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Sombrero

Pima County Medical Society


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

AUGUST/SEPTEMBER 2015

PCMS building sale underway

A voyage Down Under

Tucson, Nogales,
and bullfighting

SOMBRERO August/September 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

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

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)

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

Elegant contemporary with grand living room.


Dramatic window wall, vaulted plank &
beam ceiling and Catalina Mtn. views.
Generous eat-in kitchen finished in granite.
3,832 sq. ft., 4 bedroom, 2.5 bath.
Versatile 4th bedroom has private entry.

Madeline Friedman
ABR, CRS, GRI

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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community pool & rec. center. Wonderful central location.

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

Members at Large

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

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

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SOMBRERO August/September 2015

Inside
5 Dr. Melissa Levine: Medicare at 50and

desegregation.
7 Membership: Focus on Pima
Dermatology.
10 Milestones: Twelve Tucson urologists
open Epoch Health.
12 PCMS News: Sale of the 32-year-old
PCMS headquarters building is on track.
19 Arizona Medical Association News: New
ArMA president says we must unite the
house of medicine.
23 Behind the Lens: In the second of his
series, Dr. Hal Tretbar looks at the local
impact bullfighting once had.
28 Travel: Dr. George Makol finally went to
Australiaand proves it.
30 CME: Pima County Medical Foundation
re-locates CME meetings.

On the Cover
Former matador Diego OBolger stands next to bull-and-matador
statue at Casa Molina Restaurant on Speedway Boulevard. The
design ornamenting the bulls testicles is changed to match the next
Tucson event or holiday. Shot with Nikon D600, 40mm on the 2485mm Nikkor lens, 1/200th second at f.29 with flash fill-in (Dr. Hal
Tretbar photo).

Correction
In the second column, second full paragraph of the first page of our
last issues Time Capsule, we mis-typed route U.S. 60 as a state route.
We also made a numerical typo in the second-page, second-column,
sixth-paragraph reference to Globe: the town was founded in 1875,
though a local sign states 1876.

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SOMBRERO August/September 2015

Happy birthday to Medicare (Part 2)


Tricare. They also expanded some payments for Welfare
recipients and financed a study on the problems of the aged. All
of this led to a revival of the national health insurance debate.

By Dr. Melissa Levine


PCMS President

The Kerr-Mills act of 1960 created a program called Medical


Assistance for the Aged. This was a grant program providing funds
to states and was means-tested. It was essentially the precursor
to Medicaid. Kerr-Mills did not end the debate, as some had
hoped. Then Sen. John F. Kennedy (D-Mass.) made healthcare for
the elderly, now calling it Medicare, a major issue in the 1960
presidential election campaign. Vice-President Richard M. Nixon
actually conceded the point, and vowed to further the cause if
elected. When Kennedy won and a Democratic Congress was
again in control, the issue, like a Phoenix, rose again to the top.

ome of you may recall,


before my foray down the
Grand Canyon, I was talking
about Medicare and the ACA.
My idea was to compare and
contrast the two, showing that
essentially the beginnings were
very similar, with predictions of
socialism and ruination.
But as I delved into the real
seeds of Medicare, I found so much more history than I had
known about. I found it fascinating. Admittedly Im somewhat of
a nerd, so maybe I am just boring all of you. I hope not.

King-Anderson was proposed in 1962, and it provided for hospital


services to be provided for the elderly and paid for by Social
Security. The AMA launched an all-out effort against the most
deadly challenge ever faced by the medical profession. Dr. Bruce
Hekrinsen, a New Jersey surgeon, wrote a memo and 200
members of the hospital staff said they would refuse to see
patients under legislation such as King-Anderson. But the idea
was gaining momentum. The American Hospital Association split
from the AMA saying help was needed.

In our June issue I left off in 1946 with a Republican Congress and
President Harry Truman calling for comprehensive health
insurance for all, funded through Social Security. When he
couldnt get that passed, President Truman created a national
commission to study the nations health needs. He was able to
get Congress to establish a federal grant program in 1950 that
provided matching funds to states to pay providers caring for
individuals receiving public assistance. He continued to advocate
for a national health insurance program until the end of his
presidency in January 1953.
T
The goal of Social Security was economic
independence for the elderly, and in the
early 1950s officials were troubled that they
were not meeting that objective. The reason
was the high cost of medical care. If you
remember Wagner-Murray-Dingell from the
previous article, some of them came back
then to try and fix the issue.

Most likely they thought, if instead of national


health insurance, they proposed the more
modest, healthcare for seniors under Social
Security, they could gain traction. That
proposal would be much less expensive, and it
would give the government some experience,
and in providing for a group in such obvious
need, it would be more likely to pass.
The beneficiaries proposal was batted
around, and on April 10, 1952, Senators
Murray and Humphrey, and Representatives
Dingell and Cellar proposed Senate and
House bills of what would essentially have
been Medicare. Then Dwight D. Eisenhower
was elected President, both houses of
Congress were Republican, and the idea
once again died.
Interestingly, the next program happened
under Eisenhower. In 1956 Congress enacted
permanent protection for healthcare for the
dependents of servicemen, the Dependents
Medical Care Act, which today is part of
SOMBRERO June/July 2015

In a crazy turn, Republican Rep. Frank T. Bow of Ohio proposed a


$125 income tax credit for the elderly to purchase health
insurance. If they didnt pay $125, they would be given a credit.
Rep. John Lindsay (R-NY) proposed a bill embracing
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Security financing with a private insurance option. The Senate


went further. Led by Sen. Jacob Javits (R-NY), they proposed a bill
financed by Social Security, providing three benefit options, one
of which was private insurance. This sounds suspiciously like the
ACA to me.
With all of this, an amended King-Anderson was brought to a
vote July 7, 1962, and defeated in the Senate 52-48. President
Kennedy, unhappy about the defeat vowed angrily to bring
Medicare to the voters in the next election.
Ironically, JFK could not get Medicare passed when he was
president, but after his assassination, there was a surge of
support across the country for his legislative agenda. On Sept 2,
1964, King-Anderson (Medicare Part A) passed the Senate 49-44.
Of course, then there was the House.
Though it was thought that King-Anderson would clearly pass the
house, the Ways and Means Committee blocked it. Then the
1964 election had Lyndon B. Johnson winning with the largest
plurality in history, the Democrats gained 38 seats, 295-140, the
Senate, lopsided, went 68-32, and Rep. Wilbur D. Mills (D-2ndArk.) House Ways and Means Committee chairman, saw the
handwriting on the wall. King-Anderson was the first bill
introduced in January 1965.
The AMA then came up with Eldercare, a program operated
through private insurance carriers and the states, with premiums
for low-income elderly subsidized out of federal and state
revenues. This sounds even more suspiciously like the ACA! They
boasted that it was more comprehensive than Medicare which

prompted Mills to expand the scope of King-Anderson (which


was Part A) and come up with Part B.
On March 24, 1966, the much expanded Mills Bill was
introduced. On April 8, without a whole lot of debate, and no
amendments, all 296 pages, 102 separate sections,
overwhelmingly passed the House, essentially giving birth to
Medicare. The final versions passed the House and Senate on July
27 and 28.
One last note for thought: The birth of Medicare led to the
desegregation of hospitals across the country. If a hospital did not
comply with Title VI of the Civil Rights Act, they would not get
paid. The Office of Equal Health Opportunity was charged with
certifying hospitals. They let no one off the hook and over about
four months, 1,000 hospitals were desegregated.
Medicare could be considered one of the greatest civil rights
victories of its time, and the one with the least fanfare. That in
itself is worthy of celebration.
REFERENCES
www.aapsonline.org/brochures/persuasi.htm
The Military Health System (MHS)- TriCare, Who We Are.
Social Security On LineHistory http://www.ssa.gov/history/
corningchap4.html
CMS Oral History Project.
Sternberg, Steve. US News and World Report. Desegregation:
The hidden legacy of Medicare. July 29, 2015.

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SOMBRERO August/September 2015

Membership

Pima Dermo and our Arizona enviro


Story and photos by Dennis Carey

ucson is definitely a place


where there is a lot of
attention paid to the skin, says
Gerald Goldberg, M.D., Pima
Dermatology owner and medical
director. We have made a lot of
progress in treating skin diseases
and disorders. You hear it a lot, but
catching skin cancer early increases
the chances of survival
dramatically.
After 20 years in a small office on
Rosemont Boulevard, Dr. Goldberg
has expanded Pima Dermatology to
a 10,000-square-foot facility at
5150 E. Glenn St. The practice sees
20,000 patients each year for both
medical and cosmetic treatments.
We dont feel there is a saturation
of dermatologists in the area,
Practice Administrator Sarah
Chanes said. Dermatologists in
the area are very cooperative,
and there is a good referral network
with most of the providers in
the area.

Pima Dermatologys lobby sales area serves as part of the practices one-stop shop for skin
care concerns.

