Frank Maderal, M.D. - Dade County Medical Association

Enrique Hanabergh, M.D.
President-Elect
Aurelio Mitjans, M.D.
Vice President
August 2009
The Official Publication of the Dade County Medical Association
LOOK WHAT’S INSIDE:
Message from your New President . . . . . . . . . 3
Medical Information Technology . . . . . . . . . . . 5
Board of Medicine 2009
Legislative Session Highlights . . . . . . . . . 12
Recent Challenges to Caps
on Non-Economic Damages . . . . . . . . . . . . 13
Frank Maderal, M.D.
President, Dade County Medical Association
Beny Rub, M.D.
Secretary
Elizabeth Etkin-Kramer, M.D.
Treasurer
Bernd Wollschlaeger, M.D.
Immediate Past President

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Edward Shohat, Esq. (305) 358-7000
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REAL ESTATE LAW
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William R. Radford, Esq. (305) 808-2134
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Frank R. Maderal, M.D.
President, Dade County Medical Association
It is tough to be a solo practitioner today especially if you are in
primary care. Medicare has fixed prices that pay poorly and
managed care which is dominant in Dade County dictates your
reimbursements.
It’s hard to understand why there are no primary care groups in
Dade County. If primary care doctors could come together, and
group a large number of patients, they could negotiate better
reimbursement from Medicare Advantage plans and Managed Care
payers and they could collectively pay for a competent administrator,
EMR system and other equipment to grow their practice. Specialists
have formed successful groups but none in primary care.
Businessmen have formed provider groups and hospitals are putting
doctors together but we all know who will benefit from those
arrangements.
To start a group you need physician leadership; one or a few doctors
that need to stay involved. To simply hire a lawyer or an accountant
or an administrator to put things together is like a hole in the ocean
where you throw away your money. It’s easier to start with two or
three doctors and slowly add others once the rules are set rather than
try to bring ten or twelve together at once.
Physicians leadership is the most important component; all successful
groups have strong physician leaders and whether it’s one or an
executive committee which runs the group, compensation for
management time is fair and necessary.
To form a legal group different offices can stay independent as cost
centers with only a common billing and payroll. They need to come
together with common Medicare and tax ID numbers. For peace of
mind it could be set up to be easy in and easy out, in case someone
wants to leave the group. The group can outsource to a billing
company which can now provide management software and even
EMR at a monthly charge with little upfront investment. It would
MESSAGE from your PRESIDENT:
by Frank R. Maderal, M.D.
How Primary Care
Practices Can Survive
all be web based; no need to own software and hardware which
quickly becomes antiquated. Human resources can also be outsourced
so really the group could function with just an administrator as an
umbrella uniting the different practices. Each practice (Care Center)
determines their salaries, hours, office décor, etc. Income would be
assigned to the corresponding practice minus their percentage of the
central overhead cost which could be minimal depending on set up.
Doctors are poor supervisors of personnel so any outsourcing is a
good thing. Income will improve with better billing, collection and
eventually better contracting. Pooled money would make it easier for
new opportunities.
The worst scenario for primary care is the status quo where solo
practitioners have no negotiating clout, overwhelming responsibilities
and uncertain future. Few new doctors want solo practices so
they are looking to form groups.
The group environment takes a lot of stress out of the practice allowing
the physician to enjoy his practice more. Doctors within the
group don’t even have to cover themselves for the groups to
function.
There are multiple attorneys and consultants who have done this
work numerous times and can advise about what to emulate and
what to avoid based on the experience of groups previously formed.
The DCMA wants to point out opportunities and provide information
to our members. We can provide advice and suggest resources.
The more secure our doctors are the better we are as an Association.
We plan to provide useful information regarding the current health
care debate and practice management topics in upcoming issues of
Miami Medicine and at the moment via e-mail.
Frank R. Maderal, M.D.
President, Dade County Medical Association
MIAMI MEDICINE ✚ August 2009 3

