dmj_march2013 by Dallas CMS

Get Involved v o l u m e

In this issue: On Parkland Hospital - Dallas County Judge Clay Jenkins

Project Access Dallas - Top Providers, Volunteers, FAQs, and Legacy

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Cover Photo

The first Tuesday of every month during the Texas legislative session, DCMS members travel to Austin to advocate on behalf of patients. pictured: Lee Ann Pearse, MD; DCMS staff member Anna Acuña; Drs. Kim Rice, Sue Bornstein, Robert E. Jackson (Harris CMS), Sarah Helfand, Dee Whittlesey, Angela Gardner, Sidney Gicheru, Deborah Fuller

Dallas County Medical Society PO Box 4680, Dallas, TX 75208-0680 Phone: 214-948-3622, FAX: 214-946-5805 www.dallas-cms.org Email: lauren@dallas-cms.org

DCMS Communications Committee Roger S. Khetan, MD.............................................. C h a i r Gene Beisert, MD Suzanne Corrigan, MD Seemal R. Desai, MD Gordon Green, MD Robert Gross, MD Steven R. Hays, MD C. Turner Lewis III, MD David Scott Miller, MD Clifford Moy, MD

DCMS Board of Directors Cynthia Sherry, MD.......................................... President Jeffrey E. Janis, MD..................................President-Elect Jim Walton, DO................................Secretary/Treasurer Richard W. Snyder II, MD......... Immediate Past President Mark A. Casanova, MD Wendy M. Chung, MD Christopher A. Hebert, MD Michelle Ho, MD Todd A. Pollock, MD Kim M. Rice, MD Hampton Richards, MD Erin Roe, MD Christian Royer, MD

DCMS Staff Michael J. Darrouzet................... Chief Executive Officer Lauren N. Cowling................................ Managing Editor Steven Harrell.............................. Asst. Managing Editor Bearett Wolverton................................ Advertising Sales Articles represent the opinions of the authors and do not necessarily reflect the official policy of the Dallas County Medical Society or the institution with which the author is affiliated. Advertisements do not imply sponsorship by or endorsement of DCMS. ©2013 DCMS

According to Tex. Gov’t. Code Ann. §305.027, all articles in Dallas Medical Journal that mention DCMS’ stance on state legislation are defined as “legislative advertising.” The law requires disclosure of the name and address of the person who contracts with the printer to publish legislative advertising in the DMJ: Michael J. Darrouzet, Executive Vice President/CEO, DCMS, PO Box 4680, Dallas, TX 75208-0680.

Dallas Medical Journal (ISSN 0011-586X) is published monthly by the Dallas County Medical Society, 140 E. 12th St, Dallas, TX 75203.

Subscription rates $12 per year for members; $36, nonmembers; $50, overseas. Periodicals postage paid at Dallas, TX 75260.

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Pr es ident’s Page

Take a First Tuesday

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2012 D CMS Foundation Annual Fund D o no rs

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Fir s t Tues day Photos

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How to Wr ite a R es olution for TMA The New Scar city

Jim Walton, DO, MBA

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L egis lative Update

Tracy Casto

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Pr oject Acces s D allas 2012 Top Pro vi d e rs

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Pr oject Acces s D allas FAQ

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Pr oject Acces s D allas V olunteer s

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On Par k land Hos pital

Dallas County Judge Clay Jenkins

Postmaster Send address changes to: Dallas Medical Journal, PO Box 4680 Dallas, TX 75208-0680.

submit letters to the editor to lauren@dallas-cms. org visit us online at www.dallas-cms.org • March 2013 •

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President’s Page

Take a First Tuesday ...to Address Medicine’s Issues in Austin As I write this month’s President’s Page, the Legislature has completed the first month of its 180-day session. Texas physicians have a number of legislative priorities, and I encourage each of you to let your legislators know how these issues affect you and your patients. A great way to do this is to participate in First Tuesdays at the Capitol — they’re Cynthia Sherry, MD fun and create an impact by showing physician support across specialties, helping legislators understand our issues, and learning the subtleties, nuances and downstream consequences of healthcare-related bills. The physician-patient relationship is one issue worthy of our careful scrutiny, particularly in view of today’s increasing prevalence of physician employment models. Physicians must take steps to ensure that independent medical judgment is preserved for physicians and dedicated to patients’ best interests, and that competing interests do not distract physicians from appropriate, evidence-based treatments. We must strongly support provisions that ensure corporate entities cannot direct medical decision-making; similarly, we must support provisions that prohibit retaliation against physicians who advocate for patients in this setting. Patients entrust their lives and health to their doctors’ skill, experience and concern. In turn, we bear the duty of upholding patient primacy. (Go to www.ama-assn.org/go/employment for extensive information and a white paper on contractual considerations when entering an employment situation.) I recently have been reading a collection of short stories and essays by Richard Selzer, MD, titled “Confessions of a Knife,” which delves deeply into the nature of physician-patient relationships. Although first published in 1979, these essays remain poignant and relevant 30 years later. Dr. Selzer draws upon his experiences as a surgeon in sharing with readers an emotional side of medicine. Whether he’s describing an exploratory laparotomy revealing tragic aortogastric fistula secondary to widely infiltrative pancreatic carcinoma or the inelegant excision of an ingrown toenail fragment, Dr. Selzer uses such stories to explore the many facets of the human mind and soul to uncover significance in some of the most lowly events. The following quote encapsulates his view of professionalism: I must confess that the priestliness of my profession has ever been impressed on me. In the beginning there are vows, taken with all solemnity. Then there is the endless harsh novitiate of training, much fatigue, much sacrifice. At last one emerges as celebrant, standing close to the truth lying curtained in the Ark of the body. Not surplice and cassock but mask and gown are your regalia. You hold no chalice, but a knife. There is no wine, no water. There are only the facts of blood and flesh. We may sometimes be hard pressed to perceive of our daily work as “priestly,” but Dr. Selzer’s reflections are reminders of patients’ and society’s lofty view of our role in their lives. With today’s growing population that is also growing sicker and with the emphasis on population health management, it is more important than ever that we maintain the sanctity of the physician-patient relationship. We must do our part to protect it with the full strength of our laws upholding it. Patients will be the ultimate beneficiaries of laws that support independent judgment for physicians in employment relationships. Physicians must be at liberty to have honest conversations with patients and to provide medically appropriate care. Ensuring that physicians are at the helm of healthcare teams will be key to fair and appropriate future utilization of healthcare services and expenditures. If we abdicate our leadership role to a higher concern for the bottom line, we will have failed in our most fundamental promise. Also during this legislative session, we must pay close attention to an area closely related to physicianpatient relationships — our civil justice system. Texas physicians have benefitted from the 2003 liability reforms, which provided protections on emergency services and limits on noneconomic damages. We must maintain these gains by opposing efforts that would weaken these reforms or disempower the Texas Medical Board. If we do not engage in careful surveillance, the recurring challenges could erode this safety net we enjoy and could have a profound downstream impact on patients’ access to physicians in Texas. I encourage all of you to pay attention during this legislative session to discussions regarding efforts that could harm the physician-patient relationship, such as efforts aimed to curtail physicians’ responsibility for recommending and applying appropriate, science-based treatments, or to curtail due process rights or prevent candid conversations with patients. I encourage you to go to Austin and do your part in First Tuesdays. Be part of the “White Coat Invasion” on March 5, April 2 and May 7. For registration information, contact Tracy Casto, DCMS director of public affairs and advocacy, at tracy@dallas-cms.org, or go to www.texmed.org/firsttuesdays.

visit us online at www.dallas-cms.org • March 2013 •

Board of Directors Steven Ray Hays, MD Executive Committee H. Gordon Green, MD, MPH, in honor of Richard W. Snyder II, MD H. Gordon Green, MD, MPH, in honor of Frederick James Bonte, MD Richard W. Snyder II, MD Directors Leigh E. Nguyen, MD Allen Robert Schneider, DO Terilyn R. Scott-Winful, MD Cynthia Sherry, MD James William Walton, DO

Jane Farrar Admire, MD Robert K. Bass, MD J. Michael Brennan, MD Alan L. Brodsky, MD James G. Brooks Jr., MD Allan Joel Chernov, MD Brian M. Cohen, MD Stephen Karl Donica, MD Fred Harry Dunn, MD William Burton Fears, MD Ivan Figueroa, MD Jaclyn Lee Ann Ganacias, MD Murray Gordon, MD Robert D. Gross, MD

Donors Wendy Schlessel Harpham, MD Shelton George Hopkins, MD Jeffrey Edward Janis, MD Erin Purtell Kane, MD Roger Sunil Khetan, MD Terry William Latson, MD Harriette Lutz Livingston, MD Maureen Theresa Luby, MD Jimmy Kien-Teh Lu, MD Paul Stanley Michaelson, MD Charles Dale Mitchell, MD Presley Martin Mock, MD Thomas Willingham Newsome, MD Lee Roy Radford, MD

Paul Raymond Cary, MD Elliot Joel Ginchansky, MD Thomas G. Johnson, MD Ronald Kapusta, MD Project Access Dallas Maureen Luby, MD Tich Ngoc Truong, MD

Benefactors Alexandra Dresel, MD Stephanie Hurn Elmore, MD Ross Leland Finkelman, MD Martin Giesecke, MD Robert W. Haley, MD Christian Royer, MD William R. Weaver, MD Steve Winn

Miscellaneous Donations Carey G. King, Jr., MD James Paul Knochel, MD Aneesa S. Majid, MD Luis Guillermo Michelsen, MD Ernest Poulos, MD

Murray C. Rice, MD Hampton B. Richards, MD George Walker Sandusky, MD Donald Wayne Seldin, MD John Stanley Smale, MD Troy R. Smith, Jr. MD Rattapol Srisinroongruang, MD Lisa Louise Swanson, MD Ann Marie Trowbridge, MD Tich Ngoc Truong, MD Maria Ann Turnage, MD Charles Wesley Waldrop Jr., MD Marshall Lee Wong, MD Pablo L. Xiques, MD Charles M. Preston, MD C. Victoria Rase Shinn, MD Bobby Louis Temple, MD Paul Arthur Tobolowsky, MD

DCMS Foundation General Fund Georgianna Leete in memory of Robert North, MD James Bertram Montgomery, MD, in memory of Elgin Willis Ware Jr., MD Ernest Poulos, MD, in memory of John T. Binion, MD Ernest Poulos, MD, in memory of Nancy Boehning Ernest Poulos, MD, in memory of Martine G. Tirmenstine, MD George W. Wharton, MD, in memory of Phillip E. Williams III, MD

• March 2013 • Dallas Medical Journal

F i r s t atTthe u Capitol esdays More than 230 TMA physicians, medical students and TMA Alliance members talked with their legislators during the first First Tuesday at the Capitol for the 83rd legislative session. The day started at 7:15 a.m. with TMA lobbyists outlining key issues and messaging. After meeting with their legislators and staffers, the physicians attended a news conference at the Capitol at which TMA and Border Health Caucus physicians asked state leaders to reverse funding cuts that harm access to care for thousands of Texasâ&#x20AC;&#x2122; dual-eligible patients.

Drs. Steven Hays and Sidney Gicheru

Drs. Les Secrest, Steven Hays, Angela Gardner, Deborah Fuller, Sue Bornstein, Kim Rice, Heather Owen; Freshman State Rep. Jason Villalba (R-Dallas); and Drs. John Gill, Dee Whittlesey, Robert Suter, Lee Ann Pearse, and Sarah Helfand

Drs. Les Secrest and Angela Gardner discuss strategy before a legislative meeting.

State Sen. Jane Nelson (R-Flower Mound) presents a resolution to physicians after recogonizing them from the Senate floor. â&#x20AC;˘

Accountant (CPA) / Tax Services

Legal Services

Paula Allgood, CPA……Beaird Harris & Co, P.C. 972.503.1040……PaulaA@bh-co.com

Michael H. Saks……Wright, Ginsberg, Brusilow, PC 972.788.1600……msaks@wgblawfirm.com

Lori A. Eads, CPA……Bland, Garvey, Eads, Medlock + Deppe, P.C. 972.231.2503……leads@taxsmart.com

W. Darrell Armer*……Looper, Reed & McGraw, PC 214.922.8923……darmer@lrmlaw.com *Board Certified-Health Law by The Texas Board of Legal Specialization

Design / Build Medical & Dental Contractor Grady Herzog……Structures & Interiors Inc. 817.329.4241……gherzog@structures-interiors.com

Electronic Medical Records Leslie Warren……EMR Advisory Group 972.898.5671……lwarren@emradvisorygroup.com

Employee Benefits Amy Rickman……Lockton Dunning Benefits 940.384.2720……ARickman@lockton.com

Financing / Banking Gary West……BB&T 469.791.4502……GMWest@BBandT.com

Marketing / Public Relations Barbara Steckler……Concepts in Medical Marketing 972.490.7636……barbarasteckler@yahoo.com

Medical Malpractice / Commercial Insurance James Patterson, CIC, AAI……Agapé Healthcare Partners Metro 817.329.4200……jim@agapeins.com

OSHA Compliance Jessica James 469.360.1367……jsscjames@aol.com

Personnel Recruitment

Financial / Estate / Insurance Planning

Jan Harris, CPC……J. Harris Co. Personnel Services Inc. 214.369.9545……j.harrisco@verizon.net

Mark A. Trewitt, CFP®, CLU, ChFC, AEP Integrated Financial Solutions Group 972.312.1337……mark@ifsgllc.com

Practice Management / Billing / Consulting David Loomis……The Health Group 972.792.5700……dloomis@thehealthgroup.org

Healthcare Furnishings

Promotional Products / Wearables / Filing Systems

Lisa Locke……bkm Total Office of Texas, LLC 214.902.7215……llocke@bkmtexas.com

Nance Lindstrom……Safeguard Business Systems & Promotional Products 972.596.8282……rich.nance@verizon.net

Healthcare Interior Designer Laura Ginsberg……Medical Space Design, Inc. 972.566.6771…….lauraginsberg@msddallas.com

Real Estate (Healthcare) M.W. (Hugh) Resnick……Pizel & Assoc. Commercial Real Estate 972.404.0008……hugh@pizel.com

Telecommunications Charlie Hubbard, PMP……HUBCO Communications, Inc. 469.293.3081……chubbard@gohubco.com

Power Up Your Practice. Contact the professionals behind the professionals.

w w w. d o c t o r s r e f e r ra l s e r v i c e . c o m

What’s on Your Mind?

