13 dec newsletter

December SCMS The Message Open2

Table of Contents

2013 Officers and Board of Trustees Anne Oakley, MD President David Bare, MD, President-Elect

Wellness .

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Terri Oskin, MD Immediate Past President

Hot Spotters Tackle Overuse of Medical Services . . . . . . . . .

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Shane McNevin, MD Vice President

Childhood Trauma and the Road to Homelessness .

Matt Hollon, MD, Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Karina Dierks, MD Clinton Hauxwell, MD Charles Benage, MD J. Edward Jones, MD Louis Koncz, PA-C Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – David Bare, MD

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A new Star Rising in Emotional and Behavioral Care .

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Christ Clinic and Christ Kitchen .

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ESCAPE FIRE: The Fight to Rescue American Healthcare .

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What is a Community Health Worker? . . . . . . . . . . . . . 10 Eastern Washington Physician Health Committee .

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Committee Signup Form 2014 . . . . . . . . . . . . . . . . 13 Guest Editorial: The Challenges of Evolving Technology . . . . . . 15

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society.

Advertising Correspondence SCMS Publications Attn: Lisa Poole 518 S. Maple Spokane, WA 99204 509-343-0123 Fax 509-325-3889 lisap.scms@gmail.com All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

Mann Grandstaff VA Medical Center Growing and Serving .

New Physicians .

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Membership Recognition for December 2013 .

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Positions available .

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Eastern Washington Physician Health Committee .

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Continuing Medical education / Meetings / Conferences / Events . . . 21 Real Estate . . . . . . . . . . . . . . . . . . . . . . 22 medical offices / buildings .

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is the time for comfort, for good food and warmth , for the touch of a friendly hand and for a talk beside the fire: it is the time for home.”

– E dith Sitwell

December SCMS The Message Open3

Wellness

By Anne Oakley, MD It’s the holiday season. Is everyone feeling cheery and bright? This has been quite the year for medical practitioners! A stressful year. Sorting out the implications of the Affordable Care Act (ACA) has been an issue for many, especially those still in private practice. Surviving the implementation of electronic record keeping throughout the numerous locales in the community has been even more stressful. So much stress, so many unknowns and at the root of it all, the feeling of complete loss of control. I know I am not alone in feeling like the “system” is completely in control of our lives, and it is not a feeling I enjoy.

At the risk of making biased political commentary, the stumbling roll out of the ACA is no big surprise. All of us already know that the most difficult payers to deal with in our practices are the government payers--ridiculous amounts of unnecessary red tape at every step. That being said, health insurance for all Americans is an undeniable necessity. Physicians and patients really want to know how this new law will affect them personally, and the answers seem a long way off. How “affordable” can ever fit in with the American attitude of “give me everything I want but don’t expect me to pay for it” is another issue. There really cannot be an affordable plan that does not restrict some services, but “rationing” is such an onerous idea to patients, doctors and politicians (to whom even the word is viewed as career suicide), that the middle ground for success is a long way off.

Enough politics. The most recent burden facing a large portion of our medical community currently is the roll out of Epic in the Providence hospitals, which affects everyone, even those who rarely refer to a Providence hospital. With the Epic rollout a week behind us at time of writing, and I can only describe

my colleagues’ faces as “drained”. The week started with cheery energy and has deteriorated to the point of cursing on the part of even the most reserved practitioners. Why is it so hard? Not the work, not learning new things. It is the feeling of incompetence. As health care providers, we hate not being good at what we do. The stakes are so high when we get distracted from the real job of caring for our patients that most of us are losing sleep. We hate the loss of control--at every turn we are being told “sorry, that cannot be done that way in Epic” or “sorry, you just spent an hour on that and it is wrong.” It will assuredly sort out over time, I just hope patient care does not turn out to be the big loser in the efforts to make data sharing and billing more convenient.

So what do we do with all this stress? Hide, kick the dog, go on vacation, eat too much, drink too much, retire? We should probably do exactly what we would tell our patients to do: relax, exercise, eat and drink healthily, sleep regular hours and get help if you need it. The county and state medical societies have resources for their members. Use them and do not fall victim to deteriorating mental health due to denial and refusal to admit that this is a serious problem. Physicians are statistically one of the worst groups for obtaining help in those arenas because we are always sure we are in control! Sometimes life really is too hard, and it is okay to admit it.

Thanks for listening to my ramblings for the past year. I am afraid now that I know I can always vent in this newsletter, you may not be done hearing from me! Never forget, you can vent here too!! A special salute to Michelle Caird for her work on this publication and an extra thanks to my son, Grant, who has graciously edited my work. (He claims I have improved.) I was a math major in college to avoid writing papers, so it was a challenge for him. Thanks to you all!

Happy Holidays to one and all.

The local salary and benefit survey is back!

Please log on to the Inland Northwest Medical Group Management Association (INMGMA) website to download the survey and send completed survey to Kris Linden by January 15, 2014. Participants receive results free of charge. If you have any questions, please contact Kris Linden at klinden@inwhealth.net or (509) 624-2431.

December SCMS The Message 1

Hot Spotters Tackle Overuse of Medical Services

By Shawn Vestal The Spokesman-Review Reprinted by permission October 26, 2013 Spokesman Review Randall Sluder has laid his head in a lot of downtown spots over the past 13 years. Few were comfortable, and few his own.

He spent a lot of nights simply wherever he could – or, more to the point, wherever he ended up, so drunk he couldn’t remember.

Doorways, hallways, anywhere he could find. Fire crews hauled him to the emergency room more than 50 times last year.

“I’m a habitual trespasser,” Sluder said. “I got 32 of ’em.”

But for the past two weeks, he has called a nice, new, clean onebedroom rental house near Latah Creek his home. And if he, and the significant number of people who are working to help him, have their way, he’ll be there for a while.

“I love it,” he said, grinning broadly as he stood on the front step.

“It’s beautiful! It’s fantastic!”

Sluder is one of the first to benefit from a new approach toward people who gobble up medical and social services, all without ever achieving the stability such programs are meant to provide.

A team of health care and social services providers, called the Hot Spotters, identify people like Sluder – “complex clients” who cycle constantly and expensively through the ERs and other public services – and put extra effort and resources into helping them.

“There’s six or eight people constantly watching Randall,” said Lee Taylor, director of strategic initiatives for the Spokane County Medical Society, and a member of the team.

The Hot Spotters group grew out of the collaborative spirit and projects around the work of Darin Neven, an ER doc at Providence Sacred Heart Medical Center and medical director of the Consistent Care Program at Sacred Heart. That program was established to develop ways of reducing the overuse of medical services. Part of that problem tracks back to chronic inebriates or addicts; part of it is fueled by the difficulties the homeless have in recovering from illness or injury, and their high rate of readmission.

The Hot Spotters start from the premise that these people need help – they have a heart for this population, in Taylor’s words. But there is also an economic motivation, because people like Sluder use up a lot of costly services. His ER visits in 2012 added up to more than $30,000.

In any case, Neven, Taylor, Assistant Fire Chief Brian Schaeffer, Jan Dobbs of Frontier Behavioral Health and others began working together on ways to help people with chronic homelessness stabilize their lives. This entailed identifying such people, and then “wrapping” them in services; it’s almost as if the

Darin Neven, MD, Medical Director of the Sacred Heart Hospital Consistent Care program; Randall Sluder and Sarah Bates, Community Health Worker, Spokane County Medical Society Foundation

Hot Spotters stalk people with assistance, alert to the potential pitfalls and backsliding.

Taylor pointed out that it can be a juggling act for anyone to navigate a medical emergency – treatment in an ER with a follow-up visit at a specialist and perhaps another follow-up visit later, followed by any prescriptions, etc. and etc. For people with chaotic lives, the connections often simply don’t get made.

