The head of Canton-based U.S. Acute Care Solutions (USACS), which runs emergency rooms across the country — including those at Summa Health, is moving to a new role and bringing in a new CEO.

Dr. Dominic Bagnoli, effective today, will move from CEO to the position of executive chairman of the board. The company has named James Frary as its new CEO.

In his role as executive chairman, Bagnoli will, in partnership with Frary, focus on strategic planning, business development and hospital partner relationships, the company said.

USACS runs 210 emergency rooms in 22 states. It was also the emergency physician group that took over on New Year’s Day in 2017, replacing Summa’s longtime emergency room physician group following failed negotiations. The switch resulted in upheaval at Summa, including the resignation of the CEO after hundreds of doctors voted no confidence. Summa also later in the year lost its accreditation to train emergency medicine doctors and is in the process of applying to re-establish the program.

In an interview, Bagnoli said the leadership change was his decision as part of long-term planning and has nothing to do with the Summa issues.

“I think it’s a perfect time with the transition,” said Bagnoli, who founded the predecessor to USACS and has been building the company for 25 years.

Bagnoli, 55, said he is not retiring nor slowing down. The new position will allow him to build on the physician-ownership model.

“The first three months of 2017 were very difficult with all of the things going on and the rumors,” Bagnoli said of Summa. “But we have made significant progress in the last nine months of the year. I get it. Summa is a big issue here in Northeast Ohio. But it’s five of our more than 200 [emergency rooms]. The organization is doing just fine and there is no truth to the rumor that the board pushed me out or this is about performance.”

Frary was most recently president of AmerisourceBergen Specialty Group, a company that works with providers to improve specialty care delivery to patients. In his role, Frary partnered with hospitals, oncologists, urologists and other specialists to increase access, affordability and outcomes of specialty medications.

Said Frary: “USACS has emerged as the destination for physicians seeking to preserve ownership in their practice and is the leader among acute care provider groups in quality and innovation.”

The headquarters of USACS will remain in Canton with about 400 employees, but Frary will live and work out of his home in the Dallas area. Frary and Bagnoli said he would be spending a lot of time in Canton and across the country at different sites for the company, which employs about 4,000.

Frary holds a bachelor’s degree in economics from Stanford University and an MBA from Harvard Business School.

Dr. Peter Hudson, founding chairman of the board and a director since 2015, will remain on the USACS board as a director.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Ronald McDonald House Akron, which serves as a home away from home for patients and their families at Akron Children’s Hospital, had to turn away 4,000 people last year because there wasn’t enough room.

People shouldn’t be turned away anymore now that a new $14.2 million house is ready to open with more than double the space — and room to grow.

The original 20-room house, built in 1985, is being replaced with a 42-room facility attached to the existing house on Locust Street next to the hospital. The bigger house was made possible after the city of Akron agreed to vacate a portion of Locust Street and the hospital gave land that once was a park.

“We no longer will have to say no 4,000 times a year to families we don’t have room for,” Executive Director Anne Collins said. “It’s a vast improvement over what we’ve been able to offer to our families.”

After two years of construction, the charity is holding a private ribbon-cutting and grand opening celebration for the new house on Thursday.

Then on Monday, when current families move to the new space, the existing house will be shut down for a few years. Plans are to renovate the old house to eventually offer a total of 60 rooms for guests, Collins said.

Talk of expanding the house, which is a separate entity from Children’s Hospital but has direct ties to it, began shortly after Collins arrived 10 years ago. Studies showed the house could handle 52 to 72 rooms.

A place to call home

The house offers lodging for children or their loved ones when they are patients at Children’s Hospital and don’t have the ability to travel back and forth for their inpatient or outpatient care.

“We support everyone,” said Collins. “Literally people can come here with the clothes on their back and we can help them.”

Some families arrive in emergency medical situations, while others come for planned procedures, she said.

As the hospital has expanded throughout eastern Ohio, demand to stay at the house has increased over the years, Collins said.

Rooms at the Ronald McDonald House usually are provided on a first-come, first-served basis. Some families coming from out of state with more complicated procedures may be able to make reservations. There is no time cap on how long a family can stay.

A $10 per night donation is suggested, but only about 24 percent of families last year were able to pay, said Aristea Tzouloufis, director of development for Ronald McDonald House Akron.

Patients and their families have stayed at the house from 43 counties in Ohio, 12 states and four countries.

Last year, 10,000 people representing more than 500 families stayed at the house, Tzouloufis said.

Collins knows the bigger house will allow for more families to stay, but “we really foresee a waiting list happening soon.”

Adding employees

By the end of the year, Collins wants to hire four more employees to total 12 in the home. But the house would not run without the 170 dedicated volunteers, she said.

Ronald McDonald House Akron funded the $14.2 million project with a combination of a fundraising campaign in conjunction with Children’s Hospital and some tax credits, Collins said.

Collins credits John Zoilo, a former house board member and also former president of the Akron Children’s Hospital Foundation, for getting the new house on solid financial funding.

The house expects its annual budget to increase from $1.2 million to $2.1 million with the expansion. The nonprofit is funded with donations and grants.

The house was built by Thomarios Construction.

The benefit of designing a brand new house was the ability to cater it to the needs of families.

A portion of one living room area is cozy with no television since there are many Amish families who stay at the house, Collins said.

“This is communal living,” she said. Some families choose to stay in their rooms while others like to relax with other families going through similar experiences when they are not at the hospital, she said.

The bedrooms are all on the second and third floor of the residence, creating some distance from gathering areas downstairs.

In the current house, the common area is within ear shot of some of the rooms, said Collins.

“We may have had a family playing cards and being loud and a room above them getting ready for a 5 a.m. surgery,” she said

The new house also features 10 long-term stay rooms, which have a separate living area with a mini fridge and microwave.

“Before, Mom would be in a room and would be stuck in the room after the child went to sleep,” Collins said. With a separate living area attached to the bedroom in a long-term stay room, “she can come and relax.”

Feeding families

A family pantry area off the expanded dining room provides families with an area to store their own perishable and nonperishable food in lockers. Food is provided at the house for families — simple meals for breakfast and lunch are available and a sit-down dinner is cooked by volunteers every night.

Another new feature of the house is a family kitchen with four stove areas — separate from the commercial kitchen — to allow families who want to prepare their own meals the ability to do so. In the current house, there is one small kitchen for families and the larger house meals.

The dining room went from three to four tables to an area able to seat 150 people.

The house also offers a large community meeting room, which the nonprofit wants to make available to other nonprofits and businesses for meetings.

“We did without one for years. We know what it’s like,” said Tzouloufis.

Artwork around the house has been donated or purchased at steep discounts from local artists such as Don Drumm, Zeber-Martell galleries and Harris Stanton galleries. Lazy-Boy of Northeast Ohio also donated or provided at a discount 60 percent of the living-room furniture. The Amish-made headboards and dressers and nightstands were ordered from a father of a former transplant resident of the house. The owner-operators of Northeast Ohio McDonalds also donated $1 million to the building of the house.

The old house served its purpose, said Collins.

“People loved this house, but it just wasn’t fitting our families’ needs anymore. The rooms are tired,” she said.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Summa Health’s Emergency Department, which lost its ability to train resident doctors last July, will soon be submitting its application to re-establish the program by July 2019.

“Things are going really well,” said Dr. David Seaberg, chairman of the emergency department. “We are exactly on schedule.”

Seaberg was brought in last fall to rebuild the emergency medicine teaching program after it was stripped of national accreditation earlier in the year. The hospital system was also placed on probation to start new programs.

The probation was lifted in October, clearing the first hurdle for Summa to re-apply for its emergency medicine program.

The Akron-based hospital system lost its accreditation to train emergency medicine doctors from the Accreditation Council for Graduate Medical Education (ACGME) after an abrupt changeover of Summa’s longtime emergency room physician group on New Year’s Day 2017 following failed negotiations. The switch resulted in upheaval at Summa, including the resignation of the CEO after hundreds of doctors voted no confidence.

