To learn more visit www.mcmsonline.com
IN EVERY ISSUE 4 what’s inside 8 president’s page 36 marketplace
Celebrating 60 Years
- 015 1955 2
round-up Volume 61 • Number 10 • October/November 2015
Providing news and information for the medical community since 1955.
HEALTHCARE IS ON THE MOVE. A CONVERSATION WITH DR. RANDAL 16. CHRISTENSEN, PAGE 14. 10 Understanding addiction to prescription medication triggered by chronic pain. 20 Domestic violence: A community health crisis.
24 Corporations doing good things for good people. 29 Should Arizona consider a Death With Dignity law?
30 A physician’s perspective as a patient: Why I would support a Death With Dignity bill. 32 The ACT Kids Health Fair 2015. A picture says a thousand words.
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In this issue – October 2015:
COMMUNITY By Jay Conyers, PhD
MCMS Executive Director Jay Conyers, PhD firstname.lastname@example.org 602-251-2361
ommunity has many meanings in medicine. Some old, some new. Throughout our nation’s history, no community has been considered ‘complete’ without access to a physician, and many communities have made medical accessibility a pillar of what they provide to their residents. Long ago, it was one physician per community, or a few if the community was large, but today, it’s extensive networks of physicians, clinics, and hospitals that provide care for a community. For the most part, long gone are the days of a single physicians providing all the care needs of a community – from cradle to grave, literally. As communities have evolved, and as technology has become pervasive throughout our lives, so have the roles of physicians in communities. Many medical schools today now recognize Community Medicine as a new paradigm in medicine, and staff entire departments with course offerings in this new ‘sub specialty’ of medicine. Some see it as the interplay amongst public health, preventive medicine, family medicine, and patient empowerment. Some see social media and the internet really as the driving force behind community medicine.
4 • Round-up Magazine • October/November 2015
whatâ€™s inside? But with population growth and technology, has the physicianâ€™s role in the community changed? With so many others now involved in healthcare decision making â€“ employers, payers, hospital administrators â€“ perhaps, yes. But does this mean that a physicianâ€™s role in the community no longer exists, or has been diminished to a point of insignificance?
Community can also mean a physicianâ€™s role outside of what he or she does professionally. It can mean how a physician volunteers throughout the community or might serve on a board of a local non-profit. The point is, community can mean many things and can describe numerous activities in which a physician may be involved. In this issue, we tried to capture some of the diversity of what community really means.
This month, we profile pediatrician Dr. Randy Christensen who administers to those most in need; an author of a book sure to tug at your heartstrings; and devout family man. Dr. Christensen, Medical Director of the Crewsâ€™n Healthmobile, has been caring for our communityâ€™s homeless teens and young adults since the mobile clinic rolled out of the parking lot in 1999. We hope you enjoy learning more about Dr. Christensenâ€™s role in our community.
We also have other great articles that touch on community, including one on the growing health crisis of domestic violence. In honor of Domestic Violence Awareness Month, we asked one of the valleyâ€™s leading crisis centers, Chrysalis, to write about the physical and emotional impact of domestic violence and offer some tips for how physicians can help those in need. We also have a wonderful article on com-
munity resources available for those addicted to pain medication, written by Michel Sucher, MD, Chief Medical Officer of Community Bridges, Inc., a local non-profit organization offering medically integrated behavioral health programs for more than three decades. And lastly, we have a great article from Bronwyn Medley, Vice President & Chief Marketing Officer at the Arizona Central Credit Union, one of the Societyâ€™s preferred business partners, on how organizations â€“ large and small â€“ can give back to the community. They provide numerous ways for their employees to be actively involved in community activities. Next month, we bring you our membership issue. We discuss what it means to be a MCMS member and why membership in a physician organization like MCMS is so vital in protecting the profession of medicine. We will profile Paul Jarrett, MD, our longest tenured member of the Society. Dr. Jarrett will turn 97 in February and has been an active member of the Society since 1946.
He enjoyed a decades long career as a local clinician, first as surgeon in a solo practice and later as a pathologist (yes, he completed a pathology residency after nearly thirty years of practice as a surgeon!). Dr. Jarrettâ€™s continued activity with the Society truly embodies the spirit of what it means to be a member, and weâ€™re sure youâ€™ll enjoy reading about him.
And it was great to see so many of you at the Annual Event this year, held on October 23rd at El Chorro. In addition to our long-standing members, we saw a lot of new faces in the crowd of attendees. Attendance increased 12% over last year, and we hope to continue growing the event each year. The great turnout truly speaks to our community of physicians and their love of medicine. So pencil in next yearâ€™s event for the middle of next October, and we hope to see you there. But until then, weâ€™ll have numerous events throughout 2016, the first, â€œBeers with Peers,â€? a mentorship event sponsored by MICA on January 28, 2016 in the Society courtyard. Invitations and event details coming soon. We hope to see you there! ru
Unscript is a unique program developed by Community Bridges, /ĹśÄ?Í˜Íž/ÍżĆšĹ˝Ä‚ÄšÄšĆŒÄžĆ?Ć?Ä‚ĹśÄšĆšĆŒÄžÄ‚ĆšĆšĹšÄžĹśÄ‚Ć&#x;Ĺ˝ĹśÄ‚ĹŻÄžĆ‰Ĺ?ÄšÄžĹľĹ?Ä?Ĺ˝Ä¨Ć‰ĆŒÄžĆ?Ä?ĆŒĹ?Ć‰Ć&#x;Ĺ˝Ĺś Ć‰Ä‚Ĺ?Ĺś ĹľÄžÄšĹ?Ä?Ä‚Ć&#x;Ĺ˝Ĺś Ä‚ÄšÄšĹ?Ä?Ć&#x;Ĺ˝ĹśÍ˜ / ĆŒÄžÄ?Ĺ˝Ĺ?ĹśĹ?ÇŒÄžĆ? Ĺ˝Ć‰Ĺ?Ĺ˝Ĺ?Äš Ä‚ÄšÄšĹ?Ä?Ć&#x;Ĺ˝Ĺś Ĺ˝ĹŒÄžĹś Ä?ÄžĹ?Ĺ?ĹśĆ? Ç Ĺ?ĆšĹš ĹŻÄžĹ?Ĺ?Ć&#x;ĹľÄ‚ĆšÄž DÄžÄšĹ?Ä?Ä‚ĹŻ Ć?Ć?Ĺ?Ć?ĆšÄžÄš dĆŒÄžÄ‚ĆšĹľÄžĹśĆš ÍžDdÍżÍ• ĆšĹšÄžĹś Ć‰ĆŒĹ˝Ĺ?ĆŒÄžĆ?Ć?ÄžĆ? ĆšĹ˝ ĹšĹ?Ĺ?ĹšÄžĆŒ ÄšĹ˝Ć?ÄžĆ? Ĺ˝Ä¨ Ć‰Ä‚Ĺ?Ĺś ĹľÄžÄšĹ?Ä?Ä‚Ć&#x;Ĺ˝ĹśÍ• ĹŻÄžÄ‚ÄšĹ?ĹśĹ? ĆšĹ˝ ĆľĹśĹ?ĹśĆšÄžĹśĆ&#x;Ĺ˝ĹśÄ‚ĹŻÄ‚ÄšÄšĹ?Ä?Ć&#x;Ĺ˝ĹśÍ˜hĹśĆ?Ä?ĆŒĹ?Ć‰ĆšĹ?Ć?Ć‰ĆŒĹ?ĹľÄ‚ĆŒĹ?ĹŻÇ‡Ä‚Ć‰ĹšÇ‡Ć?Ĺ?Ä?Ĺ?Ä‚ĹśÄšĹ?ĆŒÄžÄ?ĆšÄžÄš ĹľÄžÄšĹ?Ä?Ä‚ĹŻĆ‰ĆŒĹ˝Ĺ?ĆŒÄ‚ĹľÇ Ĺ?ĆšĹšÄžÄšĆľÄ?Ä‚Ć&#x;Ĺ˝ĹśÄ‚ĹŻÄ‚ĹśÄšÄ?ÄžĹšÄ‚Ç€Ĺ?Ĺ˝ĆŒÄ‚ĹŻÄ?Ĺ˝ĹľĆ‰Ĺ˝ĹśÄžĹśĆšĆ?Í˜ĆŒÍ˜ DĹ?Ä?ĹšÄžĹŻ^ĆľÄ?ĹšÄžĆŒÍ•hĹśĆ?Ä?ĆŒĹ?Ć‰ĆšÍ›Ć?Ć‰ĆŒĹ˝Ĺ?ĆŒÄ‚ĹľÄšĹ?ĆŒÄžÄ?ĆšĹ˝ĆŒÍ•Ä‚ĹśÄš/Í›Ć?ĹšĹ?ÄžÄ¨DÄžÄšĹ?Ä?Ä‚ĹŻ KÄ¸Ä?ÄžĆŒÍ•ĹšÄ‚Ć?Ä?ÄžÄžĹśÄ‚ĹŻÄžÄ‚ÄšÄžĆŒĹ?ĹśĆšĹšÄžÄŽÄžĹŻÄšĆ?Ĺ˝Ä¨ÄšÄšĹ?Ä?Ć&#x;Ĺ˝ĹśÄ‚ĹśÄšĹľÄžĆŒĹ?ÄžĹśÄ?Ç‡ ĹľÄžÄšĹ?Ä?Ĺ?ĹśÄžÄ¨Ĺ˝ĆŒĹľĹ˝ĆŒÄžĆšĹšÄ‚ĹśĎŽĎŹÇ‡ÄžÄ‚ĆŒĆ?Í˜
Round-up Magazine â€˘ October/November 2015 â€˘ 5
Providing news and information for physicians and the healthcare community since 1955. Published monthly by the Maricopa County Medical Society.