Wr it e a R e s o lu t io n fo r t h e TM A Hou se of D elegates by Tracy Casto, director of public affairs and advocacy March 22 is the deadline to offer a resolution for the TMA House of Delegates to consider at its annual meeting in May in San Antonio. Contact Tracy Casto at tracy@dallas-cms.org to submit a resolution. A delegate or alternate delegate can propose an idea or a change to TMA policy; a nondelegate must submit the resolution through a delegate or alternate delegate. The DCMS delegation to TMA will meet May 1 to discuss resolutions submitted by DCMS members and physicians across the state. If the delegation agrees with a resolution, the delegate or alternate delegate will present it as a DCMS resolution during TexMed. The alternate may present and speak to the resolution at reference committee hearings but cannot speak on the floor of the house unless he or she is credentialed as a delegate. If the resolution sponsor is an alternate delegate and if the caucus decides not to take the resolution to TMA, the alternate delegate must persuade a voting member or a section to submit it. Although resolutions may deal with complex issues, most begin simply when a TMA member recognizes a problem and offers a solution. Resolutions express the background of the problem in “whereas” clauses, and specify a specific position or course of action in one or more “resolved” statement(s). Before you start writing, make sure your proposal offers a new or different idea. Resolutions calling for policy/action similar to what exists stand little chance for adoption. Review TMA’s Policy Compendium and AMA’s Policy Compendium, if AMA action is requested, to determine whether existing policy addresses the topic. The resolution should cite relevant TMA policy to facilitate independent review by delegates. If the resolution asks for AMA action, relevant AMA policy must be included. To search for relevant TMA policy, go to www.policy.texmed.org; to search for relevant AMA policy, go to www.ama-assn.org and type “policyfinder” in the search box. To ensure the best chances for adoption of a resolution, keep in mind the following recomendations: • Make sure the resolution title reflects the action for which the resolution calls. • Indicate whether you, as an individual voting member, or your county society is submitting the resolution. • Make sure the “Whereas” statements in the resolution clearly define the need for the action you are seeking in the “Resolved” statement. The quality of your “Whereas” clauses can determine whether a resolution passes. • Because the House adopts only the “Resolved” portion of a resolution, and only the “Resolved” statements become association policy statements or directives, each “Resolved” statement must be a definitive statement that can stand alone. Too many “Resolved” clauses can cause a resolution to be referred or defeated. • Include a fiscal note when appropriate; TMA staff can help you develop fiscal information. If a resolution requires funds that are not included in the current year’s budget, the TMA staff will add a fiscal note indicating the financial implications of the recommendations in the resolution.

Example of a resolution: Subject: Health Savings Accounts for Medicare Beneficiaries Introduced by: Dallas County Medical Society Referred to: (Speaker and vice speaker will refer to a reference committee) Whereas, Medicare beneficiaries have large deductibles and copayments; and Whereas, Medicare often does not pay for medical expenses for uncovered medications, durable medical equipment or services; and Whereas, Medicare funding likely will be reduced by trillions of dollars over the next two decades; and Whereas, Medicare beneficiaries face large and increasing medical expenses that Medicare will not pay; therefore be it RESOLVED, That the Texas Medical Association adopt as policy that Medicare beneficiaries be permitted to make tax-free contributions to health savings accounts; and be it further RESOLVED, That TMA urges Congress to change federal laws to permit Medicare beneficiaries to make tax-free contributions to health savings accounts; and be it further RESOLVED, That our Texas Delegation to the American Medical Association take this resolution to the AMA House of Delegates for consideration. Relevant TMA Policy: 120.001 Health Care Reform: The Texas Medical Association voted to weigh heavily in its evaluation of healthcare reform proposals the following concepts: • Establish tax credits for deposits to individual Health Savings Accounts from which individuals would use their own money to pay small medical expenses without penalty; • Allow private insurers to repackage Medicare benefits and establish diverse policies tailored to the different needs of Medicare beneficiaries; • Give the elderly and future elderly and their employers tax incentives to self-insure through Health Savings Accounts. Relevant AMA Policy: H-330.912 Appropriate Medical Coverage for Medicare Beneficiaries: Our AMA will continue to stress that regulations should move in the direction of free market choice of plans. (BOT Rep. 16, A-99; reaffirmed CMS Rep. 5, A-09)

visit us online at www.dallas-cms.org • March 2013 •

DCMS Members and their family are invited to attend the

DCMS Spring Celebration Picnic Saturday, April 20 11 a.m. — 2 p.m.

Th e Da l l as Ar b ore t um and Bo t anic a l Ga rde ns 8525 Garland Road, Dallas

L unch, do or pr i ze s f or t h e adul ts and ac t i v i t ie s f or t h e k ids! Pa r k i ng and admis s io n a re f re e . Enjoy t h e spr i ng f lo we rs w i t h yo u r c o l le ague s and f ami lie s .

RSV P

by Friday, April 12.

Fa x t h i s f o r m t o 2 1 4. 9 4 6. 5 8 0 5, o r c o n t a c t C a r a J a g g e r s a t 214. 413. 14 2 3, o r c a r a@ d a l l a s - c m s . o r g .

DCMS Member Immediate Family Members (Names and ages of children)

Phone

E-mail

C ompliments of the DCMS Circle of Friends. 48

• February 2013 • Dallas Medical Journal

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Dallas County Medical Society

CIRCLE OF FRIENDS

2013

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PLATINUM The Medical Protective Company Envision Imaging GOLD API ProAssurance Southwest Diagnostic Imaging Center Texas Institute for Surgery

PHILIPS GEMINI GXL PET/CT system

PET/CT imaging Setting new standards in patient care.

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Goldin, Peiser & Peiser Rebecca Harrell, Medical Office Specialist Shaw & Associates Systeem Medical Information Systems The Health Group

For information about Circle of Friends, contact Bearett Wolverton, Business Development Manager, at bearett@dallas-cms.org or call 214-413-1456.

www.swdcmi.com For more information or to refer a patient, call 214-345-8300 8440 Walnut Hill Lane, Suite 100 Dallas, Texas 75231-4472 Southwest Diagnostic Imaging Center is the general partner of Southwest Diagnostic Center for Molecular Imaging.

v i s i t u s o n l i n e a t w w w . d a l l a s - c m s . o r g • M a r c h 2 0 1 3 • • 4499

PRACTICE MANAGEMENT

Isn't it about time you focused more on medicine, and less on administrative hassles?

o you enjoy reading managed care contracts? How about completing multiple applications? Do you know if you are being reimbursed correctly? Could a physician-operated IPA be the answer?

What do you get out of SPA Membership? Contracting: SPA reviews hundreds of pages of legal terms with the cooperation of the health plan and presents you with an objective summary of the terms in a format which is standardized. Then, "SPA Compare" allows you to analyze the fees offered compared to local Medicare and to other commercial plans in a way that is customized to your practice. Operations: The contract summary and SPA Compare may easily be used by your collections operation to be sure that you are being paid properly under the SPA Contract. SPA maintains relationships with its contracted health plans which help you receive what you are entitled to under the SPA Contract.

FACT: Physicians earn more money per hour in the clinic and the O.R. — practicing the skill of medicine — than they can playing accountant, coder or office manager. Delegation is the key of every successful business enterprise.

Credentialing: All SPA Contracts include delegated credentialing and recredentialing. This allows you to contract with many plans by completing only one application and allows you to keep your credentials updated with many payors through only one entity. Ancillary Services: SPA has group purchasing rates for medical supplies, medical waste disposal and other services for SPA members. This helps you to keep your overhead

costs low. Value: All of these benefits come from a physician-run IPA for less than $80 per month. Want to find out more? Call us at 214-346-6623, or visit us at www.spa-dallas.com. We can help you get back to the practice of medicine in 2013.

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Find out more about how we can help your practice at www.spa-dallas.com or call 214.346.6623 8150 N. Central Expressway • Suite 1250 • Dallas, TX 75206 •

THE NEW SCARCITY

By Jim Walton, DO, MBA, Medical Director of Project Access Dallas The new, third kind of scarcity is the emotional labor of art. The risk involved in digging deep to connect and surprise, the patience required to build trust, the guts necessary to say, ‘I made this’— these are all scarce and valuable. And they scale.

Seth Godin, “The Icarus Deception”

Saying goodbye is difficult. We all learn to do it — some more gracefully than others. This month we are saying goodbye to Project Access Dallas. Many of the staff members have moved on, and our clinic partners are finding new ways to connect sick patients to care. Along with our disappointment and sadness, we have discovered renewed interest in the question of DCMS’ leadership in this important area of Dallas’ healthcare environment. I have been reading a book by Seth Godin (“The Icarus Deception”), given to me by a 20-something entrepreneur who is working to encourage communities to recycle their scrap metal. In Godin’s writing I have found a fresh and challenging argument for this new economy in which we find ourselves … “the connection economy.” Godin says, “The connection economy functions on a steady diet of new, real and important. The connection economy builds a new asset, one that we can measure and value now for the first time. Suddenly, it’s not the building or the rules or the packaging that matters; it’s the bridges between people that generate value, and those bridges are built by art.” Applying Godin’s words to our “new normal” without Project Access Dallas, many of us might admit that the sadness we feel in the loss of Project Access Dallas

is the perceived loss of connection. Through PAD we connected people who had needs to individuals and organizations that could help address those needs. With the end of PAD, we have the opportunity to step back and think of the program’s value and the next steps forward. As a result of this time of reflection, DCMS leadership is proposing a Blue Ribbon Task Force for the Indigent, calling for the creation of a transformative blueprint to address the shortcomings of the current model of health care for the indigent/underserved in Dallas County. The task force will ask stakeholders (leaders from government, business, physician community, municipalities, and hospitals), led by DCMS President Cynthia Sherry, MD, to evaluate the shortcomings of the proposed plans for transforming health care through the Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver. Godin reminds us that we may have forgotten a key lesson in the mythological story of Daedalus and Icarus. Daedalus, the father, warned his son, Icarus, not to fly too high (close to the sun, where the heat would melt the wax on his wings) and not to fly too low (close to the sea, where the water would ruin the lift in his wings). Some of us could interpret the demise of PAD as a consequence of flying too high, reinforcing one side of the myth where we are reminded of the dangers of standing up and attempting to make a difference. But what if settling for too little is more dangerous? What if settling for something lower and less significant in the future poses a greater problem? In the face of this idea, I propose we apply Godin’s ideas: “It’s far more dangerous to fly too low than too high, because it feels safe to fly low. We settle for low expectations and small dreams, and guarantee ourselves less than we are capable of. By flying too low, we shortchange not only ourselves but also those who depend on us or might benefit from our work.” Join me in supporting the Blue Ribbon Task Force for the Indigent of Dallas County. As you go about your daily work of seeing patients, talk to those who have influence in business, government and healthcare delivery about this issue, and ask them to participate with us in this vital work. And let it never be said that we flew too low.

visit us online at www.dallas-cms.org • March 2013 •

Legislative Update by Tracy Casto, director of public affairs and advocacy

With March 8 as the bill filing deadline for this legislative session, constituents and legislators alike are shopping bills for sponsors and supporters. TMA is working with Medicine’s allies in the Capitol to back bills including those regarding Medicaid funding, public health issues and medical education.

