The Message, June 2013

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A MON T HLY NE WS M AG A ZINE OF SPOK A NE COUN T Y MEDIC A L SOCIE T Y – J U N E 2 0 1 3

Health Safety Nets

Anne Oakley, MD SCMS President

Release Your Inner Entrepreneur School Based Health Center Model of Care Healing Body & Soul

June SCMS The Message Open2

Table of Contents

2013 Officers and Board of Trustees Anne Oakley, MD President David Bare, MD, President-Elect Terri Oskin, MD Immediate Past President

Health Safety Nets .

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The Inland Northwest’s Health Care Safety Net .

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Matt Hollon, MD, Secretary-Treasurer

Healing Body & Soul .

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School Based Health Center Model of Care .

All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

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Shriners Hospital for Children-Spokane’s Forgotten Hospital .

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Release Your Inner Entrepreneur .

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Membership Recognition for May and June 2013 .

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Spokane: Popular Option for Second-Year Medical Students .

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The Trial to Assess Chelation Therapy: A Review of the Study .

Advertising Correspondence Quisenberry Marketing & Design Attn: Lisa Poole 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 Lisa@quisenberry.net

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Spokane Physicians Committed to Providing Quality Health Care to All . 5

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Numerica Credit Union - An SCMS Community of Professionals Partner .

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society.

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N. E. Washington Health Programs A history of service… .

Newsletter editor – David Bare, MD

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Community Health Association of Spokane (CHAS) –

Shane McNevin, MD Vice President

Trustees: Robert Benedetti, MD Audrey Brantz, MD Karina Dierks, MD Clinton Hauxwell, MD Charles Benage, MD J. Edward Jones, MD Louis Koncz, PA-C Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD

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In The News .

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Continuing Medical Education .

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Meetings/Conferences/Events .

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2013 SCMS Events calendar .

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“We

can ’t solve problems by using the same kind of thinking we used when we created them .”

–A lbert Einstein

June SCMS The Message Open3

Health Safety Nets

By Anne Oakley, MD SCMS President What are Health Safety Nets? Who do they serve? What do we already have? What do we still need? What is the value?

According to Wikipedia:

“Safety nets are part of a broader poverty reduction strategy interacting with and working alongside of social insurance; health, education and financial services; the provision of utilities and roads and other policies aimed at reducing poverty and managing risk.”

Wikipedia goes on to describe the three categories of people who require coverage in a safety net, the last two of whom fall into need frequently due to medical issues, large and small.

The chronic poor Even in “good times” these households are poor. They have limited access to income and the instruments to manage risk; even small reductions in income can have dire consequences for them.

The transient poor This group lives near the poverty line and may fall into poverty when an individual household or the economy as a whole faces hard times.

Those with special circumstances

Any type of “health safety net” must focus on the medical aspects of health care maintenance as well as provision of urgent and emergent care, but must also encompass the community strategies listed above. Health care cannot stand alone: giving homeless, schizophrenic people bottles of pills for their blood pressure and diabetes will probably not go far in helping them manage their diseases without mental health care, proper nutrition, housing support, transportation and financial means for refilling the prescriptions. All those services must communicate—an overwhelming task for anyone to coordinate.

I recently attended an information forum through Leadership Spokane on subsidized housing in our area. The people working in those organizations have to coordinate and pull resources from 146 different federal, state and local agencies in order to find housing. And we in medicine think we have bureaucracy to deal with!

We are blessed in Spokane with a large number of organizations dedicated to serving the resource less patient, many featured this month in The Message. The work of those organizations benefits not only the difficult and challenging patients, but our community as a whole. Learn about them, support them, do not groan when their patients get referred your way (just admit it, most of us do).

There are always going to be people in our communities that cannot care for themselves and they really do outnumber the few who simply will not take care of themselves. Who knows, any of us can one day be that person in need!

Personal note: For 21 years I have had the privilege of working at, and now for, Providence Sacred Heart Medical Center - an organization committed to providing health care for all comers.

It has made me a better person and is of course one of the reasons I became a doctor.

Sub-groups of the population for whom general stability and prosperity alone will not be sufficient. Their vulnerability may stem from disability, discrimination due to ethnicity, displacement due to conflict, “social pathologies” of drug and alcohol abuse, domestic violence, or crime. These groups may need special programs to help them attain a sufficient standard of well-being.”

If our health safety nets and health care system in general can help people avoid falling into any of these categories, all of society benefits. Developed countries need different types of safety nets than poorer nations, and are ironically called “developed nations” in large part because these programs are in place and internally funded. Decreasing poverty in our own community will make it safer and healthier. There is an abundance of evidence that health and wealth are related to each other, and not just because you can afford to see the doctor.

June SCMS The Message 1

Community Health Association of Spokane (CHAS) – The Inland Northwest’s Health Care Safety Net

By Bill Lockwood, MD CHAS Medical Director

CHAS first became a link in Spokane’s health care safety net in 1995 when the organization opened the doors to a two exam room medical clinic in downtown Spokane. The health care safety net was relatively small back then. Over the last two decades, CHAS’ portion of the safety net has expanded dramatically reflected by more patients, more providers, more clinics, more support staff and more supporting agencies.

CHAS’ portion of the safety net now supports nearly 50,000 patients, who call CHAS their health care home - a place where they can have their medical, dental, pharmaceutical and behavioral health cared for under one roof, regardless of their ability to pay for services.

In recent years we’ve seen the need to care for the uninsured and underserved in new ways. Of course medical, dental and pharmacy services have been a foundation of our services for quite some time. However, the need for behavioral health care has become very apparent in recent years. As is the case nationally, the shortage of behavioral health providers and payment for those services has always been a challenge. Despite the struggles, we’ve been actively adding more behavioral health staff to our team. The mental health of a patient is essential to them being able to live a healthy life, and as a health care home, our goal is to care for the whole person.

As we prepare ourselves for expansion of the Medicaid program, with so many previously uninsured being covered, we are excited to be a part of such a significant event in health care history.

Approximately 40% of our patients are currently uninsured.

Expanded coverage means that for the first time hundreds of thousands of people in Washington State will get needed vaccines, cancer screenings and mental health services and be able to manage their diabetes, high blood pressure and other chronic conditions. Giving people access to preventative health care promotes public health and safety that will protect our communities, saving dollars and lives. We are committed to providing a cost-effective, patient-centered health care home for low-income and vulnerable community members.

I’ve unfortunately seen how lack of coverage has affected people.

Daily we see the sad results of uninsured patients who, afraid of the cost of seeking medical care, have waited too long before coming in for help such as the 42-year-old man who presented last week with a two day history of incarcerated hernia and undiagnosed Type II diabetes and the 35-year-old gentleman who waited nine MONTHS to seek help for his iritis that led to near blindness in one eye. And then there were the patients with life-threatening conditions who wait too long to seek care including the 22-year-old male who presented nearly comatose from new onset Type I diabetes, the 60-year-old woman who waited six months to address the 20 pound ovarian tumor causing her abdomen to slowly enlarge and the many patients with acute MI’s who present after two to three days of pain. Stories like those are repeated daily in our urgent care.

CHAS has approximately 375 staff members who provide the safety net that cares for our patients who many times are very ill, have forgone care for far too long and who are now being given a chance to really change their lives. We are eager and hopeful for the future. And I personally look forward to being a small part of improving health care in the Spokane community.

