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VOLUME 71 NO. 4
MEDICINE SAN ANTONIO
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Tricentennial Health History Symposium Early Dawn of Medicine in San Antonio
By Jaime Panowsky, MD, FACS.....................................14 By David Schulz.............................................................18
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Changing the World, One Life at a Time
By Robert Hromas, MD..................................................20
BCMS President’s Message ...............................................................................................................8 BCMS Legislative News ............................................................................................................................10 Physician Leaders By Stephen Fitzer.........................................................................................................11 Business: The Irresistible Rise of Private Equity Real Estate By Ari Rastegar..............................................22 Business: Financial Focus By Elizabeth Olney ...........................................................................................24 Feature: Something to Say: The McNay presents 100 years of African American Art by Fred H. Olin, MD .......26 Book Review: Paul Theroux’s Books Revieded By Fred H. Olin, MD..........................................................28 Legal Ease: Can the Officer Really Do that To Me? By George F. “Rick” Evans, General Counsel, BCMS .............................................................................30 Opinion: Children’s path to academic, economic success begins before birth By John Menchaca, MD.....32 BCMS News .............................................................................................................................................34 BCMS Circle of Friends Directory ..............................................................................................................38 In the Driver’s Seat ....................................................................................................................................42 Auto Review: 2018 Porsche 911 By Steve Schutz, MD ...........................................................................44
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San Antonio Medicine • April 2018
VOLUME 71 NO. 4
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Texas Icon was Also its First Hospital
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San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS.
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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Sheldon G. Gross, MD, President Gerald Q. Greenfield Jr., MD, PA, Vice President Adam V. Ratner, MD, President-elect Leah H. Jacobson, Immediate Past President Kristi G. Clark, Secretary John Robert Holcomb, MD, Treasurer
DIRECTORS Rajaram Bala, MD, Member Jenny Shepherd, BCMS Alliance President Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member George F. "Rick" Evans Jr., General Counsel Vincent Paul Fonseca, MD, Member Michael Joseph Guirl, MD, Member John W. Hinchey, MD, Member Gerardo Ortega, MD, Member Robyn Phillips-Madson, DO, MPH, Medical School Representative Manuel Quinones, MD, Member Ronald Rodriguez, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative David M. Siegel, MD, JD, Member Bernard T. Swift, Jr., DO, MPH, Member
CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer
CHIEF OPERATING OFFICER Melody Newsom Alice Sutton, Controller Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director
COMMUNICATIONS/ PUBLICATIONS COMMITTEE Kenneth C.Y. Yu, MD, Chair Kristi Kosub, MD, Vice Chair Pavela Bambekova, Medical Student Darren Donahue, Medical Student Carmen Garza, MD, Community Member Fred H. Olin, MD, Member Jaime Pankowsky, MD, Member Alan Preston, Community Member Rajam S. Ramamurthy, MD, Member Adam Ratner, MD, Member David Schulz, Community Member Austin Sweat, Medical Student J.J. Waller Jr., MD, Member
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San Antonio Medicine • April 2018
PRESIDENT’S MESSAGE
CELEBRATING OUR PAST WHILE PREPARING FOR OUR FUTURE By Sheldon Gross, MD, 2018 BCMS President
This issue of San Antonio Medicine is dedicated to our city's tricentennial celebration. As I have stated before, it is an honor to be BCMS President. It is an even greater honor to be president during our city's tricentennial celebration. As mentioned by Dr. Fred Olin later in this issue, there will be a symposium on the morning of May 12, 2018 discussing the evolution of health care in San Antonio over the past 300 years. It promises to be a fascinating discussion with a luncheon keynote address by Henry Cisneros. I encourage all to attend. This issue contains outstanding discussions of how medicine evolved in San Antonio and specific physicians that played key roles. From today's perspective, we look back 200 or 300 years ago and can only view medical treatments from that era as rudimentary and at times barbaric. We have to force ourselves to remember that antibiotics were a product of the 20th century. Prior to this, fever from a bacterial infection was often fatal. If we compare medical care from 300 years ago to our present age of organ transplantation, genetic diagnosis and treatment of previously fatal diseases, laparoscopic and robotic approach to surgery, and the many other advances, it is nothing less than astounding. I recently saw a 2 monthold infant in my practice with a degenerative condition involving spinal muscular atrophy. This condition, known as Werdnig-Hoffman disease, had been uniformly fatal up until the last two or three years. There are now two different genetic approaches to actually repairing the faulty DNA and curing a previously incurable genetic disease. As physicians, we often complain about the weaknesses in our health care system. We complain about managed care, increasing bureaucratic load, maintenance of certification, and many other challenges dealt with on a daily basis. It is easy to forget exactly how much progress has been made during our lifetimes. It is astounding to see how much progress has been made over the past 300 years. It makes one wonder what medicine will be like 300 years
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San Antonio Medicine • April 2018
into the future. As a county medical society, we should also be concerned with what our health care system will look like over the following centuries and what role physicians will play in an increasingly complex society. As I mentioned above, there are new genetic treatments available to previously fatal conditions. Their cost is in the hundreds of thousands of dollars. This raises the question of how do we finance these incredible but hugely expensive treatments for a small number of people? Will physicians continue to be the captain of the ship? What role will physician extenders play and how will they fit into the administrative management of health care? These are critical questions that will largely determine the health care environment of the future. Will we continue to have a pluralistic health care system where people have a cafeteria-style option of plans to choose from? Will we, like other countries, move to a single health care payer system run by the government? There are countless other issues we cannot even imagine that will without question impact our health care delivery in this country. At the same time that I learn how health care has evolved in San Antonio, I also look to the future and hope that our community will play a major role in health care research, health care delivery, and health care education. I am optimistic about health care and the role of physicians in years to come. As always, I welcome the thoughts and opinions of colleagues in San Antonio with regards to our past, present, and future. Sincerely, SHELDON GROSS, MD President Bexar County Medical Society
BCMS LEGISLATIVE NEWS
TEXPAC Elections Update Big Wins for Medicine
Medicine had an amazing night on March 6 with several physician primary wins and only a few friends of medicine not returning to the legislature. This election cycle was unpredictable, with the departure of House Speaker Joe Straus bringing much uncertainty. We saw a big increase in voter turnout in the Democrat primary, totaling 1 million voters, although the total Republican turnout still significantly outperformed the other side with 1.5 million votes cast. In the end, TEXPAC had a 92-percent success rate in keeping our endorsed candidates in the running for the November elections. Thank you to everyone who went to the polls!
Big Incumbent Wins
TEXPAC was extremely successful in protecting our incumbents — and we could not have done that without you. First and foremost is the primary victory of House District (HD) 59’s Rep. J.D. Sheffield, DO (R-Gatesville), who won with 58 percent of the vote, overcoming constant attacks from big-spending outside interest groups. TEXPAC also helped secure victories in Republican primary races for our champions Rep. Sarah Davis (HD 134, W. University Place); Rep. Lyle Larson (HD 122, San Antonio); Rep. Chris Paddie (HD 9, Marshall); Rep. Ken King (HD 88, Canadian); and Rep. Four Price (HD 89, Amarillo). TEXPAC used your contributions to buy newspaper ads, send mailers, and sponsor fundraisers for our champions. Thank you for your continued support; every vote and dollar really do matter! Last night, we were victorious, thanks to you. In North Texas, it was imperative that we brought back Reps. Charlie Geren (HD 99, Fort Worth); Giovanni Capriglione (HD 98, Southlake); and Linda Koop (HD 102, Richardson). I am proud to say that through our efforts, we were able to bring back all three of these friends of medicine. They won by healthy margins in their Republican primary races. On the border, Democrats Reps. Mary González (HD 75, Clint) and Ryan Guillen (HD 31, Rio Grande City) had heavy opposition from certain interest groups. However, they also were able to fend off their opponents with the hard work and help from local physicians in the district. Finally, TEXPAC was instrumental in the primary victories of three freshman who had opponents. They are: HD 18 — Rep. Ernest Bailes (R-Huntsville) 100% Medicine Voting Record HD 55 — Rep. Hugh Shine (R-Temple) HD 64 — Rep. Lynn Stucky (R-Denton)
Incumbent Runoffs Unfortunately, TEXPAC-endorsed Reps. Rene Oliveira (DBrownsville) in HD 37 and Scott Cosper (R-Killeen) in HD 54 were forced into a runoff in their primaries. Other incumbents we endorsed narrowly defeated the challengers and avoided a runoff. TEXPAC will continue to be involved with and support our endorsed candidates. 10
San Antonio Medicine • April 2018
By Christine Mojezati, TexPAC Director
Incumbent Losses With the highs there are always lows. We lost five incumbents who were true friends of medicine. It saddens me to report we will see the departure of House members Wayne Faircloth (HD 23, Galveston); Roberto Alonzo (HD 104, Dallas); Jason Villalba (HD 114, Dallas) 100% Medicine Voting Record; Diana Arevalo (HD 116, San Antonio); and Tomas Uresti (HD 118- San Antonio), as well as Craig Estes (Senate District 31, Wichita Falls) in the Senate. I also am disappointed to report the defeat of Rep. Cindy Burkett in her bid to unseat Sen. Bob Hall (R-Edgewood) in Senate District 2. Senator Hall is the worst vote for medicine, and TEXPAC was all in for Representative Burkett. We will miss her tremendously in the House and thank her for her efforts on behalf of medicine. This election cycle was expensive and aggressive, and now medicine needs to face some harsh realities. The fringe groups are getting stronger, and the only way we can combat them is to increase our membership. Increased membership means we’ll have more money to contribute to our candidates so they can defeat the enemy.
