Established in 1844, our Journal is one of the oldest in the country. To learn more about the Journal and how to submit articles, please visit https://lsms.org/page/JLSMS.
JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY VOL 175 | ISSUE 2 | FALL 2023 H D2023
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VOL 175 | ISSUE 2 | FALL 2023 CONTENTS
CHIEF EXECUTIVE OFFICER Jeff Williams
JOURNAL BOARD K. Barton Farris, MD Secretary/Treasurer, Richard Paddock, MD Anthony Blalock, MD
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PRESIDENTIAL SPEECH
ACTIONS OF THE BOARD OF GOVERNORS
L.W. Johnson, MD Fred A. Lopez, MD
AMA 2023 INTERIM MEETING
2023 LSMS LEADERSHIP
LAMMICO DEFENSE COUNSEL SEMINAR
BOARD OF GOVERNORS President, Richard Paddock, MD Immediate Past President, John Noble, Jr., MD President-Elect, Roderick Clark, MD Secretary - Treasurer, Amberly Nunez, MD Speaker, Thomas Trawick, Jr., MD Vice Speaker, Robert Newsome, MD Col, Chair, Matthew Giglia, MD Ex Officio, Lampac, Chair, Susan Bankston, MD
10 ACUTE MEDIAL ELBOW PAIN AND SWELLING IN A YOUNG FEMALE PATIENT 12 NEW MEDICAL STUDENT AND EARLY CAREER PHYSICIAN BENEFIT 12 TO GET POLITICS OUT OF MEDICINE, PHYSICIANS MUST GET INTO POLITICS! 14 FIREARM SAFETY EDUCATION 14 LOUISIANA HEALTHCARE CONNECTIONS PARTNERS WITH LOUISIANA STATE MEDICAL SOCIETY TO EMPOWER INDEPENDENT MEDICAL PRACTICES 16 HOD 2323 23 MISSISSIPPI STATE MEDICAL ASSOCIATION PARTNERSHIP
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BOARD OF COUNCILORS District One, Myra Kleinpeter, MD District Two, Luis Arencibia, MD District Three, Allan Vander, MD District Four, Randall White, MD District Five, Gwenn Jackson, MD District Six, Michael Roppolo, MD District Seven, Brian Gamborg, MD District Eight, Lance Templeton, MD District Nine, Andy Blalock, MD District Ten, Nicholas Viviano, MD
You believe the practice of medicine is a profession , not just a job. LAMPAC reasons to contribute to
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You are a patient who wants to ensure the right professional is providing the right care for your safety. You want to reduce red tape, regulations, and the hassle factor so you can get back to saving lives.
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You are tired of other professions dictating what you can and can’t do.
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You know medical school matters.
SECTION REPRESENTATIVES Medical Student Section Member, Madison Thornton Resident/Fellow Section Member,Omar Leonards, MD Young Physician Section Member, Ken Ehrhardt, MD Employed Physician Section Member, John Bruchhaus, MD Private Practice Physician Section Member, Katherine Williams, MD
You want to make Louisiana a better place to practice medicine. You want to simply practice medicine.
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You want to send a message that your profession matters.
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You want your rights as a physician to be protected.
Because in Louisiana, if you’re not at the table; you’re on the menu.
SCAN TO DONATE
LOUISIANA MEDICAL POLITICAL ACTION COMMITTEE LAMPAC
Disclaimer: The author(s) of each scientific 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 sufficient to support the conclusions reached or that the experiment design or methodology is adequate.
LAMPAC needs your help to ensure that the LSMS advocacy efforts have the support they need at the capitol. Our friends in the legislature need to know that we appreciate the efforts 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.
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PRESIDENTIAL SPEECH RICHARD PADDOCK, MD
ON SATURDAY, AUGUST 5, 2023, THE LOUISIANA STATE MEDICAL SOCIETY INSTALLED DR. RICHARD PADDOCK AS THE 143RD PRESIDENT OF THE ORGANIZATION.
Dr. Paddock is from New Orleans, Louisiana. He obtained his medical degree from Tulane School of Medicine and completed a residency in Urology at Ochsner Medical Institutions. He then entered private practice and was board certified in 1985. Dr. Paddock recently retired in 2022 after 44 years of practice. He has held every position on the Jefferson Parish Medical Society board including President. He was also alternate delegate for Louisiana to the AMA and until recently was the Secretary-Treasurer of the LSMS for many years. Dr. Paddock has been married for 53 years to Shelia and has 2 children and 7 grandchildren. They presently split their time between their residence in River Ridge and a summer house in Pass Christian.
As we are all aware, the practice of medicine has been under constant challenges. Physician scope of practice, prescriptive rights, lessening the educational requirements to independently practice medicine, unauthorized practice of medicine, prior authorizations and denial of care and payment of needed medications and procedures are just a few. At LSMS, we will continue to be your advocates on a local and national level. However, the latest growing challenge and exciting new medical frontier is the introduction of the use of artificial intelligence in medicine.
I am truly honored to stand before you as your 143rd president of the Louisiana State Medical Society. In our audience as you have seen are many of our past presidents who have helped lead the society in our mission to be the trusted advocates for patients and physicians in the state of Louisiana. From Dr. Noble to Dr James Egan in 1878, I have some big shoes to fill and some great acts to follow. I may be taking the helm, however, I come aboard a ship that already has a steady course chartered with an excellent chief navigator, Mr. Williams and a phenomenal crew with the staff at the Louisiana State Medical Society. This team has had many successes regarding major medical legislation and deserves our thanks for their hard work.