addiction treatment Bridges to recovery: understanding addiction to prescription medication triggered by chronic pain.
member profile Healthcare is on the move. A conversation with Dr. Randal Christensen.
corporate volunteering Giving back: corporations doing good things for good people.
president’s page Lifting where we stand: physicians are an influence for good and hope in our communities.
hot topic Should Arizona consider a Death With Dignity law?
viewpoint A physician's perspective as a patient: why I would support a Death With Dignity bill.
act kids health fair 2015 A picture says a thousand words.
marketplace: classified ads
domestic violence A community health crisis.
On the cover: Dr. Randal Christensen and his wife, pediatrician Amy E. Christensen, MD. Cover photo by: Denny Collins Photography / www.dennycollins.com / 602-448-2437. ACT Kids Health Fair photos by: Paulson Photo/Graphic / email@example.com / 602-230-1550 Connect with your Society. Letters and electronic correspondence will become the property of Round-up, which assumes permission to publish and edit as necessary. Please refer to our usage statement for more information. Editor: Ryan Stratford, MD, MBA / firstname.lastname@example.org. Managing Editor: Jay Conyers, PhD / email@example.com. 6 • Round-up Magazine • October/November 2015
MCMS 2015 Officers
Editor-in-Chief Ryan R. Stratford, MD, MBA
Editor Jay Conyers, PhD
Advertising, Design and Production Candice Scheibel
Contributing Writer Dominique Perkins
Ryan R. Stratford, MD, MBA Adam M. Brodsky, MD
Secretary Kelly Hsu, MD Treasurer Mark R. Wallace, MD
To obtain information on advertising in Round-up, contact MCMS.
Immediate Past-President Miriam K. Anand, MD Board of Directors 2013-2015
R. Jay Standerfer, MD
Send address changes to: Round-up, 326 E. Coronado Rd., Phoenix, AZ 85004
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Shane Daley, MD Anthony Lee, MD 2014-2016 Lee Ann Kelley, MD May Mohty, MD Richard Manch, MD
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Volume 61, No. 10 October/November 2015.
Round-up (USPS 020-150) is published 12 times per year by the Maricopa County Medical Society, 326 E. Coronado, Phoenix, AZ 85004.
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To subscribe to Round-up Magazine please send a check for one-year subscription of $50 to: Round-up Magazine 326 E. Coronado Rd. Phoenix, AZ 85004
60 Years - 015 1955 2
John L. Couvaras, MD
phone: 602-252-2015 firstname.lastname@example.org
Ross Goldberg, MD Tanja L. Gunsberger, DO Marc M. Lato, MD
Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at email@example.com. All solicited and unsolicited written materials and photos submitted to Round-up will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned. The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Round-up considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content. Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission. No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.
Round-up Magazine • October/November 2015 • 7
LIFTING WHERE WE STAND: Physicians Are an Influence for Good and Hope in Our Communities By Ryan R. Stratford, MD, MBA MCMS President 2015 Ryan Stratford, MD, MBA Dr. Stratford specializes in Urogynecology/Pelvic Reconstructive Surgery. He joined MCMS in 2005. Contact Information: The Woman's Center for Advanced Pelvic Surgery 4344 E. Presidio Street Mesa, AZ 85215 www.TheWomansCenter.com P: 480-834-5111 E: firstname.lastname@example.org
e all live in a community. Most of us have neighbors and know the people who live near us. We have a work community of associates and colleagues who we see almost every day. We interact in other communities, giving our time and energy, such as church, athletic, hospital, and social communities. We are citizens of a national community and we are members of a worldwide community. As physicians, we have been taught to be outward focused – active participants in the communities we live in. How we interact and what we do in our community in many respects defines who we are. I am in awe of people who devote their time to serve others in their community. In May, I participated in one of the most enjoyable medical meetings I have attend in the past decade. The Maricopa County Medical Society’s Philanthropy Committee hosted a “Philanthropy in Medicine” event in the courtyard at the Society. Dr. Candace Lew, an Ob/Gyn who chose to retire from daily practice, go back to school at John’s Hopkins to pursue a degree in public health, and spend most of her time working on public health projects around the globe, spoke to us about how she got involved and what she has learned from people around the world through intimate interactions working with them.
8 • Round-up Magazine • October/November 2015
president’s page Dr. Randal Christensen, a pediatrician, spoke to us about his experiences providing medical care to underserved youth in the Phoenix area. He is the founder of Crews’ in Healthmobile, a mobile pediatric clinic that travels throughout Phoenix to undeserved youth (and our member spotlight this month in Round-up). His stories about the realities of health needs among youth were heart wrenching, but I was extremely impressed with the enormous hope I felt listening to him.
Dr. David Beyda, previous chief of the pediatric ICU at Phoenix Children’s and current Medical Director of Medical Mercy, One Child Matters, spoke to us about his experiences in remote locations throughout the world where a small “SWAT” teams of healthcare professionals insert themselves to care for people who have no access to care and little interaction with the outside world. Like Drs. Lew and Christensen, his message was a powerful message of hope.
Something exciting resonated with me at the event and I could sense that nearly all of the attendees shared very similar feelings. It was a cool night with a light breeze moving through the courtyard. The large screen projecting photos of people that were helped by these three physicians captured our attention. The outdoor surroundings of the event reminded us that we were all direct participants in our environment and in our communities. It was a magical night for me because I was reminded of how lucky I am to be a physician and the opportunity it provides me to spread hope to people in my community, whether it be in my immediate community or worldwide community.
I may be biased to the excitement and joys of medical service because I chose medicine largely due to my desires to provide free medical service. As an undergraduate, studying business, I struggled to jump headfirst into a business career that had as its premise the fact that everyone acts entirely in his or her own self-interest. Capitalism, based on this premise, has been the most fruitful and prosperous social system this world has known. Many other social experiments have tried to make people better off: fascism, communism, egalitarianism, socialism, and others, but none have succeeded like capitalism. Despite the reality of the success of capitalism, I struggled pursuing a career that required that I focus entirely on the self-interests of a firm or business. I had just spent two years deferring all my own self-interests and feeling more happy and fulfilled than ever before in my life as a Mormon missionary in Chile. So, I decided to forgo business and find a different career.
