Aug-Sept 2015 Sombrero

7/23/2019 Aug-Sept 2015 Sombrero

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SOMBREROP i m a C o u n t y M e d i c a l S o c i e t y

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

A U G U S T / S E P T E M B E R 2 0 1 5

PCMS building sale underway

A voyage Down Under

Tucson, Nogales, and bullfighting


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Official Publication of the Pima County Medical Society Vol. 48 No. 7

Printing West PressPhone: (520) 624-4939

E-mail: [email protected]

PublisherPima County Medical Society 5199 E. Farness Dr., Tucson, AZ 85712Phone: (520) 795-7985Fax: (520) 323-9559

Website: pimamedicalsociety.org

EditorStuart FaxonE-mail: [email protected]

Please do not submit PDFs as editorial copy.

Art Director

Alene Randklev Phone: (520) 624-4939Fax: (520) 624-2715E-mail: [email protected]

Pima County MedicalSociety Officers

PresidentMelissa Levine, MD

President-Elect Steve Cohen, MD

Vice-President Guruprasad Raju, MD

Secretary-TreasurerMichael Dean, MD

Past-President Timothy Marshall, MD

PCMS Board of DirectorsEric Barrett, MD

David Burgess, MD

Michael Connolly, DO

Jason Fodeman, MD

Howard Eisenberg, MD

Afshin Emami, MDRandall 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)

Snehal Patel, DO (Alt. Resident)

Joanna Holstein, DO (Alt. Resident)

Jeffrey Brown (Student)

Juhyung Sun (Alt. Student)

Members at Large

Richard Dale, MDCharles Krone, MD

Jane Orient, MD

Board of Mediation

Timothy Fagan, MD

Thomas Griffin, MD

Evan Kligman, MD

George Makol, MD

Mark Mecikalski, MD

Arizona MedicalAssociation OfficersThomas Rothe, MD

immediate past-president

Michael F. Hamant, MDsecretary

At Large ArMA Board R. Screven Farmer, MD

Pima Directors to ArMA

Timothy C. Fagan, MD

Timothy Marshall, MD

Delegates to AMAWilliam J. Mangold, MD

Thomas H. Hicks, MD

Gary Figge, MD (alternate)

SOMBRERO (ISSN 0279-909X) is published monthlyexcept bimonthly June/July and August/September by thePima County Medical Society, 5199 E. Farness, Tucson,

Ariz. 85712. Annual subscription price is $30. Periodicalspaid at Tucson, AZ. POSTMASTER: Send address

changes to Pima County Medical Society, 5199 E. FarnessDrive, Tucson, Arizona 85712-2134. Opinions expressedare those of the individuals and do not necessarily repre-sent the opinions or policies of the publisher or the PCMSBoard of Directors, Executive Officers or the members atlarge, nor does any product or service advertised carry theendorsement of the society unless expressly stated. Paidadvertisements are accepted subject to the approval of theBoard of Directors, which retains the right to reject anyadvertising submitted. Copyright © 2015, Pima CountyMedical Society. All rights reserved. Reproduction inwhole or in part without permission is prohibited.

SOMBRERO

Executive DirectorBill FearneyhoughPhone: (520) 795-7985

Fax: (520) 323-9559E-mail: [email protected]

AdvertisingPhone: (520) 795-7985Fax: (520) 323-9559E-mail: [email protected]

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24 Hours • 7 Days A Week

Established1971

Established1971

Medical SocietyExchange

Authorized Answering Service for

PIMA COUNTY MEDICAL

SOCIETY SINCE 1981

Se Habla Español

2434 N. Pantano

“WE ANSWER FOR YOU!”• Pagers• Voice Mail• I.V.R. (InterActive Voice Response)

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790-2121www.RinconCommunications.comwww.RinconCommunications.comwww.RinconCommunications.com

5 Dr. Melissa Levine: Medicare at 50—anddesegregaon.

7 Membership: Focus on Pima

Dermatology.10 Milestones: Twelve Tucson urologists

open Epoch Health.

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

19 Arizona Medical Associaon News: New

ArMA president says we must ‘unite thehouse of medicine.’

23 Behind the Lens: In the second of his

series, Dr. Hal Tretbar looks at the localimpact bullghng once had.

28 Travel: Dr. George Makol nally went toAustralia—and proves it.

30 CME: Pima County Medical Foundaonre-locates CME meengs.

Correction

In the second column, second full paragraph of the rst 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.

On the Cover

Former matador Diego O’Bolger stands next to bull-and-matador

statue at Casa Molina Restaurant on Speedway Boulevard. The

design ornamenng the bull’s tescles 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 ash ll-in (Dr. Hal

Tretbar photo).

Inside


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Happy birthday to Medicare (Part 2)By Dr. Melissa Levine

PCMS President

Some of you may recall,before my foray down the

Grand Canyon, I was talkingabout Medicare and the ACA.My idea was to compare andcontrast the two, showing thatessenally the beginnings werevery similar, with predicons ofsocialism and ruinaon.

But as I delved into the realseeds of Medicare, I found so much more history than I hadknown about. I found it fascinang. Admiedly I’m somewhat ofa nerd, so maybe I am just boring all of you. I hope not.

In our June issue I le o in 1946 with a Republican Congress and

President Harry Truman calling for comprehensive healthinsurance for all, funded through Social Security. When hecouldn’t get that passed, President Truman created a naonalcommission to study the naon’s health needs. He was able toget Congress to establish a federal grant program in 1950 thatprovided matching funds to states to pay providers caring forindividuals receiving public assistance. He connued to advocatefor a naonal health insurance program unl the end of hispresidency in January 1953.

The goal of Social Security was economicindependence for the elderly, and in theearly 1950s ocials were troubled that theywere not meeng that objecve. The reasonwas the high cost of medical care. If youremember Wagner-Murray-Dingell from theprevious arcle, some of them came backthen to try and x the issue.

Most likely they thought, if instead of naonalhealth insurance, they proposed the moremodest, healthcare for seniors under SocialSecurity, they could gain tracon. Thatproposal would be much less expensive, and itwould give the government some experience,and in providing for a group in such obviousneed, it would be more likely to pass.

The “beneciaries” proposal was baed

around, and on April 10, 1952, SenatorsMurray and Humphrey, and RepresentavesDingell and Cellar proposed Senate andHouse bills of what would essenally havebeen Medicare. Then Dwight D. Eisenhowerwas elected President, both houses ofCongress were Republican, and the ideaonce again died.

Interesngly, the next program happenedunder Eisenhower. In 1956 Congress enactedpermanent protecon for healthcare for thedependents of servicemen, the DependentsMedical Care Act, which today is part of

Tricare. They also expanded some payments for Welfarerecipients and nanced a study on the problems of the aged. Allof this led to a revival of the naonal health insurance debate.

