The Message, January 2014

January SCMS The Message Open2

TABLE OF CONTENTS

2014 Officers and Board of Trustees Voting was not finalized before The Message went to print.

Officers and trustees will be installed at the January 22 Board of Trustees meeting.

OPPORTUNITIES IN A NEW DIRECTION .

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David Bare, MD President

CHRIST CLINIC … A FOUNDING VOLUNTEER’S PERSPECTIVE .

Matt Hollon, MD President-Elect

2014 BRINGS CHANGES TO THE SPOKANE COUNTY MEDICAL SOCIETY FOUNDATION .

Anne Oakley, MD Immediate Past President

THE GENESIS AND EVOLUTION OF THE INSTITUTE OF SCIENCE

J. Edward Jones, MD Vice President

AND TECHNOLOGY AT NORTH CENTRAL HIGH SCHOOL .

IN MEMORIAM: JEFFREY DWIGHT AGER, MD .

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Newsletter Editor – Matt Hollon, MD

CONNECTING COMMUNITY PARTNERS WITH THE PROVIDENCE EHR .

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IN MEMORIAM : RICHARD E. ELSTON, MD, LOWELL EUGENE HORLACHER, MD . .

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Trustees Charles Benage, MD Audrey Brantz, MD Karina Dierks, MD Elizabeth Grosen, MD Clinton Hauxwell, MD Louis Koncz, PA-C Frank Otto, MD Fredric Shepard, MD Carla Smith, MD

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IS HYPNOSIS RIGHT FOR YOUR PATIENTS? .

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Gary Newkirk, MD Secretary-Treasurer

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EPICCARE AND EPICCARE LINK:

ARMED SCHOOL RESOURCE OFFICERS IN SPOKANE .

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TWO DAYS OF OUTSTANDING MAINTENANCE OF CERTIFICATION AND CME OPPORTUNITIES IN SPOKANE .

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MEDICAL OFFICES / BUILDINGS / CONTINUING MEDICAL EDUCATION / MEETINGS / CONFERENCES / EVENTS .

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PROJECT ACCESS PROVIDER APPRECIATION .

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NEW PHYSICIANS .

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CELEBRATING PROFESSIONALISM IN MEDICINE Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society.

Advertising Correspondence SCMS Publications Attn: Shannon Hill 518 S. Maple Spokane, WA 99204 509-343-0123 Fax 509-325-3889 ShannonH.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.

REAL ESTATE .

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EASTERN WASHINGTON PHYSICIAN HEALTH COMMITTEE .

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success and happiness lies in you.

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R esolve

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to keep happy, and your

joy and you shall form an invincible host against difficulties .”

– H elen K eller

January SCMS The Message Open3

Opportunities in a New Direction

By David Bare, MD SCMS President It is my privilege and honor to serve as your 2014 president. Allow me to introduce myself. I have been a part of this medical community for the last 11 years, during which I’ve known some of your personally and many of you professionally. I have served on the Board of Trustees for the last six years and on the Executive Committee for the last three years. I currently work for Community Health Association of Spokane (CHAS) Urgent Care. I am a graduate of the University of Washington and the UW School of Medicine. I served in the US Army as a physician for five years while stationed in Hawaii and Yakima Firing Center. For 25 years in Selah, Washington I was a Primary Care Provider with a full practice including Inpatient care and OB, first as a solo practitioner, then gradually adding three more providers to form a group, which eventually joined Medical Associates of Yakima with six other practices and 29 other providers. I was the Head of the Family Practice department in Yakima for three years. I served CHAS (a Federally Qualified Health Center) as medical director for nine years until 2012. During my time as a private FP I participated in numerous medical missions in southern Mexico, Guatemala, Haiti and the Dominican Republic. I have been married to Ruth, a wonderful, gifted, Godly woman for the last 44 years, have two terrific daughters and son-in-laws and seven grandchildren.

Last year I got my Medicare card.

I am passionate about being a physician and want to use the opportunity of being your president to help foster the best Health and Wellness possible for our region’s populace. This desire fits perfectly with our society’s new Mission and Vision adopted in 2012.

MISSION: The Spokane County Medical Society’s Mission is to fairly and objectively serve as a guardian of community health and wellness while leading and promoting the professional practice of medicine in our region.

VISION: The Spokane County Medical Society uses its resources and expertise, through collaboration and strategic partnerships, to facilitate the best community health possible for citizens of our region. SCMS is also well respected for its role in supporting the practice of medicine and stimulating teamwork across the regional healthcare continuum.

These can inspiration and guide us. SCMS has two operative pieces that accomplish this. One deals with the promotion of professional practice through fellowship, education, and practice support for our physician and physician assistant members.

The other is our Foundation, functioning as the guardian of community health. The overlap occurs through our collaborative member support of the foundation initiatives, financially and time allotment. These initiatives include: • Member/Community Engagement & Communication • Convener/Facilitator/Manager of Community-wide Population Health Initiatives • Cost Effective Health Care Access for uninsured and underinsured • Pursuing Healthy Populations • Regional Health Care Quality, Performance Measurement and Benchmarking • Regional Advocacy in Collaboration with Strategic Partners • Medical Practice Support • Credentialing • Community-wide CME • Financial career planning and employment resources Through this framework there are endless opportunities for you as individuals to get involved both in the support of our society and our Foundation. This can occur through Participation in: • Permanent committees. (e.g. the Medical Informatics Committee that keeps us abreast of changes in information technology and most recently has been actively directing the need for patient record access through provider portals in all community health organizations.)

• Task forces. (e.g. the Spokane Prescription Opioid Task Force brought many facets of our community together to define the problem of opioid use and abuse and put forward a strategy to solve some of the issues.)

• Public education forums (e.g. showing of “Escape Fire” a film presentation and public discussion of the barriers to best care in Medicine today.)

• Individual and group efforts in community programs that directly promote health (e.g. Project Access that allows for donation of time to see uninsured or under insured patients in the community by individual providers and organizations.)

• Advocacy in local, state and national levels to promote better health and health care (e.g. participation as delegates from our local region through our society to state and national organizations such as the Washington State Medical Association) These are just a few examples of how you can get involved individually or organizationally. continued on next page

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My personal goals to improve wellness and health through the next year are: • Wellness promotion through neighborhood efforts to educate and mobilize our youth to better health habits.

(A collaborative effort with such programs as Better Health Together and teaching and training of ACE [Adverse Childhood Experiences] initiatives) • Morphing Project Access to include overseeing and facilitating Medicaid patient access to specialty care • Increased collaboration of all Spokane organizations, expressly to improve efficiency and effectiveness of care for the good of our collective patients (Our foundation’s Partnership for Patients initiative) • Helping providers and organizations navigate the many changes of the Accountable Care Act through educational offerings (communications through our newsletter and other publications) • Promoting and coordinating the community of provider educators in all areas of health and health care to support our growing student populations (Part of our Educators Task Force).

• Formation of a “Practice Change” Task Force that can define and facilitate progression to best practices in our region (PCP Health Home initiative).

• Advocate for reform on local, state and national levels to bring about changes that allow individual providers and group practices to improve access, cost and quality of care (the Triple Aim set forth by the Institute of Healthcare Improvement).

Please join me and so many of your colleagues who have set aside time, effort and financial support to make a difference in our community. If you have questions on anything mentioned in this article please contact us through the medical society (509) 325-5010 or go online at our website (www.spcms.org) to explore these further. If you have ideas that can promote wellness and health in our community outside of what has been mentioned and you want to be involved let us know.

Christ Clinic … A Founding Volunteer’s Perspective

By Scott Edminster, MD Volunteer and Co-Founder Christ Clinic has come a long way and made a huge difference in the lives of many deserving people since its inception in 1991. Government leaders have come and gone as have their programs, but we have been an enduring presence and have remained true to our mission. The Affordable Care Act is certainly going to have some impact on the Clinic’s patient population, but it remains to be seen how. In the meantime, we are continuing to communicate God’s love by meeting the physical, mental and spiritual needs of our materially poor and under-insured neighbors in a context of shared responsibility and accountability. We are not about perpetuating or creating dependency. We aim to be extenders of grace for the purpose of freeing those whom God brings through our doors. It is clearly evident that there is no shortage of work for us to do. We are so grateful you have chosen to partner with us in delivering excellent primary healthcare to many of the Spokane area’s lower income residents who need “a leg up” in their efforts to become contributing members of our community.

Medical volunteers make the work of Christ Clinic possible.

