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Pima County Medical Society

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

APRIL 2016

Following in the footsteps

of the Ancient Ones in
Navajo National Monument

PCMS welcomes
two new board members
Match Day ends suspense
for UA medical students

SOMBRERO April 2016

Pima County Medical
Society Officers

Official Publication of the Pima County Medical Society

Jerry Hutchinson, DO
Roy Loewenstein, MD
Kevin Moynahan, MD
Snehal Patel, DO
Wayne Peate, MD
Kenneth Sandock, MD
Sarah Sullivan, DO
Salvatore Tirrito, MD
Debra Townsend, MD
Fred Van Hook, MD
Scott Weiss, MD
Leslie Willingham, MD
Jaren Trost, MD (Resident)
Aditya Paliwal, MD (alt. resident)
Jared Brock (student)

Timothy C. Fagan, MD
Michael A. Dean, MD
Susan J. Kalota, MD
Unfilled / Appointment
Melissa D. Levine, MD

PCMS Board of Directors

David Burgess, MD
Howard Eisenberg, MD
Kelly Ann Favre, MD

Members at Large

At Large ArMA Board

Charles Krone, MD
Clifford Martin, MD

Robert M. Aaronson, MD
R. Screven Farmer, MD

Board of Mediation

Pima Directors to ArMA

Timothy C. Fagan, MD

Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Sheldon Marks, MD
Mark Mecikalski, MD

Delegates to AMA
Timothy C. Fagan, MD (alternate)
Gary R. Figge, MD
Michael F. Hamant, MD (alternate)
Thomas H. Hicks, MD

Arizona Medical
Association Officers
Michael F. Hamant, MD
Vice President
Thomas C. Rothe, MD
Outgoing Past President

Executive Director
Bill Fearneyhough
Phone: (520) 795-7985
(520) 323-9559
E-mail: billf

Bill Fearneyhough
I welcome your feedback and story ideas.
E-mail: billf

West Press
Phone: (520) 624-4939

Phone: (520) 795-7985
(520) 323-9559

Art Director
Alene Randklev
Phone: (520) 624-4939
(520) 624-2715

Pima County Medical Society
5199 E. Farness Dr., Suite 151
Tucson, AZ 85712
Phone: (520) 795-7985
Fax: (520) 323-9559

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Vol. 49 No. 4

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,
Ste. 151, 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 2016, Pima County
Medical Society. All rights reserved. Reproduction in whole
or in part without permission is prohibited.

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SOMBRERO April 2016


Vice President

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Madeline is Your Connection to

Tucsons Favorite Neighborhoods!

5 Dr. Timothy C. Fagan: Who qualifies for
Home Health Care?

7 PCMS News: Drs. Patel and Sandock are

appointed to the PCMS Board and Dr.
Perez-Velez joins PCHD.

8 In Memoriam: Remembering Dr. Hubert

Estes and Dr. Walter Ahrens.

10 Behind the Lens: Dr. Hal Tretbar is

marveled by Anasazi ruins at Keet Seel.

14 Opinion: Dr. Ronald Spark urges Pima

County to support tobacco retail
licensure to cut teen tobacco use.

15 Match Day: UA Medical School graduates

find out their next step to a medical

22 Educational Programs: Upcoming CME

and medical information events.

On the Cover
Keet Seel is one of the best preserved Anasazi ruins in the
Southwest. It can be visited by hiking a difficult 9-mile trail in
Navajo National Monument near Kayenta, Arizona. (Dr. Hal
Tretbar photo).

SOMBRERO April 2016

How Much Do You Really Know About

Home Health Care?
By Dr. Timothy C. Fagan
PCMS President

any physicians,
particularly primary care
physicians for adult patients,
have documented Face-to-Face
evaluations and signed orders
for Home Health Care. Many
physicians may have wondered
about definitions, how plans of
care are developed, how Home
Health Agencies (HHAs) are
regulated, and how they are
What are the eligibility
requirements for Medicare Home Health Care?

1. Medicare A and/or B or a Medicare Advantage plan;

2. Be confined to home;
3. Need skilled services;
4. Be under the care of a physician;
5. Receive services under a plan of care established and
reviewed by a physician; and
6. Have had a face-to-face encounter with a physician or
allowed Non-Physician Provider.
What does confined to home really mean?
1. Either: because of illness or injury, the individual needs the
aid of supportive devices, such as crutches, canes,
wheelchairs or walkers; the use of special transportation,
such as a van with a lift; or the assistance of another person
to leave his or her place of residence. Or, have a condition
such that leaving his or her home is medically
2. And, there must exist a normal inability to leave home.
3. And, leaving home must require a considerable and taxing

Therapy, Occupational Therapy and Speech Therapy. Social Work

services are also available.
What does Under the care of a Physician and Receiving
Services under a Plan of Care mean?
1. A patient may be certified for Home Health Care by a
Medicare-enrolled MD. DO or DPM (only for services
related to his or her scope of practice).
2. A Plan of Care must be established and periodically
reviewed by a physician. In fact, developing such a plan of
care is beyond the expertise of most physicians. The Plan of
Care is usually developed by the skilled professional staff of
the HHA, and reviewed and signed by the physician.
3. Certification for Home Health Care is for a period of up to 60
What are the requirements for the Face-to-Face Encounter?
1. It must be conducted within 90 days before or 30 days after
the start of care (SOC).