The Kerr-Mills act of 1960 created a program called MedicalAssistance for the Aged. This was a grant program providing fundsto states and was means-tested. It was essenally the precursor

to Medicaid. Kerr-Mills did not end the debate, as some hadhoped. Then Sen. John F. Kennedy (D-Mass.) made healthcare forthe elderly, now calling it “Medicare,” a major issue in the 1960presidenal elecon campaign. Vice-President Richard M. Nixonactually conceded the point, and vowed to further the cause ifelected. When Kennedy won and a Democrac Congress wasagain in control, the issue, like a Phoenix, rose again to the top.

King-Anderson was proposed in 1962, and it provided for hospitaservices to be provided for the elderly and paid for by SocialSecurity. The AMA launched an all-out eort against “the mostdeadly challenge ever faced by the medical profession.” Dr. BruceHekrinsen, a New Jersey surgeon, wrote a memo and 200members of the hospital sta said they would refuse to see

paents under legislaon such as King-Anderson. But the ideawas gaining momentum. The American Hospital Associaon splitfrom 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 healthinsurance. If they didn’t pay $125, they would be given a credit.Rep. John Lindsay (R-NY) proposed a bill embracing Social

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Security nancing with a private insurance opon. The Senate

went further. Led by Sen. Jacob Javits (R-NY), they proposed a bill

nanced by Social Security, providing three benet opons, 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 elecon.

Ironically, JFK could not get Medicare passed when he was

president, but aer his assassinaon, there was a surge of

support across the country for his legislave 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 Commiee blocked it. Then the

1964 elecon 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-2nd-

Ark.) House Ways and Means Commiee chairman, saw the

handwring on the wall. King-Anderson was the rst 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

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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 secons,

overwhelmingly passed the House, essenally giving birth to

Medicare. The nal versions passed the House and Senate on July

27 and 28.

One last note for thought: The birth of Medicare led to the

desegregaon 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 Oce of Equal Health Opportunity was charged with

cerfying hospitals. They let no one o 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 me, and the one with the least fanfare. That in

itself is worthy of celebraon.

REFERENCES

www.aapsonline.org/brochures/persuasi.htm

The Military Health System (MHS)- TriCare, Who We Are.Social Security On Line–History hp://www.ssa.gov/history/

corningchap4.html

CMS Oral History Project.

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

The hidden legacy of Medicare. July 29, 2015. n



Membership

Pima Dermo and our Arizona enviroStory and photos by Dennis Carey

Tucson is denitely a placewhere there is a lot of

aenon paid to the skin,” says

Gerald Goldberg, M.D., Pima

Dermatology owner and medical

director. “We have made a lot of

progress in treang skin diseases

and disorders. You hear it a lot, but

catching skin cancer early increases

the chances of survival

dramacally.”

Aer 20 years in a small oce on

Rosemont Boulevard, Dr. Goldberg

has expanded Pima Dermatology to

a 10,000-square-foot facility at

5150 E. Glenn St. The pracce sees

20,000 paents each year for both

medical and cosmec treatments.

“We don’t feel there is a saturaon

of dermatologists in the area,”

Pracce Administrator Sarah

Chanes said. “Dermatologists in

the area are very cooperave,

and there is a good referral networkwith 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 bale our environment’s eects.

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 Saord.

“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 me to

come all the way to Tucson or Phoenix to get their skin checked

regularly. There is denitely 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 eld. He began

using laser rejuvenaon treatments in 1984. Pima Dermatology

oers 16 on-site laser modalies. A fracon of the laser

procedures available include acne treatment, acne scarring, skin

resurfacing, vein removal, and cosmec procedures such as hair

and taoo removal.

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

“

lasers,” Dr. Goldberg said. “Now it is a part of every dermatology

pracce. I like to think of lasers as my thing now. It’s my baby.”

He is also acve in making sure use of lasers is done safely. He is

president of the Arizona Dermatology and Dermatologic Surgery

Society. He is seeking regulaons to make sure proper training is

required for operang lasers. Another target in his sights is

geng a ban on use of tanning beds by minors.

Taking up a cause for children’s health is not surprising forDr. Goldberg. Aer graduang 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-cered in pediatrics and dermatology, and is a UofA

clinical professor of dermatology and pediatrics. He has been

a PCMS member since 1983.

Mahew Beal, M.D., joined Pima Dermatology and PCMS in July

2013. Aer graduang from the University of Arizona College of

Medicine, he interned at St. Vincent’s Medical Center in New

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

care concerns.



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 pracce 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 aliaon 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 sta. (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 Aairs 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

the UofA when necessary.

Two PAs and two RNs help

the physicians. There arefour cosmec providers in

the oce, and products

are available for purchase

to prevent or treat skin

condions.

“We are probably 70 percent

medical and 30 percent

cosmec as far as the rao

of paents 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 nancial

counseling with paents and

clients so they know what is

covered by insurance. We

don’t want paents to get

hit with a big shock.”

That might make their skin

crawl. nColleen Cotton, third-year resident at the UofA College of Medicine, consults with Dr. Matthew Bealat Pima Dermatology.





Milestones

Epoch Health opens onGrant RoadTwelve Tucson urologists including doctors Kenneth Belko ,

Peter Burrows, Bill Kuo, Michael Levin andJenne Myers have

partnered to open EPOCH Men’s Health, 4951 E. Grant Rd., Suite103, at Crossroads East Plaza.

The urologists “have come together to create Epoch Health, a

center to serve the men of Southern Arizona. Epoch oers a free

comprehensive men’s health screening that checks for vitamin

deciencies, various cancers, kidney funcon, hormone and

electrolyte levels, and other condions.” No appointments are

necessary.

Dr. Sanders co-authors naonal

report on cardiac arrestTwo University of Arizona

researchers are co-authors of

a report, released in July in

Washington, D.C., that

examines current stascs of

cardiac arrest in the U.S. and

recommends public health

strategies to improve survival

rates, the university reports.

The report from the Instute

of Medicine is “Strategies to

Improve Cardiac Arrest

Survival: A Time to Act/” Itexamines naonal data on the

incidence and survival rates

from cardiac arrest in the U.S., assesses evidence on exisng

lifesaving therapies, and recommends public health strategies

that could save lives. Addionally, the report explores CPR and

the use of automated external debrillators, emergency medical

services, and hospital resuscitaon systems of care and

resuscitaon 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 Instute ofMedicine, 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 collaboraon 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 naonal and internaonal resuscitaon guidelines,”

Dr. Sanders said. “The Resuscitaon Research Group of UA Sarver

Heart Center, including doctors Gordon Ewy and Karl Kern, were

pioneers in the eorts to improve survival in Arizona and help

Epoch Health had ribbon-cutting ceremonies July 23 for its newTucson clinic at 4951 E. Grant Rd. From left are staffers Bianca Ruiz, Zulma Valenzuela, Steve House, Crystal Kasnoff, Jesse

Leon, Mike Whiteld, Artician Gonzales, and Estrella Hernandez (Epoch photo).

