The Message, January 2013

messageT HE

– J A N U A R Y 2 0 1 3A M O N T H L Y N E W S M A G A Z I N E O FS P O K A N E C O U N T Y M E D I C A L S O C I E T Y –

WELCOME TO YOUR 2013 SCMS By Anne Oakley, MDSCMS President

Do You See What I See?

Spokane Leads the Country in Applying Brain Science to Keep Us Healthy

What’s New with Consistent Care Washington?

The Story of One

Healing for the Homeless

January SCMS The Message Open2

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January SCMS The Message Open3

T a b l e O f C O n T e n T S

Welcome to Your 2013 SCMS 1

Do You See What I See? 2

Spokane leads the Country in applying brain Science to Keep Us Healthy 4

What’s new with Consistent Care Washington? 5

Healing for the Homeless 7

The House of Charity Medical Clinic 9

Health Care Inequalities Seen In Community Health 10

Spokane Community Health Centers Impact the Community 10

How’s Project access Doing? 11

Council on Health Disparities Works to Promote Health equity for all Washingtonians 12

CPIn Can Help Reengineer Care 14

In The news 14

2013 SCMS Officers and board of Trustees elected 14

Membership Recognition for January 2013 14

Continuing Medical education 15

Meetings/Conferences/events 15

new Physicians and Physician assistants 18

Positions 19

Classifieds 21

Of all the fOrms Of inequality, injustice

in health care is the mOst shOcking and inhumane.”

― Martin Luther King Jr.

2013 Officers and Board of Trustees

anne Oakley, MD President

David bare, MD,President-elect

Terri Oskin, MD Immediate Past President

Shane Mcnevin, MD Vice President

Matt Hollon, MD, Secretary-Treasurer

Trustees:Robert benedetti, MDaudrey brantz, MDKarina Dierks, MDClinton Hauxwell, MDCharles benage, MDJ edward Jones, MDlouis Koncz, Pa-CGary newkirk, MDfredric Shepard, MDCarla Smith, MD

newsletter editor – David bare, MD

Spokane County Medical Society Message

a monthly newsletter published by the Spokane County Medical Society The annual subscription rate is $21 74

(this includes the 8 7% tax rate)

advertising Correspondence Quisenberry Marketing & Designattn: lisa Poole518 S Maple Spokane, Wa 99204 509-325-0701 fax 509-325-3889 lisa@quisenberry net

all rights reserved This publication, or any part thereof, may not be

reproduced without the express written permission of the Spokane County Medical Society authors’

opinions do not necessarily reflect the official policies of SCMS nor the editor

or publisher The editor reserves the right to edit all contributions for clarity and length, as well as

the right not to publish submitted articles and advertisements,

for any reason acceptance of advertising for this publication in

no way constitutes Society approval or endorsement of products or

services advertised herein

January SCMS The Message 1

Welcome to Your 2013 SCMSBy Anne Oakley, MD

SCMS President

Hello fellow members of the Spokane County Medical Society and welcome to 2013!

My name is anne Oakley and I am your new president My first duty as the new President

is to thank our last President Terri Oskin for her great service! She and our executive Director Keith baldwin, his staff and our board of Directors have accomplished much this past year, and the work continues

I have been a member of the Spokane County Medical Society since joining the Physician anesthesia Group at Sacred Heart in 1992 My husband, Russ Oakley, is a fellow member and works as an Orthopaedist for Providence Inland Orthopaedics I have a great life—a strong marriage, two great kids in college and a group of partners in my practice that make me feel proud every day I enjoy traveling, skiing, hiking, gardening, cooking, entertaining, sewing, reading and working hard to keep myself and those I love happy and healthy

We chose Spokane off the map 20 years ago from our far-away homes on the east Coast primarily because of the amazing medical community it had to offer, and have never regretted the decision The size of Spokane’s medical community was especially appealing to two doctors trying to avoid performing cases together (much better on a marriage!), but who preferred not to raise a family in a big city We wanted to live in a safe town that was close to the outdoor activities we love, had excellent schools and offered plenty of nice neighborhoods only 10 minutes from work Spokane has exceeded our expectations in every way! Our friends and family from back east still cannot believe we left for Washington, and continue to ask if it rains here every day

So why am I jumping into this role and writing this message today (and every other month) for the next year??? I am not really sure! but I do believe that now—more than ever in our history—doctors need an organization that brings us together and provides a united voice every few years since I have become a doctor there has been a new governmental policy, malpractice crisis, health care remodeling, cut in payments or regulation DRGs , HMOs, HIPaa, aCOs etc , etc all predicted to “ruin the practice of medicine as we know it ” Through it all we have managed to take good care of our patients, continue learning and inspire bright young men and women to follow in our footsteps Why does “medicine as we know it” keep surviving? I think it is pride in our profession that keeps us performing, and that the Medical Society is supportive—even critical—to this sense of pride in a profession that everyone else wants to control and regulate

Toward this end of remaining a united group of professionals, the Medical Society has spent the last year creating a new strategic plan to enhance its relevance to its members and further the mission of safeguarding our community’s health and wellness The new plan, which The Message has outlined in several previous issues, addresses our shifting demographics Those shifts include a large change from private group practice to employed practice models, a higher percentage of female members and a generational change as the “GenXers” replace the “boomers” as the predominant age group The “GenYers” will be old enough to be doctors soon, too! We need to help each other navigate the changes in health care each group has its strengths, as well as something to learn from the other

During the next year we will be implementing the new strategic plan, which can involve any member with an interest to participate! let me know what you want from your medical society encourage physicians to maintain their membership or rejoin if it has lapsed Pay attention to health care policy and use your voice, individually and as a group!

Happy 2013!


Do You See What I See?By Heather Wallace, Youth Coordinator

Spokane Youth Photovoice Project

In the summer of 2012, three ferris High School sophomores worked with staff and interns from the Spokane Regional Health District to research alcohol and tobacco advertising in their home neighborhood utilizing a method called Photovoice The project started with the question, “How does alcohol and tobacco advertising affect youth in east Central?”

Photovoice is a method of participatory action research that is becoming increasingly more common in public health research The process, developed by Caroline Wang and Mary ann burris 1 in the 1990s, seeks to give voice to disempowered groups by allowing them to capture images of conditions in their lives and then define the deeper social significance of those images

The teens used a survey called the Community assessment of neighborhood Stores to assess grocery, discount and convenience stores as to their placement, pricing and advertising for alcohol and tobacco and healthy food products (specifically milk, eggs and fresh fruits and vegetables) They compared stores in the east Central neighborhood (lower South Hill east of Division) with those less than five miles away in the more affluent neighborhood of Comstock (the area of 29th avenue and Grand boulevard)

The images they captured demonstrate how alcohol advertising frequently targets youth for example, the design of the high-alcohol content beverage, four loko, is remarkably similar to that of the popular energy drink, Rockstar both products are bottled in vibrant-colored cans and eye-catching, youth-friendly logos although it appears youth-friendly, four lokos is 12% alcohol by volume

The youth were also struck by how frequently alcohol products were placed directly next to items meant for children and youth such as candy, ice cream and soda The youth researchers wanted to know, “Why, what is the subtle advertising message?” They surmised that producers place alcoholic beverages in those locations in order to minimize the perception of their inherent risk and create a scripted desire for them as “treats ”

In their comparative study the youth researchers found that there were twice as many alcohol advertisements in the east Central area than there were in the Comstock area They were even more shocked by the different types of images used to advertise the same products The stores located in Comstock displayed images of americana such as fish, flags and vintage memorabilia, whereas the images in east Central were of provocatively dressed women and gangsters

The young people also looked at the data produced in the Spokane Regional Health District’s 2012 Health Inequities Report according to the report, nearly 45% of adults living in the east Central neighborhood indicated that they had lived with a problem drinker or alcoholic before they turned 18 The comparable rate for Comstock was only 20% even more striking was the difference in the rate of tobacco users - 30 5% for east Central and only 11 5% for Comstock The maternal smoking rate of 28 7% in east Central equates to a 500% higher rate than Comstock’s 5 7%

Those and other socio-ecological factors contribute to the statistic that most startled the fifteen-year-old researchers; that there is a nine year difference in life expectancy for 15-17 year-old individuals based on whether they live in east Central (approximately 56 more years) or Comstock (approximately 65 more years)

Continued on page 3

Busch advertisement at Quiki-Mart on Sprague Avenue and Havana Street

Busch advertisement at the Conoco gas station on the corner of 29th Avenue and Grand Boulevard.


