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SEPTEMBER 2026

Bulletin Allegheny County Medical Society

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The Road to H-E-L-L

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SEPTEMBER 2026

// ACMS Bulletin

inside W H AT ’S

A LETTER FROM THE MEDICAL EDITOR

ACMS ELECTION REPORT

ADVOCACY UPDATE

MATTRESS FACTORY RECAP

A PATH TO TREATMENT

REPORTABLE DISEASES

DISTINGUISHED AWARD WINNERS

GOOD SUPPLIES. GREATER IMPACT.

HIPAA SECURITY RULE CHANGES

DUQ-NCOM IS HERE

DINING WITH RESHMA

MATERIA MEDICA

FIRST PERSON CONSENSUS

MEMBER ACKNOWLEDGEMENTS

THE ROAD TO H-E-L-L

DON'T SHOOT THE THERAPIST

SPECIALTY GROUP UPDATES

ACMS FEATURED MEMBER

36 CHECK US OUT ONLINE: www.acms.org AlleghenyCountyMedicalSociety company/allegheny-county-medical-society

ACMS Bulletin //

SEPTEMBER 2026

alleghenycountyms

CHECK US OUT IN PERSON: Allegheny County Medical Society 412.321.5030 850 Ridge Avenue Pittsburgh, PA 15212

EDITORIAL/ADVERTISING OFFICES: Bulletin of the Allegheny County Medical Society, 850 Ridge Avenue, Pittsburgh, PA 15212; (412) 3215030; fax (412) 321-5323. USPS #072920. PUBLISHER: Allegheny County Medical Society at above address.

2026 EXECUTIVE COMMITTEE AND BOARD OF DIRECTORS

ADMINISTRATIVE STAFF

PRESIDENT

Sara Hussey, MBA, CAE shussey@acms.org

Kirsten D. Lin, MD PRESIDENT-ELECT

Richard B. Hoffmaster, MD SECRETARY

William F. Coppula, MD TREASURER

Alexander K. Yu, MD BOARD CHAIR

Keith T. Kanel, MD BOARD OF DIRECTORS TERM EXPIRES 2026

Michael M. Aziz, MD, MPH, FACOG Michael W. Best, MD Micah A. Jacobs, MD, FIDSA Kevin G. Kotar, DO Jody Leonardo, MD TERM EXPIRES 2027

David J. Deitrick, DO Sharon L. Goldstein, MD Prerna Mewawalla, MD Raymond J. Pan, MD Nicole F. Velez, MD TERM EXPIRES 2028

Amber R. Elway, DO Andrew Eller, MD Geoffrey F.S. Lim, MD Charles E. Mount III, MD Meilin Young, MD, FCCP

EXECUTIVE DIRECTOR

VICE-PRESIDENT OF MEMBER AND ASSOCIATION SERVICES

Nadine Popovich npopovich@acms.org MANAGER OF MEMBER AND ASSOCIATION SERVICES

Haley Thon hthon@acms.org MANAGER OF THE ACMS FOUNDATION

Melanie Mayer mmayer@acms.org MANAGER OF OPERATIONS AND FINANCE

Elizabeth Yurkovich eyurkovich@acms.org BULLETIN STAFF MANAGING EDITOR

Sara Hussey, MBA, CAE ACMS Executive Director shussey@acms.org BULLETIN DESIGNER

Victoria Gricks koonacreative@gmail.com 2026 BULLETIN EDITORIAL BOARD MEDICAL EDITOR

PAMED DISTRICT TRUSTEE James Latronica, DO, DFASAM

Natalie Gentile, MD acmsbulletin@acms.org

2026 BOARD COMMITTEES

Reshma Paranjpe, MD

BYLAWS

ADDITIONAL MEMBERS

EDITOR EMERITA

William F. Coppula, MD FINANCE

Alexander K. Yu, MD NOMINATING

Richard B. Hoffmaster, MD WOMEN’S COMMITTEE

Prerna Mewawalla, MD & Meilin Young, MD MEMBERSHIP TASK FORCE

Geoffrey F.S. Lim, MD ADVOCACY TASK FORCE

Lillian Emlet, MD Marsha Haley LoAlbo, MD Alexandra Johnston, DO Vinnie Kaschauer OMS-1 Anthony Kovatch, MD Timothy Lesaca, MD Najya Williams, MD PUBLICATION CREDITS FRONT COVER

The Bulletin of the Allegheny County Medical Society is presented as a report in accordance with ACMS Bylaws. The Bulletin of the Allegheny County Medical Society welcomes contributions from readers, physicians, medical students, members of allied professions, spouses, etc. Items may be letters, informal clinical reports, editorials, or articles. Contributions are received with the understanding that they are not under simultaneous consideration by another publication. Bulletin of the Allegheny County Medical Society reserves the right to edit all reader contributions for brevity, clarity and length as well as to reject any subject material submitted. The opinions expressed in the Editorials and other opinion pieces are those of the writer and do not necessarily reflect the official policy of the Allegheny County Medical Society, the institution with which the author is affiliated, or the opinion of the Editorial Board. Advertisements do not imply sponsorship by or endorsement of the ACMS, except where noted. Publisher reserves the right to exclude any advertisement which in its opinion does not conform to the standards of the publication. The acceptance of advertising in this publication in no way constitutes approval or endorsement of products or services by the Allegheny County Medical Society of any company or its products. Annual subscriptions: $60 Advertising rates and information available by calling (412) 321-5030 or online at www.acms.org. COPYRIGHT 2026: ALLEGHENY COUNTY MEDICAL SOCIETY POSTMASTER – Send address changes to: Bulletin of the Allegheny County Medical Society, 850 Ridge Avenue, Pittsburgh, PA 15212. ISSN: 0098-3772

Photo by Ashley Green on Unsplash

Richard B. Hoffmaster, MD

SEPTEMBER 2026

// ACMS Bulletin

Caring For Our Own A LETTER FROM THE ACMS BULLETIN MEDICAL EDITOR written by NATALIE GENTILE, MD Does anyone else feel like September brings about a slew of activity? Changing seasons tend to somehow create an air of promise and excitement, while also opening another opportunity to overbook and overcommit. If you're in the backto-school season like our family is, and shuffling around to sports and activities, you may be feeling the pressure to do it all. Sometimes (oftentimes) that pressure is born out of the confluence of all the hats we wear, the people who rely on us, and the commitment to our work. I feel like the answer we regularly get in the heat of this overwhelm is "don't forget about self-care!" And don't get me wrong, gentle encouragement is at times welcome and necessary, especially for physicians, who are trained to attend to everyone else before themselves. But there's so much more driving physician mental health than selfcare alone can fix. When we talk about physicians in particular, we also cannot ignore the toll that our jobs take on our mental health. The word "burnout" is frequently tossed around, but more often than not what I hear my colleagues experience these days is moral injury. The practice of medicine and the healthcare system as a whole have become more and more disconnected from the core values we live by when it comes to patient care. The systemic conditions of loss of clinical autonomy, RVU/productivity quotas, EHR documentation burden, prior authorization friction, and a litigious

ACMS Bulletin //

malpractice climate, to name a few, make moral injury a more predictable outcome than a rare event. And when physicians do reach a breaking point, the very systems meant to protect the public often punish us for seeking help. Many state licensing applications still ask intrusive questions about mental health treatment history, which discourages colleagues from getting care for fear of professional consequences. This inevitably leads to some of us experiencing a decline, whether temporary or permanent, in the quality of our mental health. For some of our colleagues, that decline becomes unbearable enough that they don't survive it. Physician suicide is the outcome of everything named above, not the starting point. Physician suicide isn't a personal resilience failure, it's a symptom of the bigger issues that are becoming more deafening. The physician mental health crisis isn't caused by outside forces attacking resilient people; it's produced by the system physicians already live inside. In this issue of the Bulletin, you'll hear from Dr. Vint Blackburn about the Physician Wellness Program, including their upcoming event on September 17th in recognition of Physician Suicide Awareness Day. I'd encourage you to look into this resource: it's ACMS living out our medical society's role of community accountability and caring for each other. Let's normalize colleagues

SEPTEMBER 2026

seeking care without career risk. Let's train physicians to recognize warning signs in each other, not just in ourselves. Let's push institutionally for licensing reform and confidential treatment pathways. Let's move beyond mandatory "burnout" modules and "self-care" staff pizza lunches as the extent of how we address this in our physician community. Let's take action on the underlying causes, not just the symptoms. None of us should carry this alone, and no one should have to wait for a crisis to ask for help. Call or text 988, which is the 24/7 Suicide & Crisis Lifeline, there for any of us, anytime, not just this month. Check in on a colleague who seems to be struggling, even if they haven't said so. Let's be a medical society that catches its own before it's a crisis, not after. To learn more about our Physician Wellness Program, please visit www. acms.org/physicianwellness/.

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// ACMS Bulletin

2027 Election Report ACMS Board of Directors and Delegates The Allegheny County Medical Society conducted its election from September 6, 2026  September 14, 2026. The following are the official results of the election as certified by the ACMS Board on September 15, 2026.

Chair Kirsten D. Lin, MD

President Richard B. Hoffmaster, MD

President-Elect William F. Coppula, MD

Secretary Alexander Yu, MD

*Bold = Elected Positions

ACMS Board of Directors Michael M. Aziz, MD Sarahgene Gillianne DeFoe, MD Darlene Gabeau, MD Maria D. Gioia, DO Micah A. Jacobs, MD Kevin G. Kotar, DO

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SEPTEMBER 2026

Treasurer Raymond J. Pan, MD

Board Members Currently Serving Term Expires in 2027 David J. Deitrick, DO Sharon L. Goldstein, MD Prerna Mewawalla, MD Nicole F. Velez, MD

Term Expires in 2028 Andrew W. Eller, MD Amber R. Elway, DO Geoffrey F.S. Lim, MD Charles E. Mount, MD Meilin A. Young, MD

2027 Peer Review Board – Last 3 Immediate Past Presidents Keith T. Kanel, MD (Chair) Raymond E. Pontzer, MD Matthew B. Straka, MD *A member of the Peer Review Board cannot be an active member of the ACMS Board of Directors.

ACMS Delegates Elected - Two-Year Term 2027-2028 Vint R. Blackburn, MD Donald Bourne, MD Natalie Gentile, MD Marissa Tremoglie-Barkowski, MD Valerie P. Wislo, MD

Currently Serving (Not Up for Election) Holly Appleberry, DO Alexandra M. Johnston, DO Kevin G. Kotar, DO Stacie M. McKnight, DO Devon M. Ramaeker, MD Dillon J. Stein, DO

Alternate Delegates Elected – One Year Term Ending Dec. 31, 2027 Amber R. Elway, DO Anthony L. Kovatch, MD Charles C. Walker, MD

2026 Nominating Committee Richard B. Hoffmaster, MD — Nominating Committee Chair Sharon L. Goldstein, MD Kevin G. Kotar, DO Jody Leonardo, MD Raymond J. Pan, MD Dillon J. Stein, DO Meilin A. Young, MD SEPTEMBER 2026

// ACMS Bulletin

Advocacy Update GIVING ALLEGHENY COUNTY PHYSICIANS A VOICE

written by RICHARD B. HOFFMASTER, MD – PRESIDENT-ELECT OF ALLEGHENY COUNTY MEDICAL SOCIETY AND CHAIR OF ACMS ADVOCACY TASK FORCE As we move into a busy fall for organized medicine, the ACMS Advocacy Task Force continues to focus on one central goal: ensuring that the perspectives of Allegheny County physicians are part of the conversations shaping medicine, public health and patient care. Over the past year, ACMS has become increasingly active in responding to policy developments when we believe the physician voice is important. Most recently, ACMS issued a statement on President Trump’s August executive order directing changes to the nation’s childhood vaccination schedule, including recommendations related to the measles, mumps and rubella (MMR) vaccine. Our statement reaffirmed a straightforward principle: vaccination recommendations should be guided by rigorous scientific evidence and established clinical expertise. Physicians must be able to counsel patients and families using the best available evidence and their own clinical judgment.

