West Palm Beach VA Medical Center

Amarah K. Hicks, RHIA
Chief, Health Information Management Section
Privacy Officer

Amarah K. Hicks graduated magna cum laude from Ohio State University in 2004 and maintains an active Registered Health Information Administrator credential from the American Health Information Management Association. Amarah is also a member of the Florida Health Information Management Association. She began her career in health information management at the Carl T. Hayden VA Medical Center in Phoenix, Arizona in 2004. She became the Assistant Director of the Health Information Management (HIM) Department in Phoenix in 2006, and in September 2007, she was promoted to the Chief of Health Information Management at the VA Eastern Colorado Health Care System in Denver, Colorado. Amarah now heads up the Health Information Management Section at the West Palm Beach VA Medical Center and is the Privacy Officer for the facility. The department includes release of information, document scanning, medical record coding, transcription, and records management. These duties complement her training and education in electronic health record management and her interest in healthcare. She is an active member on various medical center committees including the Medical Record Committee, Revenue Committee, Compliance and Business Integrity Committee, and the Information and Data Management Committee. Amarah is also active in national VA committees. Currently, she is a member of the Veterans Health Administration (VHA) Privacy Advisory Council as a HIM representative. Amarah enjoys working for the Department of Veterans Affairs serving veterans and also being involved in managing a fully integrated and comprehensive electronic health record system.

Roberta Watson
Chief, Ambulatory Care for Medical Administration Service

Roberta Watson serves as the West Palm Beach VA Medical Center’s Chief, Ambulatory Care for Medical Administration Service. She has direct responsibility for overseeing eligibility for health care benefits, all appointment scheduling, non-VA care referral, administrative inpatient clerical support, beneficiary travel, decedent affairs and Baker Act coordination. She is also actively involved in performance improvement activities associated with access both on a local and regional level.

She began her VA career thirty years ago at the Canandaigua VA Medical Center as a certified dental assistant and worked her way up the ladder in administrative roles to her current position. She joined the West Palm Beach VA staff in 1997. Watson finds her work very rewarding. “I have the pleasure of assuring that veterans get the best care in the timeliest manner, while being treated with the respect and dignity they deserve.” Married with two grown children, Roberta loves living in South Florida. She enjoys reading, swimming and shopping.

Catholic Hospice

Patricia M. Gunn
Vice President of Finance and Chief Financial Officer

Patricia M. Gunn assumed the responsibilities of Vice President of Finance and Chief Financial Officer of Catholic Hospice in June, 2006. As Vice President of Finance and CFO, Gunn is responsible for the overall functioning of the fiscal support services including budgetary control, strategic financial planning and investment management and Human Resources.

“Two years before joining Catholic Hospice, my father, Buenaventura Rappaccioli, became terminally ill and selected Catholic Hospice as his provider for hospice services. It was then that I experienced first hand the value of hospice services. Through this experience, I grew admiration for the mission and devotion of the Catholic Hospice staff,” said Gunn.

Gunn, who has expertise in financial and business management, came to Catholic Hospice from Memorial Regional Hospital. A seasoned financial manager with 17 years of experience in the healthcare industry, Gunn has held management positions at large organizations including National Mentor, Inc. and United Health Group. Prior to receiving her M.B.A. from the University of Alabama at Birmingham, she earned a Bachelor of Science degree in business with focus on Finance and Statistics.

North Broward Medical Center

Kevin Fusco, FACHE
COO/Ethics and Compliance Officer

Looking around North Broward Medical Center, it is hard to find an area that Kevin Fusco has not touched. As the Chief Operations Officer of the hospital, Kevin oversees allied and ancillary services including Radiology, Cardiology, Cancer Services, Laboratory, Pharmacy, Respiratory, Nutritional, Quality Management, Environmental, Security, Safety, Emergency Preparedness and Project Management. Kevin is also responsible for approximately 400 full-time employees.

Kevin joined the Broward Health family in 1985 as a nuclear medicine technologist at Broward General Medical Center. Since then, he quickly moved up the ladder and has contributed greatly to the entire Broward Health system. As Regional Manager of Radiology at North Broward Medical Center, Kevin played an instrumental role in obtaining ACR accreditation for the Nuclear Medicine Department, the first hospital-based program in Florida to achieve that designation. He successfully implemented Picture Archiving Communication Systems (PACS) at three of the four Broward Health hospitals. Not to mention, Kevin has led several Process Improvement Teams, including improving results for Patient Safety Indicators on AHCA website and Creating a Powerful Culture of Safety.

