ULLETIN lanuary,2001 The 2000 Annual Meeting

Charles Weatherby, MD passes the gavel and PCMS Presidency to Patrice Stevensoil, MD

Patrice Stevenson, MD introduces DonMotr, MD recipient ofthe 2000

C ommunity S ervice Award

See highlights page 3-5 INSIDE: 3 2OOO Annual Meeting in Review i)- Donald H. Mott, MD, Recipient of 2OOO Community Service Award 7lI February General Membership Meeting: What Color is Your ParachuteP 8 Thank you to Holiday Sharing card contributors; over $15,(X)O donated \rt' 10 Meet your Board of Trustees for 2OOl L4 Web Users Search for Medical Advice Most Often 18 Budget cuts to Impact Medical Practices BuTTETIN

PCMS Officers/Trustees: War.ryVaa/ft'1r"*/e74: * Patrice N. Stevenson, MD...... President ;fi\ ^_ Susan J. Salo, MD...... President Elect J. James Rooks, Jr., MD. ....Vice-President * Michael J. Kelly, MD ..Secretaryf[reasurer Weatherby, MD....Past President LLtrTINW Charles M. Sabrina A. Benjamin, MD Drew H. Deutsch, MD Stephen F. Duncart, MD fanuzU,2001 Kenneth A. Feucht, MD Kevin K. Gandhi, MD Sumner L. Schoenike, MD p,-$ * ib \VSMA Representatives: i Speaker of the House: Richard Hawkins, MD E"*i Trustees: David Law, MD; Nicholas Rajacich, MD :i8f AMA Delegate: Leonard Alenick, MD WAMPAC Chat/6th District: Mark Gildenhar, MD WAMPAC 9th District: Don Russell, DO

Executive Director: Sue Asher

Committee Chairs: Aging, Richard Waltman; AIDS, James DeMaio; Bylaws, Richard Hawkins; Budget/Tinance, James Rooks; College of Medical Bducation, John Jiganti; Credentials, Susan Salo; Emergency Tabtre of Contents Medical Standards, Ted Walkley; Bthics/ Standards Of Practice, David Lukens; Grievance, 2000 Recap Charles Weathetby; Labor & Industries, William 3 Annual Meeting Ritchie; Legislative, William Marsh; Medical- Legal, Mark Taylor; Membership Benefits, Inc., 4 Annual Meeting 2000 Recap Drew Deutsch; Personal Problems Of Physicians, Robert Sands; Public Health/School Health' receives PCMS Community Service Award Sumner Schoenike 5 Don Mott, MD U

The Bulletin is published monthly by PCMS 6 WSMA Legislative Priorities for 2001 Membership Benefits, Inc. for members of the WSMA Legislative Summit - January 23,200I Pierce County Medical Society. Deadlines for submitting articles and placing advertisements in The Bulletin are the 15th of the month preceding 7 February General Membership Meeting publication. (i.e. January 15 for the February issue) 8 Holiday Sharing Card raises funds for PCMS Foundation The Bulletin is dedicated to the art, science and Physicians needed for Guatemala trip delivery of medicine and the betterment of the health and medical welfare of the community. The opinions herein are those of the individual 9 TPCHD: New "Child Care Consultant" program contributors and do not necessarily reflect the official position of the Medical Society. Trustees for 2001 Acceptance of advertising in no way constitutes 10 Board of professional approval or endorse-ment of products or services advertised. The Bulletin and 11 In My Opinion: David Roskoph, MBA, CFP Pierce County Medical Society reserve the right to reject any advertising. 13 In My Opinion: Nicol Iverson, MD Managing Editor: Sue Asher Editorial Committee: MBI Board of Directors 14 Web Users Search for Medical Advice Most Often

Advertising Representative: Kristi Brittain College of Medical Education Subscriptions: $50 per year, $5 per issue 15

Make all checks payable to: MBI ll Applicants for Membership 223 Tacoma Avenue South, Tacoma WA 98402 Directory changes Phone: 253-572-3666; Physicians call 572-3667 FAX 253-572-2470 18 Budget cuts to impact medical practices E-mail address: [email protected] Home Page: http:l lwww.pcmswa.org lg Classified Advertising

2 PCMS BULLETIN January 200t v 2000 Annual Meeting - a rockin' good time The 2000 Annual Meeting brought the Sheraton Ball- room to life when the Allen A.M.E. Church Gospel Choir sang under the direction of Victoria Woodards and Willard Loggins. Performing during the social hour and dinner was the Tacoma Youth Symphony Quintet. President Charles Weatherby, MD, conducted the meeting, introducing the musical performers and asking for a moment of silence in honor of colleagues that died last year. They included Drs. Ali Sarrafan, Dumont Staatz, Charles McGill, R.A. Norton, Marlene Lazarus and Keltie Burto Robert Truckey and Charles Denzler. This year' s raffle winners were Doug Jackman, Execu- tive Director and Dr. John Rowlands. Bill Ritchie, MD won the raffle for the fruit to be delivered each month to his PCMS Vice-President Jim Rooks, MD (left) visits with home. Reverend Joseph Nixon, Pastor of Allen A.M.E. Church. Highlighting the evening was the presentation of the Rev. Nixon gave the invocation Community Service Award to Donald H. Mott, MD, Puyallup orthopedist. Colleague and President-Elect Patrice Stevenson, MD introduced Dr. Mott after reviewing his endless resume of community accomplishments. (See story page 5) A brief video was shown highlighting his dedication and commitment to the new Children's Therapy Center, "The Ark," in Puyallup. Dr. Weatherby turned over the gavel and introduced the Lv new PCMS President, Dr. Patrice Stevenson, physical medicine and rehab physician at Good Samaritan Hospital. Dr. Stevenson thanked Dr. Weatherby and outgoing board members Drs. Lawrence A. Larson, Doris Page and Ted Walkley, prior to welcoming new Trustees Drs. Ken Feucht, Steve Duncan and Sumner Schoenike. (see page 10) Vern Larson, MD, retired radiologist and his wift Kit, visit Prior to adjourning the meeting Dr. Stevenson an- with friends during the social hour nounced that Sue Asher had been named as Executive Director to replace Doug Jackman who was retiring January I,2ffiI.t

Left, Don Mott, MD, winner of the Community Service award From left, Dr. Rose-Marie Colombini and husband Rob; David \v visits with Pat Duffy, MD Sumnerfamily physician and his Law, MD and wift, Bev; Marge Ritchie and husband Bitt wife, Susie. Dr. Duffi was president in 1984 Ritchie, MD. Drs. Ritchie & Law are both past-presidents More photos page 4

January, 2001. PCMS BULLETIN 3 BuITETIN

rl Bill Ritchie, MD, Doug Ja.ckman, recentlv retired receives ul \e congratulations Execut'ive Director won from Dr. Weatherby fo, one of the winning the rffie gourmet rffie baskets. This for fruit to be delivered to his was his last home monthly. annual meeting , Dr. Ritchie is an after attending ENT physician in every one since Tacoma and 1983. He served as PCMS sltrrenders his President in 1989. ticket to Laura He currently Yu-Blumenthal, chairs the L&I daughter of Committee Amy Yut, MD

The Allen A.M.E. gospel choir were excellent perfolmers From left, Drs. Ken Feucht and David Judish, general and really woke up the crowd at the Sheraton Ballroom. The surgeon and physical medicine & rehab respectively. Both 45 member choir is well known and performs continuously practice in Puyallup. Dr. Feucht was jwst elected to the 2001 throughout the year. Board of Trustees and Dr. Judish serves on the L&I Committee

From left, outgoing President Charles Weatherby and his wife From left, Dr. Larry Larson visits with Dr. Rose-Marie Shawna with Past-President Larry Larson, DO. Dr. Larsonwill Colombini and her husband Rob. Dr. Comombini is afamily be stepping down after seven years on the Board of Trustees practitione r in P uy allup \,

4 PCMSBULLETIN January,2001' W*""V**4a/fiir*/ E*4y

g. \/

Donald H. Mott, MD recognizedfor community senrice

Editor's note: The follor,v{ng is the introduction of Donald Mott, MD, given by his colleague, Patrice Stevenson, MD, PCN4S President, r,vhen arn'arding him the 2000 PCMS Community Sen'ice Award at the December Annual h,Ieeting

Dr. Mott began his private practice Republic of China to provide care and Barrie. in Puyallup in 1913 after completion of treatment to children at the new I have been doing a Team Clinic his residency in orthopedic surgery at Children' s Rehabilitation Center that with Dr. Mott monthly for over seven the University of Utah. He graduated he was instrumental in opening. As part years and have learned a lot from him from the University of Washington of his mission in China he has recruited both on technical aspects of orthope- Medical School in 1966 and interned at therapists, physicians, and other dics and even more from his seasoned Maine Medical Center and Highland healthcare providers to become Alameda County Hospital followed by members of treatment teams who ac- a two-year stint in the U.S. Air Force. companied him to Louyang City. He For the past 27 years he has has been referred to by one of the served his patients, his profession, his children he was treating as, "the big church and his community with great American Grandpa." distinction and humility. Good Samari- At Good Samaritan he has tan Hospital and its medical staff, the treated children in the Children's Rotary Club of Puyallup, the Puyallup Therapy Unit for more than 25 Valley YMCA and the World Associa- years in clinics twice a month donat- L/ tion of Children and Parents are some ing his time to those children whose of the organtzations that have ben- families were unable to pay for his efited from his work. His selfless and services. His dedication to children untiring efforts on behalf of these con- with disabilities has most recently stituencies have resulted in his accumu- been demonstrated by his leader- lation of numerous awards and much ship role in the construction of a well deserved recognition. new Children's Therapy Unit facil- He is a distinguished member of ity "the Ark." He led ateamof 25 the Academy of Orthopedic Surgeons volunteers in raising more than $8 Donald H. Mott, MD gave his thanks for and is a nominee for the Academy's million in a capital campaign for this the recognition and honor 2001 Humanitarian Award. He is widely project. This 44,000 square foot fa- regarded as a consultant and presenter cility will provide space for treating observations on the politics of by his colleagues in the Pacific North- more than 800 children per week. He healthcare. We used to do our clinic in west and across the nation for his com- was the driving force from start to fin- cramped quarters and examine kids on petency in orthopedic surgery. ish, arranging the acquisition of the 10- the coffee table in the director's office. He has served in every governing acre site, giving and getting more than In the new facility we have a nice clinic capacity at the professional and institu- $4.5 million for the campaign, arranging with a real mat and x-ray box. I was no- tional level while on the'medical staff at a $500,000 grant from the Kresge Foun- ticing that the x-ray box seemed a bit Good Samaritan Hospital. He is widely dation and overall spearheading a high on the wall as I could barely reach regarded as a leader and a devoted ad- project that has literally changed the the 'on' switch. Since Dr. Mott is 6'6" vocate for providing the best health- face and culture at Good Sam. Finally, this is just right for him. I was describ- care possible during his service to he was the primary founder and cur- ing this situation to my colleague, Dr. Good Samaritan. rently is the Chairman of the newly or- Judish, whose appropriate reply was oowell, His commitment to the World Asso- gantzed Good S amaritan Foundation. they didn't name the building af- ciation of Children and Parents now These acts have been recognized ter YOU did they?!?!" Enough said. spans several years and includes many by the hospital board's decision to It is with great pleasure that I b/ trips at his own expense to Louyang name the new Children's Therapy present the 2000 PCMS Community City in Henan Province in the People's Center for Dr. Mott and his wife Service award to Dr. Donald H. Moff.r

January , 2001. PCMS BULLETIN 5 BurrHTtrN

LeSslative WSMA Legislative Summit 1 v priorities Tuesday,linuary23 in Olyr*pia

ofWSMA The annual WSMA Legislative Afternoon activities will include physicians meeting with their own Summit will be held on Tuesday, ,T January 23 at the West Coast Olympia legislators as well as the following With the 2001 Legislative Session Hotel in Olympia. sessions: coming soon, the WSMA is busy Activities will tHouse Health Care preparing their annual agenda. The include discus- Committee Hearing (as well agenda is based on organizational sions with Gover- as other hearings) priorities and action taken at the annual nor Gary Locke, looNew to the ProcesS," A meeting itt September. Priority items DSHS Secretary learning experience about include: the Legislature . Dennis Braddock, Adequate funding for Insurance Com- rGuided Tour of the public health programs and missioner Mike Legislative Campus tMeetings with Executive physician practices Kreidler and L&I Director Gary Branch leaders . Opposition to other health Moore. care groups' perennial attempts During the lunch There is no charge for to intrude into the scope of session, WSMA will present their WSMA members to attend the Legisla- tive Summit. Please call PCMS, 512- practice of physicians legislative priorities for the session, as well as offer talking points and tips on 3667 for a registration form or you may . Supporting the Liability how best to influence your own call Patti Smith at the WSMA 1-800-552- Reform Coalition (LRC) agenda senators and representatives. 0612 for more information. r and introducing, if necessary, \e separate tort legislation germane to the medical profession. ' Opposing legislatively mandated sharps protections as unnecessary due to WISHA workplace regulations FI ' A.ggressively fighting efforts to further fraud and abuse Tr{ legislation in our state o Preserve funds from Tobacco Settlement for tobacco prevention/control

The agenda will be adjusted as the legislative session nears. The WSMA expects to review over 2,000 pieces of legislation and will be actively engaged in several hundred bills as part of their ( )till ttxk6' .frn' nxirc irttrmntfiirnt work to represent physician interests. PIBRCE COttf{TY Mark your calendar for the LASER CLII{IC WSMA Legislative Summit on I)ircctor l)ctcr K. Illrslr II.D. Tuesday, January 23. (see (2s3) s73-0047 \, adjacent article) r

6 PCMSBULLETIN January,2001' Wn;ro*Vao//"1r*/A4 tv fudr-l invites you and your spouse/guest to the +i.

February General Membership Meeting

Tuesday, February 13, 2OO1 Landmark Convention Center Social Hour: 6:00 pm Temple Theatre, Roof Garden Dinner: 6:45 pm 47 St. Helens Avenue Program: 7:45 pm Tacoma

HOW GOLDEN NS YOIIR PARACHUTE?

David Roskoph, MBA, CFP Total Asset Management, Inc. t/ Registered Investment Advisory

) Consequences of market failures/successes ) Assessing when you can comfortably retire ) Maintaining your financial health in retirement

ALSO: PCMS WILL HONOR SEI{ATOR LORRAINE WOJAHN, (D-27) FOR HER SUPPORT OF MEDICAL ISSUES DURING IIER TENURE IN THE WASHINGTON STATE LEGISLATURE

(Register by February L Return form to: PCMS, 223 Tacoma Ave S, Tacoma 98402; FAX to 572-2470 ot call 572-3667

Please reserve dinner(s) at $20 per person (tax and tip included)

Enclosed is my check for $ _ or my credit card # is [visa f] tvtaster card Expiration Date Signature

I will be bringing my spouse or a guest. Name for name tag: b/ Signed:

January , 2001. PCMS BULLETIN 7 Bux-TETIN

:' Holiday Sh*ing Card raises over $15,000 for \g/ PCM S Foundation with over 200 contributors

-.. t A hearty thank you to members for Gerald W. Bissonnette, MD Charles Prewitt, MD generously supporting the Holiday Dr. John E. Bruce & Mrs. Yolanda Bitl & Marge Ritchie Dr. & Mrs. T. Sack Sharing Card 2000. The PCMS Foun- Sullivan-Bruce John Mick & Lavonne Campbell Timothy Schubert, MD dation, formed earlier this year to con- Stephen Elder William ShieIds,MD tinue the philanthropic work of the dis- Stephanie F. Hoefle, MI) Dr. & Mrs. Thomas H. Skrinar banded raised over in Alliance, $15,000 David Judish, MD Janice Strom, MD contributions from the Holiday Sharing David & Bev Law George & Kimi Tanbara Card. The holiday greeting card is James L.Patterson, MD DanA. WiklundoMD mailed to all PCMS members with a listing of names of all contributors. It is Physicians needed for Guatemala an easy and effective way to extend ttip holiday good wishes to colleagues and friends. Over 200 contributions were Febru ary trip being planned to care for abandoned, reformatory boys made by physicians andlor their fami- lies. On February IJ'n,2001 for the more, most of these young men are And, a very big thank you must go eighth time in the last five years, I will street boys who were abandoned or to the volunteers who helped with all be returning to Guatemala for one rejected by their own parents and the work that accompanies such a week. The pu{pose of this trip is to take relatives. Some of these boys are in project, particularly the preparation for a team of medical and health care detention not because of crimes but mailing: Nikki Crowley, Mona practitioners to provide practical and because they do not have a home to go Baghdadi, Patty Kesling, Helen immediate care to a group of 150 to. Some of these children have been \d/ Whitney, Mary Lou Jones, Cindy adolescents in a reformatory located lured to the streets by vices such as Anderson, Sharon Ann Lawsono near Guatem a\a City, as well as a inhaling paint thinner, glue, manjuana, Mary Cordova, Yolanda Bruce, Alice primitive secluded village located in and commercial solvents that are Wilhyde and Jim Crowley. the mountains in the area of Zacapa. extremely damaging to the human Thank you to the following con- The group in the reformatory does body. Every time I have asked any of tributors whose donations were re- not receive any dental or medical care them the reason they use such harmful ceived after the card went to press: while serving their sentence. Further- chemicals, their answer is the same, "so I don't feel pain." The pain they refer to is both emotional and physical. I believe that an act of love by anybody MEDICAL LICEI{SURE ISSUES that is willing to touch these more than unfortunate kids can make a change in Mr. Rockwell is available to represent physicians and other health care their life and destiny. providers with issues of concern before the State Medical Quality Assurance Would anyone reading this be Commission. Mr. Rockwell, appointed by Governor Booth Gardner, seryed for interested in traveling to Guatemala to 8 years as the Public Board Member of the Medical Disciplinary Board from help these children who have been 1985 -1993. Since then, Mr. Rockwell has successfully represented over 60 robbed of their humanity? Expenses physicians on charges before the MQAC. Mr. Rockwell's fees are competitive and contributions are tax deductible. agreement. and the subject of a confidential attorney-client representation Not only will you make a difference in Gregory G. Rockwell the lives of souls that are hurting, you Attorney atLaw & Arbitrator will also be changed by what you see and experience. lzth Avenue SE, Suit e 3055 - l 2ll If you wish to be called to this Bellevue, WA 98004 extraordinary adventure, please contact: Pastor Carlos Arroyo at, pager: (425) 822-1962 o FAX (425) 822-3043 (253) 383-0365, home: (253) 857-5150, or \y o email: [email protected] websitez "ggrockwell.wld.comtt email praiseacres @integrityol.com r

8 PCMS BULLETIN January, 2007 ,.

.:.'.:.:l..::]:::i..l...',.....il:.::..:j]. The Flealth Status of Pierce Countv Federico Cryz-Uribe, MD Director ofHeJitft \, I

Health D epartment offers new u'i'i:'*r*i:tiiff' ffi ' Child Care Consultant' program # TACOMA-PIERCE COUNTY HEALTH Regular readers of this column In Pierce County there are ap- DEPARTMENT know that the Tacoma-Pierce County proximately 900 child care centers and Health Department looks for ways to family home providers, serving 50,000 prevent those things which create i11- children. Many operators of these fa- )Caring for your Septic System, ness, injury or death. We take seri- cilities recognize that information or Safe Well Water, and other envi- ously the community's trust in us to technical assistance from the Health ronmental health issues thwart com- Department can help to prevent inju- municable ries and illness among the children at )CfritO Growth and Development diseases, the centers. The Nurse Consultant Issues, including positive disci- patho- foil Program assists those centers by pro- pline, brain development, infant gens caF viding, at the request of the center: stimulation, parenting, age appro- ried on im- priate milestones, age appropriate properly- .Child care infant nurse consulta- activities handled tion foods, and \,/ )Ctrildren's Health, including as discern rHealth and safety conferencing, sessing ill children, medication F ede rico new ap- resources, and referrals management, cofilmunicable dis- Cruz,-Uribe, MD proaches eases, childhood diseases, dental for improv- I Educational opportunities care, immunizations and nutrition ing drinking water. In addition, TPCHD staff rAdvocates examine and seal for consistent inter- )Infection Control, including children's teeth, inspect homes and pretation of regulations at all bloodborne pathogens, HIV/ educate families about preven- asthma levels of government AIDS, TB, handwashing, lice tion, educate children and adults on prevention and control, sanitation avoiding tobacco rPrivate use, and recommend sector child care nurse and safe food handling safer play equipment. consultant consultation relatively new program A at the )In3ury Prevention and Safety Is- rAssistance Health Department integrates all of for children with spe- sues, including playground these things. Public A Health Nurse cial health care needs safety, indoor safety, bike hel- anchors The Care Child Consultant mets and car seats Program. The nurse coordinates Education offerings for child care skilled professionals from Communi- providers, offered by TPCHD staff, in- Your patients may indicate con- cable Disease Control, Food and Com- clude the following: cerns about their child's day care cen- munity Safety and Source Protection ter, or as an operator ask about ways to (environmental health) to "improve )Preventing Shaken Baby Syn- advance the health of those in their and sustain the health and safety of the drcrme and other abuse/neglect care. Please feel free to contact people in Pierce County with emphasis issues TPCHD's Child Care Nurse Consult- on children in child care centers, their ant, Sue Biles, RN, at (253) 798-6487 , families and communities through )Stress Management and Health with those concerns or to ask for more promotion health and injury preven- Issues for Child Care Employees information on this unique program. r \,/ tion."

January, 20A1. PCMS BULLETIN 9 BulrET'IN

New Board of Trustees will lead PCMS in 2001 \.ri

Fa€rice Stevexescn, MF Sabrina &enjareain, fu[D practices {trnesident} practices PhYsical internal medicine with Internal Medicine medicine and rehabilitation in : Northwest in Tacoma. She received her Puyallup. She graduated from the medical degree from Uniformed University of Washington School of Services University of the Health Medicine and completed her intern- Sciences and practiced several years at ship & residency at the VA Medical MAMC. She and her husband, Selvius, Center in Los Angeles. She and her live in Olympia. husband, Craig, live on Lake TaPPs. Drew *eutscRr, lVt* practices Swsan SaEs, &,€P {Fresident- with Tacoma Radiology Associates, He EEect) is a family practitioner with received his medical degree from the Group Health in Tacoma. She earned University of Illinois College of Medi- her medical degree from the Univer- cine and completed post medical sity of Washington School of Medi- education at Cedars-Sinai Medical cine and has practiced in Tacoma for Center in Los Angeles. He lives with his 25 years. She lives with her husband, wife, Rebecca, in Gig Harbor. Robert, in Puyallup. Stephexr Funcam, V[$ is a familY Chnrles Wea€herhY, Mm practitioner with Group Health in {Fast-Fresiden€} is a family practi- Puyallup. He received his medical tioner in Tacoma. He received his degree from the Indiana University medical degree from the University of School of Medicine. He completed his Washington Medical School and internship and residency at Union completed his internship & residency Hospital Family Practice in Terre Haute, \d/ at St. Luke's Hospital in Milwaukee. Indiana. He resides in Puyallup. He and his wife, Shauna, live in Kerlneth Feueh€o MF, F&t.il. is University Place. a Puyallup general surgeon. He ,f. James R,qloks, JF", &'{N} graduated from the Oregon Health {.1iiee-Fresideset} practices oto- Sciences University of Medicine and laryngology in Lakewood. He completed a fellowship at the University attended medical school at the of Illinois in surgical oncology. He lives University of Miami School of in Puyallup with his wife, Betsy Medicine. He is a Fellow in the Kevi* Gaxadhi, &,€P is a Pediatrtcl American College of Surgeons and adult urologist. His practice is in American Academy of OtolarYngol- Puyallup. He received his medical ogy/Head/Neck Surgery. He and degree and completed his residency Penny, his wife, live in Steilacoom. and internship at Loyola University ,&,€ichaeB J. KeEEy, MS {.Sec- Stritch School of Medicine. He and his x"e€ary-Treasurer) is a familY wife, Kassy, live in University Place. practitioner in Lakewood. He Susffiner Schoenikeu I*'ID' &{PF{ graduated from the UniversitY of is a Lakewood pediatrician. He gradu- Cincinnati College of Medicine and ated from Baylor College of Medicine in completed his residen cy at Oregon Houston. He completed a fellowship in Health Sciences University. He and psychi atry at Oregon State Hospital and From top left, counter-clochuise, Drs. his wife, Bonnie, live in University received his MPH from the University Patrice Stevenson, Susan Salo, Charles Place. of Texas School of Public Health. He Weatherby, James Rooks and Michael lives with his wife, Jan, in Gig Harbor. The Board determirrcs policie s and trans acts Sumner Schoenike, Kevin Kelly; bwiness onbehnlf ofthe Society aswellos Kenneth Feucht, StePhen The B oard ofTrus* u, X c ompris ed of the P re sident, Gandhi, lnonnge s and confurct s all their prop er7y, ffirs, Vic e P re sident, P ast- P re sifunt, S e cretary/ \y Duncan, Drew Deutsch and Sabrina w ork and activitie s.They ne et on rhe first Treasurer, President-Elect attd six tnntees. Benjamin Tue sdny of each month exc ept July and August.

10 PCMS BULLETIN JanuarY, 2001 @a^", Vr*rr* a/Ur""/ gr"rbll

DH$.[d. EFF {l/

Did the Federal Resenze Actually Create That Bubble?

In the rearview miffor, trillions of event, the Fed was so unsettled that r1 pour money into the economy. The dollars have just evaporated. Gone. I they kept the printing press on 24/7 to deluge averted a small recession by spend the better part of each day in the guard against money being stockpiled flooding all companies with financing, often-frustrating pursuit of understand- into mattresses. Equity prices follow the tankers and dinghies alike. Alan ing financial markets and have been money supply (chart 2) andby early Greenspan went from repeatedly beside myself trying to explain the 2000 we were unusual awash in a sea of behavior of paper money. It US equity made the Fed seem markets hopelessly out of since late touch, but was it? sufirmer of While the bubble 1998. After inflated, Al exhausting Greenspan assured every his critics that the academic "asset bubbles could rationale, all only be reco gnized Dnvid that remains in the rearview Roskoph, A4BA, CFP is a curious mirror." Remember irreverent that in addition to ::i :1 t1 .t.i;l t: \/ conclusion. affecting interest 1:i It involves the most respected quasi- rates and the money Chart 1 public, quasi-private institution on supply, speculative earth, the Federal Reserve Bank (FRB excesses could have - or Fed). easily been tempered 14- In the fall of 1998 a funny thing by raising margin happened on the way to the Federal requirements. Margin 12- Reserve meetings. Arguably, things borrowing had t0- were fine in this greatunion of ours but skyrocketed and was Asia, the Soviet Union and Brazll were a sure sign of 8- experiencing financial difficulty. As US speculation. This was markets roiled from the potential never even seriously impact of external factors, the FRB considered. S&P 500 vs. dramatically cut interest rates three Also in the fall of yearly Yo clnnge times; two separate cuts occuffed on 1998, a tidal wave of in money supply the same day! All things being equal, innovation was when interest rates get cut, equities go building worldwide on sale and US equity markets took off with the potential to (chart 1), or did they? At that crucial dilute the US Chart 2 intersection, a divergence emerged as concentration. No the highflying tech companies pow- one was sure of how the new technol- o'irrational" ered on to ridiculous valuations (both ogy would alter the economy or who calling the markets to now o'immeasurable" those with/without earnings) while the the eventual market leaders would be. standing in awe of their average equity began a steady decent. Therefore, precise financing was new efficiencies. In the fall of 1998 the In addition to dramatically cutting impossible and the global financials Fed went from its historical role as interest rates, the Fed pumped up the were high. In my opinion, the Fed lender-of-last-resort to the opposite end \rrr money supply. Although almost indirectly financed the technological of the spectrum now functioning as everyone considered YZK a non- renaissance by finding any excuse to See "Bubble" page 12

January, 200'L PCMS BULLETIN 11 BumETII{

Bubble rrompagelr \r/ investment banker for the United States. Its role reversal exacerbated, if not created this asset bubble. The bubble is now deflating in time to compound the recession postponed since the fall of 1998. Except now the circumstances point to a much more protracted slowdown of over one yeaL Exposing the fragility of financial markets for the last year has not been the most popular position because no one really wants his or her hopes diminished. Most vested interesls on Wall Street promote going with the crowd, buying every dip and the certainty of higher valuations. As an independent financial advisor, who has questioned such hype for decades, I feel responsible to expose the effici- ency with which such vested interests have separated investors from their hard-earned capital for centuries. Whether a fad involves weight control or an investment scheme, the results are usually unsustainable. Appreciating \r/ risk when establishing a plan and sticking to it will always beat chasing the crowd. I

David Roskoph is an independent, fee- based investment advisor and Certified Financial Planner in Gig Harbon

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Shcrre Your LVe. Share Your Decision.*

For more information on organ and tissue v donation please call LifeCenter Northwest toll free, 1-877 -275-5269

1,2 PCMS BULLETIN January, 2007 W,r,*Vaa/h/r*/oYq

In, b$. p.I \-' $'WnioffJ,..... The Sacred Cow is the Secret of the Hindoo The Dollyllama.

Traveling recently through India, surgery. The physicians there also The remaining length is folded in many my wife and I were baptized by a have maintained the true values of 3-inch pleats, then tucked in the front to rickshaw ride in Delhi. We had our treating patients with kindness and cover certain parts. Voila! A wedgy! own personal teenage beggar girl with respect. This hospital has the support Since I was eating Vegan, the strict baby, who followed us for about three of Sai Baba, considered the man of vegetarian miles miracles by many diet remanded me through Indians, and more to the men's the muck, than a handful of room, where cows, Californians. As my I "The common folk stared bleakly people, wife and I traveled at the Indian cars, into some villages in India squat toilet, smoke, well off the beaten flush with the Holy path, we were have a floor. Doing privileged to meet spiritual duty in a dhoti Hawkers with some enlight- is an enlighten- lr{it'hol lverson, MD and ened teachers. We appreciation for life ing experi- vendors, did also see a ence. Try cows, couple of teachers that pLrts us \'tl removing lepers, bicycles, smoking motorcycles, who transcended to shame" one and cows. I still don't understand the enlightenment. of those things, standing dairy industry in Indi a; farrners chase Where shoes ate a barefoot in wet those stupid cows all over the place ! luxury, and goo, and These sacred animals frequent the adequate amounts attempting to get the stupid thing back freeways, side streets, front doors, and of food and water are predicated upon on without letting any of it touch the temples, but I know the meaning of the whims of monsoons, droughts, bugs slimy floor. Or losing your balance. sacred cow is no bull. It is the secret of and disease, there were an unusually "Why go to India?" you query. Hindoo. The smell ! Stick your head high percentage of villagers who were India is home of Hindus, Jains, Bud- into a septic tank, add diesel smoke, smiling. One wonders who are the rich dhists, Moslems, sprinkle traces of every known people? Sikhs, the Dolly Llama, and Mr. Mosquito. America is a spiritual excrement on the planet, and then add For the truly daft or adventurous infant. The common folk in India have a pinch of curry. Instant enlightenment. types, I suggest on YOUR next visit to a spiritual appreciation for life that puts Indians sit around meditating so that India, a Yagya. We sat through this us to shame. Do I hear a SHAME and they don't have to breathe. Incense four-hour ceremony, dedicated to an AMEN? Poor Americans are was invented to mask this odor. Lakshme, goddess of prosperity, and independently wealthy by Indian India has given me a gnu perspec- Ganesha, the god who removes standards. In "impoverished" villages, tive on life and medicine. While obstacles. The priests tossedin about children and other people I met were visiting a hospital in southern India, I 57,41 1 flowers and 17 barcels of holy oil smiling. Is it the dhotis? Nope. They was able to see medicine practiced in a into several fires to amuse and appease have families who care for them as pafi manner much better than my precon- these deities. I had to wear a Dhoti. of their culture. Returning from India ceived idea. Puttaparthi, a small town Take a translucent piece of muslin 57 one cannot escape the knowledge that north of Bangalore, has a fully feet long and 3 feet wide. Wrap it the Materialism God runs our lives. At equipped hospital capable of compli- around your waist, and tie a knot. Tight. this time of the year, we need to cated cardiovascular surgery, emer- Leave a three-foot length on one end reassess our priorities, and count our gency cardiac angioplasty with stent that you stick between your legs, and v blessings.r placement, and pediatric urological tuck into your waistband in the rear.

January, 200'J. PCMS BULLETIN 13 Bur-r-ETIN

Web Users Search for MedicalAdvice Most Often !' \r/

More Americans surfing the Web to get the information they crave," tion said advice found there improved Internet look for medical information he added. how they care for themselves. The than for sports scores, stock quotes or Most people seeking health ,. survey found that most people sought group online-shopping bargains, said a material online do so at least once a t medical material through broad studying how the Internet affects month. Most are lookittg for guidance Internet searches and gleaned data people's lives. about battling a specific disease that from sites with which they weren't An estimated szmlllion Americans afflicts them or someone they know, familiar, leading the authors to suggest have used the Internet to gain knowl- said the repofr, based on surveys of that doctors help point patients to edge about diseases and treatment, more than 12,000 people. reliable information. investi gate how to participate in clinical About 557o of all Internet users Only 97o of people using the Web trials and find low-fat recipes, the said they had sought health informa- for health information said they had group said in a recently released tion. That outranks activities such as exchanged e-mails with their doctors, report. online shopping, done by 47 7o of and 107o said they had filled prescrip- The report "illustrates perhaps the Internet users, the report said. About tions or bought dietary supplements most profound and dramatic impact the 4l7o of people polled said material online. Internet is having on Americans," Lee found during their most recent online Many were concerned about Rainie, director of The Pew Internet search affected decisions about privacy on the Internet, with 637o and American Life Project, said. whether they should go to the doctor, opposed to keeping medical records '"In an era when the face time a how to treat an illness or how to online, even at a pass-word-protected patient gets with a doctor during an question a physician, the report said. site, because of fear that others might average appointment has dipped below Nearly half of Internet users who see the information. r 15 minutes, many are turning to the have gone online for medical informa- Reprinted from The Wall Street Journal, 11/27/00 \1

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14 PCMS BULLETIN JanuarY, 2001 ffi**VAe/{.i'.*/&*y

Cd Md \,," 00rrH fiB F Primary Care Cardiolog,' CME MMIOAL set for eveningsofJ*,rury I & 16 NDUOffi[|N The College's sixth annual pro- speakers on the 9'h, three hours of gram featuring subjects on cardiology CME and end with three additional for the primary care physician will be hours of CME on the 16'h. The change held at St. Joseph Hospital,Lagerquist is in response to expressed interest by Conference Center Rooms 1A & B. physicians from the College's recent M/omen3 The course will be directed by Gregg CME survey. Physicians are finding it Ostergren, DO. difficult to take time away from their of- This year' s Cardiology for Pri- fice hours. MedicineCME mary Care CME program will be of- Topics will include Genetics & fered on two consecutive Tuesday Hyperlipedemia; ACE/ARB Combina- date to change evenings in January, instead of the tra- tion; Are Beta Blockers Underutil- ditional 6-hour program on a Friday. ized?; New Strategy in Treating Hy- This year' s program is scheduled for pertension; Optimi zing Inpatient Out- Ad";1'.:#i;?';:;Tf, 3Jl?11i",,, Tuesday, January 9'h and Tuesday, comes; Women' s Cardiology; Evalua- likely be postponed from it's previ- January 16'n from 6:00 pm to 9:00 pm on tion, Diagnosis and Management, and ously scheduled February 9th date. both nights. Lipid Intervention for Primary and Dates in May, possibly May 18,h are The program will begin with Secondary Prevention of CAC. r being considered. \r/ The one-day program addresses a variety of timely subjects relative to contemporary medicine for women. Dates Progam Director(s) Designed for the primary cate physi- cian, this CME program features issues Tuesdays, January 9 C-ardiolory for Prfunary Crreggfuogro,, DO related to diagnosis and treatment and 16 (evenings) C:re advances in treating illnesses in women. The program will be directed Wednesday-Srnrday Richard Tobr& MD by John Lenihsr, MD. r CME at \^lhistler Jannary 2+28 John Jiganti, MD WhistlerCME Advances in Women's Friday, Febrrmry 9 John tffihan, Jr., MD set for L/21-28 Medicine TBA Pain I\zlanagernent David Paly,MD The College's very popular CME in Whistler/Blackcomb still has room Thursday-Friday Internal Medicine for participants. However, the IJlrich BirlenbactU MD College's reserved block of condos at March 8-9 Review 2ffi1 Blackcomb's Aspen Lodge have all been reserved. The usual block and Saturday, April 28 Surgery Update zWL Glem Deyo, MD additional Aspen condos were booked prior to the December 1 deadline. Allerry, futlma& Those still interested in other possible Friday, lvlay 4 Pulnnnolory for Alex hfihali, MD lodging should call individual facilities or a central toll free number, 1-800- Prfurary Care r\/ , WHISTLER. The course will be directed by l)rs. John and Tuesdays, I\4ay 16 and Jiganti Medical Technolory Richard Tobin. r 23 (evenings)

January , 2001 PCMS BULLETIN 1,5 BuLLEnF.r

:' fieed offfice help i* q leurry? \.rr please send ysur ,'. email address to rls Pierce County Medical Soci"V Medical Placement Senrice at: pcrnswa@pcmswa,org the soltr tion {ar &ll uour stffi"i needsu

Prorsiding:

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Temp to Perm: A un_ique opportunita to u>ork u:ith a iotential e;nnlouee on, a trial bqsis - 752-7320 '*ithout obli,gat{on tu hire! Do you haae patients with diffiatlt emotional nnd sfress -related probluns? Psychiatric nnd For more inforrnation: psychological consultations arc ao ailable, call Deborah or Angela 572-37$S Union Avenue ltofussional Building

1,6 PCMS BULLETIN January, 2001 ?,*,*"VAa//rlrr/eYq ffi t- "iu ffi ffi of Physicians,, i..$:;...;i..;;, ir.:$',..'. ..t-rr-.,,'1..ii.t

':al Huynh-Vu, Linh T, ' :t MD il Please make note of the II Family 'r foilowing {i Practice It changes to your 2000 7CMS il Directory. 5 &, Practices at gllz s Lakewood Clinic, [4edical Brobr+ U** $ Lakewood Dr SW Room 2}3,Tacoma ffi' "t.olrot, ,retiSmen!,*emOtional, l 9&199;589-7030 Kenneth Feucht, MD Medical School: Spartan Health Change address to: !, Sciences University 1408 Third Srreet SE #150 : Residency: Niagara Falls Family Puyallup, 98372-3703 Your c;rrc€;"s Practice Phone: 841-9640 Fax: 841-7645 Gill, Alan R., MD Douglas Kingo MD Family Practice Change address to: 'l,i,,'',, Practices at Tacoma Family Medicine, 1408 Third Srreet SE #150 *Robert 52I Martin Puyallup 98372-3703 iuo*, mq ciiair 7:sz-6ats6 Luther Kirg Jr Wy, , Tacoma98405; 403-29ffi Phone: 841-9640 Fax: 84I-7645 Bill Dean, NID .,, , Z7Z.+013 rio*'ur*roor'MD' ' Medical School: Univ of Michigan Bitl'noo,nnD ' ' *Uti,it Residency: University of Missouri Douglas Hassflr, MD - Tacoma address: n Dennis'Waldron, MD'' Z6E;-2sg4 Sun, Howard, MD 2420 South [Jnion #300 Diagnostic Radiology Tacoma,98405 Practices at Tacoma Radiology, 3402 Phone: 756-0888 Fax : 7 56-6444 L-/ South 18th, Tacoma98405; 383- l09g Gig Harbor address: Medical School: University of Illinois 5801 Soundview #150 Confidentiatitv Gig 'u College of Medicine Harbor, 98335 Assl'I.red Internship: Swedish Hospital Phone: 853-4111 Fax: 853- 4321 Residency: University of Washington Fellowship: University of Washington

ltrcLUelert' Health Service A servlce of Northwest Medlcal Speclaltles, PLLC INTERNATIONAL TRAVEL CAN BE HAZARDOUS TO YOUR HEALTH . PRE-TRAVEL CARE . POST-TFIAVEL CARE 'hT: ii HOURS CALL EARLY WHEN PLANNING MON-FRI 9-5 Union Avenue Phormocy & i 253-429-9754 tt; Corset Shop *./ . i or 253- 6274123 lqrnely Smith's Corbet Shop i A SERVICE OF INFECTIONS LIMITED .*3.31-1-t;-Y.?l-"I.1Y:,Jn:]..1.91..-,i PS 1624 south I suite 102 (next to st. Joseph,s Hospital)

January, 200'J., PCMS BULLETIN lT BurrH,TxIq

State budget cuts to further impact medical practlces i \s' Budget writers for the Office of Financial Management (OFM) are proposing a six percent cut in health related programs. The proposed cuts include significantly reducing or eliminating a number of health care progrurms for low-income Washing ton residents such as:

$30.5 million in reduced services to seniors due to eligibility changes $7 million in reduced services to seniors from eliminating the chore services prbgram $13.4 million in reduced payments for prescription drugs $2.9 million from eliminating dental care for adults on Medicaid $20.4 million from eliminating coverage for the medically indigent $50.7 million from reducing payments to Medicaid providers $29.4 million from reducing payments to Medicaid providers under Healthy Options

NOW is the time to contact the Governor to remind him of the promises he made during his campaign to fight to keep the delivery system viable. Please contact him by calling the Capitol Hotline at 1-800-562-6000 and leave a message for him or email him at www.governor.wa.gov/contacVgovemail.htm expressing:

. Funding should be increased, not decreased for Medicaid and the Basic Health Plan . Current programs are inadequately funded with Medicaid rates at one-half the commercial health plan average making it a real possibility that physician practices will not be able to continue providing care for these patients ; . The state's programs will continue to deteriorate if left under-funded, and more people will seek care in emergency rooms From WSMA Membership MEMO, I 2/l 5/00

18 PCMS BULLETIN January, 2001 'W*o*V*&o/{r/'r*/ c71

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2A PCMS BULLETIN January, ?441. John Rowlands, MD, left, thanked Doug Jackman, for 17

\ ' years of exemplary leadership as PCMS Executive Director. Dr. Rowlands was PCMS President in 1996

See story and photos, page 7-9

The physicians of PD R - Back row, from left, Drs. Cordell Balm, Jim Komorous, Alan Tice, Belinda Rone, Mark Craddock, Pat Hogan, David Law; Front row, from left, Craig Rone and Ken Graham

See their story, page 11

INSIDE: 3 President’s Page: The Year of Transition 4 Alan White, MD, sends greetings from New York 5 A Report on the 2001 Board Retreat 7 Doug Jackman says, “Thank You for a Very Enjoyable 17 Years” 9 John Rowlands, MD thanks Doug Jackman at his retirement party 11 The Physicians of PDR and their project at Pt. Defiance Park 15 In Memoriam - Remembering Robert B. Truckey, M.D. B u lletin

P C M S Officers/Trustees: Patrice N. Stevenson. MD President Susan J. Salo, M D ...... President Elect J. James Rooks, Jr., M D ...... Vice-President Michael J. Kelly. MD ...... Secretary/Treasurer Charles M. Weatherby. MD....Past President Sabrina A. Benjamin, MD Drew H. Deutsch, MD Stephen F. Duncan. MD Kenneth A. Feuchl, MD February, 2001 Kevin K. Gandhi, MD s 7 Sumner L. Schoenike, MD

WSMA Representatives: Speaker of ihe House: Richard Hawkins. MD Trustees: David Law, MD: Nicholas Rajacich, MD AMA Delegate: Leonard Alenick, MD WAMPAC Chair/6lh District: Mark Gildcnhar. MD W AM PAC 9th District: Don Russell, DO

Executive Director: Sue Asher

Committee Chairs: A ging, Richard Waltman: AID S. James DeMaio; B ylaw s. Richard Hawkins: Budget/Finance, Mike Kelly; College of Medical Education, John Jiganti: Credentials. Susan Salo: Ethics/Standards Of Practice. David Lukens; Grievance, Charles Wealherby; Labor & Industries, William Ritchie; Legislative. William Marsh; Medical-Legal, Mark Taylor; Membership Benefits, Inc.. Drew Deutsch; Personal Problems Of Physicians, Robert Sands; Public Health/School Health, Sumner Schoenike 3 President's Page: The Year of Transition

The Bulletin is published monthly by PCMS Membership Benefits, Inc. for members of the 4 Alan White, MD sends greeting from New York Pierce County Medical Society. Deadlines for submitting articles and placing advertisements in 5 A Report on the Board Retreat The Bulletin are the 15th of the month preceding publication, (i.e. January 15 for the February issue) 7 Doug Jackman says "Thank You” The Bulletin is dedicated to the art, science and delivery of medicine and the betterment of the 9 PCMS honors Doug Jackman on his retirement health and medical welfare of the communily. The opinions herein are those of ihe individual contributors and do not necessarily reflect the 11 The Physicians of PDR official position of the Medical Society. Acceptance of advertising in no way constitutes 12 Dr. Zoltani thanks supporters professional approval or endorse-ment of 12 HIPAA Privacy Regulation to take effect products or services advertised. The Bulletin and Pierce County Medical Society reserve ihe right to reject any advertising. 13 TPCHD: Public Health Accomplishments in 2000

Managing Editor: Sue Asher 15 “In Memoriam” Remembering Robert B. Truckey, MD Editorial Committee: MBI Board of Directors

Advertising Information: 253-572-3709 17 In My Opinion: "The Genesis of Managed Care” Subscriptions: $50 per year, $5 per issue 19 College of Medical Education Make all checks payable to: MBI 223 Tacoma Avenue SouLh, Tacoma WA 9K402 Phone; 253-572-3666; Physicians call 572-3667 21 Applicants for Membership FAX 253-572-2470 23 Classified Advertising E-mail address: pcmswa&'pcmswa.org Home Page: http://www.pcmswa.org

2 PCMS BULLETIN February, 2001

V B u i.J J E T IN

Hello from New York

by Alan W hite, MD

Many of you, my colleagues in teach basic laparoscopic skills and Tacoma, are not aware where I have three computer-based virtual reality ventured to. A little over two years ago training devices that teach these same I was recruited to take over the skills but allow us to change the degree / ;l® S r M Directorship of the newly established of difficulty and allow us to measure the Monlefiore Institute for Minimally skills progression. In addition these Invasive Surgery (MIMIS) of Albert devices allow us to measure ambidex­ Alan White, MD Einstein College of Medicine. At that trous skills as well as errors in the time it was a concept and several trainee. Also in the institute there are interviews and visits to New York, I six animal operatories, totally state-of- declined the position. I was selected the-art equipped with the newest From a lifestyle standpoint, New for this position based on my success camera equipment, etc. One of these York isjust likeTacoma, only bigger!! with Jackie Doyle (Day Surgery of facilities is teleconferenced to the 35 Not true!! It is difficult to summarize the Tacoma) in establishing the MultiCare seat conference room. The confer­ differences in a few words, so I won’t EndoSurgical Institute which appar­ ence room is teleconfe'renced to/from try today. Suffice it to say. New York is ently was noticed elsewhere in the US. two patient operating rooms on each of exciting and entertaining at a minimum. Clearly MultiCare Mcdical Center was our two hospital campuses. This allows Maybe I'll follow this note to the PCMS on the leading edge of bringing for broadcast and interchange of Bulletin with a follow-up in this regard. advance laparoscopic surgery to ongoing procedures to the teaching If you find yourself in New Tacoma and still is today through this facility. Finally, the facility is York or come to visit, please call. institute. teleconferenced to the hospitals’ I would love to show each and A year ago the opportunity at auditoriums and to anywhere in the every one of you our training Montefiore Medical Center once again world that has a polycomm link. facility and show you what drew was offered to me and I could not turn Currently, we are trying to establish a m e h ere. it down again. So, I left my surgical tele-medicine link to a university I can be reached at: Montefiore group and with a great deal of angst hospital and four rural hospitals in India Institute of Minimally Invasive Sur­ ventured to the Big Apple, starting to demonstrate the ability to have an gery, Hofheimer - 2nd Floor, 111 East here on April 1, 2000. In addition to internationally linked teaching modal­ 2 10th Street, Bronx, NY 10467,718-920- becoming Director of MIMIS. 1 ity. These are interesting times, 5182. e-mail: [email protected], assumed Chief of Surgery position at professionally. fax:718-994-3367, a Jack D. Weiler Hospital, the teaching hospital on the Albert Einstein College of Medicine campus. What drew me here was the opportunity to teach advanced UNION AVENUE PHARMACY laparoscopic skills to newly training residents and fellows as well as to aid the other surgical subspecialties in their Professional Compounding Center of Tacoma, WA adoption of scope technology. There has truly been a revolution in surgery Vaginal Suppositories Gel, Ointment, and Cream and “minimal access surgery” is Rectal Suppositories IV Services becoming the norm and is bringing Urethral Inserts Capsules about marked improvements in care for Sublingual Troche Lip Balms patients. Today, the Institute for Minimally Invasive Surgery at Montefiore is a 2302 South Union Avenue 752-1705 reality. It consists of a skills training center with seven individual trainers to

4 PCMS BULLETIN February, 2001 iPem v orfhdical C^fociety.

2001.. .The Odyssey Continues A Report on the 2001 PCMS Board Retreat by Jean Borst

The peaceful Commencement Bay medical care, and wasting person ington State University to conduct an setting of C. I. Shenanigan’s was a bit power. In some cases, it could actually in-depth study of Washington’s health in contrast with the issues facing physi­ make a difference in providing timely care system. The results were nol en­ cians in the coming year and beyond. care to a patient. couraging: As the Pierce County Medical Society Referring to himself as a physician Board of Trustees came together Janu­ first and an administrator second, Dr. •Funding for state health programs is ary 6 for their annual retreat, it was ob­ Donohue assured the Board that he inadequate to match the programs’ vious that the road ahead will continue will act as an advocate for physicians. eligibility or demand to be a complex and challenging odys­ “As a doctor.” he said, “I understand •Medicare payments in this state sey. your position and offer this pledge: I ranked 5* from the bottom nationally Hearing from a variety of sources will never intentionally mislead you; I Between 1998 and 1999, Medicare - insurance companies, academia, pledge that you will be paid to contract payments in Washington experienced WSMA, and physician groups - the terms; I cannot negotiate reimburse­ the 611' fastest decline of all states Board received a broad overview of ment rates; and I will accurately inter­ •Premiums for commercial health what is going on now and what is to pret your issues to our leadership.” insurance continue to climb while come. WSMA Issues and Legislative payment to physicians continues to fall Relationship Issues: Health Plans/ Priorities for 2001 "If funding problems are not Physicians/Hospitals/Groups “For years, our legislative agenda solved,” Auer noted, “the ramifications will be serious.” Most notably, the fol­ “We don’t want to Band-Aid your has been focused primarily on one lowing trends can be expected: problems, we want to find out what the thing” according to WSMA President problem is and fix it.” As Physician Nancy Auer, MD, “access to health • More people will be forced to Ombudsman forRegence BlueShield, care services for the citizens of Wash­ change physicians or health plans on Dr. Larry Donohue’s role is to investi­ ington State, and we have promoted a regular basis gate reported complaints, report find­ that vigorously” However, escalating • More people will seek care in ings and help achieve equitable settle­ malpractice claims and a large exodus ments. In addition to sharing some of of physicians no longer able to afford hospital emergency rooms the examples of the work he is cur­ to stay in practice in Washington State • There will be longer waits for certain rently doing, Dr. Donohue expressed has prompted WSMA to shift its ap­ types of care and to see certain types his desire for a continued positive proach. “Citizens are mad about health of physicians working relationship with PCMS mem­ care,” Dr. Auer stated, and are ex­ • Jobs and the tax base of communities bership. “I believe we have a good ap­ pressing their disdain through malprac­ will be threatened peals process,” he said, “and I encour­ tice claims. In response, WSMA and • Chronic underfunding of state health age you to continue using it. Every Physicians Insurance have funded care programs will result in increased complaint is an opportunity for im­ CURE (Citizens United for Reform); a costs for businesses and employees. provement.” coalition of more than 1,000 patients As a result, WSMA’s greatest focus Board members voiced a particular and several thousand Washington Slate during the upcoming legislative session concern to Dr. Donohue over what the doctors that last year helped pass the group termed, “referral rage.” While Patients’ Bill of Rights. The group is will be on the budget. “We will be chal­ lenging the governor to walk the talk referrals from primary care physicians now fighting to get the state Legislature to specialists are rarely denied, physi­ to adequately fund the state’s health based on what was discussed during the campaign." noted WSMA Execu­ cians are still required to take the time programs, so that practices and clinics and effort to make them. Doctors feel slay open for all patients in every com­ tive Director Tom Curry. “It’s going to be a tough, tough battle. We know the they are always in the position of “ask­ munity. This year, the Washington State ing permission,” and believe the pro­ Medical Education and Research Foun­ delivery system is in jeopardy, and we cess is pitting specialists against pri­ dation (WSM-ERF) retained the know there are huge economic prob- mary care physicians, slowing down University of Washington and Wash­ See “Retreat” page 6

February, 2001 PCMS BULLETIN 5 from page 5 lems with the budget." There are various issues affecting their thoughts and opinions to the graduate medical education at present. PCMS Board. While they all brought a University of Washington Dr. Coombs explained. "In addition to unique perspective to the table, all were Medical School/UWPN Clinics the affects of the Balanced Budget Act in agreement that not only is managed Update of 1997,” he noted, “other factors are care here to stay, but Washington Two years after attending his last significantly restraining our ability to state will experience a significant re­ PCMS Board retreat, John Coombs, train people." He explained that rules surgence in the next few years. Ml). UW School of Medicine Associ­ have changed regarding what a resi­ Rebecca Sullivan, MD: “No Big ate Dean, returned this year with an up­ dent can and cannot do with direct su­ Surprises Here...” date on the UW School of Medicine pervision; clinical service demands and the Physicians Network Clinics. have increased: there have been strate­ Admitting that the information she The UWSOM, now considered an gic realignments in community clinics; was presenting was likely nothing new "academic medical center" offering and accreditation changes have been to PCMS physicians, PVH’s Dr. education, research and clinical care, made. "In terms of organization, qual­ Rebecca Sullivan offered various currently has 759 medical students, 155 ity and finances,” Dr. Coombs said, national trends in regard to the state of physician assistant students, and 444 "we are in real significant period of physicians’ practices. The consensus? Ph.D. students. The school has been a change." Productivity is increasing while leader and innovator in technology In its fourth year of operation, the salaries are not keeping up with infla­ and research, and is now the largest University of Washington Physicians tion; overhead is on the rise; national combined cancer research program in Clinics system now consists of nine sites managed care is experiencing signifi­ the nation. A recent, major curriculum staffed by 64 physicians, six physician cant growth and more physicians are review' (the first conducted at the assistants and two nurse practitioners. taking disability or early retirement school in 30 years) indicated that the Last year, 167,000 patient visits were re­ than ever before. school "does not require a major over­ ported. and 75,000 patients are cur­ Playing the role of soothsayer, Dr. haul,” and that the school’s overall fo­ rently under carc. Dr. Coombs listed Sullivan offered “Becky's Crystal cus will be to "prepare physicians for various issues directly affecting the Ball," her “predictions” for the future: lifelong learning.’' There are plans to clinic system, including specialty refer­ divide the school into five colleges. Dr. rals: finances (“With current reimburse­ 1. Premiums will increase Coombs noted, and additional expan­ ment rates, it's hard for clinics to break 2. Reimbursements will remain flat or sion and enhancement are being dis­ even."), payer mix; staffing ("The tight increase only slightly cussed. labor market makes it difficult to keep 3. There will be a shift away from tight Dr. Coombs said 55 percent of clinics fully staffed.”) and integration of referral management. “The public UWSOM graduates are practicing students and residents. For more infor­ doesn't like it. and it’s not clear that it medicine in the five-state-area known mation on the clinics. Dr. Coombs in­ saves money" as WWAMI - Wyoming, Washington, vited members to visit the website: 4. There will be a blurring of lines Alaska, Montana and Idaho. This com­ uwphysicians.org/where.html between HMO and PPO (for the same bined area makes up 27 percent of the reasons expressed in item 3) total US land mass and 3.3 percent of Contracting, Employment and 5. There will be a declining number of the US population - 55 percent of Relationship Trends: primary care residents. Reimburse­ who live in rural communities. The ments have had a greater percent predominant providers in rural commu­ A panel discussion featuring Rebecca change on the income of primary care nities are primary care physicians. Sullivan, MD, Puyallup Valley physicians than on specialists, and A current shortage of specialists Healthcare (PVH); Cliff Robertson, referral management has hit primary (and foreseeable increased shortages) MD, Franciscan Medical Croup care hardest in the WWAMI region, is a concern. (FMG); Pal Briggs, Northwest 6. Physicians will increasingly refuse Dr. Coombs anticipates a large number Physicians Network (NPN); and to take the lower paying plans of positions available in anesthesiol­ Smokey Stover, MD, MidtiCare (government-sponsored programs). ogy, diagnostic radiology, nephrology Medical Group (MMG) 7. Employers are beginning to look at and neurology. "There are areas experi­ Noting recent developments, cur­ defined contribution instead of defined encing significant shortages of these rent activity and foreseeable trends, benefit, which could cause enormous specialists,” he said. “In some comm u­ representatives from four major physi­ changes in how health care is nities, the shortages are severe." cian groups in Pierce County offered See “Retreat” page 10

6 PCMS BULLETIN February, 2001 Special Feature by Doug Jackman

Thank You for a Very Enjoyable Seventeen Years

The environment of medicine and did not really know a thing about the Duffy, testify before the county council Pierce County Medical Society have Society or the issues of interest to the on the harmful effects of second-hand changed considerably since I attended members. Tom and I finally walked smoke. The ordinance passed and was my first PCMS Executive Committee into the cafeteria about 7:45 a.m. and one of the first anti-smoking ordinances meeting in December, 1983. The medi­ there was Pat with a big smile on his in the state. cal director was about the only physi­ face to In cian employed by hospitals at the time. greet 1988, the The major insurer in the county was us. “i can’t recall mair\ days when 1 did Public the Pierce County Medical Bureau With «_ T t /' , ■■ rr* Health/ with nearly half of its board consisting his not iook ronvara to gOinST to the omee School of physicians. That is not the case to­ abun­ or another meeting...... I owl* debt' ol Health day. In an effort to control double-digit dance thanks to so m any su th e .soeie-l'y tnut i (PH/SH) health care costs, Medicare adopted of pa­ Commit­ DRG’sin mid-1984. Today, Medicare is tience tee, with asking its beneficiaries to report any and President, suspected fraud and abuse by the phy­ ready B ill sician or health care provider. wit, Pat managed to tolerate my lack of Jackson, committee chair. Terry It was at that Executive Committee knowledge and the slow learning Torgenrud, and Alliance volunteers meeting that a conference call was curve that first year. I have always ap­ leading the way, secured 5,000 signa­ made to the Society's legal counsel to preciated his patience, kindness and tures to get the fluoridation of Tacoma's determine how the organization should sense of humor during that year. I also water supply on the ballot. The issue respond to an application for member­ missed a lot of sleep in 1984, 85, 86. et passed quite easily, but the opponents ship by an individual that had twice id. gathered signatures and had the issue been denied membership. It started a PCMS has always had a tremen­ placed on the 1989 ballot. The voters three-year process concluding in fed­ dous core of volunteers. It never look again passed the measure and Tacoma eral court with a summary dismissal of more than a few phone calls to recruit children have much better dental health the case. The judge ruled that the ap­ members for the numerous positions as a result of PCMS efforts. Bill Jackson plicant had misrepresented himself and on committees, task forces and boards. and I had occasion to meet with then the facts in his application. Not once did During my tenure the Society never Tacoma Mayor Doug Sutherland and the members of the Credentials Com­ had a president or board member he related to us a phone call he had mittee or the Board of Trustees con­ come to the office with a personal taken from a lady complaining that the sider amending their decision despite agenda or attempt to enhance their fluoride in the water had killed her the threat of treble damages if we lost particular' specialty, office or cause. goldfish. He had to tell her that the fluo­ the antitrust suit. Needless to say, such They all had the best interests of the ride had not yet been added to the wa­ a loss would have bankrupted the Soci­ organization, medicine and the com­ ter. ety. munity at heart. All gave freely and Today, the PH/SH Committee, un­ Shortly after that meeting I thought graciously of their time devoted to the der pediatrician Sumner Schoenike, I might as well start reading the “help Society. The Presidents' and Secre­ will be attempting to educate the 16 wanted” ads when I realized I was go­ tary-Treasurers’ were the individuals school boards in the county on the im­ ing to be more than 30 minutes late for that required much time and interrup­ portance of the school nurse, whose my first meeting with the new PCMS tions from staff. role has diminished so much this last de­ President. Dr. Pat Duffy, Sumner During 1984, PCMS spearheaded cade. Family Physician, was to meet with Tom an effort to secure a county ordinance One of the true assets of PCMS has Curry, my predecessor, and me in the to control tobacco smoking in public been its Grievance Committee. The So­ Good Samaritan Hospital Cafeteria. places and in the workplace. PCMS ciety office used to take a lot of calls This was my first week on the job and I had twelve members, led by Dr. See “'Thank You'’ page 8

February, 2001 PCMS BULLETIN 7 \ ^ - , B u l l e t in

T h s n k Y o u from page 7 behooves physicians to get to know they are a gracious and considerate their legislators and congressman. Ex­ group of individuals. They made the from patients who were unhappy with perience tells me that they enjoy talk­ job easy. They are: Pat Duffy, Guss some facet of their care. The calls con­ ing to physicians about medicine. They Bischoff, Richard Hawkins, Dick tinue today, but are far fewer in num­ like to talk to doctors about their expe­ Bowe, Bill Jackson, Bill Ritchie, ber than in the past. The Committee is riences. Don’t be intimidated if you Gordie Klatt, Bill Marsh, Eileen made up of seven physicians and two don’t know' a bill number or the intrica­ Toth, Jim Fulcher, Peter Marsh, lay members. The lay members were cies of pieces of legislation. Explain to Stan Harris, Dave Law, John added in 1986 and have been a posi­ them what is happening in your prac­ Rowlands, Jim M. Wilson (Inter­ tive feature of the committee. One lay tice. They need to know what the in­ nist), Larry A. Larson (Ped) and member is a prominent banker and the surers are doing with their referral Charles Weatherby. other is a university provost who has systems, delayed reimbursement, ha­ During the 17 years I always had a written two books on medical ethics. rassment, etc. You will be surprised at strong, dedicated, hard-working staff. Probably 80% or more of the griev­ how accessible they are. Their phone And, a person could not ask for a finer ances are a result of poor communica­ numbers and addresses are in the front associate than Sue Asher, my assistant tion between the patient and the front of your PCMS Physician Directory. for sixteen of those years. The Search desk or physician. The committee re­ I can’t recall many days when 1 Committee seeking my successor se­ views the written grievance of the pa­ did not look forward to going to the of­ lected Sue after reviewing many appli­ tient and the response from the fice or another meeting. Not many cants and interviews. It was a wise physician(s) involved and responds ac­ people are that fortunate. I owe a debt choice. Her knowledge of the mem­ cordingly. The Committee always con­ of thanks lo so many in the Society that bership, the Society, the community ducted itself with the highest sense of I can’t mention all of them, but I do and the issues confronting the profes­ ethics and had no reservations chastis­ need to recognize the 17 presidents sion is exceeded only by her profes­ ing a member for poor communica­ that I served under who were dedi­ sionalism and loyalty to the Society. tions. unnecessary' tests or politely tell­ cated individuals, willing to give their Thank you for a very enjoyable ing the patient that the charges were time and talent to lead the Society for a 17 years and "May the wind be always within the community standard. Atten­ year of their life. As I noted above at your back.” ■ dance of the committee was always very good, particularly when we thought we might get one of John Rowland’s book reviews. Providing quality health care Alan Tice, Infectious Diseases Specialist, put together the AIDS Com­ coverage to our community 1 501 Market Street mittee with patients, agencies and mem­ for th e past 81 years. Downtown Tacoma bers and led the way to educate the 253.597.6520 physicians of Pierce County on this new disease long before other commu­ nities recognized the seriousness of AIDS. Alan and his Infectious Dis­ eases Group have worked with PCMS subsidiary the College of Medical Edu­ cation to host the Annual Infectious Diseases seminar. As we continue to see health care driven by the insurers, Congress and state legislatures, I have found it disap­ pointing that more members did not be­ come more politically involved. I am not a supporter of special interest groups, such as PACS. I believe as they are currently employed it is not healthy for this nation or its future. ® Regence However, until we have a courageous BlueShield Congress (is that an oxymoron?) pass some valid campaign finance reform, it

8 PCMS BULLETIN February, 2001 p / f< ? p c e % 0 / u t / f Q 4 (ed ta.d Q /o-cietii

Special Feature by John Rowlands, MD PCMS honors Doug Jackman on his retirement

Editor’s Note: PCMS thanks John Rowlands, M Dfor presiding at Doug Jackman’s retirement party. If you missed the party, below is the text o f Dr. Rowland’s presentation to Doug.

