san antonio medicine february 2016

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MEDICINETHE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • FEBRUARY 2016 • VOLUME 69 NO. 2

cyber security

4 San Antonio Medicine • February 2016

Cyber SecurityHealthcare industry is vulnerable

to cyber attacksBy John Dickson, principal at Denim Group .........12

There is privacy. Then, there’s Texas PrivacyBy David Schulz .............................................14

Theft of Patient Information on the UpswingBy Medical Protective ......................................18

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

A Special Library By Fred Olin, MD ..............................................................................................20

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

Healthy Observations: Here’s Whats Buggin’ Me By Robert G. Johnson, MD........................................23

2016 BCMS Installation of Officers photo spread ...................................................................................24

UTHSCSA Dean’s Message By Francisco González-Scarano, MD ........................................................26

Legal Ease: If you’re worried about patient claims, you need to read this article

By George F. “Rick” Evans, Evans, Rowe & Holbrook..........................................................................28

Wild World of Medicine: Roaches By Barbara R. Schmitz, LCSW ..........................................................30

BCMS Circle of Friends Services Directory .............................................................................................33

In the Driver’s Seat...................................................................................................................................39

Auto Review: Porsche & Land Rover ‘experiences’, By Steve Schutz, MD ............................................40

MEDICINETHE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • FEBRUARY 2016 • VOLUME 69 NO. 2

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BOARD OF DIRECTORS

OFFICERSJayesh B. Shah, MD, PresidentSheldon Gross, MD, Vice PresidentLeah Jacobson, MD, President-electJames L. Humphreys, MD, Immediate Past PresidentGerald Q. Greenfield Jr., MD, PA, SecretaryAdam V. Ratner, MD, Treasurer

DIRECTORSRajaram Bala, MD, MemberJorge Miguel Cavazos, MD, MemberJosie Ann Cigarroa, MD, MemberKristi G. Clark, MD, MemberJohn W. Hinchey, MD, MemberJohn Robert Holcomb, MD, MemberJohn Joseph Nava, MD, MemberBernard T. Swift, Jr., DO, MPH, MemberFrancisco Gonzalez-Scarano, MD, Medical School RepresentativeCarlos Alberto Rosende, MD, Medical School RepresentativeCarlayne E. Jackson, MD, Medical School RepresentativeJennifer Lewis, BCMS Alliance PresidentRoberto Trevino Jr., MD, Board of Censors ChairJesse Moss Jr., MD, Board of Mediations ChairGeorge F. "Rick" Evans Jr., General Counsel

CEO/EXECUTIVE DIRECTORStephen C. Fitzer

CHIEF OPERATING OFFICERMelody Newsom

Mike W. Thomas, Director of CommunicationsAugust Trevino, Development DirectorBrissa Vela, Membership DirectorAlice Sutton, Controller

COMMUNICATIONS/PUBLICATIONS COMMITTEERajam S. Ramamurthy, MD, ChairKenneth C.Y. Yu, MD, Vice ChairFred H. Olin, MD, MemberEsmeralda Perez, Community MemberDavid Schulz, MemberJ.J. Waller Jr., MD, Member

Thank you for bestowing me with this honor.

It is my privilege and honor to represent 4,700 Bexar county physi-

cians, residents and fellows; the 8th largest county medical society in

the United States.

I have had the privilege, for the past 16 years, of working in many

capacities in our organization for our shared vision; A healthier Bexar

County populace. For these entire 16 years, one person has always

stood by my side as my support and my critic - my wife Neha, a phys-

ical therapist and Lymphedema Specialist.

It is my passion to serve organized medicine. Last year, an incident

in my own family gave me a totally new perspective about health care,

which I would like to share with you briefly.

In August of 2014, my mother suddenly developed left-sided weak-

ness. After hospitalization and rehab for 50 days, she came home.

From an invalid, she got stronger day-by-day and now is able to walk

with a walker and is able to feed herself. During this stressful time, I

saw the American health care system from the other side of the fence,

not as a physician, but as a family member of a patient. And what I

saw was an efficient health care system that worked. I saw that the

health care system and team-based care put a smile on my mother’s

face and brought relief to our family.

I share this story not to tell you what is good or what is bad about

the health care system, but to help us, the physicians, to understand

how to practice medicine in these times of change and how to con-

tinue to do the right thing for our patients.

It reminds me that life is fragile and can change in a fraction of a

second. It reminds me that we are on this earth for a limited time and

just like my mother keeps that beautiful smile under all adversities;

let us remember to keep that smile.

It can be frustrating to practice medicine at certain times, when

you are overwhelmed with the number of patients we have to see with

limited resources, when the electronic health record system or the

computer stops working in the middle of a busy day, when the insur-

ance company denies authorization for a test or treatment that our

patients need. I know I am not alone in my frustration — I hear from

physicians of every specialty who are concerned about the new regu-

lations forced on us every year - fights with the insurance companies,

the unsustainable pace of their jobs, poor leadership and lack of sup-

port. We all agree: providing excellent care to patients is NOT nego-

tiable. Together, we have demanded that the barriers physicians face

in delivering excellent care to our patients be removed. Please join me

to “stop the RED TAPE CAMPAIGN.”

The Medicare trust fund will be insolvent by 2030. Inaction is not

an option. We must make structural reforms to Medicare to ensure it

is a sustainable program that will be around for our children and

grandchildren. To strengthen Medicare and to ensure that it meets

the healthcare challenges of current and future seniors, we must take

steps to develop long-term solutions. These solutions must protect

the doctor-patient relationship, increase provider and consumer re-

sponsibility and accountability, promote cost efficiency, fair access and

preventive health and bring back the satisfaction and joy in practicing

medicine.

Our patients share with us their difficulties, their pains, their life

and they trust us to help them. As physicians, we try to keep our pa-

tients happy and help them meet their needs. There is no other pro-

fession as rewarding as ours. A recent American Medical Association

survey showed that 75 percent of patients wanted to see their physi-

cians even if they had to wait longer. A recent survey of 8,000 patients

by the University of Chicago showed that 97 percent of the patients

wanted the doctor to discuss the treatment options and two-thirds of

them wanted their doctor to make decisions for them. Polls consis-

tently showed that the patients trust their physician and what better

job satisfaction can we get than our patient’s trust.

AMA recently surveyed 600 primary care physicians. Doctors in

the survey said that forming long-term relationships with the primary

care physician is the most important thing that can be done to obtain

better medical care and to decrease the cost of health care. Research

backs this up. If patients change their doctor, they have delayed diag-

PRESIDENT’SMESSAGE

Every Physician Counts andEvery Patient MattersBy Dr. Jayesh Shah, 2016 BCMS President

8 San Antonio Medicine • February 2016Continued on page 10


PRESIDENT’SMESSAGE

nosis and spend more on care than a patient who has a consistent re-

lationship with the same physician.

As your medical society President, I will continue to advocate for

the patients at the core of which is the physician- patient relation-

ship. Your involvement in the Bexar County Medical Society is at

the core of advocating for our patients and our profession.

BCMS successfully fought for scope of practice issues so that pa-

tient access to physicians stays intact. Physicians should continue

to lead the team-based care as healthcare continues to evolve in the

next century. In the last legislature, 40 scope of practice bills were

introduced and organized medicine won all of them.

This was accomplished with only 10 percent of TEX PAC mem-

bership and less than 1 percent of the members going to the First

Tuesday visit at the capital. This, in my view is unacceptable. It is

our moral duty as physicians to be members, to be a part of TEX

PAC and to give our time and talent to protect this profession.

BCMS successfully helped to pass medical tort reform in Texas

to ensure access to care for patients. BCMS with TMA has been

advocating for physicians, patients, and our community since 1853.

But we cannot do it without you. Next year we plan to develop fo-

cused key contacts for each state representative and senator because

they listen to their constituents and once we build the relationship,

it is easy to get our point across. With the 2016 election cycle com-

ing, this is the time for you to get engaged with our local state rep-

resentative and our senators.

For the past decade we have not had a BCMS member serve as

president of TMA. Now we have the man for the job. I have seen

him leading the BCMS delegation to TMA and now leading the

TMA delegation to AMA. He understands the issues at its core and

he will represent us all well at the Texas Medical Association. Dr.

David Henkes - is running for the position of President-elect of

TMA. Each one of us can do our part to ensure that a BCMS mem-

ber leads the state association in the upcoming election in May.

Thanks to my predecessors, past presidents of BCMS. Thank

you for your vision and service to the society. It is because of your

hard work, we are where we are today.

BCMS has a new home on 1604/ Lockhill Selma.Our theme this year is BCMS is Our Society Where“Every Physician Count’s and Every Patient Matters”

It does not matter whether you are an academic, private practice

or military physician; whether you are hospital-employed or insur-

ance-employed;

whether you are a military physician or a researcher; whether you

are in the first five years of practice or 40 years of practice; or

whether your practice is small or large.Your new home will provide

the perfect environment for members to address common issues.

Thanks to BCMS staff and able CEO.

BCMS has a new home for our legacy to continue so that all

our patients continue to receive the best healthcare like my mother

did, for years to come and all our aspiring young people like my

daughter Prachi, a public health student at UTSA and my son Aj,

a junior at Keystone, continue to feel that becoming a physician is

still one of the best choices and feel that they have the strength of

an organization like BCMS to back them; because for BCMS -

“Every Physician Counts and Every Patient Matters.”