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AI IN THE HEALTHCARE MARKET ACCOUNTED FOR $14 BILLION DOLLARS IN 2020, BUT IT IS PROJECTED TO REACH $119.8 BILLION DOLLARS BY THE YEAR 2027
A QUICK STORY. Has anyone gone to a quest lab lately? The reason I ask is because I recently went to have some labs drawn. I walked in, it was early, and I was the only person in the room. There was no one there but myself and a wall with four kiosks with gray TV screens looking at me. I walked up to one of the screens and it flashed touch here and I did, hoping that some sort of candy or reward would come out of a slot. It didn’t. It then flashed scan in your driver’s license which I did and then the screen read hello Richard. Then I replied hello back not realizing I was talking to a computer screen. It asked me to verify my address and date of birth then scan in my insurance cards which I did and pressed finish. It then asked me to have a seat. A TV in the waiting room area quickly displayed my name and the time I registered. Almost immediately the phlebotomist opened the door, called my name and I had my blood drawn. The whole episode took about 20 minutes. I left realizing that I had briefly seen only one human during this exchange. Most of you who know me know that I am very afraid of needles. I missed the receptionist checking me in and assuring me that it wasn’t going to hurt and that I was going to be fine. Sitting in the car I thought this was efficient and quick but very impersonal. Is this what we want for our patients and the future of medicine? Sacrificing compassion and reassurance of the human experience for the sake of efficiency? Or, do we want a blend of both to deliver the best healthcare we can. Artificial intelligence is the ability of machines to perform tasks that normally require human intelligence such as reasoning, learning, decision making and problem solving. AI uses computer software to simulate human cognition that drives machine learning algorithms that can teach the machine how to perform a specific task and provide accurate results by identifying patterns. It does so by developing its own algorithms from massive amounts of downloaded data. We see this in Google, Siri, Alexa, IBM Watson, directional maps and more which have permeated our daily lives such that we are absolutely in need and are dependent on them. Already, the use of AI has affected the labor force. One survey reported that 75% of the companies questioned said they expect AI technology to eliminate up to 26 million jobs over the next five years. The medical community is no different and jobs have been lost and more will or be modified in many sectors. The use of AI is also moving from hospital administrative tasks to actual clinical decision making. AI is being used in pathology, radiology, cardiology, gastroenterology, and primary care. Algorithms for diagnosis and treatment of various disease entities and emergencies are already being used and more are
being formulated and tested. Amazon, last fall, launched a virtual clinic in 50 states staffed by “licensed providers.” Licensed by whom and where? The recent Covid pandemic helped accelerate AI development. Globally, AI in the healthcare market accounted for $14 billion dollars in 2020, but it is projected to reach $119.8 billion dollars by the year 2027. AI is a wonderfully exciting complex innovation that will no doubt help but will also change the landscape of the practice of medicine to come. But, not without serious concerns about its ability to overtake and stifle the human art of medicine. The president of the artificial intelligence society stated that the medical community and society will have difficulty moving through this “transitional phase” where machines will be doing better and more efficiently than humans. There is that word again, efficient. The FDA and the AMA are taking steps to develop a model for evaluating, standardizing, and regulating the use of AI but it is still in its early days and essentially AI is unregulated. Big tech is already fighting some minor regulations. There are some phenomenal assets that AI can bring as an adjunct to the practice of medicine. AI can provide real time data for a quicker diagnosis and decision making allowing for earlier and more personalized therapies. AI can streamline tasks such as scheduling, coding, reviewing insurance claims and even generating care paths/ By maximizing productivity and cutting healthcare costs, it can reduce the estimated $750 billion that is wasted annually. It can help monitor patient progress and alert patients and providers if a condition worsens. Recently a woman was awakened in the middle of the night by her smartwatch alerting her that she had gone into atrial fibrillation and her risk for stroke. AI can advance medical research by analyzing massive amounts of data to discover new insights patterns and correlations from large and complex datasets that would be otherwise difficult for humans to process. With limited or nonexistent healthcare access in impoverished communities exacerbated by the shortage of health care professionals, AI can improve health care by enhancing remote access to these areas. It is estimated by the year 2035, there will be a global deficit of 12.9 million skilled healthcare workers in the workforce. Although I’ve touched on a few of the phenomenal things that artificial intelligence can do to enhance the practice of medicine,
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IT IS IMPERATIVE THAT WE ENSURE THAT DOCTORS OVERSEE THE DEVELOPMENT OF THE HEALTH ALGORITHMS AND THEIR IMPLEMENTATION.