Medicine landed in my lap and I dove right in to prepare myself to be a physician. Later, while in medical school, I chose to go back to business school so that I could find ways to align incentives and provide funding for physicians to give their time in free medical service. I set up a free pediatric clinic on the south side of Chicago in the first floor of one of the housing projects. I made plans for future service to countries in need and began formulating plans on how to organize and fund such projects. All of my grand plans have not yet come to fruition, but I feel energized when I see and hear people like Drs. Lew, Christensen and Beyda.
We all have opportunities to broaden our influence in helping within our own communities, and it does not have to be within medicine only. My son, who needed to find a community program at which he could provide service to meet his scouting requirements, discovered a small program that puts together life-saving food packets for people who are starving throughout the world, called Feed My Starving Children. As a father of a family of five young children, we have volunteered many times at the facility. Each time, the children are excited to go back. There is something bonding about doing service together and doing it because we want to, without coercion (something our children may feel is not reflective of their service at home). Opportunities to reach out to our community can include involvement in advocacy, public service, or in supporting causes we feel will improve our communities. It could be in church service, in service at our local schools, or in giving our time to volunteer in medical societies or communities. Whatever the extent we willingly give of our time, we are always abundantly rewarded. It is my hope that we each recognize the valuable and powerful influence we have and can have as we look to our individual communities. The sky is the limit and the rewards are innumerable. I encourage each of us to consider how we can participate in our communities and then decide today to do something, no matter how small.
I admire what each of you do as physicians, not because you are bright and capable of helping others in ways that no one else can, but because something inside you drove you to choose a career of service, a career where you willingly put the needs of others ahead of your own. Because of who you are, I know that with very little encouragement, you are driven to help in your community. Let’s all agree to lift where we stand and be an influence for good and hope in our communities. ru
Round-up Magazine • October/November 2015 • 9
Bridges to Recovery: Understanding Addiction to Prescription Medication Triggered by Chronic Pain By Michel Sucher, MD Addiction to painkillers as well as other prescription drugs is a national epidemic. The occurrences today are so prevalent they touch each of us in some form or another – whether through a loved one, our patients or even ourselves. The growth in the use of prescribed pain relievers has resulted in a widespread epidemic of prescription drug misuse and addiction among people of all ages, posing an even larger addiction problem than their illegal counterparts. As an emergency physician in Arizona for more than 20 years before specializing in the field of addiction medicine, I treated my share of critical incidents arising from drug-related trauma, drug interactions and overdoses. I now lecture extensively to medical groups across the country on how the addiction situation has evolved and where we are at today in the treatment of prescription medicine addiction, especially focusing on what many consider to be the most dangerous area – narcotic painkillers. Most physicians recognize that we have essentially become a society of painkillers-on-demand, and it’s resulted in unintentional addiction for people who have an underlying medical condition causing them chronic pain. At Community Bridges, we have made significant advances in this area of treatment. We recognized a number of years ago that we were seeing an increase in prescription drug addiction where many people had some injury or illness that caused chronic pain, triggering their addiction disorder. CBI developed a comprehensive approach to unintentional addiction, recognizing that addiction is a primary disease and that all substances and behaviors associated with addiction are addressed in treatment. 10 • Round-up Magazine • October/November 2015
addiction treatment Pain medication historically was prescribed to treat acute medical situations often resulting from some sort of trauma or medical condition. Early in my career as an emergency physician, if we prescribed 60 mg. per day of Oxycodone for a broken arm or sprained ankle, it was considered a very high dose.
The synthetic painkillers of today are much more potent than the formulations of several years ago. There are many more options within the formulations, and there is a constant flood of newer drugs that are contributing to the increasing numbers of narcotics. Pharmaceutical companies are developing new variants all the time – long acting, slow acting, with or without acetaminophen, etc. In the past five to eight years, prescription painkiller medication has grown in strength and potency, and dosages once considered very high are now a fraction of common current regimens. At today’s typically prescribed dosages, patients can easily become addicted in as little as 10 days, all while following label directions. Prevention is the key to combating substance abuse. While patients are trained to trust that their physicians are fully informed about the impact of drugs we are prescribing, it’s often not the case. Once patients become addicted, they often seek continued or recurring prescriptions to ease their pain. Many physicians, in an effort to relieve the symptoms, are persuaded to comply with these requests. Even following medical guidelines, it’s often not physicians or even patients who first recognize that something is off. Very often it’s the families, especially children, who are most sensitive to odd behaviors in their parents, grandparents or even siblings.
As I mentioned above, early in my career I observed 60 mg. per day of Oxycodone was a high dose, but today we commonly see people who are on a 160 mg. of a long-acting Oxycodone dose three times a day, plus additional painkillers for breakthrough. Today, people are often taking 10 times the doses that we used to consider high even a few years ago.
For many years, pain has been considered “the fifth vital sign” along with blood pressure, pulse, temperature and respiration. We ask patients to rate their pain from 1 to 10 and prescribe accordingly, but it’s still a very subjective scale. Since physicians are now rated on patient satisfaction, it’s a common practice to want to write a pain med prescription with the advice that the patient shouldn’t take it unless the pain becomes severe.
Patients have come to expect getting a prescription when they visit a physician, and physicians have become accustomed to writing those prescriptions. Both patients and physicians are busy, so writing a prescription is sometimes quicker than looking into the underlying condition that’s causing the patient’s chronic pain. When this fifth vital sign notion came along, the medications being promoted were prescribed in doses that were much safer and less often addictive. A wide range of medications today have addictive potential, but few are as lethal and dangerous over time as narcotics for pain, anxiety and sleep medications. The rise of painkiller addiction has also led to a resurgence of street heroin. With skyrocketing street prices for prescription narcotics and physicians under pressure to be cautious in prescribing, heroin quickly becomes a viable alternative that is easy to obtain, inexpensive and very pure. We’ve seen a recent surge, corroborated by the Centers for Disease Control and Prevention, in heroin addicts who started out on legitimate prescription pain medications.
Addiction is almost impossible to understand without medical knowledge of how it affects the nervous system and functioning of the brain. It’s deeply hurtful and puzzling to family members who often mistake a loved one’s frightening transformation for a lack of willpower. I explain the syndrome to families this way:
“We all have the biological drives to eat, sleep and drink liquids, but they are conscious drives experienced as hunger, fatigue or thirst. The most primitive drive you have is the drive to breathe. With addiction, the unconscious chemical lie the body tells its victim is that, ‘You need this drug to stay alive.’It’s not true, of course, but the addict can’t tell the difference, and that’s why people who are addicted often attempt such desperate acts as lying, stealing and engaging in criminal activity to obtain and use the drug.” The strength of the “chemical lie” that accompanies addiction is largely misunderstood. When addiction takes hold, the brain chemistry changes and the addiction becomes as strong for the addict as the biological drive to breathe. Without treatment most addicts won’t quit using until they distance themselves from the drug for a sustained period of time and receive enough treatment and education to master the tools that will help them hold that unconscious chemical lie in check. Round-up Magazine • October/November 2015 • 11
addiction treatment Unscript is a non-invasive integrated system of education and physician-monitored medical protocols specifically designed to treat unintentional physical dependence on prescription pain medication.
There is no ‘blaming, shaming, guilting” or psychotherapy. Patients are treated as men and women who, while addressing a legitimate medical condition, became unintentionally dependent on increasing doses of prescription pain medication.
As with all addiction, this is a medical problem that must be dealt with using science, education and alternative forms of pain management to address the underlying chronic pain that triggered the addiction disorder.
People come to our program in all stages of acceptance of their condition. The program is voluntary, and there are varying degrees of awareness in dealing with the fact they are addicted. Many individuals don’t perceive the problem themselves, but it’s their family members who contacted us.
We often are contacted by and meet with family members before patients come for treatment.
Complete discretion is important because no one should be labeled an addict, other than as having a medical condition. This fear of being found out or labeled often keeps individuals from seeking treatment they need. No one is immune to addiction. It’s not confined to the streets. It cuts across all socioeconomic levels and all walks of life.
