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Use the “Pause” and Review Your Practice Agreements

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By Marc Beckman, JD

Monday, June 29, 2020

On March 22, Governor Cuomo put New York State on “Pause,” closing all non-essential businesses statewide. As of this writing, upstate New York has just begun its multi-phase reopening.

Physicians have been hit particularly hard by the COVID-19 pandemic. While some serve bravely on the front lines while battling a new and unknown virus without adequate supplies of personal protective equipment, others were suddenly left with empty schedules as patients were unable or unwilling to be seen in the office. Revenue disappeared almost overnight, and overhead and staffing personnel had to be drastically reduced wherever possible.

During this time, physicians saw some of the best qualities of their partners. Many such partners readily acquiesced to numerous and unexpected necessary changes, whether it be adjusting their work schedules to implement telemedicine, or drastically adjusting practice routines and physical office layouts to ensure patients and staff felt as comfortable as possible.


Marc Beckman, JD

Ultimately, many voluntarily took significant pay cuts. However, some partners did not.

As attorneys to physicians, we know that legal agreements are often meant to be signed, put in the file and often never looked at again. When the parties to such agreements all mutually agree to modify their relationship, then the changes sometimes needed for a practice or an individual are easily made. However, when a party does NOT agree to a change, whether it be a clarification to avoid misunderstandings or a substantive change needed because of the pandemic, those agreements may need to be dusted off to determine the relative rights and obligations of the parties.

That is, when the written words really matter, what do they say? It is at that time when practices often regret not having regularly reviewed their legal agreements to ensure they are updated as the practice has changed over time. Here are a few examples.

Shareholders Agreements and Bylaws – This Agreement is between the practice and ALL of its shareholders. For a partnership or a professional limited liability company, shareholder agreements and bylaws are typically bound up into a partnership or operating agreement. Critically, these documents typically define the events, the occurrence of which obligates an individual physician owner to sell their equity and for the practice to be obligated to buy it. Typical events include death, permanent disability and termination of employment. However, other events to address include partial disability, opportunities/obligations to become part-time (including call and coverage obligations), and closure/modification of practice locations. In addition to the obligation to buy/sell, the purchase price must be addressed, whether it be absolute or formulaic.

Here may be the first place to begin your review. The value of an equity interest in a medical practice is likely very different now than it was even just one year ago. Does your document account for this? Also, the tax implications of how the purchase/sale is accomplished must be discussed so all parties understand the intent and ramifications. For this reason, it is not uncommon to create a separate deferred compensation arrangement that is taxed as ordinary income to the departing physician and fully deductible to the practice. Does your agreement keep the departing physician responsible for his/her billing in case of audit or investigation?

Employment Agreements / Member Services Agreements – This is the Agreement between the individual physician and the practice. Typically, this can only be amended with the agreement of both the individual physician and the practice. From the practice perspective, this document should be as flexible as possible. From the individual perspective, this document provides individual protective “rights”, including the conditions of termination and on what notice. Instead of having a compensation formula within the employment agreement, better to make reference to a separate document more readily amended — or even better — a “plan” that can be modified as determined by the managing Board or delegated to an even smaller set of leaders such as a compensation committee.

Finally, commonly overlooked is a discussion about the requisite votes to modify these agreements. Collectively, we are referring to the “rule books” for how decisions are made amongst partners and between the partnership and the individual. Too often, practices discover after the fact that this is more difficult than presumed because of one or two recalcitrant holdouts.

Like we are doing with the coronavirus, take a small pause now and avoid a bigger problem later.

Marc Beckman is a founding member of CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6244 or mbeckman@ccblaw.com.

Comprehensive, Leading-Edge MRI Services at Magnetic Diagnostic Resources of Central New York

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By Thomas Crocker

Monday, June 29, 2020

Celebrating 35 years as Central New York’s premier provider of MRI services, Magnetic Diagnostic Resources of Central New York (MDR of CNY) draws on the expertise of dozens of fellowship-trained radiologists and a relentless commitment to quality to provide an exceptional experience for patients and referring clinicians.

The prostate MRI patient experience begins with compassion and care and ends with image quality excellence.
Pictured: MRI technologist Paul Mingle

 

Established in 1985, MDR of CNY’s mission is to provide superior, specialized MRI services in a welcoming, warm and patient-focused environment, transforming what often is an apprehensive experience into a notably calm one.

“A variety of factors distinguish our services from others in the region,” says Jacqueline Floyd, ARRT(R)(MR), MBA, CEO of MDR of CNY. “We have nine convenient locations throughout Central New York, and we invested in the latest specialized software to offer organ-specific specialty scans, some of which are not available at other organizations in our region. We think it’s important to offer a host of MRI services to Syracuse and surrounding communities.”

The new wide bore 1.5T GE 450W high-field scanner will enhance breast MRI comfort with a unique range of exclusive, patient-friendly features so you can relax in comfort during the scan. Pictured: MRI technologist Paula Mulholland
 

A Variety of Specialty Scans

MDR of CNY has long been known for providing breast MRI. In certain cases, this modality can complement mammographic findings during diagnostic evaluation, help measure the extent of known breast cancer, assist in assessing eligibility for or response to hormone therapy or chemotherapy, provide additional information about suspicious findings, and screen patients at high risk due to genetic mutations or history of radiation therapy to the chest, according to The American Society of Breast Surgeons Consensus Guideline on Diagnostic and Screening Magnetic Resonance Imaging of the Breast. MDR of CNY was an early adopter of dedicated breast coils — components that play a key role in creating images of the breasts by transmitting and receiving radio waves during a breast MRI — and CADstream, a software program that helps radiologists visualize abnormalities and plan interventions in a timely manner. MDR of CNY was also one of the first MRI providers to offer MRI-guided breast biopsy. The American College of Radiology (ACR) has accredited MDR of CNY for nine MRI accreditations and four breast MRI accreditations. The organization maintains its status by seeking reaccreditation every three years.

“MDR of CNY has always focused on ACR accreditation for MRI in general and for subspecialty MRI,” says Scott Buckingham, MD, partner radiologist at MDR of CNY. “ACR accreditation is a hallmark of quality and the most widely recognized guarantee for patients that an outside entity has reviewed the capabilities, experience and training of the professionals who conduct MRI studies.”

In addition to breast MRI, MDR of CNY is a high-volume provider of prostate MRI — which can help determine whether a biopsy is warranted and provide guidance during that procedure, as well as aid prostate cancer staging and radiation therapy planning — and many other specialty MRI services, including:

  • Cardiac MRI
  • Conditional pacemaker MRI
  • Enterography
  • Elastography
  • Fetal MRI
  • Inhance, non-contrast MRA
  • MR arthrography
  • MR urography
  • Spectroscopy
  • Stroke and advanced neurofunctional imaging

Patients who have a specialty scan at MDR of CNY can be confident they will receive an accurate reading of their images, as one of the organization’s key differentiators is its team of 47 board-certified, fellowship-trained partner radiologists from two of Central New York’s largest radiology groups, CRA Medical Imaging and St. Joseph’s Imaging Associates. These radiologists possess subspecialty training in a variety of fields, including breast imaging, neuroradiology, musculoskeletal imaging and body imaging.

“Our team has many years of experience performing subspecialty reads,” Dr. Buckingham says. “That’s important because patients whose images are read by a radiologist with specific training in an MRI subspecialty and high-volume experience tend to enjoy more accurate results.”

The patient experience and excellence in quality starts with an experienced and professional leadership team.

