You are on page 1of 24

Sombrero

Pima County Medical Society


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

OCTOBER 2015

Tumamoc Hill:
To your health!

Paramedicine: Coming
on strong in Rio Rico
The old Presidio:
Spanish garrison medicine

SOMBRERO October 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

Vol. 48 No. 8

Arizona Medical
Association Officers

Snehal Patel, DO (Alt. Resident)


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

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

Members at Large
Richard Dale, MD
Charles Krone, MD
Jane Orient, MD

At Large ArMA Board

Board of Mediation

Timothy C. Fagan, MD
Timothy Marshall, MD

R. Screven Farmer, MD

Pima Directors to ArMA

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)

Executive Director
Bill Fearneyhough
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: billf 5199@gmail.com

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

Printing
West Press
Phone: (520) 624-4939
E-mail: andyc@westpress.com

Advertising
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: dcarey5199@gmail.com

Art Director
Alene Randklev
Phone: (520) 624-4939
Fax:
(520) 624-2715
E-mail: alener@westpress.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 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.

CE

ILL

TH
OO

NT

Sabino Vista Hills

RA

Hill Farm Contemporary

Impeccably maintained one owner home in Sabino


Vista Hills. 3,284 sq. ft., 5 bedroom, 2 Full/1 Half
baths, split bdrm plan. 1/2 acre lot with park-like yard
including numerous fruit trees & full width covered patio.
Community pool & tennis.

Elegant Hill Farm contemporary on the lake!


2,024 sq. ft., 3 bedroom, 2 bath,
updated granite kitchen w/mesquite topped
island & maple floors. Convenient central location.
Community pool & rec center.

$475,000

$459,000

Madeline Friedman

SOMBRERO October 2015

ABR, CRS, GRI

Vice President

296-1956 888-296-1956

Madeline is Your Connection to


Tucsons Favorite Neighborhoods!
www.tucsonazhomes.com TucsonHomeFinder@aol.com
3

Inside
5

Dr. Melissa Levine: Sometimes we must take


stock of what is most important.

6
8

Letters: AAPS forecast on Medicare.

10

PCMS News: AHCCCS expansion ruling appeal


heads for Arizona Supreme Court.

Milestones: For doctors Clavenna, Goldberg,


Schram, and Wong.

12 Public Health: Dr. Ron Spark helps improve


Tumamoc Hill.

14 In Memoriam: Dr. Roland V. Murphy dies at 94.


15 Behind the Lens: Drifting along with those
(pesky but hardy) tumbling tumbleweeds.

17
20

Paramedicine: Rio Rico test case looks good.


Time Capsule: Dr. Rudy Byrd has a military
medicine part to play in the Tucson Presidio
Trust for Historic Preservations 18th- and 19thcentury exhibition starting this month.

On the Cover
This tumbleweed patch was so dense, the tripod could not be placed.
Its a maturing Russian thistle with a red-and-purple-striped stem, its
leaves becoming tube-like, with pointed ends. The small flower is
2mm across. Shot with Nikon D600, Tamron 70-300mm on macro
setting, ISO 400, f.5.0, 1/1600th second, hand-held (Dr. Hal Tretbar
photo).

Brain Trouble
What brain problem is represented when we call one neurology
practice by the name of another? Seven obituaries in one issue? With
two CNI news items? Whatever the diagnosis, we glaringly erred in
our June-July issue obituary for Dr. Bill Masland, who died in May,
when our editor somehow claimed the nonsense that the former
Neurological Associates of Tucson is now Carondelet Neurological
Institute. In fact, Marketing Manager Alanna Gonzales reminded us,
Neurological Associates of Tucson still exists, and is doing business as
Center for Neurosciences. Our apologies to her and our member
doctors Norton, Callahan, Rivero, Sanan, Song, and Valdivia. The
minds mysteries are endless, and we salute the seekers.
Also, in our August-September Membership profile of Pima
Dermatology, we had some more name confusion. The practice
administrator is Rachel Chanes. The marketing and cosmetic
manager is Sarah Cadrobbi.

SOMBRERO October 2015

Our members are our essence


By Dr. Melissa Levine

Ill paraphrase a story my Rabbi recently told. Bob Baffert is the


trainer of American Pharaoh, the horse that won the Triple Crown
of thoroughbred racing this year, the first to do so in 37 years.
Baffert is also from Southern Arizona. What I did not realize is
that Baffert came within a nose of a Triple Crown in 1998 with a
horse named Real Quiet. As the photo-finish showed, Victory
Gallop came out of nowhere and won by a nose. As Bob Baffert
realized he had lost the racethe Triple Crown and a $5 million
prizehis four-year-old daughter Savannah said, Daddy, you still
have me.

PCMS President

Happy New Year!


Rosh Hashana, Sept. 13-15, new
year 5776 on the Hebrew
calendar, marks the the High
Holy Days for Jews around the
world. The New Year is a time to
take stock, to atone, and to
think about whats important.
This is also somewhat of a new
start for your medical society.

Rabbi Tom implored those present to take stock of what is


important. I implore you to do the same. The medical society
building was not the Washington Monument, and the medical
society is not the building. We still have what is important. We
have a good staff who work hard for us, we have good people
who volunteer their time to serveand we have our members.

Last Friday, Sept. 11, I signed


the papers to sell the PCMS building. While this was not my idea
or project, if I were simply a board member, I would have voted
for it. Good or bad, it will likely become my legacy as PCMS
president. Only time will tell us if it was the right move. It gives a
needed infusion of cash into our coffers. It removes
from us an encumbrance that I consider a growing
liability. I hope it will make us more flexible and
better able to meet the needs of our members.
Many of you have read the time-line in last months
Sombrero about the sale of the PCMS building. If so,
I am sorry to be repetitive, but I think a few
highlights bear repeating. At our March 2014 board
meeting, Dr. Jim Klein and a few others presented
ideas about ways to save money and renovate the
building. The board, and our executive director,
looked into those. In October 2014, Dr. Timothy
Marshall wrote his editorial in Sombrero about the
health of the PCMS building. In that discussion he
noted that members had received a survey asking if
they would be willing to contribute to the
renovation, and asking members to vote.
Approximately 12 percent of members answered
that survey, and it was two-to-one against.
My first Sombrero column talked about relevance.
The Executive Committee and the Board of
Directors struggle with that. How do we increase
the societys relevance? I am still searching for that
answer, but one of the ways is to have the funds for
lobbying the legislature, or the local city council,
about the needs of physicians and our patients.
After all, I think that despite our differences, that is
what we want. We want to take care of our
patients, and be able to take care of our families.
We invite members to give us ideas, to share in civil
discourse, and to engage in conversation intended
to enhance understanding. Your board wants to
know what the needs of the members are, and
what PCMS can do for them.

LShana Tova Tikatavu. May you all be inscribed for a good


year.

w!
o
rN

te
s
i
g
Re

2015 End-of-Life
Community Conference

Integrative Approaches
to End-of-Life Care
Featuring

Andrew Weil, M.D.