Adding to his list of numerous achievements, this past January Kevin was named a Fellow of the American College of Healthcare Executives, the nation’s leading professional society for healthcare leaders. Fellow status represents achievement of the highest standard of professional development and only 7,500 healthcare executives maintain this distinction.

It is Kevin’s dedication to process improvement and unique sense of humor that make him such a valuable asset to both North Broward Medical Center and the entire Broward Health family.



The patient, a 78-year-old woman, was unresponsive with no hope of recovery as a result of a severe hemorrhage. Her daughter—her designated healthcare surrogate—consulted the family physician for advice.

The doctor reviewed the patient’s advance directives, which stated that she did not want to be kept alive if she could not recover. Reassured that she was following her mother’s wishes, the daughter authorized the withdrawal of her mother’s feeding tube. Another patient rejected a surgeon’s recommendation of cardiac bypass surgery. While still lucid with full mental capacity, the patient understood that—without surgery—he faced the risk of myocardial infarction, which could lead to stroke, coma and death. The family physician advised the patient to put his decision in writing and discuss his end-of-life wishes with his family.

Shortly thereafter, the patient had a heart attack. He was hypoxic and no longer capable of making medical decisions. The surgeon again recommended cardiac bypass, but the family—knowing the patient’s wishes—chose palliative care, instead.

The importance of written advance directives cannot be overstated. Physicians have seen first-hand the pain, anguish and cost that can result when patients no longer can confirm with their loved ones what kind of healthcare they want or which “heroic measures” they would accept.

The consequences of not making one’s healthcare wishes known have been made all-too-publicly clear over the past several decades in three dramatic cases:

  • The 1975 case of Karen Ann Quinlan led to the establishment of advance directives and hospital ethics committees.
  • In 1990, the case of Nancy Cruzan marked the first time a court ruled in favor of discontinuing PEG feeding based on a previous statement the patient had made to a friend. This and the Quinlan case led in 1991 to the passage of a Federal law known as the Patient Self-Determination Act (PSDA), which gives Americans the right to refuse any medical treatment, including ventilators and feeding tubes.
  • More recently, the Florida case of Terri Schiavo demonstrated the importance not only of making your end-of-life wishes known, but of documenting those wishes, even at a young age.

“Physicians can play an important role in the execution of advance directives by encouraging their patients to talk about and document their healthcare wishes before a healthcare crisis arises,” says Paul Rozynes, M.D., medical director for VITAS Innovative Hospice Care® of Broward County.

“Discussing end-of-life choices can be uncomfortable,” adds Alan Marcus, DO, team physician for VITAS’ inpatient hospice unit at Columbia Hospital in West Palm Beach, “but it’s important for physicians to know what their patients want so they can care for their patients when they can no longer speak for themselves.”

Advance directives typically consist of one or both of the following:

  • A living will—which outlines the patient’s wishes as to medical treatment should he or she become unable to communicate.
  • A medical power of attorney—which appoints a trusted family member or friend to make decisions about medical care, if necessary.

“The existence of an advance directive can help family members come to peace with their decisions when their loved one is incapacitated, and it can help the physician write a ‘do-not-resuscitate order’ (DNR) with confidence,” says Paul Pugliese, M.D., associate medical director for VITAS Innovative Hospice Care® of Miami-Dade/Monroe.

Once advance directive documents are signed, it is important for all involved to know where the documents are. “Patients’ directives should travel with them, from home to nursing home to hospital, so all caregivers are aware of its location and what it contains,” says Rozynes.

In some cases, a patient’s healthcare surrogate or family members might disagree with the patient’s plan of care, even if advance directives exist. Hospice is uniquely suited to help in these cases, says Pugliese. “Because they are trained in palliative and end-of-life care, hospice physicians and nurses can help loved ones understand that continuing ‘extreme’ measures actually can harm the patient and cause greater discomfort and pain as death approaches and the body begins to shut down.”