increasing dependence on AI in healthcare. Also, what effect will it have on the autonomy of caregivers to independently decide on treatments for their patients? The stakes are very high if things go wrong with our development and legislation of this phenomenal revolutionary new technology. To quote Dr. Deepak Chopra, “The basic nature of being is to react to unpredictability and the infinite possibilities, whereas artificial intelligence reacts on previous predictability and draws conclusions from that. Humans have the power of awareness which a computer cannot and will never develop nor possess.” This freight train silently coming down the track at full speed cannot be left unchecked. There needs to be significant in- depth studies on its impact on the practice of medicine, the delivery of healthcare, training of future doctors as well as the present and future health care labor force. We will, as before, continue this coming year to stay focused on immediate issues that affect the practice of medicine and health care in Louisiana, however the main focus of my year will be to explore AI’s impact on our practice of medicine. To create an awareness and bring it to the forefront of discussion with doctors and legislators to recognize the obvious need for standardization and regulation before full implementation. We need to avoid the chaos we have already seen in the unregulated development of electronic medical records. I will do my best to help our society form policies and guidelines to help enhance our physician’s ability to practice better and more accurate medicine. But clinicians need to understand that these tools are to augment clinical decision making and should not be used to replace it. Yes, the landscape of medicine is changing and will continue to do so for more generations of physicians to come. Let’s not abdicate our responsibility of training the next generation of doctors to artificial intelligence. We must encourage our future doctors to continue to practice the human aspect of the Art of Medicine and to teach it for generations to come. Anyone or anything can learn the science of medicine, but it takes a human to teach how to live our oath to give compassion, empathy and your whole life and essence to another person for their well-being and healing. A computer cannot and will not ever learn how to do this. The handshake, encouragement, the touch and sometimes just your presence are all as necessary for healing as being correct with the diagnosis and treatment. As Carl Jung said, “Medicine cures diseases; doctors cure patients” . We cannot let the quest for efficiency and accuracy in medicine overshadow the human art of medicine. I will continue to advocate for the physicians of Louisiana. I hope to help us balance the delivery of efficient, accurate medicine with the extraordinarily valuable art of medicine. To quote Hypocrites
there are concerns about the implementation of artificial intelligence in the healthcare arena. It comes with significant risks to the delivery of medical care, the patient doctor human relationship and the future educational experience and training of doctors and other medical allied professionals. There are major ethical concerns with the development and use of AI in health care. AI can make decisions that can have significant impacts on human lives, health, and well-being. Interestingly a recent poll showed that 67% of patients do not trust AI as being a total driving force in their healthcare. The information from portable healthcare monitoring devices is not subject to privacy laws and is used in AI databases. The data from smartphones and watches about our lifestyles, eating habits, exercise and everything we do can go directly to our insurance companies which could be used to adjust future coverage and premiums. Conglomerates like Google and Microsoft are already partnering with large healthcare providers to download massive amounts of medical data to enhance machine learning of artificial intelligence. With these partnerships between large private equities and large healthcare delivery systems one would think that there should be a moral responsibility to share these algorithms with smaller institutions, however this may not be the case in the future. With the influx of massive amounts of private equity money, will we see a point where all major healthcare systems will be owned and operated on a for profit model and cause healthcare costs to rise? Will the new healthcare delivery team be the hospital CEO, the chief digital officer and the AI computer? Cybersecurity is paramount. With increasing amounts of patient data being stored and transmitted electronically, healthcare providers are facing growing security risks. Cyber-attacks can compromise patient data, disrupt scheduling healthcare services and potentially interrupt the delivery of healthcare altogether. A recent survey showed that in 2020 security breaches had jumped 42%. Investments in cybersecurity is expected to reach $24.1 billion by the year 2026. AI is not infallible and can be prone to mistakes or fail to perform as expected. Data shows that AI error rates are almost equal to the human error rate in medicine at present. However, when used as an adjunct to diagnose, human accuracy improves dramatically. Bias issues are another concern. Unless they are corrected, the data introduced into its algorithms may prejudice the decisions made by AI. A major discussion occurring right now is where will the impact fall for accountability and responsibility? Who is liable for the outcomes and consequences of AI’s decisions or actions. Who is responsible for the oversight and regulation and who is entitled to the benefits and risks of AI in healthcare. International medical groups are calling for the establishment of oversight of how algorithms behave in real world scenarios. It is imperative that we ensure that doctors oversee the development of the health algorithms and their implementation.
“Where the art of medicine is loved there is also a love of humanity.”
I wish to thank my lovely wife Shelia and my family for years of unwavering love and support and thank you for your confidence entrusting me with the responsibilities and duties of President of the Louisiana State medical society. ■
These are some of the questions that need to be addressed before
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ACTIONS OF THE BOARD OF GOVERNORS SEPTEMBER 13, 2023
The Louisiana State Medical Society (LSMS) Board of Governors met in Baton Rouge on Wednesday, September 13, 2023, at the City Club. The bulleted points below highlight the actions taken by the board. Draft minutes are maintained in the office of the Executive Vice President until such time they are approved by the board, signed by the secretary/treasurer, and appended to the LSMS Website.
• Approved a new interim “Code of Conduct” policy for LSMS meetings and events.
• Approved the minutes of the last two LSMS Board of Governors meetings, which were held on June 7, 2023 and August 4, 2023.
• Approved a LSMS position statement on the appropriate use of the term “provider” as directed from the 2023 House of Delegates via Resolution 110. • Approved holding the inaugural LSMS Annual Meeting, which will include a smaller House of Delegates, in Destin, Florida during August 2024 as directed by the 2023 House of Delegates via Resolution 117. • Referred Resolution 208, related to future legislation on the corporate practice of medicine to the LSMS ad hoc committee addressing this issue. • Indefinitely tabled Resolution 307 from the 2023 House of Delegates, which asked the Society to acknowledge that improved mental health outcomes were associated with gender affirming care.
