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A Healing State of Mind: SUNY Upstate Medical University Is Advancing the Landscape of Neurology and Neurosurgery

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By Katy Mena-Berkley

Monday, November 2, 2020

At the State University of New York Upstate Medical University, neurologists, neurosurgeons and neuroscience researchers work together to offer a robust spectrum of neurological solutions to the Central New York community.

Ruham Nasany, MD, is leading a multi-disciplinary team for the new Neuro-Oncology program.
 

Located in Syracuse, Upstate is the region’s main referral center for specialized medical care and the only one to have a comprehensive neurological disorders program.

“Central New York is a large territory that covers one-third of the state and is home to one-tenth of New York’s population,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “In order to satisfy and meet the needs of our community, we have expanded our established programs to form the Upstate Neurological Institute. This is critically important at a time when neurology and neuroscience is the most sought-after specialty in the country.”

In the past 15 years, SUNY Upstate Medical University’s neuroscience offerings have expanded tremendously. Together, the departments of Neurology and Neurosurgery have doubled its number of faculty, recruiting the best and brightest clinical minds from all corners of the United States, and have also retained a significant portion of SUNY Upstate Medical University trainees and residents.

“Our clinical neuroscience program is the most advanced in the region, touching on the three pillars of neurological clinical care, education and research,” Dr. Mejico says. “We have invested a lot of effort into generating programs that provide the best care for our community, and we continue to expand and improve high quality care here in Central New York.”


Luis Mejico, MD, is the Chair of Neurology and is part of the multidisciplinary Neuro-Ophthalmology clinic, one of the dozen specialty clinics in the department.

Satish Krishnamurthy, MD, leads the Neurosurgery department and is a funded researcher. In Fall 2020 he received a $324,000 DOD grant to find a pharmacological solution for hydrocephalus instead of repeated shunt surgery.

Leading-Edge Solutions Close to Home

While people may need to travel for specialized operations such as neurosurgery, Upstate provides a more convenient option for patients and families in Central New York, as well as northern and western Pennsylvania.

“We cover the length and breadth of neurosurgery, offering the treatment options that our community needs,” says Satish Krishnamurthy, MD, MCh, FAANS, Professor and Interim Chair of the Department of Neurosurgery at SUNY Upstate Medical University. “The idea is to have the country’s best care right here in our patients’ backyard.”

Established in 1966, the Department of Neurosurgery has a long-standing history of training neurosurgeons to manage a wide variety of disorders found in the brain and spinal cord.

“Neurosurgery at Upstate has always catered to the sickest of the patients, while also contributing to education and making sure neurosurgeons not only do a good job, but provide the community with the best care possible,” Dr. Krishnamurthy says. “We have a specially trained team and high-end technology right here.”

Stroke Care and Telemedicine

Patients in rural communities who experience stroke can trust the board-certified stroke physicians at Upstate University Hospital to provide expert care via telemedicine. Using and interactive video conferencing, Upstate’s team can connect with emergency departments at partnering regional hospitals in real time. Each patient may see a consulting neurologist and Upstate’s stroke specialists. Together, this team provides timely medical evaluation and administration of tPA treatment to improve outcomes and minimize risk of long-term complications.

Upstate Brain & Spine Center is staffed by the largest team of neurosurgical specialists in Central New York, providing a spectrum of services to patients at Upstate University Hospital. The team also provides support to patients at multiple Upstate facilities, including its Level I trauma center — the only one in the region — Upstate Cancer Center, Upstate Golisano Children’s Hospital, neonatal care units and Upstate Comprehensive Stroke Center.

Intensive Care for Neurological Conditions

Upstate University Hospital is home to the only structured neurocritical care service in Central New York. The dedicated unit is designed to treat, manage and evaluate patients with the most severe and complex conditions affecting the brain and spine. During the past decade, Upstate’s Neuro ICU has nearly more than tripled in size, expanding from an eight-bed unit to a 27-bed unit.

“The expansion meets the growing needs of the region,” says Julius Gene Latorre, MD, MPH, Medical Director of the Upstate Comprehensive Stroke Center. “This was in part fueled by the advancement in acute stroke care and in medical advances in the management of neurosurgical conditions and traumatic brain injuries.”

The neurology specialists in the Neuro ICU typically treat patients with intercranial hemorrhage that may be related to a spontaneous hemorrhage of the brain or traumatic hemorrhage of the brain. They are also practiced in managing the care of patients experiencing brain injury related to loss of oxygen from cardiac arrest. Other conditions these specialists may see include uncontrollable seizures and complex neuromuscular conditions, such as Lou Gehrig’s disease.

In addition to technology and equipment commonly found in ICUs, the Neuro ICU at Upstate University Hospital also has monitoring equipment specially designed to monitor brain function, such as continuous electroencephalogram (CEEG) monitoring critical in the detection of non-convulsive seizures.


Julius Gene Latorre, MD, MPH, Medical Director of Upstate Comprehensive Stroke Center, the first in the region

Harish Babu, MD, Assistant Professor of Neurosurgery at Upstate, is one of the clinicians providing care to patients with surgical disorders of the brain and spine. Together with his colleagues, Dr. Babu provides intensive neurosurgery embracing sophisticated technologies. The neurosurgeons and neurosurgical researchers specialize in brain bleeds, brain tumors, hemorrhages, pediatric care, nerve and spine problems, and strokes. Upstate’s neurosurgical technologies include:

  • Minimally invasive robotic surgery — Operating through small incisions, can avoid some complications associated with surgery that requires a larger opening. Using stereotactic laser ablation, the neurosurgery team can address multiple neurological conditions, including epileptic foci and tumors.
  • Endoscope — “Using an endoscope, we are able to investigate the nooks and crannies of the brain in a manner that does not disturb surrounding tissue,” Dr. Babu says. “We can use endoscopes through the nose to reach the brain for surgeries. Then we can use pointed lasers to burn tumors. We also have computerized microscopic navigation techniques, which are like a GPS for the brain that allows you to target a specific pinpointed area.”
  • Fluorescein-guided neurosurgery — Using a green-water soluble dye known as sodium fluorescein, neurosurgeons can more accurately investigate a tumor site. The dye accumulates on areas of the brain where the blood-brain barrier has been damaged, highlighting the tumor tissue more clearly.
    “In some patients, we do not think that we can see every single cell with our eyes or an MRI machine,” Dr. Babu says. “When we inject the dye as part of surgery, the tumor cells will light up differently compared to the normal brain. That helps us remove those tumors and keep the normal parts of the brain in intact.”
  • Focused radiation Gamma Knife — This computerized treatment planning software helps neurosurgeons precisely locate targets in the brain and deliver concentrated doses of radiation to the affected area. As a result, surrounding tissue is spared. Gamma Knife radiation may be used to treat a variety of neurologic conditions, including benign brain tumors, such as meningiomas and pituitary adenomas, malignant brain tumors, such as primary brain tumors and metastatic tumors, blood vessel defects, such as arteriovenous malformations, and functional complications like trigeminal neuralgia. The region’s only Gamma Knife is considered to be patient friendly as it is a one-time outpatient procedure.
  • Awake craniotomy — Using specialized anesthesiology techniques, neurosurgeons are able to operate while a patient is still awake. Neurosurgeons may ask a patient who is undergoing an awake craniotomy to perform an action, such as playing the violin or singing, during the surgery.
    “We do this to make sure that the function of the brain is preserved, and we are not cutting into important brain tissue,” Dr. Krishnamurthy says.

Expert Epilepsy Care

A Level 4 comprehensive epilepsy center, Upstate University Hospital is equipped with the technology and expertise to deliver effective epilepsy care. The epilepsy program has expanded during recent years, increasing the monitoring unit in the hospital. If surgery is needed, fellowship-trained neurosurgeons can perform a range of procedures, including Robotic Stereotactic Assistance (ROSA) for localization and treatment of the epileptic foci using minimally invasive surgical methods.

Robert Beach, MD, monitoring patient Amyee Rodriguez of Gouverneur, New York

An Exploration of Possibility

The Brain Tumor Research Laboratory at SUNY Upstate Medical University is a unique resource that works hand in hand with the Department of Neurosurgery to enhance patient care and outcomes.

“The laboratory is a research unit, a self-contained research facility that is completely integrated with the clinical mission of the Department of Neurosurgery,” says Mariano Viapiano, PhD, Associate Professor of Neurosurgery and Neuroscience and Director of the Brain Tumor Research laboratory. “We support the work of the clinicians by allowing them to perform research activities with clinical specimens. That research allows them to receive better details about the clinical case of the patients and more information about the tumors, enabling a better diagnosis and prognosis.”

