The Message, June 2014 by Spokane County Medical Society

2014 Officers and Board of Trustees

Table of Contents

David Bare, MD President Matt Hollon, MD President-Elect

President’s Message: Changing the System for the Better . . . . . . . . . . . . . . 1

Anne Oakley, MD Immediate Past President

In-Depth Interview: Biking Across the Country: A McCarthy Family Experience . . . . . . . 3

J. Edward Jones, MD Vice President Gary Newkirk, MD Secretary-Treasurer Trustees Charles Benage, MD Audrey Brantz, MD Karina Dierks, MD Elizabeth Grosen, MD Clinton Hauxwell, MD Louis Koncz, PA-C Frank Otto, MD Fredric Shepard, MD Carla Smith, MD Brian Tryon, MD Newsletter Editor – Matt Hollon, MD

Guest Column: Colville Rural Medicine . . . . . . . . . . . . . . . . . . . . 7 Medical Education in Spokane: Spring – Graduation and Recognition . . . . . . . . . .

Group Health: Health Care for More Americans: The Future We Wished For Is Here . . . . .

WSU: Regents Approve Creation of WSU College of Medicine . . . . . . . . . . . .

Hospice Spokane: End of Life: Part II, Palliative Care . . . . . . . . . . . . . . .

Spokane Scholars Foundation Banquet 2014 . . . . . . . . . . . . . . . . . . 14 STD Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

INSIDE FRONT COVER AD

Arthritis Northwest PLLC: Update in Exercise for Fibromyalgia . . . . . . . . . . . . 17 Spokane County Medical Society The Message A monthly newsletter published by the Spokane County Medical Society. Advertising Correspondence SCMS Publications Attn: Saraj Bailey 211 W 2nd Ave Spokane, WA 99201 509-343-0123 Fax 509-325-3889 Saraj@quisenberry.net 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.

In the News: Spokane Eye Clinic Announces New Neuro-Opthalmologist . . . . . . . . . 19 In Memoriam: Arthur B. Craig, MD / George S. “Bud” Eugster, MD . . . . . . . . . . 19 / 20 For Your Information: The Dr. Robert Bree Collaborative Introduces New Website . . . . . . 21 New SCMS Members . . . . . . . . . . . . . . . . . . . . . . . . . 23 Positions Available . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Meetings / Conferences / Events . . . . . . . . . . . . . . . . . . . . .

Real Estate / Medical Offices / Buildings . . . . . . . . . . . . . . . . . . . 27

“Rest is not idleness, and to lie sometimes on the grass under trees on a summer’s day, listening to the murmur of the water, or watching the clouds float across the sky, is by no means a waste of time.” – John Lubbock,

President’s Message

CHANGING THE SYSTEM FOR THE BETTER By David Bare, MD

John and me. Some of the key points that were

down because of the overwhelming

SCMS President

discussed included:

number of patients seeking care.

I recently had the

• The increased numbers of Medicaid

opportunity to spend

covered patients from the uninsured

several days in our

population. At Community Health

nation’s capital,

Association of Spokane (CHAS) we signed

advocating on

up 12,000+ patients in the ACA Medicaid

• All plans give universally the same coverage regarding the care package

I was impressed with the responsiveness

Group Health was at about this same

was going to save enough to pay for the

of our elected individuals to our group.

level of enrollment. This has provided for

program and how do we provide the expected

That responsiveness, I was made aware,

better access to those individuals and has

level of care to a greater number of individuals

was due in part to the size of the group,

allowed us, as an organization, to begin

with the current level of provider resources.

the succinctness of our requests and the

to understand their various pent up needs

There are three big ticket items that can

consistency with which GSI has yearly met

as well as come to an understanding

occur in the system where there is proven

with our representatives. We met with aides

that it will take a number of months to

savings through managing care. First is

of our congressional representatives and then

address and meet those needs. From the

reduced use of the Emergency Departments

with Senator Patty Murray, Senator Maria

perspective of Primary Care I believe the

(ED); second is fewer and shorter hospital

Cantwell and Representative Cathy McMorris

ACA has improved access. Some of the

stays and third is appropriately and fully

Rodgers. We also met with individuals from

positive aspects of the ACA are as follows:

utilizing skills and training of healthcare

• The fact that adult children are able to stay

providers at all levels to deliver quality

transportation, military, health care, education

on their parents’ insurance longer if they

healthcare with reimbursement appropriate

and several others. They seemed genuinely

are attending school has also provided

to the level of care provided. All of those

interested in our needs, but also had questions

access through insurance for this niche

interventions will likely decrease the hospital’s

for our group in order to better understand

population.

income as there is no payment for empty beds

changed regarding the Affordable Care Act (ACA). Also asked was, what would save

• The ability to move from job-to-job and carry your insurance with you. • Access to specialty care for those

things legislatively that can help this process

use ancillary staff to do the navigating and care

of change along the way, most obviously in

care including the insurance product that

coordination for patients, that would improve

developing clear, concise, and realistic rules

allows access to the care. If we are looking

their disease management and help with health

and regulations. But the biggest part of the

for best practice from a business perspective

maintenance. But there will be very little cost

change is going to have to be local and is

those are the organizations that can do what

savings there, to individual practices, as Pay

going to have to be a business model that

it takes to improve access, do quality care at

for Performance (or other similar programs)

fits with the local environment. So perhaps

lower cost. This meets the triple aim that the

is very limited and having healthier patients

as a group of interested and engaged

ACA is striving to achieve.

who use the ED less and are hospitalized

physicians we might foster change in the

fewer days doesn’t save the ambulatory care

direction where several complete vertically

office anything. Practices that are in partially

integrated systems, to include the insurance

integrated organizations can have a slight

product, are offered and every patient is a

bump in their Medicare payments for patients

member of the cooperative and enters into

they are managing in this same fashion, but not

contract with such an organization for a set

most likely not enough to actually offset the

monthly price. As a partnership between

cost of the increased management fees. So

insurers and providers the money might be

the key again, no matter what is done with the

more creatively used to meet the triple aim

ambulatory care organizations or the partially

and hopefully realize cost savings through

vertically integrated systems, is owning or

reduced patient visits, less hospitalization,

working in conjunction with the insurance

and the addition of health coaches resulting

piece. Unless there is more cooperation with

in a healthier, more informed populace.

efficiencies in the outpatient world, but until

discussed with John were how the legislation

I thought was good and what needs to be

was capitated we would have more flexibility to

Kaiser is another. They have all aspects of

payment and the deductible.

up for the state of Washington). I know

having a pre-existing condition.

such an organization and on the West Coast,

can be had in our current system through

Spokane Incorporated (GSI). While there,

only physician in the group, I was asked what

these discussions is that there are certainly

variability between the plans is the co-

Two of the biggest concerns that Dean and I

• The ability to obtain insurance despite

One conclusion that I keep coming back to in

that is legislated and if more of our practice

There are certainly some cost savings that

program (about 2% of those who signed

some situations. On a personal note, as the

Obviously payment reform would be a piece

organization. In our area Group Health is

regardless of the cost of the program. The

behalf of the Spokane region with Greater

various committees or agencies including

There are examples of this type of

nor payment for patients not seen in the ED, but there would also likely be offsetting cost savings in facilities, equipment and manpower. The entities that would save money are insurance companies who provide payment

and unless insurances are run by those who are actually providing the care there will be mixed incentives for the very services that will save enough money to potentially pay for health care reform. Currently most relationships between insurance companies and medical care organizations are adversarial. For each separate entity to “make money”, they have to perform at polar opposites. Insurers are most successful through reduction in payments so they strive for fewer hospitalization days, ED visits and procedures. On the other hand, health care organizations getting paid fee for service need more hospitalizations, ED visits

insurance organizations to share any gains made in improved access, quality and cost between all parties concerned, there can be no sustainable change in US health care whether it is the ACA or some modified piece of legislation to come.

