoming issue ofPlastic Surgery Clinics of NorthAmerica.

Also on July 13, I was able tovisit the research laboratory ofDr. Gordon Lynch, a lecturer inphysiology at the University ofMelbourne. Dr. Lynch and I havea common research interest inthe area of skeletal muscle me-chanical function, and we planto collaborate on an examina-tion of mechanical dysfunctionsin skeletal muscle after neu-rovascular transfer and distrac-tion osteogenesis.

After traveling for several daysby car, we arrived in Adelaide onJuly 15, 2001. On July 16, I vis-ited Flinders Medical Centre.Mr. Ian Leitch and Mr. NicholasMarshall were our hosts. Aftermorning ward rounds, I spoke ata conference attended by plasticsurgery staff and house officersthat highlighted cultural differ-ences in the practice of plasticsurgery between the U.S. andAustralia. I was able to attendtheir outpatient clinic thatmorning, and I had a chance tointeract with their house staffthroughout the day.

On July 17, I was honored tolead a teaching session for allplastic surgery residents inAdelaide. The program, orga-

nized by senior registrar Dr. Pe-ter Riddell, was held at QueenElizabeth’s Hospital in Ade-laide. This half-day session fo-cused on peripheral nerve injuryand repair. We examined a pa-tient with a newly diagnosedbrachial plexus lesion and dis-cussed the management of thisproblem in detail. We reviewedthe physiology of nerve regen-eration and covered the man-agement of peripheral nerve in-juries in detail. I gave a formaltalk on the management of fa-cial nerve injuries. I was alsoable to participate in wardrounds at Queen Elizabeth’sthat morning.

That evening, I gave a formallecture at a meeting of the South

Australian Society of PlasticSurgeons. Mr. Leitch was kindenough to arrange this meeting,and I spoke on the intersectionbetween research and clinicalpractice in plastic surgery. Themeeting was attended by attend-ing surgeons and residents fromseveral hospitals in Adelaide.

For the next week, my familyand I enjoyed touring AyersRock, northern Queensland, andthe Great Barrier Reef, arrivingin Sydney on July 25, 2001.

While in Sydney, I visitedPrince of Wales Hospital withmy host, Mr. Mark Gianoutsos.After attending their monthlyresearch conference, I spentthe day visiting the Ortho-paedic Research Laboratories

The following citations appearon my curriculum vitae as a re-sult of my visits to medical cen-ters in Australia in July 2001:

Kuzon WM: “Improving Re-animation in Patients with Fa-cial Palsy.” Plastic and Recon-structive Surgery Teaching Con-ference, Royal Melbourne Hos-pital, Melbourne, Victoria, Aus-tralia, July 10, 2001.

Kuzon WM: “Skeletal Muscleand Peripheral Nerve TissueEngineering.” Special ResearchSeminar, Bernard O’Brien Insti-tute of Microsurgery, Mel-bourne, Victoria, Australia, July10, 2001.

Kuzon WM: “Cultural Deter-minants of Practice in PlasticSurgery.” Plastic and Recon-structive Surgery Teaching Con-ference, Flinders Medical Cen-

ter, Adelaide, South Australia,Australia, July 16, 2001.

Kuzon WM: “The Manage-ment of Facial Nerve Injuries.”Plastic and Reconstructive Sur-gery Teaching Conference, Spe-cial Resident’s Program, QueenElizabeth Hospital, Adelaide,South Australia, Australia, July17, 2001.

Kuzon WM: “Can ResearchImpact Clinical Care in PlasticSurgery?” South Australian So-ciety of Plastic Surgeons,Adelaide, South Australia, July17, 2001.

Kuzon WM: “Mechanical Dys-function in Skeletal Muscle:Denervation/Reinnervation,Neurovascular Transfer, andAging.” University of NewSouth Wales Department of Sur-gery, Sydney, Australia, July 26,2001.

Lectures presented


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at the University of New SouthWales under the direction ofDr. William Walsh. Drs.Gianoutsos, Walsh, and I areplanning a major research col-laboration examining the ef-fects of mandibular distractionosteogenesis on the mechanicalfunction of the muscles of mas-tication. I was able to visittheir laboratory and animal fa-cilities, and we spent the dayplanning our collaboration indetail. This effort will involveinvestigators at the Universityof Michigan, Stanford Univer-sity, The University ofMelbourne, and The Univer-sity of New South Wales. Thismulticenter project is possibleonly as a result of the ACStravelling fellowship. After ourdaylong meetings, I gave anopen lecture on our research inthe area of mechanical dys-

function in skeletal muscle at-tended by faculty and studentsfrom the University.

