Community and Volunteer Service - Florida Academy of Family ...

FLORIDA ACADEMY OF FAMILY PHYSICIANS AND FLORIDA ACADEMY OF FAMILY PHYSICIANS FOUNDATION2007 SUMMER BREAK AWAYExcellence in Continuing Medical Education. Planned by Family Physiciansfor Family Physicians. Merging Innovation with Tradition.Welcome to The Breakers…A legendary resort enjoying international acclaim since 1896.If you have not been there, you want the experience. If you havebeen there, you will want to return. With the ongoing revitalizationand expansion, it’s better than ever!Mark Your Calendar!2007 SUMMER BREAK AWAYJuly 26-29, 2007 • The Breakers, Palm BeachExperience a wide range of topics,including a half-day Metabolic MaladiesSymposium; pediatric ophthalmic disease,oral health and orthopedics; arrhythmia andEKG analysis; update on new ACLS; immunizations,ocean injuries and alternative medicine.Plus … the ever-popular Welcome Party, ExhibitHall, Annual Awards Presentation, Installation of Officersand more! It’s the place to be if you are a family physician.For more information, check the FAFP Web site at www.fafp.org or call 800-223-3237.

THIS IS AN ADVERTISEMENTProblem Gambling and HealthFor many people, gambling turns into an addiction. The American Psychiatric Association defines pathological gambling (commonlycalled compulsive or problem gambling) as a mental health disorder of impulse control. Problem gamblers typically experience:• A progressive addiction characterized by a need to bet more money more frequently• Restlessness or irritability when attempting to stop• Chasing losses• Loss of control• Continuation of the gambling behavior in spite of mounting serious, negative consequencesPrevalenceMore than 500,000 Floridians suffer from seriousor severe gambling difficulties. Millions more areadversely affected. Most never seek help becausethey fail to realize their illness is treatable. Manyturn to alcohol and drugs. Some present in mentalhealth and substance abuse clinics, physicianoffices, emergency rooms and elsewhere, complainingof anxiety, chest pain, headaches, highblood pressure, ulcers, hypertension, stomachaches,depression, insomnia, or other medicalconditions, none of which are ever identified asgambling related.Detection and InterventionThe best method for detecting whether a patientis suffering from a gambling problem is by askinga few questions.1. Do you gamble?2. Have you ever lied about how much you gamble?3. Have you ever felt the need to bet more andmore money?By answering yes to two questions, further assessmentis indicated and specialized treatmentshould be encouraged.24-Hour AssistanceFor more information or assistance, contact theFlorida Council on Compulsive Gambling’s 24-hourHelpLine, or visit us online, www.gamblinghelp.org.901 Douglas Ave, Suite 200Altamonte Springs, FL 32714888-ADMIT-ITFlorida Family Physician 11

2006 Research PosterContest WinnersThe following award winners were recognized at theNovember 2006 Family Medicine Weekend. Many thanks toDrs. David Feller and Amber Isley for serving as judges.Physician Award1st place: “Efficacy of Lifestyle Changes in ModifyingPractical Markers of Fitness and Wellness”Principle Author: Steven Cameron Masley, MD, St.Anthony’s Health Care, St. Petersburg2nd place: ”Screening of Men for Osteoporosis in aPrimary Care Setting”Principle Author: Kira Zwygart, MD, University of SouthFlorida College of Medicine, TampaResident Award1st place: “Polypharmacy and Potentially InappropriatePrescriptions among the Elderly at the TallahasseeMemorial Family Medicine Residency Clinic”Principle Author: Jorge Camilo Mora, MD, MPH2nd place: “Pediatric Emergency Department Utilizationand Caretaker Perceptions”Principle Authors: Noshin Najafi, MD, and Robert Griffin,MD, University of Florida, Shands, JacksonvilleStudent Award1st place: “Patient Education and Health Screening amongMigrant Farm Workers in Rural Northwest Florida”Principle Authors: Mikel Hofmann, MS2, and AngelicaSoberon, MS2, Florida State University College ofMedicine, TallahasseeOur 2007 Research Poster Contest submission deadlineis July 1, 2007. Awards will be presented at the99th Family MedicineWeekend, December 7-9, atthe Ritz Carlton, Sarasota.2007 LegislativeObjectives• Support increased funding for Medicaid providers andremoval of treatment hassle factors. Closely monitor andparticipate in Medicaid reform proposals utilizing the managedcare model.• Support legislation improving access to high-quality, accessible,affordable health care services for all Floridians.• Support the increase of funding for family practice residencyprograms, and support programs that improve the availabilityof family physicians to serve Floridians through federal andstate programs and academic institutions.• Continued support for legislation enacting civil justicereforms aimed at curtailing the health care liability insurancecrisis.• Support children’s health care initiatives that will (a) minimizeaccess to tobacco products, (b) reduce drug andalcohol abuse, (c) decrease teenage pregnancy, (d) encourageexercise and nutritious consumption of food in thehome and schools, (e) support the use of seatbelt and childrestraint protection devices, and (f) support legislation thatwill assist children with access to needed medications inthe school setting.• Support legislation protecting the physician’s prescribingauthority, assuring that patients receive prescribed medicationswithout therapeutic substitution. (This issue relates tothe switching of patient medications without the treatingphysician’s knowledge.)• Support broad access to medications in the Medicaid program.• Support legislation specifying physician responsibilities insupervising relationships with mid-level providers whenpracticing outside of the physician office practice setting.• Oppose expansion of the scope of practice, and independentpractice, of mid-level providers. Includes opposition toauthorization of non-physician providers to prescribe medicationswithout the treating physician’s knowledge.• Oppose legislation that diminishes the continuity of careand/or reduces the comprehensive care provided by familyphysicians for their patients.Florida Family Physician 13

IT MATTERSTO THAT ONEby Kimberlee Brown, MD, Ormond BeachApproaching the shores of Honduras yielded green mountaintopssurrounded by an azure sparkle as the waves lapped the shore. Insidethe plane were volunteers from the United States arriving to prepareand participate in a three-day health fair at a mission school in theremote countryside. Doctors, dentists, medical and dental students,nurses, translators, a pharmacist, spouses and grown children of theparticipants converged in the airport to begin a journey that, by theend of the week, would result in self-reflection and humility thatwould stay with them forever.Volunteering was not new to me. I started in Girl Scouts, mendingbroken toys and taking food and clothes to the needy for many years.I worked on many projects in college and for the Junior League inDaytona Beach in different capacities, always trying to improve programsfor our community. As a physician, when president of theVolusia County Medical Society, I had helped to develop a healthclinic for the non-insured and worked there gratis every Mondayevening after a full day of work at the Veterans Clinic.This particular trip was different. Remembering my days of flounderingSpanish trying to play doctor on little Mexican children outin the country while I was in medical school in Guadalajara, I wasgenuinely looking forward to seeing how much medical Spanish Ihad retained. When confronted with the smiling faces of the dearchildren living in the dirt — some with no shelter, no running water,and few clothes — it did not take long to gain their trust with smilesand hugs and colorful stickers.The Luke World Mission had established a school and health clinic,with this particular clinic being built and the plan of care for theindigent people being overseen by family physician David Yoon,MD, of Ormond Beach, Florida, and his wife, Florence Yoon, DDS.Half of the clinic was for the medical care, and the other half wasequipped for dental. The Yoons had made arrangements to start havingdental students rotate at the clinic, and a new physician, who hadjust graduated from medical school in Honduras, would work to seethe patients with medical problems.However, they could not take care of all the medical and dentalneeds in this area of the country, which is why volunteers were“recruited” to help during the health fair. Each of the doctors wasgiven a room with plenty of light from the tall windows, but noscreens. Flies, flies and more flies, but only the Americans battedthem away. The little children thought it quite amusing to see usflailing our arms in the air trying to squash those pesky critters.My room did not have water, although I had a nice sink. The waterpipe was not hooked up, so I used antimicrobial hand wash. Itserved the purpose.The patients started arriving, and for three days, I did not think theywould stop. Most of them were women with four or five children.They almost all had the same problems — parasites and rashes. Wesaw a few men and some older women who had never seen a doctorbefore. I had two exam tables in my room, and by the third day, mydaughter Brook, a first-year medical student at the time, finally hadto play doctor like I had so many years ago. At least she had takenSpanish in school, and, being younger, the little children really tookto her while she said funny things to them during examinations.We toured some poverty-stricken areas that only are found in thirdworldcountries, and, yes, you come away from such an experiencefeeling so grateful for all that our country has to offer. We felt veryhumbled by what we had experienced that week, and the nightbefore we all left, we had a testimonial session explaining to eachother how we had been affected.Upon return from our mission, I overheard someone say to a memberof our group, “Why bother? There are so many poor people allover the world, and you can’t help everyone.” True, but my daughterand I reflected on one of our favorite stories we read in the ChickenSoup for the Soul series. As a child picked up one of the numerousstarfish washed up on the beach, a passerby inquired, “Why does itmatter? There are so many.” To which the child replied, “It mattersto that one,” as she tossed it beyond the breaking waves.14

