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August Issue 2014
Inside This Issue
REPORT: OVER 90% OF NEW PHYSICIAN JOBS FEATURE EMPLOYMENT BY HOSPITALS OR OTHER FACILITIES By Phillip Miller, Vice President of Communications Merritt Hawkins
Texas A&M forges path for rapid vaccine delivery See pg.8
INDEX Legal Health..................pg.3 Mental Health...............pg.4 New Technology...........pg.6 Money Matters..............pg.7 Healthy Heart................pg.9 The Framework............pg.16
Less Than 10% Feature Private Practice Settings Over 90% of new physician job openings feature employment by hospitals, medical groups, community health centers or other healthcare facilities, according to a new report, March 31, 2014. Of these assignments, signaling the continued decline of the great majority (over 90%) featured physician private practice. practices in which newly recruited Prepared by Merritt Hawkins, the physicians will be employed, either by nation’s leading physician search firm hospitals, medical groups, community and a company of AMN Healthcare health centers, academic medical centers (NYSE: AHS), the report tracks or other facilities. Less than 10% of the 3,158 physician and advanced the recruiting assignments featured practitioner recruiting assignments the independent practice settings, such as firm conducted from April 1, 2013 to partnerships, concierge practices or solo
practice settings, down from over 45% in 2004. “The employed model is almost the only choice for physicians seeking practice opportunities today,” said Travis Singleton, senior vice president of Merritt Hawkins. “However, it also is the first choice for most physicians. see Employment by Hospitals page 20
RISK OF EBOLA AND THE EBOLA VIRUS GAINING A FOOTHOLD IN TEXAS IS EXTREMELY LOW Academy of Nutrition and Dietetics call on congress to stop cuts to public health funding See pg. 17
By Peter J. Hotez, M.D., Ph.D.
Sierra Leone’s president declared a state of emergency over the largest outbreak of the Ebola virus in history. To date, Ebola has infected more than 1,200 people in three West African countries and killed close to 700 of them. The outbreak received extra media attention when two Americans became infected and a Liberian-born and its implications. United States citizen died. The risk of Ebola and the Ebola virus gaining a foothold in Texas is extremely low, according to Dr. Peter Hotez, the fellow in disease and poverty at Rice University's Baker Institute for Public Policy. Hotez is available to comment on the outbreak
"One of the reasons this disease has spread through Guinea, Sierra Leone and Liberia is that they are still in the postconflict stage with severely depleted health systems and health care infrastructures," Hotez said. "In contrast, we are fortunate see Ebola Virus page 20
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Page 3
Legal Health
SUPREME COURT LESS IMPACTFUL THAN MANY COMMENTATORS CLAIM By Stuart M. Gerson Epstein Becker Green
The last day of the Supreme Court’s term saw recent unanimity broken by two 5-4 decisions in highly-controversial cases. However, much of the reporting about them seems overstated. In Harris v. Quinn, the Court’s conservatives held that an Illinois regulatory program that required quasi-public health care workers who declined union membership pay fees to a labor union to cover the costs of wage bargaining violated the First Amendment. The court below had held that agency fees were justified under earlier precedents. However, the Supreme Court’s majority, although noting weakness in its earlier case law
reasoning, focused decisively on the fact that the employees in question were not really public employees because the patients, not the State, had complete control over the selection of the workers and their conditions of service. Four liberal dissenters argued that the “fair share” provision at issue here was clearly governed by an earlier case that covers all public employees. This, of course, was not the majority view. However, before proclaiming public employee unionization (or unionism itself) as seriously imperiled, as some commentators have, remember that the majority only criticized, but did not overrule, its earlier public employee case law. And wholesale rejection of earlier law isn’t likely to happen because, for one thing, the Chief Justice, who has attempted to be a moderating force on the Court, going back at least to the Affordable Care Act decision, and Justice Kennedy, as well, are just not going to go there. They are strong supporters of
stare decisis, and they will stay that way. The so-called “conservative majority” isn’t that conservative and may, in many cases, not even be a majority.
for the four, the majority, again led by the opinion of Justice Alito, held that the Religious Freedom Restoration Act of 1993 (RFRA), which prohibits Even more controversial was the the “Government [from] substantially long-awaited holding in Burwell v. burden[ing] a person’s exercise of Hobby Lobby Stores, Inc. Headlines religion prevented the application to almost immediately trumpeted that closely-held (non-public) corporations “Justices Say For-Profits Can Avoid of the Affordable Care Act provision ACA Contraception Mandate.” Well, requiring that employers offer birth control coverage to their employees. not exactly. The Court held that closely held Over a lengthy and impassioned for-profit corporations are entitled to dissent by Justice Ginsburg, writing see Legal Health page 21
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August 2014
Houston Medical Times
Page 4
Mental Health
More mental health screening, treatment resources for people with diabetes needed By Glenna Picton Baylor College of Medicine
a clinical psychologist and behavioral scientist who has worked with people and families living with diabetes for In a viewpoint published online more than 30 years. “The mental in Journal of the American Medical health aspects of diabetes have been Association, mental health and diabetes significantly overlooked in the setting experts and advocates describe a critical of diabetes health care.” need for more mental health screening and treatment resources for people with Anderson authored the commentary presence of two chronic diseases or diabetes. with Lee Ducat, founder of The Mental conditions in a patient) of diabetes receive a diagnosis or treatment for Led by senior author Dr. Barbara Health Issues of Diabetes Foundation in mental health issues, according to the Anderson, a professor of pediatrics – Philadelphia, Juvenile Diabetes Research American Diabetes Association. Few psychology at Baylor College of Medicine Foundation, and National Diabetes diabetes clinics or centers provide mental and Texas Children’s Hospital, the Research Interchange; and Dr. Louis health screenings or integrate mental experts pinpoint the increased risk of H. Philipson, professor of medicine and health/behavioral health services into depression, diabetes distress, anxiety and pediatrics and director of the Kovler diabetes care, the authors noted. eating disorders in people with diabetes. Diabetes Center University of Chicago. “The incidence of both type 1 diabetes and type 2 diabetes is on the rise, so this is the right time to talk about the consequences of the mental health co-morbidities of diabetes before they lead to poor mental and physical health outcomes for increasing numbers of people with diabetes and bankrupt the healthcare system,” said Anderson,