Arizona become a leader naonally in the approach to the

treatment of paents suering 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 strokeBy Tiana Velez

Carondelet Health NetworkOn the night of June 15,

Tucsonan Edward Moran went

about his usual evening

roune of several minutes of

exercise, a light dinner, and a

smoothie. At 70 the rered

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 alsosurprised by the speed and

level of care he received at

Carondelet St. Joseph’s

Hospital, where he spent the

rst 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 Instute (CNI) and the Primary Stroke

Center at St. Joseph’s Hospital, who work together seamlessly

under intense pressure.

Dr. William Lujan



CNI neurologists Dr. William

Lujan andDr. Jimmy Nguyen

guided administraon 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 wasthen moved to the Neuro ICU

to recover.

On the morning of his stroke,

Moran checked in to his

former CPA rm, where he

occasionally helps out as a

consultant. Like many oce workers, he started his day with a

cup of coee and a quick chat with a friend. While chang, they

remarked that Moran seemed to be slurring his words.

No, said Moran, it was the coee. 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 nocing other peculiaries. He wasspilling his coee as he tried rst, to drink, and then, to slurp it.

Also, it was becoming harder to keep his grip on the mug in his

le hand. Puzzled, but knowing something denitely 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 Aack

Team was prepped and waing for Moran.

“When he presented to our hospital, we

graded his stroke symptoms on the Naonal

Instute of Health’s Stroke Scale (NIHSS) andscored him at a 6,” said Tiany Hoke, CNI’s

doctor of nursing pracce and neurocrical

care NP. The higher the score, the more

stroke symptoms a paent 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 sll represent severe

impairment and lead to devastang

disability if le untreated,” Hoke said. Moran

“had slurred speech and signicant le-side

weakness involving his face, arm, and legupon arrival. If le 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

presentaon to the hospital by way of EMS,

CT ndings, and lack of related

contraindicaons made him a perfect

candidate to receive the clot-busng drug ssue plasminogen

acvator or tPA.

“Mr. Moran received tPA within 28 minutes of entering our

doors,” recalled Hoke. “That door-to-drug me is remarkable and

far below the naonal goal of less than 60 minutes.”

Treatment didn’t stop there. The clot would have to be removed

or potenally cause further damage. “Essenally, 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 enre process lasted less than eight hours.

“Everyone here is just unbelievable,” Moran said. “The nurses

come by oen, answer any quesons you have. They never seem

rushed or too busy for you. They make me feel like I’m on a cruise.”

Three days aer entering the hospital, Moran was preparing for

his discharge. Speaking with him, it’s hard to discern any signs

that he suered a near-paralyzing stroke. Without prompng,

he shows o how much moon he’s regained on his le side —

frequently raising and lowering his le arm, and poinng 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 Aack Team members who comprise the

Carondelet Neurological Instute and the Primary Stroke

Center at St. Joseph’s Hospital. n

Dr. Jimmy Nguyen

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The most important qualities in this position are care, compassion,

enjoying time with patients, and working with a team. We’re a

team-oriented culture because it works better for our patients.

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We are looking for a physician experienced in pain and symptommanagement, and care of terminally ill patients. Locally owned andmanaged, Casa de la Luz provides hospice services to individuals in

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PCMS News

PCMS makes way for Tucson Concussion CenterBy Stuart Faxon

The Present

While not a concussion, the medical society’s 32-year-old

headquarters building has become a headache—one that’s cosng

too much for PCMS’s health.

That’s why aer much research and decision-making over the last

two years, your Society has decided to sell the building. However,

PCMS administraon 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 sociees,” PCMS Execuve

Director Bill Fearneyhough said. “We have to look 10 years from

now, and that’s what our Board of Directors has done.” He calledthe physical state of the building “a disaster waing 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

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 situaon is just one aspect of what we need to do for

our physicians,” Fearneyhough said. “This is big in the sense that itis one step toward what we need to do in years to come, in

adapng to new technology, and in how physicians interact in this

century. You can’t stop progress, especially in medicine. A

professional society is sll 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

meengs 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 emoonal aachments, especially of our oldermembers who consider the building home and fought to build it.

However, we eventually realized that this was the appropriate

direcon 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, le

PCMS his home in Snob Hollow to be used as headquarters and a

meeng place, according to December 1981 reporng 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,”creang the nancial base to build something.

According to the same history in Sombrero, it was in 1961 when

Medent Corp., a group of physicians and densts that owned the

Medical Square complex, oered free of charge a then-vacant half-

block on North Tucson Boulevard to the medical and dental

sociees for a permanent home. The land had an esmated value

of $40,000. The oer was condional that the joint headquarters

be built within two years from the date of the oer.

O.J. Farness, M.D. chaired our Long-Range Planning Commiee.

Plans in 1961 called for a 15,000-square-foot building that would

house the medical and dental sociees plus Blue Cross/Blue Shield

A 7,800-square-foot auditorium to hold 500 people; three meengrooms; 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 me there were 260 acve members,” Sombrero reported,

“and how were these 260 members to nance 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 prospecve increase

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

assessment paid by a doctor upon his death, rerement from

pracce, or removal from Pima County to another locaon of

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There followed a vote in which members voted not to build a

building: 117 opposed, and 87 in favor, with 67 not vong 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 identy.

It will be a place that various specialty sociees can holdfuncons.

The Society will be building equity.

Future costs can be controlled.

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

An assessment would allow us to build reasonably without

paying high interest.

There is the possibility for posive cash ow from renng

oce space to various specialty sociees or paramedical

groups.

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

“It is really economically sound for the Society to own its own

building?” this magazine quesoned. “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 me.” 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 membersto assess themselves had been taken, and that it was “incumbent

upon every member to fulll this obligaon.

“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 represenng a sophiscated

medical community and that they will support it in its need for

space to provide the services such an organizaon requires.”

Our building ocially opened on Jan. 5, 1983.

The Present

PCMS, commiee-chaired and goaded by the late John Clymer,

M.D., in 2007-08 raised about $40,000 for Project Restore, and

those restoraons were made. But those restoraons were

mostly supercial, 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 condioning units, and some new, energy-ecient lighng

was done in cooperaon with T.E.P.,” he said, “we sll need a new

roof and much painng and patching. The parking lot needs re-

paving and painng. We are probably out of code with EPA,

whose regulaons would add to cost of any related updates. The

Americans With Disabilies Act would be a similar potenal

regulatory cost for larger, more accommodang restrooms.”

When we got bids to do all these things, the esmates 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 informaon 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

producon.

History Commiee Chairman Jim Klein, M.D. and his commiee

are in charge of the futures of all our historical books and arfacts

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 me of our magazine producon,

prinng, and delivery, exec Bill Fearneyhough is meeng with our

aorneys, Mesch, Clark and Rothschild, represenng PCMS, to

review the agreement. Findings are presented Aug. 25 at our

Board of Directors meeng.

For years PCMS has made about $13,000 annually renng our

meeng room. The many room renters are being noed that asof Oct. 1, we will no longer be available for their meengs. We

are working with TMC to see if they can provide some

replacement meeng space for our renters.