We Were All Meant for Missionby Pamela Lewin, MD, OcalaThe word “mission” is derived from theLatin word for “sending.” Those of us inhealing professions who self-identify as followersof Christ recognize that we have apurpose as the body of Christ. We, as theChurch, His Spiritual body, must finishwhat He started in His physical body. Themission? Introducing people to God byshowing love and fostering peace. So, wetake this commission very seriously.Members of the St. Augustine MutualMission (called SAMM) and the Jamaicancounterpart, the Jamaica EcumenicalMutual Mission (JEMM), involvingPresbyterians, Methodists, United Churchof Jamaica and the Cayman Islands, theMoravian Church and with occasionalmembers from other denominations, havebeen engaged in a mutual mission programfor more than 30 years. The medical/dentalaspect of the program started in 1992, withservice performed in Jamaica, West Indies.To give some idea of how necessary a programsuch as ours is in Jamaica, one mustgrasp a few facts. Jamaica is an island,approximately the size of the state of RhodeIsland. The population is about 3 millioninhabitants. Nearly 75 percent of the populationlives in the urban area of Kingston,the capital. The remainder are scattered inrural areas, with limited direct access tomedical care, though there are many physiciansavailable in the urban areas.As of this writing, the currency exchangerate is J$62 to US$1. The cost of seeing aphysician can vary from J$800 to J$2,000,and the average prescription can cost anywherefrom J$ 1,000 to J$5,000. The minimumwage is about J$2,000 per week, butmany of the country folk are farmers ekingout a living by planting cash crops or doingdomestic work or day labor, bringing in lessthan J$1,000 per week. Traditional medicalcare, as we know it, is prohibitive in costand many turn to herbalists and other healersor treat themselves with home remedies,along with a strong dose of spirituality andprayer. Fortuitously, there are several groupssuch as ours that serve the island on a regularbasis, bringing medical, dental and ophthalmiccare for little or no cost to those whoare most in need but are unable to pay.I became actively involved in the medicalmission program in 1992, serving on thevolunteer team annually for one week inJune. We serve as guests of JEMM, and ourprogram of activities are determined bythem. The typical team comprises 20 to 25medical, dental, pharmacy and allied personswith a spiritual leader. The clinic isconducted in the sanctuary or fellowshiphall of the hosting congregation, or occasionallyin a nearby basic or elementaryschool. The visiting team members arehoused in locations sometimes three hoursaway by bus, and the patients are alwaysvery PATIENT, gracious and welcoming —some having stood in line for up to fourhours to be registered.Upon arrival at the site, we set up the pharmacy,medical “offices” and dental “surgery.”A local person performs registration.After a short devotional and introduction ofthe team members, we start seeing patientsand continue all day with a brief break forlunch. In a 5.5-day clinic schedule, we typicallydo between 1,500 and 2,000 encounters.Service includes pulling, filling andcleaning teeth; diagnosis; and pharmaceuticalmanagement of disease processes withreferrals to secondary health facilities formore complicated cases. The SAMMchurches provide the donations with whichthe medications are purchased, which arealways given to patients free of charge tohelp ease the burden borne by Jamaicans ofhaving visited the doctor and being unableto afford the treatment. We are oftenimpressed by the ability of the simple countryfolk to make do with so little, knowinghow much waste takes place in our “disposablesociety.” Their utter dependence onGod’s grace to complete their healingthrough ministry like ours is really veryhumbling! The surprising lesson we repeatedlylearn is that as we set out to bless otherswith our skills and help, we, in turn,receive many blessings by the love that isshared with all of us.Although it is a great responsibility, it is abig privilege to be used in this way by God.Mission has eternal significance. It is notnecessary to quit your job and go into fulltimeministry. God wants you to share thegood news where you are. One thing I havelearned on these trips: Though we tend to becompulsive about getting donations andacquiring and administering medications, itreally is not about the medicine.The God who can use dirt and spit toaccomplish healing can use whatever weoffer for the benefit of others. To date, ourtrust has never been disappointed: GOD ISGOOD ALL THE TIME.Florida Family Physician 15

The Story of SamaritanClinic of Barnabas Centerby Tom Washburn, MD, Fernandina BeachThe story of the Samaritan Clinic in Fernandina Beach representspeople and events coming together at the right place and at the righttime. Dr. Tom Washburn, in his role as primary care physician for theNassau County Health Department, “happened” to discover that oneof his patients was homeless and living in a homeless shelter inFernandina Beach.Dr. Washburn met with the pastor of the Assembly ofGod Church, which sponsors the homeless shelter, andstarted going to the shelter once a week to learn whatkinds of health challenges the residents were experiencing.He was soon talking with Pastor Shick about startinga free clinic for homeless persons and found thatPastor Shick had been thinking about such a clinic foreight years. They even discussed using the church’sSunday school area for the clinic, which would be openon an evening other than Sunday. Shortly thereafter, Dr.Washburn sat down with Susan Holden-Dodge, theexecutive director of Barnabas Center, to coordinateservices with their Crisis Center. For 20 years, BarnabasCenter has served people in need of emergency food,clothing, shelter and so on. Conveniently, this buildingoriginally served as a dental office and was set up witha waiting room, individual offices and an examinationroom. Working together with Barnabas Center’s Boardof Directors and a few key community support people,a committee was formed to develop the details of theclinic to be housed at the Barnabas Center and to becalled Samaritan Clinic.Many people in the community readily came forwardand generously supported the start-up and maintenanceof Samaritan Clinic. Director of the NassauCounty Health Department Dr. Eugenia Ngo-Seidelhas not only provided the clinic with cogent ideas andmoral support but also her medical services. Directorof Baptist Medical Center-Nassau Jim Mayo and thehospital’s Board of Directors have provided the clinicwith access to laboratory and radiology services, aswell as a funding grant for start-up costs and ongoinghelp with prescription costs.The Samaritan Clinic has been developed as a healthcare provider in the State’s Volunteer Health CareProvider Program. Other than the part-time cliniccoordinator, all of the staff members — health careprofessionals and non-professionals — are volunteers.That has enabled the clinic and its medical providers toserve under the umbrella of the state’s sovereignimmunity from malpractice lawsuits. The clinicaccepts for services any person older than 12 yearswho does not have health insurance and whose selfdeclaredincome is less than 200 percent of the FederalPoverty Level.The community’s outpouring of volunteers has beenamazing and gratifying. There are presently eight medicalproviders. Mental health professionals, organized bySutton Place Behavioral Health, Inc., have also volunteeredtheir services at Samaritan Clinic. This hasenabled the clinic to provide mental health and substanceabuse screening as part of the primary care program.Participating nurses have come from private offices, hospitalsand the Health Department. Some are retired nurseswho want to support this community effort.18