Frozen samples of brain cancer tumors can be carefully thawed, put in a nourishing medium and placed in a body-temperature incubator to bring them back to life at Upstate’s Brain Tumor Research Laboratory.

Dr. Viapiano works with a multidisciplinary team of experts in the laboratory, including two senior scientists who are biochemists, two research fellows, one junior trainee and a laboratory manager, Sharon Longo.

“Sharon has been lab manager for 24 years,” Dr. Viapiano says. “I am fortunate to have her here. She runs day-to-day operations, and we have an outstanding relationship.”

Together, the specialists in the Brain Tumor Research laboratory facilitate a bench to bedside pipeline to support clinical experts treating tumors associated with primary brain cancer, including glioma, neuroblastoma, rare tumors, skull-based tumors and brain metastases.

For this pipeline, a clinician may collect a tumor specimen, with patient consent, during surgery to send to the lab. Dr. Viapiano’s team performs genetic and molecular analysis on the specimen and can even reproduce the tumor. The research team can further investigate by administering experimental therapies.

“We generate a wealth of information that we can provide back to the clinicians to improve the patient’s diagnosis and prognosis,” Dr. Viapiano says. “We can provide that information to pathologists, and they can initiate therapeutic strategies based on that data.”

The Brain Tumor Research Laboratory also has an established protocol for tissue collection, allowing the team to collect specimens from every patient who consents to provide tumor tissue for research.

Expert Neuro- Oncologic Care

Upstate University Hospital is pleased to welcome Ruham Alshiekh Nasany, MD. A graduate of Upstate’s residency program, Dr. Nasany serves as Assistant Professor of Neurology, Director of the Brain Tumor and Neuro-Oncology program at the Upstate Cancer Center.

“Dr. Nasany completed her neuro-oncology fellowship at Memorial Sloan Kettering Cancer Center in New York City, which is a major cancer institute in the world,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “She has special training in neuro-oncology, which allows us to develop a program that will inspire new protocols.”

“Collecting those specimens has helped us to create a large repository or tumor bank that we can use for research purposes.”

Additionally, if a physician thinks that a unique tumor case would be of particular importance, the lab may set up a protocol to reproduce the tumor in animal models or in vitro.

“We are proud to have the best technology at the national level to provide care and the expertise we provide adds a whole component that allows us to evolve brain cancer care,” Dr. Viapiano says. “If you refer your patients to Upstate, you can count on not only the highest standard of care but also the best standard of analytical services in diagnostic prognosis and research.”

Upstate Neurological Institute

SUNY Upstate Medical University Interim President Mantosh Dewan, MD, has announced the formation of the Upstate Neurological Institute.

The new Institute unites two prominent departments — Neurology and Neurosurgery — to create the largest team dedicated to neurological disorders in Central New York.

In addition to patient care within these core departments, the Neurological Institute membership will expand to include collaboration with the 14 other clinical and basic science departments at Upstate Medical University, which have services or research to improve the health of persons with neurological disorders.

The setting supports the endeavor with many services that are one of a kind in the region. Upstate University Hospital has an entire hospital floor dedicated to patients with brain injuries. It was the region’s first comprehensive stroke center and has a level-4 level epilepsy center. Advanced neurosurgical technologies include intra-operative MRI, minimally invasive robotic and laser surgery tools, and the region’s only Gamma Knife. The Institute also is part of a medical university that offers robust neuroscience research aimed at treatments and cures.


SUNY Upstate Medical University Interim President Mantosh Dewan, MD

For more information, visit upstate.edu/neuro.

Minimal Medication, Maximum Care at Genesee Orthopedics & Plastic Surgery Associates

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By Cari Wade Gervin

Monday, November 2, 2020

Andrew Wickline, MD, FAOSS, FAAHKS, uses a joint replacement program that minimizes opioid use to promote holistic healing and better outcomes.


Andrew Wickline, MD, with a robotic surgical system. He is now also using a different type of technique called kinematics alignment for personalized fit. The negative to the robot is that it shoe horns people into the same size fit no matter what their pre-existing pre-arthritic alignment was. Kinematic alignment allows for that. Genessee Orthopedics will be performing a trial of an augmented reality system in the near future.

 

Total knee replacement is one of the more painful surgeries.

“My patients used to say, ‘I’d rather have another child than do this again,’” says Andrew Wickline, MD, FAOSS, FAAHKS, an orthopedic joint reconstruction specialist at Genesee Orthopedics & Plastic Surgery Associates.

The level of pain associated with a total knee replacement typically results in a large prescription for narcotic pain medication post-surgery. With opioid use and addiction up across the state, however, Dr. Wickline created a different approach for his patients. He now uses multiple non-opioid choices and a game-changing home therapy plan he created.

“There’s somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn’t use opioids before,” Dr. Wickline says. “That’s at least eight out of 100 people or at least 50,000 people a year nationally. That’s a frightening number.”


Dr. Wickline

“There’s somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn’t use opioids before.”
— Andrew Wickline, MD, FAOSS, FAAHKS, orthopedic joint reconstruction specialist at Genesee Orthopedics & Plastic Surgery Associates

The Problem With Opioids

In 2018, opioids were involved in almost 47,000 overdose deaths — 69.5% of all drug overdose deaths. Although New York has not been hit as hard as some other states, the problem continues to grow.

“Once you become an opioid user, you end up costing the medical system double the average amount of cost for a year,” Dr. Wickline says. “For commercial payers, for example, the average cost is around $11,000. But if you’re an opioid user, it goes up to almost $20,000.”

Even just a 24-hour prescription of narcotics has a 6% risk of chronic opioid addiction. So, after studying the issue and working with patients, Dr. Wickline published a study — 23-hour TKA in 10 Opioid Pills or Less Through 90 Days: A Non-Selected Prospective Consecutive One Year Cohort — earlier this year outlining his approach.

Dr. Wickline (center) with Uday Myneni, MS, MBBS, MCH, and his resident team at the first annual arthroplasty conference in Hyderabad, India. Dr. Wickline performed the first anterior hip replacement with the HANA table, televised live to over 400 surgeons.

 

Dr. Wickline’s Study

Published in the Journal of Orthopaedic Experience & Innovation in July and co-authored with Maryann Stevenson, RPh, the study focused on 386 patients who underwent a total knee arthroplasty (TKA).

During a four-month period, the patients received education, home-based physical therapy and a continuous adductor canal block with ropivacaine during surgery. Pain levels were recorded pre-surgery and through the first three postoperative days, then again at three weeks, six weeks and 12 weeks post-surgery.

The study found that 86% of patients were able to get through the 90-day period with 10 opioid pills or less. This is the lowest published opioid use in the nation, five times lower than the next best paper, which found people used 50 pills post-surgery on average. In addition, 85% did not need formal physical therapy, saving them around $720 and reducing their exposure to COVID-19.

“I have a lot of patients who live up in the Adirondacks, and they have no access to therapy,” Dr. Wickline says. “Patients who went to rehabilitation and had two hours of therapy every day had more pain and took more narcotics. My patients who live up north and had no access to therapy followed my simple exercises and experienced less pain.”

The formal study confirmed Dr. Wickline’s anecdotal experience, he says. His patients also experienced a 1.2% readmission rate through 90 days, one of the lowest in the nation based on CMS data. In addition, 64% of TKA patients were able to go home the same day as surgery, and 91% of patients left the hospital within 23 hours.

“By getting patients out of the hospital sooner, we prevent complications, lower the risk of MRSA and COVID 19, and lower the risk of C. diff-caused colitis,” Dr. Wickline says.

“What I saw with patients who went to rehab and had two hours of therapy every day, they had more pain and took more narcotics … than the patients who lived up north and had no access to therapy and just followed my simple exercises.”
— Dr. Wickline

Improved Outcomes, Faster

According to the study, Dr. Wickline’s patients reached 110 degrees of flexion on average within three weeks. That’s seven weeks earlier than the 2018 American Academy of Orthopaedic Surgeons textbook on rehabilitation states is normal.

Dr. Wickline stresses that his patients haven’t been cherry-picked to improve outcomes, either, which is documented in the study.

“The protocol fits everyone,” Dr. Wickline says. “If you have medical comorbidities, I might have to keep you overnight but the study shows that most patients can go home the same day. You can decrease your complications by following this protocol, and you don’t have to be a 57-year-old marathon runner with a bad knee and no medical history to qualify for this.”