How can we collectively encourage a change to create a system that is better? How can you individually encourage such a change? Better for the individual patients (and we are all part of this group as well) and better for the nation. How do we continue to allow for

and procedures (from a purely business

So how did the Group Healths of the world

competition in the market place but change

perspective) to be successful. Obviously

get started? Group Health Cooperative

the product that is being offered? How do we

there are many other subjects that can be

began in 1947 as a community coalition

promote cooperatives that do the majority of

discussed related to attaining the triple aim

dedicated to making quality health care

the business of health and health care based

to include malpractice reform, increasing

available and affordable. Today it is one of

on their superiority of better access, better

the number of Primary Care providers, fully

the few health care organizations in the

quality and less cost? As an organization, can

utilizing the skills of physicians as well as

country governed by consumers. It was of

we provide the platform of discussion that

other healthcare providers at the appropriate

the people by the people and for the people.

could allow for this kind of coalition formation

levels with corresponding payment,

It works and it works well. So why have

on the local level? A community where two

instituting Patient Centered Medical Homes

there not been more coalitions that have

or more large, fully integrated organizations

in which everyone is working to the limit of

taken up this same banner. In our day of

can compete for local business? If you have

their licensure, and many others.

need for an accessible, high quality, cost

interest in such a discussion and ideas about

effective care provider they are a Gold

who needs to be at a table to begin this local

Standard that can be held up

process, please contact Dean Larsen, CEO at

as sustainable.

the SCMS at (509) 325-5010 or dean@spcms.

money in training new providers at the level

practices that are accepting Medicaid

only for care rendered. It is our observation

of Graduate Medical Education (residencies)?

has improved, although some specialty

that a complete vertical integration of care is

Once back in Spokane I met with John Colture,

practices have become overwhelmed

necessary. For a benefit to be seen, some type

Senator Murray’s Eastern Washington

with Medicaid patients seeking that care.

of Accountable Care Organization focusing

Director, to further discuss those two

For instance, there is an emergent dental

on all phases of health care including the

So, at the end of our conversation John asked

questions. Dean Larsen, our CEO, was also in

clinic that opened their doors to Medicaid

insurance aspect must be created.

the riveting question, “So what can we do

attendance at the GSI DC trip and also met with

patients recently, but now has shut that

legislatively to help bring this about?”

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

org and let’s begin. n

| THE MESSAGE | JUNE, 2 014

In-Depth Interview

In-Depth Interview By Bonny Laughary

planned a bike trip from Seattle to Spokane.

One of the biggest hurdles in completing a

SCMS Accounting Assistant

On the first day, they ended up riding 126

cross-country trip by bike is overcoming and

miles on the North Cascades Highway. Dr.

enduring boredom. Traveling along Highway

McCarthy and Kate figured that if the boys

2, there aren’t a lot of typical tourist stops

could handle 126 miles through the North

to make or interesting historical sights to

Cascades, they were pretty much prepared

see. For the McCarthys, they found this

for anything they might encounter riding

lack of change in scenery to be difficult,

across the country. They decided they would

especially traveling through the plains. The

make the cross-country trip together the

boys learned how to step out of their comfort

following year.

zones, facing challenges and sometimes

For most kids, responses to the standard

BIKING ACROSS THE COUNTRY: A McCARTHY FAMILY EXPERIENCE

back-to-school question: “What did you do on your summer vacation?” are what you would expect: a week at a lake cabin, a trip to Disneyland, road trip to Grandma’s house, time at the beach, sleep-away camp, etc. In the fall of 2011, the teachers of Dr. John F. McCarthy’s two sons would have likely been surprised by the answers received from

The McCarthys took a year to plan their trip.

Colin, 15, and Ian, 13: our family biked across

Agreeing on a final destination in Vermont,

the country.

they planned on taking Highway 2. Highway

For Dr. McCarthy, his wife Kate and their sons Colin and Ian, biking has always played a major role in their recreational time together as a family. The McCarthys

2 is generally safer for biking than other major east-west highways as it is not as heavily travelled and connects less densely populated towns. Having made the journey

just enduring through the difficult parts of the trip. The family could talk fairly readily throughout the majority of the journey but when it was safe to do so, the boys were able to take advantage of technology such as downloaded podcasts to give them a break from the monotony.

before, Dr. McCarthy relied on his past

The McCarthys were fortunate in that

experience to help prepare for the distance.

they didn’t encounter any real problems

He knew that, for example, people tend to

throughout their trip. They didn’t experience

pack way too much. This isn’t a huge problem

any injuries or physical ailments and for the

if traveling by car but on a bike, extra weight

most part the weather was cooperative.

means extra effort required to travel the

Traveling through North Dakota, they did

same distance. The McCarthys planned to

experience one of the less pleasant parts

pack light, carrying enough food for a day.

of their journey. Formerly a quiet and

They also brought basic camping equipment

agricultural area, Williston, North Dakota is

including a stove and some cookware.

now a primary center of the North Dakota

Leaving the maps at home, they brought a

oil boom. The McCarthys were able to see

computer, their Kindles, and iPhones, which

the change in the landscape first-hand as

they used for navigation. The McCarthys

they passed through the area on Highway 2.

also talked to other families who had made

Instead of a quiet town on the highway, they

the trip and decided that they didn’t want the

encountered heavy large-truck congestion,

pressure of a firm deadline for completing

oil drills and derricks, makeshift housing,

the journey. Instead, they left their options

construction everywhere, and all the

open for returning home and didn’t make any

structures, heavy equipment and population

return-trip travel arrangements.

needed to support the burgeoning oil boom.

close to 100 miles on the Trail of the Coeur

On a rainy June morning in 2011, the

The McCarthys camped for the majority of

d’Alenes, the kids decided that they wanted

McCarthys headed east on their bicycles.

the trip. They stayed in hotels about one

to ride their bikes across the country.

With a goal of 100 miles per day in mind,

out of every four days, more frequently if

they knew they would need to find food to

there was inclement weather. For the most

eat throughout the day as well as a place to

part, the family found most people they

sleep at night but otherwise were going to

encountered to be quite friendly. At one

approach their trip as an adventure and see

point in Canada, they found themselves

how it would unfold.

in a resort town and in need of a place to

started biking with their sons when they were still in diapers. From a very early age, both children loved riding with their parents. The McCarthys used three different tandem bikes, including a recumbent bike which allowed one of the boys to ride in the front of the bike which provided a completely different perspective of the open road. So accustomed to taking long bike rides with their parents, the kids would often fall asleep. For any parent struggling to find a way to get their kids to nap, this was an easy and enjoyable way to make it happen while still enjoying some outdoor exercise. When Colin was 11 years old and Ian was 9 years old, the McCarthys rode their bikes around France for a month. After the trip, Ian declared that he was going to ride 100 miles on his own bike one day. After completing

Unlike some parents who might immediately dismiss their children’s seemingly outlandish wish to take on such an adventure, the McCarthys decided to see if the boys would be up for such a trip. As a test-run, the family

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | JUNE, 2 014

In-Depth Interview sleep for the night. Finding only expensive options available, they went to the local library to see if they could find a more suitable arrangement in town. When they explained what they were looking for to the librarian she offered to let them stay with her family. For the boys, those encounters with strangers were a positive learning

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experience. They were able to see the good side to humanity; that most people are helpful and will readily engage with others in a friendly manner. After about 32 days on the road, the McCarthys arrived at their destination in

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Vermont. For around four to five days, they stayed with a friend of Dr. McCarthy’s from his time as a resident, enjoying the rural

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trips when they can. Although no longer journeys are currently being planned, they find time to take trips together as they did last summer when they biked to Whitman College in Walla Walla, Washington where Colin is now a student.

There are numerous factors to consider when planning a long-distance bike trip. The McCarthys were experienced at long-distance bike trips by the time they were planning on biking across the country. Honestly evaluate your own experience and skill level before planning a long-distance trip.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Dr. McCarthy is the WWAMI clinical coordinator for Eastern and Central Washington. He instructs first-year medical students at WSU Spokane’s Riverpoint campus, works as residency faculty for Family Medicine Spokane, and provides patient care as an urgent care physician in Spokane. He is past president for the Washington Academy of Family Physicians and past delegate to the American Academy of Family Physicians. Dr. McCarthy was recently named the Spokane County Medical Society 2013 Physician Citizen of the Year. n

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| THE MESSAGE | JUNE, 2 014

Medical Education in Spokane

Medical Education in Spokane The students heard from third-year

“This residency is known for the range of

After lunch, while the students lingered

resident Dr. Matt Kaiser and second-

opportunities available to new doctors.”

outside before boarding their bus for the ride

year resident Dr. Paul Gloe, who are doing their training in Colville, and firstyear resident Dr. Mo Campbell, who is based in Spokane this year, but who will move north to the Stevens County town in September. Campbell, a native of Ely, a small town in northern Minnesota, said she has long known that she wanted to work in a small town and was recruited to apply for the Colville residency.

Pullman internist Stephanie Fosback – a Colville native – tells WWAMI students, during a bus ride to Colville, why she sought a career in small-town medicine. Photo by Doug Nadvornick

COLVILLE RURAL MEDICINE By Doug Nadvornick

leading the commentary on the ride out

engineering job in Pullman and they like the

WSU Medical Sciences Communications

of town, Pullman internist Dr. Stephanie

town’s school system for their children. For

Fosback, a Colville native, was in front,

those reasons, she says Whitman County is a

presenting a PowerPoint presentation about

better fit for them right now.