We’ve also been listening…listening to the needs of patients and community members saying things such as: We’re uninsured, where are we supposed to be treated for urgent care services?

Why can’t our children be seen near their home, instead of traveling miles to be seen in the city? And we agreed! It doesn’t make sense for the uninsured to be seen at high-cost emergency departments for non-emergent conditions. Isn’t there a better option? And it doesn’t make sense for parents to take a half day off work and pull their kids out of school to take them to their well-child exam. Isn’t there a better option? All of those voices became louder and resulted in two new concepts for our organization – the opening of an urgent care in north Spokane and the opening of a school-based health center at Sunset Elementary in Airway Heights. Those two expansion opportunities are timely considering the upcoming changes with the Affordable Care Act.

June SCMS The Message 2

N. E. Washington Health Programs A history of service…

available to all despite economic hardships. The company is governed by a Board of Directors made up of both users and non-users of services. Local community based Advisory Boards meet to foster communication between the communities served and the clinics.

By Helen R Loomis Grants Management & Marketing

Incorporated in 1978, N.E. Washington Health Programs (NEWHP) grew out of a collaboration between two local groups that worked together to address what had become a critical health care shortage. The company provides services to all with a focus on the medically underserved and vulnerable populations.

The Tri-County area (Stevens, Ferry and Pend Oreille Counties) are very rural and access to care could require excessive travel time and distance.

The company’s service area is heavily dependent upon timber and mining. In recent years, Stevens, Ferry and Pend Oreille Counties have experienced unemployment and poverty rates higher than the State average. There has been an increase in the number of patients who have no insurance and who have difficulty making the minimum payment for the sliding discount program, which is based on family size and income. The sliding discount program is specific to federally qualified health centers and is subsidized through federal funding.

Services are provided at sites located in Stevens, Ferry, Pend Oreille, and northern Spokane Counties. The company operates seven medical clinics, located in Northport, Orient, Ione, Chewelah, Loon Lake, Springdale and Lake Spokane (Nine Mile Falls); three dental clinics, located in Colville, Springdale and Lake Spokane; and an assisted living facility located in Chewelah. Hospice services are provided in collaboration with Hospice of Spokane.

Adapting to change in the current health care environment is a continual challenge. The company remains vigilant for ways to increase the health of the population it serves while decreasing costs. Collaborations play a vital role. Implementation of EHR/ EDR (electronic health records and electronic dental records), Meaningful Use, Primary Care Medical Home (PCMH), the resultant IT expansion and availability/unavailability of fiber and Medicaid expansion will continue to change the healthcare environment in our service area.

N.E. Washington Health Programs’ Mission is: “To ensure that a comprehensive range of high quality health care services is available to best meet the health care needs of the people residing in our service area.” This includes seeking ways to ensure that primary preventive health care services remain

N.E. Washington Health Programs continues to meet its Mission while addressing these challenges. The company’s greatest resource is its dedicated, passionate staff that is committed to the health of their patients.

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June SCMS The Message 3

Healing Body & Soul

By Barbara Comito Union Gospel Mission

Odds are, if you met Sara McDonald and Lesa Gibbs in downtown Spokane, “homeless” would not be the first word to come to mind. Both are single women in their fifties who have experienced success in their professional careers. Sara graduated from the elite Culinary Institute of America in Hyde Park, New York. Lesa was a pharmacist. Both women, however, had lost everything when they came to the Union Gospel Mission.

After a back injury, Lesa started taking pain medication. “It made me feel really good. It gave me energy and seemed to help me cope. Over time, I started taking more and more to get that same euphoric effect, and before I knew it, I was hooked.”

Lesa went to rehab and got off the opiates, “but I came home to the same mess I left.” She started drinking. Her marriage fell apart. Her pharmacy license was suspended. She couldn’t find a job. She started living off her 401K. “I just felt hopeless. I really did. I thought, OK, I’m 52 years old, and my life’s over.” She took an overdose of pills. She cut her wrists. “I really didn’t want to die.

I was just in so much pain and so lonely.”

Lesa Gibbs, patient of Helping Hands Clinic

Sara felt a similar desperation. “I had completely failed, once again,” she said. After her divorce, “I just isolated, and eventually, I started drinking again. I was not smart with my money when I was depressed. So it was a downward spiral. I wanted to die really.” Sara was living with friends, but when she started to drink again, they told her she couldn’t stay.

They brought her to an orientation at Anna Ogden Hall, an outreach of the Union Gospel Mission. “I don’t know why I ended up coming here. I didn’t even really want to do that.”

With varying degrees of hope, Sara and Lesa entered UGM’s 18-month Women’s Recovery. More than food and shelter, the program seeks to break the cycle of addiction and homelessness by bringing healing to the whole person: body, mind and spirit.

Eventually, however, she mentioned her concern to Susan Vowell, UGM’s Clinic Coordinator, who quickly set the wheels in motion.

After another clinical breast exam, Susan arranged a diagnostic mammogram and ultrasound at Inland Imaging. The results indicated the need for a biopsy which was performed the next day. Again, the results were positive. Sara needed surgery but did not have health insurance. The mammogram and ultrasound were paid for through grants from the Eastern Washington Affiliate of Susan G. Komen for the Cure and Every Woman Can. The surgery was arranged and completed through Project Access. Sara’s prognosis is good. “I’m just supposed to come back every six months for three years,” she said.

Sara is grateful to have caught the cancer early. Without UGM and all the community support, she said, “I would’ve let it go for a long time.” She is equally grateful for the financial assistance.

“There were thousands of dollars in bills. When you’re trying to get your life back together, to be saddled with a whole lot of debt is crippling. Thank God for Project Access because who knows what would have happened without it.”

Lesa’s story also has a positive outcome. Three years postmenopausal, she started bleeding. Her initial pap smear upon entering Anna Ogden Hall had been clear. Like Sara, Lesa did not have health insurance. Jenny Edminster, nurse practitioner volunteer, arranged for her to be seen by Larry Carpenter, PA-C at Christ Clinic. Lesa was struck by his request to pray with her: “I felt such peace in that heart-felt kindness.” And from that moment on, she said, “I knew God had it.” Technicians at Christ Clinic performed abdominal and intravaginal ultrasounds. Lesa then had a biopsy, which came back negative. Medical personnel advised her to be attentive and vigilant going forward, but the coast is clear for now.

“A lot of us gals who come from the place I’ve been for the past ten years don’t feel worthy to ask for things. There’s so much self-hatred. We have a difficult time forgiving ourselves.”

A community that surrounds them with kindness, compassion and generosity goes a long way toward reversing that selfhatred, and Spokane’s medical community has been an exemplary example of that for Lesa and Sara.

At the onsite Helping Hands Clinic, each woman who enters the program receives an initial physical exam, complete with Pap smear, clinical breast exam and, for women over 40, a mammogram is arranged. An individualized health plan is also created, including diet, exercise and stress management.

Sara’s initial breast exam and mammogram were clear. During a UGM health fair, however, she spent some time at the cancer prevention booth. While handling one of the models that simulated a lump in breast tissue, she recognized a troubling similarity to her own breast. “I didn’t say anything to anyone because I kept thinking, Oh, it’s going to go away. It can’t really be (cancer).”

