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A MONTHLY NEWS MAGAZINE OF SPOKANE COUNTY MEDICAL SOCIETY APRIL 2013

VOLUNTEERISM OVERSEAS –A LESSON FOR THE U.S.? By Anne Oakley, MD SCMS President

REMOTE CLINICS IN THE COUNTRYSIDE LESSONS LEARNED WHILE IN COLOMBIA DEAN F. LARSEN, MA, CAE TO BE NEW SCMS CEO


April SCMS The Message Open2


Table of Contents

2013 Officers and Board of Trustees Anne Oakley, MD President

Volunteerism Overseas—A Lesson for the U.S.? .

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David Bare, MD, President-Elect

The Harvest Is Plentiful and the Laborers Few .

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Terri Oskin, MD Immediate Past President

Lessons Learned While in Colombia .

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Fracture Care International .

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

Medical Team International .

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Pro-Papa Missions in Honduras .

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Renewal .

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In Memoriam .

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Shriners Hospital for Children-Spokane’s Forgotten Hospital . AMA Prescription for a Healthier Practice / FYI .

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Dean F. Larsen, MA, CAE to be New SCMS CEO / In The News . 2013 Women Physicians Retreat a Success .

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Eastern washington physician health committee .

All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

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Remote Clinics in the Countryside / Membership recognition . . . . 10

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Inland imaging and scms host mammogram party .

Advertising Correspondence Quisenberry Marketing & Design Attn: Lisa Poole 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 Lisa@quisenberry.net

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Medical Community Providers and Leaders Support Project Access .

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

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2013 SCMS Events Calendar . . . . . . . . . . . . . . . 18 update in obesity 2013 seminar . . . . . . . . . . . . . . 19 positions available .

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new physicians . . . . . . . . . . . . . . . . . . . 21 cme, meetings, conferences & events . classified ads .

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if it ’s a little thing, do something for those who have need of a man ’s help,

something for which you get no pay but the privilege of doing it. you don ’t live in a world all your own .

Your

For,

remember,

brothers are here too.

– A lbert S chweitzer

April SCMS The Message Open3


Volunteerism Overseas— A Lesson for the U.S.? By Anne Oakley, MD SCMS President This issue of The Message contains a variety of articles highlighting the works of the many members of our medical community who have donated their skills in places of extreme need. We applaud their contributions, but also remember that service work in third world countries serves a dual purpose. While most view volunteerism simply as a chance to help those in need, it also lends us a new, critical perspective on our own medical arena. Looking at what can be accomplished in those countries, with so few resources, forces us to re-examine our own system. Our headlines are full of tales of hardships that the “Sequestration” is causing in every segment of society, and often those stories center around its impact on health care. But anyone who has had to adjust to working in a country with no resources quickly realizes that our system is burgeoning with waste that could be painlessly cut. We are over-regulated in the name of “quality” and “safety”, rely heavily on testing and are faced with false expectations for perfect outcomes by our patients. Those articles remind us that so much can be done with so much less. Physicians in the SCMS and WSMA are taking the lead in implementing programs designed to reduce waste. An example of such an initiative is the “Ask Your Doctor, Know your Choices” campaign that targets our need to address our excess spending in delivering care. We are also working on programs to reduce the use of the Emergency Department for primary care needs.

Those are small but important demonstrations to society that physicians do care about conserving resources. We spend more time documenting patient care than providing it, mostly to satisfy governmental regulation designed by well-intentioned, but ill-informed bureaucrats. Often this documentation comes at great cost, without contributing positively to the care of a patient. Health care providers need to regain ownership of the medical process and work on streamlining. We also need to rethink our supply wastage. I work in an OR—every case generates at least two, usually four large bags of garbage. Paper drapes, paper gowns, several layers of packaging for each set of instruments, not to mention the huge number of disposable instruments, many of which get opened and never used in the name of “efficiency”. We have a bin to collect opened but not used supplies to send to third world countries!!! Nice not to discard them, but there has to be a better plan. By current law if a partial vial of a medication is used, the remainder is discarded even if it is still sterile and completely safe to use on another patient. This is not designed for patient safety; it is for proper documentation and proper billing. This ridiculous waste is even more troubling in our age of drug shortages. I learned early in my career that a septic patient costs more than any supplies we have, yet this throw-away attitude has come to dominate over logic. We all need to learn from our colleagues’ adventures, to be grateful for all we have and to do our best to be good stewards with our abundance. Critics of volunteer work abroad will ask, “Why there? We have as much need here in the US for those volunteer services.” Those remarks fail to give credit to the incredible services we have here already (which we will be highlighting in a future issue). We certainly have people falling through our medical safety net every day, but at least we have one. Most of the countries featured here have absolutely nothing until outside services arrive with supplies and trained personnel. We are all grateful for this hard work. The world is grateful. Enjoy their stories.

April SCMS The Message 1


The Harvest Is Plentiful and the Laborers Few

There is of course no end to pathology and that often is of a nature unique to the continent.

By Stephen Murray, MD Vascular Surgery Providence Inland Vascular Institute Occasionally in one’s life, the course set before you is very clear. I have always told my kids that what I lacked in the gift of horsepower I was compensated for with tenacity. With a certain goal in mind, the means to that end were speed bumps. In 1975 when I first visited a mission hospital in Africa as a freshman in college and saw Stephen Murray, MD with “sterile flyswatter” my first surgery at “0 dark thirty” I was hooked. Since then I have been to Belize, Mexico, India and many times to the Dominican Republic, but was pleased to be able to return again for the third time to Africa last February. There I served for two weeks as an attending surgeon to five of the most wonderful residents you could ever hope for. At Mbingo Baptist Hospital, Cameroon there is a residency program for surgeons under the auspices of the Pan-African Association of Christian Surgeons (PAACS). PAACS has several other participating hospitals on the continent and I served six years earlier at another (Banso Baptist Hospital) in Cameroon which has direct ties to Washington and Spokane in particular (more on that later). The residency programs are intended to train doctors to be surgeons after the western model with the intention of training only those that will make a commitment to stay in Africa upon completion of their training and thus far it has been a success in doing so. Towards that end, the training (other than the lack of an 80-hour work week...) is quite similar to any American surgery program (well, there is the weekly Bible Study, too!). The major differences come with the dire lack of imaging technology other than a laptop ultrasound, but they can make that tool sing opera! As a result there are many “African CT scans” done (exploratory laparotomies) with findings Sleeping surgery resident in O.R. generally unexpected to the average gringo surgeon.

The express purpose of both of my trips to Cameroon has been to relieve the local surgeon as they Rounding on surgery ward accompany some or all of their residents to an intense two week didactic training course in Kenya. This time around I was accompanied by another American surgeon (he is actually from western Washington). We were stretched to do things that neither of us does (or in some cases have ever done) here. Fortunately, my Army experience allows my muscle memory to kick into General Surgeon mode when I participate in those trips. That said, at least during this last trip, there were qualified orthopaedic, ob-gyn and ENT surgeons in place. That wasn’t the case six years ago when a former resident of mine from San Antonio and I were the only two surgeons in a 250-bed hospital. That trip had some very weird local connections. The duplex we lived in was shared on the other side of the wall by an ARNP from Colfax, Washington. On the Stephen Murray, MD; Mark Snell, MD coffee table were six-month and PAACS Residents old copies of Christianity Today with an address label to Norm James, MD, a plastic surgeon from Spokane, who had been there just before us. Weirdest of all though was the fact that the side of the duplex that we were staying in was once the home of Helen Marie Schmidt, MD. Helen was the first woman to finish the Virginia-Mason Surgery residency in 1968. From there she went straight to Cameroon for over three decades and now resides in Spokane! Upon my return, we had a nice meal at our home with Helen Marie, Norm James and his wife, Terry. I told you it was weird… To the task at hand...Human suffering, physical and spiritual, knows no racial or geographic bounds. There is estimated to be one surgeon for every million people in Africa so the mission is daunting. Nevertheless, the future is bright for every person that these soon-to-be surgeons will care for. I consider it an honor to be allowed to care for the whole person there alongside those intrepid future full-fledged surgeons. Anyone, of any specialty, interested in contributing to this effort can contact me or the Christian Medical and Dental Association website (http://www. cmda.org/wcm) where they can put you in contact with PAACS.

