san antonio medicine january 2016

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THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL VOLUME 69 NO. 1

BCMS CIRCLE OF FRIENDSSERVICES DIRECTORY

Dr. Jayesh Shah2016 BCMS President

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4 San Antonio Medicine • January 2016

Bexar HistoryNINEtEENth CENtury MEdICINE IN BEXAr CouNty

Part 1: Frontier Medicine ........................14Part 2: Notable Physicians of the 19th Century...........................................19

Part 3: organized Medicine in the19th Century...........................................24

Bibliography.............................................26By J. J. Waller Jr., MD

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

BCMS News..................................................................................................................................10

Book Review: Women in Prison by Fred H. Olin, MD ..............................................................................28

UTHSCSA Dean’s Message By Francisco González-Scarano, MD ........................................................30

Financial Mistakes Made by Doctors by Jim Rice, CPA..........................................................................32

Business of Medicine: Healthcare Mergers by Dana A. Forgione, Ph.D., CPA, CMA, CFE ...................34

BCMS Circle of Friends Services Directory .............................................................................................37

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

Auto Review: 2016 Mustang GT, By Steve Schutz, MD...........................................................................44

MEDICINETHE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • JANUARY 2016 • VOLUME 69 NO. 1

SAN ANTONIO

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For advertising rates and informationcall (210) 690-8338or FAX (210) 690-8638Email: [email protected] Antonio Medicine is published by SmithPrint, Inc. (Publisher) onbehalf of the Bexar County Medical Society (BCMS). Reproductionin any manner in whole or part is prohibited without the expresswritten consent of Bexar County Medical Society. Material containedherein does not necessarily reflect the opinion of BCMS or its staff. San Antonio Medicine, the Publisher and BCMS reserves the right toedit all material for clarity and space and assumes no responsibility foraccuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nordoes the Publisher or BCMS assume responsibility should such advertising or editorial appear. Articles and photos are welcome andmay be submitted to our office to be used subject to the discretion andreview of the Publisher and BCMS. All real estate advertising is subjectto the Federal Fair Housing Act of 1968, which makes it illegal to ad-vertise “any preference limitation or discrimination based on race, color,religion, sex, handicap, familial status or national orgin, or an intentionto make such preference limitation or discrimination.

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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

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Dear Friends,It is my privilege and honor to be your president and represent more than 4,700 Bexar County physicians, residents and fellows

that make up the 8th largest county medical society in the United States. It is a very proud moment for me to represent you as your first president from our new home (at 4334 N. Loop 1604 West) re-

flecting our 162 years of glorious tradition and history. I take on this role as the BCMS President at a time when physicians are facing unprecedented challenges. But these challenges

also bring opportunities for us as physicians to shape the best health care for our patients. Physician leadership is a must as our na-tion’s health care continues to evolve in the new century.

Our patients expect us to take a leadership role and they want us to be in charge. A recent survey by American Medical Associationshowed that 75 percent of patients wants to see their personal physicians, even if they have to wait longer.

A recent survey of 8,000 patients by the University of Chicago showed that 97 percent of patients wanted their doctor to discussthe treatment options with them and two-thirds of them wanted their doctor to make decisions for them. Polls consistently showthat patients trust their physicians. We cannot let our patients down.

I recently got invited to speak at the Optimistic Club’s international meeting in San Antonio. I was very impressed by their mes-sage on optimism which I would like to share with you as we start our New Year 2016.

The Optimist CreedPromise Yourself

To be so strong that nothing can disturb your peace of mind.To talk health, happiness and prosperity to every person you meet.

To make all your friends feel that there is something in them.To look at the sunny side of everything and make your optimism come true.

To think only of the best, to work only for the best, and to expect only the best.To be just as enthusiastic about the success of others as you are about your own.

To forget the mistakes of the past and press on to the greater achievements of the future.To wear a cheerful countenance at all times and give every living creature you meet a smile.To give so much time to the improvement of yourself that you have no time to criticize others.

To be too large for worry, too noble for anger, too strong for fear, and too happy to permit the presence of trouble.

After I reflected back on my presentation, after meeting some extraordinary optimistic people at the Club, and after reading thebook “Adversity to Success” by Ron Graves and Ron Palermo, I felt that if all physicians combined this positive worldview withdetermination, persistence and a strong work ethic, then we can overcome all adversities in practicing medicine and we can worktogether to “achieve the extraordinary.”

Let us work together to change the tides and create the best physician-led health care system in the United States.I wish you all a Happy Holiday Season.

Warm Regards,Dr. Jayesh Shah

PRESIDENT’SMESSAGE

An optimistic greeting from the new BCMS PresidentBy Dr. Jayesh Shah, 2016 BCMS President


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BCMS and BCVI are moving!The Bexar County Medical Society and Bexar Credentials Verifi-

cation Inc. will be moving into the new office building this month.The new office is located at 4334 N. Loop 1604 West, just inside

the loop between Lockhill Selma and N.W. Military Drive, abouttwo miles east of Interstate 10. All phone numbers and email ad-dresses will remain the same.

Beginning on Jan. 6, the old office at 6243 IH 10 West, Suite 600,will be packed up with the major portion of the move taking placeon Jan. 8-9. BCMS and BCVI will be open for business at the newoffice on Jan. 11.

BCMS will be located on the second floor of the 20,000 squarefoot building. There is also 10,000 square feet of rentable space avail-able on the first floor.

In MemoriamEstrella de Forster, MD, died on Nov. 20, 2015 at age 86.

She was a BCMS member and past president of the Texas MedicalAssociation 50-Year Club.William Pilcher Fitch III, MD, died on Nov. 29, 2015 at age 72.

He was a BCMS Life Member.Michael J. Gagnon, MD, died on Nov. 18, 2015 at age 47.

Attentionphysicians withSTRAC IDBadges thatare about toexpire or haveexpired.

STRAC is working on a newsecurity feature for the Version3 badges. Until that is completeyour STRAC ID badge willcontinue to work.

BCMS will let you know inadvance when they will beready to issue new ones.


BCMS NEWS

Healthy Futures of Texas held its 8th AnnualLuncheon with the Stars on November 6 at the beau-tiful Tobin Center for the Performing Arts. HealthyFutures of Texas provides educational programs withevidence-based curricula for teens and parents inschools and agencies. Janet Realini, MD, president ofHealthy Futures (standing) paused for a photo withguests at the BCMS table (l-r): Tyia Clark, DeannaKitchen, Alie Cole and Gilda Digman, (all second-year medical students); Mary Nava; Maria TiamsonBeato, MD and Jun Beato, MD.

For local discussion on this and other advocacy top-ics, consider joining the BCMS Legislative and So-cioeconomics Committee by contacting Mary Navaat 210-301-4395.

BCMS supporter of 8th AnnualHealthy Futures of Texas Luncheon

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BEXARHISTORY

During the first 20 years of the 1800s, Texas was a province of the

Spanish government, administered from Mexico City. From 1821

to 1836 it was a state in the Republic of Mexico, and from 1836 to

1845 it was the Republic of Texas. Thereafter it became a state in

the United States except during the Civil War when it was a member

of the Confederacy.

While under Spanish rule, the physician at San Antonio de Bexar

was appointed by the viceroy in Mexico City. From 1821 on, the

physicians in Bexar County were independent practitioners or were

part of the military units assigned to the San Antonio area.

In 1805, the Mission San Antonio de Valero (the Alamo) was

abandoned as a mission and was converted into a hospital by the

Spanish government. The area’s only physician, a civil employee,

treated all the residents of the county, including military, civilian set-

tlers, and Indians residing in the various other missions. During the

Spanish rule of Texas, excellent records were maintained of the var-

ious military and civilian medical problems encountered in the

province of Texas. These included extensive medical records, which

were then transmitted to the viceroy in Mexico and then onto the

Spanish government in Madrid. From 1821 to 1836, during the pe-

riod of revolution of Mexico from Spain, the records decreased in

frequency and from 1836 to 1845, during the Republic, records were

This presentation on the history of medicine in Bexar County during the 19th century is divided into three parts:

FRONTIER MEDICINE.NOTABLE PHYSICIANS OF THE 19TH CENTURY.ORGANIZED MEDICINE IN THE 19TH CENTURY.

There are many books and references in the literature concerning this period and they have furnished the information to compile these articles.

There is a complete bibliography at the end of Part 3.

By J.J. Waller Jr., MD

NINETEENTH CENTURY MEDICINE

IN BEXAR COUNTY

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BEXARHISTORY

visit us at www.bcms.org 15

almost non-existent.

Information from the Bexar county archives (translated from the

Spanish documents) transmitted back to Spain indicated that the

prevalent diseases at the time consisted of smallpox, pneumonia, in-

flammatory influenza, malaria, extensive gonorrhea and syphilis in

the military, and measles throughout the community. The various

treatments recommended were suggested isolation, rest, fresh air,

light diet, plenty of “rye water”, frequent bathing, cream of tartar

orally, and olive oil or butter externally applied.

Smallpox, initially introduced into Mexico by Hernando Cortez,

was rather widespread. In response to the pleas for assistance from

San Antonio de Bexar to Madrid, the king of Spain by royal decree

directed his royal physician to act. In 1805, a ship with a large num-

ber of children and a physician set sail for the Americas. Initially,

two of the children had been vaccinated with the recent “Jenner dis-

covery”. The cowpox vaccine was given to two children. From this,

two more children were inoculated every week from the prior two

children who had been vaccinated. In this way, the vaccine was kept

current until the ship reached Mexico. The process was then contin-

ued throughout the province and eventually reached San Antonio

de Bexar. The population was convinced by the local physician of

the necessity and safety of the process, and the smallpox was on its

way to eventually being eradicated.

