Sombrero

Pima County Medical Society

Home Medical Society of the 17th United States Surgeon-General

APRIL 2015

Stars on the Avenue issue

STARonSthe

ve
bell A

Camp

AVENUE

Stars on the
Avenue 2015

PRESENTED BY THE

Pima County
Medical Society

An Evening under the Stars

A Medical Community Celebration

to Honor Tucsons Outstanding Physicians
Stars on the Avenue returns April 18, 6-9 p.m., at St. Philips Plaza and features an
exclusive invitation list limited to physicians and their guests. Progressive dining is
provided by outstanding Tucson restaurants as we honor local doctors and raise money
for Mobile Meals of Tucson.
Presented by Pima County Medical Society and PCMS Alliance, Stars on the Avenue
expects more than 350 physicians to attend this years event as we honor our
Physician of the Year and others for their outstanding service and commitment to
organized medicine, volunteerism, and for a lifetime of achievement in the practice of
medicine.
Event proceeds go to Mobile Meals of Tucson, an organization that helps preserve the
health, dignity and independence of home-bound adults by delivering special diet
meals. Volunteers not only deliver meals, but also provide social contact and a
connection to other community organizations.
For group discounts or information about event sponsorships please contact PCMS
Executive Director Bill Fearneyhough at 795-7985 or email billf5199@gmail.com.
Tickets may be purchased by logging onto pimamedicalsociety.org and clicking on
Purchase Stars on the Avenue Tickets tab.
2

SOMBRERO April 2015

Sombrero
Pima County Medical
Society Officers

Official Publication of the Pima County Medical Society

PCMS Board of Directors

Eric Barrett, MD
David Burgess, MD
Michael Connolly, DO
Jason Fodeman, MD
Howard Eisenberg, MD
Afshin Emami, MD
Randall Fehr, MD
G. Mason Garcia, MD
Jerry Hutchinson, DO
Kevin Moynahan, MD
Wayne Peate, MD
Sarah Sullivan, DO
Salvatore Tirrito, MD
Scott Weiss, MD
Leslie Willingham, MD
Gustavo Ortega, MD (Resident)

President
Melissa Levine, MD
President-Elect
Steve Cohen, MD
Vice-President
Guruprasad Raju, MD
Secretary-Treasurer
Michael Dean, MD
Past-President
Timothy Marshall, MD

Snehal Patel, DO (Alt. Resident)

Joanna Holstein, DO (Alt. Resident)
Jeffrey Brown (Student)
Juhyung Sun (Alt. Student)

At Large ArMA Board

R. Screven Farmer, MD

Pima Directors to ArMA

Timothy C. Fagan, MD
Timothy Marshall, MD

Board of Mediation
Timothy Fagan, MD
Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Mark Mecikalski, MD

Delegates to AMA
William J. Mangold, MD
Thomas H. Hicks, MD
Gary Figge, MD (alternate)

Printing
Commercial Printers, Inc.
Phone: 623-4775
E-mail: andy@cptucson.com

Advertising
Phone: 795-7985
Fax: 323-9559
E-mail: dcarey5199@gmail.com

Art Director
Alene Randklev, Commercial Printers, Inc.
Phone: 623-4775
Fax: 622-8321
E-mail: alene@cptucson.com

Publisher
Pima County Medical Society
5199 E. Farness Dr., Tucson, AZ 85712
Phone: (520) 795-7985
Fax: (520) 323-9559
Website: pimamedicalsociety.org

$679,000

SOMBRERO April 2015

Thomas Rothe, MD
immediate past-president
Michael F. Hamant, MD
secretary

Richard Dale, MD
Charles Krone, MD
Jane Orient, MD

Editor
Stuart Faxon
E-mail: tjjackal@comcast.net
Please do not submit PDFs as editorial copy.

Tucson Country Club

Arizona Medical
Association Officers

Members at Large

Executive Director
Bill Fearneyhough
Phone: 795-7985
Fax: 323-9559
E-mail: billf 5199@gmail.com

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Vol. 48 No. 4

SOMBRERO (ISSN 0279-909X) is published monthly

except bimonthly June/July and August/September by the
Pima County Medical Society, 5199 E. Farness, Tucson,
Ariz. 85712. Annual subscription price is $30. Periodicals
paid at Tucson, AZ. POSTMASTER: Send address
changes to Pima County Medical Society, 5199 E. Farness
Drive, Tucson, Arizona 85712-2134. Opinions expressed
are those of the individuals and do not necessarily represent the opinions or policies of the publisher or the PCMS
Board of Directors, Executive Officers or the members at
large, nor does any product or service advertised carry the
endorsement of the society unless expressly stated. Paid
advertisements are accepted subject to the approval of the
Board of Directors, which retains the right to reject any
advertising submitted. Copyright 2015, Pima County
Medical Society. All rights reserved. Reproduction in
whole or in part without permission is prohibited.

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Inside
5 Dr. Melissa Levine: Silence is golden? Dont you
believe it!

6 Letters: He would do it again, too.

7 Milestones: Dr. Epstein retires, Dr. Weiss
honored, and more.

10 Membership: Life in the Age of Hilts.

12 In Memoriam: Dr. Clovis Jack Snider died in
February.

13 PCMS Awards: Everything you wanted to know

about our awardees, to be presented at Stars
on the Avenue April 18.

17 PCMS News: AMB takes another executive

director shot.

20 Urology: Dr. Susan Kalota addresses the vaginal

mesh controversy.

21 Stars on the Avenue: On April 18, our event

again had two reasons for its title.

23 Makols Call: Gearhead George goes to the

Barrett-Jackson.

26 CME: Credits locally and out-of-town.

On the Cover
The 11-inch Schmidt-Cassegrain telescope brings in detailed views of
the desert night sky as part of a Star Tour. Arizona Star Tours uses
several of these telescopes as part of the 2015 Stars on the Avenue
event on April 18. Ben Loker, owner of Arizona Star Tours, is featured
in this months issue. (Arizona StarTours Photo).

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SOMBRERO April 2015

Lets talk
By Dr. Melissa Levine
PCMS President

n January I received a fingerprint card and a letter telling

me to get printed and send in
$50 before I could renew my
license at the end of March.
Because this sounded like a pain
in the patootie, and I was privy to ongoing legislation that might
negate the need to do this, I delayed. While I am not loving what
Gov. Doug Ducey is doing to education, I am happy to say that
thanks to a push from ArMA, and PCMS, he signed legislation that
relieved the necessity of background checks for physicians who
are renewing licenses.
Last weekend with little hassle and a lot of $$$$, I successfully
renewed both my license and DEA online. The downside to that is
that this column was going to regale you with the details of going
down to the police station to be fingerprinted, wading through
the red tape of background checks, and what PCMS and ArMA
were doing to help you avoid a similar harrowing experience.
So, Plan B: Communication is the cornerstone of relationships,
personal, professional, and doctor-patient. You have likely heard
the story of the patient who was told by her doctor to put on a new
patch every three days, and she came in for follow-up complaining
she was running out of room to place
patches. She was wearing 10 of them.
Communication failure.

One moment please for Dr. X. I was put on hold and after a
couple of minutes it rang back, I explained to the person who
picked up that I was waiting for Dr. X, he explained that Dr. X was
at a different office and transferred me to the back line there.
Someone picked up and I again explained I was waiting for Dr. X. I
actually waited through three loops of this, caught in my own
personal, perverse Groundhog Day movie. Finally Dr. Xs MA
picked up and asked me if I needed to talk to him again. I
explained I had yet to speak to him. Unfortunately, he had left for
the hospital. It did end successfully, as she gave me his cellphone
number and we spoke.
This is where PCMS can help enhance communication. I invite all
of you to come to a board meeting, get involved. Your medical
society needs to ask you the right questions, but we can only do
this if you answer them.
Tell us what you think needs to be done with the organization,
with medicine in Pima County, and in Arizona. Or come to a Mix
at Six where we can simply socializespouses invited. Coming up
April 18, as you can tell from this issue of Sombrero, is Stars on
the Avenue, where not only can you socialize, but you can come
honor some of our local docs and support Meals on Wheels.
There are opportunities for you. Lets communicate.

We all know that communicating with our

patients, establishing the human connection
with them, is the key to the practice of
medicine. I work with an EMR, so often I am
typing as well as listening. I have to make a
significant effort to make eye contact, and
to make sure I am really paying attention.
Doctors have to ask the right questions and
listen to the answers, as sometimes the
most important part of communicating is
hearing what isnt being said.
But what about communication with other
physicians? Clearly, we need to communicate
with our colleagues. I hear frequently, In
the old days, doctors used to see each
other in the doctors lounge. Now we never
meet each other. That was certainly an
issue when I was in my own little onewoman office, I never saw other doctors,
and only communicated when I needed to
talk to a specialist about a patient.
A couple of years ago, my MA knocked on
the door and told me a cardiologist was on
the phone for me. I had just finished with
the patient I was seeing, and walked to my
office to pick up the phone. His MA said,
SOMBRERO April 2015

Now youre
Thinkin Smart

Leers

On doing it again
To the Editor:

was pleased to read PCMS President Dr. Melissa Levines

article in the March Sombrero [pondering whether a physician
would choose that career again]. Like Dr. Levine, I am one of
those who would do it again, as I loved every day of caring for
patients.