The following day, my fam-ily and I were able to meet Mr.Stephen Deanne and his wifeAnn for dinner, and we re-capped my fellowship activitiesbefore our departure for home.

ConclusionIn summary, as the 2001

Australia-New Zealand Chap-ter of the ACS Travelling Fel-low, I participated in theAustralasian College Congressin Canberra, and visited sevenmedical centers and three ma-jor university research labora-tories. I presented 10 talks orlectures, participated in threescientific panels, and inter-acted with literally dozens ofplastic surgeons and plasticsurgery house officers. As a re-

sult of my fellowship, two sig-nificant research collabora-tions are planned, and one sci-entific review article is inpreparation. This remarkableacademic interaction wouldnot have been possible withoutthe support of the ACS travel-ling fellowship.

Lastly, I would be remiss if Ifailed to acknowledge my grati-tude for the enormous hospi-tality that was extended to myfamily during our travels inAustralia. Everywhere wewent, we were taken out to din-ner, invited into private homes,given driving tours of cities,and shown special attractions.We made many new friendsand were made to feel very wel-come. It is my sincere hopethat I am able to repay thathospitality when my Austra-lian colleagues visit the U.S.

Authors of videotapes on subjects related totrauma (for example, “How-I-do-it,” operative tech-niques of interesting or challenging problems intrauma resuscitation or management) wishing topresent their videotapes during the 2002 ClinicalCongress in San Francisco, CA, Wednesday, Octo-ber 9, 1:00-3:00 pm, are encouraged to submit:

1. Preliminary information on the appropriateform, available from Gay Lynn Dykman, Commit-tee on Medical Motion Pictures, American Collegeof Surgeons, 633 N. Saint Clair St., Chicago, IL60611-3211, tel. 312/202-5262. This form is acces-

2002 Trauma Motion Picture Session:Call for videotapes

sible on the College’s Web site, www.facs.org, orby calling the faxback system, at 1-800/329-7833.

AND2. A 50-word abstract for each videotape.AND3. The videotape itself (3/4" U-matic or ½” Su-

per-VHS formats).Submit before April 5, 2002, to Rao R. Ivatury,

MD, FACS, Department of Surgery, West Hospi-tal, 15 East, P. O. Box 980454, 1200 E. Broad St.,Richmond, VA 23298-0454. For further informa-tion, call 804/828-7748.


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The CD-ROM contains syllabi from the followingpostgraduate courses:

• Professional Liability and Risk Managementin a Changing Health Care Environment

• Head and Neck Surgery• Diseases of the Liver, Biliary Tract, and Pancreas• Vascular Surgery• Thoracic Surgery• Current Controversies in Cancer Management• Gastrointestinal Disease• Minimal Access Surgery• Clinical Update in Trauma• Cardiac Surgery• Laparoscopy and Urology• Surgical Infection and Antibiotics• Breast Disease• Pre- and Postoperative Care (Nutritional Support)• Anesthetic Innovations for Improving Surgery

and Postoperative Pain Control• Practical Operating Room Management for Surgeons• Complex Hemangiomas and Vascular Malformations• Perioperative Care of the Anemic Patient• Colon and Rectal Surgery• The Anatomy and Surgical Correction of

Groin and Abdominal Wall Hernias

Postgraduate course syllabinow available on CD-ROMA CD-ROM containing select

postgraduate course syllabi from

the 2001 Clinical Congress is now

available for purchase through the

College’s Web site at

https://secure.telusys.net/

commerce/current.html

or by calling 312/202-5474.

Twenty courses are included on

the CD-ROM, which is available

for $35. There is an additional

charge of $12 for shipping and

handling for international orders.


38

The American College of Sur-geons has recently becomeaware of identity theft targetedat surgeons that has includedthe unauthorized issuance ofcredit cards and subsequentpurchase transactions againstthe fictitious cards. Although in-dividuals are not legally liablefor such purchases, clearing upthe problem of identity theft

Surgeons targeted for identity theft

takes significant time and effort.You can request that a protectivestatement, which warns credi-tors to verify identification be-fore opening new accounts inyour name, be added to your re-port. Contact TransUnion,Fraud Victim Assistance Depart-ment, at http://www.transunion.com, or call 800/680-7289, orwrite to P.O. Box 6790, Fuller-

ton, CA 92834; Equifax CreditInformation, Consumer FraudDivision, at http://www.equifax.com, or call 800/525-6285, orwrite to P.O. Box 740256, At-lanta, GA 30374; or Experian’sNational Consumer Assistanceat http://www.experian.com, orcall 888/397-3742, or write toP.O. Box 9530, Allen, TX 75013.