Dr. Wickline’s protocol includes a daily progress plan he says is simple for patients to follow.

“Patients do a little bit of exercise each hour and then immediately sit down, elevate and ice to control the swelling,” Dr. Wickline says. “They get the range of motion, but they create the least amount of swelling, so the pain goes away quicker.”

Dr. Wickline says the exercises take five to eight minutes each hour. Combined with ice, elevation and NSAIDs, most patients’ pain is manageable, he says. And the protocol is also a great option for people who have struggled with addiction, whether with opioids or other substances.

“We had around 30% of patients who did not take any opioid medication after discharge,” Dr. Wickline says. He also offers cryoablation that can freeze the nerves around the knee for up to three months for patients who want zero opioids in or out of the hospital.

“Anxiety is a prime culprit in reaching for a pain pill,” Dr. Wickline says. “I have a very detailed education book on what to expect, so my patients know exactly what is normal during their joint replacement recovery.”

Visit andrewwicklinemd.com or call 315-735-4496 to learn more about outpatient joint replacement with the least opioid use in the nation.

The Best Foot Forward at Syracuse Orthopedic Specialists

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By Cari Wade Gervin

Monday, November 2, 2020

The foot and ankle team at Syracuse Orthopedic Specialists provides quality care for patients.

Feet are something most of us take for granted once we learn to walk — until the pain starts. If patients stand all day at their jobs, run dozens of miles every week or wear too-high heels for long periods of time, foot or ankle pain eventually creeps up on them. While many minor injuries can be fixed with time and rest, more serious injuries require expert help.

That’s where the foot and ankle team at Syracuse Orthopedic Specialists (SOS) comes in. The team of surgeons, podiatrists, physician assistants, nurse practitioners, physical therapists and a pedorthist offer comprehensive foot and ankle care at the SOS Heritage Commons office in North Syracuse, providing patients with the ability to have comprehensive foot and ankle in the same building.

“SOS is a one-stop location for everything,” says Frederick R. Lemley, MD, foot and ankle orthopedic surgeon at SOS. “Patients can have their feet and ankle needs, operative and nonoperative, taken care of here.”

Surgical Specialties

Dr. Lemley is one of two board-certified, fellowship-trained orthopedic foot and ankle surgeons at SOS, along with Naven Duggal, MD. A Long Island native, Dr. Lemley started his surgical practice at SOS 14 years ago, after attending SUNY Upstate Medical Center. Dr. Duggal moved to Syracuse in 2013 after eight years at Boston’s Beth Israel Deaconess Medical Center and Harvard Medical School to be closer to his family in Canada.

“The region is great from the standpoint of what I do, because there’s a lot of athletes, sports and activities,” Dr. Duggal says. “Not only do I like to participate in those activities — and my family does as well — but, I get to take care of athletes who experience injuries to ligaments and tendons, as well as fractures.”

Of course, Dr. Duggal’s expertise is much broader than treating athletes.

“I perform reconstructions and tendon repairs, and I fix fractures,” Dr. Duggal says. “I’ll also do fusions for correcting deformities of the ankle and foot, as well as replacements of the ankle.”

Total ankle arthroplasty, along with ankle instability surgery, are Dr. Lemley’s specialties.

“There are not many people who do total ankle replacements in Syracuse,” Dr. Lemley says.

SOS physicians also have expertise in treating rheumatoid arthritis and common ailments like bunions and hammer toes.

“I think what sets SOS apart is how we have a bevy of longtime orthopedic surgeons who are experts within their field of orthopedics,” Dr. Lemley says. “We have exceptional subspecialty care at SOS. As opposed to trying to do a little bit of everything, each team works in one specific area of orthopedics.”

“Syracuse Orthopedic Specialists is really a one-stop shop for everything. Patients can have their foot and ankle needs, operative and nonoperative, taken care of here.”
— Frederick R. Lemley, MD, foot and ankle orthopedic surgeon and partner at Syracuse Orthopedic Specialists

Complete Foot Health Management

When treating patients with chronic foot pain — rather than a sudden, severe fracture — Drs. Duggal and Lemley both emphasize that they prefer conservative approaches and will only recommend surgery if nonoperative measures have not worked.

“We’ll use physical therapy, and we’ll use bracing, including orthotics, that can help people avoid surgery, which is great,” Dr. Duggal says.

Because the SOS foot and ankle team has two podiatrists, Christopher J. Fatti, DPM, and Stephanie Hook, DPM, on staff, patients with conditions like plantar fasciitis and tendinitis can easily receive care. The podiatrists also specialize in diabetic foot care, along with SOS pedorthist Maureen Kaljeskie, C.Ped.

“Maureen works closely with Dr. Lemley and me, as well as our podiatrists, to help treat patients,” Dr. Duggal says. “As the person who makes all of these orthotics, she helps accommodate that niche patients look for as well.”

SOS takes the team approach seriously when treating patients, which is what makes it such a special practice, the physicians say.

“You can always say the technology is great, and I think it is, but we have a fantastic team at SOS including our nurses, administrators, x-ray techs, and so many more departments all working together,” Dr. Duggal says. “It’s just a good place for patients. We take care of our neighbors.”

“I think people tend to underestimate that foot and ankle surgery can improve patients’ quality of life. For patients who have end-stage arthritis or a tendon that’s been chronically torn, getting it taken care of can help their symptoms.”
— Naven Duggal, MD, orthopedic foot and ankle surgeon and partner at Syracuse Orthopedic Specialists

When Is Surgery Needed?

Foot and ankle surgeries for non-acute injuries can often lead to long recovery times, which can be a big problem for people who work on their feet, live alone or have other mobility issues. And in past decades, certain procedures have gained a reputation for poor outcomes.

“I think there’s a consensus within the medical community that you should never have [non-acute] foot or ankle surgery,” Dr. Lemley says. “But what I would counter is that there are some surgeries that work very well, have excellent outcomes, and are worth the time and investment. You just have to find a surgeon who will give an honest opinion.”

Dr. Duggal says that when surgery may be needed, it’s a great option to be able to get it done in an outpatient facility.

“I think people tend to underestimate that foot and ankle surgery can improve patients’ quality of life,” Dr. Duggal says. “For patients who have end-stage arthritis or a tendon that’s been chronically torn, having it taken care of can help their symptoms and help restore some of the functionality that they’ve been missing.”

Find out more about foot and ankle surgery at Syracuse Orthopedic Specialists by calling 315-883-5881 or visiting sosbones.com/specialties/foot-ankle.

Syracuse Orthopedic Specialists Foot and Ankle Team

Surgeons: 

Naven Duggal, MD

Frederick Lemley, MD

Podiatrists:

Christopher J. Fatti, DPM

Stephanie Hook, DPM

Pedorthist:

Maureen Kaljeskie, CPed

Child Surrogacy Legalized, Finally

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By Bruce Wood, Esq.

Monday, November 2, 2020

On April 3, 2020, Governor Cuomo signed into law the Child-Parent Security Act (CPSA) of 2020, which will be effective Feb. 15, 2021, removing New York from the short list of only three states that still outlaw surrogacy contracts.

In 1992, New York outlawed surrogacy contracts in large part due to the publicity surrounding the high-profile Baby M case in New Jersey where the egg of the surrogate was fertilized by the sperm of a man who was not her husband. After the child was born, the surrogate and her husband had a change of heart and refused to turn over custody of the child to the intended parent.

There are two kinds of child surrogacy arrangements. In a gestational surrogacy, the surrogate carries to term an egg from another woman that was fertilized in vitro by the sperm of a man who was not the surrogate’s husband. The intent is for the surrogate to relinquish the newborn baby to the intended parent(s), regardless of whether the surrogate is to be paid for her services or is acting out of friendship to the intended parents.

In a genetic surrogacy, the surrogate contributes her own egg for the conception. The CPSA only authorizes gestational surrogacy arrangements, if they meet certain requirements, while genetic surrogacies will remain illegal in New York.

In adopting the CPSA, the legislature recognized that New York failed to keep pace with medical advances in assisted reproduction, causing uncertainty about who the legal parents of a child are upon birth (for example, there is a legal presumption that any child born of a married couple is legally their child). The CPSA is intended to provide clear and decisive legal procedures to ensure that children born through third party reproduction have secure and legally recognized parental relationships with their intended parents.

