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HarvardMedicat «jbra - Digitized by the Internet Archive 2015 in https://archive.org/details/indianamedicinej8619indi # 4 'kMM \ 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. (317)469-4100 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 “-‘1* Of OSTON-^'OINe d' 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 requirements - 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 (317) 261-2060 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 (201) 569-8502 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. New 50 NewHumulin50/50isthetailor-made answertoindividualpatientneeds.A Humulin 50 uniquecombinationofequalamountsof 50%human RegularhumaninsulinandNPHhuman insulin isophane suspension insulin,itwillbeusefulinsituationsin whichagreaterinitialinsulinresponseis 50%human insulin injection desirableforgreaterglycemiccontrol. (recombinantDNA origin) TheNewest Option in LikeHumulin 70/30?newHumulin50/50 Insulin Therapy offerstheconvenienceandaccuracyofa WARNING:Anychangeofinsulinshouldbemadecautiously premix.Anditcanbeusedinconjunction •aHnudmuolnilynusn7d0e/r3m0e(d7i0ca%lhsuumpearnviisnisounli.nisophanesuspension, withanexisting70/30regimen. 30%humaninsulininjection(recombinantDNAorigin]). GlobalExcellenceinDiabetesCare EliLillyandCompany Indianapolis, Indiana 46285 HI-7911-B-249343 c 1992.elilillyandcompany 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 legislators 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, (317) 261-2060 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, (317) 261-2060 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 available 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 (317) 255-2178. 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 liability 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