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MIAMI MEDICINE ✚ July 2009

Bernd Wollschlaeger, M.D., FAAFP, FASAM
In my last article I discussed the health IT provisions in the American
Recovery and Reinvestment Act (ARRA) which are designed to
promote and provide incentives for the adoption of certified EHRs.
I emphasized in the article that physicians who demonstrate the meaningful
use of a certified EHR will be eligible for up to $44,000 each in
incentive bonus payments, in addition to Medicare and Medicaid
reimbursement, provided that they implement such a technological
solution by January 1, 2011.
I admonished the Certification Commission for Healthcare Information
Technology (CCHIT) to define what the term “certified EHRs” really
means. I was especially concerned that the current certification system
favors established and certified vendors posing insurmountable obstacles
for smaller and emerging product developers, even though those may offer
a better and more cost-effective product! Well, in a surprise move during a
public meeting, CCHIT announced on June 17th a substantial revision of
their certification approach and proposed three EHR certification pathways:
• EHR-C: Certified EHR Comprehensive
• EHR-M: Certified EHR Module
• EHR-S: Certified EHR Site
The EHR-C is the same certification that CCHIT has been doing since its
inception. Unfortunately, the current certification process may mislead
doctors to believe that a certified EHR is better and safer! This may not be
the case at all! Quite frequently EHR vendors inflate their software with
“certified” and often redundant features, to be able to claim that they were
certified. Needless to say, many of those “certified” products are useless in
the clinical practice! Furthermore, a considerable number of CCHIT certified
EHR companies are going under leaving physicians behind desperately
seeking new IT solutions. It is likely that the current EHR-C certification
could be changed, added to, or modified in order to meet the
ARRA requirements.
The EHR-M certification is where CCHIT will certify certain modules
from a software vendor. CCHIT plans to combine and develop those criteria
to decide which modules will be certified. For example, an EHR vendor
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could choose to just get e-Prescribing EHR-M certified. Thereby, the use
of this EHR component could qualify for ARRA incentives. With EHR-M,
vendors can focus on one specific component of the EHR-C certification
and make sure it works. This process will probably be much cheaper and
will allow small companies to get their products certified.
The EHR-S category represents the most interesting and exciting new
component addressing the home grown EHR system market and the
so-called open-source program providers. The EHR-S certification is essentially
where CCHIT will certify a site (organization, hospital, clinic) to
show that they meet the various ARRA requirements. The EHR-S certification
only certifies that the site meets the ARRA requirements and not
necessarily that the software that site is using meets the requirements!
Basically, the EHR-S certification tries to certify that a site is using an
EHR to the ARRA requirements. This certification is a potential win-win
solution for small group practices or hospital systems that have a mixture
of all sorts of uncertified systems, but have the required functionality.
In summary, it is clear now that CCHIT is transitioning its timelines to
adapt to the new requirements of the stimulus law (ARRA/HITECH) as
well as the still-emerging work processes of the Office of the National
Coordinator (ONC/HHS) and its two advisory committees. Therefore,
there will not be a 2009 certification program! According to the CCHIT
website they intend to launch the 2011 ARRA certification in the Fall of
2009. The correlation between the 2009 criteria and the 2011 ARRA
criteria will depend on decisions yet to be made by ONC and the two
advisory committees. These new criteria will open the EHR market for a
fair competition of small and large vendors and will level the playing field.
This will help physicians to obtain cost-effective, functional and certified
EHR products that meet their professional and financial needs.
I look forward to reading your comments and suggestions on our
blog at http://miamimedblog.blogspot.com/ or send me a twit at
http://twitter.com/dadedoc.
Disclosure: The author is a practicing family physician, addiction specialist
and computer consultant. In addition, he is a founder and managing
partner of VirtualMed,LLC (www.virtualmed.com)
By Bernd Wollschlaeger, M.D., FAAFP, FASAM
MIAMI MEDICINE ✚ August 2009 5

BENEFITS ONLY FOR MEMBERS OF
THE DADE COUNTY MEDICAL ASSOCIATION
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Introducing the Next Best Thing for
Dade County Medical Association Members!
The Dade County Medical Association is pleased to endorse
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For more information on this DCMA endorsed workers’
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please call Tom Murphy at 800.966.2120.
ENDORSED BY THE
• DADE COUNTY MEDICAL ASSOCIATION •
Delray: 54 SE Sixth Avenue, Delray Beach, FL 33483 • 800.966.2120 • Fax 888.235.5008
Orlando: 541 Lake Como Circle, Orlando , FL 32803 • 888.496.0059 • Fax 407.896.0079
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Congratulations!
Baptist Health salutes
gastroenterologist
Frank Maderal, M.D.
on his upcoming term as
President of the Dade County
Medical Association.
Committed to our faith-based charitable mission of medical excellence
Visit us at www.baptisthealth.net

