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Sombrero

Pima

County

Medical

Society

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

AUGUST/SEPTEMBER

2015

PCMS building sale underway

A voyage Down Under

Tucson, Nogales, and bullfighting

2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015
2 SOMBRERO – August/September 2015

Sombrero

Official Publication of the Pima County Medical Society

Vol. 48

No. 7

 

Pima County Medical Society Officers

PCMS Board of Directors

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

Members at Large

Arizona Medical

Association Officers

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

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)

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

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

At Large ArMA Board

R. Screven Farmer, MD

Pima Directors to ArMA

Board of Mediation

Timothy C. Fagan, MD Timothy Marshall, MD

Delegates to AMA

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

 

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

Executive Director

 

Printing

West Press

 

Bill Fearneyhough

Phone:

(520) 795-7985

Fax:

(520) 323-9559

E-mail: billf 5199@gmail.com

Advertising

Phone:

(520) 795-7985

Fax:

(520) 323-9559

E-mail: dcarey5199@gmail.com

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

Art Director

Alene Randklev

Phone:

(520) 624-4939

Fax:

(520) 624-2715

E-mail: alener@westpress.com

Phone:

E-mail: andyc@westpress.com

(520) 624-4939

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

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 repre- sent 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: Medicare at 50—and

7

desegregation. Membership: Focus on Pima Dermatology.

10

Milestones: Twelve Tucson urologists open Epoch Health.

12

PCMS News: Sale of the 32-year-old PCMS headquarters building is on track.

19

Arizona Medical Association News: New ArMA president says we must ‘unite the house of medicine.’

23

Behind the Lens: In the second of his series, Dr. Hal Tretbar looks at the local impact bullfighting once had.

28

Travel: Dr. George Makol finally went to Australia—and proves it.

30

CME: Pima County Medical Foundation re-locates CME meetings.

Pima County Medical Foundation re-locates CME meetings. On the Cover Former matador Diego O’Bolger stands next

On the Cover

Former matador Diego O’Bolger stands next to bull-and-matador statue at Casa Molina Restaurant on Speedway Boulevard. The design ornamenting the bull’s testicles is changed to match the next Tucson event or holiday. Shot with Nikon D600, 40mm on the 24- 85mm Nikkor lens, 1/200th second at f.29 with flash fill-in (Dr. Hal Tretbar photo).

Correction

In the second column, second full paragraph of the first page of our last issue’s Time Capsule, we mis-typed route U.S. 60 as a state route. We also made a numerical typo in the second-page, second-column, sixth-paragraph reference to Globe: the town was founded in 1875, though a local sign states 1876.

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Happy birthday to Medicare (Part 2)

Happy birthday to Medicare (Part 2) By Dr. Melissa Levine PCMS President S ome of you

By Dr. Melissa Levine PCMS President

S ome of you may recall, before my foray down the

Tricare. They also expanded some payments for Welfare recipients and financed a study on the problems of the aged. All of this led to a revival of the national health insurance debate.

The Kerr-Mills act of 1960 created a program called Medical Assistance for the Aged. This was a grant program providing funds to states and was means-tested. It was essentially the precursor to Medicaid. Kerr-Mills did not end the debate, as some had hoped. Then Sen. John F. Kennedy (D-Mass.) made healthcare for the elderly, now calling it “Medicare,” a major issue in the 1960 presidential election campaign. Vice-President Richard M. Nixon actually conceded the point, and vowed to further the cause if elected. When Kennedy won and a Democratic Congress was again in control, the issue, like a Phoenix, rose again to the top.

King-Anderson was proposed in 1962, and it provided for hospital services to be provided for the elderly and paid for by Social Security. The AMA launched an all-out effort against “the most deadly challenge ever faced by the medical profession.” Dr. Bruce Hekrinsen, a New Jersey surgeon, wrote a memo and 200 members of the hospital staff said they would refuse to see patients under legislation such as King-Anderson. But the idea was gaining momentum. The American Hospital Association split from the AMA saying help was needed.

In a crazy turn, Republican Rep. Frank T. Bow of Ohio proposed a $125 income tax credit for the elderly to purchase health insurance. If they didn’t pay $125, they would be given a credit. Rep. John Lindsay (R-NY) proposed a bill embracing Social

Grand Canyon, I was talking about Medicare and the ACA. My idea was to compare and contrast the two, showing that essentially the beginnings were very similar, with predictions of socialism and ruination.

But as I delved into the real seeds of Medicare, I found so much more history than I had known about. I found it fascinating. Admittedly I’m somewhat of a nerd, so maybe I am just boring all of you. I hope not.

In our June issue I left off in 1946 with a Republican Congress and President Harry Truman calling for comprehensive health insurance for all, funded through Social Security. When he couldn’t get that passed, President Truman created a national commission to study the nation’s health needs. He was able to get Congress to establish a federal grant program in 1950 that provided matching funds to states to pay providers caring for individuals receiving public assistance. He continued to advocate for a national health insurance program until the end of his presidency in January 1953.

The goal of Social Security was economic independence for the elderly, and in the early 1950s officials were troubled that they were not meeting that objective. The reason was the high cost of medical care. If you remember Wagner-Murray-Dingell from the previous article, some of them came back then to try and fix the issue.

Most likely they thought, if instead of national health insurance, they proposed the more modest, healthcare for seniors under Social Security, they could gain traction. That proposal would be much less expensive, and it would give the government some experience, and in providing for a group in such obvious need, it would be more likely to pass.

The “beneficiaries” proposal was batted around, and on April 10, 1952, Senators Murray and Humphrey, and Representatives Dingell and Cellar proposed Senate and House bills of what would essentially have been Medicare. Then Dwight D. Eisenhower was elected President, both houses of Congress were Republican, and the idea once again died.

Interestingly, the next program happened under Eisenhower. In 1956 Congress enacted permanent protection for healthcare for the dependents of servicemen, the Dependents Medical Care Act, which today is part of

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Security financing with a private insurance option. The Senate went further. Led by Sen. Jacob Javits (R-NY), they proposed a bill financed by Social Security, providing three benefit options, one of which was private insurance. This sounds suspiciously like the ACA to me.

With all of this, an amended King-Anderson was brought to a vote July 7, 1962, and defeated in the Senate 52-48. President Kennedy, unhappy about the defeat vowed angrily to bring Medicare to the voters in the next election.

Ironically, JFK could not get Medicare passed when he was president, but after his assassination, there was a surge of support across the country for his legislative agenda. On Sept 2, 1964, King-Anderson (Medicare Part A) passed the Senate 49-44. Of course, then there was the House.

Though it was thought that King-Anderson would clearly pass the house, the Ways and Means Committee blocked it. Then the 1964 election had Lyndon B. Johnson winning with the largest plurality in history, the Democrats gained 38 seats, 295-140, the Senate, lopsided, went 68-32, and Rep. Wilbur D. Mills (D-2 nd - Ark.) House Ways and Means Committee chairman, saw the handwriting on the wall. King-Anderson was the first bill introduced in January 1965.

The AMA then came up with “Eldercare,” a program operated through private insurance carriers and the states, with premiums for low-income elderly subsidized out of federal and state revenues. This sounds even more suspiciously like the ACA! They boasted that it was more comprehensive than “Medicare” which

prompted Mills to expand the scope of King-Anderson (which was Part A) and come up with Part B.

On March 24, 1966, the much expanded “Mills Bill” was introduced. On April 8, without a whole lot of debate, and no amendments, all 296 pages, 102 separate sections, overwhelmingly passed the House, essentially giving birth to Medicare. The final versions passed the House and Senate on July 27 and 28.

One last note for thought: The birth of Medicare led to the desegregation of hospitals across the country. If a hospital did not comply with Title VI of the Civil Rights Act, they would not get paid. The Office of Equal Health Opportunity was charged with certifying hospitals. They let no one off the hook and over about four months, 1,000 hospitals were desegregated.

Medicare could be considered one of the greatest civil rights victories of its time, and the one with the least fanfare. That in itself is worthy of celebration.

REFERENCES

www.aapsonline.org/brochures/persuasi.htm

The Military Health System (MHS)- TriCare, Who We Are.

Social Security On Line–History http://www.ssa.gov/history/

corningchap4.html

CMS Oral History Project.

Sternberg, Steve. US News and World Report. Desegregation:

The hidden legacy of Medicare. July 29, 2015.

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Membership

Pima Dermo and our Arizona enviro

Story and photos by Dennis Carey

T ucson is definitely a place where there is a lot of

“ T ucson is definitely a place where there is a lot of Pima Dermatology’s lobby

Pima Dermatology’s lobby sales area serves as part of the practice’s one-stop shop for skin care concerns.

lasers,” Dr. Goldberg said. “Now it is a part of every dermatology practice. I like to think of lasers as my thing now. It’s my baby.”

He is also active in making sure use of lasers is done safely. He is president of the Arizona Dermatology and Dermatologic Surgery Society. He is seeking regulations to make sure proper training is required for operating lasers. Another target in his sights is getting a ban on use of tanning beds by minors.

Taking up a cause for children’s health is not surprising for Dr. Goldberg. After graduating with honors from Princeton University and from med school at State University of New York at Syracuse, Dr. Goldberg did his residency and completed a fellowship in pediatrics at the University of Arizona. He is board-certified in pediatrics and dermatology, and is a UofA clinical professor of dermatology and pediatrics. He has been a PCMS member since 1983.

Matthew Beal, M.D., joined Pima Dermatology and PCMS in July 2013. After graduating from the University of Arizona College of Medicine, he interned at St. Vincent’s Medical Center in New

attention paid to the skin,” says Gerald Goldberg, M.D., Pima Dermatology owner and medical director. “We have made a lot of progress in treating skin diseases and disorders. You hear it a lot, but catching skin cancer early increases the chances of survival dramatically.”

After 20 years in a small office on Rosemont Boulevard, Dr. Goldberg has expanded Pima Dermatology to a 10,000-square-foot facility at 5150 E. Glenn St. The practice sees 20,000 patients each year for both medical and cosmetic treatments.