Sara McDonald (right) with Helping Hands Clinic staff

June SCMS The Message 4

Spokane Physicians Committed to Providing Quality Health Care to All

This effort complements the “ER is for Emergencies” campaign, a statewide effort to reduce unnecessary emergency room visits

by Medicaid patients. The campaign - a partnership between the WSMA, the hospital association, emergency physicians and the state - is expected to save the state more than $31 million annually.

By Lee Taylor Strategic Initiatives Director, SCMS

Access to health care has become a growing issue in our community. The Spokane County Medical Society (SCMS) and Washington State Medical Association (WSMA) each are developing programs to work toward greater access to care for the underserved in our communities.

“Our activities go well beyond our offices and hospitals,” said Anne Oakley, MD, President, SCMS. “Our goal is to help facilitate the best community health possible for the citizens or our region.”

While health care reforms will likely change the way physicians practice medicine and the way patients receive care, physicians in Washington State remain focused on the ultimate goal: to improve access to safe, quality health care. The SCMS is dedicated to this effort through our work on initiatives such as Project Access, providing health care services to uninsured low-income residents, and Consistent Care Washington, a program that aims to improve care and reduce costs through focused community care coordination.

Over the past nine years, Project Access has provided much-needed health care services to uninsured, low-income residents of Spokane County. The program would not be possible without the support of leading medical institutions dedicated to improving health in the Spokane community, including Providence Health Care, Sacred Heart Medical Center, Holy Family Hospital, Providence Medical Group, Rockwood Clinics, Deaconess Hospital, Valley Hospital, PAML, Inland Imaging Services and hundreds of specialty care providers. Last year alone, more than $12 million in care was donated by our partner organizations.

Through the Consistent Care Washington program, the SCMS has focused on improving the health of high utilizers of medical services and lowering the cost of their care. Group Health and Providence Internal Medicine Residency donate primary care medical services for qualified low-income, uninsured people in Spokane County. Through collaboration with the hospital emergency departments these clients are identified as needing a connection with a primary care provider to help stabilize their health and eliminate the need for visits to the ED. In addition, by bringing together the ED providers, case management staff, hospital psych staff and behavioral health services, community-wide protocols and pathways for discharging acute mentally ill patients from local emergency departments are being established.

In addition, SCMS’ Consistent Care Washington program is working with the City of Spokane on “Prescription for Housing,” a pilot project to provide medical care and social services for homeless clients with high-risk medical conditions. Part of the focus of the grant is to create new systems and partnerships to improve care and services for these clients. Through collaboration with many community partners, including Catholic Charities, Volunteers of America, the Spokane Fire and Police Departments and major providers of behavioral health services, the program has already dramatically expanded the availability of respite beds enabling homeless patients discharged from the hospital to recover from their medical conditions instead of being discharged back to the street where they often get sick again and return to the hospital.

The “Hot Spotters” community group has been formed to bring providers of services together with other community partners to create care plans for citizens who habitually over-utilize the health care system and need special attention to help stabilize their health and living conditions.

The SCMS has been a leader in galvanizing the community and bringing community partners together to improve care for underserved populations, including Medicaid patients and the homeless. As Washington State moves forward with health care reforms, including the Health Benefit Exchange and Medicaid expansion, Spokane physicians will again be challenged to meet a growing need.

“Over the next few years health care reforms in our state will add over 500,000 new patients to the system and they will need physicians to treat them,” said Nick Rajacich, MD, president of the WSMA. “Our priority has always been patient access to quality, safe care and the activities of the SCMS are making a meaningful difference in making Washington the best place to practice medicine and to receive care.”

“We’ve made it our mission to be the guardians of community health and wellness,” said Dr. Oakley. “And we’re looking forward to continuing our work with our members and community partners to make a lasting impact on health care in Spokane.”

June SCMS The Message 5

School Based Health Center Model of Care

By Stephen Brown VP of the School Health Care Association

Sunset School Health Center at Sunset Elementary in Airway Heights is nearing its first full school year in operation. The center is operated by Community Health Association of Spokane (CHAS) with funding provided by the School Health Care Association (SHCA) through grants and donations from many funders. The Cheney School District Cheney Schools has been a strong supporter and partner through their marketing efforts and flexibility as the model of the pilot clinic is being refined.

When SHCA set out to create the first school based health care clinic in Spokane County they knew it would take time to become a part of the local community. Around 200 patient visits were anticipated for the first full year of operations. However, the dedication of all those involved with the clinic has resulted in over 200 visits from August through February alone. The marketing efforts of CHAS, Cheney Schools and the SHCA have been instrumental in dispelling several misconceptions associated with the school based health center (SBHC) model of care. These misconceptions include: that a parent would have to switch providers to have their student seen at the clinic, that a child would receive medical care without the parent’s permission and that the clinic is only for those without insurance. A consistent message has been key in creating acceptance of the new clinic.

However, all of the partners in the clinic realize there is still more work to be done when it comes to educating parents about school based health care.

We continue to seek the input of community members on how best to serve those within the Cheney School District.

As a result of a Parent Teacher Organization focus group in November 2012, clinic access was expanded from just students of the Cheney Schools to all students and their younger siblings.

A recent survey of parents within the Cheney Schools found a desire for expanded clinic hours. In April, clinic hours were extended to allow for both before and after-school services. We are also listened to school counselors and administrators who expressed a further need for mental health services within the schools. The subsequent creation of a mental health program at the clinic has been an overwhelming success. The program was quickly filled as school counselors from across the district began referring students.

The need to share the benefit of all the programs offered at the clinic in a meaningful way is a top priority of all the partners.

Currently, we are creating an evaluation tool for the clinic with the support of the Area Health Education Center and a Washington State University PhD candidate. We hope that the results of this tool will help us show what over 2,000 other schools have already discovered; that school based health care is an effective and efficient way to deliver health care and gives students a better chance to succeed in school.

Meanwhile, interest in school-based health care in other school districts remains strong with several districts interested in applying this model in their high need schools. East Valley School District recently applied for a federal capital grant to build out a center, although this grant was unsuccessful. In addition, Spokane School’s new superintendent is supportive of the SBHC model, having experienced its success in prior work. In addition to CHAS, several other medical and behavioral health providers in the area have partnered with schools in creative ways to improve student health. For example, Providence’s Family Medicine Spokane Residency provides in-school sports medicine support for athletes at Rogers High School once per week, meeting a clear need by helping keep student athletes active and healthy.

The strong support around Spokane County is currently offset by funding limitations. Sunset School Health Center is funded entirely by grants from foundations and organizations around the country. We would like to thank the Spokane County Medical Society for initial funding of the pilot center at Sunset Elementary and all our grantors for their contributions. We know that this model is not sustainable if we want to create a network of SBHCs in Spokane County. The reimbursement from medical care provides some income for the Sunset School Health Center, however, it will remain low since most students are on managed care health plans and mental health reimbursements are not yet possible. Ultimately our goal is a collaborative, multi-year funding model with a combination of city, county, state and charitable monies. We are collaborating with the Spokane Alliance and the Washington Alliance for School Health Care to build organizing power and to create good policy to support a network of school based health centers in Spokane County. We know that it will be difficult to find funding for this model of care. But, we firmly believe that this is one of the most effective models for delivering mental, dental and preventive health care and that the students of Spokane County schools deserve the chance to succeed without poor health as a barrier.