Our administrave oces will be in 925 square feet at the north

end of their current locaon once Tucson Concussion Center’s

build-out is completed. Meanwhile, plans call for PCMS

administraon to be temporarily housed across Farness Drive in a

vacant oce building.

“We want the membership to know all the details,” Dr. Levine

said, “but the boom is viability of PCMS. The board concluded

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-10coding conversion that takes effect Oct. 1



that for the long-term future, we had to become more agile,

more exible, in order to best serve members’ needs. A Society is

not a building; it is its membership.”

THMEP’s classroom alternave

The h bi-annual Colorado River Medical Conference took place

June 27 through July 3, and on the sandy beaches of the

Colorado, parcipants 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 stabilizaon.

The Tucson Hospitals Medical Educaon Program-sponsored

conference allowed for seven AMA Category 1 CME credits to be

earned at the nightly conferences. By day, aendees got to

experience one of the great natural wonders of the world with

rapids, wildlife, and a billion years of layered geology. Cold, cold

Colorado water alternang 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 smulang, collegial and

enjoyed by all. Low-tech prompts and handouts were eecve

alternaves to PowerPoint presentaons 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

interacon 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, Ascensionpartner to own, operateCHN in ArizonaIn a July 15 news release dated Dallas, San Francisco, St. Louis,and Tucson, Carondelet Health Network announced that major

insurer Tenet Healthcare Corporaon, Dignity Health, and CHN

owner Ascension signed a denive agreement to create a

partnership that will own and operate Tucson-based CHN.

The new joint venture includes three hospitals, an outpaent and

ambulatory services network, and two physician groups. Tenet

will be majority partner in the venture and will manage the

hospitals’ operaons, related physician pracces, outpaent and

ambulatory services, and aliated businesses in Tucson and

Nogales. Dignity and Ascension will own minority interests in the

partnership.

The agreement comes amid industry-wide buyouts and mergersthat 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 naon’s second-largest

health insurer, announced it had reached a deal to buy rival

Cigna Corp. in a deal valued at $54.2 billion, creang the

naon’s largest health insurer by membership, naonal news

services reported. They said the deal is part of health insurance

industry-wide following introducon of the Obama

government’s “Paent Protecon and Aordable Care Act.” The

Anthem and Aetna deals will face intense regulatory scruny

from concerns over the consolidaons driving up insurance

premiums for businesses and consumers.

“We look forward to the opportunity to partner with two highly

respected and dedicated healthcare organizaons to improve

healthcare delivery to the communies of Southern Arizona,”

Tenet President of Hospital Operaons Bri T. Reynolds said.

“Through this innovave partnership, we will not only connue

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 paent access to a wide range of healthcare

resources throughout the state. This is consistent with Tenet’s

strategy to create new, innovave models for paent care.”

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

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



Tenet and Dignity Health separately own and operate hospitals

and clinics in the Phoenix area, and together manage a growing

accountable care organizaon (ACO), the Arizona Care Network

(ACN). The organizaon currently includes more than 130

paent care facilies 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 paents, strengthen and

grow Carondelet’s relaonships with physicians, provideemployee development opportunies for current and future

employees, and fund strategic growth iniaves across

Southern Arizona.

Linda Hunt, president and CEO of the Arizona Service Area for

Dignity Health, said, “The partnership will

connue the remarkable legacy of

Carondelet in Arizona, while launching a

new organizaon capable of maximizing the

changing landscape of healthcare today and

meeng the growing demands for quality

care in Southern Arizona.”

“We are excited about this new relaonshipwith Tenet and Dignity Health,” said Robert

J. Henkel, FACHE, execuve 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, paent-

centered care. This relaonship is an

opportunity to strengthen those eorts and

enhance healthcare across Arizona.”

Facilies in the new partnership include St.

Joseph’s Hospital (486 beds) in Tucson; St.

Mary’s Hospital (400 beds) in Tucson; HolyCross Hospital (25 beds) in Nogales;

Carondelet Heart & Vascular Instute at St.

Mary’s Hospital; Carondelet Neurological

Instute 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

identy through an agreement with the

Diocese of Tucson. Addionally, Carondelet’s

exisng charity care policies will remain in

place. The transacon is subject to normal

regulatory reviews and is expected to close

in the third quarter of 2015.” Financial terms

were not disclosed.

Tenet Healthcare Corporaon says it

operates 81 general acute care hospitals, 18

short-stay surgical hospitals, and more than

400 outpaent centers in the United States

and nine UK facilies.

Dignity Health in Arizona includes ve

hospitals: Chandler Regional Medical Center; Mercy Gilbert

Medical Center; St. Joseph’s Hospital and Medical Center,

which includes Barrow Neurological Instute; 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 pracces and covers a wide range

of speciales. Dignity Health in Arizona is part of Dignity Health,one of the naon’s largest healthcare systems.

Ascension (www.ascension.org) says it is a faith-based

healthcare organizaon that is the largest non-prot health

system in the U.S. and the world’s largest Catholic health



system. “Ascension is commied to delivering person-centered

care to all with special aenon to those who are poor and

vulnerable.” “More than 150,000 associates and 35,000

aliated providers serve in 1,900 sites of care, including 131

hospitals and more than 30 senior care facilies in 23 states and

the District of Columbia.

In an odd addendum for a news release, Tenet’s “cauonary

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 oenaddress our expected future business and nancial performance

and nancial condion, and oen contain words such as

‘expect,’ ‘assume,’ ‘ancipate,’ ‘intend,’ ‘plan,’ ‘believe,’ ‘seek,’

‘see,’ or ‘will.’

“Forward-looking statements by their nature address maers

that are, to dierent degrees, uncertain. Parcular uncertaines

that could cause our actual results to be materially dierent

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

lings with the Securies and Exchange Commission.

“The informaon contained in this release is as of the datehereof. The company assumes no obligaon to update forward-

looking statements contained in this release as a result of new

informaon or future events or developments.”

AHSC’s Med-Startaims to change faceof healthcareHigh school students compevely selected

statewide spent six weeks this summer

exploring healthcare careers and educaonopportunies in a program conducng

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 compeve program is a proven

success,” the university reported. “Eighty

percent of its parcipants go on to enroll in

higher educaon courses. Med-Start has

two goals: to address the crical shortage of

a diverse health-care workforce, and to

provide high school students with

opportunies to explore health careers and

college experiences to successfully reach

their academic and career goals.

“Creang a diverse healthcare workforce

representave of the populaons 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 eorts to recruit and train a

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knowledgeable, inclusive and diverse health-care workforce

commied to eliminang healthcare disparies.

“Med-Start is one of several AHSC programs created to promote

health equity and wellness in Arizona’s communies, 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.”