The requirements for a valid surrogacy agreement are quite detailed. Here are a few of the most important ones:

  • The surrogate must be at least 21 years of age (even though 18 is generally the age of majority in New York).
  • It must be a written agreement signed by all parties before two non-party witnesses.
  • The surrogate must complete a medical evaluation and provide her informed consent concerning the possibility of multiple births, risks of medications taken for the surrogacy, risk of pregnancy complications, psychological risks, and impacts on her personal life.
  • If the surrogacy agreement provides for payment of compensation to the surrogate, the funds for the compensation and reasonable anticipated additional expenses must be placed in escrow with an independent escrow agent before the surrogate takes any medications or commences any medical procedures.
  • The surrogacy agreement must disclose how the intended parent(s) will cover the medical expenses of the surrogate and child (usually through a comprehensive health insurance policy).
  • The surrogate and her spouse (if any) must receive a copy of the Surrogate’s Bill of Rights.
  • The surrogate has the right to make all health and welfare decisions regarding herself and her pregnancy, including whether to consent to a C-section for delivery. Notably, the surrogate retains the right to abort or continue the pregnancy.
  • The intended parent(s) must agree to assume the support of all children born as result of the surrogacy.
  • The surrogate and her spouse (if any) must be represented throughout the surrogacy contract by independent legal counsel of their choosing, whose fees must be paid by the intended parents (except in the case of a “compassionate” surrogacy where the surrogacy is not compensated and waives the right to have the intended parents pay for legal representation). The intended parents must also be represented by independent legal counsel.

Most significantly, and notwithstanding the historical prohibition against “selling” babies, the surrogate can now be compensated for the medical risks, physical discomfort, inconvenience and responsibilities the surrogate is undertaking (but not to purchase gametes or embryos). The compensation must be reasonable and negotiated in good faith and payments to the surrogate cannot exceed the duration of the pregnancy and a recuperative period of up to 8 weeks. Compensation to an embryo donor is limited to storage fees, transportation costs and attorneys’ fees.

The CPSA will usher in a new era of third-party reproduction in the State of New York.

Bruce Wood is a member at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6292 or bwood@ccblaw.com.

Solid Preparation and a Spirit of Innovation: Upstate Medical University’s Response to COVID-19

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By Jennifer Webster

Thursday, September 3, 2020

Even before the coronavirus arrived in the United States, forward-thinking physicians at Upstate Medical University saw the signs and got ready for action. Their quick response, paired with a culture of institutional preparedness and creativity, helped Upstate respond effectively to the crisis. Today, its hospitals and practices are open for business across all of its clinical areas, as the commitment to addressing COVID-19 continues.

As word of COVID-19 reached the U.S. in January, infectious disease specialists at Upstate, including Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, began tracking developments in China. These physicians communicated with Upstate’s leadership, who responded with alacrity. The promptness took some of their colleagues by surprise, but their forethought was soon lauded.

“In early January, Paul Suits, Director of Infection Control, convinced our Logistics Department to purchase a big shipment of N95 masks,” Dr. Thomas says. “Initially, they asked, ‘Why are we doing this?’”

Suits, Dr. Thomas and their colleagues pointed out that when the Ebola virus outbreak took place in West Africa, equipment was difficult to obtain worldwide because only a limited number of sources make medical-grade protective gear. If the coronavirus reached the U.S., it would be problematic.

Obtaining masks represented just one aspect of the preparedness Upstate demonstrated in the early days. Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, knew that Upstate, and the entire Central New York region, could soon be facing some serious needs. When approached by Chris Dunham, Director of Emergency Management at Upstate, Dr. Corona activated the Incident Command structure, which stands ready to respond to crises.

“Even before executive orders or recommendations were issued, we had a team of more than 70 people discussing our response to COVID-19,” Dr. Corona says. “This is the longest-serving Incident Command we have had.”

Formally convening in mid-March, Incident Command met twice daily, discussing needs that included rescheduling elective procedures, freeing hospital beds for potential COVID-19 patients, cleaning and decontaminating, and testing and communicating with the wider community. The meetings were held twice daily — weekends included — with more than 100 people on the Zoom calls to hear and act on the reports. Everyone wanted to play a part and learn as much as they could about how to keep patients safe.


University Hospital staff working with PPE

In early spring, Upstate rapidly transitioned most outpatient visits in the majority of its 19 clinical departments to telemedicine and continues to offer the option for many types of visits. When patients do not need to be physically present, telemedicine provides a convenience and helps both patients and providers maintain social distance.

“Telemedicine has been something we have been readying ourselves to do for years at scale, and the crisis showed that this was viable,” Dr. Corona says.

Nursing Heroism

If science guided Upstate Medical University’s COVID-19 response, nursing care made up the backbone of that response. Nurses managed patients, communicated with families, and continuously donned and doffed protective equipment. Even though their jobs became exponentially harder, nurses found the resilience to do difficult work and even to travel to Long Island in downstate New York to render assistance in hard-hit hospitals.

Nancy Page, MSN, RN, NEA-BC, Chief Nursing Officer at Upstate University Hospital, oversaw that effort. One of the most important parts of a nurse’s role, before and especially during the pandemic, is teaching patients to advocate for themselves, she observes. Over and over, Page’s staff helped empower patients to ask providers and family members questions, such as if they’d washed their hands, and in other ways become active participants in their own care.

Observation skills also came into play.

Nancy Page, Chief Nursing Officer at Upstate University Hospital, with the team

“Nurses don’t diagnose, but we’re experts in looking at the whole person,” she says. “In COVID-19, nurses pioneered looking at people in the ICU and proning patients to improve their long-term function. Nurses and respiratory therapists were key to that intervention.”

Caring for patients with COVID-19 can be emotionally and physically stressful. Nurses at Upstate clinical locations that did not have dedicated COVID-19 units proposed a “job swap” with nurses at locations with COVID-19 wards, at University Hospital and Upstate Community Hospital.

“A nurse could come into a non-COVID unit for two weeks and vice versa,” Page says. “Numerous nurses took advantage both ways. Some wanted experience caring for people with COVID-19, while others were glad to have a short break.”

Volunteerism went far beyond the Central New York region, as Upstate’s nurses traveled downstate to help their colleagues working in the most urgent of settings. The nurses traveled in three waves, along with a cadre of respiratory technicians. Each group served for a period of time at Stonybrook University Hospital on Long Island, a SUNY sister university to Upstate. In total, Page recalls, 46 nurses along with 11 other staff members traveled to help their colleagues get through the crisis.

“Each of our departments is focused on safely handing referrals, being in touch with referring physicians and seeing patients within their comfort zones. Every service at Upstate Medical University is open for referral.”
— Robert Corona, DO, MBA Chief Executive Officer of Upstate University Hospital

Resources of an academic medical center

From the start of the pandemic, Upstate took its position as an academic medical center seriously — caring for patients, pursuing research into COVID-19 and possible treatments, analyzing data, and advising the public about the crisis as it developed. In their public-facing role, Upstate leadership drew on data modeling from its own public health experts to predict the spread of the pandemic. Drs. Corona and Thomas, as well as others, became a reliable “voice of the pandemic” for Central New York.

Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, and Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, became trusted voices of the pandemic for Central New York. Both doctors gave interviews to local media, including Channel 9 TV.

Some of the communication resulted from information gathered about the virus and the population’s influence on its spread, sharing that information with the public and, in turn, influencing the public’s response. For instance, Upstate public health experts discovered that cell phone data could help predict the virus’ spread. Areas where people were on the road more frequently experienced a surge in cases shortly thereafter.

Dr. Thomas, who was a frequent commentator in the media explains, “The data could be used as a ‘stick’ and ‘carrot.’ Based on what was happening in our community I could tell the public, ‘You’re out too much, and there’s a direct association with infections growing’ or ‘You’re doing a great job staying home, and infections are going down.’”

Upstate’s Department of Public Health and Preventive Medicine supplied much of the data and analyses that informed the public, government officials and countless areas within Upstate. As part of the College of Medicine, the department consists of epidemiologists, biostatisticians, data analysts, coordinators, community health and social scientists, who continue to provide ongoing reports and monitoring. Department Chair Christopher P. Morley, PhD, says the team is helping Upstate create a playbook that can be used for future waves of the coronavirus or another pandemic. For real time updates, faculty members Telisa Stewart, MPH, DrPH, public health, and Kathryn Anderson, MD, PhD, medicine and microbiology, immunology, helped to establish systems with a dedicated internal IMT team to collect, analyze and report infection data to Upstate leadership and Central New York.