August 2014
Depression The latest data from the Centers for Disease Control and Prevention Individuals with diabetes have two estimated 29.1 million people, or 9.3 times greater the risk for depression. percent, of the United States population Young adults with type 1 diabetes are have diabetes. especially vulnerable to depression and Currently, only one-third of people consequent poor health outcomes, said with diabetes who also cope with a the authors. mental health comorbidity (simultaneous “Diabetes distress is now recognized
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as a mental /behavioral health condition separate from and more common than clinical depression. Diabetes distress occurs because virtually all of diabetes care is self-management behavior— requiring balance of a complex set of behavioral tasks by the person and family, 24 hours a day, without ‘vacation’ days,” said the authors. Recent research has shown people with diabetes and depression as well as diabetes distress are at risk for poor adherence to treatment, poor glycemic control, higher rates of diabetes complications and impaired quality of
see Mental Health page 21
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Houston Medical Times
Special Feature: Vacation Home Ownership Report
Vacation-home ownership made simple Private Residence Club-style living is a perfect solution for busy professionals Overworked professionals understand High-pressure and high-responsibility professionals, physicians among them, are perhaps more in need of vacation getaways – places to “unplug” – than most. But an irony of second-home or vacation-home ownership is that, with upfront expenses, ongoing maintenance obligations, and travel to and from resort or exotic destinations, those second homes end up becoming responsibilities in and of themselves. What should be a peaceful retreat ends up as one more thing to “manage.” Private Residence Clubs have emerged as an increasingly popular response to that reality. Sophisticated, upscale vacation-home owners the world over have embraced the convenience and budget-friendliness of luxury Private Residence Club living for years. It’s a way of enjoying a second home in a resort or vacation destination that’s based on shared, or fractional, ownership. With this style of ownership, the upfront and ongoing costs are dramatically less than with full ownership – and, more importantly, the headaches and hassles of traditional home ownership are virtually eliminated.
absentee management of a multimillion-dollar vacation home doesn’t make sense, the ownership of a share in a Private Residence Club does. With convenient reservation arrangements that provide for flexible use for owners and their guests; with five-star amenities and services; and with a real estate investment that can be resold or transferred at any time; it's small wonder that the “PRC” has taken off as robustly as it has. Today, about 70% of American households who can afford to purchase a million-dollar vacation home choose not to. They do so for a host of reasons, including avoiding the burdens of absentee ownership, and because of concerns that they won’t use the property enough to warrant buying it. The conveniences of fractional ownership hold significant appeal for these families – perhaps yours among them.
low-density with great views, which is precisely why we chose this location. Space, light, views – in many ways, these are the real definitions of luxury.” Visitors to Seahorse remark upon the unspoiled nature of the place’s rolling dunes, waving beach grasses, and clear Gulf waters. It’s an idyllic landscape, the setting for a menu of resort-level amenities. Among them will be Seahorse’s expansive 9,000-square-foot Club House with kid’s recreation center, fitness room, spa, and bar, and the kind of dining options you’d find in a fine hotel. On-property, residents enjoy a scenic elevated pool that overlooks the Gulf, as well as private picnic pavilions, playgrounds and sports areas; walkable nature preserves; even private crabbing and fishing piers. A full-time onsite concierge makes it all run smoothly, while the beach club will ensure that the beach experience is maximized by providing beach
Over the years, luxury fractional ownership of vacation homes has become one of the fastest-growing segments of the luxury vacation-home industry. The list of fine Private Residence Clubs includes Capella Pedregal in Cabo San Lucas, Mexico; the Isle de France Club on St. Barth’s in the Caribbean; Miami Beach’s Residence at Island Gardens; and Pond Bay on St. John in the U.S. Virgin Islands. Even urban locales like New York, San Francisco, and London are home to highly sought-after Private Residence Clubs for city-lovers – properties that often cater to elite business travelers as well as urban vacationers.
A lifestyle of flexibility and good sense The fact is, for the large segment of successful professional and executive families for whom the ownership and
return year after year . . . if the homes themselves match your vacation-home dreams . . . if the idea that you are buying into a lifestyle full of amenities and service as part of the purchase appeals to you . . . then a Private Residence Club like Seahorse may be just the ticket.
PRIVATE RESIDENCE CLUBS: 5 COMMON QUESTIONS WHAT IS A PRIVATE RESIDENCE CLUB (PRC)?
A PRC is the luxury end of fractional property ownership. A PRC provides owners with the full services and amenities that they'd expect in exclusive high-end or five star luxury hotels and resorts.
WHAT ARE THE ADVANTAGES?
Owners enjoy abundant and flexible use of their vacation homes with luxurious services and amenities typically unavailable to second-home owners, inluding world-class design and furnishings. They profit from the financial good sense of minimal investment. They share their home with friends and family. And often they can exchange reservations for accommodations at sister-PRCs in other desireable locations around the world.
CAN PRCs BE RESOLD?
PRC memberships are just like any other form of real estate – they can be transferred or sold, subject to individual PRC policies.
An ownership style that has evolved Historically, the Deer Valley Club in Park City, Utah, established in the early 1990s, is often cited as the first modern Private Residence Club – embraced by ski-resort-loving owners frustrated by the financial, managerial, maintenance, and other obligations that go along with ownership of a multimillion-dollar second home.