During the 1820s and 1830s, colonization of Texas by groups

from the United States began, the first being that of the Stephen F.

Austin colony. Among the people flowing to Texas were occasional

physicians: these physicians of the 19th century were engaged in the

general practice of medicine. They depended largely on their five

senses, their experiences, and their judgment in making a diagnosis

and treatment. Much of the medical treatment was similar to that

which existed in colonial America. The motto of the times was

“bleed, puke, or purge.”

Malarial fever was a great killer that existed in almost every com-

munity. Other diseases included yellow fever, tuberculosis, small-

pox, diptheria, whooping cough, and various diarrheal conditions.

An additional responsibility on the early doctor was the necessity

to prepare and dispense his own medicine. Generally, these tasted

bad and consisted of medication such as quinine, turpentine, cas-

tor oil, and bichloride of mercury (calomel), and included local

botanical preparations.

In the 19th century there were two preventable diseases: small-

pox and malaria, the latter being treated with extract of cinchona

bark (quinine).

Pneumonia, with varieties consisting of catarrhal, croupous and

interstitial, was treated with quinine, Dover’s powders, morphine,

and Veratrum, a local herb consisting of “Indian poke (Indian helle-

bore)” and also the use of antipyrine (phenazone) for high fever. A

quote from a doctor of the time was, “The disease abates only when

there has been time for repairs through the agency of nature and oc-

casionally the art of man.”

The treatment of tetanus had utilized many modalities, but it was

found that the hypodermic injection of oil of tobacco in a few drops

in water was successful in controlling severe spasms, but not the final

outcome of the disease. There were many ways of treating whooping

cough including cocaine, hyoscyamine, cannabis, and others. Most

successful was the use of bromide as a sedative to reduce the severity

of the symptoms; however, this wasn’t a cure. Quinine was also uti-

lized in the treatment of whooping cough.

Typhlitis (inflammation of the cecum, now known as appendicitis)

was diagnosed only when it had reached the advanced stage of peri-

tonitis. Treatment consisted of sedatives to make the patient more

comfortable, along with hot or cold packs to the abdomen, and ir-

rigation of the colon when there was a possibility of obstruction. If

there was formation of an abscess in the abdomen that was palpable,

then it would be drained. The mortality was very high, approaching

90 percent in children and about 30 percent in adults.

In the summertime, there were bilious disorders present, which

were treated with calomel, quinine, and tartar emetic. Bloodletting

was popular during the early period. In 1825 and 1830, there were

epidemics of “fevers of various types,” possibly including typhoid.

In 1832, an epidemic of cholera in Gonzales was controlled by es-

tablishing a quarantine of the city from other areas of the state.

The treatment for extensive gunshot wounds consisted of boiled

light oak bark (very strong) mixed with pounded char wood and

Indian meal made into a poultice and placed around the gunshot

wound of an extremity or compound fracture for five days, after

which the mortified parts fell off and the extremity then occasion-

ally healed.

In 1857, it was reported that the treatment of yellow fever con-

sisted of the use of lobelia and quinine, as against the early treatment

with bleeding or purging. Treatment of diphtheria was with potas-

sium chlorate as well as steam inhalations of sodium chloride, car-

Continued on page 16

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BEXARHISTORY

bolic acid, or other antiseptics. Turpentine or lime were also added

to the inhalation formula at times. Secretions were regulated by the

use of the occasional dose of calomel.

Surgical treatment for internal conditions were almost unheard of

in the first half of the century. Surgery was used mainly for the treat-

ment of fractures, dislocations or external conditions. It was not until

the latter 19th century that physicians attempted to utilize surgery

for the problems within the body cavities. The latter half of the 19th

century saw the introduction of numerous medical advances. Anes-

thesia in the form of ether and then chloroform was made available.

Also, the use of Lister’s principle of antiseptic surgery was more

widely accepted.

Before the Civil War, the practitioner was frequently required

to travel great distances to treat his patients, and as a result most

of his time was required in house calls, either on foot, by horse-

back, or buggy. With the increase of population, more roads and

railroads, and the establishment of community in small towns, the

physician’s ability was increased to see more patients in his office

for longer periods each day. These offices were generally located

in his home, in his barn, in a local store, upstairs of a pharmacy,

or outside in the open.

Practicing in the frontier was frequently a dangerous activity. In-

dian attacks continued up until the 1880s. There was also the threat

of desperados waylaying the local physician out on a house call far

from town. A doctor was trained to wield a six-shooter and fre-

quently was forced to utilize it. A certain Dr. Webb was making a

trip from San Antonio to El Paso. His carriage or wagon was a “New

York rockaway” which was fit for sleeping. It was so armed that it

could be called an armory. It was a large vehicle with closed sides

and windows, and it contained the following armament: suspended

from the top was a double-barreled gun, to one of the uprights on

each side was attached a sharp repeating rifle (6 shot), and a heavy

revolver Colt six-shooter was strapped to each door. Dr. Webb and

the driver carried a pair of Colt five-shooters and a pair of Derringers.

This enabled them to fire a round of 37 shots without having to re-

load in case of an attack. On the frontier, circumstances were such

that whenever a doctor came into a community he had to become

physician, surgeon, apothecary, nurse, sanitarian, friend, veterinarian,

counselor, civic leader, educator, and even a statesman.

Diagnoses and treatment were enhanced by the introduction of

the stethoscope (from England) in 1853, and the hypodermic syringe

was in general use by 1875. The latter part of the century saw the

introduction of the germ theory of disease, broadly increasing a

physician’s understanding of many infectious diseases.

Payment of the physician in the early days was primarily in goods

or services, rather than in hard cash. Money was in very short supply

and his payment frequently was in the form of agricultural products,

horses, cows, donkeys, etc. Frequently, there was barely enough to

cover the office expense and supplies.

If we look at a page of a doctor’s journal dated1853, we find the following:

January 2 – Note to W. G. Gray, MD, for account (past)

by W. R. Lacey in amount of $9.28.

Interest 10% per year, $0.92.

Prescription and treatment that day and eye water-$1.30

January 29 – Prescription treatment and medicine, $2.50.

March 3 – One cake of shaving soap, $0.20.

April 4 – Treatment and prescription, $1.00.

Total on the books: $15.40.

In 1860, the annual income of physicians ranged from $300 to

$600. By the 1890s, the average income was $1,000 to $2,000 per

year with the latter considered a rather large income.

During these years, there were many places without regular

physicians, but there were many ‘quacks.’ These individuals easily

duped the public by advertising locally and promoting their tonics

and patented medicine. There were advertisements in local news-

papers about various treatments also. Quacks and quackery pro-

ceeded uncontrolled, but in 1853 at a meeting of the newly

organized State Medical Association of Texas the problem of quack-

ery was presented by Dr. George Cupples of San Antonio for con-

sideration by the group. In spite of such efforts, restrictions on

irregular medicine did not occur until the latter part of the 19th

century and actually was not solved until the passing of the Pure

Food and Drug Act in 1906.

Continued from page 15

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For most of the century, doctors who came to Texas were trained

elsewhere, since Texas was behind many states in the establishment

of medical schools. Graduates of medical schools had to compete

with the graduates of diploma schools that would give anyone with

$50 to spare a diploma. The New York Medical College of San

Antonio was an embarrassment to all physicians. They awarded a

diploma when the teaching staff consisted of a doctor, his wife,

and his 6-year-old child who were listed as the faculty. The Galve-

ston Medical College was established in 1865 and eventually be-

came the University of Texas Medical School.

During the days of the Republic, Dr. Anson Jones, as president,

instituted legislation for the control of physicians. It was finally

passed the second time on Dec. 14, 1837, establishing a Board of

Medical Censors and outlining requirements for the licensing of

physicians, including a fee of $20 by the applicant. The first Board

of Health in Texas was formed near Houston. However, the next

year the second Board of Health, much more productive, was

formed in San Antonio.

The physicians of the 19th century faced many hardships and

tribulations, and they practiced medicine to the best of their

ability. Despite obstructions, they made great progress in the

last few decades of the century. Literature is brimming with in-

formation about our early practitioners, their lives, and their

accomplishments. Presented here is only the briefest glimpse

into that rugged era.

J.J.Waller Jr., MD, is a member of the

BCMS Communications/Publications Committee.

COUGH DROPS — Take tincture of

blood-root, a syrup of pocacuanchia, syrup of squils, tinc-

ture of balsam tolu, and paregoric, and each of one ounce

mix. Use in severe coughs from colds; it is a valuable mixture.

Half of one drachm whenever the cough is severe.

This appeared in the San Antonio Ledger of May 27, 1852.

Another notice in the newspaper to cure hoarseness:

CURE HOARSENESS — Take the white of two eggs and beat them with two

teaspoons of white sugar, grate in a little nutmeg, then add a pint of lukewarm water. Stir

well and drink often. Repeat the prescription as necessary and it will cure the most obstinate case of

hoarseness. This appeared in the San Antonio Daily Herald of July 23, 1853.