The epidermis is the bodys largest organ, and the most visible, so
in Southern Arizona dermatologists must keep up with the latest
skin treatments and services to battle our environments effects.
There is a need for dermatology care in our rural areas, and Pima
Dermatology is working with Graham County Regional Medical
Center to set up clinical visits every month in Safford.
Some of the farmers in the rural areas have been exposed to the
sun for years, Chanes said, but they just dont have the time to
come all the way to Tucson or Phoenix to get their skin checked
regularly. There is definitely a need in these rural areas.
Use of lasers has become an important part of skin healthcare,
and Dr. Goldberg is considered a pioneer in this field. He began
using laser rejuvenation treatments in 1984. Pima Dermatology
offers 16 on-site laser modalities. A fraction of the laser
procedures available include acne treatment, acne scarring, skin
resurfacing, vein removal, and cosmetic procedures such as hair
and tattoo removal.
Some people wondered why I was getting so involved in using
SOMBRERO August/September 2015

lasers, Dr. Goldberg said. Now it is a part of every dermatology


practice. I like to think of lasers as my thing now. Its my baby.
He is also active in making sure use of lasers is done safely. He is
president of the Arizona Dermatology and Dermatologic Surgery
Society. He is seeking regulations to make sure proper training is
required for operating lasers. Another target in his sights is
getting a ban on use of tanning beds by minors.
Taking up a cause for childrens health is not surprising for
Dr. Goldberg. After graduating with honors from Princeton
University and from med school at State University of New York
at Syracuse, Dr. Goldberg did his residency and completed a
fellowship in pediatrics at the University of Arizona. He is
board-certified in pediatrics and dermatology, and is a UofA
clinical professor of dermatology and pediatrics. He has been
a PCMS member since 1983.
Matthew Beal, M.D., joined Pima Dermatology and PCMS in July
2013. After graduating from the University of Arizona College of
Medicine, he interned at St. Vincents Medical Center in New
7

York, completed his dermatology residency at the University


of Minnesota, and lectured at the Mayo Clinic in Rochester,
Minn. He is trained in all aspects of dermatology with special
interests in cutaneous oncology and psoriasis. He is president
of the Tucson Dermatology Society.
Tucson is home for me and my family, Dr. Beal said. I went
to school here, and my wife is from Tucson. I was looking for
an opportunity to practice in Tucson. Working at Pima
Dermatology was a perfect opportunity.
Having the extensive experience of Dr. Goldberg and the
energy of Dr. Beal are very complementary to each other,
Chanes said. We also have a teaching affiliation with the
University of Arizona. We feel it is very important to be
involved in the teaching aspects of the medical community.
This fall, Pima Dermatology will be adding Mohs surgeon
Sarah Schram, M.D. to its staff. (Mohs surgery, a.k.a.
chemosurgery, developed in 1938 by general surgeon
Frederic E. Mohs, is microscopically controlled surgery to
treat common types of skin cancer.) Dr. Schram graduated
from the University of Minnesota Medical School in 2006.
She received a fellowship at the Veterans Affairs Medical
Center in Minneapolis, was an intern at Evanston
Northwestern Healthcare, completed her residency at the
University of Minnesota, and served on the faculty as an
assistant professor.
Dr. Gerald Goldberg with a laser patient at Pima Dermotology.

Pima Dermatology has a Mohs surgical suite and lab on site.


They also work with the
cancer centers at TMC and
the UofA when necessary.
Two PAs and two RNs help
the physicians. There are
four cosmetic providers in
the office, and products
are available for purchase
to prevent or treat skin
conditions.
We are probably 70 percent
medical and 30 percent
cosmetic as far as the ratio
of patients and clients who
come in, Chanes said. We
try to be a one-stop shop for
anyone who is concerned
about their skin. We also try
to do extensive financial
counseling with patients and
clients so they know what is
covered by insurance. We
dont want patients to get
hit with a big shock.

Colleen Cotton, third-year resident at the UofA College of Medicine, consults with Dr. Matthew Beal
at Pima Dermatology.
8

That might make their skin


crawl.
n
SOMBRERO August/September 2015

SOMBRERO August/September 2015

Milestones

Epoch Health opens on


Grant Road
Twelve Tucson urologists including doctors Kenneth Belkoff,
Peter Burrows, Bill Kuo, Michael Levin and Jenne Myers have
partnered to open EPOCH Mens Health, 4951 E. Grant Rd., Suite
103, at Crossroads East Plaza.
The urologists have come together to create Epoch Health, a
center to serve the men of Southern Arizona. Epoch offers a free
comprehensive mens health screening that checks for vitamin
deficiencies, various cancers, kidney function, hormone and
electrolyte levels, and other conditions. No appointments are
necessary.

Dr. Sanders co-authors national


report on cardiac arrest
Two University of Arizona
researchers are co-authors of
a report, released in July in
Washington, D.C., that
examines current statistics of
cardiac arrest in the U.S. and
recommends public health
strategies to improve survival
rates, the university reports.
The report from the Institute
of Medicine is Strategies to
Improve Cardiac Arrest
Survival: A Time to Act/ It
examines national data on the
incidence and survival rates
from cardiac arrest in the U.S., assesses evidence on existing
lifesaving therapies, and recommends public health strategies
that could save lives. Additionally, the report explores CPR and
the use of automated external defibrillators, emergency medical
services, and hospital resuscitation systems of care and
resuscitation research.
Two University of Arizona Department of Emergency Medicine
researchers co-authored the report: Arthur B. Sanders, M.D.,
M.H.A., professor and a member of the Arizona Emergency
Medicine Research Center (AEMRC)Tucson and the Institute of
Medicine, andBentley J. Bobrow, M.D., professor and co-director,
AEMRCPhoenix, and medical director for the Arizona
Department of Health Services, Bureau of Emergency Medical
Services and Trauma System.
This collaboration and development of a system of care for
cardiac arrest have resulted in more than 2,500 out-of-hospital
cardiac arrest survivors in Arizona over the past decade, as well as
shaping the national and international resuscitation guidelines,
Dr. Sanders said. The Resuscitation Research Group of UA Sarver
Heart Center, including doctors Gordon Ewy and Karl Kern, were
pioneers in the efforts to improve survival in Arizona and help
10

Epoch Health had ribbon-cutting ceremonies July 23 for its new


Tucson clinic at 4951 E. Grant Rd. From left are staffers Bianca
Ruiz, Zulma Valenzuela, Steve House, Crystal Kasnoff, Jesse
Leon, Mike Whitfield, Artician Gonzales, and Estrella
Hernandez (Epoch photo).

Arizona become a leader nationally in the approach to the


treatment of patients suffering cardiac arrest. While there is
always room for improvement, much of what is recommended in
the IOM report is currently being done in Arizona.

Doctors Lujan, Nguyen


make quick work on stroke
By Tiana Velez
Carondelet Health Network
On the night of June 15,
Tucsonan Edward Moran went
about his usual evening
routine of several minutes of
exercise, a light dinner, and a
smoothie. At 70 the retired
accountant was in decent
health, which is why he says
he missed the signs of the
stroke that nearly claimed his
life in the morning.
Moran said he was also
surprised by the speed and
level of care he received at
Carondelet St. Josephs
Hospital, where he spent the
Dr. William Lujan
first few days of his recovery.
He was so impressed with his care that he instructed anyone
calling about his status to use the code phrase, I love St. Josephs.
That hes able to tell his story is a credit to the many individuals of
Carondelet Neurological Institute (CNI) and the Primary Stroke
Center at St. Josephs Hospital, who work together seamlessly
under intense pressure.
SOMBRERO August/September 2015

CNI neurologists Dr. William


Lujan and Dr. Jimmy Nguyen
guided administration of tPA
and consulted neuroradiologist Dr. Creed Rucker,
who performed a
thrombectomy to remove the
clot from Morans brain using
a catheter inserted in his
femoral artery. Moran was
then moved to the Neuro ICU
to recover.

candidate to receive the clot-busting drug tissue plasminogen


activator or tPA.
Mr. Moran received tPA within 28 minutes of entering our
doors, recalled Hoke. That door-to-drug time is remarkable and
far below the national goal of less than 60 minutes.
Treatment didnt stop there. The clot would have to be removed
or potentially cause further damage. Essentially, the whole right
side of his brain was at risk to die. Moreover, Mr. Moran was at
risk to die, Hoke said.

On the morning of his stroke,


Moran checked in to his
former CPA firm, where he
Dr. Jimmy Nguyen
occasionally helps out as a
consultant. Like many office workers, he started his day with a
cup of coffee and a quick chat with a friend. While chatting, they
remarked that Moran seemed to be slurring his words.
No, said Moran, it was the coffee. He had made it too hot, and it
had burned his tongue, causing him to slur. As he returned to his
desk, however, he started noticing other peculiarities. He was
spilling his coffee as he tried first, to drink, and then, to slurp it.
Also, it was becoming harder to keep his grip on the mug in his
left hand. Puzzled, but knowing something definitely was not
right, he called his friend to take him to the hospital. His friend
immediately dialed 911.
Prior to arriving, Emergency Medical
Services (EMS) alerted St. Josephs
Emergency Center, where the Brain Attack
Team was prepped and waiting for Moran.
When he presented to our hospital, we
graded his stroke symptoms on the National
Institute of Healths Stroke Scale (NIHSS) and
scored him at a 6, said Tiffany Hoke, CNIs
doctor of nursing practice and neurocritical
care NP. The higher the score, the more
stroke symptoms a patient exhibits. Scores
range from zero symptoms to 42, equaling
extreme symptoms with severe impairment.
Dont let the number fool you, however, as
lower NIHSS scores can still represent severe
impairment and lead to devastating
disability if left untreated, Hoke said. Moran
had slurred speech and significant left-side
weakness involving his face, arm, and leg
upon arrival. If left untreated, his symptoms
and NIHSS would have most assuredly
worsened.
Morans CT brain scan showed no
hemorrhagic stroke, but a large right middle
cerebral artery clot, which was the cause of
his stroke symptoms. Morans quick
presentation to the hospital by way of EMS,
CT findings, and lack of related
contraindications made him a perfect
SOMBRERO August/September 2015

Within 24 hours, he had gone from a 6 on the NIH Stroke Scale to


zeroshowing no sign of stroke on exam or imaging, Hoke said.
The entire process lasted less than eight hours.
Everyone here is just unbelievable, Moran said. The nurses
come by often, answer any questions you have. They never seem
rushed or too busy for you. They make me feel like Im on a cruise.
Three days after entering the hospital, Moran was preparing for
his discharge. Speaking with him, its hard to discern any signs
that he suffered a near-paralyzing stroke. Without prompting,
he shows off how much motion hes regained on his left side
frequently raising and lowering his left arm, and pointing to
his nose.
They got me all put back together, he says. They is the group
of physicians, nurses, radiology technicians, EMTs, pharmacists,
and other Brain Attack Team members who comprise the
Carondelet Neurological Institute and the Primary Stroke
Center at St. Josephs Hospital.
n

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The most important qualities in this position are care, compassion,


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520.544.9890 | www.casahospice.com

11

land, an arrangement that has always made the Society both


renter and owner.