Something similar is true among the wide range of services out there to help people. One program in one office in one part of town provides one service; another program in another office in another part of town provides another. The programs don’t communicate or collaborate much, and in some cases, due to concerns over federal privacy laws, they won’t communicate personal information at all.

“There are fairly big gaps between these services,” Taylor said.

It would take a smart, savvy, engaged, alert, sober, organized person to follow this path from homelessness and addiction to health and stability. Or it would take a team.

Sluder moved from Coeur d’Alene to Spokane 13 years ago, and spent more than a year in the volunteer program at the Union Gospel Mission – in and out of the shelter, he said – and then lived in a low-income apartment building. He worked for a while as a baker at Cyrus O’Leary’s, but his drinking repeatedly undercut his efforts to live a safe, solid life.

In recent years, he was on the streets again. In late 2012, as the Hot Spotters group was coming together, Assistant Fire Chief Brian Schaeffer’s crews were hauling Sluder to the ER a lot.

Schaeffer emailed the rest of the Hot Spotters: “Does anyone want to do anything about it?”

December SCMS The Message 2

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continued from page 2 They began trying to work with Sluder to coordinate and manage his case. He receives Social Security disability payments to live on, and qualifies for housing assistance and rehab services, in addition to his medical care. He gets a lot of public services, in other words – enough, in a perfect world, to address his problems, if they could be coordinated.

The team provided him legal help, and got him enrolled in inpatient treatment for his drinking and behavior problems. He met with doctors, counselors and a housing manager. The team worked with Sluder for a few months before he backslid and started drinking again. In August, he took a drunken fall down some stairs and hit his head, causing bleeding in the brain. He was hospitalized for a month and is still recovering.

The accident may have helped jar Sluder in a way that other events in his past have not, he and Taylor said. He’s now set up in his house. He’s got a routine for medical care and rehab. He goes to outpatient treatment for his “big-time” alcoholism twice a week.

He says he’s not drinking. Since March, he’s had just one “hospital episode.”

“For all the people working on it, it feels like a success story,” Taylor said. “But it may not be over.”

Shawn Vestal can be reached at (509) 459-5431 or shawnv@spokesman.com. Follow him on Twitter at @vestal13.

Childhood Trauma and the Road to Homelessness

By Cyrus Hahn Haselman 1st Year Medical Student For two years before entering medical school I worked as a field instructor in a therapeutic wilderness program for troubled and adjudicated teens. The program was considered behavioral health treatment and was funded in full by the state. As such, my boys came from some of the poorest families in Alaska.

To throw nine angry teenagers from nine different corners of the state together, take away their belongings and send them out for seven continuous weeks of Alaskan backcountry travel seems like a strange experiment. Indeed, as a guide I became accustomed to dealing with a variety of volatile interactions in the initial two weeks especially. My students resented being there, stripped of all things familiar and encircled by a vast and inhospitable wilderness. This harshness, however, was by design. It created vulnerability among the participants and allowed us to access their lives. In effect we became their parents for the duration of our expedition, providing for all their needs and teaching them basic skills such as communication, impulse control, conflict resolution, teamwork and goal setting.

For some, the wilderness had its transformative effect, as did our interventions. It is amazing how much the countenance of a young man can change after giving him just seven weeks of your undivided attention and unconditional love. However, in the grand scheme of human development, I think it can be agreed upon that seven weeks is a drop in the proverbial bucket. Often times the saddest point for us as guides, and the most agonizing for our participants, came late in the course when the reality of the situation sank in: that each one would have to return to their impoverished existence, their drug-addicted parents and their maladjusted friends. Whatever life affirmation or empowerment each young man had gained from the wilderness was about to be severely tested. In that moment I was forced to wonder how much seven weeks of the best possible intentions can stand up to a lifetime of neglect.

While personal stories and anecdotal evidence may tug at our heartstrings, there is nothing like a large, federally funded, multi-year research project to answer this question. To this end, the CDC and Kaiser Permanente began the Adverse Childhood Experiences (ACE) study in 1995 and have followed its 17,421 participants ever since. The study has shown an unequivocal correlation between childhood trauma and the incidence of adult morbidity and mortality, including substance abuse, suicide, heart disease, and others. For further information on the ACE study, related studies, and the role of toxic childhood stress, visit www.acestoohigh.com and www.acestudy.org. See also the recent New York Times article: http://opinionator.blogs.nytimes. com/2013/10/30/protecting-children-from-toxic-stress/.

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December SCMS The Message 3

Continued from page 3 For me it has become clear that the odds are never in the favor of a young person without a nurturing support network. While I was not allowed to communicate with my students after they had graduated from the program, I often wondered how they fared, and still do. I hope and believe that a few are finding the will to overcome their seemingly insurmountable odds and latch on to that elusive American Dream. But what of those who don’t, what happens to them? They emerge from adolescence into adulthood without the skills to create a bright future for themselves, having lacked the guidance needed to form healthy relationships, foster curiosity or inspire creativity. Many fall into addiction, made worse by mental illness developed over the course of their tumultuous youth. Those who fall the farthest end up on the street where their body and spirit continue to deteriorate.

For fifty-five years the House of Charity has been intervening in the lives of those unfortunate individuals who have hit rock bottom. The House of Charity provides food, transitional housing, mental health counseling and other services free of charge to Spokane’s homeless population. They also provide a free weekly medical clinic, which is where we as physicians and physicians in training can get involved. Along with providing a crucial service to the neediest people in Spokane, the clinic gives medical students the opportunity to gain clinical experience from the very earliest days of our training. It also aids us in developing the universal respect for human dignity that is so foundational to the practice of medicine. For practicing physicians, the clinic is a venue to pass on clinical gems and passion for the profession of medicine to the next generation of doctors. Here is some feedback from preceptors in the last year:

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“This is a good opportunity for all parties involved. I strongly support continuation of this valuable teaching/ learning opportunity. Thank you.”

“This is a great opportunity for the students to develop some independence. I love it. The teaching opportunities are numerous over the three hours. Thanks for allowing me to do this.”

Writing on behalf of WWAMI Spokane medical students, every week we look forward to the mentorship provided by our physician preceptors. Furthermore, your presence in the clinic is what allows us to continue this valuable learning experience. Please consider volunteering as a physician preceptor at the House of Charity Saturday clinic. For information on how to volunteer, contact Dr. John McCarthy at mccajf@uw.edu. Thank you!

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December SCMS The Message 4

A new Star Rising in Emotional and Behavioral Care

Located on the Morning Star campus, clients who come to the clinic work with highly trained and licensed professionals in a multitude of environments. According to clinical coordinator Darlene Pessein, having a variety of settings allows for different clients to feel at ease and comfortable with their counseling.

By Ron Irwin, Communication Coordinator Morning Star Boys’ Ranch & Morning Star Community Services The faces of emotional and behavioral care services are changing in the shadows of today’s societal environment. Pressures of our modern world are creating a host of new behavioral and emotional concerns for children and parents alike.

It is clear and widely accepted that early identification and treatment of emotional and behavioral maladies are keys in helping to prevent family crisis from occurring. Early intervention has shown to be more effective, less costly and bears better results than reactive intervention after a crisis has emerged.

Unfortunately, research has also indicated that many patients will not follow their physician’s advice in seeking emotional or behavioral services until it becomes a matter of repair, rather than prevention.

“With the clinic being at the Ranch clients don’t have to just sit in an office,” said Pessein. “We can walk in the woods, work with the livestock or play basketball in our gym. Our clients must feel at ease with the therapeutic environment, before they experience the benefits of the counseling. The Ranch does a lot to support that comfort level.”