“We don’t feel there is a saturation of dermatologists in the area,” Practice Administrator Sarah Chanes said. “Dermatologists in the area are very cooperative, and there is a good referral network with most of the providers in the area.”

The epidermis is the body’s largest organ, and the most visible, so in Southern Arizona dermatologists must keep up with the latest skin treatments and services to battle our environment’s effects. There is a need for dermatology care in our rural areas, and Pima Dermatology is working with Graham County Regional Medical Center to set up clinical visits every month in Safford.

“Some of the farmers in the rural areas have been exposed to the sun for years,” Chanes said, “but they just don’t have the time to come all the way to Tucson or Phoenix to get their skin checked regularly. There is definitely a need in these rural areas.”

Use of lasers has become an important part of skin healthcare, and Dr. Goldberg is considered a pioneer in this field. He began using laser rejuvenation treatments in 1984. Pima Dermatology offers 16 on-site laser modalities. A fraction of the laser procedures available include acne treatment, acne scarring, skin resurfacing, vein removal, and cosmetic procedures such as hair and tattoo removal.

“Some people wondered why I was getting so involved in using

Dr. Gerald Goldberg with a laser patient at Pima Dermotology. York, completed his dermatology residency

Dr. Gerald Goldberg with a laser patient at Pima Dermotology.

York, completed his dermatology residency at the University of Minnesota, and lectured at the Mayo Clinic in Rochester, Minn. He is trained in all aspects of dermatology with special interests in cutaneous oncology and psoriasis. He is president of the Tucson Dermatology Society.

“Tucson is home for me and my family,” Dr. Beal said. “I went to school here, and my wife is from Tucson. I was looking for an opportunity to practice in Tucson. Working at Pima Dermatology was a perfect opportunity.”

“Having the extensive experience of Dr. Goldberg and the energy of Dr. Beal are very complementary to each other,” Chanes said. “We also have a teaching affiliation with the University of Arizona. We feel it is very important to be involved in the teaching aspects of the medical community.”

This fall, Pima Dermatology will be adding Mohs surgeon Sarah Schram, M.D. to its staff. (Mohs surgery, a.k.a. chemosurgery, developed in 1938 by general surgeon Frederic E. Mohs, is microscopically controlled surgery to treat common types of skin cancer.) Dr. Schram graduated from the University of Minnesota Medical School in 2006. She received a fellowship at the Veterans Affairs Medical Center in Minneapolis, was an intern at Evanston Northwestern Healthcare, completed her residency at the University of Minnesota, and served on the faculty as an assistant professor.

Pima Dermatology has a Mohs surgical suite and lab on site. They also work with the cancer centers at TMC and

on site. They also work with the cancer centers at TMC and Colleen Cotton, third-year resident

Colleen Cotton, third-year resident at the UofA College of Medicine, consults with Dr. Matthew Beal at Pima Dermatology.

the UofA when necessary. Two PAs and two RNs help the physicians. There are four cosmetic providers in the office, and products are available for purchase to prevent or treat skin conditions.

“We are probably 70 percent medical and 30 percent cosmetic as far as the ratio of patients and clients who come in,” Chanes said. “We try to be a one-stop shop for anyone who is concerned about their skin. We also try to do extensive financial counseling with patients and clients so they know what is covered by insurance. We don’t want patients to get hit with a big shock.”

That might make their skin crawl.

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SOMBRERO – August/September 2015 9

Milestones

Epoch Health opens on Grant Road

Twelve Tucson urologists including doctors Kenneth Belkoff, Peter Burrows, Bill Kuo, Michael Levin and Jenne Myers have partnered to open EPOCH Men’s Health, 4951 E. Grant Rd., Suite 103, at Crossroads East Plaza.

The urologists “have come together to create Epoch Health, a center to serve the men of Southern Arizona. Epoch offers a free comprehensive men’s health screening that checks for vitamin deficiencies, various cancers, kidney function, hormone and electrolyte levels, and other conditions.” No appointments are necessary.

Dr. Sanders co-authors national report on cardiac arrest

Dr. Sanders co-authors national report on cardiac arrest Two University of Arizona researchers are co-authors of

Two University of Arizona researchers are co-authors of a report, released in July in Washington, D.C., that examines current statistics of cardiac arrest in the U.S. and recommends public health strategies to improve survival rates, the university reports.

The report from the Institute of Medicine is “Strategies to Improve Cardiac Arrest Survival: A Time to Act/” It examines national data on the incidence and survival rates from cardiac arrest in the U.S., assesses evidence on existing lifesaving therapies, and recommends public health strategies that could save lives. Additionally, the report explores CPR and the use of automated external defibrillators, emergency medical services, and hospital resuscitation systems of care and resuscitation research.

Two University of Arizona Department of Emergency Medicine researchers co-authored the report: Arthur B. Sanders, M.D., M.H.A., professor and a member of the Arizona Emergency Medicine Research Center (AEMRC)—Tucson and the Institute of Medicine, and Bentley J. Bobrow, M.D., professor and co-director, AEMRC—Phoenix, and medical director for the Arizona Department of Health Services, Bureau of Emergency Medical Services and Trauma System.

“This collaboration and development of a ‘system of care for cardiac arrest’ have resulted in more than 2,500 out-of-hospital cardiac arrest survivors in Arizona over the past decade, as well as shaping the national and international resuscitation guidelines,” Dr. Sanders said. “The Resuscitation Research Group of UA Sarver Heart Center, including doctors Gordon Ewy and Karl Kern, were pioneers in the efforts to improve survival in Arizona and help

in the efforts to improve survival in Arizona and help Epoch Health had ribbon-cutting ceremonies July

Epoch Health had ribbon-cutting ceremonies July 23 for its new Tucson clinic at 4951 E. Grant Rd. From left are staffers Bianca Ruiz, Zulma Valenzuela, Steve House, Crystal Kasnoff, Jesse Leon, Mike Whitfield, Artician Gonzales, and Estrella Hernandez (Epoch photo).

Arizona become a leader nationally in the approach to the treatment of patients suffering cardiac arrest. While there is always room for improvement, much of what is recommended in the IOM report is currently being done in Arizona.”

Doctors Lujan, Nguyen make quick work on stroke

By Tiana Velez Carondelet Health Network

work on stroke By Tiana Velez Carondelet Health Network Dr. William Lujan On the night of

Dr. William Lujan

On the night of June 15, Tucsonan Edward Moran went about his usual evening routine of several minutes of exercise, a light dinner, and a smoothie. At 70 the retired accountant was in decent health, which is why he says he missed the signs of the stroke that nearly claimed his life in the morning.

Moran said he was also surprised by the speed and level of care he received at Carondelet St. Joseph’s Hospital, where he spent the

first few days of his recovery. He was so impressed with his care that he instructed anyone calling about his status to use the code phrase, “I love St. Joseph’s.”

That he’s able to tell his story is a credit to the many individuals of Carondelet Neurological Institute (CNI) and the Primary Stroke Center at St. Joseph’s Hospital, who work together seamlessly under intense pressure.

CNI neurologists Dr. William Lujan and Dr. Jimmy Nguyen guided administration of tPA and consulted neuro- radiologist Dr. Creed Rucker, who performed a thrombectomy to remove the clot from Moran’s brain using a catheter inserted in his femoral artery. Moran was then moved to the Neuro ICU to recover.

On the morning of his stroke, Moran checked in to his former CPA firm, where he occasionally helps out as a

consultant. Like many office workers, he started his day with a cup of coffee and a quick chat with a friend. While chatting, they remarked that Moran seemed to be slurring his words.

No, said Moran, it was the coffee. He had made it too hot, and it had burned his tongue, causing him to slur. As he returned to his desk, however, he started noticing other peculiarities. He was spilling his coffee as he tried first, to drink, and then, to slurp it. Also, it was becoming harder to keep his grip on the mug in his left hand. Puzzled, but knowing something definitely was not right, he called his friend to take him to the hospital. His friend immediately dialed 911.

Prior to arriving, Emergency Medical Services (EMS) alerted St. Joseph’s Emergency Center, where the Brain Attack Team was prepped and waiting for Moran.

“When he presented to our hospital, we graded his stroke symptoms on the National Institute of Health’s Stroke Scale (NIHSS) and scored him at a 6,” said Tiffany Hoke, CNI’s doctor of nursing practice and neurocritical care NP. The higher the score, the more stroke symptoms a patient exhibits. Scores range from zero symptoms to 42, equaling extreme symptoms with severe impairment.

“Don’t let the number fool you, however, as lower NIHSS scores can still represent severe impairment and lead to devastating disability if left untreated,” Hoke said. Moran “had slurred speech and significant left-side weakness involving his face, arm, and leg upon arrival. If left untreated, his symptoms and NIHSS would have most assuredly worsened.”

Moran’s CT brain scan showed no hemorrhagic stroke, but a large right middle cerebral artery clot, which was the cause of his stroke symptoms. Moran’s quick presentation to the hospital by way of EMS, CT findings, and lack of related contraindications made him a perfect

and lack of related contraindications made him a perfect Dr. Jimmy Nguyen candidate to receive the

Dr. Jimmy Nguyen

candidate to receive the clot-busting drug tissue plasminogen activator or tPA.

“Mr. Moran received tPA within 28 minutes of entering our doors,” recalled Hoke. “That door-to-drug time is remarkable and far below the national goal of less than 60 minutes.”

Treatment didn’t stop there. The clot would have to be removed or potentially cause further damage. “Essentially, the whole right side of his brain was at risk to die. Moreover, Mr. Moran was at risk to die,” Hoke said.

Within 24 hours, he had gone from a 6 on the NIH Stroke Scale to zero—“showing no sign of stroke on exam or imaging,” Hoke said. The entire process lasted less than eight hours.

