The Louisiana State Medical Society was formed in 1878 with the sole purpose of advancing "healthcare in the state of Louisiana. Today our mission is to be the trusted advocate for patients and physicians in the State of Louisiana. Learn more about the history of LSMS here: https://lsms.org/page/History.
JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY VOL 177 | ISSUE 2 | FALL 2025 2025 H D Annual Meeting
Stability, Strength and Service >e»re here to help you navigate these changing tiTes >ith Tore than years oM e_perience LAMMICO provides Tedical proMessional liaIility insurance coverage so that you can practice with confidence – confidence that your coverage is reliaIle and your reputation will Ie protected Aggressive legal deMense personaliaed claiT handling and accredited risk TanageTent education are the Iedrock oM our Iusiness Our dedication financial strength and rock solid track record ensure that with LAMMICO as your partner you can Mocus on what Tatters Tost! your patients
VOL 177 | ISSUE 2 | FALL 2025 CONTENTS
CHIEF EXECUTIVE OFFICER Je Williams
BOARD OF GOVERNORS President, Thomas Trawick, Jr., MD President-Elect, Allen Vander, MD Immediate Past President, Roderick Clark, MD Secretary-Treasurer, Amberly Nunez, MD
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CENTURY CLUB
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PRESIDENTIAL SPEECH, THOMAS TRAWICK, JR., MD
Speaker, R. Reece Newsome, MD Vice Speaker, William Freeman, MD Council on Legislation, Chair, Matthew Giglia, MD Ex O cio, Physicians PAC of Louisiana, Chair, Susan Bankston, MD
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INAUGURATION LUNCHEON
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TRAWICK INSTALLED LSMS PRESIDENT 2025
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INAUGURATION PARTY
BOARD OF COUNCILORS District One, Myra Kleinpeter, MD District Two, Luis Arencibia, MD District Three, VACANT District Four, Randall White, MD District Five, VACANT District Six, Michael Roppolo, MD District Seven, Donald Higgins, MD District Eight, VACANT District Nine, VACANT District Ten, Michele Cooper, MD
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LSMS HALL OF FAME
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SPEAKER MIKE JOHNSON FOR LSMS
BOARD OF GOVERNORS OFFICERS
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MIDDLE EAR MIXED EPITHELIAL AND NEUROENDOCRINE TUMOR MEMENET STATUS POST MASTOIDECTOMY WITH METASTASIS TO THE LIVER
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50 YEAR PHYSICIANS
SECTION REPRESENTATIVES Medical Student Section Member, VACANT
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HOD 2025 ANNUAL MEETING
Resident/Fellow Section Member, Omar Leonards, MD Young Physician Section Member, Ken Ehrhardt, MD Employed Physician Section Member, Clay Runfalo, MD Private Practice Physician Section Member, Lance Templeton, MD
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FIFTIETH ANNIVERSARY OF LOUISIANA’S MEDICAL MALPRACTICE ACT
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IN MEMORIAM: WILLIAM OSLER HUCKABAY, JR. CAPT USN RET.
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WELCOME PARTY
SCAN TO DONATE
LOUISIANA MEDICAL POLITICAL ACTION COMMITTEE LAMPAC
Disclaimer: The author(s) of each scienti c article appearing in this Journal is/are solely responsible for the content thereof; the publication of an article shall not constitute or be deemed to constitute any representation by the Louisiana State Medical Society that the data presented therein are correct or su cient to support the conclusions reached or that the experiment design or methodology is adequate.
LAMPAC needs your help to ensure that the LSMS advocacy e orts have the support they need at the capitol. Our friends in the legislature need to know that we appreciate the e orts they have made, and will continue to make, on behalf of the LSMS. Contributions start at $50. For more information, please visit www.Isms.org.
lammico.com 800.452.2120
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CENTURY CLUB
Sharing
2025 Renewals
• SLMA • Lafayette Dermatology & Cosmetic Center • Womens Hospital • Retina Associates New Orleans • The Eye Clinic • The Skin Surgery Centre • Rhodes Pediatric Clinic • Shreveport Eye Clinic, AMC • Mid Louisiana Surgical Specialist, APMC • Gulf South Eye Associates • The Family Clinic of CROWLEY • Center for Orthopaedics • Drs. Schwartzenburg, Lafranca, Guidry, & Chapman (SLGC) • The Dermatology Clinic
• Mid Louisiana Consultants • Alexandria Women’s Center, LLC • The Family Doctors • Children’s Clinic of Southwest LA • Colon & Rectal Associates • Je erson Radiology Associates • Houma Radiology • Access Radiology Associates - Lake Charles • Freedman Memorial Cardiology Clinic
ADVOCACY • LEGISLATIVE • REGULATORY LSMS CENTURY CLUB TORY UB
• Acadiana Family Physicians • Vascular Specialty Center, LLC
both the physician and his or her group or employer. The LSMS has a long history of working with our Century Club members and leadership
• Cardiovascular Institute of the South • GastroIntestinal Specialists, A.M.C. • Alexandria Neurosurgical Clinic • BR General
THE FOLLOWING EXCLUSIVE CENTURY CLUB OPPORTUNITIES ARE OFFERED:
• Group CEOs have direct access to LSMS EVP/ CEO and LSMS Advocacy Team. • Physicians can get directly involved in issues that
• Practice or group logo and news is promoted on LSMS social media outlets and in e-newsletter, Capsules & Journal of the LSMS • Special pricing varies. Group billing is o ered if your practice is not ready to commit at 100% participation. • One convenient bill to reduce sta and administrative burdens. • Easy renewal process.
New 2025 Century Club Groups
may otherwise be seen as self-serving, such as reimbursement and scope of practice issues. • LSMS can address issues that are priority for practicing physicians but while important, may not be a priority for a system.
• The Fertility Institute Of New Orleans • LSUHS Monroe • Mary Bird Perkins
• Gastroenterology Group AMC • WK Pierremont Pediatrics
• Members can gain valuable experience through the LSMS that will help them pursue leadership positions with their practice or hospital.