June SCMS The Message 6

Shriners Hospital for ChildrenSpokane’s Forgotten Hospital Part 3 of 3

By Paul Caskey, MD Orthopaedic Surgery The Shriners Hospital’s mission is threefold, providing excellent pediatric orthopaedic services, teaching of physicians and other health care providers and performing research to ensure quality care, develop new knowledge and improve the quality of life for our patients.

Research is the third mission of our hospital and at any one time we have a number of retrospective as well as prospective investigator sponsored studies in progress at our institution. In 2012 we had one paper published and three more accepted for publication in peer reviewed journals and our staff and residents presented nine studies at regional, national and international meetings. The three dimensional Motion Analysis Lab was recently updated and is used for clinical applications as well as research. Our PhD director of our Motion Analysis Lab also serves as our director of research at the hospital.

We are a great resource and safety net for children with pediatric orthopaedic problems without insurance or ability to pay.

Patients are treated irrespective of ability to pay and medical or surgical treatment at our hospital is without cost to the family or patients. Treating patients from Mexico and Central America are important to our mission and resident education.

Over 100 patients a year are evaluated in our Nogales, New

Mexico outreach and children requiring operative intervention are treated at our hospital in Spokane. Unfortunately, we have suspended our outreach clinic in Juarez, Mexico because of the violence that plagues this border town. Our entire orthopaedic staff has been involved in volunteer work in Central America and this year two of our orthopaedic physicians and a PA from our hospital will treat patients in Honduras. Children from Central America and Africa are treated at our hospital through our relationship with Heal the Children.

Six of the Shrine Hospital physicians have served in the military, two of us were on active duty during the first Gulf War. The third year orthopaedic residents from Madigan US Army Medical Center learn pediatric orthopaedics at our hospital and we have had a long affiliation with the orthopaedic residents from William Beaumont US Army Medical Center until recently. Many of the medical students that rotate with us have Health Professions Scholarship Program scholarships as well. Every year our present and former residents give two to three presentations at the Society for Military Orthopaedic Surgeons on research that was completed at our hospital. It is not uncommon to receive e-mail from Iraq or Afghanistan asking what we would recommend for orthopaedic care of a poor child injured in one of those conflicts.

A pediatric orthopaedic surgeon from Madigan US Army Medical Center and former resident is rotating with us at this time to get more hands on operative experience after his deployment to Afghanistan. I am an active member of the Society of Military Orthopaedic Surgeons and have had an academic appointment at the Uniformed Services University of the Health Sciences for more than 20 years, so our hospital’s affiliation with the military is active and strong.

June SCMS The Message 7

Release Your Inner Entrepreneur

Unencumbered by shareholders, taxpayers or any other outside interest, the INTRP is an example of charity care at its finest, a testament to the dual powers of innovation and good will. And who knows—it might someday be known as the pioneer to a new standard of care.

By Scott Hippe, M1 WWAMI

After spending a year in Spokane as a medical student in the WWAMI Program I have been impressed by the wealth of medical providers in our community who care for the disadvantaged and disenfranchised among us. The list of services available to those who cannot afford adequate medical care is impressive. The House of Charity Clinic, Christ Clinic, federally qualified health centers such as CHAS and care coordinated by Project Access are just a few of the noble institutions providing those services.

Other institutions donating tremendous amounts of care are the emergency departments (ED) in each of our hospitals.

Much of the donated care goes to treat patients who are homeless. Nationally it is estimated that nearly one-third of visits to the ED are by those individuals. They utilize ED services because they do not have any other point of contact in the health care system. The volatile situations in which homeless people live precipitate frequent readmissions to the hospital. They simply have no secure place to fully recover from illness.

“Christopher” was a homeless individual presenting to the Providence Sacred Heart Medical Center ED with cellulitis on the dorsum of his foot. The typical course of this medical problem often features multiple readmissions to the hospital to treat recurring bouts of infection. However, Christopher was able to recover in an indoor bed as the first participant in the Inland Northwest Transitional Respite Program (INTRP).

The INTRP’s goal is to decrease readmissions to the ED by providing stable places to recover from medical problems.

For the past six month the House of Charity and Hope House have offered a few of their beds for those services and have been occupied almost continuously.

The commendable efforts of forward-thinking members in our community inspire me to release my inner entrepreneur to creatively address health challenges of today and tomorrow.

It is something we as health care providers will all have to do if we are to keep up with growing demands and challenges placed on our system.

Membership Recognition for May and June 2013 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

20 Years Peter L. Weitzman, MD, FACP 5/26/1993 Dr. Weitzman’s name was inadvertently left off of the May list.

10 Years Robert L. Arnett, MD Jeremy D. Graham, DO Christina Marino, MD, MPH Mirko Zugec, MD

The program was started by a doctoral nursing candidate at Washington State University named Becky Doughty, who noticed the frequent readmissions among the homeless population to the ED and decided to address the problem.

Starting in August, second-year medical students in the WWAMI Program will also play a role in monitoring the health of individuals recovering in those respite beds. I am looking forward to the opportunity to serve an at-need population in our community while gaining clinical experience.

Becky’s INTRP is impressive because it addresses a longstanding and deep-rooted insufficiency in our health care system in an innovative way. She looked outside of the box (and hospital) to develop a ground-level solution. Care to the patient is drastically improved and the hospital itself saves untold thousands of dollars by not having to readmit the patients who have no means of paying for services.

June SCMS The Message 8

6/25/2003 6/25/2003 6/25/2003 6/25/2003

Spokane: Popular Option for Second-Year Medical Students

By Doug Nadvornick WSU Health Sciences Communications Coordinator

When Spokane’s 20 first-year WWAMI medical students gather for their traditional end-of-year awards ceremony, their parting words are often, “See you in Seattle.”

Second-year students from all five WWAMI (Washington Wyoming Alaska Montana Idaho) states spend the year in Seattle before fanning back out across the region for two years of clinical rotations.

But at the May 3 year-end ceremony on the Washington State University Spokane campus, the goodbyes were different.

Fifteen of the 20 students are choosing to return to Spokane in August to be part of the first group to participate in a new pilot project. The goal is to see how well the second-year curriculum can be adapted and exported to the WWAMI affiliate sites.

Fifteen members of WWAMI Spokane’s 2012-13 class will return to Spokane in the fall as part of a new second-year pilot program.

(Photo by Doug Nadvornick)

“I feel like I understand material so much more when it is presented to me in a clinical case,” Reed said. “I feel the more clinical medicine we’re taught early on will help us remember that we’re treating patients that come in with a disease, rather than just diseases. It makes the learning of medicine more personal.”

Roberts says the 20 students will be split into two groups of 10.

Each group will be assigned two clinician/teachers who will serve as the students’ ‘guides’ for the year.

Student Ryan Mulligan says the small-group approach appeals to him.

“I feel like we get more of a hands-on approach here,” Mulligan said. “I think I’ll retain so much more working with smaller groups that I would with a group of 200.”

Jessica Eckstrom and Scott Hippe collect awards at the recent WWAMI Spokane end-of-year ceremony. They are among 15 students returning to Spokane this fall as part of a new second-year pilot program.