Thank you to all our current and past volunteers. If you are interested in being a Christ Clinic volunteer, contact: Larry Carpenter, PA at the Clinic Monday through Friday at (509) 325-0393 ext. 310. If you would experience joy in giving to the work of Christ Clinic, please direct your gifts to Christ Clinic, PO Box 28236, Spokane, WA 99228 or online at www. ccckministry.org. The patients and providers of Christ Clinic are grateful for your help.

January SCMS The Message 2

2014 Brings Changes to the Spokane County Medical Society Foundation

By Dean F. Larsen, MA, CAE SCMS CEO The Spokane County Medical Society Foundation is embarking on a journey of resurgence with the goal to expand and improve current programs while developing exciting new programs that will improve access to and quality of healthcare for citizens of Spokane County and neighboring communities. A pivotal part of this evolution is the development of a new Board of Directors (BOD) that clearly reflects the partnership between healthcare providers, community leaders, and the citizens we serve. Spokane Community Medical Society (SCMS) members will be well represented on this new board, but the restructuring will include the addition of key non-physician representatives from healthcare in our area as well as local business and civic leaders.

Among the top priorities of the newly formed BOD is the review of current programs and how they might change to better serve the community, the search for unmet health needs in our communities and development of new programs to meet those needs and developing self-sustaining funding programs to lessen dependence on grant funds. This is a daunting task that will ask much from the board members, but is also dependent on the support of SCMS members individually, the medical community as a whole and the citizens of Spokane County.

The easiest way for SCMS members to support the changes and program development is by becoming a member of our new Sustainer Program. If every member of SCMS joined the Sustainer Program with a monthly pledge of $20, the Foundation would realize more than a quarter of a million dollars of revenue that through Project Access alone would provide access to healthcare valued at more than $7 million, a more than 25-fold benefit on each dollar! It truly shows that when even a small amount is given by many, it lightens the load for all. To make a donation or become a sustainer, call the Foundation at (509) 532-8877 or go to the website at www.SCMSFoundation.org.

Our past efforts would not have been successful without the financial support and strong partnership with local agencies and organizations like Providence Health and Services, First Choice Health, Avista, Physicians Insurance, PhRMA, Inland Imaging, Premera, First Choice, Group Health, Washington State Medical Association, Health Sciences and Services Authority, Susan G. Komen For The Cure, Washington Trust Bank, Inland Northwest Academy of Physicians, Health Sciences and Services Authority of Spokane, Empire Health Foundation, and of course, hundreds of local physicians, physician assistants and other healthcare providers.

Our current programs include:

Project Access Provides coordinated access to a network of over 600 physicians, pharmacists, allied healthcare providers and hospitals providing donated care to people with no other access to health care.

It normalizes the distribution of donated care across the medical community helping to make the participation throughout the community equitable.

Behavioral Health Work Group Brings together the Emergency Department (ED) providers, case management staff, hospital Psychiatric staff and providers of behavioral health services to establish community-wide protocols and pathways for discharging acute mentally ill patients from the local hospital emergency departments in Spokane; working in partnership with Sacred Heart Medical Center, Providence Health and Services, Frontier Behavioral Health and Regional Support Network leadership.

Partnership for Patients - Care Transitions Pilot SCMSF is sharing the project management of the Care Transitions Pilot Project in Spokane with the Washington State Hospital Association (WSHA). This work is part of the Centers for Medicare and Medicaid Services’ (CMS) Partnership for Patients National campaign to reduce harm by 40% and readmissions by 20%.

The Partnership for Patients project leverages local and national resources with the goal of identifying solutions that are already working and bringing lessons learned to other hospitals in the region.

Representatives from all four hospital systems, Rockwood Clinic, Providence Medical Group, Group Health, Columbia Medical Associates, all of the community clinic systems, home health and skilled nursing service providers are working together to jointly to reduce hospital readmissions.

Consistent Care Washington (CCW) Developed in partnership with Dr. Darin Neven and Sacred Heart Medical Center to improve care for complex patients and reduce cost through focused and intensive care coordination.

CCW provides capabilities for patient care coordination targeting patient populations that are frequent users of ED and other medical services. CCW care coordination services are focused strategically to be non-duplicative and to add value across the regional medical community, rather than competitive with other existing care coordination services from hospital or clinic systems or medical services payers. continued on next page

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Integration of Consistent Care and Hot Spotters Group

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Health Housing Homeless Systems Integration Pilot Project (H3) CCW received a grant from the City of Spokane called the Health Housing Homeless Systems Integration Pilot Project (H3). Dr. Neven and Sacred Heart Medical Center are major partners in this project. The program focuses on homeless people who have been admitted to Sacred Heart Medical Center and their medical condition puts them at high risk of relapse or death if they are discharged to homelessness. Over 100 homeless patients have been referred to the program by Sacred Heart social workers. 41 patients were qualified and enrolled in the program. 25 clients have been successfully housed.

One of the intended outcomes of the pilot project is to create a collaborative system of care by engaging community partners in development and implementation of an effective system to provide coordinated medical care, behavioral health and housing services for homeless clients with high risk medical conditions.

Transitional Respite Program The collaborative work in the H3 program was the catalyst to significantly expand the small one-bed homeless respite program developed by WSU PhD nursing student Becky Doughty, in collaboration with the House of Charity. Sparked by the need for more respite housing for the homeless clients in the H3 program SCMSF and Dr. Neven brought together the leadership of Catholic Charities, operators of House of Charity for men and Volunteers of America, operators of Hope House for women, to discuss rapid expansion of the program. Dr. Neven and Rob McCann, CEO of Catholic Charities, requested funding for the respite program expansion from Providence Health Services Foundation. Within two months the respite program grew to six beds for men and three beds for women and plans are being made for further expansion.

Hot Spotters Group

with the Community Court The Community Court will create a better way to respond to minor “life-style” crimes which includes providing a broad range of health care and social supports that are needed to help stabilize the people who commit the crimes. The Community Court judge will be ordering clients to do multiple tasks to fulfill their obligations to the court and the community (e.g. community service, applying for Medicaid or other available insurance, getting personal identification documents, enrolling in behavioral health services and investigating housing options).

In recent meetings with the Community Court team it became clear that coordination of services across multiple service providers would be necessary for the success of the Community Court. The clients of this new court will require significant engagement by a community health worker to help them navigate the network of service providers. The staff of the Spokane County Medical Society Foundation has been doing care coordination and proactively making service connections for the past 18 months as part of the H3 grant and the Hot Spotters Group initiative. There are four staff members that are trained community health workers that will be available to participate as a team to meet the care coordination and care connection needs of the Community Court.

As you can see, your Spokane County Medical Society Foundation, together with our partners, have accomplished a great deal in the last few years and with your help we will do even more in the years to come.

COMMUNI PROFESSIO

COMMUNITY O COMMUNITY OF PROFESSIONAL PROFESSIONALS COMMUNITY OF The PROFESSIONALS

This group evolved from years of work by Dr. Neven, Assistant Fire Chief Brian Schaeffer and providers of health services. The new community collaboration that was created by the H3 project was the catalyst that launched this group. The work of the group is modeled after the Camden, New Jersey Coalition of Healthcare Providers, which originally coined the name, “Hot Spotters”. The Spokane Hot Spotters Group focuses on high risk patients with a COMMUNITY OF history of high utilization of health care and emergency response The Prewitt G PROFESSIONALS The Prewitt Group services and develops a community care plan that will provide For more information regarding the Communit the best care available while working to reduce community costs.

Program contact Dean Larsen, C Michelle Caird, Executive Assistant at (50 The group includes the Spokane fire department, providers of medical care, behavioral health and substance abuse services, as For more information the Community of Profess For more information regarding the Community of regarding Professionals The Prewitt Group The Prewitt Group Program contact Dean Larsen, CEO or Program contact Dean Larsen, CEO or well as, housing services providers and SCMSF community health Michelle Caird, Executive Michelle Assistant at (509)Executive 325-5010. Assistant at (509) 325-5010 Caird, workers. The group is instrumental in driving community-wide collaboration to solve some of the most challenging medical and For more information regarding the Community of Professionals Program contact Dean Larsen, CEO or Caird, Executive Assistant at (509) 325-5010. behavioral health cases in the community.

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

January SCMS The Message 4

The Genesis and Evolution of the Institute of Science and Technology at North Central High School

By Randall James, Director Institute of Science and Technology (This is Part 1 of a 2 Part series. In part two we will explore our student research, and national and Washington State trends in STEM.)