If your practice employs ve or more physicians, please contact Medical Group Engagement Manager, Kristen Broussard, at kbroussard@lsms.org or 225.763.2323 to discuss your Century Club membership today
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PRESIDENTIAL SPEECH THOMAS TRAWICK, JR., MD Thank y, Dr. Clark. I appreciate y and am h ed to follow y. It will be my privilege to represent each of y as the 145th President of the Lisiana State Medical Society.
I want to start by thanking Dr. Clark for his service to our society. For 11 years, Dr. Clark has served the LSBME as the representative of the LSMS and this year, for the second time as president of the Louisiana State Board of Medical Examiners. We are so blessed to have such a sel ess servant who gives so much of his time to furthering our society. Your service on the LSBME has been invaluable for all of these years and we are proud to have you representing the LSMS on this board.
And it takes time for you to realize who your giants may be. You may know them in the most mundane way only to grow up and nd out what they did for you but you never knew. I have three people that I’m going to tell you about. Growing up in Monroe, LA, Dr. John Cooksey was my Ophthalmologist, his daughter, Karen and his family were dear friends that we went to church with. Dr. John was a humble, quiet man and I had no idea of his impact on Medicine or the story that I would learn many years later. My Aunt Mary, sister to my dad, was married to Dr. Harry Winters and they lived in Caldwell Parish. He was a strong in uence in my decision to become a physician. I always knew Aunt Mary was connected with politics, but never understood her in uence on our profession. Dr. Donald Palmisano, a surgeon from New Orleans and former President of the LSMS and AMA, was truly larger than life to me. His obituary described him as a true renaissance man and as a young physician in the medical society, that is the way I remember him. What do the 3 of these unlikely individuals have to do with me and Act 817? This is where it gets interesting. At the 40-year anniversary, Dr. Palmisano addressed our House of Delegates in Baton Rouge and shared the history. I met him afterwards and told him thank you for his work. He credited Dr. Cooksey, my eye doctor, for traveling to Indiana and crafting this legislation for our state. As I walked o , he tapped me on the shoulder and said he just heard who I was and asked was my aunt, Mary Lou Winters? I shockingly told him yes and he said, “Well, then you need the rest of the story.” Dr. Palmisano shared that for months, he and Dr. Cooksey traveled the state meeting with physicians and key legislators. Finally, it came before committee and there was one senator that was a hold out. If this bill could just get out of committee, the Senate and House would pass the bill and Governor Edwards would sign it, but it looked like it was going to die in committee because it lacked the one vote needed to get out. He said, “we had to call in reinforcement, we had to call our secret weapon, Mary Lou Winters.” All of you have heard Maria say, ALL POLITICS ARE LOCAL. Back in the 70’s, legislators had phones on their desks and the phone campaign from physicians and especially the auxiliary of the LSMS was spectacular. Dr. Palmisano said it was fun to watch the legislators
I would like to introduce my family table…
At this time, I would like to recognize the sta of the LSMS – Je Williams...Executive Vice President and CEO
Maria Bowen...VP, Governmental A airs
Lauren Bailey...VP, Legal A airs
Amy Tyrell...Director of Membership - Thank her for picking up the running of the Annual Meeting. Terri had a lot in motion, but Amy is the reason we’ll pull it o !
Kristen Broussard...Manager, Medical Group Engagement
Magan Alfred...Membership Coordinator
Jeremy Lapeyrouse...HealthSync Director
As many of you know, I am a North LA Boy! Not sure if the accent gives it away or not, but I grew up outside of Monroe and I have lived in Shreveport for the last 34 years. Many of you probably have referred to Shreveport as South Arkansas or East Texas. In preparing for this address, I have learned that Shreveport has a very rich history with the LSMS. The very rst president of the LA State Medical Association, in 1878, hailed from Shreveport. Shreveport was the home town of the rst Female President of our society, Dr. Pattie Van Hook in 1992. We have the FIRST Surgeon General of the Louisiana Department of Health from Rayville, LA, and Deputy Surgeon General, Dr. Wyche Taylor Coleman, from Shreveport. In our 145-year history, I will be the 22nd president from Northwest LA. North LA has contributed much to our society. As you just heard in the rst session of the HOD, Act 817, Louisiana’s Medical Malpractice Act turns 50 yrs old, this weekend! One of my favorite LSMS stories that’s special to me, relates to its 40th Anniversary. Before telling my story, I think that it is important to recognize some of the physicians that are here with us today that were part of that legendary legislation – Dr. Pat Breaux, Dr. Larry Braud, Dr. Mike Ellis, Dr. Je White. In becoming President of the LSMS, I feel like I’m standing on the shoulders of giants. I hope for those of you who are young and just getting involved that you can one day say the same about all of us.
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to join. It is our responsibility to grow our membership, not the sta ’s!