Simplify your communications with

Simply Bits state-of-the-art managed
voice and data services

I too did not like dealing with the administrative problems, but
that did not squelch the desire to care for my patients.
I also agree with her statements about Electronic Health Records.
It was more cumbersome for physicians to use, but better for
everyone else and for patient care.
Sincerely,
Steven J. Ketchel, M.D., F.A.C.P.
Retired medical oncolocist
Tucson
[Editors note: Dr. Ketchel is PCMS 2015 Volunteer of the Year.]

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Not only did it receive accreditation in all areas, but The Breast
Center also is being recognized as a national best-practice in
breast cancer surveillance. For Tucson-area women, this means
they can receive care at Carondelet that meets the highest
standards based on national best practices.

Milestones

Dr. Epstein retires

Dr. Norman R. Epstein, a member of
the PCMS Public Health Committee,
retired from his IM practice in
January after nearly four decades as
an internist in Tucson. Dr. Leslie
Willingham and another physician
former partner in ACP/El Dorado
Internal Medicine and Family
Practice, assumed care for a majority
of his patients, Dr. Epstein reported.

The Breast Center at Carondelet St. Marys focuses on prevention,

early detection, and expert treatment of breast disease, such as
breast cancer. It differs from other breast centers, the
organization says, because of its standardized, coordinated path of
care from initial surgeon visit to post-discharge follow-ups. The
clinical team offers a holistic approach to treatment, meeting each
week to discuss treatment plans and to follow each patient through
every aspect of carefrom diagnosis to treatment to recovery.
Patients have access to genetic counseling, Carondelets bilingual
patient navigator who provides education and support, and to
other specialists, such as a physical therapist and social worker.

Dr. Epstein is a native New Yorker who

graduated from NYU, received his MD
from SUNY Downstate Medical Center in 1972, interned at Kings
County/Downstate, and completed his IM residency in the
Tucson Hospitals Medical Education Program in 1975. He is
board-certified in IM and is a Fellow of the American College of
Physicians.

NAPBC accreditation is the gold standard for breast care and

something the team of specialists at St. Marys has been working
toward since the Centers inception in 2011, said Amy Beiter,
M.D., president and chief executive officer of Carondelet St.
Marys Hospital. It is a wonderful testament to the quality of
care patients receive here and the commitment of our medical
staff and clinical teams.
Approximately 550 breast centers across the US have earned this
distinction, Carondelet reported, including three in Arizona.
Two are in Phoenix, and now The Breast Center at Carondelet St.
Marys makes three. To receive NAPBC accreditation, a facility
must undergo a rigorous process, and score top marks in all 28
program standards, which measure leadership, clinical
management, and quality improvement criteria.

He worked at El Rio Neighborhood Health Center 1975-79, then

took a one-year sabbatical to travel with his wife to the U.K.,
Greece, Kenya, and India in 1979-80. Upon his return he became
founding medical director of CIGNA Healthplan in Tucson, then
known as INA, a position he held until 1987. He remained at CIGNA
as a practicing internist until 2000 when he joined Arizona
Community Physicians, where he has practiced for the last 14 years.
Dr. Epstein is an avid Wildcat basketball fan, is
married to the botanical artist Margaret Pope,
and has a son who is a biomedical engineer in
Southern California. He said he hopes to spend
his retirement years cultivating an interest in
writing and the arts. He had three essays
printed in the On Being a Doctor section of
Annals of Internal Medicine; and has dabbled
in clay sculpture and photography, with three
photographs published in NEJM. He said he
looks forward to having an open schedule for
relaxation, travel, working around the house,
and enjoying his friends and family.

Carondelet St. Marys

awarded for breast
care

In March The Breast Center at Carondelet St.

Marys Hospital was granted full accreditation
from the American College of Surgeons
National Accreditation Program for Breast
Centers (NAPBC), the highest recognition a
breast center can receive, the organization
reported. Carondelets program is the first
breast center in Southern Arizona to receive
this distinction, making it Tucsons first and
only fully accredited breast center.
SOMBRERO April 2015

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SHM honors
Dr. Weiss
Dr. Scott Weiss recently received the
prestigious designation of Fellow in
Hospital Medicine from the Society of
Hospital Medicine, in honor of his
dedication to the specialty.
Dr. Weiss is one of two designated
Chief Hospitalists for Sound Physicians
at Carondelet St. Josephs Hospital.
Sound Physicians recently acquired Cogent Healthcare. The
combined companies are now one of the nations largest providers
of hospitalist services.

Dr. Galgiani clinical adviser

to HealthTell
Dr. John N. Galgiani, director of the
UA Valley Fever Center for Excellence,
was recently appointed a clinical
adviser to HealthTell, an early stage
life-sciences company based in San
Ramon, Calif., which is expanding its
Immunosignature technology for
accurate and timely detection and
monitoring of chronic diseases to
include infectious and autoimmnune
diseases, the university reports.

Dr. Galgiani and Chaim Putterman, M.D. of New Yorks Albert

Einstein College of Medicine were both appointed. In announcing
the appointments, Bill Colston, Ph.D., HealthTell CEO, said,
HealthTell is excited to welcome Dr. Galgiani and Dr. Putterman
to our growing team of clinical advisers. They will provide
valuable insights to expand our focus beyond oncology to
infectious and autoimmune diseases. Our robust and unique test
provides a snapshot of the immune systems response to disease.
We are grateful to have the opportunity to collaborate with
clinicians and researchers of this caliber.
There certainly is a need for new diagnostics to help physicians
manage patients with Valley Fever, Dr. Galgiani said, especially
early in the infection when current tests frequently are falsely
negative.
Dr. Galgiani has 35 years of experience in medical mycology
including the soil-borne Coccidioides fungus that when inhaled
causes coccidioidomycosis or Valley Fever, an infectious disease
primarily of the lungs. Cocci is endemic to the Southwestern
United States and Northwestern Mexico, including Arizona and
the San Joaquin Valley of California. It results in an estimated
150,000 infections annually. Often it is confused with communityacquired pneumonia and treated erroneously with antibiotics. In
a small percentage of patients it can be life-threatening. Dr.
Galgiani has devoted his career to raising awareness and
improving outcomes for people affected by Valley Fever.
The VF Center for Excellence has also produced a booklet to
improve VF diagnosis and treatment. The new pocket reference
for physicians and other healthcare professionals is available
through several organizations including the U.S. Centers for
Disease Control and Prevention.
The booklet includes all the facts that physicians and other

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SOMBRERO April 2015

healthcare professionals need about Valley Fever, including how

to diagnose it and what to do when a new infection is discovered.
While this information has existed for many years, it now is readily
available so that busy clinicians can include it in their routine
practice, the UofA reported. The booklet was made possible by
an unrestricted educational grant from Nielsen Biosciences, Inc.
This grant has enabled the Center to do something it long has
hoped for, Dr. Galgiani said. We have had this information
available on our website, but now we can distribute the
information in a form that makes it readily available to busy
clinicians. The booklet is small enough to fit in their lab coat. If
doctors were more attuned to how common Valley Fever is, they
would look for it more frequently. Early diagnosis should reduce
the use of antibiotics and lots of additional testing, none of which
helps the patient, and increases costs.
The booklets first printing, in January, was 5,000 copiesenough
for the Center to give a free copy to every medical student and
medical resident in Arizona. Copies also are available through the
Arizona Medical Association, the medical societies of Pima and
Maricopa counties, ADHS, and the CDC. An electronic copy of the
booklet also is posted on the Valley Fever Center for Excellence
website at www.vfce.arizona.edu

UAHN named ebola

treatment center
The U.S. Centers for Disease Control and Prevention last month
named University of Arizona Health Network one of 55 Ebola
Treatment Centers in the U.S., the university reported.
Wed like to thank the UA Health Network and MIHS for stepping
up to ensure appropriate treatment is available to Arizonans
when faced with any infectious disease, said Cara Christ, M.D.,
chief medical officer, Arizona Department of Health Services.
Their ability to implement higher infection control practices and
excellent patient care demonstrates their commitment to the
health and wellness of all Arizonans.
In December 2014, UAHN was named one of two Infectious
Disease Centers of Excellence by ADHS, making it Southern
Arizonas hospital for the treatment of Ebola and other highly
infectious diseases, the university reported. Since then, UAHN
has conducted two Ebola readiness drills, undergone a site visit
by CDC specialists, and sent staff members for additional training
at the CDC in Atlanta, and Emory University, where a number of
Ebola patients received treatment.
Both of UAHN hospitals, UAMCUniversity Campus and UAMC
South Campus, are prepared to identify and diagnose Ebola, the
university reported. Both hospitals draw on the expertise of
dozens of clinicians and researchers specializing in infections
disease medicine and critical care, said Sean Elliott, M.D., UAHN
infection prevention director and a member of the Governors
Council on Infectious Disease Preparedness and Response.

