MSSC normally holds elections for board members in May, but because of COVID-19, the election for 2021 board members was postponed until June.
Also, because MSSC has postponed large membership meetings, the voting will be conducted by mail, email and fax. MSSC members voted last year to allow a slate of candidates, which would be voted up or down. The ballot with the 2021 slate of candidates will be included in the June issue
of MSSC News.
As Kansas slowly starts to loosen its business and commerce restrictions under Gov. Laura Kelly’s latest reopening plan, physician offices and hospitals in Sedgwick County are carefully adjusting to a new phase in delivering care.
Hospital systems such as Ascension Via Christi and Wesley Healthcare are now allowing some non-emergent surgical procedures while many physician practices that had gone dark during lockdown – or had greatly reduced their operations – are now looking at ways to slowly get their businesses functioning again.
Gone for the foreseeable future are busy waiting rooms where patients sit in adjacent chairs and flip through magazines while waiting to see their physician. In fact, check-ins today often involve prescreening over the phone and curbside forms delivery. In many practices, patients are asked to wait in their vehicles until the office calls them in, politely requesting they wear a face mask.
“I keep asking myself, “When will things get back to normal?” But I kind of know in my heart that we may never return to what we consider “normal,” said OB/GYN Sharon Breit, MD, whose specialty requires her to regularly visit hospitals as well as maintain office hours.
Her practice discarded its magazines, put away the children’s toys, instituted regular deep cleanings and established a “sick room” – a separate entrance for patients who present with any type of questionable symptom. And that’s if they need to come in at all. Breit’s office won’t hesitate to use telemedicine if a patient needs a follow-up consultation that doesn’t require an in-person exam.
“Nobody sits in the lobby,” Breit said. “We physically bring out the paperwork to them and they fill it out in the car, and when we’re ready for them, my medical assistants meet them at the door and take them directly to the exam room.”
West Wichita Family Physicians shut down its entire after-hours minor emergency clinic and converted it to a COVID-19 clinic where patients suspected of having the virus could be screened and tested outside of the practice facility. The practice also closed its outpatient surgery center.
But the number of people coming to be tested has declined, while the number of people who actually tested positive for the virus remains low, family physician Joe Davison, MD, said. Today, practice partners are talking about how to phase down from a full-time COVID screening clinic to perhaps a half-day clinic, or maybe a drive-by clinic, and reopening the outpatient surgical center.
“We’re eager to get going,” Davison said, adding that no one is 100 percent certain exactly what the next steps should be or how quickly to take them. “We’re not getting much guidance,” he said. “We’re trying to be the middle ground, to be safe, to take all the appropriate precautions. You want to be smart – and I think we have been – but I think we can start opening up in stages.”
The American Academy of Family Physicians said conflicting information about how and when to reopen physician practices has caused hesitancy among physicians trying to balance safety with the need to see and treat patients. In issuing guidance for physicians on reopening, AAFP officials suggest that a decision to resume in-person office visits should take into consideration, among other factors, a combination of local COVID trends, reliable testing and the availability of PPE.
“If your practice chooses to resume in-person care, you should continually monitor (your) local area’s incidence of COVID-19 to take appropriate actions if the risk increases,” AAFP officials said. “Until a vaccine is widely available, there will be a risk of COVID-19.”
Effective May 18, Gov. Kelly approved a cautious, slow opening of some local services. Her latest plan to reopen Kansas acknowledges that COVID-related deaths are on the decline but that the rate of spread among residents is not, thereby slowing plans to greenlight a full-fledged reopening of Kansas businesses and gatherings by a certain date as originally thought. Phase 1.5 highlights include:
- Continued prohibition of gatherings of more than 10 people;
- Allowing nail salons, hair salons and similar personal services to reopen, but only for pre-scheduled appointments or online check-ins;
- Allowing fitness centers and health clubs to open, but with no group classes and no open locker rooms.
“Unfortunately, the daily rate of disease spread has not shown the downward trajectory necessary to move fully into Phase 2,” Kelly said on May 14. “I said from the beginning that public safety must remain the top priority, which means that our reopening efforts must be driven by data, not dates. Phase 1.5 will continue our transition, but with necessary caution.”
In line with this thinking, the decision by hospitals to reopen their ORs for some classes of non-emergent surgical services has many Wichita surgeons breathing a sigh of relief. Stories of patients putting off needed surgeries or waiting out of fear to see their doctors after experiencing potentially dangerous symptoms have resulted in escalated and more complicated health issues and, in some cases, death.
Surgeon Nick Brown, MD, estimates that before the pandemic hit, Wichita Surgical Specialists performed upwards of 25 to 40 cases a week. Once the local stay-at-home order went into effect and surgeries were limited to urgent and emergent cases only, surgeons were operating on fewer than 10 cases a week.
