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Sombrero

Pima

County

Medical

Society

Home Medical Society of the 17th United States Surgeon-General

APRIL

2015

Stars on the Avenue issue

on the STARS AVENUE Campbell Ave Stars on the Avenue 2015 PRESENTED BY THE Pima
on the
STARS
AVENUE
Campbell Ave
Stars on the
Avenue 2015
PRESENTED BY THE
Pima County
“An Evening under the Stars”
Medical Society
A Medical Community Celebration
to Honor Tucson’s Outstanding Physicians
Stars on the Avenue returns April 18, 6-9 p.m., at St. Philip’s Plaza and features an
exclusive invitation list limited to physicians and their guests. Progressive dining is
provided by outstanding Tucson restaurants as we honor local doctors and raise money
for Mobile Meals of Tucson.
Presented by Pima County Medical Society and PCMS Alliance, Stars on the Avenue
expects more than 350 physicians to attend this year’s event as we honor our
“Physician of the Year” and others for their outstanding service and commitment to
organized medicine, volunteerism, and for a lifetime of achievement in the practice of
medicine.
Event proceeds go to Mobile Meals of Tucson, an organization that helps preserve the
health, dignity and independence of home-bound adults by delivering special diet
meals. Volunteers not only deliver meals, but also provide social contact and a
connection to other community organizations.
For group discounts or information about event sponsorships please contact PCMS
Executive Director Bill Fearneyhough at 795-7985 or email billf5199@gmail.com.
Tickets may be purchased by logging onto pimamedicalsociety.org and clicking on
“Purchase Stars on the Avenue Tickets” tab.

Sombrero

Official Publication of the Pima County Medical Society

Vol. 48

No. 4

 

Pima County Medical Society Officers

PCMS Board of Directors

Snehal Patel, DO (Alt. Resident) Joanna Holstein, DO (Alt. Resident) Jeffrey Brown (Student) Juhyung Sun (Alt. Student)

Members at Large

Arizona Medical

Association Officers

President Melissa Levine, MD President-Elect Steve Cohen, MD Vice-President Guruprasad Raju, MD Secretary-Treasurer Michael Dean, MD Past-President Timothy Marshall, MD

Eric Barrett, MD David Burgess, MD Michael Connolly, DO Jason Fodeman, MD Howard Eisenberg, MD Afshin Emami, MD Randall Fehr, MD G. Mason Garcia, MD Jerry Hutchinson, DO Kevin Moynahan, MD Wayne Peate, MD Sarah Sullivan, DO Salvatore Tirrito, MD Scott Weiss, MD Leslie Willingham, MD Gustavo Ortega, MD (Resident)

Thomas Rothe, MD immediate past-president Michael F. Hamant, MD secretary

Richard Dale, MD Charles Krone, MD Jane Orient, MD

At Large ArMA Board

R. Screven Farmer, MD

Pima Directors to ArMA

Board of Mediation

Timothy C. Fagan, MD Timothy Marshall, MD

Delegates to AMA

Timothy Fagan, MD Thomas Griffin, MD Evan Kligman, MD George Makol, MD Mark Mecikalski, MD

 

William J. Mangold, MD Thomas H. Hicks, MD Gary Figge, MD (alternate)

Executive Director

 

Bill Fearneyhough

Phone:

795-7985

Fax:

323-9559

E-mail:

billf 5199@gmail.com

Advertising

Phone:

795-7985

Fax:

323-9559

E-mail:

dcarey5199@gmail.com

Editor Stuart Faxon E-mail: tjjackal@comcast.net Please do not submit PDFs as editorial copy.

Art Director Alene Randklev, Commercial Printers, Inc. Phone: 623-4775 Fax: 622-8321 E-mail: alene@cptucson.com

Printing Commercial Printers, Inc. Phone: 623-4775 E-mail: andy@cptucson.com

Publisher Pima County Medical Society 5199 E. Farness Dr., Tucson, AZ 85712 Phone: (520) 795-7985 Fax: (520) 323-9559 Website: pimamedicalsociety.org

SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual subscription price is $30. Periodicals paid at Tucson, AZ. POSTMASTER: Send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily repre- sent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Officers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted. Copyright © 2015, Pima County Medical Society. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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Inside

5

Dr. Melissa Levine: Silence is golden? Don’t you believe it!

6

Letters: He would do it again, too.

7

Milestones: Dr. Epstein retires, Dr. Weiss honored, and more.

10

Membership: Life in the Age of Hilts.

12

In Memoriam: Dr. Clovis Jack Snider died in February.

13

PCMS Awards: Everything you wanted to know about our awardees, to be presented at Stars on the Avenue April 18.

17

PCMS News: AMB takes another executive director shot.

20

Urology: Dr. Susan Kalota addresses the vaginal mesh controversy.

21

Stars on the Avenue: On April 18, our event again had two reasons for its title.

23

Makol’s Call: Gearhead George goes to the Barrett-Jackson.

26

CME: Credits locally and out-of-town.

2 6 CME: Credits locally and out-of-town. On the Cover The 11-inch Schmidt-Cassegrain telescope

On the Cover

The 11-inch Schmidt-Cassegrain telescope brings in detailed views of the desert night sky as part of a Star Tour. Arizona Star Tours uses several of these telescopes as part of the 2015 Stars on the Avenue event on April 18. Ben Loker, owner of Arizona Star Tours, is featured in this month’s issue. (Arizona StarTours Photo).

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Let’s talk By Dr. Melissa Levine PCMS President I n January I received a finger-

Let’s talk

By Dr. Melissa Levine PCMS President

I n January I received a finger- print card and a letter telling me to get printed and send in $50 before I could renew my license at the end of March.

“One moment please for Dr. X.” I was put on hold and after a couple of minutes it rang back, I explained to the person who picked up that I was waiting for Dr. X, he explained that Dr. X was at a different office and transferred me to the back line there. Someone picked up and I again explained I was waiting for Dr. X. I actually waited through three loops of this, caught in my own personal, perverse “Groundhog Day” movie. Finally Dr. X’s MA picked up and asked me if I needed to talk to him again. I explained I had yet to speak to him. Unfortunately, he had left for the hospital. It did end successfully, as she gave me his cellphone number and we spoke.

This is where PCMS can help enhance communication. I invite all of you to come to a board meeting, get involved. Your medical society needs to ask you the right questions, but we can only do this if you answer them.

Tell us what you think needs to be done with the organization, with medicine in Pima County, and in Arizona. Or come to a Mix at Six where we can simply socialize—spouses invited. Coming up April 18, as you can tell from this issue of Sombrero, is Stars on the Avenue, where not only can you socialize, but you can come honor some of our local docs and support Meals on Wheels.

There are opportunities for you. Lets communicate.

Because this sounded like a pain

in the patootie, and I was privy to ongoing legislation that might

negate the need to do this, I delayed. While I am not loving what Gov. Doug Ducey is doing to education, I am happy to say that thanks to a push from ArMA, and PCMS, he signed legislation that relieved the necessity of background checks for physicians who are renewing licenses.

Last weekend with little hassle and a lot of $$$$, I successfully renewed both my license and DEA online. The downside to that is that this column was going to regale you with the details of going down to the police station to be fingerprinted, wading through the red tape of background checks, and what PCMS and ArMA were doing to help you avoid a similar harrowing experience.

So, Plan B: Communication is the cornerstone of relationships, personal, professional, and doctor-patient. You have likely heard the story of the patient who was told by her doctor to put on a new patch every three days, and she came in for follow-up complaining she was running out of room to place patches. She was wearing 10 of them. Communication failure.

We all know that communicating with our patients, establishing the human connection with them, is the key to the practice of medicine. I work with an EMR, so often I am typing as well as listening. I have to make a significant effort to make eye contact, and to make sure I am really paying attention. Doctors have to ask the right questions and listen to the answers, as sometimes the most important part of communicating is hearing what isn’t being said.

But what about communication with other physicians? Clearly, we need to communicate with our colleagues. I hear frequently, “In the old days, doctors used to see each other in the doctors lounge. Now we never meet each other.” That was certainly an issue when I was in my own little one- woman office, I never saw other doctors, and only communicated when I needed to talk to a specialist about a patient.

A couple of years ago, my MA knocked on

the door and told me a cardiologist was on the phone for me. I had just finished with the patient I was seeing, and walked to my office to pick up the phone. His MA said,

n

with the patient I was seeing, and walked to my office to pick up the phone.
with the patient I was seeing, and walked to my office to pick up the phone.
with the patient I was seeing, and walked to my office to pick up the phone.
with the patient I was seeing, and walked to my office to pick up the phone.

Le ers

On ‘doing it again’

To the Editor:

I was pleased to read PCMS President Dr. Melissa Levine’s article in the March Sombrero [pondering whether a physician

would choose that career again]. Like Dr. Levine, I am one of those who would do it again, as I loved every day of caring for patients.

I too did not like dealing with the administrative problems, but that did not squelch the desire to care for my patients.

I also agree with her statements about Electronic Health Records. It was more cumbersome for physicians to use, but better for everyone else and for patient care.