TMA’s AGENDA

Expand Coverage, Reform Medicaid TMA is calling on the Legislature and Congress to jointly devise a benefits plan that fits the needs of childless adults, with copays and deductibles that put some responsibility on the patient. To bring Texas physicians back to Medicaid, lawmakers also must improve payment rates, cut administrative bureaucracy, and rein in overzealous fraud investigators. With only 31 percent of Texas physicians accepting Medicaid patients, health care will be tough to find. The Medicaid budget passed the Legislature that passed last session is about $4.5 billion short because, to help balance the state budget, legislators did not fund the last 4 months of Medicaid for the current biennium. So, $4.5 billion must come off the top of the next biennium budget to fully fund the Medicaid can lawmakers kicked down the road last session. Some legislators may contend that they’ve boosted Medicaid dollars because of these funds spent to make last session’s budget “whole.” With Gov. Perry’s refusal of federal funding for expanded Medicaid services, the state is giving up $80 billion to $90 billion over the next 5 years. TMA leaders have met with the governor and continue to talk with legislators about providing coverage for this patient population. Dallas County Commissioners Court is urging the state to extend Medicaid benefits to impoverished adults under the Affordable Care Act, and Medicaid expansion advocates hope other urban counties will follow suit. Despite the firm opposition of the state’s Republican leadership and concerns that the existing Medicaid provider network could not support the new patients — an additional 1.5 million Texans (133,000 in Dallas County) — the number of Medicaid expansion advocates who believe the state shouldn’t turn down federal funding is growing. The Texas Hospital Association and the Texas Catholic Conference are among the groups pushing for expansion. “People from the business, faith and healthcare communities are coming together to ask that we find a way to draw down these federal dollars, and I think it’s imperative that we do,” Dallas County Judge Clay Jenkins told The Texas Tribune. “If we don’t take it, our federal tax dollars will pay to cover this population everywhere else in the country, and our local tax dollars will pay to cover it here. That puts us at a healthcare disadvantage because we have the nation’s highest uninsured rate already, and it puts us at a competitive disadvantage because we’re paying federal taxes to cover everybody else, but we’re not getting our fair share.” If Texas expanded Medicaid coverage to impoverished adults in 2014, the state could receive an additional $100 billion in federal dollars over 10 years, helping to offset spending by local governments. Medicaid expansion could help pay for care for individuals whose care otherwise ultimately would be paid for by taxpayers and private market health insurance payers. The state would pay $15 billion during that time, which opponents of the expansion, including state Republican leaders, argue is too much. A governor’s spokesman said Perry is unlikely to change his mind. He has said that the current Medicaid system is unsustainable for the state and would be for counties, as well. For the governor to consider the federal funding, he has said that counties should have to pay the entire cost of the program, without state tax dollars.

• march 2013 • Dallas Medical Journal

Reverse the dual-eligible cuts Texas Medicaid slashed program funds at the direction of the 2011 Legislature, creating a medical emergency for hundreds of thousands of dual-eligible patients and their physicians. In January 2012, Texas Medicaid stopped paying the patients’ $140 Medicare deductible and the coinsurance. The coinsurance had been an 80/20 split, with Medicare paying 80 percent of the patient’s physician bill and in most cases, Medicaid paying 20 percent. The Texas Health and Human Services Commission has restored coverage of the Medicare deductible for dual-eligible patients, but the 20-percent coinsurance cut remains. Ensure an adequate healthcare workforce Texas needs continued and stable state support for physician education and training to cultivate Texas physicians, ensuring access to health care for all Texans. Legislators have voiced support for increased funding for graduate medical education and for the Physician Education Loan Repayment Program. TMA also wants legislators to: • Support new graduate medical education programs in the specialties that best reflect the state’s healthcare needs. • Create 10 percent more residency slots. • Sponsor research to identify and promote innovations in training primary care residents for practice in Texas. Protect the patient-physician relationship Patients must trust that their physician is not motivated or distracted by competing interests. TMA supports strong statutory provisions that protect independent medical judgment for physicians and prohibit retaliation for patient advocacy in all employment relationships. This includes opposing legislation that prevents physicians from speaking honestly and candidly with their patients or from providing medically appropriate care. TMA wants to strengthen state laws to strengthen statutory provisions to protect physicians’ due process rights. Provide appropriate state funding for physician services State leaders must realize that cutting physicians’ payments is not an effective way to control healthcare costs and often increases the cost of care. To this end, TMA is working to ensure that all Texans have access to preventive, routine and emergent care, which is possible only if Medicaid and Children’s Health Insurance Program payments for physicians are competitive. TMA hopes to gain increased funding for cost-effective, community-based mental healthcare and substance abuse treatment. Les Secrest, MD, a Dallas psychiatrist and chair of TMA’s Council on Legislation, in February testified before the Senate Finance Committee in support of increased mental health funding. His testimony put a face on Texans with mental health disorders, the Texans who care for them, and the state’s delivery system. “No one signs up for these disorders,” he said. “We work in a system that needs more care managers and more hospital resources. Lack of these resources causes all parts of the medical delivery system to become inefficient.” Senator Jane Nelson (R-Flower Mound), chair of the Senate Health and Human Services Committeee, says that mental health is a high priority for the budget workgroup she chairs. She wants to put new monies into mental health, and is requesting new ideas and solutions to maximize those funds.

Invest in prevention Evidence-based wellness and public health programs must be implemented that complement physician efforts to keep women and babies healthy, and reduce obesity, tobacco use, chronic disease, and cancer. To this end, TMA supports fully funding the Texas Women’s Health Program, increasing physical activity and health education requirements in schools, and streamlining efforts to vaccinate people who work with high-risk populations, such as employees in childcare facilities. TMA is working with the American Heart Association, Texas Restaurant Association, March of Dimes, and American Cancer Society on legislation that would require public workplaces, venues and restaurants to have an indoor smoke-free policy. Rep. Myra Crownover (R-Denton), a longtime champion for a statewide smoking ban in workplaces, plans to file a statewide non-smoking bill this session. .

THE SESSION BY THE NUMBERS

Stop the Presses! Agreed-to SB 406 expands relationship between physicians and nurses For years, scope of practice legislation has been a contentious issue between advocates for physicians and nurses. During months of discussions in 2012 and 2013, the TMA and the Texas Academy of Family Physicians held firm against the advance practice registered nurses’ and physician assistants’ call for independent practice and prescribing authority. Senator Nelson filed SB 406, which seeks to improve access to health care — without compromising patient safety — by making it easier for physicians, advanced practice registered nurses, and physician assistants to work together to deliver services. The legislation firmly establishes a “physicianled medical team” and expands prescriptive authority for advanced practice nurses and physician assistants. The bill recognizes that independent diagnosing and prescribing are the practice of medicine. It establishes a model in which a physician has both the authority and responsibility to supervise, allowing members of the healthcare team to practice to their level of education and training, according to TMA President Michael E. Speer, MD. Ultimately, the physician is held accountable for healthcare services provided to patients. Among the provisions of the bill: • The number of advanced practice nurses a physician can supervise increases from four to seven. • Physicians can delegate authority to APNs to prescribe Schedule II controlled substances in hospitals and hospice settings. (Nurses want to include community mental health settings.) • Physicians must conduct and document quality assurance meetings, which will replace site-based proxies for quality assurance (time-on-site variations, mileage limitations, mandated numbers of chart review). Physicians initially must meet with their APRNs/PAs at least monthly. SB 303 updates Texas Advanced Directives Act Sen. Robert Deuell, MD (R-Greenville), filed SB 303, which amends the 1997 Texas Advanced Directives Act. The Act provided a framework for resolving disagreements when care providers consider treatment medically futile but patients or their families do not want to give up hope. The rarely used Act has been considered the best in the nation and a model for other states. It allows patients to make their care preferences known before they need care and to protect them from discomfort, pain and suffering as a result of excessive medical intervention in the dying process. The bill protects physicians against forcing them to violate their religious beliefs, moral conscience and professional ethics. SB 303 has come under attack from right-to-life and disability groups, and is the subject of much misinformation. Senator Deuell worked with TMA, Texas Hospital Association, Texas Alliance for Life, Baptist Life Commission, and the Texas Catholic Conference in coming up with the bill.

HB 620 addresses ‘Silent PPOs’ Lack of regulatory oversight in the preferred provider organization industry has resulted in the proliferation of “rental network PPOs” or “lease network PPOs” that buy, sell and lease physician agreements and contract rates to payers. When the physician discount is shared without the physician’s authorization or consent, the arrangement is referred to as a “silent PPO.” HB 620 sheds light on this activity and regulates entities that engage in this practice. The bill regulates certain healthcare provider network contract arrangements, and establishes fair and transparent insurance markets for patients, employers and physicians. SB 186 seeks to protect against West Nile Virus SB 186 by Sen. John Carona (R-Dallas) will help public health officials prevent West Nile Virus by allowing officials to inspect, investigate and spray properties that are abandoned or uninhabited. This action would reduce the need for much more costly aerial spraying if WNV reappears this summer. The bill was proposed by the Dallas County Health and Human Services Department and unanimously approved by the Dallas County Commissioners Court. Dallas County was the epicenter of the country for West Nile Virus in Summer 2012 when it experienced 398 human cases, with 19 resulting in death. HB 1032 reduces red tape and regulations Senator John Zerwas, MD (R-Simonton), filed HB 1032 in an effort to cut through red tape, regulations and other unproductive elements that do not improve quality and interfere with physicians’ ability to practice medicine efficiently and effectively. The bill creates the use of standardized authorization request forms for medical services and prescription drugs that would simplify the administrative process for patients and injured workers. HB 1310 benefits primary care physicians State Rep. Angie Chen Button (R-Dallas) filed TMA’s vaccine tax-exemption bill that allows a physician practice to exclude from its total revenue the actual cost paid for a vaccine. The exemption would cost the state about $1.5 million to $2 million and could save the average pediatrics group practice $3,000 to $4,000 annually on its franchise tax. SB 8 addresses waste, fraud and abuse in Medicaid Senator Nelson filed this bill, which includes provision of a data analysis division that can track anomalies in utilization of service and claims. TMA has offered clarifications on the bill regarding what is considered an “anomaly” and how “waste” is defined. SB 253 deals with newborn screenings The main issue of this bill, filed by Senator Deuell, has to do with pulse oximetry related to congenital heart defects. TMA will support versions that do not cite a specific test but instead say that newborns should be screened for critical heart defects. This prevents issues that could arise if the standard of care changes in the next 2 years. TMA is working with pediatricians and cardiologists who disagree on the bill, plus the March of Dimes and American Heart Association. And what’s a session without a few scope bills? At the request of physical therapists, Rep. Craig Eiland (D-Galveston) filed HB 1039, which gives PTs direct access to patients, without working from a physician’s referral or diagnosis. SB 312 allows audiologists to use laryngoscopes, which ENTs use and bill under a surgical code. The bill extends to audiologists the ability to diagnose and provide vestibular therapy for balance issues. For complete bill texts and to follow bills throughout the session, go to Texas Legislature Online at www.capitol.state.tx.us.

visit us online at www.dallas-cms.org • March 2013 •

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9:46 AM

2012 TOP PROVIDERS

PAD recognizes these volunteers for their commitment and support in 2012. These top PAD providers for 2012 were determined by the number of patients seen and number of appointments. We thank them for joining us in caring for our community.

Tom Ballard, OD

Duane A. Barnett, MD

Deno B. Barroga, MD

C. Bradley Bowman, MD

Charles R. Chung, MD

Chrisette M. Dharma, MD

Dan B. French, MD

J. Kent Hamilton, MD

Charles Harris, MD

Michael S. Harris, MD

Sapna V. Jaiswal, MD

Kurt J. Kitziger, MD

Jonathan D. Leffert, MD

David Lief, DPM

David A. Minna, MD

Dennis E. Newton, MD

Wendy C. Parnell, MD

Brent A. Patterson, MD

Richard M. Roberts, MD

Frank C. Morrone, MD

NOT PICTURED: Elizabeth T. Dolan, MD; Rebecca Ponder, OD; Stuart R. Stone, MD

Howard Weiner, MD

Heather Winslow, MD

visit us online at www.dallas-cms.org â&#x20AC;˘ March 2013 â&#x20AC;˘

PAD FAQ project access dallas

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FREQUENTLY ASKED QUESTIONS

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Although Project Access Dallas will cease operations on March 31, DMCS is committed to finding healthcare solutions for the uninsured and underserved patients of Dallas County. Many questions have arisen regarding care of PAD patients after the program’s conclusion. Following are answers to some common questions.

What options are available for physicians who are seeing PAD patients? Physicians can provide care with PAD’s resource support until March 31, 2013. We have contacted all primary and specialty care physicians who have seen a PAD patient in the last 12 months to see if they can continue care past that date.