The truth is that addiction is a chronic, relapsing and treatable disease. Newer treatment modalities all but ensure that recovery is not just possible, but expected. As with most chronic medical conditions, the key is early diagnosis and treatment. For a list of community resources available in Arizona, please refer to the following link: http://communitybridgesaz.org/resource. ru
Michel A. Sucher, MD, FASAM, FACEP, is Chief Medical Officer of Community Bridges, Inc. and also serves as the Medical Director of the Monitored Aftercare Programs for the Arizona Medical Board, the Arizona State Board of Dental Examiners, and the State Bar of Arizona. Dr. Sucher is a Fellow of the American College of Emergency Physicians and a Fellow of the American Society of Addiction Medicine (ASAM) and is the Immediate Past President of the Arizona Chapter of ASAM.
12 • Round-up Magazine • October/November 2015
Community Bridges, Inc. (CBI) is dedicated to providing outreach and education to the community at large. Their services reach the mainstream public through education efforts, and clinical services provide quality treatment for substance use disorders for men and women. CBI believes addiction is a disease that carries tremendous consequences for individuals, families, the workplace, and the community as a whole. Community Bridges, Inc. has more than 30 locations throughout Arizona that provide behavioral and primary healthcare treatment. Unscript, for the treatment of addiction, has offices in Scottsdale, with East Valley and West Valley locations opening soon. CBI is a community-based nonprofit that is funded primarily by state and federal sources, including AHCCCS and Medicaid types of programs. CBI has contracts with most commercial insurers and accepts private pay. For families and individuals in need, grants and donations are often available. No one is ever refused assistance because of a lack of funds. For more information: CommunityBridgesAZ.Org or Unscript.com, or call 480-502-7000 for 24/7 assistance.
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* Based on 2014 data. ÂŠ 2015 NORCAL Mutual Insurance Company.
Homeless healthcare is on the move. A conversation with:
Randal Christensen, MD For many, Dr. Randal Christensen is a familiar figure. Maybe you’ve seen his bright blue mobile van, the Crews’n Healthmobile, around town as he and his team bring medical care to thousands of homeless kids and teens. Perhaps you’ve seen him discussing youth homelessness in interviews on the news. You might have read his book, Ask Me Why I Hurt, which hit shelves in 2011. Or you may have heard him speak about his experiences in the MCMS courtyard last May, at our “Philanthropy in Medicine” event. Wherever you’ve seen him, I’m sure you will agree that his efforts and history make him a valuable voice for our community issue. Round-up took the chance to sit down with Dr. Christensen to find out more about his amazing experiences, and discuss growing community involvement.
A Different Kind of Mobile Health
The Crews’n Healthmobile initiative started in 1999, and Christensen has been on board almost as soon as the idea was conceived. He was working at the Phoenix Children’s Hospital (PCH), as a faculty physician, when the hospital teamed up with another local organization called Homebase Youth Services. The difficulty of providing healthcare had been a topic of conversation in the community, and several organizations across the state had implemented similar programs to deliver much-needed care to those who needed it most.
“The idea of taking care of teens out on the street really appealed to me and I soon began to look for experiences caring for homeless individuals. I first started with a role at the Thomas J. Pappas School-based Clinic,” Christensen said.
“And ultimately a grant was written that provided seed funding for the Crews’n concept. I was asked to be the medical director and I thought this would be the perfect job for me.”
Once he signed on as the medical director, the long journey of making their mobile healthcare dream become a reality began. There were plenty of obstacles to overcome, but today the thirty-eight-foot Winnebago-turned-medical-unit stops at multiple locations per week, and has provided medical care to thousands of homeless teens throughout Maricopa County.
The stories of the children he has served are truly amazing. Some had the simple issues that result from poor hygiene and squatting in abandoned buildings, such as infected scratches or bug bites. Others, however, had more serious issues that required ongoing treatment, medication and counseling to control.
While processing them for treatment, Christensen and his team did their best to find out why the kids were homeless, and what could be done to help them after their immediate physical symptoms were treated. Many who come by the van are treated once and then never seen again, but some moved into the Homebase or other shelters and received an education and job training, eventually being able to sustain themselves.
Setting Out to Serve
Christensen knew he wanted to be a doctor from a very early age. In fact, as he relates in his book, as a child he so eagerly spoke of his dream that his classmates began to teasingly refer to him as, “Doctor.” He grew up in Tucson, and while in high school saw a flyer advertising a program at the local hospital to help teenagers learn more about the medical profession. Suddenly the dream that had gotten him teased through childhood started to take on a shade of reality.
“I had always wanted to be a doctor,” Christensen confirmed. “I was always amazed by the biology and excitement of all.”
He attended Tufts University School of Medicine in Boston, where he was a part of a combined program to get his doctorate in medicine and his master’s in public health. It was here that he saw his first mobile medical unit.
In one of his classes he heard about the Bridge Over Troubled Waters program, which had a “hospital on wheels” that served the homeless. Christensen immediately rode the
subway out to where the van was parked, just to see it. He remembers he found the idea fascinating, and rather perfect: to be able to take the healthcare directly where it was needed.
After four years at Tufts he was ready to come home and enjoy the Arizona outdoors, and he returned home to complete both his internship and residency at Good Samaritan Regional Medical Center and Phoenix Children’s Hospital.
Christensen originally thought he would become a pediatric cardiothoracic surgeon, especially after working with the CV team in Tucson, right when heart transplantation was still in its infancy.
“I went to school thinking that is what I would do but soon was pulled to a group of residents that seemed a little different,” he said. “Those residents were training in both internal medicine and pediatrics and I just seemed to fit right in.” “I always loved both medicine and pediatrics and worked for some time doing both,” he said.
Health Care Compliance • Reimbursement State and Federal Licensing • Health Care Reform, Fraud and Abuse Patient Privacy • Employment Law Counseling and Litigation Business Transactions • Corporate Law • Intellectual Property Estate Planning
16 • Round-up Magazine • October/November 2015
Christensen found many mentors and leaders in the program, and when he was offered the chance to stay on after residency he jumped on it, and signed on with PCH as a faculty physician.
“This was early in the Crews’n Healthmobile years and soon I found that my path was really caring for homeless children, teens and young adults,” he said.
A Community of Support
The Crews n’ Healthmobile initiative has received wonderful support over the years, at every level.
From the beginning, Jan Putman has been an integral and irreplaceable part of the Healthmobile. Putman is a nurse practitioner, and Christensen’s narrative of his experiences is full of praise for her experience, energy, skill, support, and amazing ability to connect with the kids they are working so hard to help.
Putman already had plenty of experience with at-risk populations, and was trained in emergency medicine as well as her extensive knowledge as a nurse-practitioner. She took to the job immediately and has been invaluable ever since. Christensen enjoys working with an amazing team, which has grown to include many different doctors, nurses, residents, interns, hospital administrators, and those whose generous financial donations and support have kept the van stocked, functional, and mobile. “I try to tell everyone I meet that it truly does take a village to succeed,” he said.
Throughout his journey Christensen has also relied on the support and perspective of his wife, Amy Christensen, MD. He and Amy met while working at PCH; she was the senior resident and he was a new intern. Now they have three children, and Amy serves on the advisory board for the Healthmobile. Round-up Magazine • October/November 2015 • 17
member profile “I have so many people that believe in me and I believe in them and together we are able to get things done,” Christensen said. “It is all about the partnerships in life – one of my favorite mentors said that to me many years ago.”
Teaming Up and Moving Forward
In addition to his family and his team, Christensen said the project has had a great relationship with both local and federal governments, as well as many other incredible service organizations, as they work to serve their unique patient population.
“Too many collaborative experiences to count but currently the Governor and the City of Phoenix have collaborations in work to help solve this human trafficking problem and again it will take a village to solve that issue,” he said.
Over the years the Crews’n Healthmobile team has made connections with other community health initiatives in the
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Valley, and Christensen said he loves that he gets to hear the wonderful stories of those out there working to help the homeless populations, and to learn about the cool things they do.