Fellows and College chapterscan keep track of proposed statelegislation and regulations via astate-issues database at http://w w w. f a c s . o r g / d e p t / h p a /state.html.

The database includes infor-mation on dates of a state’s leg-

islative sessions, a link to eachstate legislature’s Web site, andbills and regulations of particu-lar interest to surgeons. Usersmay access this information bystate, issue, word (text search),or date of last update. This da-tabase is a work in progress, and

State issues database now onlinesome states may have very fewlistings because of slower regu-latory/legislative processes orjust released actions currentlyunder consideration. For moreinformation, contact Jon Suttonat 312/202-5358, or [email protected].

digestive disease. The modern GI surgeon shouldcertainly be conversant in and adept at many ofthese procedures.

The authors review the following:• Diagnostic and therapeutic esophagogastro-

duodenoscopy.• Variceal and nonvariceal hemorrhage control.• Dilation of esophageal strictures.• Stenting of esophageal tumors.• Retrieval of foreign bodies.• Percutaneous endoscopic gastrostomy.• Diagnostic and therapeutic endoscopic retro-

grade cholangiopancreatography.• Diagnostic and therapeutic colonoscopy.• Chromoendoscopy.• Endoscopic mucosal resection.• Endoscopic ultrasound.• The potential of endoscopic suturing.The full text of “Gastrointestinal Endoscopy”

may be viewed at www.webmd.com. Click on ACSSurgery: Principles and Practice.

Looking aheadNew chapters scheduled to appear as online

updates to ACS Surgery: Principles and Prac-tice in the first part of 2002 include “Fast TrackSurgery,” by Henrik Kehlet, MD, PhD, and Dou-glas W. Wilmore, MD, FACS; “Open EsophagealProcedures,” by Richard Finley, MD, FACS, andJohn Yee, MD; “Acute Renal Failure,” by An-thony A. Meyer, MD, FACS, and Renae Stafford,MD; “Injuries to the Great Vessels of the Abdo-men,” by David V. Feliciano, MD, FACS; “Jaun-dice,” by Jeffrey Barkun,MD, and Alan Barkun,MD; and “Emergency Department Evaluationof the Patient with Multiple Injuries,” by FelixBattistella, MD, FACS.

KEEPING CURRENT, from page 32

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Highlightsof theBoard ofRegentsmeetingOctober 5-7, 12, 2001

by John P. Lynch,Director,Organization Department

FellowshipThe Regents approved

a total of 1,786 Initiatesfor induction into theCollege. The Initiatescome from the U.S. andits possessions, Canada,and 39 other countries.

Financial reportsThe Regents accepted

the audited financialstatements of the Ameri-can College of Surgeons

ommendations of theBoard of Governors:

• Domestic Fellows(U.S.) and federal: $440.

• Canadian Fellows:$335.

• Fellows from othercountries: $155.

• Associate Fellows:$188.

• Candidate Group:$20.

NOTE: In a subsequentmail ballot conducted on

as of June 30, 2001, and for the six monthsthen ended, including the independentauditor’s report from the firm Deloitte & Tou-che, LLP.

In another action, the Board approved pro-cedures for the dues approval process. Theseprocedures include annual review of the duesstructure by the Board of Regents’ (B/R) Fi-nance Committee and the Board of Governors’(B/G) Committee to Study the Fiscal Affairsof the College. The B/R Finance Committeeevaluates the dues structure and recommendsa proposed structure to the B/G Committee toStudy the Fiscal Affairs of the College. Thecommittee evaluates dues proposals from theFinance Committee and forwards its propos-als with comment to the Board of Governorsas a whole. The Board of Governors evaluatesthese proposals and forwards its recommen-dations to the B/R Finance Committee. TheFinance Committee reviews comments fromthe Board of Governors and recommends adues structure for review and approval by theBoard of Regents.

Following this procedure, the Board of Re-gents approved a dues increase of $65 for Do-mestic Fellows (U.S.) and $15 for CanadianFellows. This increase was initially approvedand subsequently recommended by theBoard of Governors at its meeting on Octo-ber 7. Dues for other membership categoriesremain the same. The following schedule ofrates for the year 2002 was then approvedby the Board of Regents based on the rec-

October 29, the Board of Regents voted to post-pone the dues increase until 2003. This actionwas taken in light of the terrorist events on Sep-tember 11, the state of the economy, and newsfrom the Center for Medicare & Medicaid Ser-vices (CMS) that all surgeons and physicianscan expect an across-the-board payment cut asa result of a reduction in the Medicare conver-sion factor of 5.4 percent from the current$38.26 to $36.19. These reductions will largelyoffset gains many surgeons were expecting asa result of the recommendations from the AMASpecialty Society Relative Value Scale UpdateCommittee approved by the CMS to increasephysician work values for over 240 general sur-gery codes as recommended by the ACS.