Friday, November 13, 2015
Tucson Convention Center
www.TucsonHospiceConference2015.eventbrite.com

In the past few weeks I have received some rather


vitriolic letters, based on misinformation regarding
the sale of the building. I have taken the time to
answer most of them. As your president, I felt that
was my responsibility. It is now time to move forward.
SOMBRERO June/July 2015

Leers

Medicare unsustainable
To the Editor:
Thanks for Dr. Levines interesting history of Medicare, Parts 1 and 2 [May and AugustSeptember Sombrero]. They read rather like the history of the PCMS building. People tried
and tried until they got it. And now it is a financial disaster waiting to happen.
The optimistic predictions about PCMS didnt happen. The gloomy predictions about
Medicare made by the Association of American Physicians and Surgeons, did.
The 2015 Trustees Report on Medicare is full of hopeful speculations. It uses the word
insolvency only once, but acknowledges that (1) the number of beneficiaries is increasing
faster than the number of workers; (2) Part A expenditures have exceeded income every
year since 2008; and (3) the Trustees minimum standards expressed as short-term financial
adequacy and long-term actuarial balance have not been met for more than a decade.
The trustees also acknowledge that if [Trust Fund] assets were depleted, Medicare could
pay health plans and providers of Part A services only to the extent allowed by ongoing tax
revenuesand these revenues would be inadequate to fully cover costs. Beneficiary access
to health care services would rapidly be curtailed.
They assume that Congress will somehow find the money [in the future hopes and
opportunities of the younger generation], but as AAPSs journal editor Dr. Lawrence
Huntoon points out, There is no way to manage a wealth transfer Ponzi scheme to make
it financially sustainable. He concludes that Medicare at 50 is terminally ill. (seehttp://
www.jpands.org/vol20no3/huntoon.pdf).
Sincerely,
Jane M. Orient, M.D.
Tucson
Dr. Orient is AAPS executive director and a PCMS past-president.

Superior medical care, right in your neighborhood!


Valley ENT is proud to offer Southern Arizona
residents the most comprehensive treatment
of the diseases of ear, nose and throat (ENT).

Steven J.
Blatchford,
MD

Our services include:

Effective, minimally invasive in-office procedures,

geared to improve your quality of life


Standard and no-shot allergy treatment
State of the art services in audiology and
hearing aids
Standard and at-home studies for sleep apnea

Call our office today to schedule an appointment!

A. J. Emami,
MD, FACS

James D.
Gordon,
MD

(520) 792-2170
Adam D. Ray,
MD

OFFICES LOCATED IN:


Tucson
Nogales
Willcox
6

Green Valley
Sierra Vista
Marana

David T.
Miyama
MD

SOMBRERO October 2015

SOMBRERO October 2015

Milestones

Dr. Clavenna joins Carlson ENT


Otolaryngologist and sinus
and allergy specialist Matthew
Clavenna, M.D. recently joined
Carlson ENT.
After earning his bachelors
degree in biochemistry at
Trinity University in San
Antonio, Texas, he earned his
M.D. in 2009 at Louisiana
State University School of
Medicine, Shreveport, where
he was elected into the Alpha
Omega Alpha Honor Society.
While in med school, he was
introduced to otolaryngology.
He completed a general surgery internship and otolaryngology
surgical residency at Louisiana State University Health,
Shreveport. Dr. Clavenna then completed a Fellowship in sinus,
allergy, and anterior skull base surgery at Vanderbilt University,
Nashville, Tenn. There he trained under internationally known
surgeons, doctors Rick Chandra, Paul Russell, and Justin Turner.
In the Fellowship he focused on advanced sinus surgeries,
including management of frontal sinus disease, nasal and skull
base tumors, pituitary surgery approaches, ophthalmologicalrelated procedures, and treatment of allergies. Many of these
cases were performed in conjunction with neurosurgeons and
ophthalmologists.
Dr. Clavenna says that one of his fondest memories from
Fellowship involved treating a patient transferred to Vanderbilt as
an emergency case for severe sinus disease encroaching on vision
in the patients right eye. Using his recently learned endoscopic
sinus surgery techniques with the aid of image guidance, Dr.
Clavenna was able to successfully treat and drain the infection
and preserve the patients vision.
Dr. Clavenna moves to Tucson with the desire of helping those in
the community with their ear, nose, and throat-related
problems, the practice reports. He is the first Fellowshiptrained sinus and anterior skull base surgeon to join a private
practice group in Tucson. Though he has a passion for nasal,
sinus, and allergy related disorders, he also enjoys treating the
full range of ENT related issues, from neck masses to ear surgery.
In his free time Dr. Clavenna enjoys spending time with his wife
and in the outdoors, and looks forward to taking advantage of our
wonderful Arizona surroundings.

Dermatology and Dermatologic


Surgery Society (ADDSS). This
year, ADDSS has been focused
on HB 2493, the bill that
would ban minors (under 18)
from using indoor tanning
devices. ADDSS and
concerned Arizona medical
providers urge you to take
action, Dr. Goldberg said.
You may sign the petition
urging Arizona legislators and
Gov. Doug Ducey to act now to
protect Arizona minors from
tanning beds. To learn more
or to sign the petition, please
visit: https://www.change.org/p/arizona-state-house-arizonastate-senate-arizona-governor-protect-arizona-minors-fromtanning-beds.
Dr. Goldberg has lectured throughout the U.S. over the past eight
months, including the Orlando Dermatology Aesthetic & Clinical
Conference (ODAC) in Orlando, Fla. in January. He presented on
Challenging Cases From a 30-Year Experienceor, Adventures
and Misadventures in Laser Therapy, and led the Fractional and
Full Ablative CO2 Laser Skin Rejuvenation Workshop.
He also lectured at the American Society for Laser Medicine &
Surgery (ASLMS) 2015 Annual Conference in Kissimmee, Fla. in
April. As a faculty member of ASLMS, Dr. Goldberg led a number
oftalks for the Fundamentals in Health Care course. His talks
included, Addressing Complications of Laser Procedures,
Tattoos, Pigmented Lesions, Melasma, and Laser Treatment of
Darker Skin Types, and Video Demonstration and Discussion of
Laser Endpoints. His plenary session talk was Combination
Laser Modalities for the Treatment of Skin Rejuvenation and
Complex Vascular Lesions.
Dr. Goldberg spoke at the Noah Worcester Dermatological
Societys 57th Annual Meeting April 29-May 3 in Asheville, N.C.,
presenting his challenging cases talk, and he reviewed laser
treatments for skin over the past 30 years. Work on tattoos,
childrens birthmarks, rosacea, skin rejuvenation, scar revision,
and wrinkles were among the topics. In May, he spoke at the
UofA Dermatology Grand Rounds with his presentation, Lasers:
A 30-Year Experience.
This fall Dr. Goldberg introduces Pima Dermatologys 17th laser
modality, the Sciton Halo. The worlds first hybrid fractional laser
delivers both ablative and non-ablative wavelengths to the same
or different microscopic treatment zones to provide ablative
results, with non-ablative downtime, Dr. Goldberg said. Pima
Dermatology is the only dermatology physician practice in Tucson
to offer this new and sophisticated laser.

Its proven to be an eventful year for Gerald N. Goldberg, M.D.,


owner and medical director of Pima Dermatology in Tucson,
profiled in our last issue.

