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Governor's Newsletter, Spring 1999

Governor's Column

James L. Bernene, MD, FACP
Governor, Connecticut Chapter

Greetings To All - and a special welcome and congratulations to our new Fellows inducted this year - a listing which you will find in this newsletter. I had fully intended to publish this addition in early spring, but so much for that plan! Nevertheless, the Council of the Connecticut Chapter and I have been busy on a number of fronts - as you will see from the columns of Drs. Dolinsky, Wu and McLean. Let me itemize what I feel to be the most important accomplishments and future issues that we need to deal with.

First, the Board of Regents officially approved our amalgamation (Connecticut ACP with Connecticut Society of Internal Medicine) during its April meeting. I view that as a major accomplishment for us and with our new combined organization, we should all be better able to pursue our goals. These goals should and do include not only representing and serving as an advocate for the majority of the practicing internists in our state, but also our residents and students in training as well.

Secondly, we now have a Chapter web site! This is largely thanks to the hard work of Paul Dolinsky. We plan to expand the content of our site over time to include local material for both residents and students, so it should have broad interest to all our membership. I hope you will find it useful. We can certainly try to establish an area where we can dialog about topics and major issues that we will face in the future.

Members of our Council have also been very involved in both health and public policy issues at state and national levels. Rob McLean and Paul Dolinsky have been our leading spokespeople for our stands on advanced nurse practitioner legislation and smoking bans in public places among several other issues. In addition, Rob and Paul recently went to

Washington on our behalf to lobby our representatives regarding the vital issues of medical insurance coverage for all Americans, restructuring of Medicare and funding of graduate medical education.

The College has stands on all of these issues nationally, but it behooves all of us to remain extremely vigilant in our reading of the political agendas in both Connecticut and nationally. Our professional lives will be greatly affected by what happens in both Hartford and Washington over the next few years. We intend to remain very active in the political process as an organization.

This should in no way diminish our goals regarding professionalism, graduate medical education and the rights of our patients. The Chapter will continue to remain strong in its educational endeavors and our recent scientific session for the associates chaired by Thom Lane, and Greg Buller is a marvelous example of this. There were over 100 oral and poster presentations, the quality of which was really remarkable. Ed Cadman, the keynote speaker, traced for us the important heritage of medical research and clinical investigation and the participation of residents in training in research. The resident physician talent we have in our training programs in Connecticut is truly impressive and needs to be encouraged in their research endeavors.

I hope you can get some feeling from the above that it has been an extremely busy and productive year for the Chapter. We are in the final stages of planning our Annual Meeting to be held October 6, 1999, at the Trumbull Marriott where Dave Podell and his Planning Committee have put together a wonderful program whose focus is on Professional Ethics of Medicine. In addition, we will have the privilege of having Dave Gullen, Chair of the Board of Regents, and Alan Nelson, Director of the College's Washington office provide their insight into what the national scene looks like and what the future may hold.

I look forward to hearing from you regarding any of the College's activities and please try to use the Chapter's web site which we are attempting to keep current for you.

Have a happy and healthy summer.

ACP Medical Student Committee Report

Barry Wu, MD, Chair

This year a new award was established to recognize one graduating medical student from Yale University School of Medicine and one from the University of Connecticut School of Medicine, who is entering a 3-year internal medicine residency in Connecticut. The award was established to recognize the outstanding academic achievement and community service of students and to promote internal medicine in Connecticut. This year, 24 of 89 graduating students from Yale and 21 of 88 graduating students from the University of Connecticut are entering internal medicine. Ten students will remain in Connecticut for their internal medicine residency. This year's award recipients are Nicole Rabidou from Yale and Catherine Holmes from the University of Connecticut. Each of the students received a certificate from ACP and a $500 award.