Self-Discovery and the Desire for Real Science Fifteen years ago, afraid that I would be retired but still in the classroom, I asked Dr. Don Lightfoot at Eastern Washington University if I could come out and spend time in his Biotechnology Laboratory. Don graciously said yes and I started what became an amazing and transformative multiple summer immersion into biotechnology and research. Within the very first week I realized that even after almost twenty years as a teacher my students had never really done any real science. My students had been doing labs that had been done for decades and their moms and dads and even their grandparents knew the answers. I realized at that moment that my students needed to capture the true meaning of science: Discovery. They needed to do a deep dive into the unknown.

Biological Solutions and the Institute was a drive to acquire the same equipment in our research laboratory that is found in other molecular bioscience laboratories. Years of seeking grants and donated equipment and reagents produced a well-equipped modern research laboratory poised to house an Institute.

The Dream Grows Six years ago we realized that to have a true Institute of Science and Technology (IST) we needed a multi-level set of immersions that build on the skills and concepts from one year to the next.

Developing the second course of the Institute, Biomedical Technology, was not without some complex challenges. Dr. Steven Gering, our principal at the time, and Lisa White, director of Spokane Public Schools CTE, and others helped negotiate the complex landscape developing this new class, which became the introductory course in the trilogy. Biomedical Technology is open to freshman and sophomores and immerses students into the concepts and laboratory skills of the biotechnology/biomedical work place. We describe it as beginning or basic biotechnology, but the work that the students do is typical of universities and research laboratories around the world. The studentscientists in Biomedical Technology perform DNA and protein extractions, SDS-PAGE analysis of proteins, DNA fingerprinting of themselves at several loci, Western Blots, restriction fragment length polymorphisms (RFLP) analysis of sharks, enzyme-linked immunosorbent assay (ELISA) and many other fundamental and foundational molecular bioscience protocols.

My mentor and finding the scientist “With-in” Those amazing summers, mentored by Don, immersed in real research, forged the vision of creating an Institute of Science and Technology at North Central High School. I wanted to design a series of courses that would allow students to discover their “Scientist Within” and immerse themselves into authentic, novel and intriguing researching questions. The first course of the trilogy was Biological Solutions. This course initially offered to seniors, now offered to sophomores, juniors and seniors, immerses students into long term research experiences while building their conceptual knowledge around DNA, genomics, molecular ecology and other topics. Currently, we are using DNA sequencing to analyze genetic diversity, gene flow and finding metabolic disorders in Mule Deer. Coupled with starting

Our first immersion field experience to the Big Hole Valley to study Artic Grayling 2011-2012. Our first endangered species.

Our IST comes Alive The final course of the trilogy is our capstone immersion called Genomic Research. The framework and foundational concepts for Genomic Research began over a conversation with Steve Fisk, our current principal, several years ago about a project he had done with his own students many years ago: digging for ancient Bison bones. I said that we could get DNA from those ancient bones and answer some novel questions using DNA sequencing.

We are doing just that along with many other authentic and novel research investigations. In Genomics, as we call it, students invest into a one to two year research investigation in their junior and

Students transferring bacteria to a tube in order to amplify genes of interest and analyze genetic diversity.

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senior years. Students truly become independent researchers in Genomics as they explore novel investigations optimize their own research investigation and ultimately present their findings at symposia. During their journey they will read dozens of journal articles focused around their questions, embrace “successful failure”, and celebrate new discoveries within science and themselves.

Some of our current research areas include: Analysis of insects for novel glutenase genes for potential Celiac disease therapy; Analysis of ancient Bison genetic diversity; Analysis of genetic diversity of 1950’s Sea Otter, Mule Deer gene flow and metabolic disorders; Arctic Grayling genetic diversity and gene flow; Searching for novel DNA polymerases in extremophilic bacteria; Optimization of Polymerase Chain Reaction involving reaction inhibitors; Analysis of native Redband Trout genetic diversity and gene flow; and an Analysis of genetic diversity within Mammoths.

Over the years we have forged a fully functioning Institute of Science and Technology operating in an authentic Molecular Bioscience Laboratory. Our students combine their laboratory immersions in the Institute with a rich mixture of classic science courses producing a gritty, capable and resilient mind-set towards STEM majors and careers. Our experiences with multiple generations of student-scientists have helped to form the following vision statement.

Group photo of our YATO’s (You Are The Ones) who will solve the world’s most challenging problems. This is a Biological Solutions class.

There has been a very large investment of time, energy, mind, and dollars from so many to evolve the Institute to its present state. A very exciting new investment comes in the form of a brand new suite of laboratory spaces on North Central’s campus.

The new construction, funded through cost savings of the Ferris high school remodel will include two large research laboratory spaces and areas for instrumentation, research team meetings, a clean room, laboratory prep, and library space. We will be moving into the new laboratory next August and we will have an open house in early September to share our new digs, the Institute of Science and Technology, and our wonderful Student-Scientists.

Please drive by and watch the new building go up and please plan on attending our Open House next fall, we hope to be hosting on Saturday, September 6, 2014.

Students have the capabilities of doing authentic scientific research with real-world practical applications.

Student-scientists can engage in authentic research while simultaneously engaging in community service and career exploration. Student-scientists can contribute to the scientific community and be seen as peers amongst research scientists. Student-scientists can communicate research findings in the form of scientific posters, symposiums and peer reviewed papers. Student-scientists can display the persistence and grit that leads to discoveries and novel findings new to the world of science.

L-R: Steve Fisk, Lifen Guo, Forrest Ireland, Marina DeFrates, and Elizabeth Rose in Moise, Montana at the National Bison Range.

Our first immersion trip to understand ancient Bison in 2009-2010

Nick Negretti visually analyzing the diversity of bacteria that has grown on a nutrient-rich plate. Nick is in the fast track PhD program at WSU. Nick is also a Howard Hughes scholar. We are proud of Nick’s persistence and tenacity with his research.

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The Power of the Mind Has Been Well Known for a Long Time.

We know your patients expect you to have all the answers. Positive Changes Hypnosis would like to present one more option that you can offer your patients. We help your patients by using powerful hypnosis backed by personal coaching to help them lose weight, stop smoking, manage pain or anxiety, and more. Hypnosis is a safe, natural and effective way for people to take control of their health and become better patients for you. Call us for a tour of our facility and experience hypnosis for yourself.

(509)462-4222 Positive Changes has programs to help with a variety of issues:

• Anxiety • Stress • Insomnia

• Weight loss • Tobacco Free • Alcohol Free

• Panic Attacks • Pain Management • Motivation January SCMS The Message 7

• Bed Wetting • Hair Pulling • Skin Picking

• Self-Con�idence • Self-Esteem • Grieving

Is Hypnosis Right for Your Patients?

Connie Rice, a local client at Positive Changes Hypnosis is living proof. “Hypnosis completely eliminated my cravings, food binges and bad eating habits.” said Rice. “I was a chocolate and carbohydrate person. I liked the fries, burgers, and all the bad stuff. Now I’ll occasionally take a bite of something and taste it, but the cravings are just gone.”

By Kevin Oliver Positive Changes Hypnosis

When most people think about weight loss it seems pretty simple right? Burn more calories than we take in. That concept is pretty straight forward, but for most people it’s anything but simple.

The Mayo Clinic even offers hypnosis as a “Complementary and Integrative Medicine” as part of a program created to address growing patient interest in wellness-promoting treatments that are not typically part of conventional medical care. And, as they state on their website, hypnosis is meant to compliment rather than replace conventional Western medicine.

Obesity is growing at such an alarming rate now that the CDC has officially declared it a disease. So why are so many people However, most hypnotists are not as they are portrayed on struggling with their weight when the concept of weight loss television or in seems so simple? movies. You are Well, the concept more likely to see may be simple but a very professional the execution is “Hypnosis completely eliminated my cravings, food binges environment, anything but. You especially at a see for most people, and bad eating habits. I was a chocolate and carbohydrate main-stream the one element person.

I liked the fries, burgers, and all the bad stuff.