Every year Dr. John McCarthy takes a group of WWAMI (Washington Wyoming Alaska Montana Idaho) medical students on a road

the need for more rural physicians.

trip. McCarthy is one of two University of

“I wanted to work in an underserved area

Washington School of Medicine assistant

and also have the chance to teach,” Fosback

regional deans based at Washington State

said. “And now I do some outpatient work, I

University - Spokane and an energetic

do some work in the ICU (intensive care unit)

promoter of rural medicine.

and I love the variety.”

One April morning his chartered bus

Fosback’s teaching duties include

pulled up next to the Pharmaceutical and

participating in a clerkship for third-year

Biomedical Sciences Building and took on

medical students. This spring, she and her

students ready for the 70-mile trip north to

colleagues are hosting an internal medicine

Colville. The excursion was funded by the

resident for a month. In 2015, she says they

group Friends of WWAMI Spokane.

will host a third-year medical student for four

This year, though, the entourage was larger than usual. For the first time, about 20

a North Dakota native who recently finished her Colville residency and has stayed in the area to practice, and Dr.

back to Spokane, first-year student Cyrus Haselman said he was impressed enough by the Colville residency that he might look into it when it is time for him to consider that.

Kal Kelley, a Montana native and former

If he does, he may find the Colville residency is

Colville resident who started his medical

unusually competitive as far as rural training

career in eastern Oregon.

track (RTT) programs go. Campbell says the

The five physicians shared stories about the challenges and joys of small-town medicine. They also talked about their roles as visible people in a small town, about

“I came here because primary care is really

trying to maintain some sense of private life

valued in the Northwest,” she said.

and about the professional and personal

RTT received 100 applications for the newest residency opening. It went to an Arizona native with a background in international medicine who will start the first year of his residency in Spokane in the fall. n

isolation they sometimes feel.

Resident physicians Matt Kaiser, Mo Campbell and Paul Gloe tell WWAMI medical students from Spokane and Pullman about their experiences working in Colville, in northeastern Washington. Photo by Doug Nadvornick

The pros and cons of working in a small town When the bus reached Colville, the first stop was not at Providence Mount Carmel Hospital, as in past years, but at Hearth and Home, a company that makes fireplaces and other heating devices.

months as part of the WRITE (WWAMI Rural Integrated Training Experience) program.

WWAMI students from Moscow and Pullman

Fosback says she wanted to practice

were making the trip; they joined a dozen or

in Colville after her residency, but her

so from Spokane. And instead of McCarthy

husband – also a Colville native -- found an

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Also at the table were Dr. Katrina Gardner,

“I want them to see the types of industry that drive small-town economies like Colville’s,” McCarthy said. After a short visit there it was off to the hospital for a brief tour and then lunch at the Garden Homes Clinic, where the students ate with two local physicians and the three family medicine residents associated with Colville’s Rural Training Track medical residency, the oldest such program in the nation.

| THE MESSAGE | JUNE, 2 014

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | JUNE, 2 014

Medical Education In Spokane

SPRING – GRADUATIONS AND RECOGNITION

Oh yes, graduation. The residents are now

Family Medicine:

Psychiatry:

completing their training and getting ready

Sara Crow, DO

Kathleen Daly, MD

to enter our ranks as colleagues. With

Spanish Peaks Behavioral Health,

this in mind, we would like to recognize

Evan Jones, MD

Pueblo, Colorado

those residents who are completing their

residency here and will be entering practice.

Keenan Milonas, MD

Once again, we have a great medical

Providence Urgent Care

community here in Spokane. We have many

Spokane Valley

wonderful clinicians who have made the

By Darryl Potyk, MD, FACP

provide excellent primary care. Many of the

Transitional Year:

Graduating residents and their future plans

University of Washington School of Medicine

students hold Dr. Maixner up as the role

2008-2009

include the following:

James Fischer, MD

Clinical Professor and Assistant Dean for

model for the physician they want to become.

2009-2010

Andre LaSalle, MD

Regional Affairs

Along with the students, we would also like

2010-2011

Don Howard, MD

Providence Internal Medicine Residency

to add our congratulations to Dr. Maixner and

2011-2012

James Elmer, MD

Spokane

thank him for his longstanding commitment

2012-2013

Dan Coulston, MD

Associate Program Director and John McCarthy, MD University of Washington School of Medicine Clinical Associate Professor and Assistant Dean for Regional Affairs WWAMI Clinical Medical Education – Eastern and Central Washington

to medical education in Spokane.

beginning and ending in the spring. Thus, springtime means many things but among them is graduation and along with graduation comes celebration and recognition. With that in mind, we would like to call attention to local graduates from our residency programs and honor those physicians in our community who have been singled out by their respective learners to be recognizing

students who choose to do their clinical clerkships almost entirely here in Spokane. This past year we had 15 third year “Spokane Track” students and 8 fourth year “Spokane Track” students. This group of Spokane students presents an annual award to honor a clinical attending who had a great impact

Practice plans TBD

Wendy Chang, MD

Hospitalist Seattle

Psychiatry: “Michael Manz Oustanding

Justin Cochrane, DO

award have included Matt Hollon (2012) and

Clinician Award”

Providence IMR Spokane –

Chris Vernon (2013).

2008-2009 Tanya Keeble, MD

Teaching Fellow

2009-2010

Lesley Blake, MD

Jaime Fair, MD

2010-2011

J Cliff Green, MD

2011-2012

Bill Grant, MD

Dawit Gabrekidan, MD

2012-2013

Amy Burns, MD

Similarly the residents in their respective volunteer attending physicians each year who has contributed to their education

professional development. While we don’t

Radiology

know this year’s winners, we thought it

2010-2011

Terri Lewis, MD

appropriate to recognize those who have

2011-2012

Gordon Teel, MD

been honored recently. Those faculty

2012-2013

Dan Murray, MD

physicians who have received this honor from our local graduate medical education programs include the following:

Providence Intensivist Group Providence Hospitalist Group

David Peek, MD

and who they feel has influenced their

MEDEX Golden Apple Speakers in Perpetuity

Locum Tenens Locally

Kang Zhang, MD

Providence IMR Spokane –

Teaching Fellow

Kodiak, AK Family Medicine

Hang Pham, MD

choice to integrate medical education into

their practices and continue to be engaged

Eugene, OR Family Medicine

Trent Shino, MD

in the medical education process. We know

Columbia Associates

that the medical students and residents

Family Health Center

benefit from your commitment. We also

Lily Wittich, MD

know that remaining engaged in medical

education is rewarding and helpful to you

Providence Obstetrical Fellowship

Matthew Kaiser, MD

as preceptors. These awards just begin to

scratch the surface of all of the good work

Eugene, OR Family Medicine

that is done by all of you. Thank you! n Radiology: Jeremiah Boyd, MD

Body Imaging Fellowship, UCSF

Steven Wilhelm, MD

Pediatric Radiology Fellowship,

Seattle Children’s Hospital

Olivier Drouin, MD

Awardees

their commitment and excellence in teaching. Each year there are a number of medical

Scott Caveny, MD, Phd

Prior recipients of this prestigious teaching

programs nominate and choose one or two

The academic calendar is a funny thing

Internal Medicine:

Practice TBD in Spokane

Private Practice – Canada

Dinesh Ratti, MD

Providence IMR Spokane - Faculty

Robert Fairfax, PA-C Brian Gates, PharmD

Internal Medicine:

Patty Hahn, ARNP

2008-2009

Nelson Chow, MD

2009-2010

Henry Mroch, MD

2010-2011

Dan Coulston, MD

2011-2012

Greg Schlepp, MD

2012-2013

Dieter Lubbe, MD

& Darren Wooley, DPM

Matthew Layton, MD, PhD Nathan Meltzer, MD Theresa Schimmels, PA-C Stephen Setter, PharmD

The above awards single out individuals

on their development as doctors. This year

who have made significant contributions to

these students chose to recognize Dr. Bob

Family Medicine:

Maixner, a local pediatrician, as the clinical

2007-2008

Lori Smetana, MD

attending who meant the most to them. The

2010-2011

Kimberly Grandinetti, MD

students cited Dr. Maixner’s professionalism,

2011-2012

Matt Layton, MD

his willingness to bring students into his

2012-2013 Daniel Zwiesler, MD

practice, his home and his life all the while

these awards are important we all recognize how fortunate we are to be surrounded by these and many other worthy physicians who practice high quality medicine and serve as mentors and role models for their colleagues,

demonstrating how rewarding it can be to

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

medical education here in Spokane. While

our residents and our students.

