san antonio medicine december 2014

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THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • DECEMBER 2014 • VOLUME 67 NO. 12

MEDICINE

4 San Antonio Medicine • December 2014

Connectingwith CommunityA look back...at 90 By Charlotte Narboni................12

“Texans helping Texans”By Col. (TX) Robert Morecook ....................................16

Program encourages students to stay in school By Edwin “Eli” J. Whitney, MD.......................................18

Having the PRIDE to heal By Gilberto Vazquez .....................................................20

BCMS President’s Message ........................................................................................................8

BCMS Alliance ............................................................................................................................10

BCMS News ................................................................................................................................22

Lifestyle: Ring in the holidays at the theater by Mauri Elbel ........................................................26

HASA: HIE is like Facebook for Doctors? by Gijs Van Oort ..................................................................30

UTHSCSA Dean’s Message by Francisco González-Scarano, MD ......................................................32

Book Review: ‘In the Kingdom of Ice (The Grand and Terrible Polar Voyage of the USSJeannette)’ written by Hampton Sides, Reviewed by J.J. Waller Jr., MD ..........................................34

BCMS Circle of Friends Services Directory ..........................................................................................35

Business of Medicine: PODs, fraud and ‘Who’s my doctor?’ by Pamela C. Smith, PhD ............41

In the Driver’s Seat ................................................................................................................................43

Auto Review: Nissan Rogue by Steve Schutz, MD................................................................................44

T A B L E O F C O N T E N T S

MEDICINETHE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • DECEMBER 2014 • VOLUME 67 NO. 12

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BOARD OF DIRECTORS

OFFICERSK. Ashok Kumar, MD, PresidentJayesh B. Shah, MD, Vice PresidentLeah Hanselka Jacobson, MD, TreasurerMaria M. Tiamson-Beato, MD, SecretaryJames L. Humphreys, MD, President-electGabriel Ortiz, MD, Immediate Past President

DIRECTORSJosie Ann Cigarroa, MD, MemberChelsea I. Clinton, MD, MemberJohn Robert Holcomb, MD, MemberLuci Katherine Leykum, MD, MemberCarmen Perez, MD, MemberOscar Gilberto Ramirez, MD, MemberAdam V. Ratner, MD, MemberBernard T. Swift, Jr., DO, MPH, MemberMiguel A. Vazquez, MD, MemberFrancisco Gonzalez-Scarano, MD,

Medical School RepresentativeCarlos Alberto Rosende, MD,

Medical School RepresentativeCarlayne E. Jackson, MD,

Medical School RepresentativeLuke Carroll, Medical Student RepresentativeCindy Comfort, BCMS Alliance PresidentNora Olvera Garza, MD, Board of Censors ChairRajaram Bala, MD, Board of Mediations ChairGeorge F. "Rick" Evans Jr., General Counsel

CEO/EXECUTIVE DIRECTORStephen C. Fitzer

CHIEF OPERATING OFFICERMelody Newsom

DIRECTOR OF COMMUNICATIONSSusan A. Merkner

COMMUNICATIONS/PUBLICATIONS COMMITTEEFred H. Olin, MD, ChairEstrella M.C. deForster, MD, MemberJay S. Ellis Jr., MD, MemberDiana H. Henderson, MD, MemberJeffrey J. Meffert, MD, MemberSumeru “Sam” Mehta, MD, MemberRajam S. Ramamurthy, MD, MemberJohn C. Sparks Sr., MD, MemberChittamuru V. Surendranath, MD, MemberJ.J. Waller Jr., MD, MemberJason Ming Zhao, MD, Member

I can’t believe it is time to write my last column as president of

the BCMS. First, I thank each of you for electing me to serve as

your president. Second, I thank our amazing board of directors, ex-

traordinary executive committee and hard-working staff who made

my tenure memorable.

In my presidential installation speech, I promised to increase

BCMS involvement in community activities, increase student par-

ticipation in organized medicine, and unite the BCMS and the

BCMS Foundation. It is rewarding to see that each promise has

been met. Here are some details about these and other key accom-

plishments:

COMMUNITY INVOLVEMENTBCMS is represented in many community organizations. For ex-

ample, we have a seat on the Mayor’s Fitness Council (MFC), and

I represent our medical society on the MFC executive committee.

At the executive committee’s first meeting, the MFC created a new

healthcare committee that I was asked to chair. The healthcare com-

mittee is developing a toolkit to help physicians participate in the

goal of preventing obesity in our community. When completed, this

toolkit will be an online resource that physicians can use to educate

their patients about how healthy eating and physical activity can im-

prove health. The BCMS board endorsed the initiatives of Metro

Health, under the leadership of Dr. Thomas Schlenker, to reduce

obesity in San Antonio. I believe these resources will be helpful to

all physicians in Texas.

This year, for the first time in history, our medical society was

honored with a mayor’s proclamation on Doctors’ Day, and a

County Commissioners Court proclamation honoring the BCMS

and Women in Medicine. I also served as the honorary chair of

the 10th Annual Texas Health Literacy Conference and worked

with the San Antonio Health Collaborative to increase health lit-

eracy initiatives.

MEDICAL STUDENTSI believe our medical society needed to tell our students that we

welcome them to the organization, want them to train to become

leaders, and cherish their participation in our society. I am delighted

that we now have a strong and active student body (UTHSCSA

Medical Student Section of TMA). We have more than 20 students

who serve on BCMS committees. Also, 16 students attended the

recent AMA meeting and now are leaders in TMA and AMA.

INTERNATIONAL AFFAIRSWe hosted the delegation from Kumamoto, Japan. This is the

22nd anniversary of our sister medical society relationship. The

news spread to Japan that I paid special attention to medical stu-

dent involvement in organized medicine, so this year we had sev-

eral medical students and pre-med students in the Japanese

delegation. These students were excited to hear about our medical

school admissions process and medical education. As usual, Hi-

roko Fay’s participation made this visit a phenomenal success.

Earlier this year, with the approval of the BCMS board, I signed

a sister-city medical society relationship with the medical society

in Monterrey, Mexico. Our BCMS delegation headed by interna-

tional committee chair Dr. Roberto San Martin attended their

annual meeting and presented the declaration. In turn, the Mon-

terey delegation will visit us in the future. We also have a sister-

city relationship with Tamilnadu Medical Association in Chennai,

India. Our delegation visited Chennai two years ago, and we re-

cently invited their delegation to visit San Antonio.

BCMS FOUNDATIONI am delighted that we successfully brought the two organizations

together to restore the functions of the foundation as envisioned by

the founders. Both groups worked diligently to enhance the bylaws

so they remain strong collaborators. I congratulate the foundation

board’s newly elected president, Dr. Geraldo Ortega, and the foun-

dation board members. I am confident that this remarkable body

will work assiduously to realize our dreams of supporting young peo-

ple wishing to join the healthcare professions by awarding scholar-

ships and other activities.

BCMS ALLIANCEIt was an honor to work with the BCMS Alliance to provide com-

munity service activities. I applaud Cindy Comfort, BCMS Alliance

PRESIDENT’SMESSAGE

Past accomplishments, future challengesBy Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP2014 BCMS President


Continued on page 25

As I prepare to write my last president’s message forSan Antonio Medicine, I reflect on this past year andall of the positive changes in the Alliance. Our missionstatement, “to create fellowship among the families ofphysicians and to foster activities in benevolent, phil-anthropic, charitable, and patriotic endeavors,” has

been my North Star. It has guided the board in our decisions and keptus focused on our heritage and future. Past presidents Mertie Woodand Rebecca Waller and board members Rena Baisden and ShirleySanders have been instrumental in advising me throughout the yearand in making it so successful in recruiting new members, building astronger board, and interfacing within the community.

Membership engagement at our general meetings was kicked off inFebruary at the New Member Welcome Luncheon at The ArgyleClub. We had the honor of TMAA officers Cheryl Jones and AngieDonahue attending the event that featured national speaker Mary SueKoontz Nelson, who spoke about “Living ... and Loving It TexasStyle!” The dining room was filled with members, friends and laughteras we enjoyed the program that featured the August Heart Founda-tion. In May, we honored our past presidents at “The Affair to Re-member” Fashion Show and Luncheon at Julian Gold. “The AnnualFall Coffee” was well-attended at Mary Henrich’s home with guestspeaker Veronica Galvan, PhD, on Alzheimer’s disease and currentaging research. In October, we had a special hosted luncheon at TheArgyle Club with Michael Clark speaking on “The Current State ofthe Economy in the USA.” Our final program will be the December“Holiday Coffee” at board member Reema Shroff Kella’s home. MaryAnne Roman's program experience and creativity has made our eventsfun and profitable.

Civic and Philanthropic Vice President Jennifer Lewis led an out-standing committee of dedicated volunteers that reinstituted pro-grams and started new programs in our community. We helped withthe City of San Antonio Pre-K program and Metropolitan HealthDistrict’s immunization program as part of the TMAA Be Wise, Im-munize program. San Antonio’s Sicolvia spring and fall events werewell-attended and there we presented helmets to needy children withthe TMAA initiative, “Hard Hats for Little Heads.” We partneredagain with the Metropolitan Health District at their back-to-schoolImmunization clinic where we gave out helmets to children afterthey received their immunizations. The most important communityaccomplishment was the formation of the Junior Volunteer Com-mittee and Junior Volunteer Council under the guidance of MonaTalukdar. This program has brought new life into our organization

while fulfilling our mission statement of working with medical fam-ilies in our community. The Junior Volunteer Council, composedof high school students of BCMS and BCMSA members, has par-ticipated in all of the BCMSA community service events and othercommunity volunteer programs. This program has drawn interestfrom other Texas alliances across the state as the success of the grouphas grown. Doctor’s Day, honoring the physicians of Bexar Countyand chaired by Katrina Theis, was held in a packed auditorium atUTHSCSA Medical School, with Mayor Julian Castro’s proclama-tion read by San Antonio District 8 Councilman Ron Nirenbergand an address by BCMS President K. Ashok Kumar, MD. Jenniferalso has interfaced with the City of San Antonio, the YMCA, UTH-SCSA Medical School, Metropolitan Health District and otheragencies bringing more visible name recognition to our organizationamong city leaders and at TMAA.

Sandra Vela, Vice President of Social, initiated several new socialgroups that have provided fellowship while promoting the BCMSAin the community. “Jazzed About Jewels” raised money for our “HardHats for Little Heads” funds and provided the members attending aninformative lecture and social time. The Alliance also started “Chairsfor Charity,” where BCMSA had a group table at citywide fundraisersfor ACS, Cancer Center Council and other groups in town. “Sips andDips” was another new interest group, hosted in homes of members.Danielle Hankes led monthly book club meetings with great discus-sions where new friendships were made.

Representing the Alliance on the BCMS Board of Directors andBCMS Foundation has been an honor. The medical society has beengenerous in offering guidance, meeting rooms and staff help through-out the year under the leadership of Steve Fitzer. Dr. Kumar has beena joy to work with, and his support of the BCMSA has been muchappreciated. The medical society has welcomed us at their eventsthroughout the year and has partnered with us at our communityservice events. My sincere thanks goes out to the BCMS and staff.