NIH grants Sarver to study contracleproteinsUofA researchers have idened the

connecon between thin-lament length and

cardiac funcon, as well as the role thin-

lament length dysregulaon plays in

cardiomyopathies. The new NIH grant will

help to uncover insights into novel

therapeuc 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 Naonal

Instutes of Health (NIH) for a study called

Deciphering the Role of Lmod2 in Thin

Filament Length Regulaon and Dilated

Cardiomyopathy (NIH Grant 1R01HL123078).”

“This award demonstrates the value of SarverHeart Center’s Invesgator 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

invesgator on the grant.

“Under Gregorio’s mentorship, Christopher

Pappas, Ph.D., a postdoctoral research

associate, obtained a Sarver Heart Center

Invesgator Award funded by the Steven M.

Gooer Foundaon. With the funding, Pappas

studied the role of the protein Lmod2 in

cardiac development and dilated

cardiomyopathy (DCM). The Invesgator

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-invesgator, Gregorio said.”

“Cardiac muscle is composed of thick and thin

protein laments. In studying the heart’s

mechanism of contracon, we found that the laments have to be

precisely organized for ecient beang. Proper contracon requires

laments of the proper length. We found that Lmod2 is an acn

lament elongaon protein that regulates the lengths of thin

laments in heart muscle,” Pappas said.

The researchers idened the connecon between thin-lament

length and cardiac funcon, as well as the role thin-lament

length dysregulaon plays in cardiomyopathies. Their goal is to

uncover insights into novel therapeuc targets for dilated

cardiomyopathy. Future direcons for the research team include

determining how short thin-lament lengths lead to dilated

cardiomyopathy and if Lmod2 mutaons are present in human

paents with dilated cardiomyopathy.

Dr. Clavenna was born in Texas butspent most of his childhood in

Baton Rouge, Louisiana. Heattended Trinity University in SanAntonio for his undergraduate work,receiving a B.S. in Biochemistry. Dr.Clavenna’s desire to personallyhelp those with ailments, led himinto the field of medicine. He earned his medical degree fromLouisiana 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 withproblems of the head and neck. Dr. Clavenna completed a generalsurgery internship and otolaryngology surgical residency atLouisiana State University Health in Shreveport.

Following residency, Dr. Clavenna completed a Fellowship in sinus,

allergy, and anterior skull base surgery at Vanderbilt University inNashville, Tennessee. There he trained under internationallyknown surgeons, Drs. Rick Chandra, Paul Russell, and JustinTurner. During fellowship he focused on advanced sinus surgeries,including management of frontal sinus disease, nasal and skullbase tumors, pituitary surgery approaches, ophthalmologicalrelated procedures and treatment of allergies. Many of thesecases were performed in conjunction with neurosurgeons andophthalmologists. One of his most fond memories from fellowshipinvolved treating a patient emergently transferred to Vanderbiltfor severe sinus disease encroaching on the vision of his right eye.Using his recently learned endoscopic sinus surgery techniqueswith the aid of image guidance, he was able to successfully treatand drain the infection and preserve the patient’s vision.

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

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‘Medjacking’: Absurdyet deadly techIn the summer Sharknado 3 “Oh hell no” category, The University

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

medical device electronic security, recognizing the potenal for

“medjacking”–malicious medical device hacking.

The UofA College of Medicine sent surgery professor DavidArmstrong, D.P.M., M.D., Ph.D. to the rst commiee meeng in

July in Bethesda, Md. Called the Cybersecurity Standard for

Connected Diabetes Devices Steering Commiee, it joins forces

with the Department of Homeland Security, Naonal 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 commiee, the UofA reports, though it

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

associated with diabetes are the inial focus, Dr. Armstrong said

the commiee is expected to examine the security of other

medical devices. “As connected devices become more pervasive

and powerful, the potenal for malicious medical device hacking

is becoming increasingly real,” he said.

“Medical devices—insulin pumps, pacemakers, arcial hearts,

le ventricular assist devices, arcial pancreas constructs—are

suscepble to the same unintenonal or intenonal and

nefarious interrupon and invasion as are bank accounts, ATM

machines and credit card devices.”

While medjacking currently exists in the imaginaon and in

laboratories, Dr Armstrong said it is only a maer of me beforethe issue “comes front and center. No one really thinks about

these things unl there is catastrophic failure. These sorts of

hacks are denitely 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 commiee is to migate

danger without sing innovaon. Dr. Armstrong said paents

must be condent in the safety of their medical devices, and

companies must be secure that they are invesng millions of

dollars in technology that is safe from cyber aack. The

commiee will examine how key elements included in embedded

systems within devices can make them less suscepble to failure

or malicious or unintenonal 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

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Uniting the house of medicineBy Nathan Laufer, M.D.

I am originally from Montreal,

Canada and have been in

pracce in Phoenix for more

than 30 years. My wife, Judy, a

kindergarten teacher, has been

an inspiraon 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 ofMcGill University in Montreal,

as is Bob Orford, one of our

past presidents. Having come

from Canada, I have a

somewhat dierent perspecve 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 connues 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 connues

to hold true today, not only with the pracce of medicine, butalso with the business of healthcare. We are living in uncertain

mes, 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 rering or changing careers at younger ages, and

those who remain are increasingly dissased with their career

choice—so much so that many don’t recommend the medical

profession to the next generaon.

Medical educaon funding has not kept up with the demand for

qualied primary care and specialty care training. It is esmatedthat the U.S. will face a shorall of more than 130,000 physicians

in 10 years, equally divided between primary care and the

speciales.

2. The administrave load and compeng regulatory programs

are increasing.

One of the greatest frustraons to physicians is the me and

expense they must devote to administrave and regulatory

requirements, taking their me away from paent care. Some of

these administrave burdens include PQRS and Meaningful Use

documentaon, HIPAA security risk analysis, and ICD 10

implementaon.

Arizona Medical Associaon News

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.

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 totake eect April 1. However, this is a mixed blessing!

The “Medicare Access and CHIP Reauthorizaon Act of 2015”

(MACRA) was signed into law by the President on April 16, 2015.

MACRA permanently repeals the awed SGR formula and

stabilizes Medicare payments for physicians. There will be a 0.5%

yearly increase in the Medicare fee schedule unl 2018, but then

it will be frozen unl 2024.

MACRA will shi Medicare compensaon from fee-for-service to

pay-for-performance. CMS intends to require that 30% of

Medicare payments are made through alternave payment

modes by 2016, and 50% by 2018, in order to improve the

eciency of care.

MACRA replaces Medicare’s mulple quality reporng programs

with a new single Merit Based Incenve Payment System, also

called the “MIPS” program. MIPS is a consolidaon 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 eciency);

(3) meaningful use of electronic health records, and

(4) clinical pracce improvement acvies.

The poorest performing doctors will see their payments cut by up

to up to nine (nine!) percent. The new incenve structure wouldbe 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 adopng 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 pracces and new grads.

The solo praconer connues to disappear. Thirty-nine percent

of physicians younger than 45 years of age have never worked inprivate pracce. But joining a hospital system is not a panacea for

physicians.

