San Antonio Medicine May 2017

SAN ANTONIO

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Generational Perspectives

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Medicine across generational borders

By Shaoli Chadhuri .......................................14 Multigenerational Medicine: The First Generation By Adam Ratner, MD .................16

Keeping medicine in the family: A fatherdaughter medical practice

By Harmon Kelley, MD ..................................22

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BCMS President’s Message ..........................................................................................................8 BCMS Alliance.........................................................................................................................................10 BCMS Legislative News ..........................................................................................................................12 BCMS News.............................................................................................................................................24 Feature: India Trip: Chalo! Chalo! By Prachi Shah ..................................................................................26 Legal Ease: You’re bumped. Now what? By George F. “Rick” Evans, Jr., ..............................................30 Business: Run a compliant medical practice By Norman Paul, Jr., JD .................................................32 Circle of Friends Directory .......................................................................................................................36 In the Driver’s Seat...................................................................................................................................43 Auto Review: 2017 BMW X4 By Steve Schutz, MD ................................................................................44

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Generational Perspectives

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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Leah Jacobson, MD, President Adam V. Ratner, MD, Vice President Sheldon Gross, MD, President-elect Jayesh B. Shah, MD, Immediate Past President Gerald Q. Greenfield Jr., MD, PA, Secretary John Robert Holcomb, MD, Treasurer

DIRECTORS Rajaram Bala, MD, Member Lori Boies, PhD, BCMS Alliance President Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member George F. "Rick" Evans Jr., General Counsel Vincent Paul Fonseca, MD, Member Michael Joseph Guirl, MD, Member John W. Hinchey, MD, Member Col. Bradley A. Lloyd, MD, Military Rep. Rodolfo Molina, MD, Board of Mediations Chair John Joseph Nava, MD, Member Gerardo Ortega, MD, Member Robyn Phillips-Madson, DO, MPH, Medical School Representative James E. Remkus, MD, Board of Censors Chair Ronald Rodriguez, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative David M. Siegel, MD, JD, Member Bernard T. Swift, Jr., DO, MPH, Member

CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer

CHIEF OPERATING OFFICER Melody Newsom Alice Sutton, Controller Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director

COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Carmen Garza, MD, Community Member Kristi Kosub, MD, Member Lauren Michael, Medical Student Sara Noble, Medical Student Fred H. Olin, MD, Member Jaime Pankowsky, MD, Member Alan Preston, Community Member Adam Ratner, MD, Member David Schultz, Community Member J.J. Waller Jr., MD, Member Jane Yoon, Medical Student

6 San Antonio Medicine • May 2017

PRESIDENT’S MESSAGE

Happy Mother’s Day — Assessing Women’s Issues

By Leah Jacobson, MD, 2017 BCMS President

May is a time to celebrate the women in our lives — our mothers, grandmothers, sisters, wives, and daughters. At this time, it is important for physicians to reflect on the many important health topics that affect women just as much, if not more than, their male counterparts.

According to Dr. Flavia Bustreo, Assistant Director General for Family, Women’s and Children’s Health, World Health Organization, the top issues for women's health in 2015 were and are still: Cancer: Two of the most common cancers affecting women are breast and cervical cancers.

Reproductive health: Sexual and reproductive health problems are responsible for one third of health issues for women between the ages of 15 and 44 years.

Maternal health: Women are now benefitting from massive improvements in care during pregnancy and childbirth introduced in the last century. But those benefits do not extend everywhere and in 2013, almost 300,000 women died from complications in pregnancy and childbirth.

HIV/Sexually transmitted infections: Three decades into the AIDS epidemic, it is young women who bear the brunt of new HIV infections. It is important to protect against HIV and human papillomavirus (HPV) infection (the world’s most common STI). It is also vital that we do a better job of preventing and treating diseases like gonorrhea, chlamydia and syphilis. Untreated syphilis is responsible for more than 200,000 stillbirths and early fetal deaths every year, and for the deaths of over 90,000 newborns.

Violence against women: Women can be subject to a range of different forms of violence, but physical and sexual violence — either by a partner or someone else — is particularly insidious. Today, one in three women under 50 has experienced physical and/or sexual violence by a partner or non-partner.

Mental health: Evidence suggests that women are more prone than men to experience anxiety, depression, and somatic complaints.

Depression is the most common mental health problem for women and suicide a leading cause of death for women under 60.

Non-communicable diseases: In 2012, some 4.7 million women died from non-communicable diseases before they reached the age 8 San Antonio Medicine • May 2017

of 70 — most of them in low- and middle-income countries. They died as a result of road traffic accidents, harmful use of tobacco, abuse of alcohol, drugs and substances, and obesity — more than 50 percent of women are overweight in Europe and the Americas.

Helping girls and women adopt healthy lifestyles early on is key to a long and healthy life.

Being young: Adolescent girls face a number of sexual and reproductive health challenges: STIs, HIV, and pregnancy. About 13 million adolescent girls (under 20) give birth every year.

Getting older: Having often worked in the home, older women may have fewer pensions and benefits, less access to health care and social services than their male counterparts. Combine the greater risk of poverty with other conditions of old age, like dementia, and older women also have a higher risk of abuse and generally, poor health.

In the United States, the Department of Health and Human Services, has developed the Healthy People (HP) 2020 (HP 2020) initiative which provides science-based, 10-year national objectives for improving the health of all Americans. Healthy People 2020 has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors; empower individuals toward making informed health decisions; measure impact of prevention activities.

Women and girl’s health goals are addressed in sixteen of the 42 topic areas of HP 2020. Some of the women and girls’ objectives for the HP 2020 initiatives include: • Arthritis, Osteoporosis, and Chronic Back Conditions (Reduce hip fractures among older adults), Cancer (Reduce the female breast cancer and cancer of the uterine cervix death rates, increase the proportion of adults who were counseled about cancer screening consistent with current guidelines), • Environmental Health (Reduce exposure to selected environmental chemicals in the population, such as mercury and lead), • Family Planning (Increase the proportion of pregnancies that are intended, reduce the proportion of females experiencing pregnancy despite use of a reversible contraceptive method, and increase the proportion of adolescents who received formal

PRESIDENT’S MESSAGE

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instruction on reproductive health topics before they were 18), Heart Disease and Stroke (Increase aspirin use as recommended among adults with no history of cardiovascular disease in Women aged 55 to 79 years), HIV/AIDS (Reduce the number of perinatally acquired HIV and AIDS cases, increase the proportion of adolescents and adults who have been tested for HIV in the past), Immunization and Infectious Diseases (Increase routine vaccination coverage levels for adolescents- Human papillomavirus vaccine (HPV) for females by age 13 to15 years, increase the proportion of children and adults who are vaccinated annually against seasonal influenza), Injury and Violence Prevention (Reduce violence by current or former intimate partners , and reduce sexual violence), Maternal, Infant, and Child Health (Reduce the rate of maternal mortality, reduce maternal illness and complications due to pregnancy, increase the proportion of pregnant women who receive early and adequate prenatal care), Nutrition and Weight Status (Reduce iron deficiency among young children and females of childbearing age), Older Adults

(Increase the proportion of older adults who are up to date on a core set of clinical preventive services.), • Sexually Transmitted Diseases (Reduce the proportion of adolescents and young adults with Chlamydia trachomatis, gonorrhea, syphillis, and human papillomavirus (HPV) infections), • Tobacco Use (Increase smoking cessation, in general, but particularly during pregnancy). ** Closer to home, women in Bexar County definitely struggle with all of the issues already mentioned in this article. Two medical diagnoses particularly prevalent in our area are obesity and type 2 diabetes mellitus. It is imperative that we, as physicians, spouses, daughters/sons, mothers/fathers, continue to discuss the importance of healthy living (diet, exercise, etc.) with our patients and our female family members to ensure that they live long and happy lives.

I want to wish all the women in our lives a very happy Mother's Day! **For more information on HP 2020, please visit www.healthypeople.gov

visit us at www.bcms.org

9

BCMS ALLIANCE

BCMS ALLIANCE GIVES BACK!

By Lori Boies, BCMS Alliance President

In late 1917, the world was entangled in World War I, spurring

2017! On March 26, we participated in the Spring Siclovia to pro-

the inception of the Bexar County Medical Society Alliance —

vide and fit 400 helmets, free of charge, to any child not wearing a

named the Auxiliary at the time — which first met on Oct. 29, 1917

bicycle helmet. We have been partnering with the YMCA’s biannual

to make surgical dressings for the local Red Cross. The ladies who

city-wide free event, Siclovia, for the past several years, and it was

started the BCMSA were focused on creating a better and healthier

so rewarding to see so many red, black, and white TMA helmets on

community. The mission of the Alliance is “to create fellowship

the heads of children as they biked — both previously and newly

among families of physicians and to foster activities in benevolent,

given away! A family even came by with their children to say thank

philanthropic, charitable, and patriotic endeavors.”

you for the helmets we gave them last year and to show off how well

One hundred years later, in 2017, we are busy working towards

they have held up! Through our efforts, we are making an impact

these goals! Our Junior Volunteer Council (JVC), which is com-

to prevent traumatic brain injuries (TBIs) and death in San Antonio

prised of teenage children of BCMS and BCMSA members, made

children. Wearing a bicycle helmet can prevent up to 85 percent of

a spaghetti dinner at one of San Antonio's Ronald McDonald

TBIs and deaths for those involved in a bicycle accident! In addition

Houses. The teenagers had a wonderful experience gaining basic

to our Hard Hats for Little Heads initiative, the BCMSA will be

cooking skills (great preparation for college!) while also serving oth-

partnering with Metro Health to increase education and awareness

ers in their time of need. JVC members were also instrumental in

for the HPV vaccine, the ONLY vaccine that prevents cancer!! For

helping Alliance members fit and distribute bicycle helmets at San

more information about our community outreach, please contact

Antonio's biannual Siclovia event. Our Junior Volunteer Council,

Valerie! Vhinojos78@yahoo.com

led by BCMSA member Liz Wilson Huang, meets monthly to give

We are committed to not only providing camaraderie and bond-

back to the community through a myriad of volunteer activities, as

ing opportunities for our members, but also making an impact in

well as social events. If you have a teenager who is interested in join-

our community through volunteering and giving back! We would

ing the JVC, please contact Liz! edwilson4six44@gmail.com

love for you to join us, and we have something for everyone! You

Alliance members also raised thousands of dollars in the first three months of 2017 to purchase bicycle helmets from the TMA Foun-

can always see the latest news, invites, event pictures, etc. at www.facebook.com/BCMSAlliance.org

dation as part of the Hard Hats for Little Heads initiative. We raised funds with wonderful raffle prizes (kindly donated by our members)

Warm Regards,

at the New Members’ Luncheon and a Stella and Dot shopping

Lori Boies

event where all the net proceeds were donated thanks to our gener-

2017 President – Bexar County Medical Society Alliance

ous VP of Civic and Philanthropic, Valerie Garrison. Our goal is to

*Our Centennial Year!*

give away 1,000 bicycle helmets to the children of San Antonio in

www.bcmsalliance.org

10 San Antonio Medicine • May 2017

BCMS LEGISLATIVE NEWS

BCMS physician, Alliance and medical student members advocate on medicine’s issues during April First Tuesdays

By Mary E. Nava, MBA, Chief Government Affairs Officer and Lobbyist At the time of this writing, there were just under 50 days left in the 85th Legislative Session. BCMS members have been working tirelessly on behalf of medicine to walk the halls of the Capitol during First Tuesdays, testify in committees, drop cards in support or against bills and make contact with legislators' offices via email and phone calls. Special thanks go out to the following physician and Alliance members who attended the April 4 First Tuesdays visits last week: Physicians: Leah Jacobson, MD, BCMS President; Dan Deane, MD; John Edwards, MD; Pam Hall, MD; David Henkes, MD; James Humphreys, MD; Alex Kenton, MD; Jesse Moss, Jr., MD; John Nava, MD; Jayesh Shah, MD and Ryan Van Ramshorst, MD. Alliance members: James Duerr; Danielle Henkes and Jennifer Lewis.

In addition, over 140 students and residents participated in the April First Tuesdays, of which about a dozen were from San Antonio.

Among the topics discussed with legislators and their staff were: State budget; Medicaid; public health; GME; surprise billing; expanded mediation; health plan network directories; medication step therapy; parents' right to know about vaccine exemptions; mental health and substance abuse; raise tobacco use age to 21; telemedicine; maintenance of certification, virtual credit cards and scope of practice.

The last First Tuesdays is May 2. To register, visit www.texmed.org/firsttuesdays.

For local discussion on these and other legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava, BCMS chief government affairs officer and lobbyist by email at mary.nava@bcms.org.

12 San Antonio Medicine • May 2017

BCMS physician and Alliance members and staff pause for a photo with Rep. Diana Arevalo (House District 116) during the April 4 First Tuesdays visit to the Capitol.

Standing l-r, back row: James Duerr; Mary Nava; Dan Deane, MD; Ryan Van Ramshorst, MD and Jesse Moss, Jr., MD. Front row (lr): Leah Jacobson, MD; Pam Hall, MD; Arevalo and Huyen Nguyen, MD. BCMS physician and Alliance members meet with Jon Schnautz, general counsel in the office of House Speaker Joe Straus (Dist 121) on April 4 during the First Tuesdays visit to the Capitol.

BCMS physicians and Alliance members visit with Rep. Roland Gutierrez, (Dist. 119) (center) and legislative aide, Paola Pina (standing) during First Tuesdays on April 4.

From (l-r) are: David Henkes, MD; Danielle Henkes; Jennifer Lewis; Pina; Gutierrez; and Alex Kenton, MD.

Physician and Alliance members pause for a photo with Sen. Donna Campbell (Dist 25) on April 4 during First Tuesdays. Standing (l-r) are: Danielle Henkes; Jennifer Lewis; David Henkes, MD; Pam Hall, MD; Campbell; Joel Dunnington, MD; Dan Deane, MD and James Deurr.

GENERATIONAL PERSPECTIVES

EDITOR’S NOTE: In the May and June issues of San Antonio Medicine we will be featuring articles by local doctors or medical students who come from families with multiple generations of physicians. The stories look at both the knowledge and experiences passed down from prior generations and the influence that has been passed on to subsequent generations. If you would like to submit an article about your family please send it to Mike.Thomas@bcms.org and it may be published in future issues of the magazine.

MEDICINE ACROSS GENERATIONAL BORDERS

By Shaoli Chaudhuri

When I was first exploring medical schools in the summer of 2013, I clicked through websites, browsed the colorful pamphlets, and I knew without a doubt that I wanted to get a dual MD-MPH degree. I had always had an interest in the social determinants of health and in global and immigrant health. I was fascinated to learn more about tropical medicine and primary care. And it’s funny to look back on that summer and realize my ideas did not start with me at all — they started two generations back.

My Dadu (i.e. maternal grandfather) grew up an ocean and continent away from Texas, in Benapur, India. Benapur is a lush, green village that sits along a river. It is known more for its rice paddies and excellent fish than its medical training. At the time, my Dadu’s family lived in a poor neighborhood and he became the second in his family to go to college. With the encouragement of his brothers, he matriculated into medical school in the bustling city of Kolkata, India. For the next 28 years, he worked as a general practitioner for the Indian railway and became fascinated with transfusion medicine and pathology in the process.

14 San Antonio Medicine • May 2017

He acted as a doctor of the community, first and foremost, seeing adults and children alike in rural India.

I learned just recently, that Dadu obtained a diploma in tropical medicine and infectious disease — merely because he found it interesting. Every time I traveled to India and spoke to Dadu about health or medicine or really any topic, he would bring up the subject of social medicine. “Here in India,” he would say, “you have to learn about these things in medical school. We all take a class on social medicine, determinants of health, how to prevent disease in people.”

And I thought to myself, He gets it. He understood what some physicians and peers do not always acknowledge: that public health can be critical in guiding your individual practice of medicine. In fact, I think he was the one who taught me that, though I never really knew it until I reflected on it.

Then came my mother, Swapna. My mother was born into a life not unlike mine. Like me, she was the eldest child and grew up with a physician-parent (I grew up with two!), and was never made to

GENERATIONAL PERSPECTIVES

feel that as a girl, she was any less capable or brilliant than a boy.

And in 1960s India, that is saying something. She always knew she wanted to do medicine and Dadu encouraged her. Women could do anything a man could do, she was told. And so she excelled.

Some people get their MDs — my overachieving parents got their MDs, then their PhDs. Women in India did pediatrics or OB — my mom did anesthesia all the way in America, to boot. She and my father took the FMGEMS, the entrance exam foreign medical graduates had to take in the 1980s, a test that was significantly more difficult than the exam Americans took: and she and my dad passed with flying colors. In India, she couldn’t and didn’t rely on tests to diagnose patients — she used her history and physical. And although she was not in primary care, she still brings humanity to her work every single day. A few years ago, she had a 16-year-old patient about to donate bone marrow to his sick brother. But her patient was petrified and no amount of emotional blackmail from his family could persuade him to change his clothes and prepare for anesthesia.

But my mom got through to him. Maybe it was experience, maybe she saw me or my sisters in the patient, whatever the case: she brought humanity to the situation and the procedure was a success.

While my Dadu taught be about social medicine, my mother has taught me about resilience and how to be a leader. She traveled thousands of miles from the people she loved to practice medicine in a brave new (cold) Midwestern world. She traded West Bengali for unfamiliar Toledo, Ohio, and then El Paso, Texas. She and my dad, also an anesthesiologist, have seen children die on the operating table, encountered racism from patients, uprooted their comfortable lives in India to make a new life and family for me and my two sisters. And through it all she has served as the chair of an anesthesia department, a residency program director, and a kickass full-time mom and full-time physician.

I can’t neglect to mention my father though. My dad is the definition of a go-getter. From a poor community in Kolkata and help-

ing to support a single mother, he became a social activist and physician. He traveled all he could and gave back even more, did disaster relief with Mother Teresa herself in response to a mudslide.

My dad was the first to tell me about Doctors without Borders and I’ve always thought he could easily fit that title himself.

These are the doctors who came before me and shaped who I am today. They taught me resilience even though I myself never had to be an immigrant or live an impoverished life. They taught me humility. They taught me to reach for the stars and not compromise who I am. They taught me to care about people’s health — their whole health — where they come from, the barriers they face, the struggles they’ve had to overcome to be in clinic or defy a disease. If I fancy myself a trailblazer, it’s only because my grandfather and parents carved the trail out to begin with.

In four short months, I will stand on a stage, sit through speeches (attentively), and become a physician. I am completely excited to be going into internal medicine, ready to help and heal people of all backgrounds. But I am also scared. I am scared of the long hours, I am scared of the emotion and stress that comes with internship and losing your patients. A year and a half ago, I lost my Dadu to prostate cancer. It was prolonged and painful in spite of our family’s best efforts, in spite of my mom flying back and forth to India and tending to him. Before that, Dadu was the healthiest, most energetic 80-plus-year-old I’ve ever known. It is never easy seeing someone fall so precipitately.

I know though, that scared as I may be, in spite of the challenges behind and before me, I am still my family’s child: motivated, social-activist-y, humanitarian-advocating, detailed, resilient child of immigrants ready to spot borders and cross them.

Shaoli Chadhuri is a fourth-year medical student at UT Health in San Antonio. visit us at www.bcms.org

15

GENERATIONAL PERSPECTIVES

MULTIGENERATIONAL MEDICINE: THE FIRST GENERATION

By Adam Ratner, MD I call medicine our family genetic disorder. Of my parents, aunts and uncles, only two were not medical professionals. My sister, Emily, and I are both physicians and a large percentage of my cousins and their spouses are physicians, nurses or other health professionals. Our daughter is a medical student.

All of my grandparents and their siblings were refugees from eastern Europe who came to this great country more than a century ago.

They came with no money, no college education and little more than the clothes on their backs. They initially didn’t even speak English but they had vision, drive and determination. My paternal grandfather wanted to become a physician but circumstances did not allow this as he had to work hard to support himself and his family. As a young child, I remember him saying to me that my father and physicians in general had the most important job on earth (as healers) and that they were “next to God.” My paternal grandmother, who was a seamstress, passed away when my father was a teenager. My father explained to me that this tragedy motivated him to become a diligent student so that he could ultimately become a physician. His mother taught him to sew, which also strongly influenced his later decision to become a pediatric surgeon.

A few words about my father, Irving A. Ratner, MD: My father loved his work. He was born and grew up in Boston.

He attended the University of Massachusetts in Amherst and then Tufts Medical School in Boston. He obtained his post-graduate training in Pediatric Surgery at the Boston Floating Hospital under the supervision of Dr. Orvar Swenson, a founder of the medical specialty. He first came to San Antonio during the Korean War, courtesy of the Air Force, to train as a flight surgeon.

After completing his tour of duty and his specialized medical training he returned to San Antonio in 1961 to establish himself as the first pediatric surgeon in the region. During the more than 45 years of his practice in San Antonio, he touched the lives of tens of thousands of young patients and their family members. He served as both a teacher and role model to many physicians including my sister and I and other relatives.

Back in the pre-HIPAA, pre-ID badge days, he used to take me to the hospital to make rounds with him. He never overtly pressured 16 San Antonio Medicine • May 2017

my sister and I to become physicians but he instead immersed us in the culture of our profession and let us decide for ourselves.

He truly believed that his patients and their families came first and dedicated his life to their service and training others to do the same. He trained many physicians, both civilian and military, and served as the Chief of Surgery at the Santa Rosa Children's Hospital for many years. He also practiced in the Baptist, Methodist and University Hospital systems and was a long-standing member of the Bexar County Medical Society. At the end of his life he was the oldest practicing pediatric surgeon in the U.S. and Canada, and we suspect in the world.

He was a private pilot and flew to underserved parts of Texas and Central America where he took care of patients and educated local physicians who did not have access to the level of medical care he could provide. He also enjoyed flying his family around the state, the country and the northern hemisphere on the relatively few vacations he allowed himself to take.

As was his wish, he passed away while working in the hospital, making rounds on his patients.

A man of energy and passion, great wisdom and insight, love and impeccable integrity, he earned the great respect of those he touched.

He lived on his terms: A healer and a teacher until the last moment of his life.

A few words about my mother, Dr. Joan Ratner: She calls herself a child of the depression. She was born in 1928 in Brooklyn, N.Y. to Abraham and Sadie Jackler, both immigrants from eastern Europe. She had an older brother, Jacob, or Jack as he was called. Jack was much older than Mom and ultimately became a cardiologist in Maine (see below).

One of the consequences of the economic hardships of the depression was that Mom and her family moved around the country following work opportunities for my maternal grandfather. They went from Brooklyn to Maine, then to Georgia and then to Holyoke, Massachusetts, where she lived prior to entering the University of Massachusetts in Amherst. She was a very good student but met and was attracted to my Dad, because he was a great student and he tutored her in physics. One thing led to the other and they were ultimately married. They moved to Boston where Dad went

GENERATIONAL PERSPECTIVES

Photos clockwise from above: Irving and Joan Ratner at their wedding Living first generation medical family members in mid 2000s: Standing: (Aunt) Betty Levitt, RN, (Uncle) Herbert P. Brown, MD, (Aunt) Sylvia Brown, RN. Seated: (Mom) Joan J. Ratner, PhD, (Dad) Irving A. Ratner, MD Dr. Irving A. Ratner and Myrna Talamontez, RN in the first specialized pediatric OR in San Antonio at Santa Rosa Childrens Hospital

to medical school and trained as a surgeon while she worked in medical laboratories. They traveled through Europe, Newfoundland and Randolph Air Force Base courtesy of Dad's surgical fellowships and the U.S. Air Force.

After a particularly bad winter in Boston, Dad was recruited to move to San Antonio by Dr. Howard Britton, bringing Mom, her mother, Sadie, and me (at the age of about 18 months). Mom was pregnant with my sister Emily during the move from Boston to San Antonio. While raising the children, Mom worked part-time at what was previously called Southwest Foundation (where the baboons on Loop 410 lived).

When Emily and I were in middle school, Mom decided that she wanted to advance her academic training. She enrolled in a masters of science program at Trinity University. While still working and raising us, she received her master’s degree after four years. She then enrolled at UTHSCSA (now UT Health San Antonio) and received her PhD in microbiology at the age of 50. Mom, now Dr. Ratner, went on to teach and research in the Department of Microbiology at UT Health San Antonio for the next quarter century. She helped teach microbiology to a significant proportion of the physicians, dentists

and dental hygienists who now practice in South Central Texas.

Mom was a pioneer and a role model for many women after facing and fighting discrimination. After learning that she was going to get her Ph.D., she was criticized by both friends and acquaintances for damaging the futures of her children and not supporting her busy husband by going back to school. At the same time, Dad was challenged by friends and colleagues who would ask how he could "allow" his wife to go back to school. Both Dad and Mom stood together. It's hard to imagine now, but times were very different four decades ago.

Mom mentored many younger women in science and was the founding president of the Women’s Faculty Association at UTHSCSA. After a quarter century of teaching at UT, she retired and went to work part-time in Dad's Pediatric Surgery practice. She worked there until Dad passed away, roughly three years later.

Mom was one of the co-founders of The Patient Institute, a nonprofit organization founded in honor and memory of Dad and his dedication to his patients and their families. She continues to support the organization and still attends the board and executive committee meetings — a dedicated leader to this day.

Continued on page 18 visit us at www.bcms.org 17

GENERATIONAL PERSPECTIVES Continued from page 17

Photos (L-R) Medical Staff Leadership of Sisters Hospital in Waterville Maine, Dr. Jack Jackler seated on right.

Joan Ratner working in a Boston microbiology lab in the early 1950s.

A few words about my uncle, Jacob (Jack) Jackler, MD (courtesy of my cousins Margot Flowerman and Robert Jackler, MD): Our grandparents Abe and Sadie lived on Hester Street in New York City and ran a vacuum cleaner factory. They had two children, a son, Jacob (Jack), born in 1923 and daughter Joan born in 1928.

By the time Joan was born, the family had moved to Brooklyn.

Jack spent his middle school and high school years in Holyoke, Mass., where his parents moved in 1933. (When Abe’s printing business failed during the Depression, Sadie’s brother-in-law helped the couple set up a store and deli in Holyoke. An honor role student, Jack won a local American Legion Oratorical Contest on the subject “Personal Liberties as a Safeguard under the Bill of Rights.” He graduated from Holyoke High School class 1940.

After high school, Jack attended Mass State College, now called the University of Massachusetts (Amherst). Jack was in the Army Service Training Program (ASTP) at Mass State leading to medical school. In an era of “Jewish quotas,” Jack applied to medical school and did not get in at first.

World War II interrupted Jack’s education in 1943. He was briefly assigned to engineering school in New York, but the program terminated in about three months. He was then enrolled in infantry.

He initially wanted to be a paratrooper. He did basic training in Shelby, Mississippi and eventually shipped out overseas, initially to

18 San Antonio Medicine • May 2017

England and later to Germany.

Jack was a member of the famed 69th Infantry Division, which made the historic first contact with the Soviet Forces at Torgan in the heart of Germany. He was tasked with authoring the official history for his unit. He fought in the famous Battle of the Bulge and rose to the rank of staff sergeant. Later in the army, he taught in the northern city of Bremen.

After the service, taking advantage of the G.I. Bill, he resumed his education at Boston University. He received his medical degree from Boston University School of Medicine in 1951, serving his residency at Boston City Hospital and the New England Medical Center, where he had a U.S. Public Health Service fellowship in cardiac medicine.

Jack specialized in internal medicine and cardiology. After an internship and residency at Boston City Hospital, he became chief resident. He was also cardiac fellow at Pratt Diagnostic Hospital in Boston. Later, he returned to Boston University as a member of the faculty. Tiring of both academic politics and Boston’s congested traffic in the pre-freeway era, he and his wife, Lynn, sought an opportunity in a small New England College town. Jack opened his practice in Waterville, Maine, home of Colby College, in 1955.

Jack and Lynn moved to Waterville, Maine in 1955, where he specialized in internal medicine and cardiology. Jack and Lynn developed a circle of friends on the Colby faculty, joined discussions of

the great books, and hosted students for holidays.

Jack joined the medical staffs of Thayer and Sisters hospitals and was involved in the Mansfield Clinic. As the only cardiologist in Central Maine, Jack was rapidly successful in his practice. Colleagues looked to him for consultation with their most complex medical problems. As there was no psychiatrist in town, and he was willing to take on patients with major psychiatric components to their illness, he helped many of the community’s more challenging patients. He was an advocate for public health championing among other initiatives, adoption of the new polio vaccine. Jack frequently took his son Robert on weekend rounds with him leaving him, as a small boy, to be doted upon in the nurse’s station where the inevitable question was “will you become a doctor like your dad?”

For a private practice physician, Jack was a prolific author.

Over his short career in Waterville, he contributed six articles to the Maine Medical Journal. His contributions spanned his primary specialty in cardiology (eg. Wolf Parkinson White syndrome) but also more fundamental issues such as end of life care and discrepancies in laboratory reports.

In March 1963, Jack (age 39) noticed an unusual ecchymosis where his medical bag rubbed his leg. Checking his own blood smear, he diagnosed his own acute myelogenous leukemia. In this infant era of hematologic malignancy therapy, he died during induction chemotherapy at Tufts which was likely nitrogen mustard induced thromobocytopenia resulting in a cerebral hemorrhage . . . less than a week after his self-diagnosis.

At the time of his memorial, he was eulogized as a brilliant diagnostician, compassionate caregiver, dedicated family man, and a humanitarian who made generous contributions to his community. The back rows of the packed synagogue were occupied by dozens of nuns, nurses from Sister’s Hospital, who needed to obtain special dispensation from the bishop to attend. A short time before his death he had been named Chief of Medicine of the Seton Hospital then under construction. This facility has a room dedicated to his memory.

Adam V. Ratner, MD is Chairman of The Patient Institute, Vice President of BCMS, Clinical Professor of Radiology and The Stewart and Marianne Reuter Endowed Professor of Medical Humanities at UT Health San Antonio.

visit us at www.bcms.org

19

GENERATIONAL PERSPECTIVES

Following a time-honored tradition to

wear the white coat

By Heidi Held McDonald

My grandfather is a retired neurosurgeon.

My mother is a practicing ophthalmologist.

My sister is a dermatology resident. I am a fourth year medical student. Each one of us is traversing a different phase of the extraordinary journey through a physician’s life: student, resident, practicing, retired. Each of us appreciates, respects, and is devoted to our patients, colleagues and profession. Each is humbled by the great privilege of working in service of others, especially in their times of greatest need. Each one of us offers unique perspective and wisdom about our profession.

When my grandfather graduated from Vanderbilt Medical School in 1955, there were only two women in his class, patient notes were penned on paper, and the first brain had yet to be scanned. Thirty years

20 San Antonio Medicine • May 2017

later, my mom’s graduating class from the University of Texas Medical School at San Antonio, included over twenty percent women, and she was considered bold to pursue a surgical specialty. In recent years, my sister and I experienced a new era in medical training. Women comprise approximately half of our medical school classes and are going into any and all specialties, notes are keyed into computers, and our etext books and iPhones overflow with breakthrough treatment options.

Our generation faces new challenges, however, including the enormous emphasis on national board exams, and a constant tug in two directions — at one end of the exam room we find our patient, and at the other, we are tasked with the tedious and time consuming aspects of electronic medical record documentation.

In light of my family’s time-honored tradition, highlighted by professional fulfillment and exponential medical progress, I was

GENERATIONAL PERSPECTIVES

shocked to discover a darkening cloud of negativity and pessimism insidiously permeating from the waiting room down the clinic hallway and hovering over the exam room, operating room, and hospital bed. As a medical student, the complaints of those working around me — attendings, residents, nursing staff, and fellow students — took me aback at first. I had devoted the first 21 years of my life diligently pursuing a life in medicine. We all know what it entails to attain that coveted spot in medical school. I was jubilant, optimistic, and ready to roll up my sleeves and take on the world.

Why was everyone upset? How did things get this way?

Is it going to change? Is being a doctor still what I dreamed it would be?

Growing up I knew that becoming a physician would be difficult. I saw my mother and sister make countless sacrifices in order to wear their white coats. Teachers, friends, and even some family members tried to persuade me to pursue other career paths, admonishing me there were more “efficient” ways to make a living. But in my opinion, there was no better reason to sacrifice than for the sick. Doctors get to use their God-given gifts to help heal the bodies and restore the spirits of our patients. Being a good doctor requires intelligence, determination, and a love of science, but being an excellent doctor requires true love and compassion for humanity and a steadfast dedication to serving the sick. We must remember that being a doctor is a noble profession, even when the world may paint us in a negative light. In so many ways, technology has saved patient’s lives, but it can also serve as a blockade in the doctor-patient relationship. We must look up from our screens and into the eyes of our patients. We must take our fingers off the keys and place our hands on the patients.

We can choose to succumb to the negative attitudes circulating and metastasizing throughout the body of medicine, emanating from both doctors and patients, complaining and waning in perpetual, pathologic rhythm, or we can answer the call to stand up for our profession and remember the Hippocratic Oath. If we don’t believe that there is hope and joy in what we do, then how can we expect our patients or the world to see it? I want to share a few prophetic words from a speech my wise physician grandfather gave in 1990 (the year I was born) that ring piercingly true today: “In these times, when an unbridled technical Utopia threatens to eliminate totally the personal doctor-patient relationship, caring and compassion must constantly be a foremost quality in our practice— we must see and feel each individual patient’s disease as if we suffered from it ourselves. We must not only understand the symptoms of organ dysfunction and the pain that the disorder calls forth, but we

must sense and be truly sympathetic to the social, economic, and psychological impact that disease has upon our patients and their families. We must find ways to communicate our feelings effectively.

We must restore hope where possible; we must console when our treatment fails.” (1) I recently text messaged my grandfather and asked him for “tips” for being a good physician, he immediately texted back: “Tips: Listen to your patient with genuine interest. Remember Dr. Thomas Brown’s advice and the admonition of Sir William Osler. -JLS” While our perspectives are unique and our medical school graduations are separated by 62 years, my grandfather, mother, sister, and I now communicate on a higher level through the shared language of medicine and are bound together by an unbreakable spirit woven of scared knowledge, passed from one generation to the next, acquired through a rite of passage endured by rare few, and appreciated by fewer. In this tradition, I will heed Grampa Jim’s tips, generational wisdom, and I will proudly and confidently listen to my patients with genuine interest, resist the unbridled technical Utopia, and fight to preserve the patient-physician relationship through caring, compassion, understanding, and communication. I will restore hope and console others even when I fail. I pray I am able to do this for my children, theirs, and many generations to come. If I don’t, who will?

References: 1) Story, J. (1990). Misericordia Medici. Neurosurgery, 27(6), 946-953.

Heidi Held McDonald is a fourth year medical student at UT Health San Antonio. visit us at www.bcms.org

21

GENERATIONAL PERSPECTIVES

Keeping medicine in the family: A father-daughter medical practice

By Harmon Kelley, MD

As I look back on my career as an obstetrician and gynecologist, I am reflective about how fulfilling it has been to have been a doctor.

Though there have been many changes in medicine, especially in regards to technology, some as aspects, such as establishing care and trust with a patient, have not changed. As opposed to when, I began my educational course to become a physician; there are so many more opportunities for my daughter, Margaret.

In 1967, I graduated from Prairie View A&M University and I matriculated to The University of Texas Medical Branch in Galveston. Until 1965, UTMB had been the only medical school in Texas that would admit black students. The University of Arkansas had admitted its first students in 1948 and Baylor College of Medicine had admitted its first black student in 1965. When I graduated from UTMB in 1971, there were only two black students in the medical school. Though early in my course of study, I felt alone and isolated, I was fortunate to have a group of fellow white classmates who befriended me and invited me to join their fraternity. I will always be grateful for their true act of friendship. Over the years, because of my gratitude for the opportunity that UTMB afforded me, I have served on the Alumni Board of Trustees of UTMB and Chairman of UTMB’s Minority Advisory Council. In addition, my wife and I have established a Presidential Endowed scholarship for a Prairie View A&M University graduate who matriculates to UTMB. My wife Harriet, daughters, Jennifer and Margaret and I moved to San Antonio in 1978, after I completed my obstetrics and gynecology residency and military commitment. I opened my practice in the Southeast area next to Southeast Baptist Hospital, where it has remained for 39 years. My good friend and colleague, James Hadnott, MD, advised me in establishing my practice.

In 2002, my daughter Margaret joined my medical practice. She too is an obstetrician and gynecologist. It has been a unique relationship being father and daughter, but also colleagues. It has been so rewarding to spend the last 15 years mentoring and teaching her.

Also, it has been a pleasure to pass knowledge and skills that I have accumulated onto her. In addition, it has been a joy to discuss pa22 San Antonio Medicine • May 2017

tient plans, medical articles, and most of all to operate with her.

However, it can be a challenge to be a teacher and a father. Sometimes, I have been reminded by my wife to be mindful of my tone when I correct Margaret, but overall we have made a wonderful team.

The benefits of having a child who is a doctor who works with one, is that she can help me with the medical technology changes.

Many of my colleagues of my generation, decided to retire rather that deal with the complexities of electronic records in the office and in the hospital. It is nice to have one’s personal computer tutor. She has patiently helped me with the technology advances, and therefore extended my years of practicing.

Therefore, in short, I have had a fulfilling career. I am grateful for the opportunities I was afforded. I have tried to show my appreciation by mentoring others. In addition, I have an answer when patients ask me, “Who will care for them when I retire?” I tell them Margaret will be here, and I have no doubt she will carry on the tradition of caring for my patients well.

Harmon W. Kelley, M.D., F.A.C.O.G., is an OB-GYN who has practiced in the Southeast area of San Antonio for 39 years. He is an Ashbel Smith Distinguished Alumnus of UTMB and a Bexar County Medical Society Golden Aesculapius Award recipient.

GENERATIONAL PERSPECTIVES

Following in her father’s footsteps

By Margaret A. Kelley, MD

It has been a very special experience to practice with my father, Harmon W. Kelley, MD for the last fifteen years. Often I am asked, “Did you become an OB/GYN because your dad is one?”

The answer is multifactorial.

One factor was my family’s strong educational background in the sciences. My maternal grandfather, Elmer E. O’Banion, PhD, was a physical chemist and was the head of the Natural Sciences Department at Prairie View A&M University. He was instrumental placing the first black medical students in Texas medical schools, through rigorous premedical preparation of students at Prairie View A&M, and by advocating on the students’ behalf. One of those students was my father, Harmon W. Kelley, M.D. who is a graduate of Prairie View A&M and The University of Texas Medical Branch. Therefore, I was fortunate to have a family background that was ingrained with science. After I matriculated into Brown University’s eightyear program in Liberal Medical Education I was on a path to become a medical doctor.

My parents did not pressure me to become an obstetrician and gynecologist but ironically the specialty was the one I enjoyed the most. I suppose there was a comfort level with the specialty because it was Dad’s specialty. However, what I liked about OB/GYN was that it was a surgical specialty and it was a specialty concerning women’s health. At the time, circa 1997, obstetrics and gynecology was not a popular specialty because of the malpractice crisis. Moreover, as I knew from my Dad’s experience, obstetrics and gynecology was a rigorous, laborious specialty because of the unpredictability of obstetrics. My mother ultimately encouraged me to choose obstetrics and gynecology. At the time, she told me it would be spectacular because I would be able to keep Dad current on current practice guidelines OB/GYN and because he would always be able to help and guide me. Once I made the decision Dad was thrilled.

After completing my residency at the UTHSCSA in 2002, I joined my father in private practice. It has been the best experience of my life. I had what my family called “the Kelley Fellowship,” in which my father perfected my gynecological surgical skills. More-

over, I have had the daily encouragement of someone who had my best interest at heart. In turn, I have helped my Dad with the change in technology medical practice. He has had an easier transition with use of electronic medical records than his colleagues of his generation because I was there to patiently help him.

In closing, Dad had a profound influence on me becoming an obstetrician and gynecologist. How could I not be positively influenced by his professionalism, commitment to his patients, and overall fulfillment and happiness as a practicing obstetrician and gynecologist? The joy of having the privilege to practice with him has been a blessing.

Margaret A. Kelley, M.D., F.A.C.O.G, is an OB-GYN who has practiced in the Southeast area of San Antonio for 15 years. She is a former President of the Texas Association of Obstetricians and Gynecologists.

visit us at www.bcms.org

23

BCMS NEWS

Dr. Fernando Guerra TO RECEIVE 2017 SERVANT LEADERSHIP AWARD ON JUNE 8 IN RECOGNITION OF LIFELONG COMMITMENT TO COMMUNITY HEALTH AND SERVICE Fernando A. Guerra, M.D., M.P.H., F.A.A.P., who served for 23 years as director of health for the San Antonio Metropolitan Health District, has been named the 2017 recipient of the St. Vincent de Paul Servant Leadership Award by Daughters of Charity Services of San Antonio. He will be honored during DCSSA’s 12th annual awards luncheon from noon to 1:15 p.m. June 8 at the Whitley Theological Center on the campus of Oblate School of Theology, 285 Oblate Drive.

A practicing pediatrician for more than 45 years, Dr. Guerra, 77, also had academic appointments as a clinical professor of pediatrics at the University of Texas Health Science Center and was an adjunct professor at the University of Texas School of Public Health at the Baylor College of Medicine in Houston and at the U.S. Air Force School of Aviation at the former Brooks Air Force Base. Dr. Guerra earned his medical degree from the University of Texas Medical Branch at Galveston and his Master of Public Health degree from the Harvard University School of Public Health, where he was a Kellogg Fellow.

He also served on federal advisory committees for the Secretary of Health and Human Services, including the National Vaccine Advisory Committee, the Committee for Infant Mortality, the National Children’s Study and the Advisory Committee for Immunization Practice.

In addition, he is an elected member of the Institute of Medicine and the Academy of Medicine, Engineering and Science of Texas, and is a member of the American Academy of Pediatrics, the American Medical Association and the Texas Medical Association.

“A servant-leader is someone who, like St. Vincent de Paul, first wants to serve, and is focused on the well-being of the community to which he or she belongs,” said Michael Bennett, president and 24 San Antonio Medicine • May 2017

chief executive officer of DCSSA. “Through that conscious choice of service arises the commitment to lead. We believe Dr. Guerra has modeled the servant-leader role through his lifelong commitments to the underserved in San Antonio and Bexar County and on a national and international basis.”

Dr. Guerra is the founding medical director of the Community Health Center, previously called the Barrio Comprehensive Clinic and now known as CommuniCare, a federally qualified community health center. He serves on the board of trustees for the Saint Susie Charitable Foundation, the Urban Institute and the Texas Philosophical Society, and the development board for the University of Texas Medical Branch.

He is recognized as the principal investigator in 30 trials for childhood vaccinations, and serves as a national and international spokesperson and consultant in the field of childhood immunizations, pediatrics and public health.

Dr. Guerra, who retired from practice in 2014, is married to Beverly Purcell-Guerra, a public relations professional.

Founded in 1958, Daughters of Charity Services of San Antonio is dedicated to establishing and maintaining neighborhood-based programs in south San Antonio and Bexar County, particularly for poor and vulnerable populations. Serving more than 14,000 individuals annually through early childhood education, after-school care, primary medical and dental care, counseling and social services, DCSSA has impacted hundreds of thousands of lives while charitably contributing more than $20 million to this critically needed ministry.

Tickets to Daughters of Charity Services of San Antonio’s annual awards luncheon may be obtained by calling (210) 334-2300.

FEATURE

Chalo! Chalo!

By Prachi Shah

This is the first time I joined a medical delegation from San Antonio to India. It was spearheaded by my dad, Dr. Jayesh Shah, who was at the tail end of his term as president of the Bexar County Medical Society (BCMS), and inspired by the sister medical society relationship with the counterpart in Chennai in South India. I have visited India several times with my parents as I was growing up; this visit made me look at the motherland of my parents from the perspective of a tourist in the company of 19 delegates (9 physicians and their family).

In late December 2016, the Indira Gandhi international Airport in New Delhi was as busy as Kennedy or O’Hare in U.S. The moment we stepped out I felt the difference. The organized chaos —

26 San Antonio Medicine • May 2017

security officers directing passengers, people trying to steer their loaded carts, the constant honking of horns; despite standstill traffic sometimes for 30 minutes. Chalo! Chalo! In Hindi meaning “let’s go” became all too familiar as the guides and the drivers kept our group moving.

The delgation visited two Union Territories — Delhi and Pondicherry, three states — Uttar Pradesh, Rajasthan and Tamil Nadu and historic cities like Agra, Delhi, Udaipur, Mount Abu, Chennai, Pondicherry and innumerable smaller cities and towns.

Each place had its own charm and variety, from landscape to weather, from culture to traditions, and from clothing style to food type.

FEATURE

We were greeted at the La Meridian hotel complete with lavish Christmas decorations and Santa as well. We joined the Christmas

rounded by 300 meters of impeccably manicured gardens that enhance the sense of peaceful beauty pervading the space. The Agra

party with noisy kids having a good time. Part of the delegations mission was to visit medical facilities and participate in an ex-

Fort nearby was another magnificent monument where Shah Jahan was imprisoned and from where he could see his Taj Mahal, a me-

change of knowledge. we visited the local Apollo Hospital where

morial for his favorite wife Mumtaz. Shah Jahan died before he

my dad gave a talk on ‘Clinical Applications of Hyperbaric Medicine.’ We toured the facility and were treated to lunch. The first place we visited was the world’s largest Hindu temple ‘Akshardham’, dedicated to lord Swaminarayan, a manifestation of Vishnu.

This branch of Hinduism has a large following in the Indian Diaspora and we even have a temple in San Antonio. The temple was an architectural marvel in marble. Apart from the sculptures of deities and the vast acreage of manicured gardens, the light and

could complete his own tomb of black marble; the foundation is seen along the banks of the beautiful river Yamuna. A flight delay gave us the opportunity to visit the ‘Lotus Temple’ built by an Iranian architect Farborz Sahba; built in line with teachings of the Baha’i faith that believes in oneness of God, religions, and mankind.

We arrived in Udaipur the night of December 27th and joined hundreds of Indian physicians who came from all over the globe for the annual Global Health Summit. We visited the Haldi Ghat, a historical site where in 1576 AD the battle between Maharana Pratap and the Mughal Emperor Akbar occurred. We travelled another 31 miles to ‘Nathdwara’ also called Shrinathji a 17th century Vaishnava shrine. We hustled among the crowds, bare feet, trying to get a glimpse of Krishna in the temple. The colorful background of flowers and paintings on the wall created an ambiance for peaceful worship. We did delve in to the little shops with handmade imitation jewelry. In the evening, we were a part of the inauguration ceremony of — the AAPI Global Healthcare Summit. We heard the Health Minister of India speak, and enjoyed the colorful dances of Rajasthan and listened to urdu ghazals poetry. The next morning, we set out to Mount Abu, the only hill station in Rajasthan, situated at an altitude of about 4,000 feet. There we visited the 11th century Dilwara Jain Temples. After lunch and a visit to the sparkling blue Nakki Lake, we returned to Udaipur and joined the other delegates and enjoyed the world famous puppet show and a cultural program of Rajasthani dances.

On 30th December, we drove an hour to the Kumbhalgarh fort that is surrounded by 13 mountain peaks, guarded by seven great gates and seven ramparts, strengthened by rounded bastions and immense watchtowers. This mountain fortress has witnessed many battles. The next stop was the famous15th century Ranakpur Jain Temple. It is built in pure white marble with 80 domes supported by 1,944 carved pillars. The Chaumukha, meaning four-faced temple, is dedicated to Lord Adinath, who is the first saint of the Jains.

On December 31st, we toured Udaipur. The Majestic City Palace, built in 1559, located near at east bank of Lake Pichola, Palace Museum, Rana Pratap Museum and the Crystal Gallery were amazing.

The boat ride in the Lake Pichola was a serene experience and so was the visit to the ‘Saheliyon ki Bari’, the garden of maids and the vintage automobile museum. New Year’s Eve was celebrated in Indo-

sound show with playing fountains of water took my breath away.

Through the colorful water fountains, the 25-minute show depicted a story about children helped by God because of their faith and devotion and destruction of ego.

The next day we toured “Old Delhi” which served as the capital of Muslim India for the most of the 12th through 19th centuries.

Many of the city’s mosques, forts, and bazaars date to the mid-17th century. In contrast, the present-day New Delhi is a city of broad boulevards, landscaped gardens, and neoclassical buildings. The imperial city is a creation of the British, who began its construction in 1911 and inaugurated it as the capital of India in 1931. Today, the city is part of the Delhi Union Territory, a federal district similar to Washington, D.C. (India Unveiled by Robert Arnett). We visited Raj Ghat, a memorial site where Mahatma Gandhi was cremated, the Red Fort, Humayun's Tomb, the Qutub Minar, a drive along the ceremonial avenue, the Rajpath, past the imposing India Gate, Parliament House, the President's residence and the diplomatic enclave. In Chandni Chowk we rode a tricycle rickshaw through the narrow streets. On one street there was a Jain temple, a Sikh temple and a church and the street led to the Jumma Maszid, one of the oldest and largest mosques in India.

On 26th December, we visited the city of Agra, which was the older capital of India during the Mughal rule in the 16th and 17th centuries. The magnificent Taj Mahal was built under the leadership of Mughal Emperor Shah Jahan over a 22-year span in the mid1600s. After looking at this huge white monument, I realized why the Taj Mahal is considered one of the Wonders of the World. Influenced by Islamic, Indian, and Persian architectural styles, the tomb was built by 20,000 workers, an architectural feat for not only the Mughal Empire but for all times. Excerpts from the Quran and precious jewels adorn the detailed inlay on the marble walls, sur-

continued on page 28 visit us at www.bcms.org

27

FEATURE continued from page 27

western style at Ananta Resort in Udaipur with food fare, drinks and dancing to Bollywood music. The crowd danced along carefree late into the night but I stayed till the countdown at 12 midnight and then we went to sleep tired and happy to catch an early morning flight to Chennai, in South India.

Our flight to Chennai was delayed and reached late. We quickly put our luggage at the Trident hotel and visited the Parthasarthy temple. On the early morning of January 2nd, we packed our breakfast and left to the Pondicherry beach and the Aurobindo ashram. I enjoyed the ashram a lot as it was a peaceful, perfect outdoor place for meditation in a garden with greenery and flowers. After lunch, we went to Mahabalipuram, about 37 miles from Chennai, which has five free standing temples, four of them are carved from same long granite boulder. They are called the five rathaas, charriots and are “vehicles” to God. We saw Arjun Dhabas, the Krishna, Mahishasuramardini and Varaha cave temples and posed to take a picture with the huge Lord Krishna’s butter ball rock. We then visited the tiered pyramid shaped Shore temple overlooking the Bay of Bengal.

Here, we learned about the different types of temples in India — monolithic, structural, and cave temples.

In the evening, we had an official event with Chennai, San Antonio’s Sister city with our BCMS counterpart, Indian Medical Association(IMA) — Tamilnadu and Association of Physicians of India (API)- Chennai. Dr. Jayesh Shah handed a check for $5,000.00 from AAPI Charitable foundation to the Rotary Club of Chennai ( Anuja - San Antonio Initiative) to build a school in Chennai. Dr. Venkat Srinivasan gave a talk on Mind and Body Medicine.

On the last day, we visited a one-of-a-kind Diabetic Hospital which provides comprehensive services for all diabetic patients at extremely economical rates. We saw the 300-year-old Kapaleeshwar temple in gopuram style or tiered pyramid shape. Here, I heard about Vastu Shastra, the science of building a home based on certain principles where the location and the direction the room’s face is based on certain principles. We also visited St. Thomas Cathedral and the Marina beach after which my Dad gave a lunch treat at a local authentic food place called Murugan Idli Shop. Here, we ate with our hands in plates that were green banana leaves. The food was served hot directly on the leaf and the idlis were freshly made in front of us. Chennai is famous for shopping for silk sarees, especially the shops of Nalli. The two hours given for shopping felt like two minutes.

“Chalo, Chalo” said Dr.Roberta Krueger one of the delegates! Yes, it was time to return home. It was an amazing trip that allowed us 28 San Antonio Medicine • May 2017

to explore the Indian culture closely in a short span of 10 days and allowed fellow San Antonians, whom we had never met before, closer to each other. I personally learned a lot about the rich history of the places we visited. Oh! and how can I forget the monkeys, that were abundant in Udaipur, Delhi and all over; without going to the zoo!

Prachi Shah is a sophomore at UTSA.

LEGAL EASE

You’re bumped. Now what?

By George F. “Rick” Evans, Jr., General Counsel BCMS

How many times have you heard that announcement that your flight has been “oversold” and the gate agent is looking for volunteers to give up their seats? If you’ve already got your ticket, the announcement may not provoke much interest unless you’re looking to make a deal. But, if you, your family member or friend is the one without a seat, that’s an entirely different kettle of fish. In this second of three articles, I’m continuing my series on the real life hassles of today’s airline travel by discussing this increasingly common problem and what your legal rights are.

Believe it or not, overbooking a plane is not illegal. If I sold you tickets to the Spurs game but you learned I also sold the same 30 San Antonio Medicine • May 2017

seats to somebody else and they got there first, you’d be within your rights to claim fraud or theft. Not in the friendly skies, however. There are, however, federal laws which do apply and afford you certain rights. Note: this article only applies to domestic travel. You will have different, and actually better, rights for international flights.

When the airline has sold more tickets than there are seats, they’re required to ask for volunteers willing to give up their seats in exchange for some form of compensation. If you’re not in a hurry, you might want to see what the offer is. Here’s what a volunteer needs to know.

LEGAL EASE

Here’s what a volunteer needs to know.

1. The law does not mandate a particular type or amount of compensation for volunteers. You can haggle for more. Or you can wait and see if the offer increases if not enough volunteers step forward. Airlines start low and raise the ante if they need more volunteers.

2. The law requires a volunteer be advised that they might be involuntarily booted off the plane and how much compensation they’d get if that happened. This is so the volunteer doesn’t settle for a lesser amount if the airline knows he was going to get the boot anyway and would get more money if he waited to be bumped rather than volunteer to give up his seat.

3. The airline will offer the volunteer a seat on a later flight. But, the volunteer needs to first verify not just when that will be, but whether the seat is guaranteed or not. If not, the volunteer could be stranded and spend money for meals/hotel that cost more than what he got for his sacrifice. If the delay will be overnight or for many hours, the volunteer should negotiate for vouchers for hotels, meals, etc.

4. If the volunteer’s luggage has already been checked in on the plane, he should verify if it will be removed and given back to him for the next flight out upon which he’s booked.

5. If the airline also offers a voucher on a future flight worth “X” dollars, the volunteer should verify how long it’s good for, whether it’s subject to blackout dates or other restrictions, and whether it can be used for international travel. It’s best to ask for money (i.e. a check) which the airline may give instead of a travel voucher if they’re desperate enough.

But what if you’re bumped against your will?

What can you do under those circumstances?

The law does step in and provide some concrete rules. Here’s a summary of your rights.

1.

Let’s start by identifying when these rules don’t apply. These laws aren’t applicable to chartered flights or those in which there are only 30 seats. The rules don’t apply if your entire flight is cancelled and everybody is given the boot. (See my earlier article for your rights in the event of cancellation).

The rules don’t apply because a smaller aircraft was substituted for safety or operational reasons. And they don’t apply if you’re reseated on the same flight in a lower class section although you’re entitled to a partial refund. So, assuming

none of the above exceptions applies to your circumstances, here are those rules.

2.

Each airline has a written list explaining your rights. If you forget what they are, at least remember to ask for the document to refresh your memory. Bear in mind that there are reports of gate agents who have tried to offer less compensation or benefits than those required by law. Or they may try to get you to take vouchers rather than cash. You can and should stand up to them by knowing your rights.

3.

If they can’t get you to your destination on another flight within one hour of your originally scheduled arrival time, you’re entitled to cash compensation; not a voucher. Cash or a check.

4.

The amount of compensation goes up the longer the delay. If an hour or less, you get nothing. If the delay is longer than one hour but no more than two hours, you’re entitled to payment of 200% the cost of your one way ticket, up to a maximum of $675.00.

5.

If the delay is longer than two hours, of if the airline doesn’t make any alternative travel arrangements for you, you’re entitled to a payment equal to 400% of the cost of your one way ticket, up to a maximum of $1,300.

6.

You get to keep your original ticket for use sometime in the future or you can request an “involuntary refund” of the cost of that ticket for that portion of the flight you were bumped from.

7.

If you paid for upgrades like for check in baggage, seat selection, premium seating like first class, etc., and you don’t get them on your replacement flight, you’re entitled to compensation in the amount you paid for those upgrades.

8.

If your ticket doesn’t show a cost (like if you’re flying on frequent flier points) you’re still entitled to be paid. The amount of your ticket will be deemed to be the lowest charge for a ticket of like kind on that flight.

9.

Airlines have policies on how they bump people. Sometimes passengers with the lowest priced tickets get the boot since they cost the least to compensate. Sometimes it’s based on the last who checked in. Because many airlines follow the second rule, it’s worth it to check in early at the airport to reduce your chances of being bumped.

visit us at www.bcms.org

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BUSINESS

Run a Compliant Medical Practice: 3 Key Employment Laws That You Need to Know

By Norman Paul, Jr., J.D., CEO of SWBC PEO Services Operating a medical practice comes with great responsibility to not only your patients but also to your employees. It is important to understand key employment laws to make sure you stay in compliance with the law and don’t jeopardize your practice or the safety of your employees.

Here are three key employment laws to keep in mind that will help manage your employees.

1. Understanding the Fair Labor Standards Act (FLSA) The purpose of the FLSA is to establish a minimum and overtime wage for your non-exempt employees and recordkeeping.

Employees who fall within this category must be paid at least the federal minimum wage for each hour worked, and one-anda-half times their hourly rate for any hours worked beyond 40 32 San Antonio Medicine • May 2017

each week. It is important to know your state’s current minimum wage since it varies from state-to-state.

Having a thorough understanding of the FLSA will help you define which employees are considered exempt and non-exempt, pay them properly, and address what, if any, work time needs to be paid, including on-call, training, meetings, and travel time.

Staying on top of FLSA rules can help prevent unnecessary pay discrepancies, saving you time and money when processing payroll. In 2016, The United States Department of Labor (USDOL) substantially increased the civil money penalties it can impose for certain violations of the FLSA. Effective Aug. 1, 2016, the USDOL can now impose a monetary policy of up to $1,894 for each repeated or willful violation of minimum wage or overtime requirements. This may also help you avoid lawsuits

BUSINESS

initiated by a current or former employee due to incorrect compensation or back pay you may owe them.

2. The Importance of Occupational Safety and Health Administration (OSHA) As a business owner, it is important to ensure you provide a safe work environment for your employees. As a medical professional you spend your day helping those with injuries and illnesses, but you also have a similar responsibility to do the same for your employees. OSHA is the primary federal agency which governs occupational health and safety in the workplace. The OSHA law and regulations ensure employers provide employees with a safe and healthy work environment free from hazards, such as exposure to chemicals, mechanical dangers, or unsanitary conditions.

Many of these hazards are common in a medical practice environment. For example, employees may be operating machinery for X-rays, MRI’s, handling potentially toxic medications, and coming into contact with bodily fluids and/or patients with contagious diseases. It is your responsibility to ensure your employees have the resources and training to know how to safely handle themselves in these situations.

Fortunately, OSHA provides various resources to help you. A few best practices you can adopt could be ensuring your employees receive safety training for medical equipment and patient care, determining the types of protective equipment needed, and training them on the proper way to report and investigate all safety-related incidents and/or accidents.

3. Accommodating your employees according to the Americans with Disabilities Act (ADA) Taking care of your patients is always a priority and many come with a variety of special circumstances when they walk through your door — but so do your employees. In 2015, 17.5 percent of persons with a disability were employed, according to the U.S. Bureau of Labor Statistics. If you are a business with 15 or more employees you are required to comply with the ADA, which requires you to provide reasonable accommodations to any employee or job applicant with a disability, unless doing so would cause the employer significant difficulty or expense. Also, as a business offering services to the general public, you must comply with ADA standards to meet the needs of disabled individuals visiting your practice.

As the business owner, you and your supervisors play a key role in identifying and implementing reasonable accommodations for employees that have a need. You can work with your HR team to identify the essential functions of the job, as well as de-

fine what “reasonable accommodations” look like for your practice in compliance with the ADA. While running your own medical practice requires a long list of duties, following key employment laws must be a priority to protect your practice, patients, and employees. Rest assured, there are plenty of resources available to help guide you to run a successful medical practice.

To learn more about these key employment laws or others, contact me at 830-980-1200 or npaul@swbc.com.

Norman Paul, Jr., J.D., is CEO of SWBC PEO Services. He is responsible for overseeing the division’s day-to-day tasks, including payroll, employee benefits administration, workers’ compensation, and HR support for more than 8,000 shared employees in Texas and 18 additional states. Norman also serves as Corporate Counsel for SWBC PEO, providing guidance on compliance issues, overseeing unemployment claims administration, and client training. visit us at www.bcms.org

33

34 San Antonio Medicine • May 2017

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.

ACCOUNTING FIRMS RSM US LLP (HH Silver Sponsor) RSM US is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services.

Vicky Martin, CPA 210-828-6281 vicky.martin@rsmus.com www.rsmus.com “Offering service more than expected — on every engagement.”

Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets.

Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ACO/IPA

ASSET MANAGEMENT

Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet investment challenges and help achieve financial objectives.

Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management”

ATTORNEYS IntegraNet Health (HHHH 10K Platinum Sponsor) IntegraNet Health is an Independent Physician Association that helps physicians achieve higher reimbursements from insurance companies whereby some of our higher performing physicians are able to achieve up to 200% of Medicare FFS. Executive Director Alan Preston, MHA, Sc.D. 1-832-705-5674 Apreston@IntegrNetHealth.com www.integraNetHealth.com

ARMY HEALTHCARE 5th Medical Recruiting BN (HH Silver Sponsor) We recruit quality men and women who would like to be a part of our team.

SFC Cherie Kirk 210-692-7376 Cherie.k.kirk.mil@mail.mil www.youtube.com/watch?v=kweqi 3TelO8 "Serving to heal, Honored to serve"

36 San Antonio Medicine • May 2017

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions.

From business transactions to physician contracts, our team can help you in making the right decision for your practice.

Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”

Strasburger & Price, LLP (HHH Gold Sponsor) Strasburger counsels physician groups, individual doctors, hospitals, and other healthcare

providers on a variety of concerns, including business transactions, regulatory compliance, entity formation, reimbursement, employment, estate planning, tax, and litigation.

Carrie Douglas 210.250.6017 carrie.douglas@strasburger.com Cynthia Grimes 210.250.6003 cynthia.grimes@strasburger.com Marty Roos 210.250.6161 marty.roos@strasburger.com www.strasburger.com “Your Prescription for the Common & Not-So Common Legal Ailment”

BANKING

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things.

Jeanne Bennett 210- 343-4556 jeanne.bennett@amegybank.com Karen Leckie 210-343-4558 karen.leckie@amegybank.com www.amegybank.com “Community banking partnership”

BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future.

Stephanie Dick Vice President- Commercial Banking 210-247-2979 sdick@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com

BBVA Compass (HHH Gold Sponsor) Our healthcare financial team provides customized solutions for you, your business and employees.

Commercial Relationship Manager — Zaida Saliba 210-370-6012 Zaida.Saliba@BBVACompass.com Global Wealth Management Mary Mahlie 210-370-6029 mary.mahlie@bbvacompass.com Medical Branch Manager Vicki Watkins 210-592-5755 vicki.watkins@bbva.com Business Banking Officer Jamie Gutierrez 210-284-2815 jamie.gutierrez@bbva.com www.bbvacompass.com “Working for a better future”

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.

Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”

IBC Bank (HHH Gold Sponsor) IBC Bank is a $12.4 billion multibank financial company, with over 212 facilities and more than 325 ATMs serving 90 communities in Texas and Oklahoma. IBC BankSan Antonio has been serving the Alamo City community since 1986 and has a retail branch network of 30 locations throughout the area.

Markham Benn 210-518-2500, ext. 26921 MarkhamBenn@ibc.com www.ibc.com “Leader in commercial lending.”

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY www.firstmarkcu.org Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans.

Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Brandi Vitier 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com

SSFCU (HHH Gold Sponsor) Founded in 1956, Security Service provides medical professionals with exceptional service and competitive rates on a line of mortgage products including one-time close construction, unimproved lot/land, jumbo, and specialized adjustable-rate mortgage loans.

Commercial Services Luis Rosales 210-476-4426 lrosales@ssfcu.org Investment Services John Dallahan 210-476-4410 jdallahan@ssfcu.org Mortgage Services Glynis Miller 210-476-4833 gmiller@ssfcu.org Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology? Expanding your office space? We offer loans to meet your business or personal needs.

Competitive rates, favorable terms and local decisions.

Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org

Frost (HH Silver Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Lewis Thorne 210-220-6513 lthorne@frostbank.com www.frostbank.com “Frost@Work provides your employees with free personalized banking services.”

RBFCU (HH Silver Sponsor) 210-945-3800 nallen@rbfcu.org www.rbfcu.org

CONTRACTORS/BUILDERS /COMMERCIAL

Cambridge Contracting (HHH Gold Sponsor) We are a full service general contracting company that specializes in commercial finishouts and ground up construction.

Rusty Hastings Rusty@cambridgesa.com 210-337-3900 www.cambridgesa.com

Huffman Developments (HHH Gold Sponsor) Premier medical and professional office condominium developer.

Our model allows you to own your own office space as opposed to leasing.

Steve Huffman 210-979-2500 shuffman@huffmandev.com Lauren Spalten 210-667-6988 lspalten@huffmandev.com www.huffmandev.com

RC Page Construction, LLC (HHH Gold Sponsor) Commercial general contractor specializing in ground-up & interior finish out projects. Services include conceptual & final pricing, design-build & construction management. Single-source management from concept to completion ensures continuity through

all phases of the project.

Clay Page 210-375-9150 clay@rcpageconstruction.com www.rcpageconstruction.com

FINANCIAL SERVICES

Northwestern Mutual Wealth Management (HHHH 10K Platinum Sponsor) Our mission is to help you enjoy a lifetime of financial security with greater certainty and clarity. Our outcomebased planning approach involves defining your objectives, creating a plan to maximize potential and inspiring action towards your goals.

Fee-based financial plans offered at discount for BCMS members.

Eric Kala CFP®, AEP®, CLU®, ChFC® Wealth Management Advisor | Estate & Business Planning Advisor 210.446.5755 eric.kala@nm.com www.erickala.com “Inspiring Action, Maximizing Potential”

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.

Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

e3 Wealth, LLC (HHH Gold Sponsor) Over $550 million in assets under management, e3 Wealth delivers truly customized solutions to individuals and businesses while placing heavy emphasis on risk minimization, tax diversification, proper utilization and protection for each client's unique financial purpose.

Managing Partner Joseph Quartucci, ChFC® 512-268-9220 jquartucci@e3wealth.com Senior Partner Terry Taylor

512-268-9220 ttaylor@e3wealth.com Senior Partner Jennifer Taylor 512-268-9220 jtaylor@e3wealth.com www.e3wealth.com

Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet investment challenges and help achieve financial objectives.

Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management” First Command Financial Services (HH Silver Sponsor) Nigel Davies 210-824-9894 njdavies@firstcommand.com www.firstcommand.com

GRADUATE PROGRAMS Trinity University (HH Silver Sponsor) The Executive Master’s Program in Healthcare Administration is ranked in the Top 10 programs nationally. A part-time, hybrid-learning program designed for physicians and healthcare managers to pursue a graduate degree while continuing to work full-time.

Amer Kaissi, Ph.D. Professor and Executive Program Director 210-999-8132 amer.kaissi@trinity.edu https://new.trinity.edu/academics/departments/health-careadministration

continued on page 38

visit us at www.bcms.org

37

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 37

HEALTHCARE REAL ESTATE SAN ANTONIO COMMERCIAL ADVISORS (HH Silver Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”

HOME HEALTH SERVICES Abbie Health Care Inc. (HH Silver Sponsor) Our goal at Abbie health care inc. is to promote independence, healing and comfort through quality, competent and compassionate care provided by skilled nurses, therapists, medical social worker and home health aides at home.

Sr. Clinical Account Executive Gloria Duke, RN 210-273-7482 Gloria@abbiehealthcare.com "New Way of Thinking, Caring & Living"

HOSPITALS/ HEALTHCARE SERVICES

Southwest General Hospital (HHH Gold Sponsor) Southwest General is a full-service hospital, accredited by DNV, serving San Antonio for over 30 years.

Quality awards include accredited centers in: Chest Pain, Primary Stroke, Wound Care, and Bariatric Surgery.

Director of Business Development Barbara Urrabazo 210.921.3521 Burrabazo@Iasishealthcare.com Community Relations Liaison Sonia Imperial 210-364-7536 www.swgeneralhospital.com “Quality healthcare with you in mind.”

Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with

38 San Antonio Medicine • May 2017

disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.” Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges.

Miranda Peck 210-482-3000 Jana Raschbaum 210-478-6633 JRaschbaum@selectmedical.com mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”

INFORMATION AND TECHNOLOGIES

Henced (HHH Gold Sponsor) Henced is a customer communications platform that provides businesses with communication solutions. We’ll help you build longlast customer relationships by effectively communicating using our text and email messaging system.

Rainey Threadgill 210-647-6350 Rainey@henced.com www.henced.com Henced offers BCMS members custom pricing.

Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com Mortgage Kristie Arocha 210-255-0013 karocha@swbc.com SWBC Mortgage www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need.

Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care.

Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

INSURANCE/MEDICAL MALPRACTICE

INSURANCE

SWBC (HHHH 10K Platinum Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships.

VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of

Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies.

Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

The Doctors Company (HH Silver Sponsor) The Doctors Company is fiercely committed to defending, protecting, and rewarding the practice of good medicine. With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer. Learn more at www.thedoctors.com.

Susan Speed Senior Account Executive (512) 275-1874 Susan.speed@thedoctors.com Marcy Nicholson Director, Business Development (512) 275-1845 mnicholson@thedoctors.com “With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer” MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com NORCAL Mutual Insurance Co. (HH Silver Sponsor) Since 1975, NORCAL Mutual has offered medical professional liability coverage to physicians and is “A” (Excellent) rated by A.M. Best.

