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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 4
The war on doctors
Banner to acquire UAHN
Tenet to acquire Ascension/CHN
Arizona: Grape
Canyon State
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Ofcial Publication of the Pima County Medical Society Vol. 47 No. 7
PrintingCommercial Printers, Inc.Phone: 623-4775
E-mail: [email protected]
PublisherPima County Medical Society5199 E. Farness Dr., Tucson, AZ 85712Phone: (520) 795-7985Fax: (520) 323-9559
Website: pimamedicalsociety.org
EditorStuart FaxonPhone: 883-0408
E-mail: [email protected] do not submit PDFs as editorial copy.
Art Director
Alene Randklev, Commerc ial Printers, Inc.Phone: 623-4775Fax: 622-8321E-mail: [email protected]
Pima County MedicalSociety Officers
PresidentTimothy Marshall, MD
President-ElectMelissa Levine, MD
Vice PresidentSteve Cohen, MD
Secretary-TreasurerGuruprasad Raju, MD
Past-PresidentCharles Katzenberg, MD
PCMS Board of DirectorsEric Barrett, MD
Diana Benenati, MD
Neil Clements, MD
Michael Connolly, DO
Michael Dean, MD
Howard Eisenberg, MD
Afshin Emami, MD
Randall Fehr, MD
Alton Hallum, MD
Evan Kligman, MDKevin Moynahan, MD
Soheila Nouri, MD
Wayne Peate, MD
Scott Weiss, MD
Leslie Willingham, MD
Gustavo Ortega, MD (Resident)
Snehal Patel, DO (Resident)
Joanna Holstein, DO (Resident)
Jeffrey Brown (Student)
Jamie Fleming (Student)
Members at Large
Donald Green, MD
Veronica Pimienta, MD
Board of Mediation
Timothy Fagan, MD
Thomas Grifn, MDGeorge Makol, MD
Mark Mecikalski, MD
Edward Schwager, MD
Arizona MedicalAssociation OfficersThomas Rothe, MD
immediate past president
Michael F. Hamant, MDsecretary
At Large ArMA BoardR. Screven Farmer, MD
Pima Directorsto ArMATimothy 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 2014, Pima CountyMedical Society. All rights reserved. Reproduction inwhole or in part without permission is prohibited.
SOMBRERO
Executive DirectorBill FearneyhoughPhone: 795-7985
Fax: 323-9559E-mail: [email protected]
AdvertisingPhone: 795-7985Fax: 323-9559E-mail: [email protected]
Madeline Friedman ABR, CRS, GRI Vice President
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On the Cover
Sonoita Vineyards and Winery south of Elgin, founded by Gordon
Du in 1983, began statewide development of Arizona as a
locale for quality wineries and product. Gordon is sll acve in
management. For your virtual tour of the Grape Canyon State,
see this issues Behind the Lens (Dr. Hal Tretbar photo).
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5 Leers: Drug war is really pain paent war.
6 Dr. Timothy Marshall: Our president knowswhen enough enforcement becomes toomuch.
8 Milestones: Recognions and achievementsof our members.
12 Mix At Six: Members and student membersmeet informally.
14 Behind the Lens: Dr. Hal Tretbar andDorothy tour and sample Arizona wineriesand wines.
17 PCMS News: If rising healthcare costs neverhit a ceiling, will big local healthcare
organizaon buyouts change anything?
24 Arizona Medical Associaon News: Dr. TomRothes year as ArMA president, plus annualmeeng report.
26 CME: Pima County Medical Foundaon hasyour most-local credits.
SOMBREROP i m a C o u n t y M e d i c a l S o c i e t y
HomeMedical Society ofthe 17th United States Surgeon-General
A U G U S T / S E P T E M B E R 2 0 1 4
The war o n doc tors
Banner to acquire UAHN
Tenet to ac quir e Ascens ion/ CHN
Arizona: Grape
Canyon State
Inside
8/11/2019 Aug-Sept 2014 Sombrero
5/28SOMBRERO August/September 2014 5
Leers
Pain patients casualtiesof War on DrugsTo the Editor:
The acons of the Drug Enforcement Administraon to eliminatediversion of Oxycodone is working to decrease its legimatemanufacture and availability in pharmacies. It has become dicultfor paents to ll their prescripons for appropriate use as well asfor the one to two percent who dont use them appropriately.
Paents have been forced to go to mulple pharmacies because
of the limited supply. They are oen turned away by pharmacistswho are fearful to dispense, having been inmidated by the DEA.Oen their poorly substanated raonale is the paent does nott their good faith dispensing prole.
The paradox is that Oxycodone is aordable (covered by AHCCCS),
an eecve pain reliever with few side eects,* but at the sameme the easily crushable favorite of abusers. Besides, not beingable to obtain a medicaon which may have worked well forthem to increase their funcon in the past, paents faceprejudice from poorly informed friends, families, and healthprofessionals. All this adds to the chronic pain and disabilitywhich brought them to seek treatment in the rst place.
There is also the irony that government acons have doubledthe street price of Oxycodone. Overdoses seen in our ERs arenow more frequently from black tar heroin. The prot for theblack market has also been aided by the threats and acons thathave frightened o medically licensed competors who mightconsider prescribing.
These acons have been eecve strategies to create negave
publicity and misinformaon for not only the medical professions,
but for policians and the public. The oen-quoted stasc, thatanyone who dies and has an opiate in their blood is counted as a
opiate death no maer what other disease they may have ormedicaons they may take, fuels the re with sciencmisinformaon.
The visibility and somemes budgets of state medical boards, theJusce Department, local police, the militarized border patrol,the prison industry, and the courts have increased. This is areecon of polical and public senment that paents on drugsmust be abusers and physicians who prescribe them drugpushers. Both are seen as making a prot and being a threat totaxpayers who feel, I dont need those drugs, why do they?Maricopa County Sheri Joe Arpaio, on the other hand, has been
reported to sayand which was reported to be echoed by PimaCounty Aorney Barbara LaWallthat we need prescribed
medicaon for pain paents or theyll become their clients.
We advise our paents to act to protect their legimate access tothe appropriate use of prescribed controlled medicaons. Theyare the real vicms of these confused policies. We suggest rst,that they call on their federal representaves to re-examine DEAsmarching orders and state licensing boards. Second, that theyexplain that they are not diverters or addicts, but rather thatcontrolled medicaon allows them to beer funcon. Third, thatthey record their experiences at pharmacies and with physiciansand complain when they are treated with prejudice anddisrespect. Fourth, that they parcipate, in their own self-
interest, in a community watch to idenfy those who aremisusing these medicaons, so that they may either be treatedfor their problems or eliminated from their unintendedconsequence of their acons that upend prescribers pracces.
Developing beer approaches to these issues of prescripon and
non-prescripon medicaon and drug abuse, decreasing theneed for and expense of more prisons for paents and non-paents (and for more Suburbans for those who ght the war),depends on evoluon of public understanding and our law. Theissues for educaon include:
That these medicaons provide legimate pain relief to manywho have a legal right to access to them via the AmericansWith Disabilies Act;
that misuse becomes less socially acceptable and tolerated bya society that is willing to recognize regulated access tomedicaon and treatment;
and that physicians are in the best posion and have aresponsibility to lead this process.
*Oxyconn is costly and its new non-crushable formulaon isdicult for many to digest. Connent or Morphine ER causesintolerable side eects for many. The Fentanyl Patch causesirritaon for many and is costly as is the long-acng Hydrocodone.Aordable Methadone has the potenal for arrythmias as well as
other undesirable features especially when used in combinaonwith other opiates.
Sincerely
David A. Ruben, M.D., M.B.A
Dr. Ruben is a diplomate in adult and child psychiatry, addicon,
and pain medicine. He writes and speaks on issues of medical
pracce and consults with lawyers and doctors on regulatory
interacons. He can be reached at [email protected] n
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Suttons Law and the war against doctorsBy Timothy Marshall, M.D.
PCMS President
Why is it that every me I
order home oxygen for a
paent I need to sign a form
that threatens me with criminal
liability? Can I actually go to jail
for prescribing someone oxygen?It seems the answer is yes.
