Oklahoma DO December 2013 by Oklahoma Osteopathic Association

The Journal of the Oklahoma Osteopathic Association

OKLAHOMA D.O.

May/June 2013 December 2013

Volume 78, No. 6

In this Issue: Oklahoma D.O.

1 OEFOM Update 1 2014 Winter CME Seminar Registration 1 Legislative Report

PAGE 1

Oklahoma D.O. | December 2013

WE KNOW OKLAHOMA HEALTHCARE AT PLICO, WE ARE HONORED TO INVEST IN OSTEOPATHIC EDUCATION AND COMMITTED TO PROTECTING YOU THROUGHOUT YOUR CAREER IN MEDICINE.

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Oklahoma D.O. PAGE 2

— KIRK JEWELL, PRESIDENT, OKLAHOMA STATE UNIVERSITY FOUNDATION

PLICO 405.815.4800 PLICO - OK.COM FINANCIAL STABILITY RATING ® OF A, EXCEPTIONAL Oklahoma D.O. | December 2013

The Journal of the Oklahoma Osteopathic Association

OKLAHOMA

May/June2013 2012 May/June December 2013

D.O.

Volume 78, No. 6

January 2012

Lynette C. McLain, Editor Lany Milner, Associate Editor

OOA Officers: Bret S. Langerman, DO, President (South Central District) Michael K. Cooper, DO, FACOFP, President-Elect (Northeastern District) C. Michael Ogle, DO, Vice President (Northwest District) Layne E. Subera, DO, FACOFP, Past President (Tulsa District) OOA Trustees: Kenneth E. Calabrese, DO, FACOI (Tulsa District) Dale Derby, DO (Tulsa District) Melissa A. Gastorf, DO (Southeastern District) Timothy J. Moser, DO, FACOFP (South Central District) Gabriel M. Pitman, DO (South Central District) Christopher A. Shearer, DO, FACOI (Northwest District) Kayse M. Shrum, DO, FACOP (Tulsa District) Ronald S. Stevens, DO (Eastern District) OOA Central Office Staff: Lynette C. McLain, Executive Director Lany Milner, Director of Operations and Education Matt Harney, MBA, Advocacy and Legislative Director Marie Kadavy, Director of Communications and Membership

The Oklahoma D.O. is published monthly from the Oklahoma Osteopathic Association Central Office: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335. Lany Milner, Graphic Designer and Associate Editor

The OOA Website is located at www.okosteo.org

Oklahoma D.O. | December 2013

2014 Winter CME Seminar Program

Winter CME Seminar Registration Form

“OSU-COM Early Admissions Program Enrolls First Students” provided by Jamie Calkins, Marketing/Media Coordinator

Student Scoop provided by Trace Heavener, OMS-II

14-15

OEFOM Scholarship Application

“Funding for TeleHealth Data Access at Hospitals & Health Care Centers” provided by Steve Casady, director of TeleHealth

OEFOM Update provided by Robin R. Dyer, DO, 2013-2014 OEFOM President

OEFOM 2013-2014 Board of Trustees and Committees

OEFOM 21st Golf Classic

Legislative Report provided by Matt Harney, MBA

2013 OOPAC Contributions

December Birthdays

What DO’s Need To Know

2014 OOPAC Pledge Form

Doctor of the Day Form

2013-2014 OOA Directory Order Form

“Burkitt’s Lymphoma in a Patient with HIV Infection”

Bureau News

“Combating Childhood Obesity” provided by the American Osteopathic Association

42-43

Classifieds & Calendar of Events

PAGE 3

For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org

“It’s That Time of Year” provided by Bret S. Langerman, DO, 2013-2014 President

Oklahoma D.O.

Copy deadline is the 10th of the month preceding publication. Advertising copy deadline is the 15th of the month preceding publication.

BRET S. LANGERMAN, DO President 2013 – 2014 oklahoma osteopathic association it’s that time of year

Oklahoma D.O. PAGE 4

As I sat down to prepare the message for this month I could not seem to stay focused on the business side of medicine. Instead, I found that my heart and my mind were thinking of family, friends, colleagues and those close to us that have been lost. The holiday season is a busy and stressful time of year so let’s not become so one tracked that we forget what the true meaning of the season is all about. Even though your office is busier than ever, take the time to give quality time to those loved ones in your lives. Without them, we as osteopathic physicians would not have the support system to

provide the quality and compassionate care that comes so natural to us. We took an oath to care for the sick and those others both close and far who may be in need of what we have to offer. Do not forget that sometimes those in need are actually our families and at times, even ourselves. I will close and just wish you a wonderful holiday season. Season’s greetings and best wishes for a happy New Year from my family to yours !! Bret, DeLaine, Callie and Kynlie OK

Oklahoma D.O. | December 2013

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Oklahoma D.O.

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PAGE 5

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Winter CME Seminar Program

Se 2

OA Winter CM O 4 E 01

of the

1-February 2

’s

ry 3

The

a nu Ja

Friday – January 31, 2014

LAB’s

’s t a h W NEW What’s HOT &NOTWhat’s

Noon – 6:00 pm

Registration-Sequoyah Foyer

2:00 – 6:00 pm

Exhibits Open

*Noon – 3:00 pm “AOA CO*RE REMS Program” www.osteopathic.org/inside-aoa/development/ continuing-medical-education/Pages/core- rems-programs.aspx *3:00 – 4:00 pm “Who Needs a Pap Smear? Age Appropriate Screening for Women” Derek R. Holmes, DO (obstetrics & gynecology, Ponca City, OK) http://womenshealth.gov/publications/our-publica tions/fact-sheet/pap-test.cfm *4:00 – 5:00 pm “Update on PSA and Testosterone” Paul G. Hagood, MD (certified urologist, Tulsa, OK) www.cancer.gov/cancertopics/factsheet/detection/ PSA *5:00 – 6:00 pm “When Platelets Fall” Kevin P. Hubbard, DO, FACOI (certified internist & hematologist/oncologist & palliative medicine, Kansas City, MO) www.mayoclinic.com/health/thrombocytopenia/ DS00691 6:00 – 7:00 pm

OOA New Physicians Meeting

6:00 – 7:00 pm Bureau on Managed Care & Physician Reimbursement- open meeting

Saturday – February 1, 2014

Hard Rock Hotel & Casino Catoosa, OK Oklahoma D.O. PAGE 6

Melinda R. Allen, DO, FACOI, program chair

Approval Requested for 19 Category 1A Credits from the AOA. Approval Requested for 19 Prescribed Credits from the AAFP.

7:00 am

Registration-Sequoyah Foyer

7:00 am

Continental Breakfast

8:00 – 9:30 am

Bureau on CME Meeting

8:00 am – Noon

Exhibits Open

*8:00 – 9:00 am “Endocrinology Lab Data: Practical Advice for the Busy Clinician" Curtis E. Harris, MD, MS, JD, FCLM (certified endocrinology, Ada, OK) www.ncbi.nlm.nih.gov/pmc/articles/PMC2605414/ *9:00 – 10:00 am

“Hypercoagulability” Kevin P. Hubbard, DO, FACOI (certified internist & hematologist/oncologist & palliative medicine, Kansas City, MO) Oklahoma D.O. | December 2013

www.clevelandclinicmeded.com/medicalpubs/dis *10:00 – 11:00 am “Atrial Fibrillation” easemanagement/hematology-oncology/ Sandeep Chopra, MD, FACC, FASE (certified hypercoagulable-states/ internal medicine Oklahoma City, OK) www.nhlbi.nih.gov/health/health-topics/topics/af/ *10:00 – 11:00 am “Platelets, What To Ask Before You Transfuse” Walter E. Kelley, DO (certified pathology, *11:00 am – Noon “Labs: The Unique, The Unusual, and The Relatively Oklahoma City, OK) Unknown” www.cpmc.org/learning/documents/bloodtrans-ws. Melinda R. Allen, DO, FACOI (certified internal html medicine, Blackwell, OK) www.healthsystem.virginia.edu/pub/medlabs/lmup *11:00 am – Noon “How Do You Like My Genes? New Biomarkers in date Oncology” Kevin P. Hubbard, DO, FACOI (certified internist & *Websites indicate Needs Assessment for each lecture. hematologist/oncologist & palliative medicine, Kansas City, MO) http://www.medscape.com/viewarticle/808930 *Noon – 2:00 pm OOA Luncheon: “Lung Nodules” Daniel A. Nader, DO, FCCP, FACP (certified internal medicine & pulmonary disease, Tulsa, OK) http://my.clevelandclinic.org/disorders/pulmonary_ nodules/hic_pulmonary_nodules.aspx *2:00 – 3:00 pm “Creating a Winning Team using the PMP” Proper Prescribing Lecture – bing a Sign-In Required for Credit Prescri Properre - Sign - dInit! Angela Wall (PMP Educator, Oklahoma City, OK) Lectu ed for cre Requir www.ok.gov/obndd/Prescription_Monitoring_ Program/ *3:00 – 5:00 pm “Risk Management and the LAB: Friend or Foe?” Risk Management Course – ment a Sign-In Required for Credit anage Risk Mre - Sign - Init! MaryAnn Digman, RN, MSHA (Senior Clinical Risk Lectu ed for cred Requir Consultant, Mesilla Park, NM) www.medpro.com 5:00 – 6:30 pm

Mentor Mentee Reception Hosted by Bret S. Langerman, DO, OOA President & First Lady DeLaine Langerman

Sunday – February 2, 2014

Registration & Continental Breakfast

8:00 – 8:30 am

OOA Past Presidents’ & District Presidents’ Meeting

8:30 – 9:30 am

AOA House of Delegates Meeting

*9:00 – 10:00 am “Discovering Disease through Urine” Kenneth E. Calabrese, DO, FACOI (certified internal medicine & nephrology, Tulsa, OK) www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010405/ Oklahoma D.O. | December 2013

• Visit www.HardRockCasinoTulsa.com Click Online Reservations located on the left side of the page then click Group Reservation at the top of the page then enter the Attendee Code: OOAJANUARY1014 • Group attendees may use the URL below: https://reservations.ihotelier.com/crs/g_login. cfm?hotelID=13572. Type in the Attendee Code: OOAJANUARY1014

Hard Rock Hotel & Casino Features: Hard Rock Store; Variety of dining options including Toby Keith’s “I Love This Bar & Grill”; Vegas style buffet; bistro-style grills; & 24-hour casino with 2,300 slot machines.

All Hard Rock Hotel Rooms Include: iPod docking stations; refrigerators; complimentary wired & wireless high-speed internet; complimentary airport transportation; complimentary covered & uncovered self-parking; complimentary fitness center; and complimentary USA Today.

Room Rate: $134 a night Cut-off date: January 10, 2014

PAGE 7

*8:00 – 9:00 am “New & Old Markers on Rheumatology” Debbie A. Gladd, DO (certified internal medicine, Tulsa, OK) www.rheumatologynews.com/single-view/new-mark ers-criteria-promote-earlier-intervention-in-juvenile-l upus/cb4ceb477ccfca8f30053272dd373606.html

For Room Reservations:

• Individuals may call toll free number: 1-800- 760-6700 Don’t forget to mention: OOA 2014 to receive the special group rate

Oklahoma D.O.

7:00 am

Room Reservations Information:

The OOA Winter CME Seminar “The ABC’s of the LAB’s: What’s New, What’s Hot & What’s Not” On or Before 1/24/14 After 1/24/14 q *DO Member Registration $340 $365 q DO Registration for Saturday afternoon “Proper Prescribing” & “Risk Management” Courses only (3 Credit Hours) $180 $205 q*Retired DO Member Registration $80 $105 q*DO Nonmember Registration $840 $865 q Nonmember Saturday Only Registration $680 $705 q *MD/Non-Physician Clinician Registration $340 $365 q Student, Intern, Resident, Spouse, Guest Registration $0 $0 Mail Registration Form & Payment to: OOA, 4848 North Lincoln Boulevard, Oklahoma City, OK 73105-3335 or Fax to 405.528.6102. DO Name (please print): ________________________________________________________________________________ Guest/Professional/Guest: _______________________________________________________________________________ Resident/Intern: _______________________________________________________________________________________ Student: _____________________________________________________________________________________________ q OMS-I q OMS-II q OMS-III q OMS-IV

Payment:

q Check Enclosed

q VISA/MASTERCARD

q DISCOVER

q AMERICAN EXPRESS

Credit Card No.: _________________________________________________________________ Card Exp. Date: ________ Signature: ____________________________________________________________________________________________ Name (as it appears on card - please print): _________________________________________________________________

Oklahoma D.O. PAGE 8

Billing Address: ________________________________________________________________________________________ City: ________________________________________________ State: _____________ Zip: ________________________ Office Telephone: (_______)_____________________________ E-Mail address: ___________________________________ Please indicate: q Printed syllabus OR q DVD syllabus PLEASE NOTE: requested print syllabus cannot be guaranteed after January 6, 2014 *Includes: Proper Prescribing Course, 2 Continental Breakfasts, Saturday Luncheon, & Evening Reception. Requests for Refunds Must Be Received Before January 24, 2014 and a $25 Service Fee Will Be Charged. Oklahoma D.O. | December 2013

Oklahoma D.O. PAGE 9

Oklahoma D.O. | December 2013

OSU-COM Early Admissions Program Enrolls

â&#x20AC;&#x153;

First Students

Provided by: Sean Kennedy, Marketing and Communication Services for OSU-Tulsa and OSU Center for Health Sciences

I have always wanted to be a physician and nothing else.

