In My Opinion - Pierce County Medical Society

J a n u a ry , 2 0 0 4
The 2003 Annual M eeting
M ichael Kelly, MD
assumes the PCMS
Presidency from
Dr. Jim Rooks at the
2003 Annual M eeting
Federico Cruz, MD recipient
of the 2003 Community Service
Award presented by Dr. Peter Marsh
M o re p h o to s p a g e 5
INSIDE:
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P r e s i d e n t ’s P a g e : “ G e t o f f t h e T r a c k o r G e t R u n O v e r ” b y M ic h a e l K e lly , M D
N e w B o a r d o f T r u s t e e s w i l l l e a d P C M S in 2 0 0 4
F e d e r ic o C r u z , M D r e c i p i e n t o f 2 0 0 3 C o m m u n i t y S e r v ic e A w a r d
S p e c i a l F e a t u r e : “ R ic k S t e v e s o n E u r o p e : T h e B e a u t y o f T r a v e l ” b y J e a n B o r s t
In M y O p in io n : “ M a r x a n d M e d ic a r e ” b y A n d r e w S ta ts o n , M D
I n M y O p in io n : “ M is t a k e s Y o u C a n ’t A f f o r d to M a k e ...” b y T e r e s a C l a b o t s , M D
B
u l l e t in
P C M S O fficers/T ru stee s:
M ic h a e l J. K elly , M D , P r e sid e n t
P a tr ic k J. H o g a n , D O , P re s id e n t E le ct
K e n n e th A . F e u c h t, V ic e -P re s id e n t
J o s e p h W . R e g im b a l. T re a su re r
S u m n e r L . S c h o e n ik e , S e c re ta ry
J . J a m e s R o o k s . J r., M D . P a s t P re s id e n t
L a u re l R . H a rris , M D
J e ffre y L . N a c b t, IV] D
J o s e p h F. Ja s p e r. M D
N a v d e e p S. R a i. M D
R o n a ld R , M o rris, M D
C a rl W . W u] festi eg , M D
January, 2004
P C M S M e m b e r s h ip B en efits, In c (M B I):
T i m S c h u b e r t , M D , P r e s i d e n t ; D r e w D e u ts c h .
M D , P a st P re sid e n t; J o e R e g im b a l. M D .S e c re ta ry T re a s u re r; K e ith D e m iijia ru M D ; S te v e D u n c a n , M D :
M a rk G ild e n h a r . M D ; S te v e S e ttle , M D ; J o e W e a m , M D
C o lle g e o f M e d ic a l E d u c a tio n (C .O .M .E .):
J o h n J ig a n ti, M D P resid en t; B a rb a ra F o x , M D ,
W illiam H o ld e rm a n . M D . S te v e K o n ic e k . M D . M a rjo rie
K r a b b c ,M D , W i lliam L ee, M D , G r e g g O s te rg re n , D O ,
B r a d P a ttis o n , M D ,C e c il S n o d g ra s s ,M D , V irg in ia
S to w e l ],M D .R i c h a rd W a l tin an ,M D ,T o d W urst, M D ;
H e r ta M a le ik e .G o o d S a m a rita n H o sp ita l; L isa W liite.
M u ltic a re H e a lth S y ste m ; S iste r A n n M c N a m a r a ,
T re a s u r e r, F ra n c isc a n H e a lth S y ste m ; S u e A s h e r,
S e c re ta ry
P C M S F o u n d a tio n : L a w r e n c e A.
L a r s o n , D O , P resid e n t; C h a rle s W e a th e rb y , M D .
M o n a B a g h d a d i.N ik k i C ro w le y . T re a su re r; S u e A sh er.
S e c re ta ry
W SM A R ep resen ta tiv es:
T ru s te e s: L e o n a rd A le n ic k ,M D ;N ic h o la s R a ja c ic h , M D ;
P a tric e S te v e n s o n . M D
W A M P A C 6 th D istrict: D o n R u ssell, D O
W A M P A C 9 th D istrict: L e o n a rd A le n ic k .M D
Table o f C ontents
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P re s id e n t's Page: “ G e t o ft'th e T rack o r G e t R u n O v e r"
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N e w B o ard o f T ru stee s w ill lead P C M S in 2 0 0 4
S t a f f : E x e c u tiv e D ir e c to r: S u e A s h e r
A d m in istra tiv e A ssistan ts: T a n y a M c C la in . C.'risti P eterso n
P la c e m e n t C o o rd in ato r: K e n S m ith
P la c e m e n t A ssistan t: M e lis sa K re g n e ss
C M E P ro g ra m A d m in istra to r: L es M c C a llu m
B o o k k e e p e r: J u a n ita H o fm e iste r
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2003 A n n u a l M e e tin g R ecap
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2003 C om m unity S e n d e e A w ard
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S pecial Feature: “R ick S tev es o n E u ro p e ”
T h e B u lletin is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n e fits, Inc. D ead lin e for su b m ittin g articles
a n d p la c in g a d v e rtise m e n ts is th e 15th o f th e m onth
p re ced in g p u b licatio n .
9
T P C H D : "M a k in g an Im p ac t"
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In M y O p in io n : "M a rx a n d M e d ic a re "
T h e B u lle tin is d e d ic a te d to th e art. sc ie n c e an d d e liv e ry
o f m e d ic in e an d the b e tte rm e n t o f the h e a lth an d m ed ical
w e lfa re o f t h e c o m m u n ity . T h e o p in io n s h erein are th o se o f
th e in d iv id u al c o n trib u to rs and do n o tn e c e s s a rily r e l i e d the
o fficial p o sitio n o fP C M S . A c c e p ta n c e o f a d v e r tis in g in no
w ay c o n s titu te s p ro fe ssio n a l a p p ro v a l or e n d o rse m e n t o f
p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B u lletin re se rv e s the
rig h t to reject any ad v ertisin g .
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A p p lica n ts fo r M e m b ersh ip
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O u r m ost intrig u in g m ed ical facts o f 2003
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L eg isla tiv e S e ssio n ju s t d a y s aw ay...
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P C M S F o u n d a tio n th an k s H o lid ay S h a rin g C ard c o n trib u to rs
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In M y O p in io n : “ M ista k es y o u C a n ’t A ffo rd to M a k e ...”
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C o lleg e o f M ed ical E ducation
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C lassifie d A d v e rtisin g
M a n a g in g E d ito r: S ue A sh er
E d i t o r i a l C o m m i t t e e : M B I B o a r d o f D ir e c to r s
A d v e rtis in g
II n f o r m a t i o n :
2 5 3 -5 7 2 -3 6 6 6
2 2 3 T a e o m a A v e n u e S o u 111, T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; i A X : 2 5 3 -5 7 2 -2 4 7 0
E -rnai Ia d d ress: p c m sw a f'i/p c rn sw a .o rg
H o m e Page: h ttp ://w w w .p c m sw a .o rg
2 PC M S BULLETIN
January, 2004
President s Page
by Michael J. Kelly, MD
Get off the Track or Get Run Over
"Even i f vou 're on the right track, y o u 'II g et run o v er i f y o u j u s t sit there. "
M ark Twain
M ichael J, Ki'llv, MD
I realize I used this quote at m y
coronation as I assum ed the presi­
dency o f PCM S from Dr. Jam es
Rooks but I felt its m essage should
be repeated. T im e has com e to get o ff
the tracks. For too long m ost o f us
have w atched from the protected
sidelines o f our practices com forted in
the belief som eone else w ould do the
work. To be successful today, m edical
liability reform requires the concerted,
combined effort o f our entire m edical
society.
Be buoyed by the know ledge we
are not alone. N ote the findings o f A
Kaiser Fam ily Foundation Poll, Janu­
ary 2003: 74% o f A m ericans said that
the issue o f m edical m alpractice insur­
ance w as either a “ crisis” or a “ m ajor
problem ;” and 72% say they favor
putting lim its on the am ount patients
can be aw arded for em otional pain
and suffering.
A telephone survey o f 600 voters
in W ashington State conducted from
October 24 through O ctober 26, 2003
by two separate organizations re­
vealed: 66% w ould support a c a n d i­
date w ho supports lim its on non-econom ic dam ages; 72% support lim its
on the am ount o f m oney ju rie s can
aw ard for non-econom ic dam ages.
Thus, it is the D em ocrats, e n ­
trenched in their false and m isguided
rhetoric, w ho are out o f step w ith their
constituents. We have captured the
interest o f the public. W e m ust not
squander it. H ow ever, w ith this kind o f
public aw areness, there m ay be co n fu ­
sion as to w hy physicians are not m o­
bilizing resources m ore actively than is
apparent. Perception is reality. 1 sug­
gest w e leave no doubt about our com ­
m itm ent to the reform m ovem ent.
We m ust all begin by financially
supporting the W SM A liability fund
and W AMPAC. T he trial attorneys
have nine PACs in this state and fund
them generously. We have one and
fund it poorly, until now. C ontact the
W SM A for further details.
We have the evidence-based in­
form ation w hich supports our conten­
tion about the liability-insurance-lessening effects o f a $250,000 cap on non­
econom ic dam ages am ong o ther a s­
pects o f reform (please see resources
available at w w w .w sm a.org, click on
“Tort R eform C risis C overage” ). Each
o f us m ust fam iliarize ourselves with
the details o f m edical liability reform . In
this way, w e w ill be able to effectively
counter the obfuscation and blatant
m isrepresentation by the opposition.
A few m onths ago, Texas show ed
the nation how properly perform ed
m edical liability reform successfully
low ers liability prem ium s. T heir reform
bill, w hich included a $250,000 cap on
non-econom ic dam ages, passed by
90% in the senate and 76% in the
house. A referendum regarding a con­
stitutional am endm ent subsequently
passed. T his assured that the reform
bill w ould not face legal challenge. W ith
this stability established, the sta te ’s
largest m ed-m al insurer, the Texas
M edical L iability T rust, a nnounced it
w ould low er rates by 12% beginning
January 1.
W ashington’s reform m ovem ent
m ust attain the sam e tw o o b jectives as
did Texas; a m eaningful liability reform
bill with a $250,000 cap on non-econom ic dam ages follow ed by a referen ­
dum putting in place a constitutional
am endm ent w hich w ill allow the cap to
w ithstand judicial challenge.
A s the debate unfolds, w e n e ed to
rem ain on m essage: m edical care starts
and ends w ith m edical access. A ccess
is the m antra o f reform .
Just as you w ould w rite yo u r o r­
ders for a patient, you m ust also w rite
a bout this im portant issue. W rite to
w hom ever you believe n eed s the m es­
sage. W rite y o u r represen tativ es, y our
senator, the entire house and senate o f
this state, even the g o vernor him self.
D o not be intim idated. J u s t a s y o u
w o u ld n ever tolerate interference w ith
y o u r m ed ica l p rescrip tio n , do n o t to l­
erate this interference with o u r m a n ­
d ate to care.
W hen you w rite, w rite w ith clarity
and brevity (one page only). T ell your
story from the heart. I f there is a caring,
feeling, hum an reading y our w ords w ith
an open m ind, y o u r m essag e w ill find
fertile ground. You m ust believe w e can
See “President’s Page” page 19
January, 2004
PCMS BULLETIN
3
B u LLET1N
New Board of Trustees will lead PCMS in 2004
M ich ael K elly, M D is a fam ily practitio n er
L au rel H a rr is, M D is a n o p h th a lm o lo g ist
in L ak e w o o d . H e re ce iv e d his m edical
e d u ca tio n from th e U n iv ersity o f C in c in ­
p ra ctic in g in T aco m a a n d P u y a llu p . S h e re ­
c eiv ed h e r m ed ic al d e g ree from E m o ry U n i­
nati C o lle g e o f M e d icin e a n d c o m p leted
v e rsity S ch o o l o f M e d ic in e . S h e c o m p le te d
his re sid e n c y at O re g o n H ealth S c ien c es
U niversity.
an in te rn sh ip at G e o rg ia B a p tist M e d ic a l
C e n te r and a re sid e n c y in o p h th a lm o lo g y at
V anderbilt U n iv e rsity M e d ic a l C e n te r in
N a sh v ille , T ennessee.
Patrick Hogan, DO p ractices n e u ro lo g y in
T acom a. H e g ra d u a te d from the U n iv e r­
sity for the H e alth S cien ces in K ansas
J o se p h Jasp er, M D p ra ctic e s p a in m e d i­
C ity, M issouri and c o m p le te d his re si­
leg e o f M e d ic in e , fo llo w e d b y a re sid e n c y
den cy at L etterm an A rm y M edical C en ter
in San F rancisco.
J. J a m es R o o k s, Jr., M D p ractices o to ­
lary n g o lo g y in L ak ew o o d . H e atten d ed
m edical school at the U niversity o fM ia m i
S chool o f M ed icin e. He is a F ellow in the
A m e ric an C o lleg e o f S urgeons a n d A m e ri­
can A c ad e m y o f O to lary n g o lo g y /H ea d /
N eck Surgery'.
K enneth F eucht, M D , P h.D . is a Puyallup
general su rgeon. H e g ra d u ated from the
O re g o n H e alth S ciences U n iv e rsity
R on ald M orris, M D is a fam ily p ractitio­
n e r in P u y a llu p . H e g ra d u a te d from the
U niversity' o fW a s h in g to n S c h o o l o f
M edicine. He c o m p le te d his fa m ily p ra c ­
tic e re sid en c y w ith U n ite d H e a lth S e r­
vices, and at W ilso n M e m o ria l H o sp ital in
Jo h n so n C ity, N e w Y ork.
J e ffr e y N a c h t, M D is a n o rth o p ae d ic
School o f M edicine and c o m p le te d a su r­
g ical re sid en c y at the U niversity o f Illin o is
w h ere he also co m p le te d a fellow ship in
surgical oncology.
re sid en c y a n d fe llo w sh ip in o rth o p ed ics at
the U n iv e rsity o f P e n n sy lv a n ia .
H ospital and M e d ic a l C e n te r as w ell as a
S u m n e r S ch o en ik e, M D p ra ctic e s p e d ia t­
N avd eep R ai, M D is a T acom a
rics in L akew ood. H e g ra d u ated from B aylor
C o lleg e o f M edicine. He c o m p le te d his
p u lm o n o lo g ist. Fie re c e iv e d h is m edical
de g ree fro m O h io S tate U n iv ersity . H e
in te rn sh ip and re sid en c y at M aricopa
C ounty G eneral H ospital and a fe llo w sh ip in
p sy c h iatry at O regon State H ospital.
co m p le te d his in te rn sh ip a n d re sid e n c y in
the U n iv e rsity o f W ashington School o f
M edicine w h e re he c o m p le te d his in te rn ­
ship, re sid en c y and a fe llow ship in g e ria t­
ric m edicine.
The trustees are responsible jar governing the organization anil sub­
sidiaries, including maintaining, developing, and expanding pro­
gram s and services fo r members, seeing that the organization is
properly managed and that assets are being eared for and ensuring
PC M S BULLETIN
in fam ily p ractice at T aco m a F a m ily M e d i­
cine, a n d in a n e s th e sio lo g y at the U n iv e r­
sity o f C o lo ra d o H e alth S c ie n c e s C enter.
su rg e o n in T acom a. H e g ra d u a te d from the
U niversity o f B ritish C o lu m b ia . H e com pleted
his in te rn sh ip a n d re sid e n c y a t M o u n t Zion
J oseph R egim bal, M D p ractices internal
m edicine in T acom a, l ie g ra d u ated from
4
cin e in T acom a. H e a tte n d e d m e d ic a l
school at the U n iv e rsity o f C in c in n a ti C o l­
January, 2004
internal m e d ic in e at C le v e la n d C linic in Ohio
as w ell as a fe llo w sh ip in p u lm o n a ry and
critical care m edicine.
C arl W u lfe stie g , M D p ra c tic e s otolaryngolog
in T acom a. H e g ra d u ated fro m U C L A School ol
M e d icin e and c o m p le te d his in te rn sh ip at the
F lospital o f the U n iv e rsity o f P e n n sy lv a n ia and
re sid e n c ie s a t P h ila d e lp h ia Je a n e s H ospital,
j
Je fferso n U n iv e rsity H o sp ita l a n d th e Univer­
sity o f C a lifo rn ia S a n D ie g o H o sp ita l.
the perpetuation o f the organization. Meetings are held on the first
Tuesday o f each month except fo r July and August. The B oard o f
Trustees is comprised o f the President, Vice President. Past President
Secretary, Treasurer, President-Elect and six trustees.
, ' ^ l w 'tiouiiti/ n M o / t r a / S o c i e t y
Annual Meeting Recap
2003 Annual Meeting - fun, festive, and social
The Sheraton Tacom a w as alive w ith m usic and c onversa­
tion on D ecem ber 9 as P C M S m em bers visited w ith old friends
and new at the A nnual M eeting, traditionally held the second
Tuesday in D ecem ber. T he e vening did not disappoint, p ro ­
viding social tim e, dinner, m usical entertainm ent, education,
and introduction o f the new leadership for 2003.
P resident J. Jam es R ook s, M D, introduced m em bers o f
the Tacoma Y outh S ym phony a n d thanked them for providing
the evening’s m usical accom panim ent.
Dr. Rooks called the m eeting to order and introduced
Nikki Crowley, PCM S Foundation B oard m em ber w ho o rches­
trated the Floliday Sharing C ard and the raffle draw ing. Nikki
introduced L aura Yu, artist fo r the card, and explained that p ro ­
ceeds benefitted the Foundation and their charitable w ork for
the betterm ent o f health in P ierce C ounty. M iss Yu has been
the artist o f the card for the p ast five years, and has gen er­
ously donated her tim e and p articularly her talent to the
project. This y e a r’s raffle w inners w ere Susan M arsh, w ife o f
Peter M arsh, M D and E d W illiam s, M D, L akew ood Ob/Gyn.
Dr. Rooks asked for a m o m en t o f silence in honor o f col­
leagues that died during the p ast year. Drs. D ou glas A. Tait,
Thomas R. West, Bartholom ew K ubat, W illiam C. Knittel,
Robert G Scherz, Alan S. P orter, and Jam es T. G illespie w ere
remembered.
The highlight o f the e vening w as the p resentation o f the
Community Service Award for 2003 to Federico C ruz, MD,
(see story page 6). Dr. C ruz jo in e d the ranks o f previous recip i­
ents, Drs. George Tanbara, C harles W eatherby, Terry
Torgenrud, G ordon Klatt, P atrick H ogan, John VanBuskirk,
David Sparling, Donald M ott, W illiam Roes and Lawrence A.
Larson.
W ith introduction o f past p residents, and a keynote, en­
tertaining speaker Mr. R ick Steves (see story p age 7), Dr.
Rooks w ent on to thank the b oard o f trustees for th eir support
and service for the year. H e p resen ted Susan Salo, M D w ith a
gift and thanked her for six years o f service on the board, in ­
cluding term s as a trustee, vice president, president-elect,
president and past president.
H e then turned the gavel over to Dr. M ich ael K elly, L ak e ­
wood fam ily p ractitioner and p resident for 2004.
Dr. Kelly thanked Dr. R ooks p ro fu sely fo r his leadership
and com m itm ent to P C M S. H e p resented him w ith a plaque
and a gift in addition to m any thanks.
Dr. K elly introduced and w elco m ed new trustees for 2004,
Drs. Jeffrey N acht, N avd eep Rai and C arl W ulfestieg, noting
that he is excited and optim istic about w orking w ith the 2004
Board o f D irectors (page 4). ■
Trustee Jo e Jasper, M D (se co n d fro m left) with, from left, Tom
Egnew, h u sb a n d o f Joan H ailey, DO. R uth Roes, w ife o f B ill
Roes, MD, J o a n H ailey, D O a n d his w ife D o n n a J a sp e r
Susan Marsh, w ife o f P eter
M arsh, M D lucky raffle
w inner - once again!
Dr. E d Williams, L a k e w o o d
O h/G yn also a w in n er o fth e
F oundation s raffle event
Left to right, P a st P residents Drs. L a rry L a rso n (his wife
M aty), G eorge Tanbara a n d C harles W eatherby w ith n ew
trustee N avdeep Rai, M D
January, 2004
PCMS BULLETIN
5
Bu L I.ET1N
2003 Community Service Award
Federico Cruz, M.D., recipient of 2003
Community Service Award
E le v e n y e ars ago, th e B o a rd o f T ru stee s th o u g h t it w o u ld
b e a p p ro p ria te to a n n u ally re co g n iz e a m e m b e r o f o u r society
w h o se c o n trib u tio n s to th e c o m m u n ity are a b o v e a n d b e y o n d
the norm . T h e first re cip ie n t, in 1992, w as p ed ia tric ia n G eorge
T an b ara. P C M S has c o n tin u e d to h o n o r a ph y sician each
y e a r - all v e ry d e d ic a te d a n d c o m m itte d to th e ir c o m m u n ity
a n d p ro fessio n . S u b se q u e n t re cip ie n ts w ere D r s. C h a rles
W eatherby, Terry T orgenrud, G ordon K latt, Patrick H ogan,
Joh n Van B uskirk, D avid Sp arling, D o n ald M ott, W illiam
R o es and L arry A . L arson.
Dr. P e te r M arsh , p a st p re sid e n t o f both PC M S and
W S M A , p re se n te d the a w ard to Dr. F ed er ic o C ruz:
T his y e a r we h o n o r a o n e -o f-a -k in d p h y sicia n . A un iq u e
individual. A p ro v e n leader. A m an m o re dedicated, m ore
d e te rm in e d than im aginable.
W hile p u b lic h e a lth is h is jo b , ru n n in g f o r g o v e r n o r is
not. Dr. F e d e ric o C ruz has been sp re a d in g the w o rd o f our
F ed e rico Cruz,
MD. a w a r d recip ien t, wi f h w ife A ld e n W illard
a n d re tired p e d ia tric ia n J o e Wearn a n d h is w ife. P al
p ro fe ssio n a c ro ss the sta te f o r the p a s t year. With his H e a lin g
W ashington F o u n d a tio n , h e sta r te d a p u b lic d ia lo g u e abo u t
h o w to m a k e g o v e r n m e n t a n d m e d icin e w o rk sm arter. H e
w a n ts to m a k e a d iffe re n c e in o u r state, in o u r lives a n d in
the liv e s o f o u r c h ild re n a n d g ra n d c h ild ren .
Dr. C ruz's p u b lic h ea lth roots w ere p la n te d e a rly w ith
v isits to m ig ra n t la b o r c a m p s w ith h is fa th e r, w ho inter­
p r e te d fo r H isp a n ic fa rm w orkers. A fte r d ro p p in g out o f
college, h e w o r k e d a t a B erke le y c lin ic d o in g health
sc re e n in g s a n d d e c id e d to a p p ly to m e d ica l school. R a th e r
than a residency, h e w en t to G u a tem a la in 1979 w here he
le a r n e d th e im p o rta n c e o f p re v en tio n .
A fte r a n O b /G y n residency, h e w o rk e d in both S a v a n ­
nah, G e o rg ia a n d Boulder, C o lo ra d o as the h ea lth officer. In
u su a l style, he tu rn e d the d e p a rtm e n ts u p sid e d o w n im p le ­
m e n tin g p r e v e n tio n stra te g ie s a n d stre a m lin in g the d e p a rt­
m ents. A fte r f o u r y e a rs, he m o v e d to the top jo b in O rlando,
F lo r id a w h e re h is d riv e to w a rd p re v e n tio n w a s n o t so
re a d ily a c ce p te d . A fte r th ree years, h e w as en ro u te to
Tacom a.
F ro m here, m o st o f y o u k n o w the rest o f the story.
F ed e rico Cruz, frfD (left) re c e iv e s his p la q u e a n d c o n g ra tu ­
la tio n s fro m Dr. P e te r M a rsh (rig h t) w h ile P re sid e n t J im
R ooks, M D lo o ks on
P re v e n tio n is his m antra. T h in k in g o u tsid e the box is his
strategy. D o in g the rig h t th in g is p a ra m o u n t. H e has taken on the to b a cc o in d u s tty a n d v e iy c o n tr o v e rs ia l issu e s su c h as A ID S
n a m e s re p o rtin g a n d flu o rid e.
H is is c o u ra g e o u s a n d n o t a fra id to take chances. H e is a n a g e n t o f c h a n g e a n d a p ro v e n leader. H is is s o ft sp o k e n a n d
q u ic k to sm ile. H e w a n ts to b e o u r governor. H e is o u r C o m m u n ity S e n 'ic e A w a r d w in n e r f o r 2 0 0 3
P C M S c o n g ra tu la te s Dr. Cruz.
Dr. M arsh also a ck n o w le d g e d and th an k ed Dr. C ru z ’s w ife, A lden W illard, n o tin g th a t b e h in d e v e ry g o o d m an is a g o o d
w om an. M s. W illard is a n u rse p ra ctitio n er w ith M u ltiC a re ’s A llen m o re In ternal M e d icin e G roup.
Dr. C ru z th an k e d ev ery o n e fo r th e ir su p p o rt and e n c o u ra g e m e n t n o tin g th a t his p u b lic h e a lth w o rk is h is jo b a n d h is c o l­
lea g u es sh o u ld e x p e c t no less from him . H o w ev er, he w as h o n o re d a n d g ra te fu l fo r the re c o g n itio n .■
6
P C M S BULLETIN
January, 2004
Special Feature
byjeanBorst
Rick Steves on Europe: The Beauty of Value Travel
O ver 1,500 y ears ago, M oham m ed said, “ D o n ’t tell m e how
educated you are...tell m e how m uch y o u ’ve traveled.”
Follow ing his travels in E urope o ver 100 years ago, M ark
Twain w rote, “T ravel is fatal to prejudice, big o try and narrow
m indedness.”
In short, “ T he value o f travel is n o thing n ew ,” according
to Rick Steves.
H ost o f the w ildly p o p u lar television show, “ Rick S te v es’
Europe,” author o f 27 trav el b ooks, and founder o f E dm ondbased “E urope T hrough the B ack D oor," Steves has been an
advocate o f sm art and independent travel since the 1970s.
Speaking to a capacity crow d at the PC M S annual m eeting on
D ecm eber 9, Steves presented a hum orous, insightful and
thought-provoking view o f E uropean travel. W hether y o u ’re a
seasoned traveler or a nervous novice. Steves truly offered
something for everyone.
A Lifelong European Experience
The son o f a piano im porter, Steves took his first trip to
Europe in 1969 w ith h is parents to visit piano factories. “1 re­
mem ber vividly thinking how m uch I d id n ’t w an t to go,” he re­
called. But as a 14-year-old, “ I saw it as m y w onderland. T hey
had different candy, w om en w ith hairy arm pits, and one-arm ed
bandits in the hotel lobbies. I w as there w ith m y parents, but
surrounded by kids a few years older than m e w ith their back­
packs and rail passes. I rem em b er looking o ver at m y parents
and thinking, ‘I d o n ’t need you guys for th is.’ G ive m e a back­
pack and a rail pass, and E urope is m y p layground.”
Today, E urope is stiil his playground, but also his life
work. Steves has spent 100 days a y ear in E urope since the
early ’70s. “W hen I traveled, I saw o ther people m aking the e x ­
act same m istakes I had m ade before. I had learned to really
value travel, and I saw' people screw ing up needlessly. 1
thought if I could ju s t package w hat I had learned from m y m is­
takes in a guidebook, then 1 could help other people have
good trips and I w ould have a good excuse to go back to E u ­
rope every sum m er to update m y m aterial.”
Subsequently, Steves established E urope T hrough the
Back D oor in 1976. It has grow n from a one-person operation
to a staff over 60 full-tim e em ployees, and em erged from a
couple o f m inivan tours each year to 200 annual bus tours that
take over 5,000 A m ericans through E urope. H e has been w rit­
ing travel books since the com pany w as established, and has
produced 80 p rogram s for public television over the last 12
years. “ It is such a thrill for m e,” he said. “I fancy m y se lf as a
tour guide, and m y to u r now is the cam era m an and director
and taking them to all the places 1 used to take m y groups o f 20
people.” W hile Steves no longer conducts tours him self, he
continues to w ork very closely w ith all his guides.
L eft to right, Dr. G eorge Brown, B a rb a ra Young, R a d io lo g ist
B ill J a ckso n a n d w ife D onna Jackson, w ith P C M S Vice
P resident Ken Feucht, f a r right a n d his frie n d , E rik ll/i
P C M S Trustee, Dr. J e ffN a c h t, a n d his w ife Gail, with retired
m em bers Drs. D ick H offineister a n d p a s t p re sid e n t Stan H arris
,-«■ ,
' ■. - *
—. ■
-»
..
-.. .
'
The A n nuaI M eeting p ro v id e d a g re a t o p p o rtu n ity f o r
ph y sicia n s to se e o ld colleagues a n d m eet new ones
See ‘'T ravel” page 8
January, 2004
PCMS BULLETIN
7
B
u l l e t in
A 1 Cl V C/1
fro m p a g e 7
so m e th in g ex ce p tio n a l is h a p ­
p e n in g . I tu n ed in, and I re a l­
L o o k in g at T ravel in a D iffer e n t L ight
W ie n h e w a s y o u n g e r, S te v e s’ im ­
a g e o f tra v e l w a s o n e sh a red by m an y -
ize d th a t th is w'as a p o w e rfu l
m o m e n t in the sto ry o f the
g re at natio n . P e o p le w e re
a 195 0 s v isio n o f “ ric h p e o p le o n b ig
there sy m b o lic a lly c lo sin g a
sh ip s o n th e C a rib b e a n ,” he d e sc rib e d .
“ It w a s re a lly a w a y to fla u n t y o u r a fflu ­
c h a p te r on an ugly p e rio d in
th e ir history. It w as so cool
e n ce . F o r tw o w e e k s o u t o f th e year,
b e in g up th ere c eleb ra tin g
y o u c o u ld b e re a lly h e d o n istic . To m e,
w ith th ese p e o p le . T h e n it o c ­
th a t d o e s n o t c o n n e c t us w ith th e w o rld
c u rre d to m e th a t p ro b a b ly
a t all. It e x a c e rb a te s the d iffere n ce b e ­
n o t one out o f 10 A m erican s
w h o w e re v isitin g that place
tw e en u s and th e re st o f the w o rld .”
E ven today, he n o tes, th a t n otion
o f trav e l p e rsists. “ F o r a lot o f p eo p le,
ha d a clu e ab o u t w hat w as
w h e n th ey th in k o f trav e l th ey w onder,
do w n to u rists.”
S tev es e x p la in ed th ere is
alw ay s the tem p tatio n to
'C a n I eat fiv e m e a ls a d a y a n d still
sn o rk e l w h e n I g e t in to p o rt? ' I ’ve been
o n c ru ise sh ip s, a n d th ey are re ally im ­
p re ssiv e . E x c e lle n t h e d o n ism . I f y o u ’ve
w o rk e d h ard , y o u ’ve got m o n ey and
y o u w a n t to do that, th e re 's n o th in g
w ro n g w ith that. B ut d o n ’t call it
tra v e l,” S tev es w arns.
O vercom in g the D u m b -D ow n Tourist
Phenom enon
S tev es sa id he so often o b se rv es
the p h e n o m e n o n o f “ d u m b ed -d o w n
to u ris ts ,” A m e ric an trav e le rs w h o e s­
se n tia lly h a v e n o clu e ab o u t w h at they
are se e in g o r ex p erien c in g . “ T h ey arc
n o t tu n ed in ” and are u n a w are o f the
h isto ric a l sig n ific a n c e o f w hat th ey are
e x p erien c in g . H e related a story about
v isitin g G e rm a n y ’s R e ic h sta g in B erlin a
c o u p le o f y e ars ago. A fte r the build in g
w as n early d e stro y ed by lire in 1933,
the N a z is p la c e d the b lam e on the c o m ­
m u n ists. P resid en t H in d e n b u rg and
A d o lp h H itle r su b seq u e n tly invoked
A rticle 48 o f the W eim ar C o n stitu tio n ,
w h ic h p e rm itte d the su sp en sio n o f civil
lib e rtie s d u rin g n ational em erg en cies,
a n d th e N a zis c am e in to pow er. “Today,
G e rm an y is u n ite d ,’ S tev es explained.
“ T h e g o v e rn m e n t is back in B erlin , and
th e y ’ve p u t this a m a zin g glass d o m e on
to p o f t h e R e ic h sta g . It is a really in­
c red ib le p iec e o f a rch ite c tu re and m akes
a p o w e rfu l sta te m en t. G e rm an s go to
th e to p o f it a n d literally look o v e r the
sh o u ld e rs o f th e ir leg isla to rs. I w as
go in g on. T h ey w ere d u m b ed R ic k Steves, m e sm e r iz e d the c r o w d s h a r in g his
kn o w le d g e a n d p h ilo s o p h ie s o j tra v e l a b r o a d
du m b dow'ii his T V scripts
and p ro v id e “ju s t fun in the
su n .” T h at isn ’t a p ro b lem , he e x ­
plain e d , “b u t i t ’s a re sp o n sib ility w hen 1
h ave a voice on p u b lic telev isio n to e x ­
pect a lot o f m y v iew ers and ex p ect a lot
o f th e e x p erien c e o f travel and help us
broaden o u r p e rsp e c tiv e s through
travel. 1 try to en co u ra g e A m erican s to
co n n ect and b e tuned in to the e x p e ri­
ence. B u t so m an y A m ericans ju s t d o n ’t
get it,” he said. “ W hen w e travel, w e
need to do o u r best to u n d e rstan d the
cultural lay o f the lan d a n d en jo y it. You
w an t to co n n ec t to p eople in a vivid
way. T h at is one o f the beautiful things
ab o u t trav el, and that is w hy a lot o f
p eople are very c o m m itte d to travel
from a w o rld -u n d ersta n d in g po in t o f
view .”
a v ery large p art o f the E uropean e x p e ri­
ence. “ E urope ch arm s m e, because I
chisel, the g re atest fa cto ry on e a r th .’
W7hat a m o m e n t th a t w as. I a sk e d i f I
c o u ld buy so m e o f his w o rk , a n d he
g ave it to m e free, lie said. ‘F o r a m an
m y age to k n o w th a t m y w o rk w ill go to
A m e ric a is re w a rd e n o u g h .’ It w as a
b eautiful m o m en t."
Sim ilarly, S teves said, “I th in k d o c ­
to rs m u st b e v ery fu lfilled , a n d I th in k
t h a t’s a b e au tifu l th in g in y o u r o c c u p a ­
tio n that y o u h ave the joy o f d o in g
so m e th in g th at re a lly m atters. In m y
trav e ls, I see p e o p le all th e tim e w h o do
port a n d m u se u m g u a rd s. T h ese p o o r
p eo p le! H o w c an y o u h a v e a n y fu lfill­
m en t ju s t sta n d in g th e re ? ”
A n E xciting T im e to b e in E urope
w ho m akes crep e s like he inven ted
m ad e this an e x c itin g tim e to travel,
them . W hen I w as in Italy last y ear, I
w as p o u re d a glass o f w ine by som eone
S tev es said. W ith u n ific a tio n , h e e x ­
p lain e d , p e o p le m ig h t th in k th a t the d i­
w hose fam ily nam e had been on that la­
bel for 150 years. I w as in Paris and
v e rsity o f E u ro p e is b e in g th reaten ed .
there w a s an org an ist p la y in g w hat
the a m a z in g diversity. Y ou go 100 m iles,
yo u e x p erien c e a w h o le d iffe re n t c u l­
m ust h ave been the m ost m ag n ificen t
tim e te a ry -e y e d G e rm an s su rro u n d you.
sam e bench - his nam e w as on the bot­
January, 2004
sky a n d d e clare d . ‘A m an a n d his
th in k p e o p le are fulfilled. T hey do
things w ith gusto. 1 m et a m an in Paris
sta n d in g on top o f th at b u ild in g , su r­
ro u n d e d b y tea ry -e y e d G e rm an s. A n y ­
P C M S BULLETIN
and m e t a m an w h o c arv e d n ic h e s for
m o sq u e s. He held his c h isel h igh in the
th in g s that re ally d o n ’t m atter. T ake a ir­
Fulfillm ent and Europe
S teves explained that fulfillm en t is
pipe o rgan in E urope. I saw a list o f
nam es o f p e o p le w ho h a d been o rg a n ­
ists for the last 300 y ears w a rm in g that
8
to m o f th at list. I k n ew he w as fu lfilled .
I w as in the b o rd e r a rea o f T u rk ey
T h e u n ific atio n o f E u ro p e has
“O n e o f th e c h arm s o f E u ro p e fo r m e is
ture, a w h o le d iffe re n t c u isin e . In a c tu ­
ality, I th in k u n ific a tio n is m a k in g th e d i­
v e rsity m o re v ivid. T h ree d iffe re n t loySee “T rav e l’' page 10
’•
—
—
- /
Jfyw ce 'fovujitif Q ^i-edtail(Society,
The Health Status of Pierce County
SSSS£2* ®
Making an Impact
As you know , I am a candidate for
Governor, T he d ecision to cam p aig n for
this position com es from m any factors,
starting w ith a com m itm ent to im prove
the life o f people across the state o f
Washington. T hat com m itm ent has its
roots in public health, particu larly suc­
cesses in this com m unity. I ’m p ro u d o f
what has been accom plished here, of­
ten through the partnership o f public
health and others, including m edical
providers. I ’m also convinced th at the
approach we have taken here can be
applied across the state, to heal W ash­
ington.
L et’s look at one exam ple that I
think will show the value o f expanding
the public health approach statew ide.
Many issues, from n eedle exchan ge to
fluoridation, could be review ed, but to ­
day 1 w ant to use the issue o f E n v iro n ­
mental Tobacco Sm oke (ETS). The
Tacoma-Pierce C ounty B oard o f H ealth
looked at the data on to b acco-related
illness and death and said, in 1995, to ­
bacco is a threat to the p u b lic ’s health.
Let’s deal w ith it. S taff at T PC H D un­
dertook the challenge, creating cam ­
paigns to keep people from sm oking ot­
to stop sm oking i f they had started.
Over a period o f tw o years, the sm oking
rate in Pierce C ounty d ecreased from
about 25% to 21% . A success, but not
enough. T hose w ho sm oked could do
so in public areas, th reatening not only
their own health, but others too.
So the B oard held a series o f com ­
munity m eetings to discuss the appro­
priateness o f a county-w ide sm oking
ban in public places. N o t everyone m et
the idea w ith favor, but at the D ecem b er
Board m eeting, several form al p re sen ta ­
tions provided B oard m em bers w ith de­
tails on the extensive h ealth im pacts o f
exposure to second hand sm oke. D u r­
ing a m arath o n m eeting that lasted
n early four h ours, over LOO people testi­
fied both fo r and against a county-wdde
ban. T he B oard o f H ealth then voted
unanim ously to im plem ent a Sm oke-free
Pierce C ounty policy.
We took on an issue that m ost af­
fects the health o f our com m unity. W e
d id n ’t look for som ething that w as easy
to im plem ent or non-controversial. We
knew there w ere d eep-seated p roblem s
related to tobacco sm oke and a high
level o f disagreem ent am ong com m u­
nity m em bers. M otivated by the desire
to confront real public health issues, w e
took action to m ove the com m unity for­
w ard tow ard a solution.
T his exam ple em bodies the core
functions o f public health: A ssessm ent,
Policy D evelopm ent and A ssurance.
A ssessm ent m eans know ing our com ­
m unity and its health issues. Policy d e ­
velopm ent asks us to p a rtn e r with our
com m unity to put a plan together to ad ­
dress the pro b lem and then taking ac­
tion. T he A ssurance function requires
th at w e follow through to m ake sure the
policies established are e arn e d out. In
the case o fth e sm oking ban, w e know
this follow -through w ill m ean a court
battle.
A ll three parts o f the process have
to be im plem ented to be successful.
The secret to the successes at the
T acom a-Pierce C ounty H ealth D epart­
m en t is that w e fire on all cylinders. We
have leadership that is shared, not solesourced hi the D irector o f H ealth but
dynam ically w oven betw een the B oard
o f H ealth, T PC H D staff, and com m unity
m em bers. A s a result, w e can take on
som e o fth e m ost v ex in g com m unity
problem s and m ake an im pact.
F ederico Cruz. MD
B efore the Sm oke-free Pierce
C ounty resolution vote, each B oard o f
H ealth m em b er to ld the a udience w hy
s/he w ould vote. In som e o f the clearest
language I ’ve ev er beard in m y career,
they described w hat public health is all
about. T hey said p ublic health a d ­
dresses the overall health o f our co m ­
m unity, prevents disease rather than
w aiting to react to illness, and acts on
the know ledge o f o n e ’s com m unity.
T hey described the active search for in­
form ation to d escribe and ch aracterize
the health conditions o f o u r neighbors.
T hey a cknow ledged the essential n a ­
ture o f p artnering w ith com m u n ities to
seek better w ays to im prove health.
T he result is, o f course, the p o ssi­
bility o f cleaner air for P ierce C ounty
and therefore less illness and death.
T he result is also a trem en d o u s m es­
sage o f hope fo r the public. So m uch
m istrust o f g overnm ent exists, so m uch
d eep-seated cynicism tow ard
g o v e rn m e n t’s ability to take on tough
issues. B u t h ere w e see a unit o f g o v ­
ernm ent that is standing up and fig h t­
ing the good fight, m aking a difference.
I am very proud to be p art o f this effort
and I w ant to recognize both the B oard
o f H ealth and sta ff o f th e T acom aPierce C ounty H ealth D epartm ent. We
are b uild in g a h ealth ier P ierce C ounty.
From the core o f public health, w e can
im pact a com m unity, from as sm all as a
n e ighborhood to an entire state. ■
January, 2004
PCMS BULLETIN
9
B
u l l e t in
navci
fro m p a g e 8
a ltie s e x is t - th e re g io n , th e n a tio n , and
a b o u t B a sq u e terro rism . T oday, y o u ’re
sive. E very tim e I go to th e U ffizi G a l­
E u ro p e . In th e last 10 y e a rs, E u ro p e has
talk in g 150 m ile s a n h o u r a cro ss L a
M a n c h a ."
lery in F lo re n c e , I w a lk b y a 3 0 0 -y a rd -
b e e n m a k in g it, a n d th a t m ea n s the n a ­
tio n s a re b e c o m in g re la tiv e ly less im ­
D riv e rs are e n jo y in g the sam e k in d
lo n g line o f h o t, sw eaty , b o re d to u rists
w a itin g to g e t in. I c a ll th e 8 0 0 n u m b e r
p o rta n t p o litica lly , a n d th a t m e a n s the
o f im p ro v e m en ts. F ifte e n y ears ago,
tw o days b e fo re I p lan to g o a n d m ak e a
re g io n s d o n ’t th re a te n a n y o n e so m u ch
a n y m o re .”
th ere w as n o t a single free w a y in P o rtu ­
gal. “ T h e last tim e I w'as th e re ,” S teves
to com e. T h a t day, I sh o w u p w ith m y
A u n ifie d E u ro p e b rings a m u lti­
tu d e o f c h a n g e s th a t w ill b e im p le ­
re la te d “ d a y a fte r day, the ro a d s w ere
c o n firm atio n n u m b e r and w a lk b y all
sc rew in g up m y itinerary. I w as a rriv in g
th o se p e o p le in line. I go in, e n jo y the
m e n te d in th e n e x t few' years. M u c h to
at m y d e stin a tio n s ho u rs b e fo re I
m u se u m , and lea v e b e fo re th e last p e r­
th e p le a su re o f the a u d ie n ce o f p h y si­
th o u g h t I w ould thanks to the fre e ­
w a y s."
so n in th at line h a s re a c h e d th e tu rn ­
In N orw ay, “ fo u r m illion people are
filling the lo n g est tu n n els in the w o rld
b laz in g to g eth e r the fjords for h ig h ­
e v ery year, but fo r th o se p e o p le in line,
th ey h ave one d a y in th e ir life in F lo ­
re n ce a n d th ey are sp e n d in g tw o hours
w ays c o n n ec tin g th e ir to w n s a lo n g the
w est c o ast,” S tev es said. Ju st a few'
years ago, D en m ark and S w eden
open ed a m assiv e b rid g e c o n n ec tin g
o f it w a itin g to g e t into the m u se u m .
T h a t’s ju s t b a d tra v e lin g .”
c ia n s, S te v es e x p la in e d th a t n e x t y e a r
e v e ry re sta u ra n t in E u ro p e is re q u ire d
to h a v e a sm o k e -fre e zo n e, “ w h ic h is
ra d ic a l,” h e said. “I n e v e r th o u g h t it
w o u ld h a p p e n in E u ro p e." A n a d v o cate
o f sm o k e -fre e e sta b lish m e n ts for y ears,
S tev es re a liz e d he w as d isc rim in atin g
a g a in st sm o k e rs w h e n his E n g la n d
b o o k d id n ’t list one sin g le b e d and
b re a k fa st th a t a llo w e d sm okers. “M y
frie n d s w h o ru n little h o tels in F rance,
Italy a n d S p a in w ill lo se m o st o f their
b u s in e s s if th ey go sm o k e free, because
M e d ite rra n e a n p e o p le sm o k e like c h im ­
those tw o c o u n tries, and M alm o , S w e ­
den and C o p e n h ag e n . D e n m ark are now'
th e sam e m etro p o litan area. “ T h e a d ­
v an ce m e n ts are literally c h an g in g the
face o f travel in E u ro p e," he said. “E v ­
n e y s ." he e x p la in ed . “ M y frien d kept
ery tim e I d o m y th ree -w e ek loop
aro u n d E urope, there are a bout tw o
te llin g m e, ‘Ju s t w a it a c o u p le o f years
and th ese A m e ric a n s w ill g e t o f f this
hours less d riv in g tim e due to n ew
roads a n d b rid g e s.”
n o -sm o k in g k ic k .’ 1th in k E urope is g o ­
W hile tran sp o rta tio n is v a stly im ­
p ro v ed , c ro w d s and lines at tourist
sites c o n tin u e to b e a m ajo r concern
and p ro b lem . “ I f y o u ’re a sm art trav ­
e ler,” S teves said, “y o u ’ll th in k about
the lines. T here are tw o IQs o f E u ro ­
pean trav e le rs - those w ho w a it in lines,
ing v e ry q u ick ly into sm o k e free. N ext
y e a r is a b ig year, b e ca u se even p u b s
w'ill be re q u ire d to e n fo rc e the new
re g u la tio n . T h a t w ill be q u ite a
stru g g le ."
U n ifica tio n has also b ro u g h t g reat
a d v a n c e m e n ts, S teves said. A s E urope
u n ites, he e x p la in ed , it is re co g n izin g its
w e ak lin k s a n d in v estin g in th o se links.
“ T ra n sp o rta tio n in E urope is b re a th ta k ­
in g .” he said. “ A ll o v e r E urope, th ey are
in v e s tin g in th eir tran sp o rta tio n in fra­
and th o se w h o d o n ’t. W hen 1 com e to
an a ttrac tio n a n d see long lines, it’s m y
re sp o n sib ility to m y read ers to find a
w ay aro u n d th o se lines. A nd it’s v irtu ­
ally alw ay s p o ssib le to do it.” he e x ­
p lain ed , “ You really n e ed to be a g g re s­
re se rv a tio n fo r th e d a y a n d tim e I w a n t
stile. T h e sa d iro n y is th a t I g e t to go
It’s a fun c h a lle n g e to trav e l
sm artly, S tev es said, a n d it’s n o t ro ck et
scien ce. A ll o v e r E u ro p e th ere are g reat
w a y s to g et aro u n d the lin es. A n d once
y o u ’re in the m u se u m s, th ere is w o n ­
derfu l new' te c h n o lo g y a v a ila b le to e n ­
han ce y o u r e x p erien c e . A t th e T ate G a l­
lery in L o n d o n , v isito rs can re n t a n a u ­
dio w a n d fo r S I .50, tak e it th ro u g h the
gal lery a n d h e a r p re -re c o rd e d c o m ­
m en ts from the m u se u m c u ra to r on the
m a jo rity o f p iec es on d isp lay . “I t ’s w o n ­
d e rfu l,” S tev es said, “ a n d th a t k in d o f
th in g is h a p p e n in g all o v e r E u ro p e .”
A TM m a c h in e s h a v e m ad e trav e l­
ing in E u ro p e easy a n d a c c e ssib le . "I
d o all m y tra v e ls on o n e A T M c ard ,”
S teves said. T h e In te rn e t is a g re a t tool
for c h ec k in g w eather, b o o k in g flig h ts,
m a k in g h otel re se rv a tio n s a n d k e e p in g
in to u ch w ith frie n d s a n d fa m ily b a ck
h om e o n ce y o u ’re on the ro ad . Y ou can
k e ep c o n n ec te d to h o m e via a cell
See “T rav el" page 14
stru c tu re like w e c an n o t im a g in e.” T he
E n g lish C h an n el T un n el no w allow s
tra v e le rs to go from B ig Ben to the
E iffel T o w e r in ju s t tw o and a h a lf
h o u rs. “ M o re b u sin e ss trav e le rs now
g o to L o n d o n a n d P aris via train than
b y all a irlin e s p u t together, S teves said.
“ I t ’s the w a y to go. A n d it m akes m ore
sen se n o t to deal w ith th e a irp o rts i f
y o u d o n ’t have to .”
S tev es also to u te d the b u lle t trains
o f S pain. “ I f y o u had told m e 20 years
ag o th ere w o u ld be b u lle t train s in
S p ain , I w o u ld th in k y o u w ere talk in g
10
PC M S BULLETIN
January, 2004
UNION AVENUE PHARMACY
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In My Opinion....
The Invisible Hand
c M v d k a f r j o c tt/if
*>yAndrew statson,
md
T h e o p in io n s e x p r e s s e d in th is w ritin g a re s o le ly th o s e o f the a u t h o r. P C M S in v ite s m e m b e rs io e x p re ss t h e ir o p in io n .'in sig h ts a b o u t s u b je c ts
relevan t to the m e d ic a l co m m u n ity, o r s h a re th e ir g e n e r a l in te rest s to rie s . S u b m is s io n s a re s u b je c t 10 E d it o r ia l C o m m ittee review .
Marx and Medicare
“One m an d u rin g an h our is w orth j u s t as m uch as
a nother m an during an hour. Time is everything,
m an is nothing; he is at the m ost tim e s carcass. "
K arl M arx (1847)
A n d rew Statson. MD
W earing his proletarian blinders,
Marx concluded that everything o f
value is the product o f so m eo n e’s labor.
Since he believed in equality, he p o stu ­
lated that w hat one w orker can produce
in an hour is as valuable as w hat any
other w orker can produce during the
same tim e. W ith his labor theory o f
value, he p roclaim ed that the value o f
goods is determ ined by the tim e re­
quired to p roduce them .
He had to adm it that no am ount o f
w ork can give value to a useless object.
He sidetracked the issue o f art v alu a­
tion. In his view, art w as an indulgence
of the higher classes, not relevant to
the working world.
A pplied in practice, the labor
theory o f value produced the econom ic
disasters o f E astern Europe. W hile the
Berlin Wall crum bled and the Evil Em ­
pire disintegrated, the M arxian ideas
blossom ed in our ow n back yard. M edi­
care em braced them as it unveiled its
RBRVS.
At the core o f th e R esource B ased
Relative Value Schedule lurks the labor
theory o f value. It takes so m any hours
to do a procedure. Add the cost o f
training, am ortized over the lifetim e o f
practice, add the overhead and other
expenses, and y o u com e up w ith the
value o f the service.
Like socialism , this concept has the
attraction o f simplicity. L ike socialism , it
has the flaw o f delusion. T hat is not re­
ality. T hat is not how people determ ine
value.
To avoid delving into axiology. I'll
skip the discussion o f w hy the labor
theory o f value is w rong. I’ll only sub­
m it a very sim ple exam ple: W hen you go
to the grocery store, there is a differ­
ence in w h at you tend to buy dep en d ­
ing on w h eth er you are hungry o r you
just had a big m eal. S om ehow the value
o f the m oney in y o u r pocket, relative to
the price o f goods in the store, is influ­
enced by the condition o f y our stom ­
ach.
E very tim e som eone uses force to
im pose artificial valuations on the m ar­
ket, the result is a distortion o f pricing.
Yet prices are a regulatory signal, re­
flecting the relative abundance or scar­
city o f goods and services. A ltering
them is like injecting epinephrine in a
subject. T he econom y receives the
w rong signals and responds by increas­
ing production and m aking investm ents
in the w rong sectors.
A fter M edicare becam e enacted,
d uring the late sixties and early sev en ­
ties, the subsidies to the patients raised
prices and induced a boom in hospital
construction and m edical and nursing
school enrollm ent. W hen the squeeze
cam e on in the eighties, that boom
turned into a bust, w ith hospitals
d o w nsizing o r closing. T he fate o f The
D octors H ospital o f T acom a is an ex ­
am ple o f w hat happened across the na­
tion.
W hen the m arket is im paired, so m e­
one has to m ake econom ic decisions in
its place. T he price signals d o n ’t work,
so som eone has to decide w h a t to p ro ­
duce, how m uch, and how to p rice it
w hen it gets to the stores. In R ussia,
that w as done b y a ccntral p lanning
com m ission. T hey h a d five y e ar plans
for investm ents and p roduction. T hey
set the retail prices o f goods.
T he result w as a dysfunctional
m arket. T he stores had goods on their
shelves th at few w a n ted to buy b e ­
cause their p rice w as too high for their
usefulness. T hen, from tim e to tim e, the
stores got goods p e o p le could use and
that w ere priced too low. W ithin an
hour o f receiving the shipm ent, a line o f
buyers w ould stretch outside the store.
A day or tw o later, the w hole shipm ent
w ould be sold.
T he store clerks, how ever, kept
part o f the goods in the b ack room and
sold them later to friends at a h igher
price, thus creating a b lac k m arket. Le­
gal? No. C om m on? Yes. The m arket al­
w ays reigns suprem e, even in a d icta ­
torship, even under the threat o f c o n ­
centration cam ps and firing squads.
T he b lack m arket is the inev itab le result
o f econom ic interv enti 011 is m .
So how is that goin g to play out
here? W hether adm itted o r not, the role
o fth e RBRV S is to control costs. A fter
p rom ising T he G reat Society, C ongress
could not go back to the p eople and
say, “ Sorry, you c a n ’t have it. We c a n ’t
pay for it.” Instead, th ey decided to re­
duce availability.
To achieve that, they had to cut
See "M arx" page lh
January, 2004
PCMS BULLETIN
11
B
u l l e t in
Applicants for Membership
Pamela L. Alvarez, MD
Saifuddin M. Kasubhai, MD
N e u ro lo g y
M e d ica l O n c o lo g y
T ac o m a S o u th M e d ica l C linic (F M G )
2111 S 9 0 th St, T acom a
N o rth w e st M ed ical S p e c ia lties
253-539-9700
M e d S ch o o l: F in ch U n iv e rsity
In tern sh ip : St. Jo s e p h M e rc y H ospital
R e sid e n c y : U n iv e rsity o f M ic h ig a n H o sp
1624 S I St #405, T acom a
253-428-8700
M ed School: G ra n t M ed ical C o llege
Internship: L in c o ln H ospital
R esidency: L in c o ln L lospital
Eugene Cho, MD
F ellow ship: A lbert E in stein U n iv e rsity
G en eral Surgery
TaeheeKim,MD
C e n te r fo r M .I.S .
1802 S Y akim a #202, T acom a
253-572-7120
Internal M e d icin e
G ig H arbor M edical C linic (FM G )
M e d S ch o o l: N o rth w e ste rn U n iv e rsity
Internship: W illiam B eau m o n t H ospital
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M ed School: U n iv e rsity o f N e w M exico
Medical problems, drugs, alcohol,
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or other such difficulties?
6401 K im ball Dr, G ig H arbor
253-858-9192
F e llo w sh ip : U n iv e rsity o fM a ry la n d
Internship: G o o d Sam & E m m an u el H osp
R esidency: G o o d S am & E m m an u el H osp
M arta D zurilla, M D
Kenneth H. Shibata, MD
In te rn a l M e d ic in e
In tern al M e d icin e
St. Jo se p h M e d ica l C lin ic (F M G )
1708 S Y akim a #110, T acom a
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1708 S Y akim a #110, Tacom a
253-627-9151
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In tern sh ip : U n iv e rsity o f O k la h o m a
253-627-9151
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R e sid en c y : U n iv e rsity o f O k lah o m a
Personal Problems of
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Internship: M ed C o llege o fV irg in ia H osp
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B ren don B. H utchinson, M D
Y ou r c o lle a g u e s
w a n t to help
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Bill D ean, MJD
272-4013
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MEDICAL LICENSURE ISSUES
M r. R o ck w ell is a v ailab le to re p re se n t p h y sic ia n s and o th er health care
p ro v id e rs w ith issues o f co n cern before the Slate M edical Q u ality A ssurance
C o m m issio n . M r. R o c k w e ll, a p p o in te d by G o v e rn o r B ooth G ardner, served lor
8 y e ars as the P ublic B oard M e m b er o f th e M edical D isciplinary B oard from
1 9 8 5 -1993. S ince then, M r. R ockw ell has su c c essfu lly represented o ver 60
p h y sic ia n s on c h arg e s b e lo re the M Q A C , M r. R ockw ell s lees are co m p etitiv e
and the su b je ct o f a c o n fid e n tia l a tto rn ey -c lie n t re p resen tatio n agreem ent.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(4 2 5 )4 5 3 -4 3 9 8 • FA X (425) 453-1534
email: [email protected] • website: www.gregrockwelllaw.com
12
P C M S BULLETIN
January, 2004
TACOM A/PIERCE COUNTY
O u tp a tie n t G e n e ra l M e d ic a l C a re .
F u ll a n d p a r t - t i m e p o s i t io n s
a v a ila b le in T a c o m a a n d v ic in ity .
V e r y fle x ib le .s c h e d u le . W e l l s u i t e d
fo r c a r e e r r e d e f i n i t i o n f o r
G P , F P , IM .
C o n ta c t A n d y T s o i, M D (2 5 3 ) 7 5 2 -9 6 6 9
o r P a u l D o ty (A lle n , N e lso n , T u r n e r
A sso c.), C lin ic M a n a g e r (2 5 3 ) 3 8 3 -4 3 5 1
Most intriguing medical facts o f2003
A m e rica n M ed ica l N e w s encounters a n um ber o f fascinating pieccs o f in form ation every w eek. E ach y e ar they look b a ck at
the y ear ju st past, and select the m ost interesting or notew o rth y facts from each issue. I f you w an t a copy o f any o f these articles,
go to am a-assn.org or sim ply call PC M S at 572-3667.
• 46,000 U .S. adults die each y ear from diseases that vaccines
can prevent. (D ec. 22/29)
• States w ith the m ost diabetics: A labam a and M ississippi.
(June 23)
• Only 5% o f sm okers successfully quit each year. (D ec. 15)
• E ach day, 17 people in the U nited States die w aiting for an
■O ne-third o f patients follow d o c to rs’ treatm ent recom m enda­
tions regularly. (D ec. 8)
• W orldw ide, there are 745,000 m easles deaths each year.
(Dec. 1)
• A bout 8% o f the adult p opulation and 5% to 9% o f children
are affected by serious m ental illness. (Nov. 24)
•A sth m a is the No. 1 reason for school absenteeism . (Nov. 17)
• SARS has been added to the list o f com m unicable diseases
for w hich quarantine is authorized. (Nov. 10)
• 1.2 m illion office surgeries are done each year. (Nov. 3)
• 60% o f M ississippians are overw eight. (O ct. 20)
• 38% o f health p rofessionals get annual flu shots. (O ct. 13)
• One Singapore hospital spent $ 13,000 a day on m asks and
gloves during the SA RS outbreak. (Oct. 6)
• A third o f diabetics m ay be undiagnosed. ( Sept. 22/29 )
• M edication errors cost the health care system m ore than
$1 billion a year. (Sept. 15)
• M ore than 70% o f p ractices are sm all enough to be exem pt
from HIPAA. (Sept. 8)
• M edicare pays up to 88% m ore than the VA for som e durable
medical equipm ent. (Sept. 1)
• It cost $700 to vaccinate a 2-year-old in 2003. (Aug. 25)
• One in 133 A m ericans is at risk for celiac disease. (A ug. 18)
• 80% o f strokes can be prevented. (A ug. 11)
• Only 2 states have law s requiring doctors to w rite legible
prescriptions. (Aug. 4)
• SCHIP covers children w ith fam ily incom es o f up to 200% o f
poverty level. (July 28)
• Recent studies on horm one therapy have discredited
benefits. (July 21)
• 1 in 5 adults cannot afford to buy som e or all o f his
prescribed m edicines. (July 14)
• The biggest U .S. health problem s are related to eating,
drinking and sm oking. (July 7)
• 16 states im pose cigarette taxes o f $ 1 o r m ore; the average is
69 cents. (June 30)
o rg a n .(Ju n e 16)
• O nly 5% o f those w ho are eligible to donate blood do so.
(June 2/9)
• M edicare Part B drug spending increased 35% in 2002, to
$8.5 billion. (M ay 26)
• 25% o f the 40,000 A m ericans infected w ith HIV each year
d o n ’t know it. (M ay 19)
• O nly 10% o f A m ericans die suddenly; 90% experience a
steady decline in health. (M ay 12)
• R ecertification can cost internists $945 or m ore. ( M ay 5)
• 18,000 doctors are also pilots. ( April 28)
• It w ould take 7.4 hours a day for p rim ary care doctors to
provide recom m ended preventive care. (A pril 21)
• C alifornia E D s lost $390 m illion in uncom pensated care last
fiscal year. (April 14)
• 90% o f adverse drug reactions go unreported. (A pril 7)
• C om m uting to w ork is riskier than receiving a sm allpox
vaccination. (M arch 24)
• T he federal governm ent loses $28 billion a year from costs o f
liability' insurance and defensive m edicine. (M arch 17)
• O nly 20% o f insurance claim s are paid properly the first tim e.
(M arch 10)
• T he num ber o f A m ericans 65 or older will double by 2030.
(Feb. 24)
• C hildhood vaccines w ere 38 tim es m ore expensive in 2001
than in 1975. (Feb. 17)
• 12 m illion doses o f flu vaccine for the 2002-03 season w ere
still unsold in February 2003. (Feb. 10)
• T w o quarts o f m ucous flow each day from the sinuses into
the nose. ( Feb. 3)
• $1.4 trillion w as spent on health care in 2001, about $5,000
per person. (Jan. 27)
• 70% o f older teens have used the Internet to look up health
inform ation, (Jan. 20)
• A d m inistrative costs account for 4 0% o f the price o f an
individually purchased health plan. (Jan. 13)
• 58% o f the p ublic fears a sm allpox attack. (Jan. 6)
January, 2004
PCMS BULLETIN
13
from p age 10
p h o n e , b u t d o n ’t tak e y o u rs from h om e
h a v e to d o y o u r tra v e ls acco rd in g ly . 1
to d a y due to te rro rism , S te v e s sa id , is
o r re n t o n e at th e h o tel. F in d a c o rn e r
k n o w a lo t o f p e o p le ju s t c a n ’t h a n d le
sto re and b u y a p h o n e fo r S 100 that
th e risk a n d th ey are g o in g to be sta y ­
ju s t the d e la y g e ttin g o u t o f th e c o u n ­
try a n d the d e la y g e ttin g b a c k in. “A n d
p ro v id e s y o u w ith y o u r o w n p h o n e
ing hom e. I ’m m ak in g T V sh o w s for
n u m b e r in E u ro p e so y o u a re a cc essib le
th em . I also th in k a lo t o f p e o p le are g o ­
in g to trav el. “
2 4 /7 . Ju s t p u rc h a s e m o re tim e i f y o u
n e e d it.
K e ep the risk in p e rsp e c tiv e ,
th e r e ’s re a lly n o th in g e ls e .” H o w has
the u n e asy c lim a te a ffe c te d S te v es?
“W ell, I lea v e m y S w iss a rm y k n ife at
h o m e n o w .” K e ep in m in d , h e said, that
T h e c o n v e n ie n c e s h av e m ad e
tra v e l so m u ch easier, b u t w h a t g o o d
S teves su g g e ste d . “ L a st y ear, 12 m illio n
E u ro p e a n s h a v e b e e n o n o ra n g e alert
A m e ric a n s w e n t to E u ro p e. N o n e w e re
fo r 20 y e ars. “T h e y w ro te th e b o o k on
are th e y w ith th e la n g u a g e b a rrie rs?
ta rg e te d o r h u rt b y terro rists, is it d a n ­
" F o r 25 y e ars. I ’v e been te llin g p e o p le
g e ro u s o r not? I t ’s y o u r call. H o w m a n y
sc h o o l g ro u p s, c h u rc h ch o irs, French
g ro u p s w e n t to E urope last y e ar? T h ey
w e re all sc u ttle d v irtu a lly b e c a u se p a r­
te rro rism , so life g o e s on. I t ’s v e ry com ­
fo rta b le a n d re la x e d in E u ro p e rig h t
th e y can trav el to E u ro p e w ith o u t
sp e a k in g die la n g u a g e s. E n g lish is the
o n ly la n g u a g e 1 sp eak . A n d sin ce I
sta rte d tra v e lin g to E u ro p e, w e ’v e had
an e n tire g e n e ra tio n g ro w up sp e a k in g
b e tte r E n g lish th an ev er." H is a d v ic e to
en ts w ere j u s t too n erv o u s.
S te v es said E u ro p ea n s are q uite
su rp rise d b y o u r fears. “ E u ro p e a n s
now . S e c u rity is h ig h , as it sh o u ld be,
a n d I ’m th a n k fu l for th a t,” h e said.
“ I g u e ss I ju s t b e lie v e th ere is g o ­
ing to b e te rro rism fo r th e re st o f our
liv e s, and A m e ric a n s are g o in g to be
ta rg e te d ,” S tev es said. “ T h a t’s ju s t the
travelers'? " R a th e r th an fra n tic a lly try ­
ing to learn a few m o re F re n c h v e rb s
lau g h o u t loud w h e n th ey h e a r the
b e tw e e n n o w a n d y o u r n e x t trip , I
tra v e le rs in E u ro p e is p e tty p u rse
w o u ld re c o m m e n d th in k in g a b o u t how
re a so n s ." he said. “ L ast year, 8,000
p e o p le w ere k ille d on o u r stre ets by
to c o m m u n ic a te in w h a t the v o ice o f
h a n d g u n s - in n o ce n t v ic tim s ju s t m in d ­
A m erica calls ‘sim p le E n g lish .’ E n u n ci­
ing th e ir o w n b u sin e ss. Flow m an y w ere
k ille d b y h a n d g u n s in E u ro p e? In G e r­
ta rg e t A m e ric a n s b e c a u se th e y are car­
ry in g p u rse s a n d w a lle ts. I k n e w a
ate e v ery letter." h e ad v ises. " A ssu m e
y o u r E u ro p ea n frien d s are re a d in g y o u r
lips. U se easy, in te rn a tio n a lly u n d e r­
sto o d w o rd s — no c o n tra c tio n s, no
slang. I f m y c a r is b ro k e n d o w n in P o r­
tu g al, I p o in t to the v e h ic le and say,
‘A u to c a p u t.’ T h a t w o u ld b e u n d e r­
sto o d .” Fie does re co m m e n d you a l­
A m e ric an s are sta y in g h o m e for sa fety
w a y it is.
S tev es said th at th e real risk for
sn a tch in g a n d p ic k p o c k e tin g . “ T hieves
w o m a n w h o had h e r p u rse sn a tch e d a
m any, 180; in E nglan d, 112; in N orw ay,
18. Now', th a t’s a danger. I f y o u care
fe w y e ars ag o , and in h e r p u rs e w as her
m o n ey belt. T h is is w h y th ey ta rg e t us!
a b o u t y o u r loved o n es, y o u ’ll take them
T h e th ie v e ry in E u ro p e is q u ite p re d ic t­
to E urope to m o rro w !”
T h e p ractical im pact o f trav e lin g
a b le ," h e ad d ed . “ I f th e re is a n y k in d o f
See "T rav e l” page 18
w a y s ask in so m e o n e ’s lan g u ag e i f they
sp e a k E n g lish . D o n ’t ju s t a ssu m e th ey
w ill u n d e rstan d you.
W e ig h in g th e R isk s o f T errorism
"P e o p le ask m e if terrorism has a f­
fe cted travel in E u ro p e,” S teves said.
“ A ll 1 can do is relate m y e x p erien ces.
I ’ve sp en t 120 days in E urope this year,
and th ere are as m any c ro w d s as ever. I
su p p o se a few less A m e ric a n s are trav ­
e lin g , b u t m y b o o k s and to u r p ro g ram s
a re se llin g b e tte r than ev er." he said.
“ M y a d v ice to y o u is that i f you
a re p la n n in g an intern atio n al trip, you
sh o u ld p lan it w ith the a ssu m p tio n that
th e re w ill be te rro rist e v en ts so m etim e
b e tw e e n n o w and w hen you d ep art —
m o st lik e ly in th e city y o u are fly in g to.
Ju s t g et c o m fo rta b le w ith th at fact.
T h e n you h ave to d e cid e, am I g o in g to
re la te to the risk in a lo g ical, statistical
w a y o r am I g o in g to flip o u t a n d a d ­
d re ss it in an e m o tio n al w ay? T hen y o u
14
PC M S B ULLETIN
January, 2004
E I W
S E
THAT TATTOO
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BO SS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
To da y's new est A le xa n drite laser,
will rem o ve y o u r tattoo
w ith m inim al d isco m fo rt &
less than 1 % risk of sca rrin g .
< . a l l (n < U (y f o r m i > i \ ‘ i n t o n i i u i i o n
PIER CE COUNTY
LASER CLINIC
D i r e e l u r I' l i i t K, M n r s l i M . l ) ,
(2 5 3 )5 7 3 -0 0 4 7
JP iem - 'i't 'Oioiiij C K '< h r « / c j o n r / i f
Medicine faces a very important 2004 Legislative Session...
H ere is the legislative situation as the session approaches:
Tort reform supporters in the Senate w ill introduce a m eaningful om nibus tort reform bill th at includes M IC'RA elem ents. We
need to ensure that it passes the Senate on a bipartisan vote as it did in 2003.
Tort reform opponents in the H ouse w ill introduce w hat they claim is reform . T hey will try to pass it out o f the H ouse w ithout
the key elem ents that are part o f the M IC R A portion o f the S en ate’s om nibus bill.
A variety o f other related bills likely will be introduced by friends and foes alike. B ills and bill num bers will be flying. It w ill be
confusing. W SM A and PC M S w ill keep y o u inform ed a bout bill num bers and on-going status reports as they becom e available.
The H ouse m ajority leaders have p u t forth draft legislation th at focuses on changes in three elem ents, civil ju stic e , insurance
and patient safety. T h eir proposal does nothing to fix the underlying problem o f raising liability insurance rates. T h eir proposals in­
clude:
P atient Safety: Sharing o f c ontinuous Quality' Im provem ent products, funding proven patient safety/m edical e rror reduction
efforts, stricter standards on health professions discipline and requirem ent o f health care providers to participate in and com plete
patient safety education program s.
M edical m alpractice insurance: M edical m alpractice insurer reporting, u n d e w ritin g standards, developm ent o f a patient com ­
pensation fund (funded how ??? by physicians paying p rem ium s to the state!!!) and the establishm ent o f a jo in t underw riting a sso ­
ciation particularly fo r long-term care and c h ild ren ’s service providers, M edicaid reim bursem ent rate increases for ob and em er­
gency physicians, and funding for a program that pays prem ium s for retired physicians w ho w ant to volunteer.
Im proving the civil ju stice system : E arly o ffer settlem ents, m ediation and arbitration, expert w itnesses, statute o f lim itation
and statue o f repose, and m odification o f the collateral source rule.
W hile som e o f the im provem ents to the civil ju stic e system m ake sense and are supported by physicians, this draft o f sug­
gested changes is a far cry from w here w e need to be to have m eaningful reform that will im pact rales.
The m essage from m edicine is key. C om m unicate to y our legislators and patients the follow ing:
• Tort reform is about access to health care - 1 w ant to be there for you w hen you need m y services.
• Tort reform m ust include the policies th at m atter and w ill be effective - a cap on non-econom ic dam ages, periodic paym ents,
and a cap on personal injury attorney fees, to begin w ith.
• L egislators m ust be allow ed to vote on a cap on non-econom ic dam ages and the other reform s that m atter
• D on’t go hom e in N o v em b er not h aving dealt w ith this crisis. It cannot wait. A nd, let the people o f this state vote 011 a
constitutional am endm ent to cap non-econom ic dam ages.
Please contact the three house m ajority leaders (even i f not in your district ):
1. Frank C hopp (D -43) H ouse Speaker - Seattle. 360-786.7920. chopp_fr@ leg.w a.gov
2. Pat L antz (D -26) Chair. H ouse Judiciary - G ig H arbor 360/786.7964, Iantz_pa@ leg.wa.gov
3. Lynn K essler (D -24) H ouse M ajority L ea d er-A b erd e en , 360.786.7904, K essler_ly@ leg.w a.gov
O thers in Pierce C ounty that need to h ear from physicians include:
1. Dennis Flannigan (D -27), 360.786.7930, flanniga_de@ leg.w a.gov
2. Steve K irby (D-29), 360.786.7996, kirby_st@ leg.w a.gov
3. Dawn Morrell (D-25), 360-786-7968, m orrell_da@ Ieg.w a.gov
4. Jim K astam a(D -25), 360.786.7648, kastam aji@ leg .w a.g o v
5. Shirley W insley (R-28), 360.786.7654, w insley_sh@ leg.w a.gov
Points to m ake:
• I m ay not be a v o ter in y our district, but I am a resident o f our state and our health care is in jeopardy.
• We need m eaningful to rt reform , including a cap on non-econom ic dam ages.
• Please let your p arty v ote on real tort reform in the 2004 legislative session.
For help in c ontacting y o u r legislators please call P C M S, 572-3667. We w ill be happy to assist.
January, 2004
PCMS BULLETIN
15
B u LLF.TIN
Marx
fro m p a g e 11
d o w n o n th e n u m b e r o f h o sp ita l b ed s,
A s it is h a p p e n in g in B rita in a n d
c ines. A s th e p rice s o f d ru g s c o m e u n ­
M R I sc a n n e rs, p ra c tic in g p h y sic ia n s,
C a n ad a , th o se w h o can p a y o u t o f
d e r c o n tro l, th o se sh o rta g e s w ill in ­
y o u n a m e it. “ Y ou w a n t a n o th e r m a m ­
p o c k e t go to p riv a te h o sp ita ls o r
m o g ra m ? Y ou b e tte r sc h e d u le it on y o u r
crease.
A t the sa m e tim e , th e sq u e e z e o n
w a y o u t o f th e d e p a rtm e n t. W e are
ab ro a d to g e t th e ir trea tm e n ts. T h o se
w h o c a n ’t pay, w ait. A s one o f m y d e r­
b o o k e d so lid fo r the n e x t six tee n
m o n th s .”
m ato lo g y frien d s o nce said, “ W h en the
p o o r h ave an itch, th ey scratch . T he
T h e n , w h e n it tak e s tw o y e ars to
sc h e d u le an e le c tiv e p ro c e d u re , as it
rich go to a d e rm a to lo g ist.” N o m atter
m en ts w ill in cre ase a n y w h e re n e a r the
w h a t w e m ay w a n t to b e lie v e, m u lti­
ra te at w hich o u r o v e rh e a d is risin g , i f at
d o e s in B rita in a n d C a n ad a , lh e y ’11 a p ­
tie red h ealth care has n e v e r c eased to
exist. T h ere alw ay s h a v e b e en and
all. A t so m e p o in t in th e n o t too d ista n t
lem a n d p ro p o se m e a su re s to re d u c e the
th ere alw ay s w ill be so m e w'ho are m ore
w a itin g tim e s fo r se rv ice s. T h e re c o m ­
equal th an the others.
c o m e a n d w e w ill h a v e to q uit.
W e are n o t th ere y e t, b u t so o n the
m e n d a tio n p ro b a b ly w o u ld be to e sta b ­
R ig h t now , the sh o rtag e is e v id en t
m o stly in the sta ffin g o f h o sp itals and
lab o rato ries. T h ere h av e b e en te m p o ­
p o in t a c o m m issio n to stu d y the p ro b ­
lish a P ro m p tn e s s C o n tro l B o a rd to
o v e rse e th e sc h e d u lin g and in v estig a te
all c o m p la in ts a b o u t d elays.
rary sh o rta g es o f in je c ta b le s and vac-
p h y sic ia n s w ill c o n tin u e . E v e n i f th e
p ro je c te d cu ts in th e M e d ic a re fe es are
re p e a le d , w e c a n n o t e x p e c t th a t p a y ­
fu tu re, o u r c o sts w ill o u tstrip o u r in ­
tim e w ill co m e w h e n w e ’ll h a v e to p la n
for a p a ralle l fe e -fo r-se rv ic e sy ste m , in­
d e p e n d e n t fro m th e g o v e rn m e n t and
free fro m g o v e rn m e n t in te rv e n tio n . It
w o u ld b e n ice i f w e c o u ld e stab lish
su c h a sy ste m openly. H o w ev e r, y o u
Allenmore
»SSu Psychological
Associates, P.S.
...a m u lti­
d iscip lin ary
b ehavioral
health group
that w orks
w ith p h ysician s
can b e sure th a t i f th e g o v e rn m e n t
sh o u ld tiy to forbid it, a b la c k m ark e t
w ill arise, n o m a tte r w h a t th e p e n a ltie s,
ju s t as there w as a b lac k m a rk e t fo r
a b o rtio n s w h e n th ey w e re ille g a l.*
752-7320
D o you have patients w ith difficult em otional
and stress-related problem s? Psychiatric and
psych o lo g ica l consultations are available.
CORRECTION
A n e rro r w as m a d e in Dr. S ta tso n ’s
U n ion A ven u e Professional Building
_____________ 1530 U n ion A ve. S.. Ste. 16, Tacoma__________
a rticle “R e la tiv e V alue” w h ic h app eared
in the D e ce m b er 2003 P C M S B ulletin.
O n p a g e 14. fourth p a ra g ra p h , the
se c o n d se n ten c e sh o u ld read: “T h e 1CD
co d es w ill in crease from the 10,000 w e
n o w h a v e to 1 4 0 ,0 0 0 .”
W e a p o lo g iz e for th e error.
rauelerS
L
H e a lth
S e rv ic e
A s e rv ic e o f
N o r th w e s t M e d ic a l S p e c ia ltie s ,
pllc
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• P R E -T R A V E L C A R E
HOURS
MON - FRI 9 - 5
A S E R V IC E OF
IN F E C T IO N S LIM ITED PS
16
P C M S B ULLETIN
• P O S T -T R A V E L C A R E
CALL EARLY WHEN PLANNING
January, 2004
____
VO LVO
BM W
SERVICE & REPAIR
(253) 588-8669
2 5 3 -4 2 8 -8 7 5 4
w w w .volvorepair.com
o r 253-627-4123
B o y le ’s F o r e ig n C a r R e p a ir
7 2 0 2 S te ila c o o m Blvd S W
220 - 15111Ave SE #B, Puyallup WA 98372
V—
--------------
/
YOU'RE INVITED!
Community Health Care, The Pierce County M edical Society and Pediatrics
N orthwest invite you to jo in a celebration o f the contribution to our com m u­
nity by Dr. George Tanbara and Com munity Health C are’s 35th Anniversary.
SAVE TH IS DATE
WEDNESDAY, MARCH 24, 2004
Tacoma Sheraton Convention Center
Social Hour at 5:30 with D inner at 6:30
For M ore Information or Tickets:
//commhealthdinner.kintera.org/
or call (253) 597-4550
C O Mjut U N I T Y
'A LT H
are
Sponsored In Part By:
W h e re (tyrne is th e final w o rd
Key Bank
w w w .cornm liealth.orE ’
January, 2004
PCMS BULLETIN
17
B
u l l e t in
Travel
from p age 14
b ig c o m m o tio n , it is lik e ly d e sig n e d to
w e alth . A n d w e ’ve e le c te d a g o v e rn ­
w ith us o n top a n d e v e ry o n e e lse try in g
d is tra c t p e o p le — th e p ic k p o c k e ts are
m en t th a t’s d o in g e v ery th in g it can to
to g et there. I re a lly b e lie v e d th at, a n d it
p ro b a b ly a t w o rk . I f y o u h av e a w a lle t
m ak e us w ealth ier. T h a t’s w h o w e vo ted
w as up to us to e n lig h te n p e o p le w h o
o r p u rse , e x p ec t to lo se it. I f you are
for and w h y ,” he e x p lain ed .
c a rry in g a p u rse , m a k e su re y o u o n ly
“T h e gap is g ro w in g b e tw ee n rich
a n d po o r,” S teves p o in te d out. “ M o n e y
d id n ’t u n d e rsta n d that. I ’ve m e t p e o p le
w h o h a v e less fre e d o m th an m e, less o p ­
h a v e a little sp e n d in g m oney, o d d s and
e n d s, a n d a fu n n y little note to the
p o rtu n itie s, less m o n e y a n d th ey
w o u ld n ’t tra d e p a ssp o rts. I t ’s v e iy in sp i­
th ief. E v e ry th in g that m atters sh o u ld be
is c o m in g from d e sp e ra te ly p o o r c o u n ­
tries into o u r c o u n try m uch fa ste r th an
tie d to y o u r bod y , tu c k e d in like y o u r
it’s g o in g the o th er w ay. T h a t’s a fact
ra tio n al.”
E x p e rie n c e s like th a t a re w h a t m akes
sh irtta il, or left in the hotel. R o u tin e ly
that m an y A m e ric an s ju s t c a n ’t b e lie v e,
b ut the resl o f the w o rld a c c ep ts it.
v a lu e trav el. “ T rav e l to m e - g o o d travel,
w h e n I am in E u ro p e, I feel the h a n d o f
a stra n g e r slip p in g into m y pocket. A nd
I ’m w e a rin g a m o n e y belt, so i t ’s ju s t
o n e m o re in te re stin g c ultural e x p eri­
e n ce. It’s n o t a big d eal. D o n ’t be vul­
n e ra b le .”
A D iffer e n t P ersp ective
H is v ie w p o in t m ay seem q uite d if­
ferent th an y o u r a v era g e A m e ric an tra v ­
eler, b u t th a t m ig h t b e b e ca u se S ieves
has sp e n t a th ird o f his life in E urope. “ I
h a v e a d iffe re n t w a y o f lo o k in g at
thin g s. T h ey tell m e — and 1 believe it
— th a t h a lf the w o rld is try in g to live
on $2 a day. T h a i’s th ree b illio n people.
T h ey e x p la in to m e — a n d I believe it
— th at 4 p e rc e n t o f this p lan e t is the
U n ited S ta te s and w e control h a lf o f th e
S tev es so c o m m itte d to w h a t he calls
O nly A m e ric a can be o u tv o te d in the
U N 180 to 2 and not find it cu rio u s. O r
be in d ig n a n t and say e v ery o n e else is
th o u g h tfu l trav e l - b rin g s u s tog eth er. I t ’s
gan g in g u p on us.
“ W hen w e travel, w e h a v e to a s ­
su m e there w ill b e terro rism . W e h a v e to
th ey c o u ld vote, I th in k o u r c o u n try
w o u ld fit b e tte r in to this e v e r-sm a lle r
a b e au tifu l thin g . I th in k w e n e e d it m ore
th an ever. I f e v e ry o n e tra v e le d b e fo re
keep the risk in p e rsp ec tiv e . A nd, i f you
w ant lo keep th o se in sig n ific an t risks
sm aller, you can travel the w ay I ’ve
been p re ac h in g fo r 25 y e ars - through
p la n e t.”
T h e re ’s a m ag ic o f trav e l, S teves
n o tes, and as a tra v e l w riter, h e is alw ays
lo o k in g fo r th o se m ag ic al m o m en ts.
“T h e y are n o t a d im e a d o z e n ,” he e x ­
plain e d . “ Y ou h a v e to look lo n g and hard
the b a ck door. Y o u ’re m eltin g into E u­
ro p e .”
fo r th em . A n d w h en I fin d th em , I ’m a
v e ry h a p p y trav e le r.”
A n d so are his re a d e rs, v ie w e rs and
H ow Travel Can O pen Your M ind
“T he d riv in g force for m e in m y
c lie n ts .■
w o rk is ho w travel can bro ad en y o u r
p e rsp ec tiv e s," S teves said. "I w as
raised k n o w in g the w orld is a p y ra m id
Note: M any thanks to Rick Steves fo r donating
10"o of the proceeds from the evening's book
and D I ’D sales to YIVCA Shelter residents.
Full Service Im aging • Call Central Scheduling at (253) 761-4200
O
u t p a t ie n t
S e r v ic e s A
v a il a b l e
S h o rt-b o re MR I • PET -H ig h Speed CT 'N u c le a r M e d ic in e
3-D U ltrasound • D ig ita l F luo ro scop y • Im age G u id e d Breast Biopsy
M a m m o g ra p h y w /C A D * Bone D e n s ito m e try (DEXA) • D ig ita l X -ray
2202 S Cedar Street, Ste 200, Tacoma
5919 100th Street SW, Lakewood
C o m in g S p rin g
W a t c h f o r us a t :
18
P C M S BULLETIN
2004, TRA
470 0 P o i n t
G ig H
TRA
arbor
F o s d ic k D
r.
NW
S te
110
M ed ical
Imaging
EXCELLENCE •PERSON T O PERSON
, ,
tramedicalimaging.com
January, 2004
X
'V.
v i:; o n t/h j '7 (((‘d u n i r '~i('•<■(ftij
President’s Page
PCMS Foundation thanks Holiday
Sharing Card contributors
from page 3
O nce again the annual H oliday Sharing C ard project w as a huge success. W ith
over 200 contributions, the p ro jec t raised o ver $ 15,000.
The card is m ailed to all PC M S m em bers w ith a listing o f nam es o f all contribu­
tors. It is an easy and effective w ay to extend holiday good w ishes to colleagues
and friends.
A nd a very big thank you m ust go to PCM S Foundation B oard m em bers M ona
Baghdadi and N ikki C row ley w ho helped with all the w ork th at accom panies such a
project, particularly the p rinting and m ailing preparation
T hank you to the follow ing contributors w hose donations w ere received after
the card w ent to press:
T o sh A k a m a t s u
C e m il B a y r a k c i, M D
P a tr ic k H o g a n
M a rg a ret L a rson
win this battle. W e need y o u r po si­
tive energy flow ing into O lym pia by
e-m ail, letter and w ith personal a p ­
pearances. W rite letters to the editor.
C om m unicate now! T im e is o f the e s­
sence. T he 2004 session, only 60
days long, begins January 12. The
PC M S office can a ssist you w ith
your response.
I do not intend to be the c are ­
taker in a system o f slow decline. As
y our president, I w ill not retire into
the shadow o f subm ission. I will be
proud to help lead this m ission for
the physicians o f Pierce C ounty to
the inevitable trium ph I know w e can
obtain, helping to reju v en ate the
practice o f m edicine in W ashington.*
D a v id M c E n ir y
D r s. P a u l N u tt e r & M a r ia R . R e y e s
C h a r le s a n d S h a u n a W e a t h e r b y
O u r Clinical
PET Specialists
O
n
-
p a t ie n t ' s
Anthony Larhs, MD
Director of Clinical PET
l in e
v ie w in g
PET
o f
your
IM A G E S A N D
W IL L S O O N
REPORTS
BE A V A IL A B L E .
Phillip C Lesh, M D
William B Jackson, M D
Please contact a TRA Custom er Care
Representative to ge t more inform ation
(253)761-4200.
For information call
( 253 ) 761-4200
Roy McCulloch, BS, CNMT
Supervisor PET & Nuclear
Medicine
2202 S Cedar Street, Ste 200
(253) 761-4200 fo r scheduling
tra m e d ic a lim a g in g .c o m
TRA
M edical
Imaging
Centers
TA C O MA
January, 2004
PCMS BULLETIN
19
B
u l l e t in
In My Opinion....
by Teresa Clabots, MD
T h e o p in io n s e x p r e s s e d in t in s w r itin g a r e s o le ly th o s e o f t h e a u t h o r. P C M S in v ite s m e m b e rs to e x p re s s t h e ir o p in io n / in s ig h t s a b o u t s u b je c t s
le ie v u n t to the m e d ic a l c o m m u n ity , o r s h a r e t h e ir g e n e r a l in te re s t s to r ie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itt e e re v ie w .
Mistakes You Can’t Afford to
Make When You Have Kids
Teresa C luhots. M D
L ittle did I k n o w th at m y five
b u n d le s o f jo y w o u ld turn into ra m ­
So w e g ave it away.
b u n c tio u s te e n a g e rs, a n d to g e th e r w ith
A fte r su rv iv in g tea c h in g th em to
drive, g e ttin g them b e a te r cars, p a y in g
w e re se rio u s a n d he w o u ld h a v e to
th e ir fu n -lo v in g frie n d s w o u ld cause m e
fo r sp e e d in g tic k e ts and sm all din g s
d riv e th a t to sch o o l. H e to o k it all in
re a so n s to h a v e g ra y hair.
T h ese v e ry a ctiv e tee n ag e rs
and d en ts out o f p o c k et, w e got a n o ­
tic e from State Farm . O n e m o re accident
stride, w a x ed it th ree tim e s, b o u g h t dice
to hang from the re a r v ie w m irro rs,
sta rte d to w o rry us w hen th ey en tered
o r tick et and they w ould d rop us. So
o u r son and his lead fo o t w ere in the
b o u g h t z e b ra c o v ers fo r the se a ts and
th e d riv in g age. W e w ere fa ce d w ith tre ­
m en d o u s liability risks on a d aily b asis,
w ith the im p e n d in g c atastro p h ic a cc i­
d e n t lea v in g us o n e step a w ay from
b a n k ru p tc y .
M an y a sle e p le ss n ig h t I w a ite d up
fo r o u r tee n ag e rs. F o r w h a t w o u ld h a p ­
pen, G o d forbid, i f o n e o f o u r c hildren
w e re in v o lv e d in an in ju ry a ccid en t, and
th ey w ere a t fau lt? W e, as p aren ts,
w o u ld b e liable sin c e the cars and in­
su ra n ce are in o u r n am es.
It se e m s th a t w e are liable fo r e v ­
e ry th in g . A ll the toys w e h a d a cq u ired
so w e co u ld h a v e fun w ith o u r kids and
th e ir friends (th e b o a rd , the je tsk i, the
tram p o lin e ) are all a c c id e n ts w a itin g to
n a n n y m o b ile (an old w h ite T aurus sta ­
tion w ag o n ) a n d oops, a cc id e n tally ran
set o f f for school in a c a r th a t w o u ld n 't
g o o v e r 30 M P H . H e w o n th e a w a rd for
b e a te r o f t h e m onth.
into a n o th e r c ar w h ich w as a
b e alerm o b ile. O u r son instantly gets
T h en w e sta rte d g e ttin g sm art. A f­
te r h e arin g ab o u t all th e w a te r a c c i­
out o f th e car, and in fro n t o f four w it­
n e sse s (his fo u r co usins visitin g ) tells
d e n ts, a sk ie r in o u r lak e hit a co n cre te
the o th er tee n ag e driver, “P le ase d o n ’t
re p o rt it to the insurance, m y paren ts
are both d o c to rs and they w ill b u y y o u r
c ar so y o u can g et a n e w o n e .”
We paid som e a b su rd a m o u n t for
the b e a te n n o b ile , w hich then sat o n our
d riv ew ay and re fu sed to sta rt ( I w as
d o c k a n d e n d e d u p in H a rb o rv ie w and I
k e p t h e a rin g o f d ro w n in g s, w e talk e d to
o u r in su ra n ce agent. H e w a s m o re than
h a p p y to sell us a lia b ility u m b re lla and
su g g e ste d th a t w e talk to an atto rn ey
a b o u t g e ttin g a liab ility w aiver.
O u r a tto rn ey re c o m m e n d e d the fol­
lo w in g lia b ility w a iv e r b e sig n e d by
a n y o n e th at c am e to o u r h o u se (see
p a g e 20).
h a p p en .
A fte r one o f our kids a cc id e n tally
goin g to m ake m y son d riv e it for
aw hile). T hat hunk o f ju n k w e ren am ed
the trash m o b ile, a n d d o n a te d it to c h a r­
ity, w ho cam e and hau led it away.
E v ery tim e our son w as in an a c c i­
b ro k e a n o th e r c h ild ’s fo rearm o n the
tra m p o lin e . S tate F arm th re a te n e d us
w ith term in atio n , sa y in g w e w ere high
dent, w e w o u ld d e m o te him . T h at m eant
he w ould driv e a sm aller, and slo w e r car.
A fte r sev eral d e m o tio n s, I w e n t to
hom e. O n e v e ry sto u t g irl d e c id e d to
risk. I to ld them , first o f all, w e had been
w ith them fo r 20 y e ars, and seco n d o f
all, w e d id n ’t b u y th e tram p o lin e , our
th e used c a r lot and fo r $1 ,5 0 0 bou g h t
d o n ’t k n o w h o w she d id th a t trick ),
ju m p e d o v e r the d o c k , k n o c k e d th ree
ch ild had g o n e o u t w ith h is ow n p a y ­
ch ec k a n d b ro u g h t it h o m e. It d id n ’t
m atter, w e had to g e t rid o f it. T hey
ev en tre sp a sse d on o u r p ro p e rly to in­
sp e c t th at it had been rem o v ed .
I trie d to d o n a te it to the school.
T h e y d id n ’t w a n t it. T oo m u ch liability.
20
P C M S BULLETIN
January, 2004
him a b eat-u p bile green V olksw agon
B eetle. T hen 1 had to pay $400 to m ake
it d riv ab le, and d rove it hom e. 1 h a d a
O u r h e a rts w'ere a little a t ease. A t
o n e g ra d u a tio n party , w e w e re ro u n d in g
up the k id s sin ce it w as tim e to go
tak e the je ts k i on a journey. S h e re v v ed
it up, it flew o u t o f t h e w a te r (h o n e stly , I
p e o p le flat into th e w a te r like b o w lin g
p in s and crash lan d e d on th e o th e r side
h a rd tim e d riv in g it since it d id not have
p o w e r ste erin g and you had to p u t y our
fo o t to the m etal and sta n d up to m ake
it go fa ster than a go-kart.
o f th e d o c k , th en flip p e d o v e r in th e w a ­
ter, b u c k in g h e r off.
T here w ere the glim m erings o f
tears in h is ey es w'hen h e realized w e
“ H o w m a n y k id s are w e m is s in g ? ”
W ith m y h e a rt in m y th ro a t, I ra n all
the w ay d o w n to the d o c k , y e llin g ,
See “ M istakes" page 20
Continuing Medical Education
COLLEGE
MEDICAL
EDUCATION
Don’t Postpone
Hawaii CME
Arrangements
T hose interested in attending C'ME
at H aw aii are urged to m ake plans now
for both air transportation and lodging.
The C ollege's block o f seats on N o rth ­
west to H aw aii are going fast.
All W anderlands T ravel, sp ecifi­
cally Jeanette, 572-6271, is prepared to
assist you in securing your seats.
To take advantage o f the reduced
rates at our conference hotel - The
Hyatt R egency K auai - you can call di­
rectly to 1-808-742-1234.
We hope to see you there! ■
Convenient Tuesday Evening Cardiology
CME set for January 13 & 20,2004
T he C o lle g e ’s seventh annual pro­
gram featuring subjects on cardiology
for the primary' care physician will be
held at St. Joseph H ospital, L agerquist
C onference C enter Room s 1A & B. The
course w ill be directed by G regg
O stergren , DO.
T his y e a r's C ardiology for Prim ary
C are C M E program will again be offered
on tw o evenings in tw o consecutive
w eeks in January, instead o fth e tradi­
tional 6-hour p rogram on a Friday. This
y e a r’s program is scheduled for T ues­
day, January 13 and T uesday, January
20 from 6:00 pm to 9:00 pm on both
nights.
The program will begin w ith three
hours o f C M E on the 13th and end with
C o lle g e ’s recent C M E survey. P hysi­
cians are finding it d ifficult to take tim e
aw ay from their office hours.
Topics w ill include:
• C urrent T esting S trategies for A ssess­
ing Y our P a tie n ts' C ardiac Issues
• U nderstanding C ardiac D isease in
W omen
• Statins, C holesterol, and M ore
• H eart A ttack Prevention
• C o-M orbidity o f D epression, A nxiety
and C ard io v ascu lar D isease
• PFO and A SD C losure: A Clinical
P oint/C ounterpoint D iscussion ■
Dates
Program
Tuesday Evenings
Cardiology for Primary
January 13; 20
Care
Wednesday-Sunday
Alternative Whistler
Condos Available
three ad d itio n a l hours o f C M E on the
20th. T he change is in response to e x ­
pressed interest by p hysicians from the
Jan 28 - Feb 1
Friday, February 27
Ronald Graf, MD
Primary Care
Internal Medicine
March 11-12
Review 2004
lege at 253-627-7137. ■
Friday, May 21
April 12-16
Rick Tobin, MD
Endocrinology for
Thursday-Friday
Gregg Ostergren, IX)
John Jiganti, MD
CME (cv, Whistler
At press tim e, close-by condos to
the Aspens w ere still available for the
C ollege’s C M E program at W histler/
Blackcom b set for January 2 8 -3 1 ,2 0 0 4 at the C ollege’s discounted rate.
If y o u ’re interested in the program ,
and a great ski vacation and location.
To m ake reservations, you m ay call the
m anagem ent com pany at 1-866-7885588. You m ust identify y o u rse lf as a
part o f the C .O .M .E . group.
For m ore inform ation call the C ol­
Monday-Friday
Director(s)
Guijit Kaeley, MD
CME at Hawaii
Mark Craddock, MD
Allergy, Asthma &
Friday, April 30
Pulmonology for
Alex Mihali, MD
Primary Care
Advances in Women's
Medicine
John Lenihan, Jr., MD
January, 2004
PCMS BULLETIN
21
B
u l l e t in
Mistakes
from p ag e 13
L u ck ily , no one w as hurt. O u r d o c k and o u rje ts k i to o k a b e a t­
ing, b u t th e kid s w ere a ll okay.
h a d th e m for y e ars. “ I d o n ’t see it in y o u r file ,” he re sp o n d e d .
1 w as b e y o n d furious. W ith the sig n e d lia b ility w a iv er, I
fe lt like m ailin g the re p a ir b ill to the m om .
a g en t to th e n e w a g en t, so m e h o w th a t h a d n e v e r b e e n re ­
I c alled o u r in su ra n c e a g en t, w h o a d v is e d m e n o t to tu rn
the claim in.
W h a t g av e m e a c h ill w as h is n e x t c o m m e n t, “ I d id n ’t
It se e m s th a t w h e n th e b ra n c h tra n s fe rre d from th e o ld
new ed.
I call m y a g en t o n c e a y e a r n o w to b e su re th a t e v ery th in g
is u p -to -d ate.
A nd, I m ake E V E R Y O N E sig n a liability w aiver. ■
k n o w y o u h a d a b o a t a n d a je ts k i.” Y es, I a ssu re d h im , w e h ave
© Teresa Clabots, MD
Liability Waiver and Agreement
I re c o g n iz e th a t th e re are c erta in in h e re n t risk s to b o th m y /m y c h ild and h is/h e r frie n d s w h ile e n g a g in g in re cre atio n al
a c tiv itie s on the p ro p e rty , h o m e, a n d p re m ise s o f Jo e a n d T ere sa C la b o ts. I fu lly u n d e rsta n d th a t th e y live o n a lak e, have
a boat, a n d je ts k i w h ic h w ill be u s e d d u rin g m y /m y c h ild ’s sta y there. I u n d e rsta n d th a t 1 w ill b e p e rso n a lly re sp o n sib le for
a n y a n d all a ctio n s o f m y se lf/m y ch ild . I a g ree to a ssu m e full re sp o n sib ility fo r a n y c laim , lo ss o r p e rso n a l injury, o r
d a m a g e s o f a n y k in d c au se d b y th e a c tio n s o f m e /m y ch ild , b o th to o th e rs a n d to m y se lf/th e m se lv e s. I fu rth e r a g re e to
indem nify', d e fen d , a n d h o ld the C lab o ts fam ily, a n d its a g en ts h a rm le s s fro m and a g a in st a n y a n d all c la im s, su its, actions,
lo sses, c o sts o f d a m a g e s o f a n y k in d , in c lu d in g a tto rn e y s fees risin g o u t o f o r re su ltin g fro m th e a c tio n s o f th e p a rtic i­
p a n ts at th e party.
C h ild ’s N a m e ________________________________________
G u a rd ia n S i g n a tu r e ___________________________________
G u a rd ia n N a m e _____________________________________
N u m b e r (h o m e, c ell) to re ac h p a r e n t__________________
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chan gin g rapidly— and not for the better. At Physicians
Insurance Agency, there’s still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find
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To discuss the ways you can best protect you and your family,
call Physicians Insurance Agency today: (206) 343-7150 or
1-800-962-1399.
V
F
■
^
PHYSICIANS
INSURANCE
AGENCY
A Wholly Owned Subsidiary of
Physicians Insurance
© Physicians Insurance 2803__________________________________________________________________________ S/iansoml by the Washington State Medical Association
22
PC M S B ULLETIN
January, 2004
ijfyerrr t/'o u n h j 0 : ( ( n h c a / ci(K'ii'/if
Classified Advertising
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OFFICE SPACE
Tacoma/Pierce C ounty outpatient
general m edical care at its best. Full
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Andy Tsoi, M D (253) 752-9669 or Paul
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T he WA A cadem y o f F am ily P hysi­
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ington on M ay 21-22, 2004. T h is event
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r
------
"X
PCMS BULLETIN
23
BlII!
% m n tf Q M eclkJtfodehj.
i sN
re Process'
A s a claim s representative a n d su p erv iso r, I see p h y sician s of all specialties
w hose lives ate su d d e n ly ch an g e d b y claim s filed against them . W h e th e r the
cases are dism issed, settled, o r go to trial, each p h y sic ia n ’s p e rso n a l a n d
p ro lessio n al life can take a tu rn for the w orse, a n d th a t's w h y I'm h e re to
help. 1 analyze each claim , stay in close c o n ta ct w ith o u r a tto rn ey s, a n d w o rk
w ith the physician on new strategies as lire case develops. Every p h y sic ia n is
im p o rta n t to m e, a n d I m ak e su re m y w o rk show s th em th a t 1 care.
To find o u t a b o u t the m a n y w a y s P h y sic ia n s In s u ra n c e w o rk s w ith a n d
for p h y sic ia n s, call u s today.
W esle m W ash in g to n
1 -8 0 0 -9 6 2 -1 3 9 9
Eastern W ash in g to n
1-8 0 0 -9 6 2 -1 3 9 8
K ari A dam s,
C laim s S u p e rv iso r
LI'l'iHlJ ami 5pon>i.ircd h;. llv_
\ \ i iiU Y J i'l St .11• M 'id li. ,il
■ “ Physicians
wTInsurance
A Mutual Company
V lr ll o u r W .jh 5no ,u p h y iit> corn
S e n iilu , W A <£> P h y s id .in s lnsurtii)i.C‘ 2 0 0 3
i
Pierce C ounty M edical Society
223 Tacoma A venue South
Tacoma, WA 98402
PR E S O R T E D
STA N D A RD
U S P O S T A G E PAID
TACOM A, WA
P E R M IT N O 605
Return seivice requested
24
P C M S BULLETIN
January, 2004
February, 2004
Dr. Tim Schubert, right, presents a plaque of appreciation to Dr. Drew Deutsch for
his service as president o f the PCMS subsidiary Membership Benefits, Inc., 19992003. The plaque was presented at the December MBI Board of Directors’ meeting
See story page 4
INSIDE:
3
5
7
P r e s i d e n t ’s P a g e : “ D a m n t h e O d d s - F u ll S p e e d A h e a d ” b y M ic h a e l
B o a r d o f T r u ste e R e tr e a t reca p
T P C H D : “ E n d u r a n c e ” b y F e d e r ic o C r u z - U r ib e , M D
K e lly , M D
9
13
18
In M y O p i n i o n : “ C o n t e m p l a t i n g R e t i r e m e n t ” b y T h o m a s B a g e a n t ,
In M y O p i n i o n : “ C e n t r a l P l a n n i n g ” b y A n d r e w S t a t s o n , M D
In M y O p i n i o n : “ S t r a w b e r r y P a t c h ” b y D a i s y P u r a c a l , M D
MD
B
u l l e t in
P C M S O ffic e rs /T ru s te e s :
--
M ic h a e l J. K elly, M D , P resid en t
P a tr ic k J. H o g a n , D O , P re s id e n t E le c t
K e n n e th A . F e u c h t, V ic e -P re s id e n t
J o s e p h W . R e g im b a l, T re a s u r e r
S u m n e r L. S c h o e n ik e , S e c re ta ry
J. J a m e s R o o k s , J r .,M D , P a s t P re s id e n t
L a u r e l R . H a r ris , M D
J e f f r e y L .N a c h L M D
Jo se p h F . Ja sp e r, M D
N a v d e e p S. R a i, M D
R o n a ld R . M o rris, M D
C a rl W . W u lf e s tie g .M D
ffie tr e
Q (le d ic td d d o n e ff
-
BULLETIN
February, 2004
P C M S M e m b e r sh ip B enefits, In c (M B I): T im
S c h u b e r t , M D , P r e s i d e n t ; D r e w D e u ts c h , M D , P a s t
P resident.: J o e R e g im b a l,M D , S e c re ta ry -T re a s u re r; K eilh
D e m iijia n ,M D ; S te v e D u n c a n , M D ;M a r k G ild e n h a r ,M D ;
S te v e S e ttle , M D ; J o e W e a r n , M D
C o lle g e o f M ed ic a l E d u c a tio n (C .O .M .E .): Jo h n
J i g a n t i , M D P r e s i d e n t ; B a r b a r a F o x , M D , W illia m
H o ld e r m a n ,M D , S te v e K o n ic e k , M D .M a ijo r ie K ra b b e ,
M D , W illia m L e e .M D , G r e g g O s te rg re n , D O , B rad
P a ttis o n , M D . C e c il S n o d g ra ss , M D , V irg in ia
S to w e ll.M D , R ic h a rd W a ltm a n ,M D , T o d W u rs t.M D ;
H e r ta M a le ik e . G o o d S a m a rita n H o s p ita l; L is a W h ite ,
M u ltic a r e H e a l th S y s te m ; S iste r A n n M c N a m a ra ,
T re a s u r e r, F ra n c is c a n H e a lth S y ste m ; S u e A s h e r,
S e c re ta ry
P C M S F o u n d a tio n : L a w r e n c e A.
L a r s o n , D O , P r e s i d e n t ; C h a r l e s W e a th e r b y , M D,
M o n a B a g h d a d i, N ik k i C ro w le y . T re a s u re r; S u e A s h e r,
S e c re ta ry
W S M A R ep resen tatives:
T ru s te e s : L e o n a rd A lc n ic k , M D ;N ic h o la s R a ja c ic h , M D ;
P a tric e S te v e n s o n , M D
W A M .P A C 6tli D istrict: D o n R u s se ll,D O
W A M P A C 9 th D istrict: L e o n a rd A le n ic k . M D
S t a f f : E x e c u tiv e D ir e c to r: S u e A s h e r
A d m in is tra tiv e A ssistan ts: T a n y a M c C la in , C risti P eterso n
P la c e m e n t C o o rd in a to r: K en S m ith
P la c e m e n t A ssista n t: M e lis sa K re g n e ss
C M E P ro g ra m A d m in istrato r: L e s M c C allu m
B o o k k e e p e r: J u a n ita 1-lo fm e iste r
Table o f C ontents
3
P re sid e n t’s P age: “ D am n the O d d s - F ull S p e e d A h e a d ”
4
P C M S S ub sid iary , M e m b ersh ip B e n efits, Inc., p ro v id e s
serv ice and re v en u e s for m em b e rs
5
B o a rd o f T ru stee R e tre at R ecap
7
T PC H D : “ E n d u ran c e ”
8
T P C H D : “R e c o m m en d e d in crease in the lev e l o f
su sp ic io n o f S A R S ”
9
In M y O pinion: “ C o n tem p latin g R e tire m e n t"
11
H o w to c o n ta ct y o u r state a n d n a tio n a l la w m a k e rs
13
In M y O pinion: “ C entral P la n n in g ”
15
W ays to red u ce y o u r p e rso n al liab ility
17
C o lleg e o fM e d ic a l E ducation
18
In M y O pinion: "S tra w b e rry P a tc h ”
19
C lassifie d A d v e rtisin g
T h e B u l l e t i n is p u b lis h e d m o n th ly by P C M S
M e m b e rs h ip B e n e fits, Inc. D ead lin e fo r su b m it tin g artic le s
an d p l a c i n g a d v e rtise m e n ts is the I 5th o i'th e m o n th
p reced i n g pu b licatio n .
T h e B u l l e t i n is d e d ic a te d to the art, sc ie n c e an d d e liv e ry
o f m e d ic in e an d th e b e tte rm e n t o f the h e a lth an d m e d ic a l
w e lfa re o f th e c o m m u n ity . T h e o p in io n s h erein are th o se o f
th e i n d i v i d u a l co n trib u to rs an d do n o t n e c e ssa rily re Fleet the
o f f i c i a l p o sitio n o f P C M S . A c c e p ta n c e o fa d v e rtis in g in no
w ay c o n s titu te s p ro fe ssio n a l a p p ro v a l o r e n d o rse m e n t o f
p ro d u c ts o r se rv ic e s ad v e rtise d . T h e B u lle tin re se rv e s the
rig h t to re je c t an y a d v e rtisin g .
M a n a g in g E d itor: Sue A sh er
E d i t o r i a l C o m m i t t e e : M B I B o a r d o f D ir e c to r s
A d v ertisin g
In fo rm a tio n :
253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; F A X : 2 5 3 -5 7 2 -2 4 7 0
E-mail address: pemswa@ pcmswa.org
H o m eP ag e: http://w w w .pcm sw a.org
2 P C M S BULLETIN
February, 2004
V
?/)cr<T 't m n i fi j r (h 'd tr a / ' t f m e f ' /
President s Page
by M ichw l J. Kelly, MD
Damn the Odds
Full Speed Ahead
''O verw helm ing odds,
L illie chance o f success...
W hen do we sta r 1? "
- G rim ley the dw arf, from "T he Ret urn o f the K ing”
T hird installm ent o f Lord o fth e Ring
As we travel to g eth er through this
ingful liability reform package. T his in­
M ich a el J. Kelly. MD
I hope all the m em bership has had
land o f legislative acts there are m any
cluded a 5250,000 cap on non-econom ic
the opportunity to read Patrick
who disdain o f purpose. T hey m ake
dam ages, and a constitutional am end­
O ’C alla h an 's tw o part Insight editorials
unfounded and m isleading pro n o u n ce­
m ent that allow ed the reform to survive
in the T N T (1 /11/04 and 1/ 18/04). I felt
ments and try to keep us o ff balance.
legislative challenge. A s a result, the
the first installm ent w as an excellent ex­
When they state that tort reform has
Texas M edical Liability Trust, the larg­
am ple o f the result o f a badly dam aged
no effect on liability rates, please refer
est m ed-m al insurer in Texas, an­
m edical liability system . Part tw o repre­
them to C olorado, M innesota, M on­
nounced it w ould be low ering prem ium s
sented our proposals for reform but
tana, C alifornia and no w Texas.
at least 12% beginning January 1, 2004.
Your board o f trustees, eager to
Dr. B ailey stressed that the im por­
seem ed to lend som e credibility to the
D em ocrats solutions. Mr. O ’C'allahan
learn the lessons from T exas liability re­
tant ingredients included a w ell-dcvel-
did finally state, “ T he preponderance o f
form o f 2003, successfully invited
oped strategic plan w ith grassroots in­
evidence suggests that a S 250.000 cap
Charles W. Bailey, Jr., M D , JD , the
volvem ent. sound policy developm ent,
in W ashington State w ould indeed act,
president o f the Texas M edical A sso ­
m essage developm ent and tim ely com ­
o v e rtim e, to curb m alpractice prem i­
ciation to address us on January 10.
m unications. P hysicians in Texas testi­
u m s.” A t long last, recognition - and in
This special ad dress w as h e ld in the
fied extensively about the crisis and its
print! F or those o f us close to the situ a ­
middle o f the annual retreat o f the
effects on access to care. N um erous
tion this is not a revelation but m ore a
board o f trustees. In vitations w ere sent
m eetings w ere held betw een physicians
vindication.
to the entire m em bership o f the PC M S,
and legislators.
the presidents o f all the m edical societ­
Dr. B ailey strongly feels that all
Please continue to talk to y o u r p a ­
tients about this issue. I have p e rso n al­
ies of the state, the entire legislature
politics are local. Talk one-on-one with
ized an inform ation sheet on tort reform ,
and the press. W e w ere ho n o red to
yo u r patients, he advised; w rite letters
the back o f w hich has an exam ple o f a
have R epresentative M ike C arrell (R-
to the paper; address service and civic
letter to a legislator. I copied a p age
28) and Senator R osa F ran k lin (R -2 9 )
clubs and m eet w ith legislators. Raise
from the T N T show ing how lo reach le g ­
present along w ith a large n um ber o f
funds but do not try to m atch the trial
islators by m ail or phone or e-m ail. P a ­
PCMS m embers.
law yers dollar for dollar (in Texas, the
tients receive these sheets, stapled to ­
T rial bar raised over $11 m illion while
gether, as they check in. In the exam
hensive and sobering. H e had also
Dr. B ailey’s address w as co m p re­
the physicians w ere less than 10% o f
room , I m ention the need for them to
spent tw o hours p rio r to his address
that).
read, respond, and send m e a copy o f
sitting in on o u r discussions and o ffer­
ing his brand o f Texas advice.
Texas w as able to do w hat we
must achieve - the passage o f a m ean ­
Texas succeeded because they re­
m ained focused on and true to one c o n ­
stant resonating m antra: access to
their response. T his takes less than a
m inute and has already p roduced a
g reat m any letters. ■
m edical care.
Februaiy, 2004
PCMS BULLETIN
3
B
u l l e t in
PCMS Subsidiary, Membership Benefits, Inc.,
provides service and revenues for members
T h e M e m b e rs h ip B e n e fits, Inc.
fo r-profit m ode. In 1985-1986 M B I b o r­
C u rren t M B I B o a rd m e m b e rs in ­
(M B I) B o a rd o f D ire cto rs p re se n te d a
ro w e d h e av ily fro m P C M S to su b sid iz e
clu d e D rs. S teve S e ttle, S teve D u n can ,
p la q u e to Dr. D r e w D e u tsch at th e ir D e ­
th e ir b u sin e ss, as th ey did in itially in
c e m b e r m e e tin g in re c o g n itio n o f his
1978-79. A ll loans h a v e b e en re p aid and
T im S c h u b e r t a n d S e c retary -T rea su re r
J o e R e g im b a l, in a d d itio n to D rs.
serv ice as P re sid e n t, 1999-2003. Dr. T im
S c h u b e r t th a n k e d h im for his y ears o f
M B I c u rren tly e n jo y s fin an c ia l freedom .
In the late 9 0 ’s, th ey w o rk e d to b u ild re ­
se rv ice , a c k n o w le d g in g th e fin an c ia l
se rv es sh o u ld d iffic u lt financial tim es
su c c e ss o f M B I, the P C M S w h o lly -
return. In 2003, th e b u ild in g req u ire d a
o w n e d , for-p ro fit su b sid iary . Dr.
new roof, n ew h e atin g duct w ork, n ew
S c h u b e rt c u rre n tly se rv es as P re sid e n t.