When asked why he robbed
banks, bank robber Willie Suon replied, Because thats where
the money is. Federal aorneys are aggressively prosecung
physicians for the same reason. They think thats where the
money is. My argument is that only part of the soluon to the
high cost of healthcare lies with prevenng fraud. The fact that
this administraon does nothing to allow tort reform, has
reduced the burden of proof necessary to convict physicians for
fraud, while piling on regulaons, the burden of EHR, ICD 10,PQRI, it all amounts to a war against physicians.
According to the FBI, Roong out healthcare fraud is central to
the well-being of both our cizens and the overall economy.
Healthcare fraud costs the country an esmated $80 billion ayear. And its a rising threat, with naonal healthcare spending
topping $2.7 trillion and expenses connuing to outpace
inaon. Recent cases also show that medical professionals are
more willing to risk paent harm in their schemes. [FBI.gov] Thegovernments healthcare fraud prevenon and enforcement
eorts recovered a record $4.2 billion in taxpayer dollars in Fiscal
Year 2012. This is a result of President Obama making the
eliminaon of fraud, waste, and abuse, parcularly in healthcare,
a top priority for the administraon.1
Im sure all physicians would agree with prosecung cases of
actual premeditated fraud, such as performing bypass gra
surgery in the absence of coronary disease, or providing home
healthcare for paents who dont exist, is very reasonable andnecessary. We do not, however, want to be persecuted, or
prosecuted, for praccing medicine to the best of our ability in
good faith.
Aer researching this arcle I have discovered that any of us
could be jailed for a coding error! Congress has created new
crimes specically addressing healthcare fraud. Under this
statute, any healthcare provider who presents a false or cous
claim or demand to the government, seeking reimbursement formedical goods or services, can be liable. The long-standingrequirement of proof of criminal intent in connecon with the
federal prosecuon of physicians has been eliminated. The False
Claims Act may be applied to physicians providing services that
were not provided, or were not medically necessary. Thepunishment for a criminal convicon under the act is up to ve
years imprisonment and a ne of $250,000.00 for each
infracon. Civil penales can be up to $11,000 per incident, plus
three mes the amount claimed.
A connuing example is the case of Dr. John Natale, a cardiovascularsurgeon who spent 10 months in a federal prison even though
the jury found him not guilty on all fraud charges. But he was
convicted on two counts of making false statements in his
operave reports. The term false statement suggests a
deliberate lie, but it could be a simple mistake. The prosecutor
does not need to prove that a doctor knowingly and willfully
lied in order to pad his fee, but only to show that an incorrect
AMA code or incorrect descripon to an incorrect AMA code was
used and that the doctor intended to get paid for his work. The
implicaons of the case are profound, the judge noted: Any error
in any medical record related to a health program could be a
federal crime. And just when you think coding errors are geng a
lile out of hand, the government imposes ICD 10.
Are there other ways to save money in healthcare? Lets look at
malpracce reform and defensive medicine. Defensive medicine
refers to the pracce of recommending a diagnosc test or
treatment that mainly serves to protect the physician against the
paent as potenal plain. Defensive medicine is said to be areacon to the rising costs of malpracce insurance premiums. I
dont pracce defensive medicine because my insurance
premiums rise. I pracce defensive medicine because one lawsuitcould erase 30 years of hard work, take away all my assets, my
home, and my future.
As youd expect, the medical literature and the trial lawyers have
a very dierent take on the extent of defensive medicine. Clearly
accurate measurement of defensive medicine is extremelydicult. A survey of 300 physicians found that more than 76
percent of the physicians responded that malpracce ligaon
had hurt their ability to provide quality care to paents. Because
of their fear of the excesses of the ligaon system:
79 percent said they had ordered more tests than they would
have based only on professional judgment.
74 percent had referred paents to specialists more oen
than they believed was medically necessary.51 percent had recommended invasive procedures such as
biopsies to conrm diagnoses more oen than they believed
were medically necessary.
41 percent said they had prescribed more medicaons, such
as anbiocs, than they would have based only on theirprofessional judgment, and 73 percent had noced other
doctors prescribing medicaons similarly.
The American Associaon for Jusce (Formerly Associaon of
Trial Lawyers of America) not surprisingly has a dierent opinion:To the extent that defensive medicine does exist, research hasfound that the movaon behind it is not liability but rather a
desire to simply help a paent or, in some cases, boost physician
income. One government agency found that doctors chose not to
order any tests or diagnosc procedures 95 percent of the me.
Doctors who ordered tests almost always did so because of
medical indicaons, and only one half of one percent of all cases
involved doctors who ordered tests due solely to medical
negligence concerns. Of all the diagnosc tests I order here inTucson that I would not have done in Canada, I can tell you its far
greater than half of one percent! In my opinion the lawyers
asseron is ludicrous.
8/11/2019 Aug-Sept 2014 Sombrero
7/28SOMBRERO August/September 2014 7
How much does defensive medicine cost? Not surprisingly, thetrue cost of defensive medicine is hard to discern. Kessler andMcClellan noted that limits on noneconomic damage awards,
such as those California has had in eect for 25 years, can reducehealthcare costs by between 5 percent and 9 percent withoutsubstanal eects on mortality or medical complicaons.Applying non-economic damage limits to the country as a whole,
with its naonal healthcare expenditure of $1.4 trillion, wouldreduce healthcare costs by as much as $126 billion, and reducethe federal governments share of such costs by as much as $50
billion, according to McClellans 2003 esmate. Imagine what wecould save based upon more recent healthcare expenseesmates. These cost savings would be dwarfed by what we couldactually achieve by removing defensive medicine altogether.
So it would stand to reason that if you want to reduce healthcare
cost, all aspects would be implemented, not just those that
protect your elecon donors. The criminalizaon of medicine has
to be stopped. The governments burden of proof requirement of
criminal intent must be reinstuted. Criminalizing speech,
without requiring proof of intent to defraud, creates a new risk of
imprisonment for anyone who is less than perfect in what he or
she documents or codes.
Some of these nancial numbers and references may be old, butare useful for illustraon. The more I researched for this arcle, themore I felt as Hamlet, besieged by the slings and arrows of our
outrageous government, jusce system, and malpracce aorneys.
The war on physicians is fully underway on many levels. Watch
your coding!
REFERENCES
1. U.S. Department of Jusce. Departments of Jusce and Health and HumanServices Announce Record-Breaking Recoveries Resulng from Joint Eorts toCombat Health Care Fraud, Department of Jusce. Oce of Public Aairs, Feb 11,2013.
2. Hellinger FJ, Encinosa WE. The Impact of State Laws Liming MalpracceDamage Awards on Health Care Expenditures.Am J Public Health2006
Aug;96(8):1375-81.3. Kessler D, McClellan M. Do Doctors Pracce Defensive Medicine? Quarterly
Journal of Economics1996; 111(2): 353-390.
4. Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volale malpracce environment.JAMA2005 Jun1;293(21):2609-17.
5. U.S Congress, Congressional Budget Oce, The Economics of U.S. TortLiability: A Primer. Washington, DC: US Government Prinng Oce Oct 2003.
6. U.S Congress, Congressional Budget Oce, Medical Malpracce Tort Limitsand Health Care Spending. Washington, DC: US Government Prinng Oce, April2006.
7. The Factors Fueling Rising Healthcare Costs. Prepared for Americas HealthInsurance Plans. Price Waterhouse Cooper, Americas Health Insurance Plans, 2006.
8. U.S. Department of Jusce. Departments of Jusce and Health and HumanServices Announce Record-Breaking Recoveries Resulng from Joint Eorts to
Combat Health Care Fraud. Oce of Public Aairs, Feb 11, 2013. 9. Hellinger FJ, Encinosa, WE. The Impact of State Laws Liming MalpracceDamage Awards on Health Care Expenditures.Am J Public Health2006Aug;96(8):1375-81.
10. Kessler D. McClellan M. Do Doctors Pracce Defensive Medicine? QuarterlyJournal of Economics1996; 111(2): 353-390.
11. Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volale malpracce environment.JAMA2005 Jun1;293(21):2609-17.
12. U.S Congress, Congressional Budget Oce, The Economics of U.S. TortLiability: A Primer. Washington, DC: US Government Prinng Oce Oct 2003.
13. U.S Congress, Congressional Budget Oce, Medical Malpracce Tort Limits andHealth Care Spending. Washington, DC: US Government Prinng Oce, April 2006.
