Medical Staff e-Update

Andrew Caughey, MD

Andrew Caughey, MD

Medical Director, Henry Ford Allegiance Anesthesia Clinical Service & Chief of Staff

Ray King, MD

Senior Vice President, Medical Affairs & CMO

Issue 25 - May 25, 2017

This year’s recipients of the Physician Excellence Award exemplifies our core values integrity, quality and teamwork. We received many nominations and there are many, many deserving physicians, but this year, two stood above the rest—Kristina Sturgill, DO, and Lawrence Narkiewicz, MD.

It is with greatest pleasure that I announce the recipients of this year’s Physician Excellence Awards.

Both are humble, dedicated, inspirational and caring. Both are true leaders. I characterize exceptional leaders as those who have authority, but rarely have to use it to get optimal results. Both have made incredible personal and career sacrifices for the greater good.

Kristina Sturgill, DO

Ray King, MD, said:

I am so happy that Kristina has dedicated herself to teaching new physicians as I hope they learn from her and take away a portion of the excellence with which she practices. If they have learned from her then I think our future physicians are going to do wonderfully.

She was never too busy to answer a question or participate in some potentially inappropriate humor.

Dr. Sturgill has been the Family Medicine program director since March of 2015. What many don’t know is that we almost had to close down our family medicine program. We went through two family medicine program directors. The program not only needed a program director working at least ½ of their time in an administrative role, but also someone who would have their practice out of the same site as the residents at the Center for Family Health. Kristina moved her career to CFH to meet the needs of the program. Many patients followed her. Dr. Sturgill filled a role vital to the success of the program leading the transition through its first ever single accreditation.

Dr. Sturgill’s quiet determination and role modeling focused on ideals for resident and her faculty. Her passion never wavered from creating an exceptional educational program based on core values of dedication, compassion, empathy and quality. Her personal sacrifices became a passion for her to ensure each resident and faculty understood work life balance. Faculty meetings discuss resident wellness and faculty wellness. Dr. Sturgill is committed to role modeling behavior in order to assist with longevity as a physician. Her influence for physician boundaries has been recognized outside of HFAH and she has been asked to speak on the topic by national organizations.

Larry Narkiewicz, MD

Ray King, MD, said:

Larry has also made personal sacrifices on behalf of Henry Ford Allegiance and the community. The list is too long to list only because I’m sure I’m not aware of everything. First and foremost, Larry is a husband, father, general surgeon and a friend to many. As with Dr. Sturgill, that would be a successful life and career all by itself.

Larry is also the Vice Chairman of the Board of Jackson Health Network and on its Executive, Finance and Nominating Committees. He is always completely prepared for each and every meeting. He also has great insight on what it would take for JHN to be successful.

In GME, Larry is faculty for the General Surgery Residency program and is a great educator.

Larry’s real claim to fame, and where he has made the greatest professional and probably personal sacrifice, is leading the formation of our Trauma Program. Larry, several years ago, began a professional journey into helping create a Trauma program here in this community. No small task. He did this, knowing and understanding the sacrifices this endeavor would bear on him personally and professionally. To show how considerate a man this is, he asked each of his partner's opinion. It felt like permission, even though it wasn't. We as a group unanimously supported his decision, and recognize that no other person could have the same influence on how this program developed, and succeeded, as it would with Larry at the helm.

After years of work and effort, it is exhilarating to see the results of his work, and that of the team working to build this program. Larry has had particular challenges, in trying to balance the life of his practice, and that of the trauma program. And yet he maneuvers through the minefield with seeming ease, the agility of a diplomat. Whether he realizes it or not, he is a respected leader in this institution and this community, and more importantly - an approachable leader.

For the past four and a half years, Larry has served as either our part-time or full-time Trauma Medical Director. He tirelessly coaches colleagues. His competency has shown through during educational sessions such as the Mock Trauma Scenarios in the ED (on all three shifts). He has worked hard to nurture a collaborative relationship with our local EMT leaders.