“We welcome you to Doug Jackman's retirement party. As painful as this must be for Doug, we thank him for allowing us to share this evening with him. his wife Connie, and his children, Scott and Susan. As a man who would forever deflect praise and recognition, he needs to know' how much we have appreciated his quiet leadership, his unquestioned professionalism, and un­ ending friendship to all who count themselves as members of our Medical Society. He leaves us having been unscathed by the rigors of the job or by the multitude of changes brought on medicine over the past 17 years. The Pierce County Medical Society is the model throughout the state. An advocate for its community’s health, a leader in policy-making at both the state and local level, a friend and conscience for its practicing physi­ cians. This is the legacy that Doug has helped forge and that will now be nurtured by our new Executive Director, Sue Asher. She knows that he will kindly offer counsel when he is not busy elsewhere. So, what do you give a man who is about to retire1? The gold watch is justnot Doug’s style. The Medical Society wishes Doug and Connie to usher in retirement aboard a new tandem bike. What better way to finally realize who the true Executive Direc­ tor is? Dan Niebrugge tells me that a definite tandem-bike culture exists. With Connie riding in the back, she will be in charge of the tire pump to beat Doug senseless whenever he starts spinning out of cadence or takes new directions not to her liking. They may be wearing these matching jackets, donning matching helmets, and drinking from matching water bottles, but Doug received his last assignment from Dr. Rowlands - there will be no mistake as to who is the boss. That is why I sug­ cut the cake! - which he hands out above gest golf as a great retirement activity; there is no boss! Finally, a small token of gratitude from the 17 past presidents who were so fortunate to have been guided by Doug. What bet­ ter way to know that you are retired than to realize that the travel voucher given has two potential lives. On one hand, it may purchase a next-day, mid-week, one-night stay over in St. Louis for you to enjoy another AMA Leadership Conference by yourself. On the other hand, when time and deadlines do not exist, CHEEPTICKETS.com will mystically send Doug and Connie to the other side of the world and back. Mai tais are in­ cluded. You just have to make the right choices, and Doug has always done that. We are forever grateful for your years of ser­ vice. May your retirement be full of good health, new chal­ Active and retired members and spouses, friends, family, lenges, and discovery.” ■ neighbors and colleagues - all were in attendance

February, 2001 PCMS BULLETIN 9 tracting. One of the things NPN has Robertson attributes his bias to being m-C LL U d L from page 6 done over the past six years is put owner of a non-medical service busi­ money back into building a very strong ness. “There are many parallels,” he delivered and the responsiveness of infrastructure. It’s important for inde­ noted. the health care system to the consumer pendent physicians to have some sort Dr. Robertson explained the struc­ 8. Medicare HMO's will not be viable of organization to support them,” Ms. ture of FMG, in that it is a separate en­ in Washington State. PacificCare in Briggs said. “By having a multispecialty tity from the Franciscan Health System. some counties has frozen enrollment model, where specialists and primary “Leadership within Franciscan Health already; nationwide, hundreds of care physicians can work together to System has changed, and they clearly thousands of people have had to shift deliver care, physicians are able to de­ understand the hospitals cannot run the out of Medicare HMOs liver very high quality care and effi­ physician practices,” he said. “That is 9. Fraud and abuse hunts are going to ciently use resources.” Despite the pit­ why a partnership has been developed continue, although there will be some falls along the way, NPN anticipates a w'ith Franciscan Health System - physi­ decrease in aggressiveness break-even year for 2000 and expects a cians are employed by FMG, not FHS. 10. There will be a continued upswing surplus in 2001. And so far, we are doing well finan­ in early retirements and disability Looking at the year ahead. Briggs cially.” “Doctors are saying. 'I've had it!' and said NPN is focusing on the following: Dr. Robertson noted three trends are looking for other options. occurring within the organization: ► Emphasis on improvement to care- As a side note, PVH is closing its delivery (physician directed) I FMG is moving to an individual doors March 1. "We've looked hard at I More substantive partnership with practice model with “system the managed care business and believe other provider partners and with thinking,” he explained. “We cannot it’s going to be two to three years be­ forget that we are in partnership with fore there is a significant shift to being health plans a health system” able to contract with groups,” Dr. I Continued push in getting Sullivan explained. “We felt the cost of physicians' voice heard in the health > FM G is moving to a revenue/ retaining our organization with limited care policy arena expense compensation model patients was just not worth it.” I The group's focus is on patient “Physicians have lost their voice access Pat Briggs: Building a ,Strong and stature in the whole health care Additionally, Dr. Robertson said, Infrastructure policy decision-making process,” "The group is staying in managed NPN is the largest physician- Briggs noted. Physicians are the main care.” FMG is now a part of Physicians owned organization in the slate, con­ patient advocates. And, you should be Health System Network (PHN), and its sisting of 230 physician owners, an­ helping to set policy about how health 65 providers have joined the PHN. We other 100 physicians, ARNPs, physi­ care resources are spent.'' are a single-contracting entity that now cian assistants, as well as other special­ Briggs also anticipates better fund­ has 165 PCPs and 400 specialists in the ists who contract with the network. Pat ing for Medicare and HMOs, and noted Franciscan Health System that act in Briggs is NPN’s Chief Executive Of­ a recent report from PacificCare that concert. “We are one of a few PHOs ficer. Briggs noted that, “We are an In­ indicated a huge infusion back into left in the state,” Dr. Robertson noted. dependent Physicians Association, but premiums. Additionally, she noted, FMG will continue with capitated con­ are becoming more of an integrated payers will be more willing to take tracts; work on improving data collec­ delivery system in partnership with more of the risk in order to keep man­ tion and information delivery; and fo­ other entities in the county. But we re­ aged care going. “State agencies are cus on the high cost of utilization and main, and will remain, entirely physi­ more willing to involve physicians, “get the heck out of the way of deliver­ cian owned.” realizing it is the only way to make ing care to patients.” The organization has experienced things work.” Dr. Robertson explained that FMG some difficulties - due to the under- is not modeled on Group Health. “We Cliff Robertson, MD: Employed funding of premiums and bad data - but are a model that is going to be as close Physicians....That’s the Ticket the group is now back on track. "Accu­ to a professional corporation as it pos­ rate data and good communication are “Physicians being employed and sibly can. FMG is driven by reality - means by which physicians can be­ being part of an integrated delivery' and that reality is bottom-line revenue. come involved with each other in mak­ system is the place I want to be, at least ing substantive change in the delivery for the immediate future,” according to Smokey Stover, MD: Many of care,” Briggs said. “Most physician Cliff Robertson, MD, Chief Medical Issues Driving the Profession groups have not had the infrastructure Officer of FMG. While he’s never to support managed care or risk con­ been in private practice, Dr. See "Retreat” page 20

10 PCMS BULLETIN February. 2001 The Physicians of PDR

PCMS physicians O ur J':1!' IW'i .r- EA and family members, '■i;j ■; A .-.-.r:, " t : For the past 20 years or so, every Saturday and Sunday Kc;' 6-: !B'c.; ;r:; at right, are listed on and most holiday mornings at 8:30 a.m. an informal group of '■"'?! r’ I : " the plaque by the folks gather at Pt. Defiance Park to run. The Point Defiance i-’A. A;. Runners (PDR) as they have come to be known, run the new drinking trails, five-mile drive once or twice, sometimes bike or even fountain adjacent to swim at the famous park. the rose garden at k k A.,:V: A favorite tradition was walking through the rose garden Pt. Defiance Park to the water fountain - a necessity after such athletic chal­ They are regular lenges - until the fountain became rusted and dismantled users o f the park; f>, /'A' j ' without plans for an imminent replacement. running, walking, About a year ago, Drs. David Law and Alan Tice, biking, or swimming, along with a couple other PDR members, decided to gather and contributed to contributions to fund a new, first-class water fountain for all the water fountain users of the park to enjoy - the highest faucet for adults, the A IIJ :J»,■ D II .i.liC that is now available middle one for children and the close-to-the-ground one for £ ■;■■■ R I.

dogs. fo r all park users - j ; ■ 11 'i The Saturday adults, children Ab,'„ li-:. before Christmas, and dogs. they all gathered to celebrate the unveiling of the much needed drinking fountain. Next time you are at the park, stop by and see the new fountain and plaque at the end of the curve by the rose garden. And. have a Alan Tice, MD, with the yet unveiled drink while you fountain, was instrumental in are there! ■ David Law, MD, volunteered many fund-raising hours organizing the project

Dr. Mark Craddock, Gig Dr. Pat Hogan, Tacoma From left. Dr. Ken Graham, Dr. Cordell Balm and his wife, Harbor family practitioner neurologist Robhi, and Dr. Jim Komorous

February, 2001 PCMS BULLETIN 11 X - - B u l l e t in

Final HIPAA Privacy Dr. Zoltani thanks Regulation takes effect supporters of Leukemia & The final regulations imposed on physicians, medical pro­ viders and health plans will take effect February 26, 2001, wilh Lymphoma Society ride compliance required by February 26, 2003. The rules are intended to protect personal health infor­ mation from misuse and/or access by unauthorized parties. The rule applies to any unidentifiable health information held or disclosed via any method - orally, on paper or electroni­ cally. Providers must give patients a clear written explanation of how they can use, keep and disclose their health informa­ tion. keep a record of disclosures and make them accessible to patients. They must permit patients lo review and/or re­ ceive copies of their records and accept requests for changes. Consent must be obtained before sharing of health care information may be made, with specific consent for non­ healthcare purposes. Policies and procedures will be required including infor­ mation access and use. staff training, a designated privacy of­ Greg Zoltani, MD (left) and his son, Daniel, biked El ficer and a grievance process. Tour de Tuscon, an 111 mile event, for the Leukemia & Enforcement will be by the F1HS' Office for Civil Rights Lymphoma Society of Washington/Alaska. The chapter which will provide assistance in meeting the requirements, in­ raised $28,000 while lhe Society raised over $2 million cluding a toll free line to answer questions, 1 -866-627-7748. nationwide for research. For more information you may also contact PCMS, 572- Dr. Zoltani and his son thank everyone that supported 3667. or visit the website www.hhs.gov/ocr or www.hhs.gov/ them with their donations.* search/press.hlml.B

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12 PCMS BULLETIN February, 2001 VPrnw Q /ttJim l & eaet/if

The Health Status of Pierce County Federico cmz-unbe, m d J Director of Health

Public Health Accomplishments in 2000

The year 2000, which even now disease reporting, review patient For more information on HIV feels like a long-past time, was a filled records and treatment protocols in con­ counseling, testing or case manage­ and fulfilling year in public health. In tract clinics, and market public health ment, contact Ardythe Fleener at 798- talking about accomplishments for 2000. ideas, models and programs. In early 2866. it is also an opportunity to provide ex­ 2000, Network Nurses emphasized re­ amples to you of ways the Tacoma- porting positive tuberculosis tests. The Substance Abuse Programs Pierce County Health Department result was 111 providers reported a to­ Methadone treatment programs works to improve the health of the tal of 520 positive PPD’s since March: provide methadone, a synthetic opiate, community. Much of our success relies 174 patients were started on therapy. and counseling and resource identifi­ on collaborating with a variety of com­ For more information on Network cation, to assist heroin and other opiate munity resources, including private Nurses, contact Sandy O'Donnell at addicted individuals to regain a more providers. So this list also includes 798-7687. healthy life. In 2000, staff increased en­ names and phone numbers of individu­ In addition. Network Nurses have rollment by 24% (from400 clients in als you could call for additional infor­ focused visits on implementing the "4A 1999. to 500 in 2000), and eliminated the mation. M odel” for tobacco-use cessation. Ask­ waiting list. TPCHD now provides ser­ ing a patient four simple questions can vices for up to ten new clients per The Delta Project help her/him to reduce tobacco use or week. In April, we learned three intrave­ quit altogether. These efforts, and For more information on the nous ding users (IDUs) had died of other marketing campaigns resulted in methadone treatment program, contact and twelve additional IDU’s were suf­ more than 1,200 individuals calling a Marc Marquis at 798-4764. fering from acute liver failure due to special tobacco quit line for help dur­ The MOMS and Women’s Recov­ hepatitis B and Delta. Within days a ing 2000. ery Programs assisted 221 women to screening and vaccination clinic was For more information on the 4A cease methamphetamine use, 99 operating. From May through Decem­ Model or other tobacco cessation ac­ women to cease cocaine, 94 women lo ber, more than 2,000 IDUs w'ere tivities, call John Britt at 798-2881. cease alcohol. 92 women to cease mari­ screened for Hepatitis A, B, C and D, juana, and 9 women to cease opiate and were started on Hepatitis vaccine. HIV Counseling, Testing and abuse/addietion in 2000. In addition, In addition, all were offered HIV tests Case Management education programs on domestic vio­ and 1,842 agreed. Results show the TPCHD staff tested and counseled lence, childhealth, communicable dis­ HIV seropositivity rate in Pierce atotalof'3,278 individuals for HIV in eases, tobacco cessation, safe gun stor­ County among intravenous drug users 2000; 28 people tested positive (com­ age and testing for HIV and tuberculo­ is a very low 1.1%. Outreach, educa­ pared to 16 positive results in 1999). sis, reached another 515 women and tion and the department’s needle ex­ Staff then located the sexual or needle- their families impacted by substance change program should help to keep sharing partners of those who were abuse. that level from rising. positive and in testing them, found For more information on substance For more information on the Delta eight to be positive. Each person was abuse programs, contact David Bischof project, contact Karen Mottram at 798- educated about how to prevent addi­ at 798-6655. 5231. tional infections. The Early Intervention Case Man­ Food and Community Safety Network Nurses agement Program (EICM) for HIV Handwashing and food prepara­ Network Nurses visit primary care positive people combines help for cli­ tion campaigns resulted in only two re­ providers, mental health clinics, sub­ ents in locating resources for medical ported Hepatitis A cases in Pierce stance abuse clinics, long term care fa­ and community services with education County in 2000 - the lowest number of cilities and day care centers - approxi­ on preventing the spread of the dis­ cases ever (the county’s average until mately 1,400 sites - every 90 days. ease. The caseload increased in 2000 - 1999 was 80/year, with the highest re- They bring updates and reminders of to 71 clients (compared to 24 in 1999). See‘‘Public Health” page 14

February, 2001 PCMS BULLETIN 13 x _ B u l l e t in

Public Health from page 13 avoid continuing criminal behavior and ties include: ported in one year to be 800). The keep them in schools. Staff handled a 9,000 students in grades 1 -6 partici­ handwashing campaign - “Got Soap?’’ - caseload of 228 families in 2000 (com­ pated in a curriculum designed to pre­ through the mobile handwash trailer pared to 158 in 1999). vent tobacco use. Preliminary results reached more than 55.000 individuals. The Tacoma Middle School show this curriculum plays a significant And. staff taught a total of 23,938 indi­ Project was successfully transitioned role in reducing tobacco use among viduals in the safe preparation and stor­ into the BECCA Truancy Project in youth. age of food, certifying them as "Food 2000, doubling capacity from 150 clients More than 1,200 individuals called W orkers.” to 3,000. This project received refer­ the health department’s tobacco quit For more information about Food rals from Juvenile Court of youth who line after seeing anti-smoking posters safety or handwashing training/cam­ have been truant from school. A public distributed by staff. paigns, contact Diane Westbrook at health nurse visits the family, assesses A county-wide partnership has 798-6045 their needs and connects them to com­ been established to reduce the inci­ munity resources and reconnects them dence of college binge drinking. This Family-based Services with the school district, with the inten­ included training 30 college counselors More than 1,400 families in Pierce tion of getting the student back into in the use of brief interventions with County were visited by a Public Health classes. students to lower the risk of alcohol Nurse in 2000. Their visits helped to For more information about Ado­ misuse. strengthen parenting skills, identify lescent Health Programs, contact David More than 150,000 cards were dis­ health needs of the children and par­ Vance at 798-6542. tributed throughout the county with in­ ents, and connected the families to ad­ formation about the Domestic Violence ditional resources in the community. In Prevention Programs helpline. This resulted in more than a addition, prevention education was Throughout the Tacoma-Pierce 20% increase in calls to that line in provided to each family on ceasing to­ County Health Department, staff have 2000. bacco use. alcohol abuse, and vio­ found ways to educate the public about For more information on preven­ lence. our three prevention priorities: to­ tion programs, contact Rick Porso at For more information about Fam­ bacco use, alcohol and other drug mis­ 798-6417. ily-based Services, contact Allison use, and violence. In addition to vari­ 2001 will bring new challenges and Keminer at 798-4700. ous activities in those programs, seven opportunities for us all. We’re looking teams of staff are working with organi­ forward to ways to continue working Source Protection Programs zations to build the community-level with all physicians in Pierce County. Environmental Health Specialists at campaigns and programs that will make Please let us know how we can work TPCHD successfully joined the newly our prevention efforts effective. Activi­ with vou. b formed Pierce County Methamphet- ainine Lab Team and responded to over 120 meth lab interventions throughout Pierce County in 2000. The MEDICAL LICENSURE ISSUES Code Enforcement Program re­ sponded to over 1,700 service requests Mr. Rockwell is available to represent physicians and other health care in 2000, dealing with issues related to providers with issues of concern before the State Medical Quality Assurance garbage, rodent sightings, and other Commission. Mr. Rockwell, appointed by Governor Booth Gardner, served for problems. Those with public health im­ 8 years as the Public Board Member of the Medical Disciplinary Board from 1985-1993. Since then, Mr. Rockwell has successfully represented over 60 plications received the highest atten­ physicians on charges before the MQAC. Mr. Rockwell’s fees are competitive tion. and the subject of a confidential attomey-client representation agreement. For more information about Source Protection Programs, contact Gregory G. Rockwell Steve Marek at 798-2955. Attorney at Law & Arbitrator 3055 - 112th Avenue SE, Suite 211 Adolescent Health Public Health Nurses and other Bellevue, WA 98004 professionals provide to the families of (425)822-1962 FAX (425) 822-3043 young moderate offenders Functional email: [email protected] website: “ggrockwell.wld.com” Family Therapy, to help those youth

14 PCMS BULLETIN February, 2001 R U l'E R I B. 1 H I h„hf-) , A J J

I was greatly saddened by the death of my friend and mentor. Bob Truckey. I have always and will forever be grateful to Bob for inviting me to Tacoma to practice. 1 always wanted to return to Washington but this city was not high on my list. As I told him then, over 30 years ago, Tacoma was just a Big Stink south of Seattle. I visited only a few months after Bob had opened his office in Allenmore. After he took me lo Gig Harbor, Lake Steilacoom, Gravelly Lake and American Lake, my view of Tacoma was changed. I remember Bob telling me, ''See, you don’t even notice the odor.” I discovered he wasn't completely correct but he always chose to look on the good side of things. A year later, I relumed and began a wonderful association with Bob and Ron Spangler. My fond memories of Bob are too numerous to relate but one was profound and has lasted through the years. He gave me some advice not long after I arrived. Something that all young doctors, especially sur­ geons, need to learn. As I was rushing through the hospital hallway, literally running, big Bob stepped in front of me bringing me to a sudden halt. He said, "Whoa! What’s the hurry?” 1 said, "Bob. get out of my way. I’m late!" He said, “Let me give you some good advice Del, when you're late, just be later." Afterward I reflected on what he said and thought, what important advice for a young surgeon. As 1 have gotten older and wiser, I see it as a wonderful philosophy for life. Bob is now where people don't need to rush around and I know he is relaxed and taking his lime. Del Prewitt, MD

In the summer of 1961,1 arrived in Tacoma to begin practice in the Medical Arts Building. It was my good fortune, while unpacking my equipment, to be visited by a tall soft-spoken otolaryngologist from down the hall. Thus began my friendship with Bob Truckey. Over the years Bob cared for the medical and surgical ENT problems of our family and was always available when we needed him. For these services I am forever grateful. Bob also was on hand if I needed advice about a patient or had someone who required evaluation or surgery, both of which were top notch. On occasion I would wander into his operating room al Allenmore to watch his work, which he performed with ease and precision. On the home front our kids played together and our wives have been great friends since 1961. Bob’s passing on December 2, 2000, is a loss beyond words. It was wonderful to have knowm him.

Max Braclivogel, MD

February, 2001 PCMS BULLETIN 15 B u l l e t in

Personal Problems of E R ^ S E Physicians Committee Medical problems, drugs, alcohol, retirement, emotional, THAT TATTOO or other such difficulties? WORRIED ABOUT WHAT YOUR SPOUSE, YOUR FRIENDS OR EVEN YOUR BOSS Your colleagues THINKS ABOUT YOUR TATTOO? want t o help OR ARE YOU JUST TIRED OF LOOKING AT IT? Today’s newest Alexandrite laser, *Robert Sands, MD, Chair 752-6056 will remove your tattoo BUI Dean, MD 272-4013 with minimal discomfort & Tom Herron, MD 853-3888 less than 1% risk of scarring. Bill Roes, MD 884-9221 <'.

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16 PCMS BULLETIN February, 2001 ['P ierce Y ooim hf (y fizd im /S ociety ,

In My Opinion.... The Invisible Hand by Andrew Statson, MD

The Genesis of Managed Care

“ 'More!' is as effective a revolutionary slogan as was ever invented by doctrinaires of discontent. The American, who cannot learn to want what he has, is a permanent revolutionary. “ Eric Hoffer (1995)

Some restaurants have buffet ser­ cial allocations and restrictions have vice for Sunday brunch. A few serve also been part of the picture in times of Andrew' Statson, MD buffet lunch and dinner all the lime. scarcity. The rule about buffet service is that When patients do not pay for their medical care, their consumption of you may eat as much as you can, but ter the most treatments wins." Wins you may not take any food home. No health care resources is limited by the what? restaurant could survive if it allowed amount of time they can spend and by When Generalissimo Francisco that. In this situation, consumption is their reluctance to undergo painful or Franco died in 1975, he was in the in­ limited by the capacity of one’s stom­ unpleasant treatments or tests. Fre­ tensive care unit of a Madrid hospital ach. Some buffet restaurants try to quently, going to a free clinic, or even for a full month, subjected to heroic keep their prices lower and their ex­ to the clinics in our military hospitals measures to keep him alive. Franco penses in line by making the foods a and some HMO’s, involves waiting for was quoted as having said. “Why is it so litde too greasy, or a little too salty, or a hours before seeing a provider, who difficult to die?" He was 83 at the time, may not even be a physician. This is a little too spicy, so that people cannot severely ill, had several cardiac ar­ eat as much. form of rationing. The patients do not rests, but was resuscitated again and Recently AOL started sending pay in cash, they pay in wasted time. again. He was kept alive because no disks of their software to get on line, To some patients, however, going one dared pull the plug. offering 700 free hours during the first to the doctor’s office, the clinic or the Samuel Butler said, “All progress is month after signing up. Since there are Emergency Room is a social event. It is based upon an universal innate desire only 720 hours in thirty days, how an occasion to get out of the house, to on the part of every organism to live could anyone be able to spend that meet people and to share the stories of beyond its income." Another bumper much time on line? In general. Internet their aches and pains. A few patients sticker expresses the same truism, “I access in this country is available for a have even asked to have a sonogram at owe, 1 owe, so off to work I go." Con­ flat fee per month, regardless of use. the time of their annual examination, so cerning medical care, however, this The limitation is in the time a person they could look at the screen and see rule does not apply. People have been can spend on line. Of course, there for themselves if there is anything told they have a right to medical care. also are the problems of getting con­ wrong. Many pregnant patients ask for They don't have to pay for it, they nected, which may be tedious, and get­ a scan, just to make sure the baby is do­ don’t have to earn it. There are no lim­ ting disconnected, which may be frus­ ing well. If they could, they would its. They don't owe anything lo anyone trating. gladly get a sonogram at every visit. by getting it. Someone else owes it to No matter how plentiful an item We can always consume more. We them. may be, consumption always has to be can live in bigger houses, have more If I remember' correctly, when the limited by some factor, or it would furniture, more gadgets, more toys. We Medicare and Medicaid laws were en­ overwhelm the supply. The most com­ can take more time off work, go on ex­ acted, the initial outlay was less than mon and most practical system is the otic trips, etc. In our consumption, we two billion dollars per year and the offi­ market mechanism, where purchases are limited to our resources. A bumper cial projections were that the costs are limited by the resources of the sticker put it very well. In the game we might reach at most five billion dollars. buyers. Even oxygen has a price play, “he who dies with the most toys The reality surpassed even lhe wildest when in limited supply. People, such as wins.” Wins what? That remains unmen­ expectations. Now the annual expendi­ sea divers and mountain climbers, pay tioned. Translated to the field of medi­ tures on healthcare are one trillion dol- to get it. Unavailability, rationing, spe­ cal care, that becomes “he who dies af- See “ Genesis” page 18

February, 2001 PCMS BULLETIN 17 Genesis from page 17 the Case Records of the Massachusetts during the last ten years is striking. The General Hospital reported during the patients over 70 were fewer than 10%. last ten years in the New England Only an occasional autopsy was done. lars and the governmental share is Medical Journal and compared them to Most of the patients had diagnostic pro­ about half of that. Granted, the value of what I remember from the decade of cedures and definitive treatment after a the dollar is about one fifth of whal it the sixties. At that time, most of the pa­ short hospital stay, seldom exceeding was then, but even so, the increase in thology specimens were obtained at two weeks. I suspect this change in costs is staggering. autopsy. The majority of the patients case selection reflects a change in the Some time ago, as the expendi­ were over the age of 70 and had spent general practice of medicine. We have tures kept going up, the authorities got several weeks in the hospital before become aware that health care con­ alarmed. They had promised loo much they died. Perhaps an extreme case sumes resources which cost money, and found they could not deliver. was that of an 84 year old woman who and these resources must be used They established the system called underwent a number of treatments, in­ wisely. “managed care" in the hope that it cluding a few trips to the operating From the patients’ point of view, would introduce the needed limits, room, and had an autopsy done after managed care has been a failure. How­ something they did not dare do. and she expired on the 182nd hospital day. ever. it brought to our attention the would save them. Many large compa­ Many of the patients had been in the economic reality of health care. This is nies also complained at the time that the hospital for two, three or four months, a fact all of us, physicians, patients and health care benefits for their workers subjected to a variety of treatments, un­ payors, will have to face and deal with, cost loo much and affected their ability til they died. preferably before the barbarians come to compete in the international market. The difference in the patient cases to our gates. ■ The car manufacturers specifically re­ ported that health care benefits cost them about 700 dollars per car, while the costs of the Japanese producers were much lower. Much of the blame was placed on TACOMA RADIOLOGY the physicians and managed care was M IM ggjgiil purportedly established to control phy­ sician practices and thus reduce health care expenses. The net intent, how­ ever. was to reduce the access to care and the choice of treatment the patients had. By blaming the physicians, the au­ thorities thought they would be able to silence the patients. Little did they know. If managed care had appeared in 1930 instead of 1990. it probably would & Femur have been readily accepted by the people. At that time it would have given Medicare covers beneficiaries every 23 months D E X A them something they did not have. Its when the following criteria are met

appearance in 1990, however, was in­ Monitoring of FDA approved osteoporosis drut; therapy may allow tor greater frequency of examination tended to take away from them some­ thing they already had. That is why it 1. Postmenopausal (estrogen deficient) women at risk for osteoporosis has been so unpopular. Once a benefit 2. Individuals with vertebral abnormalities has been given to the people, it is very 3. Individuals receiving long term gluccocortoid therapy difficult to take it away from them. They 4. Personal history of primary hyperparathyroidism will want more, not less. Such is human www.tacomarad.com nature. The Romans yelled “bread and circuses” even when the Roman Em­ Allenmore Medical Center Lakewood Office pire was crumbling and the barbarians (253) 383-2038 (253) 588-6083 were at the gates of Rome. Recently, I reviewed a number of

18 PCMS BULLETIN February, 2001 COLLEGE Continuing Medical Education OF Internal Medicine Review 2001 MEDICAL scheduled for March 8 & 9 EDUCATION The Tacoma Academy of Internal • SleepDisorders and Drug Addiction Medicine's annual two day CME • Syndrome X program is open for registration. The • The Role of ARBs program offers a variety of timely internal medicine topics and has been • Management of Unstable Coronary SurgicalUpdate- organized by Ulrich Birlenbach, Plaque: New Strategies Towards MD. CHD Prevention dissections,CME The program offers 12 Category I • Insulin and Diabetes CME credits and is available to both • Reluctance to Prescribe Opiates: The set April 27 &28 Academy members and all other area Issues and Answers physicians. The program will be held at • New I. D. Agents the Washington State History Museum Dr. Glenn Deyo, Tacoma • New Therapies for Osteoporosis general surgeon, is directing the 70,h in Tacoma. • Management and Treatment of Annual Surgical Club meeting which To register or for more information Respiratory Infections will be held please call the College at 627-7137. Friday and This year’s program includes • Advances in Parkinson's Disease Saturday, April presentations on the following topics: Management 27 and 28,2001. • GERD and Pulmonary Issues • Coagulation Disorders The very • And More ■ popular dissec­ tions, demonstra­ tions and lectures pre­ sented annually D a te s P ro g ra m D i r e c t o r ^ by the Tacoma Surgical Club will be held at Tacoma Community College in Advances in Wbmen's TBA John Lenihan, Jr., MD the Lecture Hall, Building 16.■ Medicine

Friday, April 6 Pain Management David Paly, MD Allergy, Asthma Thursday-Friday Internal Medicine Ulrich Birlenbach, MD & Pulmonology March 8-9 Review 2001

CME-May4 Saturday, April 28 Surgery Update 2001 Glenn Deyo, MD

The College’s CME program Allergy, Asthma & featuring subjects on allergy, asthma & pulmonology is set for Friday, May 5 at Friday, May 4 Pulmonology for Alex Mihali, MD St. Joseph Medical Center. The course Primary Care is under the medical direction of Alex Mihali, MD. Tuesdays, May 16 and A brochure with details regarding Medical Technology TBA the conference is scheduled to be 23 (evenings) mailed in late March.*

February, 2001 PCMS BULLETIN 19 Retreat from page 10

I’d rather discuss my experiences over the last lour years in the Washington market instead of focusing so much on MulliCare,” What problem said Smokey Stover, MD, Medical Director of MMG. In speaking lo the Board, he ech­ oed the sentiments of his counterparts, reiter­ can we solve ating the fact that "docs in Washington Stale arc working harder and making less money lhan physicians nationally.” In his ex­ for you today? periences, he finds the following issues will oiler continued challenge to MulliCare and other systems: Specialists. "There are other ways lo have cooperative relationships with special­ ists." Dr. Stover said, "and employment is probably not the optimal methodology in most cases. The exception is when you re­ Computer Networking quire a very tight working relationship with a specialist." ffil General Computer Support Small Group Practices and Regula­ tion. "It will he very difficult for a lot of practitioners lo comply with all the regula­ © Security and Virus Protection tions that are coming dow n.” Dr. Stover noted. "Small group practices are going to Custom Development face enormous challenges. The overhead for © smaller offices will probably go up dramati­ cally in order lo comply with some of the regulatory issues.” © Internet Connectivity Provider supply issue. "It is becoming evident that there are a number of specialties that are and will continue to be in very short supply." Dr. Slover predicted. One example: MulliCare has been trying to recruit a der­ matologist for over two years. Urology is be­ coming increasingly difficult to recruit, and a significant shortage in specialists is ex­ We can help you. pected over the next ten lo 15 years. Significant change in expectations Managing technology is no easy task. among physicians coming into the work­ place. "In a nutshell,” Dr. Stover said, "many IT Source can help you solve computer physicians are simply not willing to work as problems so you can get on with more many hours." important things...like your business. Gender issues. Dr. Stover noted that female physicians tend lo want to work part lime, or shorter hours. "MulliCare lias a num­ ber of female physicians who are pari lime,” he said. "And. while they bring something II very valuable lo the group, accommodations 253.835.1200 have to be made as a result.” www.itsource.com IT so u rc e Dr. Stover expressed his belief that the

© 2000 IT Source. A Continuum Company medical profession has reached the point See “Relrcal" page 22

PCMS BULLETIN February, 2001 Applicants for Membership

Cook Jr., James C, MD Karanam, Sambasivarao V, MD Newcomb III, Everett W, DO Cardiology General Practice Internal Medicine Practices at Cardiac Study Center Practices at General Medical Clinics, Medical School: Kirksville College of 1901 SCedar#301,Tacoma98405; 15005 Pacific Ave, Tacoma 98444; Osteopathic Medicine 572-7320 537-3724 Internship: Walter Reed Army Medical School: Tulane University Medical School: Patliputra Medical Medical Center School of Medicine College Residency: Walter Reed Army Internship: LA County USC Medical Internship: Patliputra Hospital Medical Center Center Fellowship: Walter Reed Army Residency: LA County USC Medical Kelley, James L, MD Medical Center Center P ath ology Fellowship: Hospital of the Good Practices at Digestive Health Nutter, Paul B, MD Samaritan Specialists, 1901 South Union #B2()05, Physical Med Rehab Tacoma 98405; 272-8177 Practices at Good Samaritan Hospital, Cosgrove, Anne E, MD Medical School: Oregon Health 407 14"’ Ave SE, Puyallup 98371 Pediatrics Science University 841-5849 Practices at Tacoma South Medical Internship: Tripler Army Medical Medical School: University of Clinic, 2111 South 90* Street C enter Washington Tacoma 98444; 539-9700 Internship: University of Washington Medical School: University of Metcalf, Sharon L, MD Residency: University of Washington Massachusetts Medical School Q B /G yn Internship: University Hospitals of Practices at The Lakewood Clinic, Reid, Dennis G, MD Cleveland 11311 Bridgeport Way SW Suite 309, P ediatrics Residency: University Hospitals of Lakewood 98499; 581 -6688 Practices at Tacoma South Medical Cleveland Medical School: Virginia Clinic, 2111 South 90"'Street Commonwealth University Medical Tacoma 98444; 539-9700 Gleyzer, Elena A, MD College Medical School: Case Western Family Practice Internship: Eastern Carolina University Reserve University School of Practices at Western State Hospital Residency: St. John Hospital Medicine 9601 SteilacoomBlvd SW, Tacoma Internship: 60th Medical Group David 98498;582-8900 Mooney, Maureen A, MD Grant Medical Center Medical School: First Leningrad Dermatology Residency: 60lh Medical Group David Medical Institute Practices at Cascade Eye and Skin Grant Medical Center Internship: Sepulveda Valucla Centers, 1703 South Meridian #101, Residency: University of Texas Puyallup 98371; 858-3000 Reilly, Philip A, MD Medical School: University of Family Practice Gray, Gina L, MD Minnesota Practices at Seamar Community Health Family Practice Internship: Hennepin County Medical Centers, 1112 Cushman Ave Practices at CHC (Lakewood) C enter Tacoma 98405; 593-2144 9112 Lakewood Dr SW Residency: New Jersey Medical Medical School: University of Lakewood 98499; 589-7030 School California San Francisco Medical School: Loma Linda Fellowship: New Jersey Medical Internship: Providence Family Practice University Medical School School Residency: Providence Family Practice Internship: Idaho State University Residency: Idaho State University

February, 2001 PCMS BULLETIN 21 X B u l l e t in

Retreat from page 20

where “we can no longer afford to always do something of net value to the patient. We are going to have to start looking at “is it worth the cost?” For example, is one day less of symptoms w'orth $50 or $60 of treatment? “My fear, in terms of a single-payer sys­ tem, is trying to get all parties at the table to agree on ways to reform the system so it is more rational and also accommodates the person who needs the extra reassurance of running to the doctor every time they cough as well as the person willing to sit on it awhile. I don’t think people have the energy to set up a system with that kind of flexibility, and I fear we’re going to end up with a rigid system like that as a default and everyone will have less choice as a result.” ■

TACOMA/PIERCE COUNIT •jjtiiJj Allenmore

Outpatient General Medical Care. ifflyPsychological Full and part-time positions U S Associates, P.S. available in Tacoma and vicinity. Y en’ flexible schedule. Well suited ------, 752-7320 , lor career redefinition for Do you have patients with difficult emotional CP, FP, IM. and stress-related problems? Psychiatric and psychological consultations are available. Contact And)’Tsoi, MD (353) 752-96B9 or Paul Dotv (Allen, Nelson, Turner oc Union Avenue Professional Building Assoe.), Clinic Manager (253) 383-4351 ______1530 Union Avel S.. Ste. 16. Tacoma

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22 PCMS BULLETIN February, 2001 Classified Advertising

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48,871 Square Foot Medical Office Building

Available Third Quarter 2001

Available Suites: Second Floor: Up to 11,000 SF Third Floor: Up to 17,000 SF

2202 S. Cedar Building Presented by Tacoma. WA 98405 Kidder Mathews & Segner Inc Join these existing tenants: B uilding features: Pacific Northwest Eye Associates, PS C ontact: Class "A" Building with high quality finishes Bill Frame, CCIM David V, Prati, MD and Troy J. Woodman, MD Located near the Allenmore Hospital Campus 253-383-0799 Allenmore Ambulatory Surgery Center State-of-the-art Building [email protected] Tenant Improvement Allowance Ample, free parking The mto/malion contained herein has been given to us toy the ow ner o r sources that we deem reliable. We have no reason to doubt its accuracy, b u t we do not guarantee it■ Prospective tenants should carefully verify 3

February, 2001 PCMS BULLETIN 23 B u l l e t in VPi&vm Q /dedim l ^fociet^,

Policyholder Concerns Come First

“I appreciated the fact that Physicians Insurance was really looking out for my interest and not just their own.”

W hether it’s a claim, a lawsuit, or a risk management issue, Physicians Insurance keeps customer concerns at the forefront. Claims representatives work closely with insured defendants and experienced attorneys to secure the best possible outcome for our policyholders. Equally as dedicated, our risk manage­ ment representatives conduct interactive seminars and respond to questions in person, by phone, and by mail. Our goal, now and in the future, is to help physicians, clinics, and hospitals remain successful. V Physicians ms Insurance Western Washington 1-800-962-1399 A Mutual Company

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24 PCMS BULLETIN February, 2001 March, 2001

John Gray, MD, sees a newborn at the Lakewood CHC Clinic. He serves as chair of the Pierce County Immunization Coalition - a group working to immunize Pierce County children by the age of two

See story page 5

INSIDE; President’s Page: “I Am an Allopath” Childhood Immunizations: Prevention is the Only C u r e PCMS honors Senator Lorraine Wojahn for thirty years of legislative support Members learn about “packing their parachute” for retirement at February meeting Mike Kreidler, Insurance Commissioner to speak a t April M eeting Tacoma Pierce County' Health Department: “Defining Public Health” Whistler CME program review - pictures tell all PCMS Officers/Trustees: Pfif'rrc? %ou-)>hf Q fief/teal {jfoaety ■ Patrice N. Slevenson, MD President Susan J. Sale, M D ...... President Elect J. James Rooks, Jr.. iVID...... Vice-President Michael J. Kelly. M D...... Secretary/Trcasurer Charles M. Weatherby. MD....Past President IN Sabrina A. Benjamin, MD Drew H. Deutsch, M.D Stephen F. Duncan. MD Kenneth A. Feucht, MD Kevin K. Gandhi, MD Sumner L. Sehoenike, MD

WSMA Representatives: Speaker of the House: Richard Hawkins. MD Trustees: David Law. MD; Nicholas Rajacich, MD AMA Delegate: Leonard Aleniek. MD W AMP AC Chair/6th District: Mark Gildcnhar. MD WAMPAC yih District: Don Russell. DO

Executive Director: Sue Asher

Committee Chairs: A ging. Richard Waltman; A ID S, James DeMaio; B ylaw s. Richard Hawkins; Budget/Finance. Mike Kelly: College of Medical Education, John Jiganti; Credentials. Susan Salo; Ethics/Standards Of P ractice. David Lukens*. Grievance. Charles Weatherby: Labor & Industries, William Ritchie: Legislative. William Marsh: Medical-Legal. Mark Taylor; Membership Benefits, Inc.. Drew Deutsch; Personal Problems Of Physicians, Robert Sands; Public Health/School Health, Sumner Sehoenike 3 President’s Page: “I Am an Allopath”

The Bulletin is published monthly by PCMS Membership Benefits. Inc. for members of the 4 Use of physician extenders posing coding problems Pierce County Medical Society. Deadlines for 4 How Stark II might affect your pay submitting articles anti placing advertisements in The Bulletin are lhe 15th of the month preceding 5 Childhood Immunizations: Prevention is the Only Cure publication, (i.e. January 15 for lhe February issue.)

The Bulletin is dedicated lo the art. science and 6 PCMS honors Lorraine Wojahn on her retirement delivery of medicine and the betterment of the health and medical welfare of the community. The 7 February General Membership Meeting Recap opinions herein are those of lhe individual contributors and do not necessarily reflect the official position of the Medical Society. 9 Mike Kreidler to speak at April General Meeting Acceptance of advertising in no way constitutes professional approval or endorsement of ll How to contact state, national lawmakers products or services advertised. The Bulletin and Pierce County Medical Society reserve the right to reject any advertising. 12 Physician Directory changes

Managing Editor: Sue Asher 13 TPCHD: “Defining Public Health” Editorial Committee: MB1 Board of Directors

Advertising Information: 253-572-3666 15 In M y Opinion: ‘"The Quest for Certainty" Subscriptions: $50 per year, $5 per issue 17 College of Medical Education Make all checks payable to: MBS 223 Tacoma Avenue South. Tacoma WA 98402 Phone: 253-572-3666; Physicians call 572-3667 18 CME at Whistler: pictures tell all FAX 253-572-2470 23 Classified Advertising E-mail address: pemswaGS'pemswa.org Home Page: http://www.pcmswa.org

2 PCMS BULLETIN March, 2001

B Li LI.El IN

Use of physician extenders posing Personal coding problems for practices Problems Physicians hiring physician assistants and nurse practitioners should keep in of mind that billing requirements of their services may vary. With many physicians using increasing numbers of practitioners and assistants to Physicians help them increase productivity, confusion about billing Medicare and commercial insurers also increases. The best way to find out exactly how to code and bill is to contact commercial Committee insurers and HCFA directly, although general billing guidelines do exist. If a physician is unable to find out what an insurer’s policy is regarding physi­ cian extender billing, the best policy is to follow Medicare regulations, which allows billing to physician services or the billing to be done independently. Medical problems, drugs, alcohol, retirement, emotional, or other such difficulties? How Stark II rules might affect your pay

HCFA recently released the first two phases of the Stark II final regulations. Stark TI is the law that prohibits physicians from referring Medicare and Medicaid Y o lip colleagues patients for certain designated health services, such as clinical laboratory, physical want to help and occupational therapy, radiology, inpatient and outpatient hospital services to any facility or entity with whom the referring physician (or immediate family member) has any financial relationship, unless an exception set forth in the statute or regulations is satisfied. It also prohibits the entity furnishing the service from billing for it if the *Robert Sands, MD, Chair 752-6056 referral is prohibited. Penalties for a violalion of Stark II are harsh and include Bill Dean, MD 272-4013 denial of payment, imposition of severe civil monetary penalties and exclusion from Tom Herron, MD 853-3888 participation in the Medicare and Medicaid programs. Bill Roes, MD 884-9221 Physician compensation, particularly distributions of productivity bonuses and F. Dennis Waldron, MD 265-2584 profit shares by physician practice groups to their individual practice physicians are impacted by the final rules, with primary relevance to employment and shareholder agreements. In general, profit and bonuses interpretations are less restrictive. Consult advisers to ensure that your groups makes compliant use of HCFA’s Confidentiality Stark II regulations. Assured Bath from AM News 2/26/01. For complete copies of either article, call PCMS, 572-3667

Medical Placement Service Allenmore owned and operated by: SSh Psychological Pierce County M edical Society Associates, P.S. *Permanent Full tfe Part Time Positions 752-7320 *Temporary Placements Do you have patients with difficult emotional Pierce County’s “medically exclusive"agency and stress-related problems? Psychiatric and Employer paid fees psychological consultations are available.

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4 PCMS BULLETIN March, 2001 Special Feature by Jean Borst Childhood Immunizations...... Prevention is the Only Cure

Few will argue that the develop­ members of the health community to ad­ on having children properly immu­ ment of vaccines to prevent childhood dress immunization concerns. Out of nized by the age of two. Community as­ diseases is one of the most far-reach­ that initial meeting, and subsequent dis­ sessments have been conducted; areas ing medical advances of our century. cussions. came the formation of the with low rates have been identified, For years, cases of diphtheria, pertus­ Pierce County Immunization Coalition and methods for improvement have sis, measles and rubella have been under the leadership of Tacoma family been determined. rare; and an epidemic of any of these physician. Dr. John Gray. While the Provider education has been more illnesses is something most of us have group has diminished in size since that intensive. Coalition member Cindy never experienced. But since the late initial meeting — it now has a core group Miron. Community Health Care Nurse 1980s. health-care providers have of about 10 members — the goals and for the Tacoma/Pierce County Health faced the re-emergence of vaccine- commitment of the Coalition remain in­ Dept., has been instrumental in that preventable diseases. In 1989-90, more tact. area. "Cindy has done a great job of than 55,000 cases of measles were re­ “We realized that wc needed to re­ developing a teaching module for ported; there were more than 150 re­ affirm for the community how important practices,” Dr. Gray said. ported deaths. And in 1993, this coun­ and safe immunizations are,” Dr. Gray Miron has worked closely with try experienced its largest outbreak of explained. “Anyone over the age of 50 providers to implement a reminder/re­ pertussis since 1967. knew someone with polio, had friends call system that automatically generates While vaccines arc available and or family members in braces, using letters to be sent to parents: encourage accessible, national immunization rates canes or crutches, or who had com­ physicians to be aware of all opportuni­ are lower than most physicians be­ pletely lost the use of their legs. ties to immunize: and provide training lieve. And with parents typically de­ “People have forgotten the statis­ for the entire office staff. pending on physicians to alert them tics.” he continued. “Thousands of “It's important for providers lo re­ about their children’s health care people were crippled annually from a alize that this is an office-wide issue.” needs, it’s vital for providers to take disease that today we never see. Wc Miron noted. “Everyone has to be on the lead. have eliminated paraletic polio caused board and committed to immunize ev­ Like the rest of the nation, con­ by wild type virus here in the U.S. ery child who comes through the office cerns over childhood immunizations Young people have literally never ex­ door." came to light in Pierce County follow­ perienced anything like it.” Physicians also must be continually ing a measles outbreak in 1989. In The measles outbreak in the late aware of all opportunities to have kids 1992, the Tacom a/Pierce County 80s brought to light a serious issue. immunized. For example, if a child Health Department conducted a “Measles kills if people are not immu­ comes in for treatment, the physician door-to-door cluster survey to nized. If we are 70 percent or below on must take the opportunity to find out if determine the immunization immunizations, the entire community is they are due for a vaccination. “Don't rates of 24-month-old children in at risk." pass up opportunities." Miron said. Pierce County. Results showed “That parent might not return for a that Pierce County lagged be­ The Immunization Coalition: well-child visit." hind the rest of the state in im ­ A three-fold effort Miron noted that a follow-up as­ munization rates. More disturb­ The Immunization Coalition has fo­ sessment would be conducted in the ing, a follow-up survey con­ cused on three fronts: outreach/commu­ near future to determine how effective ducted four years later indicated nity education, provider education, and the provider education efforts have rates were even lower. promotion of an immunization registry been in raising immunization rates. The measles outbreak, survey re­ system. sults, and a growing anti-immunization Community efforts have been on­ CHILD Profile: An Integral force in the East County prompted the going. Billboard advertising, community Part of the Equation Tacoma/Pierce County Health De­ awareness programs, and partnerships The third focus of the Coalition — partment to orchestrate a meeting with with local organizations have focused See 'Im m unizations” page 10

March, 2001 PCMS BULLETIN 5 PCMS honors Lorraine Wojahn on her retirement

More than 80 people were in at­ tion here, a sampling includes. First tendance when PCMS honored Sena­ Steps, Second Steps, Mental Health tor Lorraine Wojahn at the February System Reform, Physician/Patient Re­ General Membership meeting on her lationship, Trauma. Scope of Practice, retirement from the Washington State and the last piece of legislation she in­ Legislature after thirty years. fluenced was the Patient Bill of Rights. President Patrice Stevenson, She fought for five years or more to MD, introduced Len Eddinger, require that the director of the Depart­ WSMA's Director of Public Policy and ment of Health be a physician, and fi­ Planning as presenter of the honor and nally won. only to have the legislation gift to Senator Wojahn. vetoed by the governor. “Nobody has “They don’t come greater or ever stood up for physicians more than grander,” according to Eddinger. Senator Wojahn.” said Eddinger as he Lorraine Wojahn, he lauded, was one introduced her to the audience. of medicinc's best friends. Her support Admitting that she is having with­ of physicians and the health care com­ drawal symptoms. Senator Wojahn said Senator Wojahn talks politics with munity was steadfast and unrelenting. her fight for medicine was an easy one. Ranch Lindblcid, MD, Puyallup “In Olympia she was known as the "When you take marching orders from ophthalmologist before the meeting Norse Goddess of Terror - and. that is the likes of Dr. Tanbara and other a compliment and a testimony to her as such physicians, it’s easy," she noted. a person,” he explained. Her philosophy during her tenure was stand in the way. “I wanted to tear my Senator Wojahn served on the ‘stick to your guns.' television out,” she noted. “It was so up­ Health Care Committee for years and As the legislature currently dis­ setting just hearing about it.” paved the way for many meaningful cusses prescription rights for PCMS extends congratualtions to programs and decisions for our com­ naturopaths, it is unfortunate for medi­ Senator Lorraine Wojahn on her re­ munity and the state. Too many to men­ cine that Senator Wojahn is not there to tirement and wishes her well.i

DSHS Contact numbers:

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6 PCMS BULLETIN March, 2001 February General Membership Meeting Recap by Jean Borst

Planning for Retirement...... You Can’t Repack Your Parachute After You Jump!

David Roskophis the first to admit joy some time away from their profes­ that time". Roskoph said. The S&P In­ that 30 minutes does nol a retirement sion. Jusi 60 years ago, it just wasn’t dex made about 26.5 percent a year on plan make. As keynote speaker al the so.” Each decade of retirees is more or an annualized basis - about 250 times its PCMS February General Membership less redefining the golden age of re­ historical average. Meeting, Roskoph conceded that a tirement, he noted. "Each batch of re­ As a result. Roskoph believes lhe half-hour presentation certainly tirees is enjoying more time. Some market is "long overdue for a rest." doesn’t allow for exploring the contin­ people are spending virtually half When you prepare for retirement, he gencies and intricacies of the retire­ their lives in retirement.” said, you gather your assets and think ment-planning process. Roskoph. In looking at this new age of re­ about bailing out into a more leisurely MBA, CFP, is a Registered Investment tirement, Roskoph noted the impor­ lifestyle. “But you never know what Advisor and owner of Total Asset tance of “Critical Mass”, a term he economic climate you’re bailing into." Management, Inc., in Gig Harbor. defined as “the accumulation of Roskoph explained, "I'm here to say if While his time with the group was enough wealth to live in the you really want to prepare for a secure brief, he provided some valuable in­ style to which you are accus­ retirement, you have to take into ac­ formation and basic dos and don’ts of tomed for the remainder of your count that you might be going inlo a pro­ retirement planning. life.” In essence, Critical Mass is tracted recession. What’s going to hap­ “This group is a little bit atypical of the absence of monetary anxi­ pen to your anticipated accumulation? the normal retiree,” he said, “in that ety. According to Roskoph, this When you put money away, and you’re normal retirees are going to spend a accumulation is going to be con­ projecting it for a long period of time, certain percentage of their pre-retire- tingent upon tw o very big vari­ the first few years are critical. It’s my be­ ment income - say 70 percent. That’s ables: ( I ) The growth of the principal lief that we’re in a recession right now', because they don’t have all the costs that remains as you deduct from it ev­ and it will last until the end of the year." associated with their former career. ery' year of your retirement, and (2) Determining the Ideal Asset However, as income levels go up, the How many years that principal has to Allocation Mix probability that there’s going to be a roll forward to keep this Critical Mass “When the time comes”. Roskoph great decrease in spending goes alive. Roskoph noted that "everyone said, "I want to enjoy my retirement. I down. So chances are, what you has access to a world of information really do not want to feel like I need lo should plan for is that your spending is out there." There is a plethora of fi­ watch every bead of sweat on Alan not going to be dramatically different nancial web sites that offer relatively Greenspan's forehead. I don’t want to once you pass through the veil of re­ simple processes to determining re­ be tied that intimately to the market.” He tirement. If most of your assets are kept tirement calculations, and he encour­ presented to the group a simplified ap­ in a qualified plan, and you’re going to aged everyone to take advantage of proach to asset allocation that would pro­ be releasing them, of course you’re the resource. vide a good return and relative peace of going to pay ordinary income tax. Principal Growth mind. The formula: Subtract your age Therefore, your tax rate may nol go This country’s economic climate from I 15. The difference is going to be down precipitously either.” over the last few years has been ... what you allocate to large-cap equities; The Concept of Retirement well, quite astonishing. Traditionally, the remainder is allocated lo fixed-in- “Right now, we are living in a the market (the S&P 500) returned come instruments. For example, a 60- golden age of retirement”, Roskoph roughly 10-11 percent a year. Be­ year-old investor w'ould allocate 55 per­ said, defining retirement as between tween 1995 and 1999, however, there cent to stocks and 45 percent to bonds. the ages of 65 and 95. “People are was a period of tremendous growth, “In analyzing what markets, capitali­ amassing enough wealth and carrying and “we didn’t have to do very much zations. and bonds have done over the forward enough health to actually en­ to make money in the market during past several decades - in recessions, de-

Sce “ Retirement” page 8

March, 2001 PCMS BULLETIN 7 R etirem ent uipagc7 Did You pressions, booms, busts, peace, war - more than 4.15 percent, it gets more Remember? you find that an allocation of 63 per­ challenging and presents greater risk, cent into large-eap slocks and 37 per­ he noted. cent into intermediate-term govern­ Just How Long Will I Live? ment bonds (10-year), will give you But what if you live beyond age safe, critical mass. You will have a col­ 95? At present, life expectancy is con­ lection of monies built to withstand the sidered to be 98.5 years. Human Ge­ best of times and the worst of times, re­ nome research is just underway and gardless of when you take retire­ has the potential to not only decrease ment.'’ Roskoph noted that this alloca­ morbidity, but also substantially extend WAM PAG tion would give you a safe 4.15 per­ life. So, what happens to your retire­ cent distribution to last from age 65 to ment blueprint if you live longer than Washington Medical Political 95. "This gets us to the basic rule of planned? And how does that affect that Action Committee 24”, he explained. "If you take what 4.15 percent you were going to draw you want in retirement for an annual out? “You just need to be a little more 1800 Cooper Point Road SW distribution at age 65 and multiply it by careful about the deductions from that Bldg 7, Suite A 24, you have a safe Critical Mass.” The pool of assets”. Roskoph said. Olympia, WA 98502 emphasis of that statement is on the The question, however, still re­ 800-562-4546 (360) 352-4848 word “safe". If you want lo take out mains. Can you afford to live loo long?"

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B PCMS BULLETIN March, 2001 April General Membership Meeting

Tuesday, April 10, 2001 Landmark Convention Center Social Hour: 6:00 pm Temple Theatre, Roof Garden Dinner: 6:45 pm 47 St. Helens Avenue Program: 7:45 pm Tacoma discussions with our new. Insurance Commissioner

► Replacement of former Commissioner Deborah Senn ► University Place native ► Doctor of Optometry (Pacific University) Mike Kreidler ► Master's in Public Health (UCLA) ► Group Health Optometrist (20 years) ► 16 years in Washington State Legislature

Discussions will include: Priorities and plans for the office Specific changes and how they will impact health insurance in Washington state Restoring the individual insurance market Oversight of plans: contract review, network adequacy, compliance, etc. Kreidler's Crystal Ball: How will our health care system operate in 2010???

(Register by April 6. Return form to: PCMS, 223 Tacoma Ave S, Tacoma 95402; FAX to 572-2470 or call 572-3667

Please reserve ______dinner(s) at $20 per person (tax and tip included)

Enclosed is my check for $ ______or my credit card # is ______

□ Visa □ Master Card Expiration Date S ignature

I will be bringing my spouse or a guest. Name for name tag:

Signed:

March, 2001 PCMS BULLETIN 9 V BuLi.lETiN

Immunizations from page 5

and perhaps the most important and tered into the system from the public gram or has access to the Internet. most challenging component of all — portion of the birth certificate and by There are four access methods avail­ the immunization registry system. participating health care providers. able so providers can choose the one CHILD Profile is Washington This information forms the foundation that best suits their individual practice State's health promotion and immuni­ of two components of the CHILD Pro­ needs. The service does not require zation registry system designed to help file system — reminders and health in­ any special software. ensure that Washington's children formation mailings for parents, and the ♦generate several types of reports receive needed preventive health immunization registry for health care including documentation required by services. It is jointly managed and providers. This two-pronged approach the county, state and the CDC operated by the Snohomish Health is based on the belief that children’s ♦ensure vaccine safety by provid­ District and Public Health Seattle and health is most effectively improved ing notification of vaccine recalls King County, in collaboration with when parents and health care providers ♦provide parents with a consoli­ Washington Stale Department of work together. dated list of all vaccines - a great ben­ Health. It has been funded primarily For health care providers, the im­ efit for providing information to by public and private grants since its munization registry component is a tool schools, day care and for sports activi­ inception in 1993. that allows access to patients’ immuni­ ties "The registry is one centralized zation information in a shared, secure ♦identify areas of need, enabling repository for the state", according to database. It includes: public health departments to reach out Sherry Riddick, Customer Service to those communities and work to in­ Manager for CHILD Profile. "When a • Immunization histories crease immunization rates child’s record is pulled up, providers • Recommendations of immuniza­ can see at a glance exactly whal immu­ tions needed One very important and valid con­ nizations a child has had and needs. It's • Recall lists and mailing labels of cern among providers is confidentiality an incredibly valuable tool for the pro­ patients needing immunizations and security. Access to CHILD Profile vider and staff. • Vaccine usage reports is available to providers who sign an "Ours is an increasingly mobile • Data for practice-specific information-sharing agreement that society,” Riddick continued. “If a child immunization reports, such as emphasizes confidentiality, privacy and changes health care providers, the new CASA security of the registry. “This is a very provider may access the registry to • Tracking of children eligible for secure system,” Riddick noted, "featur­ review records and input new infor­ state-supplied vaccine ing several different levels of security mation ensuring the child's immuniza­ requiring log-in, passwords, fire walls, tion information is updated in one cen­ Office staff and providers can look and other state-of-the-art security fea­ tral location. And with an increasingly up immunization histories; update im­ tures." complex immunization schedule and munization information; enter new “It will be very important in the fu­ the frequent addition of new vaccines, children and immunizations into the ture to have a system to track and cre­ the challenge of maintaining up-to-date system; update addresses of patients; ate a reminder recall system that makes information is compounded." print an individual’s immunization it effortless for providers and parents,” There is no charge for the record; view and print recommenda­ Dr. Gray said. “Currently, the system services CHILD Profile offers, tions of needed immunizations; and can be manually intensive, and we real­ Riddick explained. “With the enter and view exemptions. ize that is a barrier. But technology will support of federal, state, and private "This is an excellent way to better be continually enhanced and the barri­ foundation funds, CHILD Profile track immunization coverage/levels ers will fall.” is committed to providing registry and raise rates.” according to Cindy “For nearly 70 percent of all chil­ services into the future at no cost to Miron. dren in the state of Washington, some participants.” In addition to the obvious immunization data already exists. The Nationally, the development of im­ time saving benefits of reducing more physicians participating in the munization registries is promoted by paperwork, offering a centralized registry, the greater the amount of data the CDC and other organizations as a resource of information, and available for all,” Riddick noted. “We way to monitor and increase immuniza­ eliminating multiple documentation, understand that staffing is an issue, and tion levels of children. It has proven to CHILD Profile can: that is why we help with alternative be a benefit to providers and parents ♦be accessed with any computer w'ays to get historical data into the reg- alike. Demographic information is en­ that can run a terminal emulation pro­ See “Immunizations'' page 21

10 PCMS BULLETIN March, 2001 How to contact your state and national lawmakers

President may be reached by mail: 1600 Pennsylvania Ave NW, Washington D.C. 20500; his message phone is 202-456-1111

U.S. Senators and Representatives: Sen.Maria Cantwell (D), 464 Russell Senate Building, Washington, D.C. 20510; 202-224-3441 (DC) or 206-220-6400 (Seattle) FAX: 202-228-0514 or email: [email protected]

Sen. Patty Murray (D), 173 Russell Senate Building, Washington. D.C. 20510; 202-224-2621 (DC) or 206-553-5545 (Seattle) FAX: 202-224-023S or email: [email protected]

Rep. Norm Dicks (D-6th), 2467 Rayburn House Building. Washington D.C. 20515: 202-225-5916 (DC) or 253-593-6536 (Tacoma) FAX: 202-226-1176

Rep. Adam Smith (D-9th), 116 Cannon House Office Building, Washington D.C., 20515: 202-225-8901 (DC) or 253-926-6683 (Tacoma) or toll free 1-888-764-8409; FAX: 253-926-1321, email: [email protected].?ov

State Offices: Governor Gary Locke, Legislative Building, PO Box 40002, Olympia 98504-0001, 360-753-6780, FAX: 360-902-4110, home page: www.governor.wa.gov

State Representatives: Washington House of Representatives, PO Box 40600, Olympia, WA 98504-0600 State Senators: Washington State Senate, PO Box 40482, Olympia, WA 98504-0482. The central Senate FAX: 360-786-1999

To leave a message for lawmakers or to learn the status of legislation, call the Legislature's toll-free hotline, 800-562-6000. The hearing impaired may call 800-635-9939.. The Legislature's Internet home page address is www.leg.wa.gov.

Legislators by district with Olympia phone numbers (ALL 360 AREA CODE) and email addresses:

2nd District, (South Pierce County ) 28th District, ( West Tacoma, U.P., Fircrest, Lakewood) Sen Marilyn Rasmussen (D) 786-7602; [email protected] Sen Shirley Winsley (R) 786-7654; [email protected] Rep Roger Bush (R) 786-7824; [email protected] Rep Mike Carrel! (R) 786-7958: [email protected] Rep Tom Campbell (R) 786-7912; [email protected] Rep Gigi Talcott (R) 786-7890: [email protected]

25th District, (Puyallup, Sumern, Milton) 29th District, (South Tacoma, South End, Parkland) Sen Jim Kastama (D) 786-764S; kastamaji@ leg.wa.gov Sen Rose Franklin (D) 786-7656; [email protected] Rep Dave Morell (R) 786-7968; [email protected] Rep Steve Kirby (D) 786-7996; [email protected] Rep Sarah Casada (R) 786-7948; [email protected] Rep Steve Conway (D) 786-7906; [email protected]

26th District, (NW Tacoma, Gig Harbor, South Kitsap) 30th District, (NE Tacoma, Federal Way) Sen Bob Oke (R) 786-7650; [email protected] Sen Tracey Hide (D) 786-7658; [email protected] RepPatLantz (D) 786-7964; [email protected] Rep Maryann Mitchell (R) 786-7830; [email protected] Rep Brock Jackley (D) 786-7802; [email protected] Rep Mark Miloscia (D) 786-7898; [email protected]

27th District, (North Tacoma, East Side) 31st District, (East Pierce County) Sen Debbie Regala (D) 786-7652; [email protected] Sen Pam Roach (R) 786-7660; [email protected] Rep Ruth Fisher (D) 786-7930; [email protected] Rep Chris Hurst (D) 786-7866; [email protected] Rep Jeannie Dameille (D) 786-7974; [email protected] Rep Dan Roach (R) 786-7846; [email protected]

For more specific information about the legislative process or for a copy of the 2001 Guide lo the Washington State Legisla­ ture which includes listings for elected state and federal officials, please call PCMS, 572-3667. ■

March, 2001 PCMS BULLETIN 11 Directory Changes

Please make note of the following changes lo your 2000 PCMS Directory. What problem Lon Annest, MI) Change address to: 1811 Marlin I.uther King Jr Wy #210 can we solve Tacoma. WA 9K4( 15 Phone: 572-8777 Fax: 572-SS35 for you today?

Glen Ik'vo. MI) Change address lo: 7206 Meadow Park Rd W Lakewood. WA 9X499

Lael Duncan, Ml) Change address to: © Computer Networking 222 I 5"1 Ave SW Suite B Puyallup. WA 9X372 Phone: 845-8991 iB l General Computer Support Physician Only: X45-0609 Fax: X45-9I4X ^ Security and Virus Protection

Carlos Garcia, Ml) Change address to: @ Custom Development 1811 Martin Luther King Jr Wy #210 Tacoma, WA 9X405 Phone: 572-8777 (@ Internet Connectivity Fax: 572-XX35

David Mcliniry, MD Change address to: 220 151'1 Ave SE Suite B Puyallup. WA 9X372 Phone: X45-899I Physician Only: 845-0609 Fax: 845-9148 We can help you.

Wendel Smith, Ml) Managing technology is no easy task. Change address to: IT Source can help you solve computer 181 I Martin Luther King Jr Wy #210 Tacoma, WA 98405 problems so you can get on with more Phone: 572-8777 important things...like your business. Fax: 572-8835

Allen Yu, MD Vascular Surgery NW Change address to: i i 253.835.1200 11311 Bridgeport Way SW Suite 203 IT so u rc e www.itsource.com Lakewood. WA 98499

“ ' 20G0 IT Source, A Continuum Company

12 PCMS BULLETIN March, 2001 PPu-Ke 'ii'M-nttf Qtttdica! dfoaeh/

The Health Status of Pierce County Federico Cruz-Uribe, MD Director of Health

Defining Public Health

“The challenges o f public health and yersinia pestis. Trying to avoid have never been greater, either in ... panic, the Indian government shared Los Angeles, ...Minnesota, or ...the Rus­ confusing data, and the World Health 9 sian Federation. The community has Organization found their labs unable to T A C O M A -P IE R C E C O U N T Y expanded ...(to )... six billion human be­ respond. By luck, rather than the con­ HEALTH ings, more than five billion o f whom certed effort needed, the plague DEPARTMENT live in the global equivalent o f New faded. And, most frightening, no speci­ York City's 1890 's tenemen ts. mens survived, so no one will know Public health needs to be - must be the true disease, etiology, and vector. ferring Anarchy and Class Disparity," -global prevention. ” In the next chapter, health work­ indicating the impact of anti- (Garrett, Laurie. Betrayal o f Trust: ers in Zaire (now Congo) were forced govemmentalism and class-based bi­ The Collapse of Global Public Health. to re-use syringes and do without the ases. Hyperion. New York: 2000.) simplest of medical equipment (gloves, She then gives a vision of the fu­ Pulitzer-prize winning author and microscopes, sheets for hospital beds). ture, wilh bioterrorism areal threat, Newsday Science Editor, Laurie As a result, ebola spread throughout leaving the reader shaken about the Garrett, sounds a clarion call in her the community, on the hands of care­ potential to fix any of this. new book, Betrayal of Trust. The book givers and medical personnel. An in­ Garrett makes a number of impor­ is a good read, whether you like a ternational effort brought that disease tant points, which boil down to the core good medical detective story or an en­ under control, for now. It is obvious competencies of public health. Public gaged, researched essay on the col­ from Garrett’s report that without health, she says, is not “an ideology, re­ lapse of public health. Her well-docu­ changes, which are nol on the horizon, ligion, or political perspective” and mented contentions: a new epidemic is wailing to erupt. then shows that when any of these 1) globalization means that no one is Garrett then traveled to Russia in powers meddle in public health, moral­ safe from epidemics, environmental 1997 to observe the onetime ity and morbidity rates rise. Instead, toxins orbiowar; superpower’s current state of health. she argues that public heallh is the pre­ 2) the public health system, historically Economic disaster has destroyed iheir vention of those factors which interfere key to protecting our collective well­ health systems, compounded by alco­ wilh health, realized in such a way that being, is too fragile to safeguard hol abuse, environmental degradation, all people - not just the wealthy, power­ anyone, currently; an abundance of violent gangs, over­ ful, or those armed with insurance - 3) radical new approaches are needed, use of antibiotics, and other changes benefit. She says that: including working together - across among the citizens that draw a picture Public health is a negative. When disciplines and national boundaries - of Russia as a very unhealthy place. it is at it’s best, nothing happens: there to prevent health problems and to Throughout, lhe reader can hope are no epidemics, food and water are respond in unity to any new disease to hide behind the seemingly-excellent safe to consume, the citizens are well- that arises. health system in the United States, but informed regarding personal habits that Garrett’s intimidatingly thick book Garrett then takes that on, indicating affect their health, children are immu­ is filled with engaging anecdotes that huge gaps and political processes that nized, the air is breathable, factories show the impacts of changes in public leave us all vulnerable. Comparing obey worker safety standards, there is health and hold one’s interest through public heallh of 100 years ago, Garrett little class-based disparity in disease or the avalanche of historical and present- outlines the decades of budget cuts, life expectancy, and few members of day health statistics. She starts with a public disinterest, and political stress on the citizenry go untreated when they plague outbreak in 1994 in India, private healthcare for the wealthy ver­ develop addictions to alcoholic or nar­ caused when residents abandon their sus public healthcare for everyone. cotic substances. communities after an earthquake. The result is a US public health infra­ The Tacoma-Pierce County When they return and open the stores structure unable to handle a serious in­ Health Department has been chal- of grain, rats that have taken refuge in fectious disease outbreak. The US the warehouses pour out, sharing fleas chapter is called, appropriately, “Pre- See “ P u b lic H e a lth ” page 14

March, 2001 PCMS BULLETIN 13 Public Health from page 13 lenged regularly by people who want to know why we privatized our clinics rather than serving indigent people our­ selves, and what in the world we are do­ E R J c S E ing asking people to stop smoking and abusing alcohol. The answer is very THAT TATTOO clear in Garrett’s book: we’re trying to safeguard and protect the health of WORRIED ABOUT WHAT YOUR SPOUSE, Pierce County citizens in the most YOUR FRIENDS OR EVEN YOUR BOSS effective ways, by preventing THINKS ABOUT YOUR TATTOO? problems in the first place, and OR ARE YOU JUST TIRED OF then monitoring diseases to be able LOOKING AT IT? to mount a response quickly. As you Today’s newest Alexandrite laser, know, we do that most effectively by us­ will remove your tattoo ing resources and partnerships with pri­ with minimal discomfort & less than 1% risk off scarring. vate providers. Together, we are re­ i'.tdl today fui' more information sponding in Pierce County to the chal­ lenges posed by Garrett’s book. Put this PIERCE COUNTY important volume on your reading list. It LASER CLINIC may help you to understand even more D i r c f l o r I’l-u t K. M :irsh M .I). clearly why our united effort is key to a (253)573-0047 healthy future. ■

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14 PCMS BULLETIN March, 2001 'd/'iwc fou?//i/ Q.d'ledtefd Cdcctef//

In My Opinion.... The Invisible Hand by Andrew Statson, MD

The Quest for Certainty

“’Oh! Let us never, never doubt What nobody is sure about!" Hilaire Belloc (1897)

,-t tulreiv at\i>n. :\U) If nothing else, the recent election reading of entrails of sacrificial animals; should have proven to most people the meaning of planetary positions; the vision of prophets, seers and psychics that when you count thousands of items out, frequently out of concern for their were widely sought, and still are. Many several times, you get several different own children. Others have found it answers. Mathematicians have known people are eager to believe that some­ easier to live without knowing. for a long time that when you deal with one can tell them what the future holds One patient presented with a 3-4 reality, numbers are only approxima­ for them. Many people base their deci­ year history of recurrent right lower sions on such advice. tions. I wonder whether the general quadrant pain. She described it as a In obstetrics, we frequently are public will understand that, too. An­ sharp pain, sometimes bad enough to confronted with the question of the other point is that the more carefully double her over, which came almost we count, the more expensive it be­ baby's sex. In the past, that was a ques­ every day. not related to her cycle nor tion for psychics and seers, but now it is comes. When our money consisted in to any activity, lasting less than a mainstream medicine. Even though the coins of silver and gold, we frequently minute. She wanted to know what ultrasound scan is not always correct, it could dispense with the counting, caused it and whether she would have is much more reliable than a psychic. weighing the bags of coins instead. to live with it for the rest of her life. In Some people are willing to pay for this, For whatever reason, people the presence of a negative physical ex­ but most aren’t. At least, not if they don’t crave certainty. They want to know amination, how far do we go in testing? have to. Why is it so important? How' what will happen next. When some­ Another patient said, "I'm worried much is such knowledge worth and thing happens, they want to know u'hy. about my baby, doctor. Is my baby go­ who should pay for it? At present, we The lack of explanation is even more ing to be okay?" Probably, but how can don’t have a good answer to these distressing than the lack of foreknowl­ one be sure? The ultrasound scan did questions. Medicine does not function edge. It creates more uncertainty in not show anything obvious. Overall, in a free market, where such questions the minds of people, perhaps because the chance of malformation if a baby is can be answered. it creates the feeling that things are out born at tenn is less than 4%. The For patients, a certain symptom of control. Generally, we have control chance of major malformation is about may provoke anxiety about the possi­ over our lives, but only within certain 1%. This is based on the clinical obser­ limits, not fully. Many people have bility of a serious illness. They may vation of millions of births. We could even know someone who started with some difficulty accepting that. say with a 95% confidence that the vague aches, tightness in the chest, This quest for certainty, or is it for baby would be normal. heaviness in the abdomen, and ended reassurance, must be a basic human Such a confidence level would up with a heart attack or cancer of some need. It has existed since the begin­ meet the criteria for evidence based ning of history. Answering it has been, sort. In other situations, patients may medicine. However, our legal friends and still is, a big business. The temple not want to know. Beyond the consid­ strongly discourage us from making of Apollo at Delphi was one of the rich­ eration of cost, the child of a patient such a statement. If we were to tell the est in the ancient world. The oracles with Huntington’s chorea may have to patient “We will take care of you and were consulted by kings and states make perhaps one of the most difficult the baby will be normal", we would be from all over the Eastern Mediterra­ personal decisions. The chance of car­ making a promise and entering into a nean and the Middle East. The inter­ rying the gene is 50% and a test is pretation of dreams and omens; the available. Some have chosen to find See “ Quest” page 16

March, 2001 PCMS BULLETIN 15 B u l l e t in

from page 15 As a result, Medicare requested that of precision of which it is capable.” the nursing homes refund all payments When a physician certifies a patient, contractual obligation. If by any chance for care in excess of six months. who then lives longer, the physician and the nursing home get in trouble the baby were not normal, we would The nursing homes then turned to with Medicare. When the patient dies have breached our contract with the the certifying physicians and refused to sooner, he is deprived of a benefit to patient and could be liable for dam­ admit any of their patients unless it was which he is entitled. How can we know ages. Gone are the days when we absolutely certain that they would die for sure what will happen to such a de­ could look at the odds for the outcome within the prescribed time. Thus, many gree of accuracy? This is a situation in and reassure the patient. patients were held back and admitted w'hich we cannot win. There are many situations like that, only when they were practically dying. Medicine has made great progress where patients insist on test after test. The average nursing home stay for within the last century. We have They may even accuse us of a lack of these patients dropped from about 18 learned a lot about many diseases, their compassion or caring for their baby, if days to about 1 1 days. The families course and the effect of their treatment. we were to refuse them a scan. Some­ complained to their congressmen and Frequently, we can guess the outcome. times they are right and a scan may re­ eventually Medicare had to relax its We can never be absolutely certain. veal a problem. Frequently, however, rule. However, there is one thing in medi­ the scans are normal. Even then, we The problem with such rules is that cine we can be sure about. It is that all cannot reassure them. Yet, often it is impossible to know how long a pa­ of us will die some day. Probably. Re­ enough, whether we find some kind of tient may live. In his Ethics, Aristotle juvenation treatments might be right a problem or not, the management of wrote, “It is the mark of an educated around the corner. If so, sign me up.« the pregnancy will remain the same. man to expect in each subject the sort We will not act on the information. Scans are popular with patients be­ cause the technique itself does not have known side-effects. The prob­ lems with ultrasound scans are related TACOMA RADIOLOGY to misinterpretation, either by seeing something that is not there, or by not seeing something that is there. The pa­ tients are much more reluctant to un­ dergo tests, such as amniocentesis or umbilical vein sampling, because of the risks to the fetus. The patients' requests for reassur­ ance can lead to expensive testing. In­ surance plans and government pro­ grams create a different problem. They 0^Spine & Femur ask for certification of disability, return to work or life expectancy for their Medicare covers beneficiaries every 23 months DFXA beneficiaries. Some time ago, nursing homes in New York had a problem when the following criteria are met with Medicare. As far as 1 remember, Mnniioring of I-DA approved osienporoMs drug therapy may allow lor greater lrcc|uency of examination the report said that Medicare would cover nursing home care for eligible 1. Postmenopausal (estrogen deficient) women at risk for osteoporosis 2. Individuals with vertebral abnormalities patients during the last six months of their life. Physicians were asked to cer­ 3. Individuals receiving long term gluccocortoid therapy tify that the patients were expected to 4. Personal history of primary hyperparathyroidism die within that period of time, so they m w u i . tacomarad.com could be admitted to a nursing home. As you would guess, some patients did Allenmore Medical Center Lakewood Office not cooperate, but continued to live for (253) 383-2038 (253) 588-6083 a while longer than their allotted time.