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SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | JUNE, 2 014

Group Health

Medical Sciences

HEALTH CARE FOR MORE AMERCIANS: THE FUTURE WE WISHED FOR IS HERE

REGENTS APPROVE CREATION OF NEW WSU COLLEGE OF MEDICAL SCIENCES

By Eric B. Larson,

care organizations (ACOs), the industry has

than the rest of the economy—already

By Doug Nadvornick

“I know that, to someone outside the

MD, MPH

Roberts began recruiting his first group of

stronger incentives to manage the health of

outspending every other portion of the

WSU Medical Sciences Communications

university, this won’t mean much,” said Ken

Vice President for

researchers to campus; they also teach

large populations of patients. This means

federal budget, including defense.

Roberts, director of WSU Medical Sciences.

Research, Group

medical students.

providers and insurers everywhere are

Health

suddenly more interested in new models of

Executive Director,

care—including those designed to boost

Group Health

efficiency while improving quality and

Research Institute

lowering costs. Organizations are trying

For years, people at Group Health Research Institute (GHRI) have been looking forward to the day when more Americans could benefit from our discoveries. Now, with further implementation of the Affordable Care Act, that day has arrived. Federal officials estimated last month that eight million people had signed up for coverage under Obamacare. While it’s still unclear how many previously uninsured people now have access to care because of the law—through state exchanges, Medicaid, or private insurers—that number will keep growing quickly. As a result, more people than ever will reap benefits from various Group Health-proven improvements that are now commonplace in American medicine:

harder to help patients avoid emergency care and hospitalization, while offering better primary care-based prevention and chronic illness care. At the same time, stakeholders are recognizing the importance of engaging patients in good habits like frequent exercise and healthy eating. I just returned from leading an Institute of Medicine workshop sponsored by the Patient Centered Outcomes Research Institute (PCORI). Health care leaders from nationally prominent organizations described how they are integrating care and research to create better value in health care. It was inspiring to hear of promising initiatives underway, including Group Health’s work on value-based benefit design and efforts here and elsewhere to use “Choosing Wisely” principles to reduce use of tests and treatments that drive up costs

• Advances in prevention, • Cancer screening, • Better care for chronic illnesses, and more.

without improving health outcomes. Helping communities afford health care The urgent need to drastically reduce

Boosting efficiency and improving quality What lies ahead? Important and timely opportunities to keep contributing as our nation strives to develop a more equitable and affordable health care system. With the new law’s emphasis on accountable

the price our communities are paying for health care underscored the workshop presentations. Despite earlier optimism that our nation’s spending might be slowing with progress toward health reform, recent reports indicate this trend has stopped: Health care costs keep rising much faster

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

The Washington State University Board

“But at WSU Spokane, it is a big deal.”

Tackling health care cost increases is

of Regents voted to create a new college

complex, but experts point to two main

that encompasses the university’s medical

Also part of the new college is WSU’s

25 full-time faculty, a similar number of

causes:

education and research programs.

Department of Speech and Hearing

part-time faculty and several dozen clinical

Sciences, with more than 100 undergraduate

physician preceptors from the Spokane area

and graduate students and a robust

who participate in teaching.

1. New medical technologies with

The College of Medical Sciences merges

tremendous benefits—and high prices;

WSU’s growing clusters in sleep and cancer

and

research with the WWAMI (Washington

research program on the Spokane campus.

Medical Sciences now employs more than

In the last year or so, Medical Sciences has

2. Our quickly aging population, with many

Wyoming Alaska Montana Idaho) medical

“We are delighted to be part of this

hired five new researchers, some of whom

more people surviving into old age and

education program that WSU shares with

education and research enterprise focused

will move to Spokane this summer from

half of Americans over 65 having at least

the University of Washington School of

on professions and disciplines that impact

places such as Duke University and the

two chronic conditions.

Medicine in Spokane and Pullman.

the quality of human health and well-being,”

universities of Wisconsin and Pennsylvania.

Most of the U.S. health care system is not

said Gail Chermak, chair of Speech and

built to prevent illness or help patients

The new college became official May 15.

manage chronic disease. And too little new

Roberts spoke about the goals of the College

technology focuses on practical solutions

of Medical Sciences and its research

The Medical Sciences program began

Each will enrich the academic environment

to help people lead healthier lives. Instead,

programs at the WSU Spokane Chancellors’

in 2008 with expansion of the WWAMI

in Medical Sciences and bring unique

our health care system cares mainly

Research Breakfast.

program to Spokane. At that time,

opportunities for students who are training

Hearing Sciences.

“We are happy to have these talented scientists joining our faculty,” Roberts said.

in Medical Sciences.”

for acute or episodic illness, providing incentives for doctors to do more care than is needed or beneficial. The result is fragmented, inefficient care that costs more than necessary. Perhaps most disturbing is the way health care is usurping resources needed in other areas essential to our society’s health and well-being: education, the environment, public safety, and sound transportation systems. Affordable health care for all

Our business is turning them into realities.

With the Affordable Care Act, the future so

We do this by helping our clients plan and manage their financial resources. Fee-only.

many of us wished for is here, but health care’s cost crisis has yet to be resolved. Now it’s up to us to help lead the way, showing how to improve health and health care at a cost our nation can afford—to preserve essential services—and our economy itself.

| THE MESSAGE | JUNE, 2 014

For a complimentary consultation or brochure, call: Greer Gibson Bacon, CFP® (509) 838-4175 or (888) 864-8827 assetplanning.com

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | JUNE, 2 014

Hospice Spokane

Spokane Scholars Foundation

END OF LIFE: PART II

SPOKANE SCHOLARS FOUNDATION BANQUET 2014

Palliative Care

By Valerie Logsdon, MD

programs. Hospice, however, requires that

The American Osteopathic Association

Hospice Spokane

a physician certify that the patient have a

(AOA) Bureau of Osteopathic Specialists

terminal condition with a life expectancy of

approved a Certificate of Added

less than six months. Hospice also requires

Qualification in hospice and palliative

that a patient NOT be pursuing curative

medicine in February 2007. Between 2009

treatment. It became clear that instituting

and 2014 candidates who had obtained a

some of the tenants of Hospice care earlier

general certification in any primary board

in the course of the disease process was

were eligible to sit for the exam. Beginning

beneficial…As is typical of many things, this

in 2015, only the American Osteopathic

concept made perfect common sense, but in

Boards of Family Medicine, Neurology

order to legitimize it, it needed to be proven.

and Psychiatry, Physical Medicine and

What is Palliative care? According to the Merriam-Webster’s Collegiate Dictionary (10th edition) “palliate” comes from Latin meaning to “cloak”. It is a verb meaning (1) to reduce the violence of (a disease), (2) to cover by excuses and apologies or (3) to moderate the intensity of. In today’s medical world, palliative medicine is a philosophy of care. Its goals include: • to relieve suffering • to improve the quality of lives of patients and families dealing with the challenges of chronic illness • to assist with difficult medical decisions • to coordinate care; help the family and patient navigate the health care system • to understand the need for emotional and spiritual support.

Studies have demonstrated improved patient outcomes and family satisfaction, cost savings and decreased resource utilization

the US provide some palliative care services.

As of May 2012, 85 Hospice and Palliative

63% of hospitals with greater than 50 beds

Medicine fellowship programs have been

have a consultative palliative care service,

created with more than 234 fellowship

a 138% increase from 2000. (A) In an effort

positions. Interesting, eh?

expert at symptom management. They

from “Palliative Care” to “Supportive Care”. I

should also be the poster children for

consider them synonymous.

practitioner. It requires that a physician

in that it is a subspecialty of 10 participating

have a broad knowledge and experience

Boards: American Board of Internal Medicine,

base and, most importantly, an ability to

primary care providers.

Anesthesiology, Obstetrics and Gynecology,

empathize with the patient. It requires a true

Physical Medicine and Rehabilitation,

knowledge of the person in order to create

Palliative care has also become a system for

Pediatrics, Psychiatry and Neurology, Surgery,

a treatment plan. Palliative care should be

the delivery of care. The US Census Bureau

Emergency Medicine, Radiology and Family

instituted early and should be a part of every

estimates that 20% of the US population

Medicine. The American Board of Internal

physician’s armamentarium.

will be older than 65 by 2030. With the

Medicine is responsible for administering

aging population, will come an incremental

the Board exam. Prior to 2012, qualification

increase in chronic disease diagnoses and

to sit for the Boards was achieved through a

the need to effectively address those needs.

demonstration of experience and competence.