Rounding out a year of advancements, Dr. Goldberg and his


associates welcome Sarah E. Schram, M.D. to their team. Boardcertified by the American Board of Dermatology, Dr. Schram
specializes in Mohs skin cancer surgery with a special interest in
cutaneous oncology and cosmetic dermatology. She is thoroughly
skilled in surgical dermatology, cosmetic dermatology, and lasers.

At years start Dr. Goldberg was elected president of the Arizona

Dr. Schram earned her M.D. at University of Minnesota Medical

Dr. Goldberg stays on the move

SOMBRERO October 2015

School. She achieved


academic honors with the
Glasgow-Rubin Citation for
Academic Achievement, and
was elected to the prestigious
Alpha Omega Alpha Honor
Medical Society. She completed
her dermatology residency at
University of Minnesota
Medical School in 2011, and
received extensive training in
Mohs and laser surgery during
a Procedural Dermatology
Fellowship at the University of
Minnesota in 2012.
Prior to joining Pima Dermatology, Dr. Schram was a dermatologic
surgeon and assistant professor at University of Minnesota
Medical School. Dr. Schram began seeing patients on Sept. 1.
Dr. Goldberg is a Clinical Professor of Dermatology at the
University of Arizona where he has been on faculty since 1984
instructing medical students and residents. He is a preceptor for
dermatology residents for the American Society of Dermatologic
Surgery (ASDS) as well as the ASLMS. He also lectures throughout
the year at Canyon Ranch, educating guests from all over the
world about the latest trends in dermatology, including anti-aging
treatments and products.

Dr. Wong joins Retina Centers

including severe diabetic eye


disease, trauma, and
proliferative vitreoretinopathy.
He has also been active in
academic medicine and
research, having given
numerous oral and poster
presentations at national and
international meetings.
Additionally, he has written
book chapters and several
papers in peer-reviewed
journals.
Retina Centers Northwest,
East, and Southwest say they
are fully equipped with stateof-the-art technology for diagnosis and outpatient treatment of
retinal disorders. The highly trained staff strives for excellence in
care, and participates in providing consultative, diagnostic, and
treatment services within one office visit when needed, an
important time saver for working and out-of-town patients.
Treatment of retinal tears and detachments, as well as diabetic
retinopathy and age-related macular degeneration, constitute a
major part of the practice.
Dr. Wong accepts Medicare Assignment, and is a participating
provider for all area health plans, including AHCCCS and TRICARE.
Central Appointments: 520.742.7444 or 800. 535-2484.
n

Retina Centers reports that Ryan K. Wong,


M.D. has joined the practice, which
includes PCMS members George S. Novalis,
M.D. and Martin A. Worrall, M.D.
Tucson native Dr. Wong is a vitreoretinal
surgeon. He earned his bachelors degree
in biology with a minor in chemistry at the
University of Pennsylvania, Philadelphia. He
earned his M.D. at Weill Cornell Medical
College of Cornell University, New York.
He did his internship at the Hospital of St.
Raphael and his ophthalmology residency
at Yale-New Haven Hospital/Yale University,
both in New Haven, Conn. Dr. Wong then
completed a two-year vitreoretinal
fellowship at the Jules Stein Eye Institute,
University of California at Los Angeles.
Dr. Wong is certified by the American Board
of Ophthalmology. He is a member of the
American Society of Retina Specialists,
American Academy of Ophthalmology, the
Association for Research in Vision and
Ophthalmology, and AMA. As a native
Tucsonan, Dr. Wong says he is excited to
return and serve the community in which
he grew up.
Dr. Wong has extensive training and
experience in management of medical and
surgical diseases of the retina and vitreous,
SOMBRERO October 2015

PCMS News

Judge rules AHCCCS


expansion constitutional

Maricopa County Superior Court Judge Douglas Gerlach ruled


recently that the simple majority vote that expanded AHCCCS in
2013 was constitutional, ArMAs Medicine This Week reported in
September.
Last December, the weekly reported, the Arizona Supreme Court
ruled to allow a lawsuit challenging Gov. Jan Brewers AHCCCS
(Arizonas Medicaid program, the Arizona Health Care Cost
Control System) expansion plan to move forward. The high court
agreed that 36 Republican legislators could sue Gov. Brewer over
the legality of a hospital assessment that funds the expansion
plan, which was passed by a bare majority in the legislature.
The Goldwater Institute, suing on behalf of the legislators, argued
that the assessment meets the criteria of a tax, and therefore
requires a two-thirds majority in the legislature. State attorneys
countered that the assessment was not a tax because it is
collected from hospitals rather than the broad population.
Without the assessment, Arizona would not have the matching
funds needed to pay its share of the expansion that is now
covering about 255,000 low-income Arizonans.
In his ruling, Judge Gerlach stated that since hospitals directly
benefit from the assessment, it is actually a fee rather than a tax.
As the judge himself pointed out during the court hearing, his
ruling meant little at that point because appeals would be filed
regardless of his decision. The case will ultimately be decided by
the Arizona Supreme Court.
The Arizona Medical Association fully endorsed and actively

Members Classifieds
ATTENTION CARDIOLOGISTS Very busy central Tucson
cardiology office is seeking an experienced cardiologist to join its
practice. Interested candidates contact Denise at timm@flash.net
with resume or any questions about the position.

10

supported Gov. Brewers work to expand the AHCCCS program,


and said it will continue to closely monitor the lawsuits progress.

Are you feeling narrower?

The majority of Arizona medical marketplace plans are


compromised of narrow networks, reports a new study by the
University of Pennsylvanias Leonard Davis Institute of Health
Economics, noted by ArMAs Medicine This Week.
The study found that the prevalence of narrow physician networks
in the federally defined Health Insurance Marketplaces varies
widely by state. It considers networks narrow if 25 percent or
fewer physicians in a rating area participate. According to the
study, 73 percent of qualified health plans offered on the
Marketplace in Arizona in 2014 were comprised of these narrow
networks, making Arizona the fifth highest state in terms of narrow
network prevalence. (Source: AzHHA Connection, Aug. 28, 2015)

Doc compensation surveyed

The American Medical Association recently released results of a


report on its 2014 Physician Practice Survey detailing how
physicians outside of solo practice are paid. The survey, completed
by 3,500 physicians around the country, identified six trends:
Slightly more than half of physicians (51 percent) reported
being paid by multiple methods.
Salary and productivity-based payment were the most
common payment methods.
On average, half of physicians total compensation was
earned from salary.
Being employed didnt necessarily mean a salary.
Outside of group practice, salary was more often a key factor
than inside group practice.
Physician payment methods vary widely across specialties.
The study found that while the structure of physician payments
has changed little since 2012, the use of productivity-based pay
and bonuses both increased by about three percent. For more
information, and to access the AMA survey report, read AMA
Wire for Aug. 25, 2015. [This story noted by ArMAs Medicine
This Week.]


n

SOMBRERO October 2015

Macular degeneration
Diabetic retinopathy
Macular diseases, e.g., macular
hole and macular pucker
Flashes and floaters
Retinal tears
Retinal detachment
Central and branch retinal vein
Pediatric retinal conditions
Tumors involving the retina
and choroid
Second opinions

St. Josephs Medical Plaza


6561 E. Carondelet Drive
Tucson, Arizona 85710
Northwest Medical Center
6130 N. La Cholla Blvd., Suite 230
Tucson, Arizona 85741
1055 N. La Caada Dr.,
Suite 103
Green Valley, Arizona 85614