(Photo by Doug Nadvornick)

“We’ll have more small-group, discussion-based class sessions, as opposed to large-group lectures. Those will typically be based around cases,” said WWAMI Spokane director Ken Roberts. “The curriculum delivery will also feature much more active learning.”

Roberts says students will be asked to do more reading and research before class so their time together can be dedicated to discussions and problem solving, rather than listening passively to lectures. That’s something that student Sara Reed likes.

Scott Hippe says he feels like a pioneer, excited to be a member of the first class to try the new second-year approach, though “any time you’re a part of something new, you’re taking a chance that maybe that it won’t work as well as what was there before,” Hippe said. “It could be so much better, but there’s also the chance you don’t learn as much.”

The new second-year class will report back to Spokane the third week of August.

June SCMS The Message 9

Numerica Credit Union An SCMS Community of Professionals Partner

growth and community. Some interpret it as an encompassing embrace, others as raising people up and still others as blossoming prosperity. All are correct. The Numerica brand expression – Life moves. Live well. – walks hand in hand with the logo and speaks to the idea that you can’t control the twists and turns of life, but with Numerica as your partner, you can live well along the journey.

By Kelli Hawkins Communications Manager

In addition, Numerica makes a promise to be what is expected of us – providing quality financial services and products that live up to our brand expectations. Throughout our line of products, including business services, financial services and home loans, we have streamlined processes, making them easier, faster and more efficient to utilize.

Over the last 75 years, Numerica Credit Union has grown from a small credit union serving railroad employees, to a $1.2 billion credit union serving over 90,000 members throughout central and eastern Washington and northern Idaho. Numerica is a memberowned not-for-profit committed to fostering well-being in the lives of our members. We accomplish this by:

Numerica’s mission is simple: “Enhancing lives, fulfilling dreams, building communities.” It’s easy to see the commonality between our mission and that of the medical and dental community in Spokane. The outreach programs, enhanced education opportunities and medical/dental programs for the underserved are exactly the type of programs that Numerica supports.

• Giving back and supporting the communities in which our members live and work through volunteerism, fund-raising and through corporate sponsorships and donations;

As a long-established credit union, the first credit union in this area, we provide not only financial solutions, but also community support for the medical and dental community throughout central and eastern Washington. What is important to you is important to us.

• Protecting and advancing each member’s financial health and • Offering innovative ways to reduce the stress and anxiety associated with managing one’s finances.

It is Numerica Credit Union’s responsibility and commitment to contribute to the medical community’s overall financial well-being and return that high-quality service to you. After all, you improve the quality of our lives; we should return the favor. Life Moves.

Live Well.

These goals have always been important to Numerica and now we have created a new brand that is reflective of that commitment.

Our new logo was chosen as a representation of wholeness,

CellNetix is pleased to announce our merger with

PATHOLOGY SERVICES, (P.S.)

at Deaconess Hospital

As well as having 4 great pathologists in Spokane, we offer over 25 subspecialty areas of expertise to Spokane patients through effective use of telepathology and slide imaging. This allows remote internal consults at no additional cost to patients.

Pathology Services, P.S. has been providing pathology services in Eastern Washington since 1979, and serves Deaconess Hospital, Shriners Hospital, Okanogan Douglas Hospital, Lincoln County Hospital, Veterans Administration Medical Center-Spokane and many clinics in Eastern Washington.

Vann E. Schaffner, M.D.

t: 866-236-8296

w: cellnetix.com

Jeffrey T. Bunning, M.D.

Irby V. Cossette, M.D.

Dennis J. Small, M.D.

a: 1124 Columbia Street, Suite 200, Seattle, WA 98032 June SCMS The Message 10

The Trial to Assess Chelation Therapy: A Review of the Study

By Will Corell, MD

The Trial to Assess Chelation Therapy (TACT) was the first large-scale, multicenter double blind placebo-controlled study designed to determine the safety and efficacy of ethylenediaminetetraacetic acid (EDTA) chelation therapy for individuals with coronary artery disease (CAD) and prior myocardial infarction (MI). The National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) and National Center for Complementary and Alternative Medicine (NCCAM) cosponsored the study, which was published in the March 27 JAMA.

Rationale Here is some background: Chelation therapy is used to remove metals from the bloodstream. Calcium EDTA is approved to treat lead poisoning, and other chelation drugs are used to manage iron overload following repeated blood transfusions. There has been a decades-long debate about whether chelation therapy could be effective as a treatment for patients with atherosclerosis and cardiovascular disease. Its use grew by nearly 68 percent between 2002 and 2007 in the United States, to 111,000 people, with increasing satisfaction among the general public. Physicians practicing Chelation Therapy have numerous anecdotal reports of clinical efficacy, but this has never previously been validated by appropriate research.

Methods For the TACT study, the protocol specified 40 infusions of at least three hours each — 30 weekly infusions followed by 10 maintenance infusions two to eight weeks apart. For the active chelation arm, a 10-component chelation solution was selected to match most closely the standard solution used by chelation practitioners. The solution contained up to 3 g of disodium EDTA, 7 g of ascorbic acid, 2 g of magnesium chloride, 100 mg of procaine hydrochloride, 2,500 U of unfractionated heparin, 2 mEq of potassium chloride, 840 mg of sodium bicarbonate, 250 mg of pantothenic acid, 100 mg of thiamine, 100 mg of pyridoxine, 100 mg of procaine, and sterile water to make up 500 mL of solution.

The placebo solution consisted of 500 mL of normal saline and 1.2 percent dextrose.

The study was conducted at 134 research sites in the United States and Canada. The research sites represented a mix of clinical settings — university or teaching hospitals, clinical practices or cardiology research centers, and chelation practices.

A total of 1,708 patients were randomized — 839 patients to chelation and 869 patients to placebo. Participants were at least 50 years old, had a myocardial infarction (MI) at least six weeks prior to enrollment, and had not had coronary or carotid revascularization procedures within the past six months or smoked cigarettes within the past three months. The patient demographics were well matched between active and placebo groups.

Results Over the four-year follow-up, the difference in the primary endpoint, 26.5 percent in the EDTA group vs 30.0 percent in the placebo group, reached statistical significance at P=.035, with a hazard ratio (HR) of 0.82 (95 percent confidence interval, or CI, 0.69- 0.99). This represents an improvement of 18% in the treated arm.

Subjects randomly assigned to active chelation infusions showed an 18 percent drop in the trial’s primary endpoint — a composite of: • All-cause mortality (10.4 percent vs. 10.7 percent), or 7% reduction • MI (6.2 percent vs. 7.7 percent), or 23% reduction • Stroke (1.2 percent vs. 1.5 percent), or 23% reduction • Coronary revascularization (15.5 percent vs. 18.1 percent), or 19% reduction • Hospitalization for angina (1.5 percent vs. 2.1 percent), or 28% reduction In a prespecified subgroup analysis, the study population with diabetes showed a dramatic benefit (39%) for the primary endpoint with an HR of 0.61 (95 percent CI, 0.45-0.83; P=.002).

Also, anterior MI patients showed significant benefit (37%) vs. other MI locations (P=.03). There was minimal effect on standard measures of quality of life with the exception of slight improvement in self-reported angina symptoms at 1 year (P=0.16).