“Everyone here is just unbelievable,” Moran said. “The nurses come by often, answer any questions you have. They never seem rushed or too busy for you. They make me feel like I’m on a cruise.”

Three days after entering the hospital, Moran was preparing for his discharge. Speaking with him, it’s hard to discern any signs that he suffered a near-paralyzing stroke. Without prompting, he shows off how much motion he’s regained on his left side — frequently raising and lowering his left arm, and pointing to his nose.

“They got me all put back together,” he says. “They” is the group of physicians, nurses, radiology technicians, EMTs, pharmacists, and other Brain Attack Team members who comprise the Carondelet Neurological Institute and the Primary Stroke Center at St. Joseph’s Hospital.

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PCMS News

PCMS makes way for Tucson Concussion Center

By Stuart Faxon

The Present

While not a concussion, the medical society’s 32-year-old headquarters building has become a headache—one that’s costing too much for PCMS’s health.

That’s why after much research and decision-making over the last two years, your Society has decided to sell the building. However, PCMS administration will remain on site in smaller space, while most of the building will be used by the new Tucson Concussion Center.

“Times have changed for medical societies,” PCMS Executive Director Bill Fearneyhough said. “We have to look 10 years from now, and that’s what our Board of Directors has done.” He called the physical state of the building “a disaster waiting to happen” in terms of what it could cost.

Our building, including structure and furnishings, cost $263,000 when it opened for use in 1983, roughly 5,000 square feet at roughly $50 per square foot. As with other tenants of Tucson Medical Park, PCMS owns the building, but TMC Holdings owns

GERALD N. GOLDBERG, MD AND ASSOCIATES PROUDLY WELCOME SARAH E. SCHRAM, MD BOARD CERTIFIED DERMATOLOGIST
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land, an arrangement that has always made the Society both renter and owner.

We pay about $20,000 per year in property taxes on the building and land, Fearneyhough said. We pay about $18,000 per year in rent to TMCH, making our building cost us $38,000 per year in fees alone, even without considering maintenance and repair. This is unsustainable for PCMS today.

“The building situation is just one aspect of what we need to do for

our physicians,” Fearneyhough said. “This is big in the sense that it

is one step toward what we need to do in years to come, in

adapting to new technology, and in how physicians interact in this century. You can’t stop progress, especially in medicine. A professional society is still a business, with customers.”

“And we tend to their needs,” PCMS President Melissa Levine, M.D. added. “In our goal to be inclusive of all physicians in Pima County, the Society needs to be more mobile, and to have physical meetings not only on the East Side.”

Our board did not take any of this lightly, Fearneyhough and Dr. Levine, agreed. “Understanding that the building is an important piece of medical history,” Dr. Levine said, the board took into account “the emotional attachments, especially of our older members who consider the building home and fought to build it. However, we eventually realized that this was the appropriate direction for the medical society’s future.”

The Past

The 32 years of our building are a tortuous, and occasionally torturous history.

In 1958 Dr. Jeremiah Metzger, who joined the Society in 1912, left PCMS his home in Snob Hollow to be used as headquarters and a meeting place, according to December 1981 reporting in this magazine. “It was not considered suitable for that purpose, and so the Society sold the property for $40,000 and invested the funds,” creating the financial base to build something.

According to the same history in Sombrero, it was in 1961 when Medent Corp., a group of physicians and dentists that owned the Medical Square complex, offered free of charge a then-vacant half- block on North Tucson Boulevard to the medical and dental societies for a permanent home. The land had an estimated value of $40,000. The offer was conditional that the joint headquarters be built within two years from the date of the offer.

O.J. Farness, M.D. chaired our Long-Range Planning Committee. Plans in 1961 called for a 15,000-square-foot building that would

house the medical and dental societies plus Blue Cross/Blue Shield.

A 7,800-square-foot auditorium to hold 500 people; three meeting

rooms; and a small restaurant were included. The 15,000 square feet would cost $264,000, with a 15-year mortgage at 6 percent.

“At the time there were 260 active members,” Sombrero reported, “and how were these 260 members to finance this building? An assessment of $200 in 1961 and $100 per year for the next eight

years, a total of $1,000. It was felt that with a prospective increase

in membership it would be possible to return the entire amount of

assessment paid by a doctor upon his death, retirement from practice, or removal from Pima County to another location of practice.”

There followed a vote in which members voted not to build a building: 117 opposed, and 87 in favor, with 67 not voting and one unmarked ballot. “In the 20 years since,” Sombrero reported in 1981, “membership has tripled, needs have tripled, interest rates have tripled, rents have tripled.”

The push for a building was revived and Sombrero was a messenger, passing along member comments:

It will give the Society an identity.

It will be a place that various specialty societies can hold functions.

The Society will be building equity.

Future costs can be controlled.

A kitchen will be available so that meetings can be catered.

An assessment would allow us to build reasonably without paying high interest.

There is the possibility for positive cash flow from renting office space to various specialty societies or paramedical groups.

We could stop paying rent at an ever-escalating rate.

“It is really economically sound for the Society to own its own building?” this magazine questioned. “That answer to that one is ‘yes’ according to the current research.”

Today we might place all this in the category of “it seemed like a good idea at the time.” But on Jan. 12, 1982 PCMS voted to assess $500 per physician. But a number of members objected to the amount, did not pay, and about 20 percent of our membership resigned in protest. Many came back later, some did not.

“We realize that not every member is convinced that this is a good project,” PCMS President Robert S. Hirsch, M.D. said in the February 1982 Sombrero. But he noted that the vote of members to assess themselves had been taken, and that it was “incumbent upon every member to fulfill this obligation.

“One thing we do not want to see is members leaving the Society for this or any other reason. We hope that the membership will realize that we are a large Society representing a sophisticated medical community and that they will support it in its need for space to provide the services such an organization requires.”

Our building officially opened on Jan. 5, 1983.

The Present

PCMS, committee-chaired and goaded by the late John Clymer, M.D., in 2007-08 raised about $40,000 for Project Restore, and those restorations were made. But those restorations were mostly superficial, said exec Bill Fearneyhough, who himself spent many volunteer handyman hours on the project.

“Though a small amount of roof repair was done, and three new air conditioning units, and some new, energy-efficient lighting was done in cooperation with T.E.P.,” he said, “we still need a new roof and much painting and patching. The parking lot needs re- paving and painting. We are probably out of code with EPA, whose regulations would add to cost of any related updates. The

regulations would add to cost of any related updates. The Dr. Marc Leib was keynote speaker

Dr. Marc Leib was keynote speaker at the PCMS-sponsored ICD-10 training workshop June 23 at Tucson Osteopathic Medical Foundation’s conference center. The workshop helps physicians and practice managers prepare for the ICD-10 coding conversion that takes effect Oct. 1

Americans With Disabilities Act would be a similar potential regulatory cost for larger, more accommodating restrooms.”

When we got bids to do all these things, the estimates ranged from $150,000 to $300,000, Fearneyhough said. This would mean an assessment of $300 to $500 per member, another link in the chain of information determining that, as he put it, “The building makes no economic sense and is an economic threat to the Society.” When surveyed in November 2014, membership voted two-to-one against such an assessment.

The Future

Things will have proceeded apace while your magazine is in production.

History Committee Chairman Jim Klein, M.D. and his committee are in charge of the futures of all our historical books and artifacts.

On July 20, TMC Holdings delivers a purchase agreement to PCMS to buy our building for $350,000. TMCH says it wants to close in six to eight weeks. During the time of our magazine production, printing, and delivery, exec Bill Fearneyhough is meeting with our attorneys, Mesch, Clark and Rothschild, representing PCMS, to review the agreement. Findings are presented Aug. 25 at our Board of Directors meeting.

For years PCMS has made about $13,000 annually renting our meeting room. The many room renters are being notified that as of Oct. 1, we will no longer be available for their meetings. We are working with TMC to see if they can provide some replacement meeting space for our renters.

Our administrative offices will be in 925 square feet at the north end of their current location once Tucson Concussion Center’s build-out is completed. Meanwhile, plans call for PCMS administration to be temporarily housed across Farness Drive in a vacant office building.

“We want the membership to know all the details,” Dr. Levine said, “but the bottom is viability of PCMS. The board concluded

that for the long-term future, we had to become more agile, more flexible, in order to best serve members’ needs. A Society is not a building; it is its membership.”

THMEP’s classroom alternative

it is its membership.” THMEP’s classroom alternative Dr. Jim Herde explains principles of hernia repair at

Dr. Jim Herde explains principles of hernia repair at the THMEP-sponsored Colorado River Medical Conference, given June 27-July 3—where else—on the banks of our desert’s life-sustaining water source (Steve Curtin photo).

The fifth bi-annual Colorado River Medical Conference took place June 27 through July 3, and on the sandy beaches of the Colorado, participants heard talks ranging from the treatment of osteoporosis, gallbladder and hernia disease, thoracic outlet syndrome, development of the trauma network, and the principles of spinal stabilization.

The Tucson Hospitals Medical Education Program-sponsored conference allowed for seven AMA Category 1 CME credits to be earned at the nightly conferences. By day, attendees got to experience one of the great natural wonders of the world with rapids, wildlife, and a billion years of layered geology. Cold, cold

wildlife, and a billion years of layered geology. Cold, cold Dr. Stephen Curtin, who wrote our

Dr. Stephen Curtin, who wrote our report on this year’s CME river conference, had to compete with the Colorado for attention (Jim Herde photo).

Colorado water alternating with hot, hot Arizona sun was the order of the day. To paraphrase PCMS President Melissa Levine, M.D., as recently stated in these pages, we “lived the life the river gave us” daily.

Professionally, evening lectures were stimulating, collegial and enjoyed by all. Low-tech prompts and handouts were effective alternatives to PowerPoint presentations as you can see in the photos. As we evolved over six days into a seasoned band of river runners, we all grew and were enriched from the professional interaction and discourse.

And it was fun!

PCMS Member-at-Large Richard Dale, M.D. has been the driving force behind this CME/travel event. We think you should start planning to go on the sixth version!

