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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

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.