This was likely due to the high rate of previous revascularization (83%), with an 80% absence of anginal symptoms at baseline.

Adverse effects were similar in both groups.

CONTINUED ON PAGE 15

June SCMS The Message 11

Spokane County Medical Society members and significant others are invited to enjoy a summer evening cruise aboard The Serendipity on the Spokane River This is a great opportunity to meet your colleagues.

Thursday, July 11 Cruise starting at Templin’s Marina Boat loading starting at 5:30 p.m.

Embarking promptly at 6:00 p.m.

Returning at 8:30 p.m.

Heavy hors d’oeuvres * Wine and other refreshments Limited space available—RSVP to michelle@spcms.org

Thank you to our Community of Professionals sponsors!

The Prewitt Group

June SCMS The Message 12

June SCMS The Message 13

I make house calls.

Jurene Phaneuf SPECIALIZING IN P H Y S I C I A N R E L O C AT I O N S

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Our team of expert pathologists believes in a collaborative approach to patient care centered on outstanding quality diagnostics and service.

InCyte Pathology, an established and trusted laboratory for over 50 years is adopting a new look and name: Incyte Diagnostics.

The progressive logo reflects our history of diagnostic excellence, while capturing the essence of our future as an innovative laboratory poised to meet the needs of clinicians, clinics and hospitals.

Learn more by visiting www.incytediagnostics.com or calling 509.892.2700 Proudly serving the greater Spokane healthcare community since 1957

June SCMS The Message 14

Continued from Page 11 Conclusions The official conclusion of the American Heart Association reads: “Post-MI patients who received chelation therapy had fewer clinical events vs. placebo.

Two groups benefited most: diabetics and those who had experienced an anterior MI. Additional research is needed to confirm these findings and to understand the mechanisms of action for the benefits seen in this trial. This is not ready for implementation into clinical practice.”

The BEST In-Home Care to the Inland Northwest since 1966.

While I agree that further research is needed, I disagree that chelation therapy for vascular disease is not ready for implementation into clinical practice. In fact, chelation therapy has already been in practice for 50+ years, with similar (even greater) benefits observed than reported here. Most patients presenting for chelation therapy are significantly symptomatic, and their improvement in quality of life indices has been one of the more gratifying aspects of performing this service. We may provide significant clinical benefits when medical therapy has been optimized and the patient remains symptomatic. This study suggests maximum benefits in patients with diabetes or those with prior anterior MI. I would be happy to further discuss our experience with those of you who might be interested. (Chelation therapy is not covered by health insurance or Medicare. A course of treatment costs $2500-$3000.)

Dr. Will Corell is a graduate of Yale College and Stanford Medical School, and is a diplomat of the American Board of Family Practice. He has practiced in Spokane since 1979 and has been offering chelation therapy services since 1996.

::

Locally Owned Home Care Provider

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Over 200 dedicated Care Givers

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One of Washington’s Top 100 Companies to Work For

Call 509.473.4949 FHCcares.com June SCMS The Message 15

EASTERN WASHINGTON PHYSICIAN HEALTH COMMITTEE (EWPHC) EWPHC is a “quick call” to find assistance

Assistance is available to you in the following areas: 

Marital and Family Issues



Death of a Spouse or Family Member



Drug/Alcohol Misuse

This commi�ee, a fusion of the former SCMS commi�ee and one including members of medical staffs of Community Health Services and Providence Health Care Hospitals, meets quarterly to educate ourselves about physician health issues, review u�liza�on and sa�sfac�on with the Wellspring Employee Assistance Program (EAP) and plan ac�vi�es, programs and resources to address needs in those areas.



Lawsuit Educa�on and Support

Some of the guiding principles of the commiƩee are:



MQAC/OSTEO Board Issues





Boundary Issues

The medical profession and healthcare community should foster physician well‐being





Disrup�ve Behavior

A sense of community with one’s peers is vital to personal well‐being



Elder Care



Assess the changes in the healthcare environment



Prac�ce Management

Physician Commi�ee Members (Name and Contact Informa�on) Jim Shaw, Chair 710‐3151 Barry Barnes

255‐6557

Michael Metcalf

927‐4102

Paul Russell

954‐4989

Steve Brisbois

953‐3798

Michael Moore

747‐5141

Robert Sexton

624‐7320

Andi Chatburn

624‐2313

Mira Narkiewicz

889‐5599

Tasca Snow

565‐4000

Deb Harper

443‐9420

Sam Palpant

467‐4258

Alexandra Wardzala

990‐1938

Michael Henneberry

448‐2558

Tad Pa�erson

939‐7563

Hershel Zellman

993‐4274

Greg Loewen

844‐8476

Rod Peterson

944‐5781

Caduceus Al Anon Family Group ‐ Meets every Thursday evening from 6:15 pm un�l 7:15 pm at 626 N. Mullan Rd., Spokane, WA. Non‐smoking mee�ng for spouses and signicant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format. No dues or fees. Contact (509) 928‐4102 for more informa�on.

Physician Family Alanon Group ‐ Physicians, physician spouses or signicant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental ill‐ ness, addic�ons, work‐related stress, life transi�ons and rela�onship difficul�es.

We meet Tuesday evenings a�er 6pm. The format is structured by the 12‐Step Alanon principles. All is conden�al and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, contact Bob at 998‐5324.

June SCMS The Message 16

In The News

PAML and CellNetix Finalize Alliance Mary Noble, MD - 2012 SCMS Physician Citizen of the Year

On May 3, 2013 received the SCMS Physician Citizen of the Year Award presented by Matt Hollon, MD at the Primary Care Update luncheon.

Dr. Noble is a regarded faculty member for Providence Internal Medicine Residency Spokane and is the Director of the Matt Hollon, MD and 2012 Providence Internal Medicine Physician Citizen of the Year Residency Spokane (PIMRS) Award recipient Mary Noble, MD Clinic. She works tirelessly to guide the residents in their chosen fields of medicine.

As a community advocate she is involved in various regional activities including being the vice-chair of Refugee Connections Spokane, an organization that provides a link for refugees with the large Spokane community through participatory projects, activities and events and as a member of the Board of Advisors for the Gonzaga University Institute for Hate Studies. The Gonzaga Institute for Hate Studies advances the interdisciplinary field of Hate Studies and disseminates new theories, models and discoveries about hate.

She has served on numerous SCMS Committees including the Continuing Medical Education (CME) Committee from 2001 – 2012, holding the position of Chair from 2007 – 2010 and the Women in Medicine Committee from 2001 – 2008.

Bill Sherman, MD Memorial Scholarship Awarded to Jonathan Patberg

First-year medical student, Jonathan “Jon” Patberg was recently presented the Bill Sherman, MD Memorial Scholarship. The scholarship is given to medical students upon completion of their first year.

With a focus on primary care, Jonathan is looking forward to the relationships that come with working closely with patients. After spending some time at the medical center in Grand Coulee he hopes to work in the rural community.

John McCarthy, Assistant Dean for Regional Affairs – WWAMI wrote, “Jon is the kind of student who has the ability to make things happen. His desire to assist the disenfranchised will continue to be an unwavering goal and to that end, he will make this world a better place.”

Congratulations, Jon.