Our response aligns with ACMS’s mission to educate our community regarding the public health. Additionally, the statement highlights one of ACMS’s primary advocacy pillars: physician autonomy to make the right decision in collaboration with, and in the best interest of, our patients. The response also demonstrated why it is important for ACMS to participate in these conversations. The statement received significant local media attention, including coverage by Pittsburgh City Paper and a discussion on Our Region’s Business with Bill Flanagan. That visibility gives physicians an opportunity to bring clinical expertise into conversations that are increasingly taking place beyond the exam room. ACMS’s work to bolster community support for vaccination couldn’t have come with more urgency, as Allegheny County faces rising measles cases on its doorstep over recent weeks.

Richard Hoffmaster, MD speaks with Bill Flanagan on Our Region's Business

ACMS Bulletin //

SEPTEMBER 2026

HOW ACMS ADVOCACY POSITIONS ARE DEVELOPED As ACMS becomes more visible on public policy issues, we also want members to understand how these positions are developed and approved. ACMS members elect physician leaders to the Board of Directors to represent the membership and guide the organization. The Advocacy Task Force works within that governance structure to evaluate emerging issues and recommend when, and how, ACMS should engage. For issues requiring a timely response, the Advocacy Task Force reviews the matter and develops a proposed position or statement. That recommendation then moves to the ACMS Executive Committee for review and approval, with the ACMS Board provided the final statement and an opportunity for any final comments prior to public release. This process allows ACMS to respond quickly enough for our voice to be relevant while ensuring that our advocacy remains physician-led and grounded in the governance structure established by, and representing, our members. Not every physician will agree with every position ACMS takes. Organized medicine encompasses physicians with different specialties, experiences and perspectives. With that said, the Advocacy Task Force wants to hear from you, to ensure we’re focused on the issues that unite us. Our responsibility is

to have a thoughtful process, rely on the expertise of our physician leaders and speak when an issue has meaningful implications for physicians, patients or the practice of medicine. BRINGING PHYSICIANS AND POLICYMAKERS TOGETHER Advocacy is also about relationships, and our August 12 Legislative Update and Leadership Social was a great example of that work in action. ACMS physician leaders gathered with policymakers and healthcare leaders for an evening focused on the issues affecting medicine in Pennsylvania and here in Allegheny County. We were pleased to welcome State Representative Arvind Venkat, MD; State Representative Jeremy Shaffer; and Jillian Irwin, MD, Medical Director and Deputy Director of Clinical Services for the Allegheny County Health Department, as well as Zac Gates and Wayne Crawford from the PAMED legislative team. The discussion gave our members an opportunity to hear different perspectives on the policy environment in Harrisburg and to talk about issues affecting physicians, practices and patients. Just as importantly, the evening created space for conversations outside of the formal legislative process. We may not agree on every policy issue, nor should we expect to. But establishing relationships with elected officials and other decisionmakers - and making sure they have opportunities to hear directly from practicing physicians - is an important part of effective advocacy. The discussion covered a multitude of topics important to Allegheny County physicians, including concerns regarding the imminent

ACMS Leadership at the August 12 Legislative Update and Leadership Social

loss of Medicaid coverage for vulnerable patients, opportunities to improve physician-stakeholder communication surrounding the benefits of vaccination and other public health issues at the local level, and the risks and opportunities related to market competition in the context of large health systems and rising private equity interests. Thank you to the many ACMS Board members, delegates, physician leaders and guests who joined us. A NEW HOME FOR ADVOCACY UPDATES Members can now follow this work more easily through the new Advocacy Updates section of the ACMS website [https://www.acms. org/advocacy-updates/]. The page brings together ACMS statements, policy updates, advocacy opportunities and other resources in one place, and provides direct connections to ACMS leadership and policymakers.

proposed by physicians from across Pennsylvania will be debated and considered. Following the meeting, we will share updates on key policy decisions and what they may mean for physicians in Allegheny County. GET INVOLVED Effective advocacy depends on physicians who are willing to lend their experience and perspective to the conversation. As we plan for 2027, we welcome ACMS members who are interested in serving on the Advocacy Task Force. You do not need to be a policy expert. We are looking for physicians who care about the future of medicine, are interested in the issues affecting their colleagues and patients, and want to help ACMS determine where our collective voice can make a difference. If you are interested in getting involved, email acms@acms.org.

As advocacy becomes a larger part of our work, we hope this resource helps members understand not only where ACMS stands, but what is happening at the local, state and national levels that may affect their practices and patients.

And between issues of the Bulletin, be sure to follow ACMS on social media and visit the Advocacy Updates page at acms. org/advocacy-updates for timely updates and opportunities to participate.

We will also be watching the Pennsylvania Medical Society House of Delegates closely in October. ACMS physicians, residents and medical students will participate in the House, where policies

AI Disclosure: The ideas and perspectives expressed in this article are the author’s own. Artificial intelligence (AI) was used to assist with drafting and refining the text.

SEPTEMBER 2026

// ACMS Bulletin

On September 17, nearly 100 physicians, trainees and community partners gathered at the Mattress Factory in recognition of National Physician Suicide Awareness Day. This event brought together colleagues from across the region in support of physician well-being. One chair remained empty, representing a physician colleague who should still be here. Together, attendees paused for a moment of silence to honor the physicians we have lost - a powerful reminder of the importance of caring for those who dedicate their lives to caring for others.

REGISTRATION OPEN

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Secretary of Health, Pennsylvania Department of Health Plus experts from Allegheny County Health Department, CHOP, University of Pittsburgh, UPMC, and Duquesne.

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THANK YOU TO OUR 2026 SPONSORS & EXHIBITORS

Pfizer | Moderna | Pathways Wellness Program | Sanofi

SEPTEMBER 2026

// ACMS Bulletin

Fiscal administration for the Allegheny County Immunization Coalition is provided by the Allegheny County Medical Society Foundation.

Photo by Olga DeLawrence on Unsplash

A Path to Treatment

HOW M.A.T.T.E.R.S. HELPS CONNECT PATIENTS TO ADDICTION TREATMENT & SUPPORT written by DELANEY KENYON, NREMT, MPH AND MALEA RUSSELL, MPH OVERVIEW Opioid use disorder (OUD) continues to have a significant impact on the health of Allegheny County residents. Many individuals seeking care still encounter challenges such as stigma, limited appointment availability, transportation barriers, and inconsistent referral pathways. To address these issues, the Allegheny County Department of Human Services (DHS) and the Allegheny County Health Department (ACHD) have partnered with the MATTERS (Medication for Addiction Treatment and Referral System) Network – a rapid referral platform designed to streamline access to medication for opioid use disorder (MOUD). It offers direct referrals, medication vouchers, transportation vouchers, peer support, harm reduction resources, follow up, and telemedicine – all at no cost to providers or patients.

ACMS Bulletin //

WHY SHOULD HEALTHCARE PROVIDERS JOIN THE MATTERS NETWORK? MATTERS’ goal is simple – make it easier for people to start treatment and stay engaged and make it easier for providers to help them do so. Using a hub‑and‑spoke model, MATTERS engages partners across healthcare, community organizations, EMS, and substance use services to connect patients to treatment quickly. Becoming a MATTERS partner – either as a referral site or treatment organization – offers practical benefits that can improve outcomes, increase retention, and reduce staff burden. 1.Easily find treatment partners who address multiple needs: Many patients require more than MOUD. They may also require other behavioral health services like peer support, mental health counseling,

SEPTEMBER 2026

and treatment for other substance use disorders (SUD). Additionally, people with OUD often have concurrent physical health conditions due to shared social and structural factors and inequities, such as viral hepatitis, HIV, sexually transmitted infections (STIs), and serious bacterial infections. Without a coordinated system, referring organizations must navigate

Figure 1. Key components of the MATTERS platform

• 24-72 hours, 30-day, 60-day, and 90-day follow up calls • Support from the entire network • Coverage for medication and transportation • Stigma-free, individualized, compassionate care This coordinated system reduces missed appointments, improves retention, and enhances treatment outcomes.

Figure 2. Map of MATTERS network in Allegheny County

separate agencies, phone numbers, waitlists, and eligibility criteria. MATTERS solves this by providing a single platform that filters treatment organizations based on the services they offer, including: • Medication for OUD • Viral hepatitis and HIV/STI testing and care • Mental health counseling • Perinatal support • Peer recovery services • Harm reduction resources • Transportation assistance This approach allows referral sites to match patients with treatment organizations that can meet all of their needs – supporting improving linkage, stronger retention, and decreased patient burden. 2. Ease of use: MATTERS is designed to be simple, fast, and intuitive. Referral sites can: • Provide referrals in under five minutes • Avoid phone calls or wait-times, OR individual logins • Use a clear, reliable pathway for connecting patients to care • Access harm reduction and educational materials

Treatment organizations can: • Receive referrals matched to your service offerings • Fill appointment slots quickly with motivated patients • Reduced administrative burden – MATTERS assists with navigation, communication, and follow-up All partners will receive ongoing onboarding, training, and integration support from ACHD, DHS, and MATTERS staff. 3. Multiorganization support: MATTERS is intentionally structured as a coordinated network involving referral organizations, treatment providers, peer agencies, DHS, ACHD, and the MATTERS team. This ensures patients remain supported throughout their treatment journey. When your organization joins MATTERS, you gain: • Automated notifications when referrals are submitted • Appointment details/vouchers sent directly to patients • Support from DHS, ACHD, and MATTERS • Connection to a county-wide network of partners

JOINING THE MATTERS NETWORK Enrollment is free, quick, and supported by ACHD and DHS. Once onboarded, your team gains access to rapid referrals, telemedicine tools, educational materials, and ongoing hands-on support. By joining MATTERS, providers can help expand low-barrier access to treatment, reduce overdose risk, and strengthen coordinated care for residents of Allegheny County. If you are interested in joining or learning more, please reach out to Delaney.Kenyon@alleghenycounty.us DELANEY KENYON AND MALEA RUSSELL Delaney Kenyon is the Overdose Prevention Program Specialist in the Bureau of Health Promotion and Disease Prevention at the Allegheny County Health Department (ACHD). Malea Russell is an Applied Epidemiologist in the Bureau of Health Promotion and Disease Prevention at the ACHD.

Meanwhile, your patients gain: SEPTEMBER 2026

// ACMS Bulletin

Reportable Diseases: Q2 ALLEGHENY COUNTY HEALTH DEPARTMENT SELECTED REPORTABLE DISEASES/CONDITIONS

* Case classifications reflect definitions utilized by CDC Morbidity and Mortality Weekly Report. ** These counts do not reflect official case counts, as current year numbers are not yet finalized. Inaccuracies in working case counts may be due to reporting/investigation lag. NOTE: Disease reports may be filed electronically via PA-NEDSS. To register for PA-NEDSS, go to https://www. nedss.state.pa.us/NEDSS. To report outbreaks or diseases reportable within 24 hours, please call the Health Department’s 24-hour telephone line at 412-687-2243. For more complete surveillance information, see ACHD’s 10year summary of reportable diseases: https://www.alleghenycounty.us/Services/Health-Department/CommunityIndicators-and-Health-Data/Infectious-Disease-Epidemiology/Disease-Surveillance.