“Being an academic medical center creates a huge advantage during this time,” Dr. Corona says. “We have experts to talk in public forums, answer media questions and meet with large groups, like manufacturing associations and other entities, to talk about how they can keep people safe. Now as more is known about the effects of COVID-19 on patients, we also have experts to address those varying aspects — from pulmonary to neurological to cardiovascular.”

Ingenuity in a Crisis

Teams at Upstate University Hospital leveraged technological savviness to protect staff and improve communications while keeping patients, providers and families in touch.

  • The chatbot, an AI addition to Upstate’s online presence, triaged COVID-19 questions, answering common ones and routing complex issues to live operators. The chatbot was designed to “speak” both English and Spanish. In five months, the chatbot supported 22,758 users.
  • iPads at the bedside helped patients safely chat with families. Providers, including physicians, nurses and dietitians, also hold consults through the more than 200 iPads now in place throughout the hospital. The tablets also function as a video call bell, saving PPE as some needs can be addressed without entering the patient’s room.
  • In-hall IV pumps and patient monitors allowed nurses to check the vital signs of patients with COVID-19 from outside patient rooms without having to don full protective gear.
  • Telemedicine expanded to include almost every service line, allowing patients to visit providers online from the safety of their homes. Continuing medical education also moved online.
  • In post-COVID recovery groups, patients obtain the support and specialized care they need. Physicians check in daily via telehealth visits, following patients until they are free of symptoms. As providers are discovering, COVID-19 can cause chronic symptoms in some people and Upstate has expertise across the areas patients need.


The coronavirus pandemic has made telehealth an integral part of the care plan.

Recovery and Resilience

After more than two months of constant vigilance, Incident Command wound down and was replaced by a month in Recovery Mode, guiding the safe, full reopening of clinical services in late June. Upstate has now transitioned to a phase dubbed “Resilience” by the C-suite. The aim for Resilience is continue to improve by optimizing operations and rapidly adopting innovations using a Tiger Team model. Amy Tucker, MD, Chief Medical Officer at Upstate University Hospital, led the recovery effort, and is now spearheading its Tiger Teams initiative. She explains that these goal-oriented teams convene for a focused period to rapidly meet emerging needs. The process is tied to the hospital’s strategic pillars, with each member of the C-suite overseeing teams that relate to their areas.

“With our Tiger Teams we aim to streamline operations and to nimbly adopt innovation so that we serve patients and our colleagues even more effectively,” Dr. Tucker commented.

“Today, as we have been all year, we are finely attuned and responsive to the needs of the community,” Dr. Corona says. “We are committed to being a safe place for patients to come. And, we are committed to being a supportive partner to the physicians who refer their patients to us. We want the community to know that we are open and safe.”

Director of Transitional Care Diane Nanno, MS, CNS, RN, NE-BC, CCCTM, with the comfort care kit

As Upstate breathes a sigh of relief and resumes visits and scheduled procedures at every location, Dr. Thomas also notes that the pandemic has enhanced the mutual respect and solidarity between the academic medical center and Central New York’s community practices. It’s a dynamic he hopes will flourish into the future.

“Everybody who works in the medical environment stepped up to ensure hospitals had space to care for the sickest patients,” he says. “For that to happen, we had to have all hands on deck. Primary care providers and community subspecialists knew they would see people who might have COVID-19. We had multiple meetings with our medical community, and physicians told us, ‘We signed up for this. We understand the risks. If you provide the PPE, the training and the means to take samples, we will see these people in our offices.’ The community really came together, and it went well.”

A Response Undergirded by Science

Scientists and the physicians at Upstate University Medical Center took every opportunity to learn about the pandemic and to use that knowledge to help protect the community. Among the projects is participation in the National COVID-19 Convalescent Plasma Project, in which patients with COVID-19 receive blood plasma from survivors of the disease, and both groups are tracked.

Tim Endy, MD, MPH, Professor and Chair of Microbiology and professor of Preventive Medicine and Public Health was the lead on that project. Upstate’s Institute for Global Health and Translational Science worked with the Red Cross to get the project up and running.”

Under the direction of Matt Elkins, MD, PhD, Director of Hemapherisis, Director of Transfusion Medicine, Medical Director of Upstate Cord Blood Bank and Associate Professor of Pathology, Upstate created its own plasmapheresis unit in support of the Convalescent Plasma Project. More than 200 people volunteered and dozens have donated, with numerous patients benefitting from those plasma donations.

Other trials investigated the effectiveness of medical treatments, while the most prominent current trial is examining the effectiveness of a new COVID-19 vaccination. In conjunction with Pfizer, Upstate started vaccinating volunteers the last week of July.

“We’ve experienced an outpouring of interest,” says Stephen Thomas, MD, Director of the Institute for Global Health and Translational Sciences and principal investigator. “The investigators are tightly focused on enrolling a diverse group of participants, ages 18–85, especially focusing on people at high risk for infection or of having a bad outcome from an infection.”

He added, “This is why we have an academic medical university, so we can bring together education and care with treatment of patients and research.”

For more information, visit upstate.edu/together.

A New Internal Medicine Practice in Skaneateles: Patsy Iannolo, MD, PhD, PC

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By Jennifer Webster

Thursday, September 3, 2020

Two generations of Central New York patients have benefitted from the expertise and respect shown to them by internal medicine physician Patsy M. Iannolo, MD, PhD. Now, Dr. Iannolo is expanding his Taft Road practice to open a second office in Skaneateles. The new location will offer a range of amenities, as well as the patient-centered care Dr. Iannolo is known for.

Patsy M. Iannolo, MD, PhD, PC, and Tina L. Finlayson, NP

 

As an Internal medicine physician with a doctorate in pharmacology Dr. Iannolo cares for adult patients who have a range of concerns, including diabetes, hyperlipidemia, hypertension, rheumatoid conditions and neurologic disorders, among others. Many of these patients have more than one complicated condition, and managing multiple comorbidities is a specialty of Dr. Iannolo’s.

“Internal medicine practices focus on the sickest patients,” he says. “My pharmacology training helps me streamline medicines. I offer consultations on the appropriate medications for each patient’s age and condition. Other physicians also reach out to me as a consultative resource for toxicology and medication improvements.”

In addition to diagnosing illness and prescribing medications, Dr. Iannolo performs in-office excision of skin lesions and other dermatology treatments, as well as joint and tendon injections. He offers psychiatric services and men’s endocrine treatments, as well.

Dr. Iannolo’s colleague, Tina Finlayson, MS, FNP-BC, offers women’s endocrine services, gynecologic exams and geriatric medicine, as well as routine internal medicine services. Together, these two providers have more than 45 years in the medical field, forming a practice where patients can find effective, experienced medical care from young adulthood through advanced age.

 

“My philosophy of care is to be part of the family of the patient. Our practice is family oriented. Everyone knows and respects each other. We are accessible around the clock. It’s essential to be available to patients in times of need.”
— Patsy M. Iannolo, MD, PhD

The Gift of Time

Dr. Iannolo exemplifies the words of the founder of internal medicine, Sir William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease.”


“At our practice, everyone is treated as if they are important and special,” Finlayson says.

This approach is especially evident in the time Dr. Iannolo, Finlayson and their staff spend with patients. While traditional physician visits may allow 15 minutes with a provider, Dr. Iannolo typically schedules 30 minutes or more with each patient and over an hour for physical exams. That allows him to make detailed assessments and give expert guidance, especially in cases of patients on multiple medications or people who require treatment for depression or anxiety.

When patients have an urgent need or question, they can reach out any time, 24 hours a day, seven days a week, to speak to the provider on call. Same and next-day appointments are often available. Additionally, Dr. Iannolo and Finlayson make house calls under select circumstances.

“We maintain a comfortable pace,” Dr. Iannolo says. “There’s no rushing during appointments. That way, we’re able to offer comprehensive physical exams and follow-ups. At the same time, our around-the-clock availability allows us to provide a level of responsiveness and sense of urgency about patients’ needs that is rare in medicine today.”

Exam Room

Convenient Care in a New Location

Dr. Iannolo’s new practice contains many of the lab and imaging services frequently offered separately from medical practices, including pulmonary function testing, ankle brachial testing, EKG, and endocrine and laboratory services. The Skaneateles location also has an X-ray machine.

“Patients will be able to avoid trips to Syracuse or Auburn,” Finlayson says. “They’ll be able to access internal medicine close to home. We’re opening in September, and we’ll be available for walk-in care for our patients as well as anyone in the community.”