M B I o v e rse e s the p u b lic a tio n d e­
garag e do o rs and carp etin g . A fter th ese
p a rtm e n t th at g e n e ra te s th e m o n th ly
B u lle tin a n d th e a n n u a l P h y sic ia n D i­
re c to ry a n d o p e ra te s the P C M S p la c e ­
m e n t se rv ic e fo r b oth te m p o ra ry and
p e rm a n e n t p erso n n el. M B I o w n s the
P C M S b u ild in g at 223 T acom a A venue
S o u th , and leases sp a c e to o th er m e d i­
c ally re la te d o rg a n iz a tio n s such as the
P ie c e C o u n ty D ental S ociety, Pierce
C o u n ty N u rs e s A sso c ia tio n a n d the
A m e ric a n L u n g A sso c ia tio n o f W ash­
D em irjian , D e u tsch , G ild e n h a r and
W earn.
M B I striv es to p ro v id e b e n efits to
P C M S m em b e rs as w ell as re m a in finan­
c ia lly viable. M B I a lso p ro d u c e s th e a n ­
nual P h arm acy D irectory, a c o m p le te
ex p en d itu re s, th ey w ill now o nce again
focus on re b u ild in g reserv es.
listin g o f P ie rce C o u n ty p h a rm a cie s,
O th e r m em b e rs th a t h av e se rv ed as
M BI P re sid e n ts since its in cep tio n in ­
co d in g m atrix es. B oth the P h a rm a c y D i­
clude: D rs. T im S chu bert, 2003; D rew
Deutsch, 1999-2003; K eith D em irjian,
1996-1998; Joe W earn, 1992-1995;
M ark G ildenhar, 1989-1992; R obert
W hitney, 1988-1989; Don Shrew sbury,
1985-1987; G regory P opich, 1984; D ale
Hirz, 1981-1983;R ich ard B ow e, 19791980; and K en G raham , 1978.
a n d h a s p re v io u s ly p ro d u c e d lam inated
re c to ry a n d c o d in g m a trix e s w e re d is­
trib u te d at no c o st a n d w e re develo p ed
at the su g g e stio n o f m em b e rs. T h e M BI
B oard w e lco m es id ea s a b o u t b en efits
th a t w o u ld be o f h e lp to the m e m b e r­
ship. P le ase call S ue A sher, 5 7 2 -3 6 6 7 at
th e S o c iety o ffice w ith y o u r su g g e s­
tio n s. ■
in g to n .
T h e p la c e m e n t se rv ice b e g a n it's
te m p o ra ry d iv isio n in 1993 and it has
p ro v e n to be a tim e ly and su ccessfu l
The Tacoma Philharmonic presents
v e n tu re . P ro v id in g te m p o ra ry personnel
fro m one day to se v e ra l m o n th s, it a l­
lo w s th e e m p lo y e r to obtain staffin g
The Empire Brass, sponsored by physicians
w ith o u t h a v in g to hire, fire, do payroll
o r p ro v id e b e n efits. T em porary' w o rk ers
are p la c e d in the o ffice and th en the e m ­
p lo y e r pays a fee to the p lac em e n t se r­
T he E m pire B rass, presen ted by
the T acom a P h ilh arm o n ic is bein g sp o n ­
so red by p h y sic ia n s in P ierce County.
T h e p e rfo rm a n ce w ill b e on Saturday,
vice for the use o f th at tem p o rary
w orker. N o record k e ep in g o r taxes re­
q u ired . T h e w o rk e r is an e m p lo y e e o f
the a g en c y a n d is re im b u rse d as such.
M arch 27 at 8 pm at the P antages T h e ­
atre in Tacom a.
T he E m pire B ra ss e n jo y s an in te r­
n ational rep u tatio n as N o rth A m e ric a ’s
T h e se rv ice has g ro w n fro m g ro ss re v ­
en u es o f S 23.000 in 1993 to o ver
finest brass q uintet, re n o w n ed for its
b rillian t v irtu o sity and the u nparalleled
$300,000 in 2003.
M B I w a s in c o rp o ra te d in 1978 as
div ersity o f its repertoire. T here are five
m u sician s - all h a v e held leading p o si­
an a v en u e fo r P C M S to g e n era te nond u e s in co m e w ith o u t je o p a rd iz in g the
tions w ith m ajo r A m erican o rch estras th at p e rfo rm o v e r 100 co n certs a y e ar in
cities such as N ew Y ork, B oston, C h i­
n o n p ro fit sta tu s o f P C M S . R evenues
fro m a d v ertisin g , p lac em e n ts, rents,
p ro g ra m s, etc. are u se d to fo restall dues
in cre ases. P C M S h a s o n ly seen one
sm all d u e s in cre ase in m an y years.
M BJ has n o t a lw ay s o p e rated in a
4
P C M S BULLETIN
February, 2004
cago, W ashington, L ondon. Z u rich and
Tokyo.
T h e T acom a P h ilh arm o n ic p ro v id es
w o rld -class classical m usic for the
South S ound. T h ey e x ist to e n rich the
cultural life o f o u r c o m m u n ity b y p re ­
se n tin g c la ssic al m u sic p e rfo rm a n c e s o f
w o rld -re n o w n e d o rc h e stra s a n d artists
o th erw ise u n a v a ila b le in th e T acom a
a rea a n d b y o ffe rin g u n iq u e m u sic e d u ­
c atio n o p p o rtu n ities.
F o llo w in g the E m p ire B rass, the
P h ilh a rm o n ic p re se n ts th e A u stra lia n
C h a m b e r O rch estra, w ith R ich ard
T ognetti, c o n d u c to r a n d P io tr
A n d e rsz w e sk i on p ian o , S u n d a y A pril
18 th at 7:00 pm .
T h e T aco m a P h ilh a rm o n ic is one o f
the o ld e st p e rfo rm in g a rts o rg a n iz atio n s
in the N o rth w e st, h a v in g b e en founded
in 1936.
F o r m o re in fo rm a tio n y o u m ay call
the P hilharm onic office at 253-272-0809. ■
Q m e d ic a l O f octetif
Board of Trustee Retreat highlights Texas Medical
Association President
The PCM S B oard o f T rustees retreated on Saturday,
January 10lh to the L andm ark in T acom a to g et acquainted
with new board m em bers and set th eir goals and direction
for the year. T heir first ord er o f business w as review o f the
m em bership priority survey conducted last fall. “ It is a
clear edict,” noted P resid en t M ike K elly, citing an 87% re­
sponse for tort reform being the n u m b er one priority. Re­
imbursem ent follow ed w ith 69% and practice viability
52%. It w as the consensus o f th e board that liability rates
are the biggest factor affecting the health care system and
unless a solution is found quickly, m any physicians will
not be practicing in the future. W hile m any issues w ere
discussed, it was clear the focus w ill rem ain on the tort is­
sue through the legislative session and the rem ainder o f
the year, with the focus being patient access.
There w as concern regarding physician unity and the
lack o f solidarity in the p rofession statew ide. T here are
many ploys to split the profession, by specialty, by e m ­
ployer, by issue, by p olitics, etc. and everyone agreed this
is o f detrim ent to the p rofession rem aining strong and vi­
tal and b eing successful in their attem pts to m ake changes
to the health care system .
L enE ddinger, D irector o f Public Policy and Planning
with the W SM A , gave a legislative update on liability re­
form. He noted the session is a short one, running from
January 12 to M arch 11. He gave a b riefing o fth e L iability
Reform Coalition, com prised o f 66 m em bers, including
Boeing, W eyerhaeuser, P harm acy M anufacturers, etc. and
the poles show that the public stands behind the coalition
on the issue.
He also reported on the W SM A and W A M PA C 's ef­
forts to m ake candidates that do not support tort reform
and who are up for re-election in 2004 very uncom fortable,
something the association has not really used as a direct
strategy in the past.
The m eeting adjourned to a nother room w here Dr.
Charles Bailey, P resident o f the T exas M edical A ssociation
gave insight into how Texas w as successful at passing
their tort reform legislation. His bottom line was that we
have to get patients involved and w e need to get out o f
our professions and out o f p olitics and put pictures o f our
children and grandchildren on the table w ith the m essage
that preserving our health care system for us and our
loved ones is param ount.
In the last session o f the day, the bo ard m et w ith hos­
pital m edical directors, Drs, G eorge B row n, D on M ott and
Mike N ew com b representing M uItiCare, G ood Sam aritan
and Franciscan H ealth System s respectively. In agreeSee “ Retreat" page 6
Past P resident Dr. Jim R ooks (left) chats w ith Dr. C harles
Bailer. P resident o f th e Texas M e d ic a l A sso cia tio n
F rom left. Drs. M ike N ew com b, John L en ih a n a n d G eorge
B row n com pare notes a fte r Dr. B ailey's talk
D r D o n M ott (left) a n d Dr. R on M orris visit after the retreat.
Dr. M orris s e n 'e s as a trustee o f P C M S
February, 2004
PCMS BULLETIN
5
B
u l l e t in
Retreat
fro m p a g e 5
m en t, th ey all re p o rte d sim ila r c h a l­
C lo se d m ed ic al staffs a re n o t b e in g
H o sp ita l m a rg in s are so th in th e y are
le n g e s to w h a t p h y sic ia n s are facing.
c o n sid e re d by the h o sp itals. “C lo se d
R e g u la to ry issu e s, p a y e r b a ttles and re ­
m o d els are n o w h e re in M u ltic a re ’s
ho sp itals. W ith in p a tie n t c a re as th e ir
im b u rs e m e n t c o n ce rn s, m edical m a l­
p la n s,” sa id Dr. B ro w n , and “ w e h a v e
fu n d a m e n ta l co re se rv ic e , th e y c an n o t
p ra c tic e issu e s, etc. “ W e h a v e m o re in
fo rc e d to fig h t the th re a t o f sp e c ia lty
a b so lu te ly n o p lan s and h a v e h a d no
a ffo rd to lo se a n y b u sin e ss to sp ecialty
c o m m o n th a n n o t,” n o te d Dr. N e w c o m b
d isc u ssio n s to clo se m edical staffs, said
a n d “ W e h a v e m o re in c o m m o n than d i­
F ra n c isc a n ’s Dr. N ew com b.
h o sp ita ls.
P C M S m e m b e rs a tte n d in g the
v id e s u s,” a d d e d Dr. B ro w n . A ll th ree
G o o d S am aritan has an e n tire n e w
B o ard o f T ru ste e s R e tre at in c lu d e d
h o s p ita l re p re se n ta tiv e s sa id th a t th eir
m an a g em e n t team and th ey are a g g re s­
D r s. M ik e K elly, J im R o o k s, K en
h e a lth c are sy ste m d o e s n o t w a n t to be
siv e ly re cru itin g d o c to rs a cc o rd in g to
F eu ch t, S u m n er S c h o e n ik e , Joe
in th e b u sin e ss o f e m p lo y in g sp e c ia l­
D o n M o tt, M D . T h ey are b u ild in g fo u r
R egim b al, L aurel H arris, J o e Jasper,
ists, b u t, as Dr. B ro w n e x p la in e d , “ the
m a lp ra c tic e c risis has c au se d the earth
n ew o p e ratin g ro o m s a n d lo oking to ­
R on M orris, J e ff N ach t, N avd eep R ai,
w ard a C O N approval for c a rd io v ascu la r
to sh ift a b it.” E m p lo y in g sp e c ia lists is
n o t o n e o f th e ir stra te g ic in itiativ es, but
surgery. H e a d d ed th a t th ey w ill be
d ro p p in g the G o o d S am aritan R esid en c y
C arl W u lfe stieg , a n d W S M A re p re se n ­
tativ es N ic k R a ja c ic h , L en A le n ic k
th e y w ill e m p lo y th em to c o n tin u e to
p ro g ram as the fin an c ia l lo sses o f th e
sician s from a ro u n d th e state, and
m e e t the n e ed . T h e sta te d p re fe re n ce
p ro g ram are n o t offset by any b en efits
P ie rce C o u n ty leg isla to rs, R o sa Franklin
fro m all th re e p h y sic ia n s is th a t they
su ch as hospital serv ice o r p h y sic ia n re ­
cruitm ent.
(D -29) and M ike C arrell (R -2S), jo in e d
them for Dr. B a ile y ’s talk on the T exas
W h ile all o f the hospital sp o k e sm a n
a g reed there are m an y issues in c om m on
e x p erien c e o f e n ac tin g m e d ic a l liability
p re fe r th a t sp e c ia lists re m a in in d e p e n ­
d e n t and run su c c essfu l p ra ctic e s in the
co m m u n ity . H o w ev er, the e co n o m ic re­
ality is in c erta in in stan ces, th ey w ould
look to e m p lo y m e n t type m odels.
and D on R u sse ll. M a n y m e m b e rs, p h y ­
reform . ■
w ith p h y sic ia n s, th ey all a g ree d that the
“ line in the sa n d ” is sp ecialty hospitals.
Protect Your Practice, Protect Your Family
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Insurance Agency, there's still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find
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To discuss Ihe ways you can best protect you and your family,
call Physicians Insurance Agency today: (206) 343-7150 or
1-800-962-1399.
F.
PHYSICIANS
INSURANCE
AGENCY
A Wholly Owned Subsidiary of
Physicians Insurance
© Physicians Insurance* 2003
6
P C M S B ULLETIN
February, 2004
Sjwnsored b y (he Washington Slate Medical Association
jP iefceH 't'o intl tf Q '/ie r lir n l & octett j
Federico Cruz-Uribe, MD
D irector of Health
The Health Status of Pierce County
Recently I w atched the m ovie E n ­
or w orse. So I stepped to the plate and
p endent course to b e st guide o u r state
durance, the story o f the Shackleton
a nnounced that I will give it a try. I am
through com plex issues, w e fin d o u r­
expedition to A ntarctica in 1914. It is an
Independent, not afraid to take on
selves w ith an election pro cess that
amazing story o f tenacity and ad v en ­
tough issues as show n by m y consis­
screens out independence. A ll too o f­
ture. He and his crew survived tw o
tently trying to address the toughest
ten candidates h ave to link them selves
years in the pack ice or on a rem ote
public health issues facing our com m u­
w ith special interest groups in order to
w ind-sw ept island ju s t o f f the coast o f
nity. I am not w edded to the system ; if
g et elected. T he p rice that is p a id is the
Antarctica. T his w as b efo re m icrofibers
anything I am com m itted to fundam en­
flexibility and independence so needed
and freeze-dried foods. I found it very
tally changing it. Since I w ork in public
to successfully take on the tough is­
moving to read the book on the ex p ed i­
health, w hich is a part o f governm ent
su es.
tion and to see the m ovie. W hat an
that has been consistently ignored over
amazing experience.
the years, I have had to learn how to
A conflict arose very early in m y
cam paign betw een m y pledges o f
get things done w hen I lack resources,
change and the need for resp ectin g tra­
critic or as a book review er. But about
political standing, or public support.
d itions and sp eaking to the positives.
two years ago I started on an adventure
B eing creative and resourceful isn’t ju st
C andidates m ake an art form out o f tell­
to run for governor o f this line but
a nice idea b u t essential to surviving
ing people w hat they w ant to hear. T he
struggling state. L ike S hackleton. I
and thriving in public health.
problem is thai our current situation
I bring this all up not as a m ovie
I spoke to m ore than 100 groups
cries out for frank discussions o f c riti­
of the G overnor), and also like
across the state. 1 brought a m essage o f
cal problem s and barriers, w ith com m it­
knew w here I w anted to go (the O ffice
Shackleton, I did n o t know' w here I w as
change in governm ent: how w e do
m ent to the innovative actions needed
going to end up. I w as ju m p in g into
business; the role o f state governm ent
to address them.
something new for m e, as 1 had never
in addressing local issues; how ser­
run for public office. I w as prep ared to
vices are provided. In general, people
level requires trem endous public sup­
To m ake change at a statew ide
change jobs, change lifestyles and go a
supported m y m essage and invited me
port. T his c a n ’t com e ju st from good
different w ay w ith m y life. So I stepped
b ack to each com m unity to speak again.
ideas and a credible gam e plan. You
forward and I ju m p e d and I landed in a
B ut w hen it cam e tim e to g arner the po­
have to b uild it. I discovered how m uch
new and different place. T he notion
litical and financial support for m y can­
n eeded b uilding in m y travels this past
that “y o u ’re not in K an sas an y m o re”
didacy, I started seeing S h ack leto n ’s
year (70.000 m iles on m y car): C reating a
pops into m y m ind on a reg u lar basis.
icy m ush. A lm ost everyone hesitated,
m ovem ent. B uilding a statew ide o rg an i­
getting trapped in non-issue questions:
zation, com m unity by com m unity. G et­
was doing, I stepped out o f the cocoon
W ho is this guy? Can he w in? Is lie a
ting y our nam e in front o f people. T his
of my jo b as a physician. T hings
good R epublican? D oes the party sup­
is very tim e intensive and costs re ­
seemed to be sliding, not ju s t one or
port him?
sources. I m ade a good start m eeting
As I realized how poorly our state
Even as our state desperately
two high profile areas but across the
folks and getting m y ideas out there.
n eeds leaders w h o could chart an inde­
board w e w ere falling into m ediocrity...
See “ Endurance" page R
February, 2004
X
PCMS BULLETIN
7
B
u l l e t in
The Health Status of Pierce County
Federico Cruz-U rib e, M D
D ire cto r of Health
Recommended increase in level of suspicion of SARS
A s th is a rtic le is b e in g w ritte n , a
D u rin g the 2 0 0 3 o u tb re a k , th e vast
w h o h av e h a d c lo se c o n ta ct w ith an ill
p e rso n w ith re ce n t trav e l to these areas.
m a jo rity o f in d iv id u a ls w h o c o n tra c te d
in G u a n g d o n g P ro v in c e, C h in a. N o
• E m p lo y m en t in an o c cu p a tio n at
p a rticu la r risk o f ex p o su re to SA R S
tics: 1) a c le a r h isto ry o f e x p o su re to a
lin k s h a v e been e sta b lish e d b etw ee n
th e th re e c ases, n o r has p e rso n -to -p e r­
(e.g., health care w o rk e r w ith d irec t p a ­
tie n t care, w o rk e rs in labs w ith live
S A R S p a tie n t or to a se ttin g in w h ic h
so n tra n s m iss io n b e e n con firm ed .
SA RS-CoV ).
• Part o f a c lu ste r o f c ases o f a ty p i­
and 2) d e v e lo p e d p n e u m o n ia .
I f you h a v e a p a tie n t w h o m ee ts
cal p n e u m o n ia w ith o u t an a lte rn a tiv e
d iag n o sis.
the a b o v e c riteria , o r i f y o u h a v e a n y
S A R S , a febrile sev e re low er resp i­
ra to ry illn ess, is c au se d by a novel
co ro n av iru s (S A R S -C o V ). T h e d isease
C ounty H ealth D e p artm en t a t 25 3 -7 9 8 6410. P re ss “0 ” a n d ask to sp e a k w ith a
th ird c ase o f S A R S ( S ev ere A c u te R e s­
p ira to ry S y n d ro m e ) has b e e n id en tifie d
H o w ev e r, in lig h t o f th ese rep o rts
a n d the ease o f w o rld w id e trav el, the
C D C is re c o m m e n d in g that U.S. p ro v id ­
ers in c re a se th e ir level o f su sp ic io n for
S A R S in p a tie n ts w h o re q u ire h o sp ita l­
ization fo r ra d io g rap h ically confirm ed
p n e u m o n ia o r a cu te re sp ira to ry distress
sy n d ro m e ( A R D S ) A N D w h o h a v e a
h isto ry o f travel to G u a n g d o n g P ro v ­
in ce (o r c lo se c o n ta ct w ith an ill p e rso n
w ith a h isto ry o f re c e n t trav e l to
G u a n g d o n g P ro v in c e ) in the 10 days
b e fo re o n se t o f sy m p to m s.
T h e C D C c o n tin u e s to ask p ro v id ­
e rs to c o n sid e r S A R S in sim ilarly ill p a ­
S A R S -C o V h a d th e se tw o c h a ra c te ris­
S A R S -C o V tran sm issio n w a s occurring,
q u e stio n s, call the T ac o m a -P ie rc e
w as first re co g n ize d in A sia in F e b ru a ry
n u rse .
I f SA R S a c tiv ity c o n tin u e s to in­
2 00 3 , a n d o v e r the next sev eral m o n th s
sp read to m o re th an tw o d o z en c o u n ­
g a rd in g th e index o f su sp ic io n m ay
trie s in N o rth and South A m erica, E u­
ro p e, a n d A sia. T ran sm issio n o f S A R S C o V a p p ears to o c cu r p rim a rily th ro u g h
c lo se in te rac tio n s w ith in fected p e r­
sons, p re d o m in an tly v ia re sp irato ry
c rease globally, re c o m m e n d a tio n s re ­
c h an g e. D e tails and u p d a te s a b o u t the
d ise ase can b e fo u n d on the C D C
w e b site (h ttp ://w w w .c d c .g o v /n c id o d /
sa rs/c lin ic ia n s.h tm ) o r th e W H O
w e b site (h ttp ://w w w .w h o .in t/c sr/sa rs/
en/). T h e C D C h a s also u p d a te d th eir
tie n ts w ith on e o f t h e follow ing:
• A h isto ry o f re c e n t trav el to m a in ­
d ro p lets. F e c al/o ra l tran sm issio n m ay
h a v e o c cu rre d in som e settings, and the
p o ssib ility o f airb o rn e tran sm issio n has
lan d C h in a, H o n g K ong, o r T aiw an, or
n o t y et been ru led out.
h ttp ://w w w .c d c .g o v /n c id o d /sa rs/g u id a n c e /b /p d fa p p 2 .p d f. ■
jo u rn e y than I w as able to. B ut th e need
fo r new ideas and a p p ro ac h es and
im p o rtan ce o f g o v e rn m e n t c h an g e). I
am a very o p tim istic p e rso n . I b e lie v e
stro n g lead ersh ip in W ashington c o n ­
tin u e s to p ress just as in te n siv e ly to­
th a t w e c an a d d re ss th e h u g e p roblem s
fa cin g o u r state. W e w ill sta rt w ith h o n ­
day as w hen I started. M y co m m itm e n t
h a s n ’t c hanged. I w ill c o n tin u e to d e ­
m a n d th at ch an g e s be m ad e at the state
esty a bout w h a t’s w ro n g a n d th en m ake
level. I w ill g e t to the m any co m m u n itie s
a cro ss o u r state, to sp eak out on k e y is­
W hen fa c e d w ith an im p o ssib le
task, S h a c k le to n tu rn ed h is a tte n tio n to
su es and d ev elo p re la tio n sh ip s so there
w ill b e b ro a d e r su p p o rt for a m ovem ent
to ch an g e state g o v ern m en t.
the e sse n tia ls, a n d m a n a g e d to achieve
T h e H ealin g W ashington F o u n d a ­
tio n w ill p e rsist and I w ill c o n tin u e to
back hom e. D e sp ite all o d d s ag ain st
th at h a p p e n in g , he w a s su c c essfu l.
on e g o e s.”
P o w erfu l re a so n s d ire c te d m y
p ilo t th at sh ip (I k ick e d o f f the p u b lic
p ro c ess by fo u n d in g H e alin g W ashing­
A n d he sa ile d a g ain . M y c o u rse w ill
shift som e, b u t I k n o w w h a t is im p o r­
co u rse as I b eg an c a m p aig n in g fo r G o v ­
ton to speak out on ch an g e s n ecessary
in o u r state for h e alth ca re and on the
ta n t fo r th e h e a lth o f o u r state. C om e
Endurance
from page 7
b u t I h ave n o t been ab le to b u ild a c re d ­
ib le sta te w id e o rg a n iz atio n n o r raise
n e c e ssa ry d o lla rs to p a y fo r the effort.
In the sh o rt run it m ea n s th at I do not
h a v e a c am p a ig n th a t is re a d y fo r the
2 0 0 4 elections.
F o r a few d a y s th a t re ality struck
m e as sh a rp ly as S h a c k le to n ’s re a liz a ­
tio n th a t h is sh ip and crew w ere cau g h t
in the ice, m ile s from help. But
S h a c k le to n ’s ow n w o rd s re fle c t m y p e r­
so n al c o m m itm e n t: “ A m an m u st set
h im s e lf to a new m ark d ire c tly the old
ernor. I e x p e c te d to g et fu rth e r on that
8
P C M S BULLETIN
re p o rtin g form . It is a v a ila b le o n lin e at:
February, 2004
the painful d e c isio n s n e c e ssa ry to heal
W a s h in g to n .
im p o rta n t, th o u g h a lte re d g o a ls - in his
c ase, sa v in g h is c re w a n d g e ttin g them
w ith m e as th is jo u rn e y c o n tin u e s.■
In My Opinion.
by Thomas Bageant, MD
The o p in io n s e x p r e s s e d in th is »tr ilin g a r e s o le ly (h o se o f th e a u th o r. P C M S in v ite s m e m b ers to e x p re ss th e ir o p in io n in s ig h ts a b o u t su b je cts
relevant to the m e d ic a l com m un ity, o r s h a re th e ir g e n e r a l in te rest s to rie s . S ubm ission s- a re s u b je c t to E d it o r ia l C o m m itte e review .
Contemplating Retirement
Thom as B ageant. M D
IF you need an incom e.
IF you enjoy your w ork.
IF you psychologically depend on y our jo b ,
IF your jo b perform ance is not im paired by physical dis­
abilities, or m ental disabilities, or drug induced disabilities.
DON’T RETIRE
For those contem plating retirem ent, rem em ber: Just as a
wedding cerem ony does not insure an enjoyable m arriage, nei
ther does an elaborate retirem ent party insure an enjoyable re­
tirement. B oth m arriages and retirem ent require tim e, w ork,
planning, and a transition process if they are to be enjoyed.
Financial Planning: A ssets m inus Liabilities equals N et
Worth
A. Assets:
a. Incom e from other sources (rental incom e,
investm ent incom e, etc.)
b. Savings
c. R eal-estate
d. W orks o f art
e. Collections
f. A ntiques
g. Inheritance
h. R etirem ent accounts
i. IR A s
ii. R oth IRAs
iii. 4 0 1(k) plans
iv. Profit Sharing Plans
v. Pension Plans
vi. Social Security Benefits
B. Liabilities:
a. Loans - m argin accounts - credit card accounts
b. D ependents
c. Shared B usiness L iabilities
d. A lim ony
e. C ontract expenses, w ritten or verbal
A ssessm ent o f net w orth should be re-evaluated 011 a
reg u lar basis, as should y our budget. B oth o f these w ill
change w ith tim e.
Budget
M ake a "re tire m e n t'' budget and include, at least, the fo l­
lowing:
A. Loan Paym ents
B. H ousing
C. Food (at hom e and for dining out)
D. Utilities: electricity, w ater, gas, trash disposal,
telephone, cell phone, cable, satellite services,
internet access, new spapers, m agazines, etc.
E. Insurance:
a. H om e ow ners or renters insurance
b. A uto insurance
c. M ajor M edical Insurance
d. L ong Term care Insurance
e. Liability Insurance
f. D isability insurance m ay not be available
if you are not w orking.
g. Life Insurance m ay not be necessary.
F. T ravel and Vacations
G. Hobbies
H. E ntertainm ent
I. C harity and C hurch donations
J. T ransportation
K. Hom e and land m aintenance
L. Cars (new and auto repairs)
I f y our net w orth does not generate adequate funds to
covcr y our retirem ent budget. PLU S IN F L A T IO N , you should
not retire, increase your incom e or m odify y o u r budget.
M ust all retirem ent funds com e from m oney earned by
your retirem ent investm ents, w ithout to u ch in g y our invested
principal? N ot necessarily. It depends on y o u r health, your
age, and w hat you w ish to leave for y our heirs.
See “ R etirem ent" page 12
A -B = Net Worth
February, 2004
PCMS BULLETIN
9
B
u l l e t in
Bite them and they’ll believe your bark
T h e 2 0 0 4 e le c tio n s are p iv o ta l to r th e fu tu re o f m e d ic in e w ith th e p re sid en t, U .S.
se n a te , c o n g re ss g o v e rn o r, o th e r sta te w id e o fficials in clu d in g th e in su ra n ce c o m m is­
sio n e r, all o i the sta te h o u se o f re p re se n ta tiv e s a n d h a lf o f th e state se n a te up fo r
e le ctio n .
Personal Problems of
Physicians
Committee
T h e re is a o n e -v o te m a jo rity in the state sen ate th a t su p p o rts to rt re fo rm and a
six -v o te m a jo rity in the state h o u se that o p p o se s it. So th e fu tu re o f to rt re fo rm m ay
w e ll h a n g in th e b a la n c e o f th is y e a r ’s election.
In c re a sin g th e m a jo rity in th e se n a te and, i f they fail to act, c h an g in g the m a jo r­
ity in th e h o u se w ill re q u ire in v o lv e m e n t and political a ctio n by th e m ed ical c o m m u ­
M ed ical p rob lem s, d ru gs, alcohol,
retirem en t, e m otion al,
or o th e r su ch d ifficu ltie s?
nity' on an u n p re c e d e n te d scale. C h a n g in g th e m ajo rity in the h o u se w ill be v iew ed
b y all a s b a c k in g up o u r b a rk w ith a bite.
H o w d o y o u go a b o u t th is? F irst, u se the in fo rm a tio n sen t to you b y W S M A to
c o n ta c t le g isla to rs d u rin g th e sessio n . A n d second, jo in W AM PAC.
C o n sid e r th is, in the 2002 electio n trial law y er PA Cs raised o ver $ 7 0 0 ,0 0 0 - m ore
th an trip le w h a t p h y sic ia n s raised. In 2003 y o u m ad e g reat striv es to grow
W A M P A C , b u t m o re is neccssary.
Y ou r c o lle a g u e s
w a n t to help
In c re a sin g n u m b e rs o f y o u r p eers are c h o o sin g to jo in W A M PA C at h ig h er lev ­
els o f $ 3 0 0 o r S 500, and even $10 0 0 . W A M PA C p ro v id es the m eans for the b ite so
th a t the leg isla tu re w ill h e a r the bark. ■
♦ R o b e rt Sa n d s, M D , C h a ir
UNION AVENUE PHARMACY
Professional Compounding Center o f Tacoma, WA
Vaginal Suppositories
Rectal Suppositories
Urethral Inserts
Sublingual Troche
Gel, Ointment, and Cream
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Capsules
Lip Balms
752-6056
Bill Dean, M D
272-4013
Tom Herron, M D
8 5 3 -3 8 8 8
Bill R oes, M D
8 8 4 -9 2 2 1
F.
D ennis Waldron, M D
265-2584
Confidentiality
Assured.
2302 South Union Avenue 752-1705
Applicants for M embership
raueler6
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H e a lth
S e rv ic e
A s e rv ic e o f
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Ju liu s S zig et, II, M D
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In tern sh ip : U n iv e rsity o f K an sas
CALL EARLY WHEN PLANNING
St. Jo sep h M e d ica l C lin ic
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253-627-9151
1708 S Y akim a, T acom a
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o r 253-627-4123
P C M S BULLETIN
206-520-3169
R e sid en c y : U n iv e rsity o f K a n sa s
MON -F R I 9 - 5
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32018 2 3rd Ave S, F ederal W ay
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
HOURS
IN F E C t S
M ark T. M urphy, M D
Fam ily Practice
L IM ITE D PS
February, 2004
220 - 15lhAve SE #B. Puyallup W A 98372
M ed S ch o o l: C a se W estern R e se rv e
In tern sh ip : W alter R e e d A M C
R e sid en c y : W alter R e ed A M C
'?/')('f-rv
Vfv■//y//// r /
How to contact your state and national lawmakers
President m ay be reached by m ail: 1600 P ennsylvania Ave NW , W ashington D.C. 20500; his m essage p hone is 202-456-1111
U.S. Senators and R epresentatives:
Sen. Maria C antwell (D). 717 H art Senate B uilding, W ashington, D.C. 20510; 202-224-3441 (D C) or 206-220-6400 (Seattle)
FAX; 202-228-0514 or email: m aria_cantw ell@ ;cantw ell.senate.gov
Sen. Patty M urray (D),
173 Russell Senate Building, W ashington. D.C. 20510; 202-224-2621 (DC) or 206-553-5545 (Seattle)
FAX: 202-224-0238 or em ail: senator_m urray@ m unay.senate.gov
Rep. Norm Dicks (D -6th), 2467 R aybum H ouse Building, W ashington D.C. 20515; 202-225-5916 (DC) or 253-593-6536 (Tacoma)
FAX: 202-226-1176
Rep.Adam Smith (D-9th), 227 C annon House O ffice Building, W ashington D.C., 20515; 202-225-8901 (D C) or 253-593-6600 (Tacom a)
orto ll free I-888-764-8409; FAX: 202-225-5893, email: adam.smith@ imail.house.gov
State Offices:
Governor Gary Locke,
Legislative Building, PO Box 40002, O lym pia 98504-0001,360-902-4 111, FAX: 360-902-4110,
hom e page: w w w .govem or.w a.gov
State Representatives:
W ashington H ouse o f R epresentatives, PO Box 40600, O lym pia, WA 98504-0600
State Senators:
W ashington State Senate, PO Box 40482, O lym pia, WA 98504-0482. The central Senate FAX: 360-786-1999
To leave a m essage for law m akers or to learn the status o f legislation, call the L egislatu re’s toll-free hotline, 800-562-6000.
The hearing im paired m ay call 800-635-9939. The L egislature’s Internet hom e page address is ww w .lcg.w a.gov.
Legislators by district with O lym pia phone num bers (A L L 360 A R E A C O D E ) and em ail addresses:
2nd District, (South Pierce County')
Sen Marilyn Rasm ussen (D ) 786-7602; rasm nsse_m a@ leg.w a.gov
Rep Roger Bush (R) 786-7824; bush_ro@ leg.w a.gov
Rep Tom Campbell (R) 786-7912; cam pbell_to@ leg.w a.gov
28th District, (W est Tacom a, LI.P., Fircrest, Lakewood)
25th District, (Puyallup, Sum ner, M ilton)
Sen Jim Kastama (D) 786-7648; kastama_ji@;leg. wa.gov
Rep Dawn Morrell (R) 786-7968; m orell_da@ leg.w a.gov
Rep Joyce M cDonald (R) 786-7948; m ed o n a ld Jo @ leg .w a .g o v
29th District, (South Tacom a, South End, Parkland)
Sen Rosa Franklin (D) 786-7656; franklin_ro@ lcg.w a.gov
Rep Steve Kirby (D) 786-7996; kirby_st@ lcg.w a.gov
Rep Steve C onw ay ( D) 786-7906; conw ay_st@ leg.w a.gov
26th District, (N W Tacom a, G ig H arbor, South K itsap)
Sen Bob Oke (R) 786-7650; oke_bo@ leg.w a.gov
Rep Pat Lantz (D) 786-7964; lantz_pa@ leg.w a.gov
Rep Lois M cM ahan (R) 786-7802; m cm ahan_lo@ lcg.w a.gov
3 1st D istrict, (E ast P ierce C ounty)
Sen Pam Roach (R) 786-7660; roach_pa@ leg.w a.gov
Sen Shirley W insley (R) 786-7654; w insley_sh@ leg.w a.gov
Rep M ike Carrell (R) 786-7958; carrcll_mi@>leg.wa.gov
R ep Cjigi Talcott (R) 786-7890; talcott_gi@!leg. w a.gov
Rep Jan S h ab ro (R ) 786-7866; shabro_ja@ lcg.w a.gov
Rep Dan Roach (R) 786-7846; roach_da@ ieg.w a.gov
27th District, (North Tacom a, East Side)
Sen Debbie R egala (D) 786-7652; regala_de@ leg.w a.gov
Rep Dennis Flannigan (D) 786-7930; flaim iga_de@ leg.w a.gov
Rep Jeannie D am eille (D ) 786-7974; d a m e illje @ le g .w a .g o v
For m ore specific inform ation a bout the legislative pro cess or for a copy o f the 2004 G uide to the W ashington State L egisla­
ture which includes listings for elected state and federal officials, please call PC M S, 572-3667. ■
February, 2004
PCMS BULLETIN
11
Retirement
fro m p a g e 9
A re tiree , in g o o d h e a lth , p rio r to e lig ib ility for e ith e r
ch ro n ic m e d ic a tio n e x p e n se s, m a y c o n sid e r “ c a ta s tro p h ic care
M e d ic a re o r S o c ial S ec 111% , sh o u ld m a k e e v ery e ffo rt to live
c o v e ra g e .” T h is type o f c o v e ra g e w ill h a v e a h ig h d e d u ctib le
w ith o u t to u c h in g his o r h e r in v e ste d p rin cip al. A re tiree o f a d ­
a m o u n t and m ay not c o v e r the c o st o f a n y o u t-o f-h o sp ita l
v a n c e d ag e, o r w ith a te rm in a l illn ess, m ay be c o m fo rtab le
m ed ic atio n s. Y ou m ig h t also c h e c k in to th e fe a sib ility o f a
sp e n d in g p o rtio n s o f his o r h e r in v e ste d p rin cip al. A s a re tiree
a g e s h e 0 1 sh e m a y c h o o se to sp e n d in cre asin g p o rtio n s o f
th e ir in v e ste d p rin cip al.
“ H e alth S a v in g s A c c o u n t” w h ic h is a p o rtio n o f th e 2 0 0 4 M edi­
care R e v isio n A ct. M e d ic a tio n s are a v a ila b le fro m C a n ad a .
T h ey are less e x p en siv e , th ey w o rk , a th re e -m o n th su p p ly is
a v ailab le, a n d th ey are d e liv e re d to y o u r hom e.
W h en e lig ib le fo r M e d ic a re , m a n y in su ra n c e c o m p a n ies
lln k n ow n s
A. H ow m u c h w ill m y in v e stm e n ts earn?
will o nly o ffe r su p p le m e n tal policies. T h ese p o lic ie s w ill also in­
B. H ow m u ch w ill m y m edical and p h arm aceutical
e x p e n s e s in c re a se w ith tim e ?
crease in p rice in the fo re se e a b le future.
R e tire m e n t is a c h an g e o f life sty le th a t re q u ire s an a d ju st­
C. H o w m u ch w ill in flation increase w ith tim e?
m en t and tran sitio n tim e. S om e re tiree s e n te r th e ir re tire m e n t
D. W ill I need “ lo n g term c a re ” ? I f so, h o w long?
E. W hen w ill I die?
w ith little o r n o tran sitio n tim e w hile o th ers m a y tak e years. A t a
re ce n t m eetin g , a p sy c h ia trist n o te d th a t w h ite m a le s, a t or
L e g a l C o n sid e ra tio n s
1 su g g e st th at e v e ry re tire e h av e a w ill, a d u rab le p o w e r o f
atto rn ey , a n d in stru ctio n s fo r p h y sic ia n s and law yers.
I b e lie v e a n y o n e c o n te m p la tin g re tire m e n t sh o u ld have le ­
g a l a ssista n c e , h e lp w ith tax p lan n in g , talk w ith a n a ccountant,
a n d c o n fe r w ith a tru sted in v estm e n t ad v iso r; as w ell as th o r­
ough d isc u ssio n s w ith th e ir spouse.
a ro u n d re tirem e n t age, w h o are e ith e r siu g le o r n o t g e ttin g
a lo n g w ith th eir w iv es, h a v e a high ra te o f su ic id e . I th in k plan­
ning and re alistic e x p e c ta tio n s, w ith re sp e c t to re tire m e n t, m ight
lessen this problem .
M o st re tiree s h ave sp e n t y e ars e a rn in g th e re sp ec t o f oth­
ers, p e rfe c tin g th e ir skills, m a k in g th em se lv es a v a ila b le to oth­
ers, b e co m in g a re so u rce for a n y o n e in te re s te d in th e ir craft,
a n d in return, th ey receiv e a g re at deal o f s e lf e stee m . M u c h of
o n e ’s social life is g e n era te d at the w o rk site. T h e se so u rc es of
S o c ia l S e c u r ity B e n e fits
E ac h y e a r th e S ocial S e c u rity A d m in istra tio n sen d s tax
p a y e rs d a ta b a se d on an e m p lo y e e ’s last 35 y e ars o f FIC A
p o sitiv e feed back c h an g e w ith re tirem e n t. R e alizin g the p o si­
tive and n e g ativ e ch an g e s th a t o c c u r w ith re tire m e n t m ake the
tran sitio n q u ite easy.
p a y m e n ts. T h is in fo rm a tio n lists b en efits receiv ed i f taken at
e a rlie st e ligibility, a g e 62, a n d at m aturity, age 65 o r later d e ­
T here is a w id e sp e c tru m o f a c tiv itie s w a itin g fo r retirees to
enjoy; from tak in g tim e each m o rn in g to re a d the p a p e r and en­
p e n d in g on y o u r y e a r o f birth. O n e can e asily c alcu la te how
jo y a cup o f c o ffee to tak in g a trip a ro u n d the w o rld . H obbies,
lo n g th ey m u st live to re ap m ax im u m b enefits, h o w e v e r there
are o th e r facto rs th at sh o u ld be c o n sid ere d w ith resp ect to
w h e n y o u m ig h t a p p ly fo r S ocial S ecu rity b enefits. Y our age at
like w o o d w o rk in g , p h o to g rap h y , g ra n d p a re n tin g , p a in tin g , writ­
ing, sew ing. RV-ing, are availab le. S p o rts, like h u n tin g , fishing,
b o a tin g , sailing, skiing, golf, etc. a w a it the retiree.
re tire m e n t, y o u r n e ed for incom e p rio r to y o u r age o f m aturity,
y o u r h e alth sta tu s a n d /o r life ex p ectan cy , the S ocial S ecurity
U se the in te rn et lor new s, sp o rts, p ro d u c t re v ie w s, pricing,
shopping, and e-m ail services. E -m ail a llo w s ra p id c om m unica­
b e n e fits a v a ila b le to y o u r sp o u se at age 62 and at her age o f
m atu rity , a n d th e e v er-c h a n g in g S ocial S ecu rity re g u la tio n s
tions w ith friends and re la tiv e s w h e re v e r th ey are and w herever
y o u are located.
sh o u ld be c o n sid ere d .
R etirem en t is one o l the few tim es w h e n you re a lly can
m ake y o u r ow n sch ed u le. E njoy y o u r re tire m e n t.
iM edical C are and In su ran ce for the R etiree
I f re tire m e n t lea v es y o u w ith o u t m edical in su ra n ce and
R em em ber, m ost h o b b ies c o st m o n e y ra th e r than m ake
m oney, so p u t that e x p en se in y o u r b u d g e t. ■
y o u are not y et e lig ib le fo r M e d ic a re b e n efits the co sts are
sta g g erin g . C o v e rag e m ay o r m ay n o t be av ailab le th ro u g h a
w o rk in g spouse. Y ou m u st b u d g e t for this expense. B ecause
d ru g m an u fa ctu re rs, m ajo r m edical in su ran ce carriers, m edical
lia b ility in su ra n ce c arriers, law y ers, and a lte rn a tiv e care givers,
n o t to m en tio n peo p le w ho a ctu ally p ro v id e m edical care, have
an in sa tia b le a p p etite fo r “ the m edical care d o lla r,” the co st o f
y o u r care w ill d e fin itely increase.
O u r leg isla to rs and g o v e rn m e n t fu n d e d p ro g ram s a d d to
th is p ro b lem by m an d a tin g set re m u n e ratio n fo r services, m ore
a n d m o re d o c u m e n ta tio n o f se rv ice s, sp ecific c o d in g for se r­
.
Allenmore
•SSL Psychological
Associates, P.S.
...a m ulti­
disciplinary
behavioral
health group
that works
w ith physicians
------------ 1 752-7320 , ----------
D o you have patients w ith difficult emotional
and stress-related problems? Psychiatric and
psychological consultations are available.
vices, and a sp c c tru m o f u n n e ce ssa ry serv ices. T h ese m an ­
d a te s are e x p en siv e a n d tak e tim e a w ay from p a tie n t caie.
R e tire es, d e p e n d in g on th eir health statu s and th eir
72 P C M S BULLETIN
February, 2004
Union A venue Professional Building
-------------------153P Union Ave. S.. Ste. 16 Tam m a_________
In My Opinion....
The Invisible Hand
by Andrew Statson, MD
T he o p in io n s e x p r e s s e d in th is w r itin g a re s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b e rs to e x p re ss t h e ir o p in io n 'in s ig h t s a b o u t s u b je c ts
relevant to the m e d ic o ! co m m u n ity, o r s h a re th e ir g e n e r a ! in te rest s to rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
Central Planning
'You can n ever p la n the future by the past.
E dm und B urke (1791)
A n d rew Statson. MD
The great projects o f antiquity, the
irrigation canals o f Sum er, the pyram ids
of Egypt, the G reat Wall o f C hina, w ere
the result o f central planning. In those
primitive econom ies, hum ans w ere used
for their m uscle power, like oxen, and
the projects required the com bined e f­
fort of thousands. The rulers achieved
monumental results. T heir w orkers per­
formed sim ple functions and w ere inter­
changeable with everyone else. T he ru l­
ers only had to gather the people and
crack the whip.
With the developm ent o f the crafts,
however, the situation changed. The
economic activity becam e m ore com ­
plex, the workers, m ore specialized.
People were interchangeable to a d e ­
gree within their ow n field and still
obeyed the crack o f the w hip, but w ith
a subtle difference. T he p ro d u ct o f their
work was m easured not o nly in q u an ­
tity, but also in quality.
The w orkers knew about th e ir jo b
and about quality m ore than those w ho
held the w hips. The m ore intricate the
craft and the m ore specialized the w ork,
the more im portant the quality relative
to the quantity o f production. T he w hip
lost some o f its effectiveness as a m o ti­
vating agent. The w orkers delivered
quality more readily w hen rew arded,
not when punished. C apitalism w as
born.
Prices function as signals o f the
relative abundance or scarcity o f goods
and services. The pricin g m echanism
coordinates supply and dem and, so
they m atch. In so doing, the pricing
m echanism tends to avoid im balances,
such as gluts and shortages.
Som ething else has to take over
that coordinating function w hen the
pricing system is subverted b y govern­
m ent intervention. T he duty and the re­
sponsibility for that falls on the shoul­
ders o f those w ho subverted the m arket
in the first place. A central planning
com m ission steps in.
In the m edical field, the com m ission
has to p roject the dem and, guess w hat
new' diseases w ill appear, w hat new epi­
dem ics w ill threaten, w hat new treat­
m ents w ill be developed, then allocate
resources to m eet those needs. I f they
guess w rong, there w ill be a large sup­
ply o f treatm ents nobody needs and a
shortage o f others that people w ant to
use.
T his does not m ean that busi­
nesses can n o t m ake m istakes w hen as­
sessin g the m arket. R em em ber the Edsel
and N ew C oke. N o, but the private en­
terprises q uickly cut th eir losses and
m ove on. T he public institutions d o n 't
know w hen to stop. L ook at A m trak. In
the thirty years o f its existence, it p ro b ­
ably has n e v er b een in the black.
T he o ther advantage o f priv ate o r­
g anizations is that there are m any o f
them . I f som e m ake a m istake, others
can ju m p in and fill the void. W hen
there is a p ro fit to be m ade, they can d e­
velop new p roduction techniques and
speed the delivery o f goods to m arket,
so long as they arc not ham pered by
regulations.
How does central planning w ork?
S om ew here in the D epartm ent o f
H ealth, a group o f planners m ake a list
o f health goals. T hey decide w hat will
be desirable for all o f us. T hey are the
experts. T hey are going to take care o f
us. We d o n ’t have to w orry about a n y ­
thing.
T he current situation w ith the flu
vaccine is an exam ple o f how central
planning functions. T he com m ittee
m aking the decisions looked at last
y e a r’s use o f the vaccine and decided
that w e 'll need the sam e am ount this
year. It also looked at the active strains
o f virus at that tim e and decided that
w e 'll need protection for the sam e
strains this year.
D eterm ining the future on the b a ­
sis o f past experience is a little like d riv ­
ing by looking in the rearview m irror. In
this situation, that approach resulted in
a shortage o f vaccine because the o u t­
break turned out to be w orse than the
one last year. A lso, the effectiveness o f
the available vaccine w as poor, b e ­
cause the predom inant strain turned
out to be different. R eportedly, only
15% o i'th e tim e, the flu virus has the
a ntigens included in the current v a c ­
cine.
T he strange thing about our legal
system is that w hen one o f us docs not
See “ Planning” page 16
February, 2004
PCMS BULLETIN
13
. ^ h ’/'rr i i i-ii/tffj G //c r/e rn /
a c t? f
Ways to reduce your personal liability
W hen review ing a contract o r a lo an docum ent, m ake sure
you check to see w hat y our p ersonal liability is if the deal goes
south. M ost loans and leases are structured as jo in t and sev­
eral among all partners, w hich can b e costly. H ere are som e key
points.
Joint and several liab ility holds each party to the contract,
loan or lease responsible for the entire debt. If the practice d e ­
faults, the bank o r landlord m ay collect all am ounts due from
one partner, even if that person is no longer with the practice.
N egotiate for several liability, u n d e r w hich each physician
agrees to be liable for a pro rata share o f the loan.
Settlem ent agreem ents am ong the partners often state that
former partners shall be indem nified against financial exposure
in connection w ith a lease or bank note. H ow ever, that prom ise
is only as good as the p ra ctic e ’s continued creditw orthiness.
The third party can seek paym ent from a partner, w ho in turn
has the right to seek reim bursem ent from the o ther contract
signers.
As part o f any term ination, it is im portant all departing
partners review every o bligation o f the practice that m ay result
in joint and several personal liability.
Indem nification clau ses can result in you or y our practice
being responsible for acts outside y our control. T he follow ing
is an exam ple o f a broad indem nification clause:
“Physician agrees to indem nify and hold payer, its em ploy­
ees, agents and contracting parties (the “ Indem nified Parties” )
harmless from any and all liability, loss, dam age, claim s, fines or
expenses, including costs and a tto rn ey s' fees (or upon the o p ­
O ur Clinical
PET Specialists
tion o f the Indem nified Party, Physician shall provide a defense
to the Indem nified P arty), w hich result from the alleged or actual
negligence, or intentional acts ( including b u t n o t lim ited to
crim inal conduct, fraud, defam ation and violation o f any
in d iv id u a l’s right to p rivacy) o f payer o r any In d e m n ified Parlies
in perform ance o f this agreem ent including losses due solely to
the acts or om issions o f any Indem nified P arties.”
W hile m any states m ay not enforce this p rovision to p ro ­
tect the payer against its ow n crim inal o r intentional conduct, a
lim ited indem nification provision is safer.
An exam ple: ‘‘Physician shall hold harm less and indem nify
payer for any and all third-party costs, losses, expenses, aw ards
or fees that payer incurs due solely to the acts or om issions o f
the P hysician for the m edical care o f an enrolled p a tie n t.”
Each p arty to a contract also should seek indem nification
from the o th e r’s acts. T his can be handled by including a m utual
or reciprocal indem nification provision, such as: “ Each party
agrees to indem nify and hold harm less the o th er p arty and its
officers, em ployees and agents from and again st all fines,
claim s, dem ands, suits, actions, or costs, including reasonable
a tto rn ey s’ fees, o f any kind and nature to the extent they arise
by reason o f the in d em n ito r’s acts or om issions."
To reduce p ersonal liability, w eed out all jo in t and several li­
ability provisions and n egotiate for several liability before sig n ­
ing any contact, loan or lease. Also, m ake sure executed settle­
m ent agreem ents include releases Itom p rio r o bligations and
elim inate broad indem nification p ro v isio n s.!
From .-! ;'| /.V;M.rs 2 /2 /0 4
O n - l in e v ie w in g o f y o u r
p a t ie n t ' s
Anthony Larhs, MD
Director of Clinical PET
Phillip C Lesh, M D
William B Jackson, M D
PET
IMAGES AND REPORTS
WILL SOON BE AVAILABLE.
HP
Please contact a TRA Customer Care
Representative to ge t more inform ation
(253)761-4200.
For information call
(253 ) 761-4200
Roy McCulloch, BS, CNMT
Supervisor PET & Nuclear
Medicine
2202 S Cedar Street, Ste 200
(253) 761-4200 fo r scheduling
tra m e d ic a lim a g in g .c o m
TRA
Medical
Imagi ng
Centers
TACOMA
February, 2004
PCMS BULLETIN
15
B
u l l e t in
Planning
fro m p a g e 13
lo llo w the g u id e lin e s a n d a p a tie n t
su ffe rs, the la w y e rs a n d th e c o u rts are
a ll o v e r us. Y et n o t m u ch h a p p en s w h en
th o se w h o w rite the g u id e lin e s m a k e a
m ista k e a n d m illio n s suffer.
N o w im ag in e for a m o m e n t, difficult
th o u g h it m ig h t be, th a t w e h a d a free
m a rk e t in flu v a c c in e s. M a n y c o m p a ­
g a n iz atio n s, su ch as the R e d C ro ss and
situ atio n w e fre q u e n tly se e in th e E R
G o o d w ill. T h e p h y sic ia n s in th e c o m ­
m u n ity a n d th e local c h u rch e s are a n ­
o th e r re so u rce .
a n d in o u r o ffic e s o f p a tie n ts w h o delay
W h en w e receiv e full p ric e from
th o se w h o can pay, w e can a ffo rd to
sp e n d a fe w h o u rs in a n e ig h b o rh o o d
c o m in g in u n til th e y h a v e d e v e lo p e d a
c o m p lic a tio n , w h ic h re su lts in a m o re
in v o lv e d and m o re e x p e n s iv e care.
T h at is p a rtia lly true. Y es, w e do
see p a tie n ts w h o c o m e late fo r c are w ith
clinic a n d give in je c tio n s at n o charge.
We c an n o t re ad ily do th a t w hen our
re su ltin g h ig h e r c o sts. T h e y d o th at
n ie s w ill m a k e v a c c in e s a n d b rin g them
to m a rk e t. T h e y w ill sp e e d u p th e p ro ­
fees are a lre ad y d isc o u n te d 50% .
Y et w e d o n ’t see th e m a n y o th e rs w ho
d u c tio n p ro c e ss, so w h e n m a rk e t d e ­
T h e flu v a c c in e situ atio n show s
now , ev en th o u g h th e y h a v e insurance.
sta rt w ith sim ila r c o m p la in ts, but w hose
m a n d is h ig h e r th an th ey h a d e x p ec te d ,
h o w the rig id ity o f a g o v e rn m e n t sy s­
p ro b le m re so lv e s on its o w n , so that
th e y can p ro d u c e m o re v a cc in e on
tem can fail in the ev er c h a n g in g c o m ­
plex ity o f life, w hile the flexibility o fth e
th ey n e v e r c o m e in.
sh o rt no tice.
T h e c o m p a n ie s w ill be m o re a tte n ­
tiv e to th e c h an g e s in the v iru le n t
m ark e t a llo w s it to do th e jo b at a profit.
G ra n ted , in the past, m edical e x ­
stra in s a n d in c lu d e a n e w stra in in th e ir
p en ses w ere a sig n ific a n t c o n trib u to r to
v a c c in e b le n d m o re re a d ily a n d m o re
p e rso n al b a n k ru p tc ie s. Today, the in ­
su ran ce c o m p a n ies seem to be g oing
b a n k ru p t m o re often, even th o u g h p e r­
p ro m p tly . T h e y w ill w o rk h a rd er to
p ro je c t th e n e e d s, b e c a u se th e ir p rofit
d e p e n d s on that. C h a n c e s arc th a t
so m e c o m p a n ie s w ill include a d iffere n t
b len d o f stra in s in th e ir v a cc in e , so that
w h e n th e flu se a so n d e v elo p s, th ey
m ig h t h av e a m o re e ffe c tiv e p ro d u ct
a n d o b tain a d v an tag e o v e r th e ir c o m ­
p e tito rs. T h e c o m p a n ie s th at guess
rig h t are m ore likely to profit.
F in ally , i f the v a cc in e s are n o t u se d
so n a l b a n k ru p tc ie s have also in creased .
In spite o f the m ark e t boom , p e rso n al
b a n k ru p tc ie s in creased m ore th an fo u r­
fold from 1980 to 2000.
T h e c o n ce rn th a t p a tie n ts w o u ld
not g et need ed care until th e y are very
sick is at th e basis o f the m ain o bjection
to the p a tie n ts p a y in g fo r m ed ical ser­
vices. T h at co n cern arises from the
W e a lso see the w o rrie d w ell, w ho
ab u se the sy ste m b e c a u se th e y d o n ’t
h av e to p a y for th e s e r v ic e , a n d those
w h o look on th e ir v isits to th e o ffice or
the E R as a social e v en t. It is a w a y for
them to m ee t p e o p le a n d talk ab o u t
th e ir pro b lem s.
T here is g o o d a n d b a d on b oth
sid e s o f t h e issue. O v e rall, p e o p le are
m o re lik ely to b e c a re fu l h o w th ey use
sc a rc e re so u rc e s w h e n th ey h av e to
p a y out o f th e ir p o c k et. T h e m ark e t
fu n ctio n s b e tte r a n d at a lo w e r co st as a
m o d e ra to r o f d e m a n d , a stim u la to r o f
su p p ly a n d a c o o rd in a to r o f b o th , than
a sy ste m o f c o n tro ls b y e d ic ts. ■
in the c u rre n t year, the c o m p a n ie s arc
m o re lik e ly to fin d a w a y to re c y c le the
p ro d u c t a n d re d u c e th e ir losses. R e­
p o rted ly , in the la st flu seaso n o v e r
tw e lv e m illio n s d o ses o f v a cc in e re ­
m a in e d u n u se d .
F o r its p a rt, the m a rk e t re ac ts to
a n y p e rc e iv e d o v e rsu p p ly o r sh o rtag e
b y a d ju stin g the p rice . If th ere is too
m u c h v a cc in e , the p ric e dro p s and the
in d ic a tio n s ex p an d . P e o p le m arg in ally
a t risk are m o re lik e ly to g e t the vaccin e.
If, on the o p p o site, there is a sh o rtag e,
th e p ric e goes up, th e in d ic a tio n s
sh rin k , and o n ly th o se m o st at risk are
lik e ly to p a y the p rice to p ro tec t th e m ­
se lv es from th e flu.
W h at a b o u t th o se w h o are at high
risk a n d c an n o t p a y ? 1 can tu rn the
q u e stio n a ro u n d b y a sk in g , w h a t ab o u t
th o se at h ig h risk w h en w e run o u t o f
v a c c in e ? J still w a n t to answ ei th e first
qu e stio n . T h ey sh o u ld re ce iv e it as a
C h ristm a s p re se n t fro m th e ir te la tiv e s 01
frien d s, o r from the m a n y c h arita b le o r­
16
P C M S BULLETIN
February, 2004
ER^SE
THATTATTO O
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BO SS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
Today’s new est A le xa n drite laser,
will rem ove y o u r tattoo
w ith m inim al d isco m fo rt &
less than 1 % risk of scarring .
C u ll U k U iv J o r n u n -c in f u n n u t iu n
PIERCE C O UNTY
LASER CLINIC
D i r e c t o r IV - lc r K . Mi ir sl i M . l )
(2 5 3 )5 7 3 -0 0 4 7
?/)en:e ''kvtoiftf
dfecte/t/
Continuing Medical Education
COLLEGE
OF
MEDICAL
EDUCATION
Endocrinology for Primary Care II
scheduled for February 27,2004
R egistration is open for the E ndo­
crinology for Prim ary Care C M E pro­
include the follow ing:
• U sing N ew Insulin A nalogs in the
M anagem ent o f Type 1 and Type II
gram set for February 2 7 ,2 0 0 4
T he new C O M E program will be
Internal Medicine
Review CME set
for March 13-14
held at St. Joseph H ospital and is di­
C hronic C o m plications o f D iabetes
rected by Ron G raf, MD.
Dr. G ra f has assem bled m ostly local
e n d ocrinologists to present on tim ely
and appropriate subjects. T he program
is com plem entary and offers six C at­
The T acom a A cadem y o f Inter­
• D iagnosis and T reatm ent o f
O steoporosis in 2004: C ase Studies
• E valuation and M anag em en t o fth e
T hyroid N odule
• O besity, Fad D iets, and the C a rb o h y ­
egory I C M E credits.
nal M edicine’s annual tw o-day CM E
D iabetes
• U pdate on the M anagem ent o f
T he program b rochure will be
m ailed in early M arch. Subjects planned
drate C ontroversy
• E ndocrine H ypertension ■
program set for M arch 11 and 12 is
open for registration
This tw o-day C M E deals with
Reminder: Primary Care CME Cancelled
recent advances in Internal M edi­
cine. Faculty includes internists and
The Prim ary Care 2004 C’M E, previ­
An U pdate in Im aging C M E will
internal m edicine su bspecialists from
ously scheduled for F ebruary 7, 2004,
likely be available in May. A program
the area and o ther parts o f the c o u n ­
has been cancelled.
brochure will be m ailed in April. ■
try. This program is offered to m em ­
bers o f the T acom a A cadem y o f In­
ternal M edicine and all local ph y si­
cians.
This y e a r’s program is directed
by Gurjit Kaeley, M D and will be
Dates
Wednesday-Sunday
Jan 28 - Feb 1
Program
Director(s)
John Jiganti, MD
CME @ Whistler
Rick Tobin, MD
held at St. Joseph Elospital. ■
Friday, February 27
Fox Island W eb Design
Owned and operated by
Rick Schoen M.D.
Web Sites for Medical, Dental,
and Small Business.
Internal Medicine
March 11-12
Review 2004
Monday-Friday
April 12-16
Ronald Graf, MD
Primary Care
Thursday-Friday
Guijit Kaeley, MD
CME at Hawaii
Mark Craddock, MD
Allergy, Asthma &
Friday, April 30
Pulmonology for
Alex Mihali, MD
Primary Care
www.foxislandwebdesign.com
253-549-4147
Endocrinology for
Friday, May 21
Advances in Women's
Medicine
John Lenihan, Jr., MD
February, 2004
PCMS BULLETIN
17
B
l il i . f.t i n
In My Opinion....
The
by Daisy Puracal, MD;
opinions e x p r e s s e d in t h is w r it in g a r e s o le ly th o s e o f t h e a u t h o r . P C M S in v ite s m e m b e rs li, e x p re s s t h e ir o p in io n /in s ig h t s a b o u t s u b je c t s
l e k \cm t to
f'/ii
m e d ic a l L om m n n in -. o r s h a r e t h e ir g e n e r a l h u e re s r s to r ie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itt e e rei-ie ii'.
Strawberry Patch
D a isy P u ra ca l. M D
hill slope. F rom the very top o f the
in g and sa v o rin g eac h bite. W hatever
into o u r v e ry first h o m e. It w as a m o d ­
slo p e , w e co u ld look o u t o n to the w a ­
d id not g et e a te n w o u ld fin d its w ay to
e st b e ig e c o lo re d h o u se w ith ru st c o l­
te r and see the ships g lid in g past. A t
a b a k in g d ish to b e tra n s fo n n e d into
ored trim .
n ig h ts w e w o u ld h e ar the m ournful
m o u th w a te rin g a p p le crisp s.
It w as M ay 1980 w h e n w e m o v ed
T h e fro n t y a rd w as o p en green
b la st o f the foghorn like the “o h m ” o f a
It w as a w o n d erfu l lea rn in g experi­
law n w ith a ra ised flo w e rb e d a d jo in in g
T ib e ta n m o n k and the b a rk o f a seal at
ence fo r the c h ild ren - a d e e p co n n ec­
the fro n t o f the h o u se. T h e flo w erb ed
play.
tio n to th e e arth a n d its ab u n d an c e. I
lo v ed e v e ry m o m e n t o f th o se days;
w as a b la z e o f c o lo r w ith p a n sies -
T h ere w ere a few fruit tree s in the
b rig h t sm ile y v a rie g a te d faces that
b a c k yard a n d a stra w b erry patch. We
e v en the ra k in g o f the n o sta lg ic carpet
m ad e m y h e art sm ile in turn. It w as the
cam e to know the seasons fro m the
o f y e llo w b row n lea v es in the fall chas­
p a n sies th at d rew m e to the house. I
ch an g e s on th e trees. T he buds b u rst­
ing a ro u n d in the w in d , a n d th e cold,
w o u ld pick th ese d a in tie s a n d posy
ing on the c h erry trees in the spring
stark b ra n ch e s in w in te r d u ste d in light
them in the bath and d in in g ro o m s - a
g iv in g w ay to clouds o f w hite bloom s.
snow , w a itin g fo r the c y cle to sta rt all
little to u ch o f c h e e r in a hectic w orld.
A s the p e ta ls fell ex p o sin g the d elicate
o v e r again.
T h e h o u se faced w est, o v e rlo o k in g
start o f t h e green fruit it laid a lacy
the g lis te n in g w a ters o f the P uget
w hite trail on the grass below . Jason
T h e ch ild ren a re g ro w n no w and
h a v e left the hom e.
S o und. T h e re fle cte d flam in g su n sets
w o u ld clim b up the tree and bend the
w a n n e d m y sen ses. T h e m y ria d tw in ­
b o u g h s w ith his w eight so w e could
In its p lac e are o v e rg ro w n w eed s. The
b a ck yard is n e g le c te d , th e a p p les and
T h e stra w b erry p a tc h is n o m ore.
k lin g c ity lights o fT a c o m a served as a
p ic k the dark plum p c h erries rig h t o ff
g o rg e o u s b a c k d ro p to the d a rk en in g
the tree w ith o u t b ra isin g them . In v a ri­
c h erries fall to th e g ro u n d , an abundant
n ig h ts. M any an e v en in g w o u ld find
ab ly tw o c h erries fo r ev ery o n e th at w e
fe ast laid o u t fo r the b ird s. T h e ships
us o u t on the d e c k o r at the b ed ro o m
c o lle cted w o u ld find its w ay to sa liv a t­
sou n d th e ir sad g o o d b y e s as th ey sail
w in d o w fe astin g on this je w e le d vista.
ing m ouths. T hen cam e the tim e fo r the
p ast. T h e p a n sies h av e b e e n replaced
straw b en 'y patch to bloom . We eag erly
by hard c o n cre te w alk w ay . T h e lights
Ja so n w as th ree a n d Ja n is, one w hen
w aited for it to fruit. I rem em b er m y
a cro ss th e w a te r h a v e lo st its appeal.
w e m o v e d in. T h e y o u n g e st, Ja im e w as
c h ild ren im p a tie n tly tu rn in g the leaves
b orn h e re and k n o w s no o th er hom e.
to look for the rip e straw b erries. A n d
T h e le ttin g go p ro c e ss h a s begun.
W h en th ey w ere o ld e r th ey fe lt cut o ff
then the sw eet re w a rd -ju ic y u n a d u lte r­
W h at w ill it be lik e in th e fin a l days
from th e city life k n o w n to th e ir friends,
ated fresh from the soil, stra w b errie s to
b u t I h a v e alw ay s e n jo y e d the serenity
thrill the palate.
w'hen it is tim e fo r m e to let go o f life it­
s e lf? *
o f th e area.
T h e b a c k y a rd w as ten 'a ce d into a
the crisp apples from the tree, c ru n c h ­
T h e c h ild ren g re w up in this house.
18
P C M S BULLETIN
February, 2004
L ate in the su m m er w e w o u ld pick
T he h o u se feels lo n ely and empty.
'V
ffie r r e ip o m / tf Q $ e d * ca /(S o c ie ty-
Classified Advertising
POSITIONS AVAILABLE
OFFICE SPACE
Tacoma/Pierce C ounty outpatient
general m edical care at its best. Full
and part-tim e p ositions available in
Tacoma and vicinity. Veiy flexible
schedule. Well suited for career
redefinition for G.P., F.P., I.M . C ontact
Andy Tsoi, M D (253) 752-9669 or Paul
Doty (Allen, N elson, T urner & A ssoc.),
Clinic M anager (253) 383-4351.
F or R ent: 3300 sq ft C lass A m edical
office in T acom a M edical Center, 1112
6th Ave, third floor. Elevator, u n d e r­
ground parking, close to hospitals. C all
253-272-2224.
Family P ractice H ou se Calls! Seeking
BC/BE physicians n ear T acom a, WA
and in San Francisco B ay A re a for
innovative new house call practice. In
our physician-owned, w ork-from -hom e
model, you can spend m ore tim e w ith
your patients and h ave m ore personal
time. You will be fully supported, have
a competitive full-tim e salary w ith
additional earning potential, and
receive full benefits. O nsite h ealthcare
will involve seeing injured w orkers at
their job for acute injuries w hile at the
same tim e developing a co ntinuity
panel o f house call patients o f all ages.
Forward C V or contact: A nthony
Barnett, M D, anthony@ O nS iteD ocs
.com or FAX 206-623-7674.
Clioicc office space in M edical/D ental
com plex in G ig H arbor available
January, 2004. 2,354 sq. ft. on m ain floor.
T w o entrances, offices w ith decks and
outside doors. L arge reception and
front office. Lab space, consultation
room , heat, electricity and w ater
included. B eautiful, w ooded setting.
5122 Olym pic D r NW, Suite A203. Call
Dr. M aiy Griffith 851-7550,468-3539.
There will be a no-host luncheon
Wednesday, February 25, 2 0 0 4 at
11:30 a.m. at Affairs restaurant
located at 27th and Bridgeport in
University Place. W ives of retired and
semi-retired doctors are welcom e.
To m ake a reservation, call
Judy Brachvogel (56 4 -43 0 3)
or Maryln Baer (564-6374)
by February 20.
Come and renew friendships!
available im m ediately. $14 sq. ft. Call
253-582-6368.
Space For Lease: Valley M edical
C enter - A uburn C linic. 3702 W est
Valley ITwy N #114, A uburn WA 98001.
Valley M edical spent $591,000 on a
class “A ” build-out. We are only asking
$12 N N N p e r sq. ft. 6,150 sq. ft.,
divisible or expandable. 425-451-1511.
F u ll a n d p a r t-tim e p o sitio n s
a v ailab le in T a c o m a a n d vicinity.
VOLVO
BMW
V ery flexible sc h e d u le . W ell s u ite d
SERVICE & REPAIR
fo r c a r e e r re d e fin itio n fo r
(253) 588-8669
TA C O M A /PIE R C E C O UNTY
O u tp a tie n t G e n e ra l M e d ic a l C a re .
G P , F P , IM .
C o n ta ct A ndy Tsoi. H D (253) 752-9669
o r Paul D oty (Allen, N elson. T u r n e r &
Assoc,), C linic M an ag er (253) 383-4351
Retired Doctors’
Wives Luncheon
O ffice space available in L akew ood/
U niversity Place -1 ,5 0 0 -3 ,0 0 0 sq. ft. m/1
w w w .volvorepair.com
B o y le ’s F o r e ig n C a r R e p a ir
7202 S te ila c o o m B lv d S W
MEDICAL LICENSURE ISSUES
M r. R ockw ell is available to represent physicians and other health care
providers with issues o f concern before the State M edical Q uality A ssurance
C om m ission. Mr. R ockw ell, appointed by G overnor B ooth G ardner, served for
8 years as the Public B oard M em ber o f the M edical D isciplinary B oard from
1985-1993. Since then, Mr. R ockw ell has successfully rep resen ted over 60
physicians on charges before the M Q A C . Mr. R o c k w e ll’s fees are com petitive
and the subject ot a confidential atto rney-client representation agreem ent.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(425) 453-4398 • FAX (425) 453-1534
email: [email protected] • website: www.gregrockwelllaw.com
February, 2004
PCMS BULLETIN
19
B u I .L F .T I N
'JPien-e % w n ty Q /(b d ica l- (S focietij,
Threatening Litigation Is a
Nightmare Process”
A s a claim s re p resen tativ e a n d su p e rv iso r, 1 see p h y sician s of all specialties
w hose lives are su d d e n ly c h an g e d b y claim s liled ag ain st th em . W h e th e r the
cases are d ism issed, settled , or go to Lnal, each p h y sic ia n ’s p ersonal a n d
professional life can take a tu rn for the w orse, a n d th a t’s w h y I'm h e re to
help. 1 analyze each claim , stay in close con tact w ith o u r a tto rn ey s, a n d w o rk
w ith the physician on new strategies as the case d evelops. Ever)' p h y sic ia n is
im p o rta n t to m e, a n d 1 m ak e su re m y w o rk sh o w s th e m th a t 1 care.
To lin d o u t a b o u t th e m a n y w a y s P h y sic ia n s In s u ra n c e w o rk s w ith a n d
to r p h y sic ia n s, call u s today.
W estern W ashington
1 -8 0 0 -9 6 2 -1 3 9 9
Eastern W ashington
1-8 0 0 -9 6 2 -] 3 9 8
K a ri A d a m s,
C la im s S u p e rv iso r
| F Physicians
^ Insurance
A Mutual Company
C r t/i ic i ! .m il i-PO IV O iv l I h y the:
V isit o u r W e ll s i t e .it p h y in s .c o m
V. JL-h irt-l.M i M .u t M o i k . t ! As =i‘ i
i e - i itlc , W A
P ierce C ounty M edical Society
223 Tacoma A venue South
Tacoma, WA 98402
f -'h v n id a n s I n s u r a n c e 2 0 0 3
PRESORTED
ST A N D A R D
US P O S T A G E P A ID
TACOM A, WA
P E R M IT N 0 6 0 5
Return service requested
20
P C M S BULLETIN
February, 2004
March, 2004
Ever popular “resort” CME programs offered through the PCMS
College of Medical Education continue to offer stimulating education
and affordable vacations for physicians. Above: The Krumin family
(l-r), Dr. Peter, Stuart, Emma, Christine and Benjamin pose for the
camera before the “boys” hit the slopes in Whistler, BC
M ore Photos Page 15
INSIDE:
3
4
7
11
13
15
P r e s i d e n t ’s P a g e : “ W h a t ’s N e x t ? ” b y M ic h a e l K e lly , M D
S p e c i a l F e a t u r e : “ C H C . .. T h i r t y F iv e Y e a r s a n d C o u n t i n g ” b y J e a n B o r s t
T P C H D : “ R e a s o n to H o p e ” b y F e d e r ic o C r u z - U r i b e , M D
In M e m o r ia m : M i c h a e l T . H a y n e s , M D
In M y O p in io n : “ P u n itiv e D a m a g e s ” b y A n d r e w S ta ts o n , M D
W h i s t l e r C M E p r o g r a m - e d u c a t i o n A N D v a c a t io n
P C M S O ffic e rs /T ru s te e s :
M ic h a e l J. K elly , M D , P r e sid e n t
P a tric k J. H o g a n , D O . P re s id e n t E le c t
K e n n e th A . I^eucht, V ic e -P re s id e n t
J o s e p h W . R e g im b a l.T re a s u r e r
S u m n e r L . S c h o c n ik e , S e c re ta ry
J . J a m e s R o o k s , J r.. M D , P a s t P re s id e n t
L a u re l R H a m s . M D
J e ff re y L. N a c h t.M D
Jo s e p h F . Jasp er, M D
N a v d e e p S. R ai. M D
R o n a ld R .M o r r is .M D
C a rl W . W u lle s tic g ,M D
March, 2004
P C M S M e m b e r s h ip B e n e fit s , Inc (M B I ):
T i m S c h u b e r t , M D , P r e s i d e n t : D r e w D e u ts e h .
M D . P a s t P re s id e n t; J o e R e g im b a l. M D , S e c re ta ry T re a s u re r; K e ith D e m iijia n .M D ; S te v e D u n c a n , M D :
M a rk G ild e n h a r . M D ; S te v e S e ttle . M D ; J o e W e a rn , M D
C o lle g e o f M e d ic a l E d u c a tio n (C .O .M .K .):
J o h n J i g a n t i , M D P r e sid e n t; B a rb a ra F o x , M D .
W illia m H o ld e rm a n , M D , S te v e K o n ic e k . M D . M a rjo rie
K r a b b e . M D . W illia m L ee, M D . G r e g g O s te rg re n , D O .
B r a d P a ttis o n . M D .C e c il S n o d g ra ss . M D . V irg in ia
S low eM .M JD . R ic h a rd W a ltm a n .M D .T o d \V u rst.M D ;
H e r ta M a le ik e . G o o d S a m a rita n F lo sp ita k L isa W h ite ,
M u lti c a r e H e a lth S y s te m ; S is te r A n n M c N a m a ra ,
T re a s u r e r, F ra n c is c a n H e a lth S y ste m ; S u e A s h e r.
S e c re ta ry
P C M S F o u n d a tio n : L a w r en ce A.
L a r s o n , D O , P r e s i d e n t : C h a r le s W e a i h e r b y . M D .
M o n a B a g h d a d i. N ik k i C r o w le y .T re a s u r e r; S u e A sh e r.
S e c re ta ry
Table o f C ontents
3
4
P re sid e n t's Page: " W h a t's N e x t? "
Special Feature: “ C o m m u n ity H ealth C are...
T h irty Five Y ears a n d C o u n tin g "
7
T P C H D : “ R eason to H o p e "
10
A p p lica n ts for M e m b ersh ip
11
In M em oriani: M ich ael T. H aynes, M D
12
H as H IP A A C h an g ed H o w W e T reat M in o rs?
13
In M y O pinion "P u n itiv e D a m ag e s"
14
D octors lor M edical L iability Reform
15
W h istle r C M E p ro g ram - e d u ca tio n A N D v a ca tio n
T h e B u l l e t i n is p u b lish e d m o n th ly by P C M S
17
C o lleg e o f M edical E ducation
M e m b e rs h ip B en e 11ts. Inc. D e a d lin e lor su b m ittin g artic le s
a n d p la c in g a d v e rtis e m e n ts is th e 15th o l'lh e m o n th
p re c e d in g p u b licatio n .
19
C lassified Adv ertising
W SM A
R ep r e se n ta tiv e s:
T ru s te e s : L e o n a rd A le n ic k .M D ; N ic h o la s R a ja c ic h .M D ;
P a tric e S te v e n s o n . M D
W A M P A C 6 th D istrict; D o n R u ssell, D O
W A M P A C 9 th D istrict: L eo n a rd A le n ic k , M D
S t a f f : E x e c u tiv e D ir e c to r: S u e A s h e r
A d m in is tra tiv e A ssista n ts: T a n y a M c C la in . C risti P eterso n
P la e e m e n tC o o rd in a lo r: K e n S m ith
P la c e m e n t A ssista n t: M e lis s a K re g n e s s
C M E P ro g ra m A d m in istra to r: L e s M c C a llu m
B o o k k e e p e r: Ju a n ita 1 lo frn e iste r
T h e B u l l e t i n is d e d ic a te d lo th e art, sc ie n c e and d e liv ery
o f m e d ic in e an d the b e tte rm e n t o f th e health an d m ed ical
w e lfa re o f t h e c o m m u n ity . T h e o p in io n s h erein are th o se ol
th e in d iv id u a l c o n trib u to rs a n d d o n o t n e c e ssa rily reflect the
o ffic ia l p o sitio n ol P C M S . A c c e p ta n c e ol a d v e rtisin g in no
w a y c o n s titu te s p ro fe s sio n a l a p p ro v a l o r e n d o rs e m e n to f
p r o d u c t s o r se rv ic e s a d v e rtise d . T h e B u lletin re se rv e s the
r iu h tto reject an y a d v e rtisin g .
M a n a g i n g F d i t o r : S ue A shei
E d i t o r i a l C o m m i t t e e : M B I B o a r d o l D ir e c to r s
A d v e rtisin g In fo rm a tio n : 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th .T a c o m a W A 9X 402
2 5 3 -5 7 2 -3 6 6 6 : F A X :2 5 3 -5 7 2 -2 4 7 0
E -m a il a d d re ss: p cm sw af« -.p em sw a.o rg
H o m e P ag e: h ttp ://w w w .p a n s w a .o rg
2 P C M S BULLETIN
March, 2004
?/)'<• ret’ f(< A (n tij O ( l e d / c a / ( " i v a c t i f
President s Page
byMichael j-
MD
What’s Next?
’Vietoiy belongs to the m ost persevering. "
N apoleon
M ichael J. Kelly. AID
As m y predecessors can attest,
the m ost difficult part about w riting
this colum n is prognostication. Final
drafts are due w eeks ahead o f p u b lic a ­
tion during w hich tim e m any o f the sa ­
lient issues m ay have changed. The
fate ofbill ESSB 5728 w ill not be know n
until m idnight F ebruary 27, although
the legislative session ends M arch 11.
If the judiciary com m ittee o f the H ouse
has not acted upon E SSB 5728 by then,
it will be officially dead. It appears w e
must prepare ourselves for the w orst.
By the tim e you read this colum n, the
authoritarian chair o f the ju d ic iary c o m ­
mittee will m ost likely have killed ESSB
5728 for the second y ear in a row.
Power corrupts.
With this in m ind, w e should p re ­
pare ourselves for the next battle in
this war to reclaim our profession and
maintain patient access. W hen you
cannot change the legislation, you
work to change the legislators. So,
what’s next?
Drs. Ron Taylor and Jim R ooks
brought an article to m y attention from
the D ecem ber2003 bulletin o fth e
American C ollege o f S urgeons as a
way to answ er the above query. E n­
titled, “A R evolutionary A pproach to
Achieving Tort R eform ,” it d ealt w ith a
cam paign initiated by the m edical so ci­
ety o f N ew Jersey and the N ew Jersey
Chapter o f the A CS in response to that
state’s legislature’s failure to pass
m eaningful tort reform du ring the sum ­
m er o f 2003.
T he state o f N ew Jersey faced the
sam e o rganized opposition to caps on
pain and suffering as w e have. T hey
m obilized o ver 8,000 physicians to
m arch on T renton February 4, 2003.
T hrough their activism , they w ere able
to h am m er out a com prom ise bill with
the senate fo r a $300,000 cap on non­
econom ic dam ages and other reform
m easures.
T heir chances looked good until
the eight dem ocratic m em bers o f the as­
sem bly, w ho indicated they w ould vote
for the senate com prom ise bill, w ere
reigned in by party leadership. The
D em ocrats called for a parly block vote
against the bill and got it. The d em o ­
crats defeated tort reform 41 -38 - a vic­
tory o f politics over patients.
N ew Jersey physicians then asked
them selves, ‘"W hat's next?" T hey de­
cided against another rally and concen­
trated their efforts instead into a
grassroots advocacy strategy designed
to defeat dem ocratic assem bly tort o p ­
ponents in the upcom ing election on
N ovem ber 4 ,2 0 0 3 . A s author A rthur
E llenberger stated in the bulletin article,
“ O ur focus w ent from changing legisla­
tion to changing assem bly faces.’’ T heir
b attlefield tactic w as local grassroots
action assigned to w innable sw in g dis­
tricts.
N ew Jersey phy sician s chose to
use a “ ...structured, politically savvy
approach, speaking directly w ith the
public about the p roblem s they believed
dem ocratic assem bly m em bers w ere per­
p etuating.” P hysicians w ere ask ed to
see patients until 2:00 p.m . on Tuesday.
O ctober 7 and then leave their offices
w earing w hite coats and m eet in groups
at 3:00 p.m . in the selected districts. “ By
the tim e w e k nocked on three doors and
talked w ith the residents, w e w ere on a
roll. T he key is telling y o u r story briefly
and asking for support in a friendly
w ay.”
T hey began in groups o f four but
split into groups o f tw o to co v er m ore
hom es and hand out m ore flyers. T his
first effort w as follow ed by a second on
N ovem ber 1 and w ent as w ell as the
first.
U nfortunately. N ew Jersey, like
W ashington State, suffers from lan d ­
slide apathy. Very few vo ters turned out
on N ovem ber 4 and the d em ocrats m ain ­
tained control o f th e state legislature.
D espite this, the N ew Jersey p h y sician s
felt they had achieved som e m in o r v ic ­
tories. Until their activism , tort reform
and caps w ere not even on the legisla­
tive agenda. T he sta te 's p h y sician s b e ­
cam e m ore aw are o f ho w im portant the
political process w as to success in their
practiccs. T he state m edical so c ie ty ’s
political action com m ittee raised m ore
funds than ever. N ew Jersey p hysicians
See “N ext" page 14
March, 2004
PCMS BULLETIN 3
B
u l l e t in
Special Feature
by Jean Borst
Community Health Care...
Thirty Five Years and Counting
m ed ically un in su red and 300 .0 0 0 lack
rep s th at c o u ld be d istrib u te d at the
d ental co v erag e.
clinics.
In ad d itio n . S ixth D istrict C o n ­
St. J o s e p h 's H o sp ital N u rsin g S chool.
C o m m u n ity 1lealth C a re (CMC ) has
In the B e g in n in g ...
g ressm an N orm D icks (w ith p rodding
g ro w n to a S22 m illio n o rg an izatio n w ith
d o o rs o f the first C o m m u n ity H ealth
25 m ed ic al p ro v id ers and 13 dental p ro ­
C a re clinic e v er o p en ed , a gro u p o f c o n ­
H ealth S e rv ice s C o rp s p h y sic ia n s to
v id ers. B ut m ost im p o rta n t, the agen cy
p a rticip a te in u rban p ro g ra m s. N H S C
F rom its h u m b le b e g in n in g s in 1969
in the c o m m u n ity room at L iste r E l­
e m e n ta ry S ch o o l and the b a se m e n t o f
In the late 1960s. w ell b efo re the
from Dr. T an b ara) w as in stru m e n tal in
c h a n g in g p o lic y to e n a b le N atio n al
h as c o n tin u a lly se rv ed the m ed ical and
c ern e d citizen s. p h y sic ia n s a n d c o m m u ­
nity lead ers jo in e d to g e th e r to ad d ress
d e n ta l n e e d s o f low - a n d n o -in co m e
h o w to serv e the health care n e ed s o f
re sid e n ts o f P ierce C o u n ty w h o m o th e r­
w ise w o u ld h ave no o th e r a cc ess to
h e alth care.
the c o u n ty ’s low - and n o -in co m e re si­
dents. Dr. G eorge T anb ara w as am ong
the first p h y sic ia n s to tak e an active
g re atest n e ed o f a cc ess to h e alth care
" M a n y o f the M edical S ociety
p h y sic ia n s h a v e a g o o d se n se o f o u r
role in d e v elo p in g so lu tio n s to the
Dr. T anbara w o rk e d o n c e a w eek at
the E astsid e C lin ic , and then expanded
w as c rea te d in 1970 to p la c e p rim a ry
care p h y sic ia n s and d e n tists in areas of
— trad itio n a lly e c o n o m ic a lly d isadvan­
taged rural areas.
h isto ry ." said D av id F lentge. C H C
p re ssin g c h allen g e o f h e lp in g th o se u n ­
ab le to a ffo rd h e alth care. H e re ca lls the
P re sid e n t and C h ie f E xecu tiv e Officer.
" T h e y w ere in stru m e n tal in the e sta b ­
first m eetin g held to e x p lo re the issue,
w hich w as atten d ed by 50 P C M S p h y si­
C lin ic w as o p e ratio n a l. A n d his involve­
lish m en t o f
cians. T h ey g a th e red to o ffe r support,
ideas and feed b ack — b u t also c o n ­
cern. Initially, th ere w as som e re lu c ­
tan ce to su p p o rt the c lin ics as there
w ere a few co n ce rn ed about c o m p e ti­
tion in the m edical m ark etp lace. D ue to
“ T h ere w ere m an y p e o p le in v o lv e d and
resp o n sib le for the su c c e ss o f the clin­
ics," Dr. T anbara said. “ M y in v o lv e ­
w h o has been a ro u n d the lo n g est. And
m an y are
the ten a city o fin d iv id u a ls like Dr.
T anbara, the p h y sic ia n s w ere c o n ­
p ro b a b ly
unfam iliar
v in ced o f the need for the facilities.
W ith PC M S su p p o rt, a g roup cam e to­
C'HC and
h a v e fo l­
lo w e d us
for a long,
long tim e.
H ow ever,
w ith o u r
c u rre n t sta ­
/ h n'iil I 'lcnly.c
tu s. and I
su sp ec t that it w ill be a su rp rise to
so m e w h o c o n sid e r us a re la tiv e ly sm all
p a rt o f the sy ste m ."
O n the co n trary . C H C is a relativ ely
g e th e r in a series o f m ee tin g s (and
m ore m eetin g s) th at ev en tu ally lead to
the o p e n in g o f tw o v o lu n te e r c lin ics —
the E astsid e C linic and the F am ily
M edical C linic in d o w n to w n Tacom a.
T h e ex p an sio n w as slow , but
his se rv ice tim e o n c e the D ow n to w n
m ent and d e d ic a tio n c o n tin u e s today.
m ent should not be v a lu e d a n y m ore
than a n y o n e else w ho has b e en in­
v olved. I ju s t h a p p en e d to b e th e one
I hap p en ed to have the in te re st and the
tim e to do w h a t I did. O th e rs m ig h t not
h ave had as m uch tim e. B ut i t ’s im p o r­
tant to a c k n o w le d g e, re c o g n iz e and ap­
p re ciate w hat e v ery o n e has d one. A nd I
w e lco m e a n y o n e w ho can h e lp and par­
ticipate. It's im p o rtan t for e a c h o f us to
do as m uch as p o ssib le to c o n tin u e the
su c c ess ol C HC as long a s th ere are
steady, a n d p h y sic ia n p a rticip a tio n and
h ospital su p p o rt w as p h en o m e n al. Dr.
u n d e is e iv e d and u n se rv ed p a tie n ts."
larg e part o f the system as the patien t
n u m b e rs alo n e indicate. T h e e ig h t m ed i­
cal c lin ics in Pierce C ounty saw 3 4 .SOI
T anbara recalls. “ T h ere w ere so m any
p e o p le and o rg a n iz atio n s in v o lv e d in
Up and Running
p a tie n ts in 2003. T h is year. C H C a n tic i­
p ates it w ill d e liv e r ap p ro x im ately 350
the su c c ess o f the c lin ics,” he e x ­
p lained. St. Jo sep h H ospital w as in stru ­
b a b ie s. “ We h ave had m ajo r gro w th in
re ce n t y e ars, and n o w h a v e the ability
m ental in sta rtin g the D o w n to w n C linic.
P uget S ound H o sp ital p ro v id ed sa n d ­
w ic h es fo r clinic v olunteers. G ood Sa­
to serv e m an y m ore p e o p le than w e
h a v e h isto ric a lly ,” F len tg e said. A nd
th ey w o u ld like to serve even m ore,
c o n sid e rin g th at out o f 7 0 0 .0 0 0 -p lu s
P ierce C o u n ty resid en ts, 100,000 arc
4
P C M S BULLETIN
March. 2004
m aritan H ospital o ffered lab services.
D ick D riscoll, p h a rm a cist at T acom a
G eneral H o sp ital, m ad e arra n g e m e n ts to
receive sam ples from ph arm aceu tical
T he clinics slow ly e x p a n d e d , and
in 19X0 becam e a part o f the H ealth D e­
p artm en t u nder the U rban H e a lth Initia­
tive fu n d in g . T he sam e year, the
S u m n e ra n d Lakew ood fa cilitie s opened
th eir doors.
CIIC teeeiv ed its first d irec t federal
g ran t in 1W 7 u nder S ect, on 30 o f the
P ublic H ealth S ervice fu n d in g A ct,
Sc-C -C l IC” page 5
'JP iem i trr-mi/i/ Q fU lir n /d jo c id y
from page 4
broke from the H ealth D epartm ent, and
established itself as a nonprofit agcncy.
The change required C H C to have a
board o f directors com prised o f at least
51 percent o f patients from its system .
A t present, there are 21 board slots, 1 1
o f which are held by patients reflecting
the wide range o f residents served by
CHC — the m ajority o f w hom are low
income.
From then on, expansion acceler­
ated:
1989 - H om eless and A dult D ental
Clinics open
1992 - Foot Care for Seniors program
begins
1993 -T illicum Clinic opens
1997 - C hildren’s D ental C linic opens
- Fam ily M edical C linic becom es
D ow ntow n C linic and m oves to
its current location
- A gency changes nam e to
C om m unity H ealth C are
2000 - Parkland and M cK inley C linics
begin operation
2001 - M cKinley Clinic becom es
Soundview C linic and m oves to
current location
- JC A H O accreditation achieved
- Parkland and D ow ntow n p h arm a­
cies open
2003 - Spanaw ay C linic opens doors
- L akew ood C linic m oves to new
facility, w hich includes a p har­
m acy an d 4 0 0 0 -sq . ft. dental clinic
- E astside and Spanaw ay p h a rm a ­
cies open
- Internal m edicine office opens at
Lakew ood Clinic
“ Our base is a fam ily practice
m odel,” according to Dr. J effrey Sm ith,
CHC M edical D irector. A t present, 15
physicians are fam ily practice doctors
who do obstetrics and one w ho does
not. There are seven m id-level practitio ­
ners and tw o internal m edicine doctors.
CHC also offers special program s. The
internal m edicine d octor in die D o w n ­
town Clinic specializes in HIV, and
L akew ood’s internal m edicine clinic fo­
cuses on M edicare patients.
Currently, the C H C clinics offer a
variety o f services in addition to family
practice m edicine. A team o f nurses, be­
havioral health sp ecialists and a n utri­
tionist com prise the Integrated M ater­
nity S u p ­
port Team.
S enior Foot
Care, in­
cluding
pedicure
level foot
care ser­
vices to
maintain
m obility
and inde­
p endence,
is offered
at 13 sites and is available to persons
over 60. H ealth care for the hom eless is
provided at three hom eless shelters two
days a w eek, and psychiatric services
are offered oncc a w eek. D ental care for
all ages is provided at L akew ood and in
dow ntow n Tacom a. The agcncy also
supports a part-tim e psychiatrist
outstationed at the Pierce C ounty A ID S
F oundation.
T he OB presence in the clinics is
signi ficant. as few er and few er Pierce
C ounty physicians arc offering obstet­
ric care. “ I am concerned as anyone
that our OB provider num bers in Pierce
C ounty are shrinking,” Dr. Sm ith said.
“ He added that they have already seen
an increase in the num ber o f O B /G yn
patients seen at the clinics and expects,
as m ore p hysicians elim inate O B ser­
vices from th eir practices, to see an
even greater influx.
But C H C needs to see m ore than
ju st an increase in O B /G yn patients.
“ C urrently. 40% o f our patients are un­
insured. W hile we w ould love to serve
all the uninsured population in Pierce
C ounty, w e c a n ’t stay in business w ith­
out seeing insured patients as w ell.”
Flentge said. “T hose num bers are in­
creasing slowly, but w e need to see
m ore. We have the capability to expand
our services and w ould love to get back
to the point financially w here w e can
add m ore physicians and see m ore pa­
tie n ts.” L ong-term plans are to add two
or three m ore p hysicians in the L ake­
w ood clinic, tw o m ore in Spanaw ay, and
renovate the E astside C linic. "B u t we
c a n ’t survive fin an cially by tillin g up
w ith uninsured patients e x clu siv ely ,' he
said. “ We realize that w e are co m p etin g
w ith everyone else. O bviously, it you
are a private p ractice p hysician, you are
inclined to take the insured p atients
and let us see the uninsured p o p u la ­
tion. We w ant physicians to un d er­
stand that w e w ould like to see both.
A nd we need those insured pa tie n ts to
survive in order to serve the u n in ­
su red ."
T here is also a m isconception
am ong the general public that C H C fa­
cilities are “free clinics" o r exist ex clu ­
sively to serve the uninsured. "P eople
are quite surprised to find out that wre
see all p atien ts," according to Dr. D avid
C am eron , a physician at the L akew ood
C linic. “ It’s our jo b to educate people
so they are aw are o f that. We are here
to serve all — uninsured, underinsured,
insured."
Flentge concurred. “We are a part
o f the m edi­
cal com m u­
nity in
Pierce
C ounty and
desire to be
a part o f
that c o m ­
munity. We
think we
play a very
im portant
role in serv ­
ing as a
7
________ ja
D a v id C am eron,
safety net, and w e ’re very proud to
serve the uninsured population. We
hope to continue to grow in the w ay we
have grow n over the past eight years
and serve m ore and m ore o f the u nin­
sured population here.
“ But we are also a m edical b u si­
ness like other p hysicians, and as a
m edical b usiness, part o f our challenge
is bringing in total revenues to support
total operations. We hope p eo p le un­
d erstan d that w e w ant to w ork w ith
See “CHC"’ page 6
March, 2004
x-
:
:
N
ID
PCMS BULLETIN
5
Bn
11 i in
CHC
from p a g e 5
th em ."
are a b le to g e t a ffo rd a b le m ed ic atio n s,
c e n te rs a cro ss the state in re co g n itio n
G o v e rn m e n t g ra n ts c o m p rise 17
p e rc e n t o f Cl 1C in co m e a n d are u se d to
p ro v id e se rv ic e s to u n in su re d p a tie n ts.
o f th e ra p id ly in cre asin g n u m b e r o f u n ­
i
" M a in M e d ic a re p a tie n ts m ig h t not
insured p a tie n ts w e are se rv in g ."
j
kn o w th a t," he said. A s a fe d era lly
fu n d ed c o m m u n ity h e alth c en ter, C H C
If the leg islativ e a ctio n s d o n ’t h a p ­
F e e for s e n ice. in c lu d in g M e d ica id ,
pen. C H C w ill sim p ly h ave to live w ithin
is a b le to p u rc h a se d ru g s at a sig n ifi­
c o n stitu te s 39 p e rc e n t o f C 'H C 's in ­
its m ea n s. F len tg e said. " W e 'r e a b u si­
cant d isc o u n t a n d p a ss a lo n g th o se
c o m e . a n d 39 p e rce n t o f fu n d in g c o m es
from c a p ita te d re v en u e s.
n e ss," he ex p la in ed . "W e c a n 't sp en d
m o re than w e tak e in. We w ill h av e to
p o rta n t issu e for u n in su re d a n d lovv-in-
m ake so m e d iffic u lt ch o ices, a n d p e o p le
c o m e p e o p le w ho a re lim ite d on w hat
C’H C 's largest sin g le funding
so u rc e is M e d ica id . F o rty -tw o p ercen t
o f t h e a g e n c y 's p a tie n ts are on M e d ic ­
aid. T h e se c o n d -la rg e st fu n d in g so u rce
is a le d e ra l g ra n t o f $2 m illio n annually.
sav in g s to th e ir p a tie n ts -
a v e ry im ­
sh o u ld u n d e rstan d w hat the c o n se ­
they can sp e n d on p re sc rip tio n s . For
q u e n ce s are i f th in g s d o n ’t c h a n g e ."
In a d d itio n to s ta ff cuts. C H C has
exam ple. Dr. C am eron e x p lain ed , in the
i
past, p a tie n ts w ith h igh b lo o d pressure
alre ad y re d u ce d o n e p ro g ram and e lim i­
h ave relied on sa m p le s ot m ed ic atio n
B asic 1 lealth Plan. M ed icare. Pierce
nated another. H ours h ave also been
and w ere u nable to a ffo rd to g el a p re ­
C o u n ty . U n ited W av o f P ierce C o u n ty
reduced. C lin ic s w e re p re viously open
M onday through Friday. 8 a.m . - X p.m ..
scrip tio n . “ W hen th ey w o u ld run out of
a n d the c itie s o f T aco m a and L akew ood
a lso prov ide funds.
" T h e p ro b le m no w ," he said, "is
m oney. T h ere are not e n o u g h funds
from g o v e rn m e n t so u rces. We need to
th e c o m m u n ity ."
an d o n ly the L ak ew o o d C linic is open
on the w eekends. Flentge h o p e s C H C
w ill be able to o ffe r ex te n d ed hours
again in th e fu tu re .
W h ile fed eral funding is secu re, at
least for the tim e b ein g , the c h allen g e.
"I a lw av s fell b e tte r about our a c ­
cessibility' w hen w e had exten d ed
F le n tg e said, has b een at the state level.
" T h e state b u d g e t crisis c au sed the leg ­
h o u rs." F lentge said. S tatistics show
that the m ajo rity o f unin su red p eople
are the w ork in g poor. "T h o se are also
the folks w h o se em p lo y e rs are the least
se n sitiv e about letting them take tim e
o f f d u rin g the day." F lentge ex p lain ed .
T h e e x te n d ed ho u rs w ere also very
ra ise fu n d s in o rd e r to keep the c lin ics
g ro w in g as long as th ere is a need in
islatu re to b a la n ce the bud g et on the
b a c k s o f lo w -in co m e people. M aking
c h a n g e s to the B asic I lealth Plan, c u t­
tin g the n u m b e r o f slots, c rea tin g need
for p re m iu m p a y m e n ts for M edicaid
kids, d e d u c tib le s and c o -p ay s — these
are the k in d s o f th in g s that crea te b a rri­
ers for lo w -in co m e people. To indiv idu­
als w ith p riv ate in su ran ce, they think
it ’s no rm al to h ave a S 15 co -p ay at the
tim e o f a v isit. But il you re a family
w ith a S 1(l.l)(III or SI 5.01 II l incom e. y ou
are faced w ith a ch o ice o f p ay in g a SI 5
e o -p av or buy in g food- We are ju st
very m uch afra id that il s going to
c a u se paren t', to not sign their kids up
for M e d ica id , and th a t's a real tragedy."
C 'H C 's m ain priority this y e ar is
sa m p les, th e ir b lo o d p re ssu re w o u ld go
u n trea te d for m o n th s at a tim e. B ut if we
and three c lin ics w ere open S a tu rd ay s
a n d S undays. C lin ics are now open 84:30 four days a w eek a n d o n e even in g ,
can get them a m ed ic atio n th ey can af­
ford and m ak e su re th ey g e t il ev ery
m onth at o n e o f o u r p h a rm a c ie s, then
their b lood p re ssu re is u n d e r m u ch bet­
ter co n tro l Ilian if th ey w ere re ly in g on
sa m p le s."
C l 1C has three m ain p h a rm a cie s
and three sa tellite p h a rm a c ie s, w hich
are d isp e n sin g m ac h in es w ith vid eo up­
link w ith the m ain Lakew o o d pharm acy.
T h is a llo w s s e n ices to p a tie n ts in clin­
ics w here space is at a p re m iu m and
v olum es are low.
I he d ecisio n to mov e into the
p h a rm a cy b u sin e ss w as a n a tu ra l leap.
b eneficial for m an ag ed care p atients b e­
cau se it kept them out o f th e em erg en cy
room s and e n ab led them to re ce iv e se r­
vices through C H C . F len tg e added that
part o f C’H C 's legislativ e agen d a has to
do w ith resto rin g so m e o f the funding
that has been lost by the hospitals.
" I t's critical to th eir survival and th eir
ab iiitv to be a p a rtn e r to u s." he said.
D espite the c h allen g e s, the ob­
stacles. and the seem in g ly unending
cu tb a ck s, the m ood at C H C rem ains
"W e w atch e d o u r p a rtn e rs a cro ss the
country and state ov er the p a st few
y ears dev elo p th e ir ow n p h a rm a c y serI
j
v ices." F lentge said. "It took a lot o f inv estm en t up front. W e had to hire a
pharm acy m an a g e r and staff, a w hole
new area w c had no prcv ious e x p e ri­
e nce w ith. ll's w ork ed out very w ell,
and it s been g re at lo r o u r p atien ts, but
w e still haven t b ro k e n e v en on o u r
i
j
p h arm acies. W e 're still in th e investm cnt stage.
p ositive. "W e feel very g o o d about
w hat w e are doing h e re." Dr. Sm ith o f­
"P art ot o u r pro b lem as a svstem is
that w e hav e built o u r c lin ic s w h ere
federal d o lla rs they receiv ed to 'b a c k
o f f on th o se p rem iu m p a y m e n ts and c o ­
fered.
pa y s lo r M e d ica id kids. W e w ould
love to see them re v erse th eir d ecision
T h e B enefit o f P harm acies
low -in co m e peo p le o f P ierce C ounty
are. It w ould be a lot m o re e ffic ie n t for
us Im ancially il all ot o u r p in sician s
u ettiim the leg isla tu re to use som e new
on th a t," he said. We arc also ask in g
th em for a very sp ecific leg islativ e a p ­
propriation o f S 15-S20 m illion that
w o u ld go to the 22 co m m u n ity health
6
PC M S B ULLETIN
March , 2004
Dr. C am eron believes C H C p ro­
vides a p articu larly valu ab le service
and oilier prov iders o p e ra te d out o f
through its p h a rm a cie s, w hich are a v a il­
able to its ow n p atien ts only. T h is is e s ­
p ecially true for M ed icare p atien ts w ho
macy m ag n ifies the p ro b lem b e ca u se a
p h a im a cist can su p p o rt so m an v pa-
one clinic. But w e d o n ’t do that. P h a r­
Soc "CI-IC" page 8
V A ej’-ce
The Health Status of Pierce County
Q - i U l i c a l d fv c ic /)f
Dl^of'Hea^6’M°
Reason to Hope
Every y ear our legislature gathers
go the next step: a c itize n s’ initiative.
in Olympia. E very year w e have high
initiatives have a clear place in
hopes for progressive action. A s p h y si­
W ashington politics. W h en the leg isla­
F eJerico Cruz, M D
cians, tort reform is at the top o f our list
ture repeatedly fails to act on an issue
every year. A nd every y ear w e are dis­
o f clear im portance to the broad m ass
appointed. This year, w e are com m itted
o f the public, then an initiative is an o p ­
tid e s discussing secondhand sm oke
to different outcom es. T his is possible
tion. T he public w ants a sm oke-free en­
and its potential harm ful effects. T he
because w e have engaged at a level
v ironm ent w hen they go out. T he te m ­
public is aw are. A nd is supportive.
that we norm ally d o n ’t reach. We are
porary ban here in Pierce C ounty
O rganized m edicine needs to w eigh
united and consistent in our m essage,
sparked a m assive am ount o f support
in. P hysicians can provide leadership
we are com m itting resources - both
to continue w ith a sm oke-free e n viron­
and be p art o f the team th at rolls up its
money and tim e - that w e norm ally
m ent. O ur ow n Sm oke Free C oalition o f
don’t do. T here is a resoluteness that
P iece C ounty is com m itted to achieving
sleeves and gets involved w ith the
just m ay get us to the next level.
a sm oking ban in public places. It is
nitty gritty activities need ed to gather
We have reason to hope.
tim e to take the next step. G et an in itia­
enough signatures. We are saying
But, before w e relax into th at hope,
tive on the b allot for next N ovem ber.
loudly and passionately th at tobacco
I want to rem ind folks that there is a n ­
This in not an easy endeavor.
use is dangerous to the individual and
A bout 280,000 signatures have to be
to the c om m unity around them . It is our
other issue that com es up every year
collected. T here is a deadline o f July 2,
responsibility as p hysicians to re in ­
that w e as physicians have long sup­
ported, argued for and gotten
force this m essage. A gain
nowhere w ith our legislature.
and again.
This is a sm oking ban to apply
_
T his can be done sim ply.
across the state in all public
Posters in y o u r offices about
“Physicians can provide leadership and be
places. H ot rhetoric each year
the dangers o f sm oking are a
part ofthe team that rolls up its sleeves and
but no m ovem ent. Is this year
good start. A n d as p art o f
more o fth e sam e? U nfortu­
the next step, m ake p etitions
gets involved with the nitty gritty activities
nately yes in m any w ays. The
available in y o u r offices so
needed to gather enough signatures. ”
leadership in O lym pia has not
that y o u r p atients can c o n ­
made it a priority and has not
tribute th eir signatures to the
effort.
advanced any bills w ith a c o n ­
certed effort. B ut this y ear could
If d o c to rs' o ffices across
2004 to get on the ballot for this N o ­
be different because o f the m om entum
the state do this, w e will not have any
vem ber. M any initiatives are begun and
developed by the sm oking ban that
problem s collecting the n e ed e d sig n a­
fail because th ey cannot gather enough
went into place here in P ierce County.
tures. G ettin g active on this one is a
signatures. M any resort to hiring p ro ­
Following the decision o f the B oard o f
clear and sure step for us to take. P h y ­
fessional com panies to gather the sig­
Health, Pierce C ounty w en t sm oke free
sicians are key m em bers o f th eir com ­
natures. We are in a stronger position.
on January 2. T he decision w as w idely
m unities. We need to use our positio n s
A sm oke-free environm ent in p ublic
supported before im plem entation and
to better the overall health o f our c o m ­
places has very strong public support.
has garnered additional p ublic support
m unities. T his m ust be m ore th an just
T here has been considerable public dis­
after the restaurants and bars w ent
p a tie n t care b ut extend to the political
cussion on the issue. E specially after
smoke free. T hough the ban is now on
arena. T his is an area in w hich w e have
the P ierce C ounty ban there w as a satu­
hold through a court challenge, the ef­
been relu ctan t to go. A s a group, p h y si­
ra te d stretch o f new s coverage on tele­
fort to challenge the status quo on
cians h ave lost m uch o f th eir influence
vision and on the radio. A ll the m ajor
sm oking has not stopped. A nti-tobacco
because o f our un fam iliarity w ith the
papers in the state ran num erous arcoalitions across the state are poised to
See “ Hope" page S
March, 2004
PCMS BULLETIN
7
Bl 1I 1 1IN
CHC
c lin ics and fill th em w ithin tw o w eeks.
fro m p a g e 6
T h e d e m a n d is o v e rw h e lm in g .”
tie n ts a n d so m an y sc rip ts p e r day.
T h e d isc o u rag in g n e w s on the
F in d in g th a t b a la n c e has b e en a c h a l­
dental side is th at c o m p a re d to 100.00(1
"F irst, w e m ain tain o u r c o m m itm en t
to the p e o p le w c a re a lre a d y se e in g ,’' lie
ex p la in ed . " B u t w e a re a ls o o u t there
m a rk e tin g to th e in su re d p a tie n t, w hich
lenge. I he sa te llite s a re a v ery in trig u ­
m ed ic ally u n in su red re sid en ts in Pierce
in o u r case are M e d ica id a n d M e d ica re
ing p o ssib ility , b e c a u se w e d o n 't have
C ounty, there are o v e r 3 00 .0 0 0 u n in ­
p a tie n ts. A p p ro x im a te ly n in e p e rc e n t o f
to h ire a fu ll-tim e p h a rm a cist fo r a n o th e r
su red fo r dental se rv ices. T h ere are
o u r folks h a v e priv a te in su ra n c e , and
site. T h e L a k e w o o d p h a rm a c ists arc not
o n ly fillin g sc rip ts front the L ak ew o o d
m ore p riv ate d e n tists relu ctan t to take
th o se are o ften the p a tie n ts w h o in i­
M edicaid due to the low ra te stru c tu re
than th ere are p riv ate d o c to rs u n w illin g
to tak e M ed icaid . A nd. o f c o u rse. M e d i­
su red . b u t are p lea se d w ith th e quality
a n d T illic u m c lin ic s, b u t they a re also
on th e te ie -\ id eo w ith th ree o th e r sites.
T h e in v e s tm e n t in e q u ip m e n t and m eds
tia lly cam e to us w hen th ey w e re u nin­
o f th e ir p ro \ id er a n d so k e e p c o m in g af­
te r th ey get in su ra n c e ."
Dr. S m ith c o n cu rs. “ We h a v e a re-
so rtin g o u t th e rig h t b a la n c e b etw ee n
care p ro v id es n o dental co v erag e. S e­
nio r c itize n s pay th eir ow n w av for d e n ­
tal s e n ices, unless they h a v e priv ate
the n u m b e r o f p h a rm a c ists a n d tech s
insurance. “ A dd to that the fact that
p roud to be p art o f th is g ro u p . C H C
a n d th e v o lu m e o f sc rip ts. It's just a n ­
o th e r e x a m p le o f t h e c h a lle n g e s w e
h a v e ."
th ey are not g ra d u atin g e n ough d e n ­
dra w s its p ro v id e rs from a c ro ss the
co u n try , as w ell as W ash in g to n State.
h a s b e e n sig n ific a n t, and w e a re still
tists from dental sc h o o ls to rep lace
th o se w h o are re tirin g , and y o u have
C H C w ill n o t exp an d a n o th e r clinic
o r o p e n a n o th e r facility w ith o u t also
p u ttin g in a fu ll-tim e p harm acy . In a d d i­
se rv e also n e e d dental c a re ." Flentge
explained.
" P e o p le are turned a w ay ev ery day
in the d e n ta l c lin ic s ." Dr. S m ith said.
"W e c o u ld p ro b a b ly d o u b le o u r dental
T h e \ a r m e here v ia d iffe re n t paths, but
n u m ero u s factors that m ake p ro v id in g
a lw a y s f o r the sam e re aso n , th ey feel a
dental se rv ice s really c h a lle n g in g .”
F lentge said.
c allin g to c o m m u n ity h ealth c a re .”
C ontinuing our C om m itm ent
W hile so m e d iffic u lt c h o ic es and
actio n s may b e on the h orizon fo r C H C .
he did his u n d e rg ra d u a te tra in in g at
the agency rem ains c o m m itte d to its
m ission: "T o provide the highest q u a l­
pleted his residency* at T ac o m a Fam ily
ity health care w ith c o m p a ssio n a te and
m edical train in g in the E astsid e C linic.
tion. any fu tu re e x p a n sio n w ill also in­
v o lv e the o p e n in g o f a d d itio n al dental
c lin ic s. "E a c h o f the p a tie n ts that w e
a lh g o o d c o re o f d o c to rs here. I'm
acc essib le service for a ll."
Dr. C a m e ro n has been w ith C H C for
just o v e r a year. A W ash in g to n native,
D uke and a tte n d ed the U n iv e rsity o f
W ashington M ed ical S c h o o l. H e co m ­
M ed icin e, a n d w ent th ro u g h a m onth of
Sec “C H C " page 0
from p a g e 7
p o litica l p ro cess. W e c a n n o t a ffo rd to
c o n tin u e this d isc o n n e c t. O u r p ro fes­
sion is at stak e. We a s p ro fe ssio n a ls
m ust step out and m o ld a n d sh ap e
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health policy in o u r c o m m u n itie s. N ow
w e d o n ’t. Instead w e c o m p la in and
w h in e w hen o th ers o u tsid e m ed icin e
m ak e flaw ed policy and w e are left with
the task o f h av in g to try to m ak e it
w ork. We n eed to c h a n g e this m indset.
W e do hav e to step out o f o u r c om fort
zone, but w hat the h e ck , w e can pick is­
sues that are a stra ig h tfo rw a rd co n n ec ­
tion to b e tte r health . A sm o k in g ban in
public places is an easy issu e a n d phy­
sician s role in sp re a d in g th e w ord on
the health risks o f to b a c c o u se a re a
n atural p la tio n n to se t inv o lv e d p o liti­
cally.
Lei s do it! W e as a p ro fe ssio n are
c o m m itte d to c o lle c tin g the sig n atu res
and e d u ca tin g the p u b lic o n the im por­
tance ol v o tin g yes on a b a n on sm o k ­
ing in public placcs. ■
8
P C M S BULLETIN
March. 2004
x-—------------------------------------------ \
Q 'd & h c a /d d o e te h j
\ CHC
from p age 8
“I really felt called to do this kind o f
work, and m y training m ade m e real ize
that this is w hat I w anted to be a part
of,” he said. “This is really taking care
o f a need in P ierce C ounty w here w e
have 100,000 people w ho d o n ’t have
health care. I’m thrilled to be a part o f
som ething that is a viable structure that
:
has resources available so w e can p re ­
vent people from going to the em er4
gency room and costing the state even
more m oney by having large fees. We
can take very good care o f them here. I f
CHC w asn’t here, along w ith o th er com munity health care organizations, our
nation w ould be in not only a health
"
care crisis, but also a financial crisis.
M ost patients w ould end up in urgent
care and em ergency ro o m s.”
I
Dr. Sm ith found his w ay to C H C via
a different route. H e grew up in a sm all
"
town in eastern W ashington and had
every intention o f retu rn in g there to
^ practice m edicine. W hen h e w as re~ cruited by CHC, he decided to jo in the
^ agency because o f the m edical school
p, loan-repaym ent options. “I cam e here
thinking, ‘I ’ll put in m y tim e. It’s a good
deal. I’ll do m y good w ork and m ove
along,” he said. T hat w as over eight
years ago. “The longer I ’m here, the
II more I like it,” he said. “ I ’m not going
t: anywhere. I hope to w ork here until I re* tire. I ju st can ’t see doing anything
:
else.” Dr. Sm ith calls the w ork addicti* ing. “All doctors are pro v id in g a ser^ vice,” he explained. “I t ’s especially nice
*• to be providing a service to p eople w ho
16 otherwise w o u ld n ’t be seen. So, w hile
the physicians at C H C have taken difk ferent paths to get here, w e all feel ex% actly the sam e w ay about the w ork w e
do.”
