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^n^ssssssssss^ ^ Medical HARVARD Digitized by the Internet Archive 2015 in https://archive.org/details/indianamedicinej8471indi INDIANA MEDICINE The Journal of the Indiana State Medical Association July 1991 Vo]. 84, No. 7 THE FRANCIS COUNTWAY A. LIBRARY OF MEDICINE BOSTON, MA rgi rgi rg^ rgi rg> rg> rg> rg^ rg^ rgdi rdg^ rdw> ndg> rdg^ rdgi rdg^ drg>drgi rdgi rdg> r^g^ rdg> rdw> rdgi rdg^ drg>drgi rg> rgi rg^ rg^ rgi rg^ rgi rg> rgi The Doctor’s Insurance Company. In More Ways Than One. Physicians InsuranceCompanyofIndiana(PICI)hasa differentapproachtomedicalprofessionalliabilityinsurance. Indiana physicians serve on the Board of Directors, Underwriting and Claims Committees. PICI works closely with the Indiana State Medical Association. It talks with physicians. It listens to physicians. It understands. It cares. PICI really isthedoctor’sinsurancecompany, in moreways than one. pHv/icifln/ m/uRAnce compflnv of inDiflm 8425WoodfieldCrossingBoulevard,Suite300,Indianapolis, Indiana46240 (317)469-4100•Tollfree 1-800-284-7424 INDIANA MEDICINE The Journal of the Indiana State Medical Association |uly 1991 Vol. 84, No. 7 INDIANA scientific contributions MEDICINE Video display terminals: Potential health effects of office automation 466 VIDEO DISPLAY Neuroimaging of AIDS 470 Warts: Benign or malignant? 476 POTENTIAL HEALTH Death occurring within one week of EFFECTS OF transplantation: Findings in eight patients 480 OFFICE HAND CLINIC AUTOMATION Posterior interosseous syndrome 484 Cover story on page 466. Cover design by Diane Alfonso, Indianapolis. features departments Optometric prescribing becomes law: How did happen? 488 it Despite ISMA opposition, optometric prescribing became law during stethoscope 459 the 1991 Indiana General Assembly. from the museum 460 what's new 462 cme calendar 464 drug names 490 the wounded healer 492 auxiliary report 494 obituaries 516 news briefs 517 people 518 classifieds 520 INDIANA MEDICINE/July 1991 457 1 INDIANA MEDICINE Devoted to the interests of themedical profession and public health in Indiana since 1908. MANAGING EDITOR Tina Sims EDITORIAL ASSISTANT Toni Settle A Natural Selection BUSINESS MANAGER Richard R. King Si. Luke's Heuliheare University's College of CIRCULATION Association aprogressive. Human Medicine. 4 I S-hed mu1 1faciIiiy Rosanna Her healthcare system located EDITORIAL BOARD CHAIRMAN in Saginaw. Michigan St. Luke's Healthcare As- GeorgeT Lukemeyer, M.D. currently has private prac- sociation is a diverse and tice and hospital career op- growingorganization, anx- EDITORIAL BOARD portunities for physicians ioustomeetwithphysicians in selected areas of interested in pursuing a I.E. Michael M.D. specialization. career marked Th(ToemramsexpiCroenswPaecy.,3M7,.D7.991) by a strong J. RobertC. Ziss, M.D. file Association taidonin/pihnyissictriaan- (Terms expire Dee. 37, 7992) cpraronogmve ipodfIeesspte-ae ttwieooarnmksihanippgpraorneadlcah-a JJRaaommbeeersstWRL...BFEuodercmshtolenejdrr,.s,oMnM.,.DD.M..D. GeorgeC. Manning, M.D. cialty care topatientcare. units, includ- Bruce E. Waller, M.D. ing adult and (Terms expire Dec. 37, 1993) RuchirSehra pediatric inten- If you'resuch Paul Forman sivecare,coro- a physician, nary care and St. Luke's (Medicalstudents) emergeney Healthcare CONSULTING EDITORS caatree.MiWcehigoapne'rs- aAnsdsoScagiaintaiow.n Steven C. Beering, M.D. omneldyiccaolm/bbeihnaevdioral health are natural selMeciticohnsi.gCaonn-. CWhaalrtleersJ.A.DaBloyn,seMt.tD,.M.D. Alvin Haley, M.D. center, treating adults, tact us today foradditional J. adolescents and children. information. Rodney A. Mannion, M.D. We recently opened The Alan T. Marty, M.D. pFraomgirleyssBiivret,h nCeenwt.ersi1ng-le-a CallnrwriteJanGould, EDITOR EMERITUS room obstetrics unit. And PhySts.icLiuakneR'escrHuoistpeirt:al Frank B. Ramsey, M.D. we cooperate in an active 700CooperAve. residency program affili- Saginaw, Ml 48602 Indiana medicine (ISSN 0746-8288) is published monthly by ated with Michigan State 1-800-633-3546. the Indiana State Medical Association. Second-class post- age paid at Indianapolis, Ind., and additional mailing offices. Address correspondence relating to editorial material, <¥> advertising orsubscriptions to: Indiana medicine,322Canal Walk, Indianapolis, IN 46202-3252. Phone (317) 261-2060or 1-800-969-7545. Annual subscription rates for nonmembers: $24 domestic, $2bCanada, $27 foreign. Medical library rates: $22domes- StUXes tic, $23Canada, $24 foreign. Full-time Indiana medical students: $12. Single copies notavailable. Subscriptions are renewableannually. POSTMASTER: Send address changes to Indiana medicine, Indiana State Medical Association, c/o Membership Department, 322Canal Walk, Indianapolis, IN 46202-3252. Views expressed do not reflect the opinions ofthe editors. No copyright isclaimed, unless specifically indicated. Copyright rests solely with authors, whoare responsible 100! St.Luke sHealthcareAssociation.Allrightsreserved forstatements in their articles. Scientificand editorial AservicentSt. Luke sHealthcareAssociation. contributionsareaccepted forexclusive publication,subject toeditorial requirements. Instructions forauthorsavailable on request. All issuessince 1967areavailableon microfilm from University Microfilms International,300 N. Zeeb Road, Ann Arbor, MI 48106. Indexed in IndexMedicus and Hospital Literature Index. Advertising ratesand data available upon request. Indiana medicine reserves the right toaccept orreject advertising. . COUNTWAY THE FRANCIS A. LIBRARY OF MEDICINE boston, ma AuG o i ,3a' stethoscope PICI includes peer review The Physicians Insurance Company of Indiana (PICI) has changed its services in liability coverage medical professional