The Samaritan Clinic opened for clinic services onOctober 18, 2005, operating one evening a week, up tofour hours each session. At this time, after the end ofthe first year of operation, services are provided to anaverage of 15 patients per evening. In the first ninemonths of operation, the total financial equivalent forprofessional and non-professional volunteer hoursdonated to Samaritan Clinic was $48,895. Patientswith chronic diseases, such as diabetes and hypertension,have been referred to the Primary Care Programof the Nassau County Health Department. Patientshave been referred to medical consultants, with thefacilitation of Health Department staff and the CountyMedical Indigent Program. The clinic has utilizedexisting programs for reduced-fee dental care, visioncare and hearing evaluations.One important aspect of urgent medical care for indigentpatients is the provision of prescription medications.The clinic has received a wide variety of samples,which helps some of the patients’ needs.Secondly, the clinic has received grant funds to supporta voucher program for further medication needs,especially short-term. The availability of the patientassistance programs of many pharmaceutical companieshas helped patients with chronic diseases whotake medications over a long period of time.The Samaritan Clinic has come to the end of its firstyear of operations with an improved efficiency ofpatient flow and ability to meet medication needs. Thefeasibility of opening the clinic for one additionalevening each week is under consideration. In the pastyear, Barnabas Center has operated two separatelyconfigured programs — dental and medical. Mergingthe two programs into one clinic operation is a logicalnext step. A long-term goal is to offer a comprehensiverange of health care services to indigent personsthroughout the entire Nassau County, in conjunctionwith the Nassau County Health Department and SuttonPlace Behavioral Health, Inc.Community Service beyond the Holidaysby Sally-Ann Pantin, MD, JacksonvilleAs health care providers, outreach to the communityseems to be second nature. At the University Boulevardlocation of Baptist Primary Care, however, it is a commitmentthat continues to grow. During the past coupleyears, the staff and physicians have adopted a family forboth the Thanksgiving and Christmas holidays to providethem with food and gift items to enjoy the season. In2006, the university office, in conjunction with the staffof Neurology Partners, collected more than 200 items forthe Toys for Tots program. This year, under the continueddirection of Sandy Broussard, the staff will volunteertheir time to programs in the Jacksonville area, includingDignity You Wear, Hubbard House and the I.M.Sulzbacher Center.Florida Family Physician 19

Community Health CentersThe Solution for Young Adult Uninsured and Underinsuredby Tavia D. IsleyJunior, Georgia State UniversityPrint Journalism MajorDaughter of a Florida Family PhysicianA 19-year-old college student is afraid shemay be pregnant. After receiving a positiveresult from a home pregnancy test, shedecides it may be necessary to acquire a moreaccurate result from a doctor. Her homephysician is not local and is cost prohibitive.She is concerned with the privacy of theschool health care center and decides to seekmedical attention on her own. Because herpart-time job does not provide adequatehealth coverage, she takes advantage of herlocal community health center.After a 22-year-old college student’s nightout on the town, heavy drinking results ina minor accident. He scraped his leg duringthe accident more than two weeks ago.The area is not healing with topical antibiotics,and he has developed a fever. Herealizes that medical attention is necessaryas soon as possible. Stressed with the decisionof how he will access health care, heconsiders the local ER versus a communityhealth center.A 28-year-old mother of two has a 3-yearoldchild with a fever she cannot controlwith over-the-counter medications. Sheattends school part-time and works at alocal department store 30 hours a week tomake ends meet. Unfortunately, she has nomedical insurance for her children and herself.Her school’s health care centerrestricts care to full-time students only. A$150 new patient visit bill in addition to thecost of prescription meds can be overwhelmingto the family’s budget. Her localcommunity health center may be the solutionshe is looking for.Community health centers (CHCs), whichdate back to the 1960s, were created in anendeavor to establish a means of health carefor medically underserved and deprivedcommunities. When a majority of the populationhad no health insurance and income toafford proper health care, CHCs wereformed to provide the public with medicalattention they could not other wise attain.Today, these types of health services accomplishthe demanding task of providing careto more than 15 million people nationally.Young adults ages 19 to 29 represent thelargest group in the United States withoutadequate health care coverage. Thirteen millionpeople in this segment of the populationreport absent, delayed or partial medicalattention because of cost. Major subsetsinclude college students and young workingpoor who are either uninsured or underinsured.According to Alan I. Glass, director ofstudent health and counseling at Washington20

University in St. Louis, “Nationally, 17 percentof college students are uninsured,accounting for about 10 percent of the country’suninsured population.” Several reasonsfor this are their inability to have a full-timejob with benefits while in college, not beingable to receive health care through their parents,and wanting to keep clinical visits a privatematter from parents. How can CHCshelp to solve this crisis? Continue their primarymission: helping those who are unableto help themselves.CHCs have been shaped and molded to fitthe needs of not only the communities beingserved, but also for the doctors and organizationsresponsible for keeping the centersafloat. CHCs are required by law to providehealth care to anyone in need regardless ofinsurance status in health professional shortageareas. CHCs are directed by a board,which consists of local community leaders,patients and medical providers. These boardswere developed to remain acutely aware ofthe demands and needs of their target population.For many regions, the centers’ clientelehave fluctuated to a younger population.Young adults and their offspring require justas many services as their elder counterparts.Populations that benefit from CHCs are peoplewho have no health insurance, are lowincome, or have inadequate education.Unfortunately, many young people areunaware of the wide array of services availableto them via CHCs. Most centers offerprimary medical care, immunizations, dentalservices, mental health services, labs, X-raysand pharmacies. Contrary to the goal whenfirst established, CHCs have the potential toprovide care to our state’s future.According the Florida Association ofCommunity Heath Centers, Florida hasapproximately 37 organizations with morethan 120 health care facilities throughout thestate to serve the needs of young Americans.Because CHCs are required by law to chargepatients based on income via a sliding feescale, young adults are ideal to receive theadvantages of these facilities. College studentscan receive care for any medical needranging from management of chronic conditions,a scrape on the knee, to sexually transmitteddisease and pregnancy testing.Because of this, college students and youngadults may find it easier to receive care froma CHC than a local ER or urgent care centerat a more reasonable rate.CHCs have become the go-to place for collegestudents since the ’90s when the numberof uninsured increased by 30 percent.According to Sharon Fisher, communicationscoordinator for the American CollegeHealth Association, “…young adults ages 18to 24 were less likely than any other agegroups to have health insurance.” This agegroup specifically targets college studentswho have either just started college or areabout to graduate. Fisher claims that only70.4 percent of that population of youngadults was insured in 2002. This means thatthe 30 percent of young adults who wereuninsured could have received treatment atCHC if in need of any form of health care.With health care cost and insurance increasing,the number of college students receivingcare at CHCs will continue to rise. The moreexpensive it is for college and graduate studentsto receive care, along with the risingcost of tuition, the more frequently studentswill turn to CHCs for health care. Accordingto The SmartStudent Guide to FinancialAid, there is about an 8-percent collegetuition inflation rate, which causes tuition todouble every nine years. With these risingcosts, college students are opting to save fortuition rather than health care.CHCs have done an adequate job of servingthe underprivileged and neglected parts ofthe nation for 40 years now. What started asa small community project to provide healthcare to the poor has become a means of medicalattention for all parts of the population.Students and working young adults constrainedby low-benefit, minimum-wagepayingjobs and inadequate health careaccess have begun to take advantage of amore economical form of health care inCommunity Health Centers.SourcesMcAlearney, John S. Health Affairs. “The FinancialPerformance of Community Health Centers: Clearevidence that many CHCs are on the brink of financialinsolvency.” March/April 2002.U.S. Department of Health and Human Services.“Bureau of Primary Health Care.” http://bphc.hrsa.gov?chc?programexpectations.htmOtrompke, John. University Business. Dec 2004.http://www.findarticles.com/p/articles/mi_m0LSH/is_12_7/ai_n8573952/printThe SmartStudent Guide to Financial Aid.“Tuition Inflation.” http://www.finaid.org/savings/tuitioninflation.phtmlNational of Community Health Centers, Inc. ® .“About Health Centers.” http://www.nachc.com/about/aboutcenters.aspFACHC. “Florida’s Community and Migrant HealthCenters “ Brochure. http://www.fachc.orgCore Content Review ofFamily Medicine SeeksAssistant Editors for CMEHome Study ProgramThe Core Content Review of FamilyMedicine, a national home-study CMEprogram and ABFM Board ReviewCourse, is seeking two family physicianswho are ABFM Board Certified to serveas assistant editors. Each position is parttime.Duties include the editing of questions/answerssubmitted by members ofour national faculty for the print, CD andonline versions of the Core ContentReview. This involves checking accuracyof information and communicating withthe authors. Applicants must have atleast two years of clinical experience andthe ability to interpret and distill complexmedical information. Medical writingand editing experience needed.Above-average computer skills are alsorequired. Interested parties: Please sendCVs and letter of interest to MarkSchuman at mschuman@ssmgt.com.Florida Family Physician 21

