Friday, November 30, 2012


The Alabama Court of Civil Appeals has unanimously overturned a lower court ruling, finding that Montgomery District Court Judge Jimmy Pool erred in his July ruling against Trinity and ordering him to enter a judgment in favor of the hospital’s relocation.

In issuing their ruling, the five-judge panel reinstated the Certificate of Need Trinity was awarded in September of 2010 and paved the way for the hospital’s relocation to Highway 280.

“We are delighted to take this important step forward with our relocation project and we appreciate the Court’s direction on this matter,” said Trinity President and Chief Executive Officer Keith Granger. “With expedited action from Judge Pool as requested by the Court, we hope to have this matter resolved within a few months so we can move forward with planning and construction as soon as possible.

The appellate court’s ruling is the sixth legal victory Trinity has achieved in the four years since the medical center first announced plans to relocate. The only decisions against Trinity came from Montgomery County District Judge Jimmy Pool, who twice ruled against Trinity and now twice has been overturned by a higher court.

“Today’s ruling is affirming not only for the thousands of area residents who need improved access to care, but also for the Trinity physicians and employees who consistently raise the bar in patient satisfaction, quality care, infection reduction and many other measures despite the limitations of our 45-year-old facility,” added Granger. 

Barring further legal delays, Trinity intends to complete planning efforts for the 280 facility within the next few months. Construction could begin as early as mid-2013.

Thursday, November 29, 2012

Alabama Supreme Court Announces Modified Four-Part Test for Application of the Physician Office Exemption Under CON Rules

By Jennifer H. Clark
Bradley Arant Boult Cummings LLP

On November 21, 2012, the Alabama Supreme Court announced a modification of the Physician Office Exemption (“POE”) to Alabama’s Certificate of Need (“CON”) rules and regulations. In Ex parte Sacred Heart Health System, Inc. (In re: “Infirmary Health System and South Baldwin Regional Medical Center v. Sacred Heart Health System, Inc.”), the court withdrew its March 2, 2012, opinion that had crafted a new test adding a fifth part, and, instead, modified the original four-part test, referred to as “the POE Application Test.” The Court indicated that the modified POE Application Test will “provide an objective standard that can be used to determine whether the POE applies to any medical practice, whether the practice is solo or group, large or small, specialized or general.”

            This case arose when Infirmary Health System and South Baldwin Regional Medical Center filed an action seeking a declaratory ruling that Sacred Heart Health System was required to obtain a certificate of need in order to develop a medical building that would accommodate physician offices, an outpatient surgery center, a diagnostic center, a laboratory, and a rehabilitation center. (The surgery center and rehabilitation center were later dropped from the project.)

            The trial court held that the part of the building that was to be occupied by Sacred Heart Medical Group physicians qualified for the POE and did not require a CON. The court later amended its judgment to hold that the exemption applied only to the part of the building to which three physicians had previously located their practices. On appeal, the Court of Civil Appeals reversed and remanded, holding that none of the building qualified for the exemption.

            The Alabama Supreme Court granted certiorari and, in its opinion, noted that the CON Review Board had previously formulated a four-part test to determine whether a proposed project qualifies for the POE. While determining that the four-part test used by the CON Review Board is still substantially sound, the court made minor modifications to the test, specifically to the second and third factors of the test. In doing so, the court reversed the judgment of the Court of Civil Appeals and remanded the case for analysis under the new POE Application Test.

            Under the current form of the POE Application Test, all four criteria must be satisfied in order to qualify for the Physician Office Exemption from CON review. The modified POE Application Test is as follows:

1.  The proposed services are to be provided, and related equipment used, exclusively by the physicians identified as owners or employees of the physicians’ practice for the care of their patients.

2.  The proposed services are to be provided, and related equipment used, at any office of such physicians.

3.  All patient billings related to such services are through, or expressly on behalf of, the physicians’ practice.

4.  The equipment shall not be used for inpatient care, nor by, through, or on behalf of a health care facility.

Tuesday, November 27, 2012

Patients Benefit From Princeton BMC’s Newest, Most State-of-the-Art Operating Rooms in the City

By Stan Hewlett, MD, FACS, General Surgeon

Alabama is home to sixteen new operating rooms bursting with industry leading technology. You will not be surprised to learn that they are located at Princeton Baptist Medical Center, which has a long history of quiet, groundbreaking innovations. The new fifty seven million dollar east expansion houses the newest, most advanced operating rooms in Birmingham.

There is no other facility in the region currently using the technology that my patients are treated with at Princeton. Complex foregut, pancreatic, hepato-biliary, intestinal, colorectal, and retroperitoneal diseases are treated with “state of the art” robotic technology and integrated complex intra-operative imaging.
The da Vinci surgical robot helps in cases not amenable to laparoscopic techniques such as Whipple, hepatectomy, esophagectomy, and others. These patients benefit from less pain and less pain medicine, less blood loss, shorter hospital stay and quicker recovery. Single site robotic cholecystectomy leaves an invisible scar, less pain, and excellent patient satisfaction.