16 PCMS BULLETIN March, 2001 COLLEGE Continuing Medical Education OF MEDICAL Internal Medicine Review 2001 EDUCATION scheduled for March 8 & 9 The Tacoma Academy of Internal ' Geriatric Depression Medicine's annual two day CME program is open for registration. The ’ Diagnosis and Treatment of Infection program offers a variety of timely in Lower-Airway Disease Womens Medicine internal medicine topics and has been ’ New Innovative Treatments of organized by Ulrich Birlenbach, Rheumatoid Arthritis CME Rescheduled MD. The program offers 12 Category I ’ Manipulation of the Unstable Coro for May 18 CME credits and is available to both nary Plaque: New Strategies To Academy members and all other area wards CHD Prevention The third annual CME program on physicians. The program will be held at Advances in Women’s Medicine has ' What’s New in Antimicrobial the Washington State History Museum been rescheduled for May 18, 2001. Therapy in Tacoma. The conference will be held at St. To register or for more information ’ Insulin Secretory Defects in Type 2 Joseph Hospital and was previously please call the College at 627-7137. Diabetes: The Issues and Answers scheduled for February 9, 2001. The This year’s program includes course is a one-day program address­ ’ Laryngeal Pharyngeal Reflux: Extra presentations on the following topics: ing a variety of timely subjects relative Esophageal Therapies to contemporary medicine for women. • DVT Prevention and Treatment: 1 Reluctance to Prescribe Opiates: The Designed for the primary care physi­ The High Risk Groups Issues and Answers cian, this CME program will feature issues related to diagnosis and treat­ • Sleep Disorders and Drug Addiction: ’ Osteoporosis Update: A Practical and ment advances in treating illness in Behavioral and Medicinal Strategies Pharmacological Approach women. John Lenihan, MD. the • New Treatment Options for Diabetes ’ Latest Developments in the Diagnosis course director, promises presentations Patients with Syndrome X The Role and Management of Alzheimers ■ on timely subjects with “outstanding” of ARB’s in Diabetic Nephropathy national speakers.*

Dates Program Directors') Allergy, Asthma Thursday-Friday Internal Medicine Ulrich Birlenbach, MD & Pulmonology March 8-9 Review 2001 CME-May 4 Friday, April 6 Pain Management David Paly, MD

The College’s CME program Saturday, April 28 Surgery' Update Glenn Deyo, MD featuring subjects on allergy, asthma & pulmonology is set for Friday, May 5 at Allergy, Asthma & St. Joseph Medical Center. The course Friday, May 4 Pulmonology for Alex Mihali, MD is under the medical direction of Alex Primary' Care Mihali, MD. A brochure with details regarding Tuesdays, May 16 and Medical Technology TBA the conference is scheduled to be 23 (evenings) mailed in late March. At present, initial planning includes Advances in Women's Friday, May 18 John Lenihan, Jr., MD presentations on: COPD, Pneumonia, Medicine Asthma & Allergy.■ . ...

March, 2001 PCMS BULLETIN 17 X --- - B u l l e t in

CME at Whistler program maintains popularity

CME at Whistler, the College’s enjoyed the rare opportunity to have winter resort program brought to­ in-depth discussions about clinical situa­ gether a number of Pierce County tions. physicians in British Columbia for fam­ Out of the classroom, conference ily vacationing and continuing medical participants and their families enjoyed education. A number of physicians out­ snow, skiing and other social activities. side Pierce County also joined the The program was directed by John group. Jiganti, MD, Tacoma orthopedist. The program featured a pot­ The College will plan a ski CME pourri of educational subjects of inter­ program next year and will likely re­ est to all medical specialties. turn to the Whistler resort area due to Conference attendees particularly it’s popularity.

James M. Wilson, MD answers questions about geriatric assessment

Drs. ami spouses, Mark Ludvigson and Carol Kovanda Carlos Moravek, MD and Kevin Schoenfelder, MD take a enjoy the sun on lop of Blackcomh Mountain break on one of the Blackcomh Mountain runs

Dr. Steve Settle and wife Sheila in front of the Aspen S The j iganli famUVi including sons (l-r) Max, Zach and Lodge with their nephew David and niece Anna Kyk< fmish Q bjg day m thg shpes

18 PCMS BULLETIN March, 2001 Peter Krumins, MD with son Maureen Mooney, MD, new CME at Whistler regulars, Dr. John Benjamin (left) and Kyle Jiganti dermatologist in Pierce County Samms and his wife. Kathy

Douglas Hassan, MD discussed Gregg Schlepp. MD (left) with common hand problems friend Bob Starkey

Gig Harbor physicians John Jiganti, Tom Herron and Ralph Katsman, MD, Tacoma gastroenterologist and Mark Craddock (I to r) with their wives Maureen Mooney, MD, Puyallup dermatologist

March, 2001 PCMS BULLETIN 19 V B u l l e t i n

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P A 'cnx 'if'n m ily Q 'lled ical C foctet tf

Immunizations from page 10 istry - such as through electronic down­ more data we have in the system, the admits, “and that’s great! But we can’t loads of billing data." greater the effectiveness of the registry. become complacent. It’s like breathing The better the system, the greater the — if you forget to do it, you die." CHILD Profile in Action: benefits.” "There is no single, magical way Community Health Care Tacoma “It is niy goal for CHILD to raise immunization rates.” Miron Community Health Care Tacoma is Profile to get every child in noted. "Many elements are involved, currently piloting CHILD Profile in two Washington State on the registry,” and that’s what makes it so challeng­ of its clinics and plans to bring other Dr. Gray stated. ing. But it can be done. We are all clinics on board. Sandy Bauer. Immuni­ In the meantime. Gray encourages accepting of the fact that change comes zation Coordinator for Community anyone who is doing pediatric medi­ slowly." Health Care in Tacoma, explained that cine to do whatever necessary to see “Developing vaccines is a luxury the clinics are utilizing the Web-based that kids get the required immuniza­ that was hard earned." Dr. Gray said. access method (CHILD Web) for data tions by the age of two. “Immuniza­ “We’ve done amazing work in the last entry in the clinics. Clinics with Internet tions are a mundane subject," Gray 50 years. We can’t let that slip away.'i access, or those that operate on an Intranet, can easily establish access to Editor's Note: For more information about the Pierce County Immunization the registry. Typical users are large Coalition call Site Asher at the Medical Society, 572-3667, or Cindy Miron at the clinic organizations or any provider Health Department, 798-6556. with Internet access. For more information about CHILD Profile, call (425) 339-5242 or <800) 325-5599. or Bauer hopes other users of the check their web site at 11 rivu ■. chiklprofile. ore. The web site is an excellent place for system will spread the word about its providers interested in participating in the registry. value and benefits. “The population our clinics serve is very mobile, but the pa­ tients’ records are not. It’s very com­ mon for parents to have outdated or nonexistent information about their Advanced Training in Management child’s immunizations. For physicians and other clinical practitioners “It’s a fast and efficient system, and very easy to use,” Bauer continued. Both the evening/weekend Master of Health Administration (M.H.A.) and Certificate “While there are barriers to overcome, Program in Medical Management assist practicing clinical professionals to develop knowledge and skills in management applicable to every day work situations. offices have to realize what tremendous benefits come with this. From my per­ Master of Health Administration (M.H.A.) This program provides sonal experience, the data entry is really advanced, in-depth knowledge and skills in planning, organizing and implementing not a big hindrance,” Bauer explained. programs which address health needs and improve the cost effectiveness and quality of “True, historical data needs to be patient care. The application deadline is April 30. Applications are currently being entered, but the time spent initially accepted. Applications received after the deadline will be reviewed on a space-available basis. saves so much time later. The percep­ tion is that it’s a lot of work, but the Certificate Program in Medical Management This program provides return is wonderful. I believe physicians participants with basic knowledge and practice-oriented skills in health services and the community will realize the management and helps participants determine if (hey would like to go further in their benefits.” management training. The application deadline is August 21.

“It’s important for the entire office Both programs are offered by the Universily of Washington Department of Health Services staff to recognize the importance of a and Educational Outreach with representation from the UW School of Medicine. registry tracking system,” Cindy Miron said. “Anyone working in a providers’ For additional information or an application packet, contact us at: office knows that it's entirely possible 206-616-2976 to call several different places to get http://depts.washington.edu/mhap/eve/index.html information on a patient. CHILD Profile offers a one-stop resource.” The UW reaffirms its policy o f equal opportunity regardless of race, color, creed, religion, national origin, sex. sexual orienlaticn. age. marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal "‘We strongly encourage providers and state statutes and regulalions. For disability services, call 206-543-6450 or 543-6452 (TTY) as soon as possible. to participate,” Riddick added. “The

March, 2001 PCMS BULLETIN 21 MEDICAL LICENSURE ISSUES

Mr. Rockwell is available to represent physicians and other health care Organ & Tissue providers with issues of concern before the State Medical Quality Assurance D O N A T I O N Commission. Mr. Rockwell, appointed by Governor Booth Gardner, served for 8 years as the Public Board Member of the Medical Disciplinary Board from 19X5-1993. Since then, Mr. Rockwell has successfully represented over 60 physicians on charges before the MQAC. Mr. Rockwell’s fees are competitive and the subject of a confidential utlomey-client representation agreement. Gregory G. Rockwell Share Your Life. Attorney at Law & Arbitrator Share Your Decision . “ 3055 - 112th Avenue SE, Suite 211 Bellevue, WA 98004 For more Information on organ and tissue donation please call LifeCenter Northwest (425)822-1962 • FAX (425) 822-3043 toll free, 1-877-275-5269 email: grocket(g

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22 PCMS BULLETIN March, 2001 'JPfcrcr t'otoiht C ((nlaft CJondij

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Tacoma/Pierce County out­ Lakewood office space Drs. W. Jackson & K. Scherbarth patient general medical care at its best. available. Directly across from St. looking for partners in 47 ft. motorboat Full and part-time positions available in Clare Hospital. Plenty of parking and and Mooney airplane. 253-752-6965. Tacoma and vicinity. Very flexible private entrance. Call Carolyn at 253- Equipment needed for commu­ schedule. Well suited for career 581-9313 or 1 -800-606-9416. redefinition forG.P., F.P., l.M. Contact nity clinic: The Neighborhood Clinic of Andy Tsoi, MD (253) 752-9669 or Paul Hospital Related Property For Tacoma (staffed by volunteers and Doty (Allen, Nelson, Turner & Assoc.), Sale: 1724 South J Street comer lot, providing care to the local indigent population) is seeking an inexpensive Clinic Manager (253 ) 383-4351. opposite St. Joseph's Hospital. Old house, yard, and garage. $95,000. Tel: or donated spot-check oximeter and a Family Practitioner wanted, (253)858-9728. laboratory microscope. Other needs Bellingham - Mt. Baker Family include stethoscopes, sphygmomano­ Medicine, a fast growing subsidiary of Office Space Available. 1-2 days meters, otoscopes, exam lamps and Mt. Baker Planned Parenthood, needs per week. St. Clare Medical Pavillion office surgery instruments. Contri­ a dynamic, full-spectram Family in Lakewood, WA. Perfect for butions are tax deductible. Please contact Phillip Schulze, MD, 253-858- Practitioner to practice out of our year- Satellite office! Form more information 5263 or [email protected]. old, state-of-the-art facility. In addition call (253 >983-9739. to spacious work areas, we offer an excellent compensation and benefit Available now, new construc­ package. Bellingham, with Puget South POSITIONS WANTED tion, 1000-6000 sq ft, close lo hospitals and the Cascades virtually at its on Union at 13’1’. Call Dr. Lovy al doorstep and 90 minutes from Seattle, Transcription Specialists are 756-2182 or 206 387 6633. has a wide variety of recreational and eager to provide prompt, accurate, and cultural activities for all members of professional transcription. Free pick­ your family. If you are interested in up and delivery. Daily turnaround . practicing in a beautiful and growing Excellent references and exceptional area please contact Jim Bymes, background in all specialties. Very Director of Clinic Operations, at 360- experienced. 253-925-3276. 714-1149 or e-mail at gymby @ aol .com. FaxCV to 360-715-8416 or mail to 1530 P o stin g : Medical Director Ellis, Bellingham WA 98225. C o m p a n y : Mary Bridge Children’s Health Alliance, Tacoma, Washington Description: Mary Bridge Children’s Health Alliance (MBCHA) is a unique health care corporation owned jointly by Mary Bridge Children’s Hospital and local pediatric providers. M BCHA works with the hospital and member pediatric providers to integrate the full spectrum of care in both the inpatient and outpatient arenas. MCBHA coordinates t AMERICAN LUNG ASSOCIATION., contracting, medical management, revenue management, data management, market ofWhshington analysis and strategic business building across a 9 county geographic region The Medical Director will assist with the implementation of an electronic medical record and practice management system and will be responsible for clinical data analysis, 1-800-LUNG-USA provider profiling and the development and execution of practice improvement initiatives. This physician leader will work directly with network providers as a change agent and will identify and communicate the clinical implications of changes in health care. Lung Information Experience: Doctor of M edicine Board Certified in Family Practice or Pediatrics. Extensive pediatric primary care clinical experience. Must possess a current, active, Service Line W ashington State license to practice medicine. The candidate will be a credible physician leader, with 5 years of management experience, who understands care management. This person will possess outstanding communication and leadership skills. Providing patient Interested parties please contact: Kenneth Dietrich, MD, MBA, Chief Executive education materials Officer, Mary Bridge Children’s Health Alliance, PO Box 5888, Tacoma WA 98415- 3, e-mail: kdietrich(a;mbcha.net. phone: 253-403-7900.

March, 2001 PCMS BULLETIN 23 Our Claims Staff Receives Top Praise

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W Phy:, sicians Patricia Mulligan, Oentcd and sponsored by ihe ■" InsuranceInsi Washington Mau W .h o i Asm Claims Representative Sr;iuk\ WA 0 PhvsiLinns Insu A Mutual Company

Pierce County Medical Society PRESORTED 223 Tacoma Avenue South STANDARD Tacoma, WA 98402 US POSTAGE PAID TACOMA, WA PERMIT NO 605 Return service requested

24 PCMS BULLETIN March, 2001 5 t actyour t e and natonal awmakers k a m w la l a n tio a n d n a ” e te u r T sta r e u B o y t to c d ta o n o o G c o “T to : w n o io H in p O y M In 15 11 e Bil l moki i aciii where mi s t g n e in s t e e r e p m e r ril a p A rs t o a in k m a e e sp r e to h w r le s id e r K ilitie c e fa ik M in r g e in n k o issio sm m n m a o b C ill e w c - n a 3 r 9 su 9 5 In ill B te a n e S 5 4 Presi ’ Page “ ng eani ” g in n a le C g in r SD p “S e: g a P <1 t’s n e id s e r P 3 iant f Members p - are growi g in w o r g e r a s r e b m u n S M C P - ip sh r e b m e M r fo ts n lica p p A oma erce Count Healh Depart : A ii i al t ” lth a e H l ta n e D in risis C “A t: n e tm r a p e D lth a e H ty n u o C e c r ie P a m co a T NSDE: E SID IN

B u l l e t i n

PCMS Officers/Trustees: Patrice N. Stevenson, MD President Susan J. Salo, M D ...... President Elect J. James Rooks, Jr., M D ...... Vice-President Michael J. Kelly, M D ...... Secretary /Treasurer Charles M. Weatherby. MD....Past President Sabrina A. Benjamin, MD Drew H. Deutsch, MD Stephen F. Duncan. MD Kenneth A. Feucht, MD April, 2001 Kevin K. Gandhi, MD Sumner L. Schoenike. MD

WSMA Representatives: Speaker of the House: Richard Hawkins. MD Trustees: David Law, MD; Nicholas Rajacich, MD AMA Delegate: Leonard Alenick. MD W AM PAC Chair/6Lh District: Mark Gildenhar, MD W AM PAC 9th District: Don Russell, DO

Executive Director: Sue Asher

Committee Chairs: A gin g, Richard Waltman; A ID S, James DeMaio; B ylaw s, Richard Hawkins; Budget/Finance, Mike Kelly: College of Medical Education, John Jiganti: Credentials, Susan Salo; Ethics/Standards Of P ractice, David Lukens; Grievance. Charles Table of Contents Weatherby: Labor & Industries. William Ritchie; Legislative. William Marsh: Medical-Legal, Mark Taylor; Membership Benefits, Inc., Drew 3 President’s Page: “Spring Cleaning” Deutsch; Personal Problems Of Physicians, Robert Sands: Public Health/School Health, Sumner Schoenike 4 Senate Bill 5993 will further restrict public smoking 4 Spina Bifida education could save lives The Bulletin is published monthly by PCMS Membership Benefits, inc. for members of the Pierce County Medical Society- Deadlines for 5 April General Membership Meeting: Insurance Commissioner submitting articles and placing advertisements in The Bulletin are the 15th of the month preceding 6 Community group meets - considers dental needs of children publication, (i.e. January 15 for the February issue)

The Bulletin is dedicated to the art. science and 7 TPCDH: "A Crisis in Dental Health” delivery of medicine and the betterment of the health and medical welfare of the community. The 8 Legislative/Payment Integrity Program Updates opinions herein are those of the individual contributors and do not necessarily reflect the official position of the Medical Society. 9 Applicants for Membership Acceptance of advertising in no way constitutes professional approval or endorse-ment of U In My Opinion: "To Good to Be True” products or services advertised. The Bulletin and Pierce County Medical Society reserve ihe right to reject any advertising. 13 Medical societies in other slates take aim and fire

Managing Editor: Sue Asher 14 Physician Directory changes Editorial Committee: MBI Board of Directors

Advertising Information: 253-572-3666 15 How lo contact your state and national lawmakers Subscriptions: $50 per year, $5 per issue 16 Physicians Insurance reports claim trends by specialty Make all checks payable to: MBI 223 Tacoma Avenue South. Tacoma WA 98402 Phone: 253-572-3666; Physicians call 572-3667 17 College of Medical Education FAX 253-572-2470 18 Technology Today E-mail address: pemswa^pemswa.org Home Page: http://www.pcmswa.org 19 Classified Advertising

2 PCMS BULLETIN April, 2001

X Bui ,!,ET!N

Senate Bill 5993 will ban smoking in facilities where minors are present

At press time. Senate Bill 5993, ban. playing-field for all restaurants state­ which will effectively reduce public- The restaurant industry actually wide. Tacoma and Pierce County smoking, had been approved by the helped craft the initiative. Experience restaurants continually opposed local Senate and forwarded to the House. has proven that curtailing smoking in legislation that they feared would drive After House passage, and approval by restaurants actually increases business. customers to King or Thurston coun­ the governor, the new law will prohibit Cleaning costs are reduced, employee ties. A state regulation makes all smoking in public except for taverns, health and morale increase and restaurants operate w'ith the same rules, lounges and cardrooms. potential liability of not providing a safe a rule that many supported if mandated Historically such legislation would work place for employees is drastically on a state-wide basis. never have made it out of committee. decreased. And, of course, education Call your representative today But in today's climate, where voter about the effects of second-hand (see page 15) to voice your support for initiatives are outlawing smoking in smoke to non-smokers, particularly Senate Bill 5993. And don’t forget to public entirely, the normal foes of such children, has raised awareness about call and thank your senator for passing legislation, the tobacco industry and the need to lessen exposure lo tobacco this “healthful" legislation. ■ restaurant association, view this toxins. legislation as a compromise to a total This legislation also levels the

Spina bifida education could save thousands of lives

Because most women tend to get disabling birth defect. pregnant and during the first trimester their health information from what they Folic acid preventable spina bifida of pregnancy. Furthermore, according read and hear, the Spina Bifida and anencephaly could be reduced by to the recommendation, women who Association of America (SBAA) "Folic up to 75 percent if women take the have had a child with spina bifida or a Acid Counseling Kit" hopes to encour­ recommended doses of folic acid. history of neural tube defect preg­ age increased discussion between The resource kit contains patient nancy need 4.0 mg of folic acid by women and their health care providers. education materials and a pocket- prescription. A recent survey reported in Reuters counseling card for physicians to The AMA encourages physicians Health found that only 30 percent of quickly provide folic acid recommen­ to help protect children during their women of childbearing age knew why dations to their patients. The U.S. fetal development by communicating folic acid was important. Approximately Public health Service recommends all this message to their patients, family one out of every 1,000 newborns women of childbearing age consume and friends. ■ suffers from spina bifida, a permanently 0.4 mg of folic acid prior to becoming

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4 PCMS BULLETIN April, 2001 cAeftv dcintfi/ Q hj'dica/C'A’ctety

invites you and your spouse/guest to the

April General Membership Meeting

Tuesday, April 10, 2001 Landmark Convention Center Social Hour: 6:00 pm Temple Theatre, Roof Garden Dinner: 6:45 pm 47 St. Helens Avenue Program: 7:45 pm Tacoma discussions with our new. Insurance Commissioner

► Replacement of former Commissioner Deborah Senn ► University Place native ► Doctor of Optometry (Pacific University) Mike Kreidler ► Master's in Public Health (UCLA) ► Group Health Optometrist (20 years) ► 16 years in Washington State Legislature

Discussions will include: Priorities and plans for the office Specific changes and how they will impact health insurance in Washington state Restoring the individual insurance market Oversight of plans: contract review, network adequacy, compliance, etc. Kreidler's Crystal Ball: How will our health care system operate in 2010???

(Register by April 6. Return form to: PCMS, 223 Tacoma Ave S, Tacoma 98402; FAX to 572-2470 or call 572-3667

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April, 2001 PCMS BULLETIN 5 Community group considers prevention for dental needs of children

Several members of the medical/ for prevention. "My time will be much dental offices are very busy and with denial community convened in March better spent trying to implement a the administrative and practice burdens to discuss a program to provide prevention program for these children of treating Medicaid patients, many preventative dental services for Pierce as opposed to continuing to drill and/or dentists opt out. Only about one-third County children under five. It has remove their teeth,” she explained. of people in the state go to the dentist been estimated that 71,000 kids be­ “The need is huge,” she added. regularly. With dental offices as busy tween one and 18 are eligible for Several issues were discussed that as they are, Washington state does not dental care funded by Medicaid, but create barriers for treating these very have the resources to provide care. only 22.000 received care. Everyone is young folks. “Many dentists are not W hich is all the more reason that in agreement that the need exists and comfortable with their skill level in the community needs to solve the no one will deny the real trauma that treating infants and young children,” problem from a comprehensive, untreated dental problems bring to a noted Dr. Peter Milgrom, from the prevention approach. Dr. Sorenson is young child’s life. There is no argu­ University of Washington School of on the right track of bringing commu­ ment that prevention works and with Dentistry. “They say they can't afford nity representatives together to education, fluoride treatments, sealants to take Medicaid children, but some­ brainstorm creative solutions for Pierce and regular check-ups, dental catastro­ times the real issue is fear of treating County’s children. The reward will be phes for children can be avoided. young patients.” Add to this that most their smiles. ■ At the table to hear about whaL is happening in other counties in the state were medical and dental society leaders, local health department and state representatives, community clinic volunteers and staff and community TACOMA RADIOLOGY agency representatives. In other counties, the ABCD program (Access to Baby and Child Dentistry) has been implemented and focuses on preschool children from birth to age five. The program began as a pilot program in Spokane County from efforts of the Medical Assistance Program and the Washington State Legislature to expand Medicaid dental services for children. In Spokane, the program is operated as a partnership of the ine & Femur Medicaid program, Spokane Dental DFXA Society. Spokane Regional Health Medicare covers beneficiaries every 23 months District, Washington State Dental when the following criteria are met

Association and the University of Mr.n liioi ing ul I'DA jpprovcKl osteoporosis rfrug Ihewpy nuiy allow lor greater frequency of examination W ashington. Dentists in the program are trained and certified and receive 1. Postmenopausal (estrogen deficient) women at risk for osteoporosis enhanced payments lo provide 2. Individuals with vertebral abnormalities improved dental services to the young 3. Individuals receiving long term gluccocortoid therapy clients. Case-management services are 4. Personal history of primary hyperparathyroidism provided to minimize the number of www. tacomarad. com missed appointments. Karen Sorenson. DDS. organizer Allenmore Medical Center Lakewood Office of the Pierce County meeting, prac­ (253) 383-2038 (253) 588-6083 tices two days a week at the Lindquist Clinic and recognizes the severe need

6 PCMS BULLETIN April, 2001 Federico Ciuz-Uribe, MD The Health Status of Pierce County Director of Health

-s#» A Crisis in Dental Health

HEALTH Recently, I published an article program. I've collected a laundry in the Tacoma News Tribune list of system problems, low reim ­ (March 4, 2001) about the difficulty bursem ent being but one of many. lo w in ­ But we cannot allow this to distract better than that. c o m e c h il­ us from the basic problem: kids are Before the federal government dren faced not able to access the care they stepped in with the M edicaid and in a c c e s s ­ need to be healthy. This should be Medicare systems, county govern­ ing dental our driver. ments were on the hook for assuring c a r e in M uch as I w'ish that our that there was a response to the P ie r c e elected officials in Olym pia and in healthcare needs of the indigent. C o u n ty . W ashington, DC had the answers. Our county responded by develop­ T h e r e a re I have learned from bitter experi­ ing a system of county clinics and a a p p r o x i­ ence that it is not wise to wait for county hospital for providing the ba­ Federico m a te ly their answers to local needs. Of sic care needed for the uninsured. Cniz-Uribe. MD 7 0 .0 0 0 course we must work with our Private medical providers were c h ild r e n elected officials to craft long term responsible for taking their share of eligible for care but only about solutions to systemic problems. patients through this system. The 22,000 actually make it into a pro­ And we do need to build a more vast majority of these kinds of vider, because there are so few pro­ rational health care system. But, systems across the United States viders who accept fam ilies with this does not give us the luxury of closed over the years as the M edic­ M ed icaid . stepping away from critical prob­ aid and M edicare systems became No one argues that these kids lems that need our attention right functional. But those systems could shouldn't have services. The need is now. We must participate with our only do what they were intended to glaringly obvious. The Health communities in addressing real­ do if providers continued to partici­ Department’s Dental Hygienist time problems now'. So the M edic­ pate. If providers didn’t take on regularly screens students in the el­ aid program is seriously flawed. their share, patients fell through the ementary schools across the county. Does that mean we do not treat cracks. Sometimes in small numbers She finds gross dental disease in the needy children in the mean­ but as in the case of our local dental small mouth after small mouth. And tim e? In the area of dental health, providers, the numbers have become following their screening many of unfortunately that is what has alarmingly large. these kids do not get the restorative happened. Dentists over the last W hat are our alternatives? and on-going care that they need, ten years have grown increasingly Though re-instituting the county even with information and referrals disconnected from the Medicaid clinic system seems like a radical sent home to parents. program and have abandoned it in step, unless we can come up with A typical response to this prob­ droves. W e’ve now reached a real-time alternatives to get the lem is a knee jerk reaction: focusing point where only about 4 % o f needed care to our children, it may on the dysfunctional nature of our dentists participate in any m ean­ be the best option open to us. health cafe system. In particular, we ingful manner. This means that W hat do you think? I'd be inter­ hear about the horrible problem s ever increasing numbers of ill ested to know' what your ideas are both users and providers encounter children have been turned away. for care for indigent kids in Pierce when participating in the M edicaid This is unacceptable. We can do C o u n ty .i

April, 2001 PCMS BULLETIN 7 Personal Problems Legislative Updates

of Physicians Optometrists’ and naturopaths' attempts to expand their scope of practice continue. SHB 2034 and SSB 6000 provide a broad expansion of the definition of the Committee practice of optometry and prescriptive authority. SB 5581 would allow naturopaths to be referred to as physicians, and ironically, would give them prescriptive authority for legend and controlled substances. These remain alive in the legislature and Medical problems, drugs, alcohol, need your voice to be defeated. (See page 15) retirement, emotional,

or other such difficulties? SB 5211, Partial Mental Health Parity for Kids has passed the Senate and has moved to the House. This bill addresses the disparity between insurance coverage for mental health services and coverage for medical surgical services and requires a Your colleagues minimum level of mental health coverage for children. Please call your representa­ want t o help tive. particularly if they are a member of the House Health Care Committee and voice your support. (See page 15) ■

*Robert Sands, MD, Chair 752-6056 Bill Dean, MD 272-4013 Payment Integrity Program Tom Herron, MD 853-3888 Bill Roes, MD 884-9221 DSHS has agreed to work with a group appointed by the W SMA to review F. Dennis Waldron, MD 265-2584 the program’s “black box” algorithms and prejudicial communications with medical practices. However, this is in no way an endorsement of the PIP program. Medical practices statewide continue to limit their acceptance of Medicaid patients Confidentiality or drop out of the program altogether. These difficult decisions must be made on Assured an individual basis factoring in the complexities and offensiveness of the PIP p ro g ra m .!

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8 PCMS BULLETIN April, 2001 Applicants for Membership

Anderson, Pauline M, MD Fegley, Janis E, DO Larson, Todd D, MD O b /G y n Family Practice Internal M edicine Practices at St. Joseph M edical Clinic Practices at St. Joseph Medical Clinic Practices at St. Joseph Medical Clinic 1708 S Yakim a, T acom a 98405:593-8437 1708 S Yakima, Tacoma 98405; 593-8456 1708 S Yakima, Tacoma 98405; 593-8400 Med School: Univ College of Dublin Medical School: Philadelphia College Med School: Vanderbilt U and Hospital Internship: Highland Hospital, NY of Osteopathic Medicine Intern: Santa Barbara Cottage Hospital Residency: Highland Hospital, NY Internship: Allentown Ost Med Ctr Res: Santa Barbara Cottage Hospital Residency: Allentown Ost Med Ctr Fellowship: UCLA Baca, Carlos E, MD, PA General Practice Field, Dean A , MD Stoman, Najibuilah S, MD, PA Western State Hospital Family Practice General Surgery 9601 Steilacoom Blvd, Practices at Gig Harbor Medical Clinic Western State Hospital Steilacoom98498; 582-8900 6401 Kimball Dr, Gig Harbor 98335; 9601 Steilacoom Blvd, Steilacoom Medical School: Utiiversidad Nacional 858-9195 98498:582-8900 Mayor De San Marcos, Lima, Peru Medical School: University of Arizona Medical School: Medical College Kabul Internship: Hospital Del Empleado Internship: Good Samaritan Medical University, Afghanistan Center, Phoenix Internship: Kabul University Bernardo, Johann V, MD Residency: Good Samaritan Medical Residency: Ayicenna Hospital Internal M edicine Center, Phoenix Fellowship: All India Institute of Practices at St. Joseph Medical Clinic Medical Sciences 1708 S Yakima, Tacom a 98405; 593-8400 Ho, Phoebe F, MD Medical School: University of the O b /G y n S u lliv a n , Kevin J, MD Philippines College of Medicine Practiccs at Tacoma South Medical Family Practice Internship: Metropolitan Hospital, NY Clinic, 2111 S 90th St, Tacoma 98444; Practices at Gig Harbor Medical Clinic. Residency: Metropolitan Hospital, NY 539-9700 6401 Kimball Dr, Gig Harbor 98335; Medical School: USC, Los Angeles 858-9195 Berns, Robert M, MD Internship: USC, Los Angeles Medical School: USC Family Practice Residency: Northeastern Ohio Internship: UCLA Practices at St. Joseph Medical Clinic Universities Residency: UCLA 1708 S Yakima, Tacoma 98405; 593-8456 Medical School: USC, Los Angeles Hong, Hui, MD Venuto, Gail C , MD Residency: Santa Monica Hospital Internal Medicine O b /G y n Practices at Tacoma South Medical Practices at Gig Harbor Medical Clinic, Chang, Emery J, MD Clinic, 2111 S 90th St, Tacoma 98444; 6401 Kimball Dr, Gig Harbor 98335; General Surgery 539-9700 858-9192 Practices at Tacoma South Med. Clinic Medical School: McGill University Medical School: George Washington 2111 S 90th St, T acom a 98444; 539-9700 Internship: Virginia Mason Med Ctr U n iv ersity Medical School: Boston University Residency: Virginia Mason Med Ctr Residency: Bridgeport Hospital Internship: Boston University Fellowship: UCLA Residency: Western Reserve Care Woodman, Troy J , M D Johnson-Colt, Holly N, MD Orbital Facial Surgery Cieri, Martin V, MD P e d ia t r ic s Practices David Pratt. MD P ed ia trics Practices at W oodcreek Pediatrics 1901 S Cedar#204, Tacoma 98405; Practices at St. Joseph M edical Clinic 1706 Meridian S #120, Puyallup 98371; 627-2900 1708 S Yakima, T acom a 98405; 593-8407 848-8797 Med School: Baylor College of Med Med School: University of Maryland Medical School: Dartmouth Internship: LI of W ashington Internship: Strong Memorial Hospital Internship: UW Children's Hospital Residency: Baylor College of Med Residency: Strong Memorial Hospital Residency: UW Children’s Hospital Fellowship: UCLA. Jules Stein Eye Inst

April, 2001 PCMS BULLETIN 9 B u l l e t in

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B u l l e t i n

kind of health care a right. In practice it W hen the system then turns to the V T V / v / v l from page 11 is alms, given reluctantly, to a snivelling sources of funds, such as the govern­ beggar. When I present my claim to ment or the insurance companies, it is tilings in a similar fashion. health care, together with thousands told there is no more money to be had. How then do I make good oil my others, the people who pass judgment on The taxpayers and the ratepayers claim to health care? In theory, I those claims, have no good way of have rebelled against further increases should be able to get it when and how I knowing how real, how important, or in taxes and rates. At the same time, the want it. In practice, it does not work how pressing my claim may be. recipients of health care are clamoring that way, In practice, there are m alin­ The resources assigned to take for more benefits. W hile all that is go­ gering children, who pretend to be sick, care of these claims are rapidly spent. ing on, the people working in the just so they don't have to go to school. The system, overwhelmed by the re­ medical field bum out and leave. In practice, there are malingering adults quests, has to resort to some kind of tri­ Those who are still working are who pretend to be sick, just so they age, to apportion limited resources in asked to do more and more with less don't have to go lo work. Parents the face of unlimited demands. Mean­ and less, in the expectation that some usually know, or easily figure out, while, the people who are expected to day they will be able to do everything when their child is not really sick. make good on these claims are over­ with nothing. That is what the dream of How are the governor's agents worked. They reach the point where the perpetual motion machine was going to figure it out? By putting they don’t care anymore. They look about. In the field of physics, that hurdles in our way to get health care. 011 the people who come to them with dream died many years ago. It still lives We have to prove that we are sick. We their claims not as patients, to be in the field of the social sciences. Medi­ have to prove it is an emergency. We treated, but as an annoyance, to be cal care as a right, whenever and in are made lo wait in the emergency avoided. If they could brush off a claim any way we want it, without doing any­ room, for an appointment, for a test, for in some way. or just delay it for as long thing to earn or deserve it, given to us an operation. I don't have to give you as possible, they would gladly do so. on the sole basis of our wishes, sounds examples. We already have many of Frequently enough, they are able to do too good to be true, and so it will turn that sort around us. If you want to just that. out to be. ■ know more, ask any Canadian, Briton, or Russian. They’ll tell you more than you want to hear. My father lived in Montreal. He Advanced Training in Management had a hernia he wanted to have re­ For physicians and other clinical practitioners paired. He had to wait six months for an appointment with the surgical clinic. Both the evening/weekend Master of Health Administration (M.H.A.) and Certificate W hen he finally got to consult a sur­ Program in Medical Management assist practicing clinical professionals to develop geon. he was scheduled to have the re­ knowledge and skills in management applicable to every day work situations. pair done two years later. In the mean­ Master of Health Administration (M.H.A.) This program provides time, he had to wear a truss and put up advanced, in-depth knowledge and skills in planning, organizing and implementing with the disability and pain. When he programs which address health needs and improve the cost effectiveness and quality of presented to have the operation, they patient care. The application deadline is April 30. Applications are currently being found an excuse to cancel it. He was accepted. Applications received after the deadline will be reviewed on a space-available not a complainer, so he put up with it. basis. He died several years later, still wear­ Certificate Program in Medical Management This program provides ing his truss. Is that what a right to participants with basic knowledge and practice-oriented skills in health services health care means? The last T heard management, and helps participants determine if they would like to go further in their about health care in Canada, the wait­ management training. The application deadline is August 21, ing time for heart surgery was about six Both programs are offered by the University of Washington Department of Health Services months; for a mammogram, about the and Educational Outreach with representation from the UW School of Medicine. same, for colposcopy in the presence of an abnormal Pap smear, about three For additional information or an application packet, contact us at; m o n th s. Under such a system, a person has 206 - 616-2976 to complain loudly enough, to whine, to http://depts.washington.edu/mhap/eve/index.html

cry, to beg. Some people may call this The U W reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marilal status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations. For disability services, call 205-543-6450 or 543-6452 (TTY) as soon as possible.

12 PCMS BULLETIN April, 2001 '&0S/;//if

Medical Societies in other states take aim and fire ...

Texas physicians issue nominations for “Clean Claims Hall of Shame”

The Texas Medical Association pay clean claims within 45 days, but in­ cians, patient care is put at risk,” said (TMA) is asking Texas physicians to surers and health plans ignored the law TMA President James Rohack, MD. submit nominations to its ‘"Clean Claims because it lacked meaningful penalties "We want a law with teeth.” Hall of Shame,” to help the association and allowed health plans to modify the The TMA proposal includes not spotlight reimbursement delays and de­ time period. allowing health plans to modify state nials it says insurers have turned into The 1999 law contained interest law through contract provisions and an “obscene art form.” A recent TMA and other penalties, but health plans providing strong civil penalties and ad­ survey fount that about 60 percent of again were allowed to modify the time ministrative enforcement. TM A also is all Texas physicians are reporting cash period required to pay. pressing the state insurance commis­ flow problems - despite two Texas “We want the public and lawmak­ sioner and legislature to do what is nec­ prompt pay law s. ers to know that when insurers refuse essary to ensure that laws are en­ The 1997 law required insurers to to pay what they legally owe to physi­ fo rce d . ■

Illinois fair-contracting bill takes positive first step

After their Fairness in Contracting bill was professionals and providers," said Leroy Sprang. MD. ISMS passed last week by the Illinois House Executive president. “No physician, health care provider or any profes­ Committee, the Illinois State Medical Society sional should be forced into 'take it or leave it' and other unfair (ISMS) and its “Fairness in Contracting” coalition contract situations."■ members are readying themselves for even stron­ ger opposition from Illinois health plans. The bill would: • Provide reasonable standardization and sim­ plification of terms and conditions of health care service contracts with health plans to facilitate un­ derstanding and comparisons; and ERASE • Eliminate provisions contained in health care service contracts which may be unfair, deceptive, THAT TATTOO misleading or unreasonably confusing in connec­ WORRIED ABOUT WHAT YOUR SPOUSE, tion with the administrative requirements, services YOUR FRIENDS OR EVEN YOUR BOSS covered or with reimbursement or payment for THINKS ABOUT YOUR TATTOO? services. OR ARE YOU JUST TIRED OF In addition to ISMS, the coalition includes the LOOKING AT IT? Illinois Hospital and Health Systems Association; Today’s newest Alexandrite laser, will remove your tattoo nurses, physical therapy, podiatry, optometry and with minimal discomfort & psychological associations; state dental and chiro­ less than 1% risk of scarring. practic societies; the Illinois Free-Standing Sur­ ('it!! lotldv Inr more itifnnnatmu gery Center Association; and the Illinois AFL- PIERCE COl^sTY CIO. The coalition represents more than one mil­ lion physicians and other professionals. LASER CLINIC “We are committed to restoring the balance Director IVlcr K \1:irxli between large payors and individual health care (253)573-0047

April, 2001 PCMS BULLETIN 13 X Directory Changes

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14 PCMS BULLETIN April, 2001 W ’t'erw it'o a ith f 04iedie«! dfocieh/

How to contact your state and national lawmakers

P resident may be reached by mail: 1600 Pennsylvania Ave NW, Washington D.C. 20500; his message phone is 202-456-1 1 I 1

U.S. Senators and Representatives: Sen. Maria Cantwell (D), 464Russell Senate Building, Washington, D.C. 20510; 202-224-3441 (DC) or 206-220-6400 (Seattle) FAX: 202-228-0514 or email: [email protected]

Sen. Patty Murray (D), 173 Russell Senate Building, Washington. D.C. 20510; 202-224-2621 (DC)or 206-553-5545 (Seattle) FAX: 202-224-0238 or email: [email protected]

Rep. Norm Dicks (D-6th), 2467 Rayburn House Building. Washington D.C. 205 15; 202-225-5916 (DC) or 253-593-6536 (Tacoma) FAX: 202-226-1176

Rep. Adam Smith (D-9th), 116 Cannon House Office Building. Washington D.C., 20515:202-225-8901 (D C ) o r 253-926-6683 (Tacoma) or toll free 1-888-764-8409; FAX: 253-926-1321. email: [email protected]

State Offices: Governor Gary Locke, Legislative Building, PO Box 40002, Olympia 98504-0001. 360-753-6780, FAX: 360-902-4110, home page: www.governor.wa.gov

State Representatives: Washington House o f Representatives, PO Box 40600, Olympia, WA 98504-0600 State Senators: Washington State Senate, PO Box 40482. Olympia, WA 98504-0482. The central Senate FAX: 360-786-1999

To leave a message for lawmakers or to learn the status of legislation, call the Legislature's toll-free hotline, 800-562-6000. The hearing impaired may call 800-635-9939,. The Legislature’s Internet home page address is www.leg.wa.gov.

Legislators by district with Olympia phone numbers (ALL 360 AREA CODE) and email addresses:

2nd District, (South Pierce County) 28th District, (West Tacoma, U .P ., Fircrest, Lakewood) Sen Marilyn Rasmussen (D) 786-7602; [email protected] Sen Shirley Winsley (R) 786-7654: [email protected] Rep Roger Bush (R) 786-7824; [email protected] Rep Mike Carrell (R) 786-7958; [email protected] Rep Tom Campbell (R) 786-7912; [email protected] Rep Gigi Taicott(R) 786-7890; [email protected]

25th District, (Puyallup, Sumern, Milton) 29th District, (South Tacoma, South End, Parkland) SenJimKastama(D) 786-7648; [email protected] Sen Rose Franklin (D) 786-7656; [email protected] Rep Dave M orell (R) 786-7968; [email protected] Rep Steve Kirby (D) 786-7996; [email protected] Rep Sarah Casada(R) 786-7948; [email protected] Rep Steve Conway (D) 786-7906: [email protected]

26th District, (NW Tacoma, Gig Harbor, South Kitsap) 30th District, (NE Tacoma, Federal Way) Sen Bob Oke (R) 786-7650; [email protected] Sen Tracey Eide (D) 786-7658: [email protected] Rep PatLantz (D) 786-7964; [email protected] Rep Maryann Mitchell (R) 786-7830; [email protected] Rep Brock Jackley (D) 786-7802; [email protected] Rep Mark Miloseia(D) 786-7898; [email protected]

27th District, (North Tacoma, East Side) 31st District, (East Pierce County) Sen Debbie Regala (D) 786-7652; regala_de@leg .wa.gov Sen Pam Roach (R) 786-7660; [email protected] Rep Ruth Fisher (D) 786-7930; [email protected] Rep Chris Hurst(D) 786-7866; [email protected] Rep Jeannie Dameille (D) 786-7974; darneillje@ leg.wa.gov Rep Dan Roach (R) 786-7846; [email protected]

For more specific information about the legislative process or for a copy of the 2001 Guide to the Washington State Legisla­ ture which includes listings for elected state and federal officials, please call PCMS, 572-3667.

April, 2001 PCMS BULLETIN 15 X B u l l e t i n

Physicians Insurance report claim trends by specialty

With the rise in public expecta­ • Neurology: failure to diagnose • Plastic surgery: reduction mammo- tions of the medical system and the le­ herniated disc, improper treatment of plasty, augmentation mammoplasty, rhytidectomy gal system 's pro-plaintifl' bias, it is no seizure disorder, failure to treat risk o f stro k e surprise that claim frequency and se­ • Psychiatry: failure to properly treat verity are increasing. To help physi­ • Obstetrics: improper reading of fetal depression, improper treatment of cians avoid situations and behavior that monitor strip, failure to do a timely c- personality disorder, sexual contact can lead to malpractice claims. Physi­ section, failure to diagnose breast • Radiology: diagnosis of breast cians Insurance continually identifies can ce r cancer, diagnosis of lung cancer, and analyzes claim trends. National complications from invasive proce­ data and iheir own records tell them • Ophthalmololgy: cataract surgery, that the highest total payments in­ treatment of retinal detachments, du res diagnosis and treatment of glaucoma volve brain-dam aged infants, • Urology: treatment of renal calculi, breast cancer, pregnancy, and • Orthopedics: surgical complications prostate surgery, renal disorders acute myocardial infarction. Be of intervertebral disc, surgery/ low is a list by specialty of medical-mal- treatment of femur fractures, carpal Good record keeping and patient practice allegations that have been the tunnel syndrome rapport remain the cornerstones of most expensive to resolve: effective risk management. If record • Otolaryngology: treatment/surgery keeping is adequate and patient • Anesthesiology: failure to monitor, of sinusitis, treatment of upper rapport is good, the likelihood of a failure to complete patient assess­ respiratory diseases, treatment of claim - regardless of the technical ment, improper intubation/positioning deviated nasal septa aspects of the care - is greatly mini­ • Cardiology: diagnosis of myocar­ • Pediatrics: treatment/resuscitation m ized. dial infarction, complications from issues of newborns, diagnosis/ If you would like to know more catheterization, medication manage­ treatment of infectious disease, about managing risk in your practice, ment of anticoagulants medication errors for chronic please contact Physicians Insurance - p ro b lem s risk@phyins. com or at 1-800-962-1399* • Dermatology: failure to diagnose sldn cancer, improper treatment of psoriasis, improper treatment of acne

• Emergency medicine: failure to “Getting on the Right Track: Life with ADD”, a national conference, will be diagnose myocardial infarction, held in Seattle, May 3-6, 2001. Key presenters include: Edward Hallowell, MD; failure to diagnose spinal fractures, Peter Jensen, MD; John Ratey, MD; Timothy Wilens, MD; Thomas Brown, failure to diagnose appendicitis PhD; Sari Solden, MD; and Thom Hartman. Featured presentations include “A User’s Guide to the Brain - Through the Lens of Attention” (Ratey); • Fam ily practice: obstetrics, failure Inattention and Executive Functions: New Understandings of ADHD” (Brown); to diagnose breast cancer, failure to “ADD and the Law in Post Secondary Education and Employment” (Latham diagnose myocardial infarction and Latham); and “ADHD/NLP: Two Days to Transformation” (Hartman). Up • Gastroenterology: failure to to 15 CEs available. W eb site: www.add.org; e-mail: conference @add.org; diagnose abdominal cancer, failure to phone: (847) 432-ADDA. diagnose appendicitis, failure to diagnose esophageal stricture Attention Deficit D isorder Resources, a non-profit organization based in • General surgery: surgical Tacoma, has a five hour training video for clinicians on ADD that professionals complications of gall bladder surgery, may borrow and view for free (deposit and $5 P&H required). This excellent hernia surgery, and breast surgery training video, produced by Dr. Daniel Amen, normally sells for $300, but • Internal medicine: failure to because our organization is committed to educating professionals about this diagnose breast cancer, failure to disorder, we loan it out for free. Interested persons should contact us at diagnose bronchus/lung cancer, [email protected] or by writing ADD Resources, PO Box 7804, Tacoma failure to diagnose myocardial WA 98406. We also maintain a free register of ADD Clinicians. If you wish to infarctio n be on this register, complete the necessary form at our web site or request the form in writing.

16 PCMS BULLETIN April, 2001 ffiw ce 'itw m tf Q -$c

COLLEGE Continuing Medical Education OF MEDICAL Pain Management Focus EDUCATION set for April 6 CME

Pain Management is the focus of in pain management relative to public the College's continuing medical concerns, discussions, and political education program scheduled for initiatives during the past decade. Allergy, Asthma Friday, April 6, 2001. The program is complimentary for PCMS members. Topics for the course include: and Pulmonology The one-day course is designed for Ml physicians and specialties and • Current Strategies in Opiate Postop­ CME-May4 will offer lectures covering acute and erative Pain Management chronic pain management including • Current Strategies in Opiate Chronic interventional and pharmacological Pain Management Including Legal The College's CME program therapies. A program brochure Issues featuring subjects on allergy, asthma & detailing the topics and faculty has pulmonology is set for Friday, May 4 at been mailed to your office. • Recent Advances in Interventional St. Joseph Medical Center. The course The program is under the direc­ Pain Management is under the medical direction of Alex tion of Dr. David Paly, a Tacoma • Problems in End-of-Life Pain and Mihali, MD. anesthesiologist and will be held at St. Symptom Management A brochure with details regarding Joseph Hospital’s Lagerquist Confer­ the conference was mai led in late ence Center. • Rational Use of NSAIDs for Acute March. This Category I CME program and Chronic Pain Management Presentations on COPD, Pneumo­ focus is a first for the College and is in nia, and Asthma & Allergy will be response to strong physician interest • Regional Anesthesia Advances for covered in the annual course. and both PCMS and WSMA continue Postoperative Pain Management To register call the COME at to encourage education for physicians 627-7137. ■ • Pains, Past and Future ■

Medical Technology CME Joins PCMS Dates Program D irector^ Membership Meeting Friday, April 6 Pain Management David Paly, MD Saturday, April 28 Surgery Update Glenn Deyo, MD The planned Medical Technology CME program meeting originally Allergy, Asthma & scheduled for May 16 and 23 will now Friday, May 4 Pulmonology for Alex Mihali, MD be combined with the June PCMS Primary Care General Membership meeting. Initial plans include review of Advances in Women's options for technological advances in Friday, May 18 John Lenihan, Jr., MD Medicine electronic medical records. Details regarding the program will follow in future B ulletins and membership corresondence.i

April, 2001 PCMS BULLETIN 17 B u l l e t i n

Technology Today

From Harrison Coever & Associates... “Companies that use the Internet tech­ nology to cut cost and improve productivity are reaping big rewards. American Air­ ; AMERICAN LUNG ASSOCIATION, lines spends less than 10 cents to create an e-ticket compared with $12 for a paper ofWjsbington v e rsio n . The las Vegas Bellagio Hotel screened 84,000 applieatns in 12 weeks, inter­ viewed 27,000 finalists in 10 weeks, and processed 9,600 hires in 11 days without a 1-800-LUNG-USA single sheet of paper.” Seen on the Internet... Lung Information In Japan, they have replaced the impersonal and unhelpful Microsoft messages with their own Japanese haiku poetry. Service Line

Three things are certain: A file that Big? Providing patient It might be useful. Death, taxes, and lost data. But now it is gone. Guess which has occurred. education materials

Chaos reigns within, Windows NT crashed: Reflect, repent and reboot. I am Blue Screen of Death. Order shall return. No one hears your screams.

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18 PCMS BULLETIN April, 2001

B u l l e t i n Q /ftS fiw l (Society J

Our Claims Staff Receives Top Praise

“I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.” Co nine Jcdynak-Bell, DO, Tacoma, Washington

laf& W hen limes are tough, physicians count on us to fight for their best interests— from the day a claim is discovered to the day it’s resolved. From die onset, we educate 1'- 1 physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly—with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t you want only the very best on your team? For more information, call us today at 1-800-962-1399. Physicians

Patricia Mulligan, CrctiiL'd am! sponsored by the ^ Insurance Washington state Medical Association Claims Representative Si?:m!e, WA l-'hysiciLins Insurance 2001 A Mutual Company

Pierce County Medical Society PRESORTED 223 Tacoma Avenue South STANDARD Tacoma, WA 98402 US POSTAGE PAID TACOMA. WA PERMIT NO 605 Return service requested

20 PCMS BULLETIN April, 2001 INSIDE: 3 President’s Page: “Kreidler Comes Calling” 5 April General Membership Meeting Recap 7 Tacoma Pierce County Health Department: “Antibiotic Resistance” 8 May 14-18 is National Women’s Health Week 9 Letter from John K. Stutterheim, MD 11 In My Opinion: “The Multi-tiered Alternative” 17 National expert to speak at Women’s Medicine CME V B u l l e t in

PCMS Officers/Trustees: Patrice N. Stevenson, MD President Susan J. Salo, MD,,.,...... ,.....President Elect J. James Rooks, Jr., IVID...... Vice-President Michael J. Kelly. M D ...... Sccrelary/Treasurer Charles M. Weatherby. MD....Pasl President Sabrina A. Benjamin. MD Drew H. Deutsch, M D Stephen F. Duncan, MD Mav,j 7 2001 Kenneih A. Feucht, MD Kevin K. Gandhi. MD Sumner L. Schoenike. MD

WSMA Representatives: Speaker of the House: Richard Hawkins. MD Trustees: David Law, MD; Nicholas Rajacich, MD AMA Delegate: Leonard Alenick. MD WAMPAC Chair/6th District: Mark Gildenhar, MD W A M PA C 9th District: Don Russell, DO

Executive Director: Sue Asher

Committee Chairs: A g in g , Richard Waltman: A TDS. James DeMaio: B y la w s, Richard Hawkins; Budget/Finance, Mike Kelly: College of Medical Education, John Jiganti: Credentials, Susan Salo; Ethics/LStandards Of P r a c tic e . David Lukens; Grievance. Charles Table of Contents Weatherby; Labor & Industries, William Ritchie; Legislative. William Marsh; Medical-Legal, M ark Taylor; M embership Benefits, Inc.. Drew 3 President's Page: "Kxeidler Comes Calling” Deutsch: Personal Problems Of Physicians, Robert Sands; Public Health/School Health, Sumner Schoenikc 4 A ShorL History of Medicine

The Bulletin is published monthly by PCMS 5 April General Membership Meeting Recap M embership Benefits. Inc. for members of the Pierce County Medical Society. Deadlines for submilling articles and placing advertisements in 6 New Board Members Elected to NPN The Bulletin are the 15th of the month preceding publication, (i.e. January 15 for the February issue.) 7 TPCHD: "Antibiotic Resistance"

The Bulletin is cl edicated to the art. science and delivery of medicine and the betterment of the 8 May 14-18 is National W omen's Health Week health and medical welfare of the community. The opinions herein are those of the individual 9 Letter from John K. Stutterheim, MD contributors and do not necessarily reflect the official position of the Medical Society. Acceptance of advertising in no way constitutes 10 Applicants for membership professional approval or endorse-ment of products or services advertised. The Bulletin and ll In My Opinion: 'T he M ulti-tiered Alternative” Pierce Couniy Medical .Society reserve ihe right lo reject any advertising. 13 In My Opinion: “M ary’s Angels” M anaging Editor: Sue Asher Editorial Committee: MBI Board ol Directors 14 New Members

Advertising Information: 253-572-3666 Suhscriplions: $50 per year, $5 per issue 15 In My Opinion: “W hy must a recession follow an

Make all checks payable to: MBI 16 Directory changes 223 Tacoma Avenue SouLh, Tacoma WA 9X402 Phone: 253-572-3666; Physicians call 572-3667 FAX 253-572-2470 17 College of Medical Education

E-mail address: [email protected] 18 Federal Health Observances for May Home Page: hllp://www.pcmswa.org

19 Classified Advertising

2 PCMS BULLETIN May, 2001

B u l l e t i n

Kreidler from page 3 PCMS FaxNews

through the auspices of the W SMA. so let Bob Pcrna know of your interest. system down, Commissioner Kreidler noted that the OIC gets the most consumer complaints about auto insurance. This means that physician complaints are certainly not at the upgrading in front of the line so the more specific we can be and the better organized the more likely we are to have some satisfactory resolution. I thought I would end with some process pithy quotes: "I’m tired of reading about the problems in health care. I know the problems...I’d like to read about the solutions.” - Dr. Donald Mott. P C M S The popular, biweekly PCMS 2000 Community Service Award recipient and Chair of the Board of Good Samari­ FaxNews, has not been delivered for tan Community Healthcare. the past month due to computer “Nobody ever went to medical school because they couldn’t get difficulties. into business school." - Dr. Stuart Seides, President. Medical Society of the Dis­ The FaxNew's is a compilation of trict of Columbia, addressing the AM A National Leadership Conference. news and current events pertaining to "I’d like to meet the guy who first said, 'We can bill your insurance medicine and health locally, statewide for yo u .”' - Mike Podrasky. CPO and owner Valley Orthopedics.* and nationally. Giving just a brief summary of newsworthy items from numerous sources, the FaxNews can be briefly read and if further informa­ A short history of medicine tion is preferred, the source document is faxed to the reader upon request. 500 B.C. "Here, eat this root." The FaxNews can be faxed or 300 A.D. “That root is heathen. Say this prayer." emailed to your home or office. Watch 1750 A.D. "That prayer is superstition. Drink this potion.” for your copy soon. If you were not 1900 A.D. "That potion is snake oil. Swallow this pill." receiving the FaxNews and you would 1945 A.D. "That pill is ineffective. Take this antibiotic." like to be on the list, please call PCMS 2000 A.D. “That antibiotic is artificial. Here, eat this root.” with your fax number or email address.■

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4 PCMS BULLETIN May, 2001 •i&w yowttf Qmemm oa,et%f'

April General Membership Meeting Recap Insurance Commissioner Mike Kreidler meets with PCMS physicians

Recently elected Insurance Commissioner Mike Kreidler addressed the 65 attendees of the April General Membership meeting to inform them of plans and direction during his tenure of leading the Office of the Insurance Commissioner (OIC). (see page 3 for details) Many participants remained after the meeting to discuss particular areas of concern with the Commissioner and/or attempt to resolve dilemmas of long-term unpaid claims or frustrating payment procedures. ‘"Healthcare is a challenging environment. The system is fragile and consumers are beginning to rebel,” noted Kreidler. “We will be visiting these challenges as time goes on,” he said. Physicians in the state hope that the time comes soon. ■ Commissioner Kreidler welcomed questions and discussion after the meeting

Gordon Klatt, MD (right> visits with Tom Bageant, MD. Dr. Drs. Charles Weatherby (left) and Mark Gildenhar enjo\ Klatt is a Tacoma colo-rectal surgeon and Dr. Bageant a visiting. Dr. Weatherby is a fam ily practitioner and Dr. retired anesthesiologist Gildenhar an ophthalmologist

Tom Charbonnel, MD, Tacoma pediatrician, answers an Dr. Joe Jasper and his wife Donna discuss a specific issue important call with Ann Koontzfrom Molina Healthcare of Washington

May, 2001 PCMS BULLETIN 5 ~\ V B u l l e t i n

E MTALA: "the law of New members elected to unintended consequences” NPN Board of Directors

From "AMNews, 4/23-30/01

Fifteen years after the "anti-dumping" law has passed. The Northwest Physicians Network (NPN) annual Emergency Departments (EDs) are struggling to meet an un­ shareholder meeting was held March 20, 2001 at the La funded mandate burgeoning with new regulations and lawsuits. Quinta Inn in Tacoma. John P. Lenihan, MD, president, EMTALA - the Emergency Medical Treatment and Active recognized the contributions of board members in 2000. Dr. Labor Act - has become the "law of unintended conse­ Lenihan also welcomed incoming board members F red quences." harming emergency medicine. Thompson, MD Tacoma-based Orthopedic Surgeon, Congress passed the law in 19S6 to slop hospitals from Nancy Karr, MD Puyallup Rheumatologist, and turning away patients who couldn’t afford care. Over the Jonathan Jin, MD Lakewood Internist. Medical Director years. Health Care Financing Administration regulations and Ralph Johnson, MD honored outgoing members D rs. court cases have expanded it. Now, some doctors say it is so Andrew Loomis, David Munoz, and Alnasir Adatia for burdensome that it's a large contributor to the crisis in their leadership in the organization. America's EDs. The physician-owned network of 330 primary and spe­ Patients know they can't be turned away from EDs, so cialty care providers is the largest independent practice as­ they use them as primary care Facilities. Emergency depart­ sociation in the state. Its m ission is to assure the provision of ment w aiting rooms sometimes get so crowded that patients wait high quality managed care for its 20,000 members of all ages for hours to see a doctor. Yet hospitals and physicians often through improved care coordination among hospitals and don't get paid for their time or the supplies they need to treat network providers throughout Pierce and South King patients. It’s led some to call the law Am erican's "national health C o u n ty . care system." "The organization’s goal is to define the standard of ex­ And, while the number of patients in emergency depart­ cellence for independently provided managed medical care ments increases, the number of specialists willing to be on call for the State of W ashington," said Patricia Briggs, CEO. She in the ED declines. That leaves some departments without spe­ applauded NPN providers who improve the quality of care cialists to back up emergency physicians. delivered to members while being successful in reducing Some say EMTALA can be blamed for all the woes. A avoidable costs in medical care delivery. She warned that nursing shortage, some HM O’s practice of using the ED as a the unfavorable tide in national politics regarding HMOs has way to get free care to increase profits and other health care created apolitical environment increasingly hostile to all system breakdowns contribute to the problems that EDs face. managed care plans. She challenged leaders in Olympia and But. there is no doubt that EMTALA is a big contributor to the leaders of medical plans to learn from managed care or­ their daily headaches and changes need to be made soon. ganizations like NPN. She concluded by saying that what is Health care lawyers say that patients are increasingly in­ already known about effective patient care management is corporating EMTALA violations into medical malpractice being used to contain costs through systematic refinement cases, and it is an inviting area for new litigation. and measurement of improvement. ■ As a result of the problems, younger physicians are sub- specializing and finding ways to avoid taking call in the ED."

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6 PCMS BULLETIN May, 2001 'JP w k c % om ih/ Q yttahcal d foatty

Federico Cruz-Uribe, MD The Health Status of Pierce County Director of Health

m Antibiotic Resistance m

Around the world, increasing at­ and, through it, the drug companies T ACOM A-PIERCE COUNTY tention has focused on the development have pressed the notion that technol­ HEALTH of drug resistance among many of the ogy has the answer for most health DEPARTMENT most common organisms that cause problems. “Got a pain, a cough, the disease. We have not been unaffected in flu? There is a drug for you and you'll the county that has to be addressed by Pierce County, although, fortunately, feel better almost instantly. Call our lawmakers. Here are some statistics that right now the resistance in some organ­ toll-free number for details." should make us all cringe: isms is lower here than across the Patients want their problems dealt • 849( of all antibiotics manufactured are county. In 2000, we saw in Pierce with quickly, leaving physicians in a used in agriculture County: bind. Wanting to provide good care • 70% of all antibiotics made are used as • twenty-one percent of Staphylococcus and to please patients causes a great growth promoters in cattle, hogs and aureus isolates were methicillin-resis- deal of stress. Add to that the limited chickens tant, up dramatically from l°/c in 1996 amount of time for each patient and • Numerous studies have shown that an­ • Vancomycin resistance in enterococ- you gel a formula for over-prescribing tibiotics used in animal feeds are not cus species is also on the rise, having antibiotics. Something has to change. limited to impacting animals, but create grown from virtually zero in 1995 to al­ We know that patient education is health dangers for humans most 4% in 2000 a valuable investment of time, both for With continuous use of antibiotics • Many isolates o f Streptococcus treat­ on farm s, pneumoniae and other bacteria have ing m u lti­ shown resistance not only to front line p ro b ­ “Patients want their problems dealt drug re­ antibiotics but to the back-up drugs lem s sistant or­ routinely used in the past when there ap- with quickly, leaving physicians ganism s were treatment failures pro- in a bind. Wanting to provide eventually pri- ap p ear There are two areas to concentrate good care and to please patients solutions on, and work needed at every ately and are level, from local, to state, to federal, and causes a great deal of stress. ” p assed to even globally. for hum ans, Physicians in Pierce County have p re­ often a large role to play in preventing anti­ venting health issues. Recent studies leading to biotic resistance. Much of the resis­ show that many physicians give in to unbeatable illness. We need lo take the tance is driven by local antibiotic use. patient pressure to maintain high pa­ time to educate state and federal officials Our local medical community needs to tient satisfaction scores. But, the stud­ about the menace of continued antibiotic confront the issue aggressively. The ies show that patient satisfaction is not misuse in agriculture. Only then will we best strategy requires that we do more associated with receiving an antibiotic have the chance of slowing or even than just issue or re-issue guidelines on prescription, but rather with the patient stopping the spread of these dangerous the judicious use of antibiotics and to feeling that the physician explained organism s. tighten or re-tighten infection control the illness and the patient understood The Health Department has orga­ procedures. We have to look more the treatment choice. We need to add nized a Pierce County Task Force to carefully at other causes that are more patient education time to physician share information and ideas about ways awkward to confront. schedules - this has to be part of the to prevent the increase of antibiotic re­ It’s common knowledge that pa­ cost of doing business. sistance organisms. Do what you can to tients push and cajole and outright de­ The second major issue is the use help, by looking at your own practice mand antibiotics, even for routine treat­ of antibiotics in agriculture. This is a and by educating not only patients, but ment of viral infections. The media real problem in this state and across lawmakers, about the threat. ■

May, 2001 PCMS BULLETIN 7 May 14-18 is National Women’s Health Week

Women-Related E-Mail Addresses

American Academy of Cosmetic Surgery Fating Disorders Awareness/Prevention National Ovarian Cancer Coalition www.sinuscarecenter.coni/laseraao.hDnl www.edap.org www.ovarian.oig/

American Diabetes Association FDA: G u id e to Contraceptive Choices National Women’s Health Information www.diatecs.org/ www.fda.gov/ldac/tealLiiei' 1997/397_baby.html Center www.4woman.gov American Dietetic Association Frequently Asked Questions: Birth Con­ www.eatrighl.eom trol Methods National Women’s History Project mvw.4women.gov/raq/biithcont.litni www.nwhp.org American Heart Association www.women.ainericimheail.org Get a Mammogram: A Picture that Can Personal Health Guide - Put Prevention Save your Life Into Practice American Obesity Association www.hcla.gov/publi311W 111an 1mog.txt www.ahiq.gov/ppip/ppadulthmi www.obesity.org Hormone Replacement Therapy Phlebology: The Treatment of Leg Veins American Medical Women's Association wwv.nih.gov/nia/heallWagepages/honnone.hlni www.plilebology.org/biiochiire.htm www.ama-assn.org/ How to Perform a Breast Self-Exam Sisters Together: Move More, Eat Better Arthritis Foundation www.cancer.org/NBCAM_breast_self_exam.hlml wmvjuddk.nih.gov/health/nutrit/sisters/sistersJitrn www.arthritis.org Menopause Guidebook Staying Healthy at 50+ Asian & Pacific Islander Women's Health www.menopause.org/mgintro.litm www.ahrq.gov/ppip/50pW wA\Av.4woniitii.go\/fcici/,\siaii_Pacific.limi National Asian Women’s Health Org. Weight-Control Information Network Breast Health Access for Women With www.nawiio.org www.niddkjiih.gov/healdVnutrit/wiahtrn Disabilities www.bhawd.org/ National Association of Anorexia What You Need to Know About Breast Nervosa and Associated Disorders Cancer Center for Research on Women with Dis­ www.anad.org http://cancemet.nci.nih.gov/wyntk_pubs/brea.sl.htm abilities www.bcm.tmc.cdn/crowd/ National Cervical Cancer Coalition Women and Bleeding Disorders wmv.nccc-otiline.org www.4wornan.gov/owh/puh/ Common Uterine Conditions: Options for Bleeding%20Disarders/index.htm Treatm ent National Institute of Mental Health www.ahrq.gov/consumer/uterine 1 ,htm www.nimhnih.gov

Women and Men: 10 Differences that Make a Difference

STDs - Women are 2 times more likely than men lo contract a Anesthesia - Women tend to wake up from anesthesia more sexually transmitted disease, and 10 times more likely lo quickly than men - an average of 7 minutes for women and 11 contract HJV during unprotected sex with an infected minutes for men. p a rtn e r. Drug Reactions - Even common drugs like antihistamines Depression - W omen are 2-3 limes more likely than men to and antibiotic drugs can cause different reactions and side suffer from depression in part because women's brains make effects in women and men. less of the hormone serotonin. Autoimmune Disease - 3 out of 4 people suffering from Osteoporosis - Women comprise 80 percent of the popula­ autoimmune diseases such as multiple scelerosis, rheumatoid tion suffering from osteoporosis, which is attributable to a arthritis, and lupus are women. higher rate of lost bone mass in women. A lc o h o l - Alter consuming the same amount of alcohol, Lung Cancer - Women smokers are 20 to 70 percent more women have higher blood alcohol content than men. likely to develop king cancer than men smokers. P a in - Some pain medication (known as kappa-opiates) are Heart Disease - Women are more likely than men to have a far more effective in relieving pain in women than in men. second heart attack within a year of the first one.