the federal government passes down through legislation like the Big Beautiful Bill. This year, LSMS successfully passed a series of resolutions. The resolutions will go to our members of Congress from the Louisiana Legislature requesting federal action on prior authorization, AI in healthcare, the corporate practice of medicine, and PBM oversight. Louisiana has done what it can on entities that must follow Louisiana Law, but the very vast majority of the companies we all have issues with follow federal, not state law. We have to nd a way to play ball in Federal Politics because the AMA does not always represent us. Speaking of the AMA, our Executive Vice President, Je Williams, met with 9 other states to share ideas and gure out how to combine resources to take advantage of economies of scale. We have to start thinking outside the borders of our state on how we can bring innovation and resources to our members. We have so many more opportunities en masse! Louisiana now has 5 med schools in this state. If we do not cultivate a relationship with our med schools and the students that are the future physicians in this state, they will not have a society to protect them in the future. I truly enjoy seeing our medical students participate in White Coat Wednesday and this year, it was such an honor to have my daughter at the Capitol for the day. She asked me, “Dad, why were there not more med students present?” I pointed out how wonderfully involved VCOM in Monroe has been in our political advocacy and we talked about how to get the other schools involved. But, how do we think di erently about engagement in our academic colleagues? This is not a 1 size ts all approach. We do not have to do that same thing at every school, but I do think that we need to do something! Please, for those of you involved with medical schools or alums of medical schools in our state, reach out to your contacts to encourage them to bring us in. You are our best ambassadors. This is a great place to start with advisory committees and I would like focus on starting a medical school advisory committee. I feel so blessed to serve with some of the very best physicians in this state. I am grateful for the support from each of you and look forward to working for and with you. I trust you to use your relationships to our advantage. Each of you knows 3-5 physicians that are not members of our society and I am going to challenge you, this afternoon to reach out to them and share why you are a member of the LSMS and convince them
third party payers. With the resulting signi cant monetary settlement that was awarded, these groups chose to create a national 501(C)3 organization that champions physician needs and research across the country. One of the primary priorities of The Physicians Foundation is Physician Wellbeing to address with urgency the immediate and ongoing impediments to physician wellbeing and provide the basis for improved practice environments and professional ful llment. Through the grants that they give and the tool kits that they o er, organizations and states are better able to build these programs. It is my hope that no physician fails to get help when they need it. We are very fortunate to have Dr. Susan Bankston as a National Board Member of this organization. Thank you, Dr. Bankston, for your service to this worthy cause. My priorities this year will be few, but deliberate. As we have seen our membership drop, it is incumbent on us, the Louisiana State Medical Society, to de ne value for our members. Remember the Value Equation in Value Based Healthcare –
squirm when they would receive calls from the spouses of their physicians about this legislation. They masterfully contacted the legislator’s personal physicians and had them call their “patient” and try to in uence them to vote for this important piece of legislation. Anyway, one Senator was the holdout, he refused to meet with anyone to discuss this legislation. Dr. Cooksey, Uncle Harry, and Aunt Mary chartered a plane from the Caldwell Parish Airport and ew to Baton Rouge. Dr. Palmisano said that he, Uncle Harry and Dr. Cooksey were hiding around the corner and watched Aunt Mary work. She approached the Committee Room, opened the door, and motioned for that Senator to come out. Kisses on the cheek and pleasantries ensued, a 30 second discussion and repeat kiss, and the senator returned to the committee room. Aunt Mary made her way back to the hiding physicians. In her signature, raspy voice, she said, “Baby, you got your vote!” The rest is history. HB 1465 came out committee, passed both Houses and was signed by Governor Edwin Edwards on August 4, 1975, to become Act 817. This bill carries immense signi cance and we need to remember and thank those that have in uenced medicine like this. We also need to remember that in the noisy world of social media and the internet, it’s more important than ever to make personal connections. We have seen our profession change so much over the last several years. Despite these changes, so much has stayed the same. In the Year I was born, 1968, The House of Delegates had a 4 Day meeting in May and a special 1-day meeting in November. You will never guess what they were addressing…Hospitals employing physicians. The LSBME reported to the HOD that they were recommending to the LA Legislature an increase in our licensing fees from $10 to $15. There were over 300 delegates in attendance. There were over 23 written and verbal reports from Committees. There were committees for everything with very little sta involvement. I am very interested in bringing back some of these committees that will have far reaching arms and allow you to be better involved in your society. Based on your interest in where to serve and through these committees, we will tap into areas that interest you and better our organization. I graduated from medical school in 1997, and that was the year Dr. Michael Ellis was inducted as President of the Society. His inauguration speech then was Let’s RAPP and although I can assure you that I am not as talented as Dr. Ellis in my rapping skills, his acronym for “Representing Aggressively Patients and Physicians” and his discussion points of Leadership, Membership, Advocacy, and Political Representation are topics that you will hear throughout my address. During that year, Medicaid was facing a de cit, due to a decrease in Federal funds and a “new” 501c3 organization was formed to assist the Physicians Health Program and is still in existence today. Resolution 119 that year, was introduced by the Shreveport Medical Society to authorize $75,000 to the New Physicians’ Health Foundation of Louisiana. This con dential foundation has helped thousands of our healthcare colleagues struggling with mental and physical conditions that are from the real stressors and pressures of being a caregiver for so many of their own patients. This foundation has a very special place in my heart! I have seen, rsthand, the toll that stress from our jobs and caring for others can take on our families and our personal health with the death of my brother-in-law, Dr. Chad Hargon, an oncologist from Shreveport. He was my med school roommate, my friend, and my brother-in-law. I’m so grateful, that as a profession, we’ve dedicated time and energy to removing the stigma associated with our own peers needing help. Today the emphasis on physician wellness continues to evolve across the country. LSMS is also part of that history, as we were one of 19 medical societies who participated in a class action lawsuit against
I want to go back to where I started. I mentioned 1968 and 1997 – the year I was born and the year I graduated from medical school. I shared what they were discussing then which happens to be what we are still discussing now. I guess the saying “what’s old is new again” is true! Back then it was all about politics and advocacy. Today it’s all about politics and advocacy. Please help me make our colleagues care! Friends, we need to go back to 1968 and make some daisy chains. Relationships are key to our success! They are important for us to have with each other. They are equally important for us to have with our legislators. Please get to know your elected o cials. Serve as experts to them. Keep in close contact with them. This is vital because if we are not helping them understand our profession, who will? I repeat, WHO WILL? It won’t be your friend or mine. It will be someone who has political goals that are inconsistent - at best - with ours. I’ve watched Dr. Giglia and the Council on Legislation work more than overtime during session. I would like to recognize Dr. Giglia and the entire COL and thank them for there tireless service to our Society. They meet weekly, and they respond immediately when asked. They are informed, involved and passionate about our profession. I urge you to engage with them and embrace their e orts. Organizations like LSMS o er you many bene ts and opportunities, but at the end of the day, they were built to protect you and your profession from political intrusions. We’re reaching a point where complacency and apathy are causing harm. It’s all hands-on deck for the foreseeable future. Ask Dr. Giglia or Maria to come to your practice, your meeting, your legislative visit. Give them the opportunity to give you the tools to advocate. I have watched our profession change so much, over my career, but I still believe that there is no more noble profession as medicine. To close, I want to reiterate the words you just heard that Dr. Donald Palmisano said at the 40th anniversary of the LA Medical Malpractice Act… “It now is up to the youth in medicine to ght to maintain ethical science-based medicine as well as a fair medical liability system so doctors can continue to advise, heal, and comfort patients in the trusted role of physician. The future is yours. Guard it well.”