PCMS News

PCMS makes way


for Tucson Concussion Center
By Stuart Faxon
The Present
While not a concussion, the medical societys 32-year-old
headquarters building has become a headacheone thats costing
too much for PCMSs health.
Thats why after much research and decision-making over the last
two years, your Society has decided to sell the building. However,
PCMS administration will remain on site in smaller space, while
most of the building will be used by the new Tucson Concussion
Center.
Times have changed for medical societies, PCMS Executive
Director Bill Fearneyhough said. We have to look 10 years from
now, and thats what our Board of Directors has done. He called
the physical state of the building a disaster waiting to happen in
terms of what it could cost.
Our building, including structure and furnishings, cost $263,000
when it opened for use in 1983, roughly 5,000 square feet at
roughly $50 per square foot. As with other tenants of Tucson
Medical Park, PCMS owns the building, but TMC Holdings owns

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We pay about $20,000 per year in property taxes on the building


and land, Fearneyhough said. We pay about $18,000 per year in
rent to TMCH, making our building cost us $38,000 per year in fees
alone, even without considering maintenance and repair. This is
unsustainable for PCMS today.
The building situation is just one aspect of what we need to do for
our physicians, Fearneyhough said. This is big in the sense that it
is one step toward what we need to do in years to come, in
adapting to new technology, and in how physicians interact in this
century. You cant stop progress, especially in medicine. A
professional society is still a business, with customers.
And we tend to their needs, PCMS President Melissa Levine, M.D.
added. In our goal to be inclusive of all physicians in Pima County,
the Society needs to be more mobile, and to have physical
meetings not only on the East Side.
Our board did not take any of this lightly, Fearneyhough and Dr.
Levine, agreed. Understanding that the building is an important
piece of medical history, Dr. Levine said, the board took into
account the emotional attachments, especially of our older
members who consider the building home and fought to build it.
However, we eventually realized that this was the appropriate
direction for the medical societys future.
The Past
The 32 years of our building are a tortuous, and occasionally
torturous history.
In 1958 Dr. Jeremiah Metzger, who joined the Society in 1912, left
PCMS his home in Snob Hollow to be used as headquarters and a
meeting place, according to December 1981 reporting in this
magazine. It was not considered suitable for that purpose, and so
the Society sold the property for $40,000 and invested the funds,
creating the financial base to build something.
According to the same history in Sombrero, it was in 1961 when
Medent Corp., a group of physicians and dentists that owned the
Medical Square complex, offered free of charge a then-vacant halfblock on North Tucson Boulevard to the medical and dental
societies for a permanent home. The land had an estimated value
of $40,000. The offer was conditional that the joint headquarters
be built within two years from the date of the offer.
O.J. Farness, M.D. chaired our Long-Range Planning Committee.
Plans in 1961 called for a 15,000-square-foot building that would
house the medical and dental societies plus Blue Cross/Blue Shield.
A 7,800-square-foot auditorium to hold 500 people; three meeting
rooms; and a small restaurant were included. The 15,000 square
feet would cost $264,000, with a 15-year mortgage at 6 percent.
At the time there were 260 active members, Sombrero reported,
and how were these 260 members to finance this building? An
assessment of $200 in 1961 and $100 per year for the next eight
years, a total of $1,000. It was felt that with a prospective increase
in membership it would be possible to return the entire amount of
assessment paid by a doctor upon his death, retirement from
practice, or removal from Pima County to another location of
practice.
SOMBRERO August/September 2015

There followed a vote in which members voted not to build a


building: 117 opposed, and 87 in favor, with 67 not voting and
one unmarked ballot. In the 20 years since, Sombrero reported
in 1981, membership has tripled, needs have tripled, interest
rates have tripled, rents have tripled.
The push for a building was revived and Sombrero was a
messenger, passing along member comments:
It will give the Society an identity.
It will be a place that various specialty societies can hold
functions.
The Society will be building equity.
Future costs can be controlled.
A kitchen will be available so that meetings can be catered.
An assessment would allow us to build reasonably without
paying high interest.
There is the possibility for positive cash flow from renting
office space to various specialty societies or paramedical
groups.
We could stop paying rent at an ever-escalating rate.
It is really economically sound for the Society to own its own
building? this magazine questioned. That answer to that one is
yes according to the current research.
Today we might place all this in the category of it seemed like a
good idea at the time. But on Jan. 12, 1982 PCMS voted to assess
$500 per physician. But a number of members objected to the
amount, did not pay, and about 20 percent of our membership
resigned in protest. Many came back later, some did not.
We realize that not every member is convinced that this is a
good project, PCMS President Robert S. Hirsch, M.D. said in the
February 1982 Sombrero. But he noted that the vote of members
to assess themselves had been taken, and that it was incumbent
upon every member to fulfill this obligation.
One thing we do not want to see is members leaving the Society
for this or any other reason. We hope that the membership will
realize that we are a large Society representing a sophisticated
medical community and that they will support it in its need for
space to provide the services such an organization requires.

Dr. Marc Leib was keynote speaker at the PCMS-sponsored


ICD-10 training workshop June 23 at Tucson Osteopathic
Medical Foundations conference center. The workshop helps
physicians and practice managers prepare for the ICD-10
coding conversion that takes effect Oct. 1

Americans With Disabilities Act would be a similar potential


regulatory cost for larger, more accommodating restrooms.
When we got bids to do all these things, the estimates ranged
from $150,000 to $300,000, Fearneyhough said. This would
mean an assessment of $300 to $500 per member, another link in
the chain of information determining that, as he put it, The
building makes no economic sense and is an economic threat to
the Society. When surveyed in November 2014, membership
voted two-to-one against such an assessment.
The Future
Things will have proceeded apace while your magazine is in
production.
History Committee Chairman Jim Klein, M.D. and his committee
are in charge of the futures of all our historical books and artifacts.

The Present

On July 20, TMC Holdings delivers a purchase agreement to PCMS


to buy our building for $350,000. TMCH says it wants to close in
six to eight weeks. During the time of our magazine production,
printing, and delivery, exec Bill Fearneyhough is meeting with our
attorneys, Mesch, Clark and Rothschild, representing PCMS, to
review the agreement. Findings are presented Aug. 25 at our
Board of Directors meeting.

PCMS, committee-chaired and goaded by the late John Clymer,


M.D., in 2007-08 raised about $40,000 for Project Restore, and
those restorations were made. But those restorations were
mostly superficial, said exec Bill Fearneyhough, who himself
spent many volunteer handyman hours on the project.

For years PCMS has made about $13,000 annually renting our
meeting room. The many room renters are being notified that as
of Oct. 1, we will no longer be available for their meetings. We
are working with TMC to see if they can provide some
replacement meeting space for our renters.

Though a small amount of roof repair was done, and three new
air conditioning units, and some new, energy-efficient lighting
was done in cooperation with T.E.P., he said, we still need a new
roof and much painting and patching. The parking lot needs repaving and painting. We are probably out of code with EPA,
whose regulations would add to cost of any related updates. The

Our administrative offices will be in 925 square feet at the north


end of their current location once Tucson Concussion Centers
build-out is completed. Meanwhile, plans call for PCMS
administration to be temporarily housed across Farness Drive in a
vacant office building.

Our building officially opened on Jan. 5, 1983.

SOMBRERO August/September 2015

We want the membership to know all the details, Dr. Levine


said, but the bottom is viability of PCMS. The board concluded
13

that for the long-term future, we had to become more agile,


more flexible, in order to best serve members needs. A Society is
not a building; it is its membership.

THMEPs classroom alternative

Colorado water alternating with hot, hot Arizona sun was the
order of the day. To paraphrase PCMS President Melissa Levine,
M.D., as recently stated in these pages, we lived the life the river
gave us daily.
Professionally, evening lectures were stimulating, collegial and
enjoyed by all. Low-tech prompts and handouts were effective
alternatives to PowerPoint presentations as you can see in the
photos. As we evolved over six days into a seasoned band of river
runners, we all grew and were enriched from the professional
interaction and discourse.
And it was fun!
PCMS Member-at-Large Richard Dale, M.D. has been the driving
force behind this CME/travel event. We think you should start
planning to go on the sixth version!

Tenet, Dignity, Ascension


partner to own, operate
CHN in Arizona
Dr. Jim Herde explains principles of hernia repair at the
THMEP-sponsored Colorado River Medical Conference, given
June 27-July 3where elseon the banks of our deserts
life-sustaining water source (Steve Curtin photo).