14. The Factors Fueling Rising Healthcare Costs. Prepared for Americas Health
Insurance Plans, Price Waterhouse Cooper. Americas Health Insurance Plans, 2006.n
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Milestones
Dr. Lavor reresDear friends and colleagues,
Dr. Michael Lavorwrote in
July, it is with mixed
emoons that I write to tell
you of my future plans.
Aer more than 23 years as a
surgeon, I will be rering from
acve surgical pracce. I will,
however, be connuing as
Saguaro Surgicals medical
director. In addion, I will be
connuing as medical director
at The Wound Center where,
through state-of-the-art
treatments, we remain available to provide specialized therapy
for chronic or non-healing wounds.
First and foremost, I want to assure you that each member of
the Saguaro Surgical medical team remains strong, commied
to excellence, and able to oer your paents the full range of
general and vascular surgical services youve come to expect.
In a few weeks Saguaro
Surgical welcomes the newest
general surgeon to our team,
Dawn Ellio, M.D., a nave of
Arizona who received her M.D.
at The University of Arizona.
Dr. Ellio, along with Saguaro
Surgicals four other surgeons,will connue to meet all the
surgical needs of your paents.
Our sta remains commied to
assisng your oce and making
certain you receive detailed
updates on each paent you trust to our care. As medical director I
will focus not only on assuring our high medical standards are
maintained, but also that all of the latest technologies and services
are available here for you and your paents.
I have valued our relaonship as medical colleagues and feel
both fortunate and grateful to have had the opportunity tomeet your paents surgical needs over the years. I sincerely
hope you will develop new and strong relaonships with my
colleagues at Saguaro Surgical, allowing us to connue to
provide general and vascular surgical care for your paents
even aer I step back from my role as a surgeon.
Although I will, obviously, remain acve in our community, my
rerement from acve pracce as a surgeon is something to be
noted and for my wife, Irene, and mesomething to celebrate.
Sincerely,
Michael Lavor, M.D., Saguaro Surgical
Dr. Lavor is an Ohioan born in 1949. He earned his M.D. in 1985
at University of New Mexico Medical School. He interned at
University of Chicagos Michael Reese Hospital, and did his
residency and chief year at University of Illinois Metropolitan
Group Hospitals, Chicago. He was a U.S. Navy Corpsman with
the Marines 1967-69. He is American Board of Surgery
cered.
Dr. Ellio earned her bachelors degree in microbiology at NAU,
and then her M.D. at The University of Arizona College of
Medicine, with a post-sophomore Fellowship in pathology. She
did her GS residency and internship with Grand Rapids (Mich.)
Medical Educaon Partners at Spectrum Health and Mercy
Health hospitals.
She has a special interest in complex hernia repair and advanced
laparoscopy including inguinal and ventral hernia repair, an-
refulx procedures, hiatal and paraesophageal hernis repair,
splenectomy, adrenalectomy, and colectomy.
Physiatry Associates
adds Dr. Lipson Physiatry Associates, Ltd.Recently announced that the
pracce is pleased to have
added Nancy Lipson, M.D.
She joins Charles Blake, M.D.,
John Larson, M.D., and
Michael Goodman, D.O. at the
pracce at 2102 N. Country
Club Rd. Building B.
Dr. Lipson graduated from
Wayne State University School
of Medicine in Detroit, andcompleted her PM&R residency
at The Ohio State University. She pracced for 25 years in
Indianapolis, Ind. before moving to Tucson in June 2014.
Dr. Lipson has experse in all areas of general rehabilitaon, and
is subspecialty board-cered in Spinal Cord Injury Medicine. She
is currently accepng new paents.
Chicanos Por La Causa honorsDr. Lpez
Ana Maria Lpez, M.D., M.P.H.,F.A.C.P., medical director of the
Arizona Telemedicine Program,
professor of medicine and
pathology at The University of
Arizona College of Medicine
Tucson, and member of
University of Arizona Cancer
Center, was one of three
women recently honored for
being a cornerstone of our
community by Chicanos Por La
Causa (CPLC) at its 34th Annual
8/11/2019 Aug-Sept 2014 Sombrero
9/28SOMBRERO August/September 2014 9
Southern Arizona Dinner celebraon, The Art of Being a
Woman.
An internaonally recognized oncologist, Dr. Lpezs work focuses
on paent-centered care of women with cancer that includes the
family and community, and on enhancing equity and access to
healthcare through innovave technology. She also is a leader in
addressing disparies and diversity in the health professions. She is
a principal invesgator for several breast and ovarian cancer clinical
trials focused on quality-of-life care and innovave treatments.
A nave of La Paz, Bolivia, she holds a bachelors degree in
philosophy from Bryn Mawr (Pa.) College; a medical degree from
Jeerson Medical College, Philadelphia; and a masters in public
health with a concentraon in health administraon and policy
from the UA Mel and Enid Zuckerman College of Public Health.
Dr. Doraiswamy joins UACollege of Medicine
Dr. Vijay A. Doraiswamy, a
resident member of PCMS, is
one of the UofA Cardiology
Fellows preparing for the next
phase of their careers, the
university reports.
In June UofA Sarver Heart
Center celebrated graduaon
of ve Fellows from the
Cardiovascular Medicine
Fellowship
Program,
and two
from the
Intervenonal Cardiology Fellowship
Program. Dr. Doraiswamy is joining the UA
College of Medicine, Division of Cardiology
as an assistant professor, primarily praccing
at UA Medical CenterSouth Campus.
Dr. Fodeman 2014Claremont LincolnFellowThe Claremont Instute, a center for polical
philosophy and statesmanship dedicated to
recovering the American idea, reported inJune that it had named Dr. Jason Fodeman
as a 2014 Lincoln Fellow.
An occasionalSombrerocolumnist, Dr.
Fodeman is a board-cered IM physician
and currently an Assistant Professor of
Medicine at The University of Arizona, and
medical director of the University of Arizona
Medical Center Home Health.
He previously studied as an adjunct scholar
at the James Madison Instute. During his
residency at Cedars Sinai
Medical Center, he was a
Senior Fellow in Health Care
Studies at Pacic Research
Instute, and president of the
Docs4PaentCare California
Chapter. He has completed a
Graduate Health Policy
Fellowship at the Heritage
Foundaon.In addion to these pages his
work has appeared in
the Washington
Examiner,Arizona
Republic, Naonal Review Online, and The Washington Times. He
is studying for an M.B.A. at the UofA. He holds an M.D. from
Albert Einstein College of Medicine at Yeshiva University, and a
B.A. in economics from The Johns Hopkins University.
Carondelet St. Marys,
St. Josephs awardedfor stroke careBeing honored for providing excellent care is the best
recognion a hospital can get, Carondelet Health Network says,
and Carondelets Tucson hospitals connue to receive valuable
recognion each year from the American Heart Associaon/
American Stroke Associaon.
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512 E Whitehouse Canyon Rd, Ste 196Green ValleyHelping you hear your best.
8/11/2019 Aug-Sept 2014 Sombrero
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The Get With The Guidelines Stroke Gold Plus Quality
Achievement Award was recently bestowed on St. Marys
Hospital for the third consecuve year, and St. Josephs Hospital,
home of Carondelet Neurological Instute, for the fourth
consecuve year.
The two hospitals, both Joint Commission-cered Primary Stroke
Centers, also earned the Target: Stroke Honor Roll Award for the
third consecuve year. Both awards are historically given to the
highest performing Stroke Centers in the country. These awards
recognize Carondelet hospitals commitment to exceponal carefor their stroke paents by the adherence to the latest evidence-
based guidelines based on the latest scienc research.
Guidelines were established by AHA/ASA in 2003 and were
designed to improve stroke care by promong consistent
adherence to the latest scienc treatment guidelines,
according to AHA/ASA. Parcipang hospitals enroll in the
program and submit data through a Web-based Paent
Management Tool provided by AHA/ASA, which is then
evaluated to determine both the hospitals baseline and
improvements. Hospitals receive these quality awards based on
adherence to the quality metrics for a designated me.
Carondelet Tucson hospitals have received the Gold Plus andTarget Stroke Honor Roll recognion for their ongoing focus on
quality stroke care.