8 PCMS BULLETIN May, 2001 ffie/w ’ ifo u iiitf Q '/'U t/tcu-/ ftfccieh j

Letter from John K. Stutterheim, MD

Editor's Note: Dr. Stutterheim submitted the following letter to the Tacoma News Tribune, the PCMS Bulletin, the Tacoma Pierce County Health Department and KOMO television.

PCMS was saddened to hear o f Dr. Stutterheim's illness and offers condolences to him and his family.

Editor,

During the month of March, the News Tribune published an article about arsenic and lead findings on the hill below the water tower at University Place, west of Tacoma. Even thought Ihe EPA seems to know which properties contain high levels of arsenic, they were not specifically mentioned.

As you probably know, arsenic effects the human body mostly in four ways, namely: skin, nervous system, kidneys, and lungs by inhalation.

My family of seven people used to live in University Place from 1964 through 1996. My youngest daughter was bom at that address. She came down with kidney cancer at the age of 28. clear cell carcinoma. My wife died from lung cancer, small cell carcinoma, the worst kind, in 1999. Daring the year of 2000, my eldest and third daughter both contracted multiple sclerosis, extremely rare to have two cases in one family.

Last week I was diagnosed with kidney c a n c e l'. Two cases in one family is unheard of.

1 would like to break a lance to get an epidemiologic study started to research ailments that occurred among children in these families who used to live in University Place during the sixties, seventies and eighties. I am fully aware that many may have moved away and must be tracked down, possibly a costly affair. Imagine the value of such an investigation. I urge you to consider this project.

I am looking forward to a positive response from your department and remain sincerely yours.

John K. Sutterheim, MD Personal Problems

At the mouth of of Physicians Gig Harbor Bay Committee

A most unique Medical problems, drugs, alco­ property hol, retirement, emotional, or other such difficulties?

Your colleagues $995,000 want to help Panoramic view from the narrows, Mt. Rainier, the lighthouse on the sand spit to the interior of the bay. W atch the boats go by from this Alan Little designed *Robert Sands, MD, Chair 752-6056 rambler on the bulkhead. Just like living on a boat. Soaring wood ceilings, Bill Dean, MD 272-4013 custom basalt floor-to-ceiling fireplace, spacious chefs kitchen, brick floors, Tom Herron, MD 853-3888 and the list goes on. Complex includes 2 buildings for a total of 4 bedrooms, 3 Bill Roes, MD 884-9221 baths, den, rec rm w/kitchen and 3 car finished carport. Please call Tova for F. Dennis Waldron, MD 265-2584 more information and to see this property, 253-973-7777. NW M LS #21033726 Confidentiality Assured

May, 2001 PCMS BULLETIN 9 Applicants for Membership

Heller, Daniel N , MI) Diagnostic Radiology Practices al Tacoma Radiology What problem 3402 S I Kill Street, Tacoma W A 9X405 253-383-1()99 Medical School: Stanford University can we solve Internship: Santa Clara Valley Med Clr Residency: UCSF Fellowship: IJCSF for you today?

Opp, Randon L, MD Diagnostic Radiology Practices at Medical Imaging NW 222 15th Ave SE. Puyallup W A 9X372 253-8414353 Medical School: Loma Linda Univ Internship: San Bernardino Med O r © Computer Networking Residency: Loma Linda Univ Med O r Fellowship: Loma Linda Univ Med Clr i S k General Computer Support Sadiq, Raheela, MD Internal Medicine Security and Virus Protection Practices at Internal Medicine NW 316 Martin I. King ,lr Way #304 Tacoma WA 98405 © Custom Development 253-272-5070 Medical School: Tile Aga Khan University Medical College @ Internet Connectivity Internship: Central Texas Med Found. Residency: Central Texas Med Found.

Yee, Lorrin K, MD Internal Medicine Practices al Northwest Medical Special lies 1024 S I Street. Tacoma WA 98405 253-428-87! Kl We can help you. Mcdical School: UCLA Internship: University of Wisconsin Managing technology is no easy task. 11(ispitals and Clinics IT Source can help you solve computer Residency: University of Wisconsin problems so you can get on with more Hospitals and Clinics Fellowship: National ( 'ancer Institute important things...like your business. II 253.835.1200 I T so u rc e www.itsource.com

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10 PCMS BULLETIN May, 2001

V B u l l e t i n

Alternative fr o m p a g e 1 ] reasonable solutions to the problem of the tension these people may create they receive by allowing physicians in health care. Our problem is that we and to take care of them. Traditionally, training to learn medicine while taking have painted ourselves into a corner. and even with the current growth of care of them. W e have turned to the law to grant the welfare state, this still to a large ex­ An interesting step in the direction people the right to health care. Since tent is done through the work of chari­ of multi-tiered health care is the Tri­ we also base our republic on the prin­ table organization, supported either by care military program. The safety net ciple of equality under the law. we are churches or by private foundations. here is provided by the military hospi­ forced to maintain that all people have The government programs have tals, where the charges to the patients equal right to health care and. there­ high overhead, because they are sub­ are the lowest. They have to pay more fore. should receive equal care. ject to rules, which decree that things to get the second level, at which they No matter how prosperous our be done in a certain way, that expendi­ can seek care from a network of physi­ country might be, it is economically im­ tures be supported by proof of need. cians and hospitals, who work under a possible to give everybody the best of The regulating agencies add a variety contract and discount their charges. medical care, such as private rooms, of other requirements, changing them This limits the patients' choice of treat­ one-on-one nursing, no waiting in the as they go. Congress has to write laws, ment facilities. The third level is regu­ office, or in the Emergency Room, or agencies have to issue regulations, ev­ lar indemnity insurance, for which the in the pharmacy, immediate control of erybody has to file forms, gel permits, patients pay even more, but which pain, immediate availability of treatment make reports, etc. For this reason about gives them the ability to go to their phy­ facilities and operating rooms, tertiary 50% of the money spent on govern­ sicians of choice and to decide on their care facilities in every hospital, etc. It ment programs is for the costs of admin­ treatment options without much inter­ should be obvious that we cannot give istration. fe re n c e . equally good medical care to every­ Private charitable organizations do The above example is an official b o d y . not have to meet such requirements. admission that equal health care for all Since the law requires us to give When private institutions run the pro­ is not possible. People will always look equal care, it will have to be equally grams, especially when they are not for the best medical care they can get bad. People will have to wait for ser­ subject to government mandates, con­ at the best possible price they can af­ vice. they will have to wait for their trols or restrictions, the administration ford. That will vary from person to per­ pain mcdication until someone gets costs are of the order of 10%. So they son. Our society must accept as inevi­ around to giving it to them, they will are better placed to meet, at a lower table the variations in the quality of have to wait for an operation, or for a cost, the needs of the indigent. These health care people receive.! test, perhaps for months, sometimes for patients will be able to earn the care years. Everyone will have to wait equally for his turn. W hat is more, if some people are willing to pay out of pocket to get MEDICAL LICENSURE ISSUES prompt and better medical care, they must be forbidden to do so, if equality Mr. Rockwell is available to represent physicians and other health care of medical care is to mean anything. providers with issues of concern before the State Medical Quality Assurance People are granted health care by law. Commission. Mr. Rockwell, appointed by Governor Booth Gardner, served for they are equal under the law, there­ 8 years as the Public Board M ember of the Medical Disciplinary Board from fore they shall receive equal health 1985-1993. Since then, Mr. Rockwell has successfully represented over 60 care. This is the contradiction we face physicians on charges before the MQAC. Mr. Rockwell’s fees are competitive and we have to resolve before we can and the subject o f a confidential attomey-client representation agreement. make sense of any societal approach to Gregory G. Rockwell the problem of health care. Attorney at Law & Arbitrator To repeat what was stated in the 3055 - 112'" Avenue SE, Suite 211 past, a society cannot function, and cer­ tainly cannot prosper, without order. Bellevue, WA 98004 People who are destitute or sick could (425)822-1962 • FAX (425) 822-3043 be a source of disorder. A wise society email: [email protected] • website: “ggrockwell.wld.com” needs to have a mechanism to defuse

12 PCMS BULLETIN May, 2001 In My Opinion.. by Teresa Clabots, MD

Maiy s Angels

As a resident in Kansas, during our When the infant was on its death­ obligatory ten months of neonatal ICU, bed (and usually M ary’s instincts were we were always short staffed during uncanny), you knew that you would our first year. My favorite nurse was have a rough shift when she would say, Teresa Chihms. A ID Mary. Mary was an old-timer. She be­ “Doctor, I’m going to go and wash this lieved that you lived and died by the baby's hair.’’ (I am going to go and bap­ rules. And, she had a very thick New tize this baby ) nails and send them to a specialized lab York accent that at times was quite diffi­ “Yes, Mary." in Chicago (remember this was the old cult to understand. And you knew you were close to days). I never heard back what the fi­ Body language was her answer. the end when she would say, “Poor nal lab results were. One look from her and you could little angel.” She didn't want those little The next month I was in the endo­ wither into the wall knowing that you angels stuck in limbo, and would bap­ crine service, and lo and behold, that had touched your hair, and would tize every single one of them. baby’s brother was being seen as a fail­ need to start rescrubbing all over 1 remember the occasion of a diffi­ ure to thrive. It turned out that the dad again: the mandatory five minute scrub cult delivery. The baby was trans­ was a GI fellow and his wife was a dedi­ from fingernail to elbow with a harsh ferred from the regular nursery to the cated teacher who was devoted to the antiseptic soap that surgeons used. neonatal ICU. Although the delivery- children's care. The older brother sure She would say, "Doctor.” had been difficult, there had been no enough had multiple signs of cystic fi­ I would answer, "Yes, Mary." meconium, yet this baby developed a brosis with steatorrhea, chronic She would admonish you. “Doctor, cough that racked its ribs. One that you pneumonias, and failure to thrive. you touched your hair.” could hear all the way down the nurs­ I followed the children over the '"Sony Mary. I’ll go rescrub” (as I ery. Mary came up behind me and course of three years. held my hands in front of me like phan­ whispered in my ear. “Do you know As the senior chief resident. I was tom limbs, already dried and cracked why that baby is coughing?" I turned taking care of the younger brother, the from all the scrubbing). and looked at her eyes and said, “No one who had the more severe cyslic fi­ Returning to my place on rounds, idea, Mary. But what do you think?" brosis who wound up in respiratory and she would say, “Doctor,” to the She answered. "Mark my words, failure, in an oxygen tent, and in C02 next person, and they would answer, that baby is very sick," With a knowing narcosis in the ICU at the age of three. “Yes, M ary.” look I stood there, baffled and said. To monitor his fluids, and narcosis, “Doctor, you touched your nose.” "Yes, Mary, but what do you think it he ran out of veins, so he had a central “Sorry, Mary.” And the poor doc­ has?" line. I refused to authorize painful arte­ tor would go and rescrub up to the el­ She smiled a little grin and said, rial sticks on him. In and out of con­ bows and come back. “Ever heard of cystic fibrosis?” sciousness the baby went with cyanotic With her ever-vigilant eyes she I was taken back. 1 asked her, fits of coughing, rectal prolapse, signifi­ would say, “Doctor." “How did you know?" cant dyspnea, slipping in and out of co­ “Yes, Mary'?” She said. "Seen it. Listen to that mas, I found the mother many a time in­ “I can see nail polish.” And, one poor angel cough.” side the oxygen tent reading to her would have to leave rounds to go re­ Now, the problem in those days three year old, an act of pure love and move every hint of nail polish and was how to prove that a newborn had desperation, since she knew of nothing rescrub. cystic fibrosis. There were 110 d ia g n o s­ else to comfort him or occupy his time. Once in awhile, the fascination tic tests. This was before the sweat He’d had a rocky three years in his with babies would overwhelm you and chloride. So, I read up on cystic fibro­ short-lived life. I was held up before Mary would say, “Doctor, don’t touch sis, called the genetics people, and then the surgery' committee for drawing the babies.” I had to ask permission of the parents to blood from a central line that they had “Yes, Mary.” cut the baby’s hair and cut the baby's placed. (They didn't want me to use

See “ A n g e ls " page 14

May, 2001 PCMS BULLETIN 13 B u l l e t i n

Angels from page 13 New Members

the central line to draw blood.) The ence approached me, hugged me, and Brown, George J, MD Chair of the department threatened to told me that his wife had just delivered a Executive/Adm inistrative terminate my chief residency. I prayed little girl. They had named her Teresa. Practices at M ultiCare Health System that the baby would go quickly since [ We have kept in contact through 315 Martin L King Jr Way, Tacoma 98405 couldn't bear to poke him anymore. (I the years, and the father has become a Phone:403-1855 was the only one he would allow near renowned research physician in the Medical School: Boston University School to draw blood.) I wonder now. if it field of gastroenterology, specifically in of Medicine would have been more merciful to cystic fibrosis. They have three more Internship: Fitzsimons Army Med Ctr have left him in the C 02 narcosis children, and the large household is Residency: Fitzsimons Army Med Ctr rather than seeing him drown in his happy, busy, athletic and successful Fellowship: W alter Reed Army Med Ctr own secretions. I cried every night even with a chronic debilitating disease. through those horrible weeks. That little boy taught me a lot about ac­ Hirota, William K, MD He finally died, and 1 presented cepting when bad things happen to good G astroenterology this case at M & M conference. After­ people. His father has devoted his life to 1112 6th Ave #200, T acoma 98405 ward with tears in his eyes, the father research in that field and to helping Phone:272-8701 who had attended the M & M confer­ other children with cystic fibrosis. ■ Medical School: Georgetown University Internship: W alter Reed Army Med Ctr Residency: W alter Reed Army Med Ctr Fellowship: W alter Reed Army Med Ctr

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14 PCMS BULLETIN May, 2001 In My Opinion.... David Roskoph, MBA, CFP

Why must a recession follow an expansion?

After more than ten years of rising When economies expand, consumer down and stock prices weaken. As in­ markets, the cry once again rings out, confidence is high, which in turn boosts vestment accounts drop, consumer con­ “Why must recessions follow expan­ business confidence. Businesses then fidence follows. Now the cycle begins sions?” The answer is simple. Long ex­ produce to meet the rising demand with to leed on itself. The feeling of confi­ pansions are never linear and have al­ larger capacity. In essence, everyone dence goes a long way in an economy. ways (so far) created dramatic imbal­ takes a snapshot of today and assumes it I'm reminded of the saying, “When ances in the economy that take a reces­ will only get better tomorrow. Money is Momma ain’t happy, ain't nobody sion to correct. The excesses gener­ loaned, plants are built and employees happy.” Replace Momma with consum­ ally involve some form of credit. hired to meet the ever-voracious con­ ers and you understand capitalism. If Credit excesses occur in equities sumer. Confidence is King as few, if you watch only one economic indicator, markets when investors’ bid-up prices any, question the projections of non­ make it consumer confidence. The fi­ are based upon unrealistic earnings stop acceleration. The valuation of eq­ nancial markets don't necessarily react forecasts. uities departs from reality as the Wall to conditions as they occur but rather Credit excesses occur in our Street machine gets cranked up. In this when the confidence is sufficiently al­ banking system when loans are made case, the internet was central to the tered to affect the flow of money. As based upon unrealistic growth projections. Credit excesses occur in our personal consumption when we borrow too much based upon an unrealistic feeling of security. All three examples revolve around unrealistic feelings of overconfidence. When Alan CONSUMER CONFIDENCE Greenspan exercised some (Future Expectations Minus Present Situation) control over the monetary sys­ tem he referred to this as “irra­ tional exuberance.” Unfortu­ nately, the Federal Reserve got into the punch bowl even though they were supposed to be the designated driver. They 84 86 88 90 92 94 96 98 00 lost control of the system back in the fall of 1998 and are still strug­ gling to regain it. Even the earliest market excesses but the real fuel was the reality that we are actually in a re­ economists realized that there is only loose credit. You could see 125% mort­ cession sets in, the headlines will con­ so much rationality in a system where gages or the no-money-down offers but tinue to get scarier. Interest rates emotions are so important. The few saw the astronomical rate at which project the recession to last until at least economy is nothing more than the ex­ people borrowed to buy stock (margin). the end of 2001 but the markets will find pression of our collective hopes and These were the warning signals for a a bottom before then as markets usually fears manifested in our spending hab­ monetary policy that was too loose. precede the headlines. Getting positive its. We are all prone to emotional ex­ When the flaw became painfully obvi­ about the market will feel as counter­ cesses that are economically described ous, the projections were finally intuitive as feeling negative did at its as “animal spirits.” They refer to the in­ brought into question. First, consumers peak last year. ■ sidious creep of irrationality into an took a breather, which means inventory David J. Roskoph, MBA, CFP is a fee- otherwise rational system until irratio­ accumulated. When inventory backs based investment advisor in Gig nality is the norm. It happens this way: up, earnings forecasts are revised H a rb o r

May, 2001 PCMS BULLETIN 15 Directoiy Changes

Please make note of llie following changes to your 2000 PCM S Directory

Marvin Brooke, MD Change office # to 864-2703 r a v e l e r d Add Physician Only # 864-5057 L Health Service Pamela Cowell, MD A service of Change address lo: Northwest Medical specialties, p llc 120 14th Avenue SE #c Puyallup. WA 98373 INTERNATIONAL TRAVEL CAN Bl Phone: 435-5200 HAZARDOUS TO YOUR HEALTH Fax: 435-8873 • PRE-TRAVEL CARE • POST-TRAVEL CARE David Judish, MD HO URS CALL EARLY WHEN PLANNING Change office # to 864-2703 MON-FRI 9-5 Add Physician Only # 864-5057 253-428-8754 or 253-627-4123 Paul Nutter, MD A SERVICE OF Change office # lo 864-2703 INFECTIONS LIMITED PS 1624 South I Suite 102 (next to St. Joseph's Hospit Add Physician Only # 864-5057

Maria Reyes, MD Change office # lo 864-2703 Add Physician Only # 864-5057

Patrice Stevenson, MD Change office # to 864-2703 Add Physician Only # 864-5057

Did You Remember?

DEXA Detect osteoporosis Assess fracture risk Washington M edical Political Action Committee Quantitate bone mineral density changes Monitor therapeutic response , 1800 Cooper Point Road SW www.tacomarad.com Bldg 7, Suite A Olympia, WA 98502 Allenmore Medical Center Lakewood Office 800-562-4546 (360) 352-4848 (253) 383-2038 (253) 588-6083

16 PCMS BULLETIN May, 2001 p /Ju-fCf: ix o tn ih j '■=. K c d tc o i (tfo n e h f

COLLEGE Continuing Medical Education □F MEDICAL National expert to speak EDUCATION at Womens Medicine CME

Nationally recognized expert • State of the Art: Hormone Replace­ Leon Speroff, MD, Professor from the ment Therapy and Alzheimer's Allergy, Asthma Oregon Health Sciences University in S y n d ro m e Portland, will keynote this year’s • State of the Art: Hormone Replace­ Advances in Women's Medicine CME and Pulmonology ment Therapy and Breast Cancer program set for May IS. Dr. Spiroff will CME-May4 speak twice at the annual CME • Panel on Hormone Replacement program - on hormone replacement T h erap y therapy and cardiovascular disease Registration for this year's CME • New Approaches to the Management and HRT and breast cancer. program focusing on subjects on of Obesity in Women This one day program directed by allergy, asthma & pulmonology remains John Lenihan, MD will address a • Depression in Women: Best Manage­ open for Friday. May 4 at St. Joseph variety of timely subjects relative to m ent Medical Center. The course is under contemporary medicine for women. the medical direction of Alex M ihali, • Clinical Pearls: Herpes and Vaginitis Designed for the primary care MD. physician, this Category 1 CME • Contraception: Newest Options and Subjects will cover: program will feature issues related to Alternatives • Pneumonia for the Primary Care diagnosis and treatment advances in Physician treating illness in women. The course will be held at the • New Directions in the Treatment of Subjects scheduled to be covered Lagerquist Conference Center - Asthma: Managing Outcomes include: Rooms 1 A&B at St. Joseph Medical • Understanding Allergic Rhinitis: C enter. Clinical Update • New concepts in Osteoporosis: A program/registration brochure • Frustrations in Treating Uticaria Prevention. Diagnosis and Manage­ was mailed in April. Those wishing to • COPD in Clinical Practice: Differen­ m ent register can do so by calling the tial Diagnosis and Management • State of the Art: Hormone Replace­ College al 627-7137. ■ • Asthma: Current Trends and New ment Therapy and Cardiovascular Strategies D isease • Food and Drug Allergies

Call C.O.M .E. at 627-7137 to register. ■ Dates Program Director^

Medical Technology Allergy, Asthma & CME featured at Friday, May 4 Pulmonology for Alex Mihali, MD Membership Meeting Primary Care Advances in Wbmen's The planned Medical Technology Friday, May 18 John Lenihan, Jr., MD CME program meeting originally IVfedicine scheduled for May 16 and 23 will now be combined with the June PCMS General Membership meeting. ■

May, 2001 PCMS BULLETIN 17

: d \ e y c r 'Ufoun.ti/ rj ( ie d u y il y

Classified Advertising

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Tacoma/Pierce County out­ Dr. K. Scherbarth is looking lor Available now, new construc­ patient general medical care at its best. partners in 47 ft. motorboat and tion, 1000-6000 sq ft, close to hospitals Full and part-time positions available in Mooney airplane. 253-752-6965. on Union at I3lh. Call D r. L o v y at Tacoma and vicinity. Very flexible 756-2l82or206387 6633. Executive Office Furniture. schedule. Well suited for career Double pedestal desk (mahogany or redefinition forG.P., F.P.. I.M. Contact oak veneer), matching credenza. Andy Tsoi, MD (253) 752-9669 or Paul bookcase, lateral file, executive chair Doty (Allen, Nelson, Turner & Assoc.), with two matching side chairs. Must sell, Clinic M anager (253) 383-4351. contact Ron at (253) 383-5949.

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Available Suites: Second Floor: Up to 11,000 SF Third Floor: Up to 17,000 SF

2202 S. Cedar Building Presented by Tamma. WA QR405 C ' Kidder Tacoma, WA 98405 1 Mathews & Segner Inc Join these existing tenants: Building features: Pacific Northwesl Eye Associales, PS Contact: Class "A" Building with high quality finishes Bill Frame, CCIM David V. Pratt, MD and Troy J. Woodman, MD Located near the Allenmore Hospital Campus 253-383-0799 Allenmore Ambulalory Surgery Center State-of-the-art Building [email protected] Tenant Improvement Allowance Ample, free parking file information contained herein has been given to us b y the ow ner or sources that we desm reliable. We h$ve no reason lo doubt its accuracy, but we d o not gua/antes ii Prospective tenants should carefully verify all information contained herein. Call for more information.

May, 2001 PCMS BULLETIN 19 Our Claims Staff Receives Top Praise

“I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.” Corrine Jedynak-Bell, DO, Tacoma, Washington

When times are tough, physicians count on us to fight for their best interests— from the day a claim is discovered to the day it’s resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That's 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly—with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t you wani only the very best on your team? For more information, call us today aL 1-800-962-1399. Physicians Patricia Mulligan, Cieated and sponsored by tho ^ Insurance W,i.shinj,>(ijn >unc \)cdk.il A^oci.mon Claims Representative Seattle. WA r. i Phv-icmni Insurant 2001 A Mutual Company

Pierce County Medical Society PRESORTED 223 Tacoma Avenue South STANDARD Tacoma. WA 98402 US POSTAGE PAID TACOMA, WA PERMIT NO 605 Return service requested

20 PCMS BULLETIN May, 2001 Lto R: Carol Jones (Peninsula), Janice Doyle (Bethel), Sunnier Sehoenike, MD (Lakewood Pediatrician) and Susan Newell (Clover Park) are all actively involved in the work of the Public Health/School Health Committee. This year the group is focusing on school nurse issues. Dr. Sehoenike chairs the committee.

See story page 5

INSIDE: 3 President’s Page: “Leadership” 4 June General Membership Meeting: “Klectronic Medical Kecords” 5 Special Feature: “The issue of School Nurses" 7 Tacoma-Pierce County Health Department: “The AIDS epidemic'' 9-14 Pierce County says goodbye to many physicians 15 In My Opinion: “Insurance Overhead” 17 PCMS welcomes new members PCMS Officers/Trustees: Patrice NT. Stevenson. MD President Susan J. Salo. M D ...... President Elect J. Jam es Rooks, Jr.. M D ...... Vice-President M ichael J. Kelly. M D ...... Secretary/Treasurer Charles M. Weatherby. MD....Past President Sabrina A. Benjamin, M D Drew H. Deutsch, M D Stephen F. Duncan, MD Kenneth A. Feucht. MD Kevin K. Gandhi. MD Sumner L. Schoenike, MD

WSMA Representatives: Speaker of the House: Richard Hawkins, MD Trustees: David Law, MD; Nicholas Rajacich, MD AMA Delegate: Leonard Alenick. MD WAMPAC Chair/6th District: Mark Gildenhar. MD WAMPAC 9th District: Don Russell. DO

Executive Director: Sue Asher

Committee Chairs: A g in g , Richard Waltman: A ID S , James DeMaio: B y la w s. Richard Hawkins: Budget/Finance. Mike Kelly: College of Medical Education, John Jiganti: Credentials. Susan Salo: Ethics/Standards Of Table of Contents P r a c tic e . David Lukens; Grievance, Charles Weatherby: Labor & Industries, William Rilchie: Legislative. William Marsh: M edical-Legal, Mark Taylor: M embership Benefits, Inc.. Drew 3 President’s Page: “Leadership" Deutsch: Personal Problems Of Physicians, Robert Sands: Public Health/School Health, Sumner Schoenike 4 June General Membership Meeting: "Electronic Medical Recor

The Bulletin is published monthly by PCMS 5 Special Feature: "The Issue of School Nurses” Membership Benefits, Inc. for members ol the Pierce County Medical Society. Deadlines for submitting articles and placing advertisements in 7 TPCHD: "The AIDS epidemic" The Bulletin are the 15th of the month preceding publication, (i.e. January 15 for the February issue) 8 Applicants for membership

The Bulletin is dedicated to the art. science and delivery of medicine and the betterment of the 9 In Memoriam: Wayne Bergstrom, MD health and medical welfare of the community. The opinions herein are those of the individual 10 In Memoriam: David Dye. MD contributors and do not necessarily reflect the official position of the Medical Society. Acceptance of advertising in no way constiiules 1] Jn Memoriam: Ronald Johnson, MD professional approval or endorsement of products or services advertised. The Bulletin and 12 In Memoriam: J. Gale Katterhagen, MD Pierce County Medical Society reserve llie right to reject any advertising. 13 In Memoriam: Robert O ’Connell, MD M anaging Editor: Sue Asher Editorial Committee: MBT Board of Directors 14 In Memoriam: Maurice Origenes, MD

Advertising Information: 253-572-3666 Subscriptions: $60 per year 15 In My Opinion: "Insurance Overhead’’

M ake all checks pavablc to: MBI 17 New Members 223 Tacoma Avenue South, Tacoma WA 98402 Phone: 253-572-3666; Physicians call 572-3667 FAX 253-572-2470 18 Directory changes

E-mail address: [email protected] 19 College of Medical Education Home Page: http://www.pcmswa.org

23 Classified Advertising

2 PCMS BULLETIN June, 2001 President’s Page by Patrice Stevenson, MD

Leadership

“Perhaps I'm a leader because I'm a poorfollower. " Herman Richard Matem, MD, FACS 2001 AMA Pride in the Profession Award Recipient

Ptiirice .j/c'iviuc/i, MD One of the benefits of being the a foursome the success of the “team" Fn. m J c;h PCMS President is the opportunity is based on the cumulative, individual to attend the W S M A and A M A scores. Physicians think the team will Leadership conferences. These were be successful if only everyone would informative and thought-provoking pull their weight. He preferred a vol­ members. While leadership is im por­ meetings covering topics from genomic leyball team model with the coordi­ tant. good followership is just as criti­ medicine to e-medicine. There are also nated teamwork of six players who can cal to the success of an organization. discussions on the nature of leadership all bump, set and spike with precision Physicians are all very busy people that provide fodder for President's and play well from all positions on the and have less time and money today to Pages. put into professional society The Human Genome membership than ever before. Project has identified the base Our societies need to be respon­ sequence letters of the human “While leadership is important good sive to the needs of the members genome. With much more work, or they will cease to exist. the words, sentences and stories followership is just as critical to the However, a few leaders cannot of this genetic map will be success of an organization.'’ do all the work of an organiza­ delineated. Ultimately all the tion. Good followers may be genes to explain disease as w'ell willing to give input, respond to as normal traits may be identi­ “calls to action" for letters to fied. I expect they will also lo­ legislators or serve on commit­ calize a gene for leadership tendencies. court. Individual heroics, such as a tees. These activities take a limited time This likely will be localized near the killer serve, will certainly help but it's commitment from any given member gene that makes one join medical soci­ the passing and setting (i.e., the support but en masse are what truly makes an eties in the first place. The leadership and enhancement of the play of all organization work effectively. gene likely has variable penetrance teammates) that is the basis of a great The professional staff of a medical dependent on a multitude of environ­ team. Well I guess I’m atypical as I've society is also key to its success. They mental factors. These factors include only played putt-putt golf but lettered allow the ideas and directions of the place (being in the wrong or right one) in volleyball in high school so the golf physician leadership and followership and time (being there at the wrong or foursome didn't come to mind. He to be put into action. We are fortunate right time) and linkage (to the inability went on to describe physician cultural to have excellent help in our mission to say “No” gene). traits that get in the way of our working from our executive director. Sue One of the best speakers at the together such as being strongly com­ Asher, and her staff. I am fond of using recent WSMA Leadership conference petitive, valuing personal autonomy Star Trek Captain Picard's directive was Joseph Bujak, MD, Vice President above all else and tending toward linear line, “make it so." I don’t have to tell of Medical Affairs at Kootenai Medical and “reductionistic” thinking that good workers how to “make it so." as Center in Idaho. He used a team anal­ causes poor systems thinking. they know what to do without ogy to help physicians think of better Fortunately, I have not witnessed micromanagement. ways of working together to achieve poor teamwork among the physician I invite you to actively lead or ac­ common goals. He said that when you leadership at PCMS. We have a dedi­ tively follow and together we will make ask most physicians to think of a team cated and hard working group of offic­ our medical society a better one. ■ they think of a golf course foursome. In ers, board members and committee

June, 2001 PCMS BULLETIN 3 p re se n ts

local experiences with Electronic Medical Records the good, the bad and everything inbetween!

Vendor displays and complimentary dinner

► Choosing a system - a BIG job Featuring: ► Costs - including the hidden and unknown Mike Kelly, MD; Lakewood Family Practitioner ► Training and transitioning i , r I , . „ Ron Morns, MD; Puyallup Family Practitioner ► The advantages of e ectromc systems _ .. .. ' r T . - . J a c , / David Munoz, MD; Tacoma Internist ► The disadvantages of electronic systems ► Will there be a happy ending??? Numerous Vendor Displays

June General Membership Meeting

Tuesday, June 12, 2001 Landmark Convention Center Displays/Social Hour: 5:30 pm Temple Theatre, Roof Garden Dinner: 6:30 pm 47 St. Helens Avenue Program: 7:30 pm Tacoma

Complimentary to PCMS physicians and their office staff member/guest

(Registration required by June 8. Return form to: PCMS, 223 Tacoma Ave S, Tacoma 98402; FAX to 572-2470 or call 572-3667

Please reserve 1 dinner for me at no charge. (PCMS Non-members/staff registration fee $30) Please fill out one form for each person attending. This form mav be copied.

Name for name tag, (please print: ______Office affiliation:______Phone:

(IF YOU REGISTER AND DO NOT CANCEL OR ATTEND YOU WILL BE INVOICED $15 FOR DINNER) THANK YOU! SEE YOU ON TUESDAY, JUNE 12

4 PCMS BULLETIN June, 2001 Special Feature by Jean Borst

The Issue of School Nurses... A Band-Aid Won’t Fix a Major Break in the System

Tn a perfect world, a school a valuable resource for disseminating Bethel School District and a committee nurse is responsible for the medical information; providing a forum for the member for over ten years, concurs. care and safety of no more than 750 community to present to or communi­ “One of the nurses is responsible for students. cate with school nurses: offering net­ 6.000 students." she notes. "The pre-ex­ tn a perfect world, medical mis­ working opportunities, as well as a ve­ isting notion that there is a nurse in ev­ takes in the school setting don't hap­ hicle to present concerns and issues; ery school simply isn't true.” With di­ pen. and near misses are nonexistent. and to provide nurses a chance to dis­ minishing numbers of school nurses, Tn a perfect world, school cuss issues with physicians on an infor­ responsibilities that historically have nurses spend time in classrooms shar­ mal level. fallen to nurses are now in the hands of ing their skills, knowledge, and exper­ The committee has tackled numer­ health technicians and paraeducators. tise. ous issues in the past, and typically "Many services are provided by unli­ And, in a truly perfect world. adopts one issue "focus" each year. censed staff with a CPR and first aid school districts have the money to Over the years, they have explored card.” Doyle said. "W hile we've had no make it all happen. such issues as health promotion, com­ catastrophic consequences yet,” she Then there’s the real world. munity education, communicable dis­ explained, "there have certainly been And it’s the real world that the Public eases, mental health issues, low-income numerous 'near misses' in Pierce Health/School Health Committee goes resources, barriers lo assessing health County.” For example, a child might head to head with. care, immunizations and more. Last sustain ahead or abdominal injury, (he Established in the 1970s with the year, the group’s concentration on severity of which is not recognized by merger of a Schools Committee and school violence resulted in the imple­ a staff member. In one specific case, a Public Health Committee, the Public mentation of violence prevention pro­ school secretary incorrectly allowed Health/School Health Committee “ex­ grams in several school districts. administration of insulin to a student, an ists to increase communication and This year, the committee zeroed in error that could have conceivably bring people to the table to talk about on school nurse issues, in light of dra­ killed the child. issues and concerns.” according to matic decreases in school nurses and Consequences can be far reach­ PCMS Executive Director Sue Asher, the resulting consequences of those ing, according to Carol Jones. Penin­ a long-time committee member. The staffing cuts. The committee is looking sula School District head nurse and a committee includes school nurses from at three specific areas: (1) delegation of committee member off and on for the most of the Pierce County schools dis­ nursing duties to unlicensed staff; (2) last 10 years. Regardless of who is ad­ tricts, physicians, the Pierce County administrative structure/accountability ministering care, the school nurse is ul­ Health Department and various other of school nurses: and (3) caseload. timately responsible. Training, direc­ agency representatives from organiza­ At the heart of the matter is the tion and follow up are provided to tions that champion children. D r. caseload issue. “The national recom­ school staff by the nurses, but when Sumner Schoenike currently chairs mendation for school nurse staffing is you are dealing with many students at the com m ittee. one nurse lo every 750 regular educa­ multiple schools, itis virtually impos­ Most notably, the committee cham­ tion students." notes Susan Newell. sible to always closely supervise the pioned such issues as fluoridating “The state staffing model recommenda­ treatm ent. Tacoma’s water and introducing city tion is I to every 1,500 students. In So while the safety of children in and county smoking ordinances. “This Pierce County, we have school nurses our schools is seemingly at the fore­ group never has an agenda problem,” responsible for well over 3.000 stu­ front these days— particularly in light of notes Asher. “They always have some­ dents, and this may include special edu­ extraordinary school violence the na­ thing to discuss.” cation and medically fragile students. tion has witnessed in recent years — Susan Newell, head nurse of the This poses a health and safety risk to why isn't the medical care of students a Clover Park School District, has been students and staff, and leaves very little prio rity ? involved with the committee off and on time for health promotion.” School districts are the guardians since 1993. She views the committee as Janice Doyle, head nurse for the See “ Nurses” page 6

June, 2001 PCMS BULLETIN 5 rses from page 5 of public education and public funds, past might have been institutionalized, Nursing input, not at the level of the notes Carol Jones. In most Piercc are in the school setting and demand school district," says Dr. Schoenike. County school districts, nurses are part one-on-one care," Doyle added. “We But, he notes, schools pay school nurse of the teachers’ union, and therefore have nurses administering to medically salaries, and they want to be in control under the teachers' salary scale. When fragile and severely challenged chil­ of those decisions. financial decisions are made regarding dren.” Among her own caseload is a Dr. Schoenike also presented find­ teachers and staff, nurses are part of high school student with the mental ca­ ings to the superintendents that sup­ that scenario. Over the years. Pierce pacity of a six-month-old. There are ported the committees concerns about County schools have experienced dra­ children with tracheotomies, feeding excessive caseloads and delegation is­ matic increases in enrollment, de­ tubes, and on oxygen. In severe cases, sues. “Caseloads are pushing the enve­ creases in nurses and the addition of state aid provides 18 hours of daily lope beyond what is reasonable,” he "health technicians." These staffers are nursing care. Some families have said. “M istakes are being made, and it’s required to have a first aid card and nurses accompany children to school, vital that we track those mistakes.” For CPR training. Period. W hile the techs while others opt to have nursing care the past few months, nurses in various and paraeducators are trained annually while the child is at home. If a nurse school districts have been recording by nurses to follow specific health care isn’t available during the school day. near misses that have occurred. Those plans, accuracy isn't ensured. Carol school districts are required to hire findings were summarized and pre­ Jones shared a recent incident that oc­ LPNs to provide care. sented to the superintendents, along curred in one of her schools. A new And with their time stretched so with a proposed "Near-Miss Reporting student came to the office for a pre­ thin, nurses are unable to do whal they Form"’ the com mittee plans to have in scribed dose of Ritalin. The dosage want to do most, Carol Jones said. each district. was written for 5 mg, the bottle indi­ "School nurses can do so much more “Needless to say,” Schoenike con­ cated that the tablets were 5 mg, but than we are able to do now. Our skills tinued, ‘‘the documented cases high­ when Jones got ready to administer the are in teaching, but time in the class­ lighted the problems in the system, and medication, she noticed that the tablets room is very limited due to all of our we got their attention.” The form, which were actually 10 mg. She didn’t give other responsibilities.” included an item for potential litigation the meds. Classified staff— the people against a school, really set the fire, Dr. who would typically give the child his Making a problem to fix a Schoenike noted. The districts are now' medication — admitted that they would p r o b le m reviewing the form — with specific input not have noticed the error. “[ work "As a pediatrician. I'm much more from attorneys weighing risk manage­ with highly professional people, and inclined to fix problems — not create ment issues — and all the parties plan to our health techs have used excellent them.” noted Dr. Schoenike. “But it was come back to the table before the end judgement, but there are times when important to start a lire in this case.” of the school term in June. Dr. mistakes are made because they simply Dr. Schoenike and Janice Doyle Schoenike is pleased with the reception are not trained to recognize those mis­ recently presented the Committee’s he received at the superintendents’ takes.” concerns to superintendents of Pierce meeting and is optimistic about contin­ Susan Newell adds. “Health County schools. “Our purpose in going ued discussion and action. paraeducators are increasingly the directly lo the superintendents was to “The issues include case loads, ones responsible for the health room. bring about an awareness of what delegation, administrative structure and These people have very little, if any, school nurses are actually doing." Dr. accountability — they are all tied to­ training and have suddenly become Schoenike explained. "There is a mis­ gether," Dr. Schoenike explained, “and the health experts on campus.” conception about what these people they are only going to get to be bigger The perception of school nurses is have to deal with day to day. We want problems before they are fixed.” not what it used to be. They are sup­ to show the districts that the nonclinical plying more than band aids and ice aspects of the job — developing educa­ The Committee: A Positive packs. "Nurses are not simply tending tion and health plans, communicating E x p e r i e n c e to the day-to-day bumps and bruises." with staff, administrative duties— belong Dr. Schoenike, Carol Jones, Janice according to Janice Doyle. The entire to the districts. The clinical part of the Doyle and Susan Newell all agree that make-up of medical care and medical job, however, should not be in their ju­ the Public Health/School Health Com­ issues in the schools has changed dra­ risdiction. There needs to be clarity on mittee is a positive and effective ve­ matically over the years. "Kids are com­ that issue. And along those lines, it’s vi­ hicle. After all, when members join a ing to school sick more often, children tal that caseload determinations and committee and stay for over 10 years, it with severe medical issues who in the delegation be made with Board of See '‘N urses" page 8

6 PCMS BULLETIN June, 2001 ■'fe , - ^ / w 't', - I f t / f 1/ ’ lla /tr a i

Federico Cruz-Uribe, MD The Health Status of Pierce County Director of Health

m The AIDS epidemic m

The AIDS epidemic continues re­ well that many individuals resist getting lentlessly. Even though we understand tested despite high levels of known-to- TACOMA-PIERCE COUNTY the disease better now than ever be­ be-risky behavior. Disease control ef­ HEALTH DEPARTMENT fore, the virus keeps moving through forts fail in this environment. And be­ our communities. We are disadvan­ cause of this we see new infections in taged by there not being a vaccine, but our community. Especially troubling is we have successfully controlled other the increasing proportion of new cases confidential information, and a desire to sexually transmitted diseases for which linked to heterosexual contacts. More protect the health of all Pierce County we lacked an effective vaccine. We and more women are getting infected, residents. How do we reach all of the have been distracted by the new drug especially women of color. HIV infected individuals here? We combinations that seemed to lower dra­ The bottom line is: we need need to find points of contact with each matically the viral loads in many pa­ your help to prevent HIV diffu­ of the key populations. For IDUs and tients, losing sight of the fact that the sion. We need to know how the people with multiple sexual partners, cocktails are not cures. Today, our only Health Department can help you two critical places are the county jail hope of stopping the virus relies on an to get more people tested for and the offices of local physicians. If aggressive prevention campaign. H IV , particularly those people whose someone regularly uses IV drugs, Across the country and certainly behaviors put them at highest risk. eventually s/he will end up in the crimi­ across our state, we have struggled with There are two primary groups that nal justice system and that means a stay what effectively prevents AIDS. At­ we have targeted because of their in jail. We can - and do - test people tempts at fully utilizing our traditional prominence in the continuing spread of there. If one has multiple sexual part­ disease control techniques have been HIV in Pierce County: IDUs (injecting ners, eventually that individual will de­ met with a myriad of arguments that op­ drug users) and individuals with mul­ velop the symptoms of a sexually trans­ posed much of what w e’ve tried. The tiple sexual partners. Sharing needles/ mitted disease and seek medical atten­ arguments focus on perceptions about syringes and having more than one tion. This is where I ask for your assis­ the disease; 1) HIV infection is unique sexual partner puts one at considerable tance. What can we do when these in­ and therefore it requires a different ap­ risk for being exposed to a bloodborne dividuals come into your office so that proach to prevention; 2) The privacy and sexually transmitted disease, in­ they get an HIV test? W ithout getting needs of infected individuals preclude cluding HIV. In order to check the tested, we are in the dark as to who has our using many of the testing and part­ spread of HIV, we need to identify all the virus. We are unable to follow ner notification approaches used in tra­ the HIV positive individuals in our through with our public health disease ditional disease control. county and notify the partners of each m odel. HTV infection in o u r co m m u n ity is one. Each partner would be tested and Let me know what you need not a unique disease. We understand counseled and, as needed, their part­ to help you convince someone to how it is spread, how it gets from one ners notified. Each HIV positive indi­ be tested. You can call me at individual to another. W e know specifi­ vidual would then be registered and (253) 798-2899, or e-mail me at cally the kinds of behaviors that lead to followed routinely to reinforce ways to [email protected]. Or, I’ll have one a more likely spread of the virus protect themselves and others. One’s of our network nurses drop by your through a population. Those behaviors personal health is not the only thing office with an official request for your parallel other sexually transmitted dis­ that changes when contacting the dis­ assistance. eases - there is nothing unique about ease. An HIV positive individual be­ I’m tired of getting caught in the HIV contagion. And when we collect comes a potential threat to the health of net of denial and avoidance. It’s time to information and begin the traditional the entire community - for the rest of work together to get in front of this dis­ lollow up with partners to prevent fur­ her/his life. This carries responsibility ease, and we can only do that by work­ ther infection, we take extensive confi­ and requires a change in behavior. ing together. ■ dentiality precautions. W e are ready with skilled and sen­ Denial pervades our community so sitive personnel, a secure system for

June, 2001 PCMS BULLETIN 7

W\<‘)

IN MEMORIAM WAYNE BERGSTROM, MD 1936^ 2001

Wayne Bergstrom was a friend of mine. I’m proud lo say that be­

cause he was an admirable man.

W ayne was born and raised in the Midwest in a small town in Iowa

just across the border from Omaha. His heritage in the Midwest molded

his charaeler-devotion to duty, friendliness, liking people, etc.

Wayne and I both went lo medical school in Omaha. He lo

Wayne Bergstrom, MO Creighton. I to the University of Nebraska. We did noi know each

other then. He siraduated in 1963.

His father was a GP in Missouri Valley, Iowa all his life. Those were the days when, if a farmer couldn’t pay his bill, you got a couple of chickens, or a pig for delivering a baby. There frequently was chicken on the Bergstrom table.

Wayne went to the University of Iowa for pre-med. then Creighton Medical School and internship in

Cedar Rapids, Iowa. He served in the Army at Ft. Lewis and Madigan General Hospital. In 1966. he came to Tacoma. He came and talked to me about an association. It was my loss that this didn’t work out. How­ ever, we shared weekend call the last few years that we practiced. Wayne was a good doctor, admired by his patients and peers alike. He seldom made mistakes and his hospital workups were exemplary. He was

Board Certified in Family Practice in 1977 and he was a member of PCMS. WSMA. and AAFP (local and national). He served on various medical committees and served as President of the Pierce County Medical

B ureau.

Wayne had two passions (probably others I didn't know about): golf and story telling. After retirement several years ago, he was able to pursue golf more vigorously, but several surgeries cut into that.

W ayne’s stories were always funny, but at times risque. I never heard Wayne speak criticism about another human being. In fact, if 1 criticized an individual, he often would change the subject, as he was un­ comfortable with the thought.

Wayne married Reta (a childhood sweetheart) close to 40 years ago. They had a good marriage. He must have been an easy man to live with. Certainly, friendship with him was easy and enjoyable.

Jim Blankenship, MD

June, 2001 PCMS BULLETIN 9 IN MEMORIAM DAVID E DYE, MD 1921.2001

David wandered out of the world of peopie and time into the world of Spirits and eternity on April 15,

2001. surrounded by his family and friends. His leaving was not totally unexpected but, none the less, a loss.

For him it is the beginning of another adventure.

David's journey began on October 5. 1921 in Roundup, Montana, where he was the 3rd child. He left

Montana on a freight train headed for the W est Coast. His tales of his adventures between then and the end

of W W II filled many an hour with joy and mirth. A lifelong Husky, he graduated from the UW School of

Medicine in 1952 and set up practice in South Tacoma.

David liked being a person who could help others and saw Medicine as his way to do that. He had to be

reminded, at the end of his first year of practice, to bill people. David never got over the idea that medicine

should he free to those who could not afford it. However, the joy lie received more than made up for any fi­

nancial damage that he may have suffered. He counted as one of his many blessings the lifelong friendships

that he established with many of his patients.

David was never inhibited by a lack of knowledge when he approached any non-medical problem. This

resulted in, among other things, his building a swimming pool in the fam ily's home that lasts to this day. The

family still recalls the time he filled the pool with goldfish (unaware of the effects of chlorine on goldfish) for

his granddaughter’s birthday.

David had a strong sense of public service. He served on the City of Tacoma Utility Board and was its

chairman in 198 J -1982, was on the Pierce County Medical Bureau Board of Directors and was a member of

the Board of the Bay view Condominiums.

David is survived by his wife of 45 years, Rosemary, sons David (Rebeca), Michael (Jeri), Craig

(Noreen), and Eric: daughter Rosemary (John) and grandchildren, Caroline. Lewis, Greta, Georgia, Robin,

and Nathan. Daughter Robin preceded him in death.

In keeping with David's spirit of public service, he asked that contributions be made to the Tacoma Art

Museum. 1123 Pacific Avenue, Tacoma WA 98402.

10 PCMS BULLETIN June, 2001 IN MEMORIAM RONALD C. JOHNSON, MD

Editor's Note: The following eulogy was presented at Dr. Johnson \s memorial service by his friend, Dan A. Wikhmd. MD.

I see so many familiar faces of colleagues as well as palients and friends of

Ron. He surely would have been delighted to see such a turnout even though he

was a humble man. My name is Dan YViklund and I am one of Ron's medical col­

leagues. Our friendship dates back 30 years to our PLU days and has survived

many mountain hikes, snowcamping and arguments, including one that completely

destroyed Ron's hiking tenl.

R onald C. Johnson. M D I am here today with my three adorable daughters and my lovely wife, Ulrike.

Somewhere il has been written, "He had no time for death, so death kindly waited

for him.” Ron did not die easily nor did he ever care to take the easy way out of anything. During the last week of

Ron’s life, his wife along with Ron’s sister. Candy, stood vigil over his bedside. Ron's sister particularly cared gen­

tly and lovingly for every need from the telling of sweet childhood stories lo moisturizing his cracked, parched lips.

The scene reminds me of the loving kindness of Mary, sister of Martha and Lazarus of Bethany, who anointed with

fragrant oil the feet and hair of Jesus, a few days before his crucifixion. Thank God for women.

1 am not here today to tell Ron’s life story nor to recount his accolades or foibles. Many of you know that Ron

received the rare distinction of being awarded PLU’s alumnus of the year a few years back as well as having the

Puyallup Helping Hand House named the Ron C. Johnson Home. Ron was humble and would be embarrassed

with a litany of praise. Rather, I would like to share with you a personal story that recounts the sweetness and toler­

ance in our relationship as well as a farewell poem.

First, let me begin with a Ron story. There are many of them. Silling in the pews I believe is Ai l Schneider, a

dear patient of Ron’s who recently celebrated his 180th birthday or something close to that. Art is a packer and has

a pasture full of mules and pack horses and wanted to take Ron and me to the Goat Rock wilderness area high

above Packwood. Now Art is a real cowboy and I was fortunate enough to grow up with horses as well. Unpacking

the horse trailers was a nightmare with a half dozen pack animals and enough equipment to set up base camp at

Everest. My wife always teased Ron and me that we spent enough money on camping equipment to be able to

spend a month at Seattle’s Four Season's Hotel. Anyway. Art, myself and all the pack mules are headed up the trail

See "J o h n s o n ” page 21

June, 2001 PCMS BULLETIN 11 B u l l e t i n

IN MEMORIAM J. GALE KATTERHAGEN, MD 1935^2001

.1. Gale Kalterhagen. MD passed away April 10, 2001 alter an extended bout with cancer.

Dr. Kattcrhagen was born in Calgary, Canada and is from a long line of wheat farmers, most of

whom still reside in Canada. In 1942 the Kattcrhagan family moved from Canada to Seattle. The

family operated a small truck farm while his father worked as a machinist at Boeing and his mother

at S ears.

Dr. Kattcrhagen graduated from Seattle University and in 1961 graduated from Creighton

University Medical School. He made significant contributions to the field of Oncology. He was a

practicing oncologist in Tacoma for over 20 years, then left in 1986 lo develop and implement can­

cer treatment centers for hospiLals in Springfield, Illinois and also Burbank and San Francisco,

California. In April of 2000, he returned Lo MultiCare Medical Center to develop the Regional

Cancer Center and Cancer System.

His greatest gift to those with cancer was his selfless giving and listening to ihose in need of

help and insight. His appetite lor IiIe extended to many areas, including running, swimming, takins

saunas, and traveling with his wife and many friends. He loved to be with his family and cherished

the delights of a yearly family pilgrimage lo Lake Chelan.

He will be missed dearly by his family and friends.

12 PCMS BULLETIN June, 2001 p/{'e/ee %Mnhj o4(e

IN MEMORIAM ROBERT A. O'CONNELL, MD

Robert "Bob” O'Connell, MD passed away Monday, April 16, 2001

at St. Joseph Hospital, the place of his birth, after a courageous battle

with cancer. Bob was born in Tacoma on March 18. 1923 and was

raised on Puyallup Avenue, at the foot of McKinley Hill, atop his

father's establishment, Toni's Tavern. He attended Holy Rosary Grade

Robert O'Connell. MD School and Bellarmine High School. Sports were always an important

part of his life and he was extremely proud of his athletic accomplish ments, having earned all-state honors in football and attending Santa Clara University on a baseball scholarship.

Dr. O'Connell received his M.D. degree from Marquette University in 1947 and continued his resi­ dency training in Milwaukee, Wisconsin, where he met and married his wife of fifty years. He practiced internal medicine in Tacoma for over forty years.

Bob received many honors and awards for his professional contributions and leadership in the community. He was Chief of the Medical Staff and a member of the Board of Trustees of St. Joseph

Hospital, a founder of Allenmore Medical Center and Hospital, served as President of the Washington

State Heart Association, and is a member of Bellarmine’s Sports Hall of Fame. He was active in Tacoma athletics, serving for forty years as team physician for Stadium and Bellarmine High Schools and giving free sports physicals to thousands of recreation league children.

Dr. O ’Connell retired from the practice of medicine in 1988 and spent the golden years with his wife, close friends and family - laughing, loving, golfing, and cheering his teams to victory.

June, 2001 PCMS BULLETIN 13 IN MEMORIAM MAURICE L. ORIGENES, JR., MD 1925^2001

Maurice L. Origenes. Jr.. MD passed away on May 15. 2001. at North­

west Hospital in Seattle at age seventy-rive due lo complications from pros­

tate cancer.

He was a pediatrician with specialties in pediatric oncology and hema-

>, j\ i ;,'m, , i ini.;, i;t .1 ![> lology since 1957. Dr. Origencs was a longtime member of the Tacoma and

Seattle communities, respected for his professional and civic contributions

and religious ministries.

He earned his medical degree at the Catholic University of The Philippines in 1954. In 1958. Dr.

Origenes came to Seattle as a Fellow in Pediatrics at the University of Washington School of Medicine. In

1967 he opened a private pediatric practice in Tacoma, until his retirement in 1992.

Dr. Origenes was a pediatrician for the Puyallup Indian Nation, Jesse Dyslin Boys Ranch. Tacoma

Runaway Youth Program. Kitsap Youth Homes. Tacoma Community House. Southeast Asian Refugees,

the El Salvador Sanctuary Refugees and Peruvian Inca Indians, both in Tacoma, and a sports physician to

numerous youth organizations.

He was recipient of a variety of civic and medical honors and awards, including "Distinguished Citi­

zen which was awarded by the Municipal League o1 Pierce County “in recognition of outstanding dedica­

tion to good government and the betterment of our community."

14 PCMS BULLETIN June, 2001 In My Opinion.... The Invisible Hand by Andrew Statson, MD

Insurance Overhead

"The high cost o f living isn 't so had if you cion 7 have to pay fo r it. " Don Marquis (1927)

Once upon a time, in the years BC ment code. Fine, but patients don't fit . b x / r t ’ u' Siarson, MD (Before Computers), the insurance the slots of treatment codes very forms contained the personal informa­ neatly. There are too many situations tion of the patient, the diagnosis, the where the diagnosis can be placed in we total all the costs related to billing, procedure and the charge. As long as this slot rather than that, and the treat­ we probably spend at least ten and pos­ the treatment was a covered benefit, ment is more likely to be coded here sibly as much as twenty dollars per the insurance paid 80% and that was rather than there. The insurance com­ claim. This includes, in addition lo the that. Computers were supposed to panies called that upcoding. That ap­ lime for training, coding and billing make things easier for us and reduce proach did not work as well as ex­ proper, the cost of the required docu­ our work load. They did the first, but pected. so the nex.1 step the insurance mentation to support our chargcs, the not the second. Because some things companies took was to make the lines costs of our time and that of our staff were easier to do, the work expended between the slots as thin as possible. spent on the phone getting approvals, to fill the available time, then over­ The slots were described precisely, so authorizations, following up on claims flowed it. that the gray areas could be eliminated. that have not been paid, etc. Computers can’t understand hu­ As a result, coding became more At the same time, the insurance man language, so the first thing that and more complex and developed into companies have to buy computers, to happened was to switch from descrip­ a branch of medicine in its own right. train and retrain their staff every year. tions to codes for the work we do. The diagnosis codes went from three As the rules change, they have to up­ Codes are slots where we have to lit di­ to four to five digits and there is rumor grade their programs, issue periodic agnoses and treatments. A rose is a a new system with six character codes regulations, print rule books and for­ rose is arose, until you listen to Ed is coming. The treatment codes added mularies. They have to submit some Hume. Then you realize that it isn’t. modifiers and were matched to specific claims to medical review, return and re­ The same is tine for diagnoses and diagnosis codes. Tn spite of all this, hu­ process others, send explanation of treatments. Diabetes is not diabetes is man beings still don’t fit into slots. Cod­ benefits and other correspondence to not diabetes. They are all different ing is so complex now that we have lo offices and to palients. They also have from patient to patient. The same is true go to classes, buy books, subscribe to lo audit and credential the physicians for colectomies, hysterectomies or for periodicals and buy computer systems on their panels and meet a variety of any other surgical or medical proce­ to help us with the coding requirements other requirements, imposed on them dure or treatment. There is an aver­ of insurance billing. To make things by those who buy their insurance poli­ age, there is a median, but in every pa­ even more difficult, the codes change cies and by the government. tient the treatment is different. As long every year, so we have to relearn cod­ 1 don’t know what the cost is to an as the insurance companies kept pay­ ing. get new books, upgrade computer insurance company to process and pay ing 80% of our charges, there was no programs, etc. a claim. Indemnity insurance overhead problem. We could charge according Not only do we have to be trained is about 10-15*5? of premiums. The size to the difficulty of the case. and retrained in coding, but so does of the average claim is probably about That was not good enough. The our staff. I don’t know what the total $100-200, so the cost to process a claim insurance companies decided they cost is to us, nor how much we spend is probably between $10-30. For man­ would pay not according to how much for every claim we submit. I suspect it aged care, the overhead is double that, we charged, but according to the treat­ varies from practice to practice. When See “ Insurance" page 16

June, 2001 PCMS BULLETIN 15

'V------P w m ’ if'OUHty Q ifecltcal n^cca-tif

New Members

Cosgrove, Anne E, MD Pediatrics Gill, Alan R, MD Metcalf, Sharon L, MD Practices at Tacoma South Med Clinic Family Practice Qb/Gyn 2111 S 90th Street, Tacoma Practices at Tacoma Family Medicine Practices at The Lakewood Clinic 253-539-9700 521 Martin L King Jr Way, Tacoma 11311 Bridgeport Way SW #309 Medical School: U of Massachusetts 253-403-2900 253-581-6688 Internship: U Hospitals of Cleveland Medical School: U of Michigan Med School: Virginia Commonwealth U Residency: U Hospitals of Cleveland Residency: U of Missouri-Columbia Internship: Eastern Carolina U Residency: St. John Hospital Fahmy, Raed N, MD Kelley, James L, MD Cardiology Pathology Mooney, Maureen A, MD Practices at Cardiac Health Specialists Practices at Dig Health Specialists Dermatology 1802 S Yakima #307, Tacoma 1901 S Union #B2005, Tacoma Practices at Cascade Eye and Skin 253-627-1244 253-272-8177 1703 S Meridian #101. Puyallup Med School: George Washington U Medical School: Oregon Heallh Sci U 253-S4S-3000 Internship: UCLA-SFVP Internship: Tripler Army. Med Ctr Medical School: U of Minnesota Residency: Loma Linda U Med Ctr Residency: Tripler Army Med Ctr Internship: Hennepin County Med Ctr Fellowship: UCLA-SFVP Residency: New Jersey Med School Fellowship: New Jersey Med School

Nutter, Paul B, MD Physical Medicine and Rehab Practices at Good Samaritan Hospital TACOMA RADIOLOGY 407 14th Avenue SE, Puyallup Medical School: U of Washington Internship: U of Washington Residency: U of Washington

Reid, Dennis G, MD Pediatrics Practices at Tacoma South Med Clinic 2111 S 90th Street. Tacoma 253-539-9700 Medical School: Case Western Reserve University Internship: David Grant Medical Ctr H^Spine & Femur Residency: David Gram Medical Ctr DEXA Reilly, Philip A, MD Family Practice Detect osteoporosis Practices at SeaMar Comm. Health Ctrs Assess fracture risk 1112 Cushman Avenue, Tacoma Quantitate bone mineral density changes Medical School: UCSF Monitor therapeutic response ^ , Internship: Providence Family Practice r www.tacom.araa.com Residency: Providence Family Practice

Allenmore Medical Center Lakewood Office (253) 383-2038 (253) 588-6083

June, 2001 PCMS BULLETIN 17 ni i.i !.i i

Directory Changes

Please tiuiki iii'h■ nl llh‘ c•luiiti’es In \m ii '001 I ’C M S Diivclni'Y.

I'Uigene Kt/korn, Ml) Change Suiic II I" 2 What problem Sandy Hills, I'A-C Change address and phone id: 104A 23rd Aseiuie SI'. can we solve Puyallup W A '>8372 Phone: 770-51.S| I-ax: 770-S152 for you today? Sponsor: Robert Vandeburg. Ml)

Andre Joseph, Ml) Change address lo: I708S Yakima A\e M40 Tacoma WA *)S. 11)5

Todd kihara, Ml) Change Aeeess I me Pager to 444-51'H Computer Networking Jay Klarnet, Ml) Delete pager number @ General Computer Support Add: Paging S e n ice l-800-235-42f>3

Patty Kulpa, Ml) Change address lo: ^ Security and Virus Protection 7282 Stinson Avenue Sle C ( iig Harbor W A ‘is <35 @ Custom Development John McCloskev, MI) Change address and phone to: Internet Connectivity 3 14 Marlin I King li Was #303 Tacoma W A ‘JN-IIIS Phone: 39 6 -IX(>8 I -ax: 396-4X711

James Morgan, Ml) Change address lo: 1708 S Yakima Ave /Kill

Tacoma W A 4X I0 S

Philip Vance, Ml) We can help you. Change address lo Managing technology is no easy task. 1708 S Yakima A\e #50 Tacoma W A ‘1X405 IT Source can help you solve computer

Matthew While, Ml) problems so you can get on with more Change address and phone to: important things...like your business. 5420 100th Si SW l/3() Lakewood W A 'tXI'W Physiciansf Inly: 5Xl> 5 Vi9 l-ax: 581-1740 Nol closed Monday/Open Saturday 253.835.1200 I I so u rc e www.itsource.com Jessie Yuan. Ml)

( 'hange office /ip code lo 98405 200U II Soiiicu, A Continuum Company

18 PCMS BULl I-UN June. 2001 COLLEGE Continuing Medical Education OF MEDICAL CME at Hawaii returns to EDUCATION “Big Island/’ Hapuna in 2002

The Hapuna Beach Prince Hotel, Built in 1994, the Hapuna is located on 32 acres edging on Hapuna Beach on the beautiful and sunny Kona coast. Stratton to Keynote at the Mauna Kea Resort (hailed as The oversized, deluxe guest quarters “one of the world's 10 best’’), has been features louvered doors and slide open Fall ID Update selected as the site for the CM E at Ha­ to roomy furnished lanais. The smart waii program in 2002 - specifical ly the design of this hole! ensures thal all Nationally known antibiotic resis­ week of April 7-13. rooms have at least partial ocean view's. tance expert Dr. Charles Stratton has The CME program returns Lo the The hotel offers reduced green agreed to keynote next fall’s Infectious “Big Island” and the Hapuna for a vari­ fees al the Mauna Kea course that be­ Diseases Update CME. ety of reasons including great review's gan the legend of Hawaii as a golfer’s Dr. Stratton is an Associate Profes­ resulting from those who attended the paradise, and Hapuna Golf Course. 18 sor of Pathology and Medicine and the 2000 meeting al the same hotel. The championship holes designed by Director of the Clinical Microbiology College was again able lo secure a Arnold Palmer and Ed Seay, with an Laboratory at Vanderbilt University. “world-class” resort at greatly reduced ocean view from every tee and green. This year’s program is set for Fri­ rates. Registrants may benefit from our To lake advantage of these sav­ day, November 2, 2001 and is directed negotiated group rates for ocean view' ings, you musl make your reservations by Dr. James DeMaio. In addition to rooms from $ 190. A second adjoining soon. THE COLLEGE'S RESERVED a presentation by Dr. Stratton, the pro­ room for children under 18 is available BLOCK OF ROOMS WILL BE RE­ gram will feature presentations by In­ al $50 below the group rale. LEASED AFTER MA RCH 8, 2002. fections Limited physicians. Program brochures will be mailed Reservations can be made by calling This program is designed for phy­ this summer. In addition Lo outlining the the Hapuna directly at (800) 882-6060. sicians as an update on common outpa­ CME program (16 Category I hours), You must identify yourself as pari of tient and inpatient infections. A brief Ihe brochure discusses transportation the COLLEGE OF MEDICAL EDU­ review and clinical update will be made and encourages early registration. CATION group." on a variety of important topics. ■ Whistler CME likely January 23

Registration will soon open for the College’s CME at Whistler/Blackcomb program. Program brochures will be mailed this summer. The conference is tentatively scheduled for January 23- 27,2002. The program offers family vaca­ tioning, skiing and the usual quality continuing medical education to PCMS members and other physicians. With Category I credits, the CM E program features a potpourri of subjects of in­ terest to all specialties. The program is under the direc­ tion of John Jiganti, MD and Rich­ ard Tobin, M D. ■

June, 2001 PCMS BULLETIN 19 B ulletin

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20 PCMS BULLETIN June, 2001 '9fyfYce ‘i'oun/y Q.'tlechcal (tfoctety

Johnson from page 11 and we shortly discovered that Ron is ging another man and the importance them and understood them. I think it was nowhere to be found. I forgot to ask of daily friendship. I could always a part of why he enjoyed ambiguity and Ron if he had ever been on a horse count on Ron calling me every morn­ vvliy he was often conflicted. His base­ before and, of course, he had not, ex­ ing at 9:30 just as I was falling behind in ment looks like an annex to a university cept for the one in front of the Safeway my clinic, telling me it was time to catch library with over 3000 books. We at­ store. His horse was headed back to my breath. Ron worked six days a tended many lectures at U W ’s Kane Hall Puyallup. We collected Ron, gave him week, twelve hours a day and knew and the Science and Technology lec­ driving instructions and nicknamed him how to pace himself. His compassion tures at the Paramount hearing great the Buckaroo. The name stuck and be­ and kindness to his patients will always speakers from the Jungian psychologist, came a metaphor for many of the com i­ be my model. James Hillman, to the agnostic anthro­ cal aspects of Ron’s personality. Ron Ron had many passions and one of pologist. Stephan Jay Gould. His true was always accepting and tolerant of the greatest was his books. He was an love was poetry and I would like lo share my teasing. He taught me how to be a avid reader of poetry and philosophy. one with you that you probably know by friend, not to be embarrassed of hug­ The scary thing is that he read most of Allred, Lord Tennyson. Tennyson also had a devoted friend from college, Arthur Halloran. who single-handedly lif&l Allenmore encouraged Tennyson to publish his early poetry. Halloran unfortunately iffly Psychological died unexpectedly at an earlier age than Associates, P.S. even Ron did. At age 81. just three years before his death, Tennyson picked up 752-7320 an envelope and wrote "Crossing The Do you have patients with difficult emotional Bar" across the back of it. The metaphor and stress-related problems? Psychiatric and in this poem refers to the pilot boat that brings you safely across the rough wa­ psychological consultations are available. ters of the bar into the safe, quiet w aters. Union Avenue Professional Building It reads: ______1530 Union Ave. S.. Ste, 16. Tacoma ... Sunset and evening star, And one clear call for Me! And may there be no moaning of the bar, When ! put out to sea. But such a tide as moving seems asleep, too full fo r sound and foam. When that which drew from out the E boundless deep Turns again home. ATTOO Twilight and evening bell, WORRIED ABOUT WHAT YOUR SPOUSE, And after that the dark! YOUR FRIENDS OR EVEN YOUR BOSS And may there be no sadness of Fare­ THINKS ABOUT YOUR TATTOO? well. OR ARE YOU JUST TIRED OF When I embark; LOOKING AT IT? For though from out of our borne of Today’s newest Alexandrite laser, Time and Place will remove your tattoo The flood may bear me far, with minimal discomfort & I hope to see my Pilot face to face less than 1% risk of scarring;.

