December 2009 >> $5

John A. Ferlita, MD

PAGE 3

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By MARK WEISENMILLER

The coming year should mark the start of a new coali-tion between BayCare, of the Tampa Bay area, and Sara-sota Memorial Hospital (SMH).

For months, negotiators for BayCare and SMH have been trying to hammer out details for the alliance – not to be confused as a merger. Ellen Simon, senior communica-tions editor with Sarasota Memorial Health Care System (SMHCS), which is working with SMH administrators re-garding the alliance, will be quick to correct any such error.

“We are looking at a strategic alliance, which has yet to be fi nalized, but it will not involve the merger, sale, or lease

Details of BayCare and SMH Alliance Slowly Emerging

By JEFF WEBB

TAMPA - For Stephen Klasko, the greatest accomplishments of 2012 also have created the greatest chal-lenges for 2013.

“The challenge for 2013 is to make all the things we implemented in 2012 work,” said Klasko, CEO of USF Health and Dean of the Morsani Col-lege of Medicine at the University of South Florida.

“Last year was a year we will never be able to replicate. When we look at what we were able to do, it was an amazing year for a state medical school during the worst state

funding crisis we’ve ever had,” he said, not-ing that state funding to the USF College of Medicine has dropped 46 percent since he came on board in 2004.

Klasko said USF President Judy Genshaft and the board of trustees guided him and his leadership team “in the right direction, creating the framework for success, and allowed us to take calculated risks toward a much greater reward.”

What resulted was “what we now call USF 3.0,” Klasko said. “That means we want to be where tomorrow’s healthcare happens today. We want Tampa Bay to be a

national leader in that regard.”Klasko cited several initiatives, most

started years earlier, that came to fruition in

Pivotal 2012 Sets Stage for Promising 2013 at USF The challenge is to move from implementation to sustainability

The Art of Mediation –

Part 3Let the negotiations begin! ... 9

Finding Wellness: This Editor’s Journey

After 25 years of writing about healthcare issues, with only

caesarian sections, a 1995 laparoscopic hysterectomy, and occasional sinus challenges on my medical chart, my health took a nosedive last summer ... 4

ManagingRisks

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By JEFF WEBB

ZEPHYRHILLS - In more ways than one, John Ferlita owes his success as an OB/GYN and surgeon to his wife Alina.

“Alina is the COE - Chief of Every-thing,” said Ferlita. “She is the blood and guts of this practice,” said Ferlita of his com-panion of 41 years who has managed his office in Pasco County for 28 years. “Man-aging the nuts and bolts of a practice like this is quite a job. I don’t have a clue what hap-pens in the office. Thank goodness I have a very intelligent wife and business partner who is exceptionally capable. If it wasn’t for her, I’d be broke,” he laughed.

But Alina’s role in Ferlita’s professional life has even deeper roots; her father is the one who persuaded Ferlita to become a physician.

It all started in Ybor City, perhaps the most historic neighborhood in Tampa.

Ferlita’s grandfather first visited Ybor in 1885. He returned to his home in Sicily, but came back in 1890. In 1895, he started a bakery business in the city of Cuban, Spanish and Italian immigrants. “He did very well, but he made his real money as a speculator,” said Ferlita. “As World War I approached, he anticipated there would be a shortage of flour. He hocked everything he owned and bought 50 train cars full of flour and he quadrupled his money because there was a flour shortage. With that money he built a small building and added another oven. It’s a nice immigrant story,” Ferlita explained.

Ferlita’s father, born in 1913, became the master baker, and through innovation and determination with his wife Rose, suc-cessfully managed the Ferlita Bakery, which is now home to the Ybor City Museum, and raised Ferlita and his older sister Deanna.

His father and mother were the most important influence of his early life, Felita said. “Lots of love, good values, strong work ethic. They taught us that all people are the same, no matter what race, creed or status in life. We all should be treated with respect and dignity.”

Ferlita met Alina when they were teen-agers, just before he got his job at the U.S. Post Office and began his undergraduate work at Hillsborough Community College and the University of South Florida. His plan was to maybe get his masters or doc-torate and become a biology or science teacher.

Alina’s father, Francisco Rodriguez, was a urologist in Tampa, “a Cuban fellow with an office near St. Joseph’s Hospital,” Ferlita said. “I was hanging out with him and his cronies, drinking scotch, smoking cigars and conversing. They took me in and I was ‘one of the boys.’ One day my father-in-law invited me to observe on a case. Then his buddies did the same. Soon, I found out I had good hands.”

Because he was “making more money

at the Post Office than both my parents put together,” Ferlita did not qualify for finan-cial aid, so he had to fend for himself. He traveled to the Dominican Republic to get his MD at the Universidad Central Del Este. That was followed by internship and resi-dency in the Department of Obstetrics and Gynecology at the University of Medicine & Dentistry of New Jersey in Newark, which he completed in 1985.

Wishing to return to Florida, Felita partnered with Dominick Caselnova, MD, in an OB/GYN practice in Dade City. “It was a decent opportunity, but I never thought I would stay in the area because I was from Tampa and I had a lot of family connections and friends there,” Ferlita re-called. “I thought I’d just get my feet wet for a year in Pasco County, but it turned out to be a wonderful place to live and work,” he said. The group of “30-or-so physicians in the area were like family, and exceptionally talented. We took care of one another and I learned a lot from them,” Ferlita said.

“Then one year turned into two, then two into three, and then I started my own shop,” he said. “I liked the patient mix. People were so nice. And the location was the best of both worlds, only 40 minutes away” from their parents in Tampa, which was a big help for a couple who were rais-ing three children.

Ferlita has treated generations of pa-

tients. “I’ve delivered many babies from women in the same room where they were delivered. That makes you feel really old!” said Ferlita, who discontinued his obstetrics practice in 2011. “I got too old for being on call for that. I’m almost 60 and it’s physically tiring to do day in and day out” as a sole practitioner, he said.