The demise of the emergency medicine residency program, effective July 1, 2017, meant 21 existing resident doctors had to find new programs. Most left the area, with a few going to cross-town rival Cleveland Clinic Akron General. Nine residents graduated from the program as it closed.

Seaberg said he’s hired 22 new doctors and has about 11 to 14 more doctors starting in July.

“We’re just about to the point where we’ve replaced all the doctors that left in January 2017. I won’t say it’s been an easy process hiring 30-some doctors to Akron,” he said. “I’m bringing in really outstanding doctors.”

The 326-page application to re-establish the program has been completed and internally reviewed, said Seaberg. It is pending approval by the internal committee of residency directors and will then be submitted, he said.

A site visit needs to be scheduled before the end of June to be included in the yearly September review by the national committee to approve the application. If Summa gets that approval, it could be included in the match for emergency medicine residents for July 2019, Seaberg said.

Mum on specifics

Summa officials declined to share details of the application or discuss the new faculty or their qualifications.

In response to questions from the Beacon Journal/Ohio.com, Summa Interim CEO Dr. Cliff Deveny said: “We have moved on from the events of last year and I am extremely pleased with the progress we are making toward the re-establishment of our Emergency Medicine Residency Program. We are early in the application process and, out of respect for the ACGME, it is premature to discuss specifics. We do look forward to sharing additional details regarding the program and faculty at the appropriate time.”

Meanwhile, the emergency room at Akron City Hospital reduced its overnight staffing of doctors during limited hours several times a week, effective April 1.

Seaberg said the reduction, which goes from two doctors and two physician assistants or nurse practitioners to one doctor and two physician assistants or nurse practitioners from 3 a.m. to 6:30 a.m. Thursday through Sunday, was made after reviewing the number of patients seeking treatment in the ER.

The ER is busy at all times on Mondays through Wednesdays, but patient visits drop from Thursday through Saturday, Seaberg said.

The change is going to be re-evaluated monthly and can be adjusted in the next quarterly work schedule, if needed, he said. Seaberg said he and the hospital’s medical director are serving as the backup, if volume were to surge.

“Can I say that four heart attacks won’t occur at 5 a.m. on a Saturday? No, that’s pretty rare. I can’t staff for that occasional very rare event. It doesn’t make financial sense in any type of business. We do have the ability to flex up when needed,” Seaberg said. “If I was a restaurant, we wouldn’t be having this discussion. It’d be irresponsible for me to have a full staff if I don’t have customers.”

Seaberg said ER visits in January and February were up from previous years, especially due to the flu season, but the March ER numbers at City Hospital dropped 6 percent from the previous year. Seaberg said he’s unsure of the exact reason, but said it could be a combination of the increase of retail urgent care sites and some national insurers who started new policies Jan. 1 that discourage patients from going to the emergency room, saying they may not pay for the visit if it is not a true emergency.

Seaberg said such policies are dangerous.

“You may come in with chest pain and it ends up being GERD (gastroesophageal reflux disease). But you still came in with chest pains,” he said.

A spokesman for Akron General said the health system would not disclose staffing levels at its emergency rooms. The spokesman said March volume was not down, but the Akron General ERs similarly see fewer patients Thursday through Sunday.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

“We’re just about to the point where we’ve replaced all the doctors that left in January 2017. I won’t say it’s been an easy process hiring 30-some doctors to Akron. I’m bringing in really outstanding doctors.”

Dr. David Seaberg

emergency department chairman

Dr. Colleen Kraft hadn’t been back to the Akron area in about 30 to 35 years.

But on her first visit back, the president of the American Academy of Pediatrics made sure she did a mini tour of her hometown.

Born at Akron City Hospital, Kraft on Thursday drove by the white Cape Cod home on Caleb Street in Cuyahoga Falls where her family lived for seven years before leaving for Virginia.

She drove past Lincoln Elementary School and looked for a little building where she was in one of the first Head Start classes. The building wasn’t there, but she remembers her Head Start teacher telling her she was so smart she could maybe someday be a doctor. Kraft spent most of her pediatric career in Virginia and in Cincinnati before taking on her national role.

She drove by the Stricklands on Bailey Road and had a vanilla custard.

Then she drove to the University of Akron and had an impromptu tour of a chemical lab when she peeked her head in. The chemists said they knew of her father, James McGrath. He was a chemist for Goodyear who then earned his Ph.D. at the University of Akron in 1967 before starting the Polymer and Macromolecular Institute at Virginia Tech.

“I have some very fond memories of Akron,” said Kraft, who began her term as the president of the group representing 66,000 pediatricians on Jan. 1, and was at Akron Children’s Hospital to talk to the hospital medical staff.

Health concerns

Among other topics covered during her hour-long Grand Rounds presentation, Kraft discussed gun safety and injury prevention, the increase of e-cigarette and vaporizer use among adolescents and telehealth, where parents can call or link to a remote doctor on call in lieu of physically seeing a doctor.

Much of the advocacy work that the academy is undergoing now is on highly politicized topics, she said, including immigrants and Deferred Action for Childhood Arrivals (DACA).

“We come down for the kids and where the kids and families are,” Kraft said. “Do not separate parents and kids at the border or anywhere else. It’s really bad for child health.”

Kraft said there are about 100 medical students nationally who are DACA students.

The academy has recently launched a Gun Safety and Injury Prevention Research Initiative to bring together experts around the country to study and implement evidence-based interventions.

“The mass shootings bring all the media attention, but the majority of our kids who are killed or hurt with firearms happen through suicide, through homicide and through unintentional injury. This is a topic that is so politically divisive. Where do we come down to the point for our kids? Where’s our role? It’s at looking at gun safety. And research that has not been funded for so long. And in what we tell our families while we’re in exam rooms with them,” Kraft said.

The Itasca, Ill.-based American Academy of Pediatrics has also sued the U.S. Food and Drug Administration over what Kraft called its irresponsibility in cigarettes and not putting teeth into e-cigarette regulations.

“The whole plethora of electronic nicotine device systems out there: e-cigarettes, vaping and juuls (pronounced “jewels”) — those are the things that look like flash drives that kids are smoking in between classes — are really turning around a lot of the success we’ve had in keeping young teenagers from smoking,” she said.

“With these devices, kids are beginning to get addicted to nicotine again. And why not, if you’ve got something in flavors like cherry or bubble gum or cotton candy, are you really marketing to adults? Let’s take the flavors out of there. Let’s put some teeth into not selling these things to kids under 21 years of age,” Kraft said.

Telehealth medicine

Kraft also touched on the academy’s concerns about the growth in telehealth medicine.

Kraft said telehealth has great potential, and she’s seen programs that work such as a program in Dallas schools, where a telehealth machine is linked to a Bluetooth stethoscope and connected otoscope to look in ears.

But most telehealth programs don’t have a way for the physician to examine the patient, which can be dangerous, Kraft said.

“There’s some things like rashes you could diagnose on the phone, but it’s hard to diagnose an ear infection without actually looking in the ear. That’s being done in programs. That to me is bad medicine.”

“Telehealth can be the great connector, but we’re not seeing that right now,” she said.

Before Kraft’s presentation to the medical staff, she also met with Akron Children’s CEO Bill Considine, whom she knew of from his state and national advocacy, but had not met in person.

“I like his sense of humility and sense of community,” said Kraft. “[Akron] Children’s has a national profile. The thing I like best about Akron Children’s is they really are responsive to their community and care about what’s going on in the community. So many hospitals are ‘We’re looking for you to come to us.’ Akron is always thinking about ‘How do we come to you.’ ”

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

An unknown number of job applicants to a division of Summa Health at the former Barberton Citizens Hospital are part of a national data breach of some sensitive personal information.

FastHealth Corporation, a Tuscaloosa, Ala.-based company which provides health care clients with operational and website services, has reported that an unauthorized third-party may have accessed or acquired information from FastHealth databases, including names, addresses, dates of birth, Social Security numbers and driver’s license numbers.

FastHealth was a contracted vendor for a Summa Health division called LabCare Plus. In 2005, the then-Barberton Citizens Hospital had contracted with FastHealth to provide website services for the hospital relating to LabCare Plus job applications.

