The Bulletin by the American College of Surgeons Sun, 01 Feb 2015 06:59:32 +0000 en-US hourly 1 Looking Forward – February 2015 Sun, 01 Feb 2015 06:59:32 +0000
David B. Hoyt

David B. Hoyt

The military and surgery have long enjoyed a mutually beneficial relationship. Surgeons in combat areas have often uncovered new procedures and treatments, which they have brought back to the U.S. to improve civilian patient care. In the process, the troops fighting for our nation and patients throughout the world have benefited from the training that surgeons have received at U.S. medical centers prior to deployment to military hospitals. In an era of resident work-hour restrictions, an alarming increase in civilian mass casualty events, ongoing conflicts abroad, and rising demands for the efficient delivery of cost-effective, high-quality care, the need for a synergistic relationship between the American College of Surgeons (ACS) and the U.S. Department of Defense (DoD) Military Health System (MHS) has grown.

Thus, I am pleased to announce that the ACS and the MHS have entered into a strategic partnership designed to improve educational opportunities, systems-based practices, and research capabilities for both parties. This strategic alliance between the MHS and the ACS was solidified when Jonathan Woodson, MD, FACS, Assistant Secretary of Defense for Health Affairs, and I signed a charter at the 2014 Clinical Congress in San Francisco, CA. Officially known as the Military Health Service Strategic Partnership American College of Surgeons (MHSSPACS), the program launched in December 2014.

Origins of the MHSSPACS

Dr. Hoyt and Dr. Woodson

Dr. Hoyt (left) and Dr. Woodson signing the MHSSPACS charter.

The concept of the partnership originated a couple of years ago as a result of a conversation I had with U.S. Navy Captain Eric A. Elster, MD, FACS, chair and professor, Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD; and retired U.S. Marine Corps Colonel Norman M. Rich, MD, FACS, DMCC, founding chair of the department and namesake of the department of surgery at USUHS. With several members of the College’s leadership—Julie L. Freischlag, MD, FACS, Past-Chair, ACS Board of Regents; A. Brent Eastman, MD, FACS, FRCSEd(Hon), Past-President of the ACS; Michael F. Rotondo, MD, FACS, Past-Chair, ACS Committee on Trauma; and other surgeons—we agreed that the College and the military should collaborate on programs aimed at ensuring that the next generation of surgeons is prepared to provide optimal care to patients injured on and off the battlefield.

We reached out to Dr. Woodson to discuss the possibility of forming a strategic partnership. He agreed that maintaining and advancing clinical knowledge and skills are critical to the readiness of the MHS and that an affiliation with the ACS would positively affect care for patients who receive health care services through the MHS and the civilian health care system.

Under the charter, the MHS and the ACS have agreed to do the following:

  • Share information related to the curriculum used to teach military surgical skills through expansion of the ACS Advanced Surgical Skills for Exposure in Trauma course and other programs
  • Share information related to existing education offerings of importance to military and surgical communities that are interested in humanitarian and disaster response
  • Share information related to validation of the military’s Optimal Resources handbook
  • Share information related to potentially increasing the involvement of military surgeons in the ACS senior leadership program
  • Share information related to review of the DoD Combat Casualty Care Research Program
  • Share information on relevant research portfolios, including research conducted through the ACS National Trauma Data Bank® and Trauma Quality Improvement Program®
  • Plan a presentation of an ACS military surgeon symposium at the 2015 ACS Clinical Congress
  • Share information related to systems-based practice, including dissemination of surgical clinical practice guidelines and development of an optimal resources manual for surgical care
Dr. Hoyt and Dr. Woodson

Dr. Hoyt and Dr. Woodson.

The College’s activities related to this strategic partnership will be coordinated by Executive Services and the ACS Division of Member Services. M. Margaret “Peggy” Knudson, MD, FACS, professor of surgery, division of general surgery, San Francisco General Hospital and Trauma Center, University of California, San Francisco, has been recruited to coordinate this effort. Dr. Knudson noted, “The past 13 years of war, the longest in our nation’s history, have yielded unprecedented advances in combat casualty care with the resultant lowest died of wounds rate ever recorded. Through this partnership, training and education platforms, research endeavors, quality improvement programs, and combat readiness and disaster preparedness efforts will be jointly shared, benefiting surgical patients in the U.S. and throughout the world in both civilian and combat arenas.”

Building on the past, preparing for the future

As noted previously, the MHSSPACS is just the most recent addition to a long list of examples of cooperation between the ACS and the U.S. military. President Woodrow Wilson (D) appointed ACS Founder Franklin H. Martin, MD, FACS, to the Advisory Commission of the Council of National Defense to prepare for the U.S. involvement in World War I and called upon the College to assist in organizing a field hospital for the American Expeditionary Force. The College’s involvement in the Great War led to significant advances in patient care. A shortage of splinting materials led to use of the plaster orthopaedic cast for treating fractures, and lessons learned during the war led to the successful management of open chest wounds and empyema.

The Great Mace

Presentation of the Great Mace to the ACS by surgeons of Great Britain, 1920. From left: Sir William Taylor, KBE; George E. Armstrong, MD, FACS; Sir Moynihan; Albert Carless, CBE; and Francis A.C. Scrimger, VC.

In 1918, Sir Berkeley Moynihan, KCMG, CB, of the Royal College of Surgeons led a delegation to America to present the Great Mace to the ACS “in memory of mutual work and good fellowship in the Great War 1914–1918.” The Great Mace continues to be presented each year at the Convocation and is prominently displayed at the College’s headquarters to serve as a lasting reminder of this legacy.

The College’s involvement in World War II dates back to the bombing of Pearl Harbor. When traveling to examine and treat patients injured during the attack, Isidor S. Ravdin, MD, FACS, took with him a supply of albumin that he used to successfully treat seven severely burned patients. In 1942 through 1944, the College replaced its sectional meetings with War Sessions throughout the U.S. and Canada to train the many physicians and surgeons entering the Army in the care of combat injuries. Furthermore, as Theater Commander for Surgery in the Mediterranean in World War II, Colonel Edward D. Churchill, MD, FACS, developed the use of delayed primary closure and early debridement of contaminated wounds and improved the air evacuation process for wounded soldiers.

In addition, Past-Director of the ACS, Paul Hawley, MD, FACS(Hon), has been credited with drawing the blueprint for the U.S. Department of Veterans Affairs’ health care system. More recently, Landstuhl Regional Medical Center, a military hospital operated in Germany by the U.S. Army and the DoD, became the only medical center outside of the U.S. to achieve Level II Trauma Center verification status from the College. In 2011, it was verified as a Level I center.

All of the individual surgeons involved in launching this initiative anticipate that the MHSSPACS will result in even greater advances for all trauma and surgical patients. If you would like to get involved in this program, please let me know. Together, we can do much to improve the quality of care and quality of life for all Americans.

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Highlights of the 2014 Clinical Congress Sun, 01 Feb 2015 06:58:44 +0000

Dr. Pellegrini and Dr. Warshaw

Dr. Pellegrini (right) presents the Presidential Medallion to Dr. Warshaw.

Dr. Warshaw

Dr. Warshaw presents his Presidential Address.

Robert D. Winfield, MD, FACS

Robert D. Winfield, MD, FACS, Chair of the RAS-ACS, speaks on behalf of Resident Members and Associate Fellows.

Dr. Linehan

Dr. Linehan presents the Martin Memorial Lecture.

Dr. Meredith

Dr. Meredith (right) receives the Distinguished Service Award.

Distinguished Philanthropist Awardees

Distinguished Philanthropist Awardees Dr. and Mrs. Austen (left and center) with
Amilu Stewart, MD, FACS, ACS Foundation Chair.

Dr. Tinkoff

National Safety Council (NSC) 2014 Surgeon’s Award for Service to Safety recipient Dr. Tinkoff (center), with Ronald M. Stewart, MD, FACS, COT Chair (left), and John Ulczycki, NSC vice-president.

Surgical Volunteerism Awards

Surgical Volunteerism Awards (from left): Francis Ferdinand, MD, FACS, Vice-Chair, Board of Governors Surgical Volunteerism and Humanitarian Awards Workgroup (B/G SVHAW); and Bartholomew Tortella, MD, FACS, Senior Director, Medical Affairs Product Lead, Hematology, Pfizer, Inc., with award winners Drs. Brown, Bach, Sakran, and Leckman; Dr. Timmerman; and Kevin Behrns, MD, FACS, Chair, B/G SVHAW.

Surgical Forum Dedication

Surgical Forum Dedication: Dr. Sarr (left) with K. Reid Lombardo, MD, FACS

Surgical Forum Excellence in Research Awards

Surgical Forum Excellence in Research Awards: O. Joe Hines, MD, FACS (sixth from right), Chair of the Committee for the Forum on Fundamental Surgical Problems, distributed awards to the recipients, pictured left to right: Drs. Liao, Bydon, Zangbar, Adams, Maan, Yi, Riesel, Carson, Bassett, Wakeam, Holley, and Min. Not pictured: Drs. Grant and Spurrier.

Dr. Sims

Jacobson Promising Investigator Awardee Dr. Sims (center, in red) with members of the
Surgical Research Committee and past recipients.

Dr. Pernar

Dr. Pernar, recipient of the Resident Award for Exemplary Teaching (second from left), pictured with (left to right): Ajit K. Sachdeva, MD, FACS, FRCSC, Director, Division of Education; Julie A. Freischlag, MD, FACS, Chair, Board of Regents; Michael J. Zinner, MD, FACS, Regent; Dr. Warshaw; Dr. Hoyt; Glenn T. Ault, MD, MSEd, FACS, Chair, Resident Award Program, Committee on Resident Education.