Tenet, Dignity, Ascension partner to own, operate CHN in Arizona

In a July 15 news release dated Dallas, San Francisco, St. Louis, and Tucson, Carondelet Health Network announced that major insurer Tenet Healthcare Corporation, Dignity Health, and CHN owner Ascension signed a definitive agreement to create a partnership that will own and operate Tucson-based CHN.

The new joint venture includes three hospitals, an outpatient and ambulatory services network, and two physician groups. Tenet will be majority partner in the venture and will manage the hospitals’ operations, related physician practices, outpatient and ambulatory services, and affiliated businesses in Tucson and Nogales. Dignity and Ascension will own minority interests in the partnership.

The agreement comes amid industry-wide buyouts and mergers that have already hit Tucson in the Banner Health buyout of University of Arizona Health Network. On July 24 Anthem Inc., headquartered in Indianapolis, Ind., the nation’s second-largest health insurer, announced it had reached a deal to buy rival Cigna Corp. in a deal valued at $54.2 billion, creating the nation’s largest health insurer by membership, national news services reported. They said the deal is part of health insurance industry-wide following introduction of the Obama government’s “Patient Protection and Affordable Care Act.” The Anthem and Aetna deals will face intense regulatory scrutiny from concerns over the consolidations driving up insurance premiums for businesses and consumers.

“We look forward to the opportunity to partner with two highly respected and dedicated healthcare organizations to improve healthcare delivery to the communities of Southern Arizona,” Tenet President of Hospital Operations Britt T. Reynolds said. “Through this innovative partnership, we will not only continue Carondelet’s 135-year healthcare mission to care for residents across Tucson and Southern Arizona, but will also connect Carondelet to a larger, growing statewide healthcare network, enhancing patient access to a wide range of healthcare resources throughout the state. This is consistent with Tenet’s strategy to create new, innovative models for patient care.”

Tenet and Dignity Health separately own and operate hospitals and clinics in the Phoenix area, and together manage a growing accountable care organization (ACO), the Arizona Care Network (ACN). The organization currently includes more than 130 patient care facilities across Tenet’s and Dignity Health’s Phoenix-based healthcare systems, with more than 3,300 providers and more than 200,000 covered lives. A Tucson– based joint venture will connect Carondelet to ACN, which will provide increased access to care for patients, strengthen and grow Carondelet’s relationships with physicians, provide employee development opportunities for current and future employees, and fund strategic growth initiatives across Southern Arizona.

Linda Hunt, president and CEO of the Arizona Service Area for Dignity Health, said, “The partnership will

continue the remarkable legacy of Carondelet in Arizona, while launching a new organization capable of maximizing the changing landscape of healthcare today and meeting the growing demands for quality care in Southern Arizona.”

“We are excited about this new relationship with Tenet and Dignity Health,” said Robert J. Henkel, FACHE, executive vice-president of Ascension and president and CEO of Ascension Health. “Carondelet shares Tenet’s and Dignity Health’s commitment to provide high-quality, low-cost, patient- centered care. This relationship is an opportunity to strengthen those efforts and enhance healthcare across Arizona.”

Facilities in the new partnership include St. Joseph’s Hospital (486 beds) in Tucson; St. Mary’s Hospital (400 beds) in Tucson; Holy Cross Hospital (25 beds) in Nogales; Carondelet Heart & Vascular Institute at St. Mary’s Hospital; Carondelet Neurological Institute at St. Joseph’s Hospital; Carondelet Medical Group; and Carondelet Specialist Group. Carondelet’s services also include imaging centers and other ambulatory services and ancillary businesses.

“The joint venture will maintain Carondelet’s Roman Catholic heritage and identity through an agreement with the Diocese of Tucson. Additionally, Carondelet’s existing charity care policies will remain in place. The transaction is subject to normal regulatory reviews and is expected to close in the third quarter of 2015.” Financial terms were not disclosed.

Tenet Healthcare Corporation says it operates 81 general acute care hospitals, 18 short-stay surgical hospitals, and more than 400 outpatient centers in the United States and nine UK facilities.

Dignity Health in Arizona includes five

hospitals: Chandler Regional Medical Center; Mercy Gilbert Medical Center; St. Joseph’s Hospital and Medical Center, which includes Barrow Neurological Institute; St. Joseph’s Westgate Hospital; and Arizona General Hospital. Dignity Health in Arizona has expanded into a comprehensive healthcare system that includes imaging centers, clinics, specialty hospitals, urgent cares, insurance providers, an ACO, and other clinical partnerships. The Dignity Health Medical Group includes more than 40 practices and covers a wide range of specialties. Dignity Health in Arizona is part of Dignity Health, one of the nation’s largest healthcare systems.

Ascension (www.ascension.org) says it is a faith-based healthcare organization that is the largest non-profit health system in the U.S. and the world’s largest Catholic health

non-profit health system in the U.S. and the world’s largest Catholic health SOMBRERO – August/September 2015
non-profit health system in the U.S. and the world’s largest Catholic health SOMBRERO – August/September 2015
non-profit health system in the U.S. and the world’s largest Catholic health SOMBRERO – August/September 2015
non-profit health system in the U.S. and the world’s largest Catholic health SOMBRERO – August/September 2015
non-profit health system in the U.S. and the world’s largest Catholic health SOMBRERO – August/September 2015

system. “Ascension is committed to delivering person-centered care to all with special attention to those who are poor and vulnerable.” “More than 150,000 associates and 35,000 affiliated providers serve in 1,900 sites of care, including 131 hospitals and more than 30 senior care facilities in 23 states and the District of Columbia.

In an odd addendum for a news release, Tenet’s “cautionary statements” said that the release “contains ‘forward-looking statements’—that is, statements that relate to future, not past, events. In this context, forward-looking statements often address our expected future business and financial performance and financial condition, and often contain words such as ‘expect,’ ‘assume,’ ‘anticipate,’ ‘intend,’ ‘plan,’ ‘believe,’ ‘seek,’ ‘see,’ or ‘will.’

“Forward-looking statements by their nature address matters that are, to different degrees, uncertain. Particular uncertainties that could cause our actual results to be materially different than those expressed in our forward-looking statements include, but are not limited to, the factors disclosed under ‘Forward-Looking Statements’ and ‘Risk Factors’ in our Form 10-K for the year ended Dec. 31, 2013, and in our quarterly reports on Form 10-Q, periodic reports on Form 8-K, and other filings with the Securities and Exchange Commission.

“The information contained in this release is as of the date hereof. The company assumes no obligation to update forward- looking statements contained in this release as a result of new information or future events or developments.”

AHSC’s Med-Start aims to change face of healthcare

High school students competitively selected statewide spent six weeks this summer exploring healthcare careers and education opportunities in a program conducting research and taking college-level courses at the Arizona Health Sciences Center, the university reports.

The six-week Med-Start summer program ended July 11. Students presented their research projects July 10 at UofA Cancer Center. Students from Douglas, Kearney, Nogales, Payson, the Phoenix area (Gilbert, Glendale, Goodyear, Mesa), San Carlos, Sells, Tuba City, Tucson, Whiteriver, Winslow, and Yuma competed for a place in Med-Start. They lived on campus.

“The highly competitive program is a proven success,” the university reported. “Eighty percent of its participants go on to enroll in higher education courses. Med-Start has

two goals: to address the critical shortage of

a diverse health-care workforce, and to

provide high school students with opportunities to explore health careers and college experiences to successfully reach their academic and career goals.

“Creating a diverse healthcare workforce

representative of the populations it serves

is a priority for Joe G.N. “Skip” Garcia, M.D.,

UA senior vice president for health sciences. He and Francisco A. Moreno, M.D., assistant vice-president for diversity and inclusion at AHSC, professor of psychiatry, and deputy dean for diversity and inclusion at the UA College of Medicine—Tucson, are leaders in AHSC’s efforts to recruit and train a

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“Med-Start is one of several AHSC programs created to promote health equity and wellness in Arizona’s communities, regardless of race, ethnicity, gender, geography, environment or socioeconomic status. Since 1969, more than 1,000 high school students, including students from Arizona’s most remote and under- represented areas, have been accepted into Med-Start. The Merlin K. “Monte” DuVal Memorial Med-Start Endowment was established to generate funds to support the Med-Start program.”

mechanism of contraction, we found that the filaments have to be precisely organized for efficient beating. Proper contraction requires filaments of the proper length. We found that Lmod2 is an actin filament elongation protein that regulates the lengths of thin filaments in heart muscle,” Pappas said.

The researchers identified the connection between thin-filament length and cardiac function, as well as the role thin-filament length dysregulation plays in cardiomyopathies. Their goal is to uncover insights into novel therapeutic targets for dilated cardiomyopathy. Future directions for the research team include determining how short thin-filament lengths lead to dilated cardiomyopathy and if Lmod2 mutations are present in human patients with dilated cardiomyopathy.

NIH grants Sarver to study contractile proteins

UofA researchers have identified the connection between thin-filament length and cardiac function, as well as the role thin- filament length dysregulation plays in cardiomyopathies. The new NIH grant will help to uncover insights into novel therapeutic targets for dilated cardiomyopathy, the UofA reported in July.

“The Gregorio Lab in the University of Arizona Sarver Heart Center’s Molecular and Cardiovascular Research Program (MCRP) was awarded $1.77 million from the National Institutes of Health (NIH) for a study called Deciphering the Role of Lmod2 in Thin Filament Length Regulation and Dilated Cardiomyopathy (NIH Grant 1R01HL123078).”

“This award demonstrates the value of Sarver Heart Center’s Investigator Awards Program, which provides seed funding for promising research ideas,” said Carol C. Gregorio, Ph.D., head of the UA College of Medicine—Tucson Department of Cellular and Molecular Medicine, director of the MCRP, co-director of the UA Sarver Heart Center, and principal investigator on the grant.