It is unclear how many potential local LabCare Plus job applicants’ data was breached. Summa spokesman Jim Gosky said since the breach is part of a “very large breach with multiple databases and multiple organizations impacted, we don’t have a specific number that we can give you with 100 percent certainty.”

Affected job applicants whose personal information was contained in the database should be notified by FastHealth and provided credit monitoring as a precaution, he said. No patient information was part of the breach, Gosky said.

Gosky referred questions seeking more details to FastHealth. Gosky said he could not disclose whether FastHealth is still a contractor for the health system.

Multiple calls to FastHealth’s corporate offices were not returned for more information.

Gosky said even though the data breach was for a time before Summa acquired the operations of LabCare Plus, “Summa Health takes the security and confidentiality of any personal data very seriously, and as such, we felt the notifications and credit monitoring were necessary.”

FastHealth can be reached at 833-215-3730 for more information on the breach.

John Simms of Akron received a letter about the breach. Simms, who does information technology work for the Beacon Journal, said he applied to LabCorp in 2006 before he was hired at the Beacon Journal.

When he phoned FastHealth about the breach, he was told 356 hospitals nationwide had their information compromised.

“I’m angry that they have my information from 12 years ago still in their server,” he said.

Simms is also unhappy that, according to the letter he received from FastHealth, the company was notified of the breach in November of last year. An investigation was complete by January and it still took two months for FastHealth to notify victims.

Simms said he was never called for an interview for the job.

Simms said he is leery of sharing his Social Security number to the company providing free credit monitoring.

He does not have a credit freeze, but said he would consider placing one with the major credit bureaus.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

AxessPointe Community Health Center, a federally funded community health center with five area locations, has doubled the size of its Arlington site in Akron.

The site, the organization’s original location at 1400 S. Arlington St., Suite 38, has gone from 7,500 square feet to 18,000 square feet. The expansion allowed AxessPointe to consolidate its administrative offices into one location and have 16,000 square-feet of space for patients.

The new waiting room is bright, large and modern.

“One of the stigmas of a federally qualified health center is they get knocked for looking run-down because we serve a vulnerable population,” said Chris Richardson, AxessPointe’s CEO. “Our facilities are met with the highest of qualities and make sure our patients feel the value. Its not based on what you look like, its not based on your socioeconomic status. We want them to be treated like we want to be treated.”

Larry Peters was sitting in the waiting room while his wife was seeing her physician for a cold.

Peters said he liked the improvements and said the changes were dramatic from their previous visits during the year-long renovation.

Federally qualified health centers receive operating grants from the federal government and provide primary medical and dental care to medically underserved areas.

Beyond the check-in area at the newly expanded clinic, available exam rooms went from 9 to 15, and dental chairs went from three to four.

The organization, which sees patients regardless of their ability to pay, treats patients on Medicare, Medicaid, private insurance and no insurance. There is a sliding-fee scale for qualifying patients.

At the Arlington location, adult and children can see a primary care physician, dentist and now a behavioral health specialist in a dedicated room. The pharmacy and area for pharmacists to consult with patients has also expanded. At other facilities, similar services as well as additional services such as a women’s clinic are also available.

The renovated and expanded Arlington location will celebrate a ribbon cutting Thursday evening with guests, including Akron Mayor Dan Horrigan and other elected officials.

The project, which cost $1.23 million, was made possible by a $1 million federal grant, said Richardson.

“It affords us not only the ability to increase in size, but [provide] more patient access and [serve] more patients in our community,” he said.

The clinic grew on both sides of its original location in the Arlington Plaza shopping strip, including expanding into some vacant space and working with landlord LRC Realty, which relocated the Rent-A-Center to another part of the plaza. Richardson said the agency was also grateful that the landlord invested in some upgrades to the facade of the center and greenery.

The South Arlington Street location is an important one, said AxessPointe Board President Dr. Jay Williamson, a Summa family physician. It is right on a bus line and is near “the original population of people we want to serve.” Sixty to 65 percent of the patients are on Medicaid.

The location is the busiest and largest and “we want it to be busier,” he said. “We’ve tried to combine the medical, dental, pharmacy and behavioral health in one place realizing patients may have difficulty getting” to multiple locations for various services, he said.

AxessPointe has five sites in Northeast Ohio, including three in Akron — South Arlington Street and two on Broadway near downtown Akron — and one each in Kent and Barberton.

The agency also has a mini clinic two days a week in the North Hill area of Akron. Williamson said the agency, which sees a lot of the immigrant population in North Hill, wants to look into a permanent site with a physician.

“We’re very pleased about Arlington. We’re not done. We’re looking actively at North Hill for a presence there and we are encouraged by the federal government to expand our sites,” he said.

The clinics also employ technology to serve its patients, including video-remote translation services for various foreign languages and sign language, a tele-health option for patients to check in with a pharmacist for routine check-ins for Warfarin (blood-thinner) management and a robotic machine in the Arlington location’s pharmacy, which collates and labels monthly and mail-order medications for AxessPointe patients.

In the works within the next two months is a free prescription home-delivery service several days a week to AxessPointe’s high-impact areas around its clinic, said LaTrice Snodgrass, chief operating officer. The agency believes it will save money incorporating the home-delivery service since the agency now spends $6,000 a month in postage for its mail-order patients, she said.

The agency employs 115 at all of its locations, including 40 at the Arlington clinic. The organization added 12 employees because of the expansion. Last year, AxessPointe saw 19,000 individual patients who accumulated a total of 58,015 visits.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Asian Services in Action Inc. is moving its Akron social service offices and health clinic into a larger, more visible building.

ASIA Inc., founded in Akron in 1995 with offices in Akron and Cleveland, has purchased a building at 370 E. Market St. at the corner of Market and Forge streets. The facility is home to the Rosen Law Firm and the former location of University Hospitals Children’s Medical Group pediatric practice, which relocated to Fairlawn.

The nonprofit agency, which offers health and social services for the local immigrant population, will more than double its space when it moves from its 4,000-square-foot leased Akron offices at 730 Carroll St. to the 11,000-square-foot space on East Market Street. The law firm will rent one floor plus a few additional offices of one of the building’s wing and ASIA Inc. will occupy the rest of the building.

The agency’s International Community Health Center, which has been operating nearby in a 1,000-square foot space at 468 E. Market St., will open in an expanded clinic in the former pediatric practice, said ASIA’s Chief Executive Director Michael Byun.

The 12 exam rooms will double the existing clinic space. The health center serves babies to older adults, providing primary care on a sliding-fee scale and also providing mental health services.

“We are excited that a one-stop center for both health and social services means individuals and families can be healthy and be productive contributors to the local region civically and economically,” Byun said.

Byun said the move and expansion for ASIA Inc.’s Akron operations is needed to serve a growing population.

“Our New American (immigrant) population is growing. An example is the Bhutanese population who come to Akron to be closer to other family members, to buy houses that are affordable, and to work for small to large manufacturing companies in the area. Many are also starting small businesses,” he said.

“The growth means an increase demand for assistance to help folks make a successful transition,” he said. “The expanded location will allow ASIA Inc. to better serve the community.”

The building was purchased for $975,000. Byun estimates renovations to the building will cost $200,000 to $300,000. He said the agency is accepting donations to help with the project and is willing to offer naming rights.

Byun anticipates a summer opening for the health center. The renovation of the social service area will take a little longer, and the move is expected for the fall. About 50 employees will relocate, he said.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

COLUMBUS: Ohio’s medical board has begun accepting applications from doctors willing to recommend medical marijuana to patients once the state’s program is launched.

The State Medical Board of Ohio says eligible applicants must hold an active, unrestricted license as a medical doctor or doctor of osteopathic medicine.

Successful applicants must complete two hours of free continuing education on qualifying medical conditions, treating those conditions with medical marijuana and possible drug interactions.

The federal government prohibits doctors from prescribing medical marijuana. Ohio’s law instead allows people with one of 21 medical conditions that include cancer, Alzheimer’s disease and epilepsy, to buy and use marijuana with a doctor’s recommendation. The law doesn’t allow for smoking marijuana.