I*
i;
fi
If
i
ft
it
it;
f
CHC providers face m ultiple challenges. L anguage barriers can cause
problem s and be v ery tim e consum ing.
In addition, m any o f the p atients have
significant m edical p roblem s and re ­
quire additional tests or the care o f a
specialist. Dr. C am eron credits an excellent sta ff o f outreach w orkers w ho try
very hard to get patients in to see specialists. “I f som eone d o e sn ’t have in ­
surance, they m ay be sent to the U W or
to H arborview ,” he explained. “ We are
also try in g to do som e o f the social
w ork, too, and try to get them the re ­
sources they need. It can be very tim e
consum ing. A lso, w e have to do quite a
bit o f paper w ork w ith co n tracts.” In a d ­
dition, “ w e have som e very needy p a ­
tients. T hey are very ill a n d d o n ’t have
health care insurance. Som etim es, they
c a n ’t qualify to get state assistance b e ­
cause they d o n ’t have a Social Security
num ber. So there are tim es w e try to be
advocates for them to get them the a p ­
plications to apply for D SH S. T hat in­
volves m any form s and a lot o f tim e.”
A nd now, w ith sta ff cutbacks at CH C,
physicians have taken on m ore resp o n ­
sibilities previously handled by support
staff.
“It goes in cycles, som ew hat,” Dr.
Sm ith said. “A few years ago, the re im ­
b ursem ent for M edicaid w-as adjusted
and m ade things a little better. B ut
w e ’re seeing changes again. M anaged
care also puts a squeeze on things. In
som e cases, w e have to send people to
H arborview because there is no one in
the county w e can send them to .”
W hile H arborview is very good about
seeing patients that C H C sends their
way, the greatest challenge is finding a
w ay to get the patients to the facility.
“ M ost o f these people have transporta­
tion difficulties, so getting all the way
to Seattle is a p roblem .” Dr. Sm ith said.
In m any cases, patients and H arbor­
view' p hysicians are in contact with
C H C , but “m any tim es w e never hear
anything from the patient again. We try
our b est to follow u p .” A dditional ch al­
lenges pose them selves. A patient
m ight visit a clinic on a M onday, p ro ­
vide a phone num ber, and by W ednes­
day the n um ber is disconnected.
Dr, C am eron gives credit to sup­
port staff, including O utreach W orkers
and nurses for their tenacity in follow ­
ing up w ith patients w ho, in m any
cases, can be nearly im possible to
track, “T hey are especially good w ith
p atients w ho need to be getting m eds
or have an abnorm al pap or m am m o­
g ram ,” he said. “T hose are things that
absolutely need to be tracked. B a si­
cally, they ju s t keep after th em until
they com e in. To them , i t ’s ju s t a p a rt o f
the jo b .” D rs. C am eron and S m ith agree
that the m ajority o f C H C em ployees —
providers as w ell as support s t a f f —
seek out em p lo y m en t at C H C because
it’s the kind o f w o rk they w ant to do.
“ Som e o fth e m , like m e, ju st say, ‘Oh,
IT] give that a try,’ and find they love
it,” Dr. Sm ith said, adding, “We
co u ld n ’t do w hat w e do here w ithout
o u r staff.”
M oving Forward
Certainly, there is no shortage o f
patients to be seen a t C H C clinics. A nd
the agency w ould like n o thing m ore
than to expand to serve as m any p a ­
tients as possible. E veryone at C H C
recognizes that the m edical p rofession
is facing difficulties right now. “ D octors
in the private realm are being squeezed
on all sides," Dr. Sm ith said. “ R ates are
going dow n. M edicaid and M edicare
are squeezing th e ir rates. Tort reform is
a p rio rity issue as insurance p rem ium
paym ents are skyrocketing. W e’ve
heard concerns expressed as w e talk
about balancing our bu d g et and n e ed
to m ake sure th at a certain n u m b er o f
our patients are insured — M edicare
and M edicaid patients. A nd w e ’ve
heard som e feed b ack from p rivate d o c ­
tors — ‘W ait a m inute. Y o u ’re here to
serve the u n in su re d .” ’ Dr. Sm ith notes
that he thinks there is som e lack o f u n ­
derstanding about w hat our budget
lim itations are. “ We d o n ’t h ave enough
m o n ey to serve the n u m b er o f u nin­
sured that w e are currently serving, let
alone all the u ninsured in the county.
So, our m essage is, to those p hysicians
w ho are not a ccepting new priv ate in ­
surance patients, or are not accepting
M edicare and M edicaid patients, w e
w ould love for y o u to refer them to our
clinics,” he said.
On M arch 24, C om m unity H ealth
C are will celebrate their 35 year a nniver­
sary and w ill honor Dr. G eorge T anbara.
T he event w ill be held at the T acom a
Sheraton C onv en tio n C en ter b eg in n in g
at 5:30 p.m . T ickets are available b y c all­
ing 253-597-4550. ■
March, 2004
PCMS BULLETIN
9
Applicants for Membership
A llen H . G raeve, M D
L ond e A . R ichardson, M D
C a rd io th o ra c ic S u rg e ry
D ia g n o stic R ad io lo g y
14 M L K ing Jr W ay # 2 0 2 , T acom a
253-403-7257
M e d ica l Im a g in g N o rth w e st
j
222 15th A venue SE, P uyallup
M e d S ch o o l: C re ig h to n U n iv e rsity
253-841-4353
In te rn sh ip : U n iv e rsity ofN evv M exico
M e d S chool: Yale U niversity
R e sid e n c y : U n iv e rsity o f N e w M ex ico
Intern sh ip : U n iv e rsity o f W ashington
F e llo w sh ip : U n iv e rsity o f T en n essee
R e sid en c y : U n iv e rsity o fT e x a s
F ello w sh ip : M ed ical C o lleg e o fV irg in ia
F ello w sh ip : U n iv ersity o fT e x a s
A n n a D . H ohler,M D
D avid E. Shook, M D
N e u ro lo g y
D ia g n o stic R a diology
M a d ig an A rm y M ed ical C enter, T acom a
253-968-1445
M ed ical Im aging N orthw est
M e d S c h o o l: B osto n U n iv e rsity
253-841-4353
In tern sh ip : M a d ig a n AMC'
M e d S chool: C re ig h to n U n iv e rsity
Intern sh ip : U niversity o f M issouri
R e sid en c y : M a d ig a n A M C
Personal Problems of
Physicians
Committee
222 15th A venue SE, P uyallup
R esid en cy : U n iv ersity o f C o lorado
Fellow ship: M ayo C linic
M ed ical p rob lem s, d ru gs, alcohol,
retirem en t, em otion al,
or o th e r su ch d ifficu ltie s?
Y o u r c o lle a g u e s
w a n t to help
R o b ert S ands, M D , C h a ir
752-6056
Bill D ean, MD
272-4013
Tom H e rro n , M D
8 5 3 -3 8 8 8
Bill R oes. M D
8 8 4 -9 2 2 1
K D ennis W a ld ro n ,
MD
265-2584
Confidentiality
Assured.
Positron Emission Tom ography (PET)
O u r C lin ica l
PET S p ecia lists
PET has been show n to be an accurate m ethod to diagnose and stage cancer, check for
tu m o r recurrence, and m o n ito r cancer therapy. Inform ation gained by the use o f PET can be
used to determ in e w hat com bination o f surgery, ra diation therapy, or chem otherapy is m ost
likely to be successful in m anaging the disease.
A n th o n y Larhs, M D
Director ol Clinical PET
P h illip C Lesh, M D
PET is also used to evaluate A lzheim er’s disease,
epilepsy, and cardiac disease.
W illia m B Ja ck so n , M D
M any insurers, including M edicare and
M edicaid, are reim bursing for m an)'
PET procedures. TRA referral
coordinators will w ork with you to
Tacom a
com plete the required pre-exam
2 2 0 2 S C e d a r St, Ste 2 0 0
authorization.
2 5 3 -7 6 1 -4 2 0 0
tra m e d ica lim ag in g .com
Call our referral coordinators at
253-761-4200.
10
P C M S BULLETIN
March, 2004
f' v/D th / Q fle<h<‘( t ! rffM 'tcfif
IN MEMO RI AM
MICHAEL T. HAYNES, MD
1949
-
2004
Dr. Michael Haynes was bom in Tacoma on February 17, 1949 and died on February 13, 2004. Fie had
suffered a massive heart attack three days earlier.
After receiving his medical degree from the University of Washington School o f Medicine in 1975, he
completed a family practice residency at Jackson Memorial Hospital in Miami, Florida. In 1977 he joined the
family medicine practice o f Dr. Charles Vaught in Puyallup and continued practicing in Puyallup until his re­
tirement in 2002.
Dr. Haynesjoined PCMS in 1978.
Those wishing to remember Dr. Haynes can make gifts to tiie Michael T. Haynes, MD Scholarship
Fund, in care o f Hill Funeral Home, 217 E Pioneer Ave, Puyallup WA 98372; or Puyallup Valley Bank, 209 S
Meridian, Puyallup WA 98371.
PCMS offers condolences lo Dr. Haynes’ wife, Kristine, and their family.
bG
i
0
1
0
ra-di-ol-o-gy \rad-e-‘al-e-je\n.
1: a branch of m edicine utilizing exams such as
MRI (m agnetic resonance imaging) and CT
(com puted tom ography) in the diagnosis and
treatm ent of disease 2: a com m itm ent to
providing cutting-edge im aging services without
the necessity of driving long distances; see TRA
M e d i c a l Im a g in g
1
• 1— H
T
i
TRA
I
aj
u
4 7 0 0 P o in t F o s d ic k Dr, S te 1 10 * F o r m o re in fo rm a tio n , call (253) 7 6 1 -4 2 0 0
tra m e d ic a lim a g in g .c o m
March, 2004
PCMS BULLETIN
11
B
u l l e t in
Has HIPAA Changed How We Treat Minors?
S in c e th e e n a c tm e n t o f the H IP A A
P riv a c y R u le, m a n y in su re d s have
a sk e d h o w the P riv a c y R ule h a s im ­
g u a rd ia n ’s co n sen t. A s a q u ick re ­
d e a lin g w ith a p a re n t’s re q u e s t fo r
m inder, a m in o r m ay co n sen t to m edical
care:
re co rd s. P a re n ts m u st b e re m in d e d that
• I f the m in o r is e m a n cip a te d (leg ally
in d ep e n d en t) or m arried
d e n tia lity and th a t y o u a re p ro h ib ite d
p a c te d th e w a y h e a lth c are p ro v id e rs
d e al w ith m in o rs. W h ile the P riv acy
R u le has c h a n g e d m an y o f the th in g s
y o u d o in y o u r m e d ic a l p ra c tic e , th ere
rig h ts re g a rd in g tre a tm e n t a n d c o n fi­
to so m eo n e at o r above age 18.
h a s b e en no c h a n g e in the W ash in g to n
law s re la tin g to tre a tm e n t o f m inors.
• In the e v en t e m e rg en c y care is n e c e s­
sary.
IIIP A A d o e s not c h a n g e o r lim it the
• F o r b irth co n tro l and p re g n an c y -related care at any age.
W ash in g to n S ate law th at g ra n ts m i­
n o rs th e a u th o rity to c o n se n t to certain
ty p e s o f h e a lth care. F u rth e r, H IPA A
h a s n o e ffe c t on W ash in g to n law that
a llo w s m in o rs to c o n tro l a cc ess to their
“ p ro te c te d h ealth in fo rm a tio n ” (P H I) in
th o se in sta n c e s w h e re they are g ra n te d
a u th o rity to c o n se n t to th e ir ow n health
care . In sh o rt, the federal law kn o w as
fro m re le a s in g re co rd s o r d isc u ssin g
c e rta in a sp e cts o f c a re w ith o u t th e
c h ild ’s exp ress w r itte n p erm issio n .
T h e b illin g issu e s c re a te d b y a
m in o r ’s re q u e st fo r c o n fid e n tia lity are
a lso sig n ific a n t. K e ep in m in d th a t when
a m in o r re q u ests c o n fid e n tia lity , you are
• F or o u tp atien t d ru g - and a lc o h o lab u se trea tm e n t begin n in g
at age 13.
p ro h ib ite d fro m b illin g the p a re n ts or
the p a re n t’s in su ra n c e c a rrie r fo r the
• F o r o u tp atien t m ental h e alth tre a t­
m ent b eg in n in g at age 13.
c o st o f trea tm e n t. B e ca u se th e p arents
did not con sen t to the trea tm en t, they
• F or sex u ally tran sm itted d iseases, in ­
c lu d in g HIV, beginning
a t age 14.
are not fin an cially o b lig a ted for care.
You m u st a d v ise m in o r p a tie n ts that
FI IPA A d o e s n o t p re e m p t W ash in g to n
law w h e n it c o m e s to the tre a tm e n t o f
th e ir m in o r c h ild h a s s ta te -g ra n te d
th ey a lo n e are re sp o n sib le for paym ent
i f th ey re q u e st c o n fid e n tia lity .
Finally, to avoid m iscom m unication,
m inors.
A s m an y know , th ere are several
tricky issu es re la tin g to trea tm e n t o f m i­
T h e age o f m a jo rity in W ashington
S tate is 18. A t age 18, an in d iv id u a l is
nors. O ne involves m a in tain in g c o n fi­
den tiality o f in fo rm atio n specific to
w a y s rem in d m in o r p a tie n ts o f th e ir con­
fid en tiality rig h ts, a n d re su lta n t fin an ­
an a d u lt and can p ro v id e c o n se n t to all
trea tm e n t au th o rized so lely by the m i­
nor. R em em ber, if a m in o r co n se n ts to
cial re sp o n sib ility , w h e n tre a tin g them
for care to w hich th e y can c o n se n t. ■
p ro p o se d h e a lth care a n d a u th o rize a c ­
cess to PH I. A n in d iv id u a l u n d e r age 18
is c o n sid e re d a m in o r and. fo r m ost
care as allow ed by law, he o r she can
re q u est c o n fid e n tia lity for that aspect
m ed ic al care, m u st h a v e a p a re n t or
o f care - w hich w ould p ro h ib ity o u from
g u a rd ia n 's c o n se n t. H o w ev er, sta te law
releasin g this in fo rm a tio n w ith o u t the
m in o r’s signed authorization. O b v i­
ously. this c an be a ch allen g e w hen
a llo w s m in o rs the rig h t to c o n se n t to
c ertain health care w ith o u t a p a ren t or
it is h ighly re c o m m e n d e d th a t y o u a l­
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01 I a n ! D o t y ( A l l e n , N e l s o n , T u r n e r lC
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72
PC M S BULLETIN
March, 2004
2 2 0 - 1 5 “ A v e S E # B , P u yallu p W A 9 8 3 7 2
Assoc.). C linic M anager (253) 383-4351
TO.
fP e r n : fo r o r /i/ r / l « h m / r% n e f i /
In My Opinion....
The Invisible Hand
by Andrew Statson, MD
The op in io n s e x p r e s s e d in th is w r it in g a r e s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b ers to e x p re ss th e ir o p in io n /in s ig h ts a b o u t s u b je cts
relevant to the m e d ic a l co m m u n ity, o r s h a re th e ir g e n e r a ! in te re st s to rie s, S u b m is s io n s a r c s u b je c t to /u lit o r iu ! C om m ittee review .
Punitive Damages
“E xcessive bail sh a ll not be required, n o r excessive fin e s
imposed, nor erne! a n d unusual p u n ish m e n ts inflicted. "
A m endm ent VIII, U S C onstitution
The idea o f punishm ent, th at is o f
discouraging future offenses by the
same or other parties, is a recent d ev el­
opment in tort law. Punitive dam ages
give the plain tiff additional c o m p en sa­
tion. above the am ount for the injury
sustained, with the purpose to punish
the defendant and to d eter others from
following his example.
In his Law o fT o rts (fourth edition,
1971), Prosser relates a n o th er purpose,
reim bursem ent for legal expenses and
“wounded feelings.” (D o w o unded feel­
ings mean pain and suffering?) H e also
adds that in order to aw ard punitive
damages there m ust be a g gravating c ir­
cumstances, such as outrageous b e ­
havior, evil m otivation, or deliberate
disregard o f others. M ere negligence is
not enough to ju stify p unitive dam ­
ages.
In defense o f punitive dam ages, j u ­
rists claim that they p rovide com p en sa­
tion to the p lain tiff for the expenses o f
litigation, such as a tto rn ey s’ fees. In
Britain, the law requires the losing party
to pay the legal expenses o f the w inner,
but in A m erica those expenses are not
compensable and are not included in
the verdict.
A nother argum ent p resen ted in fa­
vor o f punitive dam ages is the o pportu­
nity for redress they give to those w ho
have suffered m ultiple sm all injuries,
which by them selves are n o t w orth the
expense o f pursuing in court, such as
class action suits.
F rom another p o in t o f view, the
aw ard o f p unitive dam ages brings up a
q uestion o f ju stice. B y definition, ju s ­
tice requires that everyone receive his
due, no m ore and no less. Yet punitive
dam ages are an undue com pensation to
the p la in tiff in excess o f the com pensa­
tion for the sustained injuries and con­
trary to the notion o f ju stice. T hey are a
w indfall, not a right. A s such, they are
aw arded at the discretion o f the jury.
A nother point in this debate is that
punitive dam ages can be aw arded only
w hen com pensatory dam ages have
been given. If there had been no com ­
pensation, a cause for action m ust not
have existed. E ven m ore discussion a d ­
dresses the proportion o f punitive dam ­
ages to the am ount o f the aw arded c o m ­
pensation. T his has been all over the
m ap, from dam ages close to the am ount
given for com pensation to others, to­
tally out o f proportion. You m ay rem em ­
ber a recent case w here the Suprem e
C ourt gave a guideline for punitive dam ­
ages not to exceed ten tim es the com ­
p en sato ry dam ages.
P unishm ent im plies the com m ission
o f a crim e and the paym ent is like a fine.
H ow ever, it is levied d uring a civil pro­
cedure, w ithout the usual safeguards o f
a crim inal trial, such as p ro o f o f guilt b e ­
yond a reasonable doubt. Furtherm ore,
the am ount o f the fine is determ ined by
the w him o f the ju ry and is not from an
estab lish ed schedule o f penalties, like
the fines for traffic v iolations. T he latter
A n d re w S ta tso n , M D
are determ ined by statute and are set
a ccording to the type o f violation. You
d o n 't w ear y o u r seatbelt, you pay
eighty-five dollars, period.
Som e legal experts have su g g ested
that since p unitive d am ages have the
characteristic o f a fine, w hich is a p a y ­
m ent for a crim inal offense, they should
be paid to the state. O ne problem w ith
that solution is that the slate then b e ­
com es an interested party to the action.
T hat could lead to a conflict o f interest
to the detrim ent o f the defendant. A n­
oth er p roblem is that it can create
double jeo p a rd y if the defendant has
broken a law and m ay be subjected to a
crim inal trial and additional punish­
ment.
T he aw ard o f punitive dam ages
has stirred even m ore debate on the
question o f w ho should pay them . In
tort cases, the em p lo y er is ch arg ed w ith
paying the com pensatory dam ages.
Punishing him , w hen the m isconduct o f
the em ployee w as neither directed, nor
authorized, nor ratified, is not just.
H ow ever, the m ajority o f the courts
have m ade the m aster responsible for
punitive dam ages even in the absence
o f approval or ratification.
T hat has been especially true in
the case o f corporations, w here the in ­
nocent shareholders pay the price. T he
basis o f the argum ent is that c o rp o ra­
tions can only act through their agents.
T he m ain goal has been the e x p ected
Sec "D am ages” page 18
March( 2004
PCMS BULLETIN
13
B
u l l e t in
Doctors for Medical Liability Reform
D o c to rs for M edical L iability R eform (D M L R ) is a c o ali­
ing resu lts fo r m illio n s o f A m e ric an s. T h e A m e ric a n M ed ical
tio n o f 2 3 0 ,0 0 0 p ra c tic in g m ed ic al sp e c ia lists d e d ic a te d to p ro ­
A sso c ia tio n has id en tifie d 19 sta te s c u rre n tly e x p e rie n c in g an
te c tin g p a tie n ts a c c e ss to h e a lth c a re b y p ro m o tin g the p a s­
a cc e ss-to -c a re crisi s. O f the re m a in in g sta te s, 25 h a v e th e p o ­
sa g e o l fed eral leg isla tio n to p u t a cap o n n o n -e c o n o m ic d a m ­
tential to be d e e m e d “ in c risis.” O n ly six sta te s —C a lifo rn ia,
a g e s a w a rd e d in m ed ic al liab ility cases. D M L R ’s m em b e rsh ip
in clu d e s:
C o lo rad o , In d ian a , L o u isia n a , N e w M e x ic o a n d W isco n sin a re c o n sid ere d stab le; the c o m m o n d e n o m in a to r is th a t all six
N e u ro su rg e o n s to P re se rv e H e a lth C are A c ce ss
h ave in stitu ted so m e type o f re fo rm .
T h e D M L R 's P ro te ct P a tie n ts N o w in itia tiv e se e k s to edu­
A m e ric a n A s so c ia tio n o f O rth o p a e d ic S urgeons
cate a n d in fo rm p a tie n ts, p h y sic ia n s, b u sin e ss le a d e rs a n d leg'
A m e ric a n C o lle g e o f E m e rg en c y P h y sic ian s
islators a b o u t the d e stru ctiv e e ffe c ts to o u r n a tio n ’s
h ealth ca re a n d o u r n a tio n a l eco n o m y . S ta te s th a t a re fa cin g se­
A m e ric a n C o lle g e o f O b ste tric ia n s and G y n e co lo g ists
A m e ric a n C o lle g e o f S u rg e o n s P ro fe ssio n a l A sso c ia tio n
S o c ie ty o f T h o ra c ic S u rg e o n s
A m e ric a n C o lleg e o f C ard io lo g y
rio u s h ealth ca re a n d e co n o m ic c rises w ill be h ig h lig h te d
th ro u g h o u t the initiative. W ash in g to n S tate h a s b e e n h ig h ­
lig h ted by the D M L R in th e ir m e d ia c a m p a ig n a n d h a s been
A m e ric a n A c ad e m y o f D e rm a to lo g y A sso c ia tio n
fe atu red in full p ag e a d v e rtise m e n ts in th e W all S tre e t Journal
N a tio n a l A sso c ia tio n o f S p in e S p e c ia lists
A m e ric a n U ro lo g ica l A sso c ia tio n
a n d USA To day. A 3 0 -m in u te v id eo , in c lu d in g Dr. A rt M aslow ,
E sc a la tin g ju ry a w ard s a n d the high cost o f d e fen d in g
a g a in st law su its - e v en friv o lo u s o n e s - are d riv in g m ed ical li­
a b ility in su ra n c e p re m iu m in c re a se s n a tio n w id e , w ith d e v a s ta t­
Next
has been p ro d u c ed . To v iew th e ad and d o w n lo a d the 30m in u te v id eo - go to p ro tec tp a tic n tsn o w .o rg .
F o r M o re In fo rm a tio n : C o n tac t J a so n K e m p o r B ill P o w ­
ers (703) 299-0557; dm lr@ iprotectpatientsnow .org ■
from p age 3
a rc n o w ' ‘re c o g n iz e d p la y e rs” in th e p o litica l arena.
So w h at does th is h ave to d o w ith u s, y o u ask? I b e lie v e
the sa m e g ra ssro o ts a p p ro ac h a p p lie d on targ e te d d istric ts can
su c c ee d in W ash in g to n . D o n ’t forget, P a t L antz (D -2 6 ) w o n h e r
last e le c tio n b y a slim 2% o f the vote. H e r o p p o n e n t, Ed
M itc h e ll, th is N o v e m b e r is a bright, articu la te , w e ll-sea so n e d
c an d id ate . D a w n M orrell (D -2 5 ) w o n b y the slim m est o f m a r­
g in s, 5 0 .5 % in th e last election. T he point is. m a n y legislative
se a ts can b e c h an g e d by a ctiv e a p p ro p ria te activism .
T h e 'A d v a n ta g e s o f ‘B attlefield D e p lo y m e n t’” from the
A C S b u lle tin are d e ta ile d below . W h ile th ere is tim e to co n sid er
o th e r o p tio n s in th is fight to w in b a ck th e leg islatu re, I fin d the
M ew Je rse y “ d e p lo y m e n t" a v ery re aso n a b le ap p ro ach . We are
5. S u rg eo n s e x erc ised th e ir c o n stitu tio n a l rig h t to in flu e n ce
leg isla to rs th ro u g h a day o f stru c tu re d , a p p ro p ria te
g ra ssro o ts activism .
6. B y m ak in g g ra ssro o ts n o ise , w e did so m e th in g p h y sic ia n s
h ave n e v e r done before: create a b lo c k o f s q u e a k in g wheels.
T h is o u tco m e alone is lik e ly to cau se so m e le g isla to rs
in d ig estio n and situ atio n re assessm en t.
7. We bu ilt future g o o d w ill for sc o p e -o f-p ra c tic e , o th er
im p o rtan t p a tie n t a n d p h y sic ia n leg isla tiv e issu e s. ■
lo o k in g for o th e r id ea s as w ell. Y our board o f d irec to rs en co u r­
ag es y o u r th o u g h tfu l in p u t in th is im p o rtan t battle.
A d van tages o f “ Battlefield D ep loym en t”
1. P h y sic ia n s did n o t m iss a day o f p ractice.
2. P h y sic ian s, and the h o sp itals su p p o rtin g them , did not
lose incom e.
3. P h y sic ian s m ain tain ed public g o o d w ill.
4. It w a s not lik ely to d raw a d v erse edito rials. W h at co u ld
the m e d ia o r th e FT C say w as a n ti-p atien t?
14
P C M S BULLETIN
March, 2004
Allenmore
Psychological
Associates, P.S.
i 752-7320
...a m ulti­
disciplinary
behavioral
health group
that works
w ith physicians
D o you have patients w ith difficult em otional
and stress-related problem s? P sychiatric and
psych ologica l consultations are available.
Union Avenue Professional Building
------------------1530 U nion ftY?, ? ,,_£te, 16. Tacoma
//
( L ’d ic a J r-io<-(<>/if
Whistler’s 18 inches of snow, great skiing, quality CME
highlight this year’s CME at Whistler program
T he C M E at W histler course, the
C ollege o f M edical E d ucation’s w inter
resort program , w as a big hit this year,
providing excellent m edical education,
great skiing and great vacationing.
Pierce C ounty physicians that at­
tended the program , held at the B ritish
C olum bia ski resort, w ere joined by
o ther physicians from around the c o u n
try. T he program is not only know n for
excellent C M E opportunities, but for
fam ily vacationing, as well.
T he program featured a potpourri
o f educational subjects o f value to all
specialties. C onference attendees p a r­
ticularly enjoy the o pportunity to have
in-depth discussions about clinical
situations.
W hen not in the classroom , p a r­
ticipants and th eir fam ilies e njoyed
great skiing, resort activ ities and lots
o f sun and snow.
T he program w as directed by R ick
Tobin, M D and John Jiganti, M D and
w ill be offered again next y e ar at the
W histler reso rt area. ■
Dr. Pal Hogan and Joan Brookhyser enjoy
the still after a great day o f skiing
The Nordestgaardfamily (l-r) Ida. Dr. Akset, Rie and Lishet, pre­
pare for a day o f skiing following the morning CME meeting
The Wright family (l-r) Rick. Sally, Julia. Dr. Robert and Robert Jr.
pose for the camera after a great day on the slopes
Left to right. Dr. Mark Craddock. Dr. Jennifer Smith. Jack Ecklund
and Jinny Craddock enjoy pizza at the pre-conference reception in
the Aspens Conch meeting room
An apres ski dinner is enjoyed by CME attendees (l-r) Drs. Donald
Boutry. Donald Shrewsbury and Rick Tobin. Dr. Tobin co-directed
the course with Dr. John Jiganti
March. 2004
PCMS BULLETIN
15
B
u l l e t in
Dr. Gary Taubman and Tracv Gage are set for some
Dr. Carl Wulfestieg and wife Susan are a ll sm iles after
Whistler sight-seeing and shopping following the
morning s CM E session
a terrific (and sunny) day o f skiing. Dr. Wulfestieg went
The Schoeppner family (back, l-r) Sahain, Kelly. Dr.
H a ra kl and (front) Hanna, bundle up fo r a walk to the
Dr. Daniel H eller answers questions ajter ms presenta­
m is tie r Village
Bruce Snell, with Gig Harbor s NW Sports Physical
Therapv. covered -Proactive Approach to Musculo­
skeletal Injury and Degeneration "________________
16
PC M S B ULLETIN
March. 2004
up for one more run
tion on "Imaging Screening. " Dr H eller practices di­
agnostic radiologv in the Tacoma area
(L-R) Drs. Mark fiassig, Robert Wright and
Tejtnderpal Singh are looking forw ard to a great day o f
skiimi
? P tc m
r 4 (e < l(< « / d c c i r f t f
Continuing Medical Education
COLLEGE
OF
MEDICAL
EDUCATION
Internal Medicine Review CME
set for March 11 and 12
T he T acom a A cadem y o f Internal
• T he R ole o f A ngiotension 2 in H yper­
tension in C ard io v ascu lar D isease
M e d icin e ’s annual tw o-day C M E pro­
Allergy, Asthma &
Pulmonology CME
set for April 30
Plan to attend this y e a r’s C M E
gram is set for T hursday and Friday,
• Infectious D iseases U pdate
M arch 11 and 12. A program brochure
• C urrent Pharm adynam ic A pproaches
in A lzheim ers D isease
w as m ailed in February.
T h e tw o-day CM E deals w ith re ­
cent advances in Internal M edicine.
• C urrent D iabetes Prevention Problem s
w ell as national speakers. T his program
• E vidence-B ased A pproach to the
local physicians.
G u r jit K aeley, M D and will be held at
Joseph M edical Center. T he course
St. Joseph H ospital in the L agerquist
is under the m edical direction o f A lex
C onference Center, R oom s 1A & B. The
M ih a il, M D .
program offers tw elve C ategory I CM E
Women’s Health
CME Scheduled
for May 21
Plans are nearly com plete for the
College’s A dvances in W om en's
Medicine CM E scheduled for M ay 21,
2004. The conference w ill be held at St.
Joseph Flospital.
directed by John Lenihan, M D that will
A course brochure w ith p rogram
A Potpourri
• C holesterol M anagem ent: N ew
Targets, N ew O ptions
• T he A rt o f R heum atology for Ihe
Prim ary Care Internist
T his y e a r’s program includes pre­
• O ncology A dvances: D iagnosis and
sentations on the follow ing topics:
T re a tm e n t"
Dates
Prosram
Thursday-Friday
Internal Medicine
March 11-12
Review 2004
Monday-Friday
April 12-16
Directors)
Gurjit Kaeley, MD
CME at Hawaii
Mark Craddock, MD
Allergy, Asthma &
Friday, April 30
Pulmonology for
Alex Mihali, MD
Primary Care
address a variety o f tim ely subjects
relative to contem porary m edicine for
women.
• W h at’s N ew in Gl M edicine:
credits.
Recognized w o m e n ’s health
experts will lead this o ne-day p rogram
• A dvances in the M anagem ent and
T reatm ent o f A nxiety and D epression
T his y e a r’s program is directed by
course is set for Friday, M ay 21 at St.
April. ■
T reatm ent o f Pain
is offered to m em bers o f the T acom a
lergy, asthm a & pulm onology for the
A program brochure w ith regis­
System ic D iseases
and internal m edicine su bspecialists as
program focusing on subjects on al­
tration details will be m ailed in early
• D crm atologic M anifestations o f
Faculty includes b oth local internists
A cadem y o f Internal M edicine and all
primary care physician. T he annual
• C om m on D crm atologic Problem s
Friday, May 21
Advances in Women's
Medicine
John Lenihan, Jr., MD
topics and details for registration w ill
be mailed in late April. ■
March, 2004
PCMS BULLETIN
17
B u i X E T IN
from p age 13
d e te rre n t e ffe c t a n d the hope that such d a m a g e s w ill e n c o u r­
th a t the sta te s h a v e a stro n g in te re s t in th e v ia b ility o f the
a g e th e c o m p a n ie s to b e tte r c o n tro l th e ir e m p lo y e e s and to
p re v e n t o u tra g e o u s to rts.
c o m p a n ies b e c a u se o f th e se ttle m e n ts th e y h a v e re a c h e d . The
C o n c e rn in g lia b ility in su ra n c e , it w o u ld a p p e a r th at p u n i­
tiv e d a m a g e s sh o u ld n o t b e c o v e re d , b u t m o st o f th e d e cid ed
a b ility o f th e c o m p a n ie s to c o n tin u e p a y in g o n th e ir settlem ent
a g ree m e n ts w ith the sta te s is p re d ic a te d o n th e ir c u sto m e rs
c o n tin u in g to b u y th e ir p ro d u c t. T h a t a lso m e a n s th a t the
c a s e s on the su b je c t h a v e h e ld th a t the in su ra n ce c o n tra ct
states h a v e a stro n g fin an c ia l in te re s t in h a v in g p e o p le c o n ­
c o v e rs th em . A few c o u rts h av e h e ld the c o n tra ry p o sitio n .
A n o th e r p o sitio n on this issue, w h ic h m ay b e c o n sid ere d a
tin u e to sm o k e.
O n e final p o in t o f th is issu e is th e tre n d to w a rd excessive
c o m p ro m ise , is th at in su ra n ce sh o u ld c o v e r v ica rio u s liability,
co m p e n sa tio n . 1 h ave p re v io u sly re la te d c a s e s w h e re com pen­
b u t n o t c ases w h e re th e d e fe n d a n t is ch arg e d w ith a n y w ro n g
o f h is ow n doing.
satio n ra n in e x ce ss o f t e n m illio n d o lla rs, u p to o n e case o f
e ig h ty m illio n a g ain st a N e w Y ork o b ste tric ia n . M o s t o f us
T h ro u g h all th at, p u n itiv e d a m a g e s m u st n o t b e excessive.
carry' in su ra n ce o f a b o u t tw o m illio n . V ery fe w a m o n g us have
A v e rd ic t m u st h av e so m e sen se o f p ro p o rtio n in it, so m e c o n ­
assets e x c e e d in g liv e m illio n (I a m g e n e ro u s). W h a t b e n efit
n e c tio n w ith reality . I am n o t sp e a k in g in d e fe n se o f the to ­
can a cc ru e to the p lain tiffs, and to o u r so c ie ty in g e n era l, by
b a c c o c o m p a n ie s, b u t 1 m u st m en tio n the v e rd ic t o f tw en ty tw o b illio n d o lla rs a g ain st a com p an y , the to ta l w o rth o f w h ich
v erd icts th a t b a n k ru p t the p h y sic ia n s?
W h e n p e o p le are se n te n c e d to p a y in g an a m o u n t o f puni­
w a s a b o u t six ty b illio n . If one p e rso n is g o in g to re ce iv e one
tive, o r even o f c o m p e n sa to ry d a m a g e s th a t th ro w s th em into
bankruptcy, I th in k th at re p re se n ts an e x c e ssiv e fin e, and is
th ird the v a lu e o f th e com p an y , d o e s th a t serve ju s tic e in re­
g a rd to all the o th e r p e o p le w h o m ay h a v e b een in ju re d by the
n e g lig e n c e o f th a t sam e com pany. E ven liq u id a tin g all its a s­
sets w o u ld b a re ly p a y fo r th e c o m p e n sa tio n o f tw o o th er p e r­
so n s .
T h e in te re stin g tw ist in the story' o f to b a c c o litigation is
b a n n ed b y the U S c o n stitu tio n . It a lso p ro d u c e s se v e re dis­
tress to the d e fen d a n ts, a n d as such, it c o n stitu te s c ru el and
u n u su a l p u n ish m en t. 1 th in k th a t in such c ases th e defendants
sh o u ld h av e the p ro tec tio n o f the E ig h th A m e n d m e n t to our
c o n stitu tio n . ■
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18
P C M S BULLETIN
March, 2004
Sp(fit,\oretl by the Waslmitfov Slate Medical M sociathn
Threatening Litigation Is a
Nightmare Process”
A s a claim s representative a n d su p erv iso r, 1 see p hysicians ol all sp ecialties
w hose lives are su d d e n ly changed by claim s filed against th em . W h e th e r the
cases are dism issed, settled, or go to trial, each p h y sic ia n ’s p erso n al a n d
professional life can take a tu rn for the w orse, and th a t’s w hy I'm here Lo
help. 1 analyze each claim , stay in close con tact w ith o u r atto rn ey s, a n d w o rk
w ith the physician on new strategies as the case d evelops. Every ph y sician is
im p o rta n t to me, and 1 m ak e sure my w ork sh o w s th em that 1 care.
To fin d o u t a b o u t th e m a n y w ays P h y sic ia n s In su ra n c e w o rk s w ith a n d
lo r p h y sic ia n s, call us to d a y
W este rn W ashington
1 -8 0 0 -9 6 2 -1 3 9 9
Eastern W ash in g to n
1 -8 0 0 -9 6 2 -1 3 9 8
K ari A d am s,
C la im s S u p e rv iso r
Physicians
Insurance
A Mutual Company
'Hsu oar Vs't-hrile .11 plnm? com
.rin li'.l jn .J j[iLinsor.'d b i lh.'
Sc.illle, WA fy P hysic
Pierce C ounty M edical Society
223 Tacoma Avenue South
Tacoma, WA 98402
Insu ran c e 2003
PRESORTED
ST A N D A R D
US P O S T A G E PAID
TACOM A, WA
P E R M IT N 0 6 0 5
R eturn service requested
20
P C M S BULLETIN
March, 2004
Thank you,
Dr. Tanbara
for fifty
years of
medicine in
Pierce County
See story, page 7
George Tanbara, MD
INSIDE:
P r e s i d e n t ’s P a g e : “ A M a n d a t e f o r C h a n g e ” b y M ic h a e l K e lly , M D
T P C H D : “ B r e a th e E a s y , W a s h in g t o n ! ” F e d e r ic o C r u z - U r ib e , M D
F if t y y e a r s o f m e d i c i n e in P ie r c e C o u n t y
C l a s s a c t io n l a w s u i t s r e s u l t in i m p r o v e d t r e a t m e n t
In M y O p in io n : “ S o c ia l E n g in e e r in g ” b y A n d r e w S ta ts o n , M D
I n M e m o r ia m : C h a r l e s R . V a u g h t , M D
B
u l l e t in
PCM S
O ffic e r s /T r u s te e s :
I V I ic h a e l J . K e l l y , IVID, P r e s i d e n t
P a trick J. H o g a n , D O , P re sid e n tE le c t
K en n eth A . F eu ch t, M D , V ice-P r esid en t
Jo sep h W . R e g im b a l, M D , Treasurer
S u m n e r L. S c h o e n ik e , M D , S e c r e ta r y
J. J a m e s R o o k s , J r., M D , P a s t P re s id e n t
L a u re l R . H a r ris , M D
J e ff re y L . N a c h t, M D
J o s e p h F. J a s p e r , M D
N a v d e e p S. R a i, M D
R o n a ld R . M o rris , M D
C a rl W . W u lfe s tie g , M D
April, 2004
P C M S M e m b e r s h ip B e n e fit s , In c (M B I):
T im S c h u b e r t, M D , P r e s id e n t; D rew D e u tsc h ,
M D , P a st P resid en t; J o e R eg im b a l, M D . Secretary1 reasuror; K eilh D cin irjian. M D ; S te v e D u n ca n ,M D ;
M a r k G i Idenhar. M D ; S te v e S ettle, M D ; Joe W e a n i.M D
C o lle g e o f M e d ic a l E d u c a t io n ( C .O .M .E .) :
J o h n J i g a n t i , M D P r e s id e n t ; B arbara F o x , M D ,
W illiain I-Iolderman. M D , S te v e K o n ieek , M D , M aijorie
K r a b b e .M D , W illia m L ee, M D , G reg g O stergren, D O ,
B r a d P a ttiso n .M D , C e c il S n o d g r a ss.M D . V irginia
S to w e l I, M D , R ichard W altm aruM D , T od W urst, M D ;
H e r ta M a le ik e , G o o d Sam aritan H osp ital; L isa W h ite,
M u lti care H ealth S y stem ; S ister A n n M cN a m a ra ,
T reasurer. F ra n cisca n H ealth S y stem ; S u e A sh er.
Secretary
P C M S F o u n d a tio n : L a w r e n c e A .
L a r s o n , D O , P r e s id e n t ; C h a r le s W e a th e r b y . M D ,
M o n a B a g h d a d i, N ik k i C ro w ley , Treasurer; S u e A sher,
Secretory
W SM A
R e p r e s e n ta tiv e s :
T rustees: L eonard A len ick , M D ;N ic h o la sR a ja c ic h , M D ;
P atrice S te v en so n . M D
W A M P A C 6 th D istrict: D on R u ssell,D O
W A M P A C 9 th District: Leonard A len ick , M D
Table o f Contents
3
P re sid e n t’s Page: “A M an d ate for C h a n g e ”
4
N a tio n a l H e alth a n d N u tritio n E xam in P ie rce C ount}'
5
T P C H D : “ B reath e Easy, W ashington! A C itiz e n ’s In itia tiv e
for C lean In d o o r A ir”
6
A p p lican ts for M em b ersh ip
7
F ifty y ears o f m ed icin e in P ierce C o u n ty
8
C lass-action law su its a g a in st insurers: S ettle fo r fa ir treatm ent
9
In M y O pinion: “ S ocial E n g in e e rin g ”
10
W S M A C onference: “ T he A lc h em y o f L e a d e rsh ip ”
11
In M em oriam : C harles R. V aught, M D
T h e B u lle t in is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits, Inc. D e a d lin e for su b m ittin g a r tic le s
13
C ollege o f M edical E du catio n
a n d p la c in g a d v e rtis e m e n ts is the 15 th o f the m onth
p re c e d in g p u b licatio n .
14
In M y O pinion: “ R ituals atid B o w ls”
15
C lassified A dv ertisin g
S ta f f : E x e c u tiv e D irector: S u e A s h e r
A d m in istra tiv e A ssistants: T an yaM cC lain ,C risti Peterson
P lacem entC oordinator: K en Sm ith
P la c e m e n t A ssistan t: M e lissa K regn ess
C M E Program A dm inistrator: L es M cC nllum
B o o k k eep er: Juanita I-Iofm eister
T h e B u lle tin is d e d ic a te d to th e art, sc ie n c e an d d eliv ery
o f m c d ic in e an d th e b e tte rm e n t o f th e h ealth a n d m edical
w e lfa re o i'th e c o m m u n ity . T h e o p in io n s herein are th o se o i
th e in d iv id u a l c o n trib u to rs an d do n o t n e c e ssa rily re fle c t the
o ffic ia l p o sitio n o f P C M S . A c c e p ta n c e ol advei tisin g in no
w a y c o n s titu te s p ro fessio nal a p p ro v a l o r e n d o rse m e n t o f
p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B ulletin reserv es the
rig h t to reject a n y a d v e rtisin g .
M a n a g i n g E d i t o r : S u e A sher
E d i t o r i a l C o m m i t t e e : M B I B o a r d o f D ir e c to is
A dvertising
In fo rm a tio n : 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; F A X .-2 5 3 -572-2470
E -m a il a d d re s s : p c m s w a @ p c m s w a .o r g
HomePage: http://www.pcmswa.org
2
P C M S BULLETIN
April, 2004
President s Page
by Michael J. Kelly, MD
A Mandate for Change
"You'II n ever p lo w a fie ld by turning it over in y o u r mind. "
- Old Irish saying
M ic h a e l.!. Kelly. M D
The tim e to take renew ed action is
soon approaching. M ost o f you have
already been very active w riting letters
to legislators, discussing tort reform
with your patients and even traveling
to Olympia to testify. A s it played out,
that was ju st the w arm up. T he real
game is about to begin - changing the
faces o f the legislature.
The need for this activism is a p ­
parent for anyone w ho has been p a y ­
ing attention. O ur actions to pass tort
reform these past two years have been
met with m erciless, unyielding, un­
flinching opposition. O nly a fool w ould
give this dysfunctional dem ocrat
house leadership a third chance to d e ­
feat reform in 2005. Then* consistent
obstruction is our m andate for change.
Plowing the legislative field, to
continue the Irish analogy' above, up­
roots the obstructions and rem oves
undesirable noxious w eeds. T he seeds
of tort reform will find fertile ground
only in a garden w hich has been p ro p ­
erly prepared. G row th o f those reform
seeds will occur as we continue to nur­
ture them by supporting our can d i­
dates and reaching out to the elector­
ate. This clears the w ay for a su ccess­
ful crop in the 2005 legislative session.
The PCM S B oard o f D irectors has
chosen a special A d H oc com m ittee to
develop concepts on ho w to change
the faces o f the legislature to obtain
meaningful tort reform and o ther m edi­
cal-friendly legislation. T his com m ittee
will then report to the B oard and even­
tually the m em bership o f the Society.
Members o fth e com m ittee include c o ­
chairs Drs. Ron M orris and M ike
Kelly along with D rs. L au rel H arris,
Len A lenick and N avdcep Rai,
T he com m ittee will look into cre­
ative w ays to educate the press, public,
p hysicians and legislators. By the tim e
you read this, w e will be well along with
our planning but still open to ideas from
you on such effective political action.
We w ill also be discussing these issues
and coordinating efforts w ith the
W SM A .
B efore I continue, perm it m e a b rie f
digression. I am assum ing one thing that y our w aiting room and exam room s
leave no doubt as to the depths o f the
present crisis and the need for m ean in g ­
ful liability reform . I am also assum ing
you have briefly, and appropriately
b rought up the subject w ith m any o f
y our patients. Do I assum e too m uch?
I am concerned because I have
h eard from patients that they com pleted
their visit to their doctor w ithout having
received any inform ation in the form o f
posters, handouts or com m ents about
the reform m ovem ent. Do not m iss such
an opportunity to educate your p a ­
tients. T hose patients w ho have som e
know ledge o f the crisis expect you to at
least m ention the subject. To do other­
w ise, plays into the hands o f th e per­
sonal injury attorneys w ho steadfastly
claim there is no crisis at all.
In last m o n th ’s B ulletin article. I
discussed one exam ple o f political ac­
tion, the “N ew Jersey” approach, which
involved door-to-door, grass-roots ac ­
tivism . If this is used, w e w ill com m uni­
cate w ith you on the participants, exact
tim ing, date and districts.
O ther ideas m ay include bum per
stickers targeting specific candidates.
O ne b um per sticker can be w orth m ore
than S I ,000 in advertising dollars. We
will look into the cost and dissem ination
o f these m obile advertisem ents, if cost
effective.
Placing the faces o f p hysicians w ho
have left the state or retired early due to
liability issues on the b ack o f m ilk car­
tons (“ M issing Physicians” ) is a nother
possibility. T his will occur only w ith the
acquiescence o f the physicians, not to
m ention the financial feasibility.
PCM S has d eveloped a user-friendly
tort talk, com plete w ith readable text,
available to any Society m em b er w ho
w ould like to use it as a platform to edu­
cate patients or service groups in the
area. It can be dow nloaded from the new
PC M S w eb site into y our com puter. We
encourage anyone w ith a voice to c o n ­
sider using this tort reform prom otional
tool. If Rob M cK enna, R epublican can d i­
date for A ttorney G eneral, can use it.
physicians w ith a m ore intim ate un d er­
standing o f the issues should have no
problem .
T he N o v em b er elections are now
our new focus. O ther states, including
T exas, teach us that legislative change is
im perative i f w e are to succeed. To do
this, your county leadership w ill be d e ­
p ending upon your direct, intim ate in­
volvem ent. Please follow our lead. We
will not ask any m ore o f you than w e ask
o f ourselves.
Y our Society leaders will th o u g h t­
fully turn the options over in our m inds,
and then com m unicate them to you.
T hen w e w ill ask you to m ake noise; be
enthusiastic; be assertive; and plow that
field. ■
April, 2004
PCMS BULLETIN 3
B
u jlleE T 1 N
Federico C ru z-U rib e, MD
D ire cto r o f Health
The Health Status of Pierce County
National Health and Nutrition Exam In Pierce County
S ta rtin g o n M a rc h 10, 2 0 0 4 th e C e n te rs fo r D isease
m o b ile un it has b e e n e stab lish e d a t th e P u y a llu p F a ir­
C o n tro l (C D C ) and th e N a tio n a l C e n te r fo r H e alth S tatistics
g ro u n d s, in c lu d in g a tea m o f h e a lth p e rso n n e l a n d state-of-
(N C H S ) b e g an e x a m s a n d su rv e y s o f se lec t P ierce C ounty
th e-a rt equ ip m en t.
re sid e n ts as p a rt o f th e c o m p re h e n siv e stu d y o f th e health
N o m ed ical care is p ro v id e d d ire c tly in th e e x am in atio n
a n d n u tritio n a l sta tu s o f U .S. re sid en ts. A n n u a lly fo r m ore
c enter, b u t m ed ic al a n d dental re p o rts o f fin d in g s are given
th a n 4 0 y e a rs, the C D C has ra n d o m ly se lec te d a p p ro x im ate ly
to each p a rticip a n t i f th ey w ish . In d iv id u a l in fo rm a tio n will
5 ,0 0 0 re sid e n ts in 15 c o u n tie s to p a rticip a te . D a ta g a th e red
be k e p t c o n fid e n tia l, a lth o u g h the c o lla te d d a ta w ill b e use­
p ro v id e s e stim a te s on h e a rt a n d re sp irato ry d iseases and
ful fo r h e alth p ro fessio n als a n d p o lic y -m a k e rs in d e te rm in ­
c o n d itio n s su c h as d ia b e te s a n d o steo p o ro sis.
ing p o lic ies and p ra ctic e s th a t m atc h the h e alth p ic tu re o f
T h e N a tio n a l H e a lth a n d N u tritio n E x am in atio n S urvey
(N H A N E S ) w ill a sk a b o u t 4 0 0 P ierce C o u n ty resid en ts to re ­
c e iv e a c o m p re h e n siv e p h y sic al e x am and a n sw e r q u estio n s
the U.S.
O n e o r m o re o f y o u r p a tie n ts m a y re c e iv e a c a ll to take
part in this exam and survey. Y ou m ay w a n t to sh a re this in­
d u rin g a h e alth interview . P a rtic ip an ts selected for the su r­
form ation w ith them and e n co u ra g e th em to c o n trib u te to
v e y re p re se n t th e U .S. p o p u latio n in age a n d ethnicity. A
this uniq u e reso u rce for h ealth in fo rm a tio n in th e U .S. ■
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PHYSICIANS
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INSURANCE
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\
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A Wholly Owned Subsidiary of
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© phvsicians Insurance 2003
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4
PCM S
BULLETIN
f -----April, 2004
Sponsored by the Washington Slate Medical Association
^Pierce 'fpouHtij Q {(e./licn l tfe c ie h f
Federico Cruz-Uribe, MD
D irector of Health
The Health Status of Pierce County
Breathe Easy, Washington!
A Citizen’s Initiative for
Clean Indoor Air
F cJcrico Cruz, M D
Our legislature unfortunately w as
W orking in the election. R aising
1) Financial Support: T he initia­
tive process costs significant dollars.
true to form. T hey passed on dealing
m oney. Talking to voters. T he chal­
with Tort Reform and they looked the
lenge is in front o f us. If w e w ant tort
We need donations fo r the start-up
other way w hen public health tried to
reform to happen, we have to m ake it
costs ASAP. It is one o f the w isest
confront B ig Tobacco. So the session
h ap p en .
and m ost prudent investm ents we
is over and now it is tim e to m ove on.
L ikew ise, to have a sm oke-free
Wrong! It is not tim e to change the
environm ent w e w ill need a new' law
subject or to accept their shoddy b e­
creating a statew ide sm oking ban in
can m ake in the health o f our c o m m u ­
nities.
2) Petitions: We need to position
havior as acceptable. W hen legisla­
public places. A n initiative process
them in each o f our offices so that
tors repeatedly fail to act then we as
has already begun. A petition w'as
each o f our patients at sign-in can
the electorate have several alterna­
filed w ith the Secretary o f S ta te ’s o f­
read the petition and decide w hether
to sign them .
tives. The m ost obvious is to vote
3 ) A dvertise: We need to
in a new set o f legislators. T here is
get the initiative into the
a general election com ing up in
November. It is prim e tim e to m ake
change. There is an opportunity to
get a new legislature and a new
p u b lic ’s eye. P osters and bro­
“So the session is over and now
it is time to move on. Wrong! ”
chures will be available and we
need to get them posted in our
Governor and to get our ideas to
offices so as m any people as
the ballot box via a c itize n ’s initia­
tive.
p ossible see them .
A fter the m iserable e xperi­
ence o f this last legislative ses­
For both tobacco-related is­
sues and tort reform w e have labored
fice on M onday. M arch 15. A t a press
sion, w e have an issue in front o f us
since the 80s to get legislative action.
conference. W ashington State M edi­
that w e can em brace w holeheartedly.
But special interests have stopped
cal A ssociation and the W ashington
It is positive and uplifting and can
any meaningful m ovem ent b y our
State D ental Society jo in e d w ith a
m ean real positive change for our
elected delegations. So it’s tim e to
take a more direct step.
n um ber o f b artenders and w aitresses
com m unities. So le t’s get behind:
For tort reform to happen in the
and o ther hospitality w orkers to sup­
p o rt passage o f the B reathe Easy,
Breathe Easy, W ashington!
W ashington! initiative. T he initiative
A C itizen’s Initiative for C lean In­
Governor and a new S peaker o f the
calls for the establishm ent o f a state­
door Air
House. The dem ocratic incum bents
w ide ban on sm oking in public places.
PO B ox 11324
will not permit real reform to take
T his m irrors the b a n already in place
T acom a, WA 98411-0324
place. This means G E T T IN G IN ­
in P ierce C ounty.
wvw.BreatheEasvW a.org
state of W ashington w e need a new
VOLVED W ITH THE CAM PAIGNS.
Supporting individual candidates.
So how can w e as physicians
help?
2 5 3 -3 8 3 -7 7 4 4
253-276-0086 fax ■
April, 2004
PCMS BULLETIN
5
B
u l l e t in
Applicants for Membership
N aila B. A h m ad , M D
R h e u m a to lo g y
Jam es T. M ajors, M D
St. Jo s e p h M e d ic a l C lin ic
G o o d S am aritan W o m e n ’s C e n te r
1408 3rd St SE #200, Puyallup
O b/G yn
1708 S Y akim a #110, Tacom a
253-593-8400
M e d S ch o o l: W rig h t S tate U n iv e rsity
253-848-2683
M ed School: M ed U n iv o f South C a ro lin a
In te rn sh ip : U n iv e rsity o f Illin o is
Internship: U n iv o f C alifo rn ia - Irvine
R e sid e n c y : U n iv e rsity o f Illin o is
R esidency: T ulane A ffilia ted H o sp ita ls
F e llo w sh ip : U n iv e rsity o f W ashington
P ete r Y. C h en , IV1D
Sam H . S ong, M D
O b/G yn
C a rd io lo g y
G o o d S am aritan W o m en ’s C en ter
C a rd ia c S tu d y C e n te r
1408 3rd St S E #200, Puyallup
1901 S U n io n # 3 0 1 , T acom a
253-572-7320
M ed S chool: N a n to n g M edical C ollege
253-848-2683
M e d School: M ed ical C o lleg e o f
P e n n sy lv a n ia
In tern sh ip : N a n to n g M e d ica l C o lleg e
In tern sh ip and R esidency: U n iv ersity o f
R e sid en c y : N a n to n g M ed ical C o llege
C alifo rn ia - San F rancisco
R e sid en c y : M t. S inai S ch o o l o f M e d icin e
F e llo w sh ip : U n iv H o sp ita ls o f C lev elan d
W illiam R. Stubbs, M D
B arbara S. Echo, M D
F am ily P ractice/A dm M ed
M u ltiC are H e alth System
E m e rg en c y M ed icin e
315 M L K in g Jr Way, T acom a
253-403-1050
315 M L K ing Jr W ay, T acom a
253-403-1087
M ed School: U n iv ersity o f A rkansas
M e d S chool: U n iv e rsity o f W ashington
In tern sh ip : R u sh P re sb y te ria n /S t. L u k es
Internship: T he M edical C e n te r Flospital
R e sid en c y : H e n ry F o rd H ospital
C arrie C. W ong, M D
O b/G yn
G o o d S am aritan W o m en ’s C enter
1408 3rd St S E # 2 0 0 , Puyallup
Y oung H . L e e,M D
In tern a l M e d icin e
8725 S outh T aco m a W ay, L ak e w o o d
253-5884015
M e d S chool: K y u n g Vu U n iv ersity
In tern sh ip : U n iv e rsity o f Illinois
253-848-2683
M ed School: H a h n em a n n U niversity
Personal Problems of
Physicians
Committee
M ed ical p rob lem s, d ru gs, alcohol,
retirem en t, em otion al,
o r o th e r su c h d ifficu ltie s?
Y o u r c o lle a g u e s
w a n t to help
* R o b ert S ands, M D , C h a ir
Bill D ean, M D
752-6056
272-4013
Tom H e rro n , M D
8 5 3 -3 8 8 8
Bill R oes, M D
8 8 4 -9 2 2 1
F. D ennis W a ld ro n , M D
265-2584
Confidentiality
Assured
R esid en cy : U niversity o fT e x a s
R esid en cy : M t. Sinai Flospital
TACOM A/PIERCE COUNTY
O u tp a tie n t G e n era l M edical C are.
F ull a n d p a rt-tim e p ositions
available in T a c o m a a n d vicinity.
V e ry flexible sc h e d u le . W ell su ited
fo r c a re e r re d efin itio n lor
C P , F P , IM .
C ontact Andy Tsoi, M D (253) 752-96H9
or Paul D otv (Allen, Nelson, T u rn e r &
Assoe.), C linic M anager (253) 383-4351
6
PC M S BULLETIN
April. 2004
UNION AVENUE PHARMACY
Professional Compounding Center o f Tacoma, WA
Vaginal Suppositories
Rectal Suppositories
Urethral Inserts
Sublingual Troche
Gel, Ointment, and Cream
IV Services
Capsules
Lip Balms
2302 South Union Avenue
752-1705
JPtei'ce % « n h / Q 'i'U 'd ir n /r fo r ie tif
Fifty years of medicine in Pierce County
Editor's note: The N ew s Tribune reco g n ized Dr. Tanbara f o r
his work in the com m unity w ith cm article a n d p ic tu re the
day follow ing the recognition dinner. They fo llo w e d with an
editorial that is reprinted below.
W ashington, by the g o vernor and legislators from both the
Senate and the House. As representatives from each o t these
bodies stood in the audience, speaker Lyle Q uasim noted, “ Dr.
T anbara, all o f these folks n e v er agree on anything. H ow ever,
they all readily agree about y o u .”
R ounding out the highlights w as the an n ouncem ent that
Over 750 people attended C om m unity H ealth C a re's 35lh
C H C w ill nam e their new eastside clinic, after Dr. T anbara and
anniversary/annual m eeting on M arch 24lh to recognize
George Tanbara, M D for 35 years o f service to CMC and 50
his wife Kimi.
Dr. Tanbara jo in ed PC M S in 1954 at the sam e tim e he
years o f m edicine in Pierce County. It w as a m agical evening,
opened his solo practice, now' know n as P ediatrics N orthw est.
bringing together a vast spectrum o f friends and supporters;
A fter com pleting his internship at K.ing C ounty H ospital in Se­
from patients and colleagues to politicians, business and com ­
attle in 1952 and his residency at C h ild re n 's O rthopedic H ospi­
munity leaders, tennis buddies and family.
tal in 1954, Dr. T anbara settled in T acom a w here w e now know,
The event, presented in partnership w ith P ierce C ounty
he w ould dedicate
Medical Society and
the next 50 to helping
Pediatrics N orthw est,
the p o o r and d isad ­
focused on the his­
v a n ta g ed .
tory' and growth o f
Dr. Tanbara
CHC, beginning in
F o r h a lf a centuiy, Dr. G eorge Tanbara has em b o d ied the highest ideals
served as President
1969 with volunteer
o f the m edical profession.
o f PCM S in 1981. H e
operations o f two
The g o o d new s is that the 81-year-old Tacoma p ediatrician is show ing
has chaired m any
medical clinics, one
no sig n he 'II be hanging up his stethoscope anytim e soon. H e continues to
com m ittees and has
on the eastside and
p
ra c tic e m edicine a n d serve as a consultant to C om m unity H ealth Care, an
served on ju st about
one downtown
im portant P ierce C ountv health care organization he h e lp e d fo u n d 35 y ea rs
every one du rin g his
Tacoma. Dr. Tanbara
50 year tenure. Dr.
ago.
and his wife Kimi,
Tanbara w as the im ­
both worked at the
E vidence o f Dr. Tanbara s im pact on the com m unity's w ell-being w as on
p etus for the form a­
clinic. Today, the nine
display IVednesda\’ at the Sheraton Tacoma H otel C onvention Center. M ore
tion o l'th e PCM S
medical and three
than 700 p e o p le sh o w e d up to p a y tribute to Tanbara a n d the CHC. which
C om m unity Service
dental clinics serve
has since grow n into a vital health care syndicate serving the m edical a n d
A w ard, being the
over 30,000 patients
dental needs o f 34,000 low -incom e a n d w orking class p atients throughout
first recipient in 1992.
each year. W hile the
the co u n ty
He has received n u ­
Pierce County M edi­
Severa l speakers p ra ise d Tanbara s decades-long dedication to the
cal Society and phy­
m erous aw ards in­
poor. C H C P resident a n d C h ie f E xecutive D a vid F lentge sa id he w as "the
cluding but not lim ­
sicians in the com m u­
conscience o f the agency. "
ited to, The
nity contributed, Dr.
Tanbara d eserved the accolades. He also d eserved the decision to nam e
Tanbara was the driv­
C hild ren ’s H om e So­
a new m ed ica l b uilding to be built in Tacoma's Salishan neighborhood after
ing force and guiding
ciety o f W ashington,
light o f continual op­
the B oys and G irls
Tanbara a n d his wife, Kimi.
erations and success
C lubs o f Pierce
Salishan is w here it at! started. In 1969 Tanbara volunteered to sta ff a
of the clinics for
County, the Sisters
m edical clinic f o r low -incom e p a tien ts in a cpionset hut in the E a st Tacoma
many, m any years,
o f St. Francis o f
neighborhood. W hile his w ife d id the paperw ork, he trea ted p a tie n ts once a
Today, he still serves
Philadelphia,
the R o ­
w eek.
as consultant and
tary
C
lub
o
f
Tacom
a,
H is dedication to the p o o r w a s sh a p e d at least p a rtly by his ow n experi­
avid supporter o f
The M unicipal
ence w ith hardship a n d injustice. L ike all p e rso n s o f Ja p a n ese ancestry liv­
CHC.
L eague, as w ell as
ing on the West C oast during W orld Heir II, Tanbara was rounded up a n d
A highlight o f
m any others.
taken to internm ent cam ps in the nation s interior. O ver the years, he has
the evening was the
PC M S thanks
treated thousands o f p a tien ts who otherw ise w ouldn't have been able to a f­
announcement o f
Dr. Tanbara for 50
fo r d m edical care. H is d ecades-long advocacy on b e h a lf o f the p o o r has in­
George Tanbara day,
years o f c o m passion­
directly h e lp e d m any more.
by proclam ations
ate m edicine and
from the C ity o f
W hat Tanbara s m a n a g ed to accom plish is im pressive by any standard.
com m unity leader­
Tacoma, Pierce
A n d he i s n '( done yet. m
ship in Pierce
County, the State o f
C ounty. ■
R e p r i n te d fr o m th e TN T. 3 - 2 6 - 0 4
Dr. Tanbara’s lasting gifts to his community
:
i
April, 2004
PCMS BULLETIN
7
B
u l l e t in
Class-action lawsuits against insurers: Settling for fair treatment
T h e p o w e r o f o rg an ized m edicine and the attention o f individual p h y sician s w ill ensure that
settlem en ts w ith m an ag ed care com panies resu lt in b e tte r conduct to w ard doctors.
O n e o f th e lea d p riv a te a tto rn ey s
h a n d lin g p h y sic ia n c la ss-a c tio n law ­
su its a g a in st m a n a g e d care c o m p a n ies
c a lls se ttle m e n ts w ith A e tn a and
cians sa id for years, a n d it w as a b u lle t
hole betw een the eyes to those plans
the m e d ic a l so c ie tie s h a v e a ch iev e d for
m o ck in g and h u m iliatin g individual
p h y sician s w h o c h o se to step fo r­
sim ila r law su its and settlem en t d isc u s­
c e s sity sta n d ard s, fo rcin g them to fo l­
lo w C P T g u id e lin e s a n d o th erw ise c re ­
sions a g ain st c o m p an ies such as A n ­
them Inc. and W ellPoint H e a lth N e t­
a tin g m o re o p e n c o m m u n ica tio n b e ­
tw e en the c o m p a n ie s a n d ph y sician s.
w o rk s Inc., w h ic h recen tly fin alized
their m erg er to b eco m e the n a tio n ’s
largest plan. T h is pro v id es the p o ssib il­
ity th at e v en m o re p lan s w ill see the
so c ie tie s w o rk e d on p h y sic ia n s’ behalf,
p ro v id in g c o n sid e ra b le lev erag e to get,
so far, A e tn a Inc. a n d C IG N A C o ip . to
p ro m is e to a ct fairly.
A s a n y p h y sic ia n k n o w s, lev erag e
is k e y in n e g o tia tin g a m an ag ed care
c o n tra ct, a n d until these settlem en ts,
th e le v e ra g e see m in g ly alw ays b e ­
lo n g ed to the h e alth plan. A s co -lead
th ese se ttle m e n ts.
To th a t end, th e y re c o m m e n d phy­
sic ia n s look a t a W eb site
(w w w .h m o se ttle m e n ts.c o m ) created by
w ard.”
T h e se ttle m e n ts p u t the c o m p a ­
n ie s ’ fe e t to the fire, se ttin g m edical n e ­
T h e A M A , sta te , c o u n ty a n d sp ecialty
u rg in g p h y sic ia n s n o t to w a it in m aking
sure that th ey g e t th e m ax im u m o u t o f
c o rro b o ra ted w hat indiv id u al p h y si­
C IG N A “o n e o f th e g re atest v icto ries
th e ir p a tie n ts a n d th eir p h y sic ia n s,”
a n d it’s e a sy to see why.
ing th em , h e a rs th e la st a p p ea ls on
th o se cases. B ut o rg a n iz e d m ed icin e is
c o u n se l A rc h ie L am b Jr. said, “ T he
v o ice o f th o se m edical asso ciatio n s
the p la in tif f’s a tto rn e y s in the A etna
O rg an ized m ed ic in e is in v o lv e d in
and C IG N A cases. T h e site g iv es physi­
cians the d e ta ils o n e v e ry settlem ent. It
in clu d es w h a t in d iv id u a l p hysicians
m ust do to g e t a sh a re o f m o n e y for
p a st offen ses such as d o w n c o d in g —
for exam ple, in the C IG N A settlem ent,
p h y sic ia n s can re su b m it c la im s for
w hich th e y b e lie v e to b e und erp aid .
P h y sic ia n s co u ld b e le a v in g ten s o f
th o u sa n d s o f d o lla rs on the tab le if
(hey d o n ’t resu b m it.
light and decide to treat p h y sician s
w ith som e m easu re o f respect, en d in g
the u n fair bu sin ess p ractices by m an ­
aged care c o m p an ies th at have tain ted
th e ir relationships w ith doctors.
T he A e tn a and C IG N A settlem ents
A lso, th e W eb site sp ells o u t how
a n y future d isp u tes w ill be h an d led
are b e in g w ra p p ed up as the U.S. D is­
trict C o u rt in M iam i, w hich is o v e rse e ­
ag ain st the c o m p a n ies th at h ave
settled. E ac h se ttle m e n t has its ow n
p ro c ess in how a p h y sic ia n w o u ld dis­
pute a claim , or w o u ld c o m p la in about
c o m p a n y conduct.
T h e W eb site sh o u ld b e a handy
referen ce to p h y sic ia n s to en su re that
th ey g et w h a t's c o m in g to th em , al­
tho u g h it w o n ’t be the o n ly resource
E R A S E
THAT TATTOO
av ailab le. T h e A M A a n d o th e r societies
also stan d re ad y to a n sw e r questions
from p h y sic ia n s ab o u t th e settlem ents
and ho w th ey w ill a ffe c t in d iv id u a l doc­
tors.
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
T h is is n o t to sa y th a t p hysicians
w o u ld notice an im m e d ia te turnaround
in th e ir fo rtu n es o n c e th e settlem ents
Today’s newest Alexandrite laser,
will remove your tattoo
with minimal discomfort &
less than 1 % risk of scarring.
th a t o rg a n iz ed m ed ic in e h a s giv en p h y ­
sicians lev e rag e th e y d id n ’t have. W ith
the p re ssu re fro m o rg a n iz e d m edicine,
(Util t o d a y f a r
more
are fu lly im p le m e n ted . W h at is tru e is
and the v ig ila n ce o f in d iv id u a l p h y si­
cians, the m ed ical c o m m u n ity can see
to it th a t h e alth p la n s n o lo n g e r run
in tonnurion
PIERCE COUNTY
LA SER CLINIC
lo u g h sh o d o v e r p h y sic ia n s w ith im pu­
n ity a g ain .*
D ire c to r IV tc r K. M iirsli M.l>,
(253)573-0047
8
P C M S BULLETIN
Reprinted fro m AMNews, 4/5/04
April, 2004
^
?P(ey-(:e'tc:o ( n i/f n f b d i c a l S o c i e t y
In My Opinion....
The Invisible Hand
by Andrew Statson, MD
The o p in io n s e x p re ss e d in th is w r it in g a r e s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b e rs to e x p re ss th e ir o p in io n /in s ig h ts a b o u t su b je cts
relevant to the m e d ic a l com m un ity, o r s h a re t h e ir g e n e r a l in te re s t s to rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
Social Engineering
“C ursed be the social lies that w arp us from the living truth. "
Lord Tennyson (1842)
A ndrew Sialson. MD
A good, all-encom passing defini­
tion o f torts does n o t exist. Torts are
described as civil w rongs. E ach tort ad­
dresses a specific issue, not connected
to any o f the other torts. T he only
point they have in com m on is that
someone has been injured and m ay d e ­
serve com pensation.
In his “Law o f T orts” (fourth edi­
tion, 1971), Prosser m entions that the
puipose o f the law is to discourage
anti-social behavior. H e adds that liabil­
ity must be based on socially unreason­
able conduct and the injurious act m ust
be measured by an objective, disinter­
ested and social standard.
Prosser adm its, how ever, that start­
ing in the 1930’s, the courts have
moved toward discarding the absolute
requirement o f fault in order to d eter­
mine liability. Instead, they consider the
question o f w hich p a rty ’s interest
should prevail, even though nobody
may be at fault.
In spite o f all its efforts, the judicial
system cannot rem edy all w rongs.
Most instances o f ingratitude, broken
promises, cruel disregard o f the feelings
of others rem ain uncom pensated.
Prosser justifies that b y stating that to
admit such claim s as valid w ill flood the
courts with trivial cases.
O f course, courts have better
things to do than to spend their tim e
frying trivial cases. E ven so, I suspect
the real reason is m ore likely to be that
most o f those w ho com m it the above
transgressions do not have the m eans
to com pensate their victim s, and espe­
cially, their v ictim s’ law yers. T he fact
that a defendant is sued is an indication
that he has som e m eans o f paym ent. I
think that i f there w ere m oney to pay it,
even the m ost trivial case w ould be
brought to court. T he m ain thing trivial
about any case is the defendant w ith no
money.
A dram atic change in the law o f
torts occurred w ith the w idespread use
o f the autom obile and the grow th o f li­
ability insurance. T he law began to look
on liability insurance as a w ay to com ­
pensate the injured party even in the
absence o f negligence. A statute re­
quires drivers to carry insurance and
w hen som eone is hurt, the insurance
pays the com pensation.
T he social effect o f insurance has
been to m itigate the personal responsi­
bility o f individuals for their actions.
G etting into an accident is not as ruin­
ous, since w e have insurance to com ­
pensate us, therefore w e d o n ’t have to
be as careful.
In the past, insurance did not cover
injuries by drunk drivers, for instance,
b u t currently an injured party m ay have
cause for action against the insurance
com pany, even w hen the insured has
broken a law or declared bankruptcy.
We can debate w hether the higher
court aw ards are due to the increased
p opularity o f liability insurance cover­
age, or w hether the prevalence o f insur­
ance is the result o f the increased liabil­
ity risk. I suspect that the tw o have fed
on each other and have becom e the
m onsters o f today, threatening to de­
vour our society.
T he current legal policy, w hich p e­
nalizes carelessness by com pensating
for every casualty w ithout regard to
predictability or fault, claim s to be ju s ti­
fied by stating that m ore dangers are
now predictable and should be p re ­
vented. T herefore the liability has to be
m ore pervasive. Since w e can now p re ­
d ict that children m ay fall o f f sw ings,
w e have to rem ove such dangerous
equipm ent from our playgrounds. I
w onder w hat our grandparents w ere
thinking w hen they put them there.
D id n 't they k now w e could fall and in ­
ju re ourselves?
W hile the courts m ay consider
such com pensation w ithout fault as so ­
cially desirable, it destroys the sense o f
individual responsibility o f both the d e ­
fendant and the plaintiff. It has in­
creased the cost o f all com m ercial
transactions betw een the m em bers o f
our society. T he yearly costs o f litiga­
tion are estim ated at betw een $50 and
$ 100 billion. It has influenced b oth p u b ­
lic and private relationships betw een
people b y reducing m utual trust and
cooperation and b y restraining the
natural tendency o f all to com e to the
assistance o f a person in distress.
A lot has b een w ritten about the
See '"Social” page 12
April 2004
PCMS BULLETIN
9
B
u l l e t in
WSMA Conference: “The Alchemy of Leadership’"
T h e W ash in g to n S tate M ed ical A s so c ia tio n ’s annual
• L iv in g R ig h t S ide U p in a n U p s id e D o w n W orld: The
L e a d e rs h ip D e v e lo p m e n t C o n fe ren c e is sc h e d u le d fo r M ay 7
Im p o rta n ce o f In te g rity in L e a d e rs h ip a n d Y our Life
a n d 8 at C a m p b e ll s R e so rt o n L ake C h elan . T h e c o n fere n ce ,
• B e P ro a c tiv e: B e Y our O w n G ra ssro o ts A d v o c ate
e n title d “T h e A lc h e m y o f L ea d ersh ip ” w ill feature a n o u t­
sta n d in g fa c u lty a n d w ill include p le n a ry sessio n s as w ell as
T his activ ity m ee ts th e c riteria fo r up to 14 h o u rs of C at­
h a n d s-o n a n d in te rac tiv e b re ak o u t se ssio n s fo c u sed on sh a rp ­
e n in g sp e c ific skills.
T h e c o n fere n ce is d e sig n ed fo r cu rre n t a n d future leaders
of c o u n ty m e d ic a l so cieties, sta te sp ecialty so cieties, hospital
e gory 1 C M E .
To re g iste r o r fo r m ore in fo rm a tio n , c o n ta c t S ue at PCM S,
572 -3 6 6 7 o r the W ashington S tate M e d ic a l A sso c ia tio n d i­
rectly at 800-552-0612 o r w w w .w sm a.o rg . ■
m e d ic a l sta ffs, m ed ic al g ro u p p ra ctic e s a n d o th er o rg a n iz a ­
tio n s th a t d e p en d on p h y sic ia n leadership. L ea d ersh ip /m an ­
a g e m e n t tea m s are e n co u ra g ed to attend.
T h e c o n fere n ce is b e in g held in co n ju n ctio n w ith the
W S M A B oard o f T ru stee s retreat, a n d a tten d ees are inv ited to
a tte n d the B oard d in n e r on S atu rd ay n ig h t as w ell as the
Allenmore
Psychological
Associates, P.S.
B o a rd m e e tin g o n S u n d ay m orning.
T h e k e y n o te speaker, Jeffrey B auer, is a n ationally know n
h e a lth care fu tu rist and eco n o m ist w h o w ill speak o n “ M aster­
in g C h ao s: C re ativ ity 101 for H e alth C are L ea d e rs.” O th e r to p ­
ics include:
• R e la tio n sh ip s, In terests, a n d P ow er: Practical
N e g o tia tin g S trategies
• F ro m R ick y & L u cy to B eavis & B utthead: M anaging
the N e w W orkforce
• B u ild in g a C u ltu re o f Safety and Q uality
■752-7320 ,
...a m u l t i ­
disciplin ary
b ehavioral
h e alth group
th at w o r k s
w i l h p h y s ic ia n s
Do you have patien ts w ith difficult emotional
and stress-related problems? Psychiatric and
psychological consultations are available.
—
Union Avenue Professional Building
1530 Union Ave. S.. Ste. 16. Tacoma
Positron Emission Tomography (PET)
O u rC lin ic a l
PET S p e cia lists
PET has been show n to be an accurate m ethod to diagnose and stage cancer, check for
tu m o r recurrence, and m o n ito r cancer therapy. Inform ation gained by the use o f PET can be
used to d e te rm in e w hat com bination of surgery, radiation therapy, or chem otherapy is m ost
likely to be successful in m anaging the disease.
A n th o n y Larhs, M D
Director of Clinical PET
P h illip C Lesh, M D
PET is also used to evaluate A lzheim er’s disease,
epilepsy, and cardiac disease.
W illia m B Ja ck so n , M D
M any insurers, including M edicare and
M edicaid, are reim bursing for m any
PET procedures. TRA referral
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Call our referral coordinators at
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10
P C M S BULLETIN
April, 2004
TRA
IN
M E M O R IA M
C HARLES R. V A U G H T , M D
1924
-
2004
Dr. Charles Vaught was born in Boise, Idaho in 1924 and died peace­
fully at his home on March 14, 2004.
After receiving his medical degree from Creighton University in 1948,
he completed his internship at the U.S. Naval Hospital in Bremerton and
family practice residency at Pierce County Hospital. He began his practice
in 1952 in Puyallup, where he continued practicing until his retirement in
1989.
Dr. Vaught joined Pierce County Medical Society in 1952.
Those wishing to remember Dr. Vaught can make donations to the
Children’s Therapy Unit, Good Samaritan Foundation, 1401 E Main, Puyallup WA 98372, or to the
charity o f your choice.
PCMS offers condolences to Dr. Vaught’s wife, Deva, and their family.
bO
I
0
1
0
ra-di-ol-o-gy \rad-e-‘al-e-je\n.
1: a branch o f medicine utilizing exams such as
MRI (magnetic resonance imaging) and CT
(computed tomography) in the diagnosis and
treatment of disease 2: a commitment to
providing cutting-edge imaging services without
the necessity of driving long distances; see TRA
M e d i c a l I m a g in g
1
• i-H
TRA
I
u
&
4 7 0 0 P o in t F o s d ic k Dr, S te 110 • F o r m o re in fo rm a tio n , call (253) 7 6 1 -4 2 0 0
tra m e d ic a lim a g in g .c o m
April, 2004
PCMS BULLETIN
11
B
u l l e t in
Social
from p a g e 9
p ro life ra tio n o f c a u tio n a ry lab e ls on
ju s t a b o u t e v e ry p ro d u c t o n the m ark et.
M o s t o f the c o m m e n ts h a v e b e en d i­
re c te d at th e im p lic a tio n th a t th e peo p le
a re sp o n sib ility fo r th em se lv es? W h at
can be said ab o u t us w h e n w e m ak e
sult, the v e rd ic ts in to rt c ases are no
oth ers re sp o n sib le for o u r actions?
at so c ial e n g in e e rin g , a n a tte m p t to
so lv e social p ro b le m s th ro u g h legal de­
L iab ility in su ra n ce has h a d sev eral
w h o w ill u se th e p ro d u c t are m orons.
effects. A su b stan tial p o rtio n o f the
C o ffe e is ho t. K n iv e s are sharp. Soap
claim s are settled w ith o u t re g ard to the
can p ro d u c e b u rn in g in the eyes.
ex iste n ce o f liability. T h e insurance
C le a n in g a g e n ts c a n b e h a rm fu l i f sw a l­
c o m p a n ies pay m an y claim s to avoid
lo w ed . O v e n s g e t hot w h e n tu rn e d on.
E x c e ssiv e in tak e o f fo o d c au ses w e ig h t
the e x p en ses o f litigation fo r c ases in
w h ich th e d e fen d a n t c le arly w a s not at
fault o r the p la in tiff clearly w as. W h en
gain. A th re e -h o o k fish lu re c an be
lo n g e r b a se d on law . T h e y are an effort
c isio n s.
T h e c o m p e n sa tio n o f the victim s
re g a rd le ss o f fa u lt is a su b v e rsio n o f
ju stic e . It is an a cc ep ta n ce , tac it though
it m ay be, in th e c o n c e p t p ro p o se d by
K a rl M arx a n d F rie d ric h E n g e ls in the
C o m m u n ist M a n ifesto : “ F ro m everyone
h a rm fu l i f sw allo w e d . Is n ’t it nice fish
c a n ’t read ?
th e cases go to trial, the a v ailab ility o f
in su ra n ce as a m eans o f d istrib u tin g the
a cc o rd in g to his n e e d s .” T h e court de­
A lm o st n o b o d y m e n tio n s th a t all
th o se lab e ls h a v e c o sts, a n d even
ex p en se o f a loss o ver a large p o p u la ­
tio n has influenced the co u rt decisions.
term in e s th at th e p lain tiffs h ave needs,
th o u g h w e sh o u ld n ’t n e ed th em , w e
h a v e to pay fo r them . T he d efen d a n ts
are sp e n d in g b illio n s o f do llars in a
g e n e ra lly fu tile a tte m p t to p ro te c t th e m ­
ance. M o st ju risd ic tio n s do n o t allow
se lv es fro m th e risk o f litigation. I say
fu tile , b e c a u se as soon as th ey take
a tto rn ey s to tell ju rie s ab o u t insurance,
b u t th e p la in tiffs’ law yers usually are
able to c o n v ey th at in fo rm a tio n to the
one a p p e a rs on the ho rizo n . T here is no
e n d to th e w a y s p e o p le can g et th em ­
se lv es in to tro u b le, a n d as long as the
c o u rts allo w them to b lam e so m eo n e
else for th eir p ro b lem s, th ey w ill do it.
F o r th e ir p a rt, the p lain tiffs refuse
to a ssu m e th e re sp o n sib ility for their
a ctio n s. P e rh a p s the m o st c le a r ex am p le
is the to b a c c o litig atio n story. By 1960,
w h ile the in su ra n ce c o m p a n ie s have the
F o r th eir part, ju rie s in general tend
to retu rn v e rdicts, o r larg e r verdicts,
again st d efen d an ts w ho h ave insur­
m e a su re s a g ain st one threat, a n o th e r
a c c o rd in g to his a b ilities, to everyone
ab ility to pay.
A s I h a v e sta te d p rev io u sly , such
so c ialistic slo g an s h a v e the attraction
o f sim plicity. T h e y also h ave the flaw of
delusion. N e ed s h av e the un can n y trait
o f stretch in g w ith o u t lim it, w h ile abili­
tie s ten d to sh rin k as m o re a n d m ore is
e x p ected o f them . Such sy stem s are un­
jury. T hat results in larger co m p e n sa ­
tio n paym ents, w h ich in tu rn has an e f­
fect on liability insurance rates.
S om e argum ents favoring the d e ­
w o rk a b le. S om e p e o p le get o utsized
b en efits w hile the g o in g is good. Then
fense, such as the issu es o f c o n trib u ­
the sy stem c o lla p ses, b e ca u se it is un­
su sta in ab le in the lo n g run. W h en that
tory' n e g lig e n ce and the a ssu m p tio n o f
risk by th e p lain tiff, h ave w e ak e n e d
ov e r tim e. In practice, th ey have been
h ap p en s, e v ery b o d y su ffers, including
th o se w ho b e n efite d fro m it w hile it
lasted . ■
a lm o st c o m p le te ly disregarded. A s a re­
th ere w as e n o u g h m edical e v id en ce to
su sp e c t th at c ig a rette sm o k in g can
cau se lu n g cancer. In 1964, T h e Sur­
geon G eneral o rd e re d all p a ck s o f c ig a ­
re ttes to c a riy a w a rn in g a bout the
h e alth h a za rd s o f sm o k in g . E v en before
th a t c ig a rettes w ere called co ffin nails.
rauelerS
T h ere is n o b o d y in this c o u n try w ho
d oes n o t k n o w th at sm o k in g can cause
L
H e a lth
d ise a se .
M e th o d s to help p e o p le qu it have
b e en aro u n d for decades. O n e o f the
m o st e ffe c tiv e p ro g ram s, w ith o u t the
u se o f m ed ic atio n s, w as ru n b y the
A d v e n tis t C hurch. A p a rt from that,
n ic o tin e gum h a s been av ailab le for
tw e n ty y e ars and n ico tin e p a tc h es for
fifte en . Yet, re ce n t ju rie s a w ard e d b il­
lio n s o f d o lla rs to p lain tiffs w ho did n o t
avail th e m se lv e s o f the reso u rce s at
th e ir disp o sal to h e lp th em qu it a n d d e ­
v e lo p e d lung cancer. D id n ’t th ey have
12
P C M S BULLETIN
April, 2004
S e rv ic e
A service of
Northwest Medical Specialties, PLIC
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• PRE-TRAVEL CARE
HOURS
MON - FRI 9 - 5
• POST-TRAVEL CARE
CALL EARLY WHEN PLANNING
_____
ffS T l
253-428-8754
o r 253-627-4123
A S E R V IC E O F
IN F E C T IO N S L IM IT E D P S
2 2 0 - 15lh A v e S E # B , P u yallu p W A 9 8 3 7 2
'cP/'e/c<? 'ifjo tm ly c y U e c lin tl (P fo tie ly
Continuing Medical Education
COLLEGE
OF
MEDICAL
EDUCATION
Allergy, Asthma and Pulmonlogy
CME for Primary Care - April 30
T his y e a r’s course w ill focus on
R egistration fo r this y e a r’s CM E
program focusing on subjects on al­
the follow ing:
lergy, asthm a & p ulm onology rem ains
• A n U pdate in the D iagnosis and
open for Friday, A pril 30 at St. Joseph
Women’s CME
Set for May 21
M edical Center. T he course is un d er the
M anagem ent o f Pneum onia
• C urrent C oncepts on A llergic R hinitis
M anagem ent
medical direction o f A lex M ihali, M D.
A p rogram b rochure w ith registra­
tion details w as m ailed in late M arch.
• A dvances in A sthm a M anagem ent:
• C urrent and Future S trategies in
T he one-day u p d ate is designed for the
Plans are nearing com pletion for
prim ary care pro v id er focusing on ad­
the College’s A dvances in W om en .V
vances ill the diagnosis and m anage­
Medicine CM E scheduled for M ay 21,
m ent o f com m on p ulm onary problem s
2004.
and w ill offer 6 C ategory 1 C M E credits.
M anaging C O PD
• T he C hanging L andscape o f A topic
D erm atitis T reatm ent
• N ew Em erging Role o fS m all A irw ays
in the T reatm ent o f A sthm a ■
Recognized w om en’s health e x ­
perts will lead this one-day p rogram di­
rected by John Lenihan, M D that will
Dates
Program
Director(s)
C M E at H a w a ii
M a rk C ra d d o c k , M D
address a variety o f tim ely subjects
relative to contem porary m edicine for
M o n d a y -F rid a y
women. Designed for the prim ary care
A p ril 12-16
physician, this C ategory I C M E p ro ­
gram will feature issues related to diag ­
nosis and treatm ent advances in treat­
A llerg y , A s th m a &
F rid a y , A p ril 30
A le x M ih a li, M D
P rim a ry C a re
ing illness in women.
A course brochure w ith program
topics and details for registration will
P u lm o n o lo g y fo r
F rid a y , M a y 21
A d v a n c e s in W o m e n 's
M e d ic in e
Jo h n L e n ih a n , Jr., M D
be mailed in late April.
Topics under consideration for this
very popular program include:
MEDICAL LICENSURE ISSUES
•
W omen’s D epression
•
A lzheim er’s/Speet S canning
•
Ovarian C ancer
•
ICS/Pelvic Pain
•
Sleep D isorder
•
C ontraception
•
O steoporosis
•
HRT U pdate
•
Access to W om en’s C are
As usual, the course w ill qualify
for at least 7 C ategory I C M E credits.
The conference will be held at St. Jo ­
seph Hospital’s L agerquist C onference
M r. R ockw ell is available to represent physicians and o th er health care
providers w ith issues o f concern before the State M cdical Q uality A ssurance
C om m ission. M r. R ockw ell, appointed by G overnor Booth G ardner, served for
8 years as the Public B oard M em ber o f the M edical D isciplinary B oard from
1985-1993. Since then, Mr. R ockw ell has successfully represented over 60
phy sician s on charges before the M Q A C . Mr. R o c k w e ll's fees are com petitive
and the subject o f a confidential attorney-client representation agreem ent.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(425)453-4398 • FAX (425) 453-1534
email: [email protected] • website: www.gregrockwelllaw.com
Center-Room s 1 A & B . ■
April, 2004
PCMS BULLETIN
13
B
u l l e t in
Ifl -hly Opinion
o p n it n s e x p r e s s e d
in
by Daisy Puracal, MD
t h is m i t in g a r e s o le ly (h o s e o j (h e a u t h o r. P C 'M S in v ite s m e m b e rs to e x p re s s t h e ir o p in io n /in s ig h t s a b o u t s u b je c t s
t l c \ a n t ti> the i n n / k u f c o m m u n ity , 01 s h a r e t h e ir g e n e r a l in te re s t s to r ie s . S u b m is s io n s a r e s u b je c t to E d it o r ia l C o m m itt e e rev ie w .
Rituals and Bowls
D a isv Pitrcicul. hh0
1 c u p m y h a n d s into the sh ap e o f
spires all m an n e r o f bo w ls — the
M a n y th o u g h th ere he
a bow l a n d feel the cool c le a r w ater
soup a n d salad bow ls, the chalice, the
W ho w ith w o rd s o r eve n hands
from the fau cet run o v e r m y fingers.
g o b let and the tea bow l. A h, the tea
K n o w • the w av o f tea
W ater is life, so o th in g , c le an sin g and
b o w l - that is indeed sac ro san c t w ith
F ew th ere a re o r n o n e a t atI
re fre sh in g . Its so ftn e ss b e lie s the
its association to the Jap an ese tea
W ho c a n se rv e it fr o m the heart
s tre n g th and v io len ce it can w reak, as
cerem ony. A sim p le o rdinary d aily a c ­
in to rn ad o e s. 1 lift m y c u p p ed h an d s
tivity like b athing, w alk in g or d rinking
Sen R ikyu
a n d sp lash the stim u la tin g w a te r over
tea can be b ro u g h t to the lev el o f
m y sle ep y face — a c h illy brace to
ritual and a w ay o f life. I co u ld c o m ­
tual circle— ju s t th e fo u r o f us. A nn
sta rt the fresh n ew day. 1 b e n d o ver
pare it to b re ak in g o f bread a n d d rin k ­
m ad e sure that the w a te r b o ile d ju s t right.
a n d fill m y m o u th w ith w a ter from this
ing o f chalice w ine at the co m m u n io n
P o w d ere d tea w as p la c e d in each tea
m a k e sh ift c o n ta in er a n d rin se m y
table except for the religious a sso c ia ­
b o w l one a t a tim e and d isso lv e d in the
m o u th . A n o rd in a ry d a ily ritual - these
tions that no lo n g er holds true for m e.
ste am in g w a te r w ith p u rp o se fu l whisks
a b lu tio n s o f the m o rn in g . B ut yet, it
T h e Tea C erem ony as tau g h t by
We h a d a tea c e re m o n y in our spiri­
o f a b am b o o b rush.
se ts th e to n e fo r m y day. 1 am alone. I
Sen R ikyu is an e xpression o f H a r­
h a v e tim e to think. I d o n ’t g en erally
m ony, R everence, P urity and C alm .
W hen y o u h e a r the sp la sh
b la s t the rad io in the sh o w e r - that
S om eone asked R ikyu w hat the M y s­
O j the w a te r d ro p s th a t fa ll
teries ol'T ea w ere. To w hich he re­
In to the sto n e b o w l
w o u ld
ju s t j a r m y se n se s like the
sq u a b b lin g cro w s in sum m er. T he
plied, ’’You place the charcoal so that
You w ill f e e l th a t a ll th e du st
sou n d o f the ru n n in g w a ter is calm ing
the w ater boils properly, and you
O j y o u r m in d is w a s h e d a w a y
and inviting. I stretch m y n ak ed arm s
m ake the tea to bring out the proper
o u t to the w arm , d e lic io u s sp ray from
taste. Y ou arrange the flow ers, as
the sh o w e r h e a d a n d c av o rt in its re­
they ap p ear w hen they are grow ing.
v e rb e ra tin g stream . I lath e r up w ith
In su m m er y o u sug g est co o ln ess and
one w ith “ ev ery c o n sid e ra tio n .” W e cup
in w in ter coziness. T here is no o th er
o u r hands aro u n d the w a rm bow l and sip.
s o ft
fra g ra n t so a p y suds. M m m m m !! I
S en R ikyu
T he tea b o w ls w ere set before each
lo v e the feel o f a c lean sh o w er in the
se c re t.” In ad dition acco rd in g to
We are o f one p u ip o se a n d m in d - con­
m o rn in g and this little sacied tim e to
Soshitsu Sen, “You give those w ith
n ected b y this sim p le a ct - o u r circle
w hom y o u find y o u rse lf ev ery c o n ­
m ad e sacred b y p re se n c e a n d intent.
m yself.
T h e c u p p ed h a n d s - t h e very first
re ce p ta c le that m an k in d e v er used.
T h e sh a p e o f the c u p p ed h ands in ­
14
P C M S BULLETIN
April, 2004
sid e ratio n .” Such eloquence - give
Im ag in e all o f life b e in g experienced
those w ith w hom y o u find y o u rse lf
in th is m a n n e r - to sa v o r each m om ent
ev ery c o n sid e ra tio n !!
w ith g ratitu d e and re v ere n ce . ■
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PCMS BULLETIN
15
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16
P C M S BULLETIN
April, 2004
May, 2004
PCMS physicians
enjoy CME
in Hawaii
Dr. Jack Stewart and fam ily, l-r, d a u g h ter Lia, w ife
Therese and daughter Carly, enjoy the sun a n d beautiful
grounds o fth e H yatt R eg e n cy K auai
Inside:
Your practice can play a very important
role in ensuring clean indoor air in
Washington State. Initiative 1-890
needs 270,000 signatures.
D etails see page 4
The Dr. D rew D eutsch fa m ily, l-r, d a u g h ter H anna, w ife R ebecca
Sm art, a n d d a u g h ter M olly, a n ticipate m uch fu n in H a w a ii on the
isla n d o f Kauai. The P o ip u beach is in the ba ckg ro u n d
INSIDE:
3
4
5
7
8
9
13
P r e s i d e n t ’s P a g e : “ T a k in g t h e I n i t i a t i v e ” b y M ic h a e l K e l l y , M D
C le a n I n d o o r A i r I n i t i a t i v e - W e n e e d y o u r h e lp !
I n M y O p i n i o n : “ B u t A t L e a s t I T r ie d ” b y R i c h a r d W a l t m a n , M D
T P C H D : “ M R S A 2 0 0 4 ” F e d e r ic o C r u z - U r ib e , M D
In M y O p in io n : “ D r. A n d e r s o n T h e H e r o ” by F r a n c e s a
In M y O p in io n : “ P r o m is e s a n d R e s u lt s ” b y A n d r e w S ta ts o n , M D
In M e m o r ia m : G e o r g e K u n z , M D & W illia m W r ig h t , M D
B
u l l e t in
P C M S O ffic e r s /T r u s te e s :
M ic h a e l J . K e lly , M D , P r e s id e n t
P a tr ic k J . H o g a n , D O , P r e s id e n t E le c t
K -e n n e th A . F e u c h t, M D , V icc-I 're s id e n t
J o s e p h W . R e g im b a l, M D , T re a s u r e r
S u m n e r L . S c h o e n ik e .M D , S e c r e ta iy
J. J a m e s R o o k s , Jr.,IM D , P a s t P re s id e n t
L a u r e l R . H a r ris , M D
J e ff re y L . N a c h t.M D
J o s e p h F. J a s p e r , M D
N a v d e e p S. R a i, M D
R o n a ld R .M o r r is ,M D
C a rl W . W u lf e s tie g ,M D
May, 2004
P C M S M e m b e r s h i p B e n e f i t s , I n c ( M B I):
T i m S c h u b e r t , M D , P r e s id e n t ; D r e w D e u ts c h ,
M D , P a s tP r e s id e n t; J o e R eg i m b a l.M D , S ecretaryT re a s u r e r; K e ith D e m itjia n , M D ; S te v e D u n c a n , M D ;
M a r k G ild e n h a r , M D ; S te v e S e ttle , M D ; J o e W e a m . M D
C o lle g e o f M e d ic a l E d u c a t io n ( C .O .M .E .) :
J o h n J i g a n t i , M D P r e s id e n t ; B a r b a r a F o x , M D ,
W illia m H o ld e r m a n .M D , S te v e K o n ie e k .M D , M a tjo rie
K j'a b b e , M D , W illia m L e e , M D , Ciregg O stergren, D O ,
B r a d P a ttis o n .M D .C e c il S n o d g ra s s , M D , V irg in ia
S to w e ll,M D , R ic h a rd W a ltm a n .M D . T o d W u rst, M D ;
H e n a M a le ik e , G o o d S a m a rita n H o s p ita l; L is a W h ite ,
M u ltic a r e I- le a lth S y s te m ; S is te r A n n M c N a m a ra ,
T r e a s u r e r , F ra n c is c a n H e a lth S y s te m ; S u e A s h e r,
S e c re ta ry
P C M S F o u n d a tio n : L a w r e n c e A .
L a r s o n , D O , P r e s id e n t ; C h a r l e s W e a t h e r b y , M D ,
M o n a B a g h d a d i. N ik k i C ro w le y , T re a s u re r; S u e A sh e r,
S e c re ta ry
W SM A
R e p r e s e n ta tiv e s :
T ru s te e s ; L e o n a rd A lc n ie k ,]V lD ;N ic h o la s R a ja c ic h , M D ;
P a tric e S te v e n s o n , M D
W A M P A C 6 th D is tr ic t; I )o n R u s se ll.D O
W A M P A C 9 th D is tr ic t; L e o n a rd A le n ic k .M D
S ta f f : E x e c u t i v e D i r e c t o r ; S u e A s h e r
A d m in is tra liv e A s sista n ts: T a n y a M c C la in , C risii P eterso n
P la c e m e n tC o o rd in a to r; K e n S m ith
P la c e m e n t A s sista n t: M e lis sa K re g n e ss
C M E P ro g ra m A d m in istra to r: L es M c C a llu m
B o o k k e e p e r: J u a n ita I lo frn e istc r
T h e B u lle t in is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits. Inc. D e a d lin e for su b m ittin g articles
an d p la c in g a d v e rtis e m e n ts is th e I 5 th o l'th e m onth
p reced i n g p u b lic a lio n .
T h e B u lle t in is d e d ic a te d lo the art, sc ie n c e a n d d e liv e ry
o f m e d ic in e an d th e b e tte rm e n t o f t h e health and m ed ical
w e lfa re o f t h e co m m u n ity . T h e o p in io n s h e re in arc th o se o f
th e in d iv id u a l c o n trib u to rs and do n o tn e c e s s a rily re fle c t th e
o ffic ia l p o sitio n o f P C M S . A c c e p ta n c e o l'a d v e rtisin g in no
w a y c o n s titu te s p ro fe ssio n a l a p p ro v a l o r e n d o rse m e n t o f
p ro d u c ts o r s e rv ic e s a d v e rtise d . T h e B u lletin re se rv e s the
rig h t to re je c t a n y a d v e rtisin g .
M a n a g i n g E d i t o r : Sue A sher
E d i t o r i a l C o m m i t t e e : M B I B o a rd o f D ir e c to r s
A d v ertisin g In fo rm a tio n : 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; F A X : 2 5 3 -5 7 2 -2 4 7 0
E -m a il a d d ress: p c m s w a @ p c m s w a .o rg
H o m e Page: h ttp ://w w w .p c m sw a .o rg
2 P C M S BULLETIN
May, 2004
Table o f Contents
3
P re sid e n t’s P age: “ T ak in g th e In itia tiv e "
4
B re ath e E asy, W ash in g to n 1-890 W o rk p lace C lean
In d o o r A ir Initiative
5
In M y O pinion: “ B u t A t L east I T rie d ”
7
T PCH D : “M R S A 2004"
8
In M y O pinion: “ Dr. A n d e rso n T h e H e ro "
9
In M y O pinion: “P ro m ise s and R e su lts”
10
A p p lica n ts for M em b ersh ip
11
R etired m em bers gather
13
In M em oriam : G eorge K unz, M D
13
In M em oriam : W illiam W right. M D
15
C M E at H aw aii includes ed u ca tio n , fam ily a n d sun
17
C ollege o f M ed ical E ducation
19
C lassified A d v e rtisin g
r ifp n ii/i/ r l l r i h n i l t f o n e h f
President s Page
by Michael J. Kelly, M D
Talcing the Initiative
"P ic k battles big enough to matter, sm a ll enough to win. "
-Jo n a th a n K ozol
There are m any things w hich do
not go together. Seem s reform o f the
tort system and legislative action in
that regard is one exam ple. For the past
two years, the dem ocratic leadership,
with the able accom panim ent o f the
chair o f the house ju d iciary com m ittee,
has killed m eaningful liability reform . Is
there an alternative to this legislative
madness?
Yes there is. It is an alternative
well known to Tim E ym an and others
dissatisfied with legislative inertia. It is
the initiative process.
In political term inology, the initia­
tive is a process that enables citizens
to bypass their state legislature by
placing proposed statutes, and in som e
states constitutional am endm ents (not
Washington) on the ballot. T he first
state to adopt the initiative w as South
Dakota in 1898 - the m ost recent, M is­
sissippi in 1992. T here are tw en ty -fo u r
states with an initiative process.
There are tw o types o f initiatives:
direct and indirect. In the direct, or ini­
tiative to the people, petition sig n a­
tures must be Filed no less than four
months before a general election, or by
July 2,2004 this year. T he indirect ini­
tiative, or initiative to the legislature,
petition signatures m u st be filed no
less than ten days before the next
regular session o f the legislature, or by
December 31,2004.
It is the initiative to the legislature
which seems to m ake sense. T he lead­
ership o f the PC M S, the W SM A and
the presidents o f all the sta te ’s county
medical societies discussed this and
other tort reform options at a recent
meeting on A pril 21. T he discussion o f
these options has been going on for
m any m onths. T he consensus favored
the initiative to the legislature not only
because o f the longer period to acquire
signatures, but also because o f the
strict requirem ents it places on the leg­
islature. O nce subm itted, the legislature
m ust take one o f the follow ing three ac­
tions:
• T he legislature can adopt the ini­
tiative as proposed, in w hich case it b e ­
com es law w ithout a vote o f the people;
or
• T he legislature can reject or
refuse to act on the proposed initiative,
in w hich case the unm odified initiative
m ust be placed on the ballot at the next
state general election the follow ing N o­
vem ber; or
• T he legislature can approve an
am ended version o f the proposed initia­
tive, in w hich case both the am ended
and original proposal m ust be p laced on
the next g eneral election.
T he initiative actively constrains
the legislature, dictating few options
and guaranteeing the public debate and
vote w c have been denied these last
tw o years in the legislature.
To certify an initiative, to the
people or to the legislature, the sponsor
m ust circulate the com plete text oi'the
proposal am ong voters and obtain ap­
proxim ately 200,000 signatures.
T his is a blueprint for success! T he
physicians o f this state, fed up w ith the
persisten t failures o f the legislature,
given a creative alternative, w ill find the
g a thering o f signatures a therapeutic
exercise o f self-help. T he fact that we
Michael J. Kelly, MD
have until D ecem ber 31 further e n ­
hances our chances.
M any initiative signatures are ac ­
quired through the w ork o f paid sig n a­
ture gatherers. I contend we have such
a stake in this battle that p aying others
to gather signatures fo r us, to secure
our future, w ill not be necessary. T his is
our battle, not th at o f a m ercenary.
T he exact w ord in g o f the initiative
is a w ork in progress. It will contain the
sam e b asic elem ents present in senate
bill 5728 th at passed the senate earlier
this year only to be ignored to death in
the house.
You m ay w onder, once passed, how
vulnerable is the new statute? It w ould
take a tw o-thirds vote o f both houses o f
the W ashington legislature to repeal or
am end an initiative. A fter tw o years, a
m ajority vote is required to repeal or
amend.
D oes this m ean w e are abandoning
our fight to change the faces in the leg ­
islature? N o t at all. A s 1 m entioned in
the last B u lle tin , w e will be annou n cin g
plans in the n ear future that w ill target
specific districts w here w e feel w e can
e ile c tiv e ly elect a legislator supportive
o f m eaningful liability reform . Your
board o f d irectors is w orking h ard to
form ulate these p lans and w ill co m m u n i­
cate them to you at the p ro p e r tim e.
We are excited a bout the chances
for change this fall. W ith these new'
strategies and y o u r supportive action, I
know w e w ill succeed. Stay tuned to
this station for fu rth er bulletins... ■
May, 2004
PCMS BULLETIN 3
Breathe Easy, Washington
1-890 Workplace Clean Indoor Air Initiative
Medical and Dental Practices 1-890 Signature Gathering Process
Y our p ra ctice can p lay an im p ortan t p art in reducing the
e ffe c ts ol se c o n d h a n d sm o k e b y g a th e r in g sign atu res to su p ­
p ort th e 1-890 W ork p lace C lean In d oor A ir Initiative. 1-890
w ill p ro v id e sm o k e -fre e w o rk p la ce s fo r all w o rk e rs in W ashing­
to n S ta te b y b a n n in g sm o k in g in all in d o o r p u b lic places.
m u st su b m it 197,734 v a lid sig n a tu re s to th e S e c re ta ry o f State
no late r th an Ju ly 2 ,2 0 0 4 . G iv e n h isto ric sig n a tu re v alidity
rates th e c am p aig n g o a l is to c o lle c t 2 7 0 ,0 0 0 sig n a tu re s in or­
d e r to insure th a t 197,734 v a lid sig n a tu re s a re su b m itted .
T h e W ashington S tate M e d ic a l a n d W ash in g to n State
W o rk ers a n d p a tro n s o f re sta u ra n ts, bars, tav e rn s, b o w lin g a l­
ley s a n d o th e r p u b lic p lac es w ill n o lo n g e r be e x p o se d to the
m ed ic al a n d dental p ra ctic e s to c o lle c t e n o u g h sig n a tu re s to
to x ic e ffe c ts o f se c o n d h a n d sm oke.
put 1-890 on the N o v e m b e r 2 ,2 0 0 4 ballot.
D ental A sso c ia tio n s h av e e n d o rse d 1-890. It is p o ssib le for
In o rd e r to b e p la c e d on th e N o v e m b e r 2. 2 0 0 4 b a llo t w e
Campaign Strategy
B rea th e E a sy W ash in gton w ill:
Goals:
• P ro v id e 1-890 p e titio n s
• 1,000 p h y sic ia n s and 1,000 d e n tists a n d th e ir s ta f f actively
p a rtic ip a te in c o lle c tin g sig n a tu re s
• E ach ph y sician a n d d e n tist p ra ctic e c o lle c ts a m in im u m of
300 sig n a tu re s (15 p e titio n s @ 20 sig n a tu re s p e r p etition)
• P ro v id e c a m p a ig n lite ratu re
• P ro v id e o n g o in g tec h n ica l ex p ertise and sup p o rt
M ed ic a l and den tal p ractices will:
• Id e n tify a “ c h a m p io n ' w ho w ill be resp o n sib le for the 1-890
sig n a tu re g a th e rin g p ro c ess fo r th e ir p ra ctic e
• P la c e p e titio n s in c le arly v isib le p u b lic p lac es (i.e., front
c o u n te r, w a itin g room , etc.)
• T ra in s ta f f to ask p e o p le to sign the p etitio n
• M a k e su re th a t 1-890 p e titio n s are easily a cc esse d (not lost
in th e sh u ffle o f b u sin e ss, not co v ere d up w ith o th er
m ate ria ls)
• R e tu rn /m a il th e 1-890 p e titio n s rig h t aw ay or call the M e d i­
cal S o c iety o ffice to pick up (57 2 -3 6 6 7 ). D o n o t w ait to send
th em all at o n ce (th e p e titio n s are self-m ailers)
• A ll p e titio n s su b m itted to the B re ath e E asy W ashington
office n o later than Ju n e 25, 200 4 . D o n o t w a it to su b m it the
p e titio n s all at once. O n c e a p etitio n is full (2 0 signatures)
su b m it it rig h t aw ay
T im elines:
• Ju n e 25, 2 0 0 4 - last day to m ail p e titio n s to B re a th e Easy
W ashington
• June 28, 2 0 0 4 - last d a y to hand d e liv e r p e titio n s to the
Pierce County' M edical S ociety office o r B re a th e E asy
W ashington
• Ju ly 2 ,2 0 0 4 - 2 7 0 ,0 0 0 sig n a tu re s d e liv e re d to the Secretary
o f State
-1 -8 9 0 p e titio n s m ay be d o w n lo a d ed a n d p rin te d from the
K ey points:
• S e v e ral factors are critical to the su c c ess o f the 1-890
c am p a ig n :
- P h v sic ia n s a n d d e n tists p erso n ally ask in g theii clients to
sig n th e 1-890 p e titio n
- M ed ical and dental sta ff train ed to c o n sisten tly ask
p a tie n ts to sign the p e titio n (p rovide re w ard s/in c en tiv es
to staff)
- O ffice m a n a g e rs and su p e rv iso rs are su p p o rtiv e o f front
o ffice s ta f f in th e sig n a tu re g a th e rin g process. F ront desk
s ta f f play a vital ro le and n e ed to be sup p o rted and m o ti­
v ated to ask c lie n ts to sign the petitions.
- T h e S e c re ta ry o f S ta te ’s office has con firm ed that sig n a ­
ture g a th e rers do n o t have to be re g iste red voteis and
there°is n o a g e re stric tio n fo r sig n atu re g atherers. A n y o n e
w eb site w w w .B re a th e E asy W a .o rg in th e to o lk it area o r by
co n ta ctin g the B re ath E asy W A office o r the P ierce
C ounty M edical S ociety
-1 -8 9 0 in fo rm atio n , freq u en tly asked q u e stio n s, w h y
sup p o rt 1-890, a n d o th er in fo rm a tio n is a v a ila b le from
the w eb site to o lk it
P h ysician s, den tists and their sta ff can p u t 1-890 on the
N ovem b er 2 ,2 0 0 4 Ballot!!!!! T h an k you for y o u r help.
B reathe Easy, W ashington!
PO B ox I I 324, T acom a WA 98411 -0324
253-383-7744
O r call P ierce C ou n ty M ed ic a l S o ciety
2 5 3 -5 7 2 -3 6 6 7
w h o sig n s the p e titio n m u st be a re g iste red voter, h o w ­
w w w .B reatheE asyW a.org
ever.
4
P C M S BULLETIN
May, 2004
-P /o rt' ff (‘im /if Q l le d t c a /r focc-t'if
In My Opinion
by Richard W altm an.M D
The opinions e x p r e s s e d in th is w r itin g a r e s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b e rs to e x p re ss th e ir o p in io n ^ in s ig h ts a b o u t s u b je c ts
relevant to the m e d ic a l com m un ity, o r s h a re t h e ir g e n e r a l in te re st sto rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
But At Least I Tried
It started out as a typical Friday.
Lots o f follow -up appointm ents, a few
annual physical exam s. Som e add-ons,
people who had put up w ith rashes and
coughs all w eek but d id n ’t w ant to be
sick over the w eekend. But in the a fte r­
noon things began to get interesting.
A new patient at I PM , a Mr.
George Herm an Ruth. Mr. R uth w as a
stocky 32 year-old m an w ho described
himself as “ju st an old b allplayer p a ss­
ing through tow n.” H is co m plaint w as
cough and congestion, and he ac ­
knowledged he w as a heavy sm oker,
well over two packs a day. O n exam he
had a rather severe acute bronchitis,
but he also had evidence o f early
COPD. I gave Mr. Ruth som e antibiotics
and an expectorant for the bronchitis,
but I also talked to him a bout sm oking
cessation. I told him w hat w e had
learned about the harm ful effects o f
smoking and indicated to him som e
newer methods for cessation. 1 dis­
cussed the benefits o f stopping for an
athletic young m an like him. H e indi­
cated he had a chronic cough and was
“huffing and puffing around the bases
when I hit one out.” Fie agreed it w as
time to stop. We outlined a cessation
program, and I gave him som e gum and
patch samples, “i ’m going to do it,
doc,” Mr. R uth said. “A nd k eep an eye
on the newspapers. T he B abe has a few
more dingers left to hit o u t.” 1 sm iled.
“And thanks,” he said. “N o m o re sm o k ­
ing for me. T hanks a lot.” H e p o k e d m e
in the arm and left.
The Babe, how strange, I thought,
but before 1 could think v e ry long I
h eard “ A nother new patient in 2 .”
T he nam e on the chart w as Baker,
N o n n a Jean. In the exam room 1 found a
very attractive, very anxious young
w om an. She told m e that she w as an ac ­
tress. She said that p eople w ere ex p ect­
ing too m uch o f her and m aking too
m any dem ands on her. “ Pose w ith this
director, go lo that party, try this hairdo,
w e ar this outfit. I ju s t d o n 't have any
tim e for m yself,” she said. She told m e
th at she w as using pills to get to sleep
at n ig h t and o ther pills to w ake up in
the m orning. She had pills to lose
w eight, pills to relax, pills to pay atten­
tion. “ I ju s t w anted to be in the m o v ­
ies,” she said. “I n ev er expected all o f
th is.” A nd she started to cry, M s. B aker
w as obviously very depressed.
We talked about depression and
ho w life events can initiate changes in
b rain chem istry. We talked about the
dangers o f taking so m any pills a n d the
n eed for her to get som e counseling
and begin anti-depressant m edication.
She w as very excited to hear that there
w ere n e w er m edications and m ethods
that could be done to m ake her feel b el­
ter. She really opened up, and w e had a
g reat talk about her fears, her w orries,
and her dream s. I gave her a p rescrip­
tion for one o f the SSR1 agents and the
n am e o f a very good counselor. O ne o f
m y nurses called and m ade her first a p ­
pointm ent. She thanked m e fo r listening
to her - “ m ost peo p le d o n ’t," she said.
She told me she felt m uch better and
w as going to “ get better.” She kissed
m e on the cheek and said, “Tell your
w ife that M arilyn M onroe kissed you
R ichard Wahman. M D
today.” A nd then she w as gone.
M arilyn M onroe, I thought. How
odd. B ut as 1 felt w here she had kissed
m e, m y nurse said “ A nother ballplayer,
in 3.”
T he nam e on his chart w as M antle,
M ickey C harles. H e too w as a baseball
player, but a m uch y o u n g e r one. He
w as play in g his first season in the M a ­
jors. “ Som e people call m e the next Joe
D iM ag g io ,” he said “but m y favorite
p lay er has alw ays been B abe R uth.”
“ M ine to o ,” I told him . H is co m plaint
w as an u p set stom ach, and as 1 took a
history it w as easy to see why. Mr.
M antle w as eating poorly, taking too
m uch A spirin, and c onsum ing too m uch
alcohol.