Now that hospitals are slowly opening back up for “elective” surgeries – a word doctors dislike because very few surgeries are truly “elective”; most are necessary and important – surgeons are finding their patients a little worse for the wear.
“The pathology has gotten a little worse and a lot of things we take for granted – something as simple as, for example, a gall bladder, has been made more complicated by waiting,” Brown said.
Brown, also a bariatric surgery expert, noted statistics released by the Centers for Disease Control & Prevention that listed hypertension, diabetes and obesity as the three most common comorbidities of people who passed away from COVID-19. Those also are the chronic conditions most associated with bariatric patients waiting for life-saving weight-loss surgery – but the surgery is considered a “Tier 2” procedure, and, until recently, was put on hold.
“The initial stance that (some) categories of procedures were the same as cosmetic procedures couldn’t be further from the truth,” Brown said. “We do those surgeries to prevent a lot of chronic medical conditions.”
Hospitals, for their part, are slowly and methodically introducing categories of surgeries of various acuities while keeping a close eye on safety for all involved.
If there’s any doubt as to whether a physician, the hospital staff or a patient is at risk for contracting or spreading COVID-19, the surgery will be delayed – and physicians aren’t giving pushback on that, said Brian Swallow, director of surgical services for Wesley Healthcare, which is testing patients for COVID-19 prior to surgery.
“Safety is trumping everything at this point,” Swallow said. “A lot of doctors are seeing patients who are sicker than normal because they’ve waited too long or delayed surgery. What we don’t want to do is get careless. The most important thing is to make sure everybody’s safe, including the patient, the staff and the doctors.”
by Patricia Wyatt-Harris, MD —
Since I started medical school, I have always introduced myself to new patients with a handshake. I also shake hands with family members when I meet them before surgery and when I talk to them after surgery to tell them how it went. When I delivered babies, I shook the hands of the parents to congratulate them.
Come to think of it, I have shaken a lot of hands in my lifetime.
I was taught that when giving bad news, touching the patient helps a lot. I specifically remember having to tell a patient that she had a fetal demise when I was a first-year resident.
The patient was close to her due date, but she noticed that the baby had stopped moving. When the sonogram was done, there was no heartbeat. I asked my senior resident for advice. I didn’t know how I was going to tell the patient such devastating news. I remember very clearly that she said, “Touch her, make eye contact, and be honest about your findings. This is never easy.”
In our new COVID-19 world, we know that shaking hands can spread disease. Even when we are able to go to church in person, we won’t be able to “pass the peace” like we used to. We used to shake hands or touch a person’s shoulder. That won’t be happening anytime soon.
I find myself apologizing for not shaking hands. I guess I want my patients to know that I would do that if I could. They all understand, but I’ve shaken hands for so long that it feels awkward if I don’t.
We also are wearing masks at all times in the office, so our facial expressions are muted. I guess we can do a lot with our eyes and our voices, but things have really changed.
I’m getting used to this, but sometimes I forget. I wear gloves throughout the exam, even for parts that I used to do without gloves. The other day, I completed my exam on an older lady and took off my gloves. She then had trouble sitting up from a lying position, so I instinctively reached for her hand with my bare hand. I immediately reached for the hand sanitizing gel when I left the room.
Being a physician involves close contact with other human beings. Diagnosis and treatment typically require touching. Relating to patients and their families also often involves touching. I hope the changes this pandemic has brought don’t change the way physicians treat patients. I hope we can continue to give patients what they need psychologically. We want them to know that we are still the same, even though we have to act differently.
Physicians of the MSSC are continuing to do an amazing job. I know we will make necessary changes and will continue to provide excellent health care.
Garold Minns, MD, remembers the good ol’ days – those halcyon years leading up to March 2020 when he could reliably call himself the invisible man on public-health matters.
Sedgwick County’s health officer since 2008, Minns is the physician working behind the scenes monitoring local influenza and infectious disease outbreaks, including nearly eradicated diseases such as tuberculosis and measles – those kinds of quaint public health issues that come and go with barely a blip on the media’s radar.
Not so much anymore.
Minns, an infectious disease expert who is dean of the University of Kansas School of Medicine-Wichita, gets recognized a lot these days and in the most unlikely places – and it still doesn’t fail to surprise him. “I was just checking out in a grocery store and the clerk handed me my receipt and said, “Boy, I’m glad I don’t have your job!’”
First of all, Minns wondered, how on earth did she know who he was? Second, he said, she had a point.
“I understand what she’s saying,” Minns said. “There are days I wish I didn’t have my job. I can’t disagree with her. On the other hand, it’s a job that needs to be done. This too will pass.”