• Reviewed unaudited financial statements for the LSMS, and its subsidiaries, through July 31, 2023.
• Reviewed the quarterly membership report for June through August 2023.
• Received updates and/or formal reports on:
• Duties, roles, and responsibilities of board members
• Confidentiality and conflict of interest requirements for board members
• Blue Cross Blue Shield of Louisiana Acquisition by Elevance Health (Anthem)
• Appointed Susan Bankston, MD to fill the LSMS’ seat on the Physicians Foundation Board of Directors.
• Voted not to financially participate in the American Medical Association’s Litigation Center in 2024. ■
• Appointed Steven Norman, MD to fill one of the LSMS’ seats on the Health Professionals Foundation of Louisiana Board of Directors.
Last month, the Louisiana Delegation to the American Medical Association participated in the 2023 Interim Meeting in National Harbor, Maryland. Hot topics at the meeting included physician assisted suicide, health care plan network adequacy, national drug supply shortages and encroachment of administrators on medical decision-making. ■ AMA 2023 INTERIM MEETING
Pictured L to R: Laila Koduri, Tulane Medical School, Deborah Fletcher, MD, Luis Alvarado, MD, William Freeman, MD, Kamel Brakta, MD and George Ellis, MD
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2023 LSMS LEADERSHIP
BOARD OF GOVERNORS
BOARD OF COUNCILORS Myra Kleinpeter, MD District One
SECTION REPRESENTATIVES Madison Thornton Medical Student Section Member Omar Leonards, MD Resident/Fellow Section Member Ken Ehrhardt, MD Young Physician Section Member John Bruchhaus, MD Employed Physician Section Member Katherine Williams, MD Private Practice Physician Section Member
The Board of Governors serves as the trustee and the administrative board of the LSMS and transacts all business for and on behalf of the Society in the interval between HOD meetings.
Luis Arencibia, MD District Two
Allan Vander, MD District Three
Randall White, MD District Four
RICHARD PADDOCK, MD President
JOHN NOBLE, JR., MD Immediate Past President
RODERICK CLARK, MD President-Elect
Gwenn Jackson, MD District Five
Michael Roppolo, MD District Six
Brian Gamborg, MD District Seven
AMBERLY NUNEZ, MD Secretary - Treasurer
THOMAS TRAWICK, JR., MD Speaker
ROBERT NEWSOME, MD Vice Speaker
Lance Templeton, MD District Eight
Andy Blalock, MD District Nine
Nicholas Viviano, MD District Ten
MATTHEW GIGLIA, MD COL, Chair
SUSAN BANKSTON, MD Ex Officio, LAMPAC, Chair
LAMMICO DEFENSE COUNSEL SEMINAR
LSMS VP of Legal Affairs, Lauren Bailey, along with LSMS VP of Governmental Affairs, Maria Bowen, participated in the annual defense counsel seminar held during the first week of October. They presented an overview to the 2023 legislative session. You can view the presentation by clicking on the flipping book below. There were various informative presentations related to medical review panels, the impact of COVID on the gross negligence doctrine and the lack of trust juries have when it comes to healthcare providers. LSMS President, Richard Paddock, M.D. along with LSMS President Elect, Rod Clark, M.D. were also in attendance. ■
https://online.flippingbook.com/view/965694740
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ACUTE MEDIAL ELBOW PAIN AND SWELLING IN A YOUNG FEMALE PATIENT MITCHELL TA, MD; AHMED T. RASHAD, MD; NEEL D. GUPTA, MD; VISHNUPRIYA KUCHANA, MD; JEREMY NGUYEN, MD FACR HISTORY 12 year-old female with a 1-year history of discomfort and intermittent swelling along the medial aspect of her right elbow presents with acute medial elbow pain.
Figure 1
Figure 2
Figure 3
Contrast-enhanced axial CT of the elbow
Axial T1 FS +C MRI of the elbow
Sagittal T1 FS + C of the elbow
IMAGING FINDINGS Figure 1. Contrast CT in axial projection demonstrates focal calcification within the mass with adjacent heterogenous contrast enhancement. Figure 2. Axial T1 FS post contrast demonstrates a fusiform mass with heterogenous enhancement posteromedial to the medial epicondyle intimately associated with the ulnar nerve. Figure 3. Sagittal T1 FS post contrast demonstrates a fusiform mass with heterogenous enhancement posteromedial to the medial epicondyle intimately associated with the ulnar nerve. DIFFERENTIAL DIAGNOSIS 1. Intraneural hemangioma with ulnar nerve involvement
DISCUSSION Intraneural hemangiomas are benign, rare lesions of mesodermal origin formed by proliferation of vascular structures that may arise within a peripheral nerve, within the nerve sleeve, or around the nerve. Most commonly involving the median nerve, intraneural hemangiomas may also be found in association with the tibial, ulnar, digital, sciatic, and superficial peroneal nerves 1 . Ulnar nerve involvement is least common with approximately 13 published cases 2 . Intraneural hemangiomas often manifest in childhood as a painful mass that resides along the path of the nerve. Patients with this painful mass often have associated neurologic deficits, paresis, or paresthesia due to mass effect 3 . Ultrasound and MRI imaging may help form a diagnosis. Nerve conduction studies are additionally helpful in patients with neurological symptoms. Diagnosis is confirmed with histopathology, and treatment is surgical resection. Of note, incomplete resection may lead to recurrence. Intraneural hemangiomas often appear hyperintense on fat-suppressed T2-weighted sequences and enhance with administration of gadolinium. Intraneural hemangiomas follow the path of the involved nerve. MRI may also aid in the localization and size assessment of the mass while visualizing the relationship between the mass and surrounding tissue 4 .