“Mission of Mercy, St. Vincent, Healthcare for the Homeless, Neighborhood Clinic and CASS Dental are such wonderful organizations and led by such passionate dedicated people I am always in awe,” he said. The organizations often work together and share services to achieve their common goals. “In fact we are all close friends,” Christensen said.
“Reminds me of Radar in the M.A.S.H. series when he would trade supplies all over Korea to get what he needed and in exchange helped others. We often connect in much the same way. Kindred spirits if you will.”
member profile Despite amazing support, the mission of the van has plenty of challenges.
One area of need that has been hard to miss is the odd decoupling of mental health services from Arizona’s entitlement programs. Mental health issues are a huge factor in so many of today’s homeless cases, especially the youth. And getting them the help they can seem remarkably like a losing battle requiring months and even years of waiting for proper identification and help. “I think we have had tragic stories told to us over the years and it was so incredibly difficult to get these kids to where they needed to be – psychiatric services,” Christensen said.
“Getting them on AHCCCS (Arizona Health Care Cost Containment System) was only the first step, then there had to follow up in a different venue and this was very tough for those kids that had so many mental health challenges. I am always the optimist and feel that the time is right to see some great steps forward. Keep your fingers crossed!” While it is a marvel how much help and good Christensen has been a part of, he still has hopes for how his program, and others, can make a difference in the Arizona community. We asked Dr. Christensen what more would be needed to help with what he does, and while some might have expected him to name funding as his biggest need, he actually has a different answer: “The truth is that I most want is for people to hear about how successful our kids can be if given only a chance,” he said. “To understand their worth and their story makes it easy to become passionate about helping them.”
Thanks to his tireless work to help homeless kids and teens who don’t know where else to turn for help, Christensen certainly embodies the spirit of community, and encourages other physicians to become involved in the wellbeing of their own areas.
“I truly believe community starts on your own street and in your own supermarket,” he said.
“Too often I think that we feel the need to ‘go out’ to someplace far away to help when someone is probably needing help across the street or paying for a sandwich at the local Subway. I have seen so many people in need and if only someone would reach out to them they would be able to stand up and move forward.” ru
ON THE PERSONAL SIDE… 1. Describe yourself in one word. Enthusiastic. 2. What is your favorite food, and favorite Valley restaurant? I love Pizza! While my favorites change every so often Spinatos Pizzeria is one of the best. 3. What career would you be doing if you weren’t a physician? I think I would be leading a nonprofit in the healthcare field. 4. What’s a hidden talent that you have that most wouldn’t know about you? I am a pretty good photographer. 5. Best movie you’ve seen in the ten years? Avengers! 6. Favorite Arizona sports team (college or pro)? U of A Wildcats. 7. Favorite activity outside of medicine? Hiking!
Round-up Magazine • October/November 2015 • 19
Domestic Violence: a Community Health Crisis Submitted by Chrysalis
There is an issue that impacts every entity across our communities: healthcare, schools, governments, and workplaces. It thrives in silence and secrecy. It starts in the most private and valued of places – an intimate relationship. The issue is domestic violence/intimate partner violence (IPV) and it knows no boundaries when it comes to who can be a victim. Intimate partner violence occurs regardless of age, race, ethnicity, mental or physical ability, socio-economic status, sexual orientation/identity, or religious background. It can be physical violence, sexual violence, threats of physical or sexual violence, and psychological/emotional violence to name a few.
In June of this year, Vice President Joe Biden made news when he addressed an audience of over 1,100 medical and healthcare professionals and called intimate partner violence “a public health epidemic” that requires urgent attention. Calling it an epidemic was not a gross political exaggeration. The numbers are startling. The World Health Organization released a landmark report two years ago indicating that one in three women worldwide has faced intimate partner violence or sexual violence. The Centers for Disease Control and Prevention (CDC) backed that up by saying this number is consistent in the United States and an additional one in seven men are victims of intimate partner violence. These statistics can be overwhelming to even those of us working directly in the field with individuals impacted by
20 • Round-up Magazine • October/November 2015
intimate partner violence. If you are hearing them for the first time, it wouldn’t be surprising if you are overwhelmed as well. Most likely with statistics like these, you are encountering victims and their children every day in your daily work in healthcare. It is estimated that intimate partner violence results in nearly two million injuries, more than 550,000 of which require medical attention. Bruises, broken bones, sprains, back or pelvic pain are reported and yet there are sometimes alternative reasons cited for these injuries. The stakes are high for victims; if they give the real reason for the injuries, there potentially could be more severe consequences at the hands of their abuser. These are the more visible and immediate effects of the violence, but the impact on a victim’s overall health goes deeper and spreads out into other vast areas.
The Prevalence of Intimate Partner Violence Since 2010, the Centers for Disease Control and Prevention has been studying intimate partner violence, sexual violence and stalking with an extensive survey (the National Violence Against Women Survey). The data from this survey estimates: • 5.3 million intimate partner violence victimizations occur among U.S. women ages 18 and older each year. • This violence results in nearly 2 million injuries, more than 550,000, which require medical attention. • The costs of intimate partner rape, physical assault, and stalking exceed $5.8 billion each year, nearly $4.1 billion of which is for direct medical and mental healthcare services. • Intimate partner violence victims also lose a total of nearly eight million days of paid work – the equivalent of more than 32,000 full-time jobs – and nearly 5.6 million days of household productivity as a result of the violence.
Warning Signs of Intimate Partner Violence Healthcare providers should look for: • Injuries to head and neck. • Multiple or repeated injuries or bruising at different stages of healing. • Vague complaints about headaches or stomach pains. • Injuries to breast, abdomen, or genitals. • Miscarriage or any injury during pregnancy. Some behavioral signs and symptoms you should look for include: • Missed appointments. • Seeking care from different providers. • Reasons given for an injury are inconsistent with the nature of the injury. • Intimate partner refuses to allow the patient to be seen alone during the examination.
Local Domestic Violence Resources Domestic Violence Shelter Information www.cirs.org 602-263-8900 / 1-800-799-7739 Arizona Crime Victims website www.azvictims.com/domestic/services.asp National Domestic Violence Hotline website: www.ndvh.org National Coalition Against Domestic Violence website: www.ncadv.org Futures Without Violence website: www.endabuse.org National Teen Dating Abuse Helpline: www.loveisrespect.org / 1-866-331-9474
22 • Round-up Magazine • October/November 2015
In addition to the immediate trauma caused by abuse, the stress from intimate partner violence can lead to a number of chronic health problems. Conditions such as asthma, cardiovascular disease, central nervous system disorders, sexually transmitted diseases (such as HIV/AIDS) and chronic pain are just a few chronic health problems that research now shows directly correlate to the effects of intimate partner violence. Conditions that existed before the abuse also are exacerbated due to the higher levels of stress in an abusive relationship. Beyond the physical impact of intimate partner violence, victims are at a greater risk for mental health issues such as anxiety, depression, and post-traumatic stress disorder. One study found that women who had experienced domestic violence were twice more likely to suffer from depression than women who had never experienced abuse (Dienemann, et al., 2000). Additionally, victims are more likely to experience emotional detachment, sleep disorders, anti-social behaviors, low self-esteem and are more prone to suicidal behaviors.
As if the effects on the physical and mental well-being are not enough proof of just how serious this public health issue is, there is a third outcome. Victims of intimate partner violence are more likely to display behaviors that create further health risks: alcohol and drug use. One study found that survivors of intimate partner violence were over nine times more likely to be dependent on alcohol than women who had not experienced abuse, and eight times more likely to have used illicit drugs in the past 12 months (Lipsky et al., 2005). The use of both alcohol and drugs, including prescription drugs, are often a consistent coping mechanism for the stress and trauma experienced in the relationship and even after they no longer are in the relationship. Under the influence, victims may feel a sense of increased power. Victims may mistakenly believe in their ability to defend themselves against physical assaults, or their power to change the abuser.