With several decades of combined experience, the licensed therapists at Morning Star Community Services realize that no matter how conducive the Ranch environment may be for healing, not all can, or will come to the South Hill clinic. Pessein said that when it is needed and appropriate therapists will provide inhome counseling services as well.

“The fact that a client can’t make it to the Ranch clinic does not mitigate their need for assistance,” Pessein said. “We must be, and are prepared to get out of the office and address our clients’ needs in the community.”

Morning Star Community Services is looking to partner with physicians and clinics in the Spokane area in order to increase our That is why Morning Star Community Services is changing the way engagement in identifying and treating emotional and behavioral behavioral health services reaches out and engages with clients. issues before they develop into By working with physicians life-long problems. Morning Star we are creating comfortable Community Services is helping By working with physicians we are creating environments for initial families to deal with a wide comfortable environments for initial assessments and evaluations to range of concerns, including assessments and evaluations to be conducted. be conducted. Those include Social Skill Development, offering to hold regular clinic Parent/Child Conflict Resolution, hours in the physician’s office Eating Disorders, Crisis or offering in-home services, when appropriate. If follow-up Stabilization, Autism/ADHD/Asperger’s, Depression/Anxiety and counseling, parenting classes or other outpatient programs are Parent Education. deemed necessary we work with the client and our physician partners to structure discreet, convenient and comfortable access “I’ve heard it time and again,” said John Hindman, LICSW and to our services. executive director of the Morning Star Boys’ Ranch. “Clients seem less likely to seek counseling help unless it is readily available at the time of referral, and the client feels comfortable with the setting.”

Hindman said that something as simple as a person worrying a neighbor might see their car parked in a parking lot of a counseling clinic may prevent them from seeking help.

For nearly six decades, Morning Star Boys’ Ranch has operated a tranquil and compassionate campus, embraced by 200-plus acres of Spokane’s rural South Hill. They have set the bar for providing comprehensive residential services to young men suffering from emotional and behavioral issues. As the Ranch continues to draw praise for the work they do with their residents, Hindman said residential care is not a cure and that addressing the issues that lead to residential placement must be identified and addressed sooner among both children and parents.

“Two years ago we set out to form Morning Star Community Services, a separate agency, which would reach into the community and offer services for a host of concerns affecting boys, girls and parents,” said Hindman. “We set out to change the way families receive behavioral health services.”

Morning Star Community Services relies on partnerships with referring physicians to reach those in need. We have current openings for our outpatient services and would like to connect with at least three more physicians’ offices, in order to pilot cooperative clinics with the physicians’ practices.

“One sure way to engage patients with the emotional and behavioral services needs is to have those services right there in the doctor’s office,” said Hindman. “Morning Star Community Services is prepared to offer such a clinic. This way client, clinician and physician are connected in the continuum of care, which fosters greater success.”

Morning Star Community Services accepts many major insurance programs, but always places the client’s needs ahead of financial consideration.

If you would like to contact Morning Star Community Services, tour the campus or discuss having clinic services offered out of your practice please contact Ron Irwin, Communication Director at Morning Star at: (509) 448-1202 ext. 214.

December SCMS The Message 5

Providence proudly welcomes Dr. Rebecca Muntean to our team.

PROVIDENCE RHEUMATOLOGY To schedule an appointment or referral please call 509.353.4318.

For a complete listing of Providence Medical Group physicians, visit phc.org.

Morning Star Community Service Helping Kids, Healing Families, Serving our Communities

Working in partnership with healthcare providers in helping boys, girls, adolescence and adults address: Mental Health & Behavioral Concerns, such as: ADHD, Anxiety, Depression, Social Skill Development, Grief and Loss, and more.

We are currently accepting physician and

practitioner referrals to our outpatient clinic.

We meet with clients at our 200-acre Ranch

on Spokane’s South Hill, and when appropriate In-Home Counseling is available.

Call Morning Star today to nd out more: (509) 448-1202

www.morningstarcommunityservices.org www.facebook.com/morningstarboysranch

December SCMS The Message 6

Rebecca R. Muntean, MD, ND, FACR, recently joined Providence Rheumatology. Dr. Muntean is board certified in internal medicine, and specializes in rheumatology and naturopathic medicine.

Dr. Muntean provides specialized care in the treatment of adult rheumatology: • Systemic Lupus Erythematous (SLE) • Rheumatoid Arthritis (RA) • Spondyloarthropathies (SpA) • Gout • Inflammatory myopathies • Vasculitis • Scleroderma • Therapeutic intra-articular injections

Providence Rheumatology 820 S. McClellan Street, Suite 200 Spokane, WA 99204

Christ Clinic and Christ Kitchen

By Sam Palpant, MD Christ Clinic began over 20 years ago as the inspiration of several local physicians including Scott Edminster, Jeff O’Connor, Bruce Bouma and Frank Otto. Their initial vision transformed into an enduring reality that provides health care for underserved populations here in Spokane. In fact the Biblical expression “much more than you ask or imagine” describes what happened through the prayers and faithful service of staff and volunteers at Christ Clinic. From very simple beginnings, the clinic has become a beacon of hope and healing for many without other resources. Danielle Riggs, ARNP and Larry Carpenter, PA provide most of the primary care at the clinic. They, along with other staff, live out the mission with periodic support from volunteer physicians. I’m amazed by the high level of care provided at the clinic given limited resources and seemingly unlimited need. Nursing and office staff make everyone feel welcome and cared for on a level that includes their physical, emotion, mental and spiritual wellbeing.

Christ Clinic is a classic “medical home”. A recent patient with a long-term illness came in all smiles as he greeted the clinic staff. “You saved my life,” he said with an unmistakable joy. A patient-centered team approach offers patients like him complex chronic disease management with support from specialists as needed. Hospital ER visits are undoubtedly reduced because Christ Clinic patients know they will be seen in a timely way and receive excellent quality care. Among newer volunteers, Dr. Tad Patterson is one of several providers who comes to the clinic on a regular basis. Tad reviews complicated psychiatric cases with the full-time staff. Other specialists, such as nephrologist Dr. Henry Mroch, offer frequent phone consults or personal visits for Christ Clinic patients in their offices. He is one of many who enthusiastically offer their time and expertise to our patients.

Inland Imaging and Pathology Associates Medical Laboratories are among the organizations that have supported the work at Christ Clinic since its inception. They mirror the discounts given at the clinic for all lab and imaging studies. Those and other local institutions are pragmatic partners in the care that is provided for Christ Clinic patients. As one of the volunteer providers, I feel a deep gratitude for the way our community medical colleagues have joined in this vision to care for the poor.

When two or three people agree on anything these days, we find it striking. The unified imagination of a few Spokane doctors to honor the Great Physician began a process that now includes many Spokane County Medical Society members and community organizations. The outcome is a clinic where patients experience body, mind and soul care that represents much more than a few pills. Practical faith, hope and love found there touch the deepest wounds.

Sam Palpant, MD speaking at RENEW 2013 in support of Christ Clinic/Christ Kitchen last April.

As a sister healing ministry, Christ Kitchen is located on the same campus and provides work training with spiritual mentoring. The “bean ministry” is prospering and moving vulnerable people from brokenness and dependancy to wholeness and productivity. Jan Martinez, the founding mother of Christ Kitchen, practices what she writes in her new book “Christ Kitchen: Loving Women Out of Poverty”. The “echoes of mercy and whispers of love” in the Kitchen bring healing to many who have been put upon by thieves and left injured along the road of life.

Personally, I have been involved with this life-changing work for over 20 years. I hope you all will support and even participate in the work at Christ Clinic or Christ Kitchen. If you have any thought of doing justice or loving mercy, these places are worth a humble walk to see in action. They are ministries in our own town that give practical feet to the rich ideal of care for the whole person.