Sincerely,

Steven J. Ketchel, M.D., F.A.C.P. Retired medical oncolocist Tucson

[Editor’s note: Dr. Ketchel is PCMS 2015 Volunteer of the Year.]

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Milestones

Dr. Epstein retires

“Not only did it receive accreditation in all areas, but The Breast Center also is being recognized as a national best-practice in breast cancer surveillance. For Tucson-area women, this means they can receive care at Carondelet that meets the highest standards based on national best practices.”

The Breast Center at Carondelet St. Mary’s focuses on prevention, early detection, and expert treatment of breast disease, such as breast cancer. “It differs from other breast centers,” the organization says, “because of its standardized, coordinated path of care from initial surgeon visit to post-discharge follow-ups. The clinical team offers a holistic approach to treatment, meeting each week to discuss treatment plans and to follow each patient through every aspect of care—from diagnosis to treatment to recovery. Patients have access to genetic counseling, Carondelet’s bilingual patient navigator who provides education and support, and to other specialists, such as a physical therapist and social worker.”

“NAPBC accreditation is the gold standard for breast care and something the team of specialists at St. Mary’s has been working toward since the Center’s inception in 2011,” said Amy Beiter, M.D., president and chief executive officer of Carondelet St. Mary’s Hospital. “It is a wonderful testament to the quality of care patients receive here and the commitment of our medical staff and clinical teams.”

“Approximately 550 breast centers across the US have earned this distinction,” Carondelet reported, “including three in Arizona. Two are in Phoenix, and now The Breast Center at Carondelet St. Mary’s makes three. To receive NAPBC accreditation, a facility must undergo a rigorous process, and score top marks in all 28 program standards, which measure leadership, clinical management, and quality improvement criteria.”

Dr. Norman R. Epstein, a member of the PCMS Public Health Committee, retired from his IM practice in January after nearly four decades as an internist in Tucson. Dr. Leslie Willingham and another physician former partner in ACP/El Dorado Internal Medicine and Family Practice, assumed care for a majority of his patients, Dr. Epstein reported.

Dr. Epstein is a native New Yorker who graduated from NYU, received his MD from SUNY Downstate Medical Center in 1972, interned at Kings County/Downstate, and completed his IM residency in the Tucson Hospitals Medical Education Program in 1975. He is board-certified in IM and is a Fellow of the American College of Physicians.

He worked at El Rio Neighborhood Health Center 1975-79, then took a one-year sabbatical to travel with his wife to the U.K., Greece, Kenya, and India in 1979-80. Upon his return he became founding medical director of CIGNA Healthplan in Tucson, then known as INA, a position he held until 1987. He remained at CIGNA as a practicing internist until 2000 when he joined Arizona Community Physicians, where he has practiced for the last 14 years.

Dr. Epstein is an avid Wildcat basketball fan, is married to the botanical artist Margaret Pope, and has a son who is a biomedical engineer in Southern California. He said he hopes to spend his retirement years cultivating an interest in writing and the arts. He had three essays printed in the “On Being a Doctor” section of Annals of Internal Medicine; and has “dabbled” in clay sculpture and photography, with three photographs published in NEJM. He said he looks forward to having an open schedule for relaxation, travel, working around the house, and enjoying his friends and family.

Carondelet St. Mary’s awarded for breast care

In March The Breast Center at Carondelet St. Mary’s Hospital was granted full accreditation from the American College of Surgeons National Accreditation Program for Breast Centers (NAPBC), “the highest recognition a breast center can receive,” the organization reported. “Carondelet’s program is the first breast center in Southern Arizona to receive this distinction, making it Tucson’s first and only fully accredited breast center.

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SHM honors Dr. Weiss

Dr. Scott Weiss recently received the prestigious designation of Fellow in Hospital Medicine from the Society of Hospital Medicine, in honor of his dedication to the specialty.

Dr. Weiss is one of two designated Chief Hospitalists for Sound Physicians

at Carondelet St. Joseph’s Hospital. Sound Physicians recently acquired Cogent Healthcare. The combined companies are now one of the nation’s largest providers of hospitalist services.

of the nation’s largest providers of hospitalist services. Dr. Galgiani clinical adviser to HealthTell Dr. John

Dr. Galgiani clinical adviser to HealthTell

Dr. John N. Galgiani, director of the UA Valley Fever Center for Excellence, was recently appointed a clinical adviser to HealthTell, an “early stage” life-sciences company based in San Ramon, Calif., which is expanding its Immunosignature technology for “accurate and timely detection and monitoring of chronic diseases to include infectious and autoimmnune diseases,” the university reports.

and autoimmnune diseases,” the university reports. Dr. Galgiani and Chaim Putterman, M.D. of New York’s

Dr. Galgiani and Chaim Putterman, M.D. of New York’s Albert Einstein College of Medicine were both appointed. In announcing the appointments, Bill Colston, Ph.D., HealthTell CEO, said, “HealthTell is excited to welcome Dr. Galgiani and Dr. Putterman to our growing team of clinical advisers. They will provide valuable insights to expand our focus beyond oncology to infectious and autoimmune diseases. Our robust and unique test provides a snapshot of the immune system’s response to disease. We are grateful to have the opportunity to collaborate with clinicians and researchers of this caliber.”

“There certainly is a need for new diagnostics to help physicians manage patients with Valley Fever,” Dr. Galgiani said, “especially early in the infection when current tests frequently are falsely negative.”

Dr. Galgiani has 35 years of experience in medical mycology including the soil-borne Coccidioides fungus that when inhaled causes coccidioidomycosis or Valley Fever, an infectious disease primarily of the lungs. Cocci is endemic to the Southwestern United States and Northwestern Mexico, including Arizona and the San Joaquin Valley of California. It results in an estimated 150,000 infections annually. Often it is confused with community- acquired pneumonia and treated erroneously with antibiotics. In a small percentage of patients it can be life-threatening. Dr. Galgiani has devoted his career to raising awareness and improving outcomes for people affected by Valley Fever.

The VF Center for Excellence has also produced a booklet to improve VF diagnosis and treatment. The new pocket reference for physicians and other healthcare professionals is available through several organizations including the U.S. Centers for Disease Control and Prevention.

“The booklet includes all the facts that physicians and other

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healthcare professionals need about Valley Fever, including how to diagnose it and what to do when a new infection is discovered. While this information has existed for many years, it now is readily available so that busy clinicians can include it in their routine practice,” the UofA reported. The booklet was made possible by an unrestricted educational grant from Nielsen Biosciences, Inc.

“This grant has enabled the Center to do something it long has hoped for,” Dr. Galgiani said. “We have had this information available on our website, but now we can distribute the information in a form that makes it readily available to busy clinicians. The booklet is small enough to fit in their lab coat. If doctors were more attuned to how common Valley Fever is, they would look for it more frequently. Early diagnosis should reduce the use of antibiotics and lots of additional testing, none of which helps the patient, and increases costs.”

The booklet’s first printing, in January, was 5,000 copies—enough for the Center to give a free copy to every medical student and medical resident in Arizona. Copies also are available through the Arizona Medical Association, the medical societies of Pima and Maricopa counties, ADHS, and the CDC. An electronic copy of the booklet also is posted on the Valley Fever Center for Excellence website at www.vfce.arizona.edu

UAHN named ebola treatment center

The U.S. Centers for Disease Control and Prevention last month named University of Arizona Health Network one of 55 Ebola Treatment Centers in the U.S., the university reported.

“We’d like to thank the UA Health Network and MIHS for stepping up to ensure appropriate treatment is available to Arizonans when faced with any infectious disease,” said Cara Christ, M.D., chief medical officer, Arizona Department of Health Services. “Their ability to implement higher infection control practices and excellent patient care demonstrates their commitment to the health and wellness of all Arizonans.”

In December 2014, UAHN was named one of two Infectious Disease Centers of Excellence by ADHS, making it Southern Arizona’s hospital for the treatment of Ebola and other highly infectious diseases, the university reported. Since then, UAHN has conducted two Ebola readiness drills, undergone a site visit by CDC specialists, and sent staff members for additional training at the CDC in Atlanta, and Emory University, where a number of Ebola patients received treatment.

Both of UAHN hospitals, UAMC–University Campus and UAMC– South Campus, are prepared to identify and diagnose Ebola, the university reported. “Both hospitals draw on the expertise of dozens of clinicians and researchers specializing in infections disease medicine and critical care,” said Sean Elliott, M.D., UAHN infection prevention director and a member of the Governor’s Council on Infectious Disease Preparedness and Response.

Plans are underway at South Campus to convert several isolation rooms into a Southern Arizona Biocontainment Unit (SABU), ready for the treatment of Ebola or any other highly infectious diseases, he added.

“Even though the likelihood of us seeing an Ebola patient is remote, we are working every day to be ready for that possibility, and for any other emerging infectious disease emergency,” Dr. Elliott said. “Our responsibility for the health and safety of our patients, our health-

care workers and the public is uppermost in all our minds.”

