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Sombrero

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

M AY 2 0 1 5

Medicare at 50
CNI’s Brain Academy

‘Dr. Housecall’ retires

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2

SOMBRERO – May 2015

Sombrero
Pima County Medical
Society Officers

Official Publication of the Pima County Medical Society

PCMS Board of Directors
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)

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

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

At Large ArMA Board

R. Screven Farmer, MD

Pima Directors to ArMA
Timothy C. Fagan, MD
Timothy Marshall, MD

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

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

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

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SOMBRERO – May 2015

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

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

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

Tucson Country Club

Arizona Medical
Association Officers

Members at Large

Executive Director
Bill Fearneyhough
Phone: 795-7985
Fax: 323-9559
E-mail: billf 5199@gmail.com

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Vol. 48 No. 5

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 represent 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: Medicare is only 50, so it
isn’t qualified for Medicare yet.

On the Cover

 6 Letters: On Dr. Kalota’s vaginal mesh implant

Dr. Hal Tretbar and George
Ridge hiked down the Grand
Canyon’s South Kaibab Trail
circa 1980 to do a story on
Phantom Ranch for the Arizona
Daily Star. ‘Travelin’ Tretbar’
was using Kodachrome Pro film
that captured the subtle colors
well. See this month’s Behind
the Lens for more fabulous
rediscovered Arizona images.

update.

 7 Milestones: Dr. Gary Figge will serve on the
Arizona Medical Board.

10 In Memoriam: Doctors Edward A. Brucker and
Donald J. McFarlane died in March.

11 Behind the Lens: An early 1990s Physicians for

Social Responsibility calendar had some
wonderful Arizona images, recently rediscovered
by Dr. Raymond Graap and Dr. Hal Tretbar.

14 Neurology: Carondelet Neurological Institute,
Western Neurosurgery, and their Brain
Academy seek future neurologists.

17 Makol’s Call: TV generation meets the Greatest
Generation.

20 Retirement: Tucson medical legend Dr. Hector L.
Garcia’s retirement even surprises him.

22 CME: Credits locally and out-of-town.

Clarification
George Ridge, formerly of the UofA Journalism Department, is
the man providing human perspective in this Dr. Hal Tretbar
photo from the Grand Canyon’s South Kaibab Trail circa 1980.
‘Travelin’ Tretbar’ was using Kodachrome Pro film that
captured the subtle colors well. See this months’ Behind the
Lens for more fabulous rediscovered images from Arizona’s
northland.

Reminder
The May Sombrero ends our monthly publishing schedule until
October. Members and subscribers will receive bi-monthly
magazines for June-July and August-September.

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4

SOMBRERO – May 2015

Medicare: From whence it came
By Dr. Melissa Levine
PCMS President

H

appy birthday, Medicare!

Like me, Medicare turns 50 this
year, having been signed by
President Lyndon Baines
Johnson on July 30, 1965. It was
a huge congressional battle and no one seemed to like the
legislation, but now most of us depend quite heavily on it.
For better or worse, Medicare has become the basis for payment
schedules for almost all insurance. I’m sure you can see the
parallels I might draw to the Affordable Care Act. Timely, too as
one of the greatest issues with Medicare was the SGR, which
after 17 “Band-Aids” in 12 years, was finally repealed and MACRA
was signed by President Obama in April.
Thank you, Congress and Mr. President for actually doing
something. The Medicare Access and CHIP Reauthorization Act
(MACRA) clearly is not perfect, but it’s a start. It gives docs a 0.5%
increase per year from 2015-2019—not quite cost of living, but a
whole lot better than the 21 percent cut the SGR promised on
March 31. It funds graduate medical education for a couple of
years. It also lays the basis for “merit-based incentive payments,”
always scary to me. Who gets to decide my merit?
That’s what this column WAS going to be about. But in doing some
research, I found that the establishment of Medicare was not the
start of the campaign for national health insurance. It goes back a
couple of generations, so happy birthday to you, Papa.
In the early 20th century while my grandfather was a young child
in Russia, President Theodore Roosevelt supported health
insurance, believing that sick, poor people did not make for a
strong country. But there was no real government initiative to get
it started. The following could be called part one of a history on
the beginnings of American national health insurance, the seeds
of the Affordable Care Act.
In 1915 the American Association of Labor Legislation (AALL)
drafted a model bill that provided for coverage for doctors,
nurses, and hospitals. It included sick pay, maternity benefits, and
a death benefit of $50. All-working class people and their
dependents who made less than $1,200 per year were included.
Funding for it was shared between workers, employers, and the
state. Surprisingly, the AMA strongly supported the proposal, at
least initially. The American Federation of Labor (AFL) denounced
it, thinking it would weaken unions. The private insurance
industry opposed it, as it would have tanked the multimilliondollar commercial life insurance industry that made most of its
money on death benefit policies to pay for funeral costs.
Germany had established a compulsory sickness insurance in
1883, and in 1917 when the U.S. entered the European war and
all things German became bad, the opponents to the AALL bill
SOMBRERO – May 2015