April SCMS The Message 2


Lessons Learned While in Colombia By Jon Patberg MS-1 UWSOM-WWAMI As I am just starting medical school I am realizing that patient interactions as a physician are going to be, in a way, similar to the scenario that follows. Patients are going to come to me with baggage and complexities I don’t understand. My interactions with them are going to be riddled with rules, impossible expectations and personal feelings. However, as a physician I am going to have to learn to withstand the tensions and awkwardness inherent in complex patient interactions rise above all of rules, demands and red tape, see the whole picture and objectively, but compassionately, work with the patient to create a plan that works for both of us. My time in Colombia is not explicitly medical, but it taught a lot, I think, about being a doctor. I looked everywhere for another place to land my gaze. I mean, this man who called himself Frog Singer was standing right in front of me, staring, eating the pancake and jam that I had brought, waiting for an answer to his question. An answer I was sure he knew I would not be able to give. It was uncomfortable and it infuriated me. I had come to the house for a simple visit with my favorite old lady and her daughter, but as soon as we entered the dirt floor kitchen, even before we could exchange social niceties, this short man, shirt unbuttoned, cap sliding to one side, looked at us with eyes wide as half dollar pieces and shouted: “Have you heard the news? They are paying! They are paying! They are paying families who have lost children in the war! I’ve lost three! Do you know how much money that will be?!” Understanding the difficulties this question presented for me requires some context. First, since the late 1960s Colombia has been involved in a very complex, low-grade civil war between three sides: the guerilla factions, the most famous of which is the FARC, the Colombian State military and the civilian paramilitary forces that were set up by the US and Colombian governments to weed out and kill communist guerilla factions. The war has been about drugs, politics and land and has resulted in Colombia having the second highest number of internally displaced persons after Sudan. Second, the man confronting me is part of a collection of Colombian farmers called the Peace Community of San Jose de Apartado. Since each side of the civil war suspected farmers to be the enemy’s ally, they were the first to be killed in a retaliation attack, forcing many farmers to flee for safety. Recognizing that being neutral and united was the village women visited by john patberg only way to avoid

fellowship of reconciliation (FOR) house

being pushed off their lands or killed, farmers in the highlands of one of the most violent Colombian regions organized themselves into the Peace Community of San Jose de Apartado and declared before the Colombian government and international community that they were not allied with either side of the civil war. The Colombian government repeatedly promised to respect the neutrality of the Peace Community and repeatedly broke those promises. Eventually The Peace Community decided that they would not trust nor work with the Colombian Government and broke ties with all entities of the state. Given that commitment, the rules of the Peace Community would not allow the man, who was screaming at me about payments for his killed children, to accept any money or assistance from any state agency, no matter how badly he needed the money. Third, my own role in the Peace Community was difficult to manage under the best of circumstances. I was supposed to be a strictly neutral human rights observer with the international organization, the Fellowship of Reconciliation. My job was to live in this community as a citizen of the United States. Since Colombia so heavily relies on the US for military funding and political support, my status as a US citizen, with supposed direct contacts to US lawmakers, meant that I could influence US aid to Colombia. However, my perceived power hinged on an adherence to strict neutrality. This meant I was by no means a member of the community nor was I allowed to influence any policy discussions or actions of the community or its individual members. Moreover, my organization maintained relations with the all branches of the Colombian government, including the military that the community members hated so much. Given those formal constraints, I could not respond the way to which I thought this man was expecting. I could not support or indeed take any position on his desire to bend the community’s rules and accept the state funds. At the same time, though, I lived in the community, I interacted daily with the people, brought them homemade pancakes and jam and learned from them how to wash my clothes by hand or get farm animals out of my house. The longer I stayed in the community, the more difficult it became for them to see me (or for me to see myself) as purely an observer. “Sure,” they seemed to say, “you’re a foreigner and a part of a political organization, but c´mon…you see how things are! Commiserate with us, the people! Bash the unfair rules! Tell me it is okay to bend them and accept this money!”

April SCMS The Message 3

Continued on next page


It was with this attitude, and within this context, that Frog Singer stood and stared at me munching on his pancake. I hoped in vain that if I just didn’t accept his stare then the story, and the expectations of some kind of response, would stop. But the room was thick with tension as everyone, recognizing how uncomfortable the situation was, was quiet with their eyes lowered to the floor.

The epiphany in this story occurred when I stopped trying to avoid his stare, forced myself to tolerate the masticated food visible in his mouth and started to listen. To my surprise, I learned that he actually needed me to say very little. Frog Singer is rather misogynist and I just happened to be the only man in the room and thus the only person he thought mattered. I let the man talk, nodded my head, grunted and old Frog Singer was content. So content, in fact, that he flowed right into another story, this one 45 minutes long, about the time he fell off a cliff and survived.

But Frog Singer seemed oblivious. He paused for a good bite of pancake, and then, without finishing chewing, continued on about how badly he needed his surgery and how fortunate it was that the government was finally paying people for their past losses and how a soldier promised him that if he only gave him his personal data he could be registered with the health care system and get the operation for free. The entire time I could only think about how unfair it was for him to put me in this position and about what I was going to say that would be sympathetic but not cross the line into suggesting he bend the rules.

That night I did not give any good advice nor did I gracefully escape a long-winded story that forced me to miss work duties. I did, however, learn something important from the experience. People, especially Colombians, often are faced with situations much harder than I could ever understand. I clearly cannot commiserate, nor should I ever think I’m expected to. My role, rather, was to listen to the story, take it seriously and try to understand the depths of the dilemma discussed. If the person walks away feeling like someone truly heard his story, I´d consider my job “well-done.”