“Under Gregorio’s mentorship, Christopher Pappas, Ph.D., a postdoctoral research associate, obtained a Sarver Heart Center Investigator Award funded by the Steven M. Gootter Foundation. With the funding, Pappas studied the role of the protein Lmod2 in cardiac development and dilated cardiomyopathy (DCM). The Investigator Award enabled Pappas to jump-start his path to career independence by obtaining the data necessary to compete successfully for the NIH grant as a co-investigator, Gregorio said.”

“Cardiac muscle is composed of thick and thin protein filaments. In studying the heart’s

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help those with ailments, led him into the field of medicine. He earned his medical degree from Louisiana State University Medical School in Shreveport in 2009, where he was elected into Alpha Omega Alpha Honor Society.

While in medical school, he was introduced to Otolaryngology (ear, nose, & throat), a wonderful field of complex anatomy, requiring surgical and medical expertise to treat those with problems of the head and neck. Dr. Clavenna completed a general surgery internship and otolaryngology surgical residency at Louisiana State University Health in Shreveport.

Following residency, Dr. Clavenna completed a Fellowship in sinus, allergy, and anterior skull base surgery at Vanderbilt University in Nashville, Tennessee. There he trained under internationally known surgeons, Drs. Rick Chandra, Paul Russell, and Justin Turner. During fellowship he focused on advanced sinus surgeries, including management of frontal sinus disease, nasal and skull base tumors, pituitary surgery approaches, ophthalmological related procedures and treatment of allergies. Many of these cases were performed in conjunction with neurosurgeons and ophthalmologists. One of his most fond memories from fellowship involved treating a patient emergently transferred to Vanderbilt for severe sinus disease encroaching on the vision of his right eye. Using his recently learned endoscopic sinus surgery techniques with the aid of image guidance, he was able to successfully treat and drain the infection and preserve the patient’s vision.

Dr. Clavenna moves to Tucson with the desire of helping those in the community with their ear, nose and throat related problems. He is the first fellowship trained sinus and anterior skull base surgeon to join a private practice group in Tucson. Though he has a passion for nasal, sinus, and allergy related disorders, he also enjoys treating the full gamut of ENT related issues, from neck masses to ear surgery.

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‘Medjacking’: Absurd yet deadly tech

In

the summer Sharknado 3 “Oh hell no” category, The University

of

Arizona reports that it is part of an “elite” committee studying

medical device electronic security, recognizing the potential for “medjacking”–malicious medical device hacking.

The UofA College of Medicine sent surgery professor David Armstrong, D.P.M., M.D., Ph.D. to the first committee meeting in July in Bethesda, Md. Called the Cybersecurity Standard for Connected Diabetes Devices Steering Committee, it joins forces with the Department of Homeland Security, National Security Council, NASA, and other government and industry leaders to create strategies to keep the world safe from medjacking.

A podiatric surgeon and the director of the UA Southern Arizona

Limb Salvage Alliance (SALSA), Dr. Armstrong is the lone medical academician on CSCDDS committee, the UofA reports, though it

is otherwise “well represented” on the committee. While devices

associated with diabetes are the initial focus, Dr. Armstrong said the committee is expected to examine the security of other medical devices. “As connected devices become more pervasive and powerful, the potential for malicious medical device hacking

is becoming increasingly real,” he said.

“Medical devices—insulin pumps, pacemakers, artificial hearts, left ventricular assist devices, artificial pancreas constructs—are susceptible to the same unintentional or intentional and nefarious interruption and invasion as are bank accounts, ATM machines and credit card devices.”

While medjacking currently exists in the imagination and in laboratories, Dr Armstrong said it is only a matter of time before the issue “comes front and center. No one really thinks about these things until there is catastrophic failure. These sorts of hacks are definitely feasible, and reasonably clever people without a lot of resources can do some serious damage. We are trying to get out in front of this problem.”

The challenge for the CSCDD steering committee is to mitigate danger without stifling innovation. Dr. Armstrong said patients must be confident in the safety of their medical devices, and companies must be secure that they are investing millions of dollars in technology that is safe from cyber attack. The committee will examine how key elements included in embedded systems within devices can make them less susceptible to failure or malicious or unintentional breach.

Discussion has swirled around the concept of medjacking for years, the UofA reported. “Since at least 2012 we have been talking about the impending merger of medical devices with

consumer electronics,” Dr. Armstrong said. “Even the most advanced medical devices are similar to the things we have in our pockets or in our hands, such as iPhones, tablets, and home

computers.”

n

Arizona Medical Associa on News

Uniting the house of medicine

By Nathan Laufer, M.D.

Editor’s note: This speech was presented to the ArMa House of Delegates May 29, and was published in the summer issue of the ArMA magazine AZ Medicine.

I am originally from Montreal, Canada and have been in

practice in Phoenix for more than 30 years. My wife, Judy, a kindergarten teacher, has been an inspiration to me, and my moral compass. I do believe that everything we need to know in life, we learned in kindergarten!

I am a medical graduate of McGill University in Montreal, as is Bob Orford, one of our past presidents. Having come

from Canada, I have a somewhat different perspective on the U.S. healthcare debate and on the turmoil we are undergoing. I see the beginnings of the Canadian healthcare problems and more developing in the U.S.

as the healthcare dollar continues to shrink and the healthcare reform starts to take hold.

In the words of Dr. William Osler, “Medicine is a science of uncertainty, and an art of probability.” This statement continues to hold true today, not only with the practice of medicine, but also with the business of healthcare. We are living in uncertain times, and yet have to make medical and business decisions without having all the facts at hand.

Current challenges to physicians include:

1. The physician shortage. Physicians are retiring or changing careers at younger ages, and those who remain are increasingly dissatisfied with their career choice—so much so that many don’t recommend the medical profession to the next generation.

Medical education funding has not kept up with the demand for qualified primary care and specialty care training. It is estimated that the U.S. will face a shortfall of more than 130,000 physicians in 10 years, equally divided between primary care and the specialties.

2. The administrative load and competing regulatory programs

are increasing. One of the greatest frustrations to physicians is the time and expense they must devote to administrative and regulatory requirements, taking their time away from patient care. Some of these administrative burdens include PQRS and Meaningful Use documentation, HIPAA security risk analysis, and ICD 10 implementation.

HIPAA security risk analysis, and ICD 10 implementation. 3. The Medicare physician payment system is changing.

3. The Medicare physician payment system is changing. Congress has repealed the sustainable growth rate (SGR) formula which would have resulted in a 21 percent pay cut, scheduled to take effect April 1. However, this is a mixed blessing!

The “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA) was signed into law by the President on April 16, 2015. MACRA permanently repeals the flawed SGR formula and stabilizes Medicare payments for physicians. There will be a 0.5% yearly increase in the Medicare fee schedule until 2018, but then it will be frozen until 2024.

MACRA will shift Medicare compensation from fee-for-service to pay-for-performance. CMS intends to require that 30% of Medicare payments are made through alternative payment modes by 2016, and 50% by 2018, in order to improve the efficiency of care.

MACRA replaces Medicare’s multiple quality reporting programs with a new single Merit Based Incentive Payment System, also called the “MIPS” program. MIPS is a consolidation of three pay- for-performance programs already underway plus a new one.

Assessments will be based on four categories of metrics:

(1) quality – similar to the PQRS; (2) resource use (or efficiency); (3) meaningful use of electronic health records, and (4) clinical practice improvement activities.

The poorest performing doctors will see their payments cut by up to up to nine (nine!) percent. The new incentive structure would be budget neutral. For every doctor that makes more from the MIPS metrics, there will be one who makes less. A true zero-sum game, if you will.

Private insurers are also increasingly adopting value-based payment models and risk sharing. This is projected to increase to 75% of covered lives by 2017.

4. More physicians are employed by hospitals than ever before. To serve the ACA models of care, hospitals are rapidly acquiring primary and specialty practices and new grads.

The solo practitioner continues to disappear. Thirty-nine percent of physicians younger than 45 years of age have never worked in private practice. But joining a hospital system is not a panacea for physicians.

Some physicians are returning to private practice because their compensation from hospitals became less attractive after the expiration of their initial contract. The hospitals switch to performance-based pay, which can end up being lower than their initial salary. Further, physicians are asked to see more patients in less time while reporting to a hospital administrator and following hospital-imposed guidelines.

As large hospital networks acquire more and more physicians, they direct patients to their physicians. If you are outside of their network, the hospital systems will hire people to compete with you and take the losses up-front, in order to increase their patient base.

The pressures on independent physicians are such that more physicians are likely to seek to join a hospital in the coming years.

5. There continues to be efforts to expand non-physicians’

scope of practice. Numerous groups continue to try and encroach on the physician practice of medicine. Here I would like to note ArMA’s unflagging work in countering these efforts in Arizona, accomplished just in the last year. • ArMA has successfully stopped psychologist prescribing

legislation, and stopped all scope of practice expansion efforts by chiropractors and naturopaths.

• ArMA has worked to curb unsafe expansion in scope of practice (VBAC, breech, and multiples) by lay-midwives.

• ArMA was part of the Coalition that stopped administration of vaccines to children 6 - 17 years old by pharmacists without a physician’s order.

ArMA will need to stay vigilant at the state legislature, to block new attempts at expansion of scope of practice by non- physicians, in order to protect the public from untrained providers.

6. Government and payers are meddling in the doctor patient relationship.

I believe in the sanctity of the doctor-patient

I believe in the sanctity of the doctor-patient relationship. However, chart audits and prior authorizations

relationship. However, chart audits and prior authorizations are some of the ways payers are inserting themselves into the physician- patient relationship and into medical decision making.

In addition, more payers are tightening their provider networks in an attempt to rein in costs. This move toward narrow networks means many physicians are being evaluated for costs and quality, and patients may be forced to switch physicians because their physicians are dropped from networks.

