Medical Staff e-Update

Mark Smith, MD

Mark Smith, MD

Clinical Service Chief and Medical Director of Emergency Services, Executive Medical Director of Adult Hospitalist Services & Chief of Staff

Ray King, MD

Senior Vice President, Medical Affairs & CMO

Issue 21 - November 30, 2015

Allegiance Health has been named a Screening Center of Excellence by the Lung Cancer Alliance (LCA) for its ongoing commitment to responsible lung cancer screening. Low dose CT screening for lung cancer carried out safely, efficiently and equitably saves tens of thousands of lives a year.

“We are proud and honored to be working with Allegiance Health as a Lung Cancer Alliance Screening Center of Excellence. Their commitment to practice responsible lung cancer screening will lead to advancements in research and many lives saved. They are an example to follow,” said LCA President and CEO, Laurie Fenton Ambrose.

Designated Screening Centers of Excellence are committed to provide clear information based on current evidence as to who is a candidate for lung cancer screening. These Centers comply with comprehensive standards based on best practices developed by professional bodies such as the American College of Radiology, the National Comprehensive Cancer Network and the International Early Lung Cancer Action Program. These standards focus on controlling screening quality, radiation dose and diagnostic procedures within an experienced, multi-disciplinary clinical setting.

“Allegiance Health’s multidisciplinary lung team drove our decision to pursue this designation. We are now thrilled to be part of this elite group, setting an example for responsible screening practices across the country,” said Samir Parikh, MD. “This is especially meaningful because the occurrence of lung cancer in Jackson County is higher than state and national averages.”

Allegiance thoracic surgeon Mohan Kulkarni, MD, said, “Because early detection is key, we are committed to providing high quality, life-saving care to our community. We offer both low dose CT screening and navigational bronchoscopy, which are proven methods for detecting lung cancer at an early and treatable stage.”

On Friday, September 25, Allegiance Health hosted the 2nd Annual Jackson Trauma Symposium. The symposium featured six invited speakers who are trauma leaders and experts from trauma centers in our region. Topics included massive transfusion, trauma in pregnancy, safety behaviors in the trauma resuscitation bay, geriatric trauma, mutilating hand injuries, and managing acute pain in the chronic pain patient. The program was moderated by Dr. Larry Narkiewicz, Trauma Medical Director at Allegiance, who summarized lessons learned about the trauma head-to-toe assessment, anticoagulation in the elderly trauma patient, when to transfer a patient with a significant hand injury, opiate tolerance in the chronic pain patient, and fluid resuscitation in the injured pregnant patient. 

Nearly 200 trauma professionals attended, and they included attending physicians, resident physicians and medical students, nurses, EMTs, pharmacists and other health care workers. About half of the attendees came from hospitals or agencies outside of Allegiance Health. They came from as far north as Keewanau, northeast to Cass City and Caro, east to Detroit, South to Toledo, and west to Grand Haven and Dowagiac. What our guests had in common – besides a desire to learn more about state of the art trauma care – was their participation in Michigan’s new State-wide trauma system. “As we gear up for trauma,” said a nurse from Moncalm County (north of Grand Rapids), “we’re looking for seminars like this one, where our staff can learn about a variety of trauma topics without traveling too far.”

Dr. Ray King voiced similar sentiments during his welcoming remarks, when he said, “It seems that we are all on this trauma journey together, and the journey includes teaching and learning about best practices in trauma care.” He also invited everyone to mark their calendars for September 30, 2016, for the 3rd Annual Jackson Trauma Symposium.

Two cases of confirmed, six cases of probable, and four suspect cases of lymphogranuloma venerum (LGV) have been reported in Michigan as of October 2015; up from 4 probable cases reported in the health alert sent on September 29, 2015. The majority of these cases have been reported by a single health care facility in Southeast Michigan. Current cases live in Wayne, Oakland, and Macomb counties. The initial case was reported in August and the most recent was diagnosed in early October.

LGV is a rare and poorly characterized STD in the U.S. with the last reported case in Michigan occurring in 2008. LGV is caused by a serological variant of Chlamydia trachomatis. The Centers for Disease Control and Prevention (CDC) has been working with the Michigan Department of Health and Human Services (MDHHS) on managing this outbreak. MDHHS staff have been conducting partner elicitation and contact tracing with cases and referring partners for testing and treatment.