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Fracture Care International Creating Equality in Fracture Care throughout the World By Carla Smith, MD Orthopaedic Surgery On my second trip to Bhutan, the land of Gross National Happiness, I was determined to hike back to a remote and idyllic monastery called Cheri, which I had visited with a friend on my first trip. This time, my husband and 5-year-old son were with me. We headed out from the trailhead after a picnic and an impromptu soccer match with a gaggle of small children who materialized when we stepped out of our taxi. In the high Himalayan stillness we hiked for 45 minutes or so without seeing anyone, passing brightly decorated stupas and chortens, which were festooned with flowers and incense offerings. As we approached the main temple, we were “greeted” by a youngish monk who was serving a period of silence in his monastic training. By way of paper and pencil he gave us a tour of the monastery and assisted us in entering the main temple. Although we were allowed to speak, he did not and we found ourselves modulating our speech to the serene environment. After he departed, we continued to wander a bit and were basking in the high altitude mid-day sun when the shrill sound of a mobile phone ringing broke the silence. We peeked around a building to find another monk chatting away on his phone and only then did I realize the subtle differences from my trip five years earlier. Cell and radio towers had sneaked up on many of the hills and mobile phones and even televisions were becoming ubiquitous. Why was I here then? I enjoyed immensely my remote hikes and my visits to small villages and exposure to traditional customs but was that enough to warrant travelling around the world and spending a month operating in an operating room poorly equipped compared to that which I enjoyed at home? Between the two trips I saw many amazing advances including mobile phones, MRI scanners, CT scanners and Internet service. On my first trip, ordering a CT scan meant that a patient had to be loaded onto a stretcher and flown to India for the test. That meant that one really evaluated the benefit to be gained from the study. But, even in this high tech extravaganza, one critical need remained. Although digital electronics had permeated the culture and environment, there was still a profound lack of safe implants to fix broken bones. Patients languished in traction or in bed with fractures that we routinely fix in the U.S., allowing early mobilization, return to work, school or home life.

Carla smith, md in surgery

For a simple piece of steel, 20 inches long and four screws, all of which can be manufactured for about $100, patients with fractured bones lay in the hospital, unable to get up, unable to work, to walk or even to get to their homes. Yet mobile phones have become so common that they can listen to the pop radio on them and take photos. I realized then, for perhaps the umpteenth time, that I was incredibly lucky to be able to provide implants and to be a part of Fracture Care International. For the past eleven years we have manufactured nails for fixing long bone fractures (femur, tibia and humerus) and disseminated them to over 40 countries and 140 hospitals. Now, over 109,000 people have had our nails, SIGN nails, implanted and have gotten a chance to walk again. I have been going to Nepal and have sponsored a program there for nearly 10 years and have gotten to travel to many other sites as well. And now, with the digital access permeating the globe, we at Fracture Care International have found that we can harness this power to critically examine our goals, that of “Creating Equality in Fracture Care throughout the world” by gaining critical feedback and accountability for our work. The same mobile phone that the monk in Cheri chats on can be used to take a photo of an x-ray and upload it to our database. We can then review the x-rays and maintain quality control and prove the outcomes for our nails. We can also collect our signature clinical follow-up from the patient, the “Squat and Smile”. We have discovered that if a patient who has broken a leg can fully squat and smile for a photo, the fracture is very likely to be healed and this correlates well with healing on x-rays. So while I was at first dismayed at having my solitude interrupted on a beautiful winter day, I see the yin and yang of high tech and low tech and how there will always be a place for reaching out to help others. I can’t wait for my next adventure!

April SCMS The Message 5


Medical Team International By John Gollhofer, MD Obstetrics and Gynecology (Retired) When I was president at the county and state, my message was completely secular. But there is the element of spirituality that runs through the practice of medicine, and I am now blessed to be part of Medical Teams International (MTI). MTI is an international faith based relief and development organization serving people affected by disaster, conflict and poverty. Since its founding in 1979, MTI has mobilized more than 2,200 volunteer teams and shipped more than $1.5 billion in medical supplies. MTI’s key international programs include disaster response, medical service and training, community health and education, HIV/AIDS treatment and prevention, emergency medical preparedness training and support, and humanitarian aid distribution. Last year they served 2.4 million people with an annual budget of $146 million.

medical team international volunteer in Haiti

In the Pacific Northwest, MTI’s fleet of 11 thirtyeight foot converted motor homes provides

mobile dental clinics to those who lack access, improving quality of life and decreasing Emergency Department (ED) visits. Medical Teams International also partners with 70 social service agencies, delivering health and hygiene supplies to the populations they serve.

medical team international volunteer in Uganda

International medical volunteer opportunities currently exist for virtually every specialty. The need is greatest in Africa, but there are also teams going to East Asia, Eurasia, Latin America and the Caribbean. MTI’s disaster response teams serve the urgent medical needs of those affected by natural or manmade disasters. MTI’s response-ready roster has current need for internists, general practitioners and ED physicians. I invite you to join me in service with Medical Teams International. For further information go to www.medicalteams.org.

medical team international volunteer in South Sudan

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April SCMS The Message 6


Pro-Papa Missions in Honduras By Glen O. Baird, MD Orthopaedic Surgery As the airplane landed at the San Pedro Sula, Honduras airport, I looked out the window and thought of a time 30 years ago. I arrived on February 24th accompanied by my oldest son, Daniel, a college student who aspires to become a physician. We would spend a week working with two non-profit organizations treating children with a variety of musculoskeletal conditions. I reflected on the past because I had lived in this Central American country in the early 1980s for a year and a half while serving as a missionary for my church. In the process I learned fluent Spanish, embraced Honduran culture and gained great admiration for the people. As a young adult previously naïve to the realities of the third world, I saw people, particularly children, challenged with a myriad of medical problems. Experiences I had then greatly influenced my career path: becoming a physician, choosing to specialize in pediatric orthopedics and even practicing at Shriners Hospitals for Children-Spokane. Honduras faces significant challenges. According to the World Bank, 59% of Hondurans live below the poverty line and 36% live in extreme poverty. The country continues to recover from Mitch, a Category 5 hurricane that struck Honduras in 1998, killing thousands, leaving many more homeless and crippling the nation’s infrastructure and agricultural industries. Additionally, the country is plagued by violence fueled by unemployment and drug trafficking. Honduras is a transit route for illicit drugs passing from South America to the United States and has the highest homicide rate of any country in the world. Healthcare resources are limited, particularly for the poor. We spent two days evaluating children in clinics and four days providing operative treatment. For the clinics we traveled to the mountain village of Santa Barbara and the town of El Progreso. We examined about 50 children, many with debilitating, yet treatable conditions. The clinics were organized by Pro-Papa Missions, a non-profit foundation that primarily serves people living in Yoro, a department (equivalent to a state) in the northern part of the country. Yoro encompasses an area almost twice the size of Spokane County and is home to members of the Tolupanes, an indigenous group that has resided in the area for centuries. ProPapa has sponsored pediatric orthopedic missions for many Glen Baird, MD and son, Daniel, years, with the specific standing outside an OR at the Cure Hospital, goal of reaching San Pedro Sula, Honduras.

impoverished children with musculoskeletal conditions living in rural, often isolated locales. Sister Laurinda Meyer has lived in Honduras since 1981 and directs Pro-Papa. She and her staff worked prior to our arrival to arrange clinic space in local hospitals, to advertise the clinics in surrounding areas and to garner the support of local medical practitioners.

An eleven day old infant in Santa Barbara, Honduras that has clubfeet and probable distal arthrogryposis. He has a brother and a sister that have clubfeet as well, supporting the diagnosis of distal arthrogryposis.