ACMS Bulletin //

SEPTEMBER 2026

// ACMS Bulletin

Gysella Muniz MD, MBA, FAAP Ralph C. Wilde Leadership Award Dr. Gysella Muniz is an Associate Professor of Pediatrics in the Division of General Academic Pediatrics at UPMC Children’s Hospital of Pittsburgh and serves as Medical Director of Newborn Nursery Services at UPMC Magee-Womens Hospital and Regional Director of Quality for Newborn Care. A summa cum laude graduate of Universidad San Martín de Porres in Lima, Peru, she completed her pediatric residency and chief residency at Georgetown University Hospital before joining UPMC Children’s Hospital in 2015. Across her clinical, academic, and administrative roles, Dr. Muniz is committed to improving care for newborns, children, and families throughout the region. She leads quality initiatives across 16 UPMC birthing centers, advancing safer, more consistent, and equitable care for infants and families. She also serves on the Allegheny County Child Death Review Group, supporting efforts to identify preventable risks and improve outcomes. Her work reflects a commitment to translating clinical expertise into meaningful community and regional impact.

Daniel K. Grob, MD Nathaniel Bedford Primary Care Award Dr. Daniel K. Grob has called Pittsburgh home since high school and is grateful to have built his career and family in the community. He earned his medical degree from the University of Pittsburgh, completed his Family Medicine residency at St. Margaret’s, and has been a partner and practicing physician with Genesis Medical Associates for nearly 30 years. As an independent physician, he has remained focused on providing comprehensive primary care across hospital, skilled nursing, assisted living, and outpatient settings. Teaching and service have been cornerstones of Dr. Grob’s career. He serves as an Associate Professor in Chatham University’s Physician Assistant Program and has welcomed students into his clinical practice, including those from Duquesne University College of Osteopathic Medicine. For more than a decade, he has also participated in annual medical mission trips to Honduras, often bringing family members and fellow healthcare providers. Caring for his community, educating future healthcare professionals, and serving underserved communities have been among the most meaningful parts of his career.

Thomas P. Campbell, MD, MPH, FACEP ACMS Spirit of Service Award

A Pittsburgh native, Dr. Thomas P. Campbell has practiced emergency medicine in the region for more than 35 years. After completing medical school at Temple University and residency through the University of Pittsburgh, he earned a Master of Public Health in Occupational Medicine from Pitt. From 2010 to 2024, he served as System Chair of Emergency Medicine for Allegheny Health Network, overseeing 14 emergency departments and more than 340,000 annual patient visits. A longtime advocate for clinician well-being, Dr. Campbell helped establish AHN’s Clinician Wellness Program in 2018 and became its first Vice President of Clinician Wellness. He has also worked to reduce stigma around physician mental health, including efforts to remove stigmatizing language from medical licensing and credentialing applications. Today, he divides his time between emergency medicine and clinician well-being. He is an Associate Professor at Drexel University College of Medicine and is proud to have two children who followed careers in medicine.

ACMS Bulletin //

SEPTEMBER 2026

The Children's Institute of Pittsburgh Benjamin Rush Community Organization Award The Children’s Institute of Pittsburgh is a nonprofit organization with a proud legacy of serving children and families since 1902. What began by serving one child has grown into a nationally recognized resource for children and youth with complex and unique needs and the families who support them. Today, The Children’s Institute provides a comprehensive range of education, therapeutic, behavioral health, early intervention, autism, and family support services, helping thousands of children and families each year. Guided by its mission, “To Heal. To Teach. To Empower. To Amaze.” and vision, “Together, redefining what’s possible,” The Children’s Institute partners with families to provide personalized, innovative, high-quality care. For more than 124 years, the organization has remained committed to improving quality of life, advancing inclusion and opportunity, and helping every child thrive.

Anna Marie White, MD, FACP, FAAP Richard E. Deitrick Humanity in Medicine Award Dr. Anna Marie White is an Assistant Professor in the Department of Family and Community Medicine at the University of Pittsburgh School of Medicine, where she serves as a clinician, educator, researcher, and healthcare leader. She is the founding director of the Center for Street Medicine and Street Medicine Consult Service at UPMC Shadyside and provides primary care for adults and children, including specialized care for adults with Down syndrome. For more than 16 years, Dr. White has cared for people experiencing homelessness through street medicine, beginning as a medical student with Operation Safety Net. Her scholarship focuses on homelessness, mindfulness, and dementia in Down syndrome, and she is a contributing author of the Global Adult Down Syndrome Clinical Guidelines. An English major before pursuing medicine, she believes listening to and honoring people’s stories is central to compassionate care.

Gregory Anderson, MD Nathaniel Bedford Primary Care Award A native of Saxonburg, PA, Dr. Anderson earned his undergraduate degree in Neuroscience from the University of Pittsburgh and his medical degree from Temple University School of Medicine before completing his pediatric residency at The Children’s Hospital of Philadelphia. He returned to Pittsburgh in 2003 to join East Liberty Family Health Care Center, where he has practiced pediatrics for more than two decades, serving an underserved community. He has held leadership roles in informatics and quality and served as Interim Chief Executive Officer. Teaching and mentoring have also been central to Dr. Anderson’s career. He has mentored medical students through the University of Pittsburgh CMDA chapter and taught outpatient pediatrics to residents since 2011. He currently serves as an Assistant Professor at Duquesne University’s Nasuti College of Osteopathic Medicine, where he is inspired by its mission to prepare physicians to serve underserved communities and address healthcare disparities.

Brett Palestra Benjamin Rush Individual Award For the past 15 years, Mr. Palestra has worked in healthcare as a radiation therapist, and since 2017, he has served as Lead Brachytherapist at Magee. His journey to this profession was anything but straightforward. Before becoming a radiation therapist, he spent many years as a police officer. When a coworker was diagnosed with breast cancer, watching her experience made him take a hard look at his own life. He left that career and returned to school to become a radiation therapist. That decision changed his life and gave him a profession that allows him to help people during some of their most vulnerable moments. What he enjoys most about brachytherapy is helping patients face the fear of the unknown. He tries to make them feel comfortable, answer their questions and, whenever possible, make them laugh. He often tells patients it is his first day on the job, and most appreciate his sense of humor. Above all, he is grateful to the patients who have given him the opportunity to find a second calling in life. SEPTEMBER 2026

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Good Supplies. Greater Impact. HOW GLOBAL LINKS CONNECTS MEDICAL SURPLUS WITH COMMUNITIES IN NEED written by STACY BODOW – SENIOR MANAGER OF OUTREACH AND COMMUNITY ENGAGEMENT

OUR MISSION Global Links is dedicated to improving health in communities with need locally and globally. We build partnerships with healthcare providers and share medical surplus to improve access to essential care.

leaders, and others to develop projects to improve public health outcomes in vulnerable populations. Our projects focus on primary care, strengthening public health, and disaster recovery.

OUR GUIDING PRINCIPLES Always with a mind to our humanitarian and environmental mission, which begins with our three guiding principles: • Dignity and Respect for All People • Respect for the Environment • Continuous Learning and Improvement

LIVES IMPACTED IN 2025-2026: OVER 2.6 MILLION

We seek to apply these principles in everything we do. Our circular economy model of medical surplus rescue and donation keeps good, useful, often lifesaving items out of our waste stream and gets them where they are needed most. Everything from medical supplies and equipment to office furnishings and university furnishings. All the things that lead to improving healthcare for all. MEDICAL AID - INTERNATIONAL We work in communities with need primarily in Latin America and the Caribbean. We collaborate with the Pan American Health Organization/ World Health Organization (PAHO/ WHO), national and local health

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MEDICAL AID - DOMESTIC Locally, our Community Partners Program ensures that individuals and families in western Pennsylvania have access to basic health and hygiene materials through our nonprofit partners. These Community Partners are local safety net organizations serving our most vulnerable neighbors in Western PA, who often fall through the cracks due to gaps in insurance coverage, affordability of co-pays, or lack of coverage by other assistance programs. We support initiatives related to basic needs, healthy aging, respiratory health, maternal and infant health, and community health overall.

LOCAL LIVES IMPACTED IN 2025: 7,315

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IMPACT STORY 1 - ENABLING HEALTHCARE WORKERS TO IMPROVE PRIMARY CARE SERVICES Global Links provided supplies to a Primary Health Care Unit and an Integral Health Center in the Atlántida region in Honduras, serving approximately 522,996 people annually. The medical materials provided will strengthen primary care services, as well as the Maternal Infant Program, Teen Services, and Tuberculosis Program, enabling healthcare workers to improve existing services and offer new ones such as vaccination campaigns and dental and mental health services, and ensuring better care for residents in the area. Dr. Candida Maria Cruz Diaz shared in a video, “I want to express my sincere gratitude to everyone involved from Global Links and all the individuals who make such important contributions that allow us to receive these donations. These donations have not only benefited pregnant women, but the entire healthcare

system. They have improved the work environment for professionals, created a better environment for patients in every health facility, and benefited the entire population served by our health centers.” IMPACT STORY 2 - SURGICAL CATHETERS AND SUTURES ENABLING SURGERIES Through our Global Medical Partnerships program, much needed surgical supplies were hand carried and delivered to a partner hospital. The group delivered 1,008 sutures and 6,233 catheters of various types to help hundreds of patients. Staff at the hospital were truly overjoyed, and shared with our Global Links staff that just that morning they had canceled a surgery for a patient in need because they did not have a urinary catheter to ease her blockage. Now hundreds of surgeries like hers, which were postponed due to the lack of supplies, will be possible again.

IMPACT STORY 3 - HOME MEDICAL EQUIPMENT For over a decade, Global Links has partnered with CHOSEN to provide surplus home medical equipment to lower-income neighbors in Erie and surrounding counties. Staff recently shared the story of Mr. S*, who came to them in November 2024 after a fall from a threestory balcony. In urgent need of

partnerships to rescue and share medical surplus. And when we say surplus, we are talking about perfectly good items - not expired, not outdated, not broken. Simply, not needed any longer where they are. When evaluating these items, the standard question we ask you to ask yourself is, “would I use this for my mother?” If the answer is yes, we are happy to accept these items and get them where they are very much in need. We get the right items to the right people at the right time, turning our region’s surplus into lifesaving donations right here in the Pittsburgh area and internationally. a wheelchair and supplies, he received the support he needed. Months later, Mr. S returned to trade his wheelchair in for a walker. “I’ve been blessed,” he said, reflecting on his journey of healing and regaining strength. He brought back the equipment he no longer needed, hoping it could be passed on to someone else. “I want others to be helped the way that your organization has helped me,” Mr. S shared with CHOSEN. (*Abbreviation of last name for privacy.) What do these stories have in common? People in one place had items they no longer needed, while people in another place did not have items they desperately needed to improve their health, or their patients' health. As a physician or healthcare worker, we imagine you've experienced something similar. You may have upgraded equipment, switched brands, or remodeled your office. You may have items you know are useful, but no longer have a use for. And you don’t know what to do with them. ENTER GLOBAL LINKS I like to refer to us as the “Goodwill” of healthcare. Since 1989, we have been building longterm, sustainable

PARTNER WITH US AND GET INVOLVED Come out and see for yourself. We offer monthly tours the second Tuesday of each month from 11:0012:00pm and we’d love to show you around. Sign up to join one on our website at https://globallinks. org/get-involved-volunteer/tour-orrequest-a-speaker/ Donate surplus. Upgrading, downsizing, moving, or shutting down your practice? If you have items you no longer need, reach out to our Manager, Surplus Procurement & Purchasing, Meagan Sotirokos, at msotirokos@ globallinks.org Tell someone about us. Help us spread the word. Global Links relies on donations of items, including medical supplies/ furnishings/equipment, and dollars to do what we do. Join the volunteer effort. Bring your team (or come yourself) to volunteer with us sorting and packing medical supplies. Find information about volunteering and available dates at https://globallinks. org/get-involved-volunteer/ volunteer/

SEPTEMBER 2026

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KEYNOTE SPEAKER

FEATURED LECTURE LINEUP

Obstructive Sleep Apnea for the Internist Jeffrey McGovern, MD

The New Norm of Wearable Sleep Technology John Karstens, DO

OSA 2.0: The Cardiometabolic Revolution in Sleep Medicine Christian Kyung, MD

MOHAMMED AL-HALAWANI

Sleep in the Hospital: The Missing Vital Sign

Medical Director, Sleep Diagnostic Center

Insomnia: A Primary Care Perspective

MD, FCCP

Hutchinson Regional Medical Center Hutchinson, Kansas

.. ..