Page 5
DOES ONE OWN A PARTICULAR HOME OR UNIT? Now, Private Residence Club living has come to the Texas Gulf Coast, with the anticipated opening of Seahorse Beach Club & Residences – a family-oriented “country club on the beach”
The first on the Texas Gulf Coast Now, Private Residence Club living has come to the Texas Gulf Coast, with the anticipated opening of Seahorse Beach Club & Residences – a family-oriented “country club on the beach” that includes both beachfront and bayfront homes in a resort style setting. The exclusive 108-acre master-planned vacaction home community is located on scenic Follett’s Island, one of Texas’s barrier islands – just west of Galveston and about an hour’s drive from downtown Houston via 288 South. Residences at Seahorse are spacious four or five-bedroom, architecturally distinguished mini-estates conceived with respect for the traditions of Gulf coast design and the lifestyle that has brought families to Gulf beaches for generations. In the words of John Howton, Houstonian Developer of Seahorse, “We wanted to offer the Private Residence Club experience close to home, and wanted to give owners
seats/umbrellas and non-motorized beach toys, including boogie boards and kayaks. Many area executives, professionals, and their families who have always dreamed about owning their own vacation home in Galveston/Surfside are discovering Seahorse – a genuine escape, yet close enough to use for short-notice weekend getaways, truly a one-of-a-kind beach and resort community. Best of all, the Seahorse Private Residence Club is affiliated with the Registry Collection, so Seahorse residents will have the flexibility, on an exchange basis, to enjoy million-dollar homes at fine resorts throughout the world.
Is a PRC right for you? Are Private Residence Clubs like Seahorse for everyone? No. If you have extended periods of vacation time off, for example, 30 to 60 or more days off at a time, it might not be right. But if this is a destination to which you, your family, and your friends will want to
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Yes, owners receive a deed to a particular unit and PRC owners have flexible access to all villas, townhouses, cottages, or apartments at their ownership level.
ARE THERE ANNUAL FEES?
Management and operation of club residences and common areas, as well as staff salaries, maintenance, utilities, property taxes, and other expenses, are covered by owners' annual fees.
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August 2014
Houston Medical Times
Page 6
New Technology
workload more efficiently and improve patient outcomes.”
many as charting a new way forward for healthcare systems, accountable care Memorial Hermann Physician Network Launches Physician organizations (ACO) and other health Mobile Communication Solution Throughout Houston “We have worked closely with IT solutions to work with one another, the MHMD physician advisory team rather than in separate silos.” the fingertips of our physicians at the as well as the group’s IT department By Lindsey Klingensmith Memorial Herman MHMD decided to launch a point of care when referring patients to ensure the initial roll-out to the physician communication solution Accountable Care Organization After a long search for the to other physicians,” says D. Keith network (MHACO) physicians is to drive work-flow efficiencies and right HIPAA-secure mobile health Fernandez, M.D., Chief Medical Officer seamless and immediately impactful on improve the secure flow of critical communication solution, Docbook of the Memorial Hermann Accountable communications across its huge network Enterprise is set to connect one of the of physician practices. “Security is a largest physician networks in Texas into constant concern of ours even as we one real-time communication platform. look for ways to empower our physician members to improve patient outcomes,” DocbookMD, a HIPAA-secure says Dr. Shawn Griffin, Chief Quality mobile communication company, is and Informatics Officer at MHMD. in the process of deploying one of “A communication solution has to the largest physician-centric mobile balance speed and ease of access with communication solutions in Texas at a HIPAA-secure platform that will also Memorial Hermann Physician Network help physicians treat patients efficiently (MHMD) in Houston. to lower the cost of care across our Created by Austin-based physicians, network.” Tracey Haas, D.O., MPH, and Tim Gueramy, M.D, the DocbookMD DocbookMD, which launched Care Organization (MHACO). “With patient outcomes,” says Dr. Gueramy, application will be embedded into its Docbook Enterprise solution in the ability to send text messages and CEO of DocbookMD. “MHMD is a MHMD’s Accountable Care Network chat real-time with other physicians world-class healthcare organization that November of last year to help large to enhance communication between its in the Accountable Care Network, often sets the tone for the industry, so hospitals and healthcare groups better physicians. “MHMD searched for the DocbookMD will help us manage our that means our collaboration is seen by see New Technology page 21 best technology to put this capability at
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Page 7
Money Matters
Proactive vs. Reactive? By John K. Wessels Director of Ad Vanced Planning Estate Business, And Personal - Markets for ZTWEALTH
There is another choice. You can plan to be reactive. In other words, we can decide to wait, be lucky, stay lucky, hope it gets better. This is reactive planning. We are all reactive and being flexible is required of mere mortals in uncertain times. Being a reactive planner is different. Deciding not to take regular and realistic stock of your situation prevents proactivity. This is a hard truth and stock takings can be hard tasks, on a number of levels. Reactivity means settling into to a numb confidence that the unseen future is either positive, or beyond our ability to influence.
Our lives are a series of trends, counter trends and efforts to control chaotic and predictable outcomes. These activities fill our waking hours, form the basis of our plans and cost us sleep. I have spent many years refining, fixing, sketching, amending and abandoning personal and professional plans. I bet you have too. This article looks at two Proactivity entails making long types of planning, proactive and reactive, term plans. These plans will and in the context of establishing a flight must change. We will be surprised path for our financial lives. and challenged. Proactivity really
I will use proactive planning to denote attempts to examine terrain ahead, consult past travelers, expert guides and attempt to shape the unknown future. I will use reactive to mean, a plan, conscious or otherwise, to be and stay lucky when it comes to future needs, wants financial. We have all been told to plan, probably since long before we knew what planning involved and why it was done. My point is to examine for a few paragraphs, what different approaches to planning might mean. Nothing more, and hopefully not too much less, is to be found below.
means doing what you can to take full advantage of reactivity when opportunity arises. Proactive planning also means preventative financial health. How do we exercise our management skills? How do we eat the right diet of information and opportunity? How do we build relationships with primary care diagnosticians and maintenance advice providers? In short we plan, proactively.