Oklahoma D.O. PAGE 10

â&#x20AC;?

Oklahoma D.O. | December 2013

OSU-COM’s first early admissions scholars are, from left, Jessica Branstetter, Cha’ Hutchison and David McVay.

Cha’ Hutchison discovered a love of medicine at an early age. “I have always wanted to be a physician and nothing else,” says the first-year Oklahoma State University College of Osteopathic Medicine student. “In high school, the pursuit of my dream mainly consisted of shadowing experiences, and I took every opportunity I could find to be around practicing physicians.”

Students must be residents of Oklahoma with a strong desire to practice primary care in rural or underserved Oklahoma. Students apply for the program in the spring of their sophomore year in college and must meet a number of stringent academic requirements for admission, including taking the MCAT in the spring of their junior year, and meet with the selection committee. For more information on OSU-COM’s Rural and Underserved Primary Care Early Admissions Program, visit www. healthsciences.okstate.edu/com/admissions/options.php. DO OK

Oklahoma D.O. | December 2013

PAGE 11

Through a partnership with the OSU College of Arts and Sciences and the OSU College of Agricultural Sciences and Natural Resources, qualified students admitted to the program may count the first year of medical school as the final year of their bachelor’s degree. OSU-CHS has also developed similar partnerships with regional uni-

versities across the state, including East Central University, Northeastern State University, Northwestern Oklahoma State University, Southeastern Oklahoma State University and Southwestern Oklahoma State University.

Oklahoma D.O.

A new early admissions program at OSU-COM has made it possible for Hutchison and fellow first-year students David McVay and Jessica Branstetter to get an early start on their medical school training. The Rural and Underserved Primary Care Early Admissions Program recruits students to become primary care physicians for rural areas of Oklahoma.

“One of the most effective methods of ensuring physicians locate in rural communities is to select medical school candidates who spent their formative years in similar settings,” said OSU Center for Health Sciences President Kayse M. Shrum, DO. “This program allows students to get an early start on medical school by reducing the premedical education requirement from four years to three years, which enables these graduates to begin practicing in rural Oklahoma one year earlier.”

Trace Heavener, OMS-II Student Government Association President 2013 – 2014 OSU-CHS STUDENT UPDATE

On Thursday, November 21, OSU-COM hosted an event to celebrate its 25th year anniversary of Oklahoma State University College of Osteopathic Medicine becoming part of the Oklahoma State University system. The guest speaker for the event was Sister Rosemary Nyirumbe who runs the St. Monica’s Girls Tailoring Center in Gulu, Uganda. CNN bestowed Sister Rosemary with the 2007 Hero Award for her work in the war ravaged area of Uganda and South Sudan. The Pros for Africa Club partnered with Sister Rosemary and collected cloths for garments, can lids to make purses and monetary donations that were sent back with Sister Rosemary. Each year the Pros for Africa Club sends several student volunteers to do medical work in the region.

Oklahoma D.O. PAGE 12

The Merkel building is getting a facelift with several technology enhancements. Flat screen televisions, audio and wireless laptop connection capabilities are being installed in each of the group study rooms. Students have already begun to utilize the new features daily in class and in the evenings for group study sessions.

The Student National Medical Association hosted a Multicultural Food Festival on campus that was open to the community. Along with the meal, a nonperishable food drive was organized with the proceeds benefitting families from the Eugene Field Elementary School. Also, the Student Government Association hosted their annual “No Shave November” contest with the $5 entry fees benefitting a local charity. I would like to encourage all my fellow students to submit your application for the OEFOM Scholarship. Several students have been awarded with this financial opportunity and have greatly benefitted from this program. The application is available online at www.okosteo.org or can be found on page 14. I would like to wish you and your family a blessed holiday season. DO OK

Several campus clubs have been hosting events for our student body with many benefitting other organizations. Events range from guest speaker’s presentations over the lunch period to several social family events. Over the Halloween holiday, the on-campus Student Advocate Association provided a family fun night for students, spouses and children. Around 200 people attended this event with food, inflatable games and an array of costumes.

Oklahoma D.O. | December 2013

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Oklahoma D.O.

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Oklahoma D.O. | December 2013

OK_OsteoSoc_full_1c_7'375x9'75.indd 1

3/28/11 11:05 AM

PAGE 13

Email: sselman@rcins.com Visit: www.rcins.com

OEFOM Endowed Scholarship Criteria & Application

"Assisting Students in Achieving Their Dream of Becoming Osteopathic Physicians"

Application Requirements:

1. Candidates must submit a completed application form and a typed letter detailing qualifications for the scholarship award. 2. Typed letter indicating any specific financial criteria or factors that you believe will impede your commitment to Osteopathic education without scholarship support, along with your anticipated postgraduate practice plans. 3. Letters of support from one Osteopathic medical college faculty member, one Doctor of Osteopathic Medicine and one community leader must accompany the application. These letters will assist the selection committee in affirming standing with the college, professional demeanor, character, and ability and willingness to participate in community activities.

$16,000

was awarded to last year’s recipients

Eligibility Criteria:

Scholarship applicants must be lawful residents of the United States and meet one of the following requirements: 1. Non-independent students must have at least one parent, stepparent or court-appointed guardian who is an Oklahoma resident and who has claimed the applicant as a dependent on his/her federal income tax return for the previous year.

2. Independent students must have lived in Oklahoma in some capacity other than as a full-time student at a post-secondary institution for a period of at least 12 consecutive months prior to matriculation to medical school. Candidates must be able to demonstrate good standing at their college regarding academics, finances and conduct.

Other Considerations:

1. Preference will be shown to applicants who have completed two years of Osteopathic medical training and who indicate a desire to practice in Oklahoma. 2. Class standing and cumulative grade point averages will be a major determining factor in granting scholarship awards.

Other Information:

Oklahoma D.O. PAGE 14

Finalists may be interviewed by a designated Scholarship Committee Member comprised of members of the OEFOM and/or their designees. Scholarship awards will be deposited with the Office of the Bursar of the College and credited for tuition, books, fees and other applicable educational expenses. Funds will not be payable directly to the student. Scholarship awards may be “stacked” with other scholarship awards or financial aid. However, the total of these awards, excluding loans, may not exceed the educational costs for the scholarship year. OEFOM will make available the minimum amount of scholarship funds allocated by September 1, annually. Applications are due by February 1, and awards will be announced at the OOA Annual Convention. Certain “named” scholarship funds may place additional restrictions on awards. Candidates will be formally informed of amount and source of awardedOklahoma scholarships. D.O. | December 2013

OEFOM Endowed Scholarship Application

Please Complete the Following: Name: ________________________________________________________________________________ Permanent Address: ____________________________________________________________________ City: ______________________________________

ST: __________

Zip: ____________

Present Address: ____________________________________________________________________ City: ______________________________________ Phone Number: ______________________________

ST: __________

Zip: ____________

Email: _____________________________

Date of Birth: ________________________________ Hometown: _____________________________ (month/day/year) Marital Status (circle one): Married

Single

Divorced

Widowed

Parent's Name: ________________________________________________________________________ Parentâ&#x20AC;&#x2122;s Address: ____________________________________________________________________ City: ______________________________________

ST: __________

Zip: ____________

How long have you lived in Oklahoma?: __________________________________________________ High School, Community, Year of Graduation: _____________________________________________ Pre-Med College(s): ____________________________________________________________________ Dates of attendance Degree Name of Osteopathic Medical College: ___________________________________________________ (Attach transcript indicating cumulative GPA and class rank)

Classification: __________OMS-I

__________ OMS-II

__________OMS-III

Letters of Support

Each application must be accompanied by 3-letters of support, please indicate that information below:

_________________________________________________________________ Name (faculty member)

_________________________________________________________________ Name (Osteopathic physician) Name (community leader)

check list

p 1 3 Letters of Support p 1 Typed Letter of Qualifications p 1 Send to the OEFOM Oklahoma D.O. | December 2013

due February 1, 2014

OEFOM 4848 North Lincoln Boulevard Oklahoma City, OK 73105-3335 or email: lany@okosteo.org For more information: (800) 522-8379 (405) 528-4848 fax: (405) 528-6102 email: lany@okosteo.org

PAGE 15

p 1 Application

Please send applications to:

Oklahoma D.O.

_________________________________________________________________

The Oklahoma State University

Rural Health center for

Funding for TeleHealth Data Access at Hospitals & Health Care Centers

provided by Steve Casady, Director of TeleHealth, OSU Center for Rural Health

TeleHealth is a term that is being used more and more each day. The opportunities made available to patients through telemedicine and the ability to participate in training and other educational offerings for health care providers is something that sounds great. There are, however, challenges that accompany this technology. One of the most prominent challenges that exists is the cost associated with providing these services.

Oklahoma D.O. PAGE 16

Beginning January 1, 2014, Oklahoma’s Health Care Providers (HCP’s) will be eligible to receive funding support for health care connectivity from the Federal Communication Commission’s (FCC) newly available Healthcare Connect Fund (HCF). Due to the introduction of this federal program, the state of Oklahoma is requiring HCP’s who request state funding assistance for their telemedicine data connection from the Oklahoma Universal Service Fund (OUSF), to first seek “alternate funding.” This means that any qualifying HCP requesting state funding assistance for data connectivity that is eligible for HCF funding will be required to apply for the federal HCF program prior to requesting OUSF support paid for by the state.

participate in the program is to join a consortium. There are differences in the items that will be considered for subsidies based on the method of filing as well as entity and provider type. The TeleHealth Alliance of Oklahoma (TAO), http://taoklahoma.org, is the largest consortium within the state and is available to assist with questions and applying for the HCF. Other consortiums are expected to be created within the state over time and they are expected to be able to provide similar services for their members as TAO. The timeline that is in place for the implementation of the Health Care Connect Fund and the changes that are being made to funding through the Oklahoma Universal Services Fund are quickly approaching. It is important that Oklahoma health care providers take action and move to ensure they are able to obtain funding for TeleHealth activities in the upcoming year.

The HCF fund, available January 1, 2014, will provide a 65% subsidy for eligible expenses to eligible providers. In addition to the 65% subsidy for eligible expenses through the HCF, eligible providers under OUSF rules are entitled to apply for the remaining 35% of eligible expenses to be paid through the state of Oklahoma OUSF. The HCF program provides two methods that are available for HCP’s to sign-up for participation. The first method available to participate in the HCP program is for an entity to apply individually. The second method that an entity can choose to

Oklahoma D.O. | December 2013

HEALTH CARE CONNECT FUND COMPARISON OF ELIGIBLE ENTITIES & PROVIDERS HCF INDIVIDUAL Applicants

HCF CONSORTIUM Applicants

OKLAHOMA OUSF

Any provider of eligible services



Eligible local exchange telecommunications service provider3



 Yes pending legislation

ELIGIBLE PROVIDERS (vendors):

ELIGIBLE OWNERSHIP: For-Profit Not-for-profit or Public ELIGIBLE ENTITIES: Post-secondary educational institution offering health care instruction, including a teaching hospital or medical school Community health center or health center providing health care to migrants; Local health department or agency Community mental health center



Not-for-profit hospital



Rural health clinic



FQHC Only

Consortium of health care providers consisting of one or more entities



Rural Only

Urban allowed if 50% or more Rural

Urban or Rural

Department of Corrections LOCATED IN RURAL AREA

Figure 1 provides a comparison of eligible entities and providers for both the Health Care Connect Fund and the OUSF. It is easy to see that there are eligibility differences between the two programs.

