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MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies May/June 2001 1

V O L U M E 3 , N O . 3 M A Y / J U N E 2 0 0 1

C O N T E N T SPhysician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Richard J. Morris, M.D.Managing Editor Nancy K. BauerAssistant Editor Doreen M. HinesHMS CEO Jack G. DavisRMS CEO Roger K. JohnsonProduction Manager Sheila A. HatcherAdvertising Manager Dustin J. RossowCover Design by Susan Reed

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. Periodical postage paid at Minneapolis,Minnesota. Postmaster: Send address changes toMetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761.

To promote their objectives and services, theHennepin and Ramsey Medical Societies printinformation in MetroDoctors regarding activitiesand interests of the societies. Responsibility is notassumed for opinions expressed or implied insigned articles, and because of the freedom givento contributors, opinions may not necessarilyreflect the official position of HMS or RMS.

Send letters and other materials for considerationto MetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. E-mail: [email protected].

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2 LETTERThe University Needs Our Help

3 PHYSICIAN’S SO AP BO XDoctor, Who Will Help Me?

4 FEATURETwo Opposing Views on the Need for a Patient Protection Act

9 MPPA Executive Summary: How Contracts Between Health Plans and DoctorsInfluence the Quality of Medical Care and Patient Privacy

12 COLLEA GUE INTERVIEWKent Neff, M.D.

14 Building New Foundations — Surviving and Thriving Inside Corporate Medicine

16 American Medical Association Principles of Medical Ethics

17 Fundamental Elements of the Patient-Physician Relationship

18 Hospital Bed Capacity Issue Gets Attention of Legislators

19 Designated a Delegate

19 Classified Ads

21 MN PERSPECTIVEGovernor’s Budget Refocuses Health Debate

22 Another Successful Winter Medical Conference

23 HMS/RMS Sponsor Medical Student Lunch ’N Learn Sessions

RAMSEY MEDICAL SOCIETY

24 President’s Message

25 Community Internship Program

26 Caring Hearts for Homeless People

27 Applicants for Membership/In Memoriam/Resolutions

28 RMS Alliance

HENNEPIN MEDICAL SOCIETY

29 President’s Report

30 HMS News/New Members/In Memoriam

32 HMS Alliance

On the cover: This issue looks at thephysician-patient relationship.Articles begin on page 3.

MetroDoctorsDoctorsT H E J O U R N A L O F T H E H E N N E P I N A N D R A M S E Y M E D I C A L S O C I E T I E S

2 May/June 2001 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

L E T T E R S

Dear Editor:

Living in this state, we are all affected by thevitality of the University of Minnesota. Fromresearch and inventions, to food safety and aneducated workforce, the University impacts usall. That’s particularly true for healthindustries.

The Hennepin and Ramsey MedicalSociety leadership recognizes the importantrole the University’s Academic Health Centerplays in the success of our state. Withshortages of pharmacists, nurses, medicaltechnologists, dentists, and even physicians,we rely on a healthy university to meet ourfuture workforce needs. The university ishome to the leading edge research andinnovations that fuel medical technology

companies, biotech industries, and pharma-ceutical firms in Minnesota—and that’simportant for our future. In addition, I knoweach of us wants to maintain access to atransplant clinic and cancer center here if youor someone you love needs it.

If each of our members would contacttheir legislators and the Governor, we can helpensure the future vitality of the state. We’velong been proud of the quality education andhealth care provided in Minnesota, and webelieve Minnesotans want to maintain thatquality.

The schools and colleges of theUniversity’s Academic Health Center preparenearly 70 percent of the health professionalworkforce. These will be the pharmacists,dentists, physicians, veterinarians, public

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health professionals and graduate level nurseswho improve the health of our communitiesas well as discover and deliver new treatmentsand cures. Without a strong university, theAcademic Health Center cannot successfullystrengthen the vitality of our health industries.

Let your legislators and the Governorknow—we want a strong Academic HealthCenter for the future of our state. ✦

Sincerely,

Virginia R. Lupo, M.D.Chair, Hennepin Medical Society, and

Robert C. Moravec, M.D.President, Ramsey Medical Society

The University Needs Our Help


Doctor, Who Will Help Me?

P H Y S I C I A N ' S S O A P B O X

W

B Y L E E B E E C H E R , M . D .

WE PHYSICIANS HEAR THE PLAINTIVE CALLS of our patients tohelp them—help them face illness, the uncertainties and traumas of life,and often a plea to help them deal with our fragmented healthcaresystem. As physicians we align ourselves with our patients as victims of ahealthcare system in Minnesota now dominated by huge managed careorganizations. Paul Ellwood, the Minnesota father of HMOs, calledHMOs “accountable health plans” in his 1991 “managed competition”proposal, but today’s behemoth managed care organizations areinsufficiently accountable to patients or responsive to physicians.

It is very difficult for doctors to advocate effectively for patientswhen we ourselves have so little power. Power will return to patientswhen they can make choices about their doctors and treatments.Spokespeople for managed care organizations said they would beaccountable to patients, and if not to patients, to employers through themarketplace. Those who promoted managed competition spoke lessoften about accountability to doctors, but implicit in managedcompetition theory is the notion that physicians would join thosemanaged care organizations which provide quality of patient care andrespect for their professional autonomy. But even as Paul Ellwood nowsays in recent interviews, the competition fantasy turned out to be abust. Whatever “competition” exists between Minnesota health plansnow involves a race to extend the oligopoly beyond the now 95 percentof patients who are tied up in Minnesota managed care organizations.Minnesota managed care organizations don’t compete for patients anddoctors, they own them. When a few sellers rule, they are “pricemakers” and not “price takers.” They dictate the terms of medical careto patients and the working conditions of their labor supply, physicians.

Despite recent claims by Minnesota’s managed care plans that theywill now cooperate in defining medical care practice parameters basedon scientific evidence, with the adoption of standardized medicalpractice protocols, it is virtually impossible to measure the quality ofone managed care organization compared with another. This means it’simpossible to generate competition for patients based on quality ofmedical care. Consumers (patients) have been told that managed careorganizations could be rated by quality report cards allowing patients tomake choices about selecting these plans. But no report cards exist andit is unlikely that the National Commission on Quality Assurance(NCQA), or the Joint Commission on Accreditation of Hospital and

Healthcare Organizations (JCAHO), or the ICSI guidelines willprovide patients with information to allow them to make choices abouthealth plans or physicians.

Employers who purchase managed care health insurance in today’smarket are alarmed about double-digit premium increases andescalating pharmaceutical costs. It seems the way Minnesota managedcare has been able to do a measure of cost containment is by reducingaccess to care. There are three ways to do that: reduce the number ofavailable providers, shift the financial risks for health care to theproviders of care, i.e. physicians, and control the definition of what isreimbursable through “medical necessity” utilization review.

The Minnesota Physician-Patient Alliance (MPPA), building onthe work of Hennepin and Ramsey Medical Societies, recently lookedfor evidence of the ways in which health plans seek to control physicianbehavior through provider contracts with doctors. We were stunned bythe one-sided language we found in these contracts (see accompanyingarticle on page 9: How Contracts Between Health Plans and DoctorsInfluence the Quality of Medical Care and Patient Privacy).

We, at MPPA, realize that patients and physicians together mustwork to change the present system to alter the power of relationshipsbetween patients, physicians, and managed care organizations. Untilthis occurs, our ability as physicians to help our patients will be severelylimited.

Patients should lobby their employers for health care choices thatallow them more power. Unfortunately, their choices are severelylimited. Many employers offer only one or two health plan choices.Patients are also encouraged to partner with physicians in establishingdiagnosis and treatment, with patients assuming more responsibility forpreventing illness and implementing plans of care for illness, includingpharmaceutical treatment. Moreover, patients and doctors are urged toeducate their state and federal representatives about their real worlds ofhealth care. While MPPA physician members write resolutions for theMinnesota Medical Association House of Delegates, MPPA patientmembers add a reality check and partnership through our efforts.Together we have learned that we can’t trust managed care to improvethe quality of medical care in Minnesota, and we shouldn’t expect thisin the future. Our goal is to make managing care the task of doctors andpatients. Check out our website at www.physician-patient.org. Pleasejoin us. ✦

Lee Beecher, M.D., is President of the Minnesota Physician-PatientAlliance.


F E A T U R E S T O R Y

M

F a i r n e s s i n H e a l t hC a re A c t :

Why the Minnesota Legislature

Should Enact the

It’s the Right Thing for Patients

…simply puts intoplace some straight-forward proceduralsafeguards designedto reduce thedisparities inbargaining powerthat currently existbetween the healthplans and patients.

Editor’s Note: The articles on these two pages present two opposing views on the need fora Patient Protection Act.

MANY MINNESOTA PATIENTS FACE an uneven playing field when attempting toobtain coverage from their health plan. The Fairness in Health Care Act (S.F. No. 796/H.F. 868) sponsored by Attorney General Mike Hatch, Senator Don Samuelson (D-Brainerd) and Representative Ron Abrams (R-Minnetonka) would help level these dis-parities by enacting procedural safeguards for the patient.

Why is the Fairness in Health Care Act needed?A July 2000 study by Princeton Survey Research Associates for Henry Kaiser FamilyFoundation and Consumer Reports revealed that 51 percent of consumers under age 65experienced a problem with their health plan in the last year, 43 percent had moderateconsequences (financial problems or change in health status), and 18 percent had seriousconsequences. Indeed, these types of concerns are echoed in the Attorney General’s law-suit against Blue Cross and Blue Shield of Minnesota for denying medically necessarytreatment for children and young adults suffering from eating disorders, mental illnessand chemical dependency.

The procedural safeguards contained in the Fairness in Health Care Act are alsoneeded because of the unique nature of health insurance. Health insurance, unlike tan-gible goods or even financial products, is simply a promise. Patients pay premiums todaywith a promise that coverage will be provided sometime down the road — after thepremiums are paid and after the patient becomes sick.

To make things more complicated, in Minnesota three HMOs control more than80 percent of the health care market. This type of market concentration has consequences.First, it makes it difficult for patients and employers purchasing health coverage to havemeaningful choices or to change health plans if they become unsatisfied. Second, thehealth plans have considerable clout over physicians, because in many cases one-third ormore of a physician’s income is derived from a single health plan.

The Fairness in Health Care Act is not a mandated benefit bill. It does not requirenew coverages. Instead, it simply seeks to put in place some straightforward procedural

B Y A N N B E I M D I E K K I N S E L L A

(Continued on page 6)

The Fairness inHealth Care Act


A… every time theMinnesota Legisla-ture adds more“patient protection”laws, they protectfewer Minnesotans.This is why thefocus of debate isshifting from statelegislatures to theU.S. Congress. OnlyCongress canestablish uniformprotections for allpatients .

AS THE MINNESOTA LEGISLATURE CONSIDERS additional regulation of thehealth care industry in the guise of “patient protection,” it’s necessary to be more in-formed than ever before. Read the papers or watch the news and you’re convinced man-aged care companies are looking for ways to deny every single claim. Never mind that inMinnesota disputes about health plan coverage are quite rare. Most claims are paid with-out question; 86 percent of Minnesotans are satisfied with their health plan, and fewerthan a half of a percent of Minnesotans in HMOs file a complaint or appeal challenginga health plan decision.

So, what’s behind all these “patient protection” proposals? Unfortunately, the realissues that affect the vast majority of consumers are complicated, technical, impersonaland very unsexy. On the other hand, disputes between patients and health plans, whilerare, are much more interesting, personal and emotional, making them great topics forpolitical rhetoric and “investigative” journalism. Because politicians and the media focuson anecdotal exceptions, many people have a distorted picture of reality and are unawareof the real issues behind the headlines. It is hard work to fully understand the real issuesbecause you have to dig for the facts and seek balanced discussions of the issues.

So what is the real issue?The most important fact about health plan regulation is that Minnesota has a two-tieredregulatory system — one federal and one state. The State of Minnesota imposes thestrongest, most comprehensive managed care regulations and patient protections in thecountry. Laws already on the books cover patient access to care, mandated benefits, con-fidentiality, enrollee disclosures, external medical review, grievances and appeals, man-agement and organization structure, patient’s rights, premiums and rating practices, pro-vider contracting, quality assurance and utilization review, reporting and solvency. Thelist goes on. Virtually every topic that comes up in state and national “patient protection”discussions is already addressed in Minnesota law.

But, the majority of Minnesotans aren’t covered by the state’s health care laws be-cause of federal exemptions. State laws apply only to “fully insured” coverage usuallypurchased by smaller employers, individuals and state health care programs. Most of the

B Y M I C H A E L S C A N D R E T T


R e g u l a t e

It’s Time for Congress to

Health Care


Kinsella(Continued from page 4)

safeguards designed to reduce the dispari-ties in bargaining power that currently ex-ist between the health plans and patients.

A summary of thelegislationPre-authorizations Must Be Honored.If an HMO gives pre-authorization fortreatment, it must honor that decision.Right now, a health plan can pre-approvetreatment and then simply change itsmind, for no reason, leaving patients onthe hook for huge medical bills.

No Retaliation.If a physician advocates for a patient’s treat-ment, or disagrees with a health plan’s treat-ment decision, health plans can’t retaliateagainst that physician. Right now, physi-cians and medical facilities may hesitate tostand up to a health plan for fear of losingtheir provider contract. This is particularlytrue in a highly consolidated market suchas Minnesota’s. In addition, the bill pro-hibits retaliation against a physician thatdiscloses concerns to the government orthe HMO. Moreover, the bill provides thathealth plans cannot retaliate against pa-tients who participate in utilization review,obtain a second opinion, or file a claimagainst the plan.

