Thursday, September 03, 2009
Are we focusing on our patients? By Dr. Anthony Policastro

Recently I have been writing about things that add to the cost of medicine in this country. Some of those things add to both cost and patient inconvenience. Jaundice is very common in newborns. We follow the level of a chemical, bilirubin, in the bloodstream in jaundiced infants. In adults the level of bilirubin is usually about one. In newborns the average number on the third day of life is eight. A level of 25 in a newborn is dangerous. For that reason, we do not want the level to go above 20. Therefore, we watch it carefully between 15 and 20. We usually begin treating it with fluorescent lights at 17 or 18 in infants over 72 hours of age. The treatment level is lower in younger infants. Many infants reach the level of eight since it is the average. A significant number of them reach 12. Relatively few reach 15 and even fewer get above 17. At one time all children who were jaundiced had to have blood tests done. Now we can do a skin test to check the level which means many less children have to get their blood drawn. That has led to less suffering from the blood test for the infant and less cost by needing less lab tests done. However, most babies are discharged before the 72 hour point. That means that their bilirubin keeps going up after they leave the nursery. The logical thing to do would be to check their skin level of bilirubin after they leave the hospital. If an infant's bilirubin is less than 12 at discharge, it usually does not need to be repeated. Most children will never get above 15 after discharge. For that reason, the great majority of patients who are followed after discharge have levels between 12 and 15. Logically, we would not have to do blood tests on those infants unless the skin test results rose above 15. However, the Joint Commission that does hospital accreditation requires hospitals to follow manufacturer's recommendations for lab tests. The manufacturers of the skin test machine have a package insert which was reviewed by their lawyers who want to be very careful about the company getting sued. For that reason, they pick a very low number to be sure. They recommend that any infant that has a skin test above 12 needs to have a blood test drawn. Since all the patients that we follow after discharge have skin tests over 12, they need a blood test done. The reason for the blood test is related to over-cautious lawyers. In order for us to compare blood test to blood test, we need to do one before the infant leaves the hospital. Thus each infant has to get one test before discharge and a second one the next day. This causes pain for the infant and adds to the treatment expense. The overall expense to the medical care system of something like this is relatively low. However, these kinds of things add up. We have to do what is best for the patient and that usually translates to less cost to the system.

Two new laws will expand CHIP
Delaware children now have better access to health care after Governor Jack Markell signed two bills into law recently that expand the state's Children's Health Insurance Program (CHIP) and provide developmental screenings for infants and toddlers. The bills were sponsored by Rep. Teresa L. Schooley, D-Newark, who also is the director of the KIDS Count in Delaware, which collects data on the status and well-being of children in the state. House Bill 139 expands health insurance coverage for children of families with personal incomes above 200 percent of the federal poverty level. Currently, CHIP is only available to children in families that have an income level less than 200 percent of poverty. Approximately 20,000-22,000 of Delaware children - about 10 percent - are uninsured, but only slightly more than half are eligible for CHIP and Medicaid coverage. About 9,000 uninsured children are in families that earn more than 200 percent of the federal poverty level. Under HB 139, a cover-all-kids program will be established, allowing parents to pay a monthly premium of approximately $170 per child plus administrative costs, which will provide the same level of coverage the child would receive under CHIP or Medicaid. Since the parents will bear the cost of the premium, it will cost the state nothing to implement the program. Bill 199 requires screening for developmental delays for infants and toddlers, and requires that private health insurers in Delaware cover the screenings. The bill was recommended by the American Academy of Pediatrics and the Delaware Early Childhood Council. Providing these early screenings is essential to ensuring that children are diagnosed early for any problems and can get treatment as soon as possible. The program will cost the policyholders of these screenings approximately three cents a month.

Three join NMH staff
Nanticoke Memorial Hospital welcomes Meredith Arthur (formally LeQuear), DO; Dayana Duguerre, CPNP; and Patricia Donovan, MD to the staff of Nanticoke Pediatrics located at 613 High St. in Seaford. Dr. Arthur has been providing pediatric care to the community since 2007. She is board certified by the American Board of Pediatrics and the American Osteopathic Board of Pediatrics. She is a graduate of the New York College of Osteopathic Medicine and completed her residency in a combined program at Good Samaritan Hospital Medical Center and Winthrop University Hospital on Long Island. Duguerre joins Nanticoke Health Services as a certified pediatric nurse practitioner in pediatric inpatient hospital care. Duguerre is certified by the Board of Nursing and the Pediatric Nursing Certification Board. She completed her master's of science in nursing from MGH Institute of Health Professions in Boston, Mass. and her bachelor of arts in biochemistry from Regis College in Weston, Mass. She is fluent in French and Creole. Dr. Donovan is a specialist in pediatric inpatient hospital care. She completed her residency in pediatrics at Metropolitan Hospital Center/New York College of Medicine in New York and her medical degree at Universidad Latina of Panama. To schedule an appointment at Nanticoke Pediatrics, call 302-629-6525.

Lawson joins Delaware Hospice
Lydia Ruth Lawson, M.D., of Milford, has joined the medical staff of Delaware Hospice as a regional medical director with primary responsibility for the new Delaware Hospice Center. Dr. Lawson will provide medical expertise to Delaware Hospice's care teams and will consult and collaborate with physicians. She will conduct educational seminars to health care professionals to gain a better understanding of hospice care. Dr. Lawson earned her medical degree from Columbia University College of Physicians and Surgeons in New York, and completed her Family Practice Residency at the University of New Mexico's Department of Family and Community Medicine. She holds professional certifications in Hospice and Palliative Medicine and Family Practice. Dr. Lawson has served for more than 15 years in the roles of both physician and administrator for the University of New Mexico Hospital, Lovelace Health Systems, and Presbyterian Hospice in Albuquerque, N.M.

