Healthcare Underwriters Group of Florida (HUFL) recently paid its first cash dividend to its insured owners.

HUFL’s Chairperson, Steven Shapiro, M.D., said, “This dividend to our policyholders/owners is further proof that great doctors produce great results and also reflects HUFL’s strong financial position and confidence in the company’s future.”

According to HUFL’s President, Edward Feller, M.D., “Insuring the right doctors, fighting claims aggressively and managing conservatively is what gives HUFL the results that deliver rate stability to its policyholders and provides predictability in a time of uncertain market conditions and challenges

(l-r) Dr. Albert Tano, Owner, KIDZ Medical and Emergency Pediatric Services; Joshua Salman, VP & COO, Healthcare Underwriters Group of Florida; Norman Morris, Senior VP, Brown & Brown Insurance-HBA Division; Dr. Jorge Perez, Owner, KIDZ Medical and Emergency Pediatric Services; and Alfredo Andrial, Senior VP, Brown & Brown Insurance-HBA Division.

HUFL’s vision and focus is to stabilize the volatile professional liability insurance market and ensure steady growth through a combination of disciplined underwriting and vigorous claims defense. The Company is financially strong and committed to keeping Florida doctors in control of their professional liability insurance.

HUFL is a non-profit medical malpractice insurance reciprocal owned exclusively by its insureds/subscribers, Florida doctors. HUFL insures practicing physicians throughout Florida and in all medical specialties. HUFL’s highly experienced management team has a zero tolerance for nuisance claims and aggressively defends its physicians.



Our world is rapidly changing. There has been an explosive growth of technology and knowledge combined with a rapidly aging population. By the year 2040, there will be over 77 million people aged 65 and older in the United States alone. People are living longer and more people will be seeking medical treatment to enhance their quality of life.

In spite of these statistics, the number of open heart surgeries performed each year has been steadily declining. While this is partly due to the decreased incidence of cardiovascular disease, it is also because of the large-scale application of percutaneous coronary interventions. Technology now allows interventional cardiologists to go where only cardiothoracic surgeons went in the past. Traditionally invasive cardiac surgery is being replaced by transcatheter and endovascular procedures; to the point that it is something patients have come to expect. Most patients expect to undergo minimally invasive procedures with no incision and to leave the hospital within a day or two. Where does the role of the cardiac surgeon fit into this rapidly changing field of medicine and patient expectation? Quite simply, it has to evolve.

Evolution is nothing new for cardiothoracic surgery. It is a relatively new field that has been around for about 50 years. It wasn’t until the late 1950’s that the heart lung bypass machine was perfected enough to be used in surgery. For the first time, surgeons had time to work on a heart that was not only empty of blood, but which wasn’t moving. Surgeons could actually go “inside” the heart for hours at a time to perform intricate life-saving surgeries. What followed was a period of explosive growth and rapid advancement in the treatment of heart conditions.

Until about 25 years ago, most cardiothoracic surgeons operated out of university settings. This changed in the early 1980’s. As the demand increased, universities were overloaded from a volume and financial perspective due to the high acuity of these patients. Community hospitals began building open-heart surgery programs. More and more hospitals wanted to offer this cutting edge technology and invested large amounts of money in building operating suites and attracting highly trained surgeons and ancillary staff members. Until the mid-1990’s cardiac surgery continued to enjoy solid growth.

As we approach the end of another decade, cardiac surgery is evolving again. While there will always be a demand for cardiothoracic surgeons, some areas of cardiac surgery are being replaced by percutaneous and endovascular procedures performed by interventional cardiologists and vascular surgeons. This includes a substantial portion of coronary surgery, aortic, mitral and pulmonary stenosis surgery, arrhythmia surgery (pacemaker and defibrillator implants have been taken over by electrophysiologically trained interventionists), and atrial septal defect. Even thoracic aortic aneurysms are being treated with endovascular procedures.

Even with these advances, open surgery is still the only option in certain cases and the skill of experienced surgeons remains indispensable. Unfortunately, due to declining volumes, fewer physicians are electing to pursue the additional education and training necessary to specialize in cardiac surgery. Hospitals are finding it harder to recruit and retain not only cardiac surgeons, but also the paramedical staff needed to sustain a quality cardiac program. In order to remain competitive, hospitals will need to be proactive and invest in new technology and treatment protocols and develop market niches. Cardiac surgeons and interventionists will need to adjust to a team approach. As technology drives changes, there will be no room for solo endeavors. Each specialty will become more dependent on the other with the safety of the patient always being of paramount importance.