In another action, the Regents approved theactions taken by its Finance Committee pro-viding funding of $1,532,000 for scholarshipand fellowship awards beginning in the year2002 and 2003. This included funding for anew scholarship, the American College of Sur-geons/Royal College of Surgeons of EnglandResearch Fellowships Exchange to be spon-sored jointly by the two organizations.

Continuation of SESAPThe Regents approved the continuation of

the Surgical Education and Self-AssessmentProgram (SESAP). This program has evolvedfrom a self-assessment tool into an importantpart of the College’s efforts to work with theAmerican Board of Surgery on recertificationefforts. The eleventh edition of SESAP was


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launched at the 2001 Clinical Congress in NewOrleans and will be in circulation for threeyears.

Proposed VA/ACS partnership onexpansion of the NSQIP into theprivate sector

The Regents approved a standard Consor-tium Agreement with the U.S. Departmentof Veterans Affairs (VA) to administer theAgency for Healthcare Research and Qual-ity (AHRQ) grant of $5.25 million to evalu-ate the VA’s National Surgical Quality Im-provement Program (NSQIP) as a report-ing system to improve patient safety in theprivate sector. The College will test the pro-gram in 10 nonfederal hospitals and evalu-ate the results, and will also evaluate theresults of NSQIP previously conducted in123 VA hospitals. The NSQIP was estab-lished in 1994 to expand the work of theNational VA Surgical Risk Study in devel-oping and validating risk-adjustment mod-els in 123 VA hospitals that perform majorsurgery for the prediction of surgical out-comes and the comparative assessment ofthe quality of surgical care among multiplefacilities. The U.S. Department of VeteransAffairs has developed, implemented, con-ducted, and supported this national data col-lection and feedback system of risk-adjustedsurgical outcomes for the purpose of con-tinuous quality improvement in its surgicalservice.

If the program proves successful in the pri-vate sector, the ACS and the VA could de-cide at a later date to establish a formal part-nership to extend the program nationally.This endeavor should provide important in-formation on patient safety issues in surgerythat will have significant implications forACS Fellows in clinical practice.

Statement on bicycle safetyThe Regents approved a Statement on Bi-

cycle Safety and the Promotion of BicycleHelmet Use, developed by the ACS Commit-tee on Trauma’s Subcommittee on Injury

Prevention and Control. The statement,published on page 30 of this issue of theBulletin, emphasizes the College’s supportof efforts to promote, enact, and sustainuniversal bicycle helmet legislation.

American Association ofEndocrine Surgeons listing

A request from the ACS Advisory Councilfor General Surgery recommending that theAmerican Association of Endocrine Sur-geons be included in the official list of ap-proved surgical societies in the ACS mem-bership directory database was approved bythe Board. The society has a total of 276members, 211 of whom are Fellows of theCollege.

College participation in MedemThe Board approved the recommendation

that the College join with Medem in offer-ing physician Web sites for its members.Medem is a company that assists medicaland surgical society members in establish-ing Web sites for their practices. It also as-sists medical society members in providingreliable medical information through theirWeb sites. There are currently more than 30medical, surgical, and state medical societ-ies offering these services to their membersthrough the capabilities of Medem.

Establishment of New York ChapterAt the request of the Governors from the

Upstate New York Chapter, the Regents ap-proved issuing a charter for the establish-ment of the New York Chapter. Creation ofthis chapter will help to advance the socio-economic and educational issues related tosurgery in the state by providing a forumfor all Fellows in New York State to work inadvancing surgical issues. With the forma-tion of this chapter, the Upstate New YorkChapter and the New York State Society ofSurgeons will dissolve their organizationsand meet together under the new organiza-tion. There are currently five other chaptersin New York State.


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Highlights of the Board of Regents meeting, continued


41

ACS Bylaws changesThe Regents approved several changes in

the current Bylaws of the American Collegeof Surgeons. The majority of the changes arerelated to the reorganization of the Collegeinto four divisions in place of several depart-ments.

ACS branding/marketing programThe decision to vote on a proposal for an

ACS branding/marketing program was de-ferred until the February 2002 Board of Re-gents meeting in light of the terrorist eventsof September 11 and the uncertainty of theultimate impact of these events on theCollege’s financial health. The program wouldseek to establish a strong brand for “FACS,”and would be directed toward two main audi-ences—the public and the surgical community.