In the US, palliative care was first predominantly delivered through hospice

Since then, completion of a certified fellowship

A. State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals. 2011. Available from www.capc.org/reportcard/ findings. Accessed May 12, 2014. n

is required.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Convention Center on April 21. Special recognition was given to donors Drs. Jonathan Holloway, Hampton Irwin and Elizabeth Welty for their continued generous support.

the 27 private and public high schools were honored, each individually introduced on stage in front of an audience of nearly 900, each given a personalized SSF medallion, and then 24 of the students received cash grants. Over the course of the 22 years, the SSF has honored over 2,800 Scholars and

Dr. Eric Johnson, co-founder and president of the SSF, served as the master of ceremonies. The SSF has as its mission the

distributed more than 1.25 million dollars in cash and matching grants.

Dr. Johnson stated, “It was once again an inspiring evening for all in attendance, seeing these talented and hard-working students receive the recognition they deserve. The physicians in this community step up each year to support the program. I am proud to be a member of a profession that has such a generous heart.” For more information on the Spokane Scholars Foundation, see www.

Dr. Bare represented the nearly 85

spokanescholars.org. n

physician donors who contributed

LUXURY URBAN LIVING & PROFESSIONAL OFFICE WITH SEPARATE ADDRESS Imagine living and working in the thriving downtown Spokane environment, where you can walk to shopping, restaurants and entertainment. Dream with your eyes open! See yourself in this inviting, expansive and luxurious home and entertaining with friends and family. This is the lifestyle you’ve been seeking. Own It!

changes, the need for palliative services is a return to the practice of a general

of chronic illness, and should begin with our

Scholars Foundation (SSF) Banquet at the

population ages and our systems of delivery

in 2006. It is unique in allopathic medicine

philosophy should be instituted at the onset

studies and world languages) from each of

represented at the 22nd Annual Spokane

have grown in response to a need. As our

by the American Board of Medical Specialties

chronic illness. It is my belief that a palliative

(English, fine arts, math, science, social

Spokane County physicians were well

believe that palliative care programs

will continue to escalate. In my mind, this

spiritual and social concerns that come with

individually in the banquet program.

best students in six academic disciplines

Granted, I am completely biased, but I

Palliative Care was approved as a subspecialty

to address all of the physical, emotional,

among the region’s high school seniors. The

Spokane Scholars Foundation

presented the top awards in Science and

become a relatively new subspecialty.

Hospice), many have changed their name

Co-founder and President

in hospice and palliative medicine.

result, almost two-thirds of all hospitals in

Palliative medicine physicians should be

this year and whose names appeared

Dr. David Bare, president of the SCMS,

So, Hospice and Palliative Medicine has

to better clarify services (and to distance

public recognition of academic excellence

offer the Certificate of Added Qualification

with inpatient palliative care services. As a

themselves from the connotations that attend

working in multidisciplinary teams in order

Rehabilitation and Internal Medicine will

By Eric Johnson, MD

| THE MESSAGE | JUNE, 2 014

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| THE MESSAGE | JUNE, 2 014

1 2

UW School of Medicine, Continuing Medical Education & UW School of Nursing, Continuing Nursing Education

August 14 2014

STD U PDATE

Optional Clinical Practicum

Topics include: • “Diagnosis and Management of Chlamydia and Gonorrhea"

– Jeanne Marrazzo, MD, MPH

• “Update on Vaginal Health"

Boise, Idaho

– Hillary Liss, MD

8:00am – 5: 00 pm

• “Genital Herpes Update"

Cost: $100

– Christine Johnston, MD, MPH

Pre-enrollment by August 7th is required.

• "Overview of Genital Dermatology" – Sue Szabo, PA-C

Hotel rooms, dinner meals, and parking fees are not covered in the registration fee and are the participants’ responsibility. Lunch and a Continental breakfast will be provided.

• "Genital Infections with Human Papillomavirus"

Please visit our website for online registration and payment information

– Sue Szabo, PA-C

• "Syphilis: Refresher and Update"

www.seattlestdhivptc.org (206) 685-9850 seaptc@uw.edu

– Sue Szabo, PA-C

Course participants will learn how to:

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 17 Cruise starting at Templin’s Marina Boat loading starting at 6:00 p.m. Embarking promptly at 6:30 p.m. Returning at 9:00 p.m. Heavy hors d’oeuvres * Wine and other refreshments Limited space available—RSVP to michelle@spcms.org

Thank you to our sponsor!

√ Describe the latest clinical and lab diagnostic and testing procedures for the infections covered. √ List the current recommended treatments, follow-up, and prevention messages for the infections covered.

The Prewitt Group

Continuing Medical & Nursing Education Available Continuing Medical Education: The University of Washington School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Washington School of Medicine designates this live activity for a maximum of 7.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education: A certificate for 7.6 contact hours (of which 7.3 are in pharmacology at the advanced practice level) will be awarded for completing all course activities, a pre/post test and an evaluation.

Continuing Nursing Education at the University of Washington School of Nursing (UWCNE) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC). Psychologists: UWCNE qualifies as a CE program sponsor under WAC 246-924.240(1). Social Workers and Counselors: UWCNE qualifies as a Washington State CE program sponsor under WAC 246-809.610. Other disciplines: A contact hour certificate will be awarded for use in documenting completion of this continuing education activity.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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Guest Column

UPDATE IN EXERCISE FOR FIBROMYALGIA By Christopher M. Valley, ND

with their pain. Patients often start to

Therefore, most patients will often over-do

Arthritis Northwest PLLC

identify themselves as a “pain patient”

and set themselves back with more pain

rather than an individual who happens

which leads to frustration and less exercise

to have pain. Exercise has shown to not

(vicious cycle).

The research on Fibromyalgia has improved markedly over the last several years, although there is still a very long way to go in understanding the pathophysiology and treatment of the condition. The studies are quite clear that patients respond more effectively to a multi-disciplinary treatment incorporating exercise, sleep restoration, pain psychology and behavioral modifications, along with appropriate medications. In all of the recent studies performed, exercise has clearly shown to be the most consistently effective treatment in the condition. Of course, when patients hurt

only improve pain and function, but to decrease “pain catastrophizing”. 2 The mechanisms of exercise in neuropathic pain are multifactorial. Exercise decreases pain via the production of endogenous endorphins which increases the action on μ-opioid receptors. There are also increased neurotrophins such as “brain derived neurotrophic factor” (BDNF) and endogenous cannabinoids along with many other neurotransmitters involved in modification of pain pathways. 3

I can think of no other single treatment that treats every layer of health (physical, emotional, psycho-social, spiritual) like exercise with virtually no cost and no risk of doing so. At each follow-up visit, re-emphasize the importance of exercise in the treatment plan. Think strongly about actually writing it out on a prescription for the patient. Also consider asking the patient to keep a pain/ activity journal and to bring it in at the followup visit. It is amazing how this can change the meaning/importance of this in their healthcare.

constantly, the last thing they want to do is

Recent studies have demonstrated that low-

Anything we can do to put patients in the

exercise. So, where do we go from here?

moderate cardiovascular training with some

“driver’s seat” with this very difficult to treat

resistance training may be more effective than

condition is certainly worth doing. Of course,

just cardio alone. However, recent studies

if a physician or practitioner is uncomfortable

indicate that working towards moderate to

treating this condition, there are a number of

high intensity cardiovascular training has

well-trained chronic pain physicians in the

shown some promise in other neuropathic pain

community. Please refer to your local medical

syndromes such as Complex Regional Pain

society for resources, or also visit http://www.