The confirmed, probable, and suspect cases are nearly all among African American men who have sex with men (MSM) who also have HIV. Many of the reported cases are contacts of each other and have met partners online. Commonly reported symptoms have been penile lesions, anogenital symptoms, and inguinal lymphadenopathy; please refer to the attached case definition for a more specific list of LGV-associated symptoms. Providers seeing patients with these symptoms should consider LGV in their differential diagnosis, especially among MSM in Southeast Michigan with symptoms and for those with positive chlamydia tests whose symptoms do not resolve with standard treatment.

In persons with a clinical presentation compatible with LGV infection, nucleic acid testing for Chlamydia trachomatis of the affected area (e.g. anal swabs and/or swabs of ulcers) is indicated. Urine nucleic acid testing will frequently be negative. Samples that test positive should be forwarded to MDHHS laboratories for referral to CDC for specialized testing. Details on proper specimen collection methodologies are attached.

The recommended treatment regimen for LGV is Doxycycline 100 mg orally twice a day for 21 days. Sexual partners of a probable or confirmed LGV case should be tested for chlamydia infection and presumptively treated with doxycycline 100 mg orally twice a day for 7 days. Given the context of this outbreak, where cases are occurring among HIV-infected persons or persons at elevated risk of HIV infection, 21 days of treatment should be considered.

All information related to clinical and laboratory reports on suspected or probable cases should be made to Jim Kent at (517) 335-8247 or and entered into the Michigan Disease Surveillance System (MDSS).

Further questions about this health alert can be directed to Karen Krzanowski at (517) 241-0870 or

Cryoablation is a minimally invasive procedure that uses extreme cold to correct an irregular heart rhythm  called atrial fibrillation. Atrial fibrillation can be a detriment to quality of life. This relatively new technology is an alternative to radiofrequency ablation, which uses thermal energy or heat to suppress symptomatic atrial fibrillation. A cardiologist determines which treatment is most appropriate, according to each patient’s condition and needs. 

During the cryoablation procedure, an electrophysiologist inserts a balloon catheter, from a vein in the leg into the pulmonary veins located in the left upper chamber of the heart, the left atrium. A finite area of heart tissue surrounding each of the four pulmonary veins is frozen to help maintain normal rhythm and to prevent atrial fibrillation from recurring.

“Typically, cryoablation is completed in less than half the time it takes to perform radiofrequency ablation and with fewer complications,” said Allegiance Electrophysiology Medical Director Bipin Ravindran, MD, MPH. “A smaller amount of anesthesia is required, and patients often have less post procedure pain.”

Research shows that cryoablation can be more effective than medication alone in treating atrial fibrillation in selected patients. This is an FDA approved treatment for in-and-out atrial fibrillation that is not controlled by antiarrhythmic drugs.

“Allegiance Health’s investment in this state of the art technology reflects a real commitment to this community. Patients no longer have to travel out of town to receive the best treatment options and care,” said Bipin Ravindran, MD, MPH. “While cryoablation is not appropriate in every case, it does offer significant advantages in the treatment of atrial fibrillation.”

Allegiance Health is proud to offer women in our community the most advanced mammogram technology available. Digital breast tomography (DBT) is a non-invasive, three-dimensional imaging technique used for the early detection and diagnosis of breast cancer.

“This FDA-approved procedure provides the radiologist with multiple-layered images that separate overlapping breast tissue, adding clarity to the digital mammography image,” said Samir Parikh, MD, vice chief of Imaging Services.  This technology is ideal for patients with dense breast tissue (about 40 – 50 percent of women), which provides a challenge for traditional mammograms. “If a patient has been notified of having dense breasts, tomography is best suited for them,” Dr. Parikh said.

At Allegiance Health, DBT will initially be used for diagnostic purposes “That is when a woman identifies a breast lump, has dense breast tissue, or had a two-dimensional mammogram that revealed an area concern,” said Amy McCann, Imaging Services clinical manager. “A radiologist will determine which type of breast imaging follow up is most appropriate in each case.”

Because of the improved visualization DBT allows the radiologist, the technology has been shown to result in fewer false positives. With a lower rate of call backs for follow-up mammograms, it may also lead to fewer unnecessary biopsies. All of these outcomes mean positive gains in terms of greater efficiency and patient care.

