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VOLUME 69 NO. 2
MEDICINE SAN ANTONIO
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Cyber Security
By John Dickson, principal at Denim Group .........12
There is privacy. Then, there’s Texas Privacy By David Schulz .............................................14
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BCMS President’s Message ...........................................................................................................8 A Special Library By Fred Olin, MD ..............................................................................................20 BCMS News..................................................................................................................................22 Healthy Observations: Here’s Whats Buggin’ Me By Robert G. Johnson, MD........................................23 2016 BCMS Installation of Officers photo spread ...................................................................................24 UTHSCSA Dean’s Message By Francisco González-Scarano, MD ........................................................26 Legal Ease: If you’re worried about patient claims, you need to read this article By George F. “Rick” Evans, Evans, Rowe & Holbrook..........................................................................28 Wild World of Medicine: Roaches By Barbara R. Schmitz, LCSW ..........................................................30 BCMS Circle of Friends Services Directory .............................................................................................33 In the Driver’s Seat...................................................................................................................................39 Auto Review: Porsche & Land Rover ‘experiences’, By Steve Schutz, MD ............................................40
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Theft of Patient Information on the Upswing By Medical Protective ......................................18
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Healthcare industry is vulnerable to cyber attacks
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BOARD OF DIRECTORS
OFFICERS Jayesh B. Shah, MD, President Sheldon Gross, MD, Vice President Leah Jacobson, MD, President-elect James L. Humphreys, MD, Immediate Past President Gerald Q. Greenfield Jr., MD, PA, Secretary Adam V. Ratner, MD, Treasurer
DIRECTORS Rajaram Bala, MD, Member Jorge Miguel Cavazos, MD, Member Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member John W. Hinchey, MD, Member John Robert Holcomb, MD, Member John Joseph Nava, MD, Member Bernard T. Swift, Jr., DO, MPH, Member Francisco Gonzalez-Scarano, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Carlayne E. Jackson, MD, Medical School Representative Jennifer Lewis, BCMS Alliance President Roberto Trevino Jr., MD, Board of Censors Chair Jesse Moss Jr., MD, Board of Mediations Chair George F. "Rick" Evans Jr., General Counsel
CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer
CHIEF OPERATING OFFICER Melody Newsom Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director Alice Sutton, Controller
COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Fred H. Olin, MD, Member Esmeralda Perez, Community Member David Schulz, Member J.J. Waller Jr., MD, Member
6 San Antonio Medicine • February 2016
PRESIDENT’S MESSAGE
Every Physician Counts and Every Patient Matters By Dr. Jayesh Shah, 2016 BCMS President
Thank you for bestowing me with this honor. It is my privilege and honor to represent 4,700 Bexar county physicians, residents and fellows; the 8th largest county medical society in the United States. I have had the privilege, for the past 16 years, of working in many capacities in our organization for our shared vision; A healthier Bexar County populace. For these entire 16 years, one person has always stood by my side as my support and my critic - my wife Neha, a physical therapist and Lymphedema Specialist. It is my passion to serve organized medicine. Last year, an incident in my own family gave me a totally new perspective about health care, which I would like to share with you briefly. In August of 2014, my mother suddenly developed left-sided weakness. After hospitalization and rehab for 50 days, she came home. From an invalid, she got stronger day-by-day and now is able to walk with a walker and is able to feed herself. During this stressful time, I saw the American health care system from the other side of the fence, not as a physician, but as a family member of a patient. And what I saw was an efficient health care system that worked. I saw that the health care system and team-based care put a smile on my mother’s face and brought relief to our family. I share this story not to tell you what is good or what is bad about the health care system, but to help us, the physicians, to understand how to practice medicine in these times of change and how to continue to do the right thing for our patients. It reminds me that life is fragile and can change in a fraction of a second. It reminds me that we are on this earth for a limited time and just like my mother keeps that beautiful smile under all adversities; let us remember to keep that smile. It can be frustrating to practice medicine at certain times, when you are overwhelmed with the number of patients we have to see with limited resources, when the electronic health record system or the computer stops working in the middle of a busy day, when the insurance company denies authorization for a test or treatment that our
patients need. I know I am not alone in my frustration — I hear from physicians of every specialty who are concerned about the new regulations forced on us every year - fights with the insurance companies, the unsustainable pace of their jobs, poor leadership and lack of support. We all agree: providing excellent care to patients is NOT negotiable. Together, we have demanded that the barriers physicians face in delivering excellent care to our patients be removed. Please join me to “stop the RED TAPE CAMPAIGN.” The Medicare trust fund will be insolvent by 2030. Inaction is not an option. We must make structural reforms to Medicare to ensure it is a sustainable program that will be around for our children and grandchildren. To strengthen Medicare and to ensure that it meets the healthcare challenges of current and future seniors, we must take steps to develop long-term solutions. These solutions must protect the doctor-patient relationship, increase provider and consumer responsibility and accountability, promote cost efficiency, fair access and preventive health and bring back the satisfaction and joy in practicing medicine. Our patients share with us their difficulties, their pains, their life and they trust us to help them. As physicians, we try to keep our patients happy and help them meet their needs. There is no other profession as rewarding as ours. A recent American Medical Association survey showed that 75 percent of patients wanted to see their physicians even if they had to wait longer. A recent survey of 8,000 patients by the University of Chicago showed that 97 percent of the patients wanted the doctor to discuss the treatment options and two-thirds of them wanted their doctor to make decisions for them. Polls consistently showed that the patients trust their physician and what better job satisfaction can we get than our patient’s trust. AMA recently surveyed 600 primary care physicians. Doctors in the survey said that forming long-term relationships with the primary care physician is the most important thing that can be done to obtain better medical care and to decrease the cost of health care. Research backs this up. If patients change their doctor, they have delayed diagContinued on page 10
8 San Antonio Medicine • February 2016
PRESIDENT’S MESSAGE Continued from page 8
nosis and spend more on care than a patient who has a consistent relationship with the same physician. As your medical society President, I will continue to advocate for the patients at the core of which is the physician- patient relationship. Your involvement in the Bexar County Medical Society is at the core of advocating for our patients and our profession. BCMS successfully fought for scope of practice issues so that patient access to physicians stays intact. Physicians should continue to lead the team-based care as healthcare continues to evolve in the next century. In the last legislature, 40 scope of practice bills were introduced and organized medicine won all of them. This was accomplished with only 10 percent of TEX PAC membership and less than 1 percent of the members going to the First Tuesday visit at the capital. This, in my view is unacceptable. It is our moral duty as physicians to be members, to be a part of TEX PAC and to give our time and talent to protect this profession. BCMS successfully helped to pass medical tort reform in Texas to ensure access to care for patients. BCMS with TMA has been advocating for physicians, patients, and our community since 1853. But we cannot do it without you. Next year we plan to develop focused key contacts for each state representative and senator because they listen to their constituents and once we build the relationship, it is easy to get our point across. With the 2016 election cycle coming, this is the time for you to get engaged with our local state representative and our senators. For the past decade we have not had a BCMS member serve as president of TMA. Now we have the man for the job. I have seen him leading the BCMS delegation to TMA and now leading the TMA delegation to AMA. He understands the issues at its core and he will represent us all well at the Texas Medical Association. Dr. David Henkes - is running for the position of President-elect of TMA. Each one of us can do our part to ensure that a BCMS member leads the state association in the upcoming election in May. Thanks to my predecessors, past presidents of BCMS. Thank you for your vision and service to the society. It is because of your hard work, we are where we are today.
BCMS has a new home on 1604/ Lockhill Selma. Our theme this year is BCMS is Our Society Where “Every Physician Count’s and Every Patient Matters” It does not matter whether you are an academic, private practice 10 San Antonio Medicine • February 2016
Dr. Jayesh Shah addresses the audience at the BCMS officers installation ceremony on Jan. 23.
or military physician; whether you are hospital-employed or insurance-employed; whether you are a military physician or a researcher; whether you are in the first five years of practice or 40 years of practice; or whether your practice is small or large.Your new home will provide the perfect environment for members to address common issues. Thanks to BCMS staff and able CEO. BCMS has a new home for our legacy to continue so that all our patients continue to receive the best healthcare like my mother did, for years to come and all our aspiring young people like my daughter Prachi, a public health student at UTSA and my son Aj, a junior at Keystone, continue to feel that becoming a physician is still one of the best choices and feel that they have the strength of an organization like BCMS to back them; because for BCMS “Every Physician Counts and Every Patient Matters.” Thank you. Dr. Jayesh Shah
CYBER SECURITY
Healthcare industry is vulnerable to
cyber attacks By John Dickson, principal at Denim Group
Whenever I go to parties or social functions, I’ll invariably rub shoulders with a host of people I don’t know. As part of the introduction process, I get asked what I do for a living. My response is typically “I’m a security guy” after which I’m asked “do you leave money in a bank?” My response is well 12 San Antonio Medicine • February 2016
honed, including thoughts on online banking protections, account monitoring, and how using more than a simple username and password is a good idea. Bottom line is that the banking, and in general the financial services industry, has their act together from a cybersecurity perspective.