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Membership

Man ages, car stays same

Story and Photos by Stuart Faxon

Dr. Schuyler Hilts

Nuclear medicine pioneer

ts pretty amazing, amazes Dr. Schuyler Van Dusen Hilts, 87,

that other than high blood pressure, theres nothing wrong
with me.
Craggy, tall and gangling, with hearing aids, he goes to the Y
three days per week where he fights machines. He enjoys poker,
and blackjack depending on the odds, adding that the Dutch are
at least as parsimonious as the Scots are said to beand that he
has Scots blood to boot. Even the 1931 Ford Model A he still drives
as regular transportation keys into what he calls being cheap.
I came to Tucson with a station wagon, he recalled. I found
that was an expensive way to move around town. The family
needed another car, so I was looking for a VW bug, but I saw an
ad for the Model A for $250. That was my price range!

This photo, taken next to the old PCMS offices on Grant Road
circa 1980, shows Dr. Schuyler Hilts and the 1931 Ford Model A
he adopted in 1958 (PCMS photo).

It was 1958 and the car had 200,000 miles on it, so it took some
fixup, but now the cars gone 570,000 miles. Keeping it mechanically
sound and looking stock naturally has meant attentive upkeep,
though if rust ever sleeps, it certainly does so in our desert.
Sky was born in 1927 in Yakima, Wash., four years ahead of the
car. He earned his B.A. in bio-sciences with distinction at
Stanford in 1948, and then his M.D. in 1952 at The Johns Hopkins
University. He interned at the U.S. Naval Hospital in Oakland,
Calif., and did his IM residency at Kaiser Foundation Hospital, San
Francisco. During his residency, he took a Navy correspondence
course in use of radioactive isotopes I-B1 and P-32 including
chromic phosphate.
Hed joined the Navy at 17 in 1944 as a hospital corpsman, and hes
still in, as a retired reservist. His ID cards expiration is labeled
indef. A liberal Democrat and environmentalist, whose business
card has tree huggers after his and his wifes names, Sky makes
sure to sign any correspondence to warhawk Republican Sen. John
McCain with Cmdr. Ret., USNR after his name.
I got interested in nuclear medicine because of what they were
doing there on site, he said, and I wanted to learn more about
it. Id always had an interest in physics as it comes into medicine. I
wanted to investigate the activity of lumps in the thyroid,
whether that activity was hot or coldmalignant or not. So he
took over the Kaiser hospitals isotope lab and became the second
Atomic Energy Commission-licensed physician to do the procedures,
mostly thyroid uptakes and lab blood tests involving T3s and T4s.
In San Francisco Sky met another internist who was from Tucson,
and they talked about the Sonoran Desert climate, Sky already
hating winters. That doc wanted another internist to come into his
office, so Sky and his then-wife drove another persons car from
San Francisco to Tucson in 1957. That was in July, he recalled, and
I liked it then. I still love living here more than any other place.
He practiced internal medicine while sub-specializing in
diagnostic and therapeutic use of radioisotopes. I practiced
internal medicine for 10 years at $5 for an office call, $7 for a
hospital visit, and $10 for a house call. There was one doctors
directory in town for every kind of physician.
10

Dr. Hilts and his pet car in 2007 outside PCMS.

TMC was interested in starting an isotope lab, and they came to

me because I was licensed, Sky said. Only two docs in town were,
and the other was associated with St. Marys. They got the stuff for
me, and the chief tech didnt get along well with the head of
pathology, so this led to him coming to work for me. Since they
were both hardheaded bastards, the tech went to Oakland to
take a course in radioisotopes, then Sky took the same course
from his own chief tech. Subsequently, Sky said, they both taught
other technologists there and at other places in Tucson.
Nuclear medicine is multidisciplinary, making it hard to pinpoint
SOMBRERO April 2015

that, and a two-thirds full-time internal medicine job. Something

had to give! Since nuclear medicine was more fun, he went
into it full-time at TMC.
After hed been at TMC awhile, he recalls, they got more scanners
and had to move to a larger department space. Gerd Schloss,
the guy who was running the lab, and all of us got a percentage of
what the lab made, but Gerds percentage got astronomical, so
they stopped the percentage deal, and [the choice was] either he
did all his own billing, or became a hospital employee. So he
became a TMC employee. As business increased, he made more
and it amounted to a good living. [PCMS member Gerd T.
Schloss, M.D., who died at 93 in 2007, was a microbiologist and
TMC pathologist.]
Retired since 1991though he only gave up his medical license
last yearSky looks back on a time when we were one of the few
specialists in town, we all liked each other, and I could always get
help with anything I needed. The biggest change took place just
as Sky was leaving: positron-emission tomography (PET) scanners.
Atheism is a major component of the Sky Hilts philosophy. My
parents didnt consider religion important, he said, even
though I was raised near a local Protestant evangelical church. I
was sent to Sunday school there. Mom said, Its part of our
culture. I came home and told her, Mom, they dont like little
boys asking questions! It wasnt part of my life from then on.
In the Navy, Sky got called before the platoon commander, a
Texan, who said: I hear you dont believe in God! I dont want
you talking to them like that no more. These are good, Godfearin boys! Sky says hes often raised a toast to Sin,
degradation, and the State of Texas!
Dr. Hilts today, 87 and still four years older than the car.

its beginning. We can only place it between the discovery of

artificial radioactivity in 1934, and production of radionuclides at
Oak Ridge National Laboratory for medicinal use, in 1946.
So on either side of 1960 the two Tucson men were running a
little isotope lab in a closet at TMC when scanners came long,
which then cost about $10,000. But with them, radioactive doses
could be imaged in the brain, and later in the liver and lungs, Sky
said. The first thing I knew, I had two-thirds full-time job doing

SOMBRERO April 2015

For many years he scuba-dived in the Sea of Cortez and other

places. I loved it. Its the only sport I miss. If if I had not become a
doctor, I would have become a marine biologist.
Hes been married to his wife, Anne, since 1991. I love being
married, Sky exults. I got married in med school, at 21, and
stayed married for 42 years. I feel real lucky now. Im more in love
with Anne now than when we first married. Shes only 72. Shes
my child bride!
Disclaimer: Both the writer and Dr. Hilts often attend monthly
dinner meetings of Tucson Atheists.

11

In Memoriam
By Stuart Faxon

Clovis Jack Snider, M.D.

1928-2015
A society grows great when old men plant trees in whose
shade they know they shall never sit.
Quoted at memorial service

lovis Jack Snider, M.D., otorhinolaryngologist, retired U.S.

Army colonel, acoustic bassist and longtime communityminded Tucson resident, and PCMS member 1967-76, died on
Feb. 4 in Tucson, his family reported in the Arizona Daily Star. He
was 86.
He was born Nov. 9, 1928 in Danville, Ill., and when his family
moved to Tucson in 1943 he went to Tucson High School,
graduating in 1946, the family reported. At The University of
Arizona he ran on the track team and was a founding member
of the Alpha Phi Omega service fraternity, one of the first such
organizations to be racially integrated.
He earned his undergraduate degree at the UofA, his masters at
the University of Illinois, and his M.D. in 1956 at Northwestern
University Medical School, Chicago. He interned in surgery at
Charity Hospital of New Orleans, and did his GS residency at
University of Michigan Hospital, Ann Arbor.
He served active duty in the U.S. Army 1957-61 and was a lifelong
reservist. The family reported that his assignments included
Germany in his early career, and Honduras in the late 1980s. In
Tucson, Col. Snider commanded the 6251st U.S. Army Hospital
before his retirement in 1996.
Dr. Snider was board-certified in otorhinolaryngology. In 1967 he
opened his practice for ENT surgery on North Iroquois Avenue in
the St. Marys Hospital area because it was where he felt his
service would be most beneficial to the community, the family
said. But a statement he made in 1976 upon leaving PCMS could
now be called prescient:
I would observe that some of my fellow physicians are in less
than satisfactory financial condition, Dr. Snider wrote when it
embarrassed him that PCMS dues had become a hardship. They,
too, are reluctant to formally describe their circumstances. The
inexorable increases in costs seem out of proportion to the ability
of the public to pay. It appears to me that unless he has some
special income arrangement, the ethical, careful, solo
practitioner can no longer survive.
Dr. Snider retired in 2005, but he maintained his licenses for
several more years in order to be prepared, if needed, in times of
crisis, the family reported.
Beloved by his friends and family, Dr. Snider will be remembered
for his intellect, compassion, sense of humor, and commitment to
12

Dr. Clovis Jack Snider in 1967 when he joined PCMS.

service, the family said. He dedicated his lifes work to the wellbeing of others in his community and the environment, both
locally and globally.
He volunteered in many church and civic activities, supported
sheltering of homeless persons, cared for veterans, and actively
practiced conservation of resources, especially water. He will also
be remembered with fondness for his advocacy of a healthy
eating style (big breakfasts and no supper), his discipline for
physical fitness, his love of music and poetry, and beautifully
designed rock construction.
Two of his passions were music and running. He played string
bass in a local folk, gospel and cowboy music group, the
Canyonaires, and with the Tucson Fiddlers Association,
performing at care facilities, church gatherings, and community
events in Southern Arizona.
An avid long-distance runner into his late 70s, Dr. Snider
completed the Tucson Marathon several times and participated
in many other races. His favorite race was a benefit run Sundown
at the Pass, that passed his driveway on the way to Gates Pass.
Dr. Sniders younger brother Carl predeceased him. His wife of 57
years, Emily Jean; daughters Lauri and Mary Sue; younger sister
Mary June Stoddart of Castro Valley, Calif. and her son, Collin;
nieces Una and Airdri; granddaughters Kenna and Amelia Malone
and Hannah and Hattie Houser; and a widely extended family of
nieces, nephews and their children survive him.
Memorial contributions may be donated to First United Methodist
Church, 915 E. 4th St., Tucson 85719; Clovis B. Snider Scholarship
Fund at Claremont School of Theology, Claremont, Calif. 917113199; Pine Canyon Camp, 1701 S. Downings Pass Rd., Willcox
85643; Tucson Communith School, 2109 E. Hedrick, Tucson
85719; or National Parkinson Foundation, www.parkinson.org . n
SOMBRERO April 2015

he proved time and again his dedication to the care of his

patients.