Syndrome (CRPS).5 Of course exercise needs

aapainmanage.org/ for more details. n

The primary goal(s) in treatment of fibromyalgia should not be to eliminate pain. This is generally an unrealistic expectation, and often results in frustration for the patient and the healthcare provider. The primary directive should be to improve function and quality of life, and hopefully pain is reduced as this occurs (or at the very least, coping strategies for pain management are improved). The difficulty we all face as healthcare providers is to convince patients that they need to be in full control of the treatment of the condition. Simply taking a pill for fibromyalgia will almost never help them to achieve the quality of life they remember once having. Exercise has been shown to reduce pain as much as 50% in clinical trials. All exercise appears to exert benefit, and there has been special interest in forms such as Tai Chi, Qi

to be tailored to the individual with regards to level of conditioning, other physical ailments, comorbidities, etc. The truth is all patients can start somewhere (e.g. sit and be fit). It is much better to start with short duration exercise more often rather than longer durations less often. This is less likely to set patients back with more pain, and will help to establish the “ritual” of exercise. Also think about asking patients to exercise at the same time each day, and to have their exercise schedule written down and displayed for daily viewing. Understand that virtually all patients with fibromyalgia will have more pain initially, but

Gong, Yoga.1

as they improve conditioning, this will improve

One of the primary challenges we face

patients with fibromyalgia remember what

is to help patients not “over-identify”

it was like before they had the condition.

slowly with time. Please note that almost all

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

References: 1. Mist DS, Firestone KA, Jones KD. “Complementary and Alternative Exercise for Fibromyalgia: a meta-analysis”. J Pain Res. 2013; 6:247-60

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2. Jones KD, Liptan CL. “Exercise Intervention in Fibromyalgia: Clinical Applications from the Evidence. Rheum Dis Clin North Am. 2009 May; 35(2) 373-91

4. Cazzola M, Atzeni F, Pilaff F, et al. “What kind of exercise is best in fibromyalgia therapeutic programs? A practical review.” Clin Exp Rheumatol. 2010; 20(6 supp 63): S117-S124

| THE MESSAGE | JUNE, 2 014

HOME OFFICE: Seattle, WA

Our pediatric specialists are part of a comprehensive team dedicated to the care of children and providing a full range of services . Our newest specialists include Dr. Guzman, with expertise in nephrology and acute kidney injury; and Dr. Plymale, specializing in pediatric cardiology. Nelio Guzman, MD, Pediatric Nephrology 105 W. 8th Ave., Suite 7060 Spokane, WA 99204 509.340.0930

3. Busch AJ, Webber SC, Brachaniec M, et al. “Exercise therapy for fibromyalgia”. Curr Pain Headache Rep. 2011; 15(5): 358-67

5. Hauser W, Klose P, Langhorst J, et al. “Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials”. Arthritis Research & Therapy 2010, 12(3).

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PROVIDENCE PEDIATRIC SPECIALISTS Accepting new patients. For a complete listing of Providence Medical Group physicians, visit phc.org.

Jennifer Plymale, MD, Center for Congenital Heart Disease 101 W. 8th Ave., Suite 4300E Spokane, WA 99204 509.474.6707

In The News

In Memoriam Spokane Eye

Being a native to the area, Dr. Kinard is

policy and shape the manner in which

Clinic announces

returning to start her practice at the Spokane

CAP delivers services to its members by

new neuro-

Eye Clinic in July. Her professional interests

serving as a “think tank” for councils and

opthalmologist

include diagnosis and treatment of Neuro-

committees.

Spokane Eye Clinic is proud to announce that Krista Kinard, MD will join the practice as a Neuro-Ophthalmologist. Dr.

Ophthalmic issues, orbital ultrasound, electrophysiology, general ophthalmology and cataract surgery, temporal artery biopsies, and optic nerve sheath

Washington University and received her

Elected to CAP

medical degree from the University of

WA State House of

Utah School of Medicine. She completed

Delegates

and her Ophthalmology Residency at the John A. Moran Eye Center. She continued her education at the Moran Eye Center where she is completing a fellowship in Neuro-Ophthalmology. She also pursued additional training in Orbital Ultrasound and Ocular Electrophysiology. She is a member of American Academy of Ophthalmology, North American Neuro-Ophthalmology Society, American Medicine Association and American Society of Cataract and Refractive Surgery.

prior to joining Incyte Diagnostics. He is and clinical pathology with subspecialty

Incyte Pathologist

the University of Utah School of Medicine

Department of Pathology at Emory University board certi!ed in cytopathology, anatomic

fenestrations.

Kinard graduated cum laude from Eastern

a preliminary year in Internal Medicine at

Dr. Logani was an Associate Professor in the

expertise in gynecologic pathology. n

Sanjay Logani, MD was selected as an alternate delegate to the Washington State House of Delegates for the College of American Pathologists (CAP). The position is a three-year term. The House of Delegates serves as the voice for the College of American Pathologists’ over 18,000 members. They are responsible for apprising CAP leadership of the needs of its members and how well they are meeting those needs. Delegates provide guidance in crafting and implementing the organization’s

SAVE THE DATE Spokane County Medical Society Presents

Medicine 2014 Friday—September 26, 2014 8:00 a.m. to 5:00 p.m.

Red Lion Hotel at the Park

Watch for more details!

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | JUNE, 2 014

Arthur B. Craig, MD Arthur Bell Craig, MD was born on August 3, 1926 in Boston to Arthur B. and Marion Campbell Craig. He passed away on April 23, 2014. He graduated from the Quincy High School where he was captain of the football team. Two years at Williams College were followed by two years at Harvard, graduating in 1947. He entered Johns Hopkins University School of Medicine, receiving his medical degree in June 1951. That same month he and Hopkins classmate, Joan Groschupf, were married in Spokane by her father, Rev. John M. Groschupf of Emmanuel Lutheran Church. They returned to Baltimore as the first married interns allowed to live together within the Hopkins system, while serving their internships. Having completed a three-year residency at the University of Washington, Dr. Craig returned to Johns Hopkins on a fellowship in pulmonary physiology. Upon returning to Seattle he was on the staff of the Firlands Sanatorium before relocating permanently to Spokane in 1957. He and his wife opened their first office in the Paulsen Building, moving soon thereafter to the new Medical Center Building at 8th and McClellan. Remaining in solo practice until 1988, they joined the Rockwood Clinic in anticipation of retirement. On leaving the active care of patients, Dr. Craig became the medical director of the western division of The Guardian Insurance Company. During his years in Spokane, Dr. Craig served as the tuberculosis control officer for Spokane County. When Medicare was introduced in 1966, as president of the Spokane County Medical Society, he faced the familiar uproar that accompanies national changes in health care. He was president of the

Spokane Society of Internal Medicine, and served on many medical positions and committees of the Sacred Heart, Deaconess and St. Luke’s Hospitals. He was a founding member of the Inland Northwest Community Foundation and an early board member of the Spokane Mental Health Association. In 2007 the Craigs moved to their home in the Rockwood South Retirement Community. Dr. Craig is survived by his wife of 63 years; four sons, Brad Craig (Suzanne), San Francisco; Paul Craig, MD (Joni Nichols, MD), Spokane; David Craig (Cathy), Sammamish and Andrew Craig (Brenda), Spokane; a daughter, Ann Elizabeth Lisa Napoli (Gregg), San Francisco; seven grandsons and eight granddaughters. Dr. Craig was preceded in death by his daughter Caroline Augustyn, MD and her husband Damian Augustyn, MD. He is survived by his sister, Marylyn Lightfoot, of Mercer Island and his brother, Glenn Craig in Oakland, Calif.

George S. “Bud” Eugster, MD Dr. George S. Eugster died May 4, 2014 at home surrounded by family. George was born in Wayzata, MN on March 12, 1941 to George and Helen Eugster. Graduating from Mound High School and Carleton College with honors, he entered medical school at the University of Minnesota, graduating in 1967. He was elected to Alpha Omega Alpha, the honorary medical society. In 1966 George married Susan Sturley of St. Paul, Minn. and together they moved to Denver, Colo. where he completed his internship, medical residency and cardiology fellowship. The couple, along with their two young daughters Jennifer and Betsy, moved to Albuquerque, NM where Major George Eugster became the Director of Internal Medicine at Kirtland AFB. The family moved to Spokane in 1974

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

amid the excitement of Spokane Expo. George joined Associated Internists as a cardiologist. Later the couple’s son, Andrew, was born. George was involved with the building of the Fifth and Brown Medical Building’s new addition. In 1983 he, Dr. Reisig, and Dr. Stifter joined Drs. Notske and Hensley in forming the Spokane Heart Clinic. Realizing a need for a cardiac rehabilitation in the Spokane community, he and Dr. Hinnen co-founded the first program which was housed at the YMCA. He was also the president of the Northwest Chapter of the American Heart Association 1980-81. In 1989 George joined a committee to create The Heart Institute of Spokane and at the completion of the two year project, the Institute became a reality with George as the first president of the Board of Directors. His group, Spokane Heart Clinic, moved their office into that building and over the years those doctors blended with another practice now known as Heart Clinics Northwest. He was president of Heart Clinics Northwest from 1995 until he retired in 2000. Retirement was not a time to be idle. George, who is fondly known as Bud, became a volunteer for Habitat for Humanity. While active on committees and boards, he found time for his family. Bud was an active sportsman with love for bird hunting, sailing, running, skiing, and more recently fly fishing. Susan and Bud also loved traveling and the highlight of their many experiences was the trip to Antarctica just two years ago. George is survived by his loving wife of 47 years, Susan; daughters Jennifer Yeatts (Matthew), Betsy Koehler (Thomas); son Andrew Eugster (Erin); grandchildren Grant, Lauren and Mark Yeatts, Rose and Kent Koehler, Bromley and Parks Eugster; brothers Stephen and Jack (Camie); motherin-law Jane Long and many other relatives and friends.