The law passed by the Legislature in 2016 requires medical marijuana to become available in September.

Falling concrete prompted Akron Children’s Hospital officials to immediately close a large parking deck on its campus, removing more than 600 parking spots on an already crowded campus in downtown Akron.

Hospital officials offered alternative parking decks for patients and said the hospital would be expanding valet services. The hospital also is working with the city to find alternative parking on city-owned lots with a shuttle service.

The hospital on Tuesday closed its Locust Parking Deck, 300 Locust St., to patients of the hospital and medical practices leasing space in the Locust Professional Building, hospital employees and volunteers.

The closing of the parking deck, which has 656 parking spaces, was in response to an engineering report commissioned by the hospital that found serious structural concerns with the 46-year-old deck, hospital officials said.

“We regret the inconvenience this causes everyone … whether it is for a doctor’s appointment or a lab/radiology test, as well as our nearly 300 employees who park in the Locust Parking Deck,” Akron Children’s President Grace Wakulchik said. “But we approached this decision just as we would approach a medical issue — we felt the need to act upon this information as quickly as possible to avoid harm.”

Akron Children’s Hospital had planned to replace the Locust Parking Deck in the next few years as part of its Akron campus master plan. However, falling concrete prompted the hospital to obtain a structural review by the GPD Group, the hospital said. The firm’s conclusions prompted the hospital to make immediate plans to close the deck and divert vehicles to other parking decks.

Valet parking for patients also is being expanded.

Patient families of the hospital and private medical practices located in the Locust Professional Building who normally park in the Locust Parking Deck should park in the Bowery Parking Deck at 199 W. Bowery St.

Patient families who normally park in the Bowery or the Exchange Parking Deck at 156 W. Exchange St. should continue to park in those lots.

Both the Bowery and Exchange decks are accessible to the main hospital by pedestrian bridges. A map showing the location of the decks is available at http://www.akronchildrens.org/parking.

Late Tuesday, Akron Children’s Hospital began alerting employees and volunteers about the parking changes.

Hospital officials are finding alternative spaces at other downtown parking decks and surface lots owned by the city of Akron. A shuttle service is running throughout the day to get employees and volunteers to and from the hospital.

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Sue Miller knew no horse could replace the beloved Petie the Pony.

But Miller, co-owner of Victory Gallop in Bath and one of Petie’s three handlers, knew she needed to find a new pony to bring therapeutic healing and joy to children at local hospitals.

For 20 years, Petie the Pony visited patients at Akron Children’s Hospital weekly. For about eight years, he also visited weekly at Rainbow Babies and Children’s Hospital in Cleveland.

Petie gained national attention as the first horse to be allowed access to visit patients in a hospital in the United States.

He also drew a fan base of adoring patients, families and staffers in and outside the hospitals. When Petie developed cancer and had to be euthanized in September, more than 150 people came to a memorial service and open house at Victory Gallop.

At the time of his death, Miller told me: “I think Petie would be really disappointed in all of us if we didn’t carry on his legacy. We will definitely bounce back because that’s what we do and Petie knew what he did was special. We have to carry that on.”

Enter Willie Nelson.

“I was on the internet and was Googling ponies,” Miller recalled. “My first reaction was just the name, Willie Nelson. I thought it was cute.

“The song — On the Road Again — it was playing and as it was playing, his little ears started showing up and then this little guy starts coming. He was pulling a wagon.

“He was hooked up to a harness and the cart. The music is going and he’s just trotting up this country road and I just thought it was adorable.”

Miller called his owner in Colorado, who had bought the 7-year-old pony for his grandkids to ride in the summers. Before that, he had been with an Amish family.

She saw a photo of him with two Amish kids riding him as he pulled a cart with a third kid inside. “We figured if he could tolerate all of that, probably what we were going to do was going to work.”

Pony in training

Miller, her Victory Gallop co-director Kim Gustely and Petie’s main handler, Toril Simon, gave Willie time to chill at the farm once he arrived in October. They wanted him to get used to the other horses and dogs that live there. Slowly, they started training him, including taking him into Miller’s house on the property and banging pots and cabinets in the kitchen to make sure he wouldn’t get spooked. They also took him on field trips, including to pet stores, a nursing home and one quick trip to the hospital, where he rode the elevator.

On a recent day, I watched as handlers tried a training session for the first time in two months.

They took him into the farm’s activities room, where Simon led him around a table while Miller, carrying a bucket in case he needed to go to the bathroom, also banged chairs around him and bumped into him.

“We want this to be no big deal. He’s going to sometimes be in a room that’s confined,” Miller said.

Nothing fazed Willie. Simon reclined on a bench to mimic being in a hospital bed. Willie stayed near her, letting her stroke his head.

“Sometimes the kids can’t really move a lot; they may have IVs or be sore,” Miller said. “We want him to be like, ‘This is OK, I can hang here.’ ”

When they were in the farm’s offices, Miller explained that by Willie turning his head to sniff a dog bed next to a chair with Simon in it, he showed he wasn’t completely focused on her.

“Kids are going to come at him fast. They’re going to poke. I don’t want him to be like ‘Oh, my gosh,’ ” Miller said.

They also took him into Miller’s kitchen, walking him around the island, banging doors, turning on faucets. This time, he stayed focused.

‘There’s a pony’

On another training day, Willie headed to the Pets Pajamas in the Montrose area of Bath. As soon as he walked in, he was met by 7-year-old Elise Helms, who was visiting the pet store with her mom, Leslie.

Willie didn’t mind the cramped store quarters, or Elise or another toddler petting him while dogs were barking nearby and a blow-dryer from the grooming area was going.

His trainers were happy with his progress. The last time he visited the store, he didn’t want to go in the front door and seemed more anxious to leave.

As he was preparing to leave, Mary Rood and her adult daughter, Tess, came in. Tess had told her mom, “There’s a pony in there” as they approached the store.

“Is he being trained to take Petie’s place?” Mary Rood asked Miller.

“He is! He’s hopefully going to be the next Petie,” Miller replied.

But not Petie

“Kim and I feel he definitely has the potential,” Miller said. “I try really hard not to compare him. He’s not going to be Petie. He’s going to have his own personality. What is important to Kim and I and Toril as his handler is his safety.”

They don’t want Willie Nelson to panic when he’s in a hospital room, which could cause injury to him or a patient if his foot hits a machine.

At the end of the visit to Pets Pajamas, Miller said Willie Nelson is ready.

“I have high hopes,” she said. “He has a tough role to fulfill, but we’re hopeful.”

Patients and staff at the hospital can’t wait to meet Willie, said Vicki Parisi, director of volunteer and visitor services at Akron Children’s.

“Petie left such an impression here for so many years,” Parisi said. “There was such a sadness. We’ll never forget Petie.”

Parisi, who hasn’t met Willie yet, thinks he will come in and bring joy and smiles, just like Petie.

Miller hopes to have Willie make his first short visit to the hospital in late April — and we’ll be there to follow along. If it goes well, they will move to more regular visits. They hope to add visits to Rainbow in the summer.

Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Many of them had already endured their share of heartache. Some had been trying for years to get pregnant, suffering through multiple miscarriages.

Others had undergone cancer treatments that destroyed their fertility.

Now, hundreds of these women and couples have learned that the eggs and embryos they froze for eventual use in starting or expanding a family may have been destroyed by storage tank failures March 4 at two fertility clinics in suburban Cleveland and San Francisco.

Authorities are investigating what went wrong to cause the biggest such loss in the U.S. since in vitro fertilization began nearly four decades ago.

But some of these patients at University Hospitals Cleveland Medical Center and the Pacific Fertility Clinic fear their last, best chance of having children may be gone.

Hopes for a sibling

Marlo Emch didn’t grow up with a brother or sister near her age. That’s why she desperately wanted another child after giving birth last April to a son conceived through in vitro fertilization.

She imagined her son having a partner to help navigate life and someone who would be there after she and her husband were gone. “It makes me sad to think he may never have a sibling close to his age,” she said.

Emch and her husband, Jeremy, married in their late 30s and struggled to have a child, losing one pregnancy after three months, before turning to a fertility clinic.