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Under the definition of confined to home, absences must be:

For periods of relatively short duration;
For the need to receive health care treatment;
For religious services;
To attend adult day care programs;
For other unique or infrequent events, e.g. a funeral, a
graduation, or a trip to the barber.
What skilled services are available?
Skilled services include Nursing on an intermittent basis, Physical
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2. It can be performed by:

a. The primary care or other outpatient certifying
b. The physician who cared for the patient in an acute or
post-acute care facility;
c. A Nurse Practitioner or Clinical Nurse Specialist who is
working in collaboration with physician a or b above;
d. A Certified Nurse Midwife or Physician Assistant under
the supervision of physician a or b above.
There must be documentation in the patients medical record of the
date of the Face-to-Face encounter and which justifies the referral
for Medicare Home Health services. The actual note documenting
the Face-to-Face encounter must be in the medical record.
Patients may be recertified for Home Health Care at the end
of the initial 60 day episode if they continue to meet eligibility
requirements, unless the patient is discharged with goals met and
no expectation of a return to Home Health Care, or the patient has
elected to discontinue or transfer out of Home Health Care. There
is no limit on the number of continuous episodes of recertification
for patients who continue to meet the eligibility criteria.

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How is payment for Medicare Home Health Care determined?

the Southwest!

The estimated required skilled services during the 60 day

certification are calculated using the Outcome and Assessment
Information Set (OASIS) by the skilled professional personnel of
the HHA. The evaluation includes diagnoses, health risk factors,
overall status, living situation, sensory status e.g. vision and
hearing, skin status e.g. ulcers and pre-ulcerative conditions,
respiratory status, bowel and bladder elimination status,
neuroemotional and behavioral status, activities of daily living
(ADL) status, fall risk, medications, and patient assistance
available in the home.

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Physicians & Surgeons
Other Medical Professionals
Healthcare Facilities & Services

Professional Liability
General Liability & Property
Employee Benefits

The information from this 13 page assessment is used to

generate a HHRG (Home Health Resource Group) code, a HIPPS
(Health Insurance Prospective Payment System) code, a Case Mix
Weight and a prospective payment amount. The payment is sent
to the HHA, and if the patient does not complete the planned
therapies, part of the payment is returned to Medicare.
How does Value Based Care affect Medicare Home Health Care?
Home Health Care is intended to shorten and/or prevent much
more expensive hospitalizations. As the United States has
become more aware of the rising cost of health care, Home
Health Care has become as highly regulated as inpatient and
outpatient care. As CMS moves toward Value Based, rather than
Volume Based payments for physicians, it is also moving in this
direction for Home Health Care. On January 1 of this year, a
multiyear pilot program in nine states, including Arizona,
introduced Value Based payments for Home Health Care.
Additional information is available at

866.467.3611 fax

Fagan, an internist and clinical pharmacologists, is vice governor

and treasurer of the Arizona Chapter of the American College of
Physicians, University of Arizona professor emeritus and serves as
an ArMA alternate delegate to AMA.
SOMBRERO April 2016


Board of Directors Profiles

The Pima County Medical Society Executive Committee filled two
vacancies on the Board of Directors at its meeting on February
23. Here is an introduction to the new appointees:
Snehal Patel, DO Dr. Patel
joined PCMS as a resident in
February 2014. She specialized
in internal medicine and is
currently in the first year of a
two-year fellowship in allergy
and infectious disease at the
University of Arizona. She is
also doing translational
research in asthma. She
graduated from Western
University of Health Sciences
College of Osteopathic
Medicine of the Pacific in
Pomona, Calif. in 2012.
I want to play an active role in dealing with legislative and
patient care issues that come up during our Board meetings,
Patel said. She added that she is also anxious to work with and
urge medical students to get more involved in organized
Ken Sandock, MD A PCMS
member since 1983, Dr.
Sandock has contributed his
services in many capacities.
Currently he is a member of the
Bioethics and History
Committees. He has also served
as a Board Member at Large.
Dr. Sandock is a diagnostic
radiologist and graduate of the
Indiana University School of
Medicine in Indianapolis. He
completed his internship at
Michael Reese Hospital and
Medical Center in Chicago and a residency in radiology from the
Illinois Masonic Hospital and Medical Center. A second residency
in nuclear medicine followed at Georgetown University Medical
Center in Washington, DC. along with a fellowship in diagnostic
radiology at Tulane University Hospital in New Orleans before
moving to Tucson.
He is an officer at the Southern Arizona Transportation Museum
and Tucson Computer Society and is active with the Tucson
Association of Museums and the Gadsden-Pacific Division Toy
Train Operation Museum.