Value = Quality/Cost
People will pay for value and not only do we have to de ne that value, through a grass-roots e ort, we have to sell it! As was a topic of discussion in 1968, physician practices have changed over the last two decades with nearly 60%, currently employed. Katrina accelerated this but we are still responsible for our profession and the direction it is taking. Why would we let non physicians and legislators dictate how we practice medicine and how we care for our patients? Passively sitting back and letting others guide our profession is not sustainable and, I believe, is what is contributing to early burnout of Louisiana physicians and the destruction of our profession. Not only in our state society, but locally, in our hospital medical sta s, we are watching physician interest in serving on committees and medical sta wane. This disinterest and complacency are what is tearing down our institution of medicine. One area that I will work diligently is to help Dr. Bankston achieve the rebranding of our Political Action Committee. Remind yourself, “All politics are local” and our members need to work together to remind our elected o cials that WE are the locals! All of us need to know our elected representatives and stay in contact with them. We’re here to help you, but we need each of you to commit to being involved. To make it easier, Dr. Bankston will be sharing how the PAC plans to use a regional concept with advisory groups to give You, our members and contributor some say in how the PAC makes decisions. We will start using these local advisory groups to contribute to your candidates that are friends of medicine in your area. You will be delivering these dollars to these candidates and OUR Reps and Senators will know exactly where this money came from! Within the rst few months, it is my goal to visit each LSMS district so our members recognize the value that the LSMS brings to them. It is so important that I am able to hear their needs rsthand. Please pick up the phone and invite me to events. I want to serve you and LSMS in a very visible way! I believe that we also have to get more involved in Federal Politics. A friend of mine who is a cardiologist says, we all work for the Government. The majority of us have a very large Medicare population in our practice. What is going to happen to us in LA with the One Big Beautiful Bill that just recently passed Congress? In this year’s Louisiana budget, Maria and others fought hard to get Millions of dollars and ensure that doctors in Medicaid are at least able to be paid at 85% of Medicare. Also, the Physician Loan Repayment was quietly funded, due in part, to the advocacy of the LSMS. These items could very easily be cut in future years as Louisiana deals with what
I look forward to serving you this year as your president and I will count it as one of the greatest honors of my career. ■
Payers share data, too! Seven information exchange insights to know. Health Data Management
Please welcome these new practices in 2025: • Pediatric Center of Southwest Louisiana • Pontchartrain Pediatrics • ACT ONE Health
Payers are increasingly participating in Health Information Exchange (HIE). From the payers perspective they are likely already receiving health data from many di erent sources related to managing their quality programs. The ow and maintenance of this data can be costly and time-intensive for them as each data source requires a one-o exchange and integration into their own data warehouse. HIE eases this burden for payers by eliminating the need for many data sources making data integration seamless for payer operations. This also reduces the burden on providers reporting quality measures to payers. The HIE can calculate those quality measures in real time for all parties. Please review the attached article for more insights into the sharing of health care data among payers and be on the lookout for the follow up articles.
HealthSYNC and the LSMS anticipate beginning a Value Based Contracting arrangement with LHCC in the rst quarter of 2025. Scan the QR code below for more insights into the sharing of health care data among payers and be on the lookout for the follow up articles.
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Inauguration Luncheon
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LSMS Elects Leaders Page 2
Dr. Trawick and his wife, Ronda, are the proud parents of two children: Allison Grace, a third-year medical student at LSU Health Shreveport, and Graham, a senior pre-health student at Baylor University. Elected to serve as the organization’s President-Elect was Allen W. Vander, MD. Dr. Vander is a fellowship-trained, board-certified nephrologist at the Kidney Center of South Louisiana in Thibodaux. Raised in Sulphur and a graduate of McNeese State University, Dr. Vander graduated from the LSU School of Medicine in New Orleans. He completed his residency in internal medicine at Earl K. Long Medical Center in Baton Rouge prior to attending the University of Florida for fellowship training. Dr. Vander and his wife, Emily, have two daughters, Elizabeth and Isabella. ---------- Established in 1966, the LSMS Hall of Fame recognizes LSMS members, who have contributed long-term meritorious service and valuable leadership to the Society. This year’s inductees are Susan M. Bankston, MD, a pediatrician from Baton Rouge and Richard J. Paddock, MD, a urologist from River Ridge. Susan M. Bankston, MD, is a pediatrician with the Baton Rouge Clinic who has been a member of the LSMS since 2003. Dr. Bankston has served in multiple roles within LSMS, including President of the society, demonstrating a deep commitment to her patients and the practice of medicine. Today, she continues to give her time as the current chair of the political action committee, a member of the Board of Governors and Executive Committee, as well as serving as the LSMS representative on the Physicians Foundation Board. She is married to David Voss. Richard J. Paddock, MD, is a urologist who has been a dedicated member of LSMS for more than forty years. Serving as Treasurer for over a decade before accepting the presidency, Dr. Paddock’s other roles within the Society include having been a delegate to the House of Delegates, a member of the Board of Councilors and LSMS Foundation Chair. Now retired, Dr. Paddock and his wife, Sheila, have two children and seven grandchildren. ---------- Other physicians assuming leadership roles: • Roderick Clark, MD, conducted the swearing in of Dr. Trawick and assumed the role of Immediate Past President. Dr. Clark is a board-certified nephrologist from Lafayette. • Amberly Nunez, MD, an anatomic pathologist from Baton Rouge was re-elected to serve as Secretary-Treasurer. • R. Reece Newsome, MD, a radiologist from Baton Rouge was re-elected Speaker of the House of Delegates. • Will Freeman, MD, a board-certified emergency medicine physician from Baton Rouge was elected Vice-Speaker. • Matthew Giglia, MD, a colorectal surgeon from Baton Rouge, was re-elected as Chair of the Council on Legislation. • Susan Bankston, MD, a pediatrician in Baton Rouge, LA, continues to serve as an Ex-Officio member through her Presidency of LAMPAC.