 

Prioritizing Safety

Patient safety is paramount for MDR of CNY, which is why its technologists and other members of the team take all necessary steps to safeguard patients before conducting scans. Those steps include verifying that patients’ medical implants are MRI compatible, analyzing records of patients’ previous studies and evaluating kidney function, as the use of a gadolinium-based contrast agent during an MRI can cause problems for certain patients, such as those with diabetes or chronic kidney disease. When appropriate, the MDR of CNY team uses a handheld device called i-STAT to conduct a point-of-care blood analysis that can reveal kidney function.

“Patients can undergo testing with i-STAT in the office at the time of the scan rather than having lab work at a different facility,” Dr. Buckingham says. “That’s a much more convenient way of determining whether a patient is suitable to receive a contrast agent because it doesn’t require separate office visits and eliminates unnecessary cancellation of studies.”

If a patient needs an MR angiogram but has suboptimal kidney function, the MDR of CNY team can perform his or her study using Inhance, a technique that allows technologists to capture images of the renal arteries without using a contrast agent.

Highly trained radiologists at MDR of CNY are board certified with the American Board of Radiology and
considered experts in their field. Pictured: MRI technologist Stephanie Labulis and radiologist David Wang, MD

Convenient and Compassionate

Providing a seamless, one-phone-call scheduling experience for referring providers is a point of pride for MDR of CNY, as is the organization’s ability to accommodate urgent imaging requests and its commitment to scheduling appointments within a two-week timeframe. When needed, MDR of CNY can accommodate STAT requests.

When patients arrive at one of MDR of CNY’s nine locations, they encounter an atmosphere designed to allay any anxiety they may feel about undergoing an MRI. The staff sets the tone.

“Patients have never met a kinder or more compassionate staff,” Floyd says. “Our technologists truly understand how to calm and reassure patients. If a patient is feeling exceptionally anxious, we may give him or her the option to visit the office a day or two before the appointment to talk with our staff about the scan and observe the machine. Our experienced technologists ensure that the patient feels safe and comfortable and stay in voice contact throughout each exam.”

For patients with claustrophobia, a wide-bore MRI scanner and an open unit are available at neighboring locations on Brittonfield Parkway in East Syracuse.

“We do what is best for our patients,” Floyd says. “Our technologists treat every patient with compassion and professionalism, which is why we routinely receive comments in our patient satisfaction surveys singing their praises.”

For more information, visit mdrcny.com. Click on “Referring Physicians” to request an appointment for a patient or call 315-454-4810, press 1.

Timely Communication

Swift communication with referring providers and seamless transmission of scan results is a priority for Magnetic Diagnostic Resources of Central New York. That is why the organization, its partner radiology groups CRA Medical Imaging and St. Joseph’s Imaging Associates, and their associated health systems use a shared picture archiving and communication system. Referring providers receive nonurgent image reports within 24 hours. Providers receive urgent results as soon as a radiologist finishes reading the images.

Historic Heart Care at St. Joseph’s Health Cardiovascular Institute

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By Allison Gorman

Monday, April 27, 2020

With a growing team of specialists, the most advanced treatments and state-of-the-art facilities, St. Joseph’s Health Cardiovascular Institute continues to make history as a top regional and national cardiac program.

From performing the first successful open-heart surgery in Syracuse to helping pioneer new protocols for transcatheter aortic valve replacement (TAVR), St. Joseph’s Health has been at the forefront of cardiac care, both regionally and nationally, for decades. In the past 10 years, St. Joseph’s has reinforced that position, expanding its team of highly trained cardiac specialists and adding to its menu of advanced interventional procedures, minimally invasive surgeries and mechanical supports to treat even the most complex cases.

The heart of St. Joseph’s cardiac program is its flagship hospital in Syracuse, which capped off $400 million in renovations with the addition of a state-of-the-art surgical tower in 2014 and a 45,000-square-foot Cardiovascular Institute in 2018. The program serves a 15-county area that extends from Canada to Pennsylvania and the Finger Lakes to Utica.

St. Joseph’s has also invested in meeting people where they live to fight heart disease — the leading cause of death in New York and the United States. With the addition of CareFlight, a medical helipad on its Syracuse campus, and more satellite locations opening throughout Central New York, St. Joseph’s ensures that distance is no obstacle for treatment at one of the nation’s top cardiac programs.

A team, including vascular surgeon Syed Zaman, MD, performs surgery in one of St. Joseph’s state-of-the-art surgical suites. The St. Joseph vascular team has more experience performing a full range of services than any other hospital in the region. The hospital’s exceptional outcomes earned them a High Performing rating in abdominal aortic aneurysm repair by U.S. News and World Report.
 

Cycle of Success

The axiom “success breeds success” is especially true when failure can have fatal consequences. In other words, it’s no coincidence that St. Joseph’s performs about 1,000 cardiac surgeries a year (including the most open-heart procedures in the region, with the lowest risk-adjusted mortality rates) — and that it was named one of the top six hospitals in the nation for heart surgery by The Society of Thoracic Surgeons.

“There are many heart surgery programs in Central New York, but there’s only one that does more than a thousand cases a year,” says Joseph Spinale, DO, MBA, Chief Medical Officer (CMO) for St. Joseph’s Health. “That’s how we get the outcomes we do.”

It’s a self-perpetuating cycle: More heart valve surgeries than any other provider in the region and more coronary artery bypass grafting (CABG) procedures means more patients referred to St. Joseph’s or sent there from places like Watertown, Ogdensburg and Binghamton.

Expert providers are key players at St. Joseph’s, too, according Ahmad Nazem, MD, FACS, Chief of Cardiac Surgery at St. Joseph’s.

“The only way you have more cases is to obtain good outcomes — those go hand in hand,” Dr. Nazem says. “With that kind of volume, you end up attracting better talent at all levels.”

Dr. Russell Silverman, MD, FACC, Director of Medical Cardiology for St. Joseph’s, sees the same dynamic at work on the interventional side. St. Joseph’s is one of the top five producers in the state, with four times more volume than any other hospital is Syracuse.

“Our cath lab is available 24/7 for patients with acute problems that we can address,” Dr. Silverman says. “It’s even available for elective procedures seven days a week, which means we perform inpatient elective procedures on the weekends.”

The medical helicopter also keeps the cath lab busy.

“We transport critically ill patients and perform necessary procedures,” Dr. Silverman says. “We have some of the best interventional physicians in the state.”

James Connelly, MD
“It’s a given: When you do more cases, you end up with more experience, and more experience translates into better outcomes.”
— Ahmad Nazem, MD, FACS, Chief of Cardiac Surgery at St. Joseph’s Health
 

Becoming an Institute
Dr. Spinale, an invasive cardiologist, suspects his medical specialty is part of what led St. Joseph’s to offer him the newly created position of CMO in 2017. He admits that St. Joseph’s renowned cardiovascular program, including its impressive new surgical tower, was part of what inspired him to accept the offer.

His first goal as CMO was to unite the competing cardiovascular groups upon which the program was built, to create a single enterprise: the Cardiovascular Institute.

“One of the biggest sources of waste in health care is clinical variation,” Dr. Spinale says. “By pulling everyone together and having one way of managing treatments that are based on best practices and clinical research, we can eliminate that waste and provide quality care with better outcomes at a lower cost.”

Since then, the Institute has steadily grown. Its team of specialists now includes five cardiac surgeons, 11 cardiac anesthesiologists, five vascular surgeons, six interventional cardiologists, two cardiac electrophysiologists, 16 medical cardiologists, and 22 physician assistants and nurse practitioners.