SOMBRERO April 2016

Perez-Velez Named Deputy

Chief Medical Officer for PCHD
Carlos M. Perez-Velez, MD, is
the new deputy chief medical
officer for the Pima County
Health Department.
He will serve as control officer
for tuberculosis and for sexually
transmitted infections, and as a
consultant for the
Communicable Disease &
Epidemiology Team and the
Consumer Health and Food
Safety Team. Perez-Velez
provides broad oversight and
support for immunization
activities. He attended medical school at the University of
Antioquia, completed a combined internal medicine and
pediatrics residency at New Jersey Medical School, Rutgers
University, and did a combined adult and pediatric infectious
diseases fellowship at the University of Colorado School of
Before joining the Pima County Health Department, Perez-Velez
was a faculty physician at Banner-University Medical Center
Phoenix, teaching students, interns, residents, and fellows of the
University of Arizona College of MedicinePhoenix. Previously,
he was an instructor of Medicine at National Jewish Medical and
Research Center and
at the University of
Colorado School of
He is a member of
the Infectious
Diseases Society of
America, the
American Thoracic
Society, and the
International Union
Against Tuberculosis
and Lung Diseases.
He has been a
technical consultant
for Mdecins Sans
Frontires (Doctors
Without Borders),
the World Health
Organization, and
the Pan American
Health Organization.
Perez-Velez is a
member of the
Pediatric TB
Biomarker Working
Group of the
National Institutes
of Health.

He loved nature and enjoyed photographing, with family, the

deserts and forests in Arizona, Oregon and Ireland.

In Memoriam
By Dennis Carey

Dr. Hubert Estes

Hubert Estes, MD, psychiatrist
and founding physician of Palo
Verde Hospital, passed away in
Tucson on January 29, 2016. He
was 90.
Estes was born in Chicago on
February 21, 1925 and entered
the Navys accelerated
education program as an
undergraduate at the University
of Chicago and Dartmouth
College. He graduated from
Northwestern University
medical school in 1947 and
served his internship at
Evanston Hospital. He
completed his internal medicine residency at Mayo Clinic in
Rochester, Minn. After serving two years at Lowry Air Force Base
during the Korean conflict, he returned to May Clinic in 1953 and
completed a three-year fellowship in psychiatry. He was in private
practice in Houston, Texas for one year then moved to Tucson in
1957 to open a practice. He joined PCMS that same year.
Estes commitment to mental health issues and involvement in
organized medicine began immediately. He served on the PCMS
Problems of Aging and Mental Health and Child Guidance
Committees. He remained active on the Mental Health
Committee, serving as its chair for 10 years. Estes was also a
member of the Societys Teaching Service and Medico-Legal
Committees, and Board of Censors. In 1960 he was named to the
Professional Advisory Committee of the Pima County Association
of Mental Health. He served as president of the Pima County
Psychiatric Society and a delegate to the Arizona Medical
Association for two years.
His commitment to the community was also noteworthy. He was
Chairman of the Board of Trustees at Palo Verde Hospital and
member of the Palo Verde Foundation board. He taught at the
University of Arizona Medical School for 20 years.
After leaving private practice, he worked with the Department of
Economic Security in Disability Determination Services until he
retired at age 89.
Honors included the Arizona Psychiatric Society Humanitarian
Award and a Life Fellow of the American Psychiatric Association.

Estes was preceded in death by his wife Mickie, and son Ken.
Survivors include sons Dave, Bob, John Estes and daughter Holly
Coast; daughter-in-law Laura Bennett; grandchildren Dan, Katie,
Brian Matthew, Caitlin, Jenny and Emily Estes and five great
grandchildren. A memorial was held at Brings Broadway Chapel
on March 12. In lieu of flowers, donations should be made to the
Alzheimers Association or similar organization.

Dr. Walter E. Ahrens

Pediatrician Walter E. Ahrens,
MD passed away on February 18,
2016 at age 87. Ahrens was
known as a dedicated physician
and champion of finding
solutions to public health issues
in Pima County.
Born on March 5, 1928, Ahrens
received his B.A. from
Swarthmore College in
Pennsylvania and then attended
medical school at Boston
University where he graduated in
1954. He interned at
Massachusetts Memorial
Hospital and completed a twoyear residency in pediatrics at Childrens Hospital of D.C. In 1957 he
began a two-year pediatric stretch in the U.S. Air Force Medical Corps
at Davis Monthan Air Force Base and then joined Thomas-Davis
Medical Center where he practiced until retirement in 1992.
Ahrens joined PCMS in 1959 and was a member of the
Entertainment, and teaching Services Committees. He served on the
PCMS Public Health and School Medicine Committee for six years,
which included a two-year chairmanship. He served four years as a
Society alternate delegate to ArMA and was a member of the
Insurance Review Committee. He was named to the Arizona Medical
Association Commission on Poison Control in 1963 and was active in
the Pima County Pediatrics Society and a fellow of the American
Academy of Pediatrics.
After retirement, Ahrens became an advocate of the Arizona Poison
Control and Drug Information Center. In 1993, when the center was
scheduled to close because of financial difficulties, Ahren helped
save the center through his many advocacy letters and media
opinion pieces.
Details on memorial services were not available before deadline.

