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October 2012

From the Governor

This edition of the newsletter includes information on several upcoming events and webinars, a recap of the recent Board of Governors meeting I attended, an important update regarding a meningitis outbreak, our new members, and some items of interest. As always I would like to hear back from ACP members about we can be doing to bring new initiatives to the chapter. I can be contacted at jneal6@iuhealth.org or (765) 747-4350.

J. Matthew Neal, MD, MBA, FACP
Governor, Indiana Chapter


Don't forget to register for the 2012 Indiana Chapter Meeting!

November 9-10, 2012
The Marten House & Lilly Conference Center
Indianapolis, IN

For more information and to register, visit our News & Meetings page.

ACP Indiana Chapter Young Physicians’ Event

Julie Reed, General Counsel for ISMA, will be giving a seminar on “Negotiating Contracts” free from 6:30 to 7:30 at ISMA headquarters on October 9. The seminar is free of charge and food and drinks will be provided. If interested in attending please contact Donna Seawards at donnaseawards@gmail.com.


ACP Indiana Chapter Webinar: "Preparing Poster and Platform Presentations"

Wednesday, October 3, 2012, 6:30 pm EST

Justin Whitt, MD and Carrie Shue, PhD

Registration Link: https://www3.gotomeeting.com/register/503461542


1. Enable the participant to design a visually appealing poster that effectively and concisely portrays the scholarly work presented.
2. To enable the participant to properly organize relevant information into a poster or platform presentation.
3. To enable the participant to deliver an appealing oral summary of scholarly work, emphasizing effective public speaking tendencies.

Indiana University Health Ball Memorial Hospital is accredited by the Indiana State Medical Association (ISMA) to sponsor continuing medical education for physicians. IU Health Ball Memorial Hospital designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


ACP Board of Governors Meeting Recap

I just returned from the Board of Governors’ meeting in Vancouver where we discussed and made recommendations on the following resolutions to the Board of Regents (the College’s policy-making body), who will decide on the final disposition of these resolutions at its November 17-18 meeting. The BOG meets twice yearly (each fall and right before the Annual Meeting). It is a great opportunity to network with a diverse group of Governors from all areas and bring new ideas back to our Chapter.

A summary of the resolution recommendations sent to the BOR:

Recommended for Adoption:

10-F12. Supporting the Concept of “I’m Sorry” Laws

Recommended for Adoption with Amendments:

1-F12. Exploring the Benefits of Establishing a Mechanism to Engage Retired Physicians

3-F12. Working with ABIM and ABMS to Investigate Options to the 10-Year MOC Examination

6-F12. Advocating Against Institution of ICD-10 and Evaluating Other Options Including ICD-11

7-F12. Evaluating the Impact of Medicare and Medicaid Contractor Denials on the Quality of Care for Patients

9-F12. Developing a Position Paper on Acceptable Health Care Reform Measures that Engages Patients in Making Positive Health Care Choices

12-F12. Collaborating with Constituents to Develop Creative Solutions for GME Financing

13-F12. Exploring the Feasibility of Developing a Minimum National Educational Standard for All Disciplines that Grant Prescription Writing Privileges

Recommended for Adoption as Reaffirmation:

2-F12. Working with ABIM toward Reducing the Cost of Recertification

Recommended to Refer for Study:

4-F12. Recognizing and Endorsing Priorities for Primary Care Payment and Practice Reform

5-F12. Recognizing and Endorsing Priorities for Subspecialty Payment and Practice Reform

Not Recommended for Adoption:

8-F12. Supporting the Immediate Adoption of a Single-Payer Health Insurance System


11-F12. Drafting Policy on the Risks of Non-Scientifically Based Health Legislation


Multi-state Outbreak of Meningitis Following Epidural Steroid Injections of Methylprednisolone

The Centers for Disease Control and Prevention, along with state health departments, are investigating a multi-state outbreak of meningitis following epidural steroid injections (ESI) of preservative-free methylprednisolone. Many of these cases developed stroke in deep brain locations.

On September 18, 2012, the Tennessee Department of Health was notified of a patient with culture-confirmed Aspergillus fumigatus meningitis following ESI at a Tennessee ambulatory surgical center. Subsequent outreach demonstrated nine additional patients with clinically-diagnosed meningitis in Tennessee and North Carolina. Symptoms of meningitis, including headache, stiff neck, and fatigue, developed within one to four weeks post-injection. Five patients have developed additional focal neurological deficits due to stroke in the base of the brain or brainstem. All patients had a similar cerebrospinal fluid (CSF) profile with low glucose, elevated protein and high, neutrophil-predominant white cell count; CSF cultures on the nine subsequent patients are negative to date. Patients have generally received antibacterial antibiotics without improvement and although steroids have resulted in short term improvement in many patients clinical deterioration has followed steroid cessation.

All patients received one or more ESIs during July 30 to September 18, 2012. All patients received injections of preservative-free methylprednisolone acetate solution from a single compounding pharmacy. In addition, all patients received subcutaneous injections of lidocaine from a common manufacturer and skin prep with povidone-iodine from another common manufacturer.

To understand the scope of this cluster and identify possible etiologies, we are seeking information on patients with clinical meningitis, other neurologic infection (epidural abscess, spinal osteomyelitis, etc.) or cerebrovascular accident with symptom onset within 1 month following epidural injections since July 1, 2012.