Some physicians are returning to private pracce because their

compensaon from hospitals became less aracve aer the

expiraon of their inial contract. The hospitals switch to

performance-based pay, which can end up being lower than their

inial salary. Further, physicians are asked to see more paents in

less me while reporng to a hospital administrator and

following hospital-imposed guidelines.



As large hospital networks acquire more and more physicians,

they direct paents 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 paent 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 connues to be eorts to expand non-physicians’

scope of pracce.

Numerous groups connue to try and encroach on the physicianpracce of medicine. Here I would like to note ArMA’s unagging

work in countering these eorts in Arizona, accomplished just in

the last year.

• ArMA has successfully stopped psychologist prescribing

legislaon, and stopped all scope of pracce expansion

eorts by chiropractors and naturopaths.

• ArMA has worked to curb unsafe expansion in scope of

pracce (VBAC, breech, and mulples) by lay-midwives.

• ArMA was part of the Coalion that stopped administraon

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 aempts at expansion of scope of pracce by non-

physicians, in order to protect the public from untrainedproviders.

6. Government and payers are meddling in the doctor paent

relaonship.

I believe in the sancty of the doctor-paent

relaonship. However, chart audits and prior

authorizaons are some of the ways payers

are inserng themselves into the physician-

paent relaonship and into medical decision

making.

In addion, more payers are ghtening their

provider networks in an aempt to rein in

costs. This move toward narrow networks

means many physicians are being evaluated

for costs and quality, and paents may be

forced to switch physicians because their

physicians are dropped from networks.

Arizona became the rst state in the naon to

pass into law an informed consent provision

that guarantees women seeking aborons be

told by their physician, that it may be possible

to reverse the eects of the aboron pill with

progesterone. This law is based on six paents

treated by a family doctor in San Diego. It’s

junk science, and it is suspended as it awaits achallenge in the courts.

ArMA is making a dierence.

I have, for over three decades, been a rm

believer in the instuon of organized

medicine and the good that we can

accomplish with unied acon. ArMA has

steadily grown to be the most signicant,

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 Legislave

Report included with this publicaon.

Looking forward during my presidenal 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 violaons, which include dropping

physicians from networks and delay in

payments for clean claims.

2. Be vigilant regarding potenal antrust

acvies of large hospital and health plan

networks.



3. Increase ArMA membership by demonstrang relevance to

employed as well as private pracce physicians.

4. Work with speciales and county sociees to help them be

more united in the House of Medicine in Arizona.

5. Work with the medical board to streamline complaints and

improve eciencies.

6. Connue the physician leadership program that was

pioneered by our Immediate Past President Je Mueller,

M.D.

Insurance companies and hospitals have powerful policallobbies. Yet, without physicians they cannot funcon very well.

These enes have managed to divide us by specialty and by

groups within each specialty. This has to stop!

At this crical me we must have a united House of Medicine. We

sll have power in numbers, if we can overcome specialty and

group dierences 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 eld. This is due to government

intervenon and to a lack of unity within the physician

community.

As I have outlined, there will be many changes to Americanmedicine in the coming years. We must always remember that, as

physicians, we are sll the best, and somemes the only

advocates that paents have. Paents and their families are

turning to us to help them navigate the complexies 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 reorganizaon, we must connue to provide the most

honest, ethical, and superb care that the public expects of us.

I also remain cauously opmisc about the future. Healthcare

reform won’t be easy, but I cling to the noon that the new

generaon of doctors and paents will gure it out. I sll

recommend medicine to any young person who asks my opinion.

The life of a praccing physician can sll be incredibly rewarding.As Hippocrates said, “Wherever the art of Medicine is loved,

there is also a love of Humanity.”

Physicians connue to be unique in that our services will always

be needed. We are sll one of the most highly respected and

trusted professions in the country. No maer how the healthcare

debate evolves, and no maer what acons we may take to

preserve our profession, we must never jeopardize our paents’

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. n





La Danza de la Muerte at homeBy Hal Tretbar, M.D.

Behind the Lens

I

n our June-July Behind the

Lens, we took a look at Spain

and South America for the

internaonal state of the sport/

art of bullghng in history and

today. For August-September

we see La Danza de la Muerte

from a local perspecve.

My parents took me to a

bullght in Mexico City when I

was in high school. Dorothy and

I went to one in Madrid in

1959.

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 bullghts in

Nogales, Sonora, was a popular thing to do. You would take in a

bullght 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 alloed gallon of tax-free booze before returning home.

Spain’s Conquistadors brought bullghng

to the New World, and Mexico City became

the epicenter. The rst ght there is said to

have been in August 1529. Finally the 1907

El Toreo ring in theLa Condesa

neighborhood was replaced by the largest

bullring in the world. The Plaza Mexico ring

with 41,262 seats was nished in 1944 and

opened in 1946. It has hosted the top

bullghters in the world. Bullghng has

become less popular recently and

somemes Plaza Mexico will host musical

events or prize ghts.

There is a history of bullghng in the USA,

although it is illegal to kill the bull. In 1884,

Dodge City, Kansas was losing its image as atrue Wild West town and needed something

to perk up its reputaon. The mayor and

city council organized a true bullght for the

Fourth of July, 1884 celebraon. They built a

ght ring and hired ve genuine bullghters,

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 authories 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 ght drew naonal aenon. Four thousand spectators and

a multude of out of town reporters aended. In the two day

event there was only one truly impressive bull. He went down

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



from a trust from Matador Gregario Gallardo’s anque 150 yearold Toledo sword. Overall the enre bullght week end was a

huge success The bars and the shady ladies prospered. Dodge

City regained its wicked reputaon.

In Mexico many cies have had bullrings. In the 1950s there were

said to be about 220, but only 30 or so had at least four ghts a

year. Some of the most popular rings developed along the border

including those in Matamoros, Nuevo Laredo, Cuidad Juarez,

Nogales, Mexicali, and Tijuana.

Nogalesinternaonal.com for Oct. 18, 2001 gives some

background. “Nogales, Sonora was once a hotbed for bullghts,

spanning back to 1914 when a rusc ring was built on Calle

Internaonal almost parallel to the border. In 1948, Don PedroGonzales sold his curio shop and used the money to build the

concrete Plaza de Toro [in 1952]... Among the crowds in the glory

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 bullghng world.”

Today few Tucsonans remember how popular bullghng in

Nogales was from the 1950s to the ’80s. There were corridas

almost every week. Phoenix television staon KPAZ/Channel 21

carried live bullghts 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 bullght acionado. In

2007 Arizona Daily Star writer Ernesto Porllo wrote that Frontainwas “one of the best writers on the subject. He took damn good

bullghng photos and his books on (Carlos) Arruza and bullghng

are highly prized.” Dick regularly reviewed the previous day’s

corridas in Nogales for the Star . He also collaborated with Tucson

arst Ted de Grazia in 1967 for his series of painngs on the

Mexican border bullrings. Frontain died in 2007.