If you would like to support the work of Christ Clinic or consider volunteer opportunities, please contact: Raelene Vogelsang, Development Director at (509) 939-3595 or www.christclinic.org. Christ Clinic is a ministry of Christ Clinic/ Christ Kitchen – www.ccckministry.org

Scott Edminster, MD, Medical Director for Spokane Fire Dept., volunteers at Christ Clinic every Wednesday afternoon.

December SCMS The Message 7

ESCAPE FIRE: The Fight to Rescue American Healthcare

Physicians

Over 80 physicians; physician assistants; faculty; spouses and medical, dental, speech pathology, physical therapy, nursing and hospital administration students attended the showing of the film ESCAPE FIRE: The Fight to Rescue American Healthcare on Wednesday evening November 6 at the WSU Riverpoint Campus Nursing Building. After the showing of the film a panel comprised of Drs. J. Craig Whiting, Rockwood Health System; Jeff Collins, Providence Sacred Heart Medical Center and John McCarthy, WWAMI Program answered questions from the audience.

“I would very much like to thank the Spokane County Medical Society for providing the showing of Escape Fire. It was a wonderful forum for the SPCMS members to interact with the current medical students. I very much appreciated the input from the medical directors of the hospitals and the spirited discussion after the movie. Thank you Spokane County Medical Society for fostering the education of our medical students and providing such a stimulating forum for all the attendees!“

Thank you to everyone who attended the film.

Comments from attendees Second year graduate students in speech language pathology “I enjoyed hearing people’s stories and getting the information on the health care system.”

“I was surprised by the information presented in the documentary. Very impacting!”

“I really liked having the medical community members there. It was so nice to hear from people who are actually practicing and experiencing the medical system.”

Second year medical student “The documentary was thought-provoking and I appreciated the chance to interface with the greater Spokane community and the medical society.”

Second year physical therapy student “There were about 25 physical therapy students who came to the presentation, and “Escape Fire” resonated powerfully with all of us. As PTs, we often will treat patients suffering from the negative impacts of physical inactivity, obesity and smoking, and so we definitely saw a future for therapists in the film’s recommendations to reduce preventable chronic illnesses.

The film and panel presentation made such an impact on my classmates, that we led a group discussion with the whole class on Thursday morning to discuss our take-away impressions. I also met with the director of the Eastern PT program, Dr. Meryl Gersh, to talk about potentially organizing another viewing for the entire department; instead of just a viewing, we will now be incorporating “Escape Fire” into the curriculum for both the DPT1 and DPT2 classes for the spring quarter.

Thank you for this opportunity to participate in this SCMS event-- I also saw nursing, OT, MD and dental students at the presentation, and it’s reassuring to know that our convictions are shared across all health disciplines!

Thank you! And I look forward to attending similar events in the future.”

“The movie about the challenges in American healthcare and discussion points were excellent!”

“I had the opportunity to attend the SCMS showing of the film “Escape Fire” along with many health professionals and students.

A very well done documentary outlining many of the flaws of our current health system. I especially liked Dr Andrew Weil’s comment, “ we do not have a health care system in this country, we have a disease state system”. This couldn’t be more true. It was nice to see so many medical and allied health students in the audience. They are the future and it will be up to them to start their own escape fires to change the future of his nations health care crisis.”

In Memoriam

Thomas S. Gilpatrick, M.D. Born at Deaconess Hospital in Spokane, Wash. on January 12, 1925, Dr. Thomas Gilpatrick, passed away at Spokane Veterans Home on Friday October 18, 2013. Thomas graduated from Lewis & Clark High School, Harvard College and the University of Washington School of Medicine. He served his internship at Madigan Army Hospital, Fort Lewis, Wash. His residency was at Barnes Hospital in St. Louis where he worked with Dr. William Masters. His Harvard education was interrupted by his service in the Army Signal Corps during WWII. Thomas practiced medicine in Spokane, Wash. with Drs. Wade Robinson and George Rice. Seeing a need for education and affordable care in women’s health, Thomas helped to bring Planned Parenthood to Washington State. He served as their Spokane Medical Director for years.

Thomas married Audrey Simpson. They were blessed with two children Susan and David. Later Thomas was married again to Janet Majer, gaining two daughters, Dawn Saari and Annie Gilpatrick-Kapelke. They blessed him with three granddaughters, Sophie Saari and Annie’s twins who brought him great joy.

Thomas enjoyed various athletic pursuits. He played baseball and football in his youth, and golfed, water skied, and snow skied into his sixties. He raced a hydroplane the “Quick Delivery” for several years, going as far as the U.S. National Championship in Florida.

An avid bridge player he played regularly at the B.O.F and the V.F.W. He also was a great Cougar football supporter beginning with his father in the 1930s attending games until 2011. He loved many and was loved by many.

December SCMS The Message 8

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What is a Community Health Worker?

By Jim Ryan, Project Access Program Coordinator It’s 7:25am on a Wednesday morning and Sarah Bates is standing in the alley between 2nd and 3rd Avenues off of Howard Street with a dozen or so folks who have migrated from beneath Spokane’s downtown underpasses and various panhandling corners to be there. Sarah, who stands out from the crowd with her orange IKEA briefcase and unpretentious but decidedly first-hand attire, smiles and connects with several faces that she knows. “Did you get that foot looked at?” she asks one gentleman. “Do you need another bus pass?” she offers a middle-aged woman. Then it’s 7:30 and the door to Shalom Ministries opens. Inside, a hot breakfast is served every weekday to “downtown Spokane’s most vulnerable and at-risk community members.”

Sarah, Operations Manager for Project Access Spokane, is not here to eat, though occasionally she’ll grab a cup of coffee and join one of her clients for a meal. Rather, she is here to outreach in her capacity as Community Health Worker for the city’s H3 (Homelessness, Housing & Health Care) Grant. Administered by the Spokane County Medical Society Foundation, the H3 grant seeks to identify and assist Spokane’s most medically vulnerable homeless citizens through intensive coordination with community providers of medical and behavioral health care, substance abuse treatment, housing, dental care and other social services with a goal of long-term stabilization, easy and continuous access to appropriate health services, and broad-based improvement in the patient’s health outlook.

As you might expect, this population can be difficult for which to coordinate services —not necessarily because of any negligence on their part, but because of the logistical complications that come with living on the streets. Daily, street-level outreach is vital in maintaining the connection that is required to successfully transition these individuals out of the vicious circles in which they have found themselves caught, usually for many years.

Specifically, the H3 grant specifies a number of conditions that are statistically predictive of extreme medical vulnerability among the homeless, including: cirrhosis of the liver, end-stage renal disease, HIV +/AIDS, a history of frostbite, being aged 60 or older or a combination of substance abuse, mental illness and Emergency Department usage. The statistics show that when coupled with other serious medical problems, those are especially fatal conditions for anyone living on the street.

I recently accompanied Sarah on a chilly Wednesday morning to the Days Inn downtown, where she was temporarily housing two clients during the transition from the street to more permanent housing. One client, whom we’ll call Marvin, is a 64-year old Vietnam veteran who, in addition to being over 60, has a history of frostbite and suffers from neuropathy and PTSD. Marvin currently needs to have several toes amputated but cannot undergo such a procedure until he is housed. Obtaining housing has been difficult for him, not only for the obvious financial

reasons, but also because his homeless status has resulted in several misdemeanor trespassing charges, mostly around the Plaza bus terminal. Sarah has been working with Marvin to find a housing provider that will take the totality of his circumstances under consideration and give him the chance he needs to transition to stability. The H3 grant will then pay his security deposit and two month’s rent to get him on his feet, at which point he’ll be expected to pay his own way with SSI income.