Dr. Russell

Dr. Russell, recipient of the Jameson L. Chassin, MD, FACS, Award for Professionalism in General Surgery (fifth from left), with (left to right): Mark T. Savarise, MD, FACS, professor of surgery, University of Utah School of Medicine (UUSOM), Salt Lake City; Courtney Scaife, MD, FACS, University of Utah and Affiliated Hospitals, Salt Lake City; Daniel J. Vargo, MD, FACS, Residency Program Director, UUSOM; Dr. Sachdeva, Dr. Freischlag; Dr. Hoyt; Dr. Warshaw; Clark J. Rasmussen, MD, FACS, Intermountain Medical Center, Salt Lake City, UT; Amalia Cochran, MD, FACS, associate professor of surgery, UUSOM; Leigh A. Neumayer, MD, MS, FACS, ACS Regent; and Raymond R. Price, MD, FACS, Intermountain Medical Center.

Best Scientific Poster of Exceptional Merit winner

Best Scientific Poster of Exceptional Merit winner Dr. Sancheti (right) with Dr. Derkay (left) and Dr. Duncan.

CoC Liaison Outstanding Performance Awardees

CoC Liaison Outstanding Performance Awardees Dr. Hoshi (second from left) and Dr. Carp (second from right) with Dr. Milroy (far left), CoC Liaison Co-Chair, and Dr. Roland, CoC Liaison Chair. Not pictured: Dr. Moysaenko.

International Scholars and Travelers 2014

The International Scholars and Travelers 2014, International Relations Committee members, and guests. Front row, left to right: Drs. Heriot, Raymundo, Turney, Sugimachi, Bindal, Tabiri, Tewari, Ekpe, Muhssein, Kumar, Lehwald, Oladele, and Mullen. Back row: Drs. Wahlgren, Kao, Toumpoulis, Pradeep, Baba, Harper, Bonilla, Toussaint, Li,
Croner, Chaudhery, Tóth, and Kumar.

Oweida Scholarship presentation: Dr. Pellegrini (left) with Dr. McBee.

Oweida Scholarship presentation: Dr. Pellegrini (left) with Dr. McBee.

Past-Chairs of the COT

Past-Chairs of the COT gather at the annual trauma dinner. Left to right: Dr. Stewart; A. Brent Eastman, MD, FACS, FRCSEd(Hon); C. Thomas Thompson, MD, FACS; Erwin Thal, MD, FACS; Dr. Hoyt; Donald D. Trunkey, MD, FACS; Michael F. Rotondo, MD, FACS; and Dr. Meredith.

The College’s Resource Center in the exhibit area.

The College’s Resource Center in the exhibit area.

The 2014 Clinical Congress of the American College of Surgeons (ACS) in San Francisco, CA, provided surgeons, medical students, surgical residents, and other members of the operating room team with the opportunity to immerse themselves in a variety of educational experiences and to interact with their peers. Total registration for this year’s meeting was 13,960, including 9,354 physicians; the remaining attendees were exhibitors, guests, spouses, and convention personnel.


Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), surgeon-in-chief emeritus, Massachusetts General Hospital, and the W. Gerald Austen Distinguished Professor of Surgery, Harvard Medical School, Boston, MA, was installed as the 95th President of the ACS at the 2014 Convocation ceremonies October 26. Dr. Warshaw presented his Presidential Address, Achieving Our Personal Best—Back to the Future of the American College of Surgeons, to the College’s 1,640 Initiates and other attendees.

Two Vice-Presidents assumed office at the Convocation, as well: Jay L. Grosfeld, MD, FACS, FRCSEng(Hon), FRCSI(Hon), FRCSGlasg(Hon), as First Vice-President; and Kenneth L. Mattox, MD, FACS, as Second Vice-President. Dr. Grosfeld is Lafayette F. Page professor emeritus of pediatric surgery, and past-chairman, department of surgery, Indiana University School of Medicine, Indianapolis. Dr. Mattox is distinguished service professor, Michael E. DeBakey department of surgery, Baylor College of Medicine, and chief of staff and chief of surgery, Ben Taub General Hospital, Houston, TX.

In addition, Honorary Fellowship was conferred on six international surgeons: Pierre-Alain Clavien, MD, PhD, FACS, FRCSEng, FRCSEd, Zurich, Switzerland; Alberto Raul Ferreres, MD, PhD, MPH, FACS, Buenos Aires, Argentina; O. James Garden, BSc, MB, BCh, CBE, MD, FRCSEd, FRCPEd, FRSE, Edinburgh, Scotland; Antoon (Toni) Lerut, MD, FACS, FACCP, FRCSEng(Hon), FRCSI(Hon), AFC(Hon), ASA(Hon), Leuven, Belgium; Chung-Mau Lo, MB, BS, FACS, Hong Kong SAR, China; and Edgar Rodas, MD, FACS, Cuenca, Ecuador.

Named Lectures

Clinical Congress featured several Named Lectures, starting with the Martin Memorial Lecture, presented immediately after the Opening Ceremony on October 27. W. Marston Linehan, MD, chief, urologic surgery and urologic oncology branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, delivered the well-received lecture, Targeting the Genetic and Metabolic Basis of Cancer.

Other Named Lectures presented at the 2014 Clinical Congress were as follows:

  • Valerie W. Rusch, MD, FACS, vice-chair for clinical research, department of surgery, and Miner Family Chair in Intrathoracic Cancers, Memorial Sloan Kettering Cancer Center, and professor of surgery, Weill Cornell Medical College, NY, presented the John H. Gibbon, Jr., Lecture: Evolution in Lung Cancer Care: From Scalpels to Molecules.
  • Dr. Mattox presented the Charles G. Drake History of Surgery Lecture: Symbiotics and Serendipity in Aortic Trauma Management.
  • Piero Anversa, MF, FAHA, CCNS, professor, anesthesia and medicine, Harvard Medical School, and director, Center for Regenerative Medicine, Brigham and Women’s Hospital, Boston, MA, presented the I. S. Ravdin Lecture in the Basic and Surgical Sciences: The Human Lung: A Self-Renewing Organ.
  • David A. Rothenberger, MD, FACS, Jay Phillips Professor and Chair, department of surgery, and founder and co-director, emerging physician leaders program, University of Minnesota Medical School, Minneapolis, presented the Herand Abcarian Lecture: Surviving and Thriving As a Surgeon: What’s in Your Bag?
  • Norman M. Rich, MD, FACS, DMCC, COL, MC, USA (Ret.), founding chair and namesake of the Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, presented the Excelsior Surgical Society/Edward D. Churchill Lecture: Military Surgeons and Surgeons in the Military.
  • C. William Schwab, MD, FACS, FRCS, professor of surgery, University of Pennsylvania Medical School, and trauma surgeon, Hospital of the University of Pennsylvania, Philadelphia, presented the Scudder Oration on Trauma: The Winds of War.
  • Barbara L. Bass, MD, FACS, John F. and Carolyn Bookout Distinguished Endowed Chair of Surgery, Houston Methodist Hospital, TX; director, Methodist Institute for Technology, Innovation and Education, Houston; and professor of surgery, Weill Cornell Medical College of Cornell University, New York, NY, presented the Olga M. Jonasson Lecture: Our Lives As Surgeons: Finding a Sense of Place and Purpose.
  • Meena N. Cherian, MD, lead, emergency and essential surgical care program, service delivery and safety department, Health Innovation Systems, World Health Organization, presented the Distinguished Lecture of the International Society of Surgery: Surgical Care in the Global Health Agenda.
  • Steven Z. Pantilat, MD, FAAHPM, MHM, professor of clinical medicine, Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care, director of the palliative care program and Palliative Care Leadership Center, and director of the Palliative Care Quality Network, University of California, San Francisco, presented the Ethics and Philosophy Lecture: Doctors Do Everything: Life and Death in the ICU.
  • Carolyn C. Compton, MD, PhD, FCAP, chief medical officer of the National Biomarkers Development Alliance, member of the Biodesign Institute; chief medical officer of the Complex Adaptive Systems Initiative, and professor, life sciences, Arizona State University, Phoenix; and professor, laboratory medicine and pathology, Mayo Clinic School of Medicine, Rochester, MN, presented the Commission on Cancer Oncology Lecture: Challenge, Convergence, Complexity, and Change in Cancer Care: Are We Ready?

Notable events

The ACS and the Department of Defense, Military Health System (MHS), signed an agreement at Clinical Congress. The partnership is meant to benefit both parties in the areas of education, systems-based practices, and research. (See Dr. Hoyt’s Looking forward column.)

In light of the events preceding the start of Clinical Congress, a session on the Ebola virus was presented. Ebola: Pragmatic Information for Surgeons covered the pathogenesis, testing, treatment, transmission, and protective measures for the virus. The session featured Michele Barry, MD, FACP, professor of medicine at Stanford School of Medicine, CA; David B. Hoyt, MD, FACS, ACS Executive Director; Sherry M. Wren, MD, FACS, professor of surgery at Stanford School of Medicine, CA; and Gillian Lee Seton, MD, a general surgeon who provides care to patients in Monrovia, Liberia, and assistant professor of surgery at Loma Linda University, CA.

Holding its inaugural session at this year’s Clinical Congress was the ACS Surgical History Group (ACSSHG). The Panel Session, moderated by LaMar S. McGinnis, Jr., MD, FACS, Chair of the ACSSHG’s Executive Committee, was titled Factors Shaping Surgery during the 20th Century. The purpose of the ACSSHG is chiefly to promote and enhance the appreciation of American surgical history.

Awards and honors

Several surgeons were honored for their contributions to the ACS. Thomas R. Russell, MD, FACS, former Executive Director of the ACS, was posthumously awarded the Lifetime Achievement Award at the Convocation. The award is presented periodically “to an extraordinary individual for a lifetime of contributions to the art of medicine and surgery, and service to the ACS,” said Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), Immediate Past-President of the ACS. Dr. Russell’s wife, Nona, and his two daughters, Katie and Jackie, accepted the award.