CURE International is a non-profit organization that sponsors medical programs in many developing countries and operates 10 hospitals world-wide, including a pediatric orthopedic hospital in San Pedro Sula, Honduras. Children from Pro-Papa clinics requiring surgery are treated at the CURE Hospital. The hospital staff includes full-time volunteers Ted Beemer, retired orthopedic surgeon, and his wife, Susan, a nurse anesthetist from South Carolina. The hospital provides excellent care but must constantly balance a paucity of resources with a never ending supply of patients. The staff is periodically augmented by visiting specialists who assist in patient care and participate in educational exchange. In four full days of surgery at CURE, I operated on children with a variety of orthopedic conditions, including hip dysplasia, clubfoot and polydactyly, sharing with a very capable medical staff the procedures used at the Shriners Hospital in Spokane. Conversely, I learned treatment methods for chronic osteomyelitis, an endemic problem in tropical Central America. Additionally, an anesthesiologist visiting from South Carolina educated the CURE staff on the use of peripheral nerve blocks. This was my second medical trip to Honduras. Bryan Tompkins, MD, a pediatric orthopedist who also works at Shriners Hospital, has made eight trips to Honduras over the last nine years. He began participating in surgical brigades with Pro-Papa through his orthopedic residency at State University of New York at Stony Brook and now leads most of the Pro-Papa orthopedic brigades. Daniel and I returned home at the end of the week feeling exhausted, but satisfied. We are humbled by memories of children like Marco, a stoic 14-year-old boy afflicted for five years with previously untreated femoral osteomyelitis that required him to wrap his leg with scraps of cloth to absorb constant purulent drainage or Odalis, a beautiful 10-year-old girl with a clubfoot never before examined by a physician, who traveled with her mother for two days from Guatemala to be seen in our clinic. We are grateful to have met these children and optimistic that their lives will be better.

April SCMS The Message 7


Renewal By Micheal J. Fallon, MD Anesthesiologist There are many reasons people go into medicine, but most want to make a difference in the lives of their patients. Yet in today’s medical staff meetings we frequently hear words like market share, Press Ganey, metrics and stakeholders. It sometimes feels like the goal of our medical systems is to separate the doctor from the patient with more focus on business than patients. Fortunately, early in my career I was able to spend three months in Southeast Asia working at a regional hospital. The weeks were full of caring for patients with diseases that I had only read about in textbooks, such as malaria, leprosy, advanced TB and malnutrition, etc. On the weekends we packed into the back of land-rovers and ventured down river bottoms and thru the jungles cutting trees and getting stuck but eventually reaching villages that only had health care once every twp years. Our field trips were pretty basic as we only had six medicines – prenatal vitamins, two drugs for parasitic worms, malaria treatment, an antibiotic and paracetamol. Record keeping consisted of one tick mark under the type of medication dispensed with many patients generating multiple tick marks. During that time I was also exposed to different cultures, religions and belief systems. Those three months convinced me I had made the right decision for my career in medicine. However, after 10 years of practicing Emergency Medicine I returned to the University of Washington and completed an anesthesia residency. While primary care is lacking in most developing countries the provision of anesthesia services is dismal and sometimes nonexistent in parts of many third world countries. The anesthetics in many countries are delivered not by MDs or CRNAs but by a floor nurse as an extra duty or technician who is not even a nurse. It truly is the see one do one training program with the trainer not very understanding of the subject. The same dose is frequently used for most if not all and those with co-morbid diseases or extremes of age may not survive induction of anesthesia. On a recent trip to Haiti I was asked about spinal anesthetic complications with C-section as this particular provider, a pediatrician, had three deaths with spinal placement for C-sections. On another trip, in Nicaragua, I was privileged to work with a very skilled Nicaraguan plastic surgeon who had returned to Miami for two additional years of training in anesthesia after his plastics residency. Most of his patients were pediatric and had a high fatality rate on induction of anesthesia by the hospital technician. He decided he must learn about anesthesia to direct the hospital technician. I was grilled constantly by him as he wanted to get current in his knowledge of pediatric anesthesia.

Happy little surgical recipent with pink hat

your history and physical exam can give you vital information. You also learn how people with limited resources have adapted ways to get things done. No non-rebreather oxygen mask is not a problem, as a Foley bag connected to an oxygen mask makes a good oxygen reservoir! Many caring people are doing the best they can with limited resources as well as limited education. I have been lucky to work with a variety of medical and surgical teams overseas that specialized in acute trauma, burn reconstruction, cleft lip and palate, obstetric and orthopedic reconstruction. On a trip to Africa with an international medical relief group that specializes in war torn and disaster areas I arrived after three days and two nights travel. First I received a two-hour briefing on dos and don’ts, kidnapping protocols and a warning people had been pulled out of vehicles and shot for taking pictures of police at intersections. As it was after 9 p.m., I was off to bed for my first goodnights sleep in three days. Two hours later a knock on the door informed me I had my first of many shootings. As the sole anesthesiologist I was to be on call the next 28 straight nights. We had two ORs and there was a three- week backlog of open femur fractures in part due to the lack of an anesthesiologist. My predecessor had been sent to Syria ten days prior to my arrival.

Volunteering overseas is as much about learning as it is about teaching. The basic monitoring we take as standard such as EKG and pulse oximetry is frequently not working or nonexistent. You learn your fingers on a pulse can be a valuable monitor. Since you may have very limited consultants you learn (again) how

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Her eyes looked at me as if to say, I am trusting you.


The backlog of open fractures was frequently “bumped” by critical patients that had been stabbed, shot or attacked with machetes. The needs were truly overwhelming. A veteran aid worker told me to stay focused on those we helped today and try not to think about those we did not get to. One particularly fatiguing night a local nurse informed me that I was lucky as I got to go home in a few days but this was her home and her life. The local nurses, as well as the expats, were frequently inspirational. I was working one particularly hot day with a expat chief nurse from Japan who told me equatorial Africa was not that hot as she had spent two years working in Iran wearing a black Burka every day! The courage of many of the patients was almost too much to believe. A 10-year old boy moved himself over from the gurney to the OR table dragging his leg with an unsplinted femur fracture and calmly bending forward for his spinal anesthetic without benefit of any benzodiazepines or opiates. A policeman who was part of the antiterrorism force had been shot five times and went to the OR four separate times before succumbing to his wounds. During my pre-op visits with him he was always telling me about his dreams of a safer life for his children. A school teacher and mother of three had a degloved tibia and a compound femur fracture but had traveled eight hours on rough African roads in the bed of a pickup truck hoping we could save her leg. The teenager who walks two miles to the hospital holding his intestines after being attacked with a machete. It was hard to say I was tired and needed to sleep with those courageous people suffering. I returned from Africa sleep deprived, 20 pounds lighter, due to parasites, and still thinking of all those I was not able to help. However, after a few days home, plus some metronidazole and my wife’s good food, I started to remember the smile of the child with the fixed femur, the happy tears of a mom realizing her child was going to live after a stabbing and the vigorous handshake of the man who will soon be able to work and feed his family. I also thought of the intense times spent with locals and expats from many countries. I thought of all I had learned from fellow physicians and coworkers and once again I remembered what the doctor-patient relationship is all about and why I choose medicine as a profession.

IN MEMORIAM

Harvey Gayle Copsey, MD Dr. Harvey Gayle Copsey, known to most as Gayle, died on March 8, 2013. He was a long time resident of Spokane and one of the original physicians at the Rockwood Clinic. Gayle was born in 1917 in Custer County, Nebraska to Harvey J. Copsey and Ruth Davis Copsey. He decided at a young age he wanted to become a doctor. When he graduated from high school in 1933, there was no money for college. Through a great deal of hard work and ingenuity he managed to scrape together money for a small regional college. From there he entered the University of Neb. medical school where he literally worked his way through school. While in medical school, Gayle met the love of his life, Patricia Hamer. They were married in 1941 and moved to Rochester, Minn. where Gayle began his residency in internal medicine and medical neurology at the Mayo Clinic. After completion of his training and the birth of their first child, Gayle and Pat moved to Staten Island, N.Y. There he served in the U.S. Army Medical Corps treating wounded during WWII. Following the end of the war and the birth of their son, Steve in 1946, they moved west. After a brief stay in Missoula, Mont. Gayle and family came to Spokane where he joined the newlyformed Rockwood Clinic as the fifth doctor in the group. He was a founding member of the Spokane Society of Internal Medicine. After the death of Patricia in 1977, Gayle married Louise Kemp in 1979. She preceded Gayle in death in 1992. He later married LaVern Rotend, who died in 2007. He was also preceded in death by his son, Steve, in 1971. Gayle is survived by his daughter, Cristine Ponti (Jim); grandchildren, Betsy Black (Nathan), Steve Marean and Annie Ponti and great grandchildren, Max and London Black. He will be missed by his family and friends.