MEDIA RELEASE
Contact: Maria Bowen Vice President, Governmental Affairs mbowenKlsms.org L (227) 939-7776
For Immediate Release August 11, 2027
T. GSTEENH TRAWICK, JR., MD, OF SHREVEPORT INSTALLED AS LOUISIANA STATE MEDICAL SOCIET PRESIDENT – SPEAKER JOHNSON OFFERS CONGRATULATIONS
Allen Vander, MD, from Thibodaux elected President-Elect@ Bankston and Paddock named to Hall of Fame
Baton Rouge, LA – Thomas Steen Trawick, Jr., MD, of Shreveport was sworn in as the 167 th President of the Louisiana State Medical Society (LSMS) at the organization’s Annual Meeting and House of Delegates in Destin, FL. The House of Delegates is the official policy-making body for LSMS which meets to discuss current health care issues, decide on a course of action for the coming year, and welcome its new leaders. In his inaugural speech, Dr. Trawick acknowledged the impact North Louisiana has had on the LSMS. GNorth Louisiana has contributed much to our society. The very first president of the Louisiana State Medical Association, in 1878, hailed from Shreveport. Shreveport was the hometown of the first Female President of our society, Dr. Pattie Van Hook in 1992. We have the first Surgeon General of the Louisiana Department of Health from Rayville, LA, and Deputy Surgeon General, Dr. Wyche Taylor Coleman, from Shreveport. In our 167-year history, I will be the 22nd president from Northwest Louisiana. In becoming President of the LSMS, I feel like I’m standing on the shoulders of giants. I feel so blessed to serve with some of the very best physicians in this state. I am grateful for the support from each of you and look forward to working for and with you.H Dr. Trawick is a board-certified Internal Medicine physician who has been an active member of the LSMS since 2000, when he "oined as a resident physician. He currently serves as a private practice concierge physician with SureAccess MD and as Chief Medical Officer for David Raines Community Health Centers, a Federally ualified Health Center serving Northwest Louisiana. Dr. Trawick has served as President of the Shreveport Medical Society, Speaker of the LSMS House of Delegates, and Chair of the LSMS Finance Committee. Joining by video, Congressman Mike Johnson, Speaker of the House, congratulated Dr. Trawick, GI was delighted to hear that my dear friend, Dr. Steen Trawick, will be installed as the next president of our state’s medical society. If you donJt know Steen, and I donJt know how you couldnJt know Steen, heJs a Renaissance man, a man of faith, a committed mentor to future physicians, an active member of the Shreveport -Bosier community and a devoted husband and father. This is a well -deserved honor, and I wish I could be there with all of you to help celebrate. To everybody in the room today, please know that here in Washington we see and deeply appreciate your hard work and your dedication to providing the best medical care to the people of our beloved state. God less you all.( A native of Monroe, Louisiana, Dr. Trawick is a graduate of Louisiana Tech University and the LSU Health Sciences Center in Shreveport, where he completed his Internal MedicineBPediatrics residency and served as Chief Resident. Last year, he was honored as the 2026–2027 Distinguished Alumnus for Louisiana Tech’s College of Applied and Natural Sciences. He continues to contribute to the academic community as Medical Director of the Physician Assistant Program at LSU Health Shreveport.
Physicians elected to serve on the LSMS Board of Councilors: • Luis Arencibia, MD – Family Medicine – Metairie, LA • Michele Cooper, MD – Plastic Surgery – Mandeville, LA • Ken Ehrhardt, MD – Pain Medicine – Hammond, LA • Myra Kleinpeter, MD – Nephrology – New Orleans, LA • Mr. Gregory Laborde – Medical Student – Lake Charles, LA • Michael Roppolo, MD – Nephrology – Baton Rouge, LA • Clay Runfalo, MD – Family Medicine – Gonzales, LA • Lance Templeton, MD – Urology – Alexandria, LA • Randall White, MD – Pediatrics – Bossier City, LA
About the Louisiana State Medical Society
Established in 1878, the Louisiana State Medical Society (LSMS) serves as the trusted advocate for patients and physicians in the state of Louisiana. LSMS aims to promote excellence in the practice of medicine and is the largest voluntary physician organization in the state, representing all specialties.
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(225) 763-8500 | LSMS.org
Inauguration Party
LOUISIANA STATE MEDICAL SOCIETY 2025 HOUSE OF DELEGATES DESTIN FL Resolution H-1 SUBJECT: LSMS Hall of Fame INTRODUCED BY: Past Presidents Advisory Council
WHEREAS , the Louisiana State Medical Society established a Hall of Fame in 1966 to recognize its members, both living and deceased, who have contributed long-term meritorious service and valuable leadership to the LSMS, therefore be it RESOLVED , that in recognition of her dedicated service in both elected and appointed positions that uniquely contributed to the welfare of the LSMS, Susan M. Bankston, M.D. of Baton Rouge, be elected to the LSMS Hall of Fame.
LSMS HALL OF FAME
LOUISIANA STATE MEDICAL SOCIETY 2025 HOUSE OF DELEGATES DESTIN FL Resolution H-2 SUBJECT: LSMS Hall of Fame INTRODUCED BY: Past Presidents Advisory Council
WHEREAS , the Louisiana State Medical Society established a Hall of Fame in 1966 to recognize its members, both living and deceased, who have contributed long-term meritorious service and valuable leadership to the LSMS, therefore be it RESOLVED , that in recognition of his dedicated service in both elected and appointed positions that uniquely contributed to the welfare of the LSMS, Richard J. Paddock, M.D. of River Ridge, be elected to the LSMS Hall of Fame.