associated it with Bolshevism and communism and general antiAmericanism—similar to the opponents of Medicare in the ‘60s
and the Affordable Care Act today.
In the 1920s healthcare costs began to rise. Middle-class people
were using hospitals, and actual medical costs became more of
an issue than lost wages. Some states made rumblings about
compulsory health insurance, but didn’t get very far. Nineteen
twenty-six saw establishment of the Committee on the Cost
of Medical Care (CCMC), funded by eight philanthropic
organizations including the Rockefeller Foundation. They met
over a six-year period and produced 26 research volumes and
15 reports. The CCMC was a conglomerate of 50 that included
economists, physicians, public health specialists, and specialinterest groups. Essentially they determined that more medical
care was needed for everyone. For the most part they
recommended voluntary health insurance as a means to that
end. The AMA was no longer on board, and the editor of JAMA
called it “an incitement to revolution.”
Now, happy birthday, Dad! President Franklin Roosevelt
considered including national health insurance in the Social
Security Bill of 1935 but feared, quite reasonably, that it would
threaten the passage of Social Security Legislation. He did
establish the Tactical Committee on Medical Care in 1937, and
out of that came the Wagner bill, the National Health Act of 1939.
The Wagner bill gave general support for a national health
program funded by federal grants and administered by states and
localities. Does this sound a bit like Medicaid to anyone else?
Then the 1938 elections brought a wave of conservatism and Sen.
Wagner went nowhere until 1943.
Wagner-Murray-Dingell transformed “Wagner” from federal grants
to compulsory national health insurance funded by a payroll tax.
The bill generated a lot of debate, but obviously never passed. It
was re-introduced in every session of Congress for 14 years. On
Jan. 11, 1944, President Roosevelt called for an Economic Bill of
Rights that included, “The right to adequate medical care and the
opportunity to achieve and enjoy good health.”
President Harry S Truman (served 1945-1953) continued the
theme and then some. In a speech to Congress on Nov. 19, 1945
he called on legislators to implement a comprehensive insurance
for all people through Social Security, not just the needy.
Although he emphasized that it was not “socialized medicine,”
still a kill-phrase today, many conservatives saw it as just that.
Sen. Robert Taft (R-Ohio) declared that compulsory health
insurance and the Full Unemployment Act came right out of the
Soviet constitution.
Republicans took control of Congress in 1946 elections and
national health insurance faced hospice once again. Stay tuned
for Part II. I can’t wait to see how this turns out!
SOURCES
Physicans for a National Health Program
CMS Oral History Project
AAFP News April 15, 2015
National Academy of Social Insurance

n
5

Now you’re
Thinkin’ Smart

Leers

Vaginal mesh
education
To the Editor:

I

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on vaginal mesh implantation. [April Sombrero].

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Sincerely,
Ron Spark, M.D.
Tucson

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SOMBRERO – May 2015

when requested by the governor’s office to serve on this board,
were simply to listen, analyze, and provide insight as requested
and required.

Milestones

Dr. Figge to serve on AMB

“I consider this a great responsibility and a great honor. My
impression in meeting the board members, going through the
confirmation process in the senate, and talking with the
governor’s office, is that any issues, in reality or assumed, of
being outdated and not strictly adhering to statute mandated
rules and processes, are now remedied and in the past.

Our former board member Dr. Gary
Figge, EM physician at Northwest
Medical Center, was recently
appointed by Gov. Doug Ducey to
serve on the Arizona Medical
Board. He joins fellow appointee Dr.
Lois Krahn, a psychiatrist with Mayo
Clinic Scottsdale.

“The future, I believe, is bright and on track for the board, and I
intend to do all I can to continue in that direction and goal of
making sure the public has access to the best healthcare
available, and that Arizona is a place the best physicians and
physician assistants would want to practice.”

Dr. Figge earned his M.D. in 1992
at Medical College of Wisconsin,
Milwaukee, did his EM residency at
the UofA, and is board-certified in
Gary R. Figge, M.D.
EM. He served as ArMA president
2010-2011. He has been a PCMS member since 2007.

Dr. Wang collaborates
in research
Mingwu Wang, M.D., Ph.D., associate professor in the UofA
Department of Ophthalmology and Vision Science, recently
collaborated in Arizona Health Sciences Center research that
found a potential cause of dry eye disease.

AMB is comprised of 12 people appointed by the governor and
approved by the state senate. Eight of the 12 must be physicians
who have practiced and lived in Arizona for at least five years
prior to appointment. Four members are from the lay public, one
of whom must be a nurse.

Researchers at the UA Steele Children’s Research Center made the
unexpected discovery into the role of NHE8, a sodium/hydrogen
exchanger protein, the university reported. The research was led
by Steele Center Director Fayez K. Ghishan, M.D., and center
researcher Hua Xu, Ph.D. in collaboration with Dr. Wang.

“There can be no more than five members from any one county,”
Dr. Figge said, “and my appointment brings Pima County to the
maximum of five along with doctors Farmer, Gillard, and Berg, as
well as public member Jodi Bain, an attorney in Tucson. So
TINNITU
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five- year terms, with the ‘twist’ that anyone
appointed to complete somebody else’s fiveTINNITUS
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BUZZING
have it count as one of their two five-year
terms, as happened with me. Thus, my
current appointed term is until 2019, as I
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left before the end of his new term.”

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“AMB went through a siginficant shakeup in
the last few years,” Dr. Figge said. “Moving
forward, AMB is committed to its legislative
mandate of protecting the public and
monitoring Arizona physicians and Pas with
that in mind. The board is charged with, and
responsible for, approving licenses to
practice as well as addressing any complaints
and concerns about practitioners they
license and, if necessary, determining
disciplinary actions when indicated up to and
including revocation of license to practice.
“My goal is to become part of a relatively
new and revamped, and updated, board in
this regard,” Dr. Figge said. “There is a
tremendous amount of work that goes into
the tasks required of the board, with many
reviews and phone calls in addition to all-day
bimonthly public meetings. My intentions,
SOMBRERO – May 2015

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Ophthalmologist Mingwu Wang, M.D., Ph.D., center, with Hua
Xu, Ph.D., and Fayez Gishan, M.D.