2. Schwannoma 3. Glomus tumor 4. Angioleiomyoma 5. Lipofibromatous hamartoma 6. Hematoma FINAL DIAGNOSIS Ulnar nerve hemangioma
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10. Doğramaci Y, Kalaci A, Sevinç TT, Yanat AN. Intraneural hemangioma of the median nerve: A case report. J Brachial Plex Peripher Nerve Inj 2008;3:5 11. Saito S, Suzuki Y (2010) Schwannomatosis affecting all three major nerves in the same upper extremity. J Hand Surg [Eu] 35:592–594 12. Marom, E., Helms, C. Fibrolipomatous hamartoma: pathognomonic on MR imaging. Skeletal Radiol 28, 260–264 (1999). ACKNOWLEDGMENTS Mitchell Ta is a PGYI intern in the Department of Internal Medicine at Harbor-UCLA. Ahmed T. Rashad MD is a PGYV Resident in the Department of Radiology at Tulane University School of Medicine in New Orleans, La. 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. Vishnupriya Kuchana MD is PGYIII Resident in the Department of Radiology at Tulane University School of Medicine in New Orleans, La. Jeremy Nguyen MD, FACR is a clinical radiology professor within the Department of Radiology at the Tulane University Medical Center. ■
It is important to consider a broad differential diagnosis due to the rarity of intraneural hemangiomas. Differential diagnosis includes intraneural schwannoma, glomus tumor, angioleiomyoma, hamartoma, and hematoma. While both schwannomas and hemangiomas may involve peripheral nerves, schwannomas on T2-weighted MRI sequences often demonstrate heterogenous signal with peripheral enhancement and central low signal – a typical target sign 5 . Glomus tumors and angioleiomyomas, on the other hand, are usually hypervascular homogenous solid masses with sharp margins. Marom and Helms described a case of a fibrolipomatous hamartoma, which characteristically demonstrates serpiginous low signal surrounded by evenly distributed fat 6 . REFERENCES 7. Châtillon CE, Guiot MC, Jacques L. Lipomatous, vascular, and chondromatous benign tumors of the peripheral nerves: representative cases and review of the literature. Neurosurg Focus 2007;22:E18. 8. Ravanbod H, Motififard M, Aliakbari M, Zolfaghari M, Hatami S. Intraneural cavernous hemangioma: a rare case of extrafascicular left ulnar nerve tumor. Am J Blood Res. 2021;11(1):72-76. Published 2021 Feb 15. 9. Bacigaluppi S., Fiaschi P., Prior A., Bragazzi N.L., Merciadri P., Gennaro S. Intraneural haemangioma of peripheral nerves. Br. J. Neurosurg. 2018;14:1–7. Mar.
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NEW MEDICAL STUDENT AND EARLY CAREER PHYSICIAN BENEFIT
STUDENT LOAN PROFESSOR AKA DOCTORS WITHOUT QUARTERS
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TO GET POLITICS OUT OF MEDICINE, PHYSICIANS MUST GET INTO POLITICS!
THIS MEANS OVER 25% OF THE LEGISLATURE IS NEW
Now is the perfect time to become engaged in politics as we are changing Governors here in Louisiana. In the last election cycle, we faced a significant turnover in the Legislature. We are again seeing a large turnover in the Legislature, but we will also be changing administrations. When you change administrations, you don’t just get a new Governor. You also get a new Commissioner of Administration, a new Health Secretary and a new Executive staff and more. By nature of the beast, the first year in any new administration lends itself to some chaos. It simply can’t be avoided when you have so many new changes and personalities involved in an adjustment of this scale. While Governor-elect Landry is both astute and sophisticated and hit the ground running, he still won’t have the full power of the office until he is inaugurated on January 8. At that point, he will have to go through the process of Senate confirmations for his selected team. This includes all cabinet appointees, in addition to boards, commissions, task forces, councils and special appointees. As the constitution allows for interim appointments if the legislature is not in regular session, the work of government does not stop. It just means that the Governor and his appointees must be focused on the appointment process while also effecting change. Shifting to the Legislature shows us 40 new members who were elected this Fall. This count addresses only those individuals who have never served, not those who moved from one chamber to the other. This means over 25% of the Legislature is new. This election also saw both the Senate President and The House Speaker termed out – meaning new leaders for both bodies. It is
expected that Sen. Cameron Henry will be the Senate President and Rep. Phillip DeVillier will be the House Speaker. What comes next will be selections for both Pro Tem positions and then new committee chairs and vice chairs will be appointed. Put your running shoes on and get ready for the round robin to come. There are people to meet, legislators to educate and chaos to overcome! We are already planning White Coat Wednesday and will be announcing that date early in January. Please make plans to join us this year as every voice is important! ■
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FIREARM SAFETY EDUCATION In accordance with Resolution 301 from the 2023 LSMS House of Delegates, we are sharing existing patient education and CME opportunities with the membership.