Another notice is the treatment of asthma:

REMEDY FOR ASTHMA — An individual who has suffered from asthma and who has vain sought relief should give concern to

the following remedy: “Procure common blotting paper, and thoroughly saturate it in a solution of nitre, (saltpeter,) and let it be

carefully dried by the fire, or by exposure to the rays of the sun. On retiring at night, ignite it, and deposit it, burning, on a plate or

square sheet of zinc or iron in your bedroom. This appeared in the San Antonio Daily Herald, January 28, 1858.

The following are some notices thatappeared in the newspapers aboutvarious treatments:


BEXARHISTORY

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BEXARHISTORY

Charcoal drawing by Kathleen Waller Stewart, M.D.

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BEXARHISTORY


Many physicians practiced in the San Antonio Bexar County area

during the 1800s, and the majority provided the best care possible

under the frontier conditions. All should be remembered for their

dedication and tenacity, but there were a few that contributed greatly

to medicine and society for one reason or another.

Dr. Frederico Zervan was the first physician mentioned in the

archives of Spanish documents for Bexar County. He accompanied

a bishop in 1805 on his travels through the province, and at the gov-

ernment’s request he remained in San Antonio de Bexar and was as-

signed to the new hospital in the Alamo. An incident occurred

during this period in which the Attorney General of the province,

made a complaint to the governor that Dr. Zervan was inefficient

and inattentive to the patients, neglecting them, and was a quack

and requested that the doctor be replaced. After an investigation by

the governor, it was determined that the doctor’s practice was greatly

appreciated by both the military and the people, and the complaint

had no grounds whatsoever. Therefore, the governor exonerated the

doctor, raised his pay to 30 pesos a month, and dismissed the attor-

ney from the position as Attorney General. (Obviously, an early

inkling of tort reform in Texas.)

In 1808, Dr. Zervan retired and a new physician, a Dr. Munive,

was appointed as the surgeon of the military hospital. He remained

for two years and left, so there was no physician in the area, according

to the archives, until 1819.

In the archives, it is stated that in 1806 the government granted a

Dr. Latigue permission to practice as a “master of surgery in the class

of dentist.” In the archives there is no further mention of this indi-

vidual, but he probably was the first dentist in San Antonio and pos-

sibly in the state of Texas.

The first battle of the Texas Revolution was fought at Gonzales on

Oct. 2, 1835, after which the Army of Texas under the direction of

Stephen F. Austin and Ben Milam moved on to attack San Antonio.

After a two-month battle, General Martin Perfecto de Cos, com-

mander of the Mexican garrison and brother-in-law to Santa Anna,

surrendered his 600-man garrison to the 250-man Texas Army. Sev-

eral of the physicians with the Army in San Antonio at that time re-

mained in the Army to eventually fight and die in the Battle of the

Alamo in 1836.

One of those remaining in San Antonio was a Dr. Amos Pollard.

He graduated from the Middlebury College and Vermont Academy

of Medicine in 1824. He joined the Stephen F. Austin colony in

1834 and joined the Texas Army in 1835. Dr. Pollard was a part of

the action in taking San Antonio, and he remained in the Alamo

and was assigned as the Chief Medical Officer of the forces stationed

there. He directed several urgent dispatches from the Alamo to Sam

Houston and Gov. Henry Smith beginning several weeks before the

siege by Santa Ana. He was urgently requesting either money or

medical supplies and additional instruments that would be needed

to care for any wounded that would occur in the forthcoming battle.

Such assistance was not forthcoming, as were neither additional

forces for the Alamo. He and two other physicians were among the

gallant defenders who were overrun and annihilated on March 6,

1836. Certain it is that at the age of 33 he, along with the other two

physicians, achieved for the medical profession a portion of the glory

of the Alamo. His portrait hangs on the walls of the Alamo.

Of particular interest at this time was the plight of two physicians

who were assigned to Fannin’s command at Goliad and were spared

from the massacre of the defenders on March 27, 1836. Eventually

these two physicians, Dr. John Shackelford and Dr. Joseph Bernard,

were under guard and escorted back to San Antonio to provide medical

care for Mexican soldiers wounded in the siege of the Alamo. They

remained there treating the wounded Mexicans and also some of the

civil population for several months following the Battle of San Jacinto

on April 21, 1836, which essentially ended hostilities with Mexico.

Dr. Bernard remained in the Texas Army for another year and then

opened a practice nearby. It should be noted that at the Battle of San

Jacinto there was a San Antonio physician who was the only casualty

of the action, Dr. William Motley, who was only 24 years old.

Dr. Edward Weidermann was a physician practicing in Bexar

County during the time of the Republic. He was a military surgeon,

a Russian scholar and naturalist. He was highly cultivated and was

considered an excellent physician and surgeon. On the night of



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BEXARHISTORY

March 19, 1840, there was an Indian raid on San Antonio and Dr.

Weidermann took an active part in the fight and killed two Indian

warriors. He approached a friend’s house to borrow a cart to take the

two bodies home. He explained that he needed actual skeletons to

continue his studies and research. That night at his home he stewed

the bodies in a soap boiler, and when the flesh was completely sep-

arated he emptied the pot into the acequia. This stream furnished

the freshwater supply to the community for drinking, whereas the

San Antonio River was used primarily for washing and bathing.

There was a city ordinance to the effect that the acequia should not

be contaminated under any circumstances and if violated would be

coupled with a heavy fine.

Dr. Weidermann now had his skeletons to study, but this was not

considered appropriate by the townspeople; they were horrified to

learn of the event, believing that the water of the acequia had been

defiled by the doctor, and they were drinking particles of Indian in

the fluid. In great indignation, a mob formed and had the doctor

arrested, and he was brought to trial. He assured the judge and jury

that the rapid-flowing acequia would have washed all the particles

during the night into the river and people were not drinking “Indian

soup.” Convinced for the most part, the court let the doctor off with

a heavy fine, assuring him that if it were not for his previous good

record he would have been run out of town at gunpoint!

Dr. George Cupples was born in Scotland in 1815 and took his

medical training at the University of Paris. He was persuaded to

move to Texas after meeting Dr. Ashbel Smith, who was representing

the Republic of Texas in the French court at that time. Dr. Cupples

arrived in the San Antonio area in 1846 and opened a practice in

Castroville. He moved to San Antonio in 1850, at which time the

population of San Antonio was 1,000, of which 90 percent were of

Mexican descent. When he opened his practice, he was either the

second or third physician in San Antonio. During the Mexican war

in 1846, he served as surgeon with the Texas Rangers. During the

Civil War, he served as a surgeon to the 7th Texas Cavalry.

Dr. Cupples helped to establish the Bexar Medical Society and was

its first president in 1853. He was also instrumental in establishing

the Texas State Medical Association at its organizational meeting in

1853 and he became its president in 1853. He returned to San An-

tonio after the Civil War to resume his surgical practice. This was a

time of notable advances and changes in medicine and surgery, and

Dr. Cupples participated in many of these events. He was the first

surgeon in Texas to use a general anesthetic and this was in a case of

an amputation of a leg. He was noted for performing several proce-

dures for the first

time in Texas. In

addition to using

ether and chloro-

form for the first

time, he was the

first in America

to resect the

tongue for cancer.

He performed

the first resection

of an ovarian

tumor in a child

age 6. He was the

first surgeon in Texas to employ the Freund’s procedure for removal

of the uterus and ovaries, and he was the first to amputate an ex-

tremity at the hip joint and also at a knee joint successfully. It is no-

table that these various procedures were performed without the

benefit of a hospital being available. Also of note is that antiseptic

surgery was not practiced in America until the end of the 19th cen-

tury. However, Dr. Cupples describes scrubbing and cleansing of the

operative sites during the above procedures.

He helped establish a committee on surgery of the Texas Medical

Association in 1885. He was chairman of the six-man committee

that sent out 6,000 questionnaires to the physicians of Texas asking

for information on the surgeries that had been performed with ex-

tensive detail and information about the patient and the procedure.

Multiple aspects of the surgeries performed were requested and 138

surgeons responded. Dr. Cupples’ summary, a 74-page report, covers

4,293 operations, and the report was exhibited at the meeting of the

Association in 1886. Included was the type of operation, mortality,

anesthetics, vital statistics, and if antiseptics were employed and their

effects and consequences. Most of the operations were not performed

in hospitals but in the office, the patient’s home, or out in the open

for better light. Chloroform was chosen over ether 35 to 1. Carbolic

acid was practically the only antiseptic. Mortality was from 10 per-

cent to 100 percent depending on the type of surgery. For all the

major operations (2,080), the overall mortality was 16 percent. A re-

view of the report was noted in the Journal of the AMA and in the

British Medical Journal. It should be noted that in the report is the

following quote by Dr. Cupples: “If the whole truth must be told,

the writer of this report remembers to have read in the London

Lancet some years ago, ‘What good (professionally, that is) can come


Dr. George Cupples, first BCMS President in 1853.

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BEXARHISTORY


out of Texas?’, and it has very much at heart to answer this sneer of

the great London Journal by proving from a survey of our work that

the surgeons of Texas, country doctors though they be, though no

long string of academic honors illustrate their names, are second to

those of no country in the variety, the boldness, the success of their

operations, in practice, skill, in fertility of resources, and in that self-

reliance founded on knowledge without which no man can be a suc-

cessful surgeon.”