But his gynecology, urogynecology and surgery practice is “very busy,” Ferlita said. “That is what I am known for. I do proce-dures that are relatively cutting edge,” he said, including being one of the most prolific and in-demand gynecological robotics surgeons in Pasco County. “I’m a pioneer in laparoscopic surgery and minimally invasive surgery,” said Ferlita, who said he and he and his partner did as many of those cases as anyone in the southeastern U.S. during the 1990s.

Today, Ferlita’s urogynecological surgeries include treatment of urinary and fecal incontinence, overactive bladder, genital prolapse, interstital cystitis, pro-lapse and sacropexies. “You have to be jack of all trades and master of all. You can’t do just one or two procedures and

manage the patients’ necessities,” he said.Ferlita sees 30-32 patients per day in

his office, sometimes more because “I never refuse patients. If they are sick, that’s when you need to see them,” he said. Tuesdays, however, are reserved for surgeries, mostly at Pasco Regional Medical Center in Dade City, an institution he holds in high regard for being “innovative and progressive,” es-pecially for its purchase of the DaVinci Ro-botic Surgical system that he uses so often. “It’s pretty amazing that a 120-bed hospital puts up that kind of investment,” said Fer-lita, who has been chief of staff and chief of surgery at Pasco Regional. “In 28 years, you do a lot of stuff,” he said.

Ferlita does find time for “stuff” outside his practice. “My hobbies are boating, fish-ing, kids and wife,” he said. The family has had a getaway residence in Englewood where he and his children, now aged 30, 27 and 26, spend as much time as possible. “I enjoy back-water fishing there, as well as upper Tampa Bay,” Ferlita said, adding that his wife is key in that endeavor, too. “If you want to catch fish, put Alina in the boat,” he said.

Another talent is gardening. “Plants al-ways perform for me,” he said. “Anything I touch grows. Plants have souls and you have to connect with them. We’re all living things and we’re all connected one way or another. Some people look at me funny when I say that, but it’s true.”

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4 > JANUARY 2013 m e d i c a l n e w s . c o m

Dave LaMond, DO

By LyNNE JETER

After 25 years of writing about health-care issues, with only caesarian sections, a 1995 laparoscopic hysterectomy, and occa-sional sinus challenges on my medical chart, my health took a nosedive last summer and I became fully entrenched in the patient ex-perience.

At age 50, I was in doctor’s offices on a weekly basis after a mild AFib sent me to a cardiologist. Even though the episode appears to have been isolated, which EKG results, a cardiac ultrasound, and a 30-day heart monitor confirmed, it began a chain reaction that’s just now stabilizing. I remem-ber thinking: I feel broken, but don’t know why.

Finding a primary care provider (PCP) was first priority. I was lucky and found a brilliant gem: Gus Vickery, MD. He diag-nosed my hypothyroidism and Vitamin D deficiency and sent me to a gastroenterolo-gist, who ordered my first colonoscopy. The procedure netted two polyps and a mandate to repeat the process in three years instead of five, and resulted in an IBS diagnosis.

That summer, I was midway through an intensive 3-year immunotherapy pro-gram for allergies to all sorts of trees, grasses, and molds when I needed ENT surgery to zap a highly infectious air bubble that was growing in my right sinus cavity, inflamed turbinates, and a deviated septum.

An August visit to an arthritis special-ist resulted in diagnoses of osteoarthritis and fibromyalgia. Under the umbrella of fibro-myalgia: IBS, hypothyroidism, Vitamin D deficiency, anxiety and depression! The domino effect was beginning to make sense. I was certainly depressed about it all.

Nine months later, with improvements being made in all ailments, I asked my PCP about green lighting a weight loss program. He recommended a relatively new clinic, Blue Sky MD. But he couldn’t give me the go-ahead until my thyroid levels were nor-mal. With my thyroid levels climbing higher than before I began taking thyroid medi-cine, he doubled my dosage. With little im-provement, he doubled it again. We waited.

In late July, a debilitating back injury knocked me further off the path to wellness, requiring weeks of intensive and painful physical therapy. By the time my thyroid levels were in the normal range, six weeks of inactivity had contributed to a lifetime high of 216 pounds.

Even though I was hopeful of a suc-cessful outcome at Blue Sky, I was skeptical. I’d tried Weight Watchers, where I lost the 6-pound average, temporarily; a program focusing on abstinence from sugar, wheat and flour that had a weird cult aura; and other programs “guaranteeing” success. Two years spent at a bariatric clinic focus-ing on a low-fat diet had resulted in minimal net weight loss, months of frustration, and more money spent than I’d like to admit. In hindsight, I recall that none of the bar-iatric clinic staffers were slim, not even the doctors. They didn’t practice what they preached. A clear picture that showed more than basic blood panels wasn’t needed; it was a cash cow business and the waiting room was always full. An RN there told me I was wasting my time. A doctor there told

me I’d never see 150 on the scales again. But hope springs eternal. And crying uncle had gone unnoticed.

My inaugural Blue Sky visit involved an in-depth consultation. Dave LaMond, MD, CEO of Blue Sky, recommended bi-oidentical hormone replacement therapy after deep-level labs showed a negative 3 testosterone level. He recommended Nia-cin and baby aspirin after my heart ultra-sound revealed the arteries equivalent to a 68-year-old woman. I followed all their rec-ommendations and noticing an immediate improvement in my quality of life.

For 12 weeks, I was restricted to 900 calories and 90 carbs daily with supplemen-tal vitamins and phentermine or natural appetite suppressants. The routine included weekly weigh-ins with a nutritionist, who de-ciphered the print-out data –water retention fluctuation, body fat percentage changes – and offered practical tips and recipes. Dur-ing each visit, I also met with a doctor or PA

and opted for B-6 and B-1/12 shots. A diet heavy on green vegetables, light

on fruit, and protein consumed five times a day seemed extreme, but it worked. When I lost nearly 7 pounds the first week, I almost wept. At the end of 12 weeks, I’d lost 33 pounds and at least a dozen inches from my waist and hips. More importantly, I under-stand the relationship of food for fuel much better. I feel great!