DaDe County MeDiCal assoCiation
DCMA President, Frank R . Maderal, M .D . receives his gavel
from Bernd Wollschlaeger, M .D ., Immediate Past-President .
DCMA President Frank R . Maderal, M .D . being
presented a proclamation by Carlos Hernandez,
on behalf of the City of Hialeah .
George Battle, M .D ., Patricio Rossi, M .D . and Ignacio
Rua, M .D . converse during the cocktail hour .
Frank R . Maderal with his parents, Mr . and Mrs . Francisco
Maderal, Sr .
Frank R . Maderal, M .D . with his daughter Laura, and his sons
Daniel and Frank Jr .
FMA President, Steven West, M .D ., DCMA President,
Frank R . Maderal, M .D ., DCMA Immediate Past President,
Bernd Wollschlaeger, and Wayne Carter from the Miami-
Dade County Office of the Mayor and Board of County
Commissioners, who presented Frank R . Maderal, M .D .
with a proclamation on behalf of Mayor Carlos Alvarez .
Attendees of the annual banquet, dancing the night away!
Bernd Wollschlaeger,
M .D . is inducted into the
DCMA Past Presidents
Council by DCMA Past-
President Nelson L .
Adams, M .D .
President Frank R . Maderal, M .D . with Immediate
Past President, Bernd Wollschlaeger, M .D .
holding a proclamation from the City of Coral
Gables and the City of Miami .

2009 Presidential Installation Banquet and Dinner
Newly installed DCMA President Frank R . Maderal, M .D . gives his
incoming speech .
Charles Dunn, M.D.
1982
Miguel A. Machado, M.D.
1997
Carlos Buznego, M.D.
2001
Alfonso Icochea, M .D .
accepts plaque from
Immediate Past-
President, Bernd
Wollschlaeger, M .D ., on
behalf of Mercy Hospital
Medical Staff .
Richard Simon, M .D .
accepts plaque from
Immediate Past-
President, Bernd
Wollschlaeger, M .D ., on
behalf of Baptist Health
South Florida .
Andre Abitbol, M .D .
accepts plaque from
Immediate Past-
President, Bernd
Wollschlaeger, M .D ., for
his service on the DCMA
Board of Directors .
Patricia Sechi, Associate
Administrator, accepts
plaque from Immediate
Past-President, Bernd
Wollschlaeger, M .D ., on
behalf of North Shore
Medical Center .
Past Presidents
The following DCMA Past Presidents Attended the “2009 Annual Installation Banquet.”
George F. Battle, M.D.
2003
Nelson L. Adams, M.D.
2007

Dade3.qxp 5/5/2009 9:50 AM Page 1
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Board of Medicine
2009 Legislative Session Highlights
Below is a summary of bills signed by the Governor following the
2009 Legislative Session that may affect your Florida license. Be sure
to go to http://www.leg.state.fl.us/statutes/index.cfm and read more
details concerning these new laws.
• SB 462 – This bill requires the Department of Health,
when funds are available, to develop a comprehensive
electronic database system for the purpose of controlled
substance prescription drug monitoring. This bill also
requires registration of certain clinics that perform pain
management. The Board plans to conduct rule workshops
in the near future. Be sure to go to the Board of
Medicine’s web page at: www.FLHealthSource.com to
stay abreast of the law and future workshops. This bill
was signed by the Governor on June 18, 2009.
• SB 720 – This bill requires the Board of Medicine to
review entities previously approved by the Board to
grant board certification in Dermatology every three
years. This bill also lifts the requirement for physicians
to co-sign charts written and prepared by physician
assistants. In addition, this bill lifts certain limitations
on ARNP’s and PA’s solely performing hair removal
with lasers. The Council on Physician Assistants will be
meeting in August to repeal rules relating to co-signature
of medical records. This bill was signed by the
Governor on June 16, 2009.
• HB 387 – This bill provides for an increase in the
number of medical faculty certificates permitted at
institutions. This bill was signed by the Governor on
June 1, 2009.
• SB 1986 – This bill primarily deals with reducing
Medicaid fraud. It also requires the Board to deny licensure
or to revoke licensure of an individual, with certain
felony health care fraud convictions. The bill also
outlines four new disciplinary violations and requires
the Department of Health to work with the Agency for
Health Care Administration to prosecute physicians
who have not remitted amounts owed to the state for
overpayments. This bill also exempts sleep related testing
facilities from the patient self referral act. This bill
was signed by the Governor on June 24, 2009.
• SB 2188 – This bill concerns Administrative Procedures.
New procedures include a requirement that Boards with
electronic agendas place copies of the public agenda
materials on their web site at least 7 days prior to the
meeting. It also requires the Boards to place a copy of
their meeting notices on the web site. This bill was
signed by the Governor on June 16, 2009.
As you can see, there are significant changes this year. Also, please
understand there are other laws enacted that are not highlighted in
this letter. It is important that you take a few minutes to go to the
web site listed above and read these new laws as well as any others
that might pertain to your specific practice type to ensure you are
practicing in compliance and that your patient’s continue to receive
quality health care.
Where do you find the laws and rules?
Florida Statutes (laws): http://www.leg.state.fl.us/statutes/index.cfm
Florida Administrative Code (Rules): http://www.leg.state.fl.us/
statutes/index.cfm
You can subscribe and unsubscribe for a no-cost, automatic e-mail of
every new item put on the Board website by going to this web site:
http://flems.doh.state.fl.us/mailman/listinfo/boardofmedicine
Author:
Crystal A. Sanford, CPM
Program Operations Administrator
Florida Board of Medicine