In a July 15 news release dated Dallas, San Francisco, St. Louis,


and Tucson, Carondelet Health Network announced that major
insurer Tenet Healthcare Corporation, Dignity Health, and CHN
owner Ascension signed a definitive agreement to create a
partnership that will own and operate Tucson-based CHN.

The fifth bi-annual Colorado River Medical Conference took place


June 27 through July 3, and on the sandy beaches of the
Colorado, participants heard talks ranging from the treatment of
osteoporosis, gallbladder and hernia disease, thoracic outlet
syndrome, development of the trauma network, and the
principles of spinal stabilization.

The new joint venture includes three hospitals, an outpatient and


ambulatory services network, and two physician groups. Tenet
will be majority partner in the venture and will manage the
hospitals operations, related physician practices, outpatient and
ambulatory services, and affiliated businesses in Tucson and
Nogales. Dignity and Ascension will own minority interests in the
partnership.

The Tucson Hospitals Medical Education Program-sponsored


conference allowed for seven AMA Category 1 CME credits to be
earned at the nightly conferences. By day, attendees got to
experience one of the great natural wonders of the world with
rapids, wildlife, and a billion years of layered geology. Cold, cold

Dr. Stephen Curtin, who wrote our report on this years CME
river conference, had to compete with the Colorado for attention
(Jim Herde photo).
14

The agreement comes amid industry-wide buyouts and mergers


that have already hit Tucson in the Banner Health buyout of
University of Arizona Health Network. On July 24 Anthem Inc.,
headquartered in Indianapolis, Ind., the nations second-largest
health insurer, announced it had reached a deal to buy rival
Cigna Corp. in a deal valued at $54.2 billion, creating the
nations largest health insurer by membership, national news
services reported. They said the deal is part of health insurance
industry-wide following introduction of the Obama
governments Patient Protection and Affordable Care Act. The
Anthem and Aetna deals will face intense regulatory scrutiny
from concerns over the consolidations driving up insurance
premiums for businesses and consumers.
We look forward to the opportunity to partner with two highly
respected and dedicated healthcare organizations to improve
healthcare delivery to the communities of Southern Arizona,
Tenet President of Hospital Operations Britt T. Reynolds said.
Through this innovative partnership, we will not only continue
Carondelets 135-year healthcare mission to care for residents
across Tucson and Southern Arizona, but will also connect
Carondelet to a larger, growing statewide healthcare network,
enhancing patient access to a wide range of healthcare
resources throughout the state. This is consistent with Tenets
strategy to create new, innovative models for patient care.
SOMBRERO August/September 2015

Tenet and Dignity Health separately own and operate hospitals


and clinics in the Phoenix area, and together manage a growing
accountable care organization (ACO), the Arizona Care Network
(ACN). The organization currently includes more than 130
patient care facilities across Tenets and Dignity Healths
Phoenix-based healthcare systems, with more than 3,300
providers and more than 200,000 covered lives. A Tucson
based joint venture will connect Carondelet to ACN, which will
provide increased access to care for patients, strengthen and
grow Carondelets relationships with physicians, provide
employee development opportunities for current and future
employees, and fund strategic growth initiatives across
Southern Arizona.
Linda Hunt, president and CEO of the Arizona Service Area for
Dignity Health, said, The partnership will
continue the remarkable legacy of
Carondelet in Arizona, while launching a
new organization capable of maximizing the
changing landscape of healthcare today and
meeting the growing demands for quality
care in Southern Arizona.

hospitals: Chandler Regional Medical Center; Mercy Gilbert


Medical Center; St. Josephs Hospital and Medical Center,
which includes Barrow Neurological Institute; St. Josephs
Westgate Hospital; and Arizona General Hospital. Dignity
Health in Arizona has expanded into a comprehensive
healthcare system that includes imaging centers, clinics,
specialty hospitals, urgent cares, insurance providers, an ACO,
and other clinical partnerships. The Dignity Health Medical
Group includes more than 40 practices and covers a wide range
of specialties. Dignity Health in Arizona is part of Dignity Health,
one of the nations largest healthcare systems.
Ascension (www.ascension.org) says it is a faith-based
healthcare organization that is the largest non-profit health
system in the U.S. and the worlds largest Catholic health

We are excited about this new relationship


with Tenet and Dignity Health, said Robert
J. Henkel, FACHE, executive vice-president of
Ascension and president and CEO of
Ascension Health. Carondelet shares
Tenets and Dignity Healths commitment to
provide high-quality, low-cost, patientcentered care. This relationship is an
opportunity to strengthen those efforts and
enhance healthcare across Arizona.
Facilities in the new partnership include St.
Josephs Hospital (486 beds) in Tucson; St.
Marys Hospital (400 beds) in Tucson; Holy
Cross Hospital (25 beds) in Nogales;
Carondelet Heart & Vascular Institute at St.
Marys Hospital; Carondelet Neurological
Institute at St. Josephs Hospital; Carondelet
Medical Group; and Carondelet Specialist
Group. Carondelets services also include
imaging centers and other ambulatory
services and ancillary businesses.
The joint venture will maintain
Carondelets Roman Catholic heritage and
identity through an agreement with the
Diocese of Tucson. Additionally, Carondelets
existing charity care policies will remain in
place. The transaction is subject to normal
regulatory reviews and is expected to close
in the third quarter of 2015. Financial terms
were not disclosed.
Tenet Healthcare Corporation says it
operates 81 general acute care hospitals, 18
short-stay surgical hospitals, and more than
400 outpatient centers in the United States
and nine UK facilities.
Dignity Health in Arizona includes five
SOMBRERO August/September 2015

15

system. Ascension is committed to delivering person-centered


care to all with special attention to those who are poor and
vulnerable. More than 150,000 associates and 35,000
affiliated providers serve in 1,900 sites of care, including 131
hospitals and more than 30 senior care facilities in 23 states and
the District of Columbia.
In an odd addendum for a news release, Tenets cautionary
statements said that the release contains forward-looking
statementsthat is, statements that relate to future, not past,
events. In this context, forward-looking statements often
address our expected future business and financial performance
and financial condition, and often contain words such as
expect, assume, anticipate, intend, plan, believe, seek,
see, or will.

Forward-looking statements by their nature address matters


that are, to different degrees, uncertain. Particular uncertainties
that could cause our actual results to be materially different
than those expressed in our forward-looking statements
include, but are not limited to, the factors disclosed under
Forward-Looking Statements and Risk Factors in our Form
10-K for the year ended Dec. 31, 2013, and in our quarterly
reports on Form 10-Q, periodic reports on Form 8-K, and other
filings with the Securities and Exchange Commission.
The information contained in this release is as of the date
hereof. The company assumes no obligation to update forwardlooking statements contained in this release as a result of new
information or future events or developments.

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16

AHSCs Med-Start
aims to change face
of healthcare
High school students competitively selected
statewide spent six weeks this summer
exploring healthcare careers and education
opportunities in a program conducting
research and taking college-level courses at
the Arizona Health Sciences Center, the
university reports.
The six-week Med-Start summer program
ended July 11. Students presented their
research projects July 10 at UofA Cancer
Center. Students from Douglas, Kearney,
Nogales, Payson, the Phoenix area (Gilbert,
Glendale, Goodyear, Mesa), San Carlos,
Sells, Tuba City, Tucson, Whiteriver,
Winslow, and Yuma competed for a place in
Med-Start. They lived on campus.
The highly competitive program is a proven
success, the university reported. Eighty
percent of its participants go on to enroll in
higher education courses. Med-Start has
two goals: to address the critical shortage of
a diverse health-care workforce, and to
provide high school students with
opportunities to explore health careers and
college experiences to successfully reach
their academic and career goals.
Creating a diverse healthcare workforce
representative of the populations it serves
is a priority for Joe G.N. Skip Garcia, M.D.,
UA senior vice president for health sciences.
He and Francisco A. Moreno, M.D., assistant
vice-president for diversity and inclusion at
AHSC, professor of psychiatry, and deputy
dean for diversity and inclusion at the UA
College of MedicineTucson, are leaders in
AHSCs efforts to recruit and train a
SOMBRERO August/September 2015

knowledgeable, inclusive and diverse health-care workforce


committed to eliminating healthcare disparities.
Med-Start is one of several AHSC programs created to promote
health equity and wellness in Arizonas communities, regardless of
race, ethnicity, gender, geography, environment or socioeconomic
status. Since 1969, more than 1,000 high school students,
including students from Arizonas most remote and underrepresented areas, have been accepted into Med-Start. The
Merlin K. Monte DuVal Memorial Med-Start Endowment was
established to generate funds to support the Med-Start program.