I talked w ith him about im proving
his diet and about the dam ag in g effects
o f alcohol on the liver. H e told m e that
he really d id n ’t enjoy drin k in g and had
started w hen he got to N e w York “ b e ­
cause all the o th er players d id .” We
talked about p eer pressure, about being
strong enough lo say no. and a bout the
need to stay healthy i f he w an ted a suc­
cessful career. "Y o u ’re right, doc.” he
said, “I can do w ithout the booze. From
now' on it’s ice tea for m e - lo n g balls,
not hig h b alls.” I gave h im som e Z antac
sam ples and said w e w o u ld do an e n d o ­
scopy i f his sym ptom s did not resolve.
1 gave him a phone n um ber for A A a n d
en couraged him to con tact them o r to
See “Tried’' page 6
May, 2004
PCM S BULLETIN
5
1 1 1 C LL
from p a g e 5
c all m e it h e e v e r fe lt h e n e e d e d a p e p
m ak e sen se o f w h a t h a d h a p p e n e d to
o v e rd o se o f sle e p in g p ills. S he w as 36.
talk. " I ’m O K n o w ,” h e said, “M a y b e
m e th at p re v io u s ly typ ical F rid a y a fte r­
noon.
liv e r d ise a se a t 63. A n d Jo h n F.
so m e d a y th e y 'll b e ta lk in g a b o u t ‘the
n e x t M ic k e y M a n tle ,’ w h o k n o w s .” He
M ic k ey M a n tle d ied in 1995 o f alcoholic
1 got h om e and ru sh e d in to tell m y
w ife. “ R u th ,” I said, “ I th in k I sav ed the
K e n n e d y w a s a ssa ss in a te d on th at trip
sla p p e d m e o n th e b a c k a n d w a s gone.
M ic k e y M a n tle , I th o u g h t, M ic k ey
lives o f fo u r peo p le this afte rn o o n . F o u r
R ick . Y ou c a n ’t sa v e e v e ry o n e .”
in 1963. H e w a s 4 6. You d id y o u r best,
M a n tle , a n d I w e n t into m y o ffice to
im p o rta n t p e o p le .” A n d I told h e r a bout
d ic ta te n o te s on th e se th ree re m a rk a b le
th ese a m a z in g and u n e x p ec te d p a tie n ts,
fell out o f m y e y es a n d ran o v e r m y
p a tie n ts. B ut b e fo re I c o u ld start, m y
w h at th ey w an ted , w h at I had told
th em , w h at th ey w ere g o in g to do. She
“ Y ou c a n ’t sa v e e v e r y b o d y ...” She was
sm iled. “ I ’m sure y o u d id a g reat jo b for
rig h t o f c o u rse, as usual. T h en 1
all o f y o u r p a tie n ts today, darling,
b u t ...”
h u g g e d h e r b a c k and n o d d e d m y head.
n u rse p o k e d h e r h e a d in: “ O n e m o re
n e w one, ro o m tw o a g ain , th e n w e go
h o m e .”
1 e n te re d ro o m tw o a n d fo u n d m y ­
s e lf fa ce -to -fa ce w ith John F itzg e rald
K en n ed y . "M r. P re sid e n t,” I sta m m e red ,
“B u t w h a t? ” I interru p ted .
" w h a t b rin g s y o u to m y o ffic e ? ” "G o in g
“ Y o u ’ve told m e th at so m etim es
e v en the b e st d o c to r c a n ’t save every
on a c a m p a ig n trip ,” he said, " a n d 1
n e ed so m e th in g to settle m y stom ach.
patien t and th at so m e tim es even y o u r
best is not en o u g h . R ight?"
W ould y o u b e lie v e a fte r so lo n g I still
g et s ic k o n p la n e s ? ” We ta lk e d a bout
the stre ss o f h is jo b a n d the d iffic u lt
tim e s w e fa ce d as a natio n . I to ld him I
w as se e in g lots o f very an g ry folks in
the o ffice , p e o p le w ho had started
fights, p e o p le w h o w ere ru d e, p eo p le
“ So? " I asked.
“ B abe R uth died in 1948 o f throat
c an c er c au sed by sm oking. H e w as 53.
M arilyn M o n ro e died in 1962 o f an
She sm ile d a n d h u g g e d m e. Tears
face. I had failed . I p o n d e re d h e r words:
A n d th en 1 said m y fa v o rite line from
m y favorite m ovie:
“B u t I trie d , d id n ’t 1 ? ...A t le a s tl
d id th a t.”
"Y es y o u d id ,” she said, “Yes you
did. A t least y o u did th a t.”
A nd I k n e w th en th a t th e next
M o n d a y I w o u ld pull in to th e hospital
p a rk in g lot at 6 in the m o rn in g and try
even harder, ju st like you. ■
FOR SALE OR LEASE
w h o w e re ta lk in g a b o u t v io le n t actio n s
a g a in st the g o v e rn m e n t. I told him w e
w e re n o w try in g to deal m o re e ffe c ­
290(1 s f with 2 private officcs, receptionist
area, sterilization, x-ray - development &
tiv e ly w ith ro a d rag e, spo u sal a n d child
a b u se , and ra n d o m acts o f v io len ce, I
g a v e P re sid e n t K e n n ed y so m e th in g for
darkroom, 7 exam rooms, 3 baths.
1400 sf with 2 offices & large open area.
a ir sic k n e ss, but 1ju s t felt I n eed e d to
say so m e th in g to him . “ Sir, a lot o f us
a re c o u n tin g o n y o u to really ch an g e
th in g s. T h ere are so m e folks out there
th at d o n ’t like y o u and w h at you stand
for. P ro m ise m e y o u ’ll b e very careful
on this trip . T ake g o o d care o f y o u r­
s e lf.” P re sid e n t K e n n ed y th an k ed m e
for m y kind w o rd s and said he w ould be
c arefu l. " J u s t for y ou, doctor. I’ll take
no c h a n c e s on th is trip .” We shook
h an d s, a n d the 3 5th P resident o f the
U n ited S ta te s w as gone.
I w e n t back to m y o ffice and
slu m p ed in to m y chair. “ S o m e o n e go
o v e r to S ta rb u c k s .” I y e lle d to the front
o ffice. “A fte r th is a fte rn o o n I n e ed a
d o u b le sh o t latte. A nd a c h o co late chip
c o o k ie .”
I fin ish e d m y c h arts, d ra n k m y
latte, ate h a lf o f the c o o k ie , m ad e h o sp i­
tal ro u n d s, and h e a d e d hom e, try in g to
6
P C M S BULLETIN
May, 2004
C all W ayne o r G raham e
Pacific R im Real E state G roup
6800 s.f. Medical Facility
253-988-4917oi-253-377-3056
MEDICAL LICENSURE ISSUES
Mr. R ockw ell is available to re p re se n t p h y sic ia n s and o th e r h e alth care
p roviders w ith issues o f concern b efo re the S tate M edical Q u a lity A ssurance
C o m m issio n . Mr. R ockw ell, a p p o in te d by G o v e rn o r B ooth G a rd n er, served for
8 years as the Public B oard M e m b er o f the M edical D iscip lin ary B oard from
1985-1993. Since then. M r. R ockw ell has su c c essfu lly re p re se n te d o v e r 60
physicians on c h a ise s bcloit. the M O A C . M i. R ockw ell s te e s are com petitive
and the subject ot a co n fid en tial a tto in ey -c lie n t re p re se n tatio n ag ree m e n t
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(425)453-4398 ® FAX (425) 453-1534
email: [email protected] ® website: www.gregrockwelllaw.com
,
(: ri l / l / l / ■? i ( ,’<h o t i r lo rn -/!j
Federico Cruz-Uribe, MD
D irector of Health
The Health Status of Pierce County
MRSA 2004
For m any years antibiotic resis­
c hange, w ith both providers and pa­
tance has risen in Pierce C ounty, a p h e ­
tients re -looking at how they utilize an ­
nomena w hich is not ju s t a local p h e ­
tibiotics. Patients need education about
nomenon, but a nationw ide trend. T he
the fact that not every infection needs
dangers o f resistant m icroorganism s are
(or responds to) an antibiotic, such as
straightforward: Increases in m orbidity
routine upper respiratory infections, e s­
and m ortality and, o f course, dram atic
pecially ear infections, w hich are p re ­
increases in treatm ent costs for re sis­
d om inantly viral. P atients need to stop
/•V i/tr/i'd
< ~ n tz .
;1 //.'*
How difficult w ould it be to gather
tant cases. Like other m edical ch al­
pressing providers to w rite out a pre­
and share inform ation? Even w ith all o f
lenges, when standard therapeutic a p ­
scription. In turn, providers need to a s­
the restrictions in place from H IPA A ,
proaches fail, extraordinary m easures to
sert good science-based decision m ak ­
setting up a registry for identified cases
treat common infections becom e neces­
ing, prescrib in g antibiotics only w hen
o f M R S A a nd/or o ther resistant o rg a n ­
sary.
really necessary. T h a t’s the p h y sic ia n ’s
ism s w ould b e allow ed, since the cases
role, w hich requires guiding c o n v ersa­
are potential threats to o u r com m unity.
So, has M RSA becom e a hot topic
in the m edical com m unity, at the top o f
tions w ith patients and som etim es even
O ther c hallenges then surface: C o lle c t­
everyone’s to-do list? U nfortunately,
saying "n o .”
ing the inform ation a n d then gettin g it
no. We do discuss this fairly regularly
T his addresses prevention o f drug
to providers in their practice settings.
but little concerted action has taken
resistance. Now, w hat about existing
Both o f these activities arc doable.
place. With all the nightm arish p ossi­
cases? S hould w e have a registry?
W ould the different h ospitals and lo n g ­
bilities o f resistant organism s ru n ­
term care facilities use this infor­
ning amok ill our com m unity,
m ation? W ould p roviders change
shouldn’t there be m ore o f a re­
treatm ent practices once they
sponse or a rising level o f con­
cern?
What do w e know about
MRSA (methicillin resistant staph
aureus)? Pierce C ounty providers
knew resistant organism s w ere
“The problem o f drug resistant infections
is going to continue and the numbers will
grow. Is it time to address this issue in our
community aggressively? ”
present in the patient?
All o f this paints an uncertain
future. We do know one fact: T he
problem o f drug resistant infec­
have been voluntarily reporting
tions is going to continue a n d the
MRSA since 2001. Statistics show
num bers w ill grow. Is it tim e to ad­
dress this issue in our c om m unity
the number o f cases increased
aggressively? Should w e system atically
from 659 in 2001 to 1144 in 2003. Local
S hould providers know w hen a patient,
hospitals reported the b ulk o f these
adm itted to a hospital or long-term care
identify the cases in our area and d e ­
cases and those data show the 40% o f
facility, harbors a drug resistant org an ­
velop standardized approaches for
isolates done in our hospital labs are
ism ? I f the p rovider w ere aw are o f an
care?
showing drug resistance. A t this point
existing drug resistant infection w ould
most of the cases are found in the e ld ­
this change how the p atient was treated
not ignore this problem . W e do have to
erly but there is a steady increase in the
or cared for by staff? My guess is that
confront it. We have som e sim ple tools
number o f cases in the 30-60 y e ar age
there are m any answ ers to these q u e s­
- reporting and a registry - but w e p ro b ­
range. The vast m ajority o f M R S A in­
tions. A nd, I think that in m any cases
ably need m ore. Please jo in m e in d ev el­
fections are in soft tissue sites.
the an sw er w ould be “ y es,” advanced
oping a new system fo r ad d ressin g a n ­
know ledge o f a p a tie n t’s status w ould
tibiotic resistance - b o th p revention
There are concrete steps w e can
I think the an sw e r is clear. W;e can ­
take to address drug resistance. T he
be helpful for best serving the p a tie n t’s
and containm ent. To do this, w e need a
most important involve b ehavior
needs and in p rotecting o th er patients.
new attitude about d rug resistance. ■
May, 2004
PCMS BULLETIN
7
B l I I 1 I IN
Ifl My Opinion
by Francesca
I h e u tm n n m v x p n - s w l in i l m . vritin j- a r e
a /< i
m i Iil hi. «//f ii/ <fw m n m h ,
,1,-Iy l l „ w o f th e in ilh n r I'l \IS
a/m/v ilwiT i'iv iir< //
m . m b . n l,. n (. ™
.s/nnt-v ,W>/mvw<i/n <i/v
//„„
m u *
wj/v- • f'
I to tutitnrial I W w /w /frr /'ru m :
Dr. Anderson The Hero
h ilih ir s
.\7tfiv The fo llo w in g essay m/.v w ritte n h r Ill- v e a r - o h l h'raneesea. the
ila n g th e r o f a s u rg e ry p a tie n t o / Ih : ( ie r a h ! Am lerson. Thttnk
s h a rin g y o u r s to ry
I tliink there arc a lot o f w ays to
show courage. One w ay is to do some­
thing you know is l ight ev en if you
aren't sure how other people w ill feel or
what they w ill think. I know somebody
that showed really awesome courage
that wav. Mis name is Dr. (G erald)
Anderson. I le is a surgeon in Tacoma
and he operated on my mom. I w ill tell
you how lie had to trust his own feel­
ings and not just my mom's tests.
When my mom w ent into surgery
the doctors were looking for one tumor
that showed on the tests. They though
it was so sm all that it would even be
hard to find, so before surgery they
used ultrasound to find it for Dr. Ander­
son. l ie didn't just look at the tests
though, he paid really close attention
w hen lie operated on my mom. I le
v d ii
Franeesea fo r
didn't worry if it took a long time or
w hat anyone else thought, lie just
cared about my mom.
I am so relieved my mom had the
surgeon she had, because there were
three more tumors besides the one that
showed on the tests. Dr. Anderson had
courage to go slow and look around
and not just do what the tests and the
other doctors told him to do. Dr. Ander­
son said. "M y hand guided me and I
knew I should look around." lie trusted
his feelings and did what lie thought
was the best thing to do.
When all four tumors got sent to
the lab there was shocking news. The
people in the lab called the operating
room and said there were two different
kinds o f tumors. The ones that did not
show 011 the tests were a different kind
v'auelev'S
/ ram e \i a
than the one that did.
Dr. Amlerson was shocked and
could not believe it. I le was so amazed
he w ent down to the lab him self to
glance at the tumors. Dr. Anderson saw
for him self that the lab was right, then
he changed the kind o f surgery lie was
doing on my mom. When he came to
the waiting room to tell our family. I re­
ally fell like he eared about my mom and
even about us. lie was so nice to us. I
think that it was hard for him to come
and tell us that she needed more sur­
gery. hut he did it anyway.
I am so glad Dr. Anderson found
those tumors so he could lake I hem all
out ol my 1110111. 1le saved my mom s life
and I think he is a hero. Dr. Anderson is
a great surgeon and I think he showed
a lot i)l courage through the whole
thing. One o f my biggest hopes is that
he w ill be a surgeon for a long lime so
he can save even more lives. ■
L
H e a lth
s erv ic e
serv ice of
N o rthw e st Medical specialties, P L i r
a
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• PRE-TRA VEL CARE
• PO ST-TRAVEL CARE
CALL EARLY WHEN PLANNING
HOURS
MO N - FRI 9 - 5
253-428-8754
|(m*i.
o r 253-627-4123
. N F E C T O N S L IM ITE D P S
8
P C M S B ULLETIN
May. 2004
2 2 0 - 15" 'Ave S E
«B.
Puyallup W A 9 8 3 7 2
T A C O M A / P I E K ( ] F, C O U N T Y
< >utpatienl ( General M e d ic a l d a re .
F till a n il p a r t - liin e p o sitio n s
a v a ila b le in I'acu m a a n d v ic in ity .
V e ry H exib le s c h e d u le . W e ll su ite d
lo r c a re e r re d e fin it io n lo r
( T . F l \ 1M .
Contact Andy Tsoi. M |) (253) 752-Ufifiy
"I Paul n,.ty lAllen. Nelson, Turner C-:
Assoc.). I .’lin ir M a n a g e r ( 253)
383-1351
'?/)<•,■ ir'ifc d iifif Q H f dii'ii i & o a < ’/i /
In My Opinion....
The Invisible Hand
by A ndrew statson,
md
The opinion s ex p r e s s e d in th is w ritin g a r e s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b e rs to e x p re ss th e ir o p im o n n n s ig lU s a b o u t s u b je c ts
relevant to the m e d ic a l com m un ity, o r s h a re t h e ir g e n e r a l in te rest s to rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
Promises and Results
" Ify o u w ant to h u rt som eone in A m erica, y o u m ay not he
able to do it with im p u n ity using a sc a lp el o r a car, but y o u
can do it w ith a law suit a n d no one w ill lav a g lo ve on y o u .
W alter O lson
At the birth o fth e tw entieth cen ­
tury, the practice o f m edicine inherited
the two m ajor developm ents o fth e
nineteenth, the discovery o f germ s and
the invention o f anesthesia. A rm ed w ith
carbolic acid and ether, w e continued in
the tradition o f our p rofession.
With full attention to their p ro b ­
lems and sym pathy for their suffering,
we gave encouragem ent and hope to
our patients, encouragem ent to keep
going and hope that their condition
might get better. Frequently, hope w as
all we could give them . It helped, even
when both we and the patients knew it
was a lie.
The last century brought about
drastic changes in the relationship b e ­
tween physicians and patients. M ed i­
cine made huge strides during that tim e,
but so did the law. The law yers put the
first blot on our profession by ham p er­
ing our ability to express com passion.
We could no longer tell patients
that they w ould be fine. T hat re p re ­
sented a prom ise and becam e a con­
tract. Then, when the patients d id n ’t
get well, we becam e liable because w e
had failed to fulfill our contract w ith
them.
Thus, the adm onition to us at m id
century was not to p rom ise anything.
We still cared about our patients, but
we could no longer give them hope.
That put the first chill in o u r re la tio n ­
ship with them. We lost o ur w arm th.
'
A s our treatm ent m ethods im ­
proved, the law yers placed another bur­
den on our shoulders, the expectation
o f results.
We can never assure the patient
w hat the result o f our treatm ent will be.
W ill they get better? We think so.
M aybe. M aybe not. T he risk o f a com ­
plication, o f an unexpected reaction to
m edication, or o f a lack o f effectiveness
is ever present.
W hen problem s occur, w e try to fix
them . S om etim es w e arc successful,
som etim es not. Yet the current legal c li­
m ate has w hipped the public into ex­
pecting the im possible. We cannot per­
form m iracles. We cannot deliver perfec­
tion.
An even w orse threat is loom ing on
the horizon, crim inal prosecution. Sev­
eral ju risd ic tio n s here and in E urope
have attem pted to do that. So far. not
m uch has com e out o f their efforts, but
the th reat is there.
For now, w e only have to put up
w ith punitive dam ages. 1 have beard
that W ashington State does not provide
for punitive dam ages in to il cases. Per­
haps, but a v erdict o f fifteen m illion
looks very' m uch like punishm ent to m e.
In a case concerning the pay m en t
o f professional fees. Judge Jam es R ob­
ert Pottle, o fth e C ourt o f A ppeals o f
G eorgia, ruled as follows:
“ It w ould nev er do to hold that
l n d r e i r S ta tso n, M l )
w here he cures the patient. If w e did,
the m em bers o f this learned profession
m ight hesitate to respond in extrem e
cases w here the chances w ere against
them . So far as w e are co n cern ed the
doctors m ay continue to b ury th eir m is ­
takes and reco v er for their services as
they have alw ays do n e.” ( Hall v. M o o r­
ing. 12G aA pp. 74; 7 6 S .E .7 5 9 ; 1912)
O f course, that w as in 1912. M any
things have changed since then. W hat
has not changed is the truth o f Judge
P o ttle's statem ent. P hysicians do h e si­
tate to treat com plex eases w hen they
are expected to produce m agical cures.
T hat w as old-fashioned w isdom ,
but the reality o f it is around us. W ithin
the last tw o years alm ost h a lf o f the
O B -G Y N s in our com m unity have
stopped doing obstetrics or retired a l­
together. We had four perinatologists.
We dropped to one and a half. T he re si­
dency program s in our state are uninsurablc and som e o f them m ay fold. I
w o n ’t discuss the situation in n e u ro ­
surgery, orthopedies, card io v ascu lar
surgery and others. T he old ju d g e
knew w hat he w as saying.
B efore the Iron C urtain rusted
through and through, and the B erlin
Wall crum bled, the elections in those
countries w ent 99.9% for the ru lin g
party. S tripped o f th eir voice, the
people voted instead w ith their feet. At
that tim e, a jo k e m ade the rounds in
a d o c to r is entitled to recover only
Sec “ Prom ises” page IS
May, 2004
PCMS BULLETIN
9
v
B
u lletin
Doctors Express Liability Worries
Applicants for Membership
A n o v e rw h e lm in g n u m b e r o f p h y sic ia n s su rv e y e d in fo u r sta te s say th ey are
D avid P. Langw orthy, M D
c o n c e rn e d a b o u t th e e fte c t o f m e d ic a l litig atio n on th e ir p ra ctic e . T h is is a b re a k d o w n
o f t h e su rv e y re su lts o f h o w c o n c e rn e d th ey are:
A n e s th e s io lo g y
T ac o m a A n e s th e s ia A sso c ia te s
515 S o u th M S tre et, T acom a
V ery
L o u isia n a
62%
Som ew hat
2 7%
N o t too
253-274-1642
N o t at all
3%
7%
M e d S ch o o l: L o m a L in d a U niversity
In tern sh ip : L om a L in d a U niversity
M iss is sip p i
Texas
'
84%
10%
74%
24%
76%
20%
3%
R e sid en c y : L om a L in d a U niversity
2%
3%
L e ste r P. W a n g , M D
1%
0%
3%
U ro lo g y
W. V irginia
F rom AM News , M a y 3, 2004
U ro lo g ic C o n su ltan ts
1519 3rd St SE # 210, P uyallup
253-8404994
M ed S chool: U n iv e rsity o f M issouri
U of W tops medical school list
Internship: U n iv e rsity o f M innesota
R esid en cy : U n iv e rsity o f M innesota
F ellow ship: B a y lo r C o lle g e o f Medicine
The best prim ary programs, according to U.S. News and World Report
T h e U n iv e rsity o f W ashington M e d ic a l S chool w as re ce n tly ra te d as h a v in g the
n u m b e r o n e p ro g ra m in p rim a ry care, fam ily m ed icin e and iural m edicine. Jo h n s
Community Health Care
H o p k in s to o k top h o n o rs for in te rn al m e d ic in e w h ile H a rv a rd ra te d first in w o m e n ’s
h e a lth a n d p e d ia tric s.
T o tal m ed ic al school e n ro llm e n t at U W w as 790 stu d e n ts in 2003 w ith 5 0% o f
g ra d u a te s e n te rin g p rim a ry care m ed icin e. T h e a v erag e u n d erg rad u ate GPA o f
Downtown Medical Clinic
w ill reopen M a y 3 ,2 0 0 4
Children’s Dental Clinic
w ill reo p en June 1 ,2 0 0 4
stu d e n ts w a s 3 .6 9 , w ith o u t-o f-state tu itio n to ta llin g $29,788.
Positron Emission Tom ography (PET)
Our Clinical
PET Specialists
PET has been show n to be an accurate m eth o d to diagnose and stage cancer, check for
tu m o r recurrence, a n d m o n ito r cancer therapy. Inform ation gained by the use o f PET can be
A n th o n y Larhs, M D
used to d eterm in e w hat com bination of surgery, radiation therapy, o r chem otherapy is m ost
D ire c to r o f C lin ic a l PET
likely to be successful in m anaging the disease.
P h illip C Lesh, M D
PET is also used to evaluate A lzheim er’s disease,
epilepsy, and cardiac disease.
W illia m B Ja ck so n , M D
M any insurers, including M edicare and
M edicaid, are reim bursing for m any
PET procedures. TRA referral
coordinators will w ork w ith you to
com plete the required pre-exam
authorization.
Tacoma
2 2 0 2 S C e d a r St, Ste 2 0 0
2 5 3 -7 6 1 -4 2 0 0
tra m ed ica lim ag in g .com
Call our referral coordinators at
253-761-4200.
•feXCEltENCE * RERSONTOPER50N
10
P C M S BULLETIN
May, 2004
.
ti'i'ini/i/ ' ' (t< f/n w / '
Retired members gather
Retired m em bers and guests had a w o n d erfu l afternoon
on April 8 when they m et for lunch at the F ircrest G o lf C'lub.
A sunny day helped m ake the occasio n m em orable.
Visiting with friends and form er co lleagues, enjo y in g the
lunch buffet, and a special speaker rounded out the a fte r­
noon. Dr. Mian A nw ar, retired a nesthesiologist, introduced
the speaker, Mr, B ob Pittm an.
Mr. Pittman is an estate plan n in g a ttorney w h o p ractices
in Tacoma. He is also the w ell-know n and respected host o f
KIRO Radio’s Legal Line. H e captivated the audience w ith
important inform ation about estate planning, em phasizing
that everyone should have a “ w hat a bout m e" segm ent in
their plan. This directive instructs the careg iv er about p e r­
sonal preferences o f a person should they b eco m e u nable to
communicate their preferences. He cited an exam ple o f Mr.
Jones, who loved to golf, preferred m ushroom soup and en­
joyed country music. If Mr. Jones instin cts th at he w ould like
to be driven around the g o lf course each w eek, prefers m ush­
room soup and likes the radio tuned to country m usic, this
becomes an easy w ay for the careg iv er to m ake Mr. Jones
comfortable and m ore secure accom m odating his p refer­
ences.
The retired m em bers and th eir guests m eet three tim es
annually for lunch at Fircrest G o lf C lub w ith a featured g uest
speaker. If you w ould like to attend and do not receive an in­
vitation, please call PCM S 572-3667. ■
Left, Mr. B o b P ittm an answ ers questions o f Dr. G il R oller
a fte r lunch
Left, Dr. Stan M u e ller visits with Dr. M ian A n w a r a n d his wife
Patt}’ before lunch
f --------------:
!>>
W)
I
0
1
1— H
0
ra-di-ol-o-gy \rad-e-‘al-e-je\.n.
1: a branch o f medicine utilizing exams such as
MRI (magnetic resonance imaging) and CT
(computed tomography) in the diagnosis and
treatment o f disease 2: a comm itm ent to
providing cutting-edge imaging services without
the necessity of driving long distances; see TRA
M e d ic a l I m a g in g
1
I
4 7 0 0 P o in t F o s d ic k Dr, S te 1 1 0 • F o r m o re in fo rm a tio n , c a ll (253) 7 6 1 -4 2 0 0
t ra m e d ic a lim a g in g .c o m
May, 2004
PCMS BULLETIN
11
B
u i .l f t i n
MuItiCare /3
At MultiCare’s New Facility,
The Future O f Surgery Is In Your Hands.
Years from now, all facilities will operate like this. B ut at the
M uItiCare Surgical C are C e n te r a n d M uItiCare Regional
H eart & Vascular C enter, the future
/
rr - g g K
is here today. Touch screens control
lighting, tem perature and eq u ip m en t.
V oice-activation technology makes adjustm ents at your com m and. A b u tto n press calls up digital
medical images right in the O.R. Tracking
Wall- an d ceiling-m ount suspension
badges locate surgical team m em bers instantly.
i
0
/fflSlL. boom s keep equipm ent easily accessible
&
yet o u t o f th e way. A nd distal protection
^><?'3*rJ 'ie \,ices, intracardiac echocardiography
i and o th e r new technologies fill th e sta te s m ost advanced cath eterizatio n
labs. T h e r e ’s m o re. To p u t a n
in fo rm a tio n
pack et,
A
in clu d in g a v irtu a l to u r on C D -R O M , in y o u r h an d s, please call 253-403-4373.
Tacoma General Hospital • Mary Bridge Children’s Hospital
Q
12
P C M S BULLETIN
May. 2004
P gR_A T j n
q
^A
t
T
h e
- F
o r e f r o n t
O f .T e c h n o
l o g y
?p„ •m- f: c m th / ", / M t a t / r f n n e / i /
IN M E M O R IA M
GEORGE G.R. K U N Z , M D
1914
-
20 04
Dr. George Kunz was bom in Tacoma in 1914 and died peacefully in his
sleep on April 14, 2004 after a valiant battle with pancreatic cancer.
Dr. Kunz received his undergraduate degree from the University of
Washington, where he also completed one year o f law school before deciding
to follow his father in the practice o f medicine. He received his medical de­
gree from Temple University in Philadelphia in 1943, followed by an intern­
ship at Harborview Hospital in Seattle and postgraduate work at Cook
County Hospital in Chicago. Dr. Kunz practiced general medicine/surgery in
G eorge Kunz, M D
Tacoma from 1944 until 1980, when he retired
Dr. Kunz was a member o f the Pierce County Medical Society since 1944.
Memorials may be made to the Tacoma YMCA or the Tacoma Humane Society.
PCMS offers condolences to Dr. K unz’s wife, Lorraine, and their family.
IN MEMORIAM
WILLIAM H. WRIGHT, MD
1924
-
2004
Dr. William Wright was bom in Michigan in 1924 and died on February
17,2004.
After receiving his medical degree from the University of Arkansas
School of Medicine in 1948, he completed his internship and residency at
Brooke Army Hospital and graduate training at Walter Reed Army Medical
Center. He began his internal medicine practice in Tacoma in 1966, where he
continued practicing until his retirement in 1996.
Dr. Wright joined Pierce County Medical Society in 1966.
PCMS offers condolences to Dr. W right’s family.
May, 2004
PCMS BULLETIN
13
B
u l l e t in
Expert Help with Environmental Health Risks
T h e N o rth w e st P e d ia tric E n v iro n m e n ta l H e a lth S p e c ia lty
risk s to h e alth c are p ro v id e rs , g o v e rn m e n t ag en cies and
U n it (P E H S U ) p ro v id e s free te le p h o n e c o n su lta tio n o n p e d ia t­
o th e r g roups. F o r ex am p le, P E H S U e x p erts provide lec­
ric e n v iro n m e n ta l h e alth risk s to h e a lth care p ro v id e rs , p u b lic
tu re s a t c o m m u n ity h o sp ita ls fo r p ro v id e rs evaluating
h e a lth p ro fessio n als, c o m m u n itie s and fam ilies (1-877-K 1D -
c h ild re n /fa m ilie s w ith h e a lth c o n c e rn s re la te d to a nearby
C H E M ). C a th e rin e K arr, M D , M S , is the lead p e d ia tric ia n on
E PA S uperfund site. (C all 206-341-4448).
th e g ra n t, and re c e n tly re sp o n d e d to c alls a b o u t p e d ia tric risks
a sso c ia te d w ith m e rc u ry in c h ild h o o d v a c c in a tio n s, c o n su m p ­
tio n o f w ell w a te r c o n ta m in a te d w ith fo rm ald eh y d e , a n d e x p o ­
su re to silic a d u st fro m d a d ’s w o rk c lothing.
• P E H S U se rv es A la sk a , Id a h o , O re g o n a n d W ashington.
F o r pro fessio n al assistan ce call l-8 7 7 -K ID -C H E M (l-8 7 7 54 3 -2 4 3 6 ). F o r g e n era l a ssista n ce , c o n ta ct P E H S U Coordinator
N an cy B eaudet, M S , C IH (206-341-4448). ■
P E H S U details:
■P E H S U e x p erts also in clu d e to x ic o lo g ists, o ccu p atio n al
a n d e n v iro n m e n ta l m e d ic in e p h y sic ia n s and o th er en v i­
ro n m e n ta l h e alth sp e c ia lists on fa cu lty at the U niversity
o f W ash in g to n .
■P E H S U also w o rk s w ith C A R E N o rth w est, a U W tele ­
p h o n e c o n su lta tio n se rv ice th a t p ro v id es in fo rm a tio n on
th e e ffe c ts o f d ru g s, c h em ica ls a n d o th er a g en ts du rin g
p re g n a n c y and lac tatio n .
■E x p e rtise on a cu te e x p o su re calls, su c h as d rug p o iso n ­
in g s, is p ro v id e d b y th e W ash in g to n P o iso n C enter.
■P E H S U p ro fe ssio n a ls are also a v ailab le to p ro v id e e d u ­
catio n al a ssista n ce on p e d ia tric e n v iro n m en ta l health
Allenmore
g J aPsychological
m i l Associates, P.S.
...a ill li 11idisciplinaiy
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Do you have patients w ith difficult emotional
and stress-related problems? Psychiatric and
psychological consultations are available.
Union Avenue Professional Building
------------------ 1530 Union A ve. S.. Ste. 16. Tacoma_________
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14
P C M S BULLETIN
May, 2004
Medical Real Estate Services, LLC
v_
' ? / ) < ' r < v '( i i h
iii
I i j 'r
{ ( < ' < ! t r < t / ( " I <'<'<<'/if
CME at Hawaii includes education, family and sun
CME at Hawaii, a C ollege o f
Medical Education resort program ,
was termed a huge success by c o n fer­
ence participants. T he program
brought together Pierce C ounty p h y ­
sicians for family v acationing and
continuing m edical education on the
island o f Kauai at the highly praised
Hyatt Regency Hotel.
This year’s program , organized
by longtime director M ark C raddock,
MD was the C ollege’s largest H aw aii
program attracting over 60 physicians
and other health care providers and
their families. The program was
COME’s 7th Hawaii program and par­
ticipants returned to K auai, site o f the
first such program in 1992.
T h e p rogram featured a p otpourri o f
educational subjects o f interest and
value to all specialties. C onference at­
tendees particu larly enjoyed the rare op­
p o rtunity to have in-depth discussions
about vario u s case studies.
O ut o f the classroom , conference
p articipants and th eir fam ilies enjoyed e x ­
ploring K auai, w ater sports, helicopter
rides, golf, b iplane rides, horseback
rid in g and, o f course, great w eather.
T he C ollege continues to o ffer resort
C M E conferences b oth in ski locations
and in sunny reso rt areas. T he next ski
program w ill be held again in W histler,
British C olum bia in January o f 2005. The
next CM E at Hawaii program will likely be
schedule for spring vacation o f 2006. ■
Dr. M ich a el Lyons addresses C M E
pa rticip a n ts on the latest d evelopm ents in
the diagnosis a n d treatm ent o f H epatitis C’
Dr. Steven Duncan a n d his w ife L vnda en jo y lunch in H a ra le i
following a rigorous hike up the Ncipali coast
From l-r. Dr. D a n ie l a n d L o ri N ehls. Dr. M ark a n d J in n v
Craddock. Dr. P at H ogan a n d Joan Brookhvser. a n d Dr. Jim
a n d P enny R ooks fo llo w in g a run dow n the h o tel w a ter slide
Drs. Alex Mihali, C hris Jo rd a n a n d J o e C labots as the sun
drops into the K auai s u r f b e h in d them
Dr. J o h n a n d K athy Sam m s with Dr. L a ird F indlav a n d w ife
L in d a B entson enjoy the conference reception
May, 2004
PCMS BULLETIN
15
Dr. G reg C a rr o u g h e r fie ld s q u e stio n s
Dr. G reg C a rr o u g h e r a n d h is daughter,
fr o m the 60 p h y s ic ia n s a n d o th er
Dr. J a n is F e g le v (right) a n d D e b o ra h
C urtis, A R N P in fr o n t o f th e m a n y
L isa, sh a r e s m ile s a t th e e n d o f a great
h e a lth c a re p r o v id e r s a tte n d in g the
sh o p s in the b e a u tifu l K a u a i H y a tt
w e ek in K a u a i
s e m i-a n n u a l CA'fE in H a w a ii p ro g ra m
Dr. D a n N eh ls a n d his son, B rady, sw im in o n e o f the H y a tt’s
m a n y p o o ls - this one a la rg e s a lt w a te r la g o o n a lw a vs
h e a te d to 82 degrees
P r o u d g ra n d p a re n ts Dr. R o n a n d K aren B en v en isle enjoy
tim e w ith th e ir granddaughter, Leah, a ro u n d the h o te ls
b e a c h a n d s w im m in g p o o l
F o rm e r C e d a r S u rg ic a l p a rtn e rs re u n ite at the o p e n in g
c
«
n r Cbri'i Iordan a n d his w ife D i. b la m e
m i Dr.
16
P C M S BULLETIN
May, 2004
^
l l ____ _ — ■ ■ ■ _______
- r
P C M S p h y sicia n s, l-r, D rs. D o u g Mcdo, L e slie M alo, T e n
C labots,
l a n d J o e C labots, d u rin g the
- F r a n k S e n ee a■■
^
Jfy/’m
COLLEGE
OF
MEDICAL
EDUCATION
Continuing Medical Education
Advances in Women’s Medicine
Draws National Faculty May 21
lated to diagnosis and treatm ent a d ­
Plans are com plete for the
vances in treating illness in w om en.
C o lle g e ’s A dvances in Women s
A course program brochure w ith
M edicine C M E scheduled fo r M ay
21,2004.
topics and details for registration w as
m ailed recently.
R ecognized w om en's health ex­
The course will qualify lor 6.5 Cat­
perts w ill lead this one-day program
directed by John L enihan, M D that
egory I C M E credits. T he conference
w ill address a variety o f tim ely sub­
w ill be held at St. Joseph H o sp ita l’s
je c ts relative to contem porary m edi­
L agerquist C onference C en ter - R oom s
cine for w om en. D esigned for the p ri­
1A & B .
m ary care physician, this C ategory I
T opics for this very p o p u lar p ro ­
gram include:
C M E p rogram will feature issues re­
Union Avenue Pharm acy
and Corset Shop
Formerly Sm ith's Corset Shop
2302 S Union Ave
752-1705
tc<‘in ilij r lle < ltc a / r f m e f y
M ark Curtis, M D, 1V1ED, FA COG
D epression: A W om an’s Perspective
H orm ones and A bnorm al B rain Function:
T he R ole o f S p e d Scanning
Pat D onley, M D
A ge-R elated Fertility: N ew O ptions
Paul Lin, M D
C ontraception Update:
Organ &Tissue
D O N A T I O N
New' O ptions for T oday's W oman
A lbert Yuzpe, M D
O varian C ancer U pdate
H ow ard M untz. M D
H orm one R eplacem ent T herapy: W hat Now "
Sherri W iner. MD
U pdate on M anagem ent o f A bnorm al Pap Sm ears
ICris G hosh, M D ■
E
Share Your Life.
Share Your D ecision
For more information on
organ and tissue donation
please call
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May. 2004
PCMS BULLETIN
17
B
lili
ETIN
Promises
fro m p a g e 9
E a ste rn E u ro p e:
d o u b le d d u rin g th at tim e. M a n y o th er
‘W h a t w ill y o u do w h e n th e y open
th e b o rd e rs ? ”
“I ’ll c lim b a tree.”
“W hy?”
“ S o 1 d o n ’t g e t tra m p le d .”
So far, o n ly a few p h y sic ia n s in a
w e g e t cuts, o r a t m o st, a p ro m is e o f a
w ell. To m eet th at in cre ase in o v e rh ea d ,
w e h a v e M e d ic a re ra is in g p a y m e n ts by
5 % increase.
F o rtu n a te ly fo r A lic e , sh e w oke up
1.5% , w ith th e e v e r p re se n t th re a t o f
c u ttin g th em later. M e d ic a id p ro m ised
in g th a t o u rs is g o in g to last a w hile
to in cre ase the p a y m e n t for o b stetrical
care b y 5% .
fe w fie ld s h a v e v o te d w ith th e ir feet.
W h e n the re st o f u s g e t sq u e e ze d
L ew is C arro ll e x p ressed o u r feel­
in g s w ell. You p ro b a b ly re m e m b e r the
tig h te r, w a tc h o u t fo r th e sta m p e d e.
To c h e e r up th o se o f y o u in the
lo w risk sp e c ia ltie s (is th ere s u c h a
th in g ? ), the M a rc h issu e o f “A C O G T o­
d a y ” re p o rte d the re su lts o f a po ll o f
th e fellow s for the y e ars 1999-2003.
fro m h e r dream . W h y d o I h a v e the feel­
lo n g er?
In v a rio u s d isc u ssio n s in som e
p h y sic ia n o n -lin e se rv ice s, o n e o f the
fe llo w s re p e a te d ly w rites, “ W e control
access. W ith o u t us, th e re c a n b e no
fo llo w in g p a ssa g e from “ T h ro u g h the
L o o k in g G lass” ;
m e d ic a l c are. T h in k a b o u t it.”
“W ell, in our c o u n try ,” said A lice,
still p a n tin g a little, “ y o u ’d g e n era lly
c u lt to sto p p ra c tic in g , e v e n fo r a short
g e t so m e w h e re else— i f you ran v e ry
fast for a long tim e as w e 'v e been d o ­
O n e h a lf o f the fello w s o f th e c o l­
leg e h a v e b e e n su e d d u rin g the p ast
m e n t ra te s to m e e t o u r ris in g overhead,
co sts o f ru n n in g a p ra ctic e w e n t u p as
I k n o w the p ro b le m . It is v e ry diffi­
tim e. T h e flow o f in co m e stops, w hile
the o v e rh e a d c o sts k e e p p ilin g up. As
long as w e m a k e e n o u g h to c o v e r the
a fte r re sid e n c y w a s six tee n y e ars. T he
ing.”
“A slow sort o f c o u n try !” said the
Q ueen. “N ow , here, y o u see, it tak e s all
a v e ra g e n u m b e r o f suits p e r fe llo w w as
the ru n n in g y o u can do, to k eep in the
2.6. O v e r 7 6% h a d h a d at lea st one
c la im , 5 7 % h a d tw o o r m ore. T he m al­
sam e place. I f you w a n t to get so m e ­
w h ere else, you m u st run a t lea st tw ice
F o r m a n y o f u s, the tim e w h e n we
sh a ll n o t b e ab le to c o v e r o u r expenses
is g e ttin g close. It is tim e to consider
p ra ctic e p re m iu m s ro se 5 3% from 1999
as fa st as th at!”
T h en , to help quen ch h e r thirst, the
o th e r op tio n s. W h en e n o u g h o f us
m ak e the sw itch , th in g s w ill change.
R ed Q ueen g ave A lice a very dry b is­
cuit. H ow appropriate! W h ile w e need
sig n ific a n t in creases in o u r re im b u rse ­
U n til then, w e ’ll c o n tin u e o u r trek
th ro u g h the la n d b e h in d th e looking
g la ss. ■
fo u r y e ars. T h e a v era g e tim e in p ra ctic e
to 2003.
T h e a b o v e fig u re s are for the
w h o le co u n try . T h e situ atio n in W ash ­
in g to n S ta te is w o rse. O u r p re m iu m s
It’s
m o re
it's a
than a
n e w
b us fare to go to w o rk a n d also have
so m e th in g left over, w e ’ll k e e p going.
b u ild in g
new experience
St. Joseph Outpatient Center • Opening June 29
•q
06
•«
6®
M
'/f.
95!
»•<
te i
,9I<
O utpatient Diagnostic Imaging, O utpatient Rehabilitation, the
Gene and Mary Anne Walters Day Surgery and the St. Joseph
Advanced Endoscopy Center are moving to the new St. Joseph
Outpatient Center located next to the hospital.
9
For these sendees, m ore is changing than just their address.
The Outpatient Center offers advanced technolog}' with greater
capacity, comfort and privacy. For physicians, we also promise
faster scheduling and report turnaround to support rapid
diagnosis, treatm ent and recovery.
We want to be your clear choice for outpatient care.
St. Joseph Medical Center
wwiu.flishealth.org
18
PCM S
BULLETIN
May, 2004
'J A j'f-n ^ o d n /if "
dfocK 'tij
Classified Advertising
POSITIONS AVAILABLE
O FFIC E SPACE
Tacoma/Pierce County outpatient
For R ent: 3300 sq ft C lass A m edical
general m e d ic a l care at its best. F u ll
o ffic e in T a c o m a M e d ic a l C e n te r, 1112
and p art-tim e p o s itio n s a v a ila b le in
6 th A v e , th ird flo o r. E le v a to r, u n d e r­
Tacoma and v ic in ity . V e iy f le x ib le
g ro u n d p a r k in g , c lo s e to h o s p ita ls . C a ll
schedule. W e ll su ite d fo r c a re e r
253-272-2224.
A n d y T soi, M D (253) 7 5 2 -9 6 6 9 o r P a u l
C hoice office space in M edical/D ental
Doty ( A lle n , N e ls o n , T u rn e r & A s s o c .) ,
c o m p le x in G ig H a rb o r a v a ila b le
C lin ic M an ager (253) 383-4 3 5 1 .
Jan ua ry, 2 0 0 4 .2 ,3 5 4 sq. ft. o n m a in flo or.
T w o e n tra n ce s, o ffic e s w it h d e c k s an d
o u ts id e d o o rs. L a r g e re c e p tio n and
looking fo r P /T to F / T B o a r d C e r t ifie d
fro n t o ffic e . L a b sp ace, c o n s u lta tio n
or B o ard E lig ib le P h y s ic ia n to j o i n a
ro o m , heat, e le c tr ic it y an d w a te r
group practice. W o r k 3 -4 d a y s a w e e k
in c lu d e d . B e a u tifu l, w o o d e d settin g.
with a great su p p o rt sta ff. B a s e s a la ry
5 1 2 2 O ly m p ic D r N W , S u ite A 2 0 3 . C a ll
plus incentive. F a x y o u r C V to 2 5 3 -8 4 7 -
D r. M a iy G r iffith 5 6 5 -2 4 4 4,468-3539 .
9630.
There will be a no-host luncheon
Wednesday, May 26, 2004 at
redefinition fo r G.P., F.P., I .M . C o n ta c t
Established Auburn Fam ily Practice
Retired Doctor’s
Wives Luncheon
11:30 am at Affairs restaurant
located at 27th and Bridgeport in
University Place. Wives o f
retired and semi-retired doctors
are welcome.
To make a reservation, call
Judy Brachvogel (564-4308) or
Marlyn Baer (564-6374) by
Friday May 21. Come and
renew friendships!
Protect Your Practice, Protect Your Family
As you know, disability insurance policies for physicians are
changing rapidly— and not for the better. At Physicians
Insurance Agency, there’s still tim e to secure the specialtyspecific 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 you and your family,
call Physicians Insurance Agency today: (206) 343-7150 or
1-800-962-1399.
W
\
PHYSICIANS
INSURANCE
AGENCY
A Wholly Owned Subsidiary of
Physicians Insurance
>Physicians Insurance 2003
Sponsored b )1the Washington StateMedical Association
May, 2004
PCMS BULLETIN
19
B
ulleti
oownh.
%T
“Threatening Litigation Is a
Nightmare Process”
A s a claims representative and supervisor, I see physicians of all specialties
whose lives are suddenly changed by claims filed against them. Whether the
cases are dismissed, settled, or go to trial, each physician’s personal and
professional life can take a turn for the worse, and that's why I’m here to
help. I analyze each claim, stay in close contact with our attorneys, and work
with the physician on new strategies as the case develops. Every physician is
important to me, and I make sure my work shows them that 1 care.
To find out about the many ways Physicians Insurance works with and
for physicians, call us today.
mam
Western Washington
Eastern Washington
Oregon
j K a ri A dam s,
I C l a im s S u p e r v is o r
1 - 8 0 0 -9 6 2 -1 3 9 9
1 - 8 0 0 -9 6 2 -1 3 9 8
1 - 8 0 0 -5 6 5 -1 8 9 2
P
j
Physicians
Insurance
A Mutual Company
C r e a te d .m d s p o n s o r e d b y th e
V isit o u r W e b s il e a l p h y in s .c o m
W a s h m c iL in S ta te M e d ic a l A s s o u a U im
S e a ttle , W A © P h y s ic i a n s I n s u r a n c e 2 0 0 2
Pierce C ounty M edical Society
223 Tacoma A venue South
Tacoma, WA 98402
PRESORTED
STANDARD
U S P O S T A G E P A ID
TACOM A. WA
P E R M IT N 0 6 0 5
Return service requested
20
P C M S BULLETIN
May, 2004
New mem bers - from left, Am ol Shah, M D and wife Sam Song, M D w ith Tammi Stefanelli, M D at the
PCMS new m em ber reception in May. Dr. Shah is an em ergency room physician at Tacom a G eneral,
Dr. Song an ob/gyn w ith G ood Sam aritan and Dr. Stefanelli is a fam ily physician in Tacom a’s north end
IN S ID E :
3
5
P r e s i d e n t ’s P a g e : “ I m p o r t a n t P o l i t i c a l A g e n d a s ” b y M i c h a e l K e l l y , M D
A m a te u r A s t r o n o m y - M a y G e n e r a l M e m b e r s h ip M e e tin g R e c a p
7
9
11
15
S p e c i a l F e a t u r e : “ M a t t R ic e M D , J D - R e p u b l i c a n C a n d i d a t e f o r t h e 2 6 t h D i s t r i c t . . . ”
T P C H D : “ B o a r d o f H e a lt h m a k e s to u g h d e c is io n ” F e d e r ic o C r u z - U r ib e , M D
In M y O p i n i o n : “ R u n n i n g F a s t e r ” b y A n d r e w S t a t s o n , M D
In M y O p i n i o n : “ R a i n b o w s ” b y D a is y P u r a c a l , M D
17
W A M P A C e n d o r s e m e n t s o f s t a t e w id e c a n d id a te s e x p la in e d
—
B
^
u l l e t in
.P O M S O f f ic e r s /T r us tees:
M i c h a e l J. K e l l y , M D , P r e s i d e n t
P a tr ic k J. H o g a n , D O , P re s id e n t E le ct
K e n n e th A . F e u c h t, M D , V ic e -P re s id e n t
J o s e p h W . R e g im b a L M D , T re a s u r e r
S u m n e r L . S c h o e n ik e , M D , S e c r e ta r y
J. J a m e s R o o k s . J r., MX). P a s t P re s id e n t
L a u re l R . H a r ris . M D
J e ff re y L .N a c h t. M D
J o s e p h F. Ja s p e r. M D
N a v d c e p S . R a i.M D
R o n a ld R . M o r r is .M D
C a rl W . W u lfe stie g . M D
June, 2004
P C M S M e m b e r s h ip Benefits, Inc (M BI):
T i m S c h u b e r t , M D , P r e s i d e n t ; D re w D e u ts c h ,
M D . P a s tP r e s id e n t; J o e R e g im b a l.M D .S e c r e ta r y Treasurer: K e ith Demi i j i an, M D ; S te v e D u n c a n , M D :
M a r k G ild c n h a r , M D ; S te v e S e ttle . M D ; J o e W e a m .M D
C ollege of M ed ical E d u cation (C .O .M .E.):
J o h n Ji ga n ti . M D President; B a rb a ra F o x . M D .
W illia m H o ld e r m a n .M D , S te v e K o n ic e k ,M D . M a ijo rie
K ra b b e . M D . W illia m L e e . M D . G r e g g O s te rs re n . D O .
B ra d P a ttiso n , M D , C e c il S n o d g ra ss , M D . V irg in ia
S to w e ll. M D . R ic h a rd W a ltm a n . M D .T o d W u r s t. M D ;
H e r ta M a le ik e . G o o d S a m a rita n H o sp ita l; L is a W h ite ,
M u ltic a re H e a lth S y ste m ; S iste r A n n M c N a m a ra ,
T re a s u r e r. F ra n c is c a n I le a lth S y s te m ; S u e A s h e r,
S e c re ta iy
P C M S F oun d ation: L aw ren ce A.
L a r s o n , D O , P r e s i d e n t ; C h a r le s W e a lh e r b y . M D .
M o n a B a g h d a d i. N ik k i C ro w le y . T re a s u re r; S u e A sh e r.
S e c re ta iy
W SMA
R epresentatives:
T ru s te e s : L e o n a rd A le n ic k . M D : N ic h o la s R a ja c ic h . M D ;
P a tric c S te v e n s o n ,M D
\V A M P A C 6 th D is tr ic t: D o n R u s se ll.D O
W A M P A C 9 th D istrict: L e o n a rd A lenick. M D
S t a f f : E x e c u tiv e D ir e c to r: S u e A s h e r
A d m in is tra tiv e A s sista n ts: T a n y a M c C la in , C risti P e te rso n
P la c e m e n t C o o rd in a to r: K e n S m ith
P la c e m e n t A s sista n t: M e lis s a K re g n e ss
C M E P ro g ra m A d m in istra to r: L es M c C a llu m
B o o k k e e p e r: Ju a n ita H o ltn e isle r
Table of Contents
3
4
4
P r e s id e n t ’ s P a g e : “ Im p o rta n t P o lit ic a l A g e n d a s ”
P r e m e ra c o n v e r s io n r u lin g d u e in J u ly
I n d u s tr y n o t re a d y f o r H I P A A s e c u r it y m a n d a te
5
A m a te u r A s tro n o m y - M a y G M M R e ca p
6
A p p lic a n t s f o r M e m b e r s h ip
7
S p e c ia l F e a a ire : “ M a t t R ic e : R e p u b lic a n C a n d id a t e fo r th e 26th
D is t r ic t - A n o t h e r W a y to M a k e a D if f e r e n c e ”
(S’
T P C H D : " C h la m y d ia I n fe c tio n s R is in g "
9
T P C H D : “ C le a n In d o o r A i r In itia t iv e ”
10
In M y O p in io n : " R u n n in g F a s te r "
12
C o n n e c t ic u t d o c to r s p u s h fo r to rt r e fo r m v e to
13
M e d ic a l M a r iju a n a : C le a r in g th e A i r
15
In M y O p in io n : " R a in b o w s "
17
W A M P A C ' e n d o rs e m e n ts o f s ta te w id e c a n d id a t e s e x p la in e d
19
C la s s if ie d A d v e r t is in g
T h e B u lle t in is p u b lis h e d m o n th ly by P C M S
M e m b e rs h ip B e n e fits , Inc. D e a d lin e fb rs u b m ittin g a rtic le s
a n d p la c in g a d \ e rtise m e n is is the I 5th o f th e m o n th
p re c e d in g p u b licatio n .
T h e B u lle t in is d e d ic a te d to th e art, sc ie n c e an d d e liv ery
o f m e d ic in e a n d th e b e tte rm e n t o f t h e h ealth an d m ed ical
w e lfa re o f t h e c o m m u n ity . T h e o p in io n s he re in are th o se ol
th e in d iv id u a l c o n trib u to rs an d d o not n e c e s sa rily re fleet the
o ffic ia l p o sitio n o f P C M S . A c c e p ta n c e o f a d v e r tis in g in no
w a y c o n s titu te s p ro fe s sio n a l ap p ro v al o r e n d o rse m e n t o f
p r o d u c t s o r s e rv ic e s a d v e rtise d . T h e B u lle tin re se rv e s the
r ig h t to re je c t a n y a d v e rtisin g .
M a n a g i n g E d i t o r : Sue A sher
E d i t o r i a l C o m m i t t e e : M B I B o a rd o t D ire c to is
A dvertising
Inform ation:
253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , 1 a c o in a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; F A X : 2 5 3 -5 7 2 -2 4 7 0
E -m ail a d d ress: p c m s w a f o j p c m s w a . o r g
H o m e P a g e : h ttp ://w w w .p c r n s w a .o rg
2
P C M S BULLETIN
June, 2004
'?fu<y<r 'tic-inil)j Q -llc d r n tf
President s Page
by M ichael J. Kelly, M D
Important Political Agendas
"A physician sh a ll recognize a responsibility to p a rticip a te in
activities contrib u tin g to the im provem ent o f the com m unity
a n d the b etterm ent o f P u b lic H ealth. ”
- P o in t V I I , A M A ’ s “ P r in c ip le s o f M e d ic a l E th ic s ”
M ichael J. Kelly. M D
T here w a s a tim e I th o u g h t b e in g a
o f preventable death in the U .S . after a c ­
b arte n d e rs, w i l l th a n k y o u .
p hysician w o u ld be a ll 1 w o u ld e v e r do.
t iv e s m o k in g a n d a lc o h o l use. T o say
N o w I re a liz e to c o n tin u e to be a p h y s i­
that th is m e rits o u r fu ll s u p p o rt is an
c ip le s o f E th ic s ,” re fe re n c e d a b o v e ,
P o in t I X o f the sa m e A M A “ P r in ­
un d erstate m en t. S u c h s u p p o rt s h o u ld
states, “ A p h y s ic ia n shall su p p ort ac­
c o m e in the w a y o f a c q u is itio n o f in it ia ­
cess to m edical care f o r a ll p e o p le .”
about tort re fo rm an d le g is la tiv e a c tio n
t iv e sig n a tu re s and, p o s s ib ly , fin a n c ia l
T h is is a d ire c tiv e to su p p o rt m e d ic a l l i ­
plans, eh? I un d erstand . P le a s e a c c c p t
s u p p o rt.
cian, I m ust b e c o m e a p o litic ia n .
So y o u ’ re g e ttin g tire d o f h e a rin g
my apo lo g ies b u t I fe e l c o m p e lle d to
S u c c e s s in th is in itia t iv e w i l l m a k e
a b ilit y re fo rm i f th e re e v e r w a s one. In
th is p o lit ic a lly ch a rg e d are n a, w h e re o ne
W a s h in g to n the s ix th state to b e c o m e
c o m m itte e c h a ir can s e r io u s ly a ffe c t
s m o k e -lr e c in a ll p u b lic in d o o r p la ce s.
m e d ic a l a c ce ss a cro ss the e n tire state,
this Bulletin w ith a p le a fo r y o u r h e lp
T h e p ro c e s s re q u ire s w e o b ta in a p p r o x i­
“ ..su p p o rt o f a c c e s s " has c o m e to m e an
about another area o f state p o litic s . In i­
m a te ly 2 7 0 ,0 0 0 sig n a tu re s b e fo re J u ly 2
su p p o rt o f p o lit ic ia n s w h o c a n h e lp us
tiative 890 - the B re a th e E a s y , W a s h ­
in o rd e r to q u a lify ' fo r the N o v e m b e r
g u a ra n te e s u c h access.
ington cam p aig n (w w w .B re a th e
b a llo t. Y o u c a n o b ta in p e titio n s fr o m the
EasyW a.org). In the M a y B u lletin , 1
P C M S o ffic e o r d o w n lo a d v ia the
y o u n e ed to k n o w , M a t t R ic e , M D , J D ,
mentioned the T o rt R e fo r m I n itia tiv e to
internet. S im p ly g o to w w w .b re a th e
an d C o lo n e l B o b L a w r e n c e U S A F (ret.).
the legislatu re, a sig n a tu re g a th e rin g
e a s y w a .o rg /to o lk it/.
D r. R ic e has ju s t a n n o u n c e d as r e p u b li­
stay w ith the m essage.
H ow ever, I th o u g h t 1 w o u ld b e g in
campaign that w i l l start in Ju ly . B re a th e
Easy is an in itia tiv e to the b a llo t p r e s ­
S p e a rh e a d in g th e state c a m p a ig n is
L e t m e in tro d u c e y o u to tw o p e o p le
ca n ca n d id a te to u n sea t P a t L a n t z ( D -
o u r o w n P re s id e n t-E le c t, Dr. P at H ogan.
2 6 ) w h ile B o b L a w r e n c e a n n o u n c e d h is
ently underw ay. I w i l l re tu rn to to rt re ­
H e and y o u r P C M S B o a r d o f D ir e c to r s
c a n d id a c y fo r the 2 8 th d is tr ic t to f i l l the
form later.
s tr o n g ly e n c o u ra g e y o u to p la c e p e t i­
seat p re s e n tly h e ld b y R e p . M ik e C’ a rre ll
tio n s in c le a r ly v is ib le p la c e s in y o u r o f ­
(R -2 8 ), w h o is c a m p a ig n in g f o r state
formed p h y s ic ia n s that y o u are, h a ve
fic e s (“ h e llo " area, w a ilin g ro o m , etc.)
senate. R e p . C a r r e ll, lo n g a p p re c ia te d as
heard o f in itia t iv e 890 and the c a m ­
a n d tra in s t a ff to a le rt p a tie n ts to the
a c h a m p io n fo r m e d ic a l cau ses, see ks
paign, w h ich w i l l b an a ll W a s h in g to n
p re s e n c e o f the p e titio n . A c c o r d in g to
th e senate seat a v a ila b le d u e th e r e tir e ­
I’ m certain a ll o f y o u , w e ll- in -
State em plo yers fro m e x p o s in g th e ir
le g a l c o u n c il, there are no H I P A A v io la ­
m e n t o f S h ir le y W in s le y . H is c a m p a ig n
employees to se c o n d h a n d s m o k e . I f
tio n s in a c q u ir in g s ig n a tu re s in th is
can be rea ch ed at 2 5 3 - 5 8 1-2 8 5 9 o r
not, craw l out fro m u n d e r th at r o c k o r
m an n e r. O n c e a p e titio n is fu ll (2 0 s ig n a ­
w w w .cc a rre ll @ ix .n e lc o m .c o m .
get the sp inach o u t o f y o u r ears. P a g e
tu res) s u b m it it r ig h t aw ay , e ith e r b y
four o f last m o n th ’s B ulletin has a n e x ­
m a ilin g (the p e titio n s are s e lf-m a ile rs ) o r
p re s id e n t a n d c h ie f m e d ic a l o f f ic e r fo r
cellent o v e rv ie w in c lu d in g “ k e y
b y c a llin g the P C M S o ffic e to p ic k it up
N o r t h w e s t E m e rg e n c y P h y s ic ia n s . D r.
points” and “ tim e lin e s .” S o m e tim e s
(572-3667).
repetition helps.
T his is a tru e w o r k p la c e p ro te c tio n
In itia tiv e 890 w i l l f u l f i ll the ab o ve
re fe re n c e d e th ic a l d ire c tiv e to “ ...p a rtic i­
M a t t R ic e , M D , J D is s e n io r v ic c
R ic e 's C 'V is e x te n s iv e an d im p re s s iv e .
H e has se rv e d as d ire c to r o f th e e m e r­
g e n c y d e p a rtm e n t o f St. C la r e H o s p ita l,
measure, w h ich w i l l e lim in a te em p lo y e e
p ate in a c t iv itie s c o n trib u tin g to th e im ­
c h a irm a n o f e m e rg e n c y m e d ic in e an d
exposure to k n o w n a irb o rn e c a r c in o ­
p ro v e m e n t o f the c o m m u n ity a n d the
r e s id e n c y p ro g ra m d ire c to r at M a d ig a n
gens. A s m an y o f y o u k n o w , secon d ­
b e tte rm e n t o f p u b lic h e a lth .” Y o u r p a ­
A r r a y M e d ic a l C e n te r an d r e c e iv e d h is
hand smoke is the third lead in g cause
tie n ts , e s p e c ia lly th e w a itre s s e s and
See “A gendas" page 16
June, 2004
PCMS BULLETIN
3
B
u l l e t in
Premera conversion ruling
due in July
T h e s e e m in g ly n e v e r - e n d in g P r e m e r a c o n v e r s io n p r o c e s s
Industry not ready for
HIPAA security mandate
H e a lt h c a r e o r g a n iz a t io n s are w o e f i il l y u n p r e p a r e d to
(th e P la n a n n o u n c e d its in t e n tio n to c o n v e r t to a s to c k c o m ­
c o m p ly w it h th e H I P A A s e c u r it y r u le a n d m u s t a c t im m e d ia te ly
p a n y 2 4 m o n t h s a g o ) m a y h a v e r e a c h e d a m ile s t o n e . L a s t
to m e e t th e A p r i l 2 1 , 2 0 0 5 d e a d lin e , a c c o r d in g to a re p o r t b y
w e e k , D e p u t y I n s u r a n c e C o m m is s io n e r J im O d io m e , p r e s e n t­
U R A C , a h e a lth c a r e o r g a n iz a tio n a c c r e d it in g a g e n c y .
in g th e O I C s t a f f ’ s r e c o m m e n d a t io n s , a d v o c a te d th a t th e In ­
s u ra n c e C o m m is s io n e r d e n y th e c o n v e r s io n .
O d io r n e s a id i f th e In s u ra n c e C o m m is s io n e r w a s d is p o s e d
U R A C w a r n e d the in d u s t r y to s ta rt c o m p lia n c e e ffo rts
n o w b e c a u s e it w i l l ta k e s ix m o n th s to a y e a r to im p le m e n t a
p r o g r a m to p r o t e c t th e c o n f id e n t ia lit y , in t e g r it y a n d a v a ila b ilit y
to a p p r o v e th e c o n v e r s io n , h e s h o u ld d o so w it h m a n y s u b ­
o f p a tie n t r e c o r d s sto re d in a n e le c t r o n ic fo r m a t o r tra n sm itte d
s ta n t ia l c o n d it io n s . H o w e v e r , e v e n i f a ll th e c o n d it io n s h e re c ­
e le c t r o n ic a lly . U R A C b a s e d its a s s e s s m e n t o n c o n ta c ts w ith
o m m e n d e d w e r e a d o p te d , th e O f f ic e o f th e In s u ra n c e C o m m is ­
3 0 0 h e a lth c a re e n tit ie s th a t h a v e in q u ir e d a b o u t o r g o n e
s io n e r ( O I C ) s t a f f s t ill r e c o m m e n d e d th e In s u ra n c e C o m m is ­
th ro u g h it s w e b s ite a n d H I P A A p r iv a c y s e c u r it y a c c re d ita tio n
s io n e r r e je c t th e c o n v e r s io n .
p ro g ra m s.
P r e m e r a h a d th e o p p o r tu n ity to re b u t th e s t a f f r e c o m m e n ­
d a t io n s la te r in th e w e e k . T h e C o m m is s io n e r ha s u n t il J u ly 19
to r e n d e r h is fin a l d e c is io n o n th e c o n v e r s io n .
S o m e o f th e s p e c if ic c o n c e r n s n o te d b y O I C s t a f f in ­
c lu d e d :
A lt h o u g h U R A C d id n o t c o n s u lt w it h s m a ll p h y s ic ia n o f­
fic e s f o r its r e p o rt, it b e lie v e s - as d o o th e r in d u s t r y o b se rve rs
- th a t d o c to r s a re e q u a lly u n p re p a re d f o r H I P A A s e c u r it y co m ­
p lia n c e .
C o m p lia n c e w i l l b e c h a lle n g in g re g a r d le s s o f s iz e , b ut
“ s m a lle r p r a c tic e s o b v io u s ly h a v e le s s w o r k to d o in th e sense
• P o t e n t ia l a d v e r s e im p a c ts o n s u b s c r ib e r s , e ith e r d ir e c t ly
th r o u g h in c r e a s e d p r e m iu m s o r in d ir e c t ly th ro u g h lo w e r r e im ­
b u r s e m e n ts f o r p r o v id e r s .
th a t th e y h a v e s m a lle r ( in fo r m a t io n ) s y s te m s a n d s m a lle r nu m ­
b e r o f in d iv id u a ls w it h w h o m th e y n e e d to b e c o n c e r n e d ,” said
C la ir e W . B a rre tt, a U R A C a c c r e d it a tio n r e v ie w e r w h o co-w rote
th e re p o rt.
• P r e m e r a ’ s fo c u s o n g r o w th in o v e r a ll r e v e n u e a n d o v e r ­
a l l m e m b e r s h ip is a fo c u s r e f le c t in g s h a r e h o ld e r in te re s ts , n o t
th e in s u r a n c e b u y in g p u b lic .
" T h e o th e r th in g to k e e p in m in d is th e s e c u r it y r u le is
d e s ig e n d ...to b e s c a la b le so th e c o m p lia n c e a c t iv it y o f p h y s i­
c ia n s w i l l b e in h e r e n tly le s s th a n a c o m p le x h o s p it a l’ s o r health
p la n s y s te m ’ s,” s a id G a r r y C a m e a l, U R A C ’ s p re s id e n t.
• T h e tr a n s a c t io n w o u ld n o t tr a n s fe r th e f u ll m a r k e t v a lu e
o f th e c o m p a n y to th e fo u n d a tio n s .
U R A C ’s r e p o r t id e n t if ie d f o u r k e y b a r r ie r s to w a r d c o m p li­
an ce: in c o m p le te o r in a d e q u a te r is k a n a ly s is e ffo r t; in c o n s is ­
te n t a n d p o o r ly e x e c u te d r is k m a n a g e m e n t s tra te g ie s to a d ­
• P r e m e r a h a s n o t p r o v id e d a c o m p le te d e s c r ip tio n o f the
d re s s s e c u r it y v u ln e r a b ilit ie s : lim it e d o r f a u lt y in f o r m a t io n sys­
tr a n s a c tio n , a n d th e C o m m is s io n e r ha s b e e n d e n ie d to ta l a c ­
te m s a c t iv it y r e v ie w ; a n d in e f f e c t iv e s e c u r it y in c id e n t re p o rt­
c e s s to w h a t P r e m e r a ’s p la n s a re p o s t - c o n v e r s io n .
in g a n d re sp o n se .
T h e re p o rt la y s o u t a 12 - m o n th tim e ta b le o f a c t iv it ie s and
• P r e m e ra h a s a lr e a d y m a d e n e g a tiv e c h a n g e s p r e -c o n v e rs io n th a t r e f le c t a f o r - p r o f it o r ie n ta tio n , s u c h as d r o p p in g P u b ­
r e c o m m e n d a t io n s fo r m e e tin g th e s e c u r it y r u le c o m p lia n c e
d e a d lin e . ■
l ic E m p l o y e e B e n e f it s B o a r d ( P E B B ) , H e a lt h y O p tio n s , B a s ic
H e a lt h , a n d its M e d ic a r e fis c a l in t e r m e d ia r y ro le .
Watch for state access survey
It is g r a t if y in g th a t O d io m e in c lu d e d p r o v id e r is s u e s as a
b a s is f o r r e je c t io n , w h ic h w a s v ir t u a lly s tra ig h t fr o m th e te s ti­
m o n ie s o f W S M A P r e s id e n t D r. J e f f C o ll i n s a n d D ir e c t o r o f
H e a lt h C a r e E c o n o m ic s B o b P e m a , b o th h a v in g te s tif ie d at the
h e a rin g .
H e n o te d th a t t h e ir t e s tim o n y s h o w e d the lin k b e tw e e n re ­
im b u r s e m e n t a n d p a tie n t a c c e s s a n d q u a lit y p a tie n t c a re (o n e
o f t h e le g a l s ta n d a rd s is th a t th e c o n v e r s io n c a n ’ t b e “ h a r m fu l
to s u b s c r ib e r s ” ). A l lo w i n g P r e m e ra m o r e m a r k e t p o w e r, h e c o n c lu d e d , w o u ld re d u c e a lr e a d y in a d e q u a te r e im b u rs e m e n t.
C o m m is s io n e r K r e id l e r c o u ld is s u e h is r u lin g s o o n e r th a n
J u ly 17. W it h P r e m e ra h a v in g a lr e a d y s p e n t a re p o rte d $31 m i l ­
lio n p lu s o n th e c o n v e r s io n , m a n y o b s e r v e r s t h in k th e P la n
w i l l a p p e a l i f th e C o m m is s io n e r r u le s a g a in s t it. ■
4
P C M S B ULLETIN
June, 2004
Every physician with a Washington State license
- active, retired, in or out o f state - will soon receive a
brief questionnaire from the WSMA. The goal: deter­
mine what type o f practice setting each physician is
in, and how malpractice premiums are affecting their
practice.
We must substantiate access to care problems
being experienced on an ongoing basis. The question­
naire should take only about 10 minutes to complete,
and respondents can call a toll free num ber at their
convenience and enter their replies.
(' <<(id tj Q /iie c h c a l (^fociely
Amateur Astronomy - May General Membership Meeting Recap
A m a te u r a s tro n o m y p r o v e d to b e a h o t to p ic fo r P C M S
p h y sician s and th e ir g u e sts at th e M a y 11 G e n e r a l M e m b e r s h ip
M eeting. Ju st o v e r 100 atte n d ed the e v e n t at th e L a n d m a r k
C o n v en tio n C e n te r in T a c o m a to he ar Dr. C h arles Jacob son ,
P u y allu p in te rn ist, te a c h a b o u t h is re v e re d a v o c a tio n .
G iv in g a w e ll- ro u n d e d p re s e n ta tio n . D r. J a c o b s o n s p o k e
not o n ly o ft h e S o la r S y s te m b u t o f th e o th e r a s tr o n o m ic a l o b ­
jects, g alaxie s, n e b u la e , a n d sta r clu s te rs . H e o u tlin e d n u m e r­
ous o rg a n iza tio n s, e ve n ts, p u b lic a tio n s , an d o th e r s u ch ite m s
that a v a il th e m se lv e s to th e a s t r o n o m ic a l en th u sia st. H e sp o k e
o f the p u b lic star p a rtie s at the F o r t S t e ila c o o m c a m p u s o f
Pierce C o lle g e , P ro je c t A s tr o , an e d u c a tio n p ro je c t fo r g rad es
1-9, sponsored b y the U o f W d e p a rtm e n t o f A s tro n o m y . H e
P uyallup p h ysicia n s Drs. C harles J a co b so n (speaker) a n d
Julie G ustafson a n d h u sb a n d D a v id K eers (right)
urged in d iv id u a ls to c o m e to th e a n n u a l A u g u s t A s tr o n o m y
Fair sponsored b y the T a c o m a A s tr o n o m ic a l S o c ie ty . H e m e n ­
tioned three o b s e rv a to rie s fo r the p u b lic in the N W . O n the
P L U cam pus, the K e c k O b s e rv a to ry , the G o ld e n d a le o b s e rv a ­
tory in G o ld e n d a le , W A an d th e B a tt le P o in t O b s e r v a to r y on
B ainb rid g e Island.
Dr. Jaco b so n w a s v e r y in fo r m a t iv e ab o u t w h a t am a te urs
do. Am ateu rs o b se rve the h e a v e n s , e x p e rim e n t w it h a v a r ie ty o f
photography e q u ip m e n t a n d c o m p u te rs , an d e x p lo r e te le s c o p e
making and am a te ur o p tic s . T h e y a ls o e n jo y s ta r p a rtie s . T h e
really serious s u b m it s e ria l o b s e rv a tio n s o f th e ir fa v o r ite s u b ­
jects to p ro fe ss io n a l g ro u p s. H a v in g b een in v o lv e d s in c e the
age o f 13, and w ith the k n o w le d g e a n d e x p e rie n c e a c c u m u la te d
Dr. W illiam H old en n a n (right) with daug h ter Lauren a n d
Dr. D a n ie l G insberg w ith daug h ter R a ch el
over the years, there w a s n o d o u b t b y a n y o n e a tte n d in g that
Dr. Jacobson is a “ s e rio u s g u y .”
H is o w n c o lle c t io n o f e q u ip m e n t in c lu d e s 17” an d 12 .5 ”
N ew tonian re fle c to rs , a 7 ” A s t r o - P h y s ic s re fra c to r a n d a 6 0 m m
Coronado S o la r Sco p e.
H is q u ic k ru n d o w n o n th e S o la r S y ste m :
•
•
•
•
T h e Sun - g o rg e o u s an d c h a n g in g
Venus - w h ite o n ly w it h p h a se ch a n g e s
T h e M oon - g reat c o n tra s ts a n d m o o n s c a p e re lie fs
Jupiter - e n o rm o u s , a fa ile d S u n , w it h great
a tm o sp h e ric d e ta ils
See "Recap” page IS
Drs. J im R ooks (left) a n d P at H ogan carefully review a
p etitio n f o r Initiative 8911 - f o r clean in d o o r air
A S T R O N O M Y R E SO U R C E S
Tacoma Astronomical Society
Jack Newton: O soyoos
Telescope information
Meetings: F irst Tuesday o f each m onth
Rm. 130 Thom pson H a l l , U PS
Star Parties: M onthly P ie rc e C ollege
Ft. Steilacoom Cam pus
w w w .jackn e\\ 'ton.com
TAS m em bers
C harles Ja co b so n 848 7(195
Goldendale Observatory
e-m ail: ja c o b so n c @ c o m c a st.n e t
5 0 9 -7 7 3 -3 1 4 1
h ttp ://co m m u n ity .g o rg e.n et/frie n d so fg o sp
Star Ware by P h illip H arrington
Astronomy Fair: S aturday A u g u st 7,h
Further information: m vw .las-ortline.org
em ail: g o ld o b s@ g o rg e.n et
Battle Point Astronomical Association
Seattle Astronomical Society
206-842-9152
li tip: //w w w . s e a ttl e a stro . org
Captain’s Nautical in Seattle
Anacortes Telescope and Wild Bird
Orion Telescope
June, 2004
X
PCMS BULLETIN
5
B
u l l e t in
Applicants for Membership
Stanley G C h en g, M D
D ia g n o s t ic R a d io lo g y
T a c o m a R a d io l o g y A s s o c ia t e s
3 4 0 2 S 18th St, T a c o m a
253-383-10 99
Franciscan
Clinical
Messaging
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F e llo w s h ip : U n iv e r s it y o fW a s h in g to n
Jill D . R ob in son , M D
D ia g n o s t ic R a d io lo g y
T a c o m a R a d io lo g y A s s o c ia t e s
3 4 0 2 S 18th St, T a c o m a
253-383-10 99
M e d S c h o o l: U n iv o f C A , S a n D ie g o
In te rn s h ip : U n i v o f C A , Ir v in e
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W h e re , and w h e n , you need it. Franciscan Clinical M essaging is
a secure, HIPAA co m p lian t, w eb-based co m m u n ica tio n archiving
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M e d S c h o o l: U n iv e r s it y o fW a s h in g to n
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D ia g n o s t ic R a d io lo g y
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3 4 0 2 S 18th St, T a c o m a
253-383-1099
• 3 + years o f historical clinical results
M e d S c h o o l: T u f t s U n iv e r s it y
• EKGs (com ing July 2004)
I n te rn s h ip : U n iv e r s it y o f A r iz o n a
Increase Clinical Effectiveness
• Gain 24/7 access to essential clinical data about yo u r patients
R e s id e n c y : U n iv e r s it y o f A r iz o n a
R e s id e n c y : M o u n t A u b u r n H o s p ita l
F e llo w s h ip : B r ig h a m a n d W o m e n ’ s H o sp
• C o m m u n ica te and share data w ith hospital intensivists
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To learn m ore about Franciscan Clinical M essaging, or to se t up your
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M e d ic a l I m a g in g N o r t h w e s t
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C harles E . W ang, M D
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June, 2004
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M e d S c h o o l: T u f t s U n iv e r s it y
In te rn s h ip : C le v e la n d C l i n i c
R e s id e n c y : U o f M a s s a c h u s e t ts M e d C tr
F e llo w s h ip : M a y o C l i n i c F o u n d a t io n
F e llo w s h ip : T u f t s N e w E n g la n d M e d C tr
dAf/ce f
Q-fle<lca(
Special Feature
octetif
byjeanBorst
Matt Rice: Republican Candidate for the 26th District
Another Way to Make a Difference
Physician, m ilit a r y o ffic e r, la w de­
gree, businessm an, te a c h e r ... D r. M a t t
c a m p a ig n , it's ju s t o n e re a so n w h y R ic e
is h it tin g the c a m p a ig n tra il.
Rice is som eone w h o b e lie v e s lie ca n
“ I th in k th is is th e rig h t tim e to g et
make a diffe ren ce, and h e ’ s sp en t h is
in v o lv e d an d g iv e b a c k to s o c ie ty ,"
entire life p uttin g th at b e lie f in to a c tio n .
R ic e sa id . “ I f p e o p le lik e m e d o n ’ t s e rv e
C u rre ntly a p r a c tic in g e m e rg e n c y
at the lo c a l, state o r n a tio n a l le v e ls ,
room p h y sic ia n an d s e n io r v ic e p r e s i­
then th e y c a n ’ t g et in v o lv e d in the
dent o f Team H e a lth W e st, a c o m p a n y
th in g s that im p a c t us in im p o rta n t
that provides p h y s ic ia n s e rv ic e s to
w a y s .” B e c o m in g in v o lv e d in th is w a y,
contracted h o sp ita ls in th e N o rth w e s t,
he b e lie v e s , “ is ju s t as im p o rta n t as the
Rice is now p re p a rin g to m a k e a d if f e r ­
ca re w e p r o v id e as p h y s ic ia n s .”
M all Rice, MD
R ic e has b een c o n s id e r in g a ru n fo r
ence in the p o litic a l arena as he d e ­
clares h is ca n d id a c y fo r th e 2 6 lh D is t r ic t
th e la st y e a r o r tw o , “ b u t i t ’s been in
seat in the W a sh in g to n State H o u s e o f
th e la st s ix to e ig h t m o n th s that I ’ ve fe lt
at B r o o k A r m y M e d ic a l C e n te r in S a n
Representatives.
I c o u ld r e a lly be a p a rt o f th e p ro ce ss
A n t o n io , T exas.
R ic e b e lie v e s it is v it a l fo r p e o p le
to get in v o lv e d in th e p ro c e s s in o rd e r
F o r m a n y y e a rs . R ic e s e rv e d as
and d o a b ette r jo b th a n P at L a n t z ,” he
sa id . “ I h a v e n o th in g a g a in s t P at as a
e m e rg e n c y m e d ic in e r e s id e n c y d ire c to r
to have a say in the issu e s th at im p a c t
p erso n , b u t [ t h in k I a m the b ette r c a n ­
fo r the M a d ig a n A r m y M e d ic a l C e n te r/
all o f us. “ It w o u ld be w r o n g f o r m e n o t
d id a te , an d 1 th in k I c a n m a k e a c o n t r i­
U n iv e r s it y o f W a s h in g to n P ro g ra m an d
to run,” he said. F r o m to rt re fo r m to
b u tio n in th is r o le .”
w'as a lso th e c h ie f o f e m e rg e n c y m e d i­
c in e at M a d ig a n f o r 10 y ears. In 1988,
transportation. R ic e is lo o k in g fo rw a rd
to the prospect o f re p re s e n tin g the 26"',
M aking a D ifference, his W hole Life
B o r n an d ra is e d in ru ra l P e n n s y lv a ­
a district that co v e rs p arts o f P ie r c e and
R ic e re c e iv e d h is la w d eg ree fr o m S e ­
attle U n iv e r s it y S c h o o l o f L a w . H e re ­
Kitsap co un ties an d in c lu d e s the c itie s
n ia , R ic e w'as a b io lo g y m a jo r at
tire d fro m the a rm y as a c o lo n e l in 2 0 0 0
of G ig H arb or, P o rt O rc h a rd an d parts o f
G e tty s b u rg C o lle g e a n d re c e iv e d h is
and is c u rre n tly s e n io r v ic e p re s id e n t o f
Bremerton. H is d e c is io n to ru n is
T e a m H e a lth W e st and c h ie f
one that sh o u ld be o f s ig n ific a n t
m e d ic a l o ffic e r o f N o r th w e s t
interest to a ll P C M S m e m b e rs,
E m e rg e n c y P h y s ic ia n s .
for R ice is se e k in g to u n se a t in ­
cumbent Pat L a n tz (D ).
Lan tz has s e rv e d as state
representative to the 2 6 lh d is tr ic t
“Dr. M att R ice is so m eo n e who believes he
can m a ke a difference, a n d he s sp en t his
entire life p u ttin g that b e lie f into action. ”
R ic e h as a lso v o lu n te e re d
c o u n tle s s h o u rs as in s tru c to r
an d a d v is o r f o r th e T a c o m a
C o m m u n ity C o lle g e P a ra m e d ic
since 1997 and is c u rre n tly in h e r
P r o g r a m and P ie r c e C o u n ty
fourth tenn. Sh e w a s in s tru m e n ­
E M S , as ra c e p h y s ic ia n f o r the
tal in stopping tw o S e n a te -a p ­
S o u n d -to -N a r r o w s . an d as a
M S in p h y s io lo g y a n d m e d ic a l d eg ree
v o lu n te e r p h y s ic ia n f o r th e A m e r ic a n
reaching the flo o r o f th e H o u s e fr o m
fro m P en n State. H e jo in e d the R O T C
R e d C ro s s . H e is a p ast m e m b e r o f the
the Ju diciary C o m m itte e , w h ic h she
a lo n g the w a y, a n d h is stro n g d e sire to
W a s h in g to n State G o v e r n o r ’ s C o u n c il
chairs. L a n tz has p u b lic ly d e n o u n c e d
s e rv e h is c o u n try le a d h im to a c tiv e
on E M S a n d T ra u m a S y s te m s , the
tort reform and b e lie v e s W a s h in g to n
d u ty in the a rm y a fte r m e d ic a l sc h o o l.
W a s h in g to n State W e st R e g io n E M S
State is in need o f in s u ra n c e re fo r m an d
H e c o m p le te d an in te rn s h ip at T r ip ie r
C o m m itte e , and le c tu re s to n u m e ro u s
other less sw e e p in g m e a s u re s to r e lie v e
A r m y M e d ic a l C e n te r in H o n o lu lu and
g ro u p s on m e d ic a l, p a tie n t s a fe ty an d
doctors from the e c o n o m ic sq u e e z e that
s e rv e d as a b a tta lio n su rg e o n an d as
le g a l issu e s. H e is th e r e c ip ie n t o f n u ­
includes ste a d ily d e c lin in g fe d e ra l
D ir e c t o r th e S tu ttg art, G e r m a n y (5th
m e ro u s a w a rd s, in c lu d in g the G S C
G e n e ra l H o s p ita l) A r m y E m e rg e n c y D e ­
A C E P O u ts ta n d in g S e r v ic e A w a r d and
p a rtm e n t d u r in g th e C o ld W ar. H e re ­
O r d e r o f M i l it a r y M e d ic a l M e rit . H e
proved m a lp ra c tic e r e lie f m e a su re s fro m
M edicaid re im b u rs e m e n t rates.
W h ile to rt r e fo r m is su re to be a
pressing issue in th is h ig h ly v is ib le
c e iv e d h is e m e rg e n c y m e d ic in e tra in in g
See “M att Rice” page 10
June, 2004
X
PCMS BULLETIN
7
B
u l l e t in
F e d e ric o C ru z-U rib e * M D
The Health Status of Pierce County
D ir e c t o r o f H e a lth
Chlamydia Infections Rising
T h e n u m b e r o f p e o p le in f e c t e d w it h C h la m y d ia c o n t in u e s
a n d /o r u r e th r a l s y n d r o m e (a c u te d y s u r ia a n d p y u r ia
to r is e a c r o s s th e sta te a n d in P ie r c e C o u n ty . In 2 0 0 3 ,2 , 6 4 4
w it h b a c t e r iu r ia )
c a s e s w e r e r e p o r te d in P ie r c e C o u n ty , c o m p a r e d to 1 ,9 9 0
• A l l s e x p a r tn e r s o f p e r s o n s w it h c h la m y d ia l in fe c tio n s
c a s e s in 2 0 0 0 . S in c e at le a s t 7 0 % o f th e c a s e s are a s y m p t o m ­
• W o m e n p la n n in g I U D in s e r t io n , d e p e n d in g o n th e ir risk
a t ic , r e g u la r te s tin g o f s e x u a lly a c t iv e m e n a n d w o m e n , p a r ­
• M e n w it h u r e t h r it is o r e p id id y m it is
t ic u la r ly th o s e u n d e r th e a g e o f 2 5 y e a r s is c r it ic a l to c o n t r o l­
lin g th e s p r e a d o f th e d is e a s e .
T h e m o s t r e lia b le la b o r a t o r y te s t is th e n e w n u c le ic a c id
H e a lt h c a r e p r o v id e r s a re u n iq u e ly p o s it io n e d to in te r ­
a m p lif ic a t io n te s t ( N A A T ) , b e c a u s e th e se te sts h a v e a 98-99%
v e n e w it h th e s p re a d o f C h la m y d ia w it h p a tie n ts u n d e r 25.
s p e c if ic it y a n d are a ls o th e m o s t s e n s itiv e . T h e c e r v ic a l sw ab
S t u d ie s h a v e s h o w n th a t y o u n g p e o p le a c c e p t th e a d v ic e o f
h as a s e n s it iv it y o f 9 2 - 9 8 % a n d s e n s it iv it y o f th e m a le u rin e
m e d ic a l p r o v id e r s ; a n d , th o s e u n d e r th e a g e o f 2 5 sta te th a t
te st is 9 6 -9 9 % . In c o n tra s t, th e G e n - P r o b e P a c e h a s a s e n s itiv ­
th e y p r e f e r to r e c e iv e s e x u a l h e a lth e d u c a tio n th r o u g h th e ir
ity o f 4 0 -6 5 % .
p h y s ic ia n s .
C h la m y d ia c a se s s h o u ld be r e p o r te d to th e T a c o m a -P ie rc e
T P C H D r e c o m m e n d s th e r e g u la r a n n u a l te sts f o r C h la m y ­
d ia f o r s e x u a lly a c t iv e m e n a n d w o m e n 2 5 y e a rs o ld an d
C o u n t y H e a lt h D e p a r tm e n t (2 5 3 - 7 9 8 - 6 5 3 4 ) to a ssu re fo llo w -u p
o f c lo s e c o n ta c ts a n d to m a n a g e p o t e n tia l o u tb re a k s .
F o r m o re in fo r m a t io n , c o n ta c t T P C H D N u r s e E p id e m io lo ­
y o u n g e r a n d w o m e n o v e r th e a g e o f 2 5 w it h a n e w se x p a rtn e r
o r m o r e th a n o n e s e x p a rtn e r. In a d d itio n , th e f o llo w in g
g is ts at 2 5 3 - 7 9 8 - 6 4 1 0 a n d /o r lo o k at th e f o llo w in g w e b site s:
s h o u ld b e s c r e e n e d f o r C h la m y d ia :
C en ters fo r D isease C on trol:
w w w .c d c .g o v / s td / C h la m y d ia / S T D F a c t - C h la m y d ia .h t m
• P re g n a n t w o m e n
• W o m e n w it h m u c o p u r u le n t c e r v ic it is ( p u r u le n t o r
m u c o p u r u le n t c e r v ic a l d is c h a r g e , o r e a s ily in d u c e
W ashington D ep artm en t o f H ealth:
c e r v ic a l b le e d in g ) , p e lv ic in f la m m a t o r y d is e a s e ( P I D ) ,
w w w . d o h .w a .g o v / c fli/ S T D / fa c t s h e e t .h tm B
It’s more than a new building
it's a
u
new experience
St. Joseph Outpatient Center • Opening June 29
O u t p a t ie n t . D ia g n o s t ic I m a g in g , O u t p a t ie n t R e h a b il i t a t i o n , t h e G e n e a n d
M a r } 'A n n e W a lt e r s D a y S u r g e r y a n d t h e St. J o s e p h A d v a n c e d E n d o s c o p y
C e n t e r a r e m o v in g to th e n e w St. J o s e p h O u t p a t ie n t C e n t e r lo c a t e d n e x t
to th e h o s p it a l.
F o r t h e s e s e r v ic e s , m o r e is c h a n g i n g t h a n j u s t t h e i r a d d r e s s .
T h e O u t p a t ie n t C e n t e r o f f e r s a d v a n c e d t e c h n o l o g y w it h g r e a t e r
c a p a c ity , c o m f o r t a n d p riv a c y . F o r p h y s ic ia n s , w e a ls o p r o m is e fa s te r
s c h e d u lin g a n d r e p o r t t u r n a r o u n d to s u p p o r t r a p i d d ia g n o s is ,
t r e a t m e n t a n d r e c o v e r ) '.
I f you w ould like more info rm a tio n or a p riv a te tom ; please call.
O utpatient Surgery, 2 5 3 .4 2 6 .6 4 3 2 • D iagnostic Im aging, 2 5 3 .4 2 6 .6 2 8 5
A d va n ced Endoscopy Center, 2 5 3 .4 2 6 .6 3 0 9 •
Therapies, 2 5 3 .4 2 6 .6 8 4 7 • Speech Therapy, 2 5 3 .4 2 6 .4 8 2 0 .
St. Joseph Medical Center
tuivw.Jhshealth. org
8
P C M S BULLETIN
June, 2004
PAerce 'ic-ounh/ Q ile d t c a l (t fe -a v /j
Fe de rico C ru z -U rib e , M D
The Health Status of Pierce County
D ir e c t o r o f H ealth
Clean Indoor Air Initiative
Editor s Note: James M. Wilson, MD, PCMS Past-Prexidenl and Pierce County Board o f
Health member isfeatured in this article discussing how difficult it has been to stay the course
with the comity smoking ban
In the arg um en t ab o u t the in d o o r
smoking ban, I ’ v e been p ro u d o f o u r
F ederico Cruz, M D
w e fin d a w a y th at w e c a n h a v e it b o th
w a ys?"’
Board o f H e a lth . T h e y m a d e a d e c is io n
“ T h e n I g o b a c k to m y o th e r life .
and continue to u p h o ld the re s o lu tio n ,
A n d in m y o th e r life , I sp en t an hour,
I g u e ss that I w o u ld n ’ t be d o in g m y
even as w e face c o u rt b a ttle s an d
ju s t th is m o rn in g , s ittin g w ith a m an
p ra c tic e a g reat s e r v ic e b y s a y in g th at I
monthly te stim o n y a b o u t p a in a n d s u f­
w h o w a s ju s t s o b b in g , w h o w a s s ittin g
f i l l o u t a lo t o f death c e rtific a te s . B u t,
fering caused b y the ban. A t the M a y
a n d h o ld in g h is h e ad in h is ha n d s and
tr a g ic a lly , in w h a t 1 d o fo r a liv in g , I do.
m e etin g , Jim
s o b b in g b e c a u se he is d y in g fro m lu n g
A n d I 'v e seen that th e y ’ ve ch a n g e d
Jim Wilson, MD
W ilson, M D re­
can cer. A n d h e ’ s n o t ju s t d y in g fro m
th e c e rtific a te . T h e re is a n e w b o x to
s p o n d e d to th e
lu n g ca n ce r, he c a n ’ t b reath e an d uses
c h e c k on dea th c e r tific a te s that in d i­
la rg e g ro u p o f
o x y g e n . H e h a d a h u g e tu m o r that c am e
cates i f s m o k in g c o n trib u te d in a n y w a y
p e o p le w h o a r­
o u t on h is n e c k th at w a s ju s t u g ly and
to w h a t h a p pe n e d . It h as ju s t a m a ze d
g u e d a g a in s t
h o r r ib le an d te r r ib le a n d re q u ire d a h o r­
m e h o w fre q u e n tly I h a v e to c h e c k
the c le a n in d o o r
r ib le su rg e ry. H e w a s ju s t re c o v e rin g
‘ y e s .’ A n d it is n o t ju s t th e lu n g c a n ­
a ir r e s o lu tio n
fro m the s u rg e ry and w a lk in g d o w n the
cer.”
b y r e c o g n iz in g
street an d h is le g b ro k e . T h e b ig b o n e
“ Y o u k n o w , y o u h e a r s o m e b o d y to ­
d a y sa y to the B o a r d o f H e a lth ,
b o th
‘ G o s h , 1 h a v e s m o k e d fo r y e a rs
s id e s o f
the situation. S o m e b u sin e s s e s
are losing reven ues as p e o p le
travel to K in g C o u n ty restau ra nts
and trib al ca sin o s w h e re th e y c a n
continue to sm o ke. O n the o th e r
hand, d ire c tly s m o k in g o r b re a th ­
ing in second-hand s m o k e has
an d I d o n ’ t h a v e lu n g c a n c e r.'
Y e a h , but i f she gets it to m o rro w ,
“There is a n ew box to check on death
certificates th a t indicates i f sm o k in g co n ­
trib u te d in a n y w ay to w hat happened. It
has j u s t a m a ze d m e how freq u en tly /
h a ve to c h eck ‘y es.
she is g o in g to be a sad p e rso n
b e ca u se th at is a p a th e tic w a y to
go. H e a rt a tta c k s and stro k e s
an d a ll k in d s o f lu n g d ise a se s
and th in g s that w e d o n o t th in k
- J im W ils o n , M D
health im pacts.
a b o u t n o r m a lly b e in g a ffe c te d
b y s m o k in g , an d s m o k e th a t w e
Jim spoke fro m the heart. A s
you talk w ith p a tie n ts w h o are
get w h e n w e are e x p o s e d in
wondering w h e th e r to q u it s m o k ­
b o w lin g a lle y s o r in th at tra in
ing, m aybe h is w o rd s w i l l in fo r m and
in h is leg ju s t sn a p p e d r ig h t in tw o . It
sta tio n o r in y o u r c a s in o , r e a lly d o e s a f­
assist y o u on w h a t to say:
sn a p p e d in tw o b e ca u se th ere w a s a b ig
fe c t us and r e a lly d o e s im p a c t o u r
tu m o r in th ere fr o m h is lu n g cancer.
liv e s .”
“ T h is is hard. T h is is re a lly , r e a lly
hard. M y heart g o e s o u t to b u s in e s s
A n d , y o u k n o w , th is g u y is s o m e o n e I
“ T h is is to u g h . T h is is to u g h b e ­
h a v e k n o w n an d ta k e n c a rc o f fo r a
ca u se 1 w a n t y o u g u y s to be s u c c e s s ­
owners and w o rk e rs an d p e o p le w h o s e
lo n g tim e . W e h a v e b een d o w n a lo t o f
fu l. I w a n t y o u r b u sin e sse s to b e s u c ­
jobs are threatened. W e d e te rm in e w h o
ro a d s together. I trie d to ta lk h im in to
c e s s fu l. I w a n t to te ll a ll o f m y fr ie n d s to
we are in o u r se lf-e s te e m an d o u r l i v e l i ­
q u ittin g s m o k in g and he a c tu a lly f in a lly
c o m e to y o u r b o w lin g a lle y now 1 b e ­
hood by h o w w e p r o v id e fo r o u r f a m i­
a c c o m p lis h e d it a c o u p le y e a rs ago, a f­
ca u se th ey ca n c o m e th ere an d not
lies and h o w w e p r o v id e fo r a n d m eet
ter h is lu n g s g o t so b ad that he w a s o n
h a v e to be p la g u e d b y th e sm o k e . Y o u
our personal needs. E v e r y tim e w e h a v e
o x y g e n a ll the tim e .”
“ T h e o th e r th in g that s w a y s m e is
a Board m eetin g, I fin d m y s e lf c o m in g
closer and c lo s e r to s a y in g , ‘ G o s h ,
y o u k n o w th e y c h a n g e d the d ea th c e r­
can’t we fin d a c o m p ro m is e h e re ? C a n ’ t
tific a te . 1 ta ke care o f o ld e r p e o p le a lot.
are g o in g th ro u g h a to u g h tim e rig h t
n o w , and 1 am so rry . B u t I t h in k th is
re s o lu tio n , the b a n n in g s m o k in g , is the
r ig h t th in g .” ■
June, 2004
X
PCMS BULLETIN
9
B
u l l e t in
Matt Rice
fro m p age 7
im p o r t a n t a n d r e la t iv e to w h a t w e see
g r o u p s th a t h a v e a n in t e r e s t in le g is la ­
e v e r y d a y in m e d ic in e : h o m e le s s n e s s ,
t iv e is s u e s . H e ’ s b e e n le a r n in g th e n u ­
s u p p o r ts a n d p a r t ic ip a t e s in v a r io u s
la c k o f in s u r a n c e , is s u e s a f fe c t in g th e
a n c e s o f g e t tin g in v o lv e d in th e p r o ­
c o m m u n it y e v e n ts a n d o r g a n iz a tio n s .
e ld e r ly , jo b le s s n e s s . I b e lie v e m y e x p e r i­
c e s s , a n d w h ile h e m ig h t n o t b e ta kin g
e n c e g iv e s m e a b r o a d p e r s p e c t iv e ,”
th e p lu n g e e a r ly in th e g a m e , he is con­
P rep arin g to Run
th er. O n e t h in g is c e r t a in , h o w e v e r. This
R ic e h a s liv e d in G i g H a r b o r s in c e
19 8 8 . H e a n d h is w if e , K i r i n , h a v e th re e
d o g s . D e s p it e h is b u s y p r o f e s s io n a l
s c h e d u le , h e s w e a r s h e h a s s p a re t im e
f id e n t th a t h is t im in g is n o t to o late, ei­
W h ile th e re w a s n e v e r a n y q u e s ­
is su re to be a h ig h ly v is ib le cam p aig n ,
a n d e n jo y s g a r d e n in g , k a y a k in g , h i k in g
t io n th a t R ic e w a s c o m m itt e d to b e c o m ­
“ I w i l l n e e d th e s u p p o r t o f a lo t o f fo lks
a n d a n y t h in g e ls e th a t is r e la te d to he
in g a c t iv e ly in v o lv e d in th e p o lit ic a l
to g e t m y m e s s a g e o u t th e re ,” R ic e
o u td o o rs . “ I lo v e n a tu r e ,” h e s a id .
p r o c e s s , th e d e c is io n to ta k e th e le a p
s a id . “ T h a t ’ s h o w I w i l l b e s u c c e s s fu l in
a n d ru n f o r o f f ic e d id n o t c o m e lig h tly .
th e c a m p a ig n a n d u lt im a t e ly h a v e the
T h e Issu es
W it h a u n iq u e p e r s p e c t iv e th at
W h ile h is c o lle a g u e s , fr ie n d s a n d a s s o ­
o p p o r t u n it y to r e p r e s e n t th o s e w h o
c ia te s are e x c it e d a n d s u p p o r tiv e , an i m ­
h a v e s im ila r v ie w s . ”
c o m e s w it h h is e x p e r ie n c e in m e d ic in e ,
p e n d in g c a m p a ig n a n d th e v e r y re a l
b u s in e s s , la w , th e m ilit a r y , a n d e d u c a ­
p o s s ib ilit y o f b e in g e le c te d is p e rh a p s
“ I f e le c te d , I ’ m lo o k in g fo rw a rd to
w o r k in g w it h s o m e o u ts ta n d in g peop le
tio n , R ic e c o m e s to th e c a m p a ig n w it h a
n o t th e b e s t b u s in e s s d e c is io n R ic e
in o u r s o c ie ty ,” R ic e e x p la in e d , “ peo p le
b r o a d p e r s p e c t iv e a n d re a d y to ta c k le a
c o u ld m a k e . “ I h a v e 3 0 0 d o c to r s w h o
w h o are c o re to w h a t w e d o , b u t w h o
w id e v a r ie t y o f is s u e s . H is f ir s t o r d e r o f
a re d e p e n d in g on m e in m y j o b , ” he
a re n o t a lw a y s h e a r d - p ro fe s s io n a l
b u s in e s s i f e le c te d , h e s a y s , is to
sa id . “ I w a n t to m a k e su re m y d e c is io n
p e o p le as w e ll as th e a v e ra g e person.
“ lis t e n ..a lo t . ”
d o e s n ’ t h u rt th e p e o p le w h o are c o u n t­
A l l p e o p le c o n t r ib u t e to o u r s o c ie ty . I
in g o n m e .” R ic e h a s w o r k e d h a rd to
lo o k f o r w a r d to s e r v in g v a r io u s groups
A m o n g th e c r it ic a l is s u e s th a t w i l l
h ig h lig h t th e c a m p a ig n are:
• T ort reform . “ I a m o b v io u s ly
c o m m u n ic a te w it h th e p h y s ic ia n s an d
a n d p r o v id in g th e b e s t re p re se n ta tio n
m a k e s u re th e y u n d e rs ta n d w h a t h is
p o s s ib le . ”
lim it a t io n s c o u ld p o s s ib ly b e in the
R ic e re ite r a te s th a t h is d e c is io n to
c o m in g m o n th s , an d is ta k in g m e a su re s
in n f o r o f f ic e i s n ’ t b a s e d o n u n seating
j u s t f o r p h y s ic ia n s , b u t fo r s o c ie t y as a
to e n s u re th e y h a v e th e s u p p o r t th e y
an u n p o p u la r in c u m b e n t, b u t a b o u t be­
w h o le . I t ’ s an is s u e w e n e e d to a d d re s s ,
n e e d . “ I h a v e a ls o a ssu re d th e m th at
lie v in g th a t h e c a n t r u ly m a k e a d iffe r ­
b e c a u s e it is a c a n c e r e r o d in g th e v e r y
th e y w i l l be a p a rt o f t h e p r o c e s s a n d I
e n c e as th e 2 6 "’ D is t r ic t re p re se n ta tiv e .
c o r e o f w h a t is im p o r t a n t to u s as
w i l l w e lc o m e an d e n c o u ra g e t h e ir in ­
“ T h e in c u m b e n t is a g o o d p e rs o n ,”
A m e r ic a n s . W e m u s t n o t lo s e s ig h t o f
p u t ."
R ic e s a id , “ b u t I b e lie v e th a t o n e -to -
v e r y in te r e s te d in to r t r e fo r m , b u t n o t
th e in d iv id u a ls w h o in m a n y c a s e s d o
O v e r th e c o m in g m o n th s . R ic e w i l l
o n e , I ’ m th e b e tte r c a n d id a te . I t ’s im p o r­
n e e d p r o t e c t io n , b u t w e c a n n o t a llo w
f i l e h is p a p e rs an d b e g in th e p ro c e s s .
ta n t lo g e t a fr e s h - e y e d v ie w o f w h a t
th e c o n t in u in g a b u s e .”
T h e fir s t step, he s a id , is to g e t h is
w e d o in t h is sta te a n d n o t j u s t lo o k at
n a m e o u t th e re . H e h a s b ee n w o r k in g
h o w w e ’ v e d o n e th in g s in th e past. We
it y o f m e d ic a l c a re . “ T h is is an is s u e at
c lo s e ly w it h re p re s e n ta tiv e s o f th e lo c a l
n e e d to f in d s o lu t io n s th a t w i l l serv e us
th e fo r e f r o n t, a n d v e r y im p o r ta n t to
a n d state R e p u b lic a n P a r ty a n d w it h
to d a y a n d in th e fu tu r e .” ■
• A c ce ss to care a n d th e a v a ila b il­
b u s in e s s e s a n d in d iv id u a ls . ”
• T ran sp ortation . “ T r a n s p o r ta tio n
is a n is s u e th a t im p a c ts o u r e n tir e s o c ia l
s tr u c tu r e - p e o p le , jo b s , e tc.,
h e sa id .
MEDICAL LICENSURE ISSUES
M r . R o c k w e ll is a v a ila b le Lo re p re s e n t p h y s ic ia n s a n d o th e r h e a lth ca re
“ W h il e I d o n ’ t h a v e a ll th e a n s w e rs to
p r o v id e r s w ith is s u e s o f c o n c e rn b e fo r e th e S ta te M e d ic a l Q u a lit y A s s u r a n c e
o u r tr a n s p o rt a t io n p r o b le m s , I d o h a v e
C o m m is s io n . M r . R o c k w e ll, a p p o in te d b y G o v e r n o r B o o t h G a r d n e r , s e rv e d fo r
a lo g ic a l m in d a n d a n o p e n n e s s to
1 9 8 5 -1 9 9 3 . S in c e th e n , M r . R o c k w e ll has s u c c e s s f u lly re p re s e n te d o v e r 6 0
le a r n in g .”
• E du cation . F o r R ic e , e d u c a tio n
h a s a lw a y s b e e n a p a s s io n . H e h a s e x ­
te n s iv e e x p e r ie n c e in r e s id e n c y t r a in ­
in g , a n d h a s h e ld n u m e ro u s f a c u lt y a s ­
s ig n m e n ts . “ I p la n to lo o k at s ta n d a rd s ,
e x p e c t a tio n s , a n d a lte r n a tiv e s to o u r
c u r r e n t s y s te m ,” h e sa id .
R ic e b e lie v e s h is e x p e r ie n c e as a
p h y s ic ia n is v e r y r e le v a n t to th e is s u e s
at h a n d . “ A l l o f t h e is s u e s a re s o c ia lly
10
P C M S BULLETIN
8 y e a rs as th e P u b lic B o a r d M e m b e r o f the M e d ic a l D i s c ip lin a r y B o a r d fro m
June, 2004
p h y s ic ia n s o n c h a ig e s b e t o ie the M Q A C . M r . R o c k w e l l's fe e s a re c o m p e t it iv e
a n d th e s u b je c t o f a c o n fid e n t ia l a t lo r n e y - c h e n t r e p r e s e n ta tio n a g re e m e n t.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(425) 453-4398 • FAX (425) 453-1534
email: [email protected] • website: 'vww.gregrockwelllaw.com
'3 P ie m 'tv o iai/if Q (le d ir a J r % e ie h j
In My Opinion....
The Invisible Hand
b y A n d r e w s ta ts o n , m d
The opin ion s e xp re ss e d in th is w r it in g a re s o le ly th o s e o f th e a u t h o r. P C M S in v ite s m e m b e rs to e x p re ss th e ir o p in io n /in s ig h ts a b o u t s u b je c ts
relevant to the m e d ic a l com m un ity, o r s h a re th e ir g e n e r a l in te rest sto rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C om m ittee review .
Running Faster
“The m ost curious p a r t o f the th in g im v , that the trees a n d the
other things ro u n d them n e ve r c h a n g ed their p la ce s a t all:
how ever f a s t th ey went, they n ever se e m e d to p a ss anything, ”
A n d rew Statson, MD
“ T h ro u g h the L o o k in g G la s s ” L e w is C a r r o ll (1 8 6 5 )
Y o u p ro b a b ly u n d e rsta n d v e r y w e ll
w o r k h o u rs d id . W h y d id the p h y s ic ia n s
how A lic e fe lt. F o r y ears w e h a v e been
in c re a s e th e ir w o r k h o u rs ? W a s n ’ t it to
running faster and faster, j u s t so w e
a v o id an e v e n b ig g e r d ro p in th e ir in ­
could stay in the sam e p la c e .
co m e ?
D u rin g the past ten y e a rs, a n u m ­
A n o t h e r paper, fro m the In d ia n a
ber o f papers ap p eared in the m e d ic a l
U n iv e r s it y S c h o o l o f B u s in e s s , c a lc u ­
literature d is c u s s in g a n e w to p ic , p h y s i­
la te d th at fo r e v e ry o n e d o lla r d ro p in
cian satisfactio n (o r is it d is s a tis fa c ­
h o u r ly net in c o m e , th e p o p u la tio n o f r e ­
tion?). T hese stu d ies w e re b a s e d on re ­
tir e d p h y s ic ia n s in c re a s e d b y 1.46%
sponses to q u e stio n n a ire s. T h a t is at
w it h in tw o years. B a s e d on fig u re s fro m
least as su b je ctiv e as a s s e s s in g p a in on
199 9 , an e a rn in g s d e c lin e o f t e n d o lla r s
a scale o f zero to ten. F o r w h a te v e r th e y
p e r h o u r w i l l m o tiv a te e le v e n th o u san d
are worth, I ’ l l g iv e y o u so m e fig u re s .
p h y s ic ia n s to re tire early. H o w e v e r, the
In Jan ua ry 2 0 0 3 , JA M A p u b l ishe d
a u th o rs say, d o n ’ t w o rry . W e h a ve an
an article on the ch a n g e s in c a re e r sat­
e x cess o f 5 0 .0 0 0 - 150,0 0 0 p h y s ic ia n s in
isfaction o f p h y s ic ia n s in 1 9 9 7 -2 0 0 1 . In
th is c o u n try , so th e p h y s ic ia n su rp lu s
1997,42.4% o f p rim a ry ca re p h y s ic ia n s
w i l l c o n tin u e f o r a w h ile .
and 43.3% o f s p e c ia lis ts w e re v e r y sat­
T h e C e n te r fo r S t u d y in g H e a lth
isfied. T hat w e n t d o w n to 3 8 .5 % and
S y s te m C h a n g e re p o rte d in M a y 2 0 0 3
41.4% in 2 0 01, n o t m u c h o f a d rop .
th a t b e tw e e n 1997 an d 2001 th e p h y s i­
However, am o n g lo c a tio n s , o n ly 8.8%
c ia n s ’ a b ilit y to p r o v id e s e rv ic e s a c ­
o f physicians in L a n s in g , M ic h ig a n
c o rd in g to d e m a n d tig h ten ed . P a tie n ts
were very d is s a tis fie d , c o m p a re d w ith
w a ite d lo n g e r fo r a p p o in tm e n ts and
34.2% in M ia m i, F lo r id a . It m u s t be a
m o re p h y s ic ia n s re p o rte d h a v in g in a d ­
question o f c lim a te . T h e p h y s ic ia n s in
eq u ate tim e w ith p atie n ts. In resp o nse ,
Lansing m u st lik e th e s n o w — it k e e p s
m o re p h y s ic ia n s w o r k e d w ith n u rse
the law yers aw ay.
p r a c titio n e r s an d o th e r ca re g iv e rs . C u r ­
The strongest fa cto rs o f d is s a tis ­
r e n tly , the a u th o rs c o n c lu d e d , p h y s ic ia n
faction w ere the lo s s o f p h y s ic ia n a u ­
c a p a c ity c o n s tra in ts m ig h t ease i f
tonomy, in c lu d in g an in c re a s e in w o r k
h ig h e r o u t-o f-p o c k e t co sts p ro m p t p a ­
hours, and the la c k o f a b ilit y to o b ta in
tie n ts to s e e k le s s care.
required se rv ic e s f o r th e ir p a tie n ts. T h e
article c o n c lu d e d th a t th e d e c lin e in in ­
D e c re a s e d p a y m e n ts p ro m p te d us
to in c re a s e o u r w o r k w e e k . T h ir t y y e a rs
come d id n o t h a v e m u c h to d o w it h a
a g o a c o m e d ia n sa id that i f y o u w a n te d
drop in sa tisfa ctio n , b u t th e in c re a s e in
a d o c to r on a W e d n e sd a y , y o u h a d to
g o to th e g o l f c o u rse . N o t a n y m o re.
T o d a y w e c a n n o t a ffo rd to ta k e a d ay
o f f d u rin g the w e e k , e v e n th o u g h w e
c o n tin u e to ta ke the sa m e n ig h t and
w e e k e n d c a lls . W e fr e q u e n tly sta rt m a k ­
in g h o s p ita l ro u n d s b e fo re 7 o ’ c lo c k ,
then w o r k in o u r o ffic e s o r the O R w it h
b a re ly fifte e n m in u te s fo r lu n c h , an d d o
n o t g et h o m e u n til 7 o ’ c lo c k at n ig h t o r
later.
In S e p te m b e r 2 0 0 3 , th e A m erican
J o u rn a l o f O bstetrics a n d G ynecology
p u b lis h e d a p o ll o f th e H o u s to n o b s te ­
tric ia n s . A b o u t 62 % o f th e m re p o rte d
w o r k in g m o re than e ig h ty h o u rs a
w e e k . T h a t is m o re than the m a x im u m
a llo w e d f o r re sid e n ts u n d e r c u rre n t
ru le s. A p riv a te p r a c titio n e r ca n o n ly
d re a m o f th irte e n h o u r s h ifts o n c a ll
a n d a d a y o f f a fte r w o r k in g at n ig h t.
In 1990, W e e k s a n d W a lla c e d id a
study, c o m p a r in g e d u c a tio n a l co sts
an d in c o m e s o f p h y s ic ia n s an d o th e r
p ro fe s s io n a ls , p u b lis h e d in M a y 1994
in the N ew E n g la n d Jo u rn a l o f M edi­
cine. T h e a n n u a l y ie ld on th e e d u c a ­
tio n a l in v e s tm e n t o v e r a w o r k in g lif e
(h o u rs-a d ju ste d in te rn a l rate o f retu rn )
w a s 16% fo r p r im a r y ca re p h y s ic ia n s ,
21 % fo r s p e c ia lis ts , 21 % fo r d e n tists,
2 5 % f o r a tto rn e y s a n d 29 % f o r b u s i­
n e ssm e n.