('dll toduyfor m ore infoniuition Ron will see his Pilot face to face, a PIERCE COUNTY man of strong faith. ■ LASER CLINIC Director Peter K. Marsh M.l) (253)573-0047

June, 2001 PCMS BULLETIN .21 Advanced Training in Management For physicians and other clinical practitioners Medical Placement Service...... owned and operated by: Both the evening/weekend Master of Health Administration (M.H.A.) and Certificate Program in Medical Management assist practicing clinical professionals to develop Pierce County Medical Society knowledge and skills in management applicable to every day work situations. ^Permanent Full & Part Time Positions Master of Health Administration (M.H.A.) This program provides ■’Temporary Placements advanced, in-depth knowledge and skills in planning, organizing and implementing programs which address health needs and improve the cost effectiveness and quality of Pierce County's "medically exclusive" agency patient care. The application deadline is April 30. Applications are currently being 223 Tacoma Ave So., Tacoma 572-3709 accepted. Applications received after the deadline will be reviewed on a space-available basis.

Certificate Program in Medical Management This program provides participants with basic knowledge and practice-oriented skills in health services management, and helps participants determine if they would like to go further in their TACOMA/PIERCE COUNTY management training. The application deadline is August 21. Outpatient General Medical Care. Both programs are offered by the University of Washington Department of Health Services and Educational Outreach with representation from the UW School of Medicine. Full and part-time positions available in Tacoma and vicinity. For additional information or an application packet, contact us at: Very flexible schedule. Well suited 206-616-2976 for career redefinition for http://depts.washington.edu/mhap/eve/index.html GP, FP, IM.

The UW reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, Contact Andy Tsoi, MD (253) 752-9669 manta] status, disability, or status as 3 disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations. For disability services, call 206-543-6450 or 543-6452 (TTY) as soon as possible. or Paul Dot)-' (Allen, NVLson, Turner & Assoc.), Clinic Manager (253) 383-4351

Will a disability put you out of commission?

As you know, disability insurance policies for physicians are changing rapidly— and not for the better. High claims have caused many major carriers to limit the most important benefits.

At Physicians Insurance Agency, there’s still time to secure the specialty- specific coverage you need. In addition, we can help you find superior life and long-term-care coverage for you and your family.

To discuss the ways you can best protect your future income, call Physicians Insurance Agency today: (206) 343-7150 or 1-800-962-1399. PHYSICIANS r ■ - INSURANCE ^ AGENCY A wholly owned subsidiary of Physicians Insurance

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22 PCMS BULLETIN June, 2001 Classified Advertising

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Tacoma/Pierce County out­ Dr. K. Scherbarth is looking for Available now, new construc­ patient general medical care at its best. partners in 47 ft. motorboat and tion, 1000-6000 sq ft, close to hospitals Full and part-time positions available in Mooney airplane. 253-752-6965. on Union at 13th. Call Dr. Lovy at Tacoma and vicinity. Very flexible Executive Office Furniture. 756-2182or206387 6633. schedule. Well suited for career Double pedestal desk (mahogany or redefinition for G.P., F.P., I.M. Contact Per Diem medical office space, oak veneer), matching credenza, Andy Tsoi, MD (253) 752-9669 or Paul Puyallup, fully furnished waiting room, bookcase, lateral file, executive chair Doty (Allen, Nelson, Turner & Assoc.). five exam rooms, reception, fax, with two matching side chairs. Must sell, Clinic Manager (253) 383-4351. phones, everything. Rent in 1/2 day contact Ron at (253) 383-5949. increments to meet your needs. 253- 848-2303.

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W hen limes are tough, physicians count on us to fight for their best interests— from the day a claim is discovered to the day it’s resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly— with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t you want only the very' best on your team? For more information, call us today at 1-800-962-1399. IP Physicians Patricia Mulligan, (..rcaicd ;snd Spon.’ Ored by ihe A Insurance Washington Siaiu Medical A/.sudaiion Claims Representative 'x'kiult'. WA €' PhvMLians Insurance 2001 A Mutual Company

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24 PCMS BULLETIN June, 2001 INSIDE: President’s Page: “The Fish Head Guy” The Medicare Scare - are physicians really opting out? June General Membership Meeting Recap Members complete Sound To Narrows Tacoma-Pierce Count)' Health Dept: “Hepatitis as a Sexually Transmitted Disease” PCMS welcomes new members In My Opinion: “Whittling the Middleman” B u lletin

PCMS Officers/Trustees: Patrice N. Stevenson. M D President Susan J. Salo. M D ...... President Elect .1. James Rooks. Jr., M D ...... Vice-President Michael J. Kelly. M D ...... Secretary/Treasurer Charles M. Wealherbv. MD....Past President Sabrina A. Benjamin. MD Drew II. Deutsch. MD Stephen F. Duncan. MD July, 2001 Kenneth A. Feuclu. MD .Sumner I.,. Schoenike. MD

WSMA Representatives: Speaker of the House: Richard Hawkins. MD Trusiees: David Law. MD; Nicholas Rajacich. MD AMA Delegate: Leonard Aleniek. MD W AM PAC Chair/fiLh Disiricl: Mark Gildenhar, MD W AM PAC 9th District: Don Russell, DO

Executive Director: Sue Asher

Committee Chairs: A g in g , Richard Wnliman; A ID S , James DeMaio; B y la w s . Richard Hawkins: Budget/Finance. Mike Kelly: College of Medical Education, John Jiganii; Credentials. Susan Salo: Ethics/Standards Of P r a c tic e . D a\id Lukens; Grievance. Charles Wealherby: Labor & Industries, William Ritchie: Table of Contents Legislative. William Marsh: M edical-Legal. Mark Taylor; M embership Benefits, Inc.. Drew Deutsch; Personal Problems Of Physicians, 3 President’s Page: "The Fish Head Guy” RoberL Sands; Public Health/School Health, Sumner Schoenike 4 The Medicare Scare - are physicians really opting out? The Bulletin is published monthly by PCMS Membership Benefits, Inc. for members of the 5 June General Membership Meeting Recap Pierce Coumv Medical Society. Deadlines for submitting articles and placing advertisements in The Bulletin are the 15ih of the month preceding 6-7 Members complete Sound lo Narrows 2001 publication, (i.e. January 15 for the February issue) 9 TPCHD: ‘'Hepatitis as a Sexually Transmitted Disease' The Bulletin is dedicated to the art. science and delivery of medicine and the betterment of Ihe health and medical welfare of the community. The 10 in Memoriam: Myron Bass. MD opinions herein are those of the indiv idual contributors and do not necessarily reflect the 11 In Memoriam: Arthur O'Leary. MD official position of the Medical Society. Acceptance of advertising in no w ay constitutes professional approval or endorse-ment of 12 Congratulations to Dr. Gerhart Drueker products or services advertised. The Bulletin and Pierce County Medical Society reserve the righl to 13 Sian Harris, MD says goodbye reject any advertising.

M anaging Editor: Stic Asher 13 New Members Editorial Committee: MBI Board of Directors 14 Directory Changes Advertising Information: 253-572-3666 Subscriptions: $60 per year 14 Applicants lor Membership Make all checks payable to: MBI 223 Tacoma Avenue SouLh. Tacoma WA 9X402 15 In My Opinion: “Whittling the Middleman” Phone: 253-572-3666: Physicians call 572-3667 LAX 253-572-2470 17 College of Medical Education E-mail address: pcmswa(e,!pcmsw'a.<»rg Home Page: http://vvww.pcmswa.org 19 Classified Advertising

2 PCMS BULLETIN July, 2001 President’s Page by Patrice Stevenson, MD

The Fish Head Guy

I was flying 011 Southwest Airlines Our committee chair. Dr. George black and white likely does not repre­ recently and reading their magazine Kevorkian (no relation) has a Greek sent our eihnic diversity, but the India (to procrastinate from reading the hook PM&R resident in his program who ink medium used lo draw' him. I like the on time management I've been carting says the words do mean something that representation of Mt. Rainier and lhe around for months). There was a little would poorly translate into "Physical water...but what is with the fish? Is it snippet in a trivia column mentioning Medicine and Rehabilitation.” The coming out of his head ala A lien or that the now world-recognized Nike Greek was old and formal (isn't all leaping out of lhe water to attack his “Swoosh” logo had been created by a Greek?) and the meanings of the stethoscope? He seems oblivious lo the graphic arts college student in 1977 for words picked for the logo were close, fish's presence. Docs the lish have $37. This seemed to be a pretty good but not quite correct. The word for some Biblical connotation or is it sym­ return on investment. I then started “medicine" meant drug or medication, bolizing one of our area's economic thinking about logos in medicine. not the practice of medicine. My con­ activities? If the fish were not ihere. I am a member of the American clusion was that some physiatrists went what would you put there? Well, there Academy of Physical Medicine and out for drinks with a Greek dictionary could be a representation of a female Rehabilitation and serve on their His­ in tow and set out to add some culture physician as we do have many women torical Preservation Committee. The lo the logo and got only so close. The members, but nol a single fish has ever subject of our rest of the committee thought that a applied for PCMS membership. Per­ logo was the likely scenario. haps the name or initials of lhe Society topic of the So what is could be (here. I am nol sure whal editor's (Claire the origin of lhe should replace the current logo, but I, Wolfe. MD) PCMS logo? for one. would like to “can" the fish. column in our The fish head Perhaps I am alone in my opinion. March 2001 guy (my per­ Perhaps the fish head guy is a cher­ newsletter. sonal term of en­ ished icon of the membership. Perhaps The Physiatrist. dearment for we could sell PCMS T-shirts sporting The outer him) is also dark his image. If not. how about a new logo circle contains the organization name and mysterious for the new millennium? 1 ask that you and the inner contains “founded,” some (at least the left submit your logo ideas to lhe PCMS of­ Greek, and the founding date (in R o­ half of his head). fice. * man numerals). The Greek was the He also just started showing up some topic of debate. A couple of Greek Or­ time in lhe 1960s. I had our former ex­ thodox priests were consulted and said ecutive director, Doug Jackman, dig it meant nothing. An “elder statesman" through the PCMS files and he physiatrist was certain the logo had couldn’l find specific mention of the been developed and approved by the logo’s creation or adoption. The fish board of trustees in 1958. A search of head guy has a certain early sixties the academy records could not find look to him with his hairstyle and the mention of the logo’s creation nor offi­ Ben Casey white uniform shirt. The cial adoption. stethoscope implies he is a doctor. The

July, 2001 PCMS BULLETIN 3

Electronic Medical Records: June Meeting Recap

There is no doubt that everyone attending the June 12 General M em ­ Let us know your specific interest bership Meeting had a definite interest in electronic medical records. With 150 for future education programs: people, including ten vendors display­ Improving patient outcomes ing their wares, the Temple Theater Pros and eons of different ballroom was a hub of activity. systems/choosing a system Im porting radiologic and/or Kudos are in order for PCMS lab im ages Secretary/Treasurer Mike Kelly, Costs; return on investment MD, Lakewood family practitioner Education and specific staff p ^ M S who is in the middle of transitioning to c h a n g e s 253-572-3667 an electronic medical record system. Immediate„ , v. future . . trends and let us know your From a PCMS interest survey con­ Speech recognition software interest for future Personal/Consumer Health technology programs ducted a year or so ago, it was obvious R e c o r d s that many in the medical community E tc . wanted more information. Dr. Kelly studied the survey results in order to put together a program that would meet the needs and interest of the majority of respondents. Bringing together colleagues, Drs. James Brown, Lakewood Allergy/Immunology; Ron Morris, Puyallup Family Practice; Ed Pullen, Puyallup Family Practice and David Munoz, Tacoma Internal Medicine, Dr. Kelly planned a program that offered an array of personal experi­ ences, opinions, and system knowl­ edge. Each speaker offered their own "story" and each was quite unique in their approach regarding the complexi­ Pane! members, left lo right, Drs. David Munoz, James Brown, Ron ties and realities of EM R systems. Morris and Ed Pullen answered questions after their presentations. Prior to the program, PCMS President Patrice Stevenson, MD welcomed everyone and introduced new members Drs. Pauline Ander­ son, Martin Cieri, W alter H assig, James Pickett, Reheela Sadiq, Najib Stoman and Troy Woodman. Those that visited five of the ten vendors were eligible for a drawing for a $100 gift certificate to a local premiere restaurant. Dr. Stevenson drew new member/ob/gyn Dr. Pauline Anderson’s name as well as Lakewood general practitioner Moo K. Lee, MD. Participants had many questions and were very interested in vendor Congratulations to the winners. ■ displays.

July, 2001 PCMS BULLETIN 5 X B u lletin

Members complete Sound to Narrows 2001

More than 6,000 runners partici­ tired cardiovascular surgeon. credible 56:37 com pared to 1:18:00 last pated in the Sound to Narrows on Sat­ In addition to the m embers pic­ y ear urday, June 16. with Dr. Tom tured below, the following physicians Dr. Lauren Colman, Tacom a Herron, Gig Harbor pediatrician, fin­ are to be congratulated: oncologist, did an even 1:00:00 ishing in the top 200 men with a time of D r. Majeed Al-Mateen, Dr. Stephen Elder, T acom a an­ 50:39. Dr. Ron Taylor, Tacoma gen­ Tacoma child neurologist, improving esthesiologist, a very competitive 53:45 eral surgeon, finished second in his di­ his lime by over two minutes at 59:16 Dr. Jim Furstoss, retired oto­ vision with an excellent time of 52:54. Dr. David Benson. T acom a laryngologist One of the remaining few who has ophthalmologist Dr. Martin Goldsmith, pediatri­ run in every Sound to Narrow s for 29 Dr. Loren Betteridge. T acom a cian, just over an hour years, was Cordell Bahn, MD re­ family practitioner, finished at an in­ New member Dr. W illia m

Gil Johnston. MD Dave Law, MD Craig Rone, MD (54:57)

6 PCMS BULLETIN July, 2001 Hirota, Tacoma gastroenterologist Congratulations to all Pierce Dr. Tom Irish, Tacoma plastic County Medical Society members and surgeon theirfamilies on completing such a New member Dr. Sharon challenging run. Metcalf, Lakewood Ob/Gyn Please forgive us if we failed to list Dr. William Shields, ophthal­ your name and contact the PCMS of­ mologist fice (572-3667) so we can include your Dr. Darryl Tan, Lakewood pe­ name in the next issue of the B ulletin. ■ diatrician, improved his time by almost Editor'sNoic: Tliai]ks So Doug Jackman for hispho- two minutes at 1:03:05 u graphic ahiiiiies. Dr. Carl Wulfestieg, Tacom a ENT

Tom Herron, MD f50:39) Patrick Hogan, DO (59:29)

Jim Rooks, MD James Schopp, MD (59:28) Ron Taylor, MD (52.54)

July, 2001 PCMS BULLETIN 7 B ulletin

M edicare from page 4

oil Medicare issues. Physician numbers: Some experts argue lhat Amid rising defections, the total percentage of physicians participating Medicare's procedures aren't any in Medicare has been increasing: worse than other payers. The pro­ gram pays faster than most, and the 2 0 0 0 : 86.3% administrative and clinical challenges 1999: 82.3% are like other managed care de­ 1998: 80.4% mands. they say. According to 1 997: 77.5% HCFA's medical advisor, some physi­ 1996: 74.8%' cians' problems with Medicare stem from misperceptions and the Source: Health Care Financing Administration agency's regional offices are work­ ing with physicians to clear up some of the confusion, she says. But Colorado physicians are Numbers of physicians accepting new Medicare patients in Pierce skeptical. The doctors think they will County be prosecuted. Dr. Paul, who will meet with physicians this July, admits Primary Care 145outof227 = 64% the program has some problems, but Specialists 389 out of 395 = 98% says recent changes - heightened education efforts lor earners and * Total 534 out of 622 = 86%' physicians, and ongoing PRIT initia­ tives - eventually will pay off. PRIT's Source: PCM S Fax Survey. 2001 41 excludes pediatrics targets include: ABNs; certificates of medical necessity, coverage of fol­ low-up visits for cancer patients, of­ ten denied as routing screenings, coverage of pre-operalive evalua­ tions. also often denied, and labora­ tory services. Dr. Paul says PRIT's efforts in the past few years are lead­ ing to changes. "I'm hopeful that even the work w e've done in the past two years will begin to be felt at the bedside.'' she says. "By the end of the year, physicians should begin THAT TATTOO to see some very specific results." Another positive development is an WORRIED ABOUT WHAT YOUR SPOUSE, increased number of practicing phy­ YOUR FRIENDS OR EVEN YOUR BOSS sicians advising HCFA. THINKS ABOUT YOUR TATTOO? Nonetheless, some physicians OR ARE YOU JUST TIRED OF say it will take more than just inter­ LOOKING AT IT? nally motivated changes. "Things like Today's newest Alexandrite laser, fairness, integrity and good business will remove your tattoo should apply to HCFA and it just isn't with minimal discomfort & le s s than 1 risk off scarring. happening," said Dr. Corlin. “There % ( '.till (oduy l<>r m ore injonm icion is a cumulative building of inappro­ priate implementation that has been PIERCE COUNTY done so badly, they are collapsing of LASER CLINIC their own weight." ■ Direelor IVfcr K, Marsh M.O. Excerpted from AM News 6/25 01 (253)573-0047

8 PCMS BULLETIN July, 2001 Federico Cruz-Uribe, MD The Health Status of Pierce County Director of Health

Hepatitis as a Sexually Transmitted Disease

1 have written several articles lor mit the virus through blood or sexual ues we feel we are potentially reaching this journal that focused on HIV. look­ contact. a very significant part of the IDLI com ­ ing at the difficulties we face in trying Approximately 3.6 million Ameri­ munity. to stop the spread of this virus. I have cans are infected with the hepatitis C For those at high risk be­ stressed that in order to get in front of virus. This is also spread through cause of multiple sex partners, the dis­ blood, particularly by those sharing we have looked to the private ease we needles, or occasionally bv sexual con­ medical community for assis­ need to tact. Chronic liver disease is the tenth tance, since most of those at risk treat it leading cause of death among adults in for hepatitis access their health like any the U.S. and 40% can be attributed lo care providers. But many cases other hepatitis C disease: in addition, it is the are missed if individuals have commu­ leading indication for liver transplanta­ mild symptoms or if they are as­ nicable tion in the LIS. Since hepatitis C be­ ymptomatic. Many times they are disease. came reportable in July 2000. in Pierce missed because we often don’t HIV is County 3,700 cases have been re­ think of viral hepatitis as a sexu­ pre- ported. This is likely just the tip of the ally transmitted disease. Every t a l c n o i domi- iceberg. encounter with a patient who Cntz-Urihc. MD nantly a There are many factors causing conies in with the symptoms of an sexu­ the high numbers of infections in our STD is an opportunity to assess ally community. The virus tends to be very them for viral hepatitis. If they transmitted disease (STD). So the hardy and tolerates broader changes in are positive, report this to the work-up for an STD needs to include temperature, humidity and pH than health department. HIV testing. many. Virus in blood or body fluids that Here is where the private pro­ But a quiet epidemic has affected are rapidly dried and left exposed to vider plays a key role in our disease many more people and caused more air remain infectious for a long period control efforts. Through your screen­ morbidity than HIV/AIDS. The dis­ of time. We in public health failed to ing efforts we get in touch much more ease? Viral hepatitis (both B and C). address viral hepatitis effectively for rapidly with the individual sources of Though it is a mild disease for many in­ many of the same reasons we have the infection that can potentially rapidly fected individuals, it can have signifi­ floundered in addressing HIV. Be­ spread through our community. If cant morbidity. The acute phase of the cause it is found much more preva­ physicians routinely screened illness can result in prolonged numbers lently in the injecting drug user (IDU) for hepatitis B and C in every of days with fever, fatigue and jaun­ community and in the group of persons patient presenting with the symp­ dice. For a significant percent, it can who have multiple sex partners, we as­ toms of a sexually transmitted lead to chronic hepatitis, with the long sumed these persons would come to disease, we would reach an term effects of liver failure and liver the health department for counseling ever-widening net of infected cancer. and testing. We assumed they would and exposed individuals. W e can Nationwide, 80,000 new hepatitis B take advantage of the available vaccine educate those at risk. Those not in­ infections occur annually; fifteen per­ for hepatitis B. Some did come because fected but at risk for hepatitis B. we can cent will continue with chronic infec­ of outreach but the majority did not. offer a vaccine to protect them. For tion. Last year, Pierce County experi­ For the IDU community we needed to those positive, we can offer support enced a hepatitis B outbreak with 26 come up with novel and aggressive and counseling on how to take better cases and three deaths, compared with ways to get them tested. This was con­ care of themselves and to protect those seven cases and one death in 1999. A ceptually easy to do, as we have good around them from contracting the dis­ total of 3,600 cases of chronic hepatitis contacts with our local needle ex­ ease. By doing these traditional disease B have been reported in our commu­ change, with our local drug treatment control measures we can get in front of nity, and that is likely a very low num­ programs, and with the staff at our the disease and greatly slow its spread ber. People with hepatitis B can trans­ county jail. Between these three ven­ through our community. ■

July, 2001 PCMS BULLETIN 9 B ulletin

IN MEMORIAM MYRON A. BASS, MD 1924,4001

Dr. Bass was horn in Seoul, Korea, where his father Harold and mother Ethel were missionaries.

He lived in Tacoma and Gig Harbor most of his adult life, after years of schooling and serving in the

armed forces. He was a beloved husband, father, grandfather, brother and physician. He practiced

Obstetrics and Gynecology for more than thirty years in Tacoma. He enjoyed his family and his home

on the water.

Dr. Bass was a board certified Ob/Gyn. He received his medical degree from the University of

Oregon in 1948 and completed his internship at Pierce County Hospital and residency at Magee

W omen's Hospital. He practiced in Tacoma from 1956 until his retirement in 1986.

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10 PCMS BULLETIN July, 2001 IN MEMORIAM ARTHUR P* O'LEARY, MD 1913,2001

Dr. Arthur P. O ’Leary was bom in Anaconda, Montana on December 12. 1913 and quietly passed away oil June 2, 2001. He received his prcmedical degree from Carroll College in Helena. Montana and his Doctor of Medicine from the University of St. Louis School of Medicine in 1941. He served his internship at St.

Joseph’s Hospital in Tacoma in 1941 and 1942.

Dr. O ’Leary began private practice in General Medicine and Surgery in Tacoma in 1942. He was ap­ pointed as Director of the Intern and Residency Services at St. Joseph's Hospital and held this post for sev­ eral years, orienting, guiding and teaching the interns and residents. He also was a past President of the

Pierce County Medical Society. 1 met Dr. O ’Leary when 1 came to serve my Internship al St. Joseph’s Hospi­ tal in 1944. He was a great deal of help to me with his guidance, instructions and in the starting of my own prac­ tice.

Dr. O'Leary was a very charitable, honest and compassionate man. He was a very competent physician and an excellent diagnostician. He turned no patient away. He treated them, not only medically for their physi­ cal needs and diseases, but also for their spiritual needs. He rendered considerable, charitable services with­ out hesitation. His interest was mainly in obstetrics and gynecology in which he excelled. He believed that the life of even the most destitute was as important as his own, which led him to give them lu ll medical and spiritual service very willingly. He was a physician for all seasons.

In 1944, Dr. O ’Leary married Nancy Stewart and he is the father of six children, all of whom hold him in high esteem and love. Nancy preceded him on her journey to heaven in 1979. He began to wind down his practice after Nancy’s passing. But the sudden passing of Dr. Frederick Schvvind, who was in the office ad­ joining his, resulted in escalation of his practice, which he continued until 1985.

Dr. O’Leary did have a neurological disorder, which he did not allow lo handicap him. I had the privilege of his assistance in surgical procedures. He was very interesting to work with. He was professional and fully evaluated the patients he referred. He was dearly loved and respected by his patients and peers.

Dr. O ’Leary loved his family and they love him. One of his granddaughters stated that he entertained them at his home for dinner every Sunday and every holiday.

I enjoyed visits with Dr. O ’Leary during his years of retirement. He maintained a mental sharpness and kept abreast of new medical developments as well as other events. He also continued to present a great sense of humor to the end. He will be greatly missed by his friends, certainly me and most definitely his family. My personal message to him is “Via Con Dios, Arturo.”

Leo Annest, MD

July, 2001 PCMS BULLETIN 11 Personal Problems Congratulations of Physicians Committee Congratulations to Dr. Gerhart Drucker on his 90th birthday. Au­ gust 23. A longtime Tacoma-area physician. Dr. Drucker was born in

Medical problems, drugs, alcohol, Vienna. Austria in 1911. Upon finishing his medical studies, he immigrated retirement, emotional, or other such difficulties? to America in 1936, settling in Tacoma in 1941. His many years of general

practice included three years as Director of the Coronary Care Unit at Your colleagues w a n t to help Lakewood General Hospital (now St. Clare Hospital), one year as Chief of

Staff there, and innumerable house calls. When not busy with his patients, *Robert Sands, MD, Chair 752-6056 Bill Dean, MD 272-4013 he could usually be found climbing up a mountain or skiing down one. Tom Herron, MD 853-3888 Dr. Drucker retired in 1982 and now lives at University Place Care Bill Rocs, MD 884-9221 F. Dennis Waldron, MD 265-2584 Center. His family will host a birthday reception August 19 at the Temple

Confidentiality Theatre in Tacoma. For more information, call the PCMS office. Assured.

Expanded Hours & W Saturdays

ACR Accredited IJNION : *Br M R I 2502 South Union Avenue, Tacoma, WA 98405

MultiCare Health System Franciscan Health System Medical Imaging Northwest Tacoma Radiology

12 PCMS BULLETIN July, 2001 Mrm %«Mty Q ttcdicat tft'Ctefy

In My Opinion... Dr. Stan Harris says goodbye

Dear Friends and Colleagues, I have decided lo give up full time surgical practice effective July 1, 20(11. I have had a wonderful career with Cedar Surgi­ cal Associates and have been extremely fortunate to have such incredible partners. 1 am not leaving because of illness or because 1 am unable to perform Ihe duties required of a busy surgical practice. 1 am sad to say that I am tired - tired of the hassles and the business of a surgical practice. The government regulations, dwindling re­ imbursements, the no-win situation with the insurers, and the unreasonable expectations from our patients have soured my out­ look, I no longer feel the personal satisfaction of helping people who do not wish to help themselves. 1 no longer wish to be awakened at nighi to work for free. My patients will continue to receive (lie highest quality care from my partners. I hope that the physicians who have been kind enough to refer to me will continue lo send patients to Cedar Surgical Associates. I would have any one of my partners care for my family or me without any reservations, I plan to stay in the area and perhaps assisl my partners in the operating room occasionally . 1 plan to pursue my hobbies of golf and bridge and perhaps get to read things i have not had time for. Perhaps T will find time to write a few articles in ihe surgi­ cal journals. Perhaps I will gel bored and need lo get back into the stream. Perhaps 1 will just cal right, workout, and slay healthy. I thank you all for your kind and generous support and wish all of you the best in the upcoming tumultuous years of “medical reform.” Sincerely, Stanley C. Harris, MD

New Members

James C. Cook, Jr., MD Holly N. Johnson-Colt, MD Kathy J. Thomas, MD Cardiology P ediatrics Family Medicine Cardiac Study Center Woodcreek Pediatrics Communily Health Care 1901 S Cedar #301. Tacoma 1706 Meridian S #120. Puyallup 1 1225 Pacific Avenue S. Tacoma 253-572-7320 Mcdical School: Dartmouth Med School 253-531-6198 Medical School: Tulane University Internship: UW Children's Hospital Medical School: U of Pennsy lvania Internship: LA County-USC Med Ctr Residency: UW Children's Hospital Internship: Swedish Family Medicine Residency: LA County-USC Med Clr Residency: Swedish Family Medicine Fellowship: Hosp of the Good Samaritan Everett W. Newcomb, ill, DO Fellowship: Loma Linda University Executive Medicine Gail C. Venuto, MD Franciscan Health System O b/G y n Janis E. Fegley, DO 17 17 S J Street Gig Harbor Medicine Clinic Family Practice 253-591-6974 6401 Kimball Drive. Gig Harbor St. Joseph Medical Clinic Med Sch: Kirksville College of Ost Med 253-858-9192 1708 S Yakima, Tacoma Internship: Walter Reed Army Med Ctr Medical School: George Washington 253-593-8456 Residency: Walter Reed Army Med Ctr Residency: Bridgeport Hospital Medical School: Philadelphia College of Fellowship: Waller Reed Army Med Ctr Osteopathic Medicine J. Denise Wells, MD Internship: Allentown Osl Med Ctr Howard Sun, MD Orthopedic Surgery Residency: Allentown Ost Med Ctr Diagnostic Radiology 4700 Pi Fosdick D r#206, Gig Harbor Tacoma Radiology 253-851-6075 Elena A. G leyzer, MD 3402 S 18th Street. Tacoma Medical School: U of Arkansas Family Practice 253-383-1099 Residency: U of Maryland Western State Hospilal Medical School: University of Illinois 9601 Steilacoom Blvd SW, Lakew'ood Internship: Swedish Hospilal 253-582-8900 Residency: University of Washington Med School: First Leningrad M ed Inst Fellowship: University of Washington Internship: Sepulveda Valucla Residency: University of Texas Residency: St. Joseph Hosn. Houston

July, 2001 PCMS BULLETIN 13

— ^

In My Opinion.... The Invisible Hand by Andrew Statson, MD

Whittling the Middleman

“Man can defeat any system that man can devise. " The Economics of Trust John Whitney

I want to start with a disclaimer. The average payment to providers is A n d r e w Slal.uin. M l) Human society is a complex organism probably about $ 150. and the provision of health care from a To pay out that amount and cover societal point of view does not have their overhead, the insurance compa­ simple solutions. The creativity of the nies have to collect Si 80 in premiums. and certainly for less than $500. Elimi­ entire nation would be required to de­ The cost to us to submit a claim is about nating the processing and the payment velop and to maintain a workable sys­ $10. So. out of a payment of ,$150. only of these claims w ill reduce the adminis­ tem. This is only possible lo achieve SI40 purchases medical care. In sum. trative costs of private insurance by when people are free of restrictions, so $180 in premiums buys $140 dollars of close to 20%, or about $ 100 billion per they can try different solutions until care. This is in addition to the co-pays year. This would translate into a de­ they find the ones that work best for and deductibles the patients have. As a crease of the monthly premium from them. There can be no single resolu­ result, they pay 32% more in premiums $1000 to $800. tion that will be best for everybody. than what their care would cost, if they In addition, eliminating the insur­ People also have to be free to fail and had paid for it directly. ance coverage of small claims, for to learn from experience. What I de­ The health care industry amounts amounts below a certain limit, will re­ scribe here is not offered as a solution, roughly to $1 trillion per year in duce the monthly premiums by at least but as an example of what part of the rounded numbers. One half of that is another $300, and perhaps as much as solution may look like. consumed by the government pro­ $500. lo lhe level of about $500. or First dollar coverage is no longer grams. The private sector spends over even $300 a month. With this kind of available from private insurance com ­ $500 billion, of which overS 100 billion savings on premiums, a family should panies. The only one that provides it is are for the cost of administration. In the be able lo meet medical expenses of up “Mutual of Olympia." I think it was government programs, because of im­ to the limit, of say $300 or even $500 by about eight years ago when the wel­ posed regulations, mandates and su­ paying out of pocket. For claims bigger fare department introduced a co-pay perimposed levels of management on than thiil amount, die insurance would requirement of one dollar for office top of the subcontracting insurance pay 80%'. visits, but that did not work out. Collect­ companies, the administration costs The above figures are hypotheti­ ing a co-pay from people who are en­ 50% of the money spent on the pro­ cal. There are no actuarial studies to titled to their care and have never had grams, or equal to (he amount of health confirm them. To my knowledge no in­ to pay their way turned out to cost care purchased. So. the $500 billion surance company offers this type of much more than one dollar. cost of the government programs buys policy. All front end deductibles that Today, health insurance for a fam­ about $250 billion of health care. The now exist are nol per claim, but per ily with children with a modest front actual figures for 1999 were $ 1.21 I bil­ year. They require the submission of end deductible and various co-pays lion total. $662 billion private, $549 bil­ claims, no mailer how small, with the as­ costs over one thousand dollars a lion government. The private funds in­ sociated cost of their processing. It month. The overhead of the best run clude out of pocket payments. should be obvious that insurance over­ indemnity plans is about 10% of premi­ Here I’ll address the issue of the head and insurance premiums can be ums. For the worst run managed care private insurance plans. Processing a reduced substantially if claims of less plans it is more than 30%. The average claim costs about the same, whether it is than a certain amount can be dropped overhead across the industry is prob­ for $50 or for $5,000. About 90% of all from coverage completely. The cost of ably of the order of 20% of premiums. claims are probably for less than $300, See "W hiiiling" page l(S

July, 2001 PCMS BULLETIN 15 W hittling from page 15 processing them is just too high. In­ which includes a large number of office programs, there even was a move to stead of front end deductible per year, visits throughout the pregnancy and af­ pay patients when they kept their ap­ we would have no coverage at all for ter delivery. Medical or surgical pa­ pointments for care. Such well inten- clai ms of less than a certain amount. tients. who require multiple treatments, tioned programs don’t work. Even The potential problem of the could be allowed lo submit one claim for when their care is paid for. people still above described coverage for the in­ a session of treatments. Their insurance tend to delay treatments and not follow surance companies would be a low policy would then cover 80% of that through. They don't want to put out the claim limit, such that the patients and cost. An example would be physical effort and spend the time. As the prov­ physicians would tend to build up the therapy once a week for three months. erb says, you can take a horse to wa­ charges to above that limit, so they Of course, the more a policy covers, ter. but you can’t make him drink. would be payable by the insurance. the more expensive it becomes. The most important problem will This probably would be common with As long as people are given a remain the tax deductibility of health a limit of $ 100. less so with S300. and choice from a range of coverage, they care expenses. The above proposal is rare with $500. Policies with various can pick the one best suited to their one example of how the cost of insur­ limit amounts can be offered, with cost needs. This type of insurance policy ance overhead can be decreased so adjusted according to projections. The will probably have its own problems much, that it w ould allow people to pay patients will decide which limit of insur­ when put into practice. One situation for their care from the savings on the ance coverage is best for them on the was the tendency of people to delay cost of their insurance and probably basis of their individual circumstances. needed care when they had to pay for have some left over. What is more, it A potential problem for the medi­ it at the time. There are always other would put the responsibility for most cal equipment companies is that certain things on which they would rather health care expenditures back in the tests, let us say a scan, may cost $300 to spend their money. hands of the patients, where it belongs. ■ perform. If the limit of the policy is set In the early days of the welfare at that amount, the patient would pay 20%, or $60. If new equipment is de­ veloped, which could reduce the cost to $ 100, it would not find ready accep­ Advanced Training in Management tance. since the total amount would For physicians and other clinical practitioners then be the responsibility of the pa­ tient. It would need to bring the cost Both the evening/weekend Master of Health Administration (M.H.A.) and Certificate Program in Medical Management assist practicing clinical professionals to develop down to less than $60 per test in order knowledge and skills in management applicable to every day work situations. lo be widely used. However, such equipment would be beneficial for pa­ Master of Health Administration (M.H.A.) This program provides tients who have a $500 limit. It w'ould advanced, in-depth knowledge and skills in planning, organizing and implementing reduce their costs significantly. programs which address health needs and improve the cost effectiveness and quality of The potential problem for the pa­ patient care. The application deadline is April 30. Applications are currently being accepted. Applications received after the deadline will be reviewed on a space-available tients of such a policy would be the basis. risk of multiple small expenses during

the year, which could come up to a Certificate Program in Medical Management This program provides large total. This is particularly impor­ participants with basic knowledge and practice-oriented skills in health services tant for patients with chronic conditions management, and helps participants determine if they would like to go further in their that require repeated treatments at a management training. The application deadline is August 21. cost lower than the coverage limit. Both programs are offered by the University of Washington Department of Health Services Now, after they reach their yearly de­ and Educational Outreach with representation from the UW School of Medicine. ductible. their expenses are covered For additional information or an application packet, contact us at: at 80%. The solution to this problem would 206-616-2976 be similar to what we now do in obstet­ http://depts.washington.edu/mhap/eve/index.html rics. W e have a flat fee for obstetrical care. It actually covers basic care The UW reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, ar status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal given from about six weeks of preg­ and state statutes and regulations. For disability services, call 206-543-6450 or 543-6452 (TTY) as soon as possible. nancy to six weeks after delivery, care

16 PCMS BULLETIN July, 2001 'if'oantif r ' ((v(!uvl^<■<'<<■(if

COLLEGE Continuing Medical Education □F Whistler CME set January 23-26; MEDICAL Condo/Hotel Reservations Open

Reservations are open for both brochure, with conference and EDUCATION the traditional Aspens Condos AND registration details, will be mailed this the nearby and elegant Chateau summer. Whistler Hotel for the annual CM E at CM E at Whistler participants are Whistler program scheduled for urged to make their condo and hotel January 23-26,2002. reservations early. Air reservations In addition to the condos, typically For reservations for the block of a part of the "room block" secured by condos. ALL IN THE ASPENS, you encouraged for the College, a block often rooms at must make your reservations soon, as Chateau Whistler have been reserved conference dates are during the high Hawaii CME this year. The rooms are available lo ski season. The College's reserved CME participants al a reduced block of rooms will be released To assure you are able to secure conference rate. after Decem ber 1, 2001. seats and get a reasonable price for The College of Medical Education Reservations can be made by CME at Hawaii, we urge you to make has again selected ihe Aspens Condos calling Aspens on Blackcomb toll your reservations NOW. A small for accommodations because of the free at 1-877-408-8899. You must refundable deposit will hold your seats. very competitive rates and quality of identify yourself as a part of the The College is working with the lodging. These negotiated group COME group. Marilyn at Olympus Travel (565-1213). rates will remain the same as ihe 2001 For reservations in Ihe Chateau, Olympus has booked some seats at rates, and combined with the Canadian/ you should also make your group rales and had access lo other US exchange rale, result in major reservations soon. This block of rooms special options at the best rates. savings for the conference registrant. must be released by December 10, Call Marilyn today. ■ A collection of one and two 2001. Again, you must identify yourself bedroom luxury condominiums just with COME and can reserve your steps from the Blackcomb chair and room al the Chateau by calling 1 -800- gondola are available. Space is 606-8244. Hawaii Hotel available on a first come first served The program is under the basis in the Aspens. direction of John Jiganti, M D and Reservations Open The conference will be held in the Richard Tobin, MD. ■ Aspens Condo building. A program Those planning to attend next spring’s CME at Hawaii program are encouraged to book their room reservations - as soon as possible. The very popular program is scheduled during the very busy spring vacation period. Registrants may benefit from our negotiated group rates for ocean view rooms from $ 190. A second adjoining room for children under IX is available at $50 below the group rale. Reservations can be made by calling the Hapuna directly at (800) 882- 6060. You must identify yourself as part of the COLLEGE OF MEDICAL EDUCATION group. ■

July, 2001 PCMS BUffETIN 17

Classified Advertising

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July, 2001 PCMS BULLETIN 19 B u lletin ' levee Tf.'amu^ dio ,

“I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.” Corrine Jcdynak-Bell, DO, Tacoma, Washington

W hen times are tough, physicians count on us to fight for their best interests— from the day a claim is discovered to the day it’s resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly— with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don't you want only the very best on your team? For more information, call us today at 1-800-962-1399, Physicians

Patricia Mulligan, Crn.ed.ind 5pnn_= .,mbylhe IllSUrSIlCC W iishin^ion Sl.uc Mcdical Association a w Claims Representative Sc.utie. w a 'H1 phvsu'inns irLji.ii.incc iooi A Mutual Company

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20 PCMS BULLETIN July, 2001 August, 2001 Hapuna Beach Prince Hotel Kohala Coast, Big Island, Hawaii

CME at Hawaii - April, 2002 For reservations seepage 1"

INSIDE: 3 President’s Page: “Access to Care” 4 College Board honors Dale Overfield, MD 5 In My Opinion: “Reflections on Vietnam” by Robert Yancey, MD 7 Tacoma-Pierce County Health Dept: “Preventing Childhood Deaths in Pierce County” 9 In My Opinion: “The Power of Discrimination” by Andrew Statson, MD 11 In My Opinion: “Nostalgia of WWII” by John Stutterheim, MD 13 PCMS welcomes new members

_____

President’s Page by Patrice Stevenson, MD

Access to Care

We have all read numerous ar­ zons define their primary care physi­ ticles and editorials about the problems cian as "the doctor 1 have to see to do with access to care over the past few the paper work to get me into the doc­ years. Most of these are anecdotal and tors I want to see." Well, the data strik­ make it difficult to accurately assess the ingly shows the opposite is true. For extent of the problem. Even Washing­ the purpose of discussion. 1 will only ton state statistics may be too general to focus on the acceptance rales of new be truly useful locally. Your Board of patients with Medicare or Medicaid Trustees decided to send out a PCMS funding. Across the county the per­ membership survey to try to define the centage of specialists accepting new to provide it. There is also an eastern situation in Pierce County including Medicaid patients varies from 74-86% Pierce County primary care shortage breaking down the data by areas: while new Medicare is 95-100%-. For relative to the booming population Tacoma (includes University Place and primary care the percentage accepting growth that results in practices closing Fife), Lakewood, eastern Pierce new Medicaid varies from 15-85% to all patients. Orting and Eatonville still County (includes Puyallup, Sumner. while new Medicare is 27-85%. only have one physician each. New Eatonville and Milton), and Gig Har­ Tacoma is the highest with both being physicians quickly fill once the word bor. We looked at acceptance of pa­ about 85%. In my neck of the woods gets out that someone is actually taking tients by payer source for Medicare, (eastern Pierce County), it is a dismal new patients. Medicaid. Healthy Options. Labor & primary care acceptance rate of 20% I have no easy answers to these Industries and car insurances as those for Medicaid and 27% for Medicare. access problems and support each seemed to be payers we were hearing The specialist acccptance rales are individual’s right to make their own de­ about as potential access problems. We 74%' Medicaid and 100% Medicare. As cisions regarding practice issues. How­ did not inquire about commercial insur­ Puyallup pulmonologist Vernon ever, as Dr. Nessan remarked to me, I ances or whether the practice was Nessan, M D explained, this results in would encourage us to "share the closed to all new patients. We had a specialists doing more primary care by wealth (of the better payers) and share better than anticipated response rate of default and generally less thoroughly the burden (of the Medicare and Med­ 227 primary care and 352 specialists re­ and less efficiently than those trained icaid patients)." ■ sponding for a total of 579 responses from 650 active members (89% re­ sponse rate). The survey results were PCMS Care Survey briefly mentioned in the July B u lletin , and a summary is provided in the adja­ Accepting New Medicare Accepting New Medicaid cent chart. If you would like the com ­ plete data please contact Shana Osmer, Primary Care Specialty Primary Care Specialty membership services coordinator, at T acom a 84% 95% 85% 84% the PCMS office, 572-3667 or e-mail (includes UP. Fife) [email protected]. There has also been a long held L akew ood 75% 100% 15% 84% belief, especially by non-medical types, East Pierce County that the access problem was getting into (includes Puyallup. Sumner, 27% 100% 20% 74% specialists for care and that everyone Eatonville, Milton) could have a primary care physician. I G ig Harbor 60% 100% 56% 86% once had a patient with Secure Hori­

August, 2001 PCMS BULLETIN 3

In My Opinion.... by Robert A. Yancey, MD

Reflections on Vietnam

The United Nations has pro­ door to increases in western foreign exist as health care centers. A fair num­ claimed 2001 the International Year of aid, international investments, and tour­ ber of Vietnamese orthopedic sur­ Volunteers and the vast number of op­ ism. geons were trained between 1965 and portunities to help is equaled only by While much of Southeast Asia has 1975 in the principles of acute trauma the amount of personal rewards to be made considerable advances in the surgery by the American physicians in gained. I was very fortunate to be able past 20 years, there has been a signifi­ Saigon and Danang. to take time out from my practice for cant gap in the development of Viet­ When one wanders throush some the month of March to work as a volun­ teer orthopedic surgeon in Vietnam under the auspices of Orthopaedics Overseas and Health Volunteers Overseas. The primary purpose of the trip was to teach operative techniques and exchange information about the practice of pediatric orthopedics. 1 also helped set up some trauma protocols with appropriate technology in four major trauma centers throughout Viet­ nam. The trip was a unique opportunity for me, my wile BettiAnn. and our five year old daughter to be hosted by Viet­ namese physicians and their families in Dr. Yancey in Hanoi four major cities in Vietnam. Not only was I able to break away from the daily nam. No longer the enigmatic crouch­ ol the hospitals in the south of Vietnam grind of insurance authorizations, pa­ ing tiger we remember from the 1960s. the physical plant, operating room plan, perwork, and the winter weather, but I Vietnam is now just another SE Asian and equipment appear strangely famil­ was able to explore the geography and underdeveloped country struggling to iar - US Governmem issue caught in a culture of a beautiful country in South­ raise their stagnant economy from a time warp from 1965. Other large hospi­ east Asia. quagmire of dependency and debt. tals were built in Hanoi to provide care Before I left I realized that almost Per capita income is about $333 for the northern forces during the war. everyone has their own individual per­ per year. Orthopedic specialists These hospitals were either military ception of Vietnam and the Vietnamese in Vietnam earn approximately hospitals (which I could not visit) or ex­ people. For many Americans, the som­ $100 per month. pansive structures with a French influ­ ber recent history of the Vietnam War Medicine in Vietnam is a melting ence consisting of pleasant open air is our only tangible link to SE Asia. pot influenced by their history. Many wards without much equipment. It re­ When the war ended in 1975, the coun­ patients are seen in the hospital after minded me of pictures I have seen of try fell into economic stagnation and in­ having been treated by a traditional old city hospitals in the 1930s. ternational isolation. This isolation con­ healer or “bonesettcr” in the provinces. In general, the Vietnamese hospi­ tinued for another decade until they Hospitals and medical schools still have tals were overflowing with patients and pulled out of their conflict with Cambo­ very active departments of Chinese they had very few supplies or equip­ dia. In the 1990s, major economic and traditional medicine. The French de­ ment. Wards are open air rooms of 10- political reforms led to an overall im ­ veloped a fairly sophisticated western 15 patients. Families generally stay with provement in their situation. Normal­ medical system during their colonial the patients on the wards and provide ization of diplomatic relations with the period from 1850 to 1954. Some of the the food and some of the nursing care.

USA resumed in 1995, opening the old colonial style Pasteur Institutes still See “ Reflections'* page 6

August, 2001 PCMS BULLETIN 5

Federico Cruz-Uribe. MD The Health Status of Pierce County Director of Health

Preventing Childhood Deaths in Pierce County

The tragedy of a child's unex­ Increasing child passenger safety % pected death can affect a family and education community. Often, most stunning are The use of infant/booster seats those situations in which a young child and seat belts has been shown to in­ dies of something that could have been crease dramatically the chances of sur­ prevented. In 1998. with support from vival in a car crash. T ACOW A-PIERCE COUNTY Governor Locke's executive order cre­ Graduating driver licensing lor HEALTH ating a statewide child death review teens DEPARTMENT system, the Tacoma-Pierce County Motor vehicle crashes are the Health Department facilitated a process leading cause of death for teens. Limit­ lo establish a Tacoma-Pierce County ing their driving privileges at first and Avoid use of soft, fluffy items in Child Death Review Team then expanding them as they gain expe­ the sleeping area (TPCCDRT). The team analyzes the rience may reduce the numbers of Sofi mattresses and bedding, pil­ causes of death of children between 0 death in this age range. low's, comforters, and other items that and 17 years old and looks particularly are made of soft, flulfv materials for ways to avert that kind of death in Using ignition/interlock devices seemed to contribute to the numbers of the future. that prevent drunk driving deaths from SIDS, possibly because TPCCDRT is a collaborative pro­ This device prevents the operation cess, incorporating representatives of a vehicle if it detects alcohol on the they obstruct an infant's airwav. from Mary Bridge Children's Hospital, driver's breath. Educate everyone providing Pierce County Sheriff's Department, SIDS - the sudden, unexplained care to infants about safe Tacoma Police Department. Pierce sleeping death of an infant under one year old - County Medical Examiner's Office. continues lo lead the causes of pre­ Parents are not the only ones who Tacoma Fire Department. Pierce ventable deaths in children in Pierce care for infants. All involved in care- County Prosecuting Attorney's Office. County. In 1999. 14 SIDS deaths were taking should know the best sleeping Madigan Army Medical Center, investigated. In 2000, 12 were re­ environments for preventing SIDS. Puyallup Tribal Health Authority, Child viewed by the TPCCDRT. Through Avoid exposure to tobacco Protective Services, and the Tacoma- June. 2001, five deaths have been ex­ sm oke Pierce County Health Department. amined. TPCCDRT recommends the Research continues to associate The TPCCDRT’s first annual re­ following to pre­ maternal smoking port (December 2000) included the re­ vent SIDS during pregnancy and view of 48 unexpected deaths and 91 deaths: smoke exposure after natural/medical deaths in 1999. Within birth with the risk of the unexpected deaths, 81% were de­ Put infants to death from SIDS. termined to have been preventable. sleep on their The chart on page 10 lists the causes of backs D iscourage co- unexpected deaths in Pierce County An Austra­ sleeping children in 1999, and whether they lian study in 1992 An infant who were deemed preventable. demonstrated that shares a bed with a SIDS and motor vehicle accidents infants who slepl TO SLEEP parent or other familv constituted the majority of unexpected on their backs members can increase deaths. Recommendations for prevent­ achieved a statis­ the risk of death by ing motor vehicle-related deaths in­ tically significant Sec "Preventing” p.ijc 10 clude: decrease in the rate of SIDS deaths.

August, 2001 PCMS BULLETIN 7 Reflections from page 6

Hue Central Hospital has 1,000 Quarter of the city vvitli its French ar­ camps after the war. Others watched beds and is the base for the major resi­ chitecture. tree-lined streets, and urban their families split up and leave on dent teaching programs and medical lakes lel't over from the colonial times. boats as refugees to avoid persecution school. Their orthopedic department li­ The populace seemed less affluent and for being affiliated with the "defeated" brary consists of a single set of out­ there were more tribal minorities in the side. Most physicians have lived in an dated orthopedic textbooks from city. People did stare ai me more often educational vacuum limited by years of twenty years ago. Danang General in Hanoi, hut probably because I was bureaucratic and economic limitations. Hospital is an S00 bed facility built by the only person on ihe back of a motor­ Everyone seemed to be thirsting for the French in 1953 and refurbished by bike with a helmet! some intellectual and cultural exchange Although the hospitals in Hanoi the Americans as an evacuation staging without any reference lo differences in center during the war. Although both w ere similar to those in the south \\ ith our political ideology. hospitals were extremely busy, they their open air wards, the ones in Hanoi In the future, the internet will be a seemed less busy and better equipped were severely under-equipped and key ingredient in improving communi­ - including a brand new arthroscopy lacked advanced technology. Anesthe­ cation and education in Vietnam. Tour­ sia had no oximetry for monitoring pa­ set-up donated by a Germ an aid ism will help fuel the expanding tients. There were no MRFs or CT agencv. Unfortunately, no one had economy and generate some needed ever reviewed the set-up procedures, scanners. Fluoroscopy was not avail­ capital. Volunteer physician programs sterilization protocols, and techniques able in the operating rooms. Simple x- and donations of medical equipment of arthroscopic surgery with the sur­ rays were our only diagnostic tools. and textbooks will help these dedicated geons nor the operating staff. My hosts W hen we needed to fix a fracture, we orthopedic surgeons to keep up with in Hanoi had a definite agenda lor me. would wander down lo the hospital the 21st century. Despite the present They had lined up a number of poten­ storeroom with our x-rays in hand and economic hardships they look at the tial arthroscopy patients for me and af­ rummage through all the donated present time as a period of relative ter we translated the directions of the boxes of orthopedic implants lo see if tranquillity in their lives. We spent set-up we proceeded to perform the we had anything that would lit. Som e­ many late evenings talking about how first arthroscopic surgeries ever done times we would modify implants at the we could improve care to the patients in Hanoi. See one. do one. teach one machine shop so that I hey would lit a and education for the physicians. was our motto. We first made practice specific application. It was definitely an There was very little conversation models out of small cardboard boxes opportunity to be ortliopedically cre­ about possible emigration strategies filled with objects to learn scope tech­ ative. I have more than a few stories and green cards. niques. Towards the end of my visit I about simple yet elegant innovations, This is my fourth trip overseas to think that our team was getting profi­ created by necessity but surprisingly work as a physician. As always. 1 am im­ cient with simple set-up and effective. pressed by the hospitality of my host arthroscopic techniques using sustain­ The Vietnamese physicians and colleagues in developing countries. I able technology. It was wonderful lo their families were incredibly gracious feel that I contributed some insights, recently receive an e-mail with an at­ hosts and there is a very positive feel­ techniques, and textbooks to their tached digital photo of my colleagues ing towards Americans. 1 was honored practices but it alw ays seems like they captioned ‘'Arthroscopic Surgery Cen­ to have many personal discussions with give me more in return. The physicians ter of Hanoi." my hosts. A generation has passed with whom I worked truly represent From Hanoi, we traveled to since the war and it seems we all are health care in the trenches...incredible Danang and Hue. located in central retrospectively re-evaluating our in­ caseloads, difficult cases, long hours, Vietnam near the coast. Hue is a beauti­ volvement in Vietnam. For many of the and low pay. My trip re-affirmed my ful city with an ancient walled citadel current young generation of orthope­ belief that as physicians, we have a that has been a cultural and religious dic surgeons in their 30s and 40s the unique opportunity for cultural and center for centuries. Although ils name recollection of the war consists of re­ educational exchange. I would encour­ is derived from (he Vietnamese word quests for chewing gum and pens from age any other physicians who might be for peace and harmony, it was unfortu­ American GIs and the echoes of distant interested in Vietnam or working travel nately the center of the infamous Tel gunfire. The older generation of sur­ abroad to contact Health Volunteers Offensive in 1968. They were strategic geons. many of whom are fiuent in Overseas at infor@ hvousa.org or their sites of staging during the Vietnam war, French, are more somber in their dis­ website. Meanwhile, I have since but now serve as a referral base for cussion of the war. Some from the made a num ber of connections to help several million people. south spent time in "re-education” See “ Reflections” page 16

8 PCMS BULLETIN August, 2001 JA'e/re ~t(cfoi/tf Q4(<-dtwd c jt ctefif

In My Opinion.... The Invisible Hand by Andrew Statson, MD

The Power of Discrimination

“The first sign of corruption in a soceity that is still alive is that the end justifies the means." Georses Bernanos (1995)

Rifle versus shotgun. This debate woman over the age of 40 to get a must be at least as old as gun powder, yearly mammogram. Granted, Andrew Snnsmi, MD probably much older. When Herod mammograms cost money, expose the was informed that a king had been women to radiation and can be painful. born in Palestine, he ordered all male Still, at our current level of knowledge, infants killed. He had no way of know­ since early detection of breast cancer only to ourselves and to our patients, ing who could be the eventual king, so saves lives, we need the shotgun ap­ with the occasional review by our he used a shotgun. That approach is proach. One day we may be able to peers. When Keflex first came out, it frequently used by people in authority. Lest a woman and tell her she will not was marketed as a urinary antibiotic. The rifle uses less power, but requires get breast cancer and she does not One of our maverick general practitio­ knowledge of the target. Authority has need to get mammograms. Today we ners admitted a patient with pneumonia a lot of power, not much knowledge, so cannot. and prescribed Keflex. The medical the shotgun is easier. Never mind the We like to know what we are committee reviewed the case and sent long range effects of such power. treating. We believe that the success of him a letter, asking him to justify the use When a sailor on a ship misbe­ our treatment confirms the correctness of a known urinary antibiotic for the haves. all hands have their shore leave of our diagnosis. That is not always treatment of pneumonia. Peer review is cancelled. When a student misbehaves, true. During the 50s and early 60s, the good, but it is not always right. the whole class is detained after hours. standard antibiotic treatment was peni­ Enter the third parly payors. Now cillin and streptomycin. Those were When a child brings a gun or a knife to treatments have to be justified to them about the only injectable antibiotics we school, all children have to go through as well. They want clean rifle shots, no had. In the presence of serious intra­ metal detectors forever after. What guessing, no hunches, they want proof. abdominal and pelvic infections, we message do we give the good chil­ The problem is that sometimes definite couldn't go higher than one gram of dren? We tell them we don’t trust them. proof conics a little loo late, like that of We tell them they are considered streptomycin a day, but we bumped the the suspected hypochondriac, who had penicillin up to over 100 million units a guilty until they can prove to us they it written on his tombstone. "I told you I day. are innocent. Meanwhile, those who was sick!" We were treating enteric bacterial want to shoot can do it on the play­ Is il good for the babies to prove infections. We thought the bad smell of ground, in the street, at the school bus. they are in distress before we can do a gangrenous bowel was from coliform even at the local McDonalds. cesarean section? Granted, some of bacteria. When injectable chloram­ With a rifle we can hit a point, them may deliver spontaneously and phenicol became available, the combi­ when such accuracy is not possible, a do well, but some of them won’t and we nation of penicillin and chlorampheni­ shotgun allows us to scatter lead over a can’t always tell the difference. We col worked very well. We did not find broad area and hit whatever is there, have to act on hunches and guesses. out until the mid to late 60s that the foul whether we want to hit it or not. In Our power of discrimination is not that smell was due to anaerobes and the medical practice, there are many situa­ good. If we wait until we have definite high doses of penicillin and the tions where we use a shotgun, because proof, we may intervene when it is loo chloramphenicol were an eflective we lack the knowledge to discriminate. late to make a difference. treatment. So much for knowing what Only one woman in nine will ever Is it good for women to lose more we were treating. develop cancer of the breast. Our lhan 30% of their red cell volume to problem is that we don’t know who she At that time, we made the thera­ is. Indiscriminately, we urge every peutic decisions and had to justify them Sec “Discrim ination" page 14

August, 2001 PCMS BULLETIN 9 B u l l e t in

Preventing from page 7

STDS because the individual could roll 1999 Child Death Review onlo ihe infant. Alcohol or drug use by Determination of Preventability by Cause of Death the parent poses a greater potential lor Preventable Cause of Death Yes No U ndet Total rolling omo the infant and should also Sudden Infant Death Syndrome (SIDS) 14 0 4 18 be discouraged. Motor Vehicle 12 0 1 13 Fire 0 1 0 Private providers can educate par­ 1 Firearm 6 0 0 6 ents and caregivers on ways to prevent Drowninq 011 2 SIDS and other accidental deaths. For Other (includes SIDS in 2 children older than 12 months) 7 1 0 8 more information on the Tacoma- Total 39 3 6 48 1 Pierce County Child Death Review Team and their suggestions for pre­ venting death among children, contact Susan Pfeifer, RN. BSN. at (253) 798- 6542. For more information about SIDS, contact Sue Walen. RN. BSN. at (235) 798-6517.-

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10 PCMS BULLETIN August, 2001 In My Opinion.... by John K. Sutterheim, MD

Nostalgia ofWWII... > Doctors Rounds in Concentration Camp Bangkong, Java, During October 1944

In the Indies there is a small and to be held up bv others. The trust in generally welcome nocturnal lizard, such a man was really low: many kids called a tok'e, or gecko, a harmless, complained, and scoffed about this "You go lo the hospital." As with our tropical, insectivores, six to ten inches physician in open defiance, not realiz­ roommate. Leon van der Broeke, go­ long. Its name, tok'e, describes its odd, ing how unfair their treatment was. If ing to the hospital didn't offer any com­ croaking mating call, and if you hear he determined that a boy was sick fort to most of us. this animal say seven times tok'e, luck enough, the child would be sent lo the There were hardly any medicines will drift your way. It attaches itself to hospital, which was nothing more than a available, although many requests for the ceiling, hunting for mosquitoes. few empty classrooms with mattresses medicines were put in to the Japanese. The beak reminded me of a miniature on the floor, and a few steel beds, su­ On top of the list was quinine. The crocodile. As kids we would feed them pervised by several of the nuns. Some typical answer of the commandant was. tobacco attached to a stick, in order to of these scenes, with a sick child and a "The Japanese army has none, so you reach them high on the walls or ten feet sicker doctor, were unforgettable. do not gel it either." If we argued ceiling. The tok'e's bite was firm and In the shade of the balcony was a about it, we received a beating, or he would not let go; to end up in a free simple four-legged table, behind it this worse, everybody had lo skip a meal. fall and walk like a drunk. Like so skinny man. seated 011 a rickety chair, We knew that the western part of the many other people in camp with nick­ his body leaning heavily on the table island of Java produced 90rk of the names. one of the few Dutch adult men top. He supported his elongated head world production of quinine. We re­ became known as the tok'e. with his left arm, the left elbow resting minded them about that fact but that in­ This man, the Tok'e, was one of on the table. His eyes were sunken furiated ihe Sons of Heaven. They the three doctors allowed to practice in and his stubbly beard was colored like must have sensed that we indirectly ac­ camp, although there were many more sail and pepper. In front of him stood a cused them of lying. physicians, sixteen in all, who were as­ feeble boy. held up and supported by- 1 had found those medical texts signed to field work, and two in the two other skinny kids. The patients fascinating not so very long ago when kitchen. Dr. Neuberger was the head awaiting their turns were sitting or lying I had been confined in Malang and of the hospital, and the T ok’e treated 011 thin mattresses spread out on the had worked to clean the doctor's of­ kids, while making rounds. Because floor. When they were finished the en­ fice. Further. Mother’s common sense this doctor suffered from throat cancer, tire scene moved a door or two down, approach to dealing with parasites and the Tok’e could hardly speak, his to evaluate the next sickly group. An tropical diseases had been ingrained in voice sounded explosive, and he al­ assigned group of younger boys would me. and so I always listened to try to ways looked exhausted. He made daily carry the table and chair to the various understand the doctor's diagnosis, rounds throughout the camp during the locations where the doctor would hold when he frequently saw my brother morning hours, but seeing to 1,400 “office hours.” The European and Anton or another boy of our Han. boys was an impossibility. The Tok'e Dutch doctors outclassed the Japanese Some of the diseases were worse than was too weak to enter the individual ones by miles, especially in treating others, especially if they w ere conta­ rooms and bend over the patients who tropical diseases, but the Tok’e could gious. We could not hope to contain were lying on the floor, so he would sit not combat the severe malnutrition and spreading diseases when our bodies down behind a small portable table on advancing starvation that was at the were depleted and there was such the patio outside the Hans, The sick root of most ailments in camp. poor sanitation in camp. boys dragged themselves out of their When patients were dragged in One of the most persistent and de­ rooms, not feeling well, to stand in front front of this doctor to be examined, we bilitating problems in camp was diar- of a doctor who had great difficulty all knew it was only to try to obtain a Sec "N o s ta lg ia " page 12 speaking to them. Some weak kids had diagnosis, or to listen to the verdict.

August. 2001 PCMS BULLETIN 11

New Members

Pauline M. Anderson, MD Hui Hong, MD James D. Pickett, IVID Ob/Gyn Internal Medicine C ard iology St. Joseph Medical Clinic Tacoma South Medical Clinic Cardiac Health Specialists 1708 S Yakima Ave, Tacoma 2111 S 90th Street. Tacoma 1802 S Yakima #307, Tacoma 253-593-8437 253-539-9700 253-627-1244 Medical School: U College of Dublin Medical School: McGill University Med School: Baylor College of Med Internship: Highland Hospital Internship: Virginia Mason Residency: St. Joseph Hospital Residency: Highland Hospital Residency: Virginia Mason Fellowship: Baylor College of Med Fellowship: UCLA Martin V. Cieri, MD Raheela Sadiq, MD Pediatrics Linh T. Huynh-Vu, MD Internal Medicine St. Joseph Medical Clinic Family Practice Internal Medicine Northwest 1708 S Yakima Ave. Tacoma Lakewood Clinic 3 16 ML King Jr Way #304. Tacoma 253-593-8407 9112 Lakewood Dr SW #203 253-272-5076 Medical School: U of Maryland 253-589-7030 Medical School: The Aga Khan Internship: Strong Memorial Hospital Med Sch: Spartan Health Sciences U University Medical College Residency: Strong Memorial Hospital Residency: Niagara Falls Family Prac Internship: Central Texas Med Found Fellowship: Children's Hospital Residency: Central Texas Med Found Todd D. Larson, MD Dean A. Field, MD Internal Medicine Family Practice St. Joseph Medical Clinic Gig Harbor Medical Clinic 1708 S Yakima Ave, Tacoma 6401 Kimball Drive. Gig Harbor Medical School: Vanderbilt IJ & Hosp 253-858-9195 Internship: Santa Barbara Cottage Hosp Medical School: U of Arizona Res: Santa Barbara Cottage Hospital Internship: Good Samaritan Med Ctr Fellowship: UCLA Residency: Good Samaritan Med Ctr Personal Problems of Physicians Committee

Medical problems, drugs, alcohol, r a i / e l e r S retirement, emotional, L or other such difficulties? Health Service A service of Northwest Medical Specialties, PlLC Your colleagues want to help INTERNATIONAL TRAVEL CAN BE HAZARDOUS TO YOUR HEALTH Robert Santis, MD, Chair 752-fi056 • PRE-TRAVEL CARE • POST-TRAVEL CARE Bill Dean, MD 272-4(113 Tom Herron, MD 853-388S HOURS CALL EARLY WHEN PLANNING Bill Roes, MD 884-9221 MON - FRI 9 - 5 F. Dennis Waldron, MD 265-2584 253-428-8754 or 253-627-4123 A SERVICE OF Confidentiality INFECTIONS LIMITED PS 1624 South I Suite 102 (next to St. Joseph's Hospital) Assured

August. 2001 PCMS BULLETIN 13

V-_-_ f-cc ''T?:fun/iij L-: (ladii'tii'^7'cacf\j

Directory Changes Bridging the Gap - Medicine and Technology

Please make note of the following 2001 Annual WSMA House of Delegates Meeting changes to your 200! PCMS Directory

Michael Bateman, MD This year's WSMA Annual Meeting will have a special focus on integrating Effective Aug. 24 change address lo: electronic technology into the medical practice. The keynote speaker will discuss 1812 SJ Street #102 how lo use medical informatics to improve practice efficiency and patient outcomes. Tacoma WA 98405 All W SM A members are invited to attend. Delegates will gather to set policy for the association - exchanging ideas and Peter Bertozzi, MD deliberating issues affecting the practice of medicine and the profession. Change phone # to: 872-4746 Any member of the House of Delegates may submit a resolution. August 2 1 is Donald Boutry, MD the final deadline for all proposed resolutions to be submitted to W SMA. If you are Change address and phone to: not a delegate but have a resolution that you would like to submit, please contact 314 M L King Jr Way #302 PCMS at 572-3667. Tacoma WA 98405 This year's meeting will be held September 21-23 at Jantzen Beach. Double Phone: 272-1037 Tree Hotel in Portland.* Fax: 272-3396 Phys. Only: 272-1960

Martin Cieri, MD Change fax # to: 593-8436 From cost cutting to patient satisfaction...

Keith Demerjian, MD Several plans have begun to pay doctor bonuses on quarterly payments if they Effective Aug. 24 change address lo: score well on patient satisfaction surveys and on how well they provide services. 1812S J Street#102 Historically, bonuses have been lied to how successful physicians were at control­ Tacoma WA 98402 ling costs. In theory, a health plan's move toward compensation not based on cost savings Kevin Kennedy, MD would stop giving incentives lo doctors lo skimp on care. Bui doctors are not so sure Office address should read: that such a change will truly be beneficial to them. “Everyone knows you cannot 1901 S Union #B3010 trust health plans to come up with an answer for patients and doctors. We are suspi­ Tacoma WA 98405 cious that this is more public relations than real change." according to Peter Warren, David Kennel, MD spokesman for the California Medical Association, which has a lawsuit pending Change address and phys. only # lo: against Blue Cross regarding alleged downcoding of claims. 5920 100th Street SW #31 Even some health plans are skeptical of satisfaction-based pay. for different rea­ Lakewood WA 98499 sons. According lo Robert J. Forster. MD. vice president of care and network for Phys. Only: 584-4879 Florida Blue Cross and Blue Shield. "There's no relationship between patient satis­ faction and the quality of health care. The relationship of the doctor to the patient Hay San Meas, MD and their access, all will impact satisfaction scores, but not necessarily the technical Change fax # to: 473-5309 delivery of health care." Susan Salo, MD More plans are increasingly using patient satisfaction or quality measures as a Change address and fax lo: greater baseline for compensation. 1708 S Yakima, T acoma WA 98405 Performance pays: • Blue Cross of California will reward physician groups up to 10% based on Richard Schoen, MD quality care measures and patient satisfaction. Parent WellPoint Health Net­ Change phone # to: 403-8770 works Inc. says it may expand the system to other plans. Change fax# to: 403-8771 • Harvard Pilgrim Health Care in Boston will pay Partners HealthCare Systems Thomas Siler, MD Inc. doctors based on quality measures, rather than cost cutting. Change fax #to: 403-1783 • Indianapolis-based Anthem is basing 5 % to 10%' of bonuses to 500 New Hampshire doctors on preventive health standards. Charles Weatherby, MD • Blue Shield of California in January initiated a quality incentive program. Effective Aug. 24 change address to: Medical groups can earn up lo 5% more based on quality measures. 18I2S J Street#102 • PacifiCare Health Systems Inc. has a quality reward system in place since Tacoma WA 98405 1998, based on about three dozen clinical measures. High-performing groups Donald W eber, MD are assigned more members, which, the insurer says, results in more rev­ Change fax# to: 826-4792 enue. ■ PnnnAM N eu's 7/30/01

August, 2001 PCMS BULLETIN 15 B u llrtin

Reflections from page 8 Providing quality health care collect appropriate fluoroscopy to the coverage to our community 1501 Market Street trauma centers. Donations are wel­ for the past 81 years. come! If anyone is interested in travel­ Downtown Tacoma ing there for work or pleasure feel 253.597.6520 free to contact either myself or my wife. It is a beautiful country and tour­ ism helps support their economic growth. In conclusion, 1 offer reflections upon two recurrent thoughts. First, we are very fortunate in America to have the technology and economy to sup­ port our medical system. 1 am reminded of this every day. Second. 1 was treated so well by so many people who have so little that it m akes me want lo contribute again lo their advancement in the future. 1 have many good memo­ ries about my trip to Vietnam and I plan to return soon. Did I mention that their ® Regence miles of white sandy beaches have not BlueShield been touched in thirty years? A jour­ ney to Vietnam could become quite a habit.* Will a disability put you out of commission?