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For Your Information

DEDICATION THE DR. ROBERT BREE COLLABORATIVE INTRODUCES NEW WEBSITE The Washington State Legislature

in the way that care is delivered, that are

has a unique page discussing the

established the Dr. Robert Bree

frequently used but do not lead to better

topic and highlighting the final reports

Collaborative in 2011 for public and private

care or patient health or that have patient

and recommendations. Learn more

health care stakeholders to have the

safety issues. For most topics, an expert

about the following topics at www.

opportunity to identify specific ways to

workgroup is formed to develop evidence-

breecollaborative.org:

improve health care quality, outcomes

based recommendations.

and affordability in Washington state. Stakeholders are appointed by the Governor and represent public health care purchasers for Washington state, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals and quality improvement organizations. Each year, the members identify up to three health care services with high variation

• Accountable Payment Models

Recommendations take into account existing

• Addiction and Dependence Treatment

quality improvement programs and the

• Cardiovascular Health (Cardiology)

work done by other organizations and are

• End of Life and Advance Directives

then sent to the Washington State Health

• Obstetric (Maternity) Care

Care Authority to guide the type of health

• Potentially Avoidable Hospital

care provided to Medicaid enrollees, state employees and other groups.

Readmissions • Spine and Low Back Pain

“We’re not just a transport team, we’re critical care where and when you need it most.” – TERRI TICKNER, RN, NREMT-P NORTHWEST MEDSTAR

The new website is the result of

Te r r i i s o n e o f 1 ,0 0 0 de di c a t e d IN H S e m pl o y e e s m a k i n g a di ff e re n c e i n o u r communities for the last 20 years. Find her i n s pi r a t i o n a l s t o r y a t

INHS.ORG/INHS20

months of collaborative work. Each of the health care services addressed INSPIRING COLLABORATION. CONNECTING COMMUNITIES.

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New SCMS Members 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.

PHYSICIANS Hooper, Stephen, MD Anatomic and Clinic Pathology Med School: U of Missouri (1991) Internship: Naval Med. Center Portsmouth (1992) Residency: Walter Reed National Med Center (1999) Joining Incyte Diagnostics 07/2014 Obregon, Victor, MD Obstetrics and Gynecology Med School: U of Texas (1985) Internship: Parkland Health & Hospital (1987) Residency: Parkland Health & Hospital (1990) Joined Obstetrix Medical Group Chesnut, Cameron, MD Dermatology Med School: U of Washington (2009) Internship: Sacred Heart Medical Center (2010) Residency: UCLA (2013) Joining Dermatology Specialists of Spokane 07/2014 Persoon-Gundy, Jo, MD Internal Medicine Med School: U of Southern CA, Keck (2002) Internship: Swedish Family Medicine (2004) Residency: USC (2013) Joined Rockwood Hospitalists Eiseman, Heidi, MD Ophthalmology Med School: Loma Linda U (2010) Internship: Arrowhead Regional Med. Center (2011) Residency: Loma Linda U (2014) Joining Rockwood Eye Clinic 08/2014 Schmutz, Daniel, MD Emergency Medicine Med School: U of Wisconsin (2011) Internship: Michigan State U (2014) Joining Northwest Pacific Emergency Physicians Date TBA Preiss, Benjamin, DO Emergency Medicine Med School: Touro U (2010) Internship: Lehigh Valley Hospital (2011) Residency: Lehigh Valley Hospital (2014) Joining Northwest Pacific Emergency Physicians 08/2014

Bray, Jeffrey, MD Obstetrics and Gynecology Med School: Medical School of Wisconsin Internship: Virginia Mason Medical Center (1997) Residency: U of New Mexico (2001) Joining Obstetrix Medical Group 07/2014 Allar, Rory, MD Ophthalmology Med School: Dartmouth, Geisel (2009) Internship: Dartmouth-Hitchcock Medical Center (2010) Residency: Oregon Health & Science U (2013) Joining Spokane Eye Clinic 10/2014

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



Hecker, Susan, MD Internal Medicine Joined Northside Internal Medicine 06/2013



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

Marks, Lacey, MD Obstetrics/Gynecology Joining Rockwood OB/GYN 09/2014



Elder Care



Assess the changes in the healthcare environment



Prac�ce Management

Maestas, Lisa, DO Radiation Oncology Med School: West Virginia School of Osteo Med. (1999) Internship: Massapequa General Hospital (2000) Residency: New England Medical Center (2004) Joining Rockwood Oncology & PET/CT Services 07/2014

PHYSICIANS PRESENTED A SECOND TIME

Grace, Travis, MD Emergency Medicine Joining Northwest Pacific Emergency Physicians 07/2014

Physician Commi�ee Members (Name and Contact Informa�on)

Barker, Jessica, MD Obstetrics/Gynecology Joining Rockwood OB/GYN 10/2014 Wagner, Aaron, MD Radiation Oncology Joining Cancer Care Northwest 07/2014

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

Gourley, Brett, MD Hematology/Oncology Joining Rockwood Cancer Treatment Center 08/2014

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

Meredith, David, MD Pathology Joining Deaconess Hospital 07/2014

Greg Loewen

844‐8476

Rod Peterson

944‐5781

Aldred, Jason, MD Neurology Joined Northwest Neurology, PLLC 04/2014

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 illness, addic‐ �ons, work‐related stress, life transi�ons and rela�onship diﬃcul�es.

Mourton, Susannah, MD Gynecology Oncology Med School: U of Otago, New Zealand (1997) Residency: U of California San Francisco, Fresno (2005) Fellowship: Memorial Sloan Kettering Cancer Center (2006) Fellowship: U of California, Davis (2009) Joining Cancer Care Northwest 08/2014

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

EASTERN WASHINGTON PHYSICIAN HEALTH COMMITTEE (EWPHC)

We meet Tuesday evenings a�er 6pm. The format is structured by the 12‐Step Alanon principles. All is conden�al and anony‐ mous. There are no dues or fees. To discuss whether this group could be helpful for you, contact Bob at (509) 998‐5324.

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SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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Classified Ads

POSITIONS AVAILABLE ESTABLISHED SPOKANE CLINICAL RESEARCH COMPANY is seeking primary care and specialty physicians interested in serving as Principle Investigators or as Sub-Investigators. There is an opportunity to assume an on-going research portfolio and to join new studies that are opening in the spring of 2014. For more information, contact Dalyn Boehm or John Driscoll at Premier Clinical Research at (509) 343-3710 or research@premierclinicalresearch.com. BC/BE PEDIATRICIAN WANTED, SPOKANE The State of Washington Division of Disability Determination Services seeks a BC/BE pediatrician to perform contract service in our Spokane office. Contract services include the evaluation of physical impairment severity from medical records and other reports, utilizing Social Security regulations and rules of law. Medical consultants function as members of the adjudicative team and assist staff in determining eligibility for disability benefits. Reimbursement: $65/hour base; potential for $68/hour for high productivity. Interested physicians should contact Chief Medical Consultant Dr. Gene Profant at (360) 6647454 or Spokane Office Manager David Bennett at (509) 329-2508. This position reviews interesting cases; teaching is thus an integral function. Hours are quite flexible. SPECTRUM HEALTHCARE RESOURCES has an immediate opportunity for a civilian Family Practice Physician at Fairchild Air Force Base. This contract position offers: Full-time; Outpatient setting; Monday through Friday, 7:30am to 4:30pm; Manageable patient load (20-25 per day) and Shared on-call responsibilities (mostly telephone consulting). The position will have the following requirements: Current and unrestricted medical license; Successful completion of a family medicine residency; Board Certified by the ABFM or AOBFP; BLS, ACLS, PALS and Ability to work in a team setting. Contact Spectrum recruiter Lisa Paska for more information at Lisa_Paska@ spectrumhealth.com or (314) 744-4107.

PHYSICIAN (OB/GYN and Urgent Care) OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE-Spokane Locations (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 Psychology, Psychiatry, Physical Medicine and Rehabilitation, Family Medicine, Occupational Medicine, 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 Maggie Dillon directly at (909) 978-3548 or mdillon@qtcm.com or visit our website www.qtcm.com to learn more about our company. 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.