T h e y re p e a te d th e a b o v e s tu d y in
1997 an d p u b lis h e d it in A p r il 2 0 0 2 in
See “ Running” page 18
June, 2004
PCMS BULLETIN
11
B
u l l e t in
Connecticut doctors push for tort reform veto
C o n n e c t ic u t G o v . J o h n G. R o w la n d
B u t la w y e r s a n d s o m e c o n s u m e r
is e x p e c t e d to v e to to r t r e f o r m th e L e g ­
a d v o c a te s a rg u e d th a t a n a w a r d lim it
te d to b e in g w r o n g a n d i f th e defendant
is la t u r e p a s s e d e a r lie r t h is m o n th , a n d
w o u ld n ’ t re d u c e p h y s ic ia n s ’ in s u r a n c e
a n d p l a i n t i f f a g r e e d to le t th e com m ittee
t h a t ’ s j u s t f in e w it h p h y s ic ia n s .
ra te s a n d u lt im a t e ly w o u ld h u r t in ju r e d
d e t e r m in e th e a w a rd .
te r m in e d a m a g e s i f a d e fe n d a n t adm it­
T h e m e a s u r e d id n ’ t c o n t a in a c a p
p a tie n ts . C o n n e c t ic u t P a t ie n t s ’ R ig h t s ,
o n n o n e c o n o m ic d a m a g e s , s o m e t h in g
an a d v o c a c y g r o u p o f a b o u t 2 0 0 f a m i­
p r o v e d a b i l l th a t th e O h io Sta te M e d i­
p h y s ic ia n s a n d in s u r e r s a rg u e is k e y to
lie s , b e lie v e s th e le g is la t io n w o u ld b e
c a l A s s o c ia t io n b e lie v e s w o u ld reduce
s t a b iliz in g th e m e d ic a l l ia b il i t y in s u r ­
g o o d f o r th e sta te a n d is fa ir to a ll
th e n u m b e r o f n o n - m e r it o r io u s m e d ical
a n c e m a rk e t. “ T h e b i l l is t o t a lly in a d ­
s id e s . “ I t ’ s a r e m a r k a b le s ta rt,” s a id
m a lp r a c t ic e la w s u its . T h e m e a su re calls
e q u a te w it h o u t a n y c a p s ,” s a id C o n ­
Je a n R e x f o r d , th e g r o u p ’ s e x e c u tiv e d i­
f o r a c e r t if ic a t e o f e x p e r t re v ie w , tighter
n e c t ic u t S ta te M e d ic a l S o c ie t y E x e c u ­
rector.
m e d ic a l e x p e r t w it n e s s re q u ire m e n ts,
t iv e D ir e c t o r T im N o r b e c k .
M e a n w h ile , th e N e w H a m p s h ir e
A t p r e s s t im e , R o w la n d h a d n o t a n ­
In O h io , th e H o u s e o n M a y 5 ap­
an d a n “ I ’ m s o r r y ” la w th a t a llo w s doc­
S e n a te a p p r o v e d a b i l l th a t w o u ld c r e ­
to r s to a p o lo g iz e o r s y m p a t h iz e w hen
n o u n c e d w h e t h e r h e w o u ld s ig n th e
ate a c o m m itte e to r e v ie w m e d ic a l m a l­
th e re is a b a d o u t c o m e w it h o u t fe ar o f
b i ll , b u t o n s e v e r a l o c c a s io n s h e h a s
p r a c tic e la w s u it s b e fo re th e y g o to tr ia l.
t h e ir c o m m e n ts b e in g u s e d as evidence
s a id h e w o u ld n ’ t s ig n le g is la t io n w it h ­
T h e p a n e l w o u ld h a v e th e p o w e r to d e ­
o f lia b ility . ■
o u t a n a w a r d s lim it .
Seeking a summer camp nurse
E it h e r w a y , N o r b e c k s a id , p h y s i­
c ia n s w i l l g o b a c k to th e state c a p ita l
n e x t y e a r to lo b b y f o r a b i ll th a t in ­
YM C A C a m p S e y m o u r is lo o k in g f o r
a q u a lifie d H e a lth C a re D ire c to r d u r ­
ing the su m m e r fr o m J u n e 17 through
c lu d e s a n o n e c o n o m ic d a m a g e s cap .
U n t il th e n , h e s a id , m o r e p h y s i­
c ia n s w i l l re tire e a rly , le a v e C o n n e c t ic u t
o r r e d u c e s e r v ic e s to k e e p t h e ir in s u r ­
a n c e p r e m iu m s a f fo r d a b le . C o n n e c t ic u t
is o n e o f 19 sta te s th e A M A s a y s is e x ­
A u g u st 21 (fle x ib le hy week).
Q u a lifica tio n s: P re fe r R N d e g re e
a n d lic e n se to p r a c tic e in W ashington
Sta te (m in im u m E M T). A lso re q u ire
p e r ie n c in g a m e d ic a l l ia b il i t y c r is is .
ra-di-ol-o-gy \rad-e-‘al-e-je\u.
1: a branch of medicine utilizing exams such as
MRI (magnetic resonance imaging) and CT
(com puted tomography) in the diagnosis and
treatm ent of disease 2: a com m itm ent to
providing cutting-edge imaging services w ithout
the necessity of driving long distances; see TRA
M e d i c a l I m a g in g
TRA
4 7 0 0 P o in t F o s d ic k Dr, S te 1 10 • F o r m o r e in fo rm a tio n , c a ll (253) 7 6 1 -4 2 0 0
t ra m e d ic a lim a g in g .c o m
12
PC M S BULLETIN
June, 2004
k n o w le d g e o f/p r a c tic a l e xp erien ce in
h e a lth c a re fa c ility o rganization, pedi­
atrics, le a d e rsh ip a n d com m unication
sk ills.
F o r m o re in fo rm a tio n c o n ta c t Magill
La n g e, C a m p in g D irector, a t 460-8883
o r e m a il m la n g e @ y m c a ta c o m a .o rg .
✓
JPie-rce t •m '/ '! Q /(e fh c a / ^ fo r te h j
Medical Marijuana: Clearing the Air
by Charles H eaney, P h .D .
a n d use o f m e d ic a l m a riju a n a , a n d fu r ­
m e a n in g in c re a se d in tr a o c u la r p re ssu re
. that allow s fo r the m e d ic in a l use o f
th er, the " P h y s ic ia n s a ls o be e x c c p te d
u n r e lie v e d b y sta n d a rd tre a tm e n ts o f
■ marijuana; the others are C a lif o r n ia , A r i ­
fr o m lia b ility ' a n d p ro s e c u tio n fo r the
m e d ic a tio n s
W ashington is o ne o f n in e states
zona, H aw aii, A la s k a , N e v a d a , O re g o n ,
a u th o r iz a tio n o f m a riju a n a use to q u a li­
Colorado, and M a in e , A l l are the re s u lt
fy in g p a tie n ts fo r w h o , in the
b y the state M e d ic a l Q u a lit y A s s u r a n c e
of voter-approved in itia t iv e s w it h the
p h y s ic ia n ’s p ro fe s s io n a l ju d g m e n t,
C o m m is s io n
exception o f H a w a ii w h e re the state le g ­
m e d ic a l m a riju a n a m a y p ro v e b e n e fi­
islature passed a b i ll e n a c tin g m e d ic a l
c ia l.” (W ash . R e v is e d C o d e 69.51 A . 005)
F o r p h y s ic ia n s w h o b e lie v e that
marijuana p ro v isio n s.
In passing In itia tiv e 692 ( N o v e m ­
m a riju a n a ca n b e e f fic a c io u s in ce rta in
• A n y o th e r c o n d itio n s a p p ro v e d
( S in c e the p assag e o f t h e in it ia t iv e ,
th e C o m m is s io n has a d d e d H e p a t it is C
an d C r o h n ’s D is e a s e to th e lis t o f c o n ­
ber 3, 1998), W a s h in g to n v o te rs stated
s itu a tio n s an d w h o w o u ld be p o s it iv e ly
d itio n s c o n s id e re d a p p ro p ria te fo r
their b e lie f that “ ...som e p a tie n ts w it h
in c lin e d to re c o m m e n d , o r “ a u th o r iz e " it
m e d ic a l m arijuan a.)
terminal or d e b ilita tin g illn e s s e s , u n d e r
w h e n a p p ro p ria te , there are tw o k e y re ­
their p h y sicia n ’s care, m a y b e n e fit fr o m
s p o n s ib ilitie s u n d e r th e c u rre n t state
the m edical use o f m a rij ua na.” T h e y fu r ­
g u id e lin e s .
ther felt that the d e c is io n to a u th o riz e
First, they m ust establish that a
patient has a “term inal or debilitating
m edical condition” defined as:
marijuana fo r su ch p a tie n ts w a s a
“ ...personal, in d iv id u a l d e c is io n b ased
Second, the physician m ust pro­
vide the patient with “Valid D ocum en­
tation” which is defined as:
“ A sta te m en t s ig n e d b y a q u a lif y ­
in g p a tie n t’ s p h y s ic ia n , o r a c o p y o f the
upon their p h y s ic ia n ’s p ro fe s s io n a l
• C a n c e r, H IV , M S , e p ile p sy , o r
medical jud g m en t and d is c re tio n ."
The intent o f the p e o p le w a s cle a r,
o th e r s e iz u re o r s p a s tic ity d is o rd e r
• In tra c ta b le p a in , th a t w h ic h is u n ­
that q u a lify in g p atie n ts (th ose w it h
q u a lifie d p a tie n t’ s p e rtin e n t m e d ic a l
re c o rd s , w h ic h states that, in the
p h y s ic ia n ’ s p r o fe s s io n a l o p in io n , the
specified illn esse s o r c o n d itio n s ) o r
re lie v e d b y sta n d a rd m e d ic a l tre atm en ts
p o te n tia l b e n e fits o f the m e d ic a l use o f
their prim ary care g iv e rs c o u ld n o t be
an d m e d ic a tio n s
m a riju a n a w o u ld lik e ly o u tw e ig h the
• G la u c o m a , acu te o r c h ro n ic ,
convicted o f a c rim e fo r th e p o s s e s s io n
See “ Medical M arijuana" page 14
O u r C linical
Positron Emission Tom ography (PET)
PET Specialists
PET has been show n to b e an accu rate m e th o d to d iag n o se a n d stage cancer, ch eck for
tum or recu rren ce, an d m o n ito r c an ce r therapy. I n lo rm a tio n gain ed by th e use o f PET can be
used to d eterm in e w h at c o m b in a tio n o f surgery, ra d iatio n therapy, o r ch em o th e ra p y is m o st
likely to be successful in m an ag in g th e disease.
A n th o n y Larhs, M D
D ire cto r o f C linical PET
P h illip C Lesh, M D
P E T is also used to evaluate A lzh eim er’s disease,
*’ r>'
epilepsy, a n d cardiac disease.
"v
W illia m B Jackson, M D
M any in su rers, in clu d in g M edicare and
M edicaid, are re im b u rsin g for m any
PET procedures. T R A referral
Tacoma
c o o rd in a to rs will w ork w ith you to
com plete th e req u ired p re-exam
2 2 0 2 S C e d a r St, Ste 2 0 0
2 5 3 -7 6 1 -4 2 0 0
au th o rizatio n .
tra m e d ic a lim a g in g .c o m
Call our referral coordinators at
253-761-4200.
TRA I
June, 2004
PCMS BULLETIN
13
B
u l l e t in
Medical Marijuana
fr o m p a g e 13
h e a lt h r is k s f o r a p a r t ic u la r q u a lif y in g
a m o u n t n e c e s s a ry f o r a s ix t y - d a y s u p ­
p a t ie n t ...”
p ly ...” W h a t c o n s titu te s a 6 0 - d a y s u p ­
th e re is a g e n u in e d if f e r e n c e o f expert
p ly is n o t s p e c if ie d an d , o f c o u r s e , c a n
o p in io n o n th e s u b je c t, w it h sig n ifica n t
L a n g u a g e is v e r y im p o r t a n t h e re
o n to sta te th a t “ ...w h a t m a tte rs...is that
v a r y b a s e d o n a p a t ie n t ’s u n iq u e n e ed s.
a n d a n e c d o ta l e v id e n c e s u p p o rtin g
a n d “ w o u ld l i k e l y ” is th e k e y p h ra s e . I f
P a tie n ts , th e re fo re , m u s t e x e r c is e p r u ­
b o th p o in ts o f v ie w . ” T h e ju s t ic e then
th e p h y s ic ia n w r it e s th a t th e b e n e fit s
d e n c e in h o w m u c h m a r iju a n a th e y
w e n t o n to e x p re s s a s e n tim e n t that few
“ m a y o u t w e ig h ” th e r is k s , e tc., a p a tie n t
h a v e in th e re p o s s e s s io n at a n y g iv e n
w o u ld d is a g r e e w it h ; “ F o r th e great ma­
c o u ld b e in je o p a r d y o f p r o s e c u t io n
tim e . C le a r ly , a h u n d r e d p la n ts in th e
j o r i t y o f us w h o d o n o t s u ffe r fro m de­
a n d , in fa c t, a n a p p e a ls c o u r t in S p o ­
b a s e m e n t p r o b a b ly w o n ’ t c u t it w it h the
b ilit a t in g p a in , o r w h o h a v e n o t
k a n e u p h e ld th e c o n v ic t io n o f a p r im a r y
p o lic e .
c a r e g iv e r , in p a rt, fo r th a t v e r y re a so n .
w a tc h e d a lo v e d o n e w a s te a w ay...it
d o e s n ’ t m u c h m a tte r w h o h a s the better
A n d so th e c h o ic e is y o u r s as to
In its r u lin g , th e c o u r t d e c la r e d th a t “ It
w h e th e r y o u b e lie v e th a t m a r i ju a n a
is n o t e n o u g h f o r th e tre a tin g p h y s i­
p o s s e s s e s a n y m e d ic a l e f f ic a c y a n d
in g fr o m M S , c a n c e r, A I D S , o r one o f
c ia n s to s im p ly s a y th a t th e p o te n tia l
th a t it c o u ld b e a p p r o p r ia te fo r a n y o f
th e o th e r a f f lic t io n s ... a n d t h e ir lo v e d
b e n e f it s o f th e m e d ic a l u s e o f m a r iju a n a
y o u r p a tie n ts u n d e r th e g u id e lin e s set
o n e s, o b t a in in g c a n d id a n d r e lia b le in ­
m a y o u t w e ig h th e h e a lth r is k s f o r a
o u t b y th e state. T h e c o u r ts a n d W a s h ­
f o r m a t io n a b o u t a p o s s ib le a v e n u e o f
q u a lif ie d p a tie n t: th e sta tu te r e q u ir e s
in g to n Sta te h a v e g u a ra n te e d y o u th e
r e l i e f is o f v it a l im p o r t a n c e .”
th e p h y s ic ia n to e x p re s s h is o p in io n
r ig h t to d is c u s s a n d /o r a u th o r iz e its use
a b o u t th e m e d ic a l b e n e fit s o f m a r iju a n a
i f y o u c h o o s e to d o so fre e o f le g a l
W a s h in g t o n ’ s m e d ic a l m a r iju a n a regula­
to a le v e l o f m e d ic a l c e r ta in ty .” In o rd e r
c h a lle n g e s . F o r th o se o f y o u s tr u g g lin g
tio n s:
to h e lp p h y s ic ia n s a n d p a tie n ts a v o id
w it h th ese ju d g m e n ts , it m ig h t b e h e lp ­
o f th is d e b a te . B u t f o r p a tie n ts su ffe r­
F o r m o r e in f o r m a t io n o n
a n y d e f ic ie n c ie s in th e p r o v is io n o f
fu l to see h o w th e C o u r t o f A p p e a ls
W ash in gton State D ep t, o f Health:
v a lid d o c u m e n ta tio n , a fo r m w a s d e v e l­
d e a lt w it h the q u e s tio n s o f th e m e d ic a l
h ttp :// w w w . d o h .w a .g o v / T o p i cs/
o p e d th a t c o n t a in s th e n e c e s s a ry la n ­
b e n e fit o f m a riju a n a . M a k in g re fe re n c e
m a riju a n a % 2 0 F a c t% 2 0 S h e e t.D O C
g u a g e . T h e fo r m c a n be d o w n lo a d e d
to a n a ly s e s b y th e A m e r ic a n P u b lic
f r o m th e “ M e m b e r s h ip R e s o u r c e s / P r a c ­
F le a lth A s s o c ia t io n , th e In s titu te o f
ACLU:
tic e R e s o u r c e ” s e c tio n o f th e W S M A
M e d ic in e , a n d o th e r g ro u p s , a n d d e v e l­
h ttp :/ / w w w .a c lu -w a .o r g / is s u e s /
w e b s ite (w w w .w s m a .o r g ).
o p m e n ts in o th e r c o u n tr ie s , o n e o f the
w a r _ o n _ d r u g s / in d e x .h t m l ■
O n c e a p h y s ic ia n g iv e s th e p a tie n t
c o n c u r r in g j u s t ic e s a llu d e d to “ ...a le ­
a s ta te m e n t a u t h o r iz in g th e use o f m a r i­
g itim a t e a n d g r o w in g d iv is io n o f in ­
E xcerpted from K ing C ount)' M edical
ju a n a , th e p a tie n t c a n e ith e r g r o w h is o r
fo r m e d o p in io n o n th is is s u e " a n d w e n t
S o ciety 's The B ulletin, A pril 2004
h e r o w n p la n t s o r o b t a in a s u p p ly
th r o u g h p a tie n t n e tw o r k s s u c h as the
G r e e n C r o s s F o u n d a t io n ( 2 0 6 - 7 2 0 - 6 171
o r w w w . g r e e n c r o s s . o r g ). T h e p r in c ip le
s t ip u la t io n h e re is th a t a q u a lif y in g p a ­
tie n t c a n p o s s e s “ ...n o m o re m a r iju a n a
r a v ever6
th a n is n e c e s s a ry f o r th e p a t ie n t’s p e r­
L
s o n a l. m e d ic a l u se, n o t e x c e e d in g the
H e a lth
S e rv ic e
A Se rvice o f
N o r t h w e s t M e d i c a l s p e c i a l t i e s , PLLC
T A C O M A /P IE R C E C O U N T Y
O u t p a t ie n t G e n e r a l M e d i c a l C a r e .
F u l l a n d p a r t - t im e p o s it io n s
a v a ila b le in T a c o m a a n d v ic in it y .
V e r y f le x ib le s c h e d u le , W e l l s u it e d
fo r c a r e e r r e d e fin it io n fo r
G P , F P , IM .
INTERNATIONAL TR AVEL CAN BE
HAZARDOUS TO YO U R HEALTH
• P R E -TR A V E L C ARE
H O U RS
MON - FRI 9 - 5
• P O S T -T R A V E L CARE
CALL EARLY WHEN PLANNING
___
253-428 -8754
14
C o n ta c t A n d y T so i, MD (253) 752-9669
o r P a u l D o ty (A lien, N elso n . T u r n e r or
A S E R V IC E O F
A sso c .), C lin ic M a n a g e r (253) 383-4351
IN F E C T I O N S L IM IT E D P S
P C M S BULLETIN
June, 2004
o r 2 5 3 -6 2 7 -4 1 2 3
2 2 0 - 1 5 ,h A v e S E # B , P u y a llu p W A 9 8 3 7 2
PAf'fcc [f ( v ( n i/ ij r 'f l e d tea I rrfo n <‘( tf
lIn My Opinion
by Daisy Puracal, MD, ABHM
The opinions e x p re sse d in th is w ritin g a r e s o le ly th o s e o f th e a u t h o r P C M S in v ite s m e m b ers to e x p re ss th e ir o p in io n /in s ig h ts a b o u t su b je cts
ivievant to the m e d ic a l com m unity, o r s h a r e th e ir g e n e r a ! in te rest s to rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
Rainbows
I am z o o m in g no rth on ro u te 5 0 9
from Tacom a o v e r the a r c h in g s u s p e n ­
sion bridge w ith its ta ll tw in p illa r s an d
r a in b o w is th e b o w l G o d u se d to h o ld
D a is r P uracal. MD
h is p a in ts w h ile c o lo r in g the b ird s.
T h e m y s tic a l r a in b o w is v ie w e d by
white painted c a b le s fa n n in g o u t o n e i­
th e N a v a h o , P o ly n e s ia n s an d se v e ra l
ther side. T h is m a n -m a d e c o n c re te m a r­
o th e r c u ltu re s as a b r id g e b e tw e e n
vel, silhouettes stark, a g a in s t th e sky. 1
h e a v e n and earth. In a Ja p an ese m y th ,
whiz by the T a c o m a D o m e w it h its p y ra ­
firs t m an Is a n a g i and fir s t w o m a n
mids ofm u te d, b lu e g ra y c o lo r s c ir c lin g ,
Is a n a m i w a lk d o w n to earth fro m
E a c h ey e sees its o w n ra in b o w . S o too
ever paler tow ards the top, s im u la tin g
h e a v e n o n the m y th ic a l r a in b o w b rid g e
are p e rc e p tio n s e n tir e ly o u r o w n . R e ­
our states treasure - M o u n t R a in ie r (o r
c a lle d N ij i. T h e y w a tc h e d the a n im a ls
fle c te d ra y s ca u se th e lig h t to be
Mount Tahom a as it w a s o r ig in a lly
a n d le a rn e d h o w to m a k e lo v e . T h e y
b rig h te r in s id e th e b o w (i.e., th e r a in ­
called). A s I crest the c o n c re te sn ake ,
w a tc h e d th e b ird s an d le a rn e d to eat
b o w e n c a p su la te s th e lig h t). A ls o , the
suspended h ig h a b o v e m o rta l g ro u n d ,
w it h c h o p s tic k s .
r a in b o w can o n ly be seen w h e n the su n
the horizon stretches 3 6 0 d eg ree s
T h e r a in b o w has in s p ire d artists
e y e o f the o b s e rv e r b y w a te r d ro p le ts.
is b e h in d y o u - th e su n b e in g the rea l
around me. T o m y rig h t is th e m a je s tic ,
th ro u g h c e n tu rie s an d is o ne o f the fir s t
s o u rc e o f the s p e c ta c u la r o p tic a l lig h t
mystical m o u n tain it s e lf w ith its e v e r-
d r a w in g s that y o u see a c h ild en gag e
sh ow .
changing face, each m o re b e a u tifu l than
in . B u t no p a in t in g can e v e r tr u ly c a p ­
the last. A n d in fro n t o f m e . . .jo y oh
ture th at e v a n e s c e n t lu m in o s it y in its
in te rn a l r e fle c tio n s in s id e the ra in d ro p
jo y .. .a rare sp e cta cle o f w o n d e r - a
th ree d im e n s io n a l g lo ry . “ T o g ild re ­
w it h a re v e rsa l o f th e c o lo r s o f th e p r i­
panoramic v ie w o f a d o u b le r a in b o w !! A
fin e d g o ld , to p a in t th e l i l y .. .o r ad d a n ­
m a ry ra in b o w . It is n o t a r e p lic a tio n o f
promise o f hope. N o , a d o u b le p r o m is e
o th e r h u e u n to the r a in b o w is w a ste fu l
the firs t - th e s e c o n d a ry r a in b o w is a c ­
ofhope - lik e b irth d a y s an d C h r is t ­
and r id ic u lo u s in e x c e s s ,” d e c la re s
tu a lly a f lip s id e o f the firs t - a g e n tle re ­
mases w rapped in one.
S h a k e s p e a re in K in g Jo hn .
In C h ris tia n tra d itio n th e r a in b o w is
T h e Iris h sa y that at the e n d o f the
A d o u b le r a in b o w o c c u rs w it h tw o
m in d e r th at there are tw o s id e s to a
sto ry .
the re c o n cilia tio n b etw e en G o d and h u ­
r a in b o w is a p o t o f g o ld . A s a c h ild I
manity - a p ro m is e to N o a h th a t G o d
used to w o n d e r w h e re th e en d o f the
p rie s t d e s c rib e s o u r liv e s as an arc
would not d e stro y the ea rth a g a in b y
r a in b o w w a s an d i f th e r a in b o w e n ­
s tre tc h in g fro m th e d a rk n e s s o f th e u n ­
flooding. T h e M a y a n s te ll o f th e f ie r y
c ir c le d the earth, to b e seen at the sam e
k n o w n b e fo re b irth to the d a rk n e s s o f
rain that fe ll w re a k in g d e s tru c tio n b e ­
m o m e n t b y s o m e o n e on the o th e r sid e
tim e a fte r death. S tre tc h in g th is im a g e a
Jo h n O ’ D o n o h u e , an Irish C a t h o lic
low. Those that e sca p e d s a w a r a in b o w
o f the w o r ld . I w a n ted to fin d that p o t
lit tle fu rth e r it is as I tu rn to the su n (o r
appear as a sig n th at the d e s tru c tio n
o f g o ld . B u t i f y o u run to w a rd s the ra in ­
s o u rc e o f lif e ) that m y lif e ta ke s on hues
was over and a n e w age h a d b eg u n .
b o w it m o v e s a w a y fro m y o u b e fo re
that I n e v e r d re a m e d p o s s ib le an d m y
y o u g et there. It is as illu s o r y as a m i ­
w o r ld a p p ea rs lig h te r an d b rig h te r lik e
beauty, “ its o w n e x c u s e fo r b e in g ,” to
rage. T h e v is io n o f b e a u ty is rea l but
th e in s id e o f the ra in b o w . I lik e to th in k
use the w o rd s o f E m e rs o n , to o k m y
th e r a in b o w is eth e re a l a n d in ta n g ib le .
that w h e n I am in tu n e to and re fle c t
breath away. “ M y he art le a p s u p w h e n I
“ T h e r a in b o w ’ s lo v e ly fo rm v a n is h e s in
th is s o u rc e o f b e in g , a s e c o n d a ry r a in ­
behold a ra in b o w in th e sk y ,” say s
the s to rm ,” to q u o te R o b e rt B u m s in
b o w fo rm s in the liv e s I b ru sh a g a in s t -
Wordsworth. B a s k in g in the g lo w o f
T o m O ’ Shanter.
ju s t as so v e r y m a n y h a v e to u c h e d m y
T his c o lo r fu l a rch , th is v is io n o f
that ephem eral, irid e s c e n t be a u ty , I
T h e r a in b o w is s u n lig h t sp read o u t
lif e an d in s p ire d m e.
come hom e to m y m u n d a n e ta sks but
in to its sp e c tru m o f c o lo r s fro m red to
am buoyant w it h th at b ru s h w it h G o d ’ s
v io le t an d e v e n b e y o n d the c o lo r s that
at m y b a c k , to p a in t th e c a n v a s o f m y
palette. In a G e rm a n c re a tio n m y th th e
the e y e can see an d is d iv e rte d to the
lif e in w a y s th at I c o u ld n o t o n m y o w n . i
S o , I ’ m w o r k in g o n k e e p in g the su n
June, 2004
PCMS BULLETIN
15
B
u l l e t in
fro m page 3
J D a t S e a ttle U n iv e r s it y S c h o o l o f L a w .
o th e r v e te r a n o r g a n iz a tio n s . H is c a m -
o n b e h a lf o f p a t ie n t a c c e s s a n d other
D r . R ic e is a p r o lif ic w r ite r , in c lu d in g
p a ig n c a n b e re a c h e d a t 2 5 3 - 5 6 4 -4 6 1 3 ,
m e d ic a l is s u e s . H e d e s e rv e s stro n g
te x t b o o k s a n d p e r io d ic a ls d e a lin g w it h
w w w .e le c tb o b @ a t t.n e t, w w w .b o b
P C M S a n d W S M A s u p p o rt, fin a n c ia l
t o p ic s r e la te d to e m e r g e n c y m e d ic in e .
la w re n c e .n e t o r P O B o x 3 9 3 2 0 , L a k e ­
a n d o th e r w is e .
H e a ls o a u th o re d a n a r t ic le title d ,
w o o d W A 98439.
“ M e d i c a l M a lp r a c t ic e In s u r a n c e ,”
W h o m to s u p p o r t? H o w m u c h to
N o w th a t w e ’ v e b e e n in t r o d u c e d , it
g iv e ? H o w d e e p ly in v o lv e d to become?
p o s t e d o n th e A C E P w e b s it e M a r c h
is u p to a ll o f u s to b e c o m e f a m ilia r w it h
W e a n s w e r th e se q u e s tio n s as in d i­
2 0 0 4 . H e c a n b e r e a c h e d at w w w .m a t t_
th e p o lit ic a l p o s it io n s o f th e se an d
v id u a ls . In a d e m o c r a c y , w e a ll h ave the
r ic e @ t e a m h e a lt h .c o m .
o th e r c a n d id a te s . I h a v e h a d th e o p p o r ­
r ig h t to m a k e o u r o w n c h o ic e s . In fo r­
t u n it y to m e e t a n d t a lk w it h D r. M a t t
m u la t in g s u c h c o n c lu s io n s , I a s k that
s tr u c to r f o r b o th g ra d u a te a n d u n d e r ­
R ic e a n d re c o m m e n d h im to y o u as an
y o u j e t t is o n p a r t y a lig n m e n t an d fo llo w
g ra d u a te s tu d e n ts in o r g a n iz a t io n a l
e x c e lle n t c a n d id a te f o r r e p r e s e n ta tiv e o f
o u r e t h ic a l d ir e c t io n s a s k in g us to
le a d e r s h ip / b e h a v io r a n d e th ic s fo r the
th e 2 6 th d is tr ic t. I f y o u r b o a r d a p ­
“ ...c o n trib u te to th e im p r o v e m e n t o fth e
lo c a l C h a p m a n U n iv e r s it y c a m p u s . H e
p ro v e s , w e w i l l be d e s ig n in g w a y s to
c o m m u n it y a n d th e b e tte rm e n t o f public
w a s r e c e n t ly s e le c te d in s t r u c t o r o f the
a c q u ir e n a m e r e c o g n itio n f o r D r. R ic e
h e a lth ” a n d “ ...s u p p o r t th e acce ss to
y e a r. B o b is a m e m b e r o f t h e C lo v e r
a lo n g w it h p o s s ib le fu n d r a is in g id e a s.
m e d ic a l c a re f o r a ll p e o p le .” B y keeping
th e p a tie n t fir s t, a n d f o llo w in g o u r ethi­
B o b L a w r e n c e , 5 6 , is a c o lle g e in ­
P a rk R o ta ry , L a k e w o o d C h a m b e r o f
M i k e C a r r e ll h a s a p r o v e n r e c o r d o f a c ­
C o m m e r c e a n d T a c o m a E lk s . H e is a lif e ­
c o m p lis h m e n t o f s u p p o r t o f m e d ic a l is ­
c a l g u id e lin e s , w e w i l l m a k e th e righ t
tim e m e m b e r o f t h e D is a b le d A m e r ic a n
su es in c lu d in g lia b ilit y r e fo rm . H is
c h o ic e s . *
V e te r a n s , A ir lif t / T a n k e r A s s o c ia t io n an d
w o u ld b e a s tr o n g v o ic e in th e se n a te
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16
P C M S
BULLETIN
June, 2004
________________________ Sponsored by the Washington State Medical Association
V
n:e t i.U /lh f
•" '
If . J t n i /
i-
hj
WAMPAC endorsements of statewide candidates explained
The W ash in g ton M e d ic a l P o lit ic a l
Action C o m m ittee ( W A M P A C ) re c e n tly
It a ls o is a r e m in d e r o f o th e r p o in ts
w o rth n o tin g :
it m o re d i ff ic u lt to w o r k w ith d e m o c ra ts
voted to endorse D in o R o s s i fo r G o v e r ­
nor. W A M P A C is the W a s h in g to n State
h is o r h e r p o s itio n o n to rt r e fo r m m a k e s
on issu e s o f a cc e ss, fo r e x a m p le , lo s e
• T h e W A M P A C B o a r d is in d e ­
s ig h t o f the fa c t that to rt re fo r m is an
Medical A s s o c ia tio n ’ s p o lit ic a l a c tio n
p e n d e n t o f the W S M A B o a r d o f T r u s t ­
committee.
ees. Its e n d o rs e m e n t d e c is io n s w e re
in c u m b e n t d e m o c ra ts are t r y in g to m a k e
b a se d o n in t e r v ie w s w it h the c a n d i­
a c ce s s to care, sc o p e o f p r a c tic e an d
dorse candidates w h o s u p p o rt m e a n ­
d ates, w it h th e ir re sp o n se s a p p lie d
to rt re fo rm (to n a m e th ree) issu e s a ll
ingful tort re fo rm ,” n o te d D o n R u s s e ll.
a g a in s t th e g o a ls a n d o b je c tiv e s o f the
m u tu a lly e x c lu s iv e - an d th e y are not.
DO, chairm an o f W A M P A C an d a p e ­
W SM A.
“ O ur n u m b er o ne g o a l is to e n ­
diatrician fro m P u y a llu p . “ M r . R o s s i is a
strong supporter o f to rt re fo rm . I-Iis v o t ­
a cc e ss to c a re issu e , an d that to o m a n y
• M a t u r e p o lit ic ia n s w i l l u n d e r­
• T h e W S M A o rg a n iz a tio n a l p r io r i­
sta n d and re sp e c t w h y an in te re st
ing record in the Se na te d e m o n stra te s
tie s, su g g e ste d b y th e E x e c u t iv e C o m ­
g ro u p m a k e s a p o lic y - b a s e d d e c is io n to
this.”
m itte e a n d a p p ro v e d b y the B o a r d o f
e n d o rse an o p p o n e n t. T h e y m a y not
Rossi re ce iv e d h ig h m a rk s fr o m the
T ru s te e s an d H o u s e o f D e le g a te s, p ro ­
lik e it, but th e y w i l l re sp e c t the ra tio n a le
PAC for w o rk in g to p re s e rv e p a tie n ts ’
v id e th e b a s is fo r o u r b u s in e s s p la n
a n d w i l l n o t p u n is h b ro a d e r c o n s titu e n ­
access to health care in W a s h in g to n
an d b u d g e tin g ea ch year.
c ie s w h e n th e ir in te re sts are a lso s u p ­
p o rte d b y the a s s o c ia tio n ( in o th e r
State w h ile a m e m b e r o f th e State S e n ­
ate. In his in te rv ie w w it h th e W A M P A C
board, R o ssi co m m itte d h im s e lf to w o r k
• T h e 2 0 0 4 B u s in e s s P la n re p re ­
sents th e W S M A ’s c o n c re te p la n to
w o rd s, i f A tt o r n e y G e n e ra l G r e g o ir e is
e le c te d g o v e rn o r, sh e s h o u ld n o t a u to ­
to im prove p a tie n ts ’ acce ss to h e a lth
im p le m e n t p o lic ie s an d p ro g ra m s that
m a t ic a lly re je c t o u r p o s itio n s o n b e h a lf
care, p a rtic u la rly th e ir d o c to rs , b y w o r k ­
s u p p o rt th e need s o f p h y s ic ia n s and
o f p a tie n ts o n issu e s o th e r th an to rt re ­
ing to reform the state’ s lia b ilit y sy ste m
th e c o m m u n itie s y o u serve.
form).
if elected governor.
Based on th e ir s u p p o rt o f m e a n in g ­
• S o m e m e m b e rs are in c r e a s in g ly
• W S M A P r e s id e n t D r . J e f f C o ll i n s ’
fru s tra te d w ith th e id e a th at s o m e h o w
A p r il lette r to the m e m b e rs h ip lis te d 1 1
dorsed B ra d O w e n fo r L ie u te n a n t G o v ­
o u r a g e n d a w i l l b e b e tte r p u rsu e d b y
s p e c ific a c tiv itie s , 10 o f w h ic h are n o t
ernor and R o b M c K e n n a fo r a tto rn e y
ju s t b u ild in g “ ra p p o rt" w it h p o litic ia n s ,
to rt re fo rm , a n d m a n y o f th ese o th e r a c ­
general.
w h ile oth ers b e lie v e that p e rh a p s the
tiv itie s p u t the W S M A in p a rtn e rs h ip o r
W S M A w i l l be b etter resp e cted , a n d /o r
a lig n m e n t w it h lib e r a l c o n s titu e n c ie s
an d p o lic y -m a k e rs .
ful tort reform , W A M P A C a ls o e n ­
Brad O w e n , a D e m o c ra t, h as been
lieutenant g o v e rn o r sin c e 1996. In h is
le ss ta ke n fo r g ranted , i f it is seen as
role as chair o ft h e Se na te R u le s C o m ­
ta k in g a s tro n g sta n ce on issu e s and
mittee, Lt. G o v . O w e n v o te d in s u p p o rt
fig h t in g f o r it a g g re s s iv e ly .
• S ig n if ic a n t g ro w th in W S M A
m e m b e rs h ip an d W A M P A C m e m b e r­
ofthe O m nibus T o rt R e fo rm ( S B 5 7 2 8 )
b ill this past sessio n. B o t h the W S M A
and W A M P A C su p p o rte d S B 5 7 2 8.
Rob M c K e n n a , a R e p u b lic a n K in g
• R e p u b lic a n s an d d e m o c ra ts a lik e
sh ip r e fle c t a g r o w in g a w a re n e ss o f the
need to k n o w th at the s u p p o rt o f the
W S M A ’ s w o r k to p r o v id e s tro n g a d v o ­
W S M A is n o t u n c o n d itio n a l.
ca cy , w h ic h is c le a r ly a rtic u la te d , and
p h y s ic ia n d riv e n . ■
County co u n c ilm a n , has m a d e to rt re ­
form - and h is c o m m itm e n t to m e a n in g ­
• T h o s e w h o arg u e that s u p p o rt­
ful tort reform - a v e iy p u b lic p a rt o f h is
in g a r e p u b lic a n c a n d id a te b e ca u se o f
campaign fo r A tto r n e y G e n e ra l.
The ab ove a n n o u n c e m e n ts
sparked interest a n d q u e s tio n s b y s e v ­
eral W S M A m e m b ers. T h e i ■e w a s c o n ­
cern regarding s e le c tio n o f c a n d id a te s
based on a s in g le issue.
The W S M A ’ s re s p o n s e is that
these d iscu ssio n s d e m o n stra te th e v i ­
tality o f the W S M A le a d e rs h ip , and
healthy en g ag em ent b y p h y s ic ia n s in
the p o licy and p r io r itie s s e ttin g p r o ­
cesses o f the a s s o c ia tio n - w h ic h ca n
be view ed as tw o h a llm a rk s o f a g r o w >ng, responsive a s s o c ia tio n .
rfSji Allenmore
iX y Psychological
■ S i Associates, P.S.
. 752-7320 ■
—
D o yo u h ave p a tie n ts w i th difficu lt em o tio n a l
and stre ss-re la te d problem s? P syc h ia tric and
p sy c h o lo g ic a l co n su lta tio n s are a va ila b le.
U n ion A v e n u e P rofessional B uilding
--------------------1530 U n io n Ave,-S.. Ste. 16. Tacom a___________
June, 2004
PCMS BULLETIN
17
Running
f r o m p a g e 11
A c a d e m ic M e d ic in e . T h e h o u rs - a d -
n e s s e s . H e a f f ilia t e d w it h th e fir m
ju s t e d in t e r n a l ra te o f re tu rn w a s 16 %
M D V I P , c u t d o w n h is p a t ie n t p a n e l to
(th e n a m e s h o u ld b e fa m ilia r ) , ranking
f o r p r im a r y c a re p h y s ic ia n s , 18% f o r
6 0 0 , c h a r g in g e a c h o n e $ 1 ,5 0 0 .0 0 a year.
m e m b e r o f th e a b o v e m e n tio n e d co m ­
s p e c ia lis t s , 2 2 % f o r d e n tis ts , 2 3 % f o r
N o w h e h a s th e tim e to ta k e c a r e o f h is
m itte e , s a id , “ T h e d a n g e r is th at i f a
a tto r n e y s a n d 2 6 % fo r b u s in e s s m e n .
p a tie n ts a n d is p a id a d e q u a te ly .
la r g e n u m b e r o f d o c t o r s c h o o s e to
T h a t w a s b e f o r e th e r e c e n t s u rg e in l i ­
a b i l it y c o s ts .
I f I r e m e m b e r c o rre c tly , a m e d ic a l
g r o u p in S e a ttle s ta rte d a s im ila r p r o ­
S o w h a t is a p h y s ic ia n to d o ? W e
h a v e r e s p o n d e d to th e c u t in p a y m e n ts
R e p r e s e n t a tiv e P e te S ta rk , D -C a lif,
o p e n u p th e s e ty p e s o f p ra c tic e s , the
h e a lth c a re s y s te m w i l l b e c o m e even
g r a m , w it h th e g u a ra n te e th a t s u b s c r ib ­
m o r e in e q u it a b le th a n it is to d ay. The
in g p a tie n ts w i l l h a v e im m e d ia t e a v a il­
w e a lt h y w i l l p a y f o r e x c lu s iv e access to
w it h a n in c r e a s e o f w o r k in g h o u rs a n d a
a b ilit y o f a p h y s ic ia n a n d a lm o s t a ll
q u a lit y c a re a n d e v e r y o n e e ls e w ill con­
r e d u c t io n o f o u r o f f ic e c o s ts . O u r s t a f f
t h e ir c a re w i l l b e p r o v id e d b y t h e ir p e r ­
t in u e to h a v e in f e r io r a c c e s s to p rim a ry
a ls o s u ffe r , b e c a u s e w e c a n n o t a f fo r d to
s o n a l d o c to r. O u r in s u r a n c e c o m m is ­
c a re p h y s ic ia n s , s p e c ia lis t s an d basic
p a y th e m w e ll. W e c u t o n th e q u a lit y o f
s io n e r th o u g h t th a t w a s a f o r m o f in s u r ­
m e d ic a l a d v ic e .”
o u r s u p p lie s . W e c u t o n th e tim e w e
a n c e a n d w a n te d to re g u la te it, b u t I
T o c o r r e c t th a t s itu a tio n , Congress
g iv e to p a tie n ts . O v e r a ll, a d e f in it e d e ­
d o n ’ t k n o w w h e th e r h e r a tte m p t w a s
n e e d s to r e p e a l a b a s ic la w o f eco no m ­
c lin e h a s o c c u r r e d in th e q u a lit y o f a t­
s u c c e s s fu l.
ic s : in th e lo n g r u n , y o u c a n n o t get
te n t iv e , p e r s o n a l m e d ic a l c a re b o th in
O th e r p h y s ic ia n s a c ro s s th e c o u n ­
m o r e th a n w h a t y o u p a y fo r. T h e y m ay
try, a n d a fe w in o u r are a, c a n c e le d a ll
e v e n tr y it, b u t th a t la w is d e r iv e d from
t h e ir in s u r a n c e c o n tra c ts a n d n o w ru n
a b r o a d e r p h y s ic a l la w , s o m e tim e s
H o u s e - S e n a t e c o m m itt e e , a F lo r id a p h y ­
t h e ir p r a c tic e s on c a s h - o n ly b a sis.
c a lle d th e s e c o n d la w o f th e rm o d y n a m ­
s ic ia n te s t if ie d th a t h e h a d c h a n g e d h is
T h e y c h a rg e less, g e t p a id in f u ll, a n d
ic s , a n d m o r e g e n e r a lly , th e la w o fth e
p a tte rn o f p r a c tic e . P r e v io u s ly h e h a d a
h a v e m o r e tim e to g iv e to t h e ir p a tie n ts .
c o n s e r v a t io n o f m a s s a n d en erg y. R e ­
o u r o f f ic e s a n d in th e h o s p ita ls .
In A p r i l 2 0 0 4 , in fr o n t o f a j o in t U .S .
p a n e l o f 2 ,5 0 0 p a tie n ts a n d h e f ig u r e d
S u c h an a p p r o a c h is fe a s ib le f o r
p e a lin g th a t m a y b e b e y o n d th e reach
o f C o n g re ss.
th a t in o r d e r to g iv e th e m th e c u r r e n t ly
p h y s ic ia n s w h o d o m o s t o f t h e ir w o r k
r e c o m m e n d e d p r e v e n tiv e c a re he
in th e o ffic e . It w o u ld n o t w o r k w e ll fo r
A n E n g lis h p r o v e r b says: “ S a il!”
n e e d e d to s p e n d 7 .4 h o u rs d a ily , w h ic h
in t e n s iv e s u r g ic a l o r m e d ic a l c a re in th e
o rd e re d th e k in g ; “ H o ld , ” sa id the wind. ■
le f t h im v e r y lit t le tim e fo r c a re o f i l l ­
h o s p ita l se ttin g .
Recap
E
fr o m p a g e 5
• S atu rn - b e a u tif u l r in g s , ra th e r
b la n d a t m o s p h e r ic d e ta ils
• M a rs - h a s it a ll! C lo u d s , d u s t
s to rm s , p o la r c a p s , s u rfa c e d e ta ils
in c lu d e 't h o s e c a n a ls ’ a n d the
h o m e fo r th e c u r r e n t ro v e rs .
H e c a u tio n e d e v e ry o n e a b o u t b u y ­
in g e x p e n s iv e e q u ip m e n t b e fo r e b e c o m ­
in g k n o w le d g e a b le .
" I f y o u a re in te re s te d in a s tro n o m y ,
d o n ’ t b u y a te le s c o p e f ir s t , ” h e w a rn e d .
“ C o m e to s ta r p a rtie s , T a c o m a A s t r o ­
n o m ic a l S o c ie t y m e e tin g s , a s k q u e s ­
tio n s , an d re a d e ith e r A stro n o m y M a g a ­
ATTOO
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
Today’s n e w e st A le x a n d rite la se r,
will rem o ve y o u r tatto o
with minimal d isc o m fo rt &
le s s than 1 % r is k o f s c a rrin g .
( ' a I I t o d a y f o r m o iv i ) \ / o n t u ( ( i o n
H is b e s t a d v ic e - c o n s id e r a p a ir o f 8 x 5 0
PIERCE COUNTY
LASER CLINIC
b in o c u la r s a n d a s ta r c h a r t to g et
Di rect or I’c l c r K. M:irsli \ | D
z in e o r S k y a n d T elescope M a g a zin e."
(2 5 3 )5 7 3 -0 0 4 7
s ta r te d .” *
18
P C M S BULLETIN
June, 2004
.
% m n ty Q /l'b d tc a l d d a c id i/
Classified Advertising
POSITIONSAVAILABLE
O FFIC E SPACE
Tacoma/Pierce County outpatient
Tacom a, WA - O ccupational M edicine
For Rent: 3300 sq ft C lass A m e d ic a l
general m edical care at its b est. F u ll
M u I t iC a r e F le a lth W o r k s , a d iv is io n o f
o ffic e in T a c o m a M e d ic a l C e n te r, 1112
and part-time p o s itio n s a v a ila b le in
M u I t iC a r e H e a lth S y s te m , see ks a b o a rd
6th A v e , th ird flo o r. E le v a t o r , u n d e r ­
Tacoma and v ic in ity . V e r y fle x ib le
c e r t ifie d o c c u p a tio n a l m e d ic in e
g ro u n d p a r k in g , c lo s e to h o s p ita ls . C a l l
schedule. W e ll su ite d fo r ca re e r
p h y s ic ia n / M R O to j o i n an e s ta b lis h e d
253-272-2224.
redefinition fo r G.P., F.P., l. M . C o n ta c t
p ro g ra m . Q u a lif ie d a p p lic a n ts m u s t be
Andy Tsoi, M D (253) 7 5 2 -9 6 6 9 o r P a u l
fle x ib le , s e lf-m o tiv a te d , c o m m itte d to
Doty (A lle n , N e ls o n , T u r n e r & A s s o c .) ,
p ro g ra m d e v e lo p m e n t a n d h a v e at least
J tfte r
Clinic Manager (253) 383-4351.
3 y e a rs e x p e rie n c e . E x c e lle n t b e n e fits,
S re a s t
in c o m e g u a ra n te e a n d in c e n t iv e b on u s.
Established Auburn Fam ily Practice
s u rg e ry
P le ase m a il y o u r C V to M u I t iC a r e
looking fo r P /T to F / T B o a r d C e r t ifie d
H e a lth S y s te m P r o v id e r S e r v ic e s at
th in k ^
or Board E lig ib le P h y s ic ia n to j o i n a
p r o v id e r s e r v ic e s @ m u ltic a r e .o r g o r fa x
o f us.
group practice. W o rk 3 -4 d a y s a w e e k
y o u r C V to 8 6 6 -2 6 4 -2 8 1 8 . W ebsites:
with a great su pp o rt sta ff. B a s e s a la ry
w w w .m u ltic a re .o rg ; w w w .m u ltic a re
plus incentive. F a x y o u r C V to 2 5 3 -8 4 7 -
h e a lth w o rk s .o rg . “ M u I t iC a r e H e a lth
9630.
S y s te m is a d ru g fre e w o r k p la c e .”
Union Avenue Pharmacy
and Corset Shop
Formerly Smith’s Corset Shop
2302 S Union Ave 752-1705
Allenmore Medical Plaza—Phase Two
3209 South 23 rd S tr e e t
Conveniently located nearby
Allenm ore Community Hospital,
Tacoma, WA
FEATURES / SPECIFICATIONS
■ 45,956 rentable square feet
- First Floor
14,452 rsf
- Second Floor
14,960 rsf
-Third Floor
16,544 rsf - leased
■ Building currently under construction
■ Completion 1st Quarter 2005
■ Tenant im provem ent allowance available
,
■ High quality finishes
f o r further information please calk
(206) 264-4592
Medical Real Estate Services, I.I.f!
June, 2004
PCMS BULLETIN
19
B u LLETIN
' tewce w c w i
“Threatening Litigation Is a
Nightmare Process”
A s a claim s representative and su p erv iso r, 1 see p hysicians o! all sp ecialties
w hose lives are su d d e n ly changed by claim s liled against th em . W h e th e r the
cases are dism issed, settled, or go to trial, each p hysician's p e rso n al and
professional life can take a
turn lo r the w orse, and th a t’s w hy I’m h e re to
help. 1 analyze each claim , slay in close con tact w ith o u r a tto rn ey s, a n d w o rk
w ith the physician on n ew strategies as
the case develops. Every physician is
im p o rta n t to m e, and I m ake sure m y w o rk show s th e m th at 1 care.
To lincl o u t a b o u t th e m a n y w ays P h y sic ia n s In s u ra n c e w o r k s w ith a n d
lor p h y sic ia n s, call us today.
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PC M S BULLETIN
June, 2004
Early days of Allenmore medical complex, South 19th and Union Streets
INSIDE:
3
5
7
7
8
9
11
P r e s i d e n t ’s P a g e : “ T h e C o l l e c t i v e ” b y M ic h a e l K e l l y , M D
T P C H D : “ G e t A c t iv e ” F e d e r ic o C r u z -U r ib e , M D
M e m b e r s c o m p le te S o u n d To N a r r o w s
P h y s ic ia n s I n s u r a n c e L ifts N e w B u s in e s s M o r a to r iu m
In M e m o r ia m : L e w i s E . L i t v i n , M D
In M y O p i n i o n : “ E n h a n c i n g R e v e n u e ” b y A n d r e w S t a t s o n , M D
In M y O p i n i o n : L e t t e r t o t h e M e m b e r s h i p b y G e o r g e T a n b a r a , M D
B
u l l e t in
PCMS
O fficers/Trustees:
M i c h a e l J. K elly , M D , P r e s id e n t
P a tr ic k J. H o g a n , D O , P re s id e n t E le c t
K e n n e th A . F e u c h t, MX), V ic e -P re sid e n t
J o s e p h W . R e g im b a l, M D . T re a s u r e r
S u m n e r L . S c h o e n ik e , M D , S e c re ta ry
J. J a m e s R o o k s , J r., M D , P a st P re s id e n t
L a u re ! R. H a r ris , M D
J e ffre y L . N a c h t, IV1D
J o s e p h F . J a s p e r, M D
N a v d e c p S. R a i, M D
R o n a ld R. M o rris, M D
C arl W . W u lfe stie g , M D
July, 2004
P C M S M e m b e r s h ip Benefits, Inc (MB1):
T i m S c h u b e r t , M D , P r e s i d e n t ; D r e w D e u ts c h e
M D , P a s tP r e s id e n t; J o e R e g im b a l, M D , S e c re ta iy T re a s u re r; K e ith D ern irj ian „M D ; S te v e D u n c a n , M D ;
M a rk G ild e n h a r , M D ; S te v e S e ttle .M D ; J o e W c a m , M D
C ollege of M edical E ducation (C.O .M .E.):
J o h n J i g a n t i , M D P r e s i d e n t ; B a rb a r a F o x , M D ,
W illia m H o ld e r m a n .M D , S te v e K .o n ic e k ,M D .M a rjo rie
K r a b b e ,M D , W illia m l.e e , M D . G r e g g O s te rg re n , D O ,
B r a d P a ttis o n ,M D . C e cil S n o d g ra ss , M D , V irg in ia
S to w e ll, M D , R ic h a rd 'W a ltm a n ,M D , T o d W u rs t,M D ;
K e rta M a le ik e . G o o d S a m a rita n H o s p ita l; L is a W h ite ,
M u ltic a re H e a lth S y ste m ; S iste r A n n M c N a m a ra ,
T re a s u r e r, F ra n c isc a n H e a lth S y ste m ; S u e A s h e r,
S e c re ta ry
PCEVIS F o u n d a t i o n : L a w r e n c e A .
L a r s o n , D O , P r e s i d e n t ; C h a r le s W c a th e r b y , M D ,
M o n a B a g h d a d i,N ik k i C ro w le y , T re a s u re r; S u e A sh er,
S e c re ta iy
WSMA
R epresentatives:
T ru ste e s: L e o n a rd A le n ic k . M D ; N ic h o la s R a ja c ic h , M D ;
P atric e S te v e n s o n ,M D
W A M P A C 6 th District: D o n R ussell, D O
W A M P A C 9 th D istrict: L e o n a rd A len ick , M D
S t af f : E x e c u t i v e D i r e c t o r : S u e A s h e r
A d m in istra tiv e A ssistan ts: T a n y a M c C la in . C’risti P eterso n
P la c e m e n tC o o rd in a to n K en S m ith
P la c e m e n tA s s is ta n t: M e lissa K rc g n e ss
C M Li P ro g ra m A d m in istra to r:L e s M c C a l Itun
B o o k k e e p e r: Ju a n ita H o fm eister
Table of Contents
3
P r e s id e n t’ s P ag e: “ T h e C o lle c t iv e ”
4
A p p lic a n t s fo r M e m b e r s h ip
5
T P C H D : “ G e t A c t iv e ”
6
2 0 0 4 P h y s ic ia n D ir e c t o r ch a n g e s
7
M e m b e r s c o m p le te S o u n d to N a r r o w s
7
P h y s ic ia n s In s u ra n c e L if t s N e w B u s in e s s M o r a t o r iu m
8
In M e m o r ia m : L e w is E . L it v in , M D
9
In M y O p in io n : “ E n h a n c in g R e v e n u e ”
11
In M y O p in io n : L e t te r to th e M e m b e r s h ip
13
D o c to r s n e ed to ta k e a le a d in g r o le o n e le c t r o n ic m e d ic a l records
15
C la s s if ie d A d v e r t is in g
T h e B u lle tin is p u b lish e d m o n th ly by P C M S
M e m b e rsh ip B e n efits, Inc. D e a d lin e fo r su b m ittin g articles
and p la c in g a d v e rtise m e n ts is the 15th o f th e m onth
p reced in g p u b licatio n .
T h e B u lle tin is d e d ic a te d to the art, sc ien ce and d eliv ery
o f m e d ic in e an d the b e tte rm e n t o f ihe health an d m edical
w elfare o f th e c o m m u n ity . T h e o p in io n s herein arc th o se o f
lh e in d iv id u al c o n trib u to rs an d do not n ecessa rily reflec t th e
o fficial p o sitio n o fP C M S . A cc e p ta n c e o f a d v e rtisin g in no
w ay co n stitu te s p ro fessio n al ap p ro v al o re n d o rs e m e n t o f
p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B u lletin re se rv e s the
rig h t to reject an y a d v e rtisin g .
i VI a n a g i n g E d i t o r : S u e A s h e r
E d i t o r i a l C o m m i t t e e : M B ! B o a r d o f D ir e c to rs
A dvertising In form ation : 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -^ 6 6 6 : F A X :2 5 3 -5 7 2 -2 4 7 0
E -m ail
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H om e
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2
PCh
July, 2004
President s Page
j- Ke||X’md
The Collective
"IVe w ill a d d y o u r biological a n d technological
distinctiveness to o u r own. Your culture w ill adapt
to serve us. R esistance is futile. We are the Borg. "
- “ T h e B o r g , S ta r T r e k T h e N e x t G e n e ra tio n
M ichael I K elly MD
(T h e B e s t o f B o th W o rld s , P a rt I)”
Ever had a b r ie f p s y c h o tic m o ­
w a s to v is it c e rta in p o litic o s in O ly m ­
A y n R a n d o n c e w ro te , “ ...there is
ment? It’ s one w h e re y o u le t y o u r
p ia in p erso n). T h e B o r g is a race o f
mind freely associate w it h a fe w d o ze n
c y b o rg s , the p ro d u c t o f a te c h n o lo g y
te n tio n a lly o r not, the la st le g is la tiv e
thoughts at the sam e tim e an d see
that “ h a rd w ire s ” a r t if ic ia l in te llig e n c e
se ssio n g av e us a c h illin g d e p ic tio n o f
what happens. 1 have a lo v e o f s c i­
d ir e c tly in to the b ra in and c en tral ner­
w h at a c o lle c t iv e b ra in w o u ld lo o k lik e .
ence fiction and have m o re than a
v o u s sy ste m . T h e re is the re m o v a l o f
T h e ir v is io n can be v ie w e d as an e x ­
passing interest in S ta r T re k . It w a s
m o s t h u m a n asp e cts p r o d u c in g a g i­
tended m e ta p h o r fo r w h a t c o lle c t iv is m
during one o f these w a n d e rin g s that I
g a n tic ro b o tic “ in t e llig e n c e ” that
o ffe rs in d iv id u a ls - a sta rk c h o ic e b e ­
pondered the B o rg .
sh ares a “ g ro u p m in d " - a k in d o f o r ­
tw ee n s u b m is s io n o r a b a n d o n m e n t
g a n ic Internet acce ssed w ith th o u g h ts
(lo ss o f p a rty su pp o rt).
I was in one o f m y fe e lin g p o w e r­
less moments w h en the a c tio n s o f the
in ste a d o f co m p u te rs. O n ly s i ll y s c i­
state legislature these p ast fe w y e a rs
en ce fic t io n , y o u protest!
I c o n te n d that the B o r g is a lre a d y
and the B o rg p h ilo s o p h y p o p p e d in to
no su ch th in g as a c o lle c t iv e b ra in ." I n ­
C o lle c t iv is m th riv e s in o u r s o c ie ty
a m o n g th o se w h o a d v o ca te ta x in g an d
re d is trib u tin g the fru its o f oth er
my subconsciousness. It then m a d e
in O ly m p ia . Ju s t lo o k at the re co rd .
p e o p le ’ s la b o r in ste a d o f p r o d u c in g and
the grueling 5 m m jo u r n e y th ro u g h the
T h e y a u to m a t ic a lly g o w h e re the
tra d in g g o o d s in a free m a rk e t. C o lle c ­
thalamus to m y co n s c io u s m in d (tw o
“ g ro u p m in d ” w ills ; sa y w h a t the
tiv is m , to o , a d v o ca te s the use o f fo rc e
hours). O f course, w h y d id n ’ t 1 see it
g ro u p m in d th in k s , v o te the w a y the
w h e n necessary. In its p o lit ic a lly c o r­
before? The B o rg . T h e le g is la tu re . I
g ro u p m in d d ire c ts. F o r those o f y o u
rect p e rm u ta tio n s in aca d e m e , c o lle c t iv ­
began to w onder - w h o is p art o f the
fa m ilia r w ith the series, th is is T h e
ism is v ir u le n t ly a n ti-in te lle c tu a l (u n a b le
collective - w hen d id this o c c u r?
B o r g C o lle c t iv e . T h e ir p o w e r is a b so ­
to g rasp the a rg u m e n ts w h ic h fa v o r re ­
lute. P o lit ic ia n s so in fe c te d act as one,
fo rm . fo r e x a m p le ) and reg ard s in d iv id u ­
u n a b le to vote th e ir c o n s c ie n c e . O n e
a lity as an e n e m y co n ce p t. In o p e ra tio n ,
ence fiction epic o f a ll tim e . O v e r the
le g is la to r, fo r e x a m p le , in the ho u se o f
c o lle c t iv is t s h a ve an u g ly re c o rd o f a c ­
past three decades, the saga has
re p re se n ta tiv e s ( B o r g d ro n e ), a c tin g at
c o m p lis h m e n t that r iv a ls th at o l'th e
given birth to fo u r te le v is io n series,
the b eh est o f t h e c o lle c t iv e , k ille d a b ill
B o r g in S t a r T r e k .
eight motion pictu res, d o ze n s o f n o v ­
seen as a threat.
As I’m certain y o u k n o w . Star
Trek is easily the m o st p o p u la r s c i­
T h e y say, “ R e s is ta n c e is fu tile , re ­
els, and a variety o f p a ra p h e rn a lia - in ­
I su gg e st C o lle c t iv is m and the
B o r g m e n ta lity , so n o te d in the p rese n t
cluding technical m a n u a ls o f the E n ­
la x . W e h a v e y o u r b est in terests at
le g is la tu re , h a ve d o n e lit tle to s o lv e
terprise, E n g lis h / K lin g o n d ic tio n a rie s ,
heart. L o o k , w e p asse d s ix te e n to rt re ­
W a s h in g to n S ta te 's e c o n o m ic , c u ltu r a l
and even books on th em es o f le a d e r­
fo rm b ills and sent them to th e senate
and te c h n o lo g ic a l p ro b le m s . W e in h a b it
ship lesions in Star T re k .
w h e re an e v il fo rc e defeated th e m .”
a p h y s ic a l u n iv e rs e that does n o t take
T h e y le a v e o u t the fa c t th at th e ir b ills
care o f us. O u r m in d s are, in d e e d , o u r
optimistic. H ow ever, it p rese n ts a
w o u ld n o t h a v e le d to a ch a n g e in
m e a n s o f s u rv iv a l: W e m u st d is c o v e r
most disturbing ex a m p le o f fu ll-
m e d ic a l lia b ilit y p re m iu m s an d w o u ld
re g u la ritie s in o u r s u rro u n d in g s a n d act
fledged c o lle c tiv ism c u rre n tly a v a il­
n o t h a v e im p r o v e d acce ss to h e alth
based o n o b je c tiv e c a u s a lity (the fa ct
able on fdm o r in p rin t (u n le ss o ne
care.
Star T re k ’s v is io n o f th e fu tu re is
See ’‘C ollective" page 12
July, 2004
PCMS BULLETIN
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u l l e t in
Applicants for Membership
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*
A C C E S S . It is v e r y s tr a ig h tfo r w a r d .
A n e le c tio n is lo o m in g . C a n d i­
E x p e r ie n c e d a n d s u c c e s s fu l p o l i ­
dates h ave ste p p ed fo r w a rd . C a m ­
t ic ia n s w i l l t e ll y o u th e s e c re t o f th e ir
paigns in tru d e o n o u r liv e s d a ily . T h is
s u c c e s s . T h e y e s t a b lis h a r e la t io n s h ip
p ra ctice; it is a lr e a d y at th e fr o n t
is all v e iy re a l. W e h a v e c o m p la in e d
w it h t h e ir c o n s titu e n ts a n d th e y in t e r ­
o f p o litic s w h e th e r you se e it o r
and c o m p la in e d e v e ry y e a r f o r as
a c t w it h th e m o n
n o t.
long as I can re m e m b e r th a t th e le g ­
j u s t w h e n th e re is a n is s u e th a t th e y
islature is n o t lis t e n in g to us. T h e
fe e l s t r o n g ly a b o u t. It m e a n s tim e ,
p o lit ic a l a g e n d a s. T h is h a s b e e n a p ­
sim ple fa ct o f th e m a tte r is th a t th e y
p e r s o n a l tim e , to in te ra c t w it h th e
p a re n t f o r m a n y y e a r s . T h e p a tie n t-
are not. A n d u n fo r tu n a te ly th e y w i l l
v o te r s in y o u r d is tr ic t. P h y s ic ia n s a c ­
fo c u s e d a rt o f m e d ic in e is a lm o s t in ­
not listen to us a ro u n d to r t r e fo r m
t u a lly h a v e a n a d v a n ta g e o v e r m a n y
c o n s e q u e n tia l in th e e y e o f d e c is io n
with the cu rre n t m e m b e rs in p la c e .
g r o u p s w h e n t r y in g to g e t th e a tte n ­
m a k e rs . F o r th e m , it is a ll a b o u t b o t ­
So is it tim e to g o b a c k to o u r o f f ic e s
t io n o f v o te r s o n a n is su e . P e o p le
to m lin e s , p r o f it m a r g in s , s e r io u s
r e g u la r b a s is , no t
D o n o t h e sita te to p o litic ize y o u r
H e a lt h c a re is b e in g d r iv e n b y
or back to o u r c o m m u n itie s
lo b b y in g , s p e c ia l in te re s t
and fo rg et a b o u t it u n til n e x t
g r o u p s th a t h a v e lit t le f o ­
___
c u s o n q u a lit y o f c a re b u t
"...w e have to venture out o f ou r com fort zones.
Get involved, m ake noise, g e t in p e o p le ’s faces,
step on toes. Things w ill happen. ”
o w n are a o f th e e c o n o m y
year? I th in k not. T h e an -
ra th e r o n b e tte r in g th e ir
swer is rig h t in fr o n t o f o u r
noses. W e m u s t g e t a c tiv e
in the p o lit ic a l p ro c e s s . I f
there are le g is la to rs that
( th in k in s u r a n c e c o m p a ­
n ie s , t h in k d r u g c o m p a ­
have re s o lu te ly o p p o s e d a n y
n ie s ). T h e p o w e r o f th e
real d ia lo g u e on to rt r e fo r m ,
p r a c tit io n e r s o f m e d ic in e is
then w e m u st w o r k to see
th e re to p r o te c t th e p r a c ­
tic e o f m e d ic in e . B u t w e
that they get u n -e le c te d .
The easy o u t o n th is n e e d to be
c o m e to th e m o n a r e g u la r b a s is . T h e
h a v e to v e n tu re o u t o f o u r c o m fo r t
z o n e s . G e t in v o lv e d , m a k e n o is e , g e t
active is to ju s t g iv e m o n e y . T h a t is
v o te r s a re r ig h t th e re , in y o u r o ffic e .
not enough. In m o d e rn p o lit ic s
T a lk to th e m . S p e n d s o m e tim e g e t­
in p e o p le ’ s fa c e s , ste p o n to es.
money is im p o rta n t, b u t f o r th e k in d
t in g th e is s u e o u t in fr o n t o f th e m .
T h in g s w i l l h a p p e n . A m e s s a g e w i l l
g e t o u t; i f it is s in c e re . I f it r e f le c t s
o f changes th at w e see n e e d in g to be
T h e r e is a n is s u e o f e x tre m e im p o r ­
done in the h e a lth c a re s y s te m , th is
ta n c e fo r th e fu tu r e o f m e d ic in e r ig h t
r e a litie s in v o t e r s ’ liv e s , it w i l l g e t
w ill req u ire re a l in v o lv e m e n t. R e a l in ­
n o w in fr o n t o f th e m . G e t th e m to
tr a c tio n a n d w e w i l l see c h a n g e . I
volvem ent, as in th e p e r s o n a l s w e a t
h e a r a b o u t it. G e t th e m to t h in k a b o u t
lo o k fo r w a r d to th e n e x t fo u r
equity w e see in fir s t tim e h o m e ­
it. G e t th e m to h e a r th a t it h a s n o t
m o n th s . It w i l l b e c r a z y a n d w i l l b e
owners w h o b u ild th ro u g h H a b ita t
b e e n d e a lt w it h . A n d g e t th e m to h e a r
c h a lle n g in g b u t i f w e ta k e it s e r io u s ly
for H um a nity. P u t s o m e m o n e y on
a b o u t th e b a r r ie r s th a t a re p r e v e n tin g
a n d p u t o u r s e lv e s in to it, w e a re g o ­
the table b u t a ls o y o u r o w n p e r s o n a l
m e d ic in e fr o m b e tte r m e e tin g th e ir
in g to se e c h a n g e . A n d th at, m y
effort to d riv e n a ils a n d c u t lu m b e r.
needs. T O R T R E F O R M = P A T I E N T
fr ie n d s , is w h a t th is is a ll a b o u t .*
July, 2004
PCMS BULLETIN
5
Please make the following changes to your 2004 Physician Directory:
W en dad A dam s, M D
M ary A nn Lee, M D
R ich ard R yn es, M D
A d d S u ite # 1 0 0 to o f f ic e a d d re s s
R e m o v e “ Jo h n P e lt z ” fr o m lis t in g
C h a n g e fa x # to 5 8 1 -1 9 1 1
D avid Bem iller, M D (retired)
R obert M cL ees, M D
C h a n g e w eb site to wwAV.gyftclinic.com
S u m n e r S c h o e n ik e, M D
C h a n g e a d d re s s a n d p h o n e to:
C h a n g e E - m a il a d d re s s to:
s c h o e n ik e @ c o m c a s t .n e t
3 9 0 5 V ie w R id g e D r iv e , A n a c o r t e s 9 8 2 2 1
360-293-3158
Sharon M etcalf, M D
P le a s e a d d lis tin g :
N eal Sh onn ard , M D
K . R oyce H ansen, M D (retired)
O b /G yn
C h a n g e o f f ic e a d d re s s to:
A d d w if e 's n a m e “ G e n n y ”
3 4 5 0 3 9th A v e S # 100,
3 8 0 1 5th S t S E # 1 0 0 , P u y a llu p 9 8 3 7 4
F e d e ra l W a y 9 8 0 0 3
G eo rg e Jack son , M D
253-952-8231
Lynn Sm elser, PA -C
C h a n g e o f f ic e z ip to 9 8 4 6 7
2 5 3 -8 3 5 -8 0 0 0 fax
C h a n g e o f f ic e a d d re s s a n d p h o n e to:
G urjitK aeley, MD
Elizabeth N euhalfen, M D
459-7008
C h a n g e fa x # to 581 -1 191
C h a n g e o f f ic e a d d re s s a n d p h o n e to:
572-3791 fax
3 3 1 5 S 2 3 rd # 200, T a c o m a 9 8 4 0 5
115 O r c h a rd A v e N , E a t o n v illc 9 8 3 2 8
Jacob K ornberg, M D
P O B o x 1060, E a t o n v ille 9 8 3 2 8 ( m a ilin g )
John Steedm an, M D
M o v i n g to K i n g C o u n ty :
253-832-6106
A d d S u ite # 1 0 0 to o f f ic e a d d re ss
9 0 0 S 3 3 6 th SI, F e d e ra l W a y 9 8 0 0 3
2 5 3 -8 3 2 -6 1 0 9 fa x
Steven Yam am oto, D O
253-815-8803
C h a n g e a d d re s s to:
3801 5th S t S E # 100, P u y a llu p 9 8 3 7 4
T h u L e ,M D
C h a n g e o f f ic e s u ite to #39
It’s more th an a new building
it's a
m
new experience
St. Joseph Outpatient Center • N o w Open
O utpatient Diagnostic Imaging, O utpatient Rehabilitation, the Gene and
Mary Anne Walters Day Surgery and the St. Joseph Advanced Endoscopy
C enter have m oved to the new St. Joseph O utpatient C enter located
n ext to the hospital.
^ For these services, m ore is changing th a n just th e ir address.
T he O u tp atien t C enter offers advanced technology with greater
( capacity, comfort and privacy. For physicians, we also prom ise faster
scheduling and rep o rt tu rn a ro u n d to su p p o rt ra p id diagnosis,
tre a tm en t and recovery.
I f you would like more information or private tour, please call
Dave Kimberling at 2 5 3.552.4119 or Belinda Moses at 2 5 3 .4 2 8 .1
St. Joseph Medical Center
w w w .fh sh m llh . org
6
PC M S BULLETIN
July, 2004
Members complete Sound to Narrows 2004
N early 6,000 ru n n e rs p a rtic ip a te d in
the Sound to N a rro w s o n S a tu rd a y,
June 12 and the 4 3 rd o v e r a ll p e rs o n to
cross the fin is h lin e w a s Dr. Tom
Herron, G ig H a r b o rp e d ia tr ic ia n . H e f in ­
ished second in h is d iv is io n w it h a tim e
o f46:49,
Dr. Ron Taylor, T a c o m a general
Irfan A nsari, M D, T a co m a p h y s i­
cal m e d ic in e & rehab, 1:32:32
Loren Betteridge, M D, T a co m a
fa m ily p ractitio n e r, 57:51
Lauren Colm an, M D , T a co m a o n ­
John Van B uskirk, DO . T a c o m a
fa m ily p h y s ic ia n , 1:15:26
C o n g ra tu la tio n s to a ll P ie rc e
C o u n ty M e d ic a l S o c ie ty m e m b e rs an d
c o lo g is t, 1:03:15
Stephen Elder, M D , T a c o m a anes­
th e s io lo g is t, a c o m p e titiv e 5 4 : 4 1
R obert Ettlinger, MD,
surgeon, was the 167th
D arryl Tan, M D, L a k e w o o d p e d ia ­
trician, 1:01:12
th e ir fa m ilie s on c o m p le tin g su ch a
c h a lle n g in g run.
P le a s e fo r g iv e us i f w e fa ile d to lis t
person to cross the
T a c o m a rh e u m a to lo g ists.
y o u r n a m e an d c o n ta c t th e P C M S o ffic e
finish line. H e fin ­
1:34:31
(5 7 2 -3 6 6 7 ) so w e ca n in c lu d e y o u r nam e
Patrick H ogan, DO,
ished first in h is d iv i­
Charles Hubbell, M D,
lent time o f 52:57.
T a c o m a d e rm a to lo g ist,
Dr. Bill Jack­
1:14:42
son, Tacom a ra d io lo ­
G eorge Jackson, M D ,
gist, finished fifth in
G ilbert Johnston, M D ,
time o f 1:05:47 and Dr.
T a c o m a c a rd io lo g is t, 1:15:44
Martin Goldsmith,
his d ivisio n w ith a tim e o f 54:52.
Co ng ratulatio ns D rs . H e rro n , T a y ­
lor, Jackson and G o ld s m ith !
One o fth e re m a in in g fe w w h o has
run in every Sou nd to N a r r o w s fo r 31
years, was Cordell Bahn, M D re tire d
cardiovascular surgeon, w h o fin is h e d
with a time o f 1:20:20.
C o ngratulations to a ll P C M S m e m ­
bers and th eir fa m ily m e m b e rs fo r a
great accom plishm ent:
Family finishers
-
12k
T a c o m a p s y c h ia trist, 53:10
his d ivisio n w ith a
Tacoma p e d ia tricia n , fin is h e d th ird in
in the n e xt issu e o f the Bulletin, m
T a c o m a n e u ro lo g ist, 1:00:37
sion w ith an e x c e l­
H a r is A n s a r i, 1 : 2 1 : 4 6
B r y c e B e tte r id g e , 5 7 : 5 0
David Law, M D , T a co m a internist,
1:07:06
Dan Niebrugge, M D , T a c o m a p e ­
V erna H e r r o n , 5 7 : 2 2
D o n n a J a c k so n 1 :0 1 :3 7
d ia tricia n , 1:03:10
Aksel N ordestgaard, M D , T aco m a
v a s c u la r su rg e o n , 58:05
L i s h e t N o r d e s t g a a r d 1 :0 0 : 2 5
J a n e t O l e ja r 2 : 1 0 : 1 6
H enry R etailliau, M D , T a co m a in ­
ternist, 1:21:17
Jim R ooks, M D, L a k e w o o d o to ­
S t e p h e n T a y lo r 4 6 :1 1
(fin ish in g 37/h overall!)
la ry n g o lo g is t, 1:12:51
W illiam Shields, M D , o p h th a l­
m o lo g ist, 1:19:14
Physicians Insurance Lifts New Business Moratorium
m ic ile d in W a s h in g to n S ta te ," sa id
w h o are n e w to the state o r e s ta b lis h ­
cians Insurance, W a s h in g to n S ta te ’s
T o m M y e r s , the c o m p a n y ’ s p re sid e n t
in g n e w p riv a te p ra c tic e s fin d q u a lity
largest m edical m a lp ra c tic e w riter,
an d C E O . “ T h is d e c is io n s ig n a ls that
co v e ra g e .
voted to lif t the c o m p a n y ’s m o ra to riu m
P h y s ic ia n s In sura nce is w e ll on its
on new business as o f its M a y 19,
w a y to re g a in in g the fin a n c ia l s ta b ility
to o u r lo n g -te rm m e m b e r p o lic y h o ld ­
2004 board m eeting. T h is m o ra to ri urn
it has e n jo y e d in the p a st.”
ers w h o h a v e re m a in e d lo y a l to th e
The board o f d ire c to rs o f P h y s i­
was put in p lace in O c to b e r o f 2 0 0 2 .
“We are p leased th at the im ­
D u r in g th ese d if f ic u lt tim e s, m a n y
p h y s ic ia n s h a v e had to s c ra m b le lo
“ T h is d e c is io n is a ls o a te sta m en t
c o m p a n y o v e r the y e a rs ," s a id T o m
M y e r s . “ It is th e ir lo y a lty that n o w a l­
proved fin an cial p e rfo rm a n c e o f the
fin d c o v e ra g e fro m the fe w re m a in in g
lo w s P h y s ic ia n s In su ra n ce to ad d ress
company a llo w s us to o n c e a g a in s o ­
p r o v id e r s in th e state. T h e lif t in g o f
th e need s o f th e ir c o lle a g u e s .” ■
licit new business fro m p h y s ic ia n s d o ­
the m o ra to riu m w ill h e lp p h y s ic ia n s
July, 2004
PCMS BULLETIN
7
B
u l l e t in
IN MEMORIAM
LEWIS E. LITVIN, MD
1916
-
2004
Dr. Lewis Litvin died April 28,2004 at his home in Palm Desert,
California.
Dr. Litvin practiced general surgery in Puyallup from 1969 until his retire­
ment in 1980. He received his medical degree from Boston University in 1941
and completed his internship at Providence Hospital in Seattle and his resi­
dency at King County Hospital.
Dr. Litvin rpracticed in Seattle from 1946 until 1969 when he relocated to
,
. „ T
„
L e w is E. Litvin. M D
Puyallup.
PCMS extends condolences to Dr. Litvin’s wife Juanita and their family.
'^A llenm ore Medical Plaza-Phase Two
3209 South 23 r d S tr e e t
Conveniently located nearby
A llenm ore C om m unity Hospital,
Tacoma, WA
FEATURES / SPECIFICATIONS
■ 45,956 rentable square feet
- First Floor
14,452 rsf
- Second Floor
14,960 rsf
-Third Floor
16,544 rsf - leased
■ Building currently under construction
1
^
■ C om pletion 1st Quarter 2005
B Tenant im provem ent allow ance available
f o r further ink'ormaiUm*, ptvase call:
(206) 264-4592
8
PC M S BULLETIN
July, 2004
■ High q uality finishes
Medical Real Estate Services, LLC
In My Opinion....
The Invisible Hand
by A n d re w Statson, M D
The opin ions e x p re ss e d in th is w ritin g a r c s o le ly th o se o f t h e a u th o r. P C illS in v ite s m em b ers to e xp re ss (h e ir o p in io n /in s ig h ts a b o u t su b je cts
relevant to the m e d ie a l com m un ity, o r s h a re th e ir g e n e r a l in te rest s to rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
Enhancing Revenue
"ll isn't im portant to com e out on top; w hat
m atters is to be the one w ho com es out alive. "
A ndrew Statson. MD
“ J u n g le o f C it ie s ” B e r to ld B re c h t (1 9 2 4 )
W e face an u n p rece d e n ted sq u e eze
The O lym pian re p o rte d that m a n ag ed
a v a ila b ilit y o f o b s te tric a l se rv ic e s .
T h e lia b ilit y re fo rm in P e n n s y lv a ­
in the p ractice o f m e d ic in e . C o lle a g u e s
care and re ce n t le g is la tio n p ro d u ce d
across the co u n try re p o rte d that th is
s u c h a p a p e rw o rk b u rd en that a lm o s t 50
n ia p r o v id e d fo r a ta x -su p p o rte d fu n d
year they had to b o rro w m o n e y so th ey
cen ts o f e v e ry d o lla r w e c o lle c t are
to g iv e reb ates to p h y s ic ia n s ag a in st
could pay th eir o ve rh e ad , b ut th ey
sp en t on a d m in is tra tio n .
th e ir p re m iu m s. O b s te tric s is o n e o f
w ould not be ab le to d o th at a g a in n e x t
year.
C o ntrary to the s itu a tio n d u rin g
O u r p ro b le m s are m u ch b ro a d e r
th an the e c o n o m ic issues. W e lo st o u r
a u to n o m y . W e lo s t c o n tro l o v e r o u r
fo u r s p e c ia ltie s targe te d f o r a 100% re ­
bate.
T h a t s o u n d s lik e m u ch , b u t it d oes
the Great D e p re ssio n w h e n p a tie n ts ap­
p ra c tic e s an d o u r liv e s . W e are tra u m a ­
n o t c o v e r p r im a r y lia b ility ', the c o s t o f
preciated our se rv ice s and atte m p te d to
tiz e d b y the leg al co n s e q u e n ce s o f p a ­
w h ic h is s till g o in g up.
pay the best th ey c o u ld , i f n o t in cash ,
tie n t e x p e c ta tio n s im p o s s ib le to f u lf ill.
then in k in d , o u r p atie n ts to d a y th in k
W e are hu m an . W e ca n n o t d e liv e r
T h e re g io n lo s t 2 5 % o f its O B
beds. S e v e n h o s p ita ls sh ut d o w n th e ir
that they have p a id us in fu ll w h e n th ey
p e rfe c tio n . W e w ill m a k e m ista k e s . T h e
O B departm en ts. T h re e oth ers c lo s e d
flash th eir in su ra n ce card . S o m e o f th em
c la im that a ju d g m e n t e rro r is an o ffe n se
th e ir d o o rs. A s n e v e r b e fo re , d u r in g the
even grum ble about o u r re q u est fo r the
a n d m u s t b e p u n is h e d is a re je c tio n o f
past y e a r H U P ( H o s p ita l o f t h e U n iv e r ­
co-pay.
o u r hu m a n n e ss. It p la c e s us in an im ­
s ity o f P e n n s y lv a n ia ) has had to c lo s e
p o s s ib le situ a tio n . H o w can w e c o n ­
its E R fo r O B a d m is s io n s at le a st e v e ry
hardship cases, but c h a rg e d m o re those
tin u e to fu n c tio n ? H o w can w e h o p e to
o th er w e e k b eca u se o f o v e rflo w . It
able to pay. W e h a v e n o s u ch o p tio n
s u r v iv e ?
B a c k then w e w a v e d o u r fees fo r
today. B a c k then, th e c o s tly a n d tim e
S o fa r o u r b est c o u rse has b e e n to
ra re ly re fu se d tra n sfe rs fr o m o th e r h o s ­
p ita ls in the past. N o w it is c lo s e d fo r
tra n sfe rs at least o n e th ird o f the tim e .
consuming d o cu m e n ta tio n re q u ire ­
in c re a se o u r w o r k h o u rs. In c lu d in g the
ments fo r p atie n t care and fo r th e b u s i­
tim e on c a ll, s ix t y h o u rs p e r w e e k is n o w
ness o f ru n n in g an o ffic e d id n o t e x ist.
a m in im u m in p riv a te p ra ctice . T h e m e ­
g en eral su rg e o n s had to p a y 1.3 m illio n
d ia n is c lo s e to e ig h ty hours. P h y s ic a lly ,
fo r in su ra n ce . W ith the reb ate fr o m the
N o w w e have to re c o rd a ll p o s itiv e
In S e lle r s v ille . P A a g ro u p o f fo u r
and negative c lin ic a l fin d in g s , even
m e n ta lly an d e m o tio n a lly , w e ca n n o t do
state, it is d o w n to 1,052,000.
though irre le v a n t to the p re se n tin g
m o re. W e are c lo s e to o u r b re a k in g
(P hysician s N ew s D ig est , M a y 2 0 0 4 )
problem; w e have to p ro v e that w e
p o in t.
gave the s e rv ic e an d p ro te c te d the p r i­
S o m e p h y s ic ia n s h ave a lre a d y
In th is e n v iro n m e n t, the p riv a te
c lin ic s c a n n o t s u rv iv e fo r lo n g as
vacy o f the patient. W e t o il u n d e r a
ta ke n re fu g e in s a la rie d p o s itio n s , o f ­
p e o p le d ro p o u t. b e ca u se o f th e u n s u s ­
cruel hoax: the statem ent that s o m e ­
fe re d b y p u b lic c lin ic s o r h o s p ita ls . In
ta in a b le p ace o f w o r k re q u ire d lo m a in ­
thing was not d o cu m e n te d , th e re fo re it
So u th e a ste rn P e n n s y lv a n ia , in c lu d in g
tain the sam e in c o m e . T h o s e w h o are
was not done. W e fa c e the b u rd e n o f
the fiv e -c o u n ty P h ila d e lp h ia re g io n , 50-
le ft h a ve to a ssu m e a g reater lo a d , ju st
C U A , A D A , O S H A , H I P A A , c o n tro l o f
7 5 % o f p r a c tic in g o b s te tric ia n s h a v e b e ­
to k e e p th e ir head s a b o v e w ater.
infectious w aste, e rg o n o m ic w o rk p la c e ,
c o m e h o s p ita l e m p lo y e e s. W ith o u t h o s ­
p roo f o f C M E , r e c r e d e n tia llin g e v e ry
p ita l in te rv e n tio n , the re g io n w o u ld
two years, e tc . In a s to ry o n 1 -1 8 -0 1 ,
h a v e fa ce d an e x tra o rd in a ry c r is is in
A n e x a m p le is the o b s te tric c lin ic
in M a n s fie ld , O h io . W o m e n ’ s C a r e Inc
See "R evenue’' page !0
July, 2004
PCMS BULLETIN
9
B
u l l e t in
A '- v
V v
i l U
t
fr o m p a g e 9
h a d s e v e n o b s t e t r ic ia n s la s t y e a r a n d
r e n tly o b s te tr ic ia n s p a y $ 1 2 0 ,0 0 0 -
in g t h e ir p r a c tic e s a n d r e t ir in g o r m o v ­
d id 1 ,0 9 3 d e liv e r ie s . T h e ir in s u r a n c e
$ 1 6 0 ,0 0 0 a n d th e ru m o r e d in c r e a s e in
in g o u t o f sta te is h e a r t- r e n d in g . T he
w e n t u p fr o m $ 6 5 ,0 0 0 to S 1 2 5 ,0 0 0 pe r
p r e m iu m s is 83% .
p r o b le m is w id e s p r e a d a c r o s s th e coun­
O th e r p h y s ic ia n s h a v e s ta rte d to
d o c t o r th is y e a r. O n e o f th e m , D r .
try. Y e t, in s p ite o f th e d e te r io r a t io n in
S te w a r t R ic k m a n , a g e 5 2 , re tire d a t the
a sse ss a ll p a tie n ts an a d m in is t r a tiv e
th e q u a lit y a n d th e a v a ila b ilit y o f health
b e g in n in g o f th e y e a r w it h o u t t a il c o v ­
c h a rg e o f te n d o lla r s p e r year. S o m e
c a re , so o b v io u s to us, th e o f f i c i a l lin e
e ra g e . H e d e c id e d n o t to p a y th e
h a v e lo o k e d at s e r v ic e s n o t c o v e r e d b y
is th a t th e p h y s ic ia n s a re s t ill o n th eir
2 0 0 ,0 0 0 d o lla r s it co s t. A n o t h e r p h y s i­
th e ir in s u r a n c e c o n tra c ts , a n d are b e ­
j o b s a n d i f a n y t h in g , th e re is a surplus,
c ia n m o v e d o u t o f state. T h e f iv e r e ­
g in n in g to c h a rg e f o r th e m . F o r e x ­
ra th e r th a n a sh o rta g e .
m a in in g d o c t o r s h a d to g et a lo a n to
a m p le , s o m e p h y s ic ia n s c h a r g e fo r p r e ­
p a y th e in s u r a n c e a n d n o w h a v e to d o
s c r ip t io n r e f ills w h e n n o t c o n n e c te d
h a v e set o u r h o p e s o n th e N o v e m b e r
th e w o r k s e v e n o f th e m d id la s t year.
w it h an o f f ic e v is it , fo r m is s e d a p p o in t­
e le c t io n a n d w e ’ l l d o o u r b est, b u t I am
T h e y h o p e t h e y ’ l l b e a b le to c o n tin u e ,
m e n ts b y re p e a t o ffe n d e rs , fo r f i l l in g
a f r a id w e ’ ll b e d is a p p o in t e d . W e cannot
b u t i f p r e m iu m s g o u p a n o th e r 2 0 % o r
o u t h e a lth fo r m s f o r s c h o o l o r w o r k , fo r
w in th is g a m e . W e lo v e w h a t w e d o and
m o r e n e x t y e a r, t h e y ’ l l h a v e to c lo s e
e - m a il a n d te le p h o n e c o n s u lt a tio n s , etc.
w e c a re fo r o u r p a tie n ts , a n d th at is our
sh o p . (M a n sfie ld N e w s J o u rn a l, 5 -3 -0 4 )
I d o n ’ t k n o w h o w s u c c e s s fu l th e y
I f w e are h o p in g f o r im p r o v e d r e im ­
h a v e b e e n in t h e ir e ffo rts . E v e n i f th e y
I a m s o r r y to b e so p e s s im is tic . We
w eakness.
W e c a n n o t a f f o r d a w o r k a c tio n in
b u rs e m e n t, w e m ig h t as w e ll fo rg e t it.
w e re , th is is at b est a s to p g a p m e a su re .
lie u o f a s tr ik e , s u c h as p r o v id in g o n ly
R e p . C h a r lie N o r w o o d ( R .-G e o r g ia )
T h e o u t lo o k fo r the p r a c tic e o f m e d i­
u rg e n t c a re fo r s e v e ra l m o n th s , as we
sta te d th a t M e d ic a r e n e e d s to fo c u s on
c in e , e v e n w it h s o m e fo r m o f lia b ilit y re ­
d id in C a lif o r n ia in 1 9 75. Y e t w e h ave to
n e w w a y s to c o n t ro l th e v o lu m e an d in ­
fo r m , is b le a k . O h io e n a c te d a ca p , b u t
m a k e o u r p o in t. S o o n o u r o n ly recourse
t e n s it y o f p h y s ic ia n s e n d e e s . T h o s e are
th e p r e v io u s o n e w a s s tr u c k d o w n b y
w i l l b e to f o ld u p a n d w 'a lk a w a y . T he
th e h id d e n c u lp r it s o f M e d ic a r e p h y s i­
th e S u p re m e C o u r t in 1 9 9 8 , a n d th e fe a r
o p t io n s a re to re tir e , i f w e c a n a ffo rd it,
c ia n s p e n d in g .
is that th e n e w la w w i l l s u ffe r the sa m e
o r to f in d a jo b in a r e la te d f ie ld n o t in ­
fate.
v o lv in g p a tie n t c a re . W h e n e n o u g h o f
A c c o r d in g to B r u c e S t e in w a ld o f
th e G A O , s in c e 1998 th e g r o w th o f
T h e n e w s a b o u t p h y s ic ia n s c lo s ­
us d o th at, th in g s w i l l c h a n g e . ■
M e d ic a r e p h y s ic ia n p a y m e n ts p e r b e n ­
e f ic ia r y h a s o u ts trip p e d b o th m e d ic a l
in f la t io n a n d th e o v e r a ll in c re a s e in
p h y s ic ia n p a y m e n ts d u e to in c re a s e d
v o lu m e and in t e n s it y o f s e rv ic e s .
D a v id W a lk e r, U .S . C o m p t r o lle r
G e n e r a l, h e a d o f t h e G A O , sta te d th at
d e c id in g w h ic h h e a lth c a re e x p e n se s
are “ in d iv id u a l w a n ts ” a n d w h ic h are
“ s o c ie ta l n e e d s ” is th e k e y . S o c ie ta l
n e e d s c o u ld in c lu d e v a c c in e s an d p r o ­
te c tio n fro m fin a n c ia l r u in d u e to c a ta ­
s tr o p h ic illn e s s .
S o w h a t are w e to d o ? W o m e n ’ s
H e a lt h C o n n e c t ic u t, a g ro u p o f 15 0 o b ­
s te tr ic ia n s , c o m p r is in g o n e th ir d o f the
o b s t e t r ic ia n s in th e state, a n n o u n c e d
th at in S e p te m b e r th e y w i l l in itia t e a
s u rc h a rg e o f 5 0 0 d o lla r s f o r o b s te tr ic a l
c a re , p a y a b le at th e fir s t p re g n a n c y
ER^SE
THAT TATTOO
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
T o d ay's n e w e st A le x a n d rite la se r,
will rem o ve y o u r tatto o
w ith m inimal d isc o m fo rt &
v is it . It is n o t k n o w n w h e th e r th e in s u r ­
a n c e c o m p a n ie s w i l l c o v e r th a t ch a rg e ,
b u t th e g r o u p in te n d s to d ro p a n y in ­
( ,a li (txU iy In r
in fo t'tiu u io n
th e m f r o m c o lle c t in g it fr o m th e p a ­
PIERCE COUNTY
LASER CLINIC
tie n ts. In C o n n e c t ic u t th e l ia b il i t y c o n ­
D ir e c to r IV u-r K. M nrsli \l I)
s u ra n c e c o n tra c t th a t w o u ld p re v e n t
tra c ts a re r e n e w e d o n S e p te m b e r 1. C u r ­
10
PC M S BULLETIN
July, 2004
(2 5 3 )5 7 3 -0 0 4 7
\
V
W ierce-
In My Opinion
Q /U e d ic a i& m d ,f
by G e o rg e Tanbara, M D
The opinions ex p re ssed in th is w ritin g a r e s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b ers to e x p re ss th e ir o p in io n .'in sig h ts a b o u t su b je cts
relevant to (he m e d ic a l commim ih>, u r s h a re t h e ir g e n e r a l in te rest s to rie s . S u b m is s io n s a re s u b je c t to E d it o r ia l C o m m itte e review .
D e a r P ie r c e C o u n t y M e d i c a l S o c ie t y M e m b e r s ,
T h a n k y o u a ll f o r th e h e lp in g e ttin g C o m m u n it y H e a lt h C a r e c lin ic s ( p r e v io u s ly
k no w n as E a s ts id e , D o w n t o w n , U r b a n H e a lt h I n it ia t iv e , C o m m u n it y H e a lt h C a r e
D e liv e ry S y s te m ) to w h e r e it is a tru e s a fe ty n e t f o r a ll p a tie n ts th a t f in d th e m s e lv e s
in a p o s itio n r e q u ir in g a h e a lth c a re h o m e . Y o u m a y h a v e p a tie n ts th a t are in a p o s i­
tion that th e y c a n n o t c o n t in u e in y o u r c a re b e c a u s e o f o u t s id e o r p e r s o n a l d e c i­
sions.
In the late 1 9 6 0 s , f i f t y M e d ic a l S o c ie t y m e m b e r s a r r a n g e d b y T o m C u r r y , e x ­
ecutive d ire c to r o f o u r S o c ie t y th e n , a s s e m b le d in th e o ld g y m o f T a c o m a C o m m u ­
nity H o u s e fo r a m o r n in g s e s s io n o f h o w to m e e t th e h e a lth n e e d s o f p e o p le w it h ­
G eo rg e Tanbara. M D
out fu nd s, w e lfa r e m e d ic a l, f o r m e r p a tie n ts o f M o u n t a in V i e w H o s p it a l ( p r e v io u s ly
P ierce C o u n ty ) a n d th e c lin ic s a n d e m e r g e n c y r o o m s . T h e h ig h e s t n e e d a p p e a re d to
be the E a stsid e S a lis h a n H o u s in g P r o je c t area. U n d e r th e le a d e r s h ip o f D r. E u g e n e W ie g m a n ( P r e s id e n t, P a c if ic
Lutheran U n iv e r s it y ) a n d Ja m e s W a lt o n ( n o w in t e r im T a c o m a C i t y M a n a g e r ) w it h c o - a d m in is tr a to r s B o b P fo te n h a u e r
and the U r b a n C o a lit io n , m e t f r e q u e n t ly th r o u g h o u t th e c o m m u n it y w it h c o m m u n it y m e m b e rs , o r g a n iz a t io n s a n d fu tu re
patients, an d in itia t e d th e E a s t s id e C l in i c . M a n y v o lu n t e e r s a n d o n e s t a f f p e r s o n ra n th e c lin ic . T h e w e e k ly c l in i c w a s
open e v e ry W e d n e s d a y e v e n in g a t th e C o m m u n it y R o o m o f th e o ld L is t e r S c h o o l w it h a d e n tis t, D r. D a n C o o k ; a h y gienist; p h a rm a c is t R ic h a r d D r is c a ll w h ile P u g e t S o u n d H o s p it a l p r o v id e d r a d io lo g y s e r v ic e s a n d s a n d w ic h e s f o r th e
staff. L a b o ra to ry s e r v ic e s w e r e p r o v id e d th r o u g h G o o d S a m a r ita n H o s p it a l a n d D r . C h a r le s L a r s o n . G o o d S a m a r ita n
and M a r y B r id g e s u p p lie d th e h o s p it a liz a t io n , e m e r g e n c y s e r v ic e s , a s w e ll as c l in i c a n d o th e r s e r v ic e s . B a te s
V o c a t io n a l
contributed m a n y h o u rs to s ta rt p a r e n tin g c la s s e s .
T h e g e n e ro s ity o f th e M e d i c a l S o c ie t y m e m b e r s h ip p r o v id e d m u c h n e e d e d s e r v ic e s at lit t le o r n o c o s t to p a tie n ts .
Due to the in c re a s e d n u m b e r o f p a tie n ts a n d th e s u c c e s s o f th e c lin ic , th e T a c o m a H o u s in g A u t h o r it y s u p p le d a
Quonset. D r. G e o r g e R a c e to o k c a re o f th e a d u lts f o r a n u m b e r o f y e a rs u n t il th e c l in i c h ir e d p e r s o n n e l in c lu d in g p h y s i­
cians a n d a d m in is tra to rs . T h e r e w a s a g re a t n e e d f o r a d o w n t o w n c l in i c so S t. J o s e p h H o s p it a l s u p p lie d p e r s o n n e l to
nig h tly c lin ic s in th e b a s e m e n t o f th e o ld n u r s in g s c h o o l, w h ic h h a d b e e n re p la c e d f o r e x p a n d e d sp a ce .
C o m m u n ity p h y s ic ia n s , e s p e c ia lly s t a f f o f St. J o s e p h H o s p it a l, as w e ll as D o u g J a c k m a n a n d S u e A s h e r , y o u r s u b ­
sequent e x e c u tiv e s , h a v e a lw a y s b e e n h e lp f u l a n d s u p p o r tiv e a n d g e n e ro u s w it h t h e ir tim e a n d e n e rg y . I r e a lly tr ie d to
thank each a n d e v e ry o n e f o r s e n d e e s r e n d e r e d b u t m a n y n e v e r in f o r m e d m e , so w e are v e r y g r a te fu l to a ll o f y o u .
F u rth e r in f o r m a t io n c a n b e o b t a in e d fr o m P ie r c e C o u n t y M e d ic a l S o c ie t y , C o m m u n it y H e a lt h C a r e , o r m e at
g ta n b a ra @ m b ch a .n e t, at th e o f f ic e 3 8 3 - 5 7 7 7 , v m 3 0 2 2 ( w h e n I ’ m in th e o f f ic e , le t p e r s o n n e l k n o w th a t I a s k e d to be
called to a p h o n e ) o r at m y h o m e 2 7 2 -5 2 3 5 .
W e c o n tin u e to n e e d y o u r h e lp .
K im a n d G e o r g e T a n b a ra
July, 2004
PCMS BULLETIN
11
B
u l l e t in
Collective
from page 3
that caps on non-economic damages
bold medical liability costs down thus
improving health care access, for ex­
ample.)
We physicians are not Borg. We
have no wish to be. We resist the Borg
mentality by acting individually on our
choices. We look for opportunities lo
find the political meaning in this state,
not pre-lbrmatted and digested mean­
ing fed by a Borg queen. We are repub­
lican, democrat, libertarian, and inde­
pendent. We apply our ethics and val­
ues against the political platforms of
the parties in this state. We speak with
the legislators in person and formulate
a slate commensurate with our indi­
vidual belief system. This process has
helped to liberate us from the Borg
mentality. Thanks to Star Trek, it is no
longer impossible to imagine what a so­
ciety controlled by an actual ''collective
mind” would be like. It isn’t pretty, and
neither is Olympia.
We are now called to act by sup­
porting candidates, which support the
survival of the practice of medicine. Na­
tional, state and local elections need
your support both monetarily and vol­
untarily. WAMPAC, our one and only
PAC, warmly solicits your contribu­
tions. Give now to change the future in
this state. Give now because we are up
against it, fighting for our profession.
Give now to prevent the further assimi­
lation of reason by the Borg in Olympia.*
MEDICAL LICENSURE ISSUES
M r . R o c k w e ll is a v a ila b le to re p re s e n t p h y s ic ia n s a n d o th e r h e a lth c a re
p r o v id e r s w it h issu e s o f c o n c e r n b e fo r e th e S ta te M e d ic a l Q u a lit y A s s u r a n c e
C o m m is s io n . M r . R o c k w e ll, a p p o in te d b y G o v e r n o r B o o t h G a r d n e r , s e rv e d fo r
8 y e a rs as the P u b lic B o a r d M e m b e r o f the M e d ic a l D is c i p l i n a r y B o a r d fro m
1 9 X 5 -1 9 9 3 . S in c e th e n , M r . R o c k w e ll h as s u c c e s s f u lly re p re s e n te d o v e r 6 0
p h y s ic ia n s o n c h a rg e s b e fo re the M Q A C . M r . R o c k w e l l's le e s are c o m p e t it iv e
a n d the s u b je c t o f a c o n fid e n t ia l a t lo r n e y - c lie n t r e p r e s e n t a t io n a g re e m e n t.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(425)453-4398 • FA X (425) 453-1534
email: [email protected] • website: www.gregrockvvelllaw.com
ra-di-ol-o-gy \rad-e-al-e-je\/i.
1: a branch of medicine utilizing exams such as
MRI (magnetic resonance imaging) and CT
(computed tomography) in the diagnosis and
treatm ent of disease 2: a com m itm ent to
providing cutting-edge imaging services without
the necessity of driving long distances; see TRA
M
e d ic a l
I m a g in g
4 7 0 0 P o in t F o s d ic k Dr, S te 110 • F o r m o re in fo r m a tio n , c a ll (253) 7 6 1 -4 2 0 0
t r a m e d ic a lim a g in g .c o m
12
P C M S BULLETIN
July, 2004
\
V .
'/Pim m /femthj,
dsfoceefy
Doctors need to take a leading role on electronic medical records
With E M R s b e c o m in g an in e v it a b ility , it ’ s e sse n tia l f o r the p h y s ic ia n s ’ v o ic e to b e he ard in h o w th e te c h n o lo g y gets im p le m e n te d
E d ito r’s Note - The P C M S C onnectivity Com m ittee, c h a ired by M att White, MD, continues to m ake pro g ress on options f o r
electronically connecting the P ierce C ounty m edical com m unity.
W ith so m a n y h e a v y h itte rs in g o v ­
P h y s ic ia n s at a re ce n t A m e r ic a n
p ro v e d an d w i l l b e tested f o r the n e x t tw o
y e a rs.
ernment p u sh in g fo r th e ir use, the q u e s ­
M e d ic a l A s s o c ia t io n m e e tin g s p o k e o f
tion o f p h y s ic ia n s ’ a d o p tio n o f e le c ­
lo o k in g at s y s te m s that a p p e a re d to d o
tronic m e d ica l re c o rd s is no t if, but
s im ila r th in g s, y e t c o s t a n y w h e re fro m
w o u ld be m a n d a te d an d i f p h y s ic ia n s
when.
$ 3 0 ,0 0 0 to $ 7 0 ,0 0 0 p e r p h y s ic ia n , n o t in ­
w o u ld b e e x p e c te d to fo o t th e b i ll th e m ­
c lu d in g lic e n s in g a n d s u p p o rt fees that
s e lv e s fo r a sy ste m re m a in s.
B u t before th e re ’ s a w h e n , there are
T h e q u e s tio n o f w h e th e r E M R s
T h e A M A H o u s e o f D e le g a te s has
a few key h o w s that n e ed to be a n ­
c o n tin u e to b e p a id lo n g a fte r the in itia l
swered. B e fo re E M R s are in e v e ry o ffic e ,
p u rch a se . A ls o , th ere w e re w o r r ie s ab o ut
p a sse d a re s o lu tio n d ire c tin g the A M A to
doctors need to k n o w h o w to m a k e a
how ' q u ic k ly th o se syste m s c o u ld b e ­
c o n tin u e to assert its r o le in th e c o n v e r ­
standardized te c h n o lo g ic a l p la tfo rm ,
c o m e o b so le te , a n d the in a b ilit y to tra n s­
sa tio n s o v e r E M R s an d e n c o u ra g e s set­
how to m ake sure re c o rd s are secu re,
fe r an E M R to a c o lle a g u e that has an
tin g h e a lth ca re in fo r m a t io n te c h n o lo g y
and how to m ake sure the c o sts d o n ’ t
E M R w it h a d iffe re n t so ftw a re p la tfo rm .
sta n d ard s that w o u ld a llo w d iffe re n t
com pletely fa ll on p h y s ic ia n s as ye t a n ­
other unfunded m andate.
P h y sic ia n s m u st h a v e a v o ic e in c re ­
ating E M R system s that w i l l a llo w the
T h e re are v a r io u s p ro p o s a ls to a d ­
p ro d u cts to be in te ro p e ra b le , y e t a lso
dress these p ro b le m s w h ile a c c e le ra tin g
w o u ld a llo w s o ftw a re c o m p a n ie s to d e ­
the p a c e at w h ic h p h y s ic ia n s ad o p t
v e lo p c o m p e titiv e sy ste m s.
It a ls o c a lls f o r w o r k in g w it h C o n ­
EM R s.
gains in patient safety, e f fic ie n c y and
P re s id e n t B u s h sa id in A p r il that he
g ress an d in s u ra n c e c o m p a n ie s to " a p ­
cost savings that ad v o ca te s s a y can be
ha d a g o a l o f g e ttin g a p e rso n a l, p o rta b le
p r o p r ia te ly a lig n in c e n tiv e s ” as p a rt o f
achieved.
E M R fo r e v e ry p a tie n t in 10 y ears, w h ile
the d e v e lo p m e n t o f t h e N a tio n a l H e a lth
Currently, v a rio u s s u rv e y s s h o w
so m e sen ato rs a ls o h a v e p ro p o se d b ills
In fo rm a tio n In fra s tru c tu re — a p u b lic - p r i­
that some 10% o f A m e r ic a n p h y s ic ia n s
that w o u ld re q u ire d e v e lo p in g E M R sta n ­
va te in itia t iv e to create an in te ro p e ra b le
use E M R s , and that fe w o f th o se p h y s i­
d a rd s.
h e a lth n e tw o rk . F in a lly , it a sk s fo r r e v ie w
cians have system s that a llo w th em to
T h e A M A ha s lo n g been in v o lv e d
o f security', s ta n d a rd iz a tio n an d c o st is ­
exchange in fo rm a tio n w it h a p h y s ic ia n
w it h atte m p ts to create a sta n d a rd ize d
sues w h e n p a r tic ip a tin g o r c o m m e n tin g
using a d ifferen t system .
E M R . A d ra ft sta n d ard has b een a p ­
on in itia t iv e s re la te d to N H I I . a
From .-M/AVu.v. 7/5/04
Our Clinical
PET Specialists
Positron Emission Tom ography (PET)
PET has been sh o w n to be an accu rate m e th o d to d iagnose a n d stage cancer, check for
A n th o n y Larhs, M D
tum or recurrence, a n d m o n ito r can ce r therapy. In fo rm a tio n g ain ed by th e use o f PET can be
used to d eterm in e w hat c o m b in a tio n o f surgery, ra d ia tio n therapy, o r c h em o th erap y is m ost
D ire cto r o f Clinical PET
likely to b e successful in m an ag in g th e disease.
P h illip C Lesh, M D
P E T is also u se d to evaluate A lzh eim er’s disease,
epilepsy, an d cardiac disease.
W illia m B Jackson, M D
M any insurers, in c lu d in g M edicare an d
M edicaid, are reim b u rsin g for m any
P E T procedures. T R A referral
Tacoma
c o o rd in a to rs will w o rk w ith you to
co m p lete th e re q u ire d p re-exam
au th o rizatio n .
2202 S Cedar St, Ste 200
253-761-4200
tramedicalimaging.com
Call our referral coordinators at
253-761-4200.
July, 2004
PCMS BULLETIN
13
B
v_
u l l e t in
T A C O M A /P IE R C E C O U N TY
r a v e le r £
L
H e a lth
a
S e rv ic e
se rv ice of
N o r t h w e s t M ed ica l sp ecia lties, p l l c
O utpatient General Medical Care.
Full and part-tim e positions
available in Tacoma and vicinity.
Very flexible schedule. Well suited
for career redefinition for
GP, FP, IM.
C o n ta c t A n d y T soi. M D (253) 752-9669
o r Paul D o tv (A llen, N e lso n , T u r n e r &
A ssoc.), C lin ic M a n a g e r (2531 383-4351
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
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think^
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CALL EARLY WHEN PLANNING
HOURS
M O N -F R I 9 - 5
2 5 3 -4 2 8 -8 7 5 4
o r 2 5 3 -6 2 7 -4 1 2 3
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IN F E C T IO N S L IM IT E D P S
2 2 0 - I ^ A v e S E # B , P u y a llu p W A 9 8 3 7 2
Union Avenue Pharmacy
and Corset Shop
Form erly Sm ith's C orset Shop
2302 S Union Ave 752-1705
Protect Your Practice, Protect Your Family
As you know, disability in su rance policies for physicians are
ch an g in g rapidly— and not for the better. At Physicians
Insurance Agency, there’s still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find
superior life an d long-term -care coverage for you a n d your
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call Physicians Insurance Agency today: (206) 343-7150 or
1-800-962-1399.
PHYSICIANS
- m INSURANCE
t T AGENCY
F,
A Wholly Owned Subsidiary of
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© Physicians Insurance 2003
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PC M S BULLETIN
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Sponsored b y Ihe Wttshitigto/i State M ei/iml /\ssodutiotl
piassified Advertising
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Tacoma, WA - Three provider group
rese arch team , s e r v in g as stu d y in v e s t i­
P h y s ic ia n s are in te g ra l m e m b e rs o f o u r
looking fo r P /T to F / T B o a r d C e r t ifie d o r
(1 M D , 2 N P s ) seeks a p a rt-tim e B / C o r
g ators, p e r fo r m in g p ro c e d u re s and p r o ­
Board E lig ib le P h y s ic ia n to j o in a g ro u p
B / E f a m ily p ra c tic e o r in te rn a l m e d ic in e
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la rg e M e d ic a r e c o m p o n e n t. E n jo y the
g o o d sta n d in g in th e State o f W a s h in g ­
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u n iq u e n e ss o f th e N o rth w e s t lif e s t y le
ton (o r lic e n s e in g o o d sta n d in g in
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s e rv ic e in teg rated h e a lth ca re d e liv e r y
cen se fo rth c o m in g ) and e x p e rie n c e in
the c o n d u c t o f c lin ic a l tria ls , w it h P h ase
certified o cc u p a tio n a l m e d ic in e
sy ste m . C o m p e t it iv e b e n e fits and sa l­
p h y s ic ia n /M R O to j o in an e sta b lis h e d
a ry m a k e th is a c h o ic e o p p o rtu n ity that
1 e x p e rie n c e d e sira b le . F o r im m e d ia te
program. Q u a lifie d a p p lic a n ts m u st be
w o n ’ t la st lon g . T h e rig h t c a n d id a te
c o n s id e ra tio n , sen d re su m e an d c o v e r
flexible, self-m o tiva te d , c o m m itte d to
w i l l e n jo y an e x c e lle n t c a ll sch e d u le ,
letter w /w a g e re q u ire m e n ts to: R ik k i
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System P ro v id e r S e rv ic e s at
H e a lth S y s te m at p ro v id e rse rv ic e sfe )
us at w w w .n w k in e t ic s .c o m .
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System is a d ru g free w o r k p la c e .”
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For Rent: 3300 sq ft C lass A m edical
office in T a co m a M e d ic a l C e n te r, 1112
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July, 2004
PCMS BULLETIN
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B
u l l e t in
(P ie v c e ^ n
‘Threatening Litigation Is a
Nightmare Process”
A s a claim s re p rc se n ialiv e a n d su p e rv iso r, I see p h y sic ia n s of all sp ecialties
w hose lives are su d d e n ly c h an g e d by claim s filed against th em . W h e th e r the
cases are dism issed, settled, or go to trial, each p h y sic ia n ’s p e rso n al a n d
professional life can take a tu rn for the w orse, a n d th a t’s w h y I’m here to
help. 1 analyze each claim , stay in close c o n ta ct w ith o u r a tto rn ey s, a n d w o rk
w ith the physician on new strategies as the case d ev elo p s. E very ph y sician is
im p o rta n t to m e, a n d 1 m ake su re m y w o rk sh o w s them th a t 1 care.
To lin d o u t a b o u t th e m an y w ay s P h y sic ia n s In s u ra n c e w o rk s w ith a n d
lo r p h y sic ia n s, call u s to d a y
W este rn W ash in g to n
1 -8 0 0 -9 6 2 -1399
Eastern W ash in g to n
1 -8 0 0 -9 6 2 -1 3 9 8
K a ri A dam s,
C la im s S u p e r v is o r
. rr.llc J .irtj ip .n t:-.']. >1 hv the
|\ .IvllillL’l"!] M.'lU ’.It IllL'.il -\s-VlI;HI011
Pierce C ounty M edical Society
223 Tacoma Avenue South
Tacoma, WA 98402
IfF Physicians
a" Insurance
A Mutual Company
\ i? il o u r W u b s ii v .n p h y m f . > u n i
-V auli.-. W A (0 P b y - n 1,105 I n s u r a n c e 2 0 0 3
PRESO RTED
STANDARD
U S P O S T A G E P A ID
TACO M A. W A
P E R M I T N O 605
Return sen/ice requested
16
PC M S BULLETIN
July, 2004
New Zealand W aterfalls
Photo by Sam lnsalaco, MD
INSIDE:
3
5
7
9
11
13
15
P r e s i d e n t ’s P a g e : “ L e s s o n s f r o m t h e R o g u e ” b y M ic h a e l K e lly , M D
S p e c ia l F e a tu r e : “ H o m e G r o w n ” by J e a n B o r st
D e r m a t o l o g i s t L lo y d E lm e r , M D , 8 9 t h P r e s i d e n t o f P C M S r e t i r e s
T P C H D : “ D is a s t e r P la n n in g ” F e d e r ic o C r u z - U r ib e , M D
In M y O p in io n : “ T h e N e w S e r f d o m ” b y A n d r e w S ta ts o n , M D
P C M S d e b a t e s W S T L A a n d e d u c a t e s P ie r c e C o u n t y a b o u t t o r t r e f o r m
P C M S e n d o r s e s W S M A ’s l e g i s l a t i v e i n i t i a t i v e o n t o r t r e f o r m
B
u l l e t in
P C M S O fficers/T rustees:
M i c h a e l J. K e l l y , M D , P r e s i d e n t
P a tr ic k J. H o g a n . D O , P r e s id e n t E le c t
K e n n e th A . F e u c h t, M D , V ic e -P re s id e n t
J o s e p h W . R e g im b a l, M D , T re a s u re r
S u m n e r L. S c h o e n ik e ,M D , S e c re ta ry
J. J a m e s R o o k s , J r., M D .P a s t P r e s i d e n t
L a u re l R . H a rris . M D
J e ff re y L. N a c h t, M D
J o s e p h F. J a s p e r . M D
N a v d e e p S. R a i, M D
R o n a ld R . M o rris, M D
C a rlW . W u lf e s tie g ,M D
August, 2004
P C M S M em b e r s h ip Benefits, Inc (M BI):
T i m S c h u b e r t , M D , P r e s i d e n t ; D re w D e u ts c h ,
M D , P a st P re sid e n t; J o e R e g im b a l, M D , S e c re ta ry T re a s u re r; K e ith D e m irjia n , M D ;S te v e D u n c a n ,M D ;
M a r k G ild e n h a r . M D ; S te v e S e ttle . M D ; J o e W c a rn , M D
College of M ed ical E ducation (C .O .M .E.):
J o h n Ji ganti, M D P res id en t; B a rb a ra F ox, M D ,
W illia m H o ld e r m a n . M D , S te v e K o n ic e k , IVTD, M a ijo rie
K r a b b e ,M D , W illia m L e e , M D , G r e g g O s te rg re n , D O ,
B ra d P a ttis o n .M D ,C e c il S n o d g ra s s .M D , V irg in ia
S to v v eIl,M D , R ic h a rd W a ltm a n , M D . T o d W urst, M D ;
H e r ta M a le ik e , G o o d S a m a rita n H o sp ita l; L is a W h ite .