Reviewers Must be Qualified.If a health plan uses a medical reviewer tosecond-guess a physician, the reviewermust be licensed in Minnesota and beboard certified. The reviewer must alsopractice in the same or a similar specialtyas the case they are reviewing. In addition,the medical reviewer must be available bytelephone to discuss his or her decisionswith the treating doctor or the patient.

Specialists Must Be Available.If a patient has a condition that needs aspecialist, health plans must allow accessto such specialists. If an appropriate spe-cialist is not available in the health plan’snetwork, the patient must be allowed togo out-of-network at in-network rates. Thebill also requires health plans to informpatients they have a right to a standing re-ferral. Patients with long-term conditionsdo not have to continually go back to a“gatekeeper.”

Medical Necessity With Certainty.The definition of “medical necessity” is oneof the most important terms in a healthpolicy. Yet, some health insurers define“medically necessary” care as “care that we,in our sole judgment and discretion, de-termine to be medically necessary basedupon our internal standards and guide-lines.” The plans then claim these “guide-lines” are “trade secret.” It’s impossible fora patient to enforce the health plan’s prom-ise to provide medically necessary care ifthe plan has the “sole” discretion to decidewhat that is, and if only the plan knows its“guidelines.” The bill puts an end to thesecrecy and requires plans to reveal theirguidelines. In addition, the bill adopts astandard definition of medical necessityand applies that definition to all healthplans.

Formularies Can’t Change Mid-stream.If a health plan establishes a drug formu-lary, and if it changes that formulary inthe middle of the year, it can’t charge pa-tients more for their prescriptions duringthat contract year. In addition, health plansmust, upon request, disclose their formu-lary before the patient buys the policy.

Court Ordered TreatmentMust Be Provided.If a court orders mental health treatment,health plans must honor that order. Cur-

rently, some health plans routinely denycoverage for court ordered treatment, un-fairly shifting the cost to families and tax-payers.

Health Plans Accountable.If a health plan is going to practice medi-cine and make a treatment decision, itshould be held accountable when its ac-tions harm a patient. In 39 other statesinsurance companies can be sued in courtfor “bad faith” actions. However, undercurrent Minnesota law, health plans can-not be held accountable. The bill providesthat, when certain conditions are met, aclaim can be filed against a health plan.First, a physician must determine treat-ment is medically necessary. Second, thehealth plan must interfere and make itsown treatment decision. Third, in makingits treatment decision, the health plan mustdeviate from an ordinary standard of care.Fourth, the patient must prove the healthplan’s actions caused them harm. Fifth, thepatient must exhaust the external reviewprocess available under state law.

The health plans seem to want it bothways. On one hand, they claim not to prac-tice medicine. On the other hand, theydon’t want to be held accountable if theydo practice medicine. This provision sim-ply puts health plans in line with otherprofessions. Doctors, lawyers, architectsand others can be sued for negligence ormalpractice. Yet, health plans operate withimmunity. When a health plan practicesmedicine, it should be accountable.

The health plans are opposed to thesemeasures. They claim patients are satisfiedand that Minnesota has plenty of laws thataddress these problems. Yet, as explainedabove, patients aren’t satisfied and currentlaw is not adequate. They also claim thechanges would not impact consumers inso-called “self-insured” plans. However, a



people in the state are exempt from theselaws under various federal laws, includingERISA law that exempts large, self-insuredemployers from state insurance regulations.Although many of these people carry ahealth insurance card from a local HMOor health plan, the company is simply hiredby the larger employer or union group todo the administrative work. State patientprotections do not apply.

To make things even more compli-cated, the high level of state regulation andmandated benefits (and the higher coststhat inevitably go with it) create an incen-tive for employers to switch to federallyexempt health plans. As more state regula-tions are added, more employers make theswitch. The past decade has seen a dramaticshift of the state’s population from state-regulated to federally exempt plans. So,ironically, every time the Minnesota Leg-islature adds more “patient protection”laws, they protect fewer Minnesotans. Thisis why the focus of debate is shifting fromstate legislatures to the U.S. Congress.Only Congress can establish uniform pro-tections for all patients.

A word about health plandenials: what would you do?In contrast to today’s popular rhetoric, Istrongly believe health plans should notcover every request for treatment. Studieshave found disturbing problems in Ameri-can health care. Our country pays morefor health care and has poorer outcomesthan other countries. Why? We have notheld our system accountable for providinghigh quality care in an efficient manner.This is changing, but we have a long wayto go.

Sometimes health plans should denycoverage. Sometimes an alternative treat-ment is of higher quality or an alternativeis as effective, but less expensive. Some-

times, the requested treatment is unproven,experimental, or even harmful. Sometimesthe patient has chosen to purchase lowercost coverage, which excludes the requestedtreatment or preferred provider. The truthis, when a health plan denies coverage thereis usually a good reason.

A recent New York Times article onearly stage breast cancer treatment outlinedthe challenges health plans face. A physi-cian requests approval of a radical mastec-tomy. The request is contrary to the Na-tional Institute of Health best practicesguideline of breast conserving surgeryrather than radical mastectomy, and thisparticular physician’s mastectomy rate isten times the regional average. Across theUnited States, there is 33-fold regionalvariation in physicians’ rates of radicalmastectomy for early stage breast cancerand more than 60 percent of physiciansare not using best medical practices.

What is “patient protection” in thecase of a patient who may be the victim ofan unnecessary radical mastectomy?

Of course, we need strong laws to en-sure that denials are appropriate and fair.Fully insured patients in Minnesota havefour options in challenging denials:• A state mandated internal appeal sys-

tem;• An appeal to state regulators;• An independent medical review; and• A lawsuit to compel payments for

needed services.The first three options ensure patients

receive the care they need at the time theyneed it. The third option, a lawsuit, takesmuch longer but can be a way of recover-ing payments after medical services havealready been delivered.

Only Congress can givethe answersUniform protections are needed — some-thing only the U. S. Congress can accom-

number of the provisions would apply toself-insured plans. And, HMOs oppose ac-countability proposals on the federal levelas well, even though those proposals wouldclearly apply to all patients.

The health plans also erroneouslyclaim the legislation will cost too much.In fact, many changes simply require dis-closure — of the right to a standing refer-ral, of the guidelines used to make treat-ment decisions, or of the drug formulary,for example. Other provisions just requirehealth plans to stick with their originaldecision — for pre-authorization or tocover certain drugs, for example. Still otherprovisions just require fairness, like pro-hibiting retaliation and requiring that amedical reviewer be available to the patient.The bill also requires HMOs to keep uptheir end of the bargain — they shouldcover court ordered treatment and theyshould offer access to specialists. Andhealth plan accountability will still allowhealth plans to control costs, just not atthe expense of the patient. The New YorkTimes reported that the first year Texanshad the right to sue, the increase in premi-ums was just 0.1 percent and there has notbeen an onslaught of lawsuits in Texas.

In short, none of the health plan ar-guments overcome the serious imbalanceof power in the current health care equa-tion. The Fairness in Health Care Act is acommon sense way to level the playing fieldand should be enacted. ✦

Ann Beimdiek Kinsella is an Assistant At-torney General and the manager of the At-torney General’s health division. Prior tomanaging the health division, Ms. Kinsellawas a member of the Attorney General’s anti-trust division.

Kinsella(Continued from page 6)

Scandrett(Continued from page 5)



plish. Minnesota’s health plans are in sup-port of the enactment of national patientprotections that:• Hold all players accountable for qual-

ity and cost-effectiveness;• Call for qualified physicians to make

coverage decisions that require medi-cal judgment;

• Give patients several legal options, in-cluding an external medical review;

• Resolve disputes at the time treatmentis needed;

• Do not drive up costs; and• Keep all health policy priorities in

mind: access, affordability and qual-ity.There is always room for improve-

ment, but Minnesotans are well-servedtoday by a health care system that leadsthe nation in access to health coverage,quality of care, prevention, and consumersatisfaction. Minnesota’s sophisticatedmanaged care system is an important rea-son for all of these positive outcomes.

Minnesotans should be wary of pro-posals that could quickly undo the progressMinnesota has made in cost, quality andaccess. Minnesota already has the stron-gest patient protections. More state regu-lations will not benefit consumers but willfurther drive up premiums, cause some em-ployers to drop coverage altogether, andcause others to switch to ERISA plans.

What can you do?Keep abreast of research and best practicesso that health plan review is less of an is-sue. Learn how managed care works andbe an effective advocate for patients. Takea moment to look behind the rhetoric forthe facts. And help keep quality health careaffordable for all. ✦

Michael Scandrett is the Executive Directorfor the Minnesota Council of Health Plans.

1973 “Health Maintenance Act of 1973.” Authorized formation of HMOs andestablished regulations governing covered services, disclosures to enrollees, financialsolvency, patient confidentiality, consumer complaint procedures.

1984 Health plan patient protections and regulations. Contained amendmentsto HMO laws and added topics such as maternity and newborn coverage, secondopinions for mental health and chemical dependency, consumer disclosures.

1988 HMO enrollee “Bill of Rights” and other regulations. Established a com-prehensive “bill of rights.” Also established regulations on referrals to specialists,prior authorizations and second opinions, coverage of emergency care, appeal rights,right to sue.

1990 Health plan patient protections and regulations. Added regulations andrequired reports, strengthened solvency protections, expanded complaint and ap-peal rights and time limits, established new penalties and regulatory powers.

1992 “MN Utilization Review Act of 1992.” Imposed requirements on “utili-zation review” activities of HMOs and other health plans, created new regulationson appeals, confidentiality, quality assessment, financial incentives.

1994 Health plan patient protections and regulations. Required HMOs to sub-mit additional action plans and reports, added regulations for denials of services,mandated expanded access to allied providers, required HMOs to participate ingovernment programs. Also included insurance reforms to improve access and placedlimits on premium rates.

1995 Health plan patient protections and regulations. Required health plansto use alternative dispute resolution, required parity for mental health and chemicaldependency benefits.

1997 “Patient Protection Act of 1997.” Prohibited “gag clauses” and retalia-tion, required disclosure of provider reimbursement, required plain language billingand prohibited exclusive contracting. Also established new regulations on coverageof emergency care, continuity of care when a person’s health plan changes, standingreferrals to specialists, disclosure of executive compensation.

1998 Health plan patient protections and regulations. Further amended lawsrelating to gag clauses, disclosure of provider reimbursement, alternative disputeresolution.

1999 Health plan patient protections and regulations. Established tighter stan-dards for geographic access to providers and established new requirements for con-sumer complaints and appeals, including the creation of an external independentreview process. ✦

Scandrett(Continued from page 7)

History of Minnesota’s Major HMO

“Patient Protection” Laws


T

MPPA Executive Summary–How Contracts Between Health Plans and DoctorsInfluence the Quality of Medical Care and Patient Privacy

Editor’s Note: The Executive Committees of theHennepin Medical Society and the Ramsey Medi-cal Society reviewed the report, “How ContractsBetween Health Plans and Doctors Influence theQuality of Medical Care and Patient Privacy,” andsupports the work of the Minnesota Physician-Pa-tient Alliance (MPPA) as the beginning of a dia-logue about the issues raised in the report. An Ex-ecutive Summary of this document is reprintedbelow for your information. MPPA has developeda number of recommendations in response to theirfindings. As this edition goes to press, these recom-mendations have not been endorsed by HMS orRMS. However, the recommendations are printedhere for your information and may spur furtherattention. A copy of the full report can be down-loaded from the MPPA web site at www.physician-patient.org or contact Kathy Dittmer at HMS(612/623-2885) or Stephanie Stanton at RMS(612/362-3706) for a copy to be mailed to you.

THE MINNESOTA Physician-Patient Alliance(MPPA), a nonprofit, physician and health careconsumer organization, was founded three yearsago for the primary purpose of returning to phy-sicians and patients the authority taken fromthem by the insurance industry. The MPPABoard of Directors includes: Lee Beecher, M.D.,President; Al Anderson, M.D., Secretary-Trea-surer; Ted Fritsche, M.D.; Robert Geist, M.D.;Robert Milavetz, J.D.; Ed Spenny, M.D.; andKip Sullivan, J.D.

MPPA undertook the compilation of thisreport, “How Contracts Between Health Plansand Doctors Influence the Quality of MedicalCare and Patient Privacy,” to help the public

understand how managed care organizationshave usurped physician-patient authority overmedical decision making. It examines in greatdetail Minnesota health plan-physician contractsfrom Blue Cross and Blue Shield of Minne-sota, BluePlus, HealthPartners, Medica, andPreferredOne. The contracts from these fiveplans were selected because together they havecontrolled 80 percent of the Minnesota healthinsurance market since 1994.

The report (as opposed to the long appen-dices) is easy to digest, and we urge every physi-cian practicing in Minnesota to read it. We be-lieve all but the most lawyerly of doctors willfind something in the report to be surprisedabout, and all readers of the report should beconcerned by its findings. That was our reac-tion. We found many provisions in these con-tracts designed to strengthen the hand of theplans at the expense of the doctors and patients.