“For women who are worried about a breast lump or an area of concern on their initial mammogram, having the 3-D imaging option right here in our community can bring real peace of mind,” McCann stated. 

Anandeep Kumar, MD, FAAPMR, FAANEM, CIME

Allegiance Physical Medicine & Rehabilitation
Medical Director Inpatient Rehab Consultative Service

Board Certifications

  • American Board of Physical Medicine and Rehabilitation
  • American Board of Electro diagnostic Medicine
  • American Board of Independent Medical Examiners
  • American Board of Disability Analysts


Practicing Physiatry PM&R for over 13 years


  • Residency:Medical University of Ohio – General Surgery Preliminary Year
  • Residency:Marianjoy Rehabilitation Hospital – Physical Medicine and Rehabilitation
  • Internship: San Fernando General Hospital
  • Medical School: Medical College & Hospitals of Sri Venkateswara University

Areas of expertise

  • Neuro-musculoskeletal and spine pain
  • Joint and neuromuscular pain injections
  • BOTOX injections with EMG guidance
  • Spasticity and dystonia including pediatrics
  • Orthopaedic and neurotrauma rehabilitation
  • Strokes, brain and spinal cord injuries
  • EMG-NCS and neuromuscular disorders
  • Orthotics and prosthetic care
  • Work injury and occupational rehabilitation
  • Independent medical evaluations IME

Welcoming new patients.

Abdullah Adnan, DO

Physical Medicine and Rehabilitation
Specialty: Physical Medicine and Rehabilitation


  • Residency: Loyola University Medical Center – Physical Medicine and Rehabilitation
  • Internship: Advocate Illinois Masonic Hospital
  • Medical School: Des Moines University


  • American Association of Physical Medicine and Rehabilitation
  • American Osteopathic College of Physical Medicine and Rehabilitation
  • American Osteopathic Association
  • American Society of Interventional Pain Physicians
  • North American Spine Society

Special interests

  • Musculoskeletal disorders
  • Stroke and neuromuscular deficits
  • Traumatic brain injury
  • Neuromusculo-skeletal pain injections
  • Spinal cord disorders


Top 10 Most-cited Joint Commission Standard for First Half of 2015

The Joint Commission regularly aggregates standards compliance data to pinpoint areas that present the greatest challenges to accredited organizations and certified programs.  The 10 most frequently cited requirements are listed in decreasing frequency for each program. Percentages indicate the number of organizations that received Requirements for Improvement (RFIs) for the standards shown. Below we have highlighted those standards (*) that AH was cited on during our Joint Commission Survey of March of 2014.  Please help prevent repeat findings.

*Allegiance Health was cited on all top 10 most-cited standards during the March 2014 survey.

  • EC.02.06.01: Maintains a safe environment: 59%
  • IC.02.02.01:  Reduces risk of infections with medical equipment, devices, & supplies:  54%
  • EC.02.05.01: Manages risk associated with utility systems:   53%
  • LS.02.01.20:  Maintains integrity of means of egress:  50%
  • RC.01.01.01: Maintains complete & accurate medical records:  48%
  • LS.02.01.30:  Provide & maintains building features to protect from hazards of fire and smoke:  46%
  • LS.02.01.10:  Building & fire protection are designed and maintained to minimize effects of fire, smoke & heat:  45%
  • LS.02.01.35:  Provide and maintain systems for extinguishing fires:  43%
  • EC.02.03.05: Maintains fire safety equipment and fire safety building features:  39%
  • EC.02.02.01: Manages risks related to hazardous materials and waste:  38%

*Allegiance Home Care Program was cited on 3 of the top 10 most-cited standards during the March 2014 survey.

  • PC.02.01.03 Provides care, treatment, or services according to orders or prescriptions:  39%
  • IC.02.01.01 Implements infection prevention and control activities it has planned: 26%
  • PI.02.01.01 Complies & analyzes data:  20%

*Allegiance Behavioral Health Program was compliant on all top 10 most-cited standards during the May 2015 survey.

Details of standards can be found on Ida through Verge links located on the left hand side of the home page.

If you have any questions, please contact Accreditation Specialists Teshna Thomas at ext.7104 or Sue Caines at ext.4269.

Exercise can help prevent future back pain by improving your posture, strengthening your back and improving flexibility.