As you know, disability insurance policies for physicians are changing rapidly— and not for the better. High claims have caused many major carriers to limit the most important benefits.

At Physicians Insurance Agency, there’s still time to secure the specialty- specific coverage you need. In addition, we can help you find superior life and long-terni-care coverage for you and your family.

To discuss the ways you can best protect your future income, call Physicians Insurance Agency today: (206) 343-7150 or 1-800-962-1399- P U PHYSICIANS H INSURANCE AGENCY A wholly owned subsidiary of Physicians Insurance

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16 PCMS BULLETIN August, 2001 '.ftctve if'oimtii C iiinint/done/,/

COLLEGE Continuing Medical Education □F MEDICAL College Board announces CME EDUCATION schedule through June, 2002

The College of Medical Education’s Board of Directors announced its CME schedule for 2001-2002 after their June meeting. The courses are offered in Common Office response to local physician interest and are designed and directed by local physi­ cians. All courses offer AM A and AAFP Category I CM E credit. Problems CME A course calendar identifying the course title, dates, brief description and course directors will be mailed in early August. For additional information on next October 5 year’s offerings, please call the College at 627-7137. Topics are set for the College's Common Office Problems CM E scheduled for Friday. October 5, 2001. Dates Program D irec to rs) The conference will be held at St. Common Office Joseph Medical Center. Rooms 1 A&B. Friday, October 5 Mark Craddock, MD The program will offer 6 Category Problems I CME credits and is again directed by Mark Craddock, MD. Infectious Diseases Friday, November 2 James DeMaio, MD This year's course will cover: Update • What You Should Know About New Antibiotics Medicine & Mental Friday, December 7 David Law, MD • Pediatric Asthma Health • Insulin Analogues and the Basal- Bolus Approach to Diabetes Wednesday; Tuesday Cardiology for Primary Management Gregg Ostergren, DO January 9; 15 Care • Dermatologic Diagnostic Dilemmas Wednesday-Sunday Richard Tobin, MD • Geriatric Assessment: Quality CME @ Whistler Versus Quantity January 23-27 John Jiganti, MD • Fibromyalgia - Is it All in Their Primary Care Michael Bateman, MD Head? Friday, February 8 • Osteoporosis Update Orthopedics Charles Weatherby, MD • Early Intervention in Chronic Renal Failure ■ Thursday-Friday Internal Medicine Tejinderpal Singh, MD Review 2002 Air reservations March 7-8 Sunday-Friday CME at Hawaii Mark Craddock, MD encouraged for April 7-12

Hawaii CME Saturday, April 27 Surgery Update 2002 Preston Carter, MD To assure you are able to secure seats and get a reasonable price for Allergy, Asthma & CME at Hawaii, we urge you to make Friday, May 3 Pulmonology for Alex Mihali, MD your reservations soon. Primary Care The College is working with Marilyn at Olympus Travel (565-1213). Advances in Women's Olympus lias booked some seats at Friday, May 17 John Lenihan, Jr., MD group rates and has access to other Medicine special options at the best rates. ■

August, 2001 PCMS BULLETIN 17 Medical Placement Service...... owned and operated by: Pierce County M edical Society

^Permanent Full & Parr Time Positions ■^Temporary Placements E Pierce County's "medically exclusive"agency ATTOO 223 Tacoma Ave So., Tacoma .572-3709 WORRIED ABOUT WHAT YOUR SPOUSE, YOUR FRIENDS OR EVEN YOUR BOSS THINKS ABOUT YOUR TATTOO? TACOMA/PIERCE COUNT!7 OR ARE YOU JUST TIRED OF Outpatient General Medical Care. LOOKING AT IT? Today’s newest Alexandrite laser, Full and part-time positions will remove your tattoo available in Tacoma and vicinity. with minimal discomfort & Very flexible schedule. Well suited less than 1% risk of scarring. for career redefinition lor ('dll loihtv for more iiifontutiion GP, FP, IM. PIERCE COUNTY Contact Andy Tsoi, MD (253) 752-9f>69 LASER CLINIC

or Paul Dotv (Allen, Nelson, Turner cc Director IVter K- M:irs|i MJ). Assoc.), Clinic Manager (253) 383-4351 (253)573-0047

48,871 Square Foot Medical Office Building

Available Third Quarter 2001

Available Suites: Second Floor: Up to 11,000 SF Third Floor: Up to 17,000 SF

Presented by 2202 S. Cedar Building TTacoma, a rn m a WWA A 98405 ' Kidder Mathews &Segner Inc Join these existing tenants: Building features: Pacific Northwest Eye Associates, PS Contact: Class "A" Building with high quality finishes Bill Frame, CCIM David V. Pratt, MD and Tray J. Woodman, MD Located near the Allenmore Hospital Campus 253-383-0799 Allenmore Ambulatory Surgery Center State-of-the-art Building [email protected] Tenant Improvement Allowance Ample, free parking fhg tnlo-rmabon ccntmrao Dersm ban oeen given to us by the owner or sources that we deem reliable. We have no reason lo doubt its accuracy, bul we do not guarantee il Prospective tenants sncuic! carefully verily all information contained heroin Call for more information.

18 PCMS BULLETIN August, 2001 Classified Advertising

POSITIONS AVAILABLE OFFICE SPACE EQUIPMENT

Tacoma/Pierce County out­ Available now, new construc­ For Sale: Spirometer. FKG. Holier patient general medical care al its best. tion. up to 1,800 sq ft remaining on first monitor, scales, exam tables, copy Full and parl-time positions available in level, will provide tenant improve­ machine, wheelchair. 253-582-7 170. Tacoma and vicinity. Very flexible ments. Close to hospitals on Union al schedule. Well suited for career 13"’. Call D r. L o v y at 756-2182 or 206- redefinition I'orG.P., F.P., I.M. Contact 387-6633. GENERAL Andy Tsoi, MD (253) 752-9669 or Paul Lakewood Professional Village Doty (Allen, Nelson, Turner & Assoc.), Dr. K. Scherbarth is looking for medical office. 650 sq ft Lease or buv. Clinic Manager (253) 383-4351. partners in 47 ft. motorboat and 253-223-0557. Mooney airplane. 253-752-6965. Does living and practicing in Fircrest Medical Office Space Washington’s beautiful San Juan Islands 41 2 Bowes Drive - 1540 sq ft consisting sound like the perfect match for you'.’ ol examine rooms, offices, reception Inter Island Medical Center located in area, lab and x-rav rooms plus 300 sq ft Friday Harbor has an immediate storage. Call (253) 863-3366 or (253) opening for a BC FP. Enjoy a relaxed 272-1588. lifestyle, the island's spectacular scenery, serenity and wildlife. San Juan Island offers outstanding housing and an excellent school system. A quick flight or a leisurely ferry ride gels you to the cultural and shopping services of the Seallle-Everett area or beautiful S a fe g u a r d M o b ile S hred Victoria. BC. Full spectrum of outpatient "Shredding Your Past to Protect Your Future ... ’ care. In addition to traditional family P.O. Box 747, Sumner, WA, 98390 medicine, our five physicians with the Phone: (253) 405-4603 / Fax: (253) 862-3987 support of an excellent EMS team, provide emergency care to island www.safequardmobileshred.com residents and to our many visitors. As a Level 5 Trauma Facility, you are EVERY MEDICAL OFFICE HAS INFORMATION afforded a challenging practice, with no THAT REQUIRES PROTECTION & DESTRUCTION hospital work. We offer reasonable call, Safeguard Mobile Shred is a local company providing for the confidential competitive compensation, and collection and destruction of sensitive docum ents... all at your office. relocation assistance. If you are interested in being a part of our model We supply free Security Consoles for the storage of documents within your rural health facility, please contact Kathy office. We come to your office on a scheduled basis, collect the documents, Guy at (360) 378-2141 ext 32, fax (360) shred them on-site In our truck-mounted industrial shredder, and recycle the 378-3655 , orkathyguy® rockisland.com. shredded paper. The shredding of stored records is also available. - =

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August, 2001 PCMS BULLETIN 19 Our Claims Staff Receives Top Praise

“I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.” Corrine Jedynak-Bell, DO, Tacoma, Washington

When times are lough, physicians count on us to fight for their best interests— from the day a claim is discovered to the day it's resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly— with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t you want only the very best on your team? For more information, call us today at 1-800-962-1399. Physicians Patricia Mulligan, Ctv.tied ;uid ^v>ri*nvd bv the ■" Insurance W.oilin^con suic Mudicil Asy.a;iln> Claims Representative Seside, WA I 1 Phv-'idan1- Insurance . A Mutual Company

Pierce County Medical Society PRESORTED 223 Tacoma Avenue South STAN D AR D Tacoma, WA 98402 US POSTAGE PAID TACOMA, WA PER M IT NO 605 Return service requested

20 PCMS BULLETIN August, 2001 September, 2001

INSIDE: 3 President’s Page: “So, What’s the Good News?” 4 Josephina Vallarta, MD speaks at Retired Member Luncheon 5 KIRO Legal Line s Mr. Bob Pittman to speak at September Membership Meeting 6 Congressman Adam Smith (0-9) meets with PCMS Executive Committee 7 Tacoma-Pierce County Health Dept: “Treat Rather Than Incarcerate” 8 Drs. Surinderjit Singh and Stan Harris Retire 9 In My Opinion: “Patient Rage” by Andrew Statson, MD 11 In My Opinion: “The Phone Call” by Stan Harris, MD B u l l e t i n

PCM S Officers/Trustees: Patrice N. Stevenson. M D President Susan J. Salt), M D ...... President Elect J. James Rooks, Jr.. M D ...... Vice-President Michael J. Kelly, MD - Secretary/Treasurer Charles M. Weatherby. MD....Past President Sabrina A. Benjamin. M D Drew H. Deutsch. MD Stephen F. Duncan. M D Kenneth A. Feucht. MD Sumner L. Schoenike, M D

W SM A Representatives: Speaker of the House: Richard Hawkins, M D Trustees: David Law. M D; Nicholas Rajacich. MD AM A Delegate: Leonard Alenick. MD W AM PAC Chair/6th District: Mark Gildenhar, M D W AM PAC 9th District: Don Russell, DO

S t a f f : Executive Director: Sue Asher Membership Services Coordinator: Shana Osmer Administrative Assistant: Tanya McClain Placement Coordinator: Deborah Pasqua Placement Assistant: Angela Kraemer CM E Program Administrator: Les McCallum Table of Contents Bookkeeper: Juanita Hofmeister

Committee Chairs: 3 President’s Page: “So, What’s the Good News?” A g in g , Richard Waltman: A ID S . James DeMaio; B y la w s . Richard Hawkins; Budget/Finance. M ike Kelly; College of Medical Education, John Jiganti; 4 Josephina Vallarta, MD speaks at Retired Member Luncheon Credentials. Susan Salo: Ethics/Standards Of P r a c tic e , David Lukens; Grievance, Charles 5 KIRO Legal Line’s Mr. Bob Pittman to speak at September Weatherby; L a b o r & Industries, William Ritchie; Legislative. William Marsh: M edical-Legal, Mark Membership Meeting Taylor: M em bership Benefits, Inc., Drew Deuisch; Personal Problems Of Physicians, Robert Sands: 7 TPCHD: “Treat Rather Than Incarcerate" Public Health/School Health, Sumner Schoenike

The Bulletin is published monthly by PCMS 8 Drs. Surinderjit Singh and Stan Harris retire Membership Benefits, Inc. for members of the Pierce Counly Medical Society. Deadline for submitting 9 In My Opinion: "Patient Rage” articles and placing advertisements in The Bulletin is the 15th of the month preceding publication (i.e. January 15 for the February issue). 11 In My Opinion: “The Phone Call”

T h e B u lle tin is dedicated to the an, science and 12 Directory Changes delivery of medicine and the betterment of Ihe health and medical welfare of the community. The opinions herein are those of the individual contributors and do 13 New York Medical Society Sues Six Insurers not necessarily reflect the official position of the Medical Society. Acceptance of advertising in no way 14 Physicians Insurance Workshop constitutes professional approval or endorsement of products or services advertised. The Bulletin and WSMA 2001 Annual Meeting Piercc County Medical Society reserve the right to reject any advertising. 16 When Bad Things Happen Applicants for Membership M anaging Editor: S u e A sh e r Editorial Committee: MBI Board of Directors Advertising Information: 253-572-3666 15 “Women In Medicine" wine and cheese reception Subscriptions: $60 per year 17 College of Medical Education Make checks payable to: M BI 223 Tacoma Avenue South, Tacoma W A 98402 Phone: 253-572-3666; Physicians call 572-3667 19 Classified Advertising FAX 253-572-2470 E-mail address: pcmswa@ pcmswa.org Home Page: http://www.pcmswa.org

2 PCMS BULLETIN September, 2001 ){ Q/tlecltcaJr^ca.etij

President’s Page by Patrice Stevenson, MD

So, What s the Good News?

These are the good old days of setting if the patient is not paying any­ medicine for our younger colleagues. thing out of pocket for the visit. This is As bad as things may be today, they the Costco mentality of buying way can always get worse. Unfortunately, more of something than needed be­ cause it is cheaper per unit. You may these were the messages t took away P a ir ic c M D from a recent meeting with Congress­ have saved a lot but you spent more man Adam Smith (D-9) and your PCMS doing it. Executive Committee (Drs. Susan Tom Curry and Len Eddinger re­ Salo, Jim Rooks, and Mike Kelly). viewed the state statistics for Medicare We were joined by: Sue Asher, PCMS and Medicaid. Washington ranks 45th currently expected to be there through Executive Director; Tom Curry', in Medicare payments and between 2028. Fie predicts more economic pres­ WSMA Executive Director; Len 1988 and 1999 had the sixth fastest rate sures in the next five years and more Eddinger, WSMA Public Policy Direc­ of decline in payments among the hard political decisions to be made re­ tor; and Sean Eagan. Field Representa­ states. Certainly our cost of living does garding the federally funded health tive for Congressman Smith’s office. not parallel these trends. They re­ care programs. This may include a fi­ Congressman Smith, an attorney, viewed MERFA, “The Medical Educa­ nancial means testing for Medicare eli­ wanted to meet with the PCMS leader­ tion and Regulatory Fairness Act of gibility with higher out-of-pocket costs ship to help his understanding of the 2001” (HR 868 and S 452) and thanked for the well-to-do retired. He asked our current concerns of practicing physi­ Congressman Smith for his support. thoughts on a single-payer system. cians. Dr. Rooks spoke of the reduc­ This would give some protections lo While this may have some appeal in the tion of Medicare and Medicaid surgical providers similar lo Ihe regulatory face of the currenl health care financ­ fees to the point that he earns less per­ reigning in of the IRS provided by the ing chaos, we urged caution in looking forming ENT surgery than his col­ IRS Restructuring and Reform Act of to that as a solution. Tom Curry re­ league who has given up the scalpel 1998. The unfunded administrative viewed the excellent WSMA report on for an office-based practice. Dr. Kelly mandates of HIPAA, “The Health In­ various models of health care financing described the conflict about taking the surance Portability and Accountability presented at last years annual meeting. extra time needed to meet the con­ Act,” were discussed with respect to The conclusion was that Congress­ cerns of his geriatric patients, during the great expense and difficulty imple­ man Smith was “not optimistic” about what was to have been a short office menting these regulations for medical seeing major Medicare or Medicaid re­ visit, w'hen they pull out the grocery list practices with the current time lines. structuring or administrative relief for of symptoms from their pocket. The pa­ Congressman Smith also supports the physicians. He noted that the govern­ tient is not satisfied if those concerns “HIPAA Administrative Simplification ment tends to use the teaching tool of are not addressed, which requires ex­ Act" (HR 1975 and S 836) which would punishing the group for the transgres­ tra history taking and more physical ex­ extend the HIPAA implementation sions of the few by piling on administra­ amination than the allotted appointment deadline from two to four years. For tive rules and regulations. Like most time. Now already running behind, he additional information on these issues, physicians, I don't have the time, en­ doesn't have the additional time to ad­ contact PCMS, 572-3667. ergy or cleverness to defraud the Fed­ equately document the encounter to Congressman Smith listened in­ eral Government. We're just trying to pass the scrutiny of “the Medicare po­ tently and heard our concerns. He re­ meet the needs on our patients' gro­ lice,” so he ends up “down coding” as a minded us of the pol itical climate at the cery lists without being accused of potential source of increased utilization time of the creation of the Balanced criminal acts and trying to not go broke of services, resulting in higher overall Budget Act of 1997. At that time the So­ in the process. ■ health care expenditures. This likely ciety Security Trust Fund was pre­ (See related article page 6) does not happen in the medical office dicted to be bankrupt this year. It is

September, 2001 PCMS BULLETIN 3

w elco m es...... KIRO Legal Line’s BOB PITTMAN, JD ------

Bob Pittman is an attorney in private practice with an emphasis on estate planning and wealth preservation. Bob is a graduate of the University of Washington Law School and has hosted Newsradio 710 KIRO’s Legal Line since 1991. He is a member of the National Network of Estate Planning Attorneys, and holds the designation of “Advanced Wealth-Strategist Planner” from the Esperti Peterson Institute for Global Wealth Strategies Planning. He was recently honored by the Washington State Supreme Court in a special Court Resolution commending his work on the radio.

► Limited Liability Corporations (LLCs) ► Family Partnerships/Trusts ► Estate Planning and Wealth Preservation ► Asset Protection ► Estate taxes ► Your questions?????

September General Membership Meeting

Tuesday, September 11, 2001 L a n d m a r k Convention Center Social Hour: 6:00 pm Temple Theatre, Roof Garden Dinner: 6:30 pm 47 St. Helens Avenue Program: 7:30 pm Tacoma

spouses and/or guests are welcome

Four at'large members will be selected for the 2002 Nominating Committee

(Register by September 7. Return form to: PCMS, 223 Tacoma Ave S, Tacoma 98402; FAX to 572-2470 or call 572-3667)

Please reserve______dinner(s) at $20 per person (tax and tip included)

Enclosed is my check for $ ______or my credit card # is ______

□ Visa □ Master Card Expiration D a te ______Signature ______

I will be bringing my spouse or a guest. Name for name tag:______

Your name (please print or stam p)______

September, 2001 PCMS BULLETIN 5

X

Federico Cruz-Uribe, MD The Health Status of Pierce County Director of Health

Treat Rather Than Incarcerate - m m

You may have seen my recent ar­ Clinics serve approximately 450 people ticle in The News Tribune about the with the synthetic opiate, getting them need to treat rather than incarcerate. back on track after years of heroine TACOMA-PIERCE COUNTY To sum­ and cocaine addiction. We've got HEALTH marize, plenty of testimonials about people who DEPARTMENT we've have renewed their lives, even re­ tried the turned to professional-level positions, prohibi­ by using methadone for daily mainte­ doctor says 1 shouldn't use lobacco at tion mode! nance. Jailing these individuals would all. Forget it. Bud. don't even bother - it didn’t not have resulted in positive outcomes. offering me a cigarette or a chew." work. For I recently saw statistics that showed Prevention and intervention are decades that, for drug abuse, law enforcement key and are points where you can now. costs fifteen times as much as treatment make important contacls. one by one. we've ar­ to reach the same result. In 1992, the Don'l forget the population-based stuff, rested LIS government spent 93% of its drug- however. Influencing policy decisions Federico people control budget on cops and courts and can also make a difference. By taking a Cruz-Uribe. MD who abuse only 1% on drug treatment. Ten years few minutes to let decision-makers alcohol later, in Pierce County, we will spend know that money spent on treatment and use other - illegal - drugs. That 8()9r of the local lax dollars on the jail makes more sense than putting dollars doesn’t seem to be working, either. Re­ and criminal justice programs, and 09r into the jail, or getting onto citizen advi­ cidivism rates are high since no treat­ on treatment. We're going the wrong sory groups looking at changing com­ ment is offered to change the behavior way. munity policies, we can create a that brought the person to jail in the You can help gel us back on the healthier community. Since the courts first case. Regardless of additional po­ right track, in a couple of ways. One is turned down the Board of Health’s lice officers, jail beds, and other pro­ lo ask clients, in earnest, about their resolution on tobacco advertising, soon grams to penalize the abuser, drug use of substances: alcohol, other drugs, we will see billboards anil l ull-color ads abuse levels are staying high. Are we lobacco. Physicians are still highly re­ featuring cartoon characters, enticing accomplishing what we set out to do? I spected by most people and a sugges­ the kids lo use alcohol and lobacco. think not. There is little or no data to tion by you that a client’s health is be­ Those ads will be almost as colorful as show that we improve our communities ing diminished by using or abusing the people on the street corner, offer­ when we arrest more drug abusers. substances carries a lot of weight. Lei ing a low-cost upper or downer to im­ There’s a lot of data, however, that them know where they can sign up for prove ihe kids' lives. Community mem­ shows that treating drug abuse as a dis­ cessation classes or get them on the bers who say. “This is not acceptable’’ ease works. nicotine patch or other tobacco treat­ can force store owners to change their We know that treatment works - in­ ment; refer them lo rehab for drug ads and drive drag sellers out of the dividuals regain their health, stop using detoxification and treatment; recom­ neighborhood. cocaine, heroin, alcohol and other mend programs from controlling alco­ None of this is new. It's a reminder drugs, get back to work, obtain homes holism, from Alcoholics Anonymous to for all of us that we can do more. We lor themselves and their families, and inpatient care. need to be intentional about preven­ stop committing crimes to support their Prevention is also essential. If you tion, intervention, and policy-setting, habits. Complete rehabilitation, where work with kids, make sure they know doing what we can at every level. The the physical and emotional addiction is that using substances is the wrong old War on Drugs hasn't worked. Let's interrupted is best, of course, but even choice. Imagine the Pee Wee League start a new’ approach and get it right this maintenance helps. Our Methadone catcher or quarterback saying, “My time. ■

September, 2001 PCMS BULLETIN 7 B u l l e t in

Retirement Congratulations

Surinderjit Singh, MD Stanley Harris, MD

Surinderjit Singh. MD. was honored on Friday. June 29 at Staff and colleagues were in abundance at the retirement a retirement party sponsored by his colleagues at the Tacoma party for Stan Harris, MD on Friday, June 29 at the Cedar Sheraton Hotel. Dinner, dancing and revelry were included. Surgical Associates office building on South 19th Street in Over 200 people attended the event. Tacoma. Featuring mega decorations, a harpist, and a heartfelt Dr. Singh graduated from Christian Medical College in and humorous poem written by practiee-partner Chris India and received his physical medicine and rehabilitation Jordan, MD, attendees vacillated between laughter and training from the University of Wisconsin Hospital and tears. He was give a Ping driver as a retirement gift with University of Washington Hospital. He founded expectations that his handicap will lower to 2! Electrodiagnosis and Rehabilitation Associates in 1980 just Dr. Harris graduated from the University of Washington after joining PCMS in 1979. School of Medicine in 1970 and did his general surgery He served on the College of Medical Education Board of training at Fitzsimons Army Medical Center. He has been a Directors for many years including as president in 1994-1995 PCMS member since 1989 and has been extremely active in and served as Examiner for the American Association of Society activities, including in his tenure as president in 1997. Electromyography and Electrodiagnosis from 1982-1998. PCMS congratulates Dr. Harris on his retirement and Dr. Singh is a world class cricket player and represented wishes him well, particularly on the golf course! ■ the U.S. team in 1979. Congratulation to Dr. Singh! ■

' '// i /

L to R: Drs. Tabasswn Saeed. Surinderjit Singh. Edgar Dr. Harris u rn “adorned ” and adored by his office staff Sleinitz, Alan Tice and Mohammad Saeed

Dr. and Mrs. Steimtz enjoyed dancing after dinner Dr. Harris with ojfice staff; saying goodbye was hard

8 PCMS BULLETIN September, 2001 jf\pjcee'i(vtMitj Q 'iii’dtca! (yfoctehj

In My Opinion.... The Invisible Hand by Andrew statson, md

Patient Rage

“...a dying culture invariably exhibits personal rudeness. Bad man­ ners. Lack of consideration for others in minor matters. A loss of politeness, of gentle manners, is more significant than a riot... This symptom is especially serious in that the individual displaying it never thinks of it as a sign of ill health, but as proof of his/her strength." Friday Robert Heinlein (1982) Andrew Suns MD

When Robert Heinlein wrote of their enemies as they could, before those lines, the word rage was not yet they themselves got killed. There is a part of the social vocabulary. It came good example of that in the pages of work out their schedule, make plans. on the scene some ten years ago, first American history. When they get to the airport, they find in the expression "road rage." Then we The defenders of the Alamo, out that their flight was overbooked or heard about passenger rage from the fewer than 200 men, laced an army of cancelled, they find themselves in a airlines and about customer rage from 4000. Outnumbered twenty to one, they bind and they strike back. Customer the stores. Recently, stunned by sev­ all perished, but they inflicted several rage is similar. People buy a product or eral large verdicts during the last year, fold their number in casualties on the a service, yet it is not what they ex­ for mishaps deemed defensible, or at army of General Santa Anna. They pected. Maybe they misunderstood, least worth much less than the eventual knew they were going to die. They maybe it was misrepresented. As long awards, WSPIE told us about patient chose to exact as high a price for their as they can exchange it or get a re­ rage. death as they could. fund. they are usually satisfied. When Many jurors have themselves re­ That was an example of battle they cannot resolve the problem amica­ ceived poor care or know someone rage. What could it have in common bly. they feel trapped and become en­ who has. In court they see someone with road rage? Yes, it is different, but raged. who has suffered a mishap related to the action is still based on being Patient rage develops in a similar health care and they sympathize with trapped, on the lack of alternatives, on fashion. Long waits for service, denial the patient. They are angry at the the impossibility of escape. The popu­ of service, lack of consideration for health care system and this is their way lation of our area has increased by their time or for their suffering, all of expressing it. This is how they can 50% during the past twenty years, yet these lead to unfulfilled expectations, get back at the system and show their the roads have changed little during which the patients see as broken prom­ rage, perhaps also their outrage. that time. When it takes one hour or ises. They feel they are in a bind, they In nature, when faced with a longer to go to work, and the same to feel nobody is paying attention to them, threat, animals tend to run away. When come back home, day after day, with nobody cares about them. To a certain that is not possible, when they are cor­ no hope of improvement, with traffic degree, such complaints have always nered, they turn back on their aggres­ getting worse instead of better, when existed, but in the past it was easy to sor with all the strength and fury they you have to hurry back to pick up the walk out and go someplace else. Now are able to muster. They know they children from daycare before it closes, they are much more likely lo feel will be hurt and probably die, but they or to cook dinner, or for some other trapped. They put up with lhat kind of intend to inflict as much harm on their appointment, and someone cuts in front treatment as long as they can, then attacker as possible before they die. of you. or slows you down, your reac­ something happens and they snap. We have the same characteristic. tion tends to be not courtesy, but exas­ In addition to the expensive jury There are many examples in the his­ peration. People get irritated and they awards, we can expect other problems. tory books of men who fought to the blow up. In the past, physician defendants won death in the defense of their territory, The same thing is seen with air about 80% of Ihe malpractice actions. I having as their only goal to kill as many passengers. They make reservations, Sec "R a g e " page 10

September. 2001 PCMS BULLETIN 9 B u l l e t in

liage from page 9

have not seen the more recent figures, have witnessed cannot continue indefi­ and fanned by envy. It builds up pres­ but I will not be surprised if this year nitely. We will have to heal the health sure, until it explodes into rage. It is de­ the plaintiffs win at least a third of the care system. The alternative is much structive, to the people who harbor it, suits. It is likely that in the future that ra­ too gloomy to even consider. and to the entire culture that allows it to tio will turn more and more against us. This rage is everywhere, not just exist. Some people hope they can We are told that suits are just another in patients, customers, passengers or profit from it and fan the flames, but cost of doing business. That cost prob­ drivers. In fact, patient rage is ex­ they will be consumed by the heal of its ably will get higher than whal it is now. pressed as jury rage. When people explosion together with the rest of us. Added to our other overhead, it will serve on juries, they find themselves Insurers have a saying, “The large make it even more difficult to meet ex­ with the power to strike back at some­ print gives, the small print takes away.” penses. Our best defense is to treat our one. anyone. The two billion verdict People are promised health care, but patients with the utmost care and con­ against Philip M orris is an example of when the promises are not kept, sideration we are able to give them. jury rage. In our country, juries are the people stop believing them. “You can We can only hope that such an ap­ representatives of the people. Jury fool some of the people some of the proach on our part will be able to de­ rage is people rage. People are hurt­ time, and some of the people all the fuse patient rage. ing and, as jurors, they want to hurt time, but you cannot fool all the people L am not sure that we will be suc­ back, to punish those who happen to all the time.” (Lincoln. 1858). No, cessful. After all, we have our prob­ be in their hands. people are not fools. W hen they are lems. too. and feel trapped. At least, we A French writer, I think it was mistreated and nobody pays attention can try. At least until we reach our limit Anatole France, wrote, "Hatred is the to them, their anger lurns into hatred, and explode in physician rage. Physi­ anger of the weak." Anger is a healthy and the hatred, into rage. People rage cian rage'? That is not conceivable, but emotion. It bursts out because of a dis­ is a dangerous thing. That was what a strange thing is happening to our pro­ agreement and dies down as soon as it pushed some Bostonians to have a tea fession. The annual meetings of the is expressed. Hatred is bottled in, be­ party. It ended up costing King ACOG used to be exciting and fun. cause the people are not free to ex­ George III much more than he could They were a good opportunity to meet press their discontent and cannot ob­ have ever hoped to collect from the tea friends from all over the country, to tain satisfaction. It arises out of broken tax. We need to find the safety valve learn new things, to enjoy a few good promises and unfulfilled expectations. and relieve the pressure before some­ evenings in the company of people It is pent-up because of powerlessness. thing like that happens, the sooner the who were happy. A few years ago, at It simmers on a fire fed by multiple irri­ better. ■ the last meeting I attended, the exhibits tations, frustrations and resentments and lectures were there, the friends were there, but the laughter sounded hollow and the happiness was gone. The bodies were there, but the spirit was missing. It was a very sad feeling, MEDICAL LICENSURE ISSUES like looking al a dear friend who was Mr. Rockwell is available to represent physicians and other health care dying, knowing we couldn't do any­ providers with issues of concern before the State Medical Quality Assurance thing to help him. Commission. Mr. Rockwell, appointed by Governor Booth Gardner, served for Patient rage is the wake-up call for 8 years as the Public Board Member of the Medical Disciplinary Board from the entire health care system. Road 1985-1993. Since then, Mr. Rockwell has successfully represented over 60 rage did not w'ake up the transportation physicians on charges before the MQAC. Mr. Rockwell’s fees are competitive department until several initiatives of and the subject of a confidential attomey-client representation agreement. the people mandated road improve­ ments. Passenger rage induced the air­ Gregory G. Rockwell lines to be more careful about booking Attorney at Law & Arbitrator their flights. Customer rage led the 3055 - 112th Avenue SE, Suite 211 stores to review their policies on han­ Bellevue, WA 98004 dling complaints. Patient rage will have to shake up the health care system and (425) 822-1962 • FAX (425) 822-3043 make it more responsive to their needs. email: [email protected] • website: “ggrockwell.wld.com” The deterioration in patient care we

10 PCMS BULLETIN September, 2001 ffie/ce 'fyxmty Qlhdtca/ octet)/

In My Opinion.... by Stan Harris, MD

The Phone Call

My father is 89 years old. Despite see the profound change in my father's growing up in a Minnesota depression mental condition since she had just family who lost their farm, he was able seen him a few months earlier. She to best his father's first grade education talked to the charge nurse and was told Stan Harris, MD and through hard work graduated from that his doctor "only'’ visited him once a the University of Minnesota School of week and the nurse was not sure my Medicine as a general practitioner. He lather was getting the latest dementia became a company doctor for the medications. The natural next step was win situation. I called him six limes and Northern Pacific Railroad in the small lo talk to his doctor to determine his was told he was seeing patienls and Montana town where I grew up. He opinions for Dad's long-term care. would call me after work. I told ihe re­ was the quintessential country doctor, She called the doctor's office and ceptionist that I was a "surgeon" and always on call, making house calls vir­ reached the receptionist, who look the wanted him to be interrupted. She then tually every night, delivering babies message and told her "Docior" would came back on the phone and told me and doing whatever was necessary to call her back after his "very busy of­ he was not in the office as he had gone care for his patients and friends. He fice." He didn’t call so she called him to an urgent meeting. 1 never received practiced until he was 77 years old. He again. Her efforts continued for three a return call from him even after I told loved medicine, loved his patients and days until she gave up and called me the receptionist I was not calling lo criti­ they loved him. after deciding to change to a “good" cize him but lo praise him for dealing Unfortunately, recent years have doctor. 1 defended the family doctor with my lather's problems so welI for so not been good to him. He has suffered and told her that little could be done to many years. a series of mini-strokes and now has ever make Dad better anyway. The Unfortunately, because of the lack rather significant dementia. Much to practitioner had obviously just been of a return call, mv own opinion of him everyone's dismay, this once proud overwhelmed with work and inadvert­ changed for the worse. 1 am and was a and independent man is no longer able ently had not been able lo return her "busy" general surgeon who always to care for himself. He is sometimes call. I told her that I knew the man and tried to return all my requested calls. I fairly lucid but most of the time he is he had known Dad for many years and never minded being interrupted by an­ confused, doesn’t remember where he certainly was able to deal with the other physician and would always talk is and cries like a baby when he wants myriad of problems my father suffered to them immediately if I wasn't in the things and can’t get them. My wonder­ better than a new doctor. She said her middle of cutting on someone. It set me ful stepmother has been caring for him mind was made up because a doctor to thinking about my own experiences day and night but she is 87. she re­ who wouldn't return calls must not be in practice and what many of my col­ cently developed her own medical any good. I asked her lo reconsider, leagues did. I vividly remember, on problems, which hampered her ability bul her mind was made up. Since she multiple occasions, calling another to care for Dad. When she was hospi­ had power of attorney, she talked to doctor's office and having the recep­ talized, no one was able to calm Dad in one of the other ten physicians in town tionists tell me the doctor was in with a the "Rest Home.” He became combat­ who agreed to take him on. patient and did I wish to talk lo him or ive and threatened suicide in spite of I felt very badly about the situation her? I would reply that I would not multiple medications and visitations and had told her to at least call the have called if I did not want to talk to from his family practice doctor of many original doctor one more time and tell him or her. I just assumed that "all" of us years. My older sister went home to him why she was doing what she was were busy seeing patienls. As a sur­ see what she could do. That is when doing. She again said "no” emphati­ geon I am certainly as arrogant as the the problems began. cally. next but I guess most us in the profes­ My sister, a medical technologist, I decided to give the doctor a call sion can be accused of the same

was obviously extremely distressed to myself and apologize to him for a no- See “Phone Call" page 12

September 2001 PCMS BULLETIN 11 B u l l e t in

Directory Changes Phone Call from page 11

malady. I guess the assumption of many of my colleagues is that “my Please make note of the following time is more valuable than yours regardless of what you are calling me changes to your 2001 PCMS Directory

about.” Including tills M ontana family doctor. Diane Combs, MD As I reflected upon the events that my sister had related, I too felt Change office listing to: the anger of being considered too inconsequential for a return call to 4700 Pt. Fosdick D r NW #207 discuss my father's care and "1 am a SURGEON!!!!" How dare he not Gig Harbor, WA 98335 return my calls! Still I was very much against abandoning a very fine Phone: 851-3992 practitioner for such a seemingly small slight. I needed the validation, Fax: 851-4310 just as everyone else, that 1 was doing a good job. How many times do

we do things as well-intentioned physicians that are perceived so com­ Larry W. Larson, MD pletely negatively by our patients and their families? A simple phone Change office address to: call is a very big deal. I know that in the future I will be more consid­ 2115 S 56th Street #301 erate and hope that you will be too. Tacoma, WA 98409 PS. My arguments to my sister prevailed and my father is still with

the same doctor. I. however, still would have switched to a "good" doc­ Susan Predmore, MD tor. since he never has called me back! ■ Change office listing to: 3333 N Whitman Tacoma. WA 98407 Phone: 759-3065 Fax: 759-3075

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12 PCMS BULLETIN September, 2001 'j/\> m! if iiaritij r /ted

Aging from page 4 New York Medical sleep including naps when needed, involvement and enthusi­ Society Sues Six Insurers asm about people and events. 6. Keeping busy, diversity and novelty with physi­ cal and mental exercises, new and creative activities such as traveling, reading, games and classes. Engage in a diverse The Medical Society of the State of range of activities that are interesting and enjoyable. Com­ bine active activities with passive ones in groups or individu­ New York sues six insurance companies ally. If you choose to retire, retire to something, not from with managed care plans in the state something. The mentally creative person never thinks of him­ self as retired. 7. Linkage, continuity, friends and social net­ works: renew and maintain good friendships and resume ac­ Physicians of the Medical Society of the State of New tivities which one has enjoyed in the past; reading, writing, York have joined the growing ranks filing suit against dancing, traveling to new' and old places, visiting relatives and managed care linns that challenge the way the companies do friends. Make new friends. Be a good friend and maintain business. links with die young. An older person's morale depends on how often she gets together with her friends rather than on MSSNY, which represents 27.000 physicians, filed how often she sees her children. separate lawsuits in August against each of the six largest 8. Healthy diet with moderate caloric restriction; de­ insurers in the state: Aetna, Cigna, Empire Blue Cross/Blue crease intake of saturated fats and easily oxidized amino acids Shield, Excellus. Oxford, and United Healthcare. and increase intake of foods with free radical oxygen inhibi­ The suits claim the companies breached contracts with tors or antioxidants. physicians by arbitrarily denying medically necessary care, 9. Reduce stress and accept undesired changes capriciously reducing reimbursement claims and subjectively in physical and mental functioning. Acceptance de­ downcoding and bundling claims. The suits also accuse the mands a balanced approach to life. Change your inner atti­ companies of using computer programs to deny claims based tude toward frustrations, problems and unwanted experi­ on arbitrary guidelines. ences. If you cannot change what is happening, think how' "We need to finally gel the insurers to lake the charges you can learn from it and reformulate them into challenges seriously," said MSSNY President Robert Bonvino. MD. "It which will give you a sense of control. Reduce anxiety about really is sad that we have to go to the court system to make normal age associated memory impairment and stowing of general responsiveness of work performance. Reading and HMOs live up to their contract. Unfortunately, there’s no memory training utilizing memory tools such as writing dia­ other way." ries, lists and the use of computers increase brain network Paul Macielak. New York Health Plan Association connections. president, said the lawsuits weren't about patients and that 10. Maintain good physical health with normal they instead aimed to enrich doctors’ pocketbooks. levels of blood pressure, blood sugar and choles­ “If the medical society and its doctors are truly concerned terol. Avoid injuries with safety precautions. Improve your about patient care, they would use their considerable re­ balance, increase your bone and muscle strength, eye hand sources on efforts to improve overall quality of care and coordination and finger dexterity with exercises. Avoid ex­ reduce medical errors." he said in a prepared statement. posure to toxins, addicting drugs, harmful activities, infections Cigna had not seen a copy of the suit but called it and factors that can further reduce your immunity and hasten unwarranted. The firm has worked with doctors and other aging of the arteries and the brain. health advocates to boost health care quality and simplify More than two thousand years ago, Cicero said: But it is our duty' to resist old age; to compensate for its defect by administrative practices, said Cigna spokesman Wendell watchful care; to fight against it as we would fight against dis­ Potter. "Medical coverage decisions are made by medical ease; to practice moderate exercise; and to take just enough professionals. Our physician medical directors share the same of food and drink to restore our strength and not to overbur­ commitment to quality care as other physicians in New' York den it. Nor, indeed, are we to give our attention solely to the and across the nation." ■ body; much greater care is due to the mind and soul; for they From AM News S/3/01 too, like lamps grow' dim with time, unless we keep them sup­ plied with oil. Intellectual activity gives buoyancy to the mind. ■

September, 2001 PCMS BULLETIN 13

1%. /<•(• itoujit/ ((eJtcu/rfoctety

'P ience (fa u tty 'T K edccai S o c ie ty

invites you to the inauguraC

X tfom en ^/n

O t j e r f i d n e

lYine & Cheese 'Reception Elizabeth Blackwell, MD First practicing woman physician ^Wednesday, September 26, 2001 6:00 to 8:00 TM Landmark Convention Center Mt. JAdams Hoorn 4 7 Saint J-fefens JAvenue, Tacoma

Special guest Nancy Auer, MD, WSMA Immediate Past President and Vice Social Hour: 6:00 PM President of Medical Affairs at Program: 6:45 PM Swedish Medical Center will speak on Discussion: 7:15 PM being a woman in a leadership role of organized medicine, and other gender-related issues.

This is a complimentary reception fo r PCMS woman members and non-members. We hope it is the beginning of a series of supportive and educational forums for the unique needs and interests o f women physicians practicing in Pierce County.

I f childcare prevents you from attending, please let us know.

Please register by Septem ber 19th, by sending this portion of the form to: PCMS, 223 Tacoma Ave. S, Tacoma, WA 98402 or FAX to 572-2470 or call 572-3667. You may also register by em ail to pcmswa@ pcmswa.org Name: (please print)______I am interested in childcare services for this reception: (phone number or email address)

September, 2001 PCMS BULLETIN 15 V B u l l e t i n

When Bad Things Happen

Every three weeks, a Medical in both groups: and that no one willingly took the Quality Assurance Commission • Bowel and viscus perforation from trouble to completely explain what (MQAC) Initial Review Panel screens surgical penetration procedures. went wrong, as if ihe problem was between 60-80 complaints to find the • Failure lo perform timely cesarean somehow the patient’s fault. 25% or fewer that require further re­ section. What can Washington physicians view by the Commission. From July • Wrong surgical target. do to reduce the impact of technical 2000 to May 2001. 603 cases were cat­ • Post-surgical ureteral obstruction. problems and bad outcomes? egorized looking for patterns or trends In the remaining cases, one is im­ • Understand that anyone performing that could provide helpful feedback to pressed with the random diversity in surgical procedures can and prob­ Washington physicians. For this article, the types of procedures which have ably will have complications. we will examine two of the more popu­ been vulnerable to mishaps and unex­ • Document your judgment and lated categories: Technical Problems pected bad outcome. procedures with the completeness an and Bad Surgical Outcome: "Bad things can and do happen in expert would require to evaluate the Technical problems are those the practice of medicine as in all of life." standard of care you provided. unplanned deviations that lead to a bad Applying Lhe wisdom of retrospect, • Know and use the skills of your outcome. many situations might have turned out colleagues for help during trouble­ Bad surgical outcomes include better had management systems been some situations. bad results with or without identifiable different. Commission members must • Be alert and responsive to the early errors of procedure. separate flawed management that may signs of a complicated outcome. There were 41 technical problem continue to injure patients from compli­ • And finally, no matter how cases. Thirteen involved insurance cations that develop in spite of good embarrassed and humiliated you may settlements ranging from twenty-five care. In the process, we are increas­ feel, go out of your way to personally thousand to one million dollars. Three ingly aware how some complications keep your patient and family fully deaths were assigned to this group. produce formal complaints from pa­ informed! ■ There were 43 cases with bad surgical tients while others do not. In the case outcomes. Four deaths were in this material, patients write that calls to re­ Reprinted from the Washington State group. port early signs of trouble were ig­ Medical Quality Assurance Similar repetitive problems appear nored by the physician or office staff. Commission's Summer 2001 Update

Applicants for Membership O r g a n S r T i s s u e

D O N A T I O N Katherine A. Choi-Chinn, MD Diagnostic Radiology Diagnostic Imaging Northwest 222 15th Avenue SE, Puyallup 253-841-4353 Medical School: New York Med College Residency: Tripler Army Medical Center

Melawati Yuwono, MD P ed ia trics NW Pediatrics Gastro & Nutrition Assoc Share Your Life . 311 South L Street, Tacoma 253-403-1473 Share Your Decision / ' 1 Medical School: Medizinische Hochschule Hannover For more information on organ and tissue donation Internship: Neustadt Krankenhaus please call LifeCenter Northwest Residency: Children’s Hospital of Buffalo toll free, 1-877-275-5269 Fellowship: Children’s Mopsita! of Buffalo

16 PCMS BULLETIN September, 2001 ^ /‘ieycc ifm n h / Z '(letlim l ^forieti/

COLLEGE Continuing Medical Education OF MEDICAL Common Office Problems CME Offers Timely Primary Care Topics

EDUCATION Registration is underway for the • What You Should Know About New very popular Common Office Prob­ Antibiotics lems CME program. This year’s con­ • Pediatric Asthma ference is schedule for Friday. Octo­ • Insulin Analogues and the Basal-Bolus ID Update CME ber 5, 2001. The conference will be Approach to Diabetes Management held at St. Joseph Medical Center. • Dermalologic Diagnostic Dilemmas set November 2 Rooms I A&B. • Geriatric Assessment: Quality Versus The program will offer 6.5 Cat­ Quantity The annua] Infectious Diseases egory I CME credits and is again di­ • Fibromyalgia - Is it All in Their Head? Update is set for Friday, November 2, rected by Mark Craddock, MD. • Osteoporosis Update 2001. The very popular course will be This year's course will cover: • Early Intervention in Chronic Renal held this year at the La Quinta Hotel. Failure ■ The program is directed by Jim DeMaio, MD and will feature Dates Program D irector^ natinally known expert Dr. Charles Stratton joining Infections Limited phy­ Common Office Friday, October 5 Mark Craddock, MD sicians as they give presentations on Problems specific disease areas. The course is designed as an update on common out­ Infectious Diseases Friday, Novmber 2 James DeMaio, MD patient and inpatient infections. Update The registration brochure will be mailed in September. ■ Medicine & Mental Friday, December 7 David Law, MD Health

Wednesday; Tuesday Cardiology for Primary Whistler CME Gregg Ostergren, DO Registration open January 9; 15 Care Wednesday-Sunday Richard Tobin, MD CME @ Whistler Registration is open for the January 23-27 John Jiganti, MD College’s CME at Whistler/Blackcomb program. The conference is scheduled Primary Care Michael Bateman, MD Friday, February 8 for January 23-27. 2002. The program Orthopedics Charles Weatherby, MD brochure was mailed in August. Reservations for the Aspen con­ Thursday-Friday Internal Medicine Tejinderpal Singh, MD dos can be made by calling Aspens March 7-8 Review 2002 on Blackcomb, toll free, at 1 -877-408- 8899. You can reserve your room at Sunday-Friday the Chateau by calling 1-800-606-8244. CME at Hawaii Mark Craddock, MD In both cases, you must identify your­ April 7-12 self as part of the COME group. Like­ Allergy, Asthma & wise, you are encouraged to make your reservations soon to ensure Friday, May 3 Pulmonology for Alex Mihali, MD space - at least by December 1, 2001, Primary Care when any remaining rooms or condos in the blocks will be released.* Advances in Women's Friday, May 17 John Lenihan, Jr., MD Medicine

September, 2001 PCMS BULLETIN 17 B u l l e t in

Dr. Shields5 staff volunteer for'T aint” ERASE THAT TATTOO Staff members of W illie Shields, M D - Brenda Hanley Lind Tracy WORRIED ABOUT WHAT YOUR SPOUSE, Sanatoria - worked with the Pierce YOUR FRIENDS OR EVEN YOUR BOSS College crew to paint South Tacoma THINKS ABOUT YOUR TATTOO? resident Dale Brenzel’s house on OR ARE YOU JUST TIRED OF Saturday. August 4 and Saturday. LOOKING AT IT? August 11. The crew spent lour days Today's newest Alexandrite laser, preparing and painting the house, will remove your tattoo fence and shed as part of the "Paint with minimal discomfort & less than 1% risk of scarring. Tacoma Beautiful" project organized ( Kniuy !<>t more inluntuaion toy Associated Ministries. Congratulations on a job well PIERCE COUNTY done! ■ LASER CLINIC

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Presented by 2202 S. Cedar Building Tacoma,Tarnma WA 98405Q84HF ^ ^ Kidder Mathews & Segner Inc m ------Join these existing tenants: B uilding features: Conlact. Pacilic Northwest Eye Associates, PS Class "A" Building with high quality finishes Bill Frame, CCIM David V. Pratt, MD and Troy J. Woodman, MD Located near the Allenmore Hospital Campus 253-383-0799 Allenmore Ambulatory Surgery Center State-of-the-art Building bframe^kmsoncof.coni Tenant Improvement Allowance Ample, free parking fr\-' MoriroriUnn :■ hy the om ior u t ;;otifCua that w o t Ja e n i. atubtr. Wo hn\ -.icy, h o i iwi rln not riunr/intcy t! iv< 11-fully vority dll inform ation cnnl.-'iuioiJ Iv.’/rlr Call for more information.

18 PCMS BULLETIN September, 2001 Classified Advertising

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September, 2001 PCMS BULLETIN 19 B u l l e t in b o u n t y , c m

Our Claims Staff Receives Top Praise

* - i M . “I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.” CoirineJedynak-Bdl, DO, Tacoma, Washington

When limes are tough, physicians count on us to fight for their best interests— from the clay a claim is discovered to the day it’s resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly— with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t )rou want only the very best on your team? For more information, call us today at 1-800-962-1399. F Physicians Patricia Mulligan, C rejifd ami sp>.insert'd by ike ■" Insurance W ashington Slate Medical Association Claims Representative "■■ejuL, W A '?.> l-’hysii.uiiL^ Insur.iruv 2 00 ! A Mutual Company

Pierce County Medical Society PRESORTED 223 Tacoma Avenue South STANDARD Tacorna. WA 98402 US POSTAGE PAID TACOMA, WA PERMIT NO 605 Return service requested

20 PCMS BULLETIN September, 2001 October, 2001

INSIDE: 3 Presidents Page: “Back to School” 4 September M embership M eeting attendees learn about asset protection 5 Jeff Nacht, M D to speak at October General Membership M eeting about embezzlement 7 Tacoma-Pierce County Health Dept: “Controlling the Spread of HIV” 9 In My Opinion: “The Phone M essage” by Cordell Bahn 11 In My Opinion: “Professionalism and Commercialism” by Andrew Statson, M D 13 In My Opinion: “My Journey Through M enopause” by Daisy Puracal, M D B u l l e t i n

PCM S Officers/Trustees: W itm e - % otmfy Q-M edim ldfocidnj- PalriceN. Stevenson. M D ...... President Susan J. Salo. M D ...... President Elect J. Jam es R ooks. Jr., M D ...... Vice-President Michael J. Kelly. M D ...... Secretary/Treasurer Charles M. Weatherby, MD....Past President Sabrina A. Benjamin. MD Drew H. DeuLseh, MD Stephen F. Duncan, VID October, 2001 Kenneth A. Feuehl, MD Sumner L. Schoenike. M D

PCMS M embership Benefits, Inc (MBI): Drew Deutsch, MD, President: Keith Demirjian, MD, Steve Duncan. MD. Mark Giidenhar. MD. Mike Kelly, MD. Secretarv-Treasurer; Art Maslow, DO. Tim Happy Schubert, MD, Steve Settle. MD. Joe Wearn. MD

College of M edical Education (C.O.M .E.): Halloween John Jiganti. MD President; .ID Fitz. M D, Barbara Fox, MD. William Holderman. MD. .Steve Konicek, MD. Marjorie Krabbe, MD, William Lee, MD, Gregg Ostergren, DO. Brad Pattison, M D, Cecil Snodgrass, MD. Virginia Stowell, MD. Richard Waliman, MD, Tod Wurst. MD. Rick Campbell. MD. Good Samaritan Hospital; Victoria Fletcher. Multicare Medical Cenlcr: Table of Contents Sister Ann McNamara, Treasurer, Franciscan Health System; Sue Asher. Secretary 3 President's Page: "Back to School” P C M S Foundation: Lawrence A. Larson. DO. President: Mona Baghdadi, Nikki Crowley. Treasurer: Sue Asher. Secretary 4 September Membership Meeting attendees learn about asset protection WSMA Representatives: Speaker of the House: Richard Hawkins. MD Trustees: David Law. MD: Nicholas Rajacich. MD 5 Jeff Nacht, MD to speak at October General Membership AM A Delegate: Leonard Alenick, MD Meeting about embezzlement W AMPAC 6th District: Don Russell. DO W AMPAC 9th District: Leonard Alenick. MD 6 Is a Handheld Organizer for You? S ta ff: Executive Director: Sue Asher Membership Services Coordinator: Shana Osmer 7 TPCHD: "Controlling the Spread of HIV” Administrative Assistant: Tanya McClain Placement Coordinator: Deborah Pasqua Placement Assistant: Angela Kraemer 8 Medical Practice Survey 2001 CME Program Administrator: Les McCallum Bookkeeper: Juanita Hofmeister 9 In My Opinion: “The Phone Message”

The Bulletin is published m onthly by PC M S Membership Benefits, Inc. Deadline for submitting 10 Directory changes articles and placing advertisements is the 15th of the New Fee Schedule for Duplicating Medical Records month preceding publication. 11 In My Opinion: "Professionalism and Commercialism” The Bulletin is dedicated to the art, science and delivery of medicine and the betterment of the health and medical well are of the community. The opinions 12 Setting it straight herein are those of the individual contributors and do not necessarily reflect the official position of PCMS. Acceptance of advertising in no way constitutes 13 In my Opinion: "My Journey Through Menopause” professional approval or endorsement of products or services advertised. The Bulletin reserves the right lo 14 Applicants for Membership reject any advertising.

M anaging Editor: Sue A sher 15 “Mary Bridge emergency crunch mirrors nationwide crisis’’ Editorial Committee: MBI Board of Directors Advertising Information: 253-572-3666 17 College of Medical Education 223 Tacoma Avenue South, Tacoma WA 9H402 253-572-3666: FAX: 253-572-2470 F-mail address: [email protected] 19 Classified Advertising Home Page: http://www.pcmswa.org

2 PCMS BULLETIN October, 2001 ^ — y e/e? T^vifinly lledfcti! rf^ctcijf

President’s Page by Patrice Stevenson, MD

Back to School

It’s back to school...for our York City for a whirlwind tour children and for humanity. It’s during Spring Break that in­ time to learn the lessons of rela­ cluded a trip to the top of the Patricc Sievcn w > //, M!) tive complacency and the value World Trade Center. On 9-11-01 l-'rcsitJaii of freedom to our society. It is in we got ready for school like any part our freedom that allows ter­ other day and ironically he was rorists to live among us and have wearing his “I Love New York” us train them how to fly our T-shirt. We didn’t have the TV and hide under their desks. planes. Unfortunately it always or radio on so knew nothing of When the security guard jiggled seems that with threats of vio­ the terrible events unfolding in the doorknob to be sure it was lence it is the freedom s of the in­ New York, Washington, D.C. locked they all about lost it. They nocent that are more restricted. and Pennsylvania. He changed were especially glad to see us We curtail our normal activities, shirts so as not to appear insensi­ come home that evening. lock our doors and endure inva­ tive. Collin is also the student sions of our privacy in the name His New York trip had been body president and is suggesting of heightened security while the lead by his humanities teacher so that they specify if a lock down is perpetrators roam free...until they spent time reviewing their from an “external threat” versus they’re caught. Then we give New York experience and pho­ an “internal threat" so maybe they them every protection our laws tos. Collin had photos of the won't be as scared next time. If allow and treat them fairly in our World Trade Center from the only our “external threats” criminal justice system. Empire State Building and a shot weren't as scary now. He also It was back to school for my looking down from the top. He believes that we should clean up three children, Collin 15, Caitlin also had a picture of the lobby the mess and re-build the World 13 and Christopher 10, w ith the rimmed with the flags of the Trade Center and not retaliate. If attendant excitement mixed with world. I am glad he had that ex­ only we could put the idealistic dread. Caitlin spent three weeks perience. I don’t know if I will fifteen year olds in charge! in New Zealand and Australia on send Caitlin and Chris. If the ter­ We should be proud of the a People to People Student Am­ rorist attacks weren’t enough, tremendous work and sacrifices bassador trip. President they then had a “lock down” at of the emergency personnel and Eisenhower founded the pro­ Sumner Junior High as a man health care workers in these situ­ gram in the 1950s to increase un­ was running around downtown ations. It is always the worst be­ derstanding and awareness of with a gun. This drill has come in havior of some that brings out the other cultures and their citizens. the wake of school shootings best behavior in these heroes.* Collin had been on a similar trip and the students lock the door, in 1999. H e also w ent to New pull the drapes, turn off the lights

October, 2001 PCMS BULLETIN 3

presents EMBEZZLEMENT

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featuring PCMS member., Jeff Nacht, M D . an accounting of his personal experiences

October General Membership Meeting

Tuesday, October 9, 2001 Landmark Convention Center Social Hour: 6:00 pm Temple Theatre, Roof Garden Dinner: 6:30 pm 47 St. Helens Avenue Program : 7:30 pm Tacoma spouses/guests welcome

generously supported by Merck

(Register by October 5. Return form to: PCMS, 223 Tacoma Ave S, Tacoma 98402; FAX to 572-2470 or call 572-3667)

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October, 2001 PCMS BULLETIN 5

Federico Cruz-Uribe. MD The Health Status of Pierce County Director of Health

Controlling the spread of HIV

We are at a crucial time now as we 1) The individual is assessed address the spread of the HIV virus in 2) S/he is referred into care The Tacoma-Pierce Coiuily our community. Many measures and 3) Partner notification is done to Board of Health will soon half measures have been taken to try to see who else was exposed consider a resolution on con­ stop the 4) Case management is provided to epidemic. follow the patient over time (as long as trolling the spread of HIV. The track they are infected) to assist them to not Elements of the resolution record for spread the virus. include requiring the testing public Critical to making this approach health, work is lo know who is positive. The fo r ///I of: during the two important groups to reach are: • All inmates of the Pierce epidemic, 1) persons with multiple sex County jail who are arrested has been p a r t n e r s spotty. We 2) heavy drug users, espe­ on drug- and sex-related have vac­ cially intravenous drug users charges illated be­ (IDU). F ederico tween tak­ In a nutshell, how do we systemati­ • All patients in who harp Cruz-Uribe. MD ing a more cally approach and test these individu­ symptoms of a sexually aggres­ als? Many of those most needing test­ transmitted disease and are sive traditional disease control ap­ ing are mistrustful oT the system and proach of identification of the person feel stigma attached lo knowing their seen by a Pierce C ounty with the virus and notifying partners, status. But, they still need to be tesied healthcare provider and following the lead of the bigger so that we can implement the process metro areas that stressed education outlined above, • All pregnant w omen, as both of the general public and target­ The Health Department recom­ part of their routine ing high-risk groups. Resources are mends three strategies to test as many prenatal care tight. The virus continues to spread. high risk people as possible. These There is no cure. There is no known are: All providers are encouraged vaccine. 1) Test all inmates of our Pierce to participate in the public For many patients, the cocktails County jail, who are arrested on drug- discussion. Call Federico have slowed the disease’s progression. and sex-related charges But there is increasing resistance and 2) Test all patients who come into a Cruz-Uribe. MD. M PH Jb r serious compliance problems for a healthcare provider’s office with the date and time of the meeting. large percent of patients. There is a symptoms of a sexually transmitted dis­ hope that AIDS can become a manage­ ease (STD) (235) 798-2853. able chronic disease. But, we are not 3) Require all pregnant women to there yet. be tested for HIV as a routine part of There are concrete steps we can their prenatal care. take now to get in front of the epidemic I ask for your support on all health system is ready to do this! here in Pierce County. We know the three recommendations, and spe­ But, we cannot be successful types of behaviors that put people at cifically (since they will impact without your active support. risk. We know who needs to be tested. your work) on the second and This fall, we will make these rec­ We have the disease control structure third proposals. Testing every ommendations to the Board of Health in place at the Health Department to person with symptoms of a sexu­ for approval. As the issue moves for­ handle all the HIV positive patients ally transmitted disease is essen­ ward for public discussion. I hope that identified. tial to our disease control mea­ you will participate and help us to con­ But they are not getting tested! sures. Each and every person at firm these advances in the effort to Our structure is basic and means high risk needs to be identified control the spread of HIV in our com­ for each H IV positive patient: and worked with. Our public munity. ■

October, 2001 PCMS BULLETIN 7 V B u l l e t in

Medical Practice Survey 2001 - Response is critically important

The Medical Practice Data Project were: turned the Medical Practice Economic will be instrumental in successfully * A declining share of health care Survey Questionnaire. If your practice educating the news media and the spending going to medical practices has not received or cannot locate the general public about the deteriorating * Slower growth in expenditures for survey questionnaire, please call the medical practice environment in public health insurance, and increas­ Washington State University Research Washington State. The project is ing budget constraints Center at 1-800-833-0867 to obtain a important to the economic survival of • Rising premiums and growing insta­ replacement copy. medical practices statewide. No other bility in health insurance markets PRACTICE MANAGERS: survey or project collects this level of • Many uninsured in Washington Please plan on time to complete the detailed data on Washington's medical State, impeding access to care Survey Questionnaire. If you have any practices. The results are vital to sup­ Please complete your survey specific questions on how to complete port work in the public policy arena as for this year and return it today!! the questionnaire, please call Bob well as with the news media. Far too many of W ashington’s Perna at the Washington State Medical Last year's project, commissioned medical practices have still not Association Seattle office, 1-800-552- by the Washington State Medical-Edu- completed the survey questionnaire 0612 or email [email protected]. cation and Research Foundation di­ for the 2001 M edical Practice Data THINK ABOUT IT: This project rected a team of analysis from the UW Project. Please don’t place the is critically important to the survival of and WSU to examine the evidence re­ entire project in jeopardy by not many (maybe your own) medical garding financial, administrative and responding. practices. The results are absolutely other pressures that negatively affect PHYSICIANS: Take a moment necessary for continued work on the financial viability of medical practices. to ask your practice manager if he or economic viability of medical practices Last year's most important findings she has received, completed and re­ in our state. ■ Will a disability put you out of commission?