This was the fifth year that medical students have participated in the Spring Scientific Meeting. The meeting was held at the Trumbull Marriott on May 14. Jennifer Botte and Stacey Raczka, both second year students from the University of Connecticut, presented an abstract on "Healthcare on Tobacco Farms: Connecting Medical Students with Migrant Farm Workers." Erika Riley a fourth year student from the University of Connecticut, presented an abstract on "Religious Participation and Sexual Risk Taking in an Urban Clinic Population." Azita Hamidani a third year student from Yale presented an abstract titled "Quality of Life Index for Hemorrhagic Stroke."

I am particularly thankful for the help of 2 of our new committee members: Nancy Angoff, MD, MPH, Associate Dean of Student Affairs, and Ellen Nestler, MD, Associate Professor of Medicine & Director of Ambulatory Medicine at the University of Connecticut. If you are interested in participating on this committee, please contact me at bwu@srhs.org. We are planning medical student jeopardy for the Fall 1999.

The Word from Washington

Robert McLean, MD, FACP

On May 25-26, Drs. Paul Dolinsky and Robert McLean participated on behalf of the

Connecticut ACP Chapter in the legislative activities designated as "Leadership Day on Capitol Hill 1999." We joined over 150 other physicians from across the country who traveled to DC for the opportunity to discuss several important health issues in person with legislators and staff.

The major topics emphasized included: 1) beginning to address the problem of the uninsured with a specific ACP plan involving tax credits and improving coverage for all Medicaid-eligible individuals; 2) opposing any "defined contribution" Medicare restructuring without first pilot-testing; 3) supporting proposals for "all payer funding" for graduate medical education; 4) supporting patient protection legislation which truly makes managed care plans liable for decisions and which mandates that medical necessity is determined by the physician; 5) supporting legislation protecting the confidentiality of patient medical records; 6) supporting the easing of anti-trust rules to allow physicians to more effectively negotiate with an ever-enlarging insurance industry; and 7) supporting gun control efforts as a public health measure.

We met with Rep. Rosa DeLauro personally and found her to support all our positions. In our meetings with Health Policy staffers for Sen. Lieberman, Sen. Dodd, Rep. Johnson and Rep. Shays, we found some of our positions received mixed political responses. Please see the Chapter web site for details of our visit and the positions of these legislators on some of these issues. Hearing from physician constituents on these issues will have an impact, and see how easily this can be done through the web site.

ACP Chapter Web Site

The Connecticut Chapter web site is active and on line. You can access it from the ACP web site now - navigate to "About ACP" on the left margin, then to "Chapter Web Pages". Our site will be a repository for newsletters and other current information, including links to communicate with the Chapter leadership. The Chapter by-laws, which define the functions of our group, are also posted for review. Up to date information from committees will be available. For example, we have posted letters presented to the Connecticut State Legislature Public Health Committee in our effort to ban public smoking in restaurants and bars. Links are available to other Connecticut organizations, such as hospitals, medical schools, insurance companies, our Medicare carrier, State agencies and other medical organizations. This will be a work-in-progress and we hope to expand its function and usefulness in the future.

We need a photograph for the introductory Connecticut web page! We would appreciate your entries. Please send them to: Nancy Sullivan, 30 Dwight Drive, Middlefield, CT 06455.

Glaucoma 2001

The Connecticut Society of Eye Physicians (CSEP) is promoting a campaign titled "Glaucoma 2001," developed by the American Academy of Ophthalmology. Its goal is to reduce the incidence and degree of visual loss from glaucoma by heightening awareness among primary care physicians of the risk factors associated with developing glaucoma.

History

People are at greater risk of developing glaucoma if they:

  • are over 40 years old (increasing with age);
  • are African-American;
  • have a family history of glaucoma (siblings>parents>first degree relatives);
  • are diabetic;
  • are high myopes; and/or
  • those over 40 who have not had an ophthalmologic exam in over 2 years.

Exam

  • have elevated intraocular pressure; and
  • have large optic nerve cup to disc ratios.

The Eye MD's of Connecticut urge our colleagues to help in our efforts to preserve our patients' vision by identifying those who are at risk and referring them for complete ophthalmogogic evaluation.