SOMBRERO October 2015

11

Public Health

Friends make a healthier Tumamoc Hill


By Ronald P. Spark, M.D.

he 7,000 or so walkers per


week on Tumamoc Hill will
now find refrigerated, filtered
water from a refurbished fountain
at the hills halfway point. How
that happened is a labyrinthine,
but delightful and ultimately
victorious tale of persistence.
The incredibly popular Tucson
recreational site is accessed by
Anklam Road, just south of the
Carondelet St. Marys Hospital
campus. While UofA scientists
work there during the day,
walkers can enjoy the one-anda-half-mile road anytime except 7:30 a.m. to 5:30 p.m. Monday
through Friday.
Set aside from open cattle grazing in 1903, Tumamoc Hill is the
worlds oldest desert ecology site, as ranked by scientific papers
from its reclamation work. The volcanic outcropping and
surrounding area have been inhabited for more than 4,000 years,
and their archaeology is prime.
The hills period basaltic rock Tumamoc Desert Laboratory
buildings are part of its National Historic Place registry. In addition
to hundreds of Sonoran plant varities, it has resident deer and
javelina herds. Bobcat and snake sightings are occasional. Walkers
have rarely reported fox or wolf.
Tumamoc Hill is controlled by the UofA Department of Science.
Monthly science lectures and docent programs are designed to
engage public support. The hills proximity to downtown allows
Tucsonans easy access to enjoy a pristine desert environment.
Since 2012 Friends of Tumamoc (FOT), of which I am the founding
member, has placed a bike rack at the entry point, and six benches
along the path. Once the bench actually helped in a medical
emergencycertainly a good thingbut the benches have a
spiritual use as well. They encourage walkers to pause and see
whats around them, a natural respite in the midst of a metro area.
The bike racks help bikers feel secure as they walk up the threemile round-trip to the top and back. Now we have added a water
fountain and also hope it will save the hill from plastic water bottle
litterers. Several FOT members pick up bottles on their walk,
looking forward to the day when there will be none.
I started Friends of Tumamoc to fund such improvements. Our
collaborator, Owen Davis, Ph.D., UofA scientist based on the hill,
searched for affordable items and supervised installation. FOT is an
informal organization made up mostly of morning walkers (contact
me at rpsparkmd@cox.net for more information). Owen runs the
TumamocWalkers homepage. Next time you tie up your bike, rest
at a bench stop, or taste the delicious refrigerated water, consider
joining the Friends!
Our latest improvements genesis dates to when the annual blast
12

The unassuming but victorious watercooler fountain on


Tumamoc Hill (Bill Rauch photo).

furnace of a Tucson May had descended upon Tumamoc Hill. Even


then, thousands of Tucsonans come to Tumamoc Desert Preserve
to enjoy the narrow, paved asphalt path elevating 752 feet over a
mile-and-a-half of Sonoran landscape. Its quite a physical
challenge to negotiate even in more temperate temps. But in the
summer months, it can be a potential public health hazard,
especially without any available water.
This was the case two summers ago when on that very hot May
morning, already past 90 degrees at 7 a.m., I resolved to confront
the water issue as a public health threat. And so it was that I spoke
to Owen Davis, pitching the idea of a water fountain midway up
the hills path.
Owen, I said, I can ask the hill walkers for donations for a water
fountain, just as we did for the paths six benches, and the bike
racks at the Anklam Road entrance.
Great idea, he said. Ill look for a vintage surplus water fountain
in the UofA storage, one thats appropriate for the Tumamoc Hills
historic designation.
SOMBRERO October 2015

Weeks pass, and sufficient money is raised.


I found an antique porcelain water bubbler, Owen said. Its
gorgeous, but it needs parts. Even Bonnets and Stems doesnt
have parts going back to the 1930s. Ive had a watch on the
Tucson recycling stores, too. No luck. The ones on EBay are way
out of our range. But Ill keep looking.

Why choose
Desert Mountain Insurance?
see why our customers did...

Last Fall arrives with good news from Owen. I found a campus
excess water cooler, but Im still looking for parts to hook it up.
Its now December and quite cold, which arguably explains the
near-glacial pace of parts installation.

Our physicians were so

A new year, and the cooler is finally functioning! Appropriately


and coincidentally, a sign pointing to the water fountain in
Spanish and English manages to pass three UofA committees.
Quixotically, its posted above most walkers line of vision and
requires binoculars to see it!

talented your team was and

Then, disaster. Vandalism, in which the perpetrators jammed a


rod down the water egress, wrecking the coolers guts.
Undaunted, the walkers still had money for another try. But now
UofA facilities management decides to put in a modern cooler.
But when the plumbers assess the hills lines, they find them so
vintage that a major upgrade becomes mandatory.
Its confounding. Then, with each line modification, another
deficiency becomes apparent. Weeks pass.
Finally, they declared completion! But wait! The water tests
positive for E. coli pathogen overgrowth! Shutdown.
Decontamination.
Its almost April, and finally its all clear!
Hmm... Well, the water bottle spout worked fine, but the bubbler
just dribbled. More parts and line surgery are needed. Finally, we
attain a stream that even an experienced urologist would be
proud of!
Its now late May, and brother, its warm. Then the vandals strike
again, snapping the water feeder liner. Facilities Management is
undaunted. They reconfigure the plumbing as armed to meet the
21st century.
So now Tumamoc Hill is finally blessed with a functioning water
cooler positioned midway up the hill. The parched can now have
their thirsts slaked. It is also an ecological and environmental
remediation success, as the number of plastic water bottles
discarded along the path drops significantly.
We are smug in our public health threat abatement! Yet Mother
Nature has a way with such human hubris. Mothers bees not
only are enjoying the water cooler, but have usurped our utility
into their realm! Mother has reclaimed Tumamoc Hill! But we
know its a natural preserve, so its really more hers than ours.
The public health moral here would seem to be: Every sweet plus
has a stinging minus!
Pathologist Ron Spark has been a PCMS member since 1975. In
his busy semi-retirement he is a clinical associate professor at the
UofA College of MedicineTucson, and lab director for the UofA
Campus Health Service, New Pueblo Medicine, and Wickenburg
Community Hospital. He is a community volunteer for Tucson
Mayor Jonathan Rothschild. For more Tumamoc information,
please visit Tumamoc.org .
n

impressed with how multithat we were able to get our


malpractice, office, workers
comp, health and disability
policies in what seemed
like an instant. I would not
hesitate to say Desert
Mountain Insurance is the
best insurance source in
the Southwest!
Eric, Administrator
Read more testimonials at
desertmountaininsurance.com

VALUED VENDOR FOR THE


PIMA COUNTY MEDICAL SOCIETY
AZ MGMA MEMBER

ONE STOP INSURANCE FOR


Physicians & Surgeons
Other Medical Professionals
Healthcare Facilities & Services

COVERAGE INCLUDES
Professional Liability
General Liability & Property
Employee Benefits

866.467.3627
866.467.3611 fax

info@desertmountaininsurance.com

www.desertmountaininsurance.com
SOMBRERO October 2015

13

In Memoriam
By Stuart Faxon

Roland V. Murphy, M.D.