ACS 501(c)(6) organizationThe Board of Regents approved in concept

the recommendation from its Health PolicySteering Committee for the establishment ofa separate ACS 501(c)(6) corporation. Finaldetails concerning establishment of this cor-poration will be developed by the task forceworking on this issue and presented for con-sideration to the Regents in February. The firstgoal of this new entity would be to facilitatean expanded legislative support program, in-cluding the creation of a political program.The new entity would enable the College tocreate new tools to augment its legislative pro-grams, and to increase the effectiveness ofsurgery’s participation in the legislative pro-cess. Other potential activities outside thescope of the ACS Division of Advocacy andHealth Policy may be assigned to this new en-tity in the future as determined by the Boardof Regents. These might include an indepen-dent management structure to provide admin-istrative services for smaller surgical societ-ies and some College chapters, and new veri-fication or education activities.

The Health Policy Steering Committee andthe Board of Governors are both on record insupporting a 501(c)(6) organization. The prin-

cipal interest in establishing this entity origi-nally centered on the need for more flexibilityto pursue an enhanced legislative support pro-gram that might include the creation of a po-litical action committee. The Board of Regents,in considering the establishment of this en-tity, emphasized the need to support programsthat are consistent with the College’s tradi-tional mission and financial interests. TheCollege would retain its 501(c)(3) status, whichwill include, for the present, responsibility forall ACS activities other than the expanded leg-islative support program.

Expanded ACS Development ProgramA business plan to expand the College’s De-

velopment Program was approved by the Re-gents. The plan provides for additional staff,including a surgeon to assume the leadershipposition of Director of Development. Futureprogram growth is expected ultimately to befunded by increased contributions from Fel-lows, medical industry, and other organiza-tions. The overall goal of the development pro-gram is to raise funds to support the ACSscholarship, research, and education programsapproved by the Regents.

ACS strategic plan updateACS Executive Director Thomas R. Russell,

MD, FACS, updated the Regents on the imple-mentation of the ACS Strategic Plan for 2001and Beyond. A copy of the plan was includedin its entirety in the September 2001 ACSBulletin, and interpreted further by Dr.Russell in his “From my perspective” columnin that issue of the Bulletin. Copies of the planwere distributed to the Board of Regents andthe Board of Governors at their October meet-ings. Copies of the plan have also been circu-lated to all College staff, along with informa-tion about the ACS internal reorganization ofthe staff under four divisions of advocacy andhealth policy, education, member services, andresearch and optimal patient care.

These detailed strategic initiatives, whichwere reviewed, discussed, and approved by theBoard of Regents at its June 2001 meeting,


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have been distributed to the ACS executivestaff for implementation.

For the second phase of the strategic plan,the Regents were updated on the review of theCollege’s standing committees. Letters havebeen sent to the chairs of all standing com-mittees asking for their personal assessmentof the viability and activities of their commit-tees. Comments will be analyzed by Collegestaff, further reviewed by a staff work group,and presented in a report to the Regents inFebruary or June 2002, which will include rec-ommendations relating to the continuation,combination, restructuring, or dissolution ofcommittees, along with suggestions for updat-ing the rules that govern them.

Summary report/Board of Governors’ annual reports

The summary report of the annual reportssubmitted by the Governors was reviewed bythe Regents. The report outlined the concernsof Fellows regarding specific surgical andhealth-related issues at the national and lo-cal levels, and identified specific recommen-dations for College programs to meet theseconcerns. This year, 233 of the College’s 265Governors (88%) submitted reports.

The Regents also reviewed the response re-port presented to the Governors by BarbaraL. Bass, MD, FACS, Chair of the Board of Gov-ernors, at the Governors’ annual meeting onOctober 7. The report outlined programs ini-tiated by the College in 2001 in response tothe major categories of suggestions made bythe Governors in 2000.

2002 Clinical Congress ProgramThe program for the 2002 Clinical Congress

to be held October 6-10 in San Francisco, CA,was reviewed by the Board.

Joint CME Sponsorship ProgramA progress report outlining initial results

of the ACS Joint Continuing Medical Educa-tion (CME) Sponsorship Program was pre-sented. Under the program, the ACS providesappropriate Category 1 credit hours for sur-

geons attending scientific programs sponsoredby the College and surgical specialty organi-zations that qualify under the program. Theinaugural joint sponsorship program was heldin 2001 with the American Society of GeneralSurgeons for their annual meeting in Toronto,ON. To date, five additional surgical organi-zations have submitted their applications forjoint CME sponsorship with the College.

Committee on Young SurgeonsA report from this committee indicated that

the 2002 Young Surgeon Representatives Pro-gram will be combined with the Chapter Lead-ership Program and held May 15-18, 2002. Theprogram will include a combined receptionand dinner for chapter officers, chapter admin-istrators, and young surgeon representatives,and combined meetings of both groups. Aworkgroup for the young surgeon represen-tatives will be held at the conclusion of themeeting.