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Dr. Schuyler Hilts

Nuclear medicine pioneer

I t’s pretty amazing,” amazes Dr. Schuyler Van Dusen Hilts, 87, “that other than high blood pressure, there’s nothing wrong with me.”

Craggy, tall and gangling, with hearing aids, he goes to the “Y” three days per week where he “fights machines.” He enjoys poker, and blackjack “depending on the odds,” adding that the Dutch are at least as parsimonious as the Scots are said to be—and that he has Scots blood to boot. Even the 1931 Ford Model A he still drives as regular transportation keys into what he calls being cheap.

“I came to Tucson with a station wagon,” he recalled. “I found that was an expensive way to move around town. The family needed another car, so I was looking for a VW bug, but I saw an ad for the Model A for $250. That was my price range!”

It was 1958 and the car had 200,000 miles on it, so it took some fixup, but now the car’s gone 570,000 miles. Keeping it mechanically sound and looking “stock” naturally has meant attentive upkeep, though if rust ever sleeps, it certainly does so in our desert.

Sky was born in 1927 in Yakima, Wash., four years ahead of the car. He earned his B.A. in bio-sciences “with distinction” at Stanford in 1948, and then his M.D. in 1952 at The Johns Hopkins University. He interned at the U.S. Naval Hospital in Oakland, Calif., and did his IM residency at Kaiser Foundation Hospital, San Francisco. During his residency, he took a Navy correspondence course in use of radioactive isotopes I-B1 and P-32 including chromic phosphate.

He’d joined the Navy at 17 in 1944 as a hospital corpsman, and he’s still in, as a retired reservist. His ID card’s “expiration” is labeled “indef.” A liberal Democrat and environmentalist, whose business card has “tree huggers” after his and his wife’s names, Sky makes sure to sign any correspondence to warhawk Republican Sen. John McCain with “Cmdr. Ret., USNR” after his name.

“I got interested in nuclear medicine because of what they were doing there on site,” he said, “and I wanted to learn more about it. I’d always had an interest in physics as it comes into medicine. I wanted to investigate the activity of lumps in the thyroid, whether that activity was ‘hot’ or ‘cold’—malignant or not.” So he took over the Kaiser hospital’s isotope lab and became the second Atomic Energy Commission-licensed physician to do the procedures, “mostly thyroid uptakes and lab blood tests involving T3s and T4s.”

In San Francisco Sky met another internist who was from Tucson, and they talked about the Sonoran Desert climate, Sky already hating winters. That doc wanted another internist to come into his office, so Sky and his then-wife drove another person’s car from San Francisco to Tucson in 1957. “That was in July,” he recalled, “and I liked it then. I still love living here more than any other place.”

He practiced internal medicine while sub-specializing in diagnostic and therapeutic use of radioisotopes. “I practiced internal medicine for 10 years at $5 for an office call, $7 for a hospital visit, and $10 for a house call. There was one doctors’ directory in town” for every kind of physician.

Man ages, car stays same

for every kind of physician. Man ages, car stays same This photo, taken next to the

This photo, taken next to the old PCMS offices on Grant Road circa 1980, shows Dr. Schuyler Hilts and the 1931 Ford Model A he adopted in 1958 (PCMS photo).

and the 1931 Ford Model A he adopted in 1958 (PCMS photo). Dr. Hilts and his

Dr. Hilts and his pet car in 2007 outside PCMS.

TMC was interested in starting an isotope lab, and “they came to me because I was licensed,” Sky said. “Only two docs in town were, and the other was associated with St. Mary’s. They got the stuff for me, and the chief tech didn’t get along well with the head of pathology, so this led to him coming to work for me.” Since they were both “hardheaded bastards,” the tech went to Oakland to take a course in radioisotopes, then Sky took the same course from his own chief tech. Subsequently, Sky said, they both taught other technologists there and at other places in Tucson.

Nuclear medicine is multidisciplinary, making it hard to pinpoint

Dr. Hilts today, 87 and still four years older than the car. its beginning. We

Dr. Hilts today, 87 and still four years older than the car.

its beginning. We can only place it between the discovery of artificial radioactivity in 1934, and production of radionuclides at Oak Ridge National Laboratory for medicinal use, in 1946.

So on either side of 1960 the two Tucson men were “running a little isotope lab in a closet at TMC when scanners came long, which then cost about $10,000. But with them, radioactive doses could be imaged in the brain, and later in the liver and lungs,” Sky said. “The first thing I knew, I had two-thirds full-time job doing

that, and a two-thirds full-time internal medicine job. Something had to give!” Since nuclear medicine was “more fun,” he went into it full-time at TMC.

After he’d been at TMC awhile, he recalls, they got more scanners and had to move to a larger department space. “Gerd Schloss, the guy who was running the lab, and all of us got a percentage of what the lab made, but Gerd’s percentage got astronomical, so they stopped the percentage deal, and [the choice was] either he did all his own billing, or became a hospital employee. So he became a TMC employee. As business increased, he made more and it amounted to a good living.” [PCMS member Gerd T. Schloss, M.D., who died at 93 in 2007, was a microbiologist and TMC pathologist.]

Retired since 1991—though he only gave up his medical license last year—Sky looks back on a time when “we were one of the few specialists in town, we all liked each other, and I could always get help with anything I needed.” The biggest change took place just as Sky was leaving: positron-emission tomography (PET) scanners.

Atheism is a major component of the Sky Hilts philosophy. “My parents didn’t consider religion important,” he said, “ even though I was raised near a local Protestant evangelical church. I was sent to Sunday school there. Mom said, ‘It’s part of our culture.’ I came home and told her, ‘Mom, they don’t like little boys asking questions!’ It wasn’t part of my life from then on.”

In the Navy, Sky got called before the platoon commander, a Texan, who said: “I hear you don’t believe in God! I don’t want you talking to them like that no more. These are good, God- fearin’ boys!” Sky says he’s often raised a toast to “Sin, degradation, and the State of Texas!”

For many years he scuba-dived in the Sea of Cortez and other places. “I loved it. It’s the only sport I miss. If if I had not become a doctor, I would have become a marine biologist.”

He’s been married to his wife, Anne, since 1991. “I love being married,” Sky exults. “I got married in med school, at 21, and stayed married for 42 years. I feel real lucky now. I’m more in love with Anne now than when we first married. She’s only 72. She’s my child bride!”

Disclaimer: Both the writer and Dr. Hilts often attend monthly dinner meetings of Tucson Atheists.

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Both the writer and Dr. Hilts often attend monthly dinner meetings of Tucson Atheists. n SOMBRERO

In Memoriam

By Stuart Faxon

Clovis Jack Snider, M.D.

1928-2015

“A society grows great when old men plant trees in whose shade they know they shall never sit.”

—Quoted at memorial service

C lovis Jack Snider, M.D., otorhinolaryngologist, retired U.S. Army colonel, acoustic bassist and longtime community-

minded Tucson resident, and PCMS member 1967-76, died on Feb. 4 in Tucson, his family reported in the Arizona Daily Star. He was 86.

He was born Nov. 9, 1928 in Danville, Ill., and when his family moved to Tucson in 1943 he went to Tucson High School, graduating in 1946, the family reported. At The University of Arizona “he ran on the track team and was a founding member of the Alpha Phi Omega service fraternity, one of the first such organizations to be racially integrated.”

He earned his undergraduate degree at the UofA, his master’s at the University of Illinois, and his M.D. in 1956 at Northwestern University Medical School, Chicago. He interned in surgery at Charity Hospital of New Orleans, and did his GS residency at University of Michigan Hospital, Ann Arbor.

He served active duty in the U.S. Army 1957-61 and was a lifelong reservist. The family reported that “his assignments included Germany in his early career, and Honduras in the late 1980s. In Tucson, Col. Snider commanded the 6251 st U.S. Army Hospital” before his retirement in 1996.

Dr. Snider was board-certified in otorhinolaryngology. In 1967 he opened his practice for ENT surgery on North Iroquois Avenue in the St. Mary’s Hospital area because it was “where he felt his service would be most beneficial to the community,” the family said. But a statement he made in 1976 upon leaving PCMS could now be called prescient:

“I would observe that some of my fellow physicians are in less than satisfactory financial condition,” Dr. Snider wrote when it embarrassed him that PCMS dues had become a hardship. “They, too, are reluctant to formally describe their circumstances. The inexorable increases in costs seem out of proportion to the ability of the public to pay. It appears to me that unless he has some special income arrangement, the ethical, careful, solo practitioner can no longer survive.”

Dr. Snider retired in 2005, but he “maintained his licenses for several more years in order to be prepared, if needed, in times of crisis,” the family reported.

“Beloved by his friends and family, Dr. Snider will be remembered for his intellect, compassion, sense of humor, and commitment to

his intellect, compassion, sense of humor, and commitment to Dr. Clovis Jack Snider in 1967 when

Dr. Clovis Jack Snider in 1967 when he joined PCMS.

service,” the family said. “He dedicated his life’s work to the well- being of others in his community and the environment, both locally and globally.