Tucson is probably the only city to have a street named for a

bullghter. Carlos Arruza was one of the greatest and most

popular of Mexican matadors, and he fought many mes 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

Mexican bullghters in Dodge City, Kansas on the 1884 Fourthof July (Photo courtesy Kansas Historical Society).

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

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



nish the third stage, tercio de muerte, on foot. Carlos was very

graceful, arsc, and adept with the sword. He was awarded

many ears and tails.

Hollywood lmmaker Budd Boecher was a close friend of

Arruza and made an hour-long documentary about him. Aer it

premiered in Tucson in 1972, the Tucson Fesval Society had a

street named aer 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 lm Aruzza onYouTube

for his outstanding horsemanship.

The Nogales Plaza de Toros was well known. It was not unusual tofeature famous ghters 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 100th anniversary of the rst bullght, they

put together a weekend of Portuguese-style bullghng 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 bullghts for three

more years.

On July 5, 1985, the Denver Post commented, “Bullghts? 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 Silve, and the world’s only

professional female bullghter, matadora Raquel Marnez strut

their stu…

“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 le 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 ghts managed by Diego O’Bolger.”

By the late 1980s and early ‘90s, bullghng was losing must of

its popularity and fewer ghts were being scheduled. However

Mario de la Fuente’s son, also named Mario, had other ideas. The

Diego O’Bolger performing the difcult and risky gaonera passwith cape held behind the back.

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



Laredo Morning Times for Nov. 13, 1999 reported that he had just

nished building a $4.5 million bullring in Nogales. The Fiesta

Brava was covered with transparent acrylic plasc. The 5,000-

seat air-condioned arena had a bar and restaurant. There were

three inaugural ghts, managed by Diego O’Bolger.

The ming could not have been worse. On Nov. 16, 1999 the

Arizona Daily Star carried two viewpoints on bullghng.

Matador Diego O’Bolger, a Tucson resident, argued that

bullghng had a long history of being a tradional art form. Lisa

Markkula from the Animal Defense League called it animalcruelty. That same day, Dillard’s stores stopped selling bullght

ckets. The last regular ght in Nogales was in December 1999.

There was an infrequent minor event unl the State of Sonora

banned bullghng on May 2, 2013.

Of all the Mexican restaurants in Tucson that at one me had

bullght posters and artwork, only Casa Molina on Speedway

retains the theme. Several large posters depict man-vs.-bull,

while smaller iers announce the me, 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 fantasc gures at the nearby

Magic Carpet miniature golf course, sculpted the statue. Gilbert

said no one has ever complained about the bullghng décor.

Today few Tucsonans remember anything about the appeal of

bullghng in Nogales. The pageantry of corrida; the ballet-like

moves of an athlec matador; the bright colors of the gold or

silver “suits of light”; the waving of the magenta and gold capote

(cape); and the invigorang 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 matadorMost Tucsonansknow 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 movedhere from Bualo,

N.Y. when was four

or ve years old. His

dad had a furniture

store on South Sixth

Avenue, and his

mom worked for

Tucson Newspapers

Inc., where the

Tucson Cizen and Arizona Daily Star were printed. James Bolger

sold newspapers downtown around Jacome’s department store

and met some bullghng acionados.

Apparently his mom got some ckets through her job, and took

young James to his rst bullght in Nogales when he was 10. He

sll remembers how he was impressed by the American woman

ghter Patricia McCormick and two Mexican professional

novilleros, or novices.

James began reading and trying to learn about las corridas de

toros. At that me in Tucson, many people were interested in the

bullghts. One was the famous arst Salvador Corona, a well-

respected Mexican matador who was severely gored in 1919. A

matador friend told him that as a bullghter he was an arst, 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 painngs were

in demand and sold through the Thunderbird Shops of Frank and

Pat Patania. He died in 1990.

James spent a lot of me with Salvador learning the basic

bullghng style and techniques, and he learned Spanish. Over

the next several years he began to understand what bullghng

was all about. While sll selling papers and playing quarterback for

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



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Diego at Casa Molina with the ier for the corrida in Nogales on May 4, 1986, when he was on the

program with Matadora Raquel Marnez.

After an outstanding corrida at Plaza Mexico in 1965, DiegoO’Bolger circles the ring holding a sombrero thrown in

appreciation while an assistant carries owers.

Salpointe High School, he

connued to aend corridas

in Nogales.

Aer high school James nally

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 leers of

introducon and changed his

name, as Diego is Spanish for

James. He reverted to his Irish

roots with the surname

O’Bolger.

Diego’s rst formal novice

ght was on Aug. 11, 1962 in

Nuevo Laredo, Mexico. On

Oct. 18, 1964, he had his

debut at Plaza Mexico. His

alternava ceremony to

become a full-edgedmatador de toros took place in

Tijuana aer a scheduled

corrida on Aug. 15, 1969. He

was only the sixth American in

300 years to achieve this disncon.

Diego had a disnguished career. He lived in and fought in Spain

for ve 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 relaons for

Casa Pedro Domecq, maker of wines and brandies.

Diego returned to Tucson with his Mexican wife, Delna, and two

children. He is sll acve in community aairs. He says he sll

misses the art and ballet that it takes to “dance” with a brave,

magnicent bull. n



Travel

Of down under and out back By Dr. George J. Makol

W ell, I waited, and I waited,

and I waited some more.

I was not waing for Earth’s

temperature to rise, because

indeed, that hasn’t happened for

about 17 years. No, I was waing

for the polar ice caps to nish

melng, causing the ocean to

rise so much that it would wash

Australia across the Pacic unl

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 connent, I gried 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

o 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 thestewardess stopped me and said that all my passport informaon

was not in the computer, and a small gure 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 rst-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 cung eects of glacial ice and shoot 2,000 feet straight

up in the air, no trees, no soil, just rock.

I was so startled by the beauty surrounding me that I just stood

frozen on the tarmac for about ve 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 laer within aboriginal

guide, and yes, the South Island really looks like it does in the

Lord of the Rings lms.

We also visited Milford Sound, which actually is a ord formed by

glaciers cung eons ago through stone. We were at rst

disappointed that it was raining, but as we cruised on our boat

the captain noted that we would see 100 waterfalls that touristsnever see in dry weather, and indeed we did. We later stopped at

New Zealand’s rst and most spectacular Kawarau Bridge bungee

jump on a span stretching 186 feet above a raging river. It has a

visitor center compable 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 o the bridge in their wedding

are. 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 pracced to be the rst Western

Waterfall at Milford Sound.



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

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 ve-star

Hermitage Hotel in Mount Cook to sip coee 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-boom boats and

modied submarines will give you spectacular views of coral and

sh somemes 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

internaonal design compeon that received 233 entries

represenng architects in 32 countries, before they chose Danish

architect Jorn Utzon. Construcon of the building took 14 years,

as it was a unique design, unlike any previous building. The

oered two-hour tour covers the inside and the outside, and the

main concert halls, which are cleverly designed and enrelylined with wood pieces, each adjusted specically to reect

sound from the stage. The sound is so perfect that performances

can be held without amplicaon 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

populaon of Australia is in the coastal cies, 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 mes the size of Texas, only have 200,000

persons living there. So, while vising Australia, it is essenal 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 naves, communicate with them, and even

brought home a couple pieces of original art we bought directly

from the arsts.