Now hypnosis they seem to be company, similar lacking is will power I’ll occasionally take a bite of something and taste it, but to a medical or motivation to the cravings are just gone.” office. Patricia make the necessary Hunte, a weight changes. And that’s –Connie Rice loss client of where hypnosis may Positive Changes be able to help your Hypnosis, put patients. it like this, “I Here are a few quick thought hypnosis facts about hypnosis: most people can be hypnotized; hypnosis would be kind of hairy fairy but it was really a learning process. can’t make anyone do anything they don’t want to do; and They taught me more during the hypnosis and it has stayed hypnosis is very effective in helping people change unwanted with me.” And what has stayed with Patricia is long-term. “I behaviors. choose food better. I choose nutritional food and I choose food that is going to do for me what I want food to do. I like So why aren’t more doctors referring their patients to reputable that.“ added Hunte. hypnotists to help them change the behaviors the doctors themselves can’t help them change? The reality is, more and So if you are looking for a healthy alternative to help your more doctors are referring their patients to hypnosis as an patients gain the drive and motivation to make the changes in alternative to medication. And it’s working! their life that they desire, and still hold you in the high regard you deserve, you may want to suggest hypnosis. Not as an alternative medicine but a complementary program to help them become a better patient!

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IN MEMORIAM

IN MEMORIAM

Richard E. Elston, MD

Lowell Eugene Horlacher, MD

Richard Eugene Elston was born on April 4, 1927 and passed away December 25, 2013, which was his favorite day of the year.

Raised in Humphrey, Nebraska by Dr. Harry R. and Lydia Elston, he later attended high school in Omaha, Nebraska. He attended Creighton University and graduated from medical school at the University of Nebraska in 1950 at age 23. He met his beloved wife of 64 years, Marcella K. O’Neil, in 1947. They later wed at St. Cecilia’s Cathedral in Omaha on December 26, 1949. They started their family in Omaha, Nebraska, and moved to Rhode Island after Richard joined the U.S. Navy in 1950. He served as a medical officer with commendation during the Korean War conflict and was stationed in Guantanamo Bay.

Born in Claresholm, Alberta on May 1, 1927, he grew up on the family farm in Alberta, as well as working numerous harvest days on the family homestead south of Rosalia, Washington. He was accepted to University of Alberta’s Medical Program in 1954.

He moved to Spokane in 1960 to start his residency program at Sacred Heart Hospital and spent the rest of his life loving and living in Spokane. He was blessed to be called home on the Eve of the celebration of our Savior’s birthday - a birth into eternal life for him.

After discharge from the Navy the Elston family moved out west to Leavenworth, Washington. Richard eventually settled his family in Spokane in 1959. A board certified general surgeon, Dr. Elston opened a family practice and general surgery office in Spokane that spanned over three decades. He was a member of the American College of Surgeons. He helped start the first House of Charity and he was the medical director there and volunteered his medical care. This was later torn down to make room for Expo. During his career he took care of all clergy for free and offered discounts to indigent patients. He also helped found Holy Family Hospital and performed the first surgery there. He was most at home in the outdoors, working on his fruit orchard into his 86th year of life. A devoted family man, his favorite photography subject was his wife and family. Richard and Marcella raised twelve children in Spokane through the Holy Names and Gonzaga schools. He is survived by his wife, Marcella and children: Maureen, Cathleen, Kevin, Laurie, Gail, Eileen, Julie, Shawn, Claire, Cara, Michael and Leigh, 29 grandchildren and 14 great-grandchildren and his brother, Dr. James Elston. He will be dearly missed by them and all who knew his joyful Christian passion for life.

Dad was a teacher to his children and grandchildren, patients, and friends; a gifted healer as a doctor who wanted patients cured, not the symptoms treated and a loving father who was always so proud of his children. He was a Board Certified Family Practice physician for 35 years who delivered over 3000 babies over two generations. He was President of Holy Family Hospital from 1970 -71 and medical staff member from 1964 to 1996. He was a lifetime NRA member, Spokane Police Reservist, a member of Spokane’s Medical Reserve Corps, an ardent Spokane Jets Hockey team doctor and Chiefs fan, avid snow skier, fisherman, skater and hunter into his 80’s and a singer and lover of music.

He is survived by Betty Jane Horlacher, his wife of 62 years; his faithful protector, Brutus; five children Dennis Lee (Leslie Lynn) Horlacher, Leslie Jo (Daniel) Sulgrove, Gail Anne (Marc) Lange, Renee Katherine (Daniel) Demand and V. Janelle (Jeffrey) Axtell; 14 grandchildren Camille Flaget, Jared and Shane Horlacher, Lindsay Swiger, Stephanie Brown, Jessica and Bryan Sulgrove, Valaree Martinez, Kallie Ingwaldson, Rebekah Bennett, Ryan and Michael Demand, Teresa Collingwood and Casey Axtell; 10 great-grandchildren Dakota Flaget, Blaine Swiger, Hadley Rose Brown, Noah Martinez, Avaree and Amorette Ingwaldson, Josie Collingwood and Caden and Westen Axtell; brothers Neil, Owen and Byron Horlacher and numerous nieces and nephews.

He was predeceased by his brother, Everett Horlacher; sister, Maxine Gilfillan and great-granddaughter, Cierra Flaget.

January SCMS The Message 9

In The News

IN MEMORIAM

Jeffrey Dwight Ager, MD

SCMS Physicians at the WSMA House of Delegates

Jeff passed away suddenly at Sacred Heart Medical Center on December 24, 2013 after a courageous eight month battle with cancer. He was born in Everett, Washington to Jeanne and the late Richard Ager. Raised in Spokane, he attended parochial schools and Gonzaga Prep High School. At the age of 15, a fateful blind date introduced Leanne Zimmer into his life. She was his high school sweetheart and eventual wife, and they shared nearly 29 years of married life together. Jeff went on to receive his undergraduate degree from Stanford University and attended medical school at St. Louis University. He completed a radiology residency at Virginia Mason Medical Center followed by a Fellowship at the University of Washington, specializing in Body Imaging. Jeff’s radiology career spanned 20 years in Spokane, where he embodied a genuine passion for excellence and professionalism while developing cherished friendships with colleagues and staff.

He endeared himself to all he encountered with his quick wit, disarming smile, and warm heart. Despite his many successes, Jeff’s greatest pleasures were found in the simple things. Jeff’s most cherished role, and likely his greatest legacy, was that of mentor and father to his boys. He was a man of few words, but his actions spoke volumes. He modeled hard work, integrity, and consistency as he loved them into men. They will forever be grateful for his steady and true guidance in their lives.

Dr. Brian Seppi

Dr. Gary Knox

On September 28 at the 2013 WSMA annual meeting in Spokane, Dr. Brian Seppi was installed as president-elect of the WSMA and Dr. Gary Knox was elected to the board of trustees. Both physicians will serve as ad hoc members of the Spokane County Medical Society Board of Trustees.

Jeff was preceded in death by his father, Richard and sister, Julie Ann. He is survived by his wife Leanne; children, Bryan Ager (wife Katie) and Casey Ager; mother, Jeanne Ager; sister, Jan Karel (husband James); in-laws, Ginny and Roy Zimmer; sistersand-brothers-in-law, Laury Byxbee (husband Warren), Mary Dinnison (husband Joe), Chip Zimmer (wife Denise); 11 nieces and nephews; and numerous loving aunts, uncles, and cousins.

He lived with open hands in generosity, and selflessly put the needs of others before his own. If the measure of a man is in the impact he had on the hearts of others, he was rich indeed.

Dr. Helen M Schmidt

Dr. William J. Doyle

Also at the WSMA annual meeting, 15 physicians entered the esteemed WSMA 50-year club (having been a physician for 50 years!). Two Spokane County Medical Society physicians were honored – Drs. Helen M. Schmidt, Liberty Lake and William J. Doyle, Colville. Thank you for your many years of dedication.

Incyte Diagnostics Welcomes Pathologist, Stanley T. Leung, M.D. Dr. Leung is board certified in anatomic and clinical pathology with subspecialty training in gastrointestinal and hepatobiliary pathology at the Mayo Clinic. Dr. Leung graduated from the University of Illinois College of Medicine and practiced pathology in the Quad Cities area of Iowa and Illinois. Dr. Leung will join Incyte Diagnostics in early January.

January SCMS The Message 10

EpicCare and EpicCare Link Connecting Community Partners with the Providence EHR

By Heidi Brown, | Clinical Informatic Support | EpicCare Link Providence Health and Services

Overview Providence Health Care went live with its new Epic electronic health record (EHR) in October 2013. The new EHR has tools to provide access for those who have a relationship with our hospitals, Providence clinicians and our shared patients. In addition to our full EHR EpicCare, Providence is pleased to offer an online tool called EpicCare Link. This online portal provides secure, convenient access to patient information stored in the Providence Epic EHR. Having one health record across the Providence system and sharing information with our community partners helps us create an excellent, consistent level of care across the regions we serve.