Minns is walking a tightrope of a job these days, placed in the unenviable position of balancing the health and wellness of Sedgwick County citizenry against the health and welfare of Sedgwick County commerce and viability. Are we being too cautious? Are we careful enough?
He analyzes data as it pertains to COVID-19, confers and consults with state and national leaders, and advises Sedgwick County Commissioners on how best to move forward with lessening or tightening restrictions.
But did he make the right call when he signed the stay-at-home order back on March 24, days before Gov. Laura Kelly issued a statewide one? He gets feedback from both ends of the spectrum, from physicians and the public. But in the end, it’s his call – and safety ultimately prevails.
“I think the jury’s still out,” Minns said. “We’re not out from this virus yet – it’s still circulating in the community. That forces me to ask, how many deaths justifies what we did? That’s a pretty hard question to answer. Obviously one of our jobs it to prevent premature deaths.”
As of May 17, Sedgwick County counted 535 cases of COVID-19 with 20 related deaths, much less than the state’s total of 8,340 cases with 172 deaths, and far less than New York’s 350,000 confirmed cases and 22,619 deaths.
Perhaps it was Minns’ quick call-to-action that helped prevent Wichita from a vicious outbreak like other parts of the country, and even the state.
“Education is very important to preventing infections like this,” Minns said. “But as with anything in life, we can overdo it and scare people. I don’t believe in scare tactics or overblowing it – it’s not like Ebola, which is almost a death sentence if you get it, but it is a somewhat unusual virus. No one had immunity to it. It spreads more quickly and it seems to have a higher mortality rate.”
That’s also why Minns likes to emphasize how many people have recovered from COVID-19 as well (361 recoveries in Sedgwick County as of May 17).
In his role as county health advisor, Minns is knee-deep in data, advising county leaders on what he knows about the virus and identifying risk areas. He said it’s really not his burden to second guess whether he’s been too strict or too lenient in his recommendations to prevent COVID from spreading – that’s up to historians and the public to decide whether the consequences justified his actions.
But Minns can point out that Sedgwick County so far has not seen a spike in cases, and hospitals are not overwhelmed here like they are in New York, Seattle or Italy – all without the implementation of what Minns calls “draconian restrictions” on people’s liberty. People stayed home and businesses were willing to shut down and prevent transmissions, he said.
“That has been somewhat successful and helped us prevent an Italy or a New York City,” Minns said. “We’re trying to walk a fine line in the middle. We can’t eradicate the virus without totally destroying our economy. On the other hand, if we go back to the Wild West and open everything back up like it was before, we’re going to have a problem similar to New York and Seattle.”
So Minns’ challenge right now, he said, is to keep educating people on how to be safe. The COVID threat isn’t gone and the need to practice prevention tactics is still important. Minns shakes his head at the vitriolic debates in the media or people on the street acting like this isn’t a problem that can affect them.
“How much can we convince the public to restrict contact with other people, continue to have church services online and wear masks?” Minns said. “We have no option to eradicate this virus until we have medicine or a vaccine. We probably don’t need to absolutely stay in the house, but when we do go out, common sense is to wear a mask, even if you don’t feel like it.”
Minns gets it. The health threat has gone on a little longer than he initially hoped it would. He’s sick of the word “COVID” and can hardly stand to watch TV anymore. He hasn’t seen his grandchildren in months (except through FaceTime), and he misses music theater and nights out on the town. His garden has never looked better. Yes, Minns said, he’s tired of it all, too.
He needs physicians to help him by educating their patients. To reach out on EMRs and other communication platforms and explain why wearing masks and keeping distances are important. Patients will listen to them, Minns said. An easing of restrictions on a statewide level does not mean all is safe and back to normal.
“We’re not done,” Minns said. “We’re trying to retain essential functions of our business and economics, but we’re walking a fine line, a tightrope. Ask yourself the essential question – what can we live without for a year? Because it’s going to take at least that long.
“It’s impossible to make everyone happy, but, in the end, it’s a small sacrifice. The worst is yet to come if we open too much, too fast, and people don’t take care.”
As public health experts determine that it is safe to see patients and stay-at-home restrictions are relaxed, physician practices should strategically plan when and how best to reopen.
The American Medical Association believes that four signposts must exist before state and local governments relax stay-at-home orders:
- Minimal risk of community transmission based on sustained evidence of a downward trend in new cases and fatalities
- A robust, coordinated and well-supplied testing network
- A public health system for surveillance and contact tracing
- Fully resourced hospitals and healthcare workforce
- Building upon CDC Phase 1 guidance for reopening facilities to provide non-emergent, non-COVID care, the AMA suggests using the following checklist to ensure that your medical practice is ready for reopening. See online for more details:
Comply with governmental guidance
States and the federal government have outlined guardrails that should be in place before reopening. State and city guidelines should be closely reviewed and followed.