Rebecca Christopherson, incoming president, has been beside meevery step this year, attending every meeting and function and offeringher great support and ideas. She has attended the TMAA conferencesalongside me and is well prepared to serve as president in January. Iwant to thank her, the board, the members, and especially the pastpresidents whose positive support has helped me throughout this year.Lori Boies has kept our financial records in order, and Gigi Gross haskept us abreast on legislative issues facing medicine during this electionyear. Thanks to all of you for all you have done to further the Allianceand our mission during 2014.

BCMSALLIANCE

Thanks to all for their support ofBCMS Alliance in 2014By Cindy Comfort2014 Bexar County Medical Society Alliance President



CONNECTING WITH COMMUNITY

Gino Narboni, MD, retired in 2002 at 79, after practicing

medical oncology in San Antonio for 19 years. Many of his col-

leagues are unaware of Gino’s earlier, non-medical pursuits result-

ing from his World War II experiences. As he celebrated his 90th

birthday in late 2013, it seemed a good time to reflect on earlier

career paths, including Gino’s time as a military pilot — author-

ized to wear the wings of three Air Forces — and later as a com-

mercial airline pilot.

His story begins in Algeria, then a part of French North Africa.

Although he dreamed of a flying career, in 1941, during WWII,

Gino, 18, was instead drafted by the Vichy French government

and sent to an army post in Algiers. As a Jew, he was not allowed

to bear arms, so he and his fellow Jewish conscripts were assigned

as convoy drivers and chauffeurs.

Meanwhile, in London, Gen. Charles de Gaulle was mobiliz-

ing a fighting force for use outside occupied France. When word

A look back...at 90Retired BCMS member Gino Narboni reflects on two of his many careers

By Charlotte Narboni

The getaway truck taking Gino Narboni from Algiers to Kairouan,Tunisia, 1943. All photos courtesy Narboni family


of the general’s call for volunteers spread

through the Algiers barracks, Gino and

several other conscripts made plans to

desert the Vichy camp. Late one evening,

after being picked up at a prearranged cor-

ner, the deserters began their journey by

truck across the Sahara desert. They were

en route to join de Gaulle’s Free French

Forces. Upon arrival in Tunisia, Gino was

allowed to choose his “arms” so he said, “I

want to be a pilot.” Eighteen months later,

Gino was sent to the United States for

pilot training.

At the end of WWII, Gino, now a pilot,

returned to Paris. At his father’s urging, he

started medical school, but remained in the

French Air Force Reserves and fulfilled re-

quirements for a commercial pilot’s license.

In 1948, while in his second year of

medical school, the United Nations de-

clared Israel a Jewish state. With that dec-

laration, war began immediately between

the Jews and their Arab neighbors. As the

United States had declared an arms em-

bargo against Israel, the new country had

limited access to equipment. The Israelis,

who had eight planes at the start of the

conflict, began a worldwide search for

parts. An Israeli recruiter contacted Gino

in Paris and asked if he would ferry a re-

cently purchased plane to Israel. Gino

agreed and with a friend from flight school

began a series of long, convoluted flights

stopping at air bases throughout Europe

and the Mediterranean basin, hiding the

fact the plane’s final stop was Israel. Over

the next few months, Gino made several

other trips, always with complicated flight

plans. Eventually, he immigrated to Israel

and joined the fledgling Israeli Air Force as

a captain. After the armistice was signed,

Gino signed on with El Al, as one of the

first pilots for the newly created Israeli na-

tional airline.

visit us at www.bcms.org 13

Gino Narboni in front of hisplane after solo flight, 1944.


50th flight, El Al — Tel Aviv-Vienna-Rome, 1st Officer Gino Narboni (far right).



Eventually, Gino Narboni became

a U.S. citizen, a physician, and a

USAF Medical Corps officer and

finished his professional USAF ca-

reer as a chief flight surgeon. While

still on active duty, he completed a

fellowship in medical oncology at

M.D. Anderson.

Friends and acquaintances, upon

hearing these stories, often declared,

“You should write a book.”

Gino and I agreed it would be a

terrific idea but putting words on

paper never seemed to happen —

that is, until the beginning of 2013

when we encountered another octo-

genarian who, after hearing Gino’s

story, sent us a copy of his own

memoir as encouragement. With

that final push, a book was born!

“When I Grow Up, I Want To Be ...

The Memoir of Gino Narboni as told

to Charlotte Narboni” was published

in time for his 90th birthday.

These episodes from Gino’s early

life continue to have ramifications

today. His service to Israel during

the War for Independence made him

a machal, the Hebrew word for

“overseas volunteer.” He was one of

the 4,400 men and women from

other countries who went to Israel

during the initial 1948-49 conflict.

Today, 66 years later, few volunteers

remain, although Smoky Simon, the

founder of the Machal

(www.machal.org.il), 94, still goes to

the Tel Aviv office on a daily basis.

For our recent visit to Israel, we

asked Smoky to arrange a visit to

EKRON, Gino’s former Israeli Air

Continued from page 13

Gino Narboni at 90, November 2013.



Force base. Today, it’s Tel Nof, an active

Israeli Defense Force installation. An of-

ficial tour was arranged. We were wel-

comed by the deputy base commander,

briefed by one of the pilots, and taken

on a squadron tour. The visit revived

many memories.

Today, with so many intervening

events crowding out the past, it’s nice to

be remembered for something one did

years ago.

Charlotte Narboni is the wife of Gino

Narboni, MD, a BCMS retired member.

For information on how to acquire “When

I Grow Up, I Want To Be ...” in print or

as an eReader, go to www.whenigrowup

ginonarboni.com. Gino Narboni (right) and IDF pilot, TelNof Air Base, Israel, April 2014.


The Medical Brigade of the Texas State Guard is an important med-

ical reserve that the governor of Texas can draw upon in response to

disasters in the state. As part of the Texas Military Forces, the Medical

Brigade, along with the rest of the Texas State Guard, and the Army

and Air National Guards, is ready to respond when Texans are in need.

Brig. Gen. David J. Cohen, MD, MPA, is the commanding offi-

cer of the Texas Medical Brigade. In late 2013, he was appointed to

the position and promoted to brigadier general in the Texas State

Guard. Cohen is a cardiothoracic surgeon, adjunct professor of sur-

gery at the Uniformed Services University of the Health Sciences,

and a member of the Bexar County Medical Society. He is a member

of the BCMS Emergency Preparedness Committee.

The mission of the Texas State Guard (TXSG) is to provide mis-

sion-ready military forces to assist state and local authorities in times

of state emergencies; to conduct homeland security and community

service activities under the umbrella of Defense Support to Civil Au-

thorities; and to augment the Texas Army National Guard and Texas

Air National Guard as required.

“We train to respond, and we do respond quickly,” Cohen said.

“We can put state guardsmen in the field faster than the National

Guard can move and thus help Texans more quickly.”

In the last few years the TXSG Medical Brigade has provided clin-

ics at disaster shelters during and after hurricanes. These included the

devastating hurricanes of Katrina, Rita and Ike, as well as others.

“During these and other hurricanes, the Medical Brigade manned

medical clinics at some of the evacuation sites, or provided shelter

management or public health services,” Cohen said.

The Medical Brigade and the TXSG are not a part of the U.S.

Armed Forces and cannot be activated by the president for federal

duty or for duty outside of the United States. As part of the Texas

Military Forces it serves only in Texas, or rarely in neighboring states.

The commander in chief is the Texas governor.

“The Medical Brigade is very active in the area of community

service to Texans,” Cohen said. “Each summer, the Medical Brigade

is very active in Operation Lone Star in the Rio Grande Valley. We

helped staff five free clinics this summer, and in 2013 over a one-

week period provided more than 42,000 services to more than 9,000

people.” Services at Operation Lone Star included primary medical

care, dental care, and free eye examinations and glasses.

“The Medical Brigade of the Texas State Guard is very active in

the community, even when there are not disasters,” Cohen said. “We

think of ourselves as Texans helping Texans.”

Other recent community service events have included staffing first

aid sites for the 13,000 bicycle riders of the annual multiple sclero-

sis150-mile Houston-to-Austin bicycle ride, and supplementing Uni-

“Texans helping Texans”Texas State Guard Medical Brigade assists

state residents in hour of needBy Col. (TX) Robert Morecook


Brig. Gen. David J. Cohen, MD, MPA, is the commanding officer of theTexas Medical Brigade. Courtesy photo


versity of Texas Medical Branch emergency

providers at the Wings Over Houston Air

Show.

Texas State Guard personnel actively

support the state in the event of cata-

strophic events and ongoing state mili-

tary missions. Members receive duty pay

(currently $121 daily, regardless of rank)

when activated by the governor and

placed on paid state active duty for a lim-

ited number of mandatory training days.

Certain expenses may be paid in case the

guardsman is called to state active duty

for disaster response; for example, car

mileage, housing and meals costs.

The Texas State Guard consists of six

Civil Affairs Regiments, two Air Wings,

the Medical Brigade and a Maritime Reg-

iment. Members' entry rank depends on

prior federal military service and/or civil-

ian education. Individuals with no prior

military service or ROTC training must

attend the Basic Orientation Training

(BOT) course. Currently, BOT lasts one

or two weekends, depending upon how

it is structured. Licensed medical person-

nel typically serve as officers, often enter-

ing with advanced rank. Personnel must

be between ages 17 and 70 when joining,

but may continue to serve after age 70.

The organizational structure follows

the federal military component structure,

with comparable positions, ranks, proto-

cols and authorities. TXSG personnel are

eligible for the same state-issued military

awards and decorations as members of

the Texas Army and Air National Guard.

The Texas military uniform worn by most of the Texas State

Guard is similar to the U.S. Army's combat uniform but with Texas

markings; the Maritime Regiment's uniform is similar to the Ma-

rine's MARPAT digital desert uniform. Air units wear a Texas vari-

ation of the U.S. Air Force uniform.

The TXSG is headquartered at Camp Mabry in Austin. It func-

tions under the authority of Title 32 of the U.S. Code and Chapter

431 of the Texas Government Code. The chief military officer is

Maj. Gen. John F. Nichols, the Texas Adjutant General.

Personnel living in and near Bexar County who want more infor-

mation about joining the Alamo Group of the Texas Medical

Brigade can send an email to the commanding officer, Col. (TX)

James Gardon, at [email protected].

Col. (TX) Robert Morecook is Medical Brigade public affairs officer

for the Texas State Guard in Austin.


Getting shots is part of the care provided at Operation Lone Star, a joint civilian and military operationeach summer in South Texas. Personnel of the Medical Brigade of the Texas State Guard contribute sig-nificantly to mission success. Photo by Texas Air Guard Senior Master Sgt. Michael Arellano

Sgt. William Alford, Tyler Medical Response Group, Texas State Guard, assists with the flow of patientsduring Operation Lone Star 2013 in Brownsville. Operation Lone Star serves residents of the SouthTexas border region who have no access to medical care or doctors. U.S. Army National Guard photo bySpec. Aaron Moreno.


Motivate Our Students

Texas (MOST) is a

501(c)(3) nonprofit or-

ganization which we

started in 2008 to help

improve the public

school system. To date,

the organization has

helped motive more than

49,000 children in more

than 44 schools in Bexar

County and three schools

in Natalia to take advan-

tage of school.

We do not believe the

public schools are bro-

ken; instead, it’s the chil-

dren’s attitude toward

school that is broken.