Thank you. Dr. Jayesh Shah

Continued from page 8

Dr. Jayesh Shah addresses the audience at the BCMS officers installa-tion ceremony on Jan. 23.


CYBERSECURITY

Whenever I go to parties or social functions, I’ll invariably rub

shoulders with a host of people I don’t know. As part of the intro-

duction process, I get asked what I do for a living.

My response is typically “I’m a security guy” after which I’m

asked “do you leave money in a bank?” My response is well

honed, including thoughts on online banking protections, ac-

count monitoring, and how using more than a simple username

and password is a good idea. Bottom line is that the banking,

and in general the financial services industry, has their act to-

gether from a cybersecurity perspective.

Healthcare industry is vulnerable to

By John Dickson, principal at Denim Group

cyber attacks

CYBERSECURITY

visit us at www.bcms.org 13

Why you ask? “Because that’s where the money is,” as suc-

cinctly stated by famed bank robber Willie Sutton. That money

attracts sophisticated attackers, who have been hacking away at

banks for over two decades. As a result, banks (mostly) have

their security act together.

A typical follow up question, though, gets me on my soapbox

fast — and that question is, “As a security guy, what industries

scare you the most?” I get that question more frequently than you

might imagine and my answer is many times the healthcare indus-

try. Here’s why:

In healthcare, the stakes are high — the well-being of my family

— which is critically important to me. If a credit card company

loses my data, I get a new card with free credit monitoring. If a

healthcare provider loses my electronic patient information, I can’t

get new information. That’s my stuff!

The reason the security of our healthcare industry scares me is

not just the impact, but how consistently ill-prepared the industry

is to defend against sophisticated attacks. I say this as a 20-year se-

curity consultant who has worked in four different companies and

delivered hundreds of security assessments, penetration tests, and

other projects.

In muted tones, many security veterans believe that sooner or

later Eastern European organized-crime hacker consortia or nation

states will direct their attention to healthcare targets. But what

scares me the most are four significant mismatches between the

sophisticated attackers and defenders in the healthcare industry:

No. 1 Closed systems In healthcare, there are efforts to push patient information into

Health Information Exchanges. These meta-databases in the cloud

provide better and more responsive healthcare. Patients who need

care away from home will have access to their private health infor-

mation remotely. Regrettably, availability is trumping security on

many rollouts and these sites are not built to the same security

standards as those in the financial industry. Healthcare.gov is more

the standard and not the exception.

No. 2 A false sense of security Healthcare views many cybersecurity threats in the abstract.

There are no Targets or Home Depots in the industry, and ar-

guably (at least as far as we know), sophisticated attackers are not

attacking them as frequently as banks. They’ve not had the number

of near-death experiences as other industries, and because of the

abstract nature of cybersecurity threats, leadership does not worry

about attacks, and security budgets suffer. No daily threat of stolen

money equals a false sense of security.

No. 3 Unfamiliar adversaries Governmental organizations are used to getting attacked by na-

tion states. Financial services companies are battling organized

crime hacking syndicates who are both savvy and sophisticated. In

the healthcare sector, the likely adversaries will be nation states as

part of a larger international crisis, or Eastern European hackers,

when they find out how to monetize either target. This lack of

day-to-day understanding of the threats lessens the sense of ur-

gency in certain healthcare organizations.

No. 4 Too much vendor trust The healthcare industry has a highly trusted relationship with

large systems and product vendors. But because they have worked

so closely for a long time, they rarely question whether these part-

ners conducted adequate security testing of their products or net-

works beyond simple vendor checklists (compared to other

industries). In financial services companies, by comparison, secu-

rity leaders ALWAYS question vendor claims. In contrast, certain

medical products provide vendor lock-in and a client mismatch of

power. Witness the many medical devices that ran on Windows

XP well after that operating system was declared “end of life” by

Microsoft. This mismatch means that many healthcare organiza-

tions had little option but to accept that certain medical system

ran on outdated software well after it should have.

The healthcare industry shares many of the same security is-

sues as other industries in our country. But it also has a unique

role in society to protect our most sensitive healthcare informa-

tion. Given the stakes, let’s hope that some of the factors out-

lined above change soon.

John Dickson is an internationally recognized secu-

rity leader, entrepreneur and Principal at Denim

Group, Ltd. in San Antonio. He has nearly 20 years

hands-on experience in intrusion detection, network

security and application security in the commercial,

public and military sectors. He is currently the Chairman of the San

Antonio Chamber of Commerce Cyber Security Committee where eco-

nomic development, workforce and advocacy issues involving San An-

tonio’s growing cyber security industry are coordinated.


CYBERSECURITY

Protecting patient information — and the penalties for getting it

wrong — underwent a major upgrade here in Texas with the passage

of House Bill 300, amending and adding new teeth and bigger bite

to the Texas Medical Records Privacy Act (TMRPA).

These 2012 changes have impact on every HIPAA covered entity

in the Lone Star State, and more critically, expand the very definition

of covered entities. It also ups the penalties for noncompliance and

willful neglect — far from an excuse, ignorance can become very,

very costly.

Let’s review who is required to comply with the law, what is asked

of them, and the risks of noncompliance.

The standard HIPAA definition of covered entities (CEs) includes

health care providers (who use digital records), health plans, and

data processors who serve them. Here in Texas, the definition covers

any individual, business, or organization that obtains, assembles,

collects, analyzes, evaluates, stores or transmits protected health in-

formation (PHI), including health care providers not using digital

(ePHI) records.

“The TMRPA or ‘Texas HIPAA’ is very broad,” said Sheila Stine,

JD, Texas Health and Human Services agencies’ first Chief Privacy

Officer. “It basically applies to anyone who handles PHI (protected

health information), with some notable exceptions, such as employ-

ers, education records, or financial institutions.”

And they don’t have to be aware of it to be held responsible under

the law.

“For example,” offers Stine, “when a physician moves away or re-

tires or passes on, leaving old medical records in a storage unit, the

owner of the storage unit may not be aware of their obligations under

the act,” said Stine. Or that wrongful disclosure or misuse of PHI

may result in civil and criminal penalties under both Texas and

HIPAA law.

Practices should review their business relationships to ensure they

are not making unwitting covered entities out of their associates.

These can include information or computer management entities,

schools, persons who maintain Internet sites and a host of other ven-

dors and affiliates.

On the other hand, says Stine, for a practice that takes its

HIPAA responsibilities to heart, the change is felt more in degree

than in kind. Perhaps most important, staff training requirements

have been upgraded. As opposed to HIPAA’s requiring training

“within a reasonable time,” a Texas staff member is required to

have job-specific, tailored training by their 90th day, with signed

attendance records kept. Entire staffs should be retrained when-

ever there’s a major change in the regulations (like these) or orga-

nizational privacy policy changes. “Best practice,” said Stine “is

annual or biannual training.”

Another change: The window to respond for a patient’s record re-

quest is 15 days if requested in electronic form, not the 30 days of

HIPAA, and with no extensions!

If a practice has electronic disclosure of PHI for any reason, a no-

tice regarding disclosure should be prominent in the office, on the

website or any other place where individuals whose protected health

information is subject will see it. And before each electronic disclo-

sure, the individual’s authorization must be obtained.

Every practice should periodically review the way it handles PHI

following any change in technology, procedure or rules, and at least

annually or biannually, “and adjust its privacy notice, policies, train-

ing or controls as needed,” said Stine.

Finally, Texas regulations on the disclosure of PHI and remunera-

tion to the practice are very tight:

Sale of PHI for purposes outside of Treatment, Payment or Oper-

ations (TPO) is forbidden; Disclosure for marketing purposes is per-

mitted only with the individual’s written authorization (although

there are exceptions).

There is privacy.

By David Schulz

Then, there’s Texas Privacy.

continued on page 16


CYBERSECURITY

Charges for making an authorized disclosure (for example, a pa-

tient asking for a copy their records) cannot exceed the “reasonable

costs of preparing or transmitting the protected health information.”

All told, this is where you sit down with your privacy officer

(you have one, right?) and make certain that the practice’s rules

on use and disclosure are up to date and effectively translated into

procedures.

Breach notification rules are also more widely applied under Texas

law than under HIPAA, thanks to the combined effect of HB300

and the Texas Identity Theft Enforcement and Protection Act. Breach

notifications are mandatory for any person who conducts business

in Texas and loses control of sensitive personal information (SPI),

not just PHI. Data cleansed of PHI can still be considered sensitive,

and a breach notice is required for electronic SPI when system secu-

rity has been compromised (with “compromised” being undefined

in the law).

HB 300 increases the penalties for failing to make breach notifi-

cations. In addition to the penalties available to the state attorney

general, it provides for additional civil penalties of $100 per individ-

ual, per day that an entity fails to take reasonable action to comply.

It’s a state felony if an individual, without the consent of the patient,

accesses, reads, scans, stores or transfers PHI via a device or electronic

payment card.

Privacy is “mission critical” to his agency, says newly appointed

Texas HHS Executive Commissioner Chris Traylor. Considering an

era of increasing penalties and public sensitivity to breaches, it’s wise

for practices to consider it “mission critical” as well. Privacy Pays, for

the provider as well as the patient!