2018 Runoff Elections — Incumbent and Open Seats
In many races, a runoff was unavoidable. This is the time for TEXPAC to become involved in some of these races; they can pay dividends in the future. The Candidate Evaluation Committee will recommend in which races TEXPAC should make endorsements. The runoff elections will take place on May 22, and the following races will appear on the ballots:
TEXAS HOUSE HD 4 — Stuart Spitzer, MD vs. Keith Bell (Rep.) HD 8 — Thomas McNutt vs. Cody Harris (Rep.) HD 13 — Jill Wolfskill vs. Ben Leman (Rep.) HD 37 — Rep. Rene Oliveira vs. Alex Dominguez (Dem.) HD 46 — Sheryl Cole vs. Chito Vela (Dem.) HD 54 ¾ Rep. Scott Cosper vs. Brad Buckley (Rep.) HD 62 — Reggie Smith vs. Brent Lawson (Rep.) HD 109 — Carl Sherman vs. Deshaundra Lockhart Jones (Dem.) HD 121 — Steve Allison vs. Matt Beebe (Rep.)
U.S. CONGRESS CD 2 — Kevin Roberts vs. Dan Crenshaw (Rep.) CD 5 — Lance Gooden vs. Bunni Pounds (Rep.) CD 6 — Jake Ellzey vs. Ron Wright (Rep.) CD 6 — Jana Lynn Sanchez vs. Ruby Fay Woolridge (Dem.) CD 7 — Lizzie Pannill Fletcher vs. Laura Moser (Dem.) CD 21 — Chip Roy vs. Matt McCall (Rep.) CD 27 — Beck Bruun vs. Michael Cloud (Rep.) CD 27 — Roy Barrera vs. Eric Holguin (Dem.)
For more information contact Mary Nava, BCMS chief government affairs officer at mary.nava@bcms.org.
ANNOUNCEMENT
Physician Leaders? By Stephen C. Fitzer, BCMS Executive Director
Leadership is one of those things where people say “I know it when I see it!” Folks make that statement because while they are willing to follow some people and not follow others, they may not be able to explain why. Generally, a leader is someone who others are willing to follow because they seem to know where they are going and they have convinced others that following them is the right thing to do because something worthwhile will be accomplished by following that leader, there is something in it for the follower personally, or it will be a fun ride. Some leaders are almost universally accepted as examples of how it’s done. Examples of leaders that everyone usually agrees were great were the likes of George Washington, Thomas Jefferson or Abraham Lincoln. Great soldiers are often thought of as great leaders, people like General George Patton or Joan of Arc (France). Great coaches are often viewed as great leaders (think John Wooden, the great UCLA basketball coach). Jack Welch of GE was considered the greatest business leader in the country in his day. But leaders exist at every level of our society, even if they are not famous. Yes, even in the physician ranks. Sometimes we see leaders that motivate only certain constituencies, but who fail to motivate or are even despised by other than their own constituency. In the field of politics, a great leader for one party is often rejected by the opposing party. In that case, are they really a leader? A reasonable person would have to say yes to that question, even when another group disagrees. The same is true in business; one company CEO may be despised by the competition while at the same time is viewed as a great leader by his/her own employees. My point in this is that there are all kinds of leaders. Some appear to be truly born with it or are just gifted. However, many leaders that were not born with it probably acquired the skills through great mentoring. Maybe they landed in fortunate circumstances or as-
sumed a position that required them to step-up to lead, or maybe people follow them just because they have lots of money (a new take on “follow the money.”) So, what does all this mean to you? Most of our readers are physicians and members of the Bexar County Medical Society. Physician medical school training is almost entirely about medicine and offers very little training in business or leadership. If you accept the premise that there are many kinds of leaders and that physicians can learn the art of leadership, BCMS is setting out to help you become a better leader. BCMS will soon announce ongoing seminars and presentations to promote basic leadership among physicians. The leadership training will be taught by a variety of business and academic leaders mostly from within our community, but also from outside of our community (Luke 4:24 – “No prophet is accepted in his own country” and “The definition of an expert is someone from out of town.”) Dr. Sheldon Gross, the 2018 elected BCMS President, has set a priority of helping physicians to lead. The Bexar County Medical Society wants our physician members to be leaders in their practices, in the community, in a hospital setting, and within organized medicine. Receiving training is definitely a lot more rational approach than making costly mistakes (however, if you are perfect, you are permitted to throw a stone here). If your practice environment is not as successful as you would like it to be, here is an opportunity to analyze, learn and implement leadership-proven techniques. Please read the San Antonio Medicine magazine, The Weekly Dose newsletter and emails we will send for further information about this leadership initiative. “LEAD, FOLLOW OR GET OUT OF THE WAY” As my grandfather used to tell me.
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TRICENTENNIAL
TRICENTENNIAL HEALTH HISTORY SYMPOSIUM Fred H. Olin, M.D. Saturday, May 12, 2018 a symposium entitled “300 Years of History and Advances in Health,” will be held at the UT Health San Antonio School of Medicine. The symposium has been certified by UT Health for five hours credit of Category 1 Continuing Medical Education. Elsewhere in this issue of “San Antonio Medicine” you can find information about pre-registration. There will also be at least one email about the symposium sent out to all members of the Bexar County Medical Society (BCMS) and subscribers to this magazine. The cost will be $50 for everyone except students, who will be admitted for $5. The doors of the Holly Auditorium will open at 7:30 a.m. for a short registration period, and the program will begin at 8 a.m. After opening remarks by Dr. William L. Henrich, president of UT Health San Antonio, Mayor Ron Nirenberg and County Judge Nelson Wolff have indicated that they will also make a few remarks. The Symposium will feature a number of presentations about the history of medical practice in South Texas and San Antonio, from a discussion of Native American medical practices to the present day. Additionally, there will be talks on the histories of the various healthcare facilities and organizations that make up today’s vibrant medical, nursing, dental and related patient care communities in the
On
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San Antonio Medicine • April 2018
city. The impact of military medicine, research, educational institutions, and community and governmental hospitals will be explored and explained by knowledgeable professionals in several disciplines. At approximately noon there will be a break to allow the Symposium to move to Room 304 of the Academic Learning and Teaching Center (ALTC) right next door to the auditorium. A box lunch will be supplied to all registrants at the ALTC. In contrast to the usual set-up of speakers on a stage with the audience in neat rows, Room 304 can seat 280 participants at round, 10-person tables. The attendees will surround the speakers and panelists for the afternoon session, which will end at 2 p.m. The keynote speaker will be former mayor Henry Cisneros, who also served as Secretary of Housing and Urban Development in President Clinton’s cabinet. His topic will be “Health Institutions as the Key to the Future of San Antonio.” Alfonso Chiscano, M.D., a San Antonio cardiothoracic surgeon and BCMS member, conceived the idea for this symposium. In 1992, Dr. Chiscano was the driving force behind a very successful similar undertaking titled “500 Years of Medicine in The New World.” Fred H. Olin, D.V.M., M.D. is a member of the BCMS Communications/Publications Committee.
TRICENTENNIAL
EARLY DAWN OF MEDICINE IN SAN ANTONIO By Jaime Pankowsky, MD, FACS
1521, Hernan Cortez conquered the Aztec empire and gave Spain territories much larger than its own. The colony was named New Spain, but the complete conquest of the country that is now Mexico was not completed until 1541. North of the then conquered lands, were much larger territories that remained mostly unexplored for almost a century. A few “conquistadores” like Coronado and Cabeza de Vaca explored some of those northern vast lands but did not settle them. Their inhabitants were Indians of the Comanche, Karankawa and Choctaw tribes. In 1689, a small contingent of Spanish soldiers came from the province of Coahuila to Texas and left a small garrison here. In 1718, an expedition led by Don Martin de Alarcon came with soldiers and established a permanent colony called San
In
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Antonio de Bexar. In 1731, 30 families from the Canary Islands settled in town. Population: 200 inhabitants. During the ensuing decade, several of the missions were built including San Antonio de Valero, now popularly known as the Alamo. This mission was secularized during the 18th Century and partly abandoned, leaving it in a state of disrepair. By the last quarter of the 18th Century, the population had grown to 3,000 inhabitants. During all those years there is no documentation showing that there was any kind of rational healthcare, other than that provided by Indian shamans and healers. This care consisted of incantations, chants and something described with disgust by a missionary, Father Morfi, of mouth-sucking of wounds and patients’ skin lesions by the mouth of the healer. He also mentioned the application of hot
TRICENTENNIAL coals to the patient’s area of pain or complaint. With the Spanish settlers came also the epidemics that had devastated the indigenous populations of Mexico and Central America: smallpox, measles, cholera and perhaps even bubonic plague. The Spanish governor in the province of Coahuila, concerned mostly about the health of the military forces here, ordered the creation of a hospital for their treatment. An abandoned hall in the Alamo was chosen, and 30 beds were constructed with reeds and bamboo and placed therein. When the first doctor appeared in town around 1805, he requested funds to repair the hospital hall, which was in need An abandoned hall in the Alamo was one of the earliest medical facilities in San Antonio. of a new roof, and the provision of In 1827, a Dr. Webber, associated with the Stephen Austin a pharmacy. colony, was described as providing care to the local population – Dr. Federico Servin (or Zervan in other reports) was the first most of them being Mexican. His treatments consisted mostly trained physician known to practice in San Antonio. He also proof emetics of a Tartaric compound. An air of contempt for them vided a limited amount of medicines from his own stock. He served seeps through the description of those patients in the pages of from 1805 until about 1807 or there abouts. He was in controversy the available record, while they were vomiting and heaving from with the civilian authorities and with many of his patients who perthe treatment. sisted in using their own remedies instead of those prescribed (or During the war of Texas Independence, sold) by the doctor. The authorities favored their local neighbors. several doctors provided care to the fighters Eventually, the doctor quit and left San Antonio. and at least one, Dr. James Grant from EngHe was succeeded by Dr. Jaime de la Garza, who practiced in San land, was killed during the battle for the Antonio from 1808 until 1811. It is not known if he was the Alamo. Other doctors who treated the sick founder or related in anyway to the powerful and famous de la and wounded in the Texas army included: Garza family of Monterrey, Mexico. Dr. de la Garza improved the Dr. Amos Pollard; Dr. Michison, who was conditions in the Alamo hospital and was well respected in the comseverely wounded; Dr. Levy; and Dr. John munity. However, after the revolution for independence, which Cameron, all of whom were praised for their started in 1810, there was political trouble in Texas. Dr. de la Garza Dr. Amos Pollard services. There are no records available dewas jailed in 1811 for being a European (Spaniard). He appealed to scribing if there were any doctors in the Mexican army treating their the governor of Coahuila and he was released after five weeks. But sick and wounded. after that he left San Antonio and did not return. During the years of Texas as an independent republic (1836Mexico gained its independence from Spain in 1821. The his1845), before its annexation as a state by the United States, there torical events from this point until the war for Texas Independwas a great scarcity of doctors in the entire state. Those who did ence in 1836 are too well known to be repeated here. In this practice oftentimes had to travel on horseback for many miles to interval, it appears that from most of this time no physician was see their patients. They had to supply and carry their own mediavailable in San Antonio. The mayor, in a letter to his superiors in cines and surgery was always a daring and gambling event of life Coahuila, lamented that there was no physician closer to the city and death. than 150 leagues. continued on page 16
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TRICENTENNIAL continued from page 15
Dr. Ferdinand Herff attended Medical school in Germany before coming to San Antonio.