The Florida legislature enacted a law in
September 2003 to place caps on noneconomic
damages in medical malpractice
cases. For Florida physicians, the success of
the passage of this tort reform measure has
had positive benefits in the form of lower
medical malpractice insurance rates and a
reduction in the number and severity of
claims.
Non-Economic Caps
Caps on non-economic damages in all Florida
court cases involving injury or death due to
medical negligence is $500,000 - regardless
of the number of defendants – in suits against
health care practitioner defendants (physicians
and surgeons) and $750,000 per claimant in suits again non-practitioner
defendants (hospitals and other non-physicians).
The court can decide to exceed these caps in certain circumstances. In cases
of catastrophic injury or negligence which results in a permanent vegetative
state or death, a patient may recover up to $1 million and $1.5 million,
respectively.
For any type of injury resulting from emergency care, the law caps noneconomic
damages at $100,000 per claimant, but not to exceed $300,000
for all claimants, in suits against practitioner defendants and $750,000 per
claimant, but not to exceed $1.5 million for all claimants, in suits against
non-practitioner defendants.
Benefits of Tort Reform to
Florida Physicians and Their Patients
The award limits established by the 2003 tort reform law are advantageous
to the quality of health care in this state, because they help control the
severity of claims filed against doctors. The caps were set to help ensure
accessible, quality health care in Florida for all patients.
Tort reform helps protect qualified doctors from exorbitant judgments that
may drive them out of the state, and even out of practice. Specialists are
more likely to accept complex cases when the threat of a significant verdict
is minimized. Losing good doctors benefits no one.
Current Court Challenges
Caps on non-economic damages are facing opposition in the Florida court
system. Recent cases, including the two mentioned below, have challenged
the constitutionality of the tort reform that was enacted in 2003. Based on
cases that are pending in the appellate courts, there is a strong likelihood
that a decision of the appellate court (for either a plaintiff or defendant)
regarding the constitutionality of non-economic damage caps will eventually
be appealed to the Florida Supreme Court for their review by the loser.
In Nadine Raphael vs. James Shecter & Emergency Physician, etc., the jury
returned an award for the plaintiff on August 30, 2007 in the amount of
$783,119 in economic damages and $9,500,000 in non-economic damages.
The total award was $10,283,119. The lawyer for the physician defendant
petitioned the trial judge to apply the non-economic damage cap to the
verdict. The plaintiff ’s lawyer argued to the trial judge that the cap was
unconstitutional and urged the judge to not to apply the cap.
On September 14, 2007, the judge ruled that the $150,000 non-economic
damage cap governing emergency room cases was constitutional. The judge
entered an order reducing the $10,283,199 award to a total of $845,119,
which included some adjustment to the economic losses that had nothing
to do with the application of the non-economic damage cap.
“Recent Challenges to Caps
on Non-Economic Damages”
By Robert E. White, Jr.
President, First Professionals Insurance Company
The plaintiff filed an appeal of the ruling regarding the cap on February 4,
2008 to the Fourth District Court of Appeal. The case has been briefed by
the parties and is set for oral argument on July 7, 2009. The Fourth District
could rule on the constitutionality of the emergency room as early as late
summer or in the fall of 2009. Regardless of what happens in the Fourth