“He volunteered in many church and civic activities, supported sheltering of homeless persons, cared for veterans, and actively practiced conservation of resources, especially water. He will also be remembered with fondness for his advocacy of a healthy eating style (big breakfasts and no supper), his discipline for physical fitness, his love of music and poetry, and beautifully designed rock construction.

“Two of his passions were music and running. He played string bass in a local folk, gospel and cowboy music group, the Canyonaires, and with the Tucson Fiddler’s Association, performing at care facilities, church gatherings, and community events in Southern Arizona.

“An avid long-distance runner into his late 70s, Dr. Snider completed the Tucson Marathon several times and participated in many other races. His favorite race was a benefit run ‘Sundown at the Pass,’ that passed his driveway on the way to Gates Pass.”

Dr. Snider’s younger brother Carl predeceased him. His wife of 57 years, Emily Jean; daughters Lauri and Mary Sue; younger sister Mary June Stoddart of Castro Valley, Calif. and her son, Collin; nieces Una and Airdri; granddaughters Kenna and Amelia Malone and Hannah and Hattie Houser; and a widely extended family of nieces, nephews and their children survive him.

Memorial contributions may be donated to First United Methodist Church, 915 E. 4 th St., Tucson 85719; Clovis B. Snider Scholarship Fund at Claremont School of Theology, Claremont, Calif. 91711- 3199; Pine Canyon Camp, 1701 S. Downings Pass Rd., Willcox 85643; Tucson Communith School, 2109 E. Hedrick, Tucson 85719; or National Parkinson Foundation, www.parkinson.org . n

PCMS Awards

Physician of the Year

PCMS Awards Physician of the Year Our 2015 PCMS Physician of the Year is Thomas C.

Our 2015 PCMS Physician of the Year is Thomas C. Rothe, M.D., a PCMS member since 1982. His practice is La Cholla Family Practice, part of Arizona Community Physicians. He and his wife, Karrin, a retired nurse, have been married 35 years.

Born in 1948 in Bowling Green, Ohio, near Toledo, Dr. Rothe came to medicine in a roundabout way, even though his was a medical family. He graduated from Stanford in 1970 with a major in history, then served two years in the Peace Corps in Venezuela.

Upon his return he attended Ohio State University before switching to the Medical College of Ohio at Toledo, where he earned his M.D. in 1977. He came to The University of Arizona for his internship and residency.

Dr. Rothe served on the PCMS Board of Directors 2001-03 and 2004-07, and as an ArMA delgate. He was PCMS president in 2007, ArMA president 2013-14, and also served as ArMA Southern District director.

When Dr. Rothe was a boy, he said, he’d sometimes go along on housecalls with his dad, a small-town Ohio family physician. “I decided while in the Peace Corps that this is what I’d like to do. You can do a lot of things in family practice, including obstetrics and pediatrics, that’s the part that’s really rewarding, but I don’t do OB anymore because it is so labor-intensive.”

Colleague Darren Hee, M.D., one of Dr. Rothe’s office partners for nearly 20 years, calls Dr. Rothe “a great physician and individual.”

Gary Figge, M.D., EM specialist at Northwest Medical Center who has also worked with Dr. Rothe in organized medicine, said that Dr. Rothe has “demonstrated his dedication to the profession no only by being involved in organized medicine and pushing for measures and legislation to ensure excellence in the healthcare of Arizonans in Pima County with his involvement in PCMS, but also at the state with ArMA, serving many years on its board, executive committee, and as president.

“Tom was one of the first to use the hospitalist service in the care of his patients when they were admitted to the hospital, so they would have an in-hospital physician directly overseeing their care in a more hands-on and efficient manner than he could from afar at his clinic, as was the tradition at the time. Prior to hospitalists, physicians would see hospital patients before clinic each morning, and trust care in between to nurses and phone calls. Once hospitalists became more often used, many more primary care physicians used their services, they no longer went to the hospital and simply saw their patients in follow-up in clinic.

“Despite realizing that admitted patients received more direct and efficient care from hospitalists, Tom still insisted he was contacted all times if his patients were in the hospital, and stopped in daily outside his clinic hours for a professional ‘visit’ as

he proved time and again his dedication to the care of his patients.

“Though Tom focused on his clinic and no longer practiced in the hospital, he continued to serve for many years as chair of the Performance Improvement Committee that continually oversees provision of care by physicians and other providers in the hospital. This ensured that the staff caring for his patients truly provided appropriate and optimal care, leading toward opportunities of improvement and documented excellence in provision of care at ‘his’ hospital that few could surpass.

“In addition, Tom impresses all by his temperament, his calm demeanor, and his thoughtful and meticulous approach to not only patient care, but solving other issues and problems in healthcare in general. and with his involvement in organized medicine and his community.

“Finally, Tom is one of those gentlemen of old whom everyone knows is just a ‘good guy.’”

Rose Marie Malone Award for Service to Organized Medicine

Rose Marie Malone Award for Service to Organized Medicine Recipient of the 2015 PCMS Rose Marie

Recipient of the 2015 PCMS Rose Marie Malone Award for Service to Organized Medicine is R. Screven Farmer III, M.D., board-certified anesthesiologist and PCMS member since 1982.

The award is named for the PCMS executive director 1981-91, who died prematurely at age 53.

Born in in Copenhagen, Denmark, Dr. Farmer earned his undergraduate degree at

the Georgia Institute of Technology and his M.D. in 1979 at Emory University School of Medicine, Atlanta, Ga. He did his internship at The University of Arizona and his residency at the University of Wisconsin, Madison.

He served twice as chief of anesthesia at Carondelet St. Joseph’s Hospital starting in 1992. He was medical staff president there for two years. He has served on the Board of Directors for his group, Southern Arizona Anesthesia Services, and is their current president.

Dr. Farmer served on the PCMS Board of Directors in 2001 and 2007-2010, and was president of the Arizona Medical Association 2007-2008. He has since served on the ArMA Board of Directors. Between 2013 and 2015 he also served on the board of the Carondelet Foundation. He currently serves on the Arizona Medical Board, the MD-regulatory board that is appointed by the governor, approved by the Senate, and comprised of eight physicians, one RN, and three members of the lay public.

He and his wife, Terri, have been married 32 years. She is a psychiatric nurse practitioner with her own practice. The Farmers have three sons, Jim, 28, who is a medical office assistant; Joe, 26, who is a chemistry teacher and swim coach at Rincon High School; and Jason, 20, who is a Pima Community College student. Dr. Farmer’s hobbies include hiking, mountain biking, scuba diving, photography, and evolutionary biology.

Dr. Farmer’s hobbies include hiking, mountain biking, scuba diving, photography, and evolutionary biology. He said his interests in medicine include health policy and economics, and the neurobiology of consciousness. “If you think about it, anesthesiology involves rendering people unconsciousness with neuropharmacologic interventions, but there isn’t any consensus on defining what consciousness even is.” He also has interest and extensive experience in measurement of, and improvement in healthcare quality.

“I’m deeply honored to accept this award,” Dr. Farmer said, “and do so on behalf of myself and several others. First, on behalf of my wife, Terri, and my family, who make the sacrifices that make service possible. Secondly, on behalf of all the doctors out there who see the work we do as not just a job and a paycheck, but as a profession, a calling, and a privilege. And finally, on behalf of the patients who rely on us to be their advocates.”

Lifetime Achievement Award

on us to be their advocates.” Lifetime Achievement Award Recipient of the 2015 PCMS Lifetime Achievement

Recipient of the 2015 PCMS Lifetime Achievement Award is James C. Balserak, M.D., M.P.H., F.A.C.S., F.A.C.E. a senior partner in Southwestern Surgery Associates, Ltd., where he performs general surgery. He also practices aerospace medicine and since 2011 has been a brigadier general in the Arizona Air National Guard and assistant to the director, Defense Health Agency, Defense Health Headquarters, Falls Church, Va.

He and his wife, Kristi, have been married 26 years, having met when they were 11. Their oldest son, JC, 19, is a sophomore at Belmont University in Nashville, Tenn. Youngest Kevin, 16, is a sophomore at Salpointe.

ABS-certified, he served three tours in Iraq and Afghanistan 2004- 09 as chief trauma surgeon, and later as a critical care physician at Ramstein Air Force Base, Germany. Occasionally known or identified by such colorful sobriquets as “Blade” and “Balz,” Dr. Balserak has been a PCMS member since 1994, and an honorary PCMS member since 2011, a rare distinction in recognition of his achievements, as there have only been six honorary PCMS members since 1904. He is also a member of Tucson Surgical Society. That he is “only” 52 means more lifetime and undoubtedly more achievement.

He comes from a decidedly military family. “My dad was a colonel in the Army, a 30-year career army officer and Vietnam vet,” Dr. Balserak said. “My brother Robert is a 30-year Air Force F-16 pilot, and a combat veteran with three tours in Iraq.”

Born at Fort Benning, Ga. in 1964, Dr. Balserak earned his M.D. in 1990 at the Medical College of Virginia in Richmond, not Virginia Commonwealth University School of Medicine. He did his GS internship and residency at University of Arizona Medical Center in the Tucson Hospitals Medical Education Program. He earned a Masters in Public Health with a Concentration in Disaster Preparedness in 2010 at Benedictine University, Lisle, Ill.