SOMBRERO April 2016

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SOMBRERO April 2016

Behind the Lens

Following in the footsteps of the Ancient Ones

in Navajo National Monument
Story and photos by Dr. Hal Tretbar

everal years ago when I was

in my prime hiking and
backpacking mode, there was
one day when I felt like Richard
Wetherill did in 1895 when he
found the Anasazi ruins now
called Keet Seel.
Earlier in 1888 Wetherill and his
brother-in-law Charles Mason
were searching for stray cows in
a snow storm in southwest
Colorado. They came to an
overlook point and across the
deep canyon they saw a
magnificent stone city perched
high up on a cliff wall under a large rock overhang. They had
stumbled on the very large ruin of an Anasazi (a Navajo term for
ancient ones) village built in the 13th century. Today it is known
as Cliff Palace, a part of Mesa Verde National Park.
The Wetherill family investigated other Anasazi sites over the
years. In the winter of 1894 and spring of 95 they were checking
areas further south. Near present-day Kayenta, Arizona, Wetherill,
with his brothers John, Al, and Charles Mason, began exploring
Laguna Creek and Tsegi Canyon. They were evaluating small ruins
mostly covered with sand and had a few pottery shards.
According to While camped in Keet Seel
Canyon, Neephi, Richards lead mule broke loose and strayed off.
The next morning while searching for the mule Richard turned a
corner and with no warning a massive ruin tucked in a cliff face
came into view.
On a very warm September day I had hiked nine miles up rugged

. The Ranger describes a typical Kiva. There is a fire pit with the
wind defector behind it. A manmade hole in the middle of the
floor is the Sipapu that symbolizes a spiritual relationship to
Mother Earth.

Tsegi Canyon in Navajo National Monument located near Kayenta,

Arizona. I had criss-crossed the stream many times avoiding cow
patties, quick sand and rattlesnakes. It was when I rounded a
corner that I was amazed by the view. Across the deep canyon high
up on the cliff wall was the impressive Anasazi village of Keet Seel.
It snuggles deep into a south facing alcove on the rocky cliff face.

The Ancient Ones built a retaining wall before leveling the floor.
Now a 40-foot ladder is needed to gain access to the well
preserved structures.

The Wetherill website continued: Wetherills party had

discovered the second largest and best preserved cliff dwelling in
the southwest and largest in Arizona. They used ancient toe holds
and a large tree trunk to gain access. (The site apparently had
been deserted with rooms virtually intact.) They left after working
3 or 4 days in the in the ruin. In contrast to other areas they had
explored there are no written records of this expedition. There is
no paper trail on the sale of nearly 400 artifacts recovered on this
trip. Richard didnt return until two years later.
SOMBRERO April 2016

There are still many items of everyday life to be found. Here are
corn cobs, pottery shards and grooved sharpening stones.

Most walls were built with flat rocks and mud mortar. Jacal
construction used slender upright poles that were plastered over.

It is hard to tell if some units are for living or for storage.

Up to 120 people lived in the 150 rooms of two storey Keet Seel.

The deep alcove protects Keet Seel from the hot summer sun.

Upright poles may show the boundaries of family units.

Under the 1906 Antiquates Act, President William Howard Taft

made Keet Seel a National Monument March 20, 1909 because
pot hunters were pillaging the area around Kayenta.

House, has many fragile dwellings and is closed to public access.

Now Navajo National Monument, it has two other well-preserved

cliff dwellings. Betatakin was discovered by John Wetherill in 1909
and first excavated in 1917. It can be seen from an overlook at the
end of a one-mile trail. The other large site, remote Inscription
SOMBRERO April 2016

Keet Seel (Kitsill) stands for broken house or broken pottery

scattered in Navajo. According to Wikipedia, The site was first
occupied around AD 1250, during a time in which a large
number of people were believed to be aggregating in sites such
as this. There was a construction boom at Keet Seel between AD
1272 and AD 1275 with construction then slowly tapering off

and halting completely in AD 1286. It is believed that at its peak

up to 120 people inhabited this site at one time. There are 150
rooms and several Kivas.
Construction is mainly sandstone blocks plastered together with
mud and mortar. Jacal walls were made from a screen of upright
wooden poles plastered together with mud The dry conditions
and protection from the elements allowed for some of the most
notable preservation in all of the Southwest.
It is not clear why this site was abandoned. Apparently there was
a climate change between 1276 and 1299 suggesting that the
agricultural land in this area was not able to sustain the
population levels.
I crossed over the canyon floor to the base of the cliff. I met the
resident Park Ranger there who said there were two others who
had camped overnight. He led us up the 70-foot long ladder to
the floor of the ruin. Because we were less than the usual 20
visitors allowed per day we had extra time to wander the cliff
dwelling with him.
The preservation is remarkable. It is impressive how many tree
trunks had been hauled up to be used in construction. Most of
the 150 rooms are open, some in two-story structures. Many are
intact with plastered walls. There are several traditional sunken
ceremonial Kivas. I was able to photograph from one end to the
other, although tripods are forbidden for obvious reasons.
Then it was a long, hot, nine-mile hike back out on the same day. I
was able to find a small pool that was not contaminated with cow
droppings. What a pleasure to strip off and sit down with water
up to my neck. The final challenge was to chug up the switch back
trail to reach the top of the 1,000-foot high Tsegi Canyon wall to
meet my wife at the campground.