Medication Therapy Managementat the Forefront of Quality Improvementby Savi Lenis, RPh,Pharm.DFMQAI Sr. ProjectCoordinatorTampaMedication therapy management (MTM) isessentially the steppingstone towards thefuture of collaborative health care. The needfor MTM arises from the estimated growth ofMedicare beneficiaries from 41.7 million in 2004 to78.3 million in 2030. 1 Medicare Part D drug expenditureis projected to be $724 billion during the period2006-2015, thus increasing the need for MTM. Underthe Medicare Modernization Act of 2003 and itsimplementing regulations, Part D drug plan sponsorsare required to establish an MTM Program (MTMP).This program is designed to optimize therapeutic outcomesfor targeted beneficiaries by improving medicationcompliance and reducing adverse events.Targeted beneficiaries are defined in the statute asindividuals who have multiple chronic diseases, aretaking multiple covered Part D drugs, and are identifiedas likely to incur annual costs for covered Part Ddrugs of at least $4,000. Drug plans may offer MTMServices (MTMS) at varying levels to Medicare Part Dbeneficiaries. In order to find out if a beneficiary iseligible to receive MTMS, instruct patients to contacttheir drug plan or local pharmacy.One of the varying levels of MTMS available toMedicare Part D beneficiaries is an in-person consultationvisit with a MTM pharmacist. This face-to-faceinteraction establishes or enhances the pharmacistpatientrelationship. Currently, retail MTM pharmacistsare being reimbursed by drug plans like Humana,AvMed and Memberhealth to provide MTMS. Theadvantages of utilizing retail MTM pharmacists includeaccessibility and the optimal ability to observe signs ofand visual cues to the patient’s health problems, such asadverse reaction to medications, lethargy, alopecia,extrapyramidal symptoms, jaundice and disorientation.Pharmacists will have a number of responsibilities thatinclude but are not limited to: monitoring refill historyand over-the-counter medication use, assessing patient’shealth status, initiating or modifying medication therapy,and monitoring and evaluating patient’s response totherapy. Comprehensive medication reviews, utilizationof lab values and effective communication with prescribingproviders are essential to a successful outcome.A care and medication treatment plan will be providedto patients after communicating with the prescribingprovider by telephone or facsimile for approval or furtherrecommendations.Most importantly, collaborative health care has beenfound to produce better outcomes. 2 The ultimate goalof the MTM service is to improve U.S. health care byhelping Medicare beneficiaries use prescription drugsmore appropriately and effectively. Prescribingproviders, who will remain at the center of patient care,plays an essential part in the success of the MTMS. Thefoundation of MTMS relies on the collaborative effortsof the MTM pharmacist, prescribing provider andpatient. MTM pharmacists will not be able to performMTMS without first obtaining and verifying medicaland laboratory information from the prescribingproviders. As a result of MTMS, it is imperative thatefficient and effective communication exists in order toimprove patient self-management. Providers can benefitimmensely from the MTM program. By havingMTMS readily available in the community, patientswill have a direct liaison to their prescribing provider.This allows pharmacists to field patient questions, thusoptimizing provider time. This service will also assistproviders with formulary compliance and improvemeasures for pay-for-performance.The Center for Medicare and Medicaid Services(CMS) has said that MTMS must “evolve and becomea cornerstone of the Medicare Prescription DrugBenefit.” 3 In an effort to successfully implement andassess the impact of pharmacist face-to-face MTMSon patient self-management, CMS has contractedwith FMQAI, the Medicare quality improvementorganization for the state of Florida. FMQAI will providetechnical assistance to the prescription drugplans and pharmacies that serve beneficiaries in thestate. For more information, visit www.fmqai.com, orcontact Savi Lenis, Pharm D, senior project coordinator,Physician Practice Medicare Part D project, at(813) 865-3528 or slenis@flqio.sdps.org.Resources1. 2005 Medicare Board of Trustees Report, “Medicare Data forCalendar Year 2004,” Table II.B1.p.42. Medication Therapy Management Program. Summary of PlanRequirements. Released January 21, 2005.3. Medication Therapy Management in Community PharmacyPractice. Core Elements of an MTM Service.4. April 29, 2005This material was prepared by FMQAI, the Medicare qualityimprovement organization for Florida, under contract with theCenters for Medicare & Medicaid Services, an agency of theU.S. Department of Health and Human Services. The contentspresented do not necessarily reflect CMS policy.FL20071dFT1D13181026722

FAMILY MEDICINE IN THE NEWSAPPOINTMENTS TO AAFP COMMISSIONS 2006-2007:• Lynn Chacko, MD* – Commission on Continuing Professional Development (Resident)• Chad Masters, MD* – AMA Delegate (Resident)• Robert Jeske* – Regional Coordinator (Student)• Dennis Saver, MD* – Commission on Practice Enhancement• George Wilson, MD* – Commission on Finance and Insurance• Amber Isley, MD* – Commission on Health of the Public* Denotes FAFP memberPHYSICIANS IN THE NEWSreserve, former and retired military officersand their surviving spouses.John M. Montgomery, MD, MPH,* wasinstalled as president of the Duval CountyMedical Society on January 11. He is shownabove with his wife, Antoinette Lloyd-Montgomery, MD.David Gooding, DO,* of Englewood was thewinner of a complimentary FAFP CME registrationin our online registration contest.Go to fafp.org to register for CME weekends,and you could be a winner, too!Terry Hashey, DO,* received the DuvalCounty Medical Society Phil Gilbert YoungPhysicians Award for OutstandingLeadership at the DCMS Annual Meeting onJanuary 11.Daniel B. Lestage, MD, USN-Ret.,* hasbeen elected to the Board of Directors of theMilitary Officers Association of America.The MOAA is the nation’s largest veterans’organization for active duty, National Guard,Edward J. Shahady, MD,* published “Barriersto Care in Chronic Disease: How to Bridgethe Treatment Gap” in the September 1, 2006,issue of CONSULTANT.Thomas L. Hicks, MD,* was awarded theCertificate of Merit by the Florida MedicalAssociation at its 2006 Annual Meeting.Dr. Hicks, medical director of Patients Firstin Tallahassee, is a past FAFP president, iscurrently president of the FAFP’s FamilyMedPAC and is treasurer of the FAFPFoundation.Eugene Charbonneau, DO, has been namedthe new director of the Liberty CountyHealth Department.* Denotes FAFP memberFELLOW OF THE AMERICAN ACADEMY OF FAMILY PHYSICIANSThe following FAFP members were recognized in September 2006 for earning the designation of Fellow of the American Academyof Family Physicians:Paul Stephen Austin, MD, Mount DoraBruce W. Blackwell, MD, KissimmeePatricio G. Bruno, DO,Jackson Heights, New YorkCornell Victor Calinescu, MD, HallandaleUlises M. Caraballo, MD, JacksonvilleJeremy Michael Katzmann, MD, LakelandGuillermo R. Quintana, MD, Vero BeachSteven Howard Selznick, DO, CasselberryJohn G. Symeonides, MD, Palm CoastHugh Wesley Thomas, DO, CasselberryEileen M. Turbessi, MD, TavernierDiana Ruth Twiggs, MD, Fernandina BeachSamuel Edward Ward, MD, GracevilleMonica Lynn Warhaftig, DO, HallandaleACTIVE MEMBERSHIP AWARDThe AAFP has awarded the Florida Chapter with First Place,Highest Percentage of Increase in Active MembershipEnrollment, Chapters with Over 1000 Active Members, 2005.Many thanks to you, our members!Florida Family Physician 23