As an undergrad at University of Virginia, Charlottesville, he earned a B.A. In chemistry, was summa cum laude and Phi Beta Kappa and graduated With Highest Distinction. In 1984 he earned

Intermediate Honors for academic excellence following completion of his second year as an Echols Scholar, and the next year he was on the Academic Atlantic Coast Conference Honor

Roll. In 1984-86 he ran men’s varsity track and field, specializing

in the long jump.

By 1990 Dr. Balserak was designated in Who’s Who Among Rising Young Americans. He has maintained an academic appointment as Assistant Clinical Professor of Surgery at the UofA College of Medicine. He chaired the TMC Department of General Surgery 2005-07. He was Arizona Diamondbacks team physician 2005-09, and when the Tucson Toros were around, he served as first-base coach as well as team doctor.

A career such as Dr. Balserak’s even forces a distinction between “mere” achievement and special achievement. In the latter

category, in 2000 he received the ArMA Distinguished Military Service Award, and in 2009-14 he was elected by his peers for inclusion in Best Doctors in America.

Volunteer of the Year

PCMS Volunteer of the Year is Steven J. Ketchel, M.D., IM physician and medical oncologist, and PCMS member since 1977, who retired last year and serves on our Bioethics Committee.

who retired last year and serves on our Bioethics Committee. Born in 1956 in Cleveland, he

Born in 1956 in Cleveland, he earned his undergraduate degree at Stanford, and his M.D. at The University of Arizona College of Medicine in 1972. His Fellowship in medical oncology was in the Department of Medical Therapeutics at M.D. Anderson Hospital and Tumor Institute in Houston, now University of Texas M.D. Anderson Cancer Center.

Dr. Ketchel has been a local supporter of the American Cancer Society, Inc. for more than 22 years, and served as its area president. He also volunteers at St. Elizabeth’s Health Center (formerly St. Elizabeth of Hungary Clinic).

PCMS cannot claim to be first in recognizing Dr. Ketchel’s volunteerism: ACS awarded him as volunteer of the year in 2001, saying he had “demonstrated his incredible dedication to the organization and its mission.” “Dr. Ketchel is a leader and an inspiration to those who have worked with him,” the local ACS Leadership Council chairman said at the time. “He excels in every aspect of his volunteerism and, though he is active with many organizations and affiliations, he remains willing to accept any task.”

“I was interested in helping people,” Dr. Ketchel said of his

beginnings. “I felt the practice of medicine was an excellent way to accomplish that, and I entered in the second class of the University of Arizona College of Medicine. I did my residency there. I felt that I could offer more to patients as a medical oncologist than an internist, and did my Fellowship at M.D. Anderson in Houston as an American Cancer Society Fellow.

“Marta and I chose Tucson as a good place to practice and raise a family, and it has been. I retired from the practice of medicine in September 2014.

“Shortly after starting practice I decided to donate time to St.

Elizabeth of Hungary Clinic, and I continue at this time. I also felt it was important to support the American Cancer Society and served as an officer and volunteer on many projects over the past 35 years.

“I have been a member of the TMC Medical Ethics Committee and served as chair for the past four years. I have also been a member of the Pima County Medical Society Bioethics Committee.

“I recently started volunteering at Reading Seed, a program of Literacy Connects. I am also a Red Blood Cell and twice-monthly platelet donor for the American Red Cross.

“Both of my parents were volunteers, and they imbued me with the desire to give back to the community in which we live. I have continued with that desire. There is not enough money in government to accomplish all we need to do to improve the quality of life in Southern Arizona, and my being a volunteer helps to achieve that.

“I am supported in these efforts by my wife, Marta. I have two wonderful children. My son Aron is an Assistant U.S. Attorney in Los Angeles and the father of my two grandchildren. My daughter Alana lives in San Francisco and is a health policy consultant with Health Management Associates.”

Steve Nash Award

with Health Management Associates.” Steve Nash Award The PCMS Steve Nash Award is given annually to

The PCMS Steve Nash Award is given annually to the non- physician who has most contributed to improvement of healthcare in Tucson. This year that is Kathy Byrne, executive director and CEO of El Rio Community Health Center since September 2004.

During her tenure the organization has added four new service sites in Tucson, and now provides comprehensive primary care medical and dental services to more than 83,000 patients annually.

“Kathy Byrne is an amazing CEO,” said Steve Nash, executive director of the Tucson Osteopathic Medical Foundation and former PCMS executive director, for whom the award was named in 2013. “When Robert Gomez retired from El Rio, no one could have imagined the place could be run better. After all, it was one of three federally qualified health centers in the U.S. that lived within its budget.

“Under Kathy Byrne, El Rio became even better, at the edge of innovation and service. It was an early adopter of EHRs, created a diabetes clinic that tested motivations to keep people healthy, and has expanded to at least 13 locations.

“Somehow she found time to serve the community in a varied number of task forces, commissions, think-tanks, and lectures. She has been an effective leader in bringing a health information exchange to Arizona and in keeping the Pima Community Access Program not only alive, but kicking. An amazing person!”

Kathy has more than 35 years of healthcare management experience in Arizona. Her career started in Tucson, including 10 years with Carondelet Health Services, 1976-87. During those years Kathy was responsible for strategic planning and new program development. She participated in the merger that brought Carondelet St. Mary’s and St. Joseph’s hospitals under one corporate umbrella.

In 1987 Kathy joined Mercy Care Plan on a full-time basis as its president and CEO, serving in that capacity through 2001. Mercy Care Plan is a statewide-managed care health plan serving the Arizona Medicaid population. During her tenure the plan grew to more than 140,000 members.

Kathy served as an assistant director with the Arizona Medicaid program 2003-04. Her focus was on the services and support processes required to meet the needs of the fee-for-service population and the providers who care for them. Most of this work was with the Indian Health Services and with Arizona tribes.

She serves on a variety of boards including the Arizona State Medicaid Advisory Committee, Arizona Health e-Connection, Arizona Alliance for Community Health Centers, and as a nonvoting member of the Mercy Care Plan Board of Directors (Southwest Catholic Health Network).

Kathy was born in Chuquicamata, Chile, and is bilingual. She earned her Bachelor of Science in Foreign Service in 1971 at Georgetown University, Washington, D.C.

“I am surprised and honored to be recognized by the Pima County Medical Society with the PCMS Steve Nash award,” Byrne said. “Thank you!

“I have had the pleasure of working in the Tucson and Phoenix healthcare arena with many of you for over 35 years. I have appreciated the sense of collaboration, partnership, and generosity that exists in Pima County. My last 10 years as executive director of the El Rio Community Health Center have been focused on working with my colleagues to improve access to healthcare for our community, expansion of the Medicaid program, support for the Pima County Access Program (PCAP), and the growth of our integrated health home model. Our collective efforts have meant so much to people in need of care in Pima County.

“During my career it’s been the freedom to innovate and collaborate on meaningful projects with others that has given me the greatest sense of accomplishment. Examples from El Rio include our mergers with Birth and Women’s Health Center and El Pueblo Health Center, rebuilding the El Rio Congress campus with a new state-of-the-art facility and our recent affiliation with St. Elizabeth’s Health Center. The other project underway that you may have heard about is the renovation of the Manning House Property downtown, where we will move 230 staff by the end of the year.

“El Rio now serves over 83,000 people thanks to the help of many

of you here tonight. Good health is paramount to quality of life. The work each of you do is important! Thank you for recognizing my passion and commitment to our field with the Steve Nash Award.”

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The 24th Annual

Southwestern Conference on Medicine ®

April 23 - 26, 2015 | JW Marriott Starr Pass Resort & Spa | Tucson, Arizona

| JW Marriott Starr Pass Resort & Spa | Tucson, Arizona Join us for our 24th

Join us for our 24th year of quality engaged learning! This activity has been approved for AMA PRA Category 1 Credit™ and AOA Category 1A Credit.

Presented by Tucson Osteopathic Medical Foundation in Joint Providership with Cleveland Clinic

Scan this with your smartphone to visit www.tomf.org/cme

Scan this with your smartphone to visit www.tomf.org/cme Register online at www.tomf.org/cme 16 SOMBRERO –

PCMS News

AMB appoints new exec dir

The Arizona Medical Board, which to say the least has had a recent undesirable performance history of its executive directors, reported March 2 that it had appointed a new executive director, Patricia McSorley.

AMB has employed McSorley since 2005, they reported. “For more than eight years she managed the Investigations Department. On two occasions she has been asked by the board, and has served, as acting interim executive director. She holds a Juris Doctorate from Brooklyn Law School.

“Previously she served as assistant commissioner for the Bureau of Investigations and Trials with the New York City Fire Department. On Feb. 26, the AMB’s Executive Director Committee appointed her as the executive director of the Arizona Medical Board, and the Arizona Regulatory Board of Physician Assistants.”

MRCSA sets training schedule

The Medical Reserve Corps of Southern Arizona has set its 2015 training calendar, which is already underway. Here it is complete:

Jan. 24

Incident Command System Training 9-10:30 a.m.