Continued from page 2

after completing the photography and analysis portions of the project the youth developed action tasks in two categories: personal responsibility and those that they would go on to seek support for from policy-makers in the community Their areas of personal responsibility included:

• Testifying in front of the liquor Control board in support of the

alcohol Impact area for east Central (The measure passed summer

2012)

• Presenting to the Spokane City Council regarding laws currently

exempting Spokane and Spokane Valley from certain alcohol

advertising restrictions

• Connecting with east Central organizations and businesses

regarding voluntary changes to their advertising practices

• enlisting neighbors in a neighborhood clean-up (Completed fall 2012)

• Continuing to educate the community through their Photovoice

presentation

The youth asked the community adults and most specifically those with the ability to affect policy decisions to support them by considering voluntary or statute-imposed changes to alcohol and tobacco advertising and placement

They also recommended that a “family-friendly” business criterion be developed to honor businesses that choose to frame their business practices in ways that support youth and families in the neighborhood

for further information or questions regarding the Spokane Youth Photovoice Project, please contact the Youth Coordinator, Heather Wallace at (509) 990-0566 1 Wang, C., & Burris, M. (1994). Empowerment through photo

novella: Portraits of participation. Health Education Quarterly,

21(2), 171-186. doi:10.1177/109019819402100204

From left to right: Megan Wallace, Elizabeth Wallace and Dustin

Schaefer


Spokane Leads the Country in Applying Brain Science to Keep Us HealthyBy Kristen West

Vice President , Grant Programs EHF

and Rowena Pineda, M.Ed.

Program Manager

Neighborhoods Matter & Weaving Bright Futures SRHD

The adverse Childhood experiences (aCe) Study conducted in the 1990s by Dr Robert anda of the Centers for Disease Control and Dr Vincent felitti of Kaiser Permanente examined the childhood origins of many of our leading health and social problems according the Dr anda’s article, The Health and Social Impact of Growing Up with adverse Childhood experiences, the key concept is that stressful or traumatic childhood experiences such as abuse, neglect, witnessing domestic violence, or growing up with alcohol or other substance abuse, mental illness, parental discord or crime in the home are a common pathway to social, emotional and cognitive impairments that lead to increased risk of unhealthy behaviors, risk of violence or re-victimization, disease, disability and premature mortality furthermore, aCes have been shown to disrupt brain and organ development causing lasting effects on brain structure and function If the aCes are chronic and persistent, complex trauma may result

a newly released book, “Scared Sick” by Robin Karr-Morse, connects psychology, neurobiology, endocrinology, immunology and epigenetics to demonstrate how chronic trauma in pregnancy, infancy and early childhood lies at the root of common diseases This book is a collection of cutting edge scientific findings that link persistent stress to diabetes, heart disease, obesity, depression and addiction later in life

Washington State is a leader in the nation for recognizing that aCes are an underlying cause for stress and complex trauma impacting health Washington State uniquely collects aCes data by county through behavioral Risk factor Surveillance System In Spokane County, an in depth study conducted by Washington State University’s area Health education Center (WSU-aHeC) involving 10 elementary schools in four school districts found that out of 2,101 randomly selected students, 23% of children have been exposed to two or more aCes Of those, 55% were eligible for free or reduced price lunches The study also found that 35% of the students with two or more aCes experience academic problems, 45% have attendance problems and 42% have serious school behavior problems furthermore, frequently reported poor health (defined as at least once a month interfering with school) occurred in 8% of children but was four times more likely to occur in children with three or more aCes

Several organizations in Spokane are doing pioneering work on aCes and complex trauma Those efforts build the resilience of children, families and the broader community to overcome the negative impact of aCes WSU-aHeC, through a grant from the bill and Melinda Gates foundation, is using a unified school-improvement model with six elementary schools in four school districts to integrate evidence-based social-emotional learning (Sel) practices for all students, with trauma sensitive responses for at-risk students Their goals are to: 1) increase academic outcomes and 2) demonstrate how schools can be a practical vehicle for addressing the effects of traumatic stress in children The Spokane Regional Health District (SRHD) is a partner in this effort SRHD embeds two public health nurses (PHns) in the schools The PHns work closely with WSU-aHeC in the implementation of the attachment, Self-Regulation, Competency (aRC) framework that is developed by Dr Margaret blaustein and Kristine Kinniburgh It is a components-based model that identifies three core domains of intervention for children and adolescents who have experienced trauma and their caregiving systems: attachment, self-regulation and competency Within those three domains, nine building blocks of interventions are identified including caregiver affect management, attunement, consistent response, routines and rituals, affect identification, modulation, affect expression, executive functions and self-development and identity a tenth target of intervention, trauma experience integration, involves an integration of all other targets, including both external resources and individual skills, addressed within this intervention framework

empire Health foundation (eHf) is interested in investing in policy and program strategies to prevent aCes and to mitigate their impacts through greater resilience eHf has conducted a Spokane metro sector readiness assessment that is available on their website, www empirehealthfoundation org In addition, eHf is funding the first three-year start-up of a Spokane Tribe network that will focus on historical trauma eHf is also participating in a statewide public-private partnership to evaluate the effectiveness of community capacity building coalitions to prevent and mitigate aCes Six sites statewide will be chosen to participate in the evaluation Community partners interested in learning more about the statewide public-private partnership should contact Kristen West, Vice President, eHf at Kristen@empirehealthfoundation org

In april of 2013, we have an opportunity to bring together service providers, health care, government agencies, philanthropy, businesses and education to begin to develop a plan on how to build a resilient community Our Kids Our business is planning to bring Robin Karr-Morse, author of “Scared Sick,” to Spokane Ms Karr-Morse will share her research on aCes and set the stage for a community discussion on how we can promote trauma-sensitive practices within organizations and through policy Pediatricians, primary care practitioners, Ob-GYns, eD practitioners, etc could all play a significant role through early identification and by learning complex stress-informed practices that could be effective with high users of the health care system Members of the Medical Society who are interested in attending this event to learn more and become part of the community response should contact Rowena Pineda at the Spokane Regional Health District, rpineda@srhd org


What’s New with Consistent Care Washington? By Lee Taylor

Director Strategic Initiatives

Consistent Care Washington (CCW) – One of the

Regional Strategic Initiatives and a Major Component of

the New Mission of the Spokane County Medical Society

The community health and wellness regional strategic initiatives are programs of the Spokane County Medical Society foundation, which is governed by the executive committee of the Spokane County Medical Society The initiatives are carried out in two programs - Project access and Consistent Care Washington