Dr. Cupples was a master of his profession and was extremely careful

in his practices, keeping meticulous records of his cases. He received

many accolades from both the state and the Bexar County Medical

Society. Dr. Cupples died in 1895 at the age of 79. His funeral, by

many accounts, was the largest ever held in San Antonio, with numer-

ous eulogies by physicians and leading citizens of the town.

Ferdinand Herff, MD, was born in 1820 in Germany. His father

was an influential politician and statesman. He attended university

and was active in the student military corps and fought many duels

throughout his training. He was interested in botany but saw no fu-

ture in this and so studied medicine, graduating in March 1843.

After graduation, he entered the Prussian Army as a military surgeon

and over the next two years had considerable experience as a surgeon

caring for military combat injuries.

During his time in Germany, there was considerable unrest politi-

cally and many professionals turned their interest to immigration to

Texas. In 1847, Dr. Herff led a group of German immigrants who

came to Texas to establish a colony on the Llano River. This was even-

tually unsuccessful for various reasons, and Dr. Herff returned to Ger-

many to marry. In 1849, he and his wife returned to Texas and

established a practice in New Braunfels. However, in 1850 they moved

to San Antonio, which was a much more prosperous town, and he es-

tablished a surgical practice. At this time, San Antonio appeared as an

old Mexican pueblo. However, it was the principal trading point to

Mexico, Santa Fe, El Paso, New Orleans, and areas north.

In 1855, in addition to his practice, Dr. Herff served as city physi-

cian for a salary of $10 per month. He served in the Confederate

Army as a brigade surgeon, but in the latter portion of the Civil War

and the instability in the country he returned to Germany briefly to

serve again in the Prussian Army. He then returned to Texas in De-

cember 1867. In 1854, he had performed an operation on a Texas

Ranger in which he performed a lithotomy and removed a very large

bladder stone. The procedure was a success, and after this his popu-

larity as a surgeon increased tremendously and he became extremely


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BEXARHISTORY

busy. There were no hospitals in San Antonio. Therefore, operations

were performed outdoors where there was sufficient light, as well as

many spectators. He is noted for being the first surgeon to perform

a number of operations not only in Texas, but also in the United

States. These include the first hysterectomy, first surgery for Jack-

sonian epilepsy, perineal lithotomy, a successful appendectomy, the

first gastrostomy, and the first cataract operations. These operations

were performed between 1847 and 1879. It is noted that with the

gastrostomy, which was performed on a teenage girl who had swal-

lowed lye, he did the gastrostomy in order to be able to introduce

nutrition through a tube in her stomach. This appeared to be un-

successful for a few weeks until he added the girl’s saliva to the con-

tents of the food being introduced into the stomach, and thereafter

the child thrived tremendously.

As mentioned earlier about the TMA’s report in 1885 of the sur-

gical procedures performed in Texas by the 138 surgeons, it is noted

that of the 4,293 surgical procedures performed, Dr. George Cupples

and Dr. Ferdinand Herff performed 25 percent of the total.

In 1891, at the founding of the University of Texas Medical School

in Galveston, there was a statewide movement to have Dr. Herff ap-

pointed as the first chairman of the Department of Surgery. He de-

clined, preferring to remain in his home in San Antonio and

continue his private practice. He became close friends with Dr. Cup-

ples, and they worked tirelessly to maintain ethical behavior for both

their businesses and professional dealings. The American Medical

Association established a Code of Ethics in 1847 and both these men

tried to maintain these principles in San Antonio. Dr. Herff and Dr.

Cupples both served as examiners for the Texas State Board of Med-

ical Examiners. In 1853, Dr. Herff helped establish the Texas Medical

Association and was one of the 35 charter members of the Bexar

County Medical Society and was a charter member of the West Texas

Medical Association. He was active in publishing medical informa-

tion and journals, and he helped establish the West Texas Medical

and Surgical Record, which for a number of years was a credit to

medical journalism.

Dr. Herff was an active member of the Hessian Association of

Physicians and Surgeons, and a member of San Antonio’s Casino

Club. In addition, he was director of the San Antonio National

Bank, which was affiliated with the San Antonio Loan and Trust

Company, and was identified with the Lacoste Ice Company, the

first to manufacture artificial ice in the United States. In April 1859,

the first drugstore where prescriptions could be filled opened in the

home of Dr. Herff.

Dr. Herff, during his earlier years in South Texas had learned sev-

eral Indian languages. As a result, he had a number of Native Amer-

ican patients. He had successfully performed bilateral cataract surgery

(one of the first in Texas) on an Indian chief, restoring his sight. In

1886, Geronimo, the famous Apache chief, while imprisoned in Fort

Sam Houston, requested a visit from Dr. Herff. They conversed in

Apache and together recalled many medical stories in which Herff

had been involved with the Indians. Later in 1888, the Lipan

Apaches were on one of their final raids and they rampaged through


Below - Dr. Frank Paschal, 1893.At right, Dr. Ferdinand Herff with graduates of theSanta Rosa Infirmary Training School in 1903.

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the burning area where Dr. Herff had his ranch. The warriors could

be heard throughout the night raiding the town and the nearby

ranches, farms, and homes. However, the Herff ranch was spared

and the next morning at the gate post was found a lone Apache arrow

with a white feather.

He performed his last surgery, an ectopic pregnancy, at age 87. He

died in his home in May 1912 at the age of 91 years and 6 months.

A fitting obituary appeared in the bulletin of the Bexar County Med-

ical Society.

Frank Paschal, MD was born Oct. 22, 1849, one of the first four

white children born in Bexar County. His father and mother were the

first American born individuals to be married in Bexar County. His fa-

ther had come to Texas in 1836 from Georgia. He came to join the

Texas Army to avenge the death of several of his friends who had been

massacred at Goliad. He later became the first sheriff of Bexar County.

Dr. Paschal received his early education in San Antonio and Mon-

terrey, Mexico where his family lived for a short period of time. He

began his study of medicine at age 19 in 1868 with Dr. George Cup-

ples as his preceptor. During the next two years, he was privileged

to observe and assist Dr. Cupples in many of his “Texas firsts in sur-

gery,” mentioned earlier. He entered Louisville Medical School in

1870, graduating in 1873 with honors, and won a competitive in-

ternship at the Louisville Hospital. He returned to San Antonio in

1874 to open a practice.

The first few months in San Antonio were not as successful as he had

hoped, and he moved south and opened up a practice in Chihuahua,

Mexico, which was a major mining center. He spoke fluent Spanish

and was highly successful. He traveled to San Antonio frequently and

married a San Antonio girl. After a few years in Mexico, he returned to

Bexar County to practice for the next 30 years. In 1890, San Antonio

was the largest city in Texas, having surpassed Galveston, which at that

time was the largest. In 1892, the population of Bexar County was

38,000. In the next 40 years, it would grow to 230,000.

The 30 years he spent practicing in Bexar County were highly suc-

cessful for him and his community. Most of his practice was accom-

plished by many house calls each day. He was an excellent diagnostician

and successful surgeon. He was highly regarded by his colleagues and

was known as “Dr. Ethics.” He was elected president of the West Texas

Medical Association in 1893. This organization’s charter expired after

a few more years.

His activities in the Bexar County Medical Society were evidenced

by the fact that he was repeatedly charged with being chairman of the

Ethics Committee. He was responsible for counseling wayward mem-

bers, occasionally resorting to reprimands and very occasionally to sus-

pension or expulsion from the society. He was active at the state level

of the TMA and served on multiple committees. He was instrumental

in exposing the activity of the New York Medical College in San Anto-

nio (previously mentioned) and its closure. He was the San Antonio

Health Officer for four years at a salary of $1200 per year.

In 1903, Dr. Paschal was elected president of the newly reorgan-

ized Texas Medical Association and the reorganization of the County

Medical Societies. Dr. Cupples, Dr. Paschal’s mentor, had been

elected president of the TMA in 1853, and his protégé fell into his

footsteps in 1903.

During his tenure, and secondary to his intense interest in the

treatment of tuberculosis, the first state sanitarian was established in

Carlsbad, Texas. It had been a 20-year pursuit by Dr. Paschal. The

TMA began collecting materials to preserve Texas’s medical heritage.

More than a century ago Dr. Paschal told the TMA House of Dele-

gates in his presidential address, “The labors of this Association

should always be conserved, and unless steps are taken the past work

will be lost forever.” He then established the Committee on Collec-

tion and Preservation of records, the forerunner of the present day

History of Medicine committee.

Dr. Paschal was concerned with organized medicine as a physician

involved in the establishment of the Texas Surgical Society and later

served as its president. Along with other physicians in Bexar County,

he was among the principal organizers of the Physicians’ and Surgeons’

Hospital. It was the precursor of the San Antonio Baptist Hospital Sys-

tem. He continued until his death in 1925 to be active in the Bexar

County Medical Society. He generously donated $10,000 to the Bexar

County Medical Society to help provide a permanent home for this

group. At that time, this was a very princely donation. “Frank Paschal

did much more than accept responsibilities for medical care. He became

a major public force for good, and as such was able to influence the de-

velopment of one of the significant urban areas of the United States in

ways that he would never himself have conceived.

There were many notable physicians in this century in Bexar County.