The difference between

successful and unsuc-

cessful people is that

someone motivated the

successful individuals to

go above and beyond

what is expected. What

children in the MOST

program learn is, “In the

real world, the fun jobs

pay more money. To get

these jobs, you need ed-

ucation and good behav-

ior.”

There are two main

components of the


Program encourages students to

STAY IN SCHOOLBy Edwin “Eli” J. Whitney, MD

SAN ANTONIO INDEPENDENT SCHOOL DISTRICTDavis Middle School, 2010-13


MOST program: educational expeditions (field trips) and a

speaker program, in which successful people from the commu-

nity go into the classroom and speak with students about their

careers and what it took to get there. The educational expeditions

occur monthly; however, to earn the right to go on these field

trips, the students must have perfect attendance the previous

month. The expeditions take place during school hours and are

a lot of fun for the students. For these reasons, in the schools

where the MOST program has been implemented, the absen-

teeism rate typically falls in half. Since the MOST program in-

volves the entire student body, the teachers quickly notice that

peer pressure turns positive, and there is an almost immediate

fall in discipline problems. The teachers also note an improve-

ment in the completion of homework by the students.

At Sam Houston High School in the 2012-13 academic year,

there was an average improvement in daily attendance from 90

percent to 94 percent. In Davis Middle School, which feeds into

Sam Houston High School, in the same school year, the average

daily attendance improved from 91 percent to 96 percent. They

went from last in the district in attendance to first in the district.

Referrals to the principal’s office were cut in half and, perhaps

most importantly, the average grades among students in all

classes improved eight points, or almost a full grade improve-

ment.

Similar improvements in attendance, grades and even TAKS

testing scores were seen in virtually all the schools where the

MOST program was implemented.

We hope Bexar County Medical Association members will

take time to go into a classroom once a year and talk about their

careers and what it took to get there. Hopefully, we can encour-

age some students to pursue a career in medicine. To learn more,

view a short video on the program, and volunteer, visit www.mo-

tivateourstudents.org.

Edwin “Eli” J. Whitney, MD, is a cardiologist at

the Heart and Vascular Institute of Texas and a

BCMS member.




PRIDE is a multidisciplinary organization of current and futureclinicians at the UT Health Science Center San Antonio (UTH-SCSA). The mission of the organization is to bring equitablehealthcare to medically under-served gender and sexual minori-ties, including lesbian, gay, bisexual, transgender and queer(LGBTQ) individuals. PRIDE works toward this goal throughcommunity outreach, health education and research.

However, building PRIDE was not always an easy task, said for-mer co-presidents Nicole Clifton and Chris Alonzo.

“Advocacy, education, fellowship, hospitality and service – theseobjectives really fueled everything we planned for PRIDE,”Clifton said. “I was in the education group – our group of stu-dents came up with the idea of a LGBTQ health education pro-gram which eventually evolved into the idea of Safe Space.” SafeSpace training aims to provide a more hospitable environment forLGBTQ people by establishing an identifiable network of peoplewho can provide support and information, and act as allies toLGBTQ individuals within the university.

In 2011, Alonzo led the implementation of the Safe Space pro-gram. “The campus attitude at the onset of Safe Space was one ofmore passive resistance than anything else,” he said. “The officeof undergraduate medical education and student center were will-ing to support the research and goal, but higher-level support wasnearly absent. Even after several attempts, it was still difficult tobe acknowledged.”

As Safe Space has grown, more than 200 students, faculty andstaff have participated within the past three years. Training hasexpanded to the Regional Academic Health Center (RAHC) inHarlingen. “With the success of the program now and implemen-tation at other sites, I believe that attitude has been changing,”Alonzo said.

PRIDE also has made significant efforts to serve the transgendercommunity in San Antonio. In collaboration with the San AntonioGender Association (SAGA), PRIDE has set up a number of trans-gender health panels that have been open to the campus. The panelsallow members of the transgender community to share their experi-ences and the challenges they face in receiving healthcare.

“Working with SAGA has been an eye-opening experience,”said Chris Lam, a current PRIDE co-president. “Not only did Ilearn that clinicians will refuse to have transgender patients intheir waiting rooms, but the attempted suicide rate of transgender

persons is 41 percent. That’s about 25 times the national averageof 1.6 percent.”

With the rise of student interest for transgender health education,PRIDE has worked with faculty to incorporate a transgender healthpanel into the required medical school curriculum and the physicianassistant program as well. “We have already received great feedbackfrom PA students on their clinical rotations, who have had wonder-ful encounters with transgender patients,” Lam said.

Faculty support for PRIDE also has been remarkable. Dr.Robert Esterl, professor of surgery and associate dean for under-graduate medical education in the School of Medicine, and Dr.Peter Andrew Guarnero, assistant professor in the Department ofFamily and Community Health Systems in the School of Nursing,are the faculty co-advisors for the group. Additionally, PRIDE hasfound more support in the School of Medicine. Dr. Dana Mc-Dowelle, assistant dean of diversity and professional development,aided the group as it held the first Texas LGBTQ “OUT forHealth” medical summit.

The inaugural “OUT for Health” summit was held April 12 atUTHSCSA in partnership with the School of Medicine's Diver-sity and Student Professional Development program. The eventattracted more than 80 registrants and included medical studentsfrom every Texas medical school. The Texas Association forGLBTQ Health was founded by these medical students to bringequitable healthcare to persons across the state.

“It’s been an exciting experience,” Lam said. “We are continu-ally in contact with other schools to share resources, and I can’twait to go to the next summit hosted by the medical school atUT-Houston.”

PRIDE continues to move forward in promoting equitablehealthcare. The group currently is leading a LGBTQ needs assess-ment survey with the purpose of understanding the medical dis-parity that the community faces in San Antonio. The informationgathered with the survey will bring the group one step closer toestablishing a LGBTQ student-run free clinic.

Gilberto Vazquez is a second-year medical student atthe University of Texas Health Science Center San An-tonio. He serves as a co-president for UTHSCSAPRIDE. He may be reached at [email protected].

Students establish group on LGBTQ healthBy Gilberto Vazquez

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mercial properties, Matin has a proven record of Excellence! Matin has achieved many Top Producer

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BCMS LEGISLATIVEAND ADVOCACY NEWS

BCMS physicians participatein legislative eventsBy Mary E. Nava, MBABCMS Chief Governmental and Community Relations Officer

1. On Oct. 14, BCMS members Michael Battista, MD,and Buddy Swift, DO, attended a reception in honor ofanother friend of medicine, state Rep. Lyle Larson (Dis-trict 122), at the Islamorada Fish Company. Pausing fora photo (from left) were Dr. Swift, Mary Nava, Larsonand Dr. Battista.

2. A reception hosted by Drs. Michael Battista and PamelaRay was held Oct. 22 in honor of State Rep. PhilipCortez (District 117). Cortez, a strong supporter ofmedicine's issues, sits on the Texas House Committeeon Public Health. Pausing for a photo were (from left)Alex Kenton, MD, Cortez and Dr. Battista.

3. A reception honoring Congressman Pete Gallego (TexasDistrict 23) was held Oct. 23 in the home of GustavoMedellin, MD. Those attending were (back row, fromleft) Jesse Moss Jr., MD; Bacel Nseir, MD; David Valdez,MD; and David Friedman, MD; (front row, from left)Michael Battista, MD; Gustavo Medellin, MD; DiannaBurns-Banks, MD; Gallego; and Shamsa Saleem, MD.

4. Drs. Michael Battista and Pamela Ray hosted a receptionin their home Oct. 29 in honor of State Sen. DonnaCampbell, MD (District 25). Pausing for a photo withCampbell were (from left) Isabel Basaldu-Prado, MD;Buddy Swift, DO; Campbell; Michael Battista, MD;Rodolfo Molina, MD; Scott Farhart, MD; and MaryWearden, MD. Also attending but not in the photo wereAlex Kenton, MD; Candace Campos-Kenton, MD; andMark Welborn, MD.

On Oct. 15, BCMS President-elect James Humphreys,MD, joined TMA advocacy staff Darren Whitehurst andDan Finch, and BCMS executive staff CEO Steve Fitzerand Mary Nava in a meeting with Congressman JoaquinCastro (District 20) to discuss a number of issues physiciansare facing at the federal level, including SGR, red-tape ad-ministrative hassles and the Geographic Practice Cost Index(GPCI).

For local discussion on this and other advocacy topics,consider joining the BCMS Legislative and Socioeconom-ics Committee by contacting Mary Nava [email protected].

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BCMS NEWS

CALL FOR RESOLUTIONS FOR 2015

It's that time of year again ... Do you have a TMA pol-icy change suggestion or recommendation for a stanceon an issue? Submit your resolutions now to the BCMSDelegation to TMA.

In order to allow adequate time for resolution reviewpreparations, the deadline to submit your resolutions toBCMS is Jan. 9. For a sample resolution form, visit www.bcms.org/del-

egation.html.

IN MEMORIAMC. Brandon Chenault, MD, died Sept. 16, 2014, at

age 84. Dr. Chenault was an obstetrician/gynecologistand BCMS life member. Francisco “Tito” Armando Gallegos, MD, died Nov.

6, 2014, at age 72. Dr. Gallegos was a plastic and recon-structive surgeon and BCMS retired member. Ernest Gregory, MD, died Oct. 12, 2014, at age 89.

Dr. Gregory, a surgeon and World War II veteran of theArmy Air Corps, was a BCMS life member.Gerhard A. Meyer, MD, died Oct. 28, 2014, at age

91. Dr. Meyer, who served in the U.S. Air Force MedicalCorps during the Korean War and specialized in internalmedicine, was a BCMS life member.Richard Tamez, DO, died March 22, 2014, at age 85.

Dr. Tamez was a surgeon and BCMS retired member.

CHCS clinic named for Dr. Burns-BanksDianna M. Burns-Banks, MD (right), and her son, Michael Burns, pause

Oct. 8 in front of the new Center for Health Care Services (CHCS) Cen-terCare Clinic. The clinic, which offers primary care services for patientsreceiving treatment for mental health and/or substance abuse, is the latestaddition to the Restoration Clinic in downtown San Antonio. The clinicwas named in honor of Dr. Burns-Banks, who served on the CHCS boardof directors from 2007 to 2014, as vice chair of the board of trustees andchair of the policy and operational committee. Courtesy photo


BCMS NEWS

“Good Health is Always in Fashion” at Women in Medicine event

Special thanks to our door-prize donors: Alamo Travel Group, Aspect Wealth Management, Bariatric Medical Institute of Texas, BBVA Compass,Cano and Cano Co., Clinical Pathology Laboratories, DataMed, Dermatology San Antonio -- Dr. Stephen Miller, Diamante Custom Homes, Doctor'sCompany, Favorite Healthcare Staffing, First Choice ER, Fleming's Steakhouse, Galen College of Nursing, Gastroenterology Consultants of SanAntonio, Generations Federal Credit Union, Kathy’s Kreations, Know Your Doctor, Massage Heights — Medical Center, Mudfire Pottery, Myke'sHair Studio, Northwestern Mutual, Perry's Steakhouse, SA Luxury Realty, San Antonio Symphony, Scentsy, Select Rehabilitation Hospital of San An-tonio, SmithPrint, Stella and Dot Jewelry, Stone Oak Dermatology, Time Warner Cable and Warm Springs Rehabilitation Hospital.For information on the BCMS Women in Medicine Committee, contact Brissa Vela at [email protected].