Committee to meet
Sussex County's Advisory Committee for the Aging & Adults with Physical Disabilities will take its September meeting on the road, hosting a session in which the public is encouraged to attend to ask questions and learn more about the issues facing today's seniors citizens and residents with physical challenges. The Advisory Committee invites the public to attend the committee's next meeting at 10 a.m. Monday, Sept. 21, at the Greenwood CHEER Center. The forum will be an open session to discuss a variety of topics, including transportation, health, state and non-profit services, and more. The Sussex County Advisory Committee for the Aging & Adults with Physical Disabilities is an 11-member panel established by the Sussex County Council to be an advocate for programs and policies that benefit older and disabled residents. The committee meets on the third Monday of January, March, May, July, September and November. All meetings are open to the public.

MS offers videoconference
Thanks to live videoconferencing technology, members of the Delaware Chapter of the National Multiple Sclerosis Society can stay close to home and still take part in the chapter's annual meeting on Saturday, Oct. 24, at the Ammon Medical Education Center on the campus at Christiana Hospital in Newark. For the first time, the videoconference will include participants at a satellite location at Nanticoke Memorial Hospital in Seaford. Like the participants in Newark, Sussex County residents who attend the satellite location will also receive lunch, take part in the chapter's annual meeting and recognition awards ceremony, and enjoy a client-focused discussion about MS research. Cost is $5 per person, and anyone who wants to attend must register by Friday, Oct. 9 either online at or by calling 302-655-5610.

Prostate screenings offered
September is Prostate Cancer Awareness Month and the Cancer Care Center staff at Nanticoke Memorial Hospital will provide prostate screenings on Friday, Sept. 18 from 8 a.m. to 5 p.m. on the first floor of the Nanticoke Cancer Care Center (located next to the hospital). There is a $5 screening fee and pre-registration is not required. Nanticoke Memorial Hospital encourages men over the age of 50 to take advantage of this service. Also men 40-years-old and at high risk of developing prostate cancer are also encouraged to participate. African-American men have a higher risk for developing prostate cancer, as are men who have a family history of the disease. For more information, call Nanticoke at 629-6611, ext. 3765.

duPont Hospital holds raffle
Nemours/Alfred I. duPont Hospital for Children is holding a raffle for a Harley-Davidson motorcycle. The motorcycle, a Soft-Tail Fat Boy in Black Denim that includes a riding gear safety package, was donated by Concordville Nissan-Subaru. Tickets are $25 each or five for $100 and proceeds benefit the hospital. The drawing will take place in the hospital lobby on Sept. 11 at 2 p.m. For ticket information, contact Kate Handling at 302-651-4383 or

NMH holds diabetes classes
Nanticoke Memorial Hospital, Seaford, will hold a four-session diabetes educational program beginning Sept. 9 and continuing Sept. 16, 23, and 30 from 5 to 7 p.m. at the hospital. Registration for this class is required. The cost of the four-session program may be reimbursable by insurance. This four-session program includes weekly education sessions and individualized meal planning for diabetes self-management. Our goal is to give you the self-management skills to control your diabetes. Family members/significant others are welcome to attend the weekly sessions. To register and obtain additional information regarding the course, contact Nanticoke Memorial Hospital's Diabetes Education department at 629-6611, ext. 2446.

Depression Support Group
There will be a free bimonthly Depression Support Group meeting in Laurel on the second and fourth Wednesday evenings from 7 to 8:30 p.m. Any person who has signs and symptoms of depression and is under the care of a professional counselor/MD is welcome to attend. To register, call Life Matters Counseling and Consulting at 302-465-6612.

Living with a chronic disease
Have you been affected by a medical condition that has caused suffering and loss of physical abilities over a period of years? Some examples of chronic disease include cancer, diabetes, heart disease, stroke, arthritis and lung diseases. If so, join Delaware Hospice and The Wellness Community-DE, as they collaborate to offer "Living a Healthy Life with a Chronic Condition". This free 6-week program begins on Monday, Sept. 14 at 9:30 a.m. and will be held at the Wellness Community's Sussex facility, which is located at 18947 John J. Williams Hwy, Suite 312, Rehoboth. This chronic disease self-management workshop is open to any persons who have one or more chronic conditions and to their caregiver or family member. To register or receive more information, call 645-9150.

Groups reach agreement The National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) have reached a favorable agreement with the Delaware State Department of Health and Social Services that will restore much of the funding that would have been lost due to rate cuts in Medicaid reimbursement to pharmacists. The associations joined together in filing a lawsuit challenging Delaware's April 1 rate cuts for Medicaid reimbursement for brand name drugs, which results in reimbursement for many drugs at a level below a pharmacy's break-even cost. The state has agreed to set reimbursement for brand name drugs at average whole price (AWP) minus 14.5 - an increase of 1.5 percent from the original reimbursement structure that led to the filing of the lawsuit.Delaware plans to reduce reimbursement for certain generic drugs, but pharmacies will have an opportunity to petition for increased reimbursement if the new rates are below pharmacy acquisition costs.

Arthritis Exercise program
Nanticoke Senior Center will offer an Arthritis Exercise Class beginning Tuesday, Sept. 8, at 1 p.m. This six-week class will meet every Tuesday and Thursday. Certified Instructor, Kathy Cordrey, will teach the four fundamentals of the Arthritis program: exercise, health education, movement activities and relaxation exercise. Cost is $40 for members, $50 for non-members. Call 629-4939 for more information.