New Era of Medicare Payment to be Accompanied by MVPS

It's official. In two years, Medicare ment cyrfos. will begin to dismantle its current charge-based physician system and In addition, the replace it with a revolutionary new reforms - which fee schedule that is expected to would base pay­ slice payments for surgery while ment on time, skill, and the other resour­ boosting fees for medical evaluation ces needed to and management. deliver a service - After years of preparing for the will place new limits change and months of haggling, on MDs' charges to lawmakers, as one of the last acts of their patients and in­ this session, adopted a proposal troduce the concept that would begin a five-year phase- of volume controls in of the new fee schedule on into Medicare forth© it falls short of the controversial ex­ January 1, 1992. Part of a three- first time. Called a Medicare penditure targets preferred by the part MD payment reform, the fee Volume Performance Standard Bush Administration and the Ways schedule is tied to a congressional (MVPS), the volume mechanism is and Means Committee. budget package that includes more stringent than one adopted by more than $1 billion in MD pay­ the Senate Finance Committee. But (Continued on page 2) INSIDE PCMS Notes from the President NEWSLETTER I look forward to serving you as physician” in the community invol­ 1990 Committee Chairs ..11 your president in 1990 and I look for­ ves many aspects - including ac­ ward to working with as many of cess to care, the involvement of the 1990 Legislators 12 ...... you as I can during the next year to physician in the community, the 1990 Officers...... 10 meet the goals of the Pierce County visibility of physicians in educating Applicants...... 5 Medical Society. the public in medical-related topics, and contributing our time, talent, Auxiliary News...... 14 The recent survey that you and treasure to non-medical com­ answered revealed that the “image Classified...... 15 munity projects. I believe that you of the physician” should be the top C.O.M.E...... 4 will find the major theme of my priority for the Pierce County Medi­ presidency related to these impor­ Election Results ...... 9 cal Society. This was also on the tant areas. Newsbriefs...... 6 top of my list and it is for that New Members...... 5 reason that I am going to em­ phasize it as my first priority during (Continued on back) my presidency. The “image of the MVPS argued that the current charge- The remaining services would get (Continued) based system favors technical pro­ there in steps, with payments each cedures and urban areas over rural year based partly on the RBRVS The AMA had backed the new fee communities and primary care. The and partly on the prior year’s schedule while pushing hard lor the new fees are expected to address blended payment (updated for infla­ tion). In 1993, the blend will be 25% defeat of the expenditure target these complaints. plan. AMA Executive Vice President RBRVS and 75% prior year’s pay­ For example, in looking at an earlier ment. In 1994,33% of the payment James H. Sammons, MD, hailed the and slightly different version of the enactment of the new payment sys­ will be based on the RBRVS. In fee schedule, PPRC estimated that 1995, the split will be 50-50; and in tem as “ a very positive move." “We family physicians would see a 38% 1996, fees will be based completely are pleased that the expenditure tar­ hike in Medicare income, while on the RBRVS. get proposal has been soundly surgeons’ income could fall by 11 % rejected,” he added. on average and by up to 20% for Proponents of payment change thoracic surgeons. Part of a three-part MD payment reform, the fee pointed to tremendous regional Similarly, the fee schedule, which variation in Medicare payments and calls for a 10% bonus payment in schedule is tied to a con­ rural and urban areas with a gressional budget pack­ shortage of MDs, is expected to im­ age that includes more PCMS Officers: prove payments in some rural than $1 billion in MD Gordon & Klatt President areas. However, a report from the ■William G. Marsh President-elect payment curbs. John B. Coombs Vice President Health Care Financing Administra­ Joseph H. Weam Secretary-Treasurei tion indicated that some rural states William T. Ritchie Past President These sweeping new payment could see little or no overall in­ modifications also will affect crease in Medicare payments as a Medicare patient’s co-payments Stuart D. Freed result of the changes. K . D avid M cC ow en and couid lead to changes in the A . R obert T hiessen David E. Law Most of the regional variations in number of MDs who bill patients for Anthony S. Lazar the balance between the Medicare William F. Roes fees would level out. But some pay­ Alice Wilhyde ment differences would remain, fee and their normal charge. Con­ since the fee schedule is to be ad­ gress thus has included several PCMS Newsletter is published eight justed to take account of provisions aimed at protecting limit­ tim es a year by PC M S M em bership Benefits, Inc., for members of the Pierce geographic discrepancies in prac­ ing patients who could face addi­ County Medical Society. The Pierce tice expenses. tional out-of-pocket expense. County Medical Society is a physician member organization dedicated to the art, science and delivery of medicine and In addition, at the insistence of the One would require MDs, as of April the betterment of the health and medical Energy and Commerce 1, 1990, to accept assignment of welfare of the community. Committee’s health subcommittee the Medicare allowance and forgo A dvertising and new sletter copy m ust ar­ balance billing for elderly citizens rive in the Society office by the 15th day chairman, California Democrat o f th e m onth preced in g th e publication Henry Waxman, one-fourth of the whose Medicare premiums and co­ date. Advertisements in this newsletter payments are paid by state are paid and not necessarily endorse­ regional variation in professional ments of services or products. Wc wel­ earnings will be taken into account Medicaid programs. Another would come and invite your letters, comments, require physicians to file all claims ideas and suggestions. in setting the fees. This provision runs counter to the advice of PPRC, (whether payment was assigned or the AMA, and most medical groups, not) within a year and prohibit char­ Editor: which had argued against an adjust­ ges for this service. The third sets David S. Hopkins ment for regional earning differen­ new limits on balance billing. ces. It also is expected to prove Managing Editor: The new limits extend the current D ou glas Jackm an slightly more favorable to urban maximum allowable actual charge Editorial Committee: areas and slightly less so to rural (MAAC) limits into 1991 and ’92. In David S. Hopkins (Chairman), communities than if only practice Stanley Tuefl, addition, they impose a new cap of W. Ben Blackett, costs had been considered. Richard Hawkins 125% of the Medicare payment in Publications Coordinator: To spread out payment shifts and 1991 and 120% in 1992. Payment Monique Johnson give MDs and their patients time to in both years is to be the MAAC or Advertising: adjust, the proposal calls for a five the cap, whichever is lowest. In Kim R eed year phase-in. In 1992, the histori­ 1993 and thereafter, no charge can MBI, Pierce County Medical Society, 572- 3709 cal charge would be raised or exceed 115% of the Medicare fee. lowered by up to 15% to bring the Pierce County Medical Society By far the most controversial 705 South 9th St., Suite 203 Tacoma, WA price for services closer to, or in line 98405 provision in the measure, however (206) 572-3667 with, the RBRVS fee. Services with payments that are due to shift by is its proposed Medicare Volume © PCMS 1989 less than 15% thus would move im­ (Continued on page 3) mediately to the RBRVS.

Page 2 • Janauary 1990 • Vol. 5, #7 Performance Standard. Intended to in determining future fee updates. bring down the rate of growth in Medicare’s spending for physician The Finance plan was seen as a pos­ Procedures sible compromise all parties could services, the notion of attaching a Targeted By volume curb to fee schedules grew live with. But participants say out of a PPRC recommendation that heated negotiations, which PPRC For Cuts called for Medicare expenditure tar­ deteriorated into name-calling at one point, got hung up over Stark’s gets. insistence that the reform plan in­ Congress cut Medicare spending by trimming MD fees on these pro­ Under the PPRC plan, Congress cludes a volume curb that would cedures: and the administration would have automatically recoup any spending set an annual target for Medicare in excess of the goal set by govern­ ‘ Breast surgery *Hip procedures spending on physician services. ment. ♦Bunion correction Then, if actual spending exceeded ‘ Knee arthroscopic procedures the target, fees were to be adjusted Under the compromise, the MVPS ‘ Sinus procedures in subsequent years to automat­ in 1990 is to be set by a compli­ '‘Larynx surgery ically recoup the spending in excess cated formula that essentially would *Lung surgery permit physician expenditures to ‘ Pacemaker procedures of the target. Dubbed ETs, the ‘ Replacement of aortic valve proposal was seized on by Rep. grow by 0.5% less than if there had ■“Coronary artery bypass Fortney “Pete” Stark (D, Calif.), who been no volume standards. Current­ *Artery repair chairs the Ways and Means health ly that is expected to result in a *Rechanneling of artery growth rate of 9.5% to 10.5%, but ■“Visualization of mediastinum sub-committee, and ultimately was “ Intestinal surgery adopted by the committee. the exact number won’t be known ''Appendectomy for certain until it is published in the ‘ Colonoscopy AMA lobbyists battled ETs Federal Register sometime before ‘ Gallbladder removal throughout the summer and fall, Jan. 1. ‘ Hernia repair ‘ Fragmenting of kidney stone and ultimately the Energy and Com­ The MVPS is intended to “slow the ‘ Prostate procedures merce Committee rejected them, ‘ Dilation and curettage calling for fee adjustments only if rate of growth” in Medicare Part B, ‘ Hysterectomy MDs hiked volume in response to Rockefeller conceded. But “what ‘ Vaginal hysterectomy ‘ Removal of spinal lamina the fee schedule. The Finance Com­ Pete Stark wanted” and didn’t get was “a direct dollar-dollar linkage” ‘ Spinal disk surgery mittee, after protracted negotiations ‘ Revision of cranial, uinar, between the AMA and Sen. Rock­ where each dollar in excess of the median nerves efeller, steered a middle course with volume standard was recouped ‘ Eye Surgery ‘ Lens procedures a plan that called for advisory MVPS through lower fee updates in later years, he said. “There is a linkage, ‘ Detached retina repair that Congress could use as a guide ‘ Treatment of retinal lesion ‘ Eardrum procedures ‘ Echo exam of abdomen ‘ Ophthalmoscopy ‘ Eye Evaluation Details of MD Payment Plan ‘ Cardiovascular procedures ‘ Heart catheterization and biopsy A new physician payment plan approved by Congress would:

yes. But [because of the floor on • Begin a five-year phase-in of a resource-based Medicare fee on Jan. 1, reduction] it is not dollar for dollar.” 1992. • Continue current Medicare payment localities for the time being and “Doctors have to feel the bill Is con­ make geographic adjustments to reflect practice costs and a portion of structive," he added, and “if they area earnings differences. think we are going to turn Medicare • Revise the resource-based relative values every five years. into Medicaid, they won’t • Create Medicare Volume Performance Standards Congress would use cooperate.” as a guideline in determining future fee updates. In 1990, the MVPS is expected to permit Medicare spending to grow by 9.5% to 10.5%. “But health care is the biggest • Set fees for non-participating MDs at 95% of fees for budget problem we face as a na­ participating MDs and ultimately limit these MDs’ charges to tion," and “this is the vehicle we 115% of their fee schedule amount. hope will begin to change the be­ • Require physicians as of April 1,1990, to accept assignment on claims havior, not just of medicine, but of of Medicare patients whose co-payments and premiums are picked up all of us who are demanding medi­ by Medicaid. cal care as well.” • Require MDs, after Sept. 1,1990, to file all Medicare patients’ claims - including those for non-assigned services. (See Upcoming Payment • Set up a new Public Health Service agency to oversee research on Reform page 4) outcome measurement and practice guidelines. College of Medical Education

Topics for Cancer Review-1990 Selected

The College’s CME program entitled Biologic Response Modifiers • Breast Cancer Screening and Cancer Review 1990 has selected • Hemopoietic Growth Factors Early Detection its program topics for the 2 day con­ • Newer Chemotherapy Agents • Surgical Treatment ference. The program, set for and Hormonal Therapy of Breast Cancer February 8 and 9 in Jackson Hall, • Radiation Therapy • Prognostic Factors in will emphasize detection, treatment • Interventional Radiology Early Breast Cancer and management of common can­ in Cancer Management • Treatment of Early cers. • Pain Management Breast Cancer • Prostate Cancer Update The program has been organized • Long Term Follow-up of Cancer Patients • Lung Cancer by Amy Yu, M.D. and will feature • Colon Cancer both local and Seattle physician • Emotional Support of Cancer Patients and Family • Update in Gyn Malignancies presenters. The program carries 12 Category I AMA and AAFP credits and is open to registration through the College now. Program topics in­ clude: C.G.M.E. Program Schedule • New laboratory Tests in the Diagnosis Center • New Concepts in Treatment: DATE(S) PROGRAM DIRECTOR(S) 1990 Survey Shows High Thurs., Law & Medicine F. Ross Burgess, J.D. Jan. 18 Symposium Jeffrey Nacht, M.D. Interest in CME Thurs., Fri., Cancer Review Amy Yu, M.D. Sun Valley Program Feb. 8 & 9 -1990 Weds., AIDS Update Alan Tice, M.D. A survey assessing interest in a Feb. 28 CME program for the Sun Valley area has recorded very positive Thurs., Fri., Tacoma Academy David Law, M.D. support Mar. 8 & 9 of Internal Medicine for the Annual Review proposal. Fri., Sat., Tacoma Surgical Chris Jordan, M.D. In just April 13 & 14 Club one week Fri., Dermatology Barbara Fox, M.D. nearly April 27 James Komorous, M.D. 150 David Brown, M.D. Pierce County Medical Society Thurs., Fri., members returned their survey in­ Aggressive Edgar Steinitz.M.D. May 10,11 dicating their interest and identify­ Musculoskeletal ing program content and date and Spinal preferences. Evaluation,Treatment and Rehabilitation The program will likely be held in the winter of 1991 and is being Mon., Tues., Advanced Cardiac James Dunn, M.D. June 25 & 26 coordinated by Mark Craddock, Life Support M.D. Clip and Savel

Page 4 • Janauary 1990 * Vol. 5, #1 Applicants for Membership Welcome New The Pierce County Medical Society welcomes the following physicians who have applied for membership. As outlined in the Bylaws, any member who Members has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for member­ The Board of Trustees has ap­ ship, shall assume the responsibility of conveying that information to the proved the Credentials Commit­ Credentials Committee or Board of Trustees of the Society. tee recommendation that the following applicants be approv­ ed for PCMS Membership. Bradley D. Pattison, M.D. M. Tarek Baghdadi, M.D. Anesthesiology. Born in Seattle, Ob/Gyn. Born in Egypt, 05/15/51. Washington, 06/29/54. Medical Medical school, Medical School of Vita S. Pliskow, M.D. school, University of Washington, the Royal College of Surgeons, Anesthesiology 1982; internship, University of 1980; internship, Saint Lawrence 3502 Olympic Blvd. W. Arizona, 1986; residency, University Hospital, 1981; resident, Royal Sus­ Tacoma of Arizona, 1987; graduate training, sex County Hospital, U.K., 1983; University of Arizona, 1989. resident 2, All Saints Hospital, U.K., Lyeette D. Charity, M.D. Washington State license, 1989; 1984; resident3, Saint Agnes Hospi­ Anesthesiology board certification, board eligible. tal, 1986; resident 4, St. Joseph 314 South K St., #302 Dr, Pattison will be practicing in Gig Hospital and Medical Center, 1989. Tacoma Harbor. Washington State License, 1989. Dr. Baghdadi is practicing with Mid­ Arthur B. Vegh, M.D. wives Associated in Tacoma. Allergy/Immunology B6010 Allenmore Medical Ctr. Tacoma Upcoming Payment Reform James R. Taylor, M.D. Pulmonary Milestone dates in implementation of payment reforms include: 316 S. K St., #401 Tacoma • Jan. 1, 1990, HHS to publish Medicare Volume Performance Standard (MVPS) for fiscal 1996. Michael J. Kelly, M.D. • Jan 1, each year, HHS must publish fee schedules for each Family Practice payment locale. 11315 Bridgeport Way S.W. • April 1,1990, MDs must take assignment on Medicare patients Tacoma whose co-payments and premiums are paid by Medicaid. • April 15, each year, HHS to recommend fee update and MVPS for the Steven M. Teeny, M.D. next year. Orthopaedics • July 1, 1990, HHS study on separate performance standards for 103 NE 53rd St. geographic areas, specialties, or services due. Tacoma • Sept 1,1990, physicians must file all claims - assigned or unassigned. • Sept. 1,1990, HHS to submit model fee schedule to Congress. E. Bruce Hilton, M.D. • Oct. 15, each year, HHS must publish updates for the following year. Physical Medicine and Rehabilita­ • Jan. 1,1991,5% bonus in manpower shortage areas expanded to 10%. tion • April 1, 1991, General Accounting Office to report on alternatives to 1901 S. Cedar, #302 Medicare payment for professional liability insurance, including binding Tacoma arbitration or a no-fault system for Medicare. • July 1,1991, various PPRC reports on rural practice costs, methods of allocation liability insurance expenses, and the adequacy of Medicaid payments due. • July 1,1991, GAO tcJ report on antitrust laws' impact on physicians’ ability to engage in group action to reduce inappropriate utilization. • Oct 1, 1991, if Congress agrees, “qualified physician groups” can opt out of the national standard and negotiate individual standards with HHS. • Jan. 1,1992, transition to resource-based fees begins. The Tacoma Hosts Needed for Goodwill Gaines

Ambulance Members of The Washington Academy of Family the Pierce Physicians and Group Health Decision Made by County Cooperative of Puget Sound are the City Council Medical among the organizations coordinat­ Community ing housing arrangements for our will have an visitors. They need physician hosts At its December 5 meeting, the opportunity to provide housing for visiting Tacoma City Council, by a vote of 8 to indirectly physicians and spouses. This offers to 1, authorized “a system of emer­ participate you a once in a lifetime opportunity gency medical service (EMS) where in the Good­ to really get to know a colleague the City of Tacoma Fire Department will Games from abroad. Most of them will be shall provide all paramedic and ad­ scheduled able to speak some English. vanced life support patient transport for July 20' for 9-1-1 emergencies and that August 5, If you would ba interested in hosting private ambulance companies shall 1990. It is estimated that 50 Soviet a visiting physician and spouse, provide all other non-emergency physicians and spouses, as well as please call the WAFP at patient transport. physicians from 50 other nations wiii 1 -352-8596 or 1 -443-7910 or the PCMS at 572-3667. The decision followed a publicly con­ be attending. tested battle between the Tacoma Fire Department and private am­ bulance service. Private ambulance took the fight to the public with several advertisements in the local Embezzlement and media. Mayor Sutherland was the only one to cast a “no” vote on the Employee Theft... resolution. His concern was that the resolution would lay the cornerstone Is There a Threat for a county-wide system and force the county municipalities and fire to Your Practice? districts to duplicate Tacoma’s sys­ tem. Manage Ability Provides: The resolution calls for a review and evaluation of the system after one • Detailed monthly, on-site examination year. Councilman Mykland re­ of your accounts quested that all ambulance services report back to the city council within sixty days on how they will deliver • Consulting Services with resources BLS services. and solutions for your practice needs Norma Larson Kay Harlan Steve Larson Pierce County Pierce County King County 840-1501 840-1501 937-7168 ManageAbility

Page 6 • lanauary 1990 • Vol. 5, #J 705 South Ninth Street • Suite 203 • Tacoma, Washington 98405 • Telephone (2061 572-3666

Presents “Medicine in the White House”

at the

Joint General Membership Meeting with MAMC

featuring

General John Hutton, Commander, MAMC

Date: Tuesday, February 13 Place: Fircrest Golf Club 6520 Regents Blvd. Time: Cocktails 6:00 p.m. (no host) Dinner 6:45 p.m. Program 7:45 p.m. Price: $15 per person* *$17 per person if registering day o f meeting Spouses Invited!

Reservations required by Friday, February 9.

REGISTRATION Yes, I(we) have reserved the evening of February 13 to join members of the Pierce County Medical Society and the MAMC at their Annual Joint Meeting. Please reserve dinner(s) at $______per person (meal, tax, and gratuities included). Enclosed is my check for S ______Dr. ______

Please make check payable to PCMS and return no later than Friday, February 9, 1990. *DAY OF REGISTRATION FEE - $17. NewsBriefs Continued,

Addictions in the Family Workplace Smoking and the Practice of Medicine in the 90’s Seminar Planned

Professional Education Associates Nicotine Addiction, The Family Dis­ On Tuesday, February 27, a Smok­ and course coordinator Patrick J. ease, and Practical Office Interven­ ing in the Workplace conference will Donley, M.D., are offering a one-day tions in Addictive Diseases. be held in efforts to help small busi­ symposium for Physicians, nesses with smoking policies and Psychologists and Directors of The course is accredited through procedures. Topics covered will in­ Treatment Centers. the College of Medical Education clude health effects of involuntary for 6 credit hours of AMA and AAFP smoking, ventilation and ambient Addiction in the Family and the credit. smoke, legal and economic issues. Practice of Medicine in the 90’s The registration fee is $30 The program will be held at will cover Current Trends in Therapy Copperfield’s Restaurant. The for Alcoholism, The Ben­ and includes lunch. Please call 1-643-5263 for more information. registration fee is $15 which in­ zodiazepines, Waking Up to cludes breakfast and handout materials. Call 565-9555 for more in­ formation. Persing, Dyckman, Toynbee, Inc., Insurance Brokers Medicine at 1600 Pennsylvania Quality Service for Quality Clients Avenue Insurance Specialists Since 1945 (206)627-7183/FAX (206)572-1430 The annual joint meeting of the Medical Society and Madigan Army Bob Sizer 705 South Ninth, Tacoma W A 98405 Doug Dyckman Medical Center will to be held Tues­ Curt Dyckman day, February 13. David Gillespie, CIC David Babbitt Auto ® Home This year’s program Ro?Ried°ernSOn' CP°U Business « Professional will feature General John Hutton, who Carrie Lugo Group • Disability « Life Bob Cleaveland, CLU, ChFC served as President Reagan’s personal physician during his two terms in the White No Increase in Premium Rates for 1990 House. Dr. Hutton’s presentation will give insights into the Reagan administration and how For the second consecutive year, our claims experience has been bet­ medicine is practiced in the White Washington State Physicians In­ ter than expected. This enables the House. surance is pleased to announce that Exchange to continue through 1990 there will be no rate increase in the with no increase in premium rates The meeting will be held at the new year. The company is continual­ over 1988 levels. Coupled with new Fircrest Golf Club with social hour ly reassessing the factor upon rate classification changes, this beginning at 6:00 p.m., dinner at which premium rates are contingent results in an overall 4.6% rate 6:45 p.m., and the program at 7:45 in order to provide the least expen­ decrease in 1990. p.m. Registration forms will be sive insurance to our subscribers. *Excerpted from Vol. 3, #3 of Washington mailed in mid-January, see insert. Based on recent actuarial studies, Physicians Quarterly Plan on joining us.

S-r-i r°- i —•----- Vol. 5, # i • Janauary 1990 • Page 7 NewsBriefs Continued..

Passing the Gavel with Holiday Spirit

Nearly 250 members and spouses nizing his father, Dr. C. B. Ritchie, It was a grand evening concluded attended the December 12, Annual who presided over the Society in by Dr. Ritchie thanking Board mem­ Joint Dinner meeting at the Tacoma 1960. bers, Committee Chairmen, mem­ Sheraton Ballroom. Dr. Bill Ritchie, bers and staff for their support out-going President and Mrs. Alice Presidents Ritchie and Wilhyde com­ during the year. He then presented Wilhyde recognized and honored mented on some of the significant the President’s Gavei to Dr. Gordon those Past Presidents of the Society events taking place during each of Klatt who briefly outlined his goals and Auxiliary who were in atten­ the past presidents tenure in office. for the year. Number one on the agenda will be the improvement of dance. Entertainment for the evening was provided by the Curtis High School the physician’s image. This was Mrs. Pearle Baskin, Auxiliary Presi­ the primary concern voiced by the dent in 1947 was the oldest auxiliary String Quartet and Swing Choir. The String Quartet performed flaw­ membership survey completed in president in attendance and Dr. November and one Dr. Klatt will Herman Judd (1958) the most lessly during the social hour and din­ ner and the Swing Choir with its direct the Society and its member­ senior Society President present. ship to work on in 1990. Dr. Ritchie had the honor of recog­ boundless energy brought the Chris- mas Spirit to the Sheraton Ballroom.

Free Medline Search vonBruck Retires After 22 l/2Years

An AMA membership service Ms. Marion vonBruck, head ference room #1. Coffee, tea, and provides two free MEDLINE sear­ librarian, Medical Library of Pierce cookies will be served between 3:00 ches yearly and $25 for each addi­ County, for 22 and a half years will and 5:00 p.m. and from 5:00 to 7:00 tional search. be honored by Multicare Medical p.m., wine and cheese wilt be Center and Pierce County Medical served. With MEDLINE on-line index of Society at a tea scheduled for Wed- more than 4,000 medical journals, nesday, January 17, 1990. This is your opportunity to thank you can request a bibliography of ar­ Ms. vonBruck for ail her years of ticles on any medical subject. Ms. vonBruck will be recognized for dedicated service to you and to Searches are completed and mailed her services to the medical com­ making the Medical Library of within two weeks. Fee to non-mem­ munity at the tea to be held at Pierce County the finest in the bers is $45 per search. Tacoma General Hospital, con­ Northwest. The AMA reference library fills members’ requests for reprints or photocopies of articles within three working days. Family Practice AMA members only: 5 free articles per request New Medical Clinic Available

$10 charge for additional article. Locatcd at 7231 So. Tacoma Way with 3,200 square feet., it ii wiihin 2 miles of 7 nursing nomcs, 4 miles from Tacoma General Hospital, 3 $10 charge for one-day RUSH ser­ miles Irom Si. Josephs Hospital, 3 miles from Puget Sound Hospital and vice (please provide a FEDEX or -1 mites from Lakewood Hospital. Situated next to Dr. William D. FAX number). Sliiirs’s denial clinic (where he has successfully practiccd since 19S5), the clinic is in llic cenlcr ol a 3lS,000 person population (within a 5 mile radius). The population is comprised ol approximately 75 percent with health insurance, 15 perccnt with medicare insurance, and 1U percent D.S.II.S. Simply stated, there are no physicians near this location which guarantee a succssful practice. Drop by to see Dr. Bill Stairs or call him at 475-6500 lor his opinion and analysis The cost is very reasonable. Call Charles Woodke at 566-0646 (wk) ov 1-1)49-211)0 (hm).

Page 8 • Janauary 1990 • Vol. 5, 41 1990 Election Results

N e w ly elected members of the their two-year term as trustees are Robert’s Rules of Orders recom­ Board of Trustees were introduced David Law, Tony Lazar, Bill Roes, mend only one candidate for each at the Annual Joint Dinner Meeting, and Past President Bill Ritchie. office. December 12. 1990 President Gor­ One of the returning ballots indi­ The basis for this is if you have a don Klatt introduced President-Elect cated that it appeared to the mem­ good strong candidate, it is difficult Bill Marsh, Vice President John ber that the election was “rail­ to find anyone to oppose that can­ Coombs, Secretary-Treasurer roaded" because only one can­ didate. Also, the losing candidates Joseph Wearn, and Trustees Stuart didate was offered for the office or are reluctant to enter a later race, Freed, David McCowen, and Robert position. Several years ago, the and the Society has lost the ser­ Thiessen. Society bylaws required two or vices of an acknowledged leader. Hold-over members completing more candidates for each office.

H P IT Aids Physicians

T h e High Priority Infant I racking risk” infant in the care of a primary to health care access are identified Program (HPIT) began in Pierce care provider. and hopefully resolved. County July 1,1989. The program assists families to keep their high 2. Promote early identification of in­ For further information and HPIT Identification forms to enroll your risk infants in primary well-child fants requiring further evaluation of services. "high risk” infants contact: care and actually help “track” the child for the first three years of life. 3. Assist in planning for health and Jeanine Hendricks, HPIT Program By continuing well-child care, the education needs of the children of Secretary, 591-6403. program actually aids the physician Washington State. in providing EPSDT services to children. Any infant less than 90 days of age who meets one or more specific ^DIAPER RASH1 Approximately three years ago, risk criteria in established biological IS NOT A WAY OF LIFE physicians in Pierce County sup­ or environmental risk categories is ported the need for tracking “high You can recommend professional eligible for program enrollment, diaper service with confidence. risk” infants in this county. They regardless of income. based this support on a number of ® Laboratory Controlled. Each month factors, but primarily because: Infants are identified in some hospi­ a random sample of our diapers is tals, through doctor’s offices’, by subjected to exhaustive studies in a -Pierce County is second in the community clinics and by local biochemical laboratory. state in birth defects (2.7% of live health department programs. When births) ® Utmost Convenience.Thanksto pick an infant is identified as a candidate up and delivery service, our product -Pierce County is first in low birth for tracking, the parent must sign comes when you need it. the identification form for enrollment weights (6.2% 2500gm) • Economical. All this service, all this and tracking. protection against diaper rash costs -Pierce County is second in births far less than paper diapers — only to mothers 17 years of age or After identification and enrollment into the HPIT Program, the lead pennies more a day than home- younger (4.3%) washed diapers. agency (the Tacoma-Pierce County -Pierce county is third in births to Health Department) will contact the CAUTION TO YOUR PATIENTS. It is illegal to single mothers (21.4%) primary care health provider at 6, dispose of human excrement in garbage. 12, 18, 24 and 36 months through a Parents are doing this with paper/plastic In 1984, 27% of the mothers who postal questionnaire. diapers. “ Disposable" is a misnomer. gave birth received no prenatal care or began care in the 2nd or 3rd This questionnaire obtains critical in­ B a b y trimester. Because of the above formation for the ongoing medical Hager concerns, Pierce County physicians and developmental monitoring of then requested the Tacoma-Pierce the child. gerwise County Health Department pursue TACOMA WA TOLL FREE the implementation of HPIT in our If a child fails to return for a well- 3 8 3 -B A B Y 1-800-562-3ABY county. child visit, active follow-up is in­ Washington's Oldest, Most Trusted HPIT Program Goals are: itiated. The health department will at­ Professional Diaper Service 1. To help parents keep their “high tempt to reconnect the child with Serving Our Second Generation I the primary care provider. Barriers 1990 PCMS Officers and Trustees

Board of Trustees

^President Gordon R. Klatt GS 627-5858 2401 North 30th

‘ President-Elect William G. Marsh FP 537-0293 11019 Canyon Rd. E

*Past President William T. Ritchie ENT 272-1777 B-3008 Allenmore Med. Ctr.

*Vice President John B. Coombs FP/PED 594-1087 315 South K Street

''Secretary-! reasurer Joseph H. Wearn Ped 593-8407 521 South K Street

T rustee Stuart D. Freed (91) FP 759-3586 2517 N. Washington

Trustee David E. Law (90) IM 272-7573 1206 South 11th St., #12

Trustee Anthony S. Lazar (90) RAD 383-3731 3402 South 18th

Trustee K. David McCowen (91) ENDO 572-5025 314 South K Street, #104

Trustee William F. Roes (90) FP 884-9221 8903 Key Peninsula No.

T rustee A. Robert Thiessen(91) ONC 383-1988 314 South K Street, #401

Trustee Alice Wilhyde (90) Aux 572-6920 515 No. C Street

* EXECUTIVE COMMITTEE members

WSMA Representatives

Vice Speaker Richard Hawkins FP 383^071 B7005 Allenmore Med. Ctr.

Trustee Richard G. Bowe OPHT 759-5555 1818 S. Union

Trustee Charles Weatherby FP 473-3741 3711 Pacific Avenue

Trustee Robert Scherz PED 594-1420 311 S. L St.

AMA Alternate Delegate Leonard Alenick OPHT 582-0525 5900 100th St. S.W., #33

Paee 10 • Janauary 1990 • Vol. 5, #1 1990 Committee Chairmen

The following members will serve as chairmen of the Medical Society’s committees in 1990:

COMMITTEE CHAIRMAN SPECIALTY

Aging James M. Wilson IM AIDS Alan D. Tice Inf. Disease Community Health Care Charles M. Weatherby FP Delivery System Credentials John F. Kemman FP Editorial David S. Hopkins FP Emergency Medical Standards Robert Wachtel EM Ethics Ronald G. Taylor GS Grievance William T. Ritchie ENT Interprofessional Robert J. Martin DER Library William M. Dean U MEDCAT Gregory Popich ORTH Medical/Legal Marcel Malden NEU Minority Health Affairs Charles M. Weatherby FP Personal Problems of Physicians Patrick Donley PSY Public Health/School Health Terry Torgenrud PED Puyallup Fluoride William G. Marsh FP Sports Medicine Stuart Freed FP Tobacco Coalition Gordon R. Klatt C-RS Trauma Surgeon Task Force Henry Zielinski SG

Watch for this Sign What Do You Think? Your PCMS We’d Like To Know

Auxiliary Wants to Send us your questions, comments, Help YOU Make story suggestions, articles etc., We welcome input from our members. Your Medical Call 572-3667 or write to: Dollars Count! Pierce County Medical Society Look for more information in 705 S. 9th, Suite 203 Tacoma, WA 98405 the February PCMS Bulletin

Vol. 5, # 1 • Janauary 1990 • Page 11 1990 Legislators

T h e Washington State Legislature will convene on Monday, January 8. The group is scheduled for a 60 day ses­ sion to resolve a number of controversial issues. Pierce County Legislators will play key roles in this session. Representative Brian Ebersole, 29th district, serves as House Majority Leader. SENATORS COMMITTEES OLYMPIA P H # 2nd District Ken Madsen (D) Agriculture 786-7602 Law and Justice Transportation 25th District Marcus S. Gaspard (D) Agriculture 786-7648 Education Ways and Means 26th District Bill Smitherman (D) Economic Development and Labor 786-7650 Financial Institutions and Insurance Higher Education 27th District Lorraine Wojahn (D) Health Care and Corrections 786-7652 Rules Ways and Means 28th District Stan Johnson (R) Financial Institutions and Insurance 786-7654 Health Care and Corrections Ways and Means 29th District A.L. “Slim” Rasmussen (D) Financial Institutions and Insurance 786-7656 Law and Justice Rules 30th District Peter vonReichbauer (R) Financial Institutions and Insurance 786-7658 Transportation Higher Education

LEGISLATIVE MAILING ADDRESS: Senator______Legislative Building Olympia, WA 98504

REPRESENTATIVES COMMITTEES OLYMPIA PH# 2nd District Marilyn Rasmussen (D) Capital Facilities and Finance Agriculture and Rural Dev. 786-7824 Education Trade and Economic Dev. Rep. Randy Dorn (D) Appropriations Education 786-7912 Financial Institutions and Insurance 25th District George Walk (D) Transportation Trade and Economic Dev. 786-7948 Randy Tate (R) Human Services Judiciary 786-7968 Trade and Economic Dev. 26th District Ron Meyers (D) Energy and Utilities 786-7964 Judiciary Rules Transportation Wes Pruitt Revenue 786-7802 Education Environmental Affairs 27th District Ruth Fisher (D) State Government 786-7930 Natural Resources and Parks Transportation 28th District Sally Walker (R) Commerce and Labor 786-7958 Education Environmental Affairs Transportation Shirley Winsley (R) Housing 786-7890 Capital Facilities and Finance Financial Institutions and Insurance Human Seivices 29th District Brian Ebersole Appropriations and Rules 786-7999 P.J. (Jim) Gallagher (D) Energy and Utilities 786-7906 Rules Transportation 30th District Jean Marie Brough(R) Appropriations 786-7830 Judiciary Rules Dick Schoon (R) Capital Facilities and Finance 786-7898 Education Environmental Affairs Trade and Economic Dev.

LEGISLATIVE MAILING ADDRESS: Representative______Caring, Concerned, Legislative Building Olympia, WA 98504 Capable. OLYMPIA TELEPHONE NUMBERS: WSMA Olympia Office “We guarantee that your patient referrals will -1-800-562-5456 receive personalized, quality care. ” State Legislative Toll Free Message We Offer Unique Solutions: L in e -1-800-562-6000 Custom-design, fabrication, fitting • Foot Orthotics (Custom Molded) (Quick and easy way to leave a and follow-up management • Sports-related Bracing messages for your legislator urging • Lower and upper extremity Prosthetics . Amputee Support Group a vote for or against, or to request Traditional and Modern Orthopedic Bracing . Process Insurance Billings copies of bills.)

Brochures and Prescription Capable. Personal Prosthetic and Orthotic Care Pads are available upon request, 11316 Bridgeport Way S.W. Call 584-8422 Tacoma, WA 98499 Auxiliary News

— C indy Anderson who donated Philanthropic Drug Conference many hours of computer time so that our material would look its best Funding Announced Planned and to Kay Pionsky who made the card into a work of art. We would like to thank all of the Pierce County Chemical Depend­ agencies who submitted applica­ ency Prevention Program and the — Sandy Shrewsbury for helping tions for funding this year. Pierce County Prevention Coalition to shoulder the load and to Helen are planning an Adult/Youth Drug W hitney for fighting with the labels. The Finance Committee recommen­ Prevention Conference to be held dation for disbursement of 1989-90 — Suzy Duffy, state AMA-ERF Saturday, March 17, 1990. The goal chair, who always meets the media philanthropic funds was approved is to build a strong partnership be­ by the general membership on deadlines for me and who has been tween youth and adults working doing a great job doing selling November 17. Funds to be raised at together in prevention. Pierce Coun­ sweatshirts for us. a gala spring event will be awarded ty parents, school staff, to: 1) WSMAA Health Foundation, municipalities, local government, — Mamy Weber for her super job $500 for Pierce County students youth leaders, churches, and espe­ of selling more than enough Sally and educators to attend the teen cially youth are encouraged to at­ Foster Gift Wrap to cover the expen­ health forum, Choice. Not Chance. tend. Mark this date on your calen­ ses of our Sharing Card Project. April 1990, at CWU, Ellensburg, WA; dar. Contact Nikki Crowley, 922- 2) Pierce County Park Department 7233, for more information. — Everyone who helped at the mail­ Sprocket Man Program, $1,500 for ings. Peggy Smith, Mary Lou bicycle safety program for elemen­ Jones, Sandy Shrewsbury, Alice tary school children; 3)Good Many Thanks Wilhyde , Nikki Crowley, Dotty Samaritan Hospital, Teen Parent Truckey, Lori Fisher, Mary Cor­ Resource Center, $750 for prenatal My gratitude to everyone who con­ dova, Kit Larson, Cindy Ander­ teen parenting program; and tributed to the success of this year’s son, Debby McAlexander, Helen 4)Pierce County AIDS Foundation, AMA-ERF fundraiser — the Holiday Whitney, Candy Rao, Sandy $1,000, emergency funds for clients’ Sharing Card. So far, 229 families Shrewsbury and Colleen Vercio. not covered by other grants. have donated a total of $15,115. Thanks to those who made We also thank committee members Although not included on the card reminder calls: Kris white, Lori Juley Hoffmeister, Mary Lou Jones, insert, the following people send Fisher, Alice Wilhyde, Mary Lou Kit Larson, Dottie Truckey, Rubye their best wishes to the medical Jones, Debby McAlexander, Ward, Alice Wilhyde, and Chairman community: David & Kathy Brown, Helen Whitney, Nikki Crowley and Mary Cordova. Chris & Diane Miller, Buck & Grace Mary Cordova. Moses, and George & Kimi Tanbara. Special thanks also to Doug Jack­ Auxiliary Meeting SPECIAL THANKS GO TO: man, Sue Asher and secretaries at Auxiliary President Alice Wilhyde, the Medical Society office. Notice who not only was always available to help, but who provided the idea — Gail S. Allenick The January PCMSA meeting is for the theme of the card. PCMSA-AMAERF, Chair Friday, January 19, from 10:00 a.m. to 1:00 p.m. at C.l. Shenanigans , 3017 Ruston Way. Carol Trettevick of Classic Northwest of Bothell will present “Instant Dress Thin,” an hour of effective, flattering dress techniques and use of accessories. Invite a friend to join you and learn how to disguise those extra holiday THE AFFORDABLE ALTERNATIVE! pounds. Reservations must be made by January 12. Send your CREATED BY A PHYSICIAN THAT KNOWS check for $11 per person, to Joan It w o r k s . o ~ , Dan & Dawn Dube Sullivan, 5404 104th St. S.W., Tacoma, WA 98499. Your cancelled S safe' (206)848-0711 check is your receipt. It S fa s t. Independent ToppMed™ Distributor SUPPORT GROUPS AVAILABLE

Page 14 • Janauary 1990 • Vol. 5, #1 CLASSIFIEDS

PSYCHIATRIST - To follow patients Positions Available at a small intermediate care nursing home. Sumner Care Center, Bill 6 n & M t Smith, Administrator 863-0433. RADIOLOGIST - Immediate open­ ing for Board Certified general diag­ v M M 1 nostic radiologist at hospital near o £ u & . Tacoma. Need US, CT, and Mammo plus limited angio and inter­ Equipment Union Avenue Pharmacy ventional ability. Regular hours, & Corset Shop fulltime or 6 to 9 months per year; 5 FOR SALE - Baker 8000 Hematol­ Formerly Smith's Corset Shop year contract. Call Dr. Bernstein 2302 S. Union Ave. 752-1705 (206) 840-9652. ogy Machine. Does CBC and platelet counts. Includes printer, dilutor. Scrupulously maintained, PHYSICIAN OPENING. Ambulatory perfect condition. Contact Dr. A.R. General care/minor emergency center. Thiessen (206) 383-1988. Full/Part time for FP/IM/EM trained, experienced physician. Located in GRAVELLY LAKE WATERFRONT: Tacoma area. Flexible scheduling, MICROSCOPES, MAYO STANDS, Madera, security gate, alarm, hot pleasant setting, quality medicine. Flex-Sigmoidoscope, Scrub Sink, tub, four br., 2 1/2 bth., garage Contact David R. Kennel, M.D., at Exam Table, Ritter Power Tables. $1600/mo. Call MGM 627-4810 or 5900-100th St. S.W., #31, Tacoma Call for information and a free 851-8189. 98499. Phone: (206) 584-3023 or catalog. Lynlee’s Inc. (206) 867- 5415. 582-2542. WATERFRONT: Gig Harbor Condo. 2 + br, 2 1/2 bth., 2 car MEDICAL DIRECTOR - Small inter­ USED OFFICE AND MEDICAL garage, pool and more! $1,000 - mediate care nursing home with am­ equipment for sale. $1,275. Call MGM 627-4810 or 851- bulatory light care patients requires Call Dr. W. Morrison at 848-7297. 8189. a Medical Director. (A retired M.D. would be acceptable). Sumner Care Center, Bill Smith, Ad­ ministrator 863-0433. Advertise in the Classifieds PHYSICIAN OPENING - Small in­ termediate care nursing home with Prices Advertisers IName and Address ambulatory light care patients re­ quires a physician to follow new ad­ PCMS Newsletter - ______mits. Some private pay. Sumner 75 cents per word ______Care Center, Bill Smith, Ad­ The Bulletin - ' ______ministrator 863-0433. 85 cents per word 10 word minimum Ad Copy on all ads. ______Qualified Physicians Deadline Needed February Bulletin deadline is Jan. 5.

Western Washington • Low Volume Please call 572-3709 • 24 beds, 8 patients per hour ® 12-72 for more information. hour shifts • Graduate of an accredited Medical School • Current WA License Send check to: and ACLS Certification « One Year Pierce County Emergency Room Experience • Mai- parctic Coverage Provided: Claims Made Medical Society, 705 U nlim ited Tail South 9th, Suite 301 CALL NES -1-800-554-4405 Tacoma, WA 9&405

Vol. 5, #J • Janauary 1990 © Page 15 Notes (Continued) The Perfect My second priority that I plan to Car Consultant develop is educating all physicians 752-8888 in the Medical Society — especially 3009 Bridgeport Way West • Suite 4 primary care physicians — in assist­ ing their patients in smoking cessa­ tion. I strongly believe that this is a large, untapped resource, which if BUYING SERVICE • PRICING developed properly, can greatly CONSULTING ♦ APPRAISALS reduce the amount of tobacco-re- lated illness in this community within the next ten to twenty years. This is also a national priority of many or­ Domestic & Imports ganizations, including the American Medical Association, the American Cars & Trucks Cancer Society, and the American Lung Association. ANY MAKE -A N Y MODEL My last priority will be the expansion of our membership to include all eligible physicians practicing in or We can save you time and money on the living in Pierce County. Currently, there are many physicians who purchase of your next vehicle... could benefit from membership in Guaranteed our society and also contribute a great deal to our efforts to improve the image of the physician and the profession in our community. "Call before you buyI" 752-8888

Again, I look forward to serving you as your president in 1990 and urge you to call me at any time with con­ cerns you have in the coming year.