Graduate Medical EducationCommittee (GMEC)

The Regents reviewed a report from thiscommittee that indicated that the committeewill sponsor the Surgeons as EducatorsCourse, February 23 to March 1, 2002. Thebooklet, Prerequisites for Graduate SurgicalEducation, will be revised during the next sev-eral months to more effectively reflect Accredi-tation Council on Graduate Medical Educa-tion competencies. More than 30,000 copieshave been distributed to date. The StudentMentoring Subcommittee of the GMEC heldits second “Day at the American College ofSurgeons,” in New Orleans, LA, during theClinical Congress, in cooperation with theNew Orleans public school system and theLouisiana State University outreach programin science. Approximately 120 ethnic and mi-nority mathematics and science students at-tended.

Candidate and Associate SocietyThe Regents were informed that the current

enrollment of the Candidate and Associate So-


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ciety of the American College of Surgeons is6,374 members. The Council of Representa-tives now stands at 133. The society presenteda symposium on resident work hours and theworking environment on October 7 during theClinical Congress.

Professional liability activitiesThe Regents considered an update on pro-

fessional liability activities from the Commit-tee on Patient Safety and Professional Liabil-ity. The committee is developing a new patientsafety manual for distribution by the College.Several chapters have been completed and arebeing reviewed by members of the committee.The committee presented a postgraduatecourse, Professional Liability in a ChangingHealth Care Environment, and a panel pro-gram on Medical Errors: Improving PatientSafety—From Basic Science to Bedside, at the2001 Clinical Congress.

Legislative/regulatory updateA review of College legislative and regula-

tory activities was presented to the Board.These activities included ACS efforts to in-fluence legislation in the areas of managedcare reform bills, medical records confiden-tiality, Medicare and physician payment is-sues, E/M documentation guidelines, anti-fraud and other enforcement issues, traumaemergency care and injury prevention, theEmergency Medical Treatment and LaborAct (EMTALA), and graduate medical edu-cation.

The College hosted a Medicare ReformSymposium in Washington, DC, this pastsummer for leaders in the surgical specialtysocieties. The event included presentationsfrom the various stakeholder groups—insur-ers, beneficiaries, medical device manufac-turers, and the pharmaceutical industry. Theprogram was aimed at developing consen-sus recommendations from the various sur-gical specialties that the College can bringto policymakers on Capitol Hill and in theWhite House. In another activity, 19 chap-ters visited Washington, DC, this year as part

of the College’s Chapter Visit Program.The College completed its 2001 program of

educational workshops on Current ProceduralTerminology and ICD-9-CM coding for gen-eral surgeons. Workshops were held in SanFrancisco, CA, Chicago, IL, and Delavan, WI.A total of 146 surgeons attended the work-shops. Sites and dates for 10 workshops pro-posed for 2002 were being finalized. The ACScontinues its coding hotline to assist Fellowsand their staffs with coding questions.

AMA House of Delegates meetingThe Regents received information on the

July 17-21, 2001, AMA House of Delegatesmeeting. The ACS was represented by fivedelegates and a College representative to theAMA Young Physicians Section. The Surgi-cal Caucus of the AMA met a day before theHouse of Delegates went into session. Tho-mas R. Russell, MD, FACS, ACS ExecutiveDirector, outlined the College’s strategicplanning activities at the Caucus meeting,and David L. Nahrwold, MD, FACS, a Col-lege Regent, presented a program on thesurgical competence movement and the in-volvement of the College and the other sur-gical specialties.

Communications/informatics activitiesAn update on College communications and

informatics activities was presented to theBoard. By mid-September 2001, more than2,000 online registration records had been pro-cessed for the Clinical Congress. The onlineprogram for the Congress was augmented thisyear with the addition of a searchable sessionfinder. A virtual exhibit hall was added as alink to the Clinical Congress program infor-mation.

Development Program updateThe Committee on Development re-

ported that the College received cash con-tributions of $764,400 during the 2001calendar year. These contributions help tofund the ACS scholarship and researchawards program.


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Office of Evidence-Based SurgeryA status report indicated that this office was

in the initial stage of building the infrastruc-ture to support the various programs in thegeneral area of outcomes research. As part ofthe College’s strategic plan, the administra-tive and grant management of existing out-comes programs have been transferred to thisoffice. In addition, this office is providing theadministrative and grant management sup-port for several outcomes projects in which theACS is collaborating with outside organiza-tions including the Centers for Disease Con-trol and Prevention and the Agency forHealthcare Research and Quality.