The convenience of a cardiothoracic surgeon at the community level will become increasingly rare and it is also likely we will see a more regionalized approach for complex cardiac care. While community hospitals will continue to experience growth in percutaneous and endovascular cases, more complex cases will be referred to regional centers which will have the expertise of the entire cardiac team, including the surgeon, interventionist, and paramedical support staff.



Robert Hasty, D.O., FACOI

It’s almost impossible for Dr. Robert Hasty to go anywhere at Nova Southeastern University’s Health Professions Division without a student, faculty or staff member stopping the affable doctor to say hello. Dr. Hasty, D.O., FACOI, is extremely popular, especially among his students because of his expertise in internal medicine and his dedication to helping them succeed.

As he walks through HPD Café, the well-dressed and bespectacled doctor preaches to his enthusiastic students the Three A’s to success in medicine: Affability, Availability and Ability. At 34, Dr. Hasty’s mastery of the three A’s helped him become one of the youngest professors at NSU’s College of Osteopathic Medicine.

During his short tenure, Dr. Hasty has started the NSU medical school Grand Rounds, a monthly lunch meeting where physicians, other healthcare professionals and professors from across South Florida talk about medical issues ranging from mental health to radiology. Dr. Hasty has also been a leading NSU researcher on obesity as well as Coumadin, a blood thinner drug.

Aside being a mentor to his students and a caregiver for his patient, Dr. Hasty is also a dedicated researcher.

He is currently the principal investigator for the ROCKET-AF study to find a replacement for the blood thinner Coumadin. Currently, patients taking the drug, also known as warfarin, are experiencing irregular heartbeat because it has many serious side effects. The ROCKET-AF study, which Johnson & Johnson pharmaceutical has chosen NSU’s medical school as a site for its Coumadin test trials. Dr. Hasty is investigating a possible replacement drug called rivaroxaban.

His other area of research is obesity, a topic he lectures about across the country. His goal is to raise public awareness about the issue, and to develop innovative medications that can reduce obesity. He’s hoping to eventually get federal research dollars for his project.

Pablo J. Calzada, D.O., M.P.H., FAAFP

Since joining Nova Southeastern University’s College of Osteopathic Medicine in 2003, Dr. Pablo J. Calzada, D.O., M.P.H., FAAFP, has been a leader and innovator in providing top-quality health care. His efforts to provide comprehensive and compassionate care were rewarded over the years with a promotion to the position of chair of the Department of Family Medicine and being named as medical director of NSU’s medical clinics. He is now the assistant dean of clinical operations.

As he celebrates his sixth year at NSU, Dr. Calzada is looking toward the future by continuing to provide patient care and conducting clinical and primary care research. “I’ve always kept active in providing patient care by seeing patients by myself or with residents at least one day a week,” said Dr. Calzada, who also served as interim DME at Broward General Medical Center from June 2007 through March 2008. “I have also maintained several ongoing projects in which some research is being done at the primary care level to look at what we can do to improve our medical clinics.

He has participated in a project on community engagement with NSU’s Center for Psychological Studies to conduct a combined interdisciplinary approach to help enhance the level of care NSU provides. He has also worked on a project with health care providers at NSU’s North Miami Beach clinic. The project involves using a postdoctoral fellow from the NSU’s Center for Psychological Studies to counsel patients who suffered from mental health issues such as depression and anxiety, so they could be seen promptly within at NSU’s Health Care Centers instead of being referred somewhere else.



With medical malpractice rates spiraling out of control, the Florida Orthopaedic Society (FOS) and its sister organization, the Bones Society of Florida (BSOF) teamed up last year to establish the Florida Orthopaedic Risk Purchasing Group (FORPG), one of the largest risk purchasing groups for medical liability insurance in the nation.

“Malpractice insurance rates are outrageous,” says Dr. Brian Ziegler, president of FORPG. “They’re unaffordable in some parts of Florida and because the rates are so high, some doctors won’t even get malpractice insurance. When you’re paying $100,000 a year for $250,000 of coverage, it doesn’t add up very well.”

Risk purchasing groups, like FORPG, allow professionals to collectively negotiate insurance coverage for members of the group, often leading to significantly discounted rates.

“This is a new idea in medicine,” says Dr. Ziegler. “Doctors traditionally have not had the ability to negotiate on a collective basis. We’d love to have the ability to collectively negotiate contracts with insurance companies but antitrust laws prevent it. We’re unable to negotiate most of the things that we do on a collective basis, but we are allowed to negotiate for a product like malpractice insurance.” Matt Gracey, president of Danna-Gracey—a Delray Beach independent insurance agency with a team of specialists focused on medical liability coverage—approached FOS with this idea early last year after seeing how successful it was for the Florida Gastroenterologic Society Risk Purchasing Group.