College of Medicinewelcomes 2018 classThe University of Arizona College of MedicineTucson welcomed
its newest class of medical students with free iPads and three-
days of community-building acvies beginning July 30, the
university reported. One hundred een students began three
days of orientaon on their four-year, hands-on training
commitment to learn leading-edge paent care under the
mentorship of disnguished clinician-educators at the University
of Arizona College of MedicineTucson.
Students were welcomed by campus leaders including Joe G.N.
Skip Garcia, M.D., UA senior vice president for health sciences
and interim dean of the UA College of MedicineTucson;
Francisco Moreno, M.D.,deputy dean for diversity and inclusionand professor of psychiatry; and Kevin Moynahan, M.D., deputy
dean for educaon, director of the UA College of Medicine
Tucson Sociees Program and associate professor of medicine.
Included was a community service-learning day, during which
the medical students will volunteer with local community
organizaons to build a sense of community and to gain an
understanding of some of the social issues the Tucson
community faces.
The goal of orientaon the university says, is to develop a
sense of professional identy, community and collegiality among
a diverse group of future physicians. The College of Medicine
Tucson Class of 2018 includes 33 students who graduated from
the UA, 40 percent of the students are Arizona residents, 25 hold
graduate or professional degrees, a lile more than half are
female and two are student-veterans. n
8/11/2019 Aug-Sept 2014 Sombrero
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Society welcomes students, interns at Mix
Mix At Six
By Dennis Carey
P
CMS had its latest a Mix At Six social July 25 at La Paloma
Country Clubs 19 thHole, with former PCMS and ArMA
President Thomas, Rothe, M.D., serving as host.
Society members welcomed several medical students and interns
to the local medical community, providing an opportunity for
them to meet praccing physicians and other students in an
informal seng.
Students and interns have been very enthusiasc about the Mix
Dr. Basil Skeif and his wife,Allison, and Dr. Ken Sandock enjoyrefreshments and conversation inMix At Sixs relaxed atmosphere.
Former PCMS presidents MichaelHamant, M.D. and Timothy Fagan,M.D. sample the guacamole andappetizers while relaxing at LaPaloma Country Clubs 19th Hole.
New PCMS student members SeanBehan, Edwin Telemei and Jack Rusingenjoy their frst Mix At Six social.
New PCMS student members Pooja Rajguru, CarolynSleeth, Jared Brock and Joelle Wang were amongMix At Sixs early arrivals.
Dr. Steve Cohen and med student JeffBrown fll out nametags at the mix.
At Six events, PCMS Execuve Director Bill Fearneyhough said.
Its a great opportunity for them to network with colleagues and
introduce themselves to praccing physicians. We look forward to
their parcipaon in the Society, and in the medical community.
More Mix At Sixes will be given throughout the year. Watch for
noces of coming events here in Sombrero, on the Society
website pimamedicalsociety.org, and in e-mail. As the clich
goes, be there or be square! n
8/11/2019 Aug-Sept 2014 Sombrero
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Arizona: Grape Canyon StateBy Hal Tretbar, M.D.
Behind the Lens
A
rizona is beginning to be
recognized for the newines coming from our
wineries. It all started in the
Sonoita-Elgin area when UofA
professor Gordon Du
recognized that soil and
weather condions were similar to noted French Burgundy
vineyards. More recently excellent vineyards have become
established in Santa Cruz, Cochise, and Graham counes.
Where there are vineyards there are wineries. In the Elgin regiontwo of the oldmers, Dus Sonoita Vineyards (1983) and
Callaghan Vineyards (1990), have had their best served in the
White House on numerous presidenal occasions.
Then it was determined that the Verde Valley along lower OakCreek south of Sedona near Cornville has the climate and soil
similar to the Rhone region of Southern France. Mediterranean
and Spanish varietals such as Mourverde, Roussanne, Grenache,
Syrah, Viognier, and Connoise now ourish there.
Recently Dorothy and I drove the Verde Valley Wine Trail. If youstart from Sedona, go south 12 miles on 89A and turn le of Page
Springs Road. If you are coming o of Interstate 17, turn west at
exit 293. Go 9 miles to Cornville to reach Page Springs Road, and
3.5 miles in either direcon brings you to three of the vewineries in the Verde Valley. Oak Creek, Javelina Leap, and Page
Springs Cellars are just down the road from each other. Echo
Canyon is near Sedona, while Alcantara is closer to Camp Verde.I certainly am not a wine connoisseur; maybe a someme
acionado. We watched a family friend give up his hobby storebusiness in Tucson to become a vintner. Robert Bob Webb was
a pioneer in Cochise County when he planted 20 acres of
Cabernet Sauvignon, Merlot, and Riesling, at Kansas Selement
in1983. This was at the at thesame me Gordon Du
started in Santa Cruz County.
Bob built the nice
Mediterranean- style
R.W.Webb Winery on I-10
just east of Tucson. In spite
of quality wines, the wineryfailed because of manage-
ment problems, poor locaon,and lack of ambience.
I was in a limited partnership
for Terra Rosa Vineyards,
located a few miles west of
Elgin. We planted 20 acres of
Merlot and other popular
varietals. Aer four years ofincreasing producon and
some excellent vintages, we
were wiped out by Pierce disease, transmied by the glassy-
winged leaopper. As oen happens with limited partnerships,
there was insucient funding to replant.
In spite of aging tastebuds and possibly early anosmia (loss of smel
ability), I sll enjoy stopping at tasng rooms to chat with the localsand sip what they are passionate about. I tend to go with the
whites because my cardiologist said red wine might aggravate an
arrhythmia. I can tell you what appeals to my taste, but I cantdepict it as a Chenin Blanc has been described at Javelina Leap.There are honeysuckle aromas followed by layers of apple, honeymango, and pineapple with hints of buerscotch and lemon curd.
There was acvity in the yard next to the Javelina Leap Vineyard
entrance when we stopped by in mid-August.
A forkli was moving large
empty plasc containers and
the driver said, We are aboutready to harvest, and the crush
should be good this year.
Annie Jones was behind the
bar in the tasng room and
gave us the vineyard historyas we tasted several
varietals. Rod, a chef, and
Cynthia Snapp started from
the ground up nine years ago
and have been open for eight
years. They have developed
a number of outstanding
varietals including a pinkPinot Grigio, Chenin Blanc,
and a Tempranillo. Most of
the grapes are from 20 acres
Tasting Room Associate Tim Godin at Page Springs Cellars isready to pour a splash of a Rhone Valley-type blend.
At the Javelina Leap tasting room, Annie Jones says that a Zinfandelwould go well with the pizza snack.
8/11/2019 Aug-Sept 2014 Sombrero
15/28SOMBRERO August/September 2014 15
in the Verde and Skull valleys.
Javelina Leap has become well known for its
Zinfandels. Their 2012 AZ Zinfandel comes
from their Dragoon Vineyard. The 2012 Estate
Legacy Zinfandel is from the 4.5 acres ofseven-year-old vines outside the front door.
They oer only one blend, made with Arizona
Zinfandel, Merlot, and Pete Sirah.
The Page Springs Cellars tasng room wasbusy with a hum of relaxed conversaon.
Beyond the sunlit room with its tradional
bar and wine bole racks was an inving
alcove. Subdued lighng and so musictempts one to sink into a so leather sofa and
linger over a glass of wine.
We chose to have a Flight that combined both
reds and whites. A Flight gives you a chance totry four or ve of the winerys favorites, usually
all red, white, or specialty. A splash of each can
be snied and rolled on the tongue for about $8
to $10. Tim Godin was our very knowledgeable
Tasng Room associate. Some that we chose tosample were the Rhone style 2011 La Serrana
($26), the 2012 Arizona Chardonnay ($24) and a
red 2012 El Serrano ($32).
The Serrana is a pleasant blend of 75 percent
Viognier and 25 percent Roussanne from theStronghold vineyard at Kansas Selement.
The Chardonnay was fresh and spirited. It is 100 percent varietal,
combining Chardonnay grapes from both Bonita Springs and
Arizona Stronghold. Dorothy enjoyed the Serrano, the agship
blend from Page Springs Cellars. This is their 10thyear of blending42 percent Mourvedre, 41 percent Syrah and 17 percent PeteSirah, all from Arizona.