Members of the BCMS Women in Medicine Committee gather at the Nov. 1 luncheon and fashion show(from left): Dr. Lan-Anh Le Ngo, Dr. Leah H. Jacobson, Dr. Linda J. Banta, committee chair Dr. ChelseaClinton, Dr. Carmen Emery, Dr. Nancy Dru Bryant, Dr. N. Carol Dornbluth, committee vice chair Dr.Maggie Beato and Dr. Wendy B. Kang.

Dr. Robin Eickhoff offered sug-gestions on ways busy professionalscan create life-work balance.

TITLE SPONSOR

SPECIAL SPONSOR CONTRIBUTINGSPONSORS

IN-KIND SPONSORSFASHION SHOW

SPONSOR

More than 300 people attended the Nov. 1 BCMS Women in Medicine event at the Omni San Antonio Hotel.“Good Health is Always in Fashion” was the theme of the event, which included shopping opportunities, networking with BCMS Circle

of Friends representatives, a fashion show featuring women physicians, luncheon, and guest speaker Robin Eickhoff, MD, who discussed“Nurturing Your Soul.”

Thank you to all the sponsors and supporters who made this year’s event a great success!


president, and her entire team. We worked closely to establish a

collaborative relationship among the UTHSCSA Medical Student

Section, Junior Volunteers and the BCMS Alliance to accomplish

many community activities, such as “Hard Hats for Little Heads”

and “Be Wise, Immunize.”

NEW HOME FOR BCMSAs you know, our board members and the staff are working

hard to build our new home. You have already seen the artist’s

rendition of the building and other details of fundraising for this

purpose via U.S. mail. I urge you to contribute to this worthy

cause and identify some prospective donors the society can ap-

proach to achieve the goal of a home for our medical society.

OUR FUTURE IS HERE Today’s students are the “future of our organization.” I believe

that they are more informed, and more energetic than ever before

with current budding student leaders in the TMA and AMA stu-

dent sections. These are the individuals who will lead BCMS,

TMA and AMA in the future.

CHALLENGESOur medical society has many challenges ahead. Examples of

these challenges include changes in healthcare and payment re-

form, repealing of SGR, getting San Antonio’s own Geographic

Practice Cost Index, increasing patient access to care, and preserv-

ing the doctor-patient relationship and scope of practice. We can

achieve our goals if we work together. I am reminded of President

John F. Kennedy’s famous quote, “Ask not what your country can

do for you, ask what you can do for your country.” I encourage

you to become active in the society, contribute your ideas to solve

our problems, participate in committee work, and show our

strength in numbers so that we can represent the medical com-

munity with one voice. On my part, I will continue to serve the

society.

I thank you again for supporting me throughout the year. I

thank BCMS CEO/Executive Director Steve Fitzer and our ded-

icated staff for helping me to serve you better.

Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP, is the 2014 pres-

ident of the Bexar County Medical Society.

Continued from page 8PRESIDENT’S MESSAGE


LIFESTYLE

TOBIN CENTER FOR THE PERFORMING ARTSwww.tobincenter.org (210-223-8624)

If you haven’t checked out the impressiveTobin Center, which opened in September,there is no better time to do so than Decem-ber –– three holiday performances are goingon this month. “The Tobin Center takespride in its family programming for the hol-idays –– a perfect time to come out andcheck out the new state-of-the-art center forSan Antonio,” says Christopher Novosad,senior marketing manager. “Careful thoughtand care have been given to creating some-thing for everyone at the Tobin Center, fromthe only San Antonio-based Nutcracker intown to the Cirque twist on the holidays.”

The NutcrackerH-E-B Performance Hall Nov. 28-Dec. 27The Nutcracker is a must-see production

by Ballet San Antonio and the San AntonioSymphony. Created by San Antonio artistsfor San Antonio audiences, this enduringclassic realizes Tchaikovsky's original visionwith exquisite choreography, sets and cos-tumes, performed to live symphonic music.The Nutcracker follows Clara and herbeloved nutcracker on a magical ChristmasEve journey as the two survive a raging bat-

tle between a horde of mice and toy soldiers,experience the wintry beauty of the Land ofSnowflakes and savor an array of delights inthe Kingdom of Sweets.

Cirque Dreams Holidaze H-E-B Performance Hall Dec. 11-14

Lighting up the 2014 holiday season,Cirque Dreams Holidaze is a not-to-misscirque performance, Broadway musical, hol-iday spectacular and family show all in one.With rave reviews spanning The WashingtonPost to the New York Daily News, Broadwaydirector Neil Goldberg reimagines the holi-

day season with more than 300 costumes,20 acts and 30 performers from 12 countriesshowcasing an endless variety of heart-pounding and gravity-defying feats you haveto see to believe –– think gingerbread menflipping mid-air and toy soldiers marchingon thin wires.

Rudolph the Red-Nosed Reindeer: The Musical H-E-B Performance Hall Dec. 22-24

A half-century later, this beloved Christ-mas classic which first aired in 1964 stillcaptures the hearts and wonder of fans of all

AT THE THEATERAs the holidays approach, get the whole family into the spirit

with San Antonio’s seasonal theater performances guaranteedto entertain everyone from grandma to junior. This December,this city brims with holiday shows playing out on various stagesbig and small from the brand-new $203 million Tobin Centerfor the Performing Arts to the Magik Theatre and Rose TheatreCompany. Below are six holiday shows you and your childrenwon’t want to miss this month.

Ring in the holidaysSix family-friendlySan Antonioshows to seethis season

By Mauri Elbel

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LIFESTYLE

ages. Soaring off the screen and onto thestage, the Tobin Center brings all of your fa-vorite characters from the animated televi-sion special, including Santa and Mrs. Claus,Hermey the Elf, Bumble the AbominableSnow Monster, Clarice, Yukon Cornelius,the Misfit Toys and, of course, Rudolph, inthe all-new Rudolph The Red-Nosed Reindeer:The Musical, a theatrical adventure thatteaches us what makes you different is alsowhat makes you special.

MAGIK THEATRE www.magiktheatre.org (210-227-2751)

Junie B. Jones: Jingle Bells, Batman Smells!Nov. 21-Dec. 27

Gather the entire family for a holiday out-ing to Magik Theatre, designed to educateyoung people and adults while nurturing the

next generation’s theater audience. The the-ater is a miraculous place, says Magik The-atre’s Beth Graham. What better time toshare in the magic of the theater than duringthe holidays? Watch as Junie B. returns toMagik Theatre’s stage presenting a hilariousholiday tale based on the book Jingle Bells,Batman Smells! by Barbara Park, author of

The New York Times bestselling Junie B.Jones series. Between Junie B. participatingin the holiday pageant and picking a SecretSanta gift for her big rival, Tattletale May,there’s never a dull moment in the life of theworld’s funniest first-grader. Laugh alongwith your family as you discover togetherwhether Junie B. will make the right choiceand give May something other than a lumpof coal –– but no matter the outcome, JunieB. is sure to capture your hearts and upliftyour spirits. “Share the book at home, thenwatch it come to life on stage,” Graham says.

THE ROSE THEATRE CO.www.therosetheatreco.com(210-360-0004)

Rudolph the Red Nose Reindeer,Dec. 17, 18, 20 and 23

Holy Holidays B@tman!, Dec. 5-20

The Rose Theatre, a black box theatertucked away in the Elms Shopping Centerlocated off Wurzbach and Lockhill Selmaroads, prides itself on being a theater thatnon-theater go-ers love, says co-owner JessieRose. Formerly known as the Steven StoliPlayhouse, the Rose Theatre Company hasbecome a popular production house in SanAntonio that organizes theater workshopsand acting classes for adults as well as kidsand conducts comedy shows, improvisa-tional theater, live musicals and concerts.This holiday season, the Rose Theatre willbe running its children’s show, Rudolph theRed Nose Reindeer. “Children see howRudolph became the famous reindeer thathe is today,” Rose says. “This play has every-thing you need to get into the spirit, Christ-mas carols and fun for the whole family.Every show is geared toward children 1 to8 years old and packed with audience par-ticipation allowing the kids to be a part ofevery moment.” As nighttime rolls around,treat the family with tickets to Holy Holi-days B@tman! which runs on Friday andSaturday nights Dec. 5-20. This family-friendly comedy is a hilarious holiday spoofof the famous 1960s Batman and Robinthat promises to have the whole familylaughing as the duo takes on the many vil-lains who try to sabotage Christmas.


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HASA

That’s just what a new study, published in theprestigious journal, Information Systems Research,and highlighted in a Brookings Institute blogpost, concludes. The authors ask, “Would youhave joined Facebook if you had no friends whowere already using the social network?” Thenanswer the question with a resounding, “Prob-ably not!”

“Facebook,” the authors say, “with no friendsis a lonely place.” And so is an HIE without acritical mass of clinical data.

The study tracked HIE adoption and usagepatterns among more than 2,000 physicians and430 practices over three years. It found thatdoctors are like anyone else, they want to bewhere their peers and colleagues are. And iftheir fellow physicians and referral colleagues areconnected to and sharing data via an HIE, thenthat’s where they also want to be.

The problem with all of this is the classic“chicken and egg syndrome.”

The study’s authors correctly state that “the potential of a HIE plat-form can only be realized when its multiple constituent users activelyparticipate in using its variety of services.” By the same token, if doc-tors are waiting for all of their fellow physicians to jump on beforetaking the plunge, then what we have is a kind of standoff.

According to two studies published in the journal Health Affairs,hospitals and healthcare systems made “phenomenal progress” inadopting electronic health records in 2013, but still have a ways togo to meet all the criteria for Meaningful Use (MU) Stage 2 and theimplementation of HIEs.

Susan Hall, an editor and author writing in FierceHealthIT, a dailynewsletter covering IT in healthcare, says, “Despite their dependenceon data to improve care, most ACOs – 76 percent -- do not partici-pate in a health information exchange at a community level.”

In South Texas, HASA’s 22-county service area, the situation issimilar. In Bexar County, five of the six hospitals are on board andparticipating. But physician groups in the community are laggingbehind.

In part, it is an issue of the cost to interface from their EMR sys-tems to HASA, which can vary greatly, but also it is exactly what the

national study reported. Physicians have their own set groups ofother doctors they work with on a regular basis. The primary caregroups want to wait until the specialty groups are participating andvice versa. In a perfect world, everyone would sign up at the sametime and the benefits would be overwhelming to the community.

We fundamentally believe that as more hospitals and practicegroups sign on, and their physicians and administrators see the busi-ness and patient care benefit, those numbers will grow.

REFERENCEYaraghi, Niam and Du, Anna Ye and Sharman, Raj and Gopal, Ram D. and

Ramesh, Ram, Health Information Exchange as a Multi-Sided Platform: Adoption,Usage and Practice Involvement in Service Co-Production (August 13, 2014). Avail-able at SSRN: http://ssrn.com/abstract=2480093

Gijs van Oort, PhD, is the executive director forHealthcare Access San Antonio (HASA), the local HealthInformation Exchange (HIE) provider authorized by theState of Texas to create a community-based, region-wideHIE in Bexar County and 22 surrounding counties. Visitwww.hasatx.org.