FCC Health Care Connect Report and Order , Released December 21, 2012. Downloaded from www.fcc.gov, January 15, 2013. HEALTH CARE CONNECT FUND 47 C.F.R. Part 54, Subpart G. §54.6 Terms and Definitions. COMPARISON OF ELIGIBLE SERVICES 2 Title 165, Chapter 59. Oklahoma Universal Service. Permanent Rules. Amended, Effective 7-11-2013 Downloaded from www.occeweb.com, FCC October 8, 2013. 165:59-1-4. HEALTH CARE CONNECTDefinitions. FUND 1 OKLAHOMA2 3 Id. at 165:59-3-14. Eligibility to receive OUSF funding OUSF- Telemedicine Support INDIVIDUAL Applicants CONSORTIUM Applicants Any advanced telecommunications or information One telecommunications line or Eligible Services service that enables HCPs to post their own data, interact with stored data, generate new data, or communicate, by providing connectivity over private dedicated networks or the public Internet for the provision of health information technology.

Support provided Reasonable & Customary Installation ©Kellogg & Sovereign® Consulting, LLC Charges (≤$5,000 undiscounted cost) www.rhcprogram.com Lit Fiber Lease

wireless connection, provided free of charge to an eligible healthcare entity within the State, sufficient for providing such telemedicine services as the healthcare entity is equipped to provide. Varies based on telemedicine use, 3 alternative funding sources

65%



Dark Fiber



Connections to Research & Education Networks



HCP Connections Between Off-Site Data Centers & Administrative Offices



Upfront Charges for Deployment of New or Upgraded Facilities HCP-Constructed and Owned Facilities Eligible Equipment • Equipment necessary to make broadband service functional • Equipment necessary to manage, control, or maintain broadband service or dedicated health care broadband network 1

Section V - FCC Health Connect Fund Report & Order, Released December 21, 2012 (see page 51, Paragraph 106)

Title 165. Chapter permanent rules effective July 11, 2013. Oklahoma D.O.59|OUSF December 2013 2

Last Amended, The Oklahoma Register, Volume 30, Number 20, July 11,2013 Publication. Pages 1495-1896

OUSF requires "seeking alternative funding first."

PAGE 17



Oklahoma D.O.

• Recurring charges (lease of fiber and/or lighting equipment, recurring maintenance charges) • Upfront payments for IRUs, leases, equipment

A review of Figure 2 shows that, not only are there differences between the two programs, there are also differences in the items and services that will be subsidized based on the method of filing. As one can see, there are more eligible services available through the HCF than the OUSF. It is also clear that applying for participation in the HCF through a consortium provides added benefit over applying for participation individually.

robin r. dyer, do President 2013 – 2014

oklahoma educational foundation for osteopathic medicine

Greeting from your Foundation! This fall has been very busy for the office of OEFOM. We just wrapped up the 21st Annual OEFOM Golf Classic held at the Coffee Creek Golf Course on October 11, 2013. Thanks to all of you who participated and to C. Michael Ogle, DO, for chairing this year’s tournament. All proceeds from this tournament go towards the students for activities and programs at Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSUCHS COM) where state funding is not available.

Oklahoma D.O. PAGE 18

We are currently accepting applications from Oklahoma osteopathic medical students for next year’s OEFOM Scholarship Program. The scholarship committee will review each application submitted and choose students to receive scholarships for the 2014-2015 school year. These scholarships will be awarded during the OOA’s 114th Annual Convention held at the Norman Embassy Suites April 24-27, 2014. If you know of a student who is in need of financial assistance, please encourage those individuals to submit an application. For further information, please see page 14 or visit www.okosteo.org.

I would also like to take this opportunity to thank all of the OEFOM Board members. Each of these individuals take time out of their busy schedule to drive to Oklahoma City to partake in the business of the OEFOM. Additionally, they serve on various OEFOM committees. With their commitment OEFOM is able to promote the educational future of osteopathic medicine in our state, so thank you to each and every one who has devoted and served on the OEFOM Board of Trustees. Lastly, I would like to wish each of you a happy holiday season. I hope you are all able to spend time with friends and family and enjoy the reason for the season. DO OK

As you all know, the OEFOM also relies heavily on your contributions for the majority of our scholarship funds. Many of you directly contribute to the OEFOM Scholarship Fund by honoring a deceased individual with a memorial contribution or honoring contribution for individuals who are still living. Thank you all for your continued support.

Oklahoma D.O. | December 2013

2013-2014 OEFOM Officers & Trustees

Robin R. Dyer, DO President Board Certified Family Physician & Neuromusculoskeletal Medicine Term Expiring 2014 Tulsa, OK

Gore Gaines, JD President-Elect Lay Member Term Expiring 2016 Edmond, OK

Dennis J. Carter, DO, FACOFP Board Certified Family Physician/ Geriatrics Term Expiring 2018 Poteau, OK

Patti W. Shaw, DO Board Certified Internal Medicine Representing the OSU-COM Alumni Association Term Expiring 2014 Tulsa, OK

Sherri L. Wise, CPA Representing the Osteopathic Founders Foundation Term Expiring 2014 Tulsa, OK

Michael K. Cooper, DO, FACOFP OOA President-Elect Board Certified Family Physician Claremore, OK

Gary McClanahan Vice President Lay Member Term Expiring 2018 Edmond, OK

Larry Derryberry, JD Vice President Lay Member Term Expiring 2015 Oklahoma City, OK

Kristopher K. Hart, DO Board Certified Emergency Medicine Term Expiring 2016 Oklahoma City, OK

Jeffrey L. Shipman, DO Board Certified Emergency Medicine Term Expiring 2017 Oklahoma City, OK

Stephen W. Woodson, DO Board Certified Family Physician Term Expiring 2015 Stigler, OK 74462

Lynette C. McLain Secretary/Treasurer OOA Executive Director Oklahoma City, OK

Bret S. Langerman, DO OOA President Board Certified Emergency Medicine Oklahoma City, OK

C. Michael Ogle, DO OOA Vice President Board Certified Internal Medicine/ Emergency Medicine Enid, OK

Oklahoma D.O. | December 2013

Scholarship Committee Jeffrey L. Shipman, DO Kristopher K. Hart, DO Planned Giving Committee Stephen W. Woodson, DO Sherri L. Wise, CPA Michael K. Cooper, DO

Bylaws Committee C. Michael Ogle, DO Bret S. Langerman, DO Larry Derryberry, JD Dennis J. Carter, DO Gary McClanahan Lynette C. McLain

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Executive/Finance Committee Robin R. Dyer, DO Gore Gaines, JD Gary McClanahan Lynette C. McLain

Oklahoma D.O.

2013-2014 OEFOM Committees

21st Annual OEFOM Golf Classic Thank you to all who participated in this year’s 21st Annual OEFOM Golf Classic. All proceeds from this tournament are directed to the students for activities and programs at Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-CHS COM) in areas where state funds are not available. With your support, we are able to continue fulfilling our goal of supporting osteopathic medical students.

special thanks to our

event partners

Rich and Cartmill/MedPro

for being this year’s t-shirt sponsor

thanks to

Oklahoma D.O. PAGE 20

our sponsoring partners ACOFP-Oklahoma State Chapter Paul F. Benien, Jr., DO Dr. Dennis and Sheri Carter Classic Printing Cory’s Audio Visual Services Dr. Bobby and Walli Daniel Derryberry & Naifeh LLP First Commercial Bank INSURICA Healthcare MedPro/Rich & Cartmill Norman Embassy Suites Hotel & Conference Center Oklahoma Osteopathic Association Osteopathic Founders Foundation OSU-COM Alumni Association Wilshire Pennington Group

Oklahoma D.O. | December 2013

Oklahoma D.O. PAGE 21

Oklahoma D.O. | December 2013

memorium

THOMAS C. REED, DO Thomas Colburn Reed, DO, 88, passed away surrounded by loving family members on Oct. 23, 2013, at Centennial Park Retirement Village in North Platte, Nebraska. Dr. Reed was born May 13, 1925, to Chautauqua Pearl and Catherine Marie Peterson Reed, in Moorhead, Minn. He grew up in East Grand Forks, Fairmont and Albert Lea, Minn. During high school, Dr. Reed was a multi-sport athlete and later played football at Hamline University in St. Paul, Minn. He was a proud veteran of World War II, serving with the Army Air Corps in the South Pacific from 1943 to 1945. On July 2, 1947, Dr. Reed married his longtime sweetheart, Joyce Byers, in Fairmont, Minn., before moving to Des Moines, Iowa, where he earned his Doctor of Osteopathy degree from Des Moines Still College of Osteopathy and Surgery. Dr. Reed and Joyce then moved to Tulsa, Okla., where he worked as a general practitioner for his entire career. At the age of 38, Dr. Reed served as the youngest president of the Oklahoma Osteopathic Association in 1963-1964 and was an active member of the Boston Avenue Methodist Church in Tulsa. Together with their three children, the Reeds enjoyed annual camping vacations throughout the United States, always highlighted by a week at Little Pine Lake in Minnesota. As a family, they also enjoyed raising and showing Palomino quarter horses. Dr. Reed and Joyce led a healthy and active lifestyle during their 25 years of retirement. They lived in Naples, Fla., where they played tennis, fished and followed local sports teams. They loved to travel and visit their children and other family members, including his Norwegian relatives. Dr. Reed will be remembered for his love and propagation of exotic plants, especially orchids, and for his magnetic personality and smile. In 2011, Dr. Reed moved to North Platte to live with his son, Chuck, and his family. Dr. Reed was preceded in death by his wife, Joyce; his parents, Chautauqua Pearl and Catherine Reed; and brothers, Chuck and Bobby Don. He is survived by his daughters, Barbara (Bill) Read, of Minneapolis, Minn., and Elizabeth (Bob) Carroll, of Pollock Pines, Calif.; a son, Charles (Marla) Reed, of North Platte; seven grandchildren and seven great-grandchildren.

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RICHARD G. COOPER, DO Richard Grant Cooper, DO, was born March 8, 1934, on Staten Island, New York, to Sidney and Lucille (Kyle) Cooper. He married S. Jane Edmondson in 1970. Dr. Cooper attended the University of Kentucky, receiving B.S. and M.S. degrees. He received a PhD in physiology from the University of Texas, Galveston. At the College of Osteopathic Medicine and Surgery in Des Moines, IA, he received his Doctor of Osteopathic Medicine and Surgery degree. He was an Assistant Professor of Physiology at the University of Missouri and a research associate of the Space Sciences Research Center at the University of Missouri where he co-authored many scientific publications. Dr. Cooper was an Assistant Professor of Physiology and Pharmacology at the College of Osteopathic Medicine and Surgery in Des Moines, lA. He served as an Associate Professor of Preclinical Science, Physiology, and Pharmacology at the Oklahoma College of Osteopathic Medicine and Surgery. Dr. Cooper was in private practice as a family physician for several years. After retirement, he volunteered in the Archives area of St. Francis Hospital. Earlier he volunteered at Neighbors Along the Line and the Salvation Army. He was a member of the Kirk of the Hills Presbyterian Church. Survived by: wife, Jane, of the home; two brothers, Jim Cooper and wife, Diane, of Reston, VA, and John Cooper and wife, Linda, of Lexington, KY.

Oklahoma D.O. | December 2013

JERRY D. LEMONS, DO Dr. Lemons passed away surrounded by his family on Saturday, November 23, 2013 in Lawton, Oklahoma. Dr. Lemons was born on March 2, 1957 in Sioux City, Iowa to Tommy and Wilma (Carlson) Lemons. During his childhood, he traveled to various military bases with his family where he attended local schools. Dr. Lemons graduated from Elgin High School in 1975. After high school, he joined the United States Navy and was honorably discharged. He married Tina Rogers March of 1978 in Lawton, Oklahoma. Dr. Lemons attended medical school at Oklahoma State University College of Osteopathic Medicine, graduating in 1996. Dr. Lemons practiced in Oklahoma City and Lawton in Emergency Medicine, at the AM/PM Clinic and later at the Veterans Clinic at Fort Sill. Dr. Lemons later married Kimberly R. Hubbard, DO, on August 27, 1997, in Gainesville, Texas.

Contributing

n OEFOM Memorials n

Mr. John and Patti Denman Dr. David and Rita Hitzeman Dick Phillips Family Dr. Paul and Bonnie Benien Dr. Thomas and Glenda Carlile Harriet H. Shaw, DO Oklahoma Osteopathic Association Oklahoma Osteopathic Association Dr. David and Rita Hitzeman Dr. Thomas and Flo Conklin Dr. Ralph B. Coffman Dr. Gary and Donna Cannon Dr. Paul and Bonnie Benien Dr. Stanley and Barabara Grogg Oklahoma Osteopathic Association Oklahoma Osteoathic Association Dr. Walter and Betty Wilson

In Memory of

John D. McCuistion, DO John D. McCuistion, DO John D. McCuistion, DO John D. McCuistion, DO Richard G. Cooper, DO Richard G. Cooper, DO Richard G. Cooper, DO Thomas C. Reed, DO Edwin A. Berger, DO Edwin A. Berger, DO Edwin A. Berger, DO Edwin A. Berger, DO Edwin A. Berger, DO Edwin A. Berger, DO Edwin A. Berger, DO Jerry D. Lemons, DO Cherry Kempe

EDWIN A. BERGER, DO Edwin A. Berger, DO, passed from cholangiocarcinoma. His amazingly positive attitude throughout his lifetime of 74 years 10 months, and excellent care during illness, contributed to a incredible quality of life for 30 months following his diagnosis and surgery.