NIH grants Sarver


to study contractile
proteins
UofA researchers have identified the
connection between thin-filament length and
cardiac function, as well as the role thinfilament length dysregulation plays in
cardiomyopathies. The new NIH grant will
help to uncover insights into novel
therapeutic targets for dilated
cardiomyopathy, the UofA reported in July.
The Gregorio Lab in the University of Arizona
Sarver Heart Centers Molecular and
Cardiovascular Research Program (MCRP) was
awarded $1.77 million from the National
Institutes of Health (NIH) for a study called
Deciphering the Role of Lmod2 in Thin
Filament Length Regulation and Dilated
Cardiomyopathy (NIH Grant 1R01HL123078).
This award demonstrates the value of Sarver
Heart Centers Investigator Awards Program,
which provides seed funding for promising
research ideas, said Carol C. Gregorio, Ph.D.,
head of the UA College of MedicineTucson
Department of Cellular and Molecular
Medicine, director of the MCRP, co-director
of the UA Sarver Heart Center, and principal
investigator on the grant.
Under Gregorios mentorship, Christopher
Pappas, Ph.D., a postdoctoral research
associate, obtained a Sarver Heart Center
Investigator Award funded by the Steven M.
Gootter Foundation. With the funding, Pappas
studied the role of the protein Lmod2 in
cardiac development and dilated
cardiomyopathy (DCM). The Investigator
Award enabled Pappas to jump-start his path
to career independence by obtaining the data
necessary to compete successfully for the NIH
grant as a co-investigator, Gregorio said.
Cardiac muscle is composed of thick and thin
protein filaments. In studying the hearts
SOMBRERO August/September 2015

mechanism of contraction, we found that the filaments have to be


precisely organized for efficient beating. Proper contraction requires
filaments of the proper length. We found that Lmod2 is an actin
filament elongation protein that regulates the lengths of thin
filaments in heart muscle, Pappas said.
The researchers identified the connection between thin-filament
length and cardiac function, as well as the role thin-filament
length dysregulation plays in cardiomyopathies. Their goal is to
uncover insights into novel therapeutic targets for dilated
cardiomyopathy. Future directions for the research team include
determining how short thin-filament lengths lead to dilated
cardiomyopathy and if Lmod2 mutations are present in human
patients with dilated cardiomyopathy.

Dr. Matthew Clavenna,


MD
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
17

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Medjacking: Absurd
yet deadly tech
In the summer Sharknado 3 Oh hell no category, The University
of Arizona reports that it is part of an elite committee studying
medical device electronic security, recognizing the potential for
medjackingmalicious medical device hacking.
The UofA College of Medicine sent surgery professor David
Armstrong, D.P.M., M.D., Ph.D. to the first committee meeting in
July in Bethesda, Md. Called the Cybersecurity Standard for
Connected Diabetes Devices Steering Committee, it joins forces
with the Department of Homeland Security, National Security
Council, NASA, and other government and industry leaders to
create strategies to keep the world safe from medjacking.
A podiatric surgeon and the director of the UA Southern Arizona
Limb Salvage Alliance (SALSA), Dr. Armstrong is the lone medical
academician on CSCDDS committee, the UofA reports, though it
is otherwise well represented on the committee. While devices
associated with diabetes are the initial focus, Dr. Armstrong said
the committee is expected to examine the security of other
medical devices. As connected devices become more pervasive
and powerful, the potential for malicious medical device hacking
is becoming increasingly real, he said.
Medical devicesinsulin pumps, pacemakers, artificial hearts,
left ventricular assist devices, artificial pancreas constructsare
susceptible to the same unintentional or intentional and
nefarious interruption and invasion as are bank accounts, ATM
machines and credit card devices.
While medjacking currently exists in the imagination and in
laboratories, Dr Armstrong said it is only a matter of time before
the issue comes front and center. No one really thinks about
these things until there is catastrophic failure. These sorts of
hacks are definitely feasible, and reasonably clever people
without a lot of resources can do some serious damage. We are
trying to get out in front of this problem.
The challenge for the CSCDD steering committee is to mitigate
danger without stifling innovation. Dr. Armstrong said patients
must be confident in the safety of their medical devices, and
companies must be secure that they are investing millions of
dollars in technology that is safe from cyber attack. The
committee will examine how key elements included in embedded
systems within devices can make them less susceptible to failure
or malicious or unintentional breach.
Discussion has swirled around the concept of medjacking for
years, the UofA reported. Since at least 2012 we have been
talking about the impending merger of medical devices with
consumer electronics, Dr. Armstrong said. Even the most
advanced medical devices are similar to the things we have in our
pockets or in our hands, such as iPhones, tablets, and home
computers.
n

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SOMBRERO August/September 2015

Arizona Medical Associaon News

Uniting the house of medicine


By Nathan Laufer, M.D.
Editors note: This speech was presented to the ArMa House of
Delegates May 29, and was published in the summer issue of the
ArMA magazine AZ Medicine.

am originally from Montreal,


Canada and have been in
practice in Phoenix for more
than 30 years. My wife, Judy, a
kindergarten teacher, has been
an inspiration to me, and my
moral compass. I do believe
that everything we need to
know in life, we learned in
kindergarten!

I am a medical graduate of
McGill University in Montreal,
as is Bob Orford, one of our
past presidents. Having come
from Canada, I have a
somewhat different perspective on the U.S. healthcare debate
and on the turmoil we are undergoing. I see the beginnings of the
Canadian healthcare problems and more developing in the U.S.
as the healthcare dollar continues to shrink and the healthcare
reform starts to take hold.
In the words of Dr. William Osler, Medicine is a science of
uncertainty, and an art of probability. This statement continues
to hold true today, not only with the practice of medicine, but
also with the business of healthcare. We are living in uncertain
times, and yet have to make medical and business decisions
without having all the facts at hand.
Current challenges to physicians include:
1.The physician shortage.
Physicians are retiring or changing careers at younger ages, and
those who remain are increasingly dissatisfied with their career
choiceso much so that many dont recommend the medical
profession to the next generation.
Medical education funding has not kept up with the demand for
qualified primary care and specialty care training. It is estimated
that the U.S. will face a shortfall of more than 130,000 physicians
in 10 years, equally divided between primary care and the
specialties.
2. The administrative load and competing regulatory programs
are increasing.
One of the greatest frustrations to physicians is the time and
expense they must devote to administrative and regulatory
requirements, taking their time away from patient care. Some of
these administrative burdens include PQRS and Meaningful Use
documentation, HIPAA security risk analysis, and ICD 10
implementation.
SOMBRERO August/September 2015

3.The Medicare physician payment system is changing.


Congress has repealed the sustainable growth rate (SGR) formula
which would have resulted in a 21 percent pay cut, scheduled to
take effect April 1. However, this is a mixed blessing!
The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) was signed into law by the President on April 16, 2015.
MACRA permanently repeals the flawed SGR formula and
stabilizes Medicare payments for physicians. There will be a 0.5%
yearly increase in the Medicare fee schedule until 2018, but then
it will be frozen until 2024.
MACRA will shift Medicare compensation from fee-for-service to
pay-for-performance. CMS intends to require that 30% of
Medicare payments are made through alternative payment
modes by 2016, and 50% by 2018, in order to improve the
efficiency of care.
MACRA replaces Medicares multiple quality reporting programs
with a new single Merit Based Incentive Payment System, also
called the MIPS program. MIPS is a consolidation of three payfor-performance programs already underway plus a new one.
Assessments will be based on four categories of metrics:
(1) quality similar to the PQRS;
(2) resource use (or efficiency);
(3) meaningful use of electronic health records, and
(4) clinical practice improvement activities.
The poorest performing doctors will see their payments cut by up
to up to nine (nine!) percent. The new incentive structure would
be budget neutral. For every doctor that makes more from the
MIPS metrics, there will be one who makes less. A true zero-sum
game, if you will.
Private insurers are also increasingly adopting value-based
payment models and risk sharing. This is projected to increase to
75% of covered lives by 2017.
4.More physicians are employed by hospitals than ever before.
To serve the ACA models of care, hospitals are rapidly acquiring
primary and specialty practices and new grads.
The solo practitioner continues to disappear. Thirty-nine percent
of physicians younger than 45 years of age have never worked in
private practice. But joining a hospital system is not a panacea for
physicians.
Some physicians are returning to private practice because their
compensation from hospitals became less attractive after the
expiration of their initial contract. The hospitals switch to
performance-based pay, which can end up being lower than their
initial salary. Further, physicians are asked to see more patients in
less time while reporting to a hospital administrator and
following hospital-imposed guidelines.

19

As large hospital networks acquire more and more physicians,


they direct patients to their physicians. If you are outside of their
network, the hospital systems will hire people to compete with you
and take the losses up-front, in order to increase their patient base.
The pressures on independent physicians are such that more
physicians are likely to seek to join a hospital in the coming years.
5. There continues to be efforts to expand non-physicians
scope of practice.
Numerous groups continue to try and encroach on the physician
practice of medicine. Here I would like to note ArMAs unflagging
work in countering these efforts in Arizona, accomplished just in
the last year.
ArMA has successfully stopped psychologist prescribing

legislation, and stopped all scope of practice expansion


efforts by chiropractors and naturopaths.
ArMA has worked to curb unsafe expansion in scope of
practice (VBAC, breech, and multiples) by lay-midwives.
ArMA was part of the Coalition that stopped administration
of vaccines to children 6 - 17 years old by pharmacists
without a physicians order.
ArMA will need to stay vigilant at the state legislature, to block
new attempts at expansion of scope of practice by nonphysicians, in order to protect the public from untrained
providers.
6. Government and payers are meddling in the doctor patient
relationship.
I believe in the sanctity of the doctor-patient
relationship. However, chart audits and prior
authorizations are some of the ways payers
are inserting themselves into the physicianpatient relationship and into medical decision
making.
In addition, more payers are tightening their
provider networks in an attempt to rein in
costs. This move toward narrow networks
means many physicians are being evaluated
for costs and quality, and patients may be
forced to switch physicians because their
physicians are dropped from networks.
Arizona became the first state in the nation to
pass into law an informed consent provision
that guarantees women seeking abortions be
told by their physician, that it may be possible
to reverse the effects of the abortion pill with
progesterone. This law is based on six patients
treated by a family doctor in San Diego. Its
junk science, and it is suspended as it awaits a
challenge in the courts.
ArMA is making a difference.
I have, for over three decades, been a firm
believer in the institution of organized
medicine and the good that we can
accomplish with unified action. ArMA has
steadily grown to be the most significant,
recognized, health care voice at the Arizona
State Capitol and with regulatory agencies. Its
successes are too numerous to list here, but I
urge you to review our Annual Legislative
Report included with this publication.
Looking forward during my presidential term.
My goals for ArMA during my term as
president include the following:
1. Have ArMA become a liaison with the
department of insurance to help oversee
health plan violations, which include dropping
physicians from networks and delay in
payments for clean claims.
2. Be vigilant regarding potential antitrust
activities of large hospital and health plan
networks.