“People who are able to conceive naturally have no idea of the level of despair a woman has when they can’t become pregnant,” she said.

Everything worked perfectly with the birth of their son, and they planned trying for just one more this spring until being told last week that their seven remaining embryos may no longer be viable.

The couple, both now 42, won’t know until the embryos are thawed and tested.

“Chances are very, very low. The mother in me has to find out for sure. I almost feel like I’m going to have to grieve all over again,” said Emch, who lives in Burton.

Since receiving the devastating news, she started a Facebook support group open to the 700 affected patients from the suburban Cleveland center.

One woman told of how her husband has died since the couple froze their embryos. “That was her last connection to him,” Emch said.

Last chance destroyed

Before undergoing chemotherapy at age 23 for a rare cancer that affects bones and soft tissue, Elliott Ash decided to have his sperm frozen.

He hadn’t even met his future wife, but knew he wanted children someday.

Married five years ago, he and his wife decided in 2014 to start the process of having a child through in vitro fertilization while in their early 30s.

Their son was born the next year, and two frozen embryos remained in storage at University Hospitals.

“In an instant, everything was taken away,” said Amber Ash.

Doctors have told the couple the embryos did not survive the thaw.

Her first thought was about her son and his lost opportunity to have a genetic sibling.

While her husband’s cancer is in remission, chemotherapy left him sterile.

Creating new embryos with his sperm is no longer an option.

The Bay Village couple was among the first to sue the hospital.

“So many of us were cheated, cheated of the opportunity to start families or expand our families,” said Amber Ash.

“Our motive really is we want to prevent this from happening again. To prevent another family from going through this complete nightmare.”

Costly quest

Cameron Michalak and his wife, Amber, spent close to eight frustrating years trying to have a baby — both naturally and through fertilization treatments.

When nothing they tried worked, their doctor advised that their best and maybe only chance for a pregnancy would be through in vitro fertilization.

Expensive and exhaustive, the process took over their lives. Family and friends in the Cleveland area raised $13,000 through a GoFundMe campaign.

There were hundreds of injections, multiple times per day for Amber. Strict schedules for the waves of drugs.

Another failure on the first round.

And then more shots after Amber became pregnant with a girl due in April.

“Extraordinarily invasive,” said Cameron Michalak. “I wouldn’t wish that on her ever again.”

Now, though, it’s a decision they may face again.

The couple had five frozen embryos — created by combining their eggs and sperm — that were frozen and stored in the failed tank.

Now, repeating the process may be their only shot at having another child.

University Hospitals is offering to help patients with new fertility treatments.

That may still be an option for the Michalaks, who live in Vermilion, because both are 34, but that might not be true for older patients.

Others are deciding whether it’s worth risking additional health complications.

“That was my first thought, all of the people who have not had a chance to have success yet,” said Cameron Michalak.

“All of the people who don’t have the time to wait or their time is now.”

‘So many questions’

Katie Miller has had two children using her frozen embryos and was starting treatments at Pacific Fertility Clinic so she could have a third when she was got an email saying something went wrong.

She was among 500 people who have been told their embryos were in a storage tank that had dangerously low liquid nitrogen levels.

The clinic said the embryos were transferred to a new tank.

“You don’t even think about what’s happening in the lab. You just assume that that’s really being taken care of and that’s not something to worry about,” Miller told KGO-TV in San Francisco.

The extent of the damage has not been disclosed.

“There really are so many questions at this point, and hopefully there will be some good news,” she said.

“But at the same time, there have to be people who have already received probably very devastating news.”

Summit County had a better year in its annual health checkup, inching a few notches above its 2017 ranking average in the state.

The community finished 46th out of 88 Ohio counties in the new “County Health Rankings & Roadmaps” report released Wednesday.

Summit improved four spots from its 50th ranking last year and 52nd in 2016; in the previous four years, however, it had been ranked in the 40s.

Medina County continues to rank highly, moving up to be the fourth healthiest county in the state from fifth the year before. Stark County also improved, up to 42nd from 45th. Two counties in the region, Portage and Wayne, did worse this year. Portage fell from 27th to 31st and Wayne from 12th to 15th.

The ninth annual study, done by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, determines the rankings for counties nationwide. The researchers use a variety of data to come to its conclusions for the overall health rankings and also “health factors,” including tobacco use, exercise, access to medical care, educational levels, income, safety and housing conditions.

Here are the county rankings for health factors: Summit 44th, up from 48th last year; Medina fifth, down from fourth; Portage 24th, up from 25th; Stark, 39th, up from 40th and Wayne, which stayed steady at 13th in the state for two years.

Rankings can go up and down year to year, said Kate Konkle, an associate researcher with the Population Health Institute, but more telling are the snapshots in the various subcategories.

In looking at Summit County’s rates of premature death before the age of 75, for instance, Konkle said two red flags would be the rise to the top 5 of what’s categorized as accidents or unintentional injuries, which can include drug overdoses and also deaths by intentional self-harm or suicides.

The accidents or unintentional injuries stayed at No. 3 for Summit County and suicides rose from No. 6 in 2017 to No. 5 in 2018.

Accidents and suicides tend to fall to a younger population, said Konkle, though those two items being in the top five mirror other parts of the state and country.

Those findings do not surprise Cory Kendricks, director of population health for Summit County Public Health.

“Now especially with the opioid epidemic, accidents have increased to the top in most communities,” he said.

Kendricks and his colleague, the department’s Chief Epidemiologist Rich Maroonis, said the county uses its own data, which can sometimes be more up to date than the study’s figures, to get accurate snapshots of the county’s health.

Still, being able to see how Summit County ranks compared to other counties in the state can help the department focus on trends and where to focus its resources, Kendricks said.

The rankings show that where you live influences how well and how long you live, researchers said.

They pointed to key drivers such as children in poverty, saying children in poverty are less likely to have access to well-resourced and quality schools and have fewer chances to be prepared for living wage jobs.

Summit County came in at 20 percent, the same as both the Ohio and national rate of children in poverty. When broken down by race, 12 percent of white children in Summit were living in poverty compared to 46 percent of black children and 21 percent of Hispanic children.

Konkle said “we have seen the peak of children in poverty — during the Great Recession — has started to reverse, but it has not returned to pre-recession levels in most communities.” Maroonis said findings are similar in Summit County.

For more details and to check out all of the rankings, go to http://www.countyhealthrankings.org

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Ashley Haney had no warning signs before she wound up on the family room floor of her parents’ house in the middle of the night in December 2016.

The young mother, then 26, doesn’t remember having a seizure as her then 2-year-old daughter cried.

Doctors discovered a baseball-sized tumor in the Akron woman’s brain and removed it.

Similarly, Emily Schall of Akron had no symptoms before a sudden onset of extreme headaches when she was 20 in November 2016.

A brain tumor was discovered at the base of her brain stem and removed.

While the two women don’t know each other, the thing they have in common is the use of a relatively new proton radiation therapy treatment at University Hospitals Seidman Cancer Center and UH Rainbow Babies and Children’s Hospital in Cleveland.

The machine, one of only 27 in the nation, targets its radiation with high precision for children and adults with cancer, especially in the brain and spine. The next closest proton therapy centers are in Chicago, Cincinnati and Royal Oak, Mich.

While there are many types of radiation that are successful for cancer treatment, the benefit of using proton beams is that they target the treatment area without hitting other healthy areas, said Dr. Mitchell Machtay, chair of the UH department of radiation oncology.

“The difference about protons — because of the physics of high-energy protons — as it goes in and it hits something and lands somewhere, after it does that and releases its energy, it stops. It doesn’t scatter out the other end where it can hit and damage other organs that are behind the target,” Machtay said.

Proton therapy patients get customized plates to shape the beam to the exact target, he said.

Treatments can be as short as five minutes, but appointments can take about 30 minutes while the machine and laser beam are set up. The course lasts from 15 to 40 treatments five days a week.

Proton therapy isn’t necessarily better in terms of immediate treatment for a tumor or likelihood it would return, but potentially provides advantages years later, especially for younger patients, said Dr. Duncan Stearns, a Rainbow Babies pediatric hematologist/oncologist who was Haney’s oncologist.

