NCGB Awards: Honoring Dr. Joseph Pepe

National Clinical Governance Board’s Clinical Excellence Awards

At the most recent US Acute Care Assembly, six of our outstanding clinicians received the USACS National Clinical Governance Board’s Clinical Excellence awards for their extraordinary work with our hospital partners.

• Isabelle Hertig, MD, Critical Care, Shady Grove Medical Center, nominated by Ajit Kuruvilla, MD
• Joseph Pepe, DO, Emergency Medicine, AdventHealth Carrollwood, nominated by Jeremy Kirtz, MD
• Mark Sheatzle, MD, Emergency Medicine, Allegheny General Hospital, nominated by Dennis Hanlon, MD
• David Hoch, PA-C, OBS, Ascension Texas, nominated by Brian Aldred, MD
• Logan Rencher, DO, Pediatric EM, Dell Children’s, nominated by Sujit Iyer, MD
• Shirin Trisha, MD, Hospitalist, Cedar Park Regional Hospital, nominated by Shea Combs, MD.

Today, we are featuring Dr. Joseph Pepe, who has been working with USACS since 2019.

When offered the opportunity to recommend a nominee for the National Clinical Governance Board’s Clinical Excellence Awards, Dr. Jeremy Kirtz had a lot to say about Joseph Pepe, DO, including this excerpt (to read the entire nomination, go to the end of the story):

To be the Clinician of the Year, you must go beyond the typically excellent, and really show your commitment to making both your patients and your community safer. Dr. Pepe does just that. Dr. Pepe has shown himself to be a physician that embodies the best of what we do.  He is a person that we all look to and think, ‘I’d love to be a doctor like that.’

 

Here’s a Q&A with Dr. Joseph Pepe:

What made you want to become a doctor?

I have always been interested in the medical field from a young age.  My father was an internist and probably in part, I grew up with “medicine in my blood.” I initially worked as a paramedic and wanted to advance my training and perform the full scope of emergency medicine.

Why, particularly, Emergency Medicine?

I think of emergency medicine as the best parts of every specialty. We get the most variety and focus on the immediate and most urgent needs of patients. It’s so interesting to treat a stroke in one room, remove a corneal foreign body in the next, reduce a shoulder in the third, etc. We have the opportunity to experience all aspects of medicine and make an immediate impact on patients’ lives.

 According to Dr. Kirtz, you are constantly going above and beyond for your patients. Why is that important?

We will all likely be in need of emergency care at some point in our lives. Our own families will need emergency care. Every patient we interact with is someone’s family member/loved one. I think that we need to remember that. When you think of it that way, “above and beyond” suddenly becomes the personal standard of care.

Dr. Kirtz also noted, “He is a person that we all look to and think, ‘I’d love to be a doctor like that.” Are there people who have inspired you to be a better doctor? 

I was fortunate to have many great mentors throughout my education and career. I trained under several great EM physicians in residency. A particular shout out to Dr. Laura Foreman who not only is an excellent clinician, but really taught me a lot about how to treat patients and their families, how to treat myself, and how to think positively and improve my longevity in this challenging environment.

Can you tell me more about the epidemic of synthetic marijuana laced with super warfarin that Dr. Kirtz mentioned? What caused you to look deeper?

This was a very interesting and difficult set of cases. I initially had a few cases of spontaneous bleeding, such as epistaxis or GI hemorrhage. I had two such cases in a shift. When the coagulation studies were checked, the INR on both patients was greater than 10. This was quite unusual. I had heard of one of my colleagues having a third case. Given this information, I initially thought we may have a lab error. I and some of the lab and ER staff went through numerous blood tubes to check the lot numbers to see if we were dealing with a manufacturing error. When we found the lot numbers were different, it seemed that true elevation of the INR to that level was likely. The differential included both toxicologic, as well as biochemical/infectious etiologies. I immediately instructed the patients to be placed in negative pressure rooms and I contacted the CDC and poison control center. Over the next 24 hours, I was informed of similar cases presenting at different hospitals. Synthetic marijuana as a source was suspected due to previous history of similar cases several years ago. Confirmatory testing was collected from the patients and sent to reference labs which ultimately confirmed our suspicion. I received treatment recommendations from the poison center and then made calls to the ICU as well as my colleagues at other hospitals so they would know how to properly identify and treat these cases.

