A Newsletter for Orange Regional Medical Center ’s Medical Staf f | Vo lume 1 Number 1

THE RAISING BARA N E W S L E T T E R F O R M E D I C A L S TA F F O F O R A N G E R E G I O N A L M E D I C A L C E N T E R S U M M E R 2 0 1 6

A member of the Greater Hudson Valley Health System

Orange Regional hosted its 2016 Physician Recognition Reception on May 6 at the West Hills Country Club. Orange Regional’s Medical Staff was honored for its dedication to delivering quality healthcare to the community. This year, special recognition was given to physician honorees Elliot Mayefsky, MD, FACS of Horizon Family Medical Group, PC and Phillip Massengill, MD of ENT and Allergy Associates, LLP for their outstanding leadership and medical achievements.

General Surgeon, Dr. Mayefsky was presented with the 2016 Lifetime Achievement Award. This award is given to physicians who have continually improved the level of patient care, whose professional body of work has served to elevate their profession and who, through personal example, have earned the respect of their peers and the community. Dr. Mayefsky joined the Medical Staff at Orange Regional’s Horton Campus in May 1982 and currently serves as the Director of the Surgical Residency program and Surgical Clerkship Director for Touro College.

Otolaryngologist, Dr. Massengill was the recipient of the 2016 Leadership Award. This award recognizes involvement in the development of new or enhanced medical programs,

promotion of staff education within the physician’s field and professional excellence. Dr. Massengill joined the Medical Staff at Orange Regional’s Horton Campus in June 2006 and served as past Chair of the Otolaryngology department. He currently serves as Vice President of the Medical Staff.

Physicians Honored

In This IssueMedical Staff Update Scenes from the Physician Recognition Dinner Medical Education Update

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This year the Medical Staff Services Department recognized Family Medicine practitioner, Francis Imbarrato, MD of Horizon Family Medical Group, PC for 30 years of service. Dr. Imbarrato was featured in the Winter/Spring 2012 issue of Raising the Bar, which highlighted his work as a Christian missionary physician for almost 13 years.

L to R: Elliot Mayefsky, MD, FACS and Phillip Massengill, MD, FACS

Francis Imbarrato, MD

F R O M T H E

CHIEF MEDICAL OFFICER

The Zone

Have a Question? Need Info?The Medical Staff Services Department can help For assistance with initial credentialing, contact Deborah Lasch at 845-333-1110. For assistance with re-appointment credentialing, contact Kathy Mikulski at 845-333-1108. For general assistance, contact Alicia Remey at 845-333-1106.

The weather is changing for the better and the golfers are out swinging away. This makes you feel more alive and I see a little spring in everyone’s step.

Athletes are said to be “in the zone” when everything during the game slows down in their mind and whatever they are doing becomes seemingly effortless. We marvel at their brilliance in sports.

Consider for a moment our doctors in the emergency room, operating room, on the floors, in the ICU – presented with a patient in distress – the calmness with which they respond; the efficiency with which they perform their life saving procedures is nothing short of fantastic. They are “in the zone” and when you think about it, it’s much more remarkable than hitting a big shot in a game.

So take a step back, take pride in what you do every day – and continue to be prepared for the unexpected. There will always be another game – there might not always be another moment for a patient. Regards, Jim Oxley, DO Chief Medical Officer

Welcome New Practitioners December 2015 – March 2016

Achuthan, Vindya Medicine

Brooks, Hannah L. Surgery

Choi, Lisa Eunju Orthopedics

Davidson, Dennis Pediatrics

Deol, Ajit Surgery

Dimov, Nikolay Pathology

Heublum-Colton, Rona R. Medicine

Khan, Saqiba Emergency Medicine

Lam, Hao Family Medicine

Lee, Annie Medicine

Lovig, Leif Cameron Pediatrics

Malhotra, Sandeep Surgery

Nerkar, Sanjay D. Medicine

O’Brien, Michael Robert Medicine

Paralkar, Mayur Ajit Medicine

Perez, Elynor Giannin Orthopedics

Rosenfeld, Lonny Orthopedics

Sachdeva, Amrita Medicine

Schwartz, Shimon Psychiatry

Sharma, Rita Medicine

Stockl, Thomas Jerome Pathology

Wood, Katherine Delia Orthopedics

Medical Staff Meeting Schedule

The 2016 Medical Staff meeting schedule is now available on the Orange Regional Medical Center website and can be accessed by visiting www.ormc.org/medicalstaff.