20

SOMBRERO August/September 2015

3. Increase ArMA membership by demonstrating relevance to


employed as well as private practice physicians.
4. Work with specialties and county societies to help them be
more united in the House of Medicine in Arizona.
5. Work with the medical board to streamline complaints and
improve efficiencies.
6. Continue the physician leadership program that was
pioneered by our Immediate Past President Jeff Mueller,
M.D.
Insurance companies and hospitals have powerful political
lobbies. Yet, without physicians they cannot function very well.
These entities have managed to divide us by specialty and by
groups within each specialty. This has to stop!
At this critical time we must have a united House of Medicine. We
still have power in numbers, if we can overcome specialty and
group differences and unite in some fashion under one tent.
It is surprising to me that the laws of supply and demand dont
seem to apply to the healthcare field. This is due to government
intervention and to a lack of unity within the physician
community.
As I have outlined, there will be many changes to American
medicine in the coming years. We must always remember that, as
physicians, we are still the best, and sometimes the only
advocates that patients have. Patients and their families are
turning to us to help them navigate the complexities of their
health plans, Medicare, and hospital systems.

It is crucial for us all to understand the changes coming and


hopefully help guide and lead some of these changes. Despite
any future reorganization, we must continue to provide the most
honest, ethical, and superb care that the public expects of us.
I also remain cautiously optimistic about the future. Healthcare
reform wont be easy, but I cling to the notion that the new
generation of doctors and patients will figure it out. I still
recommend medicine to any young person who asks my opinion.
The life of a practicing physician can still be incredibly rewarding.
As Hippocrates said, Wherever the art of Medicine is loved,
there is also a love of Humanity.
Physicians continue to be unique in that our services will always
be needed. We are still one of the most highly respected and
trusted professions in the country. No matter how the healthcare
debate evolves, and no matter what actions we may take to
preserve our profession, we must never jeopardize our patients
trust in us.
If am not for myself, then who will be for me? And if am only for
myself, then what am I?
And if not now, when?
Hillel, Ethics of the Fathers, 1:14
Nathan Laufer, M.D. is the 124th ArMA president. Dr. Laufer is a
cardiologist and the medical director of the Heart & Vascular
Center of Arizona.
n

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22

SOMBRERO August/September 2015

Behind the Lens

La Danza de la Muerte at home


By Hal Tretbar, M.D.

n our June-July Behind the


Lens, we took a look at Spain
and South America for the
international state of the sport/
art of bullfighting in history and
today. For August-September
we see La Danza de la Muerte
from a local perspective.
My parents took me to a
bullfight in Mexico City when I
was in high school. Dorothy and
I went to one in Madrid in
1959.
We used to go to Mexico quite a bit when we moved here in
1965. There was no trouble crossing the border, and the dollar
was worth a lot. In the 1960s and 70s going to the bullfights in
Nogales, Sonora, was a popular thing to do. You would take in a
bullfight at the Plaza de Toros and then eat at a nice restaurant
such as La Roca, Elviras, or La Caverna. Finally, you would buy
your allotted gallon of tax-free booze before returning home.

An early 1950s postcard of the Nogales, Sonora Plaza de Toros.

to stop the event, it was reported that saloonkeeper and former


mayor Alonzo B. Webster snorted, Hell, Dodge City aint in the
United States!
The fight drew national attention. Four thousand spectators and
a multitude of out of town reporters attended. In the two day
event there was only one truly impressive bull. He went down

Spains Conquistadors brought bullfighting


to the New World, and Mexico City became
the epicenter. The first fight there is said to
have been in August 1529. Finally the 1907
El Toreo ring in the La Condesa
neighborhood was replaced by the largest
bullring in the world. The Plaza Mexico ring
with 41,262 seats was finished in 1944 and
opened in 1946. It has hosted the top
bullfighters in the world. Bullfighting has
become less popular recently and
sometimes Plaza Mexico will host musical
events or prize fights.
There is a history of bullfighting in the USA,
although it is illegal to kill the bull. In 1884,
Dodge City, Kansas was losing its image as a
true Wild West town and needed something
to perk up its reputation. The mayor and
city council organized a true bullfight for the
Fourth of July, 1884 celebration. They built a
fight ring and hired five genuine bullfighters,
four matadors, and a picador, from Paso del
Norte (Juarez), Mexico. The wildest Texas
bulls, always mad as they could get, were
selected from herds that had been driven to
the rail-head. When federal authorities tried
SOMBRERO August/September 2015

23

Trying to avoid the horns while placing the banderillas, in Plaza


Mexico bullring, Mexico City 1954.

Mexican bullfighters in Dodge City, Kansas on the 1884 Fourth


of July (Photo courtesy Kansas Historical Society).

from a trust from Matador Gregario Gallardos antique 150 year


old Toledo sword. Overall the entire bullfight week end was a
huge success The bars and the shady ladies prospered. Dodge
City regained its wicked reputation.
In Mexico many cities have had bullrings. In the 1950s there were
said to be about 220, but only 30 or so had at least four fights a
year. Some of the most popular rings developed along the border
including those in Matamoros, Nuevo Laredo, Cuidad Juarez,
Nogales, Mexicali, and Tijuana.
Nogalesinternational.com for Oct. 18, 2001 gives some
background. Nogales, Sonora was once a hotbed for bullfights,
spanning back to 1914 when a rustic ring was built on Calle
International almost parallel to the border. In 1948, Don Pedro
Gonzales sold his curio shop and used the money to build the
concrete Plaza de Toro [in 1952]... Among the crowds in the glory
days would be such celebs as John Wayne, Lee Marvin, Gary
Cooper, and Ava Gardner.
Regularly, the Plaza hosted masters. most of whom were assigned
pointed monikers referring to their prowess, such as Carlos The
Cyclone Arruza; Luis The Soldier Castro; and Fermin Espinosa,
known as the maestros maestro in the bullfighting world.
Today few Tucsonans remember how popular bullfighting in
Nogales was from the 1950s to the 80s. There were corridas
24

A close call with no injuries, Plaza Mexico, Mexico City 1954.

almost every week. Phoenix television station KPAZ/Channel 21


carried live bullfights 1967-69 along with jai alai games. Plaza
de Toro had special discount days for Davis-Monthan airmen
as well as UofA students. Tickets were sold at Dillards
department stores.
Dick Frontain taught for many years at Marana High School and
Pima College, but he is remembered as a bullfight aficionado. In
2007 Arizona Daily Star writer Ernesto Portillo wrote that Frontain
was one of the best writers on the subject. He took damn good
bullfighting photos and his books on (Carlos) Arruza and bullfighting
are highly prized. Dick regularly reviewed the previous days
corridas in Nogales for the Star. He also collaborated with Tucson
artist Ted de Grazia in 1967 for his series of paintings on the
Mexican border bullrings. Frontain died in 2007.
Tucson is probably the only city to have a street named for a
bullfighter. Carlos Arruza was one of the greatest and most
popular of Mexican matadors, and he fought many times in
Nogales. In later years he fought as a rejoneadorone who faces
the bulls on horseback. However, to the crowds delight, he would
SOMBRERO August/September 2015

Diego OBolger performing the difficult and risky gaonera pass


with cape held behind the back.

premiered in Tucson in 1972, the Tucson Festival Society had a


street named after him. Located east of Granada Avenue, Calle
Carlos Arruza is a half block long on the north side of the Tucson
Music Hall. Its worthwhile to watch the film Aruzza on YouTube
for his outstanding horsemanship.
The Nogales Plaza de Toros was well known. It was not unusual to
feature famous fighters such as Manolete or El Cordobes.
Manuel Laureano Rodriquez Sanchez or Manolete, was
considered to be one of the best in Spain. He was famous for his
ability to perform many passes without moving his feet. He
appeared in Nogales just before he was fatally gored in Spain in
August 1947.
Mario de la Fuente Flores bought the Nogales Plaza de Toros in
1963 and refurbished it. The great Spaniard, El Cordobes, Manuel
Benitez Perez, fought twice there in 1969. He was known for his
behind-the-back passes.
In 1984 Dodge City, Kansas again tried to revive the past. To
commemorate the 100th anniversary of the first bullfight, they
put together a weekend of Portuguese-style bullfighting where
no bulls are put to the sword. There were four well-known
matadors including Diego OBolger. Dick Frontain was the MC and
he explained the intricacies of a corrida to the excited crowd. The
weekend was so successful that they had bullfights for three
more years.
On July 5, 1985, the Denver Post commented, Bullfights? Thats
how 4,000 people in Dodge City, Kan. celebrated their July
Fourth. The standing-room-only crowd saw matadors Diego
OBolger, David Renk , David Silveti, and the worlds only
professional female bullfighter, matadora Raquel Martinez strut
their stuff

A ticket for University of Arizona Day in Nogales, Oct. 25, 1970.