Because of MPPA’s emphasis on the phy-sician-patient relationship, we focused our ex-amination of the contracts on those provisionsthat affect quality of medical care and privacyof patient records. We ignored numerous pro-visions in the contracts that did not clearly anddirectly affect quality and privacy. The reportexamined these nine categories of contractclauses which:(1) with little or no regard for the health sta-

tus of the doctor’s patients, entitle doctorsto earn more money if they order fewermedical services and which obligate themto earn less money if they order more medi-cal services;

(2) permit health insurance companies to ter-minate contracts with doctors without hav-ing to give an explanation;

(3) allow health insurance companies to

change unilaterally the terms of the con-tract with doctors in the future after it issigned;

(4) obligate doctors to follow rules and poli-cies affecting quality of care promulgatedby the insurance company, but definingthese rules and policies poorly or not atall;

(5) give health insurance companies controlor influence over physician referrals, ad-missions, and prescriptions;

(6) limit or eliminate the company’s liabilityin the event that doctors are alleged to pro-vide inferior medical care in whole or inpart because of the financial incentives,rules, policies or behavior of health plancompany employees;

(7) discourage doctors from discussing relevantmatters with their patients or the public atlarge (gag clauses);

(8) offer vague descriptions of the process adoctor may follow in the event the doctorwants to challenge a decision by a healthinsurance company to deny medical careto a patient or, in some cases, no descrip-tion at all;

(9) obligate the doctor to turn patient medi-cal records over to the health insurancecompany whether the patient approves ornot.We examined these five contracts:

• Blue Cross and Blue Shield of Minnesota(BCBSM) Aware Agreement, effective July1, 1999;

• BluePlus Primary Care Clinic Provider Ser-vice Agreement, effective January 1, 2001;

(Continued on page 10)B Y L E E B E E C H E R , M . D .A N D K I P S U L L I V A N , J . D .


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• HealthPartners Referral Provider Agree-ment, effective March 15, 1999;

• Medica Self-Insured Associate Clinic Par-ticipation Agreement, effective February 1,1999;

• PreferredOne Workers’ CompensationProvider Agreement, effective January 1,2000.The report does not claim, and we do not

claim here, that these five contracts are repre-sentative of all contracts issued by these plans.We selected these contracts because they werethe most recent of the contracts examined bythe HMS and RMS medical societies as part oftheir ongoing health plan contract analysisproject.

Each of the nine types of clauses, along withthe recommendations of the MPPA Board fordealing with the problems created by theseclauses, are discussed in the report (available onthe website). The recommendations rely heavilyon legislative actions.

Risk-SharingRisk-sharing requirements were found in twoof the five contracts. Risk-sharing means thatphysicians benefit financially when less treat-ment is provided. Virtually all experts agree thatrisk sharing payment methods that are not ad-justed to reflect the health status of patients seenby particular doctors or clinics put great pres-sure on the physicians who see sick patients todeny services to them. Adjusting payment meth-ods to reflect patient health is known as “riskadjustment.” One study cited in the reportfound that the value of medical services actu-ally provided to patients by a primary care“group” ranged from $3 per member per monthto $27. However, the study found that the doc-tors in this group were paid $10 to $12 permember per month. Obviously, the doctors see-ing the $20 and $25 patients were under greatpressure to reduce services to these patients.Neither of the two contracts that required risk-sharing obligated the plans to risk-adjust thosepayments.

MPPA Recommendation:We believe risk-sharing without risk adjust-ment poses such a serious threat to quality ofcare that the Legislature should declare such pro-visions illegal and, until then, physicians shouldseek to strike such provisions from their con-tracts.

Contract TerminationAll five of the contracts examined allow the in-surers to terminate physicians with no explana-tion. This exposes doctors to the risk that theywill be unable to explain to other health insur-ance companies why they were terminated. Thisfact gives the insurers leverage over doctors thatdoctors do not have over insurers.

MPPA Recommendation:We recommend that the Legislature prohibitclauses that authorize plans to terminate physi-cians without good cause and without an ex-planation.

Contract ModificationsAll five contracts contain clauses giving the com-panies the authority to change the contract af-ter the contract has been signed. Two of thesecontracts give the physician the right to vetothe amendments, but we could not determinewhether these “right to veto” clauses take prece-

dence over numerous other clauses authorizingunilateral amendments by the health insurancecompanies.

MPPA Recommendation:We recommend that the Legislature outlaw suchclauses, and we urge physicians to insist that alldocuments cited in the contracts they sign beattached to the contracts.

Contract TerminologyAll five contracts contain vague terminologydesigned to enhance the power of the healthinsurance company at the expense of the doc-tor. For example, the BluePlus contract requiresclinics to “comply with all rules and regulations,quality improvement, care management, andutilization review requirements and proceduresestablished by BluePlus from time to time, in-cluding but not limited to” a list of five vaguelydefined programs.

MPPA Recommendation:We recommend that the Legislature pass legis-lation that: (a) prohibits plans from placing intheir contracts clauses that require physiciansto treat the contract as a secret; (b) authorizesthe Departments of Health and/or Commerceto publish all plan-provider contracts on a regu-lar basis; and (c) requires managed care organi-zations to file annual reports with a state agencydescribing in detail the programs most com-monly cited in their contracts, notably, “qualityassurance” and “utilization review” programs,as well as all practice guidelines relied upon bythe plan to make medical necessity decisions.

Referrals, Admissions,and PrescriptionsAll five contracts give the insurance companiesconsiderable influence over admissions and re-ferrals, and some mention drug prescribing aswell.

MPPA Recommendation:We recommend that legislation be developedand passed that requires all plans to file reportsannually with an appropriate state agency de-scribing any guidelines or evidence they rely onto decide whether to allow a referral or an ad-mission, all evidence relevant to a decision notto include a drug in a formulary or in a favoredtier formulary, and discounts and rebates to hos-pitals and drug manufacturers that do businesswith the plan. The legislation should require that

MPPA

(Continued from page 9)


the state agency that receives this informationmust publish it. We also favor full public internetdisclosure of all health plan formulary drugs,patient co-payments, and formulary overriderules.

LiabilityAll five contracts go to considerable lengths toplace all responsibility for the quality of medi-cal care delivered to patients on the doctor andto insulate the insurers from any legal liability.Clauses in some of these contracts even obli-gate the doctor to concede in advance that noth-ing the health insurance company might docould possibly influence the doctor’s behavior.

MPPA Recommendation:We recommend that such clauses be outlawedby legislation, and that the Legislature shouldenact SF 414 introduced this year and supportedby the MMA which amends the current utiliza-tion review statute to require that physicians whoconduct UR “must be licensed in the state andmust be currently practicing in the same spe-cialty as the physician who is ordering care.”

“Gag Clauses”All five contracts obligate doctors not to talkabout broadly and poorly defined topics.HealthPartners’ contract, for example, states thatthe doctor may not discuss “all information re-lating to the operations of HPI (HealthPartners,Inc.).” To take another example, the list of sub-jects in the PreferredOne contract that physi-cians may not discuss is long, and includes vaguephrases such as “methods, systems, practices orplans.”

MPPA Recommendation:We recommend that legislation be created thatprohibits “gag clauses” that cover anything ex-cept information about patients and plan en-rollees. There is simply no public interest servedby clauses which prevent physicians from talk-ing about how managed care organizations payphysicians, how they decide what drug will beon a formulary, how they make “medical neces-sity” decisions, how they develop guidelines, etc.

Appeal ProcessNone of the contracts describe in sufficient de-tail their processes for hearing physician objec-tions to decisions by insurance companies notto authorize a service, and three offer no detail

at all. This is an example of an issue discussedby the AMA in its Model Contract.

MPPA Recommendation:We endorse the AMA’s call for clear contractualprovisions describing how physicians may ap-peal any decision the physician believes is ad-verse to the patient’s interest. We go beyond theAMA’s recommendations and recommendclauses that require the plan to turn over to thephysician all guidelines, studies and other evi-dence the plan relied on in reaching the dis-puted decision. Because this solution seems soobviously justifiable, we think this solution maybe achievable in negotiations between physiciansand plans.

Release of Medical RecordsAll five contracts contain abundant languageauthorizing plans to demand patient recordsfrom doctors. Only two of the contracts men-tion patient consent, and these two place theburden of extracting consent on the doctor.Minnesota already has a law on the books thatprohibits the release of medical records withoutpatient consent.

MPPA Recommendation:We recommend an investigation by the Legis-lature to answer the question: Is the current lawbeing honored and, if not, what role do plan-physician contracts play in violating the law?

The complete report, “How ContractsBetween Health Plans and Doctors Influencethe Quality of Medical Care and Patient Pri-vacy,” can be downloaded from the MPPA website at www.physician-patient.org, or, for a hardcopy, please contact: Kathy Dittmer, HennepinMedical Society, (612) 623-2885, email:[email protected]; or Stephanie Stanton,Ramsey Medical Society, (612) 362-3706,email: [email protected]. ✦

Lee Beecher, M.D. is president of MPPA, a westmetro MMA trustee, and a psychiatrist in SaintLouis Park.

Kip Sullivan, J.D., is a graduate of HarvardLaw School and the author of nearly 100 articlesabout health policy. He has published in theNEJM, Health Affairs, the Am J. Pub Health,the NY Times, the LA Times, Minnesota Physi-cian, the Pioneer Press, and the Star Tribune.

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C O L L E A G U E I N T E R V I E W

Kent Neff, M.D.

Editor’s Note: “Colleague Interview” provides HMS and RMS mem-bers with an opportunity to ask questions of their colleagues who are inunique roles. In this issue, interview questions were asked by Drs.: BruceAdams, William Petersen, Michael Tedford, Deane Manolis, Ann Lowryand Kathy Sweetman.

How did you become interested in physician stress?

My first work after residency was to develop a psychiatric program in alarge private urban teaching hospital, and I was the only psychiatrist withan office in the hospital. So many physicians and family members werereferred for evaluation and treatment. And I was asked to consult regard-ing physicians with disruptive behavior, alcoholism, and the like. Eventu-ally the medical association asked me to establish a Physicians AssistanceProgram, and physician stress became a major interest.

What are common behavior problems you see inphysicians? How do you address them?

One of the most common behavioral problems currently seen in physi-cians is a competent, often excellent, highly productive physician withvery high standards who strives for perfection but does not treat otherskindly in the process. He or she means well, but the behavior is harsh anddisrespectful. And the doctor has little realization of the negative effectshis behavior has upon others around him.

Another common problem is inappropriate outbursts of anger to-ward nurses and even patients when the doctor is under stress. There areseveral key aspects to addressing these problems. First, it is important tohave a fairly low threshold of tolerance for this kind of behavior. Second,separate the behavior from the person. Be hard on the behavior, but re-spectful toward the individual. Third, don’t let it continue. Intervene, pref-erably with several colleagues, and tell the individual that you value himbut that his behavior is unacceptable. Fourth, be willing to set limits andapply consequences when the behavior does not change. Finally, providesupport to the physician during the rehabilitation process. It is very im-portant to give the physician a reasonable opportunity to change his be-havior and allow him to return to work when he makes needed changes.

What are the most effective ways to support staff members(M.D./Non M.D.) who must interact with a disruptivephysician?

One of the best ways to support those who must deal with these behav-ioral problems is to adopt a written behavioral standard for workplace

behavior. One I have used is called the “Principles of Partnership,” anddescribes the rationale for insisting upon respectful behavior in the work-place. This is helpful in alerting physicians to the fact that all our behav-ior, not just the clinical part, is important.

Given a workplace where endemic abuse is ignored or per-petrated by those in high level positions (often physicians),have you any knowledge of successful initiatives by individu-als or groups at the bottom or middle of the hierarchy? Shortof leaving, how do you advise people to handle these situa-tions? It has been my experience that these people are at riskof being labeled “disruptive.”

There is a lot more that individuals at all levels of the hierarchy can dothan is generally appreciated. Empowerment of all workers is one of thekeys to success. An empowered worker can set limits much better right onthe spot. Physicians will often respond to these limits and improve theirbehavior. I recall many experienced nurses who were never treated poorly— they simply carried themselves in a manner that commanded respect.We are seeing increasing numbers of workers who, when subjected tobehavior they considered abusive, are filing harassment claims with thehospital. There is considerable liability for both hospitals and medicalgroups when this occurs.

What tactics have you found to be most successful inaddressing problems of drug and alcohol abuse in physicians?

Alcoholism and drug addiction remain common among physicians. Theyare highly treatable and have a very good prognosis. The great majority ofphysicians with these illnesses can be successfully rehabilitated and returnto a productive life. Key elements in success include the following: First,ongoing education of physicians and staff about the signs and symptoms


as well as the good prognosis. It is critical that the organization have atruly rehabilitative orientation, so everyone knows that physicians are val-ued and every effort will be made to support the physician in his rehabili-tation. Second, the process must be fully confidential at all levels. Third, itis important to develop written policies and procedures that reflect thesepositive attitudes, but set limits on inappropriate behavior. Defining clearlimits on the use of alcohol and drugs in the context of practice is helpful.Also, having the right to request a body fluid specimen for cause when thephysician shows signs of intoxication is very important. I do not like ran-dom drug testing at all, except in a physician who is a known addict andis being monitored. Fourth, prompt intervention by a group of concernedphysician colleagues who insist on appropriate evaluation and treatment.Fifth, these physicians must be carefully monitored to insure that theyremain safe to practice. Such monitoring is not usually a problem if it isplanned for in advance.

In addition, setting up a Physicians Assistance Committee (PAC) inyour medical group or hospital can have a very positive effect on identify-ing, intervening with, and monitoring these physicians. Such a commit-tee would consist of respected, experienced physicians representing differ-ent specialties who would be expected to develop expertise in dealing withthese problems. Having several recovering alcoholic physicians on thecommittee is critical if they can be identified. These physicians can bepowerful motivators for physicians in difficulty.