After the Mexican-American War, the population of Bexar County increased considerably, reaching 10,000 inhabitants. Of these, according to those records, there were 1,120 AfricanAmerican slaves valued at $676,060 (shame!). Many troops were still stationed in the area and physicians
were still a rare species. Following the abortive revolution of 1848 in Central Europe, a large number of Germans migrated to the United States. Some of them chose Texas as their final destination and established new communities in what are now New Braunfels, Federicksburg and others. Among them there were several physicians who left their mark in Bexar County. Dr. John Gaenslen had the distinction of serving in both armies, Union and Confederate, during the Civil War. The best known in San Antonio was Dr. Ferdinand Herff who practiced for many decades in San Antonio and founded a dynasty of physicians also practicing in this city: Dr. Ferdinand Herff, his son; Dr. John Herff and Dr. August (Auggie) Herff who was an active and practicing surgeon well into the second half of the 20th Century. Dr. Herff senior was born in Darmstaadt city in the old independent German state of Hesse and graduated in Germany before coming to Texas. In 1853, a group of Austin physicians took the initiative for organizing the first Texas Medical Association. San Antonio doctors joined eagerly and one of them, Dr. George Cupples, was elected as one of the officers. The purpose was to unify their voices and actions to promote better care and health for the people of Texas. Dr. Cupples, along with other Bexar physicians, organized the Bexar County Medical Society that same year, the first of its kind in Texas. Dr. Cupples was to enjoy a long and beneficial professional career in San Antonio. Besides being one of the founders and early presidents of the Bexar County Medical Society, Dr. Cupples was instrumental and very active in convincing the city fathers to create a Committee of Health for the city. At that time, San Antonio suffered a number of severe epidemics which caused hundreds of fatalities: smallpox, measles, cholera and dysentery. The Committee 16
San Antonio Medicine • April 2018
of Health (which later on evolved into the Health Department) was charged with the task of improving the hygienic conditions in the streets and eating places, water purification, and most important at that time, vaccination against smallpox in schoolchildren. Dr. Cupples practiced in San Antonio for many years, spanning the better part of the 19th Century. There is a street in the west part of San Antonio that is named after him. After the Civil War, there was another increase in the population of the city, exceeding 30,000 to 40,000 people. All over the world, medical science was making remarkable progress and they came to San Antonio as well as the rest of the Western world: the discoveries of Louis Pasteur on the cause of infectious disease; Robert Koch and other investigators identifying causative agents of infections and the introduction of antisepsis by Lord Liston. This new knowledge required re-evaluation of health care and San Antonio proceeded apace. In 1869, the first Santa Rosa hospital, built and managed by the Sisters of Charity, opened its doors on Military Plaza. Later on it was rebuilt and expanded in its present location at the corner of Houston street and Santa Rosa. The first City Hospital was built in 1886, to be replaced and expanded under the name of the Robert B. Green Hospital. In the years to come, it would become affiliated to the University of Texas for the education and training of medical residents. Today it is one facility of the large city complex of medical facilities that are part of the University of Texas Medical School in San Antonio. This article is but a very brief and compacted history of the evolving history of medicine and healthcare in Bexar County. Much remains to be said and to be written. The facts and data presented here were provided by the well written book by Dr. Pat Nixon “A Century of Medicine in San Antonio.” Unfortunately, it was published in 1936 and much remains to be told since that year that is important in the great advances in medicine and healthcare that have been created and developed in the city since that time. Dr. Jaime Pankowsky is a retired physician and a member of the Communications/Publications Committee of the Bexar County Medical Society.
TRICENTENNIAL
TEXAS ICON was also its First Hospital By David Schulz
ew visiting the Alamo know its distinction as the first hospital in Spanish Texas. Manuel Antonio Cordero y Bustamante, acting governor of Texas, established an infirmary on the site on October 19, 1805 to care of soldiers stationed on the frontier. He wrote his superior: I have provided, without any cost whatever ... the equipment of a partly ruined chamber in the secularized Mission San Antonio de Valero as a military infirmary. I have had it provided with beds made of reeds in order to avoid the dampness of the ground. The patients of all companies or posts who may be sent here will be placed in them under the necessary care of a nurse, a woman to take care of the kitchen and guard of the company of the Alamo which is stationed in that mission.
F
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San Antonio Medicine • April 2018
The infirmary, partially repaired from its deteriorated condition to provide a clean room, occupied an upstairs portion of the old convento or Long Barrack. The area's only physician, a civil servant of the Spanish government, was commissioned to treat all the residents of the county, including the military. The hospital existed throughout the occupation of the Alamo by Spanish troops. In addition to the physician, who was paid 30 pesos a month, there was one nurse, a male, who was paid 12 pesos a month, and a woman to do the cooking for the patients, who was paid 8 pesos a month. The population of San Antonio at that time was approximately 300. Due to the increasing number of patients, the governor had two
TRICENTENNIAL
additional rooms in the Alamo repaired to house more patients and to provide one as a pharmacy. He ordered the purchase of lumber to construct "30 beds fully equipped." This was completed in 1807. In 1809, the hospital instituted the smallpox vaccination for all military and civilian members of the community. It continued as a military infirmary until 1821 when Mexico became a republic and funds were no longer available to maintain the Alamo as a hospital. But armies on campaign must care for their sick and wounded. During the Texas Revolution, the Provisional Government of Texas commissioned a number of doctors to serve as surgeons and following the Battle of BĂŠxar, an infirmary was again established at the Alamo to care for the wounded. At that time, the surgeons were Samuel Stivers and Amos Pollard. The departure of Stivers left Pollard as senior surgeon of the garrison in San Antonio, a post he held during the siege and battle. Surgeon Pollard, who trained at Vermont Academy in Castletown, was not the only doctor at the Alamo. John Purdy Reynolds, who assisted Pollard, studied at Jefferson Medical College in Philadelphia. At least five other members of the garrison had medical training: William D. Howell, Edward F. Mitchasson, John W. Thomson, and John H. Forsyth.
Records indicate that the hospital was located in the second floor of the Long Barrack. (The preceding article is drawn from writings by Dr. Richard Bruce Winders, Director of Education & Curation, Alamo Trust; and Dr. J. L. Waller, Bexar County Medical Society Communications Committee member.) David Schulz is a member of the BCMS Communications/Publications Committee. visit us at www.bcms.org
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TRICENTENNIAL
Changing the World One Life at a Time By Robert Hromas, MD, FACP
we celebrate San Antonio’s Tricentennial – 300 years of history – we have the opportunity to learn more about how the early Spanish settlement in San Antonio influenced the economic and cultural development of our city through today. We can peer into the uniqueness of our culture and how, as a result of being continually reshaped over time, San Antonio has grown and transformed. The city’s continued evolution has certainly benefited medicine, science and health for our community. Today, the bioscience industry for San Antonio exceeds $37 billion dollars. This industry employs more than 1 in every 6 members of the San Antonio workforce and has added nearly 50,000 net new jobs over the past decade fueling growth. UT Health San Antonio and its prestigious Long School of Medicine has been a benefactor of that growth and has demonstrated its own transformational progress and innovation for
As
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medical education, research in the biosciences and patient-centered health care. Serving the region’s only academic health center, UT Health San Antonio is a catalyst for advancements in medicine and the provision of health care, which has brought to market new products for disease management and exceptional outcomes for patients. These advancements have made a significant, direct and positive impact on the communities we serve. As a nationally known hub for science and education, we have been most fortunate to recruit outstanding faculty, researchers, scientists and staff. Over our 50-year history, much like our beloved San Antonio, we too have changed history for the better. There are numerous examples of leading-edge medicine and how UT Health San Antonio is working hard to Make Lives Better – one of them happens to be a device that weighs less than a paperclip, but revolutionized medicine throughout the world.