J. Wayne Meredith, MD, FACS, the Richard T. Myers Professor and Chair, department of surgery, Wake Forest School of Medicine; surgeon-in-chief, Wake Forest Baptist Health; and medical director, Childress Institute of Pediatric Trauma, Wake Forest University Baptist Medical Center, Winston-Salem, NC, received the ACS Distinguished Service Award, the College’s highest honor, at the Convocation. The Board of Regents presented the award to Dr. Meredith in appreciation of “his continuous and devoted service” to the organization, as well as “his distinctive scientific contributions in cardiovascular physiology during resuscitation, trauma registries, and trauma systems.”

The Fellows Leadership Society (FLS) of the ACS Foundation presented the 2014 Distinguished Philanthropist Award to Patricia R. and W. Gerald Austen, MD, FACS. The award was announced during the 26th annual FLS Benefactor Recognition Luncheon in recognition of Mrs. and Dr. Austen’s philanthropic contributions and service to the international and surgical communities.

Glen H. Tinkoff, MD, FACS, associate vice-chair, surgery for emergency surgical services, Christiana Hospital, Newark, DE, received the National Safety Council 2014 Surgeons’ Award for Service to Safety at the annual ACS Committee on Trauma (COT) Dinner. The award citation recognized Dr. Tinkoff’s “commitment to the advancement of care of injured patients in Texas through leadership in the organization of a regional trauma care system and outstanding trauma research.”

Harry S. Brown, MD, FACS, an ophthalmologist from Santa Barbara, CA, received the 2014 ACS/Pfizer Surgical Humanitarian Award for starting an international health care organization dedicated to restoring sight and preventing blindness in disadvantaged individuals. Additionally, three surgeons received the ACS/Pfizer Surgical Volunteerism Awards. Joseph V. Sakran, MD, MPH, FACS, a general surgeon from Boston, MA, received the Surgical Volunteerism Award for developing long-term interventions aimed at reducing the global burden of surgical disease, participating in numerous disaster relief efforts, and compiling medical supplies for communities of low- and middle-income countries. Robert D. Bach, MD, FACS, a general surgeon from North Haven, ME, received the Surgical Volunteerism Award for his decades of medical service to the impoverished and isolated population of northeastern Nicaragua. Scott A. Leckman, MD, FACS, a general surgeon from Salt Lake City, UT, received the Surgical Volunteerism Award for his efforts to provide free health care to low-income, uninsured patients in Salt Lake County.

The 2014 Owen Wangensteen Surgical Forum on Fundamental Surgical Problems was dedicated to Michael G. Sarr, MD, FACS, chair, division of general and gastroenterologic surgery, Mayo Clinic, Rochester, MN, in recognition of his exemplary leadership and mentorship of surgical residents.

Practicing surgeons, residents, and medical students were recognized for their contributions to advancing the art and science of surgery. Residents honored with the Surgical Forum Excellence in Research Awards included: Christa Grant, MD; Christopher Holley, MD; Bardiya Zangbar, MD; Johanna Riesel, MD; Mohamad Bydon, MD; Peter Adams, MD; Zeshan Maan, MB, BS, MS, MRCS; Elliott Wakeam, MD; Hyeyoun (Elise) Min; Jeniann Yi, MD; George Liao, MD; Ryan Spurrier, MD; Jeffrey Bassett, MD; and Jeffrey Carson, MD.

Carrie A. Sims, MD, MS, FACS, assistant professor of surgery, division of trauma, surgical critical care, and acute care surgery, University of Pennsylvania, Philadelphia, received the 10th Joan L. and Julius H. Jacobson II Promising Investigator Award. The award honors outstanding surgeons engaging in research, advancing the art and science of surgery, and demonstrating early promise of significant contributions to the practice of surgery.

The 12th annual ACS Resident Award for Exemplary Teaching was presented to Luise Ingeborg Maria Pernar, MD, a fifth-year resident in general surgery at the Brigham and Women’s Hospital in Boston, MA.  The award is sponsored by the Division of Education to recognize excellence in teaching by a resident and to highlight the importance of teaching in residents’ daily lives. Dr. Pernar was selected by an independent review panel of the Committee on Resident Education.

The second annual Jameson L. Chassin, MD, FACS, Award for Professionalism in General Surgery was presented to Katie White Russell, MD, a chief resident in general surgery at the University of Utah and Affiliated Hospitals in Salt Lake City, Utah. The award recognizes a chief resident in general surgery who exemplifies the values of compassion, technical skill, and devotion to science and learning. The ACS established the award with gifts from the family, colleague, and friends of the late Jameson L. Chassin, MD, FACS, who was a skilled surgeon, teacher, and scholar in New York, NY. The award is administered by the ACS Division of Education. Dr. Russell was selected by an independent review panel of the Committee on Resident Education.

Craig S. Derkay, MD, FACS, Vice-Chair of the ACS Program Committee, and Audra A. Duncan, MD, FACS, ACS Program Committee member, awarded the Best Scientific Poster of Exceptional Merit award to Manu S. Sancheti, MD, for Risk Factors for 30-Day Mortality after Pulmonary Resection for Lung Cancer from the National Cancer Data Base: An Analysis of More than 200,000 Patients. The coauthors of this poster included the following: Theresa Gillespie, PhD; Dana Nickleach, MA; Yuan Liu; Kristin Higgins, MD; Suresh Ramalingam, MD; Joseph Lipscomb, PhD; and Felix G. Fernandez, MD, FACS, Emory University, Atlanta, GA.

Furthermore, the following medical students were honored for their Basic Science Research posters:

  • First place: Debi Thomas, University of Southern California, Los Angeles: Identifying Strains of Opportunistic Pathogens in Necrotizing Enterocolitis
  • Second place: Steven Koprowski, Medical College of Wisconsin, Milwaukee: Curcumin-Mediated Notch 1 Signaling: A Potential Molecular Target in Cholangiocarcinoma
  • Third place: Danny Mou, Emory University: Virus Induced CD28 Down-Regulation As a Driver of Costimulation Resistant Allograft Rejection

The following medical students were recognized for their Clinical and Educational Research posters:

  • First place: Michelle Chua, Harvard University: Stratification of Recanalization for Patients with Endovascular Treatment of Intracranial Aneurysms
  • Second place: Melina Deban, McGill University, Montreal, QC: McGill Simulation Complexity Score: Development of an Objective Complexity Scoring System for Virtual and Mannequin-based Simulations in Trauma
  • Third place: Cynthia Miller, Massachusetts General Hospital: Immediate Implant Reconstruction Is Associated with a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study

The International Relations Committee welcomed the International Guest Scholars for 2014 and other guests at a luncheon on October 28, including: Yoshifumi Baba, MD, PhD, Japan Exchange Fellow; Vivek Bindal, MB, BS, Baxiram S. and Kankuben B. Gelot Community Surgeons Travel Awardee; Fernando Bonilla, MD; Saud Majid Chaudhery, MB, BS, Dr. Pon Satitpunwaycha Community Surgeons Travel Awardee I; Roland S. Croner, MD, FACS, Murray F. Brennan Scholar; Eyo Effiong Ekpe, MB, BS; Jeffrey M. Farma, MD, FACS, 2014 Traveling Fellow to Germany; Luke Harper, MD; Alexander G. Heriot, MB, BChir, FRCSEd, FRCSEng, FRACS, ANZ Exchange Fellow; Huang-Kai Kao, MD, Louis C. Argenta Scholar; Subodh Kumar, MB, BS, FACS, Dr. Abdol and Mrs. Joan Islami Scholar II; Nadja Lehwald, MD, PhD, Germany Exchange Fellow; Jiang-Tao Li, MD, Carlos Pellegrini Traveling Fellow; Haidar Mohammad Muhssein, MB, BCh, FACS, Dr. Pon Satitpunwaycha Community Surgeons Travel Awardee II; John T. Mullen, MD, FACS, 2014 ACS Traveling Fellow to Germany; Ayodeji O. Oladele, MB, BCh, FWACS, Dr. Pon Satitpunwaycha Community Surgeons Travel Awardee III; Puthen Veetil Pradeep, MB, BS, FACS, Dr. Pon Satitpunwaycha Community Surgeons Travel Awardee IV; Eliza M. Raymundo, MD; Keishi Sugimachi, MD, Elias Hanna Scholar; Stephen Tabiri, MD; Mellika Tewari, MB, BS, MS; Dezso Tóth, MD, PhD; Ioannis K. Toumpoulis, MD, Stavros Niarchos Foundation Scholar; Sterman Toussaint, MD, International Surgical Education Scholar; Benjamin W. Turney, MB, BChir, PhD, Dr. Abdol Islami and Mrs. Joan Mae Islami Scholar I; Carl Wahlgren, MD, PhD; and Wei Zhou, MD, PhD, FACS, 2014 Traveling Fellow to ANZ.

The Commission on Cancer (CoC) presented the State Chair Outstanding Performance Award to the following surgeons: Ned Zachary Carp, MD, FACS, Pennsylvania; Hisakazu Hoshi, MD, FACS, Iowa; and Valeriy Moysaenko, MD, FACS, Ohio.

John M. McBee, MD, FACS, a general surgeon in Pendleton, OR, attended Clinical Congress as the recipient of the 2014 Nizar N. Oweida, MD, FACS, Scholarship (see Dr. McBee’s report). Additionally, Anees B. Chagpar, MD, MPH, FACS, director of the Breast Center-Smilow Cancer Hospital at Yale University, New Haven, CT, and recipient of the 2013 Claude H. Organ, MD, FACS, Traveling Fellowship, spoke before the ACS Scholarships Committee.

Lastly, the winners of the 2014 Resident and Associate Society (RAS) of the ACS essay contest spoke at the RAS Symposium. The theme of the essay contest was the Five-Year General Surgery Residency Program: Reform or Revolution? Jahan Mohebali, MD, third-year resident at Massachusetts General Hospital, Boston, was the first-place winner for the “reform” side. Edna Shenvi, MD, who has completed two years of residency at Brigham and Women’s Hospital, Boston, MA, was the first-place winner for the “revolution” side.