...

KEYNOTE TOPIC Obesity Hypoventilation Syndrome and the Hospitalized Patient

Friday, November 6, 2026

RLA Learning and Conference Center 850 Cranberry Woods Drive Cranberry Township, PA 16066

Sushruta Cerejo, MD

Christopher Pham, DO

Dementia, Sleep, and the Glymphatic System Daniel Shade, MD

Scan the code to register or visit

CME.AHN.org.

Preparing Your Practice for the Next HIPAA Security Rule Changes

*This is an advertorial.

WHY DOCUMENTATION, RECOVERY, AND RISK MANAGEMENT WILL MATTER MORE THAN EVER Chris Bowman - Director of Managed Security Services at Vertilocity Healthcare organizations have always been responsible for protecting electronic protected health information (ePHI), but the proposed updates to the HIPAA Security Rule signal a more prescriptive approach to cybersecurity. Although the rule is not final, HHS/OCR’s current regulatory timetable indicates that final publication is projected for July 2027, giving practices time to prepare in four areas likely to receive increased scrutiny: risk analysis, recovery, documentation, and vendor oversight. 1. Risk Analysis Must Lead to Action HIPAA has long required risk analysis, but a report alone provides limited value. Practices should be able to show how findings are prioritized, assigned, and resolved. • •

Which systems create, receive, maintain, or transmit ePHI? Which risks remain open?

• •

Who owns remediation? How is progress documented?

Risk Identification Without Remediation Creates Compliance Exposure 2. Recovery Expectations Are Increasing The proposal would strengthen contingency planning and require written procedures to restore certain electronic information systems and data within 72 hours. Practices should understand restoration priorities before an incident occurs. • •

How quickly can the EHR and other critical systems be restored? Are backups isolated and regularly tested?

•

Can clinical operations continue during an outage?

Patient Care Depends On Accessibility As Much As Confidentiality 3. Documentation Must Reflect Reality Policies often fall behind technology. A practice may move email, applications, or patient data to cloud services while its documentation still describes an on-premises environment. • •

Review security and acceptable-use policies Update incident response and continuity plans

• •

Retain training and testing records Record exceptions and management decisions

Outdated Policies Can Create the Same Problems As Missing Policies 4. Vendor Risk Has Become Healthcare Risk Cloud platforms, software vendors, managed service providers, and other business associates may process or store ePHI. Their access and safeguards must be understood, documented, and reviewed. • •

Confirm Business Associate Agreements Identify subcontractors and data locations

• •

Review security evidence and incident-notification terms Define responsibility for backup and recovery

Your Compliance Program Extends Beyond Your Own Network Final Thoughts The proposed changes reflect a growing expectation that healthcare organizations actively manage cybersecurity risk, rather than simply document compliance. Practices that maintain current risk assessments, test recovery procedures, review vendor relationships, and align policies with actual operations will be better positioned for both compliance and resilience. The goal is not simply passing an audit. It is protecting patient trust, supporting continuity of care, and keeping critical healthcare services available when they are needed most.

Chris Bowman is Director of Managed Security Services at Vertilocity, where he helps healthcare organizations strengthen cybersecurity programs, manage compliance obligations, and reduce operational risk through practical, business-focused security strategies. Learn more at Vertilocity.com. SEPTEMBER 2026

// ACMS Bulletin

DUQ-NCOM Is Here

DUQUESNE’S MEDICAL SCHOOL BEGINS A NEW CHAPTER OF SERVICE IN WESTERN PA written by VINCENT J. KASCHAUER – SECOND YEAR MEDICAL STUDENT AT DUQUESNE UNIVERSITY NASUTI COLLEGE OF OSTEOPATHIC MEDICINE In 2024, the Duquesne University Nasuti College of Osteopathic Medicine (DUQ-NCOM) was a new building on Forbes Avenue, preparing to welcome its first class. No third-year students were entering hospital floors or operating rooms. No second-year students could tell stressed first-year students what the first anatomy practical would feel like or how quickly the months would pass. Now there are. This year, for the first time, students are learning across all three of the stages of medical education at DUQ-NCOM. First-year students are beginning the core sciences. Second-year students are learning medicine by organ system and preparing for the transition toward board examinations. And the students who walked through these doors as Duquesne's inaugural class are now walking through different doors: hospitals, clinics, operating

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rooms, and physician practices throughout Western Pennsylvania. A VISION MORE THAN A CENTURY IN THE MAKING The idea of establishing a medical school at Duquesne is more than a century old. The Spiritans considered it around 1910, but that vision would wait more than one hundred years to become reality. In July 2024, Duquesne finally welcomed the inaugural class of its College of Osteopathic Medicine. Medicine represented something new for Duquesne. Osteopathic medicine, however, felt familiar. There is a natural connection between osteopathy and the mission of a Spiritan university. Duquesne has long emphasized educating the whole person, serving communities that have been marginalized or disadvantaged, and asking students to consider not simply what they

SEPTEMBER 2026

will accomplish with their education, but whom that education will allow them to serve. The College carries that philosophy into medicine. Its vision calls for developing servant leaders committed to caring for the whole person, mind, body, and spirit, while its mission places particular emphasis on disadvantaged communities and health disparities. It also creates space to ask where spirituality, values, dignity, and service belong in modern medicine. Perhaps medical school should be a place where we learn to ask those questions, too. In 2025, another chapter started. Originally opened as the Duquesne University College of Osteopathic Medicine, the school became DUQNCOM following a transformational naming gift from Jim and Celeste Nasuti and their family. The gift, one of the two largest philanthropic

contributions in Duquesne's history, includes significant support for medical student scholarships. Jim Nasuti, a 1970 Duquesne alumnus, connected the gift to the University's longstanding tradition of service. THEIR BEGINNING For DUQ-NCOM’s newest medical students, Block 1 is underway. There are few transitions quite like the beginning of medical school. Subjects that once existed independently begin melting into one another. Anatomy becomes physiology. Physiology becomes pathology. A structure on a cadaver becomes something you will need to recognize in a patient. And for many students, that begins in the anatomy lab. At a time when some schools have reduced traditional dissections or moved toward digital alternatives, first-year students still have the opportunity to learn anatomy through hands-on dissection while using modern technology. For many students, the anatomy laboratory is their first experience with someone who has entrusted their body to their education. Before we ever care for a living patient, someone has already chosen to teach us.

WHEN THE CLASSROOM STARTS LOOKING LIKE MEDICINE One year ahead of them, the second-year class has entered systems-based medical education, where the foundational concepts of the first year begin to converge. Cardiology builds into pulmonology; both intersect with the kidneys, vasculature, immune system, and the medications used to treat disease across them. The boundaries between disciplines begin to disappear because patients, inconveniently, do not arrive divided into organ systems. Medical imaging adds another dimension to that integration. Students learn to interpret radiographs and recognize how disease alters the anatomy. Through point-of-care ultrasound (POCUS), structures once confined to diagrams become moving valves, contracting ventricles, pleural lines, and vessels visible in real time. These skills go beyond the classroom, with POCUS incorporated into clinical service opportunities and medical outreach trips, allowing students to apply what they have learned while caring for patients in the communities they serve.

Another awareness is beginning to settle over the second years: boards and clinical rotations. Over the coming months, students will compress two years of fundamental knowledge into the reasoning expected on licensing examinations and, more importantly, at the bedside. LEARNING THROUGH SERVICE That movement beyond the classroom begins well before clinical rotations. Service is integrated throughout the DUQNCOM experience, giving students opportunities to understand health not only from inside an examination room, but within the communities where patients live. For second-year students, the Social Determinants of Health (SDOH) Scholars in Action project asks students to translate what they are learning into evidence-informed health education. Working with faculty and community partners, students develop projects around local and national health priorities and bring them into settings such as schools, food pantries, and community centers.

Just steps away, students begin learning another medical language in the osteopathic manipulative medicine laboratory. Osteopathy stops existing entirely on a screen. Students learn through palpation, developing the awareness to recognize tissue texture, asymmetry, restriction, and motion. Before they can identify what is abnormal, they must first train their hands to understand what normal feels like. Soon, the first-year class will mark another milestone as they receive their white coats for the first time. SEPTEMBER 2026

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DUQ-NCOM’s clinical education network extends throughout Western Pennsylvania and the surrounding region, offering students experience across a wide range of urban, suburban, and rural communities. These sites expose students to different health systems, practice environments, physicians, and patient populations, from large hospital networks and communitybased practices to smaller regional and rural settings. All clinical sites are located within approximately two hours of campus, with the vast majority within about an hour. Other opportunities place students directly alongside the communities they serve. Through the College’s partnership with the Neighborhood Resilience Project, students participate in direct patient care alongside DUQ-NCOM faculty while providing acute and chronic care to patients without health insurance. Students can also volunteer at food pantries and kitchens, health education events, and larger initiatives such as Mission of Mercy Pittsburgh, a two-day free clinic at the David L. Lawrence Convention Center that brings students together to serve the region. That commitment reaches beyond Pittsburgh. In early October, students have the opportunity to travel to Barahona, Dominican Republic, for a week-long medical mission alongside physicians, translators, volunteers, and community partners. In December, another group will travel to Roatán, Honduras, where DUQ-NCOM is partnering with Clínica Esperanza, a communitybased health center delivering accessible, low-cost care to underserved patients. These experiences allow students to encounter healthcare in different cultural and resource settings while

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learning from the communities and professionals already serving them. The scale of that involvement is already measurable. During the 2025-26 academic year alone, students recorded 4,304 volunteer and Translating Osteopathic Understanding into Community Health hours, with 21 students completing between 50 and 100 hours of approved service and another 10 surpassing 100 hours. DUQ-NCOM LEAVES THE CLASSROOM Perhaps the clearest evidence of how quickly this school is growing can now be found beyond the walls of 1305 Forbes Avenue. For years, this medical school existed as an idea. Then it became architectural blueprints. Then steel and glass. Then classrooms waiting for students. Then those classrooms filled. And now the mission is walking out the door. The students who walked into a brand-new medical school two years ago are now walking into hospitals, clinics, physician practices, and operating rooms as members of clinical teams. That transition belongs to them, certainly. But it also belongs to the College.