TRICENTENNIAL Julio Palmaz, MD
The Palmaz Stent
Julio Palmaz, M.D., Ashbel Smith Professor and radiologist at UT Health San Antonio, was named a charter fellow by the National Academy of Inventors for his invention of the Palmaz Stent. The Palmaz Stent is a catheter containing a wire-mesh tube with a balloon that is inserted into clogged arteries in a procedure called angioplasty. The stent remains after the catheter and balloon are removed in order to keep the artery open. A U.S. patent was granted in 1988. Before the stent, the standard of care was major invasive surgery including balloon angioplasty for percutaneous coronary interventional (PCI) procedures and coronary artery bypass grafting (CABG) for surgical bypass of blocked coronary arteries. The concept of balloon angioplasty was described by Dotter and Judkins in 1964, and was first performed by Andreas Gruntzig in 1977. In the 1980s, the prevalence of CABG increased and safety improved. Angioplasty did revolutionize the percutaneous treatment of coronary artery disease, but the outcomes were compromised by re-narrowing and rebound occlusion (or blockage) of the artery, often leading to severe complications including acute myocardial infarction (AMI/heart attack) and the need for emergency coronary artery bypass grafting (CABG). Coronary stents were developed to overcome the restenosis and re-occlusion challenges after balloon angioplasty. The Palmaz Stent was the first balloon-expandable, stainless steel, slotted tube device that could be successfully and consistently deployed across narrowed blood vessels, and became one of the most studied and widely used stents since its introduction in the 1990s. In 1993, two landmark trials, the Belgium Netherlands Stent Arterial Revascularization Therapies Study (BENESTENT) and the North American Stent Restenosis Study (STRESS), demonstrated superiority of the bare metal stents (BMS) over plain old balloon angioplasty (POBA), thus replacing balloon angioplasty and establishing coronary stent implantation as the accepted standard of care for percutaneous coronary intervention (PCI). The use of coronary stents increased exponentially and by 1999
stents were used in nearly 85 percent of PCI procedures. Thanks to the introduction of more successful and less invasive percutaneous coronary interventional (PCI) procedures like stents, the number of CABG is declining from a peak of 519,000 operations in 2000 to an estimated 300,000 cases in 2012. There has also been a similar trend of a paradigm shift in the treatment of peripheral arterial disease from surgical bypass of the occluded arteries to percutaneous interventions due to the introduction of the stent due to its long-term successful outcomes. Since the introduction of the Palmaz Stent, at least 10 million people in the U.S. have undergone coronary or peripheral artery stenting to repair occluded arteries. Today, more than 2 million stents that derive from Dr. Palmaz’s invention are placed in patients annually worldwide. This device is lauded in medicine for its elegance and simplicity as well as for being a model example of bench-to-bedside translational research in medicine. The impact has been incalculable and has stirred the imaginations of untold numbers of researchers and scientists. The stent was recognized in Intellectual Property Worldwide magazine as one of “Ten Patents that Changed the World” in the last century. Dr. Palmaz’s early stent research artifacts are part of the medical collection of the Smithsonian Institution in Washington, D.C. Dr. Palmaz continues his work in developing new vascular devices. We are, indeed, privileged and honored to have him as a member of our community. At UT Health San Antonio, we believe that small observations lead to big ideas from which other innovations and transformations in patient care can be made. We strive to do our very best to make lives better for those we serve. The incidence of heart disease in the community is high, but we are proud and honored to have had such an influence on improving the health of the people in our community and around the world. Dr. Robert Hromas is the Dean of the Long School of Medicine at UT Health San Antonio.
visit us at www.bcms.org
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BUSINESS OF MEDICINE
The Irresistible Rise of Private Equity Real Estate Private equity real estate can deliver a tangible financial return — and preserve capital — even in today’s yield-starved market. By Ari Rastegar
For high net worth investors, these are extraordinary times impacted by disruptive changes to the regulatory and political landscape. Today, CEOs, doctors, attorneys, and other sophisticated investors are exploring new ways to preserve and grow their capital, including adjusting their asset allocations and making strategic moves into alternative investments. In many cases this means getting out of hedge funds and into private equity. In this brave new world, I believe that private equity real estate is worth strong consideration. Private equity real estate can deliver a tangible financial return — and preserve capital — even in today’s yield-starved market. If all else goes wrong, and barring war or a major global disaster, property will continue to exist long after fiat paper money and other traditional investments have imploded or even vanished (anyone for Lehman Brothers, The Royal Bank of Scotland, or Lloyds Bank). The first step in defining a concept such as private equity real estate investment, that might be unfamiliar to some, can often be to explain what it is not. Private equity real estate investment is not to be confused with investing in a publicly traded, or non-traded, REIT (real estate investment trust) vehicle, the most commonly used real estate investment product. Typically, private equity real estate investment refers to pooled funds that are professionally managed and will invest in multiple as22
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sets over a seven to ten-year period. Sometimes the investment period is even shorter. In structure and operations, it mirrors traditional private equity funds whether they be in the oil and gas industry, technology and venture industry, or other asset classes. The scale ranges from smaller end funds of US$10 million to $25 million to the tens of billions of dollars where only institutional investors like endowments, superannuation funds, pension plans, etc., will participate. The proceeds are then managed by a fund and controlled by the general partner (GP), which identifies and executes investment opportunities. The GP is compensated through two primary components. First, is an ongoing management fee calculated as a percentage of assets under management. The management fee is a flat rate and typically can be 2 percent of the total assets under management. In addition, the GP is usually entitled to a share of the fund profits only if the investors achieve a minimum level of investment return, also known as the hurdle rate. This fee is known as carried interest and is calculated as a percentage of the overall net profits, such as 20 percent. The concept of carried interest is to provide additional incentive for the GP to maximize the total fund return. Many of the world’s largest investment names, including Blackstone, Starwood Capital, KKR, The Carlyle Group, Oaktree Capital
BUSINESS OF MEDICINE Management, and others are active in the private equity real estate sector across many different strategies. My own firm, Rastegar Equity Partners, for example specializes in income producing, recession-resilient commercial real estate investments, including self-storage and discount retail investments. According to figures from specialist data provider Preqin, as last year played out, closed-ended funds had record amounts of dry powder (capital committed, but not yet invested) at their disposal. Managers worldwide had some US$239 billion to deploy (at December 2016), up from US$210 billion in 2015. A decade previously, the figure was just US$132 billion. In its 2017 outlook for the sector, Preqin calculates that private equity real estate firms have increased their investment activity rapidly in recent years. Deal flow slowed in 2016, however, impacted by financial market volatility, the Brexit vote for the UK to leave the European Union, concerns over the Chinese economy, and uncertainty in the run up to the US presidential election. Preqin notes that while fund managers are also finding it harder to find attractive opportunities in a crowded market, they still invested more capital in 2016 than they did in 2014. In the conclusion to its own 2017 private equity real estate out-
look, global professional services firm, EY, notes that many markets globally face the prospect of a slowdown in the real estate market. But today’s market has been preceded by low economic growth and therefore lower levels of development in many markets, it adds, than at the height of the last property cycle in 2006. “Should the market turn, we expect a rather softer landing this time around,” writes the professional services firm EY. “So, while there are clearly good reasons for concern — from high pricing and political uncertainty to the future direction of trade winds — the fact that real estate funds now hold record amounts of dry powder is highly positive.” Any turning of the cycle will present many new investment opportunities and with capital to deploy, the global real estate fund market is in a very strong position to capitalize on these. As high net-worth investors continue to seek alternative investments for diversification as well as improvement of their overall investment return profile, my colleagues and I will work to serve and educate them and foster new opportunities for growth. Ari Rastegar is the founder and CEO of Rastegar Equity Partners, a Dallas-based private equity real estate firm.
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BUSINESS OF MEDICINE
FINANCIAL FOCUS Match Short- and Long-Term Goals with the Right Investments By Elizabeth Olney
Not all investments are created equal. Some are better suited for short-term goals, while others can help you build resources for objectives far in the future. As an investor, then, one of your biggest challenges will be to match your short- and long-term goals with the appropriate investment vehicles. How should you proceed?
For starters, identify your short- and long-term goals.
Your shorter-term goals will change throughout your life. When you are starting out in your career, for example, you might aspire to purchase a home in the next three to five years. Later on, though, your biggest short-term objective might be to save enough money for a long tour of Europe – without racking up credit card debt. As for long-term goals, your biggest one likely will be to enjoy a comfortable retirement. But you may well have other long-term plans, too, such as sending your kids to college in 10 or 15 years. After you have a clear sense of your short- and long-term goals, you can choose the right investments to help you meet them. Let’s start with the shorter-term ones. When you’re saving for a down payment on a home or for an expensive European vacation, you want to make sure that a certain amount of money will be available to you at a certain time. Consequently, you may want to avoid stocks or stock-based vehicles, which will constantly fluctuate in price, because you don’t want the value of your investment to be down at the moment you need the money. Instead, for short-term goals, you may want to consider a fixed-income vehicle, such as a bond, which is designed to provide regular interest payments and return your full 24
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principal upon the bond’s maturity (providing the issuer doesn’t default, which, with investment-grade bonds, is generally unlikely). For longer-term goals, such as college for your kids and a comfortable retirement for yourself, it’s a different story. To achieve these goals – and especially for retirement – you generally need to accumulate as much as you can. As a result, you need investments with growth potential, which means you will need to consider stocks and stock-based instruments. As mentioned above, stocks will always fluctuate in value, and they may be worth more or less than your original investment when sold. However, building a portfolio with an investment mix that’s appropriate for your risk tolerance, and that contains a reasonable amount of growth-oriented vehicles, can potentially help you overcome short-term volatility and continue making progress toward your long-term goals. Plus, you have some attractive long-term options available. With a 529 college savings plan, you can save for college and possibly achieve tax benefits, too. And by contributing regularly to your IRA and 401(k) or similar employer-sponsored plan, you can defer taxes while spreading your dollars among a wide range of investments. But there’s one thing all long-term investments have in common: You need patience and discipline to stick with them. So, there you have some ideas on short- and long-term investing. Keeping this distinction in mind when you invest can help boost your confidence that you’re making appropriate moves for all your goals. Elizabeth Olney is a financial advisor with Edward Jones Investments. She can be reached at Elizabeth.olney@edwardjones.com.