“The difference I’d be hopeful for would be five, 10, 15 and even 30, 40 and even 50 years down the line,” Stearns said. “I would be hopeful that Ashley’s brain would work better, that she’ll have a better quality of life, that her risk of other tumors forming from the radiation and that the risks of other things from the radiation like strokes and other blood pressure changes, all of that would be reduced as a result of the proton.”

UH’s proton therapy machine has been operational for about 1½ years. It cost $30 million and is considered to be one of the world’s first “compact” proton therapy centers, featuring a single-room system that is significantly smaller than earlier generations of machines.

While UH’s machine still takes up space on several floors behind the scenes at the hospital, other machines can be the size of a football field and cost up to $300 million.

So far, the UH proton therapy machine has been used by about 205 children and adults, including 21 from the Akron area.

Ashley’s story

On the night of Dec. 5, 2016, Ashley Haney said nothing felt unusual.

“The only thing I remember was a hard time falling asleep,” said Haney, who lives with her husband, Jamie, and their daughter, Penelope, on the lower level of her parents’ Akron home.

Her husband is a video-gamer and was planning on staying up late that night to play games and sleep on the couch.

“I had just laid down,” he recalled. “I heard Penelope crying in our room. She hadn’t been feeling well for the last couple of days. Ashley got up and took the baby.

“It probably wasn’t five minutes from the time she took her upstairs that I heard Penelope say: ‘I want my daddy. I want daddy.’

“…As soon as I get up here, Ashley is laying on the ground and Penelope is on the couch crying. I knew right away that something was wrong.”

Ashley Haney began vomiting in the ambulance on the way to Summa Akron City Hospital.

Once at the hospital, doctors quickly assessed her and sent her for a CAT scan and an MRI. That’s when they found the baseball-sized tumor on the front left top of her brain. “I was just crying all night long. It was devastating,” she recalled. “I would have never guessed in a million years I had a brain tumor.”

Doctors referred her to University Hospitals, where she had surgery to remove the tumor, followed by chemotherapy and proton therapy.

She had the daily proton therapy treatment five days a week for six weeks. She also took chemotherapy pills.

Haney, now 28, continues to get monthly breathing treatments since the type of chemotherapy she had makes her susceptible to a rare pneumonia.

Her husband said he can see little things, but most people would not know from looking at his wife today that she had a brain tumor and is missing part of her brain.

“It’s amazing how the brain heals,” he said.

Her oncologist, Stearns, said the location of the brain tumor determines the severity of lasting side effects.

In Haney’s situation, he said, “lucky is not a word you would ascribe with a brain tumor. But she was lucky in both the type of brain tumor she had and the location.”

Emily’s story

Emily Schall had just graduated from the University of Akron and was beginning her graduate school studies in library sciences at Kent State University when she started having stabbing headaches that would last about five to 10 minutes.

“I wrote it off,” Schall said.

But the headaches started to interfere with her job at the Akron-Summit County Library’s Portage Lakes branch and her parents urged her to see a doctor.

Several doctors eventually referred Schall to a neurologist, who found a small tumor in the third ventricle of her brain through scans. She had surgery right after her 21st birthday.

Schall, now 22, underwent the proton therapy five days a week for about two months. She started while she was taking her first semester of classes at Kent. She was unable to finish some of the classes.

She is now being seen every three months for check-ups.

Like Haney, Schall said she has had little to no side effects from the tumor or treatments.

“When I was having the treatment, I felt like I was having short-term memory loss,” she said. “But since I’ve been done, I’m side-effect free. Occasionally I’ll have a spot of forgetting something.

“I’m very lucky.”

Schall said she’s grateful her insurance allowed her to go to Cleveland for her proton therapy. Otherwise, she would have had to go to St. Jude Children’s Hospital in Tennessee.

Machtay, the UH radiology chair, said Medicare and some — but not all — insurers are paying for the new therapy.

“It is probably the single biggest challenge and frustration of this,” he said. “Ultimately, if you decrease radiation to organs, you’re helping people in the short run by lessening toxicity and improving quality of life.”

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Cleveland Clinic Medina Hospital will construct a new medical-surgical unit, the latest in a series of investments in the hospital.

The 15-bed medical-surgical unit will serve a wide range of patients — from those who are acutely ill to those who are recovering from surgery, hospital officials said. Features of the $4.1 million unit include all private rooms with work space for caregivers to care for patients with medically and surgically complex needs.

“This investment will help our caregivers continue to provide the highest quality care for members of our community right here in Medina County,” said Dr. Richard Shewbridge, president of Medina Hospital. “The new medical-surgical unit will provide the best environment for our caregivers to take care of patients and for our patients to heal and recover.”

Construction of the new unit, which is just under 18,000 square feet, begins this month and is expected to be completed by the end of the year.

Last year, Medina Hospital renovated its intensive care unit, making more than $1.7 million in upgrades. The hospital is nearing completion of a $5.8 million renovation of its emergency department.

Cleveland Clinic has invested more than $105 million in Medina Hospital since it joined the health system in 2009, including new operating rooms, a wound center clinic and other outpatient services.

Health insurer Cigna is buying the nation’s biggest pharmacy benefit manager, Express Scripts, the latest in a string of proposed tie-ups as health care’s bill payers attempt to get a grip on rising costs.

The $52 billion deal announced Thursday follows the drugstore chain CVS Health Corp.’s roughly $69 billion bid to buy the insurer Aetna Inc., an acquisition the companies detailed in December.

Insurers and pharmacy benefit managers — which run drug plans for insurers and employer-based plans — have struggled to keep costs under control for clients like big companies that provide coverage to their workers. They are pushing to shift health care from a system that treats the sick to one that essentially tries to prevent you from getting sick in the first place or keeps you out of an expensive hospital.

They’re not the only ones hunting for solutions. Amazon said earlier this year that it will collaborate with billionaire Warren Buffett and JPMorgan Chase to create a company that provides their employees with high-quality, affordable care. No one knows what that means yet, but it sent a shudder through the industry.

Insurers and others say they want to get more involved in patient care, to supplement what a regular doctor provides and keep people healthy and on their medications. They are especially focused on those with chronic conditions, like a diabetic who needs regular blood sugar monitoring and care to stave off heart attacks or other serious illnesses.

“They want to be the consumer’s partner in managing their health through data and services that help them take charge of their own health,” said health economist Paul Keckley.

Aetna and CVS have said they hope to create “front doors” to care through CVS drugstores. That deal could turn many of the chain’s more than 9,800 locations into one-stop shopping for an array of health care needs like blood work and eye or hearing care, in addition to their traditional role of filling prescriptions.

UnitedHealth Group Inc., which runs the nation’s largest insurer, is spending almost $5 billion to buy nearly 300 primary and specialty care clinics and some urgent care and surgery centers. That push will help the company steer patients away from hospitals and cut down on unnecessary emergency room visits.

Another insurer, Humana Inc., is making a separate deal to better manage the care of its Medicare Advantage patients.

Cigna already uses Express Scripts’ Accredo business, which manages prescriptions for complex specialty drugs. The companies said Thursday that expanding their relationship will help improve service, personalize care and give doctors a more complete picture of the patient.

A key element will involve how the combined company uses the massive amounts of patient data and information it collects. For instance, if a doctor prescribes an antidepressant, that data may show that the medicine won’t work well for that person. Cigna could then tell the doctor and recommend an alternative treatment, said Keckley, the health economist.

The acquisition will combine an insurer that covers around 16 million people with a drug plan manager that processes more than a billion prescriptions a year.

Bloomfield, Connecticut-based Cigna Corp. will pay $48.75 in cash and a portion of stock in the combined company for each share of St. Louis-based Express Scripts Holding Co. Cigna shareholders will wind up owning about 64 percent of the company, which Cigna CEO David Cordani will lead. His Express Scripts counterpart, Tim Wentworth, will stay on as a president.

The boards of both companies have approved the deal, which is expected to close at the end of this year.