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TO THE PHYSICIANS WHO WERE HERE BEFORE US Until this point, this has largely been an update about what is happening at Pittsburgh's newest medical school. But for the physicians of the Allegheny County Medical Society, there is another part of this story. Because we hope you become part of it. DUQ-NCOM is working to develop medical students defined not simply by academic achievement, but by curiosity, humility, clinical preparedness, service, and an understanding of the responsibility that accompanies becoming a physician. Teach us the lessons that never make it onto a licensing examination. Because we are no longer simply preparing to enter Pittsburgh's medical community someday. We are here. We are excited to learn alongside you. We are even more excited to learn from you. Please welcome us into the community we are finally beginning to serve.

*Photos courtesy of the NasutiMed Instagram account

Dining with Reshma FALL NOURISHMENT written by DEVAL (RESHMA) PARANJPE, MD, MBA, FACS Autumn is here, and with the advent of this season of mist and mellow fruitfulness comes the desire for comfort food and warming spirits. You will find plenty of both at Titusz, the new Austro-Hungarian restaurant in Lawrenceville helmed and owned by Chef Csilla Thackray which I mentioned briefly in the last issue. I’ve been back several times, and the offerings just keep getting better. Apparently, I’m not the only one who thinks so: Titusz was recently named to The New York Times’ Restaurant List 2026. You will also find deeply comforting Indian food at Monroeville’s Haveli, the third Indian restaurant of a chain helmed and coowned by Chef Rohit Mhatre—it is well worth the trip to the suburbs. TITUSZ 4129 BUTLER STREET LAWRENCEVILLE Titusz occupies the former Merchant Oyster Co. space and has quickly become one of the hottest reservations in town. At short notice, the 5:30 pm slot may be your best bet—even the bar areas on both levels fill quickly. Fortunately, Convive Coffee Roastery is nearly across the street if you need somewhere to linger beforehand. The demand is deserved. The food is exceptional, the atmosphere warm and cozy, and the drinks distinctive, with Austro-Hungarian aperitifs, wines and after-dinner spirits you won’t find elsewhere in Pittsburgh. Start with the langos—fried potato bread topped with goat gouda and

topfen cheese—or the paprikaspiked Liptauer farmer’s cheese. The tangy potato salad provides a refreshing counterpoint, while the Sour Cherry Soup with sour cream is beautifully balanced and an ideal transition to heartier fare. For mains, the chicken paprikash is a standout: fall-apart tender chicken in a rich sauce over tiny spaetzle, balanced by cucumber salad. Meat lovers can opt for sausage or roast duck, while vegetarians will appreciate cabbage rolls filled with savory mushroom and rice. Save room for dessert, particularly the Violet Sorbet. Inspired by Empress Sisi’s love of violet-flavored treats, this deep-violet ice made with Crème de Violette, champagne and simple syrup is elegant, refreshing and the perfect finish to a rich Austro-Hungarian meal. HAVELI 245 MALL PLAZA BOULEVARD MONROEVILLE If you’ve been to Sankalp in Cranberry and Reva in town, complete the trilogy with Haveli. A haveli is an aristocratic multistory mansion built around a central courtyard, and the restaurant’s décor evokes that elegance with artwork and flickering faux lamps. The menu is extensive without being overwhelming. Appetizers range from Indo-Chinese favorites like Manchow Soup and Hakka noodles to samosas, chaat, momos, Dahi Bhalla and Medu vada. The Tandoori

offerings include whole roasted pomfret—a fish beloved by anyone who has spent time in Mumbai. I asked about the Sharabi (“drunken”) Chicken Tikka. “It’s 90% like regular chicken tikka,” our server explained. What’s the other 10%? “I’m not sure, but it’s delicious.” Despite the name, there’s no alcohol involved. So the chicken isn’t drunk—it’s just high on tandoori spices. And it was delicious, as were the Saoji chicken curry, made with a Nagpur spice blend and toasted coconut; the excellent dum chicken biryani; and chicken Vindaloo. Vegetarian curries, naan, roti, sides and condiments round out the menu. Order a Thums Up, India’s beloved drier, less-sweet cola, and finish with a mango lassi. Ours was sublime—not too sweet, not overdone, just perfect. Haveli deserves a spot in regular rotation. Co-owner Chef Rohit Mhatre, who is from Mumbai, also offers catering. Like Sankalp and Reva, this is Indian food made the way Indians enjoy it, with a largely Indian clientele to match. While you’re there, stop at Patel Brothers across the street for fresh produce, paneer, spices, chai, South Indian coffee, prepared foods, desserts and everything else you could need for an Indian feast. Haveli and Patel Brothers together make for a pretty convincing trip to India— minus the airfare and jet lag. Until next time!

SEPTEMBER 2026

// ACMS Bulletin

Image: Librepath, CC BY-SA 3.0, via Wikimedia Commons

Zegfrovy

(Sunvozertinib)

A NEW OPTION FOR EGFR EXON 20–POSITIVE LUNG CANCER...BUT WHAT’S THE CATCH? written by LAUREN FASTH, PHARMD, BCPS AND REBEKAH COX, PHARMD BACKGROUND Non-small cell lung cancer (NSCLC) comprises approximately 87% of all lung cancer cases.1 Approximately 2-3% of those cases are driven by epidermal growth factor receptor (EGFR) exon 20 insertion mutation (exon20ins). First-line treatment typically involves platinum-based chemotherapy. However, clinical outcomes remain suboptimal, with objective improvement of about 20% and a median progression free survival of six months. Therapeutic options following progression on platinum-based regimens have historically been limited.2,3 Sunvozertinib (ZEGFROVY™) is an orally administered, irreversible kinase inhibitor that selectively targets multiple EGFR mutations, including exon20ins.4 By binding to and inhibiting the EGFR exon 20 insertion mutation, sunvozertinib disrupts downstream signaling pathways implicated in tumor

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proliferation and survival. ZEGFROVY™ is manufactured by Dizal Pharmaceutical and became FDA-approved on July 2, 2025 following the results of the WUKONG1 Part B study.3 While platinum-based chemotherapy remains the standard initial approach for patients, sunvozertinib is a targeted second-line treatment option for those who experience disease progression and have the exon20ins mutation. SAFETY The safety evaluation of sunvozertinib was consistent across two, phase II clinical trials. WU-KONG6 was a single-group, open-label, multicenter phase II trial of sunvozertinib monotherapy, conducted across 37 medical centers in China from July 2021-May 2022. Patients with confirmed locally advanced or metastatic NSCLC whose tumor tissue carried an EGFR

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exon20ins mutation were included in this trial.2 WU-KONG1B was a phase II, dose-randomized study that assessed the antitumor efficacy of sunvozertinib in pretreated patients with advanced NSCLC with EGFR exon20ins mutations studied across 13 countries from November 2021 to November 2023.3 In the WU-KONG6 study, patients received sunvozertinib 300 mg once daily (n = 97). 47 patients (45%) experienced at least one treatment emergent adverse event (TEAE) of ≥ grade 3 severity, including elevated blood creatine phosphokinase (18 [17%]), diarrhea (8 [8%]), and anemia (6 [6%]). Drug-related TEAEs led to dose interruptions in 39 patients (38%), dose reductions in 30 patients (29%), and dose discontinuations in 10 patients (10%). Serious treatmentrelated adverse events (TRAEs) included interstitial lung disease (5 [5%]), and anemia (3 [3%]).

In the WU-KONG1 Part B trial, which compared sunvozertinib 200 mg daily (n = 91) to sunvozertinib 300 mg daily (n = 111), the most common ≥ grade TRAEs mirrored those observed in WU-KONG6. Diarrhea occurred in 2 patients (2.2%) in the sunvosertinib 200 mg group and 20 patients (18%) in the sunvosertinib 300 mg group. Elevated blood creatine phosphokinase was reported in 6 patients (6.6%) and 14 patients (12.6%), respectively, while anemia was observed in 4 patients (4.4%) and 7 patients (6.3%), respectively. Dose reductions due to adverse events in this trial were more frequent in the 300 mg group (47 [42.3%]) compared to the 200 mg group (23 [25.3%]). The most common TRAEs that led to dose reduction were diarrhea (3.3% v 9.9%) and elevated blood creatine phosphokinase (4.4% v 7.2%). TRAEs resulting in treatment discontinuation in 2 or more patients included interstitial lung disease (0% v 1.8%), pneumonitis (0% v 1.8%), and pneumonia (0% v 1.8%).3 TOLERABILITY The most commonly reported adverse events include diarrhea, rash, nausea, and paronychia, with incidence rates of 68.1%, 40.7%, 27.5%, and 26.5%, respectively, at the FDA approved dose of 200 mg once daily.2 These events were typically grade 1 or 2 in severity and consistent with known safety profiles of EGFR tyrosine kinase inhibitors (TKIs), such as mobcertinib.5 Dose interruptions and reductions were implemented in some patients to manage tolerability, though permanent discontinuation of sunvosertinib due to adverse events remained low in both trials.2,3 EFFICACY The primary endpoint of the WU-KONG6 trial was objective response rate (ORR), defined as the

percentage of patients achieving complete or partial response, on two separate assessments ≥ 4 weeks apart. Of the 97 total patients, 57 achieved tumor response receiving sunvosertinib 300 mg daily, with an ORR of 61% (95% CI, 50-71), all of which were considered partial responses.2 In contrast, mobocertinib achieved an ORR of 32% (95% CI, 26-40) after an average follow up period of 12 months, and this was inferior to the response rate found for chemotherapy.5 Mobecertinib was removed from market because it did not meet this primary endpoint. For sunvosertinib, median response time to treatment was 43 days (interquartile range [IQR] 42-45). No in-group differences in the primary outcome were observed by varying baseline characteristics including age, sex, brain metastasis, EGFR exon20ins subtype, and prior chemotherapies utilized. With a median follow-up period of approximately 8 months, a KaplanMeier analysis was utilized to estimate a 12-month survival of 71% (95% CI, 55-82). 19 deaths occurred across the study period.2 In WU-KONG1B, the ORR among patients receiving sunvosertinib 200 mg daily (n=85) was 45.9% (97.5% CI, 33.6-58.5), which was similar to the ORR observed in the 300 mg daily group (n=89, 47.2%; 97.5% CI, 35.1-59.5).3 PRICE As of September 2026, no out-of-pocket cost estimate has been released, and Dizal Pharmaceutical has not announced when ZEGFROVY™ will become commercially available in the U.S.6

progressed on platinum-based chemotherapy. Sunvosertinib is recommended to take daily with food to reduce incidence of gastrointestinal adverse effects and should be swallowed whole.4 Concomitant use with hormonal contraceptives, strong CYP3A4 inhibitors, moderate/ strong CYP3A4 inducers is not recommended. Prior to starting treatment, confirmation of exon20ins is required with FDA-approved lab testing.4 BOTTOM LINE Sunvosertinib is a novel oral treatment for patients with EGFR exon20ins NSCLC that progressed following platinumbased chemotherapy. However, its unknown cost and access in the U.S. drug market may be a barrier for implementation into general practice.6 Further research is needed to evaluate safety and efficacy in a larger population size with greater geographic diversity. Enrollment in a phase III, multinational headto-head comparator trial assessing ZEGFROVY™ as a first-line treatment compared to platinum-based chemotherapy finished in July 2025.6 LAUREN FASTH AND REBEKAH COX Dr. Lauren Fasth, PharmD, BCPS is a PGY2 Pharmacy Resident in Geriatrics at UPMC St. Margaret and can be reached at fasthl@upmc. edu. Dr. Rebekah Cox, PharmD is a PGY1 Pharmacy Resident at UPMC St. Margaret and can be reached at coxr6@upmc.edu. Dr. Lindsay Nakaishi, MD, MPH, DipABLM, FAAFP served as editor and mentor for this work and can be reached at nakaishil@upmc.edu.