PAML, LLC and CellNetix announced the completion of the purchase by PAML of a minority equity position in CellNetix laboratory business as well as the formation of a jointly owned national Esoteric Anatomic Pathology reference laboratory offering . Having had a strong working relationship for many years, both parties are excited to move ahead with their expanded partnership.

PAML, LLC headquartered in Spokane, WA, is an industry leader in reference laboratory testing, information technology, operational excellence and community based partnerships.

CellNetix, headquartered in Seattle, WA, provides comprehensive sub-specialized anatomic pathology services to hospitals and clinics in Washington, Idaho, Oregon and Alaska. Both parties have invested heavily in IT and Logistics and will soon roll out unified service delivery capabilities. This transaction positions PAML, LLC and CellNetix to offer a unique range of services to hospitals, clinics and referring pathology groups in a sector that has both been dominated by the large national labs on the Clinical Pathology (CP) side and largely fragmented on the Anatomic Pathology (AP) side. Notably, many hospitals are currently working hard to streamline operations in the face of healthcare reform and are likely to welcome this new CP/AP option.

Gary Newkirk, MD Receives Special Thank You at Annual Meeting

Gary Newkirk, MD, chairman of the Primary Care Update program for the past 20 years, received a gift of a one-week’s stay at a winery in Tuscany to be enjoyed later this year.

The presentation was made on May 5, 2013 at the 30th annual meeting as a thank you for his many years of service to the program, which is otherwise uncompensated. Dr. Newkirk has been on the program committee for 26 of the program’s 30 years. Primary Care Update was started in 1983 and is now touted to be the largest annual meeting on the West Coast directed toward primary care providers.

It has been through Dr. Newkirk’s guidance that the program has kept up with all the technologic changes and everchanging requirements for providing quality continuing medical education programming.

Dr. Newkirk received his medical degree in 1978 from the University of California, San Diego. He is board certified in Family Medicine. Dr. Newkirk is a member of the Spokane County Medical Society Board of Trustees.

June SCMS The Message 17

Continuing Medical Education

Meetings/Conferences/Events

Moderate (Conscious) Sedation and Analgesia: 3.0 Hour(s) of Category 1 CME credit, sponsored by the Spokane County Medical Society. Tuesday, September 17, 2013 at the Providence Sacred Heart Medical Center Mother Joseph Room. This is SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety. For more information contact Karen Hagensen at (509) 325-5010 or email karen@spcms.org.

Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

Rockwood Health System Breast and General Tumor Boards: The tumor boards are jointly sponsored by Rockwood Health System and the Spokane County Medical Society. Tumor Boards will be held weekly June – December 2013. Each Tumor Board is worth 1.0 Category I CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@ rockwoodclinic.com.

Promoting Healthy Families (Practice Management Alerts from the American Medical Association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org.

Spokane Guild of the Catholic Medical AssociationMeets second Wednesday of each month at 6 p.m. at Providence Sacred Heart Medical Center Administrative Board Room in Administration on the Main Floor.

All are welcome. For inquiries contact Phil Delich, MD at (509) 465-1554 or e-mail at delichphil@gmail.com.

Free National Environmental Health Association Courses sponsored by the CDC and EPA available. Courses include National Environmental Public Health Performance Standards Workshop: Building Local and National Excellence, Biology and Control of Insects and Rodents Workshop, Environmental Health Training in Emergency Response and Environmental Public Health Tracking 101. For more information go to the website at www. nehacert.org.

Physician Family Alanon Group: Physicians, physician spouses or significant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addictions, work-related stress, life transitions and relationship difficulties.

We meet Tuesday evenings after 6pm. The format is structured by the 12-Step Alanon principles. All is confidential and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, please contact Bob at (509) 998-5324.

Healthcare Collections Workshop – No Pay/Slow Pay: In challenging economic times, physicians’ practices increasingly experience delays in payment, or get no payment at all, from some patients. As your patients struggle to make ends meet, it’s increasingly important that you engage with them, and in a timely manner. Find workable financial strategies to keep “good” patients coming to your practice, and learn how to manage those relationships appropriately. Join us as we cover the essentials of efficient and effective medical collections, to ensure a steady revenue flow to your practice. Spokane June 26, Valley Hospital 12:30 – 4:30 p.m. For more information, including how to register, online: www.wsma.org/seminars-webinars or call Michelle Lott at (206) 441-9762 or (800) 552-0612.

June SCMS The Message 18

The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

Highfill, Thomas M., MD Emergency Medicine Practicing with Valley Hospital Emergency Department 08/2013 Mueller, Enkhtuyaa L., MD Interventional Cardiology Practicing with Rockwood Heart & Vascular 09/2013 Schwintek, Jason R., MD Internal Medicine Practicing with Apogee Physicians 07/2013

PHYSICIANS Wister, Jason D., MD Pediatrics Med School: Loma Linda U (2006) Internship: Loma Linda U Medical Center (2007) Residency : Loma Linda U Medical Center (2009) Fellowship: Loma Linda U (2012) Practicing with Pediatrix Medical Group 08/2013

Spangler, Sean A., MD Cardiology Practicing with Providence Spokane Heart Institute 07/2013

Snelson,Timothy, MD Emergency Medicine Med School: Loma Linda U (2008) Internship: Mayo Clinic School of Graduate Medical Education (2009) Residency: Mayo Clinic School of Graduate Medical Education (2011) Practicing with Valley Hospital Emergency Department 08/2013

PHYSICIANS PRESENTED A SECOND TIME Akselrod, Dmitriy, MD Diagnostic Radiology Practicing with Radia Inc. 08/2013

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Bani Hani, Samer H., MD Nephrology/Transplant Nephrology Practicing with Providence Medical Group - WA Transplant Surgery 8/2013 Barnes, Ryan D., MD Physical Medicine & Rehabilitation Practicing with Rockwood Neurosurgery & Spine 08/2013 Deters, Levi A., MD Urology Practicing with Spokane Urology, PS 07/2013

BRINGS YOUR RUG’S COLORS AND BEAUTY BACK TO LIFE!

Spokane’s only Deep Water Rug Washing facility.

Featuring a 6-step hand wash process and a 7-step inspection process with a 15% cash & carry discount.

Ferrin, Lance J., MD Gastroenterology Practicing with Rockwood Digestive Health 7/2013 Forrester, Matthew D., MD Cardiothoracic Surgery Practicing with Providence Health Services dba Northwest Heart & Lung Surgical Associates 08/2013

RUG SPA .COM 2 2 0 E . 2 N D AV E N U E • S P OK A N E , WA 9 9 2 0 2 • 5 0 9 - 624 - 8 0 8 4

June SCMS The Message 19

POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/ work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact CHAS Human Resources at (509) 444-8888 or hr@chas.org. Visit our website to learn more and to apply www.chas.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at (800) 260-1515 x5366 or gmelkus@qtcm.com or visit our website www.qtcm. com to learn more about our company.

PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential.

Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments. We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical!

PROVIDENCE FAMILY MEDICINE RESIDENCY SPOKANE Immediate opening with Providence Family Medicine Residency Spokane (PFMRS) for a full- time BC/BE FP physician who has a passion for teaching. PFMRS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices.

We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Linda Barkley, Program Assistant at (509) 459-0688 or Linda.Barkley2@providence.org.