Bradley Clifford Lind, MD Brad Lind, age 62, formerly of Tacoma and a Group Health physician from 1984-1994, had been living and practicing in Colville, WA died suddenly February 2, 2013. He is survived by his wife Lynn, ex-wife Janet, his and Janet’s two daughters Laura of Tacoma, and Kirsten, now in Munich Germany, his mother, Laura Lind of Stuart, Florida and his brother Fred Lind of Greensboro, NC.

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Remote Clinics in the Countryside By Derek Weyhrauch UWSOM MS3 The heavy weight of the canvas rucksack pulls on the thin nylon straps wrapped around my shoulder. My attention is elsewhere as I carefully take each step in the deep, red mud that only loosely constitutes a path through the jungle. Finally the steep downhill levels out into a grassy path meandering through the village. The rain has abated somewhat and I chance a glance forward, catching a glimpse of the rope bridge that will carry me over the shallow river and to the clinic site: a grassy clearing with a modest community center. This center is located, approximately, one 6-hour van ride, two hour boat ride, 1.5 hour 4x4 jeep ride, and one deep, red muddy hike outside of Guatemala City. The weight of the pack, filled with pharmaceutical supplies for the clinic, is lifted as I near my destination. Out of the corner of my eye, I notice a few children staring at me as I hike past, protected from the rain inside strawthatched huts. Guatemala is just one of the countries I have been extremely blessed to have visited while volunteering overseas, and each trip has been colored by many moments such as David Weber, MD, performs an ultrasound examination, with a machine generously on loan this one. Numerous from Sonosite, during one of his many trips to Guatemala with La Misión. The young woman was organizations tearful at the opportunity to see her baby for the first time in the womb. exist that facilitate the integration of American physicians with local organizations that work towards extending and establishing continuous care to remote reaches of underdeveloped nations in desperate need of medical service. The Dominican Republic was the site of my first medical humanitarian trip, a two-week journey completed with Medical Ministry International. We traveled to Nagua, in the northeastern region of the island nation, and held remote clinics in the surrounding countryside. With several physicians, amazing support volunteers, and an excellent (but highly portable) pharmacy, we were able to see and treat roughly 100 patients each day. I was just a pre-med volunteer at the time, but serving as an English-Spanish interpreter alongside the physicians afforded me an incredible window into interacting with patients while learning from my physician mentors. “It’s amazing,” Dr. Brown told me during lunch one day, “I love coming down here… it’s the practice of medicine as it should be - unencumbered by an insurance company disputing a claim or the threat of litigation and every patient seems truly grateful.” To my novice eyes, it

certainly seemed to be the case, as I watched each patient leaving with a smile after visiting the clinic and attending a health-prevention educational session while waiting for University of Washington Medical Students above Lake Atitlan, Guatemala during a month-long trip their prescription working alongside the organization La Misión. La Misión is a Guatemalan organization dedicated to to be filled. Just serving the impoverished of the country through establishing education and medical care. You can as fulfilling are learn more at www.lamision.org.gt. From Left to the enduring Right: Michael Harms (UW MS2), Derek Weyhrauch (author) and Justin Brandler (UW MS2). relationships formed, as I regularly visit with my longstanding mentor Lowell Johnson, MD, one of the physicians from this trip. There are innumerable reasons why one would feel led to participate in a short or long-term medical humanitarian service trip. Be it the culture, the people, the appreciative patients or even the incredibly intriguing chief complaints found amongst the bread-and-butter cases of gastritis and dermatitis. Oh, and of course, there’s also the coffee. Waking up early in the morning, I grab a cup and sit beneath a colossal tree overlooking the cliff-side view of Nagua and the Caribbean. The sun rises over the sleepy city and the tree awakens to birdsong as it’s warmed by the sun. I know that an all-too-brief day in clinic waits in one of the distant hills. There’s no better coffee than this on Earth. Derek Weyhrauch is a third-year medical student at the University of Washington, on the Spokane TRACK. He looks forward to more experiences, and more coffee, volunteering abroad in the future.

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

20 Years Mark A. Kontos, MD Kenneth E. Symington, MD Angela M. Ball, MD Maria L. Montenegro, MD Jay B. Reynolds, MD Kathleen R. Schuerman, DO

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4/7/1993 4/12/1993 4/14/1993 4/14/1993 4/14/1993 4/14/1993


Shriners Hospital for ChildrenSpokane’s Forgotten Hospital Part 1 of 3 By Paul Caskey, MD Orthopaedic Surgery As a longtime member of the Spokane County Medical Society, I enjoy reading the “The Message” every month when the newsletter arrives in the mail. Over the last couple years the month’s focus has included medical education, health inequities and safety net services in Spokane, military medicine, volunteer medical programs abroad as well as physician leadership. I feel it is timely to share with the Spokane County Medical Society the services the Shriners Hospital for Children provides as a resource in our community and as a participant in the medical issues focused above! The Shriners Hospital in Spokane opened in 1927 as a charity hospital for children with chronic orthopaedic conditions, primarily deformity and weakness from polio, cerebral palsy, spina bifida and Perthes disease. In the early 1990’s the focus of our hospital changed from this charity hospital model to a specialty hospital for pediatric orthopaedic problems provided by orthopaedic surgeons with fellowship training in pediatric orthopaedics, spine deformity and hand. We are part of a 22 hospital system in North America that provides care for children and adolescents with pediatric orthopaedic conditions, burns and spinal cord injury. Although our hospital will take insurance, all patients are cared for regardless of ability to pay and without cost to patients or families for services provided at our hospital.

deformity, complex pelvic osteotomy, limb lengthening, surgical dislocation of the hip, childhood and adolescent sports injury and ambulatory cerebral palsy. We offer acute care of stable pediatric fractures, slipped capital femoral epiphysis and are happy to help out with pediatric septic arthritis and osteomyelitis. Two of our surgeons are experienced in childhood and adolescent sports injury, especially injury about the knee. Last year our hospital performed surgery on over 800 patients including 54 spinal deformity fusions and evaluated over 7800 outpatients. You may have heard that the Shriners Hospital for Children in Spokane had been selected for closure several times in the last 25 years and may think we only treat chronic orthopaedic problems in children with no other means of medical care. I have good news - our hospital is alive, healthy and ready to serve the community. The clumsy application for treatment is no longer needed, you may fax your referral and chart notes to (509) 777-1223 or feel free to call one of our medical staff at (509) 623-0428 if you have a stable fracture, slipped capital femoral epiphysis, possible septic arthritis, osteomyelitis or other orthopaedic condition that you wish to refer or discuss with us emergently. Thank you for the opportunity to share the role and services the Shriners Hospital provides in our community.