CYBER SECURITY
Why you ask? “Because that’s where the money is,” as succinctly stated by famed bank robber Willie Sutton. That money attracts sophisticated attackers, who have been hacking away at banks for over two decades. As a result, banks (mostly) have their security act together. A typical follow up question, though, gets me on my soapbox fast — and that question is, “As a security guy, what industries scare you the most?” I get that question more frequently than you might imagine and my answer is many times the healthcare industry. Here’s why: In healthcare, the stakes are high — the well-being of my family — which is critically important to me. If a credit card company loses my data, I get a new card with free credit monitoring. If a healthcare provider loses my electronic patient information, I can’t get new information. That’s my stuff! The reason the security of our healthcare industry scares me is not just the impact, but how consistently ill-prepared the industry is to defend against sophisticated attacks. I say this as a 20-year security consultant who has worked in four different companies and delivered hundreds of security assessments, penetration tests, and other projects. In muted tones, many security veterans believe that sooner or later Eastern European organized-crime hacker consortia or nation states will direct their attention to healthcare targets. But what scares me the most are four significant mismatches between the sophisticated attackers and defenders in the healthcare industry:
No. 1 Closed systems In healthcare, there are efforts to push patient information into Health Information Exchanges. These meta-databases in the cloud provide better and more responsive healthcare. Patients who need care away from home will have access to their private health information remotely. Regrettably, availability is trumping security on many rollouts and these sites are not built to the same security standards as those in the financial industry. Healthcare.gov is more the standard and not the exception.
No. 2 A false sense of security Healthcare views many cybersecurity threats in the abstract. There are no Targets or Home Depots in the industry, and arguably (at least as far as we know), sophisticated attackers are not attacking them as frequently as banks. They’ve not had the number of near-death experiences as other industries, and because of the
abstract nature of cybersecurity threats, leadership does not worry about attacks, and security budgets suffer. No daily threat of stolen money equals a false sense of security.
No. 3 Unfamiliar adversaries Governmental organizations are used to getting attacked by nation states. Financial services companies are battling organized crime hacking syndicates who are both savvy and sophisticated. In the healthcare sector, the likely adversaries will be nation states as part of a larger international crisis, or Eastern European hackers, when they find out how to monetize either target. This lack of day-to-day understanding of the threats lessens the sense of urgency in certain healthcare organizations.
No. 4 Too much vendor trust The healthcare industry has a highly trusted relationship with large systems and product vendors. But because they have worked so closely for a long time, they rarely question whether these partners conducted adequate security testing of their products or networks beyond simple vendor checklists (compared to other industries). In financial services companies, by comparison, security leaders ALWAYS question vendor claims. In contrast, certain medical products provide vendor lock-in and a client mismatch of power. Witness the many medical devices that ran on Windows XP well after that operating system was declared “end of life” by Microsoft. This mismatch means that many healthcare organizations had little option but to accept that certain medical system ran on outdated software well after it should have. The healthcare industry shares many of the same security issues as other industries in our country. But it also has a unique role in society to protect our most sensitive healthcare information. Given the stakes, let’s hope that some of the factors outlined above change soon. John Dickson is an internationally recognized security leader, entrepreneur and Principal at Denim Group, Ltd. in San Antonio. He has nearly 20 years hands-on experience in intrusion detection, network security and application security in the commercial, public and military sectors. He is currently the Chairman of the San Antonio Chamber of Commerce Cyber Security Committee where economic development, workforce and advocacy issues involving San Antonio’s growing cyber security industry are coordinated. visit us at www.bcms.org
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CYBER SECURITY
There is privacy. Then, there’s Texas Privacy. By David Schulz
Protecting patient information — and the penalties for getting it wrong — underwent a major upgrade here in Texas with the passage of House Bill 300, amending and adding new teeth and bigger bite to the Texas Medical Records Privacy Act (TMRPA). These 2012 changes have impact on every HIPAA covered entity in the Lone Star State, and more critically, expand the very definition of covered entities. It also ups the penalties for noncompliance and willful neglect — far from an excuse, ignorance can become very, very costly. Let’s review who is required to comply with the law, what is asked of them, and the risks of noncompliance. The standard HIPAA definition of covered entities (CEs) includes health care providers (who use digital records), health plans, and data processors who serve them. Here in Texas, the definition covers any individual, business, or organization that obtains, assembles, collects, analyzes, evaluates, stores or transmits protected health information (PHI), including health care providers not using digital (ePHI) records. “The TMRPA or ‘Texas HIPAA’ is very broad,” said Sheila Stine, JD, Texas Health and Human Services agencies’ first Chief Privacy Officer. “It basically applies to anyone who handles PHI (protected health information), with some notable exceptions, such as employers, education records, or financial institutions.” And they don’t have to be aware of it to be held responsible under the law. “For example,” offers Stine, “when a physician moves away or retires or passes on, leaving old medical records in a storage unit, the owner of the storage unit may not be aware of their obligations under the act,” said Stine. Or that wrongful disclosure or misuse of PHI may result in civil and criminal penalties under both Texas and HIPAA law. Practices should review their business relationships to ensure they
are not making unwitting covered entities out of their associates. These can include information or computer management entities, schools, persons who maintain Internet sites and a host of other vendors and affiliates. On the other hand, says Stine, for a practice that takes its HIPAA responsibilities to heart, the change is felt more in degree than in kind. Perhaps most important, staff training requirements have been upgraded. As opposed to HIPAA’s requiring training “within a reasonable time,” a Texas staff member is required to have job-specific, tailored training by their 90th day, with signed attendance records kept. Entire staffs should be retrained whenever there’s a major change in the regulations (like these) or organizational privacy policy changes. “Best practice,” said Stine “is annual or biannual training.” Another change: The window to respond for a patient’s record request is 15 days if requested in electronic form, not the 30 days of HIPAA, and with no extensions! If a practice has electronic disclosure of PHI for any reason, a notice regarding disclosure should be prominent in the office, on the website or any other place where individuals whose protected health information is subject will see it. And before each electronic disclosure, the individual’s authorization must be obtained. Every practice should periodically review the way it handles PHI following any change in technology, procedure or rules, and at least annually or biannually, “and adjust its privacy notice, policies, training or controls as needed,” said Stine. Finally, Texas regulations on the disclosure of PHI and remuneration to the practice are very tight: Sale of PHI for purposes outside of Treatment, Payment or Operations (TPO) is forbidden; Disclosure for marketing purposes is permitted only with the individual’s written authorization (although there are exceptions). continued on page 16
14 San Antonio Medicine • February 2016
CYBER SECURITY continued from page 14
Charges for making an authorized disclosure (for example, a patient asking for a copy their records) cannot exceed the “reasonable costs of preparing or transmitting the protected health information.” All told, this is where you sit down with your privacy officer (you have one, right?) and make certain that the practice’s rules on use and disclosure are up to date and effectively translated into procedures. Breach notification rules are also more widely applied under Texas law than under HIPAA, thanks to the combined effect of HB300 and the Texas Identity Theft Enforcement and Protection Act. Breach notifications are mandatory for any person who conducts business in Texas and loses control of sensitive personal information (SPI), not just PHI. Data cleansed of PHI can still be considered sensitive, and a breach notice is required for electronic SPI when system security has been compromised (with “compromised” being undefined in the law). HB 300 increases the penalties for failing to make breach notifications. In addition to the penalties available to the state attorney general, it provides for additional civil penalties of $100 per individ16 San Antonio Medicine • February 2016
ual, per day that an entity fails to take reasonable action to comply. It’s a state felony if an individual, without the consent of the patient, accesses, reads, scans, stores or transfers PHI via a device or electronic payment card. Privacy is “mission critical” to his agency, says newly appointed Texas HHS Executive Commissioner Chris Traylor. Considering an era of increasing penalties and public sensitivity to breaches, it’s wise for practices to consider it “mission critical” as well. Privacy Pays, for the provider as well as the patient! David Schulz, certified information privacy and certified HIPAA professional, is Executive Director and CEO of Cyber Risk Associates, LLC, compliance specialists for small and boutique healthcare practices and associates in the San Antonio area. Confidential review of practice’s needs and areas for improvements freely offered; detailed risk analysis, remediation and training offered on one-time or continual basis: 210-281-8151.
visit us at www.bcms.org
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CYBER SECURITY
Theft of Patient Information on the Upswing By Medical Protective
Thieves have discovered that, often with little risk, they can break into healthcare practitioners’ offices and steal computers. Generally, they’re not interested in the clinical information that the computers may contain — although that remains a concern. What they’re hoping to steal is something they can use for a variety of criminal schemes: Social Security numbers and credit card numbers. And they’re having a lot of luck. Doctors have an ethical and legal responsibility to ensure both the security and the privacy of patient information. This includes the need to protect patients from the possibility of identity theft.