David Schulz, certified information privacy and cer-

tified HIPAA professional, is Executive Director and

CEO of Cyber Risk Associates, LLC, compliance special-

ists for small and boutique healthcare practices and asso-

ciates in the San Antonio area. Confidential review of

practice’s needs and areas for improvements freely offered; detailed risk

analysis, remediation and training offered on one-time or continual basis:

210-281-8151.

continued from page 14


CYBERSECURITY

Thieves have discovered that, often with little risk, they can breakinto healthcare practitioners’ offices and steal computers. Generally,they’re not interested in the clinical information that the computersmay contain — although that remains a concern.What they’re hoping to steal is something they can use for a variety

of criminal schemes: Social Security numbers and credit card num-bers. And they’re having a lot of luck.Doctors have an ethical and legal responsibility to ensure both the

security and the privacy of patient information. This includes theneed to protect patients from the possibility of identity theft.

The following suggestions may help prevent theftof patient information:

• Install security passwords on all computers in the practice. En-force their use and periodic change by employees.

• In general, authorize as few people as possible to have keys tothe office. Employees who have access to the office should havea key to the main door only.

• Do not authorize an employee to have a key to the office untilthat person has successfully passed a probationary period.

• Stipulate the return of keys from all employees, regardless ofwhether they quit or are terminated. Employees who are firedshould be required to turn in their keys, collect their personalbelongings, and leave the office immediately upon termination.They should not be given the opportunity to access any patientor business-related information.

• If an employee is fired or leaves under less-than-ideal circum-stances, consider changing office locks.

• Automatically change passwords whenever an employee quitsor is terminated.

• Backup disks, tapes, or reports should be kept under lock andkey, preferably off site.

• No laptop computer should be used for clinical purposes unlessit has complete password installation. Laptops with clinical in-formation on them should not be left in cars, not even intrunks.

• Firewalls should be built into all office systems. Contractualarrangements with vendors should specify the security resultsthe practice hopes to achieve with its security system.

• Consider installation of a security system for the office.

• Use only bonded cleaning staff. If you cannot control the clean-ing process (i.e., you rent office space in a building that pro-vides cleaning services), inquire about the security check thatthe company uses to screen potential hires. Depending on thesetup of your office, you may need to ask the cleaning crew’semployer to sign a Business Associate Agreement to ensureHIPAA compliance.

• Ensure that access to clinical areas is locked during lunch times,hours when patients are not in the office, or if an employee isworking late. If possible, main office doors should also be lockedduring these times.

• Report any suspicious activity, possible breach of security, orthreats of violence from terminated employees (or disgruntledpatients) to the police.

• Report any theft (prescription pads, drug samples, patient in-formation, office materials, etc.) to the police.

• Report any breach of patient confidentiality to a Medical Pro-tective claims representative at 800–348–4669.

This article was produced by the clinical risk management team atMedical Protective, the nation’s oldest professional liability insurancecompany dedicated to the healthcare professions. For additional infor-mation, please contact Laura Cascella at [email protected] orvisit the Medical Protective website at www.medpro.com.

Theft of Patient Informationon the Upswing

By Medical Protective

visit us at www.bcms.org 19visit us at www.bcms.org 19


LIBRARYREVIEW

One of the unsung treasures of the University of Texas Health

Science Center at San Antonio is the P. I. Nixon Medical Historical

Library, located on the fifth floor of the Briscoe Library at 7703

Floyd Curl Drive.

Physically, it is an attractive room with comfortable seating,

book-lined shelves and large tables upon which one can work. You

can see a picture of it here: http://library.uthscsa.edu/

2011/11/nixon-library/ Perhaps you recall Dr. J. J. Waller’s recent

contributions to San Antonio Medicine about the history of med-

icine in San Antonio: much of the research was done here.

I visited the library a couple of times and visited with Lisa Matye

Finnie and Jaclyn Georges, the staffers who manage the library and

its collections. They are friendly and helpful, and know the place

inside and out. They told me that there are now about 6,000 items

in the library, distributed over three major collections: The P. I.

Nixon Medical Historical Library, the University Archives and ma-

terial relating to the history of medicine in San Antonio and envi-

rons. Let’s look at all three.

The core of the collection of the Historical Library was

brought together by the Bexar County Medical Society largely

through the efforts of the late P. I. Nixon, M.D. The materials

range from the oldest book, De Medicina by Celsus, from 1481,

to newer items from the early 20th Century. Included are a copy

of Vesalius’s seminal book on human anatomy, De Humani Cor-

poris Fabrica, (1543) and one of Robert Hooke’s books, Micro-

graphia, (1667). Vesalius did a wonderful job, considering the

limitations on dissection that were in place during his lifetime:

the illustrations are clear and even the nomenclature is familiar.

Hooke’s book intrigued me because of my background as a vet-

erinarian. He was one of the earliest academic microscopists.

There’s a drawing of a flea that rivals anything I saw (or drew)

in the very extensive and memorable parasitology course we had

By Fred Olin, M.D.

The plush seating area in the P.I. Nixon MedicalHistorical Library.Opposite: The cover of Dr.George Cupples' casebook. Opposite: A draw-ing of a flea from Robert Hooke's 1667 book Mi-crographia. Opposite: The title page forVesalius' book on human anatomy De HumaniCorporis Fabrica published in 1543.

LIBRARYREVIEW


at the University of Illinois College of Veterinary Medicine.

Here it is: this drawing is about two feet across. That vertical

line through the flea’s thorax is the fold in the page, made to

allow it to fit into the volume.

The University Archives contain a fairly amazing mass of mis-

cellaneous documents. Besides the things you might expect,

such as historically important university records there are pub-

lications, oral histories, correspondence, yearbooks and even a

complete set of a short-lived student newspaper, “The Organ

for the Artificial Dissemination of Information,” which is where

I got my first experiences writing for publication. ‘The Organ”

was suppressed in my senior year, just after our dean was fired.

The “Temporary Institutional Head,” a retired Army Medical

Corps general imported from Galveston, didn’t appreciate some

of our opinions and reporting and ordered us to stop. I still

have the letter he sent to the various writers and our editor. It

still incenses me a bit.

The Local Medical History stuff is fascinating. There are pho-

tographs of physicians and hospitals, records of various local med-

ical organizations, and hand-written records by the physicians

themselves. I took a picture of the cover of one of Dr. George Cup-

ples’ casebooks, which you can see nearby: It is filled with hand-

written descriptions of individual cases, in great detail, including

the patient’s demographic description, history of present illness,

etc. It isn’t easy reading, but it is fascinating.

Someday, if you have the urge to see some medical treasures or

research something in your specialty from way back when, visit

the P. I. Nixon Library. It will be worth your time.

Fred H. Olin, M.D., is a semi-retired orthopaedic sur-geon. He has never been either a woman or in prison. Per-haps that’s why he was so taken by these books.


BCMS NEWS

Call for ResolutionsAttention BCMS members: If you have any issues you would like the BCMS Delegation to

TMA to consider regarding changes in policy or a stance you wouldlike them to take on a particular issue, it’s time to submit your issuein the form of a Resolution. For a sample resolution, go to http://bcms.org/geninfor/Resolu-

tionForm2016.docPlease return your draft resolutions to BCMS by Monday, Feb.

15, 2016 by email to [email protected] questions, contact Mary Nava at 210-301-4395.

In Memoriam James Finney, M.D., died on Dec. 25, 2015, at age 97. He was a

U.S. Army physician during World War II and was a member ofBCMS.Luis Canales, M.D., died on Jan. 6, 2016, at age 82. He served in

the U.S. Army for 31 years and was chief of the department of pedi-atrics at Brooke Army Medical Center for 16 years.Chester Pruett, M.D., died on Jan. 11, 2016, at age 68. He ran a

pain and anesthesiology clinic in San Antonio for over 25 years andwas a member of BCMS.Patrick Holden, M.D., died on Jan. 15, 2016. He served as a fac-

ulty child psychiatrist at the UT Health Science Center for over 30years.

The Bexar County Medical Society and Bexar Credentials Verification Inc. have settled into a new home at 4334 N. Loop 1604 West on the second floor.

The building is located inside the loop between Lockhill Selma and N.W. Military Drive.All phone numbers and email addresses are the same as before.

Come check out our beautiful new building.

BCMS HAS MoVED

What: BCMS General Membership Meeting

When: April 5, 2016, beginning at 6 p.m.

Where: Cumberland Surgical Center (formerly Victory Medical Center Landmark)

5330 N. Loop 1604 West, San Antonio 78249

SAVETHE DATE


I’m back, and I’m re-inspired. I was in a slump—fighting a major

case of writer’s block. Just when I thought I’d run out of lampoon-

able stuff—they appear—and right under my nose. What, you ask,

could work such a reanimation of the soul?

Bug lights! Yes, you heard me right—bug zappers. In my hospital.

In the corridors outside the operating suites. Three perfectly parallel,

purplish, plush neon lights. Reminds me of summer camp fifty years

ago. Such memories. I honestly could never decide what I enjoyed

more: the zapping, electrical sizzle, or the aroma of freshly roasted

horse fly.

My colleagues were equally moved. One fellow-surgeon asked

when the Jimi Hendrix posters would appear. Another told me the

lights emitted a heavy-acid-metallic-rock music that, apparently, only

he could hear. An anesthesiologist swore that when he stood at one

particular intersection of corridors, where he could simultaneously

triangulate three of the fly-killers, voices from outer space spoke to

him (but he’s an anesthesiologist—been inhaling his own gases). Per-

sonally, all I’ve noticed is a fluorescent glow to my lab coat.