The previous discussions seem to represent some of the finest among

many. Remarkable progress was made from the end of the Civil War

to the end of the century. Considering the medical knowledge of the

day, their accomplishments were noteworthy. They all took their work

seriously and met the demands of the frontier with dedication and de-

votion to their patients. They prepared a foundation upon which suc-

cess would be obtained by their successors with even greater

accomplishments.

J.J.Waller Jr., MD, is a member of the

BCMS Communications/Publications Committee.

BEXARHISTORY


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BEXARHISTORY

In January of 1853, a group of physicians from mainly Austin and

San Antonio met to form a medical organization. A constitution and

bylaws were proposed and discussed. The first regular meeting of the

Texas State Medical Association was held in San Antonio in early

September 1853. The constitution and bylaws were accepted and

subordinate local organizations were proposed. The first to receive a

charter in the state was Bexar County in late September 1853. It was

to be known as the Bexar Medical Society and the first president of

both the state and Bexar county group was Dr. George Cupples. The

original certificate resides in the offices of the Medical Society. Dur-

ing the 1870s through the 1880s and 1890s, the certificate was kept

in the offices of Dr. Frank Paschal until the Society finally secured a

“home” of its own. In the early 20th century, it was transferred to

the Society offices for safekeeping.

In 1853, San Antonio was a small village of about 3,000 inhabi-

tants. The surrounding area was wild and uninhabited. Indian raids

were frequent and occasionally reached into the center of town. At

the start, Medical Society meetings were held once a month. Each

man attending carried a sidearm (see previous article). It was

recorded that at meetings all sidearms were required to be checked

at the door until the meeting was complete.

Due to various impediments (including primarily the Civil War),

the Texas State Medical Association did not have regular meetings

again until 1869. For the next several years after that, meetings were

occasionally held in various towns around Texas with as few as seven

members attending at a time. There are no surviving records of any

meetings of the local society that may have been held by the Bexar

Medical Society during this period.


On Jan. 17-19, 1853, 35 physi-cians from the surroundingcommunities met at theMethodist Church in Austin tofound and organize the TexasMedical Association.

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BEXARHISTORY


The first recorded attempt locally to reestablish a county organi-

zation was in 1873 with the formation of the West Texas Medical

Association by some of the physicians who had initially been in-

volved in the formation of the Bexar Medical Society (including such

notables a George Cupples, Ferdinand Herff, John Herff, Rudolph

Menger, and others.)

The exact reason behind the formation of a different local organ-

ization is not entirely clear. A number of factors may have come into

play, including the following: 1. The extended absence of meetings

of the state organization. 2. Once meetings of the state were resumed,

to attend required long transport by horseback or buggy through

still hostile and hazardous country. 3. The adjustments to recon-

struction were still progressing slowly. 4. Problems of unavailability

of hard currency. 5. The economic panic of 1873 was nationwide,

and bankruptcy was common in many commercial ventures, includ-

ing the large ranchers of South Texas. This may have induced the

county physicians to form a different organization over which they

had more control.

The West Texas Medical Association was chartered by the State of

Texas to last 25 years, commencing in 1873. (A copy is in the

archives in the P.I. Nixon Library, and the original in the lobby of

the Bexar County offices.) According to a summary by Dr. Frank

Paschal (located in the archives), about 1900 he stated it had been a

very active and well-organized association through the years. It con-

tinued with monthly meetings with increasing membership as the

town grew (1877 population 19,278 — number of physicians 13;

1890 population 37,173 — number of physicians 41; 1900 popu-

lation 53,321 — number of physicians 60). It later added clinical

discussions of local cases and autopsy reports and discussions of local

health problems, fees and ethics.

In the beginning, the Association met in the county courthouse,

and later meetings were held in various settings throughout the

county, including the Pulling’s Hall which after a while the group

was asked to move; various doctors’ offices; the Hall of the Broth-

ers of Locomotive Engineers; the Elks Hall; next to a local dance

hall (however the noise of the music drowned out the discussions);

and in the dance hall of the St. Anthony Hotel until all the chairs

were broken and they were requested to move; and then other var-

ious places. During the 25 years, the total rent paid amounted to

50 dollars. By 1900, it was obvious that the organization needed

a home of its own. This would not occur until 20 years later. More

detailed information about the meetings of the Association is not

available.

From the Bexar County Medical Society archives in the P.I. Nixon

Library, it appears the West Texas Medical Association continued its

contact with the Texas State Medical Association. There were occa-

sional disagreements between the two organizations, but Bexar

County hosted the state meetings in 1878 and 1889. In 1903 the

American Medical Association reorganized, and the state associations

followed suit. The charter of the West Texas Medical Association had

expired, and the basis of the system was once again the local societies.

The state became the Texas Medical Association and locally, the

Bexar County Medical Society. Great strides were to be made in or-

ganized medicine during the next century, but the frontier physicians

of the 19th century forged the real basis of the county medical or-

ganizations. It was orchestrated by a group of honest, intense, tal-

ented, dedicated and tough physicians. We should all be proud of

this heritage.

J.J.Waller Jr., MD, is a member of the BCMS Communications/Publications Committee.

The Charter of the Western Texas Medical Association, signed in 1877.

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BEXARHISTORY

Atkinson, Donald T. Texas Surgeon. An Autobiography, New York:Ives Washburn, Inc., 1958

Brown, Mel, San Antonio in Vintage Picture Card/ Post Card His-tory, Austin, Texas: Texas Medical Association Archives, Austin,Texas: SC Arcadia Publishing, 2000

Cox, I. Wayne, The Spanish Acequia of San Antonio, SanAntonio,Texas: Maverck Publishing Co., 2005

Daniel, F.E., M.D., Daniel’s Texas Medical Journal, Vol. IV, July,1888 to June, 1889: Edited and Published in Austin, Texas, 1889Ferris Van Voast, Slyvia and Sellers Hoppe, Eleanor, Scalpels andSabers, Austin, Texas: Eakin Press, 1985

Garrison, F.H., M.D., Introduction to History of Medicine,Philadelphia: W.B. Saunders Co., 1929

Gray, W.G., M.D., Page From Personal Journal, 1865 (In my pos-session)

Hood, R. Maurice, M.D., Early Texas Physicians, Austin, Texas:Statehouse Press, 1999

Hoyt, Henry F., A Frontier Doctor, Boston: Houghton Mifflin Com-pany, 1929

Jones, Bill M., Health — Seekers in the Southwest 1817-1900, Nor-man Oklahoma: University of Oklahoma Press, 1967

Nixon, Pat I., M.D., A Century of Medicine in San Antonio, Pri-vately Published by Author, San Antonio, 1936

Nixon, Pat I., M.D., The Medical Story of Early Texas, San Antonio:Mollie Bennet Lupe Memorial Fund, 1946

Nixon, Pat I., M.D., History of the Texas Medical Association,Austin, Texas: University of Texas Press, 1953

Nofi, Albert A., The Alamo and the War For Texas Independence:Da Capo Press, 1922

Oberste, William H., Texas Irish Empresarios and Their Colonies,Austin, Texas: Von Boeckmann-Jones Company, 1953

Schuman, Henry, Sixty-five Notable Milestones in the History ofMedicine in the Bexar County Medical Library, San Antonio, Texas,1961

Young, J.W. Sr., It All Comes Back, Sweetwater, Texas: Watson FocattCompany, 1962

Texas State Journal of Medicine Centennial Issue, Volume 49, Num-ber 5, May 1953

Bexar County Medical Society Archives, (AR 61 – 51 Boxes) Pat I.Nixon Medical Historical Library in the Dolph Brisco Library of theUniversity of Texas Health Science Center, San Antonio, Texas

Transcripts Relating to the Medical History of Texas, Thirty-oneBound Notebooks, Texas Medical Association Archives, Austin,Texas, 1923-1953

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BOOKREVIEW

Orange is the New Black: My Year in a Women’s Prison by Piper Ker-nans and The Execution of Noa P. Singleton by Elizabeth L. Silver haveonly one thing in common: they each involve an incarceratedwoman. Otherwise, they couldn’t be more different.

It’s likely that you have heard of Orange is the New Black, as it wasthe inspiration for a series that has appeared on Netflix. I’ve never seenthe TV show, but I’ve been told that it isn’t particularly true to thebook. Ms. Kernans is an upper-middle-class Smith College graduatewho, after graduation, fell in with an older lesbian woman, Nora, aminor drug runner. One time only, Kernans ferried some money backfrom the Far East for Nora. She then dropped back into both sensesof the straight world; she moved to San Francisco, started dating theman who would ultimately become her husband, and went to work.

Many years after she committed the offense, someone (probablyNora) ratted on her and she was arrested, tried and sentenced to 15months in the women’s prison in Danbury, Connecticut. Her talefrom prison combines character studies of her fellow inmates, storiesabout her interactions with them and discussions of her activities:among other things, she is assigned to the electrical shop where shelearns how to be an electrician.

She discovers that others who didn’t have access to private counseland had to depend on public defenders were serving much longersentences for offenses of even lesser severity than her own. She realizesthat she was part of her colleagues’ problems: “[F]or the first time Ireally understood how my choices made me complicit in their suf-fering. I was the accomplice to their addiction.” She continues: “Alengthy term of community service working with addicts on the out-side would probably have driven the same truth home and been ahell of a lot more productive for the community. … Instead, our sys-tem of ‘corrections’ is about arm’s-length revenge and retribution.Then its overseers wonder why people leave prison more broken thanwhen they went in.”