1920-2015
Roland V. Murphy, M.D., internal
medicine physician who practiced
for 35 years in Tucson, and PCMS
member 1954-2002, died Aug.
23 in Tucson. He was 94.

Dr. Roland V. Murphy


in 1984.

Roland Virgil Murphy was born


Nov. 28, 1920 in Toledo, Ohio. By
the time he graduated from the
University of Toledo in 1942, the
nation was at war. In 1945, the
year of the wars end, he
graduated from the University of
Cincinnati College of Medicine.
Dr. Murphy interned at Harper
Hospital in Detroit.

He served as a U.S. Army medical


officer 1946-48. In 1951-52 he
was a staff physician at the Veterans Administration Hospital in
Dearborn, Mich., and 1952-54 at the VA hospital in Tucson before
entering private practice, from which he retired in 1988.

Dr. Murphy working on his fishing gear in an undated PCMS photo.

In the early 1970s Dr. Murphy served on our Board of Censors,


antecedent to the Board of Mediation. He was also quite the
angler, and in 1964 the Tucson Citizen published a photo of him
displaying a string of trout he caught on River Lake at Greer,
including an 18-incher.
Dr. Murphy is survived by his daughters Maureen and Kathleen,
two grandsons, and one great-grandson. His wife, Mary,
predeceased him, as did his son John Bell Murphy, 43, in 1995.
Services were Sept. 4 at Adair Funeral Homes Dodge Chapel,
Tucson.

WE ANSWER FOR YOU!


Live Answering

Remote Receptionist
Appointment Scheduling
Order Taking

Message Delivery via Pagers


Live Operator, Email, Voice Mail
Text Messaging,
I.V.R. (InterActive
Voice Mail or Fax
Voice Response)

24 Hours 7 Days A Week


Authorized Answering Service for

PIMA COUNTY MEDICAL


SOCIETY SINCE 1981

Se Habla Espaol

2434 N. Pantano

Medical Society
Exchange

790-2121

Established
1971

www.RinconCommunications.com
14

SOMBRERO October 2015

Behind the Lens

Drift along with this


By Hal Tretbar, M.D.

umbleweed, or Russian
thistle, is a common plant
in the West, known scientifically
as Salsola tragus. Your mental
image of it depends on which
name you give it.
Call it Russian thistle, and you
think of the large dry weed that
stacks up against fences or
houses and causes traffic
problems when it blows across
your lane, getting stuck in your
car grille.
But when you call it tumbleweed, your thoughts turn to an iconic
image of the Old West. Here a cowboy slouches on his horse as a
tumbleweed bounces across the barren landscape. Your brain
probably starts playing Tumbling Tumbleweeds, written by Bob
Nolan in 1933 for the Sons of the Pioneers:
Im a roaming cowboy riding all day long
Tumbleweeds around me sing their lonely song.
Nights underneath the prairie moon,
I ride along and sing this tune.
See them tumbling down
Pledging their love to the ground
David B. Williams writes on the website www.desertusa.com/
flowers/tumbleweed:
Although tumbleweed is native to the arid steppes of the Ural
Mountains in Russia, it is now ubiquitous throughout the Western
states, growing in disturbed soils such as agricultural fields,
irrigation canals, and roadside shoulders and ditches. These
plants thrive in salty and alkaline soils...
Tumbleweeds were first reported in the United States around
1877 in Bon Homme County, South Dakota, apparently

SOMBRERO October 2015

transported in flax seed imported by Ukrainian farmers. Within


two decades the plant had tumbled into a dozen states, and by
1900, tumbleweeds had reached the Pacific Coast.
Virtually everyone recognizes a mature Russian thistle, which
looks like the skeleton of a normal shrub. Plants may be as small
as a soccer ball, or as large as a Volkswagen beetle. Most people,
however, would fail to recognize the seedling and juvenile plants
bright green, succulent, grass-like shoots, which are usually red or
purple striped. Inconspicuous flowers grow at axils (where leaf
branches off of the stem) of the upper leaves, each one
accompanied by a pair of spiny bracts
As it rolls down a desert road, Russian thistle plants do what
they do bestdisperse seeds, which typically number 250,000
per plant. Seeds are unusual in they lack any protective coat or
stored food reserves. Instead each seed is a coiled embryonic
plant wrapped in a thin membrane. To survive winter without a
warm coat, the plant does not germinate until warm weather
arrives.
When moisture falls, the plant is ready to uncoil and germinate.
All that is required are temperatures between 28 and 110
degrees F. It then quickly sends up two needle-like leaves and
begins to shoot skyward. By autumn the plant has reached
maximum size, flowered and begun to dry out. A specialized layer
of cells in the stem facilitates the easy break between the plant
and the root, and the journey begins anew.
The widely traveled plant now grows in every state except

15

Florida, and in most countries worldwide. Attempts to control


large areas of tumbleweeds with herbicides have proven very
difficult. Recent research has concentrated on a biologic
approach to control Russian thistle. According to an article in
Popular Science posted Sept. 24, 2014, two fungi found on S.
tragis in Hungary may hold the answer to control. Extensive
testing by the U.S. Agriculture Research Service has found the
fungi have little effect on other closely related species. The fungi
work against the tumbleweeds when they are saplings so they
dont have a chance to grow into bushes, dry out, and roll away.
The research service has made applications for commercial use,
but approval is still pending. It will be easy to use. A half-kilogram
of rice infected with the fungus would be dumped every 5,000
meters for those who want it. Rain and tumbleweeds tumbling
will do the rest.
Since government approval for biologicals is notoriously slow, I
think we can keep on singing:
I know when night is gone
Theres a new world at dawn
Ill keep on rolling along
Deep in my heart is a song
Here on the range where I belong
Drifting along with the tumbling tumbleweed
Tumbleweeds will grow in the most inhospitable places. They
were the first plants to appear at the Trinity site in New Mexico
after the first atomic bomb test was done there.

The 2013 tumbleweed Christmas tree in


Chandler, Ariz. (Gina Sowell photo).

The Chandler effect


If Russian thistle is a nuisance without purpose, the Phoenix
suburb of Chandler thinks otherwise. For the last 59 years the city
has put tumbleweeds to an inventive use.
In 1957 resident Earl Barnum had an idea to make a tumbleweed
Christmas tree. Each year since, such a tree has been fashioned
by the city parks department. A center pole is bolted to the
ground, and 30 cables are strung from a ring at the top to a
bottom anchor ring.
Chicken wire is placed over the cables to provide a framework for
the tumbleweeds. But not just any tumbleweed will do It must
be well-rounded, three feet in diameter, and just beginning to
turn brown. To find the just right tumbler, parks personnel may
have to go to the Gila River Indian Reservation.
The tumbleweeds are then tied to the chicken-wire and shaped.
First the tree is sprayed with fire retardant, then given two coats
of latex paint and 50 pounds of glitter. Once it is dry, the workers
add 1,100 lights.
Chandlers unique holiday tradition starts Saturday, Dec. 5.
Downtown street vendors are open at 4:30 p.m. The Tumbleweed Tree Lighting and Parade of Lights starts at 7 p.m.