What is being done to ensure that patients will receive adequate care after Project Access Dallas closes? If a primary care physician is unable to continue care after March 31, we are attempting to find a new medical home for the patient. If a specialty care physician is unable to continue care, we notify that patient’s medical home so another specialty care volunteer can be arranged to treat that patient. Since Jan. 31, PAD no longer accepts specialty physician care referrals. As of mid-February, the PAD staff had assisted most patients in obtaining specialty physician care referrals. However, 129 specialty physician care referrals are pending. To address these remaining referrals, PAD is accessing physician volunteers and resources, particularly from the University of Texas Southwestern Medical Center and Parkland Hospital, plus specialty clinic nights provided by charitable clinics. Additionally, we are attempting to locate support for PAD patients who need costly medications. PAD staff members and Community Health Navigators are submitting applications for a pharmacy assistance program for those patients. The CHN team is confirming that all 114 patients who are receiving full-time navigation have a medical home and have scheduled a medication consultation with their physician. CHN continues to receive episodic referrals for transportation, translation and medication copay assistance. How are the charitable clinics affected by the discontinuation of Project Access Dallas? All our charitable clinic partners have agreed to continue serving as the medical home for the PAD patients assigned to their clinic — that’s 2,288 patients! Almost all of those clinics have agreed to accept more PAD patients who have lost their medical homes as a result of the closing of the program. Will DCMS continue caring for the working poor of Dallas County? DCMS is working with several other entities to develop a plan for improving healthcare delivery for the uninsured and underserved working poor of Dallas County. We anticipate that a multistakeholder task force will be convened in the coming months to develop a plan. visit us online at www.dallas-cms.org • March 2013 •

Project Access Dallas thanks our medical volunteers for giving their time and their talent to serve the needs of the working poor in Dallas County. Dennis Abbas, MD Mina Abbassi-Ghanavati, MD Robert Abbate, DO Abier Abdelnaby, MD Ramzi Abdulrahman, MD Shawn Abel, MD Henia Abid, DO Osama Aboul Fettouh, MD Reeni Abraham, MD Muhanned Abu-Hijleh, MD Jose Aceves, MD Ashish Acharya, MD Gary Ackerman, MD Heather Adair, MD Jeffry Adcock, MD Tayo Addo, MD Adebola Adesanya, MD Soumya Adhikari, MD Carl Adkins, MD Nidhi Agarwal, MD Raymon Aggarwal, MD Nalini Aggarwal, MD Mark Agostini, MD Deepak Agrawal, MD Marco Aguirre, MD Vincent Aguirre, MD Vivian Agumadu, PA Zahid Ahmad, MD Tasneem Ahmed, DO Mahmood Akhavi, MD Mahmood Alasmi, MD Ford Albritton IV, MD Preston Alexander, MD Drew Alexander, MD James Alexander, MD Sadia Ali, MD Deeba Ali, MD Farida Ali, MD Malik Ali, DO Amina Allaudin, MD Marcus Allen, MD Kimulique Allen, MD Henry Allen, MD Audrey Allen, PA Michael Allison, MD Carol Alonso, MD Saleh Alqahtani, MD Michael Alvares, MD Naiara Alvarez, MD Rebeca Alvarez, MD Wassila Amari, MD James Amatruda, MD Bardia Amirlak, MD Rajiv Anand, MD Robert Andersen, MD John Andersen, MD Paul Anderson, MD Amy Anderson, MD Robert Anderson, MD Carol Anderson, MD Larry Anderson, MD Matthew Anderson, MD Ron Anderson, MD Richard Anderson, MD J. Valerie Andrews, MD Thomas Andrews, MD Oscar Andujo, MD Mohammad Ansari, MD Thomas Anthony, MD Kimberly Aparicio, MD Madeline Aponte Lopez, MD Kristine Appel, MD Victor Aquino, MD Farshid Araghizadeh, MD Rebecca Arant, MD

Carlos Arauz-Pacheco, MD Arnaldo Arbini, MD Ryan Archie, MD Thuy-Dung Ardaman Juan Arenas, MD Keith Argenbright, MD Frank Arko III, MD Susan Arnold, MD Brett Arnoldo, MD Gaurav Arora, MD Yull Arriaga, MD Sami Arslanlar, MD Akilan Arumugham, MD Vijayasree Arvind, MD Steven Arze, MD Thaddeus Ashmore, MD Carolyn Ashworth, MD Massimo Asolati, MD Manish Assar, MD Alireza Atef-Zafarmand, MD James Atkins, MD Frederick Atkinson Jr., MD Eric Aubel, MD David Auerbach, MD Sherrill Auman Jr., MD Raphael Aybar, MD Stephanie Aymond, MD Bilal Aziz, MD Namrata Babaria, MD Robert Bachoo, MD Susan Bacsik, DO Mohamed Badawy, MD John Bagwell, MD Donna Bailey, MD Ralph Baine, MD Christopher Baird, MD Douglas Baker, MD Karen Baker, MD Jonathan Baker, MD Linda Baker, MD Jyoti Balani, MD Glen Balch, MD Sunil Balgobin, MD David Balis, MD Tom Ballard, OD Carmen Ballestas, MD Rahul Banerjee, MD Subhash Banerjee, MD Pooja Banerjee, MD Jennifer Bang, MD Matthew Banks, MD Bharati Bansal, MD Catherine Barden, MD Ainslie Barnard, PA Aliessa Barnes, MD Duane Barnett, MD Samuel Barnett, MD Patrick Barr, MD Richard Barrera, MD Deno Barroga, MD Brad Barth, MD Theresa Barton, MD Renuka Basavaraju, MD Robert Bash Jr., MD Paul Bassel, MD Katrina Bassel, MD Angela Bates, MD Sukhpreet (Pete) Batra, MD Richard Batz Jr., MD Michel Baum, MD Barbara Baxter, MD Swathi Bayya, MD Laura Beard, MD Robert Beard, MD Cynthia Beauchamp, MD

• March 2013 • Dallas Medical Journal

Anthony Beaverson, MD Philip Becker, MD Grant Beckham, MD Marian Bednar, MD Sara Beers, MD Joseph Behan, MD Leonard Behr, MD Peter Beitsch, MD Melody Bellinghausen, DO Nicholaos Bellos, MD Elie Benaim, MD Rui Benevides II, MD Fernando Benitez, MD Nicole Benjamin, PA Jerry Bennett, MD Arthur Benzick, MD Rafic Berbarie, MD Patricia Bergen, MD Paul Bergstresser, MD Alan Berk, MD Martin Berk, MD Christopher Berry, MD Jarett Berry, MD Joseph Beshay, MD Victor Beshay, MD Eric Beshires, MD Sara Best, MD Brian Bethea, MD Christopher Bettacchi, MD Chester Beyer Jr., MD Kamal Bharucha, MD Seema Bhat, MD Shubha Bhat, MD Amol Bhatki, MD Kavita Bhavan, MD Ravi Bhoja, MD Michael Biavati, MD Ashkan Bidgoli, DO Shaad Bidiwala, MD Samuel Bierner, MD Amby Bindra, MD John Birch, MD J. Bird, MD Kristen Bishop, MD Michael Black, MD Christopher Black, MD Katherine Blakeley, MD Catherine Blakeney, MD Shannon Blalock, MD April Bleich, MD Sheldon Blend, MD Christopher Blewett, MD Bruce Blome, MD Preston Blomquist, MD Steven Bloom, MD Richard Bluestein, MD Sarah Blumenschein, MD Tiffany Bogan, MD Michael Bolesta, MD Erin Bolivar, MD David Boltan, MD Lindsay Boltan, MD David Bond, MD Frederick Bonte, MD David Bookout, MD William Boone Jr., DO Timothy Booth, MD Sita Boppana, MD Muriel Boreham, MD Todd Boren, MD Joseph Borrelli Jr., MD W. Bourland Jr., MD Christina Bourland, MD Cindy Bowens, MD Bruce Bowers, MD

Daniel Bowers, MD R. Bowman, MD C. Bowman, MD Katherine Boyd, DO Jessamy Boyd, MD Katrina Bradford, MD Karen Bradshaw, MD John Brady, MD Wesley Brady, MD David Bragg, MD Dan Brajtbord, MD Anne Brancaccio, MD Timothy Brannon, MD Steven Bray, MD Amy Brenski, MD Peter Bressler, MD John Bret, MD Cecelia Brewington, MD M. Brickner, MD Emmanouil Brilakis, MD Luc Brion, MD Ronald Bristow, MD Craig Brockman, MD Jenifer Broderick-Thomas, MD A. Compton Broders III, MD Alan Brodsky, MD Greta Brodsky, MD John Brooks, MD Donald Brotherman, MD Marc Brown, MD Kathryn Brown, MD Kendall Brown, MD Herschel Brown, MD Randal Brown, MD Jeffrey Browning, MD Travis Browning, MD Rebecca Broyles, MD Robert Bruce, MD William Bruck, MD Anton Brucks, MD Brian Bruel, MD James Brugarolas, MD Morris Bryant, MD David Bryant, DO Richard Buch, MD George Buchanan, MD Robert Bucholz, MD Nitin Budhwar, MD Scott Bundy, MD Liza Bunting, MD Stephen Burgher Sr., MD Wayne Burkhead Jr., MD Sudeep Burman, MD James Burner, MD Karen Burnett, MD A. Jay Burns, MD Dennis Burns, MD Debra Burns, MD Erza Burstein, MD Erik Burton, MD Matthew Bush, MD Nicol Bush, MD Jason Busigo, MD Lawrence Butcher, MD Stephanie Byerly, MD Jeffrey Cadeddu, MD Nina Cahan, MD William Caire, MD Ron Calhoun, MD Craig Callewart, MD William Calley, MD Lauri Campagna, MD Rafael Canadas-Zizzias, MD Daniel Canchola, MD Stephen Cannon, MD

Carolyn Cannon-Mccullough, MD Myrna Carag-West, MD Ted Carelock, MD Michael Carley, MD Mary Carlile, MD Mary Carlin, MD Kendall Carll, MD Angela Carollo, MD Troy Caron, DO Bruce Carr, MD Kelley Carrick, MD J Carroll, MD Gregory Carter, MD Michela Caruso, MD Paul Cary, MD Mark Casanova, MD Kristen Casenave, MD Brian Casey, MD Lisa Casey, MD Catherine Casteel, DPM Harvey Castro, MD Travis Caudill, MD William Caudill, MD Mary Ellen Cavalier, MD H. Cavanagh, MD, PHD Dominick Cavuoti, DO Evangeline Cayton, MD Elizabeth Chacko, DO Mandeep Chadha, MD Ripa Chakravorty, MD Lina Chalak, MD Julie Champine, MD Danny Chan, MD Teresa Chan, MD Becky Chandler, MD Preston Chandler, MD Deborah Chan-Fung, MD Charles Chang, MD Shelly-Ann Chang, MD Alice Chang, MD Nandini Channabasappa, MD James Chapman, MD Huntly Chapman, MD Nalinda Charnsangavej, MD Jayshri Chasmawala, DO David Chason, MD Shailendra Chavda, MD Don Cheatum, MD Jorge Cheirif, MD Lakshmi Chekuri, MD Richard Chen, MD Clifford Chen, MD Edward Chen, MD Kenneth Chen, MD Weina Chen, MD Jonathan Cheng, MD Matthew Cherno, MD Edson Cheung, MD Samir Chhaya, MD Cynthia Chi, MD Hsi Chiao, MD Kelly Chin, MD Shilpa Chitnis, MD Kwok Chiu, MD Hsienchang Chiu, MD Duke Choi, MD Henry Choi, MD Benjamin Chong, MD Tae Chong, MD Deborah Chong, MD Ramsey Choucair, MD Sultan Chowdhary, MD Hak Choy, MD Margaret Christensen, MD Wendy Chuang, MD Christopher Chumley, MD Andrew Chung, MD Charles Chung, MD Wendy Chung, MD Paul Chung, MD Joel Ciarochi, MD Chris Clark, MD Gregory Clark, MD James Clark III, MD Leslie Cler, MD R. Click Jr., MD Jenny Clifford, MD Marcie Coben, MD Clay Cockerell, MD Amy Coffey, MD Stewart Coffman, MD Steven Cohen, MD Jack Cohen, DO Evan Cohn, MD Richard Coker, MD Bridgette Coker, MD Jayne Coleman, MD Laura Collins, MD Robert Collins Jr., MD Leesa Condry, MD Nicole Conselman, MD Jill Conway, PA

Charles Cook, MD H. Cook, MD Daniel Cooper, MD Sandy Cope-Yokoyama, MD Lawson Copley, MD Marco Coppola, DO Scott Corcoran, MD Cindy Corpier, MD Marlene Corton, MD Melissa Costner, MD Carl Couch, MD Ardith Courtney, DO John Cox, DO Matthew Cox, MD Rody Cox, MD James Cox, MD Katherine Coyner, MD Quanita Crable, MD Margaret Craig, MD Laura Craigmiles, DO Randall Crim, MD Carol Croft, MD Michael Cronholm, MD Uel Crosby, MD Samuel Crowley, MD Ponciano Cruz Jr., MD Norma Cump, MD Trang Cung, DO Anna Curry, MD George Curry, MD Thomas Curry III, MD Amy Curtis, MD John Cush, MD Jennifer Cuthbert, MD R. Garret Cynar, MD Hemant Dand, MD James Daniels, MD Carl Danzig, MD Tuoc Dao, MD David Darrigan, DO Robert Darrow, MD Shounak Das, MD Sandeep Das, MD Tony Das, MD Neeraja Dasari, MD Jodi Dashe, MD Pramesh Dave, MD Owen Davenport, MD Ingemar Davidson, MD Laura Davidson, MD Quanetta Davis, PA Dan Davis, MD Jeffrey Davis, MD Sarah Davis, MD Michael Day, MD Armando De Fex, MD M. Teresa De La Morena, MD James De Lemos, MD Jean De Leon, MD Guillermo De Leon, MD Oscar De Leon, MD Brendan De Marco, MD Luciana De Oliveira, MD Ralph Deberardinis, MD Meelie Debroy, MD Jacqueline Decker Karpel, PA Roberto Dela Cruz Jr., MD James Delaney PA Suzanne Dellaria, MD Larua DeMoya, MD William Denam, DO Jennifer Denning, MD Jeremy Denning, MD Ira Denton, MD Sanjeevani Deolapure, MD Howard Derrick III, MD Dev Desai, MD Seemal Desai, MD Allan Devilleneuve, MD Richard Dewey Jr., MD Archana Dhar, MD Shashi Dharma, MD Chrisette Dharma, MD Norman Diamond, MD Sharmila Dias, MD Thomas Diaz, MD Bryan Dickson, MD John Dietschy, MD Roderick Diggs Jr., MD Thomas Diliberti, MD Jeanne Dillenbeck, MD John Dimaio, MD Vasiliki Dimas, MD Robert Dimeff, MD Quynh Chi Dinh, MD James Dirting, MD William Dittman, MD Huy Do, MD Alison Dobbie, MD William Dockery III, MD Elizabeth Dolan, MD Bart Dolmatch, MD