The following suggestions may help prevent theft of patient information: • Install security passwords on all computers in the practice. Enforce their use and periodic change by employees. • In general, authorize as few people as possible to have keys to the office. Employees who have access to the office should have a key to the main door only. • Do not authorize an employee to have a key to the office until that person has successfully passed a probationary period. • Stipulate the return of keys from all employees, regardless of whether they quit or are terminated. Employees who are fired should be required to turn in their keys, collect their personal belongings, and leave the office immediately upon termination. They should not be given the opportunity to access any patient or business-related information. • If an employee is fired or leaves under less-than-ideal circumstances, consider changing office locks. • Automatically change passwords whenever an employee quits or is terminated. • Backup disks, tapes, or reports should be kept under lock and key, preferably off site. 18 San Antonio Medicine • February 2016
• No laptop computer should be used for clinical purposes unless it has complete password installation. Laptops with clinical information on them should not be left in cars, not even in trunks. • Firewalls should be built into all office systems. Contractual arrangements with vendors should specify the security results the practice hopes to achieve with its security system. • Consider installation of a security system for the office. • Use only bonded cleaning staff. If you cannot control the cleaning process (i.e., you rent office space in a building that provides cleaning services), inquire about the security check that the company uses to screen potential hires. Depending on the setup of your office, you may need to ask the cleaning crew’s employer to sign a Business Associate Agreement to ensure HIPAA compliance. • Ensure that access to clinical areas is locked during lunch times, hours when patients are not in the office, or if an employee is working late. If possible, main office doors should also be locked during these times. • Report any suspicious activity, possible breach of security, or threats of violence from terminated employees (or disgruntled patients) to the police. • Report any theft (prescription pads, drug samples, patient information, office materials, etc.) to the police. • Report any breach of patient confidentiality to a Medical Protective claims representative at 800–348–4669. This article was produced by the clinical risk management team at Medical Protective, the nation’s oldest professional liability insurance company dedicated to the healthcare professions. For additional information, please contact Laura Cascella at laura.cascella@medpro.com or visit the Medical Protective website at www.medpro.com.
visit us at www.bcms.org
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LIBRARY REVIEW The plush seating area in the P.I. Nixon Medical
Historical Library.Opposite: The cover of Dr.
George Cupples' casebook. Opposite: A drawing of a flea from Robert Hooke's 1667 book Mi-
crographia. Opposite: The title page for
Vesalius' book on human anatomy De Humani Corporis Fabrica published in 1543.
By Fred Olin, M.D.
One of the unsung treasures of the University of Texas Health Science Center at San Antonio is the P. I. Nixon Medical Historical Library, located on the fifth floor of the Briscoe Library at 7703 Floyd Curl Drive. Physically, it is an attractive room with comfortable seating, book-lined shelves and large tables upon which one can work. You can see a picture of it here: http://library.uthscsa.edu/ 2011/11/nixon-library/ Perhaps you recall Dr. J. J. Waller’s recent contributions to San Antonio Medicine about the history of medicine in San Antonio: much of the research was done here. I visited the library a couple of times and visited with Lisa Matye Finnie and Jaclyn Georges, the staffers who manage the library and its collections. They are friendly and helpful, and know the place inside and out. They told me that there are now about 6,000 items in the library, distributed over three major collections: The P. I. Nixon Medical Historical Library, the University Archives and ma20 San Antonio Medicine • February 2016
terial relating to the history of medicine in San Antonio and environs. Let’s look at all three. The core of the collection of the Historical Library was brought together by the Bexar County Medical Society largely through the efforts of the late P. I. Nixon, M.D. The materials range from the oldest book, De Medicina by Celsus, from 1481, to newer items from the early 20th Century. Included are a copy of Vesalius’s seminal book on human anatomy, De Humani Corporis Fabrica, (1543) and one of Robert Hooke’s books, Micrographia, (1667). Vesalius did a wonderful job, considering the limitations on dissection that were in place during his lifetime: the illustrations are clear and even the nomenclature is familiar. Hooke’s book intrigued me because of my background as a veterinarian. He was one of the earliest academic microscopists. There’s a drawing of a flea that rivals anything I saw (or drew) in the very extensive and memorable parasitology course we had
LIBRARY REVIEW
at the University of Illinois College of Veterinary Medicine. Here it is: this drawing is about two feet across. That vertical line through the flea’s thorax is the fold in the page, made to allow it to fit into the volume. The University Archives contain a fairly amazing mass of miscellaneous documents. Besides the things you might expect, such as historically important university records there are publications, oral histories, correspondence, yearbooks and even a complete set of a short-lived student newspaper, “The Organ for the Artificial Dissemination of Information,” which is where I got my first experiences writing for publication. ‘The Organ” was suppressed in my senior year, just after our dean was fired. The “Temporary Institutional Head,” a retired Army Medical Corps general imported from Galveston, didn’t appreciate some of our opinions and reporting and ordered us to stop. I still have the letter he sent to the various writers and our editor. It
still incenses me a bit. The Local Medical History stuff is fascinating. There are photographs of physicians and hospitals, records of various local medical organizations, and hand-written records by the physicians themselves. I took a picture of the cover of one of Dr. George Cupples’ casebooks, which you can see nearby: It is filled with handwritten descriptions of individual cases, in great detail, including the patient’s demographic description, history of present illness, etc. It isn’t easy reading, but it is fascinating. Someday, if you have the urge to see some medical treasures or research something in your specialty from way back when, visit the P. I. Nixon Library. It will be worth your time. Fred H. Olin, M.D., is a semi-retired orthopaedic surgeon. He has never been either a woman or in prison. Perhaps that’s why he was so taken by these books.
visit us at www.bcms.org
21
BCMS NEWS
BCMS HAS MoVED
The Bexar County Medical Society and Bexar Credentials Verification Inc. have settled into a new home at 4334 N. Loop 1604 West on the second floor. The building is located inside the loop between Lockhill Selma and N.W. Military Drive. All phone numbers and email addresses are the same as before. Come check out our beautiful new building.
Call for Resolutions Attention BCMS members: If you have any issues you would like the BCMS Delegation to TMA to consider regarding changes in policy or a stance you would like them to take on a particular issue, it’s time to submit your issue in the form of a Resolution. For a sample resolution, go to http://bcms.org/geninfor/ResolutionForm2016.doc Please return your draft resolutions to BCMS by Monday, Feb. 15, 2016 by email to mary.nava@bcms.org. For questions, contact Mary Nava at 210-301-4395.
SAVE THE DATE 22 San Antonio Medicine • February 2016
In Memoriam
James Finney, M.D., died on Dec. 25, 2015, at age 97. He was a U.S. Army physician during World War II and was a member of BCMS. Luis Canales, M.D., died on Jan. 6, 2016, at age 82. He served in the U.S. Army for 31 years and was chief of the department of pediatrics at Brooke Army Medical Center for 16 years. Chester Pruett, M.D., died on Jan. 11, 2016, at age 68. He ran a pain and anesthesiology clinic in San Antonio for over 25 years and was a member of BCMS. Patrick Holden, M.D., died on Jan. 15, 2016. He served as a faculty child psychiatrist at the UT Health Science Center for over 30 years.
What: BCMS General Membership Meeting When: April 5, 2016, beginning at 6 p.m. Where: Cumberland Surgical Center (formerly Victory Medical Center Landmark) 5330 N. Loop 1604 West, San Antonio 78249
HEALTHY OBSERVATIONS
Bug lights guarding the OR’s: If you get the angle just right, they speak to you.
I’m back, and I’m re-inspired. I was in a slump—fighting a major case of writer’s block. Just when I thought I’d run out of lampoonable stuff—they appear—and right under my nose. What, you ask, could work such a reanimation of the soul? Bug lights! Yes, you heard me right—bug zappers. In my hospital. In the corridors outside the operating suites. Three perfectly parallel, purplish, plush neon lights. Reminds me of summer camp fifty years ago. Such memories. I honestly could never decide what I enjoyed more: the zapping, electrical sizzle, or the aroma of freshly roasted horse fly. My colleagues were equally moved. One fellow-surgeon asked when the Jimi Hendrix posters would appear. Another told me the lights emitted a heavy-acid-metallic-rock music that, apparently, only he could hear. An anesthesiologist swore that when he stood at one particular intersection of corridors, where he could simultaneously triangulate three of the fly-killers, voices from outer space spoke to him (but he’s an anesthesiologist—been inhaling his own gases). Personally, all I’ve noticed is a fluorescent glow to my lab coat. I don’t get it. How do we go from zero bug prophylaxis all the way to the highest-tech devices in one fell swoop? Before I can operate on a patient’s back, I have to prove to the insurance company that lesser measures have tried and failed. Here’s my point: Shouldn’t the hospital have started with a few strategically placed fly-swatters? Low tech and inexpensive. Then move on to those brown, sticky, tape things that hang from the ceilings and grab onto unsuspecting entomological body parts. It’s more humane that way. At the end of each day, the OR supervisor could release the poor little beggars off the
HERE’S W H AT ’ S BUGGIN’ ME By Robert G. Johnson, M.D.