liability insurance contract to include coverage for any claims arising out of the insured physicians' participation in a peer or utilization review process. PICI broadened its policy provi- sions because of the growing involvement of physicians in peer and utilization review processes. With the rapid expansion of managed health care plans, more physicians are being asked to serve on peer and utilization review committees. Generic substitutions required The new Indiana budget will require pharmacists to substitute ge- for Medicare, Medicaid neric drugs for Medicare and Medicaid patients unless the physician writes "brand medically necessary" on the prescription. The law patients took effect July 1 Previously pharmacists were allowed, but not required, to substitute the generic equivalent of a drug unless the physician wrote "brand medically necessary" on the prescription. Under the new law, pharmacists will not be allowed to dispense the brand drug unless the physician is contacted and gives approval. Physicians who give such approval over the phone will then be required to mail in the revised prescription. Patients Compensation Fund The increase in the Patients Compensation Fund surcharge to 150% surcharge increase delayed will be delayed. The Indiana Department of Insurance had indicated that it could go into effect as early as July 1. The date it will become effective remains unclear. The delay represents a "good news, bad news" scenario for physicians. It means physicians will not have to pay as soon, but a lengthy delay may mean the surcharge, when implemented, will be higher than 150% to offset the current and pro- jected shortfall in the fund. The ISMA will continue to monitor the situation. ISMA forms Drug Utilization In response to the Omnibus Budget Reconciliation Act of 1990, the "eview Committee ISMA has formed a Drug Utilization Review Committee to make policy implementation recommendations to Indiana's DUR board. The committee, which met June 12 to review the federal law and its requirements, is comprised of four ISMA physicians: Debbie Allen, M.D.; Richard Reedy, M.D.; Ed Ross, M.D.; and John Wernert, M.D. OBRA '90 requires each state to have a drug use review program for covered outpatient drugs in effect by Jan. 1, 1993. These programs will assure that prescriptions for drugs under Medicaid are appropri- ate, medically necessary and not likely to cause adverse medical results. ANA MEDICINE/July 1991 459 j museum from the gets or needs, but rather on how toured the museum. The neigh- Two encouraging events well they use the resources they borhood is a depressed area; few, recently occurred at the Indiana have. In the museum community, if any, of the children aspire to Medical History Museum on the this highly competitive monetary attend college, let alone medical same day. Early in the morning, award carries great prestige. Re- school. For one of the boys, it the organization learned that it cipients are recognized as leaders was his third visit within the past was one of seven Indiana muse- in their field. several months. He explained ums and one of two Indianapolis The Institute of Museum Ser- that he was fascinated by the mu- museums receiving an Institute of vices provides the only federal seum, and each time he learned a Museum Services General Operat- source of general operating sup- little more about medicine and its ing Support Grant. Other grant- port for our nation's museums. history. He also said he now ees include The Children's Mu- Grant recipients include museums wants to become a physician so he seum, Fort Wayne Museum of with only one staff person to can help people. That boy's visit, Art, Greater Lafayette Museum of those with more than 2,000; bud- his interest in the museum and his Art, Sheldon Swope Gallery in gets range from less than $20,000 new career goal reaffirm that the Terre Haute, Monroe County His- to more than $70 million. All organization is beginning to meet torical Society and Fort Wayne types of museums receive awards. its educational mission to the Children's Zoo. Award amounts equal 10% of the community. Perhaps with the The grants are awarded after museum's operating budget, with Institute of Museum Services a nationwide competition evalu- a maximum of $75,000. grant and the help of individual ates all aspects of the museum's The Indiana Medical History donors, the museum will be able operations. Of the 1,390 museums Museum will use the $7,200 grant to expand its educational services that applied for these grants, only to develop programs for school to challenge the minds of the 432 received them. The museum children, self-guided tours of the younger generation. professionals who reviewed these museum and exhibits on the his- applications reported that nearly tory of health care. The grant also Other museum news 90% of the applicant museums will be used to purchase supplies The exhibit "Great Medical Dis- were meeting or exceeding rigor- and materials for the care and coveries" will be displayed at the ous standards of museum opera- conservation of its collection of museum's changing exhibit gal- tions. According to Susannah more than 15,000 medical and lery until Aug. 30. The museum Simpson Kent, director of the health-related artifacts. entrance is located at 3045 W. Institute of Museum Services, Later that day, another event Vermont St., adjacent to Central grant recipients "demonstrate occurred that reinforced the State Hospital, in Indianapolis. excellence in all areas of museum museum's educational potential in For more information, call operations." Museums are not the minds of the staff. Two boys (317) 635-7329. judged on the size of their bud- from Indianapolis' near westside 460 INDIANA MEDICINE/July 1991