With the Epic EHR, access to patient information is configured to each user’s role – giving them access to the information they need. This means more connected clinical teams, safer care and more personalized service for our patients. Depending on the level of access needed, authorized users can log in to see lab, imaging reports and test results; hospital admissions; discharge summaries; orders placed by physicians, and more. EpicCare Link, our web-based access, allows for easy, paperless referrals, and with nothing to install.

Depending on a user’s role and access level, they are able to see: • Patient demographics, chart review, histories, problem list • Lab and test results • Hospital admissions • Discharge summaries • Consultation notes • Orders placed by physicians • Office visit notes • In-Basket notifications • Results notifications • Insurance information • Benefits and eligibility

Previous Clinical Information Systems Resources Continue Information that was previously received via IRM and Meditech continues to community practices and hospitals.

For more information Users are invited to contact Heidi Brown at (509) 474-5387 or heidi.brown@providence.org to discuss access options that best meet your needs.

Examples of who is using EpicCare and EpicCare Link: • Credentialed physicians providing services in a Providence facility • Office staff of privileged and affiliated physicians and providers • Community physicians • Community service providers such as ambulance, blood banks or tissue banks • Skilled nursing facilities • Rural hospitals and health clinics • Third party providers that support community practices such as billing services

January SCMS The Message 11

Armed School Resource Officers in Spokane

By Kristy Wessels, PA School shootings have become a phenomenon in our culture over the past 30 years. The Newtown incident, approximately one year ago, is one of the most serious. Just recently, a begrudged student who was reprimanded by a teacher went to school with a shotgun, critically injuring one student and killing himself. Many would contend that something needs to be done to increase the odds of our children returning home each day from school. The question is, “What?”

Approximately two years ago, the Spokane Public School District commissioned a safety audit to identify areas that need to be addressed that would increase the safety of our children1. Among the recommendations from the audit was that of increasing the number of School Resource Officers (SROs) and arming each with a handgun. When this goes into effect, the Spokane Public School District will be the third in the state of Washington to arm its SROs. This is relatively new territory for public schools, implemented without much educational governance—at the state or federal level. Larger and wealthier school districts have the funds to employ SROs, who typically have had formal firearms training via previous law enforcement or department of corrections jobs. The question is, as the larger school districts begin to place armed officers in the schools, will smaller schools follow?

A slippery slope can occur when authorizing security staff, that have not been professionally trained, to carry arms in order to make schools appear as “safe.” The APA did reply for this article; however, they have stated previously that they do not ever endorse educators arming themselves.

The question I intimated at the beginning, what is to be done, has been answered by the Spokane Public School District by arming the SROs. The next question naturally follows, “Will it make the children safer?” One report, authored by the US Secret Service and US Department of Education, analyzed the Columbine shooting, as well as others.2 The report stated that time and resources trying to prevent such incidents are best focused upon teaching hostage negotiation skills to first responders and implementing anti-bullying campaigns. Keep in mind, Columbine had an armed officer in the school on that day and the perpetrators appeared to commit suicide. It is unclear what role the security officer had on that horrible day. There’s a National Rifle Association (NRA) saying, “The only thing that stops a bad guy with a gun is a good guy with a gun.”

Governance: County/State/Federal The SROs will be trained by the Spokane Police Department and employed by the school district. The Spokane Teacher’s Association had “no comment” regarding the issue of arming the SROs. Neither the AMA nor APA has a position about staffing

schools with armed officers. “The AAP affirms that the most effective measure to prevent suicide, homicide, and unintentional firearm-related injuries to children and adolescents is the absence of guns from homes and communities.”3 The Office of Superintendent of Public Instruction produced a safety manual that implements safety protocol for all 295 schools in the state of Washington. The safety manual, last updated in 2008, offers specific protocol for school lock downs and fire drills. There are consequences for a student who brings a firearm to the school, but the manual does not address any of the potential issues with having armed SROs in the school. It appears that each school district is allotted discretion regarding this issue. In the medical profession the guidelines are clear as to who governs/directs what and which agencies have authority. With the issue at hand, there are no guidelines and no governing authority, other than the school district itself. Senator Dianne Feinstein has led federal legislation to ban “assault weapons” and the NRA asserts their right to bear arms, no matter what type.4 This national legislation, which the AMA, APA and many other medical organizations endorse, is at a standstill.

Really?

Death by gunshot is one of three leading causes of death of American youth, according to the American Academy of Pediatrics, as stated in their October issue entitled;” FirearmRelated Injuries Affecting the Pediatric Population in the U.S”.

Obviously, bullets kill. But let’s bring this back to the school setting, which encompasses a variety of children. Special needs students often get the attention of others because of their behavior. Their behaviors may warrant attention from a school resource officer. Guidelines and training for the school resource officers in a variety of situations, particularly with our most vulnerable, is a must.

The medical community is committed to our Hippocratic Oath, “Do no harm.” Are we “doing no harm” and protecting our children by this action? Or is it just an act that can be perceived as bringing more safety to our children when other measures could benefit more. Is it better to have an armed guard at one end of the school or a staff trained to identify troubled students and a psychologist on hand to assess the potential for dangerous behavior? Remember, Columbine had an armed safety officer on campus. Think about it. Please be aware of this, as we approach new, unchartered, unmandated territory of education coupled with school officers carrying a Glock .40 this year.5 1 -http://www.spokaneschools.org/cms/lib/WA01000970/Centricity/ domain/702/_files/Spokane%20Public%20Schools%20Safety%20 Audit%203.6.13.pdf 2 - http://www.secretservice.gov/ntac/bystander_study.pdf 3 - http://pediatrics.aappublications.org/content/130/5/e1416.full 4 - http://www.feinstein.senate.gov/public/index.cfm/assaultweapons-ban-summary 5 - http://www.khq.com/story/23133910/spokane-school-boardmay-ok-armed-employees

January SCMS The Message 12

Two Days of Outstanding Maintenance of Certification and CME Opportunities in Spokane Internal medicine specialists and subspecialists, are you wondering how to fulfill the new American Board of Internal Medicine (ABIM) Maintenance of Certification requirements?

Are you looking for high quality CME credits? Get them both in two days in Spokane.

Mark your calendars for February 21-22, 2014!

As most of you know, ABIM has announced changes to the Maintenance of Certification (MOC) process for board certified internal medicine specialists and subspecialists, effective January 2014. Beginning in 2014, ABIM will report two credentials for all board-certified internists: whether you are Board Certified and whether you are meeting ongoing MOC Requirements. If you are not sure how the changes will affect you, check out the details at the ABIM website (http://www.abim.org/moc/). Keep in mind that the same MOC points can apply to each certificate you renew (e.g. internal medicine and a subspecialty certificate). You only need to earn 100 points every five years no matter how many certificates you renew.

ACP MOC SESSION The Washington American College of Physicians (ACP) Chapter will offer ABIM MOC modules from 1:00 to 5:00 p.m. on Friday, February 21 in Spokane. Faculty will teach the modules by presenting and analyzing each question, reviewing current evidence and highlighting clinical pearls and key points. The format will be highly interactive with use of an audience-response system. The scheduled modules are the 2013 Internal Medicine Update (Module C0-P) and 2013 Hospital Medicine Update (Module 83-P). Participants will leave the session ready to submit completed modules to ABIM for 10 MOC points each (and 4 category 1 CME credits). This event runs from 1 to 5 p.m. and will be held in the Isabella Room at the Davenport Hotel in downtown Spokane. Register through the Washington ACP Chapter website at http://www.acponline.org/about_acp/chapters/wa/news_meet. htm.

and hear updates about both organizations including becoming a fellow of the ACP. We will provide beverages and heavy hors d’oeuvres. Please pre-register for this event through the SSIM meeting registration (see below).

SSIM 65TH ANNUAL SCIENTIFIC MEETING The Spokane Society of Internal Medicine will hold its 65th Annual Scientific Meeting on February 22, 2014 on the beautiful WSU Riverpoint Campus in downtown Spokane. This year’s meeting features nationally recognized general internist and author, H. Gilbert Welch, MD, MPH, whose research has focused on the problems created by medicine’s efforts to detect disease early. It also features David Moller, PhD who is nationally recognized for his work on the interface between serious illness, end-of-life care and poverty. Among other topics, the meeting will also feature updates in ambulatory and hospital medicine, a focused session on current questions in endocrinology, gastroenterology and neurology. ACP Governor-Elect Joyce Wipf, MD will provide a session on ophthalmology for the internist. Other topics include evidence based physical diagnosis and new clinical aspects of hyponatremia. For overall details of the program agenda and registration email spokanesocietyim@gmail.com or go to www. spokanesocietyim.org/attachments/Website%20Brochure.pdf.