M u ltic a re H e a lth S y ste m ; S iste r A n n M c N a m a ra ,
T re a s u r e r, F ra n c isc a n H e a lth S y s te m ; S u e A s h e r,
S e c re ta ry
P C M S F o u n d a t i o n : L a w r e n c e A.
L a r s o n , D O , P r e s i d e n t ; C h a rle s W e a lh e rb y , M D ,
M o n a B a g h d a d i, N ikki C ro w le y , T re a s u re r; S u e A sh e r,
S e c re ta ry
W S M A R epresentatives:
T ru s te e s: L e o n a rd A lc n ic k , M D ; N ic h o la s R a ja c ic h . M D ;
P a tric e S te v e n s o n , M D
W A M P A C 6 th D is tr ic t:D o n R ussell, D O
W A M P A C 9 th D is tr ic t: L eo n a rd A le n ic k .M D
S t af f : E x e c u tiv e D ire c to r: S u e A s h e r
A d m in is tra tiv e A s sista n ts: T a n y a M c C la in . C risti P eterso n
P la c e m e n tC o o rd in a to n K erri B a k e r
P la c e m e n t A s sista n t: M e lis sa K re g n e ss
C M E P ro g ra m A d m in istra to r: S c o ttP e te rs o n
B o o k k e e p e r: J uan i ta H o fm e iste r
T h e Bul l et i n is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits. Inc. D e a d lin e for su b m ittin g articles
an d p la c in g a d v e rtis e m e n ts is th e 15 th o f th e m onth
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o f m e d ic in e a n d th e b e tte rm e n t o f th e h e a lth and m ed ical
w e lfa re o f the c o m m u n ity . T h e o p in io n s h erein are th o se o f
th e in d iv id u al c o n trib u to rs and do not n e c e ssa rily re fle c t the
o ffic ia l p o sitio n o f P C M S . A c c e p ta n c e o f a d v e rtisin g in no
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M a n a g i n g Editor: S ue A sher
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H o m e Page: h ttp ://w w w .p c m sw a .o rg
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P C M S BULLETIN
August, 2004
Table of Contents
3
4
P r e s id e n t’ s P ag e: “ L e s s o n s f r o m th e R o g u e "
D e n ia l o f P r e m e r a C o n v e r s io n R e q u e s t B i g S u c c e s s
f o r P h y s ic ia n s / P a tie n ts
5
S p e c ia l F e a tu re : “ H o m e G r o w n - R e g io n ’s T h r e e H o s p it a l
S y s t e m s E x p a n d in g S e r v ic e s a n d C a p a b ilit ie s ”
7
D e r m a to lo g is t L lo y d E lm e r , M D , 8 9 th P r e s id e n t o f P C M S retires
7
L e s M c C a llu m “ re tir e s ” fr o m C o lle g e o f M e d ic a l E d u c a t io n
9
T P C H D : “ D is a s t e r P la n n in g ”
11
In M y O p in io n : “ T h e N e w S e r fd o m ”
13
P C M S d e b a te s W S T L A a n d e d u c a te s P ie r c e C o u n t y a b o u t
to rt re fo rm
14
2 0 0 4 P h y s ic ia n D ir e c t o r y c h a n g e s
15
P C M S e n d o rs e s W S M A ’ s le g is la t iv e in it ia t iv e o n to r t re fo r m
17
C o lle g e o f M e d ic a l E d u c a tio n
19
C la s s if ie d A d v e r t is in g
'JPieive %ountf QPPcfhca/tfiwe/y
President s Page
by M ichael J. Kelly, M D
Lessons from the Rogue
"There is a tide in the affairs o f m en
W hich taken at the f o o d leads on to fo rtu n e ;
O m itted, all the voyage o f their life
Is b o u n d in sh a llo w s a n d in m iseries.
On such a f u l l sea are w e now afloat,
A n d w e m ust take the current w hen it serves,
o r lose o u r ventures. "
M ichael J. Kelly, M D
- W illia m S h a k e s p e a re , “ J u liu s C e a s a r ”
Disclaimer: The com m ents a n d
suggestions herein represent m y o pin­
ion only and do not necessarily reflect
the opinion o f the P ierce C ounty M edi­
cal Society or its B o a rd o j Trustees.
The u p c o m in g state le g is la tiv e
• F a m ilia r iz e y o u r s e lf w ith the c a n ­
d id a te s in y o u r le g is la tiv e d is tr ic t and
tees, a p o s it io n o f a b s o lu te p o w e r c o n ­
c e r n in g th e fate o f le g is la tio n . W e h a v e
a c t iv e ly s u p p o rt th o se w h o se p la tfo rm
o b se rv e d the ab u se o f that p o w e r in th e
in c lu d e s s u p p o rt fo r to rt re fo rm
h o u se j u d ic ia r y c o m m itte e f o r th e p ast
tw o le g is la tiv e se ssio n s. T h e re m u st be
• C o n trib u te y o u r tim e an d m o n ­
a w a y to a c h ie v e c o n tro l o f th ese c o m ­
elections re m in d m e o f r a ftin g d o w n a
eta ry s u p p o rt o f these c a n d id a te s, in ­
m itte e s in o rd e r to h e lp better g u a ra n tee
w ild river. In a p re v io u s life , m y w ife
c lu d in g d is p la y in g b u m p e r s tic k e rs ,
acce ss to m e d ic a l care.
and I enjoyed m a n y y e a rs o f ra ftin g the
p la n t in g s ig n s , an d ta lk in g w ith y o u r
Rogue R iv e r near G ra n ts P ass, O re g o n .
p a tie n ts
urge y o u r s u p p o rt o f th e ir ca m p a ig n s:
We learned so m e v e r y im p o rta n t le s ­
sons on that stretch o f w h ite w a te r
• P la c e a p e rs o n a l lette r in y o u r
which seem apro po s to the u p c o m in g
w a it in g ro o m v o ic in g s u p p o rt o f these
legislative ele ction s.
c a n d id a te s a n d w h y . C o n s id e r a s h o rt­
First, the riv e r d oes n o t ca re ( n e i­
ther do m an y v o te rs o r le g is la to rs ). A
ened fo rm to use as a “ b ill s tu ffe r” to
rea ch m o re o f y o u r p atie n ts
In the 25th D istrict ( P u y a llu p ):
W a tly N a s h , Jo y c e M c D o n a ld ,
R o se H ill
In the 26th D istrict ( G ig H a rb o r):
M a t t R ic e , L o is M c M a h a n
mistake c o u ld lead to g ra v e c o n s e ­
quences. Se con d , an d ju s t as im p o rta n t,
I su g g e st the f o llo w in g sla te o f
c a n d id a te s as fr ie n d s o f m e d ic in e and
• O b ta in v o te r re g is tra tio n m a te ri­
In the 28th D istrict ( U n iv P la ce ):
preparation is key. T h e R o g u e R iv e r
als to h a ve in y o u r w a it in g ro o m ( P C M S
M ik e C a r r e ll, B o b L a w re n c e ,
guides rem in d ed us that the m o st im ­
can h e lp s u p p ly these). E n c o u ra g e
G ig i T a lc o tt
portant part o f ra ftin g w a s to p r o p e rly
th o se n o t re g iste re d to vote to d o so
line up y o u r c ra ft b e fo re e n te rin g the
w h ile th e y are v is it in g y o u r o ffic e
once you entered in to th e p o w e r fu l
W h ile these are a ll v e r y im p o rta n t
races, o ne sta n d s o u t as a lit m u s test
rapids. T h is w as im p o rta n t b eca use
W h ile there are m a n y im p o rta n t
fo r the stre ng th o f c o n v ic t io n o f the
river h y d ra u lic s there w a s lit tle y o u
le g is la tiv e co n te sts in th is state, let m e
p h y s ic ia n s o f P ie rc e C o u n ty . I 'm re fe r­
could do to chang e y o u r c o u rs e o r o u t­
su g g e st th e need to fo c u s o u r e ffo rts
rin g to the race b etw e en M a tt R ic e and
come.
p r im a r ily in th e 25 th , 26 th and 2 8 th d is ­
Pat L a n tz . M a tt R ic e , lo c a l e m e rg e n c y
tric ts. T h e s e are im p o rta n t d is tr ic ts in
d o cto r, is e m in e n tly q u a lifie d to le a d th e
into the v o rte x o f the u p c o m in g e le c tio n
o u r le g is la tiv e lig h t to e n a c t m e a n in g fu l
2 6 th d is tr ic t an d re p re se n t its c o n s t it u ­
frenzy. L ik e the p la c id r iv e r b e fo re the
to rt refo rm .
en cy. H e is a le a d e r w h o ca n g ra sp the
We fin d o u rs e lv e s d r if t in g s lo w ly
drop, it is calm now , b ut n o t fo r lo n g .
I k n o w 1 s h o u ld h a v e p aid m o re at­
in tr ic a c ie s o f th is im p o rta n t p ost. H e is
W hat w e do to “ lin e u p ” o u r s h ip w ill
te n tio n to m y h ig h s c h o o l c iv ic s c la ss
a ls o a s y m b o l. H is e le c tio n w i l l s a y v o l ­
allow us to s u c c e s s fu lly n e g o tia te the
w h e n th e y d is c u s s e d the a u th o rity o f
um e s a b o u t the d epth o f p h y s ic ia n fe e l­
elections. To p rep are o u rs e lv e s , I w o u ld
th e c o m m itte e ch a ir. T h e m a jo rity pa rty
in g s an d th e c ry fo r a p p ro p ria te le a d e r-
suggest the fo llo w in g :
has c o n tro l o f th e c h a irs o f t h e c o m m it­
See “ Lessons” page 16
August, 2004
PCMS BULLETIN
3
B
u l l e t in
Denial of Premera Conversion Request Big Success for Physicians/Patients
l ik e lih o o d th a t P r e m e r a w o u ld b e a c q u ir e d b y a n a t io n a l in ­
W h a t ’ s th e in s u r a n c e c o m m is - s io n e r ’s r u lin g a g a in s t
s u re r ," h e s a id .
P r e m e r a ’ s c o n v e r s io n re q u e s t w o r th to p h y s ic ia n s ? P h y s i­
In s p ite o f th e p l a n ’s a d v e r t is in g p r o m is in g th a t its c o n ­
c ia n s c o u ld h a v e lo s t c lo s e to $ 2 3 m illio n p e r y e a r in r e im ­
b u r s e m e n t i f th e P la n 's c o n v e r s io n to a s to c k c o m p a n y h a d
v e r s io n w o u ld c re a te a c h a r it a b le w in d f a ll to b e n e f it c o n s u m ­
b e e n a p p r o v e d , a n d th e P la n b r o u g h t its p h y s ic ia n p a y m e n ts
ers, a n d th a t th e c o n v e r s io n w a s n e c e s s a r y to r a is e n e e d e d
in lin e w it h o th e r f o r - p r o f it c a r r ie r s . ( T h is fig u r e is b a s e d 011
c a p ita l, in d e p e n d e n t e x p e r ts h ir e d b y th e sta te t w ic e c o n ­
c a r e f u l r e v ie w o f c o m p a n y d a ta b y th e W S M A ’s le g a l c o u n ­
c lu d e d th a t a f o r - p r o f it P r e m e ra w o u ld m o r e l i k e l y ra is e p re m i­
sel.)
u m s a n d c u t p a y m e n ts to d o c t o r s a n d h o s p it a ls in E a s te rn
W a s h in g t o n b y u s in g its m a r k e t c lo u t. ■
T h u s , w h e n C o m m is s io n e r K r e id le r a n n o u n c e d h is r e je c ­
t io n o f P re m e ra B lu e C r o s s ’ p r o p o s a l to c o n v e r t la s t T h u r s ­
d a y , h e d e liv e r e d a h u g e w in fo r th e W S M A a n d its m e m b e rs .
In m a k in g h is a n n o u n c e m e n t. K r e id le r m a d e m a n y o f th e
p o in ts w e s tre s s e d o v e r th e c o u rs e o f the t w o - y e a r lo n g p r o ­
c e ss. A s n o te d in a S e a ttle Tim es a r t ic le c o v e r in g th e eve nt:
• " K x e id le r 's a n n o u n c e m e n t...c a m e a lte r c o n s u m e r s , d o c ­
to rs a n d h o s p ita ls v ig o r o u s ly o p p o s e d P r e m e r a 's p la n an d
AUenmore
.ySy Psychological
Associates, P.S.
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c o n fid e n t it is a f a ir an d j u s t d e c is io n .” H e s a id th e m o v e
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m PHYSICIANS
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€) Physicians Insurance 2003________________________________________________
4
P C M S B ULLETIN
August, 2004
SJmmoved by the m slm g lo ii Stale Malic/il Association
Special Feature
by Jean B o rs t
Home Grown
Region’s Three Hospital Systems Expanding Services and Capabilities
A s the d em a n d f o r h e a lth c a re s e r­
vices increases, th e r e g io n ’ s th re e h o s ­
pital system s are r e s p o n d in g w it h state-
p a n s io n is a ls o p la n n e d fo r c a r d io v a s ­
v a n c e d c a n c e r - fig h tin g d ia g n o s tic te c h ­
c u la r s e rv ic e s .
n o lo g y , c o m p re h e n s iv e tre a tm e n t an d
W it h an E m e rg e n c y D e p a rtm e n t
s u p p o rt s e r v ic e s f o r c a n c e r p a tie n ts
of-the-art te c h n o lo g y , p a tie n t c o m fo r t
p r o v id in g s e r v ic e to m o re than 5 6 ,0 0 0
an d fa m ilie s , a n d an e x p a n d e d la b o ra ­
and co n ven ie n ce , and a d v a n c e d m e d i­
p a tie n ts a n n u a lly , G o o d S a m a rita n a lso
to r y to s u p p o rt G o o d S a m a r ita n ’ s c a n ­
cal cap a b ilitie s. F r a n c is c a n F le a lth S y s ­
re c o g n iz e s th e n e ed to e x p a n d e m e r­
c e r re se a rch p ro g ra m ,” s a y s G o v ie r .
tem, G o o d S a m aritan an d M u lt iC a r e
g e n c y s e rv ic e s . D u r in g c o m in g y ears,
Health System are a ll in th e th ro w s o f
the h o s p ita l w i l l in v e s t a p p r o x im a te ly
a ry P o s itro n E m is s io n T o m o g ra p h y /
phenom enal g ro w th in o rd e r to m e e t the
$ 7 0 m illio n to c o n s tru c t a n e w 150,000
C o m p u te r T o m o g ra p h y ( P E T / C T ) te c h ­
increasing d em a nd s o f th e p o p u la tio n s
s q u a re -fo o t E m e rg e n c y D e p a rtm e n t and
n o lo g y . E x t r a o r d in a r ily a d v a n c e d , th e
they serve. A n d th e y are c re a tin g f a c il i ­
P a tie n t C a r e P a v ilio n .
sc a n n e r c o m b in e s tw o w e ll- k n o w n im ­
ties that not o n ly b est se rv e th e ir p a ­
G o o d S a m a rita n is en g a g e d in an
T h e ce n te r w i l l o ffe r the r e v o lu t io n ­
a g in g sy ste m s to p r o v id e p h y s ic ia n s
tients, but th e ir p h y s ic ia n s an d s t a f f as
a g g re s s iv e p la n to r e c ru it p h y s ic ia n s to
well.
the re g io n . T h e h o s p ita l’ s M e d ic a l
le a d to m o re s u c c e s s fu l c a n c e r tre a t­
M a n p o w e r P la n d e v e lo p e d a stra te g y
m ent. “ T h is d ia g n o s tic te c h n o lo g y is
to r e c r u it 6 0 n e w p h y s ic ia n s to the
v e r y a d v a n c e d ," sa id Dr. R ichard
G o o d S a m a rita n m e d ic a l s ta ff d u rin g the
O sten son , m e d ic a l o n c o lo g is t at G o o d
n e x t f iv e y ears. M o r e th an o ne th ird o f
Sam aritan .
H ere is an o v e r v ie w o f w h a t’s h a p ­
pening around the S o u n d .
Good Samaritan
P u y a llu p -b a se d G o o d S a m a rita n is
currently in the m id s t o f a m u lti-p h a s e
th o se p h y s ic ia n s w i l l be f a m ily p ra c tic e
an d in te rn a l m e d ic in e p h y s ic ia n s . H ig h
w it h c r it ic a l n e w in fo r m a t io n th a t can
T h e C a n c e r C e n te r w i l l a ls o fe atu re
e x p a n d e d re se a rc h fa c ilitie s , p r o v id in g
plan to expand its m e d ic a l c a m p u s as
d e m a n d s p e c ia lty r e c r u it in g areas in ­
a m o re c o n d u c iv e e n v ir o n m e n t to d is ­
w e ll as its m e d ic a l sta ff. D u r in g th e n e x t
c lu d e o b s te tric ia n / g y n e c o lo g is ts , g e n ­
c o v e r n e w c a n c e r tre atm en ts, as w e ll as
decade, G o o d S a m a rita n is p o is e d to in ­
e ra l su rg e o n s, o rth o p e d ic su rg e o n s and
g re a te r su p p o rt o f c lin ic a l tr ia ls fo r n e w
vest as m u ch as S2 2 2 m ill i o n o n c a p ita l
c a r d io lo g is ts .
c a n c e r - fig h tin g d rug s.
projects that w i l l p r o v id e a se rie s o f
new state-of-the-art fa c ilitie s .
O n e o f t h e la rg e st phases o f G o o d
“ G o o d S a m a rita n is s e ttin g the n e w
S a m a r ita n ’s e x p a n s io n is th e p la n n e d
sta n d ard fo r re g io n a l c a n c e r c a re ,” a c ­
o p e n in g o f a n e w s ta te -o f-th e -a rt c a n ­
c o r d in g to O s te n so n . “ F o r y e a rs. G o o d
the most r a p id ly g r o w in g re g io n s in the
c e r ce n te r e a r ly n e x t year. “ T h e ce n te r
S a m a rita n ha s p r o v id e d a m o n g the
state o f W a sh in g to n ,” s a id G e o rg e
w i l l u n ite s o m e o f t h e w o r ld 's m o st a d ­
“ Eastern P ie rc e C o u n ty is o n e o f
See “ Home G rown” page 6
Govier, G o o d S a m a rita n P re s id e n t and
C h ie f E x e c u tiv e O ffic e r, “ an d G o o d S a ­
maritan is b u ild in g th e c a p a c ity to care
for our e x p a n d in g c o m m u n ity .”
In June, G o o d S a m a rita n o p e n e d its
new advanced S le e p M e d ic in e C e n te r, a
six-bed f a c ility fe a tu rin g sta te -o f-th e -a rt
technology. C o n s tru c tio n is c u r r e n tly
underway on a n e w 3 4 ,0 0 0 -s q u a re -fo o t
clin ical un it w it h in th e w e s t w in g , w h ic h
marks a $24 m illio n in v e stm e n t in m e d i­
cal fa c ilitie s an d a s s o c ia te d r e m o d e lin g
projects. T h e ne w u n it w ill in c lu d e a 14bed inten sive ca re u n it a n d fo u r o p e ra t­
ing room s as w e ll as sp a c e fo r a se co n d
cardiac ca th e te riza tio n la b o ra to ry . T h e
increase in o p e ra tin g ro o m s s ig n ifie s a
com m itm ent b y G o o d S a m a rita n to e x ­
pand its su rg ic a l p ro g ra m s . F u r th e r e x ­
This w ill be the n ew G ood Sam aritan C a n cer C enter s la te d to open e a rly next year.
The c en ter w ill fe a tu r e com prehensive trea tm en t a n d su p p o rt se rvices fo r c a n ce r
p a tie n ts a n d fa m ilies a n d an e xp a n d e d laboratory to su p p o rt research
August, 2004
PCM S BULLETIN
5
Home Grown
fr o m p a g e 5
m o s t h ig h ly r e s p e c te d c a n c e r s e r v ic e s
c lu d in g a n e w h o s p it a l - are on
fo r p a tie n ts in th e state. W e a re p ro u d
F r a n c is c a n H e a lt h S y s t e m ’ s slate .
th at o u r c o m m u n it y 's n e w C a n c e r C e n ­
In re s p o n s e to in c r e a s e d d e m a n d
• St. J osep h C e n te r fo r A dvanced
E n d o sc o p y in c lu d e s f o u r so p h is tic a te d
p r o c e d u r e r o o m s f o r d ia g n o s in g and
te r w i l l le a d th e w a y a g a in b y o ff e r in g
f o r o u tp a tie n t s u rg e rie s a n d o th e r s e r ­
tr e a tin g g a s t r o in t e s t in a l d is e a s e s and
d ia g n o s t ic s , tre a tm e n t, s u p p o r t a n d re ­
v ic e s , St. J o s e p h M e d ic a l C e n te r r e ­
o th e r c o n d it io n s .
s e a r c h in a s in g le lo c a t io n c lo s e to o u r
c e n t ly o p e n e d its n e w O u t p a t ie n t C e n ­
p a t ie n t s ’ h o m e s ."
ter, a s ta te -o f-th e -a rt h e a lth c a re f a c ilit y
e q u ip p e d w it h th e n e w e s t te c h n o lo g ie s
• D ia g n o s tic Im a g in g C en ter is
th at fe a tu re s th e la te s t in m e d ic a l te c h ­
f o r M R J , c o m p u t e r iz e d to m o g r a p h y
th e c e n t e r ’ s d e s ig n . “ T h is m o d e l o f
n o lo g ie s , a s e re n e h e a lin g e n v ir o n m e n t ,
( C T ) , u lt r a s o u n d a n d d ig it a l X - r a y .
c o m p r e h e n s iv e c a re m a rk s a s ig n if ic a n t
s p e e d y a d m is s io n s p ro c e s s , c o n v e ­
in v e s t m e n t in th e w e ll- b e in g o f o u r p a ­
n ie n t a c c e s s to a b ro a d ra n g e o f se r­
tie n ts , t h e ir f a m ily m e m b e r s a n d fr ie n d s ,
v ic e s , a n d free v a le t p a r k in g .
C e n t r a liz e d c a re is at th e h e a rt o f
an d u lt im a t e ly o u r e n tire c o m m u n ity ,”
T h e 1 5 2 ,0 0 0 -s q u a re -fo o t f a c ilit y in ­
• R e h a b ilita tio n T h era p ies Center
fe a tu re s c o m p r e h e n s iv e p h y s ic a l, neu­
r o lo g ic a l, o c c u p a t io n a l a n d sp e e c h
th e r a p y s e r v ic e s , c e n t r a lly lo c a te d fo r
a c c o r d in g to M a r g a r e t E a d e , R N , D ir e c ­
c o rp o ra te s F r a n c is c a n ’ s p h ilo s o p h y o f
c o n v e n ie n t a c c e s s b y p a tie n ts , p h y s i­
to r o f O n c o lo g y a t G o o d S a m a rita n .
tr e a tin g th e m in d , b o d y a n d s p ir it , a c ­
c ia n s a n d c l in i c a l s ta ff.
“ W h e n p a tie n ts a n d f a m ilie s f in d c a n ­
c o r d in g to Jo e W ilc z e k , F r a n c is c a n 's
c e r s e r v ic e s in a s in g le lo c a tio n , th e y
p r e s id e n t and c h i e f e x e c u t iv e o ffic e r . In
p r o c e d u r e s h as d e c re a s e d th e n e ed for
a re a b le to h a v e a m o r e h o lis t ic , h e a lin g
a d d itio n to a d v a n c e d m e d ic a l te c h n o lo ­
o v e r n ig h t h o s p it a l s ta y s , a c c o r d in g to
e x p e rie n c e .”
g ie s , th e c e n te r fe a tu re s c o m fo r ta b le
W ilc z e k . " T h e St. J o s e p h O u tp a tie n t
p a tie n t-c a re are as, w e lc o m in g v is it o r
C e n t e r p r o v id e s a u n iq u e h e a lin g e n v i­
B y o f f e r in g th is c e n tr a liz e d m o d e l
T h e a d v a n c e d t e c h n o lo g y o f m any
o f c a re , th e n e w C a n c e r C e n te r w ill
area; a g e n tle a n d s o o t h in g a tm o s p h e re
r o n m e n t th a t r e s p o n d s to th e n e ed s o f
e lim in a t e th e n e ed fo r m o s t c a n c e r p a ­
o f n a tu r a l c o lo r s , c u r v e d h a llw a y s , a rt­
th e in c r e a s in g n u m b e r o f p a tie n ts w h o
tie n ts to tr a v e l to m u lt ip le lo c a tio n s fo r
w o r k , a n d la rg e w in d o w s o ff e r in g
c o m e to St. J o s e p h fo r d ia g n o s is , treat­
tre a tm e n t.
s w e e p in g v ie w s a n d n a tu ra l lig h t.
m e n t o r r e h a b ilit a t io n w it h o u t th e need
A l s o h o u s e d in th e C a n c e r C e n te r
F e a tu re s o f t h e n e w c e n te r w i l l in ­
f o r o v e r n ig h t c a r e ” he e x p la in e d .
w i l l b e G o o d S a m a r ita n ’ s R a in ie r O n c o l­
c lu d e :
o g y o f f ic e s , w h ic h in c lu d e m e d ic a l o n ­
c ie n c y fo r p h y s ic ia n s , " a c c o r d in g to
c o lo g y c h e m o th e r a p y , a n d in d e p e n ­
• G en e and M ary A nn W alters D ay
Su rg ery C en ter, fe a tu r in g e ig h t 5 0 0 -
d e n tly o w n e d T a c o m a V a lle y R a d ia tio n
s q u a re -fo o t s u rg e ry s u ite s e q u ip p e d
a n d c o m m u n ic a t io n s m a n a g e r. “ T h e fa­
O n c o lo g y . W it h in ste p s, p a tie n ts w i l l
w it h m u lt i- u s e v id e o a n d d ig it a l e q u ip ­
c i l i t y fe a tu re s th e n e w e s t m e d ic a l tech­
f in d m e d ic a l s e r v ic e s in c lu d in g d ia g ­
m e n t that a llo w s u rg e o n s to p e r fo r m a
n o lo g y th r o u g h o u t. M e m b e r s o f o u r
n o s t ic im a g in g , c h e m o th e ra p y , ra d ia tio n
v a r ie ty o f p r o c e d u r e s o n an o u tp a tie n t
m e d ic a l a n d n u r s in g s ta ffs p r o v id e d ira-
tre a tm e n t, in f u s io n s , s y m p to m m a n a g e ­
b a s is .
m e n t a n d a c c e s s to c lin ic a l tr ia ls .
T h e C e n te r w i l l a ls o c o n s o lid a t e
T h e n e w f a c il i t y “ is a m o d e l o f e ffi­
G a le R o b in e tt e , F r a n c is c a n ’s m a rk e tin g
Sec "H om e G row n” page 8
1
s e v e ra l s u p p o r t s e r v ic e s , in c lu d in g an
e d u c a tio n an d r e s o u r c e ce n te r, a p p e a r­
a n c e ce n te r, n u t r it io n a l c o u n s e lin g , p a s ­
to r a l c a re , p s y c h o s o c ia l p ro g ra m s , s u p ­
p o r t g r o u p s a n d a le n d in g r e s o u r c e l i ­
b rary .
B o a s t in g an e n v ir o n m e n t c o n d u ­
c iv e to th e u tm o s t in p a tie n t c a re , th e
c e n te r w i l l fe a tu re s tu n n in g v a lle y an d
m o u n ta in v ie w s th r o u g h la rg e s p a n s o f
g la s s , as w e ll as th e s o o t h in g e le m e n ts
o f n a tu ra l lig h t, m u s ic , a r tw o rk , p riv a te
s p a c e s a n d g a rd e n s .
F ran ciscan H ealth S ystem
T h e re c e n t o p e n in g s o f n e w f a c il i ­
tie s , th e e x p a n s io n o f e x is t in g s e r v ic e s ,
The n e w St. J o se p h O u tp a tie n t Center, a d ja ce n t lo th e hosp ita l, h o u se s the new
an d p la n s f o r fu tu re c o n s t r u c tio n - in ­
O u tp a tie n t D ia g n o stic Im aging, O u tp a tie n t R e h a b ilita tio n , th e G en e a n d M a y Aim
W atters D a y S u rg e ry a n d the St. J o se p h A d v a n c e d E n d o sc o p v C e n te r
6
P C M S B ULLETIN
August, 2004
Les McCallum “retires” from College of Medical Education position
The C o lle g e o f M e d ic a l E d u c a tio n
p a r t ic u la r ly in e n s u rin g n o t o n ly the
s itio n e a s ie r fo r a n e w s t a f f p e rso n .
lost a lon g -tim e, v a lu a b le s t a f f m e m b e r
c o m m e r c ia l in te g rity b ut the fin a n c ia l
E ig h t p ro g ra m s w i l l be o ffe re d (see p r o ­
when L e s M c C a llu m le ft h is p ro g ra m
in t e g r ity o f o u r C M E p ro g ra m s , n o ted
g ra m s c h e d u le p a g e ! 4 ) in c lu d in g th e a n ­
adm inistrator p o s itio n J u ly 30. “ I t ’s a
S u e A s h e r, E x e c u t iv e D ir e c t o r o f
n u a l W h is t le r c o u rs e , as o p p o se d to the
huge loss fo r the C o lle g e ,” sa id P r e s i­
P C 'M S . H e has b een c o n s is te n tly c o m ­
n o rm a l e le ve n . H a w a ii w ill c o n tin u e in
dent John Jiganti, M D . “ L e s has d on e
m itte d and w o r k e d e x tr e m e ly h a rd in
2 0 0 6 a n d o th e r c o u rs e s w i l l e ith e r be o f ­
a tremendous jo b fo r us and w i l l be
o f f e r in g s u b s ta n tiv e a c c re d ite d p r o ­
fe re d a n n u a lly o r w i l l rotate fr o m y e a r to
very d iffic u lt to re p la c e .” he added.
g ra m s at n o o r v e r y lo w cost.
year.
As
an in d e ­
Les M cC a lh im
T h e C o lle g e B o a rd o f D ire c to rs
c o n s is t o f tw e lv e p h y s ic ia n s a p ­
S c o tt P e te rs o n has been h ire d to re ­
p la c e M c C a llu m an d b egan h is n e w p o ­
pendent
p o in te d b y the P C M S B o a r d o f T r u s t­
s itio n A u g u s t 1. P e te rso n h a ils fro m
c o n tra c ­
ees, th ree p h y s ic ia n s a p p o in te d b y the
O ly m p ia w ith a p u b lic re la tio n s an d p ro ­
to r fo r
C o lle g e B o a r d a n d o n e re p re se n ta tiv e
g ra m a d m in is tra tio n b a c k g ro u n d . H e
th e C o l ­
a p p o in te d b y each h o s p ita l sy ste m in
se rv e d as c a m p a ig n m a n a g e r fo r
lege,
th e c o u n ty ; F r a n c is c a n H e a lth S y ste m ,
F e d e ric o C r u z ’ s g u b e rn a to ria l c a m p a ig n
M cCallum
G o o d S a m a rita n , and M u lt iC a r e H e a lth
an d a ssiste d on In itia t iv e 190.
w o rk e d
S y s te m . T h e E x e c u t iv e D ir e c t o r o f
o th e r
P C M S se rv e s as S e cre ta ry. T h e C o l ­
to re m a in in v o lv e d to e n su re a sm o o th
jo b s an d
le g e B o a r d o v e rs e e s th e fin a n c e s a n d
tra n s itio n , so y o u m a y see h im at u p ­
c h o s e to
th e a d m in is tr a tio n o f t h e C o lle g e .
c o m in g C o lle g e co u rse s. P a r t ic u la r ly at
d o w n s iz e
T h e C o lle g e B o a rd o f D ire c to rs
F o rtu n a te ly , M c C a llu m has o ffe re d
the W h is t le r C M E p ro g ra m in Ja n u a ry ,
as he w o rks to w a rd retire m e n t. A fter 16
v o te d to o ffe r fe w e r c o u rse s in the
w h e n he w i l l be a s s is tin g P e te rso n w ith
years o fp ro g ra m o rg a n iz a tio n , he m a d e
2 0 0 4 -0 5 p ro g ra m y e a r to m a k e the tran-
h is n e w d u ties. ■
the d iffic u lt d e c is io n to le a v e h is C o l ­
lege p osition and m o v e on to a less
hectic lifestyle .
M c C a llu m w a s in s tru m e n ta l in
helping the C o lle g e o f M e d ic a l E d u c a ­
tion id e n tify p ro g ra m s that w o u ld b est
serve the m is s io n , w h ic h is to p r o v id e a
local resource fo r q u a lity C a te g o r y 1
C M E program s. T h e in te n t is to g iv e
Dermatologist Lloyd Elmer, MD,
89th President of PCMS to retire
A f t e r p r a c tic in g D e rm a to lo g y in
T a c o m a fo r the past 35 y e a rs. Dr.
Lloyd E lm er retired June 30. D r. E lm e r
the m e dical c o m m u n ity an o p tio n to
p ra c tic e d
share and e xcha ng e e x p e rtis e , in ­
crease com petence, a n d p r o v id e
quality patient care. T h e p ro g ra m s
planned are in ten d e d to p r o v id e
some elem ent o f s p e c ia liz e d e d u c a ­
tion to m ost m e d ic a l s p e c ia ltie s , b ut
and 1979, and as a P C M S T ru ste e in
1976 -1 977 and 1980. H e also w a s a m e m ­
b e r o ft h e C r e d e n tia ls C o m m itte e , c h a ir ­
in the
m an o ft h e B u d g e t and F in a n c e C o m m it ­
A lle n m o r e
tee an d se rv e d as a d e le g a te at the
area d u r­
W S M A A n n u a l M e e tin g s in 19 7 9 and
in g h is c a ­
1980. H e se rv e d as a T ru s te e on th e
reer,
W S M A B o a r d o f T r u s t e e s in 1980.
o p e n in g
primary care e d u c a tio n is g iv e n the
se rv e d as S e c r e t a r y - T re a s u re r in 1978
Dr. E lm e r w a s in s tru m e n ta l in the
h is p ra c ­
fo r m a tio n o l'th e P C M S f o r - p r o f it su b ­
highest p rio rity . T h e C o lle g e is fin a n ­
tice in
s id ia r y M e m b e r s h ip B e n e fits , Inc. in
c ia lly se lf-s u s ta in in g an d has to c o n ­
19 69 at
1978. T h e s u b s id ia ry , to d a y k n o w n as
sider not o n ly w h a t s u b je c t m atte rs
A lle n m o r e
M B 1 , c o n tin u e s to w o r k w e ll fo r P C M S
M e d ic a l
as it gen erates n o n -d u e s re v e n u e fr o m
C e n te r a f­
p u b lic a tio n s , p e rs o n n e l a n d o th e r s e r­
are o f m ost im p o rta n c e a n d n e ed in
L lo y d Elmer, M D
the com m unity, but m u st k e e p an ey e
on the fin a n cia l f e a s ib ility as w e ll.
“ It’s getting in c r e a s in g ly d if f ic u lt each
year,” noted M c C a llu m , “ as p h a rm a c e u ­
tical com panies are b e in g m o re r e s t r ic ­
tive w ith fu nd s an d p h y s ic ia n s h a ve
many more o p tio n s f o r o b ta in in g lo w
cost C M E .”
Les has done a n in c r e d ib le jo b ,
te r c o m p le tin g h is in te rn s h ip at
v ic e s , an d h as p u rc h a s e d and o w n s the
M a d ig a n G e n e ra l H o s p ita l an d h is
b u ild in g w h ic h p r o v id e s re n ta l in c o m e
r e s id e n c y in N e w O r le a n s at C h a r it y
f o r M B I , a s s is tin g P C M S in k e e p in g
H o s p ita l o f N e w 'O r le a n s .
th e ir dues to a m in im u m .
D r. E lm e r w a s v e r y a c tiv e in the
P C M S th a n ks D r. E lm e r fo r h is
m e d ic a l c o m m u n ity a n d th e m e d ic a l
y e a rs o f m e m b e rs h ip an d s e r v ic e and
so c ie ty . H e s e rv e d as th e 8 9 lb P r e s i­
w is h e s h im th e v e r y b est in h is r e tir e ­
d e n t o f P C M S in 1982 a fte r h a v in g
ment. ■
August, 2004
PCMS BULLETIN
7
B
u l l e t in
Home Grown
from p age 6
p o rta n t su g g e stio n s a n d id ea s d u rin g
th e d e sig n p h a se o i'th e O u tp a tie n t
o p e n ed th e new St. Jo se p h D ialy sis
D ire cto r o f M u ltiC a re S u rg ic al Services.
C e n te r in G ig H arb o r, w hich featu res six
“W e b e lie v e w ith th e s e en hancem ents,
C e n te r, w h ic h h e lp e d e n su re th a t the fa ­
d ia ly sis sta tio n s e q u ip p e d w ith the la t­
M u ltiC a re is m o re p o is e d th an ev er to
c ility w o u ld be p a tie n t-c e n tric a n d m eet
est te c h n o lo g y and p ro v id e s o u tp atien t
m e e t th e n e e d s o f o u r p a tie n ts and phy­
th e d a ily n e e d s o f o u r h e a lth c a re p ro ­
v id e rs .”
hem o d ialy sis.
s ic ia n s .”
F e a tu rin g the la te st m ed ic al tech­
St. Jo s e p h M e d ica l C e n te r is also
FH S has a lso re ce iv e d a pproval
from the W ashington S tate H ealth D e ­
n ology, the new su rg ic a l c e n te r offers:
• T o u ch - a n d v o ic e -a c tiv a te d con­
u n d e rg o in g a $15 m illio n re n o v atio n o f
its in p a tie n t surgery, w h ich w ill be c o m ­
p a rtm e n t to d ev elo p an in p atien t h o s­
pice c en ter in th e T acom a area w hich
tro ls fo r lig h tin g , te m p e ra tu re and
p lete in Septem ber. 2005. T he ex istin g
w ill begin service so m etim e in 2005.
equ ip m en t.
e ig h t large 6 0 0 -sq u a re -fo o t-p lu s suites.
M ultiC are H ealth System
n ica tio n S ystem (P A C S ) in all operating
T h e re m o d e lin g w ill e x te n d to su rg ery
W ith sev eral p ro je c ts in th e w o rk s
o r on the d ra w in g board, the m o st high-
• T h e P ic tu re A rc h iv e a n d C om m u­
o p e ra tin g ro o m s w ill be c o n v e rte d to
su p p o rt a rea s, in clu d in g a n ew w aitin g
ro o m , new p h y sic ia n and s ta ff locker
ro o m s, re n o v atio n o f th e a n e sth e sia o f­
fice a n d n e w su rg e ry a d m in istra tio n o f­
fices.
su ites to a llo w p h y sic ia n s to access
p ro file ex p an sio n p ro jec t at M ultiC are
th re e -d im e n sio n a l d ia g n o s tic images.
• C e ilin g -m o u n te d su rg ic al booms.
H ealth S ystem is the new S urgical C are
C e n te r and R e g io n a l H e art a n d V ascular
su ites, larg e r th an n o rm al to provide ad­
• F o u r d e d ic a te d c a rd io v ascu la r
C enter, w hich o p e n ed in June. T h e a d ­
eq u ate sp a c e fo r th e m ed ic al team s and
v a n ce d su rg ical facilities, c o m p le te w ith
e q u ip m e n t v ital to th e m o st com plex
th e latest tec h n o lo g y a v a ila b le , w as d e ­
sig n ed to allo w for se a m less integ ratio n
c a s e s.
• F o u r c a rd ia c c a th e te riz a tio n labs,
b u ild an 8 0 -b e d . a c u te -c a re h o sp ital in
north G ig H arbor. C o n stru c tio n on the
197.0 0 0 -sq u are-fo o t facility w ill begin
o f th e next g en era tio n o f surgical a d ­
v a n ce m e n ts, su c h as ro b o tic s and c o m ­
lo ca ted ju s t ste p s a w a y fro m adjacent
next su m m er, and the do o rs w ill open in
2007 o r 2008. St. A n th o n y H ospital will
P h y sic ian and s ta ff input w as an in te ­
g ral p art o f th e C e n te r's d esig n process.
featu re a 2 4 -h o u r-e m e rg e n c y d e p a rt­
m en t; m ed ic al, surgical and critical care
“ O u r g oal w a s to create a surgical
c e n te r c o m p le te w ith h ig h -te ch tools
a n d low -tech h e alin g e n v iro n m en ts,
th at e q u ip p e d p h y sic ia n s and
F ra n c isca n H ealth S ystem has also
re c e iv e d a u th o riz a tio n from the W ash­
in g to n S ta te D e p artm en t o f H e alth to
u nits; in p atien t and o u tp a tie n t su rg ery ;
a h e art c ath ete riz atio n lab; d iag n o stic
se rv ice s; p h y sic a l, o ccu p a tio n a l and
sp e e c h th era p ie s; and a sleep d iso rd ers
clinic. A m edical office b uilding w ill be
a d ja c e n t to the h o sp ital.
“ A s w ith th e St. Jo sep h O u tp a ­
tient C enter, w e w ill seek input from our
m edical s ta ff m em b ers re g ard in g how
o u r n ew h o spital in G ig H a rb o r should
p re h en siv e e le ctro n ic m edical records.
h e a lth c a re p ro fessio n als w ith e v ery ­
th in g th ey need to p ro v id e o u r p atients
w ith the h ig h est q u a lity care p o ssib le ,"
said S helly M ullin, R N , A d m inistrative
in clu d in g o n e d e d ic a te d to pediatrics,
c a rd io v a s c u la r su ites to fu rth e r improve
su rg ical access.
• C a m e ra s in the su rg ic al lights so
p ro c e d u re s can be v ie w e d to facilitate
C o n tin u e d M e d ica l a n d N u rs in g educa­
tion, w h ile m a in ta in in g p a tie n t confi­
dentiality.
• A c e n te r c o re th a t p ro v id es easy
a cc ess to m ed ic al su p p lie s at any m o­
m en t d u rin g surgery.
See “ H om e G row n" page 12
be d e sig n ed a n d e q u ip p ed to b est m eet
the n e ed s o f p h y sic ia n s and th eir p a ­
tie n ts ,” a cc o rd in g to R obinette. “ T he
p a rticip a tio n o f o u r m edical sta ff in re­
v iew in g p ro g ra m m in g and d esig n c o n ­
c ep ts w ill b e a b so lu te ly vital for us to
ach ie v e o u r v isio n fo r th e G ig H arb o r
h o sp ital, ju s t as such p a rticip a tio n
h elped turn the v isio n fo r the St. Jo ­
se p h O u tp a tie n t C e n te r into reality .”
O th e r p ro je c ts at F ra n c isca n in­
c lu d e the e x p an sio n and ren o v atio n o f
St. C lare H ospital in L ak ew o o d , w hich
w ill b e c o m p le te d this m o n th and in­
c lu d e a n e w e m e rg en c y d e p artm e n t.
In a d d itio n , F ra n c isca n re ce n tly
M u ltiC a re s e xp a n sio n p ro je ct, in c lu d in g the n e w S u rg ic a l C are C e n te r a n d
R e g io n a l H e a rt a n d V ascular Center, o v e rlo o k s the f o u n ta in a n d ro se garden,
h ig h lig h ts o f the M u ltiC a re c a m p u s
The Health Status o f Pierce County
Federico Cruz-Uribe, MD
Director of Health
Disaster Planning
Missing vials o f anthrax. A stolen
crop duster. A plane crash in Puyallup.
Bioterrorism com es to the Puget Sound.
This was the scenario p layed out for us
at a recent training in P uyallup that
public health sta ff p articipated in. A s I
sat through one o f the sessions talking
about isolation and quarantine issues
my mind wandered and I thought about
how probable, how really likely w as a
bio-terrorist event in our county. It is
certainly possible but it’s not likely. So,
with resources being so scarce, w hy are
we doing this? T here are good answ ers
to this question but m y m ind w as on a
roll and 1 evaded them and pressed on.
What are we m ost likely going to c o n ­
front in the near future? A re there
threats, serious public health threats
that loom in our near future.
I have to share w ith you
that I had mental Iy already
stacked the deck on this issue. I
just finished reading an account
ofthe Great Flu Pandem ic o f
1918. The book, call The G reat
Influenza, gives a gripping ac­
count o f how the epidem ic
started in a little tow n in central
Kansas, spread rapidly to a nearby
army base, then to the trenches in
France and then back to the U.S. Two
years later tens o f m illions o f people
worldwide were dead and o ver a 100
million had fallen desperately ill. M any
of us have read accounts o f w hat hap­
pened in this country: T he m assive d is­
ruptions; closed schools; b u sinesses
with no em ployees; hospitals so over
run that no care was o ffered to th e sick;
the dead piled up nightly on the curb to
be carted o ff to m ass graves at the edge
of town.
W hen I ta lk w it h m y c o lle a g u e s in
public health, w ithout exception, they
all feel that a flu p andem ic is in our fu­
ture. W ith the recurrence o f avian flu in
m any p arts o f the w orld, it is ju s t a m at­
ter o f tim e before we see its crossover
into the hum an population.
So I am sitting there in Puyallup
fretting over the tim e 1 am spending on
a farfetched anthrax scenario. D oes this
help our com m unity prepare lor a p o s­
sible flu pandem ic w here te n 's o f thou­
sands o f Pierce C ounty residents sud­
denly fall ill and flood our local health
care system s needing care? F ortu­
nately, the sim ple answ er is yes. The
constant m eetings, m ockups and drills
do indeed w ork. We need to becom e
m ore fam iliar with each other - police
and em ergency responders, the m ilitary.
F ederico Cruz, M D
to connect w ith the public and keep a
clear channel o f com m unication going.
H ysteria is alw ays a real th reat and can
ruin any effective response to a crisis if
the public is not kept in the loop and re­
a ssu red .
W e have to rem em b er that each o f
us is also part o f the public. Even
though as health p roviders w e w ould
play a very active role in confronting a
flu pandem ic w e have our ow n personal
needs ju st as any m em ber o f th e public
has. W e c a n ’t pretend that w e w ould
act any differently than o th er non­
health professionals. W hen w e look at
w hat happened in the pandem ic
o f 1918, w e have to recognize
that, though m any o f our c o l­
“ When I talk with my colleagues in public
leagues ju m p e d right in and
provided heroic am ounts o f
health, without exception, they all feel
care (and there w ere very high
that a flu pandemic is in our future. ”
m orbidity and m ortality rates
am ong providers), m any o f our
colleagues absented th em ­
selves from any o rganized re ­
hospitals, pharm acies, clinics, indi­
sponse out o f fear and concern for their
vidual providers, port officials, jail offi­
ow n personal situations. People w ill be
cials, parks and library leaders. A ll con­
dem anding m uch o f us during a d isa s­
tribute to how a com m unity w ould re­
ter and w e need to see that we are there
spond to a disaster. T hese drills help us
and can perform . T his is our role as
to develop the relationships now, e n ­
physicians. But w e c a n ’t accom plish
courage us to learn how to w ork to­
our m edical role if w e d o n 't resolve now
gether. We actually do the needed plan­
the personal dem ands on us. We have
ning and then practice executing jo in t
lo prepare for com m unity crises, and
efforts. N ow , today, before pandem ic flu
recognize that our ow n needs w ill have
or the next earthquake, so if a m ajor
to be m et if w e are to be effective. O ur
event happens w e are not w inging it
fam ilies will need attention and care
w hen lives are threatened.
w hile patients w ill also require our best
In this exercise, one o f the stan ­
professional skills.
dard critical issues com es up early: how
See “D isaster” page 10
August, 2004
PCMS BULLETIN 9
B
u l l e t in
Disaster
fro m p a g e 9
In a n y d is a s te r p la n n in g , w e have
lo n g k n o w n th a t p rio rity n e e d s to be
g iv e n to th o se p e rso n s a n d th e ir fam i­
lies th a t p la y a c e n tra l p a rt in th e com ­
Franciscan
Clinical
Messaging
m u n ity re sp o n se to a d isa ster. T h ey are
the o n e s w h o a re g o in g to k e e p the
c o m m u n ity p o in te d in th e rig h t d irec­
tio n d u rin g th e to u g h tim e s. B ein g to­
tally d istra c te d a n d c o n su m e d over per­
so n al w o rrie s d o e s n ’t c u t it w h en we
are c alled on to se rv e on th e fro n t lines
o f c o m m u n ity serv ice.
S o how to p re p a re . W e n e ed to
sc h e d u le c o u n ty -w id e e v e n ts w here the
m a jo r p a rts o f o u r lo ca l h e a lth care sys­
tem s a c tu a lly p a rtic ip a te in th e activi­
pow ered by Elysium, a p ro d u ct o f Axolotl Corp.
ties and w e as p ro v id e rs g e t th e train­
ing and o rie n ta tio n w e n e e d to face a
c o m m u n ity -w id e th re a t su c h as a flu
p andem ic.
Im a g in e having y o u r p a tie n ts ' m e d ica l in fo rm a tio n at y o u r fin g e rtip s .
W h e re , and w h e n , yo u n eed it. F ranciscan Clinical M e s s a g in g is
a s e c u re , H IPAA c o m p lia n t, w e b -b a s e d c o m m u n ic a tio n arch iving
s y s te m th a t b rin g s you th e in fo rm a tio n you n eed fro m St. Jo se p h
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Franciscan Health System
w w w . f h s h e a I t h . o r
6reast
surgery
thin^
o f us.
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and Corset Shop
Formerly Smith's C orset Shop
2302 S Union Ave 752-1705
10 PCMS BULLETIN
August, 2004
?P<er-cc "t(
In My Opinion . . . .
The Invisible H and
C
((edica/octal>/
b y A n d r e w s ta ts o n , m d
The opinions e x p re ssed in th is w r itin g a r e s o le ly th o s e o f th e a u th o r. P C M S in vites m e m b e r s to ex p r e s s th e ir o p in io n /in s ig h ts a b o u t su b je c ts
relevant to th e m e d ic a l co m m u n ity , o r s h a r e th e ir g e n e r a l in te r e s t s to n e s . S u b m is s io n s a r e s u b je c t to E d ito r ia l C o m m itte e review .
The New Serfdom
" / d i d n '/ kn o w I was a sta ve until I fo u n d
out I couldn ’/ do the things I w anted. "
Frederick D ouglas (1845)
A n d rew Statson, M D
On January 2 6 ,2 0 0 4 the A MA
News reported the story o f Julie K.
McCammon, M D. She had practiced as
a solo OB-GYN in Clarksburg, W est Vir­
ginia, since 1988. She w anted to relo ­
cate to neighboring V irginia at the end
of2003 because o f rising insurance
costs.
She had to pay $ 190,000 to g et tail
coverage and could not afford it. T hen
she learned that her insurance com pany
will stop w riting liability coverage in her
state in 2005 and she w ould have to
close her office.
She filed suit against the W est Vir­
ginia Trial Law yers A ssociation and its
president for engaging in frivolous law ­
suits, thus increasing the cost o f insur­
ance coverage. She argued that every
time aphysician w as nam ed in a law ­
suit, even if dropped later, the insur­
ance company had to open a file, re ­
view records, etc. T hat prelim inary w ork
could easily consum e m ore than ten
thousand dollars.
Her grievances included econom ic
loss, professional lim itations, em otional
distress, m ental anguish and other non­
economic damages.
The first ju d g e assigned to the
case recused h im se lf because the d o c ­
tor had delivered his w ife ten years ear­
lier. The second ju d g e accepted the
case, even though his w ife is a trial at­
torney. He dism issed the claim . T h at d e ­
cision is on appeal. Dr. M cC am m on
hopes that she w ill be allow ed to p ro ­
ceed w ith discovery o f evidence.
W hile this case received the m ost
publicity, m any o ther physicians have
had to decide w hether to pay huge
am ounts o f m oney to escape from a sti­
lling liability' environm ent or to take
their chances and forgo the tail.
T he exam ples abound and com e
from across the country. The Southern
Illinoisan reported on 5-1 1-04 that ac­
cording to a physician recruiting firm in
Saint Louis, m alpractice issues w ill keep
as m any doctors in Illinois as they will
keep away. M any Illinois physicians are
tied dow'n by their tail coverage. T hey
typically m ust pay double the yearly
rate w hen changing policies.
T he sam e paper interview ed a na­
tive o f C arbondale, w ho will start her
residency in internal m edicine in Saint
Louis. Lana C lark graduated from the
Southern Illinois U niversity M edical
School in Springfield (story from 6 - 1904). She w ould like to return to
C arbondale to practice, but not unless
the m alpractice situation im proves by
the tim e she com pletes her residency.
T he p ap er reported that M adison
and Saint C lair counties in Southern Illi­
nois are considered ju d ic ial hell holes.
T hey are havens for attorneys and
p laintiffs to reap big ju ry aw ards.
A s a result, in spite o f the cost o f
tail coverage, m ore p hysicians are leav­
ing Illinois than going in. G eorgia, N e­
vada and probably Pennsylvania are in
the sam e situation. In M ay o f this year,
the W yom ing M edical Society reported
a long list o f p hysicians w ho are m ov­
ing out, m ostly to C olorado, w here the
liability clim ate is better.
The trial law yers use official fig­
ures to dispute those claim s, but the
statistics o f licensed p hysicians do not
reflect the n um ber o f those in active
practice. B esides, the tim e lag o f the
data is at least a year, if not m ore.
C om pared to the total n u m b er o f
physicians, those w ho abandon their
p ractices and relocate are still a sm all
p ercentage. In the face o f our grow ing
and aging population, how ever, the
trend is in the w rong direction.
So w hat options do w e have?
1f you are consid erin g retirem ent,
m ake sure y o u 'll have a good tail insur­
ance. If you have to pay fo r the tail,
perhaps it w ould be better to stop p ra c ­
ticing before the effective renew al date
o f y o u r policy w ith its con co m itan t in­
crease in prem ium s.
If you are thinking o f relocating,
see that you can afford the tail. If next
year the cost o f insurance for o b stetri­
cians goes to $ 160.000, as p rojected in
M aryland, or higher, as expected in
C onnecticut, you m ay need to pay over
$300,000 to buy the policy.
If you are a resident, you should
look for a place w ith favorable liability
law s and hope they d o n ’t change d u r­
ing the thirty or m ore years y o u 'll be in
practice. I f you are going to w ork for a
Sec “Serfdom " page 18
August, 2004
PCMS BULLETIN
11
B
u l l e t in
Home Grown
fro m p age 8
a n n iv e rsa ry o f M a ry B rid g e C h ild re n ’s
“ M a ry B rid g e h a s a lo n g -sta n d in g
H o sp ita l, the n ew M ary B rid g e
C h ild re n ’s H ealth C e n te r w ill open th e
cal care. W ith th is n e w fa cility - and the
w ith p a tie n ts, re d u c in g p re o p e ra tiv e
d o o rs to a new' sta te -o f-th e -a rt o u tp a-
a tte n tio n o u r s ta f f a n d d o n o rs have
stre ss fo r e v ery o n e . W ith a c o n fid e n tia l
tie n t facility. T h e 6 0 ,0 0 0 -sq u a re -fo o t a d ­
giv en to c re a tin g an id ea l h e a lin g envi­
c o d e, fa m ily m em b e rs are a lso able to
ro n m e n t for kid s - 1 b e lie v e o u r reputa­
tra c k a p a tie n t’s p ro g re s s th ro u g h o u t
dition w ill in clu d e 50 p a tie n t ro o m s,
su p p o rt se rv ice s in c lu d in g lab, p h a r­
su rg ery a n d reco v ery . W ith the
m acy and X -ray, and p a tie n t-fa m ily se r­
th o u g h tfu l d iv isio n o f sp a c e in the v isi­
c u se d fa c ility w ill c o n tin u e to g ro w .”
In 2 0 0 4 , M u ItiC are is a ls o advanc­
to r w a itin g a rea, p h y sic ia n s are ab le to
vices.
N atural light, open sp a c e and
sp e a k p riv ately w ith fam ily m em b e rs in
im a g in ativ e d esig n a p tly d e sc rib e the
T h e c e n te r a lso fe a tu re s a p re -su rg ical a sse ss m e n t a rea, a re la x ed e n v i­
ro n m e n t w h e re fa m ily m e m b e rs can stay
re p u ta tio n fo r p ro v id in g e x c e lle n t clini­
tion as a h e a lin g , c h ild - a n d fa m ily -fo ­
ing M e d ica l Im ag in g tech n o lo g y .
M u ItiC a re h a s o p e n e d a n e w outpatient
an a d ja c e n t c o n su lta tio n area.
sp e c ia lty c linic, w hich c o m b in e s tw o
im a g in g c e n te r in G ig H arbor, installed
“O u r te a m w o rk e d c lo sely w ith o u r
m e d ic a l and n u rsin g staffs to design
im p o rta n t prin cip les - m odern m edical
s ta te -o f-th e -a rt M a g n e tic R eso n an ce
uses and p a tie n t c o m fo rt. W in d o w s at
th e end o f c o rrid o rs, tw o o u tsid e c o u rt­
Im a g in g M R I a tA lle n m o re H ospital and
th e n e w fa c ility to be th e m o st ad ­
v a n c e d su rg ic al facilities in the region
w ith the latest m ed ic al in te g ratio n and
im a g in g sy s te m s,’’ sa y s T odd K elley,
M e d ia R e la tio n s M a n a g er for
M u ItiC are . “T h a t c o lla b o ra tio n and in­
te g ra tio n d irec tly b e n efits o u r p a ­
tie n ts .”
A s the d o o rs o p e n ed to the su rg i­
cal c e n te r in Ju n e , the w alls w ere being
ra ised on a n o th e r m ajo r b u ild in g
p ro ject. N e x t sp rin g , in tim e for the 50th
y a rd s, stu n n in g a rtw o rk and a th em e for
each flo o r are so m e o f the e le m en ts th at
help p ro v id e a so o th in g and se ren e a t­
m o sp h e re for p a tie n ts, fam ilies and
in stalled a new 16 -ro w C o m p u te d Axial
T o m o g ra p h y (C A T ) s c a n n e r a t Tacom a
G e n e ra l/M a ry B rid g e. R e n o v atio n s to
install a se c o n d 16-row C A T scanner
staff. T he first floor w ill fe atu re a sea
a n d i .5 T esla MR.I w ith T IM tech n o l­
ogy at T G /M B are w ell u nderw ay.
m o tif, the seco n d flo o r focuses on land,
and the third flo o r w ill b o a st a sky
film less im a g in g tec h n o lo g y . T his tech­
them e.
“ I’m very pro u d o f th e w o rk o f our
s ta ff and the design te a m ,” said M ady
M urrey, M ary B ridge adm inistrator.
M u ItiC are is a lso m o v in g tow ard
n o lo g y w ill a llo w us to c o n tro l and
m ove im ag es electro n ically , w ill signifi­
c an tly sh o rte n e x am tim e s a n d im prove
See "H om e G row n” page 14
Allenmore Medical Plaza—Phase Two
3 2 0 9 S ou th 2 3 r d S tr e e t
C o n v e n ie n tly lo cated n e a rb y
A lle n m o re C o m m u n ity H o sp ita l,
Tacom a, W A
FEATURES / SPECIFICATIONS
■ 45,956 re n ta b le sq u a re fe e t
- F ir s t F lo o r
14,452 rs f
- Second F lo o r
14,960 rs f
-T h ird F lo o r
16,544 rs f - leased
■ B u ild in g c u rre n tly u n d e r c o n s tru c tio n
■ C o m p le tio n 1st Q u a rte r 2005
■ Tenant im p ro v e m e n t a llo w a n c e ava ila ble
■ H igh q u a lity fin is h e s
Medical Real Estate Services, LLC
12 PCMS BULLETIN
August, 2004
'fie r c e
<tnr/ y
i l ' i c t f (pfceteitf
PCMS debates WSTLA and educates Pierce County about tort reform
On Friday, July 9, P resident M ik e
Kelly, MD had the distinct pleasure o f
debating the issue o f tort reform w ith
then President-E lect o f the W ashington
State Trial L aw yer’s A ssociation
(WSTLA), attorney R odney Ray. In­
stalled later in July as W ST L A ’s Presi­
dent; Mr. Ray practices in T acom a and
is a graduate o fth e U PS Law School.
The debate w as hosted by the
Eastern Pierce C ounty C ham ber o f
Commerce and w as held at the Best
Western Park Plaza in Puyallup. The
lunchtime debate attracted a favorable
crowd o f about 80 people.
In traditional debate form at, each
participant was given ten m inutes to
present their perspective on tort reform .
Dr. Kelly, o f course, focused on patient
access, citing the facts th at patients will
continue to see increased difficulties
finding physicians i f changes a r e n 't in­
stituted. He blam ed the legal system
noting that runaw ay ju ry aw ards m ust
be stopped. Mr. R ay cited the expected
arguments against reform o f th e current
tort system, blam ing insurance com pa­
nies and their investm ent practices as
well as bad doctors that are not d isci­
plined. A fter their introductory rem arks,
each was given tw o m inutes to an sw er
the same questions asked by the m od­
erator. A fter answ ering questions, both
were given tw o m inutes to give closing
comments. The debate w as then
opened to questions from the audience
to either or both presenter.
While nothing w as resolved, audi­
ence members had lots o f questions
and were very interested in hearing
from both leaders o f their respective
professions.
Dr. Kelly has been very busy
speaking to num erous organizations
and groups about to rt reform this year.
He lias developed tw o pow er point p re ­
sentations, both data driven, one being
more com prehensive than the other. H e
has had m any opportunities to share
his wealth o f know ledge a bout to rt re­
form, and is currently serving on a sp e ­
cial task force o f attorneys, legislators,
and physicians trying to th in k cre­
F rom right, P C M S
P re sid en t M ike Kelly,
M D a n d W STLA
P re sid en t R o d n ey Ray,
J D a fter their tort
reform d ebate before
the E astern P ierce
C ounty C h a m b er o f
C om m erce in July. Dr.
K elly's e xcellen t data
a n d p re se n ta tio n
o b v io u sly d id n 't open
R av s eves
atively about how the issue could be
resolved. T his is in spite o f the fact that
there is no agreem ent, nor probably
ever w ill be, regarding the prim ary
cause.
Dr. K elly has addressed num erous
groups regarding tort reform such as
the G overnm ent A ffairs C om m ittee/
Eastern Pierce C ounty C ham ber o f
C om m erce, H ealth Care A ccess Team
(U nited W ay). Franciscan Inpatient
T eam , T acom a A rea M edical M anagers,
W ashington State R epublican C aucus,
K K M O R adio, and both the Pierce
C ounty D em ocratic Party and the Pierce
C ounty R epublican Party organizations.
He has also m et w ith num erous leg isla­
tors including C ongressm an A dam
Smith.
If you w ould like give a p re sen ta ­
tion on tort reform to any organization
or civic group. Dr. Kelly will gladly
share his pow er point p resentation and
script and PC M S w ill provide the eq u ip ­
m ent and assistance. Call Sue A sh er at
the Society office 572-3667 for m ore in­
form ation. ■
H ealth
S erv ice
A s e r v ic e o f
N o r t h w e s t M e d ic a l s p e c ia ltie s , PLLC
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• PRE-TRAVEL CARE
HOURS
• PO ST-TRA VEL CARE
CALL EARLY WHEN PLANNING
M O N -F R I 9 - 5
253-428-8754
o r 253 -6 2 7 -4 1 2 3
A SERVICE OF
INFECTIONS LIMITED PS
220 - 15"1Ave SE #B, Puyallup W A 98372
August, 2004
PCMS BULLETIN 13
r=
B
^
u l l e t in
Please m ake the following changes to your 2004 Physician Directory:
Patty K u lp a ,M D
C h a n g e o ffice n a m e to: W o m e n 's P re m ie r H e alth C e n te r
T heodore L au, M D
C h a n g e o ffic e a d d re ss a n d p h o n e to:
C a rd ia c H e alth S p e c ia lists
E u g en e S. L a p in ,M D
1802 S Yakim a #307, T acom a 9 8 4 0 5 ......................627-1244
A d d in fo rm a tio n to a c tiv e m e m b e r se c tio n and
FA X
.................................................................. 627-6576
d e le te n a m e from retired section:
L ap in , E ug en e S., M .D . (M arg aret)
C a r d io lo g y - T
S h aron M etcalf, M D
A d d in fo rm a tio n to a ctiv e m e m b e r sectio n :
Off: 1901 S C edar #301, T acom a 9 8 4 0 5 ............... 572-7320
FA X (m edical records, T acom a).............................627-0712
FA X (b ookkeeping)................................................... 627-3191
Off: 1322 - 3rd St SE #330, P uyallup 9 8372 ........841-4347
FA X (m edical records, P uyallup)...........................845-4948
Res: 2944 E B ay D rN W , G ig H arb o r 9 8 3 3 5 .......858-0775
D S H S B illin g # 8185100
UPIN # A 0 8 7 7 2
M etcalf, S h a ro n L ., M .D .
O b/G yn
34503 9 tb A v e S # 1 0 0 , Federal W ay 98003 .........253-952-8231
FA X............................................................................... 253-835-8000
R. Ivan Z baraschuk, M D
C h a n g e o ffice a d d ress and p h o n e to:
2709 E M ain, P uyallup 9 8 3 7 1 ................................848^-520
FA X ............................................................................... 848-5249
Home Grown
from page 12
a cc ess for re fe rrin g p h y sician s. O u r first large scale d e p lo y ­
m en t o f th is te c h n o lo g y is e x p ected at A llen m o re Flospital by
the end o f the year.
th eir p h y sic ia n s and a cc ess parts o f th e ir m ed ic al record. My
M uItiC are a llo w s p a tie n ts to sc h e d u le o r c h a n g e a p p o in t­
A n o th e r s ig n ific a n t e x p a n sio n e ffo rt for M uItiC are is the
c o n tin u e d roll out o f E le ctro n ic M ed ical R eco rd s (E M R )
th ro u g h o u t th e sy stem . M u ItiC are re ce n tly u n v e ile d the M y
or sc ree n in g s and re ce iv e h e alth re m in d ers.
M u ItiC a re p a tie n t a cc ess sy ste m , w hich a llo w s M uItiC are
M edical G ro u p p a tie n ts to c o m m u n ica te e le ctro n ica lly w ith
m en ts, o rd e r a p re sc rip tio n re fill, v iew re su lts o f m edical tests
M uItiC are w ill con tin u e to im p le m e n t th e e lectro n ic medi­
cal record th ro u g h o u t its h o sp ital in 2 0 0 5 a n d b e y o n d , which
w ill a llo w health care p ro v id e rs to d o c u m e n t, at the bedside, all
patien t in form ation electronically. ■
ra-di-ol-o-gy \rad-e-al-e-je\n.
1: a branch of m edicine utilizing exams such as
MRI (magnetic resonance imaging) and CT
(com puted tomography) in the diagnosis and
treatment o f disease 2: a com m itm ent to
providing cutting-edge imaging services without
the necessity o f driving long distances; see TRA
M e d ic a l Im a g in g
4 7 0 0 P o in t F o s d ic k Dr, S te 1 1 0 • F o r m o re in fo r m a tio n , c a ll (253) 7 6 1 -4 2 0 0
t r a m e d ic a iim a g in g .c o m
14
PCMS BULLETIN
August, 2004
iftierce 'ip v m ly Q -fle d u x J C ^ o a e /tf
PCMS endorses WSMA’s legislative initiative on tort reform
Editor’s N ote: The P C M S B o a rd o f Trustees has e n d o rse d the
“Doctors f o r S ensible L a w su it R eform . " fVSMA s cam paign to
enact reasonable tort law s in W ashington.
The W ashington State M edical A sso ciatio n , w orking
through a cam paign com m ittee called D octors for Sensible
Lawsuit Reform, recently filed an initiative to the legislature
with the Secretary o f State.
The objective is to break the gridlock that is preventing
sensible liability reform in W ashington Stale.
In the past tw o legislative sessions, d espite a d em on­
strated need for action, a few obstructionist p oliticians in the
House have refused to take action on bills passed by the S en­
ate - essentially killing them in com m ittee and p reventing m em ­
bers from voting. P hysicians are left w ith no choice other than
to try to force the legislature to take action on this im portant
issue.
The initiative, 1-300, is m edical only and includes provi­
sions to:
• maximize patient recovery o f dam ages
• fully com pensate p atient injury
• guarantee paym ents o ver tim e
• simplify the process
• m akejuries aw are o f o ther paym ents
• require defendants to be accountable for their share
of fault
• require notice p rio r to a claim
• establish a specific period o f tim e for filing suits
A ttorney Phil T alm adge, form er chair o f the Senate Ju d i­
ciary C om m ittee, form er State Suprem e C ourt Justice, and a r­
dent foe o f tort reform - filed o bjections in T hurston C ounty
S uperior C ourt on b e h a lf o f W S T L A lo the language su b m it­
ted for the tort reform initiative. A s is their right, the o th er side
can object to the ballot title and sum m ary for the initiatives,
w hich are drafted by the A ttorney G e n e ra l’s office.
T he drafts from the A G ’s office d id n ’t reflect w'hat w as
suggested, but W ST L A has objected and W SM A w ill p ro ­
ceed to fde necessary briefs to im prove the language. A fter a
hearing (not yet scheduled), the court w ill have five days to
m ake a decision.
T he form al b allot title and official sum m ary will occupy
ju s t a sm all portion o l'th e initiative form - and w ill be m ore
than offset by the public positioning o f the initiative and the
other language and m aterial distributed as a part o f th e c am ­
paign.
A n initiative to the legislature forces action. T he leg isla ­
ture w ill have these options. T hey can:
• A dopt the initiative as proposed, in w hich case the ini­
tiative becom es law w ithout being sent to the ballot.
• R eject the initiative or take no action, in w hich case the
initiative goes on the N ovem ber 2005 general election ballot.
• A pprove an alternate version, in w hich case both the
original m easure and the alternate go on the N o v e m b er 2005
ballot. ■
O u rC lin ic a l
Positron Emission To m o grap hy (PET)
PET S p e cia lists
P E T has been show n to be an accu rate m e th o d to d iag no se and stage cancer, ch e ck to r
tu m o r recurrence, and m o n ito r can cer therapy. In fo rm a tio n g ained b y the use o f P E T can be
used to d eterm in e w h at c o m b in a tio n o f surgery, ra d ia tio n therapy, o r ch e m o th erap y is m ost
lik e ly to be successful in m a n a g in g the disease.
A n th o n y Larhs, M D
Director of Clinical PET
P h illip C Lesh, M D
P E T is also used to evaluate A lz h e im e r ’s disease,
epilepsy, and c a rd ia c disease.
W illia m B Ja c k s o n , M D
M a n y insu rers, in c lu d in g M e d ic a re and
M e d ic a id , are re im b u rsin g fo r man)'
P E T procedures. T R A referral
Tacom a
co o rd in a to rs w ill w o rk w ith y o u to
co m p le te the req u ire d pre-exam
2 2 0 2 S C e d a r St, Ste 2 0 0
2 5 3 -7 6 1 -4 2 0 0
a u th o riz a tio n .
tra m e d ic a lim a g in g .c o m
Call our referral coordinators at
2 5 3 -7 6 1 -4 2 0 0 .
August, 2004
PCMS BULLETIN
15
B
u l l e t in
Lessons
fro m p a g e 3
ship. W e m u st su p p o rt him w ith all o u r
re so u rc e s and e n th u sia sm . To do o th e r­
w ise , is to d e m o n s tra te to the p e rso n a l
E
in ju ry a tto rn e y s o u r lack o f c o m m itm e n t.
M a n y o f y o u h ave a lre a d y receiv ed ,
o r w ill s o o n re ce iv e , in v ita tio n (s) for
ATTO O
fu n d -ra isin g e v en ts. 1 e n c o u ra g e s you
to p u t y o u r m o n e y w h e re y o u r c o n v ic ­
tio n lies. We m ay not be a b le to m atch
the tria l b a r d o lla r-fo r-d o lla r, but w e can
m ak e a sig n ific a n t im pact.
So le t’s line o u r ra ft up w ell as w e
p re p are to e n te r th e fray. I be lie v e our
p re p ara tio n s w ill b e a r fruit. T hen w e ’ll
kn o w th a t e u p h o ria o f ta k in g on the tu r­
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
To d a y ’s n e w e s t A le x a n d rite laser,
w ill re m o v e y o u r ta tto o
w ith m inim al d is c o m fo rt &
le ss than 1 % ris k o f s c a rrin g .
b u le n t u n fo rg iv in g ra p id s w h ile su c ­
c e ssfu lly n a v ig a tin g th ro u g h . T hen w e ’ll
d e m o n s tra te p h y sic ia n s are a force in
this state, a n e ffe c tiv e a d v o c a c y g ro u p
w ith a p la c e at th e leg isla tiv e table. T hen
( lu l l t f x l i t y f o r m o r e in j( tn n u ti( > n
w e ’ll e x p erien c e the v icto ry c eleb ra tio n s
PIERCE COUNTY
LASER CLINIC
w h ich sy m b o liz e th e o p p o rtu n ity fo r
m ean in g fu l to rt refo rm lead in g to im ­
p ro v e d a cc ess to m ed ic al care.
D i r e c t o r I V t c r K. M a r s h M.I>.
(253) 573-0047
It’s
m o re
than a
n e w
b u ild in g
m
it's a new experience
St. Jo sep h Outpatient Center • O pening Ju n e 29
O u t p a t i e n t D ia g n o s tic I m a g in g , O u t p a t i e n t R e h a b i l it a t i o n , th e G e n e a n d
(13 M a ‘7 '^rln e W a lte rs D ay S u rg e r y ancl th e St. J o s e p h A d v a n c e d E n d o sc o p y
C e n te r a r e m o v in g to th e n e w S t.J o s e p h O u t p a ti e n t C e n te r lo c a te d n e x t
to th e h o s p ita l.
F o r th e s e s e rv ic e s , m o r e is c h a n g i n g t h a n ju s t t h e i r a d d r e s s .
F h e O u t p a t i e n t C .e n te r o i l e r s a d v a n c e d t e c h n o l o g y w ith g r e a t e r
capacity, c o m f o r t a n d privacy. F o r p h y sic ia n s, w e a ls o p ro m is e faster
s c h e d u lin g a n d r e p o r t t u r n a r o u n d to s u p p o r t r a p i d d ia g n o s is ,
t r e a t m e n t a n d re c o v e ry .
IJ you w o u ld hlti‘ wore in fo rm a tio n or a p riv a te toui; p h a s e call.
O utpatient Surgery. 2 5 3 .4 2 6 .6 4 3 2 • D iagnostic Im aging, 2 5 3 .4 2 6 .6 2 8 5
A d va n c ed Endoscopy Center, 2 5 3 .4 2 6 .6 3 0 9 •
Therapies. 2 5 3 .4 2 6 .6 8 4 7 • Speech Therapy, 2 5 3 .4 2 6 .4 8 2 0 .
St Joseph Medical Center
io w w .fh s h e a U h .o r g
?ftier-ce 'ilo in ity Q ((e d tc a l tfo c ie ttf
COLLEGE
OF
MEDICAL
EDUCATION
Common Office
Problems CME
set October 29
Topics are set for the C o lle g e ’s
Common Office P roblem s CM E sched­
uled for Friday, O ctober 2 9 ,2 0 0 4 . The
conference will be held at St. Joseph
Medical Center, R oom s 1A & B.
The program will offer 6 C ategory I
CME credits and is again directed by
M ark Craddock, MD.
This y ear’s course will offer:
• A Prim ary Care D erm atology
Review and U pdate
• Osteoporosis: W h at’s N ew in
Prim ary C are D iagnosis and
M anagem ent
• Initial Insulin T herapy: C hoices
for Prim ary Care
• Treatm ent O ptions for C O PD :
An Update
• An U pdate on D epression
• An U pdate on Pediatric
Cardiology
The course is designed for the p ri­
mary care clinician and focuses on
practical approaches to the m ost c o m ­
mon dilemmas faced in the d aily routine
of medical practice. Look for the regis­
tration brochure in the m ail ju s t after
Labor Day.
Form ore inform ation, please call
the College o f M edical E ducation, 6277137. ■
Continuing Medical Education
C.O.M.E. Board Announces 20042005 CME Program Schedule
T he C ollege o f M edical
E d u ca tio n 's Board o f D irectors an­
nounced its C M E schedule for 20042005 at the June m eeting. C ourses are
offered in response to local physician
interest an are designed and directed
by local physicians. A ll courses offer
A M A C ategory 1 credit.
A course calen d ar identifying the
course title, dates, b rie f descrip tio n and
course directors will be m ailed in early
Septem ber. F or additional inform ation
on next y e a r’s offerings, please call the
College at 6 2 7 -7 137. ■
CME at Whistler, Blackcomb
Lodging Reservations Available
Plans are set for C M E at W histler
scheduled for next January 26-3 1 ,2 0 0 5 .
A program brochure w as m ailed in late
July.
T hose interested in attending
should secure th eir condos soon. The
C ollege has arranged for accom m oda­
tions prim arily at the A spens C ondos at
the sam e rates as 2004. R eservations for
the condos can be m ade by calling A s ­
p e n s on B lackcom b. toll free at I -866788-5588. You m ust identify y o u rse lf as
part o fth e C O M E group. You are en­
couraged to m ake y o u r reservations
soon to ensure space - at least by D e­
cem ber 1.2 0 0 4 , w hen any rem aining
condos in the block w ill be released. ■
Dates
Program
Director^
Friday, October 29
Common Office
Problems
Mark Craddock, MD
Friday, November 12
Infectious Diseases
Update
Lawrence Schwartz,
MD
January 11 & 18
Cardiology for Primary
Care
Gregg Ostergren, DO
January 26-31
CME at Whistler
Rick Tobin, MD
John Jiganti, MD
Friday, February 4 or
Saturday, February 5
Gastroenterology for
Primary Care
Ralph Katsman, MD
Thursday-Friday
Internal Medicine
Review 2005
Art Knodel, MD
Tuesday (evenings)
March 31- April 1
Friday, April 22
Friday, May 20
Radiology for the
Non-Radiologist
Rick Tobin, MD
Andy Levine, MD
Primary Care 2005
Steve Duncan, MD
August, 2004
PCMS BULLETIN
17
B
u l l e t in
Serfdom
fro m page 1 1
P e r h a p s a f e w o f th e m w e r e w is e
I ’ l l s to p n o w a n d le a v e th e d is c u s s io n
p r o v id e s in s u r a n c e c o v e r a g e in c a s e
e n o u g h to g e t o u t e a r lie r , b u t a f te r th e
o f o u r o p t io n s a n d w h a t o u r c o lle a g u e s
y o u a re la id o f f o r d e c id e to le a v e .
p o g r o m th e y a ll h a d to le a v e .
g r o u p , m a k e s u re th a t y o u r c o n t ra c t
F o r e x a m p le , w h e n a h o s p ita l
c lo s e s its O B d e p a r tm e n t o r E m e r g e n c y
in o th e r p la c e s a re d o in g f o r n e x t
O u r s itu a tio n h e re is n o t m u c h d i f ­
m o n th . ■
fe re n t. Is th e re a w a y o u t? I d o n ’t k n o w .
R o o m , th e p h y s ic ia n s it e m p lo y s are
o u t o f a j o b . W i l l th e y a ls o lo s e t h e ir
co ve ra g e ?
T h e P h y s ic ia n s N e w s D ig e s t fo r
E a ste r n P e n n s y lv a n ia re p o rte d th a t
p e rh a p s tw o h u n d r e d p h y s ic ia n s w e r e
la id o f f in th e P h ila d e lp h ia are a w it h the
r e c e n t c lo s in g s o f n in e o b s t e t r ic d e p a r t­
m e n ts a n d s e v e ra l h o s p ita ls . I c o u ld n ’ t
f in d o u t w h e t h e r th e y g o t t a il c o v e r a g e
MEDICAL LICENSURE ISSUES
M r . R o c k w e ll is a v a ila b le to r e p re s e n t p h y s ic ia n s a n d o th e r h e a lth c a re
p r o v id e r s w it h is s u e s o f c o n c e r n b e fo r e th e S ta te M e d i c a l Q u a lit y A s s u r a n c e
C o m m is s io n . M r . R o c k w e ll, a p p o in te d b y G o v e r n o r B o o t h G a r d n e r , s e r v e d fo r
8 y e a rs as th e P u b lic B o a r d M e m b e r o f th e M e d ic a l D i s c i p l i n a r y B o a r d fro m
1 9 8 5 -1 9 9 3 . S in c e th e n . M r . R o c k w e l l h a s s u c c e s s f u lly re p r e s e n te d o v e r 60
p h y s ic ia n s o n c h a rg e s b e fo r e th e M Q A C . M r . R o c k w e l l ’ s fe e s are c o m p e t it iv e
a n d th e s u b je c t o f a c o n f id e n t ia l a t t o r n e y - c lie n t r e p r e s e n t a t io n a g re e m e n t.
a n d w h o p a id f o r it. W i l l th e c o m p a n y
th a t h ir e s th e m a fte rw a r d s a ls o in s u r e
th e m fo r th e ir p r e v io u s w o r k ?
I a p o lo g iz e a g a in fo r th e b a d n e w s .
1 fe e l lik e th e m a n in “ F id d le r o n the
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
R o o f , " w h o re a d in th e p a p e r a b o u t p o ­
g r o m s in o th e r v illa g e s a n d tr ie d to te ll
h is n e ig h b o r s , b u t th e y d id n ’ t w a n t to
(4 2 5 )4 5 3 -4 3 9 8
•
F A X
(4 2 5 ) 4 5 3 -1 5 3 4
email: [email protected] • website: www.gregrockwelllaw.com
lis te n . T h e n , o n e d a y , t h e ir tu rn c a m e .
•ft
Same Day MRIs
Precision Imaging of Puyallup offers
state-of-the-art MRI's with same day
appointments, easy scheduling and
fast report turnaround times for
referring physicians.
Precision Imaging
at th e Brain an d Spine Center U
1519 3rd SE, Suite 103 • Puyallup, WA 98372
Phone: 253.841.0851 • Fax: 253.841.4997
18 PCMS BULLETIN
August, 2004
\
V
dpi, </ee Ytmnfof £■ (ledtea/dJoct.rty
Classified A dvertising
POSITIONS AVAILABLE
Tacoma/Pierce Count}' outpatient
general m edical care at its best. Full and
part-time positions available in Tacom a
and vicinity. Very flexible schedule. Well
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F.P.J.M. Contact A ndy Tsoi. M D (253)
752-9669 or Paul D oty (Allen, N elson,
Turner & Assoc. ), C linic M anager (253)
3834351.
EstablishedAuburn Family Practice
looking for P/T to F/T B oard C ertified or
Board Eligible P hysician to jo in a group
practice. W ork 3-4 days a w eek w ith a
great support staff. Base salary plus
incentive. Fax your CV to 253-847-9630.
Established Spanaway Fam ily Practice
looking for P/T to F/T B oard C ertified or
Board Eligible physician o rA R N P /P A to
join a practice. W ork 4-5 days a w eek
with a great support staff. B ase salary
plus incentive. Fax your CV to 253-5363070.
Tacoma, WA - O ccupational M edicine
MuItiCare H ealth W orks, a d iv isio n o f
MuItiCare H ealth System , seeks a board
certified occupational m edicine
physician/MRO to jo in an established
program. Q ualified applicants m u st be
flexible, self-motivated, com m itted to
program developm ent and have at least
3 years experience. E xcellent benefits,
income guarantee and incentive bonus.
Please mail your C V to M uItiC are H ealth
System Provider Services at
poviderservices@ m ulticare.org or fax
your CV to 866-264-2818. W ebsites:
www.multicare.org; w w w.m ulticare
healthworks.org. “M uItiC are H ealth
System is a drug free w o rk p lace.”
O pportunity to start new m edical prac­
tice w ithout large outlay for overhead
expenses. W aiting room , business of­
fice space, p h y sic ia n ’s office and tw o
exam room s available. Two separate en­
trances and p artially furnished exam
room s. R ent only, no staffing offered.
Please cal1206-861 -1810 or lax CV 206709-8452.
Prim ary C are/Internal M edicine Prac­
tice opportunity. M D or A R N P - 100%
outp atien t prim ary care practice sp ecial­
izing in HIV care and m anagem ent. 30
hours/w eek, no nights, w eekend nor in­
patient care. P arking, m edical/dental/vision. m alpractice and salary. C andidate
should be gay-friendly, open-m inded
and w ork w ith an attitude o f no ju d g ­
m ent and no guilt. T his position re­
quires m em bership in K C M S, M edicare,
DSH S and all private local billings
plans. Please call 206-861 -1810 or fax CV
206-709-8452.
Tacom a, WA - Three provider group
(1 M D , 2 N P s) seeks a part-tim e B/C or
B/E fam ily practice or internal m edicine
physician w ho has a special interest in
geriatrics and pro v id in g nursing hom e
care. P ractice is adult prim ary care w ith
large M edicare com ponent. Enjoy the
uniqueness o f the N orthw est lifestyle
w ith the back up and support o f a full
service integrated healthcare delivery
system . C om petitive benefits and sal­
ary m ake this a choice opportunity that
w o n ’t last long. T he right candidate
will enjoy an excellent call schedule,
com pensation and benefits. C andi­
dates m ust have com pleted a three-year
accredited US residency program .
Please em ail y our C V to M uItiCare
H ealth System at providerservices@
m ulticare.org or fax your CV to 866-2642818. Please m ention opportunity #273.
W ebsite: w w w .m ulticare.org
Join N orthw est K inetics’ expert earlyphase p h arm aceutical research team
N orthw est K inetics, a P hase I & II c lin i­
cal research organ izatio n , is seeking a
R esearch Physician to jo in our team .
C om pany offers o utstanding benefits 401k plan, m edical, dental, paid tim e o ff
and an o pportunity to w ork in an en tre­
preneurial, high-grow 'th environm ent.
Physicians are integral m em bers o f our
research team , serving as study in v esti­
gators, perform ing procedures and pro­
viding m edical assessm ents, ju d g m e n ts
and leadership in support o f all study
activities. Q ualified applicants m ust
have current P h y sic ian ’s license in
good standing in the State o f W ashing­
ton (or license in good standing in
hom e state, w ith W ashington State li­
cense forthcom ing) and experience in
the conduct o f clinical trials, w ith Phase
I experience desirable. F or im m ediate
consideration, send resum e and cover
letter w /w age requirem ents to: Rikki
Johnson, H um an R esource M anager.
N orthw est K inetics. 1401 N . 5"1St,
Tacoma, WA 98403. Fax: (253) 682-4351.
Email: rjohnson@ nw kinetics.com . Visit
us at w w w .nw kinetics.com .
OFFICE SPACE
For Rent: 3300 sq ft C lass A m edical
office in T acom a M edical Center, 1112
6th Ave, third floor. E levator, under­
ground parking, close to hospitals,
ow nership options. Call 253-272-2224.
O ffice sp ace for lease in m edical
com plex. G ig Harbor. 2354 sq ft, main
level. 468-3539 or 565-2444.
N ew office b u ild in g for sale or lease.
3000 leased, 3600 for lease. Large
parking lot. Fircrest. 564-8784
“ M uItiC are is a d rug-lree w ork place”
August, 2004
PCMS BULLETIN
19
B
^PieKe
u l l e t in
oM ediad ffiociehj,
“Threatening Litigation Is a
Nightmare Process”
A s a claim s rep resen lativ e and su p erv iso r, I see p h y sic ia n s of all specialties
w hose lives are su d d e n ly changed b y claim s tiled againsl th em . W h e th e r the
cases are dism issed, settled, o r go to trial, each p h y sic ia n ’s personal a n d
professional life can take a tu rn for the w orse, and th a t’s w hy I’m here to
help. I analyze each claim , stay in close contact w ith o u r a tto rn ey s, and w o rk
w ith the physician on new strategies as the case develops. Every p h y sic ia n is
im p o rtan t to m e, a n d I m ake sure m y w ork sh o w s th em th a t I care.
To find o u t a b o u t th e m a n y w a y s P h y sic ia n s In s u ra n c e w o rk s w ith a n d
lo r p h y sic ia n s, call us today.
W estern W ash in g to n
1 -8 0 0 -9 6 2 -1 3 9 9
E astern W ashington
1 -8 0 0 -9 6 2 -1 3 9 8
K ari A dam s,
C laim s S u p e rv iso r
nJ-lwu.-rall'yiSK
mi'suiK Mrj,Jn il .-V.-::Cv_i.it.ioi
Pierce C ounty M edical Society
223 Tacoma A venue South
Tacoma, WA 98402
■F Physicians
mmInsurance
A Mutual Company
V isit n u r W e b s i l t ai p h y in s .u o m
V a u l r , W A ici [ 'h v f ia a n .s I n s u r a n c e 2 0 0 3
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ST A N D A R D
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20
PCMS BULLETIN
August, 2004
S e p te m b e r, 2 0 0 4
Physicians bike for fun, for health and for worthy causes
From le ft-D rs. P at H ogan, John L oesch, H enry R etailliau, Patrick M osler( physician from H eidelberg, G erm any), Harald
Schoeppner, M ark C raddock and D on S hrew sbury atop S noqualm ie Pass ready for the start o f th e C ourage C lassic
See story, m ore photos Page 5
INSIDE:
3
P r e s i d e n t ’s P a g e : “ T h e P r o p e r U s e o f P o w e r ” b y M ic h a e l K e l l y ,
4
5
7
9
11
12
A n t i t r u s t r e f o r m : P h y s c i a n s n e e d t h e r ig h t to n e g o t i a t e
B ik e r id e r s e n jo y b o th S e a t t le - t o - P o r t la n d a n d C o u r a g e C la s s ic e v e n ts
S e p t e m b e r G e n e r a l M e m b e r s h i p M e e t in g : “ E l e c t r o n i c M e d i c a l R e c o r d s ”
In M y O p in io n : “ T h e S e a T u r tle ” b y J o s e p h J a sp e r , M D
T P C H D : “ O b e s ity E p id e m ic ” F e d e r ic o C r u z - U r ib e , M D
W S M A L a u n c h e s I n it ia t iv e C a m p a ig n to F o r c e A c tio n o n L ia b ilit y R e fo r m
MD
13
I n M y O p i n i o n : “ T h e l a s t O b / G y n in G ig H a r b o r s p e a k s o u t ” b y L o r e n F in le y
B
V
u l l e t in
P C M S O fficers/T rustees:
M i c h a e l J. K elly, M D , P r e s id e n t
P a tr ic k J . H o g a n ,D O , P re s id e n t E le c t
K e n n e th A . F e u c h t, M D , V ic e -P re s id e n t
J o s e p h W . R e g im b a l, M D , T re a s u r e r
S u m n e r L . S c h o e n ik e ,M D , S e c re ta ry
J . J a m e s R o o k s , J r ., M D , P a s t P re s id e n t
L a u re l R .H a r r i s .M D
J e ff re y L .N a c h t ,M D
J o s e p h F. J a s p e r ,M D
N a v d e e p S . R a i,M D
R o n a ld R . M o r r is ,M D
C a rl W . W u lf e s tie g ,M D
September, 2004
P C M S M e m b e r s h i p B e n e fits, Inc (M B1):
T i m S c h u b e r t , M D , P r e s i d e n t ; D r e w D e u ts c h ,
M D ,P a s t P re s id e n t; J o e R e g im b a l, M .D , S e c re ta ry T re a s u r e r; K e ith D e m irj ian , M D ; S te v e D u n c a n . M D;
M a r k G ild e n h a r , M D ; S te v e S e ttle , M D ; J o e W c a m .M D
C ollege o f M edical E ducation (C.O .M .E.):
J o h n Ji ga n ti, M D Pre side nt; B a rb a ra F o x , M D ,
W illia m H o ld e n n a n , M D , S te v e K o n ic e k , M D , M a ijo rie
T C rab b e,M D , W illia m L e e ,M D ,G r e g g O s te r g r e n , D O ,
B r a d P a ttis o n ,M D , C e c il S n o d g ra s s ,M D , V irg in ia
S to w e] 1, M D , R ic h a rd W a ltm a n , M D , T o d W u rst, M~D;
H e r ta M a le ik e , G o o d S a m a rita n H o s p ita l; L is a W h ite ,
M u ltic a r e H e a lth S y s te m ; S is te r A n n M c N a m a r a ,
T re a s u re r, F ra n c is c a n F lealth S y s te m ; S u e A s h e r,
S e c re ta iy
P C M S F oun d ation : L aw r en ce A.
L a r s o n , D O , P r e s i d e n t ; C h a r le s W c a t h e r b y , M D ,
M o n a B a g h d a d i, N ik k i C ro w le y , T re a s u re r; S u e A s h e r,
S e c re ta iy
W SMA
R epresentatives:
T ru s te e s : L e o n a r d A le n ic k .M D ;N ic h o la s R a ja c ic h , M D ;
P a tric e S te v e n s o n , M D
W A M P A C 6 th D istrict: D o n R u s s e ll. D O
W A M P A C 9 th D istrict: L e o n a rd A le n ic k . M D
Table o f Contents
3
P re sid e n t’s P age: “ T h e P ro p e r U s e o f P o w e r”
4
A n titru st refo rm : P h y sic ian s n e e d th e rig h t to n e g o tia te
5
B ike rid e rs e n jo y b oth S e a ttle -to -P o rtla n d a n d C o u rag e
C lassic e v en ts
6
A p p lica n ts fo r M e m b ersh ip
7
S e p tem b e r G M M : “E le ctro n ic M edical R e c o rd s”
8
S ocial S e c u rity D isa b ility a n d the E le c tro n ic F u tu re
S t a f f : E x e c u tiv e D ir e c to r: S u e A s h e r
A d m in is tra tiv e A s sista n ts: T a n y a M c C la in , C risti P e te rso n
P la c e m e n t C o o rd in a to r: K erri B a k e r
P la c e m e n t A s s is ta n t : M e lis s a K re g n e ss
C M F P ro g ra m A d m in islrator: S c o tt P eterso n
B o o k k e e p e r: J u a n ita H o fm e iste r
9
In M y O p in io n : “ T h e S ea T u rtle ”
10
In M y O p in io n : “ E x o d u s”
11
T PC H D : “O besity E pidem ic”
T h e Bul l et i n is p u b lis h e d m o n th ly by P C M S
M e m b e rs h ip B e n e fits , In c. D e a d lin e for s u b m ittin g artic le s
an d p la c in g a d v e rtis e m e n ts is the 15th o f th e m o n th
p re c e d in g p u b licatio n .
12
W S M A L au n c h es In itia tiv e C a m p a ig n to F o rc e A ctio n
on L iability R eform
13
In M y O p in io n : “ T h e last O b /G y n in G ig H a rb o r sp e a k s out”
15
In M y O pinion: “ Dr. H e k k in g ”
17
C o lle g e of M edical E du catio n
19
C lassifie d A d v e rtisin g
T h e B u l l e t i n is d e d ic a te d lo the art, sc ie n c e an d d e liv e ry
o f m e d ic in e an d th e b e tte rm e n t o f t h e h e a lth an d m ed ical
w e l f a r e o f t h e c o m m u n ity . T h e o p in io n s h e re in are th o se o f
th e in d iv id u a l c o n trib u to rs an d do not n e c e s sa rily re fle c t the
o ffic ia l p o sitio n o f P C M S . A c c e p ta n e e o fa d v e rtis in g in no
w a y c o n s titu te s p ro fe s sio n a l a p p ro v a l o r e n d o rse m e n t o f
p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B u lle tin re se rv e s the
rig h t to re je c t a n y a d v e rtisin g .
M a n a g i n g Editor: Sue A sh er
E d i t o r i a l C o m m i t t e e : M B I B o a rd o f D ire c to rs
A dvertisin g Inform ation: 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9X 402
2 5 3 -5 7 2 -3 6 6 6 ; F A X :2 5 3 -5 7 2 -2 4 7 0
E -m ai Ia d d re ss: p e m s w a fftip e m sw a .o rg
H o m e P ag e: h ttp ://w w w .p c m sw a .o rg
2
PCMS BULLETIN
September, 2004
President’s Page
by Michael J. Kelly, M D
The Proper Use of Power
“P lace vo u r iron h a n d inside a velvet glove. "
- N apoleon
It’s already Septem ber. C an you
hear the strange sucking sound? It’s
the hiss o f the vacuum left by the m as­
sive movement o f cam paign con trib u ­
tions from the personal injury a ttorney
PACs to the coffers o f their liandpicked
candidates. We shouldn’t be surprised.
After all, m oney curries favor, obtains
influence. It reminds m e o fth e axiom :
“He with the gold rules.” A t least that is
the principle to w hich the trial bar as­
cribes. While it is true m oney can buy a
degree o f power, it is not the final deter­
minant. Since we cannot m atch the trial
bar dollar for dollar, how do w e over­
come such pow er? Perhaps w e n eed to
understand ju st w hat pow er is.
Power is not som ething to w hich
physicians overtly and actively aspire.
To many o f us the notion o f con­
sciously playing p ow er gam es - no m at­
ter how indirect - seem evil, asocial.
However, like it or not, w e are all
trapped in a giant schem ing court.
There is no use in trying to opt out o f
the game. You m ay choose to avoid p o ­
litical action, but I suggest at y o u r ow n
peril.
Instead o f struggling against the
inevitable, instead o f arguing and w hin­
ing and feeling guilty, it is by far better
to excel at power. L earning the gam e o f
power requires a certain w ay o f looking
at the world and at o u r situation as
physicians - a shifting o f perspective. It
takes effort since b asic skills are re­
quired which do not com e naturally.
Power is essentially am oral and
one of the m ost im portant skills to ac­
quire is the ability to see circum stances
rather than good o r evil. P o w er is a
gam e, and in gam es you do not ju d g e
yo u r o pponents by th eir intentions but
by the effect o f their actions. R e presen­
tative L antz states she is pro to rt re ­
form , yet she killed ph y sician -sp o n ­
sored senate legislation tw o straight
years in h er ju d ic iary com m ittee. How
often are so m e o n e ’s intentions m ade
the issue only to cloud and deceive? It
is only natural for the people o fth e
26th D istrict to cover up her actions
w ith all kinds o f ju stific atio n s, alw ays
assum ing that she acted out o f g o o d ­
ness. We know differently and need to
co m m unicate this to others.
W e physicians have the potential
pow er to assure the m edically favorable
ou tcom e o f this election - if w e choose.
C o u ld n ’t be true you say? T his is ab­
surd. w e are only hum ble servants o f
our patients, you add. Perhaps. H ow ­
ever, w hat i f every physicians in W ash­
ington State c om m unicated w ith ten
peo p le a day concerning their m edical
candidate(s) o f choice? T he pow er in­
vested in such a concerted effort w ould
be enorm ous!
M ost acknow ledge that all politics
is local. In the sam e m anner, m edicine is
practiced locally, one p atient at a tim e.
P eo p le com e to physician offices by the
hundreds each w eek. Trial law yers do
not have a fraction o f such exposure.
O ur patients respect our opinions.
W hen w e tell them how the present cri­
sis o f m edical access co u ld adversely
affect them and their fam ilies, th ey will
be greatly influenced. T his is our fun­
dam ental edge and the law y ers’ g reat­
est w eakness. We m ust utilize this strat­
egy-
M ichael J. Kelly, MD
T he com m unication 1 envision
need not involve a direct discussion by
the physician w ith the patient. C onsider
these suggestions for obtaining p ow er
in this election:
• H anging w all posters regarding
the issues and candidates, gen ero u sly
placed about the w aiting room and
exam room s
• C onstantly p lay in g a 30-m inute
v ideotape on the m edical liability crisis
from D octors for M edical L iability Re­
form ( D M LR) in the w aiting room (avail­
able at no cost from W SM A )
• D isplaying b um per stickers and
yard signs annou n cin g your choices
• D oorbelling for y o u r candidate(s)
o f choice, door to d oor - a d a u n tin g but
very effective use o f pow er
• P lacing v oter registration m aterial
(available from PC M S office) in your of­
fice and e n couraging those not regis­
tered to do so during their visit. If you
doorbell, take registration m aterial w ith
you on yo u r w alk
• A ctively c o ntributing m oney to
the candidates w ho support to rt reform
I know the p hysicians o f P ierce
C ounty and W ashington State can use
their extraordinary and unique p o w er to
affect the outcom e o f this e lection to
m aintain access to m edical care and
preserve our practices. In the end, life is
short, o p portunities are few, and we
have only so m uch energy to draw on.
L et us not sq u an d er this o p p o rtu n ity !!
September, 2004
PCMS BULLETIN
B
u l l e t in
Antitrust reform: Physicians need the right to negotiate
With the
F T C a n d t h e J u s t i c e D e p t, r e i te r a t i n g t h e i r s t a n c e a g a i n s t j o i n t n e g o t i a t i o n
with
h e a l t h p l a n s , i t s m ore
i m p o r t a n t t h a n e v e r f o r C o n g r e s s to p a s s a n t i t r u s t r e l i e f f o r p h y s i c i a n s
tio n in th e h e a lth c are m a rk e t as a re a so n w h y they, a g ain , are
c o n n e c tio n to quality.
W h a t’s a m o re lik e ly re su lt o f h e a lth p la n s ’ v irtu a lly un­
re fu s in g to a llo w p h y sic ia n s to n e g o tia te c o lle c tiv e ly w ith
c h e c k e d p o w e r is a p ro fit-d riv e n sq u e e z e o n p h y sic ia n pay and
h e a lth p lan s. A n d y e t th ese a g e n c ie s, again, are failing to re c o g ­
p a tie n t b e n e fits — h a rd ly an e n c o u ra g in g p ic tu re fo r patient ac­
n iz e th e lo n g -te rm im p a c t h e alth in su ra n ce c o m p a n y m erg e rs
cess o r c h o ic e.
M e a n w h ile , th e c o n so lid a tio n g o e s on. A M A a n d other phy­
T w o k e y fe d e ra l a g e n c ie s cite th e n e e d fo r m o re c o m p e ti­
w o u ld h a v e o n p a tie n ts and p h y sic ia n s.
T h e F e d e ra l T rad e C o m m issio n a n d th e D ept, o f Ju stic e
sic ia n a d v o c a te s h a v e to ld th e g o v e rn m e n t th a t h e alth plans con­
(D O J) o n Ju ly 23 re le a s e d a 3 0 0 -p a g e re p o rt say in g , again, that
tin u e to g ro w la rg e r and h o ld m o re p o w e r o v e r th e health care
c o lle c tiv e b a rg a in in g by in d ep e n d en t p h y sic ia n s w o u ld h a v e a
m arketplace.
T h e FTC a n d D O J fo u n d n o tro u b le a t a ll to h e a lth care com­
p e titio n w h e n th ey a p p ro v e d the $ 1 6 .4 b illio n m e rg e r o f Anthem
n e g a tiv e im p a c t on health care c o m p e titio n . T h is c o m es a fte r 27
da y s o f te stim o n y in 2002 a n d 2 003.
T h e A M A w a s a m o n g th o se testify in g ab o u t w h y a n titru st
r e lie f is n ece ssa ry . A b ig reason w hy: h e alth p la n s c o n tin u e to
g e t la rg e r a n d larger, g iv in g p h y sic ia n s less a n d less lev e rag e to
n e g o tia te c o n tra c ts. T h e plans n o t o n ly d icta te re im b u rse m e n t,
Inc. and W ellP o in t H e a lth N e tw o rk s to c re a te th e n a tio n ’s largest
h ealth plan, and th e $3.7 bi ilion m e rg e r o f O x fo rd H ealth Plans by
th e n a tio n ’s N o . 2 h e alth p lan , U n ite d H e a lth G ro u p . (A s o f this
w aiting, A n th e m is su in g a C a lifo rn ia r e g u la to r w h o refused to ap^
b u t also u n ila te ra lly d efin e m ed ic al n e ce ssity and o th er c o v e r­
p rove the m erger, and U n ite d is fig h tin g th e M e d ic a l Society of
a g e issu es th a t w o u ld a ffe c t p a tie n ts. D esp ite the F T C and D O J
N e w J e rs e y ’s effo rt to o v e rtu rn sta te r e g u la to rs ’ a p p ro v al o f that
re p o rt, th e A M A re m a in s c o m m itte d to b rin g in g a n titru st r e lie f
deal.)
N e ith e r a g en c y m a d e a p e e p a b o u t th e im p a c t health care
plan c o n so lid a tio n - w ith th e to p tw o p la n s in a n y g iv en metro­
to all p h y sic ia n s.
T h e F T C a n d D O J re p o rt re states th e ir p a st p o sitio n th at
p h y sic ia n s m ay not n e g o tia te c o lle c tiv e ly w ith p lan s unless
th e y are e m p lo y e d , o r th ey w o rk in a handful o f sta te s th a t h ave
p a sse d p h y sic ia n c o lle c tiv e b a rg a in in g law s. In stead , the rep o rt
re c o m m e n d s th a t in su re rs a n d the g o v e rn m e n t find p a y m e n t
m eth o d s th a t e n c o u ra g e p h y sic ia n s to lo w e r co sts, im p ro v e
q u a lity a n d in n o v ate . P e rh a p s i f g ro u p s that in te g rate d c lin i­
p o lita n a rea g e n e ra lly h a v in g g re a te r th an a 5 0 % m a rk e t share - is
h a v in g on h ealth care.
W h at p h y sic ia n s are lo o k in g fo r is a fa ir fig h t. A nd, the AMA
is c o n tin u in g to look for s u p p o rt fo r the H e a lth C are A ntitrust Im­
p ro v e m e n ts A c t o f 2 0 0 3 . It’s a H o u se b ill th a t w o u ld allow physi­
c ian s to n e g o tia te c o lle c tiv e ly w ith in su re rs. It a lso w o u ld limit
c ally fo u n d w a y s to m ee t th o se g o a ls, ra th e r th an focus on
san c tio n s a g ain st p h y sic ia n s w h o w e re fo u n d n o t to be in accor­
p ric e s, the F T C and D O J say th ey m ay look k in d ly on c o lle ctiv e
n e g o tia tio n .
be in “ g o o d fa ith .” It also w o u ld e sta b lish d e m o n stra tio n projects
C ertain ly , lo w e rin g costs w hile im p ro v in g q u a lity is a lau d ­
a b le goal. H o w ev e r, even the a g en c ie s a c k n o w le d g e in the re­
p o rt th a t m o st p la n s ’ p a y m e n ts to p h y sic ia n s g e n era lly are
based on a sim p le a c c o u n tin g o f se rv ice s re n d ere d , w ith no
d ance w ith a n titru st sta tu te s, b u t w h o se c o n d u c t w a s deem ed to
a llo w in g d o c to rs jo in tly to n e g o tia te c o n tra c ts w ith h ealth plans.
T h is is w h a t is n e e d e d to e n su re th a t m a n a g e d care doesn’t
g e t a g re a te r and g re a te r c arte b lan c h e to im p o s e its w ill on physi­
c ia n s and p a tie n ts. A g ain . ■
D .
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4 PCMS BULLETIN
September, 2004
Bike riders enjoy both Seattle-to-Portland and
Courage Classic events
Congratulations are in order to PC M S m em bers w ho rode this y e a r’s C ourage C lassic a nd/or S eattle-to-P ortland bike riding
events. They are Drs. G eorge B row n, A dm inistrative M edicine; M ark C raddock, Fam ily Practice; A llen G raeve, C ardiothoracic
Surgery; Pat H ogan, N eurology; N ick Iverson, Internal M edicine; W illiam M artin, G eneral Surgery, and his w ife Karyl; R ob ert
Osborne, Vascular Surgery; H en ry R etailliau, Internal M edicine; H arald Schoeppner, G astroenterology'; Steve Settle, Physical
Medicine and R ehab; D on Sh rew sbu ry, O tolaryngology; and G ary T aubm an, G astroenterology.
The 13th A nnual C ourage C lassic (C C ) bicycle tour, w hich took place on A ugust 14-16, started in S noqualm ie w ith the first day
ending 57 m iles later in C le E lum . T he second day leads riders to L eavenw orth a lte r a 55 m ile ride. T he third day riders end up in
Skykomish after com pleting the final 60 m iles o f the ride, for a total o f 172 m iles. Total elevation gain for this ride is 10,036 feet! P ro ­
ceeds from the C ourage C lassic benefit the R otary E ndow m ent for the Intervention and P revention o f C hild A buse and N eg lect at
Mary Bridge C hildren’s H ospital as w ell as the C h ild re n ’s T rust Foundation.
The 25th A nnual 200 m ile Seattle-to-P ortland (ST P) Bicycle C lassic R ide took place on July 17-18. M ost o fth e 8,000 riders stay
the first night in C entralia or C hehalis, w hich is 94 m iles from the U niversity o f W ashington starting point. A bout 1.500 o f them do
the ride in one day.
Congratulations to all riders! ■
Drs. Bill M artin (left) a n d M u rk
Craddock at a rest stop on Stevens
Pass on day 3 o fth e C ourage C lassic
D ia n e C ecchettini, C E O /P resident o f
M ultiCare, a n d Dr. A lien G raeve
fee lin g g rea t on day three o f th e CC
Dr. Steve Settle on day three o f th e
C ourage C lassic takes tim e f o r
n ourishm ent at the top o f S tevens P ass
Dr, George B row n (rt) a n d h is brother
Dr. Russell B row n sto p in Leavenw orth,
the second day o f the C ourage C lassic
Dr. N ick Iverson refuels at the halfw ay
p o in t in C entralia on the Seattle-to-
Drs. H a r a ld S ch o ep p n e r (left) a n d
G ary Taubm an start out fresh on dav
P o rtla n d ride
one o f t h e S e a ttle-to -P o rtla n d ride
September, 2004
PCMS BULLETIN 5
B
u l l e t in
A pplicants for Membership
Franciscan
Clinical
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F ra n cisca n C linical M e s s a g in g is easy to u se — w e 'll s h o w yo u
h o w . It's available at no charge to Franciscan medical staff.
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M e d S c h o o l: U n iv e rsity o f Io w a
In te rn sh ip : St. M a r y ’s H e a lth Services
R e sid e n c y : U n iv e rs ity o f M in n eso ta
Troy D avis, PA -C
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1703 S M e rid ia n # 1 0 1 , P uy allu p
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T rain in g : U n iv e rsity o fN e b ra s k a
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1703 S M e rid ia n # 1 0 1 , P u y allu p
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M e d S c h o o l: U n iv e rsity o f W ashington
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In tern sh ip : N a v al M e d ic a l C e n te r
• C o m m u n ic a te and sh a re data w ith h o sp ita l in te n s iv is ts
R e sid en c y : B re m e rto n N a v a l H ospital
• F o rw a rd p a tie n t in fo rm a tio n to o th e r C linical M e s s a g in g users
J u lie J a r v is, P A -C
D e rm ato lo g y
• H o s p ita l-b a s e d tra n s c rip tio n
• 3 + ye a rs o f h is to ric a l clin ica l re su lts
• EKGs (c o m in g J u ly 2004)
Increase Clinical Effectiveness
o r a u to -fa x to c o lle a g u e s w h o d o n 't use C linical M e s s a g in g
Get Started
C a sc a d e E y e & S k in C e n te rs
1703 S M eridian # 101, P u yallup
253-848-3000
To learn m o re a b o u t F ranciscan Clinical M e s s a g in g , o r to s e t up yo u r
T rain in g : W ic h ita S ta te U n iv e rsity
• R e d u ce fa x in g and filin g d e lays
a c c o u n t, call J o a n A rtm a n at 2 5 3 ,4 2 8 .8 4 6 9 .
J essica H . K im , M D
L C A T H O L I C HEALTH
t i n i r i a r i v *: s
Franciscan Health System
W W W
f h
h
a 1 t h
o r
D e rm ato lo g y
C a sc a d e E y e & S k in C e n te rs
1703 S M e rid ia n # 1 0 1 , P u yallup
253-848-3000
M e d S c h o o l: U n iv e rsity o f M aryland
In tern sh ip : W alter R e ed A rm y M ed Ctr
R e sid e n c y : W alte r R e e d A rm y M ed Ctr
“ A p plicants fo r M e m b e rsh ip ” cont. page 14
6 PCMS BULLETIN
September, 2004
explores
Electronic Medical Records
and
Electronic Connectivity for Pierce County
The How ’s and W h y ’s of EMRs
Connecting Pierce County
Improve access to inform ation
An update on the PCMS C onnectivity C o m m itte e
Decrease expenses, operate m ore efficiently
Developing a ‘com m unity’ solution
Increase reimbursements; im prove docum entation
Secure Messaging
Meet regulatory and liability concerns
Bringing labs, xrays, etc. to your EMR
“Find your champion”
N o m ore scanning o r O C R !
Presented by:
Matthew White, MD; Chair, PCMS Connectivity Committee
Featuring: Testimonials' by Pierce County physicians
September General Membership Meeting
Vendor displays ❖ complimentary dinner
Other important agenda items:
►Initiative 330 discussion, W S M A ’s Initiative to the Legislature for tort reform
►Four at-large members will be selected for the 2005 Nominating Committee
R e g istra tio n r e q u ir e d b y S e p t e m b e r 1 0 th . R e tu r n fo r m to P C M S 2 2 3 T a c o m a A v e S o , T a c o m a 9 8 4 0 2 , fa x to 5 7 2 - 2 4 7 0 o r c a ll 5 7 2 - 3 6 6 7
Please re s e rv e
d in n e r(s) fo r m e at no charge. (O N E F R E E G U E S T P E R M E M B E R )
Additional g u e s ts /s ta ff or n o n -m e m b e r re g istra tio n fee is $25
Member Nam e (please print) __
Guest/staff nam e (please print)
Additional guests (please print)
No Ch arg e
No Charge
$ 2 5
e a ch
(a t ta c h c h e c k o r p a y a t d o o r )
The parking lot across th e s tre e t charges $ 3 , but th e re is usually am ple s tre e t parking a t no charge
Thank you. We hope you will join us._____________________________________________________________________
September, 2004
PCMS BULLETIN 7
VB
/
u l l e t in
Social Security Disability and the Electronic Future
The Social Security Administration
(SSA) and its affiliated State Disability
Determination Services (DDSS) each
year request about 15 million medical
and other records on behalf of claim­
ants for Social Security disability ben­
efits. SSA is probably the largest single
third party requester of protected
health information. SSA has begun sev­
eral initiatives to improve the timelines
and efficiency of its huge disability pro­
grams, including development of a
paperless case processing system.
Health professionals play a key role in
determining the efficiency, effective­
ness and, ultimately, the success of
SSA’s efforts.
SSA is migrating to a fully elec­
tronic case processing system. This
means that Social Security records will
be maintained in an electronic folder
that is entirely paperless. For a fully
electronic case processing system, SSA
must store medical and functional evi­
dence in an electronic format. There­
fore, it makes sense to receive evidence
in an electronic format whenever pos­
sible. Otherwise, we must digitally scan
the paper and then arrange for its dis­
posal. Transferring documents elec­
tronically will mean savings for provid­
ers, SSA and taxpayers.
The Social Security Administration
recognizes that providers may have a
wide range of electronic capabilities and
needs, therefore, is building a flexible
v
Im
v
'5
S erv ice
s e rv ic e o f
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• P R E -T R A V E L C AR E
HOURS
• P O S T -T R A V E L CARE
C A LL E A R LY W H E N P L A N N IN G
M O N - FRI 9 - 5
2 5 3 -4 2 8 -8 7 5 4
o r 2 5 3 -6 2 7 -4 1 2 3
A S E R V IC E OF
IN FE C TIO N S LIM ITE D PS
a g in g
t r a m e d ic a lim a g in g . c o m
September, 2004
lL e
e
N o r t h w e s t M e d ic a l S p e c ia ltie s , P ile
4 7 0 0 P o in t F o s d ic k Dr, S te 1 1 0 • F o r m o r e in fo r m a t io n , c a ll (253) 7 6 1 - 4 2 0 0
8 PCMS BULLETIN
u
a
ra-di-ol-o-gy \rad-e-‘al-e-je\j 2 .