loading dock by the dumpster. I remember once (the only time in thirty years I might add) when a fly was dive bombing me in the operating room, the anesthesiologist chased it down with a can of benzoin spray. Didn’t kill it—just gummed up its landing gear. Cheap, effective, humane. On a serious note (if there is one), the bigger question is: Why do we even need bug lamps in the hospital? Have there been sightings? Is it a JCAHO, OSHA or OBAMAcare requirement? Three supervisors and a couple of assistant administrator’s later I spoke to an honest-to-goodness entomologist. Do gnats (in this case) spread disease (‘nosocomial zoonoses’ to sound erudite)? Gnatitis—never had a patient come down with a case of that. One of the real concerns was whether or not the lights might cause eye damage (or sterility). There are three categories of ultraviolet light: a, b, and c. UVb and UVc may affect eyes and skin respectively, but UVa is safe. How do they work? We can buy so-called ‘bug lights’ at Home Depot. These are low energy yellow and work by providing enough illumination for humans to see at night but don’t attract bugs. But yellow lights won’t kill the critters. On the other hand, high energy light (UVa, 365 nm) drives them wild with desire. Gnats are drawn to the purplish glow, but the light doesn’t do the killing—there is a sticky board in the back that wrestles them down (a quaint marriage of old and new technology). Don’t know about you, but I feel safer already. Victor Hugo (1802-1885) once said: “Fame must have enemies as light must have gnats.” Looks as though the technology is not all that modern after all. Personally, I’m still good with fly swatters.
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2016 BCMS INSTALLATION
2016 BCMS INSTALLATION OF OFFICERS The 2016 BCMS Installation was held Jan. 23 at the University Center Ballroom at UTSA where Dr. Jayesh Shah was installed as the new BCMS President and Jennifer Lewis was installed as the new BCMS Alliance President.
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1 1. Incoming Alliance President Jennifer Lewis is sworn-in by outgoing President Rebecca Christopherson. 2. Mauli Agrawal, vice president of research, represented the University of Texas at San Antonio which donated the use of the ballroom for the 2016 BCMS Installation. 3. Outgoing BCMS President James L. Humphries, M.D., presents the gavel to incoming President Jayesh Shah, M.D. 4. August Charles Trevino, development director for BCMS, with Moses D. Luevano of Physician Lending Group at Regions Bank, Gilda Digman, immediate past president of AMA/TMA/BCMS Student Chapter, and Mike Digman.
24 San Antonio Medicine • February 2016
4 5. Current and past presidents of BCMS includes (Back Row) Vijay Koli, M.D.; David Schulman, M.D.; Marc Taylor, M.D.; Jayesh Shah, M.D.; Neil Gray, M.D.; Manuel Quinones, M.D.; Roberto San Martin, M.D.; K. Ashok Kumar, M.D.; (Front Row) J. Marvin Smith III, M.D.; Stephen Gelfond, M.D.; Jose Benavides, M.D.; Al Sanders, M.D.; Rajam Ramamurthy, M.D.; David Henkes, M.D.; James L. Humphreys, M.D.
2016 BCMS INSTALLATION
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8 6. Dr. David Henkes, a past president of BCMS now running for president of TMA, with his daughter Nicole Henkes and wife Danielle Henkes. 7. Members of the Texas Indo-American Physicians Society Southwest Chapter presented a check for $50,000 for the BCMS Building Fund. 8. UTSA Sapna, a Bollywood-Fusion dance team that included Dr. Shah’s daughter, performed during the BCMS Installation.
9 9. BCMS Executive Board for 2016 includes Adam Ratner, M.D., treasurer; Sheldon Gross, M.D., vice president; Leah Jacobson, M.D., president-elect; Jayesh Shah, M.D., president; James L. Humphreys, M.D., immediate past president; and Steve Fitzer, CEO of BCMS.
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UTHSCSA DEAN’S MESSAGE
Non-Traditional Medical Students
at the UT Health Science Center at San Antonio By Francisco González-Scarano, MD
Over the past several decades there have been many changes in the training of physicians, from adjustments in the curriculum to diminution in the work hours of residents and other post graduate trainees. One of them we are proud to embrace has been the admission and encouragement of non-traditional medical students. First, let us define what we consider to be non-traditional. The traditional route to medical school takes a student from a bachelor’s degree with completion of premedical requirements and appropriate testing such as the MCAT to immediate admission to the first year of medical school. Non-traditional students take a different path. Some return to school to complete premedical requirements not fulfilled during the undergraduate years. Others delay medical school for personal or professional motives, such as supporting a spouse’s career or raising children. Some students enter medical school after a time in another endeavor – some as dentists, nurses, PAs, or other medical professionals; others as lawyers, businesspeople, or members of the military. The medical educational system recognizes that non-traditional students bring their own benefits to the school experience and to the wider world of medicine. Older and more-experienced, they are sometimes seen as especially diligent and disciplined. They can display a savvy understanding of the way the “real world” works, a sophisticated ability to cooperate, novel approaches to problem solving, and a well-developed sense of compassion. In sum, non-traditional students possess unique blends of imagination, life skills, and cultural and relational insight that can profit their fellow students, the larger medical community, and most importantly, our patients. Medical schools have embraced this way of thinking. In 2007, the Association of American Medical Colleges (AAMC) established the Advancing Holistic Review Initiative with the aim of helping medical schools attain diversity goals through admissions techniques. Since then, its mandate has widened, but a key admissions focus remains taking account of the whole applicant,
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rather than only academic considerations. In light of this, medical colleges are encouraged to evaluate candidates according to the AAMC Experiences-Attributes-Metrics Model, which ascertains in an individualized way how an applicant is likely to contribute both during and after medical school. Along with academic metrics, these give a balanced consideration to experiences such as leadership roles, life experiences and community service, as well as attributes that include ethnicity, languages spoken, and faith. I am proud of our record of attracting and supporting non-traditional medical students. This is a commitment we proudly continue. In fact, nearly 60 percent of last year’s incoming class of medical students started one or more years after attaining their original degree. This number is not not dissimilar to that of other schools of medicine. For us, the question is not how soon after a bachelor’s degree a candidate enters UT School of Medicine at San Antonio. Whether an applicant comes straightaway, after a year, or after decades, we pose the same question: How was the intervening time used? In our admissions process, we take a highly individualized approach to each application. How students spent those years varies from person to person, but their diverse experiences tend to benefit each one individually, as well as the class as a whole. While non-traditional students offer a great deal, they may also require extra support. In light of that, we offer a Pre-Matriculation Program that is specifically targeted to those who are not arriving directly from an academic environment, were non-science majors, or feel anxious about medical school. It provides extra help in the transition to a new academic, environmental, and social setting, and is only one of the ways that we prepare our nontraditional students for future success. I am extremely proud of the non-traditional students who are currently excelling in our program. They bring a wealth of skill, perspective, and imagination to our educational experience. I
UTHSCSA DEAN’S MESSAGE
would like to highlight several, to give an idea of the breadth and diversity our policies have brought to our current student body. Second-year medical student Spencer Cope was diagnosed with dermatomyositis when he was 13 years old, and suffered with the rare autoimmune disease until the age of 19. After graduation from Brigham Young University, he took a summer internship at the University at Utah in pediatric rheumatology. His experience over the summer was transformative; he felt as if he were participating in cutting-edge medical research as part of a clinical team, and simultaneously interacting with and personally helping children in the same circumstances that he had endured. Spencer deferred medical school for two years after we accepted him, amassing an impressive research pedigree and a deep understanding of how medical research is conducted. Mazen Hassan’s route was entirely different, but just as fascinating. He graduated from the University of Texas at Austin with a radio-television-film and marketing double major, which he immediately put to work, spending five years in Hollywood. He returned to Austin to work as an associate video producer for a large advertising agency, and there discovered a latent love for science. A part-time job at a bookstore gave him access to science texts and kindled a dream to change professions. He moved to San Antonio, took undergraduate prerequisites, and now, at 34, is one of the oldest in his cohort of second-year medical students. Mazen’s experience in the fast-moving business of film production has developed his ability to quickly solve problems in complex environments, a skill that profits his studies now and will benefit his patients in years to come. For Janice De Surmont, a path across continents and industries grants important perspective. After an itinerant childhood with an Air Force family, she earned an economics degree from Brandeis University and worked in a string of financial positions for firms focused on venture capital, benefits consulting, and the mortgage industry. Since then, her husband’s job has taken her to far-flung locales like Nigeria and France, where she prepared to enter medicine; after experiencing a money-making career, she now values the prospect of a profession that helps others. In addition, her experiences with many cultures, walks of life, and socio-economic status have broadened her ability to connect with all kinds of people – and influence their health for the better. Third-year medical student Eric Bready delayed medical school
twice. During his undergraduate career at Brigham Young University, he took a two-year hiatus for a Mormon mission (an experience he has in common with Spencer Cope), to which he attributes his ability to talk to people across cultures and educational backgrounds. After graduation, he spent another year in the business world, working for a company that tests medical device packaging, an encounter that gives him an uncommon appreciation for the community of behind-the-scenes partners that contribute to success in the operating room. Last, but not least, Henderson Jones spent seven years practicing law in his native Mississippi before he recognized a strong desire to change professions. Inspired by an older brother who is an emergency physician, Henderson dedicated himself to preparations for medical school, and is now a 35-year old second year medical student. His legal training gives him a unique perspective on medicine and public health and he serves as a Student Government representative for the School of Medicine; he has been instrumental in recent initiatives involving issues including mental health and a community garden. He credits his time as a lawyer for a nuanced understanding of how power works in a society, and has a vision for translating that understanding to endeavors that ensure medical decisions are made for the patient’s benefit, rather than for other reasons. This is a small sampling of the non-traditional students preparing for a medical career here. The experiences and attributes of these and others help to bring a more diverse set of perspectives to patient care – a very valuable asset for our patients that continue to become more and more diverse themselves. All the best, Francisco González-Scarano, MD Dean, School of Medicine Vice President for Medical Affairs Professor of Neurology John P. Howe, III, MD, Distinguished Chair in Health Policy The University of Texas Health Science Center at San Antonio scarano@uthscsa.edu