“NHEs are a group of membrane proteins that function to
exchange extracellular sodium (Na+) for intracellular hydrogen
(H+). NHE proteins contribute to many physiological functions,
such as intracellular (within cells) acidic (pH) regulation, cell
volume regulation and sodium absorption. They play an
important role by transporting sodium and electrolytes through
the gastrointestinal tract,” the university reported.
“In previous research, Ghishan and Xu discovered that NHE8
plays a role in mucosal protection in the intestinal tract and in
male reproduction. ‘When we deleted NHE8 in mice, we
observed that they developed gastric ulcerations, became more
susceptible to infections and the male mice became sterile,’” Dr.
Ghishan said, ‘And now, we have discovered that mice lacking
NHE8 expression also develop dry eye disease.’”
Dry eye disease (DED) is a very common eye disease, especially in
Arizona, due to low humidity and high temperatures. Individuals
with DED have symptoms of discomfort, visual disturbance and
even loss of vision. The disease affects millions of people, and
billions of dollars are spent annually for treatment in the United
States alone.
“Ghishan and Xu collaborated with Dr. Wang, who is an expert in
treating patients with dry eye disease. Dr. Wang helped
characterize dry eye phenotypes in NHE8-deficient mice. ‘It was
very interesting to observe clinical dry eye characteristics in the
NHE8-deficient mice in comparison to the wild type mice,” Dr.
Wang said. “Much more research needs to be done to delineate
the exact underlying mechanism.’”
“Their study, ‘Loss of NHE8 expression impairs ocular surface
function in mice,’ was published in January in the American Journal
of Physiology—Cell Physiology,” the university reported. “This work
was supported by National Institute of Diabetes and Digestive and
Kidney Diseases Grant R01-DK-073638 (F. K. Ghishan and H. Xu),
Research to Prevent Blindness Foundation (M. Wang), and
University of Arizona Faculty Research Seed Grant (M. Wang).”

8

William Nevin, M.D. was presented with the Pima County
Medical Foundation Award in recognition of Exemplary
Lifetime Achievment in Furtherance of Medical Education April
14 at PCMS. Dr. Nevin is a pulmonologist, educator, local HMO
pioneer, and volunteer at Clinica Amistad. (Stuart Faxon photo.)

‘Gold’ for Carondelet St. Mary’s
stroke care
The American Heart Association
recently awarded Carondelet
St. Mary’s Hospital with its Get
With the Guidelines—Stroke
Gold Plus, and Target: Stroke
Honor Roll quality
achievements awards,
Carondelet Health Network
reports.
“This is the fourth consecutive
year St. Mary’s has been
honored for its continued
implementation of national
quality guidelines scientifically
Francisco R. Valdivia, M.D.
linked to improved treatment
rates in stroke patients,” they said. “The AHA/ASA awards
recognize St. Mary’s for complying with each of the association’s
seven stroke achievement measures in at least 85 percent of
eligible patients.”

SOMBRERO – May 2015

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“The team of professionals in our stroke program has done an
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Mary’s Hospital is among the best in the nation,” said Amy Beiter,
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SOMBRERO – May 2015

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In Memoriam
By Stuart Faxon

Edward A. Brucker, M.D.
1924-2015
Edward A. Brucker, M.D.,
anatomical and clinical
pathologist who joined PCMS
in 1962, and who served as a
medic in World War II, died
after a long illness March 21 at
his home, the family reported
in the Arizona Daily Star. He
was 90.
Edward Arthur Brucker, Jr. was
July 24, 1924 in Chicago, where
he earned his M.D. at Loyola
University Stritch School of
Medicine in 1951. He interned
at Chicago’s Cook County
Edward A. Brucker, M.D.
Hospital, and his residency at
in the 1980s.
Milwaukee County Hospital,
Wisconsin. For six years he was director of laboratories at St.
Mary’s Hospital, Madison, Wis. He was American Board of
Pathology-certified. Before coming to Tucson he was a member
of Dane County (Wis.) Medical Society.
In 1979 Dr. Brucker retired from active practice with Associates in
Laboratory Medicine, Inc. a seven-physician practice with five
Tucson locations. He then became director of laboratory services
for Group Health Medical Associates, P.C. on East Carondelet
Drive.
“Ed loved to travel with his wife and family and made many trips
worldwide,” his family told the paper. “He was an avid reader, and
had a great desire to learn about everything. He enjoyed playing
golf and was a member of Tucson Country Club.”
Dr. Brucker was active in the American Society of Clinical
Pathology and the Arizona Society of Clinical pathology. He
often did criminal pathology and was recognized for his work in
that discipline.
“He belonged to the Knights of the Equestrian Order and was an
active member of St. Thomas the Apostle Catholic Church,” the
family said. “One of Ed’s passions was studying the Shroud of
Turin.* Every Lent, he shared the medical perspective on the
Shroud with churches and organizations in Tucson and around
the U.S., and he authored a book, ‘The Holy Face.’”
Dr. Brucker’s wife of 61 years, Pat; sons Ed III, Matt, Peter, David
and Andrew; daughters Trish Lawler, Suzanne Williams and Betsy
Allen; 16 grandchildren; and five great-grandchildren children
survive him.
A Memorial Mass was celebrated March 26 at St. Thomas the
Apostle Catholic Church. The family expresses sincere gratitude