I’ve graduated to a 1,200-calorie, 120-carb daily diet, and was glad to have dodged the 600-calorie, 60-carb daily starter option. Twelve hundred calories doesn’t sound like much, but I eat well. Yesterday, I had low-fat cottage cheese, strawberries and wal-nuts; string cheese and a hard-boiled egg; chicken, Kashi crackers and an apple; yo-gurt and Fiber 1 cereal; and lean beef with mushrooms, reduced-fat cheese, along with sweet potatoes and a tablespoon of butter and shake of cinnamon. Total calories: 1,175. Carbs: 112. Portion control is man-

datory; variety makes it easy. Experiences in the healthcare field

over the last 18 months have given me a much deeper understanding and greater respect of the challenges that hinder health-care providers from doing what they love – healing people.

I’m healing, and eternally grateful. With a goal of 150, which I’m confi-

dent I’ll see in early 2013, the journey isn’t over. On the last day of November, I was in the 170s! Will keep you posted.

Happy New Year & God Bless,Lynne Jeter

P.S. Full disclosure: Blue Sky MD didn’t solicit or pay for publicity. It’s a

good story, period. My instinct tells me PCPs will appreciate knowing about this reliable patient refer-ral option and a career option with the “next big thing.” Read more about it in “Taking Flight.”

Finding Wellness: This Editor’s JourneyObesity’s Cascading Effect on Health

By LyNNE JETER

H E N D E R S O N -VILLE, NC — Medical entrepreneur Dave La-Mond, DO, has incor-porated an innovative clinical model of care for obese and overweight patients that’s garnered such positive results that he’s expanding quickly while also retaining a hands-on personal touch that’s gained a loyal and appreciative clientele.

After seeing the frustration shared by many primary care physicians (PCPs), La-Mond blended two business concepts – a tradi-tional fee-for-service medical spa and a weight loss clinic – to establish Blue Sky MD in 2009.

Founded on the principle of providing comprehensive care, with systems in place to meet all of a patient’s needs, Blue Sky has a culture of customer service and patient-cen-tric care that’s a cornerstone for the practice.

“My mantra is ‘take care of the patient and everything else will take care of itself,’” he said. “The practice was based on pro-viding cutting-edge care, with the primary goal of true primary prevention, or preven-tion of disease before complications.”

The practice has evolved into what LaMond described an “age-management” practice, focusing on nutrition, hormone opti-mization and non-surgical aesthetic offerings.

“We’re focused on producing clinical data to provide payors with cost savings and to validate our protocols,” he said. “We’re developing simplified protocols to provide ‘turn-key’ solutions to other providers in an ancillary service model. In other words, we’ll deliver the care for other providers. This so-lution will focus on weight control services.” Finding the right clinical care model and

organizational structure proved the greatest challenge developing the business, said La-Mond, who follows Medicare and National Institutes of Health (NIH) guidelines for the care of patients who need weight con-trol services, and “metabolically” manage weight and bill under medical co-morbidi-ties. “Without a proper, scalable solution in place, you’re destined to fail,” he admitted. “Also, I have an incredible team with a can-do attitude. They love this business and the culture. They’re adaptable and flexible and able to troubleshoot. The patient care piece is my passion, so that was easy! I love devel-oping protocols. I’m constantly in the ‘lab’ refining and improving the program.”

Core CurriculumThe core curriculum of the program

has remained relatively stable; LaMond continues adding tools to motivate pa-tients while also measuring and screening for disease. An incentive for weight loss patients: they receive a $25 credit toward products and services for every 10 percent of weight lost, and also for every referral.

“Our process starts with an exten-sive intake, which takes 60 minutes,” ex-plained LaMond. “We assume the role of clinical detective, with our objective to create an outline based on a series of clinical events. The underlying theme is often ‘abnormal weight gain,’ which was either a lifelong struggle or triggered by an event, either physiologic/medical or life change. We then use various tools to treat the underlying cause, often with a multi-pronged approach.”

LaMond’s goal is to measure metabolism. “We compare our measured metabo-

lism value with a calculated/predicted value,” he said. “The bottom line, if some-one’s metabolism is off by 20 percent or

more of what we predict it should be, the patient has underlying metabolic issues/metabolic syndrome. We work to correct these issues with diet and nutrition, exer-cise, nutraceuticals, medications and hor-mone replacement therapy.”

When done properly, hormone ther-apy is a game changer, said LaMond.

“This will become standard of care,” he said, “and already is in certain cases, such as male hormone replacement therapy.”

Low testosterone is a marker for meta-bolic syndrome, he noted.

“It’s standard of care to screen for this post myocardial infarction (MI) and in pri-mary care settings,” he said.

Inside OutThe aesthetic portion of the practice

typically comes into play once a patient is feeling better, often within weeks to months of the start of the weight loss pro-gram, LaMond said.

“Our patients want to be beautiful inside and out,” he said. “We offer ev-erything from natural skin care, custom compounded skin care, mineral make-up, peels, neurotoxins, fillers and laser/light-based technology for hair removal, wrin-kles, skin laxity, and sun damage. We’re experts in this space … and we’re develop-ing a natural skin care line.”

Staffing Blue Sky MD is an artform, said LaMond, who has a very simple rule: all personnel must walk the walk to talk the talk. Every employee follows the food plan outlined for patients; each one is healthy and slim, including LaMond. All dressed in black, the female staff adds scarves and boots to add spark while allowing the pa-tient to stand out.

“We have a culture of excellence, and

Taking FlightA PCP’s best pal – and possible outlet – Blue Sky MD helps patients lose weight fast, keep it off

(CONTINUED ON PAGE 6)

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Glenda F. Parker, MDI n t e r n a l M e d i c i n e

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20043.indd 1 12/14/2012 11:46:32 AM

of our organization. Sarasota Memorial will remain an independent public hospital governed by our elected hospital board,” Simon explained.