finish the third stage, tercio de muerte, on foot. Carlos was very
graceful, artistic, and adept with the sword. He was awarded
many ears and tails.
Hollywood filmmaker Budd Boetticher was a close friend of
Arruza and made an hour-long documentary about him. After it
SOMBRERO August/September 2015

OBolger was tossed by his bull. The bull charged and knocked
him to the ground. OBolger tried to roll his body and protect his
face, but the bull hit him in the mouth and arm. OBolgers right
front tooth was broken, and his lip was left with a hole A few
minutes later OBolger was standing on his own and waved to the
crowd that he was all right The rest of the night went smoothly,
with three inaugural fights managed by Diego OBolger.
By the late 1980s and early 90s, bullfighting was losing must of
its popularity and fewer fights were being scheduled. However
Mario de la Fuentes son, also named Mario, had other ideas. The
25

Laredo Morning Times for Nov. 13, 1999 reported that he had just
finished building a $4.5 million bullring in Nogales. The Fiesta
Brava was covered with transparent acrylic plastic. The 5,000seat air-conditioned arena had a bar and restaurant. There were
three inaugural fights, managed by Diego OBolger.
The timing could not have been worse. On Nov. 16, 1999 the
Arizona Daily Star carried two viewpoints on bullfighting.
Matador Diego OBolger, a Tucson resident, argued that
bullfighting had a long history of being a traditional art form. Lisa
Markkula from the Animal Defense League called it animal
cruelty. That same day, Dillards stores stopped selling bullfight
tickets. The last regular fight in Nogales was in December 1999.
There was an infrequent minor event until the State of Sonora
banned bullfighting on May 2, 2013.
Of all the Mexican restaurants in Tucson that at one time had
bullfight posters and artwork, only Casa Molina on Speedway
retains the theme. Several large posters depict man-vs.-bull,
while smaller fliers announce the time, place, and matadors for
coming events.
According to Gilbert Molina, his grandfather Gilberto opened the
restaurant in 1947. In 1966 his father Elias commissioned the
bigger-then-life bull and matador in front of the restaurant. Lee
Copeland, who had done all of the fantastic figures at the nearby
Magic Carpet miniature golf course, sculpted the statue. Gilbert
said no one has ever complained about the bullfighting dcor.
Today few Tucsonans remember anything about the appeal of
bullfighting in Nogales. The pageantry of corrida; the ballet-like
moves of an athletic matador; the bright colors of the gold or

silver suits of light; the waving of the magenta and gold capote
(cape); and the invigorating paso doble (double step) music.
Now only the ghosts of worthy bulls and the memories of famous
matadors hang over the remains of bullrings in Nogales, Sonora.
If you listen closely to gusty winds, you may hear the faint sounds
of Ole! Ole!

Meet the local matador


Most Tucsonans
know the largerthan-life bull and
matador sculpture
at Casa Molina
Mexican restaurant
on Speedway.
Recently over lunch
there, Diego
OBolger reminisced
about growing up in
Tucson.
His family moved
here from Buffalo,
N.Y. when was four
or five years old. His
dad had a furniture
store on South Sixth
Avenue, and his
mom worked for
Diego OBolger in his suit-of-lights days.
Tucson Newspapers
Inc., where the
Tucson Citizen and Arizona Daily Star were printed. James Bolger
sold newspapers downtown around Jacomes department store
and met some bullfighting aficionados.
Apparently his mom got some tickets through her job, and took
young James to his first bullfight in Nogales when he was 10. He
still remembers how he was impressed by the American woman
fighter Patricia McCormick and two Mexican professional
novilleros, or novices.
James began reading and trying to learn about las corridas de
toros. At that time in Tucson, many people were interested in the
bullfights. One was the famous artist Salvador Corona, a wellrespected Mexican matador who was severely gored in 1919. A
matador friend told him that as a bullfighter he was an artist, and
that he would do well as a painter.
Salvador became famous in Mexico for his folk art style. He
represented Mexico at the 1939 New York Worlds Fair. He visited
Tucson, and moved here in 1940. He became famous for his
murals in the homes of prominent Tucsonans. His paintings were
in demand and sold through the Thunderbird Shops of Frank and
Pat Patania. He died in 1990.
James spent a lot of time with Salvador learning the basic
bullfighting style and techniques, and he learned Spanish. Over
the next several years he began to understand what bullfighting
was all about. While still selling papers and playing quarterback for

26

SOMBRERO August/September 2015

Salpointe High School, he


continued to attend corridas
in Nogales.
After high school James finally
pursued his dream of becoming
a torero. He rode his motorcycle
to Mexico City to train in Plaza
Mexico, the worlds largest
bullring. He took letters of
introduction and changed his
name, as Diego is Spanish for
James. He reverted to his Irish
roots with the surname
OBolger.
Diegos first formal novice
fight was on Aug. 11, 1962 in
Nuevo Laredo, Mexico. On
Oct. 18, 1964, he had his
debut at Plaza Mexico. His
alternativa ceremony to
become a full-fledged
matador de toros took place in
Diego at Casa Molina with the flier for the corrida in Nogales on May 4, 1986, when he was on the
Tijuana after a scheduled
program with Matadora Raquel Martinez.
corrida on Aug. 15, 1969. He
was only the sixth American in
300 years to achieve this distinction.

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After an outstanding corrida at Plaza Mexico in 1965, Diego


OBolger circles the ring holding a sombrero thrown in
appreciation while an assistant carries flowers.

Diego had a distinguished career. He lived in and fought in Spain


for five years while helping with an art gallery. During the 27 years
he lived in Mexico City as a matador, Diego also was a model for
TV commercials. For six years he worked in public relations for
Casa Pedro Domecq, maker of wines and brandies.
Diego returned to Tucson with his Mexican wife, Delfina, and two
children. He is still active in community affairs. He says he still
misses the art and ballet that it takes to dance with a brave,
magnificent bull.
n
SOMBRERO August/September 2015

ROC #278632

27

Travel

Of down under and out back


By Dr. George J. Makol

ell, I waited, and I waited,


and I waited some more.

I was not waiting for Earths


temperature to rise, because
indeed, that hasnt happened for
about 17 years. No, I was waiting
for the polar ice caps to finish
melting, causing the ocean to
rise so much that it would wash
Australia across the Pacific until
it bumped up against the
California coast. I could then
avoid the 16-hour plane ride,
and just walk across a koi-pound
bridge to get to Sydney.
Alas, this never happened, but since Australia was to be my
seventh continent, I gritted my teeth and planned the trip to
occur in April. If you have not visited this country yet, let me
address the advisability of going to New Zealand as well. Australia
vs. New Zealand is what I would call a Gilligans choice; Ginger or
Mary Ann, and my answer to either of these dilemmas is both.
But my adventure on this trip started before the plane even got
off the ground, so more about New Zealand later.
My wife and I were in the Qantas lounge in L.A., enjoying ourselves
so much we almost forgot to go down to board the plane. We had
to move quickly, as they were just boarding our seats when we
arrived at the now-empty check-in line. As I stepped forward the
stewardess stopped me and said that all my passport information
was not in the computer, and a small figure moved around my wife
and me, and as I turned, I almost knocked over country star Keith
Urban! Apparently he had just arrived from the American Idol set,
T-shirt, jeans and no luggage, to visit family in Sydney.
Now Im not usually starstruck, and Im not interested in
autographs, but I had seen Keith play in Phoenix last year, and in
my opinion hes the most astounding guitar player in all of
country music, even given the massive guitar talents of Vince Gill
and Brad Paisley. At the concert he actually came and played in
our row, about six seats down from where we were seated. He
was quite friendly, and I wouldve loved to talk guitar with him,
but the stewardesss dodge kept me from going down the ramp
with him, and he quickly disappeared downstairs to one of the
private first-class quarters on the Airbus 380. And no, fellas,
Nicole was not with him!
About 19 hours later, including a stop in Sydney, we arrived in
Queenstown, New Zealand. I cannot say enough about this
arrival, as the huge plane swooped in seemingly almost touching
2,000-foot sheer rock precipices on either side. The mountains
look nothing like the mountains in Arizona, as they were formed
by the cutting effects of glacial ice and shoot 2,000 feet straight
up in the air, no trees, no soil, just rock.
28

Waterfall at Milford Sound.

I was so startled by the beauty surrounding me that I just stood


frozen on the tarmac for about five minutes, and my wife and our
guide had to come back and retrieve me. In the next few days we
visited waterfalls and the rain forest, the latter within aboriginal
guide, and yes, the South Island really looks like it does in the
Lord of the Rings films.
We also visited Milford Sound, which actually is a fjord formed by
glaciers cutting eons ago through stone. We were at first
disappointed that it was raining, but as we cruised on our boat
the captain noted that we would see 100 waterfalls that tourists
never see in dry weather, and indeed we did. We later stopped at
New Zealands first and most spectacular Kawarau Bridge bungee
jump on a span stretching 186 feet above a raging river. It has a
visitor center compatible with something you would see at the
Grand Canyon, and we arrived just as a bridal party came to
watch the bride and groom jump off the bridge in their wedding
attire. The event was captured on video, so 20 years from now
when their children call them old fuddy-duddies, they can shut
them up by playing this clip.
Next we were on to Mount Cook, the former home of Sir Edmund
Hillary and a place where he practiced to be the first Western
SOMBRERO August/September 2015

Indigenous artists offer their wares.