This trail goes down the 1,000-foot wall to Tsegi Canyon that
leads you to Keet Seel.


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SOMBRERO April 2016

SOMBRERO April 2016



Curbing Youth Tobacco Use in Pima Co.

By Dr. Ronald Spark

rizona youth tobacco use continues to steadily climb as has

local retailers sales to minors. A Point of Tobacco Sale license
and enforcement has been documented elsewhere to reduce youth
smoking on average 31% and in some localities as much as 50%.
We have an opportunity to bring this effective abatement tool here

when the Pima County Supervisors consider tobacco retail licensure

this spring. Im urging PCMS members to register their support by
contacting their Pima County Supervisor.
It is well known, if smoking doesnt start before age 24, tobacco
use is much less and the habit easier to quit. Unfortunately, in
Arizona, 39% of 12th graders have already tried cigarettes and
17% in the last 30 days. Despite being required to stop, it has
been estimated that our state tobacco
advertisers spend $104 million annually
marketing products such as little cigars,
flavored tobacco and e-cigarettes, all directly
targeting the youth market.
A Pima County Point of Sale license is a way to
ensure retailers comply with responsible
tobacco sales as well as making these
products less accessible. Arizona is one of
only 12 states that do not require tobacco
retailers to be licensed. Actually, Tucson is the
only Arizona city with such an ordinance but
its rarely enforced due to lack of funding and
officers. The Pima County proposed ordinance
would effectively address both problems.

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1. All tobacco retailers purchase an annual

$300 license.
2. The fees collected from the estimated 800
tobacco retailers would cover the budget for
Pima County Health Departments
administration, retailer education and
effective program enforcement.
3. Penalties for violators would be graduated
including sales suspension and ultimately
4. Any violation of local, state or federal
tobacco statutes constitutes violation of the
County ordinance.
5. Written notice of first violation requires
retailer education. Subsequent violations are
graduated from 90 day to one-year license
The $300 fee is based on comparable
jurisdictional experiences and designed to
have minimal impact on small businesses.
Consider the commonplace business and
professional licensures we accept. We expect
each licensee knows wrongful practice could
jeopardize that privilege. Having a high
standard of practice for tobacco retailers is
reasonable and helps the public good by
reducing youth tobacco use.
SOMBRERO April 2016

Makols Call

Medical School is Not the Path to Forbes 400

By Dr. George J. Makol

here is one thing you will

never see happen in your
lifetime, and that is to see a
medical doctor listed on the
Forbes list of the 400 richest
Americans because of what he
earned practicing medicine.
Oh, there have and are a few
doctors named on this exclusive
register, such as Armand
Hammer, the oil baron who
actually held an MD degree but
never practiced medicine. (His
terminally handsome grandson
Armie Hammer is an actor who
recently played the Lone Ranger on the big screen).
There is also my ex-dermatology professor from Mount Sinai Hospital
in Miami, Philip Frost, MD, who bought Key Pharmaceuticals when it
was a tiny Miami company famous for its time release theophylline.
He would take that time release concept and built the company until
he sold it to Schering-Plough for 1.2 billion dollars which he split with
his partner Michael Jaharis. As if that wasnt enough, he took his
share of the money and created Ivax, the
United States biggest generic pharmaceutical
company. He built the company into a giant,
selling it to Teva Pharmaceuticals of Israel for
about 1.6 billion.

2. Doctors dont know how to invest and never receive

instruction in that area.
3. Doctors rely too much on active income, i.e. only looking at
what they earn from practicing, and not earning money while
theyre sleeping or vacationing.
4. A doctor does not need to be creative to do his job.
5. Doctors rarely bother to network outside of the medical
My dad, who was also a physician, told me as I was entering
medical school to never get too big of a head about being a
doctor. He said, You may be a professional, highly-regarded in
your community, and help people, but never forget that you are
just really a highly-paid piece worker. To make his point he
reminded me about a recent European trip that he, my mom,
uncle and aunt had taken a few years earlier. They hired a
chauffeur who spoke five languages and went really first class
across the continent. Upon their return, my dad calculated that
he had spent $25,000 on the adventure, and earned not a penny
while away from his office. On the other hand my uncle, who
owned burger joints, had netted $25,000 during those 10 weeks.
Henry Ford was once quoted as saying that he would rather make