5 Reasons to Trust St. Joseph’s Health for Cardiac Care

  1. Excellus BlueCross BlueShield Blue Distinction Center+ for cardiac care
  2. Consumer Reports top 15 heart surgery centers in the U.S.
  3. Society of Cardiovascular Patient Care accreditation for chest pain with percutaneous coronary intervention and resuscitation
  4. Accreditation for Cardiovascular Excellence for cardiac catheterization
  5. American Association of Critical-Care Nurses “Silver level” Beacon Award for cardiovascular-surgical ICU

The ultramodern cardiac facilities at St. Joseph’s Health in Syracuse were built to accommodate a burgeoning caseload. The $63 million Christina M. Nappi Surgical Tower includes an expansive waiting area and 110 spacious, private rooms that are primarily used by cardiac inpatients.

“When the patient feels better in a space, that affects their improvement, and the family feels more at ease with the patient staying there,” Dr. Spinale says.

The tower’s design also enhances the progress of patient care. When communication is easier and transfer times are shorter, outcomes improve.

Similarly, the $32 million Merola Center for Cardiac Care, which houses catheterization, electrophysiology, interventional radiology facilities, 40 patient bays and a hybrid OR, was designed both for patient comfort and for the delivery of safer, more coordinated care.

Care Flight Helicopter

“Our goal is to do what’s right for the patient. Not necessarily what any one individual wants to do, but what the group thinks is best, based upon best practices and guidelines in the cardiology and cardiovascular surgery literature.”
— Russell Silverman, MD, FACC, Director of Medical Cardiology at St. Joseph’s Health
 

Advanced Surgical Treatments

St. Joseph’s cardiac surgical program provides a full menu of advanced treatments, including robotic and minimally invasive procedures, for valvular disease, stenosis and insufficiency, as well as aortic pathologies.

“A large part of our procedures is minimally invasive,” Dr. Nazem says. “For example, we go through the right side of the chest with a small incision and do mitral valve surgery, aortic valve surgery and tricuspid valve surgery. Almost all the incisions are, at most, 7 to 8 centimeters in length.”

Some of the surgical techniques offered at St. Joseph’s, like the valve-saving “David Procedure,” aren’t available elsewhere in Central New York. Other surgical options offered there are less about a specific technique than the surgeons’ comfort and experience treating complex cases in a minimally invasive way.

“We do triple valve replacements through a right-side, thoracotomy, minimally invasive incision,” Dr. Nazem says. “That wouldn’t happen many other places.”

For CABG, St. Joseph’s surgeons offer both robotic surgery and open bypass, including an off-pump procedure for patients at high risk for embolization or stroke.

St. Joseph’s Health: Heart History in the Making

  • The first successful open heart surgery in Syracuse was performed at St. Joseph’s Hospital in 1958, and St. Joseph’s was the third hospital in the U.S. to perform angioplasty.
  • Famous physicians who have worked or studied at St. Joseph’s include Charles Dotter, MD, a pioneering interventional radiologist who invented angioplasty; Andreas Gruentzig, MD, who expanded Dr. Dotter’s angioplasty; Goffredo Gensini, MD, who first identified coronary vasospasms (and established St. Joseph’s cath lab); and Antonio Colombo, MD, who pioneered the concept of adequate stent deployment and the use of intravascular ultrasound for coronary stenting.

“Because St. Joseph’s has the largest cardiac and critical care anesthesiology team in Central New York, it can safely offer procedures for patients who wouldn’t otherwise be cleared for them,” says Courtney Maxey-Jones, MD, a cardiac anesthesiologist and intensivist at St. Joseph’s and its Medical Director for extracorporeal membrane oxygenation (ECMO) and mechanical support.

The Institute added ECMO in 2018, to better support “the sickest of the sick,” according to Dr. Maxey-Jones. She’s part of a smaller team of critical care cardiac anesthesiologists that provides 24/7 evaluation of eligibility for ECMO for cardiac or respiratory etiology. The team also works closely with the cardiologists and cardiac surgeons to manage day-to-day operation and then removal of mechanical support devices.

“The program has really taken off,” Dr. Maxey-Jones says. “It has allowed us to have some patients who either come in having an acute MI or otherwise would die of cardiogenic shock and to recover some of them and return them to independent daily living.”

Dr. Nazem says St. Joseph’s cardiac surgeons often use Impella heart pumps independently or in combination with ECMO to support patients in heart failure.

Nelly Kazzaz, MD
“Once you get out of New York City, St. Joseph’s is the premier cardiac program in the state.”
— Joseph Spinale, DO, MBA, Chief Medical Officer at St. Joseph’s Health

Advanced Structural Techniques

As the relatively young subspecialty of structural cardiology continues to evolve, St. Joseph’s has stayed ahead of the field by sending its providers to receive training from high-volume providers of advanced procedures, such as TAVR and MitraClip, and by hiring new physicians from strong interventional and structural heart programs.

St. Joseph’s is known for helping advance the use of TAVR, a minimally invasive procedure for severe aortic stenosis. The American Heart Association compares the down time and recovery of a TAVR procedure to that of a balloon treatment or angiogram.

St. Joseph’s participated in clinical trials for the use of TAVR in low-risk patients, and it’s still the major provider of TAVR in Central New York.

“We do a lot of minimally invasive surgeries that other hospitals in the area wouldn’t be able to do,” Dr. Nazem says. “We are ahead with TAVR in this area, and we’re definitely the only robotic center that has done it for years and has great experience with it. The fact that the Merola Center for Cardiac Care has a hybrid OR for TAVR procedures helps us enormously.”

A situation like TAVR failing is extremely fatal. The shorter time between patients getting CPR and getting their chest opened, the better the outcomes and the more lives get saved.

In addition to structural procedures, St. Joseph’s interventionalists offer the WATCHMAN procedure for atrial fibrillation; emergency interventions, such as EkoSonic Endovascular System (EKOS) for acute pulmonary embolism; cryoablations and radio frequency ablations; and implantation of pacemakers and defibrillators.

St. Joseph’s Health anesthesiologists work in the Electrophysiology Lab, studying the electrical activity of a patient’s heart to find where an arrhythmia is coming from. St. Joseph’s performs more than 1,700 electrophysiology procedures, 250 radio frequency ablations and 350 implantable cardioverter defibrillators annually.
“The most critically ill patients are those undergoing cardiac surgery, so having additional training in either critical care or cardiac anesthesia is very important to safety as well as having good outcomes in the cardiac surgery world.”
— Courtney Maxey-Jones, MD, Cardiac Anesthesiologist and Intensivist, Medical Director for extracorporeal membrane oxygenation and Mechanical Support at St. Joseph’s Health

Clinical Care

Structural and surgical cardiology might make headlines, but therapeutic management of heart disease is critical to a robust cardiology program. St. Joseph’s cardiologists have long been known for their clinical excellence, which they extend to patients across Central New York through the hospital’s many satellite locations.

In April, St. Joseph’s opened its 11th location: a heart failure clinic operated in conjunction with Strong Memorial Hospital in Rochester. Both hospitals work together to provide remote monitoring of patients with implanted devices.

A 12th location, which will be the Cardiovascular Institute, is set to open in Fayetteville in June.

The Institute is built on a service line model that begins with the medical cardiologist. If more specialized treatment is required, the best approach is determined by a full team of cardiac physicians, in consultation with the patient and often the primary care physician.

“It takes a committee, not a doctor, to make these decisions,” Dr. Silverman says.

He cites the recent example of a 78-year-old patient who came to him with shortness of breath. The patient, a smoker, had significant pulmonary and coronary disease. He’d had a heart attack and a number of coronary interventions, including bypass, and Dr. Silverman had followed the patient’s aortal stenosis for years. The question was whether this new symptom was related to a diseased valve or diseased lungs.

After a battery of tests and evaluations by pulmonary, surgical and interventional specialists, the team determined that TAVR was the correct approach. Two weeks after the valve replacement, Dr. Silverman watched his longtime patient walk up and down the hall, breathing easier.