Stephen Donica, MD Joan Donley, MD Kevin Doody, MD Amanda Doughty, FNP Linda Douning Olivo, MD Jonathan Dowell, MD Michael Dowling, MD, PHD J. Downs, MD Jessie Deam Doyal, MD Mark Drazner, MD Molly Droge, MD Rosemary Dubiel, DO Philip Duchamp, MD Suzanne Dugopolski, MD Robert Duhaney, MD Tara Dullye, MD Barbara Durso, MD Peter Dysert II, MD John Early, MD Alexander Eastman, MD Valentine Ebuh, MD Scott Eckert, MD John Edlin, MD Alaina Edmunds, MD Jennifer Edwards, MD Stephen Edwards, PA Abram Eisenstein, MD Waleed El-Feky, MD Paul Ellenbogen, MD Teresa Elliott, MD Jeffrey Elliott, MD Paul Ellis III, MD Malathi Ellis, MD James Ellis, DO Bruce Elliston, MD Alison Elmquist, MD Ahmad Elsharydah, MD Jacqueline Emmons, MD Ronya Emory, MD Graham Emslie, MD Natalie Engelman, PA-C William Engle, MD Becky Ennis, MD Kathleen Erdman, MD William Erdman, MD Julian Escobar, MD Roberto Estrada, MD Aaron Estrera, MD David Euhus, MD Rebecca Euwer, MD Carolyn Evans, MD W. P. (Phil) Evans III, MD Walter Evans II, MD Rachael Evans, DO Patricia Evans, MD Rebecca Evans, MD Laurie Even, AUD David Ewalt, MD Gene Ewing, MD Philip Ewing, MD Maynard Ewton Jr., MD Dennis Factor, MD Warren Fagadau, MD Karana Fairley, MD Yijun Fan, MD Xinqing Fan, MD Yisheng Fang, MD Rochelle Farley, DO Wayne Farley Jr., DO Derek Farley, DO Ramin Farzaneh-Far, MD Susan Favour, MD Michael Fawcett, MD Yomi Fayiga, MD Brian Feagins, MD Trudy Fedorko, DO M. Nicholas Feliciano, MD Kim-Ngan Fellman, MD Mary Beth Felty, MD Sing-Yi Feng, MD Andrew Feranchak, MD Caroline Ferris, MD Joshua Fine, MD Robert Fine, MD Ross Finkelman, MD Maureen Finnegan, MD Jason Fisch, MD Anne Fischer, MD Gary Fish, MD John Fitz, MD John Fitzgerald, MD David Fixler, MD Ari Fleishman, MD Sean Fleming, MD Glenn Flores, MD Robert Foglia, MD Ted Fogwell, MD Yolando Fong, MD Michael Fontes, MD Caryn Michelle Forbes, MD Joseph Forbess, MD Lisa Forbess, MD

Danielle Ford, MD Kenneth Ford III, MD Steve Fordan, MD E. Forsyth Jr., MD Jeri Foshee, MD Steven Foster, MD Maurilia Foster, NP Daniel Foster, MD William Foster, MD Michelle Fowers, MD Raymond Fowler, MD David Francis, MD Jonathan Franklin, MD Danika Franks, MD Dan French, MD Eugene Frenkel, MD Peter Frenkel, MD Corinne Fribley, MD Thomas Froehlich, MD Elliot Frohman, MD Steve Frost, MD Laura Frye, MD Franklin Fuda II, DO Deborah Fuller, MD Dwain Fuller, MD Dana Fuller, MD Clifford Fullerton, MD James Fulmer, MD Vincent Gabriel, MD Melisa Gagrica, MD Alexander Gaidarski, MD Amanda Galloway, MD Shari Gamarnik, MD Vanthaya Gan, MD Christine Garcia, MD Jose Enrique Garcia, MD Joseph Garcia, MD Nilda Garcia, MD Alfredo Garcia, MD Sandeep Garg, MD Abhimanyu Garg, MD Patricio Gargollo, MD Leslie Garner, MD Lisa Garner, MD Thomas Garrad, PA-C Christopher Garrison, MD Dan Garwood, MD Shanna Garza, MD Aimee Garza, MD Irina Gasanova, MD Stephen Gasper, MD Jyothsna Gattineni, MD Larry Gentilello, MD Robert Genzel, MD Jim George, MD Thomas Geppert, MD Quin Gerard, MD David Gerber, MD Yonas Getachew, MD Seema Ghaffar, MD Kirat Ghosh, MD Candace Gibbin, MD Rima Gidwani, MD Marty Giesecke, MD Steven Gilbert, MD Nathan Gilbert, MD Joshua Gilchrist, MD James Gill, MD Kevin Gill, MD Alexandra Gillespie, MD John Gilmore, MD Jim Gilmore, MD Nora Gimpel, MD Charles Ginsburg, MD Carlos Girod, MD Donald Glass, MD Robert Glatz, MD Craig Glazer, MD Chris Glover, MD David Godat, MD Kenneth Godsey, MD Anuj Goel, MD Brian Gogel, MD Sefik Gokaslan, MD Marc Goldman, MD Robert Goldsteen, DO Jerald Goldstein, MD Joseph L. Goldstein, MD Daniel Goodenberger, MD Grady Goodwin, MD Wendy Goodwin, MD Murray Gordon, MD Lauren Gore, MD Collin Goto, MD Alisa Gotte, MD Frank Gottschalk, MD Sally Goudreau, MD Champa Gowda, MD Alexander Gozman, MD Phillip Graehl, MD Audrey Graham, MD Lafaine Grant, MD

visit us online at www.dallas-cms.org • March 2013 •

Reese Graves, MD Julia Graves, MD Larry Gray, MD De Shawndranique Gray, MD Gloria Gray, FNP-C James Gray, MD Vincent Graziano, MD Benjamin Greenberg, MD C. Greenfield, MD Kathryn Greenway, MD Laura Greer, MD Linda Gregory, DO Nancy Greilich, MD Philip Greilich, MD Landis Griffeth, MD James Griffin, MD James Griffin III, MD William Griffith, MD Clarice Grimes, MD Misti Grimson, MD Ellen Grishman, MD Robert Gross, MD, MBA Perry Gross, MD Erik Grossman, MD Stanley Grossman, MD Davinder Grover, MD Rebecca Gruchalla, MD, PHD Thomas Grugle, MD Scott Grundy, MD Ugis Gruntmanis, MD Sarah Gualano, MD Dax Guenther, MD Ricardo Guerra Jr., MD Chad Guetersloh, MD Fatma Gul, MD Kristine Guleserian, MD Tawanda Gumbo, MD Robert Gunby Jr., MD Thomas Gunning III, MD Sandeep Gupta, MD Samir Gupta, MD Shaili Gupta, MD Punkeet Gupta, MD Eve Guth, MD Brandon Guthery, MD Natalia Gutierrez, MD Oren Guttman, MD Paul Hackett, MD Samuel Haddock Jr., MD Nicholas Haddock, MD Robert Hagood, MD Stacey Hail, MD Jeffrey Haithcock, MD Linda Halbrook, MD Richard Haldeman, MD Clinton Haley, MD John Haley, MD Robert Haley, MD Barbara Haley, MD Carlton Haley, MD Katherine Hall, MD Catherine Hall, MD Christiana Hall, MD Amy Haller, MD Ronald Haller, MD Ethan Halm, MD Lisa Halvorson, MD Melissa Ham, MD Farrukh Hamid, MD Cherine Hamid, MD Rita Hamilton, DO W. Hamilton, MD John Hamilton, MD Mary Hammack, MD Brenda Hampton, MD Robert Hancock, DO Stacey Hanley, MD Greg Hansen, DO Martha Hardee, MD Stephen Harder, MD Rebecca Hardesty, PA-C Madeline Harford, MD Amy Harker-Murray, MD Paul Harker-Murray, MD Donald Harper, MD John Harrington, MD Charles Harris, MD Michael Harris, MD Emmanuel Harrison, MD Clanton Harrison III, MD John Hart Jr., MD William Hartman, DO William Harvey, MD Said Hashemipour, MD Luann Hassan, MD Kimmo Hatanpaa, MD Sumitha Hathiramani, MD Leslie Havemann, MD Melissa Hawkins, PA Lorrie Hayes, MD David Haymes, MD Shane Haynes, MD

Steven Hays, MD Yu-Guang He, MD Sandra Heard, MD Emily Hebert, MD Marjaneh Hedayat, MD Saghar Hedayati, MD H. A. Tillmann Hein, MD Lisa Heistein, MD Daragh Heitzman, MD Sarah Helfand, MD Sana Hemani, DO David Hemsell, MD Halim Hennes, MD Magda Hennes, MD Desmond Henry, MD R. Henry, MD Katherine Henson, FNP Pierre Herding, MD William Herlihy, MD Cathy Hernandez, MD Jennifer Hernandez, MD John Herndon III, MD Emily Herndon, MD Monica Herrera, PA John Herring, MD Steven Herzog, MD George Hewell, MD Cynthia Heyne, MD Roy Heyne, MD J. Hieber, MD D. Michael Highbaugh, MD Francis Hill, MD Gary Hill, MD Joseph Hill, MD, PHD Richard Hinton, MD Joseph Hise, MD Michelle Ho, MD Christine Ho, MD Binh Ho, MD Khanh Hoang, MD Helen Hobbs, MD W. Hodges, MD Timea Hodics, MD Steven Hoffman, MD Barbara Hoffman, MD Sandra Hofmann, MD, PHD R. Hogan, MD Joyce Hohn, MD Sarah Holder, DO Alisa Holland, MD Robert Holland, MD Priscilla Hollander, MD Elizabeth Holper, MD Roxane Holt, MD Shelby Holt, MD Clifton Hooser, MD Shelton Hopkins, MD Claire Horn, MD Brad Hornberger, PA Robyn Horsager-Boehrer, MD Marilyn Horton, MD Jay Horton, MD Gary Hoss, MD Srikanth Hosur, MD Wilbur (Dub) Howard, MD Donna Howard, FNP Temple Howell-Stampley, MD Ronald Hoxworth, MD Connie Hsia, MD Chris Hsiao, MD Alice Hsu, MD Randy Hua, OD Chou-Long Huang, MD Craig Huang, MD Theresa Huang, MD Philip Huber Jr., MD Anne Hudak, MD Ashton Hudson, MD Mitchell Huebner, MD Sergio Huerta, MD Randall Hughes, MD Lawrence Hum, MD John Humphrey, MD John Hunt, MD Michael Hunte, MD Michael Huo, MD Jefferson Hurley, MD George Hurst, MD Jodie Hurwitz, MD Abiha Husain, DO Ziad Husseini, MD Michele Hutchison, MD James Huth, MD John Hyatt Jr., MD Thomas A. Hyslop, MD Susan Iannaccone, MD Ahamed Idris, MD Peter Igarashi, MD Catherine Ikemba, MD Benjamin Im, MD Didem Inanoglu, MD Jula Inrig, MD

• March 2013 • Dallas Medical Journal

Robert Inzer, MD S. Isaacs, MD Brandon Isaacson, MD Arsalla Islam, MD Ginger Isom-Batz, MD Robert Israel, MD Kamel Itani, MD Roy Ivy III, MD Sandhya Iyer, MD Gregory Jackson, MD Linda Jackson, OD Jincy Jacob, MD Heidi Jacobe, MD Ahmed Jafri, MD Naseem Jagani, MD Mamta Jain, MD Tulika Jain, MD Sapna Jaiswal, MD Mambarath Jaleel, MD Naznin Jamal, MD Jeffrey Janis, MD Nolan Jenevein, MD William Jernberg, MD Lenelle Jerome, FNP-C Michael Jessen, MD Qing Jia, MD Jose Joglar, MD Jeanne Jogler, MD Theodore Johns, MD Steven Johnson, DO Douglas Johnson, MD Christine Johnson, MD Nichole Johnson, MD Frederick Johnson, DO Mark Johnson, MD Romaine Johnson, MD Raymond Johnson, MD Richisa Johnson, MD Sarah Johnson-Welch, MD Walter Johnston, MD Charles Johnston II, MD Stephanie Jones, MD Gregory Jones, MD Alan Jones, MD Sydney Jones, MD Brian Jones, MD Freddie Jones, MD Jodi Jones, MD R. Jones, MD William Jones, DO Kirk Jordan, MD Dakeya Jordan, DO Richard Joseph, MD Shelby Joseph, MD Shellie Josephs, MD Girish Joshi, MD Janna Journeycake, MD Tya-Mae Julien, MD Manjula Julka, MD Amy Juraszek, MD Khadija Kabani, DO Wareef Kabbani, MD Kevin Kadesky, MD Jeffrey Kahn, MD Raj Kakarla, MD Vijay Kalidindi, MD Amy Kalina, DO Jeffrey Kam, MD Amin Kamali, DO Jennifer Kampas, MD Colin Kane, MD Erin Kane, MD Ghana Kang, MD Sunjun Kang, MD Subhasri Kannan, MD Dennis Kao, MD Norman Kaplan, MD Richard Kaplan, MD Patricia Kaplan, CCCA AUD Nagarajani Kapu, MD Payal Kapur, MD Nitin Karandikar, MD Catherine Karni, MD Lori Karol, MD David Karp, MD Sirisha Karri, MD Melanie Kaspar, MD Beth Kassanoff, MD Galit Kastner Ungar, MD Darryl Kawalsky, MD Alan Kaye, MD Mark Kazewych, MD Farhana Kazi, MD Felicia Kearney, FNP Rafal Kedzierski, MD Gordon Keehn, MD Gregory Keelen, DO Siobhan Kehoe, MD Michael Kellam, MD Nancy Kelly, MD Jeffrey Kenkel, MD Alexander Kennedy, MD