Location:

Pima County Medical Society, 5199 E. Farness Drive, Tucson 85712

Trainer:

Les P. Caid, Chief, Rio Rico Fire District and MRCSA Board President

Feb. 21

Emergency Civilian Casualty Care Training 8a.m.-12 noon

Location:

Tucson Fire Central, 300 S. Fire Central Place, Tucson

85701

March 28

START Triage Training 9-10:30 a.m.

Location:

Pima County Medical Society, 5199 E. Farness Drive, Tucson 85712

Trainer:

Mike Bishop, Captain, Emergency Management, Tucson Fire Dept.

April 9

Tour of Pima Emergency Communications & Operations Center 4:30 p.m.

Location:

PECOC Building, 3434 E. 22 nd St.

Leader:

Caren Prather

May 9

Red Cross Shelter Training 9 a.m.-12 noon

Location:

Red Cross Chapter Building, 2916 E. Broadway Blvd. Tucson 85716

Trainer:

Geneviève Sansonetti Sicé and Red Cross Staff

May 16

Red Cross Shelter Exercise 8 a.m.-2 p.m.

Location:

Red Cross Chapter Building, 2916 E. Broadway Blvd. Tucson 85716

July 11

Mass Vaccination Clinic Training and Public Health

at 9a.m.

Call Center Tour 9-11:30 a.m.

Location:

Pima County Health Department, Abrams Building

Trainers:

Ronald Zack, Mary Stebbins and health department staff

September (Date TBA)

Location:

November (Date TBA)

Disaster Table-Top Exercise

To Be Determined

Power Outage Roundtable and Effects of Long Term Outages on Community Mem- bers with Functional and Access Needs

Location:

To be determined (in collaboration with Physicians for Social Responsibility)

Additional training and tours to be scheduled include:

Arizona Poison and Drug Information Center tour

Emergency Civilian Casualty Care training

Psychological First Aid/Disaster Behavioral Health training

Decontamination Assist Teams Training/Donning and Removing PPE/Contamination Control

U of A-led research:

U.S. cocaine supply shrunk

Federal chemical controls have shrunk the nation’s cocaine supply, according to research reported by The University of Arizona and reported in the journal Addiction.

Following a December 2006 federal restriction on a chemical critical to cocaine production, the university reported March 9, the U.S. “experienced a 35 percent decrease in cocaine purity, 1 32 percent decrease in cocain seized, and a 100 percent increase in cocaine price—all indications of a major downward shift in cocaine supply.

Cocaine producers have yet to recover, according to an international research team led by James Cunningham, Ph.D., an epidemiologist with the Department of Family and Community Medicine at The University of Arizona College of Medicine— Tucson.

“The 2006 restriction by the U.S. Drug Enforcement Administration (DEA) targeted sodium permanganate, a cocaine ‘choke chemical’ central to, and difficult to replace in the cocaine production process,” the university reported. “Sodium permanganate began to be commercially mass produced around the early 2000s, primarily in the U.S., without controls or restrictions. Cocaine supply started increasing at that time and continued rising until December 2006, the point when the restriction required that large-volume sales of the chemical be approved by the DEA.

“The same study also tested whether impacts occurred at the times of three earlier chemical control restrictions. In December 1989, the U.S. government placed restrictions on potassium permanganate, another cocaine choke chemical mass produced in the U.S. Immediately following that restriction, cocaine supply dropped sharply.

“In 1992 and 1995, restrictions were implemented on sulfuric acid, hydrochloric acid and methyl isobutyl ketone (a solvent), all of which commonly are used in cocaine production but do not reach the level of choke chemicals. These restrictions also were associated with immediate drops in cocaine supply, but not as large as those associated with sodium permanganate and potassium permanganate.

“Cunningham pointed out that sodium permanganate and potassium permanganate are oxidizing agents that have numerous legitimate commercial uses, including municipal water and wastewater treatment, metal processing and air and gas purification. ‘The goal of chemical controls is to reduce supply and thus the drug’s use,’ he said. … According to the National Survey on Drug Use and Health, the number of persons in the U.S. reporting current cocaine use dropped from 2.42 million in 2006, in effect the year prior to the December 2006 restriction, to 1.54 million in 2013, a 36 percent decline.

“Cunningham and colleagues previously published the first studies showing that controls on chemicals needed to produce methamphetamine and heroin also have impacted supplies of those illicit drugs. ‘Large-scale production of the big three drugs—cocaine, methamphetamine and heroin—requires

massive amounts of selected commercial chemicals,’ he said. ‘Research indicates that controls on these chemicals can lessen the drugs’ supply. Costs of implementing the controls typically are minor, for both the government and the chemical companies involved.’”

The study, “U.S. federal cocaine essential (‘precursor’) chemical regulation impacts on US cocaine availability: an intervention time–series analysis with temporal replication,” was published March 5 online before print in the scientific journal Addiction.

White coat ceremony for Doctor of Nursing Practice students

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The UofA reported March 9 that more than

60 students in the Doctor of Nursing Practice

online program at the College of Nursing will take part in the college’s first White Coat Ceremony.

“During the event, students representing 12 states will receive their white coats and affirm their commitment to providing compassionate healthcare as future advanced nurse practitioners (NPs) specializing in either family, pediatric, adult- gerontology acute care or psychiatric mental health,” the university reported.

“Nurse practitioners are essential to our healthcare system, particularly in primary care, where we are facing a significant and growing provider shortage,” said Joan Shaver, Ph.D., R.N., F.A.A.N., dean and professor at the College of Nursing. “Especially in rural and underserved areas, nurse practitioners are often the only healthcare providers.”

“According to the American Association of Nurse Practitioners, more than 205,000 NPs

are licensed in the U.S. In 2012, more than

80 percent of NPs were educated for primary

care practice. Studies show that NPs can expertly deliver 80-to-90-percent of care provided by primary care physicians. Primary care NPs are significantly more likely than primary care physicians to practice in urban and rural areas, provide care in a wider range of community settings and serve a high proportion of uninsured patients and other vulnerable populations.

“Although the Institute of Medicine has recommended that NPs be able to practice to the full extent of their education and training, the scope of practice for NPs varies by state, ranging from full autonomous practice authority, as in Arizona, to restricted practice, requiring physician oversight of diagnoses, treatment plans, and prescribing by NPs (via collaborative agreement or

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supervision.)”

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Urology

Vaginal mesh controversy: An update

By Susan J. Kalota, M.D.

Vaginal mesh controversy: An update By Susan J. Kalota, M.D. Routine use of vaginal mesh in

Routine use of vaginal mesh in vaginal prolapse surgery was introduced into routine clinical use in 2005. The mesh currently used is non- absorbable porous polypropylene.

Mesh in general was introduced to aid in repair of weakened or poorly supportive tissue. It was initially introduced, and extensively used for abdominal and inguinal hernia repairs. Due to use of this mesh for hernia repairs, it was felt that no specific studies needed to be done prior to their release for vaginal “hernia” surgery. This is done through a 501 FDA clearance which states that the new product is sufficiently similar to an existing approved device that it does not need to undergo the usual new product testing and process of approval.

Use of vaginal mesh was then marketed to the gynecologic or urologic surgeon for any and all prolapse repairs without specific recommendations about the ideal patient. Subsequently, as FDA received more and more complication reports, there was an FDA panel—in which I was able to participate—convened in 2011 to discuss the concerns.

That panel’s outcome was that in January 2012, FDA ordered that post-market surveillance studies on mesh used for pelvic prolapse repair be conducted by the vaginal mesh manufacturers to evaluate the safety and effectiveness of the mesh. This was not mandated for the full retropubic or obturator mesh slings, or for mesh used in abdominal colposacral suspensions. “Multi-incision slings” were felt to already have shown their efficacy and safety through previously performed clinical studies. The safety and efficacy of single-incision mini-slings were not felt to have been sufficiently documented, so they are required to undergo further studies.

Since then

Several companies chose to remove all or some of their products from the market rather than conduct the expensive studies. No product was removed from the market by FDA.

There has not been a statement declaring an inherent problem with the mesh itself, kits in general or with a specific mesh product.

American urological and gynecological societies, as well as European societies and the British health department, have issued guidelines on use of vaginal mesh for prolapse. The goal has been to have adequately trained clinicians place appropriate products in appropriately selected patients, and identifying who they are. There is also emphasis on making sure the patients are well-informed of the risks and benefits of mesh use.

In a collaboration between urogynecologic societies, FDA, and industry, a national prolapse surgery registry is being attempted. There has also been a recommendation that surgical removal of

problematic mesh be undertaken by “qualified specialists” or at “Centers of Excellence.”

Risks and benefits

Many of the quoted risks of mesh prolapse repair are as much related to the procedure as to the repair; some of the risks are clearly only present due to the use of mesh.

The most serious risks are those of erosion or perforation of an organ, vessels, or nerve with the mesh. Fortunately, these are not frequent. Vaginal mucosal extrusion is common, but a much less serious issue. If the woman is not symptomatic it usually does not need to be addressed.