“We made the best decision in that case,” Dr. Silverman says. “The patient’s longevity is more than a year, despite his lungs, and the life that he will have now will be better than the life he had prior to the intervention.”

With all the awards St. Joseph’s cardiac program has earned, its physicians ultimately measure success by moments like this.

“I’ve seen patients in dire situations: If they move, they can have a heart attack, fibrillate and die,” Dr. Nazem says. “But I take them to the OR and complete the necessary procedure, and the next day they’re sitting up in bed, and the next day they’re walking. There’s nothing more rewarding than those results for my patients.”

To learn more about St. Joseph’s Health heart care, visit everybeatmatterssjh.org.

Targeting Tick-Borne Disease in Central New York

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By Katy Mena-Berkley

Monday, April 27, 2020

The Central New York Lyme and Tick-Borne Disease Alliance is on a mission to eradicate increasingly prevalent tick-borne illnesses that have historically gone undetected in Central New York.

CNY Lyme Alliance members tour Thangamani Tick Lab at SUNY Upstate

 

A year and a half ago, career strategist and coach Anne Messenger was experiencing unusual fatigue, a symptom her provider attributed to sleep apnea when she went in for a routine annual physical.

“I yawned all the way through that appointment,” Messenger says. “But I also had other symptoms that were affecting my quality of life.”

In addition to the debilitating exhaustion, Messenger had heart palpitations, pain in her left foot, a strange tickling sensation in the back of her neck and brain fog that interfered with her ability to remember something as simple as the current score during a game of tennis.

It would take the counsel of another medical professional whose children were devastatingly impacted by Lyme disease to finally offer a possible explanation — Messenger may have Lyme disease herself.

To get to a definitive diagnosis, Messenger consulted Kristopher Paolino, MD, Assistant Professor in the Department of Medicine at State University of New York Upstate Medical University.

“Dr. Paolino is Upstate’s Lyme person,” Messenger says. “He figured out my diagnosis and invited me to a research conference at Cornell University.”

At that conference, the Central New York Lyme and Tick-Borne Disease Alliance began to take shape in the minds of people who could make a difference. Clinicians, researchers, scientists and higher education executives from Cornell University, Binghamton University, SUNY College of Environmental Science and Forestry and Upstate Medical University were gathered together, investigating opportunities for translational research and collaboration.

“Multiple times in multiple ways, I heard scientists in the back of the room say they needed patients to observe,” Messenger says. “That happened again and again.”

Syracuse resident Royale Scuderi came to Messenger’s mind as she brainstormed about an organization that could effectively address the challenges of tick-borne disease.

Group presentation in Old Forge, New York (Left to Right): Kathy Ruscitto, Vice Chair; Kristopher Paolino, MD, MTM&H, FACP;
Anne Messenger, Alliance Board Chair; Brian Leydet, PhD, SUNY ESF; Scott Santarella, CEO, Global Lyme Alliance

“It is clear that delay in diagnosis and initiation of treatment of Lyme disease can result in increased morbidity with increased risk for chronic symptoms. Missing a case of anaplasmosis can have dire consequences.”
— Kristopher Paolino, MD, Assistant Professor in the Department of Medicine at State University of New York Upstate Medical University

Life with Lyme Disease

Diagnosed with late stage Lyme disease in March 2011 and with another tick-borne disease known as Babesia just four months later, Scuderi knew first-hand about the life-changing consequences of not having the right information at a critical time.

“I did not see a tick, nor did I have the bull’s eye rash,” Scuderi says. “Consequently, there is no way to discern how long I was infected with those diseases prior to my diagnosis. I do not remember when the symptoms started, but if I had the typical flu-like symptoms, we dismissed them as just that, flu or a virus. Lyme was not something that I or my doctors even considered.”

For months before her diagnosis, Scuderi experienced a widening range of debilitating symptoms, among them recurring headaches, nausea, joint pain, severe fatigue, and neck and back pain. She also began to develop fever, chills, shortness of breath, heart palpitations, stiff neck, insomnia, mental fogginess, difficulty concentrating and problems recalling words.

“As my health declined, I visited doctor after doctor,” she recalls. “I was tested for autoimmune diseases, cardiac conditions, pulmonary complications and allergies, along with an MRI to look for multiple sclerosis or neurological causes. I was misdiagnosed with arthritis and fibromyalgia. I was told repeatedly that the test results all looked normal and they could find nothing wrong with me.”

A local clinician finally tested Scuderi for Lyme and treated her with doxycycline. But relief of her symptoms was brief, as the Babesia co-infection further compromised Scuderi’s health.

After consultations with a specialist in Long Island, and another year of treatments, Scuderi finally began to find some relief, but only after the tick-borne diseases cost her significant time, money and wellness. It was three years before Scuderi could return to her normal daily activities.

“The toll of this long journey caused enormous hardship and suffering for myself and my family, along with years of lost wages and the end of a career as a freelance writer, as I could no longer form coherent thoughts,” Scuderi says. “It took several more years to eliminate the substantial debt incurred as a result of lost wages, treatments not covered by insurance and extensive travel.”

Scuderi says that when Messenger approached her during summer 2019 with the concept of an organization that would bring together clinicians, patients, researchers and advocates in an effort to solve the mysteries of tick-borne disease, she was eager to get involved. Today, Scuderi has turned her experience into action and serves as Executive Director for the Central New York Lyme and Tick-Borne Disease Alliance.

“The hope is that we can help attack the Lyme and tick-borne illnesses in our region through education and outreach to medical providers and to the community at large,” says Dr. Paolino, who is one of the founding members of the Central New York Lyme and Tick-Borne Disease Alliance. “We will also approach the problem via research initiatives that target environmental factors to help with prevention, as well as laboratory and clinical studies.”

Addressing a Growing Concern

Investigating the rapid rise of tick-borne disease is one of the chief objectives of researchers like Brian F. Leydet Jr., MPH, PhD, Assistant Professor of Epidemiology & Disease Ecology in the Department of Environmental and Forest Biology at SUNY College of Environmental Science and Forestry. In his research, Dr. Leydet, who is also on the board of the Central New York Lyme and Tick-Borne Disease Alliance, saw a spike in tick-borne disease in the region in 2008, an uptick that has not slowed.

“If we don’t think about stopping the spread of ticks in this area, then eventually, they are going to be everywhere,” Dr. Leydet says “We will also see increases in cases of tick-borne diseases, like Lyme disease, Babesia and anaplasmosis, unless we can figure out vaccines or some miracle method to wipe out the entire tick population. Once ticks are established, they are very hard to get rid of. We need to stop these ticks from spreading, because that is what is bringing disease into new areas.”

In partnership with area infectious-disease clinicians and scientists also involved with the Alliance, Dr. Leydet is working to advance diagnostics and vaccines for tick-borne diseases.

“I cannot think of a place where this would work better than in Syracuse,” Dr. Leydet says. “All I do is study tick-borne disease. The infectious disease clinicians are doing so many different things with patients and the local university experts have important insight into what is going on in the community. The Alliance will be a source of very unique information for patients and clinicians alike.”

A Resource for the Underserved

Due to lack of access to financial and medical resources, tick-borne disease has historically gone undetected and untreated in underserved communities such as the inner city, another challenge that the Alliance is seeking to address.

“So many families do not have access to the care they need, and when they are finally diagnosed, they are not covered by insurance,” says Kathy Ruscitto, Vice Chair of the Central New York Lyme and Tick-Borne Disease Alliance. “Early treatment is essential.”

Investigating the Offender

Saravanan Thangamani, PhD, Professor of Microbiology and Immunology at State University of New York Upstate Medical University and Director of the SUNY Center for Environmental Health and Medicine, leads a tick-submission program for patients who find a tick on their bodies. Through the Citizen Science Tick Testing Program, those patients may send the tick in so that Dr. Thangamani and his team can assess the tick for pathogens and gather data to better understand the threat presented by these arachnids.