Good plans mean building good teams. Spouses, friends, information sources and regular planning workouts help. Proactivity is a skill that develops because we invest in developing it. Being fortunate is fabulous but neither required Being proactive starts with a nor, assured. creative exercise. Where am I today in Proactive planning is the diet and my financial life? Am I at or near my exercise of your financial life. It's about peak earnings? Can I save with today 's cost structure? Can I, do I, have a the journey as much as the destination. productive way to put savings to work? Don't worry, life makes sure we all get What can I do to make my income plenty of chances to be reactive. Getting more stable, higher, tax advantageous? into healthy routines and building a Can I gather the information to make community, team that helps usually a smart proactive plan? Likely, you can. makes for a better journey and a richer destination. medicaltimesnews.com
August 2014
Page 8
Houston Medical Times
Texas A&M forges path for rapid, flexible vaccine delivery By Holly Lambert Texas A&M Health Science Center
and academic partners as well as the State of Texas, the Texas A&M Center for Vaccines are among the greatest Innovation in Advanced Development achievements in the history of public and Manufacturing (CIADM) is one health. However, past challenges with such center – and the only one housed vaccine development processes and within an academic institution – frequent shortages during times of need designed to develop vaccines, biologics have highlighted the importance of more and therapeutics much more rapidly, extensive and reliable manufacturing efficiently and cost-effectively than ever operations. The 2009 H1N1 influenza before. As a public-private partnership, pandemic brought to light some key areas the center leverages the expertise of in need of improvement on a national a renowned research university and scale: dated, slow vaccine technology and health science center, innovation of too much reliance on foreign factories. emerging biotechnology firms, and the development and manufacturing Mobile clean rooms allow for development and simultaneous production of millions of doses of As H1N1 reached a peak in June capabilities of global pharmaceutical medical countermeasures against some of the world’s deadliest threats. 2009 withall 50 states in the United companies. less than the current approach. as second generation anthrax vaccines, States, the District of Columbia, Puerto antibody therapies and treatments for Rico, and the U.S. Virgin Islands “The three national centers are the Mobile clean rooms – standalone, radiation poisoning, which will serve as reporting cases of infection, the federal first major U.S. domestic infrastructure to modular, biopharmaceutical “pods” – a national response platform for new government began putting into place a address biodefense threats and pandemic within the facility allow for development naturally emerging infectious diseases and simultaneous production of millions like SARS and West Nile Virus. The of doses of medical countermeasures goal is to speed response to public health against some of the world’s deadliest threats before impending situations threats. These mobile clean rooms can reach pandemic proportions. be configured to support manufacture “We need to be prepared for all of vaccines against pandemic influenza hazards, not just the last one that hit or antidotes to biological, chemical or us,” Parker said. “Other threats could radioactive agents. Each room can be emerge, such as the coronavirus behind unplugged, pushed across the warehouse, Middle East respiratory syndrome, and connected to a new production line which surfaced in Saudi Arabia in 2012, — ready in days to make a different or the Ebola virus outbreak currently life-saving product as compared to the devastating West Africa. If one of these months that previous processes required. viruses begins to spread and a vaccine Once the center is fully operational, can be developed, the center will need the facilities will have the capability to to produce it quickly and prepare it for supply fifty million vaccine doses within the market at speeds never before seen.” four months of receipt of a pandemic Ultimately, efforts at Texas A&M influenza strain, with first doses available will have profound implications for the in 12 weeks. This is twice as fast as the entire pharmaceutical industry, and In the wake of recent disease outbreaks, the need for quick access to high-quality, life-saving vaccine response to the H1N1 outbreak most importantly for patients in need vaccines shines light on the importance of reliable, U.S.-based vaccine manufacturing efforts. in 2009. of life-saving new therapies. plan to more effectively address the need for highly flexible and adaptive domestic manufacturing technologies The results? Launch of three government-funded biodefense centers aimed at building the national medical countermeasure stockpile in the U.S. to stand ready with a near-immediate response to the next national public health threat, whether naturally occurring or a deliberate attack. Founded on an initial $285.6 million public-private investment from the U.S. Department of Health and Human Services (HHS), including $176.6 million from the U.S. government and the remainder cost-shared by commercial August 2014
influenza,” said Gerald Parker, D.V.M., Ph.D., M.S., vice president for public health preparedness and response at the Texas A&M Health Science Center and principal investigator of the Texas A&M CIADM. “Their development represents a major step forward in ensuring our ability to protect the health of Americans when our nation faces imminent threats.”
Unlike traditional inf luenza vaccines, grown in fertilized chicken eggs, the Texas A&M CIADM will produce the vaccines in animal cells, a cleaner and quicker process that also eliminates many of the allergic risks associated with egg-based vaccines. In fact, the center is expected to produce as many influenza vaccine doses in a single month as a traditional lab does in one year, at a fraction of the cost.
“The threat of bioterrorism is very real and something we as a nation need to be prepared to face so that we can mitigate potential damage and save lives,” Parker said. “As a leading academic institution with a history of dedicated national service, Texas A&M is highly motivated to support vaccine and medical countermeasure development, manufacturing, licensure and delivery to populations in need.It The center’s technology is founded In addition to revolutionary influenza may sound odd to think that the nation’s on a 150,000-square-foot revolutionary vaccine manufacturing, the Texas A&M future can be found in a warehouse in facility that has pioneered highly CIADM is also refining advanced College Station, Texas, but that is the flexible, adaptable mobile manufacturing manufacturing techniques for all vaccine case, and we stand ready.” platforms, at a capital cost 80 percent and medical countermeasures against biological and chemical threats, such medicaltimesnews.com
Houston Medical Times
Page 9
Healthy Heart
LEARN THE SIGNS OF HEATSTROKE By American Heart Association Staff
them drink a cool, nonalcoholic beverage without caffeine, preferably water, and As the mercury soars and cool water fan them with cool air.” and shade becomes more precious than If someone is exhibiting stroke gold, the American Heart Association/ warning signs, bystanders should call American Stroke Association asks consumers to learn the signs of 9-1-1 immediately and let the operator heatstroke, which differ from the signs know it may be a stroke. of stroke. “Stroke patients who arrive at the “While heatstroke contains the hospital by ambulance not only have word stroke and both are potentially a greater chance of living through the life-threatening medical emergencies, stroke, but also have a greater chance of stroke and heatstroke are not the same preserving independence and having a condition,” said, Rani Whitfield, M.D., full recovery,” Whitfield said. family practitioner and American Stroke Symptoms of stroke: Association spokesperson. Heatstroke, sometimes called sunstroke, occurs when core body temperature rises to more than 104 degrees Fahrenheit and organs can’t function properly.
∙
Facial Drooping
∙
Arm Weakness
∙
Speech difficulty
∙
Additional signs of stroke include sudden trouble seeing, dizziness, confusion, severe headache, or weakness on one side of the body.