1: a branch o f m edicine utilizing exams such as
M Rl (magnetic resonance imaging) and CT
(com puted tomography) in the diagnosis and
treatment o f disease 2: a com m itm ent to
providing cutting-edge imaging services without
the necessity o f driving long distances; see TRA
e d ic a l
' a
H ea lth
'
M
set of HIPAA-compliant tools to obtain
electronic records. To find out more in­
formation about exchanging records
electronically please contact the Wash­
ington State Division of Disability Deter­
mination Services, Medical/Professional
Relations Department at 1-800-562-6074.*
220 - I ^ A v e SE #B, Puyallup W A 98372
fie rc e if:oioi(y QpledicaJ S ociety
In My Opinion....
The Invisible H and
by Joseph jasper, m d
The opinion s e x p r e s s e d in th is w r itin g a r e s o le ly th o s e o f th e a u th o r. P C M S in vites m e m b e r s to ex p ress th e ir o p in io n /in s ig h ts a b o u t s u b je c ts
relevant to the m e d ic a l co m m u n ity , o r sh a r e th e ir g e n e r a l in te r e s t sto r ie s . S u b m is s io n s a rc s u b je c t to E d ito r ia l C o m m itte e review .
The Sea Turtle
I find studying nature helps me
learn about people. A re ce n t visit to an
aquarium taught m e about sea turtles.
As we all know, th ey have a hard shell,
impenetrable to m ost predators. T hus,
the turtle glides about the shallow s
feeding along the coral reefs relatively
unconcerned about threats lurking
within the ocean. I f threatened, it can
tuck its head and lim bs w ithin its arm or.
Unfortunately, sharks are capable o f
seizing the creature and crushing the
shell.
Doctors see them selves as capable
ofpracticing m edicine w ithout in terrup­
tion. Our w orlds are perceived as w ithin
some sanctum that no one should dare
breach; w e w ould never dare to ven­
ture outside. Society w ill revere and
care for doctors. T here has been no
tim e for politics.
O ur security is as false as the sea
turtle. O ur livelihood is threatened by
rapidly rising overhead, and incom e
th at fails to keep pace w ith inflation.
T he culprits o f our dem ise are know n:
trial attorneys and the p oliticians they
have contributed so heavily to that
d are not support tort reform .
W hile the sea turtle m ust evolve a
b e tte r d efense over m illennia, w e m ust
adapt to our new w orld m ore rapidly.
We m ust realize w e have no im pen­
etrable shell; ii has been shattered;
Joe Jasper. M D
our flesh exposed. We m ust participate
w ith our tim e, action and dollars.
Please, do not ignore the p leas for
y our participation. Fundraisers for p o liti­
cians w ill help our side becom e stronger
in the effort to brin g a bout m eaningful
tort reform.
Do not be a co m placent turtle. Let
us turn the tables. B ecom e the predator,
not the helpless prey. ■
Positron Emission T o m ography (PET)
O u r C lin ica l
PET S p e cia lists
PET has been shown to be an accurate m ethod to diagnose and stage cancer, check for
tum or recurrence, and m onitor cancer therapy. Inform ation gained by the use of PET can be
used to determ ine w hat com bination of surgery, radiation therapy, or chem otherapy is most
likely to be successful in m anaging the disease.
A n th o n y Larhs, M D
Director of C linical PET
P h illip C Lesh, M D
PET is also used to evaluate Alzheimer's disease,
‘ '■
f
^
epilepsy, and cardiac disease.
~s
M anv insurers, including Medicare and
-• '>§£;-
Medicaid, are reim bursing for many
PET procedures. TRA referral
coordinators will work with you to
complete the required pre-exam
authorization.
W illia m B Ja c k s o n , M D
Tacom a
2 2 0 2 S C e d a r St, Ste 2 0 0
2 5 3 -7 6 1 -4 2 0 0
tra m e d ic a lim a g in g .c o m
Call our referral coordinators at
2 5 3 -7 6 1 -4 2 0 0 .
September, 2004
PCMS BULLETIN 9
B
u l l e t in
In M y Opinion....
The Invisible H and
b y A n d r e w
s ta ts o n , m b
T h e o p i n i o n s e x p r e s s e d in t h i s w r itin g a r e s o le ly t h o s e o f t h e a u t h o r . P C M S in v ite s m e m b e r s to e x p r e s s th e ir o p in io n /in s ig h ts a b o u t s u b je c ts
r e le v a n t (o t h e m e d ic a l e u m m im itv . o r s h a r e th e ir g e n e r a ! in te r e s t s to r ie s . S u b m is s io n s a r e s u b je c t to E d i t o r ia l C o m m itte e rev ie w .
Exodus
"S o m e p e o p le c h a n g e w h en th ey se e the
tight, oth ers, w hen they’ fe e l the heat. "
C a ro lin e S c h ro e d er
A n d r e w S ta ts on, M D
T h e c ity o f C a rb o n d ale, Illin o is, felt
th e h e at. T h e C h ica g o Tribune re ­
p o rte d on 7 -1 3 -0 4 th a t th e C a rb o n d ale
c ity co u n cil p assed an o rd in an c e e sta b ­
lish in g c ap s on m ed ic al m alp rac tic e
c ases and re stric tin g v e n u e , so th a t all
in cid e n ts lea d in g to c la im s th at o c ­
c u rre d w ith in th e c ity w o u ld be trie d in
th e city. C a rb o n d ale is in an area c o n ­
sid e red a ju d ic ia l hell hole.
W h a t p ro m p te d th em to a ct w as
the d e p a rtu re o f t h e last tw o n e u ro ­
su rg e o n s. w h o c lo se d th e ir o ffice in
M a y a n d re lo c ate d to South C aro lin a.
D rs. T h eo M ellio n a n d S am eel Lai w ere
p a rtn e rs in N e u ro lo g ic a l A sso c ia te s o f
S o u th e rn Illinois. T h ey sh o p p e d for in­
su ra n c e a n d the best q uote th e y c o u ld
g e t w as $ 3 0 0 ,0 0 0 p e r p e rso n . In South
C lare H o sp ital in L ak e w o o d w as n o t the
an in cre ase in p re m iu m s o f fifteen per­
o nly one. T h e p h y sic ia n s in o u r c o m m u ­
c e n t fo r 2 0 0 5 , in sp ite o f th e cap.
nity' w h o re tire d or sto p p e d d o in g o b ­
ste tric s w ere n o t alone. T h e p h e n o m ­
In a d e c isio n h a n d e d d o w n on 7-704, th e M ic h ig a n S u p re m e C o u rt ruled
enon is w id e sp re a d a n d a ffe c ts m o st
states o f the union.
th at “ d a m a g e c ap s are c o n stitu tio n al in
c au ses o f a ctio n sp rin g in g out o fth e
A s an ex am p le, four o f th e six o b ­
c o m m o n law^ b e c a u se th e L egislature
ste tric ia n s in E n id . O k la h o m a sto p p e d
h as th e p o w e r u n d e r o u r C onstitution
d o in g o b ste tric s th is sum m er. T h ey did
1,200 d e liv e rie s last year. C an tw o o b ­
to a b o lish o r m o d ify n o n v e ste d com ­
ste tric ia n s h a n d le th at k in d o f v o lu m e
m on law rig h ts a n d re m e d ie s .”
T h e c ase, P h illip s v. M ira c Inc,
by th em se lv es? H ow long do you th in k
th ey w ill last? P erh ap s th e y m ig h t re ­
cruit so m eo n e. W ill th ey re c ru it four?
V arious citizen a n d c o n su m e r
g ro u p s, p e rh ap s a ctin g as fronts fo r trial
co n ce rn ed a 1995 M ic h ig a n law limiting
atto rn ey s, d isp u te the c la im th a t care is
n o t av ailab le or th a t p h y sic ia n s are
liab ility o f t h e re n ta l c o m p a n ie s w as un­
leaving in large num bers. O n 4 -1 8-04,
the v ica rio u s lia b ility o f c a r re n ta l com­
p a n ie s to $ 2 0 ,0 0 0 p e r p e rso n and
$ 4 0 ,0 0 0 p e r a c c id e n t in c a se one o f their
cars w as in v o lv e d . P rio r to th a t law, the
lim ited. T h e a b o v e d e c isio n do es not
m en tio n m ed ic al m alp rac tic e caps, but it
C aro lin a, th e y ’ll pay $40,000 each.
T h e m a y o r o f C a rb o n d ale, B rad
m call.com in H a rrisb u rg , P ennsylvania
rep o rted that th ere w as n o e x o d u s o f
is a n ice p re c e d e n t.
C o le, said th a t the crie s fo r h e lp n e ed e d
do cto rs from th a t state. T h e m edical so ­
o u r sta te , a n d w e d o n ’t h a v e a cap yet.
to be a n sw e re d before they becam e
c iety is c ry in g w olf. I f a n y th in g , there
are m ore p h y sic ia n s p ra ctic in g in P en n ­
and the p ro je c te d in cre ases in prem i­
tea rs o f sorrow . N ic ely put. T h e ir action
w ill be to o late fo r the lea v in g n e u ro ­
sy lv a n ia now th an there w'ere a few
I d o n ’t k n o w w h a t w ill happen in
M a ry la n d and C o n n e c tic u t h ave no cap
um s are 4 0 -9 0 % o r m o re , d ep en d in g on
the sp ecialty . In C o n n e c tic u t, the prem i­
su rg e o n s, b u t it m ig h t h e lp recruit
y e ars ago. T h e o n ly d e cre ase w as in the
so m e o n e else.
In the m ean tim e, the liability reform
n u m b e r o f neuro-, o rth o - and general
su rg e o n s and o b ste tric ia n s, w h o w ent
from 4,721 in 2002 to 4,665 in 2004, cer­
um s fo r o b ste tric ia n s w ill d ouble. GE
tain ly n o t a big drop, and the re p o rte r
ste tric ia n s p a y 9 3 .7 % m ore.
d isp u ted the a cc u rac y o f that figure,
too.
see th e light. H ow b a d d o th in g s have
E ven w ith tort reform , the o u tlo o k
is bleak. R ates are not g o in g to go
re p e a t so m e th in g I h a v e sa id before.
dow n. O h io , for instance, enacted a cap
S in c e 1 am re tired , it is e a sy fo r m e to
say it. I f y o u c a n figure a w ay, leave the
ro o m s, tra u m a c en ters, etc. g ro w s. So
last year, but th at has not been teste d in
co u rt and the p re v io u s law had been
d o e s th e lis t o f p h y sic ia n s re lo c a tin g or
o v e rtu rn e d . T h e in su ran ce c o m p a n ies
lea v in g th e p ra c tic e o f m ed ic in e . T h e St.
are c au tio u s and th ey c u rre n tly p ro jec t
bill is stalled in the Illin o is legislature
a n d th e g o v e rn o r is o p p o se d to caps.
T h e p h y sic ia n s w h o can g e t out o f
th ere are m o v in g to W isconsin, In d ian a
o r o th e r p lac es, w hile the p arty (fo r the
trial a tto rn e y s) g o e s on.
T h e list o f h o sp itals c lo sin g th e ir
o b ste tric a l d e p artm e n ts, e m e rg en c y
10 PCMS BULLETIN
September, 2004
M e d ica l P ro te c tiv e a lre a d y increased
its a v e ra g e ra te s by 8 9 .6 % in July. O b­
O u r o p p o n e n ts o b v io u sly cannot
to b e c o m e for th em to fe e l th e h eat? I ’ll
p ra ctic e o f m ed ic in e . It m a y be hard to
b e lie v e, but th e re is life o u tsid e o f
See “ E xodus” page 18
.
r
I The Health Status of Pierce County
o M e J ti-a l (^fuaety-
Federico Cruz-Uribe, MD
Director of Health
Obesity Epidemic
I had the opportunity to see the
new movie “ Super Size It!” A s m ost o f
you know, this film chronicles the e f­
forts o f a young m an w ho goes on a
McDonald’s diet. Yes, 100%
McDonald’s fast food breakfast, lunch
and dinner for 30 days. 1 saw the film
with my 16-year-old daughter, a so b er­
ing experience as we reacted to the film
very differently. I w ould cringe at a
scene and she w ould say “ w ow !” I
gagged and she responded “n eat!” to
gross encounters on the screen. I
would hear m usic that I liked and she
would com m ent it w as boring. B ut, the
basic point o f the film got through to
both o f us. Eating fast food every day
was basically harm ful to y o u r health.
We all know this intuitively. We
as physicians are aw'are o f how im ­
portant a good diet is to good
health. Yet, it has not been a central
part o f our efforts to com bat disease.
We see too m any children from a
very early age becom e accustom ed
to high fat/high carbohydrate diets.
And not ju st any fats but saturated
fats. Fats that are partially h y d ro g e ­
nated (the trans fats), the very dietary
factors that are m ost prone to causing
long term health problem s. A d d to
those fats huge am ounts o f sucrose
and other highly refined carbohydrates
and you’ve got a health problem w ait­
ing to happen.
The end result o f all this culinary
mayhem is that our country has becom e
“fat.” The CDC has released m aps o f
the United States that show the p ro ­
gression o f obesity state by state, start­
ing in 1970, then by 10-year increm ents
until 2004. It is shocking. T he m aps
show “progression” from a few areas
p lag u ed by obesity in both adults and
children to the m ajority o f states w ith
o besity levels o f at least 25% -30% . We
see e xtraordinary num bers o f kids w ith
p re-diabetic conditions.
I w ish that I w as exag g eratin g b ut I
am not. P oor diet, lack o f sufficient exer­
cise (the all too pervasive couch potato
syndrom e), p oor role m odeling by par­
ents and other adult role m odels, and
ineffective health education curricula in
our schools has added up to a situation
w ith grave consequences for the cur­
rent and future health o f o u r country.
D espite obesity bein g at epidem ic lev­
els and the cost o f health care for the
associated chronic diseases, there is
not a nationw ide or statew ide or even
“It w o n ’t be easy but we have to
take obesity on with a passion. ”
countyw ide effort to confront this
problem .
W hy w e h a v en ’t ju m p e d forw ard
on this in a reasoned, m easured and
c om prehensive w ay is a com plicated is­
sue. T he health issue is not due to an
infection; ju s t getting an antibiotic to
the afflicted w o n ’t do. Likew ise, there is
no vaccine to prevent obesity from
happening. O besity involves behav­
iors, it entails attitudes, it requires p u b ­
lic policy directly affected by large
b u sin e ss interests.
It w o n ’t be easy but w e have to
tak e obesity on w ith a passion. P hysi­
c ians need to be directly involved both
F ederico C m :. M D
in the office and, just as im portantly, in
the com m unity. We c a n ’t solve this by
health education alone. Pow erful c o ali­
tions need to be put to g eth er w ith our
school districts, w ith our churches,
w ith local governm ent and w ith broad
citizen groups and private agencies.
T here is a clear unifying issue: the
health o f o u r com m unity.
T his is an oppo rtu n ity for us as
physicians to shine in o u r role as h e al­
ers. O ur com m unities have b ecom e sick
and are in dire need o f treatm ent.
The cro sso v er to political action
is obvious. T his isn ’t about
m oney or m alpractice issues. T his
c a n ’t be m isconstrued as selfserving. We are v enturing o u t on
an issue o f over-arching im p o r­
tance to the broad com m unity
(pun intended!).
I th in k that our credibility as lead­
ers is at stake. It is im portant for the
public to see doctors valiantly strug­
g ling w ith others to take on this im p o r­
tant issue, stepping out to dem and
changes. W e have to tak e initiative on
this one: N o one is going to hold our
han d s or publicly speak up m andating
our involvem ent. O u r en g ag em en t is e x ­
pected and it is necessary. A n d ev ery ­
one w ill notice if w e d o n ’t step to the
plate. G et involved! A c o u n ty w id e c o a ­
lition is form ing up to create a strategy
to reverse the direction o f the epidem ic
o f obesity. E ach o f u s sh o u ld co n sid er
jo in in g and sup p o rt its e ffo rts.*
September, 2004
PCMS BULLETIN
11
W SM A Launches Initiative Campaign to Force Action on Liability Reform
F ru s tra te d by th e la c k o f a ctio n on
w ith o u t th e c o n sta n t fe a r o f a la w su it.”
b e e n w a rn in g th a t e x c e ssiv e costs and
m ean in g fu l m edical liability reform , the
1-330 re sto re s fa irn e ss a n d b a la n c e
to th e lia b ility sy ste m so d o c to rs can
th e a b ility o f p h y sic ia n s to practice
W S M A h a s la u n c h e d an in itia tiv e c a m ­
a n u n fa ir leg a l sy ste m a re th reatening
p a ig n d e sig n e d to b re a k th e g rid lo c k in
c o n tin u e to p ra c tic e m e d ic in e and serv e
m e d ic in e - p o te n tia lly le a v in g patients
O ly m p ia o v e r se n sib le re fo rm o f m edical
th e ir p a tie n ts and c o m m u n itie s. I f the
w ith o u t a c c e s s to n e e d e d care.
D o c to rs a re lim itin g v ital services
lia b ility law s. D o c to rs fo r S e n sib le L a w ­
leg isla tu re fa ils to act on th e in itiativ e
su it R e fo rm , a g ro u p re p re se n tin g m o re
d u rin g th e leg isla tiv e se ssio n b e g in n in g
such as o b ste tric s, m am m o g rap h y ,
th a n 9 ,0 0 0 p h y sic ia n s in W ash in g to n
in Jan u a ry , 1-330 w ill p ro c ee d to th e g e n ­
tra u m a c are a n d b ra in su rg e ry because
S tate, w ill beg in g a th e rin g the re q u ire d
eral electio n b a llo t in the fall o f 2005.
o f th e fe a r o f b e in g su e d and the un­
197,734 v a lid sig n a tu re s to p la c e In itia ­
F o r sev eral y e ars p h y sic ia n s h ave
c o n tro lle d c o sts o f t h e legal s y s te m .!
tiv e 3 3 0 - T h e H e a lth C a re A c c e ss I n itia ­
tiv e (1-330) b efore th e leg islatu re in 2005.
“F o r the p a st tw o leg isla tiv e se s­
sio n s, d e sp ite a d e m o n s tra te d n e ed fo r
a ctio n , a fe w o b stru c tio n ist p o litic ia n s in
th e H o u se h a v e re fu se d to tak e a ction on
m ean in g fu l m edical liability reform , p re­
v e n tin g H o u se m em b e rs from even v o t­
in g on the issu e .” sa id Dr. J e f f C o llin s,
p re sid e n t o f W S M A and p ra c tic in g in te r­
n ist in S p o k an e. “ T h is g rid lo c k m u st end.
W e h av e n o o th e r c h o ic e th an to com pel
th e leg isla tu re to do its jo b so w e can get
b a c k to d o in g o u r jo b - tre a tin g p atients
Allenmore
.jffly Psychological
Associates, P.S.
.
752-7320
.
D o you have patients w ith d ifficult em otional
and stress-related problem s? P sych ia tric and
p sych o lo g ica l consultations are available.
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-------------------- 1530 U n ion A ve. S.. Ste. 16. Tacoma__________
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Phone: 253.841.0851
12 PCMS BULLETIN
September, 2004
• Fax: 253.841.4997
<)<m(y Q.4leJical $octefy
j
In My Opinion
by Loren Finley, MD
The opinion s e x p r e s s e d in th is w r itin g a r e s o le ly th o s e o f th e a u th o r. P C M S in vites m e m b e r s to ex p r e s s th e ir o p in io n /in s ig h ts a b o u t su b je c ts
relevant to th e m e d ic a l co m m u n ity , o r s h a r e th e ir g e n e r a l in te r e s t sto rie s. S u b m is s io n s a r e s u b je c t to E d ito r ia l C o m m itte e review .
The last Ob/Gyn in
Gig Harbor speaks out
sonally have to m ake up this increased
cost in volum e (deliveries). To date, I
the Peninsula G ateway.
am w illing to do this, but m any o f m y
I am deeply concerned about the
colleagues have been unw illing or un­
future o f our m edical care system . If
able to do so.
changes are not m ade soon, p eople will
2. “Insurance com panies over­
have a difficult tim e finding a p h y si­
charge for p rem iu m s.” Liability insur­
cian, especially in O B. orthopedics,
ance com panies spend large am ounts
neurosurgery, and general surgery.
o f m oney in pretrial as well as ju ry trial
The excess cost o f business, esp e ­
defense. In cases that go to trial, the
cially m alpractice prem ium s, are driving
jury' finds for the defendant (physi­
physicians out o f W ashington state.
cian) 8.5 o f 10 tim es. M y insurance
My fear is that it w ill take the death o f
com pany spends betw een $500,000
a child, pregnant m other, or unborn
and $1 m illion to win a case; costs that
baby, due to the u n availability o f a
are reflected in all the policy h o ld ers’
physician before any prevention m ea­
prem ium s. T he n um ber o f claim s has
sures are im plem ented. T his is n o t ac­
not increased in years, but the aw ard
ceptable.
settlem ents (payouts) have signifi­
I am the last O B /G Y N physician
cantly increased in the last three to
seeing patients in G ig H arbor. T hree
four years, causing sk yrocketing rate
years ago there w ere four. T acom a has
increases. Less than 5% o f m y insur­
seen a reduction from 25 to nine in
ance c o m p a n y ’s reserves are held in
three years. In the last 4 years 39% o f
anything other than secure, principal
family practitioners, and 19% o f O B ’s
protected financial entities, as required
have dropped obstetrics. We are expe­
by the State Insurance C om m issioner.
riencing three to six m onth w aits for
3. “Caps on non-econom ic dam ­
urology and derm atology referrals for
ages d on ’t w ork,” and “C aps are un­
insured patients. A nd, it is alm ost im ­
fair to p eople.” Bunk! Physicians bepossible to recruit n ew p hysicians to
lieve that in all eases o f proven n egli­
our area unless th ey have fam ily ties or
gence, all m edical care be provided and
some com pelling reason to live here.
all econom ic dam ages be com pen­
We see the im pending crisis and
sated, along w ith a reasonable ‘pain
want to prevent it. H ere are a few c o n ­
and su ffe rin g ’ aw ard. Society needs to
cerns/m isconceptions I have heard d is­
determ ine a m axim um level for non­
cussed:
econom ic dam ages (often called pain
1.
“M alpractice prem ium s are not and suffering) that is “ fair,” as ev ery ­
a significant part o f a doctors overhead
one pays for runaw ay ju ry aw ards. 1
cost.” This is absolutely u ntrue. I per­
w as shocked w hen Rep. Patricia L antz
Editor's No!e: This o p -e d p ie ce, w ritten by
Loren Finley. M D w as p u b lis h e d in J u ly in
used the exam ple o fth e Strep infection
patient (in the January, 2004 G atew ay
editorial) and im plied that this person
w ould be lim ited to the cap am ount.
T hat is outright ridiculous and m is­
leading. W hat Rep. L antz failed to re­
port is th at all this p a tie n t’s m edical
care, prosthesis care, car expenses, fu­
ture earnings, and so on (defined as
econom ic dam ages) w ould be c o m p e n ­
sated w ithout lim it. T his w as not the
im plication m ade by R ep. L antz as she
stated that the cap am ount w ould be
the total am ount o f the p a tie n t’s com ­
p ensation. T his is an exam ple o f the
o u tright m isrepresentation that p e r­
sonal injury law yers use to m uddy the
water. It has been proven in num erous
studies that caps on non-econom ic
dam ages do w ork to stabilize p rem i­
um s. M y insurance com pany. P hysi­
cians Insurance, has clearly stated
they w ould reduce prem ium s a m ini­
m um o f 10% i f and w hen the leg isla­
ture passes a $250,000 cap on n o n ­
e conom ic dam ages th at is enforced by
the courts. T h ey agreed to this b e ­
cause the true data clearly show s that
caps do stabilize prem ium s.
We have a legal system th at a t­
tem pts to right the w rongs that occur
in life. T his is very im p o rtan t and p h y ­
sicians ta lly w ant patients to have
th eir day in court. B u t how m any d o l­
lars are enough fo r pain and suffering?
H ow can Society afford to pay these
e x orbitant aw ards? H ow does Society
Sec “Finley" page 16
September, 2004
PCMS BULLETIN
13
B
u l l e t in
Applicants for Membership
cont. fro m p a g e 10
C h ad B. K rilich, M D
K evin F. M urray, M D
D avid M . Shaw, M D
F a m ily P ractice
F am ily Practice
P u lm o n a ry & C ritic a l C a re M edicine
S p a n a w ay M e d ica l C linic (C H C )
T acom a F am ily M ed icin e
521 M artin L K in g Jr W ay, T acom a
P u lm o n a ry C o n su lta n ts
M e d S c h o o l: T u fts U n iv e rsity
253403-2900
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253-572-5140
In tern sh ip : T aco m a F a m ily M ed icin e
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R e sid en c y : T aco m a F am ily M e d icin e
R esid en cy : T aco m a F a m ily M e d icin e
R e sid en c y : U C - S a n D ieg o
1 3 4 - 1 8 8 th S tre et S, S p a n a w ay
253-847-2304
3 1 6 M a rtin L K in g J r W ay # 4 0 1 , Tacoma
M e d S c h o o l: Y ale U n iv e rsity
F ello w sh ip : U C - S a n D ieg o
T heodore K . L au, M D
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C a rd ia c H e a lth S p e c ia lists
1802 S Y akim a #307, Tacom a
253-627-1244
M e d S chool: M cG ill U n iv ersity
In tern sh ip : U n iv e rsity o fT e x a s H S C
R e sid en c y : U n iv e rsity o fT e x a s H S C
F e llo w sh ip : B a y lo r C o lleg e o f M e d icin e
E ric O . R asm u ssen , M D
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P e n in su la D e rm a to lo g y & L a se r C linic
Fam ily M ed icin e
4 700 Pt. F o sd ick D r N W, G ig H a rb o r
G o o d S a m aritan F a m ily M ed icin e at Sumn
1518 M a in S treet, S u m n e r
253-851-7733
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Intern sh ip : U n iv e rsity o f C o lo rad o
R e sid en c y : O re g o n H e a lth S c ien c es U n iv
253-863-6338
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F ello w sh ip : O re g o n H ealth S c ien c es U niv
R e sid en c y : C a p ita l R e g io n M edical Centei
In tern sh ip : C a p ita l R e g io n M ed ical Center
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14 PCMS BULLETIN
September, 2004
Sponsored by the Kiisbinglm Stale Medical Association
P ftw ce % o u n (tf Q/i'ie.dical d f o c i d y
In My Opinion
by John S tu tte rh e im , MD
The o pin io n s e x p r e s s e d in th is w r itin g a re s o le ly th o s e o f th e a u th o r . P C M S in vites m e m b e r s to ex p r e s s th e ir o p in io n /in s ig h ts a b o u t su b je c ts
relevant to the m e d ic a l co m m u n ity , o r .share th e ir g e n e r a l in te r e s t s to r ie s S u b m is s io n s a r e s u b je c t to E d ito r ia l C o m m itte e review .
Dr. Hekking
Dr. H a n H e k k in g , w h ile w o r k i n g o n th e in fa m o u s B w m a - T h a i R a il r o a d ,
sa v e d m a n y A m e r ic a n P O W 's liv e s o f th e L o s t B a ta lio n a n d th e C r u is e r
U SS H o u s to n d u r i n g W W II. H e > tm h o n o r e d b y C o n g r e s s in 1 9 8 3
The lost battalion w as the N ational
loved nature and becam e acquainted
H ekking h im self becam e ill, uncon­
Guard 131st Field artillery unit from
w ith m any tropical plants and cam e to
scious for seven days. T h ey all w alked
Texas under C olonel E ubank, sent o rigi­
appreciate their im portance for the sick
in G -strings, barefooted through the
nally to the P hilippines, but diverted to
people.
the island o f Java, in the form er D utch
In 1938, he spent tim e to study
m uck, m ixed with excrem ents o f sick p a ­
tients.
East Indies. T hey surrendered w ith the
m edicine in B ergam o, Italy w here the
Dutch troops on M arch 8, 1942. The
p opulation w as so po o r and he saw p e l­
their 3 9 th re u n io n , invited the 80-year-
Cruiser USS Houston survived the
lagra, a d eficiency disease, an ailm ent
old Dr. H ekking to com e to Texas. He
battle o f the Java Sea but w as to rp e­
ram pant on the death railway.
doed by the Japanese in the Strait o f
Dr. H ek k in g 's actions and heroic
T he e x -P O W ’s o fT ex a s, during
had an o verw helm ing w elcom e at the
D allas/F ort W orth airport. M any parties
Sunda, where m any sailors sw am
spirits saved m any A m erican lives, only
w ere given in his honor and attended
ashore in B antam , Java. T he Japanese
13 died out o f 90. H e conflicted in his
by U.S. S enator John Tower.
moved Am erican, D utch, B ritish and In­
treatm en ts w ith the tw o B ritish doctors,
donesian coolies to w ork on the
fresh from E urope, w ho am putated se ­
planned B urm a railroad, to connect
v erely ulcerated legs in a hurry, and
introduction to the U.S. Senate on F ri­
Siam with Burm a. This railroad w as built
used hot poultices, m aking the bacte­
day, N ovem ber 18,1983.
through the m ountains in record tim e at
rium grow faster. N one o f H ek k in g ’s
the cost o f so m any lives.
p eople underw ent am putation due to
and Mr. P resident, 1 w ould like to take
T he new sp ap ers w'rote his sto iy
and the culm ination o f his visit w as his
It started as follow s: “ Mr. T ow ers
his treatm ents. He collected herbs and
this o pportunity to pay trib u te to a hero
in the colonial arm y and ended up on
fat and used even arsenic to com bat
o f W orld W ar II.” M any form er crew
this RR track to take care o f the A m eri­
dengue fever. A sharpened teaspoon
m em bers cam e forw ard to state that
cans o f the lost B attalion and U SS
w as used to dig out ulcerated tissues,
they ow ed th eir lives to him . H e w as d e ­
Houston.
very painful indeed w hile som ebody
scribed as a physician and p sy c h o lo ­
w as h o lding dow n the leg. M aggots
gist, to som ehow treat the m ind, spirit
Dr. H ekking w as a D utch physician
He w as bom in Surabaja, Java in
1903 and spent m any years w ith his
w ere instilled to eat the dead tissue.
and so u l o f those p risoners o f w ar w ho
grandmother in the m ountains w here he
C aused by a virus, a tropical ulcer
had little or no reason to be co nfident
about the future.
was exposed to her herb treatm en ts o f
n e v er crusts over in contrast w ith bac­
the natives. H e learned to co llect herbs
terial infections. He filled the scraped
in the forests. He studied in Leiden,
out ulcer w ith a m ixture o f purple tannic
the sam e hospital room w here his w ife
Netherlands and in 1929 as an M D in
p o w d er and fat, covered by a
M ae w as being trea te d for a stroke.
the armed forces w as sent to C elebes,
ranunculoides leaf. T ropical le a f tea
Kolonodale, an outpost w ith few re­
w as given to bring tem peratures dow n.
governm ent, but not by his fellow
sources. H e grew v egetables and herbs
G round up ch arcoal w as the rem edy for
A m erican s."
in the back yard o f the hospital. He
diarrhea, the m ost com m on ailm ent. Dr.
Dr. H e k k in g died at the age o f 90 in
He w as forgotten by the D utch
September, 2004
PCMS BULLETIN 15
B
u l l e t in
from p a g e 13
d e c id e ? S h o u ld it b e a le g isla tiv e b o d y
th a t a re h a rm e d to be ra p id ly a n d fa irly
te m in a c o m p le te r e fo rm p a ck a g e. We
and th e p e o p le , o r a ju ry ?
c o m p e n sa te d . We n e e d a c ap o n n o n ­
n e e d to re p la c e le g isla to rs th a t w o n ’t
e co n o m ic d a m a g e s th a t so c ie ty d e te r­
lo o k at tru e in fo rm a tio n . T h e sa d part
H o u se Ju d ic ia ry C o m m itte e w h e re c ru ­
m in e s is fair. We n e e d le g isla to rs w h o
a b o u t o u r c u rre n t situ a tio n is th a t we
cial to rt re fo rm b ills d ied the la st tw o
w ill lo o k at th e issu es, d e te rm in e the
w ill a ll be losers. O n c e o u r h e a lth care
y e ars. A s ch air, sh e h a d the p o w e r to
b rin g th e b ill fo rw a rd fo r d isc u ssio n ,
tru th , a n d m ak e c h an g e s th at w ill sta b i­
sy ste m is g o n e , w e w ill n o t g e t it back
lize a n d im p ro v e o u r m ed ic al care sy s­
easily. ■
R e p re s e n ta tiv e L a n tz c h a ire d th e
b u t sh e n e v e r a llo w e d it out o f c o m m it­
tee. W o u ld it h a v e p a sse d ? W ith c u r­
re n t p a rty p o litic s I d o n ’t know . P e r­
h a p s a ro b u st d isc u ssio n c o u ld h a v e
u n c o v e re d so m e c rea tiv e so lu tio n s. I f
the C h a ir d o e s n ’t a g ree to look at d ata,
w h a t can y o u do? R e p re se n ta tiv e s in
the H o u se are up fo r re elec tio n every
tw o y e ars. T h e y n e ed to kn o w ho w you
feel a b o u t th e issu es, and h o w y o u w ill
v o te a t th e ir n e x t e le ctio n . I f w e do n o t
MEDICAL LICENSURE ISSUES
M r. R o c k w e ll is a v ailab le to re p re se n t p h y sic ia n s a n d o th e r h e a lth care
pro v id ers w ith issues o f c o n c e rn b e fo re the S tate M e d ica l Q u a lity A ssurance
C o m m issio n . M r. R o c k w e ll, a p p o in te d by G o v e rn o r B o o th G a rd n e r, se rv ed for
8 y ears as the P u b lic B oard M e m b e r o f the M ed ical D isc ip lin a ry B o a rd from
1985-1993. S ince then, M r. R o c k w e ll has su c c e ss fu lly re p re se n te d o v e r 60
p h y sic ia n s on c h arg e s b e fo re the M Q A C . M r. R o c k w e ll’s fees are com petitive
and the su b je ct o f a c o n fid e n tia l a tto rn e y -c lie n t re p re se n ta tio n ag reem en t.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
like th e a c tio n s o f o u r leg isla tiv e re p re ­
se n tatio n , o u r p o w e r is in o u r rig h t to
vote.
It is m y o p in io n that w e n e ed to d e ­
velo p n ew sy ste m s o f m edical a c c o u n t­
ability, c e n su re th e ra re b a d d o c to r
m ore effectiv ely , a n d allo w fo r p a tie n ts
(425)453-4398 • FAX (425) 453-1534
email: [email protected] • website: wwvv.gregrockwelllaw.com
Allenmore Medical Plaza—Phase Two
-
j
.
_________________________________________________________________________________________________
3 2 0 9 S outh 2 3 r d S tr e e t
C o n v e n ie n tly lo cated n e a rb y
A lle n m o re C o m m u n ity H o sp ita l,
Tacom a, W A
FEATURES / SPECIFICATIONS
■ 45,956 re n ta b le sq u a re fe e t
- F ir s t F lo o r
14,452 rs f
- Second F lo o r
14,960 rs f
-T h ird F lo o r
16,544 rs f - leased
■ B u ild in g c u rre n tly u n d e r c o n s tru c tio n
■ C o m p le tio n 1st Q u a rte r 2005
■ Tenant im p ro v e m e n t a llo w a n c e ava ila ble
F o r f u r t h e r in fo r m a tio n ,
p le a s e c a lk
(206 ) 264-4592
16 PCMS BULLETIN
September, 2004
■ H igh q u a lity fin is h e s
Medical Real Estate Services, LLC
COLLEGE
OF
MEDICAL
EDUCATION
Whistler CME
set January 26-31
Plans are set for C M E at W histler
scheduled for next January 2 6-3 1 ,2 0 0 5 .
Aprogram brochure w as m ailed in early
September.
Those interested in attending
should secure their condos soon. The
C ollege has ar­
ran g ed for ac­
com m odations
prim arily at the
A spens C o n ­
dos at the
sam e rates as
2004. R eserva­
tio n s for the
condos can be m ade by calling A sp e n s
onBlackcomb, toll free at 1-866-7885588. You m ust identify y o u rse lf as part
ofthe COM E group. You are encour­
aged to m ake y our reservations soon to
ensure space - at least b y D ecem ber I ,
2004 when any rem aining condos in the
block will be released. ■
Plan for ID
CME on 11/12
The very p opular and annual In fec ­
tious Diseases U pdate C M E is set for
November 12,2005.
The program this y e a r w ill be di­
rected by Larry Sch w artz, M D and the
program has m oved to the F ircrest G o lf
Club. A program brochure should be
available in early O ctober. ■
Continuing Medical Education
Common Office Problems CME
features timely primary care topics
R egistration is set for the C o lle g e 's
C om m on O ffice P roblem s C M E sch ed ­
uled for Friday, O ctober 2 9 ,2 0 0 4 . The
conference w ill be held at St. Joseph
M edical Center, R oom s 1A & B.
T he program will offer 6 C ategory I
C M E credits and is again directed by
M ark Craddock, MD.
T his y e a r’s course w ill offer:
• A Prim ary C are D erm atology
R eview and U pdate
• O steoporosis: W h at’s N ew in
P rim ary C are D iagnosis and
M anagem ent
• In itia l Insulin T herapy: C hoices
for Prim ary Care
• T reatm ent O ptions for C O PD :
A n U pdate
• A n U pdate oil D epression
• A n U pdate on P ediatric
C ardiology
T he course is designed for the p ri­
m ary care clinician and focuses on
practical approaches to the m ost c o m ­
m on dilem m as faced in the daily routine
o f m edical practice. L ook for the re g is­
tration brochure in the m ail ju s t a fter
Labor Day.
F o r m ore inform ation, please call
the C ollege o fM e d ic a l E ducation, 6277137. ■
Dates
Proeram
Director(s)
Friday, October 29
Common Office
Problems
Mark Craddock, MD
Friday, November 12
Infectious Diseases
Update
Larry Schwartz, MD
Tuesday (evenings)
January 11 & 18
Cardiology for Primary
Gregg Ostergren, DO
Care
January 26-31
CME at Whistler
Rick Tobin, MD
John Jiganti, MD
Friday, February 4 or
Saturday, February 5
Gastroenterology for
Primary Care
Ralph Katsman, MD
Thursday-Friday
March 31- April 1
Internal Medicine
Review 2005
Art Knodel, MD
Friday, April 22
Radiology for the
Non-Radiologist
Rick Tobin, MD
Andy Levine, MD
Friday, May 20
Primary Care 2005
Steve Duncan, MD
September, 2004
PCMS BULLETIN
B
u l l e t in
Exodus
from p a g e 11
w ith the h ig h est risk o f lia b ility ? R e fe r
th e N a tio n a l C a n c e r In stitu te , in India,
o r w h e re v e r?
p a n y o r in o th e r a d m in istra tiv e p o s i­
th e p a tie n ts to the u niversity. L e t th em
h a n d le th e c o m p lic a tio n s. I f y o u h a d a
tio n , in a c o m m u n ity o r p u b lic h ealth
b a d o u tco m e , th e law y ers w ill c la im you
e ra l p a th o lo g ists se n t th e ir tu m o r slides
c lin ic, as a fin an c ia l a n aly st o f m edical
w e re in co m p e te n t. W hy not say up
to th e u n iv e rs ity o r to th e A F IP for con­
a n d p h a rm a c e u tic a l c o m p a n ie s, a n y ­
fro n t th a t y o u are not q u a lifie d to
th in g , b u t g e t o u t o f p ra c tic in g m e d i­
h a n d le th e p ro b lem s and se n d th e p a ­
firm a tio n o f t h e d ia g n o s is b e fo re they
re c o m m e n d e d trea tm e n t?
cin e. W h en th e c h an g e s o c c u r and y o u
tie n ts out?
A ra d io lo g ist to ld m e th a t G E M e d i­
D o y o u th in k th a t su c h actions
m ig h t, ju s t m ig h t, tu rn th e h e a t on high
medicine.
R etire, w o rk for an in su ra n ce c o m ­
w a n t to g o b a ck , d o so.
W h a t w o u ld h a p p e n i f all the gen­
cal P ro te c tiv e sto p p e d w ritin g p o lic ie s
e n o u g h to g e t us lia b ility re fo rm ? Well,
F o r g y n e c o lo g ists a n d fa m ily p h y s i­
fo r ra d io lo g ists a n d p a th o lo g ists in his
it is s o m e th in g fo r y o u to th in k about
c ia n s, it is to sto p d o in g o b ste tric s.
M a n y h a v e a lre a d y d o n e that. T he
state. Fie w a n ted to re ta lia te by not
and fo r m e to d re a m a b o u t. a
co m in g rises in p re m iu m s w ill force
m a n y o th ers to follow .
b e tte r w ay.
You p ro b a b ly fig u red o u t th a t the
F in e , b u t th e re are o th e r op tio n s.
b u y in g G E e q u ip m e n t, b u t th e re is a
re aso n fo r th a t step m u st be the risk o f
T A C O M A /P I E R C E C O U N T Y
W h a t w o u ld h a p p en i f all intern ists,
d e la y e d d iag n o sis o f c a n c e r and sp e ­
O u tp a tie n t G e n e ra l M e d ica l Care.
fa m ily p h y sic ia n s and p e d ia tric ia n s
cifically, b re ast cancer. M a m m o g ra p h y
is d e v elo p in g as a su b sp e c ia lty o f ra d i­
F ull a n d p a rt-tim e positio n s
available in T a c o m a a n d vicinity.
V ery flexible sc h e d u le . W ell suited
fo r c a r e e r re d e fin itio n for
G P . F P , IM .
W h a t a b o u t th e o th e r sp e c ia lties?
sto p p e d d o in g h o sp ital w o rk ? R e stric t
y o u r p ra ctic e to th e office, tak e care o f
ology. I v a g u ely re m e m b e r th a t C o n ­
m in o r p ro b le m s a n d send th e re a lly sick
g ress e n co u ra g e d such a m ove.
p a tie n ts to th e h o sp italists. Y our w o rk
m ay b e co m e b o rin g a fte r a w h ile, but
W h at w o u ld h a p p en i f all th e g e n ­
eral ra d io lo g ists d e clare d th at th ey are
the legal risk w ill be m u ch lower.
not c o m p e te n t to re ad m am m o g ram s
and se n t every' film to a sp e c ia list fo r in ­
te rp re ta tio n , at the u niversity, the C D C ,
W h a t w o u ld h a p p en if the su r­
g e o n s sto p p e d d o in g the p ro c ed u re s
C o n ta c t A n tlv T so i, M D (2 5 3 ) 752-9669
o r Paul
DotY (A llen .
N e ls o n , T u r n e r &
A ssoc.), C lin ic M a n a g e r (2 5 3 ) 383-4351
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September, 2004
'M e m t - m n h f
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(1 MD, 2 N Ps) seeks a part-tim e B /C or
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physician who has a special interest in
geriatrics and providing nursing hom e
care. Practice is adult p rim ary care w ith
large M edicare com ponent. Enjoy the
uniqueness o f the N orthw est lifestyle
with the back up and support o f a full
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won’t last long. T he right candidate
will enjoy an excellent call schedule,
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must have com pleted a th ree-y ear ac­
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email your CV to M ultiC are H ealth Sys­
tem atproviderservices@ m ulticare.org
or fax your CV to 866-264-2818. Please
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“MultiCare is a drug-free w ork place”
After
Breast
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tilin g
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Union Avenue Pharmacy
and Corset Shop
Formerly Smith's Corset Shop
2302 S Union A ve
752-1705
Established A uburn Fam ily Practice
looking fo r P/T to F/T B oard C ertified or
B oard E ligible P hysician to jo in a group
practice. W ork 3-4 days a w eek w ith a
great support staff. B ase salary plus
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are in search o f an M D or D O to jo in our
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F or Rent: 3300 sq ft C lass A m edical
office in T acom a M edical Center, 1112
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ground parking, close to hospitals,
ow nership options. Call 253-272-2224.
O ffice space for lease in m edical
com plex, G ig Harbor. 2354 sq ft, m ain
level. 468-3539 or 565-2444.
N ew office b u ild in g for sale or lease.
3000 leased. 3600 for lease. L arge
parking lot. Fircrest. 564-8784
Established Spanaw ay Family Practice
looking for P/T to F/T B oard C ertified or
B oard E ligible fam ily physician, pediatri­
cian o r A R N P /P A to jo in a p ra c tic e .
W ork 4-5 days a w eek w ith a great sup­
port staff. Base salary plus incentive.
Fax your C V to 253-536-3070.
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PCMS BULLETIN
19
B ul I.E T 1 N
QPie/me
o M e d u x d (Sfociehi,
“Threatening L
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A s a claims representative and supervisor, I see physicians of all specialties
whose lives are suddenly changed by claims filed against them. Whether the
cases are dismissed, settled, or go to trial, each physician’s personal and
professional life can take a turn for the worse, and that's why I’m here to
help. I analyze each claim, slay in close contact with our attorneys, and work
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important to me, and 1 make sure my work shows them that I care.
To find out about the many ways Physicians Insurance works with and
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Vi s i t o u r W e b s it e a t p h y in s .c u m
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S e a ttle . W A © P h y s ic i a n s I n s u r a n c e 2 0 0 2
Pierce C ounty M edical Society
223 Tacoma A venue South
Tacoma, WA 98402
PRESORTED
ST A N D A R D
U S P O S T A G E PAID
T A C O M A , WA
P E R M IT N O 605
Return service requested
20 PCMS BULLETIN
September, 2004
INSIDE:
3
5
I
8
9
II
P r e s i d e n t ’s P a g e : “ T h e T r u e C a u s e o f E s c a l a t i n g L i a b i l i t y P r e m i u m s ” b y M i c h a e l K e l l y , M D
S e p te m b e r G e n e r a l M e m b e r s h ip M e e tin g U p d a te
T P C H D : “ B e a L e a d e r ” F e d e r ic o C r u z - U r ib e , M D
N e w r e p o r t a “ p r i m e r ” o n s h a p i n g u p h e a lt h c a r e
In M y O p i n i o n : “ N o S a f e H a v e n ” b y A ndrew S t a t s o n , M D
I t ’s W h i s t l e r t i m e a g a i n . M a k e p l a n s n o w for t h is p o p u l a r J a n u a r y C M E c o u r s e
B
u l l e t in
P C M S O fficers/T rustees:
M i c h a e l J. K e l l y M D , P r e s i d e n t
P a tr ic k J . H o g a n D O , P re s id e n t E le c t
K e n n e th A . F e u c h t M D , V ic e -P re s id e n t
J o s e p h W . R e g im b a l M D , T re a s u r e r
S u m n e r L. S c h o e n ik e M D , S e c re ta ry
J. J a m e s R o o k s , J r ., M D , P a s t P re s id e n t
L a u re l R . H a r r is M D
J e ffre y L. N a c h t M D
J o s e p h F. J a s p e r M D
N a v d e e p S . R ai M D
R o n a ld R . M o rris M D
C a rl W . W u lf e s tie g M D
—
B
PArpre
<on(>f r: ‘H cdica/ (9oc<e/if
~ —
U L L E T IN
October, 2004
P C M S M e m b e r s h i p B e n e f i t s , I n c ( IVIBI):
T i m S c h u b e r t M l ) , P r e s i d e n t ; D re w D c u ts c h
1VID, P a st P re s id e n t; J o e R e g im b a l M D .S e c re ta ry T rc a s u re r; K e ith D c m ir j ianJVID; S te v e D u n c a n M D; M a rk
G i I d e n h a r M D ; S te v e S e ttle M D ; J o e W e a rn M D
C ollege o f M edical E ducation (C .O .M .E.):
J o h n J i g a n t i M D , P re s i d e n t ; B a rb a ra F o x M D .
W illia m H o ld e n n a n M D . S te v e K o n ic e k M D , M a rjo rie
K r a b b e M D , W illia m L e e M D ,G r e g g O s te r g r e n D O , B rad
P a ttiso n M D ,C e c il S n o d g ra ss M D SV ir g m ia S k n v e llM D .
R ic h a rd W a ltm a n M D .T o d W u r s tM D ; H e rta M a le ik e .
G o o d S a m a rita n H o s p ita l; L isa W h ite , M u ltic a re H e a lth
S y s te m ; S is te r A n n M c N a m a r a , T re a s u re r. F ra n c isc a n
H e a lth S y s te m ; S u e A s h e r, S e c re ta ry
Table o f C ontents
3
P re sid e n t’s Page: “T h e T rue C a u se o fE s c a la tin g L ia b ility Premium
5
G M M U pdate: “ E le ctro n ics h ig h lig h te d a t S e p te m b e r m eeting”
P C M S F o u n d a t io n : L a w r e n c e A.
L a r s o n D O , P r e s i d e n t ; C h a rle s W e a th e rb y M D ,
M o n a B a g h d a d i,N ik k i C r o w le y ,T re a s u r e r; S u e A s h e r,
S e c re ta ry
6
A p p lica n ts for M e m b ersh ip
7
T P C H D : “B e A L ea d er”
VVSMA R e p r e s e n ta tiv e s :
T ru s te e s : L e o n a rd A le n ic k M D ; N ic h o la s R aj ae ic h M D ;
P a tric e S te v e n s o n M D
W A JV 1P A C 6th D istrict: D o n R u s s e ll D O
W A M P A C Q th D istrict: L eo n a rd A le n ic k M D
8
N e w re p o rt a “ p rim e r” on sh a p in g u p h e alth care
9
In M y O p in io n : “ N o S afe H a v e n "
11
In M y O pinion: "T an g led W ebs and T ru th "
14
S o lu tio n s fo r F a m ily C a reg iv ers, O ld e r A d u lts, a n d P erso n s
w ith D isabilities
17
C o lle g e o f M edical E d u catio n
19
C lassifie d A d v e rtisin g
St a f f : E x e c u tiv e D ir e c to r: S u e A s h e r
A d m in istra tiv e A ssistan ts: T a n y a M c C la in , C’risti P e te rso n
P la c e m e n t C o o rd in a to r: K e rri B a k e r
P la c e m e n t A s sista n t: M e lis s a K re g n e ss
C M E P ro g ra m A d m in istra to r: S c o tt P eterso n
B o o k k e e p e r: J u an ita H o fm e iste r
T h e Bul l et i n is p u b lish e d m o n th ly b y P C M S
M e m b e rs h ip B e n efits, Inc. D ead lin e I'o rs u b m iltin g a rlie le s
an d p la c in g a d v e rtis e m e n ts is the 15th o l'th e m onth
p reced in g p u b licatio n .
T h e Bu l l e t i n is d e d ic a te d to die a rt, sc ie n c e an d d e liv e ry
o f m e d ic in e an d the b e tte rm e n t o f the health an d m ed ical
w e lfa re o l'th e c o m m u n ity . T h e o p in io n s herein are th o se o f
th e in d iv id u a l c o n trib u to rs an d do not n e c e ssa rily re Heel the
o ffic ia l p o sitio n o f P C M S. A c c e p ta n c e o f a d v e r tis in g in no
w ay c o n s titu te s p ro fe ssio n a l a p p ro v a l o r e n d o rse m e n t o f
p r o d u c ts o r s e r v ic e s a d v e r tis e d . T h e B u lletin re se rv e s the
rig h tto re je c t an y a d v e rtisin g .
M a n a g in g Editor: Sue A sher
E d i t o r i a l C o m m i t t e e : M B I B o a rd o f D ir e c to r s
A d vertisin g Inform ation: 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; F A X : 2 5 3 -5 7 2 -2 4 7 0
E -m ail a d d re ss: p e m s w a ^ p e m s w a .o r g
H o m e P age: h ttp ://w w w .p c m sw a .o rg
2
PCMS BULLETIN
October, 2004
Correction:
(n last m onth s issue of the B u lle tin an e rro r o c c u rre d in Dr.
S tu tterh eim s a rticle “ Dr. H e k k in g .” T h e first se n te n c e o f the
fifth parag rap h sh o u ld h ave read “ ...o n ly 13 died o u t o f 190.”
PC M S ap o lo g iz es for this error.
?/n-nr tv u n /t/ C ((e d ia t/rfc n e /tf
President s Page
by Michael J. Kelly, MD
The True Cause of Escalating
Liability Premiums
M ichael.I. Kelly. MD
one because such alteratio n s in ph y si­
cian p ractices directly affect y o u r a c ­
cess and that o f y our fam ily to m edical
care.
M ost o f us have a love-hale rela­
tionship w ith insurance. We resent the
cost but recognize the responsibility lo
purchase coverage, fighting the p e rsis­
tent, uneasy feeling w e are bein g o v e r­
charged and underserved. A fter all,
these are big, unresponsive, pow erful
com panies. W'e all have little love or p a ­
tience with the insurance industry.
H ow ever, the p u b lic 's attiHide tow ard the insurance in­
__
ticing in Pierce County. A padustry is being m anipulated bytient, aware o f the crisis o f
special interests that have a
affordability o f m edical liability
“...th e p u b l ic 's a t titu d e to w a r d th e in s u r a n c e in ­
need to transfer this distrust to
insurance, recently asked me
d u s t r y is b e in g m a n i p u l a te d b y s p e c ia l in te r e s ts
why our prem ium s w ere so high
the com panies w ho insure p h y ­
th a t h a v e a n e e d to tr a n s fe r th is d is tr u s t to th e
and wanted to know w hat we
sicians for m edical m alpractice.
c o m p a n i e s w h o in s u r e p h y s i c i a n s f o r m e d ic a l
physicians were doing about it.
T hey w ant you to believe the
m a lp r a c tic e . T h e y w a n t y o u to b e lie v e th e w o rs t
w orst about these com panies
His comments reflected an un­
a b o u t th e s e c o m p a n ie s a n d d ir e c t y o u r a n g e r
derstanding that such sk y ro ck ­
and direct y our an g er and fru s­
a n d f r u s t r a t i o n to w a r d th e m . "
eting costs were leading to a
tration tow ard them . T his calwell-recognized crisis in access
culated obfuscation clouds the
to medical care. W hat is not
legitim ate u nderlying cause o f
well-recognized is the cause o f
escalating liability' insurance
264) and 39% o f Fam ily Physicians (150
our liability prem ium problem , the sub­
prem ium s - the cost o f insurance co m ­
out o f 386) have slopped delivering ba­
ject of my com m ents.
pany defense, settlem ent and ju ry
aw ards.
bies in W ashington Stale.
Such prem ium increases have af­
Drs. Pringle and Lenihan are rep­
fected m ost every physician in W ash­
T here are personal injury attorneys
resentative canaries in the m edical m ine
ington Stale, including Drs. R obert
w ho claim that “a ll” o f the non-partisan
shaft, tw o exam ples am ong hundreds o f
studies on this issue trace the rising
Pringle and John Lenihan. Both are
W ashington p hysicians from all spe­
well respected O bstetrician/G ynecolo­
prem ium s charged by m edical liability
cialties lhal are restricting, retiring or re­
gists. Dr. Pringle, M ount Vernon physi­
carriers lo th eir incom petent m an ag e­
locating Iheir practices as a direct result
cian, stopped d elivering babies this
m ent, careless slock m arket invest­
o f the extrem e cost o f m edical liability'
year because his liability insurance rose
m ents “com pounded by their g re ed .”
insurance. T his is a concern for ev ery ­
to S79,000, nearly tw ice w hat it w as tw o
President's N ote: The article
which follow s m ay be redundant fo r
those o f you who are a v id readers o f
the The N ews Tribune. It was su b m itte d
on September 20 a n d sh o u ld have al­
ready appeared on the edito ria l p ages
as an Op/Ed. / w o u ld hope so. H o w ­
ever. I f e a r n o t - w h ich is th e re a so n
we d e c id e d to p u b l is h it in o u r
B ulletin.
I would like to address the co n fu ­
sion surrounding m edical liability insur­
ance premium s. I am a board certified
Family Physician actively prac­
years ago. Dr. L enihan. Tacom a physi­
cian, also stopped delivering babies
last January as his insurance bill bal­
looned to $74,000. H e had w anted to
continue delivering babies for another
eight y'ears. His insurance prem ium
dropped to $28,000 as he lim ited his
practice to gynecology.
T h eir insurance w oes are now
m edical access problem s lor their p a ­
tients. T his is not, how ever, an isolated
situation. Since the year 2000. 14% o f
O b stetrician/G ynecologists (37 out o f
S ec “ L iah iiily " p age 4
October, 2004
Z
PCMS BULLETIN 3
from p age 3
T h is is a se rio u s c h a rg e w o rth fu rth er
m o st e x c lu siv e ly in flu e n c e d by b o n d
m en ts in su re rs c an p u rc h a s e a n d exten­
in v e s tig a tio n u tiliz in g “ n o n -p a rtisa n ”
s o u rc e s .
m a rk e t p e rfo rm a n ce , not sto c k m ark e t
siv e re q u ire m e n ts re g a rd in g public ac­
p e rfo rm a n c e . T h e p e rso n a l in ju ry a tto r­
co u n tab ility .
A stu d y p u b lis h e d b y A m e ric a n s
fo r In su ra n c e R efo rm . O c to b e r 2002,
se e m s to b a c k up the trial bar, stating.
n e y s, on the o th e r h and, w a n t y o u to
be lie v e that m ed ical liab ility co m p a n y
losses, such as P h y sic ia n s In su ra n ce ,
To m a in ta in so lv e n cy . P hysicians
In su ra n c e a n d s im ila r c o m p a n ie s m ust
set ra te s b a se d upon th e ir b e st clairvoy­
o c cu rre d in the sto c k m ark et, n o t the
c o u rtro o m . T h ey c o n siste n tly and
a n ce re g a rd in g fu tu re lia b ility costs dur­
th e y are se e k in g w a y s to m ak e up for
d e c lin in g in te re s t ra te s a n d m arket-
sh re w d ly m is re p re se n t th is su b tle, b u t
o f d e fe n se , s e ttle m e n t a n d ju r y verdicts.
b a se d in v e s tm e n t lo sse s.” T h e re p o rt
c o n te n d s th e m ed ic al lia b ility c o m p a ­
very im p o rtan t difference.
B B H c o n c lu d e d th at, “In v e stm e n ts
T h o se o f us w h o p a y m o n th ly insurance
p re m iu m s realize th e tru e cau se o f liabil­
n ie s su ffe red h u g e lo sses in th e stock
did not p re c ip ita te the c u rre n t (m edical
ity rate in c re a se s a n d c o n tin u e to sup­
m a rk e t fo llo w in g th e d o t-co m c rash a n d
lia b ility ) c risis.” In stead , th is crisis o f
the a ffo rd a b ility o f liability in su ra n ce is
po rt P h y s ic ia n s In su ra n ce , o u r company.
the d irec t re su lt o f the c o st o f in su ra n ce
fe ssio n a ls w ith a g la rin g c o n flic t o f inter­
c o m p a n y c la im s losses.
est in th e re alm o f m ed ic al m alpractice,
T h e trial bar fu rth e r claim “ b ig ” in­
su ra n c e c o m p a n ies are “ g re e d y ” p ro fi­
teers w h o se p u rp o se is to g o u g e u s u n ­
w a n ts to m ain tain th e p re se n t liability
"In s u ra n c e c o m p a n ie s ra ise rates w hen
p o s t 9 -1 1 , n o t lo sses d u e to liability
claim s.
H o w ev e r, o n the o th e r h and.
B ro w n B ro th ers H arrim an and C o m ­
pany, the o ld est a n d larg e st p riv ately
o w n e d b a n k in the U S, a w e ll-re sp e cte d
c o m p a n y sp e c ia liz in g in in su ra n ce a s ­
set m a n a g e m e n t, fin d s the A IR arg u ­
m en ts b o th “ .. .m isle a d in g and in a c c u ­
su sp e c tin g p h y sician s. T h is co n te n tio n
is lau g h in g ly in co rrect c o n sid erin g
W ashington d o c to rs ow n P hysicians
ing the u p c o m in g y ear, fa c to rin g in costs
T h e trial bar, a se le c t g ro u p o f pro­
sy stem th a t so ric h ly re w a rd s them . As
you h av e seen , h o w e v er, the m edical li­
a b ility c o m p a n ie s a re n o t th e bad guys,
a s th ese sp ecial in te re sts w a n t you to
believe.
R e c o g n iz in g th a t c la im severity and
rate. ” In Ja n u a ry 2 0 0 3 , B B H pub lish ed a
stu d y e n title d , "D id In v e stm e n ts A ffe ct
Insurance, w h ich w rites o nly o n e type
o f insurance, m edical liability. In fact,
M e d ica l M alp ractice P re m iu m s? ” w hich
o v e r 6 0% o f the m edical liability c o m p a ­
n ies in th e U .S. are d o c to r-o w n e d and
stick to a lim ited m enu o f in su ra n ce o p ­
pro b lem lea d s us to p o ten tial solutions.
tions.
To p lace P h y sic ian s In su ra n c e in
the sam e c ate g o ry o f o th e r “ b ig ” in su r­
an ce c o m p a n ies is q uite a stre tc h , but
o n c e again se rv es the p u rp o se o f the
trial b a r to h arn ess the latent h o stility
C o n g re ss, the G e n e ra l A c c o u n tin g Of­
fice. the C o n g re ssio n a l B u d g e t O ffice,
a n a ly z e d th e im p a c t o f in s u re rs ’ asset
a llo c a tio n a n d in v estm e n t in co m e on
the p re m iu m s th ey charge.
B B H sta te d th at th ere is no c o rre la ­
tio n b e tw e e n th e p re m iu m s ch arg ed by
the m ed ical liab ility in su ra n ce industry,
on th e o n e h a n d , and the in d u stry ’s in­
v e stm e n t y ield , the p e rfo rm a n ce o f the
U .S . eco n o m y , o r in te rest rates, on the
o th e r hand.
C o n tin u in g th is a sse rtio n , a cc o rd ­
ing to A M B e s t’s A g g re g a te s and A ver­
ag es, P ro p erty -C asu alty , 2002 edition,
th e in v estm e n t y ield s o f m edical m al­
p ra ctic e in su rers h a v e been stable and
p o sitiv e sin ce 1997 b e ca u se m ost o f
th e ir in v estm e n ts are not in the sto ck
m ark et. T h o se retu rn s h ave averaged
from 5 . 0 - 5 . 5 % , and include incom e
from in te rest, d iv id e n d s, and real estate
incom e.
P h y sic ia n s Insurance, a m edical li­
m an y o f us h av e to w ard th ese u n fe e l­
ing and d icta to rial m o n o lith s and d irec t
it tow ard the m edical m alp ractice c o m ­
panies. M oreover, as for th e alleged
g reed o f P h y sic ian s In su ra n ce - for us
d o c to r-o w n e rs to o v e rch a rg e o u r­
selv es, m akes no sen se a t all.
A n o th e r sa feg u a rd for m edical li­
a b ility co m p a n y in v estm en ts is o v e r­
sight. T h ere are sig n ific a n t c o n strain ts
on the in v estm e n t and b u sin e ss a c tiv i­
ties o f th ese liability c arriers, w hich p re ­
clude the type o f sto c k m arket in v est­
m en t, claim ed to have cau sed the cash
co sts o f d e fe n se and se ttle m e n t are the
M a n y e x p ert n o n -p a rtisa n g roups, such
as th e Jo in t E c o n o m ic C o m m issio n of
a n d the A g e n c y for H e a lth c a re Research
a n d Q uality , a g re e th a t m ea n in g fu l re­
form o f the p re se n t lia b ility system in­
c lu d in g a cap on n o n -e c o n o m ic damages
sta b ilize s the ra m p a n t rise in liability pre­
m iu m s lea d in g to im p ro v e d access to
m edical care. S uch re fo rm , strongly
b a ck e d by p h y sic ia n s o f all p o litical per­
su a sio n s, c rea te s no lim its, w hatsoever,
on re co v e ry o f e c o n o m ic dam ages. Doc­
to rs su p p o rt th is a p p ro a c h to reform be­
cause w e k n o w it w ill lead to the predict­
a b ility th a t the in su ra n c e in d u stry has
long sought.
M ean in g fu l liability re fo rm in
W ash in g to n S ta te w ill p re v e n t future
loss o f p h y sic ia n ta le n t the calib er o f
D rs. L en ih an a n d P rin g le, ju s t as it has in
67 % o f the d o c to rs in W ashington
flow p ro b lem s fo r the in su ran ce c o m p a ­
nies. T he O ffice o fln s u ra n c e C o m m is­
o th e r p ro g re ssiv e sta te s. A s k y our doc­
to r a b o u t this vital issu e. D isc u ss tort re­
S ta te , in v ests o v e r 85 % o f its asse ts in
fix ed -in co m e in stru m e n ts such as trea­
sio n e r o f W ashington strictly regulates
and m o nitors the so lv e n cy o f m edical li­
form w ith the leg isla tiv e can d id ate s from
sury, m u n ic ip a l, and co rp o ra te bon d s
ab ility c o m p a n ies such as P hysicians
O lym pia w ill d eterm in e w h eth er medical
a n d less th an 5% in the stock m arket.
T h e ir re tu rn on in v este d assets is al­
Insurance. In a d d itio n , there are strict
c are in W ash in g to n S ta te im proves or
d e clin es. ■
a b ility c o m p a n y th a t c o v ers m o re than
4
PCMS BULLETIN
October, 2004
lim its on the type and risk o f in v est­
y o u r d istric t. T h e ir fu tu re d ecisio n s in
September General Membership Meeting Recap
Electronics highlighted at September Meeting
The Septem ber M em bership M eeting focused on electro n ic s -fo r m edical records in the p h y sic ia n ’s office as well
as connectivity for all p roviders in our h ealth care com m unity.
Over 100 people attended to hear Dr. M atthew W h ite give
an update on the PCM S C onnec­
tivity C om m ittee that has w orked
on this issue for the past tw o
years. T he com m ittee recently rec­
om m ended to the B oard o f T ru st­
ees that they support the N PN
collaboration w ith Siem ens/R each
M y D octor C om m unity H ealthcare
N etw ork product. Siem ens pro­
vided a review o f how the project
can w ork in a com m unity that has
Man While. MD
m yriad E M R system s in place
w ithout causing interruption. The
project is now under developm ent and w ill be revealed in a
later issue o f the B ulletin.
Dr. W hite gave a presentation on the h o w ’s and w h y ’s o f
electronic m edical records and w as supported by colleagues
Drs. Steve Egge o f Sum m it View' C linic/Puyallup and Joe
R egim b al o f Internal M edicine N orthw est/T acom a g iv in g their
personal testim onials. T hey concurred that o perating effi­
ciently. decreasing expenses, im proving access to inform ation
and en hancing reg u lato ry and liability concerns w ere all ben­
efits o f an electronic system .
Vendor sponsors for the e vening included A4 H ealth S ys­
tem s. C hart L ogic. Physician M ircro System and S iem ens
M edical Solutions. W hile Siem ens is not a p ro v id er o f elec­
tronic m edical records, they p articipated as a ven d o r because
o f their collaboration on the com m unity netw ork association
with NPN.
O ther agenda item s included three m em bers being no m i­
nated to the N om inating C om m ittee. T hey w ere Drs. G ary
Tart. David Law and N ick Rajacich. N ew m em ber Dr. Keith
D ah lh au ser w'as introduced.
Dr. M ike K elly also reported on the W SM A Initiative 330
for m edical liability reform encouraging everyone to take p e ti­
tions, posters and patient handouts for their offices. O v e r
200.000 signatures m ust be secured to present to the legisla­
ture by the end o f this year. ■
Drs. Joe R egim bal (left) a n d S teve E gge re p o rte d p e rso n a l
experiences with the use o fE M R s
Drs. N ick R ajacich (left) a n d A n d y L o o m is visit a fte r the
m eetin g
Family practitioners H a v en S ilv e r (left) a n d B ill R oes
compare notes after the m eetin g
P uyallup p h y sicia n s Dr. K en F eucht (left) a n d R o b ert M arsh
chat during the so c ia l hour
October. 2004
PCMS BULI FTiN F,
Applicants for Membership <
Seattle-to-Portland Update
J o y c e S. A h n -R h ee , M D
In th e S e p te m b e r 2 0 0 4 issue o f the B u lle tin , the M edical S o c iety c o n g ra tu la te d
m e m b e rs w h o c o m p le te d the 2 5th A n n u al S e a ttle-to -P o rtla n d (S T P ) B icy cle C lassic
^
R id e, w hich to o k p lace Ju ly 1 7-18 a n d took rid ers from
jJ C o j
In tern a l M e d ic in e
S o u n d F a m ily M e d ic in e
3908 10th S t SE , P u y allu p
S n o q u a lm ie to S k y k o m ish . We in a d v e rte n tly failed to include
253-848-5951
M aureen M ooney, MD.
O u r a p o lo g ie s to Dr. M o o n e y and c o n g ratu la tio n s! ■
M e d S c h o o l: U n iv e rsity o f V erm ont
In tern sh ip : U n iv e rsity o f Illin o is
R e sid en c y : U n iv e rsity o f Illinois
PCMS Has New Email Address
S p en cer A . C oray, M D
O rth o p e d ic s/S p o rts M e d icin e
L ak e w o o d O rth o p e d ic S u rg e o n s
PC M S has ch an g ed th e ir em ail ad d ress to p c m s (a p c in s \v a .<>r g ,
P le ase m ak e a n o te in y o u r d irectory. ■
7308 B rid g ep o rt W ay W # 2 0 1 , Lakewood
253-582-7257
M ed S c h o o l:C re ig h to n U niversity
Internship: U n iv e rsity o f O klahom a
R esidency: U n iv e rsity o f O klahom a
F e llo w sh ip : A s p e n S p o rts M edicine
1330 Petitions Available
'\r»,
P C M S has a m p le su p p lies o f petitio n s, posters, p a tie n t h an d o u ts
and o th er 1330 cam paign m aterials. Please call the PC M S o ffice, 572366 7 , i f y o u n e ed aadditio
d d itio n al m ate ria ls o r if you h ave co m p le te d p e titio n s to p ick up. We deliver!
W aldo A. D agan, M D
Internal M e d icin e
G o o d S a m aritan F a m ily M ed at Sumner
1518 M ain S treet, S u m n e r
253-697-7400
M ed S chool: F ar E astern U niversity
Mark Your Calendar for Annual Meeting
Intern sh ip : U n iv e rsity o f Illinois
R esidency: U n iv e rsity o f Illinois
P lease sa v e the date o f T uesday, D e ce m b er 14 for the PC M S
A nnual M e e tin g . T h e sp e a k e r this y e a r w ill be D avid T h o m a s w ho
w ill p re sen t his e n te rta in in g and e n lig h te n in g p re sen ta tio n about
“ L iv in g R ight Side U p in an U p sid e D o w n W orld." T h is talk a bout
" in le a ritv ” is one y o u w o n ’t w a n t to m is s .a
John IS. D aniel, M D
Fam ily Practice
102B 2 3rd Ave SE, P u y allu p
253-8454934
M ed S chool: Sri R am a C h a n d ra M ed College
In tern sh ip : In H is Im age R esidency
R e sid en c y : In H is Im a g e R esidency
J en n iferT . K n ow les, M D
Fam ily M edicine
r
a
v
e
H ea lth
l Le
r
S o u n d F a m ily M ed icin e
d
S erv ice
A s e r v ic e o f
N o r t h w e s t M e d i c a l S p e c ia ltie s , PLLC.
I N T E R N A T I O N A L
H A Z A R D O U S
T O
T R A V E L
Y O U R
C A N
H E A L T H
or 253-627-41 23
6 PCMS BULLETIN
October, 2004
M ed S ch o o l: U niversity' o f W ashington
Internship: V alley M edical C en ter
R esidency: V alley M edical C en ter
BE
• PRE-TRAVEL CARE ♦ POST-TRAVEL CARE
HOURS
C A L L E A R L Y WHEN PLANNING
MON-FRI 9 - 5
g fl
2 5 3 -4 2 8 -8 7 5 4
A S E R V IC E OF
IN FE C TIO N S LIM ITE D PS
3908 10th St SE , P uyallup
253-848-5951
P aul W. S ch m id t, DO
Fam ily M edicine
K ey M edical C e n te r
15610 89th St C t K P N , L ak eb ay
253-884-9221
M ed S chool: U o f H ealth S c ien c es, ICC
Internship: T aco m a F am ily M edicine
R esidency: T aco m a F a m ily M edicine
220 - 15"1Ave SE #B, Puyallup W A 98372
ffierrr t(vun.hj Qd’ln lca l rfnot/tf
The Health Status o f Pierce County
This is a com plex tim e For the m edi­
cal profession. O ur w orkloads are stag­
gering. The satisfaction o f p racticing
good m edicine faces intrusions on all
sides. The altered p atient-physician re­
lationship, the litigious nature o f m od­
em society and the fiscal pressures o f
“managed care” all m ake for a shaky
and often unpleasant mix.
All o f this m eans m ore and m ore
pressure is placed on the p h y sic ia n s'
shoulders: To be caring, to be efficient,
to be precise, to be know ledgeable, to
be technically expert, to be c om m unica­
tive. The list is actually longer and
an impossible one to m eet. I have
bad news for you. T here is another
addition to the list that w e cannot
ignore, but one that if we m aster it
can take o ff m uch o f the pressure
from the other expectations. It is a
straightforward one and a difficult
one: To be leaders!
M any issues face our com m unities
that need physician involvem ent. U n­
Federico Cruz-Uribe, MD
Director of Health
spring up in any com m unity. A nd, the
physician w as looked to in her/his role
as the k eeper o f the health agenda. C re ­
ating a m ore healthy com m unity was
seen as the p h y sic ia n ’s purview , and
people w ere both com fortable with that
perspective and also actually expected
it.
I am saddened by w hat has been
lost. P hysicians are no longer engaged
the sam e way. A nd it's not ju st that a
truly im portant perspective is not being
heard but that w e are set up for failure
by people w ho think w e can solve com ­
g laring truth is that clinical interactions
in p h y sic ia n s' offices w ill not resolve
the obesity crisis. Too m any obesity
foundations lie w ithin society at large
and therefore need c o m m unity-based
strategies to m ake any change. B ut the
e xpectations are still there for p h y si­
cians to be involved. T he easy re­
sponse for this public expectation is to
continue to talk to our patients about
obesity and engage them clinically as
w e treat the sym ptom s - one person at a
tim e. T hat is one approach, but one that
squanders a huge opportunity to ce ­
m ent the im portant role physicians
play in the health o f their c o m m u ­
nities.
“This is an open window for docs to
Let m e be blunt: We have to
show their knowledge, their commitment,
step out o f the box, aw ay from the
their compassion and selflessness. "
securities o f our practices. W e'v e
got to engage w ith co m m unity e f­
forts, using our p ersonal tim e in
churches and school system s,
m unity-level issues one-by-one in our
school boards and U nited Way cam ­
offices. M any o f the health problem s
paigns, w ellness program s in private
that patients bring into our offices find
and public agencies and so forth.
fortunately as our p ractices get m ore
th eir roots in culture-based behaviors
and more dem anding, o u r actual en­
T he physician brings w onderful
that require new social norm s. A physi­
skills to these p rocesses and ones that
gagement with com m unity-level activi­
cian c a n ’t realistically expect lo change
ties gets m ore and m ore tenuous. T his
are desperately needed. T his is an open
m uch in those behaviors, yet the pa­
has happened gradually over m any
w indow for d ocs to show their k n o w l­
tient still brings those problem s to us.
years. Previously, any renew al effort,
edge, their com m itm ent, their com pas­
W here do w e go with this? W hat is
community developm ent cam paign, any
sion and selflessness. T hese are very
to be done?
school board or school policy effort al­
public processes. You w ill be seen for
L e t’s look at a specific situation as
ways had prom inent physician e n g ag e ­
w hat you pul in on the table. If it is e n ­
an exam ple needing a solution. In a pre­
ment. The public expected it. P hysi­
ergy and enthusiasm , i f it is ju st hard
vious article for the PC M S B u lletin I
cians, held in high esteem , often acted
w ork and the ability to m erge different
talked about the obesity epidem ic that
as brokers betw een the differen t fac­
ideas together, you will be am azed at
our c om m unity struggles w ith. The
tions or special interest groups that
See ‘‘Leader” page 12
October. 2004
PCMS BULLETIN 7
New report a “primer” on shaping up health care
T h e W ash in g to n A llia n c e for a C o m p e titiv e E co n o m y re ­
c e n tly re le a s e d a h e a lth care re p o rt on sh a p in g up h e a lth care
in o u r sta te a n d the n a tio n .
T h e e le v e n p a g e re p o rt p iec es to g e th e r the v a rio u s data
W ash in g to n S ta te ’s m a n d a te s d riv e u p o u r c o sts signifi­
cantly. W ash in g to n is th e o n ly sta te in th e country' th a t requires
c o v era g e o f n e u rd e v e lo p m e n t th e ra p y a n d o n e o f o n ly two
states re q u irin g p o rt-w in e sta in e lim in a tio n a n d c o v era g e o f
a n d p e rs p e c tiv e s on h e alth care c o sts a n d c o n d itio n s in o rd e r
d e n tu rists. C o v e rag e fo r p re sc rip tio n d ru g s a n d c hiropodists are
to u n d e rsta n d th e ir e ffe c ts on e m p lo y e rs and on the b u sin ess
co v ere d by o n ly th ree sta te s, W ash in g to n b e in g one, and cover­
c lim a te in w h ic h th e y m u st co m p e te. T h e y did fin d c h a n g in g
age fo r m assa g e th e ra p is ts a n d n a tu ro p a th s a re p ro v id ed by
n a tio n a l p o lic ie s a n d tren d s in health care that p ro v id e som e
four states, o n e b e in g W ash in g to n . T h ese m a n d a te s drive up
co sts o f h ealth care in su ra n c e by as m u ch as 4 5 % in som e mar­
o p tim ism fo r th e fu tu re. B ut, th e y note th at W ashington State
has sig n ific a n t w o rk to do i f it h opes to b e n efit from the n a ­
tio n a l tre n d s a n d re fo rm s a n d to be c o m p e titiv e ly p o sitio n e d
k ets and in crease th e p e rc e n ta g e o f p e o p le w h o g o w ithout in­
su ra n ce c o v e ra g e d u e to c o st, th e re p o rt c laim s.
T h e re p o rt g iv es the fo llo w in g c o n c lu sio n s a n d recom m en­
for c o n tin u e d e co n o m ic recovery.
T h e th ird -p a rty p a y er sy stem , co u p le d w ith the c o m p lic a ­
tio n s o f su b sid ie s on w hich th e sy stem d e p en d s, c au ses m u ch
o f the c o n fu sio n in p a y in g fo r health care. W hile p riv ate se c to r
tren d s d e p ic t a p ro b lem , the p u b lic se c to r is a sy stem o u t o f
c o n tro l, th e y rep o rt.
d a tio n s:
A sk e d i f th ere is a p a rtic u la r v illain re sp o n sib le for the cur­
rent state o f h ealth c are, e c o n o m ist M ic h a e l E. P o rte r says no
o n e “ e n tity has m ad e the fatal d e c isio n s th a t h av e caused the
sy ste m to b e th e w ay it is. Indeed, th e re w a s a set o f incentives
c rea te d p artly by g o v e rn m e n t re g u la tio n a n d p a rtly by history.
• 71 % o f W a sh in g to n 's m a jo r e m p lo y e rs req u ire w o rk e rs to
T h ey h ave led eac h a c to r in the sy ste m to b e h av e in w ays that
c o n trib u te to th e ir health in su ran ce p re m iu m s c o m p a re d to 88%
w e re rational fo r th em but w ere n o t a lig n e d w ith im proving
in the W est and 83% n a tio n a lly
health care v a lu e ...T h e sy stem is not d e sig n e d to rew ard to most
• E m p lo y e rs w h o re q u ire an e m p lo y e e c o n trib u tio n average
S40 m o n th ly c o m p a re d to S73 in the W est and $78 n a tio n a lly
• 64% o f W ash in g to n 's large e m p lo y e rs o f f e r '‘alte rn a tiv e
m e d ic in e c o v e ra g e " c o m p a red w ith 5 0% in the W est and only
2 7 % n a tio n a lly
e ffic ie n t p ro v id e rs...p e o p le h ave trie d all th e sim p le things, and
th ey h a v e n ’t w o rk ed . I th in k m o st p e o p le are n o w step p in g back
and sa y in g , “ ...w e 'v e got to re th in k th is w h o le sy s te m .” (Hol­
stein 2004)
In a new book on health care, fo rm er C o lo ra d o governor Ri­
chard L am m strikes a m ore a la rm in g n ote. “A m e ric an expecta­
tio n s for health c are o v e r th e la st thirty' y e a rs h ave been devel­
oped d u rin g the m ost m assiv e tra n s fe r o f w e a lth into one sector
M a n y a n a ly sts b e lie v e th at the m o st im p o rtan t facto rs
(health care) th a t histo ry has n e v e r seen. H e alth care is a fiscal
d riv in g h e alth c are co sts a re g o v e rn m e n t health in su ra n ce m an ­
b lack hole into w hich w e can p o u r all o f o u r c h ild re n 's future.”
(Lamm 2004)
d a te s, litig atio n c o sts, h o sp ital costs and p re scrip tio n drugs
and d ru g im p o rta tio n - all fa cto rs in w hich state p u b lic p o licy
has a ro le to play.
H ealth care refo rm is n ecessary. T h ere are b a sic a lly two di­
rectio n s to go from o u r cu rre n t situ atio n : U n iv e rsa l care or con­
su m e r-d riv e n care. The e v id e n ce is c o m p e llin g th a t consum erd riven care ho ld s th e m ost p ro m ise for su c c ess. In fo rm ed pa­
tients, in c o n su lta tio n w ith th e ir d o c to rs, have the b e st potential
lor d e cid in g how b e st to sp e n d th e ir h e alth c are d o llars, sorting
th ro u g h the o p tio n s av ailab le and se le c tin g th o se m o st effective
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8
PCMS BULLETIN
October, 2004
D o you have patients w ith difficult emotional
and stress-related problems? Psychiatric and
psychological consultations are available.
VS
C.
...a m u lt i­
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b e h a v io r a l
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^Pierce C oitnhj o H edica/rjocte / ;/
In My Opinion....
The Invisible Hand
b y A n d r e w s t a ts o n . M D
The o p in io n s e x p r e s s e d in (h is w r itin g a r e s o le ly th o s e o f th e a u th o r . P C M S in vites m e m b ers (<> ex p ress th e ir r/p in io n in s ig h ts a b o u t su b je c ts
relevant to th e m e d ic a l co m m u n ity , o r s h a r e th e ir generis! in te r e s t s to r ie s S u b m is s io n s a r e su b je c t to E d ito r ia l C o m m itte e review .
No Safe Haven
"A n d J have a sk e d to he
W here no storm s come.
W here the g re e n sw e ll is in the heavens dumb.
A n d out o f the sw in g o f the sea. "
G erald H opkins
W hile the m alpractice w hirlw ind
sweeps m ost o f the country, a few
states enjoy a relative calm . R elative is
the key word.
Indiana was the first state to enact
a medical tort law in 1975. It established
a patient com pensation fund. All p h y si­
cians pay to the fund w ith a surcharge
on their liability prem ium s. I think that
the amount o f the surcharge varies ac­
cording to specialty'.
The com pensation for pain and
suffering is lim ited to $250,000 and the
total recovery in m edical cases was
$750,000 for acts that o ccurred prior to
7-1-99, raised to S I,250,000 thereafter.
Any amount aw arded in excess o f these
limits is paid from the patient fund.
Contingency fees for the am ount paid
by the patient fund are lim ited to 15%.
The patient fund m ust have al­
ready been in trouble w hen the leg isla­
ture passed that increase. Perhaps that
was the reason for the change. T he re­
serves o fth e fund w ere 118 m illion dol­
lars in 1999. T hey dropped to 4.3 m illion
in 2003.
C olorado lim its the total aw ard for
dam ages in m edical cases to one m il­
lion, o f which 5 250,000 ( increased to
$300,000 in 2003) can be for noneco­
nom ic dam ages. I am not clear w hether
the one m illion lim itation also applies
to future costs o f m edical care. C olo­
rado, like Cali fornia, allow s binding ar­
bitration contracts.
T he C alifornia law is well known.
It has a cap o f $250,000 for non eco ­
nom ic dam ages. T he trial law yers have
repeatedly attacked the cap, hoping to
raise it, but so far they have not been
successful. C ontingency fees are lim ­
ited to 15% on any am ount above
5600,000. Thus an aw ard o f one m illion
allow s a S222.000 fee. T hat in itself
m ay be a dam per on the num ber o f
suits. T he Texas experience a fter e n ­
acting the cap seem s to confirm that.
N ew M exico lim its total dam ages
in m edical liability cases to S600.000,
except for the costs o f future m edical
care and related expenses. Louisiana
does the sam e, but has a $500,000
The average prem ium s increased
72.6% in 2004. N eurosurgeons and ob­
stetricians saw the biggest rises. T he
premiums for obstetricians w ent from
$26,000 in 2003 to $49,000 in 2004, an
89% increase. O ther practice costs also
rose, but reim bursem ents did not keep
up and the physicians are feeling the
squeeze.
W isconsin, like Indiana, has a p a ­
tient com pensation fund. It covers
dam ages above the basic coverage o f
one m illion dollars. P hysicians pay
into the fund. T he rates v a n ' acco rd ­
ing to specialty. T he cap on noneco­
nom ic dam ages w as set at S350.000, in­
dexed for inflation. It was $422,632 in
2003. C ontingency fees on the am ount
limit.
A ihlrew Staison. MD
paid by the fund are lim ited to 20% .
Last y ear the patient fund had
$600,000,000 in assets. In June o f 2003,
the legislature attem pted to tap the fund
for $200,000,000 to help balance the state
budget. Fortunately that m ove w as d e ­
feated. The fund in fact had an actuarial
deficit o f $200,000,000, because it had to
allocate 5800,000.000 for future claim
paym ents. Som e recent aw ards have e x ­
ceeded several m illion dollars.
W hy are these states less affected
by the liability crisis? C aps seem lo help,
but they are not enough. N evada en ­
acted a $350,000 cap on 10-1 -02, but that
did not w ork. Insurance p rem ium s c o n ­
tinued to rise. M ore insurance co m p a­
nies dropped their m edical liability line.
The num ber o f new physicians is not
grow ing as it did in the 1990's.
Since the law becam e effective in
N evada, m ore physicians have been
nam ed in suits than previously. T he cap
created a perverse incentive to sue, be­
cause the lim it is per p la in tiff and per de­
fendant. T he m ore plaintiffs join the suit
and the m ore defendants are nam ed, the
higher the aw ard can be.
T he lim it on the c ontingency fees is
probably m ore effective. A ttorneys tend
to avoid handling claim s unless they can
hope to get m ore than w hat trying a case
w ould cost them . T hat cost now runs at
5300,000-500,000 or more. A prelim inary
report from Texas confirm ed the im presS ec “ H av en " p ag e HI
October, 2004
PCMS BULLETIN 9
Bui
LET IN
Haven
from page 10
sio n th a t the n u m b e r o f p o te n tia l low
retu rn c ases h a s d e cre a se d . L aw y ers
h av e re fu s e d to h a n d le c ases w h e re the
o n ly c la im fo r d a m a g e co u ld b e pain
a n d su ffe rin g .
E ven th o u g h th e a b o v e states are
b e tte r o f f th an the rest o f th e co u n try ,
the e ffe c t o f th e ir lia b ility law s is
ste a d ily e ro d in g . In a n o th e r five years
th ey m a y w e ll be w h ere w e are now.
T h e av erag e m alp rac tic e p re m iu m s re­
m ain ed re la tiv e ly ste ad y th ro u g h m ost
o f th e 19 9 0 ’s, b u t b e tw ee n 2 0 0 0 and
2002 th ey in cre ased by clo se to 4 0 % in
sta te s w ith o u t cap s a n d 50% in states
w ith caps.
A s long as p a y m e n ts fo r m ed ical
se rv ic e s re m a in fro ze n , th e sq u e e ze on
E R ^ S E
TH AT TA TTO O
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
T o d a y ’s n e w e s t A le x a n d rite laser,
w ill re m o ve y o u r ta tto o
w ith m inim al d is c o m fo rt &
le ss than 1 % ris k o f s c a rrin g .
p h y sic ia n in co m e s w ill co n tin u e. I am
afra id th e so lu tio n can o nly be a c o m ­
p le te ly d iffe re n t ap p ro ac h to p h y sic ia n
p a y m e n ts a n d a c o m p le te ly d iffere n t
sy ste m for p a tie n t c o m p e n sa tio n in
( '.(ill H/duy for more intonixiriou
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10 PCMS BULLETIN
October, 2004
V
Jfye-jfce ^t[:o n n ttj O f(e<hc<t/(tfoae/'if
In My Opinion
by David Aoyama, M D
The opinion s e x p r e s s e d in th is w r itin g o r e s o le ly th o s e o f th e iiiillior. P C M S b ir ila t m e m b e r s In e.\pres,i th e ir o p in io n /in s ig h ts a b o u t s u b je c ts
relevant to the m ciiico! c o tiin w n ify, 01 s h o v e th e ir g e n c v a l in terest slo v it w . Siihnii.ssii.ms avt? sith/ci 7 tn Iiilih w inl C o n m iiltc c review .
Tangled Webs and Truth
D avid A oyam a. M D, Internal
Medicine. Seattle, was in su re d w ith
Physicians Insurance d u rin g the
course o f the law suit d e sc rib ed below.
He wrote the fo llo w in g a rticle to ex ­
plain his experience, educate his col­
leagues, a n d com ply w ith a court m a n ­
reim bursem ent and rising overhead is
leading to ev er-increasing w orkloads.
T his all m ay be true, but our real A chil­
les heel is liability insurance. W ithout li­
ability insurance, w e are out o f busi­
ness.
I continued to page through the
chart, but I c o u ld n ’t focus on its c o n ­
tents. Fear rose as 1 cam e to the “o b v i­
ous" conclusion that a m alpractice a c ­
tion w ould m ost certainly lead to the
cancellation o f m y liability insurance.
A fter all, w e all know physicians with
spotless m alpractice histories w ho were
victim s o f nonrenew al based solely on
th eir specialty. I w ould lose my practice.
S eventy-hour w eeks for 20 years, all for
nothing. Flow w ould I support my fam ­
ily? T he feeling w as intense and o ver­
w helm ing. It quickly m ushroom ed out
o f control. I decided to m ake the chart
bulletproof.
A dishonest act, in m any w ays, is
like sliding dow n a steep ice field w ith­
out an ice axe. It starts w ith a sm all slip.
First, you m ake additions to the chart.
A fter all, you are sim ply docum enting
w hat really happened. You begin slid ­
ing dow n that icy slope. You w ithhold
your dirty little secret from y our ow n a t­
torney. Faster and faster. You lie at the
deposition about the additions to the
record. You are now careening uncon­
trollably dow n that slope. M ore quickly
than you can im agine, you reach a
point w here the only thing that will
stop you is a large crevice or a huge
rock. And it w ill. And it will have co n se­
qu e n ce s.
You will lose an otherw ise defen­
sible case. The case will be referred to
the N ational Practitioner Data Bank.
You will be reported to the W ashington
State M edical Q uality A ssurance C om ­
m ission. You will have to explain your
actions to the credentialing com m ittees
o f the hospitals at w hich you practice
date.
It had been a day not unlike any
other workday. It w as 6:30 p.m . and I
was attacking the ever-grow ing pile o f
mail on my desk - the usual am algam ­
ation ofjo u m als, verbal orders, DM E
orders, VN S certifications and co rre­
spondence from consultants. W orking
through the pile at a steady pace, 1
thought that there w as a glim m er o f
hope that I could be hom e by 7:30 p.m.
Suddenly, dealing w ith the m ail
stopped, tim e stopped, m y w orld
stopped. There, buried in the stack o f
mail was my landm ine for the day - a re­
quest for a patien t’s m edical record by a
malpractice plain tiff attorney.
1 recalled the case. 1 had repeatedly
advised the patient to have an endo­
scopic evaluation lor an iron-deficiency
anemia. A fter she had left m y practice,
one o f her friends had told m e th at her
new physician had discovered colon
cancer. She had had curative surgery,
but had been left w ith a colostom y. A t
that time, 1 rem em ber w ondering how
her new physician had convinced her
to have the endoscopy w hen I had
been so unsuccessful. A s I review ed
the chart, I found a copy o f m y letter o f
referral to the g astroenterologist but,
incredibly, there w as not a single nota­
tion in the chart d ocum enting the refer­
ral or my repeated instructions to see
the gastroenterologist. T he gnaw ing
sensation in the pit o f m y stom ach grew
as my panic escalated.
I am a solo practitioner. A lot has
been written about solo p ra c titio n e rs’
being a dying breed because declining
and to the insurance p lan s w ith w hich
you participate. You w ill be hum iliated
and suffer the loss o f y our integrity' and
credibility before y our co lleagues, p a ­
tients. friends, neighbors and family.
Oh, yes. Your m alpractice insur­
ance will not be renew ed. The
nonrenew al letter will m ention concerns
over alternations o f the records as a
reason. You m ay be able to get co v er­
age through surplus liability carriers.
M ultiply y our current prem ium by three.
You m ay also be subject to a sanctions
hearing to establish y our p unishm ent
for m aking additions to the records and
then lying about it. T his hearing is
separate from the m alpractice action.
Your m alpractice carrier is un d er no o b ­
ligation to pay for y o u r defense at this
hearing. I w as lucky. My c arrier paid for
m y defense. A ny m onetary sanction
com es out o f y our pocket. I am ap p ly ­
ing for a loan.
A sanctions hearing is the m odernday equivalent o f a public flogging. Ex­
pect television and n ew sp ap er c o v er­
age o f the event. I look the w itness
stand and endured a w ell-deserved
public hum iliation. It seem ed to last for
an eternity. D uring the hearing, one o f
the p la in tiff’s attorneys quoted Sir
W alter Scott: “Oh w hat a tangled w eb
we w eave. W hen first w e practice to d e ­
ceive."
At the end o f the hearing the ju d g e
delivered a m uch d eserved, scath in g re­
buke ol m y conduct, lie next im posed
m onetary and nonm onetary sanctions,
including w ritin g this article to help
educate physicians about the perils o f
m y behavior. It w as the w orst day o f m y
life. It was a pain fu l, em barrassing, and
hum iliating experience, but I had su r­
vived the ordeal, or so I thought.
A lte r the h earing I w ent to w ork.
A s 1 w aded through the self-p ro p aaatS cc '"T an g led '' p ag e 18
October, 2004
X
PCMS BULLETIN
11
Bu LLHTiN
Leader
UNION AVENUE PHARMACY
from p age 7
h o w re sp o n siv e y o u r c o m m u n ity w ill
be.
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L et m e tell y o u a se c re t. I sta rte d
Vaginal Suppositories
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Urethral Inserts
Sublingual Troche
this a rtic le ta lk in g a b o u t lea d ersh ip .
T h a t's w h a t y o u w ill be d isp la y in g
w h en y o u step up to the p late w ith
th ese c o m m u n ity e ffo rts. S im p le and
o ld -fa s h io n e d le a d e rsh ip . W h e n the
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to u g h issu e s are b e in g fa ce d , w hen
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MEDICAL LICENSURE ISSUES
and so c io -e c o n o m ic lin es, th ere is
w h ere w e sh o u ld fin d o u rse lv es, p u sh ­
ing, u rg in g , d e sig n in g , a n d b u ild in g
w a y s to im p ro v e th e h e a lth o f o u r c o m ­
m unities.
1 h o p e th at as w e m o v e forw ard
w ith o u r p re v e n tio n c am p a ig n s to c o n ­
front o b e sity here in P ie rce C ounty, you
w ill sta n d sh o u ld e r to sh o u ld e r w ith m e
M r. R o c k w e ll is a v a ila b le lo re p re se n t p h y sic ia n s a n d o th e r h e a lth care
p ro v id e rs w ith issu es o f c o n c e rn b e fo re the S ta te M e d ic a l Q u a lity A ssurance
C o m m iss io n . M r. R o c k w e ll, a p p o in te d b y G o v e rn o r B o o th G a rd n e r, serv ed lor
8 y e a rs as the P u b lic B oard M e m b e r o f the M e d ica l D is c ip lin a ry B o a rd from
19 8 5 - 19 93. S in c e [hen. M r. R o c k w e ll has su c c e ss fu lly r e p re s e n te d o v e r 60
p h y sic ia n s on c h a rg e s b e fo re the M Q A C . M r. R o c k w e ll's fe e s a re com petitive
and the su b je c t o f a c o n fid e n tia l a tto rn e y -c lie n t re p re s e n ta tio n a g ree m e n t.
Gregory G. Rockwell
Attorney at Law & A rbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
a n d o th e r “ le a d e rs.” T h ere is no b e tte r
p lace for y o u to be to sh o w that p a rt o f
b e in g h e alers for y o u r p a tie n ts also
m eans h e alin g y o u r c o m m u n itie s. ■
(425)453-4398 • F A X (425) 453-1534
email: [email protected] • website: www.gregrockweIllaw.coni
subspecialists
( s u b 's p e ’sh'a-P'sts) n.pl.
1: t e a m o f 31 b o a r d c e rtifie d p h y s ic ia n s w ith
e x p e rtis e in a re a s o f r a d io lo g y s u c h as
m u s c u lo s k e le ta l, n e u ro ra d io lo g y ,
m a m m o g r a p h y a n d w o m e n ’s h e a lth , p e d ia tric s ,
i n te rv e n tio n a l ra d io lo g y a n d n u c le a r m e d ic in e
2 : d e d ic a te d in d iv id u a ls w o rk in g as a te a m to
/
p r o v id e e x c e lle n c e to p a tie n ts a n d p h y sic ia n s; see
TRA M
e d ic a l
I m a g in g
C lin ic lo c a tio n s in:
G ig H a rb o r ® L a k e w o o d • Tacom a
T R A R a d io lo g is ts also serve:
M ary B rid g e C h ild re n 's H o sp ita l
St. Francis H o sp ita l
St. Jo se p h M e d ica l C e n te r
Tacom a G e n e ra l H o sp ita l
12 P C M S BULLETIN
October, 2004
For s c h e d u l i n g c a ll 2 5 3 - 7 6 1 - 4 2 0 0
TRA 1
M edical
Imaging
EXCELLENCE • PERSON TO PERSON
P rim e r
fro m p a g e 8
their personal circumstances. Health care markets will respond, in turn, by offering
more of what patients discern to have value and less of what they perceive to he unnec­
essary.
The m ain q u e s tio n r e m a in in g is w h a t s p e c ific p o lic ie s w ill a c h ie v e th is o u tc o m e .
for
Personal Problems o f
Physicians Committee
E nactm ent o f fe d e ra l le g is la tio n a llo w in g h e a lth sav in g s a c c o u n ts h a s ta k e n us a lo n g
way in se ttin g th e sta g e fo r a n a p p r o p ria te c o n s u m e r-d riv e n re s p o n s e .
And m a rk e ts
have alread y b e g u n to a n tic ip a te an d r e s p o n d to th e n e e d fo r b e tte r c o n s u m e r in fo rm a ­
tion system s.
The following recommendations address several important health care reforms that
remain for state legislative action:
1. In order to encourage the full range of physicians and health practitioners and to
discourage unnecessary' price spikes for pharmaceuticals:
• Adopt caps on non-economic damages.
• Eliminate or restrict joint and several liability.
• Establish a fair statute of limitations on liability.
2. In order to enhance access to fullest range of personal health insurance products:
■Eliminate state mandates requiring insurers to cover various health providers.
services, and patient populations.
• If full elimination of mandates is not feasible, allow insurance companies to
offer a more affordable plan for smaller employers.
3. Encourage development of HSA options within insurer portfolios. Include these
options in plans offered by government employers and programs.
4 . Review existing hospital rate setting, payment, and regulatory systems, in light of
new and changing competitive environment that includes opportunities for cash-paying
patients and boutique hospitals.
M edical problem s, drugs, alcohol,
retirem ent, em otional,
or oth er such difficu lties?
Y o u r c o lle a g u e s
w a n t to help
*R obert Sands, M D , C hair
752-6056
Bill Dean, MD
272-4013
Tom H e rro n , MD
853-3888
Bill R oes, MD
884-9221
F. Dennis W aldron, MD
265-2584
Confidentiality
Assured
To obtain a copy of the full report, call PCMS 572-3667 and provide your fax num­
ber or mailing address. ■
r
Our Clinical
PET Sp ecialists
Featuring software fusion for image
registration with multiple modalities
(CT, MRl and SPECT).
Anthony Larhs, MD
Director of Clinical PET
Phillip C Lesh, M D
For a comprehensive referral packet,
call your Custom er Care Representative,
William B Jackson, M D
(253) 761-4200.
For information call
(2 5 3 ) 7 6 1 - 4 2 0 0
TRA
Roy McCulloch, BS, CNMT
Supervisor PET & Nuclear
Medicine
2202 S Cedar Street, Ste 200
Mledica
Imaging
(2 5 3 ) 7 6 1 -4 2 0 0 f o r s c h e d u lin g
L ary n g eal
EXCELLENCE • PERSON TO PERSON
October, 2004
PCMS BULLETIN
13
B u l l e t in
Solutions for Family Caregivers, Older Adults, and
Persons with Disabilities
There’s only so much a physician
and office staff can know. Meeting the
myriad needs of family caregivers, older
adults, and adults with disabilities can
be a perplexing dilemma. Pierce County
Aging and Long Term Care can be the
best place to start.
Aging and Long Term Care invites
physicians and office staff to attend a
special orientation to the scope of ser­
vices provided to the community
through the Family Caregiver Support
Program, Senior Information and Assis­
tance, Pharmacy Connections, case
management services, and a variety of
associated resources. The presentation
will include a review of services and
programs, methods to access them, re­
sources for staff, materials for physi­
cians' offices, and models for implemen­
tation.
The 40-minute workshop will be
held six times: Tuesday, October 12 at
7:00 a.m.. 9:00 a.m.. and 12:15 p.m. and
Wednesday, October 13 at 7:00 a.m.,
9:00 a.m., and 12:15 p.m. at the Pierce
County Human Services building, 3580
Pacific Avenue in Tacoma. A continen­
tal breakfast or light lunch will be
served. There is no cost for this presen­
tation. Reservations are requested by
calling Bob Riler at 253-798-7384.
In Pierce County it’s more than
likely that about one-quarter of a physi­
cians’ patients are family caregivers.
Some are long-distance caregivers;
some provide care in their own homes.
They carry the practical responsibilities
of providing housing, fixing meals, ar­
ranging transportation, and organizing
care during work time. They also cam'
the emotional weight of seeing their
loved one - spouse, parent, child, rela­
tive, or friend - struggle through what
may be a difficult time.
Providing adequate support to
caregivers, older adults, and persons
with disabilities is one key to a healthy
community. Aging and Long Term Care
coordinates appropriate programs and
services available in the community
that best fit the needs of the individual
in their particular situation.
Aging and Long Term Care, a ser­
vice ofPierce County Human Services,
is one of 13 Area Agencies on Aging in
Washington State. It is our job to speak
for the rights of elders and to plan and
manage long term care programs that
help older and disabled people to re­
main secure and independent. We are
able to achieve our goals by coordinat­
ing long term care services with the
Washington Department of Social and
Health Services and other local agen­
cies. ■
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14
P C M S BULLETIN
October, 2004
S
a
v
e
t
h
e
D
a
t
e
T h e E d w in C . Y o d e r
H o n o r L e c tu r e s
Friday, November 19, 2004
This year, our Yoder presenter is James P. AuBuchon, MD, FCAP, FRCP who is the Chair of
Pathology and Professor of Medicine at Dartmouth Medical School, Dartmouth-Hitchcock
Medical Center. He has worked closely with clinicians to promote improved transfusion
practices through the Transfusion Committee and implemented innovative approaches to
reduce the two greatest risks of transfusion, bacterial contamination and mistransfusion.
He served as a member of the Advisory Committee on Blood Safety and Availability of the
US Department of Health and Human Services (1997-2000) and has frequently been called
upon to testify before Congressional committees and federal advisory committees. He
served the American Association of Blood Banks as chair of the Scientific Section
Coordinating Committee (1998-2002) and a district director (2003 - present) on the Board of
Directors. He chairs the Transfusion Medicine Resource Committee of the College of
American Pathologists. He is the current chair of the Biomedical Excellence for Safer
Transfusion Collaborative, an international research group dedicated to improving
transfusion safety and efficacy.
This program is designed for physicians and is accredited for 2.0 Category 1 hours.
Location:
Schedule:
2:00 3:00 pm
3:00 4:00 pm
4:00
4:15
4:1 5 pm
5:15 pm
St. Joseph M edical C enter - Rooms AB&C
Social H our w ith hors d oeuvres and w ine
T ra n s fu s io n Safety: A lig n in g E ffo rts w ith Risks
James P. AuBuchon, MD
Break
M anaging Change in T ra n s fu s io n M edicine
James P. AuBuchon, MD
Reservations required. Limited seating. Please call in your reservation no later than
Thursday, Novem ber 11th to the FHS Office of Academ ic Affairs at (253) 426-6035
This is a Physician Only Event
CHI-W/FHS A ca d e m ic A ffa irs is a c c re d ite d by th e W a sh in g to n Stae M edical A s s o c ia tio n CME A c c re d ita tio n
C om m ittee to s p o n s o r c o n tin u in g m e d ica l e d u c a tio n fo r p n ysicia n s.
CHI-W/FHS A ca d e m ic A ffa irs d e s ig n a te s th is e d u c a tio n a l a c tiv ity fo r a m a x im u m o f 2 C a te g o ry 1 c re d its to
satisfy th e re lic e n s u re re q u ire m e n ts o f th e W a s h in g to n State M edical Q u a lity A ssu ra n ce C o m m is s io n and
toward the A M A P hysician's R e c o g n itio n A w a rd . Each p h ysicia n sh o u ld cla im o n ly th o s e h o u rs o f c re d it
that he/she a c tu a lly s p e n t in th e e d u c a tio n a l a c tiv ity .
October, 2004
PCMS BULLETIN
15
B u l l e t in
Infections Limited, P.S. is pleased to announce
the arrival of two new associates.
M arina Arbuck, M D graduated from M edical school in
Y aroslavl, R ussia. She com pleted Internal M ed icin e train in g at
St. V incent H ospital in Indianapolis, In d ian a fo llo w ed by an
Infectious D iseases fellow ship at In d ian a U n iv ersity M edical
Center. A ttracted to the beauty and clim ate o f the P acific
N orthw est, Dr. A rb u ck relo cated here one year ago. She jo in ed the p h y sician s of
Infections L im ited in July o f 2004. H er son M ichael is an In d ian a U n iv ersity
graduate and is p ursuing a M aste rs’ degree in B iology at M edical C o lleg e o f Ohio.
H er oth er interests include classical m usic, opera, theater, hiking, g o u rm et cooking,
and taking care o f tw o S cottish terriers.
Dr. A rb u c k ’s special interests in Infectious D iseases include bone in fectio n , travel
m edicine and infections in im m unosuppressed patients.
Ann Hyder, A R N P has been a N urse P ractitioner in the Tacom a
area for the past 10 years. P rior to jo in in g Infections L im ited she
supervised the H IV C linic at M adigan A rm y H ospital for m uch
o f that tim e. W hile her husband w as in the A ir F orce she
traveled extensively, receiving her B achelor o f S cience degree
in Los A ngeles and her M asters degree from K ings C ollege L ondon. A fter settling
in T acom a, she received her N P degree from P acific L utheran U niversity.
^
M s. H yder has been in practice with Infections L im ited since D ecem b er o f 2003
w here she m anages m any o f the clin ic ’s H IV and H epatitis C patients. She also
sees o th er patients in consultation with the infectious diseases physicians.
W hen not w orking, A nn enjoys gourm et cooking, bead w ork and em broidery.
Dr. Arbuck and Ann Hyder are accepting referrals at our
Tacoma office at 253-627-4123.
16
P C M S BULLETIN
October, 2004
^P(py.(;e '"({<•-!/))(ij ^ ( U c a l
COLLEGE
OF
MEDICAL
EDUCATION
It’s Whistler time!
January 26-31
Everyone interested in attending
the CME at Whistler, British Columbia
is encouraged to make plans now for
travel and lodging. This popular event
is scheduled for Wednesday through
Saturday. January 26thto the 30'\ 2005.
Reserva­
tions for the
program’s con­
dos can be
made by call­
ing A sp en s on
B la c k c o m b ,
toll free at 1866-788-5588.
You must identify yourself as part of
the COME group. You are encouraged
to make your reservations soon to en­
sure space - at least by December 1.
2004 when any remaining condos in the
block will be released.
All Pierce County Medical Society
members have been mailed detailed in­
formation on the program and lodging,
but feel free to call Les McCallum for
more information at 253-627-7137.
The Whistler CME is a “resort”
program. It combines family vacation­
ing, world-class skiing, a resort atmo­
sphere, and our usual high-quality con­
tinuing medical education.
This program features a potpourri
of subjects of interest to all specialties.
The course directors are Dr. R ichard
Tobin and Dr. John Jigan ti, and the
speaking lineup is better then ever.a
(f
Continuing Medical Education
Infectious Diseases Update Scheduled
for Fircrest Golf Club, November 12
The annual Infectious D iseases
is set for Friday, November 12,
2004. This important course was held
for the first time last year at the Fircrest
GolfCIub, and we return. The food, fa­
cilities and setting are perfect for con­
tinuing medical education.
The program is directed by Dr.
L arry S chw artz featuring nationally
recognized authorities, as well as our
own infectious disease specialists serv­
ing Pierce County. The Pierce County
Health Department will also report on
U pdate
new approaches for diagnosing and
treating community-associated methicillin-resistant S. aureus (C’A-MRSA).
This program was developed for
physicians and is designed as an up­
date on common outpatient and inpa­
tient infections. A brief review-' and clini­
cal update will be made on a variety of
current and important topics. This year,
specialists and sub-specialists will fo­
cus on specific practice areas.
This is a popular program, please
register early. ■
Common Office Problems Set for October 29
Don’t forget to sign up for the
Common Office Problems CME focusing on practical approaches to primary
Dates
Friday, October 29
Friday, November 12
, care medicine set for October. Call
I COME at 627-7137 to register. ■
Proeram
Director(s)
Common Office
Mark Craddock, MD
Problems
Infectious Diseases
Larry Schwartz, MD
Update
Tuesday (evenings)
Cardiology for Primary
January 11 & 18
Care
January 26-31
CME at Whistler
Friday, February 4
Gastroenterology for
Primary Care
Thursday-Friday
Internal Medicine
May 5-6
Review 2005
Friday, April 22
Friday, May 20
Gregg Ostergren, DO
Rick Tobin, MD
John Jiganti, MD
Ralph Katsman. MD
Art Knodel, MD
Radiology for the
Rick Tobin, MD
Non-Radiologist
Andy Levine, MD
Primary Care 2005
Steve Duncan, MD
October, 2004
PCMS BULLETIN
17
B u i j .F.TIN
Tangled
from page
ing stack of mail on my desk, there were
requests for medical records from
plaintiffs’ attorneys. Thank God for
little favors. The thoughtful physician
with whom 1share call responsibilities
graciously insisted on taking call even
though he had been on call for the past
two weekends while I prepared for the
hearing. Feeling a sense of relief. 1
drove home.
The sense of relief was short-lived.
I was met at the door by my daughter,
whose first comment was "'Gee, Dad,
they made you out to be the worst doc­
tor in the world." She had recorded the
television news piece lor me to enjoy at
my leisure. It turned out that this was
not necessary, because through the
marvel of 24-hour news channels, I
could see the clip once an hour. This, I
thought, is the price of freedom. 1 had
just been visited by the First Amend­
ment.
I knew I should call my relatives to
tell them my side of the story. It would
save them needless embarrassment and
concern. 1 had a martini and went to
110
18
P C M S BULLETIN
October, 2004
bed instead.
The next morning, I went to work
with a sense of dread over what would
undoubtedly be my biggest humiliation.
I work at a small community hospital.
There is no such thing as anonymity. I
went to the doctor’s lounge and dis­
covered that my case had made the sec­
ond section of the newspaper. Bracing
for the worst, I stayed in the lounge
and answered questions and explained
my side ol'the story to my colleagues.
Next, with the same sense of dread, I ar­
rived at the office and took the same
lack with my patients. Much to my sur­
prise, I received a tremendous outpour­
ing of support and encouragement from
my colleagues, the hospital staff and
my patients.
One of my attorneys called. 1think
she was afraid I might fall on my sword.
! was truly touched by this act of kind­
ness. Now I feel better about the fact
that her children will grow up having
never won an argument with their
mother.
That night when I not home. I real­
ized that Tonly thought that I had faced
my biggest embarrassment and humilia­
tion. 1 called my relatives. To be per­
fectly honest, my wife made me call my
relatives. I am glad she did.
This could have turned out differ­
ently. Juries understand that busy prac­
titioners do not always do a good job
of documentation. A chart with poor
documentation is always better than an
altered chart. An altered chart is worse
than having no chart. Trust your attor­
neys to handle your problem. Worstcase scenario, you lose the case. That
is why you have insurance. We, as
physicians, must never lose sight of the
larger issue. Sacrificing your integrity
and betraying the public's trust, as I
did. is wrong. Please do not let it hap­
pen to you.
Walter Scott’s observation 200
years ago is no less valid today. Mark
Twain offered another: “When in
doubt, tell the truth.” *
R e /tr im a l fr o m P h y s ic ia n s R isk Update.
Volume A7' Number 4
''M e rr r ic v /i/ifi/ ^ '( { e d u v l C% c ie / y
Classified Advertising
OFFICE SPACE
T A C O M A /P I E R C E C O U N T Y
Tacoma/Pierce County outpatient
For R ent: 3300 sq ft C lass A m edical
O u tp a ti e n t G e n e r a l M e d ic a l C a re .
general medical care at its best. Full and
part-time positions available in Tacoma
and vicinity. Very flexible schedule. Well
suited for career redefinition for G.P.,
F.P., l.M. Contact Andy Tsoi, MD(253)
752-9669 or Paul Doty (Allen, Nelson,
office in Tacoma Medical Center, 1112
6th Ave, third floor. Elevator, under­
ground parking, close to hospitals,
ownership options. Call 253-272-2224.
Turner & A sso c.), C lin ic M a n a g e r (2 5 3 )
complex. Gig Harbor. 2354 sq ft, main
level. 468-3539 or 565-2444.
P O SITIO N S A V A IL A B L E
3834351.
F u ll a n d p a r t- tim e p o s itio n s
av ailab le in T a c o m a a n d vicinity.
V ery flex ib le s c h e d u le . W e ll s u ite d
fo r c a r e e r re d e f in itio n fo r
G P , F P , IM .
O ffice sp ace for lease in m edical
C o n t a c t A n d y T s o i, M D (253) 7 5 2 -9 6 6 9
o r P au l D o tv (A lle n , N Y ls o n , T u r n e r Cc
A ssoc.}, C ‘1in to YU u k i ^')' (353,^ 3 8 3-43 51
Established Auburn F am ily Practice
looking for P/T to F/T Board Certified or
Board Eligible Physician to join a group
practice. Work 3-4 days a week with a
great support staff. Base salary plus in­
centive. Fax your CV to 253-847-9630.
N eed office help in a hurry?
Pierce County Medical Society - Medical Placement Service
the solution fo r all your staffing needs
P ro v id in g e m p lo y e e s w ith o u t the h a ssle o f salary, b e n e fits, ta x e s and o th e r such
e m p lo y e e re q u ire m e n ts, a n d ...T em p to P erm : A u n iq u e o p p o rtu n ity to w ork w ith a
p o ten tial e m p lo y e e on a trial b a sis - w ith o u t o b lig a tio n to hire!