This robust gathering of information has already helped identify where ticks are most prevalent and offers patients vital information about whether they have contracted infections, including Lyme disease, Babesia and Ehrlichia.

To learn more about Lyme education for healthcare professionals, visit globallymealliance.org/education-awareness/physicians-training-program.

To track the emergence of ticks and tick-borne diseases in New York, visit www.thangamani-lab.com.

Brandiss Pearson, RN, Director of Community Engagement at Saint Joseph’s Health Hospital, was recruited to join the Alliance as a board member and to closely connect with inner-city communities.

“Underserved individuals are often not able to get the support they need,” Pearson says. “My role gives me the opportunity to speak about Lyme in a way that I would not have been able to before.”

One of the earliest initiatives of the Alliance is a grant for outreach to those in the region’s underserved neighborhoods.

“It is perplexing to me that we fight mosquitos, treat EEE, yet we have no strategy for tick control, eradication or treatment,” Ruscitto says. “Our goal in the Alliance is to help connect research, education, and treatment to help the residents of New York.”

To learn more, visit cnylymealliance.org.

World Class Care in Central New York at Auburn Community Hospital

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By Katy Mena-Berkley

Monday, April 27, 2020

Auburn Community Hospital offers a wealth of specialized services to the Finger Lakes region.

When patients in Cayuga County and surrounding areas need high-quality, patient-centered health care, they do not have to travel far. Auburn Community Hospital (ACH), a not-for-profit facility, provides both acute and general hospital services to the population of 80,000. Roughly 95% of ACH physicians are board-certified in one or more specialties, ensuring that the majority of patients can access the care they need close to home.

ACH’s comprehensive scope of services includes cardiology, neurology, radiology, bariatrics, and obstetrics, as well as lifestyle-focused programs in areas such as nutritional counseling and pastoral care.

“At Auburn Community Hospital, our vision is simple. We will provide the best outcome for every patient, every time. We want you to know that we are always challenging ourselves to make the healthcare experience better for our patients, physicians and staff and ultimately our community. ACH health system invests in our community to make it better and trusts that our community will make the health system better in turn. We are neighbors and we need to take care of each other,” stated Scott Berlucchi, President & CEO, Auburn Community Hospital.

Collaborating for Cancer Care

Enhancing the expertise of the oncology specialists at ACH is a partnership with Syracuse-based Upstate Cancer Center, the only academic medical center in the region. Upstate’s program is ranked in the top 20% in the United States by the American College of Surgeons Commission on Cancer and is the only facility in Central New York accredited by the organization.

Located on the hospital’s first floor, Upstate Cancer Center at Auburn Community Hospital offers a spectrum of advanced diagnostic and treatment resources delivered by board-certified physicians and nurses with extensive experience in hematology and oncology.

“We’re very excited about bringing all of the resources of Upstate and an academic medical center to Auburn,” says David B. Duggan, MD, Professor of Medicine at Upstate Cancer Center and Medical Director of Upstate Cancer Center at Auburn Community Hospital. “The physicians we work with are highly trained and have many years of specialized training.”

The skilled nursing staff at Upstate Cancer Center at Auburn is trained to administer a variety of treatments, including chemotherapy and infusion regimens, implementing plans designed by specialists and tailored to each individual patient. In the event that consultations or procedures are not available at the Auburn location, patients will have priority access to the facility in Syracuse. In either location, patients can expect a multidisciplinary case review by a team of experts. 

“Bringing the Upstate team to Auburn provides that team approach to cancer care that all patients want,” says Christina Sherman, RN, Director of Auburn Community Hospital Cancer Services, Upstate Cancer Center at Auburn Community Hospital.

An Engine for Economic Health

In addition to enhancing the physical wellness of the community, Auburn Community Hospital (ACH) is doing its part to improve economic fitness. Specifically, the Healthcare Association of New York State reported the following statistics associated with ACH:

People in Numbers

  • 400 babies delivered
  • 5,300 individuals admitted to hospitals
  • 25,000 individuals treated in the emergency room
  • 140,000 outpatients received care

Dollars and Cents

  • $175,000,000 in economic activity
  • $60,000,000 in payroll expenditures
  • $21,000,000 of generated tax dollars
  • $11,000,000 in community benefits and investments

“We want second opinions. We want to know what other doctors think. These are doctors who are world-class in their fields of expertise. This practice is built with the patient in mind.”

As a resident of Auburn and a longtime member of the Upstate Cancer Center team in Syracuse, Sherman was a strong proponent of the collaboration with ACH.

“Auburn was an underserved area in terms of cancer services, and I was seeing patients from my community drive to Syracuse for the expertise that they needed,” Sherman says. “The Upstate Cancer Center at Auburn offers local options from a multidisciplinary team in a familiar and intimate setting. Dr. Duggan grew up in Auburn, and his expertise in the field is unmatched.”

In addition to cancer treatments, Upstate Cancer Center at Auburn provides on-site pharmacy and phlebotomy services to streamline the delivery of medications and lab results.

Upstate Cancer Center at Auburn Community Hospital
 
Examination Room
 
Infusion Room
 

Dedicated to Core Values

In every area of expertise, clinicians, nurses and administrators at Auburn Community Hospital deliver service in accordance with four key principles. Clinicians who refer patients to ACH can count on:

  • Collaboration. Each individual on the ACH team works together with patients, external partners and one another to enhance health and well-being throughout the community.
  • Accountability. The ACH staff takes personal responsibility for individual and team performance.
  • Respect. Treating patients, families, co-workers and other members of the community with consideration, dignity and sensitivity is a priority for ACH.
  • Excellence. Adhering to the highest standards when delivering clinical care and overall service as well as continuously enhancing knowledge and skills is of paramount importance to the ACH team.

“Not only do we take care of you and your family when you have health issues, but we are also the largest employer in the area and with that comes a significant responsibility. Auburn Community Hospital generates more than 1,200 jobs in this community and helps maintain and improve our quality of life in this beautiful region of New York State,” Scott Berlucchi stated.

Answering the Virtual Call During the COVID-19 Pandemic

One of the most critical ways Auburn Community Hospital has been a leader in meeting the needs of the community during recent months is by rapidly enhancing telehealth capabilities for 90% of affiliated healthcare providers. The adoption of telehealth at ACH has been led by Paul Fu, MD, neurologist and Deputy Chief Medical Officer. Initially intended to offer choices for rural patients in need of routine appointments, the telehealth options were made available to any patients who would prefer to have consultations at home during the pandemic.

Auburn-based software development and services company Medent provides the telehealth options to ACH, and the process is seamless for clinicians and patients alike. Once a patient schedules his appointment, he receives a link through either an email or text message. When the appointment time arrives, the patient may open the link on a computer, smartphone or tablet and virtually connect with the provider.

Celebrating Advancements in Orthopedics: Syracuse Orthopedic Specialists’ One-Day Surgery Center

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By Hillary Eames

Monday, April 27, 2020

The Syracuse Orthopedic Specialists’ One-Day Surgery Center celebrates one year of merging convenience with high-quality care in their new location.

April marks the one-year anniversary of the new, expanded location of the Syracuse Orthopedic Specialists’ One-Day Surgery Center.

 


J. Alan Lemley, MD


Brett Greenky, MD

“We opened our same-day surgery center in April 2019,” says James Alan Lemley, MD, President of the Surgery Center and Orthopedic Surgeon with Syracuse Orthopedic Specialists. “It’s given us the capability to do things that were previously only available to patients in hospital settings.”