During meetings, Larry is willing to listen to everyone, even when they don’t agree. He is capable of pulling them back in when they are off on a tangent. He is never bombastic or dictatorial, but always respectful and a really good facilitator.

The Trailblazer Award was started years ago to recognize the physicians who were willing and had the courage to lead the medical staff and health system past our comfort zone and enhance the level of care for members of our community.

Several years ago, we began looking for health system affiliation partners. We engaged many physicians early on as we evaluated our initial option. Those meetings were invaluable and offered more perspective than just clinical alignment opportunities.

In late 2014, when we broadened our search for partners, we again entertained feedback from physicians on attributes we should be looking for. The four partnership essentials used as criteria were:

  • Clinical Resources
  • Access to Capital
  • Our Community
  • Our People, including Physicians and Staff

We selected five physicians to help us do the deeper dive for fit with potential partners. They went out of town with us on interviews and helped guide our decision-making, which eventually led us to choose Henry Ford Health System as our partner.

Those five physicians are:

  • Brian Adamczyk, MD
  • David Halsey, MD
  • Sandra Kilian, MD
  • Shawn Obi, DO
  • Mark Smith, MD

Congratulations!

Following a multi-year process, Henry Ford Allegiance Health joins the ranks of the 22 hospitals in Michigan verified as a Level II Trauma Center to provide comprehensive trauma care to severely injured patients, including those who have had major automobile accidents, sporting accidents, falls, head injuries and spinal injuries.

“While we have historically provided stabilization and initial care for patients with traumatic injuries, this verification will now allow the team to treat and admit the most severely injured patients, providing the highest level of care for the region we serve,” said Henry Ford Allegiance Health President and CEO Georgia Fojtasek.

Staying prepared

The American College of Surgeons, the organization that oversees Trauma Center verification nationally, has four Trauma Center designation levels. To be designated as a Level II Trauma Center, a hospital must demonstrate an organized and coordinated approach to treating serious injury across the continuum of care. Requirements include the around the clock availability of all necessary trauma personnel, equipment, supplies, education and guidelines for care, such as:

  • Immediate 24-hour coverage trauma surgeons
  • Coverage by specialists in
    • Orthopedic surgery
    • Neurosurgery
    • Anesthesiology
    • Emergency Medicine
    • Radiology
    • Critical Care
    • Cardiac Surgery
    • Thoracic Surgery
    • Vascular Surgery
    • Hand Surgery
    • Plastic Surgery
    • Oral Maxillofacial Surgery
    • Otolaryngology
    • Urology
    • Obstetric and Gynecological Surgery
  • Incorporation of a comprehensive multidisciplinary trauma quality assessment and patient safety program
  • Community outreach and injury prevention
  • Continuing education programs for staff related to trauma

Although Henry Ford Allegiance Health has been recognized by independent organizations as one of the best hospitals in Michigan for emergency care, being officially verified assures the community, health care providers and regulatory bodies that the health system has met the rigorous requirements necessary to care for critically injured patients across the entire continuum of care.

“Now, very few patients will have to experience the 40-minute ambulance ride or helicopter transport ride to another facility. They will be cared for here in Jackson,” said Trauma Program Medical Director Lawrence Narkiewicz, MD. “For the most severely injured, eliminating that transport time can mean the difference between surviving or not.”

Keeping trauma care local

“Many people would be surprised to know that trauma is the leading cause of death for people age 44 and younger – more deaths than cancer and heart disease combined,” said Dr. Narkiewicz. “Henry Ford Allegiance will help reduce the tragic impact of severe injuries as a Level II Trauma Center.”

The Henry Ford Allegiance Emergency Department had more than 85,750 patient visits in 2016, and of those individuals, nearly 15% were injured. This includes all types of trauma, from mild to severe.

According to recent data from the Michigan State Police, in Jackson County alone, more than 5,000 people were injured in motor vehicle crashes in 2015, and an additional 1,000 individuals were injured due to other circumstances that year.

“Our goal is to offer our community improved access to trauma care and improve outcomes for serious injury,” Dr. Narkiewicz said.