The Shriners Hospital’s mission is threefold, providing excellent pediatric orthopaedic services, teaching of physicians and other health care providers and performing research to ensure quality care, develop new knowledge and improve the quality of life for our patients. Our employed medical staff includes four fellowship trained pediatric orthopaedic surgeons, the only fellowship trained pediatric orthopaedic surgeons in the Spokane region, a pediatric hospitalist, three orthopaedic PA’s and five anesthesiologists. Consulting staff includes fellowship trained hand and total joint orthopaedic surgeons, plastic surgeons, a thoracic surgeon, pediatric urology and a pediatric neurologist. Nursing staff, respiratory therapy and physical therapists with expertise in the management of the inpatient and outpatient pediatric orthopaedic patient complete our team. The expert medical staff at our hospital care for the full spectrum of pediatric orthopaedic problems including developmental dysplasia of the hip, slipped capital femoral epiphysis, upper and lower extremity deformity, spine deformity, pediatric amputations, benign bone tumors and neuromuscular problems such as cerebral palsy. Individual members of our medical staff have special expertise in the treatment of clubfoot, early and late onset scoliosis as well as other spinal April SCMS The Message 11


AMA Prescription for a Healthier Practice

For Your Information

Understand your contracts

In a March 1st open letter, the U.S. Food and Drug Administration (FDA) is encouraging physicians to take steps to help curb the nation’s growing epidemic of misuse, abuse and diversion of prescription painkillers containing opioids. In a blog posting about the announcement, FDA Commissioner Margaret Hamburg, MD, noted that the AMA is actively engaged in activities aimed at reducing the misuse and abuse of opioid medication. In response to the FDA initiative, the AMA encourages its members to make sure they know and understand the current drug labels for all opioids they prescribe; become educated about appropriate opioid prescribing practices and inform their patients about appropriate use of opioids, potential risks and proper disposal techniques for unused medications. More information about efforts to combat prescription opioid abuse and diversion are available on the AMA web page devoted to this topic.

FDA Urges Physicians to Help Address Opioid Misuse

For this month’s practice checkup, don’t let contracts with managed care organizations intimidate you—gain a better understanding of what they say. Start with “Obtaining, uploading and utilizing your contracted fee schedules,” and sign up for AMA Practice Management Alerts for additional helpful resources.

Prepare for health insurer retrospective audits The AMA, with cooperation from the American Academy of Neurology, created the educational resource “How to prepare for a health insurer retrospective audit” (for AMA members) to educate physicians and their practice staff about the recoupment efforts of health insurers through the retrospective audit process. Physician practices can use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit’s findings. Visit the AMA website to learn more about overpayment recovery and audits. The tips are part of the AMA Practice Management Center’s “Prescription for a healthier practice” series to help physicians and their staff examine how their practices are performing in key administrative processes. For more information go to AMA website at www.ama-assn.org/go/pmalerts.

May 1: Important Medicare Enrollment Date The Centers for Medicare and Medicaid Services (CMS) announced that, starting May 1, physicians who refer or order services for Medicare patients will be required to be enrolled in Medicare. Claims submitted on or after May 1 that include the name and National Provider Identifier (NPI) of a physician who referred or ordered services for a Medicare patient but who is not enrolled in Medicare will be denied. CMS had originally planned to implement this requirement in 2010, but the AMA succeeded in getting it delayed for several years, during which CMS has worked to ensure that physicians are enrolled. Physicians who have a valid opt-out affidavit on file are not required to enroll in Medicare. CMS also has a special, shorter enrollment form for use by physicians and other health professionals who just refer and order services but do not bill Medicare directly, known as the 855-0. More information on the new edits can be found at the CMS website. For more information on Medicare enrollment in general, please visit the AMA’s Medicare enrollment website.

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Dean F. Larsen, MA, CAE to be New SCMS CEO

In The News

Dean Larsen, who has been in the Salem area for over 17 years with the Marion-Polk County Medical Society (MPCMS), was chosen as the new SCMS CEO. The Search Committee chose Dean from of a number of qualified candidates. Dean says he is “still” very interested in the Spokane area after having applied for the SCMS CEO position in the past and thought it was a great opportunity then. After traveling around the world with the US Air Force, he thinks that the northwest is the place he wants to live. Many characteristics of the two medical societies are similar. Dean had great success in doubling the membership in the MPCMS during his tenure. He was successful in developing non-dues revenue sources so that the MPCMS only had to rely on dues for 10% of its budget over the last four years. Both of those accomplishments are significant for medical societies today. Effectively juggling multiple organizations, programs, issues and priorities was routine for Dean who was the executive director the last twelve years, in addition to operating a successful for-profit subsidiary and two 501 (c) 3 charitable foundations, He operated a physician and PA-C/NP recruiting program and developed a management agreement with the Oregon Dental Hygienist Association. It is exemplary that he was a true advocate for the medical community and called on often in Salem to represent the best interests of physicians in community-wide program activity that benefited the health of local communities.

Congratulations to Travis Prewitt, UBS-The Prewitt Group, an SCMS Community of Professionals partner, for being named as one of the “Best Financial Advisors for Doctors” for the third straight year! “Medical Economics’ recognition of our team as one of the country’s best financial advisors for doctors highlights our commitment to provide the same kind of specialized expertise and dedication to physician wealth care that physicians provide to community health care.” Travis Prewitt Recognized among 2012’s list of “Best Financial Advisers for Doctors” by Medical Economics magazine, The Prewitt Group works with physician clients in several states. Team leader, Travis Prewitt, has more than 32 years of experience providing wealth management to the medical community. Travis notes that, “Physicians are high achievers and should have high expectations for those who serve them. The financial rewards of their careers are delayed by many years of expensive medical training, so it is vital that they make the most of their window for building wealth.” Team financial advisors Travis Prewitt and Brad Desormeau bring in specialists as needed from one of the world’s largest wealth management organizations, and collaborate with the physician’s other professional advisors. They also understand the time constraints that physicians operate under, so the team works to be efficient and are “on call” to fit the schedules of their medical clients.

Dr. William “Bud” Pierce, PhD, MD, past president of the MPCMS and current President of the Oregon Medical Association had great things to say about Dean. “He always seems to get the right people into the room, including community members, when there were issues to be discussed and he really has helped the MPCMS develop well attended annual meetings.” Jan Buffa, MBA, PhD, CEO of the WVP Health Authority in Salem said, “Dean is so professional that I contracted with him for his management expertise, not to mention the fact that he is a very strategic thinker and really knows how to develop relationships.” As the new SCMS CEO, Dean will be supporting the leadership in their implementation of the new Mission, Vision and Strategic initiatives which were developed in 2012. Please join with all the members of the SCMS in welcoming Dean to Spokane and the medical community as he begins his duties on Monday, April 15, 2013.

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2013 Women Physicians Retreat a Success! The Bozarth Mansion and Retreat Center was the setting of the 2013 retreat attended by 22 women physicians. Friday evening, March 15, started with appetizers and getting to know one another, followed by dinner and massages provided by the staff of the Inland Massage Institute, Inc. Saturday morning was a time for walking around the grounds and enjoying the deer and peace and quiet, participating in the gentle stretching exercise class led by Cynthia Cilyo, MD or just sleeping in. After breakfast, author Glenda Burgess reviewed her book, The Geography of Love. Following a short break, Emily Kelly, from Witherspoon – Kelley Attorneys & Counselors, presented a talk on Estate Planning Fundamentals. Witherspoon – Kelley generously sponsored the rental of the mansion.

