Category: NOVEMBER – DECEMBER MD News 2020

Listening, Learning and Responding to Disparities in Health Care

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By Kathryn Ruscitto

Monday, November 2, 2020

I am not sure I realized what white privilege meant until I sat in a room of diverse women several years ago.

As we went around the table and discussed our careers, I listened to issues that I had not encountered. When the evening was over, I left asking myself how I could use my position and advantage to open more doors and help advance the careers of diverse women. That was a lesson I wished I had learned earlier in my career.

There were times I would ask board committees I was on or at events I was part of to recruit more diverse candidates for board positions or honors. Some organizations listened and acted, others did not.

Many years ago, I was also involved with setting policies that involved choosing a location for senior housing or clinics without asking myself if underserved populations could access the facilities. Later in my career, when those questions were asked, it resulted in better access and funding awards to benefit all communities.

The past several months of public discourse have helped me understand what my Black friends tried to tell me, how my own discomfort prevented me from recognizing the racism they faced every day and the pain that resulted for their families.

Those of us who have worked and are working in health care cannot let the disparities that exist in access and treatment to continue. The data is clear. According to the Centers for Disease Control and Prevention:

  • Diabetes among white adults is 7.5 %
  • Diabetes among Black adults is 11.7 %
  • Diabetes among Hispanic adults is 12.5%

These same disparities exist in breast cancer, Lyme disease , heart failure and maternal outcomes. Funding for research and treatment for chronic diseases must have a priority to reverse these trends. Our voices in our associations’ legislative agendas should advocate for this focus.

This period in our country demands we acknowledge we have a lot of learning and change to initiate, followed by action plans. I’ve stopped asking my BIPOC friends what to do. It’s time to figure out what I have to do to be a better colleague, friend and neighbor.

We all have opportunities to move this discussion forward by asking in our own spheres of influence:

  • Are our boards reflecting diversity?
  • Are our executive teams diverse?
  • Are our providers culturally sensitive?
  • Are our staff trained to be welcoming and culturally sensitive?

If the answer is no to any of the above, then, we must decide what are we doing to mentor, train and hold ourselves and our teams accountable for progress. It’s up to all of us to lead on these issues.

Resources Available

There are great resources available to help on this journey.

  • healthypeople.gov
  • ama-assn.org
  • Health Disparities Toolkit
  • Unequal Treatment, Institute of Medicine
  • Just Medicine: A Cure for Racial Inequality in American Health Care
  • Health Disparities in the United States

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

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By Katy Mena-Berkley

Monday, November 2, 2020

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

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

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

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

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

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


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

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

Leading-Edge Solutions Close to Home

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

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

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

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

Stroke Care and Telemedicine

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

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

Intensive Care for Neurological Conditions

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

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

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

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


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

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

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

Expert Epilepsy Care

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

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

An Exploration of Possibility

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

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

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

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

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

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

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

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

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

Expert Neuro- Oncologic Care

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

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

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

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

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

Upstate Neurological Institute

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

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

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

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


SUNY Upstate Medical University Interim President Mantosh Dewan, MD

For more information, visit upstate.edu/neuro.

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

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By Cari Wade Gervin

Monday, November 2, 2020

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


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

 

Total knee replacement is one of the more painful surgeries.

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

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

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


Dr. Wickline

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

The Problem With Opioids

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

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

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

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

 

Dr. Wickline’s Study

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

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

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

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

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

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

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

Improved Outcomes, Faster

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

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

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

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

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

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

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

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

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

The Best Foot Forward at Syracuse Orthopedic Specialists

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By Cari Wade Gervin

Monday, November 2, 2020

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

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

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

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

Surgical Specialties

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

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

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

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

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

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

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

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

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

Complete Foot Health Management

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

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

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

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

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

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

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

When Is Surgery Needed?

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

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

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

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

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

Syracuse Orthopedic Specialists Foot and Ankle Team

Surgeons: 

Naven Duggal, MD

Frederick Lemley, MD

Podiatrists:

Christopher J. Fatti, DPM

Stephanie Hook, DPM

Pedorthist:

Maureen Kaljeskie, CPed

Child Surrogacy Legalized, Finally

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By Bruce Wood, Esq.

Monday, November 2, 2020

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

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

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

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

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

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

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

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

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

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