10

to TMC Hospice nurses and staff for their excellent care.
Condolences can be left at www.bringfuneralhome.com .
*In this century the Shroud of Turin was revealed as a medieval
fake circa A.D. 1300, a surviving one of many that were
distributed, as there was a great trade in faked “relics.” Pope
Francis termed it an “icon” rather than a “relic,” a distinction
meaning it remains a powerful symbol of Christ’s suffering, while
the Church makes no claim to its authenticity. The cloth’s image
has fascinated believers and skeptics since a negative
photographic image was revealed in the late 19th century.

Donald J. McFarlane, M.D.
1926-2015
Donald J. McFarlane, M.D.,
general surgeon who joined
PCMS in 1975, died March 26,
the family reported in the
Arizona Daily Star. Retired
since 1993, he was 88.

Dr. Donald J. McFarlane in
1975 when he joined PCMS.

Donald John McFarlane was
born Oct. 18, 1926 in Toledo,
Ohio. In 1944-45 he served in
the U.S. Army Air Corps,
predecessor to the U.S. Air
Force. He attended John Carroll
University and earned his M.D.
in 1957 at Loyola University
Stritch School of Medicine.
Chicago. He interned and did
his GS residency at St. Vincent
Charity Hospital, Cleveland.

Dr. McFarlane practiced in Iowa 1952-73. He and his wife, Kathy,
came to Tucson in 1973. “He was chief attending at the TMC
and UMC emergency departments,” the family reported, “an
adjunct professor of surgery at the University of Arizona College
of Medicine, a surgeon in private practice at the Carondelet
hospitals, and he treated many members of the Tohono
O’Odham Nation.
“After a brief ‘retirement’ he worked with the wonderful
physicians and staff at Arizona Radiation Oncology. He loved
being a surgeon, he loved his patients, and above all he
loved his family.”
Dr. McFarlane’s son Michael predeceased him. His wife of
41 years, Kathy; sons Stephen, Kevin, Jeffrey, and Peter;
daughters Amie. Kathleen, and Molly; and eight granddaughters
survive him.
A memorial service was given April 19 at Catalina Foothills
Church. Memorial contributions may be made to Interfaith
Community Services or Gideons International.

n

SOMBRERO – May 2015

Behind the Lens

Rediscovery
By Hal Tretbar, M.D.
Arizona’s world-famous
geography and topography
always offer discovery and
rediscovery for travelers, hikers,
tourists, and photographers.
We even have our own statepublished magazine for them
all: Arizona Highways.
Recently I received a package
from Ray Graap, M.D., the
longtime Tucson endocrinologist.
In it were three calendars from
1990, ‘91, and ‘92, published by
the Tucson branch of Physicians
for Social Responsibility. Ray
had enticed me to submit images for possible use.
“Recently while cleaning out some shelves,” Ray wrote, “a longoverdue task which is usually put off by those of us further along

in years, I discovered there were three different calendars printed
locally and used as fund-raisers for PSR. The pictures were taken
by local physicians and healthcare professionals, using that
substance we knew as film. We must say that they came out very
well, and look great even to this day, digital technology aside.
“In Fall 1988, PSR sponsored a national tour of four Soviet
physicians that stopped in four cities, including Tucson. For three
days the USSR docs were shown around the city, had discussions
with local physicians, and gave presentations on the key topic
‘Medicine, Perestroika, and Security: Soviet Viewpoints.’ The
latter concerned nuclear weapons and the desire to eliminate
and/or control this scourge of human survival.
“One of the visits was to the Titan Missile Museum, a surreal
experience as they observed firsthand the means of nuclear
delivery to their country. We left going up the outdoor stairs from
the facility, and observed a sign over the outside door: “Caution;
beware of rattlesnakes!” An ironic message considering the
threat of global destruction!
Physicians for Social Responsibility, founded in 1963, continues to
pursue its original goal of nuclear disarmament. For further
information see www.psr.org”
The big surprises in the old package were the five original glossy
proof pages of my images that had been chosen for the
calendars. After 25 years I no longer can find some of the original
transparencies.

In 1969 I won first prize in a contest for the best image of Sedona’s Bell Rock. A land developer sponsored it, so I’m to blame for the
sprawl that is now across this once-pristine area. I also won the second month of the contest. That gave Dorothy and me a weekend in
Las Vegas!
SOMBRERO – May 2015

11

Red Rock Crossing, southwest of Sedona on Oak Creek, is one of Arizona’s prettiest places and most famous images. Late afternoon
light brings out the color of Cathedral Rock. This reflecting pool was washed out long ago.

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SOMBRERO – May 2015

Ribbon Falls is on the North Kaibab Trail. It drops from an overhang and this view from behind shows the mossy ground below. I sat
there alone, enjoying the warm shower splashing on the soft moss.