Pierce County Medical Society 705 South Ninth Street, Suite 203 Bulk R ate Tacoma, WA 98405 U.S. Postage PAID T a c o m a , WA Permit # 605 ADDRESS CORRECTION REQUESTED Pierce County Medical Society February 1990

INSIDE... The Image of the Medical Profession — see page 5 For treatment of diabetes: I"? REPLACE ^ n/OAS'^4>^7Or.- Orr S'On Human Insulin

| /

With Human Insulin

H um uliri® human insulin [recombinant DNA origin]

Leadership v/ i.h.’fnoe of insulin should S & ty ■ ;n:jrit-~Criuliou$iy rind only In Diabetes Care ‘rj>

PCMS Officers: Gordon R. Klatt...... President William G . M arsh...... President-elect ------TABLE OF CONTENTS John B. C oom b s...... Vice President Joseph H. Weam Secretary-Treasurer William T. Ritchie Past President FEATURES PCMS Trustees: Stuart D. Freed Annual Joint Dinner Meeting: Photo Review...... 16 K. David McCowen The Duck Lady...... 26 A. Robert Thiessen David E. Law, From the Past - Hierarchy a M yth! ...... 23 Anthony S. Lazar, William F. Roes, 1990, You Make Medicine’s Organized Policies AJice Wilhyde How to Deal with the Future: Health Care Rationing...... 19 Executive Director: D ouglas Jackman How You Feel About PCMS...... 12 Board and Committee Chairman.- AIDS, IPPNW 9th World Congress...... 27 Alan T icei^sna James M. Wilson; Bylaws, Stanley Tuell; Budget/Finance, Josep h H. The Image of the Medical Profession:...... 5 Wearn; CHCDS, CharlesM. Weatherby; Col­ An Individual and Collective Responsibility lege o f Medical Education, David Brown; Credentials, John F. K em m air Emergency Membership Opinion Survey...... 13 Medical Standards, Robert F. Wachtef; EihicslSiandards o f Practice, R o n a ld G . Practice Brochure Can Be a Marketing Asset...... 24 Taylor; Griei'ance, William T. Ritchie; Inter­ Your Medical Dollars...... 21 professional, Robert J. Martin- Legislative, Gregory A. Popich; Library, Wilfiam M. Dean; Medical-Legal, Marcel Malden; M em ­ bership Benefits, Mark Gildenhar; Minority COLUMNS/DEPARTMENTS Health Affairs, Charles M. Weatherby; Per­ sonal Problems of Physicians, Pat donley; Program John B.’ Coombs; Public Auxiliary N ew s...... 29 Health/School Health, Terry W. Torgenrud; Puyallup Fluoride, William G. Marsh; February General Membership Meeting...... 9, 18 Tobacco Task Force, Gordon Klatt; Sports C.O.M.E. N ew s...... 10 M edicine Comm ittee, Stuart Freed. Classified...... 31 The Bulletin is published quarterly, February, May. August and November by PCMS Mem­ NewsBriefs...... 6 bership B enefits, Inc., for m em b ers o f the Pierce County M edical Society. Deadlines New Members...... 25 for submitting articles and placing advetise- President’s Page...... 5 m ents in The Bulletin are the first of the monthprecedingpublication (i.e., April 1 for Readings...... 25 M ay issue). Retirement Luncheon...... 28 The Bulletin is dedicated to the art, science Sports Medicine M eeting...... 15 and delivery of medicine and the betterment of the health and medical welfare of the com­ munity. The opinions herein are those of the individual contributors and do not necessari­ D ISPL A Y A D V E R T ISE R S ly reflect the official position o f the Medical Society. Acceptance o f advertising in no way constitutes professional approval or endor­ Baby Diaper Service...... 7 sement of products or services advertised. The Bulletin and Pierce County Medical Capable...... 23 Society reserve the right to rejcct any adver­ Dwyer, Pemberton and Coulson...... 26 tising. EliLilly...... 2 Manor Care...... 6 Editor: David S. Hopkins Metabolic Associates...... 21 Managing Editor: D ouglas Jackman National Emergency Services...... 23,24 Editorial Committee: D avid S. H opkins Perfect Car Consultant...... 12 (Chairman), StanleyTuell, W. Ben Blackett, Persing, Dyckman & Toynbee...... 20 Richard Hawkins Physicjans Insurance...... 32 Publications Coordinator: M onique Johnson Pierce County Medical...... 22 Advertising; St. Joseph Hospital...... 30 Pierce County Medical Society, MBI Toppfast...... 8 Kim Reed, 572-3709

Subscriptions: $20 per year, $2 per issue. Make all checks payable to; Pierce County Medical Society 705 South 9th St., Suite 203 Cover: Dr. Bill Ritchie hands over the President’s gavel and Tacoma, W A 98405 (206) 5712-3667 the helm of the Medical Society to Dr. Gordon Klatt during ©PCMS 1989 the festive Annual Joint Dinner Meeting held December 12.

The Bulletin • February 1990 « Page 3 QUALITY CONTROL F m r m-nt-r.u ion1! ai;o, in IS i7, the AM A was design programs to inform, educate and monitor t< Hindi-..I "to promote the art and science ol ourselves. And that's whv we've recently estab­ nn-dicini- and t he hri trrm rnt of I hi' public health" lished the AMA Office of Quality Assurance. I iv ,id\.incinu i hr quality ol medical care. And But our quality assurance efforts extend although thi'» youngster doesn't know it, hrr future even further still. For example, to help physicians r. I)ni.1,h11■ r and hrr life expectancy is longer partly evaluate drills, devices, and procedures, there's | >f ■( .11 j-.c i >t mil dri III Jteil rf forts. DATTA— the Diagnostic and Therapeutic I lie l,ictor\ ml Inrncirm the quality ol mrdical Technology Assessment program. i ari ■ ti >dav are more complex than t hry were in These are two of the many activities at the | ;-i-1 7. Thi'te are (|iirs( ions i tf evolving lech AMA to improve quality health care. Because at noli >i.;ics, new drhvrrv syMems, policy debates, the AMA, we're interested not only in the quality i.dsI ( onrammenl and mote each needing to hr of medicine, hut the quality of life. eifill'd lo i leii rnnnr wltal const uutrs I lie hrsl ()//>■ members m ale a difference. qualilv cai'r lor individual palirnls. !/ you )e already a member, ire need your fill! ar the A M A . wr Mill hrlirve only continued support. If you re not. JOIN TODAY. physic ians can pr< tvide I hr answers. I hat s w hy Call I-800-AM A-M52 w e ( ontinur to lead lhe medical com m unity and

III riiHM t medical association dues m:iy he deductible ;is professional or business expenses, f jik ", .m il nilii-t i-i >n i rilm I intis io l lie AM A arc not deductible as clmritalili' com ritml ions lor I'edcral incom e tux purposes. The Image of the Medical Profession j - An Individual and Collective Responsibility

T h e last three annual physicians drug infested society, and the access of us carry. I believe we are doing surveys of the Pierce County Medical to care issue, especially for the poor well in this regard. Many of our mem­ Society revealed that “the public image and pregnant. This is a full plate of ac­ bers are involved with community ser­ of the medical profession" should be tivities, however, it is im portant for vice, church, and Scout groups. given the greatest emphasis by the the public to see the Society speak­ Many are members of Boards of Society. I have been one of the ing out and acting in these very im ­ Directors in the arts, community or physicians listing it as a high priority portant areas. Continuing and in­ other nonprofit organizations. For and it is for this reason that it will be m y creasing emphasis in all these areas many of us, our spouses are our link focus for my presidential year. as well as doctor/patient relation­ with the public and the Pierce County The image of our profession en­ ships, access to health care for medical community. We can be compasses a large area of activity Medicaid, Medicare, and "no pay” proud of their involvement. The and involves the Society as an or­ patients, and public education of Pierce County Medical Auxiliary is a ganization. More importantly, our patients on health related topics, strong, vibrant and dedicated group. image is dependent on each of us in­ especially preventive medicine, is im­ Clearly, it is the best County Auxiliary dividually who practice medicine perative. in the State of W ashington. whether we are a member of the As a body of organized physicians, Can we rest on our laurels and con­ Pierce County Medical Society or the Society can have an impact. How­ gratulate ourselves? No, there is not. As a Society and as individuals, I ever, we can make an even stronger more we can do as a Society and as believe we have been doing a better impact on the public’s perception of individual members or spouses. job recently of presenting ourselves the profession daily, as individual Much good can be accomplished to the public. The Society has be­ doctors working with the public (our that we haven’t even touched by get­ come involved in issues that focus on patients, employees, friends, neigh­ ting more members involved with the public health, including fluoridation of bors, and other community mem­ working of the Society and the the water, tobacco as a major health bers). One bad experience or one Auxiliary. As individuals, we must hazard, the pre-hospital treatment of good experience with a physician look at our involvement in the com­ trauma patients, the medical care of can be the influencing factor in an munity. What have we done to en­ the socio-economically disad­ individual’s attitude toward our hance the image of the profession? vantaged, the health issues of our profession. This is a responsibility all Are we accepting a share of non­ paying, Medicaid, or Medicare patients? Are we focusing on the doc­ tor/patient relationship, or are we be­ coming a factory worker in the health profession - stamping out the dis­ ease? Let's start the 1990’s by ad­ dressing the image of the physician - all of us individually - and not just checking it on a questionnaire as a high priority of the Society. This is my challenge to us as President and much of my communications this year will address this topic in one way or another. I am grateful for the challenge set before me as President of the Pierce County Medical Society as we begin a new decade. I look for­ ward to the year with enthusiasm. □

- GRK

77te Bulletin • February 1990 • Page 5 The Pharmacist Speaks with the Physician

Here I am again, bringing up a little physician for the script and returned various practices (physician and phar­ issue that may seem trivial at first in about 45 minutes with one for Per- macist alike) that we do not realize glance. I cocet Demi. I can understand what that we are creating problems for our trust you the physician wanted to do, but there patients rather than solving them. We will not find is no such product. The only Demi is all need to take a much closer look at them trivial with Percodan which has aspirin. So what we are doing for the people we but informa­ again I had a prescription which I are supposed to be helping. Both tive and in­ could not fill. I called the office and ex­ these situations discussed were not structional. plained that the physician would need deliberate, but created by rush, That is to rewrite it. The patient crutched him­ and/or preoccupation. their intent. self back to the physicians office I could (which was across town) to get the - Your Local Pharmacists title this correct order. When he returned, the "Friday the physician had simply scratched out Thir­ the Demi and initialed it. This is not teenth", as acceptable by law so the script was both situations I will discuss hap­ still unfillable. Need I go on? pened on that day. They were frustrat­ These are extreme examples. We ing to the patients, frustrating to me often get so busy and hurried in our and frustrating to the physicians. The wife of one of my patients brought in a prescription for Tylox ^100. This patient is in the advanced stage of rectal cancer and using Manor Care n-.Lch pain medication The prescrip­ tion v.'as good except the physician C<>N\ ALF.SCF.NT W D REHABILITATION CENTER z i r _. _ s. _o i k ob'_.ause this was a C-2 d.'L,g the problem could not be corrected over the phone. The ; r':‘I:n Adi u ieless as it existed. 24 Hour Skilled _r|-e j ’! office is in Seattle N ui'mp,;; Care iini; the //re ■ eo leave oea-Tac in '.-j' This v/as finally resolved with Long-1 erm and mush mierplay between the Seattle of- \ -nation Stays !,’ j and rnyselr b / using the Emergen­ cy C-2 guidelines. The physician ne;or did mail the emergency Occupational. prescription as agreed, so the next Speech and week I had to take additional steps to Physical Therapies get it. Me/t a patient who was just put on Coumadin because of a clot after Medicare Certified surgery needed pain medication. He had received Darvocet M-100 before Deluxe Heritage the Coumadin was given. I informed Wing him that Propozyphene and Coumadin have a major contraindica­ tion They had been giving him Per- cocet in the hospital so the patient went to the physician’s office to get 474-8421 the script, it also is a C-2 drug. He hobbled off on his crutches to the 5601 S. ORCHARD ST. • TACOMA Mcdical Director, John Atkinson, M.D.

rape 6 • The Bulletin • February 1990 NEWSBRIEFS

AMA President-Elect Meets with PCMS

The image of the physician, tobac­ achieved and grievances between Washington State legislature. He co ordinances, and recruitment of patients and physicians are resolved. said that locally we are facing a crisis. new members are the three goals of The attendees were honored to "Even though the access issue has new PCMS President, Dr. Gordon hear John Tupper, M.D., AMA Presi­ dominated, it is the cost issue that Klatt for 1990. Dr. Klatt presided over dent-Elect from Davis, California. Dr. gets the legislature’s attention. And, the annual Board Retreat held on Tupper, who will be assuming the health care costs are all discretionary Saturday, January 6 at the Sheraton Presidency of AMA in June, informed funds,” he added. “There is a crisis, which was attended by Board of Trus- the group that the independence of practice guidelines are critical, and tees, Past Presidents, Hospital Medi­ doctors and the freedom of patients we need to help get durability and ac­ cal Staff Presidents, Specialty Society are threatened by Congressional ac­ countability," was his advice. Dr. Presidents, WSMA Representatives tion. So far, he reported "we are win­ Sprenkle also reported that the most and Auxiliary Officers. ning". He cited defeat of mandatory crucial factor is that our repre­ Committee reports were given by assignment four times, as well as the sentatives don’t know physicians as Committee Chairmen James Wilson, defeat of Expenditure Targets (E.T.’s). people. Physicians need to be out M.D., Aging; Alan Tice, M.D., AIDS; Dr. Tupper reported that coverage front and lead the charge. He sug­ William Dean, M.D., Library; Robert for the uninsured is a priority issue for gested taking advantage of the mind­ Wachtel, M.D., EMS; Stuart Freed, 1990 as well as practice parameters, set that people like to be possessive M.D., Sports Medicine; Gordon warning labels for alcohol, and ICD9 of doctors. Get to know your legis­ Klatt, M.D., Tobacco Task Force; code elimination. Dr. Tupper’s ap­ lators, help them become comfort­ and an Auxiliary Report by Mrs. Alice pearance was made possible by the able with the medical profession and Wilhyde, PCMS Auxiliary President. AMA. they will soon be referring to you as It was reported that the 19 commit­ Art Sprenkle, M.D., Repre­ one of “their doctors”. tees of the PCMS are the backbone sentative (D-39) Everett, was the con­ of the organization. It is through this cluding speaker for the day. Dr. structure that accomplishments such Sprenkle retorted to Dr. Tupper by as fluoridation of the water and ac­ saying that the AMA may prevail, but ^DIAPER RASH^t cess to care for AIDS patients are that medicine could very likely “get shot out of the water” in the JS NOT A WAY OF LIFE, You can recommend professional diaper service w ith confidence.

Senators Gaspard & Madsen Meet • Laboratory Controlled. Each month a random sample of our diapers is with MEDCATS subjected to exhaustive studies in a biochemical laboratory. Senator Marc Gaspard (D-25th) Both meetings took place before met with Drs. Bill Marsh, Mike the current legislative session began • Utmost Convenience. Thanks to pick Haynes, and Mrs. Lavonne Stewart- and gave the legislators and up and delivery service, our product Campbell. physicians/auxilians an opportunity to comes when you need it. In the 2nd District, Senator Ken become acquainted and review some • Economical. All this service, all this Madsen (D-2nd) met with Drs. Bill of the health issues expected to protection against diaper rash costs Knittel and Mike Spiger. come before the legislature. fa r less than paper diapers — o n ly pennies more a day than home- washed diapers.

CAUTION TO YOUR PATIENTS. II is illegal lo Volunteer Physicians Needed in Olympia dispose of human excrement in garbage. Parents are doing tfiis with paper/plastic The WSMA Legislative First Aid during the day. You are not confined diapers. "Disposable" is a misnomer. Clinic needs physicians to volunteer to stay in the clinic the entire period. their medical services. The clinic is For scheduling information - call £ ^ 4 i B c s b y open 9:00 a.m.-12:00 p.m. each Winnie Cline at the WSMA Olympia of­ m d m m weekday during the session, begin­ fice at 1 -800-562-4546 or 352-4848. ning Monday, January 8. You’ll find it a very rewarding ex­ This is an excellent opportunity to perience. TACOMA WA TOLL FREE watch the legislature in session. You 383-BABY 1-800-562-BABY can sit in the galleries of the House or Washington's Oldest, Most Trusted Senate or meet with your legislator Professional Diaper Service Serving Our Second Generation i F

The Bulletin • February 1990 • Page 7 NEWSBRIEFS

Mayor Vialle Meets with PCMS

Dr. Gordon Klatt, PCMS Presi­ It is now being estimated by the of children entering kindergarden in dent met with Tacoma's new Mayor, medical community that 1 in 15 1989 were adequately immunized) Karen Vialle, at the beginning of the babies are born with cocaine in their were also discussed. Mayor Vialle new year. Several issues were dis­ blood. asked the Medical Society to be an cussed with most of the time spent The magnitude of the AIDS crisis active participant in her projected on the impact the drug problem is and its current and future effect on “community summit” . Dr. Klatt gave having on medical care in the com­ health care; pre-hospital care and her a strong “yes” answer and of­ munity. trauma, and the Tacoma School Dis­ fered the assistance of the Society to trict immunization record (only 48% the Mayor and to the City.

Health Department and PCMS Get together Bernie Siegel

Al Allen, M.D., Director, Tacoma- Health Affairs and AIDS Committees Conies To Tacoma Pierce County Health Department of the Society. They have been and and several of his division directors continue to be valuable resources for Bernie S. Siegel, M.D., a pediatric met with Drs. Gordon Klatt, Presi­ the Society. and general surgeon and world- dent, Bill Marsh, President-Elect Dr. Allen and staff will be meeting renowned expert on the connection and staff to critique mutual concerns with the Board of Trustees in the near between the mind and the body in the and activities. future to review the Needle Exchange healing process, is this year’s Char­ Health Department staff are mem­ program which the Board endorsed lotte Senecal Johnson Symposium bers of the Public Health/School in March 1989. guest speaker. Dr. Siegel will speak Health, Aging, Fluoride, Minority on “Love, Medicine and Miracles: The Psychology of Illness and the Path to Wellness." The symposium is on Tues­ Locally Produced AIDS Video day, March 27, from 8:30 a.m. to 4:30 p.m. at the Tacoma Sheraton. The Goes International cost, which includes lunch, is $65. Dr. Siegel is a physician and Children in all 50 states, West Ger­ disease. Hautala also explains how teacher at Yale Medical School who many and Iceland are learning to people do contract AIDS. "But," he believes in and practices treatment protect themselves from AIDS thanks reminds them, “AIDS is a disease of methods outlined in his best-seller to a video produced by Pierce Coun­ behavior. It’s not who you are - but Love. Medicine & Miracles. "No one is ty Viacom what you do." Viacom producer Ed untouched by pain,” he says. "My "What Kids Want to Know About Hauge feels the effort that went into philosophy is that life is about what AIDS" features local fifth and sixth- "What Kids Want to Know About you do with your pain." graders asking local pediatrician Dr. AIDS" was well worth it. Just one year The fourth annual symposium is John Hautala about AIDS. after production, Pierce County held in honor of Charlotte Senecal In a calm, non-threatening voice, Viacom’s AIDS video is educating Johnson, a St. Joseph nurse Dr. Hautala dispels myths and out­ kids across the United States and the educator who touched the lives of lines the ways children can avoid the world. many hospital staff members and patients before she died of cancer in 1986. For more information, please call 591-6624.

NEWSBRIEFS (Continued on page 29) m ■ D IET P L A N

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Paw H • The Bulletin • Febntary 1990 Presents “Medicine in the White House”

at the

Joint General Membership Meetin^ -i/lAMC

featunng \ ^ v General John Huttor der, MAMC

Date: Tuesday, February 13 A v Place: Fircrest Golf Club 6520 Regents Blvd O * A* Time: Cocktails 6:0r, Dinner Prograr' .11. Price: $15y% * ~rson if reg. ,ig day of meeting Spouses Invited!

Reservations required by Friday, Februaiy 9.

REGISTRATION Yes, I(we) have reserved the evening of February 13 to join members of the Pierce County Medical Society and the MAMC at their Annual Joint Meeting. Please reserve dinner(s) at $______per person (meal, tax, and gratuities included). Enclosed is my check for $______Dr.______

Please make check payable to PCMS and return no later than Friday, February 9, 1990. *DAY OF REGISTRATION FEE - $17. f College of Medical Education

AIDS Update Available for ALL Physicians

Alan Tice, M.D.. local Infectious course is sponsored by the College cuss HIV Infection development in Diseases Specialist, has organized an of Medical Education and will offer 4 Washington State; Alan Tice, M.D., AIDS Update" CME program for hours of AMA and AAFP Category I will update us on HIV infections in local physicians. The course is credit. Tacoma; Seattle Physician, Sandra scheduled for Wednesday, February Nationally and locally recognized Burchett, M.D., wiii discuss Pediatric 28, 1990 and will be held in the con­ experts will lecture and sit on a panel HIV Infections; and Anna Wald, ference Center - Room 3A and 3B in for questions and answers. Donald M.D., Harborview Medical Center St. Joseph Hospital's South Pavilion. C. DesJalais, Ph.D., Deputy Director AIDS clinic, will discuss treatment op­ Designed as a half day (afternoon) of AIDS research for Narcotic and tions for HIV Infections. conference, the program will serve as Drug Research Inc. in New York, will For registration and more informa­ a timely review and update covering discuss HIV infections in drug addic­ tion please contact the College at developments and treatment options tion; W illiam Lafferty, M.D., DSHS 627-7137. in HIV infections and AIDS. The Director of AiDS Surveillance, will dis­

Cancer Review Program Set for C.O.M.E. Program Schedule February 8 & 9 DATE(S) PROGRAMDIRECTOR(S) 1990 Final registration is underway for the "Cancer Review -1990” CME pro- Thurs., Fri., Cancer Review Amy Yu, M.D. gram scheduled for Thursday and Feb. 8 & 9 -1990 Friday, February 8 and 9. The course is sponsored by the College of Medi­ Weds., AIDS Update Alan Tice, M.D. cal Education and will be held at Jack­ Feb. 28 son Hall- Organized by local oncologist Thurs., Fri., Tacoma Academy David Law, M.D. /hematologist, Amy Yu, M.D., the Mar. 8 & 9 of Internal Medicine course offers 12 hours of Category I Annual Review credit with both the AMA and the AAFP. Fri., Sat., Tacoma Surgical Chris Jordan, M.D. Designed for the primary care April 13 & 14 Club physician and internist, the program focuses on a comprehensive review Fri., Dermatology Barbara Fox, M.D. of cancer detection, treatment, and April 27 James Komorous, M.D. management. The faculty includes David Brown, M.D. recognized cancer experts from both Tacoma and Seattle. Thurs., Fri., Aggressive Edgar Steinitz.M.D. if you have not received a Cancer May 10, 11 Musculoskeletal Review - 1990 brochure or have not and Spinal r^giVfered, please call the College of Evaluation,Treatment i/iedical Education at 627-7137. and Rehabilitation

Mon., Tues., Advanced Cardiac James Dunn, M.D. June 25 & 26 Life Support

Clip and Save!

I'ayt: 10 * The Bulletin • February 1990 College of Medical Education Receives Grant From Allenmore Medical Foundation The College of Medical Education Medical Society provides in-kind sup­ has been notified of a grant for port such as low-rent office space $6,000 from the Allenmore Medical and personnel assistance. Foundation to be used for the year In addition, the College receives 1990-1991. The grant will be allocated volunteer support from Board Mem­ as directed by the College’s Board. bers, speakers, program directors, The grant is a most welcome gift and other allied health personnel. The because the College is self support­ College does not pay honoraria for ing, unlike most other subsidized local speakers. The local hospitals CME programs which rely on hospital support the College by providing or school of medicine support. meeting rooms and breakfasts or din­ The primary source of income for ners for the College Board of Direc­ the College is course fees. Other tors Meetings. minor sources of funding include con­ tributions from Pierce County Medical Society members, accreditation fees, and sales from advertisements in pro­ gram brochures. The Pierce County College of Medical Education Tnanks Contributors Personal The College of Medical Education would like to thank the following con­ tributors for their generous donations. As directed by the Board of Direc­ Problems of tors, the College is now self supporting and no longer receives subsidiza­ Physicians tion from the Pierce County Medical Society or local hospitals. Expenses Committee are paid directly from enrollment fees, donations, and/or grants. The Con­ tributions are used to provide quality, low-cost, Category I CME programs for Pierce County Physicians. For Impaired Physicians Your Colleagues College of Medical Education Contribution List Want to Help Clarence Anderson, M.D. Thomas Miskovsky, M.D. Mian Anwar, M.D. Stanley Mueller, M.D. Richard Baerg, M.D. John Nagie, M.D. Medical Problems, Drugs. Wing Chan, M.D. Thomas Norris, M.D. Juan Cordova, M.D. David Pomeroy, M.D. Alcohol, Retirement, William Dean, M.D. Gilbert Roller, M.D. Emotional Problems Diagnostic Imaging Northwest Donald Rose, M.D. Patrick Donley, M.D. Mohammad Saeed, M.D. James Furstoss, M.D. Paul Schneider, M.D. Committee Members George Gilman, M.D. Richard Schoen, M.D. Patrick Donfey, Chair 272-2234 Galen Hoover, M.D. Dennis Scholl, M.D. Kiyoaki Hori, M.D. Joseph Kramer 845-9511 Phillip Schulze, M.D. Jonathon Hurst, M.D. Surinderjit Singh, M.D. John R. McDonough 572-2424 William Jackson, M.D. Michael Smith, M.D. William A. McPhee 474-0751 Michael Jarvis, M.D. David Sparling, M.D. Ronald C. Johnson 841-4241 Thomas K. Jones, Jr., M.D. Edgar Steinitz, M.D. Jack P. Liewer 588-1759 Chris Jordan, M.D. Gail Strait, M.D. Kathleen Sacco 591 -6681 Herman Judd, M.D. Ronald Taylor, M.D. Dennis F. Waldron 272-5127 Eugene Lapin, M.D. Kenneth Trnka, M.D. Mrs. Jo Roller 752-6825 Marion Larsen, M.D. Stanley Tuell, M.D. Larry Larson, M.D. Needham Ward, M.D. Jonathan Levant, M.D. Barry Weled, M.D. Marcel Malden, M.D. Matthew White, M.D. WSMA Robert Martin, M.D. 1- 800 - 552-7236

The Bulletin • February 1990 • Page 11 /* "\ How You Feel About PCMS ... 239 Members Responded 33% Response Rate — Editor

B<► ecause PCMS strives to support Bulletin Preferred • Nearly 9% of the respondents were and respond to our membership's female which correlates with the The Bulletin is preferred by a wide needs, we urged you to respond to our margin over The Newsletter. Over female membership of PCMS. annual survey. Many of you did. 33% - 67% read the Bulletin as opposed to • The majority of respondents are be a total of 239 members returned their 32% who read the Newsletter. 50% surveys. This 33% response rate is con­ tween the ages of 36 and 45. read the Newsletter and Bulletin sidered an excellent return for any or­ thoroughly. ganization - the average being 10- Thank You 15%. Here are some of your top views. A special thanks to the members Membership Demographics that returned our sun/ey. We ap­ Representation is key Of the respondents: preciate your time. By asking your • 32% have been practicing for opinions, we are better able to serve In 1989, members ranked “The less than five years. 31% have you. We hope that you will continue need to be represented by state and been practicing for 5-10 years. to express your opinions to us. For county legislative/regulative bodies” more survey results see page 13. □ as the #1 reason for belonging to • 107 members are in a single PCMS. specialty group or clinic partner­ Over 80% would recommend mem­ ship. 82 are in solo practice. bership in the PCMS to a new physician in the area.

Image is #1 Again \^The Perfect For the third year in a row, the Car Consultant public image of the medical profes­ 752-8888 sion was identified as the #1 area — 3009 Bridgeport Way West • Suite 4 where PCMS should place greater emphasis. Following through with that concern, is newly elected presi­ dent, Gordon Klatt, M.D., (see pg. 5). BUYING SERVICE • PRICING CONSULTING • APPRAISALS Contract Negotiations First For the second year in a row, "Con­ tract negotiations with hospital/third party payors" remains the most im­ Domestic & Imports portant member benefit and service Cars & Trucks that PCMS offers. Practice Liability In­ surance ranked as the #2 benefit and Individual/family/staff health in­ ANY MAKE -A N Y MODEL surance ranked as the #3 benefit. We can save you time and money on the N o D ues Increase 31% use the Medical Library of purchase of your next vehicle... Pierce County quarterly. 53% favor Guaranteed no dues increase to support the Library. "Call before you buy!" 752-8888

Paw 12 • The Bulletin • February 1990 tierce County Medical Society

for the betterment of Public Health since 1S88

Member Opinion Survey

How important is each of the following to you as a reason for belonging to the Pierce County Medical Society? (PLEASE RATE EA CH REASON)

Very Somewhat Not No Important Important Im portant Opinion

a. The need to be represented before slate and county ...... 197 (1) 36 (10) 3(10) - legislative/regulatory bodies. b. PCMS Newsletter and Bulletin ...... 78 (4) 129 (1) 24 (9) 3 c. Continuing Medical Education ...... 96 (2) 110 (7) 32 (8) 3 d. Membership Benefits (health/practice...... 30 (8) 120 (5) 79 (3) 5 insurance programs, personnel assistance, etc.,) e. Useful professional credential.. looks good on a resume ...... 20 (10) 102 (8) 134 (1) 6 f. To have my interests and accomplishments communicated ...... 45 (6) 92 (9) 84(2) 8 to the general public g. A vehicle for exchanging my views with others in the profession . . . 60 (5) 120 (4) 52 (6) 2 h. Assistance with practical p ro b le m s ...... 37 (7) 126 (2) 67 (5) 5 i. Personal service from the executive office ...... 24 (9) 114 (6) 77 (4) 12 j. Support of the medical library...... 70 (3) 124 (3) 3 (7) 3

Would you recommend membership in the Pierce County Medical Society to a new physician in your area? Definitely Possibly No No Opinion 81.6% 15.8% .8% 1.7%

In the future, what level of emphasis should the Pierce County Medical Society give to each of the following issues? (PLEASE RATE EACH ISSUE.) Greater About the Less No Emphasis Same Emphasis Opinion

a. The public image of the medical profession ...... 153 (1) 75 (18) 3 2 b. Relationships with hospital adm inistrations...... 51(13) 152 (4) 15 12 c. Professional liability and malpracticc s u i t s ...... 92 (6) 125 (12) 11 4 d. Relationships with third parly p a y o rs ...... 112 (4) 105 (16) 12 2 e. State/federal government involvement in health care ...... 143 (2) 82 (17) 7 1 f. Accessibility of quality health care to c itiz e n s ...... 116 (3) 112 (14) 9 6 g. Physician/patient relationship ...... 60(12) 150 (6) 13 8 h. Alternate health care delivery systems (HMOs, PPOs, etc.) ...... 28(10) 141 (9) 55 7 i. Continuing Medical Education ...... 45(15) 153 (3) 28 2 j. Cost of Medical c a r e ...... 91 (7) 110 (15) 11 3 k. Legislative affairs/lobbying ...... 110 (5) 112(13) 5 3 1. Relations between medical specialties ...... 46(14) 151 (5) 27 6 m.Environmental public health issu es ...... 73 (8) 143 (7) 9 5 n. Issues related to the influx of “limited health practitioners” ...... 62(11) 130 (11) 16 19 o. Healthy lifestyles advocacy ...... 72 (9) 136 (10) 19 4 p. Contributions to political candidates (through PAC) ...... 22(17) 163 (3) 68 12 q. Publications S e rv ice s...... 9 (19) 174 (1) 27 6 r. Auxilary Support ...... 12(18) 164 (2) 34 13 s. Discipline/ethics of doctors ...... 66(10) 142 (8) 2 3 Overall, how effective do you feci the Society has been in responding to your most important concerns? Very effective - 25 Somewhat effective -154 Ineffective - 21 No opinion -17

Many professional associations or societies oiler members a variety of benefits and services, some of which the members pay for m addition to their annual dues. How important are each of the following member benefits and services to you? (Please rate each benetit or service.' Very Somewhat Not No Important Important Important Opinion a. Individual/family/staff health insurance ...... 42 (3) 58 (12) 116 (9) 6 b. Practicc liability insurance ...... 57 (2) 54 (13) 103 (13) 7 c. Disability income insurance ...... 33 (4) 63 (10) 120 (7) 8 d. Practice management seminars ...... 29 (5) 192 (1) 79 (16) 8 e. Legal services ...... 22 (7) 63 (11) 113 (11) 7 f. Contract negotiations with hospitals/third party payors .58 (1) 85 (5) 82 (15) 9 g. Group Buying Discounts ...... 26 (6) 90 (2) 96 (14) 5

How olten do you use the Medical Library of Pierce County? weekly - 5.6% monthly - 22.8% quarterly - 31.5': annually - 23.2% never -16.8%

Would you favor a dues increase to help support the medical library? $25-30.3% $50-13.2% $100-2.5% None - 53.9%

H ow would you characterize your reading of the Society’s N ew sletter and B u lle tin ?

Thoroughly - 50%. Read several articles -21.3%- Occasionally read it - 26.6% Never read it - 2.3% Do you prefen the N ew sletter - 32.2% the B ulletin - 67.7%

How long have you been practicing in Pierce County ? Linder 5 y e a rs -3 2 % 5-10 years - 31.4% 11-20 years -3.4% 21-30 years - 16.6%. over 3 0-16.6%

Which of the following best describes your current professional activity (PLEASE CHECK ONLY ONE ANSWER.)

Solo ...... 82 Partnership, gruup or clinic (single sp e c ia lty )...... 107 Partnership, group or clinic (multi-specialty)...... 14 Fuli-timc hospital staff ...... 4 Government/Military practice ...... 3 Administration ...... 0 Industrial/corporate s ta f f ...... 1 Resident ...... * Retired or inactive ...... ^ Other

Are you male? - 91.3% female? - 8.7% Y0Ur age? 35 years or less - 8.9% 36-45 - 42.1 % 46-55 - 20.4%. 56-65 - 17.8% 66 + - 10.6% 705 South Ninth Street • Suite 203 • Tacoma, Washington 98405 • Telephone (206) 572-3666

Presents Pitfalls of the Sprained Ankle”

Featuring

Jonathan P. Bacon, M.D.

on

Wednesday, February 28

7:00 A.M.- 7:45 A.M.

at

Jackson Hall Auditorium 314 South K Street

Coffee and rolls will be provided. For more information, please call 572-3666.

Sponsored by: Sports Medicine Committee Pierce County Medical Society Annual Joint Dinner Meeting

t,

Dr. Bill Marsh, President Elect for 1990, accepts a plaque Dr. C.B. Ritchie (left), PCMS President in 1960 of appreciation from Dr. Ritchie for serving as Secretary- had (he opportunity to be recognized and honored Treasurer for 1989. Dr. Marsh is a family physician practic­ by the outgoing President, his son, Dr. Bill Ritchie. ing in Puyallup.

Dr. Ken Graham, PCMS President in 1979, compares ties with Dr. Jim Fulcher and Dr. Terry Torgenrud as Jan Torgenrud looks on. Dr. Torgenrud was recognized by the Society for his leadership in the Tacoma Fluoride campaign.

Page 16 • The Bulletin • February 1990 December 12,1989

Mrs. Cindy Anderson, Kris White, Mary Lou Jones, Dr. Charles Anderson, and Dr. Tom Jones enjoyed the evening. Mary Lou is Auxiliary President-Elect and Kris served as President in 1988. Dr. Ritchie, PCMS President in 1989, and Mrs. Alice Wilhyde, PCMS Auxiliary President, honored past Society and Auxiliary Presidents.

Dr. Ritchie awards Dr. John Rowlands a plaque of ap­ preciation and thanks from the Society for his service as a Trustee.

The Bulletin • February 1990 • Page 17 Tacoma - SheratonHotel

Enjoying the social hour of the Annual Joint Dinner M eeting were President Rilchie and his wife M arge and Secretary-Treasurer, Dr. Joe W earn and his wife Pat.

Dr. Jim Fulcher, Vice President and Program Chairman, receives thanks from Dr. Ritchie for his contributions during the year.

We’re Rescheduling! “Medicine in the White House, ” our February General Membership Meeting, has been RESCHEDULED. We regret any inconvenience this may cause you. General Hutton will be speaking at the March General Membership Meeting on Tuesday, March 13. Please call 572-3667 if you have questions.

Page 18 • The Bulletin • February 1990 How to Deal with the Future: Health Care Rationing

— Harry Schwartz, Ph.D.

Future historians of American That other chief motive power was medicine will undoubtedly note Nov. Congress’ desire to rein in the rapidly 20, 1989, as a m ilestone in the rising costs of physician services socioeconomic and political evolution under Medicare. In about 1985, that of American medicine. It was on that desire threatened to result in legisla­ sharp limits on the amount of extra date that a House-Senate conference tion that would have reimbursed billing that physicians could require committee approved the historic reor­ physicians for Medicare patients even of patients willing to pay more ganization of physician compensation under a strict capitation system. The than assignment amounts. And the under Medicare, a reorganization that American Medical Association, sear­ American College of Surgeons won a is virtually certain to become the model ching for an alternative, won the back­ separate category for surgeons. for all other third-party payers. ing of its delegates - many of whom The present is therefore, it seems were understandably suspicious - for to me, an opportune moment to look a project to set up what we now call . . . the opportunity to see at the history of the elements of that resource-based relative value scale which physician leaders are compensation scheme, to try to un­ (RBRVS). the medical statesmen and derstand how it became what it now Congress was persuaded to hold is, and to evaluate the portents for the off capitating Medicare reimburse­ which are simply future impact of this revolutionary ment while the RBRVS was prepared. short-term opportunists. .. restructuring of physician fees. But of course the RBRVS at the begin­ This revolution in physician fees ning and even now is simply a device had two sources of motive power. for changing the division of the From one point of view, the final One was the discontent of internists Medicare fee pie so that some result is an acceptable compromise. and family physicians with their physicians get more and others get It gives everybody something, permit­ average low incomes as compared to less. So the great unknown was what ting each major faction and player to surgeons and to procedural price Congress would eventually claim victory. But the claims will not specialists such as radiologists and exact for the RBRVS in the shape of a obscure the fact that in the short run anesthesiologists. measure to rein in the cost of the big winners are those who spe­ physician services. We now know cialize in "cognitive” procedures how the drama played itself out. The while the big losers are surgeons and . .. by the mid-1990s, if RBRVS was calculated. Rep. Fortney proceduralists. A major step has "Pete” Stark (D. Calif.) and his col­ been taken toward equalizing the not sooner, the pressures leagues on the House Ways and average incomes of the key medical for more explicit rationing Means Committee paired the RBRVS specialties. and more explicit limits of with the expenditure targets (ET) It is pointless to argue now device that the AMA assailed as a whether this is good or bad, and I the total incomes of means of forcing doctors to ration have never hidden my deep reserva­ physicians will again be care. tions about all this. The real question A House subcommittee under Rep. is what comes in the next act. fierce. Henry Waxman (D., Calif.) and then My own view is that the rationing of the Senate Finance Committee back­ health care has, at best, been This discontent, pushed initially by ed less onerous alternatives; alterna­ delayed. And by the mid-1990s, if not the American Society for Internal tives that nevertheless contained sooner, the pressures for more ex­ Medicine and then by other organiza­ measures of volume of services that plicit rationing and more explicit tions representing these specialists, could at some future time become limits on the total incomes of came to occupy the center of the the basis for rationing medical care. It physicians will again be fierce. political stage in the mid-1980s as the was the Senate Finance Committee result of a response of organized alternative that went into the final bill. medicine to the other chief motive In the wrangling and maneuvering power. that accompanied the months-long struggle, the bill was modified to put (Continued on page 20)

V ie Bulletin # February 1990 • Page 19 RATIONING If we assume that five years have population than has been observed {Contniued) been gained by the maneuvering of this past year. the past half decade, they can best One other area cries out for medi­ The medical profession will then be used by the medical profession in cal statesmen to act. The saddest again come under intense political seeking to figure out how medical part of the struggle now concluded pressure which it will be less able to care can be rationed in the future at was the ignorance of the general withstand because of the bitterness the least cost to patients and with population - of the mass of patients and divisiveness created by the strug greatest justice to physicians and and potential patients - to the issues gle over the RBRVS. other health care workers. To use a involved and to the potential conse­ rather trite phrase, doctors must be­ quences of the solution for patients. come part of the solution to the prob­ I don’t believe that people like Rep. . . . tomorrow's political lem of rationing health care rather Stark really represent the population battles must be fought, thty than part of the problem. of this country. But until doctors ener­ can be fought by a much In the period ahead we shall all gize their patients and make them a have the opportunity to see which political force, the Starks in Congress more united physician physician leaders are the medical will continue to have a larger say in population . . . statesmen and which are simply what happens than the merits of their short-term opportunists looking for ideas deserve. Q] immediate advantages for their con­ But perhaps in the long run there is stituents with no regard for the long­ - From the December 8, 1989 JAMA. no alternative. The nation’s resources term consequence of what they do. are finite. The demand for free or al­ And since the most serious internal most free medical care - which is a problem of the medical profession is privilege most Americans enjoy under its internal divisions and enmities the present melange of government born of the struggles of recent years, and private medical insurance - is the chief opportunity for medical necessarily larger than the nation can statesmen is to take measures that pay for, especially given the graying will heal today's raw wounds so that of our population and the enormous when tomorrow's political battles and still rapidly growing national debt. must be fought, they can be fought by a much more united physician

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Paw 20 • The Bulletin • February 1990 I t seems a week doesn't go by that the Pierce County Auxiliary without a letter in the mail, a phone call donated to the Southwestern Chapter around dinner time, or a friend or col­ of Multiple Sclerosis paid for one year league contacting you to donate your of physical therapy and has enabled time or money for something. Each this young mother to live a viable life. support we can offer to qualified non­ year physicians and their families con­ Your Medical Dollars Work . .. profit organizations. tribute thousands of dollars to our Last year over twelve organizations When you next see this symbol, community organizations — social ser­ made application for our support. We know it will be your chance to make vice agencies, the arts, churches, were able to fulfill the needs of only Your Medical Dollars count in health related causes and many other two with a total amount of $2470. Pierce County. Our goal this year is worthwhile endeavors. Each year the Pierce County Medical $5000. □ Just look in the programs of local Society Auxiliary holds a special arts productions, the back of annual event with the funds earmarked only reports, or the bricks in front of the for the philanthropic applications. It is Pantages to see the individual efforts an opportunity for the community to of the Pierce County medical com­ recognize the collective efforts of munity. There is, yet, another sig­ physicians and their families and the nificant way your medical dollars con­ tribute to this community. Did you know last year Your Medi­ cal Dollars went to .. .

Helping a Young Woman wi th Advanced Stages of Multiple Sclerosis Offering the OPTIFAST™ Program Six years ago a Pierce County single mom was diagnosed with MS. for your patients who are significantly overweight Last year she could no longer care and may have associated medical problems. for herself and her seven year old by Physician Referral daughter. She sought a full-time caretaker. The rapidly progressing ill­ ness created an isolated, low self- Medical Supervision image, frustrated young woman with Friendly, courteous, professional clinical team, no social outlet or family support. physicians, dietitians, nurses, behaviorists With the help of the local Multiple Sclerosis Society, the YMCA Aquatherapy program especially If we can assist you in the care of your patients designed for MS patients was recom­ call: Tacoma 572-0508 -Federal Way 874-3860 mended. Today this same young woman goes every Wednesday after­ noon for one hour to the YMCA train­ ing pool. Her life has changed dramatically. She's made friends with other individuals with MS where ques­ •PTIFA tions and concerns can be voiced 1 and resolved. Her muscles have been strengthened and aerobics have in­ creased her energy level. The $1500 Cedar Medical Cenlcr Si. Francis Mcdical Officc Building 1901 S. Cedar, Suite 205 ■ Tacoma, Wa 34509 9ih Ave. S., Suite 200 • Federal Way, WA

The Bulletin * February 1990 • Page 21 R1EROE COUNTY MEDICAL Committed and Responsive!

As Chairman of the Board of Trustees lor Pierce Count} Medical. I recognize Ihis corporation's effectiveness in the health care industrv. Pierce Count\ Medical strives lo be innovative in its products, responsive to the changing needs of the community, professional in its conduct, and technical!) sophisticated in prov iding its services. The major problem facing the health care indusln today is control of costs while main­ taining access lo, and qualilv of, care. If the private sector docs not control the skvrocketing costs of health care in the United Slates, surclv the go\ ernmem will trv to step in. Pierce Count} Medical works with its provider network to control these costs. For instance, preventive care is incorporated into Pierce Count\ Medical health care plans: providers ulmyc lo utilization review; and. peer review amoiii providers is encouraged. W hen providers suggest wavs lo control costs. Pierce County Medical listens. Physicians were instrumental in dev eloping Preferred Provider Plans, m iw the choice of most of our subscribers. At the request of an avid physician cyclist. Pierce Counlv Medical added the bicvcle helmet inccn- Pierce Count}' Medical remains commilled to uve to that already in effect for auto salely belts the needs ol our subscribers and responsive to and motorcvcle helmets. the suggestions ol our prov iders. We encourage Further, because a group of physicians urged continued involvement and input from the Pierce County Medical lo become involved in physician community. Please keep the ideas the Basic Health Plan, we became one of I he coming! first health care organizations to administer in this stale-sponsored health care program lor ihe Ronald J. CJraf. M.D. uninsured. Chairman. Board of Trustees

Pierce County Medical A Blue Shield Plan

1114 Broadway Plaza Tacoma, Washington 98402 597-6633 From the Past — Hierarchy a Myth! You Make Organized Medicine’s Policies

— Stanley W. Tuell t ..._ V i

— The following editorial by Dr. from his own practice and his family - Waldo Mills, a Seattle surgeon. Stan W. Tuell was taken from the Oc­ yet his conscience just won’t quite let They're not members of a hierarchy! tober, 1969 PCMS Bulletin. him say “no”. Nobody’s perfect. Nor is the AMA It is as fitting today as it was twenty or the WSMA. Each makes mistakes. years ago, if not more so. — Editor Pierce Delegation 100% But to list all the services that these associations have rendered to their This attitude starts with the members, and for the public good, delegates. When the roll was called in would take a volume several times W hhat Hierarchy? the State House of Delegates at its Any physician who uses the word the size of the Bulletin. final session in September, the Pierce “hierarchy” when referring to the The strength of organized med­ County delegation was present -100 leadership of the American Medical icine depends on the interest, con­ percent! Association or the Washington State cern and support of its individual Who sets the policies of organized Medical Association reveals his com­ members. In years past, the practic­ medicine? You do. You elect the plete lack of understanding of how or­ ing physician could look at his own delegates who establish the policies ganized medicine gets organized. practice through his own little lead at the State level. Your delegates rep­ pipe and let the rest of the world go Some uninformed members of resented you on two of the four refer­ these Associations think that the by. But no more. The present medi- ence committees that ironed out the cal-socio-economic upheaval in the policies are established by a closely finer details of all actions before con­ knit exclusive clique, the members of rendering of health care is already af­ sideration by the House. The State fecting the lives and practices of which have maneuvered themselves House of Delegates elects delegates into power by political chicanery. every physician, and more changes to the AMA. Washington has four are on the way. We must be or­ such delegates. They are Peter ganized, if we are to be able to in­ ’Tain’t so! Brooks, a Walla Walla surgeon; Char­ fluence these changes so they will For a list of self-effacing, home- les D. Muller, a Bremerton not jeopardize the high quality of the loving, conscientious doctors who gynecologist; Robert Hunter, a Sedro- medical care that American would really prefer to be left alone to Wooley general practitioner; and physicians have provided. □ conduct their practices as they see fit, just list the past presidents of the WSMA. At the state level of organized medicine, I have yet to see an officer who “pushed" to get his job. Invariab­ Caring, Concerned, ly he has to be drafted or coaxed into taking on chores that he knows will take many hours, and dollars, away Capable.