I don’t get it. How do we go from zero bug prophylaxis all the way

to the highest-tech devices in one fell swoop? Before I can operate

on a patient’s back, I have to prove to the insurance company that

lesser measures have tried and failed. Here’s my point: Shouldn’t the

hospital have started with a few strategically placed fly-swatters? Low

tech and inexpensive. Then move on to those brown, sticky, tape

things that hang from the ceilings and grab onto unsuspecting ento-

mological body parts. It’s more humane that way. At the end of each

day, the OR supervisor could release the poor little beggars off the

loading dock by the dumpster. I remember once (the only time in

thirty years I might add) when a fly was dive bombing me in the op-

erating room, the anesthesiologist chased it down with a can of ben-

zoin spray. Didn’t kill it—just gummed up its landing gear. Cheap,

effective, humane.

On a serious note (if there is one), the bigger question is: Why do

we even need bug lamps in the hospital? Have there been sightings?

Is it a JCAHO, OSHA or OBAMAcare requirement? Three super-

visors and a couple of assistant administrator’s later I spoke to an

honest-to-goodness entomologist. Do gnats (in this case) spread dis-

ease (‘nosocomial zoonoses’ to sound erudite)? Gnatitis—never had

a patient come down with a case of that. One of the real concerns

was whether or not the lights might cause eye damage (or sterility).

There are three categories of ultraviolet light: a, b, and c. UVb and

UVc may affect eyes and skin respectively, but UVa is safe. How do

they work? We can buy so-called ‘bug lights’ at Home Depot. These

are low energy yellow and work by providing enough illumination

for humans to see at night but don’t attract bugs. But yellow lights

won’t kill the critters. On the other hand, high energy light (UVa,

365 nm) drives them wild with desire. Gnats are drawn to the pur-

plish glow, but the light doesn’t do the killing—there is a sticky board

in the back that wrestles them down (a quaint marriage of old and

new technology).

Don’t know about you, but I feel safer already.

Victor Hugo (1802-1885) once said: “Fame must have enemies as

light must have gnats.” Looks as though the technology is not all that

modern after all. Personally, I’m still good with fly swatters.

HEALTHYOBSERVATIONS

H E R E ’ SWHAT ’SBUGGIN’MEBy Robert G. Johnson, M.D.

Bug lights guarding the OR’s: If you getthe angle just right, they speak to you.


2016 BCMSINSTALLATION

The 2016 BCMS Installation was held Jan. 23 at the UniversityCenter Ballroom at UTSA whereDr. Jayesh Shah was installed asthe new BCMS President and Jennifer Lewis was installed as the new BCMS Alliance President.

1. Incoming Alliance President Jennifer Lewis is sworn-in by outgoing President Re-becca Christopherson.

2. Mauli Agrawal, vice president of research, represented the University of Texas at SanAntonio which donated the use of the ballroom for the 2016 BCMS Installation.

3. Outgoing BCMS President James L. Humphries, M.D., presents the gavel to in-coming President Jayesh Shah, M.D.

4. August Charles Trevino, development director for BCMS, with Moses D. Luevanoof Physician Lending Group at Regions Bank, Gilda Digman, immediate past pres-ident of AMA/TMA/BCMS Student Chapter, and Mike Digman.

5. Current and past presidents of BCMS includes (Back Row) Vijay Koli, M.D.;David Schulman, M.D.; Marc Taylor, M.D.; Jayesh Shah, M.D.; Neil Gray,M.D.; Manuel Quinones, M.D.; Roberto San Martin, M.D.; K. Ashok Kumar,M.D.; (Front Row) J. Marvin Smith III, M.D.; Stephen Gelfond, M.D.; JoseBenavides, M.D.; Al Sanders, M.D.; Rajam Ramamurthy, M.D.; DavidHenkes, M.D.; James L. Humphreys, M.D.

2016 BCMS INSTALLATIONOF OFFICERS

2

1

4

3


9. BCMS Executive Board for 2016 includes Adam Ratner, M.D., treasurer;Sheldon Gross, M.D., vice president; Leah Jacobson, M.D., president-elect;Jayesh Shah, M.D., president; James L. Humphreys, M.D., immediate pastpresident; and Steve Fitzer, CEO of BCMS.

6. Dr. David Henkes, a past president of BCMS now running for president of TMA,with his daughter Nicole Henkes and wife Danielle Henkes.

7. Members of the Texas Indo-American Physicians Society Southwest Chapter presenteda check for $50,000 for the BCMS Building Fund.

8. UTSA Sapna, a Bollywood-Fusion dance team that included Dr. Shah’s daughter, per-formed during the BCMS Installation.

2016 BCMSINSTALLATION

98

7

65

UTHSCSADEAN’S MESSAGE

Over the past several decades there have been many changes in

the training of physicians, from adjustments in the curriculum

to diminution in the work hours of residents and other post grad-

uate trainees. One of them we are proud to embrace has been

the admission and encouragement of non-traditional medical stu-

dents.

First, let us define what we consider to be non-traditional. The

traditional route to medical school takes a student from a bach-

elor’s degree with completion of premedical requirements and ap-

propriate testing such as the MCAT to immediate admission to

the first year of medical school. Non-traditional students take a

different path. Some return to school to complete premedical re-

quirements not fulfilled during the undergraduate years. Others

delay medical school for personal or professional motives, such

as supporting a spouse’s career or raising children. Some students

enter medical school after a time in another endeavor – some as

dentists, nurses, PAs, or other medical professionals; others as

lawyers, businesspeople, or members of the military.

The medical educational system recognizes that non-traditional

students bring their own benefits to the school experience and to

the wider world of medicine. Older and more-experienced, they

are sometimes seen as especially diligent and disciplined. They

can display a savvy understanding of the way the “real world”

works, a sophisticated ability to cooperate, novel approaches to

problem solving, and a well-developed sense of compassion. In

sum, non-traditional students possess unique blends of imagina-

tion, life skills, and cultural and relational insight that can profit

their fellow students, the larger medical community, and most

importantly, our patients.

Medical schools have embraced this way of thinking. In 2007,

the Association of American Medical Colleges (AAMC) estab-

lished the Advancing Holistic Review Initiative with the aim of

helping medical schools attain diversity goals through admissions

techniques. Since then, its mandate has widened, but a key ad-

missions focus remains taking account of the whole applicant,

rather than only academic considerations. In light of this, med-

ical colleges are encouraged to evaluate candidates according to

the AAMC Experiences-Attributes-Metrics Model, which ascer-

tains in an individualized way how an applicant is likely to con-

tribute both during and after medical school. Along with

academic metrics, these give a balanced consideration to experi-

ences such as leadership roles, life experiences and community

service, as well as attributes that include ethnicity, languages spo-

ken, and faith.

I am proud of our record of attracting and supporting non-tra-

ditional medical students. This is a commitment we proudly con-

tinue. In fact, nearly 60 percent of last year’s incoming class of

medical students started one or more years after attaining their

original degree. This number is not not dissimilar to that of other

schools of medicine.

For us, the question is not how soon after a bachelor’s degree a

candidate enters UT School of Medicine at San Antonio.

Whether an applicant comes straightaway, after a year, or after

decades, we pose the same question: How was the intervening

time used? In our admissions process, we take a highly individ-

ualized approach to each application. How students spent those

years varies from person to person, but their diverse experiences

tend to benefit each one individually, as well as the class as a

whole.

While non-traditional students offer a great deal, they may also

require extra support. In light of that, we offer a Pre-Matricula-

tion Program that is specifically targeted to those who are not ar-

riving directly from an academic environment, were non-science

majors, or feel anxious about medical school. It provides extra

help in the transition to a new academic, environmental, and so-

cial setting, and is only one of the ways that we prepare our non-

traditional students for future success.

I am extremely proud of the non-traditional students who are

currently excelling in our program. They bring a wealth of skill,

perspective, and imagination to our educational experience. I

Non-Traditional Medical Studentsat the UT Health Science Center at San Antonio

By Francisco González-Scarano, MD



UTHSCSADEAN’S MESSAGE

would like to highlight several, to give an idea of the breadth and

diversity our policies have brought to our current student body.

Second-year medical student Spencer Cope was diagnosed with

dermatomyositis when he was 13 years old, and suffered with the

rare autoimmune disease until the age of 19. After graduation

from Brigham Young University, he took a summer internship at

the University at Utah in pediatric rheumatology. His experience

over the summer was transformative; he felt as if he were partici-

pating in cutting-edge medical research as part of a clinical team,

and simultaneously interacting with and personally helping chil-

dren in the same circumstances that he had endured. Spencer de-

ferred medical school for two years after we accepted him,

amassing an impressive research pedigree and a deep understanding

of how medical research is conducted.

Mazen Hassan’s route was entirely different, but just as fascinat-

ing. He graduated from the University of Texas at Austin with a

radio-television-film and marketing double major, which he im-

mediately put to work, spending five years in Hollywood. He re-

turned to Austin to work as an associate video producer for a large

advertising agency, and there discovered a latent love for science.

A part-time job at a bookstore gave him access to science texts and

kindled a dream to change professions. He moved to San Antonio,

took undergraduate prerequisites, and now, at 34, is one of the

oldest in his cohort of second-year medical students. Mazen’s ex-

perience in the fast-moving business of film production has devel-

oped his ability to quickly solve problems in complex

environments, a skill that profits his studies now and will benefit

his patients in years to come.