Known for cordial relations with his colleagues (especially for his willingness to consult over complex pharmacological issues), Dr. Iannolo welcomes referrals to his Skaneateles location. He keeps in close contact with referring providers, maintaining those relationships that have made him a reliable colleague and trusted physician across decades of practice.

Patsy Iannolo, MD, PhD, PC

5180 W. Taft Road
North Syracuse, NY 13212
315-458-4622
driannoloandassociates.com

1551 US Route 20
Skaneateles, NY 13152
315-291-7069
driannoloandassociates.com

Patsy Iannolo, MD, PhD, PC

Tina Finlayson, MS, FNP-BC

Meet the Providers

Patsy Iannolo, MD, PhD, PC, a native of Syracuse, attended Cornell University, and then obtained his medical degree and a doctorate in pharmacology at Upstate Medical Center, where he completed a residency in internal medicine. Also trained in emergency medicine, Dr. Iannolo has been practicing in local hospitals and in private practice since 1984. In addition to his practice on Taft Road in North Syracuse, Dr. Iannolo is Director of the Emergency Department at Auburn Community Hospital and on the medical faculty at SUNY Upstate Medical University, where he teaches pharmacology. Dr. Iannolo is board-certified in emergency and internal medicine.

Dr. Iannolo has been recognized for excellence numerous times by his colleagues. In 2009, the Central New York Regional Emergency Medical Services Council named him a Physician of Excellence for the CNY region. In 2019, Dr. Iannolo received the President’s Award for Outstanding Voluntary Faculty from SUNY Upstate Medical University.

Tina Finlayson, MS, FNP-BC, worked in industry for 18 years before attending nursing school. After beginning her career as a nurse, she obtained a master’s degree in nursing and became a family nurse practitioner in order to diversify her scope of practice. Her scope of practice includes internal medicine, urgent care, women’s health, as well as geriatric and emergency medicine.

For more information, call 315-458-4622. Visit the Skaneateles location online at driannoloandassociates.com.

Syracuse Orthopedic Specialists Offers Full-Spectrum Spine Surgery

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By Thomas Crocker

Thursday, September 3, 2020

At Syracuse Orthopedic Specialists (SOS), a four-physician team of orthopedic surgeons specializing in spine surgery performs the gamut of procedures for neck and back pain, including a variety of outpatient operations at the practice’s ambulatory surgery center.

In most cases, nonoperative treatments provide sufficient relief from neck or back pain to allow patients to carry out daily functions and enjoy favorite activities. Options include nonsteroidal anti-inflammatory medications, chiropractic care, acupuncture, nerve-blocking cortisone injections and physical therapy (PT), which is available from the orthopedics and sports therapy team at SOS. Nonoperative care is also available from one of SOS’ partners in care, New York Spine & Wellness Center.

“PT is a mainstay of spine care and is quite effective at treating most back problems,” says Richard DiStefano, MD, orthopedic surgeon at SOS. “It’s an advantage to have PT in our practice because it’s easy for physicians and therapists to collaborate to tailor therapy for patients.”

Surgical Solutions

When conservative therapies prove ineffective, surgery may be appropriate. Large operations, such as cervical laminectomy, cervical fusion, cervical laminoplasty, and lumbar laminectomy and fusion, typically require hospitalizations of two or more days, and SOS spine surgeons perform these procedures at St. Joseph’s Health and Crouse Health.

Many spine surgeries do not require a hospital stay, and for these, SOS has a dedicated home: Specialists’ One-Day Surgery Center, located at 5801 East Taft Road in North Syracuse. There, surgeons perform anterior cervical discectomy and fusion, lumbar discectomy, and one-level laminectomy. Another outpatient procedure, sacroiliac joint fusion, may provide relief for individuals with sacroiliac joint dysfunction. Requiring just two small incisions in the buttocks, the procedure allows a spine surgeon to solidify the joint with a cage-like implant.

One of the most common procedures that Dr. DiStefano performs at the Specialists’ One-Day Surgery Center is spinal cord stimulator implantation. Spinal cord stimulation uses implanted electrodes and a small generator to deliver mild, pain-relieving electrical impulses to the cervical or lumbar spine.  Candidates include individuals for whom back surgery did not provide relief or who have chronic back or leg pain, degenerative spine changes, reflex dystrophy in the foot or knee, or painful neuropathies in the feet or hands, according to Dr. DiStefano.

Telemedicine Appointments Available

Video visits played a crucial role in allowing Syracuse Orthopedic Specialists to continue caring for patients during the COVID-19 pandemic. Telemedicine appointments through the SOS Virtual Visit App remains an option for initial and follow-up appointments, as appropriate, for patients who wish to see their orthopedic surgeon from the comfort of home.

“Patients undergo a one-week trial using electrodes placed percutaneously and an external battery pack,” Dr. DiStefano says. “If that’s successful, we permanently implant the electrodes in the spine through a small incision in the upper or lower back. The wires are connected to a generator in the buttocks. Patients can adjust the strength of the electrical signal with a remote.”

The variety of outpatient spine procedures available at the Specialists’ One-Day Surgery Center is indicative of the sweeping nature of spine care at SOS.

“Ours is a comprehensive spine program,” Dr. DiStefano says. “We perform procedures on all parts of the spine in inpatient and outpatient settings, and we also offer a wide range of nonsurgical treatments. Patients get all-encompassing care at SOS.”

For more information, visit sosbones.com or call 315-703-3442.

How the Coronavirus Will Impact Your Hiring Process

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By Kathryn Ruscitto

Thursday, September 3, 2020

As we return to work, we will see a dramatic impact in openings and hiring to fill those jobs.

In “How the Coronavirus Is Changing Hiring and Recruiting Going Forward,” Robin Ryan at Forbes states, “The fallout will fundamentally change recruiting and hiring practices long after the pandemic has passed.”

Locally we have seen the emergence of more remote work as teams are finding unique ways to use technology in healthcare delivery — from telemedicine to scheduling remotely, transportation, utilization of accessing records and messages through portals.

Susan Crossett, CEO at CPS Recruitment, notes many practices and healthcare organizations have reached out to utilize CPS’s remote expertise in leveraging technology to source quality candidates. The challenges she has observed in this environment include:

  • Long-term care facilities facing recruitment challenges as employees become increasingly concerned about safety and exposure to the coronavirus.
  • Hospital challenges with personal protective equipment are impacting their ability to recruit.
  • Nurses and clinicians are asking to see safety protocols in health environments before they will consider interviewing for a position.


Kathryn Ruscitto

The advantages Crossett sees developing are clear increases in productivity from remote work as employees see less challenges with transportation and child care. She also says employers will need to consider how to keep the team connected and support each other while working remotely from social opportunities to communications.

Employees are looking for work experiences that allow flexibility and safety and, in exchange, are providing unique approaches to filling back room needs.

Mike Humphrey, CEO at SOS , a multifaceted orthopedic practice with multiple locations, states, “We have now found that remote work offers new opportunities for efficiencies and for workforce satisfaction. At the same time it has required new workflows and processes.”

An Indeed survey reports the top five benefits of remote work for employees are related to personal satisfaction:

  1. Better work life balance
  2. Reduced stress
  3. Reduced absences
  4. Improved morale
  5. Fewer sick days

For further information, visit:

I chair the board of an arts organization that put more classes, exhibits, and performances online, which was done by employees working remotely. The result: an explosion of new visitors to the website and a realization that moving forward we need to offer both online and in-person opportunities. It has been a way to expand our market and, we hope, bring in new visitors as we reopen.

Kathryn Ruscitto, Advisor, can be reached on LinkedIn at Kathrynruscitto or at krusct@gmail.com.

Crouse Health: Where Family is the Foundation

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By Cari Wade Gervin

Monday, June 29, 2020

The staff at Crouse Health’s Kienzle Family Maternity Center spend so much time helping new families come into existence, they’ve become their own workplace family, too.

 

“I feel like there’s a lot of camaraderie, which you need,” says Maria Ciciarelli, MD, FACOG, partner at CNY Women’s Healthcare. “If an urgent situation arises, nurses, other physicians and other attendings on the floor are the first to jump in. I think that’s one of the best things about working at Crouse.”

Suzanne Bartol, MD, FACOG, partner at Loftus, Ryu & Bartol agrees.

“We all work together and help each other out,” Dr. Bartol says. “But we are friends outside of being colleagues when we’re at work. That goes on at all levels, from residents to nurses to attendings.”