Annual Business Meeting

The ACS Annual Business Meeting of Members convened on October 29 with Dr. Warshaw presiding and the following officials presenting reports: Julie A. Freischlag, MD, FACS, Chair of the Board of Regents; Robert R. Bahnson, MD, FACS, Chair of the ACS Professional Association political action committee (ACSPA-SurgeonsPAC) Board of Directors; Gary L. Timmerman, MD, FACS, Chair of the Board of Governors; and Dr. Hoyt.

The election of the ACS President-Elect, Vice-Presidents-Elect, Regents, and Governors also took place at the Annual Business Meeting.

J. David Richardson, MD, FACS, professor of surgery and vice-chairman, department of surgery, University of Louisville School of Medicine, KY, was elected President-Elect. Ronald V. Maier, MD, FACS, Jane and Donald D. Trunkey Endowed Chair in Trauma Surgery, and professor and vice-chairman of surgery, University of Washington School of Medicine, Seattle, was elected First Vice-President-Elect; Walter J. Pories, MD, FACS, founding chair, department of surgery; professor of surgery, biochemistry and kinesiology; and director, bariatric surgery research group, East Carolina University, Greenville, NC, was elected Second Vice-President-Elect.

The Board of Governors of the ACS reelected six members of the Board of Regents to additional three-year terms: James K. Elsey, MD, FACS, a general and vascular surgeon, Atlanta, GA; Gerald M. Fried, MD, FACS, FRCSC, FCAHS, a general surgeon, Montreal, QC; B. J. Hancock, MD, FACS, FRCSC, a pediatric surgeon, Winnipeg, MB; Lenworth M. Jacobs, Jr., MD, MPH, FACS, a general surgeon, Hartford, CT; Mark A. Malangoni, MD, FACS, a general surgeon, Philadelphia, PA; and Valerie W. Rusch, MD, FACS, a cardiothoracic surgeon, New York, NY.

The Board of Governors elected Fabrizio Michelassi, MD, FACS, a general surgeon, to serve as Chair of its Executive Committee; Karen J. Brasel, MD, FACS, a general surgeon, Portland, OR, as Vice-Chair; and James C. Denneny III, MD, FACS, otolaryngologist, Alexandria, VA, as Secretary. Newly elected to serve on the Executive Committee of the Board of Governors are Kevin Behrns, MD, FACS, a general surgeon, Gainesville, FL; Diana Farmer, MD, FACS, a pediatric surgeon, Davis, CA; and Steven C. Stain, MD, FACS, a general surgeon, Albany, NY. Governors-at-Large from throughout the world and Specialty Society Governors also were installed.

Clinical Congress 2015

Be sure to attend the 2015 Clinical Congress, October 4–8, in Chicago, IL. Details regarding the educational program, registration, housing, and transportation will be posted at

For more information

This article contains information that is discussed in greater depth in previous issues of the Bulletin. The following is a list of where these articles can be found.

September 2014

October 2014

November 2014

December 2014

The photos accompanying this article were taken by Charles Giorno Photography, Stewart Bloom Photography, and Oscar and Associates.

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The disruptive physician: Addressing the issues Sun, 01 Feb 2015 06:57:04 +0000

Editor’s note: The following is the fourth in a series of excerpts from Being Well and Staying Competent: Challenges for the Surgeon, a guidebook issued in 2013 by the ACS Board of Governors’ Committee on Physician Competency and Health. The complete document is posted in the General Surgery community’s library in ACS Communities (login required).

Most health care professionals have witnessed their colleagues engaging in disruptive behavior with coworkers, relatives, patients, and other acquaintances at one time or another. However, it is imperative to make the distinction between being disruptive and advocating on the behalf of a patient. For example, when a physician assumes a firm patient advocacy position in a conversation regarding the long-term care facility placement of an elderly patient, this may be an appropriate and effective behavior. Conversely, when a physician angrily demeans a nurse in a crowded hospital hallway or raises his or her voice, shouting profanities in a committee meeting, these actions are inappropriate and disruptive. When physicians exhibit this behavior in such a setting, it may be a signal that a more widespread issue within the health care system requires attention.1 Disruptive actions listed in the American Medical Association Code of Medical Ethics, adopted in 2009, include: “any abusive conduct, including sexual or other forms of harassment, or other forms of verbal or nonverbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised.”2 Specifically mentioned are the following actions:2

  • Physically threatening anyone [in the hospital]
  • Making threatening or intimidating physical contact with another person
  • Throwing things
  • Threatening violence or retribution
  • Sexual and other harassment
  • Persistent inappropriate behavior, rising to the level of harassment

Specific inappropriate behaviors outlined in the code include, but are not limited to, the following: making belittling, sarcastic, or condescending statements; calling people names; using profanity; blatantly failing to respond to patient care needs or staff requests; and deliberately failing to return calls, pages, and messages.

Mounting pressures

As the complexity of medical care increases, the need for well-functioning partnerships between members of the medical team becomes more important. At the same time, the stresses, demands, and distractions for surgeons also continue to mount. As a result of the relatively high profile of physicians, disruptive behavior by these individuals is perceived to have a greater impact—and greater potential for disruption.

Despite physicians’ best efforts to work within “the system,” quite often surgeons are urgently contacted for an issue that ultimately does not qualify as an emergency. At other times, surgeons responding to a call arrive only to find that necessary preparations have not been made or equipment is not available for a procedure. Perhaps an important change in a patient’s condition went unrecognized, or the staff did not notify the physician of the change. Feelings of anger and frustration are understandable in these situations, but a physician must consider his or her response carefully.

Although little evidence is available to indicate that the frequency of disruptive conduct has increased in recent years, the issue is being increasingly studied, and physicians who display this behavior continue to be penalized. In 2008, The Joint Commission issued a Sentinel Event Alert, which stated, “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.”3 For example, Joint Commission-accredited hospitals are mandated to have defined mechanisms in place for identifying and addressing disruptive behavior.

Although the overall prevalence of this type of conduct is unknown, large-scale studies suggest that disruptive behavior occurs frequently. In a 2002 survey of 675 nurses at 50 Veterans Affairs (VA) hospitals, 86 percent of the respondents reported witnessing disruptive physician behavior—a finding supported by the results of other studies.4 Most of these incidents involved nursing staff or other health care professionals. In 2011, another survey of more than 800 physicians found that disruptive behavior occurs in more than 70 percent of hospitals each month.5 More than 10 percent of the physicians surveyed reported that these behaviors occur weekly. Similarly, in 2009, more than 2,000 physician executives acknowledged encountering behavioral problems with physicians in their institution.6

It is important to note, however, that “a single episode of disruptive behavior does not render a physician a disruptive physician,” according to experts on the topic.7 Current research suggests that it is generally a small percentage of physicians who are responsible for the majority of the inappropriate behavior. Most reports describe 3 percent to 5 percent of physicians exhibiting disruptive behavior; unfortunately, it appears that surgeons are among those most often identified as disruptive (particularly general surgeons, neurosurgeons, cardiovascular surgeons, and orthopaedic surgeons).5 Another important clarification is that most disruptive physicians are not impaired or suffering from a substance abuse pathology, but are likely exhibiting longstanding behavior patterns. In fact, fewer than 10 percent of physician behavior issues are related to substance abuse.8,9

Effects of disruptive behavior

The consequences of disruptive behavior can be significant, and may even affect patient care. Furthermore, these behaviors often result in diminished morale and productivity and create work environment disturbances due to increased stress and turnover of health care employees.1 Collegiality is impaired by disruptive behavior, leading to a less efficient and less functional team. A colleague on the receiving end of inappropriate behavior may be less likely to question orders, express concerns regarding discrepancies in patient consents, or notify the physician of other patient-related issues, thereby increasing the potential for medical error.

As unimpeded communication becomes more difficult, patient safety is also compromised. In a survey conducted at 102 VA hospitals with 4,530 participants, 67 percent of respondents said they felt that disruptive behavior was linked to adverse events, 71 percent saw a link to errors, and 27 percent saw a link to patient mortality.5

Patient and family satisfaction deteriorates as a result of disruptive physician behavior.10, 11 These occurrences may lead to complaints to the medical staff office, and multiple complaints may serve as an indicator of a disruptive physician. A review of complaints to state medical boards indicated that 36 percent of these reports were related to inappropriate physician behavior.12

Disruptive physician behavior also has economic consequences, including slowed patient throughput as a result of decreased efficiency, increased employee turnover leading to additional hiring and training expenditures, elevated costs for hospitals because of increased errors and adverse events, and an additional financial burden for physicians resulting from liability claims.13

How to address disruptive behavior

Because of the significant consequences associated with disruptive physician behavior, it is important that health care institutions and the profession address this problem. The following approach should provide a systematic and effective approach for reducing and deterring disruptive behavior.


The first step in addressing disruptive behavior is prevention. Hospital systems should develop a clearly outlined approach for making all employees, including physicians, aware of what constitutes disruptive behavior, as well as the consequences of any transgressions. It is essential that health care professionals understand that the codes of conduct/standards apply to all patient care team members.

To address the issue of disruptive behaviors, most hospital systems have incorporated specific language in their medical staff bylaws. This behavior falls under the category of “professionalism,” requiring health care professionals to display a minimum standard of behavior toward colleagues, employees, and patients.14 Any violation of the tenets of professionalism may serve as justification for taking action to address this behavior. The definition and expectations of professional behavior have some expected variance across health systems, but there are common components, including the following:

  • Expected behaviors should be clearly defined
  • Consequences for divergence from these behaviors should be delineated
  • Repercussions should be in accordance with the severity of the incident
  • Consequences for repeat behaviors should increase in a step-wise fashion
  • Clear communication should occur and be documented after each and every reported incident

It is imperative to recognize that the individual displaying disruptive behavior(s) and the individual(s) on the receiving end of such behaviors may perceive these behaviors differently. Some physicians may claim that whether the behavior is positive or negative is in the eye of the beholder. Therefore, a code of conduct that is equally applied to all health care professionals is essential in order to establish a well-defined foundation to support any conduct-related conversation or disciplinary action. It also is essential to include due process in the code of conduct. Complaints should only be considered valid if a verification process is in place. In a report issued by the American Association for Physician Leadership (formerly the American College of Physician Executives), code of conduct bylaws should include an appeals process, along with an option for a fair hearing.15 For physicians, acknowledgment (and signing) of the code of conduct is frequently part of the credentialing process.


