Board of Medicine: Inside this issue. - Lee Memorial Health System

June 2012 

Inside 

this issue. 

Recognitions 

SafeLee News 

New Physicians 

DNV Update 

System Updates 

CMEs & Trainings 

Physician of the Month 

Visit us at 

www.leememorial.org/ 

physicianpub 

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3 

4 

5 

6 

7 

Back 

Medical Expert Witnesses 

Florida law sets forth certain qualifications for 

expert witnesses in medical negligence cases; 

however, until recently, possessing a Florida 

license to practice medicine or osteopathic 

medicine was not specifically required. 

Recognizing that physicians come from 

other states to provide testimony, the 

2011 Florida Legislature passed a law, s. 

458.3175, Florida Statutes, requiring all 

physicians not licensed in Florida wishing 

to provide expert medical testimony in this 

state to obtain an expert witness 

certificate from the Florida Board of 

Medicine (the Board). The Governor 

recently signed into law CS/CS/CS/HB 

1355 (2012) which further expands the 

purpose of the expert witness certificate. 

Beginning October 1, 2012, a physician 

may not provide expert testimony in a 

criminal child abuse case unless the physician 

has a Florida medical or osteopathic license or 

has obtained an expert witness certificate from 

the Board. 

Importantly, Florida licensed physicians have 

opportunities to provide expert medical 

testimony. The Department of Health often 

seeks expert opinions in various specialty 

areas. Experts are needed to review complaints 

that have been filed against medical 

professionals to determine if the licensee 

conformed to proper standards of care. 

Offering expert opinion in this instance is an 

excellent opportunity for Florida physicians to 

play an active role in the regulation of the 

profession. 

CHAIRMAN, EMERGENCY MEDICINE 

Jason Wilson, MD 

CHAIRMAN, RADIOLOGY 

Donald Gerson, MD 

CHAIRMAN, PATHOLOGY 

George Kalemeris, MD 

CHAIRPERSON, THE CHILDREN'S 

HOSPITAL (PEDIATRICS) 

Anantha Krishnan, MD 

Board of Medicine: 

CHAIRMAN, OB/GYN 

William O'Brien, MD 

CHAIRMAN SURGERY 

Ralph Gregg, MD 

Facts Every Physician 

Should Know 

CHAIRPERSON, MEDICINE 

Mary Magno, MD 

PRESIDENT 

F. Brett Shannon, DO 

HEALTHPARK MEDICAL CENTER AND LEE 

MEMORIAL HOSPITAL 

CHAIRPERSON, CLINICAL DEPT OF THE 

CHILDREN'S HOSPITAL 

Anantha Krishnan, MD 

To be an expert for the Department of Health, a 

physician must have an active, unencumbered 

Florida license with no history of disciplinary 

action and be currently practicing medicine. 

Experts can be volunteers or paid by the 

department for their services. Volunteers receive 

up to 15 hours CME credit per renewal biennium 

for case review and written opinions; however, 

for other services such as testimony or 

depositions, the physician is compensated at an 

hourly rate. Currently experts are needed in the 

following areas: 