The program has been designated for a maximum of 9.0 PRA Category 1 Credits. ACP and SSIM members get discounted registration. Supporters of the meeting include the Washington Chapter of the ACP, Providence Health Care, Rockwood Health System, Inland Imaging, Premera and Cancer Care Northwest as well as an unrestricted educational grant from Physicians Insurance.

ACP SOCIAL EVENT The MOC session will be followed on Friday evening by ACP “meet and greet” social event from 5:30 to 7:30 p.m. – also at the Davenport Hotel. The social event also serves as the kickoff for the Spokane Society of Internal Medicine’s (SSIM) 65th Annual Scientific Meeting. It is an opportunity for ACP and SSIM members as well as internists and internal medicine subspecialists interested in membership in those professional organizations to connect with your professional community, see old friends and meet new ones, talk with local leadership in both organizations, January SCMS The Message 13

MEDICAL OFFICES/BUILDINGS

MEETINGS/CONFERENCES/EVENTS

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.

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.

CONTINUING MEDICAL EDUCATION Ask, Screen, Intervene (ASI): Incorporating HIV Prevention into the Medical Care of Persons Living with HIV ASI is designed to enhance clinicians’ efforts to incorporate HIV prevention into the medical care of persons living with HIV. Monday, February 03, 2014, Spokane, WA, 10:30 a.m. – 3:00 p.m. This training and CME Credits are free of charge, but preregistration is required. Objectives include Outline a correct approach for screening for STDs, Address patient misconceptions about HIV transmission, Provide brief behavioral interventions and referrals for more intensive interventions and Initiate discussion of the five partner referral options with patients. 3.75 AMA PRA Category 1 Credits™. Register at www.seattlestdhivptc.org.

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.

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 08 January 2014 6:00 -8:00 p.m. at the Spokane Regional Health District 1101 W. College Ave., Auditorium.

Meeting agenda to include a presentation on Individual and Family Disaster Preparedness, an update on Training, Exercise, Equipment, Recruitment, Recognition and Communication and a Coordinator’s Report. Next meeting scheduled for 12 February 2014

January SCMS The Message 14

Sponsors of the Provider Appreciation Campaign:

Health Sciences & Services Authority of Spokane County Providence Health & Services Premera Susan G Komen for the Cure The Bank of America Foundation Group Health

Inland Imaging Washington State Medical Association Washington Trust Bank Cellnix Inland Northwest Academy of Family Physicians

City of Cheney City of Deer Park City of Liberty Lake City of Millwood City of Spokane Valley

Thank You Donating Providers!

Abadir, Janet S., MD Aberle, Marie, ARNP Adams, Dave, P.T. Adams, Jessica, PA-C Ahlstrom, Karen K., MD Ahmad, Rana, MD Ahmed, Saima, MD Ahrnt, Scott, PA-C Alcaraz, Veronique, MD Alder, Paul, DC Alexander, Susan, MD Alexianu, Mihai, MD Aley, Lynn, PT Allen, Eric, MD Anderson, Christian, MD Anderson, Christopher , MD Anderson, Debra, ARNP Anderson, Eric, MD Anderson, Kurt, MD Anderson, Stacee, PA-C Arguinchona, Henry, MD Arora, Anupam , MD Aspinwall, Patricia, PT Atkinson, Leonard, PA-C Atkinson, Marie, MD Badger, Mary, DO Bailey, Kimberly, OT CHT Baker, Amery, PA-C Baker, Jane, PT Balazs, Andrea, ARNP Bare, David, MD Barko, Natalia, ARNP Barnes, Barry, MD Barrong, Shawn, MD

Barrow, Craig, MD Bassett, Mark, MD Batchelder, Andrew, MD Batkoff, Braden, MD Bax, Timothy, MD Bazzano, Robert, PA-C Bean, Jami, DPT Behne, Christopher, MD Belanger, Eric, PA-C Bell, Christopher, PA Bell, Gina, MD Benage, Charles, MD Bender, Berdine, MD Bender, William, MD Bennett, William R, MD Berg, Tracy, MD Bergman, Melanie K., MD Bestick, Mark, PT Beuscher, Mark, PA-C Beyersdorf, Steven, MD Bingham, James, MD Bishop, Timothy, MD Bitello, Nancy, PA-C Bocek, Zdenek, MD Bogarosh, Christopher, MD Boulet, Andrew, MD Bowton, Eric, MD Bowton, Kari, OT Boyd, John, PA-C Boyum, John, MD Brandt, Nicole K., MD Brasch, James, MD Bray, Robert, MD Bray, William, MD

Brennan, Heather, MD Bright, Andrew, MD Brim, Stewart, DPM Brisbois, R. Steven, MD Bristow, Megan, OT CHT Brockbank, Greg, DPM Brophy, Michael, MD Brown, Anthony, MD Brown, Douglas, MD Brown, Edward, MD Brunck, Brian, PA-C Bunn, Jeffrey, MD Burg, Pamela, MD Burks, Oliva, PA Burns, Erica, MD Butler, Jeffery, MD Byazrova, Eteri, MD Byrd, Leroy, MD Cain, Sue, ARNP Campbell, Julie, PA-C Canaday, Donald, MD Carey, Coleen R., MD Carlson, Jonathan, MD Carlson, Scott, MD Cathcart, Ken, DO Cathcart, Sharon, DO Chaganur, Kavitha, MD Chang, Edwin, MD Chang, Wendy, MD Chaudhry, Arvind, MD Cheek, Andrew, MD Chester, Kawal, MD Chilson, Donald A., MD Chow, Nelson, MD

Chow, Ward, MD Christ, Constance, MD Christensen, Janice, MD Christianson, Mark, PT Clode, Jeffrey, MD Clyde, J. Courtney, MD Cochrane, Justin, MD Coff, Philip, MD Cohen, Arnold N., MD Cohen, Jeffrey, PA-C Colburn, Jeffrey D., MD Colby, Jessica, ARNP Cole, Steve, MD Coleman, William, MD Collar, Jan, ARNP Connelly, Jan, MD Consiglieri, Giac, MD Cook, Caron, PA-C Cooke, Dennis B., MD Cooke, Roger, MD Cope, Jeremy, MD Coulston, Daniel, MD Cox, Svetlana, MD Craig, Gary, MD Craig, Paul, MD Cronin, Brian, P.T. Cruz, Michael, MD Cubberley, Don, MD Cunningham, Michael, MD Cvancara, Joseph, MD Danielson, Alan, MD David Sandler, MD Davis, Elliott, P.T. Davis, Joseph, MD

January SCMS The Message 15

Dawley, Joshua, MD Day, Steven E., MD Dehart, Julie, PT Delich, Philip, MD Derby, Lynn, MD Desaveur, Brandi, PA-C Deters, Levi, MD Dickey, Sandra, PA-C Dieter, Michael, PA-C Dionne, Daniel, MD Dittman Jr., William, MD Dominey, Andrea, MD Dong, Mei, MD Dooley, Phillip, MD Douglas, Ronald, DPM Doyle, James , MD Drouin, Oliver, MD Dudenhofer, Eric, ARNP Dunlap, James N, MD Dunn, Paul, MD Durcan, F. Jane, MD Durnford, Robert K., MD Dutta, Sanjit, MD Eddy, Amy, MD Edge, Sara, ARNP Edwards, Kathy, ARNP Eldridge, Nancy, OT Elghannam, Hesham, MD Elizabeth Peterson, MD Ellern, Jeannie, PA-C Ellgen, Bryce, P.T. Ellingsen, Donald, MD Elmer, Jeffrey, MD Espinoza, Randall, MD