The following is a summary of the current activities in Consistent Care Washington:

1. Emergency Department (ED) to Primary Care Program

The eD to Primary Care Program provides access to primary care medical services from providers willing to donate their services, for low-income uninsured people residing in Spokane County Participating providers are Group Health and Providence Internal Medicine Residency Spokane They provide no cost care for up to six months for 50 patients per year referred by all four Spokane eDs Currently 35 clients are receiving care through the program Client care includes ongoing care coordination and support including help with connections to behavioral health and other community services

2. Behavioral Health Workgroup

This workgroup brings together the eD providers, case management staff, hospital Psych staff and providers of behavioral health services to establish community-wide protocols and pathways for discharging acute mentally ill patients from the local hospital eDs in Spokane On December 12 over 30 people from all four hospitals and the key providers of behavioral health services participated in an all-day facilitated meeting creating a plan for community wide changes designed to improve patient care and operational efficiency in the eDs

3. Prescription for Housing Community Care Coordination

CCW received a grant from the City of Spokane called the Health Homeless Housing Systems Integration Pilot Project The community name for the project is Prescription for Housing because the clients who will benefit from the services provided need health care services to “turn the ship” in the right direction for successful transition away from homelessness The pilot project will serve approximately 40 homeless persons with complex medical conditions

early progress in the project has created new communication protocols for hospital social workers to identify homeless patients and refer them to a housing services coordinator The coordinator works collaboratively with the social workers on a discharge plan that moves the homeless patient as quickly as possible to safe housing The multidisciplinary team then connects the patient with an appropriate medical home that manages the patient’s condition in the home setting and dramatically reduces the chance of hospital readmission

4. “Hot-Spotters” Community Collaboration

This activity identifies high risk patients with a history of high utilization of health care services and develops a community care plan that provides the best care available while working to reduce community costs On December 12, a community group including the fire and Police Departments, behavioral health providers and Consistent Care Washington staff met to develop a plan for a person with a history of very high utilization of the “911” emergency system and being transported to the eD as many as 40 times over two months The meeting was the beginning of an important focus on community-wide collaboration to solve some of the most challenging medical and behavioral health challenges in the community

Please call me if you have questions or if you have ideas that you would like to share, at (509) 220-2651 or email me at lee@spcms org

The Story of OneBy Scott Hippe, MS1

UWSOM

"Carla, is there a Carla here?" I ask the group of patients waiting to be seen at the House of Charity Clinic I am a first-year UW medical student at the Riverpoint Campus as a class we support this clinic on a completely volunteer basis along with community physicians a woman seated in the corner of the room stands gingerly and walks into the exam room Her shoulders are hunched and her head is angled down towards the tile floor

She blinks and a single tear slowly slides down her cheek, shimmering in the fluorescent lighting coming from the ceiling above

"What can we do for you today, Carla?" I inquire

"I need help," she begins with a quivering lower lip "My endometriosis is getting worse The doctor didn't get it all when I had surgery My belly hurts and my back I can't hold my son like I used to You can't imagine how depressing it is nothing helps Ice, advil, pain pills nothing I can't function anymore and then there's the test "

I momentarily stop my frantic note-taking to glance up at her She cannot contain her emotions any longer and begins to sob in earnest

Continued on page 7


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"I ran out of medicine for my aDHD next week I take the manager's test at the fast food restaurant where I work but without the medicine I can't focus I need to pass that test so I can get benefits Otherwise I—" she pauses to clear her eyes and wipe her nose, "—I'm at the end my rope "

The physician preceptor and I did everything we could for Carla She stood a little taller and looked the world in the eyes as she left the clinic My soul was moved, and to this day I continue to wonder how she did on her manager's test I will not forget how she cried That is why I signed up to be a doctor after all, to help people who find themselves in times of need There are plenty of people in great need both near and far Health inequities run deep in our Spokane community for example, life expectancy is about fifteen years higher for residents of South Hill neighborhoods compared to residents downtown Teen pregnancy rates are thirteen times higher in West Central than in Manito but the numbers are cold and, if anything, discourage me from engaging in issues of health inequity Statistics and data do not capture what health inequity is really about

behind every statistic is a story and a human being with hopes, dreams and fears Carla's story compels me to continue as a medical student and to become a future physician who is committed to reducing health inequity not because it seems like the statistically sound thing to do, but because addressing health inequity changed Carla's story and will change the stories of many like her for the better I offer my efforts and support to House of Charity, Spokane-area students and other projects in the community because I want others to look the world in the eyes like Carla did

The title of this article comes from a simple quote that says "the story of one is the story of us all " and we—the poor and rich, unfortunate and fortunate, healthy and sick—are all in this together I for one will be playing a part in writing a good end to our story, and I hope you consider taking up the pen to be an author yourself

Healing for the HomelessBy Barbara Comito

Staff Writer

Union Gospel Mission

When he arrived at the Union Gospel Mission (UGM), larry had a hernia that prevented him from working Having worked survival-type jobs most of his life he had no money and no insurance by the end of each day, he was often doubled over in pain Dr allen Seely, one of the volunteer doctors who serves in the UGM medical clinic, examined larry and arranged for him to see a surgeon who agreed to repair the hernia free of charge

UGM staff assisted larry with the paperwork to apply for Project access, a network of local hospitals and doctors serving the poor When all was said and done, larry had no bills from the surgery that required an overnight stay at Sacred Heart Medical Center “This is life changing for me because I’m able-bodied and ready to get back to work,” larry said

UGM has two free medical clinics serving the poor and homeless One is located at the Men’s Shelter on east Trent avenue and the other is for women and children at anna Ogden Hall on West Mallon avenue In addition to serving guests from both shelters, the men’s clinic sees people off the streets as walk-ins and the women’s clinic serves guests from the UGM’s Crisis Shelter for Women & Children on east Sprague avenue a third clinic will soon be operational at the new Center for Women & Children in Coeur d’alene, Idaho an eye clinic is also available at the Men’s Shelter

“The existence of the clinics means that those people with hypertension, diabetes, depression, respiratory issues, urinary tract infections – who have no ability to pay and would otherwise have no other recourse than to go to the eD – are able to get the medical care they need,” said Jenny edminster, a nurse practitioner who volunteers at UGM on a weekly basis The UGM medical clinics conducted 1,237 patient visits over the past 12 months The majority of those clients have been in survival mode for a long time Having to deal with being homeless, suffering from abuse, addiction and dangerously low self-esteem, they are primarily concerned about where they (and often their children) are going to sleep and what they are going to eat Once their immediate needs of food and shelter are met, the goal is to break the cycle of homelessness in their lives by addressing the myriad of factors behind it – physical, emotional, social, educational and spiritual Taking care of themselves – believing they are worth the effort – is often a new idea and one that must be encouraged and reinforced

UGM patient Larry with Dr. Allen Seely

Continued on page 9


InCyte Pathology and Eastside Pathology

have entered into a merger agreement.

The merger will create a northwest

regional pathology practice where

physicians and hospitals can access

36 board certified pathologists

with expertise in

27 disciplines and subspecialties.

Proudly serving the greater Spokane healthcare community since 1957

Learn more by visiting www.incytepathology.com

or calling 509.892.2700

Diagnostic Excellence

Spanning the State

Two premier laboratories have joined forces to deliver

progressive diagnostics and patient care to the Northwest.