A violation of professional boundaries is devastating to notonly the patient(s), but to the physician and the medicalcommunity as well. How do you effectively counsel aphysician who has been accused and/or convicted of suchactivities?

The area of professional boundary violations is very important and highlycomplex. Such violations are much more common than is generally real-ized. It is often not possible to tell how serious the problem is from thenature of the boundary transgression. Again, a firm, yet rehabilitative ap-proach works best.

In terms of counseling the physician accused of such activities, I liketo tell him that being honest about what happened and making an openinquiry into what made him vulnerable for the problem behaviors areessential. Not only are the roots of such behavior usually chronic condi-tions, the same roots lead to increased distress and unhappiness. Oftenthese boundary violations are “red flags,” which indicate other unresolved,painful personal issues. Without appropriate treatment, the problem be-haviors may well recur, despite the physician’s best intentions. With goodtreatment and monitoring, a majority of such physicians, in my experi-ence, can return safely to practice. And, remarkably, these rehabilitatedphysicians and their spouses often report that their lives have substantiallyimproved, personally, as well as professionally.

How are patients/physicians usually referred to you, andwhat resources can you recommend for physicians whoneed evaluation?

Physician patients are both self-referred and referred by colleagues in po-sitions of leadership, with the latter being more frequent. Physicians whose

behavior is problematic are often the last to recognize how serious a prob-lem it has become.There are two programs in the midwest which evaluatephysicians with behavior problems: Rush Behavioral in DuPage, Illinois,and the Menninger Clinic, in Topeka, Kansas.

With the JCAHO requirement that hospital medical staffshave a method to determine how to deal with physicianhealth issues, what advice can you give medical staff leaders?

Take the long view. Be proactive and positive rather than punitive. De-velop a program that will be helpful to physicians in addressing a wide-range of behavioral, mental, emotional, stress, and physical issues that arereally just part of the human condition. Support them in the rehabilita-tion process.

Can you give us your thoughts on the basic Hippocratic Oathand how this relates to the impaired physician?

This is a significant issue. We often cut way too many corners with col-league physicians when they come for help. It is important to convey atruly nonjudgmental, accepting attitude when colleagues give signals thatthey might need psychiatric help. Insist that they receive care in an appro-priate medical setting, communicating the message that they are too valu-able to receive less than optimum care. It is also critical to give the doctorpermission to be sick when that is appropriate, and to allow himself to betaken care of. Usually this means being assertive and directive with thephysician patient. I have seen numerous physicians who needed a briefmedical leave, but who were continuing to try to take care of their pa-tients — when they were just barely able to hang on themselves. It is verydifficult, as you know, for many physicians to be in the patient role. Re-member that, at some point, patient care may be compromised — the lastthing that the physician wants to happen.

Any thoughts on helping physicians accept need forpsychiatric consultation/care, rather than “curbstoneconsults?”

We need to pay more attention to the important role of grief in medicalpractice. We see physicians with extraordinary levels of unresolved grief— some related to professional life, and some, personal. Physicians oftentend to continue to move forward without stopping to address their owngrief and losses. It piles up and can cause serious problems for the doctor.Some specialties, oncology, for example, are particularly difficult in termsof the cumulative losses they present to the physician.

Please feel free to make any additional comments.

These are extraordinarily difficult times for physicians. Distress is ram-pant. Many physicians are working far beyond sustainable levels and en-joying it less and less. The joy of practice is gone for many of our col-leagues. I think it is time that we as a profession begin addressing theseproblems in a more aggressive and proactive manner. No one else will doit for us. ✦


D

Building New Foundations —Surviving and Thriving Inside Corporate Medicine

Editor’s Note: The following is a follow-up toan article that appeared in the March/Aprilissue of MetroDoctors on physicians leavinglarge groups for independent practice.

DOCTORS CHOOSING independent prac-tices are often seeking personal freedom and pro-fessional autonomy. Doctors choosing largehealth systems and medical groups have otherreasons in mind. I recently talked with five doc-tors who have either joined or sold their prac-tices to large systems and groups.

Decisions are BothFinancial and PersonalConventional wisdom in the Twin Cities saysthat by the mid-1990s independent practicesbecame endangered species. The burden of jug-gling practice demands, absorbing rent increasesand satisfying staff salary demands were morethan most doctors could bear. “We sold outwhen office overhead hit 70 percent and wecould not make our base-income,” recountedDoug Godfrey, M.D., Allina Medical Group.

Jim Giefer, M.D., HealthEast InternalMedicine, added, “We were concerned that ina few years the value of our practice, the oppor-tunity to be compensated for our equity, wouldbe gone.” By the mid-1990s most practices hadnegotiated a sale to a health system or large groupin exchange for cash and income guarantees. Theonce hot market for practice purchases went coldjust after that.

Not all decisions about practice setting aredriven by economics. Matt Layman, M.D.,Twin Cities Anesthesia, PA, recently moved toSt. Paul from Bismarck, North Dakota. “Bis-marck is a fine place to live but we wanted to becloser to our families and live in a larger metro-politan area.” For Layman, joining a large anes-thesia group opened up new professional op-

portunities. Charles Terzian, M.D., United Hos-pital, talked about personal priorities. “Mychoice was definitely tied to family. I wantedregular hours and a shorter commute so I couldspend more time with our new daughter. My wifeis in a sales position at a major corporation andtravels frequently, so I needed to be home more.”

It is Different and It can be BetterNo one I spoke to is practicing at a leisurelypace. “We put in the same amount of time butsee more patients,” Godfrey noted. “Makingyour numbers means shorter contact times; a20-minute level-3 visit is now 15 minutes, a 60-minute physical exam is 45 minutes.”

Len Parsons, M.D., Park Nicollet Clinic,mentioned “I haven’t personally changed as aphysician but there’s no question my practicestyle has been ‘morphed’ by corporate rules.”Or as Godfrey said, “I make a point of ignoringrules that I don’t believe make sense for goodpatient care.” But there are subtle pressures onphysicians to change their practice profile. “Sys-tem executives talk to us family practitionersabout high volume, high margin services andhow obstetrics is not worth our time,” Parsoncommented.

Trying to keep up with a traditional officepractice takes its toll in other ways. “Whenevera hospitalized patient took a bad turn I was re-ally torn,” said Terzian. “Did I drop everythingor stay at the office and maintain my sched-ule?” The increasingly “helpless feeling that camefrom not being able to do it all” pushed Terziantoward his new career as a full-time hospitalist.“I miss office practice, the ongoing contact withpatients,” he said, adding, “and I miss smallthings like talking with pharmaceutical repre-sentatives about new medications.”

Adjusting to Reality ofCorporate MedicineEconomics may be a primary reason for givingup an independent practice but, “you have to

understand,” Godfrey emphasized, “that oper-ating costs in big groups and systems are notlower — you work at a faster pace to make upfor higher overhead and you don’t give free ser-vices or extras.”

The culture of a big group or system canbe a shock. “You will be a provider number andyour patient will be a chart — be ready to livewith that,” Parsons warned. Working as a staffphysician is different but as Terzian remarked,“Sure you lose autonomy but you’re not man-aging daily headaches like regulations, reim-bursement and recruiting.”

The transition may be toughest for physi-cians in their peak practice years and who havebeen accustomed to independence. “They knowwhat they’re giving up and they know they can’tretire soon,” Layman observed.

The hierarchy, meetings and memos thatseem to define corporate medicine create theirown stresses. “Going from running my ownshow to being an employee was a challenge forme,” admitted Parsons. The relative stability andsecurity of a big system means giving up free-dom and authority. “We don’t decide who’s hiredor fired, and losing a valued employee is frus-trating because we can’t change the conditionsthat led to their departure,” Godfrey observed.

Know What You Wantand Care AboutNegotiate the best possible terms at the frontend several stressed. “Don’t assume you can bar-gain for better terms once you’re hired,” Lay-man cautioned and then suggested, “Ask your-self what you want from your practice and yourcareer.” A decision to join a system or large groupcan be a step backward or a step forward. “Ifyou’re a partner, the authority and seniorityyou’ve built up in your group disappears.”

Godfrey looked back on his decision andconcluded, “Personally, I’d make the same choicetoday because conditions haven’t changed.”Giefer echoed that thought saying, “I’m con-B Y B O B T H O M P S O N


tent — it was the right choice for me at thattime — maybe I could have hung on but theheadaches would have been a huge distractionfrom my patient care.” Giefer added, “My ad-vice is to stay independent if you’re satisfied withyour income and can live with the hassles ofpractice management.”

Recent graduates don’t have to make thatemotional and financial adjustment. “Theyhaven’t had the experience of practicing in tra-ditional, independent settings,” Giefer said. Thenewest generations of physicians may be moreidealistic; that is more focused on medical prac-tice and less on medical economics. “Older phy-sicians certainly derive great satisfaction fromcaring for patients but the considerable financialrewards so prominent 20 and 30 years ago un-doubtedly influenced who chose medical careers.”

Rebuilding the Practice of MedicineThe next 15 years are expected to be about ab-sorbing the changes of the past 15 years andbuilding a foundation for corporate medicalcare. “I expect to see greater use of extenders,”Godfrey predicted, “with the doctor function-ing as team leader and consultant.” Terzian sug-gested “Segmentation by the type of patient andalong the continuum of care will increase whileinformation technology will overcome the frag-mentation that we see now.”

Yet to develop adequately among corpo-rate medical practices are concepts like profes-sional growth and career tracks. “Primary caretoday looks like a dead-end profession,” Godfreysaid, “when you compare the up-front personalinvestments with the probable lifetime earn-ings.” Terzian believes younger physicians arethinking strategically about career plans and havedefinite professional and personal goals in mind.

Some Ominous Prospects“Niches for nimble, independent practices stillexist in the Twin Cities but options for primarycare practices are dwindling fast,” Parsons be-lieves. Doctors will not come to or stay in a re-gion with a heavy-handed managed care envi-ronment. “We’re headed for serious physicianshortages in the Twin Cities simply because ourpractice environment doesn’t attract or keepdoctors with better options,” Giefer maintains.

Layman asked, “If we lose many of our bestsenior physicians to early retirement who willmentor younger doctors?” A recent transplantto the Twin Cities, he remains shocked by thecumulative effects of consolidation and cut-backs. In contrast, he said, “Bismarck doctorsretain a strong sense of community identity and

responsibility.” He is surprised at how much hemisses the deep sense of mission expressed atSt. Alexius Medical Center in Bismarck. “Callme an idealist,” he declares, “but I want to dosomething about the professional apathy that Isense in the Twin Cities.”

Reclaiming a Future with PurposeCan an older generation of doctors rally togetherto show the younger generation that there is a

better way? Layman believes “we must begin amovement that puts back into medicine a stron-ger sense of purpose and excitement.” ✦

Bob Thompson is an independent hospital and phy-sician consultant. Bob has worked across the U.S.enabling doctors, hospitals and large systems to im-prove their performance and regain their sense ofpurpose. He can be reached at www. [email protected], or 952/929-7270.

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American Medical AssociationPrinciples of Medical Ethics

Editor’s Note: The Principles of Medical Ethicsare under consideration and will be reviewedby the AMA House of Delegates, June 2001.Please go the AMA’s web site for details pertain-ing to the proposed revisions. www.ama-assn.org/CEJA.

Future issues of MetroDoctors will includefurther decscription of the Code of MedicalEthics.

Preamble:The medical profession has long subscribed toa body of ethical statements developed prima-rily for the benefit of the patient. As a memberof this profession, a physician must recognizeresponsibility not only to patients, but also tosociety, to other health professionals, and to self.The following Principles adopted by the Ameri-can Medical Association are not laws, but stan-

dards of conduct which define the essentials ofhonorable behavior for the physician.

I. A physician shall be dedicated to provid-ing competent medical service with compassionand respect for human dignity.

II. A physician shall deal honestly with pa-tients and colleagues, and strive to expose thosephysicians deficient in character or competence,or who engage in fraud or deception.

III. A physician shall respect the law and alsorecognize a responsibility to seek changes inthose requirements which are contrary to thebest interests of the patient.

IV. A physician shall respect the rights of pa-tients, of colleagues, and of other health profes-sionals, and shall safeguard patient confidenceswithin the constraints of the law.

V. A physician shall continue to study, applyand advance scientific knowledge, make relevantinformation available to patients, colleagues, andthe public, obtain consultation, and use the tal-ents of other health professionals when indi-cated.

VI. A physician shall, in the provision of ap-propriate patient care, except in emergencies,be free to choose whom to serve, with whom toassociate, and the environment in which to pro-vide medical services.

VII. A physician shall recognize a responsibil-ity to participate in activities contributing to animproved community. ✦

Source: Code of Medical Ethics, American Medi-cal Association, © 2000.


F

Fundamental Elements of thePatient-Physician Relationship

FROM ANCIENT TIMES, physicians have rec-ognized that the health and well-being of pa-tients depends upon a collaborative effort be-tween physician and patient. Patients share withphysicians the responsibility for their own healthcare. The patient-physician relationship is ofgreatest benefit to patients when they bringmedical problems to the attention of their phy-sicians in a timely fashion, provide informationabout their medical condition to the best of theirability, and work with their physicians in amutually respectful alliance. Physicians can bestcontribute to this alliance by serving as theirpatients’ advocate and by fostering these rights:

1. The patient has the right to receive infor-mation from physicians and to discuss the ben-efits, risks, and costs of appropriate treatmentalternatives. Patients should receive guidancefrom their physicians as to the optimal courseof action. Patients are also entitled to obtaincopies or summaries of their medical records,to have their questions answered, to be advisedof potential conflicts of interest that their phy-sicians might have, and to receive independentprofessional opinions.