Meeting high standards

Verified Trauma Centers must meet the essential criteria that ensure trauma care capability and institutional performance, as outlined by the American College of Surgeons' Committee on Trauma in its current Resources for Optimal Care of the Injured Patient manual. To ensure strict adherence to standards, Henry Ford Allegiance Health will then be required to re-verify every three years. These standards emphasize quality, community education, injury prevention, response time and staffing.

“Meeting the rigorous verification quality standards is challenging,” said Dr. Narkiewicz. “However, when lives are at stake – nothing less than excellent quality is acceptable.”

About the American College of Surgeons

The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to raise the standards of surgical education and practice and to improve the care of the surgical patient. The College has over 72,000 members and it is the largest association of surgeons in the world. Longstanding achievements have placed the ACS in the forefront of American surgery and have made it an important advocate for all surgical patients.

In the recent CareChex® Quality Rating System’s State Scorecard, Henry Ford Allegiance Health ranked in the 99.2 percentile for Heart Failure Treatment, which placed us Number One in the State of Michigan.

In addition, the CareChex National Scorecard rated Henry Ford Allegiance Health above the 90th percentile nationally in several clinical categories.

  • Neurological Care: 98.6
  • Cardiac Care: 97.0
  • Heart Attack Treatment: 90.7

We are extremely proud of these recognitions, which reflect our system-wide teamwork and our continued effort to consistently implement best practices for quality.

There have been some recent legislative updates that have an impact on the practice of Physician Assistants (PA) and Nurse Practitioners (NP). Henry Ford Allegiance Health’s Collaborative/Participating Physician Agreement is being rewritten to reflect these changes. If you are currently engaged in one with an NP or PA, you will be approached to sign the new document. In brief the following is an overview of practice changes with the new Laws (Michigan Public Act 379, passing of HB 5533, and HB 5400) in place:

  • A new practice agreement for PA’s with a ‘participating’ physician, changes in verbiage , changing ‘supervising’ physician to ‘participating’ physician
  • Public Act 379 removes the previous PA/physician ratio that had been limited
  • PA’s are now defined as independent ‘Prescribers’ within a practice agreement
  • PA’s can continue to prescribe schedule 2-5 substances, but now may apply for and obtain a State of Michigan Controlled Substance License (CSL) in addition to maintaining their DEA license. The CSL applications will not be approved before March 22, 2017.
  • NP and Certified Nurse Midwife (CNM) can have delegated controlled substance authority 2-5 within a written collaborative practice agreement. Effective immediately (Dec ember 6, 2016)
  • Clinical Nurse Specialists (CNS) are added to Michigan Public Health Code, allowing for specialty certification and inclusion in changes in following bullet points, which are effective 90 days from January 9, 2017.
    • NPs, CNMs, and CNSs can prescribe physical therapy, speech therapy and order restraints
    • NPs, CNMs, and CNSs can prescribe schedule 2-5 drugs under delegation and non-scheduled drugs autonomously

Henry Ford Allegiance Health continues to succeed with Single Accreditation. Most recently our Traditional Internship was approved by the Accreditation Council Graduate Medical Education (ACGME) Review Committee (RC) for the Transitional Year program. The program had three citations that are being addressed. One citation involved moonlighting which needed additional clarification that PGY 1 residents are not allowed to moonlight.

Family Medicine was notified they received ACGME accreditation. The RC met in February and indicated a letter with citations could take up to 60 days.

Both programs succeeded in receiving initial accreditation on the first application. Five out of six programs are ACGME accredited. Psychiatry will submit an application in June.

Henry Ford Allegiance Health is now using germ-zapping robots to destroy dangerous germs on hospital surfaces and further reduce the potential for hospital-acquired infections. The Xenex LightStrike™ Germ-Zapping Robot™ uses Full Spectrum™ pulsed xenon ultraviolet (UV) light to quickly destroy bacteria, viruses, fungi and bacterial spores. The portable disinfection system is also effective against pathogens such as C. diff, norovirus, influenza, Ebola and MRSA.