There is also Thomas Frist Jr., MD, who with

his father built Hospital Corporation of
America into a premier health care
organization worth billions of dollars. He
was a former flight surgeon. His brother,
Bill Frist, MD, a cardiovascular surgeon,
served as majority leader in the United
States Senate. Their family net worth is
now in the neighborhood of $9 billion.
Although this may be hard to believe, on
one recent Forbes 400 listings there were
seven times more college dropouts than
MDs. Computer icon Michael Dell was
routinely told by his father to quit messing
with computers and stay in school or he
would never become a doctor! This little
morsel was passed along to me by
Michaels uncle.
Somewhat of an explanation for this
phenomenon was put forward in a May
2013 posting on the website Dr. CPR by CPA
Larry Miller. He noted that:
1. Physicians begin in a medical student
mode, respecting authority and always
playing by the rules.
SOMBRERO April 2016


one dollar each from a 100 men, than $100 from one man.
Personally, Im just happy when I make a hundred bucks.
With that said, would one really want to be in that top one
percent considering how selectively vilified they are today by the
press and the political class? Today we have politicians accusing
incredible businessmen, like those mentioned, of not paying their
fair share of taxes, of making too much money, and, in general,
being bad people. It is interesting however that the same
hypocrites do not criticize the astronomical salaries of actors such
as Tom Cruise, entrepreneurs like Oprah Winfrey, or sports stars
who sign contracts for hundreds of millions of dollars, many of
whom never reaching their potential as players due to personal

In my opinion, its time we turned our fire on the Internet and old
media demagogues who continue to vehemently ridicule the rich
for making too much money and paying too few taxes. Just a few
months ago, the IRS published a table showing how much the
400 richest Americans pay in taxes. It received coverage in the
December 2015 Wall Street Journal and was posted on the
Internet. It only took me a few keystrokes to bring it up on my
computer screen. The data is through tax year 2013. According
to the report, these 400 individuals paid an average of 60.8
million each in federal income tax on total earnings of 265
million. That calculates into an average federal tax rate of 22.9%.
Keep in mind this does not include Medicare and Social Security
taxes, state taxes, county taxes, sales taxes, luxury taxes, real
estate taxes and gift taxes since many in this bracket frequently
gift money to their families.

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Numerous studies have shown that

Americans feel that the highest and fairest
tax rate in the country should not exceed
25%. These people are paying at least 25%
and they are being vilified. Now Ive heard
nonsensical arguments like they still have
plenty of money left after paying taxes, but
wasnt this country formed because the
colonists didnt have much left after King
George III taxed them to death? On the
other hand, if you put forward the argument
that hedge fund managers should not use
the carried interest dodge to avoid paying
income taxes, I would readily agree with you.
That is one of the glaring errors in the tax
code that should be changed by our
esteemed representatives.
Of course, it was the same group of
representatives, or their equally-befuddled
predecessors back in 1969, who came up
with the alternative minimum tax after a
report identified a very wealthy National
Football League owner had paid no taxes the
prior year. It was part of a more lengthy
report detailing 155 wealthy taxpayers that
had avoided federal income tax altogether,
so the alternative minimum tax was born.
Unfortunately, that particular group of
legislative geniuses forgot about inflation
when drafting the new legislation. Although
the law has been tweaked over the years,
currently married couples who are both
teachers in New York City and make more
than a combined $80,000 per year are
subject to the alternative minimum tax. They
went fishing for the wealthy sports team
owner, but also netted millions of
underserving taxpayers.
Even though I have seen incomes for
lawyers, accountants, and even dentists sail
past doctors, as Im stamping out disease
daily, Im happy they havent taxed the soles
of my stamping shoes at least not yet! n
SOMBRERO April 2016

Match Day 2016

UA Medical Students learn where they

will continue medical careers
By Jane Erikson

ourth-year University of Arizona medical student Shawn

Ong danced across the stage of DuVal Auditorium on
March 17, after opening his Match Day envelope to learn he
will be doing his residency training in internal medicine at Yale
New Haven Hospital.
Ong was one of 99 students in the UA College of Medicine
Tucson Class of 2016 who have anticipated this day since their
first day in medical school, nearly four years ago. Its the day
they learn where they will spend the next several years as
resident-physicians, the next step in building a medical career.
Fourth-year UA medical students Whitney Burns and Jeffrey
Robertson, both of whom received their undergraduate
degrees from the UA, will marry next month. But on this
Friday their excitement was all about Match Day. Whitney
matched into one of two emergency medicine residency
programs offered by the UA College of Medicine Tucson,
where Jeffrey will do his residency in anesthesiology.
We are so happy. This is our first choice. This is where we
want to be, Whitney said. We have our roots here, and we
have our friends and family here, and we love the faculty here.
We are just so happy.
UA College of Medicine Tucson officials were equally pleased
with the students outcomes, with nearly 40 percent choosing
residencies in primary care in which Arizona and the whole
nation face serious shortages. Several students matched into
prestigious programs out of state, including Yale; Johns
Hopkins in Baltimore, Weill Cornell Medical Center in New
York and others.

SOMBRERO April 2016

Fourth-year UA medical student Shawn Ong reacts to the news

he will do residency training in internal medicine at Yale-New
Haven Hospital. Photo courtesy of University of Arizona Health
Sciences Office of Public Affairs.

This is one of the most successful matches weve had, said

Kevin Moynahan, MD, PCMS member and deputy dean for
education at the college. Its really great to see the students
four years of hard work finally realized, and for them to be
able to say Ive done it. Even though graduation may be the
ultimate ceremony, this day means the most to the students.
They know where theyre going. Theyve been accepted into
the profession.