Arizona became the first state in the nation to pass into law an informed consent provision that guarantees women seeking abortions be told by their physician, that it may be possible to reverse the effects of the abortion pill with progesterone. This law is based on six patients treated by a family doctor in San Diego. It’s junk science, and it is suspended as it awaits a challenge in the courts.

ArMA is making a difference.

I have, for over three decades, been a firm

believer in the institution of organized medicine and the good that we can accomplish with unified action. ArMA has steadily grown to be the most significant, recognized, health care voice at the Arizona State Capitol and with regulatory agencies. Its successes are too numerous to list here, but I urge you to review our Annual Legislative Report included with this publication.

Looking forward during my presidential term. My goals for ArMA during my term as president include the following:

1. Have ArMA become a liaison with the

department of insurance to help oversee

health plan violations, which include dropping physicians from networks and delay in payments for clean claims.

2. Be vigilant regarding potential antitrust

activities of large hospital and health plan networks.

3. Increase ArMA membership by demonstrating relevance to employed as well as private practice physicians.

4. Work with specialties and county societies to help them be more united in the House of Medicine in Arizona.

5. Work with the medical board to streamline complaints and improve efficiencies.

6. Continue the physician leadership program that was pioneered by our Immediate Past President Jeff Mueller, M.D.

Insurance companies and hospitals have powerful political lobbies. Yet, without physicians they cannot function very well. These entities have managed to divide us by specialty and by groups within each specialty. This has to stop!

At this critical time we must have a united House of Medicine. We still have power in numbers, if we can overcome specialty and group differences and unite in some fashion under one tent.

It is surprising to me that the laws of supply and demand don’t seem to apply to the healthcare field. This is due to government intervention and to a lack of unity within the physician community.

As I have outlined, there will be many changes to American medicine in the coming years. We must always remember that, as physicians, we are still the best, and sometimes the only advocates that patients have. Patients and their families are turning to us to help them navigate the complexities of their health plans, Medicare, and hospital systems.

It is crucial for us all to understand the changes coming and hopefully help guide and lead some of these changes. Despite any future reorganization, we must continue to provide the most honest, ethical, and superb care that the public expects of us.

I also remain cautiously optimistic about the future. Healthcare reform won’t be easy, but I cling to the notion that the new generation of doctors and patients will figure it out. I still recommend medicine to any young person who asks my opinion.

The life of a practicing physician can still be incredibly rewarding. As Hippocrates said, “Wherever the art of Medicine is loved, there is also a love of Humanity.”

Physicians continue to be unique in that our services will always be needed. We are still one of the most highly respected and trusted professions in the country. No matter how the healthcare debate evolves, and no matter what actions we may take to preserve our profession, we must never jeopardize our patients’ trust in us.

“If am not for myself, then who will be for me? And if am only for myself, then what am I?

And if not now, when?” –Hillel, Ethics of the Fathers, 1:14

Nathan Laufer, M.D. is the 124th ArMA president. Dr. Laufer is a cardiologist and the medical director of the Heart & Vascular Center of Arizona.

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22 SOMBRERO – August/September 2015

Behind the Lens

La Danza de la Muerte at home

By Hal Tretbar, M.D.

the Lens La Danza de la Muerte at home By Hal Tretbar, M.D. I n our

I n our June-July Behind the Lens, we took a look at Spain

and South America for the international state of the sport/ art of bullfighting in history and today. For August-September we see La Danza de la Muerte from a local perspective.

My parents took me to a bullfight in Mexico City when I

was in high school. Dorothy and I went to one in Madrid in

1959.

in high school. Dorothy and I went to one in Madrid in 1959. An early 1950s

An early 1950s postcard of the Nogales, Sonora Plaza de Toros.

We used to go to Mexico quite a bit when we moved here in 1965. There was no trouble crossing the border, and the dollar was worth a lot. In the 1960s and ‘70s going to the bullfights in Nogales, Sonora, was a popular thing to do. You would take in a bullfight at the Plaza de Toros and then eat at a nice restaurant such as La Roca, Elvira’s, or La Caverna. Finally, you would buy your allotted gallon of tax-free booze before returning home.

Spain’s Conquistadors brought bullfighting to the New World, and Mexico City became the epicenter. The first fight there is said to have been in August 1529. Finally the 1907 El Toreo ring in the La Condesa neighborhood was replaced by the largest bullring in the world. The Plaza Mexico ring with 41,262 seats was finished in 1944 and opened in 1946. It has hosted the top bullfighters in the world. Bullfighting has become less popular recently and sometimes Plaza Mexico will host musical events or prize fights.

There is a history of bullfighting in the USA, although it is illegal to kill the bull. In 1884, Dodge City, Kansas was losing its image as a true Wild West town and needed something to perk up its reputation. The mayor and city council organized a true bullfight for the Fourth of July, 1884 celebration. They built a fight ring and hired five genuine bullfighters, four matadors, and a picador, from Paso del Norte (Juarez), Mexico. The wildest Texas bulls, “always mad as they could get,” were selected from herds that had been driven to the rail-head. When federal authorities tried

to stop the event, it was reported that saloonkeeper and former mayor Alonzo B. Webster snorted, “Hell, Dodge City ain’t in the United States!”

The fight drew national attention. Four thousand spectators and a multitude of out of town reporters attended. In the two day event there was only one truly impressive bull. He went down

In the two day event there was only one truly impressive bull. He went down SOMBRERO
In the two day event there was only one truly impressive bull. He went down SOMBRERO
In the two day event there was only one truly impressive bull. He went down SOMBRERO
In the two day event there was only one truly impressive bull. He went down SOMBRERO
Mexican bullfighters in Dodge City, Kansas on the 1884 Fourth of July (Photo courtesy Kansas

Mexican bullfighters in Dodge City, Kansas on the 1884 Fourth of July (Photo courtesy Kansas Historical Society).

from a trust from Matador Gregario Gallardo’s antique 150 year old Toledo sword. Overall the entire bullfight week end was a huge success The bars and the shady ladies prospered. Dodge City regained its wicked reputation.

In Mexico many cities have had bullrings. In the 1950s there were said to be about 220, but only 30 or so had at least four fights a year. Some of the most popular rings developed along the border including those in Matamoros, Nuevo Laredo, Cuidad Juarez, Nogales, Mexicali, and Tijuana.

Nogalesinternational.com for Oct. 18, 2001 gives some background. “Nogales, Sonora was once a hotbed for bullfights, spanning back to 1914 when a rustic ring was built on Calle

International almost parallel to the border. In 1948, Don Pedro Gonzales sold his curio shop and used the money to build the

Among the crowds in the glory

concrete Plaza de Toro [in 1952]

days would be such celebs as John Wayne, Lee Marvin, Gary

Cooper, and Ava Gardner.

“Regularly, the Plaza hosted masters. most of whom were assigned pointed monikers referring to their prowess, such as Carlos ‘The Cyclone’ Arruza; Luis ‘The Soldier’ Castro; and Fermin Espinosa, known as the ‘maestro’s maestro’ in the bullfighting world.”

Today few Tucsonans remember how popular bullfighting in Nogales was from the 1950s to the ’80s. There were corridas

was from the 1950s to the ’80s. There were corridas Trying to avoid the horns while

Trying to avoid the horns while placing the banderillas, in Plaza Mexico bullring, Mexico City 1954.

the banderillas, in Plaza Mexico bullring, Mexico City 1954. A close call with no injuries, Plaza

A close call with no injuries, Plaza Mexico, Mexico City 1954.

almost every week. Phoenix television station KPAZ/Channel 21 carried live bullfights 1967-69 along with jai alai games. Plaza de Toro had special discount days for Davis-Monthan airmen as well as UofA students. Tickets were sold at Dillard’s department stores.

Dick Frontain taught for many years at Marana High School and Pima College, but he is remembered as a bullfight aficionado. In 2007 Arizona Daily Star writer Ernesto Portillo wrote that Frontain was “one of the best writers on the subject. He took damn good bullfighting photos and his books on (Carlos) Arruza and bullfighting are highly prized.” Dick regularly reviewed the previous day’s corridas in Nogales for the Star. He also collaborated with Tucson artist Ted de Grazia in 1967 for his series of paintings on the Mexican border bullrings. Frontain died in 2007.

Tucson is probably the only city to have a street named for a bullfighter. Carlos Arruza was one of the greatest and most popular of Mexican matadors, and he fought many times in Nogales. In later years he fought as a rejoneador—one who faces the bulls on horseback. However, to the crowd’s delight, he would

A ticket for University of Arizona Day in Nogales, Oct. 25, 1970. finish the third

A ticket for University of Arizona Day in Nogales, Oct. 25, 1970.

finish the third stage, tercio de muerte, on foot. Carlos was very graceful, artistic, and adept with the sword. He was awarded many ears and tails.

Hollywood filmmaker Budd Boetticher was a close friend of Arruza and made an hour-long documentary about him. After it

Arruza and made an hour-long documentary about him. After it Diego O’Bolger performing the difficult and

Diego O’Bolger performing the difficult and risky gaonera pass with cape held behind the back.

premiered in Tucson in 1972, the Tucson Festival Society had a street named after him. Located east of Granada Avenue, Calle Carlos Arruza is a half block long on the north side of the Tucson Music Hall. It’s worthwhile to watch the film Aruzza on YouTube for his outstanding horsemanship.

The Nogales Plaza de Toros was well known. It was not unusual to feature famous fighters such as Manolete or El Cordobes. Manuel Laureano Rodriquez Sanchez or Manolete, was considered to be one of the best in Spain. He was famous for his ability to perform many passes without moving his feet. He appeared in Nogales just before he was fatally gored in Spain in August 1947.

Mario de la Fuente Flores bought the Nogales Plaza de Toros in 1963 and refurbished it. The great Spaniard, El Cordobes, Manuel Benitez Perez, fought twice there in 1969. He was known for his behind-the-back passes.