"We guarantee that your patient referrals will receive personalized, quality care. ” Qualified Physicians Needed We Offer Unique Solutions: Custom-design, fabrication, fitting • Foot Orthotics (Custom Molded) Western Washington • Low Volume • 24 beds, 8 patients per hour • 12-72 and follow-up management • Sports-related Bracing hour shifts • Graduate of an accredited Lower and upper extremity Prosthetics . Amputee Support Group Medical School • Current WA License > Traditional and Modern Orthopedic Bracing . Process Insurance Billings and ACLS Certification • One Year Emergency Room Experience • Mal­ practice Coverage Provided: Claims Brochures and Prescription Personal Prosthetic and Onhotic Care Made with Unlimited Tail Capable. Pads are available upon request. CALL National Emergency 11316 B rid g e p o rt W ay S.W. caii 584-8422 Tacoma, "WA 98499 Services: 1-800-554-4405

The Bulletin * February 1990 • Page 23 Practice Brochure Can Be a Marketing Asset

— Neil Baum, M.D.

H o w much of your staff's time is them. If your practice has an unusual promise, especially one offered in spent answering basic - but important - or unique background - for example, writing. questions about your practice? if it was the first to perform a proce­ On rare occasions your secretary If you are like most practice-based dure in your community - note that, may not check out with your answer­ MDs, the answer is “ plenty”. too. ing service or call-forward the office A practice brochure can be a prac­ line and your patients will not be able tical way to turn this situation into a Spell Out Your Policies to reach you by calling the office marketing asset, and it’s something number. Therefore, it is a good idea you and your staff can prepare Your appointment policy should be to include the telephone number of together. described in detail. Inform the your answering service in the patients of brochure. how your Introduce Yourself State practice A practice brochure is no longer your policy It can inform your current and handles walk- considered unusual and should be a on emer­ potential patients of the services you ins and emer­ gencies offer, office policies, and practice gencies. necessary ingredient of your and after­ philosophy, while setving as an intro­ State your marketing strategy. It takes some hour calls. duction to you, your staff, and your cancellation You may hospital. policy and if effort to create a good one, but you want to The brochure should introduce you you charge will be rewarded with the results. mention and your practice. You should briefly for missed ap­ the name include your education, board cer­ pointments. and tification, professional organizations, You also telephone number of the MD who and any special training you may want to mention how far in advance covers for you when you are not on have completed. Most of us have im­ they should call for an appointment. call. pressive CVs, and we should share Your telephone policy should be these with our patients. covered in a concise manner. There are probably several areas that you Make Location Easy are willing to discuss over the phone If you have patients who come Define Your Specialty and they should be clearly stated. For from great distances, include an easy- You want to describe or define example, will you give laboratory to-read map indicating the location of your specialty and any special areas results over the phone? Do you refill your office. Often your hospital can of interest within your specialty. Brief­ prescriptions over the phone? If you provide a camera-ready map that ly let your patients know exactly what routinely do not refill prescriptions you can incorporate into your your specialty is and how it can help you may want to state why. You will brochure. want to briefly describe what can and cannot be covered by the nurse. Herald Your Amenities Another very important area regard­ ing the phone is to mention what time If you provide any amenities or ad­ Qualified Physicians you routinely make return calls to ditional services, mention them in the Needed patients. This prevents patients from brochure. This would include free waiting all day for your return calls or parking, house calls, a toll-free “800" Seattie • Low Volume • 60 beds • 12 - 36 Hour Shifts • Graduate of an keeps the patient from making fre­ number, or transportation for elderly Accredited Mcdical School • Current quent calls to your office and tying up or visually impaired patients. W A License and ACLS Certification your office staff and telephone. • One Year Emergency Room Exper­ But whatever policy you set out in ience • Malpractice Coverage Provided: Explain Your Payment Policy the brochure, make sure that you fol­ Claims Made with Unlimited Tail You also will want to include infor­ low it scrupulously. There can be CALL National Emergency mation regarding payment and in­ legal implications to not keeping a Services: 1-800-554-4405 surance guidelines. If you expect pay-

Page 24 • The Bulletin • February 1990 ment at the time of service, say so. you define them in the brochure. The Explain that this keeps down costs by readability should be at about the avoiding increases in billing and level of a high school graduate. After Welcome secretarial expenses. State your you have completed your brochure, policy on Medicare assignment and have it edited by a friend or col­ New Members explain what assignment means to league, or better yet someone with your patients. If you accept credit copy-editing experience. Your hospi­ The Board of Trustees has ap­ cards, specify which ones. tal marketing and public relations proved the Credentials Commit­ Discuss your policy on late or delin­ departments often have staff mem­ tee recommendation that the fol­ quent payments, especially if you add bers that do medical and lay writing lowing applicants be approved for a monthly service charge. Indicate and can be of assistance. PCMS Membership. you have an office manager for patients to contact with bill-related The Technical End Stanley C. Harris, M.D. questions. Now that you have created your General Surgery State your policy regarding in­ 1901 S. Cedar, #204, Tacoma surance forms, especially if you hand­ brochure how do you get it printed? le them without charge. This extra ser­ The least expensive way is to type vice promotes prompt filing of the in­ and photocopy it; photocopiers can Gregory J. Hallas, M.D. surance form. It also puts your office print on both sides of a piece of Internal Medicine in charge of the processing proce­ paper. 10507 Gravelly Lake Drive S.W. dure and ensures accurate comple­ A more professional look can be #1, Tacoma tion of the form. created by having the brochure typeset by a printer or prepared by a Sabine E. Speer, M.D. company that specializes in desktop Comment on Your publishing. Anesthesiology Practice Philosopy If you are concerned about an 314 S. K. St., #302, Tacoma Finally, a brief comment on your even more polished final product - practice philosophy should be in­ and don’t mind paying - there are Lance W. Kirkegaard, M.D. cluded. For example, my practice firms that will produce the brochure Internal Medicine/Critical care philosophy is: “We are committed to for you. 11311 Bridgeport Way S.W., excellence, to provide the best health Pierce County Medical Society’s Tacoma care. We pay attention to little details Publication Services Department fre­ because they make a big difference.” quently produces practice brochures Robert J. Kenevan, M.D. for members at discounted rates. Plastic Surgery Be Personal 2021 S. 19th St., Tacoma Distribution The language of your brochure should appear as if you are talking After your brochure is printed, what with the reader. Try to use words do you do with it? Having a stack of such as “we,” “you,” "us,” and “our.” them for patients to pick up in your of­ new patients with an accompanying Try to avoid medical terms unless fice is not the most effective use. I introductory letter. Also send a they are commonly used words or suggest you send a brochure to all brochure to all established patients. Offer brochures to referring physicians. If you do public speak­ ing, have the brochure available for Applicants for Membership the audience. A practice brochure is no longer The Pierce County Medical Society welcomes the following physicians considered unusual and should be a who have applied for membership. As outlined in the Bylaws, any member necessary ingredient of your market­ who has information of a derogatory nature concerning an applicant’s ing strategy. It takes some effort to moral or ethical conduct, medical qualifications or other such requisites for create a good one, but you will be membership, shall assume the responsibility of conveying that information rewarded with the results. to the Credentials Committee or Board of Trustees of the Society. If you are interested in creating your own practice brochure and Richard C. Ostenson, M.D. would like PCMS Publications Ser­ training, University of vices to send you a free estimate, Oncology/Hematology. Born Washington, 1981. Washington please call 572-3709. □ 07/01/49 in Tacoma. Medical state license 1976; board certifica­ School, University of Washington, tion, Medical Oncology, 1981; Inter­ - From the October 27, 1989 JAMA. 1974; internship, University of nal Medicine 1978. Dr. Ostenson Arkansas, 1978; residency, Univer­ currently practices in Puyallup. sity of Arkansas, 1975; graduate

The Bulletin • February 1990 • Page 25 The Duck Lady

— Adria Burrows, M.D. New York, N Y

W e used to call her "the Duck ing her choppy gait and making duck Lady." sounds. One even used a drawing of The Duck Lady always sat on a her in a slide presentation, as a joke. stone ledge in front of our inner-city I wondered if she knew her name, A hospital with a shopping bag nearby, or had any family. Once, when I was quacking like a duck. She was a short on call, I saw her from a window, woman with no teeth and a dirty scarf sleeping on the sidewalk near her wrapped around her head. She al­ ledge. clean, but still wore the shoes I'd ways wore a tattered raincoat and her Perhaps the Duck Lady struck a given her, even in bed. feet were bare, although they were so particular chord in me because she “Doc" she rasped. I walked to the filthy it looked almost as if she had was so petite and delicate looking. foot of her bed. “I remember you. shoes on. I wondered how she ate Obviously she was not in the real You gave me the shoes.” I nodded and if she lived anywhere. Once I saw world, as she strutted back and forth and asked if she was all right. "They the corner hot-dog man give her a quacking, but when someone gave call me the Duck Lady but my name's hot dog. On rainy days she was her some change, she bowed and Nora.” She coughed. “ People leave nowhere to be seen. said thank you. you alone when they think you’re My classmates made fun of her at One day I retrieved from my closet crazy.” She coughed and gasped a some of our teaching sessions, imitat- an old but still serviceable pair of gray moment. She shouldn’t be talking, I suede shoes, carried them to the told her so. hospital, and placed them by her "You also don’t have to wear the shopping bag. She came right up to shoes in bed.” me in her duck walk and bowed. “Oh, no, I have to. You see, not "Thank you,” she said. too many people have ever been "See if they fit,” I replied. They did, kind to me. These shoes, they mean and from then on I always saw them a lot to me.” She had another cough­ D fisC on her feet. She never seemed to ing spell, so I left the room, telling her remember me after that, however, be­ I’d be back. DWYER PEMBERTON cause she always quacked at me and Did she have a home? Was there ANDCOULSON then looked away when I came to the any family? Accountants and Consultants hospital, just as she did everyone on At each conference, the medical the street. student who had Nora on his service 945 Fawcett, Tacoma, WA 98402 Some weeks later I didn’t notice was grilled by the others: Did she still her at her usual spot and shrugged. quack? Did she ever talk? Was she Tax Services Maybe a police officer had finally told getting better? Auditing Sen/ices her to move on. However, that day at Yes, he reported, she quacked all our medical student conference, I dis­ Financial Reporting the time and flapped her arms like a covered she had been admitted for bird. A psychiatry consultation had Estate Planning pneumonia. The student who had her been ordered, but Nora only quack­ Litigation Support on his sen/ice stood up proudly and ed and cackled until she finally said, Investment Consulting began to do the duck walk and “Get out of here.” Projections/Forecasts quack. “Sometimes we feed her duck The important thing was that she Computer Consulting weed,” he said with a laugh. was getting better. She gained Purchase Decisions I decided to visit the Duck Lady. weight and coughed less. I'd visit her Would she still be quacking? Selling Decisions frequently and sit on her bed. She Her room was silent, except for an was friendly and never quacked Bankruptcy occasional cough. She lay in bed when I came. Her roommate also Financial Analysis wearing a hospital gown, an oxygen knew of the quacking farce but was Personnel Placement mask over her nose and mouth. She quiet about it. Nora’s existence was was much thinner than she'd seemed based in front of the hospital. “ I like to 572-9922 in her raincoat; I could see her hip­ (Continued on page 27) bones through the gown. She was

Page 26 • The Bulletin • Febmary 1990 IPPNW 9th World Congress Glass from that window had been blown about 12 feet to George H. Hess, M.D. become embedded in the opposite plaster wall.

X he International Physicians for shambles. The the Prevention of Nuclear War (IPPNW) walls were 9th World Congress opened with there, but it was ceremony in Hiroshima in October. no longer a Over 3,000 delegates assembled to lay hospital - no a bouquet of flowers at the memorial water, no cenotaph for atomic bomb victims. electricity, We were welcomed by Dr. Hagie patients dead Ohta, Ophthalmologist, of the or dying in their Hiroshima Medical Society. She beds! Staff and recounted her experience of the 80% of Hiroshima bombing - 44 years ago. Hiroshima’s tv.. _i J * „ 1 ? _ t In a fraction of a second the rein­ doctors were ______O p e n in g ceremony in Peace Park. forced concrete hospital was a killed or injured. Dr. Ohta has no clear recollection of We discussed national politics, fear those first few days after the bomb, psychology, small war hot spots, the but she recalls the burned flesh, arms race and corporate morality. vomit and feces. At the closing ceremony, the I didn't fully appreciate Dr. Ohta’s IPPNW Distinguished Citizen Award experience until I visited the hospital. was given to Dr. Joseph Ratblatt, There was a hospital stair-well lighted Professor Emeritus of Physics, Univer­ by a small window. Glass from that sity of London. This 81-year-old window had been blown about 12 nuclear scientist escaped from Ger­ feet to become embedded into the many but lost his family in the opposite plaster wall. The actual num­ Holocaust. He worked on the Manhat­ bers of injured was in the thousands. tan Project to beat Hitler’s atomic For five more days the IPPNW con­ capability. After Germany sur­ ference of physicians from 70 rendered, the momentum of science countries heard numbing statistics of took over and the A-bomb had to be nuclear developments, disasters, and completed and tested - twice in three improved killing power. We were days. Dr. Ratblatt was the only briefed on nuclear victims and their atomic scientist to resign from Los Mrs. Adriana Hess in front of the “wall therapy. Experts from many fields Alamos. □ of stain” showing glass embedded from alerted us to environmental effects. shattered window.

DUCK LADY She was, in a week. I saw her in She bowed again but quickly turned (Continued) the same raincoat, wearing her “new” away to sit on her ledge and cackle shoes, back to her old ways, quack­ to herself. see the people come and go. Don’t ing at passersby. I said hello one I never saw Nora again, but still get that from looking out my win­ morning but she looked away. ask colleagues who work at the dow.” There actually was a home ad­ On my last day of rotation at the hospital about the Duck Lady. dress on her chart: in the toughest, hospital, I brought her a sandwich “Yes, she’s still there,” they always most run-down part of the city. "They and put it by her shopping bag. She say. “She’s really crazy.” Maybe she don’t know me as Nora. I’m famous bowed and said thank you. is, but she still wears gray suede as the Duck Lady. Give the doctors a “I won’t be seeing you again,” I shoes. □ hard time but they make me better told her. “I’m done at this hospital.” anyway. I don’t give no one too much She held her head sideways, as — From the November 24, 1989 JAMA. trouble. I’ll be back outside soon.” though she were about to quack, but didn’t. “Take care of yourself, Nora.’’

Tile Bulletin • February 1990 « Page 27 ■ U.I Nujib Ninth Street • Suite 203 • Tacoma, Washington 9&405 • Telephone (2061 572-3666

Presents

Our Quarterly Luncheon Meeting For Retired Members and Spouses

“Travels and Medicine in China ”

Featuring

Mian Anwar, M.D.

Date: Wednesday, February 21, 1990 Time: Lunch 12:00 p.m. Program 12:45 p.m. Place: Tacoma Dome Hotel (McAllister Room) 2611 E. “E” Street Price: $10.50 per person

To register, please complete the attached registration form and return it along with a check payable to PCMS or call the Medical Society office at 572-3667 to confirm your attendance by Friday, February 16.

Registration Yes, I (we) have reserved February 21 to join retired members of the Pierce County Medical Society at the "Travels and Medicine in China” Luncheon.

Please reserve lunch(es) at $10.50 per person (tax and gratuities included). Enclosed is my check for $______. I regret that I am unable to attend the lunch portion of the meeting. I will attend the program only. Dr.______Return no later than Friday, February 16,1990. Auxiliary Meeting Notice

Our next meeting will be Wednes­ The group will meet at the WSMA Limit: 50 people. A special lunch is day, February 28, 1990 at 10:00 a.m. office in Olympia for an update on planned. in Olympia. health issues currently before the Area carpools will be scheduled as You don’t have to or want to be in­ legislature. We will meet with legis­ needed. Details will be published in volved in politics to enjoy this “up lators in the State Reception Room the February Pulse. For more informa­ close and personal” visit to our State (depending upon their schedules) tion, please contact Karen Dimant Capitol. and watch the Legislature in action. A 851-9404. guided tour of the Capitol is included.

NEWSBRIEFS (Continued) Access To Care: You Tell Us

The following article was taken Cons: Many health care providers and large firms. Lower wages, higher from the January, 1990 issue of AARP say they are reluctant to treat prices of layoffs might result as firms Bulletin. Medicaid patients because the pro­ shift costs to employees and con­ "Many American corporations that gram does not pay them enough for sumers. once scorned national health in­ their services. Also, the benefits Cost: The Pepper Commission surance as 'socialized medicine’ are covered by Medicaid vary from state estimates that combining mandated changing their tune about govern­ to state and Medicaid has a welfare employer coverage with Medicaid ex­ ment involvement in health care. ” stigma. pansion, the buy-in and increased “More and more business people Cost: The Bipartisan Commission payments to some providers could are not just whispering but talking on Comprehensive Health Care (the entail an annual new cost of about out loud about making health care Pepper Commission) preliminarily es­ $27 billion. Three percent of those financing a government respon­ timates the annual new costs of ex­ under age 76 would be uninsured. sibility, ” says Chrysler Corp. Chair­ panding Medicaid, allowing the near­ man Lee lacocca. poor to “buy-in" and raising pay­ *Regulate Insurance Among corporate advocates of ments to some providers could be change are Chrysler and the Ford about $21 billion. Nine percent of Pros: Regulation could stand­ Motor Co.. They say a system where those under age 65 would remain ardize benefit packages, prohibit ex­ the government pays the country's uninsured. clusions based on preexisting condi­ medical bills while also rationing tions, require rate-setting based on community-wide averaging, permit care may be required. *Mandate employer-provided The AARP Bulletin then asked its small employers to join larger risk readers to vote on the following health insurance and expand pools and require insurers to accept health care system options. Medicaid everyone who applies for coverage. Cons: There’s no way to deter­ Alternatives offered by critics of Pros: Employers could be re­ mine how much this approach would this county’s health care system in­ quired to provide health coverage to cost or how many people it would clude: employees only, or in a more com­ benefit. Also, critics say it would not prehensive version, to employees address the fundamental flaws in the and their dependents. *Expand Medicaid health care system. This approach would build upon Pros: Proponents offer two major the existing structure of employer- approaches. One would establish based health insurance. Also, given ♦Institute national uniform Medicaid eligibility at or near that over two-thirds of the ap­ the federal poverty level. The other government-sponsored proximately 34 million uninsured health insurance would let those with income above Americans are workers or their de­ the poverty level yet below a set ceil­ pendents, employer-provided health Pros: The government would in­ ing "buy in” to Medicaid on a sliding insurance could target a large portion sure all citizens against the costs of scale based on income. of the uninsured. basic health care services, much as These changes would extend Cons: Providing insurance would Medicare currently does for the aged coverage to those most vulnerable to, burden some small businesses and and disabled. The most obvious ad­ and least able to afford, health care self-employed individuals whose vantage would be the universal, com­ costs. Also, the changes would build health plans tend to be more expen­ prehensive coverage. Also, since all on an existing structure. sive than those provided by medium (Continued on page 31)

The Bulletin • February 1990 « Page 29 What’s new for physicians at St. Joseph Hospital?

Advanced Technology New Services ♦ Arthroscopic Video System. ♦ Family Birthing Suites. These new, The St. Joseph Same Day Surgery offers the expansive rooms in the maternity unit allow latest in video technology featuring the “S" expectant mothers to labor, give birth and care system to view the knee joint using the for their newborns in the same room. Plenty of highest quality video reproduction. The room for family participation in the birth process. equipment allows surgeons to document their Mothers still have access to both Level I and the findings both on videotape and with still more intensive Level II nurseries. pictures. ♦ Diabetes Services. Comprehensive out­ ♦ Laser Laparoscopic Video Augmen­ patient education program complements ta tio n . Provides for an improved view of hospital's inpatient unit. People with diabetes the peritoneal structures and pathology and and their families receive practical, every-day enables the surgeon to magnify small lesions knowledge designed to help them avoid more effectively and to treat disease around hospitalization. Special programs for women the bowel, bladder and fallopian tubes. with gestational diabetes also available. Surgeon.-; can operate in an upright position, relieving back strain. ♦ Center for Personal and Family Development. Trained psychologists, ♦ Laser Lithotripsy. Treats kidney stones therapists, nurses and dietitians provide trapped in the ureter. Laser beans are sent outpatient care for for people with depression, out through minute optic fiber to fragment low self-esteem, eating disorders, a history of the stone. Unlike other technology to remove past sexual abuse and other emotional ureteral stones, no detectable heat is stresses. Psychological evaluations and group generated and there rarely is need to dilate therapy available. the ureter. ♦ Free Valet Parking. Available seven days a ♦ Cultured Epithelial Autograph. week for your patients and their visitors from Allows for more effective skin grafting for the hospital’s main entrance on I Street. Simply burn patients. This sophisticated process have your patients pull up to the entrance and a allows for laboratory reproduction of a burn uniformed valet wrill park their cars and retrieve victim’s own skin. them when they are ready to leave.

ST. JOSEPH HOSPITAL

For more information, call 591- 6767. CLASSIFIEDS

Positions Available Equipment Questions About Hiring? Firing? PHYSICIAN OPENING. Am­ FOR SALE - Baker 8000 Hematol­ bulatory care/minor emergency ogy Machine. Does CBC and Raises? Etc.? center. Full/Part time for FP/IM/EM platelet counts. Includes printer, trained, experienced physician. Lo­ dilutor. Scrupulously maintained, cated in Tacoma area. Flexible perfect condition. Contact Dr. A.R. We’d Like To Help! scheduling, pleasant setting, Thiessen (206) 383-1988. quality medicine. Contact David R. Kennel, M.D., at5900-100th St. BIG SALE! 50% off manual exam Call the Medical-Dental S.W., #31, Tacoma 98499. Phone: tables for the month of February Placement Service (206) 584-3023 or 582-2542. ONLY. Call for a free catalog, Lyn- lees, Inc., Redmond, WA 867-5415. 572-3709. MEDICAL DIRECTOR - Small inter­ mediate care nursing home with ambulatory light care patients re­ quires a Medical Director. (A Office Space ACCESS TO CARE retired M.D. would be acceptable). (Continued) Sumner Care Center, Bill Smith, Ad­ ministrator 863-0433. BEST MEDICAL SPACE in town. Cedar Medical has 1,450 sq. ft. health insurance would be provided available on the golf course side - by the government,administering PHYSICIAN OPENING - Small in­ 1901 S. Cedar. Call Crawford and financing the system would be termediate care nursing home with Katica, Inc. Gary Crawford, 272- simpler. ambulatory light care patients re­ 9200. quires a physician to follow new ad­ Cons: Implementing national mits. Some private pay. Sumner health insurance would involve Care Center, Bill Smith, Ad­ JUST RETIRED. Available now - profound and comprehensive chan­ ministrator 863-0433. busy 2 doctor medical office, 2,400 ges in the way health care is sq. ft., 32 car parking lot. Excellent provided in the country. location near hospital. For sale or PSYCHIATRIST - To follow Furthermore, critics contend it lease - 610 S. Meridian, Puyallup - would shift a large portion of cur­ patients at a small intermediate 848-8176 or 848-6478. care nursing home. Sumner Care rent health expenditures from the Center, Bill Smith, Administrator private sector to an already 863-0433. strained federal budget. Cost: The Pepper Commission preliminarily estimates that the an­ nual new costs of this program could range from $33-38 billion. All Advertise in the Classifieds would be covered.

Prices: Advertisers Name and Address Representative PCMS Newsletter - ______Brough Meets with 75 cents per word. ______The Bulletin - ______PCMS 85 cents per word. 10 word minimum. Ad Copy Representative Jean Marie Brough (R-30), Federal Way, who Deadline: sits on the very important March Newsletter Judiciary, Rules and Appropria­ deadline is Feb. 15. tions Committee, met with Gordon Please call 572-3709 Klatt, M.D., Dave Hopkins, M.D., for more information. and Bill Bilnoski, M.D., in late December. Send check to: The major topic of conversation Pierce County was the current session of the legis­ Medical Society, lature and what the profession 705 South 9th, Suite 301 could expect to come out of it. Ac­ Tacoma,WA 98405 cess, liability, trauma and smoking legislation were also discussed. Clearly Our Philosophy Is Working!

Physicians Insurance is owned and directed bv Washington physicians and operated by a stat! ol dedicated insurance professionals. We currently sei-vc over b0''<. ol Washingtons private practice physicians, and in less than eight vearshave become the leading professional liability insurance carrier in Washington State. The (ounding principle of Physicians Insurance was a commitment to consistent])' provide superior insurance services. We remain dedicated to that principle today. W e imite you to contact us for more information about our coverage programs, services and subscriber benefits. Western Washington 1-800-962-1.399 sicians Eastern Washington I-800-962-] 398 F L Phy

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Pierce County Medical Society Bulk Rate 705 South Ninth Street, Suite 203 U.S. Postage Tacoma, WA 98405 PAID Tacoma, WA Permit # 60S ADDRESS CORRECTION REQUESTED L

PCMS LV A -\

I s r r r ‘ A publication of the Pierce County Medical Society

Volume 5, # 2 March 1990 We’re Moving!

T h e purchase of an office building tems were in very acceptable con­ at 223 Tacoma Avenue South was a dition. major decision made by the Board of Trustees at a special meeting on The Board seriously considered January 18,1990. The unanimous the various options available in­ decision came after serious con­ cluding remaining in the office sideration from special reports, in­ space that is currently leased, new construction to specification, pur­ vestigations, and previous discus­ chase of other buildings, or pur­ sions regarding the move. chasing the building at 223 The Board had collected opinions Tacoma Ave. So. After careful re­ and data from PCMS Members, the search, the option to purchase the PCMS Accountant and Banker, 223 Tacoma Ave. building con­ other Medical Societies that have tinued to be the most affordable, made building purchases, real es­ realistic option. ganization as well as visibility in the tate personnel and Board Members. It was determined that owning a community. Purchase of the build­ In addition, building inspections building will provide a sense of per­ ing will be made through the for- revealed that the structure and sys­ manence and stability to the or­ (Continued on back) Medicare Update INSIDE PCMS President Bush asked for consider­ In separate appeals to Congress, NEWSLETTER ably less in Medicare budget reduc­ hospital groups, the AMA, and 28 na­ tions than had been feared by the tional medical specialty societies Applicants...... 4 medical sector in his budget ad­ asked that restraint be exercised in Auxiliary News...... 17 dress to Congress. However, his making further cuts in federal Classified...... 19 proposal continues to perpetuate Medicare budget outlays. the drastic assault that Administra­ C.O.M.E. News...... 3 tions have leveled against Medicare Nearly half of the proposed General Memb. Meeting....5 in the last decade. Medicare Part B savings would be derived from two sources - reduc­ HIV/AIDS Questions 16 The President proposed trimming ing payments for outpatient depart­ I'd Pick More Daisies 14 FY 1991 Medicare expenditures by ment services (670 million), and March Meeting Schedule 13 5.5 billion, Part A being targeted for denying physicians any Medicare 60% of the brunt, and Part B for Economic Index (MEI) updates ex­ Newsbriefs...... 6 40%. Under this approach, cept for primary care services (450 New Members...... 4 Medicare Part A cost would be million). The renewed MEI freeze President’s Notes...... 2 chopped by about 3.3 billion and comes on top of the one in effect for Part B by about 2.2 billion. Com­ Sports Medicine C.M.E.... 12 FY 1990 through April 1. For the bined cuts in excess of 8 billion remaining 6 months of this fiscal Surplus of Physicians? 12 generally had been envisioned prior to the budget address. (Continued on page 2) President’s Notes

Individuals in the non-medical com­ many non-medical professionals vide them munity do not really have an ap­ who put in as many hours as we do the oppor­ preciation of the daily activities of but none carry the burden of liability tunity to those of us who work in the medical or the life/death challenges over so witness profession. A physician’s typical many hours each day. surgery, lab tests, x-rays, emergen­ day usually includes early morning cy medicine procedures, obstetrical In April, we plan to initiate a program rounds, an early morning meeting, services, office practices, charting, which will allow prominent non-medi­ surgery, morning office hours (many hospital rounds, and everything that cal members of our community to times eclipsing the lunch hour) after­ is required to provide quality medi­ spend a day or two with select noon office hours, and/or surgery, cal care. physicians of various specialties. plus many interruptions for emergen­ This program, which will be pat­ If you would be interested in sharing cies or consults. This day often con­ terned after a successful project in your practice with a member of our tinues with a night on call, or, if Portland, Oregon, will be entitled “In­ community, please contact me or lucky, just an evening staff meeting ternship 90." We hope to repeat the Doug Jackman at the PCMS office, prior to returning home. There are program every three to four months 572-3666. We can provide you with to allow more community members more information and arrange for to gain a better appreciation of what you to be a participating faculty PCMS Officers: we do on a daily basis. member in our first program. Gordon R. Klatt Presid en t William G. Marsh President-elect We are looking for physicians who Thank you. We are excited about John B. Coombs Vice President Joseph H. Wearn Secreta ry-Treasurer would be interested in volunteering our new “Internship 90” program William T. Ritchie Past President to have an “intern" follow them and look forward to its implementa­ PCMS Trustees: around for a day or two, giving them tion this spring. Stuart D. Freed the real picture of a physician's prac­ - GRK K. David McCowen A. Robert Thiessen tice of medicine. We want to pro- David E, Law Anthony S. Lazar William'F. Roes • Limit radiologyfee —110 million Alice Wilhyde Medicare (Continued) • Reduce fees for “overpriced" procedures —110 million P C M S N ew sletter is published eight times a year bv PCMS Membership Benefits, Inc., year, most physicians will receive a • Limit payments for supervised tor members of the Pierce County Medical anesthesia -70 million Society. The Pierce County Medical 2% update in their payments. Society is a physician member organization Physicians providing primary care • Limit payments for surgical glo­ dedicated to the art, science and deliveiy bal fees —50 million of medicine and the betterment of the services will receive a 5.3% update. health and medical welfare of the com­ There will be no update for • Reduce payments for overpric­ munity. radiologists and anesthesiologists. ed localities —50 million, Advertising and newsletter copy must ar­ Here are some of the other sources • Limit payments to new physi­ rive in the Society office by the 15th day of cians —50 million the month preceding the publication date. of proposed FY 1991 budget cuts Advertisements in inis newsletter are paid that would affect physicians: • Limit payments for technical and not necessarily endorsements of ser­ • Reform payments for assistants radiology component vices orproducts. We welcome and invite —40 million1 your letters, comments, ideas and sugges­ in surgery — 120 million tions.

Editor: “Nutrition and Culture” David S. Hopkins Managing Editor: — A one day course providing culturally appropriate Douglas Jackman Editorial Committee: nutation services for selected ethnic minorities. David S. Hopkins (Chairman), StanleyTuell, W. Ben Blackett, Friday, March 23, 8:00 a.m.-4:45 p.m. Richard Hawkins Tacoma Comunity College Publications Coordinator: Monique Johnson General Admission -$50, SPSDA-$45, Students-$25 Advertising: Presented by Kim R eed _ Pierce County Medical Society, MBI Western Washington Area Health Education Center 572-3709 Pierce County Medical Society and 705 South 9th Sta Suite 203 Tacoma, WA 98405 South Puget Sound Dietetic Association (2 06) 5 1 2 -3 6 6 1 For more information, call Jodi Perlmutter at 441-7137. © PCMS 1989

Page 2 • March 1990 • Vol. 5, #2

Applicants for Membership

The Pierce County Medical Society welcomes the following physicians who have applied for membership. As outlined in the Bylaws, any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medi­ cal qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Committee or Board of Trustees of the Society.

William P. Andrade, M.D. pines, 10/01/52. Medical school, Far school, University of Washington, Allergy. Born in Hawaii, 06/02/41. Eastern University, 1979; internship, 1986; internship, University of Min­ Medical school, University of Quirino Memorial Medical Center, nesota, 1987; residency, University Washington, 1973; internship, 1980. Washington State License, of Minnesota, 1989. Washington 1984. Dr. Tible is currently practicing State License, 1989, board eligible. Fitzsimmons Army Hospital, 1974; at 7923 Rainier Avenue South, #201 Dr. Vehe is practicing at 521 South residency, Fitzsimmons Army Hospi­ K Street in Tacoma. tal, 1976; graduate training, Fitzsim­ in Seattle. mons Army Hospital, 1982. Washington State License, 1990; Raymond L. Vercio, M.D. Cheryl M. Yokoyama, M.D. board certification, Internal Anesthesiology. Born in California, Ophthalmology. Born in Los An­ Medicine, 1982; Allergy/Immunol­ 08/29/52. Medical school, Loma geles, California, 03/26/56. Medical ogy, 1983. Dr. Andrade is practicing Linda University, 1984; internship, school, University of California, San at Madigan Army Medical Center. LA County - USC, 1985; residency, Francisco, 1983; internship, Santa Loma Linda University, 1987; Barbara Cottage Hospital, 1984; Sharon Shual-Berke, M.D. graduate training, Loma Linda residency, Baylor Medical Center, University, 1988. Washington State Texas; graduate training, Moorfields Cardiology. Born in New York, License, 1988. Dr. Vercio practices Eye Hospital, London, 1989. 01/14/52. Medical school, Oregon at 21 33rd Avenue Court N. W. in Washington State License, 1987; Sciences Health University, 1980; in­ Gig Harbor. board certification, Ophthalmology, ternship, Oregon Sciences Health 1988. Dr. Yokoyama is currently University, 1982; residency, Oregon practicing at 1901 South Cedar, Sciences Health University, 1982; Cynthia L. Vehe, M.D. #101 in Tacoma. graduate training, Oregon Sciences Internal Medicine. Born in St. Paul, Health University, 1985. Washington Minnesota, 10/15/55. Medical State License, 1985; board certifica­ tion, Internal Medicine, 1982; Car­ diovascular Disease, 1987. Dr. Cascade Systems Consultants Schual-Berke is practicing at 1802 " T he S pec ia lists in H e a l th C a r e A u t o m a tio n " South Yakima Avenue, Suite #302 in Tacoma. P r e se n ts: P rac tic e P a r t n e r ™ Prudencio G. Tible, M.D. General Practice. Born in the Philip- ■ Medical Billing. We I co Hie ■ Patient Records. ■ AppointmentSchedul New Members ■ Medical Writer". The Board of Trustees has approved H Office Management the Credentials Committee recom­ Consulting. mendation that the following ap­ plicants be approved for PCMS Mem­ bership. We are a full service computer system design and consulting firm, offering the finest Gregory J. Hallas, M.D. computer installation and support in the industry. Internal Medicine 10507 Gravelly Lake Drive S.E. #1 Tacoma Call Now for a free demonstration and Office Feasibility Study! David S, Brantley, M.D. Hematology/Oncology (206) 941-9132 or (206) 924-0341 1802 S. Yakima, #102 31601 32 Ave. S.W ., Federal Wav WA 98023 Tacoma 705 South Ninth Street * Suite 203 • Tacoma, Washington 98405 • Telephone (206) 572-3666

Presents “Medicine in the White House” at the

Joint General Membership Meeting with MAMC

featuring

General John Hutton, Commander, MAMC

Rescheduled to March 13

Date: Tuesday, March 13 Place: Fircrest G olf Club 6520 Regents Blvd. Time: Cocktails 6:00 p.m. (no host) Dinner 6:45 p.m. Program 7:45 p.m. Price: $15 per person* *$17 per person if registering day of meeting Spouses Invited! Reservations required by Friday, March 9.

REGISTRATION Yes, I(we) have reserved the evening of March 13 to join members of the Pierce County Medical Society and the MAMC at their Annual Joint Meeting. Please reserve dinner(s) at $______per person (meal, tax, and gratuities included). Enclosed is my cheek for $______Dr. ______

Please make check payable to PCMS and return no later than Friday, March 9, 1990. *DAY OF REGISTRATION FEE - $17. AMA Works Toward Developing “Access-To-Care” Policy for Uninsured and Uninsurable

Resolving the extremely serious na­ lion Americans who are currently not is likely to be adopted in 1991. tional problem of the uninsured and covered. uninsurable has motivated the AMA Resolution of the problem, which and several national medical special­ Eliminating the current plight of the has reached the crisis stage, has ty societies to work together to for­ uninsured and the uninsurable is been high on the AMA's agenda for mulate a comprehensive broad- high on the agendas of Congress, some time. In testimony before based and proactive stance on the administration, organized medicine, health committees and the first ses^ issue. and the public in general. While the sion of the 101 st Congress, AMA ar­ outlook for obtaining a legislative ticulated its position. It calls for ex­ The immediate objective is to solution this year is not promising panding the Medicaid program and develop a joint “access-to-care" because Congress will be in ab­ mandating employer health in­ statement setting forth a broad set breviated election-year session, the surance coverage of employees, of public policy principles that would national debate on the issue will along with appropriate tax incen­ guarantee access to health in­ definitely broaden and clearly estab­ tives to ease any economic burdens surance to the approximately 31 mil- lish the framework for legislation that on employers. Dr. Waltman Addresses Tacoma Rotary 8

Richard Waltman, M.D., Family Physician and Geriatrician, author, Offering the OPTTFAST™ Program and Executive Vice-President of the for your patients who are significantly overweight Tacoma Stars, introduced Mr. Earl Foreman, speaker for the meeting and may have associated medical problems. and President of the M.I.S.L., to a by Physician Referral gathering of about 350 Tacoma Rotary 8 members recently. Dr. Medical Supervision Waltman is one of 20 community leaders who purchased the Stars to Friendly, courteous, professional clinical team. help keep them in Tacoma when the physicians, dietitians, nurses, behaviorists demise of the organization was im­ minent. If we can assist you in the care of your patients In his remarks to Rotary, Dr. call: Tacoma 572-0508 -Federal Way 874-3860 Waltman stated that he and the other owners of the Stars were not in it for financial gain, but for the com­ The munity. He stated that once the Stars turn the corner financially, the profits would go back into the com­ o w ifA s r munity in such ways as parks, spon­ Pm g/um sorships, scholarships, etc. Dr. Waltman’s brief remarks were Cedar Mcdical Center St. Francis Medical Office Building received very favorably by the 1901 S. Cedar, Suite 205 • Tacoma, Wa 34509 9lh Ave. S., Suite 200 < Federal Way, WA Rotary.

Page 6 • March 1990 • Vol. 5, #2 NewsBriefs Continued..

AMA’s Executive Vice President, Dr. Sammons, Resigns

James H. Sammons, M.D., who for the future. vinced that the AMA should focus has been AMA’s Executive Vice on the future now and not wait until I President since 1974, has resigned. The Board is pleased to name go - as planned. The judgments James S. Todd, M.D. as acting Ex­ which will have to be made over the AMA’s Board of Trustees and Dr. ecutive Vice President, effective im­ next year by the Board, House of Sammons issued the following state­ mediately. Dr. Todd has served as Delegates, and Executive Vice Presi­ ments regarding the resignation: Senior Deputy Executive Vice Presi­ dent, will affect the Association and dent since 1985. Prior to that he was the profession for years to come. I Board of Trustees’ a member of the AMA Board of Trus­ have had my 15 year tenure. Its Statement tees from 1980-85. Bom in Mas­ legacies, I hope, will be judged to sachusetts and educated at Har­ have benefited the profession. It is ; The Board of Trustees of the vard, Dr. Todd practiced general important that we delay no longer in ; American Medical Association today surgery for 22 years in Ridgewood, looking ahead with new leadership ; accepted the resignation of James New Jersey. toward the new decade. ; H. Sammons, M.D. as Executive ; Vice President. The Board recog- The Board feels confident that the I want to express my deep apprecia­ ; nizes the major contributions that American Medical Association is tion for the opportunity of having ' Dr. Sammons has made to the AMA prepared for the challenges of this served the profession. I want to ex­ and medicine over the past 15 decade. press my deep gratitude to the ■ years. The scientific, financial, and Board of Trustees, House of : political strength of the AMA has Dr. Sammons’ Statement Delegates, and all of my friends in : never been greater. I am today resigning as Executive medicine for their support over the years. I am proud of my service and The Board commends the states­ Vice President of the American Medi­ my Association. manship of Dr. Sammons in his cal Association. I am relinquishing ] decision to resign now in order for my duties 10 months earlier than I the Association to focus its priorities had intended to because I am con­

“We’re in a Time of Change”

The January 20 Leadership Con­ Dr. Nelson said “We’re in a time of Governor Booth Gardner was the ference organized by WSMA at­ change.” Regarding medical care, luncheon speaker and he had a lot tracted over 200 members from he quoted columnist George Will, on his mind. He stated quite em­ around the state. Nearly 20 PCMS “What do people want? They want it phatically that, “There will be chan­ members attended the session that all.” Dr. Nelson concluded, “We can­ ges in the near future, because there featured AMA president, Alan Nel­ not permit the system to become a are too many young pregnant girls son, M.D., as the keynote speaker. utility." who can’t find care and too many people without health insurance.” He said, “health care has placed the state in financial distress, 17% of the Persing, Dyckman, Toynbee, Inc., state’s population, 735,000 do not have health coverage. Health care Insurance Brokers now consumes 14% of the state’s revenue and it is estimated that by the year 2000 it will be 23% without Quality Service for Quality Clients the addition of any new programs.” Insurance Specialists Since 1945 At the Janauary 21 WSMA Board of (206)627-7183/FAX (206)572-1430 Trustees meeting, past president, George Schneider, M.D., Spokane, Bob Sizer 705 South Ninth, Tacoma W A 98405 Doug Dyckman urged Board members to get the Curt Dyckman word out to the membership that David Gillespie, CIC “times are changing, and it requires David Babbitt Auto • Home Marge Johnson, CPCU all physicians to become involved in Rob Rieder Business • Professional the process or be left at the starting Carrie Lugo Group • Disability • Life gate." Bob Cleaveland, CLU, ChFC

March 1990 • Vol. 5, • Pane 7 NewsBriefs Continued...

PCDS Awards Dr. Klatt Testifys on Universal Health Care Dr. Torgenrud Gordon Klatt, M.D., PCMS Presi­ was delivered before a full commit­ Honorary dent, testified on Representative tee room of interested onlookers. Braddock’s Universal Health Care Braddock’s Committee held two M embership before the House Health Care Com­ other meetings on the bill, one in mittee on January 15. Dr. Klatt ob­ which they listened to the repre­ jected to the bill because, “ It may be sentatives of the British Columbia The Pierce County Dental Society a quick fix to a very complex prob­ health system and one which al­ awarded PCMS member Terry Tor­ lem.” He went on to say that, “I lowed public testimony. (See below genrud, M.D., Honorary Member­ think (the system) desperately - Bradock Bill Update) ship in the Dental Society for leading needs to be fixed.” The testimony the effort to fluoridate Tacoma's water supply.

Making the presentation at the Den­ tal Society’s January 18 Membership Therese Jiganti Stewart Meeting was Dr. Dan Gallagher who Registered Representative Personal Financial Planner had represented the Dental Society on the Committee for Better Dental An Amentan ExpnSS company Bus. (206) 922-2929 Health. Torgenrud chaired the Com­ Res. (206) 851-2578 mittee for nearly five years. Dr. Tor­ IDS Financial Services Inc. IDS Life Insurance Company genrud was presented with a beauti­ Suite 201 ful plaque for all the time and effort 3700 Pacific Highway East he had devoted to the campaign. Tacoma, WA 98424

PCMS staff members Sue Asher and Doug Jackman were also honored for their efforts in the fluoridation campaign. Braddock Bill Update

Representative Dennis Braddock, health access, health care costs, AMA Calls for Chairman of the House Health Care and quality of health services. The Committee, House Bill 2252, that primary focus of the new commis­ Waiting Period would have set up a commission to sion will be to find ways to control develop and implement a Universal costs. Braddock contends that Before Firearm Health Care System similar to the rising medical costs are at the root British Columbia government-run of the problems of an estimated Purchases system, was reduced to a study by 750,000 people in Washington who the Committee on January 25. do not have health insurance. Physicians are deeply concerned about the tragic firearm fatalities that A Commission will be established are taxing our overburdened health that will study problems relating to care system. That’s why the AMA is calling for legislation requiring at least a one-week waiting period before the sale, delivery, or transfer of any firearm in the U.S.A. A one- Qualified Physicians Needed week waiting period would not prevent legitimate purchases of Walk-in Clinic • Military Facility • Eight hour shifts • Excellent sup­ firearms. But it could greatly reduce port • $35.00 per/hr • Full and Part-time Positions • Graduate of an spur of the moment purchases and Accredited Medical School • Current Washington License • Current sudden, violent uses of guns. The BLS/ACLS Preferred • Malpractice Coverage: Claims Made With AMA voiced its concerns in a recent Unlimited Tail letter to the Senate. For more information please call: National Emergency Services — 1-800-554-4405

Page 8 • March 1990 • Vol. 5, #2 NewsBriefs Continued.