Ayers Rock at sunset.

man to ever summit of Mount Everest. The views there are


astounding and the hiking equally spectacular, but near the base
of the mountain there are numerous plaques placed in memory
of those who had died while hiking there. Just climbing up to read
the plaques made me dizzy, so we retreated to the five-star
Hermitage Hotel in Mount Cook to sip coffee from the balcony
and take in the breathtaking scenery.

are in the process of turning the resort over to the indigenous


population, who will run it in the future; this is entirely
appropriate, as they owned the land in the past.

Since we traveled 21,000 miles in 22 days, all cannot be


recounted here. Words cannot really describe the Great Barrier
Reef, and even if you cannot swim, glass-bottom boats and
modified submarines will give you spectacular views of coral and
fish sometimes only 18 inches below the glass.
The Sydney Opera House, the citys most visible symbol, is an
architectural wonder inside and out. The Australians held an
international design competition that received 233 entries
representing architects in 32 countries, before they chose Danish
architect Jorn Utzon. Construction of the building took 14 years,
as it was a unique design, unlike any previous building. The
offered two-hour tour covers the inside and the outside, and the
main concert halls, which are cleverly designed and entirely
lined with wood pieces, each adjusted specifically to reflect
sound from the stage. The sound is so perfect that performances
can be held without amplification equipment. Personally,
however, I would love to see Led Zeppelin play there.
One thing that most Americans do not realize is that most of the
population of Australia is in the coastal cities, and that the center
part of the country is almost uninhabited. Whereas there are
about 23 million people in Australia, the huge northern
territories, several times the size of Texas, only have 200,000
persons living there. So, while visiting Australia, it is essential to
go to the Outback, and we spent a couple of days smack in the
middle of Outback at Ayers Rock.
We were incredibly lucky to have Crocodile Dundee as our guide
(his name was actually Leroy, but he was a gem and just as funny
as Paul Hogan). Our guide was also close friends with the
aborigines, now addressed as indigenous peoples, so we were
able to meet these natives, communicate with them, and even
brought home a couple pieces of original art we bought directly
from the artists.
We stayed in a fabulous five-star plus resort Sails in the Desert.
There is a small town built around the resort, and 1,000
employees all work for one company, Voyager of Australia. They
SOMBRERO August/September 2015

You may know Three Dog Night as a 1970s American rock group,
but the origin of the name is aboriginal, as on cold nights
indigenous warriors would dig a hole in the gound and sleep with
one or two dingoes (Australian dogs) on top to keep warm; so a
three-dog night represents a very cold one in the Outback.
Yes, there are incredible numbers of black flies in the air around
the Ayers Rock monument, and we were given mosquito net
headgear to wear hanging down from our hats. The Indigenous
find this frankly hilarious, as they seem to just ignore the flies and
I believe the flies ignore them, as they greatly prefer tourists.

This eight-foot croc was in the estuary at Cairnes.

Is it worth the long trip? I say it definitively is. In fact, I met many
persons working in Australia and New Zealand who had
absolutely no accents and were obviously at one time Americans.
When I asked them how they got there, invariably I heard, I
came here for vacation 10 years ago and never left. That sums it
up better than I can.
Sombrero columnist George J. Makol, M.D., a PCMS member
since 1980, practices at Alvernon Allergy and Asthma, 2902 E.
Grant Rd. His Makols Call will return in October.

29

CME

Pima County Medical


Foundation CME
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, with dinner at 6:30 p.m. and presentation is at 7.
New location is Tucson Osteopathic Medical Foundation
headquarters, Camp Lowell and Swan roads. Make turn on first
street on right and follow curved road to front door. Scheduled
for September is:
Sept. 8: Whats Up Down BelowHot Topics and Controversies in
Testosterone, ED, PS, Prostate Cancer, and Vasectomy Reversals
and Impotence with doctors Sheldon Marks and Peter Burrows.

September
Sept. 22-27: Cycling CME in Colorado says: Please joins us for a
unique CME experience in beautiful Colorado! These two CME
conferences emphasize nutrition, exercise as medicine, and
common musculoskeletal problem therapy. Conference groups
are small, helping to create an atmosphere conducive to
interactive learning in a hands-on atmosphere. Each day we will
be rewarded with a challenging road bike ride through beautiful
terrain. If you enjoy active learning, cycling, and Colorado, please
join us in 2015. Cycling CME Western Colorado is in Grand
Junction Sept. 22-27. Website is www.cyclingCME.com .
Sept. 24-26: The Western Occupational & Environmental Medical
Association presents the Western Occupational Health Conference:
To Workers Health in the West at Loews Ventana Canyon in Tucson,
offering more than 20 hours CME credit for physicians.
WOHC 2015 provides opportunities for learning using the
latest information in medical education to provide for workers
health, organizers say. This includes updates in general health,
effects at the workplace, environmental and medical surveillance,
and late-breaking controversial issues. PCMS member Scott
Krasner, M.D., M.P.H., F.A.C.O.E.M., medical director of Krasner
Medical Consultants, chairs the conference.
Included are work-site tours including Asarco Copper mine and
Raytheon. For staying at the resort, call Loews Ventana Canyon at
800.234.5117. Deadline is before Sept. 1. For more information,
e-mail WOEMA at woema@woema.org, call 415.764.4918, or fax
415.764.4915. Registration fees vary by additional Thursday
events attended. Friday and Saturday Plenary Sessions are $675
for ACOEM/WOEMA member physicians, $795 for non-members,
and $425 for allied health professionals including NPs, PAs, and
RNs. Registration forms can be mailed to WOEMA, 575 Market
St., Suite 2125, San Francisco, Calif. 94105.

October
Oct. 1-2: Ethical DilemmasConsultation and Problem-Solving:
the Mayo Clinic Approach is at Mayo Clinic Education Center,
5777 E. Mayo Blvd., Phoenix 85054. AMA, AAFP AOA, and nursing
accreditation to be announced.
Ethical dilemmas related to patient care can be associated with
30

medical, psycho-social, ethical, and spiritual challenges for


healthcare team members. This course focuses on how to
effectively determine patient preferences and appropriate goals
of care; developing a coordinated, consistent approach to ethical
dilemmas to reduce both the frequency of occurrence, and stress
among providers, patients and their families, and the community;
and implementing an ethics consultation service in your practice
based on the four-quadrant approach.
Website: https://ce.mayo.edu/ Contact: Lilia Murray, CMP, Mayo
Clinic Scottsdale, 13400 E. Shea Blvd., Scottsdale 85259; phone
480.301.4580; fax 480.301.8323
mca.cme@mayo.edu https://ce.mayo.edu/
Oct. 1-3: The Association of American Physicians and Surgeons
72nd Annual Meeting is Constitutional Symptoms: Curing
American Medicines Government-Induced Illness is at the Hilton
St. Louis Frontenac, 1335 S. Lindbergh Blvd., St. Louis, Mo. 63131.
Doctors must lead the charge, AAPS says. This must-attend
meeting will arm you with the tools youll need to help in this
fight to save American medicine. Join your colleagues and learn
how you can make a difference!
For reservations call 314.993.1100 and mention AAPS to receive
group room rate of $129 per night. Link to online room
reservations at aapsonline.org/2015am. Registration: AAPS
member $475 until Sept. 1 increase to $525; $250 spouse or
guest. Scholarships available for med students and residents.
CME: Max 12.0 AMA Category 1 designated by New Mexico
Medical Society with joint providership of Rehoboth McKinley
Christian Health Care Services and AAPS.
Oct. 9: The Fourth Annual Current Trends in Liver Disease:
Hepatitis C From A to Z is 11:30 a.m. to 5:30 p.m. at Sonntag
Pavilion, St. Josephs Hospital and Medical Center in Phoenix,
directed by Richard A. Manch, M.D., FAASLD,FACE,FACG, St.
Josephs Center for Liver and Hepatobiliary Disease chief of
hepatology.
Register by calling ResourceLink at 1877.602.4111. For more info,
contact Liver@dignityhealth.org
Topics include Hep C Current Standard of Care; Which Fibrosis
Assessment is Best: Biopsy vs. Labs?; Special Populations: Renal
Failure, Decompensated Cirrhosis, Pre- and Post-Transplant;
Future of HCV Treatment: Whats in the Pipeline? and Payer
Perspectives: Is There Light at the End of the Tunnel? Panel
discussion included.
Oct. 15-18 and Oct. 29-Nov. 1: The 18th Annual Mayo Clinic
Internal Medicine Update: Sedona 2015 is at Hilton Sedona
Resort, 90 Ridge Trail Drive, Sedona 86531; phone 928.284.4040.
http://www.hiltonsedonaresort.com/ Accreditation TBA.
Four-day course offers primary care physicians, NPs and PAs a
practical update on a variety of subspecialty topics, including
anesthesiology, allergy, cardiovascular diseases, consultative
medicine, dermatology, endocrinology, gastroenterology,
hematology, infectious diseases, nephrology, neurology,
otolaryngology, palliative, preventative medicine, psychiatry,
pulmonary, urology, womens health, and other areas applicable
to todays practice and patients.
Website: https://ce.mayo.edu/internal-medicine/node/3762
Contact: Registrar, Mayo School of Continuous Professional
Development, 13400 E. Shea Blvd., Scottsdale 85259; phone
480.301.4580; fax 480.301.8323 mca.cme@mayo.edu
http://www.mayo.edu/cme
SOMBRERO August/September 2015

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A TUCSON TRADITION FOR MORE THAN 80 YEARS

SOMBRERO August/September 2015

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MICA_Sombrero11'14ad_MICA_Sombrero05'04ad 10/17/14 9:52 AM Page 1

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(800) 352-0402
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SOMBRERO August/September 2015