Syracuse Orthopedic Specialists has offered outpatient surgery services for two decades, but as trends in orthopedics suggest outpatient procedures will become the standard of care, expanding to the new, state-of-the-art center was necessary to continue providing excellent care.

“There is a movement in orthopedics to make procedures traditionally inpatient-only, such as spinal surgeries or total joint replacements, into outpatient procedures,” says Brett Greenky, MD, President of Syracuse Orthopedic Specialists. “The advantages of same-day surgery for orthopedic procedures are significant.”

Benefits of Same-Day Total Joint Replacement

Total joint replacements, in particular, have shifted toward outpatient versus in-hospital procedures in recent years, and surgeons at Syracuse Orthopedic Specialists were the first to embrace the trend. Physicians use equipment and technology in outpatient settings that were previously considered only fit for hospital settings, allowing patients to receive hospital-quality care without spending several days in the facility. The practice of outpatient procedures lowers medical costs for patients and insurance companies, discounting the prices at an average of roughly 40%.

“Studies also show that the risk of infection goes down with the amount of time spent in the operating room,” Dr. Lemley says. “We’ve created a team of physicians, anesthesiologists, nurses and scrub technicians who know how to perform surgeries as efficiently and optimally as possible to minimize patient risk and complication.”

Patient Selection Designed to Increase Success

To ensure the success rate of outpatient orthopedic surgery is kept at optimal levels, physicians and staff at the center also implement a conservative patient selection process. If a patient has an A1c of 8.0 or higher, a BMI above 40 or other comorbidities that Syracuse Orthopedic Specialists’ physicians refer to as “hard stops,” the patient is discouraged from receiving orthopedic surgery on an outpatient level. Physicians, however, do not allow this to prevent patients from receiving excellent orthopedic care.

“We have a total joint replacement council that meets monthly to discuss such cases,” Dr. Greenky says. “If we think a patient needs an operation but has one or more of those hard stops, the panel reviews the case before anyone makes a decision and puts it to a vote. We will also continue to adjust our guidelines as new information becomes available.”

For patients for whom outpatient surgery is not an option, the locally owned One-Day Surgery Center also maintains a close relationship with nearby referring hospitals to ensure patients receive safe, effective and excellent orthopedic care.

To learn more about Syracuse Orthopedic Specialists, visit sosbones.com.

Virtual Visits

Syracuse Orthopedic Specialists is now offering Virtual Visits, to ensure timely and safe care for their patients. Also known as telemedicine, Virtual Visits allow patients to schedule a video visit with their doctor. Patients can stay home and continue their care without interruption.

Visit sosbones.com or call 315-251-3100 to learn more.

Crouse Health: Leading the Way in Robotic Surgery — Past, Present and Future

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By Sherry Christiansen

Wednesday, February 26, 2020

As modern medical technology continues to see exponential growth, the Crouse Institute for Robotic Surgery remains a leader in the industry, largely due to its pioneering spirit and team-centered approach.

 
Since its inception in 2008, the Crouse Institute for Robotic Surgery has evolved to become the largest multispecialty robotic surgery program in Central New York. Crouse Health has a sizable team of highly skilled, experienced surgeons, each committed to the use of the newest, most advanced surgical technology available today. Surgeons at Crouse Health continually enhance their minimally invasive surgical skills in order to offer their patients the highest level of care possible.

Surgeons and administrators at Crouse, particularly those who were instrumental in laying the initial foundation for the program’s infrastructure, share their perspectives on how Crouse became the market leader in this highly competitive and continually evolving field of modern medical technology.

 

History of Robotic Surgery

Central New York was not the birthplace of robotic surgery, and the da Vinci Surgical System was certainly not the first robot designed to assist in performing surgical procedures. According to the American Journal of Robotic Surgery, a robot was used for the first time in a procedure over 30 years ago, when the PUMA 200 was utilized for needle placement during a CT-guided brain biopsy. There have been many advances in robotic technology since that first robotic-assisted procedure back in 1985. Each improvement led to the first da Vinci Surgical System, which was approved by the Food and Drug Administration in 2000. This early da Vinci model broke new ground as the first robotic surgery technology approved for general laparoscopic surgery

The Making of a Leader

Eventually, the Crouse Health team began to contemplate what it would take to establish a successful robotic surgery program of its own. When approached by its highly skilled staff of surgeons who had learned about the many benefits of robotic surgery, administrators at Crouse saw the promise of such a program and committed the resources to building it, in partnership with its surgeons.

Po Lam, MD, a board-certified urologist at Crouse Health, performs close to 200 robotic procedures each year. His fellowship training included endourology, laparoscopy and minimally invasive surgery at the University of Oklahoma Health Sciences Center. Dr. Lam was instrumental in getting Crouse Health’s robotic surgery program off the ground.

“In 2006, Crouse did not have a robotic surgery program. I met with Paul Kronenberg, MD, [CEO of Crouse Health at the time] to ask him if we could start a program,” Dr. Lam says. “Since then, the Crouse program has grown significantly.”

Dr. Lam, as well as GYN/oncology surgeons Mary Cunningham, MD, and Douglas Bunn, MD, conducted much of the initial research to learn about program start-up costs. They also estimated the number of cases it would take to make the investment in the technology, training and other expenses worth the initial expenditure.

“At that time, the technology cost between $1.2 million and $1.4 million,” Dr. Lam says. “This was a significant investment, but adding the technology made sense because of the tremendous service we would be able to offer to the community.”

After Dr. Lam and the other Crouse surgeons presented data on how and why the hospital should consider a new robotic surgery program, hospital administration gave the technology their stamp of approval, fully supporting the surgeons’ vision of bringing the leading-edge technology to Crouse.

The purchase of the hospital’s first da Vinci robot in 2008 was just the beginning.

“It’s vital to undergo the right preparation and training before using robotic surgical technology. Crouse Health provides great training for the surgeons, both the experienced surgeons and the new surgeons and residents, as well as the rest of the team.”
— Po Lam, MD, board-certified urologist at Crouse He

Meet the Team

Crouse Health features the largest multispecialty robotic surgery program in Central New York.

General Surgery

  • Akbar Ahmed, MD
  • Kenneth Cooper, DO
  • Jeffrey DeSimone, MD
  • Steven Gelb, MD
  • Taewan Kim, MD
  • Benjamin Sadowitz, MD
  • James Sartori, MD

Colorectal

  • David Nesbitt, MD
  • John Nicholson, MD

Gynecology Oncology

  • Rinki Agarwal, MD
  • Douglas Bunn, MD
  • Mary Cunningham, MD

Gynecology

  • Stephen Brown, MD
  • Nikole Bucsek, MD
  • Carla Liberatore, MD
  • Myron Luthringer, MD
  • Navpriya Oberoi, MD
  • Byuong Ryu, MD
  • Shane Sopp, MD

Urology

  • David Albala, MD
  • Po Lam, MD
  • Hadley Narins, MD
  • Nedim Ruhotina, MD
  • Harvey Sauer, MD
  • Jeffrey Sekula, MD
  • Daniel Welchons, MD

Bariatrics

  • Kenneth Cooper, DO
  • Jeffrey DeSimone, MD
  • Taewan Kim, MD

Teamwork

John Nicholson, MD, colon and rectal surgeon at Crouse Health, graduated with honors from SUNY Upstate Medical University in Syracuse in 1973. As a highly skilled surgeon, Dr. Nicholson was one of the first in the area to be trained on the da Vinci system.

“Crouse Health’s state-of-the-art technology wouldn’t be what it is today if it hadn’t been for the efforts of the staff and the support of the administration,” Dr. Nicholson says. “When the robotics program first launched, it was considered a badge of honor for nurses to be on the robotics team, so those who were selected worked very hard to ensure that the program was successful.”