The owner, inspiraon, driving force, and vintner for the cellars is
Eric Glomski, who comes from a California winemaking
background. He briey worked at Echo Canyon Winery before aprime property became available on Oak Creek near Cornville.
The rst vines were planted in 2004, and Eric planned to have a
small bouque aair.
In 2007 he partnered with Maynard James Keenan, a well-known
rock singer who came from an Italian winemaking family.
Together that had big plans. They wanted to put the best wines at
a fair price all across the country. They bought the 80-acre Dos
Cabezas vineyard at Kansas Selement from Don Buel. Don had
expanded the original 20 acres planted by Bob Webb. Theyrenamed it Arizona Stronghold. Later they added the Bonita
Springs Vineyard 20 miles north of Wilcox. The Stronghold winery
is in Camp Verde and the tasng room is in Coonwood.
Aer an intense cross-country tour and adversing campaign,
they were ready to sell in 38 states as well as in Canada, Australia,and New Zealand. In 2012 Arizona Stronghold produced 12,000
cases of wine.
Soon there was a clash of personalies and in the spring of this
year the divorce happened. TheArizona Republicreported onMay 12, 2014 that Keenan would take possession of theStronghold vineyard in Kansas Selement and change the name
Danielle and Barry of Gilbert enjoy the cool Page SpringsCellars Vineyard.
8/11/2019 Aug-Sept 2014 Sombrero
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8/11/2019 Aug-Sept 2014 Sombrero
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PCMS News
Sellout Summer?Buyout Binge?Within a month of each other, two large local healthcare
organizaons, that reportedly lost more than $30 million each
last year, made agreements to be fully or partly bought.In June, University of Arizona Health Network and Banner Health
entered what they called a long-term agreement.
In July, Ascension (formerly Ascension Health) and Carondelet
Health Network signed a leer of intent to form a partnership
with Tenet Healthcare and Dignity Health, exploring a joint
venture that would aquire Carondelet.
UAHN, Banner
In announcing the move, UAHN and Phoenix-based Banner
Health called it an historic eort to create a statewide
organizaon to transform and advance healthcare in Arizona.
The university press release called plans a comprehensive new
model for academic medicine. This ground-breaking agreement
will formalize discussions and is intended to lead to nal
denive agreements someme in Fall.
The proposed transacon is ancipated to generate
approximately $1 billion in new capital, academic investments,
and other consideraon and value benecial to UA and the
community, the university reported. The ancipated transion
of 6,300 employees working at UAHNs two hospitals, the health
plan, and the medical group into Banner will create Arizonas
largest private employer with more than 37,000 employees.
The acon followed votes from the UAHN and Banner boards ofdirectors in support of proceeding with negoaons, as well as a
vote by the Arizona Board of Regents (ABOR) to authorize the
UofA to also move forward with UAHN and Banner. The pares
will now work together towards nal denive agreements,
ancipated to be completed and signed in September. The
denive agreements must also be approved by ABOR and the
boards of directors of UAHN and Banner. The proposed
transacon is expected to close a few months following the
signing of the denive agreements.
They stated these proposed key transion elements:
To create an Arizona-based, statewide health system that
improves care for all the states cizens by reliably and
compassionately delivering superior care to all who turn to this
system;
To create a naonally leading health system that provides
beer care and improved paent and member experiences at
lower costs through valued-based or accountable care
organizaons that ulize populaon health management models
that emphasize wellness;
To expand University of Arizona Medical Center capabilies
for complex academic/clinical programs such as transplantaons,
neurosciences, genomics-driven precision health, geriatrics, and
pediatrics while providing for investment opportunies in other
areas;
To bolster scal sustainability, eliminang persistent shorall
and low operang margins currently experienced by UAHN.
In addion to solving the immediate nancial needs, they said,
the proposed agreement will:
Eliminate the debt burdening UAHN (currently projected to
be $146 million);
Provide resources for improved hospital infrastructure,
including the $21 million purchase of land currently leased to
UAMC and $500 million within ve years to expand and renovate
the medical center, and build new facilies as appropriate, suchas a major, mul-specialty outpaent center to be constructed in
Tucson;
Create a $300 million endowment which will provide a
$20-million-per-year revenue stream to advance the UAs clinical
and translaonal research mission;
Preserve historic funding levels between the clinical and
academic partners in addion to a $20 million per year
enhancement;
Allow addional funding support based on growth in
revenues generated by the clinical and academic partnership;
Improve operaonal eciencies;
Secure and sustain a lasng relaonship with, and
commitment to, the University of Arizona, anchored by an
Academic Division within Banner. The Academic Medical Centers:
The University of Arizona Medical CenterUniversity and South
Campuses and Banner Good Samaritan Medical Center and the
faculty pracce plan, will support the growing needs of the
Colleges of Medicine in Phoenix and Tucson and create a value-
based delivery system;
The Phoenix and Tucson academic medical centers will be
infused with operaonal strength through the proposed
transion and rapidly evolve into major economic drivers that wil
aract highly skilled, trained and paid professionals, elevang
Arizona as a bioscience desnaon;
Train more physician specialists and allied healthprofessionals, including pharmacists and advanced pracce
nurses for Arizona;
Provide a comprehensive plaorm for the development of
physician-sciensts who will drive discovery across basic science
studies, paent-oriented clinical research, health services
research, and populaon health;
Enhance and elevate academic medical excellence across
Arizona to naonal leadership levels; and
Secure and sustain an operaonal foundaon for the College
of Medicine in Tucson and Phoenix that will maximize the value
of the ongoing state funding received annually through legislave
appropriaons.
When these respected organizaons unite, the potenal for
delivering top-er academic medicine throughout the state,
recognized naonally, becomes a reality, UAHN Board Chairman
Steve Lynn said.
Added UAHN President and CEO Michael Waldrum, M.D., Im
especially pleased that this proposed transion will infuse
stability and energy into our organizaon. This will benet our
paents, faculty, sta and students as we pursue excellence.
Ulmately, were moving from a situaon in which we can only
maintain status quo, to a situaon in which we can create a
premier Academic Medical Center.
8/11/2019 Aug-Sept 2014 Sombrero
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With healthcare here in Arizona and across the naon facing
new challenges and opportunies every day, this agreement will
allow the Arizona Health Sciences Center and the enre UA to
advance our mission to provide educaon, conduct research and
enhance paent care that will transform healthcare at the state
and naonal level, said UofA President Ann Weaver Hart.
Combining the world-class care at UAHN and Banner will beer
meet the needs of paents in Arizona and throughout the region,
while also providing tremendous learning experiences for
students at the University of Arizona. By forming thiscollaboraon we will accomplish more for Arizonas residents and
for the advancement of medical knowledge and pracce than we
could do in isolaon.
Added Banner Presidient and CEO Peter S. Fine, Were honored
that the UAHN Board of Directors strategically sought Banner to
create Arizonas rst statewide health system to help strengthen
medical educaon. Banners vision is to sustain a posion of
naonal leadership. This opportunity to join with a premier
academic organizaon signicantly advances Banner towards this
vision. In addion, were especially mindful of UAHNs legacy of
excellence in Tucson and throughout the state, which must be
maintained, nourished and strengthened.
The press release said that The University of Arizona Colleges ofMedicine and Banner Health have a long history of successful
aliaon through the Graduate Medical Educaon program at
Banner Good Samaritan Medical Center in Phoenix. Each year,
Banner and the UA Colleges of Medicine
collaborate in the training of nearly 260
physicians in ve residency programs and
in numerous fellowships.
Ascension & CHN, Tenet & Dignity
In a July 22 press release datelined St.
Louis, Mo. and Tucson, involved pares
announced that Ascension and CarondeletHealth Network had signed a leer of
intent to form a partnership with Tenet
Healthcare and Dignity Health, and that
they will ex-plore a joint venture that
would acquire Carondelet. Ascension is
the parent of CHN. They called the leer
with a Tenet subsidiary exclusive and
non-binding.
Upon closing, they said, it is ancipated
that Ascension would retain a minority
interest in such a joint venture. The pares
have launched a period of due diligencewhich they expect will result in a denive
agreement.