SAFETY FIREARM
https://edhub.ama-assn.org/interactive/17579432
https://www.ama-assn.org/delivering-care/public-health/ how-physicians-can-talk-patients-about-gun-violence-and-firearm
https://pubmed.ncbi.nlm.nih.gov/29360028/
https://health.ucdavis.edu/news/headlines/free-course-to-help- health-care-providers-reduce-gun-violence-/2022/08
LOUISIANA HEALTHCARE CONNECTIONS PARTNERS WITH LOUISIANA STATE MEDICAL SOCIETY TO EMPOWER INDEPENDENT MEDICAL PRACTICES
opportunities to improve quality outcomes for their patients, at a reduced cost. This important partnership will strengthen the practice of medicine for those physicians desiring to remain independent. Ultimately, this means better care for Louisiana’s Medicaid members.” The Louisiana State Medical Society’s Health Information Exchange (HIE), HealthSYNC, plays a pivotal role in this collaboration. By partnering with Louisiana Healthcare Connections, the HIE aims to enhance interoperability for independent primary care practices across the state. This breakthrough initiative enables small independent practices in Louisiana to participate in value- based payment models for Medicaid members, thus improving healthcare quality and outcomes. “The Louisiana State Medical Society is proud to partner with KONZA National Network to develop, implement, and operationalize HealthSYNC statewide,” said Jeremy Lapeyrouse, Director of HealthSYNC for LSMS. “This collaboration ensures that our members have a simple, streamlined solution to access national and state health information exchanges, comply with government quality program measures, gain deeper insights, and utilize powerful analytic tools. This work aligns with our vision of promoting excellence in the practice of medicine.”
Baton Rouge, La. (November 1, 2023) – In a strategic move to enhance healthcare accessibility and quality for independent medical practices in Louisiana, Louisiana Healthcare Connections is joining forces with the Louisiana State Medical Society (LSMS). This collaborative initiative aims to extend value-based payments and quality incentives to independent practitioners, enabling them to harness the benefits of economies of scale. Additionally, a $1 million investment is being made by Louisiana Healthcare Connections to enable participating practices to implement electronic medical records. Stewart T. Gordon, M.D., FAAP, Chief Medical Officer for Louisiana Healthcare Connections, expressed his enthusiasm for this groundbreaking partnership, stating, “As a physician deeply committed to improving the Louisiana system of healthcare, I am excited about the possibilities this collaboration between LSMS and Louisiana Healthcare Connections offers to independent medical practices. By pooling together to participate in value-based payment models, independent practices gain
For more information or a copy of the full press release, please contact Jeremy Lapeyrouse: jeremy@lsms.org ■
14 J LA MED SOC | VOL 175 | FALL 2023
Why Attend
We are thrilled to invite members and non-members to our revamped meeting. In 2024, we are introducing a new format with a strong focus on CME, alongside fun social gatherings. The 2024 Annual Meeting, hosted August 1 - 3 at Baytowne Conference Center, will include the traditional House of Delegates and Inauguration activities with a mix of CME presentations and family activities, all bundled at a fantastic resort in Miramar Beach, Florida. We are excited about the new programing and location. Plan your family vacation and earn CME credit - we can’t wait to see you at the beach! Book your room now! 2024 ANNUAL MEETING
• Acquire practical skills for your medical practice
• Stay updated on healthcare policies • Expand your professional network • Relish the sun and sea in beautiful Sandestin • Create lasting memories with your family
Room sizes and rates vary. Suites, 1 BR and 2 BR are available on both the Bayside (Conference location) and Oceanside. First come, first available. LSMS rates are available 3 nights before and 3 nights after our event.
THURSDAY 5:30 PM
3:00 PM 3:00 PM 7:00 PM
Opening Session HOD Breakout/CME Sessions
Tentative
Welcome Reception
Inauguration Party
2:00 PM
Board of Governors / Past Presidents Advisory Council
SATURDAY 8:00 AM
Schedule (subject to change)
FRIDAY 8:00 AM 9:00 AM
Breakfast
9:00 AM 9:00 AM
MSS, YPS, RFS Caucus’ Breakout/CME Session
Breakfast
General Session 10:00 AM Breakout/CME Sessions 12:30 PM Inauguration Lunch 2:00 PM Dessert with Exhibitors
10:00 AM Panel Discussion 10:00 AM HOD 8:00 PM
Smores on the Beach
Details
All meeting details will be placed on the official landing page. Scan the QR code to visit the site.