Over the years, Dr. Berger enjoyed earning a pilotâ&#x20AC;&#x2122;s license, playing golf-anywhere, anytime-especially with the early group at Page Belcher, raising Black Angus cattle at BAR near Okmulgee, boating and fishing on Lake Tenkiller, supporting local arts and sports events. Travel was a passion - Dr. Berger and Linda visited 55 countries on 6 continents as well as all 50 states. Ed was an avid reader; he embraced life with joy and curiosity, marveling at all this world had to offer. Oklahoma D.O. | December 2013

PAGE 23

Actively involved in the Tulsa Osteopathic community, Dr. Berger served on many hospital committees, served on the Board of Trustees and in 1989 became Chief of Staff at what had become Tulsa Regional Medical Center. Among his memorable moments was receiving the Doctor of the Year Award in 1997 from the Oklahoma Osteopathic Association. Community activities included serving on the Board of the Tulsa Chamber of Commerce Professional Council and the Business Health Coalition. Dr. Berger and Linda were active volunteers with the Tulsa Global Alliance, escorting and hosting international visitors to Tulsa.

Oklahoma D.O.

Dr. Berger was born in Nappanee, Indiana, on a dairy and grain farm. He graduated from Nappanee High School, earned a B.A. from North Central College, Naperville, Illinois, and went on to graduate from the Kirksville College of Osteopathy and Surgery in Kirksville, Missouri, in 1966. After a rotating internship at Oklahoma Osteopathic Hospital in Tulsa, Dr. Berger was drafted and became a U.S. Army Aviation Medical officer, serving 13 months in Vietnam where he was awarded a Bronze Star. Returning from military service in 1969, Dr. Berger began his 41 year career as a family practice physician in Tulsa, retiring in 2010. His patients, professional associates, office staff, family and friends, and his life with Linda in the city and state he loved were among his great joys.

LEGISLATIVE REPORT provided by Matt Harney, MBA Bill filing begins in the state legislature

On November 19, Ervin Yen, MD, announced his candidacy for Senate District 40. Senate 40 is being vacated by the term-limited Senator Cliff Branan. SD 40 covers portions of northwestern Oklahoma County including Warr Acres, Nichols Hills, and portions of Bethany.

The legislative session in Oklahoma begins February 3, 2014, and must adjourn no later than May 30, 2014. More than 2,400 bills and resolutions were filed in the House and Senate for the 2013 regular legislative session.

Dr. Yen is a past president of the Oklahoma Society of Anesthesiologists and past Chief of the Anesthesiology section at Saint Anthony Hospital. Dr. Yen practiced medicine for nearly 30 years in Oklahoma City and has demonstrated leadership by serving as co-chair of the Patients First Coalition along with Gabriel M. Pitman, DO. Patients First works to ensure patients are protected by defending against scope of practice overreaches.

Osteopathic Medicine Day at the Capitol

The Oklahoma Osteopathic Association is excited to announce it will be hosting Osteopathic Medicine Day at the Capitol in Oklahoma City on Monday, March 3, 2014. Osteopathic Medicine Day allows osteopathic physicians, residents, and students the opportunity to communicate the importance of osteopathic medicine in Oklahoma directly with your state legislators. As our state faces a critical physician shortage, challenges to state funding for OSU Medical Center, and dangerous scope of practice overreaches, it is vital we inform our legislators of the valuable role of osteopathic physicians in the communities we serve. Lunch and a legislative briefing will be provided for all who participate. A brief program featuring legislative leadership will begin at 1pm on the 2nd floor of the capitol rotunda. Our osteopathic physicians, residents, and students in attendance will be introduced from the House and Senate Floor. Also, meetings will be scheduled with your specific state legislators. To aid these meetings, you will be provided with a packet containing talking points, a legislative directory, and more. Oklahoma D.O. PAGE 24

Dr. Yen announces for Senate District 40

As of the publishing of this journal, nine bills have been filed for the 2014 legislative session. None of the bills currently filed directly relate to the osteopathic family. The bill filing deadline for the 2014 legislative session is December 13, 2013. Substantive language must be approved by December 20.

To participate in Osteopathic Medicine Day at the Capitol, please contact Matt Harney at matt@okosteo.org or (405) 5284848.

In his candidacy announcement, Dr. Yen said, “I have lived in District 40 since 1961. This is my home—I went to school here, I was married here, I’ve raised my family here and I worship here. I look forward to representing our district in the State Senate.” Despite his extensive medical background, Dr. Yen wants to be more than just “the health care candidate.” Dr. Yen is entering a crowded primary battle as he is the fifth Republican to announce for SD 40. Two Democrats have filed for the race as well. The official candidate filing period for the state of Oklahoma is April 9-11, 2014. The primary election will be June 24, 2014. In the event no candidate receives majority of the votes, the top two finishers will advance to a primary runoff election on August 26. If elected, Dr. Yen would be the third physician in the Oklahoma legislature. Map of Senate District 40: http://www.oksenate.gov/Senators/2011_maps/districts/ District_40.pdf.

Many new federal laws impacting health care took effect this past year. Here’s a look back at Affordable Care Act provisions implemented in 2013: Affordable Care Act Provisions Starting January 1 of this year, preventive coverage was expanded as a component of the Affordable Care Act. To encourage preventive care, the law provides new funding to state Medicaid

Oklahoma D.O. | December 2013

programs that choose to cover preventive services for patients at little or no cost. The Department of Health & Human Services created the following list of covered preventive services for adults, women, and children:

26 Covered Preventive Services for Children 1. Alcohol and Drug Use assessments for adolescents 2. Autism screening for children at 18 and 24 months 3. Behavioral assessments for children of all ages Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 4. Blood Pressure screening for children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 5. Cervical Dysplasia screening for sexually active females 6. Congenital Hypothyroidism screening for newborns 7. Depression screening for adolescents 8. Developmental screening for children under age 3,

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22 Covered Preventive Services for Women, Including Pregnant Women The eight new prevention-related health services marked with an asterisk (*) must be covered with no cost-sharing in plan years starting on or after August 1, 2012. 1. Anemia screening on a routine basis for pregnant women 2. Bacteriuria urinary tract or other infection screening for pregnant women 3. BRCA counseling about genetic testing for women at higher risk 4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40 5. Breast Cancer Chemoprevention counseling for

Oklahoma D.O.

15 Covered Preventive Services for Adults 1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked 2. Alcohol Misuse screening and counseling 3. Aspirin use for men and women of certain ages 4. Blood Pressure screening for all adults 5. Cholesterol screening for adults of certain ages or at higher risk 6. Colorectal Cancer screening for adults over 50 7. Depression screening for adults 8. Type 2 Diabetes screening for adults with high blood pressure 9. Diet counseling for adults at higher risk for chronic disease 10. HIV screening for all adults at higher risk 11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary: o Hepatitis A o Hepatitis B o Herpes Zoster o Human Papillomavirus o Influenza (Flu Shot) o Measles, Mumps, Rubella o Meningococcal o Pneumococcal o Tetanus, Diphtheria, Pertussis o Varicella 12. Obesity screening and counseling for all adults 13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk 14. Tobacco Use screening for all adults and cessation interventions for tobacco users 15. Syphilis screening for all adults at higher risk

women at higher risk 6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women* 7. Cervical Cancer screening for sexually active women 8. Chlamydia Infection screening for younger women and other women at higher risk 9. Contraception: Food and Drug Administration- approved contraceptive methods, sterilization pro- cedures, and patient education and counseling, not including abortifacient drugs* 10. Domestic and interpersonal violence screening and counseling for all women* 11. Folic Acid supplements for women who may become pregnant 12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes* 13. Gonorrhea screening for all women at higher risk 14. Hepatitis B screening for pregnant women at their first prenatal visit 15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women* 16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older* 17. Osteoporosis screening for women over age 60 de- pending on risk factors 18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk 19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users 20. Sexually Transmitted Infections (STI) counseling for sexually active women* 21. Syphilis screening for all pregnant women or other women at increased risk 22. Well-woman visits to obtain recommended preventive services*

Oklahoma D.O. | December 2013

H O U S Oklahoma D.O. PAGE 26

and surveillance throughout childhood 9. Dyslipidemia screening for children at higher risk of lipid disorders Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 10. Fluoride Chemoprevention supplements for children without fluoride in their water source 11. Gonorrhea preventive medication for the eyes of all newborns 12. Hearing screening for all newborns 13. Height, Weight and Body Mass Index measurements for children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 14. Hematocrit or Hemoglobin screening for children 15. Hemoglobinopathies or sickle cell screening for new borns 16. HIV screening for adolescents at higher risk 17. Immunization vaccines for children from birth to age 18 doses, recommended ages, and recommended populations vary: o Diphtheria, Tetanus, Pertussis o Haemophilus influenzae type b o Hepatitis A o Hepatitis B o Human Papillomavirus o Inactivated Poliovirus o Influenza (Flu Shot) o Measles, Mumps, Rubella o Meningococcal o Pneumococcal o Rotavirus o Varicella 18. Iron supplements for children ages 6 to 12 months at risk for anemia 19. Lead screening for children at risk of exposure 20. Medical History for all children throughout development Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 21. Obesity screening and counseling 22. Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years. 23. Phenylketonuria (PKU) screening for this genetic disorder in newborns 24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk 25. Tuberculin testing for children at higher risk of tuber- culosis Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 26. Vision screening for all children The Affordable Care Act also expands authority to bundle payments by establishing a national pilot program to encourage hospitals, doctors, and other providers to work together to im-

prove the coordination and quality of patient care. Payment “bundling” occurs when hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. This was effective no later than January 1, 2013.

Expanding the Primary Health Care Workforce

The Affordable Care Act, the American Recovery and Reinvestment Act of 2009 (Recovery Act), and ongoing federal investments in the health care workforce have led to significant progress in training new primary care providers with additional focus on underserved areas, including: • Nearly Tripling the National Health Service Corps: As a result of historic investments by the Obama Admin- istration, the numbers of primary care providers in the National Health Service Corps (NHSC) are at all-time highs, nearly tripling between 2008 and 2012. Today, 10.4 million people in communities nationwide re ceive health care from nearly 10,000 National Health Service Corps clinicians. The National Health Service Corps has invested nearly $900 million in providing scholarship and loan repayment incentives to primary care providers and students in return for service in the areas that need them most. • Supporting Community Health Centers: The Afford able Care Act created the Community Health Center Fund, which provides $11 billion over five years for the operation, expansion and construction of health centers nationwide. Today, more than 1,200 health centers operate nearly 9,000 service delivery sites that provide primary care to more than 20 million patients nationwide, a third of whom are children. Since the beginning of 2009, health centers have added an ad ditional 2,200 full-time physicians and 2,400 full-time nurse practitioners, physician assistants, and certified nurse midwives. • Training New Primary Care Providers: The Affordable Care Act invests in the training of new primary care providers, including providing nearly $230 million to increase the number of medical residents, as well as funding to increase the number of nurse practitioners and physician assistants trained in primary care. With these investments, by 2015, more than 1,700 new pri mary care providers will have been trained and enter primary care practice. The Fiscal Year 2014 budget in cludes investments that will expand the capacity of in stitutions to train 2,800 additional primary care providers over five years. • Training Physicians in Community-Based Settings: The Affordable Care Act created the Teaching Health Oklahoma D.O. | December 2013

Center Program to help move primary care training into community-based settings. The five-year investment in this program is expected to support the community-based training of over 600 new primary care physician and dental residents by 2015. • Supporting Mental Health Training: Mental health is sues rank in the top five chronic illnesses in the United States. In Fiscal Year 2012, the Affordable Care Act invested $10 million to support training to help close the gap in access to mental and behavioral health care services by increasing the number of adequately pre pared mental health and substance use health providers. • Expanding Residency Slots for Primary Care: To en courage more medical residents to pursue careers in primary care, the Affordable Care Act redistributed unused residency positions and directed those slots for the training of primary care physicians. In distributing the residency slots, priority for awarding residents was given to hospitals that have rural training tracks, train residents in geriatrics, are using the additional slots to create or expand a primary care program, demonstrate focus in training residents to pursue careers in primary care, or serve a primary care health professional short age area. • Expanding Training of Advanced Practice Nurses: The Affordable Care Act allows up to five hospitals, named last year, to receive $50 million each year after a com petitive application process, for fiscal years 2012 to 2015, to train advanced practice nurses, including nurses in community-based settings.