Under the proposed agreement, Tenet
would be the majority partner in the joint
venture with management responsibility
for all operaons of Carondelets assets,
including St. Josephs and St. Marys
Hospitals in Tucson Holy Cross Hospital
in Nogales Carondelet Medical Group,
Carondelet Specialist Group, and
Carondelets ancillary businesses. Once
the acquision is complete, the joint
venture would maintain Carondelets
heritage and identy, connuing
Carondelets Catholic sponsorship.
Tenet and Dignity Health both own and
operate hospitals in the Phoenix area.
Their parcipaon in a Tucsonbased joint
venture will connect Carondelet to a
regional healthcare system, including
Tenets and Dignity Healths growing
accountable care organizaon, Arizona
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Care Network; strengthen and grow Carondelets relaonships
with physicians; and fund strategic growth iniaves in Southern
Arizona.
We are excited to pursue this relaonship with Tenet and Dignity
Health, Carondelet President and CEO James K. Beckmann said.
Like Carondelet, Tenet and Dignity Health are commied to
providing high quality, low cost, person-centered care. This
relaonship is an opportunity to strengthen those eorts,
enhance healthcare across Arizona, and connue Catholic
sponsorship of Carondelet. The people of Tucson and SouthernArizona will connue to benet from the tremendous dedicaon
and talent of Carondelets associates and physician partners.
The pares said they do not plan to provide any further detail
unl such point as a denive agreement is reached.
Tenet Healthcare Corp. described itself as a leading healthcare
services company, through its subsidiaries operates 79 hospitals,
193 outpaent centers, including six hospitals and four
outpaent centers in Arizona, and Conifer Health Soluons, a
leader in business process soluons for healthcare providers
serving more than 700 hospital and other clients naonwide.
[www.tenethealth.org]
Dignity Health in Arizona said it includes four outstanding
hospitals: Chandler Regional Medical Center, Mercy Gilbert
Medical Center, St. Josephs Hospital and Medical Center, which
includes Barrow Neurological Instute and St. Josephs Westgate
Hospital. From this foundaon, Dignity Health in Arizona has
expanded into a comprehensive health care system, which
includes imaging centers, clinics, specialty hospitals, urgent cares,
an insurance provider, an accountable care organizaon and
other clinical partnerships. The Dignity Health Medical Group
employs more than 250 physicians, who cover a wide range of
speciales. Dignity Health, Arizona Service Area, is part of Dignity
Health, one of the naons ve largest health care systems.
Ascension reported that last year it provided $1.5 billion in care of
persons living in poverty and in community benet programs, and
that it employs more than 155,000 associates serving in more
than 1,900 sites in 23 states and the District of Columbia.
Ascensions direct subsidiaries provide services that include
healthcare delivery, medical equipment management, treasurymanagement, resource and supply management, venture capital
invesng, physician pracce management, and risk management.
CMS: Open PaymentsSunshine program meansmore transparencyBy Betsy Thompson, M.D., DrPH, Region 9 CMO
As part of the Open Payments program, the Centers for Medicare
& Medicaid Services will soon make data about the nancial
relaonships between the health care industry and physicians
(e.g. including medical doctors, doctors of osteopathy, densts,
chiropractors, and others) and teaching hospitals available to the
public. Oering this data will create more transparency and allow
those interested to use, analyze and monitor it.
Open Payments, previously known as the Sunshine Act, is a
federal transparency program enacted by Congress in 2010. Under
this program, CMS collects and publicly reports data about
8/11/2019 Aug-Sept 2014 Sombrero
20/2820 SOMBRERO August/September 2014
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payments (transfers of value), ownership,
or investment interests between drug and
device manufacturers and physicians and
teaching hospitals. Beginning with the last
ve months of 2013, CMS will collect this data
annually from industry and make it publicly
available, downloadable, and searchable.
Every year CMS will connue to release this
nancial informaon as it becomes available
about the prior year (e.g. by June 30, 2015 for2014 data).
These nancial interacons can happen for
many reasons: research, conference travel
and lodging, gis, and consulng. They can
foster collaboraon among physicians,
teaching hospitals, and industry
manufacturers that may contribute to the
design and delivery of life-saving drugs and
devices. However, they also can potenally
lead to conicts of interest in how health
care providers prescribe medicaons or give
medical care.
While CMS doesnt make assumpons or
draw conclusions about the reported
informaon, the Agency will take steps to
ensure that only accurate informaon is
made public. For example, as part of this
inial data collecon process, CMS has
The Faces of Casa are the
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wonderful holistic patient care focused
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Hospice services are paid for by Medicare
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engaged stakeholders as pilot users to ensure that reporng
systems are user-friendly and performing properly.
In addion, CMS will give physicians and teaching hospitals an
opportunity to be sure that informaon reported about them is
accurate. In order to review the data and make correcons if
necessary, physicians and teaching hospitals must rst register in
CMS Enterprise Portal starng on June 1, 2014. Then, starng in
July, they must register in the Open Payments system (via CMS
Enterprise Portal). This voluntary review and dispute period is
open for 45 days.
CMS strongly encourages physicians and teaching hospitals to
register in our Enterprise Portal and Open Payments systems so
they can review their specic data. Any data that physicians or
teaching hospital dispute, but is not corrected by industry within
the dispute resoluon period, will be included when the data is
made public and marked as disputed.
It is important that physicians or teaching hospitals know about
this program, how and what nancial relaonships are reported,
and how to answer quesons from paents. Visit go.cms.gov/
openpayments to get more informaon about Open Payments
(the Sunshine Act) and the resources available to understand the
program. Health care providers and others with quesons and
concerns can be e-mailed to [email protected].
This informaon was provided by the United States Department
of Health and Human Services.
Hyperbaric ambulance:fast HBOT treatmentsaves brainsBy Carol L Henricks, M.D.
A hyperbaric oxygen therapy (HBOT) equipped ambulance is beingdeveloped in North Carolina through a collaborave eort of the
FDA, Wake Forest University Hospital system, and the UHMS.
The hyperbaric ambulance will prolong the therapeuc window
to allow TPA therapy (ssue plasminogen acvator or clot
buster) to be given to paents who have suered an acute
stroke and have a long travel me to a hospital.[1] TPA improves
stroke outcome=less disability.
HBOT intervenon, preferably within three hours of rescue, also
improves the outcome in acute anoxic brain injury caused by
near-drowning and cardiopulmonary arrest. Hyperbaric
ambulances and/or acute HBOT treatment would change the
associated disability of these injuries forever! The research of
French physician Dr. Mathieu suggests a mechanism by which you
interrupt the cascade of intracellular injury caused by acute
anoxia under hyperbaric condions at 2.0 ata 100% medical
oxygen.[2]
In the worldwide literature we know that Japan has been using
hyperbaric ambulances since the 1970s. In Japan, if you call 911
and may have a heart or brain related emergency, EMS will arrive
in a hyperbaric ambulance to minimize the loss of heart and brain
ssue.[3]
Oxygen under pressure provides physiological benets that are
not present when a paent is breathing oxygen under
atmospheric pressure condions. HBOT creates oxygen radicals in
a hyperoxic environment and triggers healing mechanisms
including acute arrest of the cascade of intracellular injury,
release of stem cells, induced healing, bacteriostac eects, and
modicaon of gene expression.
All physicians should get to know the benets of hyperbaric
oxygen therapy.[4]
REFERENCES
1. Membership Newsleer of the Undersea & Hyperbaric Medical Society
(UHMS ). Stroke Ambulance in Development. Pressure: 23. Nov/Dec 2013.
2. Mathieu D et al. Hyperbaric oxygenaon in acute ischemic encephalopathy
(near-hanging). Eur J Neurol 7(Suppl3);151.
3. Discussed at the Third Internaonal Symposium for Hyperbaric Oxygen
Therapy in 2003, Fort Lauderdale, Fla.
4. Henricks C. HBOT acvates healing mechanisms. Sombrero Feb 2014.
AMA: Prevent diabetesbefore it startsGiven that 86 million Americans have pre-diabetes, you likely
have paents with this common but treatable condion.
To help these paents and improve outcomes for your pracce,
you can refer people who have prediabetes to an evidence-based
diabetes prevenon program at the YMCA of Southern Arizona.
This program can have a posive impact on paents, providers,
and communies such as ours seeking to reduce the incidence of
type 2 diabetes.
