Past Issues

Who Are AL DÍA's 2023 Top Doctors?

As AL DÍA Top Doctors enters its fifth year of honoring Latino doctors from across the Philadelphia region and beyond, the tradition grows ever stronger with yet another cohort of Latino honorees from across the vast spectrum of medicine.

They will be honored on Monday, June 12, 2023, in the historic hall of One North Broad Street, at the Masonic Temple across from Philadelphia City Hall in Center City. 

This year's awards also mark the first year in a partnership that will see Penn Medicine become the presenting sponsor for AL DÍA's Top Doctors for the next three years.

The 2023 honorees are as follows:

Kicking off this year's awardees is a name that has long been affiliated with AL DÍA in a lot of its event endeavors, and that's Drexel College of Medicine's Dr. Daniel Schidlow.

A Chilean, born to Jewish parents who fled Nazi Germany for the South American country in 1939, Schidlow is a previous health archetype honored at AL DÍA's Hispanic Heritage Month Awards back in 2017.

Back then, he was five years into his tenure as the Dean and Senior Vice President of Health Affairs at Drexel's College of Medicine and told AL DÍA that his "best and most important asset" was his Hispanic background. It helped him when he first arrived at what was then Drexel's St. Christopher's Hospital for Children, as he was able to relate to the surrounding North Philadelphia community.

These days, Schidlow is a Dean Emeritus, and remains a professor of pediatrics, medicine and pharmacology and physiology at Drexel's College of Medicine.

From lifetime achievement to a rising star in medicine with his whole career ahead of him, Jordan Juarez — the Emerging Leader award winner this year — is a rising fourth-year MD candidate at Temple University's Lewis Katz School of Medicine.

Born to a large Mexican American family and raised in the predominantly Spanish-speaking community of Chula Vista in Southern California, Juarez's first desire to go into the healthcare field came when he learned his grandmother's story.

She immigrated to the U.S. Across the southern border from Mexico in the 1960s and took up work as a low-wage seamstress in factories. Her little English proficiency made it difficult for her to access any kind of healthcare throughout her life and she eventually developed type II diabetes later in life.

It's these kinds of disparities Juarez was out to eliminate as part of the 2022 National Institute of Health Medical Research Scholars Program. He devoted his time to internal medicine, specifically the research, practice and promotion of equitable care for all communities.

Juarez received his undergraduate and masters degrees from the University of Southern California in neuroscience and global medicine, respectively.

Dr. Arleen Ayala Crespo is an associate professor of obstetrics, gynecology and reproductive sciences at Temple's Lewis Katz School of Medicine. She's also the director of both the division of general obstetrics and gynecology and the obstetrics, gynecology and reproductive sciences clinical simulation at Temple University Hospital.

The latter is a center at Temple's Lewis Katz School of Medicine that allows students and residents to simulate real-life situations in a doctor's day-to-day and practice their responses/

Ayala Crespo has Puerto Rican roots, receiving her bachelor's in biology at the University of Puerto Rico-Mayagüez, and then her MD at the University of Puerto Rico School of Medicine in San Juan. 

She completed her residency in obstetrics and gynecology at Temple University Hospital, where she continues to work to this day.

Dr. Vilmaris Quiñones Cardona currently works as a pediatric practitioner at St. Christopher's Hospital, where she is the associate director of the neonatal and perinatal fellowship program. 

The program is a three-year training that exposes participants to a career in neonatal and perinatal medicine — dealing with newborns and infants born prematurely.

Quiñones Cardona is also an assistant professor of pediatrics at Drexel College of Medicine.

She is a two-time graduate of George Washington University, receiving both her bachelor's in biology and a master's of public health, focusing on community-oriented primary care. Quiñones Cardona got her MD from the University of Puerto Rico School of Medicine.

Dr. Marlyn Ramos Lamboy is the medical director of the Spinal Cord Injury Program at Moss Rehab, part of the Jefferson Health Network.

Her focus there is rehabbing patients who have sustained debilitating spinal cord injuries back to points where they can live as pain free and independent as possible.

"Rehabilitation is happy medicine," Ramos Lamboy said in a promotional video for the program.

Like the previous two honorees, Ramos Lamboy also has Puerto Rican roots, receiving her medical degree from Universidad Central del Caribe, located in Bayamón. From there, she completed an internship in internal medicine at Mount Sinai School of Medicine in New York City before going into physical medicine and rehab during her residency at New York Medical College. 

Ramos Lamboy then completed a fellowship in spinal cord injury rehab at the University of Pittsburgh Medical Center (UPMC).

Dr. Jimmy Ruiz is an obstetrics and gynecology specialist in the Jefferson Health Network, operating primarily out of Jefferson-Torresdale and Jefferson-Abington Hospitals.