In 1984 Dodge City, Kansas again tried to revive the past. To commemorate the 100 th anniversary of the first bullfight, they put together a weekend of Portuguese-style bullfighting where no bulls are put to the sword. There were four well-known matadors including Diego O’Bolger. Dick Frontain was the MC and he explained the intricacies of a corrida to the excited crowd. The weekend was so successful that they had bullfights for three more years.

On July 5, 1985, the Denver Post commented, “Bullfights? That’s how 4,000 people in Dodge City, Kan. celebrated their July Fourth. The standing-room-only crowd saw matadors Diego O’Bolger, David Renk , David Silveti, and the world’s only professional female bullfighter, matadora Raquel Martinez strut their stuff…

“O’Bolger was tossed by his bull. The bull charged and knocked him to the ground. O’Bolger tried to roll his body and protect his face, but the bull … hit him in the mouth and arm. O’Bolger’s right front tooth was broken, and his lip was left with a hole… A few minutes later O’Bolger was standing on his own and waved to the crowd that he was all right… The rest of the night went smoothly, with three inaugural fights managed by Diego O’Bolger.”

By the late 1980s and early ‘90s, bullfighting was losing must of its popularity and fewer fights were being scheduled. However Mario de la Fuente’s son, also named Mario, had other ideas. The

Laredo Morning Times for Nov. 13, 1999 reported that he had just finished building a $4.5 million bullring in Nogales. The Fiesta Brava was covered with transparent acrylic plastic. The 5,000- seat air-conditioned arena had a bar and restaurant. There were three inaugural fights, managed by Diego O’Bolger.

The timing could not have been worse. On Nov. 16, 1999 the Arizona Daily Star carried two viewpoints on bullfighting. Matador Diego O’Bolger, a Tucson resident, argued that bullfighting had a long history of being a traditional art form. Lisa Markkula from the Animal Defense League called it animal cruelty. That same day, Dillard’s stores stopped selling bullfight tickets. The last regular fight in Nogales was in December 1999. There was an infrequent minor event until the State of Sonora banned bullfighting on May 2, 2013.

Of all the Mexican restaurants in Tucson that at one time had bullfight posters and artwork, only Casa Molina on Speedway retains the theme. Several large posters depict man-vs.-bull, while smaller fliers announce the time, place, and matadors for coming events.

According to Gilbert Molina, his grandfather Gilberto opened the restaurant in 1947. In 1966 his father Elias commissioned the bigger-then-life bull and matador in front of the restaurant. Lee Copeland, who had done all of the fantastic figures at the nearby Magic Carpet miniature golf course, sculpted the statue. Gilbert said no one has ever complained about the bullfighting décor.

Today few Tucsonans remember anything about the appeal of bullfighting in Nogales. The pageantry of corrida; the ballet-like moves of an athletic matador; the bright colors of the gold or

of an athletic matador; the bright colors of the gold or silver “suits of light”; the

silver “suits of light”; the waving of the magenta and gold capote (cape); and the invigorating paso doble (double step) music.

Now only the ghosts of worthy bulls and the memories of famous matadors hang over the remains of bullrings in Nogales, Sonora. If you listen closely to gusty winds, you may hear the faint sounds of “Ole! Ole!”

Meet the local matador

the faint sounds of “Ole! Ole!” Meet the local matador Most Tucsonans know the larger- than-life

Most Tucsonans know the larger- than-life bull and matador sculpture at Casa Molina Mexican restaurant on Speedway. Recently over lunch there, Diego O’Bolger reminisced about growing up in Tucson.

His family moved here from Buffalo, N.Y. when was four or five years old. His dad had a furniture store on South Sixth Avenue, and his mom worked for

Diego O’Bolger in his suit-of-lights days.

Tucson Newspapers Inc., where the Tucson Citizen and Arizona Daily Star were printed. James Bolger sold newspapers downtown around Jacome’s department store and met some bullfighting aficionados.

Apparently his mom got some tickets through her job, and took young James to his first bullfight in Nogales when he was 10. He still remembers how he was impressed by the American woman fighter Patricia McCormick and two Mexican professional novilleros, or novices.

James began reading and trying to learn about las corridas de toros. At that time in Tucson, many people were interested in the bullfights. One was the famous artist Salvador Corona, a well- respected Mexican matador who was severely gored in 1919. A matador friend told him that as a bullfighter he was an artist, and that he would do well as a painter.

Salvador became famous in Mexico for his folk art style. He represented Mexico at the 1939 New York World’s Fair. He visited Tucson, and moved here in 1940. He became famous for his murals in the homes of prominent Tucsonans. His paintings were in demand and sold through the Thunderbird Shops of Frank and Pat Patania. He died in 1990.

James spent a lot of time with Salvador learning the basic bullfighting style and techniques, and he learned Spanish. Over the next several years he began to understand what bullfighting was all about. While still selling papers and playing quarterback for

Salpointe High School, he continued to attend corridas in Nogales.

After high school James finally pursued his dream of becoming a torero. He rode his motorcycle to Mexico City to train in Plaza Mexico, the world’s largest bullring. He took letters of introduction and changed his name, as Diego is Spanish for James. He reverted to his Irish roots with the surname O’Bolger.

Diego’s first formal novice fight was on Aug. 11, 1962 in Nuevo Laredo, Mexico. On Oct. 18, 1964, he had his debut at Plaza Mexico. His alternativa ceremony to become a full-fledged

matador de toros took place in Tijuana after a scheduled corrida on Aug. 15, 1969. He was only the sixth American in 300 years to achieve this distinction.

the sixth American in 300 years to achieve this distinction. Diego at Casa Molina with the

Diego at Casa Molina with the flier for the corrida in Nogales on May 4, 1986, when he was on the program with Matadora Raquel Martinez.

when he was on the program with Matadora Raquel Martinez. After an outstanding corrida at Plaza

After an outstanding corrida at Plaza Mexico in 1965, Diego O’Bolger circles the ring holding a sombrero thrown in appreciation while an assistant carries flowers.

Diego had a distinguished career. He lived in and fought in Spain for five years while helping with an art gallery. During the 27 years he lived in Mexico City as a matador, Diego also was a model for TV commercials. For six years he worked in public relations for Casa Pedro Domecq, maker of wines and brandies.

Diego returned to Tucson with his Mexican wife, Delfina, and two children. He is still active in community affairs. He says he still misses the art and ballet that it takes to “dance” with a brave,

magnificent bull.

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Travel

Of down under and out back

By Dr. George J. Makol

Travel Of down under and out back By Dr. George J. Makol W ell, I waited,

W ell, I waited, and I waited, and I waited some more.

I was not waiting for Earth’s temperature to rise, because indeed, that hasn’t happened for about 17 years. No, I was waiting for the polar ice caps to finish melting, causing the ocean to rise so much that it would wash Australia across the Pacific until it bumped up against the California coast. I could then avoid the 16-hour plane ride, and just walk across a koi-pound bridge to get to Sydney.

Alas, this never happened, but since Australia was to be my seventh continent, I gritted my teeth and planned the trip to occur in April. If you have not visited this country yet, let me address the advisability of going to New Zealand as well. Australia vs. New Zealand is what I would call a Gilligan’s choice; Ginger or Mary Ann, and my answer to either of these dilemmas is both. But my adventure on this trip started before the plane even got off the ground, so more about New Zealand later.

My wife and I were in the Qantas lounge in L.A., enjoying ourselves so much we almost forgot to go down to board the plane. We had to move quickly, as they were just boarding our seats when we arrived at the now-empty check-in line. As I stepped forward the stewardess stopped me and said that all my passport information was not in the computer, and a small figure moved around my wife and me, and as I turned, I almost knocked over country star Keith Urban! Apparently he had just arrived from the American Idol set, T-shirt, jeans and no luggage, to visit family in Sydney.

Now I’m not usually starstruck, and I’m not interested in autographs, but I had seen Keith play in Phoenix last year, and in my opinion he’s the most astounding guitar player in all of country music, even given the massive guitar talents of Vince Gill and Brad Paisley. At the concert he actually came and played in our row, about six seats down from where we were seated. He was quite friendly, and I would’ve loved to talk guitar with him, but the stewardess’s dodge kept me from going down the ramp with him, and he quickly disappeared downstairs to one of the private first-class quarters on the Airbus 380. And no, fellas, Nicole was not with him!

About 19 hours later, including a stop in Sydney, we arrived in Queenstown, New Zealand. I cannot say enough about this arrival, as the huge plane swooped in seemingly almost touching 2,000-foot sheer rock precipices on either side. The mountains look nothing like the mountains in Arizona, as they were formed by the cutting effects of glacial ice and shoot 2,000 feet straight up in the air, no trees, no soil, just rock.

feet straight up in the air, no trees, no soil, just rock. Waterfall at Milford Sound.

Waterfall at Milford Sound.

I was so startled by the beauty surrounding me that I just stood frozen on the tarmac for about five minutes, and my wife and our guide had to come back and retrieve me. In the next few days we visited waterfalls and the rain forest, the latter within aboriginal guide, and yes, the South Island really looks like it does in the Lord of the Rings films.

We also visited Milford Sound, which actually is a fjord formed by glaciers cutting eons ago through stone. We were at first disappointed that it was raining, but as we cruised on our boat the captain noted that we would see 100 waterfalls that tourists never see in dry weather, and indeed we did. We later stopped at New Zealand’s first and most spectacular Kawarau Bridge bungee jump on a span stretching 186 feet above a raging river. It has a visitor center compatible with something you would see at the Grand Canyon, and we arrived just as a bridal party came to watch the bride and groom jump off the bridge in their wedding attire. The event was captured on video, so 20 years from now when their children call them old fuddy-duddies, they can shut them up by playing this clip.

Next we were on to Mount Cook, the former home of Sir Edmund Hillary and a place where he practiced to be the first Western

Indigenous artists offer their wares. man to ever summit of Mount Everest. The views there

Indigenous artists offer their wares.

man to ever summit of Mount Everest. The views there are astounding and the hiking equally spectacular, but near the base of the mountain there are numerous plaques placed in memory of those who had died while hiking there. Just climbing up to read the plaques made me dizzy, so we retreated to the five-star Hermitage Hotel in Mount Cook to sip coffee from the balcony and take in the breathtaking scenery.