We stayed in a fabulous ve-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

are in the process of turning the resort over to the indigenous

populaon, who will run it in the future; this is enrely

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 ies in the air around

the Ayers Rock monument, and we were given mosquito net

headgear to wear hanging down from our hats. The Indigenous

nd this frankly hilarious, as they seem to just ignore the ies and

I believe the ies ignore them, as they greatly prefer tourists.

Is it worth the long trip? I say it denively is. In fact, I met many

persons working in Australia and New Zealand who had

absolutely no accents and were obviously at one me Americans.

When I asked them how they got there, invariably I heard, “I

came here for vacaon 10 years ago and never le.” That sums it

up beer than I can.

Sombrero columnist George J. Makol, M.D., a PCMS member

since 1980, pracces at Alvernon Allergy and Asthma, 2902 E.

Grant Rd. His Makol’s Call will return in October. n

Indigenous artists offer their wares. Ayers Rock at sunset.



CME

Pima County MedicalFoundaon CMEPima County Medical Foundaon, a 501(c)3 nonprotorganizaon derived from, but separate from PCMS, presentsConnuing Medical Educaon lectures by our members and

others, for our members and others, on second Tuesday eveningsmonthly, with dinner at 6:30 p.m. and presentaon is at 7.

New locaon is Tucson Osteopathic Medical Foundaonheadquarters, Camp Lowell and Swan roads. Make turn on rststreet on right and follow curved road to front door. Scheduledfor 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.

SeptemberSept. 22-27: Cycling CME in Colorado says: “Please joins us for aunique CME experience in beauful Colorado! These two CMEconferences emphasize nutrion, exercise as medicine, andcommon musculoskeletal problem therapy. Conference groupsare small, helping to create an atmosphere conducive tointeracve learning in a hands-on atmosphere. Each day we willbe rewarded with a challenging road bike ride through beaufulterrain. If you enjoy acve learning, cycling, and Colorado, please

join us in 2015. Cycling CME Western Colorado is in GrandJuncon Sept. 22-27. Website is www.cyclingCME.com .”

Sept. 24-26: The Western Occupaonal & Environmental MedicalAssociaon presents the Western Occupaonal Health Conference:

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

WOHC 2015 provides “opportunies for learning” using “thelatest informaon in medical educaon to provide for workers’health,” organizers say. “This includes updates in general health,eects at the workplace, environmental and medical surveillance,and late-breaking controversial issues.” PCMS member ScoKrasner, M.D., M.P.H., F.A.C.O.E.M., medical director of KrasnerMedical Consultants, chairs the conference.

Included are work-site tours including Asarco Copper mine andRaytheon. For staying at the resort, call Loews Ventana Canyon at800.234.5117. Deadline is before Sept. 1. For more informaon,e-mail WOEMA at [email protected], call 415.764.4918, or fax415.764.4915. Registraon fees vary by addional Thursdayevents aended. 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, andRNs. Registraon forms can be mailed to WOEMA, 575 MarketSt., Suite 2125, San Francisco, Calif. 94105.

OctoberOct. 1-2: Ethical Dilemmas—Consultaon and Problem-Solving:

the Mayo Clinic Approach is at Mayo Clinic Educaon Center,

5777 E. Mayo Blvd., Phoenix 85054. AMA, AAFP AOA, and nursing

accreditaon to be announced.

“Ethical dilemmas related to paent care can be associated with

medical, psycho-social, ethical, and spiritual challenges forhealthcare team members. This course focuses on how toeecvely determine paent preferences and appropriate goalsof care; developing a coordinated, consistent approach to ethicaldilemmas to reduce both the frequency of occurrence, and stressamong providers, paents and their families, and the community;and implemenng an ethics consultaon service in your praccebased on the four-quadrant approach.”

Website: hps://ce.mayo.edu/ Contact: Lilia Murray, CMP, MayoClinic Scosdale, 13400 E. Shea Blvd., Scosdale 85259; phone

480.301.4580; fax 480.301.8323

[email protected] hps://ce.mayo.edu/

Oct. 1-3: The Associaon of American Physicians and Surgeons72nd Annual Meeng isConstuonal Symptoms: Curing

American Medicine’s Government-Induced Illness is at the HiltonSt. Louis Frontenac, 1335 S. Lindbergh Blvd., St. Louis, Mo. 63131.

“Doctors must lead the charge,” AAPS says. “This must-aendmeeng will arm you with the tools you’ll need to help in thisght to save American medicine. Join your colleagues and learnhow you can make a dierence!”

For reservaons call 314.993.1100 and menon AAPS to receive

group room rate of $129 per night. Link to online roomreservaons at aapsonline.org/2015am. Registraon: AAPSmember $475 unl Sept. 1 increase to $525; $250 spouse orguest. Scholarships available for med students and residents.

CME: Max 12.0 AMA Category 1 designated by New MexicoMedical Society with joint providership of Rehoboth McKinleyChrisan Health Care Services and AAPS.

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

Hepas C From A to Z is 11:30 a.m. to 5:30 p.m. at SonntagPavilion, 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 ofhepatology.

Register by calling ResourceLink at 1877.602.4111. For more info,contact [email protected]

Topics include Hep C Current Standard of Care; Which FibrosisAssessment is Best: Biopsy vs. Labs?; Special Populaons: RenalFailure, Decompensated Cirrhosis, Pre- and Post-Transplant;Future of HCV Treatment: What’s in the Pipeline? and PayerPerspecves: Is There Light at the End of the Tunnel? Paneldiscussion included.

Oct. 15-18 and Oct. 29-Nov. 1: The 18th Annual Mayo Clinic

Internal Medicine Update: Sedona 2015 is at Hilton SedonaResort, 90 Ridge Trail Drive, Sedona 86531; phone 928.284.4040.hp://www.hiltonsedonaresort.com/ Accreditaon TBA. Four-day course oers primary care physicians, NPs and PAs apraccal update on a variety of subspecialty topics, includinganesthesiology, allergy, cardiovascular diseases, consultavemedicine, dermatology, endocrinology, gastroenterology,hematology, infecous diseases, nephrology, neurology,otolaryngology, palliave, preventave medicine, psychiatry,pulmonary, urology, women’s health, and other areas applicableto today’s pracce and paents.

Website: hps://ce.mayo.edu/internal-medicine/node/3762Contact: Registrar, Mayo School of Connuous ProfessionalDevelopment, 13400 E. Shea Blvd., Scosdale 85259; phone480.301.4580; fax 480.301.8323 [email protected]

hp://www.mayo.edu/cme



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Documents

Aug-Sept 2015 Sombrero