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8 PCMS BULLETIN October, 2001 ? / /'e-tee i< -om itif C l l e t / f c a / ty c c t e t i f

Ifl M y O pinion .... Cordell Bahn, MD

The Phone M e s s a g e

As a retired surgeon who is ever billed over those years for only a few years senior to Dr. numerous visits, and with each Stan Harris (PCM S B u lletin , request to the physician for a bill September 2001), a reflection of for services rendered, they were my own origins, career and told “our doctors helped me and present attitudes leads me to a my family when I was in medical similar view on the present state school and I’m just passing it of collegiality in our profession. along.” A phone m essage, rather than a I was never able to identify call, is central to this essay. any of my patients as medical CorJell Buhn. MD One of my father’s best students or parents of medical friends was our fam ily doctor students but I was fortunate to and school physician. I spent have several physicians or their hundreds of hours talking with family members as patients in this man about his life, walking Tacoma and Bend, Oregon. I take care of me and those I love. the orchards and w oods of his never billed them for my ser­ As to the billing - above what farm with him and sitting in his vices beyond whatever their in­ paltry Medicare allows - I'll un­ school office, listening to count­ surance covered, even into the derstand. It is harder for you to less stories of wintry house calls, period of disgraceful reimburse­ get here than it was for me. late night vigils and home deliv­ ment of the late ‘90s. Back to “The M essa g e.” I eries, and being “alw ays on call,” What am I coming to here? think I saw it coming shortly af­ like Stan’s dad. I also counted Simply that it is a changed prac­ ter I returned from practicing in him as a best friend, and was tice culture that Dr. Harris and I Bend in 1992. The general and likewise saddened to watch him have chosen to leave, probably internal medicine offices where I deteriorate into near-total blind­ in both of our cases several years rented space changed their before we had to. 1 began my ness and cardiac disability. phone message greeting to the Tacoma career debt-free, and the Later, as an orderly in our very uptown “Thank you for tax laws favored a degree of en­ community hospital, I got to your call, our doctors are busy terprise which allowed me to ac­ know the physicians in our town. with other cu stom ers. Please complish retirement at the right I would have lunch with them, stay on the line.” The manager time. I had been fairly compen­ make rounds with them and for these younger physicians sated for my work, largely by a watch them operate. Their rela­ around me had decided upon this Medical Bureau (PCMB) that I tions with one another as well as greeting as more in line with the helped manage. the nurses’ attitudes about them day's business environment of As I move unavoidably into were cardinal issues in my later medicine and it had been ac­ the status of health care recipient decision to go into medicine. cepted without complaint. At that from health care provider, I be­ Medicare had not yet been same time, 1 realized that my lieve the practitioners that I de­ enacted in my later pre-medical years of deep satisfaction in my pend upon now or will do so in and medical school days. M y work along with personal recog­ the future were not as lucky, and parents, both elderly in that time, nition and reward for the effort, I’m wiling to spot them the unan­ began to need general medical were indeed numbered. * and specialist help from our local swered calls, exasperating as that doctors. I don’t think they were is, if they are eventually there to

October, 2001 PCMS BULLETIN 9 B u l l e t i n

Directory Changes New Fee Schedule for Searching

Please make note of the following and Duplicating Medical Records changes lo your 2001 PCMS Directory A rules hearing was held on July 10, 2001, for the purpose of amending WAC Lon Annest, MD 246-08-400, fees for searching and duplicating medical records. Every two years the Change office address lo: Department of Health is required to adjust the fee that medical providers may 1812 S J St #210. Tacoma WA 98405 charge for searching and duplicating records. The adjustment is based on the change in the consumer price index for all consumers for the Seattle/Tacoma area. Duncan Baer, MD Change office address to: Fees for copying were adjusted to: 2202 S Cedar # 100. Tacoma W A 98405 • Eighty-three cents per page for the first thirty pages • Sixty-three cents per page for all additional pages Richard Bone. MD • The provider can charge a nineteen-dollar clerical fee for Change office address to: searching and handling records 2202 S Cedar # 100, Tacoma WA 98405 This rule is effective August 20, 2001 through June 30, 2003. If you have any Dean Field, MD questions, please contact Yvette Lenz at (360) 236-4606." Change office phone#to: 858-9192

Martin Goldsmith, MD Change fax # to: 403-7921 Business Exam iner offers special John Goodin, MD subscription rates Change office address lo: 2202 S Cedar # 100, Tacoma WA 98405 The Business Examiner newspaper is offering special discounted subscription rates to members of the Pierce County Medical Society. A one-year subscription Gregg Ostergren, DO which would normally cost $36 is being offered at $25. Special two and three-year Change office phone # to: 403-8740 subscriptions are also available. Fax: 403-8741 If you are interested in subscribing the Business Examiner, please contact the Physician Only: 403-8739 PCMS office (572-3667) and we can mail you the subscription form. ■

Joseph Pham, MD Change office address to: 2202 S Cedar#] 00. Tacoma WA 98405

Henry Retailliau, MD Change office phone # to: 403-7199 Fax:403-7196 r a i / e lL e r ' S Maan Salloum, MD Change fax# to: 952-7987 Health Service A service of Wendel Smith, MD N o rthw est M edical specialties, PLIC Change office address to: 1812 S J St #210. Tacoma WA 98405 INTERNATIONAL TRAVEL CAN BE HAZARDOUS TO YOUR HEALTH Kevin Sullivan, MD • PRE-TRAVEL CARE • POST-TRAVEL CARE Change office phone# to: 858-9192 HOURS CALL EARLY WHEN PLANNING Gail Venuto, MD MON - FRI 9 - 5 Change office phone # to: 858-9192 253-428-8754 or 253-627-4123 Christopher Young, MD A SERVICE OF INFECTIONS LIMITED PS 1624 South I Suite 102 (next to St. Joseph’s Hospital) Change fax # to: 435-9318

10 PCMS BULLETIN October, 2001 f-’ce '((vftnlif Q Qdoctef)/-

In M y Opinion.... The Invisible Hand by Andrew statson, md

Professionalism and Commercialism

“There are two fools in every market, the one who asks too little and the one who asks too much Russian proverb

Several leaders of our profession It helped sell Apple computers, and have spoken against commercialism in Apple computers helped sell Visicalc. I nil it u ' ShiiM'ii, MD the practice of medicine. The essence Both were priced quite high relative to of their comments was their objection to the cost of production and gave a high using financial considerations as the ba­ return on investment. In addition, sis for medical decisions. Obstetrics and Apple made its computer architecture enough to comer the market and get Gynocology carried an article on pro­ proprietary, which excluded any com­ rid of the competition. It fell Hat on its fessionalism in its July issue. I suspect petition. Neither company considered face. Had it made the platform open, it the concern expressed in these state­ what the cost of entry into the business is possible that manufacturers would ments has to do with the goals of treat­ by other companies would be. have produced video recorders with ment. The question is whether the When IBM introduced its PC, it in­ both tape capabilities until the Beta for­ treatment should aim to palliate symp­ advertently made the right decision by mat proved itself superior and took toms at the lowest possible cost, while opening the architecture. Within one over the market, just as the 3 1/2 inch resulting in a lower quality of life and a year the market took off with the sup­ lloppy eventually displaced the 5 1/4 more significant limitation of function port of the clones and left Apple in the inch format in computers. than could be achieved by more ex­ dust. Several other calc programs ap­ Phillips had a different approach pensive means. One example would be peared as well and Visicalc became when it developed the tape cassette. It the treatment of hernia with a surgical history. Apple tried to fight back, but opened the platform to all comers. repair or with a truss. The former lost and is now' just limping along. IBM Some people said that it made a mistake would restore the patient to normal ac­ was stunned by the success of its PC, and should have kept it proprietary. tivity. the latter would relieve some of decided that it had a good thing going Perhaps, but the result was such a huge the discomfort, but the physical activity and thought it would be able to corner market, that Phillips probably sold many of the patient would remain signifi­ the market and get the competition out. more recorders and tapes than it would cantly limited. To that end, it developed a significant have otherwise. At the same time, the First, I’ll discuss commercialism. It improvement to the PC with the proprietary 8-track cartridge faded is defined as an approach which puts MicroChannel bus and the OS/2 sys­ away. the stress on profit, without concern tem. In order to keep the market to it­ Most big companies that thought about quality or service. It is frequently self, it make both proprietary. As a re­ they were strong enough lo control the called crass and associated with the sult, the market pulled the rug out from market have had the same experience. term unbridled capitalism. under it. Even though profit is the goal of any There is no doubt that many It is easy for someone who has business enterprise, no business can people in business and elsewhere created a market to believe that he survive by shortchanging its customers. have an inflated notion concerning the owns it, just as parents sometimes be­ If it does not deliver good quality prod­ value of their products or services. In a lieve that they own the children they ucts and services, it will not make it in free market, they are rapidly deflated have created. Wrong. Children belong the marketplace. Only a government to size. Before IBM entered the per­ to themselves, and so do markets. monopoly can continue to exist regard­ sonal computer market, the indisput­ Sony made the same mistake when less of the sort of service it provides, able leader was Apple Computer Co. it developed the Beta format for video­ but even then, not forever. No private Visicalc was a program that made it tapes. It had come out with the VHS park, not even Disneyland or Sea very attractive. It was developed by first, made it open and, of course, had World, could continue to exist if it al- two programmers in about six months. many competitors. It thought it was big See "P rofessionalism " page 12

October, 2001 PCMS BULLETIN 11 B u l l e t in

rom page 11 Professionalism f Personal Problems

lowed on its premises the level of se­ charge. Some of our leaders have de­ of Physicians curity, perhaps I should say insecurity, cried this change. It has been the tradi­ we have in our public parks. Commer­ tion of the medical profession to take Committee cialism without concern about the qual­ care of the poor without expecting pay­ ity of its products and services leads ment. How come we don’t want to do it Medical problems, drugs, alcohol, nowhere. It is self-destructive. It is the any longer? retirement, emotional, fool who asks too much. To quote Alan Physicians who practiced during or other such difficulties? Abelson as he paraphrased Dorothy the Great Depression related that they Parker, “Time wounds all heels." frequently treated patients who had no When Henry Ford came out with money, but were able to pay them in Your colleagues his Model T. he charged his customers kind. They would get a chicken, a want to help less and paid his workers more than dozen eggs, a slab of meat, a basket of

any other car manufacturer of that fruit or vegetables, whatever the patient *Robert Sands, MD, Chair 752-6056 time. When he became complacent. could afford to give them. However, Bill Dean, MD 272-4013 General Motors overtook Ford by in­ when they treated patients who could Tom Herron, MD 853-3888 troducing a variety of styles and col­ pay, they charged and received their BiU Roes, MD 884-9221 ors. W hen the American industry fell full fee. F. Dennis W aldron, M D 265-2584 asleep at the wheel, it was rudely In the past, we considered it our awakened by the Japanese and VW. obligation to take care of the poor, Confidentiality In their efforts to cut down costs, since overall we were properly paid for Assured the large employers were the stron­ our services. At present, we are gest proponents of managed care. Un­ squeezed dry. We have no more left to fortunately, they did not pay enough give. During the past 15 years, our in­ attention to the discontent of the work­ comes have dropped by more than ers with their health care coverage. 50%. At the rate we are paid now, we Setting it Straight The employees had to turn to the poli­ are barely able to meet our overhead. ticians for redress and the current To those of our leaders who want us to A sentence was inadvertently omitted from backlash against managed care be­ return to our professionalism by asking Dr. Patrice Stevenson’s President Page in the September Bulletin., explaining Dr. Mike came a political, rather than an eco­ that we be paid what our services are Kelly’s report to Congressman Adam Smith nomic battle, resulting in a higher cost worth, I want to express my deep grati­ about coding complex office visits. The corrected for everyone. tude. paragraph shows the omitted portion in bold text. Professionalism, on the contrary, If any among them would want us is defined as stressing service and is to return to our professionalism without ' ‘Now already running behind, he doesn’ t not concerned about profit. It is fre­ regard to our reduced income, I would have die additional time to adequately document quently qualified as altruistic. Profes­ be presumptuous enough to speak in the encounter to pass the scrutiny of “the Medi­ sionals are people in some service the name of most of my colleagues and care Police' so he ends up “down coding” the businesses. They are expected to give say to them, “We have an offer to make visit to be on the safe side. Repeat this their services even to people who are you. Hand us over half of your pay­ scenario multiple times a day and physi­ unable to pay for them. In this respect, checks and we will provide to the poor cians end up over worked and under and particularly in the medical profes­ all the care that your money will buy. It compensated. I have also read of the dangers of “down coding” as apotential sion, it has the features of the priest­ is only fair. Our income has dropped by source of increased utilization of services resulting hood. half, let yours do the same.” in higher overall health care expenditures.” In the current economic environ­ In the marketplace, we seldom ment, this is done less and less. When hear about the fools who ask too little. PCMS apologizes to Dr. Stevenson and Dr. we are barely able to cover oar ex­ They quietly fade away. Unfortunately, Kelly for the error. ■ penses, we are not in a good position it looks like that is what is happening to to give away our services at no our profession, r

12 PCMS BULLETIN October, 2001 '^ercf^uiutif edetl'cal

In My Opinion by Daisy Puracal, MD

My Journey Through Menopause

Menopause has been viewed as pause for me is the threshold for this the onset of aging. Cartoons and jokes new dimension - time for myself after abound making fun of the menopausal the children are gone and the "sowing Dais\ Puracal, MD woman. Is it any wonder that millions and reaping” are done. of dollars are being spent to staunch Similarly, Jung talks about the life­ this tide to keep menopause and aging time being divided into two: the first half at bay? Part of this movement is poten­ is the Lime for relationships and the sec­ response related to the deteriorating tiated and supported by the medical ond half for following die ''Marga” ovarian function. No studies have been profession touting hormone replace­ (path) or finding the sense of life within, done to research the function of FSH/ ment therapy as preserving the youth­ without care for achievement or pres­ LH after the reproductive years. Could ful nature of skin and mucus mem­ tige. it be that these hormones have a role to branes (in addition to the other ben­ "In primitive tribes, irp observe play in the larger scheme of life? Could efits). that the old people are almost always it be that these are wisdom hormones? As I transitioned through meno­ the guardians o f the mysteries and Ihe (A concept touched on by Christiane pause, I came to this crossroad with all laws. And it is in these that the cultural Northrup. MD and others.) Could we the fears of growing old. The current heritage o f the tribe is expressed. " - be doing humanity an injustice by sup­ thinking was strongly supportive of Jung pressing these hormones with estro­ HRT (hormone replacement therapy). In tribal cultures, women achieved gens and robbing future generations of So I tried estrogens, but in spite of re­ increased power and wisdom after the the wisdom of the ages? (Note that simi­ ducing the doses to even a tenth of the menopause and became high priest­ lar FSH/LH elevations are seen in recommended dose. I found I could esses or attained "elder status." males of the same age.) not tolerate the medication. I felt I looked into the physiology of the With this in mind I designed a “cloudy,” not myself, as if I needed to hormonal changes in the lifetime of a questionnaire to compare spiritual “get out from under." I knew HRT was woman. I came up with some interesting growth as an end-point of wisdom not for me. revelations. Looking at FSH/LH levels amongst users and non-users of HRT. I felt I needed a new paradigm to during the lifespan of a human being I interviewed 13 postmenopausal deal with and understand what was we note a peak during the second tri­ women (ages 52-68). six of them being happening to me. In my search I read mester of fetal life, another peak during HRT and the rest not. No meaningful Nietzsche’s writings where he talks of the first six months of the neonatal pe­ statistical conclusions can be drawn the three metamorphoses of the riod. and then regular rhythmic eleva­ from this small study, but subjectively I spirit. ..the stages of the camel, the lion tions corresponding to ovulation during felt that the women who were non-us­ and the child. The camel is the stage of the reproductive years. Each of these ers exhibited a deeper level of indi­ life where knowledge is "loaded" or elevations is associated with tremen­ viduation and social commitment than piled onto one - the growing up or stu­ dous changes and is of momentous sig­ users. Even if this may be a biased dent stage. The lion that conquers and nificance. The young adolescent girl opinion, this issue definitely needs fights with the dragons is the adult goes through body, mood and men­ more research. achiever, focused on home, family and strual changes much like the I have not personally used the work, getting on with life. The last state perimenopausal woman. Yet we do not "natural" hormones such as soy prod­ is back to the child - a new beginning, stop these changes in the adolescent ucts and Dong Quai. although anecdot­ a first movement, a sacred "‘yes" to the knowing what is in store for her. ally some women have had good results universe. The spirit now comes into During menopause and thereafter with these. We do not know if these her/his own and goes inward to con­ FSH/LH levels increase. But this in­ products would have a similar effect on quer her/his own world. The meno­ crease. we were taught, is a secondary See "Menopause” page 14

October, 2001 PCMS BULLETIN 13

“Mary Bridge emergency crunch mirrors nationwide crisis”

Editor s Note: I his editorial, by PCMS President Patrice Stevenson, MD appeared nr, the editorial page of The News Tribune, 9/16/01

While aptly reporting on the sur­ as hospitals have decreased beds and worrying about “not working too many geon scarcity affecting care at Mary have been forced to operate, like doc­ hours and having enough compensa­ Bridge Children's Hospital, Sandi tors. on decreased Medicare and Med­ tion.'' In our slate, private medical prac­ Doughton (TNT, 9-2) Tailed to mention icaid reimbursements that used to be tices lost an average of $95,000 last that this problem is not new nor unique reasonable enough to provide care for year, they are taking out loans to meet to Tacoma. those unable to pay. payroll: they are turning away Medi­ U.S. News undWorld Report's Attracting physicians is difficult, in care and Medicaid patients, and in some Sept. 10 cover story. “Crisis in the ER.” some specialties impossible, with in­ cases they are even shutting their outlines a “national emergency" created creased paperwork, federal regula­ doors. by a demand lor health care without ad­ tions and reimbursements cut so low it’s In California. 25 percent of medical equate resources to provide it. difficult meeting overhead expenses. practices are on the brink of bank­ For example, hospitals in Virginia Commercial insurers have squeezed ruptcy. according to the Los Angeles are often on “reroute,” meaning ambu­ reimbursements and taken advantage Times. Physicians' workweeks have in­ lances just drive on by. Massachusetts in of physicians' inability to say no to con­ creased tremendously due to paper­ investigating a death from an asthma at­ tracts that don’t adequately reimburse work requirements, and many in this tack that happened because the hospital diverted the ambulance. A California hospital lost three lives from delayed di­ U.S. News mdWorldReport’s Sept. 10cover alysis treatments. Long waits, major frustration and story, “Crisis in the ER,” outlines a “national fear abound, even at nationally re­ nowned hospitals like Johns Hopkins emergency’ ’ created by a demand for health Hospital, University of California at San Francisco Medical Center and Cleve­ care without adequate resources to provide it. land Clinic - where ambulances were on reroute 50 percent of the time. Insur­ ance doesn't help, status doesn't help, them. state are wor king more than 70 hours wealth doesn't help. When there is not a To add insult to injury, the govern­ pel' week. bed and not a nurse or doctor, you don't ment not only expects doctors to take They have had to hire additional get care. care of the poorest patients al below staff to comply w ith paperwork and re­ The problem is complex and is cost reimbursement rates, but hassles ferral requirements of government and caused by myriad factors. Emergency them about fraud and abuse for doing commercial payers, with no additional room visits are rising sharply as the vast so. revenue to offset the expense. number of uninsured seek care in emer­ Carrie Whalen's Sept. 6 letter to No physician went to medical gency rooms. Supply has been reined in the editor chides physicians for only school because they really wanted to be a small business owner, but unfortu­ nately that is what they have become. It UNION AVENUE PHARMACY is not surprising that our best and brightest are retiring at earlier ages Professional Compounding Center of Tacoma, WA than ever, seeking new careers and not encouraging anyone they know, par­ Vaginal Suppositories Gel, Ointment, and Cream ticularly their children, to enter their Rectal Suppositories IV Services once-beloved profession. Urethral Inserts Capsules It’s hard to fathom that our country, with state-of-the-art technology, the Sublingual Troche Lip Balms world’s best physicians and nurses and the ability to provide the fines medical 2302 South Union Avenue 752-1705 care, is on the brink of disaster. ■

October, 2001 PCMS BULLETIN 15 B u l l e t i n

Save The Date The Edwin C. Yoder Honor Lectures

Friday, November 16, 2001

This year, our Yoder presenters are Stephen M. Ostroff, MD who is the Associate Director for Epidemiologic Science at the CDC and Colonel Edward M. Eitzen, MD who is the Commander of the U. S. Army Medical Research Institute of Infectious Diseases. The topic of this program is bioterrorism and emerging infectious diseases. Dr. Ostroff will discuss emerging infectious disease threats in the USA. Dr. Eitzen will discuss the medical effects of biological agents and the management of biological injuries.

This program is designed for physicians and is accredited for 2.0 Category 1 hours.

Location: St. Joseph, Medical Center - Rooms 1ABC Schedule: Piease note the change in the program schedule this year. Based on gour feedback, we are attempting to starttne program later in the dag to minimize goar time awag from the office. 2:00-3:00 PM Social Hoar with hors d'oeavres and wine 3:00-4:00 PM "Emerging Infections of the New Millennium " Stephen Ostroff, MD 4:00-4:15 PM Break 4:15 - 5:15 PM “Bio terrorism; Reality and Response " Colonel Edward M. Eitzen, Jr., MD

Reservations required. Limited seating. Please calf in your reservation no later than Thursday, November 8th Invitations will he mailed In October. For reservations, call The FHS Office of Academic Affairs at (253) 207-6035.

"CHI-W/FHS A cadem ic Ajfairs is a ccred ited by the W ashington State Medical Association CME Accreditation Committee to sp on so r continuing medical education jbr pTtysicians. CHI-W/FHS Academic Ajfairs designates tkis educational activity jbr a m axim um o_f2 Hours in Category 1 to satisfy the relicensure req u irem en ts o f the WashmgtonState Medical Quality Assurance Commission and tke AMA Physician's Recognition Award, Eack physician skould claim only tkose hoars ojcredit tkat h e /s h e a ctu a lly spent in the educational activity."

16 PCMS BULLETIN October, 2001 Nf c . ------/ 'iyr-.tui/u ^ (l& h ra / ^Jocu'hj > ■' ______COLLEGE OF Continuing Medical Education MEDICAL ID Update set for Novem ber 2 EDUCATION at the La Quinta Inn This Year The annua] Infectious Diseases This year’s program includes presen Update is set for Friday, November 2. tations on: 2001. The very popular course will be • Hepatitis C: You and Me held this year at the La Quinta Hotel. • The Man in the Blue Suit Mental Health The program is directed by Jim • HIV for the Primary Care Physician DeMaio, MD and will feature nation­ • Antibiotic Resistance CME set for ally known expert Dr. Charles Stratton • Antibiotic Resistance in Pierce County December 7 joining Infections Limited physicians • Infection Prevention as they give presentations on specilic • Advances and Retreats in Infectious disease areas. The course is designed as Diseases The continuing medical education an update on common outpatient and • Mad Cow Disease: Is it Here? focusing on the diagnosis and inpatient infections. • Infections in the IV Drug User ■ managment of mental health complaints faced in the primary care and internal Dates Program Director^) medical practice is set for Friday, December 7. Common Office Friday, October 5 Mark Craddock, MD The complimentary program, di­ Problems rected by David Law, MD offers 6 Category 1 CME credits. Infectious Diseases A program brochure will be mailed Friday, Novmber 2 James DeMaio, MD Update in October. ■ Medicine & Mental Friday, December 7 David Law, MD Hawaii CME Health Wednesday; Tuesday Cardiology for Primary Gregg Ostergren, DO Plans? Air January 9; 15 Care Reservations Urged Wednesday-Sunday Richard Tobin, MD CME @ Whistler January 23-27 John Jiganti, MD To asure you are able to secure seats and get a reasonable price for Primary Care Michael Bateman, MD CME at Hawaii, we urge you to make Friday, February 8 Orthopedics Charles Weatherby, MD your reservations NOW. A small re­ fundable Thursday-Friday Internal Medicine deposit will Tejinderpal Singh, MD hold your March 7-8 Review 2002 seats. Sunday-Friday T he CME at Hawaii Mark Craddock, MD College is April 7-12 working with Marilyn Allergy, Asthma & at Olympus Friday, May 3 Pulmonology for Alex Mihali, MD Travel (565-1213). Olympus has Primary Care booked some seats at group rates and has access to other special options at Advances in Women's the best rates. Friday, May 17 John Lenihan, Jr., MD Medicine Call Marilyn today, a

October, 2001 PCMS BULLETIN 17 B u l l e t i n

Handheld from page 6 drugs. Point your browser to Anatomy on your PDA times crash unexpectedly. The Palm www.epocrates.com. I have a schematic of the liver, OS almost always recovers gracefully, gallbladder, bile ducts and pancreas on though. Backups (hot syncs) prevent Avoiding trouble with the Orga­ my handheld, which is useful for pa­ data loss. Palm OS extension programs nization formerly known as tient education or obtaining informed carry such colorful titles as HCFA consent for ERCPs. I use a program Hackmaster. which must send chills The coding of evaluation and man­ called Fire Viewer for image display. I down the spine of directors of hospital agement services is a major headache. have to admit that images on most IS departments. Some of the most use­ Of course, the medical Palm community handhelds are less than awe-inspiring. ful programs (ZapBill) require some has come up with an answer, the ST AT The above-mentioned iPAQ is an ex­ tinkering by the end user before they E&M coder. This is a program that can ception. Recently a stunning anatomy become fully functional (i.e., populate be used concurrently during dictation suite was released that really looks databases with CPT and ICD codes). of the visit note. Elements of the 1997 good on this Windows C.E based de­ Eventually, the Palm OS will probably HCFA documentation guidelines are vice. go the way of Netscape and the ama­ checked off as one dictates along and teur developers will turn to new ven­ the currently reached CPT level is in­ Crashes, Hackers and the Future tures. However. PDAs can boost your dicated. 1 bet that after several months The PDA culture in 2001 re­ productivity now and the upfront in­ of using it the prompts are no longer sembles, to a certain extent, that of the vestment is small. ■ required and the program has outlived Internet in 1995 when large scale adop­ its usefulness. A trial version is avail­ tion in the business community was just Reprinted from Spokane County Medi­ able for download at around the corner. Popular programs cal Society's monthly newsletter, “The www .statcoder.com. are still written by amateurs and some­ Message "

48,871 Square Foot Medical Office Building

Available Third Quarter 2001

Available Suites: Second Floor: Up to 11,000 SF Third Floor: Up to 17,000 SF

2202 S. Cedar Building Presented by Tacoma,Tarnma WA QfMOfi98405 Kidder Mathews & Segner Inc '“1------Join these existing tenants: Building features: Pacilic Northwest Eye Associates, PS Contact: Class "A" Building with high quality finishes Bill Frame, CCIM David V. Pratt, MD and Troy J, Woodman, Located near the Allenmore Hospital Campus 253-383-0799 Allenmore Ambulatory Surgery Center State-of-the-art Building [email protected] Tenant Improvement Allowance Ample, free parking Flie mformaiion contained herr/m has been given t< > us by the owner or sources lhal w e d e e m re tra oie. '.Ve have no >eason to dovt>! its accuracy, but tve d o n o t g u a ra n te e it. P ro s p e c tiv e te n a n ts s h o u ld c a re fu lly v e rify a ll in fo rm a tio n c o n ta in e d h e re in Call for more information.

18 PCMS BULLETIN October, 2001 fierce ^o u n h j C} (ledtcal & oc

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Tacoma/Pierce County out­ Seattle/Tacoma. M edical Group Available now, new construc­ patient general medical care at its best. seeks B/C or B /Q Family Practitioner tion, up to 1,800 sq ft remaining on first Full and part-time positions available in or IM/Peds for Urgent Care float level, will provide tenant improve­ Tacoma and vicinity. Very flexible position. All clinics are located within 40 ments. Close to hospitals on Union at schedule. Well suited for career minutes of downtown Seattle. 13"'. Call D r. L o v y at 756-2182 or 206- redefinition for G.P., F.P., I.M. Contact Experience the best of Northwest 387-6633. Andy Tsoi, MD (253) 752-9669 or Paul living, from big city amenities to the Doty (Allen, Nelson, Turner & Assoc.), pristine beauty and recreational Lakewood Professional Village Clinic Manager (253) 383-4351. opportunities of the great outdoors. Furnished medical office. 650 sq ft. Live and practice where housing is still Lease or buy. 253-223-0557. Washington State Division of affordable and traffic is still Disability Determination Services. manageable. Excellent benefits and Fircrest Medical Office Space Medical Consultant positions available. income guarantee. Three-year family 412 Bowes Drive -1540 sq ft consisting The State of Washington Division of practice or internal medicine residency of examine rooms, offices, reception Disability Determination Services seeks in accredited U.S. residency program area, lab and x-ray rooms plus 300 sq ft psychiatrists to perform contract required. For more information, please storage. Call (253) 863-3366or (253) services in the Seattle Regional office. e-mail C.V to providerservices® 272-4588. Contract sendees include the multicare.org or fax to 253-403-5431. evaluation of mental impairment Check out our website: Office Space For Lease. Sound- severity from medical records and www .mu 11 i care. org. view Medical Plaza, located at 361 I other reports, utilizing Social Security South D Street, currently has office regulations and rules. Psychiatric space available for lease to medical or Medical Consultants function as POSITIONS WANTED general healthcare practices. We of­ members of the adjudicative team and fer very competitive lease rates; spa­ assist staff in determining eligibility for Transcription Specialists - We cious. updated facilities: shared recep­ disability benefits. Requirements: have years of experience in most tion; accessible support staff; excellent Current Medical License in medical specialties. We guarantee security, maintenance and janitorial Washington State. Board certified accuracy, fast turnaround lime, free services; and access to onsite radiol­ desirable. Reimbursement: $57.01/hr. pickup and delivery and reasonable ogy and blood labs. Our location, just Interested psychiatrists should contact charges. Outstanding references. Call off of Pacific Avenue, is adjacent to Guthrie L. Turner, Jr.. MD, MPH, 925-3276. the Pierce Counly Health Department Chief Medical Consultant, Acting at and Puget Sound Behavioral Health, (360)664-7361 or the respective and is easy access to and from free­ regional manager: S eattle: Michael ways and on a bus line. For lease rates Theisen, Regional Manager (425) 430- and more information, call Lindy 4811. Vincent at 798-4520.

LOOKING FO R A HOM E

“Norman” needs a home. He loves attention, but is not necessarily a showed up at the Medical Society of­ lap cat. He is basically a special cat fice lost and hungry and all efforts to looking fora special home without find his owner have not been success­ other cats and children. He needs to ful. live indoors will: devoted caretakers. Norman is a mature, mellow cat If you or anyone you know is in­ who doesn’t get into mischief. H e h as terested in providing a home for been neutered and declawed Norman, please call Tanya at the Medi­ and uses the litterbox. He has beauti­ cal Society office. 572-3667. ■ ful, soft fur (brown/black tabby). He

October, 2001 PCMS BULLETIN 19 Our Claims Staff Receives Top Praise

“I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.” Corrine Jedynak-Bell, DO, Tacoma, Washington

When times are tough, physicians count on us to fight for their best interests— from the day a claim is discovered to the day it’s resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and—most importantly—with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t you want only the very best on your team? For more intormation, call us today at 1-800-962-1399. ■P Physicians Patricia Mulligan, (."Tre.iiud ;iiiJ ijnTSiorcd by ihij ■" Insurance W jilu n g tu n Si.'ite Medical A5

Pierce County Medical Society PRESORTED 223 Tacoma Avenue South S TAN D AR D Tacoma. WA 98402 US POSTAGE PAID TACOMA. WA PERM IT NO 605 Return service requested

20 PCMS BULLETIN October, 2001 November, 2001

Cover photo by Sara Insalaco. MD

INSIDE: 3 President’s Page: “Focus” 5 October GMM: “Embezzlement...The Medical Practice’s Dirty Little Secret” 6 Retired Members dine with Bart Ripp 7 Special Feature: “The Tacoma Trauma Center: A Lesson in Cooperation” 9 Tacoma-Pierce County Health Dept: “Betrayal of Trust” 11 In My Opinion: “The Sickness of Terrorism” by Andrew Statson, MD 15 In Memoriam: Drs. Edward McCabe and Bernard Rowen, 98 years of PCMS B u l l e t i n

PCMS Officers/Trustees: Patrice N. Stevenson. MD President Susan J. Salo, M D ...... President Elect J. James Rooks. Jr., M D ...... Vice-President Michael J. Kelly, M D ...... -Secretary/Treasurer Charles M. Weatherby, MD....Past President Sabrina A. Benjamin, MD Drew H. Deutsch, MD Stephen F. Duncan, MD November, 2001 Kenneth A. Feucht, MD Sumner L. Schoenike, MD

PCM S M em bership Benefits, Inc (MBT): Drew Deutsch. MD. President: Keith Demirjian. MD. Steve Duncan, MD, Mark Gildenhar, MD, Mike Kelly, MD, Secretary-Treasurer; Art Maslow, DO, Tim Schubert, MD, Steve Settle, MD, Joe Wearn, MD

College of M edical Education (C.O.M .E.): John Jiganti, MD President; JD Fitz, MD, Barbara Fox, MD. William Holderman. MD, Steve Konicek, MD, Marjorie Krabbe, MD, William Lee. MD, Gregg Ostergren, DO, Brad Pattison, MD. Cecil Snodgrass, MD. Virginia Stowell, MD, Richard Waltman. MD. Tod Wurst, MD. Rick Campbell. MD. Good Samaritan Hospital; Victoria Fletcher, Multicare Medical Center; Sister Ann Table of Contents McNamara, Treasurer, Franciscan Health System; Sue Asher. Secretary 3 President’s Page: “Focus” PCMS Foundation: Lawrence A. Larson, DO, President; Mona Baghdadi, Nikki Crowley, Treasurer; Sue Asher. Secretary 4 Pierce County physicians participate in WSMA policy making

YVSMA Representatives: 5 October General Membership Meeting: “Embezzlement... Speaker of the House: Richard Hawkins, MD The Medical Practice’s Dirty Little Secret” Trustees: David Law, MD: Nicholas Rajacich, MD AMA Delegate: Leonard Alenick, MD WAMPAC 6th District: Don Russell, DO 6 Retired Members dine with Bart Ripp WAMPAC 9th District: Leonard Alenick, MD 7 Special Feature: “The Tacoma Trauma Center: A Lesson in Staff: Executive Director: Sue Asher Membership Services Coordinator: Shana Osmer Cooperation” Administrative Assistant: Tanya McClain Placement Coordinator: Deborah Pasqua 8 Pierce County women physicians meet Placement Assistant: Angela Kraetner CME Program Administrator: Les McCallum Bookkeeper: Juanita Hofmeister 9 TPCHD: “Betrayal of Trust"

The Bulletin is published monthly by PCMS 11 In My Opinion: “The Sickness of Terrorism” Membership Benefits, Inc. Deadline for submitting articles and placing advertisements is the 15th of the month preceding publication. 13 In My Opinion: “How Do You Do It?”

The Bulletin is dedicated to the art. science and delivery 15 In Memoriam: Edward F. McCabe, MD of medicine and the betterment of the health and medical In Memoriam: Bernard R. Rowen, MD welfare of the community. The opinions herein are those of the individual contributors and do not necessarily reflect the official position of PCMS. Acceptance of 19 New Members advertising in no way constitutes professional approval or endorsement of products or services advertised. The 21 College of Medical Education Bulletin reserves the right to reject any advertising.

Managing Editor: Sue Asher 23 Classified Advertising Editorial Committee: MBI Board of Directors Advertising Information: 253-572-3666 223 Tacoma Avenue South. Tacoma WA 9S402 253-572-3666; FAX: 253-572-2470 E-mail address: [email protected] Home Page: http://www.pcmswa.org

2 PCMS BULLETIN November, 2001 President s Page by Patrice Stevenson, MD

Focus

In his inaugural address, incoming cently had several patients who have WSMA President Sam Cullison, M D lost primary care Mid specialist physi­ emphasized the need for focus in the cians to oul-of-state moves. One next year. In fact, focus was his top woman lamented that she had had the n three priorities for the year. He m eant same doctor growing up and in the past this for physicians individually and for five years has had to change primary the house of medicine collectively. care physicians four times due to prac­ In tough economic times our focus tices dropping her insurance or mov­ needs to sharpen from the telephoto ing. th erap y . lens to the close up. W e need to be I still th in k it is a lo n g tim e co m in g Focus is not an easy task with the sure things are in order and running as until the public understands the true multitude of tilings demanding our time efficiently as possible i n our office as economic pressures of providing the and attention. It is easy to get chroni­ well as in our medical organizations as type of medical care they want, expect cally distracted and become disorga­ there is simply no more slack in the sys­ and demand. Quality care is a given nized and drained. Ideally we should tem. We can only work so much expectation of providers, payers and g o fro m o n e p a tie n t to th e n e x t o r o n e harder, so to improve practice econom ­ patients. Quality costs. All I have read task to the next in a chain of focused ics we fo cu s o n th e e s se n tia ls a n d the about medical economics is in the most and productive efforts. W e could then non-essential niceties go by the way­ negative of terms...skyrocketing costs, go home and be focused there and re­ side. This could be from stopping of­ the drain on businesses and individuals turn to work the next day refreshed fering free coffee in the office waiting to pay for it. cost centers and burgeon­ and ready to focus again. Unfortunately room to dropping professional society ing administrative expenses. People I have not figured out how to do this in m em berships. It is an u n w ritte n g o al o f expect health as a baseline but do not 16 years of practice. For those of you PCMS and W SM A to be considered an lik e 10 pay for it. who have achieved this ability, please essentia] professional business ex­ It w as m e n tio n ed at the W S M A share your wisdom! pense to our members. meeting that Regence had paid more At least for PCM S we are fortunate While most physicians abhor the out in massage therapy benefits than to have efficient and focused staff to business side of m edical practice, the for chem otherapy! This tells me that help in our efforts. Our newly created recent economic downturn forces us to patients want "satisfying" care more membership committee chaired by pay attention to these details. W e have than “quality” care. Satisfying does not President-Elect Susan Salo, MD is been shocked by the economic failures necessarily mean satisfactory. Satisfy­ w o rk in g to w a rd a b e tte r u n d e rsta n d in g of long term institutions such as the M e­ ing care to one patient may be receiv­ ot the wants, needs and desires of the morial Clinic in Olympia. M any hospi­ ing cutting edge diagnostic evaluation membership. W e want you to be satis­ tals are currently in the red or running and treatm ent while to another it is low- fied that you got your m oney's worth on the narrowest of margins. I've re­ tech but high touch, such as massage for your investment in PCM S. ■

November, 2001 PCMS BULLETIN 3 B u l l e t i n

Pierce County physicians participate in WSMA policy making

The Annual Meeting of the Wash­ • Creation of incentives to encourage The report calls for W SMA re­ ington State Medical Association, held citizens to obtain insurance cover­ sources to be focused on the following in Portland, set the work goals and pri­ age and promotion of "needs testing” organizational priorities: orities for physicians and staff for 2002. so that society ensures access to The meeting was held September 21- coverage for low-income citizens. • Preserve and promote the viability of 23. just ten days after terrorists at­ medical practices in Washington tacked the United States. No doubt, • Support of federal legislation to: S tate. the incident had an impact on those at­ • Promote the health of the public. tending the meeting, and perhaps, - Create fully refundable tax credits • M aintaining and building medical even contributed to the less conten­ for individuals who buy health practice revenue whenever and by tious, more uniform decisions made by insurance in the individual insur­ whatever means possible. d eleg ates. ance market. • Promoting quality care, patient safety The attack also prompted discus­ and physician accountability. sion regarding the need for coordina­ - Elimination of the cap under fed­ • M aintaining the W SM A’s viability - tion in response to terrorist activities. eral law on the amount of Medical economically, as the “place to come” A resolution was passed directing the Savings Accounts given preferen­ for physician support and assistance, W SMA to coordinate with existing na­ tial tax treatment. and as an information/understanding tional. state and local disaster agencies re so u rc e . a response system to mobilize all phy­ - Creation of more balance in the sicians and medical students to volun­ private marketplace between in­ Attending this year’s meeting for teer assistance in the event of a disas­ surers and physicians and other Pierce County were Board of Trustees ter in Washington state. This would providers of care. m em b ers: include bio-terrorism, chemical expo­ Patrice Stevenson, MD sures. radiation and/or mass casualties. • Support of legislation to eliminate Charles Weatherby, MD Delegates also directed the the Business & Occupation (B&O) Susan Salo, MD WSMA to continue its work to support Tax on revenues that medical prac­ Sabrina Benjamin, MD a market-based approach to the dete­ tices receive from public payers Steve Duncan, MD riorating delivery system and to work such as Medicare, M edicaid and the Ken Feucht, MD with the Washington Healthcare Fo­ Basic Health Plan. Sumner Schoenike, MD rum Services to seek tangible and meaningful administrative simplifica­ The House also accepted Report Alternate Delegates included: tions for medical practices. Specific H, WSMA Organization Priorities, in­ Federico Cruz-Uribe, MD actions to restore the state’s health care cluding adoptions of resolves that in­ George Tanbara, MD delivery system include: cluded reaffirming the overriding or­ Cecil Snodgrass, MD ganizational value statement that: Ron Morris, MD • Seeking increases in the state's Medicaid program so that it reim­ “Regardless of specialty or prac­ AMA/W SMA/Specialty Society Reps burses medical practices at today’s tice setting we remain, at our core, in clu d ed : Medicare rates. physicians. The WSMA represents Len Alenick, MD and advocates for all physicians who David Law, MD • Advocating for more affordable are - and must be - responsible and Nick Rajacich, MD “bare bones" health insurance, in­ accountable for medical decision­ Don Russell, DO cluding the repeal of mandates that making, and promotes the health o f all Richard Hawkins, MD currently require a variety of non- Washingtonians." David BeMiller, MD essential benefits and providers of se rv ic e s.

4 PCMS BULLETIN November, 2001 V.. ffierre Q.4(edi<.-af dfoaety

October General Membership Meeting by Jean B o rst

Embezzlement... The Medical Practice’s ‘Dirty Little Secret’ Dr. Jeff Nacht shares his not-so-pleasant experience to help others

Close your eyes and imagine this... lished a practice in You think your marriage and fam ­ 1990, dedicated to ily life is great. There might be some the high school and bumps and problems, but fo r the most smal 1-college athlete. part, everything seem s fin e. They originally con­ One day, vou wake up and you sid ered a jo in t v e n ­ find out your wife has left you, your ture with St. Joseph’s house has been taken by the bank, Hospital, and that’s your kids hate you, and all the money how they began their you had in the bank is gone. Then you association with realize that it isn 't a divorce. It's your Francis Corey- business. That person wasn 7 y o u r w ife; Boulet. A vice presi­ it was your employee. And he em­ dent at St. Joe’s, bezzled you. Corey-Boulet had Dr. Nacht (left) and his wife Gail, answered many questions It’s shocking, unconscionable, ille­ excellent refer­ after his talk at the October Genera! Membership Meeting gal... and common. Embezzlement in the ences, extensive medical office might be thought of as management and just a “dirty little secret.” but it’s a preva­ planning experience, and came highly in 1998. “Our wives started to talk to lent issue that Pierce County physi­ recommended by the hospital’s presi­ each other about the issue,” Dr. Nacht cians must be aware o f dent. Corey-Boulet came on as the recalls. His own wife, Gail, had an ex­ This silent and financially draining medical office’s manager. tensive business background and crime is happening at medical offices The practice flourished, but its fi­ agreed to look at the state of the prac­ across the nation and across the street. nances did not. “We realized very tice. At the same time, the bank called And, as victims of this white-collar early that our projections weren’t on in their loan of several hundred thou­ crime can attest, it’s difficult to discuss target,” Nacht said. “We did a lot of re­ sand dollars and wanted immediate and admit. But, talking about the issue, adjusting, but the problems kept occur­ payment. (Unknown to Drs. Nacht and sharing experiences, and working to ring.” As the practice grew, the prob­ Popich, the bank had placed the of­ prevent others from succumbing to this lems remained. “We were struggling to fices’ accounts into "special credits" be­ crime is the key. And that’s why Jeff pay bills, regardless of our growth. We cause of numerous late payments.) “We Nacht, MD brought his own experi­ were very busy, and didn’t see the for­ knew we were having problems, and ence to the forefront at the October 9 est for the trees,” he explained. had been thinking about going back to General Membership Meeting of the Things became increasingly shaky St. Joe’s and working on ajoint ven­ PCMS. over the year's, but their office man­ ture. So, we approached the hospital “This is a problem that is very ager always seemed to have an answer and discussed our problems and the much within our community,” Dr. Nacht for their financial woes. The difficulties hospital agreed to pay off the loan and explained. “One-third of the physicians weren’t ignored, however; the office purchase a portion of the company. It in this room will be embezzled. This is was subjected to three separate audits was a solution for us, but it was a solu­ not a small problem.” over the years performed by the De­ tion that was very hard for us to swal­ partment of Revenue, a partner’s per­ low.” What Happened to Our Office? sonal accountant, and St. Joe’s account­ Gail Nacht started discretely look­ In an effort to bring a higher level ing department. The audits revealed ing at the office’s system. She exam­ of sports medicine to the community, nothing out of the ordinary. ined the accounting system and bank Drs. Nacht and Greg Popich estab­ Significant developments occurred See “ E m b e z z le m e n t” page 14

November, 2001 PCMS BULLETIN 5

tM

invites you and your sj>ouse or guest to the

2 0 0 1 fl UNCIAL. M eeTIN Q

Tuesday, December 11,2001 Social Hour: 6:30 pm Sheraton Tacoma Hotel, Ballroom Dinner: 7:00 pm 1320 Broadway Plaza Program: 8:00 pm

“© oom ers to ©ustgxs -

tlow G enerations “Relate” a humorous and entertaining session featuring Marilyn Moats fenn^dy Business owner, author, career consultant and nationally-known speaker. Moats Kennedy is founder and managing partner of Career Strategies, a 24-year old consulting firm in Willmette, Illinois

♦Introduction of tlie 8002 Officers ♦Please bring an unwrapped toy (for a child) and or a -wrapped gift (for a w oman) for TW CA Shelter residents

'lease return before Friday, December 7 to: PCMS, 223 Tacoma Ave S, Tacoma, WA 98402. You may fax to 572-2470 or call 572-3667

Please reserve dinner(s) at $35 per person. Enclosed is my check for $______

Or, charge my credit card # ______Expiration D ate______

□ Visa EH Mastercard Signature______

My name for name tag: (please print or stam p)______

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Special Feature by Jean Borst

The Tacoma Trauma Center: A Lesson in Cooperation Lori Morgan, MD, Trauma Director, talks of successes and challenges that remain

Auto accidents, falls, gun shot one might expect - her calm demeanor scenario: There is a car accident. EMS wounds, burns, stabbings, blunt as­ seems incongruous with her position. personnel arrive on the scene and saults. To the victims of traumatic inju­ Not even the sudden demise of her contact triage base stations at either ries, seconds are precious and minutes Palm Pilot appears to shake her. Dr. Good Samaritan Hospital or Madigan can mean the difference between liv­ Morgan recently took a short time out Army Medical Center. Depending on ing and dying. (literally between traumas) to reflect on the EMS assessment, the base station Recognizing the importance of the trauma unit's first year in operation. will call the hospital on call for trauma, providing the best care to the commu­ While the fledgling center is only 13 and determine the level of injury. With nities they serve, two hospitals have months old, there seem to be relatively a Step 3 case. Dr. Morgan explained, ensured that Pierce County residents few growing pains. EMS personnel may not find abnor­ have the quickest possible access to Dr. Morgan joined Tacoma Gen­ malities, but “boy. does that accident trauma care. On June 21 of last year, eral Hospital one month before the look bad!” With a Step 2, they see a Tacoma General Hospital and St. Jo­ center opened. She recalls the kick-off fairly significant injury, but the patient - seph Medical Center were jointly des­ and subsequent year with enthusiasm. from a blood pressure or hemodynamic ignated as adult Level II trauma cen­ “For a new system that required a lot of standpoint - appears to be ok. With ters serving Pierce County. The two preparation and participation, things Step 1, the victim appears to be fairly locations alternate daily seeing trauma have gone remarkably smooth," she re­ injured and there are some definite ab­ patients. (Madigan Army Medical Cen­ called. Dr. Morgan noted that the pa­ normalities either in neurological status, ter is also a state-designate adult Level tient numbers have been higher than or as indicated by blood pressure or II trauma facility and operates concur­ anticipated, but the center has been heart rate. rently 24 hours a day, seven days a equipped and prepared to handle the Morgan noted that there is some­ week.) The cooperative effort was a load. Over 1,400 trauma care patients times a fine line when the triage system coup for the community. Prior to the were seen in the center the first year. is making the decision about sending a center’s opening. Pierce County The Tacoma Trauma Center is a patient to the trauma center. “Particu­ trauma victims were transported to designated Level II facility. Leveling larly in a new trauma system. I would Harborview Medical Center in Seattle. follows very closely the American Col­ much rather see over-triage than un­ By offering trauma care closer to lege of Surgeons levels and is based der-triage,” she said. "It's better to see a home, the chance of survival for critical on the condition of the patient and what few too many patients than miss some­ cases improves dramatically. resources are necessary to devote to one who really needs to be seen.” Headed by Lori M organ, MD, that patient. Level I trauma centers pro­ At the hospital on call, a trauma the core of the center is a staff of four vide the highest level of definitive and surgeon and physician’s assistant are surgeons board certified in general comprehensive care for patients with available and immediately on the scene surgery and critical care, and six physi­ complex injuries. The center sees a va­ when a trauma case arrives along with cian assistants, each of whom has com­ riety of trauma cases, from relatively ER nurses and technicians, IV thera­ pleted PA surgical residencies and are minor trauma to catastrophic injury. pists, respiratory therapists and extensively trained. But the success of “You never know what’s coming in radiololgy technicians. Depending on the program goes way beyond the sur­ the door,” Dr. Morgan said. “You might the level of trauma, OR nurses and an­ gical team, as Dr. M organ notes. “I see have a patient go home, or you might esthesiologists may be involved. the surgeons and PAs as the final piece end up in the OR with a patient losing “This is a tremendous medical com­ of the puzzle,” she said. “W e make it 30 units of blood. W hen a trauma pa­ munity effort," Dr. Morgan said, and go, but we couldn’t do it without the re­ tient comes in, you assess the patient, credits the commitment of administra­ sources we have.” make a plan, and move on and decide tion at both hospitals and a vast array of No “Typical” D ays the best way to take care of him or her. subspecialists. “The trauma center is a “You just never know what might Everyday is different. Every minute is significant resource user." Dr. Morgan happen around here,” said Dr. Mor­ different. There is no typical day.” said. “W e try to release personnel as gan, in a much more understated tone This might, however, be a possible See ‘Traum a” page 18

November. 2001 PCMS BULLETIN 7 B u l l e t i n

Pierce County women physicians meet in recognition of Women in Medicine Month

In recognition of "National ness, healthcare reimbursement issues, W omen In Medicine Month,” Pierce and other such concerns were dis­ County Medical Society held an inau­ c u s se d . gural Women In Medicine Wine and Dr. Auer encouraged physicians Cheese Reception on September 26 at to contact their government officials the Landmark Convention Center in and share their stories of poor reim­ Tacoma. The reception was open to bursement and the overwhelming bu­ women physicians practicing in Pierce reaucracy of the healthcare system and C o u n ty . the impact it has on their ability to prac­ In keeping with the theme "Lead­ tice medicine. She encouraged physi­ ers M aking a Difference,” PCMS cians and patients alike to be advocates P r e s id e n t Patrice Stevenson, MD in the healthcare community. “An angry and W SMA Immediate Past President patient is a strong advocate with a and Vice President of Medical Affairs strong voice,” she said. at Swedish Hospital, Nancy Auer, MD “There are a myriad of opportuni­ The next Women In Medicine spoke with their colleagues on a vari­ ties to share your passion of politics or event is to be announced. It is hoped to ety of subjects. The history' of the policy at your local, state and national be the beginning of a series of support­ W omen In Medicine Committee, levels,” added Dr. Auer. “We must be ive and education forums for female healthcare policy, legislative aware­ active at all levels.” physicians. ■

Everett Medical Office Closing Doors

The Everett Family Practice Cen­ significantly increased costs. And, Office Space ter, founded in 1977, and one of the squeezed profit margins - with govern­ largest stand-alone family practices in ment payers as well as private party in­ Pierce County Medical Society Snohomish County, will close their surance were all factors in the decision 223 Tacoma Avenue South doors for good on November 16, 2001. to close. The clinic reached a point Tacoma, WA 98402 The practice serves approximately where the challenges became too large 6,000 families. to overcome, according to Dr. Over the past six months, the num­ K om arow . 183 square feet ber of doctors at the center has fallen The clinic cut the equivalent of 17 professional location from fourteen to seven. More doctors full-time employees, trying to slash north o f downtown left than they could possibly replace in costs but it wasn’t enough. They also utilities included a short period of time, according to Dr. sought a merger partner, but failed. conference room & kitchen Julie Komarow. the center’s president. The doctors who remain on the janitorial service Not surprisingly, the practice is center’s staff are interviewing for new p a r k in g closing due to the loss of physicians, positions elsewhere, Komarow said. the general economic downturn and Patients were notified of the pending tight insurance reimbursements. closure in mid-October and will be noti­ Office equipment and other business necessi­ Changes in the regulatory environ­ fied by letter in November as to where ties available if desired. $200 per month. ment disenchanted some doctors. New their physicians will be. The remaining Please call 572-3667 for more information. M edicare rules, designed to tackle 62 employees were also notified that fraud, greatly increased paperwork re­ their jobs would terminate as of No­ quiring chart notes to be twice as long, vember 16. ■

8 PCMS BULLETIN November, 2001 j ' w K e ifVinitty Q (iedtca/ 'ty

Federico Cruz-Uribe, MD The Health Status of Pierce County Director of Health

I Betrayal of Trust m

The September 11 th events have through air or water, a bio-weapon been truly unsettling. The pain and suf­ sickens and kills many people over a TACOMA-PIERCE COUNTY fering of victims in New York and at fairly short period of time. Human com­ HEALTH the P en ta­ passion, dignity, respect for life, the DEPARTMENT g o n rules of law go out the window when to u c h e d one of these weapons gets used. e v e ry one I have been trained to prepare for There is much that can be done to o f us. bio-terrorism. Bui I will admit to you that preserve the health of our community, T h ro u g h ­ while I was listening to the lecturers, even in the event of bio-terrorism. It’s out the part of my mind was saying, “Don’t standard public health practice, magni­ days that worry, Federico, this will never hap­ fied: Look for patterns, identify the vi­ follow ed pen. People will not cross this line. It is rus oi' bacteria or chemical used, and the terror­ too horrible. Pay attention, but you will prevent further spread of the agent. In ism . m any never have to use this information.” As the short history of the United States, staff at the I was sitting there in the dark last week we have had to face many a horrific H ealth D e­ looking at my wall, L realized that the plague - malaria, yellow fever, cholera. partm ent line had been crossed. There were no These plagues killed thousands and cam e by moral restraints or customs of civiliza­ sickened tens of thousands. There my office to ask if I was okay. Each tion that would prevent the terrorists were no vaccines or drugs to fight time I hurriedly offered back “sure. I'm who plunged those airplanes into the them. But they were stopped because fine.” But then it dawned on me why World Trade Center and the Pentagon communities came together, instituting were they asking. They of­ clear and straightfor­ ten found me sitting in my of­ ward control measures. fice, in the dark, staring at They restricted travel, the wall. I was overwhelmed There is much that can be done they often placed se­ by the enormity of what hap­ to preserve the health of our vere limitations on per­ pened. And also - I’m afraid sonal behavior. They in­ to say - by the enormity of community, even in the event of stituted strict quarantines what could happen next. bio-terrorism. It’s standard public on infected individuals. Part of my staring at the This was the beginning wall was my having to think health practice, magnified... of public health in our the unthinkable: To prepare c o u n try . for mass suffering and death The Tacoma-Pierce if WMD - weapons of mass County Health Depart­ destruction - are used. We ment is ready to respond have known about WMD, or bio-weap­ from using bio-weapons against the to a weapon of mass destruction. ons, for many years. From history we people in my community. W e’ve asked emergency rooms, phy­ know that plague and small pox were So what are we to do when faced sicians and clinics to contact us if they released many times into cities to with the specter of their use? Just as the see patterns of unusual illnesses in the weaken resistance to an invading army. military has different levels of alertness population or a rise in deaths from what Our own government developed and during times of national disasters, public looks like a common respiratory dis­ stockpiled bio-weapons during the cold health also has alerts, particularly to re­ ease. Once notified, we’ll take the ac­ war era. But we stopped production, spond to chemical and biological teiror- tions necessary to control the spread of along with most countries, as the weap­ ist activity. This past week we were put the bio-weapon. ons became more and more horrific. on a heightened state of alert by the Weapons of Mass Destruction not Centers for Disease Control. Designed to be easily dispersed See “Betrayal” page 10

November, 2001 PCMS BULLETIN 9

In My Opinion.... The Invisible Hand by Andrew Statson, MD

The opinions expressed in this writing are solely those o f the author. PCMS invites members 10 express their opinion/insights about subjects relevant in the medical community, or share their genera! interest stories. Submissions are subject to Editorial Committee review.

The Sickness of Terrorism

“Trade is the natural enemy o f all violent passions. Trade loves modera­ tion, delights in compromise, and is most careful to avoid anger. It is pa­ tient, supple and insinuating, only resorting to extreme measures in cases of absolute necessity. Trade makes men independent of one another and gives them a high idea o f their personal importance: it leads them to want to manage their own affairs and leaches them to succeed therein. Hence it makes them inclined to liberty, but disinclined to revolution. Andre]!' Shitsi'jn. MD Democracy in America, Alexis de Tocqueville (1840)

I hope I’ll be forgiven for diverg­ relevant to us today, as the effort of a the German and the Japanese people. ing from m y usual topics on eco n o m ics man to exorcize from his mind the A sizable minority, probably even a and medical practice to discuss the eco­ ghost of the evil he suffered as a child. majority among them, did not share the nomics of a sick mindset. There are two Yet the horror he describes is related goals nor approve of the methods of ways to obtain goods and services in to that we witnessed on September 11. their rules. They were terrorized into this world, by trade and by force. The questions Alexander Solzhenitsyn submission and many of them died in Those who use force are robbers. raised when discussing the Soviet the war. We fought the cold war against They are the kleptocrats. They use Gulag was not a rhetorical one. “How the mindset of the master social class, their position of power to enrich them­ could humans be so cruel to fellow hu­ not against the Russian people, who selves. They have been around since man beings?” he asked. The answer is suffered more than anyone else under the beginning o f h istory and there is in the mindset of the terrorists. the tyranny of the communists. Now we very little chance that they will ever go No matter which god they bow to, are faced with the mindset of the master away. Perhaps the most notorious re­ if any, terrorists share the same reli­ faith. cent examples were Marcos of the gion, the religion of violence. Its basic Terrorism is not an issue of reli­ Philippines and Suharto of Indonesia. tenet was expressed best by Mao Tse gion, of social class, or of race. It is an More baffling to us, the producers Tung, “Power flows from the barrel of issue of the terrorist mindset, based on of wealth in this world, are the terrorists a gun.” No matter whether they bomb their determination to acquire and who are not interested in wealth. They embassies or military installations, trade maintain power and control over oth­ are satisfied to live in their tents and to centers or abortion clinics; no matter ers. Religion, class and race are ex­ travel with their camels. They don’t whether they abuse and torture their cuses. If terrorists did not have them, want our skyscrapers or our jets. Yet, spouses and children or defenseless they would invent others. The fight they don’t want us to have them, either. strangers; no matter whether they burn against terrorism is the fight against the They don’t want to get out of the mud books or humans, churches or syna­ terrorist mindset. We need to under­ in which they live, they want to drag us gogues; no matter whether they kill stand it, to learn to recognize it, to iso­ into it. They don’t want to rise to our people in gas chambers or herd them late and destroy it, in order to win. level, they want us to sink to theirs. As in concentration camps, terrorists share In the preface to L ea ves o f G rass. their recent actions proved, they don’t the same belief, that they are the mas­ Walt Whitman expressed the meaning care to live, they want us to die. ters, destined to ride the world. They of America, as the country of the com­ The heart-rending story of Dr. share the same goal, power over oth­ mon people, as the place where the Stutterheim is an example of terror­ ers. President takes off his hat to the ism in action. One may try to dismiss it We fought WWII against the people, while they keep theirs on. This as som ething fro m the d istan t past, n ot mindset of the master race, not against See “Terrorism" paye 12

November, 2001 PCMS BULLETIN 1 Terrorism from page 11 is in contradistinction to the East, sia is painfully slow. people to revolt. W e have to under­ where people may approach their Another one was the Shah Riza stand the reason for this threat in orde; leaders only while crawling on their Pahlevi of Iran. He recognized that he to face it better. W e have to under­ hands and knees. needed an educated middle class to stand that they target us because of The rulers who maintain them­ help him bring his country into the what we are, because we exist. selves in pow'er through terror have a twentieth century. Starting shortly after So what do we do about that? Un­ very good reason to fear and hate WWII, at government expense, he sent fortunately, bullies don’t understand America. Again, this is not an issue of a large number of high school gradu­ nice language. An illustration of thatis religion. They readily dealt with the ates to the universities of W estern Eu­ a statement attributed to Stalin. When Soviet Union, in spite of its atheism, rope. to learn medicine, engineering told of something the Pope had said, even though it was a definite military and the sciences, to help bring technol­ he replied, “And how many divisions threat to them. The communists were ogy to his country and to develop its in­ does the Pope have?” Perhaps the an­ fellow terrorists. They could under­ dustrial base. Some clerics did not like swer we seek is in the words from a stand each other. his efforts and eventually gathered Country-W estern song, “You don’t They fear and hate America be­ enough strength to depose him. In spite have to fight to be a man, but when cause they cannot deal with us on their of that, the ferment of freedom is stir­ you are a man, sometimes you have to terms. We are traders, not victims. ring the masses in Iran. It may still take a fight.” W hy would we want to do that? They fear and hate the rays our Torch long time, but freedom is going to shine Because, while realizing that we can of Liberty shines across the ocean to there as well. never achieve absolute safety, we their lands. They fear and hate our These are the reasons America is a want to make the world a little safer for system of individual freedom, capital­ target for destruction. They, who can­ our children; because we want to live ism and the free market. They fear and not design planes and build skyscrap­ in a world where there is room for all hate our prosperity, the result of pro­ ers, want to destroy ours, so that they faiths, for all classes and for all races, ductive work. can more easily keep their own people where humans treat each other as hu­ They fear and hate Israel, be­ enslaved. They don’t want us to have mans; finally, because we are traders, cause it is an outpost of freedom, capi­ the good life, so as not to tempt their not victims. ■ talism and the free market at their doorsteps. Some clerics look across the border and see, oh horror, women walking in the streets without veils Providing quality health care over their faces, going to work side by coverage to our community side with men, even serving in the for the past 81 years. 1501 Market Street army and shooting with rifles. They Downtown Tacoma look at their men as they watch across 253.597.6520 the border a productive people lead a free and happy life, wanting the same for themselves. They look at their women and see the yearning for free­ dom in them as well. Then the clerics understand that they are losing control over their own people and they de­ clare a holy war against the “Satan of the W est” and against Israel. There have been enlightened leaders in the East who tried to mod­ ernize their countries and bring them in step with the Western world. Tsar $ ■ « Peter the Great of Russia built Saint Petersburg and moved his capital there to be closer to the W est, to stimu­ W. Regence late more contact between his own BlueShield people and Western Europe. He did not achieve much and change in Rus­

12 PCMS BULLETIN November, 2001 In My Opinion by Teresa Clabots, MD

The opinions expressed in (his writing are solely those of the author. PCMS invites members to express their opinion/insights about subjects relevant to the medieul community, or share their general interest stories. Submissions are subject to Editorial Committee review.

How Do You Do It?

I g et tire d o f p e o p le a s k in g m e th e for rice, milk, and toilet paper. By brib­ same question all the time. H ow did I ing our way out with m y m other's jew ­ do what? Raise five kids with a job? elry, we were able to escape first to W ork ‘ro u n d th e c lo c k a n d ta k e ca ll? Spain and then waited two years for the Why, millions of women around the quota to come to America, the land of /iTr.S >!S, M fj world do it all die time, and som e barely opportunity. make enough to eat. I feel privileged H o w e v e r, m y m o th e r h a d to learn and lucky to b e in a c o u n try w h e re I how to fend for us kids. She learned to have extraordinary freedoms, and un­ drive, to scrub floors, to wash clothes equaled luxuries; a car, a toilet, a TV , a (many a thing was shrunk in the dryer, innards (euch) thrown in with chicken phone, a computer, enough food that I or had holes when she threw the gallon bouillon, lots of potatoes and a lum p of am never hungry, and control over m y of bleach in with the blue pea coats Crisco. The only good thing about it is own body. T h e n th a t g ets m e to th in k ­ from Salvation Army). th at it w a s w arm an d salty. B e liev e m e ing about my mom. She used her embroidery skills to when 1 say that was the best meal in her My mother was the world’s worst dam our socks over and over again cooking repertoire, wdiich was com ple­ cook. I say that with a little pride, since and to hem our hand-me-downs. Our mented with donated Safe way bread, I am not a very good cook, but she knee socks were held up by rubber o ld e n o u g h th a t w e h a d to p ic k the makes me look like a gourm et cook. bands, giving me varicose veins at the m old off the crust. (To this day 1 have She was raised in the lap of luxury, age of 15. She had to learn survival an aversion to bread crust.) the youngest heiress to a tobacco plan­ skills, but we never went on welfare. If you ate your chicken soup (or tation owner in Cuba. She then married One winter she traded in her coat in pretended to), you were rewarded aprominent physician with the busiest exchange for the school tuition. W e with a single cone of delicious pathology practice in Havana. Those did without. neopolitan ice cream for dessert. Yum. golden days were spent raising her ten How did we survive? By having As 1 throw chicken breasts, fresh children w ith th e h e lp o f th e c o o k , th e good friends. I was always eating vegetables, potatoes, bouillon and ol­ seamstress, the m any nannies, the som eone's left over lunch, and early ive oil into our Sunday chicken soup, 1 chauffeur, and the maids. She could o n fig u re d o u t th a t b y w o rk in g in a re s­ think of my mom, andbow hard she speak three languages, entertain, and taurant at least food was assured. The h a d it. embroider beautifully. She was a lady. su m m e r I w a s o n th e sw im team 1 ate a For in difficult times, it is not w hat is Then came the revolution, and the lot of left over pie, but qu it the team in the soup that nourishes our soul. It’s family lost everything to Castro who since 1 just too darned hungry. the ultimate sacrifice our parents made, confiscated the lands, the houses, the I look now at the Sunday soup that the courage it took, and the unspoken cars, and froze the bank accounts. All 1 m ake and all the ingredients my lo v e th a t it sto o d fo r th a t co u n ted . was lo st mother could never afford. Our Sun­ I am proud to be an American, liv­ W hen 1 was six, the schools were d a y so u p b a c k th e n w a s o n e p o o r l ittle ing in the land of hope and opportu­ closed at gunpoint, and I stood in line skinny chicken, extra neck bones and nity. ■ ©Teresa Clabots, MD

November, 2001 PCMS BULLETIN 1 V

B u l l e t i n

Embezzlement from page 5

statements, posing numerous questions pened to you, is there anything I can ceived at the front desk; pockets the to manager Corey-Boulet. "He had an do to help? And let me tell you cash . explanation for everything." In gen­ about what happened tom e!!!” "Unfor­ • Employee over-withholds income eral. his response was that the practice tunately, most of us don’t share this in­ tax payment and applies for rebate the was "hard to manage." Gail was con­ formation with each other," Dr. Nacht following year. cerned that her continual inquires said, '‘but we should. It’s very valuable. • Employee records a write-off of were "bothering" the manager, and she But it's very embarrassing. It’s not that all or a portion of a check received to­ decided to go directly to the bank to in­ we’re not smart, it’s that we’re unpre­ ward an account, then endorses the quire about missing checks. She dis­ pared. If we share these stories with check to him self or herself and deposits covered all the missing checks were each other, we’re protecting each it to their personal account. written to cash, signed and endorsed other as a family. And that’s why I’m • Office m anager slips personal bills by Corey-Boulet, and deposited into h e re ." into stack of practice checks to be his personal account. sig n e d . W hile it was initially thought that What’s Happening in Your Back • Employee pockets cash received $20,000 had been taken from the busi­ Yard? as co-payments at the front desk after ness. extensive investigation deter­ Dr. Nacht shared a laundry list of crediting patient’s account. mined that Corey-Boulet had em­ what he termed, "Embezzlement bezzled over $800,000 during his eight Schemes from the Real W orld of You know it happens...now how do years managing the practice. “We Tacoma," with the hope that physicians you prevent it? didn't see a pattern of loss creeping in, will take note of how to avoid the traps. Dr. Nacht has learned that there because it was happening from the be­ “All these occurrences are prevent­ are some important initial steps to take to ginning," Dr. Nacht explained. The able if you know the intra workings of ensure your practice is protected. Run crowning blow came with the discov­ your office," he explained. Here are background and credit checks on ery that $10,000 was stolen July 9,1990 some incidents shared by local offices: all prospective employees before - the very first day the practice was in • Office manager writes checks to hiring. “Our manager was someone operation under his management. "cash," deposits them to his personal who came to us with great credentials,” account, and enters a false entry into he explained. ’’He was vice president at Embezzlement happens all the the general ledger to account for the St. Joseph’s, vice president at Hillhaven, time...and the perpetrators are check amount. his wife was a Pierce County prosecu­ not your usual suspects • Office manager leaves enough tor, he had experience in planning, and Embezzlement is the fraudulent space on check to fill in extra amounts. he was introduced to us by the presi­ appropriation of property by a person • Office manager adds fictitious dent of the hospital who said, ’Here is a to whom it has been e n tr u s te d . It is a employee name to roster, pockets the guy who I think can help you.’ What we different crime from ordinary theft or funds from salary and withholding. didn’t know' was that his personal fi­ larceny. (FYl...the average bank rob­ • A temporary or terminated em­ nances w'ere in chaos, and he was in ber nets the crook $34,000: the average ployee is issued additional paychecks and out of credit counseling.” Dr. Nacht embezzler nets $102,000) Embezzle­ in the general ledger (checks made recommended talking to an accountant ment is perpetrated by someone in out to “cash .” ) about getting background checks. your company whom you trust. • Vendors or purchasing agents Awareness is the key, Dr. Nacht Physician practices rank number offer supplies manager rebates or stressed. “Understand how your internal one as the most frequently embezzled kickbacks for use of their price-in­ system works.” He also suggested these business in the United States, followed flated supplies. additional, ongoing actions: by attorney's practices, dental offices, • Employee purchases items for • Be certain you have different em­ and CPA firms. personal use with the company credit ployees handling your accounts pay­ “We didn’t make a strong effort to card or account. able and accounts receivable conceal what had happened to us.” Dr. • Employee undercharges or • Require that bank statements be Nacht explained, especially once the writes off charges for relatives or delivered to the physician/managing story appeared in the newspapers. His frie n d s. partner unopened. office received many supportive calls • Overtime is falsified. • Review all cancelled checks, from PCMS members, and he recalls • Employee swaps checks re­ match them with invoices, and be aware that about one of five went something ceived in the mail and credited to of any unusual patterns such as dual en- like this, “I feel terrible about what hap­ patient’s account for co-payments re­ S ee “ E m b e z z le m e n t” page 16

14 PCMS BULLETIN November, 2001 ffiw v e ^ omt(if Q'iledica/ ^ocicty

LC E, MCCABE, MD

Dr. McCabe was bom in Idaho Falls and grew up in Spokane. He attended the

University of Washington, received his undergraduate degree from Gonzaga Uni­ versity and his medical degree from Marquette University. He served as Lieuten­ ant in the Medical Coips of the U.S. Navy and served aboard the USS Drew in

1944-1945. He was a prominent family physician in Puyallup for 42 years until his retirement in 1989. Edward McCabe, MD

Dr. McCabe served on the medical staffs of Good Samaritan, St. Joseph's,

Tacoma General and Mary Bridge hospitals. He was a member of Pierce County

Medical Society for 54 years, joining in 1947 when he opened his Puyallup practice.

PCMS offers condolences to his wife Lue and their children.

IN MEMORIAM

Dr. Rowen was bora in Queens County. New York in December, 1919. He graduated from Yale University School of Medicine in 1943 and completed his in­ ternship at Mt. Sinai Hospital in New York. He did residencies in bacteriology and pathology at Mt. Sinai and internal medicine and gastroenterology at the Los Ange­ les VA Hospital. He served in the Army Medical Corps from 1944-1946. \ Dr. Rowen practiced internal medicine in Tacoma beginning in 1987 until his Bernard Rowen, MD retirement in 1985. He was a Pierce County Medical Society member for 44 years, having joined in 1957.

PCMS extends their sympathies to Dr. Rowen’s family.