While the robotic technology is the same at every hospital, the quality of the surgeons using the technology is what really matters.

“Crouse Health has the right staff and the right surgeons with the right training,” Dr. Lam says. “That is the recipe for success.”

The Crouse Institute for Robotic Surgery has continued to progress since its inception.

“Every few years a newer version of the technology is available,” Dr. Lam says. “Our administration helps us stay up to date on the newest technology, which allows us to offer the most advanced care possible to our patients.”

“Our robotic surgery program is physician driven, with an active steering committee and talented physicians, PAs, nurses and technicians, all trained to perform optimally as a team. The robot technology is just another tool for the staff. The physicians’ talent and engagement is what really drives the program, creating an environment where the staff providing patient care can really excel.”
— Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer, Crouse Health

Expanding the Team

Benjamin Sadowitz, MD, FACS, a board-certified general surgeon, joined CNY Surgical Physicians (now known as Crouse Medical Practice – General Surgery) in 2015. He completed his fellowship in advanced gastrointestinal and hepatopancreaticobiliary surgery at Florida Hospital Tampa. Currently, Dr. Sadowitz largely specializes in robotic general surgery, which includes gallbladder, hernia, colon, appendix and anti-reflux procedures.

Dr. Sadowitz has firsthand experience of just how efficient the teamwork is at Crouse.

“About 18 months ago, we grew from two to four robotic systems at Crouse. Logistically, we needed to train a significant number of staff members to get all four systems up and running,” Dr. Sadowitz says. “We had a large group of OR staff — technicians, nurses and physician assistants — undergo training. Our robotics coordinator, Lisa Miller, our Director of Perioperative Services, Jill Hauswirth, and our head physician assistant, Cathy Burkett, were instrumental in identifying and eliminating training roadblocks.”

“The expansion was a huge initiative for Crouse,” says Dr. Sadowitz. “All four robotic systems were up and running by January 2019.”

“There used to be limitations when the robotic technology first came out. For example, patients with scar tissue from previous surgeries may have been disqualified. Now, there are fewer limitations because the technology is much better.”
— Po Lam, MD, board-certified urologist at Crouse Health

Crouse Institute for Robotic Surgery Today

Presently, Crouse Institute of Robotic Surgery providers perform over 1,750 robotic surgery procedures each year.

“Our four robots are not only in use full-time during the weekdays, but the robotic technology is also used after hours and on weekends,” Dr. Sadowitz says.

Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer at Crouse Health, continues to support the legacy that his father, former CEO Paul Kronenberg, MD, started in 2008.

Dr. Seth Kronenberg has been a member of the senior administration at Crouse Health since 2014. He chose Crouse because of its culture of collaboration with the medical staff.

“Physicians here have a voice in the decision-making process, a focus which I believe differentiates Crouse Health from other hospitals and health systems in the region,” Dr. Seth Kronenberg says.

While Crouse Health may have been the last in Central New York to implement the infrastructure needed to perform robotic surgery, the hospital has surpassed all other programs when it comes to patient volume and availability of clinical applications. Today, in addition to having four state-of-the-art da Vinci Xi multispecialty robots, Crouse partners with Intuitive, the company that provides the robotic technology. Through the work of the surgeons, OR staff and the unique partnership with Intuitive, Crouse Health has become the regional leader.

“Crouse Health has the highest number of robotic surgeons in the area, including 25 multi-specialty surgeons, each providing the highest level of quality to our patients by using the robotics technology,” Dr. Lam says.

“When using the robot platform for cholecystectomy, a special imaging system [Firefly fluorescence imaging] helps to highlight the bile duct. Such illumination helps minimize the risk of injury to this fragile structure during dissection.”
— Benjamin Sadowitz, MD, FACS, board-certified general surgeon at Crouse Medical Practice – General Surgery.

The Future

Considering recent advances in robotic technology and the accomplishments of Crouse’s robotics team, it’s exciting to imagine what more the future might bring. Dr. Sadowitz believes Crouse may increase the number of robotic surgical systems it uses to five.

“Robotic surgery is fast becoming the standard of care for many surgical conditions,” Dr. Sadowitz says. “More than 40 companies are vying to get into the robotic surgery market, so it makes sense that there will be a role for robotics in every operating room in the country. There will be very few places or areas of surgery where robotics won’t be involved.”

Dr. Lam also sees an exciting future involving the next generation of robotic surgical systems.

“I think the new technology will be more intuitive, with many alert signals to notify surgeons when a situation during a procedure may require additional attentiveness, such as moving in the proximity of adjacent blood vessels. The launch of the newest technology may occur within the next 12 to 18 months,” Dr. Lam says. “At Crouse, we’re prepared to be one of the first to successfully adopt new generations of robotic surgical system technology.”

“We perform a procedure called a total proctocolectomy and ileal-anal pouch — sometimes referred to as j-pouch or an s-pouch. With robotic-assisted surgery, this procedure can be done sparing the anal sphincter, which means the patient will usually not need a permanent ostomy. With traditional surgery, these patients were hospitalized for one week to 10 days. After a robotic-assisted total colectomy, the patient can typically go home in three to five days.”
— John Nicholson, MD, colon and rectal surgeon at Crouse Health

Benefits of Robotic Surgery

Robotic surgery offers many benefits to patients compared to open surgery, including:

  • Shorter hospitalization
  • Reduced pain and discomfort
  • Faster recovery time and return to normal activities
  • Smaller incisions, resulting in reduced risk of infection and less scarring

For the surgeon, benefits of robotic surgery include:

  • An enhanced visual field: Surgeon has a superior view of the operating area. The high-definition camera provides a magnified, detailed view of the affected area
  • Superior dexterity
  • Access to hard-to-reach places

For more information about robotic-assisted surgery services offered at the Crouse Institute for Robotic Surgery, visit Crouse.org/robotics.

Upstate Urology Brings a Better Way to Detect Bladder Cancer to Central New York

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By Thomas Crocker

Wednesday, February 26, 2020

To enhance a burgeoning bladder cancer program, the Department of Urology at Upstate Medical University offers Blue Light Cystoscopy (BLC) with Cysview, a method that has been proven to increase detection rates of certain forms of bladder cancer.

Cysview is a photoactivating solution that causes bladder tumors to fluoresce when absorbed. Using it with BLC allows urologic oncologists to detect cancers that might have gone unnoticed under standard white light. Bringing BLC with Cysview to Upstate was a priority for Joseph Jacob, MD, MCR, Chief of the Bladder Cancer Program in the Department of Urology and Assistant Professor of Urology at Upstate Medical University. He joined Upstate Urology in 2017, intent on using his fellowship training to help meet the need for bladder cancer care in Central New York. Part of that meant acquiring advanced technology to improve quality.

“High-level evidence from recent randomized trials showed BLC with Cysview has been proven to benefit patients,” Dr. Jacob says. “This technology has been shown to increase the rate of detection of carcinoma in situ, which is typically flat, often difficult to see and identify, and can progress to more aggressive types of bladder cancer. That higher detection rate is a huge deal for patients.”

Studies have also demonstrated higher detection rates of nonmuscle invasive papillary bladder cancer using BLC with Cysview compared with white light cystoscopy.

“Upstate Medical University invested in Blue Light Cystoscopy with Cysview based solely on a desire to improve quality for patients in Central New York. That makes me proud to be part of Upstate.”
— Joseph Jacob, MD, MCR, Chief of the Bladder Cancer Program in the Department of Urology and Assistant Professor of Urology at Upstate Medical University

 

 

Detection and Removal

Most patients with bladder cancer are candidates for BLC with Cysview due to the typically noninvasive nature of the disease, according to Dr. Jacob. Available at Upstate Cancer Center at Upstate University Hospital since March 2019, BLC with Cysview begins with the introduction of Cysview into the bladder via catheter. The medicine is left to coat the bladder for one hour.