Cynthia Cilyo, MD leads attendees in gentle stretching

Everyone is looking forward to 2014!

Emily Kelly, Witherspoon Kelley Law Offices, presents Estate Planning Fundamentals

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Author Glenda Burgess discusses her book

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Val Logsdon, MD; Deb Harper, MD and Cynthia Cilyo, MD (members of the event planning committee)


Medical Community Providers and Leaders Support Project Access at Public Hearing By Sarah Bates, Project Access Operations Manager The Community Development Block Grant (CDGB) is one of the few ways to access public funding for Project Access. Those are federal dollars that are channeled through the Spokane County Community Services, Housing and Community Development Department that manages the local grant process. The grant requests are reviewed by the Spokane County Housing and Community Development Citizen Advisory Committee, a volunteer committee of local citizens from each of the communities in Spokane County. It makes preliminary funding recommendations that are reviewed and approved by the Board of County Commissioners in mid-April. Approved funding is disbursed in July. Project Access received funding from the CDBG, $7,000 to $14,000 per year from 2008 through 2011, to cover the cost of prescriptions, transportation and durable medical equipment for clients. In 2012 Project Access submitted a request for $46,000 to cover general operating expenses and unfortunately received nothing. Project Access submitted a 2013 grant request for $27,400 to cover general operating expenses. The Advisory Committee is recommending that Project Access receive $20,000. It isn’t a huge amount of funding, but one of the important things is that this year the funding will be a commitment for two consecutive years, so this is potentially a total of $40,000 over two years. The preliminary funding recommendations were open to public comments at a public hearing on March 7. Sometimes, the Committee makes changes to their recommendations based on public comment. We wanted to do everything possible to make sure Project Access receives the recommended amount. Thank you to Bill Bender, MD, Rob Benedetti, MD, Larry Carpenter, PAC and Nathan Meltzer, MD for attending the hearing. They presented their reasons for supporting Project Access. With their permission, we recorded their comments and share excerpts of their statements below. All of us at Project Access greatly appreciate the support we received from this cross-section of medical community providers and leaders!

Bill Bender, MD “I am and neurologist from Columbia Medical Associates and I have been donating services to Project Access since its inception nine years ago” When charity care is uncoordinated, “it mostly amounts to visits to the emergency rooms and urgent care centers, and never really ‘scratches the itch’ to provide the type of healthcare that actually

restores people to being productive members of the community.” “For me as a neurologist, I deal with a number of chronic healthcare conditions that keep people out of the workforce. Conditions as simple as chronic headaches or seizures, conditions that are fairly easy to treat for neurologists, but are difficult to be treated on intermittent visits to the emergency room when that person does not get follow up [care]. I feel very good about the care that I provide to potentially bring people back to a restored status.” “Project Access takes uncoordinated, uncompensated care…. and coordinates it and helps make something productive out of it which is why I will continue to participate in Project Access.”

Larry Carpenter, PAC “I am a Physician Assistant. I work at Christ Clinic…a clinic that primarily takes care of low income, working class poor, uninsured and homeless people. I am one of the people in the trenches that access the care these great doctors donate…I have patients who would have died or had horrible outcomes if it had not been for Project Access” “I have one patient, a 20-year-old young lady who I first saw about a year ago…I suspected Lymphoma [in this patient]. Project Access got her to Inland Imaging. She got an ultrasound and a biopsy and the pathology confirmed the diagnosis; she had Lymphoma throughout her entire body. Through Inland Imaging, she got a PET scan. She had it in her bones, her stomach, her lungs, her neck, everywhere. Through Project Access, she got access to oncology management. I saw her about a week ago – she is now cancer free….I can’t even say how valuable Project Access is to our community.” “Regardless of what is going to happen with Obamacare…there will always be people who fall through the cracks and Christ Clinic is going to be there to bridge that gap and we use Project Access on a regular basis…I hope that you support Project Access.”

Robert Benedetti, MD “I am a kidney specialist and the Medical Director at Rockwood clinic. I have participated in Project Access personally and, as Medical Director at Rockwood, I oversee the quality of care in addition to the access to care that all the doctors at Rockwood Clinic participate in.” “Project Access adds value to our organization by making sure that those physicians who are willing to donate charity care do so on a level playing field. There are many of us who feel that is our obligation to [provide charity care] and would do it even if Project Access were not around. However, what Project Access does that is so valuable is that it collects all the willing providers who are donating their care and disperses that care in an equal basis so that no one is doing an unfair share of charity care.”

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“Without Project Access patients would wait a lot longer to get care….it would take months to get into specialists’ offices without insurance. They add value to the patients because they receive care more quickly and in a more coordinated fashion and sooner than they would have.”

Inland Imaging and SCMS Host Mammogram Party

“The cost to the community would be increased from more advanced stages of diseases that progress because people don’t get care as quickly as they needed and the cost to the individuals would certainly be greater. “I would encourage you to give as much as you can to Project Access because it adds great value to our community”

Nathan Meltzer, MD “I’m a physician at Valley OB/GYN….I think in the broken and very unjust system that we call healthcare, there is a place for us to take care of our own. I think Project Access does that in a way that I’ve not seen anywhere else.” “I had a patient…who was in that situation where she was the working poor. She made just enough money to not qualify for Medicaid, but she was having a heavy amount of vaginal bleeding from her condition that required a surgical intervention that she couldn’t afford. It would have bankrupted her. Plenty of people fall through the cracks…and people go bankrupt or just don’t get the care they need. What she was able to do was to go through Project Access. That allowed my group to accept her as a patient, which empowered me to take her to the hospital so the radiologist, pathologist and surgical staff would allow me to do a simple surgery, requiring only a one night stay. This cured her bleeding so she could back to work full-time. She is now back to being a member of society with good health.”

Amy Henkle, MD (Inland Imaging Radiologist) reading the mammograms.

On the evening of February 28, Inland Imaging and SCMS hosted a Mammogram party. Massage therapists from Whispering Falls Massage Therapy provided chair-massages and the Varicose Vein Center offered free vein screenings. There was plenty of food and drinks for everyone to enjoy and time to visit with colleagues Thank you to Dr. Florence Gin and Inland Imaging for arranging the party. Plan to attend next year and join the fun!

“Project Access exists because there is that need. It’s not the answer, but a piece of the puzzle that I think is critical and I think it is a highly efficient use of dollars….Doctors, like myself, feel very, very good about donating care [through Project Access].”

Project Access Thanks You For Your Support!

Terri Oskin, MD; Flo Gin, MD and Mary Badger, MD Mammogram Party attendees

Attention Bloomsday Runners & Walkers Need a safe place to leave your warm-up suit? Would you like something to eat or drink before the race? This year UBS - The Prewitt Group, an SCMS Community of Professionals Partner, is providing a secure, warm location at the Bank of America Building for all SCMS members and their families and friends before and after the race.