She went on to report that “patients wouldn’t notice much of a difference, since there would be no change in our name, identity, mission or ownership, but the proposed collaboration with BayCare would give Sarasota Me-morial Hospital access to the extra resources, size, and scale of a large health system, the poten-tial for joint venture and growth opportunities to improve patients access to care, and the oppor-tunity for both organiza-tions to share our quality practices.”

SMH, an 806 bed facility which boasts almost one doctor for every bed – the hospital has 802 physicians – has, like many organizations in the past two or three years, been a victim of the lethar-gic recovery of the U.S. economy. SMH, in its last fiscal year, recorded a deficit of over 19 million dollars. One of the after-effects of this is that 33 employees jobs were eliminated.

The main executives at SMH will at least partially fall under the aegis of BayCare. Chief Executive Officer Gwen MacKenzie’s job would remain the re-sponsibility of the SMH Board of Direc-tors. The responsibilities of COO David

Verinder and CFO William Woeltjen would fall under BayCare’s watch.

BayCare would set the salaries of the executives but the hospital board would have to give approval and Sarasota Me-morial Hospital would pay those salaries.

As many, directly or indirectly, in-volved in the healthcare industry in south-west Florida know, SMH administrators have been looking for ways of cutting costs at the hospital.

One such interested spectator to all of this is Manatee County Commis-sioner Carol Whitmore. When she is not attending county commissioner duties, Whitmore, a registered nurse, works eight hours a week in the office of her husband, Andre Renard, MD, a plastic surgeon for over 40 years.

How would this proposed alliance between BayCare and SMH affect the competitive medical healthcare business between Manatee and Sarasota counties? “It will affect it tremendously, and it will affect it drastically,” opined Whitmore. “The (healthcare services) that used to be offered by a local, sole company, and the philosophy of hospitals always work-ing with local healthcare companies, is a thing of the past. They (the SMH Board of Directors) are looking long distance to remain profitable. It’s disappointing that they don’t want to use local, or commu-nity healthcare services.”

Lisa Cresswell, a spokeswoman for BayCare, passed along all questions re-

garding the BayCare-SMH confederation to Kim Savage, senior communications editor for SMHCS. Savage said that “de-tails (of the agreement) won’t be available to the public until they are first presented to the hospital board.”

Yet she did note that “both our staff and BayCare’s staff will have opportunities to learn from each other through training, educational programs, and quality sum-mits, among other collaborative quality initiatives. By sharing clinical outcomes and quality data, both organizations can benchmark to identify strengths and op-portunities for improvement.”

In 2011, BayCare HomeCare and Sarasota Memorial Hospital’s home care program merged. This merger included specialists and professionals from a wide variety of vocations, from dietitians to oc-cupational and physical therapists.

However, Savage wanted to empha-size the fact that “it’s important to note that the home care merger is far differ-ent than the strategic alliance we are cur-rently considering with BayCare. The home care service is wholly owned and operated by BayCare HomeCare. As part of the deal, Sarasota Memorial became a partner in BayCare HomeCare. Simon stressed that the strategic alliance is not a merger, lease, or sale. It is an agreement to collaborate on joint projects developed to meet joint strategic goals – but Sara-sota Memorial will not become part of the BayCare network.”

Details of BayCare, continued from page 1

if this isn’t what my staff wants, we’re not afraid to make a change,” he emphasized. “It’s best for the patients and the individ-ual who’s not working out. We take time and understand someone’s skill sets ... pro-mote from within when able and take time to identify needs … understand when staff is spread too thin (and) create channels of clear communication and expectations.”

In 2009, LaMond opened offices in North Carolina (Arden and Hender-sonville) and Tennessee (Brentwood and Chattanooga), primarily in office building suites. Now his practice is so robust, he’s leasing office buildings.

“Our plans for 2013 are to open six ancillary service model clinics within exist-ing practices,” said LaMond. “We’ll pro-vide a turnkey solution to provide weight control and/or hormone therapy services within a practice. We already have com-mitments from two offices.”

LaMond frequently fields calls from overworked PCPs interested in opening a Blue Sky office, thus eliminating on-call requirements, overtime and other energy-draining issues.

“Blue Sky MD is far superior to any program I’ve studied,” said PCP Gus Vickery, MD, of Vickery Family Medicine in Asheville, NC. “When I saw the pro-gram Dave had in place, I dropped my in-house weight loss program and outsourced it. I’d send patients to Dave and they’d come back months later, 40 to 50 pounds lighter and much healthier and happier.”

Taking Flight, continued from page 4

Gwen MacKenzie

m e d i c a l n e w s . c o m JANUARY 2013 > 7

Dr. Dipali Patel has a new office and hospital where she will be providing care.

t o w n a n d c o u n t r y h o s p i t a l . c o m

As members of the Town & Country Hospital network of

providers, these two talented and passionate doctors have

access to a leading local hospital location, advanced

technological equipment and a large staff of specialists. You

can count on these doctors for the care your family needs, and

should you need more specialized attention, Town & Country

Hospital will provide them with the support they require.

Dipali Patel, MD is an experienced and caring primary care physician that has moved into

a new, convenient office near Westchase on Countryway Blvd. Dr. Patel is excited to help

the area’s families with their health care needs as well as promoting preventative care and

healthy lifestyles. She is a member of the American Academy of Family Physicians and the

American College of Obstetricians and Gynecologists.

Dr. Glenda Parker is a board-certified physician in internal

medicine. After completion of her training at Emory University

and residency at Johns Hopkins Bayview Medical Center, she

served as an attending physician with Johns Hopkins University

and is also a former V.A. health care provider.

Joining Dr. Patel is Glenda F. Parker, MD Internal Medicine

Call (813) 443-5650 for an appointment. Dr. Patel and Dr. Parker accept most insurance plans.