After spending just a short time with Marvin, it becomes abundantly clear that he could never make this transition on his own. He is well-read, articulate, and profoundly likable, but he is debilitated by social anxiety, paranoia and speech patterns that tend to be rather erratic and mumbling. These might not be barriers to stability in and of themselves, but in concert with one another, they have marginalized Marvin. With coordinated intervention, however, he has been responsive and responsible.

He has kept his appointments, lived up to his promises and proven time and again that he is willing and able to hold up his end of the bargain.

The other client we met that Wednesday morning was Ethan, a 56-year old chronic inebriate with a history of frequent emergency room visits. He has a couple of 20-30 year-old felony convictions, one of which included a charge of “assault with the intent to commit sexual offense,” a misdemeanor. In some states, this charge rather unreasonably requires Ethan to register as a sex offender. In Washington, it does not, but Ethan’s travels over the years have earned him two “failure to register” citations which, bizarrely, are a problem for the state and show up on his record. As a result, housing is difficult to come by. The best he could do recently was a ratty, bed bug-infested slum for which he was paying $500/month while being eaten alive at night. Sarah is working with Ethan to demonstrate that he long ago cleaned up his act and deserves the opportunity to live somewhere clean and safe.

Those are just a couple of examples of the outreach Sarah is doing through the Spokane County Medical Society Foundation’s various initiatives. Depending on the day, you might find her at Shalom, House of Charity, Truth Ministries, Volunteers of America or any number of other charitable organizations around town.

You might find her at Value Village or Goodwill, purchasing warm clothing, blankets or other necessities which she will take directly to the corner, underpass or shelter where a client may or may not be expecting her visit. You might find her working with a Spokane deputy prosecutor to mitigate an outstanding warrant for a client; reducing his sentence from jail time down to community service.

The biggest surprise, she tells me, is how many of those individuals defy expectations when they are engaged in this way.

Marvin, in particular, was regarded by many in the community as “unapproachable,” “cranky,” and “mean.” He had long ago been written off as a lost cause. Today, he is preparing to move into his own small apartment. His problems are not solved, to be sure, but he is one big step closer to stability. This is a winter that will not find Marvin literally freezing to death beneath the rumble of traffic on I-90.

December SCMS The Message 10

Eastern Washington Physician Health Committee

By Jim Shaw, MD, Chair The Eastern Washington Physician Health Committee (EWPHC) was formed in 2002 as a collaborative effort between the administrations and medical staffs of, at that time, Empire Health Services and Providence Services of Eastern Washington hospitals. Shortly after the committee was formed, it fused with a similar Spokane County Medical Society (SCMS) committee.

The name of the committee may suggest wider involvement and participation in Eastern Washington, but really only includes SCMS and the medical staffs of the two (now) Community Health System and four Providence Health Care hospitals medical staffs.

Some elements of the original Charter for the committee follow.

Mission To provide leadership, education and support which fosters physician health and well-being spiritually, emotionally, physically and socially through an organized and systematic program that is sponsored by the member hospitals and their medical staffs.

Guiding Principles • Physician health is important.

• Healthy physicians are a community asset • Healthy physicians are fundamental to quality and safe patient care • A sense of community with one’s peers is vital to personal well-being • Healthy physicians are more productive and enhance the workplace environment • The medical profession and healthcare community should foster physician well-being.

• Changes in the healthcare environment are contributing to personal and professional challenges and new stressors for physicians • The medical profession has inherent stressors that require specific attention • Physicians should train and work in an environment that promotes healthy lives for them, their families, their support personnel and their patients • Well-being depends on responsible behavior and decision-making by all parties in the healthcare environment • Physicians should have resources available to them to anticipate and manage episodic personal issues • Continuous learning is fundamental to a healthy lifestyle.

• Educational and support programs should foster physician well-being • Medical education programs have a responsibility to promote knowledge, attitudes and skills necessary for personal and professional wellness

Purpose (Education, Awareness, Referral) Implementing a rehabilitative and therapeutic physician wellness program that is non-punitive in its design.

Developing a coordinated and relevant educational program for physicians, their families, hospital staff and office staff that consists of at least four programs per year.

Promoting activities that support the spiritual and emotional health of physicians.

Creating an environment within the member hospitals in which the staff have an increased awareness of the importance of physician wellness.

Creating and maintaining a linkage between the committee and an early assistance program (EAP).

Providing a linkage between the committee and the Washington Physicians Health Program (WPHP) and to cooperate with the WPHP when a physician’s rehabilitation requires monitoring.

Continually encouraging referral and self-referral to the EAP. Safeguarding confidential information except as limited by law, ethical obligation or when the safety of a patient or staff is threatened.

Monitoring the utilization of the EAP and reporting annually to the administrative and medical staff leadership of the member hospitals.

Assisting the member hospitals in assessing and re-assessing physician wellness.

Reporting to the appropriate authority or member hospital(s) when a physician is thought to be a threat to a patient or staff.

Assuring that the physician wellness program is ongoing; that it is designed, sustained and funded by the member hospitals and their medical staffs.

Current Activities The six area hospitals contract with the Wellspring Employee Assistance Program for their medical staffs and their families.

Wellspring, through arrangements with local and northwest regional professionals in psychiatry, psychology, counseling, behavioral health and others, provides a voluntary, confidential resource available to physicians and their families for prompt help with professional, personal, emotional, family and other problems.

Access to those EAP services begins with a confidential phone call to (800) 553-7798, available 24/7. The Committee works with Wellspring to assure that their local provider network is high quality and includes clinicians known for successfully working with physicians, their families and peers. The Committee also reviews our experience with the Wellspring group on a regular

December SCMS The Message 11

Continued on next page

Continued from page 11 basis, and has received several spontaneous supportive reports and no complaints regarding their services in 10+ years. The EAP and the EWPHC membership are separate from hospital medical staff disciplinary functions, and all records and plans of the EAP are confidential and released only with written consent of the physician or family member, except as required by law.

The committee has received several updates and in-services from the leadership of the Washington Physicians Health Program (WPHP). We recognize the invaluable resource the WPHP is to physicians and other covered professionals in Washington State.

Currently over 90% of physicians enrolled in WPHP programs successfully continue or return to professional practice, a success rate our committee wants all physicians to be aware of. We hope the knowledge of these success rates might ease the barriers to seeking treatment.

The EWPHC includes experts in mental health, behavioral health and chemical dependency in addition to many physicians from other specialties who are just committed to and interested in the health and wellness of their physician peers. Those physicians have agreed to have their personal phone numbers published

in the notice about this Committee in the SCMS The Message several times a year. While not all of us are experts on the reasons physicians may call one of us, we usually can serve as a confidential source of useful referral information.

The Future of EWPHC The physician organizational landscape has changed dramatically in Spokane and elsewhere over the past decade, and has become less hospital-centric. Fewer primary care physicians and even several other medical specialties are on hospital active medical staffs now compared to ten years ago. But the needs as outlined in the Mission and Guiding Principles of the EWPHC are certainly as real today as they were then. The Committee will be meeting again early in 2014 with hospital, physician and SCMS leadership to revisit our structure, function and strategic plan for moving forward and partnering successfully with those we wish to serve.

If you have an interest in participating in this effort or have ideas for the Committee, please feel free to contact me or the SCMS office. In the meantime, take care of yourself so that you can care for others.

Contact: (509) 710-3151 (phone or text) or jimsshaw@msn.com

Happy Holidays from your Spokane County Medical Society Staff Dean Becky

Karen

Margie

Bonny

Lee

Lana

Michelle

Sarah Jim

Wishing you and yours all the best in 2014!

December SCMS The Message 12

December SCMS The Message 13

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December SCMS The Message 14

Guest Editorial The Challenges of Evolving Technology

By Grant Oakley Grant Oakley is the son of Anne Oakley, and has edited the monthly president’s newsletter article for the last year. Here he outlines his impressions of the changing healthcare profession from a software engineer’s perspective.