William O'Brien, MD 

CHAIRMAN, SURGERY 

Alexander Lozano, MD 

CHAIRMAN, MEDICINE 

Timothy Keys, MD 

SECRETARY 

Donn Fuller, MD 

PAST PRESIDENT 

Thomas Carrasquillo, MD 

PRESIDENT ELECT 

David Reardon, MD 

MEDICAL STAFF PRESIDENT 

Timothy Dougherty, MD 

CAPE CORAL HOSPITAL 

CHAIRMAN, RADIOLOGY 

Randy Knific, MD 

CHAIRMAN, PATHOLOGY 

Larry Seidenstein, MD 

CHAIRMAN, EMERGENCY MEDICINE 

Larry Hobbs, MD 

� Pain-management 

� Anesthesiology 

� Neurosurgery 

� Orthopedic spine surgery 

� Neurology 

� Cardiology: interventional and noninterventional 

� OB/GYN 

CHAIRMAN, PEDIATRICS 

Emilio DelValle, MD, GCH 

CHAIRMAN, ANESTHESIA 

Charles Homolka, MD 


Steven Sager, DO, GCH 

CHAIRMAN, SURGERY 

Larry Black, MD, GCH 

Richard Lane, MD, SWFRMC 

CHAIRPERSON, MEDICINE 

Debra Roggow, MD, GCH 

Sunil Lalla, MD, SWFRMC 

PAST PRESIDENTS 

James Borden, MD, SWFRMC 

Richard Bloy, MD, GCH 

SECRETARY 

William Hearn, DO 

To obtain the application to become a Florida 

Expert Witness with the department, go to the 

Board’s website at 

www.doh.state.fl.us/mqa/medical 

PRESIDENT ELECT 

Charles Bisbee, MD 

MEDICAL STAFF PRESIDENT 

Gary Correnti, MD 

GULF COAST HOSPITAL AND SOUTHWEST 

FLORIDA REGIONAL MEDICAL CENTER 

� Hover your cursor over Forms and 

Information so the list of forms appears 

� Click on Expert Application – Work for the 

Department 

While you are at the Board of Medicine web site, 

please consider joining the Interested Parties 

List (Mailman) to receive regular communication 

regarding your profession. As always, if you have 

questions, you can email the Board of Medicine 

at MQA_Medicine@doh.state.fl.us. 

James W. Orr, M.D. F.A.C.O.G., F.A.C.S. 

Member, Florida Board of Medicine 

Crystal A. Sanford, CPM 

Program Operations Administrator 

Florida Board of Medicine

Recognitions. 

Jon Brillman, M.D. Honored 

Jon Brillman, M.D., provider for 

neurology consult services, has 

received an amazing honor from 

Allegheny General Hospital. Its 

inpatient stroke unit has been 

renamed to honor him for his role as 

Chairman Emeritus of the Department 

of Neurology and as a driving force 

behind the establishment of the 

hospital’s Comprehensive Stroke 

Center. The newly-‐named Jon Brillman 

Stroke Care Unit was unveiled earlier 

this month. 

We are fortunate to have Dr. Brillman as a member of our 

medical staff here in Southwest Florida. 

Gregory Hoy, M.D. Retires 

Gregory Hoy, M.D., a member of The 

Children’s Hospital Pediatric 

Specialists, was appointed to the 

medical staff in January 2000 as a 

pediatric general surgeon. He received 

his medical degree at SUNY-‐Brooklyn, 

completed his Internship and Surgical 

Residence at Ohio State University 

Hospital in Columbus and followed 

with a Pediatric Surgical Fellowship at 

Columbus Children’s Hospital. He is 

board certified by the American Board 

of Surgery with subspecialty certification in pediatric 

surgery. Dr. Hoy previously served as Associate 

Professor of Surgery in Pediatrics, Director of Pediatric 

Surgery, and an Associate in the Lombardi Cancer Center 

at Georgetown University in Washington, D.C. 

We are thankful for the opportunity to have worked with 

Dr. Hoy over the last 12 years. We wish Dr. Hoy well in 

his new endeavors and are truly thankful for his 

contributions to Lee Memorial Health System and to the 

patients in our community. 

www.leememorial.org/physicianpub 

System Recognized for 

Electronic Health Records 

System 

Lee Memorial Health System has been recognized by the 

Southwest Florida Regional Technology Partnership for 

its implementation of system-‐wide electronic health 

records (EHRs) for patients. 

“The implementation of a system-‐wide electronic health 

records system is truly transformative in terms of 

improving the patient experience and simplifying what 

can be a complex and time consuming process when it 

comes to compiling medical records,” Partnership 

President Brooke Gabrielsen says. “Electronic health 

records are at the heart of where technology and the 

human experience intersect to improve lives when it 

comes to health care.” 

“The EHR’s ability to deliver more complete and timely 

information supports better collaboration and 

communication among physicians, other caregivers and 

even the patients themselves, throughout the various 

care delivery settings. This helps to eliminate redundant 

tests and enables improved, more effective, and safer 

care delivery” states Chief Information Officer Mike 

Smith. 

2

We are SafeLee. 

2012 Core Measure Updates 

. 