11031 Countryway Blvd., Tampa

A N N O U N C E S

11031 Countryway Blvd.Tampa, FL 33626813-443-5650

Dipali Patel, MDP r i m a r y C a r e

Dr. Dipali Patel is a primary care physician. She completed her undergraduate studies in chemistry at the Florida Atlantic University, Boca Raton. She received her medical degree from the Ross University School of Medicine in Dominica. She completed a residency in family medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ.

Dr. Patel is a member of the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists. Her special interests include women’s health, preventative care, and volunteer healthcare opportunities. She is fluent in Gujarati and Hindi. Dr. Patel lives in Tampa with her husband, an ophthalmologist.

Glenda F. Parker, MDI n t e r n a l M e d i c i n e

Glenda F. Parker, MD, completed her undergraduate studies at Washington University in St. Louis, MO. Dr. Parker then earned her medical degree from Emory University School of Medicine in Atlanta, GA. She completed her internal medicine residency at Johns Hopkins Bayview Medical Center in Baltimore, MD.

Dr. Parker is board-certified in internal medicine. After completion of training, she served as an attending physician with The Johns Hopkins University in Baltimore, MD. Dr. Parker is also a former V.A. health care provider and ran a “triple threat” clinic for veterans with uncontrolled hypertension, diabetes and high cholesterol before relocating to Tampa with her husband, a radiologist, and their three children.

Dr. Patel and Dr. Parker are currently accepting new patients and accept most insurance plans.

Announce_flyer_Patel_Parker.indd 1 11/30/12 4:51 PM

20043.indd 1 12/14/2012 11:46:32 AM

The discovery of a brain damage pro-tein marker in the bloodstream by Orlando Regional Medical Center (ORMC) re-searchers may lead to a simple blood test to help doctors diagnose and treat concussions sooner.

“Preliminary re-search shows the protein is detectable within an hour of injury,” said Linda Papa, MD, an emergency medicine physician, direc-tor of academic clinical research at ORMC, and principal investigator of the study. “Also shown is the ability of the protein to determine how severe the injury. While the results so far are promising, more research is needed before direct patient ap-plication.”

In a national multicenter study pub-lished in the May 2012 edition of Journal of Trauma, investigators tested the ability to identify the protein – ubiquitin C-terminal hydrolase (UCH-L1) – in the bloodstream after a head injury. The higher the level of protein in the blood, the more severe the brain injury was, which indicated a risk of bleeding in the brain and of the need for

urgent surgery. The abil-ity to detect the elevated protein levels in the blood-stream may lead to the de-velopment of a blood test to diagnose concussions, a mild traumatic brain in-jury (TBI), and more seri-ous TBIs.

“Knowing whether there’s an injury to the brain, including a concus-sion, is critical to directing the path of treatment for patients,” said Papa. “It can make the difference in whether a patient is dis-charged to home or remains in the hospital for surgery or other treatment followed by the appropriate inpatient and/or outpatient rehabilitation.”

The same protein discovered in the bloodstream is also found in a patient’s ce-rebrospinal fluid following a TBI.

“We’ve known the protein is present in the cerebrospinal fluid after injury,” said Papa. “Because it’s not practical or safe to remove this fluid from every patient, devel-oping a blood test is important.”

In the ongoing study, patients with TBI are compared to two control groups – normal adult volunteers without any acute injuries; non-head injured patients treated in the emergency department with either a single broken arm or leg or after a motor ve-hicle crash, but without blunt head trauma.

“The brain is such an important organ,” said Papa. “Even after years of brain-related research, there are no blood tests available to diagnose concussions or more severe forms of TBI as there are with

other common conditions like heart disease, diabetes, liver problems and thyroid disorders.”

Instead, doctors rely heavily on CT imaging to assess the level of severity of TBI.

“While CT imaging has proven to be an effective measurement tool, the tech-nology doesn’t capture all injuries and raises concerns over exposure to radiation,” said Papa. “A blood test may also be able to detect protein markers that indicate a prob-

lem, but may not show up on a scan. We hope this test is the first step toward being able to provide a more complete and accu-rate diagnosis sooner.”

Nearly 1,500 TBI cases of all severities are treated annually at the ORMC Level 1 Trauma Center, Central Florida’s only Level 1 Trauma Center. The National In-stitutes of Health awarded a $2.25 million grant to ORMC to study TBI, which began in 2009 and will end in 2014.

Concussion Blood Test?ORMC researchers identify protein marker to detect concussions and more severe traumatic brain injuries

Dr. Linda Papa

8 > JANUARY 2013 m e d i c a l n e w s . c o m

Pivotal 2012, continued from page 1

2012. Each, he said, had a fundamental question as its premise: “What’s going to be obvious 10 years from now?”

The USF Health System was estab-lished with the addition of its first hospital partner Lakeland Regional Medical Cen-ter. The partnership will create 200 to 250 new residency slots in West Central Florida, making USF’s residency program the larg-est in the state.

“It was clear that as healthcare systems and hospitals consolidated and everybody started talking to everybody else, us not having a health sys-tem as a medical school with different affiliates, wasn’t necessarily going to put us on the cutting edge or in a leader-ship position,” said Klasko. “We believed Tampa Bay needed an academic medical center, so we created the USF Health Sys-tem,” he said. Partnering with Tampa Gen-eral Hospital and Moffitt Cancer Research Center “really creates the one thing we’ve been missing, a coordinated academic med-ical center in Tampa Bay that can compete with a Pittsburgh, Birmingham, San Diego or Philadelphia. When people talk about Tampa Bay academic medicine they will talk about Tampa General, Moffitt and USF as coordinated entity. It doesn’t mean that anybody has to own anybody,” he said.

The USF Health Center for Ad-vanced Medical Simulation and Learning, or CAMLS, which opened in downtown Tampa in March, is the largest facility for the assessment of technical and teamwork competence in the world, according to USF.