“Cysview is full of molecules that can be absorbed by cells, and the cells can be activated with a certain wavelength of light,” Dr. Jacob says. “In the procedure room, I use a standard white-light camera that allows me to switch to blue light. Under that wavelength, cancers pop out in bright pink that’s quite obvious compared with normal bladder tissue.”

Treatment often takes place concurrent with BLC with Cysview, which can supplement transurethral resection of a bladder tumor, a common procedure for staging and removing bladder cancer. Removing the tumor may set the stage for intravesical therapy, such as immunotherapy or chemotherapy.

“The bladder is an imperfect sphere with areas that require careful scrutiny,” Dr. Jacob says. “Using only white light, we might miss some subtle, small or flat lesions, but BLC with Cysview helps prevent that. If we were to overlook a flat carcinoma in situ, for example, then we would miss the opportunity to provide immunotherapy, which is the treatment of choice for this type of cancer.”

For information about the Department of Urology at Upstate Medical University, visit upstate.edu/urology.

Public Health: Surveillance, Research and Prevention

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By Kathryn Ruscitto; Wednesday, February 26, 2020

The current crisis with the emerging Coronavirus, combined with a challenging flu year, reminds us all of the important role of our Public Health officials.

Public health takes the entire health system — including patients, community providers and environmental factors — into account. The CDC and local health departments provide early warning systems. Public health has played a key role in every community across this country, from managing communicable diseases such as HIV to the outbreak of the coronavirus. Laboratories and clinicians report results to local health departments, who then coordinate aggressive tracking and communications across their communities and with the New York state health department.

“The foundation of our work is based on our mission to protect [the] health of our community residents with [a] vision of community partnership. We follow [the] principle of health equity and advocate for [the] CDC’s Health in All Policies (HiAP) [approach] because these impact social determinants of health,” says Indu Gupta, MD, Onondaga County Health Commissioner. “Both as a practicing physician and now as a leader of a mid-size public health department, I always followed these two principles in order to improve health outcomes, and continue to do so now.

“It is important to understand and acknowledge that health care and public health are interdependent, [such that] one’s focus to improve and protect [the] health of one person at a time can result in improving [the] health of the entire community by collaborative partnership with all the members of a public health system. Public health departments play a central role in this. While health systems work at the micro level, public health provides [a] bridge to the community to provide a macro-level perspective and leadership to engage all those [who] impact [the] health of a community!”

Helpful Resources

A report exploring the social determinants that factor into health status can be found at the Onondaga County Health Department website and is an excellent summary of data and actions that have been coordinated across local health systems and providers. While these are identified actionable goals, public health must deal equally with emerging, unpredictable health challenges.

Clinicians across Central New York are part of the public health system and may be the first to experience an outbreak or indication of a systemic gap in care.

Dr. Gupta began her career as a primary care internal medicine physician and appreciates the role clinicians play in the health system. She cares deeply for her patients and understands the importance of assessing the whole person and their environment to understand the best approach to treatment. Onondaga County is in a unique position to have a leader who experienced the provision of clinical care before leading an experienced team of public health professionals.

The coming year will challenge all health providers to think about how they prepare for emerging trends in health. Environmental factors are influencing the increase in asthma, diarrhea and food-borne illness, tick-borne disease, and heat-related conditions.

Key Priorities for Onondaga County

Indu Gupta, MD, Onondaga County Health Commissioner, notes that key priorities of the Onondaga County Community Health Assessment and Improvement Plan for 2019–2021 include:

  • Preventing chronic diseases
  • Promoting well-being and preventing mental and substance-use disorders
  • Promoting a healthy and safe environment
  • Promoting healthy women, infants and children
  • Preventing communicable diseases

You can reach out to Kathryn Ruscitto on LinkedIn or via email at krusct@gmail.com.

 

The Labor and Employment Law Landscape

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By Anastasia Semel

Anastasia Semel

Several significant changes to state and federal labor and employment laws are taking effect this year. Employers need to be aware of these laws in order to adjust employment policies and procedures accordingly. Understanding and complying with these laws is essential. Below is a nonexhaustive list of laws enacted to date:

1. Increases In Minimum Wage and Salary Thresholds

Effective Dec. 31, 2019, the minimum wage is $11.80 for employees in areas of New York state, other than New York City, Nassau, Suffolk or Westchester counties. Additionally, New York state’s Minimum Wage Act and applicable regulations raised the minimum salary threshold to $46,020.00 annually ($885.00 weekly) for exempt executive and administrative employees in areas other than New York City, Nassau, Suffolk or Westchester counties. 

New York state does not have its own minimum salary threshold for exempting professional employees; however, the federal Fair Labor Standards Act and applicable regulations increased its threshold amount to $35,568.00 annually ($684.00 weekly). Employers should confirm that their wage rates and exemption classifications are in compliance with federal and state laws.

2. Salary History Ban

Effective Jan. 6, 2020, New York Labor Law Section 194-a bans employers from inquiring about or relying on salary history, including compensation and benefits, when making employment decisions. More specifically, the law bans employers from asking job applicants and current employees about their salary history and relying on salary history as a factor in deciding whether to hire or how much to pay an applicant or employee. Employers cannot (1) require applicants or employees to reveal salary history as a condition of consideration for a position; (2) request salary history information from an applicant’s or employee’s former employer; or (3) refuse to interview, hire, promote, or otherwise employ or retaliate in any other way against an applicant or employee who exercises the right not to reveal salary history.

If an applicant or employee voluntarily discloses his or her salary history, the employer may take it into consideration. Additionally, if the applicant or employee volunteers his or her salary history information in order to negotiate higher pay when an offer of compensation is made, the employer may take steps to confirm the accuracy of that information.

Employers should train human resources personnel, and anyone involved in the hiring process, on permissible and prohibited questions and actions under the new law.

3. Employee Rights Regarding Reproductive Health Decisions

Effective Nov. 8, 2019, New York Labor Law Section 203-e prohibits employers from (1) accessing an employee’s personal information regarding the employee’s (or dependent’s) reproductive health decisions without prior informed, affirmative written consent; (2) discriminating or taking any retaliatory personnel action against an employee with regard to compensation or the terms, conditions or privileges of employment because of or based on the employee’s (or dependent’s) reproductive health decisions; and (3) requiring an employee to sign a waiver or other document that purports to deny the employee the right to make their own reproductive healthcare decisions.

The law permits employees to bring a civil action in any court of competent jurisdiction and seek various legal and equitable remedies, and it also provides for an additional award of civil penalties against any employer who retaliates against an employee for bringing a complaint.

4. Expanded Worker Protection Under the New York State Human Rights Law

Several changes to the New York State Human Rights Law (NYSHRL) take effect in 2020.

Nondisclosure agreements (NDA) as part of employment contracts entered on or after Jan. 1, 2020 must include an explicit policy that allows the employee or potential employee to speak with “Law enforcement, the Equal Employment Opportunity Commission, the state Division of Human Rights, a local commission on human rights or an attorney retained by the employee or potential employee.” Without this language, NDAs are void and unenforceable to the extent that they prohibit disclosing factual information regarding any future claims of discrimination.

Effective Feb. 8, 2020, employers of any size, including those with just one employee, are subject to the NYSHRL.

Finally, effective Aug. 12, 2020, the statute of limitations for reporting claims of sexual harassment to the state Division of Human Rights will be extended to three years.

Employers should ensure they are in compliance with these laws and consult legal counsel if they have specific labor and employment law questions or concerns.

Anastasia Semel is an associate at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. She can be reached at 315-477-6232 or asemel@ccblaw.com.