For more information and materials for your staff, contact CSEP at: (860)567-3787 or the American Academy of Ophthalmology at: (415)561-8500.

Chapter Health & Public Policy Committee

Robert McLean, MD, FACP

The Chapter Health & Public Policy Committee leadership has worked closely with the legislative liaisons of the Connecticut State Medical Society (CSMS) during the current January to June legislative session in Hartford. Most of the legislative work from January through March involved different committees in Hartford deciding through hearings which specific bills of the myriad proposed would actually be passed along to the General Assembly and in what amended form (altered language, combining similar bills, etc).

Our Committee chose as a legislative priority to support a bill to disallow smoking in public restaurants. We tried to mount a grassroots letter-writing campaign by discussing the issue at conferences at several of the hospitals and posting information about the issue in hospitals' physician lounges. CSMS supported us in these efforts, but the Public Health Committee decided to not raise the bill. As of mid-May, there is still an opportunity for the bill to be amended to another tobacco-related bill which remains alive, and the CSMS lobbyist is currently working on this.

As the internists' voice, we provided much input to CSMS during efforts to settle the issue of advanced practice registered nurse independence. After much negotiation, compromise language was reached which requires all APRNs to work in a formal collaborative relationship with a physician, and this relationship must be in writing if the APRN is going to have any prescriptive authority. It would be the responsibility of the physician and the APRN to structure the relationship appropriately and to adequately address and provide for quality patient care, including specifically stating in the agreement a method of disclosure of the collaborative relationship to the patient. This bill has apparently been passed by the Public Health Committee and is to be considered by the General Assembly.

Managed care reform legislation has been the biggest health topic in Hartford this year. Several bills have come out of various committees and are to be combined into one comprehensive piece of legislation. We still hope to see the inclusion of six key issues: 1) fairness standards in physician contracting; 2) managed care liability; 3) privacy of medical records; 4) elimination of restrictive drug formularies; 5) medical necessity determined by physicians; and 6) improvements in the 1998 timely payment legislation. Among many issues that did not survive was a bill requiring state licensure of HMO medical directors. Please see the CSMS web page for updated information on some of these legislative topics. A final bill and vote will likely occur in early June.

At the national level, many similar discussions are taking place about managed care reform and other issues like prescribing pain medications for the terminally ill, Medicare reform and improving health care access to the uninsured. At a state Health Policy networking session I attended at the ACP Annual Session in April, there was much discussion of the just introduced "Access to Care Plan" as a first step toward universal coverage by advocating the use of tax credits, expansion of Medicaid coverage, and subsidies for COBRA coverage.

Please check the ACP home page for "Call to Action" alerts where you can express your important opinion to your representative in Congress on active issues. "Where We Stand" provide excellent summaries of ACP positions on some of these crucial topics and what sort of actions we are and should be taking to make our voice heard.

Many other chapters like ours have begun to work through their state medical societies as more efficient ways to have our voices heard and utilize lobbying networks already in place. In this climate where legislative action has such a direct impact on our efforts to simply provide appropriate medical care to our patients, physicians must remain informed and willing to speak out as advocates for our patients and the public health. We cannot sit back and assume that the voice of reason will prevail! We need to establish a more effective grassroots network of physicians in the state to help in our efforts. Please follow our new Chapter we page where we hope to keep you informed of current Health & Public Policy news, and join our list of e-mail alerts to help on the issues which need physician input when advance notice is short.

Medical Knowledge Challenge ("Medical Jeopardy")

Sherri Clayton, MD, FACP

The National American College of Physicians has an Associates Medical Knowledge Challenge Tournament and for the first time in the chapter's history, Connecticut participated by sending a team to the national ACP meeting. Preparation for this event is a great way to study for the internal medicine boards and have fun while you do it!