Charity Adusai, who moved to Arizona at age 17 with her family

from Ghana, proudly displays the letter showing she matched
with pediatrics residency at Phoenix Childrens Hospital. The
first in her family to graduate from college, she will receive a
dual MD-MPH degree from UA in May. Photo courtesy of
University of Arizona Health Sciences Office of Public Affairs.

Soon-to-be married medical students Whitney Burns and

Jeffrey Robertson are thrilled to learn they will be staying in
Tucson for her residency in emergency medicine and his in
anesthesiology. Photo courtesy of University of Arizona Health
Sciences Office of Public Affairs.









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Said Violet Siwik, MD, the colleges interim

associate dean for student affairs, These
students make us proud because of all
their community involvement, and their
humanism, which theyve demonstrated
every year. And Im very excited for them.
Thirty-nine of the Class of 2016 students
matched into residencies in primary care
fields: 11 in family medicine, 12 in internal
medicine and 16 in pediatrics. Thirty-four
graduates will complete their residencies
in Arizona: 13 in Phoenix and 21 in Tucson.
Thats more good news for the state,
because of the physician shortage here.
According to the Association of American
Medical Colleges (AAMC), overall, 38.7
percent of medical and osteopathic
students end up practicing in the same
state where they received their
undergraduate medical education.
Notably, nearly half of Arizona medical
school graduates end up practicing in
For four years, the nations medical
students anticipate Match Day, the
SOMBRERO April 2016

annual event culminating the complex

process that matches graduating medical
students with residency programs.
National Resident Matching Program
results are released nationwide at
ceremonies coordinated to occur on the
same date (the third Friday in March) at
the same time (1 p.m. Eastern time), at
medical colleges throughout the country.
The 2016 Main Residency Match was the
largest on record, with more than 40,000
U.S. and international students and
graduates applied to match on Friday with
one of the more than 30,000 first-year
residency positions offered in this years
match, according to the NRMP.
The UA College of Medicine Tucson held
its Match Day ceremony in DuVal
Auditorium at Banner University Medical
Center Tucson. An overflow crowd of
medical students, their parents, siblings,
spouses and children gathered for the
event, which featured a skit, titled Netflix
and Match, written and performed by the

The Faces of Casa are the

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UA residency programs provide training in

environments known for their diverse
patient populations and exceptional faculty-to-resident ratios,
and they are crucial in attracting and training doctors who will
remain in Arizona.
Sixteen students in the UA College of Medicine Tucson Class
of 2016 and two in the UA College of Medicine Phoenix Class
of 2016 matched with the UA College of Medicine Graduate
Medical Education Program, which oversees 52 residency and
fellowship programs in all major specialties and subspecialties,
all accredited by the Accreditation Council for Graduate
Medical Education (ACGME). The 18 students will pursue UA
residencies in anesthesiology, dermatology, diagnostic
radiology, emergency medicine, internal medicine, neurology,
general surgery, obstetrics and gynecology, pathology,
pediatrics or radiation oncology. The UA College of Medicine
GME Program trains more than 600 residents and fellows at
Banner University Medical Center Tucson and other major
participating institutions in Tucson.
Four students in the UA College of Medicine Tucson Class of
2016 matched with the University of Arizona College of
Medicine at South Campus graduate medical education
program, which has six ACGME-accredited residency
programsemergency medicine, family medicine, internal
medicine, neurology, ophthalmology and psychiatryand one

SOMBRERO April 2016

fellowship in medical toxicology. Two of the students will

pursue UA residencies in family medicine, two in psychiatry.
Each UA College of Medicine at South Campus residency
program has achieved continued accreditation from the
ACGME. Approximately 110 residents are participating in
these programs, which focus on providing health care in rural
and underserved areas of Arizona to help reduce the Arizona
physician shortage and improve access to health care
throughout the state.
Resident-physicians undergo in-depth on-the-job training in
their fields under the supervision of practicing faculty
physicians. Residency programs vary in length from three
years for internal medicine and family practice to eight years
for the most specialized of surgeons. Most residencies will
begin July 1.
Doctor of Medicine degrees will be conferred at the UA
College of Medicine Tucson convocation ceremony on
Thursday, May 12.
Jane Erikson is a Writer/Communications Specialist for the UA
College of Medicine Tucson Telemedicine Program and
Family Community Medicine.


Global and Border Health

The University of Arizona College of Medicine, Office of
Global & Border Health invites you to a free, premiere
screening of a short film about cross-border health care
on April 21, 6:30-8 p.m. at the Loft Cinema. The film
centers on the work of the UA Office of Global &
Boarder Health, the Arizona Sonora Border Project
for Inclusion and the Sonoran University Center of
Excellence in Developmental Disabilities. Doors open
at 6 p.m.