Everett, John P., MD Fair, Jamie, MD Fairbanks, Robert K., MD Fairchild, Thomas, MD Fairfax, Robert, PA-C Faloon, William, MD Fay, Michael, PA Feld, Andrew, MD Feliciano, Beejay, MD Fenton, Jeff, PT Fern, Peter, MD Ferraro, Angelo S., MD Ferrin, Lance, MD Fine, Kurt, MD Fitterer, J.D., MD Fleming, Tod, PA-C Fletcher, Stephanie A., ARNP Floyd, John, MD Foss, Caleb, P.T. Foutz, Mary S., ARNP Freeland, Lisa, ARNP CNM Freeman, Sean, PT Frerich, Dennis, PA Freshour, Larry, APT Friesen, Susan, ARNP Fritz, Ronald M., DO Fuhs, Bryan, MD Fuller, Deborah, N.P. Fuller, Deborah, NP Galloway, Joel, MD Gallowy, Joel, MD Garabedian, Carl, MD Garabedian, Hrair, MD Gardner, Glenn, MD

Gardner, Timothy, MD Gebrekidan, Dawit, MD Germain, Rasha, MD Gersh, Robert H., MD Giddings, Neil, MD Gilbert, Liz, PT Gillum, Michael, MD Glavin, Christina, PA-C Goff, James S., MD Goldberg, Harold, MD Golden, Robert, MD Gondor, Elizabeth, OT Goodell, Steven E., MD Goodman, Francis, MD Goodman, Steven, MD Gopaluni, Srivalli, MD Gordon, Luke, PT Gordon, Mark, MD Gordon, Robert, PT Gore, Debra, MD Graham, Janice, MD Grant, Dominique, MD Gray, Brieanne, ARNP Gray, Susan, PT Greeley, David, MD Green, Todd, MD Gregg, Amy, PA-C Grosen, Elizabeth A., MD Groth, Karen E., ARNP Groza, Petru, MD Gruber, David, MD Guglielmo, Eric S., MD Guthrie, Carol, MD Halvorson, Thomas, MD Ham, Larry, MSPT Hammil, Sara, MD Hanson, Carl L., MD Harbour, Chad, MD Hardy, Ron, MD Hartnett, Kimberly, MD Harwood, Mark, MD Hatcher, John, OT CHT Hatcher, Kathleen, OT Havin, Derrick, MD Haymore, Jonathan, MD Hebner, Shawna, M.Ed., MS, LMHCA Hechtman, Jody, MD Hedges, Clinton, MSPAS Hendrikson, Carolyn, ARNP, SFFC Henneberry, Craig , DPT Henneberry, Michael, MD Herbach-Neder, Barbara, ARNP Herdener, Richard, MD Hesselgesser, Pat ARNP Hestdalen, Staci, MD Hideg, Alisa, MD Hill, R. Dean, MD Hilton, Jeffrey, MD Hirschauer, Jeffrey, MD Ho, Elizabeth, MD Hoefer, Megan, MD Hoffman, John, MD Hogberge, Trappy, PA-C Holbert, D. Vernon, MD Holbert, D. Vernon, MD Holbrook, Ryan F., MD Hollenbaugh, Darren, MD Holmquist, Gunnar, MD Holt, Sara, ARNP, CNM Hong, Steven W., MD Hook, Jonathan, DPT Horn, Paul, MD Horne, Landon, MD Hostetler, Michael D., MD Houglum, Karl P., MD Howard, Donald, MD Howlett, Andrew, MD Hsu, Benjamin, MD

Hubbard, Clinton, OT CHT Huber, Philip, MD Hunt, Donna, ARNP Hussein, Omar, MD Icenogle, Timothy, MD Inman, Leah, MD Jackson, Scott, PA-C Jacobsen, Elizabeth, PA-C Jacobson, Randall K., MD Janout, Marek, MD Janout, Maria, MD Janout, Martin , MD Jaramillo, Juan PT, DPT, COMT Jaramillo, Stacy PT, DPT, COMT Jawed, Irfan, MD Jenkins, Ronald D., MD Jensen, Richard, MD Jeter, David, PT Johnson, Alan M., OD Johnson, Jerry, PT Johnson, Mark, MD Johnson, Stephen, MD Jones, Cheryl, OT CHT Jones, Christina L., PA-C Jones, D. J. PA-C Jones, Jason H., MD Joseph, Samuel, DO Joy, Lori, MD Judah, Dwain, PA-C Julian, Geoffrey, MD Juviler, Adam, MD Kadel, Keith A., MD Kahl, Krista, PA-C Kamai, Kandon, MD Kanwar, Priya , MD Katz, Guy, MD Kavanaugh, Kevin M., MD Kaya, Hakan, MD Keeve, Jonathan, MD Kelley, Michael, MD Kellogg, Kevin, PA-C Kenney, Howard, MD Kero, Shawkat, MD Kersten, Tycho, MD Kestell, Michael F., MD Kettleson, Lisa, PT Kettleson, Ryan, PT Keuhn, Karen, PA-C Keyser, Larry, PA-C Khoory Locum, MD Kim, Michael, DPT King, Kathy, PA-C Kirk, Kate, NC Klarnet, Jay, MD klipstein, Arthur MD Kody, Michael, MD Kohlmeier, Lynn, MD Kolbe, Suzanne, MSW, LICSW Kordish, David, OD Krafft, Patti, ARNP Kruger, Trisha, MD Kunkel, Ralph, MD Kwasman, Michael, MD Lambert, Richard, MD Lamoreaux, Wayne T., MD LaSalle, Sean, MD Laugen, Robert H., MD LaValle, Gregory, MD Lavalle, Gregory, MD Le, Steven, MD Le, Tommy, MD Leavitt, Eric, MD Lebedoer, Karee, ARNP LeClaire, Jerry E., MD Lee, Catherine, MD Lee, Christopher M., MD Lefcort, Donna, MD Leimgruber, Pierre, MD

Lejameyer, Kathy, ARNP Morimoto, Kaiulani, MD Leland Siwek, MD Mroch, Henry, MD Lengl, Trent, PA-C Mueller, Eric, MD Lenz, Kari, OTR Mueller, Jan, MD Leonard, Jack, MD Mulheims, Gerhard, MD Lessmeier, Timothy J., MD Murphree, Taffie L., ARNP Lgerquist, Lynn, MD Murphy, William, MD Lin, Henry, MD Murray, Stephen, MD Lin, Paul, MD Myers, Paul, MD Ling, Benjamin, MD Nachreiner, Ryan, MD Liu, Eashen MD Nair, Giju, MD Logsdon, Valerie, MD Naylor, John, MD Lott, Hillary, PT Nelson, Brad MD Louis, Koncz, PA-C Nesse, Rolf, MD Lovell, Tim, MD Newkirk, Gary, MD Lovell, Timothy, MD Newman, Corliss, MD Lubbe, Dieter, MD Nichols, Joni C., MD Luna, Greg, MD Nickoloff, Jonathon, MD Lund, Kirk, MD Nievera, Conrad, MD Lynch, Patrick, MD Nisco, Steven J., MD Maccini, Dave, MD Nixon, Chris, PT Maccini, David M., MD Njuguna, Ndegwa M., MD MacFarlane, Mark, MD Norquist, Douglas G., MD Maddox, James, MD Oakley, Russell, MD Magee, William, MD O'Connor, Jeff, MD Maher, Stephen C., MD Olds, Michael, MD Maier, Mitchell J.V. , OD Oliva, Alfonso, MD Malireddi, Krishna, MD Olson, Mark, MD Malone, David, MD Olson, Soren, MD Manek, Salil, MD Olson, Stephen, MD Margraf, Robert, MD Orme, Eric C., MD Marino, Christina, MD Oskin, Teri, MD Mark, Jamie, ARNP Ostlie, Todd PA-C Martin, Jennifer PA-C Ota, Stephanie, MSPT Martinez, Deborah, MD Padmaraju, Aparna, MD Martinicic, Danko, MD Padrtra, Brian, MD Martz, Dean, MD Page, William, MD Matei, Cristina, MD Pagotelis, Alex, MSPT Mathia, Kelley, MD Pagotelis, Rebecca, MSPT Maughan, Timothy, MD Pakkianathan, Stephen, MD McAbee, Dorien, MD Palpant, Samuel MD McCaffree, F.M., MD Parisot, Michael, MD McClatchey, Lynn, ARNP Partoll, Linda, MD McClelland, Bruce, MD Parviz, Maryam, MD McDonald, Michael, MD Patel, Jiten, MD McElgunn, Ryan P.T. Peek, David, MD McFadden, Sue, ARNP Pellow, Thomas, MD McInnis, Brad, PT Pena, Holly, ARNP McKenna, John I., MD Pessein, Darlene, MSW McKinnon, John PT, OCS Peterson, Arnold, MD McNevin, Shane, MD Peterson, Deborah, DPT McPherson, Venetta, ARNP Peterson, John, MD McVey, Kevin, MD Peterson, Shaun, MD McWhorton, Dan, PT Pfeffer, Robert, MD Melaku, Habtamua, ARNP Pietro, Anna I., ARNP Melich, Christopher, DC Pirie, Jennifer J., OD Meline, Lewis, MD Pittman, James, ARNP Meltzer, Nathan, MD Pokorny, Alan, MD Messinger, Robin, MD Pope, Brad, MD Meyer, Marynell, MD Poppel, Clinton, MD Meyer, Timothy, MD Porter, James, DPM Michels, Kevin, MD Pounds, Denise, MD Mikkelson, David, MD Powell, Timothy, MD Mikles, Erika, PA-C Powers, Timothy, MD Mildef, Emily, ARNP Preiksaitis, Harold, MD Miles, Katherine M., MD Pugh, Steven, MD Milligan, Robert MD Quinlan, Linda, PA-C Milligan, Robert, MD Ranson, Nicholas T., MD Milsow, Larry, MD Raschko, Dale, PA-C Mitchell, Brian, DO Ratti, Dinesh, MD Mitchell, Bryan, MD Rawlins, Mathew, MD Mocabee, Richard, MAPT Reddy, Vijayakumar MD Mock, Jennifer, OT Redman, Scott, MD Moffatt, Kelly M., OD Reed, Katherine, MD Moise, Vivian, MD Reese, Stephen, MD Moline, Stephanie R., MD Reichard, A. Kirk, MD Mondale, Kenneth, MD SCMS The Reigh, Rhoda, 16 PA-C January Message Moore, Michael, MD Reilly, Kathleen, MD