PCMS Cruise Highlights

On Saturday, January 20 par­ formed much in recent years. Also dancing ticipants in the PCMS sponsored featured was Leslie Gore (Mrs. abilities, and Mexican Cruise organized by Gor­ Patty Kesling) performing with the poor Carole don Klatt, M.D., President, left from Gorettes her famous hit tune “It’s My Winegar is still Seattle-Tacoma airport. After a flight Party And I’ll Cry If I Want To". Les­ trying to figure to Los Angeles and a bus ride to the lie cried copious tears as she enter­ out how to beat Pier, the travelers boarded the Fair tained the audience. her husband at gin rummy. Princess for a seven-day voyage to Mazatlan, Cabo San Lucas, and Other highlights.... it was rumored Well, maybe another PCMS spon­ Puerto Vallarta. The tourists en­ that Robert Winegar, M.D., spent sored cruise in the future will add joyed fine dining, entertainment and most his time shopping as he found your name to the highlights. If you the blue skies and seas of Mexico. bartering with the Mexican mer­ are interested, please call the Medi­ chants very inticing...the rumor mill cal Society office, 572-3667, and let Highlights of the cruise included ex­ also suspects that Clyde Koontz, us know your preference for when cellent entertainment at the 50's M.D., lost at the 21 Table the entire and where you would be interested Rock N'Roll Party. Elvis Presley $500. that his wife, Sydna, won at in vacationing. Group discount (Peter Kesling, M.D.) was one of B in go -o r maybe even more that rates through the travel agent are the headliners. Cruisers rocked with we don't know about??...PCMS available for Society sponsored Elvis and found that his music is still President Dr. Klatt and his wife cruises. tops and his style remains provoca­ Trudy, are known to have won a bot­ tive even though he hasn’t per­ tle of champagne for their expert

PCMS Mailing Label Policy

■ m PLAN At their February 6 meeting, the THE AFFORDABLE ALTERNATIVE! Board of Trustees unanimously adopted a policy regarding release CREATED BY A PHYSICIAN THAT KNOWS . .. of PCMS mailing labels. The new policy defines price, purpose, and It works. Dan & Dawn Dube conditions for release of labels. It’s safe. (206)848-0711 Such as: It’S fast. Independent ToppMed” Distributor • labels will be released to PCMS SUPPORT GROUPS AVAILABLE members at cost - $25.00 per list • labels will be released to for- PCMS Executive Committee profit and non-profit organiza- Approves Contributions announcing a continuing medi­ cal education activity or dis­ tributing medical education At its December 19 meeting, the Ex­ University in Ellensburg. Topics this material. The cost for non-profit ecutive Committee approved the year will be Personal Loss and Fit­ organizations is $50.00; the cost contributions of $500 to the WSMAA ness For Life. The forum theme to for-profit organizations is Teen Health Forum and $350 to the “Choice, Not Chance” will be the $100.00. Tobacco Addiction Coordinating focus of all presentations. Other specifications of the policy are Council. that labels will not be released to The Committee also voted to award political candidates or campaigns, Sharon Ann Lawson, Immediate $350 to the Tobacco Addiction unless the request is from a PCMS Past President of WSMAA, or­ Coordinating Council to support its member. All requests must be pre­ ganized the first Teen Health Forum, efforts in lobbying for tobacco legis­ paid, in writing, and except from "Choice, Not Chance,” held last year lation in the 1990 legislature. PCMS members, must include a which attracted over 500 middle Several important bills will be con­ copy of all material to be mailed. school students and staff. sidered during the session — par­ ticularly distribution of free samples The forum will be held April 17 on and selling of individual cigarettes in the campus of Central Washington convenience stores.

March 1990 • Vol. 5, • Page 9 NewsBriefs Continued..

AMA Wants Your Help in Reducing Childhood Firearm Accidents

Unintentional firearm accidents are homes of your patients: The AMA is also working with state the fourth leading cause of death in medical children aged fourteen and under. • ask about the presence of societies and One study shows that most uninten­ household firearms other or­ tional firearm deaths among • educate your patients about the ganizations children result from guns left loaded dangers of firearms to raise and not locked up. To reduce the • ask your patients to instruct public aware­ number of such incidents, the AMA their children and neighbors ness of Board passed a resolution that en­ about firearm safety, and firearm courages physicians to educate the • remind patients to obtain safety. public about firearm safety. Here’s firearm safety locks, store guns what you can do to childproof the under lock and key, and keep ammunition separate.

Dr. Lawley and Dr. Liewer Retire after 34 Years of Pierce County Practice

Tom Lawley, M.D., announced his 1955. He graduated from Dartmouth the State University of Ohio in 1956 retirement effective February 1. Dr. College in 1941 and the University of and did his internship in General Lawley has practiced Ob/Gyn in Rochester School of Medicine in Practice at St. Joseph Hospital in Pierce County since January 10, 1944. Prior to settling in Tacoma, Dr. 1956-57. Lawley practiced medicine in San Francisco, California. Dr. Liewer served on the Board of Trustees in 1971, and has served on rj=^DIAPER R A SH ^t Dr. Lawley practiced active the Ethics Committee, Personal IS NOT A WAY OF LIFE. obstetrics until 1988 helping a large Problems of Physicians Committee, You can recommend professional number of Medicaid patients attain and several other committees as diaper service with confidence. quality obstetric care. well as numerous hospital commit­ tees. The Society wishes Dr. Liewer • Laboratory Controlled. Each month John (Jack) Liewer, M.D., has an­ and Dr. Lawley an enjoyable and a random sample of oar diapers is nounced that he will be retiring healthy retirement. subjected to exhaustive studies in a March 2. Dr. Liewer graduated from biochemical laboratory.

• Utmost Convenience. I ha n ks to p ick up and delivery service, our prpduct Stanley Tuell Appointed to State Board comes when you need it

• Economical. All this service, all this Stanley Tuell, M.D., PCMS Presi­ The Tacoma native retired in 1986 protection against diaper rash costs dent in 1963 and current Chairman after 33 years of private general far less than paper diapers - only of the Bylaws Committee, was ap­ surger/ practice. He continues to be pennies more a day than home- pointed by Governor Booth Gardner active in the Society and the medical washed diapers. ______to the State Board of Medical Ex­ community. CAUTION TO YOUR PATIENTS. It is illegal lo aminers. dispose of human excrement in garbage. Dr. Tuell serves on the Editorial Parents are doing this with paper/plastic The December appointment came Board of the Society’s publications diapers. "Disposable” is a misnomer. as a result of Dr. Tuell being recom­ and Chairs the Society’s Bylaws mended by the Pierce County Medi­ Committee. His Committee was cal Society and the Washington responsible for a 2 1/2 year effort Diaper State Medical Association. Tuell will that totally revised the Bylaws. replace George Tanbara, M.D., se rvice whose five-year term on the board His wife, Stephanie, is an active TACOMA WA TOLL FREE has expired. The Board of Medical member of the Auxiliary and was a 383-BABY 1-800-562-BABY Examiners sets policies governing stalwart Tel-Med volunteer when the Washington's Oldest, Most Trusted the granting of licenses to Society had the Switchboard in its of* - Professional Diaper Service r physicians entering practice in the fice. - j — i Serving Our Second Generation i \ state.

Pace 10 • March 1990 • Vol. 5, #2 NewsBriefs Continued..

Advanced Nurse Practitioners Seek Prescription Writing Authorization

Washington is among several states Board of Nursing is given authority for prescribing where advanced nurse practitioners to regulate this area with minimal privileges. are seeking state legislation to ex­ input from the Board of Medicine or They see it as pand their scopes of practice by ob­ Pharmacy. a necessary taining prescription writing authoriza­ step to direct tion. While the additional training in a reimbursement specialty area such as obstetrics, and dilation of Many feel that this expansion into anesthesia, pediatrics, psychiatric, physician medi­ medical practice is inappropriate, or family practice makes nurse prac­ cal direction re­ even if under established protocols titioners more knowledgeable than quirements. with collaborating physicians. The other nurses, it in no way qualifies This unrestricted practice of nurses argue that access to health them to be physician substitutes. medicine by non-physicians poses care will be improved if they can Certified registered nurse anes­ great potential harm to patients. prescribe. Typically, the State thetists are the strongest advocates

Average Professional Liability Premiums Paid By Self-employed M.D.’s, 1985-88

Average premiums (in thousands) Average Annual rate of change 1985 1986 1987 1988 1985-88 All Physicians $10.5 $12.8 $15.0 $15.9 14.8% Family Practice 6.8 7.3 8.9 9.4 11.4 Internal Medicine 5.8 7.1 8.4 9.0 15.8 Surgery 16.6 21.3 24.5 26.5 16.9 Pediatrics 4.7 6.3 7.1 9.3 25.5 Ob-gyn 23.5 29.3 35.3 35.3 14.5 Radiology 8.9 10.4 9.5 12.4 1.7 Psychiatry 2.5 3.4 3.8 4.4 20.7 Anesthesiology 17.9 20.5 22.9 23.6 9.7 Pathology 3.1 4.4 6.2 4.9 16.5 ‘ Excerpted from January issue of JAMA,

House Sitters PCMS and MAMC Discuss Trauma Care

A perennial problem for members On February 1, Gordon Klatt, M.D., the Trauma Committee appointed by leaving on vacation is trying to find a PCMS President, and staff met with the legislature. house sitter. The Society is willing to General John Hutton, Commander be a clearing house for names of of Madigan Army Medical Center; As a direct result of this meeting, house sitters that you have used and Major Chris Kaufmann, Surgeon; PCMS is calling together the leader­ found to be reliable. This would be a and Major Claude Gatrell, Emer­ ship of the medical community to great service to your colleagues. gency Medicine to discuss trauma discuss the feasibility of Madigan Please submit your names by calling care in Pierce County. and the medical community col­ 572-3667 or write Doug Jackman, laborating to enhance trauma care Pierce County Medical Society, 705 Dr. Klatt reviewed the current trauma in Pierce County. S. 9th, Suite 203, Tacoma WA, care situation as well as the report of 98405.

March 1990 • Vol. 5, • Page 11 705 South Ninth Street • Suite 203 • Tacoma, Washington 98405 • Telephone (206) 572-3666

Presents 66 Hand and Finger Injuries in Sport”

Featuring

Wade Lillegard, M.D.

on

Wednesday March 28

7:00 a.m. - 7:45 a.m.

at

Jackson Hall Auditorium 314 South K Street

Coffee and rolls will be provided.

For more information, please call 572-3666

Sponsored by: Sports Medicine Committee Pierce County Medical Society PCMS March Meeting Schedule

DAY DATE EVENT/MEETING TIME PLACE

Tuesday 6 Board of Trustees 6:30 p.m. St. Joseph Hospital

Wednesday 7 COME Board Meeting 7:00 a.m. St. Joseph Hospital

Thurs-Fri 8-9 Internal Medicine Review 7:00 a.m. Jackson Hall

Tuesday 13 General Membership Meeting 6:00 p.m. Fircrest Golf Club

Wednesday 14 Credentials Committee 7:00 a.m. Allenmore (Drs. Dining Room)

Thursday 15 Grievance Committee 7:00 a.m. Tacoma General Hospital

Friday 16 Sports Medicine Committee 7:00 a.m. MBCH

Tuesday 20 Executive Committee 7:00 a.m. MBCH

Wednesday 21 Public Health/School Health 7:00 a.m. Tacoma Dome Hotel

Wednesday 21 Medical Library Board 5:30 p.m. Tacoma General Hospital

Thursday 22 EMS Committee 7:00 a.m. MBCH (Lg. Bd. Rm.)

Friday 23 Minority Health Affairs 7:00 a.m. Tacoma General Rm. #4

Thursday 29 M.B.I. Board Meeting 7:00 a.m. Allenmore (Drs. Dining Room)

C.M.E.-Ski Meetings The Perfect Car Consultant Drs. Tosh Akamatsu, David Wil­ 7 5 2 - 8 8 8 8 hyde, George Gilman, and Tom 3009 Bridgeport Way West • Suite 4 Miskovsky participated in the Rainier Educational Emprize meeting in Nakusp, B.C., Canada. These physicians and Bill Jackson, M.D., BUYING SERVICE • PRICING participated at Schladming, Austria CONSULTING • APPRAISALS the previous year. If you are inter­ ested in participating in future educa- tion-ski meetings in Canada and Europe, please contact Dr. Tosh Domestic & Imports Akamutsu at 572-4619. Cars & Trucks

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March 1990 • Vol. 5. • Popp n Are You Picking Enough Daisies?

I read this poem a few months ago, and it has remained these doctors’ universe is their hospital and their profes^ prominently on my desk ever since. In addition to govern sional status within it. Their families and other interests get ing some of my thoughts each ______whatever time and attention may day, it makes me think about some be left over. of my patients and colleagues. I Even for a successfully practicing particularly wonder how I - and my physician, life is-or should be- I recall a conversation with a sur­ acquaintances—will sit back and more than medical practice. The geon contemplating retirement evaluate our lives when we're 85. old man’s poem asks whether you from a fine group practice. He told me he had never taken the tirmta Medical practice becomes such an are keeping things in perspective be active other than in medicine, all-consuming activity. So many despite the natural pressures for and now he feared the loss of his doctors I know run week-after- professional and financial “suc­ one activity upon retirement. It week from office hours to hospital cess. ” may have been too late for him- duties to meetings to night call, ------and many similar colleagues-to breaking the routine only a few pick more daisies. weeks a ye a r-o fte n oriented to professional and educational seminars. The center of How about you? Are you balancing medical practice and life's other features? Here’s the poem:

I’d Pick More Daisies By Ray Lucbt (85 years old at the time).

/f I had my life to live over, I’d try to make more mistakes next time. I would relax. I would limber up. I would be sillier than I have been on this trip. I know of very few things I would take seriously. I would be crazier. I would be less hygienic. I would take more chances. I would take more trips. I would climb more mountains, swim more rivers, and watch more sunsets. I would burn more gasoline. I would eat more ice cream and less beans. / would have more actual problems and fewer imaginary ones. You see, I am one of these people who lives prophylactically and sensibly and sanely, hour after hour, day by day. Oh, I have had my moments. And, if I had it to do over again, I'd have more of them. In fact, I’d try to have nothing else. Just moments, one after another. Instead of living so many years ahead of each day. I have been one of those people who never go anywhere without a thermometer, a hot water bottle, a gargle, a raincoat, and a parachute. If I had it to do over again, I would go places and do things. And travel lighter than I have. If I had my life to live over, I would start barefooted earlier in the spring. And stay that way later in the fall. I would play hooky more. I wouldn't make such good grades except by accident. I would ride merry-go-rounds. I'd pick more daisies.

•Reprinted from the Nnrth Carolina Medical Journal,

Page 14 • March 1990 • Vol. 5, 4 2 V Will There Be a Surplus of Physicians?

Contrary to earlier predictions, a rose 34 percent during that period. organizations, and perhaps, a rate new analysis concludes there that is even higher,” the authors should not be a surplus of The authors further support their write. physicians for the foreseeable future contention that a physician surplus in the United States, the January 26 should not take place in the foresee­ They add their predictions may not come true if extensive health care issue of the Journal of the American able future by citing two major Medical Association reported. physician recruitment studies. The rationing occurs. first was a survey of 788 hospitals In an accompanying editorial, Alvin The latest prediction is based upon two years ago, in which 60 percent a review of physicians’ work pat­ of those responding said they were R. Tarlov, M.D., of The Henry J. terns and their income between actively recruiting physicians or plan­ Kaiser Family Foundation, Menlo 1982 and 1987. Strong evidence ning to within the next year. The Park, Calif., says the authors incor­ arose from this study showing second study, conducted last year, rectly applied standard economic demand for physicians' services showed about half of medical theory to the question of physician rose at least as quickly as the supply groups with three or more surplus. of doctors, writes William B. physicians looking, or planning to Tarlov writes, “increasing hours Schwartz, M.D., and Daniel N. Men- look, for more physicians. worked, increasing numbers of delson, M.D., of the Department of “A rapid rate of technological patients seen, and increasing in­ Medicine, Tufts University School of come per physician can be viewed Medicine, Boston, Mass. change, the growth and aging of the population, an increase in the num­ as indicators of increasing use “Indeed, the data suggests that the ber of cases of acquired im­ rather than as an authentic rise in demand for physician’s services, as munodeficiency syndrome, and the demand.” measured by hours of patient care likely extension of health insurance •Excerpted from 1/26/90 issue of JAMA. and real income, has been rising coverage to the uninsured are likely faster than physician supply,” the to maintain a rate of increase in authors write. “Moreover, a variety demand of at least 2.2 percent per of forces is likely to maintain the year, the historical rate of growth in growth in demand for physicians’ demand seen in health maintenance services, thus preventing the development of an appreciable surplus.” In the late 1970s, the Graduate Medi­ Dear Doctor: Puget Sound Treatment Center cal Education National Advisory offers real help, and hope for your patients who Committee (GMENAC) predicted by this year, the U.S. would have are struggling with alcohol or drug problems! 70,000 more physicians than it needed and 150,000 too many by Cited As One Of The Nation's Best Treatment Facilities the year 2000. Other studies since the GMENAC study predicted even (206) 756-9548 or 1-800-522-0920 larger surpluses. Dr. Olle Garrison, Medical Director, 474-0561, ext. 392 The data shows each physician is spending more time providing • Accredited Treatment For Adults & Adolescents patient care, there was a drop in the number of patient visits, and • Confidential, Professional Assessments physicians’ aggregate net income • Complete Inpatient, Outpatient And Variable Length-Of-Stay; Family And After-Care Programs • Close Consultation With Referring Physician Qualified Physicians Needed • Treating Alcohol, Cocaine And Other Addictions • Medically Supervised Detoxification Western Washington • Low Volume • 24 beds, 8 patients per hour • 12-72 • Specialized Detoxification For Pregnant Women hour shifts • Graduate of an accredited Medical School • Current WA License • Intervention Training and ACLS Certification • One Year Emergency Room Experience • Mal­ • DWI Treatment Services PUGET practice Coverage Provided: Claims ffit An American Made with Unlimited Tail 215 S. 36th Street Heallhcare SOUND CALL National Emergency Managem ent, Inc. HOSPITAL Tacoma, WA 98408 Facilily Services: 1-800-554-4405

March 1990 • Vol. 5, • Page 15 The HIV/AIDS Program Answers Your Questions

Is training required to per­ How long should patient with multiple risk factors may form HIV/AIDS counsel­ HTV/AIDS counseling require extensive risk reduction ing? take? education. Specific training on AIDS counsel­ The time required for HIV/AIDS Some patients, because of prior ing, pretest counseling, or posttest counseling, pretest counseling, or reading, calling HIV/AIDS hotlines, counseling is not required for health posttest counseling is dependent on or prior HIV testing are quite care professionals who order or several variables. The time required knowledgeable about HIV/AIDS. A prescribe a test for evidence of infec­ may only be five minutes or may be review of the individuals risk factors, tion with HIV. more than an hour. The most impor­ the risks and benefits of HIV testing’ and a reinforcement of risk reducing Such training is recommended, tant variables include: risk status of the patient, the patient’s prior behaviors m ay be sufficient to meet especially for health care providers knowledge of HIV/A1DS: and if patient needs and the requirements of law. Finally, where HIV counseling/test­ ing is being offered as a separate Qualified Physicians Needed service, the time requirements for this service will appear greater. As Seattle • Low Volume • 60 beds • 12-36 hour shifts • Graduate of an part of a sexually transmitted dis­ Accredited Medical School • Current W A License and ACLS Certifica­ ease examination, those time re­ tion « Two years or 2000 hours Emergency Room Experience • 150 quirements will appear less, as hours of CME Credits - credits must be AOA-AM A approved and docu- those services share certain risk as­ mentable ♦ Malpractice Coverage Provided: Claims Made With sessment and risk reduction educa­ Unlimited Tail tion elements. Call National Emergency Services — 1-800-554-4405 — Mimi L. Fields, M.D., Assistant Secretary, HIV/AIDS and Infectious Diseases serving persons whose behavior HIV/AIDS counseling/testing is being Department of Health may increase their risk of HIV infec­ offered separately or as part of a full tion and for health care providers range of health care services. who are not otherwise prepared to deal sensitively with issues such as Washington Administrative Codes re­ sexuality, drug use, and H)V risk quire HIV/AIDS counseling to be reduction. The need for training can based on the individual’s risk fac­ best be judged by the principal tors. A patient who is deemed “vir­ health care provider or health care tually at no risk of infection” requires facility administrator in consultation few of the risk reduction messages. with a qualified HIV/AIDS counseling Risk reduction education, therefore, trainer. could be very brief. Conversely, a Sen/ice providers who routinely offer HIV risk reduction counseling and testing should have staff specifically trained and have a quafity assurance James D. Me Alexander, D.P.M . program in pJace. Preliminary results of a study of trained HIV/AIDS coun­ selors in Washington State suggest Announces risk assessment and risk reduction his association with education deficiencies. Training is not a substitute for quality as­ Stephen M. Fusony D.P.M . surance. Training assures the coun­ 7800 Pacific Avenue, Suite #1, Tacoma/473-5566 selor has been exposed to the and necessary skills and knowledge, not that those skills are practiced or the the opening of knowledge shared. The Gig Harbor Foot and Ankle Clinic Olympic Drive N.W.,, Suite A -104.-104, Gig Harbor/858-8100Harbor/858- L ^Evening and Saturday hoars by appointment only. Page 16 • March 1990 • Vol. 5, #2 Auxiliary News

perintendent of Auxiliary Meeting Public Instruc­ tion to offer a Notice day-long health Watch Your Mail conference for "Prevention and Early Intervention of middle school for Important Drug and Alcohol Abuse” is the students and Information topic of the next general member­ staff. Two stu­ ship meeting - Friday, March 16, dents and one April 1! 10:00 a.m. at the United Methodist educator from Church, 1919 West Pioneer, Puyal­ each public and lup, Washington. private middle need to be receptive to accurate in­ Our speaker, Elizabeth Noods Fraus- school are invited to attend. This ex­ formation in order to make respon­ to, M.S.W., has worked in the drug citing event is scheduled for April 17 sible decisions for a healthy life. prevention field for ten years. She and it will again be held on the Central Washington University cam­ The Auxiliary plans to increase atten­ currently contracts with Pierce Coun­ pus in Ellensburg. dance to 800 plus participants this ty Social Services to provide coor­ year. Your help is needed. We need dination and technical assistance to The conference topics, Personal you to contact the middle schools in schools and communities to help Loss and Fitness for Life, were your community to encourage par­ them develop prevention and early selected after surveying the interests ticipation. This can be done by intervention programs, conferences, of teens, school staff, physicians, phone or in person. Even though and seminars. and auxilians. Development of these schools receive triple mailings about issues will include information on dis­ Please join us for this timely discus­ the forum, the notice often fails to ease prevention and mental health. sion, that in one way or another, reach the right “motivated” persons. Mimi Johnson, M.D.(Kirkland), and touches all of our lives. Let’s get as many Pierce County Douglas Shadle, M.D.(Wenatchee), teens as possible to the forum. If will present the two large you can devote 2-4 hours during workshops. Other health profes­ one school day, please call Jo Roller sionals will facilitate small group dis­ (752-6825) or Alice Wilhyde (572- Choice, Not Chance cussions on specific subtopics. 6920). The forum theme, Choice, Not PCMS Auxiliary has assumed the PCMS Auxilians are needed to help Chance, will be the focus of all responsibility for processing the con­ prepare for the second annual teen presentations. Nancy Thies Mar­ ference evaluations. Please call Jo health forum, Choice, Not Chance. shall, former U.S. Olympic gymnast, or Alice if you can assist with tallying is our keynote speaker. She will set answers. Auxilians and physicians are work­ the tone for the day emphasizing the ing jointly with the Office of the Su­

Graduating Seniors

The Medical Society and Auxiliary would like to recognize our sons and daughters who are graduating this year. If you have a son or daughter graduating from high school, vocational school, college, graduate school, etc., please take a moment to fill this out and return it to Patty Kesiing/3720 Horsehead Bay Dr. N.W./Gig Harbor, WA 98335. This information must be received by April 1,1990. Student s Name: ______. . —___ -_ > School:______Home Address: . ,______,______Parent’s Name(s): ______Degree or Diploma Received: ______Future Plans: ______

March 1990 « Vol. 5, • Page 17 Introducing Our New One Stop Practice Protection

Physician’s Insurance Agency is pleased to introduce a new service called One Stop Practice Protection for individual and group practices. One Stop Practice Protection offers a complete range of professional and personal insurance plans and packages including:

a Business Office ■ Disability ■ Health Care ® Life Insurance a H om eow ners ■ A nnuities ■ Auto & Boat « Umbrella Packages

Physicians Insurance Agency is owned by Washington physicians and managed by dedicated professionals committed to quality, convenient service.

For more information about our new One Stop Practice Pivtection service, please call Nora Dacus, Agency Manager, today.

Western Washington 1-800-962-1399 Eastern Washington 1-800-962-1398

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Positions Available PHYSICIAN RETIRING - For sale - reception room furniture, 2 exam Personal rooms of furniture will be available Problems RESEARCH ORIENTED physician 5/1/90. Contact Dr. Judd at 584- who is mature enough to be inter­ 5559(wk.) or 588-2686(hm.). of Physicians ested in and able to afford working Committee half-time, yet vital enough to retain FOR SALE - Gyntech cryoprobe enthusiastic entrepreneurship to with nitrous oxide tank and several For Impaired Physicians help a thriving research clinic con­ different tips - $600. Dr. Morrison - Your Colleagues tinue to expand. All this while living 848-7297. in a pleasant Pacific Northwest com­ Want to Help munity of less than 50,000. (The pos­ Medical Problems, Drugs, sibility of practicing “on the side” un­ Alcohol, Retirement, likely.) Call 206-357-6689. Office Space Emotional Problems PRIMARY CARE PHYSICIAN - JUST RETIRED. Available now - Rainier School, Washington State's Committee Members busy 2 doctor medical office, 2,400 Patrick Donley, Chair. 272-2234 largest residential care facility for the square feet, 32 car parking lot. Excel developmentally disabled adults, is Joseph Kramer...... 845-9511 lent location. Near hospital. For sale seeking an Internist or a Physician. or lease. 610 S. Meridian, Puyallup - John R. McDonough.. 572-2424 Salary negotiable up to $70K (Inter­ 845-8176 or 848-6478. William A. M cPhee..... 474-0751 nist) or$63K (Physician), plus Ronald C. Johnson...... 841-4241 malpractice insurance, medical and Kathleen Paris...... 591-6681 dental, life and long term disability in­ BEST MEDICAL SPACE IN TOWN. Dennis F. W aldron...... 272-5127 surance, a good retirement plan Cedar Medical has 1,450 square feet Mrs. Jo Roller...... 752-6825 along with paid sick and vacation available on the golf course side - leave. Contact Dr. R. Ruvalcaba, 1901 S. Cedar. Call Crawford Katica, WSMA Clinical Director, Rainier School, Inc., Gary Crawford, 272-9200. 1-800-552-7236 P.O. Box 600, Buckley, WA 98321 or call (206) 829-1111, Ext. 411.

PHYSICIAN OPENINGS - Emergency Department/Am­ bulatory Care. Civilian opportunities at the Naval Hospital - Bremerton, Advertise in the Classifieds WA. Full time EM/FP/IM with ACLS and ATLS certification. Contact David C. Jester, D.O., EMAC Medi­ Prices Advertisers Name and Address cal Director, Naval Hospital - Bremer­ ton, Boone Road, Bremerton, WA PCMS Newsletter - — 98312, (206) 478-9585 or (206) 478- 75 cents per word __ .______9322. The Bulletin - _ 85 cents per w o r d ______10 word minimum Ad Copy on all ads. - Equipment Deadline April Newsletter LARGE SUPPLY of rolling exam deadline is March 15. stools, mayo stands, and goose Please call 572-3709 neck lamps at substantial savings. for more information. Call Lynlees’ at 867-5415 for more information and a free catalog. Send check to: ______Showroom open Mon. - Thurs. 8:30- Pierce County — ------— ------: 4:30, Fri. 8:30 - 3:00 and Sat. 10:00 - Medical Society, 705 : 12:00 in Redmond. South 9th, Suite 3 0 1 ______— ------'■ Tacoma, WA 98405 I ...... j Vol. 5, #2 • March 1990 • Page 19 Helping people discover their capabilities Capable works with Physicians as Partners in Patient Rehabilitation.

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N aiinruillv Ai_t Liuned K n jo liic I lij'h-T i-di Sy.'-lcm \inpnii.v s'uppi >n I'ni'up ■ Arrns: M.iriual, Mvoelecim', I’assive < >i\ o il ! t’ "pii.il I’run.-Mii" >1 In'uraiur Oaniis, \'A. ORTHOTICS: Lightweight Orthotic Specialists Dslls I. .S I. IAK. Me-Jicalc ■ Buck. Knee, Ankle. W rist, und Sport* Brannt' A-.'i^nnieni ( .1 >tirr\n_'l I I Cu^om-Makk-il Fool Orrlnuio> thrush eduv.,ti'in B Soli O 'liiJ.v t?a<:k, VC'rKi, and Ankle Siippnrh, ComprvNsion ‘'loekinys

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Moving (Cont/nued) monthly mortgage obligation. The central to the major hospitals and Pierce County Dental Society has many medical offices in town. With become the first tenant. a new conference room available to profit subsidiary of PCMS, Member­ seat approximately twenty people, it ship Benefits, Inc., allowing for tax Moving day will be April 1. Renova­ is hopeful that more meetings will be benefits, The new building will pro- tion will be taking place during the able to be scheduled at the Society vide space for future growth, as well month of March, prior to occupancy. office. as rental income to help defray the The new Society office remains

Pierce County Medical Society 705 South Ninth Street, Suite 203 B u lk Rate Tacoma, WA 98405 U.S. Postage PAID T a c o m a , W Permit #605 ADDRESS CORRECTION REQUESTED PCMS J

)

J - , A publication of the

Volume 5, #3 ♦ April 1990

H ealth Access Am erica

The AMA Proposal to Fcxisration staff at the AivlA's Nation­ considered "medically uninsurable". al Leadership Conference in . _ Improve Access t o ----- Phoenix. Feb. 24-26. It is a for­ ..AMA’s multi-faceted plan envisions Affordable, Quality midable 16 point proposal that is ox - expanding access to health care Health Care pected to dominate the coverage to all Americans while Association’s activities for several undertaking actions to control inap­ years. propriate costs and reduce paper- workand bureaucracy. T he AMA is embarking upon an The foremost objective of the cam­ intensive campaign aimed at .__ paign is to stimulate enactment-ef"' Here are the 16 objectives of Health giving the medically vulnerab:o t’u; Tegislativ&and other prdgrartis taas- "Access America: uninsured, underinsureiiand the. sure affordable coverage ofquality \ v H 1) Effect major Medicaid uninsurable-ready access to wfiat health care selvices fqr..the;33 rpiil- reform to provide uniform ade­ other Americans already enjoy tr,e lion Americans who now lack either quate benefits to all persons world’s most advanced medical public or private health insurance. below the poverty level. health system. Comprising about 70% of this unin­ sured group are 24 million working .HI 2) Require employer provision “Health Access America” was individuals and their families. previewed for physicians and Another three million Americans are (Continued on page 4)

INSIDE... April 17 General Membership ' Applicants...... 5 Meeting Rescheduled ; Auxiliary News...... 21 Classified...... 23 Due to a conflict with the Annual Meeting of C.O.M.E. News...... 3 Pierce County Medical, the April 17 General Directory Changes...... 5 Membership Meeting has been rescheduled. General Meeting...... 19 April Meeting Schedule... 18 If you have pre-registered and this poses a con­ Medical Ethics...... 17 flict with your schedule, please call the PCMb of­ Newsbriefs...... 6 fice for reimbursement. Office Lab Regulation 15 Stuart Farber, M.D. will present “Palliative Office Theft...... 16 Medicine; An International Experience — Is Pierce President's Notes...... 2 County Ready for It?” at a Fall General Member­ Prenatal Care...... 10 ship Meeting. Retirement Luncheon...... 14 President’s Notes

cussion of the AMA’s proposal to im­ former U.S. Surgeon General. His O n February 24-26,1990, Dr. prove access to affordable, quality presentation convinced me that he William Marsh, Doug Jack­ health care. is truly a medical statesman and con­ man and I attended the American tinues to represent our profession Medical Association Leadership Con­ This proposal, which was released well. ference in Phoenix, AZ as repre­ pubiicly on March 7, is entitled sentatives of the Society. We were “Health Access America" (See front Upon returning to my practice, it be­ also joined by Dr. Eileen Toth, Inter­ page), and contains sixteen “ points came more obvious to me that each nist, and President of the Allenmore of action”. These "points of action of us must become involved in help­ Medical Staff. will be the original focus of discus­ ing to solve these problems. If we It was an intensive two and one-half sions with national, business, legal, do not, then we are a big part of the days of meetings on many aspects government, insurance and patient problem and will not have a chance of organized medicine. Many ses­ advocate groups. Together they will to control our own destiny. sions were focused on developing attempt to solve the access and PCMS has purchased the AMA and improving leaderships skills; cost problems of health care in this Leadership Conference audio tapes however, the primary thrust of the country. for you to enjoy at no charge. meeting was the unveiling and dls- The concept that practicing P/ease take a moment to look over physicians have an opportunity and the tapes (below) and call 572-3667 obligation to heip solve this national to reserve your tape. ^ PCMS Officers: Gordon R. Klatt President problem was discussed very elo­ William G. Marsh President-elect quently by Dr. C. Everett Koop, ~GRK John B. Coombs V ice President Joseph H. Wearn Secretaiy-Treasurer William T. Ritchie Past President

Stuart D. Freed AMA Leadership Conference Audio Tapes K. David McCowen A. Robert Thiessen David E. Law Tapes are available through the Profession Self-regulation Anthony S. Lazar William F. Roes PCMS office on several presenta­ - A look at the controversial issues Alice Wilhyde tions given at the AMA Leadership - professional, legal, political - in­ Conference in Phoenix, Arizona in volved in medical self-regulation. February. Speakers on all the topics p oy Membership Benehts, Inc., Understanding Our National for members of the Pierce County Medical were national leaders in their field. If Society. The Pierce County Medical you would be interested in hearing Priorities Society is a physician member organization dedicated to the art, science and delivery one please call the Medical Society - A growing number of interests of medicine and the betterment of the office at 572-3667. must compete today for increasingly health and medical welfare o f the com­ munity. scarce federal funding. How can we SQ_Years of Progress Advertising arid newsletter copy must ar­ set priorities among education and rive in the Society office by the 15th day of - Speaker Michael DeBakey, M.D. housing, health care and defense? the month preceding the publication date. and George H. Poste, Ph.D., DVM, Advertisements in tfiis newsletter are paid A panel of experts offer their views. and not necessarily endorsements of ser­ ScD, President, Smithkline Beecham vices or products. W e welcome and invite Pharmaceuticals. The speakers ex­ your letters, comments, ideas and sugges­ tions. amined our unique health care sys­ - Health care rationing may be ex­ tem and the remarkable medical ad­ plicit or implicit, its effects both prac­ vances it has fostered. Presentation tical and ethical. Experts in medical Editor: by Dr. Poste is particularly fascinat­ ethics discuss the implications of David S. Hopkins ing and enlightening. such rationing for the providers and Managing Editor: recipients of health care services. Douglas Jackman Bridging IHp Editorial Committee; - The tape consists of a series of Current Trends In Risk s ° X sT"°ii;ltins(a*lm,an5' panelists describing a number of ex­ Management W. Ben Blackc-tt, isting programs that demonstrate - Find out about recent develop­ Richard Hawkins that the medical profession can ments that promise to affect the Publications Coordinator: regain the public’s trust. Monique Johnson practice and profession of medicine. Advertising: Q ualiM arameters Kim Reed MMlcine in the ponr^ - Can medical practice parameters - Supreme Court Justice Black- wh lpaHS$Ure 9h quality patient care mun has piayed a key role in iacom a, W A 98402 while decreasing overutilization'’ Supreme Court decisions that help (206)572-3667 How can they be applied to medical shape today's medical practice. He. © PCMS 1990 and physician shares his views on the ever-chan|r liability? Peter Bouxsein, J.D. ing relationship between medicine and the courts. + Page 2 • April 1990 • Vol. 5, #3 College of Medical Education

Sun Valley CME Registration Underway

Registration for the Sun Valley CME The conference offers a quality program in 1991 has begun. Spon­ CME program (12 Category I sored by the College of Medical Credits) as designed by program Education, the conference will be coordinators Mark Craddock, M.D., held at Elkhorn Resort and is Stuart Freed, M.D., and John scheduled for February 27, 28, Lenihan, M.D. March 1, 2 and 3, 1991. Lodging has been arranged at Sun To assure space in the conference, Valley’s Elkhorn Resort and offers to arrange for the best lodging at considerable savings for hotel reduced rates, and to secure limited rooms and condos. Reduced rates air transportation at convention have also been arranged for flight tie fellowship, this program offers an rates, those interested should plan reservations. However, as air service opportunity for PCMS members and to register soon. Registration pack­ is limited, conference participants their families to get away from the of­ ets have been mailed only to those are urged to resen/e space now. For fice and enjoy one of the most Pierce County Medical Society Mem­ lodging and flights, the negotiated beautiful spots in the country. bers who returned the initial Sun Val­ savings is good immediately before ley CME Survey. Other PCMS mem­ and after the conference for those Also planned is a pre-conference bers may receive registration and who wish to extend their visit. wine and cheese reception, a lunch lodging information by calling the and fashion show, sleigh rides, din­ College at 627-7137. Unlike large national CME meetings, ners and breakfast each morning for which are expensive and provide lit- all conference participants. ♦ Surgical Club

The 59th Annual Meeting of the Jordan, M.D. and sponsored by the featuring local speakers, will follow Tacoma Surgical Club, featuring dis­ College of Medical Education. As in Saturday until about 4:00 p.m. and sections, surgical demonstrations, the past, the dissections and surgi­ will offer Category I CME credits. and lectures, is scheduled for April cal demonstrations will be held on Social events for club members are 13 and 14 at University of Puget Friday, April 13 from 1:00 p.m. to scheduled for Friday and Saturday Sound's Thompson Hall. 5:00 p.m. and on Saturday, April 14 evenings and require reservations, f from 8:00 a.m. to 9:00 a.m. Lectures, The program is coordinated by Chris Dermatology C.O.M.E. Program Schedule The College's Dermatology Program DIRECTGR(S) is scheduled for Friday, April 27 in DATE(S) PROGRAM Jackson Hall. Organized by Barbara Fri., Sat., Tacoma Surgical Chris Jordan, M.D. Fox, M.D., Davide Brown, M.D., and April 13 & 14 Club James Komorous, M.D., this full day program will provide an update on Fri., Dermatology Barbara Fox, M.D. pertinent dermatologic subjects in­ April 27 James Komorous, M.D. cluding dysplastic nervi; cutaneous David Brown, M.D. manifestations of AIDS; psoriasis and other papulosquamous dis­ Thirs., Fri., Aggressive Edgar Steinitz.M.D. eases; a practical approach to acne; May 10 & 11 Musculoskeletal genital warts; and common der­ and Spinal matologic procedures. Guest lec­ Evaluation,Treatment turers from the University of and Rehabilitation Washington will be included. For registration information, call the M on, Tues Advanced Cardiac James Dunn, M.D. College at 627-7137. June 25 & 26 Life Support

Vol. 5, * 3 * April 1990 • Page 3 Health Access (Continued) One-Day Gallbladder Removal of health insurance for all full­ Is Now Available Exclusively time employees and their families, creating tax incen­ tives and state risk pools to At Puget Sound Hospital enable new and small busi­ nesses to afford such Laparoscopic Laser By using four small puncture coverage. incisions instead of the tradi­ Cholecystectomy - tional long abdominal incision, B 3) Create risk pools in all most patients are out of the a remarkable new procedure states to make coverage avail­ hospital the next day, and back able for the medically unin- that could save patients weeks to work and other normal surable and others for whom of painfull recovery by eliminat­ activities within a week. individual health insurance ing the major abdominal inci­ policies are too expensive and sion - is now being performed at Estimates are that up to 90% group coverage is unavailable. Puget Sound Hospital. of patients facing cholecystec­ I 4) Enact Medicare reform to Using Puget Sound's compre­ tomy due to gallstones or other avoid future bankruptcy of the hensive Laser Surgery Center, disease could benefit from the program by creating an ac- the procedure is being per­ Laparoscopic L aser procedure. tuarially sound, prefunded pro­ formed by Glenn Deyo, MD. F or more information on the gram to assure the aging population of continued ac­ Dr. Deyo is Board Certified in Laparoscopic Laser procedure, cess to quality health care. General Surgery, and has or to make a patient referral,. The program would include trained at the HCA Laser Cen­ please call Dr. Glenn Deyo at catastrophic benefits and be ter in Nashville under Dr. Eddie 756-8560. For information on funded through individual and Reddick, who pioneered this Puget Sound's Laser Center call employer tax contributions new procedure. Bruce Brandler at 474-0561. during working years. There would be no program tax on senior citizens. 9) Develop proposals which ■ 5> Expand long-term care B lated health insurance polices, financing through expansion encourage cost conscious providing fair competition. of private sector coverage en­ decisions by patients. 14) Repeal or override state- couraged by tax incentives, B to) Seek innovation in in­ mandated benefit laws to help with protection for personal as­ surance underwriting, includ­ reduce the cost of health in­ sets, and Medicaid coverage ing new approaches to creat­ of those below the poverty surance, while assuring level. ing larger rather than smaller thorough legislation that ade­ risk spreading groups and quate benefits are provided in B 6) Enact professional liability reinsurance. all insurance, including self-in­ reform essential to reducing in­ 11) Urge expanded federal surance programs. ordinate costs attributable to B liability insurance and defen­ support for medical education 15) Seek reductions in ad­ sive medicine, thus reducing research and the National In- ’ ministrative costs of health health care costs. stitutes of Health, to continue care delivery and diminish the progress toward medical excessive and complicated B 7) Develop professional prac­ breakthroughs which histori­ paperwork faced by patients cally have resulted in many tice parameters under the and physicians alike. direction of physician organiza­ lifesaving and cost effectinq tions to help assure only ap­ discoveries. 16) Encourage physicians to propriate, high quality medical practice in accordance with 12) Encourage health promo­ services are provided, lower­ B the highest ethical standards tion by both physicians and ing costs and maintaininq and to provide voluntary care quality of care. patients to promote healthier for persons who are without in­ lifestyles and disease preven­ B 8) Alter the tax treatment of tion. K surance and who cannot af­ employee health care benefits ford health services. to reward people for makinq ■ 13) Amend ERISA or the economical health care in­ federal tax code so that the surance choices. same standards and require- S-f^to^lf-m sured (tRlSA)plans as to state-regu-

Page 4 • April 1990 • Vol. 5, #3 Document Patient Teaching Beginnings: A Practical Guide 1990 Directory Changes Through Your Pregnancy Allenmore Hospital Comprehensive, current prenatal educa- j Specialty Services (pg. 156) the correct Main Hospital tion. Based on guidelines of Washington Number is:. 5Z2-2323 NOT 752-2323. Prenatal Task Force. 8th Grade reading I level. Six segments by gestational age. Brandt Bede, M.D. Easy documentation reduces liability risks. J Correct physician's only phone number is 272-3670. Fully reviewed by OB and FP fellows. Affor- I dable. Contact Practice Development, Inc. Steven Brack, D.O. 2821 - 2nd Ave. Suite #1601, Seattle, WA 98121 (206) 623-7395 Change from M.D. to D.O. William Bulley, M.D, Correct home phone number is 840-9404. Robert Ferguson, M.D. Delete insurance address. Applicants for Robert McAlexander, M.D. Membership Where it reads “To schedule at all Labs call. . the cor­ rect Suite number is 10. His actual office is in Suite #201. The Pierce County Medical Society welcomes the follow­ Jessop McDonnell, M.D. ing physicians who have ap­ Correct office phone number is 272-5525. plied for membership. As out­ George Macha, M.D. lined in the Bylaws, any mem­ Correct home phone number is 752-4043. ber who has information of a derogatory nature concern­ Craig Rone, M.D. ing an applicant’s moral or Delete the Answering Service number. ethical conduct, medical qualifications or other such requisites for membership, shall assume the respon­ sibility of conveying that infor­ i The following physicians (Cedar Surgical Associates) are no longer mation to the Credentials ! in Suite #204 — They are now in Suite #303: Committee or Board of Trus­ I Stanley Harris, M.D. tees of the Society. j Chris Jordan, M.D. j Ronald Taylor, M.D. j Carrie Thoms, M.D. K irkE . Rue, M.D. Anesthesiology. Bom in Los I The following physicians Accept Referral Patients Only: Angeles, 05/10/50. Medical | Patrick Hogan, D.O. school, Loma-Linda Univer­ j James Griffith, M.D. sity, 1975; internship, Univer­ r The following physicians have retired as of 12/31/89: sity of Washington, 1977; I . : John Colon, M.D. residency, University of ' Thomas Lawley, M.D. Washington, 1979; graduate pT - Edward McCabe, M.D. training, Kings College, Lon­ pCharles McGill, M.D. don, 1987. Washington State « , Michael Morrell, M.D. License, 1978; board cer­ tification, Anesthesiology, 1981. Dr. Rue is practicing at 314 South K Street. Qualified Physicians Needed Daniel P. Coffey, PA-C Physician’s Assistant. Born in Chewelah, WA, 11/04/47. Walk-in Clinic • Military Facility • Eight hour shifts * Excellent sup­ Physician’s Assistant Pro­ port • $3\0(/per/hr • Full and Part-time Positions « Graduate of an gram, Yale University, 1978. Accredited Mcdical School • CurrcntWashingtonLiccnsc • Current Washington State License, BLS/ACl .S Preferred • Malpractice Coverage: Claims Made With 1988. Mr. Coffey is assisting Unlimited Tan Dr. Kevin P. Schoenfelder at For more information please call: 1515 South K Street. National Emergency Services — 1-800-554-4405

Vol. 5, #.? ® April 1990 • Page 5 Bylaws Revision

2. In Chapter IV, Section 5, amend The following revisions in the Medi­ The following Bylaws amendments to read as follows: cal Society Bylaws were recom­ would give osteopaths the option of belonging to either the WSMA or mended by the Bylaws Committee The President, President-Elect, Vice WOMA. However, the member to the Board of Trustees of the Medi­ President, Immediate Past Presi­ would be required to belong to one cal Society for approval: The Board dent, Secretary-Treasurer, and the of the state organizations. The of Trustees at its March 6 meeting appropriate number of trustees amendments will be brought before approved the recommended chan­ selected by the President and ap­ the May 8 General Membership ges. Approval of these changes will proved by the Board, shall serve as Meeting for a vote. Additions are un­ be voted on at the May 8 General delegates from this Society to the Membership Meeting of the Medical derlined. They are: Washington State Medical Associa­ Society. 1. In Chapter III, Section 1, A., a., tion House of Delegates; provided, iv., change the wording to read: that no member who is not a mem­ Rationale: ber nf the WSMA shall be eligible tn iv. maintain membership in the There are 42 osteopaths who prac­ serve as a delegate to the House nf Washington State Medical Associa­ tice in Pierce County and 14 of Delegates of the WSMA. those 42 are currently members of tion onheVVashr^ ^indicates addition to Bylaws. the Medical Society. A survey indi­ Medical Association.* cated many nonmembers would join the Medical Society if they were not required to join the Washington State Medical Association. They would prefer to beiong to the Washington Osteopathic Medical As­ sociation. Pierce County Medical Society Bylaws require membership in the Washington State Medical Associa­ tion. Dues to WSMA are $418. The Offering the OPTIFAST™ Program Washington Osteopathic Medical As­ for your patients who are significantly overweight sociation dues are $550. This and may have associated medical problems. places a considerable financial bur­ den on our osteopathic colleagues by Physician Referral who want to belong to WOMA. Medical Supervision Friendly, courteous, professional clinical team, physicians, dietitians, nurses, behaviorists

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Page 6 • April 1990 • Vol. 5, #3 NewsBriefs Continued..