2. The patient has the right to make deci-sions regarding the health care that is recom-mended by his or her physician. Accordingly,patients may accept or refuse any recommendedmedical treatment.

3. The patient has the right to courtesy, re-spect, dignity, responsiveness, and timely atten-tion to his or her needs.

4. The patient has the right to confidential-ity. The physician should not reveal confiden-tial communications or information without theconsent of the patient, unless provided for by

law or by the need to protect the welfare of theindividual or the public interest.

5. The patient has the right to continuity ofhealth care. The physician has an obligation tocooperate in the coordination of medically in-dicated care with other health care providerstreating the patient. The physician may not dis-continue treatment of a patient as long as fur-ther treatment is medically indicated, withoutgiving the patient reasonable assistance and suf-ficient opportunity to make alternative arrange-ments for care.

6. The patient has a basic right to have avail-able adequate health care. Physicians, along withthe rest of society, should continue to work to-ward this goal. Fulfillment of this right is de-pendent on society providing resources so thatno patient is deprived of necessary care becauseof an inability to pay for the care. Physiciansshould continue their traditional assumption ofa part of the responsibility for the medical careof those who cannot afford essential health care.Physicians should advocate for patients in deal-ing with third parties when appropriate. ✦

Source: Code of Medical Ethics, American Medi-cal Association, © 2000.

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UUNDER THE AUSPICES of the MetropolitanHospital Physician Leadership Committee, 16physicians gathered at the State Capitol for ahearing before Senators John Hottinger andSheila Kiscaiden, and Representatives Jim Abelerand Fran Bradley on February 27. VirginiaLupo, M.D., HMS Chair, and Robert Moravec,M.D., RMS President, framed the purpose ofthe meeting as an opportunity to present theconcerns of the medical community about theloss of 1,200 nursing home beds in the metro-politan area in the past year, the recommendedclosure of more nursing home beds by the Min-nesota Department of Human Services, the in-creasing length of stays in hospitals caused bythe nursing home bed shortage, and the capac-ity limits of hospitals and nursing homes due tothe shortage of nurses and other personnel.

The physicians had an opportunity to de-scribe situations of ambulance diversions froma hospital “closed” due to the lack of capacity inthe emergency room, which may be as a resultof no in-patient beds available in the hospital.No availability of nursing home beds has con-tributed to this “capacity crunch,” which in ad-dition to providing long-term care for patientsin need, also serve as short-term rehabilitative

institutions. The shortage of nurses and otherpersonnel was additionally credited with theinability to staff licensed beds at both hospitalsand nursing homes. Another area of concernexpressed was for the possible risk of decreasedquality of care when emergency rooms are forcedto serve as intensive care units, and for a patientwho is delivered to another ER/hospital that maynot be equipped to care for the patient’s needs.

The legislators acknowledged that theworkforce shortage is a significant concern, how-ever, the legislators noted they might not be thebody that can solve this problem. Before build-ing new training programs, there is a need tofocus on filling current slots. Sen. Kiscaiden andRep. Abeler both suggested “career laddering”as possible solutions whereby employers, in col-laboration with academic centers, would offeron-site training and incentive programs to em-ployees to learn a new skill.

The legislators offered two challenges tophysicians:• Provide your legislators with the expertise/

information to best address these issues;• Encourage public involvement. The pub-

lic needs to understand these health careissues and the consequences for not ad-dressing them appropriately. The focus ofthe public is currently on education, there-

fore, health care is taking a back seat. Ifhealth care is to be a priority at the legisla-ture, physicians and the public need to bemore vocal.

The following physicians participated inthis meeting:

David Anderson, M.D.Robert Beck, M.D.Arthur A. Beisang, M.D.Mick Belzer, M.D.Ray Gensinger, M.D.Bruce Hyde, M.D.Frank Indihar, M.D.Donald Jacobs, M.D.Peter Kelly, M.D.Virginia Lupo, M.D.Robert Moravec, M.D.Aaron Nathenson, M.D.Michael Popkin, M.D.Shelley Springer, M.D.David Swanson, M.D.T. Michael Tedford, M.D. ✦

Hospital Bed Capacity IssueGets Attention of Legislators

HMS and RMS members met with legislators regarding the hospital bed capacity issue.Representative Fran Bradley and SenatorSheila Kiscaiden.

Representative Jim Abeler.


AAS SPRING HAS BARELY sprung, it is diffi-cult to already start thinking about autumn inMinnesota. A time when the spring green leavesturn maroon and gold, crisp wind blows fromthe north, and Canadian geese fly south inpreparation for the winter. It is also a time whenphysicians, medical residents, and medical stu-dents from all over the state of Minnesota gatherin one location for an annual event of majorimportance to the health of Minnesota. It’s theMinnesota Medical Association (MMA) AnnualMeeting, an annual event in my life for the lastthree years as a delegate. This year it will be heldin St. Cloud, Minnesota, September 19-21.

The MMA Annual Meeting is when theHouse of Delegates meets to determine the poli-cies and agenda of the MMA each year. TheHouse of Delegates is a legislative body of theMMA and consists of members representingcomponent medical societies, specialty societ-ies, and sections of the MMA such as medicalstudent and resident/fellow sections. The over-all membership of a group determines the num-ber of delegates and members of each groupchoose their delegates and alternate delegates.The role of a delegate is to act as a representa-tive for others in their group. It is, therefore,important that members of the group notify thedelegate if they have strong views on issues. It isalso important for members of the group toconsider volunteering for the role of delegate.

I have been designated a delegate for thelast three years through my involvement inRamsey Medical Society as a Family PracticeTrustee, and now as secretary. The experiencehas been incredible and I would highly recom-mend it to any physician feeling the need to“advocate” for their patients and “to do some-thing” about the profession of medicine. I’ve

Designated a Delegate

especially enjoyed the honor of being a Refer-ence Committee member and in 2000, a Ref-erence Committee chair. The experience hasgiven me a deeper understanding of the healthissues facing our patients, such as a resolutionto investigate the price of prescription drugs,and the professional issues, such as advocatingfor improved reimbursement and opening dis-cussions to empower physicians to collectivelynegotiate contracts with health plans.

The House of Delegates debates andadopts resolutions put forth by MMA mem-bers. Prior to the annual meeting, resolutionsare developed and submitted by MMA mem-bers, component medical societies, and specialtysocieties. This allows physicians and medicalstudents to advocate for patients, address im-portant current health related issues and advo-cate for the profession of medicine.

At the annual meeting, the resolutions aresent to reference committees composed of mem-bers of the MMA who have agreed to serve aschair or a committee member. The referencecommittees hear testimony from the resolutionsponsor or delegates or other interested indi-viduals in organizations. The reference commit-tees, with the exceptional assistance of the MMAstaff, prepare reports to be presented to theHouse of Delegates for debate, consideration,amendment, and eventual vote for adoption.

Adopted resolutions become policy of theMMA and determine the work plan for theMMA each year. Some resolutions are referredto the Board of Trustees for study or action. TheBoard of Trustees manages the ongoing affairsof the MMA and some of the work is accom-plished through the 12 standing committees ortask forces designated by the MMA. Reports ofthe Board, committees, and task forces are pre-sented each year at the annual meeting.

I’ve been very impressed by the MMA staff,their knowledge of the issues, and their ability

to be proactive to effectively advocate for physi-cians and public health issues effecting Minne-sotans. MMA lobbyists and policy analysts re-view and advocate for fair and effective legisla-tion and regulations for physicians and theirpatients. As a delegate to the MMA AnnualMeeting and Reference Committee participant,this allows physicians to have representation inpublic policy making.

Through involvement in our componentsocieties at the local level and as delegates at thestate level, physicians will have their voices heardto advocate for their patients and the profes-sion of medicine. I greatly encourage your indi-vidual involvement. ✦

B Y J A M I E D . S A N T I L L I , M . D .

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No, we’re NOT clowning around!


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Governor’s Budget RefocusesHealth Debate

GOVERNOR VENTURA’S BUDGET propos-als for health this year lay out a path for somefundamental reforms in Minnesota’s health sys-tem. This budget is different in some impor-tant ways from what we’ve seen in the past. It’snot about insurance or clinical care alone;rather, it’s about trying to refocus the debate onhealth status outcomes, and that’s an even big-ger and more complex picture. Yet, some of theGovernor’s proposals are refreshingly straight-forward.

Here are some of the premises in the bud-get proposal that will get us on the road to aworkable and affordable health system.

Engage consumers differently. Improvinghealth, and strengthening the health system,can’t be government’s job alone. Health reformis not just about what the legislature is doing inSt. Paul. It’s about what communities, businessesand individuals can do, and it’s about the choiceswe all make. Here at the Minnesota Depart-ment of Health, we’ll continue to work withour local public health agencies, schools, healthcare providers and plans to establish aggressivecommunity-wide prevention goals — and strat-egies to reach them.

And, we’ll make sure there are ways to en-gage the public in an ongoing discussion aboutthe future of health care. We must have the pub-lic involved in developing a consensus aboutwhat we want from our health system and whatwe’re willing to pay for. Changing consumer de-mand requires that we engage the public in un-derstanding the role of their own choices,including health risk behaviors. Doctors have alarge role in that, but we can’t expect them toeducate their patients without attention to theeconomic incentives in the insurance system,and without supportive public health campaigns

to reinforce their efforts, by trying to createhealthier norms in the larger community.

Give increasing priority to prevention. Pub-lic health is about prevention first and foremost.The leading causes of disease, disability and pre-mature death in this country are preventable.We must continue to strengthen our efforts here,or anything else we do in health reform will bebeside the point. As a nation, and as a state, wespend far too little on prevention — estimatesrange from less than 2 percent to no more than4 percent of all health expenditures. Until thischanges, we’ll keep pouring more and moremoney into increasingly more expensive inter-ventions. The Governor’s proposals to addressracial and ethnic health disparities, reduce teenpregnancies, and improve the health of school-age kids through prevention strategies, are allexamples of trying to move “upstream” on healthchallenges.

Address emerging health threats. Globaliza-tion, antibiotic resistance, cumulative environ-mental exposures, changes in wildlife habitatsand the potential for chemical or biological ter-rorism are all new but very real health threats.The Governor’s budget would strengthen thecapacity of Minnesota’s world-renowned Pub-lic Health Laboratory. Its priorities are in moni-toring trends, early and rapid detection of newthreats, constant emergency response capabil-ity, and “real time” investigation of threats.

Focus on quality improvement. We truly needthe leadership of the health professions to drivea quality agenda in health care. We propose es-tablishing the Center for Health Quality toimprove our measurement and reporting ofquality of Minnesota’s health system. If we wantto reward providers for improving quality, weneed better ways to document it. If we want thepublic to make better choices about their ownbehaviors and the demands they put on health

care resources, we need to give them the tools todo so. The Center will help support steps recom-mended by recent Institute of Medicine reportscalling for improved patient safety and quality.

Shore up investments in the health care in-frastructure. The Governor’s budget recognizesthat in addition to trying to increase insurancecoverage, we also need to invest in the “safetynet” providers who provide care to the unin-sured and to geographically isolated populations.And, we need to deal with the state’s growinghealth workforce needs through investments notonly in the academic institutions and trainingsites, but also through loan forgiveness andscholarship funds to draw individuals into healthcare fields. Our plan also calls for $141 millionin health tax relief. We first eliminated thosetaxes with the most limited assessment base, andpermanently set the provider tax at 1.5 percent.These changes will make health care taxes fairerand more predictable.

A different pathIn recommending his budget, the Governorpointed out that the health of Minnesotans isnot determined strictly by the health care deliv-ery system, or whether people are covered byinsurance. Our environment influences us, andso do our personal choices. So, too, does get-ting everyone involved in shaping the future ofour health system. Without that kind of dia-logue, and leadership from key players, we willcontinue to pursue “band-aid” solutions that willbe increasingly unsuited to the fundamentalchallenges we face. ✦

Jan Malcolm was appointed Minnesota Commis-sioner of Health by Governor Jesse Ventura in Janu-ary 1999. The Minnesota Department of Healthis the state’s lead public health agency, responsiblefor protecting, maintaining and improving thehealth of all Minnesotans.

B Y J A N M A L C O L MM i n n e s o t a C o m m i s s i o n e r o f H e a l t h

M N P E R S P E C T I V E


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Another SuccessfulWinter Medical Conference

THE 2001 HMS/RMS Winter Medical Con-ference attracted 25 physicians and a group ofmore than 50 that traveled to the Moon Palace,a four star all inclusive resorton the Mayan Riviera south ofCancun, Mexico February 17-24.

Sixteen hours of CMEjointly sponsored with theMMA were offered on topicsranging from Genetics andMolecular Biology of ColonCancer to the Approach to Pa-tients with Obesity. The evalu-ations of the program by theparticipants were excellent.