For Janice De Surmont, a path across continents and industries

grants important perspective. After an itinerant childhood with

an Air Force family, she earned an economics degree from Brandeis

University and worked in a string of financial positions for firms

focused on venture capital, benefits consulting, and the mortgage

industry. Since then, her husband’s job has taken her to far-flung

locales like Nigeria and France, where she prepared to enter med-

icine; after experiencing a money-making career, she now values

the prospect of a profession that helps others. In addition, her ex-

periences with many cultures, walks of life, and socio-economic

status have broadened her ability to connect with all kinds of peo-

ple – and influence their health for the better.

Third-year medical student Eric Bready delayed medical school

twice. During his undergraduate career at Brigham Young Uni-

versity, he took a two-year hiatus for a Mormon mission (an expe-

rience he has in common with Spencer Cope), to which he

attributes his ability to talk to people across cultures and educa-

tional backgrounds. After graduation, he spent another year in

the business world, working for a company that tests medical de-

vice packaging, an encounter that gives him an uncommon appre-

ciation for the community of behind-the-scenes partners that

contribute to success in the operating room.

Last, but not least, Henderson Jones spent seven years practicing

law in his native Mississippi before he recognized a strong desire

to change professions. Inspired by an older brother who is an

emergency physician, Henderson dedicated himself to preparations

for medical school, and is now a 35-year old second year medical

student. His legal training gives him a unique perspective on med-

icine and public health and he serves as a Student Government

representative for the School of Medicine; he has been instrumen-

tal in recent initiatives involving issues including mental health

and a community garden. He credits his time as a lawyer for a nu-

anced understanding of how power works in a society, and has a

vision for translating that understanding to endeavors that ensure

medical decisions are made for the patient’s benefit, rather than

for other reasons.

This is a small sampling of the non-traditional students prepar-

ing for a medical career here. The experiences and attributes of

these and others help to bring a more diverse set of perspectives to

patient care – a very valuable asset for our patients that continue

to become more and more diverse themselves.

All the best,

Francisco González-Scarano, MD

Dean, School of Medicine

Vice President for Medical Affairs

Professor of Neurology

John P. Howe, III, MD, Distinguished

Chair in Health Policy

The University of Texas Health Science

Center at San Antonio

[email protected]


The Texas Supreme Court may have

given you a new opportunity to protect

yourself against all sorts of patient

claims - especially malpractice. In

short, you may be able to avoid the

courthouse altogether and go to ar-

bitration instead. A number of ar-

ticles were written about this

decision in the past months, but I

don’t see that anybody gave doctors some concrete advice. But I

sure will. Keep on reading.

Let’s start with what arbitration is. It’s been around for decades

and I guarantee you’ve signed plenty of contracts that require ar-

bitration if you wind up crosswise with the other side. Arbitration

is a mechanism by which parties resolve their disputes outside the

court system. It’s typically much faster than the judicial process

and usually is cheaper, too. A neutral arbitrator (or a panel of ar-

bitrators) is selected to serve as judge and jury. A hearing is held

but it isn’t as formal as a trial and there is no jury. The “no jury”

part is important because you don’t have to worry about the risk

of getting a poorly educated juror influenced by emotions rather

than fact. The hearing is almost always quicker than a trial. And

there typically isn’t nearly as much discovery (depositions and

stuff ) done beforehand. The arbitrator renders a decision which is

pretty much final because there is no arbitration court of appeals.

There are downsides to arbitration. I could list them but isn’t it

sufficient to say that the plaintiff ’s bar fought tooth and nail a doc-

tor’s right to demand arbitration? What does that say? Yes, there

are downsides but, on balance, most doctors would prefer arbitra-

tion of a jury trial, particularly if you’re in a pro-plaintiff venue.

Now, to the case at hand. It begins with Elisa Zapata who

reached that point in her life that she needed a little more help

than in her younger years. As such, she became a patient of the

Fredericksburg Care Company a few miles north of us. Part of the

admission process required she sign the usual terms of admission.

But, this time there was something different. The papers contained

a clause that required arbitration of any disputes between her and

the nursing home.

Of course, it’s no surprise to you to read that she died and her

heirs claimed it was only because of negligence. Hence, the lawsuit.

The nursing home demanded the case go to arbitration instead of

the courthouse. The courthouse disagreed and kept the case. The

nursing home persisted and the whole mess wound up before the

Texas Supreme Court.

Now, here’s the rub. Texas state law allows physician/patient ar-

bitration agreements in theory but not in practicality. To have one

that satisfies our state law, it has to be in 10-point bold-faced type

telling the patient that he’s losing a lot of important rights. Most

of all, the agreement must be signed by the patient’s attorney. Not

just the patient. Now how many people are going to do that? In

this case, the nursing home’s agreement fell short of the require-

ments and, by Texas law, was invalid.

Yet, the Supreme Court yanked the case from the judicial system

and sent it over to arbitration. Why? Well, it’s a boring legal ex-

planation but, in short, it’s because the nursing home received

Medicare payments and was therefore involved in interstate com-

merce. Because it was involved in interstate commerce, federal ar-

bitration law took precedence over Texas law. And, because the

nursing home’s arbitration clause satisfied federal requirements

(which are pretty sparse compared to Texas law), the Court held

the agreement valid.

Okay, what’s this mean to you? Should you get your attorney to

draft an arbitration clause that your patients need to sign? Should

it be part of all new patient intake forms? If you receive federal

LEGALEASE

If you’re worried about patient claims, you need toread this articleBy George F. “Rick” Evans, Evans, Rowe & Holbrook


funds (odds are high that you do), you may have this option now.

Here’s my take on it. I lean towards it provided you get the right

type of arbitration clause drafted by a crackerjack attorney with

the input of a seasoned malpractice defense attorney.

You can’t make this decision on your own. You must have a dis-

cussion with your insurance company to see if they’ll agree to it.

There are reasons they may want to manage your claims in the ju-

dicial system rather than arbitration. For example, if you’re in ar-

bitration, you may lose your right to get the case dismissed because

the other side failed to file a proper expert report in 120 days. Or,

you may lose the statutory caps on damages. Or, the right to review

in higher courts if the arbitrator gets it wrong. Or, a conservative

jury if you live in a conservative county.

This isn’t a black-and-white decision but I think you need to

look at this very hard with the advice of some top-notch attorneys

and your insurer. Arbitration isn’t a panacea but the plaintiff ’s bar

didn’t fight arbitration so hard during the last round of tort reform

for nothing. It’s harder to get emotionally laden, runaway verdicts.

It’s hard to badger a doctor with endless, invasive discovery. I think

that, on balance, arbitration will favor most doctors. And, aside

from malpractice, arbitration clauses can be used to resolve many

other patient disputes (no, not the TMB).

So, borrowing from the drug companies’ TV ads which say “is

“X” drug right for you? Ask your doctor,” you need to ask your

attorney and insurer if arbitration is right for you. There may be

compelling reasons they think not, in which case you should defer

to them. But they may also look at your practice and wonder why

they didn’t think of it first.

George F. “Rick” Evans Jr., is the founding partner of

Evans, Rowe & Holbrook. A graduate of Marshall Col-

lege of Law, his practice for 36 years has been exclusively

dedicated to the representation of physicians and other

healthcare providers. Mr. Evans is the BCMS general counsel.

LEGALEASE

WILD WORLDOF MEDICINE


Roaches, masters of evolution, are the ultimate survivors dating

back 350 million years and can survive in nearly all environments.

They need little introduction since all of you have met them. They

are related to mantises and grasshoppers and have highly organized

societies similar to that of ants

Basically, roaches are personally clean. The problem with them vis-

iting our cupboards is that while they eat, they frequently throw up

a little and also leave their droppings where they eat. By doing this,

they mark the spot with their peculiar odor so they can come back

later. Under extremely unsanitary conditions they can pick up bac-

teria and acquire viruses on their feet from the filth left by humans

as well as from their own living quarters such as a sewer system. They

can crawl all over the place and hang on with their little claws, pick-

ing up disease and virus pathogens. When this occurs, they harbor

bacteria that can stay in their digestive system for over a month. Then

they contaminate your food and countertops with their feces. Sal-

monella can survive in their feces for years. Other pathogens that

they can potentially carry are pneumonia, typhoid fever, bubonic

plague and leprosy. Some believe they can cause human allergies and

exacerbate asthma. They love to party on your crumbs, leftover’s, pet

food, book bindings, fruit peelings, peanut butter, wood, flower

petals, leaves, ants, termites, dead animals, bat droppings, Vaseline,

leather, wood, rayon, fingernail clippings, all found with their fan-

tastic sense of smell. They abhor soda crackers, sugar, cucumbers

and cheese. Would you believe they are still classified as vegetarians?

There are from 4,000-7,500 kinds of roaches with only about 20

hanging out with humans. Most are brown but some have exquisite

coloring from dots and stripes to translucent, brilliant green, maroon

to rich mahogany.

Roach fossils of 300 million years ago have been discovered. At

that time, they adapted a simple and secure way of life and have

rarely departed from it. Some fascinating things about roaches are:

they can have six legs and 18 knees; they can hold their breath for

40 minutes. Their ears are in their knee joints; their teeth are in

their stomach. Their hearts are tubes with valves that pump blood

backwards and forwards. They can live one week without a head and

die of thirst because they must have their mouth to drink; they can

survive a month without food. They have two brains located in the

tail and head, but don’t need the one in the head to live. They can

be frozen, thawed and then walk away; they can survive 216G’s (as-

tronauts black out at 12); they can endure 50 to 100 percent the ra-

diation as humans.