In the Tucson area, a grant covers the cost for people over age 65
with pre-diabetes to aend the YMCAs Diabetes Prevenon
Program. Adults under 65 who have pre-diabetes can sll
parcipate by paying out-of-pocket or by having a health plan
that covers parcipaon.
The YMCAs Diabetes Prevenon Program is based on the Centers
for Disease Control and Prevenons Naonal Diabetes
Prevenon Program. AMA and the YMCA of the USA are
collaborang to increase the number of Medicare parcipants in
the YMCAs Diabetes Prevenon Program. Addionally, YMCA of
the USA is parcipang in a Center for Medicare & Medicaid
Innovaon grant that pays for at-risk people older than 65 to
aend its diabetes prevenon program in 17 communies across
the country, including Tucson and Phoenix.
Physician referral tools
While physician pracces can already refer paents with pre-
diabetes to the YMCAs Diabetes Prevenon Program, AMA isseeking to enhance a referral process that works well across
dierent types of pracces. It has created tools to:
Increase educaon and awareness of pre-diabetes by
promong physician screening of those at risk.
Increase physician referrals of people with prediabetes to the
diabetes prevenon program oered by the YMCA.
Create a feedback loop linking the paents progress in the
program to the physicians pracce so that informaon can be
integrated into the paents care plan.
These easy-to-use tools, created as part of a pilot project with
physician pracces in Delaware, Indianapolis and Minneapolis/St.
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Paul, are available to physician pracces at no cost and can be
adapted to meet a pracces specic needs. Check out and
download the tools at ama-assn.org/go/prediabetes, and/or contact
Janet Williams at [email protected] to receive them.
AMA is also engaging insurers to collaborate on strategies for
expanded coverage of evidence-based services shown to prevent
type 2 diabetes, including services delivered through YMCA.
YMCAs Diabetes Prevenon Program
This program is a one-year, community-based program led by atrained lifestyle coach. Parcipants and the coach gather in a
relaxed classroom seng, at a local YMCA or elsewhere in the
community, and work together in small groups for 16 weekly
sessions, then eight monthly sessions to incorporate healthier
eang and moderate physical acvity into their daily lives.
The program is based on research funded by the Naonal
Instutes of Health and published in the New England Journal of
Medicinein 2002. The research showed that among people with
pre-diabetes who enrolled in a diabetes prevenon program,
there was a 58 percent reducon in the total number of new
diabetes cases, and a 71 percent reducon in new cases among
those 60 or older.
Reserve Corps works oncivilian casualty caretraining, moreMedical Reserve Corps of Southern Arizona reports that it has
undertaken threesignicant projects this summer:
The MRCSA Nurses Task Force, together with Tucson Electric
Power, will host a high-level Emergency Power Outage Roundtable
on Friday Sept. 19, bringing together key stakeholders to discuss
the funconal and access needs of community members who arehomebound or have condions requiring durable medical
equipment during an extended power outage.
Parcipang organizaons will be asked to summarizetheir
current emergency plans that address needs of the target
populaon during a power outage of more than three days.
Similaries and gaps will be idened and next steps will be
proposed. Those interested in aending the roundtable should
contact MRC for more informaon or to join up: 520.445.7035;
e-mail [email protected].
Emergency Civilian Casualty Care (E3C) training, established in
February of this year, has provided life-saving instrucon to more
than 300 medical professionals, business leaders, security
personnel and students.
Created by Dr. Sheldon Marks and Capt. Kris Blume for civilian
training, E3C is based on the militarys Taccal Combat Casualty
Care (TCCC). The program teaches the newest advances in life-
saving trauma care including the proper use of tourniquets,
traumac and life-threatening wound treatment, triage, violent
encounters, situaonal awareness and community resilience.
Goals are to train 1,500 people within the rst year, develop a
train-the-trainer program, and enlist a cadre of individuals who
will provide E3C training throughout Southern Arizona.
Individuals interested in becoming a trainer are encouraged to
contact the MRCSA oce at 520.445.7035.
MRCSA is also working to beer address the needs of the
Southern Arizonacommunity through Community Needs
Assessment surveys. Focus is on jointly establishing priories and
planning eorts with Tucson metro hospitals, community clinics
and emergency response agencies.
Surveys are designed to provide a current snapshot of communit
preparedness and awareness of available resources foremergency and disaster response and recovery. MRCSA will use
the informaon it gets to create a volunteer corps of physicians,
nurses, pharmacists, mental health professionals and others
that most eecvely addresses the needs of the community.
Our objecve is to be stronger and beer prepared in the event
of any emergency situaon through an investment in long-term
community resiliency, MRCSA said in a release. Project partners
include University of Arizona Medical Center, Northwest Medical
Center, Tucson Medical Center, Carondelet Medical Group,
Kindred Hospital, Tucson Fire Department, the University of
Arizona College of Nursing, Arizona HOSAFuture Health
Professionals, and Pima County Public Health Nurses.
PCOA: Reach nutrionout to eldersBy Debra Adams
Access to an adequate amount of nutrious food is important for
everyone, but can be even more crical as you age. Good
nutrion plays a crical role in prevenng and managing chronic
condions, maintaining energy levels, aiding in recovery and
promong overall health.
Many physiological and socio-economic factors aect the
nutrional status of our communies elders, leading to foodinsecurity. For some, limitaons on physical mobility interfere with
the independent performance of daily living acvies including
shopping for and preparing healthy, well-balanced meals.
For others, depression and social isolaon lead to inadequate
consumpon of enough calories because many seniors do not eat
regularly when having to dine alone. Sll others cannot aord to
buy nutrious food because they live on very limited xed
incomes. If not addressed, these factors can lead to poor health
and eventual loss of independence.
Every three years Pima Council On Aging conducts a Community
Needs Assessment to idenfy the needs and concerns of Pima
Countys older adults. Preparing nutrious meals moved into the
top eight serious problems for the rst me in the 2012
Community Survey. In prior years this problem has been noted as
a serious concern for survey respondents 85+ years of age, but
has now been idened as a serious problem for all 60+ age
groups combined.
PCOAs Nutrion Program for the Elderly, and its component
services of Congregate Meals and Home-Delivered Meals, has for
the last 34 years been a reliable source for nutrious, prepared
meals for many of Pima Countys older adults. These programs
8/11/2019 Aug-Sept 2014 Sombrero
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decrease social isolaon and assist many frail older adults in
remaining safely and comfortably in their own homes.
Ten Congregate Meal Centers in Tucson have been strategically
placed to be accessible to older individuals across the community,
while also targeng the most vulnerablethose in greatest
economic need, minority elders, and individuals with limited
means for transportaon. The City of Tucson Parks & Recreaon
Dept. administers programs at Armory Park, Archer, Donna Liggins,
William Clements, Freedom and El Rio centers. The Tucson Urban
League operates at the Quincie Douglas Neighborhood Center.Catholic Social Services administers sites at El Pueblo
Neighborhood Center, Flowing Wells/Ellie Towne Neighborhood
Center and the Eastside/El Dorado Center. Three addional sites
are available in Robles Ranch, Ajo, and Green Valley.
For those who are unable to aend a Congregate Meal site, PCOA
contracts with two agencies to deliver nutrious, prepared
home-delivered meals throughout the metropolitan Tucson area
and select areas of Pima County.
Both the Congregate and Home-Delivered Meals meet one third
of the Daily Reference Intake. Meals are provided on a donaon
basis with individuals contribung what they can aord toward
the cost of the meal.
Of the 1,237 nutrion program parcipants who completed the
program evaluaon survey in FY 13-14, 90 percent stated that the
meals helped them maintain their health; 88 percent stated that
the meals provided a larger variety of fruits, vegetables and
meats than they would be able to prepare for themselves; and 84
percent stated that meals increased their daily intake of food.
Please help PCOA in reaching out to those older individuals who
nd themselves unable to prepare or access the foods necessary
to maintain good health. Assistance is available. Encourage your
paents to call the PCOA Help Line at (520) 790.7262 or visit
www.pcoa.org.Debra Adams is PCOA chief operang ocer.
PCOA, Carondelet partner
in post-hospital paentsupportCarondelet Health Network reported Aug. 13 that with the goal
of of improving paent care quality and safety, and reducing
hospital readmissions, they are collaborang with Pima Council
On Aging.