The Artis Zeego Robotic radiographic imaging system by Siemens, the only one currently in the state,  is housed in the three million dollar futuristic ‘multi-use’ angiographic and advanced endoscopic OR suite. The Artis Zeego system utilizes Robotic fluoroscopy and intra-operative computerized axial tomography using automotive assembly line precision robotic technology. This, combined with 3-D software, allows unprecedented intra-operative imaging. It is used for angiography, ERCP, cholangioscopy, PTC and ablative techniques such as RFA. On-table, intra-operative 3-D reconstruction with real time CT or previously acquired CT/MRI overlay provides the stereo tactic targeting previously only dreamed of. The surgical applications are being expanded daily.

Fluorescence imaging using indocyanine green (ICG) angiography has applications in lymphatic, tumoral, and conduit perfusion. It is useful in liver resection, esophagectomy, bowel resection, and promises to replace second look surgery in cases of questionable bowel viability.

Access to the newest, most advanced OR’s in town must be combined with the training and experience that allows adoption of these techniques and realization of their benefits. Fellowships in Laparoscopy, Surgical Endoscopy & ERCP and over a decade of experience at Bethesda and Princeton have provided me the privilege of offering the most advanced robotic and endoscopic options to every patient, no matter how complex the disease.  

Wednesday, November 21, 2012


By Judd A. Harwood
Bradley Arant Boult Cummings, LLP

Another month has gone by without the publication of the final Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH Act) regulations (referred to as the HIPAA Omnibus Final Rule). The HIPAA Omnibus Final Rule is expected to include modifications to HIPAA privacy and security rules required under the HITECH Act; data breach enforcement and penalty requirements; regulations related to the HITECH Act’s breach notification rule; and changes to HIPAA to incorporate the Genetic Information Nondiscrimination Act (GINA). The HIPAA Omnibus Final Rule is also expected to extend HIPAA liability and obligations directly to business associates and their subcontractors. 

By way of background, on March 24, 2012 the Office of Civil Rights (OCR) sent a final HIPAA Omnibus Final Rule to the Office of Management and Budget (OMB) for review before publication in the Federal Register. Despite indications from the Director of the OCR late this summer that the Omnibus Final Rule was extremely close to publication, the OMB elected to extend its review of the rule under Executive Order 12866. Under Executive Order 12866, OMB is given ninety (90) days to review most proposed and final rules. However, the Executive Order permits OMB to extend the review period for an additional thirty (30) calendar days on its own, and, with the agreement of the agency head, for longer periods of time. 

It has now been over three and a half years since the HITECH Act was passed and almost two and a half years since the proposed HITECH Act regulations were published in July of 2010. As autumn gives way to winter and proceed past the election season, there’s no sign of the HIPAA Omnibus Final Rule yet. Healthcare attorneys and compliance specialists have been left to speculate about what the hold-up is and to eagerly wait for the issuance of the final rule.

Thursday, November 15, 2012

Chronic Obstructive Pulmonary Disease (COPD)

By Sandra Gilley, MD
Pulmonary Associates of the Southeast

COPD refers to two lung diseases, chronic bronchitis and emphysema, that cause airflow obstruction that interferes with normal  breathing. Asthma is not included in COPD, but people with asthma  may develop COPD over time. The incidence of COPD among adults in the US in 2008 was 12.1million people. COPD is the fourth leading cause of death in the US.

Tobacco use is the key factor in the development of COPD in the US. Approximately 80 to 90 percent of COPD deaths are caused by smoking. But air pollution in the home and work place, second-hand smoke, and genetic factors also play a role. In developing countries the use of indoor wood-burning cook stoves is thought to play a much larger role in the development and progression of COPD, especially among women. Thus, COPD is a largely preventable disease and early detection  might change its course.

The diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum  production and/or a history of exposure to risk factors for the disease. Spirometry is required  to make the diagnosis. The severity of the disease is assessed based on the patient's symptoms, risk of exacerbations, degree of spirometric abnormality, and the identification of comorbidities.

The most important step to preventing COPD and slowing its progression is to stop smoking.  Treatment of COPD is based on the symptoms  and disease severity. Pharmacologic therapy included bronchodilators, steroids,  and other medications. These can reduce COPD symptoms, reduce the frequency  and severity of exacerbations, and improve health status and exercise tolerance. Vaccinations for Influenza and Pneumococcal pneumonia  can reduce serious  illness and death in COPD patients. All patients with COPD appear to benefit from rehabilitiation and maintenance of physical activity. Supplemental oxygen therapy improves  exercise tolerance and reduces  mortality.

World COPD Day is an annual event organized  by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to improve awareness and care of COPD. This year, the event took place on November 14th, with this year's theme being "It's Not Too Late." As part of World COPD Day, Pulmonary Associates of the Southeast hosted a COPD fair in the 1st floor lobby at 880 Montclair Road.