FEATURE
SOMETHING TO SAY
The McNay presents 100 Years of African American Art On February 8th, my wife and I were privileged to be present at the opening of an exhibit at the McNay that features a number of pieces of African American art collected by Dr. and Mrs. Harmon W. Kelley, and held by their Harmon and Harriet Kelley Foundation for the Arts. Additionally, there are a few pictures from other collections. It is the museum’s first ever survey of African American art. Running simultaneously in another part of the same gallery is “30 Americans: Rubell Family Collection” which is dedicated to more contemporary African American art. They are each very much worth experiencing, and will be available until May 6th. The Kelleys acquired “Portrait of My Wife” by Horace Pippin when Dr. Kelley was considering buying a Ferrari. They had admired the painting for a long time, and when it came available, Har26
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By Fred Olin, MD
mon had to choose; the car and the painting cost about the same. The portrait is viewable at the McNay, but the Ferrari isn’t. As we walked through the exhibit, there were several pieces that basically stopped me in my tracks. One was Rose Piper’s spooky “The Conjuring Woman,” and another was the evocative “The Night Letter” by Eldzier Cortor. The latter piece has everything I like in portraits; it makes one speculate on the subject’s personality, thoughts or situation. Although the painting is not of a specific person, I looked at it and wondered what message the subject, a young woman, had received that has upset her so. You can see “The Night Letter” on the McNay’s site, www.McNayart.org, by following the links to the exhibit and then on to the “Related Gallery” where only a few of the works hanging are illustrated.
FEATURE
Opposite: Children at Ice Cream Stand 1939 William Henry Johnson This page: Two Rebels 1963 Jacob Lawrence
30 Americans; The Rubell Family Collection
This part of the exhibition covers the last 30 years or so of African American art. One of the centerpieces is a huge painting by Kehinde Wiley. It is titled “Equestrian Portrait of the Count Duke Olivares 2005” and, in my opinion, is another “stop in your tracks” painting. A bit of online research revealed that it carries the same title as a 1636 work by Diego Velázquez and a striking resemblance to an equestrian portrait of Napoleon. Mr. Wiley’s portrait of former President Obama was recently unveiled at the National Portrait Gallery. It shares Wiley’s characteristic complex treatment of the background with many of his other works. One of the first objects you will see if you enter the right side of the Rubell exhibit is a a sculpture by Nick Cave called “Soundsuit01 2008.” I was looking at it from a short distance when my wife and another woman got really close and started exclaiming about the myriads of sorts of fabric and hand work (needlepoint, crocheting, embroidery, etc.) involved in the construction of the figure. Even
I, whose needlework is limited to suturing and sewing on the occasional button, was impressed when I got my nose in close enough. Both of the parts of this combined exhibition include a small vignette sort of setting with a chair and a table on a low platform where a visitor can sit and have his or her picture taken by family or friend. It’s a clever idea that was getting a bit of play the evening we were there. There is also a collection of empty picture frames for you to hold up in front of your face and have your “framed” portrait photographed. A note about Dr. Kelley: In 2011 he was honored with the Bexar County Medical Society’s Golden Asclepius Award for “ A lifetime of distinguished service by a BCMS member to our patients and our profession.” Fred H. Olin, D.V.M., M.D. is a semi-retired orthopaedic surgeon and a member of the BCMS Communications/Publications Committee. visit us at www.bcms.org
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BOOK REVIEW
PAUL THEROUX’s BOOKS Fred H. Olin, M.D.
Author Paul Theroux, Photographer – William Furniss
Every now and then a TV magazine show such as “CBS Sunday Morning” or “20/20” will present what they call an “Appreciation” of some person, often one who has died recently. Now, to the best of my knowledge, as of this writing Paul Theroux hasn’t died, but I’m going to write this anyway. Mr. Theroux has been writing travel books for more than 40 years, and I have been buying and reading them. These are NOT about beaches, cathedrals, castles, museums, sight-seeing or fancy hotels, no, no, no! He decides to take a journey and does it the hard way… on the ground, using railroads and local transit and walking. His first travel book, “The Great Railway Bazaar,” tells about his 1973 trip by rail (mostly) from London to Tokyo, via Istanbul, India, Burma, Vietnam and Japan (as well as places in between) and his return on the Trans-Siberian Express. He describes the various characters he met along the way and tells us what he learns about them. “The Kingdom by the Sea” recounts a walk/ride he took around the periphery of England and Scotland. When asked about the rather acerbic tone of “Kingdom,” he said “No one had written about the British as natives of a foreign country who talk funny, have funny eating habits, wear funny clothes and have recreations and entertainments that seem strange.” A relatively recent travel book, “Ghost Train to the Eastern Star” (2008), is a veritable repeat of the first except now the Soviet Union is gone, so he includes several central Asian republics and China is now open to him. Among the 14 travel books he recounts journeys through Africa (“Dark Star Safari” and “Last Train to Zona Verde”), Latin America (“The Old Patagonian Express”) and the South Pacific (The Happy Isles of Oceania.”) In “Happy Isles” he starts in New Zealand, checks out Australia and then, traveling with a collapsible kayak, visits several of the island nations of the Pacific. In 2015, he published “Deep South,” his first travel book about the U.S., in which he tells about driving from his part-time home in Massachusetts (he mostly lives in Hawaii) down the east coast and across the South. He pretty much avoids big cities and freeways and visits dying small towns, African-American churches, sharecroppers and Grandes Dames, and is both sympathetic and crit28
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BOOK REVIEW ical of what he sees and the folks he deals with. The editor won’t give me enough space in “San Antonio Medicine” to summarize all of the books, so let me give a generalized opinion about the lot: every one is worth reading. Theroux is an observant, gregarious, talkative risktaker. He drops into dingy bars in secondary cities, avoids luxury, eats locally, meets the natives, talks with cops, prostitutes, salesmen, mayors, bartenders and anyone else he comes in contact with. And he observes, observes, observes. He also looks up various famous folks as he travels, and gives insight into their personas. He appreciates beauty, courtesy and honesty, and is bluntly critical of people who don’t come up to his standards. Mr. Theroux does tend to see the world with a somewhat jaundiced eye: There are times when he is downright curmudgeonly, but never uninteresting. In addition to the travel books, he has written a number of novels. I’ve read at least three of them that I can recall: ”The Mosquito Coast,” “Half Moon Street” and “My Secret History.” I enjoyed them all. So, here's my unsolicited advice for you: Check out the San Antonio Public Library, your favorite bookstore, Amazon or wherever and get acquainted with Paul Theroux. Fred H. Olin, M.D. is a semi-retired orthopaedic surgeon who wishes he had two heads, so that he could read more books.