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Marketing That Sticks Sweeten Up Your Brand With Honey
SPEAKER MIKE JOHNSON FOR LOUISIANA STATE MEDICAL SOCIETY
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THOMAS TRAWICK, JR., MD President
RODERICK CLARK, MD Immediate Past President
ALLEN VANDER, MD President-Elect
AMBERLY NUNEZ, MD Secretary - Treasurer
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MATTHEW GIGLIA, MD Council on Legislation, Chair
LUIS ARENCIBIA, MD Chair of the Board of Councilors
WILLIAM FREEMAN, MD Vice Speaker
ROBERT NEWSOME, MD Speaker
16 J LA MED SOC | VOL 177 | FALL 2025
MIDDLE EAR MIXED EPITHELIAL AND NEUROENDOCRINE TUMOR MEMENET STATUS POST MASTOIDECTOMY WITH METASTASIS TO THE LIVER MITCHELL TA, MD, CHRISTIAN HUEBNER, MD, MICHELLE HONDA, MD, JEREMY NGUYEN, MD, FACR, RYAN CRAIG, MD, PHD, NEEL GUPTA, MD, JAGAN GUPTA, MD, AND JOSHUA DIENER ABSTRACT Middle ear, mixed epithelial, and neuroendocrine tumors (MeMeNETs) are particularly rare middle ear tumors whose nature has been subject to much discussion in the literature. We present a case of a 33-year-old man with partial left facial paralysis, hearing loss, otitis, and tinnitus. Imaging via computed tomography (CT) demonstrated a soft tissue mass in the left middle ear and external auditory canal. Frozen section pathologic examination of the mass following mastoidectomy revealed spindle features favoring a neoplastic process. The lesion was found to have both neuroendocrine markers (synaptophysin, chromogranin, and NSE) and epithelial cytokeratin marker (AE1/3), alongside a Ki67 proliferation index of approximately 30%, and was determined to be a MeMeNET. On follow-up status-post mastoidectomy and tumor excision, positron emission tomography and computed tomography (PET/CT) ndings were concerning for recurrent and metastatic disease. Subsequent liver biopsy con rmed metastasis, with repeat PET/CT 3 months later demonstrating uptake concerning for progression of disease in the liver while ruling out recurrent disease in the middle ear.
Figure E
Figure F
pre-operative CT, axial section
post-operative CT, axial section
Figure G
Figure H
FDG-PET/CT, axial sections, and MIP PET
PET/CT Ga-68, axial section, and MIP PET conducted 3 months later
Figure A
Figure B
hematoxylin and eosi
AE1/AE3 (pancytokeratin
IMAGING FINDINGS Figures A-D. Microscopic sections from this middle ear lesion demonstrate tumor cells in an in ltrative but nested growth pattern with occasional glandular di erentiation and neuroendocrine- like nuclear features (“salt and pepper”). The tumor cells express both neuroendocrine markers (synaptophysin, chromogranin, and NSE) and epithelial cytokeratin marker (AE1/AE3). The Ki-67 proliferation index is elevated at ~30%. Figures E-H. E. Opaci cation of the middle ear cavity and relatively homogenous soft tissue mass (red arrow) in the medial external auditory canal with erosion of the incus and demineralization of the stapes (pre- operative CT, axial section).
F. Findings are consistent with a left wall down mastoidectomy. Apparent disruption of the tegmen tympani with absent ossicles and questionable disruption of the labyrinthine segment of the facial nerve and subjacent inner ear structures (post-operative CT, axial section). G. Multiple foci of higher-than-expected radiotracer uptake within the liver, with some larger foci corresponding to areas of hypoattenuation. (FDG-PET/CT, axial sections, and MIP PET). H. Regional uptake overlying the pterygoid likely re ecting posttreatment changes versus residual disease (left), and radiotracer-avid low-attenuation hepatic lesions increased since the prior imaging study (right) (PET/CT Ga-68 Dotatate, axial section, and MIP PET conducted 3 months later).
Figure C
Figure D
Ki-67
synaptophysin
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CONCLUSION While rare pathology of the middle ear with debatable imaging and clinical features, MeNETs are malignant tumors which may be considered as a potential di erential diagnosis for a middle ear soft tissue lesion. Paraganglioma of the middle ear, meningioma, cholesteatoma, carcinoid tumor, teratoma, and schwannoma are other possible di erential diagnoses for middle ear lesion.6,7 Preoperative diagnosis is di cult, and de nitive diagnosis will be elucidated through imaging and biopsy. Long-term follow-up is strongly advised to assess for recurrence and metastasis. REFERENCES 1. Werner RA, Solnes LB, Javadi MS, Weich A, Gorin MA, Pienta KJ, Higuchi T, Buck AK, Pomper MG, Rowe SP, Lapa C. SSTR-RADS Version 1.0 as a Reporting System for SSTR PET Imaging and Selection of Potential PRRT Candidates: A Proposed Standardization Framework. J Nucl Med. 2018 Jul;59(7):1085-1091. 2. Sandison A. Update from the 5th Edition of the World Health Organization Classi cation of Head and Neck Tumours: Tumours of the Ear. Head Neck Pathol. 2022 Mar;16(1):76- 86. 3. He S, Shi S, Qin R, Wang H, Sun Y, Zhang J, Zhang R, Wang W. Neuroendocrine neoplasms of the middle ear: report of 2 cases and review of the literature. Int J Clin Exp Pathol. 2019 Sep 1;12(9):3453-3458.
DIFFERENTIAL DIAGNOSIS 1. Paraganglioma 2. Meningioma 3. Cholesteotoma 4.