“It was clear to us that (medicine) is not going to be the only profession that never gets competency tested,” said Klasko. “It was equally obvious that we needed a USF presence in downtown Tampa. So, the abil-ity to get that industry investment started is going to be a long-term opportunity for us and Tampa,” he said. More than 30,000 health professionals – doctors, nurses, sur-gery technicians, combat medics – from all over the world are expected to come to CAMLS to train and have their skills evalu-ated, making it a significant economic de-velopment component for Tampa Bay.

USF Health is midway through its first full year of the SELECT program, which chooses medical students based on emotional intelligence rather than relying solely on their academic records. USF Health has partnered with the Lehigh Valley Health Network in Allentown, Pa., to create what they hope will be a model for the nation. In 2013, the char-ter class of SELECT students will transition from the first two years of medical school at USF to their final two years of medical school clinical training in Allentown.

We’ve been wanting to get our medical school named ever since I got here,” said Klasko, and that finally happened in 2012. A $37 million gift from Frank and Carol Morsani established the Morsani College of Medicine at USF. “At that level, philan-thropists ask themselves ‘Is this is a good in-vestment’ and ‘Do I believe in the people?’” Klasko said. The Morsanis’ financial com-mitment, Klasko said, was an endorsement

of USF Health’s leadership and plans to move forward.

In the spring of 2012, the USF Heart Institute was awarded $8.98 million in state and county funding, and hopes to get up-wards of $20 million more approved by the Florida Legislature this spring. The insti-tute, which focuses on regenerative medi-cine for cardiovascular disease, using the latest in gene and stem cell therapy, as well as personalized medicine based on an indi-vidual patient’s DNA. Directing the Heart Institute is Les Miller, MD, who previously was chair of the Department of Cardiovas-cular Science. That position is now held by Arthur Labovitz, MD.

“These are two of the top people in the country,” Klasko said, and in 2013 they will expand the institute’s clinical studies and put USF at the center of some of the most advanced research in cardiovascular care.

Another key person who joined USF Health in 2012 was Stephen Liggett, MD. Liggett heads the USF Health’s interdisci-plinary Center for Personalized Medicine and Genomics, which targets the discovery of genetic variations to predict who will get a disease, how fast it will progress and the best drug to use for treatment.

“He is one of the top people in the world to combine the clinical and research elements of molecular genomics,” Klasko said. Bringing Liggett here from the Uni-versity of Maryland was “one of the biggest coups of the year,” he said.

USF significantly raised its information technology profile by transforming its Paper Free Florida project from one of the worst-performing in the nation to one of the best. The progressive effort to make electronic health records the communal norm saw USF Health’s ranking as a federally funded Regional Extension Center go from 57th in the nation to 6th. (See November Tampa Bay Medical News http://tinyurl.com/c2s7a2w.)

Even with all those achievements in 2012, Klasko said there are still “plenty of things that will keep me up at night” in 2013. “People don’t have a clue how crazy this is going to get with the Affordability Act and decreases in Medicare reimburse-ments, bundled payments and things like that,” he said. “So, the whole issue of being high quality and high cost is going to be a killer. Insurance companies are going to start making decisions based on value-based purchasing. The concept of a diabetic pa-tient who has seven different docs who don’t talk to each other is going to go away. You’re going to have to get together with folks you’ve never gotten together with,” said Klasko. “The future is happening at a dizzying pace and we all have to make sure we are not over- or under-reacting.

But Klasko is single-minded about his top priority: “Implementing the things we have started and make sure they are sustain-able,” he said. “A Tampa Bay-based medi-cal academic center” is key to that success, he said. “We want to have people around the country say ‘Hey, Tampa Bay is really getting its act together from an academic medicine perspective.’ We’re going to be the next big thing.”

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By TIMOTHy R. BONE

Recap of Parts 1 and 2: Having been ordered by the court to attend mediation in your pend-ing medical malpractice lawsuit, you’ve left your busy practice and entered into a foreign world filled with lawyers, mediators, risk managers and claims managers, otherwise known as the land of suits – with briefcases.

You know you did nothing wrong in treating this patient, yet you also have to acknowledge the real-ity: you didn’t document the record as completely as possible. And the defense experts, though supportive of your care, have also admitted they would’ve ordered the additional test; which “more likely than not,” would’ve resulted in an earlier diagnosis and possibly a better patient outcome.

The mediation begins. You sit with arms firmly crossed next to your attorney, while glaring at the plaintiff’s attorney, and listen as each lawyer sum-marizes their client’s case. You resist correcting their presentation of the medical facts and envision your day in court. Yet, as this lengthy discussion unfolds, you realize that rather than have a jury of six people – whose only clinical qualifications are that they pos-sess a valid driver’s license – decide your fate, you conclude in your own mind that this matter needs to be resolved. The allegations of negligence supported by the plaintiff’s “expert” – an assistant professor from an academic institution on the other side of the continent – will get this case to a jury. And when you then consider your own time, stress, and financial exposure, you conclude it is best to compromise today.

Now is the time to make sure your defense team understands the medicine involved to counter the often absurd clinical allegations of the plaintiff’s attorney. Take a deep breath, exhale slowly, and survive. Let the negotiations begin!

Once the attorneys have completed their presentation, the mediator will keep the largest group of people – usually all defen-dants and their representatives – in the main conference room while the plaintiff’s attor-ney and plaintiff disappear to a smaller con-ference area. When there’s criticism among defendants, they will also separate, but this isn’t usually the case as open, public criticism of one defendant against another only inures to the advantage of one party: the plaintiff.

During the next half hour, you’ll discuss all possible ramifications of this mediation with your attorney in one room, while the mediator meets with the plaintiff and plain-tiff’s attorney in another space. This is where the mediator begins to display incredible skills of diplomacy by cajoling and badger-ing each side to expose their weaknesses, in an attempt to drive them to the center of the argument. After meeting with the mediator, the plaintiff attorney’s initial outrageous de-mand will be brought to your defense team by the mediator, along with insightful com-ments concerning the mediator’s take on the case. You’ll be tempted to simply walk

out of the mediation at this point, but the mediator will encourage you to “engage.”