Warm temperatures in thehigh 80s and sunny skies werethe norm. Physicians, spouses, CME faculty (Back row from left): Thomas Dunkel, M.D.,

Anthony Orecchia, M.D., John Allen, M.D., Tim Diegel, M.D.and Pamela Herder, J.D. (Front row from left): MichaelGonzalez-Campoy, M.D., Ph.D., Ken Nollet, M.D., Ph.D., andSteven Tredal, M.D. (Not pictured): Andrew Portis, M.D.

and children enjoyed the opportunities for ex-cursions to the Mayan ruins, snorkeling, fish-ing, swimming, and relaxation. ✦

Physicians attending a lecture.


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HMS/RMS Sponsor Medical StudentLunch ’N Learn Sessions

FIRST AND SECOND YEAR medical studentsturned out in droves for the February 15 andMarch 13 Lunch ’n Learn sessions, co-sponsoredby the Medical Student Section and theHennepin and Ramsey Medical Societies.

Using dual slides and case examples, JanisAmatuzio, M.D. left an intriguing impressionof a career in forensic pathology in February. InMarch, Patricia Stewart, D.O. delivered an en-lightening overview of physical medicine andrehabilitation, and Sheldon Burns, M.D., sportsmedicine, entertained the students with storiesof athletic injuries and his work with the Inter-national Olympic Committee. ✦

Janis Amatuzio, M.D. discusses forensicpathology.

Sheldon Burns, M.D. and Patricia Stewart, D.O. spoke at the March session.

Sheldon Burns, M.D., discusses sports medicine with the students.

PRESIDENT ’S MESS A GER O B E R T C . M O R A V E C , M . D .

RMS-Officers

President Robert C. Moravec, M.D.

President-Elect Peter H. Kelly, M.D.

Past President John R. Gates, M.D.

Secretary Jamie D. Santilli, M.D.

Treasurer Peter J. Daly, M.D.

RMS-Board Members

Kimberly A. Anderson, M.D., Specialty Director

Victor S. Cox, M.D., Specialty Director

Charles E. Crutchfield, III, M.D., At-Large Director

Kelley C. du Ford, Medical Student

Thomas B. Dunkel, M.D., MMA Trustee

Michael Gonzalez-Campoy, M.D., At-Large Director

James J. Jordan, M.D., Specialty Director

F. Donald Kapps, M.D., Specialty Director

Kathryn M. Klingberg, M.D., Resident Physician

Charlene E. McEvoy, M.D., At-Large Director

Ragnvald Mjanger, M.D., Specialty Director

Kenneth E. Nollet, M.D., Ph.D., At-Large Director

Thomas F. Rolewicz, M.D., Specialty Director

Paul M. Spilseth, M.D., At-Large Director

Lyle J. Swenson, M.D., MMA Trustee

Jon V. Thomas, M.D., At-Large Director

David C. Thorson, M.D., Specialty Director

Russell C. Welch, M.D., At-Large Director

RMS-Ex-Officio Board Members &Council Chairs

Brent R. Asplin, M.D., AMA Young Physician SectionBlanton Bessinger, M.D., MMA PresidentKenneth W. Crabb, M.D., AMA Alternate DelegatePaul J. Dyrdal, M.D., Sr. Physicians Assoc. PresidentStephen P. England, M.D., Community Health

Council Chair*Michael Gonzalez-Campoy, M.D., Education

Resource Council ChairEleanor Goodall, Alliance PresidentFrank J. Indihar, M.D., AMA DelegateWilliam E. Jacott, M.D., U of MN RepresentativeMatthew D. Layman, M.D., AMA Delegate for

American Society of Anesthesiologists*F. Donald Kapps, M.D., Council on

Professionalsim & Ethics ChairMelanie Sullivan, Clinic Administrator*Lyle J. Swenson, M.D., Public Policy Council Chair*Russell C. Welch, M.D., Communications

Council Chair

*Also elected RMS Board Member

RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive OfficerDoreen M. Hines, Membership & Web Site Coordinator


OFrom Where I Sit…The Doctor-Patient Relationship

ONE OF THE KEY PRINCIPLES in medicalcare is the “doctor-patient relationship.” I’ve hadthe privilege of reviewing numerous local andstate medical society mission statements throughmy role as a surveyor for continuing medicaleducation. In many of them, this principle isheld as the highest principle to be preserved,enhanced, and protected.

This principle carries an enormous respon-sibility for clinicians. In an age of remarkabletechnical advancement in the acute care arena,the doctor-patient relationship continues to bewhat patients relate to when they reflect on theiroverall satisfaction of their care.

Patient satisfaction surveys focus on howwell the health care team communicated andprovided explanation to patients and their fami-lies. Patients recall how much comfort they feltbefore and after procedures or during a medicalcrisis. If clinicians are berated by the public, it isoften focused on our inability to bridge this re-lationship in a meaningful way. To be sure, thepublic expects competency in surgical skills,treatment of medical emergencies, delivery of ababy, and office evaluations for an acute illness.Satisfaction of care comes from their percep-tion of the adequacy of communication and un-derstanding of the events surrounding the caredelivered. It is a responsibility that can be sharedby a medical care team (both in the hospital oroffice) or handled by the physician, but it can-not be abdicated or ignored. All clinicians shouldfocus their incredible energy and talents whendeveloping and enhancing this relationship.

The second Institute of Medicine (IOM)report, Crossing the Quality Chasm: A NewHealth System for the 21st Century, released inMarch 2001, discusses our failure as a system tolive up to our charge. We (as a system) fail todeliver care for up to 40 million Americans inthe United States. We (as providers) take an av-erage of 17 years for new knowledge generatedby trials to be incorporated into practice (seethe reference, Bates and Boren – Yearbook of

Medical Informatics, 2000 from the IOM Report.)Our best practice guidelines and evidence-basedrecommendations are often refuted as “cook-book medicine” which threatens clinical judg-ment and the “doctor-patient relationship.”

I submit to you that the doctor-patient re-lationship is based on trust – trust that we willdeliver up-to-date, competent care in an effi-cient manner and trust that we will be availableto answer questions and concerns about ourpatient’s issues.

This most recent IOM report describes thehealth-care needs of Americans shifting fromacute episodic care to care for chronic condi-tions. We know that chronic conditions are theleading cause of illness, disability, and death andaccount for the majority of health care expen-ditures. This aspect of care is best handled byfocusing on trusted, up-to-date, and accessiblecare – the “doctor-patient relationship.”

The IOM Report identifies six aims thatwe should be striving for. Those aims can besummarized as care that is:• Safe;• Effective;• Patient-centered;• Timely;• Efficient; and• Equitable.

Isn’t this what the doctor-patient relation-ship is all about?

Whether through a trusted team approachor through individual communication, this prin-ciple will serve as our foundation during the up-coming period of health care transformations. ✦


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Community Internship ProgramReaches Out to Health Policy Class

PROFESSOR DUCHESS HARRIS ofMacalester College (immediate past presidentof the Ramsey Alliance) had another successfulsemester with her Health Policy Course. Thecourse has three objectives: 1) to familiarize thestudents with competing theoretical perspectivesabout political behavior and policymaking; 2)introduce students to the history of health careorganizations in Minnesota and the U.S. fromClinton to the present; and 3) to examine cross-cultural issues in health.

The Ramsey Medical Society provided avery important addition to this class by offeringto coordinate a Mini Community InternshipProgram March 5-12. Eleven students, who arepre-medical and/or public health hopefuls, were

each matched with two physicians inthe metropolitan area. The internsshadowed each assigned physician forone-half day. Interns ventured to theemergency room, scrubbed in for sur-gery, and went to clinics such as theRamsey Health Center for Women,Clinic 42, Model Cities, and Commu-nity University Health Care Clinic.The students found their experiencesto be very informative and most ofthem came away with new concerns.Many are much more concerned withthe availability of care for the low-in-come, uninsured, and immigrantpopulation. As part of the intern pro-gram the faculty and interns are invited to open-ing and closing receptions to share their experi-ences. Drs. Peter Bornstein, Brett Gemlo, andJames Hart attended from the faculty.

Following the Community Internship Pro-gram and after numerous weeks of engaging inintellectual discourse, the students were well pre-pared for a guest lecture on MinnesotaCare pre-sented by Dr. James Hart.

In addition to clinic visits, the class at-tended the Minnesota chapter of the AmericanAcademy of Pediatrics “Day at the Capitol.” Thissession provided a focused and accessible pic-ture of the law-making process. The group ar-ticulated that one of its legislative priorities for

Fozia Abrar, M.D.Brian Amdahl, M.D.Peter Bornstein, M.D.Larry Cohen, M.D.David Current, M.D.Paul Donahue, M.D.Naomi Duke, M.D.Michael England, M.D.Stephen England, M.D.Ralph Frascone, M.D.Brett Gemlo, M.D.

Thank you to the following physicians forparticipating in the Community InternshipProgram.

Students participating as Community Interns included: (from left) Corey Kurtz, Ryan Abbe, Kim Russell,Jennifer Fields, Nicholas Kassebaum, Duchess Harris, Ph.D., Brandi Hill, Wairimu Njoya, Andre Carrington,Maimouna Toliver, Kati Miklik, and Anna McCartney-Melstad.

Dr. Naomi Duke (right) reviews some paperworkwith Brandi Hill at Model Cities.

Ryan Abbe (left) learned about occupationalmedicine from Dr. Joseph Wegner at thePhysicians Neck and Back Clinic.

the year 2001 is to ensure universal access tocare for all children, adolescents, and pregnantwomen.

The students in Macalester’s Political Sci-ence 47 rounded out their experience by track-ing legislation on the web and conducting re-search on the disparities between urban and ru-ral health care.

Thanks to all the physicians who partici-pated in this Community Internship Program.Without your commitment and sharing of yourtime and expertise, this program could not suc-ceed. To participate in future programs, pleasecall Doreen Hines at 612/362-3705. The nextone is scheduled for May 14-17, 2001. ✦

Rich Gray, M.D.Teresa Gunnarson, M.D.James Hart, M.D.Melanie Johnson, M.D.Tina Martin, M.D.David Plummer, M.D.Steven Tredal, M.D.John Wahlstrom, M.D.Joseph Wegner, M.D.Clinic 42


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Caring Hearts for Homeless People2001 Supply Drive

THE NINTH ANNUAL “Caring Hearts forHomeless People,” sponsored by Ramsey Medi-cal Society, Ramsey Medical Society Alliance andHealthEast Care System, began on Saturday,February 10 and concluded on Sunday, Febru-ary 25.

This year’s drive was a huge success!Twenty-three medical clinics, 45 churches,HealthEast Care System, and many volunteersfrom the Ramsey Medical Society Alliance, andmany other organizations (4-H clubs, girl scout

Mark your calendarsThe 2002 Caring Hearts for HomelessPeople Supply Drive, will be held Feb-ruary 9 through February 24, 2002.Please call Doreen at 612-362-3705 ifyou would like to have your clinic addedto the 2002 drive. You may even con-sider beginning to collect items now.One idea would be to focus on collect-ing one item each month (i.e., June-sun-screen; July-bug lotion; August-socks;etc.) You could also call and we couldprovide you with some of the items thatthe recipient organizations never seemto have enough of.

troops, high school youth groups, el-ementary class groups) pitched in tocollect and sort over $55,000 worthof hygiene and medical supplies forthe Health Care for the Homelessclinics, Listening House, andSafeZone. In addition, more than$1,500 in cash contributions was col-lected. These organizations rely heavilyon donated medications, hygiene sup-plies, toys, juice and monetary dona-

tions to help meet thephysical, emotional andmental health needs oftheir clients. This drivecontributes the majorityof supplies needed for theentire year. Carole Nimlos coordi-nated the activities of theRMS Alliance memberswho worked hard pickingup the supplies from 23participating medical clin-ics. ✦

Advancements in DermatologyAllina Medical Clinic – ShoreviewAmerican Red CrossDermatology Consultants, P.A.Hamm Memorial Psychiatric ClinicHealthEast Shoreview ClinicHealthEast Vadnais Heights ClinicMetropolitan Medical AssociatesMinnesota Medical Joint Services OrganizationMinnesota Epilepsy Group, P.A.Minnesota Gastroenterology – East MetroNorth Suburban Family Physicians, P.A. - Shoreview

Partners Obstetrics and Gynecology, P.A.Physicians Neck & Back Clinic, P.A.Ramsey Family PhysiciansRamsey Health Center for WomenSt. Croix Orthopaedics, P.A.St. Paul Internists, P.A.St. Paul Surgeons, Ltd.Twin Cities Anesthesia AssociatesUniversity Family Physicians – Bethesda ClinicUniversity Family Physicians - Phalen Village ClinicUniversity of Minnesota – medical students

Thank you to the clinic managers, staff, and physiciansof the following clinics that participated:

Some of the many volunteers helping out with thesorting of the numerous donations.

Red Cross Medical Services employee Jo Launderville andAmy Gullickson, volunteer, coordinated the packaging of1,500 care packages. Carole Nimlos, RMS Alliance, pickedup the donated items at the American Red Cross.

Donna Mowlem, RMS Alliance member and Dr. AlMowlem, retired physician, are at St. Joseph’s Hospitaldropping off the items they collected from some ofthe participating clinics.


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Applicants forMembership

We welcome these new applicants forRamsey Medical Society membership.

ActiveSophia H. Kim, M.D.St. Louis University Medical SchoolInternal MedicineSt. Paul Internists, P.A.