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POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/ work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Toni Weatherwax at (509) 444-8888 or hr@chas.org. QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at (800) 260-1515 x5366 or email gmelkus@qtcm.com or visit our website www.qtcm.com to learn more about our company. PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments. We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical! CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide. OPI owns and operates plasma collection centers critical to the development of lifesaving patient therapies utilized by thousands of patients globally. Learn more at www.OctapharmaPlasma.com. Apply today by sending your resume/CV to Careers@OctapharmaPlasma.com! PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com. FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University

of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at (509) 4590688 or e-mail at BorgwaD@fammedspokane.org. SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PA-C N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider. Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org. PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS Let us help you get started in earning additional professional income! We are an established I.M.E. practice currently looking for Active Practice and Board Certified Orthopedic and Neurological Doctors, to perform Workers Compensation Exams. Located just minutes away from Rockwood Clinic in North Spokane, we offer a flexible schedule in a helpful, working environment. Previous experience performing Workers Compensation Exams is not required. Please contact Lorraine Stephens for further information at (509) 484-0380. EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, (509) 565-4352, email maikeshi@ dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800. PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education. Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by Alice Wasilwa RN with two other Kenyan nurses and provides primary care. Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV. There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly. We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct. 18 – 28, 2012. If you would like to volunteer please contact Stacey Mainer at info@ partneringforprogress.org. NORTHWEST MEDICAL SPECIALTY EVALUATIONS - Physicians wanted for medical disability exams in our Spokane office. Excellent pay. Work is low stress with minimal paperwork and no ongoing patient care responsibilities. We can schedule around your availability seven days per week. For more information call (509) 588-7340.

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PROVIDENCE HEALTH & SERVICES has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Regular 8-5 hours, five-day week. New physicians will join Providence Medical Group, our physicianled multispecialty medical group with clinics throughout the metropolitan area. Excellent compensation and benefits. Providence Medical Group (PMG) – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or 509-474-6605 for more information.

The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

PHYSICIANS Badgley, Margaret K., MD Internal Medicine Med School: David Geffen - UCLA (2010) Internship & Residency: Providence Medical Center (2013) Practicing with Rockwood Clinic 07/2013

PROVIDENCE MEDICAL GROUP (PMG) - Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in this scenic suburb of Spokane. Full-time opportunity with our growing medical group in what will be a large, stateof-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only. Competitive compensation and comprehensive benefits. Providence Medical Group – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@ providence.org or 509-474-6605 for more information.

Phillips, William H., MD Family Practice Med School: U of Washington (1999) Internship & Residency: U of Minnesota/North Memorial (2002) Practicing with Community Health Association of Spokane 01/2013

FULL-TIME LICENSED PHYSICIAN ASSISTANT - PA (Spokane) Physician Assistant wanted for expanding clinic in Spokane, WA. Currently see patients four days per week, Monday through Thursday, 8 am to 5 pm. Approximately 24 patients per day. No call, weekends or holidays. Fabulous benefit package. Vacation and CME benefits provided. Starting salary depends on experience. Submit resume and cover letter to knorton@neuroandspine.com.

Nye, Andres M., MD Family Medicine Med School: Albany Medical College (1997) Practicing with Providence Family Medicine Residency 03/2013

Greenawalt III, James W., MD Anesthesiology Med School: U of Oklahoma (1983) Internship & Residency: U of Oklahoma (1983) Practicing with Anesthesia Associates 8/2013

PHYSICIANS PRESENTED A SECOND TIME

Rajendra, Rajeev, MD Internal Medicine/Oncology/Hematology Med School: Dr. D.Y. Patil Medical College (India) (1996) Practicing with Medical Oncology Associates 08/2013

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Continuing Medical Education

Meetings/Conferences/Events

Obesity Update 2013: This 2.75 hour AMA Category I CME seminar is sponsored by the Spokane County Medical Society. This activity has also been reviewed and is acceptable for up to 2.5 Prescribed credits by the American Academy of Family Physicians. This conference is one of the evening workshops for the 2013 Primary Care Update and will be held on May 2, 2013 5:30 – 9:00 p.m. at the Red Lion Inn at the Park. The 2013 course will present the latest material on the pathophysiology, the medical management and surgical treatment of obesity. This program will provide attendees with take-home strategies for improved treatment for this patient population. Contact Karen Hagensen at (509) 325-5010 or email Karen@spcms.org for more information. Rockwood Health Systems Breast and General Tumor Boards: These tumor boards are jointly sponsored by Rockwood Health Systems and the Spokane County Medical Society. Tumor Boards will be held weekly January – June 2013. Each Tumor Board is worth 1.0 Category I CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@ rockwoodclinic.com. Promoting Healthy Families (Practice Management Alerts from the American Medical Association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org.

Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at 509.358.7631. Spokane Guild of the Catholic Medical Association- Meets second Wednesday of each month at 6 p.m. at Providence Sacred Heart Medical Center Administrative Board Room in Administration on the Main Floor. All are welcome. For inquiries contact Phil Delich, MD at (509) 465-1554 or e-mail at delichphil@gmail.com. Medical Reserve Corps of Eastern Washington General Membership Meeting - Spokane Regional Health District Auditorium, 1101 West College Avenue, 6:00 - 8:00 p.m. Wednesday, 10 April 2013. Everyone is welcome to attend. Meeting topics include Gunshot Wounds, Psychological Assistance for Gunshot Wound Victims and the Coordinator’s report. Established date for next month’s meeting, 8 May 2013. Disaster response and preparedness involves all of us at home or at work. For more information contact David Byrnes at DByrnes@srhd.org. Free Bloomsday Training Programs – Are you doing Bloomsday this year? Check out www.stepupandgo.org for free 8 to 16-week training programs to help you meet your walking or running goals for the 2013 run and for life. You will find the training programs under the Challenges tab at the top left corner of the website, next click on the View Available Challenges link to find the Bloomsday Tracker. What are you waiting for! WSMA Webinar - Health Benefit Exchange & Medicaid Expansion: Guidance for Physician Practices Tuesday, April 9, 12:00–1:30 p.m. By early 2014, an estimated 280,000 Washingtonians will become insured through Healthplanfinder, Washington’s health benefit exchange, dramatically reshaping the health care market. Physicians and practice staff will need to consider many critically important questions as health insurers offer new products, assessing which networks to join and the impact of those choices on the financial viability of their practice. Build your understanding of the health benefit exchange and the Medicaid expansion during this timely webinar. WSMA and WSMGMA members can participate for $49. For more information contact Jenelle Dalit at 1-800-552-0612 or jcd@wsma.org. Free National Environmental Health Association Courses sponsored by the CDC and EPA available. Courses include National Environmental Public Health Performance Standards Workshop: Building Local and National Excellence, Biology and Control of Insects and Rodents Workshop, Environmental Health Training in Emergency Response and Environmental Public Health Tracking 101. For more information go to the website at www.nehacert.org.

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Cl assified Ads REAL ESTATE

MEDICAL OFFICES/BUILDINGS

Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including full-sized washer and dryer. Wired for cable and phone. For Rent $ 850/month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com. Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962. Large Second Owner Custom Built Executive Home with unparalleled views of Liberty Lake and Spokane Valley on five acres available for sale or lease in March. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den. Walk out basement, wood stove, kitchen and bathroom. Large 30 x 100 pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512.

South Hill – on 29th Avenue near Southeast Boulevard Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860. North Spokane Professional Building has several medical office suites for lease. This 60,000 sf. professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include pediatricians, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease. Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net. Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com. Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic. Parking is ample and convenient. The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location.

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Stay and Play rates starting at $199! Rates include golf for two players- 18 holes, cart with GPS, practice facility and one night stay.

8 0 0 5 2 3 2 4 6 4 | U S H W Y 9 5 , W O R L E Y, I D A H O | C I R C L I N G R A V E N . C O M

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

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The Message, April 2013