You should do so. Over the next few

hours, each party will parry and thrust with demands and offers, with each one at-tempting to drive the other toward their goal. Plaintiff’s attorney will want to receive as much money as possible

for the plaintiff; your defense attorney will want to pay out as little as pos-sible on your behalf.

Interwoven with a continuing discussion of the facts and the expert testimony, various methods of negotiation will be used, depend-ing on what actually works with this particu-lar group of people. Some behave like used car salesmen and simply jockey back and forth. Others give a hard and fast number and say “That’s it!” Some use “brackets.” For example, plaintiff’s attorney may say something like, “I’ll agree to decrease my demand to $250,000 if you agree to increase your offer to $150,000.” In so doing, he’s clearly signaling that he wants to settle the case for $200,000. So the defense then of-fers another bracket, with a midpoint that’s lower than $200,000. An infinite number of possibilities exist on how to best negotiate resolution of a medical malpractice claim; what’s used on a given day is that which is best suited to the facts of the case and the people involved.

At the end of the process, the mediator will finally announce that all parties reluc-tantly agree to a final settlement number. The mediator then prepares a document formalizing this agreement, which will con-tain a clause stating you haven’t admitted to any negligence.

The mediation has concluded. There’s no fanfare, no shaking of hands between plaintiff and defendant. By the time you thank the mediator and move toward the lobby, the plaintiff and plaintiff’s attorney will have already departed.

In the parking lot, you thank your attor-ney and your claims manager for applying their skills on your behalf today. And with your mind absolutely numb, you walk to your car. It’s over. You survived. It’s now time to remember to take that big breath of fresh air, exhale slowly and then drive care-fully to spend the evening with your family and friends. Relax. Chill. You deserve it. And when you return the next day to the practice of the most honorable profession in the world, remember the words of Sir Wil-liam Osler: “The best preparation for tomor-row is to do today’s work superbly well.”

Timothy R. Bone, president of Florida-based MedMal Direct Insurance, may be reached via Tim@MyMedMal.com.

The Art of Mediation – Part 3Let the negotiations begin!

Managing Risks

‘‘The best preparation

for tomorrow is to do today’s work

superbly well.’’ – Sir William Osler

10 > JANUARY 2013 m e d i c a l n e w s . c o m

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By MARK WEISENMILLER

Speaking of Women’s Health Con-ferences have been successful events since 1996 and the latest conference held in southwest Florida was no exception.

The theme of the all day conference, held in mid-November at the Braden-ton Area Convention Center, was “Share Good Health.” Through a variety of speeches and symposiums, that is precisely what happened. This was the 10th annual Speaking of Women’s Health Conference held in southwest Florida.

The over 500 people who attended the conference, who paid five dollars apiece for general admission tickets, had access to speeches given by a wide variety of health and medical professionals, a dozen compli-mentary screenings, and even a gift bazaar. At the latter, people browsed, shopped, and bought, jewelry, makeup, and other various knick-knacks.

Already, organizers have the date for the 2013 Speaking of Women’s Conference to be held in our area. It’s set for Sunday, November, 16, 2013 at the Bradenton Area Convention Center. “The event ben-efits the Manatee Memorial Foundation,

Inc. The foundation’s major emphasis is on healthcare needs within our commu-nity and scholarships for medical educa-tion,” explained Betty Chambliss, director of advertising and community relations at Manatee Memorial Hospital.

This year’s keynote speaker was Maureen Whelihan, MD, OB/GYN, whose presentation was the attention-grabbing “No Sex in the City: Love Life Boot Camp.”

At the recent conference wives brought their husbands and girlfriends brought their boyfriends. “Men are not prevented from coming to this event. We have worked with the Manatee County School Board on a men’s event during the year. This event is designed to be a fun and educational day for women, one they can share with moth-ers, daughters, sisters, and friends. Women often put their family above themselves. This is a once-a-year time for them to think about themselves and their health and well-being,” noted Chambliss.

She has her own views on why these conferences, celebrating the many ben-efits of women’s health, are both well re-garded and also well attended: “Speaking of Women’s Health is popular because it is

the perfect mix of education and entertain-ment. Some have called it ‘edu-tainment.’ Attendees are pampered with complimen-tary health screenings and samples of food and gifts. They also have the opportunity to hear from a team of experts on a variety of important health and well-being issues. It is a high energy atmosphere full of learning and laughter and a special time to spend with other women and the opportunity to form some new relationships.”

The Speaking of Women’s Health website – www.speakingofwomen-shealth.com – reveals the group as a strong social and health movement whose goal is presenting women the most health and safety information as possible to help them make wise decisions for themselves and their family.

Speaking of Women’s Health was the brain-child of Dianne Dunkleman, who began just wanting to produce a one-day health event in Cincinnati in 1996. It has since grown to a national foundation with more than 50 events in 40 cities nationwide.

Speaking of Women’s Health Conference Attracts Large Crowd in Bradenton

By DEBBIE ZORIAN

Tuesday, January 29HCMA office, 606 S. Boulevard,

Tampa, Tools & Tips for Marketing Your Practice

HCMA Benefit Provider, Full Circle PR, is hosting a seminar to assist HCMA members in gaining more patients for their practice on January 29th, 5:45 pm at the HCMA office. There is no charge for mem-bers to attend. Call 813.253.0471 for more information.

Tuesday, February 5InterContinental Hotel, Ken-

nedy & Westshore Blvds.HCMA General Membership

Dinner MeetingThe HCMA’s next general member-

ship dinner meeting has been scheduled. So-cial hour will begin at 6 pm, the dinner and program will commence at 7 pm. Program details forthcoming. HCMA members are in-vited to call 813.253.0471, with any questions or to RSVP.

New Benefit for HCMA Members

The Florida Healthcare Law Firm, an HCMA Benefit Provider, invites members to celebrate the grand opening of their new on-line store. Free legal documents are available for instant download covering topics from Confidentiality Agreements to Space Leases! Audio/visual presentations are also available for purchase (HCMA members receive a 25 percent discount by using a discount code).