Dr. Rob Nardino and myself, both from the Hospital of St. Raphael, organized this event which was held at the Hospital of St. Raphael in New Haven. Ten Connecticut Internal Medicine Residency programs participated in a round-robin playoff to determine which team would go on to represent CT at the national meeting. The University of Connecticut Internal Medicine program with associate members, Rob Zenenberg, Anke Pohl, Adil Sanaulla, Ramesh Venkatarama and organizing chief resident, H. Vikram defeated nine CT teams and came out with the winning trophy which will be passed on annually to the winning CT hospital. They also received an all-expense paid trip to the national meeting in New Orleans to play in the tournament.

The final competition was held in New Orleans on April 22, 1999. Known as "Doctor's Dilemma," this event included seven chapters from across the US and one Canadian chapter. The eight teams were divided into two groups of four teams for the preliminary match. The winner from each group went on to the final round. UCONN, representing the Connecticut Chapter, and the University of Miami, representing the state of Florida, beat the other teams and qualified for the finals.

An anxious and tense crowd of resident and attending physicians watched in amazement as the two finalists battled for the crown. The scores were tied and all that remained was the final jeopardy question. Risking their entire score for the final wager, the UCONN team emerged victorious as winners with the correct answer to the final answer. A hard act to follow next year, but the Connecticut Chapter seems up the challenge for a repeat performance!

1999 Spring Scientific Session Awards

Tom Lane, MD, FACP

The ACP Connecticut Chapter held its 1999 Annual Spring Scientific Session on May 14, 1999 at the Trumbull Marriott Hotel in Trumbull. The following awards were presented:

Oral Presentation Awards

First Prize: Josette Boukhalil, MD (Griffin Hospital Program) - "Nutrient Effects on Endothelial Function: A Randomized Double-Blind Cross-over trial in Healthy Adults"

Second Prize: Gabriel Uwaifo, MBBS(UCONN Internal Medicine Program) - "Primary Hyperaldosteronism As An Important Cause of Resistant Hypertension"

Third Prize: Anu Gupta, MD(Yale Internal Medicine Program) - "The International Health Program: The Fifteenth Year Experience with the Internal Medicine Residency Program at Yale University"

Poster Presentation Awards

First Prize: Ramesh Venkataraman, MD (UCONN Internal Med Program) - "Coronary artery Dissection Caused by a Softball: A Case Report of a Delayed Presentation and Success for Therapy"

Second Prize:Anita Saran, MD (Yale Primary Care Int. Med. Program) - "Successful Treatment of Lupus Glomerulonephritis with Myclophenolate Mofetil"

Third Prize:Zhong Zhao, MD, Ph.D.(Norwalk Hospital Program) - "The Timing of In-Hospital Mortality among Patients with Pneumonia and Pneumococcal Bacteremia"

Highlights of Hartford Legislative Sessions

Be aware that there was a budget cut which eliminates Medicaid co-payments and deductibles for dual eligible Medicare patients, effective July 1, 1999!

This will affect your pocketbook directly, and it passed despite aggressive lobbying by CSMS on behalf of all physicians. The Managed Care Accountability Act which did pass has several important provision and we want to highlight the creation of an Office of Managed Care Ombudsman, effective October 1999.

We must inform this office with any and all problems we or our patients encounter. Otherwise, the bureaucrats will be led to believe there are no problems! Please see www.csms.org for a full Legislative Report.

Save the Date

1999 ACP Connecticut Chapter Scientific Meeting
Wednesday, October 6, 1999
Trumbull Marriott Hotel
Trumbull, CT
8:00 AM - 4:40 PM

"The Doctor's Dilemma-Ethical Challenges Facing Medicine in the 21st Century"

Brochures will be mailed out in August. For more information, please contact Nancy Sullivan, Exec. Secretary., ACP Chapter, at 860-349-8995 or e-mail at 76032.660@compuserve.com.

Contact Information

Robert Nardino, MD, FACP
ACP Governor, Connecticut Chapter

Nancy Sullivan
30 Dwight Drive, Middlefield, CT 06455
Phone: (860) 349-8995
Fax: (860) 349-3004 or
E-mail: ctacp@comcast.net

Visit the CT Chapter Blog