If a health care professional witnesses unwanted behaviors, they should identify and report the act in a timely and professional manner. Disruptive behaviors may be viewed as diminishing the strength of the health care team and, therefore, detrimental not only to other staffers and the physician involved, but, ultimately, to patient care.10 Identifying disruptive behavior is the cornerstone of promoting better patient care and encouraging long-lasting, meaningful relationships among all hospital staff. Most institutions recommend that reports of unfavorable physician behavior be directed at either the medical staff director/administrator or human resources. It is crucial that behavior standards are universally applied and that no perception of favoritism occur (that is, higher tolerance for inappropriate attitudes or actions exhibited by prominent or highly productive physicians). Identification of disruptive behavior must be done in accordance with defined criteria and must not be applied arbitrarily. Formal mechanisms, including detailed reporting, should be in place for documenting these events, alongside policies to protect those colleagues who are reporting them from retaliation; some individuals may otherwise be hesitant to report misconduct for fear of the repercussions.


Addressing disruptive behavior in a relaxed, informal setting with either the medical staff executive or in conjunction with a physician mentor is most likely to result in a desirable outcome. The degree and pattern of behavior may be a predictor for a positive outcome. For example, for a physician who has an unusual, uncharacteristic outburst, a private conversation with a colleague may be most appropriate. The physician with an ongoing pattern of unacceptable behavior may best be addressed by physicians in leadership—either within the department structure or via the institutional physician executive structure. Unfortunately, such a physician may have long-established behavior patterns and lack insight into his or her behavior.10 In these cases, changing the counterproductive and damaging behavior patterns is likely to require prolonged and intensive counseling. Physicians in this position generally must be mandated to enter counseling programs, as they are unlikely to seek assistance voluntarily.

In a structured format, the physician’s behaviors should be discussed and include specific documentation. The physician should have an opportunity to self-evaluate. Relevant cultural factors also should be addressed. A plan for future actions should be developed, agreed upon, and documented with stepwise progression up to and including dismissal from the medical staff, if the disruptive behaviors continue. Consequences of continued/repeated inappropriate behavior should also be explained to the physician. The conversation should be documented and the physician’s progress monitored. The ultimate goal of these actions is focused on two outcomes—improved patient care and a physician who embodies optimal behaviors and capabilities.

Additional resources

For more information on recognizing and responding to disruptive physician behavior, view the following:

For information on contacting individual state medical boards, visit the Public Resources page at the Federal State Medical Boards website.


As part of the corrective plan, a monitoring program should be put in place. Established behavior patterns may be resolved incrementally, and while relapses are not uncommon, improved conduct is expected. If the behaviors persist, the agreed-upon penalties should be implemented. The monitoring period will vary, but it should extend at least six to 12 months to encourage the maintenance of appropriate behavior. Most state medical boards provide or contract with formal programs for the evaluation and rehabilitation of physicians who exhibit disruptive behavior, and these are available to hospitals as an option for resolution. These programs can be found on the website of the Federation of State Health Programs and the Federation of State Medical Boards (see sidebar). These programs provide the offending physician an opportunity to confidentially undergo rehabilitative counseling or behavior modification without jeopardizing his or her licensure.


In an era in which quality care and patient safety are high priorities, the surgical profession can no longer tolerate disruptive behavior in or out of the operating room. These behaviors should be addressed early on and in a stepwise fashion to reduce their impact and presence, to maintain the morale of other members of the health care delivery team, and to protect our patients’ well-being.


  1. Williams MV, Williams BW, Speicher M. A systems approach to disruptive behavior in physicians: A case study. J Med Lic Disc. 2004;90(4):18-24.
  2. American Medical Association. 2011 AMA Code of Medical Ethics. Opinion 9.045–Physicians with disruptive behavior. Available at: Accessed January 12, 2015.
  3. Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464-471.
  4. Rosenstein AH, O’Daniel M. Disruptive behavior and clinical outcomes: Perceptions of nurses and physicians. Am J Nurs. 2005;105(1):54-64.
  5. MacDonald O. Disruptive physician behavior. May 15, 2011. Available at: Accessed December 9, 2014.
  6. Johnson C. Bad blood: Doctor-nurse behavior problems impact patient care. Physician Exec. 2009;35(6):6-11.
  7. Reynolds NT. Disruptive physician behavior: Use and misuse of the label. J Med Regul. 2012;98(1):8-19.
  8. Porto G, Lauve R. Disruptive clinical behavior: A persistent threat to patient safety. Patient Safety and Quality Healthcare. Lionheart Publishing Inc. July/August 2006. Available at: Accessed December 9, 2014.
  9. Leape LL, Fromson JA. Problem doctors: Is there a system-level solution? Ann Intern Med. 2006;144(2):107-115.
  10. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951-2957.
  11. Daniel AE, Burn RJ, Horarik S. Patients’ complaints about medical practice. Med J Aust. 1999;170:576-577.
  12. Patel P, Robinson BS, Novicoff WM, Dunnington GL, Brenner MJ, Saleh KJ. The disruptive orthopedic surgeon: Implications for patient safety and malpractice liability. J Bone Joint Surg Am. 2011;93(21):e1261-1266.
  13. American College of Surgeons. Statements on Principles. Available at: Accessed December 9, 2014.
  14. Papadakis MA, Teherani A, Banach MA, et al. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005;353(25):2673-2682.
  15. Weber DO. Poll results: Doctors’ disruptive behavior disturbs physician leaders. Physician Exec. 2004;30(5):4,6-14.


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Patient loss: Surgeons describe how they cope Sun, 01 Feb 2015 06:56:47 +0000 Dr. Dunn Dr. Walsh Dr. Numann Dr. Greene Dr. Santry Dr. Hughes

Losing a patient is an experience that all surgeons are likely to face at some point in their careers. The circumstances surrounding these deaths differ—one patient’s life might have been in the process of ending for years due to a terminal illness, while another might suffer complications during what should be a routine procedure. These events can be devastating for everyone involved, and with that in mind, several Fellows of the American College of Surgeons (ACS) are sharing strategies they’ve learned that ease the difficulty of patient loss, as well as advice they would offer to people considering careers in surgery.

Telling the truth

Geoffrey P. Dunn, MD, FACS, general surgeon, department of surgery, and medical director, palliative care consultation service, University of Pittsburgh Medical Center (UPMC) Hamot, Erie, PA, said he has seen a change in the way that death is perceived in the surgical world. Dr. Dunn said that when he started his career 30 years ago, surgeons were not inclined to see death as a natural occurrence. The main question was, “Is my treatment of the patient working?” Recently, however, Dr. Dunn has noticed the focus shift from the single event of the death to improving the surgeon’s ability to anticipate it and to enhance the patient’s comfort level during this time. Dr. Dunn is the Editor-in-Chief of Surgical Palliative Care: A Resident’s Guide, published by the ACS, and in the introduction, he and one of the book’s Associate Editors write that over the last decade, palliative care has become recognized as an essential component of patient care.

When he began practicing at UPMC, Dr. Dunn learned how important it is to be completely honest with patients’ families because, many times, he knew the families and would often cross paths with them outside of the hospital. And as the son, grandson, and great-grandson of surgeons who practiced at the same institution, Dr. Dunn said he felt a great sense of responsibility to his patients and their loved ones. Recently, he treated a 102-year-old man on whom his grandfather also had operated.

Having that connection can be helpful, Dr. Dunn said, but it can also make it more painful if something happens to the patient. Even in those circumstances, though, staying in touch with the patient’s family has helped him to cope. One of the first losses Dr. Dunn experienced was with a patient on whom his father had operated years before. After the funeral, the family invited him to dinner, where he heard them talk about the man’s life. He and the family kept in touch for years.

Dr. Dunn said he also became an early believer in the value of a condolence letter, which serves as a tribute to the patient and a source of comfort to the survivors. In those letters, he makes sure to recall qualities of the patient and offers a way to keep in touch.

“Death is not a final, defining point for the individual or the relationship that occurred around it,” Dr. Dunn said.

Developing a relationship with a patient’s family also helped Danielle Saunders Walsh, MD, FACS, get through the loss of a patient. Dr. Walsh, a pediatric surgeon who has been practicing for approximately 10 years, is an associate professor at Brody School of Medicine, East Carolina University, Greenville, NC.

Dr. Walsh said the death of every child affects her, regardless of how well she knows the family. “Children bring a different perspective in dealing with death. In general, we view them as innocent. We see it as a loss of an opportunity for someone to experience a full life,” she said.

One of her first experiences with loss occurred with a teenage patient who had a birth defect that had become increasingly problematic as the girl matured. No other physician whom Dr. Walsh consulted was able to help. The girl died suddenly while Dr. Walsh was performing a procedure.

Dr. Walsh said that losing this patient was extremely difficult, and she contemplated whether a career in surgery was right for her. “If this is so painful, why am I doing it?” she wondered. But at the funeral, the girl’s mother could tell she was hurting. “She said, ‘I hope you don’t give up,’” which reassured Dr. Walsh that she should continue in her chosen career.

Dr. Walsh said that in her experience, many conversations with patients and families would be easier if Americans could view death as a natural part of life—no matter how brief or lengthy that life may be. But we are not quite there yet as a society, she said, because people tend to think there is always more, medically, that can be done.

Patricia J. Numann, MD, FACS, FRCSEd(Hon), FRCSGlasg(Hon), is an ACS Past-President and Lloyd S. Rogers Professor of Surgery Emeritus, Upstate Medical University, Syracuse, NY, and State University of New York Distinguished Teaching Professor Emeritus. Dr. Numann said she has noticed that accepting the death of patients seems to be harder now than when she started her career as a surgeon. When she was a medical student in the 1960s at the State University of New York Upstate Medical University, there were no intensive care units, according to Dr. Numann. “A lot more people died. We didn’t have these extraordinary, heroic things that we could do for people.”