District, the losing side will appeal the ruling to the Florida Supreme
Court.
A ruling from the Florida Supreme Court may take as long as 18 to 24
months after the Fourth District ruling. The end result is that it could be
2011 (or eight years after the cap was passed) before a definitive ruling on
the issue.
Another case currently working its way through the Florida courts is Daniel
Weingrade, M.D., vs. Kimberly Ann Miles and Jody Haynes. The result of this
case was a $1 million judgment against the defendant after the $500,000
cap was applied.
On April 7, 2008 a Miami-Dade County jury returned a verdict for the
plaintiff in Miles v. Weingrad for $16,104 in economic loss and $1,500,000
in non-economic loss for a total verdict of $1,516,104. The trial judge
reduced the non-economic portion of the loss from $1,500,000 to $500,000
making the total judgment entered against the doctor $516,104. This case
was appealed and is in the briefing stages in the Third District Court of
Appeal. It will be set for oral argument some time later this year.
Florida Medical Malpractice Trends
Florida is one of the most litigious states in the country. Knowledge of the
medical malpractice industry is critical for physicians in the state. Florida
was ranked 42nd in the U.S. Chamber’s Institute for Legal Reforms 2008
State Liability Systems Ranking Study and 50th in Pacific Research
Institute’s 2008 U.S. Tort Liability Index. South Florida was ranked the
#1 Judicial Hellhole by the American Tort Reform Foundation. These
rankings were awarded during a nearly five-year span of relative malpractice
calm which recently came to an abrupt halt in Florida. Since November of
2007, juries in four separate trials returned plaintiffs verdicts of over $30
million each. This is the highest concentration of such large verdicts to ever
occur in Florida. Unfortunately, large verdicts like these tend to attract more
lawsuits.
With the increase of these substantial plaintiff awards, it is essential that the
tort reform package that passed in 2003 survives the expected constitutional
challenge. As the largest and longest-serving medical malpractice insurer in
Florida, First Professionals Insurance Company is committed to its partnership
with Florida physicians. We will continue to support physician organizations
in their efforts to protect the progress made almost six years ago
with the passage of caps on non-economic damages.
Summary
The award limits established by the 2003 tort reform law are advantageous
to the quality of health care in this state, because they help control the
severity of claims filed against doctors. The limits apply only to noneconomic
or punitive damages, not compensatory damages. It is essential
that the caps on non-economic damages survive current and future constitutional
challenges to provide maximum protection for both patients and
physicians.
The information contained herein does not establish a standard of
care, nor is it a substitute for legal advice. The information and suggestions
contained here are generalized and may not apply to all
practice situations. First Professionals recommends you obtain legal
advice from a qualified attorney for a more specific application to your
practice. This information should be used as a reference guide only.
First Professionals Insurance Company is Florida’s Physicians Insurance Company SM and the endorsed carrier for professional liability insurance by 22 county medical societies, 15 specialty societies, and
two statewide associations in Florida. The information below does not establish a standard of care, nor is it a substitute for legal advice. The information and suggestions contained here are generalized and
may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a
reference guide only.
MIAMI MEDICINE ✚ August 2009 13