“The portable germ-zapping robot can disinfect a typical patient room or procedure room in four or five minute cycles,” said Director of Hospitality Services Jason Hammond. “It can be used in any department or unit, including isolation rooms, operating rooms, patient rooms, contact precaution areas, emergency rooms, bathrooms and public spaces.”

Henry Ford Health System is the only health system in the United States to use the Germ-Zapping Robots in every one of its six hospitals.

Frank La Marca, MD, Neurosurgeon

Dr. La Marca recently joined Henry Ford Allegiance Neurosurgery, where he will work alongside Harish Rawal, MD, and Amritraj Loganathan, MD. For the past 13 years, Dr. La Marca has served at the University of Michigan Medical School as Chief of the Spine Section, Department of Neurosurgery. He is also a Professor of Neurosurgery, Orthopedics and Biomedical Engineering at the U – M Medical Center.

Dr. La Marca earned his medical degree and completed a residency in neurological surgery at the Catholic University Medical School of the Sacred Heart, in Rome. He later completed both an internship in general surgery and a residency in neurosurgery at Northwestern Memorial Hospital McGraw Medical Center in Chicago. Among his areas of clinical interest are minimally invasive spine surgery, degenerative spinal disease, pediatric spinal deformity, spinal cord injury, spinal oncology and spinal trauma. His research interests include 3-D printing technology applications to spinal implants, degenerative disk disease treatments and spinal cord regeneration.

Jordan Knepper, MD, Vascular Surgeon

Dr. Knepper has joined Paul Corcoran, MD, and Brian Daily, MD, at Henry Ford Allegiance Vascular Surgery. He was most recently on the medical staff at St. Joseph Mercy Hospital in Ann Arbor, and he serves as an Adjunct Assistant Professor of Vascular Surgery at the University of Michigan.

After earning his medical degree at the University of New Mexico School of Medicine, Dr. Knepper completed a master’s degree in Clinical Science, a residency in integrated vascular surgery and a research fellowship, all at the University of Michigan Health System. U of M honored him with both a Faculty Award of Excellence and the Greenfield Research Award.

Dr. Knepper’s special interests include quality measurement and validation, vascular surgery outcomes research, and policy effect and outcome measures.

Important Information Regarding Your DEA Registration Renewal:

Starting January 2017, DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration.

At this time, DEA will otherwise retain its current policy and procedures with respect to renewal and reinstatement of registration. This policy is as follows:

  • If a renewal application is submitted in a timely manner prior to expiration, the registrant may continue operations, authorized by the registration, beyond the expiration date until final action is taken on the application.
  • DEA allows the reinstatement of an expired registration for one calendar month after the expiration date. If the registration is not renewed within that calendar month, an application for a new DEA registration will be required.
  • Regardless of whether a registration is reinstated within the calendar month after expiration, federal law prohibits the handling of controlled substances or List 1 chemicals for any period of time under an expired registration.

Important Information Regarding License Renewal and New CME Requirement:

Because the office has received questions regarding medical license renewal, associated CME, etc., I thought it would be useful to provide you with information directly from LARA’s website.

Continuing education requirements apply to every physician renewing a Michigan medical license who has been licensed in the 3-year period immediately preceding the application for renewal. The requirements apply whether or not the physician is actively engaged in the practice of medicine. No one, including medical school faculty and resident physicians, is exempt from this requirement.

Each medical doctor is required to complete 150 hours of continuing education in courses or programs approved by the board of which a minimum 75 hours of the required 150 hours must be earned in courses or programs designated as Category 1 programs. A minimum of 1 hour of continuing education must be earned in the area of medical ethics. Effective December 6, 2017 a minimum of 3 hours of continuing education must be earned in the area of pain and symptom management.

Every medical doctor who is renewing his/her license should retain records documenting the completion of continuing education. Those documents must be retained for 4 years from the date of applying for license renewal.

Do not send the continuing education documents along with the license renewal application. The Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing will conduct an audit at the conclusion of the renewal period. Physicians chosen for an audit through an automated random selection process will be contacted by letter to submit documented evidence of the completion of 150 hours of continuing education.

