Indiana medicine : the journal of the Indiana State Medical Association

598 Pages·1993·47.5 MB·English

by  Indiana State Medical Association

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LEGISLATIVE
AGENDA
William H. Beeson, M.D.,-President
Indiana State Medical Association
T
3
1 nes your professional liability WpHV/icifln/ m/uppnce Indiana^ft
insurance company support the Indiana comppnv or inDionR SMleadtiecal >*
Compensation Act for Patients (INCAP)? Association
"Together, WeMake TheDifference'
Does your policy include a "consent to
settle" clause? 8425 Woodfield Crossing Blvd.,
Suite 300
PICI's answer to these questions is a Indianapolis, Indiana
46240
resounding YES.
[phone]
800-284-7425
While some insurers may waver and
waffle, PICI stands firmly with the ISMA in
support of a stable medical professional
liability environment in our state. That,
and high-quality protection, is reason
enough to support PICI.
INDIANA
MEDICINE
A
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The Journal of the Indiana State Medical Association 1993
January/February 1993 Vol. 86, No. 1
features
Health economist stresses coordination of care 8
Indiana medicine interviews Deborah Freund, Ph.D., director of the Bowen Re-
search Center at Indiana University, on how to improve health care deliv-
ery.
Improving preschool-aged vaccination coverage:
Not business as usual 14
Adoption of the Standards for Pediatric Immunization Practices could help
alleviate obstacles to vaccination.
Commission criticizes fee-for-service system 22
The 700-page Indiana State Health Policy Commission report recommends
a managed care system that pays providers on a capitated or salaried
basis.
Health care tops legislative agenda 24
The health policy commission report and the Medicaid budget are two Cover story on page 24. Photo
issues expected to generate much discussion during the Indiana General ofStatehouse rotunda by Kim
Assembly. Charles Ferrill of Indianapolis.
Design by Diane Alfonso of
Why physicians should be involved in the political process 28 Indianapolis.
A state senator encourages doctors to let legislators know their views on
health care reform.
COLA program meets CLIA requirements 30 departments
Physicians have an alternative for meeting the CLIA certification require-
ments - the Commission on Office Laboratory Accreditation.
stethoscope 4
Physicians needed for risk management program 34 letter to the editor 6
Indiana primary care physicians are invited to participate in the Practice
Assessment/Quality Improvement project. annual reports 58
resolutions 63
Doctor bottles award-winning wines 36
An Indianapolis obstetrician/gynecologist is doing his part to see that Indi- auxiliary report 82
ana wineries get some long-overdue respect. from the museum 103
1992 ISMA convention highlights 42 cme calendar 104
obituaries 106
1992 ISMA convention coverage 46
people 109
ISMA Fifty Year Club 80 classifieds 114
scientific contributions
Thrombolysis in acute myocardial infarction:
A hospital emergency room experience 38
NDIANA MEDICINE/January/February 1993
. 3
YOCON’
INDIANA MEDICINE
Devoted to the interests ofthe medical profession and
public health in Indiana since 1908.
YOHIMBINE HCI MANAGING EDITOR
Tina Sims
EDITORIAL ASSISTANT
Description: Yohimbine isa3a-15a-20B-17a-hydroxyYohimbine-16a-car-
boxylicacidmethylester. ThealkaloidisfoundinRubaceaeandrelatedtrees. Toni Settle
Also in Rauwoffia Serpentina (L) Benth. Yohimbine is an indolalkylamine
alkaloid with chemical similarity to reserpine It is a crystalline powder, BUSINESS MANAGER
odorless. Eachcompressedtabletcontains(1/12gr.)5.4mgofYohimbine Richard R. King
Hydrochloride.