Roaches have a lot of body fat. It is revolting if you are starving

and you have to eat them. Some people in New Orleans eat choco-

late-covered roaches but they can’t eat enough to control them.

Cockroaches have many defense mechanisms. Their immune

ROACHESBy Barbara R. Schmitz. LCSW

WILD WORLDOF MEDICINE


response is spectacular and almost like that of humans. They have

an incredible sense of smell; they touch food with their antennae

and cerci (appendages) which pick up tastes, smells and vibrations;

they have palps in front of their mouth which are used for tasting;

they bite a piece of food with their mandible and if it is not good

they will spit it out. Should they eat a poisonous bait and live

through it, the future generations will develop resistance to the

bait. They can regenerate previously severed antennae, mouthparts

and broken legs while molting. They can disappear within 1/28th

of a second which is equal to 93 mph. Their bodies are covered

with wax (cuticle). They can flatten themselves and get into cracks

no bigger than a match stick.

There are over 3,000 roach control products registered in the

U.S. About the only way to get rid of them is to deny them water

as they quickly dry out. Flushing them down the toilet won’t do

any good because they take up residence in your sewer line. If you

vacuum them, the best thing to do is freeze the bag of roaches and

then discard.

Despite this, there is not one way to totally control cockroaches.

And, do you really want to? Like termites, roaches are the ultimate

recyclers, eating decaying organic material and breaking it down for

re-use by plants.

Without the recyclers we could be ankle-deep in dung, dead bod-

ies, and other waste. They make good food for hedgehogs, frogs,

mice, centipedes, spiders and reptiles. If you don’t like roaches in

your home, do all you can to protect the common house centipede.

They will decimate your roach population as will the gecko.

Always keep in mind that when using pesticides, adhere to rec-

ommended levels. We must not jeopardize human health, the en-

vironment, and other wildlife. There is considerable public

concern about the effects chemicals have on the genetic resistance

of insects to the chemicals and the disruption of naturally occur-

ring biological control.

Roaches are important in medical research because they develop

cancerous tumors similar to those grown by humans and are used in

cancer research.

Lastly, a cockroach aversion is learned, not inherited. According

to two U.S. Dept. of Agriculture researchers, they found that chil-

dren under the age of 4 have no aversion to cockroaches until their

parents teach them.


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

Continued on page 34

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The Bank of San Antonio(HHH Gold Sponsor)We specialize in insurance andbanking products for physiciangroups and individual physicians.Our local insurance professionalsare some of the few agents in thestate who specialize in medicalmalpractice and all lines of insur-ance for the medical community.Brandi Vitier [email protected]

SSFCU(HHH Gold Sponsor)Founded in 1956, Security Serviceprovides medical professionalswith exceptional service andcompetitive rates on a line ofmortgage products includingone-time close construction,unimproved lots/land, jumbo andspecialized adjustable-rate mort-gage loans.Commercial ServicesLuis [email protected] ServicesJohn [email protected] ServicesGlynis [email protected]

Bank of America(HH Silver Sponsor)Bank of America provides people,companies and institutional in-vestors the financial products andservices they need to help achievetheir goals at every stage of theirfinancial lives.Jennifer Dooling [email protected] Martinez [email protected]://about.bankofamerica.com/en-us/index.htmlMaking financial lives better —one connection at a time

Firstmark Credit Union(HH Silver Sponsor)Address your office needs: Up-grading your equipment or tech-nology • Expanding your officespace • We offer loans to meetyour business or personal needs.Competitive rates, favorableterms and local decisions.Gregg ThorneSVP [email protected]

Generations Federal Credit Union(HH Silver Sponsor)Generations provides a wide arrayof innovative products including

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORYContinued from page 33


loan, deposit and investment so-lutions for personal and commer-cial banking needs.Yvonne "Bonnie" M. [email protected]“For this generation and the next.”

RBFCU(HH Silver Sponsor)[email protected]

BIOMEDICAL WASTE DISPOSAL

BioMedical Waste Solutions, LLC (HHH Gold Sponsor)Save costs on your medical wastedisposal! BioMedical Waste Solu-tions provides a compliant, reli-able and low-cost service.Wes Sonnier [email protected] Loyacano1-877-974-1300Joe@BioMed-Disposal.comwww.BioMedicalWasteSolutions.com“BCMS members save 10 percent offor one free month! Request a freequote in 10 seconds at www.Bio-MedicalWasteSolutions.com.”

CONTRACTORS/BUILDERS/COMMERCIAL

Huffman Developments(HHH Gold Sponsor)Premier medical and professionaloffice condominium developer.Our model allows you to own yourown office space as opposed toleasing.Steve Huffman 210-979-2500Shawn Huffman 210-979-2500www.huffmandev.com

RC Page Construction, LLC(HHH Gold Sponsor)Commercial general contractorspecializing in ground-up and in-

terior finish-out projects. Servicesinclude conceptual and final pric-ing, design-build and construc-tion management. Single-sourcemanagement from concept tocompletion ensures continuitythrough all phases of the project.Clay [email protected]

ELECTRONIC DOCUMENTATION ANDTRANSCRIPTION SERVICES

Med MT, Inc.(HHH Gold Sponsor)Narrative transcription is physi-cians’ preferred way to create pa-tient documents and populateelectronic medical records.Ray Branson [email protected]“The Med MT solution allowsphysicians to keep practicing justthe way they like.”

ELECTRONIC MEDICALRECORDS

Greenway Health(HHH Gold Sponsor)Greenway Health offers a fully in-tegrated electronic health record(EHR/EMR), practice manage-ment (PM) and interoperabilitysolution that helps healthcareproviders improve care coordina-tion, quality and satisfaction whilefunctioning at their highest levelof efficiency.Stacy Berry830-832-0949Stacy.berry@greenwayhealth.comwww.greenwayhealth.com

FINANCIAL SERVICES

Northwestern Mutual WealthManagement(HHHH 10K Platinum Sponsor)Comprehensive financial plan-ning, insurance and investmentplanning, estate planning andtrust services.Eric Kala, CFP, CLU, ChFCWealth Management Advisor210-446-5752

[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 and freedom toachieve more in life.Jeffrey Allison [email protected]“Get what you deserve … maxi-mize your Social Security benefit!”

Frost Leasing(HHH Gold Sponsor)As one of the largest Texas-basedbanks, Frost has helped Texanswith their financial needs since1868, offering award-winningcustomer service and arange of banking, investment andinsurance services to individualsand businesses.Laura Elrod Eckhardt210-220-4135laura.eckhardt@frostbank.comwww.frostbank.com“Commercial leasing for a doctor’sbusiness equipment and vehicle.”

Bob Davidson New York Life(HH Silver Sponsor)Dedicated agent at New York Lifehelping physicians and medicalprofessionals achieve their finan-cial dreams. Bob Davidson 210-321�1445 [email protected]/in/bobdavid-sonnyl“Taking care of those who takecare of us.”

Retirement Solutions(HH Silver Sponsor)Committed to providing compre-hensive, reliable consultation tohelp you navigate the complexworld of retirement planning.Robert C. Cadena210-342-2900robert@retirementsolutions.wswww.retirementsolutions.ws

HEALTHCARE REAL ESTATE

San Antonio Comercial Advisors(HHH Gold Sponsor)Jon Wiegand advises healthcareprofessionals on their real estatedecisions. These include invest-ment sales- acquisitions and dispositions, tenant representa-tion, leasing, sale leasebacks, site selection and developmentprojectsJon Wiegand [email protected]“Call today for a free real estateanalysis, valued at $5,000”

HIPAA COMPLIANCE SERVICES

Cyber Risk Associates(HH Silver Sponsor)Cyber Risk Associates providesHIPAA compliance services de-signed for small practices, offer-ing enterprise-quality privacy andsecurity programs, customized toyour needs.David Schulz210-281-8151DAS@CyberRiskAssociates.comwww.CyberRiskAssociates.com

HIPAA/MANAGED IT/VOIP/SECURITY

Hill Country Tech Guys(HHH Gold Sponsor)Provides complete technologyservices to many different industries, specializing in theneeds of the financial and medical industries. Since 2006,our goal has always been to deliver relationship-based technology services that exceed expectations.Whit Ehrich, [email protected]://hctechguys.com/“IT problems? Yeah… we can fix that!”

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY

Continued on page 36


HOSPITALS/ HEALTHCARESERVICES

Southwest General Hospital(HHH Gold Sponsor)Southwest General is a full-ser-vice hospital, accredited by DNV,serving San Antonio for over 30years. Quality awards include accredited centers in: Chest Pain,Primary Stroke, Wound Care, and Bariatric Surgery.Business Development DirectorBlake Pollock210-243-9151bpollock@iasishealthcare.comwww.swgeneralhospital.com"Quality healthcare with you inmind."

Warm Springs•Medical Center•Thousand Oaks•Westover Hills(HHH Gold Sponsor)Our mission is to serve peoplewith disabilities by providingcompassionate, expert care dur-ing the rehabilitation process, andsupport recovery through educa-tion and research.Central referral line210-592-5350“Joint Commission COE.”