SIMPLICITY Sunvosertinib is the only approved oral treatment for EGFR exon20ins NSCLC, for patients whose disease SEPTEMBER 2026

Scan the QR code to view the article’s full list of references.

// ACMS Bulletin

FIRST PERSON

Consensus written by RICHARD H. DAFFNER, MD, FACR

Consensus is defined as a general agreement among a group of people regarding a decision, an opinion, or a plan. Reaching consensus signifies that most, if not all, members of the group support the outcome or conclusion of the issue under consideration. While not requiring 100% agreement (unanimity), consensus indicates there are no major disagreements. Although I was aware of the term, I never gave it serious thought until I became a member of the American College of Radiology (ACR) Expert Panel on Musculoskeletal Diseases. In 1994, the ACR formed a task force to begin developing scientifically based guidelines to assist nonradiologist physicians in making appropriate decisions for ordering imaging studies for their patients, based on the clinical conditions of their patients. The methodology for determining appropriateness relied on evidence published in the peer-

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reviewed scientific literature1. Each member of an Expert Panel authored one or more topics, for which they reviewed the literature and, most importantly, the validity of the conclusions of each article. The author then produced an Evidence Table summarizing the results of the studies, which was subsequently sent to the other members of the panel. In addition, the author created a list of variants for each category, which was also sent to the other members. The panel members voted, using a scale of 1 (not indicated) to 9 (highly indicated – mandatory) for each imaging procedure (x-ray, CT scan, MRI scan, isotope study, ultrasound) for each variant based on the benefits of performing a specific procedure for each clinical scenario balanced against the risks. The ratings made by each panel member were based on the evidence in the literature as well as their personal experiences.

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Following the initial voting round, the results were sent back to each panel member for a second vote. This second vote often resulted in a change of how a panel member initially voted once they could now see how their colleagues had voted. (“Gee, I thought that was appropriate, but I guess I’m wrong.”) A final vote followed. After the final vote, a conference call was held for reconciliation. When 80% of the panel agreed, consensus was achieved, and the author wrote the final document. If consensus was not reached, comments explaining the reason(s) were given in the narrative portion of the final document, which now became part of the ACR Appropriateness Criteria2 (ACR AC®). The ACR AC® are available online for anyone at: www. acr.org/ac. In the seventeen years of participating (including five years as panel chairman), we had fewer than a dozen instances of not reaching consensus, mostly because of

evolving technologies. My second experience where reaching consensus became an issue occurred in 2013 when, as a member of the Board of Trustees of my alma mater, Albany College of Pharmacy and Health Sciences, I chaired a search committee tasked to find a new President. The committee was made up of seven trustees, and two each from the administration, the faculty, and the student body. The purpose of this diverse group was to make sure that all stakeholders were represented.

Our committee and the Board reached consensus. As I am writing this, our country is terribly divided. The news is full of reports of Senate votes of 51 – 49, or House votes of 215 – 212 as our elected representatives are voting “along party lines.” The results of such votes are what I would call bad decisions, rather than voting for what is best for the country. We need to return to a time when we could put petty politics aside and honestly reach consensus for the betterment of all.

REFERENCES 1. Appropriateness. ACMS Bulletin May 2022, pp 8-10 2. ACR Appropriateness Criteria®. American College of Radiology, Reston VA, 2026

I have been a trustee on and off since 1982, and throughout all my terms there was always an attitude from administration and especially faculty of “Them Versus Us” as regarded the Board of Trustees. There were many occasions when I had to explain that trustees’ responsibilities were to oversee the running and the finances of the College; and to provide the resources and funds to allow the President to institute the strategic plan. And so, I was not surprised that at the initial meeting of our search committee one of the faulty members said, “Well, this committee is rigged. The trustees outnumber the rest of us.” I looked at him and replied, “If we ever have a situation where a vote is 7 to 6, that’s a bad decision. My goal is for us to reach consensus”. So, what happened? Our task was to select appropriate candidates from the list of 30 applicants. We interviewed 20 of them and submitted three names to the full Board of Trustees for them to make the final selection . We were unanimous in choosing the three finalists. The Board interviewed each candidate and then voted by written ballot. They unanimously selected the same individual for President. SEPTEMBER 2026

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Member Acknowledgements CELEBRATING ACHIEVEMENT, SERVICE & LEGACY THOMAS R. RADOMSKI, MD, MS Congratulations to Dr. Thomas Radomski, recipient of the ACLGIM Leadership Award, recognizing his contributions to leadership in academic general internal medicine. MAZEN AL-QADI, MD Congratulations to Dr. Mazen AlQadi, recipient of the 2026 John W. Kreit Outstanding Educator Award, recognizing his contributions to medical education. ALEXANDRA JOHNSTON, DO Congratulations to Dr. Alexandra Johnston, recipient of the 2026 Special Recognition Award from the Western Pennsylvania Chapter of the American College of Physicians. Dr. Johnston was also honored with a 2026 Drexel University College of Medicine Clinical Educator Award.

JAMES B. REILLY, MD Congratulations to Dr. James Reilly, recipient of the 2026 Drexel University College of Medicine June Klinghoffer Educational Award, recognizing excellence in medical education. ALEXANDER C. WHITING, MD Congratulations to Dr. Alexander Whiting, recipient of Drexel University College of Medicine’s 2026 Early Career Clinical Scientist Award, recognizing his innovative work in functional neurosurgery, epilepsy, neuromodulation and neurotechnology. DORIAN KUSYK, MD Congratulations to Dr. Dorian Kusyk, who received a $77,914 research PAMED Innovation grant to advance work using high-density surface EMG to improve neuromodulation care for patients with Parkinson’s disease. PRERNA MEWAWALLA, MD Congratulations to Dr. Prerna Mewawalla, recipient of Drexel University College of Medicine’s 2026 Faculty Professional Development, Sponsorship and Allyship Award and recognized as a 2026 Castle Connolly Exceptional Woman in Medicine, honoring her commitment to mentorship, leadership development and excellence in medicine.

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IN MEMORIAM: JOHN WADDELL “JACK” SMITH, MD ACMS remembers longtime member John Waddell “Jack” Smith, MD, who passed away on March 11, 2026. A World War II Navy veteran, Dr. Smith built a distinguished career as a general and colon and rectal surgeon in Pittsburgh, including serving as Chief of Surgery at St. Francis Medical Center and Associate Professor of Surgery at the University of Pittsburgh. Even after retirement, his commitment to service continued as he provided free medical and surgical care for 14 years to patients in South Florida. ACMS extends its condolences to Dr. Smith’s family, friends and colleagues. Full Obituary can be found at: https://obituaries. baldwincremation.com/johnwaddell-smith

Photo by Ashley Green on Unsplash

The Road to H-E-L-L WHAT’S REALLY IN OUR FOOD, WHAT IT MAY BE DOING TO OUR HEALTH, AND WHAT WE’RE FEEDING OUR KIDS written by ANTHONY KOVATCH, MD

“The road to heaven feels like hell. The road to hell feels like heaven." – ATTRIBUTED TO BUDDHA

When I undertook the task of writing an article on the pros and cons of a diet heavy in ultraprocessed foods (UPFs), my intended “road to heaven”, I was completely unaware that it would progressively turn into a project laden with obfuscation, damn politics, misleading cosmesis, and a primer on the factors contributing to poor mental health – a “road to hell”! I felt I had a personal ax to grind, as I had begun during retirement to replace my predominantly healthy vegan diet with conveniently prepared, attractive-to-the-eyeand-palate, frozen dinners with foods touted throughout the world for their originality, like coconut curried chicken. Although retired

from general pediatric practice for over 4 years (but still working parttime in the mental health arena), I was galvanized to undertake the task of educating others in my field after I recently read a disturbing commentary in the journal Contemporary Pediatrics detailing a study (1) reporting that children who consumed more UPFs during their first 6 years of life showed measurably smaller (approximately 2%) volumes in several subcortical brain structures – regions involved in reward processing, emotional regulation, and motivation – at age 6; fortunately, there was no associated diminution in cognitive functioning nor corroboration of the negative behavioral/ emotional symptoms previously found in an investigation of Canadian children. Even more alarming, a study published in Nutrition Research and recently highlighted on

HealthDay News on July 31, 2026 (2) determined that fathers who eat more UPFs before conception tend to have offspring with a greater accumulation of fat in the thighs and around the waist at birth secondary to resultant modifications in sperm quality and in the expression of exclusively paternal genes (especially insulin-like growth factor 2) passed onto the baby. Conversely, mothers who consume more UPFs early in pregnancy tend to have smaller babies. A study reported this week in the American Journal of Medicine hit even closer to home: investigators found that men who ate the most ultraprocessed foods had as much as a 34% higher risk of prostate cancer, compared to those who ate less. The overall preoccupation with UPFs and its political underpinnings began as early as the final 2 decades of the 20th century and was based on

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alarming statistics. Between 1980 and 2000, the number of calories in the food supply went from 3,200 per capita per day to 4,000, roughly twice what the human population needs; consequently, the average American adult weight increased by 15-20 pounds over that 20 year interval! The present day prevalence of obesity in the US is an astonishing 75% – compared to a worldwide prevalence of 43%. This staggering rise in the US from only 10-20% in 1980 has been attributed to politically driven changes in how food is produced, intensively marketed, and made universally available. In order to focus on the bigger picture, I sought consultation with a leading medical agency, the Americal Heart Association, on one hand, and with practical experts in nutrition per se, husband and wife registered dietician team Daniel and Katie Fridley, MS, RD, LDN. Most foods are processed – changed, prepared or packaged – in some way before we eat them. To define whether a food is “ultraprocessed,” several classification systems have been devised, the most widely employed of which is called Nova.