Reinhardt, Susan, ARNP Reuter, Jason, MD Reynolds, Branden, MD Rhoads, Daniel, PA-C Richards, Steven, MD Richardson, Heidi, MD Richardson, Steven, MD Riggs, Robert, MD Ring, Michael, MD Risse, Kelly, MSPT Ritchey, Timothy, MD Roberts, Meghan, MD Robinson, Kirsten, MD Robison, Jeanne, ARNP Rogers, Nick, P.T. Roland, Megan, PT Roller, Carrie, MD Romney, Douglas, DPM Roth, Jason, MD Rowbotham, Kirk, MD Rutherford, Robert, MD Ryan, Michael, MD Ryan, Thomas, MD Sandhu, Neelwant, MD Satterfield, Traci, MD Sayres, William, MD Schade, Scott, MD Schemmel, Mark, MD Schillious, Terry, ARNP Schimpf, Mariah, MD Schlegel, Peter, MD Schlepp, Gregory E, MD Schreoter, Rosemary, MD Schubert, Michelle, P.T. Schucker, Michael, PA-C Scott, Amaryllis, MD Scott, David, MD Scott, Ryan, ES, MA Sears, Joel, MD Seervin, Shannon, DO Sementi, Olivia, MD Seppi, Brian, MD Serbousek, Lori, PT Sestero, Anthony, MD Shabaneh Al-Tamimi, Hamed, MD Sheneman, Damon, MD Shepard, Fredric, MD Shirzad, Khalid, MD Shuster, John, MD Sienko, Mark E., MD Sikora, Michael, MD Silverstein, Pamela, MD Singh, Satirn, MD Sinha, Renu, MD Skoog, Erik D., MD Skrei, Richard, MD Sledge, James, PA-C Smalley, Chris, PA-C Smentek, Craig, MD Smetana, Lori, MD Smilden, Rhaejon, PA-C Smit, Barbara A., MD Ph.d Smith, Becky, OTR/L Smith, Carla, MD Smith, Craig, PT Smith, Nanette, MD Smith, Scott, MD Smolinski, Ann, PA-C Snow, Jodi, NA Snow, Rita, MD Spangler, Seam, MD Spitz, Jonathon, MD Spyra, Wolfgang J.T., MD Srikureja,Wichit, MD Stephens, Craig, PT Steves, S. Wade, MD Stobie, Michael, PT Stolp, Janine N., OD

Stovall, William, MD Strandy, James, PT Strandy, Zach, DPT Strom, Rod, PT, CHT Stromberg, Craig, P.T. Stucky, Eric D., MD Stumm, Robert, PA-C Sukut, Chad, MD Swanstrom, Katie, DPM Swartz, Robert, MD Swiggum, Joseph, MD Sypherd, Dirk, MD Tapp, Diane, PT Taylor, Jessica, ARNP Taylor, Julie, PA-C Taylor, Susan, PT Thew, Stephen T., MD Thumma, Saritha C., MD Tidwell, Sandy, ARNP Tomeh, Antoine, MD Treloar, Richard, MD Tsai, Katherine, MD Tubbs, Eric, MD Tupper, Teri, ARNP Tuttle, Katherine, MD Ulloa-Michaelis, Julie, MD Valente, Michael, CH Vanderwilde, Russell, MD Varns, Lance, ARNP Venters, Wayne, MD Vishwanath, Mandya, MD Vitello, Nancy, N.P. Vulcan, Meagan, ARNP Wadhwa, Sheila A., OD Waggoner, L. Douglas, MD Wales, R. Alan, MD Wallace, Matthew, MD Wallace, Pierrette, PT Wang, Valerie, PT Weaver, Victoria, MD Webb, Joel, MD Webster, Diana, ARNP Webster, Erin, PA-C Ween, Jon, MD Weidner, Philip, P.A. Weigel, William, MD Werschler, Kara, RD Werschler, Philip, MD West, Doug, PA-C Whisenant, Michael, MD White, Jeffrey, MD Wickre, Nancy, ARNP Wigert, Robert, MD Wildman, Karen, MD Williams, Michael P., MD Wills, Laura Jan, ARNP Wimberley, Genevieve, PA-C Wirthlin, Robert S., MD Wittenkeller, Jay, MD Wolf, Gretchen Rose, PA-C Wood, Benjamin, DO Wood, Robert A., PA-C Woolley, Darron, DPM Worrall, Neil, MD Wos-Elledge, Barbara, ARNP Wright, Byron E., MD Wurst, John, MD Wyrick, Jared, MD Wyser, Debra, MD Wysham, Douglas, MD Yang, Daniel, MD Zhang, Mancong, MD Zimmer,Joan, ARNP Zografos, Peter, DC Zwiesler, Daniel, MD Zylar, Leanne, ARNP

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.

Sundaralingam, Dhakshayani, MD Internal Medicine Practicing with Apogee Physicians 12/13 Levine, Andrew R., MD Diagnostic Radiology Practicing with Radia 02/14

PHYSICIAN ASSISTANTS Gaines, Joseph, PA-C Physician Assistant School: U of WA - Medex NW (2013) Practicing with St Luke’s Physiatry Practice 11/13

PHYSICIANS Dieter, Garry P., MD Anesthesiology Med School: Loma Linda U (1997) Internship: Virginia Mason Medical Center (1998) Residency: Virginia Mason Medical Center (2001) Joining Providence Anesthesia Services 03/2014

McVeity, Mary, PA-C Physician Assistant School: U of WA - Chattham U (2010) Practicing with Rockwood Pulmonary & Critical Care Center 12/13

Rostad, Steven W., MD Anatomical and Clinical Pathology Med School: U of Washington (1983) Internship: U of Colorado 1984 (1984) Residency: U of Washington (1988) Practicing with Cellnetix Pathology 12/2013 Weiss, Joseph B., MD Cardiovascular Disease Med School: New York U (1988) Internship: Columbia Presbyterian Medical Center (1989) Residency: Columbia Presbyterian Medical Center (1991) Fellowship #1: UCSF Affiliated Hospitals (1993) Fellowship #2: Cardiovascular Research Institute (1994) Fellowship #3: Stanford U (1997) Practicing with Rockwood Heart & Vascular 11/2013

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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.

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.

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.

January SCMS The Message 19

January SCMS The Message 20

PRSRT STD

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

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The Spokane County Medical Society is changing

from gardening to skydiving. We just need your help

the monthly newsletter, The Message, and is

getting names and ideas. Our writers will contact

looking to include human interest stories about our

members to do interviews.

physician and physician assistant members.

We are interested in exciting, different and/or

Please contact Michelle at michelle@spcms.org or

unusual activities and hobbies. It can be anything

(509) 325-5010 with any information. Thank you.