Dr. Numann said she was always reasonably comfortable talking about death. As a child, she would walk around Woodlawn Cemetery in the Bronx, NY, with her aunt, and they would look at the flowers on the graves. When she was a third-year medical student, Dr. Numann left school to help take care of her mother, who had pancreatic cancer and wanted to spend her remaining time at home. Dr. Numann’s mother died shortly after she returned to school. Her mother was, in a way, the first patient she lost.

From that experience, Dr. Numann began to see that some patients do tend to cling to life, waiting for certain events—babies to be born, graduations—before they pass away. It can be important to the process that they have something to look forward to, she said, and she always made it a habit to visit dying patients at home when she could. Many families want to know that their loved ones are not alone when they are close to death. Dr. Numann said family members have asked her to sit with patients if they are not emotionally strong enough to do so.

Dr. Numann said she would always try to go to the family’s calling hours after the death of a patient in order to cope. Doing that shows families that “you did truly do your best, and you did truly care about the person,” she said. Dr. Numann added that many people don’t realize how much surgeons miss some of the patients they have treated. “[Some patients] become like part of your extended family,” she said, because, as part of a trusted relationship, they would get to know what was going on in each others’ lives.

Conveying empathy

Being involved with patients’ families also helped Frederick L. Greene, MD, FACS, medical director of cancer data services, Levine Cancer Institute and former chairman, department of surgery, Carolinas Medical Center, Charlotte, NC. Dr. Greene is also the host of The Recovery Room, a podcast featured on the ACS website that deals with medical topics.

Imparting difficult information was a big part of Dr. Greene’s job as a cancer surgeon, and he found the best approach was to communicate any bad news as early as possible.

“I think it’s important that you don’t wait until an event is over. For me, if I was going to operate on a high-risk patient, a lot [of learning to report bad news] has to do with communication with the family up front,” Dr. Greene said.

He cautioned to never impart difficult information in a public arena, like a hospital hallway. Instead, he suggested taking the family into a private area, such as a conference room, and making sure they sit down. Once the information has been presented, Dr. Greene said it is important to let the family be alone. The surgeon can also offer to contact another physician for a second or third opinion. Dr. Greene added that this can be difficult for some surgeons who want to believe that they can take care of their patients better than anyone else, but “you have to be the one opening the door for that conversation,” he said.

If a death occurs, the surgeon should ask how he or she can help the family with the grieving process. Dr. Greene said he has gone into the homes of families to explain autopsy results if such a conversation is necessary to determine how the patient died, or to discuss genetic risks for survivors.

Heena P. Santry, MD, FACS, assistant professor, University of Massachusetts Medical School, Worcester, MA, rarely has the opportunity to form lasting relationships with patients or their families. As a trauma and critical care surgeon, Dr. Santry said she is usually delivering bad news within hours of meeting the patient and oftentimes within minutes of meeting the family. In her four years of practice, Dr. Santry said she has developed a gut instinct concerning how to deal with the situations she encounters when she walks into the family waiting room.

Sometimes, Dr. Santry explained, she will give families a brief overview of what happened to the patient before giving them the news. Other times, people are so hysterical or nervous that she knows she needs to tell them right away, adjusting her word choices, body language, and intonation to the emotion of the situation.

There is not much time to train surgeons in their interpersonal communication skills, Dr. Santry said, and she has relied on mentors in developing her own style. It can be difficult to teach, so the best way for trainees to learn is to watch surgeons deliver difficult news over and over again, Dr. Santry said.

“The key is to develop a style that allows you to perceive the needs of the family you’re talking to while conveying the appropriate amount of empathy,” she noted.

Returning to the OR

Dr. Greene said that weekly morbidity and mortality conferences, which enable surgeons to come together and discuss surgical outcomes, have been helpful for him. Dr. Greene said the conferences, which were started by Ernest Amory Codman, MD, FACS, a founder of the College, are educational and provide a supportive atmosphere for surgeons at all stages in their careers. Even after analyzing outcomes, however, surgeons must remember that negative patient outcomes are still, unfortunately, a reality.

“Many people can’t cope with that,” he said. “I have seen surgeons who become devastated, and that’s why burnout occurs.”

For Dr. Dunn, it’s important to get in touch with peers and not become psychologically isolated after losing a patient. When that happens, he said, you tend to lose perspective. “You’ve got to have a place to put all the negative energy that can occur because of losses. Share your thoughts with someone you trust,” he said.

If another patient is waiting to be cared for, however, the doctors agreed that there is no time to express their sadness. Dr. Walsh said that learning to silo her emotions has been helpful to her after a patient dies, particularly if she must tend to another patient right away. “You have to put those emotions away in order to go take care of the next person who needs your help,” she said. To deal with those emotions outside of the operating room, Dr. Walsh said she turns to people she cares about who can provide the words and guidance necessary to help ease the pain.

Dr. Santry said there have been times when she has cried with the families of patients after a loss. But surgeons need to have a laser-like focus, she said. They have to be so fully engaged with the next patient that they simply have to shut down lingering feelings, if only temporarily.

Tyler G. Hughes, MD, FACS, ACS Governor and Chair, ACS Advisory Council for Rural Surgery, general surgeon, McPherson Hospital, KS, agreed that sharing the experience with someone else is helpful. For him, that means talking to another physician or someone other than his wife or friends.

“You have to find some objective way to see if you contributed, and be honest with yourself about it,” Dr. Hughes said. He added that it can be difficult to do that in McPherson, where the population is 13,000, and many people know each other.

Dr. Hughes cautioned against returning to surgery too quickly after a loss. The event might cloud your judgment, he said, and you don’t realize that you’re not listening to your current patient because your head is still back in the operating room with the last one. Surgeons of his generation were trained to be “bulletproof,” he said, but he’s learned that it’s not a sign of weakness to ask for help. It can also be comforting to know that every surgeon has most likely gone through the same thing.

“Never be too proud of your work,” Dr. Hughes said. “The easiest case can go south, and [you should] expect it to do so, because that’s going to happen one day. Know that every surgeon has been right there.”

No matter the circumstances that lead to the death of a patient, the surgeons agreed it’s always difficult for all involved. Some surgeons said it was important to keep in contact with the patient’s family because interaction with the family helped to show how much these physicians cared about the patient, while another surgeon found the reassurance she needed to continue practicing surgery from these personal exchanges. Many surgeons said it was important to talk to someone they trust after a loss, whether it be a family member or fellow physicians who help them see these situations objectively. No matter how sad they may feel, however, it’s essential for surgeons to be able to put their full focus on the next patient.

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The benefits of attending a 2015 ACS Surgical Coding Workshop Sun, 01 Feb 2015 06:55:19 +0000

Each year the American College of Surgeons (ACS) hosts a series of two-day workshops on the application of changes to the Current Procedural Terminology (CPT)* code set with an emphasis on codes commonly used by general surgeons. Instructors from the practice management consulting firm KarenZupko & Associates deliver practical explanations for each change using real case examples and educational materials developed by the American Medical Association (AMA).

Who should attend an ACS Surgical Coding Workshop?

Surgeons, administrators, managers, coders, and reimbursement staff all report benefiting from the workshops. Team attendance is strongly encouraged to ensure accurate, consistent, and complete coding. Registration discounts are offered when three or more team members enroll together. Furthermore, if the physician is an ACS member, team members or practice employees may attend the workshop at the ACS member rate.

How often does coding change? Should I plan to attend a workshop each year?

Codes change frequently. In fact, the AMA updates the CPT code set annually. Moreover, improvements in coding constructs, additions of new technology, and changes to coding and reimbursement rules and payment policies make it beneficial to attend a workshop each year.

What are the advantages of attending an ACS Surgical Coding Workshop?

When accurate coding is aligned with a clear understanding of payment policy rules, practices will improve their profit margins. Attending an ACS coding workshop increases participants’ knowledge of coding principles and helps them develop the skills needed to decrease coding errors and reduce the risk of an audit. The workshop also comprises information regarding the new codes for the year and audit trends, and allows participants to practice accurate coding.

Additionally, attendees have the opportunity to share their different coding and practice management ideas, knowledge, experiences, and backgrounds with the group. Attendees can learn how their colleagues are handling coding, billing, and practice management issues.

What will I learn?

Because the code set is updated annually, the topics discussed at an ACS coding workshop change from year to year. However, the focus of the first day of the workshop is on how to code correctly. Topics include selecting the right type of code and level of service in all situations, identifying evaluation and management (E/M) services that are part of the global payment and those that may be billed separately, and the transition to ICD-10 (see related article). These topics are addressed with an emphasis on their effects on surgical practices. The second day of the workshop is dedicated to surgical case coding. The instructor discusses the information that should be included in an operative note if a surgeon is seeking reimbursement for an operation performed with an assistant or co-surgeon. Other topics discussed include:

  • The difference between CPT rules and Medicare rules and how this variance affects coding and billing
  • Services included in the global surgical package
  • Modifiers: how they are used and how they affect reimbursement
  • Coding for excisional breast biopsy or partial mastectomy
  • How to initiate a successful appeal when receiving incorrect payment
  • When and how to report E/M services for major and minor procedures, especially trauma
  • The difference between returning a patient to the operating room to treat a surgical complication and a staged procedure
  • Procedures correctly documented and reported that are unrelated to surgeries done previously in the global period

Can I earn CME for attending a workshop?

Physician attendees are eligible to receive continuing medical education (CME) credits through the ACS. Physicians are eligible for 6.5 CME credits for each day of attendance. In addition, nonphysician attendees who are members of the American Academy of Professional Coders are eligible for 6.5 continuing education units for each day of attendance.

When and where will the 2015 ACS Surgical Coding Workshops take place?