Our first trip to Havasupai was in 1967 when it was still under jurisdiction of the National Park Service. This image of Havasu Falls
was taken on one of many subsequent visits. The deep travertine pools have been washed out by flash floods. Can you see the people in
the pool on the right?
SOMBRERO – May 2015

13

Neurology

It’s all about brain
By Stuart Faxon

Photos by Carondelet Neurological Institute

W

e earthlings have only one means to learn more about
our brain: Use more brain. Our young earthlings can
always benefit from using more brain as early as possible, even
while its still developing; we certainly know what happens when
they don’t.

By such methods we may even produce the next physiciangeneration’s neurologists, which is the aim of Carondelet
Neurological Institute’s Brain Academy, an annual two-day
event for Southern Arizona’s best and best-motivated high
school students.
Western Neurosurgery’s 12 physicians staff CNI, based at
Carondelet St. Joseph’s Hospital and serving Southern Arizona
24-7 with neurology and neurosurgery. Many of Western’s
physicians are fellowship-trained in aspects of neurosurgery such
as Parkinson’s, scoliosis, and vascular diseases of the brain.
As they brainstormed about what became
Brain Academy, several physicians at Western
agreed that it was “very important to get
young people involved in the neurosciences,”
said CNI Chairman Robert P. Goldfarb, M.D.,
F.A.C.S. “Many high school students never have
an opportunity to have a one-to-one talk with
doctors, have lectures, and exposure to faculty.
This is a chance for them to see what the brain
surgeons and neurological specialists do.”
In 2011 they started collecting the most
capable and interested students, CNI
Administrative Director Leah Shea said. “We
targeted Tucson Unified School District science
and math students who showed special
aptitude. In the four years since, we now cover
TUSD, Sunnyside, Marana, Vail, Sahaurita,
Flowing Wells, Catalina Foothills, Salpointe, the
charter schools and the Christian academies.
This year we had 40 applications for 20 spots.”
Qualified students must be a junior in high
school with at least a 3.0 GPA, write an essay
answering why they are interested, and have a
teacher recommendation, Shea said. “The
selection committee reviews al the applicants
for the cream of the crop. We keep all district
sources considered, including transcripts and
course work. This year we have an
international student, from China.”
In their essays students most often describe a
family member’s experience with Alzheimer’s,
movement disorders, Parkinson’s, or stroke. It
could be a parent, grandparent, or other family
member. We want them to tell us what
interests them about science and medicine, or
their high school introduction to anatomy.”
This year’s program takes place April 24-25,
when the May magazine you’re reading was in
process of proofing and printing, so we can’t
tell outcomes in this issue. But the students

14

SOMBRERO – May 2015

CNI physicians and missions
When we asked what’s new in neurology these days, Dr.
Robert Goldfarb said that recent studies, reported earlier
this year, “definitively demonstrated that endovascular
therapy for ischemic stroke is superior to using tPA alone in
patients with clots in the major brain arteries.

Brain Academy 2013 students interact with clinical staff,
including clinical bio-engineer Jessie Heisey, who demonstrates
the Brainlab technology available in the dedicated
Neurosurgical Operating Suite.

“Approximately 30 percent of patients with ischemic stroke
have involvement of the major brain arteries and are
therefore candidates for extraction of the clots utilizing the
newest technology,” Dr. Goldfarb said. “The studies
demonstrated that time is of the essence in starting
treatment. The sooner the patient reaches a stroke center
such as CNI at St Joseph’s, that has the ability to perform
the clot removal procedure, the better the outcome. When
clot removal procedures are instituted rapidly, the death
rate from strokes was decreased by 50 percent compared
to using only tPA.”
The American Heart Association/American Stroke
Association recently awarded CNI—St. Joseph’s Hospital
the “Elite” award for its stroke program, which makes the
program among the first in the U.S. to receive this status,
Dr. Goldfarb said. CNI at Carondelet St. Joseph’s is a Joint
Commission Primary Stroke Center, designated for rapid
treatment of strokes including tPA treatment, mechanical
clot extraction from internal carotid and intracranial
arteries, and open surgery and/or endovascular treatment
of cerebral aneurysms, avms, and carotid artery stenosis.
Neurologists at Carondelet Neurological Institute at St.
Joseph’s Hospital and Western Neurosurgery, Ltd. are
William B. Lujan, M.D.; Diana V. Benenati, M.D.; David R.
Siegel, M.D.; L. Roderick Anderson, M.D.; and Hemant S.
Kudrimoti, M.D., Ph.D.

Dr. Emun Abdu talks to Brain Academy 2014 students about
interventional neurosurgery and provides a demonstration in
Carondelet St. Joseph’s Hospital’s state-of-the-art angiography
suite.

will go through a “reporting back” process, Shea said. “Five
groups of four students each get a diagnosis scenario, and they
must describe sumptoms, diagnosis and treatment options.
In interactive sessions leading up to their reporting back, “they
see what a stroke looks like, what neurosurgery looks like, and
they become familiar with various diagnoses,” Shea said. “On Day
One they get presentations on the most frequent kinds of
neurological cases, and they receive reference materials. On Day
Two the presentation is made by the group, with an individual or
the group making the verbal presentation.”
Shea said she finds the program “really inspiring. It makes you
want to go back and be one of those students again.”
SOMBRERO – May 2015

