Debra Perina: Driven to make a difference in emergency medicine
The teen had threatened to kidnap his girlfriend and explode a pipe bomb at his high school. He was Debra Perina’s patient, having been ECO’d by law enforcement. After consulting with a psychiatrist, both were in agreement that the boy needed to be committed for mental care.
But the Community Services Board (CSB) rep had a different idea: turn him loose.
“My comment to them was, ‘What are you thinking?” recalls Perina, an emergency physician at the University of Virginia Health System in Charlottesville. “Their comment to me was, ‘You have absolutely no role or ability to tell me what to do with this this patient.’”
Twenty-four hours later, the freed teen indeed kidnapped his girlfriend, disappeared, and two days later, was shot and killed while attempting to run over an officer with his car. Perina was also the medical examiner on the case, and with a large body of evidence in her favor, was determined to make a change in Virginia law to put physicians at the table in decisions regarding temporary detention orders.
“Right there is what started my advocacy,” she says.
Dr. Perina with Steve Anderson, former ACEP chair, in San Francisco after attending an ACEP Board meeting.
Perina, backed by the support of VACEP, became a one-woman army in the fight to change mental health rules in Virginia and require magistrates to consider the input of emergency physicians during the CSB decision-making process of whether to render TDOs. Statute 37.2-809 went into effect in July 2007, four months after the Virginia Tech shootings perpetrated by a gunman who incidentally was released by a CSB worker a day prior despite significant warnings by the emergency physician who evaluated him that his mental health presented an imminent danger. “I will tell you, had that bill been in effect, one wonders if Blacksburg would have ever happened,” she says.
At VACEP’s 2020 CME Conference this month, Perina was honored with the 2020 Dr. Forrest D. McCoig Career Achievement Award for her leadership in emergency medicine. Over the course of her 33-year career, the professor of emergency medicine at the UVA School of Medicine has become a state and national leader in emergency, trauma and pre-hospital care. A national speaker on a range of emergency medicine topics, she has served as chairwoman of the national ACEP and on multiple committees on the American Board of Emergency Medicine (ABEM), including serving as its 30th president.
Yet she is most proud, she says, of her role in helping create the emergency medical services (EMS) subspecialty, approved by American Board of Medical Specialties in 2011. With the subspecialty in place, EMS physicians ensure medical oversight of EMS treatments, medications and procedures, manage quality of care, and train paramedic teams to ensure they are performing correctly in the field. (During this interview, Perina, on call for EMS providers in the Charlottesville area, received a phone call from an EMT seeking her input). She is one of 803 emergency physicians nationwide who are board-certified in EMS medicine.
“Prior to the development of this specialty, there was not a lot of direct physician involvement in EMS besides a small cadre of us who were aggressive about moving EMS forward and ensuring treatments were evidence based,” she says.
Dr. Perina and members of VACEP lobby for emergency medicine in the halls of Congress.
At UVA, Perina is actively involved in research, and has authored numerous peer-reviewed papers and written and contributed chapters to textbooks. Working at an academic medical center also means mentoring the next generation of emergency physicians — indeed, she was drawn to the specialty herself by an emergency physician who mentored her. “I mentor anyone who is interested in interested to getting it,” she says.
She also encourages residents to get involved beyond shifts.
“If you look at the burnout problem in emergency medicine, there have been some pretty robust studies showing that one of the things that protects you is being involved in organized medicine, in some fashion,” she explains. “That can take several different forms but bottom line is that you do more than your shifts — you’re involved in some way. For me, that revolved around a passion for changing things for the better for patients and my peers, which drove me to want to make a difference.”
She tells others: “never doubt the ability of one person with passion to effect change.”
Meeting with U.S. Senator Tim Kaine of Virginia.
On a light note
It was Deb Perina’s med school mentor, and her penchant for being a “black cloud” during her med school that drove her to emergency medicine.
“Even as a med student, when I was doing my rotations, bad things tended to happen,” she recalls, “and by the time that I pulled my third patient out of the bathroom in cardiac arrest I thought, ‘I probably need to know how to handle this.’”
So is she still considered a black cloud?
“Oh yeah,” she says wryly. “That never changed.”