If any of these signs are present, you should call 9-1-1 immediately. The American Stroke Association teaches the acronym F.A.S.T. for stroke: Face A stroke, however, occurs when a drooping, Arm weakness, Speech blood vessel to the brain is either blocked difficulty, Time to call 9-1-1. by a clot or bursts. The disruption of Symptoms of heatstroke: blood and oxygen to the brain causes brain cells to die. ∙ Body temperature of 104 F or greater “Heatstroke is brought on by ∙ Lack of sweating. Skin will feel external environmental factors, usually hot and dry, unless heatstroke being outside or exercising outside on is cause by exercise. very hot days,” Whitfield said. “Some people may be more susceptible to ∙ Nausea, vomiting or both heatstroke due to age, weight, medical ∙ Flushed/red skin history, or medications they are taking. It’s important to know your individual ∙ Rapid, shallow breathing risk for heatstroke just as you do for stroke.” ∙ Headache Certain heart medications like beta blockers, ace receptor blockers, ace inhibitors, calcium channel blockers and diuretics, which deplete the body of sodium, can exaggerate the body’s response to heat.
∙
Conf usion unconsciousness
a n d /o r
∙
Muscle cramps or weakness
∙
Strong and rapid pulse
Take steps to cool down and “Heatstroke is life-threatening. If get medical attention immediately if you suspect someone is suffering from someone is experiencing any signs of heatstroke, you should immediately try to heatstroke. cool them down and call 9-1-1,” Whitfield said. “Take them out of the sun, have medicaltimesnews.com
August 2014
Houston Medical Times
Page 10
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August 2014
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Houston Medical Times
Age Well Live Well Help is a Phone Call Away
By Jeff Carmack, Managing Editor, Texas Department of Aging and Disability
caregivers find respite more quickly and easily.” The Take Time Texas website offers
Providing care for a parent or an adult with a disability can be overwhelming, and many people – 2.7 million in Texas alone –find they need information, assistance and support.
∙
Statewide database of respite providers that caregivers can search to find nonprofit, commercial, faith-based, and governmental respite providers.
This sort of help is available from the Texas Department of Aging and Disability Services (DADS) and the Texas Health and Human Services Commission (HHSC). Three resources – Take Time Texas, 2-1-1 Texas, and a resource sheet – take much of the guesswork (and hopefully much of the stress) out of finding help.
∙
Content to help caregivers and providers resolve problems and improve caregiving.
∙
Resources to help respite providers, outreach materials, and information on best practices and training tools.
2-1-1 Texas
Take Time Texas 2-1-1 Texas, an HHSC program, helps Caregiving is an important role Texans connect with the services, such that helps older adults and adults with as healthcare through Medicaid, food disabilities remain living in their own assistance and short-term financial help.
Help is a Phone Call Away. Caring for a parent or an adult with a disability can be overwhelming. For help, go to www.dads.state.tx.us or contact your local Area Agency on Aging at 1-800-252-9240.
homes with safety and dignity. The Take Time Texas (TTT) website is designed to help caregivers continue to provide support to their loved ones through respite care. Whether for a few hours or a few days, respite gives caregivers time away from their duties so they might rest, recharge and come back to their duties renewed.
2-1-1 Texas offers accurate, well-organized and easy-to-find information from more than 60,000 state and local health and human services programs.
The free, anonymous information and referral line is answered by nationally certified specialists 24 hours a day, seven days a week. When callers dial 2-1-1, they are connected to area information centers TTT helps caregivers learn about in their region. Specialists have access best practices, find supportive services to the most comprehensive database like training and workshops, and find a of community-based organizations, respite care provider in their community. government agencies and nonprofits Many family caregivers find the site to be in Texas. informative and use the website’s listing “It’s the number people should call of respite services to find a respite care when they aren’t sure where to turn provider in their community. for help,” said Beth Wick, 2-1-1 Texas “Based on surveys, DADS learned Program Manager. “No matter where that many caregivers do not know how you live in Texas, you can call or where to find respite care. Some do 2-1-1 and find information about not even know what respite care is, or that it is available,” said Joyce Pohlman, resources in your local community. DADS Access and Intake division. Whether you need help finding food or “Take Time Texas was created to help see Age Well Live Well page 22
August 2014
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Houston Medical Times
Page 13
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August 2014
Houston Medical Times
Page 14
Recognize Parkinson’s symptoms earlier for longer, happier lives By Katie Hancock Texas A&M Health Science Center
assistance with managing Parkinson’s symptoms, but the disease gradually While Parkinson’s disease is worsens over time. incurable, early detection of symptoms Researchers have become may lead to a better quality of life. increasingly focused on the identification Tremors, twitching, stooping and of non-motor symptoms for the earliest a masked face are commonly known detection. It is believed that the earliest signs of advanced Parkinson’s disease. signs of Parkinson’s occur in a part of the But what about earlier warning signs? Is nervous system which affects non-motor there a way to detect the disease before symptoms. these drastic symptoms develop? “Early detection gives patients with While the disease is incurable, Parkinson’s disease the greatest chance early detection of symptoms may lead at a longer, healthier life,” said Colleen to a better quality of life. The Texas Neal, M.S., RN, assistant professor A&M Health Science Center’s College at the TAMHSC College of Nursing. of Nursing discusses some of these Neal teaches community health and lesser-known early warning signs. researches aging health and long-term care. Her experience includes assessing Park inson’s disease is a and assisting patients with Parkinson’s neurodegenerative brain disorder that disease through her career with the develops when the brain stops making Aging Services Department for the the chemical dopamine. Dopamine aids State of Oklahoma. She notes that the in body movement and also helps keep risk for Parkinson’s increases with age moods stabilized and elevated. While due to nerve damage from genetic or the disease is incurable, medications can help replace dopamine and provide some
environmental factors.
be a reason to speak with a physician.
While no single one of these symptoms indicates that a person has Parkinson’s, if several of these symptoms are present an appointment should be made to speak to a physician. Here are some potential, early warning signs of Parkinson’s disease.
4. Small handwriting. A sudden shrinking in the size of handwriting can be an indicator. While handwriting can gradually change with age, this particular symptom of Parkinson’s occurs quite suddenly.