Julie Kennedy, MD Irwin Kerber, MD Raj Keriwala, MD Frank Kern, MD Joshua Kern, MD Elizabeth Kerner, MD Jeffrey Kerr, MD Corey Kershaw, MD Prabhakar Kesava, MD Elizabeth Keyes, MD Tarif Khair, MD Shamim Khambati, MD Bilal Khan, MD Mohammad Khan, MD Ahtaram Khan, MD Rabia Khan, MD David Khan, MD Muna Khan, MD Saadat Khan, MD Saleem Khan, MD Gaurav Khatri, MD Imran Khawaja, MD Michael Khazzam, MD Amit Khera, MD Talat Kheshgi, MD Anita Khetan, MD Rainer Khetan, MD Roger Khetan, MD Kimberly Kho, MD Kevin Kia, MD David Kilgore, MD Kenneth Killen, MD Benjamin Kim, MD Jong Kim, MD Kevin Kim, MD Linda King, MD Karen King, DO Cheryl Kinney, MD Judith Kirby, MD Randall Kirby, MD Stephen Kircher, MD Alexander Kirk, MD Lynne Anne Kirk, MD Haskell (Gill) Kirkpatrick III, MD Melissa Kirkwood, MD Kurt Kitziger, MD Kevin Klein, MD Kurt Kleinschmidt, MD Dawn Klemow, MD Steven Klemow, MD Laura Klesse, MD Margaret Knapp, MD Susan Knapton, MD Wendy Kniffen, PA-C Sally Knox, MD Joshua Koch, MD Justin Koch, MD Padmavathi Koduri, MD Andrew Koh, MD Kenneth Kollmeyer, MD Jun Kong, MD Jessica Konvicka, PA Bielose Konwe, MD Karanjit Kooner, MD Korgun Koral, MD Robert Kotas, MD Harry Kourlis Jr., MD William Kovacs, MD Karen Kowalske, MD Patricia Krakos, MD Herbert Kresh, MD William Krippner Jr., MD Sumant Krishnan, MD Ruth Krishnan, MD Crystal Kronenberger, MD Jo Ellen Krueger, MD Theodore Krum, MD Jai Kumar, MD Grace Kumar, MD Mithilesh Kumar, MD Udhay Kumar, MD Elizabeth Kummer, MD Aysha Kunju, MD Y-Chen Kuo, MD Joe Kutz, MD Robert Kwon, MD Hyo Kwon, MD Jeannie Kwon, MD Marc Labat, MD Micki Lacker, NP Thomas Lacour, MD Elizabeth Lagomarsino, MD Wen Lai, MD Daniel Laidley, MD Alison Laidley, MD W. Pennock Laird, MD Tracy Laird, MD William Laird II, MD Cyrus Lambert, MD Rahele Lameh, MD Jeffrey Lamont, MD Kristen Lampe, MD

Michael Landay, MD Michael Landgarten, MD Mary Alexander Landry, PA-C B. Lane, MD Lawrence Lankford, MD John LaNoue Jr., MD Sharon Larkin, MD Anne Larson, MD Hamid Latifi, MD Karen Latour, MD Steve Lau, MD May Lau, MD Michael Laughlin, MD Lawrence Lavery, DPM John Lavery, MD Yolanda Lawson, MD Binh-Minh Le, MD Lu Le, MD Brian Le, MD Joseph Leach Jr., MD Steven Leach, MD Patrick Leavey, MD Gayle Lebovic Andy Lee, MD Sandy Lee, MD Dale Lee, MD Jessica Lee, MD Jiwon Lee, MD Kenneth Lee, MD Michael Lee, MD William Lee, MD Won Lee, MD Jonathan Leffert, MD Ann Leitch, MD Gary Lemack, MD Dorothy Lemecha, DO Yuri Lemeshev, MD Matthew Lemler, MD David Lensch, MD Randolph Lester, MD Folashade Lester, MD Kenneth Leveno, MD Brian Levenson, MD Charles Levin, MD Benjamin Levine, MD Beth Levine, MD Fiona Levy, MD Deri Lewis, MD Hsiao (Jenny) Li, MD Julia Liaci, MD Lawrence Liang, MD Robert Liao, MD Valerie Liao, MD Warren Lichliter, MD Zelig Lieberman, MD David Lief, DPM James Lilly, MD Johanna Limsenben, MD Scott Lin, MD Chun Lin, MD Fangming Lin, MD David Linguist, MD Peggy Linguist, MD Ildiko Lingvay, MD Jeffrey Link, MD Richard Linsky, MD Eron Linver, MD George Lister, MD Vijayavalli Little, MD Xercerla Littles, MD Christine Liu, MD George Liu, DPM Yinghui (Carol) Liu, MD Edward Livingston, MD Jessica Lloyd, MD Julie Lo, MD Matthew Lo, MD Daniel Lockard, MD Susanne Lockhart, MD Peter Loeb, MD Charles Loehr, MD Alan London, MD Daniel Long, MD Carl Long III, MD Robert Lonian, MD Shelley Loomstein, PA Jorge Lopez, MD Yair Lotan, MD Sandra Lozano, MD Xiaohui Lu, MD Christopher Lu, MD James Luby, MD Peter Luckett, MD Percy Luecke Jr., MD Lisa Luke, MD William Lumry, MD Linda Lutz, MD Boyd Lyles, MD Mark Lyons, MD Naim Maalouf, MD Amy Macaluso, MD

Christopher Madden, MD Willis Maddrey, MD Paul Madeley, MD Antra Mahaldar, MD Elizabeth Maher, MD Joseph Maher, MD Lynn Mahony, MD Hetendra Makanbhai, MD Marjorie Ann Malbas, MD Jepsin Maliyil, MD Damien Mallat, MD Peter Malouf, DO Pradeep Mammen, MD Richard Manes, MD John Mang, MD Nicole Mangum, PHD John Mansour, MD Randy Marcel, MD John Marcucci, MD Peter Marcus, MD Linda Margraf, MD Vitaly Margulis, MD David Markham, MD Medardo Maroto, MD Bradley Marple, MD Otto Marquez-Kerguelen, MD Jorge Marrero, MD John Marshall, MD Michael Marshall, MD Alan Martin, MD John Martin Jr., MD Lisa Martinez, MD Dee Martinez, MD Joseph Martinez, MD Tanya Martinez-Fernandez, MD Javier Marull, MD Andrew Masica, MD Karen Matevosyan, MD Dana Mathews, MD Pamela Matijevich, PA Sina Matin, MD Susan Matulevicius, MD I-Fan Mau, MD Malea Maynard, MD Marlyn Mayo, MD William McCaleb, MD Timothy McCavit, MD John McClay, MD Laura McClendon, MD Hugh McClung IV, MD Ronald McCollum, MD Eddie McCord, MD Steven McCord, MD Medford McCoy, MD Rosemary McCoy, MD George McCracken Jr., MD Robert McCrea, MD Audra McCreight, MD James McCulley, MD Donald McCurnin, MD Jeffrey McDaniel, MD Frank McDonald, MD Halliday McDonald, MD Millicent McDonald, MD Warren McFarland, MD Mary McGarry, MD Tamara McGregor, MD Darren McGuire, MD John McHenry, MD Donald McKay Jr., MD Susan McKinney, MD Gail McLaughlan, MD John McMenamy, MD Adrienne McMillan, MD Kimberly McMillin, MD Lawrence McNally, MD, PA Jennifer McNeill, MD Michael McPhaul, MD Robert Meador Jr., MD Stephen Megison, MD Amit Mehta, MD Joseph Meier, MD Marcelyn Meister, PA-C James Meler, MD Gavin Melmed, MD David Meltzer, MD Dianne Mendelsohn, MD Edward Mendelson, OD Michelle Mendez, MD Nikolas Mendrygal, MD Jin Meng, MD David Mercier, MD Sonya Merrill, MD James Merritt III, MD Jeffery Metzger, MD Thiyagarajan Meyappan, MD Richard Meyer, MD Adrian Meyer, MD Dan Meyer, MD Jeffrey Meyer, MD Lawrence Meyerson, MD

Eva Meyrat, MD Kimberly Mezera, MD Bruce Mickey, MD Benton Middleman, MD Angela Mihalic, MD Sara Milchgrub, MD Michele Miles, MD Darryl Miles, MD Marjorie Milici, MD Mark Miller, MD Jennifer Miller, MD Lance Miller, DO Adam Miller, MD David Miller, MD Shane Miller, MD Michael Milner, MD Joseph Minei, MD Robert Minkes, MD David Minna, MD John Minna, MD Joseph Mishkin, MD Jere Mitchell, MD Mack Mitchell Jr., MD Shubhada Mithilesh, MD James Mitlyng, MD Shashi Mittal, MD Vineeta Mittal, MD Arjun Mittra, MD Mark Mlcak, MD Presley Mock, MD Bijal Modi, MD Seema Modi, MD Pradeep Modur, MD Orson Moe, MD Todd Moen, MD Alok Mohan, MD David Moikeha, MD Sam Molai, MD Kyle Molberg, MD Amy Moldrem, MD Kyle Molen, MD Juan Molina, MD Narinder Monga, MD Ashish Monga, MD George Moninger, MD James Montgomery, MD Everett Moody, MD William Moore, MD Al Moore, MD Paul Moore, MD Daniel Moore, MD Sudha Mootha, MD Venkateswara Mootha, MD Ann Mootz, MD Brady Mootz II, MD Pablo Mora Mora, MD Brett Moran, MD Elizabeth Moran, MD Allen Morey, MD Sherri Morgan, MD Howard Morgan, MD Kevin Morrill, MD Susan Morris, MD Michael Morriss, MD Frank Morrone, MD Maria Morse, MD Elysia Moschos, MD Jason Moshier, MD Jason Mull, MD Erica Muller, MD Mary Mullican, MD Janice Mullins, DO Matthew Mulloy, MD Kimberly Mulson, MD Jose Muniz, MD James Muns, MD Madhavi Muppidi, MD Srikanth Muppidi, MD Gerald Murphy Jr., MD Joseph Murphy, MD Susan Murphy, MD Gayle Murray, MD Sunshine Murray, MD David Musselman, MD John Myers, MD Larry Myers, MD Edgar Nace, MD Richard Naftalis, MD Rajasree Nair, MD Krishnan Nair, MD Daniel Nale, MD Vijaya Nama, MD Swati Namburi, MD Vidya Nandipati, MD Syed Naqvi, MD Roxana Narat, MD Rama Narla, MD Rao Naseem, MD Dawood Nasir, MD Lorien Nassi, MD Sharon Nations, MD

Rebekah Naylor, MD Arax Nazarian, DO Shameem Nazeer, MD William Neaville, MD Lucien Nedzi, MD Arvind Neelakantan, MD Francisco Neira, MD Alecia Nero, MD Shawna Nesbitt, MD Jo-Ann Nesiama, MD Rebecca Nessel, MD Paul Neubach, MD Mark Newcomer, MD Keith Newman, MD Christopher Newton, MD Stephanie Newton, FNP Dennis Newton III, MD Ana Nguyen, MD Anthony Nguyen, DO Lisa Nguyen, DO Leigh Nguyen, MD Lynn Nguyen, MD Phuong Nguyen, MD Anh Nguyen, MD Benjamin Nguyen, MD Janice Nhan, DO Donald Nicholas Jr., MD Farhad Niroomand, MD Raymond Nkwantabisa, MD John Noack, MD Leslie Noble, ACNP Carl Noe, MD James Norcross, MD William Norcross, MD Tara Norris, MD James Norwood, MD Pedro Nosnik, MD Roberta Novakovic, MD Alan Nugent, MD Fiemu Nwariaku, MD Teekam Ochani, MD Anthony O’Connell, MD Ellen O’Connell, MD Jon Oden, MD Elizabeth Odstrcil, MD Karen Oehler, MD Babatunde Ogunnaike, MD Scott Oishi, MD Pamela Okada, MD Godwin Okojie, PA Osehotue Okojie, MD Shirley O’Leary, NP-C Theresa Olfson, MD Wanderley Oliveira, MD Dwight Oliver, MD Patrick Olomu, MD Catherine Olsen, DO Craig Olson, MD Ben Olsson, DO Anees Omar, MD Hythem Omar, MD Barry O’Neal, MD Nesrin Onur, MD Mildred Opondo, MD Angela Orlino, MD Jeffrey Ortstadt, MD Padraig O’Suilleabhain, MD James Otto, MD Elesyia Outlaw, MD John Overbeck, MD Stuart Owen, MD David Owen, MD Heather Owen, MD Glenn Owen, MD Robert Owens, MD Orhan Oz, MD Stephen Ozanne, MD James Pak, MD Anna Pak, MD Charles Pak, MD Natalia Palacio, MD Mythili Paladugu, MD Elizabeth Palmarozzi, DO Biff Palmer, MD David Palmer, MD Geetha Pandian, MD Rajiv Pandit, MD Sandeep Pandove, MD Amit Pandya, MD Mahmood Panjwani, MD Geeta Paranjape, MD Biren Parikh, MD Joseph Park, DO Andrew Park, MD Thomas Parker III, MD Ryan Parker, MD Robert Parkey, MD Robert Parks Jr., MD Wendy Parnell, MD Howard Parness, MD Anu Partap, MD