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Medical Staff Update

Stroke Gold Plus Quality Achievement Award

Orange Regional Achieves HIMSS Stage 7

Nader Okby, MD President of

Orange Regional Medical Center’s Medical

Executive Committee

The state of healthcare has created tremendous pressures on physicians as they try to balance providing exceptional care, running a business and having a personal life. Medical practice appears to be amongst the most regulated careers with private, state and federal mandates constantly challenging physicians to do more with less. As such, it is imperative physicians police themselves rather than have a bureaucratic regulator with minimal medical knowledge perform such a function.

The Orange Regional physician leadership team, through the Medical Executive Committee (MEC) and its subcommittee, the Physician’s Excellence Committee (PEC) take medical staff conduct seriously. A formalized policy exists that provides guidance in dealing with medical staff conduct issues. Misconduct manifests in many ways ranging from inappropriate language and disruptive behavior to physical altercations. In all circumstances, collegial intervention is the initial step and ultimate goal of resolving disputes. In severe cases, varying levels of disciplinary actions may be required. However, the

aim is not to be punitive, but rather to provide counsel. The overwhelming majority of misconduct issues is successfully resolved within the sphere of medical staff governance and rarely requires intervention of outside regulatory bodies.

We should all be proud that physician leadership and the medical staff hold themselves up to high standards of excellence and professionalism. What we expect of others is something we should expect of ourselves.

The Orange Regional Medical Center Medical Staff has also been engaged in medical student and resident teaching, functioning as strictly voluntary preceptors. Physicians have been spending additional time in the hospital and in private offices imparting their knowledge to students and residents in training. Most recently, the Orange Regional medical staff through the MEC has pledged a significant amount of medical staff monetary funds to the Orange Regional Foundation targeted for teaching and educational activities. In an era of increased pressures, this voluntary commitment to the education of future physicians is commendable.

Orange Regional’s Neuroscience Program Coordinator, Teressa Bianchi, RN, MSN, TNCC and Stroke Center Medical Director, Dr. Olga Fishman.

Orange Regional received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite. The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

To qualify for the Target: Stroke Honor Roll Elite, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. Orange Regional earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

Orange Regional has been awarded with the highest designation, Stage 7, for implementing an electronic medical record (EMR) system to improve patient safety and quality of care. The Healthcare Information and Management Systems Society (HIMSS) awarded Orange Regional with Stage 7, the highest level on HIMSS Analytics’ EMR adoption model which is used to track EMR progress at hospitals and health systems.

During the fourth quarter of 2015, only 4.2 percent of the more than 5,400 U.S. hospitals received the Stage 7 Award. ORMC is one of only three hospitals in New York State to achieve HIMSS Stage 7 joining NYU Langone and the Hospital for Joint Diseases.

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Jake Kriney and Eric Savacool were Co-Chairs of the 2016 Golf and Tennis Classic. Renowned as one of the region’s finest golf outings, the 25th annual Classic raised over $250,000 to benefit The Future Is Orange Capital Campaign at Orange Regional. The widely popular event, with the addition of a tennis tournament this year, was held at West Hills Country Club, in Middletown and Stony Ford Golf Course, in Montgomery. The spectacular occasion concluded with a celebratory dinner and awards ceremony at West Hills Country Club. All golfers received a delicious breakfast, a golf cart, full lunch and an appreciation gift, as well as a tremendous golfers’ hour and buffet dinner at the awards ceremony.

For more information on how to make a donation to the Foundation or The Future Is Orange Campaign, call the Orange Regional Foundation office at 845-333-2223 or visit www.ormc.org/foundation.