PCMS Awards

Physician of the Year

Our 2015 PCMS Physician of
the Year is Thomas C. Rothe,
M.D., a PCMS member since
1982. His practice is La Cholla
Family Practice, part of
Arizona Community
Physicians. He and his wife,
Karrin, a retired nurse, have
been married 35 years.
Born in 1948 in Bowling
Green, Ohio, near Toledo, Dr.
Rothe came to medicine in a
roundabout way, even though
his was a medical family. He
graduated from Stanford in
1970 with a major in history, then served two years in the Peace
Corps in Venezuela.
Upon his return he attended Ohio State University before
switching to the Medical College of Ohio at Toledo, where he
earned his M.D. in 1977. He came to The University of Arizona for
his internship and residency.
Dr. Rothe served on the PCMS Board of Directors 2001-03 and
2004-07, and as an ArMA delgate. He was PCMS president in
2007, ArMA president 2013-14, and also served as ArMA
Southern District director.
When Dr. Rothe was a boy, he said, hed sometimes go along on
housecalls with his dad, a small-town Ohio family physician. I
decided while in the Peace Corps that this is what Id like to do.
You can do a lot of things in family practice, including obstetrics
and pediatrics, thats the part thats really rewarding, but I dont
do OB anymore because it is so labor-intensive.
Colleague Darren Hee, M.D., one of Dr. Rothes office partners for
nearly 20 years, calls Dr. Rothe a great physician and individual.
Gary Figge, M.D., EM specialist at Northwest Medical Center who
has also worked with Dr. Rothe in organized medicine, said that
Dr. Rothe has demonstrated his dedication to the profession no
only by being involved in organized medicine and pushing for
measures and legislation to ensure excellence in the healthcare
of Arizonans in Pima County with his involvement in PCMS, but
also at the state with ArMA, serving many years on its board,
executive committee, and as president.
Tom was one of the first to use the hospitalist service in the care
of his patients when they were admitted to the hospital, so they
would have an in-hospital physician directly overseeing their care
in a more hands-on and efficient manner than he could from afar
at his clinic, as was the tradition at the time. Prior to hospitalists,
physicians would see hospital patients before clinic each
morning, and trust care in between to nurses and phone calls.
Once hospitalists became more often used, many more primary
care physicians used their services, they no longer went to the
hospital and simply saw their patients in follow-up in clinic.
Despite realizing that admitted patients received more direct
and efficient care from hospitalists, Tom still insisted he was
contacted all times if his patients were in the hospital, and
stopped in daily outside his clinic hours for a professional visit as
SOMBRERO April 2015

Though Tom focused on his clinic and no longer practiced in the

hospital, he continued to serve for many years as chair of the
Performance Improvement Committee that continually oversees
provision of care by physicians and other providers in the
hospital. This ensured that the staff caring for his patients truly
provided appropriate and optimal care, leading toward
opportunities of improvement and documented excellence in
provision of care at his hospital that few could surpass.
In addition, Tom impresses all by his temperament, his calm
demeanor, and his thoughtful and meticulous approach to not
only patient care, but solving other issues and problems in
healthcare in general. and with his involvement in organized
medicine and his community.
Finally, Tom is one of those gentlemen of old whom everyone
knows is just a good guy.

Rose Marie Malone

Award for Service
to Organized Medicine
Recipient of the 2015 PCMS
Rose Marie Malone Award for
Service to Organized Medicine
is R. Screven Farmer III, M.D.,
board-certified
anesthesiologist and PCMS
member since 1982.
The award is named for the
PCMS executive director
1981-91, who died
prematurely at age 53.
Born in in Copenhagen,
Denmark, Dr. Farmer earned
his undergraduate degree at
the Georgia Institute of
Technology and his M.D. in 1979 at Emory University School of
Medicine, Atlanta, Ga. He did his internship at The University of
Arizona and his residency at the University of Wisconsin, Madison.
He served twice as chief of anesthesia at Carondelet St. Josephs
Hospital starting in 1992. He was medical staff president there for
two years. He has served on the Board of Directors for his group,
Southern Arizona Anesthesia Services, and is their current president.
Dr. Farmer served on the PCMS Board of Directors in 2001 and
2007-2010, and was president of the Arizona Medical Association
2007-2008. He has since served on the ArMA Board of Directors.
Between 2013 and 2015 he also served on the board of the
Carondelet Foundation. He currently serves on the Arizona
Medical Board, the MD-regulatory board that is appointed by the
governor, approved by the Senate, and comprised of eight
physicians, one RN, and three members of the lay public.
He and his wife, Terri, have been married 32 years. She is a
psychiatric nurse practitioner with her own practice. The Farmers
have three sons, Jim, 28, who is a medical office assistant; Joe, 26,
who is a chemistry teacher and swim coach at Rincon High
School; and Jason, 20, who is a Pima Community College student.
Dr. Farmers hobbies include hiking, mountain biking, scuba
diving, photography, and evolutionary biology.
13

Dr. Farmers hobbies include hiking, mountain biking, scuba diving,

photography, and evolutionary biology. He said his interests in
medicine include health policy and economics, and the neurobiology
of consciousness. If you think about it, anesthesiology involves
rendering people unconsciousness with neuropharmacologic
interventions, but there isnt any consensus on defining what
consciousness even is. He also has interest and extensive experience
in measurement of, and improvement in healthcare quality.
Im deeply honored to accept this award, Dr. Farmer said, and
do so on behalf of myself and several others. First, on behalf of
my wife, Terri, and my family, who make the sacrifices that make
service possible. Secondly, on behalf of all the doctors out there
who see the work we do as not just a job and a paycheck, but as a
profession, a calling, and a privilege. And finally, on behalf of the
patients who rely on us to be their advocates.

Lifetime Achievement Award

Recipient of the 2015 PCMS
Lifetime Achievement Award is
James C. Balserak, M.D.,
M.P.H., F.A.C.S., F.A.C.E. a
senior partner in Southwestern
Surgery Associates, Ltd., where
he performs general surgery.
He also practices aerospace
medicine and since 2011 has
been a brigadier general in the
Arizona Air National Guard and
assistant to the director,
Defense Health Agency,
Defense Health Headquarters,
Falls Church, Va.
He and his wife, Kristi, have been married 26 years, having met
when they were 11. Their oldest son, JC, 19, is a sophomore at
Belmont University in Nashville, Tenn. Youngest Kevin, 16, is a
sophomore at Salpointe.
ABS-certified, he served three tours in Iraq and Afghanistan 200409 as chief trauma surgeon, and later as a critical care physician at
Ramstein Air Force Base, Germany. Occasionally known or
identified by such colorful sobriquets as Blade and Balz, Dr.
Balserak has been a PCMS member since 1994, and an honorary
PCMS member since 2011, a rare distinction in recognition of his
achievements, as there have only been six honorary PCMS
members since 1904. He is also a member of Tucson Surgical
Society. That he is only 52 means more lifetime and
undoubtedly more achievement.
He comes from a decidedly military family. My dad was a colonel
in the Army, a 30-year career army officer and Vietnam vet, Dr.
Balserak said. My brother Robert is a 30-year Air Force F-16
pilot, and a combat veteran with three tours in Iraq.
Born at Fort Benning, Ga. in 1964, Dr. Balserak earned his M.D. in
1990 at the Medical College of Virginia in Richmond, not Virginia
Commonwealth University School of Medicine. He did his GS
internship and residency at University of Arizona Medical Center
in the Tucson Hospitals Medical Education Program. He earned a
Masters in Public Health with a Concentration in Disaster
Preparedness in 2010 at Benedictine University, Lisle, Ill.
As an undergrad at University of Virginia, Charlottesville, he
earned a B.A. In chemistry, was summa cum laude and Phi Beta
Kappa and graduated With Highest Distinction. In 1984 he earned
14

Intermediate Honors for academic excellence following

completion of his second year as an Echols Scholar, and the next
year he was on the Academic Atlantic Coast Conference Honor
Roll. In 1984-86 he ran mens varsity track and field, specializing
in the long jump.
By 1990 Dr. Balserak was designated in Whos Who Among Rising
Young Americans. He has maintained an academic appointment
as Assistant Clinical Professor of Surgery at the UofA College of
Medicine. He chaired the TMC Department of General Surgery
2005-07. He was Arizona Diamondbacks team physician 2005-09,
and when the Tucson Toros were around, he served as first-base
coach as well as team doctor.
A career such as Dr. Balseraks even forces a distinction between
mere achievement and special achievement. In the latter
category, in 2000 he received the ArMA Distinguished Military
Service Award, and in 2009-14 he was elected by his peers for
inclusion in Best Doctors in America.