Elite Care Emergency(HH Silver Sponsor)24/7 full-service, no-wait, free-standing ER with board-certifiedphysicians and RNs offering EliteCare advantage for patients.Marketing LiaisonDlorah [email protected] liaisonKylyn Stark210-978-4110kstark@elitecareemergency.comwww.elitecareemergency.com“When seconds count, Elite Carecan make ALL the difference.”

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

Select Rehabilitation of San Antonio (HH Silver Sponsor)We provide specialized rehabili-tation programs and services for

individuals with medical, physicaland functional challenges. Miranda [email protected]://sanantonio-rehab.com“The highest degree of excel-lence in medical rehabilitation.”

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 and geteveryone in the practice on thesame page.John Seybold210-447-6518jseybold@employerflexible.comwww.employerflexible.com“BCMS members get a free HRassessment valued at $2,500.”

INSURANCE

Frost Insurance(HHH Gold Sponsor)As one of the largest Texas-basedbanks, Frost has helped Texanswith their financial needs since1868, offering award-winningcustomer service and a range ofbanking, investment and insur-ance services to individuals andbusinesses.Bob [email protected]“Business 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.Jon Buss: [email protected] Kotfas: [email protected]

SWBC(HHH Gold Sponsor)SWBC is a financial services com-pany offering a wide range of insur-ance, mortgage, PEO, Ad Valoremand investment services. We focusdedicated attention on our clientsto ensure their lasting satisfactionand long-term relationships.VP Community RelationsDeborah Gray Marino210-525-1241 [email protected] AdvisorGil Castillo, CRPC®[email protected] Valorem Tax AdvisorNikki [email protected], investments, personaland commercial insurance, bene-fits, PEO, ad valorem tax services

Texas Medical Association Insurance Trust(HHH Gold Sponsor)Created and endorsed by theTexas Medical Association (TMA),the TMA Insurance Trust helpsphysicians, their families and theiremployees get the insurance cov-erage they need.Wendell [email protected] [email protected] Isgitt512-370-1776www.tmait.org“We 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.James L. Hayne [email protected] [email protected]

Joel Gonzales Agency Nationwide(HH Silver Sponsor)Joel Gonzales210-275-3595www.nationwide.com/jgonzales

INSURANCE/MEDICALMALPRACTICE

Texas Medical Liability Trust(HHHH 10K Platinum Sponsor)Texas Medical Liability Trust is anot-for-profit health care liabilityclaim trust providing malpracticeinsurance products to the physi-cians of Texas. Currently, we pro-tect more than 18,000 physiciansin all specialties who practice in allareas of the state. TMLT is a rec-ommended partner of the BexarCounty Medical Society and is en-dorsed by the Texas Medical As-sociation, the Texas Academy ofFamily Physicians, and the Dallas,Harris, Tarrant and Travis countymedical societies.Patty [email protected]“Recommended partner of theBexar County Medical Society.”

MedPro Group(HHH Gold Sponsor)Medical Protective is the nation'soldest and only AAA-ratedprovider of healthcare malprac-tice insurance. Thomas Mohler, [email protected] [email protected]

The Bank of San Antonio Insurance Group, Inc.(HHH Gold Sponsor)We specialize in insurance and banking products for physiciangroups and individual physicians.Our local insurance professionalsare some of the few agents in thestate who specialize in medical malpractice and all lines of insur-ance for the medical community. Katy Brooks, CIC, [email protected]“Serving the medical community.”

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORYContinued from page 35


NORCAL Mutual Insurance Co.(HH Silver Sponsor)Since 1975, NORCAL Mutual hasoffered medical professional lia-bility coverage to physicians and is “A” (Excellent) rated byA.M. Best.Patrick Flanagan 844-4-NORCAL [email protected]

ProAssurance (HH Silver Sponsor)ProAssurance Group (rated A+(Superior) by A.M. Best) helpsyou protect your important iden-tity and navigate today’s medicalenvironment with greater ease—that’s only fair.Keith AskewMarket [email protected] KeeneyDirector, [email protected] 800.282.6242www.proassurance.com

INTERNET/TELECOMMUNICATIONS

Time Warner Cable Business Class(HHH Gold Sponsor)When you partner with TimeWarner Cable Business Class, youget the advantage of enterprise-class technology and communications that are highlyreliable, flexible and pricedspecifically for the medical com-munity.Rick Garza [email protected]“Time Warner Cable BusinessClass offers custom pricing forBCMS Members.”

IT SUPPORT/VOIP/CLOUD SERVICES

ICS(HHH Gold Sponsor)ICS® is a Texas-based provider ofbusiness technology integrationsolutions, including managed ITsupport, business telephones,VoIP communications, video con-ferencing systems, surveillancecameras, and voice/data cabling.Family owned since 1981.Daniel Simons210-581-9020

[email protected] Foehrkolb [email protected]“Providing IT, voice and video so-lutions for business.”

LABORATORY SERVICES

PGX TESTING(HHH Gold Sponsor)PGX Testing is a multi-faceted di-agnostics company currently of-fering pharmacogenomics, urinetoxicology, women's health test-ing, cancer screening, and well-ness testing to the medicalprofession.Charlie Rodkey [email protected] [email protected] [email protected]

Clinical Pathology Laboratories(HH Silver Sponsor)Mitchell Kern [email protected]

MARKETING SERVICES

Digital Marketing Sapiens(HH Silver Sponsor)Healthcare marketing profession-als with proven experience andsolid understanding of compli-ance issues. We deliver innovativemarketing solutions that drive re-sults.Irma Woodruff [email protected] Ajay Tejwani 210- [email protected] www.DMSapiens.com

MEDICAL BILLING ANDCOLLECTIONS SERVICES

DataMED(HHH Gold Sponsor)Providing your practice with thelatest compliance solutions, con-centrating on healthcare regula-

tions affecting medical billing andcoding changes, allowing you andyour staff to continue deliveringexcellent patient care.Betty Aguilar210-892-2331 [email protected]“BCMS members receive a dis-counted rate for our billing services.”

Kareo(HHH Gold Sponsor)The only cloud-based medical office software and services platform purpose-built for smallpractices. Our practice manage-ment software, medical billing solution, practice marketing toolsand free, fully certified EHR hashelped 30,000+ medicalproviders more efficiently manage their practice.Regional Solutions ConsultantLilly [email protected]

Commercial & Medical CreditServices(HH Silver Sponsor)A bonded and fully insured SanAntonio-based collection agency.Henry Miranda [email protected]“Make us the solution for youraccount receivables.”

MEDICAL SUPPLIESAND EQUIPMENT

Henry Schein Medical (HHHH 10K Platinum Sponsor)From alcohol pads and bandagesto EKGs and ultrasounds, we arethe largest worldwide distributorof medical supplies, equipment,vaccines and pharmaceuticalsserving office-based practitionersin 20 countries. Recognized asone of the world’s most ethicalcompanies by Ethisphere.Tom [email protected]“BCMS members receive GPOdiscounts of 15 percent to 50percent.”

CASA Physicians Alliance(HHH Gold Sponsor)Locally owned, nationwide Multi-Specialty Physicians BuyingGroup which provides significantsavings on Pediatric, Adolescentand Adult vaccines as well asother products. Physician’s mem-berships are free.Shari [email protected] [email protected]“Providing meaningful vaccinediscount programs, products andservices.”

MENTAL HEALTH EDUCATION AND CONSULTING

The Ecumenical Center(HHH Gold Sponsor)The Ecumenical Center providesfaith-based counseling and edu-cation for healing, growth andwellness. The center is a catalyst,bringing together communityleaders in research, education,ethics, medical and mental healthprofessions.Mary Beth Fisk210-616-0885, ext. [email protected]

MERCHANT PAYMENTSYSTEMS/CARD PROCESSING

Heartland Payment Systems(HH Silver Sponsor)Heartland Payments is a true costpayment processor exclusivelyendorsed by over 250 businessassociations.Tanner Wollard 979-219-9636tanner.wollard@e-hps.comwww.heartlandpaymentsystems.com“Lowered cost for American Ex-press; next day funding.”

OFFICE EQUIPMENT/TECHNOLOGIES

Dahill(HH Silver Sponsor)Dahill offers comprehensive document workflow solutions to

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY


help healthcare providersapply, manage and use tech-nology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes.Ronel Uys210-805-8200, ext. [email protected]

PAYROLL SERVICES

SWBC(HHH Gold Sponsor)Our clients gain a team of employment experts providingsolutions in all areas of humancapital – Payroll, HR, Compli-ance, Performance Manage-ment, Workers’ Compensation,Risk Management and Employee Benefits. Bryce [email protected] together to help ourclients achieve their businessobjectives.

PHYSICIANS BUYINGGROUP

CASA Physicians Alliance(HHH Gold Sponsor)Locally owned, nationwideMulti-Specialty Physicians Buying Group which providessignificant savings on Pediatric,Adolescent and Adult vaccinesas well as other products.Physician’s memberships are free.Shari [email protected] [email protected]“Providing meaningful vaccinediscount programs, productsand services.”