According to Nova, UPFs are industrially processed products made with additives or ingredients not commonly used in home cooking; the purpose of these is not to improve nutritional value, but to purely enhance the shelf life, palatability, or visual appearance of the foods, and all have a basic “cosmetic” or financial purpose with an intention of “reeling in” young adults and children. Beware of foods sold in crumply bags, have labels containing 5 or greater ingredients with words hard to pronounce, and cannot be made in a home kitchen! The characteristics and inclusion criteria for UPFs are detailed in the Nova Group 4 category. (3) They are notoriously transformed through multiple processes with the addition of many substances and contain little or no whole foods. Think soft drinks, sugary cereals, and packaged snacks (to name a few) often produced by large international corporations. While the definition of UPFs may be obfuscating to the general public, the negative consequences of their overindulgence in the diet are wellappreciated by the medical and dietary professions and include:

Photo by Zoshua Colah on Unsplash

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• May result in eating a diet too high in saturated fats, sugar, or sodium (H-F-S-S) – with the attendant predilection to cardiovascular disease and diabetes mellitus. These morbidities can put the individual in the fast lane to a premature death – a road to H-E-L-L, so to say. • May replace whole foods and essential nutrients (UPFs often comprise 50% or more of an individual’s diet) essential to maintaining good health, especially in growing infants and children, where UPF’s can constitute 67% of a kid’s diet and 70% of baby foods. This risk is heightened in neurodivergent individuals, who commonly suffer from texture and sensory issues. I was unable to find data relevant to the standard infant formulas. • Could lead to eating too many calories and fostering obesity, as changed textures and enhanced palatability can trigger the brain to stay hungry even after eating a full meal; in this regard, UPFs are considered by some experts to be “addictive.” • May theoretically disrupt the microbiome or put one at risk for exposure to toxins I consulted the Fridley Dietician Team to provide a practical paradigm to steer us through the dichotomy of healthy versus unhealthy approaches – a path figuratively between heaven and hell. Their take on the quandary can be summarized by the motto “Protein and Produce!”: “Processed foods are a very broad category. For example, buying apple slices from your local grocery store that are considered “processed” is not an inherently unhealthy choice. Some further examples of processed foods that can be beneficial include

foods altogether, but to focus on increasing the availability of whole foods and to build a dietary pattern where minimally processed, protein- and fiber-rich foods form the foundation, while convenient processed foods can still have a place based on the individual’s needs, preferences, resources, and lifestyle.” An “avalanche” of studies in 2026 alone has explored the impact of excessive consumption of UPFs on the mental health of the pediatric population. Multiple investigations have documented a cause-andeffect relationship between diet and anxiety, depression, irritability, sleep disturbance, suicidal ideation, and ADHD symptoms. The details of these studies and the potential genetic and immunological mechanisms at play may be

Dieticians Daniel and Katie Fridley are pairing up to pave the "road to heaven."

discussed in a follow-up article – as well as strategies to remediate the widespread problem and fittingly transform the dietary road to hell we all face into a road to a nutritional heaven. REFERENCES 1. Ottino-González J, Goran MI, et al. Early-life cumulative intake of ultraprocessed foods and subcortical brain volume at age six years: a prospective cohort study. Am J Clin Nutr. Published online June 2, 2026. 2. Paternal Ultra-processed Food Consumption Prior to Conception May be Linked to Infant Birth Weight, HealthDay News, July 31, 2026. 3. https://www.elizabethrider.com/ nova-food-classification-systemguide/

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frozen vegetables, canned beans, and whole grain breads and pastas. These are far different than true UPFs like snack cakes, chips, highly processed frozen meals (this author’s Achilles heel), etc, which have significant health implications if consumed consistently rather than in moderation. Conversely, meals that are built around protein- and fiberrich whole or minimally processed foods tend to provide greater satiety, which can make it easier to regulate overall intake without consistently relying on willpower.

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Don't Shoot the Therapist WHY TREATING CHRONIC SUICIDALITY MEANS ACCEPTING RISK, UNCERTAINTY, AND THE POSSIBILITY OF LOSS written by VINT BLACKBURN, MD One of the most difficult things that any physician or healthcare provider can experience is the death of a patient. Regardless of our specialty, we devote years of our lives to learning how to diagnose illness, relieve suffering, and help people recover, yet one of the first realities that medicine eventually teaches us is that despite our best efforts, not everyone will get better. While the examples that follow come primarily from my work as a psychiatrist, I suspect the broader dilemma will feel familiar to physicians in many other specialties, particularly those who routinely care for patients with severe, chronic, or life-threatening illnesses. I often think about a friend of mine who is a pediatric oncologist, and I continue to marvel at his ability to work with some of the sickest children imaginable, many of whom, despite everything modern

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medicine has to offer, simply will not survive. Yet he genuinely loves what he does. He understands that he cannot cure everybody, but it is the children he is able to help, and the families he is able to support, that continue to give meaning to his work. At the end of the day, no one expects him to save every patient. Most patients and families recognize that he has dedicated himself to fighting extraordinarily difficult diseases, and whether or not a child ultimately survives does not become an indictment of his commitment or competence. Then I think about my own specialty, psychiatry, and how quickly the conversation changes when a patient dies by suicide. In general society understands how tenacious cancer is and therefore does not automatically expect the oncologist to cure every cancer,

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every time. Yet often, when a patient tragically dies by suicide there seems to be an underlying assumption that there must have been something the psychiatrist or therapist should have done differently. One of the few lawsuits psychiatrists and therapists commonly face is following the death of a patient by suicide, and those of us who specialize in chronic suicidality are often described as needing an extraordinarily high tolerance for risk. Unfortunately, that "risk tolerance" has gradually come to refer less to the emotional reality of working with this population of patients than it does to the professional liability associated with doing so. I think this is one of the things that saddens me most about our current system. A willingness to care for some of our sickest patients should not be discouraged by fear of

litigation. It should be supported and encouraged because these are precisely the patients who need experienced clinicians willing to remain engaged the most. The severity of the illness should not determine whether we are willing to accept the patient or not but rather our treatment approach. Over the years I have developed a practice that focuses heavily on patients suffering from borderline personality disorder and other chronically suicidal patients. Many of these individuals have lived with these thoughts for years. Some have made multiple attempts, occasionally dozens. Many have seen numerous psychiatrists and therapists before they ever arrive at my doorstep, and it is not uncommon for them to tell me that they have been "fired" by previous practitioners because of the intensity of their suicidality or what appeared to be an unwillingness to engage in treatment. Unfortunately, this is not shocking, and I fully understand why this happens. Afterall, it is extraordinarily difficult to care for patients whose suffering seems unrelenting. It is painful to repeatedly watch someone move toward suicide, or severe self-injury, or substance use despite every intervention we can think to offer. We become emotionally invested in our patients, and after enough crises, enough hospitalizations, enough late-night phone calls, enough treatment plans that appear to fail, well then, it is entirely understandable. When you add to this a fear of retribution or litigation, it starts to remind us of the old adage, "No good deed goes unpunished." Unfortunately, this creates a problem

that is unique in an important way. If we begin to avoid caring for those patients who carry the greatest risk, then who exactly is left to care for them? This is not a small population. It includes patients with severe personality disorders, chronic treatment-resistant depression, severe eating disorders, refractory substance use disorders, and others whose illnesses often persist despite years of treatment. Much like chemotherapy is reserved for some of the most aggressive malignancies, the therapeutic approaches required for these patients are often quite different from those we might use for uncomplicated depression or anxiety. They are frequently more difficult, more emotionally demanding, and at times considerably more counterintuitive. By the time many of these patients come to see me, they have already tried years of therapy, numerous medication trials, repeated hospitalizations, and often been through multiple providers. They commonly feel trapped, as though they have no meaningful control over their lives, no real sense of self-efficacy, and no future that looks substantially different from the present. Many have spent prolonged periods in psychiatric hospitals, even though the evidence suggests that hospitalization is often far less effective for chronic suicidality than many people assume and may actually carry significant risk in itself. That is certainly not to say there is not a time and a place for hospitalization. But it does remind us that chronic suicidality often requires a different way of thinking than acute crisis management. Nothing changes if nothing changes, and this includes medications and repeat hospitalizations.

One of the approaches we sometimes use, particularly within Dialectically informed Behavior Therapy, appears almost paradoxical at first. We may intentionally allow patients a greater degree of responsibility (and therefore, at times, a greater degree of risk) in order for them to begin developing the very thing they have often lacked for years: a genuine sense of self-efficacy. Often this feels uncomfortable, and perhaps it should. There are few things more emotionally difficult than resisting the urge to over-function for a patient whom we desperately want to keep safe. Yet, over the years, I have repeatedly watched individuals who seemed incapable of change begin to recover only after they gradually developed this missing sense of agency. I am certainly not suggesting that there are not occasional practitioners who engage in questionable therapeutic approaches. But I personally do not know a single psychiatrist or other physician who intentionally approaches this work without compassion or without an earnest desire to help. Most of the clinicians I know work extraordinarily hard for their patients and are extremely competent and compassionate. Which brings me back to my friend. When he prescribes chemotherapy, most people understand that the treatment itself carries substantial risks, and everyone also understands that despite excellent care, not every patient will survive. Why should it be fundamentally different for those of us who care for some of the most severely mentally ill patients? I sometimes think of my work as the oncology of psychiatry because of the extraordinary level of suffering many of my patients

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endure and because of how difficult, prolonged, and emotionally demanding their treatment can become. Honestly, I love working with this population. Watching someone who has lived with chronic suicidality for years finally begin to build a life worth living is one of the most rewarding experiences I have had as a physician. It certainly does not

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happen every time, but when it does, it reminds me exactly why I entered this profession in the first place. This is why it makes me so mad that doctors even have to consider their own professional risk when deciding whether to take on a patient. Unfortunately, that risk is real, and pretending otherwise serves neither physicians nor patients. If we truly want more experienced clinicians

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willing to devote themselves to caring for chronically suicidal patients and others with the most severe forms of mental illness, then this is something that needs to change. After all, caring for those who need us most is why many of us entered medicine in the first place.

Specialty Group Updates A LOOK AT WHAT’S HAPPENING WITHIN OUR SPECIALTY GROUPS

ALLEGHENY COUNTY IMMUNIZATION COALITION 2026–2027 CHAIR: KRISTAL ROSS, PHARMD, CTTS The Allegheny County Immunization Coalition is pleased to announce its upcoming fall 2026 events. • October 16–17 – Volunteer with ACIC at Mission of Mercy Pittsburgh at the David L. Lawrence Convention Center ACIC will provide vaccine education and connect attendees with immunization resources. Multiple volunteer shifts will be available; volunteers do not need to participate both days. Sign-up information will be shared soon. • October 28 – 2026 ACIC Immunization Conference at the Regional Learning Alliance in Cranberry Township The annual conference brings together professionals across healthcare, public health, pharmacy, school health, community outreach and vaccine education. Learn more at https://www. immunizeallegheny.org/upcomingevents/ AMERICAN COLLEGE OF SURGEONS SOUTHWESTERN PENNSYLVANIA CHAPTER 2025-2026 President: Richard Fortunato, DO, FACS The American College of Surgeons Southwestern Pennsylvania Chapter will host its annual Surgical Jeopardy competition and dinner on Wednesday, October 14, 2026, from 6:00-8:30 pm in the Press Box Room at Acrisure Stadium.