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LEGAL EASE
Can the officer really do that to me? By George F. “Rick” Evans, Jr., General Counsel, BCMS, Evans, Rowe & Holbrook
Ever wonder what rights a police officer really has? Not that you’d challenge an officer, but I bet there are times when you ask yourself what authority does an officer actually have in the event you were pulled over or stopped for questioning. In a prior article, I already addressed your rights in the context of a stop for possible DUI. But, as part of a series of articles on “everyday law,” let’s continue with that theme and discuss things apart from DUI. Can you be ordered out of your car? Short answer: yes. The more complicated answer is that the officer needs just cause to stop you in the first place. Speeding, expired tags, failure to use a turn signal, a broken taillight, etc. are all examples of just cause. Do most officers require drivers to exit the car? Of course not. But, make no mistake, it’s within the officer’s legal right to ask you to do so. If the officer asks you to exit your vehicle, do it. End of story. 30
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Can the officer search your car? Many officers will ask you to search the car. If you give permission, then obviously the officer has the authority to proceed. But what if you don’t want your car searched? What then? Well, the officer may legally conduct a search only if there is “probable cause” you’re involved in some type of criminal or illegal activity. Common examples would be the smell of some drug or the presence of some contraband or illegal or suspicious item in plain view of the officer. Also, if you are arrested for some other reason, the police may impound your car and, as part of that process, are entitled to do an inventory search of it. But, they can’t arrest you as a subterfuge excuse in order to search your car. The basis for your arrest has to be proper in the first place. And being stopped for a routine traffic violation is not a sufficient arrest to justify a search of the car. You have to be arrested for
LEGAL EASE something over and above the traffic violation. So, if you’re stopped for speeding and otherwise have zero reason to cause an officer to be suspicious, he can’t search your car. How long can I be detained? In a nutshell, the Supreme Court has held that you may be detained only the length of time necessary for the officer to reasonably satisfy the purpose of the stop in the first place. You can’t be held for any longer than that. For example, if the officer wants you to stay until he can have a drug sniffing dog check out the car, he’s in the wrong unless he can prove there was reasonable cause to believe there are drugs in the car. Officers may request you to stay but there’s a difference between a request and an order. You need to make sure of the difference and the easiest way to do that is to say “Officer, am I free to go now?” and then get a clear answer to the question. What if I have a gun in my car? Even if you don’t have a concealed carry permit, you’re allowed to have a gun with you in Texas. If it’s a handgun and you don’t have a permit, all that’s required is that it not be in plain view. It has to be in the console or some other place out of sight. Can I be handcuffed? If you have been arrested for a suspected crime, yes, you can be handcuffed at any time. Even if the officer removes the handcuffs, he has the right to put them back on again. However, in the context of a traffic stop, the officer has the right to handcuff you only if he reasonably believes it’s required for the officer’s safety. He can’t handcuff you just for the heck of it because your tail light is out. There needs to be a reasonable justification. The most common one is that the officer has some reason to think his safety may be endangered unless you’re physically restrained. His belief has to be justifiable; not whimsical. Can I be frisked? If the officer has a reasonable belief, based on articulable facts, to detain you, he also has the right to conduct a pat down search to check for weapons IF there’s a reason to suspect you might have a weapon. If the officer actually arrests you (as distinguished from a brief detention), then he certainly may conduct a pat down search. What information do I have to provide an officer? When stopped, even if briefly, you are required to identify yourself. Otherwise, you have the right to remain silent. Totally silent. Is that the smartest move? Probably not, but it’s your right. So, what’s the takeaway: Doesn’t it go without saying that police officers have a difficult enough job, a dangerous enough job, without some lawyer like me telling you how to smart mouth back to them? Oddly enough, the courts (a place super-populated with lawyers) will be the first to step forward and protect the officers rather than smart-mouthed citizens. It’s a difficult balancing act to weigh the civil rights of citizens against the needs of peace officers who must protect the community, and themselves, in a world filled
with bad guys. The courts generally give wide discretion to officers, but it’s not unbridled. Once they put a toe over the line to step on your civil rights (such as by searching your body or your car or home, or by curtailing your freedom) the Courts demand some plausible excuse as to why they did what they did. But, as a general rule, if an officer can articulate a factual, objective reason to justify what they did, it’s probably legal. Once in awhile you’ll run into a bully cop who will try to run roughshod over you. The takeaway message is this. Be polite and be deferential. You don’t have to give permission to a request but first clarify it’s a request rather than a demand. If it’s a demand, do what the officer states. Remember, this stuff is almost always recorded on car and body cams. You can always make a fuss after the fact and challenge the legality of the officer’s actions. But, even in the face of a bully cop, the time to challenge him/her is later; not then. Most importantly, make your teenage kids read this article. If they don’t know already, they need to know that there are times and places to challenge authority but, when stopped by a police officer, discretion is the better part of valor. visit us at www.bcms.org
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OPINION
Children’s Path to
Academic, Economic Success Begins Before Birth By John Menchaca, MD Scientific evidence suggests that a mother's abnormal metabolic state due to obesity can have adverse effects on her offspring's neurodevelopmental outcomes. As a retired pediatrician who had to overcome several obstacles to obtain a medical degree and practice for more than 50 years, I eagerly support the efforts of those strongly advocating for more early childhood education. After reading the thoughtful commentary by Rivard Report Publisher Robert Rivard and the announcement of the upcoming 2018 San Antonio Regional PK-12 Public Education Forum1 , I was pleased to see that people in this city are deeply concerned and willing to talk about the education of our preschoolers, especially those from disadvantaged sectors of our city. However, a child’s path to academic success does not start at birth but at conception. There is now ample scientific evidence that a mother’s abnormal metabolic state2 due to obesity, poor diet, and other environmental factors during the ensuing pregnancy will have a significant adverse effect on her offspring’s neurodevelopmental outcomes, including its cognitive abilities3. The “Western diet” of high sugar, saturated fats, and salt contents — commonly eaten by many of these mothers — is harmful to the developing baby. Mothers should be encouraged to eat better, by way of the food stamp program, if necessary. The period between birth and age 3 merits attention as offsprings of poor, obese mothers are at a distinct educational disadvantage before they even leave the newborn nursery. Prior to these children’s
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enrollment in Pre-K 3 and Pre-K4 classes, low breastfeeding rates, inadequate mothering skills, lack of time spent with babies and toddlers, parents’ inadequate English-language skills, parental absence, and adverse childhood experiences such as domestic abuse or neighborhood violence may contribute to negative outcomes. Far-reaching educational efforts could encourage mothers to increase interaction with their babies and toddlers in order to attune them to learning processes prior to being enrolled in preschool. One such program, Parents As Teachers4, already is achieving impressive results5. This international nonprofit focuses on parent education
OPINION and early development, and its graduates’ offsprings have demonstrated advantages when they enroll in preschool programs later on. Data also shows that down the road, these children have better college achievement rates than non- participants. Beyond inadequate preschool programs, poorly funded public schools, low high school graduation rates, and subpar college readiness rates only add to the equation. With San Antonio’s economic segregation come health and educational disparities. This unacceptable situation will continue unless local thought leaders succeed in convincing policymakers and the general public that San Antonio’s future depends on everyone working together to give our city’s children opportunities to succeed. Think about these outcomes a chain with individual links. I only touched on two links, and every link counts. I look forward to discussing the state of San Antonio’s preschool education at the upcoming forum6 at the Witte Museum on March 6 – the future of our city depends on what we do now to ensure our children can achieve academic and economic success. Dr. John Menchaca is a semi-retired pediatrician and a member of the BCMS Public Health Committee.
RESOURCES
1. www.sanantonioeducationforum.com 2. http://pediatrics.aappublications.org/content/early/2016/ 12/29/peds.2016-1459 3. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528. 13909/abstract 4. https://parentsasteachers.org 5. https://static1.squarespace.com/static/56be46a6b6aa60 dbb45e41a5/t/57f418c6cd0f684b529a13f7/1475614918330/Fac t_Sheet_SchoolReadiness_4_21_ 6. www.sanantonioeducationforum.com
visit us at www.bcms.org
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BCMS NEWS
GENERAL MEMEBERSHIP MEETING The Bexar County Medical Society held a General Membership meeting on February 27 at University Hospital. Members heard a talk on Fatty Liver Disease presented by Dr. Naim Alkhouri with the Texas Liver Institute in San Antonio and earned continuing medical education or CME credits.
Sen. Donna Campbell (right) visits with Dr. Rajam Ramamurthy (left) and Mary Nava, BCMS chief lobbyist.
Texas Senator Donna Campbell is greeted by BCMS President Sheldon Gross, MD, BCMS Executive Director Stephen Fitzer, Dr. Adam Ratner and Dr. Leah Jacobson.
Members enjoy snacks and beverages in the conference room at University Hospital.
Dr. Albert Sanders (center) shows a news article to BCMS President Sheldon Gross, MD, (left) and BCMS President-elect Adam Ratner, MD.
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BCMS NEWS
CIRCLE OF FRIENDS members who supported the society’s General Membership meeting on Feb. 27 included: For questions regarding services, Circle of Friends sponsors or joining our program. Please contact AUGUST TREVINO — Program Director Phone: 210-301-4366, email August.Trevino@bcms.org, www.bcms.org/COf.html Elizabeth Olney with Edward Jones Investments
Jacqueline Clark with Aspect Wealth Management
Brandy Cortinas with Warm Springs Rehabilitation Hospital of San Antonio
Blanca Yantis Rodriguez with Texas Medical Liability Trust (TMLT)
Ari Rastegar with Rastegar Equity Partners
visit us at www.bcms.org
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us. ACCOUNTING FIRMS 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.”
ASSET MANAGEMENT
Avid Wealth Partners (HHHH 10K Platinum Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and well-served by a team that's committed to helping you avidly pursue the future you want, and that's our difference. Eric Kala CFP®, CIMA®, AEP®, CLU®, CRPS® Founder & Wealth Management Advisor Specializing in Investment Management and Fee-Based Financial Planning 210.446.5752 eric.kala@nm.com avidwealthpartners.com “Plan it. Do it. Avid Wealth”
The Mani Johnston Group at UBS (HHH Gold Sponsor) Advice Beyond Investing, Dedicated Client Service Team, 4 decades serving the Bexar County medical community. Specialization in customized asset management and lending services supported by the strength of the UBS Global Bank. Senior Vice President – Wealth Management Senior Portfolio Manager Carol Mani Johnston 210-805-1075 Carol.manijohnston@ubs.com www.ubs.com/team/manijohnston "UBS is honored to be named Best Bank for Wealth Manage-
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ment in North America for 2017 by Euromoney."
ATTORNEYS
Constangy, Brooks, Smith & Prophete (HHH Gold Sponsor) Constangy, Brooks, Smith & Prophete offers a wider lens on workplace law. With 190+ attorneys across 15 states, Constangy is one of the nation’s largest Labor and Employment practices and is nationally recognized for diversity and legal excellence. Partner and Office Head Mark R. Flora 512-382-8800 mflora@constangy.com Partner William E. Hammel 214-646-8625 whammel@constangy.com Senior Counsel John E. Duke 512-382-8800 jduke@constangy.com www.constangy.com “A wider lens on workplace law.”
Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions” Norton Rose Fulbright
(HHH Gold Sponsor) Norton Rose Fulbright is a global law firm. We provide the world’s preeminent corporations and financial institutions with a full business law service. We deliver over 150 lawyers in the US focused on the life sciences and healthcare sector.