Trauma Care in Pierce County PROs Should Go,

Dr. Gordon Klatt, tal represented the major hospitals. Says IOM PCMS President, Drs. Bill Martin and Jim Buttorff called together spoke for the trauma surgeons; Drs. The Institute of Medicine had recom­ many of those in Jim Fulcher, St. Joseph Hospital mended that the excessively “adver­ trauma care on and Bob Wachtel, Tacoma General sarial and punitive” peer review or­ Friday, March 16 and Chairman, EMS Committee rep­ ganization program should be aban­ to discuss the op­ resented the neurosurgeons and in- doned. In a report mandated by Con­ tions available to tensivists respectively. gress, the IOM proposes that PROs Pierce County with be replaced by “Medicare Quality regard to trauma All those present agreed that the sys­ Review Organizations" which would care and a desig­ tem needs to be reviewed. A sub­ be research and education-oriented. nated trauma cen­ committee was named to look more After a two-year study of Medicare’s ter. closely at the current situation and come forth with some alternatives quality assurance activities, IOM con­ General John Hut­ and recommendations. Chairing the cluded that PROs are “rigid, redun­ ton, Commander, subcommittee will be Dr. Bill Martin, dant and unwieldy for providers," MAMC; Chuck Hof­ general surgeon, who has been ac­ and that the regulatory approach fman, Multicare; tive in trauma care for several years. PROs use should yield to a system and John Long, which would provide incentives to St. Joseph Hospi­ physicians and be based on analysis of scientific outcomes.

Persing, Dyckman, Toynbee, Inc., Insurance Brokers

On March 16, Dr. Joe Wearn, Quality Service for Quality Clients Secretary-Treasurer for the Society Insurance Specialists Since 1945 and its for-profit subsidiary Member­ ship Benefits Inc., signed the Deed (206)627-7183/FAX (206)572=1430 of Trust and bank loan to complete Bob Sizer 705 South Ninth, Tacoma WA 98405 the purchase agreement. Staff antic­ Doug Dyckman ipates being in the office by April 3. Curt Dyckman David Gillespie, CIC The building has a total area of David Babbitt A u to # H o m e 4,977 sq. ft. and 3,930 sq. ft. of this Marge Johnson, CPCU Business • Professional Rob Rieder is office space. Approximately 1,900 Carrie Lugo Group ® Disability • Life sq. ft. will be leased to other parties. Bob Cleaveland, CLU, ChFC The Pierce County Dental Society will be occupying two offices. An open house is planned when the building is ready to meet the public. One Stop Service In Memory INTEC ■-= —^ For the "Particular" Only James McNerthney, retired , School in Omaha, Nebraska. He obstetrician and gynecologist, served in WWII as a naval officer Letterhead and Business Card Design died Sunday, February 25, 1990 and practiced medicine for 30 Corporate Identity and years in Tacoma until his retire­ Capability Brochures while vacationing in Mexico. Dr. Newsletters McNerthney was a lifelong ment in 1986. He was a member To coma resident and a member of several medical and Our specialty is quality. ' " of the Medical Society since benevolent organizations. He is (206) 627-8282

*£ February of 1957. He graduated survived by his wife, Eloise, and Call about our Desk Top Publishing from Beliarmine, Creighton children Michael, Molly, Melissa, and Presentation Services Maureen, and Megan. KUniversity and Creighton Medical INTEC, In te g ra te d G ra p h ic Technologies H 9 S. 9th, Tacoma, WA 98402 NewsBriefs Continued...

Bon Voyage

Consortium and our county as Once upon a time, a beautiful young and journals, interlibrary loans, com­ being innovative and leaders in giri danced and sang in the fairyland puter searches, consultation on medical education. castles of Austria. A handsome educational materials, and a daily courier service between participat­ American Army officer was cap­ During these past 20 years, there ing hospitals. This did not happen tivated by her zest for life and have been many library chairmen without some effort. spirited her off to the iand of the and committee members who have free. Circumstances dictated that Dr. Lester Baskin recommended strengthened the library. Each of she pursue avocation and Tacoma closure of the Medical Society them deserves an accolade. The Generai Hospital was most fortunate Library from his position as Society library is now a free standing Central to obtain her services as Medicai President. Dr. Glen Brokaw reviewed Resource Library, governed by a Librarian in 1967. Under her the existing material, transferred the seven-member Board of Directors guidance, the library became the ancient tomes to the University and under new direction. Ms. von most used resource in our county. library, and streamlined the Bruck is retiring, though I doubt that Pierce County Medical Society met remainder to fit the needs of the she will be able to remain inactive in the auditorium basement of the practicing physician. Dr. Dick Bar- for long. Her efforts have made a Medicai Arts building. The library ronian represented Pierce County very real difference for the better in was adjacent and was filled with Medicai Society during the negotia­ our community. We can look back dusty stacks of bound medical jour­ tions and Ms. Von Bruck and I with pride in her accomplishment. nals and outdated books, including travelled the county to meet with the all the leather bound journals of the supportive administrators and library Ms von Bruck. we thank you. American Medical Association, since chairmen to establish the working — Robert A. Kallsen, M.D. * the first edition in 1881. Unhappily it relationship between the Central was little used and out of the way to Library and its members. The opera­ the expanding K Street Medical Cen­ tion of the consortium began in 1974. ter and neighborhood medical of­ fices, which proliferated after World By then it was apparent that Ms. von War II. Eight hospitals served our Bruck had developed the best stock­ county; each with an alcove devoted ed medical library in the county, with DIAPER RAS l h to a few books and scattered jour­ strong research ability via Med- IS NOT A WAY OF LIFE. nals duplicating the efforts provided Lars/Med-Une and close working You can recommend professional by a limited budget. Circumstances relationship with the Northwest diaper service with confidence. were ripe for a new concept, a Regional Health Sciences Library. Central Resource Library providing She was visited by librarians from all • Laboratory Controlled. Each month a comprehensive library service, in­ over the country. She spoke at na­ a random sample of our diapers is cluding the purchasing of textbooks tional meetings and established our subjected to exhaustive studies ins biochemical laboratory. • Utmost Convenience. Thanks to pick 95 up and delivery service, our product “Rotarian of the Year comes when you need it. 6 Economical. All this service, all this On March 8, the Tacoma Rotary 8 has made four trips overseas for (downtown) Past President. Jeff protection against diaper rash costs several months at a time contribut­ Lovely, presented Dr. Dumont far less than paper diapers - only ing his time and assuming costs to Staatz the Rotarian of the Year pennies more a day than home- provide care and education in these washed diapers. Award for Tacoma 8. Tacoma 8 has Third World countries. 405 members, and annually awards CAUTION TO YOUR PATIENTS. It is illegal lo a member who has made a sig­ Dr. Staatz graduated from the dispose ol human excrement in garbage. nificant contribution to the com­ University of Michigan Medical Parents are doing this with paper/plastic diapers. "Disposable" is a misnomer. munity for upholding the four-way School in 1943 and received his test of Rotarians. license to practice medicine and Dr. Staatz was commended for sig­ surgery in Washington in 1945. In 1964, Dr. Staatz spent three months nificant contributions to providing ~ m m r an the ship U.S. Hope in Ecuador medical care and education to Service He retired in 1986 to, “take more TACOMA WA TOLL FREE people in Jamaica and Ethiopia. He time off." 383-BABY 1-800-562-BABY Washington's Oldest, Most Trusted " I Professional Diaper Service | | Serving Our Second Generation

Page 8 * April 1990 • Vol. 5, #5 NewsBriefs Continued...

WSMA Agenda Fares Well in

WSMA’s legislative agenda fared nor Gardner has said publicly that need not include any “mandated well in the “short” regular session of he will. benefits" but must pay for hospital the legislature that ended Thursday, care and services from a physician WSMA supported bills that passed March 8. Physicians scored sig­ or an osteopath. nificant wins on a number of primary and now await gubernatorial signing: The bill forbids employers from : legislative priorities. Trauma Reform (SB 6191) - This changing in mid-stream from a plan bill will promote regional trauma As the legislature resumed business of broader coverage to a new basic plans; establish standards for in special session on Friday, March plan. Employers can offer sup­ trauma services statewide; and 9, Gov. Booth Gardner called for plemental packages to employees. '■ legislators to create a commission develop educational programs and on health access and cost, a move patient outcome measures. Hospital WSMA-opposed bills that died in­ the WSMA supports. His call came trauma center designation will start clude key licensure issues: on the heels of an announcement by in summer 1993. Chiropractic Scope of practice (HB the House and Senate leadership at One provision of the bill, not related 1492) - This measure, which would the end of the regular session that to trauma, will allow physicians in have broadly expanded the scope they are close to signing a joint residency and post-graduate of chiropractic practice, died in the resolution to establish the commis­ programs at the University of Senate Ways and Means Commit­ sion. Washington to be granted tem­ tee. It had passed the House by a - The legislature's ability to reach porary licenses. wide margin and the Senate Health and Long Term Care Committee by , agreement on a commission has Basic Health Insurance (SB 6834) — been sorely tested. Early in the ses­ a 5 to 2 vote (Sens. West and This measure will allow health care Wojahn voted to oppose) before sion, a revised version of the Brad­ insurers to offer a truly basic benefit dock bill (HB 2252) — calling for a being referred to the Ways and package to groups of 25 full-time Means because of its significant fis­ commission to study a single payor employees or fewer. The package system - passed out of the House cal note. lj handily. The Senate Health and Long Term Care Committee even- • tually performed major surgery on ^ the bill, transforming it into a com- The P erfect n prehensive, balanced and reasonable commission, appointed Car Consultant : by the governor with all interested 752-8888 parties represented. But that 3009 Bridgeport Way West - Suite 4 reworked measure was promptly submerged by Senate Republican leadership. BUYING SERVICE • PRICING As of this writing, a balanced com- CONSULTING • APPRAISALS mission appears likely, but if law- makers ultimately fail to act, Gover­ Domestic & Imports Cars & Trucks

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Vol. 5, #5 ® April 1990 * Page 9 Recommendations of the Prenatal Care Committee

risen to the point of being a crisis. prenatal care to DSHS patients. T he Prenatal Care Coalition was Only 4 of the total 64 physicians will developed in response to the accept new DSHS patients. The fami­ prenatal care crisis 'in Pierce County. Prenatal Care: ly practice physicians reflect a One of its charges is to respond to The Problem simiiar trend. the Maternity Access Law which re­ There are three major trends which quests designated distressed areas There are three basic causes of this affect access to prenatal care today. to submit a county report. This coali­ trend: These include a decreasing number tion is an extension of the Prenatal of physicians, increasing number of Care Challenge Committee that was 1) inadequate physician reimburse­ patients without physicians and an appointed by the Tacoma-Pierce ment increasing proportion of high-risk County Board of Health to study patients. These three trends interre­ 2) increased cost of malpractice problems with access to prenatal late and each one is the result of care and recommend solutions for 3) increased physican fear complex societal factors. our community. It is co-chaired by of litigation Dr. John Coombs and Mr. Tom Hosea, Vice-Presi­ The First Steps legisiation dent, Puget Sound Bank. increased physician reim­ bursement, which may The recommendations of Fierce County States decrease or slow down the the Prenatal Care Chal­ numbers of physicians leav­ lenge Committee suggest ) 23 percent of births in Pierce County were to Medicaid- ing obstetrics. However, it both short-term and long­ eligible women as compared to 23.7 percent statewide. does not appear that the in­ term solutions. The Com­ Pierce County is ranked 12th in percent of Medicaid creased provider rates will mittee believes the short­ births. entice physicians to return term solutions will result in to the delivery of infants. immediate improvement in - 34.1 percent of Medicaid-eligible women receive inade­ the prenatal care problems quate prenatal care in Pierce County as compared to The medical liability en­ in Pierce County. How­ 33.2 statewide. Pierce County ranks 21 st in the percent­ vironment will continue to ever, the Coalition believes age of iow-income women receiving inadequate prena­ exert a negative influence that long-term strategies tal care. on access to care for preg­ must be pursued. To eradi­ nant women and women ■ 9.1 percent of the babies born to Medicaid-eligible cate many infant health anticipating pregnancy. problems and lessen infant women in Pierce County, weighed five-and-one-half The rear of lawsuits and the mortality, we must make pounds or less (below birthweight) at birth as com­ cost of liability (malprac­ fundamental changes in pared to 7.0 percent statewide. Pierce County ranks tice) insurance, continue to the way our society ad­ 31 st in iow birthweight births. be the chief concerns of dresses health issues. Prenatal problems are Pierce County ranked 27th in the average number of physicians. deliveries to Iow-income women per provider. complex; neither the root Despite findings to the con­ causes of problems nor Pierce County ranked 20th in the percent of Iow-income trary by the National their solutions are simple. women delivering their babies outside of their county Academy of Science, of residence. providers continue to view Pierce County Medicaid recipients as Status being more likely to bring suit against them. The access system for prenatal care Decreasing Physicians in Pierce County continues to be There is a growing crisis in obtaining The increased fear of litigation is the seriously strained. The number of prenatal care in Pierce County, espe­ most complicated of these three women seeking prenatal/OB care on cially for Iow-income women. There trends. Physicians report the results Medicaid continues to increase, has been a dramatic decline in the of litigation are traumatic, causing while the number of physicians number of physicians that will pro­ loss of practice, loss of reputation, decrease. Since January 1990, three vide prenatal care. If this trend con­ and severe emotional distress. physicians have discontinued their tinues, there will simply not be Physicians stress this fear as the services to Medicaid patients, one enough physicians to provide ser­ most compelling reason to cease physician delivered approximately vices to the pregnant women in our providing prenatal care, especially 75 babies a year. The low income county. since a lucrative practice can be women in Pierce County, who are maintained without this particular not under a physician's care at con­ Within the last 18 months, there has service. ception, continue to have difficulty been a 50% loss of physicians will­ obtaining prenatal care. The Coali­ ing to provide prenatal services. tion believes that this problem has There are 64 obstetricians in Pierce Increasing Patients County; 28 (44%) are providing While the number of physicians con­

Page 10 • April 1990 • Vol. 5, #3 tinues to decrease, the number of ber of high-risk clients. The most Establish a system to connect patients who are Medicaid-eligible striking of these high-risks are in the patients and providers. This system continues to increase. In 1988, area of substance abuse, which is in­ must maintain status of availability there were 9,634 deliveries in creasing dramatically, and teenage of services and include a follow-up Pierce County. Of these, 2,260 or pregnancy, which continues to function to assure that clients who 23% were paid for by Medicaid. maintain at about 2,600 a year in are referred are, in fact, getting into The number of Medicaid deliveries Pierce County. service. in Pierce county has been increas­ ing approximately 10% each year The issue of infants born addicted to Action: Apply for funding to estab­ while the total number of deliveries drugs is an issue that is escalating lish a system which accesses remain fairly consistent. rapidly. It is now being estimated patients to appropriate services. by the medical community that 1 System must include: The new state legislation (HB 2244) in 15 babies are born with cocaine significantly increases the number of in their blood. ® encouragement of physiciansto women eligible for Medicaid. Now, join a rotating referral system 40% of pregnant women are Recommendations for ® central point of contact for covered by a payment mechanism patients to call for information that is not acceptable to providers. Community Action and assistance in locating a These recommendations will help Therefore, 40% of Pierce County’s physician pregnant women may have a dif­ mitigate the effects of the three ficult time finding a physician to pro­ trends described. It is important to ® proper triaging of patients to vide care and deliver their babies if note that these recommendations physicians based on patient the physician participation in are short-term and will only have need Medicaid does not increase. lasting effects if the long-term issues are also concurrently being ad­ © continued follow-up of patients dressed. and physicians to maintain sys­ Increasing High Risk tem Patients Short= Term The two problems cited above, Case management decreasing physicians and increas­ /Support Services ing number of Medicaid patients, are Triage/Clearing House compounded by the increasing num­ System Develop a multifaceted prenatal ser- (Continued on 13)

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Vol. 5, # 3 ® April 1990 • Page 11 223 Tacoma Avenue South • Tacoma, Washington 98402 « Telephone (206) 572-3666

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Coffee and rolls will be provided.

For more information, please call 572-3666

Sponsored by: Sports^Medicine Committee rierce County Medical Society Prenatal coordinated system and improve ac­ and effective treatment needs avail­ cess. (Continued) able in the community. Continue the outstation eligibility ap­ Action: Establish a task force con­ vice that provides nursing, social plication protocols for Medicaid with sisting of prenatal care professionals work, nutrition services and the Health Department and expand and drug abuse professionals to childbirth education classes to Iow- these efforts to Community Health coordinate activities and recom­ income pregnant women in acces­ Care Delivery System. mend solutions. sible areas in the county and is coor­ dinated with existing services. Ser­ L o n g - T e r m Minority Services vice should also be sensitive to transportation and child care needs I he following issues are defined as Ensure a method to ensure prenatal of patients. long-term to the coalition. These is­ outreach and services are culturally sues will require the formation of sensitive and appropriate to the Action: Apply to state office of sub-groups to develop strategies needs of minorities. Medicaid assistance under Maternity and options to these findings. These Access Act (2244) for case manage­ sub-groups should be broad based Action: ment and maternity support services. and include individuals from e Promote cross-cultural training schools, business, social, medical, of providers. Tacoma Family Medicine/Heaith legal and insurance. It is anticipated Department OB Access Clinic the subgroups will need to be in ex­ • Encourage minorities to be­ Establish a secondary system to pro­ istence for a minimum of one year. come members of the health vide prenatal care services to high- team (task force, sub-groups). risk Iow-income women for whom Provider Recruitment • Encourage networking with the private providers are not available. Develop a system that ensures an Puyallup Indian Health Service. adequate number of physicians Action: By utilizing the funding for a «• Access the needs of all minority distressed area under the Maternal delivering prenatal services in Pierce County. populations, including aliens, Access Act (2244), this will increase and establish systems that meet the number of women receiving ser­ Action: the population needs. vice in the OB Access Clinic to 400. • Explore methods to increase Coordination of activities between participation of physicians in School Access Tacoma-Pierce County Health Medicaid practice. Explore methods to provide preven­ Department/Tacoma Family tion and early intervention in the Medicine Cooperative Clinic, and • Explore recruitment of teenage population. Community Health Care Delivery physicians practicing OB. System (CHCDS) to maximize ser­ Action: vices available in the community. ® Provide feedback to state that adequate reimbursement for ® Encourage the public schools to hospitals taking dispropor­ disseminate pregnancy testing Public Information tionate share be made to assure and service availability in the /Outreach costs are covered. school setting. A method to inform clients and • Examine ways to strengthen the • Re-examine the concept of providers of available services and community clinic system in school-based clinics, a concept need for prenatal care. Pierce County. that has worked well in other Action: Encourage the development areas of the country. of pregnancy testing and counseling Dreg Dependent Pregnant at appropriate sites in the com­ Women munity and market the availability of such services. Develop a method of identification Coordinate with First Steps public education campaign. Qualified Physicians Needed Medicaid Application Process Seattle ® Low Volume ® 60 beds • 12 - 36 hour shifts ® Graduate of an Simplification of the Medicaid Accredited Medical School ® Current WA License and ACLS Certiiica- process needs to occur. tion » Two years or 2000 hours Emergency Room Experience ® 150 hours of CME Credits - credits must be AO A-AM A approved and docu- Action: Prenatal Care Coalition mentable a Malpractice C o v e r a g e Provided: Claims Made With should monitor and eva'uate the im­ Unlimited Tail plementation of the Medicaid Call National Emergency Services — 1-800-554-4405 simplification process. Encourage providers and Medicaid to set up a

Vol. 5, # 3 ® April 1990 ® Page 13 223 Tacoma Avenue South • Tacon,a. Washington 9840; ■ Telephone (206) 572-3666

Presents

Our Quarterly Luncheon Meeting For Retired Members and Spouses

“Palliative Medicine; An International Experience Is Pierce County Ready for It?”

featuring

Stuart J. Farber, M .D. Please Note:

The PCMS Photographer will Date: Wednesday, May 9 be at this meeting to take your PSace: Quality Inn (Tacoma Dome Hotel) photographs for the 1990 (Hickman Room) Pictorial Directory. 2611 East “E” Street There is NO CHARGE TO Time: Lunch 12:00 p.m. HAVE YOUR PICTURE Program 12:45 p.m. TAKEN. Price: $10.50 per person

We Hope That You To register, please send your reservation to Will Participate/ PCMS or call us at 572-3667 no later than Friday, May 4.

REGISTRATION ^dical Society ,0 near "Pa,„a-

Encfoledfm/cH5bk t o P er Person <>*’ ^ gratuities included).

_ _ I regrel that I am unable to attend the lunch portion of the meeting. 1 will attend the program only.

Dr.

Please make check payable to PCMS and return no later than Friday, May 4.

J Few Exem ptions fo r ’Sim ple’ Tests Draft Regulations Target In-Office Labs

P hysician office laboratories The draft document is being circu­ The draft document noted that the (POLs) would come under strin­ lated within the administration for in­ Public Health Service (specifically gent federal regulation and be ternal comment before it will be the Food and Drug Administration forced to pay a minimum of $2,000 released for publication in the and Centers for Disease Control) per year for certification fees, under Federal Register. At that time, had “not determined any test that draft regulations recently issued by public comment will be solicited. will meet the criteria the Health Care Financing Ad­ specified in CLIA ’88 for a The American Medical Association ministration (HCFA). certificate of waiver." HHS is studying the draft and plans to proposed that labs holding The news came as a shock to many comment when the proposed regula­ physicians, who believed they tions are published. certificates of waivers only would be exempt from such federal be allowed to perform a scrutiny because they did only CLIA ’88 legislation was enacted fol­ few dipstick or tablet "simple" tests in-house. lowing a year of news reports and reagent urinalysis tests. congressional hearings alleging Tests at Level One According to the federal Clinical proficiency testing abuses in various labs would have to Laboratory Improvement Amend­ lab settings. The most frequently be directed by ments of 1988 (CLIA ’88), all labs — cited problem involved Pap smear . a physician including those in physician offices testing. As a result of the hearings, - were potentially subject to regula­ members of Congress discovered who tion, except those performing only that a great deal of testing was done would “simple” tests that posed no “risk of in physicians' offices, and that most be re- harm to a patient if done incorrectly.” of the nations’s roughly 100,000 y # fe !>• quired POLs were virtually unregulated. to What physicians didn’t know was The fear that patients could be that Health and Human Services harmed by untrained personnel per­ Secretary Louis Sullivan, M.D., forming tests in these and other set­ would propose an interpretation of tings led lawmakers to require labs “simple" tests that was so narrow to meet certain requirements for per­ that the testing most POLs do ex­ sonnel, proficiency testing, and personally ceeds it, said J. Stephen Kroger, other standards to be developed by review M.D., a trustee of the American HHS. Society of Internal Medicine. Dr. Sul­ and initial livan has the power to make such a Three categories are listed in the all test results prior to any clinical in­ decision, said Dr. Kroger, who also draft proposal: those that qualify for tervention. The draft also requires is president of the board of the Com­ a certificate of waiver, Level One, that the physician “ensure that all ab­ mission on Office Laboratory As­ and Level Two. Levels One and Two normal screening test results for pre­ sessment (COLA), a voluntary will be distinguished by the com­ viously undiagnosed conditions are education and accreditation pro­ plexity of tests performed. confirmed by quantitative test gram for POLs. methods in a Level Two certified laboratory.’’ Level Two labs are facilities perform­ Tests Exempt from Regulation ing one or more tests not included in the other two categories. Under the draft, these labs must have a The following tests would be exempt from CLIA standards under HCFA director who is either a pathologist draft rules. or a doctoral scientist. • Dipstick or tablet reagent urinalysis for the following: Bilirubin, Glucose, Hemoglobin, Ketone, Leukocytes, Nitrite, pH, Protein, Specific Gravity, According to ASIM’s Dr. Kroger, Urobilinogen under the draft regulations, even a • Fecal Occult blood glucose finger-stick test —which • Microhematocrit diabetics frequently give to them­ : • Microscopic examination of the following: Urine sediment, Pinworm prepara­ selves at home-would be con­ tion, Vaginal wet mount preparation sidered a Level One test. • Ovulation tests — visual color tests for human luteinizing hormone "In fact,” he added, “most chemistry • Whole blood clotting time tests don’t even fall into Level One. , ; • Urine pregnancy test The only chemistry tests listed there (Continued on page 16)

Vol. 5, • April 1990 • Page 15 A Senstive Issue...

A physician must entrust so many is why preventive procedures are ach doctor in private practice necessary to physician employers. E aspects of his/her practice to staff has an important role to play in Risk management should not only members. In many small offices, minimizing the occurrence of one person is in control of the entire be practiced to lessen the risk of employee theft. While most accounting cycle from opening the malpractice suits, it also is essential physicians mail to posting charges and to prevent employee theft from oc­ are aware receipts, balancing the books, curring. As the employer, your role of this tact, preparing deposits, managing petty in prevention can be simple and the they lack cash and preparing checks for policies easy to implement. The the basic payroll and paying bills. This cycle most important first step is under­ knowledge allows far too much control for one standing how it can happen and essential to employee. Too often it provides the what you can actually do to lessen protect basic ingredients for office theft - the chance it will happen to YOU. themselves temptation and access. from em­ On May 2, 1990, Pierce County bezzle­ A doctor's time is so absorbed by Medical Society will present a half ment. the practice of medicine that many day program titled “Office Theft”. This program is designed especially It’s a sens­ “little things” happening in the office go untended and certain “attitudes" tive issue, (Continued on back page) many of staff members go unnoticed. This employers are afraid to think they could be at risk of theft from their staff. The number of embezzlement cases in­

volving physicians throughout the 2 3 SB DIET PLAN country, and here in Pierce County, is enough to alarm the most op- THE AFFORDABLE ALTERNATIVE! tomistic and trusting employer. Checking references is an excellent CREATED BY A PHYSICIAN THAT KNOWS .. , management practice, but as many It works. pan ^ Dawn Dube other employers will attest, it is not always a tool of prevention where It's safe. (206)848-0711 theft is concerned. It's fast. independent ToppMed’" Distributor SUPPORT GROUPS AVAILABLE

Office Labs are the finger-stick glucose and He said most POLs do complete screening cholesterol test." blood counts; blood urea nitrogen (Continued) tests; and biood tests for potassium, sodium, or bilirubin; this would make them Level Two labs. Proposed Level I Dr. Kroger said he thought many Requiring Physician Director Only physicians would drop their office labs as a result of this proposed draft, because the current form • Antistreptolysin 0 (ASO) screen - slide card agglutination test. would make them cost prohibitive. • Cholesterol screen - qualitative and semiquairtative determinations. • C reactive protein (CRP) screen - slide card agglutination test. "Physicians have maintained their in­ • Rheumatoid factor screen - slide card agglutination test. office labs primarily for ease of diag­ « Glucose screen - whole blood dipstick method. nosis and patient convenience." he • Gram stain (vaginal and urethral discharge). said. "This is going to have a major impact on the quality of health care • Infectious mononucleosis screening - slide card agglutination tesl and the cost effectiveness of health • Potassium hydroxide (KOH) preparation care." and si^scept^bOity CCLInISf° rUr'nar^ traCt'nfecti0r1, not,° inc*ucle identification - Diane M. Gianelli Erythrocyte sedimentation rate. Sickle cell screening - methods other than electrophoresis, Reprinted from I he 2/16/90.

Page 16 • April 1990 • Vol. 5 , American Medical Association Principles of Medical Ethics

P reamble: The medical profes­ to seek changes in those require­ other health professionals when indi­ sion has long subscribed to a ments which are contrary to the best cated. body of ethical statements interests of the patient. developed primarily for the benefit of VI, A physician shall, in the provision the patient. A member of this profes­ IV. A physician shall respect the of appropriate patient care, except sion, a physician must recognize rights of patients, of colleagues, and in emergencies, be free to choose responsibility not only to patients, of other health professionals, and whom to seiA/e, with whom to as­ but also to society, to other health shall safeguard patient confidences sociate, and the environment in professionals, and to self. The follow­ within the constraints of the law. which to provide medical services. ing Principles adopted by the V. A physician shall continue to VII. A physician shall recognize a American Medical Association are study, apply and advance the scien­ responsibility to participate in ac­ not laws, but standards of conduct tific knowledge, make relevant infor­ tivities contributing to an improved which define the essentials of mation available to patients, col­ community. honorable behavior for the physician. leagues, and the public, obtain con­ I. A physician shall be dedicated to sultation, and use the talents of providing competent medical ser­ vice with compassion and respect for human dignity. II. A physician shall deal honestly Tacoma-Seattle with patients and colleagues, and strive to expose those physicians Outpatient General Medical Care at its best. Full and deficient in character or com­ petence, or who engage in fraud or part time positions available from North Seattle to South deception. Tacoma. Very flexible schedule. Well suited for career redefinition for G.P., F.P., I.M. III. A physician shall respect the law and also recognize a responsibility Contact: Andy Tsoi, IV .D.: 537-3724 Bruce Kaler, M.D.: 255-0056.

Notes from the AMA Leadership Conference, Feb„ 24=26 -Phoenix, AZ.

I n 1969, there were 6,400 group With the RBRVS, group practices medical school. medical practices. In 1988, there will seek out more primary care Third party payers will seek greater were 16,079. physicians and will seek talented patient care oriented students out of discounts. “A good letter to be immortal does not have to be eternal." - Churchill "An era of the AMA has ended.” COMING SOON - Dr. John Ring, Chairman, AMA Board of Trustees, regarding resig­ nation of Dr. James Sammons, AMA 4th Street Medical Clinic Executive Vice President. Phase II "The RBRVS will only redistribute ex­ penditures and will not solve the 6,500+ sq. ft. of First Class Medical Office Space at the front Part B problem." - Mr. Jim Haug, door of Good Samaritan Hospital. Pre-lease agreements are American College of Surgeons. currently being accepted. Many other medical spaces (500 sq. ft. to 3,000 sq. ft.) available “The sixteen percent annual in­ throughout Pierce County. crease in health care costs is a driv­ To solve your office space or investment needs ca ll. . . ing force for change.” L.J. and Judy Lyle “There will be no major push toward Northwest Investment Properties inc. (Continued page 18) (206) 565-9790 Tacoma

Vol. 5, # 3 • April 1990 • Page 17 April PCMS Meeting Schedule

BATE EVENT/MEETING TIME PLACE BAY Tacoma General Hospital - CR#1 Board of Trustees 6'30 p.m. T uesday April 3 7:00 a.m. Tacoma General Hospital - CR#4 Wednesday April 4 AIDS Committee 7:00 a.m. Mary Bridge Children’s Hospital - TOA#2 Thursday April 5 lntern-’90 7:00 a.m. Allenmore Hospital - Drs. Dining Room Friday April S Aging Committee 7:00 a.m Allenmore Hospital - Drs. Dining Room Wednesday April 11 Credentials Committee 7:00 a.m. Tacoma General Hospital - CR#4 Thursday April 12 Grievance Committee 7:00 a m. Mary- Bridge Children’s Hospital Tuesday April 17 Executive Committee Small Board Room

Tacoma General Hospital - CR#4 Wednesday April 13 Public Health/School Health 7:00 a.m. Jackson Hall Wednesday April 18 Sports Medicine CME 7:00 a.m. "Elbow and Shoulder" Aliermore Hospital - Drs. Dining Room . Thursday April 19 Tobacco Coalition 7:00 a.m.

Friday April 20 immunization Committee 7:00 a.rn. Mary Bridge Children’s Hospital - TOA#2 Friday April 20 Sports Medicine 7:00 a.m. Thursday April 26 EiViS Committee 7:00 a.m. Mary Bridge Children’s Hospital Large Board Room

We wilt have to shift our values from snacks. Leadership Notes what are everyone's needs to what (Continued) does Society as a whole need. “The average American watches 7 physician DRGs in the near future.” 1/2 hours of television daily.” Children age 2-5, on the average, - Christine Fergeson, J.D., Office of "Mike Wallace is outside waiting for Senator John Chafee. watch 29 1/2 hours of television weekly. Fifty percent of the commer­ you.” - Most dreaded words one “The health care system needs cials are dealing with sweets and will hear> major changes and band-aids will no longer do.” - C. Everett Koop, M.D., former U.S. Surgeon General. "Something is terribly wrong with a James D. McAlexander, D.P.M. system that is treating fewer and fewer patients.” - C. Everett Koop, A nnounces M.D. his association iviih “Business cannot continue to bear these health care costs and be com­ Stephen M. Fuson, D.P.M . petitive.” - C. Everett Koop, M.D. 7800 Pacific Avenue, Suite #1, Tacoma/473-5566 "Since World War (I, Americans and have abrogated their responsibility.1" the opening of - C. Everett Koop, M.D. The Gig Harbor Foot and Ankle Clinic “We are not going to recommend 5122 Olympic Drive N.W., Suite A -11)4, Gig Harbor/858-8100 the Canadian system to the United States." - Representative W.D. Gradison (R) Ohio 'fivcnin^ and Saiunlay hours bv appointment only.

J Page 18 • April 1990 e Vol. J, #.? Presents “A Designated Trauma Center — The Pros and Cons”

featuring

Donald Gann, M.D. Department of Surgery University of Maiylancl Tuesday^ May 8

Place: Fircrest Golf Club 6520 Regents Blvd. Time: Cocktails 6:00 p.m. (no host) Dinner 6:45 p.m. Program 7:45 p.m. Price: $15 per person* *$17per person if registering day of meeting

Reservations requested by Friday, May 4. Spouses are Invited!

REGISTRATION Yes, I (we) have reserved the evening of May 8 to join members of the Pierce County Medical Society to hear “A Designated Trauma Center — The Pros & Cons” Please reserve dinner(s) at $______per person (meal, tax, and gratuities included). Enclosed is my check for $______Dr. Please make check payable to PCMS and return no later than Friday, May 4. *DAY OF REGISTRATION FEE — $17. i -'■'V ■ •» -'ii: ■ »'•* m i PHYSICIANS

Your Army Reserve Personae! Counselor,

Major Jane L McCullough

Would like to talk to you about the following opportunities in the United States Army Medical Department:

9 Part-Time Income e Retirement Potential ® Post Exchange Privileges ® Insurance SMscounts ® Continuing Medical Education * 9 Attendance at A.M.A. Conferences* 9 T rain in g mi U.S. A rm y H ospitals*

*AU pa id fo r by the U.S. A rm y Reserve.

PO. BOX 38 Madigan Army Medical Center Tacoma, WA 98431-5038 206-967-5046

M atty groups TALK about building a better America- The Army Reserve WORKS at it. Auxiliary News

Auxiliary Meeting Conflict Resolution: Sticky Situa­ tions and Prickly People, Dorothy building and antique mall Notice Wilhelm, Porcupine Handler. • Aerobics class Dorothy Wilhelm calls herself a por­ • Entertainment with dinners cupine handler and says we all are. The April meeting will be held We encounter impossible people A full meeting schedule and registra­ Thursday, April 19, 7:00 p.m., at every day. Learn how to handle tion form will be printed in the April Skyline Presbyterian Church, 6301 them and have a great time doing it! Pulse. Westgate Blvd. N., Tacoma 98407. (Thursday, April 26- 1:45 to 3:15 PSD Credit) The program for this evening meet­ ing is “How to Prevent Being Time Management: Managing N_ B A_ A Mugged.” Colleen Hacker, doctoral Your Time through a personal candidate in physical education and plan of Improvement, by Warren By now you will instructor at PLU, will show us how Dean Starr, PhD., former superinten­ know what this logo to prevent an assault. She will also dent of Public Schools, Yakima, WA. means: demonstrate a few defense moves Dr. Starr was such a hit at the fall And you know what that could come in handy. Dessert convention, that by popular and coffee will be served. Make your N_ B A_ A__ demand, we have asked him back to means. Most of you are probably reservation by calling Jerol-Ann Gal- further outline strategies for han­ lucci (582-8858), Sue Akamatsu meaning to send your $25, $50, or dling all the time we have. (Wednes­ $100 to the Auxiliary to support this (572-4619), or Elita Lesh (851-2602) day, April 25 -1 :30 - 3:00 PSD year's non-event fund raiser. by April 13. Credit) Please take a moment right now — Organ Donation: Bone Marrow don't even finish reading this article Transplant, Ron Ruhl, M.D. Olym­ — leave now and write that check. Highlights of the pia, WA. A physician reviews his ex­ WSMA Auxiliary perience with a controversial, ex­ Thanks for being a part of the Pierce perimental, and extremely County Medical Society family of Annual Meeting dangerous course of treatment. He physicians and spouses who collec­ speaks about what he and his family tively say, WE CARE. faced and reviews the area of organ Plan to join other auxilians from transplant and donation. Other See you at the ILCU Ballroom where around the state in Olympia, April 25- speakers will be participating. we can dance till 00:00 p.m. to Ar­ 27,1990, for WSMA Auxiliary annual (Thursday, April 26 - 10:00 -11 :30 - thur Sopic and the Bone Crushers meeting. House of Delegates is the PSD Credit) and feast on Heart of Palm Salad, “business meeting” for auxiliary; Breast of Chicken Dijon, Skins of however, it is a wonderful time to SPECIAL EVENTS: Potato, and Lady Finger Torte. meet new friends, rekindle old Send to Sydna Koontz, 7502 88th friendships, learn something, see a • Tour of Governor’s Mansion and new city, and discover just what the State Capitol Campus Ave. SW, Tacoma, WA 98498 PCMS Auxiliary is! • Dinner in historic Carnegie library

I Graduating Seniors i i The Medical Society and Auxiliary would like to recognize our sons and daughters who are graduating this year. If ; | you have a son or daughter graduating from high school, vocational school, college, graduate school, etc., please j I take a moment to fill this out and return it to Patty Kesling/3720 Horsehead Bay Dr. N.W./Gig Harbor, WA 98335. ; ■ This information must be received by April 15,1990. j ; Student's Name:______j I School:______j | Home Address:______■ j Parent's Name(s):______I j Degree or Diploma Received:______j ; Future Plans: ______■ i...... J Vol. 5, #3 • April 1990 • Page 21 fotrodudng Our New One Stop Practice Protection

Physician’s Insurance Agency is pleased to introduce a new service called One Stop Practice Protection for individual and group practices.

One Stop Practice Protection offers a complete range ol professional and personal insurance plans and packages including:

■ Business Office ■ Disability ■ Health Care ■ Life Insurance ■ Homeowners ■ Annuities b Auto & Boat ■ Umbrella Packages

Physicians Insurance Agency is owned by Washington phvsicians and managed by dedicated professionals committed to quality, convenient service.

For more information about our new One Stop Practice Pivtcction service, please call Nora Dacus, Agency Manager, today

Washington 1-800-962-1399 CLASSIFIEDS

Positions Available PRIMARY CARE PHYSICIAN - 1901 S. Cedar. Call Crawford Katica, Rainier School, Washington State’s Inc., Gary Crawford, 272-9200. largest residential care facility for the FULL-TIME FACULTY POSITION developmentally disabled adults, is at University of Washington-affiliated seeking an Internist or a Physician. FOR SALE LAKEWOOD MEDICAL Family Practice Residency program Salary negotiable up to $70K (Inter­ Complex, Built in 1984. Good Loca­ in south Seattle area. Board certifica­ nist) or $63K (Physician), plus tion, high traffic count, 100 parking tion and OB experience preferred. malpractice insurance, medical and spaces, pride of ownership building. New opening created by program dental, life and long term disability in­ I have excellent financing available. expansion. Interested in joining us? surance, a good retirement plan For an investment with 11 1/2% Please send letter and CV to Drew along with paid sick and vacation return. Call James - Aalpha Realty Oliveira, M.D., Program Director, Val­ leave. Contact Dr. R. Ruvalcaba, 565-8772. ley Family Care, 3915 Talbot Rd. Clinical Director, Rainier School, So., Suite 401, Renton, WA 98055. P.O. Box 600, Buckley, WA 98321 or call (206) 829-1111, Ext. 411. General RESEARCH ORIENTED PHYSICIAN who is mature enough PHYSICIAN OPENINGS - INFECTIONS LIMITED to be interested in and able to afford Emergency Department/Ambulatory TRAVELERS’ HEALTH SERVICE, working half-time, yet vital enough Care. Civilian opportunities at the Directed by David W. McEniry, M.D., to retain enthusiastic entrepreneur­ Naval Hospital - Bremerton, WA. Full formerly of the Hospital for Tropical ship to help a thriving research clinic time EM/FP/IM with ACLS and ATLS Diseases, London and the London continue to expand. All this while certification. Contact David C. School of Hygiene an Tropical living in a pleasant Pacific Northwest Jester, D.O., EMAC Medical Direc­ Medicine. Providing complete medi­ community of less than 50,000. (The tor, Naval Hospital - Bremerton, cal services for the international possibility of practicing “on the side’’ Boone Road, Bremerton, WA 98312, traveler - pre-travel assessments unlikely.) Call 206-357-6689. (206) 478-9585 or (206) 478-9322. and medical advice, required im­ munizations and medications, treat­ ment for travel related illness. For an appointment call 627 -4123, Infec­ Office Space tions Limited, P.S., Physicians Medi­ cal Center, 1624 S. I Street, Suite Personal BEST MEDICAL SPACE IN TOWN. 402, Tacoma, 98405. Alan D. Tice, Problems Cedar Medical has 1,450 square feet M.D., Peter K. Marsh, M.D., Philip C. available on the golf course side - Craven, M.D., David W. McEniry, of Physicians M.D. Committee For Impaired Physicians Your Colleagues Advertise in the Classifieds Want to Help Prices Advertisers Name and Address

Medical Problems, Drugs, PCMS Newsletter- ______:______.______Alcohol, Retirement, 75 cents per word ______Emotional Problems The Bulletin - ______85 cents per word ______10 word minimum Committee Members on all ads. A d C o p y Patrick Donley, Chair. 272-2234 Joseph Kramer...... 845-9511 Deadline John R. McDonough.. 572-2424 May Bulletin William A. M cPhee..... 474-0751 deadline is April 5. Ronald C. Johnson...... 841-1894 Please call 572-3709 Kathleen Paris...... 591-6681 for more information. Dennis F. W aldron...... 272-5127 Mrs. Jo R oller...... 752-6825 Send check to: Pierce County WSMA Medical Society, 705 South 9th, Suite 301 1- 800 - 583-0127 Tacoma, WA 98405

Vol. 5, #3 • April 1990 • Page 23 Primary Care Positions Madigan Army Medical Center

Several Immediate Openings For:

> Backup Coverage. Intermittent, part-time, “on-call" for the Acute Illness Clinic. No minimum number of hours. This walk-in clinic sees patients of all ages, seven days a week. Primary coverage is through a contract group. Practitioner must provide own malpractice coverage. Compensation based on negotiated hourly rate. > CHAIV1PUS Partnership. Full, part, or shared time positons in the Initial Visit Clinic. This clinic sees ambulatory adult patients by appointment, with one to three day lead. Practitioner must provide own malpractice coverage, plus nursing assistant and clerk (may be shared by more than one provider). Madigan provides laboratory, radiology, pharmacy, and consultant support. Compensation based on negotiated percentage of ususa! CHAMPUS fees. > Full-Time Civil Service. Initial Visit Clinic position, seeing ambulatory adult patients by appoint­ ment. Salaried position with full government benefits.