Modernizing Primary Care Training and Practice

PAGE 27

Oklahoma D.O. | December 2013

• Creating Primary Care Payment Incentives: The Affordable Care Act authorizes a 10% Medicare payment bonus from 2011 to 2015 for physicians who specialize in family medicine, internal medicine, geriatric medicine, or pediatric medicine, nurse practitioners, clinical nurse specialists, or physician assistants for whom primary care services account for at least 60 percent of their Medicare allowed charges. The Affordable Care Act also increases primary care physician payment rates in the Medicaid program to match Medicare payment levels in 2013 and 2014. • Realigning financial incentives in Accountable Care Organizations (ACOs): Under old payment systems, care coordination – the hallmark of effective primary care – wasn’t rewarded financially. Medicare’s shared savings program changes that model by rewarding physicians and other primary care practitioners for high-quality care and preventing the need for care in the first place. Already, more than 250 ACOs have joined one of the ACO programs offered by CMS. 220 ACOs have joined the permanent shared savings program. CMS has also created two demonstration programs to supplement the shared savings program: the Pioneer ACO initiative for 32 large and experienced health systems ready to move into accountable care quickly; and the Advanced Payment ACO, for smaller practices that need help with startup costs. To gether, these initiatives are improving primary care for nearly 4 million people with Medicare. • Innovation Center: The Center for Medicare & Med- icaid Innovation has launched a number of initiatives involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 States, the District of Columbia, and Puerto Rico. Many of those are explicitly designed to promote primary care. o Comprehensive Primary Care Initiative: A public-private multi-payer partnership in which Medicare is working with commercial and state health insurance payers to strengthen primary care. 497 practices repre senting approximately 2,300 providers are providing enhanced primary care services for an estimated 315,000 Medicare beneficiaries in 7 markets across the country. o Bundled Payments for Care Improvement: Under this initiative, health care organizations enter into payment arrangements that include financial and performance account- ability for episodes of care that will lead to improved quality of care and better coordinated care for Medicare beneficiaries. More than 400 health care organizations are participating across four broadly defined models of care.

Oklahoma D.O.

Implementation of the Affordable Care Act provisions is strengthening the primary care training infrastructure, creating new primary care clinical training opportunities, and supporting primary care practice. These efforts include: • Encouraging Physician Training in the Community: The Affordable Care Act provides incentives for hospitals to train primary care physicians in the community by providing flexibility in Medicare residency training requirements. Prior to the law, hospitals had to bear the cost of education in non-hospital sites, often by paying both the resident’s and teaching physi cian’s salary. This requirement discouraged training in community settings, which encourages primary care practice. The Affordable Care Act changed this policy and requires hospitals to only pay the resident salaries. • Encouraging Health Homes: Under the Affordable Care Act, States are incentivized to create Medicaid “health homes” for individuals with chronic health conditions. Health homes encour age the use of integrated care to help patients better manage their health. States that create health homes will receive enhanced federal matching funds for care coordination services for the first eight quarters a health home state plan amendment is in effect.

Modernizing Payment and Improving Financial Incentives for Coordinated Care

o Federal Qualified Health Center (FQHC) Advanced Primary Care Practice Demons- tration: This initiative makes approximately $42 million available over three years to support 492 FQHCs in 44 States with care coordination payments that will allow the FQHCs to become medical homes, the hub of a patient’s primary care needs. This initiative started in 2011. o Multi-payer Advanced Primary Care Practice Demonstration: Under this initiative, Medicare is participating in existing state multi-payer reform efforts that already include Medicaid and private health plans to make medical homes more broadly available. Launched in 2011, 8 states are currently participating in the initiative. o Independence at Home: This initiative sup- ports home-based care for patients with multiple chronic conditions that would benefit from primary care coordination. 15 independent physician practices and 3 consortia of additional physician practices are participating in the initiative to provide primary care services in the homes of up to 10,000 Medicare beneficiaries with complex health needs. o State Innovation Models: This initiative is providing up to $300 million for states committed to planning, designing, and testing new state-based payment and service delivery models. 6 states will be implementing their State Health Care Innovation Plan that describes their strategy of how it will reform its health care delivery system while 19 states are working to produce their plans. o Health Care Innovation Awards: This initiative is funding up to $2 billion in awards to organizations that are implementing the most compelling new ideas to deliver better care and lower costs for Medicare,

Medicaid, and Children’s Health Insurance Program (CHIP) enrollees. 107 participants are implementing innovative projects, including projects that focus on primary care delivery, across the country. A second round of Health Care Innovation Awards was re- cently announced to solicit proposals from a broad array of organizations in four defined categories, with an emphasis on outpatient care.

Oklahoma Osteopathic Political Action Committee (Double “O” PAC)

As the osteopathic family will be fighting yet again for funding for OSU Medical Center, the Oklahoma Osteopathic Political Action Committee (OOPAC) is more important than ever before. Our goal remains to sustain OSUMC through inclusion into the base as a recurring annual appropriation. The Oklahoma Osteopathic Association is the only osteopathic entity in Oklahoma lobbying on the profession’s behalf at the state capitol. The OOA and its political action committee, OOPAC, are crucial to the continued success of osteopathic medicine. The need to defend against scope of practice overreaches is at an all-time high. Therefore, we must recommit to OOPAC with renewed vigor. To contribute $250 to every state representative (101) and every state senator (48) each year, OOPAC must raise no less than $37,250 annually. This amount does not include enhanced contributions for legislative leadership, committee chairs, and the governor. Your investment in OOPAC is crucial to our continued success. The OOA would like to thank the following individuals for their financial support in 2013:

Oklahoma D.O. PAGE 28

TRACKING Oklahoma D.O. | December 2013

oklahoma w osteopathic w Political w Action w Committee

Premier PAC Partner ($501-$1000) Brian Allee, DO Michael K. Cooper, DO Duane G. Koehler, DO Tammie L. Koehler, DO Gordon P. Laird, DO Bret S. Langerman, DO Sharon K. Little, DO Tony A. Little, DO John C. Loose, DO Timothy M. Moser, DO Richard W. Schafer, DO Ryan W. Schafer, DO Christopher A. Shearer, DO Kayse M. Shrum, DO Layne E. Subera, DO

Contributed less than $250 Janice Bratzler Justin R. Bryant, DO Ronald M. Cable, DO Brooke Esteves, DO Susan J. Jones, DO Ryan T. Morgan, DO G. Lea Rollings, DO Rebecca L. Wright, DO

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Oklahoma D.O. | December 2013

Executive PAC Partner ($1001-$2499) Paul F. Benien, Jr., DO Kenneth E. Calabrese, DO Thomas J. Carlile, DO Thomas H. Conklin, Jr., DO Bobby N. Daniel, DO Dale Derby, DO Melissa A. Gastorf, DO Gregory H. Gray, DO Stanley E. Grogg, DO David F. Hitzeman, DO R. Randy Hunt, DO C. Michael Ogle, DO Gabriel M. Pitman, DO John F. Rice, DO LeRoy E. Young, DO

Oklahoma D.O.

committed to preserving medicine

Platinum PAC Partner ($2500+) Dennis J. Carter, DO

PAC Partner ($250-$500) Robert E. Baker, DO Howard Barnett, JD B. Eric Blackwell, DO Stephen G. Bovasso, DO Nancy A. Brown, DO Steven C. Buck, DO Mindy M. Bull, DO Michael R. Carney, DO Katherine D. Cook, DO Lora D. Cotton, DO Scott S. Cyrus, DO John S. Dennis, DO Larry J. Dullye, DO Perry W. Evans, DO Dean R. Fullingim, DO Lindell Gardner Terry R. Gerard, DO Gary E. Gramolini, DO Terence E. Grewe, DO Jeffrey S. Grove, DO John C. Hervert, DO Gregory A. Hill, DO David S. James, DO Jeremy L. Jones, DO Bobby Chu Kang, DO Beverly J. Mathis, DO Andrea E. McEachern, DO Trudy J. Milner, DO Karen Muse William J. Pettit, DO Paul B. Rock, DO Michael B. Shaw, DO Laurie Simmons, DO Joan E. Stewart, DO Christopher C. Thurman, DO Melvin J. Van Boven, DO Christos E. Vassiliou, DO Brad White, DO David R. White, DO Michael H. Whitworth, DO Sherri L. Wise, CPA Rudolph J. Wolf, DO

December Birthdays

Oklahoma D.O. PAGE 30

December 1 James D. Ford, DO Holly J. Patton, DO Richard R. Polk, DO Brad W. Stahlheber, DO

December 7 Amy C. Brownell, DO Amanda R. Cain, DO Kenneth E. Calabrese, DO Carla J. Jones, DO

December 2 Ray E. Bishop, DO Steven C. Buck, DO Janet E. Cheek, DO Benjamin O. Cornwell, DO Franklin J. Evans, DO Afsaneh Foroozan, DO Derek L. West, DO Jim M. Wiley, DO D. Matt Wilkett, DO

December 8 Joseph J. Back, DO Martha M. Barlow, DO Shawnaree L. Beeson, DO Joe D. Sagely, DO R. Jeff Wright, DO

December 3 Nolen Dale Anderson, DO Joanna J. Crawford, DO Anne Williams, DO December 4 Max Robert Cieminski, DO Chad E. Crawley, DO Stephanie D. Runyan, DO W. Todd Swearingen, DO December 5 G. Scott Jones, DO Terry M. Lee, DO Charles H. Mitchell, DO Brian A. Plaxico, DO Justin B. Plaxico, DO Robert L. Skelton, DO Andrew J. Sperling, DO Nathaniel D. Stetson, DO William F. Sturdevant, DO Jeremy D. Thomas, DO John D. Walton, DO December 6 Shannon P. Calhoun, DO George E. Freeman, DO Ronald L. Heim, DO Laura L. Miller, DO J.T. Oâ&#x20AC;&#x2122;Connor Jr., DO Gregory L. Wilson, DO

December 9 Steven G. Danley, DO Teresa J. Lynn, DO Mark A. Troxler, DO December 10 Corey R. Babb, DO John J. Chiaffitelli, DO David N. Chorley, DO Robin M. Mikel, DO Paul D. Morrison, DO Daniel Gregory Reiter, DO Vergil D. Smith, DO December 11 Deborah D. Archer, DO Mark S. Carlson, DO Sheryl E. Ghan, DO William B. Parsons, DO Dawn R. Tartaglione, DO December 12 Jerry C. Crain, DO David C. Crosswhite, DO Michelle L. Fugitt, DO Wm. Joseph Harrison, DO Scott T. Shepherd, DO December 13 Mitsi A. Faubion, DO Clint F. Kirk, DO Leon J. Yoder, DO December 14 Charles D. Black, DO Rebecca E. Burton, DO Bobby N. Daniel, DO David J. King, DO C. Patrick Sullivan, DO

Oklahoma D.O. | December 2013

December 15 Nancy A. Brown, DO Jay K. Johnson, DO Brian G. Ogg, DO Nghia T. Phan, DO Paul B. Rock, DO Ray E. Stowers, DO

December 20 Earl U. Bachenberg, DO Ashley K. Burdex, DO Semira Charboneau, DO Dawn Rachelle Davis, DO Donna L. Schneider, DO Carol M. Sherman, DO

December 16 Frances F. Haas, DO Stacey W. Hedlund, DO Rod F. Linzman, DO Mona J. Motz, DO Sean E. Neely, DO JoAnn G. Ryan, DO Julie M. White, DO

December 21 Robert J. Breckenridge, DO D. Kirk Depriest, DO Gary W. Hillman, DO Marilyn L. Hines, DO Eric S. Lee, DO Theodore A. Mickle, DO Neal W. Siex, DO

December 17 Melinda R. Allen, DO James David Campbell, DO Brian C. Diener, DO Tom W. Ewing, DO Tamara J. Holloway, DO Vernon L. Jenkins, DO Daniel W. Langley, DO Terrance P. McDermott, DO

December 22 Sheila S. Newcomb, DO Kyra K. Vineyard, DO

December 18 Shannan Bond, DO R. Brian Hightower, DO Mary K. Mercer, DO Caroline E. Merritt-Schiermeyer, DO Heidi Metheny, DO Thomas H. Osborn Jr., DO Shannon L. Reed, DO Jana L. Wilkins, DO Robert C. Williams, DO

December 24 Ellen R. Basile, DO Traci L. Carney, DO Martin J. Davis, DO Wilmer D. Fast, DO Victor R. Palomino, DO Julie A. Riddle, DO December 25 Peter C. Chambers, DO Holly B. Costner, DO Jeremy S. Fullingim, DO Valerie N. Ritter, DO Alyson B. Willis, DO

December 27 Troy A. Glaser, DO Laurel M. Jordan, DO Jack R. Lamberson, DO Chriss B. Roberts, DO December 28 Steven D. Baker, DO Kimberly J. Bennett, DO Colony S. Fugate, DO E. Kim King, DO James D. Smith, DO Tim B. Truong, DO Connie M. Wilson, DO H. Stan Wood, DO Linda K. Youngberg, DO December 29 Kristopher R. Avant, DO Eric T. Lee, DO Michael Owens, DO December 30 Mark E. Blubaugh, DO E. Michael Callery, DO Gerry P. Holland, DO Sarah J. Passmore, DO Theron A. Risinger, DO Gregory M. Schmidt, DO December 31 Ronald Fried, DO Robert W. Nebergall, DO Victoria E. Pardue, DO Joseph E. Wolf, DO

Oklahoma D.O. | December 2013

PAGE 31

The OOA wishes a very happy birthday to all of our DOs who celebrate their birthday this month!