For more information call Kerri or Melissa at 572-3709
Protect Your Practice, Protect Your Family
As you know, disability insurance policies for physicians are
chan gin g rapidly— and not for the better. At Physicians
Insurance Agency, there’s still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find
superior life and long-term -care coverage for you and your
familv.
To discuss the ways you can best protect you and your family,
call Physicians Insurance Agency today: (206) 343-7150 or
1-800-962-1399.
w
PHYSICIANS
INSURANCE
AGENCY
\
A Wholly Owned S u b sid iary of
P h ysician s Insurance
© Physicians insurance 2003
S /m s n m l by Ihf
October, 2004
Sink- M aliailAssniulion
PCMS BULLETIN
19
U L!..E 1'IN
tigat
cess’
A s a claims representative and supervisor, I see physicians of all specialties
whose lives are suddenly changed by claims filed against them. Whether the
cases are dismissed, settled, or go to trial, each physician’s personal and
professional life can take a turn for the worse, and that’s why I’m here to
help. 1 analyze each claim, stay in close contact with our attorneys, and work
with the physician on new strategies as the case develops. Every physician is
important to me, and 1 make sure my work shows them that I care.
To find out about the many ways Physicians Insurance works with and
for physicians, call us today.
Kari Adams,
Claims Supervisor
Western Washington
Eastern Washington
Oregon
Physicians
Insurance
A Mutual Company
C ro .ittid a n d spi"in?i'iri-;d b y Ilie
V isit o u r W e b s it e a t p h y in s .c o m
\ V , ^ h i n t: i . 'n 5-„itc M c J i o ! A > ? o :u '
be liu 1 1 , W A (m p h y s ic ia n s I n s u ra n c e 2002
Pierce C ounty M edical Society
223 Tacoma A venue South
Tacoma, WA 98402
R eturn service requested
20
1-800-962-1399
1-800-962-1398
1-800-565-1892
P C M S B ULLETIN
October, 2004
PRESORTED
STANDARD
USPOSTAGEPAID
TACOMA, WA
PERMIT NO 605
November, 2004
WSMA Delegates - Your Leadership
PCMS members at the WSMA House of Delegates in Spokane. L to R - Front Row: Drs. Ken Feucht, Len
Alenick, Joe Jasper, Laurel Harris, Mike Kelly and Patrice Stevenson. Back Row: Drs. Don Russell, Sumner
Schoenike, Nick Rajacich, Federico Cruz, Pat Hogan, Ron Morris and Richard Hawkins
S e e W S M A p r io ritie s , p a g e 5
IN S ID E :
3
P r e s i d e n t ’ s P a g e : “ P r e - E m p t i v e E l e c t i o n R e f l e c t i o n s ” b y M i c h a e l K e lly ,
4
5
7
9
C a m p a i g n i n g f o r M a t t R ic e
W S M A se ts o r g a n iz a tio n a l p r io r itie s fo r 2 0 0 5
T P C H D : “ V a c c in e S h o r t a g e ” F e d e r ic o C r u z - U r ib e , M D
In M y O p i n i o n : “ S e r v i n g T w o M a s t e r s ” b y A n d r e w S t a t s o n , M D
MD
11
P C M S W e lc o m e s S c o t t P e t e r s o n , n e w C o lle g e o f M e d ic a l E d u c a tio n P r o g r a m A d m in is t r a t o r
B u l letin
P C IV1S O f f i c e r s / T r u s t e e s :
M ich a el J . Kelly M D , P resid en t
P a tric k .!. H o g a n D O . P re s id e n t E le c t
K e n n e th A . F e u c h tM D . V ic e -P re s id e n t
J o s e p h W . R e g im b a l M D ,T r e a s u r e r
S u m n e r L. S e h o e n ik e M D , S e c re ta ry
J. J a m e s R o o k s , J r., M D 5P a s tP r e s id e n t
L a u re lR . H a r ris M D
J e ff re y L. N a c h tM D
Jo sep h F. Ja sp e r M D
N a v d e e p S. R a i M D
R o n a ld R . M o rris M D
C a rl W . W u I fe s tie g M D
P C M S M e m b e r s h ip B e ne fits, Inc (M B I):
T i m S c h u b e r t M D , P r e s i d e n t ; D r e w D e u ts c h
M D , P a s t P re s id e n t; J o e R e g irn b a l M D , S e c re la iy T re a s u r e r; K e ith D e m iijia n M D ; S te v e D u n c a n M D ; M a rk
G ild e n h a r M D ; S te v e S e ttle M D ;J o e W c a m M D
College of M edical E ducation (C .O .M .E .):
J o h n Ji g a n ti M D , President; B a rb a ra Fox M D .
Y V illiam H o ld erm a n M D , S te v e K o n ic e k M D , M a rjo rie
K r a b b e M D , W illia m L ee M D .G r e g g O s te r g r e n D O ,B r a d
P a ttis o n M D .C e c il S n o d g ra s s M D , V irg in ia S to w e l 1M D .
R ic h a rd W a ! tm a n M D ,T o d W u rst M D ; Ju lie S c h n e id e r,
G o o d S a m a rita n H o s p ita l; L isa W h ite . M u ltic a re H e a lth
S y s te m ; S is te r A n n M c N a m a r a , T re a s u re r, F ra n c isc a n
H e a lth S y s te m ; S u e A s h e r. S e c re ta ry
P C M S F oundation: L aw ren ce A.
L a r s o n D O , P r e s i d e n t ; C h a rle s W e a lh c rb y M D .
M o n a B a g h d a d i, N ik k i C row ley., T re a s u re r; S u e A s h e r.
Secretary'
3
President’s Page: “Pre-Emptive Election Reflections"
4
Campaigning for Matt Rice
5
WSMA sets organizational priorities for 2005
6
Applicants for Membership
WSMA
R epresentatives:
T ru s te e s: L e o n a rd A le n ic k M D ; R o n M o rris M D ;
N ic h o la s R a ja c ic h M D ; D o n R u sse ll D O
W A M P A C 6 th D istrict: D o n R ussell D O
W A M P A C 9 th D istrict: L eo n ard A lenick M D
7
TPCTID: "Vaccine Shortage”
9
In My Opinion: “Serving Two Masters”
Staff: E x e c u tiv e D ire e to r: S u e A s h e r
A d m in is tra tiv e A ssistan ts: T a n y a M c C la in .C risti P e te rso n
P la c e m e n lC o o rd in a to r:K e rri B a k er
P la c e m e n t A s sista n t: M e lis s a K re g n e ss
C M E P ro g ra m A d m in istra to r: S c o tt P eterson
B o o k k e e p e r: J u a n ita H o fin e iste r
13 In My Opinion: “Teeter/Totter (more or less)’’
11 PCMS Welcomes Scott Peterson, new College of Medical
Education Program Administer
14 Lawyers sick over Texas malpractice caps
T h e B u lle t in is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits, Inc. D e a d lin e for s u b m ittin g a n ic ie s
an d p la c in g ad v e rtis e m e n ts is the I 5 th o f the m onth
p re c e d in g p u b licatio n .
15 Site to help residents buy drugs from Canada
T h e B u lle t in is d e d ic a te d to th e art, sc ie n c e and d e liv e ry
17 College of Medical Education
o f m e d ic in e an d th e b e tte rm e n t o f the h ealth an d m edical
w e lfa re o f t h e c o m m u n ity . The o p in io n s h erein are th o se o f
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rig h t to re je c t an y a d v e rtisin g .
M a n a g in g Editor: Sue A sher
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2
Table of Contents
P C M S BULLETIN
November, 2004
16 Don t Forget to Make Those Whistler Condo Reservations
19 Classi lied Advertising
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by Michael J. Kelly, MD
Pre-Emptive Election Reflections
"A citizen o f A m erica w ill cross the ocean to
fig h t f o r dem ocracy, hut w on ’1 cross the street to
vote in a natio n a l election. " -Bill Vaughan
"P oliticians are like diapers. They hath n e e d
c h anging reg u la rly a n d f o r the sa m e reason. "
M ichael J. Kelly, M D
-Author Unknown
you know it’s true.
The same survey found that 70
percent of the respondents had no idea
who the vice-presidential candidates
were, one-third thought they might get
around to voting and the vast majority
wanted to know how to write in Daisy
Fuentes’ name. Trust me, if the Federal
Elections Commission would allow
write-in votes as hearts with initials in­
side, she’d be president faster than you
can forget the name Monica Lewinsky.
Another survey found that 21 per­
With all the election hype and con­
cern over the issues that deeply affect
us, it recently occurred to me no one
pays much attention to how people de­
cide to vote, or whether to vote in the
first place. As far as the incentive to
vote, a friend of mine told me, it was
easy. Just launch a promotional cam­
paign, take out a couple of ads, and 10
million people will cast ballots for their
favorite new M & M color. Alterna­
tively, put an A m erican Id o l on the air
and watch the finale draw 65 million
votes.
Yet, if you held a presidential elec­
tion and spent $343 million, as candi­
dates did in 2000, somehow it only man­
ages to eke out 105 million votes, about
51.3 percent of eligible voters. “Doesn’t
seem logical,” Spock would say.
O.K., so John Kerry is no Fantasia
Barrino, and George Bush can’t pro­
nounce Reuben Studdard let alone sing
like him, but that doesn’t mean we can’t
get more people motivated to vote, ab­
sentee or in the flesh. According to a
local political think tank, all it would
take is a few changes to the process it­
self. However, more about that later.
I ’d say it’s a sad day when 25 per­
cent of our eighteen to twenty-four
year olds can’t name both presidential
candidates. This not-so-startling news
recently came from MTV, the world’s
foremost source for music videos, dry
ice smoke, and Mentos commercials, so
cent of young people eighteen to
twenty-nine obtain their political opin­
ions from comedian Jon Stewart of
Comedy Central’s "The Daily Show."
Jon himself labels his program "Fake
Journalism." There is obviously a sig­
nificant disconnect between what is
“fake” and what is real journalism. But
it gets worse: 40 percent of voters un­
der 30 years of age say they get their
political information from late-night TV
talk show monologues. It’s scary to
See “ Reflections'* page 12
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November, 2004
X
PCMS BULLETIN
3
B i L LETIN
Campaigning for Matt Rice
In efforts to elect Malt Rice to a House of Representa­
tives position in the 261'1Legislative District (Gig Harbor),
many Pierce County physicians became politically active for
the first time in their lives. From sign waving to doorbelling, at­
tending fund raisers to letter writing, physicians participated
like never before.
Numerous physicians participated in overpass sign wav­
ing organized by neurologist D an N eh ls, M D . Dr. Nehls
worked tirelessly organizing physicians lo wave Matt Rice
campaign signs each and everv morning on the overpass in
Gig Harbor as commuters inched along on their way to work.
Beginning the day after Labor Day, September 7, until Election
Day. November 2. Dr. Nehls or one or two of his colleagues
were on the overpass early in the morning until rush hour
ended. Joining Dr. Nehls were D rs. R o b K u n k le. Wes
Greydanus, and Joe Jasp er, Physician Assistant Lee
B e r g m a n n , D rs. K aren N e lso n , Paul Mathews, Wes Hart,
L oren F in ley, J o s C ove, Phil Bouterse, K irk R u e, Jim R ook s.
Dave Langwort, G erry A n d erson , G ortly K latt, Stacy
Sweeney. Brad VanDuker, Todd Donato. Tim Lord. R an dy O tto,
C arol K ovan d a, C laire S p ain-R em y, K ari V itikainen, Tony
Forte, C h a rle s S ou liere, A n dre Josep h , Bill Cammarano, Bob
F in n erty, Jim Taylor, C raig R on e. Belinda Rone, Bob W righ t,
D o o rb ellers f o r M att R ic e fr o m le ft
- J a s o n C ham bers,
c a m p a ig n s t a f f Drs. S tev e D liras, M ik e Kelly, c a n d id a te
M a tt R ic e a n d w ife K irin, Drs. W illie S h ie ld s a n d J im
R ife n b e r y N o t p ic tu r e d - Dr. Vita P lisk o w
M ik e M a rtin , J oh n Blair, T h e r esa T erem , C liff Porter, Peter
K esling, M ark L u d vigson , C ordell B ah n , Ian L aw son ,N ick
R a ja c ich , V icky S ilas, N ea l S h o n n a rd , Tony Garcia, Frank
Sec "Rice" page 6
Protect Your Practice, Protect Your Family
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A Wholly O w ned S u b sid iary of
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4
P C M S BULLETIN
November, 2004
S fm im v d h r the Kiisliiiigtoii S'ti/te Medical Association
:
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WSMA Annual Meeting Recap
WSMA sets organizational priorities for 2005
The WSMA Annual Meeting, held in Spokane in late Sep­
tember, was well attended by representatives from Pierce
County.
Representing Pierce County were PCMS Board members
Drs. Mike Kelly, P at H ogan, K en F eucht, Laurel Harris,
Sumner Schoenike, Ron M orris and Joe Jasp er; WSMA
Board members Drs. Len A len iek , N ick R ajacich and P atrice
Stevenson; WAMPAC Chair Dr. Don R ussell; and alternate
delegates Drs. Federico C ruz and Richard H aw kins.
The House of Delegates is the policy setting body of the
organization and determines the priorities and direction of the
Association. For 2005, the House adopted Board of Trustee
Report G, which outlines the WSMA priorities as follows;
As an organization, the WSMA is strong. The association
has a committed leadership, a growing membership, and re­
mains financially sound.
The WSMA’s focus is a means to an end. The purpose of
our work is to maintain practice viability, enact tort reform and
push for more administrative simplification to create an envi­
ronment where physicians can practice the art and science of
medicine.
The WSMA’s policies also reflect that:
• Regardless of specialty or practice setting, we remain, at
our core, physicians;
• The WSMA represents and advocates for all physicians
who are - and must be, by training, experience and ethi­
cal code - responsible and accountable for medical decision-making; and
• We promote the health of all Washingtonians.
One of the hallmarks of the WSMA is that it represents
strong advocacy, clearly articulated, and physician driven.
The association works tirelessly to represent our values and
priorities.
We partner with county medical societies and specialty
societies through the County Medical Society Council and the
Interspecialty Council. We partner with our practice managers,
through individual contacts, and the state chapters of the
Medical Group Management Association and American Medi­
cal Group Association. We will partner with any group or orga­
nization that shares our objectives.
The purpose of the WSMA is reflected in the following
recommended organizational priorities for 2005: To represent
the professional interests of the membership on behalf of pa­
tients - including their ability to have access to affordable
health insurance and physicians - and to promote effective
physician leadership in the evolving health care system.
Recommendations:
THEREFOREBE IT
RESOLVED, that in 2005 the WSMA focus its resources
on the following organizational priorities:
Care:
1. Enact meaningful tort reform as a means to promote the
capacity of the delivery system to meet the public’s need for
access lo care, and to foster an environment that promotes pa­
tient safety and error reduction.
• Affirmative legislative action on 1-330 or an agreeable
alternate, and/or voter approval of 1-330 or an agreeable
alternate in November 2005.
• Focus public awareness of the impact of the tort system
on access to care and medical practices.
• Have 100% of the active members contribute to the
1-330 Campaign Fund if the initiative goes to the Novem­
ber 2005 ballot.
• Enactment of a constitutional amendment allowing a cap
on non-economic damages if necessary.
• Support passage of a federal tort reform bill.
• Evaluate and promote, iLfeasible, other types of long­
term tort law reform beyond those represented in 1-330,
including the establishment of a medical court system.
2. Improve the quality ofmedicine in Washington State;
promote patient safety and error reduction efforts.
• Promote programs and relationships with other organi­
zations and the purchasing community to support this
priority.
• Use the WSM-ERF as a vehicle to bring physicians and
purchasers together to identify common measurements
of safety and quality and to promote or conduct pro­
grams to support the priority.
3. Promote medical practice economic viability and simpli­
fication of administrative requirements.
• Seek better funding of Medicare physician payments.
• Seek better funding of Medicaid physician payments.
• Achieve tangible reductions in administrative complex­
ity and operating expenses for medical practices.
• Push the public discussion of health care “reform" away
from nonproductive reiterations of long-held assump­
tions and positions. Reiterate the WSMA's position of
supporting a marketplace-based approach to reform of
the financing system while challenging both ends of the
See “W SM A" page X
November, 2004
PCMS BULLETIN
5
B
u l l e t in
Learn to live Right-Side Up at the
PCMS Annual Meeting
Fun, festive and entertaining as always, the PCMS Annual Meeting will be held
on Tuesday, December 14 at the Tacoma Sheraton Hotel.
The annual dinner meeting will host a number of activities including music by
the Tacoma Youth Symphony during the social hour, a raffle to benefit the PCMS
Foundation, a keynote speaker and, of course, installation of new officers and Trust­
ees. Dr. M ik e K elly, will thank Dr. J im R ook s for his many years of service on the
board and will install Dr, P a t H ogan as the new President.
As always, toys for children and gifts for women will be collected for donation
to the YWCA Support Shelter for women.
The keynote speaker, David Thomas from Houston, Texas will talk about integ­
rity - and the importance of “living right side up in an upside down world.” With a
wave of corporate scandals and the realities of a post 9/11 world, integrity must re­
main a timeless and timely virtue. In an entertaining and enlightening manner, Mr.
Thomas will answer questions such as what is integrity and why is it important, why
is integrity vital in the workplace, and how can we remain ethical when we are sur­
rounded by those who operate differently. This is a presentation you will not want to
miss - entertaining and thought provoking!!
Please mark your calendar for Tuesday, December 14 and join your PCMS col­
leagues, spouses and guests for the PCMS Annual Meeting. Watch your mail for de­
tails. ■
from page 4
Christina Cszigcti,
as well as others.
Physicians statewide contributed financially to Matt Rice’s campaign. Most all
physicians realized the importance of defeating his opponent, Pat Lantz (26-D) in the
election. Lantz single-handedly refused to allow tort reform legislation to be passed
out of her committee for discussion on the House floor for two consecutive years.
Matt’s Public Disclosure Commission report had not only Pierce County but many
physicians from many counties in the state listed as contributors, recognizing the
critical need to replace Lantz.
A few hearty souls were even willing to go door to door in efforts to help Dr.
Rice. Drs. M ik e K elly, Steve D u ra s, W illiam Sh ield s, Jim R ifen b ery and V ita
P lisk o w all experienced political campaigning from the grass roots level as they vis­
ited Gig Harbor residents door to door asking for support of their candidate. “I feel
like I am really contributing and doing something.” noted Dr. Shields. “This is ac­
tion.” Others were equally exuberant. Dr. Rifenbery visited the homes of many pa­
tients, noting "they were really surprised to see me at their door.”
At press time the outcome of this election is unknown, but win or lose, candi­
date Matt Rice has hopefully felt the support and efforts of his colleagues in his ef­
forts to go to Olympia.
PCMS congratulates Dr. Matt Rice on a well run and valiant campaign effort.■
A pplicants for Membership
D eborah J. C onw ay, M D
Diag Radiology/Pediatric Radiology
TRA Medical Imaging
3402 S 18th St, Tacoma
253-383-1099
Med School: University of Alabama
Internship: Memorial Flealth University
Residency: Memorial Flealth University
Fellowship: University of Washington
M a ry C. H oagland-Scher, M D
Family Practice
Group Health
209 Martin L King Jr Way, Tacoma
253-596-3300
Med School: Harvard Medical School
Internship: Framingham Union Hospital
Residency: Group Health Cooperative
Tim othy R. K ennedy, M D
Anatomic & Clinical Pathology
Navy, active duty
Med School: Michigan State University
Internship: Portsmouth Naval Hospital
Residency: Portsmouth Naval Hospital
Fellowship: Medical Univ of S Carolina
K im , R on K n igh t, Steve H am m er, M ark C radd ock , John S am m s,
A ndrea R . M anzo, M D
Tom Irish, P at H ogan
Diagnostic Radiology
TRA Medical Imaging
3402 S 18th St, Tacoma
253-383-1099
Med School: University of Tennessee
Internship: Eisenhower Army Med Ctr
Residency: Madigan Army Med Ctr
PCMS has a new e-mail address
P C M S has ch anged their e-m ail address to:
[email protected]
P lease m ake a note in y o u r directory
6 P C M S BULLETIN
November, 2004
J. M arshall N ew b ern , D O
Family Practice
Lakewood MultiC'are Clinic
9332 Bridgeport Way SW, Lakewood
253-459-6060
Med School: West Virginia School of
Osteopathic Medicine
Internship: Flint Osteopathic Hospital
Residency: Henry Ford Hospital
C h ristin e P u ig ,M D
Otolaryngology, Head & Neck Surgery
Ear, Nose, Throat & Plastic S u r g e r y Assoc
101 2nd St NE, Auburn
253-833-6241
Med School: Texas Tech University
Internship: Mayo Clinic
Residency: Mayo Clinic
Fellowship: University of Missouri
p A ic m ’H v H /iftf Q ( ( e d ic a / (S o c ie ty
The Health Status of Pierce County
F e de rico C ru z -U rib e , M D
D ir e c t o r o f H ealth
Vaccine Shortage
V
F e d e r ic o C ruz, M D
The Chiron Corporation. A name
million number was low' from the outset:
public health in order lo participate in
that 1had seldom heard before now
using CDC guidelines, well over one
disease control situations designed to
confronts me daily. Currently, the U.S.
million people in our state are in the
fail. We are scurrying around, trying to
population receives flu vaccine from
make the best of a bad situation. This is
high-risk categories.
two companies. This vaccine is the
This does not bode well for us as
not the way to run an anti-influenza
main bulwark in protecting our commu­
we move quickly into the flu season.
campaign. In the future in order to re­
nities from the ravages of an influenza
Significant numbers of high-risk per­
spond to the low-vaccine/high-need
epidemic. We truly depend on these
sons will be vulnerable to this illness.
circumstance, 1 may have to issue an
companies for their vaccines. There is
Flow did we get into this situation?
emergency order that binds all agencies
no fallback plan. We have no magic re­
It’s a long, sad story, filled with much
and individuals who administer flu vac­
serves, no hidden stockpiles.
rhetoric and posturing by many sides.
cine to their patients and the public to
What is missing from the equation is a
As you know, Chiron recently an­
follow CDC guidelines.
nounced that the British
In the meantime, my rec­
government had seized all
ommendations are straightfor­
of their current stock of flu
ward: A ll existin g stock s o f
vaccine because of irregu­
vaccine should only be used to
“I f we follow the CDC guidelines, we should he
larities in production. No
vaccinate high-risk individu­
able to protect a large part ofthe most vulnerable
risks to the public have
als, as defined by the CDC:
in our communities. Sometimes during a bad
been clearly stated, but
situation, where there are no solutions, we can
there are allegations of
• All children, aged 6-23
only work to make it a little less bad."
widespread contaminants in
months
different lots of the vaccine.
• Adults over 65 years old
Over 50 mil lion doses were
seized, half of the approxi­
• People between the ages of
side that solely represented the public,
mately 100 million doses needed in the
2 and 64 who have underlying chronic
which said during every policy discus­
U.S. to cover the high-risk populations
medical conditions
sion, “We must make certain enough flu
and those in the general public who
• All women who will be pregnant
vaccine is available for every citizen in
sought to avoid the disease. Without
during influenza season
need.” Instead, discussions were domi­
Chiron’s production, we are desperately
nated by concerns about liability, prof­
short. The average person will probably
• Residents of nursing homes and
its, market forces, agency authority, and
not have access to vaccine this year.
long-term care facilities
a host of peripheral issues that suc­
Washington State’s share of the U.S.
• Children 6 months to 18 years on
ceeded in keeping everyone’s eye off
vaccine supply was to have been about
chronic aspirin therapy
the primary, essential concern of avail­
one million doses. The chances of our
state getting its full share are slim, since
ability'for all.
• Healthcare workers with direct patient
The process and current outcome
much ofthe vaccine is already commit­
care
make me want to scream obscenities
ted to contracted vendors and distribu­
Sec “Shortage” page X
and tear my clothes. I did not go into
tors across the country. And, the one
November, 2004
PCMS BULLETIN
7
WSMA
from page 5
Dr. G eo r g e T a n b a r a ’s resolution, Improving Access to
Care for Children, was adopted by the House of Delegates and
directs the WSMA to work with County Medical Societies,
where appropriate, in bringing together governmental, non­
profit, and other interested organizations to improve access to
care for the uninsured and the underinsured.
Resolution C-l 1, Achieving Universal Health Coverage in
Support'.
Washington State, drew' the most attention and called for vote
counting on the House floor. The Resolution was amended
4.
Build the strength and viability of the WSMA as a pri­ and finally accepted. The final resolution eliminated nine spemary resource to physicians.
cific principles to the plan and that the WSMA retain a re­
search firm to conduct a poll measuring the public’s accep­
• Realize a net membership gain as of December 31,2005.
tance of a universal health insurance plan. The Final Resolu­
• Expand and increase the “brand awareness: of the
WSMA programs and services.
tion, as originally submitted directing that the WSMA urge the
Governor and/or state legislature to appoint a blue-ribbon
• Strengthen the Interspecialty County and County Medi­
commission to develop recommendations for achieving uni­
cal Societies Council to promote effectiveness and fos­
ter two-way communications.
versal health coverage and access for citizens of Washington,
• Maintain a demographically representative governance
and that the commission include representatives of the legisla­
structure.
ture, the executive branch, federal health program officials,
• Maintain a fiscally sound association.
providers, employers, labor, the health insurance industry,
consumers, and the uninsured. ■
Other House actions included Resolution A-1 introduced
by PCMS Board member K en F eu ch t, M D , Puyallup surgeon,
on generated waste in the health care system. The resolution
was adopted with two resolves calling for the WSMA to rec­
ognize that medical waste contributes to environmental degra­
dation and risk to health and that they support and promote,
when possible, the use of reusable, recyclable and/or biode­
from page 7
gradable products.
Dr. Feucht also introduced Resolution B-13 calling for
• Out-of-home caregivers and household contacts of children
limitation of physician work hours. This resolution was re­
under 6 months old
ferred, meaning that the WSMA will study it further. The reso­
lution calls for support of 12 hour limitations in each 24 hour
Public flu clinics and private practice offices must screen
period for physicians to be involved in either call or actively
out every individual who comes forward to be vaccinated who
working and a 60 hour limitation per week for working. It also
is not on the list. A ll a g en cies w h o h a v e flu v a c cin e through
asks for a compliance agency to fine and discipline for infrac­
their ow n contracts w ith a d istrib u to r sh ou ld rep ort the
tions. Dentists, alternative health care providers, associated
am ou n ts ot vaccin e to the H ealth D ep artm en t. T his w ill as­
health care providers, psychologists, licensend health and hu­
sure new sh ip m en ts o f vaccin e w ill get d istrib u ted rationally.
man service providers, and law and political professionals also
My goal is not to make life harder for providers and dis­
fall under the guidelines.
tributors,
but to protect the youngest, oldest and those
D rs. J o e J a sp e r and Ken Feucht sponsored Resolution
chronically
ill. With your cooperation, we should be able to
B-4, an appeal fora Physician Bill of Rights which was also re­
protect
a
large
proportion of those high-risk patients in our
ferred by the House of Delegates. This resolution asks the
community.
But
it does leave a huge number of the rest of the
WSMA to approve of a Physician Bill of Rights and recom­
population uncovered. We have to hope that we do not have a
mend that the AMA support the bill, and that they stand
severe llu season this year.
supportively by a physician when any of their rights are vio­
But even i I it is a milder llu season, we don’t have enough
lated.
vaccine
to protect everyone. 1 therefore want to repeat myself:
Dr. Feucht’s Medicare Age Reduction resolution w'as
1
1
we
follow
the C’DC guidelines, we should be able to protect
amended by asking the WSMA [nterspecialty Council to ad­
a latge part of the most vulnerable in our communities. Some­
dress policies of the Medicare program in regard to eligibility,
times dining a bad situation, where there are no solutions, we
benefits and payments to physicians. This resolution w'as ask­
can
only work to make it a little less bad. Please, do your part
ing for many changes to the Medicare program including age
in
making
the best of this.
limitations and treatment coverage options.
political spectrum to look at new concepts. Promote
greater access to affordable insurance.
• Promote a medical care-financing environment that
supports new medical practice options.
• Promote the use of appropriate technology in physi­
cians’ practices.
8
P C M S BULLETIN
November. 2004
V
:% w
In My Opinion....
The Invisible Hand
o ile d t'ca l < df«ctdf
by A n d re w statson,
m d
The opinions e x p r e s s e d in th is w r itin g a r e s o le ly th o s e o j th e a u th o r. PC AIS in v ite s m e m b e rs to c x p r iw th e ir o p in tn n -in sig h ts a b o u t su b je cts
relevant to the n ic ilic c il com m un ity, o r s h o re th e ir g e n e r a l in te rest sto rie s . S u b m is s io n s o r e s u b je c t to i. iiit o n a l C o m m itte e review .
Serving Two Masters
"H e w ho serves tw o m asters m ust lie to one o f them. "
Italian proverb
A n d r e w Statson. MD
You must remember the story
about the frog that was trained to jump
on command. The trainer cut off one of
its legs, then another. Finally, with all
four legs cut off, the frog didn’t jump
and the trainer concluded that it had
become deaf.
Think of us in the position of that
frog for a moment. Our trainers cut their
payments to us and we still jump, even
though it is harder, even though it re­
quires more effort. We work longer
hours and spend less time with each
patient, to compensate for the smaller
payments.
Then, our trainers cut another one
of our legs, this time by piling regula­
tions on us that rob us of our time and
energy. Again, we jump on command.
We put in even more effort and time, we
grit our teeth, and we keep working.
Flow long will we continue? Flow
long can we? When are we going to ex­
haust our physical and emotional
strength? When are we going to turn
deaf?
The latest plan abroad is the link of
payments for services to quality and ef­
fectiveness of care. The argument in fa­
vor of that is based on the recent study
from the Rand Corporation, which
found that fully half of the patients with
certain conditions did not get the rec­
ommended care.
As reported in The W ad Street
Journal on 9-17-04, insurers and health
plans claim that doctors have failed to
provide high quality cost-effective
care. The stress, as expected, is on
cost-effective.
How does one determine quality?
The patients usually can tell. We
treat them, they get better and they are
satisfied. Or perhaps, we didn't help
them. There was a complication, or
their expectations were not met, and
they are unhappy.
It was so under the fee-for-service
system, when the patients were in the
driver’s seat. They made the deci­
sions. We served them. Now. we serve
a different master. The third parties
make the decisions on what is good
care for the patients and what isn’t.
The Peoples State of Minnesota
has another plan. The Citizen Council
on Health Care in Minnesota reports
that the state will issue directives on
disease management and the physi­
cians, hospitals and all ancillary ser­
vices will be held accountable if they
do not comply.
In addition, HealthPartners, a ma­
jor insurance company in that state,
has announced that it will not pay for
services when a medical error has oc­
curred. They will decide what consti­
tutes a medical error and then, nobody
will get paid for services given during
the course of that treatment, whether
before, during or after the error oc­
curred. That includes all services the
patient received, by hospitals, physi­
cians and others. Considering that
sometimes errors are not discovered un­
til a year or two later, for how long are
they going to withhold payments? Or are
they going to ask for a refund of pay­
ments they already made?
The most common method the new
masters use to determine quality is by re­
view of the records. As long as we treat
the patients’ charts right, we have done
our job. Whether we have spent a
minute or an hour on the subject of
weight reduction, smoking cessation,
seat belt use, caution about alcohol and
drug use or safe sex, and all the other
politically correct aspects of care, as
long as it is in the chart, we have done
our job.
At one time, a criterion for good ob­
stetrical practice was a low cesarian sec­
tion rate and a high rate of vaginal deliv­
eries after sections. Now, the pendulum
is swinging toward sections on demand.
So what is right and w'liat is wrong? It all
depends on the pronouncements of
those in power.
The problem about disease manage­
ment (I apologize for repeating myself) is
that diseases don’t exist independently
of patients and what may be right for
one patient may be wrong for another.
The role of the clinician is to make that
determination and to treat the patient ac­
cordingly. without running the risk of
getting a black mark for not following the
directives.
Behind the Iron Curtain, we had a
See “ M asters" page 10
November, 2004
PCMS BULLETIN
9
B u l l e t in
1
l/V^l o
from page 9
joke about the perfect party man. He
was the one who firmly adhered to the
part}' line and wavered along with it.
We’ll have to do that in our practices,
waver along with the official line. We
have a patient on a previously recom­
mended treatment, and it is working.
When the official line on how to treat
his disease changes, we either have to
change the treatment or be blacklisted.
When the current flu season ap­
proached, the officials told us that it
was going to be bad and everyone
should get the vaccine. When the
shortage became obvious, the official
line changed. The flu season was not
going to be bad, so only those at very
high risk of complications should be im­
munized.
Yes, of course. Right on. Three
cheers for the party' line. Long live Big
Brother. The old truth goes down the
memory hole. The new truth is plastered
in the headlines. You thought 1984
never happened.
The rising costs of health care,
largely due to the regulatory and liabil­
ity burden, and the declining quality of
care, due to shortages of staff, supplies
and equipment, have resulted in wide­
spread popular dissatisfaction. The din
for a national health service is getting
louder.
If it should ever come to be, we
should seek to obtain one important
provision in the mechanism of payment.
In Canada, neither the patients nor any­
one else is allowed to pay directly for
services. Physicians can only bill Medi­
care. The only way Canadians are able
to opt out of their system is to come to
the U.S. for care.
Australia, on the contrary, allows
physicians the option either of billing
medicare, which they call bulk biIling, or
of charging the patients directly. When
they bulk bill, they get paid the amount
medicare allows for their sendees.
When they charge the patients, they set
their lees. The patients then send their
claims to medicare and get reimbursed
according to the official schedule.
As you can understand, the pay­
ment schedule of Medicare has not kept
10
P C M S BULLETIN
November, 2004
up with the rising overhead expenses
and liability premiums. More and more
Australian physicians have stopped
bulk billing and look to the patients for
the payment of their fees.
The same type of arrangement ex­
isted in France when 1 was there. The
patients paid the physicians directly
and the Health Service paid them back
according to the official schedule,
which at that time was about half of the
usual physician fees.
Another important option is avail­
able in Britain, where physicians can
have a private office and work for the
NF1S either part time or not at all. Britain
also has private hospitals and insurance
companies that sell private health insur­
ance.
The reports coining out of Western
Europe, Canada, Japan and other coun­
tries reveal creaking systems that are
chronically underfunded. Faced with
progressively worsening staff short­
ages and increasing waiting lists, these
systems are now turning to more and
more restrictions on medications and
services, and to patient participation in
the cost of care with more deductibles,
higher copayments and more frequent
denials of service.
1 hope that the sheer cost of such
a system will militate against it. I hope
that the experience of the other West­
ern countries will penetrate the skulls
of our leaders and help turn us away in
our march on the road to disaster, I
hope that Americans will have enough
sense to understand that our health
care system cannot serve two masters.
Our master will either have to be the pa­
tient in a fee-for-service system, or the
payor, single or multiple, in a third party
payor system. ■
THAT TATTOO
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
T o d a y 's n e w e s t A le x a n d rite la s e r ,
w ill re m o v e y o u r ta tto o
w ith m inim al d is c o m fo r t &
l e s s th an 1 % r is k off s c a r r in g .
( .ttll ( ( x l d v f o r m o r e i n j o n n t t t i o n
PIERCE COUNTY
LASER CLINIC
D ir c c lo r IV u -r K. M nrxh \ ( I)
(253) 5 7 3 -0 0 4 7
'PPierce
Q -U c d k a /^ jo c t e fif
PCMS Welcomes Scott Peterson, new College of
Medical Education Program Administrator
Scott Peterson is feeling some
pressure.
“I feel a burden to maintain what
Les McCallum has built here,” said
Peterson, who recently replaced
McCallum as the new College of Medi­
cal Education's program administrator.
“1hope to maintain the standard of ex­
cellence and continue to provide firstclass, and in some cases world-class,
continuing medical education for our
doctors.”
A public relations and public af­
fairs consultant, Peterson is no stranger
to Pierce County or to many o f the
area’s physicians. As campaign man­
ager for Dr. Fcderico C ruz during his
recent gubernatorial bid. Peterson had
the opportunity to meet several PCMS
physicians. Now, wearing a different
hat, he is looking forward to meeting
and working with the membership as he
takes the helm at the College of Medical
Education.
“I’m starting to make contacts, and
I am currently meeting with course di­
rectors,” Peterson said. He recently
completed his first COME program of
the year, C om m on O ffice P ro b lem s ,
held October 29th.
A native of Portland. Oregon.
Peterson lived for several years in the
Washington, DC area. Involved in poli­
tics from the time he was in high
school, he took a different track in col­
lege, graduating from the University of
Virginia with a degree in religious stud­
ies. “Liberal arts degrees are equally
useless,” lie joked, “so 1wanted to pick
something that would be interesting
and challenging — something that
would prepare me for getting back into
politics. The best liberal arts degree of­
fered at the school was in religious
studies which is a combination of his­
tory and philosophy, essentially. And,
it was a great experience, and definitely
worth it."
Scot! P eterson
Going to school so close to the
nation’s capital also exposed Peterson
to a diverse and exciting group of class­
mates. One friend’s father was secretary
general at the UN. Another classmate
was the son of a diplomat, although
Peterson recently found out that he was
actually in the CIA. “I loved being so
close to DC," he said, adding that he
frequently made the two-hour train ride
Sec “ Peterson" page 18
ACCME changes conflict-of-interest rules
Tighter controls would limit continuing medical education speakers
Editor's N ote: These c hanges to
CME accreditation rides becom e effe c ­
tive May, 2005 a n d w ill not im pact the
College o f M edical E ducation p r o ­
grams f o r the 2004-2005 c a lendar
year. A ny im pact the n ew rules w ill
have on College courses a n d /o r the
continuing ability’ to p ro v id e no-cost,
quality CM E p ro g ra m s fo r p h y sicia n s
is not com pletely know n at this point.
Pressure from the Office of Inspec­
tor General has the medical profession
making serious changes to continuing
medical education, according to CM E
leaders.
The Accreditation Council for Con­
tinuing Medical Education, of which
the American Medical Association is a
member, laid out revised rules Septem­
ber 28 to further distance CME from
commercial influence. CME providers
will have until May 2005 to come into
compliance, and the impact of these
changes is still being weighed. But
physicians who make presentations at
CME events or help plan these activi­
ties can count on tighter controls over
what they can speak about.
Van Harrison, PhD, a professor at
the University of Michigan Medical
School and director of its CME office,
said. “As I’ve talked with other long­
term CME directors, this change has
more impact than any other change
ACCME has made in the last 20 years.”
What’s new is that the ACCME no
longer will accept disclosure of a
presenter's ties to a drug company or
medical device manufacturer as suffi­
cient to resolve this conflict of interest.
Individuals must end their financial re­
lationship with the company or not
speak on a topic.
All involved in planning a CME
event will be held to these same stan­
dards. Conflicts of interest in financial
ties of spouses or partners also must be
resolved.
Marcia Jackson, PhD, president of
the Alliance for Continuing Medical
Education, said this means that some
qualified people will not be allowed to
speak. For example, if a doctor is asked
to present information on a new diabe­
tes treatment and the research was
funded by the drug company, he or she
may report only on the data and results
of the research. Someone else must dis­
cuss the recommendations for using
this treatment, but there might be no
one else qualified to speak because the
drug is so new. ■
Reprinted from AMNews. 10/18/114
November, 2004
PCMS BULLETIN
1
/
B u l letin
Reflections
from page 3
think that C’onan O’Brien and Jay Leno
are giving the future leaders of America
their civic lessons.
I was mulling over these electionrelated thoughts the night of October
24 as I prepared this President’s Page.
Consider it a written time capsule which
you will open as a November PCMS
B u lle tin article three weeks from now obviously following the general elec­
tion of November 2 .1 wanted to write
something now that would be relevant
then - a sort of pre-emptive reflection
on the now future, but as you read,
past election.
So, who won - who lost? I now
spend part of my time, as perhaps you,
listening to attack adds on radio and
TV. 1 read the various political distor­
tions in the TNT and other publica­
tions. Promotional mailings multiply in
my mailbox. The reality is. by the time
you read this, federal, state and local
elections and initiatives will have been
settled - barring any challenge from the
“...cloudoflocust-like lawyers”
(George Will Editorial 10/24). poised
coast to coast, representing the van­
quished presidential aspirant.
Any regrets? Can we honestly say
we did enough to educate and stimulate
our patients, the electorate, and indeed
our own medical colleagues, about the
important issues of the now' past na­
tional and local political campaigns?
How effective was our "doctors
lobby?” Were you involved? I’d like to
think we helped to influence the elec­
tions of George, Dino, George, Matt,
Mike. Gigi, Marilyn, Bob. Dick and
many others - but did we?
Did the political soothsayers get it
right? flow close were they? These
days it seems that there’s a new press
release every 45.2 minutes (with a mar­
gin of error of 4%). The N e w s Tribune
published its local, state and national
choices, including a surprise endorse­
ment of Dino Rossi. The pundits have
worked up complicated computer mod­
els of prediction. State party chairs
publish the Public Disclosure
Commission’s information regarding
trial attorney, union and special interest
12
P C M S B ULLETIN
November, 2004
contributions and discuss whether a
dog’s thighbone points north if tossed
at a baying cat under the full moon.
Despite all the information, it
seems when it comes to political depth
of thought, most of Washington State
and the U.S. are wading in the unnatu­
rally warm, shallow-end of the kiddie’s
pool. A local political think tank. The
KILL, has instead taken a bold head­
first leap into the deep end of that same
pool - and "Ouch!”
The Kelly Institute of Lame Logic
(motto: “Same daily thoughts, different
conclusions"), working on developing
the science of prognostication, pro­
duced an algorithm to predict who will
win the presidency. To be clear, an a l­
g o rith m is a mathematical construct,
not a jab at the 2000 Democrat
candidate’s peculiar dancing style. Us­
ing our own patented electabi lity fac­
tors, the KILL concluded that either
Democrat Governor James B. Hunt, Jr.
or Republican Governor William J.
Janklow would win the 2004 election.
However, since Janklow ended up in jail
for killing a motorcyclist and no one
knows where Hunt is, our research and
development seems a bit suspect.
The Institute’s most important
work, however, has been to focus on
ideas to increase voter involvement. A
brief overview will give you an idea of
the quality of those thoughts:
1. A llo w call-in voting. This recog­
nizes the basic laziness of the average
American. We’re used to being able to
sit back in our Lazy-Boy and order a
pizza, CDs, an Air Turbo Microwave
Pasta Cooker, just by getting someone
to hand us the phone, so why can’t we
vote that way? No, don’t get up...
2. H old the election d u rin g prim e
tim e. Since we’ll be able to vote by
phone, the polls don’t have to be open
as long. Besides, being an anti-delayed
gratification, short attention span, ADD
nation, we want our election to be quick
and painless, not a miniseries. So why
not hold it after dinner when we’re re­
laxed? We can try to focus on it. vote
Personal Problems of
Physicians Committee
M ed ica l p r o b le m s, d rugs, alcohol,
retirem en t, em otion al,
or o th e r su ch d ifficu lties?
Y o u r c o lle a g u e s
w a n t to help
* R obert S a n d s, M D , C h a ir
752-6056
Bill D ean, M D
272-4013
Tom H erron, M D
853-3888
B ill R oes, M D
F. D ennis W aldron,
884-9221
MD
265-2584
Confidentiality
Assured
and comfortably fall asleep -ZZzzzzperhaps in that order.
3. L e t p eop le v ote m ore than once.
Election history shows us only 76 per­
cent of those who are of voting age are
registered, and of that group, only 67
percent bother to vote - which means
that just over half of those people who
can vote, did.
Therefore, the Institute advocates
letting people vote more than once.
Consider the fact that each A m erican
Id o l viewer voted an average of twice.
We say if all those potential presiden­
tial voters aren’t going to use their bal­
lots, why not let others who are actu­
ally concerned about what happens to
this country use them. Why let all
those votes go to waste? Remember,
there are children in China who go to
bed voteless.i
i
i
In My Opinion
by Daisy Puracal, MD
th e opinions e x p r e s s e d in th is w r it in g a r e s o le ly th o s e o f th e a u t h o r. P C M S in v ite s u v m l v n in e xp re ss t h e ir o p h r io n /iu s ig h u a h u m su b je cts
relevant lo the m e d ic o ! co m m u n ity, o r s h a re t h e ir g e n e r a l in te rest s to rie s . S u b m is s io n s a re su b je ct u> E d it o r ia l C o m m itte e review-.
Teeter/Totter (more or less)
Lately there has been a great deal
of talk about obesity and Type 11 diabe­
tes in our young children. So much so
that McDonald's has taken off the mar­
ket their super-size programs. That pro­
gram was a marketing ploy which led us
to believe that we were paying less for
more. You may also have noticed that
there is not much to take home in
doggy bags from restaurants anymore.
But the prices of the foods have not
changed. In other words, we are getting
less for the price we paid.
It is funny that with the current low
cholesterol fed diets, extra fat is re­
moved but the cost of this reduced
food is more. Similarly, for caffeine-free
drinks and even bottled water we get
less for more.
I am dairy intolerant, so in restau­
rants I have to order pizza without
cheese or spaghetti without Parmesan.
But the price still stays the same for me.
So I pay more for less. Yet, if I had
asked for additional mushrooms you
can bet the price would be more.
A few years ago there was a push
to use generic medications rather than
name-brand drugs to help cut the cost
of medical care. But what has happened
is that new drugs are priced several
times higher to ensure that a profit is
made before the patent runs out. The
generic version is now priced some­
what lower than the name brand but
even so, the cost is probably more sub­
stantial than the cost to manufacture
the drug in the first place. So as a result
the consumer pays more for a less reli­
able product.
Similarly, in order to cut costs, mas­
sage therapy was offered as a health
benefit. By divorcing massage therapy
from physical therapy a patient referred
for physical therapy, lor whatever rea­
son. is given the therapy without mas­
sage. Patients are paying more and get­
ting less of a benefit from the therapy.
Health insurance premiums have
steadily climbed over the years and so
have co-payments blit the benefits pro­
vided have not changed. It may have
even decreased. Neither has the health
of our country improved as a result of
this. We are paying more for less.
Malpractice insurance premiums
have been steadily increasing over the
years. In order to keep abreast with
these increases, I have given up deliv­
ering babies and assisting in major sur­
geries. So I am utilizing less and less of
my skills and paying more and more in
premiums.
In medical offices, in an effort to be
efficient and maximize time, an invisible
barrier is placed around doctors so they
are not distracted from “productivity"
by patient calls. Patients are getting
less of a service even though they pay
more in premiums and co-payments.
Less time has to be spent with pa­
tients to allow more time for more docu­
mentation for more dollars. In my own
practice I have found myself having to
take on more and more of the responsi­
bilities which had been delegated to
staff in the past (e.g., coding). Cheat
sheets are no longer practical as more
and more specific codes are required for
better reimbursement. So I spend more
time with the codebooks and, hence,
less time with patients.
To satisfy insurance companies
when they come in for their audits and
lawyers in case of a lawsuit, I spend
more time documenting, therefore less
D aisv P u ra c a l M D
time with patients. Because they have
to read my notes, I now' scribble oil pa­
per at the time of the patient visit, then
dictate the encounter into a machine.
These notes are sent off to a third
world country where they are tran­
scribed and then sent back to me. I then
check and edit and sign off. Again, do­
ing more for less of the service I was
trained to provide. More and more we
are caught up in this elaborate system
that serves 110 purpose in the larger
scheme of things.
Years ago, frustrated with the long
hours at work with inadequate remu­
neration and little appreciation for the
work I was doing, I made a conscious
effort to streamline my practice and re­
duce my work hours. Doing less at
work gave me more time off to pursue
other interests in life that have really al­
lowed me to grow as a person. I am no
longer the slave to my vocation that 1
had tended to be before.
Recently, I closed my private clini­
cal practice of 21 years and joined a
physician group as an independent
contractor. The intent was to let go of
my administrative functions and re­
sponsibilities so 1can do less for more
peace of mind. We will have to wait and
see if this goal is achieved.
Have I made some wrong choices
along the way? More likely than not.
Would I have been more financially
successful? Very possibly so. Yet, am 1
happy with the way my life has
evolved? Yes - more or less. ■
November. 2004
PCMS BULLETIN
13
B u l l e t in
Lawyers sick over Texas
malpractice caps
Damage caps on medical malpractice awards, which took ef­
fect in Texas a year ago, are reducing the frequency of lawsuits,
providing an incentive for specialized physicians to practice in
the state and slowly reducing the cost of malpractice premiums,
according to the D a lla s M o rn in g N ew s.
L a w su it filin g s h a v e d eclin ed in sev era l T exas counties: In
Dallas, lawsuits dropped from about 127 per month between
January and August 2003, to 19 per month after September 2003,
when the damage caps took effect.
dfjJjAllenmore
Psychological
■fllAssociates, P.S.
752-7320 ■
...a m ulti­
disciplinary
behavioral
health group
that works
w ith physicians
Do you have patien ts w ith difficult emotional
and stress-related problems? Psychiatric and
psychological consultations are available.
Union Avenue Professional Building
____________ 1530 Union Ave. S.. Ste. 16. Tacoma_________
P h y sic ia n s p r a c tic in g in h ig h -r isk sp ec ia ltie s su ch as
In May 2004,419
neurosurgeons are licensed in the state, up from 407 in May
2003, while licensed obstetricians, gynecologists and Ob/Gyns
number at 3,201, up from 3,054 lastyear.
n eu ro su rg ery and o b stetrics h ave increased:
MorganStanley
In su ran ce prem iu m s have g one dow n for m any hospitals,
p a r ticu la r ly th o se th a t se lf-in su r e fo r th e in itial $5 m illion ,
The state’s hos­
pital association said that on average, its members reported an 8
percent decrease in premiums in 2004 and a 17 percent drop for
renewals into 2005.
The Texas Medical Liability Trust, the state’s largest medi­
cal liability insurer, has reduced its rates by 16.4 percent. Mean­
while, the state's joint underwriting association was denied a
35.6 percent rate increase by the Texas Insurance Commissioner.
$ 1 0 m illio n or $25 m illion o f p o te n tia l losses:
Source: Terry M axon, "No Cure-All: Time H a sn 't H ea ted C ontroversy
O ver C aps on D am ages, " a n d "D octors Still A w aiting L ow er Rates, "
D alla s M o rn in g N ew s, S ep tem b er 26, 2004. m
Morgan Stanley Funds come with an
extra dividend: Sound Advice.
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221 Fifth Avenue W
Olympia, WA 98507
800-733-3433
Call me for brochures and prospectuses, which contain
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Please read the prospectuses carefully before investing.
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14
P C M S BULLETIN
November, 2004
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Site to help residents buy drugs from Canada
Editor s Note: In regard to pharm aceutical sales from co n n in ' to
country. Dr. L en A le n ic k discovered in his research that there is a
little known world trade agreem ent p a ss e d in 1994 that dictciles that
any U.S. company that refuses to com ply with another co n n in ' s phar­
maceutical price controls by sellin g drugs a t greatly reduced p rices
risks losing its p a tent protection. This agreem ent - which only applies
to pharmaceuticals - has the p u rch a ser saying, "ire '// p a y yo u h a lf the
cost ofyour drugs an d i f y o u don't agree, we will violate yo u r pa ten t
and make kn o ck-o ff versions. "
Part o f this deal is that the p urchasing co n n in ' will not turn
around and re-sell the drugs to A m ericans. But, purchasing countries
like Canada are illegally re-selling anyway, as the law is rarelv en­
forced.
Consequently, the p h arm aceutical com panies d o n '/ like this and
are limiting supplies they sell to C anada f o r their use. but not enough
to re-sell back to Americans. It is a n ticipated that as dem ands from the
U.S. increase because o f costs, there w ill be a dw indling supply for
Canada to sell back to the U.S.
Washington state recently launched a website to help
guide senior citizens and others to Canadian pharmacies for
lower-cost prescription drugs.
Outgoing Governor Gaiy Locke, a Democrat who has
clashed with the Bush administration over its ban on
reimporting U.S.-made drugs from Canada, announced the
state’s plan to defy that edict and link with Wisconsin’s online
access to Canadian pharmacies.
“It’s for our citizens that we are taking matters into our own
hands and fighting against the skyrocketing cost of prescrip­
tion drugs.” the governor told a news conference.
The website, www.rxAva.gov, does not directly link to any
Our Clinical
PET Specialists
Anthony Larhs, MD
pharmacies. Instead, it offers a link to the Wisconsin site. The
Wisconsin site offers links to three Canadian pharmacies.
The Washington site also includes background on buying
Canadian drugs, various warnings about possible downsides and
an acknowledgment that reimporting U.S.-made drugs from
Canada or those manufactured abroad violates federal law.
Clifford Webster, a lobbyist representing the Pharmaceutical
Research and Manufacturers of America, had no immediate objec­
tion to Locke’s new program.
“He has essentially done a gigantic Google search for con­
sumers, something they can already do," he said. “The devil will
be in the details.”
Locke said he assumes that the Bush administration will ob­
ject, but that it’s up to Washington state residents whether to
avail themselves ofthe consumer information. The states have a
strong legal basis for helping their citizens this way, said Locke,
who is not seeking a third term.
Locke said Wisconsin and Minnesota have checked out the
companies and attest that they are “safe, reputable and reliable.”
Bruce Reeves of the state Senior Citizen Lobby said Rhode
Island and Vermont have similar programs.
“If they’re safe for Canadians, they’re safe for us,” he said.
By December 1, the state will launch a retail price comparison
service for the 25 most commonly used prescription drugs, includ­
ing the Canadian prices.
Locke said that more than 700,000 Washington residents, in­
cluding an estimated 210.000 seniors, don’t have prescription
drug coverage and have to buy at full price. They will be the most
likely to benefit from buying Canadian, he said. ■
R e p rn itc if fro m th e S e a ttle PI. 1 0 /2 7 /0 4
Featuring software fusion for image
registration with multiple modalities
(CT, MRI and SPECT).
Director of Clinical PET
Phillip C Lesh, MD
William B Jackson, MD
For a comprehensive referral packet,
call your Customer Care Representative,
(253) 761-4200.
For information call
(2 5 3 ) 7 6 1 -4 2 0 0
Roy McCulloch, BS, C N M T
Supervisor PET & Nuclear
M edicine
2 2 0 2 S C ed ar S tre e t, S te 200
(2 5 3 ) 7 6 1 -4 2 0 0 f o r s c h e d u lin g
TRA
tedical
a g in g
EX CELLEN C E - PERSON TO PERSON
November, 2004
PCMS BULLETIN
15
B u l l F T IN
Don’t Forget to Make Those Whistler Condo Reservations
Registration continues to be open for
the College’s CiVIE at Whistler/Blackcomb
program. The conference is scheduled for
January 26-30.2005.
CME at Whistler participants are
urged to make their condo reservations
early. A collection of one and two bed­
room luxury condominiums just steps
from the Blackcomb chair and gondola are
available. Space is available on a first
come first served basis.
Reservations for the block of con­
dos. A LL IN 111E. / .S77-..V.VO N
B L A C K C O M B , are available. To take ad­
vantage of these savings, you must make
your reservations soon, as conference
dates are during the high ski season. The
College's reserved block of rooms will be
released after December 1. 2005.
Reservations can be made by calling
the A sp e n s on B la c k c o m b toll free at 1866-788-5588. You must identity' yourself
as a part of the COME group. For more in­
formation call the Colleue at 627-7137. ■
C M E at W h istler p ro g ra m lo d g in g lo ca tio n - th e A sp e n s on B la c k c o m b - has skiin /ski-o u t o n e a m i tw o bedroom co n d o s at la st real' s c o n fe re n c e p ric e s
Same Day MRI's
Precision Imaging of Puyallup offers
state-of-the-art MRI's with same day
appointments, easy scheduling and
fast report turnaround times for
referring physicians.
Precision Imagine
at the Brain and Spine Center
1519 3rd SE, Suite 103 • Puyallup, WA 9 8372
Phone: 2 53.8 4 1.0 8 5 1 • Fax: 2 5 3.8 41.4 9 9 7
16
PC M S BULLETIN
November. 2004
?P(pj'rv 'tip im fif Q '( { w /t c a ld /o m /if
COLLEGE
OF
MEDICAL
EDUCATION
Need Whistler
Condo Reservations!
January 2 6 - 3 0
Don’t forget, the popular CME pro­
gram at Whistler is Wednesday
through Saturday, January 26'1' to the
30“', 2005. It is important for you to re­
serve your lodging as soon as possible.
The College has arranged for ac­
commodations
primari ly at the
Aspens Condos.
Reservations can
j
\
be made by cal I\
ing A sp en s on
\
B la ckco m b , toll
free at 1-866-7885588. You must identify yourself as part
ofthe COME group. Please make your
reservations by December 31.2004, be­
cause after that date any remaining
condos will be released.
The course directors arc Dr. R ich ­
ard Tobin and Dr. John Jiganti. Course
topics include:
■N ew C oncepts in M igraines a n d
H eadaches
■Outpatient Sp in e Surgery
■Fat: The G I P erspective
■33 Seconds a n d C ounting
■A dvances in the D ia g n o sis a n d
Treatment o f B reast C ancer
The Whistler CME is a “resort”
program, combining family vacationing,
skiing, a resort atmosphere, with con­
tinuing medical education. ■
Continuing Medical Education
Cardiology for Primaiy Care coming
January 11 and 18,2005
Sign-up begins now!
The College’s eighth annual pro­
gram featuring topics in cardiology for
the primary care physician will be held
at St. Joseph Hospital in the Lagerquist
Conference Center. Gregg Ostergren,
DO returns as the Course Director.
The C ardiology fu r P rim ary Care
conference will be held on two con­
secutive Tuesdays. January 11 and
January 18.2005.
This is an evening program for
your convenience, giving you CME
credit opportunity outside of office
hours. The programs run from 6:00 pm
to 9:00 pm on both nights, for a total of
six credit hours.
This is a popular program, please
register early. ■
Continuous Improvement at the College
The College of Medical Education
is respected throughout Pierce County,
as well as our entire region, for the
quality of its continuing medical educa­
tion. This is not an accident. Every
year, each aspect ofthe College is
evaluated. Everything from course con­
tent to conference locations to quality
of speakers is reviewed, searching for
areas of improvement, as well as affirm­
ing those areas that were successful.
For fifteen years, Les McCallum set
a standard of excellen ce, and the new
Program Administrator Scott Peterson
will continue that tradition by con­
stantly improving. Scott encourages
the physicians of Pierce County to slay
in touch, providing feedback, both
positive and critical, so the College can
always do better. You can reach Scott at
(253)627-7137 or via e-mail at
scotltSpcmswa.org. ■
Dates
Program
Director(s)
Friday, November 12
Infectious Diseases
Update
Larry Schwartz, MD
January 11 & 18
Cardiology for Primary
Care
Gregg Ostergren, DO
January 26-31
CME at Whistler
Tuesday (evenings)
Friday, February 4
Gastroenterology for
Primary Care
Thursday-Friday
Internal Medicine
May 5-6
Review' 2005
Friday, April 22
Friday, May 20
Rick Tobin, MD
John Jiganti, MD
Ralph Katsman, MD
Art Knodel. MD
Radiology for the
Rick Tobin, MD
Non-Radiologist
Andy Levine, MD
Primary Care 2005
Steve Duncan, MD
November, 2004
PCMS BULLETIN
17
B u l l e t in
Peterson
TACOMA/PIERCE COUNTY]
from page 11
into the city.
Peterson and his wife Janet, a Spo­
kane native, returned to Olympia a few
years ago with their three children (now
ages 10, 11 and 13). “We needed to get
the grandkids close to their grandpar­
ents,” he said. He still feels a close con­
nection to DC, however, and makes cer­
tain to keep close contacts there for vis­
its when the opportunity arises.
Peterson’s professional life is varied
as he provides public relations and pub­
lic affairs consulting services to a variety
of clients, including Microsoft, Kraft
Foods, Southern Company, as well as
other Fortune 500 businesses. In addi­
tion, he consults with a coalition of util­
ity companies on federal regulations;
deals with the local American Heart As­
sociation on tobacco-control issues; and
provides development assistance to
Pierce County nonprofit organizations,
including the Tacoma Urban League,
R iJ H ) \ ' 1 J
#
J
J jij
Central Latino, and others. He has been
extensively involved with the Clean In­
door Smoking Initiative Campaign, and
also provides pro bono help to the
Olympia Symphony and the Thurston
County Habitat for Humanity. In addi­
tion, Peterson worked in the Washington
State House of Representatives during
the 2001 -2003 legislative sessions.
With the demands of running his
own business, Peterson doesn’t have a
lot of spare time these days, but he does
enjoy golf, reading and touring U.S. his­
torical sites when he has the opportu­
nity. He and Janet are also busy attend­
ing their children’s band concerts and
tennis matches.
He looks forward to continuing the
success of the College of Medical Edu­
cation and welcomes new challenges as
they are presented to him.
PCMS and the College of Medical
Education welcome Scott Peterson.■
Outpatient General Medical Care.
Full and part-time positions
available in Tacoma and vicinity.
Very flexible schedule. Well suited
for career redefinition for
GP, FP, IM.
C ontact A ndy Tsoi, M D (253) 752-9669
o r Paul Dots-- (Allen, N elson. T u rn e r &
Assoe.), C linic M anager (253) 383-4351
: AMERICAN LUNG ASSOCIATION*
ofV\fcshirtg!on
1-800-LUNG-USA
L ung Inform ation
Service L ine
Providing patient
ediication materials
A Better WayTo Relieve
Office Headaches
T'J
D rfjiia
| w w w .o n e h e a h ^ip o rt.c o m
Join thousands of local health care providers who have discovered a cure for
endless paperw ork and phone calls! A free single password from OneHealthPort
allows you to securely sign on to the provider web sites of leading local health
care plans'1. And now, O neH ealthPort also provides direct access to services
that help m anage both the clinical and
adm inistrative sides of your practice.
It’s easy to register for a O neH ealthPort
password, and it’s free. Just go to
w w w .onehealthport.com .
Of
HealthPort"
L e t O n e H e a lth P o r t ta k e th e
h e a d a c h e o u t o f d a ily o ffic e work.
In a recent online survey, more
than 1,300 subscribers ranked
OnetlealthPort’s top benefits as:
• Eliminates calls and faxes (85%)
• Saves time (80%)
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-'Now available on O neH ealthP ort: A.suris N orthw est H ealth, F irst C hoice H e a lth A dm inistrators,
G ro u p H ealth C ooperative, P re m e ra B lue Cross, R egence B lueS hield, U niform M edical P lan a n d othere.
18
P C M S BULLETIN
November, 2004
V , —
—
—
- --
—
Classified Advertising
POSITIONS AVAILABLE
Need office help in a hurry?
Tacoma/Pierce C ounty outpatient
general medical care at its best. Full and
part-time positions available in Tacoma
and vicinity. Very flexible schedule. Well
suited for career redefinition forG.P,
F.P., t.M. Contact Andy Tsoi. MD (253)
752-9669 or Paul Doty (Allen, Nelson.
Turner & Assoc.), Clinic Manager (253)
3834351.
Established Auburn Fam ily Practice
looking for P/T to F/T Board Certified 01Board Eligible Physician to join a group
practice. Work 3-4 days a week with a
great support staff. Base salary plus in­
centive. Fax your CV to 253-847-9630.
OFFICE SPACE
For Rent: 3300 sq ft C lass A m edical
office in Tacoma Medical Center. 1112
6th Ave, third floor. Elevator, under­
ground parking, close to hospitals,
ownership options. Call 253-272-2224.
Office space for lease in m edical
Pierce County Medical Society - Medical Placement Service
the solution for all your staffing needs
P ro v id in g e m p lo y e es w ith o u t the h a ssle o f salary, b e n efits, ta x e s and o th e r such
em p lo y e e re q u ire m e n ts, and...T em p to P e rm : A unique o p p o rtu n ity to w o rk w ith a
p o te n tia l e m p lo y e e on a trial b a sis - w ith o u t o b lig a tio n to hire!
For more information call Kerri or Melissa at 572-3709
MEDICAL LICENSURE ISSUES
Mr. Rockwell is available to represent physicians and other health care
providers with issues of concern before the Stale Medical Quality Assurance
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 ol a confidential attornev-client representation agreement.
Gregory G. Rockwell
Attorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
(425) 453-4398 • FAX (425) 453-1534
email: [email protected] • website: www.gregrockwelllaw.com
complex. Gig Flarbor. 2354 sq ft, main
level. 468-3539 or 565-2444.
rauelerS
L
H e a lt h
S e r v ic e
A service of
JAfter
breast
surgery
th in t^
o f us.
Union Avenue Pharmacy
and Corset Shop
Formerly S m ith's C orset Shop
2302 S Union Ave 752-1705
N o r t h w e s t M e d ic a l S p e c ia lt ie s, P L i c
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• PRE-TRAVEL CARE
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o r 253 -6 2 7 -4 1 2 3
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INFECTIONS LIM ITED PS
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November, 2004
PC/v/6' BULLETIN
19
B u i .i . h t i n
woimtm
oM eduxd &odA
&
/)
A s a claims representative and supervisor, I see physicians ol all specialties
whose lives are suddenly changed by claims filed against them. Whether the
cases are dismissed, settled, or go to trial, each physician’s personal and
professional life can take a turn for the worse, and that’s why I’m here to
help. I analyze each claim, stay in close contact with our attorneys, and work
with the physician on new strategies as the case develops. Every physician is
important to me, and I make sure my work shows them that I care.
To find out about the many ways Physicians Insurance works with and
for physicians, call us today.
Western Washington
Eastern Washington
1-800-962-1399
1-800-962-1398
1-800-565-1892
Physicians
Insurance
A Mutual Company
V isit n u r W e b s ite a t p h y in s .c o m
WA
Pierce C ounty M edical Society
223 Tacoma A venue South
Tacoma. WA 98402
Return service requested
20
P C M S BULLETIN
November, 2004
&
P h y s ic i a n s I n s u ra n c e 2002
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA. WA
PERM IT NO 605
2004 Holiday Sharing Card
Artist: LauraYu, daughter of Amy Yu,MD
Annual Meeting: S eepageS
IN S ID E :
3
4
5
7
9
P r e s i d e n t ’s P a g e : “ T h e P C M S S t r e t c h ” b y M i c h a e l K e lly , M D
D o y o u t e n d to u n d e r c o d e ? Y o u ’ re n o t a lo n e
J o in u s f o r t h e A n n u a l M e e t i n g D e c e m b e r 14
L i a b i li t y p r e m iu m i n c r e a s e s s l o w i n g , y e t r a t e s r e m a in a t r e c o r d h ig h s
In M y O p i n i o n : “ A C a ll to A c t i o n ” b y A n d r e w S t a t s o n , M D
14
T h e P o w e r o f t h e A p o lo g y
V
B u l l e t in
ifa w tty Q -lledim f <3 ocw lf
P C IM S O f f i c e r s / T r u s t e e s :
M i c h a e l J. K e l l y M D , P r e s i d e n t
P a tric k J. H o g a n D O , P re s id e n t E le c t
K e n n e th A . F e u c h t M D , V ic e -P re s id e n t
J o s e p h W . R e g im b a lM D , T re a s u r e r
S u m n e r L . S c h o e n ik e M D , S e c re ta ry
J. J a m e s R o o k s , Jr.. M D , P a s t P re s id e n t
L a u re l R. H a r r is M D
J e ff re y L. N a c iitM D
J o s e p h F. J a s p e r M D
N a v d e e p S . Rai M D
R o n a ld R . M o rris M D
C arl W . W u lf e s tie g M D
..^ =
U L L E T IN
December, 2004
P C M S M e m b e r s h ip Benefits, Inc (M B I):
T i m S c h u b e r t M D , P r e s i d e n t ; D r e w D e u ts c h
M D , P a s t P re sid e n t; J o e R e g im b a lM D , S e c re ta ry T re a s u re r; K e ith D e m iijia n M D ; S t e v e D u n c a n M D iM a r k
G i ld e n h a r M D ; S te v e S e ttle M D ; J o e W e a m M D
C ollege of M ed ical E ducation (C .O .M .E.):
J o h n J i g a n t i M D , P r e s i d e n t ; G a r r ic k B r o w n
M D , S te p h e n D u n c a n M D , B a rb a ra F o x M D , D a v id
K ilg o re M D , W illia m L ee M D , G r e g g O s te rg re n D O . B ra d
P a ttis o n M D ,G a r i R e d d y M D .C e c il S n o d g ra ss M D .
V irg in ia S to w e llM D . R ic h a rd W a ltm a n M D .T o d W u rst
M D ; Ju lie S c h n e id e r, G o o d S a m a rita n H o s p ita l; L isa
W h ite , M u ltic a r e H e a ltb S y ste m ; S iste r A n n M c N a m a ra ,
T re a s ttre r. F ra n c isc a n H ealth S y ste m : S u e A s h e r,
3
President’s Page: “The PCMS Stretch"
4
Do you tend to undercode? You’re not alone
5
Join us for the Annual Meeting December 14
7
Liability premium increases slowing, yet rates remain
at record highs
W SMA
Representatives:
T ru s te e s: L e o n a rd A le n ic k M D: R o n M o rris M D ;
N ic h o la s R a ja c ic h M D ;D o n R u s s e ll D O
W A M P A C 6 th D istrict: D o n R ussel) D O
W A M P A C 9 lh D istrict: L eo n a rd A le n ic k M D
9
In My Opinion: “ACall to Action”
S t a f f : E x e c u tiv e D ire c to r: S u e A s h e r
A d m in istra tiv e A ssistan ts: T a n y a M c C la in , C risti P e te rso n
P la c e m e n tC o o rd in a to r: K eiri B a k e r
P la c e m e n t A s sista n t: M e lis s a K re g n e ss
C M E P ro g ra m A d m in istrator: S c o ttP c te rs o n
B o o k k e e p e r: Ju a n ita H o fm e is te r
13 College of Medical Education
Secretary
P C M S F o u n d a t io n : JLawrcncc A.
L a r s o n D O , P r e s i d e n t ; C h a r l e s W e a lh e r b y M D ,
M o n a B a g h d a d i. N ik k i C ro w le y . T re a s u re r; S u e A sh e r.
S e c re ta ry
T h e Bul l et i n is p u b lish e d m o n t h l y by P C M S
M e m b e r s h i p B e n e (Its. inc. D e a d lin e lo r su b m i t t i n g ar ticles
a n d pl a c i n g a d v e r t i s e m e n t s is the I 5th oi'the m o n th
p r eced in g publication.
T h e Bul l et i n is d e d i c a t e d to the art. sc ien ce and d eliv ery
o f m c d i c m c a n d the b e t t e r m e n t o i'the health an d m edical
w e l f a r e o f the c o m m u n i t y . T h e o p i n i o n s herein are th o se o l ‘
the in dividual co n t r i b u to r s an d d o not n ecessa rily r e l i e d the
o fficial posilion o f P C M S . A c c e p l a n c c o f a d v e r l i s i n g in no
w a y c o n s titu te s p ro fession al ap p r o v al or e n d o r s e m e n t o f
p r o d u c t s o r s e rv ic e s ad v ertised . T h e Bulletin re se r v e s the
right to r e j e c t a n y a d vertising .
M a n a g i n g Editor: S ue A sher
E d i t o r i a l C o m m i t t e e : M B I B o a rd o f D ire c to rs
A d vertisin g Inform ation: 253-572-3666
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
2 5 3 -5 7 2 -3 6 6 6 ; F A X :2 5 3 -5 7 2 -2 4 7 0
E -m a il a d d ress: p em sff/ip c m sw a .o rg
H o m e P age: h ttp ://w w w .p c m sw a .o rg
2
Table of Contents
P C M S BULLETIN
December, 2004
12 Applicant for Membership
Physicians in crisis states contemplating moving
14 The Power of the Apology
15 Classified Advertising
j/ 't e x c e iio t u t t z O - d e d a a ! t f m e / t f
President s Page
b>
M'c h a d ) K‘ ll?' MD
The PCMS Stretch
P olitics, it seem s to me, fo r years, o r all too long, has been
c oncerned with right o r left in stea d o f right o r wrong.
- Richard Armour
When trouble a rises a n d things look bad, there is ahvavs
one individual w ho p e rc eive s a solution a n d is w illing to
take com m and, ie r v o ften, th a t p e rso n is crazy.
M ic h a e l J. K cllv. M D
-Dave Barry, “Things That Took Me 50 Years to Learn”
I don’t think there is a PCMS presi­
dent who doesn’t feel relieved that his/
her tenure is nearing its end. And why
not? The job is truly daunting, time
consuming, challenging, frightening,
while at the same time, rewarding, selfrevealing, and oddly satisfying. The job
truly causes one to stretch, and grow.
So - thanks for the stretch.
As 2004 began, 1quickly found
myself moving outside my tidy comfort
zone of medical practice right into the
foreign realm of politics. This process
ofpoliticization concerned me greatly. I
didn’t want to become a politician. Call
someone a politician and he or she may
well challenge you to choose between
swords and pistols at sun-up. We cry
politics when we think someone has
made a statement that leaves a credibil­
ity gap - as if you are accusing that
person of having a forked tongue.
But it wasn’t as bad as I feared.
Despite nearly 12 months on this job,
my tongue is intact. Not only that, I’ve
learned that it is possible to be political
without becoming an obnoxious, selfserving, power-hungry despot (though
some state legislators may disagree...).
I learned it is possible to work with
physicians and politicians of disparate
political philosophies toward common
goals affecting our profession without
inviting political invective or acrimony,
whether the issue is fluoride, smokefree workplaces or tort reform.
For the past year. 1 have observed
the political activities of the WSMA
with great admiration and regard. Their
support of the Pierce County Medical
Society this past year is worthy of note.
The WSMA-introduced Initiative 330 is
an excellent example of the appropriate
use of power on behalf of the patients
and physicians of this state. By the
time you read this, we should have
enough valid signatures to present this
important initiative to the legislature in
2005.
[t should come as no surprise to all
but the politically naive that if we are to
maintain practice viability, continue to
speak out for the medical welfare of our
patients, and work toward meaningful
liability reform, continuing and, indeed,
increasing our political activities are of
paramount importance. However, with
the wide range of political philosophies
and sensitivities, is this truly possible?
For the answer, one has only to look at
the activities of the members of our so­
ciety this past year - one in which po­
litical commitment became a cause celebre.
Our own Health Department Direc­
tor. F ed erico C ruz led the way by run­
ning for governor. Emergency depart­
ment physician Matt Rice mounted a
strong campaign to unseat incumbent
Rep. Pat Lantz in the 26"' district. Ron
M orris, board member of PCMS and re­
cently elected member of the WSMA
board of trustees, committed himself
and his family to the daunting task of
running for the state house of represen­
tatives from the 25th district. P at
H ogan, incoming president of PCMS,
led the statewide effort to make the
Washington workplace smoke-free. D an
N ehls became the lord of the overpass
in Gig Harbor as he organized the earlymorning sign waving for legislative
candidate Matt Rice. Joe and Donna
Jasp er gave generously of their time
formally medically friendly candidates,
including a fundraiser for Sen. Mike
Carrell. K en Feucht went door to door
with Wally Nash in Puyallup to energize
Wally’s campaign.
I could continue this litanv, hui
time and space limit (he inckisi. ■i i
many other worthy PCMS ptr, ah. iar*s
SCl- "Sirei'-li"
D ecem ber. 2 004
P C M S B U L L E I IN
Do you tend to undercode? You’re not alone
A study confirm s w hat many doctors already believe - they don’t give them selves
credit for everything they do. That affects fees and, perhaps, quality m easurem ent
Bill Thrift, MD, a family physician
in Prescott, AZ says his office fre­
quently undercodes claims after treat­
ing patients with multiple, complex
problems. He’s just anticipating what
insurers might reject.
“One of the hardest things for us
to do is really charge what we’re
worth,” he said. “We’re not aggressive
at working the system.”
Weary of fighting with insurers,
fearful of getting audited by Medicare,
or merely unsure about what they can
code for — for whatever reason, many
physicians habitually undercode.
A recent study has quantified how
much family physicians don’t put on
their bills. The numbers raise questions
not only about undercoding’s effect on
a physician’s income, but also about its
effect on quality measurement pro­
grams that use claims data to determine
how' well patients fare, and what sort of
cash bonus a doctor might receive as a
result.
The coding study, by researchers
at the University of Wisconsin Medical
School, found that family doctors man­
age an average of 3.05 problems per pa­
tient visit. But they record only 2.82 in
the chart, and 1.97 on the bill.
“1 have been tending to undercode
my visits, and I didn’t really realize it
until this project,” said Cynthia Haq,
MD, a family doctor in Madison, WI
who was one of 29 physicians whose
charting and billing methods were scru­
tinized. “ I often undercode ... and write
down one or two [problems] when
there might be four or five."
Family physicians tend to accept
that they advise patients on a variety
of issues but will be compensated for
only some, knowing insurers will look
at some CPT codes but ignore others if
they feel additional payment isn’t war­
ranted for the same visit. Physicians
don’t have enough time to record every
facet of a visit if the system doesn’t re­
ward that kind of thoroughness. Dr.
Haq said.
But in some cases additional cod­
ing could result in more income, experts
say. The Wisconsin study found family
physicians, in particular, don’t often bill
when they counsel for mental illness,
substance abuse or tobacco addiction,
because they don’t think reimburse­
ment is likely.
Though 29 physicians may seem
like a small sample, many say their expe­
riences are typical. Dr. Thrift, who
wasn’t part ofthe study, said he spends
about 30% of his time on matters related
to emotional problems but many payers
reimburse family doctors reluctantly or
not at all for anything that looks psy­
chiatric. “We are very good at [counsel­
ing],” he said. “All [family doctors] do
it, and all ofthe time, and we don’t get
paid for it.”
In other cases, physicians want to
shield patients from possible adverse
actions if insurers learn about emotional
problems or addictions, and leave those
conditions off the bill or chart or both,
according to the study, which appeared
in the September-October^n/jar/.v o f
F a m ily M edicine.
Doctors should record the level of
service they provide, despite their
doubts about payment, said John C.
Nelson, MD, MPH, president of the
AMA. It is “no wonder physicians are
apprehensive about appropriately re­
porting complex procedures and ser­
vices they provide for fear of health
plan retribution, given current health
plan business practices of downcoding,
bundling and reassigning physician
CPT codes to reduce or deny physician
payment,” said Dr. Nelson, a Salt Lake
City ob-gyn.
But ifprimary care physicians are
telling insurers about only a portion of
what they do, quality measurement pro­
grams may not work to their potential,
experts said.
“Most of the time looking at claims
data, you don’t know what took place
at the encounter,” said Josie Williams,
MD, an internist and gastroenterologist
and co-chair of the Physician Consor­
tium for Performance Improvement, a
large group of quality experts periodi­
cally convened by the AMA.
Charles M. Cutler, MD, head of na­
tional quality management for Aetna
Inc., said claims data can still be useful
for tracking adherence to certain best
practices ranging from child vaccina­
tions to mammogram rates. He said he’d
be " happy to hear about” ideas for bet­
ter measurements from family physi­
cians.
But Dr. Cutler, an internist, added:
“I don’t know one could ever measure
the universe of what a family physician
does.”
Dr. Thrift, for his part, is trying to
survive in that universe, even if he un­
derstands that payers never will know
everything he does for patients. After
one recent patient visit, he decided to
be a bit bolder in his billing.
The patient, who has developmen­
tal disabilities, talked about her anxiety
and sleep disturbances and the medica­
tions she takes for them. Dr. Thrift
checked her blood pressure and ex­
plained the importance of controlling it.
But for the bulk of the visit, he spent
time cutting her painful toenails, be­
cause he knew the payer did not cover
trips to a podiatrist.
In what he calls a “risk” and a
"gamble,” Dr. Thrift decided to add the
toenail trimming to the bill using a CPT
modifier— a $20 charge. It was a very
tiny but, in his view, a long-overdue
step in the direction of opposing selfdowncoding.
“This is the first time I’ve tried to
bill for it, and I’ve done it a zillion times
before,” he said. “Whether they’ll pay
for it is something that remains to be
seen. Let’s see if I can do it.” ■
Reprinted from AMNews, Nov. 22129, 2064
4
P C M S BULLETIN
December, 2004
— ^
2 0 0 4 A N N U A L M E E T IN G
T u e s d a y , D e c e m b e r 14, 2 0 0 4
S o c ia l H o u r :
6 :3 0
Sheraton Tacoma Hotel, Ballroom
Dinner:
7:0 0 p.m.
1320
P ro g ra m :
8 :0 0
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p .m .
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w ith the In rrn a tiu n ol In te ^ n T a lk __ M a k in g a d it k 'iv m
w ith i n l r n r it y ! A ^ rat In ate oh th e U n iv e rs ity nh Texas .if A u s tin (K B A , Jl. >> he I 'lc a m t1 ,i CPA am i has aeqi.iin
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♦ Introduction of the 200? 0 ^ ' cers ar)d President, £)r. Patrick )“1o^an
: bring an unwrapped toy (child) a n d /o r a w rapped gift (woman) fo r V W C -/X .5 h elter residenbs
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la c o m a A v e n u e S o u th ,
la c o m a , W A 9 3 4 Q ;'
You m a y fa x to 5 7 2 -2 -3 7 0 o r c a ll 5 7 2 -3 6 6 7 fo r m o re in fo rm a tio n
Please reserve _ _ _ _ _ dinner(s) at $40 per person.
Enclosed is my check for $
Or. charge my credit card # __________________________________
□
Visa
□
M a ste rC a rd
S ig n a tu re :____
E xpiration date ______
_______________________________
My nam e for nam e tag (please print or s ta m p ) __________________
My spouse/guest nam e for nam e t a g
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W e hope you will jo in us!
D ecem ber. 2 004
P C M S B U L L E ilN
from page 3
who have contributed their time, money and support to medi­
cal political agendas this past year.
Our society has bucked the trend toward ideological seg­
regation as we have chosen to set aside partisan politics for
the good of our patients and our profession. We bridge this
gap by getting to know one another. Whether conservative,
liberal or libertarian, physicians on our board and in the medi­
cal society hold many common values and similar professional
qualities. It is of great importance to the success of PCMS and
the physicians of this state, that we maintain this focus and
fraternity.
Because of our allegiance and strength of purpose, we
have attracted more physicians to join PCMS, during this past
year, than in the recent past. We have become a larger, stron­
ger, and more vocal society.
Senator Dale Brandland said at a rally in 2003 that we
nai've physicians were being “out politicked.” He strongly
suggested we needed to learn the political ropes and apply
such knowledge if we were to evoke change in Olympia. Since
then we have proven to be an effective political force, deserv­
ing a seat at that table. Through our concerted efforts, we
have achieved a degree of recognition and respect with key
members ofthe legislature.
So what of the future? This is not the time to stand
around patting our collective selves on the back, or whining
about missed opportunities this past year. There is plenty to
do. There is also great opportunity. Lucky for us we have the
right physician to lead us, Pat Hogan. Pat is a proven leader
who will be backed by an excellent board of directors, includ­
ing incoming members D a v id B a les, and L o r en F in ley. He is
just the man Dave Barry had in mind.
The superb anchoring influence of our executive direc­
tor, Sue Asher, will continue to serve PCMS in 2005. Sue is
the hub around which we physician spokes emanate - the
glue that holds us together and keeps us true to our mission.
With her outstanding leadership and with the help from the
PCMS staff, we can continue to be a force for our profes­
sion.
At the request of Pat Hogan and with the blessing of
the board, I will continue to be active on behalf of medical li­
ability reform. I know that with persistence we will eventually
achieve meaningful results rendering any such further tortrelated activities unnecessary.
“Everything has an end - except a sausage, which has
two,” so goes an Old Danish proverb. In my case, though
my ten Lire as your president was not a sausage, it may have
seemed hammy on more than a few occasions. Nonetheless,
it has ended. I’ve had a wonderful time representing you. So,
thanks again for that stretch, a period of growth, better than
anything I could have imagined!*
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To discuss the ways you can best protect you an d your family,
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U PHYSICIANS
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6
P C M S B ULLETIN
December, 2004
_______________________________ fyo iiso ra l by Ibe W eb tu tfm i State Medical Association
—
J / \ Cra- is<>in<l<i C (le d tc a /Q fo c te h .f
Liability premium increases slowing, yet rates
remain at record highs
15% of insurance companies expect “significant” rate increases over the next year.
In 2003, 83% held that outlook
More than 67% of medical liability
insurers say premiums seemed to be
leveling off in 2004, according to results
from the annual M edical L ia b ility
Monitor rate survey that looks at how
much medical liability insurers are
charging doctors.
But that’s a thin silver lining in
what is still a substantial cloud.
Rates are not leveling off every­
where. Triple-digit increases are still be­
ing reported by some carriers, the sur­
vey showed. And physicians who are
experiencing smaller increases are still
paying record-high rates.
Also, no one is predicting the end
of a “hard market” that has insurers
pulling out of certain areas and being
more choosy about which physicians
they’ll insure.
“The crisis we see is not over,"
said American Medical Association
President John C. Nelson, MD. MPH.
“It’s a tough time for doctors right now
in the liability arena."
Tort reform that includes a $250,000
cap for noneconomic damages remains
theAMA’sNo. 1 legislative priority.
Some liability insurers are reporting
triple-digit rate hikes.
Those with a hand in the insurance
business agree that the problem isn't
solved.
“A lot of the big increases are be­
hind us, but insurers have had big
losses,” said Lawrence Smarr, president
of the Physician Insurers Association
ofAmerica, an association of doctorowned and/or operated medical liability
insurers.
The 2004 rate survey asked compa­
nies to report their mature claims-made
manual insurance rates with limits of S1
million/$3 million as of July 1 for three
specialties: internists, general surgeon
and ob-gyns.
Among the 788 rates that were re­
ported, the majority of increases fell
within the 6.9% to 24.9% range. That’s
an improvement over last year, when
the majority of increases fell between
the 10% and 49% range.
Barbara Dillard, editor o f M edical
L ia b ility M onitor, noted that although
the increases might be smaller, they are
being added on to historically high in­
surance bills.
“Even though Dade County, Fla.,
obstetricians, for example, experienced
only an 11.3% increase, their annual
premiums were reported at 5277,241 by
one insurer," she said. “Illinois obstetri­
cians are paying as much as $230,428,
and in Michigan, it’s as high as
$193,819.”
Location matters
Where physicians practice medi­
cine did make a difference in how much
they paid.
Medical Society' of the State of
New York associate counsel Moe
Anster said rates continue to be trend­
ing upward, not stabilizing.
But in Nebraska, the environment
is stable. Physicians there pay some of
the lowest premiums in the country, and
they credit tort reforms first enacted in
the 1970s for the friendly environment.
“We have doctors moving here from
other states.” said Sandy Johnson, ex­
ecutive vice president of the Nebraska
Medical Assn.
In some states, whether a practice
is in an urban or a rural area often
makes a difference in rates, too.
Physicians in large urban areas
tend to pay higher rates than doctors in
other parts of the state, the survey
showed. For example, internists in the
Detroit area insured by APCapital are
quoted $33,514 under the survey’s cri­
teria. The rate quoted for internists in­
sured with that same company in other
parts of the state (with the exception of
the Saginaw and Grand Rapids areas) is
$16,757.
"On the east side of the state
[where Detroit is], we are hearing anec­
dotal stories about problems that phy­
sicians are experiencing,” said John
MacKeigan, MD, president of the
Michigan State Medical Society. “A
number of physicians in Wayne County
have been forced to take employment
situations with hospitals. It’s the only
way to continue practice. ... On the
west side of the state, we’re not hearing
the same difficulties."
Dr. MacKeigan said the latest num­
bers are discouraging. Michigan has
some tort reforms, including tough ex­
pert witness standards, a rule that
holds physicians responsible only for
their portion of the damages and a cap
that is tied to inflation — more than
$350,000 now.
“We are trying to get a handle on
why we are paying some of the highest
rates in the country,” he said. "We are
looking at alternative dispute resolution
mechanisms."
For the most part, though, doctors
in states with tort reforms tended to
fare better than those in states without
reforms, according to the survey.
For example, in California, where
there is a $250,000 cap on noneconomic
damages and other tort reforms, the
highest reported rate for an ob-gyn in
the Los Angeles area was $89,953. ac­
cording to the survey. In Illinois, where
the state Supreme Court has struck
down previously passed caps, the
highest rate reported was $230,428 in
the Chicago area.
“The tort system is broken,” said
Harold L. Jensen, MD. chair of ISM IF
Mutual Insurance Co., a policyholderowned and -operated company. “ T h e
hard market is not over."
NORCAL Mutual lnsiir:-'u: ;“ ex­
ecutives said they s e c a iJiiYi. re n c e in
S j u ■■L I.tl- Iilit;. "
D ecem ber. 2004
P C M S B U L L t ; iN
S
Liability
from page 7
the need for rate increases based on whether tort reform is in
place. The company needed a 2% rate increase in California
this year and took a 20% increase in Rhode Island after actuar­
ies said a 51% increase was needed in the state, which lacks
reforms.
“So much hinges on the local tort laws," said Phil
Hinderberger, senior vice president and general counsel for
NORCAL. As long as California’s MICRAis in place, “we’re
looking at rate increases that track the cost of living.”
Local doctors staff
medical tent at Ironman
Triathalon Championships
L ook in g ahead
Compared with past years, fewer insurance firms expect to
have to raise rates “significantly” in the coming year, the rate
survey showed.
About 15% of firms that responded to the 2004 M e d ic a l
L ia b ility M o n ito r rate survey said they expect rates to in­
crease significantly next year. In 2003, 83% forecast signi ficant
increases in the next year. (The survey did not quantify “sig­
nificant.”)
Physicians in states that have passed tort reforms in re­
cent years are particularly optimistic. Mississippi and parts of
Ohio are starling lo see some stabilization.
In Texas, where voters enacted a $250,000 cap and then
passed an initiative that made the cap constitutional, about
half the state's physicians have seen a decrease in rates, with
the Texas Medical Liability Trust decreasing rates by 17%.
“We’re beginning to turn the comer,” said Texas Medical
Association President Bohn D. Allen. MD. “We’re just keep­
ing our fingers crossed that other states get relief.”*
Reprinted from A:\fNews, 11/15/04
(See related graph page 11)
F ro m left, Drs. L o ren B etterid g e , M ic h a e l B a te m a n a n d Ben
B e tte r id g e
Drs. L oren B etterid g e, M ik e B a te m a n and Ben
Betteridge staffed the medical tent at the Ironman Triathlon
Championship in Kona, Hawaii in October to provide medical
assistance to participants. Dr. Ben Betteridge is currently the
chief resident of Emergency Medicine at Madigan. Dr. Mike
Bateman and Dr. Loren Betteridge are family/sports medicine
doctors with private practices in Tacoma. Dr. Bateman serves
as the team physician at the University of Puget Sound. Dr.
Loren Betteridge has provided medical support for Curtis High
School athletics and competed in marathons and local
triathlons. ■
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P C M S BULLETIN
December, 2004
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In My Opinion.
The Invisible Hand
by Andrew Statson, MD
The opin ion s e x p r e s s e d in th is w r itin g o r e s o le ly th o s e o f th e a u th o r. P C M S in v ite s m e m b ers to e x p re ss th e ir o p in io n /in s ig h ts a b o u t su b je cts
relevant to the m e d ic a l co m m u n ity, o r s h a re th e ir g e n e r a l in te re st s to rie s. S u b m is s io n s a re s u b /e ct h> E d it o r ia l C o m m ittee review .
A Call to Action
"We are born to action; a n d w hatever is capable o f suggesting
a n d g u id in g action has p o w e r o v er us fr o m the first. "
Charles Colton Cooley (1902)
A n d rew Statson, M D
Even though I strongly mistrust
politicians and have minimal faith in
the political process, 1 thought I
should pass along the information 1
just gathered, for the benefit of those
of you who still believe that the legisla­
ture might want to do the right thing
and grant us relief.
So far public rallies and meetings
with legislators have been ineffective.
Whenever our representatives have
condescended to listen to us, they
have taken what we had to say "‘under
advisement” and have continued on
their merry way.
One colleague from Maryland re­
ported that their representatives, after
canceling several scheduled sessions,
finally met with the physicians and
said that they will work on solving the
problem,... eventually.
In the meantime, in Cheverly,
Prince George county, there were eight
practicing obstetrical groups prior to
November 1,2004. Only one has con­
tinued to do deliveries. The average in­
crease in premiums for Maryland phy­
sicians was 28% this year and will be
35% in January. Of course, neuro-sur­
geons and obstetricians face much
higher increases.
The physicians on the staff of
Prince George Hospital in Cheverly
voted to request from the administra­
tion that they be allowed to practice
without insurance. So far the request
has not been granted and there is little
likelihood that it will be. The physi­
cians are considering work slow­
downs.
Virginia already has a cap on total
awards in medical malpractice cases.
Currently it is $1.75 million and is set
to rise to S2 million next year. Obvi­
ously, that cap has not worked. Mal­
practice premiums have continued to
rise with no relief in sight.
The Virginia physicians asked for
a limit on attorney fees and a cap on
pain and suffering of $250,000, in a
way, a cap within a cap. They had ral­
lies, meetings with the legislature and
work stoppages, but so far they have
not been successful.
This time, the Medical Society of
Virginia has decided to stage a sit-in
during the coming legislative session.
They will have one hundred doctors
wearing white coats in the chambers
of the legislature every day that it is
in session. I don’t know whether they
intend to carry signs or just be there
and be seen.
Of course, the trial lawyers have
countered that they will parade pa­
tients who have been presumably in­
jured by malpractice through the halls
of the legislature, wheelchairs and all.
The con frontation, if they indeed pro­
ceed with it, promises to be interest­
ing.
The Maryland Medical Society
has not decided yet, but it may follow
the example of the Virginians. The
Connecticut Medical Association is
currently discussing a similar ap­
proach and it seems that there is
enough agreement among them to go
ahead with it.
Whether anything will come out of
these attempts is another story, but we
are getting desperate and we are reach­
ing for desperate measures.
As 1 indicated, I am pessimistic. As
long as we remain on the job and con­
tinue to take care of patients, the legis­
lators will look on us as just whining
and nothing much is going to happen.
Our voting block is too small to matter.
We may contribute to political cam­
paigns, but we can never hope to
outspend the trial lawyers.
Our only hope is to appeal to the
decent citizens of our state. When they
understand our predicament and that it
affects them as well; when they see that
the more we suffer, the more they will
suffer; when they realize what the pow­
ers that be are doing to us and that it is
destroying our profession and at the
same time destroying their chances for
obtaining good medical care; they will
come to our rescue and then we will
win, but not before that.
1 don’t know whether actions as
the one planned in Virginia will make a
difference. 1’m sure we’11hear if any­
thing comes out of the Virginia legisla­
ture.
A German proverb asks, wliai - . 't
use of running when we a re m u m
right road? The question H J■■: c:
'which one is the right r»ud. ; inn afra id
we don’t yet h a v e a ck:n answer. a
D e c e m b e r 2004
P C M S B U LL E T IN
9
B u l l e t in
Personal Problems of
Physicians Committee
M ed ic a l p rob lem s, d rugs, alcohol,
retirem en t, em otion al,
o r o th e r su ch d ifficu ltie s?
Y o u r c o lle a g u e s
w a n t to help
* R o b ert S a n d s, M D , C h a ir
E R ^ S E
THAT TATTO O
WORRIED ABOUT WHAT YOUR SPOUSE,
YOUR FRIENDS OR EVEN YOUR BOSS
THINKS ABOUT YOUR TATTOO?
OR ARE YOU JUST TIRED OF
LOOKING AT IT?
7 5 2 -6 0 5 6
T o d ay ’s n e w e s t A le x a n d r ite la s e r ,
w ill r e m o v e y o u r ta tto o
w ith m in im al d is c o m fo r t &
l e s s th an 1 % r is k o f s c a r r in g .
Bill Dean, M D
272-4013
to d d y f o r m o r e u it(tn n ( ilio n
Tom H erron, M D
853-3888
PIERCE COUNTY
LASER CLINIC
B ill R oes, M D
884-922]
F. D ennis W aldron, M D
265-2584
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(2 5 3 )5 7 3 -0 0 4 7
Confidentiality
Assured
subspecialists
( s u b ' s p e s h ' a - U s t s ) n .p l.
1: team of 31 board certified physicians with
expertise in areas of radiology such as
musculoskeletal, neuroradiology,
m am m ography and women’s health, pediatrics,
interventional radiology and nuclear medicine
2: dedicated individuals working as a team to
provide excellence to patients and physicians; see
T R A Mp.i>ical1mac;in<;
Clinic locations in:
G ig H a rb o r • L ake w o o d • Tacom a
TRA Radiologists also serve:
M ary B rid g e C h ildren 's H ospital
St. Francis H ospital
St. Jo se p h M e d ic a l C e n te r
Tacom a G e n e ra l H ospital
10
P C M S B ULLETIN
December, 2004
For scheduling call 253-761-4200
TRA1
Medical
Medical
Imaging
EXCELLENCE ■ PERSON TO PERSON
.ed'
Sc
Who’s Paying What
See related story page 7
By specialty, these are the geographic areas with the highest or lowest reported premiums as of July 1. Companies reported
the numbers based on their manual rates for specific mature claims-made policies with limits of £ 1 million/S3 million. They do not re­
flect credits, debit, dividends or other factors that could reduce or increase a premium. The ranking is by state, based on the high­
est and lowest rate reported in each state for each specialty'. It is not an average for all of the rates reported for that specialty in
that state and rates may vary by geographic area.
Highest Rates
2003
2004
Lowest Rates
$65,697
$34,099
$39,562
$18,883
£38,568
$69,310
$58,514
$63,898
$41,998
$36,018
$226,542
$99,806
$120,538
$64,875
$131,348
$277,241
$183,560
$193,819
$132,314
$135,406
£249,196
$138,031
$163,807
$128,1 14
$136,020
$277,241
$230,428
$193,819
$172,178
$165,054
£3,770
£3,375
$3,212
£3,697
£5,147
$3,770
S3,3 75
$3,212
$3,697
$5,147
Georgia (North Ga.)
Idaho
Minnesota
Nebraska
South Dakota
$17,003
$14,514
$11,306
$9,621
$9,597
$17,003
$14,514
$11,306
$10,976
$11,545
$19,320
$18,307
$16,194
$14,662
$23,677
$19,320
$19,630
$16,194
$17,638
$23,677
O bstetrician s-gyn ecologists
O bstetricians-gynecologists
Florida (Dade)
Illinois (Cook)
Michigan (Wayne)
Pennsylvania (Philadelphia)
Texas (Cameron. Hidalgo)
Idaho
Minnesota
Nebraska
South Dakota
Wisconsin
G eneral Surgeons
General Surgeons
Florida (Dade)
Illinois (Cook)
Michigan (Wayne)
Missouri (Kansas City)
Pennsylvania (Philadelphia)
2004
Internists
Internists
Florida (Dade)
Illinois (Cook)
Michigan (Wayne)
Ohio (Northeastern)
Texas (Cameron, Hidalgo)
2003
Idaho
Minnesota
Nebraska
South Dakota
Wisconsin
S o u rce: M e d ic a l L ia b ility M o n ito r 2 0 0 4 R a te S u rv e \
■■■>
iL J - t L
■■
Our Clinical
PET S p ecialists
------
Featuring s o ftw a re fusion fo r im ag e
re g is tra tio n w ith m u ltip le m o d a litie s
(CT, MRI and SPECT).
Anthony Larhs, M D
Director of Clinical PET
Phillip C Lesh, M D
For a com prehensive referral packet,
call yo u r C ustom er Care R epresentative,
William B Jackson, M D
(253) 761-4200.
For information call
(2 5 3 ) 7 6 1 - 4 2 0 0
Roy McCulloch, BS, C N M T
Supervisor PET & Nuclear
M edicine
2 2 0 2 S C ed ar S tre e t, Ste 2 0 0
(253) 76 1-42 00 fo r s c he duling
L a ry n g e a l c a n c e r
TRA
Medics
EXCELLEN CE • PERSON
D ecem ber. 2 004
P C M S B U L L E T IN
11
Physicians in crisis states contemplate moving
Applicants for M embership
In states that the American Medical Association lists as being in a medical liabil­
ity insurance crisis. 60% of physicians have considered moving to another state to
reduce their premiums, according to a survey of 816 physicians.
They study, by physicians search company Jackson & Harris, also found that:
• 41% of physicians in crisis states have considered dropping their insurance
and “going bare.”
• 92% of physicians in crisis states said they were not happy with the way liabil­
ity reform is progressing in their state.
• 86% of physicians in crisis and noncrisis states said medical liability reforms
should apply uniformly across the United States. ■
K ristin R . B riejer, M D
R e p r in te d fr o m A M N e \w , 11 / 15 /0 4
v'auelerS
Family Practice
University Place Medical Clinic (MHS)
4230 Bridgeport Way W, University Place
253-459-7140
Med School: University of Washington
Internship: Tacoma Family Medicine
Residency: Tacoma Family Medicine
G eorge N. G iacopp e, M D
General Medicine/Pulm/Crit Care Med
Madigan AMC, Tacoma
253-968-1290
Med School:Uniformed Services University
of the Health Sciences
Internship: Madigan AMC
Residency: Lettennan AMC
Fellowship: Fitzsimons AMC
L
H e a lt h
S e r v ic e
A serv ice o f
N o r t h w e s t M e d i c a l s p e c i a l t i e s , PLIC
INTERNATIONAL TRAVEL CAN BE
HAZARDOUS TO YOUR HEALTH
• PRE -TR A V E L CARE
• PO ST-TR A VEL C ARE
C A L L E A R L Y W H E N P L A N N IN G
H O U RS
MON - FRI 9 - 5
2 5 3 -4 2 8 -8 7 5 4
o r 253-627-4123
A SER VIC E OF
IN FEC TIO N S LIM ITED PS
220 - 15,nAve SE #B, Puyallup W A 98372
M ED ICA L LICENSURE ISSUES
Mr. Rockwell is available to represent physicians and other health care
providers with issues of concern before the State Medical Quality Assurance
Commission. Mr. Rockwell, appointed by Governor Booth Gardner, served for
8 years as the Public Board Member of the Medical Disciplinary Board from
I 985-1993. 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 attorney-client representation agreement.
12
N a n cy R . Ju h lin , M D
Otol ary n go Iogy/A 1lergy
Ear, Nose, Throat & Facial Plastic SurgAssi
101 2nd St NE, Aubum
253-833-6241
Med School: University of Iowa
Internship: Washington Hospital Center
Residency: Georgetown Univ Med Center
K irin M . R ice, D O
Emergency Medicine
St. Francis Hospital
253-944-7971
Med School: Chicago College of
Osteopathic Medicine
Internship: Brooke AMC
Residency: Brooke AMC
PCMS has a
new e-mail
address
G regory G. Rockwell
A ttorney at Law & Arbitrator
2200 - 112th Ave NE, Suite 140
Bellevue, WA 98004
PCMS has changed their
(425)453-4398 • FAX (425) 453-1534
email: [email protected] • website: www.gregrockwelllaw.com
Please m ake a note in
P C M S BULLETIN
December, 2004
e-m ail address to:
pcms@ pcmswa.org
your directory
ffie r c c % o u u tif G & v f i a t / <$fecf'e/>/
COLLEGE
MEDICAL
EDUCATION
Register now for
the Cardiology
for Primary
Care Program
The College’s eighth annual Cardi­
ology program featuring topics in cardi­
ology for the primary care physician
will be held at St. Joseph Hospital in the
Lagerquist Conference Center.
This is an evening program that of­
fers a total of six credit hours over two
consecutive Tuesdays on January 11
and January 18,2005. G regg
Ostergren, DO continues as the
Course Director.
Topics for the upcoming program
include:
Continuing Medical Education
Snow Is Calling - Make Your W histler
CME and Condo Reservations Today
Registration continues to be open
for the College’s CME at Whistler/
Blackcomb program. The conference is
scheduled for January 26-30,2005.
CM E at Whistler participants are
urged to make their condo reserva­
tions early. A collection of one and
two bedroom luxury condominiums,
just steps from the Blackcomb chair
and gondola, are available. Space is
available on a first come first served
basis.
The College’s reserved block of
rooms were released on December 1,
but rooms may be available.
Reservations can be made by call­
ing the A sp e n s on B la ckco m b toll free
at 1-866-788-5588.
Registration for the actual CME
conference is also open. Course direc­
tors D rs. R ichard Tobin and John
Jigan ti have arranged another quality
multi-specialty conference featuring
timely topics.
To register or for more information
call the College at 627-7137. ■
So m any runs, so little tim e! Two w orld-class m ountains, B lackcom b a n d W histler
o ffe r un lim ited runs a n d trails lo the M ed ica l Society sk ie r a n d their fam ily. S ign up
fo r the J a n u a ry “C M E at W h istler" p ro g ra m today
• M etabolic Syndrom e: R isk
A ssessm ent a n d C ardiac Therapy
• Interhtm inal H ealth
• Women a n d C ardiovascular
D isease
• R adiology a n d C ardiology
This is an evening program for
your convenience, giving you CME
credit opportunity outside of office
hours. The programs run from 6:00 pm
to 9:00 pm on both nights.
This is a popular program. You can
register right away by calling 253-6277137.«
Dates
Program
Director(s)
Tuesday (evenings)
January 11 & 18
Cardiology for Primary
Care
Gregg Ostergren, DO
January 26-31
CME at Whistler
Rick Tobin, MD
John Jiganti, MD
Friday, February 4
Gastroenterology for
Primary Care
Ralph Katsman, MD
Thursday-Friday
May 5-6
Internal Medicine
Review 2005
Art Knodel. MD
Friday, April 22
Radiology for the
Non-Radiologist
Rick Tobin, MD
Andy Levi11--. '■■!!■
Friday, May 20
Primary Care 2005
Steve
Du i' V . ii ).
D ecem ber. 2004
PCMS
: v i D
B U LL E T IN
13
v.
B u l l e t in
The Power of the Apology
In th is d a y a n d a g e, w ith p h y sic ia n s fe elin g b e sie g e d by
m a lp ra c tic e c la im s a n d the fe a r o f litig atio n , m an y p h y sic ia n s
firm ly b e lie v e th a t a p o lo g iz in g for a b a d o u tco m e in care is
e q u iv a le n t to an a d m iss io n o f g u ilt o r w ro n g d o in g . T h e o b v i­
ous c o n c e rn is th a t w e ll-in te n d e d e x p ressio n s o f e m p a th y w ill
late r be u se d as e v id e n c e a g a in st the p h y sic ia n s by the very
p a tie n ts th e y w e re try in g to co n so le! T h ese sam e p h y sic ia n s
n a tu ra lly a ssu m e th a t th e ir in su ra n ce c o m p a n y w o u ld not
w a n t th em a p o lo g iz in g fo r a p o o r re su lt o r re v e a lin g in fo rm a ­
tio n to a p a tie n t a b o u t w h a t w e n t w ro n g a n d w hy. C ertain ly ,
w h e n a ctu al m ed ic al e rro rs d o occur, th e a p p ro p ria te re sp o n se
sh o u ld a lw a y s be “ deny and d e fe n d ,” rig h t?
A c tu ally , n o th in g c o u ld be fu rth er from the tru th . In o u r
T h is w a s a c c o m p lish e d th ro u g h e n a c tm e n t o f R C W 5.66.010,
w h ic h states:
R C W 5 .6 6 .0 1 0
A d m issib ility o f sy m p a th e tic g estu res.
1) T h e p o rtio n o f sta te m e n ts, w ritin g s , o r b e n e v o le n t gestures
e x p re ss in g sy m p a th y o r a g e n era l se n se o f b e n e v o le n c e relat­
ing to the p a in , su ffe rin g , o r d e a th o f a p e rso n in v o lv e d in an
a c c id e n t, a n d m ad e to th at p e rso n o r to th e fa m ily o f th at per­
son, sh a ll be in a d m issib le as e v id e n c e in a c ivil actio n . A state­
m e n t o f fault, h o w e v er, w h ic h is p art o f, o r in a d d itio n to, any
o f the a b o v e shall n o t b e m ad e in a d m issib le b y th is section.
view , it is a lw ay s a p p ro p ria te to be stra ig h tfo rw a rd w ith the
pa tie n t re g a rd in g all a sp e c ts o f care. T h is a p p lie s in all c irc u m ­
sta n ce s, w h e th e r y o u are d e a lin g w ith a bad o u tco m e o r actual
2 ) F o r p u rp o se s o f th is sectio n :
a. “A c c id e n t” m ea n s an o c c u rre n c e r e s u ltin g in injury or
p a tie n t in ju ry re su ltin g fro m a m ed ic al error. T h e fa cts re g a rd ­
ing y o u r care are w h a t th e y are. T h e facts w ill not c h an g e and
death to one o r m o re p e rso n th a t is n o t th e re su lt o f w illful ac­
th e y sh o u ld be sh a red w ith th e p atien t. In sh o rt, y o u r p atients
tio n b y a party.
h a v e a rig h t to all o f the in fo rm a tio n y o u p o sse ss re le v a n t to
b. “ B e n e v o le n t g e stu re s” m e a n s a c tio n s th a t convey a
th e ir m edical c o ndition.
O u r e x p e rie n c e at P h y sic ia n s In su ra n ce c le a rly d e m o n ­
stra te s th at an a u th e n tic a n d sin c ere a p o lo g y o r e x p ressio n o f
sen se o f c o m p a ssio n o r c o m m ise ra tio n e m a n a tin g from hu­
m an e im pulses.
c arin g a n d co n ce rn o v e r the p a tie n t’s o u tc o m e has a tre m e n ­
d o u s in flu e n ce in stre n g th e n in g the p h y sic ia n -p a tie n t rela­
tio n s h ip a n d p ro m o tin g p a tie n t trust. Im p o rtan tly , th is e n ­
h a n ce d tru st g re a tly re d u c e s th e lik e lih o o d th a t the p a tie n t w ill
c. “F a m ily ” m ea n s th e sp o u se , p a re n t, g ra n d p are n t, step­
m other, ste p fath er, c h ild , g ra n d c h ild , b ro th er, sister, h a lf
se e k a n sw e rs th ro u g h th e fin a n c ia lly and e m o tio n a lly ta x in g
leg a l sy stem .
en ts o f an in ju red party.
M o st o ften , it is a lack o f communication o r a p h y sic ia n ’s
failure to commiserate th a t m ak e a p a tie n t be lie v e the p h y s i­
O f note is the fact th at a n y “sta te m e n t o f fa u lt” is admis­
sible.
b rother, h a lf sister, ad o p te d c h ild o f a p a ren t, o r sp o u se ’s par­
cian is u n c o n ce rn ed . T h en th e p a tie n t c o n sid ers w a y s to tak e
c o n tro l o f the situ atio n to g e t the p h y s ic ia n 's atte n tio n . T ypi­
cally, this in v o lv e s h irin g a p la in tiff a tto rn ey to “ get so m e a n ­
In su m m ary , y o u sh o u ld a lw ay s re m e m b e r th e power of
the apology' a n d the im p o rta n c e o f y o u r e x p re ss io n s o f con­
s w e rs” - and th en the m isery begins!
cern and carin g . T h ese are so m e o f the m o st im p o rta n t tools
y o u can use in d e v e lo p in g p a tie n t tru s t a n d c o n fid e n ce , allow^
F o rtu n a te ly , th e S tate o f W ashington also b e lie v e s that
sa y in g you are so rry is a g o o d th in g to do. T h e state e n c o u r­
a g es th ese sy m p a th e tic g e stu re s b y re d u cin g c o n ce rn s that
th ese e x p ressio n s m ay later be used as e v id e n ce a g ain st you.
ing you to th en e n jo y all o i'th e b e n e fits o f a stro n g e r physi­
c ia n -p a tie n t re la tio n sh ip . ■
R i’firin tL ’t l f r o m P h y s ic ia n s R is k M a n a g c m e n i U P D A T E . V o lu m e X V , N um ber 5
UNION AVENUE PHARMACY
Professional Compounding Center o f Tacoma, WA
Vaginal Suppositories
Rectal Suppositories
Urethral Inserts
Sublingual Troche
Gel, Ointment, and Cream
IV Services
Capsules
Up Balms
2302 South Union Avenue 752-1705
14
P C M S BULLETIN
December, 2004
T A C O M A /PIER C E COUNTY
O u tp atien t G eneral M edical Care.
Full and p art-tim e positions
available in T acom a and vicinity.
V eiy flexible schedule. W ell suited
io r care e r redefinition for
GP, F P , IM .
C o n ta c t A ndy T soi, M D (253) 752-9669
o r P aul D o ty (A llen, N elso n , T u rn e r &
A ssoc.), C lin ic M a n a g e r (253) 383-4351
2Pieere Y iiw M ltf Q '/lc d im l ojoaefaf-
Classified Advertising
i
OFFICE SPACE
POSITIONS AVAILABLE
Tacoma/Pierce County outpatient
Tacoma, W A - O ccupational M edicine
F or R ent: 3300 sq ft C lass A m edical
general medical care at its best. Full and
part-time positions available in Tacoma
and vicinity. Very flexible schedule. Well
suited for career redefinition for G.P.,
F.P., I.M. Contact Andy Tsoi, MD (253)
752-9669 or Paul Doty (Allen, Nelson.
Turner & Assoc.), Clinic Manager (253)
3834351.
office in Tacoma Medical Center, 1112
6th Ave, third floor. Elevator, under­
ground parking, close to hospitals,
ownership options. Call 253-272-2224.
Established Auburn F am ily Practice
MultiCare Health Works, a division of
MultiCare Health System seeks a board
certified occupational medicine physician/MRO to join an established pro­
gram. Qualified applicants must be flex­
ible, self-motivated, committed to pro­
gram development and have at least 3
years experience. Excellent benefits, in­
come guarantee and incentive bonus.
Please email your CV to M ultiC are
looking forP/T to F/T Board Certified or
Board Eligible Physician to join a group
practice. Work 3-4 days a week with a
great support staff. Base salary plus in­
centive. Fax your CV to 253-847-9630.
H ealth System P rovider Services at
p ro vid erservices@ m u ltica re.o rg or f a x
y o u r C V to 866-264-2818. Websites:
xnnv.m ulticare.org; www.muUicare
healthw orks.org. “MultiCare Health
O ffice sp ace for lease in m edical
complex. Gig Harbor. 2354 sq ft, main
level. 468-3539 or 565-2444.
System is a drug free workplace."
Same Day MRl s
Precision Imaging of Puyallup offers
state-of-the-art MRI's with same day
appointments, easy scheduling and
fast report turnaround times for
referring physicians.
-O
J .&
,
£u m
•
a Precision Imaging
at the Bram and Spine Center
1519 3rd SE, Suite;
Phone: 253.8
’ T r.
r
D ecem ber. 2 004
P C M S B U L L E T IN
15
Bui.L F.T lN
PAer-ce bounty- o M e d ica lffim dnj,
‘Threatening Litigation Is a
Nightmare Process”
A s a claims representative and supervisor, I see physicians ol all specialties
whose lives are suddenly changed by claims filed against them. Whether the
cases are dismissed, settled, or go to trial, each physician’s personal and
professional life can take a turn for the worse, and that’s why I’m here to
help. I analyze each claim, stay in close contact with our attorneys, and work
with the physician on new strategies as the case develops. Ever}' physician is
important to me, and I make sure my work shows them that I care.
To find out about the many ways Physicians Insurance works with and
for physicians, call us today.
Kari Adams,
Claims Supervisor
Western Washington
Eastern Washington
Oregon
^
Physicians
^ Insurance
A Mutual Company
C r c .ite d a n d s p o n s o r e d b y th e
V im o u r W e b s u e a t p b y in s .c o m
W a s h i n g t o n S ta le M tdiL-.il A ssoi
S e a ttle . W A © P h y s ic i a n s I n s u r a n c e 2002
P ierce C ounty M edical S ociety
223 Tacoma Avenue South
Tacoma, WA 98402
R eturn service requested
16
1-800-962-1399
1-800-962-1398
1-800-565-1892
P C M S BULLETIN
December, 2004
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERM1TN0 605