American College of SurgeonsOncology Group (ACOSOG)

The Regents were informed that the move-ment of the ACOSOG to the Duke UniversityMedical Center went smoothly and the rela-tionship of the program to the Duke ClinicalResearch Institute is positive. The Regentswere updated on the status of the protocol de-velopment, the current status of patient ac-crual, and the recruitment of staff. The Boardendorsed the College’s continuation as the fun-damental base and sponsor of ACOSOG.

Report of the Executive DirectorDr. Russell reported on meetings of the B/R

Executive Committee and other matters.These items included presentation of the stra-tegic plan to the Fellowship in the SeptemberBulletin, at the meetings of the Board of Re-gents and the Board of Governors, and in theACS Clinical Congress Resource Center. Otherissues discussed included ACS staffing underthe reorganization called for in the strategicplan, the proposed formation of the ACS501(c)(6) organization, the ACS-proposedbranding/marketing program, and approval ofa three-year agreement with the College’shealth policy and advocacy consulting firm,Health Policy Alternatives, Inc. Dr. Russell hasutilized a monthly electronic newsletter to in-form Regents and ACS Officers of these de-velopments.

Committee and council appointmentsThe Regents approved changes in member-

ship for several College standing committeesand specialty advisory councils.

Statements: Unconventional Acts ofCivilian Terrorism and Disasters fromBiological and Chemical Terrorism

The Regents reviewed a Statement on Un-conventional Acts of Civilian Terrorism, pre-pared by the Chair of the B/G Committee onBlood-Borne Infection and EnvironmentalRisk and approved by the Board of Governorsat its October 10 adjourned meeting, and aStatement on Disasters from Biological andChemical Terrorism—What Should the Indi-vidual Surgeon Do? prepared by the Chair ofthe Committee on Trauma. The statementswere distributed as part of a special session atthe Clinical Congress on Unconventional Ci-vilian Disasters: What the Surgeon ShouldKnow, presented by both chairs. The Regentsrecommended that the statements be dissemi-nated to the Fellowship via the Bulletin, e-mail, and the College’s Web site. The state-ments were posted on the ACS Web site onOctober 17, and all Fellows with e-mail ad-dresses were notified of the link to the Website in a special e-mail from Dr. Russell. Thestatements were also published in the Novem-ber 2001 Bulletin, along with a special “Frommy perspective” column by Dr. Russell.


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Change your Update your Update other Pay youraddress & professional/ practice duescontact info academic information

information

Now ACS Fellows can do all of these things ONLINE:

MEMBERS ONLYAmerican College of Surgeons at www.facs.org

▲●

Just go to www.facs.org, and click on the Members Only link.

There you can Access the Fellowship Database by entering your

eight-digit Fellowship ID number (found on your Fellowship ID

card) and your last name.

There’s no need to contact the American College of Surgeons—

your membership record is automatically updated for all ACS

mailings, including the Bulletin and the Journal of the American

College of Surgeons.

You can also pay your dues online and search for contact infor-

mation on other Fellows in the database.


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Chapternews

To report your chapter’s news, please contactRhonda Peebles toll-free at 888/857-7545, or viae-mail at [email protected].

Southwest Missouri Chapterconducts fall meeting

The Southwest Missouri Chapter held its fallmeeting on September 19 in Joplin. The meetingincluded the election of officers for 2002, and a pre-sentation to the outgoing President, Allan Allphin,MD, FACS. New officers include Joseph Newman,MD, FACS, President; Thomas Pearson, MD,FACS, President-Elect; and John W. Buckner III,MD, FACS, Secretary-Treasurer. The educationalportion of the program featured presentations onimaging, including breast imaging, stereotacticsurgery, and positron emission tomography.

Connecticut Chapter meetsThe Connecticut Chapter conducted its 2001

annual meeting November 6 in Waterbury. Theday-long education program, which was attendedby 150 Fellows, residents, and medical students,featured competitions for trauma, cancer, and gen-eral surgery papers, three “cine papers” (video pre-sentations), and 22 poster presentations. Beforethe education program, various committees met,including the cancer liaison, trauma, and youngsurgeons committees. Thomas R. Russell, MD,FACS, the College’s Executive Director, deliveredthe keynote address. In addition, Sherman Bull,MD, FACS, a Connecticut Chapter Past-President,related his experiences ascending Mt. Everest; Dr.Bull is the oldest man to summit, an achievementhe completed with his son.

New Jersey Chapterobserves 50th anniversary

The New Jersey Chapter conducted its 2001annual meeting December 3 with more than 200Fellows, Associate Fellows, Candidates, resi-

by Rhonda Peebles, Chapter Services Manager, Division of Member Services

dents, and medical studentsin attendance. The day-longeducation program fea-tured a paper competitionfor residents and medicalstudents (see photo, p. 47),nine surgical specialty ses-sions, a luncheon, theSheen Award Lecture, andthe annual business meet-ing.