Action: Yohimbine blocks presynaptic alpha-2 adrenergic receptors Its CIRCULATION
awcetaikoenronanpderoifphsehroarltbdluernadtivoens.selYsohriemsbeimnbel'essptehraitphoefrarlesaeruptionneo,mtihcoungehrviotuiss Rosanna Her
ssyymsptaetmheetfifcect(aidsretnoergiincc)reaacsteiviptayr.asyItmpiasthteotibce(ncohtoeldinetrhgaitc)inanmdaldeecsreexausale EDITORIAL BOARD CHAIRMAN
performance, erection is linked to cholinergic activity and to alpha-2 ad- GeorgeT. Lukemeyer, M.D.
renergicblockadewhichmaytheoreticallyresultinincreasedpenileinflow,
decreasedpenileoutfloworboth. EDITORIAL BOARD
Yohimbineexertsastimulating action on the moodand may increase Thomas Conway, M.D.
aanlxtiheotuyg.htShuecyhapacpteiaornstohraevqeuinroethbiegehndoasdeeqsuoaftetlheydsrtuudgiedYoorhirmeblaitneedhtaosdaosmaigled PanayotisJ.G. Iatridis, M.D.
anti-diuretic action, probably via stimulation of hypothalmic centers and Robert C. Ziss, M.D.
releaseofposteriorpituitaryhormone (Termsexpire Dec. 31, 2995)
Reportedly,Yohimbineexertsnosignificantinfluenceoncardiacstimula- James R. Buechler, M.D.
tionandothereffectsmediatedbyB-adrenergicreceptors,itseffectonblood James W. Edmondson, M.D.
pressure,ifany,wouldbetolowerit,howevernoadequatestudiesareathand Robert L. ForsteJr., M.D.
toquantitatethiseffectintermsofYohimbinedosage. GeorgeC. Manning, M.D.
Indications:Yocon isindicatedasasympathicolyticandmydriatric. Itmay Bruce F. Waller, M.D.
haveactivityasanaphrodisiac (Terms expire Dec. 31, 1993)
Contraindications: Renal diseases, and patients sensitive to thedrug. In Franklin Roesner
viewofthelimitedandinadequateinformationathand,noprecisetabulation Paul Forman
canbeofferedofadditionalcontraindications
(Medicalstudents)
Warning:Generally,thisdrugisnotproposedforuseinfemalesandcertainly
mustnotbeusedduringpregnancy Neitheristhisdrugproposedtorusein CONSULTING EDITORS
pediatric, geriatric or cardio-renal patients with gastric or duodenal ulcer
history Norshould itbe used in conjunction with mood-modifyingdrugs StevenC. Beering, M.D.
suchasantidepressants,orinpsychiatricpatientsingeneral. Charles A. Bonsett, M.D.
AdverseReactions:Yohimbinereadilypenetratesthe(CNS)andproducesa WalterJ. Daly, M.D.
complexpatternofresponsesinlowerdosesthanrequiredtoproduceperiph- Alvin Haley, M.D.
J.
erala-adrenergicblockade. Theseinclude,anti-diuresis,ageneralpictureof Rodney A. Mannion, M.D.
central excitation including elevation of blood pressure and heart rate, in- Alan T. Marty, M.D.
creasedmotoractivity,irritabilityandtremor.Sweating,nauseaandvomiting
arecommonafterparenteraladministrationofthedrug 1 2 Alsodizziness, EDITOR EMERITUS
headache,skinflushingreportedwhenusedorally.1
Desag*and Administration: Experimental dosage reported in treatmentof Frank B. Ramsey, M.D.
erectileimpotence.1•3-4 1tablet(5.4mg)3timesaday,toadultmalestaken
orally. Occasionalsideeffectsreportedwiththisdosagearenausea,dizziness Indiana medicine (ISSN 0746-8288) is published six times a
ornervousness. IntheeventofsideeffectsdosagetobereducedtoV2tablet3 year (in January, March, May,July, September and Novem-
timesaday,followedbygradualincreasesto1tablet3timesaday. Reported ber) by the Indiana State Medical Association. Second-class
therapynotmorethan10weeks.3 postagepaid at Indianapolis, Ind., and additional mailing
HowSupplied:OraltabletsofYocon1' 1/12gr 5.4mgin offices.
bottles of 100’s NDC 53159-001-01 and 1000's NDC
53159-001-10.
Address correspondence relating to editorial material,
References:
1. A. Moralesetal„ NewEnglandJournalofMedi advertisingorsubscriptions to: Indiana medicine,322Canal
cine:1221.Novemb—er12, 1981 Walk, Indianapolis, IN 46202-3252. Phone [phone] or
2. Goodman,Gilman ThePharmacologicalbasis 1-800-257-ISMA.
ofTherapeutics6thed.,p. 176-188.