Intimate partner violence is a pattern of coercive control that one person exerts over another person. A victim feels powerless, fearful and knows that there are severe consequences if their secret is discovered. For this reason, intimate partner violence thrives on silence and secrecy. A victim learns to conceal the abuse with friends, family, coworkers and with medical professionals. Once the secret is shared, the abuser has lost a considerable amount of their power and retaliation is a very real threat. The risk of death
domestic violence or injury to a victim is greatest when leaving an abusive relationship or shortly thereafter. The National Network to End Domestic Violence reports that on average, three women die at the hands of a current or former intimate partner every day. With children present in the relationship, these worries intensify. Victims worry that if their mental health is called into question or issues with alcohol or chemical dependency are reported that this will be used against them and they will lose custody of their children. None of this makes it easy for someone to intervene, and yet we know it is necessary and life-saving when done correctly.
A recent study found that 44 percent of victims of intimate partner violence talked to someone about the abuse; 37 percent of those women talked to their healthcare provider. Additionally, in four different studies of survivors of abuse, 70 percent to 81 percent of the patients studied reported that they would like their healthcare providers to ask them privately about intimate partner violence. This is encouraging news.
Chrysalis, a 34-year-old Arizona agency, leads the community to broad-based solutions to prevent domestic abuse. The lives of more than 1,300 individuals are impacted each year. Services include crisis shelter, transitional housing, outpatient counseling, offender treatment, and victim advocacy. For more information, visit www.noabuse.org or call 602-955-9059.
What can you do as a medical professional? 1) Start by knowing the warning signs of intimate partner violence (see side bar). Educate yourself and the staff around you about the dynamics of intimate partner violence. 2) Seek out information on intimate partner violence intervention and assessment. Establish an intimate partner violence protocol or review and amend an existing protocol for your healthcare setting. 3) It may seem small in comparison to the other items listed, but creating a supportive environment for victims. Place victimsâ€™ safety cards in the bathroom, and/or exam rooms for patients who need information, but may not be ready to disclose. Hang domestic violence posters in waiting areas to give patients the message that support is available. 4) Reach out to local domestic violence organizations, like Chrysalis. We are here to help educate and also provide an important resource when and if you need to refer someone. For example, at Chrysalis we not only provide shelter, but an entire wrap around approach with additional non-residential services such as counseling for adults and children, court victim advocacy and offender intervention. Together, we can help end the silence, offer support and stop the cycle of abuse. To get started and find more indepth information on screening for intimate partner violence visit: http://www.healthcaresaboutipv.org. For more information about Chrysalis and our programs visit noabuse.org or call 602-955-9059. ru
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GIVING BACK: Corporations Doing Good Things for Good People By Bronwyn Medley
et’s say that your company wants to do something beneficial where you work and live. Specifically, let’s say that your owners or board want to launch an initiative that will have a positive halo effect on your employees, your clients, your friends, family and overall community. Studies have proven that volunteering has mental benefits, especially in the realm of social connectedness. But there is a growing body of evidence that indicates that volunteering also has great physical benefits – including lower blood pressure and a longer lifespan.
There are many worthy nonprofit organizations that are always looking for volunteers to help them out, but if you want to start a volunteer program for your own business, where do you start? What do you consider? How much time do you ask your employees to volunteer? Do you want to raise money for a cause through your volunteer efforts? Or are you only interested in donating physical man hours?
Arizona Central Credit Union has always been community minded, but in 2010 we decided to deepen our commitment by creating a formal volunteer program. The past five years have definitely been a learning curve for us and our intent in writing this article is to share some of those learnings with you. Following are the steps that we found were important to consider as we set up our own community outreach program. Step One – Develop a strong vision and mission: create policies and procedures. Step Two – Create a solid infrastructure: lay a foundation for success. Step Three – Keep on course: monitor and evaluate all of your initiatives.
Step One – Develop a strong vision and mission: create policies and procedures.
It has been our experience that not only do you need to have a strong vision and mission that resonates with your organization and your employees, you also need to have policies and procedures that act as a backbone for your volunteer program. Round-up Magazine • October/November 2015 • 25
Bronwyn Medley is the Vice President & Chief Marketing Officer at Arizona Central Credit Union. Her experience includes driving market creation, increasing profitability and share, and establishing roadmap needs, growth strategies, and customer loyalty initiatives. Contact her at email@example.com
At Arizona Central, our dedication to making a tangible impact in our communities forced us to consider the following points: • With the hundreds of requests that we receive for volunteering events and donations, how do we decide, which requests we will support and which ones we will say no to? • What guidelines do we give our employees around how and when they can volunteer?
As a result, we created a steering committee (a group of six people from our leadership team) to collectively develop our community outreach guiding principles and shepherd our efforts. We have three partner categories – strategic, community and independent partners – and developed the following selection criteria: • Does it positively impact the health and well-being of children and families? • Does it have a financial literacy opportunity?
• Is the organization a 501(c)(3) with less than a $5 million annual operating budget?
• Does the organization align with our strategic objectives and target markets? • Does the organization align with our vision and mission?
We currently have seven strategic partners, and an additional seven community partners. Anyone outside of those organizations seeking a donation or sponsorship of any kind from Arizona Central must complete a sponsorship or donation request application that is then evaluated for fit by our Community Development Steering Committee.
Through our program we have continued to build strong relationships with local non-profit organizations. In 2014, with fewer than 200 total employees, we participated in 70 community engagement activities and donated over 2,000 hours of service. These events helped us raise nearly $89 thousand for eight organizations, including Relay for Life, Phoenix Children’s Hospital and Cancer Support Community Arizona. Remember to set realistic fund raising goals, but also don’t be scared to set them high and make your organization stretch. Of note, 2014 was the second
26 • Round-up Magazine • October/November 2015
year that our annual golf tournament benefitted one of our partners – Cancer Support Community Arizona. The 2013 benefit raised $60,000 and the 2014 benefit raised an additional $55,000 for a total of $115,000. We are hoping our 2015 benefit on their behalf will be even more successful! Step Two – Create a solid infrastructure: lay a foundation for success.
Your volunteer program is going to need some internal personnel to support it. Arizona Central has a dedicated Community Development Manager whose primary responsibility is to strengthen our community outreach efforts and to coordinate employee involvement in the community. Our company has approximately 200 employees and we wanted to build a large scale program. Therefore it made sense for us to have a full-time role dedicated to making this happen. Our employee spent a lot of her time building relationships with companies we wanted to partner with, as well as organizing the various events themselves. We also wanted to create a rewards program for our volunteers, meaning she also initially spent a lot of time manually tracking our employees’ volunteer hours. However, we feel that smaller businesses should not see needing a dedicated resource as a barrier for entry; all you need is someone in your business who is detail-oriented and communityminded who can apply a few hours of their time every week. You are also going to need some external documentation. This includes a sponsorship or donation request application, agreements with the businesses that you partner with (outlining both volunteer and organizational goals, expectations and responsibilities) and
corporate volunteering volunteering guidelines as a reference guide for your own volunteers.
Additionally, as mentioned, we track all events and volunteer hours, and have now moved to a web-based, corporate volunteer portal. This program is used to manage relationships, coordinate volunteer events, promote upcoming volunteer opportunities, and track staff, family and friends’ volunteer hours.
Finally, our volunteer program could not be successful without the dedication and support of our employees. From our Board down, our employees are all encouraged to become involved. When asked recently to comment on Arizona Central’s volunteer program, our President and CEO commented, “People Helping People” is a philosophy and founding principle of the credit union movement. However, at Arizona Central our Central Cares Program takes this commitment to a whole new level. Our employees recognize needs in our local community and generously open their arms and hearts to help those people out. I couldn’t be prouder of them!” In order to encourage employee involvement, if it doesn’t create a staffing conflict, we also allow our staff to volunteer during working hours. We have found that our employees are proud of their collective efforts and the program, in general, has been an overall and significant employee morale booster.
a single year, gold is 40-99 hours, and platinum is 100+ hours. Awards recognizing their outstanding service are given out at our annual all-employee meeting. Step Three – Keep on course: monitor and evaluate all of your initiatives.