Shares of both companies careened in opposite directions after the deal was announced early Thursday. Cigna’s stock was down nearly 11 percent, or $21.09, to $173.16 in afternoon trading. Express Scripts had climbed about 9 percent, or $6.42, to $79.48 while broader indexes were largely flat.

The nation’s biggest health insurer will pass drugmaker rebates along to some customers starting next year, giving a potential break to those taking expensive prescriptions.

UnitedHealthcare said Tuesday it will let people covered by certain employer-sponsored health plans collect rebates when they fill prescript

ions or at the point of sale. Those rebates could amount to a few bucks or several hundred dollars, depending on the drug.

Drugmakers frequently give rebates for prescription drugs, but those discounts rarely flow directly to the people filling prescriptions. How these rebates are used has become a growing source of debate in recent years as the cost of some treatments has soared.

The Pharmacy Benefit Management Institute says insurers and employers most often use the money to reduce overall plan costs.

The rebates that UnitedHealthcare plans to pass along could lower customer expenses like deductibles or co-insurance payments. Those costs in general have climbed steadily in recent years as employers shift more of the coverage expense to people who use the prescriptions.

UnitedHealthcare’s announcement marks a “major win” for patients, according to Adam Fein, who follows the industry as CEO of Drug Channels Institute. He noted that most rebates come from patients using brand-name drugs to treat chronic conditions, but that money frequently goes toward lowering costs for everyone, including healthier customers.

“A small number of people are generating most of the rebate dollars, and they are not seeing the direct benefit,” he said.

Separately, President Donald Trump also has proposed giving rebates directly to Medicare prescription drug customers.

UnitedHealthcare’s plan is a “prime example of the type of movement toward transparency and lower drug prices for millions of patients that the Trump Administration is championing,” U.S. Health and Human Services Secretary Alex Azar said in a statement Tuesday.

But the industry lobby America’s Health Insurance Plans said these point-of-sale rebates offer limited help in reducing the overall drug prices that make everyone’s cost of coverage rise.

“The bottom line is the original list price of a drug — which is solely determined by the drug manufacturer — drives the entire pricing process,” spokeswoman Cathryn Donaldson said in an email. “And if the original list price is high, the final cost that a patient pays will be high.”

Donaldson said her association was speaking about these rebates in general and not about UnitedHealthcare, which it does not represent.

UnitedHealthcare’s rebate plan will apply to about 7 million people who have fully insured coverage through an employer. That’s a relatively small slice of business for an insurer that covers more than 49 million people.

The plan does not apply to the insurer’s individual coverage or to insurance offered through most large employers.

UnitedHealthcare is the insurance arm of Minnetonka, Minnesota-based UnitedHealth Group Inc.

———

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report from Washington.

Dr. Joseph Congeni knows and loves sports.

He’s been Akron Children’s Hospital medical director of sports medicine and the Hoban High School team doctor for 30 years.

He’s also a father of six with 18 years of coaching experience, including football and basketball.

“I’m a sports guy. I love the benefit of sports,” said Congeni, who is this month’s expert for my monthly Healthy Actions column.

“There’s so many life lessons with competition and team sports. Everything I learned in school I learned in youth sports,” he said.

But over the course of his career and especially in the last few decades, Congeni has seen an increase in injuries among young athletes from overuse, overload or overstress to their young bodies.

Many of the overuse injuries are preventable with education, Congeni said.

His biggest concern is young or pre-teen athletes, those from age 8 to 14 or late elementary school to middle school. By high school, athletes’ bodies have matured and can handle the training and play, he said.

Young athletes’ muscles are tight and their growth plates are growing fast. The growth plates in younger and middle-school athletes are not as strong as the bone in a fully-matured kid, he said.

Training wrong or not taking care of your body can make a young athlete more prone to injury, Congeni said.

But first, Congeni has some general tips for all athletes, including high school athletes.

Research shows that injuries go down when athletes limit their training to five days a week, no more than 10 hours total (playing and training) and taking a season off. During that off season, Congeni said, “just do something else.” It’s the repetitive nature of doing the same motion over and over again which can lead to injuries. “If you want to do some conditioning and training, even if you want to do another sport, yeah, we love that.”

To keep young athletes healthy, here are some topics to keep in mind.

Burnout

Sometimes kids are encouraged to specialize in a particular sport so early that by the time they’re in middle school or high school, the child is burned out, Congeni said. Some kids start to specialize in third and fourth grade.

“Wow, that’s way too soon,” said Congeni. Junior high is still too soon, he contended.

Doing too much

Congeni said he gets it. Especially when the kids are young, you want to expose them to different sports. But layering too many sports at the same time can be a problem.

Layering of too many teams, like a recreational or school team, an all-star team and a travel team, is also concerning.

“It’s not unusual in my office to ask how many games you’ve played in a sport in soccer or baseball where kids will tell me 60, 80, 100 games a year,” said Congeni. “At a position that’s really high risk (for injury) like a goalie or pitcher, say particularly [a] pitcher: How many of those games do you pitch? Forty percent of the 80 or 100 games. Oh my gosh, we wouldn’t do that to a professional pitcher by any circumstance and yet we do that to a younger player.”

Over-scheduling sports can also lead to what Congeni called “Frantic Family Syndrome,” where families are always on the run to practices, games or traveling for sports and they “give up valuable family time, which ends up leading to dysfunction that is the opposite of what we love about sports.”

Weight-training

For high-schoolers, weight-training on their own or with a coach is reasonable, Congeni said. But he does not believe middle-school students should be told to go to the weight room on their own.

Congeni will give the green-light to middle school students — both boys and girls — with some stipulations.

It must be one-on-one or directly supervised. Kids should also start with body-weight exercises for at least the first four to six weeks. Weight-training should be free weights at lower levels and “with more repetitions and no maxing out or working more than 50 percent of their max,” he said.

Congeni also said young athletes should not be in the weight room for more than 30 minutes, not on back-to-back days and no more than three days a week. “Try to mix it up and have a well-balanced program with upper body, lower body and trunk” with a good warm-up and stretching program, he said.

Congeni notes that younger male athletes won’t see muscle gain because they don’t have the testosterone levels yet, but kids can gain strength.

Supplements

Middle school and high school athletes should be getting enough protein with a well-balanced diet that protein supplements are for the most part unnecessary, Congeni said.

“For people who are buying the big vats of protein, it’s a pretty expensive insurance policy,” he said. “The body can only use so much … you’re basically peeing out your expensive supplements.”

Still, Congeni said supplements are not dangerous and are pretty safe. He does recommend staying away from anything with creatine, which he thinks has very little upside and can cause cramping.

Congeni said he is not opposed to a young athlete going to a certified strength and conditioning coach, as long as they still follow the weight stipulations above. It is important, however, to go when the athlete is not injured. An injured athlete needs to go to a physical therapist, he said.

Dancers

Dancers are also athletes and are also prone to a certain set of injuries, said Congeni, who has worked with many dance patients.

Congeni would still like dancers to adhere to the same rules of no more than 10 hours a week, five days a week, nine months of the year, but he recognizes that for some advanced dancers, they are at the studio for 20 or more hours a week in order to perfect their art.

“They’re inherently going to have overuse,” he said. “If that happens, I’ll be here to help you.”

Overall, Congeni said “there’s so many good things about sports. We just have to keep them in balance. A lot of times well-meaning adults push that out of balance. I can gently nudge them back to the balance world.”

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty.

Summa Health has a goal of achieving a 1.5 to 2 percent operating margin within the next two to three years after the previous tumultuous year, which ended with a $28 million loss.

Interim leaders of the Akron-based health system shared that goal and reviewed Summa’s financials and history of the past year’s troubles and recovery during a public investor call for its bondholders on Monday.

Summa expects to end this year with a 0.9 percent operating margin, with revenues exceeding expenses by $12 million.

In a wide-ranging call, Summa Interim President and CEO Dr. Cliff Deveny and Interim Chief Financial Officer Thomas O’Neill said Summa finished the year with an operating loss of $28 million. That was better than an initial $60 million loss predicted last June and an updated $35  million loss estimate in November.