n

Neurosurgeons at Carondelet Neurological Institute at St.
Joseph’s Hospital and Western Neurosurgery, Ltd. Are
Robert P. Goldfarb, M.D.; Hillel Z. Baldwin, M.D.; Eric P.
Sipos, M.D.; Matthew P. Wilson, M.D., Ryan M. Kretzer,
M.D., and Emun Abdu, M.D.
“Our most frequent neurosurgical treatments are for spinal
disorders (minimally invasive as well as complex spinal
surgery), brain cancer surgery, and stroke treatment to
include tPA , clot removal,” Dr. Goldfarb said. “Our medical
neurologists’ most common treatment is for headaches,
vascular disease of the brain, epilepsy, and neuromuscular
diseases.”
Treated spinal disorders include herniated discs, lumbar
stenosis, adult scoliosis, and spondylolisthesis. For brain
tumors there is surgical treatment and stereotactic
radiation treatment.
For Parkinson’s disease there are medical treatment and
surgical deep brain stimulation procedures. There are
surgical treatments for chronic pain, and medical
diagnoses and treatment for headaches, MS, cerebral
vascular disease, neuromuscular conditions, epilepsyseizures, and cognitive impairment.
15

16

SOMBRERO – May 2015

Makol’s Call

Hogan’s, and other heroes
By Dr. George J. Makol

I

hate “reality television.”

Let’s face it, television was
invented in the first place so
that all of us could escape
reality and inhabit a wonderful
fantasy world filled with heroes
like Superman, Flash Gordon,
Davy Crockett, and Daniel
Boone. Or, we could slip into
uncontrolled laughter following
the antics of Lucille Ball, Red
Skelton, or Dick Van Dyke.

These days, it’s almost
impossible to turn on your TV
without being confronted by idiotic “housewives,” ill-tempered
chefs, and generally just the kind of people you’ve spent your
whole life trying to avoid and wouldn’t allow in your home. And
now you’re paying outrageous cable TV rates for this privilege—
still with commercials. Remember when the proposed “pay TV”
would not have those?
And how much reality is there in “reality”
shows, anyway? If you look at the credits of
Survivor, a supposedly death-defying trial
for contestants, set in the wilderness, you’ll
notice they have an art department, a
sound department, a stunt department,
animation, a costume, makeup and
wardrobe department, transportation,
and catering.

killed during the war. Leon Askin was also in a pre-war French
internment camp and his parents were killed at Treblinka. Caine,
who was also Jewish (his birth name was Cohen), was American,
and Jewish actors Harold Gould and Harold J. Stone played
German generals. Jon Cedar played a camp guard.
As a teenager, Werner Klemperer (Klink), son of famed symphonic
conductor Otto Klemperer, fled Hitler’s Germany with his family
in 1933. During the show’s production, he insisted that Hogan
always win over his Nazi captors, or else he would not take the
part of Klink. He defended his playing a Luftwaffe officer by
claiming, “I am an actor. If I can play Richard III, I can play a Nazi.”
Banner attempted to sum up the paradox of his role by saying,
“Who can play Nazis better than us Jews?” Klemperer, Banner,
Caine, Gould, and Askin played stereotypical World War II
Germans, and all had served in the U.S. Armed Forces during
World War II.
Wait, you might say, how can a totally unrealistic program about
a beneficent prison camp with an incompetent colonel in charge
possibly be of interest to a modern physician? It is because of my
friendship with a patient, a real “Hogan’s hero,” that went on for
more than 15 years before he told me of his war experience.

I have resorted to putting up amplified
rabbit-ear antennas on all my TVs so I can
pick up TV Land and other oldies channels.
This led me to a recent fascination with the
series “Hogan’s Heroes.”
Wikipedia reminds us that the actors who
played the four major German roles—
Werner Klemperer (Klink), John Banner
(Schultz), Leon Askin (Burkhalter), and
Howard Caine (Hochstetter)—were Jewish.
Furthermore, Klemperer, Banner, Askin,
and Robert Clary (LeBeau) were Jews who
had fled the Nazis during World War II.
Clary says he spent three years in a
concentration camp, that his parents and
other family members were killed there,
and that he has an identity tattoo from the
camp on his arm (“A-5714”).
John Banner had been held in a pre-war
concentration camp, and his family was
SOMBRERO – May 2015

17

Let’s call him Mr. M, a native Austrian living there in 1935, and
being Jewish, he was obliged to flee the country and come to
America to avoid persecution. He happened to move to my
hometown of Springfield, Mass., where he opened a foreign
sports car dealership on Boston Road, near my house.
Although I was only about six years old, I can remember driving
by with my parents and seeing the fantastic “rides” like the
Austin Healeys, Jaguars, MGBs, and Alpha Romeo convertibles
parked out front. My eyes bugged out, but I never got to see the
owner, as my dad in those days only bought Cadillacs.
Fast-forward 25 years or so, and this gentleman moves to Tucson
to retire, is followed for his asthma by my senior associate, and
then becomes my patient when the older doctor retires.
Although this man is 30 years older than I, I discover he’s from my
hometown, is a former race-car driver, and like most of our
seniors has a treasure trove of knowledge to impart. We become
fast friends and go out to lunch virtually every other month for
many years. In all honesty I think he learned more about me over
those years than I did about him, up until just about the last time
we went out to lunch.
It was then, after all that time knowing him, that he told me the
story about coming to America to escape the forming Nazi
regime, volunteering for the U.S. Army, and being sent back over
to fight for the freedom for his countrymen.
He did not just join the Army and get stationed at some outpost
behind the front lines, but landed on Omaha Beach on D-Day.
This beachhead was center of the Allies’ Normandy invasion, and
as I’m sort of a history buff, I thought I knew a lot about this.