Preference will be given to physicians who have completed residency training in a primary care specialty, although others will be considered. Contact Cioyd Gatrell M.D. or Mrs. Vi McNiel (206) 967-3185.

Sensitive Ltd., Bill Otway, Ph.D. The program the Society office at 572-3709. The (Continued) is planned to answer many of your program, which will be held at Jack­ questions and instruct you in steps son Hall, is for employers only and toward prevention for your practice. is part of the Society’s continuing ef‘ for physicians in private practice. If you have not received your pro­ fort to provide it’s members with The presenter will be the President gram brochure or want more infor­ good practice management tools. ♦ of Northwest Medical Consultants, mation on the program, please call

Pierce County Medical Society 223 Tacoma Avenue South Tacoma, WA 98402 B ulk Rate U.S. Postage PAID ADDRESS CORRECTION REQUESTED T a c o m a , WA P e rm it # 6 0 5

t m

May 1990

The Doctor-Patient Relationship — See Page 5 The Goodwill Physicians Exchange- -- See Page 21 a r m y r e s e r v e o f f e r s

NEW FINANCIAL INCENTIVES

FOR RESIDENTS IN ANESTHESIOLOGY,

GENERAL SURGERY AND ORTHOPAEDIC SURGERY

If you are a resident in Anesthesi­ with flexible scheduling so it ology, General Surgery or Otho- won’t interfere with your resi­ paedic Surgery, the Arm y dency training, and in addition Reserve has a new and exciting to your regular m onthly Reserve opportunity for you. The new pay, you’ll receive a stipend of Specialized Training Assistance $664 a m o n th . Program will provide you with You’ll also have the opportu­ financial incentives while you’re nity to practice your specialty for training in one of these special­ two weeks a year at one of the ties. A rm y’s prestigious Medical Centers. Here’s how the program can Find out more about the Army work for you. If you qualify, you Reserve’s new Specialized Train­ may be selected to participate in ing Assistance Program. Call (col' the Specialized Training Assist- lect) your U.S. Arm y Medical ance Program. You’ll serve in a Department Reserve Personnel local Arm y Reserve medical unit Counselor: Major Jane I. McCullough

( 206) 967-6180 ARMY MEDICINE* BE ALL YOU CAN BE. The Official Publication of the Pierce County Medical Society

PCMS Officers: ------TABLE OF CONTENTS Gordon R. Klatt...... President William G. Marsh...... President-elect John B. Coombs...... Vice President Joseph H. Wearn...... Secretary-Treasurer FEATURES William T. Ritchie...... Past President Case Study: Electronic T ransitions...... 29 PCMS Trustees: Stuart D . Freed Editorial: OB Providers Need to Take First Steps ZZZZZZZZ.2A K. David Me Co wen FAX has a Place in M.D.’s Office...... 25 A. Robert Thiessen David E. Law, First Steps Program Expands Eligibility...... 23 Anthony S. Lazar. William F. Roes, 1990, Negotiating the Ins and Outs of Buying and Selling a Practice 27 Alice Wilhyde An Individual and Collective Responsibility Executive Director: D ouglas Jackman PCMS Coordinates Goodwill Games Physicians Exchange" 21 Board and Committee Chairman;/!/£)$ Alan Tice; Aging, James M. Wilson; Bylaws. Stanley Tuell: midgetlFinance, J o sep h H . COLUMNS/DEPARTMENTS Wearn; CHCuS. Charles M. Weatherby; Col­ lege o f M edical E ducation, David Brown; Credentials, John F. Kemman; Emergency Auxiliary News...... 32 Medical Standards, Robert F. Wacntel; May General Membership M eeting ...... 10 Ethics/Standards of Practice, R o n a ld G . Taylor; Grievance, William T. Ritchie; Inter­ C.O.M.E. News...... 17 professionalRobert J. Martin; Legislative, Gregoiy A. Popich; Library, William M. C lassified...... 33 Dean\Medical-Legal, Marcel Malden; Mem­ N ew sBriefs...... 6 bership Benefits. Mark Gildenhar; M inority Health Affairs, Charles M. Weatherby; Per­ New Members...... 15 sonal Problems of Physicians, Pat Donley; Progratri John B.' Coombs: Public P resident’s P ag e...... 5 Health/School Health, Terry W . Torgenrud; Puyallup Fluoride, William G. Marsh; R eadings...... 15 Tobacco Task Force, Gordon Klatt; Sports Retirement Luncheon...... 16 Medicine Committee, Stuart Freed.

The Bulletin is published quarterly, Februaiy, May. August and N ovem ber by PCM S Mem* DISPLAY ADVERTISERS bersnip Benefits, Inc., for members of the Pierce County Medical Society. Deadlines for submitting articles and placing advetise- Baby D iaper Service...... 7 ments in The Bulletin are the first of the C apable...... 34 month precedingpublication (i.e., April 1 for May issue). Darmic Labs...... The Bulletin is dedicated to the art, science Dwyer, Pemberton and Coulson...... 11 and deliveiy of medicine and the betterment 18 of the health and m edical welfare o f the com ­ Eli Lilly...... munity. The opinions herein are those o f the Infections Limited Traveler’s Health Service 28 individual contributors and do not necessari­ ly reflect the official position of the Medical In te c ...... 31 Society. Acceptance of advertising in no way constitutes professional approval or endor­ M anor C are...... 6 sement of products or services advertised. Medical & Professional Interiors ...... 14 The Bulletin and Pierce County Medical Society reserve the right to reject any adver­ Metabolic Associates...... 9 tising. National Emergency Services...... 12,14, 29 Outpatient Care ...... 26 Editor: David S. Hopkins P.C. Healthcare...... 21 Managing Editor: Douglas Jackman Perfect Car Consultant...... 13 Persing, Dyckman & Toynbee...... 24 Editorial Committee: David S. Hopkins (Chairman), Stanley Tuell, W. Ben Blackett, Physicians Insurance...... 22, 36 Richard Hawkins Pierce County Medical...... 2 Publications Coordinator: ...!...... 30 Monique Johnson St. Joseph Hospital...... Tacoma Antique Gallery ...... 32 Advertising Representative: 8 Kim Reed T o p p fa st...... 35 Subscriptions: S20 per year, $2 per issue. U.S. Army Reserve...... Make all checks payable to:

Pierce County Medical Society 223 Tacoma Avenue South Tacoma, W A 98402 C o v e r : Gymnastics and figure skating are two Tacoma ^ (206) 572-3667 events to be held at the 1990 Goodwill Games © P C M S 1 9 9 0

The Bulletin * May 1990 • Page 3 CHIC. That’s the way they see smoking. It’s the message for smokeless tobacco products. Yet children are in the advertising they see every day: smoking is still being seduced by the “glamour” of smoking. sophisticated, smart, part of the good life. Smok­ As physicians, we share a responsibility for ing helps these kids feel they “belong”... and that’s our nation’s health. That's why the AM A is call­ what they want, desperately. ing for legislation that would ban all tobacco Meanwhile, tobacco-related illnesses result in advertising. And whv we have testified before over 350,000 premature deaths in this country Congress to defend the constitutionality of every year. In fact, the annual death toll from such legislation. cigarettes alone is greater than that from heroin, To succeed in this effort —and in our work cocaine, alcohol, fire, automobile accidents, toward a tobacco-free society by the year 2000— homicide, suicide and AIDS combined! Yet we need your help. In return, we’ll stand up for cigarettes are our most heavily advertised you on all issues that concern the medical consumer product. profession. This must change! The AMA has been saying Our members make a difference. so for years, and we’ve won many victories in our If you 're already a member, we need your war against tobacco. Warning labels on smokeless continued support. Jfyou re not, tobacco packages, an increased federal excise tax JOIN TODAY. on cigarettes, a smoking ban on most domestic Call 1-800-AM A-1452 airline flights, and a television advertising ban

In m ost cases, medical association dues may he deductible a5 professional or business exoenses Dues and other contributions to the AMA are not deductible- <■« r-hurir 'l. business expenses. ui jetnictii'ic us cham jh|c contributions (or Federal incom e tax purposes. Doctor-Patient Relationship — The Foundation of Our Profession h

T h e re were two teachers during my tients’ basic needs — communicating other with liver failure secondary to medical training that stood out and with them, giving them our time and cystic fibrosis; both died within could be considered mentors in my life. attention, and attempting to ap­ several months of the request. What One is Dr. Stanley Goldberg, who was preciate or understand their message did they suggest? Did they my professor of Colon and Rectal psychosocial dilemmas. This applies want these new young doctors to find Surgery at the University of Minnesota, whether our patients’ problem is a the cure for cancer or cystic fibrosis? and the second is Dr. A.B. Baker who headache, a hemorrhoid, ora poten­ No. Siegel says that they had simple was the Chief of Neurology at the tially life-threatening acute or chronic requests. One patient said, "Tell them University of Minnesota when I was a illness. to let me talk first;” the other said, medical student in the mid-60's. Dr. This struggle to, “walk a mile in the “Tell them to knock on my door, say Baker was a respected, though hello and goodbye, and look at times feared, teacher of me in the eye when they talk medical students. He taught a to me.” unique way to evaluate and “To write a prescription I have found three books care for patients on his neurol­ tremendously valuable in my ogy rotation. He called his ap­ [orperform a procedure] is easy■ own reflection in the study of proach, “Total Treatment.” He the doctor-patient relationship made us focus not only on the but to come to an understanding and I highly recommend them disease process of the patient, to all physicians. They are: but also on the patient from the with people is hard. ” The Clay Pedestal, A Re-ex- emotional, psychological, and — Franz Kafka amination of the Doctor- social standpoint. This was the Patient Relationship, by only time during my entire for­ Thomas Preston, M.D.; Head­ mal medical training that relating to the patient’s shoes,” is a challenge to me first, The Biology of Hope, by Nor­ patient as another human being was on a daily basis and has stimulated man Cousins; and Peace, Love, and made such a focus. me to search out continuing educa­ Healing, by Bernie S. Siegel, M.D. Simple methods of listening to a tion in this area. Most of the time, Currently, very important issues patient, spending time with them, sit­ these courses are filled with nurses, are being addressed by our profes­ ting rather than standing at their bed­ social workers, and other paramedi­ sion, including access to care, quality side, touching them in an under­ cal personnel. The attendance by of care, the spiraling costs of medical standing way, hugging them, or even physicians is abysmally low. Since care, and tort reform. We need to ad­ crying with them, are a lost art in our our medical school training has not dress these issues. However, the profession. At best, these ways of addressed this important area of basic issues of how to relate to and relating to patients are used rarely by caring for the patients, our attention how to care for the needs of our us. A century ago, other than a few to these educational opportunities is patients are how future generations patent medicines and some limited imperative. Currently, many medical will look back and judge our profes­ technical skills, these were the only schools are now addressing this very sion. n tools we had. With the growth of important aspect of physician educa­ -GRK scientific knowledge and technology, tion. Hopefully more will follow. we became a profession of curers What are our patients’ needs? If we rather than healers. We are now reim­ ask them, what do they tell us? Dr. bursed, not for the time we spend Bernie Siegel was asked to speak at with the patient, but rather, by the the Cornell University Medical School technical procedures or testing we Commencement and he asked two of do. his critically ill patients what they In my opinion, this shift of focus would recommend that he tell 100 has been one of the primary reasons new doctors on their graduation day. for the faltering image of our profes­ Both patients were young, one with sion. We are not meeting our pa­ metastatic breast cancer and the

The Bulletin * May 1990 ® Page 5 Hepatitis C Antibody Detection: A Welcome Addition To Our Infectious Disease Armamentarium

Recently, the FDA licensed a test reminder, every donated unit is now referred to their physician for further detecting antibody to Hepatitis C tested for syphilis, Hepatitis B Sur­ evaluation. Virus (previously Non-A, Non-B face antigen, Anti-Hepatitis B care an­ We believe that recommendations Virus). Immediately following licen­ tigen, ALT (SGPT), Anti-HTLV-I, Anti- may soon follow from the Public sure, theTacoma-Pierce County HIV-I, and most recently...Anti-HCV. Health Service advising all physicians Blood Bank began testing all blood Although the test will markedly im­ to consider HCV testing their patients and components in the county’s in­ prove recipient safety, it will not total­ who have received blood or com­ ventory as well as all new donations. ly eliminate post transfusion hepatitis. ponents prior to implementation of The test is an excellent, but not a We anticipate it will identify around HCV testing. The blood bank will perfect, biologic test. It is a first 80% of individuals harboring the virus offer outpatient HCV testing to area generation screening test and will be and will decrease the rate of post- laboratories and physician’s offices. licensed without a confirmatory test. transfusion hepatitis to about 2% of Finally, despite the additional test­ We anticipate that despite its high our recipients. ing, the safety of transfusion med­ specificity, a number of false positive Since the blood bank is not a diag­ icine is still dependent on ensuring results will occur. Also, the test will be nostic center, it will be unable to pro­ that only recipients truly in need of somewhat limited in diagnosing acute vide further evaluation for reactive blood are transfused. Hepatitis C infection since many in­ donors. As has been our policy, all dividuals may take up to four months donors with a reactive test will be — Tacoma-Pierce County Blood Bank for the development of a detectable antibody. The test for Hepatitis C will join an expanding list of transfusion trans­ mitted disease markers. As a Manor Care

CONVALESCENT AND REHABILITATION CENTER Head Start Kids Require New • 24 Hour Skilled Immunization - HIB Nursing Care

Head Start has a new federal re­ • Long-Term and quirement stating “that all Head Start children under the age of 5 years be Vacation Stays immunized against Haemophilus In­ fluenza Type B disease." • Occupational, We appreciate your cooperation in Speech and doing hematocrits and blood pres­ sure readings during physical ex­ Physical Therapies aminations, as these are also required by Head Start Performance Stand­ • Medicare Certified ards. Thank you for providing services to • Deluxe Heritage Head Start children. If you have ques­ L ic c n s c tions about the Head Start Program W ing or Head Start requirements, please call either Beverley Ritter or Marianne Larson at 272-2277. 474-8421 5601 S TIARD ST. • TACOMA

Medical Director, John Atkinson, M .D .

Page 6 e> The Bulletin $> May J990 NEWSBRIEFS Tacoma-Pierce County Health Department Infectious Waste Regulations AMA Hospital Medical Staff Recently the Tacoma-Pierce Coun­ treatment facilities within Tacoma- ty Board of Health unanimously ap­ Pierce County will be regulated. Infec­ Section proved infectious waste regulations tious waste generating facilities in­ Fifteenth Assembly for incorporated cities in Pierce Coun­ clude but are not limited to the follow­ ty. The Board of Health then for­ ing types of facilities; hospitals, Meeting warded the regulations to the clinics, nursing homes, laboratories, Tacoma City Council and the Pierce physicians' offices, dental offices, re­ June 21-25,1990 County Council with the recommen­ search facilities, and funeral homes. dation that the infectious waste Medical Staffs from across the regulations be enacted into law by How will these regulations country are encouraged to elect a these bodies. affect me? medical staff representative to par­ Upon being enacted into law, infec­ ticipate in the AMA-HMSS Assembly The infectious waste management tious waste activity within the city of meeting June 21 -25, 1990 at the plan is the cornerstone of the Chicago Marriott Hotel in Chicago. Tacoma and unincorporated Pierce TPCHD’s infectious waste regulation. County will be regulated. The HMSS Assembly provides The infectious waste management medical staffs with a unique oppor­ What is infectious waste? plan consists of applicable policies tunity to discuss and participate in the and procedures developed by a The Tacoma-Pierce County Health policymaking process of the AMA. responsible person or committee at For further information about the Department (TPCHD) defines infec­ each facility that specifically addres­ tious waste as “waste capable of AMA-HMSS, please call (312) 645- ses the following components: 4754 or 645-4761. causing an infectious disease.” The • Infectious waste management following disease transmission fac­ training for all employees tors must be considered when defin­ ing and identifying specific waste • Segregation and containment of items as infectious waste. infectious waste • Presence of a pathogen of • Storage of infectious waste DIAPER RASH sufficient virulence • Contingency plan IS NOT A WAY OF LIFE. • Dosage • Spill management plan You can recommend professional diaper service with confidence. • Portal of entry • Record keeping • Laboratory Controlled. Each month • Susceptible host • Disposal a random sample of our diapers is Specific waste items considered in­ • Treatment methods (if ap­ subjected to exhaustive studies in a fectious waste according to the biochemical laboratory. TPCHD infectious waste regulations plicable) are: • Transportation requirements (if • Utmost Convenience. Thanks to pick up and delivery service, our product • Contaminated sharps applicable) comes when you need it. • Blood and blood products • Storage and treatment operation plan (if applicable) • Economical. All this service, all this • Cultures and stocks of protection against diaper rash costs An annual permit application and infectious agents and far less than paper diapers — o n ly fee, and an on-site facility inspection associated biologicals pennies more a day than home- is included. There is also a penalties washed diapers. • Contaminated laboratory wastes section - anyone violating or failing to comply with the regulations, upon CAUTION TO YOUR PATIENTS. II is illegal to • Human pathological wastes dispose ol human excrement in garbage. conviction, would be guilty of a mis­ • Disease specific contaminated Parents are doing this with paper/plastic demeanor and subject to a fine, im­ items diapers. “ Disposable” is a misnomer. prisonment, or both. • Miscellaneous contaminated Contact Ron Norton, Infectious items Waste Information, TPCHD, for addi­ tional information — 591-6471. Who will be regulated? All infectious waste generating TACOMA WA TOLL FREE facilities, transporters, storage and/or 383-BABY 1-800-562-BABY Washington's Oldest, Most Trusted Professional Diaper Service p Serving Our Second Generation ] j p r»

The Bulletin « May 1990 * Page 7 NEWSBRIEFS

AMA Service Helps You Bargain with Payers

The AMA has a telephone “hot The AMA’s Physician Advisory Of­ norance of the law is no protection line” to field your questions on the fice is ready to help you bargain with from possible civil or criminal penal­ subject. Just call (312) 645-5601. A HMO’s, insurance companies, and ties.” referral list of attorneys experienced other third party payers. Collective conduct by inde­ in antitrust is also available. This AMA service can boost your pendently practicing physicians can negotiating power and answer your result in illegal price fixing agree­ As an AMA member, you can questions about antitrust laws. ments under the antitrust laws. Such receive a free booklet, called “Collec­ “Many Doctors are unaware of the violations can incur severe sanctions, tive Negotiation and Antitrust.” Write: potential for violations of antitrust law including criminal prosecution, im­ Physician Negotiation Advisory Of­ when bargaining with payers,” says prisonment and fines of up to fice, AMA, 535 N. Dearborn, Chicago Michael He, J.D., the AMA’s Division $250,000. Doctors could also lose 60610, Attention: Michael lie, J.D., or Counsel for Health Law. “But ig­ their licenses to practice. call (312) 645-5601.

PCMS/TPCHD Joint Effort

At its April 3 meeting, the Board of cess to perinatal and family planning stress this places upon the medical Trustees approved a proposal to es­ services. staff and increase compliance with tablish a triage/clearinghouse system Using financial backing provided comprehensive prenatal care. to connect patients to physicians and by the First Steps Legislation (HB The program will enlist the par­ other health care providers. It would 2244) the clearinghouse would be a ticipation of private physicians to ac­ provide a centralized information joint effort between the Tacoma- cept a to-be-established number of source for Pierce County around ac­ Pierce County Health Department patients per year referred to them by and the PCMS. The clearinghouse the clearinghouse. All physicians will be located in the PCMS offices. agreeing to participate for the mini­ Staff would consist of a public health mum number of referrals per year will Personal nurse and two outreach workers. be eligible for additional payment by The clearinghouse proposes to es­ the State on all obstetrical services. Problems tablish a voluntary rotational system Specifically, if a physician agrees to of Physicians for patient provider referral which accept the minimum number of refer­ calls upon the existing provider pool rals made by the clearinghouse per Committee of private physicians, the Tacoma year, the State will increase reimbur­ Family Medicine Clinic (TFM), the sement by $200 per delivery to the For impaired Physicians Community Health Care Delivery Sys­ provider on alt Medicaid deliveries Your Colleagues tem (CHCDS), the TFM Fellowship rendered by the provider within any Want to Help Clinic, and Associated Midwives. given year covered by the agreement. The goal is to reduce the hospital Medical Problems, Drugs, drop-in of pregnant women and the Alcohol, Retirement, Emotional Problems

Committee Members Patrick Donley, Chair. 272-2234 Joseph Kramer...... 845-9511 John R. McDonough .. 572-2424 William A. M cPhee...... 474-0751 DIET PLAN Ronald C. Johnson...... 841-1894 Kathleen Paris...... 591-6681 TFiE AFFORDABLE ALTERNATIVE! Dennis F. W aldron...... 272-5127 CREATED BY A PHYSICIAN THAT KNOWS .. . Mrs. Jo Roller...... 752-6825 Dan & Dawn Dube WSMA (206) 848-0711 1-800-583-0127 inclependenl ToppMed'" Distributor ■'OKT GROUPS A V A IL A IU X

Page 8 © The Bulletin « May 19% NEWSBRIEFS

Putting Their Best Feet Forward to Fight Cancer

The medical community will be out Army Hospital, MultiCare, St. Joseph search, educa­ in force, May 18-19, footing their way Hospital, the medical offices of Mt. tion, and patient toward raising $750,000 dollars for Rainier Surgical Associates, Medical service the American Cancer Society at the Oncology/Hemo Associates and programs. 6th Annual City of Destiny Classic. Edward Williams, M .D .. Dr. Klatt’s A group of The 24-hour walk/run on Stadium family team has registered under the young cancer Bowl Track is the realization of a name “The 'K' Team." Other medical­ patients from dream for Gordon Klatt, M.D., Colo­ ly related teams include the Camp Good- rectal Surgeon and President of the Northwest Therapy and Rehabilitation times will Medical Society. "I had a dream six group, the United Ostomy Associa­ take a years ago as I circled Baker Field tion, and the McChord A.F.B. team ceremonial track for 24-hours that some day this captained by Neil Andren, M.D. lap around the effort would evolve into a team relay Corporate sponsorships, (to pay track hand-in- event." This year teams from all over for expenses related to putting on the hand with a Washington State are putting their 24-hour run), are provided by Mt. celebrity media best feet forward. Rainier Surgical Associates, Multi- team made up In Tacoma alone, 60 teams will par­ Care Medical Center, Pierce County of Tacoma-Seat- ticipate. They hope to raise $100,000. Medical, Premier Industries, Puget tle television, The medical teams include nursing, Sound Bank, St. Joseph Hospital, radio and operating room, administration and The Morning News Tribune, and U.S. newspaper oncology personnel from Allenmore Surgical Corporation. All funds by reporters. The Hospital, Good Samaritan Hospital, participants go directly to the Camp Goodtimes children will par­ Lakewood Hospital, The 50th General American Cancer Society to aid in re­ ticipate the full 24-hours or as long as allowed by their personal physicians. Medical support at the track will be provided by the St. Joseph Foot and Ankle Clinic and Drs. Jonathan Bacon and Greg Popich. Shari Hoffman and a group of massage therapists will provide round the clock muscle relief. For more information, or if you Offering the OPTIFAST™ Program would like to join a team, contact the Pierce Unit of the American Cancer for your patients who are significantly overweight Society at 473-1853. and may have associated medical problems. by Physician Referral Dr. Singh Serves on ABEM Oral Exams Medical Supervision Friendly, courteous, professional clinical team, Surinderjit Singh, M.D. was asked physicians, dietitians, nurses, behaviorists to serve as an examiner for the oral portion of the American Board of Electro Diagnostic Medicine (ABEM) If we can assist you in the care of your patients Exams at the Rehabilitation Institute caH: Tacoma 572-0508 -Federal Way 874-3860 of Chicago, on April 7, for the seventh consecutive year. Dr. Singh has been a Medical The Society member for 10 years and serves on the Board of Directors for the College of Medical Education. He OPTIFAST' is a member of the American Associa­ Pmgrum tions of Electromyography and Electrodiagnosis and the American Academy of Physical Medicine and Cedar Medical Center St. Francis Medical Office Building Rehabilitation. 1901 S. Cedar, Suite 205 • Tacoma, Wa 34509 9th Ave. S., Suite 200 - Federal Way, WA

The Bulletin # May 1990 « Page 9 223 Tacoma Avenue South • T a c o m a , Washington 98402 • Telephone (206) 572-3666

Presents A Designated Trauma Center — The Pros and Cons”

featuring

Donald Gann, M.D. Department of Surgeiy ^ ' . University of Maryland Tuesday, May 8

Place: Fircrest Golf Club 6520 Regents Blvd. Time: C ocktails 6:00 p.m. (no host) D inner 6:45 p.m. Program 7:45 p.m. Price: $15 per person* *$] 7 per person if registering tlar of meeting

Reservations requested by Friday, May 4. Spouses are Invited!

REGISTRATION ^ ’[/^kaveTeserv-ed the ewnmgof May-S lo join members ofihe Pierce County Medical Sociclv lo hear A Designated Trauma Center - The Pros & Cons" Please reserve dmner(s) at $______per person (meal. Ins, and iivaUmies included). E n c lo se d is m y ch eck for S "

Dr.

Please make check payable lo PCMS and return no luier than Friday, May 4. t .. _ *d a y OF REGISTRATION FEE — $17. NEWSBRIEFS

Notes from Your Local Pharmacist

Recently, while having breakfast such a negative response to the few without even knowing what I did or with a friend, I listened to yet another he did ask. I have heard similar how I did it. story of a patient’s dissatisfaction stories from patients many times. I It may be wise to ask for feedback with his physician. know that none of us wishes to from your patients. Put a comment My friend had just visited his deliberately harm the patient or their box in the office, supply paper and physician with a written list of con­ feelings, yet these things do happen. pen, and encourage its use. cerns. He was very discouraged Generally we are unaware of these when the physician showed little inter­ happenings unless someone brings — A Pierce County est in dealing with these concerns. In them to our attention. I know that I fact, he didn't even finish asking all can estrange a customer or a patient Pharmacist his questions because he received r ~ Call for Resolutions DWYER PEMBERTON The WSMA Annual Meeting will be AND COULSON held September 20-23, 1990, in DftC Accountants and Consultants Spokane. Any member may submit a resolu­ tion to the House of Delegates meet­ Extensive practice experience providing con­ ing. Pierce County Delegates will in­ troduce resolutions submitted prior to temporary tax, business, financial and invest­ July 20 by members of the Society. ment services to medical professionals. If you would like WSMA to take ac­ tion on any issue, call the Society of­ fice and they will help you draft a 572-9922 resolution to the House of Delegates. WSMA is committed to responding to 945 Fawcett, Tacoma WA 98402 the actions of the House, so please submit your ideas today! Over 50 resolutions were intro­ duced and acted upon by the House in 1989. They dealt with such issues as access, state income tax, Med­ Shauna Weatherby Receives icare assignment, expert witness tes­ National Urban League Award timony, peer review, and AIDS.

Shauna Rae Weatherby was Shauna is the wife of Charles selected recipient of the Western Weatherby, M.D., who also is a Regional Volunteer Services Award noted volunteer in the medical com­ by the National Urban League at its munity. He chairs the Minority Health Regional Assembly in Portland, Affairs Committee, is a past PCMS Oregon, March 31. Board Member and is currently serv­ Anonymous AIDS Antibody She will be presented a Certificate ing as a WSMA Trustee and member Testing and Counseling of Recognition at the Volunteer of the WSMA Health Access Task Recognition Breakfast during the Na­ Force that developed WSMA’s RESULTS IH 24 H01M S ■ SAME DAY SERVICE AVAILABLE tional Urban League’s National Con­ Washington Health Access 2000 2000 116lh Ave N E ference in New York City on July 29. “Report P” in 1989. The Medical Bellevue, WA 98004 Society salutes Shauna and Charles n cc -i n c i Near Overlake Hospilal The recognition of Mrs. Weatherby 455-1967 is for her many efforts in organizing Weatherby for their many contribu­ tions to the community. Satellite Office in Tacoma programs beneficial to the general Call for an appointment. health of the minorities in the com­ munity.

The Bulletin « May 1990 * Page 11 NEWSBRIEFS

New Clinic Seeks Volunteer M.D.’s to Provide FREE Medical Care to the Needy

problems are addressed. For more Trinity University Presbyterian This clinic is not designed to com­ complex patients the clinic acts as a Church is sponsoring a medical clinic pete with, but to supplement St. Leo’s Neighborhood Clinic. The clientele fre­ referral source. called the Trinity Neighborhood Clinic Patients are not charged for ser­ located at 1619 6th Avenue in the quenting each appear to be some­ vices rendered. Whenever possible, rebuilt second floor of the manse. what different - although they both free medications are prescribed. No The church is situated behind share the same needs. class four drugs are kept on the J.D. Byrd’s Chicken. The current administrator is John premises. Frank Louis, a missionary from Morgan, retired Executive Director of University Place United Presbyterian the Tacoma-Pierce County YMCA. If you are interested in participat­ Church, has been the driving force Bruce Buchanan, M.D. is the Medi­ ing, please contact Bruce at 572- creating the clinic. The clinic has cal Director. For the time being, the 5140, 9:00 a.m. to 5:00 p.m., Monday been initially designed to care for the Clinic Board operates under the through Friday. For call and possible families of the children from Bryant umbrella of the Pierce County schedule conflict purposes, the clinic Elementary School at the corner of Alliance - for insurance purposes. convenes from 6:00 to 8:00 p.m. on 8th and Grant, who are tutored twice Currently there are adequate num­ Thursdays. weekly, by the church. It is hoped bers of physicians, but the clinic can that word of mouth will increase the always use additional M.D.’s. Oniy clinic clientele. basic pediatric and family medicine

Dr. Klatt Nominated Minority Health Affairs Committee For WSMA Board Recommends Survey

Gordon Klatt, M.D., PCMS Presi­ Charles Weatherby, M.D., Chair­ wide ranging from preventative care, dent, has been nominated by the man, Minority Health Affairs Commit­ prenatal programs, seniorhealth care Board of Trustees for a position on tee, and members representing the programs, to drug programs. the WSMA Board of Trustees. Dr. Tacoma Urban League, Tacoma Com­ Dr. Weatherby and Gordon Klatt, Klatt, if elected, will be replacing Bob munity House, Alpha House, Tacoma- M.D., met with the Black Collective Scherz, M.D., Pediatrian, who has Pierce County Health Department, on Saturday, April 14 to discuss the represented Pierce County on the and Community Health Care Delivery concerns of the black leadership on Board since 1983. System Clinics met to establish goals health care in Pierce County. Look Renominated for WSMA Trustees and objectives for the Committee. for information on this meeting in the were Dick Bowe, M.D. and Charles The members of the Committee June Newsletter. Weatherby, M.D.; Richard Hawkins, strongly recommended that the The Committee will meet again in M.D. was renominated for Vice Society conduct a survey to deter­ May to follow up on the survey and to Speaker; and Bob Wachtel, M.D. mine or gather the perceptions of address the objectives of the Commit­ was nominated to serve on the physician members providing ser­ WSMA EMS Committee. tee. vices to minorities. That survey will be The Board commended Dr. going out in April. The concerns were Scherz, who is stepping down from his WSMA position, for his service on the Board since 1983. His repre­ sentation of Pierce County and medicine has always been of the highest quality. He will be missed by Qualified Physicians Needed his colleagues on the Board. Bob is semi-retired and putting in Seattle • Low Volume • 60 beds • 12-36 hour shifts • Graduate of an about 50 hours a week in his Accredited Medical School • Current WA License and ACLS Certificat­ numerous efforts. ion • ° r 2000 hours Emergency Room Experience • 150 nours o CME Credits - credits must be A O A -A M A approved and docu- racntabic • Malpractice Coverage Provided: Claims Made With Unlimited Tail Call National Em ergency Services - 1-800-554-4405

Page 12 • The Bulletin « Mav 1990 NEWSBRIEFS

Measle Threat To Dr. Hoffmeister Needle Exchange Medical Personnel... President of WSOA Update

The Board of Trustees, at their April Richard Hoffmeister, M.D., The Board of Trustees, at their April meeting, discussed the need for Tacoma Orthopedist and member of 3 meeting, were updated regarding physicians and their office staff to be PCMS since 1978, has assumed the the Needle Exchange Program by Al current on their measles immuniza­ Presidency of the Washington State Allen, M.D., Director, Tacoma-Pierce tions. It was reported that two emer­ Orthopedic Association. His County Health Department(TPCHD) gency room physicians in King Coun­ predecessor was Bill Grainger, M.D. and members of his staff. They ty contracted measles because they of Spokane. reported that the program is benefi­ were exposed to infected patients. Dr. Hoffmeister, WSOA's Vice Presi­ cial, is legal, and that the main intent It is highly recommended that all dent for the past two years, has is to interrupt transmission. Holly persons born after 1956 should chaired the WSOA Legislative commit­ Hagen, Epidemiologist, presented in­ check their immunization status. If tee since 1986. This last legislative formation that had been gathered unknown, immunized prior to 1968 session he served as vice chairman of regarding the program’s effective­ or immunized prior to one year of the WSMA Legislative Committee. ness. From this information, the age, you need to be re-vaccinated. The committee met weekly to review TPCHD is confident they are making There are currently 10 cases of events as they occurred in Olympia. a difference. They reported that there measles in Pierce County that are He is also the legislative are many promising modalities in the confirmed and/or physician diag­ committee’s liaison to the WSMA's prevention of AIDS and Needle Ex­ nosed. Three local hospitals have in­ liability committee and its political ac­ change is one. They have docu­ fected patients. Please be advised tion committee, WAMPAC. mented that people who utilize the ex­ that your office staff members need to The Society congratulates Dick Hof­ change decrease their susceptibility follow these same protocols. fmeister on his position with WSOA to the disease. The Board requested and thanks him for his efforts on be­ that Dr. Allen report back in 1991 with half of medicine. more solid evaluation results.

The Perfect Car Consultant 752-8888 3009 Bridgeport Way West • Suite 4

BUYING SERVICE • PRICING CONSULTING • APPRAISALS

Domestic & Imports Cars & Trucks Building Purchase Update ANY MAKE -A N Y MODEL As we go to press in mid-April, the Medical Society office is still located We can save you time and money on the at 705 South Ninth, and anticipating, but not promising, to be in the new purchase of your next vehicle... building by May 1. Guaranteed Due to revision of the renovation plans and the structure of the build­ ing, it was necessary to add addition­ al supports in the lower level where "Call before you buy!" 752-8888 the walls have been removed from the reception area.

The Bulletin * May 1990 m Page 13 NEWSBRIEFS

Dr. Koop Address “Managing Diabetes in the ’90?s”

to AMA Leadership The Diabetes Association of Pierce hours by the American Osteopathic Conference Available County and the American Diabetes Association. Association are co-sponsoring a The seminar's objectives are to It was Sunday morning in the one-half day clinical education pro­ provide state-of-the-art information ballroom of the Sheraton Hotel in gram for physicians "Managing about the practical management of Phoenix. The giant, blue, white and Diabetes in the ’90's” on Saturday, diabetes and to improve the quality black banner draped behind the May 12. of care provided to all people with podium proclaimed “Strong Physicians attending will receive diabetes. Medicine.” Former Surgeon General 3.5 Category I credit hours for the Pre-registration is $65 and will be of the United States C. Everett Koop, Physician Recognition Award of the taken until Wednesday, May 19. M.D., stroked his trademark whiskers, American Medical Association and Registration at the door will be $75. looked out into an audience of 1,800 for the relicensure requirements of The fee includes a continental break­ physicians and others packed into the the Medical Examiner of the State of fast and reference materials (2 ballroom and intoned: Washington. This program is also ac­ books, and 3 pamphlets) on diabetes. “I feel up to delivering a sermon.” credited for 3.5 hours by the Call 272-5134 for more information And deliver one he did.* American Academy of Family or to receive a brochure. He addressed the group on the Physicians and 3.5 elective credit subject of "Building Bridges between Physicians and the Public.” if you would like a copy of his Scenic Tacoma Bicycle Ride presentation, please call the Society office at 572-3667. You will like what Enjoy a bike ride through one of Points of Interest: he has to say. the most beautiful areas of the » The Narrows Northwest. This 35 mile ride begins in *L£kCMA Physician, April 2, 1990. • Union Station Point Defiance Park, continues through beautiful Northend residen­ • Tacoma Dome tial areas into downtown Tacoma, on • Cliff House to the “tide flats” and East Tacoma. • Old Smelter Stack Return via the waterfront to Point We will meet on Saturday, May 12, Defiance Park. Several stops for 9:30 a.m. at Point Defiance Park Are you worried about leaving your “eats." entrance. Contact Dave Wilhyde, home unattended during your vaca­ tion? Don’t worry. Call the Medicai M.D., Tacoma, 572-6920. Society. We have several professional housesitters available. These sitters are experienced and have good references. Call PCMS at 572-3667 to get in Let Us Help touch with your sitter. You Look GREAT! lisle

Western Washington e> Low Volume Interiors, Inc. • 24 beds, 8 patients per hour ® 12-72 consulting with over 30 years hour shifts » Graduate of an accredited Medical School « Current WA Liccnsc and ACLS Certification » OneVear Emergency Room Experience e Mal­ practice Coverage Provided: Claims Made with Unlimited Tail ation CALL National Emergency Office inv, Services: 1=800-554-4405 Days: 572-9998 ” 8 4 5 - 1 8 2 1 G ene & Marie Smith

Page 14 9 The Bulletin • May 1990 V Applicants for Membership

The Pierce County Medical Society welcomes the following physicians who have applied for membership. As out­ lined in the Bylaws, any member who has information of a derogatory nature concerning an applicant’s moral or ethi­ cal conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of convey­ ing that information to the Credentials Committee or Board of Trustees of the Society.

Randall P. Bennett, M.D. Frank S. FI oca, M.D. Northwestern University Medical School, 1985; residency, Psychiatry. Born 05/12/50 in Otolaryngology. Born 09/18/54 in Northwestern University Medical Texas. Medical school, University of California. Medical school, Ohio School, 1989. Washington State State University, 1982; internship, Texas Medical Branch, 1976; inter­ License, 1990. Dr. Gray is practic­ nship, Long Beach VA Medical Cen­ Madigan Army Medical Center, ing at 2420 South Union. 1983; residency, Madigan Army ter, 1977; residency, University of Medical Center, 1987. Board cer­ Cal-lrvine Medical Center, 1979. Ales Matzenauer, M.D. tified, Otolaryngology, 1987. Dr. Washington State License, 1989; Internal Medicine. Born 01/29/53 Bennett is practicing at 1609 South board certified, Psychiatry, 1983. in Czechoslovakia. Medical school, Meridian. Kent R. Gebhardt, D.O. Palacky University, Czechoslovakia, 1978; internship, Lincoln Hospital, Glenn A. Deyo, M.D. Family Practice/Emergency 1987; residency, Lincoln Hospital, Medicine. Medical school, College General Surgery. Born 01/04/52 1989. Washington State License, in Texas. Medical school, University of Osteopathic Medicine, 1986; in­ 1989; board certified, Internal ternship, Cook County Hospital, of Texas Medical School of Hous­ Medicine, 1989. Dr. Matzenauer is ton, 1982; internship, Madigan 1987; residency, Cook County practicing at 7511 Custer Road W. Army Medical School, 1983; Hospital, 1989. Washington State residency Madigan Army Medical License, 1989; board certified, Fami­ Doris A. Page, M.D. Center, 1987. Washington State ly Practice, 1989. Dr. Gebhardt is License, 1989; board certified, practicing at 2209 East 32nd Street. Family Practice. Born 06/11/45 in General Surgery, 1988. Dr. Deyo is Newark, N.J. Medical school, practicing at 3611 South D Street. Richard E. Gray, M.D. University of Colorado, 1982; inter­ nship, Mercy Medical Center, 1983. Orthopedic Surgery. Born Washington State License, 1989. 05/31/60, New Orleans. Medical Dr. Page is practicing at 3716 school, Northwestern University Pacific Avenue, Suite G. Medical School, 1984; internship,

Welcome To New Members

The Board of Trustees at its March 14 meeting approved the Credentials Committee recommendation that the fol­ lowing applicants be approved for membership into the Society. They are:

ACTIVE MEMBERS: Sharon Schual-Berke, M.D. ASSOCIATE MEMBERS: Cardiology, 1802 South Yakima M. Tarek Baghdadi, M.D., Avenue, #302, New York Medical William P. Andrade, M.D. Ob/Gyn,1811 South K Street, College - 1979 Allergy/Internal Medicine, #203, “Royal College of Surgeons” Madigan Army Medical Center, Ireland — 1980, Medical Director of Henriette P. Schwab, M.D. University of Washington School of Midwives Associated Dermatology, 1706 South Medicine -1973 Lance W. Kirkegaard, M.D. Meridian Street, #140, State Univer­ sity of Leiden, Netherlands, 1980 Lee E. Payne, M.D. Internal Medicine/Critical Care Emergency Medicine, Madigan 11311 Bridgeport Way S.W., #301 Cheryl M. Yokoyama, M.D. Army Medical Center, Vanderbilt University of Texas School of Ophthalmology, 1901 South University School of Medicine -1983 Medicine - 1978 Cedar, #101, University of Califor­ Jerry E. Markussen, M.D. nia, San Francisco Medical School - 1983 Internal Medicine, 521 South K Street, University of California -1976

The Bulletin • May 1990 • Page 15 Presents

Our Quarterly Luncheon Meeting For Retired Members and Spouses

“Palliative Medicine; An International Experience Is Pierce County Ready for It?”

featuring

Stuart J. Farber, M. D. Please Note:

The PCMS Photographer will D ate: Wednesday, May 9 be at this meeting to take your P5ace: Quality inn (Tacoma Dome Hotel) photographs for the 1990 (Hickman Room) Pictorial Directory. 2611 East “ E” Street There is NO CHARGE TO Time: Lunch 12:00 p.m. HAVE YOUR PICTURE Program 12:45 p.m. TAKEN. Price: $10.50 per person

We Hope Thai You To register, please send your reservation to Will Participate/ PCMS or call us at 572-3667 no later than Friday, May 4.

REGISTRATION Yes, I (we) have reserved May 9 to join retired members of fhp Pi- r> tive Medicine', An Internationa! Experience - Is Pierce County'Ready*foM r?' edical Society to hear "Pallia- Please reserve lunch(es) at $10.50 per person fra* anH , . ■■ Enclosed is my check for $ ’ 01 gratuities included),

- 1 re9re’,ha'' '-on peon o, 1|18 meeting., wi„ altencl lhe program Qn|y

Please + College of Medical Education

Aggressive Musculoskeletal and Spinal Evaluation, Treatment and Rehabilitation Program is Set for May 10 & 11

The Aggressive Musculoskeletal focus on Diagnostic Subsets, Tech­ The conference will also cover and Spinal Evaluation, Treatment and nologic Advances, Injection Techni­ electrodiagnostics, radiological Rehabilitation Program is scheduled ques, Exercise Prescription, Surgical scans (CAT, MRI, & contrast enhance­ for May 10 and 11 at the Tacoma Approaches, Early Intervention, and ment) and reflex sympathetic Sheraton Hotel. Sponsored by the Disability Prevention. dystrophy. The program will also ex­ College of Medical Education, the 2 The conference faculty includes amine pediatric, geriatric, and day program has been organized by. many local and regional experts and rheumatologic considerations. Dis­ Edgar Steinitz, M.D. physiatrist with will feature Jeffrey Saal, M.D., a San cussion of the physiatric armentarium Electrodiagnosis and Rehabilitation Francisco Rheumatologist and and issues surrounding the shoulder Associates of Tacoma. Dr. Steinitz is Physiatrist. Dr. Saal is the Director for and lumbar spine will also be in­ also Medical Director of Northwest Research and Education of the San cluded. Therapy and Rehabilitation of Francisco Spine Institute and the Those who have not registered for Tacoma. Chief, P.M.& R. of the Spine Care the conference, may do so by calling The program is accredited for 16 Medical Group of Daly City, California. 627-7137. Category I C.M.E. hours and will

Sun Valley Registration Continues

The Sun Valley C.M.E. program, completed and returned the College's and to secure limited air transporta­ set for February 27, 28 and March 1, interest survey. However, other tion at convention rates. 2, and 3 of 1991, continues to register Pierce County Medical society mem­ The interest survey indicated that participants. The program sponsored bers may receive the extensive pro­ many physicians planned to take by the College of Medical Education, gram packet by calling 627-7137. their entire family and spend a whole will be held at Sun Valley’s Elkhorn Those who have yet to register are week. The reduced rates for Elkhorn Resort. encouraged to act soon to assure resort and Horizon Air are available Registration packets were mailed space in the conference, to arrange for participants and their families' ex­ last month to those physicians who for the best lodging at reduced rates, tended stays.