The last part of the story is different. She is moved via “ConAir”,the federal government’s prisoner transfer air service, to OklahomaCity, which is sort of a prisoner movement hub, and then to theChicago federal holding facility to participate in a trial of another ofNora’s accomplices. These two places make Danbury seem prettygood to her. While in Chicago, her sentence ends, with time off forgood behavior. She is released onto the street, where her fiancé meetsher and takes her home.

The above is a really superficial review: the book is beautifullywritten, full of interesting details and observations, hard to put down

and worth your time. Now, on to a totally different sort of story.The Execution of Noa P. Singleton is an intensely moving novel.

The first-person narrator of much of the story is Noa, a 35-year-oldwoman who has been on death row in a Pennsylvania prison for 10years, living through a series of unsuccessful appeals. She was con-victed of killing Sharon Dixon and her unborn child. That child’sfather is Noa’s ex-con father, Caleb, a totally worthless sort of guy.No one disagrees that Noa shot Sharon, not even Noa. However, asthe book progresses, this reader, for one, began to wonder exactlywhere the truth lay. There is not one really likable or admirable char-acter here: not Noa, not Sharon, not Caleb, not Sharon’s motherMarlene, a high-powered lawyer, or Marlene’s sidekick, OliverStanstead, a young English law graduate.

The story starts six months before “X day,” which is what Noacalls the proposed date of her execution, and progresses one monthat a time. It is a tale of maternal neglect, maternal dominance, in-trospection, lack of introspection, memory and amnesia. Oliver’s jobis to draw out Noa’s life story, ostensibly to help Marlene get aclemency order from the governor, allowing Noa to serve a life sen-tence without possibility of parole… but it was Marlene who insistedon the death penalty at the time of Noa’s trial. She says that she’s hada change of heart, but one wonders.

Interspersed between chapters of Noa’s narration are letters writtenby Marlene to her dead daughter, who had been a classmate of Noa’sat the University of Pennsylvania. As the story progresses, the plotweaves back and forth in time, and we learn more about Noa, Caleband Sharon, and what someone once described as “the real realismof the real reality” becomes more and more obscure… and clearerall at the same time. There’s even a bit of an advantage in the storyfor those us with medical knowledge: Did the “fatal” shot really killSharon? We may never know.

The author, Elizabeth Silver is a lawyer and has degrees in creativewriting. One of her jobs included working for the Texas Court ofCriminal Appeals on death penalty cases. She admits that she alwayswanted to be a writer, and she has succeeded admirably with thisfirst novel. It was chosen as “Best Book” of the year by several or-ganizations and very definitely deserved the honors.

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.

WOMEN IN PRISONTwo books with little in commonBy Fred H. Olin, MD

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UTHSCSADEAN’S MESSAGE

Our School of Medicine is leading the way in an expanding fieldthat promises to revolutionize health care in the next severaldecades: point-of-care ultrasound.

Point-of-care ultrasound is becoming routine in many areas ofclinical practice, taking on an increasingly important role in clinicaldecision making and improving efficiency in patient care. Likemany technological devices, ultrasound equipment has becomemore portable, powerful, and affordable. This point-of-care ap-proach is now widely used in some specialties such as cardiology,obstetrics, emergency, and internal medicine. The expectation isthat it will benefit more specialties as they find appropriate uses.However, as with many new technologies, there is still a lag betweendevelopment and integration into clinical practice.

Our recently launched Center — which opened in December2015 — is helping bridge that lag, and ultrasound training is nowbuilt into our curriculum from the first year through residencytraining. The Center and our faculty’s achievements in this newtechnology are distinguishing the School as one of the country’sleading training grounds for point-of-care ultrasound.

In the traditional model, ultrasound tests are most commonlyperformed in an imaging facility, acquired by a skilled technicianand then interpreted by a radiologist; sometimes the image is ob-tained at the hospital bedside by technicians and then reviewed.With the new more portable machines, clinicians directly use theinstrumentation. While the clinician may not capture all the detail

that a radiologist can, in many cases the gains in efficiency and speedsave lives.

For example, if a patient is at high risk for cardiac arrest becauseof pericardial effusion and tamponade, the diagnosis can be madequickly. Similarly, abdominal aortic aneurysms can be detected rap-idly in patients with abdominal or back pain. In a hypotensive pa-tient, point-of-care ultrasound can quickly establish whether theproblem is to due heart failure, or identify collapsed great veins dueto hypovolemia.

To prepare our students for a future where these technologies areroutine, we are investing resources in teaching students and housestaff how to acquire the necessary images, along with the knowledgeto understand and interpret them.

Nilam J. Soni, MD, Associate Professor of Medicine, is co-direc-tor of the Ultrasound Curriculum and director of the all new Centerfor Clinical Ultrasound Education. He is one of the physicians whois helping to integrate ultrasound into medicine on a local, nationaland international level. Dr. Soni is the chief editor and co-authorof the book Point-of-care Ultrasound, a definitive guide to the prin-ciples and diverse applications of the technology. The book recentlyreceived the prestigious President’s Choice Award at the 2015British Medical Association’s Medical Book Awards, competingagainst 630 books in 21 categories. The book, which also earnedthe designation “Highly Recommended” in the BMA’s internalmedicine category, is available in print and also digitally with videos

Point-of-Care UltrasoundChanging the Practice of Medicine

By Francisco González-Scarano, MD


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visit us at www.bcms.org 31visit us at www.bcms.org 31

UTHSCSADEAN’S MESSAGE

of ultrasound images to allow readers to quickly access images on atablet or laptop. The book is now available in Chinese and is alsobeing translated into Spanish.

Dr. Soni’s interest in ultrasound began in his medical school days,when the focused assessment with sonography for trauma (FAST)exam emerged as one of the main protocols for evaluating patientsin the emergency department. He wondered aloud why physiciansdo not use ultrasound with all patients and became committed toexpanding the use of the technology

He credits the technology with saving many patients during hisyears on night shifts at the University of Chicago. In addition to de-veloping proficiency with the tool, he solidified his belief that ultra-sound has much more potential in a variety of medical applications.In fact, seeing the potential to teach and train other physicians in theuse of ultrasound is one of the reasons Dr. Soni came to us in 2012.In addition to his work with students, Dr. Soni provides CME train-ing locally, nationally and internationally.

Together with Dr. Soni, Craig Sisson, MD, RDMS, FACEP, As-sociate Clinical Professor of Emergency Medicine, is co-director ofthe School of Medicine’s ultrasound curriculum. Our School is oneof only a handful of medical schools around the country that inte-grates ultrasound into the curriculum of each year of medical schoolso that even undifferentiated students learn how ultrasound is usedin various environments and have the opportunity to choose electivesto further explore point-of-care ultrasound.

This curriculum will reduce one of the primary limitations of thetechnology: provider training. Today’s medical students are the nextinnovators; they will devise new ways to use the technology to de-crease patient risk and improve outcomes. That is why our goal is tointroduce them to ultrasound as early as possible in their medicaltraining to expose them to the possibilities of the technology.

No other medical school in the United States has a center such asthe Center for Clinical Ultrasound Education, making our School anational model for the multidisciplinary integration of ultrasoundinto healthcare education. The facility is a 1,000 square foot labora-tory containing eight ultrasound stations, each equipped with cam-eras and 40-inch plasma screens to share images, along with anadjacent 1,700 square foot lecture hall. This resource gives studentsvaluable hands-on exposure in both using the equipment and inter-preting ultrasound images while providing videoconferencing capa-bilities that enable up to 145 students to simultaneously benefit fromthe curriculum.

Bedside ultrasound offers four main application areas: Education.Ultrasound can teach students anatomy and help them

understand the structural relationship between different organs inthe body.

Diagnostics. Point-of-care ultrasound is vital in emergency medi-cine, where time is of the essence. In a rural setting, this may be theonly real diagnostic imaging that is available quickly.

Therapeutics. Point-of-care ultrasound offers applications for pro-cedural guidance, such as vascular access in chronically ill patients.Screening. Ultrasound can quickly and efficiently screen patients

for specific conditions such as an abdominal aortic aneurysm. De-tected early and easily with point-of-care ultrasound technology,physicians can refer patients to vascular surgeons for appropriatetreatment, thereby saving lives.

It should be emphasized that point-of-care ultrasound does not re-place radiologists. There are certain conditions that can be safelyidentified with point-of-care ultrasound, while others require moredetailed analysis. The in-depth analysis provided by advanced imag-ing and radiology will continue to be vital and may become increas-ingly so as ultrasound becomes more widely used. In addition,point-of-care ultrasound may lead to improved communication be-tween physicians and radiologists, fostering the continuum of carebetween many specialties.

Ultrasound will play an increasingly greater role in health care aswe move toward more efficient, higher-value patient care. Equipmentwill become increasingly more affordable and readily available withportable ultrasound equipment apt to become as common as a bloodpressure machine in patient care settings. It is quite possible thatsmaller hand-held devices will become as common as stethoscopesare today.

As these advances happen, the School of Medicine will remain fo-cused on training clinicians to explore the diverse applications andtremendous potential point-of-care ultrasound can bring to ourproviders and their patients.