Employment & Labor Mario Barrera 210 270 7125 mario.barrera@nortonrosefulbright.com Life Sciences and Healthcare Charles Deacon 210 270 7133 charlie.deacon@nortonrosefulbright.com Real Estate Katherine Tapley 210 270 7191 katherine.tapley@nortonrosefulbright.com www.nortonrosefulbright.com “In 2016, we received a Tier 1 national ranking for healthcare law according to US News & World Report and Best Lawyers”
Strasburger & Price, LLP (HHH Gold Sponsor) Strasburger counsels physician groups, individual doctors, hospitals, and other healthcare providers on a variety of concerns, including business transactions, regulatory compliance, entity formation, reimbursement, employment, estate planning, tax, and litigation. Carrie Douglas 210-250-6017 carrie.douglas@strasburger.com Cynthia Grimes 210-250-6003 cynthia.grimes@strasburger.com Marty Roos 210-250-6161 marty.roos@strasburger.com www.strasburger.com “Your Prescription for the Common & Not-So Common Legal Ailment”
ASSETS ADVISORS/ PRIVATE BANKING
U.S. Trust ( Gold Sponsor) At U.S. Trust, we have a long and rich history of helping clients achieve their own unique objectives. Since 1853, we've been committed to listening, building long-term relationships, and helping individuals and their families realize the opportunities they create for themselves, their children, businesses, communities and future generations. SVP, Private Client Advisor, Certified Wealth Strategist® Christian R. Escamilla
210.865.0287 christian.escamilla@ustrust.com “Life’s better when we’re connected®”
BANKING
Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship 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. Stephanie Dick, Vice PresidentCommercial Banking 210-247-2979 sdick@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com
BBVA Compass (HHH Gold Sponsor) Our healthcare financial team provides customized solutions for you, your business and employees. Global Wealth Management Mary Mahlie 210-370-6029 mary.mahlie@bbvacompass.com www.bbvacompass.com “Working for a better future”
Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY supporting the medical community. Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”
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. Sam Fisher Vice President/Commercial Lender 210-319-3503 samf@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
RBFCU (HHH Gold Sponsor) RBFCU provides special financing options for Physicians, including loans for commercial and residential real estate, construction, vehicle, equipment and more. Novie Allen Business Solutions 210-650-1738 nallen@rbfcu.org www.rbfcu.org
Synergy Federal Credit Union (HHH Gold Sponsor) BCMS members are eligible to join Synergy FCU, a full service financial institution. With high savings rates and low loans rates, Synergy can help you meet your financial goals. Synergy FCU Member Service (210) 345-2222 or info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”
Frost (HH Silver 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.”
BUSINESS CONSULTING Alto Vista Enterprises, LLC (HH Silver Sponsor) We specialize in helping physicians grow their business according to the goals and timeline of the practice. Customized business development strategies are executed by an experienced and dedicated team of consultants. Michal Waechter, Owner (210) 913-4871 MichalWaechter@gmail.com “YOUR goals, YOUR timeline, YOUR success. Let’s grow your practice together”
BUSINESS SERVICES
New York Life Insurance Company (HHH Gold Sponsor) We believe that any great relationship starts with great core values: Attention, Accountability, Appreciation, Adaptability and Attainability Financial Consultant Doug Elley 210-961-9991 dougelley@financialguide.com www.newyorklife.com
CONTRACTORS/BUILDERS /COMMERCIAL
Cambridge Contracting (HHH Gold Sponsor) We are a full service general contracting company that specializes in commercial finishouts and ground up construction. Rusty Hastings Rusty@cambridgesa.com 210-337-3900 www.cambridgesa.com
Beyond helps you take care of your people with a single-source, cloud-based human resources system that is simple yet powerful enough to manage the entire employee life cycle. From online onboarding to certification tracking to payroll processing, manage your people anytime, anywhere. Founding Member Division Sales Director San Antonio and Austin Jeromé Vidlock 972.839.2423 jerome.vidlock@getbeyond.com www.getbeyond.com "Beginning relationships honorably with a clear understanding of what you can expect from us"
FINANCIAL ADVISOR
Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney, Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabetholney "Making Sense of Investing"
FINANCIAL SERVICES
Avid Wealth Partners (HHHH 10K Platinum Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and wellserved by a team that's ommitted to helping you avidly pursue the future you want, and that's our difference. Eric Kala CFP, CIMA, AEP, CLU, CRPS Founder & Wealth Management Advisor Specializing in Investment Management and Fee-Based Financial Planning 210.446.5752 eric.kala@nm.com avidwealthpartners.com “Plan it. Do it. Avid Wealth”
EMPLOYEE MANAGEMENT
Beyond (HHH Gold Sponsor)
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!”
Beyond ( Gold Sponsor) Beyond is a financial technology company offering a suite of business tools including payment processing, employee management (payroll, HR, compliance), lending, and point-of-sale. Beyond demonstrates business ethos with unwavering commitment and delivers results that make a difference. Founding Member Division Sales Director San Antonio and Austin Jeromé Vidlock 972.839.2423 jerome.vidlock@getbeyond.com www.getbeyond.com "Good enough is not nearly enough. We go Beyond!"
Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"
RBFCU (HHH Gold Sponsor) RBFCU Investments Group provides guidance and assistance to help you plan for the future and ensure your finances are ready for each stage of life, (college planning, general investing, retirement or estate planning). Shelly H. Rolf Wealth Management 210-650-1759 srolf@rbfcu.org www.rbfcu.org
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 39
HOSPITALS/ HEALTHCARE SERVICES The Mani Johnston Group at UBS (HHH Gold Sponsor) Advice Beyond Investing, Dedicated Client Service Team, 4 decades serving the Bexar County medical community. Specialization in customized asset management and lending services supported by the strength of the UBS Global Bank. Senior Vice President – Wealth Management Senior Portfolio Manager Carol Mani Johnston 210-805-1075 Carol.manijohnston@ubs.com www.ubs.com/team/manijohnston "UBS is honored to be named Best Bank for Wealth Management in North America for 2017 by Euromoney."
GRADUATE PROGRAMS
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.” Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com
Trinity University (HH Silver Sponsor) The Executive Master’s Program in Healthcare Administration is ranked in the Top 10 programs nationally. A part-time, hybrid-learning program designed for physicians and healthcare managers to pursue a graduate degree while continuing to work full-time. Amer Kaissi, Ph.D. Professor and Executive Program Director 210-999-8132 amer.kaissi@trinity.edu https://new.trinity.edu/academics/departments/health-careadministration
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.”
HEALTHCARE TECHNOLOGY
Network Alliance (HHH Gold Sponsor) We are experts in managed IT services, business phone systems, network security, cloud services and telecom carrier offerings, located in the heart of the medical center at Fredericksburg & Medical Dr. Rod Tanner (210) 870-1951 rtanner@network-alliance.net Carl Lyles (210) 870-1952 clyles@network-alliance.net www.network-alliance.net “Delivering solutions through technology”
RubiconMD (HH Silver Sponsor) RubiconMD enables primary care providers to quickly and easily discuss their e-Consults with top specialists so they can provide better care - improving the patient experience and reducing costs Shang Wang Business Development (845) 709-2719 shang@rubiconmd.com Cyprian Kibuka VP of Business Development (650) 454-9604 cyprian@rubiconmd.com www.rubiconmd.com “Expert Insights. Better Care."
INFORMATION AND TECHNOLOGIES
INSURANCE
SWBC (HHHH 10K Platinum Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus
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San Antonio Medicine • April 2018
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 Mortgage, Kristie Arocha 210-255-0013 karocha@swbc.com SWBC Mortgage www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services
TMA Insurance Trust (HHHH 10K Platinum 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.”
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
INSURANCE/MEDICAL MALPRACTICE
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
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.” MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance. Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) 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
Network Alliance (HHH Gold Sponsor) We are experts in managed IT services, business phone systems, network security, cloud services and telecom carrier offerings, located in the heart of the medical center at Fredericksburg & Medical Dr. Rod Tanner (210) 870-1951 rtanner@network-alliance.net Carl Lyles (210) 870-1952 clyles@network-alliance.net www.network-alliance.net “Delivering solutions through technology”
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY MEDICAL BUSINESS CONSULTING
Progressive Billing (HHH Gold Sponsor) The medical billing professionals at Progressive Billing realize the importance of conducting business with integrity, honesty, and compassion while remaining in compliance with the laws and regulations that govern our operations. Owner – Lettie Cantu 210-363-1735 Lettie@progressivebilling.com Administrator - Richard Hernandez 210-733-1802 richard@progressivebilling.com www.progressivebilling.com "We provide quality, professionalism and results for your practice."
MEDICAL BILLING AND COLLECTIONS SERVICES
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.”