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, (509) 565-4352 or maikeshi@dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

PROVIDENCE HEALTH & SERVICES has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Regular 8-5 hours, fiveday week. New physicians will join Providence Medical Group, our physician-led multispecialty medical group with clinics throughout the metropolitan area. Excellent compensation and benefits. Providence Medical Group (PMG) – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence. org or 509-474-6605 for more information.

PROVIDENCE MEDICAL GROUP (PMG) - Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in this scenic suburb of Spokane. Full-time opportunity with our growing medical group in what will be a large, state-of-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only.

Competitive compensation and comprehensive benefits.

Providence Medical Group – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or 509-474-6605 for more information.

FULL-TIME LICENSED PHYSICIAN ASSISTANT (PA) wanted for expanding clinic in Spokane, Wash. Currently patients are seen four days per week, Monday through Thursday, 8am to 5 pm. Approximately 24 patients per day. This could expand into five days a week in the future. No call, weekends or holidays. Fabulous benefit package offered. Vacation and CME benefits provided. Starting salary DOE. If interested, submit resume and cover letter to Kris Norton, Office Manager at knorton@neuroandspine.com.

June SCMS The Message 20

June SCMS The Message 21

Cl assified Ads REAL ESTATE Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided.

Call (408) 594-1234 or (509) 993-7962.

Large Second Owner Custom Built Executive Home with unparalleled views of Liberty Lake and Spokane Valley on five acres available for sale or lease. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den.

Walk out basement, wood stove, kitchen and bathroom. Large 30’ x 100’ pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512.

Beautiful Priest Lake Cabins for Rent Our newly restored cabins are located on the historic site of Forest Lodge in the entrance to the scenic Thorofare. Two cabins are available. Each sleeps 8. They are located at the water’s edge, have gorgeous views, bordered by the National Forest and 18 acres of private land. The beds and furnishings are all new and cabins have all the amenities - decks, docks, beaches with fire pits, walking trails and forest to explore.

Boating, hiking, swimming, sailing, snowmobiling in winter or just relaxing in the sunshine. You will enjoy a peaceful, fun-filled vacation at this amazing site. For available dates, pricing, photos and details call Jeannie or John at (509) 448-0444.

Greenbluff Tuscan Estate situated on nearly 10 acres.

Stunning marble foyer opens to soaring ceilings and magnificent double stairway. The formal living room has spectacular natural light, floor to ceiling fireplace, impressive pillars and French doors to a backyard deck. The dining room with its built in bookshelves, French doors and hardwoood flooring is designed to entertain a large guest list. Additionally, there is informal kitchen eating space and a comfortable family gathering room.

The master bedroom has a renovated bathroom as well as its own private balcony (one of several). The home is equipped with three additional bedroom suites. Outside, the sports-minded enthusiasts will enjoy the in-ground heated pool and hot tub, tennis, pickleball and volleyball courts and a 4-stall horse barn.

With a three-car attached garage, a 2-car detached and a 1,800 square foot shop, there is plenty of space for whatever you enjoy. Gated and located in the Mead School District, the home is conveniently located near the new exit off the North Spokane Corridor. Contact Kathi Pate, Windermere Manito Real Estate LLC, (509) 701-0998.

mediCAL OFFICES/BUILDINGS South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling.

Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf. professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue.

The building has various medical office spaces available for lease from 635 to 10,800 contiguous usable square feet. and has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways.

Other tenants in the building include urgent care, family practice, pediatrics, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, CPM®with O’Rourke Realty, Inc. at (509) 624-6522, mobile (509) 999-2720 or psrourke@comcast.net.

June SCMS The Message 22

MARK YOUR CALENDARS Watch for more details!

2013 SCMS EVENTS Community of Professionals River Cruise July 11 Thursday

Spokane River

CME prior to WSMA Annual Meeting September 27 Friday

The Davenport Hotel

Moderate (Conscious) Sedation Program September17 Tuesday

SHMC—Mother Joseph Room

Orange Flag Building

Phone: (509) 325-5010

104 South Freya Street, Suite 114

Fax: (509) 325-5409

Spokane, WA 99202-4686

Website : www.spcms.org

June SCMS The Message 23

Spokane County

MEDICAL SOCIETY

June SCMS The Message 24

PRSRT STD

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

U.S. Postage

PAID

Spokane, WA Permit No. 307

ADDRESS SERVICE REQUESTED

Printed on GP Spectrum® Paper: Certified by the Sustainable Forestry Initiative. Please recycle.

Coeur d’Alene Lake, Windy Bay, 237’ frontage, 2 acres, well installed, several drainfields installed, paved road, great views! Call Bill Fanning $995,000

Coeur d’Alene Lake, Carey Bay, Conkling Park area, 50` frontage, 3 bdrm, 3 bath, 2650 sq ft, Panbode Cedar Home, boat dock and slip.

Call Bill Fanning $645,000

Coeur d’Alene Lake, Rockford Point, 103’ frontage, 3 bdrms, 2 baths, 1488 sq ft, rancher w/daylight basement, great privacy, boat dock.

Call Bill Fanning $595,000

Coeur d’Alene Lake, Arrow Point, 80’ frontage, 4 bdrms, 2 baths, 2856 sq ft, 2 car garage, patio, remodeled in 1994. Call Bill Fanning $850,000

Coeur d’Alene Lake, Rockford Bay, 145’ frontage, High Quality Construction, 4 bdrms, 4 baths, 4018 sq ft, 2 car detached garage with guest quarters above, community water and sewer, dock/boat slip, great deck, firepit.

Call Bill Fanning $1,895,000

Clear Lake, 200’ frontage, 3 bdrms, 3 baths, 2614 sq ft, den, 2 car attached garage, 24 x 36 pole building, dock, large veranda, cathedral ceilings, hardwood floors. Call Jenna Nicol $549,000

Loon Lake, 72’ frontage, 2 bdrms, 1 bath, 676 sq ft, covered porch overlooking lake, large lawn area, newer dock, public water & sewer, nice beach area.

Call Jenna Nicol $250,000

Deer Lake, 50’ frontage, 2 bdrms, 1.5 baths, 1446 sq ft, office, bonus room, great room, vaulted ceilings, central A/C & heat, gas fireplace, 2 car attached garage, stamped concrete, dock, sea wall, deck and patio, beautiful sunsets. Call Jenna Nicol $319,000

Waterfron t.

Bec ause it’s Our Pass io n, you are getting the best!

Loon Lake, 50’ frontage, main home: 2 bdrm, 1 bath, 1242 sq ft, guest house above shop: 3 bdrm, 1 bath, 1600 sq ft, 2 car garage plus RV parking, flat lawn area, multiple decks, large EZ dock.

Call Jenna Nicol $339,000 EXCLUSIVELY WATERFRONT

JENNA NICOL

cell (509) 290-3698 direct (509) 321-1110 fax (509) 321-1131

Loon Lake, 48’ frontage, 2 bdrm, 1 Beutler - Waterfront bath, 988 sq ft, remodeled interior, furnished, living/dining room overlooking the lake, large decks, public sewer and private well, public water available, storage BILL FANNING shed, fenced yard, sandy beach, dock. BROKER Call Jenna Nicol $375,000 cell (509) 999-5444

www.21Waterfront.com

direct (509) 321-1132 fax (509) 321-1131