Oklahoma D.O.

December 19 Patricia A. Costner, DO J. Aaron Henley, DO

December 23 Sean D. Boone, DO Homer N. Flora Jr., DO Benjamin K. Getter, DO Brent W. Henderson, DO Joseph C. Nemcok, DO Erik E. Paulson, DO W. W. Stoever, DO

December 26 Kevin M. Pargeter, DO Michael J.Simulescu, DO

What DO’s Need To

KNOW

New and more robust HealthCare.gov tools to help you enroll Here are some of the new features you’ll find on HealthCare.gov: More robust window shopping. You can now see detailed information about each Marketplace health insurance plan offered in your area before you apply. This new tool will allow you to see plan prices displayed much more accurately, based on the household information you supply. You can compare plans, covered benefits, physician and hospital networks, and more. No login or application required. Just answer a few simple questions to see plans and prices in your area. You will still need to complete the application to find out how you can get lower costs, but this is a much enhanced version of earlier information and one more way you can get the information you need to help you get ready to enroll and find a plan that fits your needs and budget. You can remove problem applications. If you’ve experienced problems filling out your online application, you can start over with a brand new application. To do this, you’ll first need to log in to your account; select your current application; and then choose to “Remove” the application. You will then need to close out your web page and then log back in using your same account. You can then start a brand new application. Get help enrolling online, on the phone, or in person. You can get help where and when you need it. For example: You can start an application online and then call 1-800-318-2596 (TTY: 1 855-889-4325) 24 hours a day, 7 days a week to get help enrolling over the phone. You can also find in–person help from certified assisters in your area. Just enter your zip code to get started. You can apply offline and continue your enrollment online. If you submitted a paper application or applied over the phone, you can create a Marketplace account to pull up your eligibility determination and complete your enrollment. To do this, you’ll need your application identification number, and you can contact the call center to get it if you don’t know it. Direct enrollment in a Marketplace plan. Many insurers are now offering the opportunity for you to enroll directly in a Marketplace plan with that company, whether through the insurance company’s website, an agent or broker, or an online health insurance seller. These new functionality improvements are in addition to the hardware and software improvements we’ve made over the past eight weeks to improve the consumer experience, increase capacity, and ensure that you can successfully move through the entire enrollment process. We’ll continue to make improvements to HealthCare.gov in the weeks and months ahead, and we encourage you to come back and explore your new coverage options. You have until December 23 to enroll in health coverage that can start as soon as January 1, 2014, and the Marketplace Open Enrollment period runs until March 31, 2014. Here are some shopping tips to get you started

Oklahoma D.O. PAGE 32

Blog is live at https://www.healthcare.gov/blog/new-and-more-robust-healthcare-gov-tools-to-help-you-enroll/ Committees approve Medicare physician payment reform legislation News from the American Osteopathic Association: The U.S. Senate Finance Committee and the House Ways and Means Committee each met December 12, 2013, to consider legislation that, if signed into law, would permanently reform Medicare’s physician payment system. In its place, the proposals would create a system that adequately values physician services, rewards physicians who strive to provide higher quality care, and promotes the development and expansion of innovative payment models as the path forward. It would also prevent the more than 20 percent physician payment cut on Medicare services from taking effect on Jan. 1, 2014. Unfortunately, the full House and Senate will not be able to consider the legislation with the limited time remaining in 2013. In order to allow more work on the bill in early 2014 and to prevent the impending payment cut, Congress is expected to consider a threemonth payment proposal. Visit the Every Patient Counts website to send a letter to your elected officials supporting payment reform. When on the site, access educational materials on the detrimental impact of the current payment system and share stories about your Medicare experiences. Oklahoma D.O. | December 2013

Oklahoma D.O. PAGE 33

Oklahoma D.O. | December 2013

Doctor of the Day at the State Capitol

The Oklahoma Osteopathic Association (OOA) will sponsor the Doctor of the Day Program during the month of March 2014 at the Oklahoma State Capitol. This is the 40th year osteopathic physicians have provided this service at the State Capitolâ&#x20AC;&#x2122;s First Aid Station during the legislative session. The Doctor of the Day program allows DOs to bring osteopathic medicine directly to policymakers. Physicians are needed to serve in March on Mondays, Tuesdays & Wednesdays from 8:30am-4:00pm and on Thursdays from 8:30 am-noon. Each doctor can expect to see a handful of patients. If you are interested in volunteering, please contact Matt Harney at the OOA (405.528.4848 or matt@ okosteo.org) or complete and fax the form below to 405.528.6102 no later than January 15, 2014. We'll ensure you're introduced in both the House and Senate chambers. Thanks in advance for helping make this program a success!

Yes! I want to participate in the Oklahoma Osteopathic Association Doctor of the Day Program! Name:________________________________________________________________________________ Office Telephone:____________________________________ Email:_____________________________ Home Address:_________________________________________________________________________

Oklahoma D.O. PAGE 34

City, State, Zip:_________________________________________________________________________ internal use

State Senator:_______________________________________________ District #:___________________ House Member:______________________________________________District #:___________________ I prefer to serve on

Monday

Tuesday

Wednesday

Thursday

does not matter

Please fax this form to the Oklahoma Osteopathic Association Central Office at: 405.528.6102 no later than January 15, 2014. Oklahoma D.O. | December 2013

The Journal of the Oklahoma Osteopathic Association

OKLAHOMA

May/June 2012 May/June 2013

D.O.

2013-2014 Directory Order Form I would liked to order______ copies of the 2014 directory @ $55 per directory. Shipping and Handling is not included in the price, please call for pricing (405) 528-4848 or (800) 522-8379 PAYMENT INFORMATION: 1 I have enclosed a check in amount of $__________. 1 Please bill my credit card

Check card type: ______VISA ______MC ______AMX ______ DSC_____

Card Number:_____________________________________________

Name on Credit Card: _______________ _______________________ Signature: ___________________________Exp. Date____________

BILLING INFORMATION:

Company: __________________________________________________________ Contact Person: _____________________________________________________

Address: ___________________________________________________________

City: _____________________________________ State: _______ Zip: _________

Phone: ________________________________ Email: _______________________

Please return form by mail or fax

Oklahoma D.O. | December 2013

FAX TO: (405) 528-6102

PAGE 35

Mail: 4848 N. Lincoln Blvd. Oklahoma City, OK 73105-3335

Oklahoma D.O.

CENTER FOR HEALTH SCIENCES David F. Hitzeman, DO, FACOI, Editor Professor of Medicine Department of Internal Medicine Burkitt’s Lymphoma in a Patient with HIV Infection Steve Dixon, DO Internal Medicine Resident Oklahoma State University Medical Center Jeffrey S. Stroup, PharmD, BCPS Associate Professor of Medicine Oklahoma State University Center for Health Sciences Mousumi Som, DO, MS Assistant Professor of Medicine Oklahoma State University Center for Health Sciences

Oklahoma D.O. PAGE 36

Johnny R. Stephens, PharmD Associate Professor of Medicine Oklahoma State University Center for Health Sciences

BACKGROUND Burkitt’s Lymphoma (BL) is a form of B-cell lymphoma that is rarely seen in the United States. But, it is noted to have a higher rate of occurrence in patients infected with human immunodeficiency virus (HIV). As the highly active antiretroviral therapy (HAART) era continues to evolve and HIV positive patients live longer, the occurrence of BL may increase. BL is a particularly aggressive form of lymphoma and proper action is needed to ensure a good prognosis. We present a case of a well controlled HIV positive male that presented with BL. CASE REPORT A 53 year-old African American male was seen at the outpatient clinic with a chief complaint of diffuse body pain after receiving amoxicillin from his primary care physician for a chest infection. Within the first few hours of taking this antibiotic, he started having pain as well as nausea. The

Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998

pain was located in his chest, thighs, buttocks, back, and shoulders. He described it as a pressure and was 10/10 in intensity at its worst. Hydrocodone and hot showers only temporarily relieved the pain. Nothing seemed to aggravate the pain. In addition, two days prior to his arrival, he began vomiting. He denied hematemesis or coffee ground emesis. He reported decreased oral intake over the last two days as well.

of 10.6 g/dl and a platelet count of 85,000 cells/mm3. One month prior, his platelet count was 325,000 cells/mm3. A lactate dehydrogenase (LDH) was found to be elevated at 8,475 units/L.

Past medical history was significant for HIV and hypertension. His HIV was controlled, with a CD4 count of 415 cells/mm3 and undetectable viral load. His HAART therapy consisted of abacavir/lamivudine and efavirenz. At the time of presentation, he was not taking any medications for hypertension.

Taking into consideration the patient’s HIV status and his HAART therapy, there was initial concern that the patient might be suffering from a hypersensitivity reaction to abacavir/lamivudine or developing immune reconstitution syndrome. Review of the medical records noted a negative HLAB*5701 allele which is linked to abacavir hypersensitivity. The patient’s CD4 count had never been below 300 cells/mm3, therefore immune reconstitution was low on the initial differential.

Surgical history consisted of an incision and drainage procedure of a right axillary lymph node the previous year as well as some minor surgeries in the distant past. Socially, the patient had a 15-pack-year smoking history and denied any alcohol or drug use. He was currently on disability from being a construction worker.

With the history of fluctuating fevers and elevated LDH, the concern for lymphoma or indolent infections was high. The patient underwent a computed tomography (CT) scan of the chest, abdomen, and pelvis. These were all negative for overt malignant features. Viral studies indicated a positive Epstein Barr serology with an elevated ratio.

In a review of systems, it was noted that the patient had noticed a 25 pound weight loss over one month. He also complained of night sweats, subjective fevers, and overall weakness.

The patient’s LDH continued to trend upwards and blast cells were noted on peripheral smear that were not noted on initial presentation. Hematology/Oncology was consulted. It was suggested that the patient undergo a bone marrow biopsy. This was attempted at 4 different sites, but no aspirate was able to be obtained. However, a core biopsy was retrieved, which demonstrated packed marrow as well as areas displaying necrotic marrow.

The patient’s vitals showed a pulse of 114 and a blood pressure of 146/76 mmHg. The rest of the exam was relatively benign except for a profound weakness that was exhibited by the patient against examiner resistance. The patient demonstrated no palpable adenopathy, hepatomegaly, or splenomegaly. Review of labs showed a metabolic profile that was within normal limits. He displayed a normocytic anemia with a hemoglobin

As the patient’s hospital stay continued, he started to complain of headaches and appeared to also be experiencing nuchal pain as well. A lumbar puncture was recommended. Prior to the lumbar puncture, a

Oklahoma D.O. | December 2013

CT scan of the brain was performed and this was found to be negative. The cerebral spinal fluid (CSF) from the lumbar puncture was found to be xanthochromic and the fluid was bright yellow. The protein count was approximated to be 4500 and white blood cell and red blood cell counts could not be calculated. Further studies of the CSF showed 25 blasts cells. The patient began experiencing diplopia. Examination showed a developing cranial nerve III palsy, that was not present on the initial exam. At this point, Neurology was consulted and the patient underwent a magnetic resonance imaging (MRI) of the brain, cervical spine, thoracic spine, and lumbar spine. The results of these showed diffuse enhancement of the meninges throughout the spine. This was concerning for infective meningitis or a lymphoma type process. Given his worsening clinical signs and increasing LDH, Infectious Disease was consulted. Concern for an infectious etiology prompted a second lumbar puncture by Interventional Radiology under fluoroscopic guidance which resulted in no volume of CSF being obtained.