The End of LifeAnd Other Musings onHarold was a peach farmer who stepped into my life when he brought a Mason jar half full of red urine to myoffice. Bobbie, my nurse, had already done the dipstick urinalysis, and the results were lying on top of the jar inthe back exam room, where Harold sat looking a bit nervous. After greeting and shaking hands, Harold noddedtoward the jar with the paper on top and asked, “What’s the test tell ya?”by Russ Hostetler, MDPlant City“Well, no surprise that it’s blood and not beet juice that’s making it red,” I said as I scanned the report. “But, otherthan that, it’s normal. I’m going to look at it under the microscope to see what else I can learn. First, let me askyou some questions to hone in what might be going on.”I found out that he had started having troublepeeing about nine months ago but thought itwas just his getting older (he was 62). Thenhe found blood in his semen and in his urine,but neither peeing nor sex caused any pain. Iasked about pain anywhere, and he replied,“My back has hurt me more than usual, butI’m sure it’s because of the work we’re doingin the groves and arthritis letting me knowI’m not getting any younger.”I found point tenderness in not only his lumbararea, but also his thoracic spine and hisright hip, and I found a prostate gland thesize of an orange and about as hard with a 2-centimeter knot bulging out of the left side.The thought that ran through my mind was:“Unfortunately, Harold, you’re not going toget much older.” Under the microscope in thekitchen where we had our lab, I found lots ofred blood cells, a few scattered white bloodcells, some debris, no visible bacteria andclumps of cells with dark nuclei.Back in the exam room, I asked Harold,“What do you think is going on?”“I figured I probably have cancer,” heresponded without a hint of emotion.I paused before responding, “I think you’reprobably right, but I’m hoping against hopethat it’s just an infection involving yourprostate. The blood in your semen is actuallya good sign in that regard. I’ll ask Bobbie todraw some blood, get some urine for culture,get some X-rays, and help you get an appointmentwith Gene Miller, the urologist.”The next week, I reviewed the lab and X-rayreports with Harold and his wife, Elizabeth.There was no sign of infection. He wasn’tsignificantly anemic from blood loss, butsomething was eating the bones of his thoracicand lumbar spine.“It’s probably prostate cancer, Harold,” I saidquietly while Elizabeth clutched his hand,“and it has spread already.” He took theinformation with stoicism, and there wassilence for several moments. Tears welled upin Elizabeth’s eyes, and Harold put his armaround her and pulled her close. “GeneMiller will be able to sort out the next stepsand treatment for you.”Looking back, Harold probably had thetreatment plan already set in his mind by thetime I told him it looked like prostate cancer.Harold did go see Gene Miller. He did havebiopsies done, and when Gene mapped out asurgical, hormonal and radiation battle plan,Harold thanked him but refused it all.It took eight months for the cancer to takeHarold from us. Of that time, Harold workedfor most of the first six. When we graduatedto morphine for pain control, Harold stoppedworking because the nausea was worse whenhe moved around. I started making housecalls and placed a couple of Foley catheters(not at the same time!) to keep urine flowing.Elizabeth had called one Saturday morningsaying Harold’s eye was causing a lot ofpain, and since it wasn’t the usual dullaching cancer pain, she called me. I grabbedmy bag and went to their house. When I gotthere, the whole family was in the kitchenexcept Harold. In the living room where theyhad his bed, I diagnosed and treated Harold’scorneal abrasion. For Harold, it was instantrelief, and nearly as instantly, he went backto sleep.Out in the kitchen, I met the whole crew,shook hands with all of the men and boys,and got hugs from all of the women. It waslike I was an instant member of the family.I ate a bowl of grits and drank a cup of coffeewith them. There was never a questionabout why this group of people used theirvacation time and took their kids out ofschool to be there. This was a strong andloving family anchored by a strong and lovingcouple, and there was no doubt in mymind that their strength and love would seethem through the inevitable separation thatloomed on the horizon.Emma, the youngest daughter at 20, askedthe inevitable question.“How long will he be with us?” she said,barely above a whisper and choked by tears.People want to know. They want to beready for an event for which you never canbe ready.24

in a Mason JarBeing a Family Doctor“I can’t say for sure; maybe a week,maybe longer, maybe tomorrow. None ofus are in the driver’s seat with regard tothat,” I said.I visited Harold four times in that subsequentweek. On Friday evening, I talkedthe local respiratory therapy companyinto providing a tank of oxygen, tubingand some nasal prongs without any supportingblood gases or pulse oximetry,just to see if it would make him morecomfortable. It did, and it made Elizabethmore comfortable, too.Harold died the next day. It was actuallyLarry, the oldest, who called me to say thathis dad was breathing funny. I told him toturn up the oxygen a little and that I’d beright over.When I arrived, they were all there atHarold’s bedside. The grandchildren wererunning around in and out of the house, butthe adult children were standing in ageorder around the bed. Harold was fullydressed and lying on top of the covers,propped up 45 degrees on pillows, mouthopen, eyes closed. I examined him. He wasnearly comatose. He turned his head in mydirection when I called his name and, withoutopening his eyes, slurred through,“Wha? Hey.” He smiled. When he relaxedagain, his breathing became agonal. WhenI told them that agonal breathing was asign that the end was near, all the womenhugged their husbands and cried, andEmma hugged her mother, who, blinkingback tears, smiled at me.“He’s been in more pain lately,” she said.“He tries not to show it and refuses extramedicine, but he has suffered. I hope hedoesn’t suffer any more.”“Elizabeth, I think he is lapsing into a comaand that soon he will feel no pain, but he maynot be able to hear you or respond to you.”I didn’t have to say anything more. Larrytouched his dad’s shoulder and said “I loveyou, Daddy.” Beth picked up her dad’s handagain and said, “I’m here, Daddy. I loveyou.” And Lester reached out to massageHarold’s feet and said, “Me too, Dad.” Istepped back, and Emma rushed in to pickup his right hand. There was a folding chairnearby, and I put it where Emma could sitnext to the bed. She did and brought herdad’s hand to her cheek. Elizabeth leanedover and kissed his cheek.It took several hours for Harold to finallybreathe his last. In that time, parents hadto deal with children, and lunchtime came,so the family just fell into taking randomshifts of sitting on the folding chair andholding Harold’s hand. They would not lethim die alone. The girls were in thekitchen with the aroma of baking browniesfilling the air, and Elizabeth got up to goto the bathroom, so I sat down to pick upHarold’s hand.Elizabeth had returned to the bedside andwas painting his dry tongue with water anda toothbrush when the breath left his lungsfor the last time. Elizabeth stopped whatshe was doing and just looked at him. Igave his hand to her. She held it to herchest and just looked at him. After a whileshe leaned over and kissed his cheek, sayingher silent goodbyes.She didn’t yell. She just said, “Larry, Beth,Lester, Emma.” Within seconds they wereall there by the bedside, touching him, crying.There in the midst of death was theinfinite strength of the life-affirmingongoing family.The funeral was Tuesday evening. After thegraveside ceremony, I shook hands with allof the men and hugged all of the women,lastly Elizabeth, in whose ear I whisperedthat she should call me anytime if sheneeded anything.I got in my MG and drove off to makerounds, my heart aching not only for havinglost Harold, but also for both of my parents,who had departed this life several yearsbefore. I realized it was loneliness thatcaused my heart to ache. Dead peopleleave. We are deprived of their physicalpresence, yet they live on in the hearts andminds of those who remember them andlove them. To this day, I remain so gratefulto be one of the custodians of Harold’sremarkable life.Florida Family Physician 25