Some facilities may have performed injections at other body sites, and because the source of these infections is not yet known, clinicians are encouraged to remain alert for and promptly report complications associated with these other types of injections.

Because Aspergillus meningitis can be difficult to diagnose, clinicians should consider this diagnosis in any patient presenting with similar signs and symptoms of neurologic infection post-ESI. Diagnosis of Aspergillus meningitis should be sought by evaluating CSF for Aspergillus (galactomannan) antigen; fungal cultures of CSF should also be performed, preferably following centrifugation concentration. Empiric treatment with amphotericin B or voriconazole should be considered if Aspergillus meningitis is suspected.

Clinicians who learn of suspected cases of clinical meningitis, other neurologic infection (i.e. epidural abscess, spinal osteomyelitis, etc.) or cerebrovascular accident with symptom onset within 1 month of epidural injection since July 1 2012, or who have identified complications associated with other types of injections, are asked to notify Dr. Joan Duwve, ISDH Chief Medical Officer, at 317-233-7164.


Items of Interest

School Debt, Income Expectations Discourage Med Students from Primary Care

HealthDay (9/28) reports on a new study published online Sept. 19 in the journal Medical Education, which found that "school debt and income expectations are two main reasons many medical students decide to enter a high-paying specialty instead of becoming primary care doctors." There is a shortage of primary care physicians in the US. Among the lowest paid of all physicians, "primary care doctors are front-line health providers and usually are the first to diagnose illnesses." The article says that "medical students who anticipated high levels of debt and placed a premium on high income were more likely to enter a high-paying medical specialty - such as dermatology, radiology or anesthesiology - than to enter primary care."

AAMC Says House Bill to Increase Residency Slots Is a Good First Step

Rep. Joseph Crowley (D-N.Y.) Sept. 25 introduced the Resident Physician Shortage Reduction Act of 2012, H.R. 6562. This legislation would increase the number of Medicare-supported residency slots by 15,000, or 15 percent, over 5 years. In a press statement, AAMC President and CEO Darrell G. Kirch, M.D., said, “This legislation is an important component of any effort to increase support for physician training and help ensure that all Americans can see a doctor when they need one.”

View the complete story

US Doctor Shortage Compounded By Increase In Insured Population

Bloomberg BusinessWeek (9/28, Wayne) reports on the "looming" doctor shortage in the US, which will be compounded in 2014 when the Affordable Care Act's insurance mandate goes into effect. According to HHS, there are currently 15,230 less primary-care physicians than needed, and the country is set to add 30 million newly-insured patients. Yet, "teaching hospitals aren't rushing to fill the void," mostly because Congress has capped enrollment in residency programs at 85,000 students a year. Lobbying groups are pushing for legislation that would provide funding for 3,000 more residencies a year. However, "deficit watching Republicans" don't want the government to fund the program.

Bayh Argues Against the ACA's Medical Device Tax

Evan Bayh, former Democratic Governor and US Senator from Indiana, writes an op-ed for the Wall Street Journal (9/28, Bayh, Subscription Publication) explaining the negative effects of the Affordable Care Act's 2.3% tax on medical devices. He argues that this tax could take away from the industry's ability to compete on a global scale, and will likely lead to job loss. Bayh concludes that the negative state of the economy should make the choice clear to Congress, to take away the tax or suffer the consequences.


Welcome new ACP Members from July-September!

  • Nabil Abdo, MD
  • Zhanna Albany, MD
  • Mary S Baker, MD
  • Bhuvaneswari Burugapalli, MD
  • Brian E Cunningham, MD
  • Jacques R Daoud, MD
  • Tyler Lee Davis, MD
  • Eric Djenge, MD
  • Ann DeBourcy Flynn, MD
  • Santi Gottumukkala, MBBS
  • Michael J Hornbecker, MD
  • Karthik P Karanam, MBBS
  • Samuel Wamathai Kimani, MBChB
  • Venkata L P Kureti, MD
  • Munish H Lapsia, MBBS
  • Annamarie Lim, MD
  • Prasanna K Marpu, MBBS
  • Jeffrey Meglin, MD
  • Michelle D Miller, MD
  • Nicholas R Newsom, MD
  • Khawaja O Omar, MD
  • Sangeetha Pabolu, MBBS
  • Jim Parkerson, DO
  • Adam J Patrick, MD
  • Karthik R Polsani, MBBS
  • Christen Prible, MD
  • Stephanie A Riggen, MD
  • Viplove Senadhi, DO
  • Timothy J Shoemaker, MD
  • Jennifer Shoreman, MD
  • Marcella Tashjian, MD
  • Nora Vasquez, MD
  • Audrey M Wehr, MD
  • Manu C Joseph
  • Sarah D Pace, MD


Contact Information

Indiana Chapter Governor:
J. Matthew Neal, MD, MBA, CPE, FACP, FACE
Email: jneal6@iuhealth.org
(765) 747-4350; Fax (765) 751-1451

Donna Seawards
Executive Director
Email: donnaseawards@gmail.com
Ph: 623-225-5527

Chapter Address:
4319 West Clara Lane, PMB #288
Muncie, Indiana 47304