LOUISIANA STATE MEDICAL SOCIETY
H D2023
PROCEEDINGS OF THE HOUSE OF DELEGATES 142ND ANNUAL MEETING
CALL TO ORDER Thomas Trawick, Jr., MD, Speaker of the House called the opening session of the Annual Meeting to order at 8:30AM on Saturday, August 5, 2023 at the Renaissance Hotel in Baton Rouge, Louisiana. The Reverand Andrew Rollins offered the invocation then the Pledge of Allegiance was recited. REMARKS OF THE SPEAKER Thomas Trawick, Jr., MD, Speaker of the House began his remarks by welcoming all participants and thanking them for making the trip to Baton Rouge. Dr. Trawick announced that the procedure for elections for offices elected by the House of Delegates would be outlined by the Committee on Rules and Order of Business. The Speakers prepared election sheets for all elected offices and previously announced candidates for each office as a slate of candidates which will be presented to the House. As each position comes up for election, the Speakers will indicate the announced candidate(s) and call for any additional nominations from the floor. Any delegate has the right to extract any item from either the proceedings of the HOD or BOG to be debated. If anything was extracted from those proceedings, debate on those items only would occur immediately. Additionally, the Speakers reminded delegates that minutes from BOG meetings cannot be changed. Dr. Trawick reminded the delegates of the process by which resolutions are numbered and categorized. He reiterated the Speakers make only minor editorial changes to the resolve segment of resolutions to clarify their structure prior to publication and mailing to the House. He emphasized most are grammatical or procedural in nature and do not reflect any change to the intent of the resolution. He noted any portion of a resolve can be amended during debate. Because the WHEREAS portions of resolutions are dropped once resolves are adopted, each resolve should always be in a form which can stand alone after adoption.
Dr. Trawick noted the procedure for offering amendments. Amendments should be submitted to the designated LSMS staff member in the back of the House. When the author wishes to introduce an amendment, he will say so then the coordinating amendment will be displayed on the screens. Dr. Trawick explained that the meeting would follow the rules of Sturgis. Dr. Trawick reminded attendees that when speaking at the microphones to identify yourself, who you represent, and state whether you support or oppose the resolution or amendment. REPORT OF THE CREDENTIALS COMMITTEE Paul Perkowski, MD, Committee Chair, reported that a quorum of certified delegates was present and seated.
Report of the Committee on Rules and Order of Business
Anthony Blalock, MD, Chair, presented the report of the Committee on Rules and Order of Business which met earlier in the day. The Committee recommended the following rules for use by the 2023 House of Delegates: 1. Limitation of Debate: The tradition of previous meetings regarding limitation of debate be as follows: Each speaker addressing an item brought to the floor for a vote is limited to two minutes of debate. Each delegate may return to the floor for one minute for the purpose of rebuttal or to summarize his/her position.
2. Election packet was approved as presented.
3. Late Resolutions L-1 was submitted by Rod Clark, MD and accepted to be introduced, however it needs a two-thirds vote by the House to include in the order of business.
The report and recommendations of the committee on Rules and Order of Business were approved by the House of Delegates.
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16 J LA MED SOC | VOL 175 | FALL 2023
50 YEAR PHYSICIANS
Gordan Nutik, MD Carter Paddock, MD Fred Reid, MD Alton Romero, MD
Bruce Iteld, MD Mark Juneau, Jr., MD Michael Kudla, MD Edwin Lin, MD William M. Long, MD* Edward Lyons, MD Laurence M. May, MD Gordon Mead, MD Charles Mitchell, II, MD Ricardo Mora, MD Barbara Morgan, MD Linda Nall, MD John Naponick, MD
Brian Barnes, MD David Boudreaux, MD Chester C. Coles, MD Clifford G. Crafton, MD Chris J. DiGrado, MD William Eddleman, MD Edwidg Eugene, MD Jeffrey Fritter, MD Robert Freeman, Jr., MD Gordon Gidman, MD Gary Guidry, MD Akshey Gupta, MD Timothy Hart, Sr., MD
YEARS
Richard Sabatier, MD Carlton Sheely, MD Mohammed Suleman, MD* Henry Taliaferro, MD Lance Turkish, MD Willard Washburne, MD Charles Woodard, MD
In Memoriam
Daniel Strain, MD John T. Wilson, MD
Russell Pavich, MD James Robinson, MD Stanely Smith, MD
William Haynie, MD Kenneth Mauterer, Jr., MD Donald J. Palmisano, MD
Walter Asseff, MD James Bergeron, MD Richard Dickey, MD
17
J LA MED SOC | VOL 175 | FALL 2023
REMARKS OF THE PRESIDENT Dr. Trawick introduced John Noble, Jr., MD to give him an opportunity to address the House. “ Mr. Speaker, thank you for this privilege. Good morning and welcome to all. Thank you for attending and being a committed member of your state medical society. This year has been eventful, productive, and enlightening. I am incredibly proud of the accomplishments of our staff, The Council on Legislation, and the Board of Governors. I want to update you on many of our achievements this year. We began 2023 by representing our Society at the Mystic Krewe of Louisianians’ Washington Mardi Gras, strengthening many relationships along the way. DC Mardi Gras is a remarkable networking experience, and I encourage you to consider attending this spectacle at least once in your lifetime. In February 2023, we launched the Advantage Physician’s Healthcare Trust, offering group health coverage to our members and their office staff. The plan allows us to provide our members with high- quality health coverage at reasonable rates. This self-funded health plan can do many things, but, most importantly, it will enable small groups of individuals to secure pricing at large group rates. In the industry, a plan of this type is called a Multiple-Employer Welfare Arrangement (or MEWA). I encourage anyone struggling to remain independent while still trying to provide health insurance for your staff to consider obtaining a quote from this plan. The LSMS continues to work with the Louisiana Board of Pharmacy relative to automatic prescription refills and the ownership of prescriptions. Due to our Society’s tireless efforts, we arrived at the revised language “The prescription may be refilled when requested by the patient or his caregiver.” This action prevents the inadvertent refill of medications previously discontinued but remaining on an automated refill protocol. The Board of Pharmacy has agreed that the prescription belongs to the patient, and they can fill it anywhere they choose. Suppose it is sent electronically to one pharmacy. In that case, the patient can request to have the prescription transferred to the pharmacy of their choice without contacting the physician’s office, and “any Transferring pharmacy shall comply with