The next workshop on point-of-care testing for providers is Feb.12-13, 2016. If you would like to enroll or just learn more aboutpoint-of-care ultrasound, visit our website at:http://cme.uthscsa.edu/ultrasound.asp

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]

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To become a physician takes exceptional dedication and focus.Doctors acquire a vast quantity of medical knowledge but too littlein the business management area. In today’s environment, businessissues can dominate the running of a medical practice. It is im-portant for you to be aware of common mistakes that are made inoperating a practice, and even more importantly, to address thepossibility that you are making some of these mistakes. The mis-takes below were gathered from years of experience in assistingphysicians in their practices.

# 1 Putting the wrong people in placeA medical practice deals with many different insurers with their

own codes and rules. Billing and coding errors can quickly be thedownfall of a practice. With the government stepping up fraudabuse audits, hiring an expert billing assistant can be crucial. Yourspouse, cousin, best friend, etc. may seem like a good way to avoidtheft and give you an assurance in dealing with someone you arecomfortable with, but does this person know health informationtechnology or accounting so that you get timely and accurate in-formation on how your practice is doing? Placing too much re-sponsibility and reliance on one person can also be a problem.Embezzlement occurs too often in medical practices. Establish in-

ternal controls to safeguard cash in and out. You invest much timeand cost into your staff. Hire well.

# 2 Trying to keep it simpleDoctors don’t want more complexity to an ever challenging career.

However, complexity can provide great benefits. Separating differentlocations and services can give asset protection and isolate loss cen-ters. Owning your building in a separate partnership provides manyadvantages. Moving your unprotected investments into a family lim-ited partnership creates asset protection and allows for future taxplanning. The right federal taxable entity for your practice can helpavoid payroll taxes. Tracking provider performance and clearly estab-lishing compensation goals can create motivation and reward. Withthe low interest rates, financing your life insurance premiums andusing the arbitrage makes sense. Don’t operate on a handshake; doc-ument all agreements with fellow partners and employees.

# 3 Not paying attention to the numbersAccountants prepare financial statements all day long that doctors

do not look at or understand. These financial statements, if timelyprepared with comparison to similar prior periods, can identify ex-cessive expenses, declining collections, etc. The data can also help thedoctors anticipate future income tax payments that are looming andtherefore budget for them. Doctors do not have time to learn howto interpret financial data, and they tend to not ask for help. Getyour accountant to sit with you and explain what the financial state-ments mean and how you should use that information. If you have

Five Major Financial MistakesMade by Doctors

By Jim Rice, CPA

FINANCIALMISTAKES

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financial budgets, review them with the actual results. If you don’thave budgets, establish some. If you have to ask your accountant forhelp, you may need a new accountant.

# 4 Mixing business with pleasureDoctors can forget that their practice is a separate entity. They dis-

tribute collections out of the practice for personal matters, pay per-sonal expenses through the practice bank account and investpersonally with practice funds. It is important from a tax planningand asset protection perspective that all personal financial activity bekept out of the practice. Doctors have a reputation, right or wrong,for being easy marks and spending too much. A medical practice canbe a very successful business that is destroyed by the personal spend-ing habits of the doctor. Determine what your personal spendinghabits are and how they affect the operations of your practice. Manydoctors complain of working harder and having less to show for it.This may be perception only or it could be a sign of the practiceand/or the physician not controlling costs or protecting revenues.

# 5 Not planning for the futureI don’t just mean for retirement. We have heard many times over

how none of us are adequately putting money away for our retire-ment. This is more true for doctors who after years of school starttheir retirement funding later than most. There are also things doc-tors should be addressing before retirement. Is there an adequate buy

sell agreement for your practice? Do you have a succession plan toprotect your practice? Are you insuring your most valuable asset –Yourself? Disability insurance may seem expensive until you need it.Apart from retirement funding, do you have readily available reservesin case of a rainy day?

Physicians have worked hard to get to where they are. Making themost of their efforts is the goal.

Jim Rice, CPA is a shareholder at Sol Schwartz& Associates, P.C. ([email protected]). He has 32years of experience in public accounting. In addi-tion to providing business consultation, financialplanning and various other accounting services,Jim specializes in income tax planning and con-sultation. He works with a high concentration of

physician practices and high net worth individuals. Contact Jim at(210) 384-8000 Ext. 112.

FINANCIALMISTAKES

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BUSINESS OFMEDICINE


It seems just about everyone in healthcare is either merging, plan-

ning to merge, or debating if they should merge. We’ve been through

this before. Merging. Unmerging. Re-merging. I suppose it’s to avoid

sub-merging (sorry, couldn’t resist…). Some research shows that the

anticipated benefits of mergers often will never be realized. But it’s

all about strategic market share and negotiating clout. Of course it

doesn’t hurt that the brokers and lawyers earn tidy fees putting the

deals together, and taking them apart again later. Why, the latest

merger announcement about the Pfizer and Allergan’s $150 billion

mega-merger of the century already includes discussion of how they’ll

divide the impending biggest drug company in the world into two,

before the deal has even obtained its regulatory approval. Physician

practices are being acquired by hospitals, and then the hospitals and

systems are merging — so the payers are also merging to build

counter-clout. We’ll no doubt end-up seeing the market consolidate

into an oligopoly of national, fully-integrated healthcare organiza-

tions. Maybe that’s a good thing. Maybe it’s not. So what should you

consider if a merger or acquisition opportunity presents itself?

First and foremost, consider your expectations. For example, why

are you interested in merging? What are your greatest issues of con-

cern? What essential issues and risks need to be identified and ad-

dressed before starting a merger? What might the new organizational

governance structure be like, and how would it affect your role?

What benefits do you anticipate, and what is the prospect of realizing

those benefits? Are there other ways to achieve those benefits apart

from a merger?

For example, I was approached by a young cosmetic surgeon once

about wanting to acquire the practice of another cosmetic surgeon

who was planning to retire. I asked him what he was expecting to

gain from the acquisition. The patient referral base, of course. It takes

time to build a referral base, and this would be a way to jump-start

that process. We talked about the potential for hidden liabilities, un-

known malpractice claims yet to be asserted, patient attrition, and

other issues. I suggested that rather than acquire the practice, why

not just work with the other surgeon for a year, capitalize on his

goodwill, build a reputation and relationships with referral sources,

and then carry on with your own practice. Was the cost and risk of

an acquisition really necessary or desirable?

Second, what information do you need to make a properly in-

formed decision? Too many deals go sour and end up dissolving. Ex-

pectations are not met, and adequate information is not obtained in

advance. While not a merger, I did a litigation support engagement

once where four surgeons were suing a hospital over alleged fraudu-

lent misrepresentation of the economic prospects for their practices

in the region. The issues are relevant. The hospital management had

done a health needs assessment for the surrounding community, and

determined it needed four more general surgeons. So the hospital

actively recruited these four surgeons from across the country, offer-

ing them signing bonuses, payment of their relocation expenses, and

collection-guarantee loans to help support them as they built up their

new practices. Of course the loans would be forgive on a pro-rata

basis over four years, as long as the surgeons stayed and continued

to serve the community. In compliance with Stark, patient referrals

to the hospital were explicitly not required. If the surgeons decided

to leave before their four-year term expired, all amounts would be-

come immediately due and payable. As collateral for the loans, the

hospital could take their office equipment, and both current and fu-

ture accounts receivable. There was also a non-compete agreement

upon severance.

The docs accepted the offers, signed the contracts, moved into

town, set up their practices, and bought homes. It’s an old story. Let’s

digress here for a minute. Some of you may be old enough to re-

member Tennessee Ernie Ford singing about 16 Tons:

You load sixteen tons, what do you get?

Another day older and deeper in debt

Saint Peter don’t you call me ’cause I can’t go

I owe my soul to the company store

The “company store” is an old economic routine, dressed-up in

new clothes. My grandfather was one of them. He was an Italian

immigrant who worked in the sand quarries of Long Island in

New York. The workers worked long hours and had to buy their

food and supplies only from the company store. And on their low

wages, the workers all quickly became deeply in debt to the store.

Moonlighting was not allowed. So what did he do? He would

HEALTHCARE MERGERSBy Dana A. Forgione, Ph. D., CPA, CMA, CFE

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BUSINESS OFMEDICINE


sneak out at night and dig clams on the local beaches (which was

illegal). He sold enough of them to eventually buy his way out of

debt, and started a one wheel-barrow construction company.

Things went well for him until the great depression, but that’s a

story for another time. My point? Those four surgeons got them-

selves locked into the company store.

What happened was the hospital had not obtained adequate buy-

in from the local physicians who were critical as a patient referral

base for these four newcomers. When the local docs didn’t refer

enough patients, the four surgeons got deeper and deeper into debt

to the hospital. They couldn’t leave, because it would trigger imme-

diate repayment of all the loans, and they didn’t have enough money

to pay them off. And all their equipment and future receivables

would be taken. And they couldn’t stay, because they were not mak-

ing enough money to support their practices without drawing down

even more on the collection guarantee loans. They were economically

trapped. “I owe my soul to the company store.” So what did they

do? They sued the hospital for alleged fraudulent misrepresentation

of the economic prospects for their practices. While there were prob-

lems, the court found that there was not fraud. All four of them were,

no doubt, brilliant surgeons. But tragically one of them ended up

bankrupt. It didn’t need to end that way. You never have enough in-

formation. And you can never eliminate all uncertainty. But take

stock of your own expectations, and be sure to do your due diligence

and gather all of the salient information you can get. Your future

may, rather will, depend on it.