Being the son of two physicians, I have grown rather accustomed to the seemingly incessant drone of workplace gripes over the last 20 odd years. But I cannot help but notice the change in their tone in recent months. What were once complaints easily disregarded as normal “workplace moaning” have evolved into serious questions of what it means to practice medicine in the era of information.

Whether this opinion was unfairly biased by living with two “old school” docs who struggle to email a word document, or if their complaining was truly justified, was impossible to determine until quite recently. In preparation for beginning nurse practitioner school, my sister was required to complete an “Intro to Epic Software.” (I believe that a similar course was recently required for most, if not all, healthcare providers in Providence hospitals.) I thought that surely a 23-year-old college graduate with moderate computer skills would have little trouble mastering records and billing software, but was shocked to find that even she extensively struggled with trivial, everyday tasks.

Being a software engineer, I know there is a principle in software design that “frequent tasks should be fast and infrequent tasks should be achievable.” The electronic medical record (EMR) software I reviewed achieves neither of those goals. In all honesty, I would expect better user experience design from students in the introductory level design course that I Teacher Assist. The software valued at millions of dollars had a user interface that would have looked modern sometime around Y2K. A simple task (that I am told is performed dozens of times a day) required a cryptic series of menu traversals and button clicks. Patient information I would regard as useless in 90% of cases stood in the foreground, whereas vital information required prying around and opening records. Clearly there is a problem.

How are many of these EMR systems selected for use despite crippling shortcomings? The government regulations forcing the adoption of software not yet ready to see the light of day is certainly a factor, but having witnessed the rate at which good software can be produced by talented engineers under the right management, I do not believe that this is the sole cause. Frankly, a majority of these programs do not need to satisfy their users, because their users are not their customers. The health care providers who use the EMR for their daily jobs do not have the luxury of browsing a vast open market of software options, but are instead often prescribed their software tools by individuals who lack “on the ground experience” needed to make proper choices and demands from software providers.

So how can you make the most out of your EMR? Never become complacent; identify your concerns, confer with other users, formulate your proposed solution into specific changes you would like to see, and then bring those to your software technical rep in an official forum. Coming from the technical side, many poorly designed features stem from the client not really knowing what it is they want, or not conveying their needs clearly to the engineers.

At the end of the day, medical records software is a tool and it should make doing your job easier while improving the quality of care you can deliver. The tool is only standing in your way until you reach the day that you can look back and say, “Can you believe we used to have binders full of paper medical records? How did we get anything done?” And I am certain that that day will eventually come, but only if you take an active role in the design cycle. And like it or not, computerization of every profession is coming, so make sure that you are doing your part to learn how to use the newest tool of your trade as proficiently as you would any other.

December SCMS The Message 15

Mann Grandstaff VA Medical Center Growing and Serving

By Kevin Dudley, Marketing and Communications Coordinator at Greater Spokane Incorporated Did you know the Mann Grandstaff VA Medical Center in north Spokane provides mental health care to 5,000 veterans every year? Or that it serves a 64,000 square mile area?

There’s a lot you might not know about the VA Medical Center here.

While the larger hospitals in the region are more well-known, Mann Grandstaff serves a specific population – veterans, of course – and doesn’t get much attention outside that market.

On November 8, Linda Reynolds, the Medical Center Director at Mann Grandstaff, spoke to more than 160 area business leaders at Good Morning Greater Spokane, a monthly program hosted by Greater Spokane Incorporated.

“I have found that our community is one that very much supports its veterans and really works together as a region in all kinds of ways,” Reynolds told the crowd. Mann Grandstaff does, too. It not only serves veterans but half of its employees are veterans.

Mann Grandstaff is named after Private First Class Joe E. Mann, a WWII Army veteran, and Platoon Sergeant Bruce A. Grandstaff, a Vietnam Army Veteran. Both men were local residents and lost their lives in battle. Both are recipients of the Medal of Honor.

Mann Grandstaff isn’t just tucked away in north Spokane; it also has an outreach center in downtown Spokane, a clinic in Coeur d’Alene, a rural clinic in Colville and a mobile medical unit that roams around the area, serving veterans in rural areas.

The rural clinic and mobile medical unit are especially important, as 52 percent of veterans in the area live in rural areas. The difficulties of rural veteran health care, though, include public transportation, volunteers and more.

That’s where the mobile medical unit comes in handy.

“It gives us the ability to have our veterans go to a clinic and then be able to access specialty care,” Reynolds said.

For example, the mobile medical unit can travel to Moses Lake so a veteran doesn’t have to make the trek to Spokane.

Technological advances have allowed the VA to use their resources in a wise way.

“The patients can come and get their care closer to home,” Reynolds said. “A lot of care doesn’t necessarily mean you have to have a face-to-face interaction. Depending on the individual, using technology allows us to give them the type of medical care they need so they don’t have to drive to see us.”

Vietnam veterans make up the largest segment Mann Grandstaff serves. It also hosts graduate medical students.

“VAs nationwide have affiliations with one hundred and seven medical schools,” Reynolds said. “Many physicians have had part of their training and clinical rotations in a VA.” This matters to our region because the growing medical school at the Riverpoint Campus can feed students into Mann Grandstaff.

The health care sector in Spokane is large. Growing residency positions is a goal of many in the community, and knowing there’s a resource like Mann Grandstaff is good news.

“We really enjoy having the opportunity to contribute to the training of those that are going to join us in the future,” Reynolds said.

A key partnership Mann Grandstaff has in the community is one with Farichild Air Force Base. The medical clinic on base often sends its staff to Mann Grandstaff. “(Fairchild) staff will come and get training,” Reynolds said.

“They may not have the opportunity (on base) to get some of the training that’s very important to keeping clinical competencies.”

Reynolds said Fairchild medical personnel often use Mann Grandstaff for use of the MRI machine.

Since the Department of Veterans Affairs – the umbrella organization for Mann Grandstaff – is the second –largest department in the nation, it has resources to help the community in other ways, such as emergency and disaster relief.

“It could be sending our staff to those areas, or it could be deploying mobile medical units,” Reynolds said, while adding that VAs across the country have sent relief staff after hurricanes and other national emergencies.

The medical center recently added a 7,200 square foot audiology clinic and an 18,000 square foot behavioral clinic, proving that it continues to grow after all these years, providing care for our many area veterans.

So it’s obvious that Mann Grandstaff is an essential medical system in our community.

December SCMS The Message 16

THURSDAY 09 JANUARY 2014

GENERAL MEMBERSHIP MEETING R E D L I O N 3 0 3

W

6 : 0 0 P M 7 : 0 0 P M 8 : 0 0 P M

H O T E L

N O R T H

R I V E R

A T

D R

T H E

P A R K

S O C I A L H O U R D I N N E R A N D B U S I N E S S M E E T I N G G U E S T S P E A K E R A N D B O O K S I G N I N G

Guest Speaker: Mack Dryden Comedic Motivator and Emcee

“He was a BIG hit! Everyone was rolling in the aisles with laughter.”

Live Happy, Laugh Loud As a comedian he’s performed on dozens of TV shows, including The Tonight Show with both Johnny Carson and Jay Leno. As an actor he’s appeared in several movies and on many TV shows, including JAG and a recurring role as a judge on ABC’s The Guardian.