that request as soon as possible but no later than the end of the next business day.” NOW ON TO LEGISLATIVE WINS We had an outstanding session. Both pieces of prior authorization legislation requested by the Society were passed and signed by the Governor. Thank you to all who invested your time and resources to help us succeed! ACT 312 creates an infrastructure and minimum standards for health insurance issuers. It requires health insurance issuers to do many things related to prior authorization and puts us on par with our regional neighbors. This is one of the most significant Legislative Acts to benefit physicians in years. I won’t go into all the details, but one of the most exciting components of the bill is that it requires a specialty peer-to-peer review with few exceptions. ACT 333 closely tracks transparency requirements proposed by the Centers for Medicare and Medicaid Services relative to Medicare Advantage organizations expected to go into effect on January 1, 2026. This is also a vital Legislative Act and requires health plans to report specific prior authorization metrics annually to the Department of Insurance. This will now give us data to track whether or not our state’s commercial insurance companies are acting in good faith. Scope of practice remains one of our Society’s top priorities. This year saw two significant scope of practice bills filed. Both dealt with specific issues we’ve seen before. Rep. Barbara Freiberg filed HB 471 at the request of corporate pharmacies. If passed, it would have allowed any licensees of the Louisiana State Board of Pharmacy to give any vaccination to any child aged seven and older. This would include pharmacists, pharmacy techs, and their interns. Proponents of the legislation touted this as an improvement in access to care, but our stance is that children are best treated in a pediatric medical home. This bill died in the House. We also effectively beat back a bill regarding Global signature authority and another bill regarding the standard of care under emergency declarations. PAGE 20 ⊲
18 J LA MED SOC | VOL 175 | FALL 2023
THE INDEPENDENT PHYSICIAN IS ENDANGERED. THE LATEST STATISTICS SUGGEST 75% OF US ARE EMPLOYED
The independent physician is endangered. The latest statistics suggest 75% of us are employed. Whether employed or independent, we must support and preserve independent practice everywhere. Once we lose our option of practicing independently, we lose tremendous bargaining power as a profession. As physicians, we must do everything we can to support one another. I caution against trying to be all things to all people. We cannot and should not try to solve all of the world’s problems. As the tattoo artist in the ATT commercial says, “Stay in your lane, bro.” We must reject the distraction of esoteric issues and commit to fixing kitchen table issues that affect every physician in the state. We must tirelessly fight and advocate for two things: patient safety and the preservation of our profession. We must never, ever give up. Finally, I want to thank our staff for being so supportive over the past several years. We are blessed to have such a highly talented and productive team. I would also like to thank my colleagues on
PODCAST PARTNERSHIP The LSMS has partnered with the law firm of Chehardy Sherman Williams to promote the LSMS agenda and policies. The Health Law Talk podcast focuses on the expansive area of healthcare law. Each episode addresses various legal issues and current events surrounding healthcare topics. I’m also thrilled to announce that we are very close to making our health information exchange, HealthSync, even more valuable, with hopefully some exciting news this weekend. During this meeting, there will be much discussion about the modernization of this Society. For us to continue to grow, we must change with the times. Technology and transportation afford us opportunities that were never possible decades ago.
ELECTIONS: THE FOLLOWING MEMBERS WERE ELECTED TO SERVE: BOARD OF GOVERNORS Position Name Term President-Elect Roderick Clark, MD 2023 Speaker, House of Delegates Thomas Trawick, Jr., MD 2023 Vice Speaker, House of Delegates Robert Newsome, MD 2023 Secretary- Treasurer Amberly Nunez, MD 2023 Chair, Council on Legislation Matthew Giglia, MD 2023 Medical Student Member Madison Thornton 2023 Resident Member Omar Leonards, MD 2023 Young Physician Member Ken Ehrhardt, MD 2023 Employed Physician Member John Bruchhaus, MD 2023 Private Practice Physician Section Katherine Williams, MD 2023
AMA DELEGATION Position
Name
Term
Delegate Delegate Delegate
William Freeman, MD Luis Alvarado, MD Kamel Brakta, MD Deborah Fletcher, MD
2023-2025 2023-2025 2023-2025 2023-2025 2023-2025
Alternate Delegate Alternate Delegate
Clay Runfalo, MD
COUNCIL ON LEGISLATION Position
Name
Term 2023 2023 2023 2023 2023
Medical Student Member
Paige Wilson
Resident Member
Omar Leonards, MD Lindsey Fauveau, MD Matthew Bernard, MD
Young Physician Member
Private Practice Physician Member Employed Physician Member
Clay Runfalo, MD
20 J LA MED SOC | VOL 175 | FALL 2023
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