Topics include: buying a medical practice, how to hire a physician, Florida’s prompt payment laws, and more! Call 813.253.0471 for more information.

New HCMA Focus GroupsNewly formed HCMA focus groups,

the Young Physician Section (YPS) and the Women in Medicine Section (WMS), are looking for members. It is the goal of the HC-MA’s YPS and WMS to reach out to these physician member groups of the HCMA, and in our county, who have been inconspic-uous, albeit very important segments of our medical community. The goal of these focus groups is to promote a forum for networking and continuing education, and solicit ideas and energy from these members to make the HCMA relevant and useful to them, their practices, and their families.

Young Physician Section (YPS): Cre-ated for all HCMA members 40 years old or younger. Women in Medicine Section (WMS): Created for all HCMA female phy-sicians. HCMA members are encouraged to contact the HCMA office if interested in participating in either of the new focus groups at 813.253.0471.

HCMA Health PlanThe HCMA continues to offer health

insurance through Florida Blue. The plan is available to HCMA members, their families, and their staff. The purpose of the plan is to keep annual premium increases to a mini-mum while providing physicians with a great membership benefit. Members who enrolled last year will see no increase in their premiums!

HCMA members can call 800.622.9124 for details or visit: www.trusthcma.com. Mark Thompson, an agent for the HCMA Health Plan, can be reached by calling 813.639.3066.

HCMA Has Gone SocialFollow the HCMA on Twitter – http://

twitter.com/HCMADocs – and like us on FaceBook– www.facebook.com/HC-MADocs. Keep updated on HCMA events and important notices!

HCMA’s Photo SiteThe HCMA has created a website of

photos taken during HCMA events. Please visit http://hcmaphotos.shutterfly.com and check back often for updates. A link to this site is also posted on the HCMA website: www.HCMA.net.

HCMA.NET – Always Changing

Visit the HCMA website to find a host of information, including new advertisers, the latest issue of The Bulletin, the HCMA Benefit Providers, a list of the HCMA officers, or a list of upcoming CMEs. You can also check out the photos from the FMA Annual Meeting, the HCMA Foundation Charity Golf Clas-sic, and recent dinner meetings, or look up an HCMA member’s contact information! Visit the site at www.HCMA.net.

To learn more about the Hillsborough County Medical Association, or to find out how to become a member, please visit our website at www.HCMA.net.

Hillsborough County Medical Association

m e d i c a l n e w s . c o m JANUARY 2013 > 11

Moffitt Cancer Center will present several conferences in 2013 for a variety of healthcare professionals.

JANUARY 19, 20139th Annual Clinical Breakthroughs & Challenges in Hematologic MalignanciesDisney’s Grand Floridian Resort, Lake Buena Vista

The 9th Annual Clinical Break-throughs and Challenges in Hema-tologic Malignancies Conference is designed to present the most recent diagnostic and therapeutic advances in hematologic malignancies to practicing hematologists, oncologists, pharma-cists, physician assistants and oncology nurses. Join us to hear national experts discuss the most recent treatment op-tions and emerging therapies in these topics: myeloid malignancies, MDS, AML, NHL, ALL, CLL and multiple my-eloma. Ample time will be available for case presentations and discussion.

For more information visit the con-ference website at: www.MOFFITT.org/Hematology2013or contact Melissa Pearson at 813-745-1247.

FEBRUARY 28 – MARCH 1, 2013 13th Annual Current Perspectives in Oncology Nursing ConferenceMoffitt Cancer Center, Tampa

The goal of this annual nursing con-ference is to provide information perti-nent to the practice of oncology nurses at all stages of their careers. Topics are chosen to educate the novice, update the proficient and challenge the expert oncology nurse. Call for abstract is avail-able and nursing continuing education contact hours are offered. Special Event included: 9th Annual Rhinehart Recep-tion and Lecture on February 27, 2013.

For more information visit the con-ference website at: www.MOFFITT.org/Nursing2013 or contact Chrystyna Pospolyta at 813-745-4918.

MARCH 9, 2013 State-of-The-Art NeuroOncology ConferenceSheraton Sand Key, Clearwater Beach

This conference will present the most recent diagnostic and treatment information and advances in neuro-oncology and neurosurgery. A variety of topics on neurological abnormalities will be presented.

Moffitt is the only brain cancer cen-ter in Florida and one of only 15 in the U.S. recognized by the National Cancer Institute as a founding and active mem-ber of the Adult Brain Tumor Consor-tium, which aims to develop more ef-fective therapies for these tumors.

For more information visit the con-ference website at:www.MOFFITT.org/NeuroOncology2013 or contact Me-lissa Pearson at 813-745-1247.

FOCUS ON CANCER RESEARCH, TREATMENT UPDATES, SCREENING AND DIAGNOSIS

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Andrew E. Hano, DO

Vu Tran Ho, MD

Nuruddin Jooma, MD, MPH

Craig S. Kitchens, MD

Richard A. Knipe, MD

Julio Lautersztain, MD

Don D. Luong, MD

Joseph R. Mace, MD

Idelfia A. Marte, MD

Arthur J. Matzkowitz, MD

Edgar G. Miranda, MD

Magda Melchert, MD

Jeffrey L. Paonessa, MD

Janelle Park, MD

Y. K. Peter Park, MD

Hitesh Patel, MD

J. Andrew Peterson, MD

Mark S. Robbins, MD

Joseph Sennabaum, MD

Ramesh K. Shah, MD

Shalin R. Shah, DO

Shaukat Shaikh, MD

Gerald H. Sokol, MD

R. Waide Weaver, MD

David Wenk, MD

David D. Wright, MD

Gail Lynn Shaw Wright, MD

Lane D. Ziegler, DO

Tampa Bay Area Physicians

Caring for patients in 15 Greater Tampa Bay Area communities