14
President
President-Elect
Vice President
Secretary
Treasurer
Immed Past President
District One
District Two
District Three
District Four
District Five
At Large
Advisory Board Member
Fellows-Residents
Medical Students
Executive Vice President
Alliance President
Legal Counsel
DCMA Staff
Administrative Assistants
Managing Editor
Frank Maderal, M.D.
Tel.: (305) 822-4107
Enrique Hanabergh, M.D.
Tel.: (305) 933-2111
Aurelio Mitjans, M.D.
Tel.: (305) 836-1077
Beny Rub, M.D.
Tel.: (305) 932-1007
Elizabeth Etkin-Kramer, M.D.
Tel.: (305) 674-8038
Bernd Wollschlaeger, M.D.
Tel.: (305) 940-8717
Eugene Fu, M.D.
Tel.: (305) 585-6970
Term Expires May 2010
Athanassios Tsoukas, M.D.
Tel.: (305) 324-4840
Term Expires May 2011
Wentworth Jarrett, M.D.
Tel.: (305) 253-4340
Term Expires May 2011
James A. Voglino, M.D.
Tel.: (305) 596-3707
Term Expires May 2010
Jeffrey Horstmyer, M.D.
Tel.: 305 856-8942
Term Expires, May 2010
Eleanor Pimental, M.D.
Tel.: (305) 445-0700
Term Expires May 2012
Andrew Nullman, M.D.
Tel.: 305 534-4404
Term Expires, May 2010
Thomas Mesko, M.D.
Tel.: (305) 674-2397
Term Expires May 2010
Alfonso Icochea, M.D.
Tel.: (305) 444-7628
Term Expires May 2010
Barbara Montford, M.D.
Tel.: (305) 696-0806
Term Expires May 2012
Jeff O. Gonzalez, M.D.
Tel.: (305) 822-4107
Term Expires May 2011
Randy Miller, M.D.
Tel.: (305) 377-1700
Term Expires May 2012
Vacant
Daryl Eber, M.D.
Shaun Patel, M.D.
Arash Handa
Sean Warsch
Patricia C. Handler
Tel.: (305) 324-8717
Sandi Chamyan
Tel.: (305) 720-9488
Ziskind & Arvin, P.A.
Ana Silvera
Ericka Carlson
Nancy Nuñez
Patricia C. Handler
Miami Medicine is the official publication of the Dade County Medical Association (DCMA).
C M E O P P O R T U N I T I E S T H R O U G H
B A P T I S T H E A L T H S O U T H F L O R I D A
Baptist Health offers many other CME conferences at no charge. To obtain information about upcoming
conferences, go to www.baptisthealth.net/meded. To request monthly mailings and symposium announcements,
call Julie Zimmett, Medical Education, 786 596-2398 or e-mail meded@baptisthealth.net.
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the membership and/or from which the DCMA may receive financial support.
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those of Miami Medicine or the DCMA. Miami Medicine reserves the right to edit all contributions for clarity and length, as well as to reject
any material submitted.
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TWENTY-EIGHTH ANNUAL
⌦ECHOCARDIOGRAPHY SYMPOSIUM
October 30 & 31, 2009
Doral Marriott Resort
10 Credits
HANDS ON CORONARY CTA IN THE
EMEGENCY DEPARTMENT SETTING
November 7 & 8, 2009 Eden Roc Hotel,
Miami Beach, Florida
CME Calendar
To obtain information or to register
for upcoming conferences,
go to www.cme.med.miami.edu
and click on “Conferences” or call
University of Miami Miller School of Medicine,
Division of Continuing Medical Education at
305-243-6716
or email us at umcme@med.miami.edu
MEDICAL CLINIC
FOR RENT
Palm Springs North
(7854 N.W. 178th St.)
1,914 Square Feet.
Suitable for group practice.
X-Ray equipment available.
Phone Morton Glosser:
(305) 258-3264
NEUROCRITICAL CARE SYMPOSIUM:
FUNDAMENTALS OF NEUROCRITICAL CARE
December 5, 2009
Biltmore Hotel, Coral Gables
4.5 Credits
NINTH ANNUAL⌦EMERGENCY
RADIOLOGY SYMPOSIUM
November 8 - 11, 2009
Eden Roc Hotel, Miami Beach
18 Credits
SAVE THE DATE
January 15-17, 2010
2nd World Conference:
Hormonal and Genetic Basis
of Sexual Differentiation Disorders
The Eden Roc Resort
Miami Beach, FL
February 18-20, 2010
Neurology Update and
Stroke Intensive 2010
The Alexander Hotel
Miami Beach, FL
March 4-6, 2010
5th Annual Perioperative
Medicine Summit 2010
The Eden Roc Resort
Miami Beach, FL
March 11-14, 2010
Pediatric Nephrology
Seminar XXXVII
The Alexander All-Suite
Ocean Front Resort
Miami Beach, FL
April 16, 2010
Florida Ethics:
Debates, Decisions, Solutions
The Miami Beach Resort & Spa,
Miami Beach, FL
MIAMI MEDICINE ✚ July 2009

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