visit us online at www.dallas-cms.org • March 2013 •

Anna Parton, NP Sirous Partovi, MD Juan Pascual, MD Amy Pass, MD Michael Passanante, MD Muhammad Patel, MD Helen Patel, MD Mahendra Patel, MD Ankit Patel, MD Ashish Patel, MD Hetal Patel, MD Kalpesh Patel, MD Nova Patel, MD Parag Patel, MD Reina Patel, DO Satin Patel, MD Vishal Patel, MD Ajay Pathak, MD Brent Patterson, MD Tena Patterson, MD Matt Pattillo, MD Mary Paulk, MD Paul Payne, MD Margaret Pearle, MD Eric Pearlman, MD Lee Ann Pearse, MD Mary Pearson, MD John Pease, MD Elizabeth Pelletier, PA Matthias Peltz, MD Rene Pena, MD Michael Pendola, MD Jeffrey Penfield, MD Fangyu Peng, MD Yan Peng, MD Yolande Pengetnze, MD John Pennant, MD Paul Pepe, MD, MPH Beverly Perez, DO Carlos Perez, MD Julio Perez Fontan, MD P. Perry, MD Kimberly Persley, MD Ronald Peshock, MD Joel Pessa, MD Mark Peters, MD Brian Peters, MD Katharine Petersen, MD Valerie Peterson, MD Gail Peterson, MD William Peterson, MD David Pettett, MD Larry Pettit, DO Andrew Phan, MD Amy Phelan, MD Kay Philips, MD William Phillips, MD, DDS Joseph Phillips Jr., MD Charles Phillips, MD Nancy Phillips, MD Leslie Pidgeon, DO Marc Pieniek, MD Ava Pierce, MD Chris Pierotti, MD John Pillow, MD Paul Pin, MD James Pinckney II, MD Karen Pinto, MD Bradley Pirtle, DO David Pistenmaa, MD Shawnta Pittman-Hobbs, MD David Podeszwa, MD Daniel Podolsky, MD Harlan Pollock, MD Todd Pollock, MD Rebecca Ponder, OD Leslie Porter, MD Tom Postma, MD Craig Powell, MD, PHD Jerry Powell Jr., MD Raghavendra Prasad, MD Edward Prejean III, MD John Preskitt, MD Glenn Pride Jr., MD Marcia Pritchard, MD Jeffrey Pruitt, MD Sridhar Pudu, MD Jay Pudupakkam, MD Ankit Punatar, MD Kit Purdy, MD Phillip Purdy, MD Nancy Puzziferri, MD James Pyron, MD Stephanie Quarles, MD Mary Quiceno, MD Raymond Quigley, MD Henry Quinones, MD Jennifer Rabaglia, MD Elizabeth Race, MD Suzanne Racz, PA-C Lee Radford, MD Susan Raff, MD

Adnan Rafique, MD Dina Rahhal, MD Robert Rahimi, MD Pervaiz Rahman, MD David Rahn, MD Jack Raisanen, MD Ganesh Raj, MD Kalyani Raja, MD Harikrishna Raja, MD Nilum Rajora, MD Claudio Ramaciotti, MD Kalpana Ramakrishna, MD Lakshmi Raman, MD Victor Ramon, MD Shelley Ramos, MD Bruno Ramos Flores, MD Maria Ramos-Roman, MD Michael Ramsay, MD Ryan Randles, MD Kenneth Raney III, MD Shobha Rao, MD Roshni Rao, MD Uma Rao, MD Alan Raphael, MD Peter Rappa, MD Philip Raskin, MD Karl Rathjen, MD Maheshika Ratnayake, MD Gargi Raval, MD Catherine Raver, MD Ahmed Raza, MD Ahmad Raza, MD Roy Rea, MD Don Read, MD Rosalyn Reades, MD Lee Reagor, MD Claire Reddick, MD Suman Reddy, MD Virginia Reddy, MD Jason Reed, MD Melanie Reed, MD Chet Rees, MD Erin Reese, MD Bradford Reeves, MD Robert Rege, MD Diana Reggiardo, MD Robert Reilly Jr., MD Andreas Reimold, MD Sharon Reimold, MD Charles Reinert, MD Jami Reissig, MPA-C Thomas Renard, MD Hector Reyes, MD Chanhaeng Rhee, MD Ramona Rhodes, MD Norman Rice, MD Kim Rice, MD Gregg Rice, MD John Richard III, MD Hampton Richards, MD Benjamin Richards III, MD Charles Richardson, MD Debra Richardson, MD Kim Rickert, MD William Ring, MD Kathy Rinnert, MD Homero Rivas, MD Julio Rivera, MD Antonio Rivera, MD Wilfredo Rivera, MD Yadira Rivera-Sanchez, MD Shelley Roaten Jr., MD L. Roberts, MD Tana Roberts, MD Richard Roberts, MD Albert Roberts Jr., MD Scott Roberts, MD Ellis Robertson, MD William Robertson, MD Kiran Robertson, MD Laura Robinson, PA-C Amber Robinson, DO Vivyenne Roche, MD Rosemary Roderick-Roseberry, MD Tanya Rodgers, MD Adriana Rodriguez, MD Gustavo Rodriguez, MD Norberto Rodriguez-Baez, MD Roberto Rodriguez-Ruesga, MD Martha Rodriguez-Ruiz, DO Erin Roe, MD Claus Roehrborn, MD Joel Roffman, MD Nicole Rogers, MD Donza Rogers, MD Dora Rogers, MD Beverly Rogers, MD David Rogers, MD Thomas Rogers, MD Vanessa Rogers, MD Zora Rogers, MD Anand Rohatgi, MD

• March 2013 • Dallas Medical Journal

Rod Rohrich, MD Rebecca Rojas, MD Peter Roland, MD Ray Rollins, DO Nancy Rollins, MD Gary Roloson, MD Enid Romanelli, MD Lynn Roppolo, MD Myron Rosen, MD Robin Rosen, MD Robert Rosen, MD Frances Rosenbaum, MD Roger Rosenberg, MD Randall Rosenblatt, MD Charles Rosenfeld, MD David Rosenstein, MD Julio Rosenstock, MD J. Rosenthal, MD Shayzreen Roshanravan, MD Renee Rossi, MD Brett Roth, MD Michael Rothkopf, MD Karen Roush, MD L. Routh, MD Shai Rozen, MD Arnold Rubenfield, MD Melissa Rubenstein, MD Howard Rubin, MD Craig Rubin, MD David Ruiz Bello, MD Michael Ruk, MD Timothy Rupp, MD Michael Russo, MD Charles Rutherford, MD Cynthia Rutherford, MD John Rutherford, MD Matthew Ryan, MD Assad Saad, MD John Saad, MD James Sackett, MD Hesham Sadek, MD Jane Sadler, MD Arthur Sagalowsky, MD Rana Said, MD Joseph Sailors, MD Michel Saint-Cyr, MD Khashayar Sakhaee, MD Karen Saland, MD Kenneth Saland, MD Angel Salazar, MD Adrian Salazar, MD Gilberto Salazar, MD Luis Saldana, MD William Salter, MD Colleen Sam, MD Kamalanathan Sambandam, MD Joseph Sample Jr., MD Duke Samson, MD Robert Samuelson, MD Pablo Sanchez, MD Rinarani Sanghavi, MD William Santangelo, MD Patricia Santiago-Munoz, MD Pamela Santone, DO Shehnaz Sarmast, MD Ravindra Sarode, MD Venetia Sarode, MD Meghana Sathe, MD Ashoke Sathy, MD Clark Saunders, MD Timothy Saunders, MD Rashmin Savani, MD Daniel Savino, MD Kirti Saxena, MD Ramesh Saxena, MD Stephanie Sbong, MD Pier Scaglioni, MD Joseph Schaffer, MD Mary Schenkel, NP Joan Schiller, MD David Schindel, MD Tammi Schlichtemeier, MD Allen Schneider, DO Jay Schneider, MD Joseph Schneider, MD Thomas Schott, MD Richard Schubert, MD William Schucany, MD Barbara Schultz, MD Tom Schulz, MD Armond Schwartz Jr., MD Barry Schwarz, MD Margaret Schwarz, MD Roderich Schwarz, MD Donald Schwarz, MD Daniel Scott, MD Harold Scott, MD Kelly Scott, MD Susan Scott, MD William Scott, MD Matthew Scott, MD Terilyn Scott-Winful, MD

Leslie Secrest, MD Marjan Seddighzadeh, MD Richard Seggerman, MD Luis Seguias, MD Lori Seibert, MD Jack Seidel, MD Mouin Seikaly, MD Stephen Sellers, DO Mhammad Semrin, MD Dorothy Sendelbach, MD Youcef Sennour, MD Dan Sepdham, MD Charles Sessions, MD Anthony Setiawan, MD Stephanie Setliff, MD Shahriar Setoudeh-Maram, MD Shahid Shafi, MD Harivadan Shah, MD Dhiren Shah, MD Amit Shah, MD Anjali Shah, MD Monal Shah, MD Nisarg Shah, MD Daniel Shaheen, OD Hassan Shahidi, DO Amer Shakil, MD Sadat Shamim, MD Donna Shannon, MD Gabriel Shapiro, MD Nima Sharifi, MD Kapil Sharma, MD Mahesh Sharma, MD Manisha Sharma, MD Rohit Sharma, MD Shiv Sharma, MD Carey Sharp, MD Jessica Sharry, MD Philip Shaul, MD Mary Shaw, MD Maeve Sheehan, MD Paul Sheeran, MD Michael Sheffield, MD Eugene Sheffield, MD Jeanne Sheffield, MD Yu-Min Shen, MD Laquita Shepherd, MD Cynthia Sherry, MD Dorothy Sherwood, MD Rashmi Shetgiri, MD Chen Shi, MD Sarika Shivnani, MD Stephen Shivvers, MD Pardeep Shori, DO Joyce Shotwell, MD Matthew Shuford, MD Bill Shumate Jr., MD Alison Sibley, MD Zafreen Siddiqui, MD Jane Siegel, MD Mark Siegelman, MD Paul Siemers, MD Sigurdur Sigurdsson, MD Erin Silav, MD Stuart Simon, MD Walter Simon, MD Robert Simonson, DO Michael Sims, MD Gina Sims, MD Robert Sims, MD Gary Sinclair, MD Amit Singal, MD Mike Singer, MD Deepa Sirsi, MD Julide Sisman, MD Kerri Sistrunk, MD Walter Skinner, MD Michael Skinner, MD Gary Skrivanek, MD Charles Slack, MD Robert Slagle, MD David Slater, MD Elizabeth Slaymaker, MD Matt Sloan Jr., MD Louis Sloan, MD Tamra Slone, MD Michael Smerud, MD Randlow Smith Jr., MD Weldon Smith Jr., MD Jennifer Smith, MD Chene Smith, MD Liesl Smith, MD Oluwatosin Smith, MD Eric Smith, MD Demetria Smith, MD Allison Smith, MD Troy Smith Jr., MD Wesley Smith, MD Warren Snodgrass, MD Wynne Snoots, MD William Snyder III, MD Richard Snyder II, MD Mie Mie Sohn-Mcgowan, MD

Paul Sokal, MD Matthew Sokol, MD Saul Sokol, MD W. Sory, MD Paul Southern Jr., MD Stefanie Spaeth, MD Thomas Spain, MD Ann Spangler, MD Dave Spear, MD John Spieker, MD Joseph Spigel, MD Jack Spitzberg, MD Ramano Sprueil, MD J. Sreenarasimhaiah, MD Pranavi Sreeramoju, MD Karthik Srinivasan, MD Geetanjali Srivastava, MD Divya Srivastava, MD Peter Stack, MD Ronney Stadler, MD David Stager, MD Charlotte Starghill, MD Adam Starr, MD Peter Stastny, MD A. Staub, MD Eric Steen, MD Martha Stegner, MD Edward Stehel, MD Elizabeth Stehel, MD Matthew Steidl, PA-C Joel Steinberg, MD Michel Stephan, MD Jacqueline Stephen, MD Jeff Stephens, MD Jill Stephenson, MD William Stevens, MD Elizabeth Stevenson-Gargiulo, DO Robert Stewart, MD Carlyle Stewart, MD, MPH Michael Stewart, MD Cristina Stiles, MD Matthew Stoll, MD Stuart Stone, MD Louis Stool, MD Bradley Strout, MD Kristy Stucka, MD Jill Studley, MD Daniel Sucato, MD Daniel Suez, MD Robert Sugerman, MD Sumitha Sukumar, MD Melanie Sulistio, MD Brian Sullivan, MD Paul Sullivan, MD Baran Sumer, MD Kathryn Sumpter, MD Kirtana Sunderajan, MD Terri Suresh, ACNP Richard Suss, MD Robert Suter, DO Laurie Sutor, MD, MBA Sharad Swami, MD Mark Swancutt, MD Susan Swanson, MD Lisa Swanson, MD Prabhakar Swaroop, MD Raymond Swienton, MD Thomas Swygert, MD Asif Syed, MD James Syler Jr., MD Maurice Syrquin, MD M. Szuszkiewicz-Garcia, MD William Tallmadge, ACNP John Tan, MD Natalia Tan, PA Charles Tandy, MD Alexander Tanjuakio, FNP Grace Tannin, MD Weike Tao, MD Lori Tappen, PA-C Cristina Tarango, MD Tania Tarjan, MD Laura Tasa, MD Berge Tasian, MD Chad Tate, MD Joel Taurog, MD Walton Taylor, MD Wayne Taylor, MD Jeff Taylor, MD Myiesha Taylor, MD Robert Taylor, MD Roosevelt Taylor Jr., MD Shane Taylor, DO Charlotte Taylor, OD Lisa Taylor-Kennedy, MD Prabhav Tella, MD Robert Tenery Jr., MD John Tenny, MD Lulu Tenorio, MD Sumeet Teotia, MD Lance Terada, MD Alexander Tessnow, MD