HIE is likeFacebook for doctors?By Gijs Van Oort


UTHSCSADEAN’S MESSAGE

This has been an eventful year for the Cancer Therapy & Re-

search Center (CTRC), the National Cancer Institute-designated

Cancer Center for San Antonio and South Texas. In 2014, we

celebrate the 40th year of service to the 4.5 million men, women

and children of South Texas. Re-competition for our NCI grant

extending our Cancer Center designation for another five years

was time consuming, but ultimately rewarding; thanks to the hard

work of more than 450 individuals, we received a “high-impact”

score and consequent funding.

Our mission is five-fold: (1) comprehensive, multidisciplinary

care for all forms of cancer, (2) basic science discoveries of mech-

anism of oncogenesis and how we can better target them for ther-

apy, (3) clinical trials of the next generation of methods to prevent,

diagnose and treat cancer, as well as to prevent and control side

effects of cancer and its treatment, (4) education of the next gen-

eration of cancer physicians, surgeons and scientists, as well as (5)

a major focus on cancer prevention for the 38 counties of South

Texas. These are the distinguishing characteristics of National

Cancer Institute-designated Cancer Centers.

Since our last NCI review in 2008, our progress has been for-

midable. Metrics include a three-fold increase in accrual to clin-

ical trials (to over 2,000 in 2013), a seven-fold increase in accrual

to investigator-initiated trials (those that are developed by our

own faculty), a more than doubling of publications, and, despite

a dramatic flattening in NIH funding, a 32 percent increase in

total peer-reviewed funding to more than $23 million in grant

funding in 2013.

HISPANIC PATIENTSThe CTRC has a major focus on cancers that disproportion-

ately affect the South Texas region, including liver cancer (which

is seven times more common in Hispanic men than in the U.S.

population at large) cervical and stomach cancer, and pediatric

leukemias. We also have a very special interest in prevention, di-

agnosis and treatment of cancer in Hispanics, the fastest-growing

segment of the U.S. population. Unfortunately, at a national

level, few studies include many Hispanic patients, making con-

clusions regarding treatment in this important population diffi-

THE CANCER THERAPY & RESEARCH CENTER:40 years of serving Central and South Texas

By Francisco González-Scarano, MD

Alonso N. Gutierrez, PhD (left), and BCMS member Chul S. Ha, MD, talk with a CTRC patient. Courtesy photo


UTHSCSADEAN’S MESSAGE

cult. At the CTRC, by contrast, 46 percent of patients on treat-

ment trials are of Hispanic ethnicity and 76 percent on non-treat-

ment studies (such as prevention or early detection studies) are

Hispanic. We are very proud that much of the national knowl-

edge base on how best to prevent and treat cancers in this impor-

tant segment of the U.S. population comes from San Antonio and

the CTRC.

With the growing San Antonio and South Texas population, in

mid-2014 the CTRC recruited a host of new physicians to pro-

vide the subspecialty cancer care that is state-of-the-art today.

These include: Meghan Lautner, MD, breast cancer surgery; Vir-

ginia Kaklamani, MD, and Kate Lathrop, MD, breast cancer

medical oncology; Sukeshi Patel, MD, and Laura Tenner, MD,

gastrointestinal medical oncology; Woondong Jeong, MD, uro-

logic medical oncology; Michael Liss, MD, and Dharam Kaushik,

MD, urologic surgical oncology; Sumit Madan, MD, hematologic

oncology; and Ian Makey, MD, cardiothoracic /lung surgery.

These new physicians have joined the CTRC’s multidiscipli-

nary cancer treatment teams including breast cancer, prostate and

urologic cancers, colorectal, pancreas and liver cancers, brain can-

cers, sarcomas and bone cancers, hematologic cancers, gynecologic

cancers, endocrine cancers, lung cancer, and head and neck cancer.

The CTRC also is blessed to have a comprehensive skin cancer

clinic including the availability of MOHS surgery. These treat-

ment teams are augmented by subspecialists in radiologic imaging,

pathology, genetics and epidemiology. Together, they work to de-

velop individualized treatment plans for patients with common

and uncommon conditions.

The CTRC’s clinical research programs further augment the

care of cancer patients and those who are at risk of cancer includ-

ing individuals with a family history of cancer. This program ben-

efits from the presence of the storied Institute for Drug

Development, one of the oldest and most successful Phase I pro-

grams in the United States where first-in-human clinical trials are

conducted, including therapies developed by our own physicians.

The newest example of this success is the development of an ex-

tremely promising new treatment for recurrent brain cancer, a dis-

ease that is almost always lethal within a very short time. A team

of scientists and physicians developed a formulation that packaged

a high-intensity radiation source into microscopic fat bubbles –

186Rhenium Nanoliposomes (or RNL). In early studies, this

treatment almost universally cured experimental brain tumors.

After years of intensive research, the U.S. Food and Drug Admin-

istration approved a Phase I clinical trial at the CTRC that will

begin soon, offering this promising treatment first to our own pa-

tients from San Antonio and South Texas. Other promising drugs

are in the CTRC pipeline, including repurposing of older drugs

to make current cancer medications more effective, often in a dra-

matically more cost-effective manner; in one CTRC study, a

generic antimalarial drug – hydroxychloroquine – made

chemotherapy more effective at a cost of only 50 cents per day.

The CTRC’s 80 scientific Full Members (MDs and PhDs) and

66 Associate Members provide the scientific discoveries that push

scientific discovery into improving cancer care and reducing the

burden of cancer. They work side-by-side with our physicians to

develop the next generation of cancer care therapies.

REDUCING THE BURDENAn overarching goal of the CTRC is to reduce the burden of

cancer for our 38-county region of South Texas, an area about the

size of Pennsylvania, where many patients have to drive up to five

hours for our specialty care. To reduce this burden, a group of

Virtual Tumor Boards have been developed. For patients seen at

the CTRC, a group of specialists in the specific cancer (for exam-

ple, breast cancer) will evaluate new cases to develop an individ-

ualized treatment plan, often for very complex cancers. The

tumor boards are conducted in real-time format over high-speed

Internet connections allowing physicians in distant locations to

present their patients to these panels of experts. Virtual Tumor

Boards have been established in Edinburgh and Laredo, with mul-

tiple other sites in planning stages. Ultimately, it is the CTRC’s

goal to provide the highest-level cancer care in our patients’ own

communities where they are supported by their families, avoid

long drives for therapy, and “sleep in their own beds at night.”

There is much work to do to provide the very best cancer care

for South Texas. We are fortunate to have a National Cancer In-

stitute-designated Cancer Center like the CTRC in San Antonio,

thanks to the vision of a group of San Antonio leaders 40 years

ago. The CTRC’s growth and contributions to the health of our

community have been made possible only through community

support, support of the UT Health Science Center and the Uni-

versity of Texas system, and the dedicated service of our staff,

physicians and scientists. Ultimately, it is our mission to dramat-

ically reduce the burden of cancer for our region and provide “the

answer to cancer.”

Dr. Francisco González-Scarano is dean of the

School of Medicine, vice president for medical affairs,

professor of neurology, and the John P. Howe III,

MD, Distinguished Chair in Health Policy at the

University of Texas Health Science Center at San An-

tonio. His email address is [email protected].


BOOK REVIEW

During the latter portion of the 19th century, the world was ex-cited about the possibility of some country accomplishing the chal-lenge of attaining the North Pole. This was the last unexplored areaof the world, and several unsuccessful attempts had been made byEuropeans. International esteem would fall to the country thatcould plant their flag on the north tip of the world. Many theoriesexisted as to the nature of the polar ice cap and how to navigate tothe North Pole, but the true geography was not understood. WriterHampton Sides relates the story in his book, “In the Kingdom ofIce (The Grand and Terrible Polar Voyage of the USS Jeannette).”

The U.S. Navy prepared an expedition to accomplish this feat,and it was underwritten by James Gordon Bennett Jr., the ultra-wealthy owner of the New York Herald newspaper. He had sent Stan-ley to Africa to successfully find Dr. Livingstone several yearspreviously. The expedition was under the command of a youngnaval officer, George Washington DeLong, who had gainedrecognition for a rescue attempt off the north shore of Green-land. The group set sail on the USS Jeannette, a refitted ship for

the polar exploration, on July 8, 1889, heading north from SanFrancisco to the Bering Sea and hopefully farther north to the pole.With a select crew of 32 men, they set sail to bring recognition tothis young country just emerging from its catastrophic Civil War.

LEAD POISONINGThey arrived at the polar ice cap, but being unable to find an open

water passage they became entrapped in the ice. They remained suchfor almost two years, constantly moving with the ice flow north-westerly. Survival during this period was relatively easy while still onboard the ship. There was plenty of coal on board for energy needs,supplies, and plenty of game (polar bears and seals) for additionalfood.

All hands became ill at one point with strange symptoms that werefinally diagnosed by the ship surgeon to be lead poisoning from thecans containing tomatoes used primarily to prevent scurvy.

Finally open water was encountered but the ship was struck in thehull by an underwater iceberg and shortly sank. All hands, consid-erable supplies, and equipment were saved, but the expedition founditself trapped on the ice with the nearest land being the northernshore of Siberia 1,000 miles distant.

Thus with the crew, tons of supplies, sleds, and three small openboats began one of the most perilous and heroic journeys recordedin naval history. To move south over the erratic ice and reach openwaters and then sail to Siberia in three open boats produced chal-lenges never imagined. With the ice flow moving north while theymarched south, occasionally they made only a few miles a dayagainst the subzero weather and treacherous terrain. They managedto gain ground overcoming immense odds.

Finally reaching open water, they manned the boats and set offsouth for Siberia. Combatting constant storms, frequent fog, un-bearable cold, and lack of sufficient food, they continued but thethree boats became separated. They eventually reached Siberia indifferent areas. The crews were now fully exhausted mentally andphysically. Desperate from the inhumane environment and dwin-dling food supplies, they made for the nearest settlement hundredsof miles to the south. Some froze to death and others died fromfrostbite leading to infection and gangrene.

Finally, a settlement was reached and eventually a town with tele-graph, and word was flashed to Washington and the world aboutthe plight of the Jeannette and her crew. The journey had takenmore than three years, but most of the information was recorded indetail in the logs by Captain DeLong. Their accomplishment of sur-vival became international news, and they were acclaimed as heroes.This story of dedication, perseverance, determination and sacrificemakes for an extremely interesting, exciting and enjoyable read.

J.J. Waller Jr., MD, is a member of the BCMS Commu-nications/Publications Committee.

‘In the Kingdom of Ice (The Grand and Terrible Polar Voyage of the USS Jeannette)’

Reviewed by J.J. Waller Jr., MD


• ACCOUNTING

Anderson, Johns & Yao CPAs(HH Silver Sponsor)We strive to provide a profes-sional and friendly atmosphere forall your accounting and financialneedsAnn Yao, CPA/PFS, [email protected] Antonio based CPA firm with 30 plus years of experience

Padgett Stratemann & Co. LLP(HH Silver Sponsor)Padgett Stratemann is one ofTexas’ largest, locally-ownedCPA firms, providing sophisti-cated accounting, audit, tax, andbusiness consulting services.Vicky Martin, CPA 210-828-6281Vicky.Martin@Padgett-CPA.comwww.Padgett-CPA.comOffering Service. More Than Ex-pected. On every engagement.