MEAL CHOICES SERVED WITH SALAD, BREAD, DESSERT AND COFFEE/TEA

CREDIT CARD TOTAL$ Account Number

Double Cut Pork Loin Chop

Expiration Date

Served with apple bourbon mustard

Card Holder’s Name

glaze, smashed red potatoes and fresh vegetable

Chicken Oscar Boneless skinless breast of chicken

MAKE CHECKS PAYABLE TO SCMS

Visa MasterCard

Phone #

Card Holder’s Billing Address City

State

Zip Code

topped with Dungeness crab,

Meal Requests:

asparagus and béarnaise sauce with

Name_________________________________________ Pork Chicken Vegetarian

saffron rice and fresh vegetable

Name_________________________________________ Pork Chicken Vegetarian

Vegetarian Chef’s choice

$38 per person

SCMS * Orange Flag Building * 104 S. Freya St., Ste. 114 * Spokane, WA 99202 (509) 325-5010 Fax (509) 325-5409

RSVP by January 3, 2014 No cancellations or refunds after January 3.

December SCMS The Message 17

The following physicians and physician assistants have applied for membership and notice of application is presented.

Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

PHYSICIANS

PHYSICIANS PRESENTED A SECOND TIME Uhder, Kristen, MD Internal Medicine Practicing with Providence Medical Group - IM Hospitalists 09/2013 Dominguez, Jaime, MD Internal Medicine Practicing with Apogee Physicians 09/2013 Coleman, Morgan, MD Women’s Health, OB with Delivery Practicing with Group Health Permanente (Riverfront Medical Center) 10/2013

Lang, Brook Y., MD Pediatrics/Neonatal-Perinatal Medicine Med School: Creighton U (2007) Internship: U of Utah (2008) Residency: U of Utah (2010) Fellowship: U of Utah (2013) Practicing with Pediatrix Medical Group 01/2014

Chen, Arthur, MD Family Medicine Practicing with Apogee Physicians 11/2013

McCulloch, Madison, MD Radiology-Diagnostic Med School: Virginia Commonwealth U Health System (2007) Internship: Virginia Commonwealth U Health System (2008) Residency: Virginia Commonwealth U Health System (2010) Fellowship: Virginia Commonwealth U Health System (2013) Practicing with Radia, Inc., PS 02/14

Kommidi, Sudeep, MD Family Medicine Practicing with Apogee Physicians 11/2013 Olson, Jolanta, MD Internal Medicine Practicing with Apogee Physicians 11/2013

Myers, Kirk V., DO Radiology-Diagnostic, Vascular and Interventional Med School: Western U of Health Sciences (2005) Internship: Arrowhead Regional Medical Center (2006) Residency: LAC/USC Medical Center (2010) Fellowship: U of Washington (2011) Currently practicing with Radia, Inc., PS

Leung, Stanley T., MD Anatomical and Clinical Pathology Practicing with InCyte Pathology 01/2014

Pary, Jennifer, MD Neurology/Vascular Neurology Med School: U of Iowa Carver College of Medicine (1999) Internship: U of Iowa Des Moines Internal Medicine Program (2000) Residency: U of Iowa (2003) Fellowship: U of Texas – Houston (2004) Currently practicing with Providence Medical Group- Neurology

PHYSICIAN ASSISTANT

Sundaralingam, Dhakshayani, MD Internal Medicine Med School: St George’s U - Grenada (2000) Internship: Seton Hall U - St Michael’s Medical Center (2002) Residency: Seton Hall U - St Michael’s Medical Center (2004) Practicing with Apogee Physicians 12/13 Levine, Andrew R., MD Diagnostic Radiology Med School: New York Medical College (1979) Internship: U of Michigan (1980) Residency: U of Michigan Medical Center (1982) Fellowship: U of Michigan Medical Center (1983) Practicing with Radia 02/14

Saxey, Roderick, MD Diagnostic Radiology Practicing with Radia, Inc., PS 01/2014

Cassels, Kathalene M., PA-C Physician Assistant School: U of WA - Medex NW (2013) Practicing with Rockwood Epilepsy and Stroke Center 11/13

Membership Recognition for December 2013 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

20 Years Neil A. Giddings, MD Russell D. Rider, MD

December SCMS The Message 18

12/15/1993 12/15/1993

POSITIONS AVAILABLE PHYSICIAN (OB/GYN and Urgent Care) OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANESpokane Locations (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact CHAS Human Resources at (509) 444-8888 or hr@chas.org.

Visit our website to learn more and to apply www.chas.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Psychology, Psychiatry, Physical Medicine and Rehabilitation, Family Medicine, Occupational Medicine, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Maggie Dillon directly at (909) 978-3548 or mdillon@qtcm.com or visit our website www.qtcm.com to learn more about our company.

PROVIDENCE FAMILY MEDICINE RESIDENCY SPOKANE Immediate opening with Providence Family Medicine Residency Spokane (PFMRS) for a full- time BC/BE FP physician who has a passion for teaching. PFMRS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships.

This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Linda Barkley, Program Assistant at (509) 459-0688 or Linda.Barkley2@providence.org.

PROVIDENCE MEDICAL GROUP (PMG) – Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in Spokane Valley, a scenic suburb of Spokane. Fulltime opportunity with our growing medical group in what will be a large, state-of-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only.

Competitive compensation and comprehensive benefits. PMG – Eastern Washington is our physician-led network of more than 450 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@ providence.org or (509) 474-6605 for more information.

SPECTRUM HEALTHCARE RESOURCES has an immediate opportunity for a civilian Family Practice Physician at Fairchild Air Force Base. This contract position offers: Full-time; Outpatient setting; Monday through Friday, 7:30am to 4:30pm; Manageable patient load (20-25 per day) and Shared on-call responsibilities (mostly telephone consulting). The position will have the following requirements: Current and unrestricted medical license; Successful completion of a family medicine residency; Board Certified by the ABFM or AOBFP; BLS, ACLS, PALS and Ability to work in a team setting. Contact Spectrum recruiter Lisa Paska for more information at Lisa_Paska@spectrumhealth.com or (314) 744-4107.

MID-LEVEL OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE - Family Practice ARNP and Physician Assistant needed in Spokane, WA and Moscow, ID. Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about employment opportunities, contact CHAS Human Resources at (509) 444-8888 or hr@chas.org. Visit our website to learn more and to apply www.chas.org.

PROVIDENCE MEDICAL GROUP (PMG) – Eastern Washington has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Excellent compensation and benefits. PMG – Eastern Washington is our physician-led network of more than 450 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital.

Contact Mark Rearrick at mark.rearrick@providence.org or (509) 474-6605 for more information.

December SCMS The Message 19

December SCMS The Message 20

Continuing Medical Education

Meetings/Conferences/Events

Update in Internal Medicine 2014: This seminar is jointly sponsored by the Spokane Society of Internal Medicine and the Spokane County Medical Society. 9.0 AMA Category 1 Credits. Conference will be held on February 22, 2014 from 6:45 a.m. – 5:30 p.m. at the Spokane WSU River Point Campus, Health Sciences Building. For additional information please contact Jennifer Anderson at (509) 448-9709 or email spokanesocietyim@gmail.com.

Rockwood Health System Breast and General Tumor Boards: The tumor boards are jointly sponsored by Rockwood Health System and the Spokane County Medical Society.

Tumor Boards will be held weekly June – December 2013.

Each Tumor Board is worth 1.0 Category 1 CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@rockwoodclinic.com.

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

Diagnosis and Management of Chlamydia and Gonorrhea: Treatment and Challenges, 1.0 Prescribed credit(s) by the American Academy of Family Physicians, sponsored by the Spokane Regional Health District’s STD Medical Coalition and the Seattle STD/HIV Prevention Training Center. Presented by Devika Singh, MD, MPH via webcast on December 10 from noon to 1 p.m. Designed for providers and clinicians caring for patients at risk for chlamydia and gonorrhea, this webinar will focus on epidemiology, diagnosis, and strategies for patient and partner management as well as diagnosis and management of pelvic inflammatory disease. Register at http://stdtoolkit.srhd. org/stdcme or contact Anna Halloran at ahalloran@srhd.org for more information.