Accountability Contributes to 

High Reliability in Patient Safety As you may know, LMHS has 

identified the Safety Absolute/ 

Red Rule for employees of using two 

reliable identifiers to identify patients 

each and every time that we care for 

them. A Red Rule is a rule that is critical 

to patient safety. Safety Absolutes/ Red 

Rules communicate the importance of 

an action in preventing patient harm. 

"It Takes Two" (using two reliable 

patient identifiers) is an important rule 

for safety and accountability within our 

health system, and first requires that 

system barriers preventing reliable 

identification of patients are detected. 


We are forming a Safety Absolute/Red 

Rule Oversight Committee to enhance 

safety accountability for employees in 

the application of the Patient 

Identification policy S 03 05 708. The 

Committee will provide valuable insight 

across LMHS to ensure consistent 

application of the Unsafe Acts Algorithm 

for the Safety Absolute Red Rule. 

For more information on this topic, 

please contact: 

Charles A. Krivenko MD, MHA 

Chief Medical Officer, Clinical & Quality 

Services at 239-343-6573 or 

chuck.krivenko@leememorial.org 

3

Medical Staff Additions & Updates. 

Robert D. Feinstein, M.D. 

Cardiology 

GCMC, LMH 

Madhava Pally, M.D. 

Amirul Islam, M.D. 

Internal Medicine 

HPMC, LMH 

Cogent Healthcare 

Ram P. Sharma, M.D. 

Anesthesiology 

GCMC 

Anesthesia & Pain Consultants 

Leonid B. Trost, M.D. 

Dermatology 

HPMC 

Solo practitioner 

Medical Staff Additions & Updates. 

Barbara P. Asorian, Lisbeth ARNP N. Malaret, M.D. 

AlexandraSivakumar P. Vasilescu, Raman, D.O. M.D. 

Lee Physician Group Internal Medicine Joseph Grillo, DPM 

PediatricYeneneh Gastroenterology D. Woldetensaye, M.D. 

Associates in Cardiac CCH, Care GCMC, HPMC, LMHSolo 

practitioner 

FloridaHPMC, ID Specialists TCH 

8960 Colonial Center IMADrive Hospitalist #302Group 

14391 Metropolis Ave., Suite Pediatric 104 Gastroenterology Mailing and Practice of FL Address: 

Fort Myers FL 33905 

Fort Myers, FL 33912 

13670 Metropolis Ave., #106 

239-343-9700 phone 

239-931-3668 phone 

Fort Myers, FL 33912 

239-343-9699 fax 

239-333-3669 fax 

Carrie A. Gittings, M.D. 

Lee Physician Group 

Dunbar United Way House 

13279 N. Cleveland Ave. 

N. Fort Myers, FL 33903 

239-997-9733 phone 

239-997-2859 fax 

Robert D. Feinstein, M.D. 

Cardiology 

GCMC, LMH 

Lisbeth N. Malaret, M.D. 

Madhava Pally, M.D. 


CCH, GCMC, HPMC, LMH 

IMA Hospitalist Group 

Amirul Islam, M.D. 


HPMC, LMH 

Cogent Healthcare 

Barbara P. Asorian, ARNP 

Lee Physician Group 

Associates in Cardiac Care 

8960 Colonial Center Drive #302 

Practice Updates 

Name change: 

Rebecca J. Bernas, Psy.D. to 

Rebecca J. Kirkwood, Psy.D. 

Practice Updates 

Joseph Grillo, DPM 


14391 Metropolis Ave., Suite 104 

Ram P. Sharma, M.D. 

Anesthesiology 

GCMC 

Alexandra P. Vasilescu, D.O. 

Anesthesia & Pain Consultants 

Pediatric Gastroenterology 

HPMC, TCH 

Pediatric Gastroenterology of FL 

Leonid B. Trost, M.D. 

Dermatology 

HPMC 


Sivakumar Raman, M.D. 

Yeneneh D. Woldetensaye, M.D. 

Florida ID Specialists 

4 

Mailing and Practice Address:

DNVHC Survey Update. 

Medical Staff Education 

May 2012 Survey (Findings & Actions) 

Record Content 

CMS Regulations 482.24 (c)(1)(iii) and NIAHO 

Standards MR.5 require that all medical record 

entries are legible, complete, dated and timed; and 

authenticated by the person responsible for 

providing or evaluating the services provided. 