Matthew D. Layman, M.D.University of New MexicoAnesthesiologyTwin Cities Anesthesia Associates

Barbara A. Leone, M.D.Harvard Medical SchoolFamily PracticeNorth Memorial Family Practice Clinic

Linda Anne Long, M.D.Dartmouth UniversityOccupational Medicine3M

1st Year PracticeFozia A. Abrar, M.D.Semmelweis Medical University, BudapestOccupational Medicine/International HealthRegions Hospital International Health

Joseph J. Baraga, M.D.Harvard Medical SchoolDiagnostic RadiologySt. Paul Radiology, P.A.

Paula S. Mackey, M.D.University of MinnesotaPediatricsHealthEast Woodbury Clinic

Medical Student(University of Minnesota)

Kriston A. Hines

Transfer into RMS — ActiveNancy L. Struthers, M.D.University of MinnesotaFamily PracticeAllina Medical Clinic - Cottage Grove

Transfer into RMS — 1st YearPracticeTheodore J. Passe, M.D.Neuro RadiologySt. Paul Radiology, P.A.

Transfer into RMS — ResidentEric M. Brown, M.D.University of Minnesota ✦

In MemoriamALBERT F. HAYES, M.D., died March 12.He was 88. He graduated from the Universityof Minnesota Medical School, and completedhis internship and a residency in obstetrics andgynecology at the University of MinnesotaHospitals. Following his residency training, hejoined the military. Dr. Hayes joined RMS in1946.

PAUL F. JAROSCH, M.D., died April 13 atthe age of 52. He graduated from theUniversity of Minnesota and completed aninternship at Abbott-Northwestern Hospitaland his residency at the University ofMinnesota. Dr. Jarosch was board certified indiagnostic radiology and currently a partner atSt. Paul Radiology. He transferred from HMSand joined RMS in 1989.

IAN MARC SWATEZ, M.D., died March 6at the age of 53. He graduated from theUniversity of Minnesota Medical School. Hecompleted a transitional internship at HennepinCounty Medical Center and his residency atthe University of Minnesota. Board certifiedin diagnostic radiology, Dr. Swatez was Chiefof Radiology at Regions Hospital and apartner of St. Paul Radiology. He transferredfrom HMS and joined RMS in 1997. ✦

The 28 Delegates of the Ramsey

Medical Society will be represent-

ing you at the Minnesota Medical

Association House of Delegates An-

nual Meeting September 19-21,

2001 in St. Cloud. Over the next

several weeks, the Delegation will

be identifying issues and develop-

ing resolutions to carry to the

House of Delegates, where MMA

policy is established.

The RMS delegation of delegates

and alternate delegates, chaired by

Dr. John Gates, will caucus on

Wednesday, May 23 and again on

Thursday, June 7. Both meetings

will be held at 7:00 a.m. in the St.

Joseph’s Room at St. Joseph’s Hos-

pital in St. Paul. Please help us to

assure that your interests are accu-

rately conveyed to the House of

Delegates by contacting the RMS

staff to submit resolutions:

phone: 612/362-3704,

fax: 612/623-2888,

e-mail: [email protected].

Call forResolutions


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RMS ALLIANCE NEWSE L E A N O R M . G O O D A L L

A Message for Spouses of Physicians:Life Work Planning

MY YEAR AS PRESIDENT of the RamseyMedical Society Alliance draws to a close. And,as one prepares to leave a leadership role, it’snatural to reflect on a few questions, such as:“How did I do over the course of the past year?Were my mistakes small and, hopefully, my ac-complishments larger? Did the organizationbecome better, stronger, and more viable dur-ing my tenure? Am I leaving it in good shapefor those who follow me?

The year, however, is now in the past and Iwant us to look at the future. While it’s impor-tant that we learn from the past, the potentialin each of our lives lies in our planning for thefuture — deliberately and thoughtfully plan-ning our life work, however we define it.

There are four important life questions:• Who are you?• Where did you come from?• What are you doing here?• Where are you going?

These are important because, when youcan answer them, you consciously understandyour role in the universe, in your own life, inyour work and in your associations with others.

Let’s take them one at a time and brieflylook at what each is asking.

Who are you? Superficially, this may seemlike the philosophical pondering of a college stu-dent, but we need to have knowledge of self inorder to comprehend our capabilities, to realizeour potential. You can’t be the best person withinyou unless you know who that person is to startwith. Are you a musician, an artist, a thinker, amotivator, a helper, a visionary, and so on? Thepoint is that by knowing yourself in all the vari-ous facets of your life, you can stretch to reachthe heights of each, thereby creating for your-self a truly wonderful life.

Where did you come from? We need asense of belonging, of tradition, history, andculture. We all probably have some mix of goodand not-so-good experiences in where we come

from and we need to come to terms with ourbackground in order to move forward.

What are we doing here? Whether youbelieve in a specific God, a universal God, aSpiritual Being, a natural Entity, there is an or-der to life. What I mean is that existence of ev-erything is either in order or chaos. And, clearlyatoms, molecules, annual seasons…line up inorder. So, where do you fit in this grand schemeof things? Does each of us have a purpose? Howdo we discover it?

Where are you going? Ah, perhaps thetoughest of all to grasp. The first three ques-tions deal with the past and the present. And,while not necessarily easy to search out the an-swers, the material is there for us to work on.This question addresses the future — your fu-ture. And recognizing that you have the powerto shape it. To do this, we need to be able tolearn.

I want you to reflect a little. Think of allyou know as fitting into three piles:1. Things I absolutely know are true.2. No way are these true. Totally false. Wrong.3. I just don’t know. Could be true. Might be

false.For many people life is simply a duality.

Things are right or wrong. But — there is a lotin between. Seldom are things or situations blackor white, but rather one of many shades of gray.Build that third pile. In order for you to learn,this pile needs to be much larger. The first twopiles close off learning to you. The longer youlive, the bigger the third pile grows because ev-ery time we learn something we become awareof how much we don’t know.

Think of your life as a book. The title ofthe book is “My Life.” Each chapter is a year ofyour life. So, think about the chapter you areon right now (that would be, of course, howold you are).What would be the title for thechapter of your last twelve months? How doyou want to title the next chapter? Where areyou going with your life? Where do you want

to be five or 10 years from now? And, what areyou doing to create that reality? How do youcreate that reality?

Being what you want to be means open-ing up to learning. It means building on thatthird pile. It means a congruent flow of energywithin your life. How do we do this?

The “source” of our being is our soul orspirit. Through this we KNOW. Then comesour mind, our emotion, and our body andthrough these we THINK, FEEL and ACT. Ifwe are the same person at all levels, we are inalignment, we are integrated in our life. Energyflows back and forth, there are no blockages. Ifwe have a mental, emotional, physical, or spiri-tual problem, there is a break. We cannot be allwe are capable of being.

When you forget yourself and what you’rehere for — you get caught up in stuff. And itbecomes harder and harder to get things donethat move you along the design process of yourlife.

Be patient. We grow by stages. Do what isimportant to you to get you where you want togo. Keep yourself integrated, in alignment. Keepbody, mind, emotion and soul in sync. The ideais to consciously think about your life, to planthe way you want to live, and to live well. Youcan’t die well unless you have lived well.

As I look over this piece, I see a lot of ques-tions. The answers are within each of you. I urgeyou to search for them.

It has been a splendid year! Thank you forthe opportunity to lead this Alliance. You aregood people doing good work. Continue tolearn, to grow, to be all you can be! ✦


THMS-Officers

Chair Virginia R. Lupo, M.D.

President David L. Swanson, M.D.

President-Elect T. Michael Tedford, M.D.

Secretary Richard M. Gebhart, M.D.

Treasurer Michael B. Ainslie, M.D.

Immediate Past Chair David L. Estrin, M.D.

HMS-Board Members

Ben Baechler, Medical Student

Michael Belzer, M.D.

Carl E. Burkland, M.D.

Jeffrey Christensen, M.D.

William Conroy, M.D.

Dianne Fenyk, Alliance Co-PresidentPaul A. Kettler, M.D.

James P. LaRoy, M.D.

Ronald D. Osborn, D.O.

Joseph F. Rinowski, M.D.

David F. Ruebeck, M.D.

Richard D. Schmidt, M.D.

Marc F. Swiontkowski M.D.

D. Clark Tungseth, M.D.

Trish Vaurio, Alliance Co-PresidentJoan M. Williams, M.D.

HMS-Ex-Officio Board Members

Barbara H. Subak M.D., Senior Physicians AssociationLee H. Beecher, M.D., MMA-TrusteeKaren K. Dickson, M.D., MMA-TrusteeJohn W. Larsen, M.D., MMA-TrusteeRobert K. Meiches, M.D., MMA-TrusteeHenry T. Smith, M.D., MMA-TrusteeDavid W. Allen, Jr., MMGMA Rep.

HMS-Executive Staff

Jack G. Davis, Chief Executive OfficerNancy K. Bauer, Associate Director

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THIS EDITION of MetroDoctors is devoted tothe role of physicians as patient advocates. Forthe past seven years, organized medicine, in al-liance with other interested parties, has advo-cated for our patients by lobbying for a patientprotection bill.

Last year, success seemed attainable. TheHouse of Representatives passed the Norwood-Dingell Patients’ Bill of Rights with an impres-sive 275-151 vote, with 68 Republicans votingfor the passage. In the Senate, unfortunately, thebill stalled. The members of Senate ConferenceCommittee were interested in protection of adifferent kind, the protection of their contin-ued gluttony at the trough of the drug and healthplan lobbyists. The Patients’ Bill of Rights diedin committee.

That fact remains that our patients needthe passage of a patient protection bill. It is theright thing to do, and it needs to be done now.The American Medical Association has outlinedwhat the bill should include:1) There must be a guarantee that the deci-

sions regarding medical necessity are madeby physicians and their patients, not byhealth plan bureaucrats and staff.

2) There should be a mechanism by whichpatients can appeal denials of health care.Those appeals should be independent ofthe plans, binding, and obtained in a timelyfashion that does not subject any patientto risks due to a delay.

3) Health plans should be held accountablefor their decisions, while employers whodo not make medical decisions should beprotected from the liability that resultsfrom injurious health plan decisions.

4) Patients must be permitted to sue the man-aged care plans under state law when theplans’ decisions are negligent and result indeath or injury.

5) Patients must be allowed to choose a pointof service option with appropriate accessto specialists, especially when willing to doso at their own added expense. This op-tion must be exercised without penaltiesresulting from appropriate medical deci-sions made by those point of service phy-

sicians. Women should be permitted toobtain gynecological/pregnancy care froman ob/gyn physician and children to ob-tain pediatric care without a referral.

6) There should be a reasonable standard fordetermining when a plan must cover emer-gency medical services, and that standardshould be based on what a “prudent lay-person” would do when faced with a per-ceived emergency.

7) Health plans should be required to intelli-gibly disclose to enrollees the basic infor-mation about their medical coverage. Gagclauses, or the implementation of gag prac-tices, should be forbidden.

8) The rights of states to govern the healthcare of its citizens should be respected. AsChief Justice Rehnquist has said, the statecourts should be the forums for any per-sonal injury suits arising from the denialof medical care, ERISA oversight notwith-standing.There is now a Compromise Bipartisan Pa-

tients’ Bill of Rights before Congress that in-corporates most of these ideals—S283/284,HR526. The insurance industry has spent $100million to derail this legislation. It needs oursupport.

There is a simple way you and I can advo-cate for our patients today, now, taking only fiveminutes of our time. Even if you are not a mem-ber of the AMA, you can simply go to thiswebsite: http://capwiz.com/ama/home/. Enteryour zip code and you will automatically belinked to the e-mail addresses of President Bush,Paul Wellstone, Mark Dayton, and your Con-gressman. Tell them in a few words what theCompromise Bipartisan Patients’ Bill of Rightsmeans to you and your patients. (Be sure to in-clude your home mailing address, or the staffperson screening your e-mail will toss it right inthe trash. If your address is on the e-mail, it willbe read and forwarded.) ✦

PRESIDENT ’S REPORTD A V I D L . S W A N S O N , M . D .


HMS NEWS

New MembersHMS welcomes these new members to the

Society as of February 1, 2001. Schools listed

indicate the institution where the medical de-

gree was received.

Regular ActiveGordon M. Aamoth, M.D.Northwestern University Medical SchoolOrthopedic SurgeryMinneapolis Orthopaedic & Arthritis Institute

Ingrid Abols-Mantyh, M.D.Universite de Paris VII, Paris 5eNeurologyMinneapolis Clinic of Neurology

Steven O. Anderson, M.D.Northwestern University Medical SchoolOphthalmologyNorthwest Eye Clinic

Gary D. Berman, M.D.Mayo Medical SchoolAllergy & ImmunologyAllergy & Asthma Specialists, P.A.

Thomas N. Berscheid, M.D.University of Minnesota Medical SchoolAnesthesiologyNorthwest Anesthesia, P.A.

Mark R. Bixby, M.D.University of Illinois College of MedicineFamily PracticeUniv. Family Physicians - North Memorial Clinic

Miriam Bednar Boyer, M.D.Lekarska Fakulta Univerzita Komenskeho, BratislavaAnesthesiologyAnesthesiology, P.A.

Martin Nicholas Burke, M.D.Yale University School of MedicineCardiologyMinneapolis Cardiology Assoc.

Lyn Palmer Chapman, M.D.University of Minnesota Medical SchoolPediatricsPartners in Pediatrics, Ltd.

Emily Parker Chapman, M.D.Dartmouth Medical SchoolPediatricsWayzata Children’s Clinic, P.A.