During the businessmeeting, R. Scott Jones,MD, FACS, the College’sPresident, presented a 50thanniversary commemora-tive charter to officers ofthe New Jersey Chapter(see photo, p. 47). Also, during the luncheon, the2001 Sheen Award was presented to James C.Thompson, MD, FACS, a Past-President of theCollege. His address was titled Endocrine Tu-mors of the Pancreas. Also during the businessmeeting, Art Ellenberger, Executive Director ofthe New Jersey Chapter, announced that EricMunoz, MD, FACS, recently had been elected toa two-year term to the New Jersey Assembly. Mr.Ellenberger noted, too, that Dr. Munoz won hisfirst election to statewide office by a significantmajority (see photo, this page).

Dr. Munoz

New York ChapterOn October 6, 2001, the Board of Regents

approved the formation of the New York Chap-ter. As a result of the Regents’ action, theUpstate New York Chapter and the New YorkState Society of Surgeons will combine. Theinterim officers of the New York Chapter areJohn Nicholson, MD, FACS, President; PeterMax, MD, FACS, President-Elect ; SaqibChaudhry, MD, FACS, Secretary; and PeterD’Silva, MD, FACS, Treasurer. In addition,Heather Bennett, JD, will serve as ExecutiveDirector.


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Chapters continue support forthe College’s funds

During 2001, 19 chapters contributed a total of$35,025 to the College’s Endowment Funds. Thechapters’ commitment to the various funds sup-port the College’s pledge to surgical research andeducation. Chapters can contribute to several dif-

ferent funds, such as the Annual Fund, the Fel-lows Endowment Fund, or the Scholarship Fund.The chapters that contributed during 2001 in-clude:

Life Members of the Fellows LeadershipSociety:† Arizona, Southern California, Louisi-ana, Maryland, Nebraska, Brooklyn-Long Island(NY), and Ohio.

Annual Members of the Fellows Leader-ship Society: Florida, South Florida, Georgia,Hong Kong, Illinois, Indiana, Metropolitan Chi-cago, Michigan, New Jersey, North Carolina, Met-ropolitan Philadelphia, North Texas, South Caro-lina, and Virginia.

Contributors: Maine, Alberta.

Chapter anniversariesMonth Chapter Years

January Northern California 50Louisiana 50

February Arizona 50Australia-New Zealand 17South Florida 48Iowa 34Italy 16Lebanon 39Montana-Wyoming 37Eastern Long-Island, NY 34Westchester, NY 50Peru 25South Korea 15Washington State 50

Leadership conference forofficers and young surgeons

In 2002, two important education programsare being combined. These education programs

New Jersey Chapter, left to right: Elizabeth Robinson;Gregory Albaugh, DO; Dr. Jones; Saraswati D. Dayal,MD*; and Arash Mohebati.

New Jersey Chapter: Displaying the 50th AnniversaryNew Jersey commemorative charter, left to right: H.Stephen Fletcher, MD, FACS, Treasurer; Paul LoVerme,MD, FACS, Vice-President; Dr. Jones; J. ThomasDavidson, MD, FACS, immediate Past-President; RobertW. Hobson II, MD, FACS, President; and Mr. Ellenberger.

†The Fellows Leadership Society (FLS) is the distinguished donororganization of the College. Chapters that contribute at least$1,000 annually are members. Chapters that have contributed$25,000 are FLS Life Members.*Denotes participant in the Candidate Group.

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The March issue of the Journalof the American College of Surgeonswill feature:

Original scientific articles:• Identifying Patient Preoperative Risk• Factors and Postoperative Events: VA NSQIP• Factors Associated with Conversion to Laparotomy in Laparoscopic Appendectomy

Collective review:• Overview of Bariatric Surgery

Ethics:• Ethics and Philosophy Lecture

What’s new• In Trauma and Critical Care• In Plastic and Maxillofacial Surgery

NNNNNext month in JACS

include the Young Surgeons RepresentativesAnnual Meeting and the Chapter LeadershipConference. These programs will be held at theCollege’s headquarters in Chicago, IL. A prelimi-nary schedule for the combined event includes:

May 15: Half-day education program for chap-ter administrators and executive directors.

May 16: Full-day education program for chap-ter officers and chapter administrators; joint re-

ception and dinner for young surgeons, chapterofficers, and chapter administrators.

May 17: Full-day education program for youngsurgeons, chapter officers, and chapter admin-istrators, including plenary sessions and break-out workshops.

May 18: Half-day education program for youngsurgeons.

Documents

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