Common symptoms of this issue is a vaginal discharge (bloody or not), complaint of discomfort by the woman’s partner during intercourse, or a scratching poking pain complaint by the patient. Depending on the location and extent of the extrusion, it can often be excised in the office.

Pain can be present from the start, or occur over time. It can be present continuously, only with certain activities, or only with intercourse. This can be present due to location of the mesh, tension of the mesh due to initial placement, or due to shrinkage over time, or potentially from infection of the mesh. The pain is often relieved by removal of the mesh or physical therapy—but not always.

The benefits seem to be a decrease in the rate of recurrent prolapse in the repaired compartment, but there may be an increase in recurrence in other compartments. Current studies do appear to show anatomical advantage with the repair in the anterior compartment, but less so in the posterior compartment.

Personally I have found that the ideal candidate is one with severe prolapse in either the anterior (cystocele) or posterior (rectocele) compartment. A woman with minimal or even moderate prolapse is not a good mesh candidate. I have personally found that the width and depth of the vaginal vault is more likely to be maintained with a mesh repair, and the risk of recurrence is substantially lessened.

There does seem to be a higher risk of perioperative bleeding which very rarely requires a transfusion. The risk of vaginal mesh extrusion has been noted as high as 10 percent, but many of these are asymptomatic or can be excised in the office.

I believe that mesh is a wonderful and effective option for repair of severe prolapse. I believe it has an important place in our surgical toolbox. I also believe that many of our early problems occurred in patients whom we would no longer consider to be candidates for mesh repair or with kits/devices that have been updated, so my expectation is that the number of complications will be substantially less in the future, and mesh will maintain its place for use in the complicated prolapse patient.

Tucson’s original female urologist, ABU-certified and with sub- specialty certification in Female Pelvic Floor Medicine and Reconstructive Surgery, Dr. Kalota practices with Urological Associates of Southern Arizona.

REFERENCE Jha S. The rise and fall of the vaginal mesh. BJOG 2014;1438.

n

Stars on the Avenue

Story and Photo by Dennis Carey

From film stars to the real thing

Arizona Star Tours featured at SOTA

S tars on the Avenue” may not seem self-explanatory, though it is on Tucson’s well-traveled Campbell Avenue, and it is

under the stars at St. Philip’s Plaza. Last time, Hollywood and film stars were added as the motif.

On April 18 for this years’ event, the stars will be the real thing as Arizona Star Tours owner Ben Loker provides more than a theme.

At the event, Pima County Medical Society is honoring community physicians and an activist CEO for their contributions to bettering local healthcare, while Pima County Medical Society Alliance raises funds for its primary project, Mobile Meals of Tucson.

Participation of Arizona Star Tours, hosted by Loker, will allow attendees to look at the moon, planets, and other objects in the night sky as they may have never done before. The portability of powerful telescopes has taken Southern Arizona stargazing parties to a new level. At the event Arizona Star Tours will provide several telescopes with magnification of 70 to 900 power—not too far different from what stargazers might experience at the Kitt Peak observatories.

“Like so many other things, the technology of telescopes has changed by leaps and bounds since I first got interested in astronomy,” Loker said. “I can program them to compensate for the rotation of the earth, and put in information that will allow me to focus on an object in no time and keep it there. I don’t have to spend a lot of time searching for something or constantly make adjustments. They are battery-powered, so they can go anywhere.”

It’s a long way from the used and broken telescopes Loker used in the beginning to satisfy his astronomical curiosity. He worked at telescope shops, and he was handy enough that he could fix old ones people would bring in, as long as he could find the parts. His love is getting out and looking at the stars, even if only with a pair of binoculars or the naked eye.

“I was home-schooled,” he said, “so I was lucky I could stay up

late at night and not have to worry about getting up early to catch

a bus or get to school. I’m also lucky I live where there is a lot of interest in astronomy, and there are a lot of resources I can turn to in Tucson and Arizona.”

Loker attended the University of Arizona for one semester before dropping out. He acknowledged it is one of the best schools in the world for studying astronomy, but he found out there was not

a lot of time spent actually looking in the skies to earn a degree.

time spent actually looking in the skies to earn a degree. Ben Loker of Arizona Star

Ben Loker of Arizona Star Tours stands next to an 11-inch- diameter Schmidt-Cassegrain telescope, one of the ‘scopes he uses that will be part of the 2015 Stars on the Avenue event April 18.

“It was too much time in front of a computer monitor and not enough time looking through an eyepiece,” he said. “In fact, I have some astronomers with advanced degrees who attend my events and tell me they hardly ever get the chance to look through a telescope at school or work.”

After a brief stint working in construction, Loker decided to go all- in, starting Arizona Star Tours. In 2010, he placed nearly everything he owned on Craig’s List and sold it to finance the business.

“It was scary,” he said. “I was not sure I was going to be able to make a living at it, but I was very passionate about it. Not everyone can get up every day and be able to work on something they truly love. I hesitate to call it work.”

Arizona Star Tours found a niche by catering to those who were interested in astronomy, but may not have the time or means to get to an observatory or get a telescope of their own. The local resorts booked star and sun Tours on a regular basis. Visitors at the resorts came to Tucson for a vacation or conference, and they could only squeeze so much into their stay.

“They know Tucson is a great place for astronomy, but they cannot spend an entire day traveling to Kitt Peak. I bring the observatory to them,” Loker said. “I also love hosting events with visitors from all over the world. I learn as much from them as they do from me.”

There is as much going on in the day as at night. Sun tours allow viewers to observe solar activity that includes sunspots, storms called solar prominences, solar spectra, and on rare occasions a solar eclipse. His telescopes have lenses and filters that allow viewers to look at the sun.

Loker has recruited 10 people to help him with events around the state. Some, like archaeological astronomer Larry Behrens, have extensive professional experience. Others are just people like himself who want to share their enthusiasm for astronomy. They host everything from star-themed wedding receptions and back- yard family parties to large corporate events.

The telescopes can be set up to take photos using cell-phone cameras. It makes it easy to take memories of the party with you.

“You might learn something new on one of our tours,” Loker said.

learn something new on one of our tours,” Loker said. Portable telescopes come in all sizes.

Portable telescopes come in all sizes. This Questar model can go anywhere and is used for both stellar and solar viewing. Attachments let users take photos with a cell phone camera.

“I usually learn something new myself. It may spark someone’s interest in science. But I started doing this because I want people to see how fun astronomy can be.”

Stars on the Avenue is April 18, 6-9 p.m. at St. Philip’s Plaza. Tickets are available at pimamedicalsociety.org or call the PCMS

office at 795.7985. Dennis Carey is PCMS Associate Director.

n

The Faces of Casa are the Dr. Ann Marie Chiasson Associate Medical Director “ Working
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” 520.544.9890 | www.casahospice.com Hospice services are paid for by Medicare 22 SOMBRERO – March 2015

Makol’s Call

Dream on

By Dr. George J. Makol

Makol’s Call Dream on By Dr. George J. Makol “ I s this a great country,

I s this a great country, or what?” my cousin asked me

as we entered the Great Hall of this year’s Barrett-Jackson Auction in Scottsdale, the self- proclaimed “world’s greatest collector car auction.”

He was talking about the fact that three cousins who had come a long way in more than one sense, were reuniting 44 years after working together at a fast-food burger-joint in Massachusetts. Yes, we all began working for minimum wage, but our parents had taught us not to stay at minimum wage. This is known as capitalism, and can have spectacular results, but I will return to this subject later.

The Barrett-Jackson began as a charity auction in 1967, started by Russ Jackson and Tom Barrett, after Jackson showed an interest in Barrett’s 1933 Cadillac V-16 Town Car. Although the company now has other locations, its main show is at Westworld in Scottsdale and runs for eight days. Activities include a collector car auction, fashion shows, wine tastings, and generally many of the new car manufacturers are represented.

Of course you know by now that I am a hopeless gearhead, interested in almost every type of vehicle, but this show offers much more than cars. Think of it this way: when a chubby, opulently rich 60-year-old guy shows up to sell a couple of his Ferraris, the 25- year-old girl on his arm needs something to keep her busy. Hence the fashion shows, jewelry stands, mini- boutiques, olive oil/flavored balsamic vinegar stands, leather- coat- and-vest booths, and even exercise machines are on display. Maybe that sexagenarian needs more cardio along with the sex!

The show covers a huge acreage, and though we walked for seven or eight hours, we only covered the main tent though there are five in all. A fantastic assortment of foods is available, and I would say there were more food booths and snack trailers than I’ve seen in any state fair in my life. The food booths covered an area about the size of a football field, and as long as you’re not looking for health food, there are creations and libations to satiate any appetite.