Popular ACLS C.O.M.E. Program Schedule Course Accepting DATE(S) PROGRAM DIRECTOR (S) Registrations 1990 The College of Medical Education’s second of two annual advanced Car­ Thurs., Fri., Aggressive Edgar Steinitz,M.D. diac Life S upport classes is May 10,11 Musculoskeletal scheduled for June 25 and 26 in Jack­ and S pinal son Hall. Evaluation,Treatment The course is coordinated by and Rehabilitation James Dunn, M.D., and offers 16 Category I C.M.E. credits in addition Mon., Tues., Advanced Cardiac James Dunn, M.D. to ACLS certification. Those inter­ June 25 & 26 Life Support ested in registering are encouraged to sign up soon - as the course fills early. Clip and Save!

The Bulletin • May 1990 • Page 17 nizatidine capsules S p f a c e b o ^ p m a i B Ies 01 '.k6 kVer we,s ll’ cr6ased m f a high-dose males as compared Btlal Samroarj. consult tie eacHage literature (or complete Information. Human dos°V 2 - ™ ^ ^ dl>se Axid |2 '000 ^ k g /d a y . about 3 3 0 times the h S S i t l 5" ? s,a"stl“ "v s,sni,,canl " « * » « « hepatic carcinoma and Indications and Usage: 1. Active a m e n t t t o - f o r up io eight weeks of treatment Mosi patients itear wilhin lour weeks. ™ua W m TS! r M e " '« an* <* “» ^ groups, seen lor the strain of mice ire ^ T h ^ ,a°se animats was within the historical control limits 2. Maintenance therapy-tur healed duodenal ulcer patients at a reduced rinsa™ „i tolerated dose ^ ,he lecnsle mi“ were 0-ven a dose larger than the maximum 150 mg h.s The consequences gf tHerapy with Axid toi longer man one year are not known controls and evidence miw w i WB'ahr apc'ement as comoared w * wncumitit C O B tratadlM tlO B -. K tw m (a the Utu9 use with caulion in patients with finding ai h.nh t o ™Tn(transaminase elevations). The occurrence ol a marginal hypersensitivity lo other Hr receptor antagonists n with no evidence of a ^ c nnn , r m 9: 6" a" w * s 9re and » " ' « * ' « hapatotoxic dose, Precautions: G en era/-1 Symptomatic response in nizatidine theraoy presence ot gastric malignancy. muotrae Hie con sid er evidence ol a care,nQgen,c Co,entfa?®or Add.8 n83at'Ve nlu,a0en'citV Datte,V are n°> 2. Dosaje should be reduced in patients with moderaie to severe renal insufficient 3. in patients with normal renal function and uncomplicated hegatic rtw iuiiim r, »,■ toxicity. i t t a iS n ^ t e S a i m n ia im rf'L i1 16515 Jer1,,[met! to evaluate its potential genetic, disposition oi nizatidine is similar to that in normal subjects ■ lne exchange, mouse lymphoma asssv rhr f u" s^heflulB() DfJA synthesis, sister chromatid th raoyfa ,W fts,s" False' pasit've lests ,0f ur°bilinogen with Multislix’- may occur during e 'n a 'v-o-geneialon p eTm at^ n i ' T ' 3"0" ,esls’ and a micronucleus lest 650 proOuced no aduew ^ S 1? M ) l m ,a's ’ d05es 01 nira,ltfme UP t0 Drug mmcfms-Ha interactions have been observed with theophylline chlortfiaiPDoiciria animals or ttieir progonv steels on ihc /eprocfuclive performance of parental lo tazepam, iidocame. phenytom, and warfarin. Axid does not inhibit the cvtochrom P i?n enzyme system: therefore, drug interactions mediated by inhibition o< njoata » S ^ u P t o l ' T O h r ! ^ Category C -O ra l reproduction studies in rats not expected to occur. In patients given very high doses (3.900 mg) ol aspirin dail„ e t,uman dose revealed no isvidenci- n im m m 3 rabt)i,s at doses up 10 55 ,imes serum salicylate levels were seen when nizatidine. 150 mg b 11 , was administered n n n ! r S juiwieni to 300 i,mes the human rioci K 0f 'era'ogerrc effect Out, at a dose Carcinogenesis. Mutagenesis. Impairment ol Fenihti-p, tac-yew wai cam nSS /' w ' depressed letai weiohk'rin mi lab'Jils fiad abortions, decreased number ol study in rats with doses as high as 500 mg/kg/day (about 80 times the recommended i£' V therapeutic dose) showed no evidence ol a carcinogenic effect There was a d o s w e n a mcreasc in the density ol enterochromaftm-llke (ECU cells ,n ihe oasttK o«vrn,r m ,^ V , S ' aMomer'' sP'na bUiria liwj or'fnini h ms' k°' 11 praduced ventricuiar anorr a two-year study in mice, there was no evidence ol ’ carcinogenic -effect -- ■ in mucosa,mala mice in to S n fr:;,.5^ ««>■ "Vdroccoht and ^ . » , * W , i . a v.'^ c o oie? ^ 1 nd enlarqed hean " « W w . There are, ne can cause t o l "'°'r e r ' 11 is al® knw ,n ^ d 1 (nizatidine.i. Lilly) Lilly) administered (o a pregnant woman or can affect Because safety cannot be taken for granted in H2-antagonist therapy

AXM n iz a t id in e Minimal potential for drug interactions Unlike cimetidine and ranitidine,1 Axid does not inhibit the cytochrome P-450 metabolizing enzyme system.2 Swift and effective H2-antagonist therapy ■ Most patients experience pain relief with the first dose3 ■ Heals duodenal ulcer rapidly and effectively4-5 ■ Dosage for adults with active duodenal ulcer is 300 mg once nightly (150 mg b.i.d. is also available)

R e fe re n c e s 1. U S P D / Update. Septem ber/October 19QQ, p 120. 2. Br J din Pharmar.nl 1985;20:710-713. 3. Data on file. Lilly Research Laboratories. 4 . Scand J Gastroenterol 1987;22(suppl l36):61-70. 5. Am J Gastroenterol 1989;84:769-774.

reproduction capacity. Nizatidine should be used during pregnancy only it the potential benefit with equal frequency by patients on nizatidine and those on placebo. Gynecomastia has been justifies (tie potential risk to ttie Telus. reported rarely. Nursing Motfiers-Sludies in lactating women have shown that 0.1% of an oral dose is Hematologic-Fa\a\ thrombocytopenia was reported in a patient treated with nizatidine and secreted in human milk in proportion to plasma concentrations. Because of growth depression another H2-receplor antagonist. This patient had previously experienced thrombocytopenia in pups reared by treaied lactating rats, a decision should be made whether to discontinue while taking other drugs. Rare cases of thrombocytopenic purpura have been reported. nursing or Ihe drug, taking into account the importance ol the drug to the mother. Iniegumenial-Sweating and urticaria were reported significantly more frequently in Ped!3t/>c Use-Salety anfi effectiveness in children have not been established. nizatidine- than in placebo-treated patients. Rash and exfoliative dermatitis were also reported. Use in Elderly ft//e/M $-Healing rates in elderly patients were similar to those in younger Hypersensitivity-A s with other H?-receptor antagonists, rare cases ol anaphylaxis following age groups as were the rates of adverse events and laboratory test abnormalities. Age alone nizatidine administration have been reported. Because cross-sensilivity among this class has may not be an important factor in the disposition ol nizatidine. Elderly patients may have been observed, Hr receptor antagonists should not be administered to those with a history of reduced renal function. hypersensitivity to these agents. Rare episodes of hypersensitivity reactions (eg, bronchospasm, laryngeal edema, rash, and eosinophilia) have been reported. Adverse Reactions; Ciinlcal trials of varying durations included almost 5.000 patients. Among Offier-Hyperuricemia unassociated with gout or nephrolithiasis was reported. Eoslnophilia, the more common adverse events in domestic placebo-controlled trials of over 1,900 nizatidine fever, and nausea related lo nizatidine have been reported. patients and over 1,300 on placebo, sweating (1% vs 0.2%). urticaria (0.5% vs <0.01% ), and somnolence (2.4% vs 1.3%) were significantly more common with nizatidine. II was not Overdosage: Overdoses of Axid have been reported rarely. If oveidosage occurs, activated possible to determine whether a variety of less common events was due to the drug. charcoal, emesis, or lavage should be considered along with clinical monitoring and tfepatfc-Hepatocellular injury (elevated liver enzyme tests or alkaline phosphatase) possibly supportive therapy. Renal dialysis lor lour lo six hours increased plasma clearance by or probably related to nizatidine occurred in some patients. In some cases, there was marked approximately 84%. elevation (> 5 0 0 IU/L) in SGQT or SGPT and, in a single instance, SGPT was > 2 ,0 0 0 IU/L PV 2098 AMP [091269) The incidence ol elevated liver enzymes overall and elevations of up lo three times the upper limit of normal, however, did not significantly differ from that in placebo patients. Hepatitis Additional information available lo the profession on request and jaundice have been reported. All abnormalities were reversible after discontinuation ol Axid. Cardiovascular- In clinical pharmacology studies, short episodes of asymptamatic ventricular Eli Lilly and Company tachycardia occurred in two individuais administered Axid and in three untreated subjects. Indianapolis, Indiana CA/S-Ffere cases of reversible mental confusion have been reported, 46285 fijcfocnne-Clinical pharmacology studies and controlled clinical trials showed no evidence ol antiandrogenic activity due to nizatidine. Impotence and decreased libido were reported NZ-2926-B-049314 'P 1990, EU LILLY AND COMPANY Axid® (nizatidine, Lilly) — aHEALTH « - - -REPORT------— \_ V______- . ,h „ m„nih r v ^ nrior to first oarircipation in mterscholastic athletics in middle school and prior to participation in high school. Clearance TIME OF EXAMINATION: For. athletics, during he 2 mo p f ol inSefSCtolaslic athletics A yearly clearance from the exammer is needed for continued parfdpatkm for continued participation is to be provided on, ims >o p phV 5 ,Cian knowledgeable regarding each aspect of his. her health. Examination m ay be performed by a licensed

ChH0 IC E V n T o a i a 5 S 7 y « iS a ssS oJ a cenSaS ped-atnc or lamHy !u*e p^ltoner « under the d ire ct o< a P W ™ .hose name IS l0 be ^

!, T„ « r„„p , FTED BY THE PMENT OH GUflBDBN BEFORE EXAMINATION BY THE PHYSICIAN. PLEASE PRINT------

— ------B/rthdate: Mofith'D ay-'Y ear S e x :F o rM Nam e of school, cam p or organization F irs t M id d le L a st n a m e

Z ip H o m e p h o n e A d d re s s W o rk phone Name of parent or guardian

P h o n e D e n tis t Phone Usual physician or source of health care

riR rLE PtJRPOSE OF REPORT' SCHOOL-Preschool. ChildFmd, Head Start, ECEAP. kindergarten, elementary school, middle school, high school. To enter grade Sept 19 INTERSCHOLASTIC ACTIVITIES— baseball, basketball, cross counlry. football, gynm astics, soccer, swimm ing, tennis, track, volleyball, wrestling. 07HEfl: day care, developmental center, child study, park board recreation, boys club, camp, lilesaving, other (specify)— ------—------lg THERE ANY ILLNESS OR HANDICAP or other situation which might atieci perform ance? (please explain)

CHILD HAS HAD THE FOLLOWING: Circle Ihe appropriate item(s) and explain on the right Nam e other doctors important m child s care ORTHOPEDIC' fracture or sprain, scoliosis, congenital hip SKIN: aerie, eczema VISION: glasses, contacts NEUROLOGICAL: convulsions, meningitis, cerebral palsy HEAPNNG. aids METABOLIC: diabetes NOSE: b le e d in g BLOOD, anemia, sickle cell disease MOUTH: dental decay, orthodontia ALLERG IES' load, insect, pollen, contact, drugs, LUNGS: asthma, bronchitis other (specify) HEART: congenital, rheumatic HOSPlTAUZATIONfSHyear a reason) GASTROINTESTINAL: ulcer, colitis, hepatitis OPERATION(S) /year & reason): GENITOURINARY: kidney or bladder infection HANDICAP■ physical, mental, behavioral, social, learning, vision, hearing, speech, hyperkinesis It female, menstruating: Yes ( ) No [ ) Has child had. rubeola ( ), rubella ( ). mumps | ), chicken pox ( |, whooping cough ( ) If child is under 3 years, gwe btrth-weighi______Describe unusual iactors regarding birth or health imm ediately after b irth ______

THIS SECTION IS THE RESPONSIBILITY OF THE PHYSICIAN. PARENTjS) SHOULD BE PRESENT FOR EXAMINATION.

Doses received IMMUNIZATIONS None Month Day Year 1 2 3 4 5 or more Immunizations Diphtheria, Tetanus, Pertussis OTP,OT,Til Any combination ot OTP DT Td (circle flose given) Oral Polio Vaccine (OPV) OPV'IPV injectable Polio Vaccine (IPV[ (circle cfose given)

MMfl (Measles, Mumps, Rubella) MMR

Hemophilus Influen2a 6 Vaccine Hemophilus

Vision: Right Lefft Vision corrected Right L e tt Color vision Tuberculosis, skm test. Dale T y p e R e s u lt 20-- 20 glasses, contacts 20 20 (circle which)

CIRCLE ABNORMAL AREAS— DISCUSS AT RIGHT ANY CONDITION CIRCLE A p p e a ra n c e S c a lp T h ro a t Neurological Eczema, allergy, asthm a exercise Development H e a d C h e s t D e n ta l Induced asthm a, obesity, lung, N u tritio n E ye s L u n g s G e n ita lia A c n e heart, orthopedic, other ______E a rs H e a rt Extremities R a s h e s N o s e A b d o m e n Back {shows no evidence of Kyphosis or Scoliosis) An additional narrative report is attached or will be forwarded— Yes ( I No i l

INTERVAL NOTE- Identify any occurrences since examination wh,ch could affect participation ,n school, athletics or other activities.

REFER RAL(S) (circle] eye, ear, dental, orthopedic, other (describe) Please name other doctors involved in care ol child. Parents need help to obtain— Yes |

ASSESSMENTS THAT MAY BE NEEDED IN SCHOOL OR OTHFR Pam rrv k , should b e considered for special education, please describe need above 6 spe ' Psycllotogy. occupational therapy, physical therapy, guidance, learning If you believe i

RECOMMENDED PHYSICAL ACTIVITY. " ■------

□ s S m n g 16' preSC h° 01' p h y s 'c a l sP0l1s « camp activity MINIMUM W EIGHT-REQUIRED FOR WRESTLERS ONLY □ Modified or restricted activity (describe) 101 108 115 122 129 135 141 148 150 16S 178 180 Unlimited A Dhvsician?S!f''C " Wres"in9' not to 9 ° twlow what weight lb r .. "medra| — m ave - daais abwe

Next recommended dale of examination Physician's nam e (please print) S ig n a tu r e & title

Services, child care, youth and camping organizations" C00pera,ltjn Wlth preschools and schools! Tacoma-Pierce County Health Dept Dept, ol SccialT ISS^S-ia.Raa.^ao PCMS Coordinates Goodwill Games Physicians Exchange-

— Editor

Host Families Needed Responsibilities of PCMS is co-sponsoring the Good­ the Host Family will Games Physicians Exchange™ We hope to have enough in conjunction with the Goodwill volunteers to make it possible Games Seattle Organizing Commit­ for each Soviet physician to tee and will be administering and have 2-3 host families who coordinating the host program. We would feed, house, and show need your help to make this cultural them the sights. We especially exchange work. want to give them the oppor­ Thirty-five Soviet physicians will be tunity to visit the host’s office, arriving July 22 to visit the Puget clinic, hospital, and see how Sound area. The Medical Society cur­ American medicine is practiced. rently has approximately 100 There is no requirement that physician members and non-m em ­ they or the hosts attend the bers who have expressed an interest G oodwill Games™. It is an­ in hosting a Soviet guest. ticipated that Goodwill Games™ will set aside a block of tickets for certain events for guests and Counselor Accounts Receivable hosts to attend, if they wish to Medical Office Software do so. The hosts will be ex­ pected to purchase the tickets. Orientation Session iMS-DOS/ IBM / Novell compatible, There is a lot of flexibility in the pro­ DBASE compatible (III and up), An orientation meeting will be held gram. Much depends on the hosts Totally Menu Driven, user friendly, June 14 and June 19 to outline the ar­ Allows Rapid response to patient or and what they want to show the rangements. We hope to match Ins inquiries, visitors. One requirement is neces­ Soviet physicians with physicians of Input of Visit Information: < 1 m inute, sary: the Soviet Government requires Input of Patient Info: < 2 m inutes1, similar specialties. ICD, CPT and Ins Company info on file, that they be able to reach any of their PSMF program followup and statistics, physicians at any time. This can be C.M.E. Program Patient Callback, accomplished by calling the Medical Laboratory Billing and Followup, Society office and informing them There will be a one-day seminar Electronic Claims at no extra charge where the physician will be during the sponsored by the Physicians for So­ Easy billing to any Ins. by paper, cial Responsibility. It is scheduled for Rapid Deposit entry: < 1 m inute1, day. Can Handle: payments, takebacks, refunds, Tuesday, July 24. The Soviet guests overpays, writeoffs, adjust off, special Expenses will be expected to attend this meet­ billings, sliding scale, prof courtesy, ing. It will be held in Tacoma...loca­ No unusual expenses should be in­ Summary Reports by Day, Month, Y ear tion had not been decided at press Automated Statements, curred that would not be expected of time. Variety of Training available, someone hosting a guest or ex­ The Goodwill Physicians Well documented manual on all features. change student. However, there is ARC archiving software included. Exchange™, as originally conceived one exception. The hosts may be Optional online support. by Robert Klein, M.D., is a chance of Free updates and phone support for 1 year. asked to purchase a health insurance a lifetime. It provides us the oppor­ In use in medical offices since 1987. policy for the guest, estimated cost is tunity to meet people of a different $12-$30. Goodwill Games has sug­ $1000.00 / $1150.00 with online support culture and share our medical gested that it would be appropriate to (hardware also available) knowledge, abundance, democratic buy them a gift. This will be dis­ ideals, and develop lasting P.O. Healthcare 474-9484 cussed in detail at the orientation ses­ friendships. sion. with average typing skills and software fam iliarity. If you would like to host a Soviet

DBASE III is the reg. trademark of Ashton-Tate.IBM physician, please call the Medical is the reg trademark of IBM, MS-DOS is the reg Society at 572-3667. Q trademark of M icrosoft.

77ie Bulletin • May 1990 # Page 21 New One Stop Practice Protection

Physician’s Insurance Agency is pleased to introduce a new service called One Stop Practice Protection for individual and group practices. One Stop Practice Protection offers a complete range of professional and personal insurance plans and packages including: ■ Business Office ■ Disability ■ Health Care ■ Lite Insurance o Homeowners ■ Annuities ■ Auto & Boat ■ Umbrella Packages Physicians Insurance Agency is owned by Washington physicians and managed by dedicated professionals committed to quality, convenient service. For more information about our new One Stop Practice Protection service, please call Nora Dacus., Agency Manager, today.

Washington 1-800-962-1399 First Steps Program Expands Eligibility

— Department of Social and Health Services

First Steps is a new program that women to ensure that we meet a expands eligibility for Medical Assis­ 5 day timeframe. When the ap­ tance. It’s for pregnant w om en and in­ plicant first requests an appoint­ fants with a family incom e up to 185% ment, she is interviewed by the of the Federal Poverty Level. financial screener. The screener The Community Services Offices makes sure the applicant knows (CSOs) are using changes in state what verification will be needed and federal laws to provide medical (social security card, current in­ coupons to more pregnant wom en come/wage verification, iden­ and young children than ever before. tification for the pregnant women, and good health habits. The media The gross monthly income a family pregnancy verification including es­ campaign will start in September. can earn and still receive medical as­ timated date of delivery signed by a This campaign will cause more preg­ sistance for a pregnant fam ily mem­ licensed medical practitioner). nant women to look for prenatal care. ber more than doubled on August 1, If the applicant is potentially We will need more physicians to take 1989. This is: eligible for other programs, First these women into their practices, Steps eligibility is still established providing them with prenatal and even if the other program eligibility is delivery care. FAMILY SIZE MONTHLY pending. * If you are willing to serve First GROSS First Steps offers physicians a Steps obstetrical patients, call 591 - INCOME higher reimbursement for state- 6428. 2 (1 + unborn) $1,236 funded pregnant patients: * Have your billing staff call (206) 3(2+ unborn) 1,551 • reimbursement for OB care and 586-6478 to make sure you’re billing 4 (3+ unborn) 1,865 delivery from $750 to $850; correctly for high risk First Steps 5 (4+ unborn) 2,180 patients. New codes have been set • $100 for labor management; 6 (5+ unborn) 2,494 up. 7 (6+ unborn) 2,809 • $50 initial assessment fee; * Let your staff know that First 8 (7 + unborn) 3,123 • up to $300 for high-risk pregnan­ Steps is a new state funded program cy management by trimester. to help low-income (working and non­ working) pregnant women obtain In addition, more program con­ Physicians caring for high-risk First needed prenatal care. tinuity accompanies the expanded Steps patients can contact the CSOs * Make sure every one on your eligibility standards. Once a wom an and request that the patient be staff knows that the local DSHS CSO begins to receive medical coupons, referred to a case manager or sup­ is the point of entry for First Steps the coupons will continue unchanged port services nurses and social patients. throughout her pregnancy unless she workers who will reinforce the * Give the DSHS CSO telephone moves to another state. physician’s advice and make sure the number to low-income pregnant The CSOs are using a shortened patient shows up for her appoint­ women who come into your office application form and process. The ap­ ments. Case managers or support seeking prenatal care. These women plications can be filled out at and with services can guide patients to help, need to go to the CSO to fill out an the assistance of the Health Depart­ such as nutritional counseling and application to be eligible for First ment or Community Health Care childbirth education. Case managers Steps coverage. They may be eligible Delivery Systems. The goal of these can also assist in getting patients into for other benefits. If in doubt, refer! changes are to make CSO services drug and alcohol abuse programs. * With First Steps patients you more available. The CSOs will see The patient should be sent to the think might be high risk, make sure new clients that are pregnant w ithin 5 CSO because she may be eligible for that a case manager or support ser­ days and complete processing the ap­ a broad range of services including vices (reachable through the DSHS plications within 15 days. food stamps, dental care, and medi­ CSO) find out and get involved. The CSO’s in the Tacoma area cal transportation. For more information, please call have also established expedited ap­ A media campaign will be Allison Kemmer, First Steps Program, pointment slots for all pregnant launched to heighten public aware­ ness of the need for prenatal care 596-2874. □

T7ie Bulletin • May 1990 » Page 23 Editorial: OB Providers Need to Take First Steps

-Philip Henderson, III, M.D. Past President Washington State Obstetrical Association

X he numbers of poor women show- obstetrical access problem. We have ing up in the emergency room to deliver helped to educate the public about their babies - without prenatal care - the difficulties, frustrations, and finally grew so large they couldn’t be shortcomings in trying to provide ignored- In 1986, some 3,200 pregnant obstetrical care to indigent patients, However, it is imperative that we women received almost no care. Their some of whom have overwhelming obstetrical providers play a central babies died at a rate significantly higher social problems that cannot be role in the development and im­ than those whose mothers received resolved by physicians alone. plementation of local programs prenatal care. As I see it, the ultimate significance called for in First Steps. We are the Last year the legislature acknow­ of this legislation is that maternity final common pathway in any obstetri­ ledged the problem by passing First care for indigent patients in the state cal service delivery system. To leave Steps, the Maternity Access Act of of Washington is now a public health the planning to social health bureau­ 1989. issue. No longer are poor obstetrical crats is not only illogical, but dooms When we were pressing the case patients the sole responsibility of us and the program to failure. for First Steps, we had the chance to private physicians, hospitals, and present physicians’ views on the local health clinics. (Continued on page 31)

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Bob Sizer Doug Dyckman Dave Gillespie, Curt Dyckman CIC

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* UablUty * GWUP # DisahiHty * Aut0 * Home * Life 705 South 9th, Tacoma, WA 98405

Page 24 • Vie Bulletin FAX Has a Place in M.D.’s Office

—Reprinted from AMA News. October 13,1989.

Jeffrey Long, M.D., uses his to trips -one to pick up specimens and “You can’t just pick up the phone analyze isodose calculations to guide another to deliver results,” Con­ and transmit information about the course of treatment for cancer omikes says. isodose calculations,” he says. “The patients. C. Alan Brown, M.D., uses his Physicians say fax machines make expeditious initiation of treatment in to help cardiac care nurses determine quicker work of many administrative these patients is extremely impor­ whether a patient’s abnormal ECG is a tasks - ordering office supplies and tant... The fax gives us the combina­ real problem or just a loose lead. Geof­ handling tax matters or contract tion of improving the speed and the frey Bland, M.D., uses his to consult problems with accountants and quality of radiation therapy we're with specialists or get second opinions lawyers - but they seem more en­ giving." in tricky cases. thusiastic about using the fax as a Dr. Long also uses the fax regular­ They aren’t relying on the latest tool for managing patient care. ly to obtain copies of medical journal wave of medical technology but an of­ For Dr. Long, the fax provides a articles not available at Decatur fice machine that’s revolutionizing the crucial link between Decatur Memorial or other nearby hospital way many physicians take care of Memorial Hospital in central Illinois, libraries. patients and business - the fax. where he is director of radiation on­ “Often the literature we need is Capable of transmitting exact cology, and Sarah Bush Lincoln available only at the largest medical replicas of documents in seconds via Health Center in Mattoon, about 50 libraries,” he said. “When we need to telephone lines, facsimile machines miles southeast, where the hospital make a fairly rapid decision on a have become almost standard in busi­ operates a satellite cancer-treatment patient, we call up the library and ness offices since their introduction center. have them fax the article we need." just a few years ago. Dr. Long drives to Mattoon several The portable fax machine shared National wholesale office supplier days each week to see patients, fre­ by Dr. Brown and four other MDs Quill Corp. reports that fax machines quently ordering tests, the results of who make up Santa Barbara (Calif.) account for about 47% of the firm’s which aren’t available until the follow­ Cardiovascular Medical Group total office machine sales, compared ing day - when he is back in Decatur. means fewer late-night trips to the with less than 5% two years ago. Fax “The tests take so long, the results hospital. popularity is booming in the medical are never available while we’re still at profession as physicians and hospi­ the hospital,” Dr. Long says. “The tals come up with creative ways to only way we can do the isodose one The cardiologist on call use them in patient treatment and of­ day and begin treatm ent the next is each night takes the fice management. with fax.” portable fax home and "Our total fax business during the Typical treatment planning involves fiscal year to date is up more than having the patient "simulated,” and x- receives electrocardiograms 100% over the same period last year, ray procedure that defines the area of directly from the hospital and the medical market is up about the body being treated for cancer; or­ 135% to 150%,’’ says Scott Karoll, a dering a CT scan for cross-sectional ECG department or senior buyer with Lincolnshire, III.- anatomical information; feeding the coronaty care unit, both of based Quill. data into treatment-planning com­ which have fax machines. “Most people we did business with puter software; and performing an two years ago did not have them; isodose calculation - which produces now almost everyone does,” says a graphic illustration of radiation in “We have the choice of - in the Los Angeles-based consultant the patient's body and the dosage of case of pre-op ECGs - just faxing our George Conomikes. radiation to the cancerous tumor. interpreted results back to them, so He tells of one internal medicine The isodose calculations are they have a tracing with our signature practice that was given a fax by its shipped via fax from the Mattoon or, with the CCU, picking up the outside pathology lab so the hospital to Dr. Long in Decatur as phone and discussing with the nurse physicians could have the results soon as they're available the next what an abnormality means,” says sent to them as soon as they were morning, enabling him to analyze the Dr. Brown, who has used the port­ available. “It was a service for the d o c­ findings and begin treatment immedi­ able fax for about two years. The tors, but it also saves the pathology ately. company from having to make two (Continued next page)

The Bulletin ® M ay 1990 ® Page 25 and images, most new ones can vir­ ho spita l labs, send the ir own test FAX tually duplicate the quality of the results to the hospital and consult (Continued) original document, Karoll said. with one another, among other “We get a very high-quality tracing things, Dickman says. MDs also have personal computers at that is perfectly adequate fo r inter­ “We had a couple of [physicians] home linked to the office computer, pretation,” said Dr. Brown, adding at first who said, ’I don’t know why I’d he adds, so all have quick access to that the ECGs he receives are only need th is ,’ b u t by th e tim e the other patient medical histories. the tracing, which he then superim­ d o c to rs g o t th e m achines and the “In the case of pre-op ECGs, the poses over a graph template to inter­ c o m m o n phrase became, ’Well, I’ll fax eliminates having to go to the pret. fax it to you,’ then they called and hospital completely,” he says. The number of documents wanted it," she says. While the fax obviously can’t physicians expect to send and Dr. Bland, w h o practices with a 65- replace in-person examinations if a receive are the key considerations MD m ultispe cialty group, says the fax patient’s EGG shows abnormalities, when shopping for a fax, Karoil said. m akes life easier fo r office staff, who Dr. Brown says, it can help the Infrequent users probably can do spend less time on the phone chas­ physician spot those that can be easi­ without paper cutters, speed dialing, ing lab results, and saves time and ly corrected. and other extras, he said, but high- money previously spent moving infor­ "There’s nothing worse than get­ m ation a m o n g physician’s offices, ting out of bed at tw o o ’clock in the volume users might find those fea­ hospitals, and labs. morning to find out you’ve been tures worth the extra money. called in for a loose limb lead," he Offices with personal computers It’s also made some of the chan­ ges in m edical practice easier, he says. can buy "fax boards," which convert said. While physicians are using fax a PC into a fax and cost $300 to machines to transmit highly technical $1,000, less than many fax machines, “ It used to be that people were ad­ test results, using the fax itself is quite Karoll said. However, he said, boards mitted to the hospital a day or two simple, says Dr. Bland, a family transmit documents more slowly and before surgery so tests could be physician in Springfield, III. takes the PC out of commission. d o n e ,” he said. “ N o w we've gone to "The hardest thing is getting Also, he said, fax boards can only same-day admission for surgery and people to remember the phone num­ send computer-generated files. Send­ m ost of th e tests are done in the of­ ber they have to dial when they send ing an already-printed document fice. W e can d o the testing here, fax stuff to us," says Dr. Bland. means buying a “scanner,” which the results, and they’ll be at the hospi­ A fax operates like a photocopier electronically “reads” the document tal when the patient checks in.” with a remote printer. Typically, and costs $500 o r m ore - o r typ in g it However, Dr. Bland says, the fax senders feed docum ents into a slot by hand. hasn’t influenced w here he sends on the fax and dial a telephone num­ Dr. Bland was among about 200 patients who have to be hospitalized. ber to link it with a fax on the receiv­ physicians who received fax "O ur practice is split about 50-50 ing end. When the phone connection machines free two years ago from between the tw o hospitals,” he says. is made, the original docum ent is Memorial Medical Center, one of "W e’re very grateful to Memorial, but “read" by the fax and a copy is Springfield’s two hospitals. has it led us to favor that particular printed at the other end onto a long The donations were part of a hospital? Probably not. We use the roll of paper. marketing plan aimed at making it fax just as much for transmitting infor­ While all faxes perform the same easier for physicians to communicate mation to the other hospital.” basic functions, prices can range with the hospital and, it was hoped, Still, he says, the fax has become from $500 to $2,000 and more, admit patients to Memorial rather an integral part of the way he prac­ depending on the “accessories” a than Springfield’s other hospital, says tices medicine. user wants, Karollsaid. Features Linda Dickman, director of physician "It’s like the phone,” he says. such as paper cutters (which cut relations. “When you didn't have one, you got documents to size as they’re printed), The machines enabled physicians a lon g fin e w ith o u t it. But once you speed dialing, polling (which can fax to send medical records of patients g o t it, you feel like you can’t live a document to several places at once being admitted, receive results from without it.” □ or wait to send until long-distance rates drop) all add to the price. Telephone line charges for fax machines are the same as regular local and long-distance calls, unless Tacoma-Seattle I the machine is tied to a “dedicated” line used for fax only. Dedicated lines cost $75 to $100 to install, plus Outpatient General Medical Care at its best. Full and monthly fees that run about $40 part time positions available from North Seattle to South Karoll said. Tacoma. Very flexible schedule. Well suited for career For some physicians, such as Drs redefinition for G.P., F.P., I.M. Long and Brown, quality of reproduc­ tion is important. While older fax Contact: Andy Tsoi, M.D.: 537-3724 machines sometimes distort letters Bruce Kaler, M.D.: 255-0056.

Page 26 • The Bulletin $ May 1990 Negotiating the Ins and Outs of Buying and Selling a Practice

— From the November 6 issue of the LACMA Physician.

T h e purchase of a medical practice him in developing a relationship with should consider having a portion of can be a traumatic experience for both the patients. If the seller continues to the deposit money held in an escrow buyer and seller. For the seller, often work at the practice after the sale, the account to ensure that all liens have the sale means giving up a practice to transition of patients is eased. If the been paid prior to releasing all which many years of hard w o rk and seller is leaving the practice, then the monies to the seller. devotion were committed. Additionally, agreement should provide for a suffi­ The agreement should expressly if the seller is financing any part of the ciently long period to allow the intro­ state whether or not accounts receiv­ purchase price, there is the concern of duction of the buyer to a majority of able, including outstanding payments whether the buyer will be successful the patients. The agreement should due from health insurers, and con­ and be able to meet the financial obliga­ also provide that an announcement tracts with health maintenance or­ tions to the seller. For the buyer, there that the buyer has purchased the ganizations and suppliers, are in­ is the concern of investing a substantial practice be sent to the seller’s cluded in the assets being sold. amount of money and effort into a rela­ patients. tively unknown practice w ithout any It is to the seller's advantage to Price guarantees of success. have the patients accept the buyer as A wide variety of factors affect the A carefully drafted agreement of their doctor, especially if any part of determination of price, including the sale between buyer and seller often the purchase price will come from the seller’s reason for selling; the loca­ goes a long way to ease both parties' earnings of the practice. The seller, tion of the practice; the suitability of concerns and to insure that the trans­ however, should insist on a provision the office premises, including the action flows smoothly. The properly in the agreem ent to the effect that the potential for expansion; the favorable­ drafted agreement of sale should buyer understands that the seller can­ ness of the lease; the number of ac­ cover four main areas; assets, price, not provide any guarantee regarding tive patients and average number of warranties and representations, and future success of any transfer. new patients per month; the number liabilities and obligations of the prac­ Patient records, files and charts of days worked in the practice per tice. comprise an important part of good­ month; the average amount charged will. The buyer should receive the for patient visits; the practice’s total Assets records of all current and former receipts, and average accounts In almost all cases, the purchase of patients. However, the seller should receivable for a given number of past a practice will involve the sale of as­ retain continued access to patient years; the ability to keep the seller’s sets. In a medical practice, intangible records in order to respond to any fu­ telephone number; the amount of dis­ assets are the most important. Intan­ ture questions. The agreement counts to third party insurers; the age gible assets include patient lists, files should preclude the buyer from of the practice; patient charac­ and records, and perhaps the most destroying any patient records teristics, such as age, income, and important asset, goodwill. Goodwill is without the seller’s consent, and also place of residence; the seller’s reputa­ the personal relationship between the require the buyer to handle the tion; and the quality of both patient seller and his patients, and the expec­ records ethically. and financial records. tation of continued patronage by Tangible assets (equipment, sup­ In general, a proper price is one those patients. Goodwill is also the plies, etc.) are usually a less sig­ that is established on the basis of the most difficult asset either to value or nificant part of a practice. The buyer’s intangible element of goodwill, the transfer. There is no guarantee that primary concern is that he is receiv­ tangible assets (including office fix­ existing patients will accept the buyer ing good title to these assets. The tures, furnishings, equipment, sup­ as their doctor. However, often the buyer’s attorney should perform a plies, office lease), and the accounts seller's recommendation of the buyer search to ensure that there are no receivable, if any. G oodwill is often is sufficient to convince most patients liens on the assets. If any equipment expressed as a percentage of one to accept the buyer. is leased, the express approval of the year’s gross earnings from the prac­ The agreement of sale should in­ lessor to the transfer should be ob­ tice. That percentage should reflect clude a provision that the seller will tained. the factors listed above. cooperate fully with buyer, both If there is any question as to during and after the sale, in assisting whether there are any liens, the buyer (Continued on next page) As the TRA requires that the alloca­ claims of gross and new income and Buying and Sellin. tions be reported to the IRS by buyer expenses are th e key to determining (Continued) and seller, the agreement should in­ the true value of the practice. The clude a provision that requires both buyer should demand that the seller parties to agree on the allocations represent and w arrant unequivocally, The agreement of sate should pro­ and agree to report the same to the among other things, the complete­ vide for the review by the buyer or his IRS. ness and a ccu ra cy of the financial representative of books, ledgers d o cu m e n ts provided, as well as any patient cards, financial statements Financing the Purchase Price o th e r in fo rm atio n provided concern­ and tax returns to ensure that the A buyer may be financing the pur­ in g th e practice, including the exist­ seller’s representations are true and chase price either through outside ence of actual or threatened litigation. that the price correlates to the in­ financing or through seller financing. Sim ilarly, th e seller should require come generated by the practice. Writ­ If the buyer is using outside financing, representations and warranties from ten appraisals and inventories of the he should be careful to make the pur­ the buyer. Among the buyer’s repre­ equipment, furnishings, leasehold im­ chase of the practice contingent sentations and warranties should be provements, and clinical and office upon his obtaining the required th a t he is a d u ly licensed physician, supplies should be included as part financing. that any information furnished to the of the agreement. The number of If the seller is pro vid ing th e fin a n c­ seller is complete and accurate and patient charts, current accounts ing, several issues arise, the most im­ that he (or his agents) has inves­ receivables, aged accounts receiv­ portant being how the financing will tigated the books and records of the ables and credits due patients from in­ be collateralized. The seller ideally p ra ctice to the ir satisfaction, and un­ surance reimbursement and co-pay- wants the financing to be collateral­ de rsta nd s th a t there is no guarantee ments should be verified. ized by some secure asset such as o f success. Equipment and office leases real estate. However, buyers often do should be examined and, where ap­ not have, or do not want to use, real Liabilities and Obligations of plicable, valued as part of the pur­ estate to collateralize the loan. Any the Practice chase price. The buyer should also seller financing should, at a minimum, review contracts and information G enerally, in a sale of assets, the be collateralized by the assets of the regarding all of the seller’s prepaid b u ye r will n o t assum e any liabilities of practice. health plans, and any ongoing con­ th e seller. If th e buyer will assume Both buyer and seller should make tracts for supplies. a ny liabilities. The agreement should certain that the rights of the parties expressly so state. Allocation of Purchase Price which relate to the securing agree­ The agreement should also pro­ ment are spelled out in a separate In the past, the allocation of the vide th a t all expenses of the practice agreement. The seller should also file purchase price for tax purposes was be pro-rated as of the closing date. a financing statem ent to p ro te ct the a hotly debated issue. A favorable al­ The areas discussed above are seller’s interest in the assets. The location to either buyer or seller was general, and should be considered in seller might also require that the automatically detrimental to the a lm o st every purchase and sale of a buyer obtain a policy of life insurance other. However, the Tax Reform Act m edical practice. However, they pro­ to secure the purchase price. The of 1986 (the TRA) has made alloca­ vide on ly a starting point for the buyer should insist on having the tion much simpler. Seller and buyer preparation of an agreement. Each right to prepay any or all of his obliga­ can now agree to allocations benefi­ purchase and sale presents unique tion at any time without penalty. cial to the buyer without concern for circumstances, which should be the seller. spe cifica lly addressed in the agree­ Warranties and Representations Under the TRA, capital gains and ment of sale. □ ordinary income are taxed at the The value of a practice depends in same rate. Thus, the distinction be­ large part on the accuracy and truth­ tween capital gain and ordinary in­ fulness of the information given by come is no longer relevant to the the seller to the buyer. The seller’s seller. Allocation still remains important to the buyer, as certain items, most notably goodwill, cannot be ex­ pensed or amortized. The buyer Infections Limited Travelersy Health Service should limit the amount allocated to Directed by David W. McEniry, M.D., formerly o f the Hospital for Tropical goodwill, and allocate the maximum Diseases, London and the London School o f I-Iygieae and Tropical Medicine. amount possible to items that have a Providing Complete Medical Services for the International Thiveler fair market value and may be Pre-Travel Assessments and Medical Advice depreciated. Patient lists and records Required Immunizations and Medications leasehold improvements, the value of 1 reatmeni for Travel Related Illnesses the office lease, and the seller’s covenant not to compete are often E S S i E S ? * , For an Appointment call 627-4123. “ K overlooked as depreciable assets "> J I S ir.* ,. Sune #402 pbilip C Craven, M.D. IVomn, W^h.npton David W. McEnity, M.D.

Page 28 • The Bulletin t> May 19<)Q Case Study: Electronic Transitions

- Matthew Newman, M.D.

I have been fascinated by computers petent front office staff person who / I since the ninth grade when I first did not use the computer as directed learned to program in BASIC and and destroyed the books and ac­ IM&^B8S88& FORTRAN IV. I was allowed to use the counts. The PCMS recommended a ; Denver Public School System's old IBM rescue team that reconstructed the mainframe with paper printouts and system, trained new staff, and made punch card entry; CRT’s were a dream recommendations for an ideal com­ an opportunity to begin working on to come. puter program and system. development of a program based on When I set up my practice in 1984, I soon learned that I was not col­ standard DBase files and language. I wanted to use computers but wiser lecting revenues with any great The program has been extensively heads than mine advised against it. I speed. Sometimes patients would get debugged and solidly adapted to think I would rather have started from paid directly by the insurance com­ ideal usage for a medical office. the very beginning as I look back. pany and keep the money. Since we The software contains the sum of You may recall in 1986 when DSHS do not insist on payment at the time my experience in having worked with converted to Electronic Billing, they of service, some patients wait two or other software packages, having my let us know that electronic billing three statements before submitting front office ruined, and my cash flow (EMC) would be processed in two their insurance forms with our visit stopped. The program now triple weeks, paper in three months. I im m e­ slip. I was burdened by an enormous checks cash flow, easily bills any in­ diately signed up, began using an time requirement filling out insurance surance company (to be paid to doc­ Electronic Claims package, and forms and collecting accounts receiv­ tors directly), does electronic claims started my transcriptionist using a able. for DSHS without double entry, and word processor. My charts improved, In searching for a computer pro­ is correctable. In addition, the pack­ my DSHS turnover improved. I was gram I found that when software is age does reports, has collection aids hooked! The program printed out targeted to medical offices, the ex­ built in, and has interfaces for letters HCFA's, but the accounts receivable pense is enormous. I looked at as well as many other features. were all completed by hand, then programs from $2000 to $8000. As I For me, this software is just what entered again to process. continued my search and became the doctor ordered. However, it may The next step was a medical office more knowledgeable, I found a net­ not be for every office. It is ideal for a software package. This was som e­ work compatible designation raised low budget office interested in what better, but still required double the price four to five hundred percent. streamlining office staff and collec­ entering to do electronic claims. The Some packages would add electronic tions. documentation in the reports and the claims, some phone support, etc., No software package will do every­ inability to fix mistakes in m athem ati­ but the cost would always increase. thing for everyone but we are well cal processing were disappointing. After not finding a program that pleased. Another setback was hiring an incom ­ would be affordable for me, I found I have found after a very painful transition to computers that I would not be without them. In my office, I run a three station network and I also have one at home. I have learned a Qualified Physicians Needed great deal in the last three to four years and have tried to pass on those Walk-in Clinic • Military Facility • Eight hour shifts • Excellent sup­ difficult and costly lessons to others. port • $35.00 per/hr • Full and Part-time Positions • Graduate of an I recommend to everyone to give Accredited Medical School • Current Washington License • Current computers a chance, or perhaps in BLS/ACLS Preferred • Malpractice Coverage: Claims Made With your case a second chance. Even a Unlimited Tail solo practitioner can benefit from this mechanization. Q For more information please call: National Emergency Services — 1-800-554-4405

The Bulletin • May 1990 • Page 29 physicians at St. Joseph Hospital?