We recently launched The Future Is Orange, a campaign that I think really positions the hospital for great things. I am pleased to report that the Medical Staff made a recent commitment to the campaign, but I believe we need to also make a personal commitment to support this exciting campaign. It includes a fundraising component for academic medicine, something you know is very dear to my heart. Our plan is to raise $500,000 and create an endowment that will assist both preceptors and medical students while we shift from a community hospital to a teaching medical center.

I think the fund will be best managed by the doctors in our medical education program and am supported in this position by the hospital and our Foundation. This is an important step in our journey to become the hospital that provides the very best training for our residents, medical students, our CME programs, and you, our seasoned physicians.

This is an important time in the history of Orange Regional Medical Center. A strong medical education program will make us all better practitioners. So I am asking you to support this effort at any level you can. Every gift large and small counts and moves us forward. Thank you for your consideration. There are many naming opportunities also available. Please feel free to call Bill Dauster, Foundation President, at 845-333-2333 with any questions. Thank you for your consideration.

All my best wishes,

Ron Israelski, MD, Director of Academic Affairs

TEE TIME!

FOUNDATION UPDATE

Ronald Israelski, MD

2016 Golf and Tennis Classic Committee

Recognizing Our Physicians The 2016 Physician Recognition Reception was held on May 6 at the West Hills Country in Middletown.

Our Medical Staff was honored for its dedication to delivering quality healthcare to the community. Here are some scenes from the event.

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Recognizing Our Physicians The 2016 Physician Recognition Reception was held on May 6 at the West Hills Country in Middletown.

Our Medical Staff was honored for its dedication to delivering quality healthcare to the community. Here are some scenes from the event.

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First graduate of Medical Education Department “Dr. Jason Taniguchi has successfully completed his Osteopathic Transitional Rotating internship. Dr. Taniguchi has all the qualities of an excellent physician. He is kind, patient, intelligent and introspective. In addition, he is humble and will do an excellent job at continuing to educate himself as his career progresses in the future. Dr. Taniguchi from day one impressed me as a conscientious, mature, and humble physician. Dr. Taniguchi is committed to patient care, and dedicated to fostering his own growth in knowledge and skills. Congratulations to our first graduate of the ORMC Medical Education Department.”

– Submitted by Cristian Castro-Nunez, D.O; FHM, Program Director, Transitional Rotating Internship

Orange Regional’s Medical Residency Program continues to expand by leaps and bounds. This year, we received 600 applications for our programs and interviewed 300 for 27 available spots. The relationship cultivated by Orange Regional and Touro College of Osteopathic Medicine has yielded positive results in attracting medical students to the area and availing them to the residencies that Orange Regional offers. Our proximity to Touro College makes us the closest Academic Teaching Center for Osteopathic students in this area. Our location facilitates a relationship with the college that behooves our residents by having Osteopathic Manipulative Medicine lectures accessible to them at the college every month. Orange Regional also has access to their library resources and their cadaver labs and simulation labs.

Touro opened its Middletown campus in 2014 at the former Horton Hospital building, and admits nearly 300 students each year. The college also offers a program in interdisciplinary biological and physical sciences. In addition to our medical student programs, Orange Regional inaugurated its first residency in Family Medicine in 2014 as well, welcoming its first two residents – one from Chester and the other from Long Island – who began their three-year residency. A medical residency is a stage of graduate medical training or education. A resident is a physician who practices medicine usually in a hospital or clinic under the direct or indirect supervision of an attending physician. Four additional residencies have been added including Emergency Medicine, Psychiatry , a traditional rotating internship (1 year) and Internal Medicine. Orange Regional strives to be unlike every other residency program. We remain open to new ideas and new ways of doing things. The Graduate Medical Education at Orange Regional should not be separated by specialties at all times. For example, all residents can attend any lecture in any program that they wish to. This sets us apart from some residency programs that like to keep their programs separate. While our residency programs are compartmental, it is our practice to encourage all our residents to interact with one another. For more information about the Residency Program, please contact Administrative Director of Medical Education, Jenny Vosganian-Clancy, at 333-1138 or jclancy@ormc.org.