Volunteer of the Year

PCMS Volunteer of the Year is
Steven J. Ketchel, M.D., IM
physician and medical
oncologist, and PCMS
member since 1977, who
retired last year and serves on
our Bioethics Committee.
Born in 1956 in Cleveland, he
earned his undergraduate
degree at Stanford, and his
M.D. at The University of
Arizona College of Medicine in
1972. His Fellowship in
medical oncology was in the
Department of Medical
Therapeutics at M.D. Anderson Hospital and Tumor Institute in
Houston, now University of Texas M.D. Anderson Cancer Center.
Dr. Ketchel has been a local supporter of the American Cancer
Society, Inc. for more than 22 years, and served as its area
president. He also volunteers at St. Elizabeths Health Center
(formerly St. Elizabeth of Hungary Clinic).
PCMS cannot claim to be first in recognizing Dr. Ketchels
volunteerism: ACS awarded him as volunteer of the year in 2001,
saying he had demonstrated his incredible dedication to the
organization and its mission. Dr. Ketchel is a leader and an
inspiration to those who have worked with him, the local ACS
Leadership Council chairman said at the time. He excels in every
aspect of his volunteerism and, though he is active with many
organizations and affiliations, he remains willing to accept any task.
I was interested in helping people, Dr. Ketchel said of his
beginnings. I felt the practice of medicine was an excellent way
to accomplish that, and I entered in the second class of the
University of Arizona College of Medicine. I did my residency
there. I felt that I could offer more to patients as a medical
oncologist than an internist, and did my Fellowship at M.D.
Anderson in Houston as an American Cancer Society Fellow.
Marta and I chose Tucson as a good place to practice and raise a
family, and it has been. I retired from the practice of medicine in
September 2014.
Shortly after starting practice I decided to donate time to St.
SOMBRERO April 2015

Elizabeth of Hungary Clinic, and I continue at this time. I also felt

it was important to support the American Cancer Society and
served as an officer and volunteer on many projects over the past
35 years.
I have been a member of the TMC Medical Ethics Committee
and served as chair for the past four years. I have also been a
member of the Pima County Medical Society Bioethics
Committee.
I recently started volunteering at Reading Seed, a program of
Literacy Connects. I am also a Red Blood Cell and twice-monthly
platelet donor for the American Red Cross.
Both of my parents were volunteers, and they imbued me with
the desire to give back to the community in which we live. I have
continued with that desire. There is not enough money in
government to accomplish all we need to do to improve the
quality of life in Southern Arizona, and my being a volunteer helps
to achieve that.
I am supported in these efforts by my wife, Marta. I have two
wonderful children. My son Aron is an Assistant U.S. Attorney in
Los Angeles and the father of my two grandchildren. My daughter
Alana lives in San Francisco and is a health policy consultant with
Health Management Associates.

Steve Nash Award

The PCMS Steve Nash Award
is given annually to the nonphysician who has most
contributed to improvement
of healthcare in Tucson. This
year that is Kathy Byrne,
executive director and CEO of
El Rio Community Health
Center since September 2004.
During her tenure the
organization has added four
new service sites in Tucson,
and now provides
comprehensive primary care
medical and dental services to more than 83,000 patients
annually.
Kathy Byrne is an amazing CEO, said Steve Nash, executive
director of the Tucson Osteopathic Medical Foundation and
former PCMS executive director, for whom the award was named
in 2013. When Robert Gomez retired from El Rio, no one could
have imagined the place could be run better. After all, it was one
of three federally qualified health centers in the U.S. that lived
within its budget.
Under Kathy Byrne, El Rio became even better, at the edge of
innovation and service. It was an early adopter of EHRs, created a
diabetes clinic that tested motivations to keep people healthy,
and has expanded to at least 13 locations.
Somehow she found time to serve the community in a varied
number of task forces, commissions, think-tanks, and lectures.
She has been an effective leader in bringing a health information
exchange to Arizona and in keeping the Pima Community Access
Program not only alive, but kicking. An amazing person!
SOMBRERO April 2015

Kathy has more than 35 years of healthcare management

experience in Arizona. Her career started in Tucson, including 10
years with Carondelet Health Services, 1976-87. During those
years Kathy was responsible for strategic planning and new
program development. She participated in the merger that
brought Carondelet St. Marys and St. Josephs hospitals under
one corporate umbrella.
In 1987 Kathy joined Mercy Care Plan on a full-time basis as its
president and CEO, serving in that capacity through 2001. Mercy
Care Plan is a statewide-managed care health plan serving the
Arizona Medicaid population. During her tenure the plan grew to
more than 140,000 members.
Kathy served as an assistant director with the Arizona Medicaid
program 2003-04. Her focus was on the services and support
processes required to meet the needs of the fee-for-service
population and the providers who care for them. Most of this
work was with the Indian Health Services and with Arizona tribes.
She serves on a variety of boards including the Arizona State
Medicaid Advisory Committee, Arizona Health e-Connection,
Arizona Alliance for Community Health Centers, and as a
nonvoting member of the Mercy Care Plan Board of Directors
(Southwest Catholic Health Network).
Kathy was born in Chuquicamata, Chile, and is bilingual. She
earned her Bachelor of Science in Foreign Service in 1971 at
Georgetown University, Washington, D.C.
I am surprised and honored to be recognized by the Pima
County Medical Society with the PCMS Steve Nash award, Byrne
said. Thank you!
I have had the pleasure of working in the Tucson and Phoenix
healthcare arena with many of you for over 35 years. I have
appreciated the sense of collaboration, partnership, and
generosity that exists in Pima County. My last 10 years as
executive director of the El Rio Community Health Center have
been focused on working with my colleagues to improve access
to healthcare for our community, expansion of the Medicaid
program, support for the Pima County Access Program (PCAP),
and the growth of our integrated health home model. Our
collective efforts have meant so much to people in need of care in
Pima County.
During my career its been the freedom to innovate and
collaborate on meaningful projects with others that has given me
the greatest sense of accomplishment. Examples from El Rio
include our mergers with Birth and Womens Health Center and
El Pueblo Health Center, rebuilding the El Rio Congress campus
with a new state-of-the-art facility and our recent affiliation with
St. Elizabeths Health Center. The other project underway that
you may have heard about is the renovation of the Manning
House Property downtown, where we will move 230 staff by the
end of the year.
El Rio now serves over 83,000 people thanks to the help of many
of you here tonight. Good health is paramount to quality of life.
The work each of you do is important! Thank you for recognizing
my passion and commitment to our field with the Steve Nash
Award.
n

15

The 24th Annual

Southwestern Conference on Medicine

April 23 - 26, 2015 | JW Marriott Starr Pass Resort & Spa | Tucson, Arizona

Join us for our 24th year of quality engaged learning! This activity has been
approved for AMA PRA Category 1 Credit and AOA Category 1A Credit.
Presented by Tucson Osteopathic Medical Foundation in Joint Providership with Cleveland Clinic

Scan this with your

smartphone to visit
www.tomf.org/cme

Register online at www.tomf.org/cme

16

SOMBRERO April 2015

PCMS News

AMB appoints new exec dir

The Arizona Medical Board, which to say the least has had a
recent undesirable performance history of its executive directors,
reported March 2 that it had appointed a new executive director,
Patricia McSorley.
AMB has employed McSorley since 2005, they reported. For
more than eight years she managed the Investigations
Department. On two occasions she has been asked by the board,
and has served, as acting interim executive director. She holds a
Juris Doctorate from Brooklyn Law School.
Previously she served as assistant commissioner for the Bureau of
Investigations and Trials with the New York City Fire Department.
On Feb. 26, the AMBs Executive Director Committee appointed
her as the executive director of the Arizona Medical Board, and the
Arizona Regulatory Board of Physician Assistants.

MRCSA sets training schedule

The Medical Reserve Corps of Southern Arizona has set its 2015
training calendar, which is already underway. Here it is complete:

Jan. 24
Incident Command System Training 9-10:30 a.m.
Location: Pima County Medical Society, 5199 E. Farness Drive,
Tucson 85712
Trainer:

Feb. 21

Les P. Caid, Chief, Rio Rico Fire District and MRCSA

Board President
Emergency Civilian Casualty Care Training 8a.m.-12
noon

Location: Tucson Fire Central, 300 S. Fire Central Place, Tucson

85701

March 28 START Triage Training 9-10:30 a.m.
Location: Pima County Medical Society, 5199 E. Farness Drive,
Tucson 85712
Trainer:

April 9

Mike Bishop, Captain, Emergency Management,

Tucson Fire Dept.
Tour of Pima Emergency Communications &
Operations Center 4:30 p.m.

Location: PECOC Building, 3434 E. 22nd St.