He has over 24 years of experience in obstetrics and gynecology and is a 1998 graduate of the Drexel College of Medicine.

Dr. Alejandro Delgado Daza specializes in internal medicine, particularly infectious diseases, and is part of the Jefferson Health Network.

In addition to lecturing on internal medicine and infectious diseases, Delgado Daza also works as a clinical ethicist. 

Amid the COVID-19 pandemic, Delgado Daza was also part of Einstein Health's Vaccine Crisis Communication team that worked to get accurate COVID-19 vaccine information to communities across Philadelphia.

He has Venezuelan roots and is a graduate of Universidad Central de Venezuela. Delgado Daza also completed a fellowship at Thomas Jefferson University Hospital.

Dr. Enrique Hernandez is the J. Robert Willson Professor and Chair Obstetrics and Gynecology at Temple University's Lewis Katz School of Medicine.

Before rising at Temple, Hernandez completed both a fellowship and residency at Johns Hopkins Hospital in Baltimore, Maryland. His fellowship was in gynecology oncology, and his residency focused more on becoming an OB/GYN doctor.

Hernandez is a graduate of the University of Puerto Rico School of Medicine in San Juan.

Dr. Erik Forno holds a number of clinical and academic roles as part of the University of Pittsburgh Medical Center (UPMC). 

He is the director of UPMC's Pediatric Asthma Center and the co-director of the Severe Asthma Clinic at UPMC's Children's Hospital of Pittsburgh.

On the academic side of things, Forno is an associate professor of pediatrics and clinical and translational science at UPMC.

Forno has Peruvian roots and is a graduate of the Universidad Cayetano Heredia, located in Lima, Peru, where he received his MD. 

It was at that point, Forno made the jump to the U.S., where he got his masters of public health from the Harvard School of Public Health. 

Before working at UPMC, Forno completed residencies in pediatrics at the Children's Hospital of Denver and pediatric pulmonology at the Children's Hospital of Boston. He also completed a research fellowship at Harvard's Channing Lab. 

Dr. Sarah Ramirez is a practitioner of family medicine and obstetrics as part of the Penn State Health Medical Group in Harrisburg. 

She also previously served on the Population Health Committee and Council on Diversity, Inclusion and Equity at the Penn State Health Milton S. Hershey Medical Center and was a director and instructor in Penn State College of Medicine's medical interpreter program.

In academics, Ramirez is an assistant professor in the department of family and community medicine at the Penn State Cancer Institute.

Ramirez has been recognized in multiple capacities in her career, first in 2018, as part of Penn State College of Medicine's "Exceptional Moments in Teaching" program, and then in October 2022 by Latino Connections for her work as the "most valuable player" of CATE, Pennsylvania's COVID-19 mobile response unit.

"Dr. Ramirez's innovation and passion inspired so many important components of this initiative that simply would not be possible without her help," George Fernandez, chief executive officer of Latino Connection, said at the time. "She assisted with developing safety protocols for the transportation and refrigeration of the vaccines distributed through the CATE unit, a critical part of this initiative's success."

Latino Connection had previously honored her in 2018 as one of Pennsylvania's 100 most influential Latino leaders.

As for schooling, Ramirez graduated from the Ross University School of Medicine for her medical degree, then located in Portsmouth, Dominica in the Caribbean. These days, the school is based in Bridgetown, Barbados. From there, she completed a residency in family medicine at MedStar Franklin Square Hospital Center in Maryland, and then a fellowship in women's health, obstetrics and gynecology at the University of Illinois College of Medicine in Peoria.

AL DÍA's 2023 Top Doctors Forum and Reception will happen on Monday, June 12.

He Returned To The US For His Daughter's Wedding. He Left With A $42K Hospital Bill

By Sarah Jane Tribble

Last June, Jay Comfort flew to the United States from his home in Switzerland to attend his only daughter's wedding. But the week before the ceremony — on a Friday evening — Comfort said he found himself in "excruciating pain."

"I tried to gut it out for three hours because of the insurance situation," said Comfort, a retired teacher and American citizen who has Swiss insurance.

When the pain became unbearable, Comfort called his brother, who drove him and his wife, Nazuna, a few miles to the nearest emergency department, at the University of Pittsburgh Medical Center's hospital in Williamsport, Pennsylvania.

Every bump of the drive was "like someone taking something and just jabbing it into my abdomen," he said.

At the hospital, Nazuna Konishi Comfort handed over her husband's Swiss insurance card, which confirmed coverage by Groupe Mutuel. Jay recalled the staff making copies of his insurance card and then treating his acute appendicitis. Doctors performed emergency surgery to remove the inflamed appendix.

Diagnostic tests confirmed he had a rare cancer, which doctors in Switzerland later removed with another surgery after he returned home. "It was a miracle," Comfort said, adding that the cancer was completely removed.