If you are contemplating buying a new vehicle, the manufacturers are there in droves, with almost every model available for perusal. There are technical experts available answer your questions, and of course gorgeous or handsome models to demonstrate the features of the car for you. These are vehicle

the features of the car for you. These are vehicle Some of the activity at this

Some of the activity at this year’s Barrett-Jackson, naturally attended by our other gearhead: (Dr. Hal Tretbar photo).

experts and not salespeople, and you can find out much more about a vehicle’s performance, safety, and available options than you ever will find out dealing with the salesman at a retail car dealership.

out dealing with the salesman at a retail car dealership. • Allergies • Nasal/sinusitis problems •
out dealing with the salesman at a retail car dealership. • Allergies • Nasal/sinusitis problems •

• Allergies

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• Thyroid and parathyroid gland surgery

• Cosmetic/Aesthetic surgery

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6340 N. Campbell Ave., Ste. #256 • Tucson, AZ 85718

Parking is free, although you may did need a trail guide to get you from the far-out lots to the front door of the tent. It is around $25 to get in, but they do give a senior discount, as I discovered. I find it interesting that by the time you’re financially successful in life and have become a “seasoned citizen,” you get discounts, just at the time you don’t really need them. Maybe the 30-year-old guy with a wife and three kids needs a discount more than I do, but who am I to question this logic? I even get a “senior coffee” at McDonalds for 89 cents, so I can’t complain, but I’ve often wondered, is the coffee old, or just me?

There are numerous other auto shows at the same time in the greater Phoenix area, including Russo and Steele, Bonhams, and

R&M among others. This leads me back to my two cousins, to whom I will refer as the Burger Boys. You see, while I went to medical school, my cousins stayed in the fast food world, both building their own companies.

While they did collaborate over the years, it was my cousin Don who struck out to the deep South in search of his future. This included building a collection of more than 260 restaurants that he recently sold for about $150 million, some of which went to my first cousin. So while my cousin Don flew in on his private jet to the Scottsdale Airport, I of course drove up in my trusty Ford. I do have to say that they never let me pick up a check just because I was the doctor in the group.

It was about 2:30 p.m. when Don said, “George, have you ever been to the R&M auction?” I answered “No,” since my idea of heaven was walking around the Barrett- Jackson tent drinking a Diet Coke and eating caramel corn. So as you can see, I was a little out of my element when we walked into the Arizona Biltmore ballroom where the R&M auction was to begin in two hours. I was surrounded by multimillion-dollar Ferraris and James Bond-era Aston Martins, perfectly restored Jaguar XKEs, and a gaggle of lithesome Ukrainian waitresses offering me champagne, caviar, shrimp cocktails—and even Diet Coke.

I couldn’t figure why I was getting all his attention, until I looked down and realized that Don had slipped a “buyer” badge around my neck, and I was being mistaken for a person who would actually buy one of these vehicles, which would merely consume my entire net worth. But don’t think I didn’t contemplate it! You see, about 25 years ago at the Barrett- Jackson I sat next to a guy wearing a T-shirt and shorts who had the winning bid on a 1962 Ferrari GTO at $650,000. Today that car is worth $5 or $6 million, and I don’t think you could get that kind of return at the bank.

Whether you’re likely buyer or not, I highly recommend that you take a day next January and travel up to the Barrett-Jackson. I can guarantee you will have a wonderful time, even if you haven’t the slightest interest in cars.

And yes, maybe I should have stayed in the burger business; at least they don’t have price controls like we do.

Sombrero columnist George J. Makol, M.D., a PCMS member since 1980, practices with Alvernon Allergy and Asthma, 2902 E. Grant Rd.

n

a PCMS member since 1980, practices with Alvernon Allergy and Asthma, 2902 E. Grant Rd. n
SOMBRERO – March 2015 25

CME

Local CME from Pima County Medical Foundation

Pima County Medical Foundation, a 501(c)3 nonprofit organization derived from but separate from PCMS, presents Continuing Medical Education lectures by our members and others, for our members and others, on second Tuesday evenings monthly at PCMS headquarters. Dinner is at 6:30 p.m. and presentation is at 7. Scheduled presentations are:

April 14: Pharmacogenomics—How Medicines Affect Differing Demographics of Patients with Dr. Timothy C. Fagan. PCMF will also present the Foundation Award for Lifetime Achievement in Furtherance of Medical Education to Tyler Kent, M.D. and Bill Nevin, M.D.

May 12: Healthcare Reform 2015—What the Hell is Happening?? with several speakers coordinated by Dr. Timothy C. Fagan.

June 9: Heart-Healthy Diet with cardiologists Dietmar Gann and Charles Katzenberg.

Sept. 8: Vasectomy Reversals and Impotence with Dr. Sheldon Marks.

Oct. 13: To be announced.

April

April 17-19: The 21 st Mayo Clinic Urogynecology and Disorders of the Female Pelvic Floor 2015 is at Hilton Scottsdale Resort and Villa, 6333 N. Scottsdale Rd., Scottsdale 85250; phone

800.498.7396.

hilton-scottsdale-resort-and-villas-SCTSHHF/index.html

Accreditation: Mayo Clinic College of Medicine designates this activity for a maximum of 20.50 AMA PRA Category 1 Credits. A record of attendance will be provided to all registrants for requesting credits in accordance with state nursing boards, specialty societies, or other professional associations.

Course presents latest treatments for urogynecology and female pelvic floor disorders emphasizing surgical management of urinary and fecal incontinence, overactive bladder, and repair of

http://www3.hilton.com/en/hotels/arizona/

Members’ Classifieds

NEW OFFICE SPACE FOR RENT: Office space available for rent in Northwest Tucson off of Oracle Rd adjacent to a busy rheumatology practice. Office has separate reception, breakroom, physician office, 4 exam rooms, and nursing space. A total of 1,778 sq. ft. is available. Fulltime rental is preferred but could discuss office sharing if multiple providers looking for part-time space. Great location for a satellite office. For information, please contact Sue Haeger 382-4795.

MEDICAL PRACTICE FOR SALE: Hector L. Garcia MD and Hector F Garcia are selling their Internal Medicine practices located in Tucson and Douglas. The offices are located at 1601 N. Tucson Boulevard, Suite 1A, Tucson, and 1116 G. Avenue, Suite 7, Douglas. Interested parties may call 298-7251 for details.

pelvic organ prolapse. Course features didactic lectures supplemented with video presentations of advanced laparoscopic robotic and vaginal surgery. Surgical case presentations, panel discussions, and an interactive system are used to communicate immediate feedback, providing an optimal learning experience for interaction between faculty and course participants.

Website: https://ce.mayo.edu/women-s-health/women-s-

health-2015s983

Contact: Mayo School of Continuous Professional Development,

Bobbi Carter CMP, Mayo Clinic Scottsdale, 13400 E. Shea Blvd.,

Scottsdale 85259[ phone 480.301.4580; fax 480.301.8323

cme@mayo.edu

mca.

https://ce.mayo.edu/

April 23-26: Tucson Osteopathic Medical Foundation, in joint providership with Cleveland Clinic, present the 24th Annual Southwestern Conference on Medicine at JW Marriott Starr Pass Resort and Spa, 7:30 a.m. Thursday through 12:45 p.m. Sunday.

Accreditation: Approved for AMA PRA Category 1 and AOA Category 1A credit. Conference is designed to bridge practice gaps between primary care providers’ current knowledge and practice performance, and the ever-evolving standards of modern medical care. Last year 400 DOs, MDs, NPs, and PAs attended.

Faculty members include Shonda Banegas, D.O., Bennet E. Davis, M.D., Edward A. Dominguez, M.D., Timothy C. Fagan, M.D., Anne C. Goldberg, M.D., Jonathan R. Insel, M.D., Arthur McCullough, M.D., Jamie Moenster, D.O., J.D. Polk, D.O. PCMS Board of Directors member Jerry H. Hutchinson, D.O. chairs the conference.

For more information, including the conference agenda or to register please visit www.tomf.org/cme or call 520.299.4545.

April 24-25: A Multidisciplinary Update in Pulmonary & Critical Care Medicine is at Westin Kierland Resort, 6902 E. Greenway Pkwy., Scottsdale 85254; phone 480.301.4580. Email: info@

kierlandresort.com

Accreditation: 18.25 Category 1 toward AMA PRA; AOA 18.25 hours 2A. Optional session: Ultrasound Workshop 8 Category I AMA PRA; AOA 8 hours 2A.

Course offers lectures, case presentations, and pulmonary and critical care literature reviews. Multidisciplinary faculty gives presentations by leaders in pulmonary and critical care medicine, pulmonary pathology, and radiology for a comprehensive approach to current evaluation and management of various respiratory diseases.

The hands-on workshop Use of the Ultrasound in the ICU is on Friday, April 24 and Saturday, April 25, 1:15 to 4:30 p.m. Workshop gives participants better understanding of how to use state-of-the-art technology and offers didactic and hands-on skill- building opportunities. Separate registration fee applies.

Website: https://ce.mayo.edu/pulmonary-medicine/pulmonary-

medicine/node/1834

Contact: Mayo School of Continuous Professional Development, Lilia Murray, 13400 E. Shea Blvd., Scottsdale, 85259; phone

480.301.4580; fax 480.301.8323 http://www.mayo.edu/cme

http://kierlandresort.com/

mca.cme@mayo.edu

Radiology Ltd. now offers 3D Mammography. The physicians of Radiology Ltd. believe in personalized and
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