COLUMBIA MEDICAL ASSOCIATES

is currently seeking a BC/BE Internist to join

our Northside Internal Medicine Group in

Spokane, Washington to meet our increased

service utilization. We are a group of over 40

physicians providing comprehensive medical

care to families and individuals of all ages

within the Spokane region. The position

offers the following:

•flexible schedules and outstanding teams

make this opportunity worth exploring

•Competitive Salary and Generous benefit

Packages

•Conveniently located only two blocks from

Holy family Hospital

•established relationship with local hospitalist

group for admitting, rounding, and discharge

Our physicians are committed to maintaining

the health and well being of all their patients

through preventive care measures and

working closely with community specialists.

Our new partnership with Group Health and

collaborative care models ensure patients

have access to the best care in Spokane.

To apply or inquire for further information

please contact:

Nancy Longcoy, Physician Recruiter

[email protected]; Ph: 206-448-6132



This holistic approach requires a long-term commitment and a willingness to stand by people over the long haul “Three-fourths of what we do here is education,” said Clinic Coordinator Susan Vowell, bSn, with the major emphases being smoking cessation, eating right and exercising The goal is for each individual entering UGM’s recovery programs to receive a physical exam and to assume personal responsibility for his or her health by sitting down with a medical professional and creating a long-term wellness plan with incremental goals

Dr Charlie Wolfe, who has been serving at UGM’s medical clinic for 16 years, said the average age of the men he sees has dropped considerably over that time He now sees a large number of men in their late twenties and early thirties When he first started, his Mission patients were predominantly in their late fifties or sixties and suffering the effects of decades of alcohol abuse “now, the number one problem is meth,” said Dr Wolfe “They are aging prematurely It affects everything: their blood pressures are up; their lungs are damaged; their skin is older; their teeth are terrible It’s a premature aging and, along with that, come the diseases of aging ” Dr Wolfe added that if even half of the patients seen in the UGM medical clinics in a year ended up in the area’s emergency departments, the costs (estimated at $500 per visit) would have added up to over $300,000 It is also important to note that UGM operates 100% free of government funding and practices careful stewardship In 2011, 88% of funding went directly to program services UGM has been meeting the needs of the poor and homeless for over 60 years and is privileged to partner in its health and wellness efforts with the empire Health foundation, the Safeco Insurance foundation, bank of america, every Woman Can and the eastern Washington affiliate of Susan G Komen for the Cure, as well as the extraordinary medical professionals who volunteer their time in our clinics “I believe the Mission is a picture of the church community caring for the poor in the way God designed,” said UGM executive Director Phil altmeyer “The doctors and nurses who serve in our medical clinics are the reaching arms and healing hands of Christ, and we are incredibly blessed by their dedication and enthusiasm ”

Dr. Charlie Wolfe examining a UGM patient

The House of Charity Medical Clinic By Jerry Schwab

Assistant Director House of Charity

The House of Charity Medical Clinic is the oldest free medical clinic in the state of Washington, running for over thirty-six years It was founded by Sister Peter Claver, Sacred Heart president, in 1976 to provide high quality, basic medical care, without cost, to the homeless, indigent, elderly and underserved of Spokane The House of Charity is the host for the clinic, with Providence Sacred Heart providing resources and volunteer doctors and nurses The clinic is the only completely free clinic in Spokane It doesn’t even take medical coupons for the majority of those years, Dr arch logan oversaw the clinic He has retired his license recently but continues to help organize the clinic in its off hours The clinic runs on Tuesday and friday afternoons and now also on Saturday morning with the help of the University of Washington Medical School at WSU to provide service learning opportunity for first and third year medical students Dr leRoy byrd is now the clinic director

The clinic provides primary care to homeless and low-income community members One day last week there were 13 new patients out of the 25 seen Of the 1,000 plus patients seen in a year, 85% are seen three or fewer times Dr logan saw one patient for over 15 years

The clinic takes the load off of local emergency departments except in cases where there are severe acute life-threatening issues Many patients report frustration with other health care providers because they feel they are dismissed or discounted due to being poor, homeless or powerless

Most commonly seen issues are respiratory infections, skin infections (MRSa), abdominal problems, joint conditions, diabetes, hypertension, hepatitis, foot care and mental health concerns (depression, bi-polar, schizophrenia, and anxiety)

The House of Charity is located at 32 West Pacific avenue for more information call (509) 624-7821


Health Care Inequalities Seen In Community HealthBy Rita Davis MSN,

FNP-C, Lead Provider Spokane Urgent Care

On any given day a community health center in Spokane sees an average of 215 uninsured patients that range in age from infants to the elderly They are representative of both those who have been of low socioeconomic status their entire lives and the “new poor”, people who once had good jobs or businesses of their own and now find themselves unemployed and uninsured Those in middle age are the hardest hit by this They are the people who are getting to the point in life where they need some medical care so the loss of insurance hits them hard They are also the ones finding it hardest to secure a new job that provides them with insurance

Patients new to community health centers are characteristically different from those who have adequate medical coverage They rarely come here early in their disease process or condition They wait for care They wait because they know they will have to pay out-of-pocket for the visit and for any labs, radiology or medication they need They may also wait because they are not aware that there are organizations in Spokane that offer care on a sliding scale Those patients also come to us with conditions that would better be worked up in the emergency department (eD), including chest pain, because they are unable to pay an eD bill Many of them tell us they are here instead of the eD because they have already learned what it is like to owe money on a medical bill Yes, the hospitals may write off some of their costs, but rarely do medical providers, ambulance companies or radiology afford the same charity Some have had their lives completely turned upside down by an illness while not insured They tell stories of daily calls from collection agencies, bad credit (which many employers check during the hiring process), bankruptcy and increased stress in their lives Delay in care often leaves those patients with a much more complicated or advanced illness Case in point: the patient with strep throat who waits four weeks to seek out medical care and only comes to us when they can barely open their mouth and their face is significantly swollen Instead of a simple case of strep throat they now have a peritonsillar abscess that needs surgical draining

another specific case is that of a 62 year-old man with “bladder pain” and “peeing blood” He staggers into our waiting room with the help of his wife because he lost so much blood in a short time that he is in need of a blood transfusion In two weeks his hemoglobin and hematocrit went from 16 and 47 to 7 and 21 He sought out care previously He was seen in the eD on two occasions and sent home He applied for assistance and was referred to a specialist both by the community health center and by the eD, but it is very hard for the community to absorb all the patients in need of specialty care, so he had to wait

On this day I personally wheeled him over to the eD and after giving the staff a thorough history he was seen, given a much needed transfusion and admitted to the hospital He did then receive the care that was needed but there was a two-month delay from the time he originally presented with this significant complaint until he was treated This man was diagnosed with advanced stage, extremely aggressive, prostate cancer This story is not over after 42 treatments with radiation he is in "wait and see" mode We may never know whether that two months made a huge difference, but it does highlight the difficulties of the uninsured

Or there is the all too common story of the patient that has already gone to a for-profit medical organization The patients are told that they will have to pay up front, in cash, since they don’t have insurance If unable to do so they won’t be able to afford the care that their provider insists they have if they are going to be treated So they come to us

Yes, it would be wonderful if they could receive state-of-the-art work-ups, specialty care and treatment, but they can’t afford them So we at community health centers spend our days problem-solving along with our patients’ input How can we achieve the same results with less expense? How can we get a patient into specialty care? How can they get the treatment they need for a lower cost?