This tight-knit collegiality is why so many OB/GYNs have stayed at Crouse since they started medical school rotations or their residencies — in Dr. Bartol’s case, 19 years, and 16 years for Dr. Ciciarelli. It’s also why the standard of maternity care is so high at Crouse, says George Stanley, MD, FACOG, Assistant Professor of Obstetrics and Gynecology at Upstate Medical University and a Crouse-affiliated obstetrician.

“We have a highly experienced and trusted team of obstetricians who look out for each other and are able to assist colleagues while teaching residents and medical students,” Dr. Stanley says. “It’s a different experience when you are managing difficult cases, deliveries and surgeries with a person who is in training. It means you, as the trainer, have to really know what you’re doing to guide the trainee so they eventually will be as good as — or even surpass — your skill set.”

Suzanne Bartol, MD and Maria Ciciarelli, MD, FACOG

When you ask physicians and staff what they love about working at Crouse Health’s Kienzle Family Maternity Center in Syracuse, you hear one word over and over: camaraderie.

 

“What differentiates Crouse maternity care is the fact that we have an entire hospital team available for both patients and physicians,” says Betty O’Connor, director of women’s and infants services. “There are five members of our nursing leadership team available to assist physicians and prospective patients through the process of selecting a physician and hospital to have their birth experience.”

Betty O’Connor, director of women’s and infants services confers with Brynne Stockton, RN, Nurse Manager (right)

 

A History of Woman-Centered Care

In 1887, no hospital in Syracuse offered maternity care or treated children. A group of 14 female community leaders, including Jessie Lansing Crouse (whose family would later fund the hospital enough to change its name), launched the Syracuse Women’s Hospital and Training School for Nurses. Crouse herself took the first five patients in her carriage to the home that housed the hospital.

Much has changed in medicine and maternity care over the past 133 years at Crouse, but the commitment to putting mothers first is still the number one priority.

The physicians, nurses and midwives at the Kienzle Family Maternity Center deliver close to 4,000 babies each year — more than any other hospital in upstate New York. Crouse also serves as the Regional Perinatal Center for the Central New York region.

Mothers come from diverse and varied backgrounds and hail from the Southern Tier all the way to the Canadian border.

Dr. Stanley says the nursing staff at Crouse has plenty of experience in treating different types of patient populations, which helps improve patient outcomes.

“We have nurses who have been with Crouse for 20 to 30 years and more,” Dr. Stanley says.

“These are our neighbors — our friends. These are the people we see in the grocery store. In a city the size of Syracuse, you run into your patients nonstop. And I think it’s a true team effort to provide the best care.”
— Stephen Brown, MD, FACOG, Director of Low-Risk Obstetrics at Crouse Health and President of CNY Obstetrics & Gynecology
Suzanne Bartol, MD

 

Low-Risk, High-Risk and Everything In-Between

The Kienzle Family Maternity Center is well known for its treatment of high-risk pregnancies, but most births each year are routine, low-risk births.

“If moms don’t want interventions, we don’t want to do any unless we need to,” Dr. Ciciarelli says.

The experience levels of the staff are important for all births, says Stephen Brown, MD, FACOG, director of Low-Risk Obstetrics at Crouse Health and president of CNY Obstetrics & Gynecology.

“I hear, ‘He’s the director of low-risk obstetrics, what’s his experience with high-risk obstetrics?’ Well, you never know when a pregnancy is going to go from low risk to high risk.” Dr. Brown says. “In the past week, I had a set of twins and another preterm baby who are both in the NICU right now.”

Given the maternal and infant mortality rates in the area, that level of care is crucial. In 2016, the state of New York was ranked 30th in the nation in maternal mortality. And Onondaga County has averaged 6.7 infant deaths per 1,000 live births in recent years, one of the highest rates in the state. It also has an 8.6% rate of preterm births, with 7.9% of babies born underweight.

“Crouse has 24-hour anesthesia care onsite,” Dr. Stanley notes. “When emergencies happen, we don’t have to call an anesthesiologist. If a patient has unplanned conditions that require intensive care, general surgery or neurosurgery, we have all those high-tech specialists right here at our fingertips.”

In addition to physicians and nurses, the maternity team includes lactation consultants, technicians and support staff.

“We are able to provide the one-on-one care our high-risk patients need,” Dr. Ciciarelli says.

And when neonatal intensive care is needed, the staff is ready.

“We have the highest level of NICU care available 24-7,” Dr. Brown says. “This gives patients confidence knowing they’re going to have anesthesia care and neonatal care available when they need it, if they need it. And it gives the physician — whether the pregnancy is low-risk or high-risk — the comfort level to say, ‘Listen, we can do what’s right. We can do it quickly. And we have backup in the NICU that’s available to us at all times.’”

“I really enjoy working at Crouse Health, even when it’s a stressful workday. It’s a work environment that’s conducive to taking care of patients and providing the best care possible.”
— Maria Ciciarelli, MD, FACOG, Partner at CNY Women’s Healthcare

Special Care for Tiny Babies

The Walter R.G. Baker Neonatal Intensive Care Unit at Crouse serves up to 1,000 preterm and medically challenged babies each year. It is the only NICU in Central New York designated by the New York State Department of Health as a Regional Perinatal Center.

“We take care of the sickest babies,” says Brynne Stockton, RN, MSN, nurse manager of perinatal services. “We have highly skilled nurses who are always staying up-to-date with the latest evidence-based practices and the highest standards.”

Some infants need longer-term care. The antepartum care team provides support for those mothers and families, often becoming close friends.

“I personally have had an experience with a family that was here with an antepartum patient,” Stockton says. “The mother delivered here, and the baby was in the NICU for many days. I still keep in touch with that family. We try to meet each other when they’re in the area. And that’s not just an experience I’ve had, it’s an experience that many Crouse OB nurses have.”

Stockton says nurses become friends with former patients, and that patients routinely send Christmas cards and updates about their now-grown babies.

Dr. Bartol and George Stanley, MD

On the Same Page

Even during low-risk births, it’s important to have staff in sync.

“When you have a patient who’s laboring, you could spend significant time up there with the same people, and you really get to know each other and you also get to know your patients very well,” Dr. Bartol says. “ I think that makes the unit work really well. It’s not just a place to clock in and clock out.”

During high-risk births, that cohesive unit is invaluable. Dr. Brown experienced one situation when a patient was transferred to Crouse from another hospital after the delivery took a serious turn.

“The anesthesia team, NICU staff, nurses and I all communicated before the patient’s arrival,” Dr. Brown says. “Then, as soon as the lab work and our initial evaluations were done, we were in the operating room ready to deliver the patient’s baby. The ICU was notified in case the mother needed intensive care afterward. To have everyone on the same page, before the patient even arrived at the hospital — I think that that type of communication and that type of skill level is evident only at an institution like Crouse that has all the resources available around the clock.”

Those resources led Dr. Stanley’s wife to have her three children at Crouse. Dr. Bartol also delivered her three children at the hospital.

“Clearly, I’m biased because I have chosen to work at Crouse, but I also chose to have my own children here,” Dr. Bartol says. “I feel we’re able to provide that higher level of care with excellence without patients feeling like we are trying to medicalize their care. We want our patients to follow their birth plans as safely as possible.”

That’s what the Crouse camaraderie is all about.

“We are very supportive of each other,” Dr. Brown says. “Everyone truly wants what’s best for patients because we take pride in following evidence-based medicine and providing compassionate care. I think patients truly do get a great experience when they deliver at Crouse.”

A Regional Focus

The Crouse Health’s Kienzle Family Maternity Center doesn’t just serve Syracuse — it’s also been the Regional Perinatal Center for Central New York since 1975, serving mothers and infants from a 14-county region. The program provides care and promotes healthy outcomes for mothers and babies during pregnancy, birth and after, with a focus on high-risk pregnancies and children with special needs.

Physicians across the region refer patients to Crouse, based on New York State’s system for perinatal care, which delineates four different levels. As the RPC, Crouse provides education, advice and support to affiliate hospitals throughout the region.

Stephen Brown, MD, FACOG, with baby
 

For more information on maternity services at Crouse, visit crouse.org/services/maternity.

Auburn Community Hospital’s New Home for Women’s Health

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By Thomas Crocker

Monday, June 29, 2020

Anchored by OB/GYN services with a reputation for excellence, the Women’s Health Center at Auburn Community Hospital is fast becoming a comprehensive destination for women’s health that encompasses more than maternity services and gynecologic surgery.

Established earlier this year, the Women’s Health Center reflects a fundamental fact of women’s lives: their health and wellness needs change dramatically throughout life, from family planning and prenatal care to menopause and beyond. Caring for women across their lifespan requires diverse services, and that is what the Women’s Health Center offers.