Members Classifieds

One NovaSure Endometrial Ablation RF Controller with

cavity assessment Model 09;
One NovaSure Endometrial Ablation Footswitch;
One NovaSure Endometrial Ablation AC Power Cord.
(Please note that the NovaSure CO2 canisters used in
conjunction with the operation of this machine are not
available for sale. The sterile single-patient use NovaSure
Disposable Device is not for sale either. These must be
purchased from the manufacturer).
Hysteroscopy Equipment:
One ACMI Micro digital IP4.2 Single-Chip Image
Processing Video Endoscopy Camera System. Includes
camera and adaptor.
One ACMI ALU-2B 150 watt halogen light source w/
detachable light cord
Sony Color Video Printer UP-21MD
Magnavox 15 Color Monitor
Contact Catherine Westerband, MD at 520-498-5000 or


Northwest Medical Center campus with great visibility

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aesthetically-pleasing with high efficiency, suited for
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Available April 2016 (Current leaser is merging with
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Susan Goodman, RN, JD of Mesch, Clark Rothschild answers

questions aabout HIPAA compliance and regulations for Tucson
physicians and practice staff at a HIPAA Update Workshop
hosted by the Pima County Medical Society on March 18. Joshua
Plicht of 1701 Solutions was also a guest speaker addressing IT
concerns regarding HIPAA regulations.

Pima County Medical Foundation

Speakers Series
April 12: Healthcare Reform: Beyond the
Affordable Care Act, Dr. Timothy Fagan.
May 10: Language Development in Children,
Dr. Arthur Andrew.
June 14: Pain Management 2016, Dr. Ken
Sept 13: Balloon Dilation of the Sinuses , The
Only Constant in Life is Change, Dr. Steven
October 11: Teatment of Thrombophlebitis
and other Vascular Problems, Dr. Christopher
Nov 8: Biphosponates and Fractures of the
Femur, Dr. Jennifer Schneider.
All programs begin at 7 p.m. at the Tucson
Osteopathic Medical Foundation, 3182 N. Swan
SOMBRERO April 2016

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SOMBRERO April 2016 phone.

520.624.4939 | 888.637.0337

Contact: Dylan Johnson, Mayo Clinic Scottsdale, 13400 E.

Shea Blvd., Scottsdale 85259; 480-301-4580; fax 480-3018323,,

Medical Educaon


April 8-10: The 3rd Annual Southwest Laryngology

Conference: Focus on Voice Disorders is at Mayo Clinic

Taylor Auditorium on the Mayo Scottsdale campus, 13400
E. Shea Blvd., Scottsdale.
Accreditation: 15.75 AMA PRA Category 1 (General
Session); 4.0 AMA PRA Category 1 (Optional Workshops
Separate Fee) Course will submit for ASHA CEUs
(Intermediate level, Professional area).
Conference will provide a state-of-the-art discussion and
instruction on comprehensive evaluation and management
of voice disorders and related rehabilitation techniques.
Experts in laryngology and voice rehabilitation present
lectures, panel discussions with case presentations and the
opportunity to interact with Mayo and guest faculty.
Keynote topic is Translational Studies of the Aging Voice.
Conference targets physicians, PAs, NPs and speechlanguage pathologists, but all specialties are welcome.
Note: If you are unable to attend the course in person, you
may register for the live-stream webcast, during which you
may ask questions.

April 28-May 1: 25th Southwestern Conference on

Medicine, presented by Tucson Osteopathic Medical
Foundation, is at Westin La Paloma Resort and Spa, 3800 E.
Sunrise Drive.
Accreditation: AMA, AOA, AAFP. CME credit is also offered
for NPs and Pas. Go to for more information,
or call Nicole Struck at 299-4545.
April 29May 1: 22nd Mayo Clinic Urogynecology and
Disorders of the Female Pelvic Floor 2016 is at Scottsdale
Resort at McCormick Ranch, 7700 E. McCormick Parkway,
Scottsdale 85258; 800-540-0727.
Accreditation: max 21.25 AMA PRA Category 1. A record of
attendance will be provided to all registrants for requesting
credits in accordance with state nursing boards, specialty
societies or other professional associations.
Course presents latest treatments for urogynecology,
female urology, and pelvic floor disorders. Course features
didactic lectures supplemented with video presentations of
advanced laparoscopic and robotic surgery, surgical case
presentations and panel discussions.
Contact: Bobbi Carter, Mayo School of Continuous
Professional Development, 13400 E. Shea Blvd., Scottsdale
85259; 480-301-4580; fax 480-301-8323; carter.bobbi@mayo.

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SOMBRERO April 2016

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Welcome to the

Corinne D. Strickland, M.D.

M.D. University of Arizona, 2008
Diagnostic Radiology, University
of New Mexico School of Medicine,
Abdominal Imaging, Beth Israel
Deaconess Medical Center,

Eszter D. Wolf, M.D.

M.D. University of Arizona, 2009
Transitional, Louis A Weiss Memorial
Hospital, 2009-2010
Diagnostic Radiology, University of
Arizona Medical Center, 2010-2011
Breast Imaging, University of Arizona
Medical Center, 2014-2015


SOMBRERO April 2016

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Jason E. Wright, M.D.

M.D. Georgetown University School
of Medicine, 2007
Internal Medicine, University of Arizona
Medical Center, 2007-2008
Internal Medicine, University of Arizona
Medical Center, 2008-2010
Diagnostic Radiology, University of
Arizona Medical Center, 2010-2013
Nuclear Radiology, University of Arizona
Medical Center, 2013-2014
Body MRI, University of Arizona Medical
Center, 2014-2015


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SOMBRERO April 2016