Spokane Community Health Centers Impact the CommunityBy Glenn Cassidy

Public Relations Director

Yakima Valley Farm Workers Clinic

for many living in the Spokane area, community health centers offer affordable, accessible care They provide treatment without regard to a person’s ability to pay, welcoming Medicaid and Medicare patients and offering sliding fees based on a family’s income

Two of those centers are Spokane falls family Clinic, which opened in 2001, and Riverstone family Health, which opened in Spokane’s northeast Community Center in early 2011 both are affiliated with the Yakima Valley farm Workers Clinic that operates 18 health centers throughout Washington and Oregon at the two Spokane clinics, it’s estimated that over 80 percent of the patients are under the federal poverty level The family practice physicians there treat people of all ages, with a significant share of their patient panels consisting of children and women receiving prenatal care

like most family practices, common diagnoses include colds, viral infections, hypertension and diabetes Depression is detected in many patients, a diagnosis that’s not uncommon among the population with which they typically deal

Continued on page 11



Riverstone family Health also offers dental care, with special emphasis on preventive care for children It’s also home to the Spokane Dental Society’s IDea Clinic, which relies on volunteer dentists donating their time to treat patients in need

a pharmacy has been serving patients of the Spokane falls clinic since it opened Riverstone is set to open its pharmacy in the spring of 2013

The two clinics also operate a first Steps program that provides maternity support services and infant case management Through the program, Medicaid-eligible women have access to a team that includes a community health nurse, a counselor and a community health worker The intent of the statewide program is to provide enhanced preventive health and education services and brief interventions to pregnant women as early in a pregnancy as possible following birth, the goal is to improve the welfare of infants by providing parents information and assistance on accessing medical, social and educational services in the community

lanie Cox, M D , a family practice physician and clinical medical director for Spokane falls and Riverstone, appreciates the challenges of providing care to a diverse population that can often have problems accessing care “It is very rewarding to be able to serve people who would otherwise not get care and to make a positive difference in patients’ and families’ lives This is why most of us got into medicine in the first place ”Dr Cox is joined by a roster of colleagues at the two clinics that includes four other physicians, four nurse practitioners, a psychiatric nurse practitioner, two dentists, two dental residents and four pharmacists

They, along with other community health centers serving the Spokane area, are committed to serving a population that often has health-related issues according to the Spokane Regional Health District, adults in the county who are below 100 percent of the federal poverty level (fPl) are 7 1 times more likely to be in fair or poor health compared to adults at or above 400 percent of the fPl

at the same time, parents below 100 percent fPl are 17 4 times more likely to rate their children’s health as fair or poor compared to parents at or above the 400 percent level The health district also reports that the rates of diabetes and obesity are higher among low-income populations and adults who are at or below 100 percent fPl are 10 4 times more likely to experience poor mental health

The disparity in health rates is the reason that community health centers in the region have strived to expand facilities and add staff in recent years and it’s why Spokane falls family Clinic and Riverstone family Health maintain programs and services that complement a physician’s care: dentistry, since poor oral health has a direct connection with physical health; pharmacies with reduced-price medications, to help avoid prescriptions going unfilled due to a lack

of funds; and counseling and education programs, to help patients understand the factors that affect the health of them and their children

as Dr Cox points out, it’s rewarding for her and others at Spokane’s community health centers to make a difference after all, “it’s why most of us got into medicine in the first place ”

How’s Project Access Doing? By Lee Taylor

Director

We are thrilled to report that our community stakeholders have provided the funding necessary to keep Project access going Continued funding from many organizations, as well as new funding from community stakeholders in response to our “Call-to-action”, helped us solidify our funding for the next several months

Project access is very grateful for the financial support from the following organizations:

While the short-term concern about a financial shortfall is behind us, we still must work on sustainability We have trimmed our budget for 2013 by approximately 20% and we believe we have solid commitments for funding to support our budget We must continue pursuing financial support for Project access to ensure that an increasing number of clients are served and that our financial reserves are restored

Project access will serve more than 900 clients in 2012, up from 651 in 2011 The need continues and Project access continues to grow even while operating expenses shrink We need the full support of our community to help us continue this important work

We encourage you to help us shape the future of Project access Your thoughts about the value of Project access in our community are important Please feel free to contact me, lee Taylor, Director, Project access, at (509) 220-2651 or lee@spcms org to share your thoughts also, please contact me if you have any thoughts about people or organizations that may be interested in making cash donations to support Project access Thank you for your support of Project access and your participation in this important discussion

Health Sciences and Services AuthorityProvidence Health CarePremera Blue Cross Health and Welness FundThe Mike and Muffy Murphy FundNumerica Credit UnionThe Bank of America Charitable FoundationGroup HealthPhysicians InsuranceFirst Choice HealthAmericanWest BankEmpire Health FoundationPACT Project - Client led cycle teamAvista

Spokane Tribe of IndiansPhRMAWSMAInland ImagingCity of Airway HeightsCity of CheneyCity of Deer ParkCity of Liberty LakeCity of Medical LakeCity of MillwoodCity of Spokane ValleyINHS


CDC Health Disparities and Social Determinants of Health

Resources The following resources can be located on the Centers for Disease Control and Prevention website at http://www cdc gov/nccdphp/dach/chhep/library/social_determinants htm

CDC Health Disparities and Inequalities Report—United

States, 2011 underscores CDC’s commitment to health equity The report provides analysis of the recent trends and ongoing variations in health disparities and inequalities in selected social and health indicators, both of which are important steps in encouraging actions to reduce modifiable disparities by using interventions that are effective and scalable

Promoting Health Equity—A Resource to Help Communities

Address Social Determinants of Health This workbook is for community-based organizations, public health practitioners, and community health partners seeking to create health equity by addressing the social determinants of health The workbook can be used to help expand new or existing public health initiatives, for example:

• Developing successful partnerships and guiding principles

• assessment methods for social determinants

• Creating action plans to address social determinants Data Set Directory of Social Determinants of Health at the

Local Level This directory contains an extensive list of existing data sets that can be used to address the social determinants of health The data sets are organized according to 12 dimensions, or broad categories, of the social environment each dimension is subdivided into various components Additional Health Disparities Resources

• THRIVE (Tool for Health and Resilience in Vulnerable

Environments) is an interactive Internet tool to help

communities understand and prioritize environmental factors

that impact health disparities

• Strengthening Communities: A Prevention Framework for

Eliminating Health Disparities examines the environmental

conditions that hold the most promise for reducing health

disparities in low-income communities of color, and further

delineates the community factors that can contribute to or

prevent health disparities

• The Imperative of Reducing Health Disparities through

Prevention outlines promising approaches and next steps for

reducing health disparities

• laying the Groundwork for a Movement to Reduce Health

Disparities assesses the landscape of existing efforts to address

disparities, identifies gaps and imbalances, and discusses

what elements are necessary to develop an effective national

movement

Council on Health Disparities Works to Promote Health Equity for All WashingtoniansBy Christy Hoff, MPH

Health Policy Advisor, Governor’s Interagency Council on Health

Disparities

In Washington State, native american men can expect to live seven years fewer than their white neighbors, and black mothers are twice as likely to have their babies die during their first year of life as white mothers These are just two examples of health inequities that persist in Washington State

Underlying these inequities are the many interrelated social and economic factors that lead to differential access to resources and conditions that influence health Specific examples include less access to nutritious food, safe and healthy environments, and culturally and linguistically appropriate health care services, as well as increased exposure to chronic stress resulting from institutional and interpersonal racism

eliminating health inequities is a daunting yet attainable challenge Washington has taken important steps toward meeting that challenge In 2006, the legislature created the Governor’s Interagency Council on Health Disparities The Council has seventeen members—a Chair and two consumer representatives appointed by the Governor as well as representatives from fourteen state agencies, boards and commissions The Council’s primary responsibility is to identify policy recommendations to eliminate health disparities by race/ethnicity and gender The Council convenes advisory committees with representatives from the public, private and community sectors to assist with identifying recommendations