16

SOMBRERO October 2015

Paramedicine

Rio Rico paramedicine project


indications strong
By Steve Nash

ou have never seen a Paramedicine department in Sombrero


because this is the first one.

After years of preliminary work, the first Southern Arizona


community healthcare paramedicine program, begun in
January 2014, now has lessons learned from its first 15 months.
This is called the Rio Rico Fire and Medical District Community
Integrated Paramedicine Program, Rio Rico Fire and Medical
Chief Les Caid said. The term comes from Community
Paramedic, which is trademarked, so when I first became
interested in this concept in 2010, I wanted to use a term that
was close enough, but did not infringe on the trademark.
Since then the concept has gained traction throughout Arizona.
In 2014 Arizona Department of Health Services put together a
steering group under the term Community Integrated
Paramedicine (CIP). This is a term I support, because this program
truly must be integrated into the overall healthcare resources of
each community if it is to be successful.
Five conditions qualify patients to enter the program: congestive
heart failure, heart attack, pneumonia, diabetes, and chronic
obstructive pulmonary disease (COPD). The Rio Rico CIP provides
in-home healthcare services to residents with these chronic
illnesses.
The initial project focuses on helping participants manage their
medical conditions so that they dont have to return to the
hospital or call 911 so often. They identified 911 high-use patients
from their system, specifically individuals who suffer from
chronic disease, Caid said. Once identified, we scheduled
appointments in an attempt to help them manage their disease.
It is cheaper for us to send two firefighter/paramedics at 2 p.m.
than four to six firefighters for an emergency 911 call at 2 a.m.
Our CIP teams consist of a firefighter, an emergency paramedic,
and a firefighter EMT, Caid said. While at the home, the CIP
team gets a baseline set of vitals and conducts a health survey.
Working with the Arizona Poison and Drug Information Center,
we do a medication reconciliation, to ensure they are taking their
meds properly, that they are not duplicating medication, or have
medications that are counteracting each other. We also conduct a
home environmental and safety survey to identify and mitigate
trip-fall hazards, mold, or other environmental issues that can
adversely impact health. If we suspect mold, for example, we can
work with community resources to make the home safe.
Caid says these services are to help engage and guide participants
in understanding their health and disease processes. We also
want to try to identify the core reason that drives the need for
frequent 911 calls, and help the individual identify other
SOMBRERO October 2015

Rio Rico Fire and Medical Chief Les Caid says, I truly believe
that working pro-actively in the health of our communities, to
improve outcomes, is the logical evolution of the fire service
(Photo courtesy Les Caid).

healthcare resources that exist, but which they may not have
known about, or known how to access.
Caid brings a wealth of experience to the job. He began his fire
service career in 1979, and served 25 years with the Tucson Fire
Department. While with TFD he worked in all areas of the
department, including many years as a paramedic and EMS
supervisor, battalion chief of technical rescue; hazmat; and
support services. He retired as the deputy chief of emergency
management. While with Tucson Fire, Caid was recognized at the
national level for his work in building the Tucson Metropolitan
Medical Response System (MMRS). He worked four years with
Rural Metro Fire as regional fire chief, running operations in
Arizona and Oregon.
Caid has an A.A. in fire science, a bachelors degree in public
administration, and an MS in executive leadership. He is
president of the Medical Reserve Corps of Southern Arizona. He
sits on the IAFC Exercise and Response Subcommittee, is EMS
Representative for the Arizona Fire Chiefs Association, and is a
long-standing member of the AFCA Mutual Aid Committee. He is
currently co-chairman of the USEPA Border 20/20 Emergency
Preparedness Task Force, chairs the Santa Cruz County LEPC, and
chairs the Pima Community CollegeFSC-EMT Advisory Board.
He has served on numerous boards, including the Board of
17

Directors of the American Red Cross, Greater Tucson Leadership,


the Arizona School Counselors Association, and World Care.
Caid calls the CIP program ideal for follow-up home visits of posthospital-discharge patients, which I know will prove to be very
beneficial in reducing re-admissions, he said. With the PPACA
there are penalties for hospitals that have patients re-admitted
within 30 days. Working with a fire-based CIP team can help the
bottom-line financials of hospitals. If we do this right, we can help
the patient and the hospital, and that is a win-win that you have
to love!
The concept of using certified emergency paramedics (CEPs) for
preventive healthcare is not new, and has been around for maybe
20 years, but the concept started internationally and slowly

Dr. Matthew Clavenna,


MD

gained traction in the U.S., Caid said. Last October, I spoke in


Reno at the 10th Annual International Roundtable on Community
Paramedics. The project we started in Rio Rico is the first in
Arizona, and from my understanding, at the time it was one of
only a handful of fire-based programsthat is, care provided by a
fire department or fire district.
Caid said he became involved because he knew that putting out
fires is far from the only thing such department do, and that the
public may not realize that. Most people do not know what the
U.S. Fire Service is all about, he said. They see the term fire
and think that is all we do. We must always be trained and know
how to put out fires, but in actuality, fire is only a small
percentage of what we do. If you look at the statistics, Emergency
Medical Services (EMS) is really the bulk of
what our jobs entail. In addition, community
risk reduction is a term we have used in the
fire service for years. We have been involved
for decades in fire prevention, drowning
prevention, and in advocating seatbelt use
and bike safety.

Dr. Clavenna was born in Texas but


spent most of his childhood in
Baton
Rouge,
Louisiana.
He
attended Trinity University in San
Antonio for his undergraduate work,
receiving a B.S. in Biochemistry. Dr.
Clavennas desire to personally
help those with ailments, led him
into the field of medicine. He earned his medical degree from
Louisiana State University Medical School in Shreveport in 2009,
where he was elected into Alpha Omega Alpha Honor Society.
While in medical school, he was introduced to Otolaryngology
(ear, nose, & throat), a wonderful field of complex anatomy,
requiring surgical and medical expertise to treat those with
problems of the head and neck. Dr. Clavenna completed a general
surgery internship and otolaryngology surgical residency at
Louisiana State University Health in Shreveport.

Following residency, Dr. Clavenna completed a Fellowship in sinus,


allergy, and anterior skull base surgery at Vanderbilt University in
Nashville, Tennessee. There he trained under internationally
known surgeons, Drs. Rick Chandra, Paul Russell, and Justin
Turner. During fellowship he focused on advanced sinus surgeries,
including management of frontal sinus disease, nasal and skull
base tumors, pituitary surgery approaches, ophthalmological
related procedures and treatment of allergies. Many of these
cases were performed in conjunction with neurosurgeons and
ophthalmologists. One of his most fond memories from fellowship
involved treating a patient emergently transferred to Vanderbilt
for severe sinus disease encroaching on the vision of his right eye.
Using his recently learned endoscopic sinus surgery techniques
with the aid of image guidance, he was able to successfully treat
and drain the infection and preserve the patients vision.
Dr. Clavenna moves to Tucson with the desire of helping those in
the community with their ear, nose and throat related problems.
He is the first fellowship trained sinus and anterior skull base
surgeon to join a private practice group in Tucson. Though he has
a passion for nasal, sinus, and allergy related disorders, he also
enjoys treating the full gamut of ENT related issues, from neck
masses to ear surgery.
Dr. Clavenna in his free time enjoys spending time with his wife,
the outdoors, and looks forward to taking advantage of the
wonderful surroundings Tucson and Arizona have to offer.