Advanced Technology New Services ♦ Arthroscopic Video System. ♦ Family Birthing Suites. These new, The St. Joseph Same Day Surgery offers the expansive rooms in the maternity unit allow latest in video technology featuring the “S” expectant mothers to labor, give birth and care system to view the knee joint using the for their newborns in the same room. Plenty of highest quality video reproduction. The room for family participation in the birth process. equipment allows surgeons to document their M others still have access to both Level I and the findings both on videotape and with still more intensive Level II nurseries. pictures. ♦ Diabetes Services. Comprehensive out­ ♦ Laser Laparoscopic Video Augmen­ patient education program complements tation. Provides for an improved view of hospital’s inpatient unit. People with diabetes the peritoneal structures and pathology and and their families receive practical, every-day enables the surgeon to magnify small lesions knowledge designed to help them avoid more effectively and to treat disease around hospitalization. Special programs for women the bowel, bladder and fallopian tubes. with gestational diabetes also available. Surgeons can operate in an upright position, relieving back strain. ♦ Center for Personal and Family Development. Trained psychologists, ♦ Laser Lithotripsy. Treats kidney stones therapists, nurses and dietitians provide trapped in the ureter. Laser beans are sent outpatient care for for people with depression, out through minute optic fiber to fragment low self-esteem, eating disorders, a history of the stone. Unlike other technology to remove past sexual abuse and other emotional ureteral stones, no detectable heat is stresses. Psychological evaluations and group generated and there rarely is need to dilate therapy available. the ureter. ♦ Free Valet Parking. Available seven days a ♦ Cultured Epithelial A u tograp h . week for your patients and their visitors from Allows for more effective skin grafting for the hospital's main entrance on I Street. Simply burn patients. This sophisticated process have your patients pull up to the entrance and a allows for laboratory reproduction of a burn u niformed valet will park their cars and retrieve victim’s own skin. them when they are ready to leave. Pierce County Chapter of Medical Assistants has installed new officers for 1990. They are (from left to right): Gay Blanch, Treasurer (Ulrich Birlenbach, M.D.); Joy Krumdiack, Secretary (Diane Coombs, M.D.); Sharron Vigil, Past-President (En­ docrine Consultants Northwest); Edith Howe, President (Endocrine Consultants Northwest); and Sandra Mason, President-Elect (Clover Park Vocational-Technical Institute).

issues and obstetrical manpower O n e S top Se/vfca Editorial: OB Providers (Continued) shortages. Nonetheless, in the eyes INTEC — of the legislature and public, this act For the "Particular" Only I call on all obstetrical providers to with its generous funding is the solu­ Letterhead and Business Card Design establish working relationships with tion to maternity problems in our Corporate Identity and local DSHS and county health state. Capability Brochures authorities. Take the time to under­ I believe that we, as obstetrical Newsletters stand the services included in the providers, have an ethical respon­ Our specialty is quality. Maternity Access Act so that you sibility and a vested interest to active­ ly participate in and support access (206) 627-8282 may better utilize them in caring for indigent patients. programs. The organization and func­ Call about our DeskTop Publishing tion of these programs will take place and Presentation Services Present projections show that ap­ proximately 38 percent of all obstetric with or without our support and ex­ Rn INTEC, Integrated Graphic Technologies patients will be DSHS-funded by pertise. _ “ VI9 S. tth , Tacom a, W A 98402 1992. It would seem prudent to be on As participants and leaders in the good terms with the largest obstetri­ quest to improve maternity care, I cal insurance company in the state. believe that we will be given due It has been argued that the Mater­ credit. If w e d o not participate in a c­ nity Access Act does not address or cess programs, then the failure of solve all m aternity access factors. It this legislation to lower perinatal mor­ has been faulted because it fails to bidity and mortality will eventually lie provide corrective action on liability at our feet. □

The Bulletin • May 1990 • Page 31 Ideal Mother’s Day Gift

“All A m erican M o m ” AMA -ERF LOGO The May luncheon meeting will be held Friday, May 18, at sw eatshirts are available 10:00 a.m. at the home of S ha ron Lukens, 2808 East Bay in time for Mother’s Day — Drive, Gig Harbor 98335. a pe rfe ct gift fo r the The program witl feature "Floral Creations” by Wayne favorite Mom in your fami­ Piepers. Mr. Piepers is a nationally recognized floral desig­ ly. The sweatshirts, ner and the recipient of many designed by Fife-based national awards including the Morning Sun, are part of Sylvia Award which is the Oscar Auxiliary’s on-going AMA- of the world of floral design. ERF fundraising project. Join us for this rare opportunity The bright red, white to learn from a master floral payable to WSMA collared shirts with puffed designer. Auxiliary. PCMS Auxiliary lettering are available in We will be honoring PCMSA will receive credit for the sizes M, L, and XL They past presidents and introducing $11.50 per shirt that is are $25 per shirt plus a $1 the new officers at this last do na te d to AMA-ERF. Call deliverey fee or a $2.50 general membership meeting of Susie Duffy at 863-4314 mailing fee. Make checks the 1989-90 auxiliary year. and order your shirt today. Make your reservation by call­ ing Jerol Ann GaSlucci, 582- 8858; Elita Lesh, 1-851-2603; or Sue Akamatsu, 579-4619 by May 11.

Edward S. Curtis

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Page 32 9 The Bulletin 9 May 1990 CLASSIFIEDS

two urban hospitals. Malpractice Positions Available paid. ABEM certification or prepara­ tion required. Flexible scheduling to Questions About allow you to enjoy the Pacific Hiring? Firing? PHYSICIAN OPENINGS - Em ergen­ Northwest. Reply with C.V. to TECP, cy Department/Ambulatory Care. 955 Tacom a Avenue S., Suite #210. Raises? Etc.: Civilian opportunities at the Naval Tacoma, WA 98402. (206) 627-2303. Hospital - Bremerton, WA. Full tim e EM/EP/IM with ACLS and ATLS cer­ We’d Like To Help! tification. Contact David C. Jester, WASHINGTON, PUGET SOUND. D.O., EMAC Medical Director, Naval Full-time position available with Hospital - Bremerton, Boone Road, Physician owned Corporation. Bremerton, WA 98312. Partnership potential. Established Call the Medical-Dental (206) 478-9585 or (206) 478-9322. group needs replacement for partner Placement Service relocating to East Coast. Requires ABEM certification or preparation with 572-3709 FULLTIME FACULTY POSITION at high volume experience and interest University of W ashington affiliated in administrative responsibility. Reply Family Practice Residency program with C.V. to TECP, 955 Tacoma in south Seattle area. Board certifica­ Avenue S., Suite #210, Tacoma, WA tion and OB experience preferred. 98402. (206) 627-2303. SEATTLE, WA: VIRGINIA MASON New opening created by program ex­ MEDICAL CENTER pansion. Interested in joining us? Seeking board certified or eligible RADIOLOGIST/LOCUM TENENS - Please send letter and CV to Drew OB/GYN physician for challenging Need B/C Radiologists for locum for 2 Oliveira, M.D., Program Director, position in satellite clinic of a large to 3 months per year at Madigan Valley Family Care, 3915 Talbot medical center. Virginia Mason North Army Medical Center -Tacoma. Con­ Road S., #401, Renton, WA 98055. is a growing primary and specialty tact G. Bernstein (206) 840-9652. group practice currently undergoing WASHINGTON, PUGET SOUND. expansion. We offer an opportunity to Part-time position available with open an OB/GYN practice in a Physician-owned Corporation staffing smaller clinic along with the educa­ tional and professional benefits of our large downtown multispecialty group practice, teaching hospital, and medi­ cal research center. Please send CV to: Robert Scarr, M.D.; Virginia Mason North; 18631 A lderw ood Mall Advertise in the Classifieds Boulevard; Lynnwood, WA 98037.

Prices: Advertisers Name and Address PCMS Newsletter - ______Office Space 75 cents per word. ______The Bulletin - ______85 cents per word. BEST OF BOTH WORLDS! In between Lakewood General Hospi­ 10 word minimum. Ad Copy tal and hospitals located in the Allen- more and Tacoma area. We have Deadline: 1,177 square feet available, built out June Newsletter fo r a physical therapist. However, it deadline is May 15. would accomodate a wide range of Please call 572-3709 physician uses. Rent negotiable. Call for more information. Crawford/Katica, Inc., Gary Crawford, 272-9200. Send check to: Pierce County Medical Society 223 Tacoma Avenue South Tacoma,WA 98402

The Bulletin # M ay 1990 • Page 33 SUMMER NANNY - Conscientious CLASSIFIEDS grad student will provide child care in (continued) your home. Excellent references. Karen - 535-8201.

WE ARE PLEASED to announce Peachy Smalling has joined the firm of Windemere Real Estate in Gig Har­ 5 ANTIQUE EXAM TABLES, fine bor. She specializes in waterfront, wood bases, $400-$500. Call Lynlee’s, view, and custom homes in Tacoma, Inc., 867-5415, preowned medical Gig Harbor, and Lakewood. Canter- equipment. wood homes and lots also available. Days: Tacoma/Lakewood — 627- If you have information PREOWNED MEDICAL OFFICE 1125, Gig Harbor - 851-7374. Even­ equipment, large quantity, excellent ings and Weekends: 851-3336. you would like to submit condition, excellent prices. Call for for publication in the our NEW SUMMER CATALOG. OCEAN FRONT WEST MAUI PCMS Newsletter or the Lynlee’s, Inc., Redmond, 867-5415. CONDO FOR RENT Bulletin, please send to: (Papakea) - 3 bedroom, 3 bath - great privacy for large family, 3 couples. Pierce County Medical Society General 1 mile beach walk to Kaanapoli 223 Tacoma Avenue South Resort 1-800-736-7667. Tacoma, W A 98402

MEDICAL OFFICE STAFF - All ap­ In fo rm a tio n is subject to plicants are screened, references are editorial committee review. checked, inten/iewed, evaluated, and matched against your specific require­ ments. We only refer those who qualify - call today! PCMS Medical- Dental Placement Service, 572-3709.

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Page 34 • The Bulletin ® May 1990 P IE R C E CO UN TV M E D I C A L Committed to Our Subscribers - Your Patients

Over 215,000 of your patients, including 75,000 Medicare beneficiaries, are served by Pierce County Medical. Here's how we fulfill our commitment to them - and to you! • We offer prompt service and easy accessibility. We understand the problems unique to Pierce County. Our responses to your patients' concerns are quicker and more appropriate than if we were headquartered in Omaha or Hanford • We are technically sophisticated while still pro­ viding tremendous flexibility and unparalleled personal service. • Our Customer Service Department, nationally recognized for its excellence, responds to your patients quickly and accurately. • With our convenient ID cards, your patients do not have to hassle with claims forms - and we pay your office directly. • We serve your patients' needs with a broad array of plans; they all provide quality, cost effective Janet L. West health care coverage. Manager, Customer Service We value our subscribers - your patients! and Professional Relations

Pierce County Medical A Blue Shield Plan

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* \ di r . ♦ A publication of the Pierce County Medical Society

Volume 5, # 4 June 1990 Presidents Notes: A Time for Action!

1 he Pierce County Medical There is a wide difference of opinion Society is taking a leadership role in in the medical community about It is important that we go addressing the trauma issue in how we should approach this issue. to the county and muni­ Pierce County. A committee consist­ As I talk with physicians throughout ing of trauma surgeons, em ergency the county, the recommendations cipal communities with a room physicians, hospital ad­ vary from Madigan being named the plan that represents what ministrators, and intensivists from trauma center to keeping the is best for the people o f the civilian and military com m unity present system of trauma coverage will be investigating the best method at Good Samaritan Hospital, Pierce County. Political, to serve Pierce County citizens. This St. Joseph Hospital, Tacoma economic, and territorial committee will be chaired by Dr. W il­ General Hospital, and Mary Bridge. biases and prejudices liam Martin and will give a report to Children’s trauma also needs to be the Board of Trustees later this sum ­ part of this discussion. must be pu t aside. mer. My hope is that we can then go It is im portant that w e go to the to the community with a plan of ac­ county and municipal communities ty. Political, economic, and territorial tion before the state dictates to us with a plan that represents what is biases and prejudices must be put what will be done. best for the people of Pierce Coun- aside. We will keep you informed as we proceed. I urge you to contact com­ mittee members if you have any GoodWill Exchange Update thoughts or ideas on the subject. T raum a C o m m itte e : Jam es G. Thirty-two Soviet physicians will be the guests of Puget Sound area Billingsley, M.D.; James D. Buttorff, physicians and medical professionals during the Goodwill Games, M.D.; Barry Connoley, CEO, Multi- July 22-August 5. Sponsored by the Physicians for Social Responsibility Care Health System; John B. and officially hosted by the Pierce County Medical Society, the Soviets Coombs, M.D.; James K. Fulcher, will be welcomed by more than 100 medical community families who will M.D.; Lt. Col. Cloyd Gatrell, MAMC; take them into their homes as both friends and colleagues. Dave Hamry, President, Good Samaritan Hospital; Charles F. Hof­ This two-week cultural exchange will allow Soviet physicians to directly fman, Director, Allenmore Hospital; experience American medicine through visits to local hospitals and Gen. John Hutton, Jr., MAMC; Chris­ medical practices. topher Jordan, M.D.; Major Chris Our guests will also be attending “Nuclear Hazards and New Oppor­ Kaufman, MAMC; Gordon R. Klatt, tunities after the Cold W ar,” a sem inar produced by the Physicians for M.D.; John Long, President, Social Responsibility. They will also have the option to tour the State St. Joseph Hospital; William G. Capital, The Morning News Tribune, KSTW Television, and have a hands- Marsh, M.D.; William G. Martin, on learning lesson at Quantum Computers. We hope that through this M.D.; Robert F. Wachtel, M.D.; Barry cultural exchange our Soviet friends will come away from Puget Sound J. Weled, M.D.; G. Michael Wiese, with a positive and balanced view of American medicine. M.D. — Gordon R. Klatt, M.D., President Stop By and See What’s New!

Yes! It’s true-w e’ve finally moved. The new layout has already proven new building is also targeted for the We are pleased to announce that its efficiency. There are bigger, Pierce County Pre-natal Clearing- our new location is at 223 Tacom a brighter windows and skylights, House, a joint effort between PCMS Avenue South, Tacoma 98402. which provide plenty of light, and and the Tacoma-Pierce County soft muted colors running through Health Department. After months of anticipation and both the carpets and walls. preparation, we began the Our new sign is already out front- monumental task of sorting through Currently our tenants include the you can’t miss it. Stop by for a con* the accumulation of the last ap­ Pierce County Dental Society, the plimentary tour and look for details proximately nine years (since our Seattle Deposition Reporters, and of our open house in the August Bul­ last move). It wasn’t easy, but we Hiltbrunn Insurance. Space in the letin. managed to get most of the office moved by April 30.

We traded in our multi-floor, pea- green building for an attractive one- story, brick building with gray trim.

Gordon R. Klatt President William G . Marsh President-elect John B. Coombs Vice President Joseph H. Wearn Secretaiy-Treasurer William T. Ritchie Past President PCMS Trustees: Stuart D . Freed K David McCowen A. Robert Thiessen David E Law Anthony S. Lazar William F. Roes Mary Lou Jones HEALTH CARE AT THE CROSSROADS PCMS Newsletter is published eight times a year by PCMS Membership Benefits, Inc., tor members of the Pierce County Medical ~ 1 9 9 0 AHNUAL MEETING Society. The Pierce County Medical Society is a physician member organization ______SHERATON CONVENTION CENTER ______dedicated to t£e art, science and delivery of medicine and the betterm ent o f the ~ ~~ SPOKANE, WASHINGTON health and medical welfare of the com­ munity. SEPTEMBER 20-23,1990 Advertising and newsletter copy must ar­ ~ WASHINGTON STATE MEDICAL ASSOCIATION rive in the Society office by the 15th day o f the month preceding the publication date. FOR FURTHER INFORMATION CALL 1-800-552-0612 ~ Advertisements in this newsletter are paid and not necessarily endorsem ents o f ser­ vices or products. We welcome and invite your letters, comments, ideas and sugges­ tions. 66 WSMA

Editor: David S. Hopkins Managing Editor: D ouglas Jackman Call for Resolutions Editorial Committee: The WSMA Annual Meeting will be S , sT?,0ii;kins

C.O.M.E. Announces 1990-91 Calendar

The College of Medical Education Specifically, the Board relied upon Category I and AAFP credit. Board of Directors has announced responses from a recent survey con­ In addition, all of the programs are its calendar of CME program s for ducted by the College of Medical organized and directed by local Education. 1990-91. physicians who are sensitive to com­ The calendar is made up of 11 The schedule also reflects the suc­ munity interests and needs. The programs which have again been cessful tradition of several CME directors call on local, regional selected based upon Pierce County programs which are offered annual­ (Seattle), and often nationally recog­ Medical Society member interest. ly. All of the programs offer AMA nized experts presenting up to date information and techniques for their program s.

To the left is a list of the 1990-1991 scheduled programs, their an­ C.O.M.E. 1990-91 Schedule ticipated dates, and their coor­ dinators. The annual College calen­ dar brochure will be mailed to Date(s) Program/Subject Coordinator(s) Pierce County Medical Society members and other southwest 1990 Washington physicians in June. The calendar brochure will include Weds., Thurs. Common Office Problems Mark C raddock, M.D. more direct program emphasis. In­ October 17 & 18 dividual and detailed program Fri. Diagnosis and Eric Luria, M.D. brochures will be mailed ap­ November 9 Treatment of Depression proximately six weeks in advance of each program. Thurs,, Fri. Advanced Cardiac Mark Craddock, M.D. 'December 6 & 7 Life Support For further information, please call the College of Medical Education at 627-7137.

Thurs. Law and Medicine David Condon, J.D. January 17 Symposium Sun Valley Fri., Sat. HIV Infections and AIDS Alan Tice, M.D. February 8 & 9 Child Care Weds.-Sat. Sun Valley Program Mark Craddock, M.D. February 27 & 28 Stuart Freed, M.D. Available March 1 & 2 John Lenihan, M.D. Several child care options are avail­ Thurs., Fri. Tacoma Academy of Amy Yu, M.D. March 14 & 15 Internal Medicine able for those who attend next February’s CME program in Sun Val­ Fri., Sat. Surgical Club James Stilwell, M.D. ley with children. Three general child April 12 & 13 care approaches are available with multiple options for each approach. Fri. Office Procedures Mark Craddock, M.D. May 10 Tom Norris, M.D. Elkhorn resort offers individual , Fri. Office Gynecology John Lenihan, M.D. babysitting services utilizing local € M a y31 babysitters. Those seeking this ap­ proach should contact the resort l# ^ n,l Tues. Advanced Cardiac James Dunn, M.D. long before the conference to ! June 24 & 25 Life Support reserve a babysitter. * '

Clip and Savel (Continued on next page)

Vol. 5, #4 • June 1990 • Page 3 Child Care (Continued) Welcome New Members!

There are also a num ber of private day care operations in the Valley. The Board o f Trustees has a p p ro ve d th e C redentials C om m ittee recorri* Elkhorn recommends "Yellow Bal­ mendation that the following applicants be approved for PCMS Member loon Day Care” (726-0770), “Potato ship. Patch Kids” (726-8112), and “Great Escape Babysitting” (726-8666). Daniel P . Coffey, PA. Cynthia L. Vehe, M.D. The Sun Valley Company also Physician Sponsor: Internal Medicine operates a preschool/day care which Kevin P. Schoenfelder, M.D. 521 South K Street normally is available to their guests 1515 South K Street Tacom a only, but has been open to Elkhorn Tacom a guests in the past. Raymond L. Vercio, M.D. Roger J.C. Meyer, M.D. Finally, Sun Valley offers a number of Anesthesiology ski school options for children includ­ Pediatrics 21 33rd Avenue Court N.W. ing skiing lessons and day care. In­ 709 North Yakima G ig H a rbo r formation on this approach is avail­ Tacom a able from the College of Medical Education at 627-7137.

Applicants for Membership

The Pierce County Medical Society welcomes the following physicians who have applied for membership. As outlined in the Bylaws, any mem­ ber who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of con­ DIAPER RASH veying that information to the Credentials Committee or Board of Trus­ IS NOT A WAY OF LIFE. tees of the Society. You can recommend professional diaper service with confidence. David A. Acosta, M.D. Frood is practicing at 7424 Bridgeport Way W., #103. • Laboratory Controlled. Each month Family Practice. Born in Califor­ a random sample of our diapers is nia, 06/19/53. Medical school, subjected to exhaustive studies in a Leo Lebitty, P A biochemical laboratory. University of California-lrvine, 1979; internship, Community C ardiothoracic. Physician Spon­ • Utmost Convenience. Thank's to pick Hospital Santa Rosa, 1980; s o r—Cari Vitikainen, M.D. up and delivery service, our product comes when you need it. residency, Community Hospital P hysicians Assistant Program, Santa Rosa. 1982. Washington Cornell University Medical Col­ • Economical. All this service, all this State License, 1989; board cer­ lege, N ew York, 1977. Mr. Lebit­ protection against diaper rash costs tification, Family Practice, 1982; ty is pra cticin g at 1207 South ■far iess than paper diapers — only 1989. Dr. Acosta is practicing at 5th. pennies more a day than home- 419 South L Street. washed diapers. Laura K. Morris, M.D. ’ CAUTION TO YOUR PATIENTS. It is illegal to Lawrence R. Frood, M.D. P ediatrics/N eurology. Medical dispose of human excrement in garbage Parents are doing this with paper/plastic Radiology. Born in Michigan, school, University of Pittsburgh,. diapers. "Disposable” is a misnomer. 09/24/59. Medical school, Loma 1977; internship, Walter Reed Linda University School of A rm y M edical Center, 1978; Medicine, 1985; internship, residency, Walter Reed Army Loma Linda University School of M edical Center, 1980; graduate Medicine, 1986; residency, training, Walter Reed ArmyMedi Loma Linda University School of cal Center, 1983. Washington TACOMA WA TOLL FREE Medicine, 1989; graduate train­ State License, 1983; board cer­ 383-BABY 1-800-562-BABY ing, Loma Linda University, tifica tio n , Pediatrics, 1982; Washington's Oldest, Most Trusted 1990. Washington State License, Neurology, 1985. Dr. Morris Is “ ] Professional Diaper Service 1990; board certification, Diag­ currently practicing at 1530 ^\S e rvin g Our Second Generation nostic Radiology, 1989. Dr. South Union, #1.

Page 4 • June 1990 • Vol. 5, # 4 PCMS Members are Running Straight from the Heart

The 11th Annual St. Joseph Heart walking the Heart Center Walk John Hill, Tacoma; Bill Jackson, Race, Fun Run, and Heart Center where you could opt for either dis­ Tacoma; Gilbert Johnston, Tacoma, Walk was off and running bright and tance. The Heart Center Walk was a 38:50; Pat Kulpa Mohr, Gig Harbor; early 9:00 a.m., Saturday, May 12. noncompetitive event. Emanuel Lacsina, Tacoma; David St. Joseph Hospital hosted the Law, Tacoma, 32:43; David Munoz, Dr. Taylor was the Society’s “ Best event and Seafirst Bank, KSEA Tacoma; Joseph Nichols, Tacoma; Overall” this year finishing first in the (Channel 11), and KTAC/KBRD spon­ Lee Payne, Gig Harbor, 37:20; sored it. Over 1,300 participants 8K race in his age division, 16th over­ Michael Priebe, Tacoma, 32:31; walked and ran their way tow ard col­ all out of 1,074 and 16th out of 599 Michael Regalado, Gig Harbor, lecting approximately 10,000 dollars males. 37:47; Ron Taylor, Tacoma, 28:11; for the St. Joseph Hospital Heart Doctors from the Pierce County and Richard Witt, Gig Harbor. Center. Medical Society included: 8k Heart James Billingsley, Tacoma, ran the “The money is not targeted for a Run —Lon Annest, Tacoma; Thomas 3.5Kfun run. Two members ran the Baker, Tacoma, 38:24; Richard specific use as of yet,” said Kitty course as part of the Cardiothoracic Gibbs, the 1990 Heart Race Direc­ Bowe, Gig Harbor; Thomas Brown, Surgeons Team, they were: Gilbert tor. "We’ll put the money where the Tacoma, 39:15; Joe Clabots, Johnston and Lon Annest. need is greatest.” Tacoma; Shirley Deem, Tacoma; Carlos Garcia, Tacoma; Ron Graff, Participants had the choice of run­ Tacoma, 37:12; Kenneth Graham, ning the 8K race, 3.5K fun run or Tacoma; John Hautala, Tacoma; Personal Problems Susie Duffy “Management of of Physicians Nominated IVDU/HIV Patients” Committee

President, The Pierce County Aids Foundation, For Impaired Physicians WSMA Auxiliary the Pierce County Medical Society, Your Colleagues and MultiCare’s Department of Con­ Want to Help tinuing Medical Education invite you At the annual meeting of WSMA to attend a video workshop on Medical Problems, Drugs, Auxiliary, Ms. Susie Duffy was "Management of IVDU/HIV Patients" nominated to serve as President. Alcohol, Retirement, sponsored by the Physicians As­ Emotional Problems Susie was president of the Pierce sociation for AIDS Care (PAAC). County Medical Society Auxiliary in The video will be shown on Wednes­ 1986-87 and has served the last tw o Committee Members day, June 13 from 7:00 to 8:00 a.m. years as chairman of the WSMAA at Jackson Hall Auditorium (314 So. Patrick Donley, Chair. 272-2234 AMA-ERF fund. Under the chairman­ K Street, Tacoma). Joseph Kramer...... 845-9511 ship of Susie, the AMA-ERF fund has John R. McDonough.. 572-2424 reached new heights for fund raising The program is approved for one William A. McPhee.....474-0751 •or medical students. hour of AMA Category I Credit. Pre­ Ronald C. Johnson...... 841-1894 registration is not required. If you Susie is the wife of Pat Duffy, M.D., Kathleen Paris...... 591-6681 have any questions, please call Multi- Sumner family physician, w ho Dennis F. Waldron...... 272-5127 Care Continuing Medical Education served as President of the Medical Mrs. Jo Roller...... 752-6825 at 594-1221. Society in 1984. They are the proud parents of nine children. Susie will WSMA Apriliggj18 presidency of WSMAA in 1-800-583-0127 •W . ------

NewsBriefs Continued...

New Publication Helps Physicians Decide if Incorporation Still Offers Advantages

Trying to decide if it still makes ing a professional corporation by A P hysician's G uide to Professional sense with the new tax law for your translating this complex issue into C orporations. OP 378289, is avail­ practice to be incorporated? The all­ common terms using a point-by- a b le a t $18.00 fo r AMA members point approach. {$27.00 fo r nonm em bers), from the American Medical Association, This authoritative publication addres­ help you resolve this question. Book and Pamphlet Fulfillment, P.O. ses the following topics: Nontax Ad­ B o x 10946, Chicago, IL., 60610- Available from the American Medical vantages of Incorporation, Tax Ad­ 0946, o r call 1-800-621-8335 with Association, the book explains the vantages of Incorporation, Disad­ VISA o r M astercard to order. pros and cons of incorporation, and vantages of Incorporation, and clearly outlines legal and tax implica­ Selecting a Corporate Retirement tions. it clarifies the rules of operat­ Plan.

“Office Theft” COMING SOON Participants Sing Program’s Praises 4th Street Medical Clinic Phase II “...practical information which held everyone’s attention." 6,500 + sq. ft. of First Class Medical Office Space at the front door of Good Samaritan Hospital. Pre-lease agreements are "enjoyable.. .concise.,. informative currently being accepted. ... entertaining” Many other medical spaces (500 sq. ft. to 3,000 sq. ft.) available throughout Pierce County. These were some of the comments expressed at the Medical-Dental To solve your office space or investment needs call... Placement Program “Office Theft,” L.J. and Judy Lyle on May 2 at Jackson Hall Auditorium. Northwest Investment Properties j«. Bill Otway, President of Northwest (206) 565-9790 Tacoma Medical Consultants, Ltd., presented a three hour workshop outlining con” trol techniques to reduce the risk of employee embezzlement. Mr. Otway was available after the presentation Winners Circle to answer questions individually. Cycling on the backroads of In 1989,134 trekkers reached the Several people suggested future Washington, ferry rides, sunshine programs such as hiring and firing, $600 fundraising level to become and the company of friends, both members of the Winners’ Circle. In marketing, programs for office staff, old and new, came back to the fact, this year’s members averaged and more practice management minds of more than two-hundred $865, well beyond the Winners techniques. If you have suggestions veteran trekkers, volunteers and Circle minimum, for an incredible to help PCMS plan further programs friends as they attended the 1989 total of $113,000. for you and you r office staff, please American Lung Association of contact Sharon Bain at the Society Washington (ALAW) Winners’ Circle office, 572-3709. Four tre kke rs jo in e d th e elite 2000 c-ftu^ratlon on February 3rd at the Club, raising more than $2,000 to Fifth Avenue Theatre in downtown support ALAW’s programs. Hank Zielinski, M.D., tre kke ra n d PCMS member, was one of these. NewsBriefs Continued..

Respite Access Program Dr. Klatt Honored Gives Caregivers Relief with Association

A new program for caregivers of dis­ take a vacation. Respite can be Service Award abled adults is now available in provided in the home by specially Pierce County. Many families in­ trained personnel from social and At the annual meeting of the volved in caring for a loved one in health agencies or outside of the Washington Society of Association their home receive a great deal of home in professionally staffed adult Executives (WSAE), Gordon Klatt, satisfaction, but like anyone else, respite centers. M.D. was awarded the “1990 As­ may need some relief. sociation Volunteer Service Award.” Caregivers providing at least 16 Pierce County Executive Joe Stortini hours of unpaid care to an adult 18 Dr. Klatt was presented the award by states that even for the most caring years of age or older are en­ Greg Kaveney, President of the of families, the constant needs of a couraged to call. Cost of respite ser­ WSAE, for his outstanding com­ disabled or chronically ill fam ily vices is based on the income of the munity efforts—working with the member can create emotional or person receiving the care. Persons American Cancer Society (ACS) and physical stress. “Time away from with low-incomes receive services at its county, state, and national af­ caregiving allows the caregiver to no cost. A sliding-fee scale deter­ filiates to raise funds. He also maintain a healthy and well- mines the cost for those with higher worked very closely with the Pierce balanced life.” incomes. For more information, con­ County Medical Society to help tact the Respite Access Program at facilitate the Pierce County-wide The Respite Access Program helps 591-7236 or toll-free at 1-800-642- hospital smoking ban. caregivers plan for time away to run 5767. errands, visit with friends or even The original fund raising event was a 24-hour run that raised $26,000 for the ACS in 1986. The City of Destiny Classic, as it is now called, has evolved into a state-wide team run/walk and raised over $123,000 in Pierce County on May 18-19. Philanthropic Fund Applications Available

Does your health-oriented Pierce County organization wish to receive consideration for philanthropic funding from the Pierce Daffodil Classic County Medical Society Auxiliary? Proof o f 501 (C)3 IRS rating is re­ Attracts Members quired. For an application call or write: Several PCMS members turned out Mary Cordova April 29 in Orting for the 11 th Annual Daffodil Classic, sponsored by the 10207-104th St. Ct. S.W. Tacoma Wheelman’s Club. Bicycle Tacoma, WA 98498 riders had the option of riding 20, 50, (206)588-3126 or 100 mile loops through very scenic country. APPLICATION DEADLINE IS: Most of the members were observed doing the 50 mile loop that began in SATURDAY, SEPTEMBER 15, 1990. Orting and passed through Buckley, Lake Tapps, and the Sumner area. Some of those participating were Jack and Terri Stewart; Jim and Judy Wagonfeld; Dick Bowe; Pat Kulpa and her husband Troy Mohr; and Dave Wilhyde.

Vol. 5, 4 4 • June 1990 • Page 7 NewsBriefs Continued...

RCMT Announces Best Dictation Nominees

Eleven Tacoma area physicians The physicians nominated are: physician who consistently have been nominated for the 1990 Ronald J. Benveniste, M.D., pro d u ce s th e kind of dictation that Best Dictation Award. The aw ard is Timothy K. Chung, M.D., David G. makes a transcriptionists job a joy presented annually by Rainier Chap­ Clark, M.D., Thomas G- Griffith, and not a headache, according to ter Medical Transcriptionists (RCMT) M.D., G. Gilbert Johnston, M.D.. RCMT members. High-quality dicta­ in celebration of National Medical John R. McDonough, M.D., John tio n is one o f th e keys to getting Transcription Week, held annually in J. McKelvey, M.D., Gregory A. rep orts th a t are accurately and time­ May. Popich, M.D., Henry F. Retailliau, ly transcribed, both of which are of M.D., and Shay K. Shual-Berke, utmost importance for quality M.D. patient care a well as for protection, o f th e physician in any liability is­ AMA Video Shows The winner and first two runners-up sues that might arise. will receive their awards at RCMT’s Relevance of annual Mini-Symposium scheduled For more information, contact this year for June 2 at the new RCMT president, Sharon Campbell, Practice Parameters Lakewood Hospital. Colo-rectal sur­ CMT, m anager o f Tacoma Medical geon Gordon Klatt, M.D., PCMS Transcription, a private transcription The AMA has produced a video President, was the recipient of the company in Lakewood, Monday- which explains w h at practice first annual Best Dictation Award in F rida y 10 a.m . to 2 p.m. (584-3177) parameters are and describes how 1989. Runners-up were Rob R. or write RCMT, P.O. Box 111627, scientifically sound, clinically Roth, M.D., pathologist, and David Tacoma, WA 98411. relevant parameters can be useful to G. Clark, M.D., cardiologist. physicians in the day-to-day practice of medicine. The award was created to provide an annual opportunity to honor a The Medical Society has one copy of this video which can be loaned out on request; copies of the video can be purchased from the AMA for $20. The Perfect For additional copies of the video, Car Consultant please contact: PCMS at 572-3667. 752-8888 3009 Bridgeport Way West • Suite 4 Dr. Farber Speaks at Retirement BUYING SERVICE • PRICING CONSULTING . APPRAISALS Luncheon

Approximately 35 retired PCMS M em bers attending the M ay 9 Retire­ Domestic & Imports ment Luncheon had the distinct pleasure of hearing Stuart Farber, Cars & Trucks M.D.’s presentation on palliative medicine. Dr. Farber chronicled his ANY MAKE —ANY MODEL year’s travels including nine months in Israel and three months in Lon­ don, He focused on the differences We can save you time and money on tl in cultures in regard to medicine, health, life, and death. His presenta­ purchase of your next vehicle... tion is excellent and not to be missed. Dr. Farber will be the fea­ Guaranteed tured speaker at the General Mem­ bership M eeting on O ctober 9. Call before you buy!" 752-8888

Page 8 • June 1990 • Vol. 5, 4 4 Managing Practice Cash Flow: The Big Mistakes are Easy to Avoid

Symptom of poor cash manage­ services are rendered, not after in­ sociates Workshops, Dr. Nancy Rus­ ment: The office is habitually short surance pays. sell (an internist), and Dr. William of cash even though the practice Mikkelson (a general dentist) of com­ Actively manage collections through seems to be profitable. This situation bined Health Care Professionals in patients' statements and direct develops because the revenue and Kansas city, phone contact when called for. Key: disbursements process is not MO, have out­ Constant contact. Personalize your properly managed. standing finan­ reminder notices whenever possible. cial considera­ Essential in correcting cash Mary Gail Lantzy from Dr. Kerry W. tions printed shortage problem s: The do ctor Kirsch’s office says it best. in their patient and/or office manager must set cash "After several years of using stick­ information management as a priority. Only then booklets: will formal cash management proce­ ers, stamped messages, and other dures and policies be developed. business forms; I have found that “Payment of using one’s own personal touch of fees is en­ Where cash practices 1st, 2nd, final notices etc., in magic couraged at the time of your visit. marker has returned more outstand­ For your convenience, we accept typically go wrong in ing payments than any other, even MasterCard and Visa. Although fees managing cash... computerized statements.” for your dental and medical care Mistakes: Not sending out bills Mistake: Sloppy collection proce­ may be reimbursed through your in­ surance coverage, ultimate respon­ promptly. Rule: There should never dures. This can come from the prac­ be a set of circumstances where tice having inconsistent payment sibility rests with you. We are happy to print your medical and dental in­ patients are not billed monthly. Bill­ policies. (Example: One patient is surance claim forms and mail them ing is the first shot the office has in asked to pay at the time of service, for you. On your first visit to our of­ improving cash flow. and another patient is not.) A first step in improving collection is estab­ fice, please bring your insurance card and a complete dental or To correct billing lishing very specific policies and pro­ health insurance claim form. Feel cedures involving how the office re­ problems, establish free to ask questions about your ac­ quests payment at the time of ser­ procedures to . . . count, or fees for dental or medical vice and makes financial arrange­ services. Your inquiries and interest Generate statements even though in­ ments in extenuating circumstances. surance is pending. (Exceptions are w elcom e." might be federal and state insurance 2) Set procedures to qualify patients programs.) Remember: Out of sight, To improve collections: for extended financial arrangements. out of mind. Key: Improved com ­ 1) Establish your payment and in­ Run credit checks if necessary for munications between patients and surance procedures, and put these credit arrangements over a set front office staff. Patients should un­ into your patient information book­ amount, for instance $1,000. (Con­ derstand that their portion is due as let. Past participants of Palmer As­ tact your local credit bureau for more information on credit checks.)

3) Design your graceful exit area so it is a convenient place to "stop and Persing, Dyckman, Toynbee, Inc., pay,” rather than a congested space Insurance Brokers where patients will refrain from dis­ cussing the fees incurred.

4) Consider giving a courtesy for Quality Service for Quality Clients payment at the time of service to ac­ Insurance Specialists Since 1945 celerate the collection of accounts. (Families and older patients ap­ (206)627-7183/FAX (206)572-1430 preciate this courtesy.) Important: SJifokman 705 South Kinlh> Tacoma WA 98405 1) Have a consistent policy that is Curt Dyckman applied across-the-board. 2) Cour­ David Gillespie, GIG tesy terms must make economic David 3abbitt Auto • Home sense to the practice as well as to Rob9RiedernS°n’ CPCU Business • Professional the patient. Here is an excellent ex­ ample of the courtesy terms of a SSI.-®;3ob Cleaveland, . CLU, ChFC Group • Disability • Life (Continued on next page)

Chemical Dependency Masquerading as Depression

Ti. here are approximately 9 to 10.5 of their curricula. Still, much work chemical dependency before cer­ million alcoholics and problem lies ahead if the multi-faceted tain medications are prescribed. drinkers in the U.S. It is known that problems of substance abuse and Treating depression with antidepres­ a great number of deaths once at­ giving physicians a strong under­ sant medications, especially tributed to physical illnesses, such standing of disease addiction, its tricyclics, has become quite as heart or liver failure, acute treatment and prevention are to be pancreatitis, and internal hem orrhag­ brought into the mainstream of medi ing are really alcohol deaths. To cal education. this number add the violent deaths The medical complications that resulting; from automobile accidents, often result from chronic alcoholism homicide, and suicide, and alcohol are too numerous and profound to is the number one killer. Add to this go into here. It is best to focus on the number of deaths related to illicit the early and middle and prescription drug abuse and the stages of the dis­ mind boggles. ease; this is where Where does Pierce County stand? In the primary care popular. However, Nortriptyline, 1989, the Medical Examiner’s Office provider can be most effective by as­ Amitriptyline, Desipramine, Doxepin, analyzed 380 cases of a repre­ sisting in detection and early inter­ and Imipramine, when mixed with al­ sentative population of 1,200 and vention, before serious medical com­ cohol, may result in enhanced CNS found that 53% of those deaths were plications arise. The disease is not depression. In addition, many of the directly related to alcohol and/or curable, but it is treatable, and effec­ drugs frequently prescribed for pain drugs. tive treatm ent is available. and sleep disturbances are highly addictive and may only accelerate and/or exacerbate the patient’s dis­ ease.

Key Community Resources Added caution should be taken with the elderly patient. Although elderly ■ C.A.R.E. ■ Alcoholics Anonymous men are four times more likely to 572-CARE 584-5873 abuse alcohol than elderly females, elderly females are more likely to 1 Pierce County Prevention ■ Alanon and Alateen abuse prescription medications.5 Coalition 272-3081 With the elderly, some of the things 863-2201 to watch out for include: bruises, ■ Narcotics Anonymous ■I repeated falls and/or accidents, con­ ■ Pierce County Information 531-8792 and Referral Line fusion, drowsiness or slurring of words, deterioration of personal 759-6700 ■ Adult Children of hygiene, poor eating habits, increas­ ■ Alcoholics Anonymous ■ Washington State Sub­ 927-1781 ing isolation, grief reactions, chronic stance Abuse Coalition anxiety, and chronic pain. The 1-800-662-9111 ■ Pierce County Task Force shame and guilt that so often sur­ on Drinking/Driving round the disease for the elderly ■ Washington State Council 591-7792 patient will make him/her especially on Alcoholism challenging to w o rk with. 643-2244 ■ National Institute on Drug Abuse If you suspect a patient of being 1-800-662-HELP chemically dependent, there are a number of public and private com­ munity resources available. Although alcohol contributes to the A high percentage of patients who REFERENCES illness of 20-50% of patients in visit the primary care provider, espe­ general hospitals, physicians are cially those who come to the family ^oyce, J.E. Alcohol Problems & Alcoholism. 1981., p. 28. diagnosing just 5% of their patients physician, are often primarily diag­ as being alcoholic. The basic un­ nosed with depression. Since chemi­ 2Ibid, p. 24. derlying reason for this under-diag- cal dependency and depression Pierce County Medical Examiner nosis is the lack of education and share a similar symptomatology Editor, Alcohol Health training in medical schools. How­ & Research World. Vol. 13 (e.g., sleep disturbance, G-l distur­ (1); 1989, pp. 8-13. ever, the disease of addiction has bance, appetite/weight changes, warranted enough uproar that medi- teleconference on Alcoholism loss of interest in enjoyed activities, and Substance Abuse in Older i« ■ s are be9inning to include etc.), it is important that the Adults, Virginia Commonwealth raining in substance abuse as part University, fUchmond, VA., physician rule out the possibility of February 14,1990.

Vol 5, # 4 • June 1990 • Page 11 Management Cannot Be Left to Chance.

T h e dilemma is familiar. Having problem s. W orking on-site, a ManageAbility spent years preparing to practice professional recommends and impl^ One of the most distressing medicine, the physician finds in­ ments necessary business checks problems encountered by Manage- creasing tim e and energy spent in and co n tro ls and reviews the critical Ability is the issue of dishonesty by managing the business. Personnel elem ents o f the m onthly practice ac­ trusted employees. Recent statistics issues, collections, business sys­ tivity. The physician is also provided provided by the American Medical tems, third party insurers, and new with Practice Analysis Reports Association suggest that embezzle­ government regulations force atten­ w h ich gra p h ica lly present indicators ment and employee theft have tion upon the profitability and ef­ critical to the health and manage­ reached epidemic proportions. Al­ ficiency of the practice. ment of the business office. though physicians may find it hard Recognizing the overwhelming to believe that they may be the vic­ Management cannot be left to demands placed on physicians, tims of embezzlement, in reality they chance. Building an office atmos­ ManageAbility was formed in 1989 are often the most vulnerable. The phere of accountability and trust to provide resources and solutions results to their practices are usually takes de lib era te and careful effort, for medical office management. The devastating, including decreased b u t pays big dividends to both the com pany com bines the talents and cash flow and damaged staff physician and staff. experience of three partners whose relationships. Much time and effort professional qualifications and is required to rebuild the staff and education make them uniquely able the practice. M a n ap eA b ilitvis a local com pany specializing to respond to physicians’ business in co st effective services to improve and protect needs. Their services are as varied An old adage states "an ounce of your practice. Call N O R M A LA RSO N 840- 1501, KAY HARLAN 475-7231, or STEVE as their client needs. Successful as­ prevention is worth a pound of LARSON (King Co.) 937-7168 fora com­ cure.” ManageAbility had developed signments have included setting up plimentary consultation. new physicians’ practices, streamlin­ a package of services that w o rk with ing business systems, resolving per­ physicians and staff to address the ( Practice A nalysis R eports designed by Manage- Ability. All copyrights reserved.) sonnel issues and analyzing and issue of embezzlement and to en­ solving billing and collection hance trust and accountability.

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Page 12 • June 1990 • Vol. 5, #4 Pierce County Chapter of Medical Assistants: Healthcare’s Most Versatile Professionals

M edical Assisting is the nation's • Local Newsletter The Pierce County Chapter of Medi­ second fastest growing career field. cal Assistants meets regularly on • Professional Journals Men and women already in the the second Monday of the month, except for July and August, at the field-and those entering in the near • Reduced Rates for Seminars (in­ Harvester Restaurant located at 29 future-will most probably find a cluding those sponsored by Tacoma Avenue North. Through this growing demand for their services PCMS), conventions, regional local association, you will meet a and ample opportunities for conferences, certification, and whole new group of people with recertification. similar interests and goals. Monthly The AAMA is a national professional chapter meetings begin with a no association fo r medical assistants. It host dinner at 5:30 P.M. Being able is a non-profit organization dedi­ to share your views with other medi­ cated to the education and profes­ cal assistants enriches everyone's sional advancement of medical as­ professional experience. sistants through continuing educa­ Many physician employers pay the tion, professional journals, school annual membership dues for their accreditation and certification of medical assistants. If you would like medical assistants. The AAMA more information about member­ provides a broad based information ship, please contact Edith Howe, advancement in the years ahead. Be­ network for medical assistants inter­ C.M.A., President PCCMA, at 572- coming active in a local Chapter of ested in providing better health care 5025. the American Association of Medical and furthering their careers in the Assistants (AAMA) offers profes­ health care field. sional' growth for the member and in­ creased productivity in the medical office. Members have the oppor­ tunity to learn the newest and most effective techniques in clinical, ad­ ministrative, and managerial aspects of the medical practice in addition to important risk management strategies. Annual membership dues bring tri- level membership at the national, state, and local levels. A few of the Offering the OPTEFAST™ Program advantages of membership are: for your patients who are significantly overweight and may have associated medical problems. • Group Insurance by Physician Referral • Continuing Education

• Professional Prestige Medical Supervision and Fellowship Friendly, courteous, professional clinical team, • State Newsletter physicians, dietitians, nurses, behaviorists

If we can assist you in the care of your patients call: Tacoma 572-0508 -Federal Way 874-3860 C n e a & t a u n y e s iy The

6(4,. ©FFIFAST Union Avenue Pharmacy Pmguni & Corset Shop Cedar Medical Center St. Francis Medical Office Building Formerly Smith's Corset Shop 2302 S, Union Ave. 752-1705 1901 S. Cedar, Suite 205 • Tacoma, Wa 34509 9th Ave. S., Suite 200 • Federal Way. WA

Vol. 5, # 4 • June 1990 • Page 13 Auxiliary News

3rd Vice President/Bylaws Tosh