Dr. Kirtz wrote this:

During the height of the Delta surge, Dr. Pepe got a patient at a freestanding ED with a saddle embolism, hypoxic and hypotensive. Dr. Pepe stabilized, but upon needing to transfer could find nowhere to send the patient. Our own tertiary center was full, our nearby large educational center (TGH) was full, our other nearby institutions were full. Then Orlando (the whole city) was full, Gainesville wouldn’t accept, nowhere in Florida could accept…after dozens of calls, Dr. Pepe was able to get acceptance at University of Maryland. Of course, he then went ahead and arranged the fixed-wing transport himself….

How did you know how to arrange the fixed-wing transport?

I was aware of the different modes of transport and challenges associated with each due to my previous career in EMS working as a paramedic.

What made you contact University of Maryland?

It certainly was not anyone’s first choice from Tampa, FL! The transfer center worked tirelessly trying to find an accepting institution. Unfortunately, we needed to find a hospital that not only had an COVID-19 ICU bed, but also had the capability for thrombectomy. The patient was critically ill and due to the fact that the patient was stuck at the freestanding ED, without any specialty backup, we had to administer systemic tPA to stabilize the patient. Between the transfer center and me, we called over 60 different hospitals sequentially up the east coast until we were able to find an accepting institution several hours later. I did my trauma rotations at University of Maryland and knew they had the capabilities to handle such a patient.

Are you this relentless with all your patients?

Yes!

 Anything else you’d like to mention? 

We have a great team down here in Tampa. None of the positive outcomes we have had would be possible without great nurses and support staff, along with strong local leadership. Dr. Kirtz, Dr. Fasi, Dr. Garcia, Dr. Perfetti, Dr. Edginton, Brian Baker- thank you all for your support, especially through this pandemic.

Nomination letter

Thank you for this opportunity to recognize USACS’ greatest physicians. I am honored to present Dr. Joseph Pepe, DO as the Outstanding Clinician of the Year for Emergency Medicine. It goes without saying that if you are being nominated for this award that you are an amazing physician and team player. Dr. Pepe checks the boxes of being an excellent clinician and colleague. He diagnoses Lyme, does culture callbacks in his down time, he is always positive, has students come in and work with him (in a non-educational institution) with his own daily syllabus, and has attended every single monthly site meeting for two different campuses. However, to be the Clinician of the Year, you must go beyond the typically excellent, and really show your commitment to making both your patients and your community safer. Dr. Pepe does just that. To illustrate this, I will give 3 examples from just the last six months:

• During the height of the Delta surge, Dr. Pepe got a patient at a freestanding ED with a saddle embolism, hypoxic and hypotensive. Dr. Pepe stabilized, but upon needing to transfer could find no where to send the patient. Our own tertiary center was full, our nearby large educational center (TGH) was full, our other nearby institutions were full. Then Orlando (the whole city) was full, Gainesville wouldn’t accept, nowhere in Florida could accept…after dozens of calls, Dr. Pepe was able to get acceptance at University of Maryland. Of course, he then went ahead and arranged the fixed-wing transport himself!
• Pepe also is a strong advocate for his patients even in the face of specialists disagreeing with his clinical plan. A patient came to our tertiary center with a stroke and hemiparesis, arriving outside of the window for IV tPA. The neurologist refused to send the patient for interventional treatment, but Joe disagreed. He had the patient transferred to TGH, where they underwent interventional thrombectomy.
• Finally, locally we recently had an epidemic of synthetic marijuana laced with super warfarin. Over the course of a couple of shifts he identified several bleeding patients with INR > 13. With careful history he identified that the common thread amongst these patients was their use of Spice. He then contacted poison control and explained what he thought was happening. Finally, he took it a step further and contacted the State Health Department to inform them of the situation. His identification of Patient Zero and his disseminating this information led to a community-wide response involving all levels of local government and the Tampa hospital community. He truly helped to make our community safer.

For each of these examples and several others, Dr. Pepe has shown himself to be a physician that embodies the best of what we do. He is a person that we all look to and think, ‘I’d love to be a doctor like that.’ Above all, because he inspires those around him to be a better physician and person, he deserves to be recognized as the USACS Outstanding Clinician of the Year. Thank you for your consideration. Sincerely, Jeremy Kirtz, MD, FAAEM, FACEP Medical Director, AdventHealth Carrollwood