In our May 2012 survey; all hospitals were cited 

for a second year for non-‐conformance to this 

requirement. Receiving a citation during two 

consecutive surveys requires implementation of a 

corrective action plan followed by intense 

monitoring for 60 days. The results of that 

monitoring must be reported to DNV in August. 

Therefore, each unit will be actively tracking 

entries being dated, timed and legibly 

authenticated (by provider’s name or 

identification number). We will be following up 

on entries that are deficient; asking for the missing 

information to be documented in accordance to 

the regulations and standards. 

Operative Reports 

In January 2012, CMS revised the regulation 

482.51(b)(6) for post-‐operative note contents. 

Additions to the previous requirements included: 

• Blood administered 

• Type of anesthesia administered 

• Grafts or implants 

During our recent DNV survey, it was cited that 

our pre-‐printed post-‐operative forms were 

missing these documentation requirements. 

Therefore, the pre-‐printed post-‐operative note 

forms have been revised to include all necessary 

requirements. When the requirement is not 

routinely applicable for the type of procedure 

being performed (i.e., blood administration for 

cardiac catheterization) a pre-‐checked box such as 

this � NA; has been included on the form. 

Exceptions to the not applicable checked box 

would be required to be documented when the 

requirement was applicable. 

Informed Consent – Anesthesia 

CMS Regulation 482.51(b)(1)(ii); (b)(2) and 

482.24(c)(2)(v) and NIAHO Standards AS.3 

require informed written consent from each 

patient for the provision of medical or surgical 

care except in medical emergencies. The consent 

shall include an explanation of risks, benefits and 

alternatives for high-‐risk procedures and sedation. 

The properly executed informed consent form 

must be in the patient’s medical record before 

surgery and must be signed by the patient or the 

patient’s authorized representative. 

During our recent DNV survey, it was cited that 


informed consents for anesthesia did not indicate 

the type of anesthesia to be administered, the 

name of the person who would be administering 

the anesthesia or the name of the person who 

explained the anesthesia procedure to the patient 

or their authorized representative. 

This was the second year for receiving this citation 

for non-‐conformance to this requirement. 

Receiving a citation during two consecutive 

surveys requires implementation of a corrective 

action plan followed by intense monitoring for 60 

days. The results of that monitoring must be 

reported to DNV in August. 

Last year the Anesthesia Consent (FM #0015) was 

modified to facilitate complete documentation. 

Anesthesia Consent (FM #0015) will be revised 

again, moving this documentation to the front of 

the form since it was felt the information was not 

seen at the bottom of the form. 

Each anesthesia location will be actively tracking 

use of recent revised form and completion of all 

required documentation for informed consent. 

We will be following up on informed consents that 

are deficient; asking for the missing information to 

be documented pre-‐operatively in accordance to 

the regulations and standards. 

Post-Anesthesia Assessments 

CMS Regulation 482.52(b)(3) and NIAHO 

Standards AS.3 require a post-‐anesthesia 

evaluation for anesthesia recovery for each 

patient who has received general, regional or 

monitored anesthesia. The elements of an 

adequate post-‐anesthesia evaluation must be 

clearly documented and conform to the standards 

of anesthesia care to include: 

• Respiratory function, including respiration 

rate, airway patency and oxygen saturation; 

• Cardiovascular function, including pulse rate 

and blood pressure; 

• Mental status; 

• Temperature; 

• Pain; 

• Nausea and vomiting; and 

• Postoperative hydration. 

During review of surgical/procedure records 

during our recent DNV survey it was identified 

that records were missing the post-‐anesthesia 

evaluation resulting in a citation for non-‐ 

conformance. We will be following adherence to 

this requirement throughout the year. Findings 

will be reported through the medical staff quality 

functions. 

Our DNV survey team members who have been 

with us for three years told us they see growth, 

consistency and our commitment to quality care. 

Your cooperation with our efforts will result in 

our success and continuation of our accreditation. 

Please direct any questions 

you may have to Standards 

& Quality at 239-343-0243. 

5

System Updates. 