PROVIDENCE MEDICAL GROUP (PMG) – Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in Spokane Valley, a 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. PMG – Eastern Washington is our physician-led network of more than 450 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, Washington. Currently patients are seen four days per week, Monday through Thursday, 8 a.m. to 5 p.m. 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, including vacation and CME benefits. Starting salary depends on experience. Submit resume and cover letter to Kris Norton, Office Manager Inland Neurosurgery & Spine Associates, P.S. 105 W 8th Ave, Ste. 200 Spokane, WA 99204 or knorton@neuroandspine.com. MANN-GRANDSTAFF VA MEDICAL CENTER in Spokane has immediate opportunities for Psychiatrists, Emergency Medicine Physicians, Internists, and Hospitalists and an immediate opening for a Director of the Emergency Department. Recruitment incentives and Education Debt Reduction Incentives may be available. Please contact Rodney Gile (509) 434-7590 (Rodney.gile@ va.gov) or Robyn Highbarger (509) 434-7393 (Robyn.Highbarger@va.gov) for specific information about positions.

PROVIDENCE MEDICAL GROUP (PMG) – Eastern Washington 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. Excellent compensation and benefits. PMG – Eastern Washington is our physician-led network of more than 450 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. MID-LEVEL OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE-Family Practice ARNP and Physician Assistant needed in Spokane, WA and Moscow, ID. 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 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. We are looking for a COMPASSIONATE AND SKILLED FAMILY/INTERNAL MEDICINE PHYSICIAN/ FINAL YEAR RESIDENT for our growing clinic in the Olympic Peninsula. This setting provides a place and all the resources for setting up your own private practice in a complete turnkey manner with regulatory and administrative matters taken care of professionally. The organization is physician led and takes care of physicians very well. We would expect the new physician to start with some urgent care hours and slowly transition to a full time private practice primary care. Candidates signing up in during their residency are eligible for a $1000 per month stipend for the remainder of their residency. For further details, please call (509) 414-6390.

PHYSICIAN-BE/BC FAMILY MEDICINE General Full Time, Spokane, WA Columbia Medical Associates (CMA) is a multispecialty medical group with more than 40 clinicians in 12 locations throughout the Spokane, Wash. region. The providers of CMA are dedicated to providing patient-centered, evidence-based medical care for the 70,000 patients the organization serves each year. CMA employs 200 health care professionals and accepts all types of insurance. CMA is a subsidiary of Group Health Cooperative and its physicians are employees of Group Health Physicians. Benefits include: Full malpractice indemnification, medical/dental/vision benefits, 401(k), 4 weeks paid vacation, CME, long-term disability, long-term care benefits. Competitive salary offered. Spokane is located on the eastern side of the state. Its unique location provides year round activities including skiing, hiking, boating and kayaking. Small town charm, pleasant neighborhoods, affordable housing and a highly rated school system make Spokane a great place to live and an unparalleled place to raise a family. Columbia Medical Associates is an Equal Opportunity Employer committed to a diverse and inclusive workforce. Interested candidates may send a CV to Jessica Billings at billings.j@ghc.org. PHYSICIAN WANTED NATIVE PROJECT/ NATIVE HEALTH CLINIC—Consider joining a growing, innovative, community health clinic in Spokane, WA. NATIVE offers patient-centered care in a medical home that provides medical, dental, mental health, chemical dependency and preventative health services in a multidisciplinary practice model and needs a Family or Internal Medicine physician. Physician benefits include competitive salary and excellent medical, dental and life insurance benefits, 401(k), paid licenses and CMEs, I.H.S. and NHSC loan repayment and signing bonus. At NATIVE’s beautiful facility, we serve people of all ethnicities, income levels, ages and medical or behavioral health needs. For more information contact Dylan Dressler, Clinic Manager, at (509) 483-7535 or our website at www.nativeproject.org for the complete job description.

N.E. WASHINGTON HEALTH PROGRAMS LOON LAKE COMMUNITY HEALTH CENTER is seeking a family practice ARNP or PA-C. The ideal candidate will enjoy working with a medical team that is dedicated to the mission of NEWHP and have the ability to work autonomously. The Loon Lake clinic is nestled in the rural area of Loon Lake in N.E. Washington State. The area allows for the recreational enthusiast who enjoys, skiing, hiking, hunting, fishing, snowshoeing, horseback riding and any other outdoor event that you desire. Competitive salary and benefits. N.E. Washington Health Programs is also a NHSC/State student loan repayment eligible site. Please send resume to NEW Health Programs/Attn: HR DTR/PO Box 808/ Chewelah, WA 99109 or email to: vickien@ newhp.org. EOE & Provider NORTHWEST MEDICAL SPECIALTY EVALUATIONS SEEKS BOARD ELIGIBLE / BOARD CERTIFIED PHYSICIANS FOR SSI EXAMINATIONS. Flexible hours. No call or ongoing patient care responsibilities. This is an excellent way to supplement your clinical income. Call for more information. kcave@ nwmse.com – 509.588.7340

MEETINGS/CONFERENCES/EVENTS 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. 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 6 p.m. 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.

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Classified Ads OTHER Medicinal Cannabis and Chronic Pain Provider Survey The State of Washington Attorney General’s office has granted researchers from the University of Washington an opportunity to develop and deliver a comprehensive CME program for health care providers regarding the scientific basis, clinical applications, and legal ramifications for using medicinal marijuana to treat chronic pain. To inform the development of the training and to collect information about current beliefs and practices around medical marijuana, the researchers are inviting healthcare providers in Washington state to complete a one-time 10- minute anonymous survey. Consider sharing your perspective. For more information and to respond to the survey, visit http://adai.uw.edu/mcacp/. Advanced Disaster Life Support June 14-15, 2014, Fire Training Center, Spokane, WA. Participants demonstrate competencies in mass casualty management. Core elements include the ADLS manual and five interactive lectures (Disasters and Public Health Emergencies; Triage in Disasters and Public Health Emergencies; Health System Surge Capacity for Disasters and Public Health Emergencies; Community Health Emergency Operations and Response; and Legal and Ethical Issues in Disasters). Essential training components include scenarios discussion; tabletop exercises and situational training exercises; skills performance and video review. Basic Disaster Life Support course is a prerequisite. Free Contact Tiffany Turner tturner@srhd.org to receive registration information. Physicians, nurses, physician assistants, emergency medical technicians (EMTs), paramedics, pharmacists, allied health professionals and students in health professional schools.

REAL ESTATE River Front and Acreage, 3300ft², 4 Bedroom Home for Lease (Or Sale) $1,850/month. Close in but feels like the country. Four bedroom, three and ½ bath, master suite with corner jetted tub and large walk-in closet, open living and dining area with

great views and gas fireplace, family room with wood stove, attached two-car garage and detached two-place carport. Forced air natural gas furnace. Large multilevel deck and patio looking toward river. Wooded acres on the Little Spokane River with private trails, sandy beach and swimming hole. Plentiful wildlife. School bus comes to front drive. Mead school district. Close to Whitworth, shopping and freeways but very quiet and secluded. Cable hook-up. Grounds are river irrigated. First and last plus cleaning deposit. Utilities not included. No indoor pets. $150/month grounds maintenance fee if you choose not to do it yourself. Contact Scott (509) 435-7099. For photos go to Craig’s list - http://spokane. craigslist.org/apa/3984125910.html. 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. One of Copeland’s Best North Side Homes on over fifty acres with meadows, trees, complete privacy and gorgeous views. This home offers contemporary living at its best featuring four bedrooms, four bathrooms, three-car garage, hard rock maple floors, cabinets and built-ins, three balcony decks plus a patio with water feature. The second level has a distinctive master suite with custom built-ins, large walk-in closet, lovely master bath with lowboy toilet and bidet, a large sitting room with built-in shelving, raised gas fireplace and extraordinary views! The main floor great room boasts granite, stainless appliances, oversized pantry and very functional laundry suite with chute. Super-efficient geothermal heating and cooling affords economical year ‘round comfort. Twenty minutes from Holy Family Hospital. Mead schools! $665,000 Call Marilyn Amato at (509) 979-6027.

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side. (Owners rarely in residence) This home is located in a quiet, gated community, with panoramic views overlooking a small lake and golf course. It is totally turnkey furnished, dishes, linens, cleaning supplies etc. All new appliances, modern decor. One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size washer/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/ AC, Utilities/Water, Cable TV, Internet/WiFi, Long Distance phone. Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth University. Freeway access to south hill hospitals. Call (509) 954-8339 for details. Available immediately. Willing to rent “unfurnished.”

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.

Resident-centered and locally-owned, offering the finest senior living environments, Rockwood Retirement Communities delivers the retirement lifestyle you want and deserve. We offer two unique full-service communities with high standards of excellence to meet your life’s changing needs.

Resident’s Happiness is

Our Success.

Independent • Assisted • Skilled • Memory Care

Spokane’s Retirement Choice for over 50 Years. SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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rockwoodretirement.org 800-727-6650

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

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