“The Women’s Health Center reflects the evolution of Auburn Community Hospital’s commitment to women’s health,” says Loren Van Riper, MD, FACOG, Chief of OB/GYN Services at Auburn Community Hospital. “Initially, that revolved around obstetrics and gynecologic surgery, but we’ve pushed forward to include breast care and other services as part of the Women’s Health Center. This center was a long-term goal for the hospital because there was a need for it in our community. Women shouldn’t have to drive 45 minutes to Syracuse for the everyday health services they need.”

True to its roots, the Women’s Health Center offers full-spectrum maternity services, including prenatal care, labor and delivery, and postpartum care. In addition to providing obstetric care, Dr. Van Riper and his colleagues also perform the gamut of gynecologic surgery, including minimally invasive and vaginal procedures.

“We treat patients for endometriosis, pelvic pain, stress urinary incontinence, abnormal uterine bleeding and pelvic relaxation, among other problems,” Dr. Van Riper says. “I specialize in vaginal surgery. On the minimally invasive side, we frequently perform laparoscopic pelvic surgery, including hysterectomy, oophorectomy and tubal ligation.”

“I’m excited to work in the community where I grew up and at the hospital where I was born.”
— Amy Hoeft MacDonald, MD, OB/GYN, who joined Auburn Community Hospital and its Women’s Health Center in July

The Women’s Health Center also offers services that make it a destination for all women, not just new or expectant mothers. These services include breast care and imaging, with more planned for the future.

“Women tend to put others first — resulting in their own self-care being secondary,” says Tanya Paul, MD, FACOG, OB/GYN at Auburn Community Hospital. “It’s gratifying to be part of a center where women can receive all the care they need, including ultrasounds, screening mammograms, bone density screenings, referrals for colonoscopies and other preventive health services, and breast care from a SUNY Upstate Medical University specialist, in addition to OB/GYN services.”

An OB/GYN Team With Deep Community Ties

Auburn Community Hospital’s four board-certified OB/GYNs and three midwives recently moved their office to the hospital, where an attached, one-level building serves as the home of the Women’s Health Center. Over time, the hospital plans to migrate all women’s health providers and services to this building to bring everything under one roof.

The OB/GYN team features clinicians with decades of experience who share a passion for caring for women of all ages and improving women’s health in Central New York, where their roots run deep. Dr. Van Riper has lived in the Auburn area for years and practiced at Auburn Community Hospital for more than a decade, most of that time while serving as Chief of OB/GYN Services. A graduate of the University of Virginia School of Medicine, Dr. Paul performed her internship and residency at SUNY Upstate Medical University in Syracuse and practiced OB/GYN in Central New York for 13 years before joining Auburn Community Hospital in 2013.

OB/GYN Donald Calzolaio, MD, FACOG, graduated from SUNY Upstate Medical University and performed his residency at Upstate University and Crouse hospitals. He has cared for women in Central New York and Connecticut for 25 years, the past 10 at Auburn Community Hospital, where he enjoys the atmosphere of a small, community-based facility.

The newest member of the team, OB/GYN Amy Hoeft MacDonald, MD, joined Auburn Community Hospital in July after spending six years in private practice in Rochester. She graduated from SUNY Upstate Medical University and performed her residency at University of Rochester Medical Center.

“Auburn Community Hospital was an attractive destination for me because of the OB/GYN group’s reputation for delivering excellent care,” Dr. MacDonald says. “The hospital is focused on meeting the unique needs of the community, and the recent integration of breast care into the Women’s Health Center is a great example of that. I am excited to be part of a group that is constantly looking to grow and change to deliver better care to patients.”

Comprehensive Maternity Services

A variety of factors make Auburn Community Hospital an outstanding place to have a baby. Welcoming and homey, the Stardust Community Birthing Center In Memory of John and Irene Bisgrove features:

  • A certified lactation consultant on staff
  • A dedicated OB/GYN for performing Caesarean sections
  • All-private labor and delivery and postpartum rooms, with the former featuring whirlpool tubs for use during labor
  • Around-the-clock availability of epidural anesthesia services
  • Experienced, compassionate nurses, many of whom are certified in Advanced Cardiac Life Support, Neonatal Resuscitation, Inpatient Obstetric Nursing or Electronic Fetal Monitoring (EFM)
  • Outpatient breastfeeding support
  • Staff-led childbirth education classes and birthing center tours

The birthing center is pleased to offer EFM, which records fetal heartbeat and uterine contractions throughout labor without a provider having to be present.

“EFM is a newer innovation, and the advantage of it is that OB/GYNs, midwives or nurses can review the monitor data strips remotely and improve communication between patients, nurses and providers. It also provides educational opportunities for all staff,” Dr. Calzolaio says. “If there’s any concern, I can review the information on my phone or the computer in my office and, if necessary, attend to the patient before the nurse notifies me of a problem.”

An all-female midwifery program gives expectant mothers the option of seeing a midwife for certain aspects of prenatal care and receive one-on-one support during labor and delivery.

“Our OB/GYNs and midwives practice as part of one group, and we coordinate closely with them throughout each patient’s pregnancy,” Dr. Calzolaio says. “Patients see both OB/GYNs and midwives throughout pregnancy, and there’s a midwife on call with an OB/GYN every night. Patients’ perceptions of their delivery experience are extremely positive when they receive care from a midwife.”

Care doesn’t end with patients’ discharge.

“We place follow-up phone calls after moms and babies go home to ensure they’re doing well and point them to community resources if they need anything,” says Susan Bobb, RN, Director of Women’s Services at Auburn Community Hospital. “Women love the individual attention they get here that isn’t always possible at bigger facilities.”

Academic-Level Breast Care In a Community Setting

Last summer, Auburn Community Hospital took the first step toward establishing a comprehensive breast program when Ranjna Sharma, MD, FACS, Chief of the Section of Breast Surgery, Medical Director of the Breast Cancer Program and Associate Professor of Surgery in the Department of Surgery at SUNY Upstate Medical University, began holding a clinic and performing procedures at the hospital. Dr. Sharma joined SUNY Upstate Medical University in March 2019 after nearly a decade at Beth Israel Deaconess Medical Center in Boston. She visits Auburn Community Hospital every Monday and alternates between seeing patients in clinic and performing surgeries.

“SUNY Upstate Medical Center and Auburn Community Hospital thought it was important to make comprehensive breast services available to more people in the greater Central New York community,” she says. “We started with surgical services in 2019, and we began bringing medical oncology services to Auburn Community Hospital earlier this year. Hopefully, we’ll be able to add radiation oncology in the next two to three years to complete the program.”

Dr. Sharma sees patients with and performs surgeries to remove benign and malignant breast masses. She holds clinic at the Surgical Specialties Clinic located at 77 Nelson St. in Auburn.

“It’s exciting to bring our expertise and multidisciplinary care model to Auburn,” Dr. Sharma says. “Local breast care was something that the medical community and area residents wanted and needed. It’s important for women to have access to high-quality breast services. We’re happy to bring them to this community and look forward to expanding the program in the years to come.”

For more information, call 315-255-7011 or visit auburnhospital.org.

Community Collaboration

In partnership with the Cayuga County Health Department, Auburn Community Hospital recently established the Healthy Moms, Healthy Babies Program, which educates mothers about and helps them access a wide range of community-based services that can benefit them and their babies.

“Through the Healthy Moms, Healthy Babies Program, moms can access doula services, assistance with transportation, breastfeeding support from certified lactation counselors and the Special Supplemental Nutrition Program for Women, Infants, and Children,” says Susan Bobb, RN, Director of Women’s Services at Auburn Community Hospital. “First-time moms can sign up to receive an in-home visit from a nurse, and if children have special healthcare needs, the Healthy Moms, Healthy Babies Program can help them enroll them in early intervention programs.”

A Vision for the Future

The OB/GYNs at Auburn Community Hospital hope to make the newly established Women’s Health Center a destination that women can turn to for wellness education.

“Eventually we would like for the center to offer other services as well,” says Tanya Paul, MD, FACOG, OB/GYN at Auburn Community Hospital. “It would be wonderful for women to visit the center for meditation and yoga, nutrition services and other tools to make better lifestyle choices.”


Loren VanRiper, MD, FACOG, Chief of OB/GYN Services


Ranjna Sharma, MD


Amy MacDonald, MD


Donald Calzolaio, MD, FACOG


Tanya Paul, MD, FACOG


Susan Bobb, RN, Director of Womens Services