Dana A. Forgione, Ph.D., CPA, CMA, CFE is the

Janey S. Briscoe Endowed Chair in the Business of Health

at the University of Texas at San Antonio. He is also an

Adjunct Professor in the School of Medicine, Department

of Cardiothoracic Surgery, the Department of Pediatrics, and in the

School of Public Health, all at the University of Texas. He previously

held a joint appointment in the School of Pharmacy at the University of

Maryland, where he taught in the Doctor of Pharmacy program. His re-

search interests are in international comparisons of healthcare payment

systems, costs and quality of care, as well as financial management for

hospitals and physician practices.

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


ACCOUNTING FIRMS

Padgett Stratemann & Co., LLP(HH Silver Sponsor)Padgett Stratemann is one ofTexas’ largest, locally owned CPAfirms, providing sophisticated ac-counting, audit, tax and businessconsulting services.Vicky Martin, [email protected]“Offering service more than ex-pected — on every engagement.”

Sol Schwartz & Associates P.C.(HH Silver Sponsor)We specialize in areas that aremost critical to a company’s fiscalwell-being in today’s competitivemarkets. Jim Rice, CPA210-384-8000, ext. [email protected]“Dedicated to working withphysicians and physician groups.”

BANKING

BBVA Compass(HHHH 10K Platinum Sponsor)Our healthcare financial team pro-vides customized solutions for you,your business and employees. Commercial Relationship ManagerZaida [email protected] Global Wealth ManagementMary [email protected] Branch ManagerVicki [email protected] Banking OfficerJamie [email protected]“Working for a better future.”

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Broadway Bank(HHH Gold Sponsor)Healthcare banking experts witha private banking team commit-ted to supporting the medicalcommunity.Ken [email protected]“We’re here for good.”

Frost(HHH Gold Sponsor)As one of the largest Texas-basedbanks, Frost has helped Texanswith their financial needs since1868, offering award-winning customer service and a range ofbanking, investment and insur-ance services to individuals andbusinesses.

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IBC Bank(HHH Gold Sponsor)IBC Bank is a $12.4 billion multi-bank financial company, with over212 facilities and more than 325ATMs serving 90 communities inTexas and Oklahoma. IBC Bank-San Antonio has been serving theAlamo City community since 1986and has a retail branch network of30 locations throughout the area.Markham [email protected]“Leader in commercial lending.”

Ozona Bank(HHH Gold Sponsor)Ozona National Bank is a full-ser-vice commercial bank specializingin commercial real estate, con-struction (owner and non-owneroccupied), business lines of creditand equipment loans.Lydia [email protected]

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]

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

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORYContinued from page 37


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

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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.

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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]

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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 [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

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

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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 Pollock

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY

Continued on page 40visit us at www.bcms.org 39visit us at www.bcms.org 39

210-243-9151bpollock@iasishealthcare.comwww.swgeneralhospital.com"Quality healthcare with you inmind."

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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.”

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HUMAN RESOURCES

Employer Flexible(HHH Gold Sponsor)Employer Flexible doesn’t simply

lessen 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] Employer OrganizationBryce Fegley

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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]

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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 all

areas 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, 210-807-5593

[email protected]“Serving the medical community.”

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 helps you controlyour professional risk and navi-gate today’s changing medicalenvironment with greater ease —that’s only fair. Keith Askew, [email protected]

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORYContinued from page 39


Mark Keeney512-314-4347, ext. 7347 [email protected]“A.M. Best-rated A+ (Superior),ProAssurance treats you fairly.”

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 [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 medical pro-fession.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

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 210-884-7505LWilliams@KnowYourDoctorSA.comwww.knowyourdoctorsa.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 Smith866-434-9974

[email protected] [email protected]“Providing meaningful vaccinediscount programs, products andservices.”

MEDICAL TRAINING/HANDS ON

LINRON® Bioskills Training Institute(HHH Gold Sponsor)LINRON® is dedicated to provid-ing hands-on medical training tohealthcare professionals whowant to improve their clinical skillsand offer their patients the latestin treatment modalities whileusing state-of-the-art medicalequipment and technology.Yolanda S. Garza, RN 210-572-2434yolanda.garza@linrontraining.comwww.linrontraining.com

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.”

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY


MORTGAGE

SWBC Mortgage at La Cantera(HHH Gold Sponsor)In a complex lending environ-ment we are committed to pro-viding realistic expectations,simple solutions, and a stress-free buying experience. Exceeding customer expecta-tions is our highest prioritySr. Loan Officer #212945Jon M. Tober210-317-7431 [email protected]

OFFICE EQUIPMENT/TECHNOLOGIES

Dahill(HH Silver Sponsor)Dahill offers comprehensive document workflow solutionsto 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]

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

Robbie Casey Commercial Realty( 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( Gold Sponsor )My extensive experience andexpertise 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 830-456-2233

[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 December 17, 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.

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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

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In past reviews I’ve discussed “OneFord,” former CEO Alan Mullaly’s fa-mous plan to unify the far flung com-pany’s products as much as possible. Whynot, the great Mr Mullaly wondered,make one Ford Focus for all markets in-stead of different ones like Ford alwayshad? Naturally the answer was, “becauseit’s unbelievably hard,” but thanks to theirrecently retired CEO, Ford now producesfar fewer different car and truck modelsaround the world than they used to, andwe’re the better for it.

Want a better example than the Focus?How about the Transit, a full-size van thathas sold in Europe and other markets for

decades, and which just recently replacedthe Econoline/E-series vans in the U.S.How’s that radical change been going? Ina word, well, with sales that are signifi-cantly better than the Econoline couldmuster before it was replaced. Despitesporting a distinctly Euro design, the Tran-sit is proving to be very popular because it’sa better product than the E-series, offeringvastly better packaging and much more ef-ficient drivetrains.

OK, you say, One Ford is good. But arethere any Fords which couldn’t work innon-North American markets? Two yearsago I would have said the Mustang and F-150. I still say the F-150, but I no longer

think that about the Mustang. Not coincidentally, the new Mustang

was completely re-engineered last year andis now clearly meant for global consump-tion. Three changes in particular are de-signed to make Ford’s long time icon moredesirable in non-North American markets:replacing the solid rear axle with an inde-pendent rear suspension (IRS), cuttingweight for improved fuel economy, andupgrading the quality of the interior.

Those changes are important becausecars in Europe, Asia, and elsewhere aremore expensive than they are here. Thatmeans that customers expect their cars tobe well built with excellent materials and

AUTO REVIEW


2016 Ford Mustang GTBy Steve Schutz, MD

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AUTO REVIEW


athletic handling. Yet fuel costs and otheroperating expenses are also higher outsideof the U.S., so vehicles have to be econom-ical too.

Let’s start our discussion of the new2016 Mustang with a look at the new rearsuspension. A solid rear axle is better thanan IRS for only one thing, drag racing. Butthe IRS is costlier to manufacture, hencethe solid axle’s longevity in the Mustang.I’m not an expert-enough test driver toprobe the limits of the new ‘Stang, buteven I was able to tell that it’s more nimblethan its predecessor and noticeably moresettled over bumpy roads. The lowerweight -100-200 pounds less depending

on options, according to Ford — obviouslyhelps in this area too.

A nicer interior won’t help either han-dling or performance, but it is a welcomechange nevertheless. All of the surfaces youtouch feel softer than they used to, and allof the places you look at appear nicer.That’s kind of it. Ergonomically the newMustang isn’t significantly better than theprevious model because the older Mustangwas fine in that department. And space-wise, I’d call it a wash. Just remember, thisis a sports car not a family sedan, so don’texpect to put your in-laws in the rear seatsand have them not hate you.

The 2016 Mustang is available withthree engine options. A 300HP 3.7L V6(19MPG city/28 highway) is standard onthe base Mustang, with the next best en-gine being the 310HP EcoBoost 2.3Lfour-cylinder engine (21/32MPG). Mytester Mustang GT came with a 435HP5.0L V8 that provides 16MPG city/25highway.

OK, a word about the V8 Mustang GT:the sound that glorious engine makes whenyou step on the gas pedal is wonderful. It’sso wonderful, in fact, that when you drivethis car it’s hard to stop yourself from ac-celerating and grinning for no reason. Ob-viously, that V8 sound becomes normalafter a while, but that “normal” is still way,way better than what you hear when you

drive an average car, and that’s the beautyof owning a Mustang GT. So is the exuber-ant handling and the delicious manualtransmission (if you select it).

If you care at all about these sorts ofthings, buy a V8 Mustang now. Electrifica-tion and autonomous technology are com-ing, and it won’t be too long before we’re allriding silent self-driving drone-pods that wedon’t even own to work. Just so we canspend even more time on our phones. Soget cars with actual personality like the Mus-tang GT before they’re gone forever.

But maybe I’m wrong, and the OneFord plan is serving to show the world thatAmerican cars can be fun, full of character,and desirable like so many German carsare. And maybe that essential goodness willturn back the relentless march of thedrone-pods. I sure hope so.

If you’re in the market for this kind ofvehicle, call Phil Hornbeak at 210-301-4367 and take a look at the Subaru Legacy.

Steve Schutz, MD, is aboard-certified gastroen-terologist who lived in SanAntonio in the 1990s whenhe was stationed here in the

U.S. Air Force. He has been writing autoreviews for San Antonio Medicine since1995.

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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 December 17, 2015.

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san antonio medicine january 2016

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