Oklahoma D.O. | December 2013

DISCUSSION Epidemiology: Burkitt’s Lymphoma is an aggressive form of B cell non-Hodgkin lymphoma. It is a development of B cells and it is dependent on the over expression of c-MYC oncogene located on chromosome 8. There are three basic variants of the disease. These include endemic, sporadic, and immunodeficiency derived. Endemic pertains to a localized spread in the equatorial regional aspects of Africa and New Guinea (1). This generally affects children ages 2 to 9, rarely affecting individuals above the age of 35 (2-3). It is characterized by the facial skeleton abnormalities associated with this form of the disease (3). Sporadic BL refers to cases of BL that happens primarily in United States and Europe. These cases represent about 30% percent of childhood cases of lymphoma in the United States and less than 1% percent of nonhodgkin lymphoma cases (4). These patients

The final category is immunodeficiency derived. It is primarily seen in the HIV population, who typically have a CD4 count greater than 200 cells/mm3(6). Patients suffer from symptoms representative of their underlying immunodeficiency, but often times present with lymph node, bone marrow, and central nervous system involvement. These patients generally have been infected with HIV infections for longer periods of time and CD4 count are generally above what is associated with AIDs defining illnesses. Older age and severe immunodeficiency are other risk factors (7,8). With the introduction of HAART, the incidence of non-Hogkin’s lymphoma has decreased among HIV infected patients. However, the rate of Burkitt’s Lymphoma has not shown the same decline (9-10). Interestingly, Burkitt’s Lymphoma may now be the initial AIDs defining illness seen in patients due to the fact that the occurrence of other opportunistic infections such as Pneumocystis jiroveci pneumonia, Candida esophagitis, and cytomegalovirus infection have decreased in frequency(11,12) Morphology: As previously stated, BL occurs from an over expression of c-MYC. C-MYC is specifically located at chromosome 8q24. This region encodes the MYC transcription factor. It is not clear what causes the B-cells associated with BL to have the c-MYC defect. It is agreed that nearly all endemic cases involve chronic Epstein-Barr virus infection and a minority of sporadic (20%) and immunodeficiency derived cases (30%-40%) are known to be chronic EBV carriers (3,13). From a morphology standpoint, BL tumor biopsies have a “moth eaten” appearance, usually representing areas of hemorrhage and necrosis. Further investigation demonstrates the classic “starry-sky” presentation made by benign histiocytes that have ingested apoptotic tumor cells on the backdrop of basophilic tumor cells. At higher power fields, BL cells are noted for being medium sized, monomorphic, round nuclei, and possess a basophilic cytoplasm(5). Further

PAGE 37

The patient was then transferred to the intensive care unit and placed on rasburicase for potential tumor lysis syndrome. The patient’s HAART therapy was also restarted. While in the ICU, the patient’s clinical pic-

The patient’s LDH started trending down and fell below 10,000 units/L after his first few chemotherapy treatments. After the patient was stabilized, his primary care hospital network asked if he could be transferred to their system since his benefits were primarily through them. Given his medical improvement, it was felt that the patient was stable enough for transfer. It was recommended that the patient be transferred to a facility with neurosurgery in case an Ommaya reservoir was needed as well as a facility with radiation therapy capabilities. Both of these recommendations were available at the accepting facility and the patient was transferred. At that facility, the patient clinically worsened and passed away three months after the initial presentation of BL.

present with abdominal involvement. They can also have skeletal, bone marrow, kidney, and central nervous system involvement (5).

Oklahoma D.O.

On the fifth day of admission, the patient showed significant worsening of his laboratory data as well as clinical decline. His LDH reached 25,000 units/L and his platelet count continued to fall. He also started to develop hypercalcemia and hyperphosphatemia. The patient’s diplopia and ptosis started to worsen and overall the patient stated he started feeling much worse. In conjunction with Oncology, it was decided that the patient was likely suffering from a high-grade lymphoma process. This was most consistent with Burkitt’s Lymphoma. Given the mortality of the disease, it was felt the patient would benefit from chemotherapy. The patient was started on cyclophosphamide, mesna, dexamethasone, and intrathecal methotrexate for Days 1 through 3. Vincristine was added for Day 4 along with doxorubicin.

ture improved. His diplopia improved and overall he stated he felt much better. His creatinine, however, did increase to 1.79 mg/ dl. Nephrology was consulted and agreed to continue hydration with an alkaline based fluid as well as the continuation of the rasburicase. There were some episodes of hyperglycemia that were likely secondary from the decadron infusions. This was controlled on an intravenous insulin drip.

Oklahoma D.O. PAGE 38

diagnostic studies show tumor cells with CD19, CD20, CD22, and CD79a positivity (13). Staging: Much controversy has occurred over the years in regards to the staging of Burkitt’s Lymphoma. Originally, the Ann Arbor system was utilized. However, as new trials were developed, authors felt this system did not incorporate all of the pertinent prognostic factors. The St. Jude/Murphy Staging system was developed. However, this was developed at the time when chemotherapy was not the mainstay of treatment and surgery was used for both diagnostic as well as treatment (5,14). Treatment: The treatment of BL is chemotherapy based. There are three main chemotherapy approaches to treatment. The first is an intensive, short-course combination regimen. The second is an acute lymphoblastic leukemia (ALL) approach involving induction, consolidation, and maintenance that has a longer course. The final approach is combination therapy followed by high-dose regimen and hematopoietic cell transplant.

attention. Tumor lysis syndrome is a highrisk side effect with treatment and the use of alkalinized IV fluids with or without rasburicase is generally beneficial for prevention (16). Of particular interest, is the treatment in regards to immunosuppressed BL, particularly HIV associated BL. In the pre-HAART era, it was thought that less intense regimens would be most beneficial taking into account the patient’s underlying poor immunologic response. However, with HAART there appears to be more reserve. Recent trials have demonstrated that the more intense, shorter duration treatments have improved outcomes in this population (13,17). Further complicating the picture, is the controversy surrounding the concurrent use of HAART therapy while undergoing chemotherapy. Several authors argue that while HAART will allow for increased immune system response, it could interact with the individual chemotherapy agents, altering their effect (15,18). However, newer HAART drugs are on the market with fewer side effects. Further studies need to be conducted to evaluate the outcomes when combined with chemotherapy regimens.

The ALL approach was used initially. Most of these routines were CHOP based (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) and were found to have low cure rates (15). This was likely due to BL’s rapid turnover and the lapses of treatment for recovery with the traditional approach. BL is known to have a high growth fraction and this type of treatment might enable resistance (5).

The use of rituximab to treat BL has been gaining ground, but is still controversial in regards to treating immunosuppressed/HIV associated BL. Certain studies have demonstrated an increase in infections and severe mucositis in this population (19). Other small trials have shown the results to be comparable to non-HIV related BL, even when taking into consideration the sideeffects (20)

Intensive, short-course treatments have become increasingly utilized. These regimens consist of hyperCVAD base (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) or CODOX-MIVAC base (cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate combined with ifosfamide, cytarabine, etoposide, and intrathecal methotrexate). Both hyperCVAD and CODOX-M-IVAC can be combined with the monoclonal antibody rituximab (15).

Prior to treatment, especially in the HIV population, a comprehensive medical history and exam should be performed. This should include lab work and a detailed history. In the HIV patient, a detailed history in regards to time of infection, history of opportunistic infections, and HAART treatment history need to be elicited. CT scan of the chest, abdomen and pelvis should be conducted to evaluate for any other missed pathology. Also, evaluation of the patient’s CSF via lumbar puncture should be completed (15).

As in any chemotherapy routine, there is a need to tailor each regimen for each individual patient. CNS involvement, heart disease, and the elderly all require special

CONCLUSION BL is a rare disease in the United States. However, it is a particularly aggressive form of lymphoma with a poor prognosis if not discovered and treated appropriately. In the HAART era, HIV patients are living longer and the increased occurrence of BL in this population is a real concern. It is important to understand the disease and know treatment options to avoid potential dire consequences.

REFERENCES

1. Ogwang MD, Bhatia K, Biggar RJ, Mbulaiteye SM. Incidence and geographic distribution of endemic Burkitt lymphoma in northern Uganda revisited. International Journal of Cancer 2008; 123:2658.

2. Boerma EG, van Imhoff GW, Appel IM. Gender and age-related differences in Burkitt lymphoma- epidemiological and clinical data from the Netherlands. European Journal of Cancer 2004;40:2781.

3. Orem J, Mbidde EK, Lambert B, et al. Burkitt’s lymphoma in Africa, a review of the epidemiology and etiology. African Health Sciences 2007;7:166.

4. Morton LW, Wang SS, Devesa SS, et al. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 2006; 107:265.

5. Blum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood 2004; 104:3009.

6. Guech-Ongey M, Simard EP, Ander- son WF, et al. AIDS-related Burkitt lymphoma in the United States: what do age and CD4 lymphocyte patterns tell us about etiology and/or biology? Blood 2010; 116:5600.

7. Pederson C, Barton SE, Chiesi A, et al. HIV related non-Hodgkin's lymphoma among European AIDS patients. AIDS in Europe Study Group. European Journal of Haema- tology. 1995;55:245-250.

Oklahoma D.O. | December 2013

8. Grulich AE, Wan X, Law MG, et al. B-cell stimulation and pro- longed immune deficiency are risk factors for non-Hodgkin’s lymphoma in people with AIDS. AIDS. 2000; 14:133.

12. Mocroft A, Sabin CA, Youle M, et alChanges in AIDS-defining illnesses in a London Clinic, 1987- 1998. Journal of Acquired Immune Deficiency Syndrome.1999;21: 401-407.

13. Perkins AS, Friedberg JW. Burkitt 9. Appleby P, Beral V, Newton R, Reeves Lymphoma in Adults. Hematology G. Highly active antiretroviral therapy 2008; 341-348. and incidence of cancer in human immunodeficiency virus-infected adults. 14. Ferry JA. Burkitt’s Lymphoma: Clini- Journal of the National Cancer Insti- copathologic Features and Differen- tute 2000; 92:1823. tial Diagnosis. The Oncologist 2006;11:375-383. 10. Lim ST, Karim S, Nathwani BN, et al. AIDS-Related Burkitt's Lymphoma 15. Dunleavy K, Wilson WH. How I treat Versus Diffuse Large-Cell Lymphoma HIV-associated lymphoma. Blood in the Pre–Highly Active Antiret- 2012;119: 3245-3255. roviral Therapy (HAART) and HAART Eras: Significant Differences 16. Goldman SC, Holcenberg JS, in Survival With Standard Chemother- Finklestein JZ, et al. A randomized apy. Journal of Clinical Oncology comparison between rasburicase 2005;23:4430-4438. and allopurinol in children with lymphoma or leukemia at high risk for 11. Hogg RS, Heath KV, Yip B, et al. tumor lysis.. Blood. 2001;97:2998- Improved survival among HIV-infect- 3003. ed individuals following initiation of antiretroviral therapy. JAMA 17. Kasamon YL, Swinnen LJ. Treat- 1998;279:450-454. ment advances in adult Burkitt lymphoma and leukemia. Current Opinion in Oncology 2004; 16: 429- 435.

18. Ratner L, Lee J, Tang S. Chemothera- py for Human Immunodeficiency Virus–Associated Non-Hodgkin’s Lymphoma in Combination With Highly Active Antiretroviral Therapy. Journal of Clinical Oncology 2001; 19: 2171-2178.

19. Oriol A, Ribera JM, Bergua J, et al. High-dose chemo-therapy and im- munotherapy in the adult Burkitt lymphoma: comparison of results in human immunodeficiency virus- infected and noninfected patients. Cancer 2008;113:117-125.

20. Barnes JA, LaCasce AS, Feng Y, et al. Evaluation of the addition of rituximab to CODOX-M/IVAC for Burkitt's lymphoma: a retrospective analysis. Annals of Oncology 2011; online publication doi:10.1093/an nonc/mdq677.

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Professional Liability Insurance & Risk Management Services ProAssurance Group is rated A+ (Superior) by A.M. Best. ProAssurance.com • 800.282.6242

Oklahoma D.O. | December 2013

Bureau News: Bureau on Postgraduate Education Residents: quirements n ow available at www.oko steo.org!

Submission re

5th Annual

ROGME Poster Symposium Research in Osteopathic Graduate Medical Education

Showcase your research during the Oklahoma Osteopathic Association’s 114th Annual Convention April 24-27, 2014, in Norman, Oklahoma.