www.CarlsonENT.com
18

After almost 35 years in the fire service,


I can attest that you can teach an old dog
a new trick. I had a FF/CEP Captain Alex
Green come to me and talk about the CIP
program. After some badgering by Capt.
Green, and a little research, I became
convinced that this was an opportunity for
for fire-based EMS here.
Rio Rico is a beautiful place to live and
work. It is, however, considered a rural
setting and we are under-resourced as far as
healthcare is concerned. We we lack public
transportation. We have no buses, or
services to help our aging population get to
doctors appointments. I truly believe that
working pro-actively in the health of our
communities to improve outcomes is the
logical evolution of the fire service. To me,
since we are the gateway into the U.S.
healthcare system, we should embrace that,
and work to make others aware of the
potential to improve patient outcomes by
forming partnerships to coordinate care.
Caid said his department is still looking at
surveys and total data for 2014, but even
now he can tell from some indications We
have one participant who, in the first six
months of 2014, reduced her 911 calls and
visits to the ED by 50 percent. We had
another for whom we found local PT
resources after she was told in Tucson that
she could only drive back to Tucson for PT.
This saved her hours of driving time,
reducing her stress and risk of driving
accidents. We had one participant whom,
we found out during our medication
reconciliation, had five different physicians
who had prescribed her anti-depressants.
SOMBRERO October 2015

This is the kind of thing that would never have been caught
without someone actually going into the home and being the
eyes and ears of the primary care provider to ensure that the
reconciliation was done.

scope of practice for CIP; we just need to change the role of the
CEP. We have to work within the current scope of practice and if
we do, we can have positive outcomes right away, and we have
proven that.

Another gap paramedicine can fill is called stove piping, Caid


said. I first heard the term years ago when I was doing some
work with the CDC in Washington. D.C. Stove piping was used
inside the capital beltway to refer to agencies not familiar with
anything outside their own sphere of influence. I guess you can
say healthcare, with its lack of shared information and/or
resources, is stove piped. This lack creates barriers to good health
outcomes. If you dont know about a resource, it is not really a
resource. So when we see individuals who need help while we
are on a CIP visit, the team has to be the
connection to healthcare resources.

First and foremost CIP has to prove it will provide better


outcomes for the individuals and can reduce healthcare costs.
Once the data are in, we have to look for payers like the insurance
companies and hospitals to share in the savings that are gained
from this. We dont need to make money providing this extra
service, but we must cover our costs of providing it.
Steve Nash is executive director of Tucson Osteopathic Medical
Foundation and former PCMS executive director.

So far, the EMTs and firefighters have seen


positive outcomes. They have established
good solid relationships with these individuals
in our program, Caid said. It is so much
easier for everyone involved to interact
because this is a scheduled visit, which is a
calm setting, way outside the normal stress of
an emergency call.
In the early evaluation stage, Caid said, they
identified that they would spend 10 hours per
week on the CIP. We want to collect good
solid data to validate our premise that this
produces better outcomes. After seeing the
positive effects and outcomes, we will
continue this program until we find funding,
but there will be no cost to the participants. I
guess you can say this is the field-of-dreams
model: build it and they will come. The Rio
Rico Fire & Medical District has applied for
several grants to help fund the program.
CEPs have a strong training foundation in
acute care, Caid emphasized. Their initial
courses are between 1,200 to 1,800 hours of
lectures, hands-on skills training, and clinical
time. Once working in the field every day, FF/
CEPs are seeing people in emergencies.
However, we have to have our FF/CEP learn to
focus on a 30-day healthcare picture as
opposed to a 30-minute focus and short-term
emphasis. With the help of our supporting
partners, we have brought classes that focus
on care of chronic diseases such as diabetes,
MI, asthma and COPD. We have been very
fortunate to have great partners like Southeast
Arizona Area Health Education Center
(SEAHEC), the University of Arizona, and the
Arizona Poison and Drug Information Center
who have helped identify and provide
training.
Caid said he does not see it as necessary to
change the CEP scope of practice. We have
found that you do not have to change the
SOMBRERO October 2015

19

Time Capsule

When medicine was ... barely


By Stuart Faxon

On Oct. 9, in the week this Sombrero is published, the Tucson


Presidio Trust for Historic Preservation will open a special exhibit
and launch related programs on the evolution of medicine in the
Southwestern U.S., with an emphasis on 18th- and 19th-century
military physicians, reports John P. Langellier, Ph.D., project
manager and Presidio Trust senior historical consultant.
The exhibit will be downtown at the Presidio San Agustin del

Tucson, north of the old domed courthouse on Church Street at


Washington Street, in part of the 11-acre footprint of the original
Presidio. PCMS is contributing support to the exhibit. Admission
for the general public is $3, with children under 14 admitted free.
From Shaman to Surgeon: Military Medicine in the Southwest
1776-1916 combines photographic-text panels with artifacts
and relevant reproduction items, Langellier said. Interpretive
educational lectures and living history
presentations will enhance the exhibit that
after its premier, and public display at the
Presidio through April 2016, will be available
for travel to venues throughout the region.

We know Tucson. We are Tucson.


We are Tucsons homegrown, full-service law firm providing legal services for

Southern Arizona since 1969. We provide a wide array of legal services in business
and corporate transactions, litigation, estate planning, bankruptcy, creditors
rights, international transactions and disputes, personal injury, DUI, divorce, child
custody, and employment law.

Barry Kirschner professionally handles claims of persons who have become


medically disabled from employment through personal or group disability
insurance policies and are denied benefits. Barry has successfully litigated on
behalf of doctors, lawyers, and other professionals. Barry has handled ERISA
terminations administratively and in court, opposing every major disability
insurance carrier. Barry continues to be selected by his peers for inclusion in
The Best Lawyers in America in the field of Litigation ERISA and continues
to receive the highest AV ranking for quality and ethics from Marindale Hubbell.

For more info visit

www.wechv.com
An independent member of
MERITAS LAW FIRMS WORLDWIDE

Williams Centre | 8th Floor | t 520.790.5828


20

For generations the earliest inhabitants of


todays Arizona relied on rituals and
common sense when it came to injuries and
illnesses, Langellier said. Some groups
turned to specialized shamans or healers
that today sometimes are called medicine
men. Others looked to group curing societies
instead of individuals. These diverse customs
and practices all would be challenged when
newcomers appeared from across the sea.
In the early 16th century, Spanish
conquistadors who came in quest of gold
and glory were traveled with clergy, who
often had medical knowledge, and other
practitioners of European medicine,
Langellier said. Spanish surgeons who
accompanied the military typically treated
wounds, while physicians addressed disease
and illnesses based on a theory that ailments
were caused by corruption of air, or the
vitiation of body humors.
To combat these afflictions medicinal herbs
and other ingredients were administered
along with the use of leaches and bleeding
to draw off the cause of corruption that was
thought to be at the root of the patients
sickness. After arriving in the Western
Hemisphere, the Spanish observed medical
practices of the people they encountered in
the New World, especially in Mexico, and
published books about what they learned.
As early as the 1840s U.S. Army doctors
started to practice in the Southwest. They
treated a wide range of ailments including
the then-mysterious disease of malaria,
performed surgeries for campaign
causalities, and delivered babies for
members of the military and local civilian
SOMBRERO October 2015

An 18th-century military barber-surgeons instruments went on


the job in his canvas haversack. A bone saw has not changed
much, though this one was made for the smaller hands of
smaller practitioners. Two sizes of brass bleeding bowls were
always included.

work at first, try bleeding again. Dr. Benjamin Rush, a friend of


Washington, Adams, and Jefferson believed you could remove
three-fourths of the blood in the human bodythough he
thought we had an extra quart.
Dr. Rudy Byrd and his historical bullet-puller.
Merely jam it painfully into the wound, press
in farther to ensure a hard bone backup, then
screw the auger into the soft-lead bullet to
grab and extract. Anesthetic? Bite another bullet.