Do not renew your license if you do not have the required 150 hours of CME. A medical doctor who is unable to provide evidence of completion of the continuing education requirements, when requested, is in violation of the Michigan Public Health Code and subject to one or more of the following possible license sanctions: reprimand, probation, denial, suspension, revocation, limitation, restitution, and fine.

To assist you with “remembering” when your important documents expire, the Medical Staff and Credentialing Services office instituted a process whereby Credentialing Specialist Bev Thurston will send an email to each provider with upcoming expiring documents (license, DEA, etc.). This email will contain a list of your documents along with their 2017 expiration date(s).

The Drug Enforcement Administration (DEA) Detroit Division Office has been notified of the recent legislation amendment of Michigan Public Health Code (Code), 1978 PA 368, effective March 22, 2017. Pursuant to 2016 PA 379, a Physician Assistant (PA) shall not engage in the practice as a PA except under the terms of a Practice Agreement that meets the requirements of the state Code. The required contents of a Practice Agreement may be found in MCL 333.17047 (medicine), MCL 333.17547 (osteopathic medicine & surgery), or MCL 333.18047 (podiatric medicine & surgery) of the Code. Download the Practice Agreement and instructions provided by the Michigan Department of Licensing and Regulatory Affairs (LARA).

Pursuant to MCL 333.17076(2), 333.17548(4), and 333.18051(2) of the Code, a PA who is a party to a Practice Agreement may prescribe a controlled substance in accordance with procedures and protocols for the prescription established by rule of the department in consultation with the appropriate board.

In order to prescribe a controlled substance that is included in schedules 2 to 5 of Part 72 of the Code, a PA must obtain a state controlled substance license from LARA. The application for a controlled substance license may be found on the department's website here. If a PA prescribes a controlled substance, the PA's name and DEA registration number, must be recorded on the prescription.

PAs who have been issued a state controlled substance license will need to modify their DEA registration by updating the state licensure information. All modifications will be conducted on-line only.

Submit any changes to the DEA registration.

A Physician Assistant should list a personal email and/or contact number in case any additional information is required.

Please send questions to detroitdiversion@usdoj.gov or contact DEA Detroit Registration at 800-230-6844.

We hope you find this information useful and are happy to assist with your future needs in this regard.

Our 2016 Report to the Community — We Are Here — is now ready for you to view. With its striking videos, interactive map, photo galleries and stories about our patients, physicians and staff, the Report illustrates the many ways Henry Ford Allegiance Health connects with the community in which we live, work and raise our families.

Please take a moment to explore We Are Here online. We hope you find it both informative and inspiring.

Audiologist Deborah Livingston, AuD, F-AAA, PASC, of the Henry Ford Allegiance Hearing Center, is the only person in the state of Michigan to achieve a Specialty Certification in Pediatric Audiology (PASC). The certification is conferred by the American Board of Audiology (ABA).

This prestigious credential distinguishes individuals who have a graduate degree in audiology and have acquired specialized knowledge in the field, met eligibility requirements, and successfully completed a rigorous written exam developed and administered by the ABA. Once an audiologist successfully passes the PASC exam, she or he must renew the certification every 3 years through 60 hours of continuing education—30 of which must be specific to pediatric audiology.

Progress on the construction of the exciting new Henry Ford Allegiance Center for Health Innovation & Education (CHIE) continues. Reinforcing steel is in place, the foundation walls have been poured and interior walls are coming along. The structure is taking shape!

The project is on schedule to be completed later this year, the Center for Health Innovation & Education will serve as a technologically advanced learning center that will enhance our Graduate Medical Education program. The Center will allow our experienced care providers and community first responders to hone their skills to remain on the forefront of technology and technique.

The project will be complete this fall.

Eating junk food, fatty food and other convenience foods will result in a feeling of lethargy, tiredness, depression and bad complexion just to name a few. Try substituting these foods with high fiber, low fat food, mixed with a regular intake of fruit and vegetables.