Sol Schwartz & Associates P.C.(HH Silver Sponsor)We specialize in areas that are most critical to a company’sfiscal well-being in today’scompetitive markets. Jim Rice, CPA, 210-384-8000, ext [email protected] to working with physicians and physician groups

• ATTORNEYS

Pulman, Cappuccio, Pullen, Benson & Jones(H Bronze Sponsor)The attorneys at Pulman, Cappuc-cio, Pullen, Benson & Jones, LLPhave over 150 years of combinedexperience providing exemplaryrepresentation for clients.Eric Pullen, [email protected]

• BANKING

Amegy Bank of Texas(HHH Gold Sponsor)We believe that any great rela-tionship starts with 5 core values;Attention, Accountability, Appreciation, Adaptability & At-tainability. We work hard and to-gether with our clients to accomplish great things.Jeanne Bennett, [email protected] Leckie, [email protected] Banking Partnership

BB&T(HHH Gold Sponsor)Checking, savings, investments,insurance. BB&T offers bankingservices to help you reach yourfinancial goals and plan for asound financial futureEd L. White, Jr. [email protected]

BBVA Compass(HHH Gold Sponsor)A multinational banking group providing financial services inover 30 countries,and to 50 mil-lion clients throughout the world.Commercial Relationship ManagerZaida Saliba, [email protected] Global Wealth ManagementMary Mahlie, 210-370-6029mary.mahlie@bbvacompass.comwww.bbvacompass.comWorking for a better future

Broadway Bank(HHH Gold Sponsor)Broadway Bank is a full servicepersonal and commercial bankwith a specialized Healthcarebanking team committed tosupporting our medical commu-nity. We offer 40 convenient lo-cations in San Antonio, Austinand surrounding areas.Ken Herring, [email protected]’re here for good.

Crockett National Bank(HHH Gold Sponsor)Crocket National Bank is a leading Texas community bank specializing in mortgage, ranch and commercial real estatelending providing superior customer service and competitive financial products.Lydia Gonzales, 210-384-9304lydiagonzales@crockettnational-bank.comwww.crockettnationalbank.comDoing what we promise.

Frost(HHH Gold Sponsor)As one the largest Texas-basedbanks,Frost has helped Texanswith their financial needs since1868, offering award-winning customer service and a range ofbanking, investment, insuranceservices to individuals and busi-nesses.Lewis Thorne, [email protected]@Work provides your em-ployees with free personalizedbanking services.

The Bank of San Antonio(HHH Gold Sponsor)We specialize in insurance andbanking products for physiciangroups and individual physicians.Our local insurance professionalsare one of the few agents in the state that specialize inMedical Malpractice and all linesof insurance for the medicalcommunity.Brandi Vitier, [email protected]

Baptist Credit Union(HH Silver Sponsor)It is Baptist Credit Union’s missionto meet our members needs byproviding extraordinary service,quality financial products, andpersonal financial education. Sarah Chatham 210-525-0100, ext [email protected] commend your dedication tothe health & wellbeing of ourcommunity.

Cadence Bank(HH Silver Sponsor)Cadence Bank is a full-service fi-nancial institution serving com-mercial, consumer, treasury andwealth-management clients inTexas and the Southeast.Margarita Ortiz, [email protected] Edlund, [email protected]://cadencebank.comExplore Cadence Bank’s innova-tive financing options and treas-ury management solutions.

Citi Commercial Bank(HH Silver Sponsor)Chris McCorkle [email protected] www.citi.com

BCMS CIRCLE OF FRIENDSSERVICES DIRECTORYPlease support our sponsors with your patronage; our sponsors support us.


BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY

Firstmark Credit Union(HH Silver Sponsor)Address Your Office Needs. Upgrading your equipment ortechnology? Expanding your office space?We offer loans to meet yourbusiness or personal needs.Competitive rates, favorableterms, and local decisions.Gregg Thorne, SVP [email protected]

St. Joseph's Credit Union(HH Silver Sponsor)A Credit Union providing savings,checking, IRA, club, and CD ac-counts. Plus, Auto, signature,Lines of Credit, MasterCard and Real Estate Loans.Debra Abernathy, [email protected] Rates on Auto loans, Signature loans and PlatinumMasterCard

Jefferson Bank(H Bronze Sponsor)Full service bank specializing inmortgages, wealth management& trusts.Ashley Schneider 210-734-7848 ext [email protected] www.jeffersonbank.com

Security Service Federal Credit Union(H Bronze Sponsor)Business financing, specializingin low interest commercial realestate transactionsLuis Rosales, [email protected] members can get up to halfa percent off the origination fee

Texas Farm Credit(H Bronze Sponsor)Rural, homestead and acreage lending.Tiffany Nelson, 210-798-6280www.texasfcs.com

• CATERING

Corporate Caterers(H Bronze Sponsor)A locally owned family franchisebusiness serving the San Antonioarea.Ricardo [email protected]

Heavenly Gourmet Catering(H Bronze Sponsor)210-496-9090www.heavenlyg.com

• CONTRACTOR/BUILDERS

Huffman Developments(HH Silver Sponsor)Steve Huffman, 210-979-2500Shawn Huffman, 210-979-2500www.huffmandev.com

San Antonio Retail Builders(HH Silver Sponsor)Specializing in remodeling/finishout of medical offices. H.B. Newman [email protected] Carter [email protected] 6 months ArchitecturalSpace Plan / RenderingNo Cost or Obligation

• CUSTOM HOMEBUILDING

Diamante Custom Homes(HHH Gold Sponsor)Experience your new customhomebuilding process throughSan Antonio’s leading design-build firm. Over two decades ofstreamlining the balance be-tween your budget and yourdreams. The name you knowfrom the builders you trust!Keith Norman, 210-341-6430knorman@diamantehomes.comwww.diamantehomes.comSpecial promotions for all BCMSmembers – call us today!

• EDUCATION

Alpha Bilingual Preschool(H Bronze Sponsor)Our mission is to provide youngchildren with an integral earlyeducation in a Spanish immersionenvironment. Tania Lopez de [email protected] your children the gift ofspeaking a second language.

• ELECTRONIC MEDICALRECORDS

Greenway Health(HHH Gold Sponsor)Greenway Health offers a fully integrated electronic healthrecord (EHR/EMR), practicemanagement (PM) andinteroperability solution thathelps healthcare providers improve care coordination, quality and satisfaction while functioning at their highestlevel of efficiency.Jason Siegel 512-657-1259jason.siegel@greenwayhealth.comwww.greenwayhealth.com

• FINANCIAL SERVICES

Northwestern MutualWealth Management Company(HHHH Platinum Sponsor)Comprehensive Financial Plan-ning Insurance and InvestmentPlanning Estate Planning andTrust Services.Eric Kala CFP, CLU, ChFC, Wealth Management [email protected]

Aspect Wealth Management(HHH Gold Sponsor)We believe wealth is more thanmoney, which is why we improveand simplify the lives of ourclients, granting them greatersatisfaction,confidence, andfreedom to achieve more in life.Jeffrey Allison [email protected] what you deserve… Maxi-mize your Social Security benefit!

Frost Leasing(HHH Gold Sponsor)

As one the largest Texas-basedbanks, Frost has helped Texanswith their financial needs since1868, offering award-winningcustomer service and a range ofbanking, investment, insuranceservices to individuals and businesses.Laura Elrod Eckhardt 210-220-4135laura.eckhardt@frostbank.comwww.frostbank.comCommercial leasing for a doctor’sbusiness equipment and vehicle.

Platinum Wealth Solutions ofTexas LLC(HH Silver Sponsor)Comprehensive financial plan-ning firm who assists medicalprofessionals to protect theirincome, their wealth, their practice and legacy.Tom Valenti, 210-998-5023 [email protected] Eric Gonzalez, 210-998-5032 ericgonzalez@jhnetwork.comwww.platinumwealthsolutionsof-texas.comUnderstanding the uniqueness inthe financial life as a physician.

Bold Wealth Management(H Bronze Sponsor)Comprehensive Investment Advisory and Retirement Plan-ning Services for Businesses and Individuals.Richard A. Poligala, 210-998-5787richard.poligala@natplan.comwww.boldfinancialgroup.comComplimentary no-obligation retirement plan review to BCMS members

• GOLF

TPC San Antonio(H Bronze Sponsor)18-hole championship golfcourses designed by two ofgolf's most innovative architects,Pete Dye and Greg Norman.Matt Flory, 210-491-5816www.tpcsanantonio.com

• HOSPITALS/HEALTHCARESERVICES

First Choice Emergency Room (HHH Gold Sponsor)The nation's oldest and largest



network of independent free-standing emergency rooms. Pa-tients seen almost immediately.Board-certified physicians andemergency-trained registerednurses. In-house CT scanner, ul-trasound, digital X-ray andCOLA/CIA accredited on-site labto handle emergencies 24/7/365.Nacogdoches Road 24-hour210-447-7560Hardy Oak Boulevard 24-hour210-451-8340Tezel Road 24-hour210-437-1180www.fcer.comCheck in online – free, easy, fast!

Select Rehabilitation of San Antonio (HHH Gold Sponsor)At Select Rehabilitation Hospitalof San Antonio, we providespecialized rehabilitation programs and services for individuals with medical, physicaland functional challenges. Miranda Peck, [email protected]://sanantonio-rehab.com/Offers patients a higher degree ofexcellence in medical rehabilitation.

South Texas Sinus Institute(HHH Gold Sponsor)The South Texas Sinus Institute isa state of the art facility dedi-cated to in-office BalloonSinuplasty using the unique Painless Sinuplasty AnestheticLinked Method.Sue Musgrove, [email protected] will offer convenient sameday or lunch appointments toBCMS members.

Warm Springs Medical CenterWarm Springs Thousand OaksWarm Springs Westover Hills(HHH Gold Sponsor)Our mission is to serve peoplewith disabilities by providingcompassionate,expert care during the rehabilitation process

& support recovery througheducation & research.Central referral Line 210-592-5350Joint Commission COE

Elite Care 24 Hour EmergencyCenter(HH Silver Sponsor)We are a fully equipped emer-gency room open 24 hours aday and 7 days a week, staffedby experienced emergencyphysicians. We provide thesame level of emergency medical care that you would receive in a hospital ER.Clemente Sanchez, [email protected] Clark, 210-771-0141rclark@elitecaremarketing.comwww.elitecareemergency.comGet seen by an experiencedphysician within 10 minutes.

Methodist Healthcare System(HH Silver Sponsor)Palmira Arellano, [email protected]://sahealth.com

Seasons Hospice and Palliative Care(HH Silver Sponsor)Deb [email protected]

Southwest General Hospital(HH Silver Sponsor)Southwest General Hospital is a327-bed, state-of-the-art hospi-tal located in San Antonio, Texas.Southwest General offers com-prehensive healthcare services.Craig Desmond, 210-921-3521Elizabeth Luna, 210-921-3521www.swgeneralhospital.com

• HUMAN RESOURCES

Employer Flexible(HHH Gold Sponsor)Employer Flexible doesn’t simplylessen the burden of HR adminis-tration. We provide HR solutionsto help you sleep at night andget everyone in the practice on the same page.John Seybold, 210-447-6518jseybold@employerflexible.comwww.employerflexible.comBCMS members get a free HR assessment valued at $2,500.