5. Choking, speaking softly and 1. Loss of smell. Difficulty smelling difficulty swallowing. All three are due strongly scented foods like dill pickles to loss of control of mouth and throat or licorice may be an indication of muscles. Parkinson’s development. 6. “Freezing, falling backwards, and 2. Difficulty sleeping. Thrashing, asymmetrical arm movement. Feet can sudden movements and falling out feel “stuck to the floor” and result in of bed while deeply asleep could be a backwards fall. This often occurs indicators. after standing-up, when turning, and without warning. Other indicators can 3. Constipation. Difficulty moving be stiffness that does not go away as bowels without straining (when no other a person moves and arms that do not cause such as diet or medicine) could swing symmetrically when walking. ©2014 Tiff’s Treats
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Altus Hospice, one of the state’s leading hospice companies, hosted an open house and ribbon cutting with the Fort Bend Chamber of Commerce to unveil its newest inpatient facility, Altus House. The 20,059 square-feet building will provide 16 private inpatient suites in a comfortable, family-friendly environment designed to feel like home. Inpatient hospice is the highest level of hospice care for symptom management. The interdisciplinary medical team will be led by Chief Medical Director Dominic Sreshta, board certified in hospice and palliative care. Kraig Killough, chief operating officer of Altus Health, stated, “In our continued commitment to providing exceptional healthcare to
chaplains, bereavement coordinators office staff and volunteers. “Our multidisciplinary care team is highly trained to provide the practical, emotional and spiritual support for each patient and their family,” said Dr. Dominic Sreshta, chief medical director, Altus House. “Hospice is living with dignity, and not only do we ensure each patient is treated with respect, we also provide stability and continuity of hospice care regardless of where a patient resides, whether inside our inpatient
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center, their home, nursing home, assisted living or hospital.”
Services include palliative symptom management, physician guided care, distribution of medication, alternative therapies and social work, as well as bereavement services focusing on grief support, In addition to providing inpatient educational workshops, support for care at Altus House, Altus Hospice children and teens and counseling. provides outpatient hospice care in the greater Houston and Sugar Altus Hospice has operations in Land communities. The expansion Austin, Beaumont, Corpus Christi, will create a total of 83 positions, Dallas, Houston, Laredo and San including social workers, nurses, Antonio. physicians, home health aides, August 2014
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Houston Medical Times
Page 17
ACADEMY OF NUTRITION AND DIETETICS CALLS ON CONGRESS TO STOP CUTS TO PUBLIC HEALTH FUNDING
New Report from Coalition of More than 90 Organizations Documents Devastating Impacts of Deep Cuts to Programs that Keep Americans Safe and Healthy, Invest in Public Health By Ryan O’Malley The Academy of Nutrition and Dietetics The Academy of Nutrition and Dietetics, as part of 90 public health advocacy organizations in the Coalition for Health Funding, released a new report today documenting the dire consequences of Congress’s deep cuts to public health programs in recent years. “Faces of Austerity: How Budget Cuts Hurt America’s Health” illustrates how food security, food safety, senior nutrition programs and other critical public health initiatives have been compromised by cuts to programs that are designed to address such issues of public concern.
funding is devoted to keeping every single person in the United States healthy, which includes everything from preventing disease, to keeping our food safe, to ensuring that Americans have access to the food they need. Unfortunately, that small allotment of money has recently been subject to massive cuts,” said registered dietitian nutritionist and Academy President Sonja Connor. “We need Congress to invest in public health to support families, communities and our nation and prevent worsening rates of diabetes, obesity and hunger. If we want to give this next generation a fighting chance, then we need to show them we are serious.”
“Only a small portion of federal
According to the report, budget cuts
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have forced the layoffs nationally of more than 50,000 public health professionals who help ensure our seniors stay independent and healthy, monitor and respond to virus outbreaks, immunize children and inspect restaurants. Public health departments in 33 states and the District of Columbia have reduced their budgets. “Funds for public health overall, let alone the workforce, have been eroding for nearly a decade and sequester cuts have led to a situation that makes us all less secure and puts our health at risk. It only gets worse from here: while we have some limited sequester relief in 2015, we face the full impact of sequestration again in 2016 and for years to come,” Connor said. Most federal public health funds are distributed as block grants through
competitive awards processes to local mental health clinics, diabetes research labs and women’s health centers. They fund salaries, keep schools safe from virus outbreaks, and feed low-income seniors. Cuts to public health funding harm the fabric of communities, eliminating needed screenings, maternal and child health care, food and water safety initiatives, public hospitals and clinics, and programs that prevent diseases such as diabetes, cancer, and HIV/AIDS. “If we want to secure our kids’ future and the future of this country, then we must all stand up and demand that Congress invest in public health, safety and prevention,” said Connor.
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Why Milk Makes Us Sick
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seems to be a win-win situation, except, of course, for the patients. While pediatric patients and their inconvenienced parents appreciate our efforts, we continue to blame increasingly resistant germs and flu strains for their chronic illness, while the government and industry pin their hopes on discovering a new and more Just as in any typical family practice powerful vaccine. or pediatric medical office, my waiting So what do runny noses, sinus room was normally filled with sick children. Cough, fever, runny noses, congestions, bronchitis, middle-ear ear aches, asthma, and eczematous infections, and various body discharges skin rashes make up the bulk of a have in common? The answer: mucus. pediatrician’s or family doctor’s patients. Mucus is an excellent growth medium It took me a while to notice that kids for germs. Inflammation on the mucosal began getting sick when they received membranes of the nose, the bronchial their first immunizations and when they linings, the intestines, and elsewhere were weaned. The relationship between leads to an excessive production of
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cow’s milk and subsequent illness was obscured by the fact that so many babies, were on milk formula from the very start, so they seemed to be sickly from birth.