3 months later, a PET/CT Ga-68 Dotatate (a type of somatostatin receptor (SSTR) PET agent) scan demonstrated regional radiotracer uptake overlying the pterygoid with adjacent bony sclerosis, likely re ecting posttreatment changes versus residual disease. Di use heterogeneous radiotracer uptake noted throughout the liver with avidity signi cantly above liver background, compatible with biopsy-proven neuroendocrine tumor. Low-attenuation lesions were more notable in comparison to prior imaging study, concerning for disease progression. Per SSTR-RADs, the ndings of our patient’s liver on most recent PET/CT can be classi ed as SSTR-RADS-5, which both nearly de nitively con rms the spread of MeNETs into the liver and makes the patient a strong candidate for peptide receptor radionuclide therapy (PRRT).1 DISCUSSION Middle ear neuroendocrine tumors (MeNETs) are rare tumors, accounting for less than 2% of middle ear tumors.3 Etiology, nomenclature, and classi cation of these tumors have remained subject to debate.2, 3 Prior designation as middle ear adenoma has been recently updated for the 5th edition of the World Health Organization Classi cation of Head and Neck Tumours.2 Per Asa et al., the terminology adenoma does not correctly re ect potential for tumor to be invasive or even metastatic.6 Overall, MeNETs are malignant with properties that re ect their apparent mixed di erentiation. Clinically, these tumors present as nonspeci c ear mass in middle- aged patients without gender preference, with symptoms such as unilateral hearing loss and tinnitus. Pain and facial nerve paralysis are rare symptoms and may indicate malignancy. MeNETs present with unpredictable behavior – MeNETs have demonstrated both indolent growth and aggressive metastasis, with corresponding histological patterns.4 MeNETs cells are positive for high and low molecular weight keratins (AE1/ AE3, Cam5.2) and neuroendocrine markers (synaptophysin, chromogranin) as well as transcription factors INSM1, islet-1 (ISL1) and SATB2.2 MeNETs have been shown to produce hormones such as glucagon, pancreatic polypeptide, serotonin, and PYY, amongst others.2-3 As seen on cross sectional imaging, MeNETs are avascular soft tissue densities prone to osseous expansion within the middle ear space toward the ossicles. On MRI, these tumors may be iso- to hyperintense relative to white matter on T1 pre contrast and demonstrate variable enhancement.4 SSTR-RADS version 1.0 is a 5-point scale that was developed as a means of standardizing the interpretation of somatostatin receptor (SSTR) PET imaging to frame diagnosis and treatment of neuroendocrine tumors (NETs). Scores are subdivided based on uptake level, localization of uptake, or corresponding ndings on conventional imaging.1 Grading MeNETs based on the G1/G2/G3 grading system, generally utilized for other neuroendocrine tumors, is being investigated based on their similar overall behavior. 2,6 De nitive treatment is surgical resection with removal of ossicles, without adjuvant therapy.3 Disease recurrence has been reported in near 20% of cases, associated with high proliferation rates alongside metastasis.2,3
YEARS
Middle Ear Neuroendocrine Tumors (MeNETs)
5. 6.
Carcinoid Tumor
Teratoma
7. Schwannoma FINAL DIAGNOSIS Middle Ear Neuroendocrine Tumors (MeNETs) INTRODUCTION
First described in 1976 as “middle ear adenomas,” these lesions were recently redesignated as “middle ear neuroendocrine tumors (MeNETs)” due to their exocrine and neuroendocrine di erentiation, alongside their unpredictable clinical course.2,6 Typically thought to be indolent, non-invasive tumors, MeNETs have been found to recur and metastasize correlating with their proliferation rate.2 In this report, we present a case of an aggressive MeMeNET with biopsy-proven metastasis to the liver, while reviewing features of these tumors on imaging and histopathology, di erential diagnoses, and treatment options. CASE REPORT 33-year-old man presented last year with partial left facial paralysis, otitis, hearing loss, and tinnitus, and was diagnosed with Bell’s palsy at the time of initial presentation. Physical examination at a following visit demonstrated fullness in the left external auditory canal with a mass obliterating the ear drum. The patient was then scheduled for surgery. Preoperative CT of the temporal bone at that time demonstrated opaci cation of the middle ear cavity and relatively homogenous soft tissue in the medial external auditory canal with erosion of the incus and demineralization of the stapes, consistent with a left middle ear and external auditory canal soft tissue mass. The patient subsequently underwent a modi ed radical tympanomastoidectomy with facial nerve decompression and microdissection. Following a subsequent radical tympanoplasty with mastoidectomy a month after and further transtemporal craniotomy with temporalis muscle rotational pedicle flap and meatoplasty for tumor resection at the end of that year, the mass was determined to be a middle ear, mixed epithelial and neuroendocrine tumor (MeMeNET) with a Ki67 proliferation index of approximately 30%, indicating an aggressive tumor. The lesion was positive for AE1/AE3, synaptophysin, chromogranin, and NSE. Of note, portions of what appears to be a cholesteatoma were present. Fluorodeoxyglucose (FDG)-PET/CT obtained 2 months later demonstrated a 2.0 x 1.2 x 1.0 cm hypermetabolic soft tissue lesion with a SUV max 6.0 correlating with the previously identi ed enhancing mass along the medial aspect of the left lateral pterygoid muscle, alongside multiple foci of higher-than- expected radiotracer uptake within the liver, with some larger foci corresponding to areas of hypoattenuation. Given the concern for both recurrent neoplastic process and metastatic disease, the patient underwent proton therapy. Liver biopsy was conducted after a trial of proton therapy and con rmed metastasis.