REAL ESTATE/COMMERCIAL

San Antonio Comercial Advisors(HHH Gold Sponsor)Jon Wiegand advises health-care professionals on their realestate decisions. These includeinvestment sales- acquisitionsand dispositions, tenant repre-sentation, leasing, sale lease-backs, site selection anddevelopment projectsJon Wiegand [email protected]“Call today for a free real estate analysis, valued at$5,000”

Robbie Casey Commercial Realty(HHH Gold Sponsor)Robbie Casey Commercial Realtywas founded on the principles ofproviding thorough marketstrategies, innovative advertising,superior service, and uncompro-mising integrity. Robbie is dedi-cated to each of her clients. Shebrings enthusiasm and creativityto each project and knows howto get the job done. Robbie [email protected]://robbiecaseyrealty.com

Endura Advisory Group(HH Silver Sponsor)Endura Advisory Group specializes in representingphysicians and clients in thepurchase, lease, sale, management or sublease ofcommercial real estate. Vicki Cade, CCIM 210-366-2222Mobile [email protected] [email protected]

REAL ESTATE/RESIDENTIAL

Robbie Casey Realty(HHH Gold Sponsor)My extensive experience and

expertise in the San Antonio,Alamo Heights and Terrell Hillsreal estate market will benefityou whether you are looking tobuy or sell a home in the area.Realtor, ABS, ILHM, ALMSRoslyn [email protected]://roslyncasey.kwrealty.com“Communication is key”

Kuper Sotheby's International Realty(HH Silver Sponsor)My hometown roots are basedin Fredericksburg while myhome away from home is SanAntonio. Local knowledge —exceptional results.Joe Salinas III [email protected]“Embrace your new life ...I'll help you become a connoisseur.”

SENIOR LIVING

Legacy at Forest Ridge(HH Silver Sponsor)Legacy at Forest Ridge provides residents with top-tiercare while maintaining their pri-vacy and independence, in a luxurious resort-quality environment.Shane BrownExecutive Director210-305-5713hello@legacyatforestridge.comwww.LegacyAtForestRidge.com“Assisted living like you’venever seen before.”

STAFFING SERVICES

Favorite Healthcare Staffing(HHHH 10K Platinum Sponsor)Serving the Texas healthcarecommunity since 1981, FavoriteHealthcare Staffing is proud tobe the exclusive provider ofstaffing services for the BCMS.In addition to traditionalstaffing solutions, Favorite of-fers a comprehensive range ofstaffing services to help mem-bers improve cost control, in-crease efficiency and protecttheir revenue cycle.Brody Whitley, Branch Director210-301-4362bwhitley@favoritestaffing.comwww.favoritestaffing.com

“Favorite Healthcare Staffingoffers preferred pricing forBCMS members.”

TRAVELCONSULTANTS

Alamo Travel Group(HH Silver Sponsor)Locally owned travel agency forover 30 years, offering personalized travel services foryour next family vacation, business travel needs or grouptravel. American Express Travel Network representative.Patricia Pliego Stout210-593-5500pstout@alamotravel.comwww.amazingjourneysbyalamo.com“See what a difference we can make for you!”

As of January 18, 2015

To join the Circle of Friends program or for more information,call 210-301-4366, email [email protected], or visit www.bcms.org/Cof.html.


Gunn Acura11911 IH-10 West

Cavender Audi15447 IH-10 West

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

Batchelor Cadillac11001 IH-10 at Huebner

Tom Benson Chevrolet9400 San Pedro Ave.

Gunn Chevrolet12602 IH-35 North

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.

Gunn GMC16440 IH-35 North

*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 Lexus

611 Lockhill Selma

North Park LexusDominion

21531 IH-10 WestFrontage Road

*North Park

Lincoln/ Mercury9207 San Pedro Ave.


North Park Mazda9333 San Pedro Ave.

Mercedes-Benzof Boerne

31445 IH-10 W, Boerne

Mercedes-Benzof San Antonio

9600 San Pedro Ave.

Ancira Nissan10835 IH-10 West

Ingram Park Nissan7000 NW Loop 410

Ancira Ram10807 IH-10 West


North Park Subaru9807 San Pedro Ave.

North Park Subaru at Dominion

21415 IH-10 West

Cavender Toyota5730 NW Loop 410

North Park Toyota10703 SW Loop 410

*Ancira Volkswagen5125 Bandera Rd.

North Park VW at Dominion

21315 IH-10 West

Slowly but surely the vehicles we buy are

being homogenized. Government regula-

tions, customer expectations, and universal

benchmarking are driving automotive de-

velopment so much that it’s difficult to

make cars that stand out from their com-

petitors.

Don’t believe me? Consider this: 30

years ago you could ride blindfolded in the

back seat of a Mercedes, BMW, or Cadillac

and know after less than a mile which was

which. Today I doubt many readers could

tell the difference between a new Mercedes

E-class, BMW 5-Series, or Cadillac CTS

under the same circumstances. I can’t.

So, how do luxury automakers connect

with customers when their products aren’t

much different from the competition? The

answer increasingly seems to be to get own-

ers and prospects out of their personal cars

and into “experiences.” Presumably, when

customers are able to forget about their

everyday realities — drive to daycare, then

to work, then to the grocery store, then

home, repeat daily — and are brought to

a happier place where a particular vehicle

shines, those customers will be more in-

clined to buy that vehicle.

With all that in mind I recently visited

two automotive brand experiences, the

new Porsche Experience Center at the At-

lanta airport and the Land Rover Driving

School in Carmel, California.

Sitting as it does next to a busy runway,

the Porsche center is an assault on the

senses from the moment you walk in.

Brightly colored Porsche road and race cars

are everywhere, and the modern architec-

ture with its chrome, glass, and high gloss

surfacing grab your attention here, there,

and there. And there. They should teach

an architecture class here, and maybe they

AUTO REVIEW


Porsche & Land Rover‘experiences’

By Steve Schutz, MD

do. And then there’s the test track just out-

side, and don’t forget the airliners landing

and taking off every 20 seconds or so.

Naturally, the idea is to immerse yourself

in all things Porsche, and ideally, drive one

too, either a sports car on the short test

track, or an SUV on the off road course.

Numerous specific drives are offered rang-

ing from quick laps on the track in the

hottest sports cars to slow slogs off road in

a Cayenne or Macan SUV, and all can be

done in 1-2 hours for $500-$1,000 or so.

Inside, Porsche provides entertainment

for non-drivers as well. There’s a museum

showcasing a few historic Porsches, a cafe,

restaurant, and even a driving simulator to

entertain teenagers.

Porsche buyers tend to customize their

rides more than most luxury car buyers, so

the center includes a place to do that prior

to purchase, should you be so inclined.

Countless color palettes, leather swatches,

and bodywork samples are there to see and

touch, along with a large HD monitor and

an advisor. The process is easy and inform-

ative, though, as you’d expect, any person-

alized changes you make will be expensive.

The whole place is either a sensory de-

light or annoying cacophony depending on

your point of view, which means that

Porsche fans will feel completely validated,

but non-Porsche people may prefer to be

elsewhere while their enthusiast signifi-

cant-other enjoys the immersion.

While the Porsche center is all about

adrenaline and conspicuous consumption,

the Land Rover Driving School involves re-

laxing, unplugging, and enjoying nature.

And, of course, learning about how well

Land Rovers drive off road. Whether you

choose Asheville, N.C., Manchester, Vt.,

or Carmel, Calif., you’ll end up with a deep

understanding of how well Land Rovers do

in the dirt and mud. And you’ll know why.

I selected the Carmel location for prox-

imity and sentimental reasons — my wife

and I honeymooned there 25 years ago —

and it proved to be an inspired choice.

Connected to the relaxed but nicely luxu-

rious Quail Lodge and Golf Resort, the

Land Rover team has access to an impres-

sive array of trails that wind up and around

182 acres of tough terrain.

The experience begins with a brief but

detailed discussion of the capabilities of

whichever Land or Range Rover you’ve se-

lected to drive, followed by a drive into the

woods. Not surprisingly, you’ll tackle easy

trails at first, but as the morning progresses

you’ll find yourself on very steep and slip-

pery hills. I learned quickly that the famed

Range Rover’s capabilities were prodigious

indeed, and I began to look forward to ex-

ploring ever more challenging areas. The

afternoon session was more laid back with

a leisurely jaunt down a breathtakingly sce-

nic dirt road to Big Sur located way up

above the Pacific Ocean. As I enjoyed the

bountiful beauty below, it struck me that

the innumerable rental cars and RVs below

us on the Pacific Coast Highway had no

way of knowing how much better their

view could be.

Both the Porsche and Land Rover expe-

riences offer an opportunity to interact

with the brands in an immersive way that’s

designed to connect you with either the ve-

hicle you already own or the one you want.

And both experiences are fun. They’re just

different kinds of fun.

If you’re in the market for this kind of

vehicle, call Phil Hornbeak at 210-301-

4367.

Steve Schutz, MD, is a

board-certified gastroen-

terologist who lived in San

Antonio in the 1990s when

he was stationed here in the U.S. Air Force.

He has been writing auto reviews for San

Antonio Medicine since 1995.

AUTO REVIEW



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

MacGregor Medical Center San AntonioMEDNAX

Peripheral Vascular Associates, PA

Renal Associates of San Antonio, PASan Antonio Gastroenterology Associates, PA

San Antonio Kidney Disease CenterSan Antonio Pediatric Surgery Associates, PA

Sound PhysiciansSouth Alamo Medical Group

South Texas Radiology Group, PATejas Anesthesia, PA

Texas Partners in Acute CareThe San Antonio Orthopaedic Group

Urology San Antonio, PAVillage Oaks Pathology Services/Precision Pathology

WellMed Medical Management Inc.

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 January 17, 2016.

san antonio medicine february 2016

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