Our office has extended office hours on Fridays to accommodate patients with fractures. On behalf of the Orthopedic Care Center
Conventional medical thinking attributes the colds, runny noses, bronchitis, asthma, and other “typical” childhood conditions to viruses and germs. These conditions are then treated with a variety of medications, principally antibiotics, antihistamines, and steroids. The results of these treatments are generally poor and patients keep coming back for relief. It takes no time at all to create an assembly line or mass production mill where, incidentally, doctors, nurses, pharmacists, hospitals, and Big Pharma profit handsomely. It
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mucus, resulting in runny noses, and congestion. Ultimately, this leads to infection that is then treated with antibiotics and/or antihistamines. Sold by the millions, antihistamines attempt to block excessive histamine (that produces the inflammatory response) with variable success. Ultimately, they fail unless histamine consumption is controlled. What are Histamine and Histidine? Where does histamine come from? Histamine is a very powerful component and trigger of the inf lammatory response. We do not manufacture our own histamine,—we have to ingest it. Milk and animal protein are the main see Milk Makes Us Sick page 22
Houston Medical Times
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Employment by Hospitals Continued from page 1
Very few are seeking small, independent practices.” Both the Accountable Care Act (ACA) and market forces are driving the trend toward larger entities such as integrated hospital systems and consolidated medical groups, which typically employ physicians, Singleton said. Other proliferating sites of service, such as urgent care centers, retail clinics, and Federally Qualified Health Centers (FQHCs) also typically employ doctors.
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demand due in part to their expanded role as care coordinators in team‐based delivery models such as Accountable Care Organizations (ACOs) and medical homes, according to Singleton.
Advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) also are in growing demand, the report indicates. The number of search assignments Merritt Hawkins conducted for PAs and NPs Physicians themselves are seeking increased by 320% over the last two employed settings to mitigate financial years, according to the report. risks and to avoid the increasingly Value‐Based Incentives complex and regulated environment typical of private practice, according to The new report suggests that the Singleton. One exception is concierge use of value‐based physician incentives practice, a private practice option which stalled in the last year. In 2013, 39% appears to be growing in popularity. of Merritt Hawkins’ search assignments Merritt Hawkins conducted 32 searches offering a production bonus featured for concierge settings last year, up from at least one value‐based metric such as only ten such searches two years ago. high patient satisfaction scores or low hospital readmission rates. In 2014, that The report further indicates that for number dropped to 24%, indicating that the eighth year in a row, Merritt Hawkins employers are still struggling to create conducted more search assignments for physician compensation formulas that family physicians than for any other type incorporate both volume and value of doctor. Physicians specializing in based metrics, or are hesitating to do general internal medicine were second so until the terms of such formulas on the list, also for the eighth consecutive become clearer. year. Family physicians and other primary care doctors are in increased
Ebola Virus
Continued from page 1 to have first-rate city, county and state health departments, together with a top-flight Centers for Disease Control and Prevention. Furthermore, we should be mindful of the fact that severe tropical diseases are not new to Africa. The emergence of Ebola in West Africa is a great tragedy, but at the same time, all of the people who have died so far of Ebola are equivalent to the number of Africans who die every day from illnesses such as malaria or schistosomiasis. We too have our own neglected tropical diseases, such as dengue, Chagas disease and toxocariasis, and this too needs to be an important public health focus." Hotez is dean of the National School of Tropical Medicine at Baylor College of Medicine, where he is a professor in the Department of Pediatrics and the Department of August 2014
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Molecular Virology and Microbiology, head of the Section of Pediatric Tropical Medicine and the Texas Children’s Hospital Endowed Chair of Tropical Pediatrics. Hotez is also president of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Awareness and Research, where he leads a partnership to develop new vaccines for hookworm, schistosomiasis and Chagas disease. He co-founded the Global Network for Neglected Tropical Diseases to provide access to essential medicines for millions of people worldwide.
Houston Medical Times
Page 21
Legal Health
Continued from page 3 religious freedom protections and, in contravention of RFRA, the government did not demonstrate that the mandate was the least restrictive means of furthering a compelling government interest. Both sides of the discussion are hailing Hobby Lobby as a landmark in the long standing debate over abortion rights. This, too, likely is an overstatement. After all, the decision does not allow many employers to opt out of birth control coverage – only closely-held for-profit companies that have a good-faith ideological core, as clearly was the case for Hobby Lobby. That only puts such companies on the same footing as non-profits that are exempted from the ACA employers’
mandate. Publicly-held companies are not affected by the decision (though some are likely to argue that the controversial Citizens United campaign funding case might require such an extension. Nor are privately-held companies that can’t demonstrate an ingrained belief system. Moreover the decision has significant qualifications. For example, RFRA doesn’t shield employers who might cloak illegal discrimination (e.g., against gay people or racial minorities) as a religious practice. Moreover, the decision concerns only the contraceptive mandate not any other part of the ACA. Importantly, Justice Kennedy's concurring opinion suggests that the government could pay for the coverage itself, so that women receive it, which
the Obama administration will seek to do. In any event, per the majority, the government’s shortcoming was only that it hadn’t shown that the mandate was the least restrictive means to accomplish its end. Not only did Justice Kennedy concur in a manner respectful of the dissent, but the fact that Chief Justice Roberts didn’t assign the opinion to himself strongly suggests that he is not prepared to stand in a position of strong conflict with the Court’s liberals but instead will be a mediating figure, as he was in upholding the ACA itself.
the inherently divisive nature of the two controversial opinions decided at the end of the term, it is not unlikely that greater concord will be the hallmark of the Roberts Court as it was for the Warren Court in earlier times – and notwithstanding alarmist press and interest group statements to the contrary. Stuart M. Gerson is a member of the law firm of Epstein Becker & Green, P.C., and is a former Assistant Attorney General and Acting Attorney General of the United States.
The number of unanimous opinions of the Court this term has been the highest in recent years. Notwithstanding
Mental Health
Continued from page 4 life. “Diabetes is a chronic and progressive condition; and the complex, daily treatment of diabetes is completely in the hands of the person and family living with diabetes in collaboration with a health care team.” said Anderson. “Cognitive behavioral therapy combined with psychotropic medication has been shown to help some people with diabetes who suffer from depression.” “If a person with diabetes is depressed or struggling with diabetes distress, it is very difficult to be motivated and sustain the level of self-care needed
to successfully manage diabetes,” said compromise diabetes self-management. Anderson. Eating disorders Anxiety Additionally, women with type 1 Many people with diabetes also diabetes have more than double the risk suffer from anxiety associated with the of developing an eating disorder than initial diagnosis or when complications women without, they said. of diabetes first occur, the authors noted. Having an eating disorder in “Anxiety disorders complicate living the context of type 1diabetes leads with diabetes and its management,” the to poorer glycemic control, higher authors wrote. rates of hospitalization, increased risk Fear of hypoglycemia, anxiety about for retinopathy and neuropathy and maintaining blood glucose levels in a premature death, they said. healthy range, as well as anxiety about Identifying and treating mental injections and blood draws, can all
health issues among patients should be a priority, they concluded. “The high prevalence and costs of depression in the context of diabetes combined with evidence that behavioral factors are important for effective diabetes self-management create a unique opportunity to integrate mental health screening and treatment into multidisciplinary team diabetes care, to help improve patient and public health outcomes, and decrease health care expenditures,” said the authors.
New Technology Continued from page 6
manage their critical communications, has been working closely with MHMD’s IT Department to ensure physician contact data is complete and accurate to ensure a seamless roll-out for the first 1,800 MHACO physicians. “Anytime you upload that much data into a mobile communication solution like
Docbook Enterprise a certain amount of work is required before going live,” says David Bradshaw, CIO of Memorial Hermann Health System. “Ultimately, the key to a successful launch is to ensure all physician contact information is protected on a well-secured cloud network and to provide proactive
to do their job more efficiently, which has a direct correlation to improving patient outcomes,” says Chris Lloyd, CEO of MHACO. “This is the next step in advancing the quality and efficiency of the care we provide within “Our goal in adopting this new the MHACO.” technology is to enable our physicians physician support in the form of training and post-launch customer support. Docbook Enterprise has made serious strides toward a pre-launch strategy that bodes well for the roll-out.”
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Houston Medical Times
Page 22
Age Well Live Well
HOUSTON
Continued from page 12
housing, childcare, crisis counseling or substance abuse treatment, one number is all you need to know.”
legal services, transportation, veterans’ services and more.
issues, she said.
The sheet is updated at least annually Age Well Live Well Program to ensure the information is timely and Texas 2-1-1 can be accessed online at Manager Holly Riley said, “Many people accurate, Riley said. www.211Texas.org, or by phone at 2-1-1. don’t realize the breadth of services For more information on getting available through the federal government Resource Sheet help for an aging parent or someone and the state, much less local providers.” with disabilities, go to www.dads.state. Developed by DADS for the Age “We polled several state agencies tx.us or contact your local Area Agency Well Live Well program, this resource on Aging at 1-800-252-9240. sheet covers topics that include Medicare and found the top 10 questions they were and Medicaid, in-home assistance and getting from consumers.” The result is a -30home health care, caregiving services, resource guide founded upon real-world
Why Milk Makes Us Sick Continued from page 18
sources of histamine in our systems. This is because all animal protein is rich in histidine. Histidine converts to histamine. Milk products, especially cheese, and shellfish are particularly significant sources of histidine. The production of histamine resulting inflammation affects other areas in our bodies as well. In fact, many of the most common illnesses are associated with an inflammatory response.
cultural and financial forces that are vested on the consumption of milk and animal products. I highly recommend to my patients that they let their bodies and not the media determine what is good for them. Gilbert Manso, MD, logged over 140,000 patient visits covering the spectrum from Amoebas to Zoonosis and contributor to Rethink Food book.
Bone and joint: Rheumatoid arthritis, juvenile rheumatoid arthritis, lupus, Beheta's disease, (possibly psoriatic arthritis and ankylosing spondylitis).
Skin: Rashes, atopic dermatitis, Problems and Side Effects Associated eczema, seborrhea, hives (urticaria) with Milk Protein Consumption Nervous system (behavioral): General: Loss of appetite, growth Multiple sclerosis, Parkinson's disease, retardation. autism, schizophrenia, irritability, Upper gastrointestinal: Canker restlessness, hyperactivity, headache, sores (aphthous stomatitis), irritation lethargy, fatigue, "allergic-tension of tongue, lips, and mouth, tonsil fatigue syndrome," muscle pain, mental enlargement, vomiting, gastroesophageal depression, enuresis (bed-wetting).
The great majority of my patients, children and adults, get rid of their allergies and recurrent inflammatory mucus-produced conditions by the simple expedience of eliminating milk products from their diets. It is not uncommon in my practice to rid a patient of years of misery from allergies, eczema, and the reflux disease (GERD), Sandifer's like by just abstaining from milk for a syndrome, peptic ulcer disease, colic, couple of weeks. stomach cramps, abdominal distention, intestinal obstruction, type-1 diabetes. Humans are the only known Lower gastrointestinal: Bloody species that drinks the milk of another stools, colitis, malabsorption, diarrhea, species, and the only known species that continues to drink milk into adulthood. painful defecation, fecal soiling, infantile Cow’s milk naturally contains the colic, chronic constipation, infantile food large amount of hormones and protein protein-induced enterocolitis syndrome needed to turn an 80-pound calf into (FPIES), Crohn's disease, ulcerative colitis. a 1,000-pound cow in one year. Unfortunately, there are enormous
runny nose, otitis media (inner ear trouble), sinusitis, wheezing, asthma, and pulmonary infiltrates.
Blood: Abnormal blood clotting, iron deficiency anemia, low serum proteins, thrombocytopenia, and eosinophilia. Other: Nephrotic syndrome, glomerulonephritis, anaphylactic shock and death, sudden infant death syndrome (SIDS or crib or cot death), injury to the arteries causing arteritis, and eventually, atherosclerosis.
Respiratory: Nasal stuffiness,
Olympian Erin Hamlin’s recent visit to Texas Children’s Hospital. Patients at Texas Children’s Hospital were greeted by three-time Olympian Erin Hamlin. Most recently, Hamlin made history and took home the bronze medal in the singles luge event at the Winter Games in Sochi, Russia. The August 2014
27-year-old from Team USA brought smiles to patients, showed off her medal and even came with a luge in tow for them to ride.
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