Since we traveled 21,000 miles in 22 days, all cannot be recounted here. Words cannot really describe the Great Barrier Reef, and even if you cannot swim, glass-bottom boats and modified submarines will give you spectacular views of coral and fish sometimes only 18 inches below the glass.

The Sydney Opera House, the city’s most visible symbol, is an architectural wonder inside and out. The Australians held an international design competition that received 233 entries representing architects in 32 countries, before they chose Danish architect Jorn Utzon. Construction of the building took 14 years, as it was a unique design, unlike any previous building. The offered two-hour tour covers the inside and the outside, and the main concert halls, which are cleverly designed and entirely lined with wood pieces, each adjusted specifically to reflect sound from the stage. The sound is so perfect that performances can be held without amplification equipment. Personally, however, I would love to see Led Zeppelin play there.

One thing that most Americans do not realize is that most of the population of Australia is in the coastal cities, and that the center part of the country is almost uninhabited. Whereas there are about 23 million people in Australia, the huge northern territories, several times the size of Texas, only have 200,000 persons living there. So, while visiting Australia, it is essential to go to the “Outback,” and we spent a couple of days smack in the middle of Outback at Ayers Rock.

We were incredibly lucky to have Crocodile Dundee as our guide (his name was actually Leroy, but he was a gem and just as funny as Paul Hogan). Our guide was also close friends with the aborigines, now addressed as “indigenous peoples,” so we were able to meet these natives, communicate with them, and even brought home a couple pieces of original art we bought directly from the artists.

We stayed in a fabulous five-star plus resort Sails in the Desert. There is a small town built around the resort, and 1,000 employees all work for one company, Voyager of Australia. They

all work for one company, Voyager of Australia. They Ayers Rock at sunset. are in the

Ayers Rock at sunset.

are in the process of turning the resort over to the indigenous population, who will run it in the future; this is entirely appropriate, as they owned the land in the past.

You may know Three Dog Night as a 1970s American rock group, but the origin of the name is aboriginal, as on cold nights indigenous warriors would dig a hole in the gound and sleep with one or two dingoes (Australian dogs) on top to keep warm; so a three-dog night represents a very cold one in the Outback.

Yes, there are incredible numbers of black flies in the air around the Ayers Rock monument, and we were given mosquito net headgear to wear hanging down from our hats. The Indigenous find this frankly hilarious, as they seem to just ignore the flies and I believe the flies ignore them, as they greatly prefer tourists.

the flies ignore them, as they greatly prefer tourists. This eight-foot croc was in the estuary

This eight-foot croc was in the estuary at Cairnes.

Is it worth the long trip? I say it definitively is. In fact, I met many persons working in Australia and New Zealand who had absolutely no accents and were obviously at one time Americans. When I asked them how they got there, invariably I heard, “I came here for vacation 10 years ago and never left.” That sums it up better than I can.

Sombrero columnist George J. Makol, M.D., a PCMS member since 1980, practices at Alvernon Allergy and Asthma, 2902 E. Grant Rd. His Makol’s Call will return in October.

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CME

Pima County Medical Foundation CME

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, with dinner at 6:30 p.m. and presentation is at 7.

New location is Tucson Osteopathic Medical Foundation headquarters, Camp Lowell and Swan roads. Make turn on first street on right and follow curved road to front door. Scheduled for September is:

Sept. 8: “What’s Up Down Below—Hot Topics and Controversies in Testosterone, ED, PS, Prostate Cancer, and Vasectomy Reversals and Impotence” with doctors Sheldon Marks and Peter Burrows.

September

Sept. 22-27: Cycling CME in Colorado says: “Please joins us for a unique CME experience in beautiful Colorado! These two CME conferences emphasize nutrition, exercise as medicine, and common musculoskeletal problem therapy. Conference groups are small, helping to create an atmosphere conducive to interactive learning in a hands-on atmosphere. Each day we will be rewarded with a challenging road bike ride through beautiful terrain. If you enjoy active learning, cycling, and Colorado, please join us in 2015. Cycling CME Western Colorado is in Grand Junction Sept. 22-27. Website is www.cyclingCME.com .”

Sept. 24-26: The Western Occupational & Environmental Medical Association presents the Western Occupational Health Conference:

To Workers’ Health in the West at Loews Ventana Canyon in Tucson, offering more than 20 hours’ CME credit for physicians.

WOHC 2015 provides “opportunities for learning” using “the latest information in medical education to provide for workers’ health,” organizers say. “This includes updates in general health, effects at the workplace, environmental and medical surveillance, and late-breaking controversial issues.” PCMS member Scott Krasner, M.D., M.P.H., F.A.C.O.E.M., medical director of Krasner Medical Consultants, chairs the conference.

Included are work-site tours including Asarco Copper mine and

Raytheon. For staying at the resort, call Loews Ventana Canyon at

800.234.5117. Deadline is before Sept. 1. For more information,

e-mail WOEMA at woema@woema.org, call 415.764.4918, or fax

415.764.4915. Registration fees vary by additional Thursday

events attended. Friday and Saturday Plenary Sessions are $675 for ACOEM/WOEMA member physicians, $795 for non-members, and $425 for allied health professionals including NPs, PAs, and RNs. Registration forms can be mailed to WOEMA, 575 Market St., Suite 2125, San Francisco, Calif. 94105.

October

Oct. 1-2: Ethical Dilemmas—Consultation and Problem-Solving:

the Mayo Clinic Approach is at Mayo Clinic Education Center, 5777 E. Mayo Blvd., Phoenix 85054. AMA, AAFP AOA, and nursing accreditation to be announced.

“Ethical dilemmas related to patient care can be associated with

medical, psycho-social, ethical, and spiritual challenges for healthcare team members. This course focuses on how to effectively determine patient preferences and appropriate goals of care; developing a coordinated, consistent approach to ethical dilemmas to reduce both the frequency of occurrence, and stress among providers, patients and their families, and the community; and implementing an ethics consultation service in your practice based on the four-quadrant approach.”

Website: https://ce.mayo.edu/ Contact: Lilia Murray, 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/

Oct. 1-3: The Association of American Physicians and Surgeons 72 nd Annual Meeting is Constitutional Symptoms: Curing American Medicine’s Government-Induced Illness is at the Hilton St. Louis Frontenac, 1335 S. Lindbergh Blvd., St. Louis, Mo. 63131.

“Doctors must lead the charge,” AAPS says. “This must-attend meeting will arm you with the tools you’ll need to help in this fight to save American medicine. Join your colleagues and learn how you can make a difference!”

For reservations call 314.993.1100 and mention AAPS to receive group room rate of $129 per night. Link to online room reservations at aapsonline.org/2015am. Registration: AAPS member $475 until Sept. 1 increase to $525; $250 spouse or guest. Scholarships available for med students and residents.

CME: Max 12.0 AMA Category 1 designated by New Mexico Medical Society with joint providership of Rehoboth McKinley Christian Health Care Services and AAPS.

Oct. 9: The Fourth Annual Current Trends in Liver Disease:

Hepatitis C From A to Z is 11:30 a.m. to 5:30 p.m. at Sonntag Pavilion, St. Joseph’s Hospital and Medical Center in Phoenix, directed by Richard A. Manch, M.D., FAASLD,FACE,FACG, St. Joseph’s Center for Liver and Hepatobiliary Disease chief of hepatology.

Register by calling ResourceLink at 1877.602.4111. For more info, contact Liver@dignityhealth.org

Topics include Hep C Current Standard of Care; Which Fibrosis Assessment is Best: Biopsy vs. Labs?; Special Populations: Renal Failure, Decompensated Cirrhosis, Pre- and Post-Transplant; Future of HCV Treatment: What’s in the Pipeline? and Payer Perspectives: Is There Light at the End of the Tunnel? Panel discussion included.

Oct. 15-18 and Oct. 29-Nov. 1: The 18th Annual Mayo Clinic Internal Medicine Update: Sedona 2015 is at Hilton Sedona Resort, 90 Ridge Trail Drive, Sedona 86531; phone 928.284.4040. http://www.hiltonsedonaresort.com/ Accreditation TBA. Four-day course offers primary care physicians, NPs and PAs a practical update on a variety of subspecialty topics, including anesthesiology, allergy, cardiovascular diseases, consultative medicine, dermatology, endocrinology, gastroenterology, hematology, infectious diseases, nephrology, neurology, otolaryngology, palliative, preventative medicine, psychiatry, pulmonary, urology, women’s health, and other areas applicable to today’s practice and patients.

Website: https://ce.mayo.edu/internal-medicine/node/3762

Contact: Registrar, Mayo School of Continuous Professional Development, 13400 E. Shea Blvd., Scottsdale 85259; phone

480.301.4580; fax 480.301.8323 http://www.mayo.edu/cme

mca.cme@mayo.edu

Radiology Ltd. proudly offers 3D Mammography. The physicians of Radiology Ltd. believe in personalized and
Radiology Ltd. proudly offers 3D Mammography. The physicians of Radiology Ltd. believe in personalized and
Radiology Ltd. proudly offers 3D Mammography. The physicians of Radiology Ltd. believe in personalized and

Radiology Ltd. proudly 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.

Please call and request your 3D Mammo today! (520) 733-7226

For more information about this and other screening exams provided by Radiology Ltd., please visit our website at www.radltd.com.

A TUCSON TRADITION FOR MORE THAN 80 YEARS
A TUCSON TRADITION FOR MORE THAN 80 YEARS
Did you know? MICA Risk Management provides onsite in-service presentations for MICA members and their
Did you know?
MICA Risk Management provides
onsite in-service presentations
for MICA members and their staff.
Call today to get us on your calendar.
Medical Professional
Liability Insurance
(602) 956-5276
(800) 352-0402
www.mica-insurance.com