Leader:

May 9

Caren Prather
Red Cross Shelter Training 9 a.m.-12 noon

Location: Red Cross Chapter Building, 2916 E. Broadway Blvd.

Tucson 85716
Trainer:

May 16

Genevive Sansonetti Sic and Red Cross Staff

Red Cross Shelter Exercise 8 a.m.-2 p.m.

Location: Red Cross Chapter Building, 2916 E. Broadway Blvd.

Tucson 85716
July 11
at 9a.m.

Mass Vaccination Clinic Training and Public Health

Call Center Tour 9-11:30 a.m.

Location: Pima County Health Department, Abrams Building

SOMBRERO April 2015

Trainers:

Ronald Zack, Mary Stebbins and health department

staff

September (Date TBA) Disaster Table-Top Exercise

Location:

To Be Determined

November (Date TBA) Power Outage Roundtable and Effects of

Long Term Outages on Community Mem-

bers with Functional and Access Needs
Location: To be determined (in collaboration with Physicians for
Social Responsibility)
Additional training and tours to be scheduled include:
Arizona Poison and Drug Information Center tour
Emergency Civilian Casualty Care training
Psychological First Aid/Disaster Behavioral Health training
Decontamination Assist Teams Training/Donning and
Removing PPE/Contamination Control

U of A-led research:
U.S. cocaine supply shrunk
Federal chemical controls have shrunk the nations cocaine
supply, according to research reported by The University of
Arizona and reported in the journal Addiction.
Following a December 2006 federal restriction on a chemical
critical to cocaine production, the university reported March 9,
the U.S. experienced a 35 percent decrease in cocaine purity, 1
32 percent decrease in cocain seized, and a 100 percent increase
in cocaine priceall indications of a major downward shift in
cocaine supply.
Cocaine producers have yet to recover, according to an
international research team led by James Cunningham, Ph.D., an
epidemiologist with the Department of Family and Community
Medicine at The University of Arizona College of Medicine
Tucson.
The 2006 restriction by the U.S. Drug Enforcement
Administration (DEA) targeted sodium permanganate, a cocaine
choke chemical central to, and difficult to replace in the cocaine
production process, the university reported. Sodium
permanganate began to be commercially mass produced around
the early 2000s, primarily in the U.S., without controls or
restrictions. Cocaine supply started increasing at that time and
continued rising until December 2006, the point when the
restriction required that large-volume sales of the chemical be
approved by the DEA.
The same study also tested whether impacts occurred at the
times of three earlier chemical control restrictions. In December
1989, the U.S. government placed restrictions on potassium
permanganate, another cocaine choke chemical mass produced
in the U.S. Immediately following that restriction, cocaine supply
dropped sharply.
In 1992 and 1995, restrictions were implemented on sulfuric
acid, hydrochloric acid and methyl isobutyl ketone (a solvent), all
of which commonly are used in cocaine production but do not
reach the level of choke chemicals. These restrictions also were
associated with immediate drops in cocaine supply, but not as
large as those associated with sodium permanganate and
potassium permanganate.
17

Cunningham pointed out that sodium permanganate and

potassium permanganate are oxidizing agents that have
numerous legitimate commercial uses, including municipal water
and wastewater treatment, metal processing and air and gas
purification. The goal of chemical controls is to reduce supply
and thus the drugs use, he said. According to the National
Survey on Drug Use and Health, the number of persons in the
U.S. reporting current cocaine use dropped from 2.42 million in
2006, in effect the year prior to the December 2006 restriction, to
1.54 million in 2013, a 36 percent decline.
Cunningham and colleagues previously published the first
studies showing that controls on chemicals needed to produce
methamphetamine and heroin also have impacted supplies of
those illicit drugs. Large-scale production of the big three
drugscocaine, methamphetamine and heroinrequires

massive amounts of selected commercial chemicals, he said.

Research indicates that controls on these chemicals can lessen
the drugs supply. Costs of implementing the controls typically
are minor, for both the government and the chemical companies
involved.
The study, U.S. federal cocaine essential (precursor) chemical
regulation impacts on US cocaine availability: an intervention
timeseries analysis with temporal replication, was published
March 5 online before print in the scientific journal Addiction.

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18

The UofA reported March 9 that more than

60 students in the Doctor of Nursing Practice
online program at the College of Nursing will
take part in the colleges first White Coat
Ceremony.
During the event, students representing 12
states will receive their white coats and
affirm their commitment to providing
compassionate healthcare as future
advanced nurse practitioners (NPs)
specializing in either family, pediatric, adultgerontology acute care or psychiatric mental
health, the university reported.
Nurse practitioners are essential to our
healthcare system, particularly in primary
care, where we are facing a significant and
growing provider shortage, said Joan
Shaver, Ph.D., R.N., F.A.A.N., dean and
professor at the College of Nursing.
Especially in rural and underserved areas,
nurse practitioners are often the only
healthcare providers.
According to the American Association of
Nurse Practitioners, more than 205,000 NPs
are licensed in the U.S. In 2012, more than
80 percent of NPs were educated for primary
care practice. Studies show that NPs can
expertly deliver 80-to-90-percent of care
provided by primary care physicians. Primary
care NPs are significantly more likely than
primary care physicians to practice in urban
and rural areas, provide care in a wider range
of community settings and serve a high
proportion of uninsured patients and other
vulnerable populations.
Although the Institute of Medicine has
recommended that NPs be able to practice
to the full extent of their education and
training, the scope of practice for NPs varies
by state, ranging from full autonomous
practice authority, as in Arizona, to restricted
practice, requiring physician oversight of
diagnoses, treatment plans, and prescribing
by NPs (via collaborative agreement or
supervision.)
n
SOMBRERO April 2015

SOMBRERO April 2015

19

Urology

Vaginal mesh controversy: An update

By Susan J. Kalota, M.D.
Routine use of vaginal mesh
in vaginal prolapse surgery
was introduced into routine
clinical use in 2005. The
mesh currently used is nonabsorbable porous
polypropylene.
Mesh in general was introduced
to aid in repair of weakened
or poorly supportive tissue. It
was initially introduced, and
extensively used for abdominal
and inguinal hernia repairs.
Due to use of this mesh for
hernia repairs, it was felt that
no specific studies needed to
be done prior to their release
for vaginal hernia surgery. This is done through a 501 FDA
clearance which states that the new product is sufficiently similar to
an existing approved device that it does not need to undergo the
usual new product testing and process of approval.
Use of vaginal mesh was then marketed to the gynecologic or
urologic surgeon for any and all prolapse repairs without specific
recommendations about the ideal patient. Subsequently, as FDA
received more and more complication reports, there was an FDA
panelin which I was able to participateconvened in 2011 to
discuss the concerns.
That panels outcome was that in January 2012, FDA ordered that
post-market surveillance studies on mesh used for pelvic prolapse
repair be conducted by the vaginal mesh manufacturers to evaluate
the safety and effectiveness of the mesh. This was not mandated
for the full retropubic or obturator mesh slings, or for mesh used in
abdominal colposacral suspensions. Multi-incision slings were
felt to already have shown their efficacy and safety through
previously performed clinical studies. The safety and efficacy of
single-incision mini-slings were not felt to have been sufficiently
documented, so they are required to undergo further studies.
Since then
Several companies chose to remove all or some of their products
from the market rather than conduct the expensive studies. No
product was removed from the market by FDA.
There has not been a statement declaring an inherent problem
with the mesh itself, kits in general or with a specific mesh product.
American urological and gynecological societies, as well as
European societies and the British health department, have
issued guidelines on use of vaginal mesh for prolapse. The goal
has been to have adequately trained clinicians place appropriate
products in appropriately selected patients, and identifying who
they are. There is also emphasis on making sure the patients are
well-informed of the risks and benefits of mesh use.
In a collaboration between urogynecologic societies, FDA, and
industry, a national prolapse surgery registry is being attempted.
There has also been a recommendation that surgical removal of
20

problematic mesh be undertaken by qualified specialists or at

Centers of Excellence.
Risks and benefits
Many of the quoted risks of mesh prolapse repair are as much
related to the procedure as to the repair; some of the risks are
clearly only present due to the use of mesh.
The most serious risks are those of erosion or perforation of an
organ, vessels, or nerve with the mesh. Fortunately, these are not
frequent. Vaginal mucosal extrusion is common, but a much less
serious issue. If the woman is not symptomatic it usually does not
need to be addressed.
Common symptoms of this issue is a vaginal discharge (bloody or
not), complaint of discomfort by the womans partner during
intercourse, or a scratching poking pain complaint by the patient.
Depending on the location and extent of the extrusion, it can
often be excised in the office.
Pain can be present from the start, or occur over time. It can be
present continuously, only with certain activities, or only with
intercourse. This can be present due to location of the mesh, tension
of the mesh due to initial placement, or due to shrinkage over time,
or potentially from infection of the mesh. The pain is often relieved
by removal of the mesh or physical therapybut not always.
The benefits seem to be a decrease in the rate of recurrent
prolapse in the repaired compartment, but there may be an
increase in recurrence in other compartments. Current studies do
appear to show anatomical advantage with the repair in the
anterior compartment, but less so in the posterior compartment.
Personally I have found that the ideal candidate is one with
severe prolapse in either the anterior (cystocele) or posterior
(rectocele) compartment. A woman with minimal or even
moderate prolapse is not a good mesh candidate. I have
personally found that the width and depth of the vaginal vault is
more likely to be maintained with a mesh repair, and the risk of
recurrence is substantially lessened.
There does seem to be a higher risk of perioperative bleeding
which very rarely requires a transfusion. The risk of vaginal mesh
extrusion has been noted as high as 10 percent, but many of
these are asymptomatic or can be excised in the office.
I believe that mesh is a wonderful and effective option for repair
of severe prolapse. I believe it has an important place in our
surgical toolbox. I also believe that many of our early problems
occurred in patients whom we would no longer consider to be
candidates for mesh repair or with kits/devices that have been
updated, so my expectation is that the number of complications
will be substantially less in the future, and mesh will maintain its
place for use in the complicated prolapse patient.
Tucsons original female urologist, ABU-certified and with subspecialty certification in Female Pelvic Floor Medicine and
Reconstructive Surgery, Dr. Kalota practices with Urological
Associates of Southern Arizona.
REFERENCE
Jha S. The rise and fall of the vaginal mesh. BJOG 2014;1438.