In 2010, the Council released its first State Policy action Plan to eliminate Health Disparities The plan outlined policy recommendations aimed at closing the academic achievement gap; increasing health insurance coverage and access to culturally and linguistically appropriate health care services; promoting a diverse health care workforce; and ensuring all Washingtonians have equal opportunity to access healthy environments, make healthy choices and manage their health in order to reduce disparities in obesity and diabetes The action plan is available on the Council’s website: http://healthequity wa gov/about/docs/actionPlan pdf

The Council has recently updated its action plan and will submit it to the Governor and legislature by the end of December 2012



Continued from page 12 The recommendations in the 2012 update are aimed at increasing access to and quality of behavioral health services by promoting diversity and cultural competency in the behavioral health workforce and ensuring health equity is considered in health reform implementation; reducing environmental health disparities by promoting environmental justice, community capacity building and the precautionary approach; and reducing poverty and the impacts of poverty on health disparities by increasing capacity for culturally and linguistically competent early learning services, healthcare services in rural communities and access to healthy foods in diverse communities

faced with the reality of the State’s continuing budget deficit, the Council’s focus was to deliver recommendations that state agencies and their partners could immediately take steps toward implementing within existing resources The Council intends to monitor the implementation of its recommendations through briefings and updates at future Council meetings

In creating the updated action plan, the Council identified a number of recurring themes from its advisory committee work over the years While looking at issues as varied as diabetes, the academic achievement gap, environmental exposures and hazards and poverty, among others, the following issues reemerged as important considerations and as such may be particularly important in eliminating health disparities:

• early learning The Council’s advisory committees for

education and poverty both stressed the importance of

ensuring high-quality early learning programs are available

for communities affected by health disparities

• Cultural Competence and Diversity The Council’s

advisory committees for education, healthcare workforce

diversity, behavioral health and poverty all emphasized

the importance of providing culturally and linguistically

competent health care and other services, as well as

ensuring service providers reflect the diversity of the

population they serve

• language access The Council’s advisory committees for

health insurance coverage, behavioral health, environmental

exposures and hazards and poverty discussed the need for

ensuring meaningful interpretation and translation services

for individuals with limited-english proficiency

Community engagement The importance of ensuring affected communities are consulted with and engaged in activities related to health or the social determinants of health is an important theme discussed in all committees convened over the years

Capacity building all of the Council’s committees have identified a need for enhanced resources, staff, programs and/or expertise to effectively work toward the elimination of health disparities in different communities

Data another theme repeated across numerous advisory committees is the need to ensure data are routinely collected, analyzed and disseminated to track disparities and evaluate the effectiveness of interventions an important consideration is the need to collect racial/ethnic and other data disaggregated to the finest extent possible in order to unmask where disparities exist among racial/ethnic subgroups

The Council’s 2012 action plan will be available in electronic format on the Council’s website at http://healthequity wa gov/

to numerous eagle Scout projects including the avenue of flags, Honor Guard Walkway, Scatter Garden and others Many offerings have also lead to improved landscape features such as trees and shrubs Special events held at the cemetery such as Memorial Day, Missing in america Project and Wreaths across america are largely funded by the community because of the generosity of the community, those projects and events have been made possible

Community support of the cemetery is also shown by the charitable donations of time made by individuals, groups and organizations a Cemetery advisory board consisting of seven members volunteer their time to provide advice and assistance When the cemetery provides a military honors service volunteer groups and individuals play essential roles Individuals, groups, businesses and organizations regularly contribute their time, resources and expertise for special events and maintenance and landscape projects The facility and the service we provide is enhanced and fortified by these examples of selflessness commitment to the cemetery and our veterans

because of the patriotic commitment and continued support of the community, The Washington State Veterans Cemetery will be honoring veterans and serving their families for many decades to come

To learn more about the cemetery, please visit the website at www dva wa gov and follow the cemetery link


CPIN Can Help Reengineer CareThe Washington State Medical association has done a great deal this past year to support physicians’ ability to anticipate – and work with – the changes coming our way

One example: The Clinical Performance Improvement network (CPIn) programs the foundation for Health Care Improvement has been producing with the Puget Sound Health alliance (PSHa) and the Washington academy of family Physicians

In 2012 the following programs were conducted: Reducing Readmissions, efficient Visit Guide to Specialty Referral, Improving Pediatric Dental Care in Primary Care Settings, How to Improve the Patient experience, Shadow Coaching, Intensive Care for Persons with Multiple Chronic Conditions, Medication Reconciliation following Hospital Discharge and the Choosing Wisely Washington component of our Know Your Choices/ask Your Doctor Campaign

Programs identified for 2013 include Clinical Decision Support, the PSHa Medical Group Transformation Survey results, Results of the alliance Community Checkup, Developing and Implementing Office-based nursing Care Management, Registries Revisited, Improving access – How one Wa clinic reduced eD use, Results from the hospital readmission pilots in Pierce and Spokane counties, How to Conduct a Rapid Process Improvement workshop, better Care Practices for Medical Homes, Patient engagement – communicating with older patients, Motivational interviewing, Patients with low Health literacy, end-of-life Planning – actively engaging physicians and patients and results from the beacon Project in eastern Washington

January CPIN Programs

Wednesday, January 16, 12:15–1:15 pm CPIn Webinar | Intensive Care Management Services for Patients with Multiple Chronic Conditions – Colette Rush will present the Washington State Department of Health’s new statewide initiative to increase intensive care management for persons with multiple chronic illnesses More information, including how to register, is at http://www wsma org/clinical-performance-improvement-network#nineteen The webinar is free for all physicians, medical group staff or other care providers This activity has been approved for aMa PRa Category 1 Credit

Wednesday, January 30, 12:15–1:15 pm – CPIn Webinar | Survey of local best Practices for effective Patient Care – This webinar will present the results of a 2012 survey of over 40 medical groups in the Puget Sound region regarding their current use of specific tools and processes for effective patient care Structural elements of best practices surveyed included adoption of electronic medical records, use of registries, strategies for improved access to care, collecting information on health outcomes, patient satisfaction and health disparities, as well as care coordination resources and patient reminders

Topics covered will include:

• Specific processes, tools and practice structures linked to

patient care improvement

• The percent of local medical groups have implemented these

processes and tools

• The major barriers to successful implementation and how to

overcome them More information, including how to register, can be found online at http://www wsma org/clinical-performance-improvement-network#nineteen

In The NewsNicholas T. Ranson, MD to Be Inducted into the ASOPR

Spokane eye Clinic is proud to announce that Dr nicholas T Ranson has successfully completed a written and oral examination for aSOPRS and will be inducted into the american Society of Ophthalmic Plastic and Reconstructive Surgery at their spring meeting in June 2013 There are fewer than 600 surgeons world-wide that have earned the aSOPRS board certification Members have education, training and experience in highly specialized fields of eye, plastic, facial and reconstructive surgery

2013 SCMS Officers and Board of Trustees Elected

at the December board of Trustees’ meeting anne Oakley, MD took the oath of office as the 2013 SCMS President The executive Committee officers include David bare, MD, President-elect; Shane Mcnevin, MD, Vice-President and Matt Hollon, MD, Secretary-Treasurer Terri Oskin, MD is the Past President