MEDICAL EDUCATION UPDATE

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Physicians and Medical Students Co-author Article The article below is the first in a series of three review articles on sepsis. It is a general introduction to sepsis, co-authored with our Emergency Department physicians, Dr. Anuj Vohra and Dr. Trevor Mcginley and Touro medical students Noah Pirozzi, Nima Rejali and Matthew Brennan. To read the article, visit http://goo.gl/ABYWqL

Dr. Ofer Jacobowitz, Associate Medical Director of the Center for Sleep Medicine and Associate Editor for the second edition of “Sleep Apnea and Snoring” Elsevier textbook, was a speaker and presenter of original research at the 7th International Surgical Sleep Society (ISSS) Symposium- Surgery Sleep & Breathing, in Sao Paulo, Brazil, April 15-16, 2016. He was also the Keynote Speaker at The Annual Meeting of the Israeli Rhinologic Society, in Kfar Blum, Israel, from May 26-28, 2016.

CONGRATULATIONS

NEWS BULLETIN

Meet Your New Outpatient Physician LiaisonAlexandra Curiale has joined Orange Regional as Outpatient Physician Liaison. Alexandra is experienced in the healthcare industry and most recently worked as manager of Physician Recruitment and Onboarding at Westchester Medical Center. As Outpatient Physician Liaison, Alexandra develops an effective rapport with physicians and their office staff, markets Orange Regional programs to medical establishments and facilitates patient and community referrals. She serves as a conduit between physicians/physician practices and Medical Center leaders. She holds a Bachelor of Science degree in Management and Marketing from the State University of New York at New Paltz. Alexandra can be reached at 845-695-5833 or acuriale@ormc.org.

Orange Regional bids farewell to Dr. Michael Finck and Dr. Samuel Louie who have announced their retirements.

These two physicians have embodied what quality healthcare means for families in the local community over their numerous years of service. It has been an honor

and a privilege to have partnered with these committed professionals to work towards improving the health in our community.

Thank you and best wishes on your retirements!

Samuel Louie, MD Orange Pathology

Associates, P.C.

RETIREMENTS

Michael Finck, MD Horizon FamilyMedical Group

Introduction Sepsis continues to be a critical problem in regards to morbidity and mortality in the clinical setting. Ranked as a top cause of morbidity and mortality, sepsis can be the result of a number of pathologies and can greatly complicate the care of patients in and out of the hospital setting [1]. Despite advances in the treatment of sepsis, 28 day in hospital mortality rates still range from 15 to 45% [2].Epidemiology

Inpatient expenses related to the treatment of sepsis infections are on the rise with annual costs estimated to be in excess of $20 billion [3]. This places sepsis as one of the most costly burdens on the health care system. Sepsis rates are on the rise (Table 1) [4]. The elderly population is at a greater risk for the development of sepsis and sepsis related complications. As a result this population makes up a *Corresponding author: Murali G Krishna, Division of Pulmonary, Critical Care

and Sleep Medicine, Orange Regional Medical Center (ORMC), Middletown,

New York, USA, Tel: +1 9179519661; E-mail: murali.krishna.md@gmail.comCitation: Pirozzi N, Rejali N, Brennan M, Vohra A, McGinley T, et al. (2016)

Sepsis: Epidemiology, Pathophysiology, Classification, Biomarkers and

Management. J Emerg Med Trauma Surg Care 3: 014.Received: December 8, 2015; Accepted: February 22, 2016; Published:

March 07, 2016

significant amount of the total number of sepsis patients [1]. Similar to the general population, the elderly also have experienced dramatic increases in sepsis hospitalizations as shown in table 2 [3]. A more recent study has shown that sepsis likely contributed between 30 and 50% of mortality and had a large impact on healthcare costs in the US between 2010 and 2012 [4]. With the growing burden of sepsis on the healthcare system, there is a strong drive to develop more efficient mechanisms to detect and manage sepsis patients.