This interactive event brings together surgical residents, students, and physicians for an evening of friendly competition and networking. To register, please visit ACS-Surgical Jeopardy 2026 Be on the lookout for 2027 event dates and details! PENNSYLVANIA GERIATRIC SOCIETY WESTERN DIVISION 2026 President: Heather Sakely, PharmD, BCPS, BCGP If you are interested in becoming more involved with the Pennsylvania Geriatrics Society – Western Division, we would love to hear from you! We are always looking for engaged members who are interested in serving on the PAGSWD Board of Directors, helping guide the Society’s programs, educational initiatives, and future direction. If you would like to learn more about board service or express interest in getting involved, please contact hthon@acms.org. Fall Program – Thursday, October 29, 2026 Planning is underway for the PAGSWD Fall Program, “Technology in Geriatric Care: Balancing Safety, Independence & Aging in Place,” taking place Thursday, October 29, 2026, from 5:30-8:30 pm at the University Club at Pitt. The evening will include networking and exhibits, the PAGS-WD Business Meeting, a featured keynote presentation, and an interactive expert panel. Pam Toto, PhD, OTR/L, BCG, FAOTA, Director of the Healthy Home Laboratory, will serve as the featured keynote speaker, with a proposed

presentation on technology, aging in place, and the future of the home. The program will conclude with an interactive case discussion exploring how technology, home modifications, caregiver needs, mobility, cognition, and monitoring can help balance safety and independence for older adults. Visit pagswd.org for more details. 35th Annual Clinical Update in Geriatric Medicine – Thursday April 1 to Friday April 2, 2027 Save the date for the Pennsylvania Geriatrics Society – Western Division's premier annual conference at the Sheraton Pittsburgh Hotel at Station Square. Planning is underway, with additional program and registration details to be shared soon. PITTSBURGH OPHTHALMOLOGY SOCIETY 2026 President: Laurie A. Roba, MD The Pittsburgh Ophthalmology Society is pleased to announce the start of its upcoming monthly meeting series on September 24 at the PNC Champions Club at Acrisure Stadium. Registration is now open for the first program, featuring guest faculty John C. Hart, Jr., MD, FACS, of Associates in Ophthalmology, Farmington Hills, MI; Co-Chief of Anterior Segment Surgery, William Beaumont Hospital; Clinical Assistant Professor of Biomedical Sciences; Oakland University, Royal Oak, MI. The series continues October 15 with guest faculty Mark Breazzano, MD, Associate Professor of Ophthalmology at the Flaum Eye Institute and a member of Retina Service and Director of the

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of medicine and patients throughout our community. POS extends its sincere appreciation to the companies supporting these programs. September’s meeting is supported by ANI Pharmaceuticals, Harrow, and Sight Sciences. Supporters of the October 15 meeting include Apellis Pharmaceuticals, Amgen, and Regeneron. John C. Hart, Jr., MD, FACS

Mark Breazzano, MD

Vitreoretinal Fellowship Program, University of Rochester Medical Center, Rochester, NY.

join members in September, followed by State Representative Arvind Venkat, MD, in October. These conversations offer an important opportunity to hear directly from legislators about upcoming policy issues and the vital role of physician involvement in protecting the needs

During each POS business meeting, the Society will also welcome a distinguished legislative guest. State Representative Jeremy Shaffer will

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POS President Laurie A. Roba, MD, looks forward to a dynamic year of monthly meetings that foster camaraderie among colleagues while bringing expert perspectives and timely educational presentations from across the ophthalmic community.

More Than a Specialty GETTING TO KNOW OUR ACMS FEATURED MEMBER, DR. JOHN WILLIAMS written by JOHN WILLIAMS, MD I completed my residency in Anesthesiology at the University of Texas in Houston followed by a fellowship in London, in the UK. I returned to the University of Texas Houston and was promoted to Associate Professor before moving with my mentor Dr Gabel to UCLA. I was co-director of surgical intensive care and director of cardiac anesthesiology at UCLA and then moved to the University of Pittsburgh following the death of Dr. Gabel. I was Associate Chief of Presbyterian and then Chief of Presbyterian Hospital until being appointed the Safar Professor and Chair of Anesthesiology and Critical Care Medicine. CAN YOU SHARE A LITTLE ABOUT YOUR BACKGROUND AND WHAT LED YOU TO A CAREER IN MEDICINE? I began my career in medicine as

my father lay dying in a hospital bed in Austin, TX. He had contracted hepatitis from one of his patients and was now at end stage chronic aggressive hepatitis. I knew that I wanted to go to medical school to try and continue his abbreviated career. I would graduate from Texas A&M and Baylor College of Medicine in a total of 6 years (3 years for both) and while starting a residency in OB-Gyn, I became fascinated with Critical Care Medicine and changed careers to Anesthesiology. My natural fascination with how things work and teaching led me down the path to academic medicine. WHAT INSPIRED YOU TO PURSUE YOUR CURRENT SPECIALTY? I met my mentor Dr. Joseph Gabel in Houston and he helped shaped my career in academic medicine first in Houston followed by a fellowship

in critical care in London, UK. I then began pursuing a career in academic medicine with a focus in cardiac anesthesiology and critical care. My academic interests were in the lymphology of the heart, mechanical support for the failing heart and eventually in the role of the autonomic nervous system in cardiac disease. Throughout these journeys I taught primarily in residencies but also medical students as they rotated through the specialty. I always loved teaching and still consider teaching to be a core part of my career. HOW DID YOU FIRST GET INVOLVED WITH THE ALLEGHENY COUNTY MEDICAL SOCIETY OR WHAT HAS YOUR OVERALL ENGAGEMENT BEEN WITH THE ACMS? I have been involved with organized Medicine since my time in Houston.

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Prior to moving to Los Angeles I was president of the Gulf Coast Anesthesia Society. In Los Angeles I was a member of the Los Angeles County Medical Association and when moving to Pittsburgh became a member of ACMS. I joined the board soon after arriving in 1998 and would eventually go on to become President and later Chair of the Board and serve on the Board of the Foundation. I served as a delegate from ACMS to PAMED and the HOD for many years and greatly enjoyed my time on the delegation. It would be my experience in the ACMS delegation that would lead me to seek involvement with the PAMED delegation to the AMA. I remain a staunch supporter of the ACMS and look forward to providing my expertise whenever and wherever needed. WHAT HAS BEEN THE MOST REWARDING ASPECT OF BEING AN ACMS MEMBER? As might be suggested from my current platform in running for Vice President of the Pennsylvania Medical Society, I have always enjoyed meeting with others physicians from outside my specialty. It has always been my contention that we as a group are far stronger together than we ever will be apart. Those who seek to dominate our profession have always worked to separate and divide us: divide and conquer was never more apropos. Our ability to set aside our differences; be those specialty, geographic or site and type of practice is the only way we can continue to champion best care for our patients. ARE THERE ANY ACMS INITIATIVES (OR PAMED INITIATIVES) OR EVENTS THAT YOU ARE PARTICULARLY PASSIONATE ABOUT? As we move forward, two initiatives

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and one concern continue to require our attention. The first initiative regards the role of unionization in modern practice. Like it or not, this is becoming a significant issue not only in the Commonwealth but across the US. We will have to come to terms with what is ultimately going to be best for patients, physicians and healthcare generally. Many other members of the healthcare delivery system have decided to go down this route and PAMED is wrestling with this same issue even as we speak. The second initiative regards reimbursement. We finally have a bill in Congress that offers a solution to the recurring problem that delivers inequitable payment for physicians. All other providers but most especially hospitals have received increases over the last decade but not physicians. In fact, in real terms our reimbursement has FALLEN in real terms by over 33%. This is an unsustainable model under any circumstances. We have, with this bill, a chance to remedy this problem permanently. Physicians need to reach out to their respective congresspeople to support this bill (H.R. 9693, AKA "Patients First Act"). The concern that while slowly improving remains is the cost of medical education. Yes, there are now 2 schools who through the generosity and VERY deep pockets of donors have a process and capability to now cover the tuition costs of their students (not living expenses). And there are 4-5 schools that cover much of the costs of their students and offer generous scholarships. However, for the vast majority of students the costs fall on them either through other scholarships or federal loan programs or programs that cover the costs in exchange for entering primary care specialties and providing care in healthcare deserts. More work needs to be done to develop processes that reduce the

SEPTEMBER 2026

costs of education for all students. WHAT DO YOU THINK IS THE BIGGEST CHALLENGE FACING HEALTHCARE TODAY? The most exciting (see below) vs. dangerous issue (discussed here) we will need to address is the rise of AI. I do not believe it matters what the A in AI stands for (augmented, artificial, etc.) as all forms will need to vetted, managed and directed by physicians. Simply allowing AI to run amok or to be directed by those with lesser degrees of training will result in lesser quality of care or more troubling, poorly screened or frankly dangerous care. Is this more important than reimbursement issues, rampant abuse by insurance companies (prior authorization for example), or the cost of medical education. The more I hear from the companies developing these products the more I believe it is. HOW DO YOU SEE THE HEALTHCARE FIELD EVOLVING IN THE NEXT 5-10 YEARS? As there are a multitude of factors influencing medicine and healthcare, the evolution of healthcare will likely be complex. As I noted above, the rise of AI will require intense and thoughtful management by physicians. However, if managed correctly, AI can reduce or possibly eliminate the presence of unnecessary variation in healthcare. Clearly, variation in the delivery of healthcare is a necessary evil as humans are not machines and no two are the same. This clearly suggests that while the general approach to a particular illness may well be the same, there will be times when the standard approach will not suffice and variation will be needed. However, AI correctly managed, should help physicians both document and subsequently complete the reasons for variation in care when needed. If we act now

and in concert, we have a chance to create a best-case scenario. However, the time to act is now and the window for a positive outcome is closing rapidly. WHAT ADVICE WOULD YOU GIVE TO MEDICAL STUDENTS OR EARLY-CAREER PHYSICIANS? This is one of my favorite questions. For medical students, the best advice is to keep an open mind and open heart. Yes, sounds a little trite I know, but it is so very true. The old adage about "everything you learned in medical school will be irrelevant or wrong in X years" is only partially true. Much of what I learned in medical school was not wrong or irrelevant but rather incomplete. So, we know more about many things than when I was a student but none of what we knew was wrong. Continuous learning is just as important now as it was when I was a student. Keeping an open mind and staying curious is the only real way to stay relevant and complete. For the early career physician, keep your ear to the ground and learn to separate wheat from chaff. Yes, there will be changes heading your way but as the French say, the more things change the more they stay the same. Learn to integrate new findings and directives into the current processes and procedures you already have. It is rare that a new finding or medication requires a complete rework of your normal routine. I will say that this requires your practice setting to have the ability to alter your practice routines so make sure your practice maintains this crucial step. OUTSIDE OF MEDICINE, WHAT ARE YOUR HOBBIES OR INTERESTS? I have always loved playing golf, hiking and biking with a side of travel and cooking. Of course, I no

longer play golf as well as I did as a younger man and my top speed on my bike has slowed but the enjoyment of being out and listening to the birds and nature on a bike has not dimmed in the least. The area around Western PA has terrific "rails to trails" trails that allow for leisurely biking without concern for motorcycles, automobiles and trucks. I have to put in a shameless plug for donations for this non-profit group and their work to develop these wonderful resources for walkers, hikers and bikers.

WHAT IS ONE SENTIMENT YOU'D LIKE TO SHARE WITH YOUR FELLOW ACMS MEMBERS? More than anything else I would urge members of the ACMS to broaden their involvement beyond the borders of both our county, as well as our profession. The more integrated we, as a society, become in the general affairs of our county, be that through philanthropy, volunteerism, sports, etc., the greater the chance we find allies and support for our patient’s needs.

HOW DO YOU MAINTAIN WORKLIFE BALANCE? Well, my work is now principally in organized medicine. While I am sure that many would suggest that means I have a life-life balance now, this allows me to focus more of my time and efforts in organized medicine and allowing greater participation in the same. Of course, I keep in contact with all my colleagues and read constantly about the biggest issues facing medicine. I look forward to continuing to offer my services for non-profit boards (I recently completed my tenure on the Board of Family House for example) that intersect with healthcare the meeting the needs of those less fortunate. DO YOU HAVE A FAVORITE BOOK, PODCAST, OR RESOURCE THAT YOU WANT TO SHARE WITH OUR MEMBERS (OR THAT HAS INFLUENCED YOUR CAREER!)? While it is now a rather old book, I still think "The Seven Habits of Highly Effective People" is a classic and the best place to start a new or refresh an older journey to leadership. While a host of new books have come and gone since that book was published, it still encompasses much of what makes people effective in leadership roles. SEPTEMBER 2026

// ACMS Bulletin