Shirley Tetteh, MD Erwin Thal, MD Bharath Thankavel, MD Anam Tharoo, MD James Theisen, MD Mahesh Thiagarajah, MD Bryan Thibodeau, MD Mark Thieberg, MD Dwain Thiele, MD Maura Thielen, MD Milton Thomas, MD Emilia Thomas, MD James Thomas, MD Robin Thomas, MD Tina Thomas, NP Robert Thompson, MD Jeffrey Thompson, MD Mandy Thompson, MD Jennifer Thompson, DO Marita Thompson, MD Mayra Thompson, MD Steven Thornton, MD William Thornton, MD James Thornton, MD Katherine Thornton, MD John Thottakara, MD Amitha Thudi, MD Jeffrey Thurston, MD Mark Till, MD Elisabeth Tilleros, MD Glenn Tillery, MD Felicia Tillman, MD Carlos Timaran, MD Robert Timmerman, MD Leslie Tingle, MD Arash Tirandaz, MD Ben Tittle, MD Rachel Tobey, MD John Tong, MD William Tongier, MD Ali Toofanian, MD Seth Toomay, MD Anthony Toppins, MD Fernando Torres, MD Robert Torti II, MD Gabor Toth, MD Robert Toto, MD Hien Tran, MD Maclong Tran, MD Phuong Tran, MD Nhu Tran, DO Sara Tranchina, MD Erika Trapp, MD Don Treichler, MD Jodie Trello-Rishel, MD Clayton Trimmer, DO Jaya Trivedi, MD Kavita Trivedi, DO Ketan Trivedi, MD Craig Troop, MD Matthew Trovato, MD Ann Trowbridge, MD John Truelson, MD Mauricio Trujillo, MD Alan Trumbly, DO Tam Truong, MD Andrew Trussler, MD Eden Tsegay, NP Sharon Tucker, MD Melissa Tucker, MD Shannan Tujios, MD Paitoon Tulanon, MD Armine Tumyan, MD Gary Tunell, MD Aslan Turer, MD William Turner Jr., MD Diane Twickler, MD Kiran Ubhayakar, MD Pablo Uceda, MD Rafael Ufret-Vincenty, MD David Uhrbrock, MD Michael Ulissey, MD Seckin Ulualp, MD Ronald Underwood, MD Mercedes Uribe, MD Timothy Valek, MD Rawson Valentine, MD Peter Van Buren, MD Jeffrey Van Dermark, MD Thomas Van Dinter, MD Marvin Van Hal, MD Paul Van Ness, MD Travis Vandergriff, MD Kathleen Vandiver, MD Michael Vanpelt, DPM Deepa Varshney, MD Vasantha Vasan, MD Joseph Vaughan Jr., MD Miguel Vazquez, MD Anitha Veerasamy, MD Karen Velazquez, MD Ruben Velez, MD

Larissa Velez, MD Daniel Veltkamp, MD Jennifer Veltkamp, MD Narasimharao Vemula, MD Roopa Vemulapalli, MD Steven Verity, MD Udit Verma, MD Avesh Verma, MD Steven Vernino, MD Kim Vernon, MD Belinda Vicioso, MD Robert Viere, MD Miguel Villamil, MD Joseph Viroslav, MD Cathy Vo, MD Wanpen Vongpatanasin, MD Gayathri Vontivillu, MD Madhuri Vusirikala, MD Lewis Waber, MD Suzanne Wada, MD Jill Waggoner, MD James Wagner, MD Clifford Wai, MD Michael Wait, MD Linda Waki Ho, MD Kathryn Waldrep, MD Brent Walker, DO Brandy Walker, MD Jean Wall, MD Genevieve Wallace, MD Angela Wallace, MD David Waller, MD Richard Wallner, MD Ellen Walraven, MD Raymond Walsh, MD Deryk Walsh, MD Jennifer Walsh, MD Margaret Walter, DO Leslie Walters, MD James Walton, DO John Walton, DO Rhonda Walton, MD David Wang, MD Hao Wang, MD Serena Wang, MD Yu-Chi Wang, MD Scott Wang, MD Athol Ware, MD Worthy Warnack Jr., MD John Warner, MD Indulekha Warrier, MD David Watkins, MD Kelli Watkins, MD Cheletta Watkins, MD Mark Watson, MD Denton Watumull, MD Lori Watumull, MD Paul Wax, MD Megan Way, MD Sarah Way, MD Roberto Wayhs, MD David Weakley Jr., MD Devri Weakley, MD Paul Weatherall, MD Seaborn Weathers, MD Denise Weber, MD Winston Webster, MD Arthur Weinberg, MD Debra Weinberger, MD Howard Weiner, MD Gregory Weisbruch, MD Jonathan Weissler, MD Patrick Weix, MD Babu Welch, MD Miranda Wellington, MD Claudia Werner, MD Don West, MD Robert Westerberg, MD Henrik Westergaard, MD John Westkaemper, MD Matthew Westmoreland, MD Lawrence Whaley, MD Robert Whitaker, MD Charles White III, MD Jonathan White, MD Perrin White, MD Wendy White, MD Warren Whitlow, MD Jess Whitson, MD Anthony Whittemore, MD Charles Whitten, MD Louis Whitworth, MD Jonathan Wickiser, MD Joyclyn Wicks, MD Robert Wiebe, MD Jane Wigginton, MD Cynthia Wilder, MD Courtney Wilemon, MD Lalan Wilfong, MD Jennifer Wilkerson, MD Joan Wilkin, DO Duwayne Willett, MD

Tearani Williams, MD Joseph Williams II, MD Mitchell Williams, DPM James Willson, MD Amy Wilson, MD Ellen Wilson, MD Jean Wilson, MD Kathleen Wilson, MD Philip Wilson, MD Jennifer Wimberly, MD Robert Wimberly, MD Naomi Winick, MD Thomas Winkler, MD Heather Winslow, MD Richard Winslow, MD F. Winter Jr., MD John Wiprud, MD Scott Wise, MD Michael Witt, MD Bryan Wohlfeld, MD Leon Wolf, MD Gil Wolfe, MD Joshua Wolovits, MD Laura Wolovits, MD Kyle Womack, MD Kevan Wong, MD Richard Wood, MD Megan Wood, MD T. Wood, MD Andrea Woodroof, MD Stacey Woodruff, MD Amy Woods, MD Jay Woody, MD Randall Wooley, MD George Wooming, MD Tyler Wooten, MD Larry Word, MD Ruth Word, MD Kevin Worley, MD Daniel Worrel, MD Josiah Wrensford, MD Tracey Wright, MD Richard Wu, MD Myra Wyckoff, MD Ralph Wynn, MD Christine Wyrick, MD James Wyrick, MD Scott Wysowski, PA-C Hong Xiao, MD Matthew Yaeger, MD Kimberly Yamanouchi, MD Kim Yancey, MD Chien Yang, MD Mary Yang, MD Ky Yarborough, PA-C Franklin Yau, MD Tonia Yee, MD Zerrin Yetkin, MD Min Yi, DO Su Yin, MD Kyung Yoo, MD Hooby Yoon, DO Adam Yopp, MD Ahmer Younas, MD Lucia Young, DO Amy Young, MD Gary Young, MD Wengui Yu, MD, PHD Ludmila Zadworna, MD Ali Zamanian Yazdi, MD Michael Zaretsky, MD Nina Zatikyan, MD Thomas Zellers, MD Ilana Zeltser, MD Nestor (Nick) Zenarosa, MD Rachel Zent, MD James Zerner, MD Alfredo Zevallos, MD Bing Zheng, NP-C Xin (Joseph) Zhou, MD Mark Zibilich, MD Heather Zidow, MD Jeffrey Zigman, MD Gwendolyn Zilinskas, MMS Jennifer Zimmer, MD Philippe Zimmern, MD Andrew Zinn, MD William Zinser, MD

visit us online at www.dallas-cms.org • March 2013 •

Community

On P a r k la n d Hosp ita l Judg e C l a y J e n ki n s ,

g ive n to p hysi ci a ns a t P a rk l a nd o n D ec. 2 0 , 2 0 1 2

It is a tried but true statement that “extraordinary times call for extraordinary measures.” Those measures are taken by a few people of purpose who band together to change the trajectory of history for the common good. Most people face these times without the contemporaneous knowledge of their full significance. There are extraordinary times of personal impact that affect us in a profound way without attracting historical significance, and there are rarer times when we find ourselves part of a greater struggle. At times we are tested on a greater stage, with stakes that far surpass our personal interest and which will have a greater impact on our world. For my father, that time was Dec. 16, 1944, through Jan. 25, 1945, in the Ardennes forest. For the Kennedy administration, those times played out over 14 days in October 1962 staring down a nuclear war. Some 13 months later, the widow and children of President Kennedy would have their time as a nation grieved. Parkland would play a central role in that extraordinary time in history, and now, nearly 50 years later, Parkland Hospital is in the midst of her most extraordinary challenge. We find ourselves inextricably intertwined in Parkland’s extraordinary challenge with the full knowledge that this is a shared time. I came here tonight because I realized, perhaps later than I should have, the power of words. And that if I don’t tell you what my thoughts and beliefs are regarding Parkland, others will color that narrative in a way that does not capture the immense gratitude and deep appreciation I have both personally and as the highest elected officer in Dallas County for you, your teams, and your shared sacrifice. I know how uplifting words of appreciation can be in times of trial. I felt them in a simple “thank you” from a stranger at the grocery store or on the street during the West Nile Virus crisis. Part of my inspiration to reach out to you was brought about by Dr. Rick Snyder’s President’s Page in the July issue of the Dallas Medical Journal titled, “Ich bin ein Parklander.” Rick’s words eloquently captured a shared view of this institution: Parkland is not just a place, a hospital or a system. It is not merely a building, with brick and mortar. It is the spirit of the much broader Dallas medical community that is embodied in all those who have ever served under its roof, physicians and nonphysicians alike. Parkland has left an indelible mark on the medical community and patients of Dallas. According to DCMS records, 40 percent of all physicians in Dallas County trained on some level at Parkland. To a larger extent, Parkland is the medical community of Dallas, not just those physicians who serve within the Dallas County Hospital District system proper. It was at Parkland that our compassion and respect for human dignity and life was forged. It was through the Parkland experience that our sense of integrity, collaboration, leadership, and excellence were given birth. These gifts are not only taught by those mentors we call professors and attendings. They are especially demonstrated in the lab techs and orderlies, transporters and janitors, administrators and nurses. But, most of all, they were taught to us by the patients themselves. Parkland is a medical jewel for the citizens of Dallas where miracles happen every day. The patients themselves are the ultimate teachers.Within Parkland is a unique symbiotic relationship where the patients are the teachers and the caregivers are the students.

• March 2013 • Dallas Medical Journal

When I signed up to run for county judge, I did not understand the extent of our shared challenge, or even that it would be shared by me; nor did I know that the most important role I would play as county judge is to do my small part to save Parkland and help her thrive. I am sure Chairwoman Debbie Branson did not accept her initial appointment with that full knowledge because much of her initial information in accepting the appointment was provided by me. I told her the Board of Managers’ greatest challenges were building a facility on-time and on-budget, public relations, and perhaps some systematic changes that the Board of Managers, the C suite, or the staff might deem advisable. I misunderstood the situation because I could not know what I did not know. When you made the decision to go into medicine and to serve the under-represented at Parkland, you didn’t know about the impact of CMS, CAP, DSHS, DOJ, and, for that matter, DMN. You did it to serve the patients, and serve them you have! We share a deep love for these United States and a devotion to her. Similarly, there is a love and devotion to Parkland that runs deep in our community. You can see it in the faces of the families she has served and hear it in the voices of the 40 percent of our Dallas County Medical Society members who trained here. Patriotism, in the words of Adlai E. Stevenson, “is not [the] short, frenzied outbursts of emotion, but the tranquil and steady dedication of a lifetime.” Patriotism, while extremely noble and virtuous, is less rare than heroism in pursuit of patriotic ideals. Heroism is defined as an act of great courage, especially as exhibited in fulfilling a higher purpose or attaining a noble end. As Calvin Coolidge said, “Heroism is not only in the [person], but in the occasion.” This is the time for heroes. This is a time for heroism. For over 100 years, Parkland has been a pillar of strength for the people of North Texas and beyond. The last year and a half have been Parkland’s hour of need. Hard choices were made and careers were impacted. For those people who have separated from Parkland over the last year and a half, I hope their legacy will not be defined by these tumultuous times and the decisions and actions that created them. That would be an unfair portrayal of dedicated professionals who furthered public health and whose contributions are greater than our temporal situation. We will be forever linked to the next CMS inspection and immediate future that follows. For this is not just Parkland’s hour of need, it is your finest hour. Over the last 18 months, you have repeatedly fought for Parkland, for each other, and for your patients and, as JCAHO made clear — you are winning! There is strong physician engagement at Parkland, a sense of ownership among the nurses who have benefitted from promotion from within. Mission critical cohesion at all levels of leadership is being fostered, and CAP plan efforts are becoming ingrained and internally driven. Telling, JCAHO found three National Best Practices. Parkland will survive and thrive. You know it and I know it! That will happen because of you and the employees of this great institution. You are our community heroes. As a person and a Parkland patient and on behalf of the 2.4 million residents of Dallas County, thank you for your shared sacrifice to Parkland and public health, your courage and devotion to your patients, and your support for Parkland and for each other.

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