Mortality Mortality rates for sepsis in recent years have ranged from 18 to 40%. The identification of the correct microbial strain and initiation of the proper antibiotic treatment could significantly affect the incidence of mortality in these patients. The highest incidences of mortality are associated with sepsis arising from nosocomial infections by organisms such as methicillin resistant and sensitive staphylococcus species, pseudomonas and both candida and non-candidal fungal infections. Polymicrobial infections are also associated with increased mortality rates [6]. Biomarkers currently used in the identification and management of septic patients can provide insight into the response to therapy and prognosis. Although using biomarkers to rule in sepsis have not been identified with strong support, Lactate level measurements have been the greatest focus in recent years and have been shown to correlate well with mortality [7]. Lactate levels greater than 4.0 mmol/L have been shown to correlate with an increase in mortality. In addition, this correlation is even stronger if there is a coexistence of elevated lactate with observed hypotension [7]. Other sources have found correlations with 48 hour resolution of elevated lactate levels and sepsis prognosis [8].

Pathophysiology Sepsis and disease severity depend on various factors, ranging from the properties of the invading pathogen to the current immune status of the host [9]. Severe sepsis can develop following local infection and can stem from a number of sites including the abdomen, skin, soft tissue, urinary tract, lungs and is usually due to a primary

Pirozzi N, et al., J Emerg Med Trauma Surg Care 2016, 3: 014

HSOA Journal ofEmergency Medicine Trauma and Surgical CareReview Article

Abstract Every physician has been trained early in their careers on how to recognize and manage sepsis. Although sepsis has been one of the most researched ailments in medicine, it also remains one of the deadliest diseases in the face of recent advances. In this current article, we review the diagnostic and management criteria for Systemic Inflammatory Response Syndrome (SIRS), sepsis, severe sepsis, septic shock, and Multi Organ Dysfunction Syndrome (MODS). We then examine the implications of the “surviving sepsis” campaign as well as explore the philosophy of Early Goal Directed Therapy (EGDT) and its role in the modern day management of sepsis. In addition, we sought to highlight potential new biomarkers and current available therapies in sepsis.

Noah Pirozzi1, Nima Rejali1, Matthew Brennan1, Anuj Vohra2, Trevor McGinley2 and Murali G Krishna2,3*1Touro College of Osteopathic Medicine, Middletown, New York, USA

2Orange Regional Medical Center (ORMC) - Middletown, New York, USA3Division of Pulmonary, Critical Care and Sleep Medicine, Orange Region-al Medical Group, Middletown, New York, USA

Sepsis: Epidemiology, Patho-physiology, Classification, Biomarkers and Management

2000 Hospitalization Rate (per 10,000)2008 Hospitalization Rate (per 10,000)

Sepsis as a Primary Dx 11.624Sepsis as any Dx

22.137.7

Table 1: Sepsis Hospitalization Trends 2000-2008: Hospitalizations for sepsis

have more than doubled from 2000 to 2008 demonstrating the increasing

burden of sepsis on the US healthcare system [5].

Age Group 2003 Sepsis Hospitalization Rate (per 10,000)2007 Sepsis Hospitalization Rate (per 10,000)

18-648.3

1365-8464.7

99.885+177.1

219.7Table 2: Age specific Sepsis Hospitalization Rates in USA. Hospitalization

rates increased dramatically in the 5 year span. The rates increased dramati-

cally in all age groups over the short 5 year period [3].

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707 East Main StreetM i d d l e t o w n , N Y 1 0 9 4 0

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PAIDNewburgh, NYPermit No. 39

Upcoming Medical Staff Quarterly Meetings

Yvon Kernizan is a colleague (on right) who came up from Haiti to pick up almost 500 pairs of shoes donated by Orange Regional nurses and TouroCOM medical students for those who still suffer the effects of the country’s devastating earthquake.

Culture of Caring

Thursday, September 8, 2016 Conference Center

Middletown, New York

Thursday, December 8, 2016 West Hills Country Club Middletown, New York

SAVE THE DATES

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