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LEGAL EASE
If you’re worried about patient claims, you need to read this article By George F. “Rick” Evans, Evans, Rowe & Holbrook
The Texas Supreme Court may have given you a new opportunity to protect yourself against all sorts of patient claims - especially malpractice. In short, you may be able to avoid the courthouse altogether and go to arbitration instead. A number of articles were written about this decision in the past months, but I don’t see that anybody gave doctors some concrete advice. But I sure will. Keep on reading. Let’s start with what arbitration is. It’s been around for decades and I guarantee you’ve signed plenty of contracts that require arbitration if you wind up crosswise with the other side. Arbitration is a mechanism by which parties resolve their disputes outside the court system. It’s typically much faster than the judicial process and usually is cheaper, too. A neutral arbitrator (or a panel of arbitrators) is selected to serve as judge and jury. A hearing is held but it isn’t as formal as a trial and there is no jury. The “no jury” part is important because you don’t have to worry about the risk of getting a poorly educated juror influenced by emotions rather than fact. The hearing is almost always quicker than a trial. And there typically isn’t nearly as much discovery (depositions and stuff ) done beforehand. The arbitrator renders a decision which is pretty much final because there is no arbitration court of appeals. There are downsides to arbitration. I could list them but isn’t it sufficient to say that the plaintiff ’s bar fought tooth and nail a doctor’s right to demand arbitration? What does that say? Yes, there are downsides but, on balance, most doctors would prefer arbitration of a jury trial, particularly if you’re in a pro-plaintiff venue. Now, to the case at hand. It begins with Elisa Zapata who reached that point in her life that she needed a little more help 28 San Antonio Medicine • February 2016
than in her younger years. As such, she became a patient of the Fredericksburg Care Company a few miles north of us. Part of the admission process required she sign the usual terms of admission. But, this time there was something different. The papers contained a clause that required arbitration of any disputes between her and the nursing home. Of course, it’s no surprise to you to read that she died and her heirs claimed it was only because of negligence. Hence, the lawsuit. The nursing home demanded the case go to arbitration instead of the courthouse. The courthouse disagreed and kept the case. The nursing home persisted and the whole mess wound up before the Texas Supreme Court. Now, here’s the rub. Texas state law allows physician/patient arbitration agreements in theory but not in practicality. To have one that satisfies our state law, it has to be in 10-point bold-faced type telling the patient that he’s losing a lot of important rights. Most of all, the agreement must be signed by the patient’s attorney. Not just the patient. Now how many people are going to do that? In this case, the nursing home’s agreement fell short of the requirements and, by Texas law, was invalid. Yet, the Supreme Court yanked the case from the judicial system and sent it over to arbitration. Why? Well, it’s a boring legal explanation but, in short, it’s because the nursing home received Medicare payments and was therefore involved in interstate commerce. Because it was involved in interstate commerce, federal arbitration law took precedence over Texas law. And, because the nursing home’s arbitration clause satisfied federal requirements (which are pretty sparse compared to Texas law), the Court held the agreement valid. Okay, what’s this mean to you? Should you get your attorney to draft an arbitration clause that your patients need to sign? Should it be part of all new patient intake forms? If you receive federal
LEGAL EASE
funds (odds are high that you do), you may have this option now. Here’s my take on it. I lean towards it provided you get the right type of arbitration clause drafted by a crackerjack attorney with the input of a seasoned malpractice defense attorney. You can’t make this decision on your own. You must have a discussion with your insurance company to see if they’ll agree to it. There are reasons they may want to manage your claims in the judicial system rather than arbitration. For example, if you’re in arbitration, you may lose your right to get the case dismissed because the other side failed to file a proper expert report in 120 days. Or, you may lose the statutory caps on damages. Or, the right to review in higher courts if the arbitrator gets it wrong. Or, a conservative jury if you live in a conservative county. This isn’t a black-and-white decision but I think you need to look at this very hard with the advice of some top-notch attorneys and your insurer. Arbitration isn’t a panacea but the plaintiff ’s bar didn’t fight arbitration so hard during the last round of tort reform for nothing. It’s harder to get emotionally laden, runaway verdicts.
It’s hard to badger a doctor with endless, invasive discovery. I think that, on balance, arbitration will favor most doctors. And, aside from malpractice, arbitration clauses can be used to resolve many other patient disputes (no, not the TMB). So, borrowing from the drug companies’ TV ads which say “is “X” drug right for you? Ask your doctor,” you need to ask your attorney and insurer if arbitration is right for you. There may be compelling reasons they think not, in which case you should defer to them. But they may also look at your practice and wonder why they didn’t think of it first. George F. “Rick” Evans Jr., is the founding partner of Evans, Rowe & Holbrook. A graduate of Marshall College of Law, his practice for 36 years has been exclusively dedicated to the representation of physicians and other healthcare providers. Mr. Evans is the BCMS general counsel.
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WILD WORLD OF MEDICINE
ROACHES By Barbara R. Schmitz. LCSW Roaches, masters of evolution, are the ultimate survivors dating back 350 million years and can survive in nearly all environments. They need little introduction since all of you have met them. They are related to mantises and grasshoppers and have highly organized societies similar to that of ants Basically, roaches are personally clean. The problem with them visiting our cupboards is that while they eat, they frequently throw up a little and also leave their droppings where they eat. By doing this, they mark the spot with their peculiar odor so they can come back later. Under extremely unsanitary conditions they can pick up bacteria and acquire viruses on their feet from the filth left by humans as well as from their own living quarters such as a sewer system. They can crawl all over the place and hang on with their little claws, picking up disease and virus pathogens. When this occurs, they harbor bacteria that can stay in their digestive system for over a month. Then they contaminate your food and countertops with their feces. Salmonella can survive in their feces for years. Other pathogens that they can potentially carry are pneumonia, typhoid fever, bubonic plague and leprosy. Some believe they can cause human allergies and exacerbate asthma. They love to party on your crumbs, leftover’s, pet food, book bindings, fruit peelings, peanut butter, wood, flower petals, leaves, ants, termites, dead animals, bat droppings, Vaseline, leather, wood, rayon, fingernail clippings, all found with their fan30 San Antonio Medicine • February 2016
tastic sense of smell. They abhor soda crackers, sugar, cucumbers and cheese. Would you believe they are still classified as vegetarians? There are from 4,000-7,500 kinds of roaches with only about 20 hanging out with humans. Most are brown but some have exquisite coloring from dots and stripes to translucent, brilliant green, maroon to rich mahogany. Roach fossils of 300 million years ago have been discovered. At that time, they adapted a simple and secure way of life and have rarely departed from it. Some fascinating things about roaches are: they can have six legs and 18 knees; they can hold their breath for 40 minutes. Their ears are in their knee joints; their teeth are in their stomach. Their hearts are tubes with valves that pump blood backwards and forwards. They can live one week without a head and die of thirst because they must have their mouth to drink; they can survive a month without food. They have two brains located in the tail and head, but don’t need the one in the head to live. They can be frozen, thawed and then walk away; they can survive 216G’s (astronauts black out at 12); they can endure 50 to 100 percent the radiation as humans. Roaches have a lot of body fat. It is revolting if you are starving and you have to eat them. Some people in New Orleans eat chocolate-covered roaches but they can’t eat enough to control them. Cockroaches have many defense mechanisms. Their immune
WILD WORLD OF MEDICINE
response is spectacular and almost like that of humans. They have an incredible sense of smell; they touch food with their antennae and cerci (appendages) which pick up tastes, smells and vibrations; they have palps in front of their mouth which are used for tasting; they bite a piece of food with their mandible and if it is not good they will spit it out. Should they eat a poisonous bait and live through it, the future generations will develop resistance to the bait. They can regenerate previously severed antennae, mouthparts and broken legs while molting. They can disappear within 1/28th of a second which is equal to 93 mph. Their bodies are covered with wax (cuticle). They can flatten themselves and get into cracks no bigger than a match stick. There are over 3,000 roach control products registered in the U.S. About the only way to get rid of them is to deny them water as they quickly dry out. Flushing them down the toilet won’t do any good because they take up residence in your sewer line. If you vacuum them, the best thing to do is freeze the bag of roaches and then discard. Despite this, there is not one way to totally control cockroaches. And, do you really want to? Like termites, roaches are the ultimate
recyclers, eating decaying organic material and breaking it down for re-use by plants. Without the recyclers we could be ankle-deep in dung, dead bodies, and other waste. They make good food for hedgehogs, frogs, mice, centipedes, spiders and reptiles. If you don’t like roaches in your home, do all you can to protect the common house centipede. They will decimate your roach population as will the gecko. Always keep in mind that when using pesticides, adhere to recommended levels. We must not jeopardize human health, the environment, and other wildlife. There is considerable public concern about the effects chemicals have on the genetic resistance of insects to the chemicals and the disruption of naturally occurring biological control. Roaches are important in medical research because they develop cancerous tumors similar to those grown by humans and are used in cancer research. Lastly, a cockroach aversion is learned, not inherited. According to two U.S. Dept. of Agriculture researchers, they found that children under the age of 4 have no aversion to cockroaches until their parents teach them.