“By asking patients what their wishes are and encouraging them to document those wishes, physicians can make sure their patients are in control of their own medical decisions—even at the end-of-life,” concludes Marcus.



As the immediate past president of the Broward County Medical Association, I have been asked on many occasions about the current state of Healthcare Reform in the United States – after all – healthcare has been my life’s mission and it’s currently in strong debate – not only in Congress – but in homes, offices and, of course, hospitals. It is the one aspect of Congressional legislation that touches all of us in a most personal way – our state of health. You know the old statement, “If you haven’t got your health – you’ve got nothing!” So, many folks have serious and legitimate questions and concerns: Do physicians want coverage for all people? Do I want coverage for pre-existing conditions? How will government-run health programs affect the cost and quality of healthcare? Basically, what people are saying to me: “Will I be all right? Can I stay healthy?”

What I have always said and will continue to say to some of these concerns is, “Of course I want coverage for as many people as possible. Of course I want to improve healthcare systems in the United States. O f course I want all my patients to be all right and to stay on the road to good health.” So my question has never been do I want to improve healthcare – because as a physician I always want improvement – that’s at the basic core of modern medicine. My main concern is one of cost – that is – how can the country afford the proposed plans and who will pay for it? If we understand the answer to those questions … then we can address the big question: What kind of coverage will we have?

This past week I saw, perhaps, an inkling of where government-run healthcare might go – that is – a report indicating that female patients under 50 need not have mammograms. That report, supported by the current administration gave me reason to be concerned. After all, in my many years of medical practice, how many patients have I seen less than 50 years of age with breast cancer? Trust me, I have seen many. Even some of my co-workers have had breast cancer and some have even died. Not only as a doctor, but as a patient I am very concerned – and this is personal.

Before I finished writing this article, PAP smears, a front-line tool against cancer, were also being mentioned by proposed regulation that would change advisory to every two years after the age of 21 and every 3 years after the age of 30. This is, in my opinion, dangerous for patients—as early detection is the best way to locate, treat and beat cancer.

We’ve all heard the argument that Canadians, Britons, Italians, Icelandians, Swedes, Scandinavians and thousands of other people seeking help from countries that practice socialized or government-run healthcare programs come to the United States for medical care. These folks pay—in some cases—more than 50% of their gross income in taxes –and should they need special tests or procedures – their own counties have to first approve the test and procedures—and then place them on “waiting lists.” All of that takes much time … and some patients don’t have exactly that – time. In some cases the waiting period proves fatal. Furthermore, some of these countries prohibit certain procedures and drugs that are currently employed or used in the US. That’s why we have the highest rate of survival in the world for cancer, diabetes, heart and circulatory problems and many other ailments. I don’t believe Americans will accept (certainly not the doctors) anything less than the current standards of success – and to grow it from here!

With the proposed changes being discussed in the Healthcare Reform debate I’m concerned that we might not be saving any money – for the government or the patient. In fact, if we’re forced to wait to test – or wait to use a drug – or wait to perform a procedure – we might actually be treating more advanced diseases at a higher cost or worse – face incurable stages of disease.

This new Medicare commission, to reduce cost, is leading to rationing care across the board, which is wrong. If any rationing is to come it should be individualized doctor-to-patient relationships … not universal – since each case or situation is different.

There are a number of elements not getting the attention they deserve in the healthcare discussion: Is there a reason why so little is said about legal or tort reform? That kind of legislation could save billions of dollars – as it is already doing in California and Texas. Also, what about allowing “open enrollment” for health insurance across state lines? This could save billions of dollars in individual premiums. This is also not included in either bill being proposed.

Is this what we want for the future of medicine? Is this what Healthcare Reform will bring about? It has been proven that government-run socialized medicine simply doesn’t work – it’s expensive, it’s time consuming, it’s impersonal, it’s inefficient and most all of – it’s dangerous – for all of us.

My fellow physicians, patients, and citizens, the future of medical care is in danger. UNITE! Get involved. The life you save might just be your own!



The Goody Two Shoes of this world have had some pretty bad press over the years. At Bethesda Memorial Hospital, our volunteers are the “heart and soul” of our hospital.