. 

Pharmacy & Therapeutics 

Committee Update 

Medications added to the LMHS formulary: 

Albendazole 200 mg tablet 

Ivermectin 3 mg tablet 

Praziquantel 600 mg tablet 

Medications added to the LMHS formulary 

but not stocked: 

Alimta® pemetrexed -‐ Restricted to Regional 

Cancer Center and Outpatient Use 

Medications removed from the LMHS 

formulary: 

Vytorin 10/80 

Thiabendazole 

Therapeutic interchanges: 

Aminophylline will be prepared and 

dispensed in unit dose form in the pharmacy 

on a per patient basis, restrict to PICU, order 

set required. The current therapeutic 

interchange of Aminophylline to Theophylline 

will remain in place for all other pediatric 

areas (pediatric use only) 

Current drug shortages- IV 

Fosphenytoin -‐ limited availability 

Methocarbamol injectable-‐ limited availability 

Pancuronium -‐ not available 

Phentolamine -‐ not available 

Sodium bicarbonate injectable -‐ limited 

availability 

For additional information please see the P&T 

newsletter or contact: 

John Armitstead, MS, RPh, FASHP 

john.armitstead@leememorial.org or 

Doug Peterson, Pharm.D., BCPS 

doug.peterson@leememorial.org 

Any physician interested in participating on the P & 

T Committee, please contact Pam Fowler, RN, BS, 

CIM – P & T Secretary 

pam.fowler@leememorial.org 

New & Revised Order Sets 

Please share this list of new/revised order sets with your staff so they can 

be sure they are using the most up-‐to-‐date versions. When your order is 

finalized, a “Pending Release” reminder is sent out via email, along with 

the approved order forms that will be available 2 weeks from that time. 

The 2-‐week lag gives EPIC and Siemens time to build the order 

electronically so all venues will be available (and working) at the same 

time. It is at the time of the “Final Release” notice that the order is 

available on IntraLee (paper version) and electronically. For any 

questions related to order sets, please contact Lorna Bell-‐Kotwall at 239-‐ 

343-‐7965 or Dr. Jon Burdzy at 239-‐849-‐6092. 