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.
ACCOUNTING FIRMS Padgett Stratemann & Co., LLP (HH Silver Sponsor) Padgett Stratemann is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services. Vicky Martin, CPA 210-828-6281 Vicky.Martin@Padgett-CPA.com www.Padgett-CPA.com “Offering service more than expected — on every engagement.” Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”
BANKING
BBVA Compass (HHHH 10K Platinum Sponsor) Our healthcare financial team provides customized solutions for you, your business and employees. Commercial Relationship Manager Zaida Saliba 210-370-6012 Zaida.Saliba@BBVACompass.com Global Wealth Management Mary Mahlie 210-370-6029 mary.mahlie@bbvacompass.com Medical Branch Manager Vicki Watkins 210-592-5755 vicki.watkins@bbva.com Business Banking Officer Jamie Gutierrez 210-284-2815 jamie.gutierrez@bbva.com www.bbvacompass.com “Working for a better future.”
Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great rela-
tionship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett 210- 343-4556 jeanne.bennett@amegybank.com Karen Leckie 210-343-4558 karen.leckie@amegybank.com www.amegybank.com “Community banking partnership.”
BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future. Chris Sherman 210-247-2978 csherman@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com
Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”
Frost (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.
Lewis Thorne 210-220-6513 lthorne@frostbank.com www.frostbank.com “Frost@Work provides your employees with free personalized banking services.”
IBC Bank (HHH Gold Sponsor) IBC Bank is a $12.4 billion multibank financial company, with over 212 facilities and more than 325 ATMs serving 90 communities in Texas and Oklahoma. IBC BankSan Antonio has been serving the Alamo City community since 1986 and has a retail branch network of 30 locations throughout the area. Markham Benn 210-354-6921 MarkhamBenn@ibc.com www.ibc.com “Leader in commercial lending.”
Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans. Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com
The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com
SSFCU (HHH Gold Sponsor) Founded in 1956, Security Service provides medical professionals with exceptional service and competitive rates on a line of mortgage products including one-time close construction, unimproved lots/land, jumbo and specialized adjustable-rate mortgage loans. Commercial Services Luis Rosales 210-476-4426 lrosales@ssfcu.org Investment Services John Dallahan 210-476-4410 jdallahan@ssfcu.org Mortgage Services Glynis Miller 210-476-4833 gmiller@ssfcu.org Bank of America (HH Silver Sponsor) Bank of America provides people, companies and institutional investors the financial products and services they need to help achieve their goals at every stage of their financial lives. Jennifer Dooling 210-270-5226 jennifer.dooling@baml.com Courtney Martinez 210-419-2643 courtney.martinez@baml.com http://about.bankofamerica.com/ en-us/index.html Making financial lives better — one connection at a time Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology • Expanding your office space • We offer loans to meet your business or personal needs. Competitive rates, favorable terms and local decisions. Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org Generations Federal Credit Union (HH Silver Sponsor) Generations provides a wide array of innovative products including
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 33 loan, deposit and investment solutions for personal and commercial banking needs. Yvonne "Bonnie" M. Aguilar 210-229-1800 bonnie.aguilar@ mygenfcu.org www.mygenfcu.org “For this generation and the next.”
terior finish-out projects. Services include conceptual and final pricing, design-build and construction management. Single-source management from concept to completion ensures continuity through all phases of the project. Clay Page 210-375-9150 clay@rcpageconstruction.com
RBFCU (HH Silver Sponsor) 210-945-3800 businesslending@rbfcu.org www.rbfcu.org
ELECTRONIC DOCUMENTATION AND TRANSCRIPTION SERVICES
BIOMEDICAL WASTE DISPOSAL
BioMedical Waste Solutions, LLC (HHH Gold Sponsor) Save costs on your medical waste disposal! BioMedical Waste Solutions provides a compliant, reliable and low-cost service. Wes Sonnier 1-877-974-1300 Wes@BioMed-Disposal.com Joe Loyacano 1-877-974-1300 Joe@BioMed-Disposal.com www.BioMedicalWasteSolutions.com “BCMS members save 10 percent off or one free month! Request a free quote in 10 seconds at www.BioMedicalWasteSolutions.com.”
CONTRACTORS/BUILDERS/ COMMERCIAL
Huffman Developments (HHH Gold Sponsor) Premier medical and professional office condominium developer. Our model allows you to own your own office space as opposed to leasing. Steve Huffman 210-979-2500 Shawn Huffman 210-979-2500 www.huffmandev.com
RC Page Construction, LLC (HHH Gold Sponsor) Commercial general contractor specializing in ground-up and in-
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Med MT, Inc. (HHH Gold Sponsor) Narrative transcription is physicians’ preferred way to create patient documents and populate electronic medical records. Ray Branson 512-331-4669 branson@medmt.com www.medmt.com “The Med MT solution allows physicians to keep practicing just the way they like.”
ELECTRONIC MEDICAL RECORDS
Greenway Health (HHH Gold Sponsor) Greenway Health offers a fully integrated electronic health record (EHR/EMR), practice management (PM) and interoperability solution that helps healthcare providers improve care coordination, quality and satisfaction while functioning at their highest level of efficiency. Stacy Berry 830-832-0949 Stacy.berry@greenwayhealth.com www.greenwayhealth.com
FINANCIAL SERVICES
Northwestern Mutual Wealth Management (HHHH 10K Platinum Sponsor) Comprehensive financial planning, insurance and investment planning, estate planning and trust services. Eric Kala, CFP, CLU, ChFC Wealth Management Advisor 210-446-5752
eric.kala@nm.com www.erickala.com
HEALTHCARE REAL ESTATE
Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”
San Antonio Comercial Advisors (HHH Gold Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”
Frost Leasing (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses. Laura Elrod Eckhardt 210-220-4135 laura.eckhardt@frostbank.com www.frostbank.com “Commercial leasing for a doctor’s business equipment and vehicle.” Bob Davidson New York Life (HH Silver Sponsor) Dedicated agent at New York Life helping physicians and medical professionals achieve their financial dreams. Bob Davidson 210-321 1445 rdavidson02@ft.newyorklife.com www.linkedin.com/in/bobdavidsonnyl “Taking care of those who take care of us.” Retirement Solutions (HH Silver Sponsor) Committed to providing comprehensive, reliable consultation to help you navigate the complex world of retirement planning. Robert C. Cadena 210-342-2900 robert@retirementsolutions.ws www.retirementsolutions.ws
HIPAA COMPLIANCE SERVICES Cyber Risk Associates (HH Silver Sponsor) Cyber Risk Associates provides HIPAA compliance services designed for small practices, offering enterprise-quality privacy and security programs, customized to your needs. David Schulz 210-281-8151 DAS@CyberRiskAssociates.com www.CyberRiskAssociates.com
HIPAA/MANAGED IT/ VOIP/SECURITY
Hill Country Tech Guys (HHH Gold Sponsor) Provides complete technology services to many different industries, specializing in the needs of the financial and medical industries. Since 2006, our goal has always been to deliver relationship-based technology services that exceed expectations. Whit Ehrich, CEO 830-386-4234 whit@hctechguys.com http://hctechguys.com/ “IT problems? Yeah… we can fix that!”
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY HOSPITALS/ HEALTHCARE SERVICES
Southwest General Hospital (HHH Gold Sponsor) Southwest General is a full-service hospital, accredited by DNV, serving San Antonio for over 30 years. Quality awards include accredited centers in: Chest Pain, Primary Stroke, Wound Care, and Bariatric Surgery. Business Development Director Blake Pollock 210-243-9151 bpollock@iasishealthcare.com www.swgeneralhospital.com "Quality healthcare with you in mind."