Make a plan
Pre-opening planning will be vitally important to the success of your practice reopening.
Consider a step-wise approach to reopening so that the practice may quickly identify and address any challenges presented.
Institute safety measures for patients
To ensure that patients are not coming into close contact with one another, utilize a modified schedule to avoid high volume or density. Designate separate waiting areas for “sick” patients.
Ensure workplace safety for clinicians and staff
Communicate personal health requirements clearly to clinicians and staff.
Implement a tele-triage program
Depending on a patient’s medical needs and health status, a patient contacting the office to make an in-person appointment may need to be re-directed to the practice’s HIPAA-compliant telemedicine platform, a COVID-19 testing site or to a hospital.
Screen patients before in-person visits
Before a patient presents in the office, the practice should verify as best it can that the patient does not have symptoms of COVID-19. Visits that may be conducted via telemedicine should be.
Coordinate testing with local hospitals and clinics
Contact your public health authority for information on available testing sites.
Limit non-patient visitors
Clearly post your policy for individuals who are not patients or employees to enter the practice (including vendors, educators, service providers, etc.) outside the practice door and on your website.
Contact your medical malpractice insurance carrier
To ensure that clinicians on the front line of treating COVID-19 patients are protected from medical malpractice litigation, Congress has shielded clinicians from liability in certain instances.
Establish confidentiality / privacy
Institute or update confidentiality, privacy and data security protocols.
Consider legal implications
New legal issues and obligations may arise as the practice reopens.
Members of the Society who know a good and sufficient reason why any of the following applicants are not eligible for membership are requested to communicate with the Medical Society of Sedgwick County office.
[BC] Board Certified [R] Residency [F] Accredited Fellowship [F*] Unaccredited Fellowship [AT] Additional Training
NEW ACTIVE MEMBERS
Arif Hussain, MD
[BC] Pediatric Cardiology
Children’s Mercy Wichita Specialty Clinics
3243 E Murdock S-201, 67208
Medical education obtained at Rawalpindi Medical College, Pakistan 5/1979-3/1985. Internships in General Surgery and Pediatrics at Holy Family Hospital, Pakistan, 8/1985-8/1986. Residencies in Pediatrics at Aga Khan University Medical College, Pakistan, 8/1987-8/1990 and 6/1991-6/1992, and at Children’s Hospital of Buffalo, NY, 7/1992-6/1994. Fellowships in Pediatric Cardiology at St. Louis Children’s Hospital 7/1994-6/1997 and in Pediatric Critical Care at Children’s Hospital of Buffalo 9/1997-7/1998
Jamey L Iverson, MD
Wichita Anesthesiology, Chtd
8080 E Central S-250, 67206
Medical education obtained at KUSM-Wichita 7/2005-5/2010. Residency in Anesthesiology at KUSM-Wichita 7/2010-6/2014.
Keep your 2020 Roster current by adding the information listed below and in the Membership section of this issue of the MSSC News:
Stanley L. Capper, MD
The Dermatology Clinic, PA (6/1/2020)
835 N Hillside, 67214
Robert A. Sweet, MD
Robert J Dole Veterans Medical Center
5500 E Kellogg Dr, 67218
Gregory P. Gherardini, Jr., MD
Mid-Kansas Pediatric Associates, PA
1635 E Freedom St S-500, Derby, 67037
Jennifer S. Crosse, MD
Mid-Kansas Pediatric Associates, PA
1635 E Freedom St S-500, Derby, 67037 (alternative office)
Madan Acharya, MD
[BC] Clinical Cardiac Electrophysiology
Susanna Ciccolari Micaldi, MD
[BC] Child & Adolescent Psychiatry
Levi C. Short, MD
Wichita Nephrology Group, PA
Patrick Ters, MD
Cardiovascular Consultants of Kansas
[BC] Interventional Cardiology
M.H. Van Strickland, MD – practicing, not retired
[BC] Allergy & Immunology
10021 W 21st St, 67205
David G Sollo, MD – 3/26/2020
Salma Makhoul-Ahwach, MD – Moving out of state 6/5/2020
Paul P. Maraj, MD – Moving out of state 7/1/2020
ProviDRs Care is the only physician owned and managed Preferred Provider Organization network in Kansas. By leasing its provider network to insurance companies, third party administrators and self-funded plans, ProviDRs Care maintains choice and competition among health insurance plans in Kansas.
Medical Provider Resources is the only physician owned and managed provider credentialing verification service in Kansas. MPR delivers “best practice” support in response to the growing demands for credentialing information and other practice management requirements.