The workshops will take place on the following dates:

  • February 19–20, Las Vegas, NV
  • April 23–24, Chicago, IL
  • August 13–14, Nashville, TN
  • September 17–18, Dallas, TX
  • November 12–13, Chicago, IL

The dates and locations change each year; visit the ACS practice management Web page for the most current schedule.

How do I register?

Register for the two-day workshop online or call 312-642-8310. The ACS offers a special price for members and their coding staff, but ACS membership is not a requirement for attendance. The member price is $650 for each course or $995 for both days. The non-member price is $750 per day or $1095 for both days.

ACS Fellows and their staff should have their ACS member number available and enter it for each individual registering.

For hotel reservations, contact the hotel that is hosting the workshop using the number provided in the registration process, and then indicate that you are attending the ACS Surgical Coding Workshop for special pricing (see table).

Hotel registration information

City Date Location Phone Room rates Hotel cut-off dates
Las Vegas, NV Feb. 19–20 Wynn Las Vegas 866-770-7555



Chicago, IL Apr. 23–24 Park Hyatt Chicago 888-421-1442



Nashville, TN Aug. 13–14 Loews Vanderbilt Hotel 800-336-3335



Dallas, TX Sept. 17–18 The Magnolia Hotel 888-915-1110



Chicago, IL Nov. 12–13 Hyatt Chicago Magnificent Mile 888-591-1234



The ACS also offers special airfare discounts on United Airlines. Contact an ACS Travel Counselor at 800-456-4147 or, or contact United Airlines by phone at 800-521-4041 or online at When booking individual travel, be sure to indicate the name of the meeting and refer to the ACS file numbers provided for any applicable discounts.

The ACS file numbers are Agreement Code: 973454; ZCode: ZTEZ.

Additional ACS coding resources

To assist surgeons in their efforts to address coding questions, the ACS also offers the following resources:

  • The Coding Hotline (1-800-227-7911), 9:00 am–6:00 pm EST. The Coding Hotline staff will answer five free coding questions per year for each Fellow of the ACS. For additional information on the ACS Coding Hotline, visit the ACS website.
  • Coding and Practice Management Corner, a column in the Bulletin, provides tips on a range of reimbursement-related issues. The topics change monthly and in past years have included coding for hernia and other complex abdominal repairs, debridement, and sentinel lymph node mapping and its relation to biopsy. These and other articles are available on the ACS website.

*All specific references to CPT codes and descriptions are © 2014 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

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ACS develops ICD-9 to ICD-10 crosswalk to assist in billing Sun, 01 Feb 2015 06:54:21 +0000

In 2003, the Health Insurance Portability and Accountability Act identified the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the standard code set for reporting medical and surgical diagnoses and inpatient procedures. ICD is a diagnostic tool used for epidemiology, health management, and clinical purposes.* Currently, ICD-9-CM includes both diagnosis and procedural codes.

ICD-9 will be transitioning to the ICD 10th Revision (ICD-10), October 1. ICD-10 is expected to be an expanded code set, including additional information for ambulatory and managed care and injuries. It is expected to combine diagnosis and symptom codes to better define certain conditions, increase specificity through greater code length, and provide the ability to specify laterality.

ICD-10 will consist of two parts: ICD-10-Clinical Modification (CM) and ICD-10-Procedure Coding System (PCS). Surgeons and other health care professionals will use ICD-10-CM to report medical diagnoses. Hospitals will use ICD-10-PCS to report inpatient procedures. For more information on the differences between ICD-10-CM and ICD-10-PCS, view the American College of Surgeons (ACS) ICD factsheet.

To assist surgeons with the transition to ICD-10, the ACS has developed an ICD-9-CM to ICD-10-CM crosswalk of the most frequently reported general surgery diagnosis codes. It can be used as tool to help determine what a particular ICD-9 code will be translated to in ICD-10. It may also be used as a resource to aid in the billing process. Accurate coding is the responsibility of the provider.

ACS ICD-9 to ICD-10 crosswalk

The ACS analyzed the Current Procedural Terminology (CPT) codes that general surgeons report most commonly and compared them with the most frequently reported ICD-9 codes. The crosswalk was developed using the three ICD-9 family codes with the highest frequency of being reported as a diagnosis within the top CPT codes. The specified ICD-9 codes within these families were then crosswalked with the appropriate ICD-10 code(s). The ICD-9 codes were mapped out to the appropriate ICD-10 codes using the website The three ICD-9 family codes used in the ACS crosswalk include:

  • 569 (other orders of the intestine)
  • 553 (other hernia of abdominal cavity without mention of obstruction or gangrene)
  • 459 (other disorders of the circulatory system)

The figure below illustrates the crosswalk.

ICD-10 Crosswalk for General Surgery

This crosswalk has been developed by the ACS and may be used as a basic guide for comparing a selection of frequently reported general surgery procedures between ICD-9 and ICD-10. Note that accurate coding is the responsibility of the provider. This crosswalk is intended only as a resource to assist in the billing process.

ICD-9 (non-specified) ICD-9 ICD-9 description ICD-10 ICD-10 description
569–Other orders of the intestine 569.0 Anal and rectal polyp K62.0 Anal polyp
K62.1 Rectal polyp
569.1 Rectal prolapse K62.2 Anal prolapse
K62.3 Rectal prolapse
569.2 Stenosis of rectum and anus K62.4 Stenosis of anus and rectum
569.3 Hemorrhage of anus and rectum K62.5 Hemorrhage of anus and rectum
569.4 Other specified disorders of the rectum and anus
569.41 Ulcer of anus and rectum K62.6 Ulcer of anus and rectum
569.42 Anal or rectal pain K62.89 Other specified diseases of anus and rectum
569.43 Anal sphincter tear (healed) (old) K62.81 Anal sphincter tear (healed) (nontraumatic) (old)
569.44 Dysplasia of anus K62.42 Dysplasia of anus
569.49 Other K62.49 Other specified diseases of anus and rectum
569.5 Abscess of intestine K63.0 Abscess of intestine
569.6 Colostomy and enterostomy complications
569.60 Colostomy and enterostomy complications, unspecified K94.00 Colostomy complication, unspecified
K94.10 Enterostomy complication, unspecified
569.61 Infection of colostomy or enterostomy K94.02 Colostomy infection
K94.12 Enterostomy infection
569.62 Mechanical complication of colostomy and enterostomy K94.03 Colostomy malfunction
K94.13 Enterostomy malfunction
569.69 Other complications K94.09 Other complications of colostomy
K94.19 Other complications of enterostomy
569.7 Complications of intestinal pouch
569.71 Pouchitis K91.850 Pouchitis
569.79 Other complications of intestinal pouch K91.858 Other complications of intestinal pouch
553–Other hernia of abdominal cavity without mention of obstruction of gangrene 553.0 Femoral hernia
553.00 Unilateral or unspecified (not specific as recurrent) K41.90 Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent
553.01 Unilateral or unspecified, recurrent K41.91 Unilateral femoral hernia, without obstruction or gangrene, recurrent
553.02 Bilateral (not specified as recurrent) K41.20 Bilateral femoral hernia, without obstruction or gangrene, not specified as recurrent
553.03 Bilateral, recurrent K41.21 Bilateral femoral hernia, without obstruction or gangrene, recurrent
553.1 Umbilical hernia K42.9 Umbilical hernia without obstruction or gangrene
553.2 Ventral hernia
553.20 Ventral (unspecified) K43.9 Ventral hernia without obstruction or gangrene
553.21 Incisional K43.2 Incisional hernia without obstruction or gangrene
553.29 Other K43.9 Ventral hernia without obstruction or gangrene
K46.9 Unspecified abdominal hernia without obstruction or gangrene
553.3 Diaphragmatic hernia K44.9 Diaphragmatic hernia without obstruction or gangrene
459–Other disorders of the circulatory system 459.1 Postphlebitic syndrome
459.10 Postphlebitic syndrome without complications I87.009 Postthrombotic syndrome without complications of unspecified extremity
459.11 Postphlebitic syndrome with ulcer I87.019 Postthrombotic syndrome with ulcer of unspecified lower extremity
459.12 Postphlebitic syndrome with inflammation I87.029 Postthrombotic syndrome with inflammation of unspecified lower extremity
459.13 Postphlebitic syndrome with ulcer and inflammation I87.039 Postthrombotic syndrome with ulcer and inflammation of unspecified lower extremity
459.19 Postphlebitic syndrome with other complications I87.039 Postthrombotic syndrome with ulcer and inflammation of unspecified lower extremity


The crosswalk can be found online. Surgeons should continue to monitor the ACS ICD-10 website leading up to the October 1 transition for more ICD-9 to ICD-10 coding examples and other important information.

For additional ICD-10 resources, visit the following sites:

*World Health Organization. International Classification of Diseases. Available at: Accessed December 8, 2014.

American Medical Association. What you need to know about the upcoming transition to ICD-10. Available at: Accessed December 8, 2014.