After his appendectomy, Comfort recalled vomiting and then waiting in a recovery room. In all, he spent about 14 hours at UPMC Williamsport before being released. He attended his daughter's wedding and, eventually, traveled back to Switzerland.

Then the bill came.

The Patient:

Leslie "Jay" Comfort, 66, a retired educator who worked in Japan and Switzerland. Comfort pays a monthly fee and deductible for Switzerland's mandatory basic health insurance, which he has with the Swiss-based Groupe Mutuel. His benefits — and the prices for procedures — are defined by the Swiss government.

Medical Service:

Emergency laparoscopic appendectomy and diagnostic tests, which showed Comfort had a rare subtype of cancer called goblet cell adenocarcinoma.

Service Provider:

University of Pittsburgh Medical Center Williamsport, which is about 3½ hours northeast of Pittsburgh. The UPMC health system is one of the state's largest employers, with 40 hospitals.

Total Bill:

$42,156.50, covering emergency surgery, scans, laboratory testing, and three hours in a recovery room. His insurer has said it will pay him about $8,184 (7,260.40 in Swiss francs), which is double the procedure's price in Switzerland. This left him to cover the remaining roughly $34,000.

What Gives:

Although Comfort has health coverage, his Swiss insurance had no contract with the U.S. Hospital where he underwent emergency surgery — or with any other provider outside Switzerland.

With what is considered an excellent health system, Switzerland has the highest prices for medical care in Europe. As in the U.S., the country relies on private insurers and hospitals. But the cost of care in Switzerland is substantially lower than what is charged in the U.S., so the reimbursement his insurer offered is a fraction of what Comfort owes the U.S. Hospital.

"I'm trying to do the right thing and say I'm willing to pay my responsibility," he said.

Groupe Mutuel does not have agreements with foreign providers, such as UPMC, and does not deal with them directly, said Lisa Flückiger, a spokesperson for Groupe Mutuel. The insurer originally agreed to reimburse Comfort what would have been paid in Switzerland for the same treatment in a public hospital and then double that because it was an emergency in a foreign country — a total of 4,838 in Swiss francs, or about $5,460.

While helpful, Comfort said, that amount wouldn't pay off the $42,156.50 he owes UPMC.

UPMC has expanded its reach throughout Pennsylvania and is now the largest provider of care in many parts of the state. In 2016, it purchased a smaller health system and now runs two major hospitals, UPMC Williamsport and UPMC Williamsport Divine Providence Campus.

Studies show that in areas where hospital consolidation is high, prices go up. Because there is less competition, hospitals have more power to charge what they want when patients have private insurance or are paying out-of-pocket.

In the U.S., the amounts charged for medical care are "all over the map," said Johnathan Clarke, vice president of strategy and business development at Penfield Care, a medical cost-containment company in Canada. The company negotiates medical bills on behalf of individuals, including international visitors to the U.S., but is not involved in Comfort's case.

Clarke said he would expect an appendectomy to be priced between $6,500 and $18,800, based on his analysis of Medicare payments in the Pittsburgh area. Healthcare Bluebook — which evaluates insurers' claims data to provide cost estimates based on what insurers have paid, rather than what providers charge — says a fair price for a laparoscopic appendectomy in Williamsport is about $14,554.

Comfort said a "reasonable price estimate" based on his own internet research would be between $7,500 and $12,000.

Comfort's care included an X-ray and an EKG, or electrocardiogram for his heart, because "there was no information relating to past medical/surgical history for this patient," wrote Susan Manko, vice president of public relations at UPMC. The staff also conducted pathology work that identified cancer.

But those additional services did not fully explain the gap between cost estimates and what the hospital charged. For instance, UPMC charged $8,357 for Comfort's three-hour stay in the recovery room.

Manko said Comfort's total bill aligns with UPMC's standard charges.

The cost disparities highlight the stark difference in international pricing. Cost estimates last year showed the average amount paid for an appendectomy in the U.S. Was "nearly exactly double" that paid in Switzerland, said Christopher Watney, chief executive of the International Federation of Health Plans, an industry association whose members include health insurers on six continents.

Health care in Switzerland, though, is often expensive compared with other European countries, Watney said. The Swiss pay double for an appendectomy compared with Germans, and more than three times that of those in Spain, he said. Across the globe, Watney said, many countries include an overnight stay in the cost of an uncomplicated appendectomy in contrast to Comfort's experience, which was billed as outpatient care.

Comfort, who has dual residency in Switzerland and Japan after nearly three decades working abroad, said he worked in the U.S. Long enough to qualify for Social Security benefits and Medicare. He said he had previously tried to gain Medicare coverage at one point but still is not enrolled, after being transferred to a couple of offices and "playing phone tag."