Dear Colleague:Proposed Revision to Corporate BylawsDuring the course of the last 15 months, the Florida Academy ofFamily Physicians leadership has worked diligently to revise theAcademy’s Bylaws. A thorough revision of the Bylaws has notoccurred for many years. We believe we have made significant revisionsthat will make our organization more efficient, accessible andresponsive to its members.The pages of this edition of Florida Family Physician following thiscommunication contain, for your review and consideration, a revisedand updated set of Bylaws for the Academy. The Board of Directors,along with the FAFP attorney, has updated the Bylaws to reflect thecurrent mission and operation of the Academy and to correct internalinconsistencies. AAFP Counsel has also reviewed and acceptedthe revisions.While the revisions are extensive, none negatively impacts the membership’sinherent ability to govern the Academy. Consistent withthat philosophy, the new Bylaws will not become effective untilapproved by the FAFP membership at the July 27, 2007, membershipbusiness meeting, which will be conducted during the 2007 SummerBreak Away at The Breakers, Palm Beach.If you have questions or concerns, please send your comments inwriting to the FAFP office C/O Tad Fisher, EVP, 6720 AtlanticBoulevard, Jacksonville, FL 32211.Thank you for your assistance as we strive to position the FAFP tobetter service family practice physicians in the coming years.Sincerely,Neil R. Oslos, MD, PresidentSandra L. Argenio, MD, Chair, Board of DirectorsFlorida Academy of Family Physicians Corporate BylawsSECTION 1 – Mission Statement, Purposesand PowersSECTION 1.1 – Mission StatementThe missions of the Florida Academy of FamilyPhysicians, Inc. (hereinafter sometimesreferred to as the “Academy” or “FAFP”) are topromote excellence in health care for Floridacitizens, to advance and represent the specialtyof family medicine, and to serve the uniqueneeds of its members.SECTION 1.2 – Purposes• Promote high quality, cost-effective healthcare for all Florida citizens.• Assist members with their needs related to thepractice of medicine in their communities.• Educate our patients, our community and thepublic about family medicine and other healthrelated issues.• Provide continuing medical education opportunitiesfor our members.• Assist in attracting, encouraging and supportingmedical students and residents for careersin family medicine.SECTION 1.3 – PowersTo accomplish the foregoing aims, ideals andobjectives, this corporation shall have power toown, operate, manage and maintain buildingsand properties for use in carrying out its purposes.Further, it shall conduct such cultural, educationaland social activities as will best promoteand carry out its purposes and which are bestadopted to promote and stimulate interest of theMembership in its activities.SECTION 2 – ProfitThis corporation shall have no capital stock. It isnot conducted for pecuniary profit. Any incomewill be used solely for its purposes without profitto any of its members.SECTION 3 – DissolutionUpon dissolution or other termination of thisnon-profit corporation, its entire assets shall bedistributed to an organization qualified andaccepted under Internal Revenue Code 26,USCA, Section 50l(c)(6).CHAPTER I – MEMBERSHIPSECTION 1 – Classification of MembershipThe Florida Academy of Family Physicians shallbe composed of the same classifications ofmembership, and the requirements for electionto each classification of membership shall be thesame as outlined in the current revised edition ofthe Bylaws of the American Academy of FamilyPhysicians or as provided in these Bylaws,except 12 Florida Prescribed hours must beincluded in the 150 hours of continuing medicaleducation required for reelection to Active andSupporting membership.SECTION 2 – Qualifications and EligibilityAny doctor of medicine or osteopathy who hasmet the qualifications and conditions of eligibilityof membership as set forth in the current,revised edition of the Bylaws of the AmericanAcademy of Family Physicians shall be eligiblefor the same category of membership in theFlorida Academy of Family Physicians. The categoryof Active member in the Florida Academyof Family Physicians further requires an activeFlorida medical license.SECTION 3 – Election to MembershipApplication for membership shall be made inwriting on a form of application prescribed bythe American Academy of Family Physicians.Election to membership shall be by approval ofthe Board of Directors.SECTION 4 – Rights and PrivilegesMembership in the Florida Academy of FamilyPhysicians confers no vested right to the holderthereof, but is a conditional privilege revocablefor cause. Each doctor of medicine or osteopathy,by accepting membership in this Academy,becomes subject to all provisions of theseBylaws and subject to the disciplinary proceedingsauthorized thereunder.All rights, title and interest, both legal and equitable,of a member in and to the property of thisAcademy shall cease and terminate in the eventof any or either of the following: (a) the expulsionof the member; (b) the striking of his or hername from the role of members; (c) his or herdeath or resignation. Membership shall be automaticallyterminated with loss for disciplinaryreasons of Florida license to practice medicine.Also a member whose license to practice medicinehas been suspended for one year or moredue to disciplinary reasons will have his or herAcademy membership terminated immediately26