Benjamin W. Chaska, M.D.Harvard Medical SchoolFamily PracticePark Nicollet Clinic

Ivan J. Chavez, M.D.University of Illinois College of MedicineInternal MedicineMinneapolis Cardiology Assoc.

Daniel Steven Cohan, D.O.Univ. of Osteopathic Medical and Health ScienceFamily PracticeNorth Clinic, P.A.

Eileen Crespo, M.D.State University of New York at BuffaloPediatricsHennepin County Medical Center

Deborah A. DeMarais, M.D.University of Minnesota Medical SchoolPediatricsAndover Park Clinic

Dennis D. Dykstra, Ph.D., M.D.University of Cincinnati College of MedicinePhysical Medicine & RehabilitationUniversity of Minnesota-Medical & Rehab

Eric R. Ernst, M.D.University of Wisconsin Medical SchoolInternal MedicineMinnesota Heart Clinic

Joel L. Esmay, M.D.University of Minnesota Medical SchoolFamily PracticeRiverway Andover Clinic

Yohannes Gebregziabher, M.D.Medical College of South CarolinaFamily PracticeCamden Physicians, Ltd.

Mark Gregerson, M.D.University of North Dakota School of MedicineHand Surgery/Orthopedic SurgeryOrthopedic Surgical Consultants, P.A.

B. M. Hightower-Hughes, M.D.Bowman Gray School of Medicine of WakeForest UniversityObstetrics & GynecologyFridley Plaza Clinic

Daniel A. Keeley, M.D.University of Minnesota Medical SchoolInternal MedicineLakeview Clinic

Peter James Kernahan, M.D.Northwestern University Medical SchoolGeneral SurgeryHealthPartners – Riverside

Hyder M. Khan, M.D.Universidad Automona de Cludad JuarezPediatricsHFA Pediatrics Clinic

Marcus Kristupaitis, M.D.Kaunasskig Medicinskij InstitutPediatricsSouthdale Pediatric Associates

Nicholas P. LaFond, M.D.University of Minnesota Medical SchoolFamily PracticeLong Lake Family Physicians

James R. Larson, M.D.University of Minnesota Medical SchoolOrthopedic SurgeryOrthopedic Medicine & Surgery, Ltd.

Brian M. Leonovicz, M.D.University of Wisconsin Medical SchoolAnesthesiologyMedical Anesthesia, Ltd.

Andrew Yeng Cheng Leung, M.D.University of Minnesota Medical SchoolInternal MedicineColumbia Park Medical Group-Fridley

Richard O. Lundebrek, M.D.University of Minnesota Medical SchoolFamily PracticeCamden Physicians, Ltd.

Heather A. MacKay, M.D.Albany Medical College of Union UniversityObstetrics & GynecologySouthdale OB/GYN Consultants

Robert P. Maddock, M.D.Indiana University School of MedicineAnesthesiologyAnesthesiology, P.A.

Mary Miley, M.D.University of Minnesota Medical SchoolInternal MedicinePark Nicollet Clinic - Plymouth

Robert A. Mittra, M.D.University of Pennsylvania School of MedicineOphthalmologyVitreoRetinal Surgery, P.A.

Ibrahim Abdul Mujir, M.D.Gandhi Medical College, Omania University,Hyderabad, Andra PradeshFamily PracticeNorth Memorial Clinic - Brooklyn Park FamilyPhysicians

Theodore C. Nagel, M.D.Cornell University Medical CollegeObstetrics & GynecologyReproductive Medical Center


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In MemoriamHoang Duc Nguyen, M.D.University of Texas Medical School of HoustonAnesthesiologyAnesthesiology, P.A.

Glenn Albert Nickele, M.D.University of Michigan Medical SchoolCardiologyMinnesota Heart Clinic

Stephen L. Olmsted, M.D.University of Minnesota Medical SchoolOrthopedic SurgeryOrthopaedic Consultants, P.A.

Pamela R. Paulsen, M.D.Medical College of WisconsinCardiovascular DiseasesCardiovascular Consultants, Ltd.North Heart Center

Anil K. Poulose, M.D.University of Kansas School of MedicineCardiovascular DiseasesMinneapolis Cardiology Assoc.Minneapolis Heart Institute

Jon L. Pryor, M.D.University of Minnesota Medical SchoolUrology/Urological SurgeryUniversity of Minnesota Physicians

Kayvon S. Riggi M.D.Mayo Medical SchoolOrthopedic SurgeryOrthopedic Medicine & Surgery, Ltd.

John B. Rogers, M.D.University of Minnesota Medical SchoolOrthopedic SurgeryColumbia Park Medical Group

Thomas J. Rossini, M.D.University of Minnesota Medical SchoolEmergency MedicineNorth Memorial Health Care

Ilya Rubin, M.D.Byelorussia Medical Institute, MinskAnesthesiologyTwin Cities Anesthesia Associates

Paul R. Rust, M.D.University of Wisconsin Medical SchoolDiagnostic RadiologyConsulting Radiologists, Ltd.U of MN Hospitals, Dept. of Diagnostic Radiology

Paul A. Satterlee, M.D.University of South Dakota School of MedicineEmergency MedicineNorth Memorial Health Care

John D. Schaffhausen, M.D.University of Iowa College of MedicineFamily PracticeNorth Clinic, P.A.

Shellie Schmidtgall, M.D.Rush UniversityPediatricsColumbia Park Medical Group

Eric S. Schned, M.D.Columbia Univ. College of Physicians & SurgeonsRheumatologyPark Nicollet Clinic - St. Louis Park

Nicholas J. Schneeman, M.D.University of Minnesota Medical SchoolFamily PracticeNorth Clinic, P.A.

J. Richard Sheely, M.D.University of Tennessee Center for Health SciencesFamily PracticeQuello Clinic-Mall of America

Douglas Alan Smith, M.D.University of Minnesota Medical SchoolFamily PracticeLong Lake Family Physicians

J.R. Smith-Kristensen, M.D.University of Minnesota Medical SchoolFamily PracticeCamden Physicians, Ltd.

Doris N. Tran-Stoebe, M.D.Rush Medical CollegeFamily PracticeNorth Memorial Health Care - Golden Valley

Gary L. Trummel, M.D.University of Minnesota Medical SchoolAnesthesiologyNorthwest Anesthesia, P.A.

Jeffrey Richard Vespa, M.D.Loyola University Stritch School of MedicineEmergency MedicineNorth Memorial Health Care

Patricia Ann Welsh, M.D.University of Minnesota Medical SchoolObstetrics & GynecologyObstetrics & Gynecology - West, P.A.

Andrew G. Westbrook, M.D.Vanderbilt University School of MedicineFamily PracticeBurnsville Family Physicians

Jennifer Woodland, M.D.Ohio State University College of MedicineFamily PracticeCamden Physicians, Ltd.

Paul David Yochim, D.O.Kirksville College of Osteopathic MedicineAnesthesiologyTwin Cities Anesthesia

DAVID M. ANDERSON, M.D., diedMarch 17. He was 83. He graduated from theUniversity of Minnesota Medical School andcompleted his internship in urology in SanFrancisco. Dr. Anderson was one of the 11founding physicians of the St Louis ParkMedical Center, which is now Park NicolletClinic. He practiced at the clinic from 1950until he retired in 1987. Dr. Anderson was anadjunct professor of surgery at the Universityof Minnesota, and also taught for many yearsat the VA Hospital. He joined HMS in 1951.

JAMES EDWARD TROW, M.D., a familyphysician, died in March at the age of 88. Hegraduated from the University of MinnesotaMedical School. He served in Alaska as aSenior Medical Officer during World War II.Dr. Trow retired from practice in 1990. Hejoined HMS in 1994.

JOHN J. HAGLIN, M.D., a transplantspecialist, died February 9. He was 81. Hegraduated from Wayne State UniversitySchool of Medicine, Detroit. He was a fellowat Minneapolis General Hospital. Dr. Haglinwas a vascular surgeon and former assistantchief of surgery at Hennepin County MedicalCenter. He helped develop the MinneapolisMedical Research Foundation and was on itsboard. Dr. Haglin joined HMS in 1962.

FABIAN J. MCCAFFREY, M.D., diedFebruary 11 at the age of 85. He graduatedfrom the University of Minnesota MedicalSchool. Dr. McCaffrey, an obstetrician/gynecologist, practiced in Minneapolis. Afterretirement he became a pastoral minister at St.Patrick’s Church in Edina. He joined HMS in1942.

RALPH PAPERMASTER, M.D., diedrecently at the age of 83. He graduated fromthe University of Minnesota Medical School.Dr. Papermaster joined HMS in 1947.

KARL E. SANDT, M.D., an ophthalmolo-gist, died February 25. He was 92. Hegraduated from the University of MinnesotaMedical School. He completed an internshipat Detroit Receiving Hospital and a residencyat Manhattan Eye & Ear Hospital in NewYork City. Dr. Sandt was an associate clinicalprofessor at the U of M. He retired in 1988.Dr. Sandt joined HMS in 1938. ✦(Continued on page 32)


D

HMS ALLIANCE NEWS

Trish VaurioCo-President

Dianne FenykCo-PresidentDIANNE FENYK AND I are all too quickly

approaching the end of our year as co-presidentsof this organization. I am a weaver, and findthat in designing a woven item, one takes intoconsideration the best properties of the fibersthat will be woven into the fabric. Just as in weav-ing, our Alliance produces a fine fabric of ideasand talents in order to bring about our best.

Dianne and I wish to express our appre-ciation for all the help and support we have re-ceived this year from our wonderful loyal mem-bers, including the wisdom of those who haveled the organization before us and fresh ideasfrom our newer members.

Our thank yous go to Minnesota MedicalAssociation and Hennepin Medical Society fortheir support and extra help from the staffs ofboth, especially Jack Davis and Nancy Bauerwho have given us so much advice and assis-tance. Diane Gayes also deserves much appre-ciation for all her hard work as chair of ourchildren’s health fair, Body Works, her ongoingcommitment to the HIV/AIDS folders, and asPresident of MMAA — her leadership has beenterrific.

Special thanks to those who opened theirhomes this year for our programs, beginningwith our summer get together at Penny andCecil Chally’s lovely lake home. We enjoyed aperfect fall day for our opening event at Eleanorand Bill Goodall’s farm. And thank you as wellto Peggy and Bruce Johnson for opening theirbeautiful home for our Holiday Tea and SilentAuction in December.

As we look back over the year we feel thatwe accomplished several of our goals as statedin our mission, to help educate and promotethe health and well being of our members andthe community. Stepping Stones, the event thatwas new to us this year, was a celebration of our90th anniversary as an organization, which wecombined with a fund raising event for threeteen clinics in the West Hennepin Suburbanarea. It was our first venture into such an activ-ity, and we felt it was extremely successful. OurHoliday Tea and Silent Auction was great fun

and we thank all those who contributed to thefood, donated auction items and made purchasesto support the Philanthropic Fund. It really wasfun to get together just before the busy HolidaySeason. Body Works, our children’s health fair,was as much of a success as was possible duringa January ice storm; however, we do live in Min-nesota and have to be flexible. We promotedour own health with a fitness day at The MarshSpa in late January, just when we needed a bitof pampering.

The fund raiser this year for the AMAFoundation was a “No Show” tea party in honorof Doctors Day, March 30. This was a welcomeidea after the busy fall and winter schedule.

At our annual meeting in May, Dianne andI will pass the gavel into the capable hands ofKathy Larson, knowing she will carry on thefuture activities of Hennepin Medical SocietyAlliance very well. Dianne and I, as well as DianeGayes, have stressed the benefits of our affilia-tion with the National AMAA where we cancontribute our ideas and receive leadership train-ing and assistance with our projects. We haveapplied for a HAP (Health Awareness Promo-tion) award for the use of the “Hands are Notfor Hitting” puzzles in Body Works, and alsoapplied for, and received, a grant of 800 puzzlesfrom the AMAA to distribute the puzzles toteachers during Body Works.

The future of HMSA will be very secureunder the leadership of Kathy Larson, our in-coming President. We look forward to combin-ing some fund raising activities with RamseyMedical Society Alliance, weaving the strengthsof both organizations to provide more benefitsfor the metro area. We also look forward toworking with the Medical Student and Resi-dent Partners, to benefit both of our organiza-tions. We especially appreciate their fresh en-thusiasm and we hope to perhaps give somelonger-term experience to the spouses of medi-cal students and residents in our area.

Again, thank you very much to all whohave worked so hard this year to support Dianneand me. It has been a wonderful experience be-

cause we have such great members to work with.Our good wishes go to Kathy Larson as sheguides HMSA next year. ✦

Fondly,Trish Vaurio and Dianne Fenyk

ResidentNatalie Anne Hayes, M.D.University of Minnesota Medical SchoolFamily PracticeHennepin County Medical Center

Mark A. Houghland, M.D.University of New Mexico School of MedicineCardiologyUniversity of Minnesota Physicians

Susan Ann Leonard, M.D.University of Minnesota Medical SchoolAnesthesiologyAbbott-Northwestern Hospital

Lorinda F. Parks, M.D.University of Minnesota Medical SchoolFamily PracticeUniversity of Minnesota

Carol Joy Schlueter, M.D.University of Illinois College of MedicinePathology-Anatomic/ClinicalFairview-University Medical Center

Medical Student(University of Minnesota)Justin Lann EsterbergJonathan D. KirschKathleen M. LarsonPeter G. LundJoel WegenerRochelle Ann WolfeIrma Teresa Ugalde ✦

New Members(Continued from page 31)

2001mayjune

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