Approved May 1, 2012 

3271 Pediatric Spinal Fusion orders 

3326 Cardiac Rehabilitation-‐Outpatient orders -‐ paper only 

3469 Urology Pre-‐Procedure orders 

3640 Outpatient Urology Surgery Post-‐Procedure Discharge orders 

3642 Pediatric Hematology/Oncology Sickle Cell Admission 

3706 Pre-‐Procedure Orders Cosmetic/Hand/Trauma/Reconstruct Surg 

3750 Pediatric Rectal Sedation order 

3068 Orthopedic Post-‐Procedure orders 

3401 Acute Hemodialysis orders 


3369 Adult Filgrastim (Neupogen/G-‐CSF) Chemotherapy 

3371 Pediatric Critical Care Procedure 

3444 Refusal of Blood Products 

3524 Outpatient Pre-‐Transplant Evaluation 

3637 Comfort Care 

3643 Pediatric Hematology/Oncology Fever/neutropenia Admission 

3746 ICU/Emergency Department Bedside Bronchoscopy Procedure 

3776 Pediatric Post-‐Pyloromyotomy 

3037 Cardiac Surgery Pre-‐Procedure 

3064 Cardiac Catheterization Post-‐Procedure 

3116 Med/Surg/ Progressive Care Admission 

3247 Group B Strep 

3616 Anesthesia Vasoactive & Isotropic IV Drip Orders 

3293 Epidural Pump Trial orders 


3137 Adult inpatient Febrile/neutropenic Admission orders 

3312 AML 7 + 3 (Cytarabine + Idarubicin) Chemotherapy orders 

3343 Erythropoetin (Epoetin Alfa) orders 

3456 Podiatry Pre-‐Procedure orders 

3462 NICU pediatric Surgery Pre-‐Procedure orders 

3620 ICU Calcium Channel/Beta Blocker Toxicity protocol 

3644 Ethylene Glycol and Methanol poisoning orders 

3752 Insulin-‐Clonidine Stimulation Test orders 

3781 Outpatient Iron Sucrose orders 

3089 Standard Therapy Weight based heparin orders 

3089 EPIC Standard Therapy Weight based heparin orders 

3201 Low Dose/Cardiology Weight Based Heparin drip orders 

3201 EPIC Low Dose/Cardiology Weight Based Heparin drip orders 

3227 Pediatric Critical Care Admission orders 

3255 Neurosurgical Pre-‐Procedure orders 

3487 Acute Stroke orders 

3488 Acute Ischemic Stroke/TIA Clinical Practice Guideline orders 

3518 TPA For Ischemic Stroke orders 

3712 Critical Care Adult Hyponatremia 3% Sodium Chloride orders 

3790 Nursing Stroke Protocol 


6

Continuing Medical Ed & Training 

Nutrition in Normal Infants: 

Principles, Practice & Problems 

Pediatric Grand Rounds 

Viraine Weerasooriya, M.D. 

Pediatric Gastroenterology, Hepatology & Nutrition 

Monday, July 9, 2012 

6:30 - 7:30 pm 

HealthPark Medical Center Room 201 & 202 (2nd Floor) 

RSVP for CME & Dinner by July 6th - 424-2680 

Clinical Advances in Gastroenterology 

The 9 th Annual CME Conference in SW FL 

Saturday, July 14 & Sunday, July 15, 2012 

Sanibel Harbour Marriott Resort & Spa 

Eosinophalic Esophagitis, Sami Achem, M.D., Hepatitis B & C, 

David Nelson, M.D., Allergic GI Disorders, Sarah Glover, D.O., 

Liver Cancer, David Nelson, M.D., Endoscopic Ultrasound, Girish 

Mishra, M.D., ERCP in the Treatment of Ampullary Adenomas, 

Patrick Brady, M.D., Neuroendocrine Tumors, Jonathan 

Strosberg, M.D., Critical Moments in IBD, Arun Swaminath, M.D. 

8 CME credits 

To request a brochure, call 424-2397 or email 

joanne.gorgone@leememorial.org 

Advanced Treatments for Urinary 

Incontinence 

Carolyn F. Langford, D.O. 

Specialists in Urology 

Monday, July 16, 2012 

6:00 – 7:00 PM 

Gulf Coast Medical Center Community Room 

RSVP for CME and Dinner by July 13 th – 424-2680 

Looking ahead… 

Endocrine Conference 

Saturday, September 22, 2012 

Sanibel Harbour Resort & Spa 

7:30 am - 12:30 pm 

4 CME Credits 

Transitioning the Diabetes Patient from Pediatric Care to Adult 

Care, Asjad Khan, M.D., Osteoporosis, Roberto Pacifici, M.D., 

Polycystic Ovarian Syndrome: A Complex Condition with 

Metabolic, Reproductive and Psychological Repercussions 

Impacting our Patients Throughout their Lifespan, Craig Sweet, 

M.D. and Pituitary Disease, Anthony Morrison, M.D. 

To request a flyer, call 424-2397 or email 

joanne.gorgone@leememorial.org 


Save the Dates: 

EPIC Training 

Classroom or one-on-one training for the Lee and HP 

Epic go live will be held in the physician's lounges 

from 7am until 5pm Monday through Friday from 

July 16th through July 31st. If you prefer training on 

your own, eLearning is available anytime from any 

computer. The eLearning web site is: 

www.leememorial.org/physicianpub/cme.asp 

For questions regarding the training, please contact 

one of the physician liaisons: 

Laura Lee 239-343-7822 

Michele Hildebrand 239-343-7924 

Jan Villwok 239-343-7841 

7

Patient First ▪ Every Time 

Medical Staff Matters is a publication of the Lee 

Memorial Health System. Please direct all 

inquiries to Yvonne Luckett at 

yvonne.luckett@leememorial.org 

Kudos to Luz Peguero, M.D.! 

Lee Memorial Health System’s 

Physician of the Month 

Luz Peguero, M. D. 


Hospitalists Group 

of Southwest Florida 

Medical Staff Member 

since 2010 


FT. MYERS, FL 

PERMIT NO. 131

Board of Medicine: Inside this issue. - Lee Memorial Health System

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