Pinnacle Workforce Corp HR. Services (H Bronze Sponsor)Dan Cardenas, [email protected]

�• INFORMATIONTECHNOLOGY

Dahill(HHH Gold Sponsor)Dahill offers comprehensive docu-ment workflow solutions to helphealthcare providers apply, man-age and use technology that sim-plifies caregiver workloads. Theresults: Improved access to pa-tient data, tighter regulatorycompliance, operational efficien-cies, reduced administrative costsand better health outcomes.Stephanie Stephens, [email protected]

Allison Royce Business Technologies(H Bronze Sponsor)Business Technology Provider, specializing in HIPAA CompliantManaged IT Services and IT Sup-port since 1993.Jeff Tuttle,[email protected]

PitCrew IT Services(H Bronze Sponsor)Provides reliability for your business computers or network, enabling you to operatesmoothly.Eric Murcia, [email protected]

• INSURANCE

Blue Cross Blue Shield of Texas(HHH Gold Sponsor)Edna Pérez-Vega, [email protected]

Frost Insurance(HHH Gold Sponsor)As one the largest Texas-basedbanks, Frost has helped Texanswith their financial needs since1868, offering award-winningcustomer service and a range ofbanking, investment, insuranceservices to individuals and businesses.Bob Farish [email protected] and personal insurancetailored to meet your uniqueneeds.

Humana(HHH Gold Sponsor)Humana is a leading health andwell-being company focused onmaking it easy for people toachieve their best health withclinical excellence through coor-dinated care.Donnie [email protected]

Texas Medical Association Insurance Trust(HHH Gold Sponsor)Created and endorsed by theTexas Medical Association (TMA), the Texas Medical Association In-surance Trust (TMAIT) helpsphysicians, their families, andtheir employees get the insur-ance coverage they need.James [email protected] Isgitt512-370-1776www.tmait.orgWe offer BCMS members a freeinsurance portfolio review.

Catto & Catto(HH Silver Sponsor)Providing insurance, employeebenefits and risk-managementproducts and services to thou-sands of businesses and individu-als in Texas and the United States.Crystal MetzgerJames L. Hayne Jr.210-222-2161www.catto.com





Texas Drug Card(H Bronze Sponsor)The Texas Drug Card program is a FREE statewide Rx assistanceprogram available to all residents.Todd Walker [email protected]://texasdrugcard.com/index.php

�• INSURANCE/MEDICALMALPRACTICE

Texas Medical Liability Trust(HHHH Platinum Sponsor)Texas Medical Liability Trust is aphysician-owned health care liability claim trust, providing malpractice insurance productsto the physicians of Texas. Currently, we protect more than14,000 doctors in all specialtieswho practice in all areas of the state. TMLT is endorsed bythe Texas Medical Association,the Texas Academy of FamilyPhysicians, the Dallas, Harris, Tarrant, and Travis County Medical Societies. Patty Spann,[email protected] Partner of theBexar County Medical Society.

Medical ProtectiveMedical Malpractice Insurance(HHH Gold Sponsor)Medical Protective, the nation'soldest and only AAA-ratedprovider of healthcaremalpractice insurance. Thomas Mohler [email protected]

The Bank of San Antonio Insurance Group, Inc.(HHH Gold Sponsor)We specialize in insurance andbanking products for physiciangroups and individual physicians.Our local insurance professionalsare one of the few agents in the

state that specialize in Medical Malpractice and all lines of insur-ance for the medical community. Katy Brooks, CIC, 210-807-5593katy.brooks@bosainsurance.comwww.thebankofsa.comServing the medical community.

The Doctors CompanyMedical malpractice insurance(HH Silver Sponsor)We relentlessly defend, protectand reward the practice of goodmedicine. As the patient safetyindustry leader, we proudly offera comprehensive selection ofCME opportunity and risk-miti-gation resources.Kirsten Baze, [email protected]

• INTERNET/TELECOMMUNICATIONS

Time Warner Cable Business Class(HH Silver Sponsor)When you partner with TimeWarner Cable Business Class, youget the advantage of enter-prise-class technology and communications that are highlyreliable, flexible and pricedspecifically for the medical community.Rick Garza, [email protected] Warner Cable BusinessClass offers custom pricing forBCMS Members.

�• MARKETING SERVICES

Know Your Doctor SA(HH Silver Sponsor)Increase your practice’s uniquemarketing/communications pro-gram. Connect with SA commu-nity through video, advertising,PR and medical opinion e-news.Limited to 300 physicians.Lorraine Williams, RN210-884-7505LWilliams@KnowYourDoctorSA.comwww.KnowYourDoctorSA.com

Phiskal LLC Marketing and Promotion(H Bronze Sponsor)A leading edge marketing anddevelopment firm using propri-etary Artificial Intelligence en-gines to enhance your presencewith websites, apps & databaseapplications.Sundeep Sadheura210-865-4520

[email protected]://PHISKAL.COM/

�• MEDICAL BILLING AND COLLECTIONS SERVICES

DataMED(HHH Gold Sponsor)Providing your practice with thelatest compliance solutions, con-centrating on healthcare regula-tions affecting Medical Billingand Coding changes allowingyou and your staff to continuedelivering excellent Patient Care.Anita Allen (210) [email protected] members receive a discounted rate for our billingservices.

Commercial & Medical CreditServices(H Bronze Sponsor)A bonded and fully insured San Antonio-based collectionagency.Henry Miranda, [email protected] us the solution for your account receivables.

PriMedicus Consulting Inc.(H Bronze Sponsor)A physician-founded and builtcompany, dedication to yoursuccess. Sally Combest MD., 877-634-5666s.combest@primedicusconsult-ing.comwww.primedicusconsulting.comPriMedicus Consulting for theHealth of Your Practice.

Urgent Care Billing Solutions, LLC(H Bronze Sponsor)UCBS provides superior practicemanagement services and rev-enue optimization services to thehealthcare community in a virtualoffice environment. Ann DeGrassi, CMIS 210-878-4052 adegrassi@ucbillingsolutions.comwww.urgentcarebillingsolutions.net

��• MEDICAL SUPPLIES& EQUIPMENT

Henry Schein Medical(HHHH Platinum Sponsor)From alcohol pads and band aidsto EKG’s and Ultrasounds, we arethe largest worldwide distributorof medical supplies, equipment,vaccines, and pharmaceuticalsserving office based practition-ers in 20 countries. Recognizedas one of the world’s most ethi-cal companies by Ethisphere.Tom Rosol [email protected]/medicalBCMS members receive GPO dis-counts of 15%-50%.

McKesson Medical-Surgical(H Bronze Sponsor)MCKESSON is a leading distributor of Medical Supplies and Equipment.Karan Cook, [email protected]

��• ORGANIZATIONS

Fundacion Teleton USA(HH Silver Sponsor)Ricardo Guzman Hefferan [email protected]

• PAYMENT SYSTEMS/CARD PROCESSING

Heartland Payment Systems(HH Silver Sponsor)Heartland Payments is a truecost payment processor exclu-sively endorsed by 250-plusbusiness associations.Tanner Wollard, [email protected]://www.heartlandpay-mentsystems.com/Lowered cost for American Ex-press; next-day funding.

• PUBLICATIONMANAGEMENT FIRM �Traveling Blender(H Bronze Sponsor)Publication Management FirmJanis Maxymof, [email protected]% discount on display advertis-ing in magazine for Circle ofFriends members.



�• PRINTING SERVICES

SmithPrint(H Bronze Sponsor)SmithPrint offers custom print-ing, branding, graphic design,signage and more!Robert Upton [email protected]://www.smithprint.net/New customers: 10% discount onprint materials at SmithPrint.

• REAL ESTATE/COMMERCIAL

Cano and Company CommercialReal Estate(HH Silver Sponsor)Experienced and respected com-mercial real estate representation.We specialize in office leasing,property acquisition, and com-mercial real estate investment. Dennis Cano, Agent210-731-6613 [email protected] commercial real estatesolutions for your practice andinvestments.

Stream Realty Partners(H Bronze Sponsor)Carolyn Hinchey Shaw [email protected]

• REAL ESTATE/RESIDENTIAL

Kuper Sotheby's International Realty(HH Silver Sponsor)Joe Salinas III,

[email protected] hometown roots are based inFredericksburg while my homeaway from home is San Antonio.Local knowledge, exceptional re-sults. Embrace your new life ... I'llhelp you become a connoisseur!

Becky Aranibar Realty GroupKeller Williams(H Bronze Sponsor)Offering Real Estate Services to the San Antonio Medical Community.Carlo G. Aranibar, MBA, [email protected] free comparative mar-ket analysis to determine yourhome's value.

�• REAL ESTATE/INVESTMENTS

Texas Premier Capital(HH Silver Sponsor)A real estate development company offering and managingreal estate investment funds inthe South Texas area.H.B. Newman [email protected] Carter 210-367-7909rick@texaspremiercapital.comwww.texaspremiercapital.com

• RESEARCH STUDIES/BIOTECHNOLOGY

�

ICON Development Solutions(HHHH Platinum Sponsor)We are a respected clinical re-search organization that has anextensive reputable history in di-abetes research. Dependingupon the current studies, ICONmay establish working relation-ships with local physicians.Your expertise may be invaluableto our efforts to identify subjectsDr. Dennis Ruff [email protected] out how ICON can help yourPractice.

• STAFFING SERVICES

Favorite Healthcare Staffing(HHHH Platinum Sponsor)Serving the Texas healthcarecommunity since 1981, FavoriteHealthcare Staffing is proud to bethe exclusive provider of staffingservices for the BCMS. In additionto traditional staffing solutions,Favorite offers a comprehensiverange of staffing services to helpmembers improve cost control, in-crease efficiency, and protecttheir revenue cycle!Brian Cleary210-301-4362BCleary@FavoriteStaffing.comwww.favoritestaffing.com/pub-

lic/medicalsocieties/bexar_county/bexarcounty_index.aspxFavorite Healthcare Staffing offers preferred pricing for BCMS members.

• TRANSCRIPT SERVICES

Med MT, Inc.(H Bronze Sponsor)Narrative transcription is physi-cians’ preferred way to createpatient documents and populate electronic medicalrecords.Ray [email protected] Med MT solution allowsphysicians to keep practicing justthe way they like.

As of November 7, 2014

For more information, call 210-301-4366,

[email protected] or visit www.bcms.org.



THANK YOU to the large group practices with 100% MEMBERSHIP in BCMS and TMA

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of November 7, 2014.

ABCD Pediatrics, PAClinical Pathology Associates

Dermatology Associates of San Antonio, PADiabetes & Glandular Disease Clinic, PA

ENT Clinics of San Antonio, PAGastroenterology Consultants of San Antonio

General Surgical AssociatesGreater San Antonio Emergency Physicians, PA

Institute for Women's Health

Lone Star OB-GYN Associates, PAM & S Radiology Associates, PA

MacGregor Medical Center San AntonioMEDNAX

Peripheral Vascular Associates, PARenal Associates of San Antonio, PA

San Antonio Gastroenterology Associates, PASan Antonio Kidney Disease Center

San Antonio Pediatric Surgery Associates, PA

South Alamo Medical GroupSouth Texas Radiology Group, PA

Tejas Anesthesia, PATexas Partners in Acute Care

The San Antonio Orthopaedic GroupUrology San Antonio, PA

Village Oaks Pathology Services/Precision PathologyWellMed Medical Management Inc.