SOMBRERO April 2015

Stars on the Avenue

Story and Photo by Dennis Carey

From film stars to the real thing

Arizona Star Tours featured at SOTA

tars on the Avenue may not seem self-explanatory, though

it is on Tucsons well-traveled Campbell Avenue, and it is
under the stars at St. Philips Plaza. Last time, Hollywood and film
stars were added as the motif.
On April 18 for this years event, the stars will be the real thing as
Arizona Star Tours owner Ben Loker provides more than a theme.
At the event, Pima County Medical Society is honoring
community physicians and an activist CEO for their contributions
to bettering local healthcare, while Pima County Medical Society
Alliance raises funds for its primary project, Mobile Meals of
Tucson.
Participation of Arizona Star Tours, hosted by Loker, will allow
attendees to look at the moon, planets, and other objects in the
night sky as they may have never done before. The portability of
powerful telescopes has taken Southern Arizona stargazing
parties to a new level. At the event Arizona Star Tours will provide
several telescopes with magnification of 70 to 900 powernot
too far different from what stargazers might experience at the Kitt
Peak observatories.
Like so many other things, the technology of telescopes has
changed by leaps and bounds since I first got interested in
astronomy, Loker said. I can program them to compensate for
the rotation of the earth, and put in information that will allow
me to focus on an object in no time and keep it there. I dont have
to spend a lot of time searching for something or constantly make
adjustments. They are battery-powered, so they can go
anywhere.
Its a long way from the used and broken telescopes Loker used in
the beginning to satisfy his astronomical curiosity. He worked at
telescope shops, and he was handy enough that he could fix old
ones people would bring in, as long as he could find the parts. His
love is getting out and looking at the stars, even if only with a pair
of binoculars or the naked eye.
I was home-schooled, he said, so I was lucky I could stay up
late at night and not have to worry about getting up early to catch
a bus or get to school. Im also lucky I live where there is a lot of
interest in astronomy, and there are a lot of resources I can turn
to in Tucson and Arizona.
Loker attended the University of Arizona for one semester before
dropping out. He acknowledged it is one of the best schools in
the world for studying astronomy, but he found out there was not
a lot of time spent actually looking in the skies to earn a degree.
SOMBRERO April 2015

Ben Loker of Arizona Star Tours stands next to an 11-inchdiameter Schmidt-Cassegrain telescope, one of the scopes he uses
that will be part of the 2015 Stars on the Avenue event April 18.

It was too much time in front of a computer monitor and not

enough time looking through an eyepiece, he said. In fact, I
have some astronomers with advanced degrees who attend my
events and tell me they hardly ever get the chance to look
through a telescope at school or work.
After a brief stint working in construction, Loker decided to go allin, starting Arizona Star Tours. In 2010, he placed nearly
everything he owned on Craigs List and sold it to finance the
business.
It was scary, he said. I was not sure I was going to be able to
make a living at it, but I was very passionate about it. Not
everyone can get up every day and be able to work on something
they truly love. I hesitate to call it work.
21

Arizona Star Tours found a niche by catering to those who were

interested in astronomy, but may not have the time or means to
get to an observatory or get a telescope of their own. The local
resorts booked star and sun Tours on a regular basis. Visitors at
the resorts came to Tucson for a vacation or conference, and they
could only squeeze so much into their stay.
They know Tucson is a great place for astronomy, but they
cannot spend an entire day traveling to Kitt Peak. I bring the
observatory to them, Loker said. I also love hosting events with
visitors from all over the world. I learn as much from them as they
do from me.
There is as much going on in the day as at night. Sun tours allow
viewers to observe solar activity that includes sunspots, storms
called solar prominences, solar spectra, and on rare occasions a
solar eclipse. His telescopes have lenses and filters that allow
viewers to look at the sun.
Loker has recruited 10 people to help him with events around the
state. Some, like archaeological astronomer Larry Behrens, have
extensive professional experience. Others are just people like
himself who want to share their enthusiasm for astronomy. They
host everything from star-themed wedding receptions and backyard family parties to large corporate events.
The telescopes can be set up to take photos using cell-phone
cameras. It makes it easy to take memories of the party with you.
You might learn something new on one of our tours, Loker said.

Portable telescopes come in all sizes. This Questar model can go

anywhere and is used for both stellar and solar viewing.
Attachments let users take photos with a cell phone camera.

I usually learn something new myself. It may spark someones

interest in science. But I started doing this because I want people
to see how fun astronomy can be.
Stars on the Avenue is April 18, 6-9 p.m. at St. Philips Plaza.
Tickets are available at pimamedicalsociety.org or call the PCMS
office at 795.7985. Dennis Carey is PCMS Associate Director.
n

The Faces of Casa are the

Dr. Ann Marie Chiasson

Associate Medical Director

Working in hospice allows me to

practice both the science of medicine
and the art of medicine. Put simply,
wonderful holistic patient care focused
on comfort allows patients to live longer
and more comfortably.

520.544.9890 | www.casahospice.com
Hospice services are paid for by Medicare

22

SOMBRERO April 2015

Makols Call

Dream on
By Dr. George J. Makol

s this a great country, or

what? my cousin asked me
as we entered the Great Hall of
this years Barrett-Jackson
Auction in Scottsdale, the selfproclaimed worlds greatest
collector car auction.

He was talking about the fact

that three cousins who had
come a long way in more than
one sense, were reuniting 44
years after working together at
a fast-food burger-joint in
Massachusetts. Yes, we all
began working for minimum wage, but our parents had taught us
not to stay at minimum wage. This is known as capitalism, and
can have spectacular results, but I will return to this subject later.
The Barrett-Jackson began as a charity auction in 1967, started by
Russ Jackson and Tom Barrett, after Jackson showed an interest
in Barretts 1933 Cadillac V-16 Town Car. Although the company
now has other locations, its main show is at Westworld in
Scottsdale and runs for eight days. Activities include a collector
car auction, fashion shows, wine tastings, and generally many of
the new car manufacturers are represented.
Of course you know by now that I am a hopeless gearhead,
interested in almost every type of vehicle, but this show offers
much more than cars. Think of it this way: when a chubby,
opulently rich 60-year-old guy shows up to sell a couple of his
Ferraris, the 25- year-old girl on his arm needs something to keep
her busy. Hence the fashion shows, jewelry stands, miniboutiques, olive oil/flavored balsamic vinegar stands, leathercoat- and-vest booths, and even exercise machines are on display.
Maybe that sexagenarian needs more cardio along with the sex!
The show covers a huge acreage, and though we walked for seven
or eight hours, we only covered the main tent though there are
five in all. A fantastic assortment of foods is available, and I
would say there were more food booths and snack trailers than
Ive seen in any state fair in my life. The food booths covered an
area about the size of a football field, and as long as youre not
looking for health food, there are creations and libations to
satiate any appetite.
If you are contemplating buying a new vehicle, the manufacturers
are there in droves, with almost every model available for
perusal. There are technical experts available answer your
questions, and of course gorgeous or handsome models to
demonstrate the features of the car for you. These are vehicle
SOMBRERO April 2015

Some of the activity at this years Barrett-Jackson, naturally

attended by our other gearhead: (Dr. Hal Tretbar photo).

experts and not salespeople, and you can find out much more
about a vehicles performance, safety, and available options than
you ever will find out dealing with the salesman at a retail car
dealership.