McMillanDecemberRev. 1/85. Annual subscription rates for nonmembers: $15 domestic,
3. WeeklyUrologicalClinicalletter,27.2,July4, $17Canada, $18 foreign. Medical library rates: $14 domes-
4. 4A1.59-8M43o7.r,al1e9s82etal.,TheJournalofUrology128: tsitcu,d$e1n5tsC:a$n7a.daS,in$g1l6efcoorpeiiegsn.noFtualvla-itliambeleI.ndSiuabnsacrmiepdtiicoanls are
renewable annually.
Rev. 1/85
POSTMASTER: Send address changes to Indiana medicine,
AVAILABLE AT PHARMACIES NATIONWIDE Indiana State Medical Association, c/o Membership
Department, 322 Canal Walk, Indianapolis, IN 46202-3252.
PALISADES
PHARMACEUTICALS, INC. Viewsexpressed do notreflect theopinions oftheeditors.
219 County Road Nocopyright isclaimed, unless specifically indicated.
Copyright restssolely with authors, who are responsible
Tenafly, New Jersey 07670 forstatements in theirarticles. Scientificand editorial
[phone] contributionsare accepted forexclusive publication, subject
1-800-237-9083 to editorial requirements. Instructions forauthorsavailable
on request.
All issues since 1967areavailableon microfilm from
University Microfilms International, 300 N. Zeeb Road, Ann
Arbor, MI 48106. Indexed in IndexMedicus and Hospital
LiteratureIndex.
Advertising ratesand data available upon request. Indiana
medicine reserves the right toacceptor rejectadvertising.
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INDIANA MEDICINE/January/February 1993 3
stethoscope
ISMA members invited to The Indiana State Medical Association will sponsor its second annual
‘Medicine Day’ at the "Medicine Day" at the Indiana Statehouse Wed., Jan. 27. The day
will begin with a continental breakfast from 8:30 a.m. to 9:30 a.m. at
statehouse
the Hyatt Regency Hotel in downtown Indianapolis. Physicians will
then visit the statehouse to discuss important health care issues with
their legislators until 11:30 a.m. A lunch for physicians and legisla-
tors will be available from noon to 1 p.m. at the Hyatt.
All ISMA members are encouraged to attend. To register for "Medi-
cine Day" events, call Debbie Warner at the ISMA, [phone] or
1-800-257-4762.
ISMA/IMPAC legislative ISMA members are invited to "Escape to the Islands" during the
reception set for Jan 27 annual ISMA/IMPAC Legislative Reception set for Wed., Jan. 27,
from 6 to 8:30 p.m. at the Westin Hotel in downtown Indianapolis.
The reception will give ISMA members a chance to meet legislators
and discuss areas of concern. A steel drum band will perform at the
event, which features a Caribbean theme. For details, call Susan
Grant, [phone] or 1-800-257-4762.
Supplements available to Printed copies of a one-page supplement to the 1991 pamphlet Diph-
vaccine information pamphlet theria, Tetanus and Pertussis: What You Need to Know are now avail-
able from CORPrint of Indianapolis. Physicians who administer
immunizations to children are required to provide the one-page
supplement to the child's parent or guardian under the Childhood
Vaccine Injury Act of 1986. The Indiana State Department of Health
mailed one copy of the camera-ready supplement to every physician
last October.
To order, call CORPrint at [phone]. The supplement is $10 per
100 copies, plus tax and shipping.
Hold harmless’ clauses may Physicians who are offered a contract containing a "hold harmless"
put liability coverage at risk clause should ask that it be deleted because their professional liabil-
ity insurance carrier may not cover them. Physicians should insist
on contract language that makes each party responsible for his or her
own actions.
"Hold harmless" clauses are agreements in which one party agrees
to hold the second party harmless by promising to pay the losses,
damages, expenses, costs or attorney fees that the second party may
incur as a result of being sued or included in litigation because of the
negligent act of the first party.
Physicians should be aware that most professional liability insurance
policies will not cover them for costs incurred because of a "hold
harmless" clause.
If you have questions, call Ron Dyer at the ISMA.
4 INDIANA MEDICINE/January/February 1993