It has been our experience that any volunteer program needs regular review to ensure that it still aligns with your vision and mission. We formed a Community Development Steering Committee, and meet briefly once per month just to ensure that our program is still “on track.” This cross-functional committee includes our CEO, Chief Operations Officer, Chief Marketing Officer, VP of Human Resources, Business Development Manager, and our Community Development Manager. The steering committee is not intended to be an advisory board, and therefore only includes internal team members. Its specific purpose is to provide a forum for key stakeholders to constantly review the guiding principles of the program, discuss any sponsorship or donation request applications and also plan future events. These meetings also represent an opportunity to review how our employees may have responded to the various events that we have already conducted and course correct for future engagements as needed.
By setting up a solid volunteering program it has been our experience that it is possible to not only engage and raise the morale of our employees, but to also improve our corporate image and relations with our members as a leader who gives back at the local and national level. Moving forward we will continue to ensure that our program aligns with local organizations that meet our criteria and share the same passion for Arizona’s communities and its citizens as we do. We will also not be afraid to course correct as necessary in order to drive the continued success of our community outreach program. ru
Arizona Central Credit Union is a preferred partner of the Maricopa County Medical Society. It was founded in Arizona over 76 Conclusion. years ago, and has since beAccording to VolunteeringInAmer- come a trusted, full-service fiOur formal employee recognition ica.gov/AZ, nearly 25% of residents in nancial institution for and and rewards program celebrates our Arizona volunteer each year. At Ari- supporter of Arizona’s commuvolunteer of each quarter as well as our zona Central Credit Union our dedica- nities. volunteer of the year. We have also implemented a tiered recognition system comprising of silver, gold and platinum awards based on total annual volunteer hours. Silver represents 16-39 hours in
tion to our Community Development program has taken that statistic up a notch, with nearly 90% of our employees offering their time and volunteering on a routine basis throughout the year.
The mission of its outreach program is to bring empowerment through volunteering, financial education and gifting.
Round-up Magazine • October/November 2015 • 27
Adjusti the Sa Adjusting Sai on Your Sails Y Por Port Portf Portfolio P Po By By Mike M McCann, McC McCan McCann M Mc CFP C ÂŽ, AIFÂŽ Choosing investments is only the beginning when it comes to managing a portfolio. The financial markets are changing all the time. This fluctuation in performance alters the values of the different asset classes in a strategically diversified portfolio. Thus, as the wind LQHYLWDEO\ZLOOEORZLWÂśVLPSRUWDQW to adjust the sails of your portfolio from time to time through rebalancing. This involves reviewing the portfolio and buying or selling assets to maintain the original, desired level of asset allocation. Different asset classes Âą domestic stocks and bonds, real estate, international funds Âą yield returns at different speeds and have different levels of risk. Therefore, diversification means more than VLPSO\GLVSHUVLQJRQHÂśVHJJVLQWR many baskets. The goal is to balance risk and return within a portfolio of investments. The best way to reach that balance is through strategic asset allocation based on modern portfolio theory. Modern portfolio theory explains the benefits of portfolio diversification and demonstrates quantitatively why and how it works to reduce risk. First
documented in 1952 by Harry Markowitz, who later won a Nobel Prize in Economics for his work, the theory has become widely accepted by institutional investment managers during the past 50 years. Markowitz was also the first to establish the concept of an efficient portfolio. Simply put, if efficient is defined as more output for less input, then an efficient portfolio can be defined as more return for less risk. How often should you review and rebalance a portfolio to achieve and maintain this efficiency? There is no official rule or industry standard that determines when or how often a rebalance is required. Some advisors believe an annual
review is sufficient. Others review quarterly. At Perspective Financial, we review our client portfolios monthly. While a rebalance may not always be necessary, we believe consistent frequent review is a key to long-term success. <RXUSRUWIROLRÂśVRYHUDOOSURJUHVV should be enough to support and DFKLHYHWKHILQDQFLDOJRDOV\RXÂśYH set. The objective is to see steadily increasing value of the portfolio, even if one or more of the investments may have lost value. The proven method of achieving this objective is not to complain about market fluctuations or to hope the markets will calm. It is to keep an eye on the horizon and adjust the sails when needed.
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Mike McCann Mike M McC McCa McCan is an investment advisor and founder of Perspective Financial Services, LLC. He develops long-term relationships with physicians and other professionals to create and manage personalized financial plans and investment portfolios. He is a Certified Financial Planner ÂŽ and an Accredited Investment FiduciaryÂŽ. To learn more, visit his website at www ww www.MoneyAZ.com. www.MoneyAZ.com www.MoneyAZ.co www.MoneyAZ.c www.Money www.Mone www.Mon www.Mo www.M You may call or email him at 602 602--281 28 -435 28143 or Mike@M 4357 Mike@ Mike@MoneyAZ.com Mike@MoneyAZ.co Mike@MoneyA Mike@Money Mike@Mon anytime. All investments have the potential for profit or loss and that past performance does not guarantee future success.
Should Arizona Consider a Death With Dignity Law? By Jay Conyers, PhD
ust recently, California joined four other states in providing a legal means for physicians to prescribe lethal doses of drugs used to aid terminally ill patients in controlling their end-of-life care. Before signing the bill, termed the End of Life Option Act, Governor Jerry Brown struggled with the decision and sought guidance from religious leaders as well as those directly impacted by the lack of such a law in California. The family of Brittany Maynard – the young woman who moved to Oregon last year to take advantage of the state’s death with dignity law – encouraged Governor Brown to sing the bill so that terminally ill Californians would have options to die in their own home.
More than half the states in the U.S. have either considered, or are presently considering, ‘assisted suicide’ legislation that would provide a legal safeguard for those seeking aid in dying. Prior to California, Oregon, Washington, and Vermont had already passed similar laws, and Montana’s Supreme Court rules earlier this year that nothing in the state’s statutes made it illegal for physicians to assist patients wishing to die.
Given the moral arguments on both sides of the issue, the Maricopa County Medical Society asked its members how they felt about the new death with dignity laws, and whether or not they felt Arizona should follow suit. A short survey was conducted, asking two simple questions: 1.) Should physicians have the legal authority to prescribe lethal doses of drugs to terminally ill patients wishing to expedite death? 2.) Should Arizona pass similar legislation as to what was recently enacted into law in California?
Of those physicians completing the survey, two-thirds agreed that physicians should not be criminalized for prescribing lethal doses of drugs to assist in suicide. Those in agreement also supported passage of a death with dignity law here in Arizona. Nearly one third of those completing the survey provided comments to explain their support or opposition to assisted suicide.
Many opposed to physicians assisting patients in dying pointed to the Hippocratic oath and the slippery slope physicians would embark upon if they were to begin providing the means for patients to take their own lives. Several even felt that it was tantamount to murder. Other responses reminded us that physicians were trained to heal and had no formal training or unique skill to aid in ending one’s life. And one respondent raised an interesting question and the role of insurance companies, suggesting that payers might actually prefer a (cheaper) single lethal dose as compared to an expensive drug regimen to prolong life.
Those in support of assisted suicide largely did so with caution. Several physicians explained the need for safeguards to be put in place, so as to prevent vulnerable patients from being taken advantage of by those who may be motivated outside the best interests of the patient. Others suggested that a multidisciplinary approach be utilized to ensure that the family and mental health professionals are involved. There was also strong support for a panel-based approach, such that an independent group of physicians and behavioral health experts would evaluate each case before approving a patient’s request. And many felt that despite the excellent availability of hospice support, some patients are still in great pain, physically and emotionally, and would benefit from having options other than waiting to die.
Recognizing the importance of the physician voice in weighing the pros and cons of assisted suicide, several local media outlets reported on our results. Phoenix Business Journal’s Angela Gonzales wrote about our survey through her healthcare blog on October 12th, and KJZZ’s Steve Goldstein sat down with me on the station’s October 20th broadcast of Here and Now to discuss how Maricopa County Medical Society’s physicians feel. Both interviews are available on the Society’s website: http://www.mcmsonline.com/ about/newsroom-press. Clearly, assisted suicide is a highly sensitive topic that would come with both avid support and fervent opposition if Arizona were to ever consider death with dignity legislation. ru Round-up Magazine • October/November 2015 • 29
A Physician's Perspective as a Patient:
Why I Would Support a Death in Dignity Bill By Robert S. Lewis, MD
n July 11, 2015, I took a pickleball clinic in Coronado. I’ve had Parkinson's disease for thirteen years and was, at times, losing my balance. During the clinic I back peddled to hit the ball, lost my balance, and landed on my lower back, right side and wrist. I drove home to ice my injuries, but the following day I couldn't get out of bed by myself.