Usually bleeding was from an arm, but was considered so


essential that it was done from any vein, even underneath
ZZING the

BU

RING
BUZZ
TINNITUS

BUZZING

populace alike. Indeed, some military doctors


moonlighted on off-duty hours setting up
outside practices to treat local residents as a
supplement to their rather meager army pay.
Abraham Ruddell Byrd III, M.D. of Sonora Family
Practice, a.k.a. Dr. Rudy Byrd, PCMS member
since 1983, has in his 72 years goneif there is
such a declensionfrom history fan, to buff, to
expert. Part of the Presidio historic trust, Dr.
Byrd plays a Presidio soldier and member of the
Spanish garrison, and in this instance the
barber-surgeon. He has often spoken on Blood
and Guts Medicine in the 18th Century.
Its the nature of science that those called
physicians in the exhibits time-frame would not
even merit the name today. Yet there were still
beneficial things they did, and they saved many
battlefield lives, even if they knew little or
nothing about infections that would kill the
patient anyway.
Essentially youre bleeding people all the
time, Dr. Byrd said, because thats [thought to
be] good for everything. If bleeding doesnt
SOMBRERO October 2015

ING
G
N
I
R
BUZZING

TINNITU

RING

HUMM

RINGING
HUMMINGGING
RIN

Your patients
deserve the
best hearing
care possible

ING

HUMM

USG
T
I
N
IN
IN

BUZ

G
N
I
G

We offer
comprehensive
tinnitus
consultations.

TINNITUS

RINGING
TINNITUS

HUMMING
RINGING

BUZZING

HUMMING

TINN

ITUS
RINGIN
G

BU

HU ZZING
MM
ING

IN
Learn more about why we are a
R
preferred audiologistplease visit our website: www.arizonahearing.com
We are preferred providers
on most insurance plans.

520.742.2845

7574 N La Cholla Blvd Tucson

520.742.2845

6969 E Sunrise Dr, Ste 203 Tucson

520.648.3277

Helping you hear your best.

512 E Whitehouse Canyon Rd, Ste 196


Green Valley
Janis Gasch, Au.D.
Doctor of Audiology, Founding Director
21

tongue, or from the penis. Initially, it was believed that bleeding


needed to be done as close as possible to the source of the
problem, Dr. Byrd said, and some areas did not lend themselves
to use of the tourniquet.
They also used many cathartics and emetics, Dr. Byrd said, all
based on the Hippocratic four humors theory of achieving
balance of the four distinct fluids in the body, so as to directly
influence temperament and health. According to this theory,
which was prevalent in Europe and which the Spanish brought
when conquering Mexico, it was believed that each patient had
his own humoral composition of black bile, yellow bile, phlegm,
and blood, and that each corresponded to one of the traditional
four temperaments. This sounds crazy today, but it existed for
centuries until the advent of medical research in the 19th century.
The barber-surgeon bled the patient from the arm using a
tourniquet, Dr. Byrd said. Even bleeding injuries were treated
with more bleeding. For amputations, they used an extreme
tourniquet to cut off arterial circulation, then sliced around
through the skin and into the soft tissues using a large curved
knife such as seen on the left in our haversack photo. Then the
sawbones was ready to saw bone. Again, anesthetic was to
bite the bullet, or take on a good amount of alcohol, usually
brandy or rum. They had opiates, Dr. Byrd said, but they did
not know they could be used for pain.
They did not know germ theory but they knew a wound had to be
clean, Dr. Byrd noted, so they dressed it up, and they would look
for pus as a sign that the body was throwing off the foreign debris

GERALD N. GOLDBERG, MD
AND ASSOCIATES
PROUDLY WELCOME

and material. It was always a good sign when they got what they
called laudable pus.
The Tucson Presidio Trust for Historic Preservation operates the
Presidio San Agustn del Tucson Museum, a re-creation of the
original Spanish fort from which metropolitan Tucson sprang. The
museum functions as a monument to Hispanic history in Tucson
and the region.
The Presidios goal is to educate the public about the many layers
of Tucson history, including an archaic pit house, the northeast
corner of the Presidio, a Territorial Patio, and in the future, exhibit
space to honor the Mexican-American veteran and a visitor
center for the Juan Bautista de Anza National Historic Trail.
The humanities content of the Trusts mission is history,
anthropology, and archeology, providing the general public and
students with an appreciation of the mixture of cultures that
made up early Tucson and their success in building a culture of
cooperation that still permeates the lives of the residents of
region.
The all-volunteer staff includes two PCMS members, the aforementioned Dr. Rudy Byrd, and Robert Hunter, D.O. The Trust has
designed and constructed rotating exhibits and related programs
that honor those cultures and aspects of life that make Tucson
unique. The Trust also conducts Living History Days, and a handson school program known as Friday at the Fort. The hands-on
activities promote critical thinking, study of history, and further
exploration of this period and its cultural diversity.
n

Now youre
Thinkin Smart
Simplify your communications with
Simply Bits state-of-the-art managed
voice and data services

SARAH E. SCHRAM, MD
BOARD CERTIFIED DERMATOLOGIST

FELLOWSHIP TRAINED
IN MOHS SKIN CANCER SURGERY

SPECIALIZING IN SKIN CANCER,


COSMETIC, AND LASER PROCEDURES

ACCEPTING NEW PATIENTS


IMMEDIATE APPOINTMENTS AVAILABLE

520.795.7729
22

www.pimaderm.com

5150 E. Glenn St. | Tucson, AZ 85712

ROC #278632

SOMBRERO October 2015

Radiology Ltd. proudly offers


3D Mammography.
The physicians of Radiology Ltd. believe in personalized
and comprehensive service for all patients and are pleased
to announce a customized approach to breast screening.
Radiology Ltd.s personalized breast screening service
includes individual breast cancer risk assessment, along
with access to our Patient Education Specialists to answer
any questions you may have. We have seven locations to
serve you.

Please call and request


your 3D Mammo today!
(520) 733-7226
For more information
about this and other
screening exams provided
by Radiology Ltd., please
visit our website at
www.radltd.com.

A TUCSON TRADITION FOR MORE THAN 80 YEARS

SOMBRERO October 2015

23

MICA_Sombrero10'15ad.qxp_Layout 1 9/21/15 6:00 PM Page 1

Did you know?


Since 2014, MICA has set up
a risk retention group and
a protected cell captive
to meet the changing needs
of medical practices.

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 October 2015