Trustees elected to the board are louis Koncz, Pa-C; fredric Shepard, MD; Clinton Hauxwell, MD; Charles benage, MD and J edward Jones, MD Judy benson, MD was reelected to serve on the Credentials Committee elected as Washington State Medical association alternate delegates for the House of Delegates to be held in Spokane September 28 – 29, 2013 are Melanie lange, MD; William faloon, MD; Don Cubberley, MD; amy Occhino, MD and Jeffrey Snow, MD

Membership Recognition for January 2013Thank you to the member listed below His contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today

30 Years

P Z Pearce, MD 1/24/1983


Continuing Medical EducationPromoting Healthy Families (Practice Management alerts from the american Medical association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family The continuing medical education activity includes a video module, a detailed monograph and patient handout These activities have been certified for aMa PRa Category 1 CreditTM for more information www ama-assn org

Update in Internal Medicine 2013: This seminar is jointly sponsored by the Spokane Society of Internal Medicine and the Spokane County Medical Society 9 25 aMa Category 1 Credits Conference will be held on february 22, 2013 from 7:00 a m – 6:00 p m at the Spokane Convention Center for additional information please contact Jennifer anderson at (509) 448-9709 or email spokanesocietyim@gmail com

Meetings/Conferences/EventsInstitutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom b Should you have any questions regarding this process, please contact the IRb office at 509 358 7631

WSMA & UW Physician Leadership Course Offered in Spokane Spring 2013 - WSMa/UW Physician leadership Course is a comprehensive leadership skills development program that offers ten weeks of interactive hybrid distance learning specifically designed for physicians The course is based on UW MHa and Certificate of Medical Management curriculum eight weeks of online assignments and group work is bookended by two in-person weekend meetings, allowing physicians to develop their leadership skills in a convenient manner without needing to take significant time away from their practice or personal lives

The 40-hour course focuses on leadership and conflict management, Strategic planning and management, Safety and quality management, finance and Communication and advocacy Our next

course will be offered spring 2013 in Spokane In-person dates are March 8 and 9 and May 10 between March 9 and May 10 the course is conducted online The course is limited to 30 individuals Tuition for WSMa members is $2,000 and non-member tuition is $2,550 To apply for the spring 2013 course, send your CV, a letter of interest and a letter of recommendation before January 1, 2013 to Jennifer Hanscom at jen@wsma org

Spokane Guild of the Catholic Medical Association- Meets second Wednesday of each month at 6 PM at Providence Sacred Heart Medical Center administrative board Room in administration on the Main floor all are welcome for inquiries contact Phil Delich, MD at (509) 465-1554 or e-mail at delichphil@gmail com

Upcoming Aging and Mental Health Conference, March 8, 2013 friday, March 8th, 2013 8:00 a m to 5:00 p m The purpose of this conference is to raise awareness of the issues involved with mental health and older adults, as well as provide concrete tools for assessment and intervention Mark your calendars now More details to follow for more information contact Jamie McIntyre, MSW aging and long Term Care of eastern Washington assistant Planner/ Title V Coordinator (509) 458-2509 x211

Medical Reserve Corps of Eastern Washington General Membership Meeting – Spokane Regional Health District auditorium, 1101 West College avenue, 6:00 – 8:00 p m Wednesday, 9 January 2013 everyone is welcome to attend Disaster response and preparedContinued on page 17

Health Care Reform Seminar Series Part 1: Overview and Update on Health Care Reform Thursday January 31 8:00 a m to noon WSU Riverpoint Campus academic Center, Room 20 $199 per person $149 for HPa students, alumni or board members for more information contact Krista loney at (509) 358-7980 Register at http://hpa wsu edu/reg1212




The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS

Atkinson, Benjamin E., MDNeurologyMed School: Wayne State U (2005)Internship: Sinai Grace Hospital (2006)Residency: Detroit Medical Center (2009)Fellowship: Detroit Medical Center (2011)Practicing with Providence Medical Group 01/2013

Tehrani, Hassan Y., MDThoracic SurgeryMed School: Royal College of Surgeons–Ireland (1993)Internship: Boston Medical Center (1995)Residency: St Elizabeth’s Medical Center (1999)Fellowship: Northwestern Memorial Hospital (2001)Fellowship: Jackson Memorial Hospital (2003)Practicing with Rockwood Clinic 02/2013

Wood, Anthony J., MDAnesthesiologyMed School: Oregon Health Sciences U (1994)Internship and Residency: Oregon Health Sciences U (1996)Residency: Oregon Health Sciences U (1999)Practicing with Anesthesia Associates 02/2013

PHYSICIANS PRESENTED A SECOND TIME

Atkinson, Marie D., MDNeurologyMed School: Wayne State U (2002)Practicing with Providence Epilepsy Center 01/2013

Fang, Chunhui, MDInternal MedicineMed School: Beijing Medical U-China (1999)Practicing with Apogee Physicians 01/2013

Gomez Torres, Jeisa Y., MDInternal MedicineMed School: Universidad Autonoma de Guadalajara-Mexico (2004)Practicing with IPC of Washington/Holy Family Hospital 12/2012

Pounds, Denise R., MDFamily MedicineMed School: Saint Louis U (2008)Practicing with Group Health 09/2012

Shibley, Eric R., MD (aka Choudhury Shiblee Nomany)Internal MedicineMed School: Sir Salimullah Medical College-Bangladesh (2002)Practicing with Apogee Physicians 01/2013

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME

Owens, Gabriel P., PA-CPhysician AssistantSchool: U of Nebraska (1999)Practicing with Providence Spokane Cardiology 11/2012


POSITIOnS aVaIlable

PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CMe reimbursement, 401(k), full medical and dental, nHSC loan repayment and more To learn more about physician employment opportunities, contact Toni Weatherwax at (509) 444-8888 or hr@chas org

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations We are contracted through the Department of Veterans affairs to manage their compensation and pension programs We are currently expanding our network of family Practice, Internal Medicine and General Medicine providers for our Washington Clinics We offer excellent hours and we work with your availability We pay on a per exam basis and you can be covered on our malpractice insurance policy The exams require nO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration Please contact Gia Melkus at (800) 260-1515 x5366 or email gmelkus@qtcm com or visit our website www qtcm com to learn more about our company

PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for be/bC primary care internist to join a privately owned, multi-specialty, physician practice Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments We can’t wait to introduce you to the communities that we love and serve Call Theresa Kwate at (509) 332-2517 ext 20 or email tkwate@palousemedical com Contact us today and discuss your future at Palouse Medical!

CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH - Octapharma Plasma is hiring a Contract back-Up Physician in our Spokane, Wa Donor Center! This position requires just 4 hours per month GeneRal DeSCRIPTIOn Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws We provide on-the-job training WHO IS OCTaPHaRMa PlaSMa? Octapharma Plasma, Inc is dedicated to improving the health and lives of people worldwide OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally learn more at www OctapharmaPlasma com apply today by sending your resume/CV to Careers@OctapharmaPlasma com!