I went to the UCSD emergency room and laid on a gurney for 10 hrs. Afterwards, I was taken for an MRI and CT scan of my pelvis and lower back. The tests revealed fractures of S2 and S3 and 4 ribs, T8-T11 on the right side. I was admitted and given I.V. Dilaudid. The medication relieved my pain, but also relieved me of my sense of time, place and person. I had hallucinations that insects were crawling on the ceiling and that the nurses were trying to poison me. I rarely ate or drank, had no bowel movements, and slept most of the day and night.
After one week, I was transferred to an inpatient rehab facility. I was ordered to take physical, occupational and speech therapy. At the rehab center they stopped the Dilaudid and gave me morphine sulfate by mouth. This only perpetuated all the previous symptoms. I asked that they switch to Tylenol with codeine and soon was able to regain my appetite, was not disoriented, and was able to walk with a walker.
I still had not moved my bowels in over a week and asked for an enema. It worked, and the stool poured out of me like people fleeing a burning building. The nerves in the sacral area help to innervate the bladder and rectum rendered me incontinent, and I had only seconds to respond to the urge to urinate or defecate. If I was in bed and soiled myself, I rang for the nurse or aid and they would replace the soiled sheets. In one week the loose stools subsided and I was back to prune juice.
ner. This was the highlight of the day. I was making a decision for myself, not someone else. Laura suggested I begin taking Ensure to put more weight on. I assured her that on discharge and eating my prepared foods, I would rapidly gain the weight I lost. She had me on a semi-liquid diet, where everything like meats were liquefied in a blender and poured over rice or mashed potatoes. All the dishes tasted the same. I was able to order vanilla ice cream, which I put on top of my own pies.
Laura was the chief dietitian and was quite concerned about my loss of ten pounds. Her assistant, Anthony, would make his rounds daily to ask my choice for the next day’s lunch and din-
In the late afternoon and evening during my first two weeks, while in my room, I would hear this loud screaming from across the hallway. It was a woman yelling as loud as she could, “NURSE! NURSE! Goddamn it. Where are you? It hurts!” This would go on for hours with no break. On the last week of my rehab, I realized that there was no more yelling. I peeked into her room where I found her lying
While at the rehab center I became familiar with the staff who attended to me and some of the other patients. Kevin was the chief medication dispenser on the 7 am to 3 pm shift. He would ask me each time he dispensed meds to rate my pain from one to ten (ten is unbearable). Since my bad experience with strong narcotics, I told him numbers that were less than truthful. Because some of the tablets were huge and occasionally get stuck in my throat, he was always ready with a fresh banana or applesauce. The evening med shift was dispensed by Princess (yes her real name), who had a highpitched voice that would arouse me from sleep with, “Wake up Dr. Lewis, it’s time to take your medication.”
30 • Round-up Magazine • October/November 2015
Heidi was the bubbly activities director, who on her first introductory visit promised to have the daily paper brought to me. The paper was rarely brought to me, but I often found it at the nurses’ station. Greg was the head of the physical therapy department and gave out the assigned duties to the therapists. He introduced himself to me and wanted me to know that if I had any concerns, he would take care of them. The next day in the hall he greeted me, “How are you today, Mr. Allen?”
viewpoint on her back with arm restraints, starring into space with her mouth wide open. Why did it take so long for someone to calm this woman down?
Joy was my speech therapist. She had the most beautiful and serene manner. She was very concerned about my swallowing difficulties and gave me tips on making it easier to swallow. My physician at the rehab center was a doctor who was not able to hear despite wearing hearing aids. He rarely spoke or smiled. He did, however, refer me to an excellent orthopedic spine specialist who told me my fractures were not displaced and that time would heal the fracture.
Fortunately I am almost through the recovery process and doing well. I know that I am more fortunate than most at the rehab center but this expe-
Dr. Lewis received his MD from Hahnemann University in 1968. He moved to the Valley in 1969 to serve as a captain at Luke Air Force base. After his stint in the military and completing his residency in ophthalmology, he returned to Phoenix in 1974. In 1975 he founded Ophthalmic Surgeons and Physicians in Tempe, and also taught at the University of Arizona School of Medicine from 1990-2002. He retired from active practice in 2012.
rience has been mentally and physically taxing. I can imagine that for those who are facing a terminal illness with no chance of survival, that a choice to continue in pain and suffering or to legally end this situation would be a valuable asset. Having endured this humbling
experience as a patient, and not necessarily a physician, I would like the choice to decide when I could terminate my life. ru
Round-up Magazine â€˘ October/November 2015 â€˘ 31
The 2015 ACT Kids Health Fair:
he Arizona Coalition for Tomorrow (ACT) is a not-for profit organization of concerned citizens committed to improving the health and education readiness for at-risk children eligible for Valley Head Start Programs. In 2010, ACT broadened its reach to include the community at large.
A Picture Says a Thousand Words...
Marvin Goldstein, MD
brighter future by giving children access to preventive health services.
Since the ACT Health Fair’s inception, the Maricopa County Medical Society (MCMS) has worked to enlist and organize its physician, student, and resident members to volunteer, and each year our physicians have answered the call to help by enthusiastically participating in this wonderful community event. This year was no exception. Over 20 MCMS physician members volunteered their time on September 26th with the goal of giving back to the communities they serve and emphasizing the importance of regular health screenings and immunizations. Their dedication to their profession and willingness to give back to some of the most vulnerable children in our community is truly something to be commended - and emulated. From all of us at MCMS thank you!
Working with businesses, government and educational leaders and partnering with organizations like Maricopa County Medical Society (MCMS), ACT organizes its annual health fair volunteer event to provide preventative health screenings and immunizations, such as dental, eye, hearing and asthma screenings, lead testing, TB tests, physicals, blood tests, immunizations, vision screenings and nutrition information. They also provide transportation to and from the children’s neighborhoods, establish and update medical records, and arrange continuing care, as need. To date, over 20,000 children have been screened. The ACT Kids Health Fair To learn more about the ACT Health Fair and its orihas served as a unique example of how public and prigins, visit www.actkidshealthfair.org. Please enjoy the vate organizations in the greater Phoenix area have pictorial on the next few pages and we hope to see you come together to ensure at-risk children achieve a at the 2016 fair! 32 • Round-up Magazine • October/November 2015
act kids health fair – 2015 The following MCMS members for their time and efforts during the 2015 ACT Kids Health Fair:
Dr. Anita Murcko
Benjamin Berthet Kelcey Dunaway Leiland Fairbanks, MD Fionna Feller May Mohty, MD Ralph Mohty Anita Murcko, MD Sara Pousti Taylor Samora-Dietz Louis Trunzo, MD Kimberly Weindenbach
Dr. May Mohty
Sara Pousti, Melissa Gordon, & Dr. Alan Wong
Fionna Feller & Kimberly Weidenbach
Benjamin Berthet & Kelcey Dunaway Round-up Magazine • October/November 2015 • 33
act kids health fair – 2015
Dr. Louis Trunzo
Farmin Samareh-Jahani & Dr. Leiland Fairbanks
Taylor Samora-Dietz 34 • Round-up Magazine • October/November 2015
Are you taking full advantage of your Society benefits? The Maricopa County Medical Society (MCMS) understands the needs of physicians and recognizes that you are all not alike. As such, we have tailored our membership benefits for the different stages in your career, and to the different types of employment arrangements. We encourage you to take advantage of everything the Society has to offer. And if there is a membership benefit you would like to us to consider adding to the roster, please call the Society offices or email us your suggestion.
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