Among other highlights:

• Summa has been implementing its Performance Improvement Plan to stabilize its financial outlook since last year. The plan, developed with its minority partner Mercy Health, has identified an estimated $40 million in recurring cuts and $3.4 million in one-time improvements. The estimated impact for the 2018 budget of the plan is $33 million. The cuts include the elimination of 300 full-time equivalent positions in mid- and late 2017, said Deveny.

• Deveny, who has his first anniversary of being named interim CEO on March 13, said the search for a permanent CEO by the board of directors is ongoing. (He is an applicant.) He did not have a time frame. Deveny hopes to have a permanent chief financial officer by May.

• At a recent board of directors meeting, longtime local Summa board member, attorney and business owner Anthony Lockhart was elected chair. He replaces attorney James McIlvaine, who remains on the board. Longtime board member FirstEnergy Executive Vice President Leila Vespoli is vice chair.

• Deveny said the net effect of Crystal Clinic leaving its leased space in Summa St. Thomas Hospital will be “minimal, at best” for the health system. Deveny said Summa has been rebuilding its orthopedic business.

“Summa has added six orthopedic surgeons of our own and two spine surgeons starting in August. We will have a complement of eight operating surgeons and three nonoperating sport medicine physicians,” he said.

“A lot of that business is coming from within our system.”

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

Fairlawn will gain nearly 500 employees when the new Crystal Clinic Orthopaedic Hospital opens in mid-2020.

The physician-owned Crystal Clinic Orthopaedic Center announced this week that it is building a 60-bed hospital facility for orthopedic and plastic surgery patients. The planned four-story building in the 3500 block of Embassy Parkway also will have 12 operating rooms, expanded imaging services and Quickcare, an urgent orthopedic clinic that will move down the street from the existing Crystal Clinic outpatient campus.

The $100 million new facility has been a goal for the physician owners of the Crystal Clinic since 2008, when the clinic created a joint venture with Summa Health, Crystal Clinic President and CEO Ronald Suntken said. Construction began for a planned six-floor, 72-bed orthopedic facility on the campus of Summa’s Akron City Hospital, but plans were halted with the financial crisis in 2008 and 2009 and never resumed. Summa sold its 49.65 percent stake to an independent, third-party investor in 2014.

“We’ve never wavered once in our commitment to building a new facility,” Suntken said. “It was just a matter of where we would be and exactly what would be the size and scope of services.”

Since 2009, the Crystal Clinic has been leasing about 130,000 square feet on six floors at Summa’s St. Thomas Hospital in Akron.

Suntken said the group looked at many locations to build new and move its inpatient operations.

The 12-acre parcel on Embassy Parkway, while not directly next to the existing two Crystal Clinic buildings, is close enough for benefits, Suntken said. It also is close to interstate access, with access points at both ends of Embassy Parkway, he said.

The clinic has about 460 employees now and will be adding roughly 30 support staff, such as food service, building service and environmental service employees, who are now shared with Summa. Some new imaging service technicians also will be added, Suntken said.

“St. Thomas has been a great location for us,” Suntken said. But while patient satisfaction surveys have been good “for a 90-year-old facility” at St. Thomas, “we know [those scores] will be much improved once we move to a new facility,” he said.

Summa officials said no plans have been made for the space that will be vacated at St. Thomas when Crystal Clinic moves out in a couple of years.

The new orthopedic hospital, which will have both inpatient and outpatient orthopedic and plastic surgeries, may be the only free-standing specialty orthopedic hospital in Ohio, Suntken said.

Crystal Clinic doctors will continue to perform surgeries that require a postsurgery intensive-care unit at local full-service hospitals.

Crystal Clinic has 12 locations and about 900 employees. They currently employ 41 physicians with two more joining in the fall, Suntken said.

On Tuesday, the Revere Local School Board approved a tax increment financing agreement for the property. (While the land is in Fairlawn, it is in the Revere school district.) As part of the agreement, which still needs to be approved by Fairlawn City Council, Revere will receive 50 percent of property taxes based off the property and building estimated at $56 million.

That is estimated to be $460,000 per year for the first 10 years. After the 10th year, the schools will receive $920,000 a year. Additionally, the district will also receive an incentive payment of $250,000, made before June 30, for its upcoming building project.

Since the property is in a tax-sharing district between Fairlawn and Akron, the 2 percent income tax collected by Fairlawn will be split equally with Akron, said Fairlawn Mayor William Roth. The updated payroll for the new hospital is expected to be $20 million, so each city would receive $200,000 a year.

Roth said there were no incentives offered to Crystal Clinic, though there are some discussions to upgrade the road for higher traffic.

The project is “a very big benefit for the region. It’s a great investment. It’s not just something for Fairlawn, but for the region and an upgrade in medical care,” Roth said.

Akron Mayor Dan Horrigan said: “we had a long, and open dialogue with Crystal Clinic in which we presented and discussed several viable options for them to build a new clinic in the city of Akron. Ultimately, they selected Embassy Parkway and we wish them success with this new facility. We will be available as collaborative support for Summa Health as they explore productive future uses for the St. Thomas facility.”

Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

The Crystal Clinic Orthopaedic Center is building a new specialty hospital in Fairlawn.

The 160,000-square foot facility with 60 inpatient beds and 12 operating rooms is expected to open in mid-2020, down the street on Embassy Parkway from its existing outpatient facility. It will also feature an urgent orthopaedic clinic, imaging and other support services.

The hospital will move its services from space it currently leases from Summa Health at St. Thomas Hospital in Akron.

“We spent the first half of 2017 developing a business plan that included the project scope, timeline and projected cost. After much consideration, we selected this location in Fairlawn, close to our existing outpatient locations, because it will be easily accessible for patients throughout Northeast Ohio,” said Ronald Suntken, president and CEO of Crystal Clinic Orthopaedic Center, in a news release.

The project should take 20 to 24 months with move-in an occupancy anticipated by mid-2020, he said. Construction is expected to start in the spring on the facility at 3517 Embassy Parkway.

Crystal Clinic officials were not available for further comment Tuesday evening.

The press release did not list financials for the project, but also on Tuesday night, the Revere Local School Board approved a tax increment financing agreement with the Crystal Clinic.

As part of the agreement with the schools, which still needs to be approved by Fairlawn City Council, the property and building project are estimated to be a minimum of $56 million though Crystal Clinic officials told Revere school officials that the full project, including equipment could top $90 million.

As part of the agreement, Revere will receive 50 percent of property taxes based off that $56 million, estimated to be $460,000 per year for the first 10 years. After year 10, the schools will receive $920,000 a year. Revere Superintendent Matthew Montgomery said the district will also receive an incentive payment of $250,000, made before June 30.

“The Revere school district is excited to partner with the Crystal Clinic and the city of Fairlawn to ensure that the Clinic stays in the community for years to come,” Montgomery said. “The support they’re able to offer the community in terms of patient care is expanding as well as increasing the financial stability of the district,” he said.

Fairlawn Mayor William Roth, reached at home Tuesday evening, said Akron and Fairlawn will get an equal share of income tax revenue from the new hospital because the property is in a tax-sharing district.

“It’s a huge investment,” Roth said.

Crystal Clinic Chairman of the Board Dr. Gordon Bennett said the clinic was proud to be “owned by local physicians who are focused on optimally serving our patients’ needs.”

The Clinic has been leasing space from Summa Health inside St. Thomas Hospital in Akron for its inpatient hospital operations. Summa was a part owner of the Crystal Clinic Orthopaedic Center until the health system sold its 49.65 percent stake to an independent, third-party investor in 2014.

The Crystal Clinic Orthopaedic Center joint venture between the doctors and Summa originally planned to construct a six-floor, 72-bed orthopedic facility on the west side of Akron City Hospital on Adolph Street between East Market and Forge streets. However, construction halted in 2009 and never resumed.

Summa spokesman Mike Bernstein said “congratulations to everyone at the Crystal Clinic. We wish them all the best moving forward. Regarding St. Thomas, we are continuing to review future options for the facility, but no decisions have been made.”

Beacon Journal/Ohio.com writer Rick Armon and correspondent Jody Miller also contributed to this report. Medical writer Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter.