41 minute read
the American Prison System By Philip Whalen MS, OMS III, Chinazaekpele Nweke, OMS III, Charley Meadows, MS, OMS III, Josephine Sinamano, MS, OMS III, Valentina Bustamante, OMS III
The State of Women in the American Prison System
By Philip Whalen MS, OMS III; Chinazaekpele Nweke OMS III; Charley Meadows MS, OMS III; Josephine Sinamano MS, OMS III; Valentina Bustamante OMS III
Introduction
As of 2016, there were 111,616 incarcerated women in the United States, and an estimated 6-10% were pregnant.1,2 The National Commission on Correctional Health Care (NCCHC) and the American Public Health Association (APHA) defined standards of care for incarcerated pregnant women. However, there is no agency that enforces these standards resulting in women receiving poor nutrition, lack of exercise, unsanitary living space and little or poor prenatal care.3 In this article, we will be examining the effects of maternal incarceration on childbirth outcomes by looking at three determinants of childbirth success, as well as the long-term effect on children’s mental health, to provide evidence for the need for strict regulation of adequate prenatal care for incarcerated women. The outcomes examined include birth weight, the incidence of preterm birth, and the fetal outcomes of infant mortality, miscarriage and abortion.
Birth Weight
Low birthweight is defined as a newborn weighing less than 5 pounds, 8 ounces or 2,500 grams. The average weight of a newborn child is roughly 8 pounds. While low birth weight may be associated with developmental abnormality, this isn’t necessarily a given as some underweight newborns do not have developmental abnormalities. Few studies concluded that incarceration during the first trimester led to decreased birth weight; however, this effect was minimal. In contrast, no correlation has been found in women initially incarcerated during the second and third trimester. This is exemplified by a two-year-long cross-sectional study of pregnant females incarcerated in Texas state prisons, that reported no children born with low birth weight born by mothers entering prison past 34-week gestation.6 Overall, studies demonstrated that there is no strong correlation between maternal incarceration and low birth weight.4
Kyei-Aboagye, K. et al. concluded that the prison environment, which provided limited access to controlled substances and adequate prenatal care improved fetal and maternal outcomes of expectant mothers. For example, they found that many women who admitted to smoking and/or using recreational drugs prior to going to prison had improvements in their child’s fetal birth weight and overall health.5 As a whole, this indicates that incarceration may actually prevent harmful and addictive behaviors that negatively impact mothers and children.
Preterm Birth
Preterm birth is defined as the birth of a fetus before 37 weeks gestation. According to the Center for Disease Control and Prevention (CDC), babies born prematurely are more likely to decease or suffer from respiratory problems, feeding issues, developmental sluggishness, vision problems, cerebral palsy or hearing problems.8 It has been speculated that maternal incarceration results in increased risk of preterm births.
Shapiro-Mendoza et al.,9 stated that in the United States, preterm birth was the leading cause of death and morbidity of newborns. In 2013, preterm birth was responsible for about 36% of the 8,470 infant deaths. Some conditions seen in children born prematurely include necrotizing enterocolitis, intraventricular hemorrhage, decreased school performance, developmental sluggishness and respiratory distress syndrome. The risk factors found to increase preterm birth are advanced maternal age, low socioeconomic class, recreational drug and tobacco use, high or low Body Mass Index (BMI), multiple gestations, a previous preterm birth, pregnancy complications (placenta abruption, polyhydramnios, oligohydramnios), and maternal medical disorders (thyroid disease, asthma, etc.).9
Sufrin et al.1 conducted a study on pregnant women in prisons and found that out of 753 live births, 6% were preterm. In another study, Sufrin et al1 concluded that out of 224 pregnancies that occurred in jails, 64% resulted in live births, and of them 8% were preterm births.10
According to Shapiro-Mendoza et al., the risk of preterm birth could be minimized by increasing access to preconception care services to women of childbearing age ensuring that they enter pregnancy in peak health. They also highlighted the need for early identification of women who have an increased risk and providing them with additional prenatal care. For example, women with a history of preterm birth should be given 17 alpha-hydroxyprogesterone caproate which helps
reduce the risk by about 30%. At-risk pregnant women can also be offered antenatal corticosteroids that have been shown to decrease respiratory distress syndrome by 66%, intraventricular hemorrhage by 54%, death by 69% and necrotizing enterocolitis by 46% when compared to non-ANCS therapy.9
Mental Health
According to The Sentencing Project, in 2019, the incarceration rate for non-Hispanic black women was 84 per 100,000, twice that of nonHispanic white women, 48 per 100,000, while the rate for Hispanic women was 64 per 100,000.12,13 Reports show that for pregnant women, the mental health effects of being incarcerated can magnify existing problems or create new ones.12 Dumont, D. et al. found that incarceration of either the mother or the father is associated with depression, and other social determinants of health like unemployment and homelessness.11 They also found a strong association between the well-being of the prisoner’s family−his/her children, partners, siblings and parents alike.
The experience of incarceration qualifies as an independent contributor to health outcomes and health behaviors.11 Left unanalyzed, the effects of parental incarceration could ultimately perpetuate systemic disadvantages as populations likely affected are those of underserved minorities. We, the authors, postulate that all those effects reported can also negatively affect the mental health of the infant and affect their childhood development. The impact on the behavioral health of the mother or the infant is something worth exploring. Further research would be beneficial to target specific populations that have a strong association with parental incarceration and the perinatal outcomes as it pertains to mental health. This would bring awareness to components that if addressed, would potentially alleviate the process of systemic incarceration.
Infant Mortality, Miscarriage, Abortion
The CDC defines infant mortality as death of an infant within their first year of life. Due to the fact that jails and prisons only provide postpartum care for three days after delivery, attempts at studying birth outcomes in prison and jail settings have proven difficult.1
Sufrin, C. et al. found that incarcerated women had a much lower rate of infant survivability.1 The low survivability can be attributed to the use of shackles before and during labor, placement of chains on pregnant women's abdomens, placement of pregnant women in solitary confinement, and variability of pre- and post-partum care, including lack of follow up of the children born to incarcerated mothers.1,14
Only 37.7% of prison facilities perform a pregnancy test on intake, therefore measuring miscarriages and abortions is difficult due to the fact that women may not know they are pregnant and may have an early miscarriage without the correctional facility being aware.14
continued from page 27
Conclusion
Overall, current health and general practices in prisons were not shown to have negative health effects on children born to incarcerated women. Only one outcome was found to be negatively impacted by incarceration: infant mortality, miscarriage and abortion.1 These findings highlight that while incarceration may not have long-term effects on the child's health, it is a determinant of whether the child will be born or not. It is in our opinion that this outcome alone provides sufficient evidence that the care of incarcerated mothers needs to improve. Across all prisons and jails in the country, there are standards set forth to ensure proper infant care, but correctional facilities are not required to abide by them, meaning that perinatal care is varied throughout the country.14 Improvements that could be made include preventing the use of shackles on pregnant women, providing them lower bunk beds, prenatal vitamins, rest time and two mattresses.2
References 1. Sufrin, C., Beal, L., Clarke, J., Jones, R., & Mosher, W. (2019) Pregnancy Outcomes in US Prisons, 2016–2017. American Journal of
Public Health. https://www-ncbi-nlm-nih- gov.uiwtx.idm.oclc.org/ pmc/articles/PMC6459671/ 2. Sabol, W. J., West, H. C., & Cooper, M. (2009). Prisoners in 2008.
Washington, DC: US Department of Justice, Bureau of Justice Statistics. 3. Ferszt GG, Clarke JG. Health care of pregnant women in U.S. state prisons. J Health Care Poor Underserved. 2012 May;23(2):55769. doi: 10.1353/hpu.2012.0048. PMID: 22643607. 4. Freeborn, D., PhD, Trevino, H., & Burd, I., MD, PhD. (2020). Low
Birth Weight. Retrieved December 02, 2020, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90 5. Kyei-Aboagye, K., Vragovic, O., & Chong, D. (2000). Birth outcome in incarcerated, high- risk pregnant women. The Journal of reproductive medicine, 45(3), 190–194 6. Howard, D. L., Strobino, D., Sherman, S. G., & Crum, R. M. (2011).
Maternal incarceration during pregnancy and infant birthweight.
Maternal and child health journal, 15(4), 478–486. https://doiorg.uiwtx.idm.oclc.org/10.1007/s10995-010-0602-y 7. Testa, A., Jackson, D. B., Vaughn, M. G., & Bello, J. K. (2020). Incarceration as a unique social stressor during pregnancy: Implications for maternal and newborn health. Social science & medicine (1982), 246, 112777. https://doi- org.uiwtx.idm.oclc.org/10.1016/ j.socscimed.2019.112777 8. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2020). Preterm Birth. Retrieved from https://www.cdc.gov/reproductivehealth/ maternalinfanthealth/pretermbirth.htm 9. Shapiro-Mendoza, C., Barfield, W., Henderson, Z., James, A.,
Howse, J., Iskander, J., & Thorpe, P. (2016). CDC Grand Rounds:
Public Health Strategies to Prevent Preterm Birth. MMWR Morb
Mortal Wkly Rep. 10. Sufrin, C., Jones, R. K., Mosher, W. D., & Beal, L. (2020). Pregnancy Prevalence and Outcomes in U.S. Jails. Obstetrics and gynecology, 135(5), 1177–1183. 11. Dumont, D., Wildeman, C., Lee, H., Gjelsvik, A., Valera, P., Clarke,
J. (2014) Incarceration, Maternal Hardship, and Perinatal Health
Behaviors. Maternal Child Health J. 12. Bronson, J., Sufrin, C. (2019). Pregnant Women in Prison and Jail
Don’t Count: Data Gaps on Maternal Health and Incarceration. 13. The Sentencing Project. Fact sheet: incarcerated women and girls. 2020. https://www.sentencingproject.org/wp-content/uploads/ 2016/02/Incarcerated-Women-and-Girls.pdf. Accessed October 5, 2021. 14. Kelsey, C. M., Medel, N., Mullins, C., Dallaire, D., Forestell, C. (2017). An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States. Maternal and Child
Health Journal. doi:10.1007/s10995-016-2224-5
Philip Whalen MS, OMS III; Chinazaekpele Nweke OMS III; Charley Meadows MS, OMS III; Josephine Sinamano MS, OMS III and Valentina Bustamante OMS III are medical students at the UIW School of Osteopathic Medicine.
Pandemic and Pedagogy:
COVID-19 and Medical Education
By David Alex Schulz, CHP
Hippocrates’ Greece had two words for time: Chronos for normal time and Kairos for periods of great challenge, accomplishment and risk. Fourth-year medical students unknowingly crossed from one to the other in the spring of 2020, as schools across the country sped up graduation to help hospitals besieged by the novel coronavirus.
New York Times reporter Emma Goldberg followed some of those students, speaking with them daily. Now in a book, she details the experiences of six young physicians thrust into the frontlines at Bellevue and Montefiore Health Systems during the earliest days of the COVID-19 pandemic. The stories of newlyminted Drs. Sam, Iris, Gabriela, Jay, Elana and Ben provide fresh insights and perspectives on the enduring crisis. Documenting their sudden entrée to the world of patient care reflects on how the current crisis may alter medical education for years to come.
Goldberg’s “Life on the Line: Young Doctors Come of Age in a Pandemic” (Harper Publishing, June 2021) refrains from political or polemical judgments; its examination provides very personal recounting of events from spring through summer, 2020, concluding before a vaccine was promised or delivered. Goldberg’s journalistic technique brings the stark uncertainty and confusion of those early days back to life.
With last names redacted, we are introduced first to Dr. Sam as he finds his world in flux: “The third Friday in March was Match Day. After four years of medical school, Sam and his classmates would be placed into residency programs for the next phase of their training. After all the stress of medical school—the late-night cramming, the ungodly early wake-ups, the Step 1 exam, the Step 2 exam, all those endless exams—this was supposed to be a spring of unwinding, before residency started in July.”
Instead, NYU offered Sam’s class early graduation if they wanted to work in hospitals overwhelmed by the surge of COVID19 patients. Swearing to the Hippocratic
Oath by Webex was only the beginning of an altered reality.
Regardless of their chosen specialties, these residents would support the internal medicine units. Sam reported for assignment at Bellevue Hospital on April 13. New York State would lose 778 more patients by the time he started his first shift in the morning. For a young gay man in Greenwich Village, comparisons to the HIV crisis were inevitable, particularly when living on blocks where entire populations had vanished in the ’80s.
Mindful of this, “Sam would develop an elaborate routine to douse himself in sanitizer and try to prevent any possibility of taking the virus home.” Face masking and hand scrubbing were the new normal in this era.
Dr. Gabriela, from Massachusetts, also attended NYU. Her story is emblematic of the heartache of separation from loved ones in the middle of a health crisis, made more poignant by struggling to deal with death on a daily and hourly basis. This newly-minted doctor of Hispanic heritage was determined to become a pediatrician and a role model. Instead, she was propelled into hospice-like situations, where palliative care was the norm. Life in New York quickly became more arduous: just going out to a neighborhood store called for face coverings and gloves like a covert mission.
“But this was what the pandemic had done: turned the mundane into some cross between heroism and paranoia,” even before spontaneous cheering sections formed for health care frontline workers coming and going.
Dr. Iris attended the Einstein College of Medicine, a research-intensive medical school located in the Bronx, part of the integrated Montefiore Health System. She had left in February for a study-abroad program, completing her rotation at a hospital in Paris. She “didn’t know of reports that would suggest that the first coronavirus patient in France, a coughing fishmonger, had actually turned up in a Paris hospital on December 27.”
Dr. Iris portrays the global nature of the epidemic, from her second week in the hospital, when a patient showed up wheezing and feverish. “He was whisked away by doctors in full protective gear. Everybody on Iris’s floor started whispering about whether that patient had the novel disease.”
In March, travel from Europe to the United States was suspended, and Iris made it back home just under the wire. But she barely believed what she saw on arriving. She left a Paris of hand sanitizers, Clorox wipes and face coverings and landed in a high-risk New York airport. “There were points of possible transmission all around her: hands brushing at baggage claim, children sprawled on the linoleum ground, carts slung from passenger to passenger. She knew she was on the precipice of a historical moment.”
Dr. Jay finds a sense of mission and duty in the crisis. Choosing to graduate early, her mentor advised that “it would be a learning opportunity…given the scale of this pandemic, Jay would likely have to care for COVID patients at some point, so it was better to start early.” But families weren’t so sanguine, and her mother emailed concerns to Jay’s friends about her first day in the hospital:
“As per an executive order signed by Governor Andrew Cuomo, Jay will graduate early today from medical school and accelerate her entry into the medical workforce due to the COVID-19 crisis.
It was supposed to be different.
I was supposed to have the incredible honor of hooding her on the stage of Lincoln Center.
I was not supposed to feel as if I’m sending her off to war.”
Dr. Elana, also graduating Einstein School, found her new role at odds with Orthodox Judaism. She had to fit ancient prayers into new applications to fulfill her duty to God, as well as her patients. Yet she also found resonance: “Later that week was Passover. It was her first time celebrating far from family; she was only comfortable seeing them outside when she dropped off groceries, not indoors for a meal. But the holiday’s grandiose messages suddenly felt more real. Resilience, survival, sacrifice— none of these was theoretical anymore. Passover had all sorts of obvious parallels to their new reality. They were celebrating liberation in a time of real-life plague.”
Through these young eyes, it becomes obvious that in the hasty rush toward their future, preparation for dealing with a “real-life plague” showed both strengths and weaknesses. One student initially wanting ER residency discovered the value of longer-term patient relationships. Another finds his best purpose in the cardiac telemetry unit. But despite a love for the technical aspects of health care, “he sensed there wasn’t anything that could have properly prepared him for the telemetry floor during the pandemic.
It will be a long time before lessons from the pandemic are validated and incorporated into medical schools. Perhaps its effects will be as striking as those following the Flexner Report, emphasizing even greater clinical experience. Regardless, the effect on this particular class of doctors is profound, and Emma Goldberg’s reportage provides a snapshot not only of their preparedness to deal with the crisis, but the raw courage, determination and sense of duty in which today’s students face with unknown travail. Kairotic times, indeed.
All quotes from “Life on the Line: Young Doctors Come of Age in a Pandemic” by Emma Goldberg, Harper © 2021.
David Alex Schulz, CHP is a community member of the BCMS Publications Committee.
Patient-Centered Transitional
Care Management By Ramon S. Cancino MD, MBA, MS, FAAFP
A patient’s transition from the hospital setting to his or her next setting is one of the most dangerous times in health care. There are over 35 million hospital discharges in the United States every year, and the process of discharging from a hospital is complex and fraught with challenges.1 Challenges include ensuring patients understand why they were admitted, what medications they should now be taking and not taking, and scheduling a follow-up outpatient appointment with their primary care team. When these or other components of the discharge process do not occur consistently, patients may be readmitted back into the hospital. The cost of unplanned readmissions is $15 to $20 billion annually.2 Hospital readmissions following a COVID-19 admission contribute to the current problem. CDC investigators found, among survivors, 9% of patients were readmitted to the same hospital within two months of discharge and 1.6% were readmitted more than once.3 Hospital readmissions are often a sign of system breakdowns and poor communication between inpatient and outpatient settings. Programs to improve communication and standardized discharge processes have decreased hospital readmission.4,5 The UT Health San Antonio Regional Physician Network (RPN) has developed a patient-centered approach.
The RPN developed a data-driven evidence-based approach to transitional care management. A team of Nurse Care Managers is assigned to all RPN accountable care organization practices in the community. This team of nurses receives an electronic notification every time an RPN patient is admitted or discharged from a hospital and every time the patient enters an emergency department. Once notified, the nurse works with the patient’s primary care team to develop a transitional care plan, contacts the patient to review posthospitalization instructions including medications, and schedules the patient for a post-hospitalization transitional care management appointment at their primary care physician’s office. Using this approach, we have seen a significant decrease in our readmission rate. The readmit rate per 1,000 patients dropped from 169 to 152 from 2019 to 2021 after the program was implemented.
There are many examples where patients benefit from this approach to transitional care management. Recently, after a patient discharged from a local hospital, a nurse called the patient for a non-face-to-face assessment where she learned the patient had a severely elevated blood glucose of 490. The patient had not thought to call her primary care physician’s office and was planning to go to the nearest emergency room. Instead, upon learning this information, the nurse intervened. She called the patient’s primary care physician to explain the situation, and the patient was seen and treated in the office the same day. Rather than going to a crowded emergency room with a long wait time, the patient was able to have their medications adjusted by her primary care team, who she knew and trusted. Per protocol, the nurse care manager followed up with the patient the next day with a phone call to assess the patient’s status. The patient’s blood glucose levels were improving, and the nurse took time to provide advice on diet and exercise.
In addition to being a more patient-centered approach, this high-value activity is viewed as important by Medicare. In fact, Medicare provides increased reimbursements for these types of transitional care management encounters (CPT codes: 99495 or 99496) when compared to usual office visit E/M codes.
The UT Health San Antonio Regional Physician Network understands that, to improve the quality of life of our patient community and to improve the well-being of our health care system, we must all work together during times of care transitions. Especially during this challenging pandemic, we must not allow patients to fall through the cracks and, at the same time, support our physicians with the necessary infrastructure. In doing so, we not only support our patients, we also support physician well-being. References 1. CDC. Hospital Utilization (in non-Federal short-stay hospitals). Published March 1, 2021. Accessed September 4, 2021. https://www.cdc.gov/nchs/fastats/hospital.htm 2. Jencks SF, Williams MV, Coleman EA.
Rehospitalizations among patients in the
Medicare fee-for-service program. N Engl
J Med. 2009;360(14):1418-1428. doi: 10.1056/NEJMsa0803563 3. Kuehn BM. Hospital Readmission Is
Common Among COVID-19 Survivors.
JAMA. 2020;324(24):2477-2477. doi:10. 1001/jama.2020.23910 4. Hansen LO, Young RS, Hinami K, Leung
A, Williams MV. Interventions to Reduce 30-Day Rehospitalization: A Systematic
Review. Ann Intern Med. 2011;155(8): 520-528. doi:10.7326/0003-4819-155-8201110180-00008 5. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE,
Forsythe SR, O’Donnell JK, Paasche-
Orlow MK, Manasseh C, Martin S,
Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-187.
Ramon S. Cancino, MD, MBA, MS, FAAFP is Senior Medical Director and Medical Management Director of the Primary Care Center of UT Health Physicians. He is a member of the Bexar County Medical Society.
Artistic Expression in Medicine
By Oliver H. Johnson, MD
I started seriously taking photographs 12 years ago when a friend had booked a tenday workshop in Italy with a professional photographer and couldn’t use it. He offered the slot to my wife and me, and it seemed like the perfect learning vacation. There were ten mostly professional photographers and myself as students on the tour. I was able to watch and learn how pros do it in the beautiful landscapes of Tuscany. I learned much on that and many other workshops including ones in France, Sicily, England and Cuba as well as Death Valley, Washington’s Palouse, the Oregon coast and most recently Acadia National Forest in Maine two weeks ago. COVID-19 and retirement in 2020 gave me much time at home to hone my post-processing skills with online tutorials in Photoshop and Lightroom from nationally known tutors. My photographic journey is ongoing, and I now strive to create the 'compelling frame,’ attempting to always capture and convey the feeling I had when observing the scene, more than just a well-exposed, sharp image. Scotland and the northwest coast are my next immediate destinations. I’m constantly striving to see with the photographer’s eye.
The Bexar County Medical Society would like to thank Dr. Johnson for his work producing the February and July 2021 magazine cover photos of San Antonio Medicine featuring Dr. Rodolfo “Rudy” Molina, 2021 BCMS President and Melody Newsom, CEO. Displayed are a selection of his most prominent photographs.
Oliver H. Johnson, MD is the Chair of the Physician Health & Rehabilitation Committee and is a member of the Bexar County Medical Society.
Castle Grotti Sunrise, Tuscany, Italy, 2018
Abbey Sebanc Lavender, South France, 2014
BCMS 35th Annual Auto Show
On October 21, 2021, the Bexar County Medical Society held its 35th Annual Auto Show in the Society parking lot on 1604. Guests enjoyed reviewing car and truck models from the BCMS Auto Program dealer members and goodies from the Circle of Friends members. Great food and drink were provided by Chicken N Pickle, Drury Hotels, The Éilan Hotel and Hilton Garden Inn at The Rim. Special thanks to the 2021 Auto Show event sponsors: Arthritis Associates PA, Cano Health and Genesis Cancer Care. The BCMS would like to thank the Rick Cavender Band for the music and the great physician members with their families and staff for attending and celebrating the event.
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BANKING
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CREDENTIALS VERIFICATION ORGANIZATION
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FINANCIAL ADVISORS
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FINANCIAL SERVICES
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Security benefit!” SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Michael Leos Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512-547-6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210-253-0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”
First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512-797-5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”
Amegy Bank of Texas (HH Silver 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 EVP | Private Banking Manager 210-343-4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210-343-4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210-343-4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership” Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent and treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension and topical wound care. info@NitricOxideInnovations.com 512-773-9097 www.NitricOxideInnovations.com
HOSPITALS/ HEALTHCARE FACILITIES
UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229
INFORMATION AND TECHNOLOGIES
Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting” 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 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
Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. 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 continued on page 38
Visit us at www.bcms.org 37
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.”
MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com
ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group is A.M. Best A+ (Superior). Patrick Flanagan Southwest Regional Business Development Representative 800-282-6242 PatrickFlanagan@ProAssurance.com www.ProAssurance.com/Texas
INTERNET TELECOMMUNICATIONS
Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber –our expertise allows us to deliver customized solutions and a rewarding customer experience. Clayton Brown - Regional Vice President of Sales –San Antonio 210-693-8025 clayton.brown@upnfiber.com Aron Sweet – Account Director 210-788-9515 aron.sweet@upnfiber.com Jim Dorman – Account Director 210-428-1206 jim.dorman@upnfiber.com Tammy Carosello – Account Director 210-868-0420 tammy.carosello@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate” INVESTMENT ADVISORY REAL ESTATE
Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com
MEDICAL BILLING AND COLLECTIONS SERVICES
Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”
PCS Revenue Cycle Management (HHH Gold Sponsor) We are a HIPAA compliant fullservice medical billing company specializing in medical billing, credentialing, and consulting to physicians and mid-level providers in private practice. Deion Whorton Sr. CEO/Founder 210-937-4089 inquiries@pcsrcm.com www.pcsrcm.com “We help physician streamline and maximize their reimbursement by 30%.”
Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”
MEDICAL PAYMENT SYSTEMS/CARD PROCESSING
First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512-797-5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”
MEDICAL SUPPLIES AND EQUIPMENT
CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing customized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen, President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience.
Henry Schein Medical (HH Silver 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 to 50 percent.”
MOLECULAR DIAGNOSTICS LABORATORY
iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”
MORTGAGES
SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Jon Tober Sr. Loan Officer Office: 210-317-7431 NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober
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, nonprofit, R&D, healthcare delivery, professional services and more! President, Kevin Barber 210-308-7907 (Direct)
kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”
San Antonio Medical Group Management Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Alan Winkler, President info4@samgma.org www.samgma.org
REAL ESTATE SERVICES COMMERCIAL
Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com
CARR Healthcare (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, , relocations, additional offices, purchases and practice transitions. Brad Wilson Agent 201-573-6146 Brad.Wilson@carr.us Jeremy Burroughs Agent 405-410-8923 Jeremy.Burroughs@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”
Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management. Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease”
The Oaks Center (HH Silver Sponsor) Now available High visibility medical office space ample free parking. BCMS physician 2 months base rent-free corner of Fredericksburg Road and Wurzbach Road adjacent to the Medical Center. Gay Ryan Property Manager 210-559-3013 glarproperties@gmail.com www.loopnet.com/Listing/84348498-Fredericksburg-Rd-SanAntonio-TX/18152745/
RETIREMENT PLANNING
Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”
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. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.” TELEHEALTH TECHNOLOGY
CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing customized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience.
Join our Circle of Friends Program
The sooner you start, the sooner you can engage with our 5700 plus membership in Bexar and all contiguous counties. For questions regarding Circle of Friends Sponsorship, please contact: Development Director, August Trevino august.trevino@bcms.org or 210-301-4366
2021 John Cooper Works Mini
By Stephen Schutz, MD
In 1994 BMW AG purchased the Rover Group, which included Rover, Land Rover and Mini. Just five years later, BMW mostly exited the British car business by dumping Rover and selling Land Rover to Ford, although they elected to keep Mini. And in 2000 they launched the new Mini, a fun two door hatchback that was a modern (and much larger) reinterpretation of the original Mini, in an attempt to create a brand that would capture desirable customers who couldn’t yet afford BMWs. 20 years later, where are we? The original two door Mini hatchback has been joined by a convertible, four door hatchback and two small crossovers. And Mini has been thoroughly integrated into the BMW family.
My week with a 2021 two door John Cooper Works (JCW) hatchback reminded me that the company has evolved in a good way during their 20 years of BMW ownership.
For one thing, all Minis now share a platform with the BMW 1and 2-series cars and X1 and X2 crossovers. Engines, transmissions and most of the electronics are also shared, despite the fact that Minis continue to be manufactured in the UK.
The Mini’s exterior design retains its retro vibe from 20 years ago, but it’s become (slightly) more contemporary with time. While the old Mini-ish profile is retained, the headlights are smaller and sleeker, and the taillights, now larger and squarer, feature British flag-esque LED lighting.
Inside, many Mini standbys such as big round gauges and numerous toggle switches remain, but otherwise things are much more BMWish than they were in 2001. The gear lever in automatic transmission Minis—most Minis will come equipped with a 7-speed dual clutch automatic, but thankfully a 6-speed manual is still available—looks slightly different from BMW units, but it works just like BMW’s. And as with BMW automatics, pushing the lever forward in manual mode shifts the transmission down a gear, the opposite of what happens with every other manufacturer’s gear levers.
One fun touch is the start/stop function. In most vehicles today, you keep a fob in your pocket or purse, touch the door to get in and then push a big “start” button on the dash to start the engine. In Minis, there’s no button on the dash, just a red “start” toggle switch protruding from the center stack. It works the same as a button, but is definitely cooler.
The infotainment system is very BMW too, with a central touch screen that accesses and controls all of the usual functions, but which can also be navigated using a wheel and buttons on the center console—a setup otherwise known as iDrive in BMWs.
I have no problem with all of this BMW-ness being present in Minis. BMW makes upscale vehicles that we all like and admire, and if Mini had to develop their own systems from scratch, their cars would cost a lot more. And Minis are indeed affordable—my loaded JCW model stickered for just over $40,000, but a base two door hatchback starts at just over $23,000.
Interestingly, JCW versions of all Minis are available. Much as M versions of BMWs are the performance models, so JCWs are the sporty Minis. The JCW two door hatchback makes sense to me—and would be the version I’d get if I were buying one—but a JCW Countryman seems slightly incongruous. It’s not a big crossover by any means, but neither is it a zippy hot hatch like my press car.
For the record, the front wheel drive JCW two door Mini is totally a hot hatch. Its potent 228HP turbocharged 4-cylinder engine is “the jam,” as the kids might say, and driving one on my favorite deserted back road was a delight thanks to it and its fantastic suspension tuning. There’s virtually no understeer, and the combination of all that power and handling is really enjoyable. Honestly, there are few cars for sale today as fun as the two door JCW Mini.
Of course, all the things that make it fun detract from it being a truly practical car. Its diminutive size means that passenger and luggage space is limited; you’re safer in a big pickup or SUV, and being able to see above or around vehicles in front of you isn’t happening. In addition, those space limitations and a buzzy engine mean that long road trips in the Mini will be less pleasurable than in an F-150.
The JCW two door Mini hatchback is a seriously fun hot hatch that will entertain you every time you get behind the wheel. Just don’t expect it to carry lots of people or stuff, or be a great long-distance traveler. But if you want a zippy everyday driver that’s terrific around town or on twisty back roads, this is your car.
As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.
Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.
11911 IH 10 West San Antonio, TX 78230 Coby Allen 210-696-2232
Audi Dominion 21105 West IH 10 San Antonio, TX 78257 Rick Cavender 210-681-3399
Kahlig Auto Group
Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. Fraser 830-606-3463
Land Rover San Antonio 13660 IH 10 West San Antonio, TX Cameron Tang 210-561-4900
Kahlig Auto Group
North Park Mazda 9333 San Pedro San Antonio, TX 78216 John Kahlig 210-253-3300
Kahlig Auto Group
North Park Subaru
9807 San Pedro San Antonio, TX 78216 Raymond Rangel 210-308-0200
Northside Ford
12300 San Pedro San Antonio, TX Marty Martinez 210-477-3472
Kahlig Auto Group
North Park Lexus 611 Lockhill Selma San Antonio, TX Tripp Bridges 210-308-8900
Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX James Godkin 830-981-6000
Kahlig Auto Group
North Park Subaru at Dominion
21415 IH 10 West San Antonio, TX 78257 Phil Larson 877-356-0476
Northside Chevrolet
9400 San Pedro Ave. San Antonio, TX 78216 Charles Williams 210-912-5087
Chuck Nash Chevrolet Buick GMC
3209 North Interstate 35 San Marcos, TX William Boyd 210-859-2719
Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul Hopkins 210-988-9644
14610 IH 10 West San Marcos, TX 78249 Mark Hennigan 832-428-9507
Kahlig Auto Group
North Park Lexus at Dominion
25131 IH 10 W Dominion San Antonio, TX James Cole 210-816-6000
Kahlig Auto Group
North Park Lincoln 9207 San Pedro San Antonio, TX Sandy Small 210-341-8841
Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos Jr. 210-366-9600
Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary Holdgraf 210-862-9769
9455 IH 10 West San Antonio, TX 78230 Douglas Cox 210-764-6945
Kahlig Auto Group
North Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin Boone 210-635-5000