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What I did not know was that paratroopers
were dropped in hours before the 6:30 a.m.
arrival of the nautical forces to clear the
beaches of German obstructions and mines.
So there was Mr. M, with his fellow soldiers,
crawling on his belly on the darkened beach
with wire-cutters for the barbed wire, and
colored sticks to mark obstructions and
danger points. He and his group made their
way around the German positions and into
the French countryside by the time the main
forces landed. Although Allied casualties that
first day were nearly 10,000, he was
untouched on that day. About 10 days later
while walking outside of French village he
was grazed in the arm by a sniper’s bullet,
but survived without serious injury.
I cannot tell you how far my jaw dropped
while listening to this story, all the while
thinking of the Greatest Generation as it’s
been called, and that most of these people
are now leaving us. And I think about life
today, where we may get upset if we can’t
find a parking spot in front of the hospital, or
there are no seats left in Starbucks, or our
dry cleaning order is not ready on time. I
was recently inconvenienced myself because
the air-conditioned seats in my new car were
SOMBRERO – May 2015

not functioning properly; the seat was hot, and it is not even
summer yet!
The Hogan’s Heroes connection is that like Mr. M, Werner
Klemperer and his family fled Germany in 1935 for much the
same reasons. Klemperer too volunteered for service, joined the
Army, and was first stationed in Hawaii. Klemperer was also a
singer and violinist, an accomplished a musician like his father.
You may remember Col. Klink’s awful violin playing, one of the
show’s regular themes. It’s work for a good violinist to play badly!

SOMBRERO – May 2015

Now Mr. M, like many of the Greatest Generation, has passed on.
I cannot find anyone 30 years older than I am to go to lunch with;
in fact, I cannot find anybody 30 years older, period. My mother is
92, and even she is not 30 years older than I!
Maybe it’s best if I just start watching all the reruns of “I Love Lucy.”
Laughter is truly the best medicine.
Sombrero columnist George J. Makol, M.D., a PCMS member
since 1980, practices at Alvernon Allergy and Asthma, 2902 E.
Grant Rd.

n

19

Rerement

No bucket list for ‘Dr. Housecall’
By Dennis Carey

T

he gallows humor of a list of things to do before you “kick
the bucket” gave rise to the movie title and cultural phrase
“bucket list,” but you’ll find no such idea in plans of the legendary
Hector L. Garcia, M.D., who will retire at the end of this month
from his cardiology and IM practice after 54 years. He has been a
PCMS member for 51 of those years.
His decision to retire is a little unexpected, even to himself. There
was no specific reason, and there is no specific plan for the
future.
“We are going to play it by ear,” said Dr. Garcia about himself and
his wife, Ligia. “We will be spending some time with our
grandchildren in Boston, and will split time between California
and Arizona, but there is nothing specific on our calendar. No
bucket list. We want to be able to do some things without having
to rush back to see patients.”
He said he wants to do some non-medical reading and a little
traveling. His life’s passion has been the practice of medicine, and
there has not been a lot of time to develop other interests. He
admits Ligia pushed him toward slowing down a little, but he
decided it was time to retire.
“We just felt it was time to stop and smell the roses,” he said. “I
love being a doctor, so I kept on doing it. It was what I wanted to
spend my time doing. But we don’t know how much time we have
left, so we finally decided it was time to stop with the practice.”
It would be a tough search to find families with more physicians
than Dr. Garcia’s. The son of a physician, he was born Aug. 10,
1926 in a small town in Cuba and grew up there. He also had an
uncle and brother who were physicians. He went to Havana
Medical School and graduated in 1951. Luckily, he had completed
his training and planned to stay in the U.S. prior to Fidel Castro’s
communist revolution of 1959. He interned at Mercy Hospital in
Canton, Ohio and completed his residency in cardiology at The
Cleveland Clinic in 1958. He did some teaching in Puerto Rico and
Georgia prior to coming to Tucson in 1961. He started in Tucson at
the Veterans Administration Hospital. After three years he began
his private practice, nearly all of it has been spent at his current
office at Medical Square, 1601 N. Tucson Blvd.
It is his work outside the office that built his reputation and got
him the most attention. TV had “Dr. House.” Tucson has “Dr.
Housecall.” Dr. Garcia enjoys doing housecalls and has been doing
them every week since he started his practice. He has been trying
to help his patients adjust to his retirement, but they know it is
rare these days to find someone who will make housecalls
routinely—or at all.
“There are wonderful doctors out there who are very dedicated,”
Dr. Garcia said, “but it has become very difficult for them to
include housecalls as part of their practice and be successful. I
know there are some practices where a patient rarely sees a
20

Cardiologist-IM physician Hector L. Garcia, M.D. is retiring
after 54 years of practice in Tucson. Known for making regular
housecalls a practice cornerstone, Dr. Garcia has received
several awards in recognition of his years of service (Dennis
Carey photo).