Cash prizes! $1,500 First Place $1,000 Second Place $500 Third Place

Abstracts due January 27, 2014 Posters due February 10, 2014 Winner’s Presentation April 26, 2014

Sponsored by the Oklahoma Osteopathic Association Bureau on Postgraduate Education Melissa A. Gastorf, DO, Bureau Chair • Dale Derby, DO, Symposium Chair

Bureau on Membership The OOA Board of Trustees welcomes the following new members to the OOA family! Fiorella Avant, DO General Practice (Oklahoma City)

2014 Proposed OOA Bylaw Amendments

The proposed Bylaws amendments will be voted on during the Association’s annual business meeting at 2:00 pm, Thursday, April 24, 2014 at the Norman Embassy Suites. During the December 5, 2013, meeting, the OOA Board of Trustees approved the following revisions to the OOA Bylaws and Constitution. According to the OOA Bylaws, Article IX. Amendments, the Bylaws may be amended by this Association at any annual session by a two-thirds vote of the accredited voting members in attendance at such session... Article VII, Section 5: Charters must be renewed on an annual basis and may be revoked by the Oklahoma Osteopathic Association Board of Trustees for just cause. Revocation requires a three-fourths vote of the Board of Trustees favoring such action. Article VII, Section 6: Upon application from an organization for a charter as an affiliated organization, the Board of Trustees and the Executive Director shall investigate and, upon satisfactory proof of a general agreement in policy and governing rules with those of this Association, shall may proceed with the issuance of such a charter. The Association shall may not issue a charter to any organization which duplicates the function or prerogatives of any presently affiliated organization or the Association. All organizations, who have as their membership osteopathic physicians in good standing with the Oklahoma Osteopathic Association, whether holding a current charter or affiliation or not, shall have as a medium of communication all publications of the Oklahoma Osteopathic Association.

From the American Osteopathic Association Communications Department

Oklahoma D.O. PAGE 40

Stephanie L. Carner, DO Neonatology (Tulsa) Donald F. Swanson, DO Family Practice (Lindsay) Binh T. Phung, DO Pediatrics (Tulsa) Sarah L. Shepherd, DO Obstetrics & Gynecology (Tulsa)

HEALTH FOR THE WHOLE FAMILY “Combating Childhool Obesity” DOs and other members of the profession consider the American Osteopathic Association’s “Health for the Whole Family” series a great way to promote the profession and educate patients about a variety of health topics. To use this month’s article, you have permisson to simply make copies of the article (see page 41) for use in your office waiting room to help educate your patients about current health care issues. Oklahoma D.O. | December 2013

Combating Childhood Obesity Raising healthy children in today’s supersized and super busy world can be quite the challenge. From huge restaurant portions to disappearing gym classes, packed schedules to video games and social media, quick and easy has become the norm for many families. But recent studies report that an alarming 5% of U.S. children and teens are severely obese, putting them at risk for serious health problems like Type 2 diabetes, asthma, high blood pressure, and high cholesterol. Fortunately, there are many things parents can do to prevent their children from facing these health problems. Stanley E. Grogg, DO, an osteopathic pediatrician from Tulsa, Okla. has five easy tips for healthy parenting. Tip #1: Approach Healthy Eating the Right Way “How you discuss a child’s eating habits can make a huge difference in helping them make the right decisions,” says Dr. Grogg. When talking about nutrition, explain that healthy foods make their mind and body strong. “Kids tend to respond to that competitive edge. So whenever the opportunity arises, talk to them about the choices they can make to choose healthy foods; during grocery shopping, making dinner and at restaurants,” he says. And when you’re shopping for food, let them choose the healthy foods they like for meals. “The key is to give children some ownership over healthy meal decisions, which will make them more likely to make those same decisions in the future,” says Dr. Grogg. Tip #2: Stay on Track with Healthy Snacks It’s not just about healthy meals at breakfast, lunch and dinner. “What parents have available for snacking on in between meals is just as important,” says Dr. Grogg. Parents should try to focus snacks on maximum nutrition from fruits, low-sugar cereals, low-fat dairy products, vegetables, grains, and lean, unprocessed meats. Dr. Grogg recommends keeping plastic containers of cut-up fruit and veggies on a low shelf in the fridge so kids can easily see them. Other healthy snacks under 100 calories include: • Apple wedges with whole-grain crackers • 1 tablespoon almond butter spread on celery • Low-fat string cheese • Frozen bananas, cherries or grapes to substitute sugary desserts “Treats are fine in moderation, but limiting high-fat, high-sugar, or salty snacks is best,” Dr. Grogg adds. Tip #3: Get the Whole Family Moving “Children and teens need 60 minutes of moderate-intensity physical activity most days of the week and every day if possible,” says Dr. Grogg. “Physical activity strengthens bones, decreases blood pressure, reduces stress and anxiety, and increases confidence and self-esteem.” To integrate more movement into your family routine, Dr. Grogg recommends scheduling family physical activity time on a regular basis, like hikes, bike rides and active games. Grab some pedometers and see who can reach 10,000 steps first by the end of the day or plan a day for everyone in the house to do yard work together. If you set exercise goals for the family, Dr. Grogg recommends that you keep them modest at first so children don’t see exercise as punishment. Tip #4: Rethink that Drink “Kids who drink soda, energy and fruit drinks take in more empty calories than those who don’t, as well as sodium, tooth-decaying sugar and other additives,” says Dr. Grogg. He advises limiting sugary drinks to significantly reduce the number of calories consumed. Even 100% fruit juices contain a lot of calories.

Empower Your Kids According to Dr. Grogg, the best way to fight childhood obesity and weight problems is to get the whole family on board. Making better food choices and being more active will benefit everyone. “With thoughtful planning, support, encouragement, and positive role modeling, parents can play the most significant role in ensuring their children’s health,” Dr. Grogg concludes.

Oklahoma D.O. | December 2013

PAGE 41

Preventive medicine is just one aspect of care osteopathic physicians (DOs) provide. DOs are fully licensed to prescribe medicine and practice in all specialty areas, including surgery. DOs are trained to consider the health of the whole person and use their hands to help diagnose and treat their patients.

Oklahoma D.O.

Tip #5: Limit the Tech Time “All that inactive time spent texting and playing video games is a huge risk factor for obesity,” says Dr. Grogg. Encourage your children to find fun activities to do with family, pets, friends, or on their own that involve more physical activity and less screen time. You’ll also help them avoid mindless snacking. He advises no more than one or two hours per day of screen time, which includes the internet and video games.

Classified Advertising OFFICE FOR RENT: 1,500 square feet in an excellent area with high traffic count. Established location. Completely remodeled, very nice. Easy access from all areas of town, 7300 S Western, OKC. Rent is $1250 per month with all utilities paid. Please call Dr. Buddy Shadid 405.833.4684 or 405.843.1709. OFFICE BUILDING FOR SALE: 6501 S. Western, OKC, OK 73139. Over 1 1/2 acres total size, 10,000 sq ft building divided into 3 doctors offices. 1200 sq foot private office upstairs with private bathroom and shower. 2 double sided fireplaces, over a dozen chandeliers, rough wood cathedral ceilings. Alarm and phone system in place, double glass doors in entrance, back patio with separate storage building. Larger office is fully equipped with exam tables, Pap table, chairs, medical instruments, QBC (CBC) machine, autoclave, medical supplies, and much more. For information contact: Captain David Simpson at (405) 820-5360.

Oklahoma D.O. PAGE 42

CLINIC FOR SALE: By owner. Fully equipped: LAB, XRAY, EKG. Well established clinic, near Integris Southwest Medical Center is available for sale. Clinic is well equipped and is ideal for one or more physician practice as well as a variety of specialties. Clinic has: waiting room with refrigerated water cooler, wheelchair accessible restroom, reception and staff work stations, Nurses station, 5 - 7 exam rooms with sinks and running water, large multipurpose procedure room, 3 private offices with built-in bookcases, (One Office with 3/4 Bath), additional staff and patient restrooms, large upstairs (currently used for storage) and variety of other medical equipment. Misys Medical Software. Large Parking Lot. “Must See Inside” the all steel building located at 2716 S.W. 44th St. in OKC to appreciate the effort placed upon providing convenient and up to date medical care. PRICE IS NEGOTIABLE. Doctor prefers to sell, but would consider leasing. If interested, please call: Evelyn Francis at (405) 249-6945. IMMEDIATE OKLAHOMA OPPORTUNITY with largest family medicine clinic in Muskogee, Ok. Excellent opportunity to assume a practice that is up and running. Senior physician of four physician group leaving to pursue new career opportunities. 2,000 active patients need a physician. Two physicians currently practice OB. Surgical OB experience a plus. On site x-ray and CLIA certified lab. Nursing and support staff in place. Income guarantee. Be your own boss, work hard and practice family medicine in its historical tradition with respect and loyalty of small town patients. Contact Evan Cole, DO, 918-869-2456, ecoledo@yahoo.com, Brad McIntosh, MD, 918-869-7356, drbamc@yahoo.com Jason Dansby, MD, 918-869-7387, jasonddansby@yahoo.com or Judy Oliver, RN, practice administrator, 918-869-7357. (leave a message if temporarily unavailable) Find us on the web at www.mfpclinic.com.

JOB AVAILABILITY: A growing convenient care provider has part-time openings for licensed physicians (Family, internal, general, physical medicine & rehab, sports medicine, occupational, etc.) in our Tulsa and Oklahoma City area location. We provide primary care/immediate care medicine. Patients can drop in (no appointment necessary) to our locations and see a doctor for a wide range of primary care and family health needs, including diagnosis and treatment of common illnesses and injuries, in-house, diagnostic testing, occupational therapy, and physicals. We provide quality health care for patients who have been injured on the job or may have some illness. Providing flexibility in scheduling to meet your lifestyle and income needs. Benefits: We are offering very competitive salaries. If interested please contact Arnita (405) 6815800 or email her at:2149okc@gmail.com Clinic for sale in the Lake Texoma Area. Please call (580) 564-2143 ext. 4043 for further information or inquiries. STAFF PHYSICIAN NEEDED: The Oklahoma Department of Corrections is seeking applicants for Staff Physician at our correctional facilities statewide. The state of Oklahoma offers a competitive salary and benefits package which includes health, dental, life and disability insurance, vision care, retirement plan, paid vacation, sick days, holidays and malpractice insurance coverage. For more information and a complete application packet contact: Becky Raines 2901 N. Classen Blvd., Suite 200 Oklahoma City, OK 73106-5438 (405) 962-6185 FAX (405) 962-6170 e-mail: braines@doc.state.ok.us DOCTORS WANTED: to perform physical exams for Social Security Disability. DO’s, MD’s, residents and retired. Set your own days and hours. Quality Medical Clinic-OKC, in business for 16 years. Call Jim or JoAnne at 405-632-5151. PHYSICIAN NEEDED: The practice of Terry L. Nickels, DO is currently seeking a part-time Family Physician with OMT Skills to help cover the office. If interested please contact Dr. Terry Nickels at (405) 301-6813. IMMEDIATE NEED: FP/ER/OB Physicians, FT,PT and Temp. Bimonthly pay. Paid malpractice and expenses including mileage. To join our fast growing team call Krystal @ 877-377-3627 or send CV to kernce@oklahomaoncall.com. Oklahoma D.O. | December 2013

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Calendar of Events January 2, 2014 OOA Bureaus & Board of Trustees Meetings Oklahoma City, Oklahoma January 16, 2014 North Central District Meeting/CME Joseppi’s Italian Kitchen 223 E. Hall of Fame Stillwater, Oklahoma

February 20, 2014 Southern District Meeting/CME (Ardmore) March 3, 2014 Osteopathic Medicine Day at the State Capitol March 6, 2014 DO Day on the Capitol Hill in Washington DC

January 21, 2014 Northwest District Meeting/CME (Enid) Oklahoma D.O.

January 31-February 2, 2014 Winter CME Seminar: "ABC’s of LABS: What’s New, What’s Hot and What’s Not" Hard Rock Hotel & Casino Catoosa, Oklahoma

April 10, 2014 Southwestern District Meeting/CME (Lawton)

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Oklahoma D.O. | December 2013

Prsrt Std US Postage Paid Okla City OK Permit #209

OKLAHOMA OSTEOPATHIC ASSOCIATION 4848 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105-3335

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The Oklahoma Osteopathic Association has endorsed Rich & Cartmill, Inc. and Medical Protective since 1999 Please support your OOA and consider Rich & Cartmill, Inc. for your Professional Liability Insurance needs.

Oklahoma D.O. PAGE 44

For more information contact Scott Selman at 918-809-1461 or sselman@rcins.com

2738 E 51st Street, Suite 400 | Tulsa, OK 74105-6228 | 918.743.8811 | www.rcins.com

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SPRINGFIELD, MO Oklahoma D.O. | December 2013