Warm Springs •Medical Center •Thousand Oaks •Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research. Central referral line 210-592-5350 “Joint Commission COE.” Elite Care Emergency (HH Silver Sponsor) 24/7 full-service, no-wait, freestanding ER with board-certified physicians and RNs offering Elite Care advantage for patients. Marketing Liaison Dlorah Martin 509-592-7998 dmartin@elitecareemergency.com Marketing liaison Kylyn Stark 210-978-4110 kstark@elitecareemergency.com www.elitecareemergency.com “When seconds count, Elite Care can make ALL the difference.” Methodist Healthcare System (HH Silver Sponsor) Palmira Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com/ Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for
individuals with medical, physical and functional challenges. Miranda Peck 210-482-3000 mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”
HUMAN RESOURCES
Employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page. John Seybold 210-447-6518 jseybold@employerflexible.com www.employerflexible.com “BCMS members get a free HR assessment valued at $2,500.”
INSURANCE/MEDICAL MALPRACTICE SWBC (HHH Gold Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships. VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com Ad Valorem Tax Advisor Nikki McNish 210.376.2316 nmcnish@swbc.com www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services
INSURANCE
Frost Insurance (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses. Bob Farish 210-220-6412 bob.farish@frostbank.com www.frostbank.com “Business and personal insurance tailored to meet your unique needs.”
Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com
Texas Medical Association Insurance Trust (HHH Gold Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need. Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.” Catto & Catto (HH Silver Sponsor) Providing insurance, employee benefits and risk-management products and services to thousands of businesses and individuals in Texas and the United States. James L. Hayne Jr. 210-222-2161 jhaynejr@catto.com Corey Huffman 210-298-7123 chuffman@catto.com www.catto.com Joel Gonzales Agency Nationwide (HH Silver Sponsor) Joel Gonzales 210-275-3595 www.nationwide.com/jgonzales
Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org “Recommended partner of the Bexar County Medical Society.”
MedPro Group (HHH Gold Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance. Thomas Mohler, 512-213-7714 thomas.mohler@medpro.com Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC, 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”
Continued on page 36 visit us at www.bcms.org
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 35 NORCAL Mutual Insurance Co. (HH Silver Sponsor) Since 1975, NORCAL Mutual has offered medical professional liability coverage to physicians and is “A” (Excellent) rated by A.M. Best. Patrick Flanagan 844-4-NORCAL pflanagan@norcal-group.com www.norcalmutual.com ProAssurance (HH Silver Sponsor) ProAssurance Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease— that’s only fair. Keith Askew Market Manager kaskew@proassurance.com Mark Keeney Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com
INTERNET/ TELECOMMUNICATIONS
Time Warner Cable Business Class (HHH Gold Sponsor) When you partner with Time Warner Cable Business Class, you get the advantage of enterpriseclass technology and communications that are highly reliable, flexible and priced specifically for the medical community. Rick Garza 210-582-9597 Rick.garza@twcable.com “Time Warner Cable Business Class offers custom pricing for BCMS Members.”
IT SUPPORT/VOIP/ CLOUD SERVICES
ICS (HHH Gold Sponsor) ICS® is a Texas-based provider of business technology integration solutions, including managed IT support, business telephones, VoIP communications, video conferencing systems, surveillance cameras, and voice/data cabling. Family owned since 1981. Daniel Simons 210-581-9020
36 San Antonio Medicine • February 2016
daniel.simons@ics-com.net Robert Foehrkolb 210-225-5427 rfoehrkolb@ics-com.net www.ics-com.net “Providing IT, voice and video solutions for business.”
LABORATORY SERVICES
PGX TESTING (HHH Gold Sponsor) PGX Testing is a multi-faceted diagnostics company currently offering pharmacogenomics, urine toxicology, women's health testing, cancer screening, and wellness testing to the medical profession. Charlie Rodkey Sr. charlie@pgxt.com 210-218-8610 Ryan Rodkey ryan@pgxt.com 210-323-7717 Ron Inselmann ron@pgxt.com 210-382-7761 www.PGXT.com Clinical Pathology Laboratories (HH Silver Sponsor) Mitchell Kern 210-229-2513 mkern@cpllabs.com www.cpllabs.com
MARKETING SERVICES Digital Marketing Sapiens (HH Silver Sponsor) Healthcare marketing professionals with proven experience and solid understanding of compliance issues. We deliver innovative marketing solutions that drive results. Irma Woodruff 210-410-1214 irma@dmsapiens.com Ajay Tejwani 210- 913-9233 ajay@dmsapiens.com www.DMSapiens.com
MEDICAL BILLING AND COLLECTIONS SERVICES
DataMED (HHH Gold Sponsor) Providing your practice with the latest compliance solutions, concentrating on healthcare regula-
tions affecting medical billing and coding changes, allowing you and your staff to continue delivering excellent patient care. Betty Aguilar 210-892-2331 baguilar@datastreamllc.net www.datamedbpo.com “BCMS members receive a discounted rate for our billing services.”
Kareo (HHH Gold Sponsor) The only cloud-based medical office software and services platform purpose-built for small practices. Our practice management software, medical billing solution, practice marketing tools and free, fully certified EHR has helped 30,000+ medical providers more efficiently manage their practice. Regional Solutions Consultant Lilly Ibarra 210-714-9815 lilly.ibarra@kareo.com www.kareo.com Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”
MEDICAL SUPPLIES AND EQUIPMENT
Henry Schein Medical (HHHH 10K Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”
CASA Physicians Alliance (HHH Gold Sponsor) Locally owned, nationwide MultiSpecialty Physicians Buying Group which provides significant savings on Pediatric, Adolescent and Adult vaccines as well as other products. Physician’s memberships are free. Shari Smith 866-434-9974 shari@casaalliance.net Chris Dixon 866-434-9974 chris@casaalliance.net www.casaalliance.net “Providing meaningful vaccine discount programs, products and services.”
MENTAL HEALTH EDUCATION AND CONSULTING
The Ecumenical Center (HHH Gold Sponsor) The Ecumenical Center provides faith-based counseling and education for healing, growth and wellness. The center is a catalyst, bringing together community leaders in research, education, ethics, medical and mental health professions. Mary Beth Fisk 210-616-0885, ext. 215 mbfisk@ecrh.org www.ecrh.org
MERCHANT PAYMENT SYSTEMS/CARD PROCESSING Heartland Payment Systems (HH Silver Sponsor) Heartland Payments is a true cost payment processor exclusively endorsed by over 250 business associations. Tanner Wollard 979-219-9636 tanner.wollard@e-hps.com www.heartlandpaymentsystems.com “Lowered cost for American Express; next day funding.”
OFFICE EQUIPMENT/ TECHNOLOGIES Dahill (HH Silver Sponsor) Dahill offers comprehensive document workflow solutions to
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes. Ronel Uys 210-805-8200, ext. 10105 ruys@dahill.com www.dahill.com
PAYROLL SERVICES
SWBC (HHH Gold Sponsor) Our clients gain a team of employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits. Bryce Fegley 830-980-1245 bfegley@swbc.com Working together to help our clients achieve their business objectives.
PHYSICIANS BUYING GROUP
CASA Physicians Alliance (HHH Gold Sponsor) Locally owned, nationwide Multi-Specialty Physicians Buying Group which provides significant savings on Pediatric, Adolescent and Adult vaccines as well as other products. Physician’s memberships are free. Shari Smith 866-434-9974 shari@casaalliance.net Chris Dixon 866-434-9974 chris@casaalliance.net www.casaalliance.net “Providing meaningful vaccine discount programs, products and services.”
REAL ESTATE/ COMMERCIAL
San Antonio Comercial Advisors (HHH Gold Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”
Robbie Casey Commercial Realty (HHH Gold Sponsor) Robbie Casey Commercial Realty was founded on the principles of providing thorough market strategies, innovative advertising, superior service, and uncompromising integrity. Robbie is dedicated to each of her clients. She brings enthusiasm and creativity to each project and knows how to get the job done. Robbie Casey 210-872-8453 robbie@robbiecaseyrealty.com http://robbiecaseyrealty.com Endura Advisory Group (HH Silver Sponsor) Endura Advisory Group specializes in representing physicians and clients in the purchase, lease, sale, management or sublease of commercial real estate. Vicki Cade, CCIM 210-366-2222 Mobile 210-827-7640 vcade@endurasa.com Teresa Corbin 210-366-2222 tcorbin@endurasa.com www.endurasa.com
REAL ESTATE/ RESIDENTIAL
Robbie Casey Realty (HHH Gold Sponsor) My extensive experience and
expertise in the San Antonio, Alamo Heights and Terrell Hills real estate market will benefit you whether you are looking to buy or sell a home in the area. Realtor, ABS, ILHM, ALMS Roslyn Casey 210-710-3024 Roslyn@roslyncasey.com http://roslyncasey.kwrealty.com “Communication is key” Kuper Sotheby's International Realty (HH Silver Sponsor) My hometown roots are based in Fredericksburg while my home away from home is San Antonio. Local knowledge — exceptional results. Joe Salinas III 830-456-2233 Joe.Salinas@SothebysRealty.com JoeSalinas.com “Embrace your new life ... I'll help you become a connoisseur.”
SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resort-quality environment. Shane Brown Executive Director 210-305-5713 hello@ legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”
“Favorite Healthcare Staffing offers preferred pricing for BCMS members.”
TRAVEL CONSULTANTS Alamo Travel Group (HH Silver Sponsor) Locally owned travel agency for over 30 years, offering personalized travel services for your next family vacation, business travel needs or group travel. American Express Travel Network representative. Patricia Pliego Stout 210-593-5500 pstout@alamotravel.com www.amazingjourneysbyalamo.com “See what a difference we can make for you!”
As of January 18, 2015 To join the Circle of Friends program or for more information, call 210-301-4366, email August.Trevino@bcms.org, or visit www.bcms.org/Cof.html.
STAFFING SERVICES
Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Brody Whitley, Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com
visit us at www.bcms.org
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38 San Antonio Medicine • February 2016
Ancira Chrysler 10807 IH-10 West Gunn Acura 11911 IH-10 West
Ingram Park Auto Center 7000 NW Loop 410
Ancira Dodge 10807 IH-10 West Cavender Audi 15447 IH-10 West
* Gunn Infiniti 12150 IH-10 West
Ingram Park Auto Center 7000 NW Loop 410
Ingram Park Auto Center 7000 NW Loop 410
North Park Mazda 9333 San Pedro Ave.
North Park Subaru at Dominion 21415 IH-10 West
Mercedes-Benz of Boerne 31445 IH-10 W, Boerne
Cavender Toyota 5730 NW Loop 410
Ancira Jeep 10807 IH-10 West Ingram Park Auto Center 7000 NW Loop 410
Mercedes-Benz of San Antonio 9600 San Pedro Ave. Cavender Buick 17811 San Pedro Ave. (281 N @ Loop 1604)
Northside Ford 12300 San Pedro Ave.
Cavender GMC 17811 San Pedro Ave. Batchelor Cadillac 11001 IH-10 at Huebner
Tom Benson Chevrolet 9400 San Pedro Ave. Gunn Chevrolet 12602 IH-35 North
North Park Subaru 9807 San Pedro Ave.
* North Park Lexus 611 Lockhill Selma North Park Lexus Dominion 21531 IH-10 West Frontage Road
Ancira Nissan 10835 IH-10 West Ingram Park Nissan 7000 NW Loop 410
North Park Toyota 10703 SW Loop 410
* Ancira Volkswagen 5125 Bandera Rd. North Park VW at Dominion 21315 IH-10 West
Gunn GMC 16440 IH-35 North
* Fernandez Honda 8015 IH-35 South
* North Park Lincoln/ Mercury 9207 San Pedro Ave.
Ancira Ram 10807 IH-10 West Ingram Park Auto Center 7000 NW Loop 410
Gunn Honda 14610 IH-10 West (@ Loop 1604)
visit us at www.bcms.org
39
AUTO REVIEW
Porsche & Land Rover
‘experiences’ By Steve Schutz, MD
Slowly but surely the vehicles we buy are
under the same circumstances. I can’t.
With all that in mind I recently visited
being homogenized. Government regula-
So, how do luxury automakers connect
two automotive brand experiences, the
tions, customer expectations, and universal
with customers when their products aren’t
new Porsche Experience Center at the At-
benchmarking are driving automotive de-
much different from the competition? The
lanta airport and the Land Rover Driving
velopment so much that it’s difficult to
answer increasingly seems to be to get own-
School in Carmel, California.
make cars that stand out from their com-
ers and prospects out of their personal cars
Sitting as it does next to a busy runway,
petitors.
and into “experiences.” Presumably, when
the Porsche center is an assault on the
Don’t believe me? Consider this: 30
customers are able to forget about their
senses from the moment you walk in.
years ago you could ride blindfolded in the
everyday realities — drive to daycare, then
Brightly colored Porsche road and race cars
back seat of a Mercedes, BMW, or Cadillac
to work, then to the grocery store, then
are everywhere, and the modern architec-
and know after less than a mile which was
home, repeat daily — and are brought to
ture with its chrome, glass, and high gloss
which. Today I doubt many readers could
a happier place where a particular vehicle
surfacing grab your attention here, there,
tell the difference between a new Mercedes
shines, those customers will be more in-
and there. And there. They should teach
E-class, BMW 5-Series, or Cadillac CTS
clined to buy that vehicle.
an architecture class here, and maybe they
40 San Antonio Medicine • February 2016
AUTO REVIEW do. And then there’s the test track just outside, and don’t forget the airliners landing and taking off every 20 seconds or so. Naturally, the idea is to immerse yourself in all things Porsche, and ideally, drive one too, either a sports car on the short test track, or an SUV on the off road course. Numerous specific drives are offered ranging from quick laps on the track in the hottest sports cars to slow slogs off road in a Cayenne or Macan SUV, and all can be done in 1-2 hours for $500-$1,000 or so. Inside, Porsche provides entertainment for non-drivers as well. There’s a museum showcasing a few historic Porsches, a cafe, restaurant, and even a driving simulator to in the dirt and mud. And you’ll know why.
us on the Pacific Coast Highway had no
Porsche buyers tend to customize their
I selected the Carmel location for prox-
way of knowing how much better their
rides more than most luxury car buyers, so
imity and sentimental reasons — my wife
the center includes a place to do that prior
and I honeymooned there 25 years ago —
Both the Porsche and Land Rover expe-
to purchase, should you be so inclined.
and it proved to be an inspired choice.
riences offer an opportunity to interact
Countless color palettes, leather swatches,
Connected to the relaxed but nicely luxu-
with the brands in an immersive way that’s
and bodywork samples are there to see and
rious Quail Lodge and Golf Resort, the
designed to connect you with either the ve-
touch, along with a large HD monitor and
Land Rover team has access to an impres-
hicle you already own or the one you want.
an advisor. The process is easy and inform-
sive array of trails that wind up and around
And both experiences are fun. They’re just
ative, though, as you’d expect, any person-
182 acres of tough terrain.
different kinds of fun.
entertain teenagers.
view could be.
alized changes you make will be expensive.
The experience begins with a brief but
The whole place is either a sensory de-
detailed discussion of the capabilities of
If you’re in the market for this kind of
light or annoying cacophony depending on
whichever Land or Range Rover you’ve se-
vehicle, call Phil Hornbeak at 210-301-
your point of view, which means that
lected to drive, followed by a drive into the
4367.
Porsche fans will feel completely validated,
woods. Not surprisingly, you’ll tackle easy
but non-Porsche people may prefer to be
trails at first, but as the morning progresses
elsewhere while their enthusiast signifi-
you’ll find yourself on very steep and slip-
board-certified
cant-other enjoys the immersion.
pery hills. I learned quickly that the famed
terologist who lived in San
While the Porsche center is all about
Range Rover’s capabilities were prodigious
Antonio in the 1990s when
adrenaline and conspicuous consumption,
indeed, and I began to look forward to ex-
he was stationed here in the U.S. Air Force.
the Land Rover Driving School involves re-
ploring ever more challenging areas. The
He has been writing auto reviews for San
laxing, unplugging, and enjoying nature.
afternoon session was more laid back with
Antonio Medicine since 1995.
And, of course, learning about how well
a leisurely jaunt down a breathtakingly sce-
Land Rovers drive off road. Whether you
nic dirt road to Big Sur located way up
choose Asheville, N.C., Manchester, Vt.,
above the Pacific Ocean. As I enjoyed the
or Carmel, Calif., you’ll end up with a deep
bountiful beauty below, it struck me that
understanding of how well Land Rovers do
the innumerable rental cars and RVs below
Steve Schutz, MD, is a gastroen-
visit us at www.bcms.org
41
THANK YOU
to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA Clinical Pathology Associates Dermatology Associates of San Antonio, PA Diabetes & Glandular Disease Clinic, PA ENT Clinics of San Antonio, PA Gastroenterology Consultants of San Antonio General Surgical Associates Greater San Antonio Emergency Physicians, PA Institute for Women's Health Lone Star OB-GYN Associates, PA M & S Radiology Associates, PA MacGregor Medical Center San Antonio MEDNAX Peripheral Vascular Associates, PA Contact BCMS today to join the 100% Membership Program! 42 San Antonio Medicine • February 2016
Renal Associates of San Antonio, PA San Antonio Gastroenterology Associates, PA San Antonio Kidney Disease Center San Antonio Pediatric Surgery Associates, PA Sound Physicians South Alamo Medical Group South Texas Radiology Group, PA Tejas Anesthesia, PA Texas Partners in Acute Care The San Antonio Orthopaedic Group Urology San Antonio, PA Village Oaks Pathology Services/Precision Pathology WellMed Medical Management Inc. *100% member practice participation as of January 17, 2016.