physician even if they go to an office. Many of the procedures are
done by nurse practitioners or medical assistants. There is
nothing wrong with that, but it is being with the people that
made me want to be a doctor, so I would prefer to do it myself. I
have always felt communication and trust are the most important
parts of practicing medicine and for me that comes with talking
to the patients one-on-one.”
Dr. Garcia’s legacy looms large in Tucson’s medical community,
including four children who are physicians, three of whom
practice in Tucson. Hector F. Garcia, M.D. has practiced cardiology
with his father at offices in Tucson and Douglas. PCMS Board
member G. Mason Garcia, M.D. recently opened Sunrise
Cardiology, a direct-pay practice near TMC. His daughter Mariali
Garcia, M.D. is a Tucson endocrinologist. Son Lawrence Garcia
practices cardiology in Boston.
“My wife deserves most of the credit for our wonderful family,”
Dr. Garcia said. “She dedicated herself to the kids while letting me
SOMBRERO – May 2015

dedicate my life to practicing medicine. I am very proud of my
family. They are making their own marks as doctors.”
Dr. Garcia also has impacted local medicine by serving on the
PCMS Board of Directors 1999-2001, and from 2002 to 2004.
He was elected Southern Arizona District Director of the Arizona
Medical Association in 1997, but left after one year.
“I did not want to spend that much time in Phoenix talking about
the politics of medicine,” he said. “I wanted to practice medicine.
I felt it was taking too much time from my patients. I did enjoy
serving on the board at PCMS. I looked forward to those Tuesday
night meetings with my colleagues. It was a wonderful time.”

His colleagues must have felt the same way. He was named
PCMS Physician of the Year in 2003. In 2005 he received the
Rose Marie Malone Award for Service to Organized Medicine.
Last year Pima County Medical Foundation gave him its
Foundation Award for Exemplary Lifetime Achievement in
Furtherance of Medical Education.
Dr. Garcia appreciates the acknowledgment he has received from
his peers, but says the everyday interaction with his patients is
what he will miss most in retirement. “I have had some patients
for almost 50 years,” he said. “I am not sure new patients want
to start with a doctor my age!”

n

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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:
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.

May
May 15-17: The Second Annual Southwest Laryngology
Conference: Focus on Dysphagia and Laryngeal HyperResponsiveness is at Mayo Clinic Talor Auditorium on the Mayo
Clinic Scottsdale campus, 13400 E. Shea Blvd., Scottsdale.

Targets physicians, NPs, PAs, and speech-language pathologists.
Specialists are welcome in otorhinolaryngology, general surgery,
IM, allergy, gastroenterology, pulmonology and neurology.
https://ce.mayo.edu/otorhinolaryngology/node/1827
You may register for the live-stream webcast, which will include
the option to submit questions. Website: https://ce.mayo.edu/
otorhinolaryngology/node/3270 Website: https://ce.mayo.edu/
Contact: Cassandra Skomer, Mayo Clinic Scottsdale, phone
480.301.4580; fax 480.301.8323.
mca.cme@mayo.edu https://ce.mayo.edu/

June
June 5: The Association of American Physicians and Surgeons
presents the 22nd Thrive, Not Just Survive Workshop at the
Embassy Suites, 201 Harrison Oaks Blvd., Cary, N.C. in the Raleigh
area. Workshop is 1-6 p.m., immediately followed by Politics and
Your Practice focusing on updates on physician-led initiatives in
Washington, D.C. And nationwide to protect patient-centered
medicine.
For $124-per-night room reservations, call 919.677.1840 and
mention AAPS or use the link at aapsonline.org/raleigh
Accreditation maximum 4.75 Category 1 credits by New Mexico
Medical Society through joint providership of Rehoboth McKinley
Christian Health Care Services and AAPS. Online signup and more
information is at www.aapsonline.org/raleigh

Accreditation: 18.0 AMA PRA Category 1 (General Session); 4
AMA PRA Category 1 (Optional Workshop—separate fee). Course
is offered for 1.7 ASHA CEUs (Intermediate level, Professional
area).
Conference designed to provide state-of-the-art discussion on
comprehensive evaluation and management of dysphagia related
to head and neck cancer and neurological disorders, as well as a
thorough assessment of laryngeal hyper-responsiveness, including
chronic cough, presented by a faculty of world-renowned experts
in laryngology, dysphagia, and laryngeal hyper-responsiveness
from across the country. Program uses multidisciplinary team
approach with presentation topics including:
• Physiology of Normal Swallowing
• Skill Acquisition in Volitional Laryngeal Control
• Muscle Tension Dysphagia
• Dysphagia Evaluation and Treatment in Head and Neck Cancer
• Diagnostic Imaging of Swallowing
• Collaborative Management of Chronic Cough
• Paradoxial Vocal Fold Motion
• Neural Control of Swallowing

Members’ Classifieds
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.
22

SOMBRERO – May 2015

Radiology Ltd. now offers 3D Mammography.
The physicians of Radiology Ltd. believe in personalized
and comprehensive service for all patients and are
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Radiology Ltd.’s personalized breast screening service
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Welcome Back to the Radiology Ltd. Team!
Creed M. Rucker, M.D.

Neuroradiology and General Radiology

Dr. Rucker received his M.D. from the University of Arizona in
2000. He then completed his Internship in General Surgery
and Residency in Nuclear Medicine at Vanderbilt University
Medical Center. He went on to complete an additional
Residency in Diagnostic Radiology, along with his Fellowship in
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SOMBRERO – May 2015

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attached to your MICA policy.

Medical Professional
Liability Insurance
(602) 956-5276
(800) 352-0402
www.mica-insurance.com

The policyholder benefits presented here are illustrative and are not intended to create or alter any insurance coverage. They
should not be relied on and may differ from actual MICA policy language. Coverage provided by MICA is always subject to the terms
and conditions of your policy, and MICA strongly encourages you to read your policy in its entirety.

24

SOMBRERO – May 2015