“It’s a perfect time in the industry cycle to create a risk purchasing group because most of the malpractice insurers are doing quite well and are eager for more business,” says Gracey. “It’s a good time to get all of the doctors to unify so by the time our next crisis comes around, they will be sheltered from that crisis.”

After issuing a request for proposal to all of Florida’s medical liability carriers, FORPG selected First Professionals Insurance Company, the largest and longest-serving Florida-based medical malpractice insurance carrier. It met the criteria on several levels: it’s domiciled in Florida and has a history of supporting organized medicine. With an A.M. Best ranking of A-Excellent and surplus of more than $240 million, the company has the financial strength necessary to support this program. FPIC is an industry leader in providing high quality risk management programs. It also insured the highest number of the original FORPG members.

“We have extensive experience with orthopaedic surgeons,” says Angie Nykamp, Vice President of Marketing for the Jacksonville-based First Professionals. “Additionally, we have a great deal of experience with the members prior to this program. Because of the way they were united and the loss information provided to us, we can identify discounts that are actuarially based on their claims experience.”

As a result of this now unified front, FORPG has seen rates drop by as much as $8,000 to $10,000 annually for its members. It has also benefited non-members since other insurance carriers and independent agents throughout the state have also dropped rates to remain competitive.

“We look at this as a long-term partnership,” says Nykamp. “Those who enroll will enjoy coverage with the best carrier with the most experience managing claims in Florida.”

Dr. Ziegler says that its long-term goal is to get every orthopaedic surgeon in the state, who is eligible, to enroll with FORPG. Since October, over 250 orthopaedic surgeons, out of the 1,250 currently practicing in the state, have joined. There are several factors that may prevent surgeons from participating, including underwriting by the risk purchasing group and the carrier, as well as those surgeons who work with academic centers and hospital-owned practices who have their insurance provided by the facilities.

“If we can get most of the orthopaedic surgeons in the state to join, we’d have a tremendous power to bring the rates on malpractice insurance down,” he says. “We’re getting significant numbers, but if we can get most, it would be better. Together we are so much stronger than we are individually.”

The key components of the program are its risk management and claims review committees. The risk management committee identifies best practices and provides training and resources to the membership and their staffs. The claims review committee will work with FPIC and their defense firms to review all claims filed against members of FORPG and provide expert advice on managing those claims including strategy and testimony.

All members of the risk purchasing group are required to pay a $500 annual administrative fee that funds the operation of the program and development of marketing and educational materials. A portion of those proceeds will also be reinvested in the sponsoring organizations to fund educational programs and legislative initiatives.

“That money will be well spent,” adds Dr. Ziegler. “We are also looking at other types of products we can purchase at a lower cost for members of the risk purchasing group, like disability insurance and health insurance. These are other products we are investigating as opportunities to leverage our buying power.”



When I look back at my career I can differentiate between mentors, preceptors and nurses who helped orient me to a new unit or new job. One person in my career was, over a period of time all three. Mentoring activities include teaching, supporting, providing organizational intervention, and sponsoring.

On my pediatric unit, we mentor many types of student nurses. We have students from ADN, BSN, and LPN programs. We also have high school students, who spend a few hours daily with us over a period of time. In Pediatrics and PICU, we have students from Community and City Colleges with their instructors. We also have LPN students from Technical Colleges with their instructors. As staff nurses, we are noted asked to grad or evaluate these students but to offer them guidance. In this capacity we teach, support and sponsor the students. Organization intervention is also achieved as we can identify a student who we believe could become a future employee.

However, true mentoring goes beyond these examples. Mentoring should enrich all of us, as mentoring is a give and take phenomenon. As we are teaching a new nurse on the unit, we are ourselves learning from this relationship. For example, the new nurse may ask us a question to which we have no answer, but together we seek to find the answer. In the role of sponsoring the new nurse, we can take over where the formal orientation ended. We can invite the new nurse to outside the hospital social activities with fellow employee’s, encourage professional development, membership in local professional organizations and encourage specialty certification.

Mentoring should continue with all of the staff members. We all possess certain attributes which when blended together will make a sense of completeness. In other words, we are all better than one of us. Mentoring relationships have benefits fro the staff regardless of the length of the relationship or whether that relationship is formal or informal. Examples of informal mentoring include encouragement from one staff member to another to become certified, to join a professional organization, to attend a conference together and to work on the Clinical Practice Recognition together. Mentoring encourages a culture of working together rather than one of competition.