The Centers for Medicaid and Medicare Services (CMS)
recognized the Tucson program as a Best Pracce and says this
community-based Care Transions Program is a valuable model
for other communies to consider, CHN reported.
The program focuses on Medicare paents with mulple
chronic illnesses who have been discharged recently from the
hospital. Carondelet nurses and PCOA care coordinators partner
on making regular visits to the homes of these paents, providing
much-needed medical follow-up care and a variety of other kinds
of social support to help the paent manage their recuperaon
and maintain their health aer they leave the hospital.
Weve seen some real success with this program, said CHN CMO
Donald Denmark, M.D. Paents are improving their health
and their well-being simply by receiving the support necessary to
remain healthy and stay out of the hospital.
The program is an outgrowth of the Aordable Care Act, CHN
said. The federal government reached out to healthcare
providers in 2011, challenging them to design programs thatprovide high quality care and cut costs to the overall healthcare
system. Carondelet took up the charge, and in doing so,
recognized that medical care is only part of what paents need
aer they leave the hospital. Carondelet partnered with Pima
Council on Aging, a well-respected organizaon providing
important in-home and community-based services and social
support to older adults and family caregivers.
CHN quoted PCOA President and CEO W. Mark Clark: The Care
Transions Program works because of the unique partnership of
Carondelet nurses and PCOA coaches and navigators. Each of us
brings our medical and social service skills to the focused care of
these paents in their homes, providing medical follow-up and
specic social supports that can improve the health outcome for
the paent. n
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Arizona Medical Associaon News
A year at ArMAs megaphoneBy Dr. Thomas C. Rothe
In May I nished my one-year term as Arizona Medical
Associaon president. Fortunately, it was an easy year for
healthcare in Arizona, as Gov. Jan Brewer got the Medicaid
expansion passed in early 2013.
Legislators were so burned out by the prolonged ght over this
issue that they had lile energy le for anything related to
healthcare. As such, I was able to escape frequent trips to
Phoenix since the skirmishes were few!
ArMA has a threefold mission: paent advocacy, physician
advocacy, and scope of pracce oversight. This year ArMA has
stepped up to protect paents from non-physicians purporng to
deliver healthcare services (non-nurse mid-wives wanng to do
VBACs at home, psychologists requesng prescribing privileges,
chiropractors asking to deliver hormone therapy, etc.) I would not
call this turf protecon as some do.
ArMA follows more than 175 bills each year introduced into the
Arizona Legislature, and prides itself, and is widely respected for,
making sure we separate fact from opinion: legislators know if we
give them a fact, even if they do not agree with our opinion, the
fact has been veed and is reliable. Our credibility is surpassed by
no one at the Capitol, and our support is considered essenal
when it comes to healthcare and physician services. The governor
and sta are in close
communicaon
with ArMA as the
voice of physicians.
They know
polically we candrive an issue, and
we speak with
credibility and
honesty.
In addion, your
state medical society
has worked closely
with the Mutual
Insurance Company
of Arizona (MICA)
to cut down on
frivolous lawsuits.This has resulted
in stabilizaon,
and rebates in
malpracce
insurancepremiums.
Likewise, ArMA
works to protect
these reforms and
diligently watches
for legal-system end-
runs around them.
The biggest frustraon of my ArMA tenure was going to
Washington, D.C. to ght for the permanent repeal of the SGR, onlyto have it postponed once again. In both the House and Senate,
Republicans and Democrats overwhelmingly agreed that this
problem should be xed. Docs from all backgrounds and the AMA
vigorously fought for this, but legislators said they could not comeup with a way to pay for it. The take-home message is crystal clear:
naonal policians do not care about physician interests because of
fragmentaon and dierences within the physician community.
They know that, sense that, docs will eventually go along with
whatever legislaon is passed, and frankly would just as soon see
docs ght it out themselves. Their only interest is to maintain
power and give lip-service to everything else.
Statewide is another maer. Like medical care, all polics is local
and the representaves seem to be more interested in physician
opinions, perhaps because it relates specically to their
constuents more directly. Passage of the Medicaid expansion by
a Republican governor in a right-wing-crazy state like Arizona wasa major accomplishment!
This was good for both the cizens of Arizona as well as the
physicians. Regardless of your polical feelings on this maer,
having money to pay for medical care for those who need it most
is paramount to a healthy and more producve Arizona.
Dr. Rothe, a PCMS past-president and member since 1982,
pracces with La Cholla Family Pracce.
Annual ArMA meeng reportBy Bill Fearneyhough
PCMS Execuve Director
It was early morning coee, rolls, fresh fruit, and cloistered
conversaons as delegates from across the state gathered in
Phoenix May 30 and June 1 for the Arizona Medical Associaons
annual meeng.
Along with elecon of new ocers and general business,
delegates had a full agenda of resoluons to discuss, including
two divisive proposals for establishment of a single-payer
healthcare insurance system, and a moratorium on the
medicalizaon of capital punishment.
As in the past PCMS was well represented. Aending were PCMS
President Timothy Marshall, M.D., and PCMS Board members
New ArMA President Jeffrey Mueller, M.D., left, accepts thegavel from outgoing President Thomas C. Rothe, M.D. May 31at the ArMA Annual Meeting.
8/11/2019 Aug-Sept 2014 Sombrero
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doctors Timothy Fagan, Screven Farmer, Gary Figge, Michael
Hamant, William Mangold, and Thomas Rothe. Doctors Richard
Dale and Thomas Hicks also aended. Doctors Farmer, Figge, and
Hicks served on the Reports and Resoluons Commiees.
Presidents Address
Fridays aernoon session saw Immediate Past-President Thomas
Rothe, M.D. introduce Dr. Je Mueller as the 123rdArMA
President. Dr. Mueller is Associate Dean of Hospital Pracce for
Mayo Clinics 23 hospitals, and medical director and a sta
anesthesiologist at Mayo Clinic Hospital, Phoenix.
Dr. Mueller spoke on the numerous challenges facing physicians,
including increased hospital, clinic and physician group
consolidaons; increasing pracce administrave costs; new
payment models; the polically-driven substuon of non-
physicians for physicians; and the ever-increasing reducons in
reimbursement as demand for healthcare services escalate.
To answer these challenges and more eecvely use ArMA
resources, Dr. Mueller said the associaon should focus more on
state-based advocacy, called for physicians to acvely seek and
assume formal leadership posions within hospitals and health
systems, and recommended that the state organizaon more
closely coordinate its advocacy acvies with county and statespecialty sociees. Currently ArMA leadership meets with these
sociees once a year, but Dr. Mueller suggested meengs be held
at least twice a year to discuss how all could work together more
eciently and eecvely on behalf of Arizona physicians.
Elecons
Tucson family praconer Timothy Fagan, M.D. was voted AMA
Alternate Delegate and connues to serve as a PCMS Director;
Michael Hamant, M.D. was elected ArMA Secretary; Screven
Farmer, M.D. will serve as At-Large Director and Thomas Hicks,
M.D. as a delegate to AMA. Dr. Timothy Marshall was elected
PCMS Director, replacing Dr. Charles Katzenberg who resigned the
post earlier in the year. All join fellow ArMA Board membersdoctors Gary Figge, William Mangold, and Thomas Rothe.
Resoluons
The House of Delegates debated a multude of signicant
resoluons. Uncharacteriscally, PCMS sponsored a single
resoluon, dealing with GME funding.
Resoluons receiving delegate support:
Transferral of authority to establish membership dues from
the ArMA House to the ArMA Board of Directors.
Join with the University of Arizonas Valley Fever Center for
Excellence, public health departments, and other organizaons
to promote coccidioidomycosis awareness and/or acvely seek
funding resources for cocci awareness and educaon. Support increased GME funding in Arizona and oppose
funding cuts. The PCMS Board-approved resoluon was adopted
from a posion paper submied by PCMS Board student
members Jamie Fleming and Jerey Brown.
Propose that AMA peon the U.S. government and the
Naonal Instute of Health (NIH) requiring publicaon of all NIH-
Naonal Center for Complementary and Alternave Medicine-
funded studies without regard to results. ArMA would also
propose to AMA and the Associaon of American Medical
Colleges that medical student educaon be limited to sciencally
sound medical pracce that adheres to evidence-based physics,
chemistry, pharmacology, and biology. It also ca