Patrick Flanagan 844-4-NORCAL pflanagan@norcal-group.com www.norcalmutual.com

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY ProAssurance (HH Silver Sponsor) Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease—that’s only fair.

Keith Askew Market Manager kaskew@proassurance.com Mark Keeney Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com

MARKETING ADVERTISING SEO

Henced (HHH Gold Sponsor) Henced is a customer communications platform that provides businesses with communication solutions. We’ll help you build longlast customer relationships by effectively communicating using our text and email messaging system.

Rainey Threadgill 210-647-6350 Rainey.Threadgill@rainman.com www.henced.com Henced offers BCMS members custom pricing.

MEDICAL SUPPLIES AND EQUIPMENT

Henry Schein Medical (HHHH 10K Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.

Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”

MERCHANT CARD/CHECK PROCESSING Firstdata/Telecheck (HH Silver Sponsor) We stand at the center of the fastpaced payments ecosystem, collaborating to deliver nextgeneration technology and help our clients grow their businesses.

Sandra Torres-Lynum SR. Business Consultant 25 years of dedicated service 210-387-8505 Sandra.TorresLynum@FirstData.com ‘The true leader in the payments processing industry’

OFFICE EQUIPMENT/ TECHNOLOGIES

Dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes.

Major Account Executive Wayne Parker 210-326-8054 WParker@dahill.com Major Account Executive Bradley Shill 210-332-4911 BShill@dahill.com Add footer: www.dahill.com “Work Smarter”

PAYROLL SERVICES

SWBC (HHHH 10K Platinum Sponsor) Our clients gain a team of employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits.

Kristine Edge Sales Manager 830-980-1207 Kedge@swbc.com Working together to help our clients achieve their business objectives.

PROFESSIONAL ORGANIZATIONS The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, non-profit, R&D, healthcare

delivery, professional services and more!

President Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Program Coordinator Valerie Rogler 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”

SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resortquality environment.

Shane Brown Executive Director 210-305-5713 hello@legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Brody Whitley, Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

To join the Circle of Friends program or for more information, call 210-301-4366 or email August.Trevino@bcms.org Visit www.bcms.org

visit us at www.bcms.org

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40 San Antonio Medicine • May 2017

visit us at www.bcms.org

41

The Bexar County Medical Society is proud to Welcome TMLT as a Renewing Platinum Level Sponsor to our Circle of Friends Program

Please support this sponsor with your patronage Thank you.

42 San Antonio Medicine • May 2017

RECOMMENDED AUTO DEALERS AUTO PROGRAM

• • • •

We will locate the vehicle at the best price, right down to the color and equipment.

We will put you in touch with exactly the right person at the dealership to handle your transaction.

We will arrange for a test drive at your home or office. We make the buying process easy!

When you go to the dealership, speak only with the representative indicated by BCMS.

Ancira Chevrolet 6111 Bandera Road San Antonio, TX

Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX

Jude Fowler 210-681-4900

Esther Luna 210-690-0700

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN Honda 14610 IH 10 W San Antonio, TX

GUNN Infiniti 12150 IH 10 W San Antonio, TX

GUNN Acura 11911 IH 10 W San Antonio, TX

GUNN Nissan 750 NE Loop 410 San Antonio, TX 78209

Bill Boyd 210-859-2719

Pete DeNeergard 210-680-3371

Hugo Rodriguez and Rick Tejada 210-824-1272

Coby Allen 210-625-4988

Abe Novy 210-496-0806

Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Cavender Audi 15447 IH 10 W San Antonio, TX 78249

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

Northside Ford 12300 San Pedro San Antonio, TX

David Espinoza 210-912-5087

Sean Fortier 210-681-3399

Gary Holdgraf 210-862-9769

Wayne Alderman 210-525-9800

Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230

Ancira Nissan 10835 IH 10 West San Antonio, TX 78230

Jarrod Ashley 210-558-1500

Jason Thompson 210-558-5000

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154

Ancira Buick, GMC San Antonio, TX Jude Fowler 210-681-4900

Ingram Park Nissan 7000 NW Loop 410 San Antonio, TX Alan Henderson 210-681-6300 KAHLIG AUTO GROUP

Ingram Park Auto Center Dodge 7000 NW Loop 410 San Antonio, TX

Ingram Park Auto Center Mazda 7000 NW Loop 410 San Antonio, TX

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX

North Park Subaru 9807 San Pedro San Antonio, TX 78216

Daniel Jex 210-684-6610

Frank Lira 210-381-7532

Richard Wood 210-366-9600

John Wang 830-981-6000

Mark Castello 210-308-0200

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257

North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211

North Park Mazda 9333 San Pedro San Antonio, TX 78216

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX

Stephen Markham 877-356-0476

Justin Boone 210-635-5000

Scott Brothers 210-253-3300

Jose Contreras 210-308-8900

Justin Blake 888-341-2182

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Lincoln 9207 San Pedro San Antonio, TX

North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257

Land Rover of San Antonio 13660 IH-10 West (@UTSA Blvd.)

San Antonio, TX

Porsche Center 9455 IH-10 West San Antonio, TX

James Cole 800-611-0176

Ed Noriega 210-561-4900

Matt Hokenson 210-764-6945

Sandy Small 210-341-8841

AUTO PROGRAM

Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org

AUTO REVIEW

2017 BMW X4

By Steve Schutz, MD

The BMW factory in Spartanburg, S.C.

single U.S. plant, including every X5 and X6

a platform, engine, and transmission with an

is quite a place. Open since 1994, the Spar-

you see doing all kinds of crazy things on

equivalent X5, BMW engineers used every

tanburg plant currently pumps out about

those Russian dashcam YouTube videos. (It’s

electronic trick in the book to make the X6

1,400 crossovers every day and has produced

never an X3 or X4, don’t ask me why. And

sportier — think quicker throttle response,

a total of almost 4 million vehicles.

please don’t try to tell me I’m the only one

higher RPM shift points, and firmer suspen-

A few interesting facts about this impres-

who watches dashcam videos on YouTube.)

sion settings — and it was enough to get

sive facility: It was BMW’s first full manu-

On to the subject of this month’s review,

facturing facility outside of Germany and its

the Spartanburg-made X4 crossover, a

Not surprisingly, the X4 looks a lot like

first U.S. production facility. It was the first

coupe-ish sibling of the mid-size BMW X3

the X6. But while the larger vehicle has a

automobile manufacturing plant in the

SUV. If you’re thinking, “Gee, didn’t BMW

more aggressive look, probably because of

United States to use greener water-based (in-

do the same thing when they made the X6

its wider stance, the more diminutive X4’s

stead of high solvent) paints. It uses a landfill

out of the X5?”, the answer is yes.

design is softer and less assertive. The

yours truly to move out of haterville.

methane “Gas to Energy” program that pro-

As regular readers may recall, when the X6

coupe-like profile obviously compromises

vides 50 percent of the plant’s total energy

was launched in 2008, I was not enthusias-

rear-seat headroom, but it enables the in-

requirements. Close to 9,000 employees

tic. After all, it was essentially an X5 SUV

clusion of a rear hatch, which gives the X4

work there, making it the third largest pri-

with fewer seats and a lot less luggage space.

more utility than a 3-series sedan. (During

vate employer in South Carolina.

What’s the point? And then I drove it and

my week with it, I used the X4 to carry my

Currently, all X3, X4, X5, and X6

was surprised at how different BMW made

mountain bike and all of my riding gear,

crossovers sold worldwide are made in this

the driving experience. While an X6 shares

and it all fit easily.)

44 San Antonio Medicine • May 2017

AUTO REVIEW

Still, adjectives like assertive and aggressive

ware — have been and elected to follow suit.

are relative. Most BMWs these days are sty-

(Mercedes is doing a similar thing with their

listically underwhelming, with what I’d de-

AMG brand, by the way.)

sion and torque-vectoring all-wheel drive.

Please direct any questions about options, availability, and pricing to BCMS’

scribe as lots of trees and not much forest,

Anyway, thanks to a 355-HP turbo in-line

own Phil Hornbeak, who is glad to help

i.e. there are thoughtful styling elements

six-cylinder engine, launch control, bigger

any member find that special vehicle they’d

everywhere, but the overall effect is remark-

front brake discs, 19-inch wheels, and a

like to buy or lease.

ably subdued. (The muscular M3 sedan,

sport-tuned suspension, the X4 M40i per-

The BMW Spartanburg manufacturing

quirky but cool i3 electric car, and futuristic

forms very well in all situations. Twisty back

plant has been producing vast numbers of

i8 sports car are notable exceptions.)

roads are where it seems most at home, but

cars and crossovers for almost 25 years. The

As noted above, numerous changes ensure

cruising on the interstate and tootling

Spartanburg-made X4 isn’t as mainstream as

that driving the X4 is more engaging than

around town are no problem for this

its more conventional X3 sibling, but it’s a

piloting the X3, and that’s especially true of

crossover. Another M40i addition is a louder

fine vehicle in its own right, especially the

the X4 M40i, which has been given some

exhaust system with dual rear pipes that

M40i version.

M-division design pieces and performance

make rally car-like backfire sounds when you

enhancements.

get off the throttle in Sport mode. Nice.

If you’re in the market for this kind of ve-

A quick aside: True M-vehicles have al-

And in case members of the automotive

ways been the pinnacle of BMW perform-

media who got this particular press vehicle

ance, and BMW has historically protected

didn’t get the point about the M40i’s extra

Steve Schutz, MD, is a

the brand by putting M-badging and other

performance credentials, its exterior paint

board-certified gastroenterolo-

symbols only on actual M-vehicles. But the

color is Long Beach Blue, the M2’s launch

gist who lived in San Antonio

decision makers in Munich no doubt saw

color.

in the 1990s when he was sta-

hicle, call Phil Hornbeak at 210-301-4367.

how popular S-line Audis — non-S Audis

Other engine choices are a 240-hp turbo

tioned here in the U.S. Air

which were given sporty trim elements from

four or a 300-hp turbo in-line six. And all

Force. He has been writing auto reviews for

S Audis rather than all of the go-fast hard-

X4s have an eight-speed automatic transmis-

San Antonio Medicine since 1995. visit us at www.bcms.org

45

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