When the averageperson hears the ques-tion, “Who’s my doc-tor?” they simplywould say “Dr. X.” Asphysicians, you shouldbe aware that “Who’sMy Doctor?” is a newnonprofit group en-couraging doctors todisclose their financialrelationships withmedical manufactur-ers. The group’s slo-gan, “The TotalTransparency Mani-festo,” has a goal oftelling patients thatdoctors don’t have any-thing to hide. Thegroup encouragesphysicians to disclose“every financial con-nection to pharmaceu-tical and medicaldevice companies.”

The need for moretransparency concerning physician fee arrangements is nothing new.What is new, however, is the Centers for Medicare and MedicaidServices (CMS) Open Payments website. According to the CMS,“Open Payments is the federally run program that collects the infor-mation about financial relationships.” This data is publicly availablefor download from the CMS website, with the first reporting periodcovering transactions from the last five months of 2013. The CMSOpen Payments disclosures started Sept. 30. Subsequent reports willbe compiled on an annual basis (beginning spring 2015, for 12months of payments). This database is a requirement of the Physi-cian Payments Sunshine Act of the Patient Protection and AffordableCare Act of 2010.

TRANSPARENCY SOUGHTPatients and the CMS are not the only stakeholders interested in

financial transaction transparency. The Justice Department has taken

action on this highlycontroversial topic.In September, thegovernment filedcomplaints under theFalse Claims Actagainst a physician, aspinal implant com-pany, the company’sdistributorships andcompany owners, foralleged kickbacks de-riving from thePODs. PODs are anevolving structure ofphysician-owned dis-tributorships of med-ical devices. PODsmay provide signifi-cant cost savings, par-ticularly withorthopaedic implants.Some proponents ofPODs argue thatphysicians can elimi-nate the “middleman” and provide sig-

nificant savings to the patient. PODs also may encourage volumepricing and foster competition, which can lead to significant cost sav-ings.

The federal government began its campaign investigating potentialPOD fraud in March 2013, with the issuance of a special fraud alertby the Office of the Inspector General for the U.S. Department ofHealth and Human Services (OIG). The OIG claims such arrange-ments lead to a “strong potential for improper inducements.” Thefraud alert outlines certain questionable features of a POD, including(a) selecting investors because they are in a position to generate sub-stantial business for the entity, (b) requiring investors who cease prac-ticing in the service area to divest their ownership interests, and (c)distributing extraordinary returns on investment compared to thelevel of risk involved. This form of incentive structure may inducephysicians to perform more expensive procedures, and use “devicesthe PODs sell in lieu of other, potentially more clinically appropriate,

BUSINESS OF MEDICINE


PODs, fraud and ‘Who’s my doctor?’By Pamela C. Smith, PhD


devices.” Furthermore, in its September allegations, the Justice De-partment stated, “Improper payments to physicians can alter a physi-cian’s judgment about patients’ true healthcare needs and drive uphealthcare costs for everyone.”

CONFLICT OF INTERESTSupporters of the OIG’s actions reiterate that PODs have an in-

herent conflict of interest and “produce substantial fraud and abuserisk and pose dangers to patient safety.” Prior to the OIG FraudAlert, the Senate Finance Committee issued an Inquiry Report inJune 2011, concluding PODs raised numerous legal and ethical con-cerns, and the potential for abuse was enhanced due to the lack ofclear governmental guidance on the issue. This report resonated inthe healthcare community, causing many hospitals to scale back pur-chases from these types of companies. For example, effective No-vember 2012, HCA revised its physician-owned vendor relationspolicy to “discourage its affiliates from purchasing items or servicesfor use in patient care, including but not limited to pharmaceuticals,implants, instruments and other medical devices, from physician-owned vendors.”

The future viability of PODs has yet to be determined. Not allphysicians are engaged in fraudulent kickbacks, but the actionsof a few have raised legislative action. Increasing transparency

through more disclosures may or may not reduce allegations offraud. Financial arrangements in healthcare are complicated,evolving, and ripe for scrutiny – both positive and negative. Of-tentimes legislation cannot keep up with advances in technologyor strategic business planning. It is yet to be seen how the JusticeDepartment’s pursuits will impact the POD business model —only time and legislative action will tell.

REFERENCES1 http://www.whosmydoctor.com/2 http://www.cms.gov/OpenPayments/index.html. The law requires disclosure of

all transfers of value, including gifts, consulting and speaking fees, and mealsworth more than $10.

3 http://oig.hhs.gov/fraud/docs/alertsandbulletins/2013/POD_Special_Fraud_Alert.pdf

4 http://www.justice.gov/opa/pr/united-states-pursues-claims-against-neurosur-geon-spinal-implant-company-physician-owned

5 http://www.policymed.com/2013/04/oig-special-fraud-alert-physician-owned-distributors. html#sthash.X5pl6vil.dpuf

6 http://ec.hcahealthcare.com/CPM/LL027.doc

Pamela C. Smith, PhD, is an associate professor ofaccounting at the University of Texas at San Antonio.She teaches in the undergraduate and graduate taxprogram, as well as the MBA program, business ofhealthcare track.


BUSINESS OF MEDICINE

Gunn Acura11911 IH-10 West

Cavender Audi15447 IH-10 West

BMW of San Antonio8434 Airport Blvd.

Cavender Buick17811 San Pedro Ave.(281 N @ Loop 1604)

Batchelor Cadillac11001 IH-10 at Huebner

Cavendar Cadillac801 Broadway

Tom Benson Chevrolet9400 San Pedro Ave.

Ancira Chrysler10807 IH-10 West

Ingram Park Auto Center7000 NW Loop 410

Ancira Dodge10807 IH-10 West


Northside Ford12300 San Pedro Ave.

Cavender GMC17811 San Pedro Ave.

*Fernandez Honda8015 IH-35 South

Gunn Honda14610 IH-10 West(@ Loop 1604)

*Gunn Infiniti

12150 IH-10 West

Ancira Jeep10807 IH-10 West


*North Park Lexus611 Lockhill Selma

*North Park

Lincoln/ Mercury9207 San Pedro Ave.


Mercedes-Benzof Boerne

31445 IH-10 W, Boerne

Mercedes-Benzof San Antonio

9600 San Pedro Ave.

*Mini Cooper

The BMW Center8434 Airport Blvd.

Ingram Park Nissan7000 NW Loop 410

Porsche Center9455 IH-10 West

Ancira Ram10807 IH-10 West


North Park Subaru9807 San Pedro Ave.

Cavender Toyota5730 NW Loop 410

*Ancira Volkswagen5125 Bandera Rd.

*The Volvo Center1326 NE Loop 410


Sedans and SUVs are done. They’re not

relevant to car buyers anymore. OK, that’s an

overstatement, but the run of three box cars

and body-on-frame (non-pickup) light

trucks as clear leaders of the U.S. automotive

market is over as they are being increasingly

overlooked by customers who want

crossovers.

This is a big deal. Since at least the 1950s,

sedans have ruled the roost —and for the

record they still do for the time being; the

best-selling car through the first half of 2014

is the Toyota Camry sedan — but the growth

of crossovers has been astounding.

COMBINING ELEMENTSAs most readers know, crossovers are vehi-

cles that combine elements from sedans,

SUVs and even minivans into one appealing

package. Grandparents are increasingly shop-

ping for Mercedes M-classes and BMW X5s,

parents of teens and tweens are being seen in

more Toyota Highlanders and Audi Q5s, and

young couples with or without kids are look-

ing at Subaru Foresters, Ford Escapes, and

this month’s test vehicle, the Nissan Rogue.

It makes sense. Sedans are relatively fun to

drive and fuel efficient but don’t offer much

space, let alone flexible space. And traditional

SUVs — think early 2000s Ford Explorers,

Toyota 4-Runners and Chevy Tahoes —

offer storage room and off-road ability but

generally suffer from mediocre fuel economy

and drivability. So it should be no surprise

that crossovers, with their car-like driving dy-

namics, good fuel economy and configurable

space for dogs, skis, mountain bikes and

what-have-you, are growing in popularity.

The Nissan Rogue is a small entry-level

crossover, competing with the Hyundai

Santa Fe, Honda CRV and Toyota RAV4.

Like its competitors, the Rogue provides a

relatively high seating position — shorter

AUTO REVIEW


Nissan Rogue:Crossovers gain popularity for driving ease, economyBy Steve Schutz, MD

drivers love this — all the pluses listed above,

a good-looking exterior, and a very reason-

able price tag.

It should be said that calling the Rogue

good looking depends, as always, on what

you compare it to. If you line it up next to

the above-listed competitors, I’d say the

Rogue is a six; against all new cars it’s prob-

ably just a four. Its inoffensive design seems

to have been created by taking a slightly

rounded, generic small crossover shape and

adding numerous Nissan styling cues. While

the end result will not win styling awards, the

Rogue’s understated look will appeal to many

young couples and families on a budget, as

well as thrifty empty-nesters.

Inside the Rogue things get more interest-

ing. The diminutive Nissan comes standard

with a rearview camera (that projects to a cor-

ner of the rearview mirror), a 5-inch touch-

screen monitor to control many functions,

and Bluetooth audio. And despite its modest

starting price, the Rogue can be had with nu-

merous options typically associated with lux-

ury cars, such as lane-departure warning,

keyless entry/start-stop, and Nissan’s wonder-

ful “bird’s eye” system that uses cameras on the

grille, rear end, and under both side mirrors

to give you the impression that there’s one

camera looking down from 30 feet above the

car. If you haven't experienced it yet, you

should. It’s really something.

As I found when I reviewed the Juke re-

cently, Nissan, presumably stung by numer-

ous reviewer critiques, has improved the look

and feel of the plastics in its interiors. The

gap in quality now between the interior of

any Nissan and that of its Toyota or Honda

counterpart has narrowed markedly.

One advantage the Rogue’s cabin has over

all of its competitors is the presence of a third

seat. As you’d expect, the two seats in the “way

back” are very small, but if you are suddenly

asked to carry two extra kids to the ice cream

shop after a soccer game, you can do it without

resorting to the dreaded “double buckling.”

Nissan’s familiar 2.5-liter four-cylinder en-

gine that produces 170 hp and 175 lb-ft of

torque is what you get with all Rogues. Un-

fortunately, you also get Nissan’s CVT trans-

mission, which I and all driving enthusiasts

dislike. Front-wheel drive is standard, and

all-wheel drive costs an extra $1,200.

City/highway fuel mileage is 25 MPG

city/32 highway for the AWD model and

16/33 for the FWD model.

GOING ROGUEThe 2015 Nissan Rogue S starts at

$23,650, including destination, which is

pretty cheap. The all-wheel-drive SL model,

on the other hand, starts at a more realistic

$30,490. Expect to pay between $30,000

and $35,000 for a well-equipped Rogue.

The growing popularity of crossovers in

this country and around the world is not a

fad but rather a sea change in what people

want to drive. Sedans and SUVs may not be

irrelevant yet, but the center of gravity of the

automotive market is rapidly moving away

from those types of vehicles. I guess you

could say the market’s going Rogue.

Steve Schutz, MD, is a

board-certified gastroenterolo-

gist who lived in San Antonio

in the 1990s when he was sta-

tioned here in the U.S. Air

Force. He has been writing auto reviews for San

Antonio Medicine since 1995.

For more information on the BCMS

Auto Program, call Phil Hornbeak at 301-

4367 or visit www.bcms.org.

AUTO REVIEW


san antonio medicine december 2014

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