Allergies
Nasal/sinusitis problems
Hearing & balance disorders
Hearing aids & tinnitus
Endocrine & salivary gland disease
Voice disorders
Snoring and sleep apnea
Thyroid and parathyroid gland surgery
Cosmetic/Aesthetic surgery

Jonathan Lara, DO

Thomas S. Kang, MD

Amanda Kester, Au.D.

office: 520-775-3333 fax: 520-775-3334

www.sonoranent.com
6340 N. Campbell Ave., Ste. #256 Tucson, AZ 85718
23

Parking is free, although you may did need a trail guide to get you
from the far-out lots to the front door of the tent. It is around $25
to get in, but they do give a senior discount, as I discovered. I find
it interesting that by the time youre financially successful in life
and have become a seasoned citizen, you get discounts, just at
the time you dont really need them. Maybe the 30-year-old guy
with a wife and three kids needs a discount more than I do, but
who am I to question this logic? I even get a senior coffee at
McDonalds for 89 cents, so I cant complain, but Ive often
wondered, is the coffee old, or just me?
There are numerous other auto shows at the same time in the
greater Phoenix area, including Russo and Steele, Bonhams, and

R&M among others. This leads me back to my two cousins, to

whom I will refer as the Burger Boys. You see, while I went to
medical school, my cousins stayed in the fast food world, both
building their own companies.
While they did collaborate over the years, it was my cousin Don
who struck out to the deep South in search of his future. This
included building a collection of more than 260 restaurants that
he recently sold for about $150 million, some of which went to
my first cousin. So while my cousin Don flew in on his private jet
to the Scottsdale Airport, I of course drove up in my trusty Ford. I
do have to say that they never let me pick up a check just because
I was the doctor in the group.
It was about 2:30 p.m. when Don said,
George, have you ever been to the R&M
auction? I answered No, since my idea of
heaven was walking around the BarrettJackson tent drinking a Diet Coke and eating
caramel corn. So as you can see, I was a little
out of my element when we walked into the
Arizona Biltmore ballroom where the R&M
auction was to begin in two hours. I was
surrounded by multimillion-dollar Ferraris and
James Bond-era Aston Martins, perfectly
restored Jaguar XKEs, and a gaggle of
lithesome Ukrainian waitresses offering me
champagne, caviar, shrimp cocktailsand
even Diet Coke.
I couldnt figure why I was getting all his
attention, until I looked down and realized that
Don had slipped a buyer badge around my
neck, and I was being mistaken for a person
who would actually buy one of these vehicles,
which would merely consume my entire net
worth. But dont think I didnt contemplate it!
You see, about 25 years ago at the BarrettJackson I sat next to a guy wearing a T-shirt and
shorts who had the winning bid on a 1962
Ferrari GTO at $650,000. Today that car is
worth $5 or $6 million, and I dont think you
could get that kind of return at the bank.
Whether youre likely buyer or not, I highly
recommend that you take a day next January
and travel up to the Barrett-Jackson. I can
guarantee you will have a wonderful time,
even if you havent the slightest interest
in cars.
And yes, maybe I should have stayed in the
burger business; at least they dont have price
controls like we do.
Sombrero columnist George J. Makol, M.D.,
a PCMS member since 1980, practices
with Alvernon Allergy and Asthma, 2902
E. Grant Rd.
n

24

SOMBRERO April 2015

SOMBRERO April 2015

25

Local CME from Pima County

Medical Foundation

pelvic organ prolapse. Course features didactic lectures

supplemented with video presentations of advanced
laparoscopic robotic and vaginal surgery. Surgical case
presentations, panel discussions, and an interactive system are
used to communicate immediate feedback, providing an optimal
learning experience for interaction between faculty and course
participants.

Pima County Medical Foundation, a 501(c)3 nonprofit

organization derived from but separate from PCMS, presents
Continuing Medical Education lectures by our members and
others, for our members and others, on second Tuesday evenings
monthly at PCMS headquarters. Dinner is at 6:30 p.m. and
presentation is at 7. Scheduled presentations are:

Website: https://ce.mayo.edu/women-s-health/women-shealth-2015s983
Contact: Mayo School of Continuous Professional Development,
Bobbi Carter CMP, Mayo Clinic Scottsdale, 13400 E. Shea Blvd.,
Scottsdale 85259[ phone 480.301.4580; fax 480.301.8323 mca.
cme@mayo.edu https://ce.mayo.edu/

April 14: PharmacogenomicsHow Medicines Affect Differing

Demographics of Patients with Dr. Timothy C. Fagan. PCMF will
also present the Foundation Award for Lifetime Achievement in
Furtherance of Medical Education to Tyler Kent, M.D. and Bill
Nevin, M.D.

April 23-26: Tucson Osteopathic Medical Foundation, in joint

providership with Cleveland Clinic, present the 24th Annual
Southwestern Conference on Medicine at JW Marriott Starr Pass
Resort and Spa, 7:30 a.m. Thursday through 12:45 p.m. Sunday.

CME

May 12: Healthcare Reform 2015What the Hell is

Happening?? with several speakers coordinated by Dr. Timothy C.
Fagan.
June 9: Heart-Healthy Diet with cardiologists Dietmar Gann and
Charles Katzenberg.
Sept. 8: Vasectomy Reversals and Impotence with Dr. Sheldon
Marks.
Oct. 13: To be announced.

April
April 17-19: The 21st Mayo Clinic Urogynecology and Disorders
of the Female Pelvic Floor 2015 is at Hilton Scottsdale Resort
and Villa, 6333 N. Scottsdale Rd., Scottsdale 85250; phone
800.498.7396. http://www3.hilton.com/en/hotels/arizona/
hilton-scottsdale-resort-and-villas-SCTSHHF/index.html
Accreditation: Mayo Clinic College of Medicine designates this
activity for a maximum of 20.50 AMA PRA Category 1 Credits. A
record of attendance will be provided to all registrants for
requesting credits in accordance with state nursing boards,
specialty societies, or other professional associations.
Course presents latest treatments for urogynecology and female
pelvic floor disorders emphasizing surgical management of
urinary and fecal incontinence, overactive bladder, and repair of

Members Classifieds
NEW OFFICE SPACE FOR RENT: Office space available for rent in
Northwest Tucson off of Oracle Rd adjacent to a busy rheumatology
practice. Office has separate reception, breakroom, physician office,
4 exam rooms, and nursing space. A total of 1,778 sq. ft. is available.
Fulltime rental is preferred but could discuss office sharing if multiple
providers looking for part-time space. Great location for a satellite office.
For information, please contact Sue Haeger 382-4795.
MEDICAL PRACTICE FOR SALE: Hector L. Garcia MD and Hector F Garcia
are selling their Internal Medicine practices located in Tucson and Douglas.
The offices are located at 1601 N. Tucson Boulevard, Suite 1A, Tucson, and
1116 G. Avenue, Suite 7, Douglas. Interested parties may call 298-7251
for details.

26

Accreditation: Approved for AMA PRA Category 1 and AOA

Category 1A credit. Conference is designed to bridge practice
gaps between primary care providers current knowledge and
practice performance, and the ever-evolving standards of
modern medical care. Last year 400 DOs, MDs, NPs, and PAs
attended.
Faculty members include Shonda Banegas, D.O., Bennet E. Davis,
M.D., Edward A. Dominguez, M.D., Timothy C. Fagan, M.D., Anne
C. Goldberg, M.D., Jonathan R. Insel, M.D., Arthur McCullough,
M.D., Jamie Moenster, D.O., J.D. Polk, D.O. PCMS Board of
Directors member Jerry H. Hutchinson, D.O. chairs the
conference.
For more information, including the conference agenda or to
register please visit www.tomf.org/cme or call 520.299.4545.
April 24-25: A Multidisciplinary Update in Pulmonary & Critical
Care Medicine is at Westin Kierland Resort, 6902 E. Greenway
Pkwy., Scottsdale 85254; phone 480.301.4580. Email: info@
kierlandresort.com http://kierlandresort.com/
Accreditation: 18.25 Category 1 toward AMA PRA; AOA 18.25
hours 2A. Optional session: Ultrasound Workshop 8 Category I
AMA PRA; AOA 8 hours 2A.
Course offers lectures, case presentations, and pulmonary and
critical care literature reviews. Multidisciplinary faculty gives
presentations by leaders in pulmonary and critical care medicine,
pulmonary pathology, and radiology for a comprehensive
approach to current evaluation and management of various
respiratory diseases.
The hands-on workshop Use of the Ultrasound in the ICU is on
Friday, April 24 and Saturday, April 25, 1:15 to 4:30 p.m.
Workshop gives participants better understanding of how to use
state-of-the-art technology and offers didactic and hands-on skillbuilding opportunities. Separate registration fee applies.
Website: https://ce.mayo.edu/pulmonary-medicine/pulmonarymedicine/node/1834
Contact: Mayo School of Continuous Professional Development,
Lilia Murray, 13400 E. Shea Blvd., Scottsdale, 85259; phone
480.301.4580; fax 480.301.8323 mca.cme@mayo.edu
http://www.mayo.edu/cme

SOMBRERO April 2015

Radiology Ltd. now offers

3D Mammography.
The physicians of Radiology Ltd. believe in personalized
and comprehensive service for all patients and are pleased
to announce a customized approach to breast screening.
Radiology Ltd.s personalized breast screening service
includes individual breast cancer risk assessment, along
with access to our Patient Education Specialists to answer
any questions you may have. We have seven locations to
serve you.

For more information

about this and other
screening exams provided
by Radiology Ltd., please
visit our website at
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A TUCSON TRADITION FOR MORE THAN 80 YEARS

SOMBRERO April 2015

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SOMBRERO April 2015