FAMILY MEDICINE SPOKANE Immediate opening with family Medicine Spokane (fMS) for a full time bC/be fP physician who has a passion for teaching fMS is affiliated with the University of Washington School of Medicine We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer Ob and Sports Medicine fellowships This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices We offer a competitive salary, benefit package and gratifying lifestyle Please contact Diane borgwardt, administrative Director at (509) 459-0688 or e-mail at borgwaD@fammedspokane org

PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies for more information please contact: april Gleason, Director of business Development, (509) 390-6768, premierclincalresearch@gmail com

PROVIDENCE HEALTH & SERVICES is building its Urgent Care presence in Spokane We are recruiting for be/bC Urgent/Immediate Care physicians and advanced practice providers (nurse practitioners and physician assistants welcome to apply) This is a great opportunity to join a growing employed medical group in beautiful eastern Washington The exceptional Providence care team is implementing a system-wide standardized eHR and providers benefit from shared best practices and robust clinical and business support Providence already operates hospitals, residency programs and numerous primary care and specialty clinics in Spokane Competitive compensation and excellent benefits package, including relocation learn more: Mark Rearrick, Providence physician recruiter (509) 474-6605, mark rearrick@providence org, www providence org/physicianopportunities

SPRINGDALE COMMUNITY HEALTH CENTER aRnP or Pa-C n e Washington Health Programs (neWHP) has an immediate opportunity for an excellent Physician assistant (certified) or nurse Practitioner with family Practice experience to join our Springdale Community Health Center located in rural Springdale, Wa This position is for family Practice outpatient care; urgent care experience is a plus but not required neWHP offers competitive compensation, comprehensive benefits nHSC eligible site eOe and provider application Deadline: Until filled Send resume to: n e Washington Health Programs attn: Human Resources PO box 808 Chewelah, Wa 99109 or electronically to desirees@newhp org

PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS let us help you get started in earning additional professional income! We are an established I M e practice currently looking for active Practice and board Certified Orthopedic and neurological Doctors, to perform Workers Compensation exams located just minutes away from Rockwood Clinic in north Spokane, we offer a flexible schedule in a helpful, working environment Previous experience performing Workers Compensation exams is not required Please contact lorraine Stephens for further information at (509) 484-0380

EASTERN STATE HOSPITAL PSYCHIATRIST - eSH is recruiting for a psychiatrist Joint Commission accredited, CMS certified, state psychiatric hospital 287 beds Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants Contact Shirley Maike, (509) 565-4352, email maikeshi@dshs wa gov PO box 800, Medical lake, Wa 99022-0800

MEDICAL DOCTOR (MD/DO) (PRn openings in Spokane, Wa) Physicians needed to perform physicals and health screenings at a non-commercial medical facility MD/DO must have a current active, license from any state, available 1 to 3 mornings a week Send CV to or call: Gil: (210) 424-4008 meps@thi-terra com eOe





PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by alice Wasilwa Rn with two other Kenyan nurses and provides primary care Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct 18 – 28, 2012 If you would like to volunteer please contact Stacey Mainer at info@partneringforprogress org

NORTHWEST MEDICAL SPECIALTY EVALUATIONS - Physicians wanted for medical disability exams in our Spokane office excellent pay Work is low stress with minimal paperwork and no ongoing patient care responsibilities We can schedule around your availability seven days per week for more information call (509) 588-7340

Real eSTaTe

Luxury Condos for Rent/Purchase near Hospitals. 2 bedroom luxury Condos at the City View Terrace Condominiums are available for rent or purchase These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess) Security gate, covered carports, very secure and quiet newly Remodeled full appliances, including full-sized washer and dryer Wired for cable and phone for Rent $ 850/month for Sale: Seller financing available Rent-to-Own Option available: $400 of your monthly rent will credit towards your purchase price Please Contact Dr Taff (888) 930-3686 or dmist@inreach com

FOR SALE: 16909 n Triple butte Court, Colbert, Wa $789,000 beautiful home, custom built in 1996 by Copeland Design and Construction Situated on five wooded acres with two seasonal ponds and 220 feet of river frontage along the little Spokane River Idyllic country living but only 5 minutes from the Wandermere Shopping Center and only 10 - 15 minutes from Holy family Hospital There are 4 bedrooms, a library, a formal dining room, an open kitchen with eating area, great room, rec room, sun room, 2 full baths, a guest bath, mud room, laundry room, a 3-car attached garage and a greenhouse with fenced-in garden, covered front porch, large back deck with hot tub and a patio of cobblestones Views from the back deck look over the little Spokane River wetlands Call Dr edward Petruzzello at (509) 879-3770 no realtors please

MeDICal OffICeS/bUIlDInGS

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting building designed by nationally recognized architects both offices are corner suites with windows down six feet from the ceiling Generous parking Ten minutes from Sacred Heart or Deaconess Hospitals Phone (509) 535-1455 or (509) 768-5860

Clinical Space for Lease - built in January 2011 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc ), restroom, reception area and waiting room Rates are negotiable Interested parties contact Sharon Stephens at bates Drug Stores, Inc 3704 n nevada, (509) 489-4500 ext 213 or Sam@batesrx com

North Spokane Professional Building has several medical office suites for lease This 60,000 sf professional medical office building is located at n 5901 lidgerwood directly north of Holy family Hospital at the nWC of lidgerwood and Central avenue The building has various spaces available for lease from 635 to 6,306 usable square feet available The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways Other tenants in the building include pediatricians, dermatology, dentistry, pathology and pharmacy floor plans and marketing materials can be emailed upon request a Tenant Improvement allowance is available, subject to terms of lease Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc at (509) 624-6522 or cell (509) 999-2720 email: psrourke@comcast net

Office space located at 1315 north Division This location is two miles north of downtown Spokane and just west of Gonzaga and the university district It consists of 902 sq ft and rents for $1015 per month plus 20% of the building avista and City of Spokane bills The rest of the building is occupied by a physiatry and pain management medical practice The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic Parking is ample and convenient The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms Call (509) 321-2276 for more information or for a showing of your ideal location

Clinical Space for Lease 1602 square feet of office space for lease available 1/1/2013 Ground floor, adjacent parking with easy handicap access Ideally located midway between Providence Medical Center and Deaconess Medical Center at the corner of 5th and bernard Streets This space has been continually occupied by medical and medically-related tenants for over 20 years Reception and office configuration is ideal for immediate occupancy Call (509)710-5732 or (509)624-5121 for information

OTHeR

Ten (10) adjustable rolling physician stools, teal - $35 00 each, all in great condition for more information contact Colleen Kins at Internal Medicine Residency (509) 744-3965 or email Colleen Kins@Providence org

Went into partnership - no longer need the following items: CIRC bOaRD & ClaMPS Circumstraint circumcision board $50 Gomco circumcision clamps (sizes 1 1, 1 3, 1 45) $20ea size everything like new eKG & SPIROMeTeR - $200 Welchallyn, Schiller aT-10 eKG and Spirometer low use Maintained/inspected/serviced by Sacred Heart engineering Comes with 14 reams of additional paper, Spirometry calibration syringe and 50 disposable spirometry mouth pieces Original manuals included aUTOClaVe - $2000 Midmark, M9 UltraClave, Steam Sterilizer/autoclave low use, ideal condition Maintained/inspected/serviced by Sacred Heart engineering Comes with assortment of sterilization envelopes, sterilization wraps and confirmation tape along with 6 bottles of Speed-Clean, autoclave cleaning solution Original manual included all equipment located in Spokane Valley email shellymanson@comcast net for purchase, pictures and/or questions




The Walk Shoppe3707 S. Grand Blvd. Ste. ASpokane, Washington 99203509-747-2161

“The Stylish way to walk better”

Open Monday thru Friday10:00am-6:00pm10:00am-6:00pmSaturday10:00am-5pmClosed Sunday

Come shop with us, Spokane Medical Community!

We have a great selection of We have a great selection of Danskos!


SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING104 S FREYA ST STE 114SPOKANE, WA 99202

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Documents

The Message, January 2013