November, 2001 PCMS BULLETIN 15 B u l l e t i n

Embezzlement from page 14

dorsements or unfamiliar vendor • Run background checks on all in your way of life. Here are a few ... n am es. unknown vendors to be certain they • Your self-esteem is a wreck be­ • Physicians should sign all checks, ex ist. cause you feel like y'ou’ve failed. and two signatures should be required • Track expenses. • Your relationship with your in larger practices. • Consider an “employee dishon­ spouse will be strained or threatened. • All blank checks should be esty coverage" policy. Weigh how • Partners might assign blame to locked up and secure and accessible much of a loss you can sustain without y o u . only to authorized personnel. insurance coverage against the amount • Employees may quit outright or • Lines of credit should only be ac­ of the premiums. slowly drift away. cessed by two members of executive • W hatever you do, don't be too • Employees may blame you for committee together. trusting! Dr. Nacht quoted M. Matthews the embezzler’s actions. • The employee who opens the of Physicians HealthCare Advisors, • If you finances are impacted, you mail and strips checks should not be the In c.: “You have to assume that ev­ may be forced out of your banking re­ same employee who collects and de­ ery employee has a price. You lationship. posits co-payments from patients or j u s t don’t know how much it is. • You might suffer tax conse­ posts payments to accounts. For some employees, it’s pretty quences due to losses not written off or Once you’ve taken these initial low .” taxes left unpaid. (Dr. Nacht said that steps, you must be vigilant! Keep your by going to the IRS and explaining eyes open and be aware. “These are If you notice something is their situation, penalties were waived.) very simple fixes," Dr. Nacht said. wrong... • If employee pension funds were "Start to get smart about what happens If you discover theft, act quickly! stolen, you may, as a fiduciary, be per­ in your office and look for places Change all locks and computer security sonally responsible for their restora­ where theft occurs. As Dr. Nacht codes immediately. Notify the bank and tion, regardless of corporate protec­ stressed continually, you can prevent secure all paperwork. Dr. Nacht tion. or at least stop embezzlement if you also recommends carrying a fi­ • The legal and accounting costs take the right steps. delity bond on all employees. I t 's can be daunting or overwhelming. • Take note of employees of mod­ very inexpensive and allows recovery • You may feel your reputation in est income w'ho suddenly adopt a lavish of some money in the event of em­ the community has been seriously dam­ lifestyle bezzlement. It also takes the decision a g e d . • Keep abreast of office gossip. to prosecute out of your hands. • Long-term plans (retirement) may Something might be going on that could If you can prove that someone is be postponed or destroyed. make an employee desperate enough stealing, consider prosecuting. '‘Keep • Personal property/house may be to steal. in mind that if you don’t prosecute, they encumbered or even seized to pay off • Be suspicious of any employee will probably do it again to one of your or guarantee obligations. who avoids vacations or letting others colleagues,” Dr. Nacht warned. But • You may suffer depression and assist with their job. consider your options. “It’s not cheap,” feels of loss of self-worth. Counseling • Watch for employees hiding can­ he said. The criminal case against may be necessary. celled checks or replacing one pay­ Corey-Boulet would not go forward • Vendor relationships may be­ ment for another. until the civil action was completed. come tenuous as you struggle to pay • Examine the accounts payable. The civil case cost N acht's practice bills. • Sign only vendor checks that $ 122,000 in legal fees. “W e worried that our reputations have an invoice. had been tainted,” Dr. Nacht said. “But • S e g re g a te du ties. The Fallout...The multiple costs of that feeling went away. Our colleagues • Create computer security codes embezzlement were very supportive. And we found so only office managers and/or front Dr. Nacht cited a favorite quote out that the same thing had happened desk supervisors have authority to ad­ by Marvin Wolfgang, professor of to many of them .” In addition, he said just patients' account balances. criminology at the W harton School of that being up front with vendors and • Never allow the person who Business, University of Pennsylvania. authorities was very beneficial. Depart­ writes the checks to reconcile the bank “A conservative is a liberal w ho’s just ment of Revenue and IRS personnel statem en t. been mugged.” Embezzlement actually waived penalties associated • Use your office computer system changes you. Dr. Nacht explained, and with late or nonexistent payments. security programs. you can expect some radical alterations See “Embezzlement" page 17

16 PCMS BULLETIN November, 2001 -ce y Q'i'lefitcoJ Society-

Embezzlement from page 16 Some Frightening

However, the interest cannot be waived. Embezzlement Statistics “You’re not the only culpable people here. Think about il.. .physicians, dentists, attorneys, CPAs— you would assume that • Estimates by the accounting industry indicate that these people would be able to avoid embezzlement, but they internal fraud costs U.S. organizations S400 billion are the ones who get hit the hardest and most frequently. I p e r year. know that by sharing my experiences, people have gone back to their offices and taken simple steps to make sure it doesn’t • The average U.S. company loses $9 per clay to its happen to them. I feel better that they have at least avoided it em ployees. as a result of my experience,” he said. In August of 1999, Francis Corey-Boulet was given a 4- • Among health care employees, the median amount year, 3-month sentence, which was subsequently reduced to 3 stolen from health care offices is $105,000. years, 4 months. At present, he is on work release. The court mandated a lien on all his future wages to pay the debt, but as • One-third of all business failures can be attributed to Dr. Nacht points out, he can’t work any place he is required to employee theft. have a license. "I don’t know that he will ever make enough money to pay us back.” he said, “but we just needed to walk Source: 1996 report bv Association of Fraud Examiners , Austin, Texas away from it.” ■

Past Presidents Drs. Charles Weatherby (2000), left, and Eileen Left to right - Dr. Matt While, Ruth Roes, and her husband Dr. Toth (1992), right, discussed past-presidential matters Bill Roes, visit with Dr. Tom Herron during the social hour

Drs. Sam Insalaco (left), pathologist, and Don Shrewsbury, The social hour was a great opportunity' fo r physicians to meet otolaryngologist enjoy visiting during the social hour new colleagues and visit with old ones

November, 2001 PCMS BULLETIN 17

, ‘/'it-ft'..- f , u ritt/ fio

New Members

Johann V. Bernardo, MD Mary Anne B. McDonald, MD Kevin J. Sullivan, MD Internal Medicine N ep h ro lo gy Family Practice St. Joseph M edical C linic Evergreen Nephrology Associates Gig Harbor Medical Clinic 1708 S Y akim a, T acom a 201-B 15th Ave SW, Puyallup 6401 Kimball Dr, Gig Harbor 253-593-8400 253-840-0988 253-858-9192 Med School: U of the Philippines Med School: Loyola-Stritch Med School: USC. Los Angeles Internship: Metropolitan Hosp Ct of NY Internship: Int Med - Spokane Internship: UCLA Residency: Metropolitan Hosp Ctr of NY Residency: Int Med - Spokane Residency: UCLA Fellowship: Baylor College of Medicine Robert M. Berns, MD Troy J. W oodm an, MD Family Practice Michael J. McDonough, MD Orbital Facial St. Joseph M edical Clinic Radiation Oncology 1901 S Cedar #204. Tacoma 1708 S Yakima, Tacoma Tacoma/Valley Radiation Oncology Ctr 253-627-2900 253-593-8456 314 Martin L King Jr Way #1 1, Tacoma Med School: Baylor College of Med Med School: USC, Los Angeles 253-627-6172 Internship: University of Washington Residency: Santa Monica Hosp Med Ctr Med School: St. Louis University Residency: Baylor College of Med Internship: St. M ary’s Hosp & M ed C tr Fellowship: UCLA, Jules Stein Eye Inst Katherine A. Choi-Chinn, MD Residency: The Cancer Therapy & Diagnostic Radiology Research Center, U Texas HSC Lorrin K. Yee, MD Diagnostic Imaging Northwest Residency: Wayne State University Internal Medicine 222 15th Ave SE, Puyallup Northwest Medical Specialties 253-8414353 Robert E. Marsh, MD 1624 S I Street, #405, Tacoma Med School: New York Medical College General Surgery 253428-8700 Residency: Tripler AMC L430 3rd Street SE, Puyallup Medical School: UCLA 253-445-0800 Internship: U Wisconsin Hosp & Clinics Gina L. Gray, MD Med School: Oregon Health Sciences U Residency: U Wisconsin Hosp & Clinics Family Practice Internship: Creighton University Fellowship: National Cancer institute Community Healthcare Residency: Creighton University 9112 Lakewood Dr SW, Lakewood 253-589-7030 Randon L. Opp, MD Med School: Loma Linda University Diagnostic Radiology Personal Problems Internship: Idaho State U Family Practice Diagnostic Imaging Northwest Residency: Idaho State U Family Practice 222 15th Ave SE, Puyallup of Physicians 253-8414353 Walter M. Hassig, MD Med School: Loma Linda University Committee Gastroenterology Internship: San Bernardino Med Ctr Digestive Health Specialists Residency: Loma Linda U Med Ctr 1901 S Union #B4006, Tacoma Fellowship: Loma Linda U Med Ctr Medical problems, drugs, alco­ hol, retirement, emotional, 253-272-5127 Med School: Michigan State University Patricia J. Russell, MD or other such difficulties? Res: Blodgett/St. M ary’s/Mich State U Family Practice Fellowship: Henry Ford Health System Tacoma Central Family Medicine 2420 S Union #240, Tacoma Your colleagues want to help Daniel N. Heller, MD 253403-7380 Diagnostic Radiology Med School: University of Washington Tacoma Radiology Residency: University of Washington ^Robert Sands, MD, Chair 752-6056 3402S 18th St,Tacoma Bill Dean, MD 272-4013 253-383-1099 Tom Herron, MD 853-3888 Med School: Stanford University Bill Roes, MD 884-9221 Internship: Santa Clara Valley Med Ctr F. Dennis Waldron, MD 265-2584 Residency: U of CA, San Francisco Fellowship: U of CA, San Francisco Confidentiality Assured

November, 2001 PCMS BULLETIN 19 B u l l e t i n

a (* WSMAs 2001 Guide to ^hepard Transcriptfon Services Health Law Now Available M-A 5^epard, R.N., B-S-N-

Call now to order a copy of the 2001 edition of the Medical ■ Legal ■ Professional CD Rom • Audio Tapes ■ Video Tapes ! “Washington Physician's Guide to Health Law." T h is * guide is the only complrehensive legal guide specifi­ t1 cally for W ashington State physicians and their staff. Ph: (253)761-8073 ■ Fax:(253) 761-1521 I W ritten in plain English and in a question-and-answer E-Mail: [email protected] t * format, the Guide to Health Law covers more than 90 j to pics. T h e G u id e was researched and written for WSMA •jjtjM Allenmore by Mary Spillane and Jan Kirkwood of the law firm W illiams. Kasstner and Gibbs. You can order your copy Psychological by contacting Cryss Toycen at the W SMA SeaLtle office at 1 -800-552-0612 or (206) 441 -9762 (email: HIM Associates, P.S. cvt@ wsma.org). The cost to members and WSMGMA . 752-7320 . members is $ 150 ($300 for non-members), a Do you have patients with difficult emotional and stress-related problems? Psychiatric and psychological consultations are available.

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20 PCMS BULLETIN November, 2001 Wkvce- %emfy Q/tteJical dfocidy COLLEGE OF Continuing Medical Education MEDICAL Medicine and Mental Health EDUCATION Conference offered December 7 A continuing medical education • Depression in Women in Their focusing on the diagnosis and manage­ Lifecycles: PMS, Pregnancy, and ment of mental health complaints faced Perimenopause in the primary care and internal • Treatment of Geriatric Depression Hawaii CME medicine practice is set for Friday. M an ag em en t December 7. • Optimal Management of Psychosis Reservations The complimentary program, and Agitation in the Elderly directed by Drs. David Law and • Mental Health Patients: How to Code Available Mark Craddock offers 6 C ategory I Their Visits CME credits. Topics include: The program is scheduled for the To assure you are able to secure • Long Term Treatment of Depression Lagerquisl Conference Center of St. seats and get a reasonable price for • Managing Challenging Patients in Joseph Hospital Medical Center. Call CME at Hawaii, we urge you to make Primary Care 627-7137 for registration inform ation your reservations NOW. The College • Sexual Dysfunction and Depression is working with Marilyn at Olympus Travel (565-1213). Olympus has booked some seats at group rates and Dates Program Directors) has access to other special options at Infectious Diseases the best rates. Friday, Novmber 2 James DeMaio, MD Call Marilyn today. ■ Update

Medicine & Mental Friday, December 7 David Law, MD Health

Condo, Room Wednesday; Tuesday Cardiology for Primary Gregg Ostergren, IX) Reservations for January 9; 15 Care Whistler Urged Wednesday-Sunday Richard Tobin, MD CME @ Whistler Januaiy 23-27 John Jiganti, MD Registration is open for the College’s CME at Whistler/Blackcomb Primary Care Michael Bateman, MD Friday, February 8 program. The conference is scheduled Orthopedics Charles Weatherby, MD for January 23-27, 2002. The program brochure was mailed in August. Thursday-Friday Internal Medicine Reservations for the Aspen con­ Tejindetpal Singh, MD M arch 7-8 Review 2002 dos can be made by calling Aspens on Blackcomb, toll free, at 1 -877-408- Sunday-Friday 8899. You can reserve your room at CME at Hawaii Mark Craddock, MD the Chateau by calling 1-800-606-8244. April 7-12 In both cases, you must identify your­ self as part of the COM E group. Like­ Allergy, Asthma & wise, you are encouraged to make Friday, May 3 Pulmonology for Alex Mihali, MD your reservations soon to ensure Primary Care space - at least by December 1,2001, when any remaining rooms or condos Advances in Women's in the blocks will be released.* Friday, M ay 17 John Lenihan, Jr., MD Medicine

November, 2001 PCMS BULLETIN 21 B u l l e t i n

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22 PCMS BULLETIN November, 2001 fie r c e o M e d ic a l < § F o c u s ty

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Tacoma/Pierce County out­ Wanted: Executive Director/ Available now, new construc­ patient general medical care at its best. Board Member for Neighborhood tion, up to 1,800 sq ft remaining on first Full and part-time positions available in Clinic. Looking for volunteer to serve level, will provide tenant improve­ Tacoma and vicinity. Very flexible part-time at the Neighborhood Clinic ments. Close to hospitals on Union at schedule. Well suited for career which has provided free health care to 13th. C all Dr. Lovy at 756-2182 or 206- redefinition for G.P., P.P., I.M. Contact our community for nearly 20 years. Call 387-6633. Andy Tsoi, MD (253) 752-9669 or Paul John Van Buskirk, DO (office 403- Doty (Allen, Nelson, Turner & Assoc.), 2933 or home 593-6022) or Joan Fircrest Medical Office Space Clinic Manager (253) 383-4351. Hailey, DO (office 851-5121). 412 Bowes Drive - 1540 sq ft consisting of examine rooms, offices, reception Washington State Division of Seattle/Tacoma. Medical Group area, lab and x-ray rooms plus 300 sq ft Disability Determination Services. seeks B/C or B/Q Family Practitioner storage. Call (253) 863-3366 or (253) Medical Consultant positions available. or IM/Peds for Urgent Care float 272-4588. The State of Washington Division of position. All clinics are located within 40 Disability Determination Services seeks minutes of downtown Seattle. Exper­ Office Space For Lease. Sound- psychiatrists to perform contract ience the best of Northwest living, from view Medical Plaza, located at 3611 services in the Seattle and Olympia big city amenities to the pristine beauty South D Street, currently has office Regional offices. Contract services and recreational opportunities of the space available for lease to medical or include the evaluation of mental great outdoors. Live and practice general healthcare practices. We of­ impairment severity from medical where housing is still affordable and fer very competitive lease rates; spa­ records and other reports, utilizing traffic is still manage-able. Excellent cious, updated facilities; shared recep­ Social Security regulations and rules. benefits and income guarantee. Three- tion; accessible support staff; excellent Psychiatric Medical Consultants year family practice or internal med­ security, maintenance and janitorial function as members of the adjudicative icine residency in accredited U.S. services; and access to onsite radiol­ team and assist staff in determining residency program required. For more ogy and blood labs. Our locution, just eligibility for disability benefits. information, please e-mail CV to off of Pacific Avenue, is adjacent to Requirements: Current Medical [email protected] or fax the Pierce County Health Department License in Washington State. Board to 253-403-5431. Checkout our website: and Puget Sound Behavioral Health, certified desirable. Reimbursement: www.multicare.org. and is easy access to and from free­ $57.01/hr. Interested psychiatrists ways and on a bus line. For lease rates should contact Guthrie L. Turner, Jr., and more information, call Lindy MD, MPH, Chief Medical Consultant, V incent at 798-4520. Acting at (360) 664-7361 o rth e GENERAL respective regional manager: Olympia: Laura Wohl, Regional Computer troubles? Call On Manager (360) 664-7355 Sight Computers (253) 318-0214. We Seattle: Michael Theisen, Regional handle repair, setup, upgrade and Manager (425) 430-4811. more. First hour free! A f i s r B r e a s t POSITIONS WANTED EQUIPMENT s u r g e r y t i l i n g Transcription Specialists - We For Sale: Small office copier, o f us. have years of experience in most Sharp Z57II $150, fax machine, Sharp medical specialties. We guarantee ac­ UX114 $50. Both in excellent condi­ Union Avenue Pharmacy curacy, fast turnaround time, free tion. 253-503-8187. and Corset Shop pickup and delivery and reasonable Formerly Smith's Corset Shop charges. Outstanding references. Call 2302 S Union Ave 752-1705 925-3276.

November, 2001 PCMS BULLETIN 23 Our Claims Staff Receives Top Praise

“I had consistent contacts from my claims representative and attorney, and I was never treated as a sideline player. Pat was very supportive—a true asset to the company.”

CorrineJedynak-Bell, DO, Tacoma, Washington

When Limes are tough, physicians count on us to fight for their best interests— Irom the day a claim is discovered to the day it's resolved. From the onset, we educate physicians about the claims process and include them in claim developments. On average, each claims representative has 16 years of claims-handling experience. That’s 16 years of hard work with attorneys, plaintiffs, medical experts, physician commit­ tees, and— most importantly—with physician defendants whose work and family lives have been severely disrupted. In the darkest days surrounding a malpractice claim, don’t you want only the very best on your team? For more information, call us today at 1-800-962-1399. Physicians Patricia Mulligan, ,nd b} ,hc ■" Insurance W uihunjion M.uc Mi'dica] A.vsucuninn Claims Representative nmuIc. WA 'v I'hvsKi.trii insurant -Oui A Mutual Company

Pierce County Medical Society P R E S O R T E D 223 Tacoma Avenue South S T A N D A R D Tacoma, WA 98402 US POSTAGE PAID TACOMA, WA PERMIT NO 605 Return service requested

24 PCMS BULLETIN November, 2001 December. 2001 PCMS pays tribute to Alan Tice, MD

PCMS owes a debt of gratitude to Dr. Alan Tice for his significant contributions, particularly his commitment to public health issues, political advocacy and professional education.

He has been an ardent and tireless supporter, providing subtle and innovative leadership for both Pierce County Medical Society and the College of Medical Education.

A family of physicians: Thank you, Dr. Tice. Dr. Alan Tice, center, is examined by his father, Dr. George Tice, while his grandfather, Dr. Claude Tice, observes See story page 5 —

INSIDE: 3 President’s Page: “Time flies...” 4 November GMM Recap: A “high tech” adventure 5 PCMS bids ‘Aloha’ to Alan Tice, MD 7 Tacoma-Pierce County Health Dept: “Now is Not the Time to Cut Public Health” 9 In My Opinion: “Opportunity Costs” by Andrew Statson, MD 11 In Memoriam: Dr. James L. Vadheim 13 In Memoriam: Drs. Robert M. Freeman and Robert C. Johnson B u l l e t i n

PCMS Officers/Trustees: Patrice N. Stevenson, MD President Susan .1. Salo, M D ...... President Elect J. .lames Rooks. Jr., M D ...... Vice-President Michael J. Kelly, M D ...... Secretary/Treasurer Charles M. Weatherby. MD....Past President Sabrina A. Benjamin. MD Drew H. Deutsch, MD Siephen F. Duncan. MD December, 2001 Kenneth A. Feueht, MD Sumner L. Schoenike. MD

P C M S M em bership Benefits, Inc (MBX): Drew DeuLsch. MX). President: Keith Demirjian. MD. Steve Duncan, MD. Mark Gildenhar. MD, Mike Kelly, MD. Secretary-Treasurer; -Art Maslow. DO, Tim Schubert. MD. Steve Settle, MD. Joe Wearn. MD

College of Medical Education (C.O.M.E.): John Jiganti. MD President: JD Fit?;. MD, Barbara Fox, MD, William Holderman, MD. Steve Konicek, MD, Marjorie Krabbe, MD, William Lee. MD, Gregg Ostergren, DO. Brad Pattison, MD. Cecil Snodgrass, MD. Virginia Stowell. MD. Richard Waltman. MD, Tod Wurst, MD. Rick Campbell, MD. Good Samaritan Hospital: Victoria Fletcher, Multicare Medical Center; Sister Ann McNamara. Treasurer. Franciscan Health Syslem: Sue Asher. Secretary PCMS Foundation: Lawrence A. Larson, DO. Tabic of Contents President: Mona Baghdadi. Nikki Crowley. Treasurer: Sue Asher. Secretary

WSMA Representatives: 3 President's Page: “Time flies...” Speaker of the House: Richard Hawkins. MD Trustees: David Law, MD: Nicholas Rajacich, MD 4 November GMM, a ‘high tech' adventure AMA Delegate: Leonard Alenick. MD W AM PAC 6th District: Don Russell, DO WAMPAC L-)th District: Leonard Alenick. MD 5 PCMS Bids ‘Aloha’ to Alan Tice, MD

Staff: Executive Director: Sue Asher 7 TPCI-1D: “Now is Not the Time to Cut Public Health” Membership Services Coordinator: Shana Osiner Administrative Assistant: Tanya McClain Placement Coordinator: Deborah Pasqua 8 Referral Coordinators Meeting Placement Assislant: Angela Kraerner CME Program Administrator: Les McCallum 9 In My Opinion: “Opportunity Costs" Bookkeeper: Juanita Hofrneisier

The Bulletin is published monthly by PCMS I I In Memoriam: James L. Vadheim, MD Membership Benefits. Inc. Deadline for submitting articles and placing advertisements is ihe 15th of the month 13 In Memoriam: Robert M. Freeman, MD preceding publication. In Memoriam: Robert C. Johnson, MD The Bulletin is dedicated lo the art, science and delivery of medicine and the betterment of the health and medical 15 In My Opinion: “The Market has Left the Launch Pad” welfare of the community. The opinions herein are those of the individual contributors and do not necessarily relied the official position of PCMS. Acceptance of advertising in 16 WA State DOH pays for early HIV care no way constitutes professional approval or endorsement of products or services advertised. The Bulletin reserves 17 College of Medical Education the right to reject any advertising.

Managing Editor: Sue Asher 19 Classified Advertising Editorial Committee: MBI Board of Directors Advertising Information: 253-572-3666 2 2 . 1 Tacoma Avenue South, Tacoma WA 9 8 4 0 2 253-572-3666; FA X : 253-572-2470 E-maiJ address: pcmswa@ pcniswa.org Home Page: http://www.pcmswa.org ______

2 PCMS BULLETIN December, 2001 President’s Page by Patrice Stevenson, MD

T i m e f lie s ...

Pcuriee Steven son, AID

P r e s i d e n t

Time flies., .whether you’re having are one of the most active county medi­ fun or not. I have a watch with that on cal societies in the state. We also com­ the face. It is one of the many I wear municate with phone, FAX and e-mail. but ignore (if you ask my husband). Perhaps some day we wi II be a totally Here it is time to write my last “virtual" medical society but for now I priority on those issues as we had be­ President’s Page and it truly seems the value the personal connection with fore. We suddenly realized the value year has flown by. physicians from all specialties and prac­ of a strong Public Health System as we This was to be “The Year of tice settings. As we all seem to be work­ scrambled to get up to speed on the di­ Transition” as I wrote in the February ing harder these days, it is nice to get agnosis and treatment of Anthrax and Bulletin. PCMS rather seamlessly together and put a face to the name. other potential diseases of bioterrorism. transitioned to the leadership of our Reflecting on the year sometimes I The spotlight on the emergency medi­ new Executive Director, Sue Asher. wonder what we really accomplished. I cal system may help to increase public She has figured out the few inner was sitting next to Dr. George awareness of the fragility of that aspect workings that she didn’t already know Tanbara.PCMSPresidentin 1981,at of our health care system and bolster it and continues to organize and stream­ the November 13 General Member­ to avoid widespread collapse. With all line operations. She made a wise ship meeting. He was telling me to save of that, will anyone care about MERFA choice in hiring Shana Osmer as our my President’s Pages and look at them (Medicare Education and Regulatory Membership Services Coordinator in again in twenty years to see if anything Fairness Act of2001 )?OrHIPAA May. She will continue to increase her had really changed. We did not slay (Health Insurance Portability' and Ac­ duties and is staffing more of the com­ any dragons but kept up the tight for countability Act)? Only time will tell and mittees. She is also working on con­ patient and physician rights with gov­ itfLies by.. .whether we accomplish our struction of the new and improved ernmental and private payers. We goals or not. PCMS web site (www.pcrnswa.org) to shared in the voice of WSMA and the I sincerely thank you for the open 12-10-01. PCMS continues to look AMA on many regulatory issues to try opportunity to have served as your at ways to keep the membership in­ to simplify the practice woes we en­ President for 2001 and confidently turn formed and hopefully involved. We counter on a daily basis. After Septem­ over the gavel to Susan Salo, MD still have many in-person meetings and ber 1 l lh it was hard to place the same for2002. ■

December, 2001 PCMS BULLETIN 3 November General Membership Meeting Recap

November General Meeting, a “high tech” adventure

"Your life will be affected by the Internet.” These were Lhe opening words of Dr. Bill Crounse at his pre­ sentation to over 50 members at the November 13 General Membership M e e tin g . The meeting, "M edicine in Cyberspace" was held at the Landmark Convenlion Center in Tacoma and din­ ner was complimentary, thanks to spon­ sors Horizon Medical Systems and Regence Blue Shield. Dr. John Lenihan, Tacoma Ob/Gyn, left, and Dr. Bill Crounse, speaker, visited with other attendees before the meeting Dr. Crounse wowed the audience with a power point presentation of his pioneering partnership with Microsoft to provide health information, secure web messaging and the "virtual office visit' Citing several statistics such as " 1 5 c/f of Internet users want more health services on-line” and "89$ of physicians have access to the Internet," Dr. Crounse believes that physicians can deliver care through technology. He added that patient and physician PCMS Trustee and Puyallup surgeon Kenneth Feucht, MD, left, Internet communication must be pri­ visits with Puyallup eolleaitge Dr. M an'in Brooke vate. confidential and secure, and should not be used for emergency situ­ ations. control the market. Patients seek information. If we cannot provide it, they will go He also described Lhe future im­ elsewhere or coordinate their own care. We, physicians, are in the information pact of the Internet on our daily lives. business. We gather, interpret and share that information with our patients and col­ “In the next five years, the Internet will le a g u e s .” involve every electronic device in Dr. Crounse is a board certified family physician and Vice President of Medi­ your home from your television to cal Technology for the Overlake Venture Center in Bellevue. He is also Senior your trash compactor.” Vice President and founder of Dr.Goodwell.com, an internet start-up working in Dr. Crounse's take-home Lip was: partnership with M icrosoft to provide health information and “virtual clinic” medi­ “Those who conLrol the information will cal services to employees in high-tech industries. ■

4 PCMS BULLETIN December, 2001 Neighborhood Clinic

Wanted: Executive Director

The Neighborhood Clinic, which has provided free health care to our community for over 20 years, is looking for a volunteer Executive Director/Board Member to serve part-time. (Training and guidance provided!)

Call John Van Buskirk, DO (office 402-2933 or home 593-6022) or Joan Hailey, DO (office 851-5121).

Job Description/Qualifications

• Will develop working knowledge of the Neighborhood Clinic, its Mission Statement, objectives, standards and procedures. • Good verbal and written communication skills. • Directs development and approves standards and procedures. • Prepares agenda and chairs the Board of Directors meetings every other month. • Represents (or delegates) the Clinic at Public Meetings and serves as an alternate spokesperson to the community at large. • Signs and delivers contracts or other instruments pertaining to the business of the corporation. • Prepares an annual budget, based on past budgets, incomes and expenses. • Oversees preparation of the Annual Report at the end of December including: the mission and how it is addressed; demographic statistics; any changes; thanks to all donors and grantmakers; number of volunteer hours for physicians, nurses, students, lay persons, and cost of that care if obtained in mainstream health care system.

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juejsisej juaojaj Special Feature by Jean Borst

PCMS Bids ‘Aloha’ to Alan Tice, MD

“I’m graduating — not retiring,” and encouragement from his partners With his decision made and his says Dr. Alan Tice. and staff was immense and much ap­ partner's permission, all that was left Bidding farewell to patients, col­ preciated. “I am very grateful that they was breaking the news to his patients. leagues, friends and peers at an open allowed me the opportunity and cared "That was the hardest part.” he re­ house at the end of September, Dr. Tice for my patients while I was away,” he called. “It was very difficult to say dosed one long and illustrious chapter said. good-bye to my patient family. They in his life and prepared for another. Af­ “I knew' 1 had to take a break. I mean a lot to m e” And, it was impera­ ter more than 20 years, he made the de­ wanted more time with my family. I tive to Dr. Tice that his "family” all cision to leave his medical practice and needed time to examine my life and find quality health care with other phy­ relocate to Hawaii. Typical retirement figure out what to do with what is left. 1 sicians in ihe area. scenario? Hardly. Dr. Tice’s departure felt as if I had been running a marathon "Trying to find primary care physi­ actually marks as much a beginning as and had to slow down, ft did not seem cians to take my patients was very dif­ it does an end. In this case, it's just a little more than ironic that the Hawai­ ian word “aloha” means both good-bye and hello.

Destination Hawaii He’s not exactly trading his stetho­ scope for a surfboard, although Dr. Tice does plan to spend a good deal of time in the Pacific waters in an outrigger canoe. With connections throughout the world, he explored the possibility of re­ locating to several locations, including Switzerland, Australia and England. But an international move posed prob­ lems, particularly with Internet access, insurance, and an American high school curriculum for his daughter. His personal connections in Hawaii and an possible to do it and continue to prac­ ficult," he said. "I wanted to be sure opportunity to teach medical residents tice.” In so many careers, Tice ex­ they would continue (o gel the quality at the University of Hawaii School of plained. the focus is on "climbing the care they deserved. After all, they de­ Medicine drew him to the islands. Join­ mountain. You get as high as you can pended on me. I needed to be sure they ing him are his wife, Constance, and then what do you do? My career had were taken care of." high-school senior daughter, Amanda, been worth all the hard work, but I had The process was long, arduous, who were “thrilled by the decision.” reached a plateau, and it was time to and emotional for everyone involved. “They were ready and willing for the find my way back down. I realized that “Many patients were upset, but almost change,” he said. He added that his the journey wasn't over, it was just time all thanked me for my care and ex­ wife, a dentist, has been pleased with to go in a different direction.” While on pressed a great deal of warmth and ap­ the change from our unique northwest sabbatical. Dr. Tice made the decision preciation. They told me they would weather. to leave his practice and move to Ha­ miss me but understood why I was go­ The move was well planned and waii permanently. “It was time to ing and encouraged me. That was very meticulously laid out. Two years ago, graduate,” he said. “It was time to go to comforting.” Dr. Tice mentioned only Dr. Tice asked his partners for a year­ another level or take on a smaller one patient who was angry with him long sabbatical in Hawaii. The support m ountain.” See “ Dr. Tice” page fr

December, 2001 PCMS BULLETIN B u l l e t i n

Dr. Tice from page 5

for leaving. "He thought he deserved His grandfather was a country doctor, oping the Harvard Resource-Based me as his physician.” he said. his uncle a psychiatrist, his father a sur­ Relative Value Scale, was the liaison to After so many year’s of serving geon, his brother an emergency medi­ the American Society of Internal Medi­ others. Dr. Tice felt confident in his de­ cine physician, and his sister a derma­ cine and testified before Congress and cision to leave his practice. “Am I be­ tologist. After graduating from Harvard the Health Care Financing Administra­ ing selfish? Am I doing the wrong College and Columbia College of Phy­ tion on behalf of the IDSA. He also thing? I don't think so,” he said. sicians and Surgeons, Dr. Tice trained helped organize the first IDSA clinical "W hen I entered this profession, I felt in internal medicine at Roosevelt Hos­ conference in 1990 and the Managed indebted. I was very fortunate to have pital in New York and New York Uni­ Care in Infectious Diseases Confer­ been able to go to medical school and versity. He completed his fellowship in ence in 1995. In 1996 he was honored be trained in internal medicine and in­ infectious diseases at Tufts New' with the IDSA Clinician of the Year fectious diseases. I felt I owed people England Medical Center, and spent aw ard . for those opportunities, but 1 have now several years on the faculty of Brown Dr. Tice founded the Outpatient paid back the debt. My obligation was University's School of Medicine be- Intravenous Infusion Therapy Associa­ to take care of my patients, and I did that by being a doctor for 30 years and in practice for more than 20. In the process, I sacrificed a lot of myself and time with my family. It was not easy. I l’eel good about what I’ve done, but that I don’t have to sacrifice any more. Now I have finished that chapter, and 1 can go on to the next. I feel very fortu­ nate to have the opportunity.” That next chapter will be partially set in an academic environment. Dr. Tice will be teaching at the University of Hawaii John A. Bums School of Medicine. He will supervise medical residents in the Queen Emma Clinics part time and cover for his friend. t e Tice Family in their new Hawaii home. From left, daughter Amanda, Steve Berman, another infectious dis­ Alan, and wife Constance eases specialist. "M y work with medical students and residents will allow me to pass on what I have learned over the fore relocating to Tacoma in 1978. With tion (OPIVJTA) and was president of last three decades. It is fun to tell them extraordinary vision, creativity and de­ the organization until 1995. He is cur­ the lessons I learned from my patients termination, Dr. Tice established a rently director of the OPAT Outcomes in Tacoma. They get a different per­ group of infectious diseases specialists Registry, which is based in Tacoma. Dr. spective than the academics give and to provide hospital and clinical care. In­ Tice was a founder and president of they listen well," said Dr. Tice. In addi­ fections Limited grew from a one-phy- the Infectious Diseases Society of tion, he will continue with his work in sician operation to a group of seven W ashington, and is also responsible for outcomes research, outpatient paren­ partners. The practice offers a travel creating the Hepatitis Resource Net­ teral antimicrobial therapy (OPAT) and clinic, reference microbiology labora­ work for infectious diseases specialists his web sites (www.IDLinks.com and tory. and a tuberculosis clinic. They to develop programs to improve treat­ www.OPAT.com) through his consult­ have also developed programs in out­ ment for patients with viral hepatitis. ing office in Tacoma. patient parenteral antimicrobial therapy Dr. Tice is on the Board of Direc­ “I will miss my patients, my part­ (OPAT), clinical research and infection tors of the National Foundation for In­ ners, the other physicians in town, and co n tro l. fectious Diseases and Clinical Coun­ the weekend runners in Point Defiance During his years as a member, cilor of the Society of Healthcare Epi­ Park, but it is lime to move on.” then chairman, of the Infectious Dis­ demiologists of America. Some of his eases Society of America (IDSA) Clini­ other activities include serving as the A Stellar Career cal Affairs Committee (1988-1994), Dr. e d ito r o f Current Treatment Options in Alan Tice was born into medicine. Tice represented the IDSA in devel­ See "D r. Tice” page 10

6 PCMS BULLETIN December, 2001 Federico Cruz-Uribe, MD The Health Status of Pierce County Director of Health

Now is Not the Time to Cut Public Health

There has been much doom and by our funders at the state and local and hearing from you will be more ef­ gloom emanating from the events of level. This is not the usual slow death fective if it happens before then. Your the last two months. Terrorism in all its byr a thousand cuts but rather dramatic support in this issue is critical to us. many facets has been a terrible burden and deep cuts to our core funding. Pro­ As we head into flu and cold sea­ and d is­ posed cuts: City 8%, County 14.4% and son, it is even more important to reas­ traction to State 15%. If these cuts go through, sure patients that not every upper respi­ o u r daily they add up to a significant part of our ratory infection needs an antibiotic. We w ork. budget. The state cuts alone would re­ continue to move forward locally to T h ere are sult in the closing of most of our Fam­ address the increasing prevalence of som e ily Support Centers, decreasing mark­ antibiotic resistant organisms. Our positives edly our drug treatment services to Pierce County Task Force on Antibiotic flow ing pregnant and Resistance is from this paren tin g coming out that are m om s, and with regular im portant slashing our updates, and Federico to reflect childcare and “To my physician colleagues, my these will be Cruz-Uribe, MD on. Public teen health sent to you by h ealth is program s. message is simple: NOW IS P C M S .T h e w orking To my NOT THE TIME TO CUT first is the with other core parts of government in physician col­ ivory insert in­ new and meaningful ways. The central leagues, my PUBLIC HEALTH. Individually cluded in this protective parts of government (law en­ message is issue of the and as a group, we need your forcement and the emergency respond­ simple: NOW B u lletin . ers) work with us on a daily basis and IS NOT THE help. Our elected officials need Please look at see us more fully as part of the team. It T IM E TO the data. Close took tragic events and an ongoing CUT PUBLIC to know that cutting public to 70% of up­ threat to remind people that public HEALTH. In­ health will put our communities per respiratory health has been around a long time and dividually and infections are was ALWAYS part of a community’s as a group, we at risk. Please let your local leg­ due to viral core functions. Police, fire, and epi­ need your islator know in no uncertain agents. There demic control were what local govern­ help. O ur are simple ments started with when they first came elected offi­ terms that they need to support things you and together and functioned to serve their cials need to your staff can public health, not undermine it.” communities. Like police and fire de­ know that cut­ do to lessen partments, we are in the protection ting public the level of re­ business. health will put sistance that Unfortunately, despite this public our communi­ develops in refocusing on public health’s important ties at risk. our c o m m u ­ role, there has been much benign ne­ Please let your local legislator know in nity, mostly, in educating your patients glect over the years. We in public no uncertain terms that they need to in the appropriate use of antibiotics. It health have been pretty invisible, which support public health, not undermine it. does take time to have these discus­ means our elected officials have not We will make available to you and sions with your patients, but studies given our budgets much priority. Now PCMS staff more detailed information show that it will have a significant im­ with our economy slowing down, we on the specific cuts being proposed. pact. ■ are facing another round of reductions The legislative session starts in January

December, 2001 PCMS BULLETIN

In My Opinion.... The Invisible Hand by Andrew Statson, MD

The opinions expressed in this writing are solely those of the author. PCMS invites members to express their opinion/insights about subjects relevant to the medical coitmittnily, or share their genera! interest stories. Submissions are subject to Editorial Committee revie

Opportunity Costs

“Human felicity is produced not so much by great pieces o f good fortune that seldom happen, as by little advantages that occur every day." Benjamin Franklin (1759)

Every human action is a trade-off. boating, so he is going to miss out on Out of several options, we choose one. the fun. Paul, however, is expected Whatever we do is done instead of home to help clean the basement and something else. The foregone oppor­ help his father take the trash to the tunities are part of the cost of the action dump. To him, being detained after of those who find that it was not worth it we have chosen to perform. In eco­ school is more like a reward than like a is growing and they are looking at nomics, these are called opportunity punishment. If Paul instigated the other options. The costs of getting into costs, to differentiate them from the di­ whole incident to get out of doing the medicinc are so high, that is it difficult rect costs of the performed action. chores at home, Peter would have a to let them be lost while looking for They vary from person to person and very good reason to be angry. more satisfactory alternatives. from situation to situation. Instead of becoming physicians, The situation is different for other The opportunity costs are separate we could have chosen to be business people in the medical field. Many years from the costs incurred in the action it­ executives, airline pilots, computer sci­ ago. a hospital administrator talked to self. For instance, imagine taking six entists, Navy officers, truck drivers or me about staffing. "In boom times, staff­ months off work to go sailing around assembly line workers. In making our ing is always short,” he said. "People go the world. The opportunity costs are choice, we expected that becoming to work in the factories, they get better the lost income during the time off and physicians would be more rewarding pay and better hours. When the other the value of any other things we might than any other option we could have jobs are scarce, they come to work in have done had we stayed in town. The considered. the hospital.” The cost to enter the field costs of the action itself are the cost of For along time, that was true. In and to switch to another one are much the sailboat and all the other expenses the current economic environment, the lower for nurses and technicians. Their incurred while away. If the sailing trip effort is harder to justify. One com­ work in medicine may be more inter­ enriched our outlook, recharged our plaint from medical residents is that esting. but it is hard, emotionally drain­ batteries and we were more productive while their schoolmates in other fields ing and does not pay well enough to at­ upon our return as a result of the trip, have been at work for several years tract more people. then the costs were outweighed by the and are already making huge amounts Yet the complexity of the work re­ benefits and the trip was worth its of money, the outlook for the medical quires a large amount of knowledge, while. residents is rather bleak, considering sound judgment and sensible decision To give a simple example of op­ the length and cost of their training, making. The authorities will not be able portunity costs, consider this situation: and what they can expect to earn once to reduce the incidence of medical er­ Peter and Paul misbehave in class and they have completed it. rors unless they pay enough to hire the teacher detains them after hours. We all have had to scale down our people to do the work. Passing laws That is intended to be a punishment. It expectations. Even though many of us banning medical errors is not going to is so for Peter, because his family is go­ would rather practice medicine than do do it. Limiting work hours and call ing to the lake for a picnic and some anything else in the world, the number See “Opportunity’* page \A

December, 2001 PCMS BULLETIN 9 ULLETIN

Dr. Tice from page 6

Infections Diseases and as a section under his belt. Dr. Tice has seen many However, he cautions doctors to editor for Infectious Diseases in Clini­ changes in the medical community. And not lose sight of the satisfaction from cal Practice, American Family Practice, what he is seeing now is disturbing. patient care despite the pressures of ID Alert, and multiple other journals. “There are a lot of unhappy people in business. “We went into this profession He has also constructed the IDLinks this profession - and they started off as to take care of patients and to be ap­ web page for infectious diseases spe­ the brightest, most dedicated people in preciated for it. We are dependent on cialists, providing information and re­ the world,” he said. “But the paperwork our patients for a feeling of self-worth - sources available in infectious diseases and other problems associated with the money should not distract us.” and clinical microbiology, as well as medicine and patient care are over­ W hile retirement and a move to a services for the infectious diseases whelming. Doctors are losing sight of tropical island might not be for every­ community not available otherwise. their value and are questioning the one, Dr. Tice does encourage physi­ The site consistently has aver 40,000 purpose of what they're doing because cians to consider alternatives and op­ hits per month and attracts a wide vari­ they are being squeezed by the busi­ tions. “Doctors are very dependent on ety of international professionals, in­ ness end of medicine. The rewards of their patients. They don’t think about cluding physicians, pharmacists, nurses, this profession are in helping people, any alternatives. Sometimes you need academics and government employees. but there is an uphill battle that isn’t be­ to move on. You can do other things Dr. Tice's scientific contributions ing won. The obstacles are stripping and you can carry on,” he said. include authoring over 50 articles and away physicians’ pride in what they do. “Think differently,” he advised. abstracts on subjects ranging from out­ Some are just thinking of retirement as “Work to find a balance between help­ patient parenteral antibiotic therapy to soon as possible.” ing the patient and your own happi­ urinary tract infections, new antibiotics “Physicians are burned out," he ness.” He also counsels doctors to think and managed care. His areas of par­ continued. “They want to work 60 ahead and think hard about the idea of ticular interest include OPAT, out­ hours a week, not 90 to 100. But physi­ a sabbatical. “Academic professionals comes measures, networking, managed cians are blamed for the problems in get one every seven years. Why care, hepatitis, and appropriate antibi­ medicine, insurance companies have shouldn’t physicians have the same op­ otic use. In addition, he has lectured created more barriers and obstacles, portunity? We need refreshment and a extensively on Outpatient Parenteral there are increasing controls over the change of perspective every few Antibiotic Therapy in Argentina. physicians’ role, and the industry is top years.” Dr. Tice proposes the establish­ Australia, Canada, China, Columbia, heavy with managers and administra­ ment of some type of program for England. Greece. Hong Kong, Israel, tors. Doctors just can't do everything.” Pierce County physicians that would

Japan, Korea, Mexico. New Zealand, See “ D r. T ic e ” page 18 Paraguay. Peru, Poland, Saudi Arabia, Singapore, South Africa, Spain, Uruguay and Venezuela. While internationally renowned. Dr. Tice's contribution to the local com­ munity is immeasurable. Founder of the Pierce County Medical Society’s AIDS rai/eler'S1L Committee, Tice has provided care to more people in Pierce County with Health Service AIDS than any other single medical A service of provider. He organized an annual con­ Northwest Medical specialties, pllc ference for physicians on AIDS for more than a decade. He is a continual INTERNATIONAL TRAVEL CAN BE proponent for provider care about HAZARDOUS TO YOUR HEALTH AIDS, and consistently encouraged ac­ ceptance for people with AIDS by • PRE-TRAVEL CARE • POST-TRAVEL CARE other members of the medical commu­ HOURS CALL EARLY WHEN PLANNING nity. MON-FRI 9-5 253-428-8754 Consider Your Options...Explore or 253-627-4123 Alternatives A SERVICE OF With so many years of experience INFECTIONS LIMITED PS 1624 South I Suite 102 (next to St. Joseph’s Hospital)

10 PCMS BULLETIN December, 2001 IN MEMORIAM JAMES L. VADHEIM, MD 1912-2001

Jim Vadheim wrote his own reflections on humility and humor titled. “How 1 learned to be humble." He described a house call when, as a boy in Tyler, Minne­ sota, he accompanied his father on visits to farms. On asking how a fee of $10 could be profitable when $30 was paid for getting towed out of a mud hole, his Dad had re­ plied, "James, that is not the point. I had to go because the patient was sick and needed help.” Later, already with his MD degree, he would be asked to sit with sick family members. He recalled spending a night by a woman having a gall bladder at­ tack because her own doctor had a busy day and the patient's son wanted that doctor James Vadheim, MD to be well rested when "he finally could come to see his mother." And not long after coming to Tacoma, he was flattered by the wife of an officer from Philadelphia com­ ing to him for a cholecystectomy via Fort Lewis. On being asked why he had been the selected surgeon, the woman blushed and her husband said, "Well, to tell the truth, yours was the last name in the phone book." My earliest medical experience of him was when my neurosurgical partner. Dr. John Robson, recommended I wait outside Dr. Vadheim-s office and see how all his patients left smiling. As his wife Jeanne has said, “he touched ev­ eryone." As a fully trained general surgeon, he came here from the Mayo Clinic to quickly develop a huge case load. A familiar face in the corridors, he was also frequently seen in his surgical clothes hurrying across K Street between our office and Tacoma General. He was much enjoyed by nurses and colleagues alike. 1 have been told by a leading surgical nurse how “he was unique: we all loved him.” Not only was he considered locally by the staff to be "the best general surgeon on the West Coast,” but he also fought for the maintenance of the nursing school in Jackson Hall and became a member of the Nurses Alumni. "He was never irritable or bad tempered" - certainly an achievement in the surgical world, and there was felt to be a mutual trust between him and those caring for his patients. In the traditional way of general surgery, he did not hesitate to work in any area of the body at any time of the day or night. And also in the tradition of general surgeons, he had opinions. I remember asking him once if a certain old gentleman was still practicing. He replied, “Yes, he needs all the practice he can get." With Art W ickstrom he helped freely with tracheo­ stomies in those head injured patients with severe chest problems. He was a much sought after host at hospital meet­ ings and special events. As host and hostess, Jim and Jeanne provided many good times. The parties at Christmas time are clearly recalled. He is well remembered for his laughter. His early recollections as a country doctor included his attention to “a man brought in with what looked like the cleanest craniotomy flap I had ever seen. He was perfectly alert and surprised me by saying, “By gosh, I must be getting old because for 15 years I have ducked that horse's hoof, but today I was too slow.” In Tacoma and Hawaii we all shared many good times. In the midst of his treasured Oahu vacation, he oncc sud­ denly returned to Tacoma to take care of a lriend who he had promised surgery during this same Easter so as not to lose time teaching school. At one time he used his power boat for rounds in the South Sound. He took us together with John and Emma Bonica water skiing on Wollochet Bay. One so well remembers Jeanne’s clever elegance as she took off from a sit-

See "Vadheim'1 page ] 2

December, 2001 PCMS BULLETIN 11 FjV LL ilTT N

Vadheim from page 11

ting start on the dock - her bathing suit literally never got wet, much to the satisfac­

tion of a proud husband who drove the boat! One favorite escape of his was the Tacoma Lawn Tennis Club where he would often play with Fritz Haines, Jim Office Space Fairboum and Bob Gilroy. Clearly pictured also are Larry' Evoy, Bill Fry and Mack

Koon. In later years he would be seen at the Pacific Northwest Tournament serving Pierce County Medical Society 223 Tacoma Avenue South beer and sandwiches in the marquee - always with friends. Tacoma, WA 98402 Following a road accident and a severe head injury 20 years ago, this successful

man had to stop work. Simultaneously a slowly growing malignancy in his lower ab­

domen contributed to his distress. His wife Jeanne provided every detail of home 183 square feet professional location care during that long period of time. He became increasingly bowed and dependent north o f down town on both a walker and the help of family and friends. Friends he never lacked and utilities included thanks particularly to the efforts of men like Stan Mueller an d Gil Roller he c o n ­ conference room & kitchen tinued to frequently attend Harbor Lights for lunch with retired physicians. At those janitorial service p a rk in g meetings he w'ould glow, so delighted to be with colleagues again. That goodness

which affected us all included the excitement of youngsters joyriding with him in his

Corvette. In an early lecture in anatomy it was pointed out by the Professor that Office equipment ami other business necessi- “amongst the best people the most remarkable are the least remarkable." Many years lies available if desired. $200 per month.

later a medical speaker closer to home here described the most successful man as Please call 572-3667 Tor more information. being so often the one who is the most liked. This was the essence of Jim Vadheim. ■

Stevens Dimant, MD

Personal Problems of Physicians ERJSE Committee Medical problems, drugs, alcohol, THAT TATTOO retirement, emotional, WORRIED ABOUT WHAT YOUR SPOUSE, or other such difficulties? YOUR FRIENDS OR EVEN YOUR BOSS THINKS ABOUT YOUR TATTOO? OR ARE YOU JUST TIRED OF Your colleagues LOOKING AT IT? want to help Today’s newest Alexandrite laser, will remove your tattoo *Robert Sands, MD, Chair 752-6056 with minimal discomfort & Bill Dean, MD 272-4013 ■ less than 1% risk of scarring. Tom Herron, MD 853-3888 ('nil foditv for more infoniuttum Bill Rocs, MD 884-9221 PIERCE COUNTY F. Dennis Waldron, MD 265-2584 LASER CLINIC

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12 PCMS BULLETIN December, 2001 ROBERT M. FREEMAN, M D 1914-2001

Dr. Freeman was born in Oakland, California and moved with his family at a very young age to one of

the first homes in Fircrest. He received his medical degree from the University of Washington in 1952 and

was a general practitioner in University Place until his retirement in 1966. After retiring from medicine, he as­

sumed full responsibility for the manufacturing at W ood Freeman Autopilots in Fircrest. Dr. Freeman, the son

of the inventor of the magnetic compass marine autopilot, was an inventor of mechanical, electronic and navi­

gation devices and was the holder of ten patents. Prior to attending medical school, he had a distinguished

Naval career, was an accomplished pilot and received a Navy commendation for his work developing radar

equipped aircraft.

PCMS extends sympathies to Dr. Freeman’s wife Ethel and their children.

IN MEMORIAM

1928-2001

Dr. Johnson was born in Tacoma, Washington in July, 1928. He graduated from the University of Washington School of Medicine in 1954, opened his Tacoma prac­ tice in 1957, and practiced family medicine until his retirement in 1992.

Dr. Johnson served as Chief of Staff at Tacoma General Hospital and was the school physician at the University of Puget Sound for 22 years. He was a pioneer in the sports medicine field. He was a founding member of Baseball Tacoma and has Robert Johnson, MD had the same Cheney Stadium season tickets since 1960.

PCMS extends their sympathies to Dr. Johnson’s wife Betty, son Clif and daughter Betsy.

December, 2001 PCMS BULLETIN 1 V B u l l e t i n

Opportunity Ironi page 9

schedules cannot help until there are When that recognition is not present, other options open to them, it is pos­ enough people to do the work or to we are deprived of that type of com­ sible that the best and the brightest will tak e call. p e n s a tio n . choose other fields in preference to One approach is to import work­ Benjamin Franklin did not say what m ed icin e. ers from Eastern Europe and Asia. happens to human felicity when, instead Both the economic situation and The computer industry, for instance, of little advantages every day we meet the outside interference with the prac­ relies heavily on immigrants from India with little hassles and aggravations. tice of medicine will have to improve and South East Asia for its work force. What happens to human felicity when substantially to attract the number and To many people in the world, working we do our work, take care of our pa­ the kind of people into medicine who for the w'ages paid by our hospitals tients. answer the emergency calls, and will have the knowledge, judgment would lead to a dramatic improvement instead of being rewarded, we have to and skill needed to do their job well. in their lifestyle. This country has al­ write letters to justify our prescriptions, That is the most important factor which ways looked to immigration as a source to explain our recommendations, to beg will improve medical care and reduce of labor. The poem by Emma Lazarus for authorization to test or to treat? the incidence of medical errors. Medi­ says it well. "Give me your tired, your The last ten or fifteen years have cal care is much too complex to hope poor, your huddled masses yearning seen a significant reduction in the ben­ that devising a system, modeled after to breathe free, the wretched refuse of efit of becoming a physician. The inevi­ the cooking of hamburgers and fries at your teeming shore. Send these, the table result will be the re-evaluation of McDonalds, can provide quality and homeless, tempest-tost to me. I lift my the opportunity cost by everyone who eliminate errors, especially in the ab­ lamp beside the golden door!” considers entering this field. With many sence of adequate staffing. ■ This is as valid today as it was in the nineteenth century. The differ­ ence is that now' the immigrants need to have much more knowledge, judgment and decision-making ability than ever before. Growing up in America tends UNION AVENUE PHARMACY to give freedom of thought and inde­ pendence of judgment, qualities which Professional Compounding Center of Tacoma, WA are usually quashed in the authoritar­ ian systems of the old continent. When Vaginal Suppositories Gel, Ointment, and Cream recruiting from there we have to add. Rectal Suppositories IV Services “Only rebels need apply.” That was Urethral Inserts Capsules how this country was built, that is how it Sublingual Troche Lip Balms can continue to prosper. Recruiting nurses, technicians and 2302 South Union Avenue 752-1705 even physicians from abroad may be one solution to the staffing problems we experience. The people we recruit will have to be trained to work in our environment. That will take time and may turn out to be an expensive un­ Dr. Robert Klein created Goodwill Physicians co promote, d e rta k in g . encourage, and assist: in the fostering of goodwill between M ost of us who work in medicine countries. Goodwill Physicians is an individual effort aiming to promote cultural, educational and business exchanges do so because there is nothing else we between our citizens and peoples from all over the world. would rather be doing. There are re­ Find out how you can help: wards for doing a good job when tak­ • time • talent • donation goodwill-physicians-org ing care of people that transcend eco­ Highlights of Some International Projects: nomic compensation. These rewards • Tihlisi, Republic of Georgia - Robert Klein, M.D., P.S. Assisted orp/uim consist in the recognition not only by F a m ih Practice • Persona/ Injury • Immigration • Armenia, Kazastan, Kyrgystan, Georgia, ourselves, but also by our patients and 253-474-8777 • 253-474-8700 R ussian F ar E ast a n d C h in a - Distributed p/iarmaceuricals; taught/ami!)’ others that we have done a good job. 7513 Custer Road West: • Tacoma practice /jmiripies to p/iYsicians; I'ohm teeral persona U injuriesnw.com in Heart to Hearr Medical Missions

14 PCMS BULLETIN December, 2001 ^8*=- - : - W'km 9fwmfy Q/l'ledica/ ofociehf

In M y Opinion..... by David Roskoph, MBA, CFP

The opinions expressed in this writing are solely those o f the author. PCMS invites members to express their opinion/insights ahotti subjects relevant to the medical community, or share their general interest stories. Submissions are subject to Editorial Committee review-

The Market Has Left the Launch Pad

For almost two years now the cau­ set the stage for an economic recovery was created in 1997 and, in June of this tion flag has been held high because by early 2002. That recovery was only year, all plans were liberally expanded. of the irregularities beneath the obscured by the events of September The contribution limits for all qualified market’s misleading exterior. On Sep­ 1 Ilh, not stopped. Put in perspective, retirement plans were raised and in­ tember 3rd the yellow flag was lowered the terrorist attacks created uncertainly dexed to inflation. There are across- and the green flag raised. This market in an otherwise sublimely certain the-board catch-up provisions that allow is a rocket that has lifted off the pad America. Was the threat of further those 50 and over to actually contribute and is headed up. Don't hesitate - get Middle Eastern terrorism more severe more than the rest of us toward their re­ on. This particular rocket has three than the nuclear standoff that occurred tirement plans. For example: Individual stages to get it into orbit. First, the Fed­ in 1962? Mid September saw emotion Retirement Accounts (IRA’s) that have eral Reserve has loaded the economy take the markets down well past their been stagnant at $2,000 per year since with 40-year-low interest rates (mon­ rational values. 1974. They will be going up to $5,000 etary policy) and billions in liquid capi­ The losses to the US economy pei' year by 2006 and S5,500 per year if tal (fiscal policy) that will provide the from terrorism are real but they did not you’re 50 or over. It is plain to see that majority of the thrust. Once the ship is create the recession we entered at least the government is making it easier and safely on its way. the next stage of in­ eight months ago. The unemployment more attractive to put your own money creasing pension plan contributions rate, manufacturing capacity utilization away instead of banking on Social Se­ will kick into the market at the begin­ and consumer confidence figures all curity. Eventually most of those new ning of 2000. The last stage will be the corroborate a recession. Since the contributions dollars will find their way trickle-down effects of the income tax economy is strapped to the back of the into the market carrying it even higher. reduction written into law last June. consumer, however, we’ve been reas­ Finally, tax cuts stimulate econo­ That, however, won’t kick in until the sured that if we all just hold hands and mies - just not immediately. There is al­ summer of 2003. These three eco­ buy an SUV everything will work out. ways a lag of 18 to 24 months. However, nomic boosters are fundamental driv­ A quick study of history reveals that the downward-sloping tax rales will ers for our economy and therefore, markets recover BEFORE the eventually manifest in increased eco­ for financial markets. Despite the tu­ economy. Profit is lost waiting for some­ nomic activity. Rates are going down in mult and tragedy of recent weeks, in­ one to say " s e ll" because it’s o fficially a every income tax bracket. For ex­ vestors must focus on the fundamentals recession and profit is lost waiting for ample: the present 39.6% will decrease that drive financial markets and not the someone to say " b u y ” becau se i t ’s o ffi­ to 35% by 2006. That’s a 13% reduction emotion that all-too-often directs their cially a recovery. By paying attention in the gross margin! This third, and final actions. to fundamental indicators markets can stage will carry the market even higher Markets neither go up nor down be better anticipated so that less profit is when its effects manifest in a few years. forever and many investors make de­ lost in waiting for officia l pronounce­ The bottom line to reinvesting now lies cisions with emotion while ignoring the ments. When the fog clears, much of not in the fact that w e’re in a recession, all-important fundamentals. Even be­ the opportunity available now will be or that the market has reeled from the fore the terrorist attack, the economy g o n e. terrorist attacks, or that things lo o k showed signs of hitting its eventual If you’re still not convinced m on­ cheap, but simply because of the funda­ bottom soon. This year’s interest rate etary and fiscal policy alone will get this mental monetary & fiscal climate. Fore­ reduction is the most aggressive in the ship off the ground, consider the most, the Federal Reserve is prepared Fed’s 88-year history! Even before government’s stealth campaign to take to do what it must to get the job done. the recent crisis, the Fed’s interest-rate the burden off Social Security. Quietly, Liberalization of the private pension cuts were unprecedented. With the the government is taking the pressure system and the income lax cut lead to lone exception of the Great depres­ off of the mathematically-troubled So­ the same conclusion but will kick in sion, the market has never ignored cial Security system so it will not be the later. The economic headlines will con­ such rate-cuts: neither will it now. The sole source of retirement for so many. tinue to worsen as recession is finally first 8 rate cuts by the Federal Reserve A new tier of qualified retirement plans S ee "M a rk e t" p ag e 16

December, 2001 PCMS BULLETIN 15 b i.- L U /l If-

Washington State Department of Health HIV Early Intervention Program Pays for HIV Care

No person with HIV should go and details. should contact PMDC Systems at 1-888- without treatment because they cannot • Prescription M edications. EIP 311-7632 to become an EIP provider. personally pay for it. Early access to covers at 100% those antiretrovirals clinical care can slow or stop the pro­ and medications used to support adher­ Eligibility and Enrollment gression of HIV infection and provide ence and treat the complications of HIV patients must reside in Wash­ opportunities to reinforce risk-reduc- HTV that appear on the current EIP ington, but do not have to be U.S. citi­ tion messages, and may reduce form ulary. zens to receive EIP support. Eligibility patients' infectiousness. • Lab Tests. Many chemistry and guidelines include limited assets and a The Washington State Department hematology tests, HIV viral load, HIV gross monthly income at or below 370 of Health can pay for early intervention genotype, T cell count, related serolo­ percent of current federal poverty outpatient medical and dental services, gies, and additional tests are covered level (for a single person, $2,649 in and medications, for many HLV+ state by EIP when work is done at a con­ 2001). EIP clients cannot be eligible for residents. The Early Intervention tracted lab. VA assistance, but the EIP program can Program (EIP) is designed to help • Dental Care. EIP covers some provide limited help to clients with pri­ clients with low to moderate incomes dental services. Call us for more infor­ vate insurance and those who need who are not eligible for Medicaid or VA m ation. help with Medicaid spenddown. Call b en efits. • Medical Insurance. Since EIP is EIP for referral to local case managers not an insurance plan (it covers specific who can help clients assess eligibility Services Covered by EIP HIV care services and medications), and apply for EIP enrollment. The EIP Call 1-877-376-9316 for the EIP clients should acquire comprehensive website contains information for clients formulary, list of contracted labs, and insurance coverage. EIP can help with and case managers, including enroll­ medical and dental schedules of cover­ that task, and pay insurance premiums ment forms. age and maximum allowances. Or ac­ and Medicaid spenddown. cess this information at http://www.doh. • Referral to local case managers. HIV/AIDS Consultation wa.gov/cfh/hiv.btm. EIP staff can also Dr. Chris Behrens offers tele­ refer callers to local case managers. Provider Contracting phone consultation, on-site case con­ • Medical Care. EIP medical pro­ Medical and dental providers and sultation, and on-site training to provid­ viders can be reimbursed for .services, labs must contract with the Department ers free of charge, through the Uni­ and office visits, consultations and risk of Health to be reimbursed for services versity of W ashington’s AIDS Educa­ reduction counseling. See the to ElP-enrolled clients. Monique tion and Training Center. Dr. Behrens program's Medical Schedule of Cover­ McLeod at 360-236-3493 answers ques­ can be reached via pager at 206-994- age and Maximum Allowances for rates tions and mails contracts. Pharmacies 8773, and voice mail at 206-731 -1058. ■

Market from page 15 Allenmore acknowledged and damage from the at­ Psychological tack is quantified. Historically though, it is only when a recession is accepted E S Associates, P.S. that a market-bottom goes into place. Your emotions (and an onslaught of , 752-7320 , economic disinformation) may tell you Do you have patients with difficult emotional there is no tomorrow for the market. and stress-related problems? Psychiatric and Now is the time to assess the situation psychological consultations are available. intellectually and act against your emo­ tions.* Union Avenue Professional Building David ,!. Roskoph, MBA, C'FP i,v a fec-hused ______1530 Union Ave. S.. Ste. 16. Tacoma investment Advisor.

16 PCMS BULLETIN December, 2001 V >.pOC‘V^ i1/ ' L‘ t ' 'C' rt ■/

COLLEGE Continuing Medical Education OF MEDICAL Primary Care Cardiology CME set EDUCATION for evenings of January 9 & 15 The College’s sixth annual pro­ CME and end with three additional gram featuring subjects on cardiology hours of CME on the 15th. The change for the primary care physician will be is in response to expressed interesl by held at St. Joseph Hospital, Lagerquist physicians from the College's recent Whistler CME Conference Center Rooms 1A & B. CME survey. Physicians are finding it The course will be directed by Gregg d ifficu lt to Lake tim e aw ay from th eir o f­ set for 1/23-27 Ostergrem, DO. fice hours. This year’s Cardiology for Pri­ Topics will include: The College's very popular CME mary Care CME program will be of­ • Congestive Heart Failure Manage­ in Whistler/Blackcomb still has room fered on two evenings in two consecu­ ment for Primary Care Physicians for participants. How­ tive weeks in January, instead of the • Appropriate Cardiac Testing ever. the College's traditional 6-hour program on a Friday. • ARBs and Their Role in Heart Fail­ reserved block of This year’s program is scheduled for ure and Cardiovascular Disease co n d o s at Tuesday, January 9 and Wednesday, • Rationale for the Aggressiveness of Blackcomb’s Aspen January 15 from 6:00 pm to 9:00 pm on the N C E P - A T P IK G u id elin es Lodge at press were both nights. • W omen's Cardiac Issues booked. Those still The program will begin with • Managing Your Diabetic Patients' interested in other speakers on the 9th, three hours of Cardiac Needs* possible lodging should call individual facilities, the W histler Dates Program Directors) Lodging Company at 1-800-777-0185, or a central toil free Wednesday, Tuesday Cardiology for Primary number, 1-800-WHISTLER. The Gregg Ostergren, DO January 9; 15 course will be directed by Drs. John Care Jiganti and Richard Tobin. ■ Wednesday-Sunday Richard Tobin, MD CME @ Whistler January 23-27 John Jiganti, MD Primary Care Primary Care Michael Bateman, MD Friday, Febaiary 8 Orthopedic CME Orthopedics Charles Weatherby, MD

set for February 8 Thursday-Friday Internal Medicine Tejinderpal Singh, MD March 7-8 Review 2002 A new COME program designed for the primary care physicians’ atten­ Sunday-Friday tion to their patients’ orthopedic prob­ CME at Hawaii Mark Craddock, MD lems is set for February 8. April 7-12 The one-day program will feature speakers on evaluation, treatment and Allergy, Asthma & management, and include review ol ap­ Friday, May 3 Pulmonology for Alex Mihali, MD propriate imaging, joint injections, re­ ferral protocols and more. Primary Care The course is directed by Drs. Michael Bateman a n d Charles Advances in Women's Friday, May 17 John Lenihan, Jr., MD Weatherby. ■ Medicine

December, 2001 PCMS BULLETIN 17 B u l l e t i n

Dr. Tice from page 10 tients. "They only really told me and a great group of doctors here, but Alan thanked him at his funeral. He would Tice will be sorely m issed,” he said. “He offer assistance and guidance to those have been very proud,” he said. “I didn’t has the most creative mind I’ve ever interested in taking a leave. "It would be think that was right. And I didn’t want that seen. He is always thinking out of the of tremendous value for doctors," he to happen to me." box. It is extraordinary watching him said. Dr. Tice's “farewell luau“ was also work. No one comes close.” Dr. Tice also stressed that part of attended by a veritable W ho’s-Who of Former PCMS president and looking ahead includes financial plan­ Pierce County medical professionals - Tacoma pulmonologist Dr. John ning. "Our investments allowed us the surgeons, oncologists, nephrologists, Rowlands is a personal friend of the freedom to make this move," he said. family practice physicians and more - a Tice family. “I have always marveled at “Constance and I both worked for many further testament to his far-reaching in­ A lan’s energy,” he said. “He is not unlike years, saved money, and made good fluence in the medical community. They a parent. He’s leaving behind a great c h o ices." were there to have a good time, enjoy practice that he’s developed and a won­ wonderful food, and honor one of their derful group of physicians. They will A F arew ell Luau finest. "Alan Tice has provided so much carry on, but there will always be a void Prior to his leaving the mainland in to the community,” said D r. John Van that can’t be filled. I believe the Tice September, Infections Limited orga­ Buskirk of Tacoma Family Medicine. family will always consider this their nized a Hawaiian-theme open house at "He has been very involved with home, however, and they will miss their the office. “I wanted to be able to thank Tacoma Family Medicine helping for ties and friendships here.” my patients for what they have done for years to train residents to provide care to Dr. Alan Tice’s involvement has me. and I wanted to have the chance to indigent patients. I will always be grateful been far reaching, and his presence in say good-bye to them and for them to for his contributions. He has been a tre­ the community will be missed. He is a say good-bye to me," he explained. Dr. mendous help to the indigent patient. He man who has truly made his mark here - Tice discussed his father’s death and la­ will be missed.” an indelible mark that can’t be erased. mented that the elder Dr. Tice never re­ Dr. Jam es DeMaio, a partner at Aloha, Dr. Tice. ■ ally knew how much he meant to his pa­ Infections Limited, concurred. "W e have Alan Tice welcomes comments from physicians. He can he reached via email at giant ice@ icilinks.com.

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18 PCMS BULLETIN December, 2001 Classified Advertising

POSITIONS AVAILABLE OFFICE SPACE POSITIONS WANTED

Tacoma/Pierce County out­ Available now, new construc­ Transcription Specialists - We patient general medical care at its best. tion, up to 1,800 sq ft remaining on first have years of experience in most Full and part-time positions available in level, will provide tenant improve­ medical specialties. We guarantee ac­ Tacoma and vicinity. Very flexible ments. Close to hospitals on Union at curacy. fast turnaround time, free schedule. Well suited for career 13th. C all Dr. Lovy at 756-2182 or 206- pickup and delivery and reasonable redefinition for G.P., F.P., I.M. Contact 387-6633. charges. Outstanding references. Call Andy Tsoi, MD (253) 752-9669 or Paul 925-3276. Doty (Allen, Nelson, Turner & Assoc.), Fircrest Medical Office Space Clinic Manager (253) 383-4351. 412 Bowes Drive - 1540 sq ft consisting of examine rooms, offices, reception GENERAL Washington State Division of area, lab and x-ray rooms plus 300 sq ft Disability Determination Services. storage. Call (253) 863-3366 or (253) Computer troubles? Call Medical Consultant positions available. 272-4588. On Sight Computers (253) 318-0214. The State of Washington Division of We handle repair, setup, upgrade and Disability Determination Services seeks Office Space For Lease. Sound- more. First hour free! psychiatrists to perform contract view Medical Plaza, located at 36 1 I services in the Olympia Regional office. South D Street, currently has office Contract services include the evalu­ space available for lease to medical or ation of mental impairment severity from general healthcare practices. We of­ medical records and other reports, fer very competitive lease rates; spa­ Organ &Tissue utilizing Social Security regulations and cious, updated facilities; shared re c e p ­ rules. Psychiatric Medical Consultants tion; accessible support staff; excellent function as members of the adjudicative security, maintenance and janitorial team and assist staff in determining services; and access to onsite radiol­ eligibility' for disability benefits. ogy and blood labs. Our location, just Requirements: Current Medical off of Pacific Avenue, is adjacent to License in Washington State. Board the Pierce County Health Department certified desirable. Reimbursement: and Puget Sound Behavioral Health, Share Your Life. $57.01 /hr. Interested psychiatrists and is easy access to and from free­ Share Your Decision. " should contact Guthrie L. Turner, ways and on a bus line. For lease rates J r ., M D , MPH, Chief Medical and more information, call Lindy For more information on organ and tissue Consultant. Acting at (360) 664-7361 or Vincent at 798-4520. donation please call LifeCenter Northwest the respective regional manager: toll free, 1-877-275-5269 Olympia: Laura Wohl, Regional Manager (360) 664-7355

TACOMA/PIERCE COUNTY M e d ic a l Placement Service owned and operated by: Outpatient General Medical Care. Pierce County Medical Society Full and part-tim e positions available in Tacom a and vicinity. *Permanent Full & Part Time Positions Very flexible schedule. W ell suited *Tempora ry Placements lor career redefinition for Pierce County’s “medically exclusive” agency GP, FP, LM.

Employer paid fees Contact Andy'I’soi, MD (253) 752-9669 I 223 Tacoma Ave South 253-572-3709 or Paul Doty (Allen, Nelson, Turner B ask for Deborah or Angela Assoc.). Clinic Manager (253) 3S3-4351 |

December, 2001 PCMS BULLETIN 19 B u l l e t in . V''n:)rc '^poim \ty Q,4'teclical (Society

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20 PCMS BULLETIN December, 2001