50 YEAR PHYSICIANS Don Bell, MD Ronald Bombet, MD
F. Brabson Lutz, Jr., MD Brian Matherne, MD Weston Miller, Ill, MD Glenn Mills, MD Stephen Person, MD Edwin Ross, MD Robert Ryan, MD Lawrence Schneider, MD Alan Sheen, MD Charles Simonson, MD Robert Wallace, Ill, MD Kermit Walters, Jr., MD Charles Williams, Jr., MD Michael Zambie, MD
Leonard Bourgeois, MD Richard Bourgeois, MD David Bryan, MD Zack Buckalew, Ill, MD Robert Dawson, Ill, MD Daniel Dupree, MD Mary Eschete, MD Carl Fastaband Thomas Ferguson, MD Rajendra Gandi, MD Joseph Heard, MD Sheldon Johnson, MD Alfonso Lebron-Berges, MD
4. Katabi N. Neuroendocrine Neoplasms of the Ear. Head Neck Pathol. 2018 Sep;12(3):362-366.
5. Subedi N, Prestwich R, Chowdhury F, Patel C, Scarsbrook A. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management. Cancer Imaging. 2013 Oct 4;13(3):407-22. 6. Asa, S.L., Arkun, K., Tischler, A.S. et al. Middle Ear “Adenoma”: a Neuroendocrine Tumor with Predominant L Cell Di erentiation . Endocr Pathol 32, 433–441 (2021). 7. Baku M, Ueda H. A rare case of middle ear adenoma. Nagoya J Med Sci. 2014;76(3-4):355-360. ACKNOWLEDGMENTS Mitchell Ta, MD is a PGYII Resident at Riverside Community Hospital. Christian Huebner, MD is a practicing Radiologist in Southeastern Louisiana. Michelle Honda, MD is an Academic Assistant Clinical Professor of Radiology at Yale University. Jeremy Nguyen, MD FACR is clinical radiology professor within the Department of Radiology at the Tulane University Medical Center. Ryan Craig is a pathology professor within the Department of Pathology at the Tulane University Medical Center. Neel Dewan Gupta, MD is a clinical and academic musculoskeletal radiologist in New Orleans and serves as a clinical assistant professor within the Department of Radiology at the Tulane University Medical Center. Jagan Gupta, MD is a neuroradiologist at the Southeast Louisiana Veterans Health Care System. Joshua Diener is a 4rth year medical student at the Tulane University School of Medicine. Donald Olivares, Digital Imaging Specialist and Graphic Designer.
In Memoriam
James Phillips, MD Frederick Price, MD Stephen Breaud, MD Pedro Cazabon, MD Prentiss Smith, Jr., MD
William Bundrick, Sr., MD John Finn, Jr., MD William Glenn, MD Rozelle Hahn, MD Thomas Kramer, MD
20 J LA MED SOC | VOL 177 | FALL 2025
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2025 H D Annual Meeting
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The following article was written by Donald J. Palmisano, M.D. and originally published in the July/August 2015 Journal of the LSMS upon the 40th anniversary of Louisiana’s Medical Malpractice Act, Act 817 of 1975. Now, ten years later upon the 50th anniversary of the act, we remember the architects of Act 817 as both Dr. Cooksey and Dr. Palmisano passed away in 2022.
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Journal of the Louisiana State Medical Society
Forty-Year Anniversary of Louisiana’s Medical Malpractice Act, Act 817 of 1975 Donald J. Palmisano, MD, JD
OIstetriciangynecologist +r 2atherine >illiaTs has trusted LAMMICO to provide her Tedical Talpractice insurance Mor over years
“Do your homework, have courage, and don’t give up!” 1 Those words of wisdom for success from my heroic policeman dad once again proved correct in the medical liability reform bat- tle in Louisiana in 1975 because of the leadership of Dr. John Cooksey of Monroe, Louisiana. Dr. Cooksey was the cheerlead- er who gathered the team and constantly inspired everyone. Here we are at the 40th anniversary of the passage of the 1975 Medical Malpractice Act, Act 817. 2 How time flies! Act 817 of 1975 lives and the Louisiana State Supreme Court has ruled the current law, a total cap on all damages with its 1984 amend- ment for unlimited future medical payments as incurred (La. Act 435 of 19843), constitutional in the Butler case previously cited in the 20-year anniversary article (reprinted in this issue of the Journal). Louisiana’s law was voted into law prior to California’s famous medical liability law. 4 For another great tri- umph, see Texas and its success in 2003. 5 Three different laws; three proven long-term successes. The father of this Louisiana law, Dr. John Cooksey, is alive and well. All in Medicine should write Dr. Cooksey and thank him. His medical office listed in the 20-year anniversary article 6 re- mains at the same location. Sadly, only 3 of us in the signing photo are here today: Former Governor Edwin Edwards, Dr. Cooksey, and me. Mary Lou Winters, Attorney Jessie McDonald, Louisiana Representative Shady Wall, and Dr. Dave Carlton have passed on. May they Rest in Peace, these wonderful folks. On Independence Day, July 4, 2015, I spoke with Dr. Cooksey and he commented about our adventures in 1975: “The magic that made possible Louisiana’s Act 817 of 1975 was the team and the timing. We had a team of people who represented many different interests in healthcare and the timing was right.” 24 J LA MED SOC | VOL 177 | FALL 2025
EXPECTATIONS EXCEEDING
I leMt LAMMICO Mor lower rates that were oMMered at another Tedical Talpractice insurer I later learned that this other insurer had no Mollow up risk TanageTent education or relationships :o I caTe Iack to LAMMICO
>hen I was Maced with a claiT which can Ie a diMficult e_perience Mor any physician LAMMICO went aIove and Ieyond with claiT support during the deMense oM the claiT I Melt like they cared ;hroughout the claiT process LAMMICO Mought Ieside Te so that I prevailed in court when they could have chosen a siTpler less e_pensive path LAMMICO Taintains relationships that are Mar reaching and Ienefit all physicians ;hey»re Tore than an insurance coTpany – Katherine Williams, M.D., obstetrician-gynecologist
Dr. Cooksey (left) and Dr. Palmisano (right).
daily basis to key individuals around the state.
Building Enduring Partnerships c laTTicocoT
Let me not forget the important work of the Louisiana State Medical Society once it signed on to the quest. Component par- ish medical societies also played a critical role as its members knew the legislators personally and legislators listen best to their own constituents. After my medical office hours I pilot- ed my T-34A aerobatic plane on night flights to parish medical society meetings around the state asking all doctors to help get the proposed legislation passed. 8 Lots of excitement in those adventures.
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