Still, unlike many patients dealing with a five-figure medical bill, Comfort said he is not concerned about UPMC harming his financial reputation. The health system doesn't "seem to put bad marks against people's credit record — and I don't have credit in the United States. I've been out for 30 years."

Manko confirmed that, saying UPMC reviewed and updated its collection policy last year; it states the health system will not engage in "extraordinary collection actions" such as lawsuits, liens on homes, arrests, or reporting to credit agencies.

She said the health system — which, as a nonprofit system, is tax-exempt — maintains a "robust financial assistance program" for patients unable to pay. But "to our knowledge" Comfort has not applied for financial assistance, Manko told KFF Health News.

The Resolution:

Comfort said he spent months waiting for a bill and finally reached out to UPMC because, if the bill had arrived this year, he would have had to pay his insurance deductible again on top of the charges.

Comfort received a full UPMC bill six months after his surgery. Manko said there was "confusion" at the time of Comfort's ER registration. Comfort's wife provided the insurance information, she said, "but there was no documentation in the patients record for address, policy number or policy holder information."

Once Comfort received his bill, he realized it was much higher than his Swiss insurance reimbursement and, frustrated, contacted KFF Health News.

Flückiger said the original payment amount Comfort's insurer calculated was by episode and did not include the scan or laboratory costs. After receiving questions from a KFF Health News reporter, Groupe Mutuel "realized that we have not included the laboratory analysis and the CT scan," which are not routinely part of an appendectomy, Flückiger wrote.

After KFF Health News provided a detailed summary of the UPMC bill, the insurer increased the amount it would pay Comfort. In all, the insurer said, Comfort should receive 7,260.40 in Swiss francs, or about $8,184.

Comfort still hopes to negotiate directly with UPMC to reduce what he owes.

"I don't want to try to walk away, saying I don't owe you anything," Comfort said. "That's not right. We're moral people, you know. But if you're going to try to gouge me and play the power trip and think you're going to try to get everything you can out of me, I won't play that game."

The Takeaway:

Though the Affordable Care Act was meant to provide insurance to more Americans and bring down the cost of care, hospital bills remain extraordinarily high and highly variable.

For a nonemergency, Comfort could have tried to compare prices at other hospitals. But most hospitals in the area where he fell ill are owned by UPMC. And an inflamed appendix can't wait for comparison shopping.

Clarke, the cost-containment expert, said the "only thing" Comfort could have done differently was to purchase a travel health insurance policy before leaving Switzerland. While prices for health care in continental Europe are comparable to Switzerland, the high cost of care in the U.S. Means Groupe Mutuel insurance is "insufficient."

That is especially important for visitors to the U.S. Since, as Robin Ingle, CEO of travel insurance company Ingle International, said: U.S. Prices are "kind of crazy numbers."

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Elmhurst Hospital Doctors End Strike After Reaching Tentative Deal With Queens Hospital

Resident doctors at Elmhurst Hospital Center are ending their three-day strike will return to work after reaching a tentative agreement.

The 165 doctors, employed at Elmhurst through the Icahn School of Medicine at Mount Sinai and unionized with the Committee of Interns and Residents, claimed victory in the strike, which they said was motivated by the issue of pay parity.

On the picket lines Monday, the early-career doctors said their top priority was resolving what they saw as second-class treatment compared to doctors at other hospitals employed through the same program.

"Mount Sinai will now have to think twice about leaving Elmhurst behind and perpetuating these disparities for union doctors in the future," said Sarah Hafuth, a resident doctor at the hospital.

The terms of their agreement include wage increases of 18% over three years, retroactive to November 2022, and a $2,000 ratification bonus, according to a news release.

The strike lasted for three days out of the authorized five. The residents had been in contract negotiations with Mount Sinai for more than 10 months.

"This fight was always about power, and Elmhurst residents are truly building that together," Hafuth said. "Getting a multi-billion-dollar revenue employer like Mount Sinai to move this far really shows what our movement as residents can achieve — even up against the most flagrant union busting and profit-driven corporations."

Mount Sinai has also agreed to negotiate on hazard pay and meal allowance in the new contract, which is set to expire in 2025.

Elmhurst was devastated in 2020 by COVID-19, and the situation there was a microcosm of a larger post-pandemic labor movement playing out in the healthcare industry. This strike was the first by physicians in in New York more than 30 years.

Tanathun Kajornsakchai, a psychiatry resident who worked at the hospital during the peak of COVID, said that he was proud that the union reached an agreement.

"Our little community of physicians was able to go and demand a multi-billion-dollar corporation to meet us at the table. And for them to move the way they did for us — I think that's huge for us."

Resident physicians at Mount Sinai Morningside West, also employed by the Icahn School of Medicine, authorized a strike vote on Monday. A date for the vote has not been set.

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