In the Volunteer Office – the Goody Two Shoes Rule! One person can make a difference and our volunteers demonstrate this daily. During the last few months you might have noticed that South Florida has been chilly. Our volunteers have knit and crocheted hundreds of small blankets and given them to patients of all ages. They also knit hats for each of our newborns to wear home, having completed 4,500 hats last year. Two of our volunteers are shut-ins who live in a nursing home. These wonderful ladies cut-out, fold and assemble hundreds of paper pyramids for our patient rooms that list important telephone numbers and names.

Whether it’s pushing a patient in a wheelchair, or escorting a lost visitor to a patient’s room, our volunteers help patients and visitors get where they need to go. Our volunteers give hugs, and they’re not afraid to tell a joke. Some of our volunteers even come dressed as clowns, bringing smiles to the faces of our patients and staff, alike. Through Bethesda’s Pet Therapy program, they bring pets for our patients to meet.

Bethesda’s volunteers help the hospital by raising money in the Auxiliary Gift Shop and at the hospital’s thrift shop, the Bethesda Bargain Box. They help the hospital staff by raising funds for education through the Auxiliary scholarship program. In addition, the Auxiliary volunteers also help hospital staff members who cannot afford day care costs, by providing assistance for Bethesda’s onsite childcare facility, the Ripley Early Learning Center. Plus, the volunteers help purchase equipment for hospital departments with special unexpected needs.

When one good deed is done it comes back threefold. In February 2010 nearly 500 volunteers came to Bethesda and gave of their time. They ranged in age from 14 to 96. Among the adults we have about three women volunteers for every man. Among the teens the ratio is about even. The community is catching on that the rewards of volunteering grow exponentially, as Bethesda’s volunteers are the “heart and sole” of our community hospital who make a difference every day.



Southeast Regional Vice President, Materials Management
Holy Cross/Mercy Hospitals

Proudest Accomplishment: Election to the president of the national Association for Healthcare Resource and Materials Management (AHRMM)

First Job: Washed pots and pans and transported patients while in college; first full-time job was a Store Room Supervisor at a 300-bed Hospital in Ohio

Education: BA in Business Administration, Northeastern, Chicago, IL; MBA, Baldwin Wallace College; MHA, Ohio State University.

What skills do you need to succeed in your job: You need to be intuitive, analytical, action- and results-oriented as well as possess excellent people skills.

Work habit you possess that you are most proud of: I consider myself visionary, with an innate ability to anticipate problems and lead others.

Most valuable lesson you learned in your career: People are different – some assertive, some compassionate, some reserved, and some down right impossible. There are a number of ways to get something done. Your way is not always the only way.

The toughest part of your job: Striking the delicate balance between high quality and low cost; and delivering a consistently high level of service.

Your philosophy of success: Work hard, respect others, and above all, do what is right.

One of your goals: I have a compassion for Healthcare Supply Chain and a desire for innovation. I have been active in AHRMM in facilitating the adoption of bar code scanning for healthcare products and hope to see this come to fruition within the next 3 years.

Person You Most Admire: Paul Balcom, the former CEO of Catholic Health Partners (Lorain, OH) & my mentor, for his honesty, integrity, compassion for people, and ability to get things done.

Favorite Book: Good to Great: Why Some Companies Make the Leap… and Others Don’t by Jim Collins

Biggest Challenge Confronting Healthcare: To provide a high level of quality care and service to all in a declining and restrictive reimbursement arena.

Suggestions on how you would solve a particular problem in healthcare: Although hospitals are largely information-based systems, most can not afford all the information software upgrades they need. If the government would subsidize some of these requirements they would eventually receive a return in more efficient healthcare, improved billing, etc.

Your predictions on the future of health care: Computer software will provide additional opportunities to screen and rule out diseases and symptoms. This will affect change in our entry-level patient care and potentially compete with similar clinical services offered by practitioners.

Best Thing About Healthcare in South Florida: Patient volume is much more desirable than that in the nation’s Rust Belt.

Worst Thing about Healthcare in South Florida: The cost of living and the access to sufficiently trained personnel.

What advice would you offer young people considering a career in Health Care: To align your education with your ultimate career goal. Ideally, earn an undergraduate degree in a clinical area and a graduate degree in either business and/or your clinical concentration.