the candidate receiving the majority vote will bedeclared the winner.SECTION 5 – Receipt of BallotsAll elections shall be by mail or electronic mailballot, or the ballot may be communicatedthrough the Florida Family Physician journal. Atleast forty-five (45) days prior to the AnnualBusiness Meeting, Active, Life and Supportingmembers in good standing who have paid theirannual dues prior to May 1 will be communicateda ballot to their physical or electronic addressof record along with background information, aphoto of each candidate and a return envelope.All completed ballots must be received in theFAFP Jacksonville office at least ten (10) daysprior to the Annual Business Meeting.CHAPTER V – DUTIES AND TERMSOF OFFICERSSECTION 1 – DefinedThe officers of the Florida Academy ofFamily Physicians shall be: President, VicePresident, President-Elect, Secretary-Treasurer, Chairman of the Board ofDirectors and Executive Vice President.SECTION 2 – PresidentThe President shall be a voting member of theBoard of Directors and all commissions andcommittees and shall preside at all meetings ofthe Academy. He or she shall appoint all commissionsand committees not otherwise providedfor. The term of office shall begin at the conclusionof the first ensuing annual meeting followingthe annual meeting at which election asPresident-Elect occurs and shall expire at theconclusion of the next annual meeting or when asuccessor is seated. In the event of death or resignationduring the term of office, or if for anyreason he or she shall be unable or unqualified toserve, the President-Elect shall succeed to theoffice of President for the unexpired portion ofthe President’s term. It will be the decision of thisindividual whether he or she will also serve theterm of President to which they were elected. Inthe event the President-Elect does not wish toserve that term of office, the Board of Directorsshall nominate candidate(s) for that office, andelection of the successor to the President-Electshall take place by vote on these candidates byActive, Supporting and Life members.In the event of the death, resignation or inabilityof both the President and President-Elect theBoard of Directors shall elect a President for theunexpired portion of the term.SECTION 3 – Vice PresidentThe Vice President shall be a voting member ofthe Board of Directors and shall preside at meetingsof the Academy in the absence of thePresident. The term of office shall begin at theconclusion of the annual meeting at which theelection occurred and expires at the conclusionof the next annual meeting, or when a successoris seated. In the event of the death, resignation orincapacity of the Vice President, the Board ofDirectors shall elect a Vice President for theunexpired portion of the term.SECTION 4 – President-ElectThe President-Elect shall be a voting member ofthe Board of Directors and shall preside at meetingsof the Academy in the absence of thePresident, Vice President and Chairman of theBoard of Directors. He or she shall succeed tothe office of President at the expiration of thePresident’s term or as provided in Section 2.In the event of the death, resignation or removalfrom office of the President-Elect, the Board ofDirectors shall nominate candidate(s) for thatoffice and election of the successor to thePresident-Elect shall take place by vote on thesecandidates by the Active, Life or Supportingmembers at the next ensuing meeting as the firstorder of business following the approval of theminutes, provided, however, that nothing shall beconstrued as preventing additional nominationsfor the office from the floor.SECTION 5 – Secretary-TreasurerThe Board of Directors shall appoint aSecretary-Treasurer for a term of two (2) yearscommencing at the conclusion of the annualmeeting. If not already a member of the Boardof Directors, he or she shall be a member of theBoard of Directors with the right to vote as anActive member of the Academy. As Secretary,he or she shall perform the duties that the titleof the office ordinarily connotes, give notice ofand keep a record of all meetings, enroll andmaintain the records of members, and be thecustodian of all official documents of thisAcademy. He or she shall direct official correspondence,notifying members of meetings,and disseminating other notices and announcementsas required. As Treasurer, he or she shallreceive and be custodian of all funds of theAcademy; shall maintain a record of all fees,dues and assessments paid by members; andshall deposit or cause to be deposited allmonies and other valuables in the name of andto the credit of the Academy with such depositoriesas may be designated by the Board ofDirectors. He or she shall disburse funds asofficially ordered and shall render an accountof all transactions and of the financial conditionof the Academy when requested. TheAcademy shall provide bond for the Secretary-Treasurer in an amount determined by theBoard of Directors, the premium for whichshall be paid by the Academy.SECTION 6 – Chairman of the Board of DirectorsThe immediate past president shall be a votingmember and Chairman of the Board of Directorsfor a period of one (1) year following his or herterm as President, such term to begin at the conclusionof his or her term of office and ending atthe conclusion of the following annual meetingor when a successor is seated. The BoardChairman shall preside at all meetings of theBoard. In the absence of both the President andVice President, the Board Chairman shall presideat meetings of the Academy. In the absenceof the Chairman of the Board, the President mayact as temporary chairman for that meeting.SECTION 7 – Executive Vice PresidentThe Executive Vice President, who may but neednot be a member of the Academy, shall beappointed by the Board of Directors for a termand stipend to be fixed by the Board. He or sheshall, under direction of the Board, perform suchduties as the title of the office ordinarily connotesand such duties of the Secretary-Treasureras may be assigned by the Board. He or she shallkeep or cause to be kept an accurate record of theminutes and transactions of the annual meeting,shall supervise all other employees and agents ofthe Academy, and have such other powers andduties as may be presented by the Board ofDirectors or these Bylaws. He or she shall not beentitled to vote unless entitled to by other positionin the Academy. The Executive VicePresident shall be bonded in an amount fixed bythe Board of Directors, the premium thereon tobe paid by the Academy.CHAPTER VI – BOARD OF DIRECTORSSECTION 1 – Board CompositionSubject to the action of the generalMembership, and during the interim betweenmeetings of the Academy, the control andadministration of the affairs of the Academyshall be vested in a Board of Directors composedof fifteen (15) Active members, three (3)voting Family Medicine Resident Directors andfour (4) Student Directors, with one vote amongthem. The Student Directors will choose amongthemselves one (1) Student Director to vote ateach meeting of the Board of Directors. TheChairman of the Department of FamilyMedicine from each of Florida’s allopathic medicalschools or his or her designee, the two (2)delegates and two (2) alternate delegates to theAAFP, and the Chair of the Residency Director’sCommittee shall serve as non-voting, ex-officiomembers of the Board of Directors.SECTION 2 – Board DistrictsThe Board of Directors shall divide the State intothree (3) districts based insofar as feasible onphysician-member population and distributionand define their boundaries. The Board may,28

from time to time, redefine the boundaries ofeach district as changes in Membership distributionmay require.SECTION 3 – Election of DirectorsOne Director from each of the three (3) districtsas described in Chapter VI, Section 2, shall beelected to the Board of Directors each year byplurality vote, with voting to be statewide foreach Director, and the election to be for a term ofthree (3) years. The term of office for a Directorshall begin at the conclusion of the annual meetingat which elected and end at the conclusion ofhis or her three (3) year term of office, or whena successor is elected. A Director may serve twoconsecutive three (3) year terms on the Board ofDirectors and, after an absence of one year, beeligible for renomination. One-third (l/3) of theBoard shall be elected each year.SECTION 4 – VacanciesVacancies on the Board of Directors shall befilled by a majority vote of the remaining membersof the Board, provided, however, that suchappointments shall terminate at the next annualmeeting, at which time the NominatingCommittee shall present a nominee or nomineesfor the unexpired term.SECTION 5 – Resident DirectorsThree (3) Resident Directors shall be elected tooffice for a term of one (1) year by Residentmembers of the Academy in approved familymedicine residency programs in Florida in sucha manner as to achieve fair representation. Theprocess of election shall be that stipulated by theAcademy. The term of office of ResidentDirectors begins at the conclusion of the AnnualMeeting of the Academy following their electionand ends at the conclusion of the followingAnnual Meeting. Each of the three ResidentDirectors shall have the privilege of the floor andthe right to vote at the meetings of the Board ofDirectors, but shall be ineligible to hold office.The reasonable expenses of the ResidentDirectors attending a Board meeting shall beborne by the Academy.SECTION 6 – Student DirectorsFour (4) Student Directors, one (1) from eachFlorida allopathic medical school, shall be electedto office for a term of one (1) year. The electionof each Student Director shall be the responsibilityof each medical school from which he orshe is elected. The Student Directors shall havethe right of the floor at meetings of the Board,and at each meeting of the Board of Directors theStudent Directors shall choose among themselvesone (1) Student Director who shall havethe right to vote. The reasonable expenses of theStudent Directors attending a Board meetingshall be borne by the Academy.SECTION 7 – Executive CommitteeThere shall be an Executive Committee of theBoard of Directors composed of the President,Vice President, President-Elect, Secretary-Treasurer, Chairman of the Board, as well as thePresident and Vice President of the FAFPFoundation. The Executive Committee shall bechaired by the Chairman of the Board. TheExecutive Committee shall have full authority toact for and on behalf of the Board of Directorswhenever the business of the Academy demandsprompt action in the interim between meetingsof the Board or when it is impractical or impossibleto convene the Board. A report of its actionsshall be given by the Executive Committee to theBoard of Directors at the next ensuing meeting.SECTION 8 – QuorumA majority of the voting members of the Boardof Directors shall constitute a quorum.CHAPTER VII – DELEGATES ANDALTERNATE DELEGATESSECTION 1 – Term of OfficePursuant to the current revised edition of theBylaws of the American Academy of FamilyPhysicians, the Florida Academy of FamilyPhysicians shall be entitled to be represented inthe Congress of Delegates of AAFP by two (2)Delegates and one (l) Alternate Delegate for eachdelegate if the latter is unable to serve, each for aterm of two (2) years.SECTION 2 – Election of AAFP Delegates/Alternate DelegatesAt each annual meeting of the Academy, thereshall be elected one (l) Delegate to serve in theCongress of Delegates of the AAFP for a term oftwo (2) years. At the same time, there shall alsobe elected an Alternate Delegate, also for a periodof two (2) years.SECTION 3 – Duties of AAFP Delegates/Alternate DelegatesDelegates and Alternate Delegates shall representthe Academy at the Congress of Delegatesof the American Academy of Family Physiciansand shall faithfully perform the duties describedby the Charter and Bylaws of the FAFP and suchother instructions and resolutions as may be presentedby the Board of Directors and/or passedby the Membership. At the first meeting of theBoard of Directors following the annual meetingof the Congress of Delegates of the AmericanAcademy of Family Physicians, the delegationshall submit a written report of their actions andall other information pertinent to this Academy.SECTION 4 – VacanciesIn the event of the death, resignation or removalfrom office of a Delegate before the terminationof his or her term of office, or if for any otherreason he or she shall be unable to complete hisor her term of office, the Alternate shall succeedto the office of Acting Delegate until the nextensuing annual meeting of the Academy, atwhich time the remainder of the unexpired termshall be filled by election.CHAPTER VIII – ETHICSSECTION 1 – DefinedThe principles of Medical Ethics of theAmerican Medical Association, as they now orhereinafter provide, shall be the principles ofethics of this Academy and shall be and herebyare made a part of these Bylaws.SECTION 2 – Censure, Suspension or ExpulsionIf in good faith it is believed that any member hasviolated the Principles of Medical Ethics or theBylaws of the Academy, or is otherwise guilty ofconduct justifying censure, suspension or expulsionfrom this organization, any member mayprefer charges against him or her. The form ofsuch charges and the rights, responsibilities andobligations of all parties involved in the filingand consideration of such charges shall be ashereinafter set forth in this chapter, provided,however, that to the extent the provisions in thischapter are in conflict with applicable law, theprovisions of applicable law shall supersedethese Bylaws.All those against whom charges have been filedpursuant to this chapter shall have the right to berepresented by counsel at the initial hearing andupon appeal to the Board of Directors of theAmerican Academy of Family Physicians.Such charges must be in writing and signed by theaccuser or accusers and must state the acts or conductcomplained of with reasonable particularity.Such charges must be filed with the Secretary. Atthe first meeting of the Board held after the filingof said charges, such charges must be presentedto the Board. The Board shall then, or atany adjournment of said meeting but not morethan thirty (30) days thereafter, in executive sessionconsider the charges and shall either dismissthem or shall proceed as hereinafter set forth.If the Board fails to dismiss said charges, itshall within fifteen (15) days thereafter cause acopy of the charges to be served upon theaccused by depositing in the United States maila copy thereof, registered and addressed to thelast known address of the accused. The Boardshall also and at the same meeting fix a timeand place for hearing said charges, and theaccused shall be notified of the time and placefor hearing said charges as provided for theserving of the charges in the same manner asprovided for the serving of the charge. The timeFlorida Family Physician 29