SAVE THE DATE! Primary Care Update 31st Annual Conference May 2 and 3, 2014 Red Lion at the Park Spokane, WA This well established update is a tremendous opportunity for physicians and other health professionals to choose from more than 20 CME sessions and workshops designed specifically for primary care practitioners. Touted as the largest gathering of primary care providers on the West Coast, this forum provides time to connect with long-time colleagues and learn from others. Combined with the general excitement of Spokane’s Bloomsday Run on Sunday, May 4, this conference is one not to miss! Watch for registration information coming soon!

Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

National Environmental Health Association Courses sponsored by the CDC and EPA available. Courses include National Environmental Public Health Performance Standards Workshop: Building Local and National Excellence, Biology and Control of Insects and Rodents Workshop, Environmental Health Training in Emergency Response and Environmental Public Health Tracking 101. For more information go to the website at www.nehacert.org.

Physician Family Alanon Group: Physicians, physician spouses or significant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addictions, work-related stress, life transitions and relationship difficulties.

We meet Tuesday evenings after 6 p.m. The format is structured by the 12-Step Alanon principles. All is confidential and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, please contact Bob at (509) 998-5324.

MRC of Eastern Washington – General Membership Meeting Wednesday 11 December 2013 6:00 -8:00 p.m. at the Spokane Regional Health District 1101 W. College Ave., Auditorium. Meeting agenda to include a Presentation on Carbon Monoxide Poisoning, Updates on Training, Exercise, Equipment, Recruitment, Recognition and Communication and Coordinator’s Report. Next meeting scheduled for 8 January, 2014.

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REAL ESTATE Custom Home - Little Spokane River Valley For Sale - Nestled on a slight hill overlooking the peaceful Little Spokane River Valley with 220 feet of waterfront acreage sits a beautiful custom home designed and built by the renowned architectural firm of Copeland Design and Construction. The home surroundings are wonderfully landscaped with paths that lead to the Little Spokane River and woods. The interior has natural wood details which accentuate each room. The many Hurd windows give panoramic views of the river valley. There are 4 bedrooms, library, sun room, master bedroom, master bath with imported European tile, great room with tiled gas fireplace, kitchen with Corian counters and bar seating, laundry room, mud room, large rec room, two and 1/2 baths, furnace room, utility/wine storage room and a 3-car attached heated garage. There is a heated green house with an adjacent fenced in garden area. A paver patio, back deck with hot tub and front porch allow for enjoyment of the pleasant summer evenings. The home has solar water heating and solar electric with backup batteries and generator. It is in the Mead school district and only 10 - 15 minutes from Providence Holy Family Hospital and 25 minutes from Providence Sacred Heart and Deaconess Hospitals. There are too many other details to list here. Please call: (509) 466-6947 or (509) 879-3770.

River Front and Acreage, 3300ft², 4 Bedroom Home for Lease (Or Sale) $1,850/month. Close in but feels like the country. Four bedroom, three and ½ bath, master suite with corner jetted tub and large walk-in closet, open living and dining area with great views and gas fireplace, family room with wood stove, attached two-car garage and detached two-place carport. Forced air natural gas furnace. Large multilevel deck and patio looking toward river. Wooded acres on the Little Spokane River with private trails, sandy beach and swimming hole. Plentiful wildlife.

School bus comes to front drive. Mead school district. Close to Whitworth, shopping and freeways but very quiet and secluded.

Cable hook-up. Grounds are river irrigated. First and last plus cleaning deposit. Utilities not included. No indoor pets. $150/ month grounds maintenance fee if you choose not to do it yourself. Contact Scott (509) 435-7099. For photos go to Craig’s list - http://spokane.craigslist.org/apa/3984125910.html.

Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962.

Large Second Owner Custom Built Executive Home with unparalleled views of Liberty Lake and Spokane Valley on five acres available for sale or lease. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den. Walk out basement, wood stove, kitchen and bathroom. Large 30’ x 100’ pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512.

Beautiful Priest Lake Cabins for Rent Our newly restored cabins are located on the historic site of Forest Lodge in the entrance to the scenic Thorofare. Two cabins are available.

Each sleeps 8. They are located at the water’s edge, have gorgeous views, bordered by the National Forest and 18 acres of private land. The beds and furnishings are all new and cabins have all the amenities - decks, docks, beaches with fire pits, walking trails and forest to explore. Boating, hiking, swimming, sailing, snowmobiling in winter or just relaxing in the sunshine. You will enjoy a peaceful, fun-filled vacation at this amazing site. For available dates, pricing, photos and details call Jeannie or John at (509) 448-0444.

One of Copeland’s Best North Side Homes on over fifty acres with meadows, trees, complete privacy and gorgeous views. This home offers contemporary living at its best featuring four bedrooms, four bathrooms, three-car garage, hard rock maple floors, cabinets and built-ins, three balcony decks plus a patio with water feature. The second level has a distinctive master suite with custom built-ins, large walk-in closet, lovely master bath with lowboy toilet and bidet, a large sitting room with built-in shelving, raised gas fireplace and extraordinary views! The main floor great room boasts granite, stainless appliances, oversized pantry and very functional laundry suite with chute. Super-efficient geothermal heating and cooling affords economical year ‘round comfort. Twenty minutes from Holy Family Hospital. Mead schools! $750,000 Call Marilyn Amato at (509) 979-6027.

December SCMS The Message 22

MEDICAL OFFICES/BUILDINGS South Hill – on 29th Avenue near Southeast Boulevard Two offices now available in a beautifully landscaped setting.

Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

COMM PROF

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf. professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various medical office spaces available for lease from 635 to 10,800 contiguous usable square feet. and has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include urgent care, family practice, pediatrics, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, CPM®with O’Rourke Realty, Inc. at (509) 624-6522, mobile (509) 999-2720 or psrourke@comcast.net.

COMMUN COMMUNITY OF PROFESSI PROFESSIONALS COMMUNITY OF PROFESSIONALS COMMUNITY OF PROFESSIONALS

Th

The Prewitt Group For more information regarding t Program contact De Michelle Caird, Executive A

LOCATION—LOCATION—LOCATION Hospital district office space. 1602 sq. ft. turnkey for medical office or related medical services. Private entry, ample free parking at door, all services included. Ideally situated between Sacred Heart and Deaconess hospitals. Corner of 5th and Bernard Streets. Lease/Rent– For more negotialble rate. Call (509) 624-5121 Mirko Zugec, MD.

For more information the Commu information regarding the Community of regarding Professionals The Prewitt Group The Prewitt Group Program contact Dean Larsen, Program contact Dean Larsen, CEO or Michelle Caird, Executive Michelle Assistant at (509)Executive 325-5010. Assistant at ( Caird, For more information regarding the Community of Professionals Program contact Dean Larsen, CEO or Caird, Executive Assistant at (509) 325-5010. theMichelle Community of Professionals

For more information regarding Program contact Dean Larsen, CEO or Michelle Caird, Executive Assistant at (509) 325-5010.

December SCMS The Message 23

Innovation State-of-the-art is our standard.

Constant improvement is our watchword, so we welcome change. We frequently upgrade our processes and systems to keep pace with our own ever-higher standards because it leads to better service, top-quality patient care and improved outcomes.

-50 Board Certified Pathologists -Over 25 Subspecialty Areas of Expertise -Over 40 Years of Pathology Experience -HIS & EMR Integration

01

Women’s Health

02

Genitourinary

03

Gastrointestinal

04

Dermatopathology

05

Hematopathology

CellNetix Spokane • 800 W. 5th Avenue • Spokane, WA 99204 • 509-252-6652 • www.cellnetix.com

December SCMS The Message 24

PRSRT STD

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

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