PAYROLL SERVICES
SWBC (HHHH 10K Platinum 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. Kristine Edge, Sales Manager 830-980-1207 Kedge@swbc.com Working together to help our clients achieve their business objectives.
sandy@rastegarep.com www.rastegarep.com
PROFESSIONAL ORGANIZATIONS The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, non-profit, R&D, healthcare delivery, professional services and more! President, Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Program Coordinator Valerie Rogler 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”
REAL ESTATE SERVICES COMMERCIAL
PRACTICE CONSULTANTS Progressive Billing (HHH Gold Sponsor) The medical billing professionals at Progressive Billing realize the importance of conducting business with integrity, honesty, and compassion while remaining in compliance with the laws and regulations that govern our operations. Owner – Lettie Cantu 210-363-1735 Lettie@progressivebilling.com Administrator - Richard Hernandez 210-733-1802 richard@progressivebilling.com www.progressivebilling.com "We provide quality, professionalism and results for your practice." 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 (HHH Gold 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
New York Life Insurance Company (HHH Gold Sponsor) Our Goal, increase patient & employee satisfaction, generate more free time for practitioners and mitigate both business and personal financial risk. (No Cost Financial and Business consulting including HIPAA audit evaluations, BCMS members only). Doug Elley 210-961-9991 dougelley@financialguide.com www.newyorklife.com “20+ years helping Physicians to increase practice profits and efficiencies, reduce operations stress”
PRIVATE EQUITY
Rastegar Equity Partners (HHHH 10K Platinum Sponsor) Rastegar Equity Partners is a Private Equity Commercial Real Estate Investment Firm. Rastegar focuses on building portfolios to generate above market current income along with long-term capital appreciation. Kellie Rastegar 818-800-4901 kellie@rastegarep.com Ari Rastegar 917-703-5027 ari@rastegarep.com Sandy Fliderman 646-854-9996
STAFFING SERVICES
Rastegar Equity Partners (HHHH 10K Platinum Sponsor) Rastegar Equity Partners is a Private Equity Commercial Real Estate Investment Firm. Rastegar focuses on building portfolios to generate above market current income along with long-term capital appreciation. Kellie Rastegar 818-800-4901 kellie@rastegarep.com Ari Rastegar 917-703-5027 ari@rastegarep.com Sandy Fliderman 646-854-9996 sandy@rastegarep.com www.rastegarep.com
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 resortquality 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 (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 “Favorite Healthcare Staffing offers preferred pricing for BCMS members.” United States Air Force (HH Silver Sponsor) As a doctor in the USAF you can practice medicine without the red tape of managing your own practice. Our doctors are free from bureaucracy and paperwork and can focus on treating their patients Physician Recruiter MSgt Robert Isarraraz Robert.isarraraz@us.af.mil 210-727-5677 www.airforce.com/careers/ "Caring For Those Protecting The Nation"
TOXICOLOGY LABORATORY TESTING
Diagnostic Solutions, LLC (HHH Gold Sponsor) Partnering with Diagnostic Solutions allows providers to incorporate the industry’s best practices into drug compliance testing and clinical decision-making with accurate and timely results for UDT quantitation and identification. Jana Raschbaum, MBA, BSN, RN 210-478-6633 janelleraschbaum@gmail.com Donald Nelson, MD 928-529-5110 dhnelson@citilink.net www.trustedtox.com For questions regarding services, Circle of Friends sponsors or Joining our program. Please contact August Trevino program director: Phone: 210-301-4366, email August.Trevino@bcms.org, www.bcms.org/COf.html
visit www.bcms.org 41 41 visit usus atatwww.bcms.org
RECOMMENDED AUTO DEALERS AUTO PROGRAM
• • • •
We will locate the vehicle at the best price, right down to the color and equipment. We will put you in touch with exactly the right person at the dealership to handle your transaction. We will arrange for a test drive at your home or office. We make the buying process easy! When you go to the dealership, speak only with the representative indicated by BCMS. GUNN AUTO GROUP
Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230 Cary Wright 210-558-1500
Ancira Buick, GMC San Antonio, TX Jude Fowler 210-681-4900
Ancira Chevrolet 6111 Bandera Road San Antonio, TX
Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX
GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154
Jude Fowler 210-681-4900
Esther Luna 210-690-0700
Bill Boyd 210-859-2719
GUNN AUTO GROUP
GUNN AUTO GROUP
GUNN AUTO GROUP
GUNN Honda 14610 IH 10 W San Antonio, TX
GUNN Acura 11911 IH 10 W San Antonio, TX
GUNN Nissan 750 NE Loop 410 San Antonio, TX 78209
Pete DeNeergard 210-680-3371
Coby Allen 210-625-4988
Abe Novy 210-496-0806
Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216
Cavender Audi 15447 IH 10 W San Antonio, TX 78249
David Espinoza 210-912-5087
Sean Fortier 210-681-3399 KAHLIG AUTO GROUP
Cavender Toyota 5730 NW Loop 410 San Antonio, TX
Northside Ford 12300 San Pedro San Antonio, TX
Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX
Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX
North Park Subaru 9807 San Pedro San Antonio, TX 78216
Gary Holdgraf 210-862-9769
Wayne Alderman 210-525-9800
William Taylor 210-366-9600
James Godkin 830-981-6000
Mark Castello 210-308-0200
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
North Park Mazda 9333 San Pedro San Antonio, TX 78216
North Park Lexus 611 Lockhill Selma San Antonio, TX
North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX
North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211
Scott Brothers 210-253-3300
North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257
Jose Contreras 210-308-8900
Justin Blake 888-341-2182
Stephen Markham 877-356-0476
Justin Boone 210-635-5000
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
North Park Lincoln 9207 San Pedro San Antonio, TX
North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257
13660 IH-10 West (@UTSA Blvd.) San Antonio, TX
Porsche Center 9455 IH-10 West San Antonio, TX
Barrett Jaguar 15423 IH-10 West San Antonio, TX
Sandy Small 210-341-8841
James Cole 800-611-0176
Ed Noriega 210-561-4900
Matt Hokenson 210-764-6945
Dale Haines 210-341-2800
15423 IH-10 West San Antonio, TX Dale Haines 210-341-2800
Land Rover of San Antonio
AUTO PROGRAM
Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org
visit us at www.bcms.org
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AUTO REVIEW
2018 Porsche 911 The automotive world is changing in fundamental ways. In 30 years automobiles, assuming they’re still here, will look much more different from today’s than today’s do from the ones we drove 30 years ago. Autonomy, electrification, and urbanization will change everything. I don’t want to talk about any of that. Instead I’ll give you this challenge: name a vehicle that is, in its essence, the same as it was 50 years ago but has nevertheless evolved significantly, continues to delight its owners, and is so entrenched in our collective psyches that we can’t imagine a world without it. I thought of three: the Ford Fseries pickup, Jeep Wrangler, and Porsche 911. I had the chance to drive a new 911 recently and was impressed. Fast, luxurious, and distinctive, Porsche’s icon instantly reminds you why it resonates in 2018 as much as it did in 1963 when it was first introduced. A quick aside: the 911 was scheduled to be discontinued in the early 1980s, but the new CEO who took over in 1981, Peter Schutz (no relation), decided to save it. In saving that car, he probably saved 44
San Antonio Medicine • April 2018
By Stephen Schutz, MD
the company. Regrettably Mr. Schutz died a few months ago. While much larger and sleeker than its 55 year old predecessor, the 2018 911, known internally as the 991.2, could never be mistaken for any other car. The pinched tail, sloping rear roofline, and drooping hood framed by fenders that connect to round headlights are all styling elements that have been retained over the years. Well-heeled customers of today demand maximum safety, luxury, and performance, so the newest 911 is wider and longer than it was back in the day — larger crumple zones, less twitchy handling, and additional passenger/luggage space – heavier – ain’t nothing for free – and more expensive – ditto. The interior has been similarly transformed with modern materials, gauges, and controls. While the updated interfaces are more contemporary than the previous (991.1) generation, they’re still behind much of the competition and even the current Porsche Panamera. Like many luxury vehicles, the 911 uses a modern touch screen to control many functions such as the sat nav, climate, and audio, but
AUTO REVIEW
there are still too many buttons for my taste. I appreciate that you can do so much on that screen with just a quick glance and a touch, and that you can zoom in and out with your fingers just like you can on a smartphone. But it’s discouraging that options that many customers will skip – think sports exhaust and sunroof – have reserved space on the center console, so that if you don’t order them a blank place sits there reminding you that you’re kind of a cheap skate (which you’re not since you bought a car that starts at around $90,000 without options). Driving the 2018 911 is a lot like driving the 991.1, which might seem obvious since they’re almost identical visually, but isn’t because all non-GT 991.2 911s now have turbocharged engines. That’s right, the 911 Turbo is turbocharged (duh), but now so are all of the Carreras. Confused? Join the club, but presumably Porsche thought that the 911 Turbo was so established as their performance pinnacle that they couldn’t change its name. Whatever. Anyway, one of the hallmarks of driving a 911 is its linear throttle response, which is not what turbocharged engines are known for. And yet the Carrera 4 I drove had no discernible turbo lag and a very linear throttle response. In fact, the only difference between the 2018 model and the 2015 car I tested earlier was more low-end torque in the newer model. It even sounds the same. Interestingly, while the engine sounds you hear inside the cabin are very 991.1-ish, a loud turbo whistle can be heard if you roll down the windows. (2018 Carrera and Carrera S models come with twin-turbo 3.0L boxer engines that make 370HP and 420HP, respectively.) The dangerous off-throttle snap oversteer that early 911s were notorious for was engineered out many years ago, so driving quickly over your favorite road now is a lesson in how well an engine, transmission, and suspension can collaborate to help you go fast and feel good. No, driving the newest 911 isn’t as magical as it was in the late 1990s when the great 993 carried the 911 flag, but it’s still very, very good. Buying any Porsche will test your restraint as there are many options available. This is a Hall of Fame car, but sitting down in front of the
online configurator with a glass of Cabernet is not recommended. As we enter the age of autonomous transportation, it’s worth taking a moment to appreciate cars like the Porsche 911 which have enriched our lives for decades. Maybe let the millennials have the autonomous drone pods while the rest of us enjoy the act of driving. Despite all of its hassles, it’s still a pretty great thing to do. If you’re in the market for this kind of vehicle, call Phil Hornbeak at 210-301-4367. Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. visit www.bcms.org 45 45 visit us us at at www.bcms.org
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
Renal Associates of San Antonio, PA San Antonio Eye Center, PA San Antonio Gastroenterology Associates, PA San Antonio Infectious Diseases Consultants 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 The San Antonio Orthopaedic Group Urology San Antonio, PA WellMed Medical Management Inc.
Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of March 22, 2018.
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San Antonio Medicine • April 2018