set for said hearing shall not be less than fifteen(15) days nor more than six (6) months afterservice of charges.The accused may answer in writing but need notdo so, and failure to answer shall not be anadmission of truth of the charges or a waiver ofthe accused’s right to a hearing.The Board shall, after having given to the accuserand the accused every opportunity to be heard,including oral arguments and the filing and considerationof any written briefs, conclude thehearing and within thirty (30) days thereaftershall render a decision. The affirmative vote of amajority of members of the Board present andvoting shall constitute the verdict of said Board,which by such vote may exonerate, censure, suspendor expel the accused member. The decisionof the Board shall be expressed in a resolution,which shall contain no opinion and shall besigned only by the Chairman of the Board andthe Secretary. No member of the Board who isnot present for the entire time of the hearing shallbe entitled to vote.Censure shall mean a reprimand by theChairman of the Board of Directors administeredin the presence of said Board. No membershall be suspended for more than one year,and at the expiration of the period of suspensionshall be reinstated to membership uponapplication and the payment of dues accruedduring the period of suspension. The decisionof the Board of Directors shall be final, exceptas provided hereinafter.SECTION 3 – AppealsAny member of this Academy who has beencensured, suspended or expelled by the FloridaAcademy of Family Physicians may appealsuch action within six (6) months after noticethereof is given by said chapter to the Board ofDirectors of the American Academy of FamilyPhysicians. The jurisdiction of the Board shallextend only to matters of procedures and not offact. The AAFP Board shall fix a time andplace for the hearing of the appeal and aftergiving the appellant and representatives of thechapter from whose decision he or she appealsreasonable opportunity to be heard, shall by amajority vote either sustain or reserve suchcensure, suspension or expulsion. The decisionof the AAFP Board shall be final.CHAPTER IX – COMMITTEESSECTION 1 – OrganizationCommittees shall be appointed by the Presidentand approved by the Board of Directors.Committee Chairmen will be directly responsibleto and report to the Board of Directors.SECTION 2 – CompositionMembers of the committees shall be membersin good standing and shall be appointed bythe President in consultation with andapproval of the Board of Directors. ThePresident shall designate one (1) member ofeach committee to be Chairman.SECTION 3 – Special CommitteesSpecial committees for specific purposes may beestablished by the Board of Directors to assist itin discharge of its duties. The members of thesecommittees shall be appointed by the Presidentwith the approval of the Board. These specialcommittees may be terminated at any time by amajority vote of the Board of Directors or uponcompletion of their special assignment.SECTION 4 – Duties and FunctionsThe duties and functions of committees shall beas described in the current edition of the “FAFPOperations Manual,” as approved from time totime by the Board of Directors.CHAPTER X – AMENDMENTSAny one or more members may propose amendmentsto these Bylaws by submitting the same tothe Secretary at least sixty (60) days prior to ameeting of the Board of Directors. Such proposedBylaws amendments shall then automaticallybe referred to the Bylaws Committee,which shall consider such amendments andreport to the Board of Directors at its next meeting.The Board of Directors shall report to theMembership as being in favor of the amendment,opposed to the amendment or shall presentthe original and any substitute amendment recommended.Notice of such proposal or changeshall then be given by the Secretary to all membersin good standing at least forty-five (45) daysprior to the next Annual Business meeting.Publication of the proposed change in an officialpublication of the Academy shall be sufficient toconstitute notice thereof to the members. Anaffirmative vote of at least two-thirds (2/3) of themembers present and voting shall constituteadoption. Amendments shall take effect immediatelyupon adoption unless otherwise specified.Within thirty (30) days of adoption, the entireBylaws must be submitted to the AmericanAcademy of Family Physicians. Such amendmentsmay not take effect until they are submittedto and reviewed by the AAFP Board ofDirectors. However, if the AAFP Board failsto give written notice of its objection to anysuch amendments within ninety (90) days followingreceipt, the amendments will be consideredapproved.CHAPTER XI – RULES OF ORDERUnless otherwise provided for in these Bylaws,all meetings of this Academy and of the Board ofDirectors shall be governed by the parliamentaryrules and usages contained in the current editionof Sturgis’ Standard Code of ParliamentaryProcedure, or unless waived or modified by twothirds(2/3) vote of the members present and votingat the meeting.CHAPTER XII - INDEMNIFICATIONSECTION 1 – GenerallyThe Florida Academy of Family Physicians shallindemnify any director or officer who was or is aparty to any proceeding (other than an action byor in the right of the Florida Academy of FamilyPhysicians) by reason of his or her status asdirector or officer of the Florida Academy ofFamily Physicians, against liability incurred inthe course of such proceeding, if the director orofficer acted in good faith and in a manner he orshe reasonably believed to be in, or not opposed,to the best interests of the Florida Academy ofFamily Physicians. The Florida Academy ofFamily Physicians shall indemnify said directorsand officers against expenses, including attorney’sfees and amounts paid in settlement notexceeding, in the judgment of the Board ofDirectors, the estimated expense of litigating theproceeding to conclusion, actually and reasonablyincurred in connection with the defense orsettlement of such proceeding, including anyappeal thereof.No indemnification shall be made with respectto any claim, issue or matter as to which suchperson shall have been adjudged to be liable,unless the Board or independent counsel shalldetermine that indemnification is proper in thecircumstances because the director or officer hasmet the applicable standard of conduct.SECTION 2 – Advancement of FundsExpenses incurred by an officer or director indefending against a proceeding may be paid bythe Florida Academy of Family Physicians inadvance of the final disposition of such proceeding,upon receipt of an undertaking by or onbehalf of such director or officer to repay suchamount if it shall ultimately be determined thathe or she is not entitled to be indemnified by theFlorida Academy of Family Physicians.2/27/0730

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