All specific references to CPT codes and descriptions are © 2013 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

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Hospitals continue to improve on surgical care accountability measures Sun, 01 Feb 2015 06:53:49 +0000

The Joint Commission recognized 1,224 hospitals for outstanding accountability measure performance in November 2014 as part of its Top Performer on Key Quality Measures program. The hospitals represented 36.9 percent of all Joint Commission-accredited hospitals that reported accountability measure data for 2013 and included general, children’s, psychiatric, surgical and cardiac specialty, and critical access hospitals.*

To become a Top Performer, hospitals must have achieved the following:

  • A cumulative performance of 95 percent or above across all reported accountability measures
  • A performance of 95 percent or above on each reported accountability measure that had at least 30 denominator cases
  • Had at least one core measure set that had a composite rate of 95 percent or above, and within that measure set, all applicable individual accountability measures had a performance rate of 95 percent or above

Surgical care measure set

Since 2005, The Joint Commission has collected accountability measure data for surgical care. The surgical care measure set includes individual accountability measures for seven types of operations—coronary artery bypass graft (CABG), cardiac (other than CABG), colon, hip joint replacement surgery, hysterectomy surgery, knee joint replacement surgery, and vascular surgery. The three specific accountability measures are as follows:

  • Surgical patients receive a prophylactic antibiotic within one hour prior to surgical incision
  • Surgical patients receive appropriate prophylactic antibiotic selection
  • Prophylactic antibiotics are discontinued within 24 hours of the operation’s end time

Additional accountability measures within the surgical care measure set not specific to one of the seven surgical procedures identified earlier include the following:

  • Surgical patients on beta-blocker therapy prior to arrival receive a beta-blocker during the perioperative period
  • Cardiac surgery patients have controlled postoperative blood glucose
  • Surgical patients receive appropriate hair removal
  • Surgical patients receive venous thromboembolism prophylaxis within a time period of 24 hours before to 24 hours after an operation
  • Urinary catheter is removed on postoperative day one or postoperative day two with day of surgery being day zero

Since 2005, the average number of hospitals reporting accountability measure data for the surgical care measure set was 1,979, ranging from 258 to 2,766 hospitals. In 2009, the national average for Joint Commission-accredited hospitals submitting data for surgical care accountability measures was 95.8 percent. Today, that figure has increased to 98.7 percent.*

With more hospitals submitting data, the health care community is able to better gauge progress in quality improvement. As the performance of hospitals using surgical care accountability measures continues to improve, demonstrating the nationwide implementation of evidence-based quality improvement processes for surgery, more patients will receive the correct surgical care treatment, in the correct way, at the correct time.

There is still a long way to go in the development and tracking of accountability measures and other quality metrics. The Joint Commission encourages surgeons and hospitals to continue to strive for excellence in patient care and to share their solutions and challenges to help shorten the path to further quality improvement.

Joint Commission-accredited hospitals have access to the Core Measure Solution Exchange, a database of success stories from accredited hospitals that have attained excellent performance on core measures, including accountability measures. The database is available online and includes several surgical care solutions.

Visit The Joint Commission website for more information on the Top Performer program.

*The Joint Commission. 2014 Annual Report: America’s Hospitals: Improving Quality and Safety. Oakbrook Terrace, IL: The Joint Commission; 2014.

The Joint Commission. Top Performer 2014 eligibility criteria (for 2014 recognition). January 2014. Available at: Accessed November 25, 2014.

The Joint Commission. List of 2013 accountability measures. October 30, 2013. Available at: Accessed November 25, 2014.

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2014 Pediatric Report: How severe is it? Sun, 01 Feb 2015 06:52:50 +0000 Annual Pediatric Report of the National Trauma Data Bank (NTDB®)—which outlines a variety of issues regarding the current state of care for injured pediatric patients in the U.S. and Canada—is highlighted in this month’s column.]]>

The 2014 Pediatric Report of the National Trauma Data Bank® (NTDB®) is an updated analysis of the largest aggregation of U.S./Canadian trauma registry data ever assembled. In total, the NTDB now contains more than 6 million records. The 2014 Annual Report is based on 814,663 records submitted by 758 facilities from the single admission year of 2013. The 2014 Pediatric Report is based on 141,067 records from the single admission year of 2013. The NTDB classifies pediatric patients in this report as patients that are younger than 20 years of age.

Annual Pediatric Report

The mission of the American College of Surgeons (ACS) Committee on Trauma (COT) is to develop and implement meaningful programs for trauma care. In keeping with this mission, the NTDB is committed to being the principal national repository for trauma center registry data. The purpose of this particular report is to inform the medical community, the public, and decision makers about a variety of issues that characterize the current state of care for injured pediatric patients in our country. It has implications in many areas, including epidemiology, injury control, research, education, acute care, and resource allocation.

More than half (58.9 percent) of the 756 facilities that submitted data for the 2014 Pediatric Report are not affiliated with a pediatric hospital. The remaining 311 facilities (41.1 percent) are associated with a children’s hospital. Another 32 facilities are further characterized as pediatric-only, including 26 pediatric Level I and six pediatric Level II trauma centers. In total, 65 percent of the reporting facilities have a pediatric ward, and 33 percent have a pediatric intensive care unit. Almost three-fourths (74 percent) of the facilities transfer severely injured patients to other medical centers (see Figures 1 and 2).

Figure 1. Facilities by pediatric hospital association

Figure 1. Facilities by pediatric hospital association

Figure 2. Case fatality rate by injury severity scoreFigure 2. Case fatality rate by Injury Severity Score

Developing better data

Many dedicated members of the ACS COT, including those surgeons who serve on the Pediatric Surgery Subspecialty group, along with dedicated individuals caring for pediatric patients at trauma centers around the country, have contributed to the early development of the NTDB and its rapid growth in recent years. Building on these achievements, the goals in the coming years include improving data quality, updating analytic methods, and developing processes that allow users to draw more useful comparisons from hospital to hospital. The results of these efforts will be reflected in future NTDB reports to participating hospitals, as well as in annual pediatric reports.

Throughout the year, we will be highlighting these and other trauma data through brief reports published monthly in the Bulletin. The 2014 NTDB Pediatric Report is available on the ACS website.

In addition, information is available on the NTDB Web page about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB at

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Letters to the Editor Sun, 01 Feb 2015 06:51:47 +0000 Bulletin.]]>

Editor’s note: The following comments were received regarding recent articles published in the Bulletin.

Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to, or via mail to Diane Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611.

Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.

Google Glass liability risks

I am writing in response to the letter by Thomas R. McLean, MD, JD, FACS, published in the September 2014 Bulletin (Bull Am Coll Surg. 2014;99[9]:66). Although I retired from urology before the development of Google Glass, the majority of my procedures were performed endoscopically with a camera. All these procedures were recorded electronically and stored in a way that protected patient confidentiality. Although they were never required in court, fortunately (no medical liability experience), I reviewed the tapes as a learning tool for new camera-assisted procedures, such as laparoscopy, laser procedures, and so on. If one is required to go to court, a video copy of the procedure reveals far more than an operative report, and if the procedure was done properly, then any complication may be more readily understood as such rather than as gross negligence.

Jerry Frankel, MD, FACS
Plano, TX

Gloving technique

I am writing with regard to the cover of the November 2014 Bulletin (Bull Am Coll Surg. 2014;99[11]). When we are teaching sterile techniques worldwide, why show incorrect donning or removing surgical gloves? The correct application should avoid the thumb contamination, both in putting on and taking off surgical gloves. This is basic sterile technique, which all health care professionals should follow.

Alan S. Rapperport, MD, FACS
Coral Gables, FL

Electronic health record

I found it interesting, perhaps telling, that “The e-volution of the 21st century surgeon(Bull Am Coll Surg. 2014;99[8]:42-48) made no mention of the electronic health record. It is distressing to me that surgeons in our community who are eager to adopt advanced surgical hardware and techniques are the same ones who are refusing to learn and use electronic medical record systems.

Name withheld upon request
Oregon Fellow of the ACS

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In memoriam: Renowned trauma surgeon and former COT Chair, Erwin Thal, MD, FACS Sun, 01 Feb 2015 06:50:42 +0000
Dr. Thal

Dr. Thal

Dr. Thal

Dr. Thal with Donald D. Trunkey, MD, FACS, in the 2014 edition of photos they posed for annually at the Trauma Dinner.

Dr. Thal

Dr. Thal with Donald D. Trunkey, MD, FACS, in the 2014 edition of photos they posed for annually at the Trauma Dinner.

Erwin R. Thal, MD, FACS, 78, a world-renowned trauma surgeon, and a dedicated Fellow of the American College of Surgeons (ACS) for more than 43 years, died of heart failure December 13 at William P. Clements Jr. University Hospital, University of Texas, Dallas. Dr. Thal chaired the ACS Committee on Trauma (1986–1990), served as President of the ACS North Texas Chapter (1990–1991), and as a member of the ACS Board of Governors (1998–2004).

He led the surgical emergency department of Parkland Health and Hospital System, Dallas (1970–1994), and was appointed medical director of Parkland’s day surgery unit in 1995. He chaired the surgical postgraduate course for the department (1981–2001) and was coordinator of surgical continuing medical education (1993–2002).

Dr. Thal received his undergraduate degree from The Ohio State University (OSU), Columbus, in 1958 and his doctor of medicine degree from the OSU College of Medicine in 1962.

Dr. Thal completed his general surgery residency at Parkland Hospital in 1969, interrupted by two years of service in the U.S. Air Force (USAF) as a flight medical officer. He was awarded the USAF Commendation Medal for Meritorious Service.

After completing his residency, Dr. Thal joined the faculty at the University of Texas Southwestern Medical School (UTSMS), Dallas, as an instructor of surgery and was promoted to professor in 1982. From 1988 until his death, Dr. Thal served as the director of the UTSMS’ Willed Body Program. Dr. Thal was also a researcher who studied lead poisoning from retained bullet wounds and techniques to explore the abdominal cavities of trauma patients.

In the course of a 21-year relationship with the Dallas Fire Department, Dr. Thal developed the basic emergency management technician and advanced paramedic course for the metropolitan area. He was the recipient of many honors throughout his career, including an honorary fire chief appointment in 1985, a place on the Giants of Parkland Surgery wall, the 2000 Minnie Stevens Piper Professor award given to outstanding Texas college professors, an honorary fellowship in the Royal Australasian College of Surgeons in 2009, and numerous Excellence in Teaching Awards from UTSMS.

An avid OSU alumni who flew back for every Buckeyes home football game over the past 25 years, Dr. Thal often told friends and family members that he wanted the OSU marching band to play at his funeral. After one of his friends extended that invitation to the OSU band, 10 brass players traveled to Dallas from Columbus to perform three songs at the funeral of the lifelong fan. The Thal family covered the band members’ travel and other expenses.

Dr. Thal’s survivors include his son, James G. Thal, and his wife Rhonda; daughter Barbara Potts and her husband Steven W. Potts; daughter-in-law Kathy D. Thal; and seven grandchildren. His wife of 37 years, Carolyn, and his son, Jeffrey, preceded him in death.

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