The Message October 2010

THE

message A MON T HLY N E WS M AG A Z IN E OF SCMS – OC TOBER 2010

SPOKANE COUNTY M EDICAL SOCIETY

GRAB THE BILL FROM YOUR CURRENT PROVIDER. THEN CALL COMCAST. WE’LL SHOW YOU HOW YOUR BUSINESS CAN SAVE 40% ON PHONE AND INTERNET. We saw how much we were paying for phone and Internet service with the phone company. So we switched to Comcast Business Class. Now we have faster Internet, better phone and tools from Microsoft. All for one great deal.

Business Class Internet and Phone, just $99/month! business.comcast.com 866-823-8223 Not available in all areas and is limited to new Business Class customers. Limited to Business Class 12 Mbps High-Speed Internet and Business Class Voice service, and requires subscription to both services. Minimum 1 year contract required. Early termination fees apply. Subject to Comcast Business Class Service Order Agreement and General Terms and Conditions. Price does not include equipment and installation charges, taxes, the Regulatory Recovery Fee, or other applicable charges (e.g., international calling and per-call charges). $24.95 activation fee (per line, up to 4 lines) applies to Comcast Business Class Voice. Not all features are available in all packages. Business Class Voice: Unlimited package pricing applies only to direct-dialed calls to locations in the U.S., certain U.S. territories and Canada. No separate long-distance carrier connection available. Digital voice service (including 911/emergency services) may not function after an extended power outage. Certain customer premises equipment may not be compatible with services. EMTA required ($5/month). Business Class Internet: Many factors affect speed. Actual speeds vary and are not guaranteed. Cable modem required. Please call your local Comcast office for restrictions and complete details. Š2010 Comcast. All rights reserved.

November SCMS Message Open2

2010 Board of Trustees Gary Knox, MD President Brad Pope, MD President-Elect Terri Oskin, MD Vice President Anne Oakley, MD Secretary-Treasurer J. Courtney Clyde, MD Immediate Past President Louis Koncz, PA-C Position 1 Keith Kadel, MD Position 2 Michael Cunningham, MD Position 3 David McClellan, MD Position 4 Paul Lin, MD Position 5 Michael Metcalf, MD Position 6 Gary Newkirk, MD Position 7 Carla Smith, MD Position 8 Vacant Position 9 David Bare, MD Position 10 Keith Baldwin, MHA Chief Executive Officer

TA B L E O F C O N T E N T S

President’s Message: The challenges of training and retaining physicians in Spokane . . . . . . 1 CME 2010 Program Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Medical Thinking and Reasoning – It's Never Too Early to Start. . . . . . . . . . . . . . . . . . 3 Membership Recognition for October 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Third-Year Family Medicine Clerkship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 “Did you just call me Dr. Mackay?”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Why choose Spokane? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Madeleine Geraghty, MD – SCMS 2009 Citizen/Physician of the Year . . . . . . . . . . . . . . 6 Graduate Medical Education Summit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Take two poems and call me in the morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 James S. Shaw, MD 2010 Sojourns Award Honoree . . . . . . . . . . . . . . . . . . . . . . . . 9 Project Access Enrollment Processes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Physician Opportunitie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Health system reform may help doctors' offices offer coverage. . . . . . . . . . . . . . . . . . 11 Medical students learn from physicians who volunteer . . . . . . . . . . . . . . . . . . . . . . 12 Navigating the soft patch: is it a dip or a blip? . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Safe and Effective Analgesia and Anesthesia Administration in Office-Based Surgical Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Meetings and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Spokane County Medical Society Message Brad Pope, MD, Editor A monthly newsletter published by the Spokane County Medical Society.

The annual subscription rate is $21.74 (this includes the 8.7% tax rate).

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

An interview with Dean Martz, MD – Incoming WSMA President . . . . . . . . . . . . . . . . . 17 Spokane VA Medical Center launches health information exchange . . . . . . . . . . . . . . . 17 New Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Group Heath named to lead two Accountable Care Organization (ACO) pilots . . . . . . . . . 21 Classified Ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Pain Management 2010 Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 "Whosoever desires constant success must change his conduct with the times."

NICCOLO MACHIAVELLI

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.

November SCMS Message Open3

President’s Message: The challenges of training and retaining physicians in Spokane For many of us practicing medicine in Spokane County, our experiences in medical school or PA school are a distant memory.

Oh, I’m sure there are some things about our training that are seared permanently into our cortexes. But, much of what we all went through, especially in the early stages of training when we were drinking from the fire hose of information coming at us, has been overshadowed by more recent or more emotionally energized events.

The articles we have for you this month in the Message once again will focus on medical education. And they especially highlight medical education specific to Spokane. The Medical Society leadership has a strong commitment to supporting the idea of building a four-year medical school in Spokane as a branch campus of the University of Washington School of Medicine. We have a good start, having just recently started our third class of twenty students here. They spend their second year in Seattle, but then can come back here for most or all of their third and fourth years.

There are exciting things going on here when it comes to integrating clinical learning There are exciting things and experience going on here when it comes into the first year to integrating clinical learning of medical school.

Dr. George Novan, and experience into the first Associate Director for WWAMI in year of medical school.

Spokane, helps us understand what that trend in medical education, to expose students to clinical learning earlier in the curriculum, will really mean to the students. Dr. Anne Montgomery helps us understand more of what the real world of teaching third year students is like, and what some of the benefits are. And we have three articles from current or former students in the “Spokane track.” It is those three articles that really bring to life what it will mean to Spokane to develop a complete four-year medical school and expand graduate medical education.

When I was in medical school and evaluating my options for residency, I did not really factor in where I would eventually want to settle down. I took into account the merits of the residency program and how it would meet my needs. But at the time, it did not matter as much where the program was as what it had to offer. Ultimately, I chose Family Medicine Spokane because it had a great reputation for teaching doctors to practice in smaller communities. I had not anticipated staying in Spokane long term,

but that is what happened. Once we lived here, we fell in love with the area. Similarly, when recruiting doctors from outside of the area, sometimes it is hard to get them to come here for a visit.

For some reason Spokane isn’t at the top of some people’s list of great places to live…until they get here. Once we bring them here for a look, they like what they see.

It is the same when we talk about retaining doctors that we train, not just through medical school, but also more importantly, through residency. We are already seeing a good number of third year students coming back to Spokane after spending their first year here in the WWAMI program. But, if they go off to a residency in some other city, we will lose our recruiting advantage with some of them who will settle close to where they did their residency. To achieve our goal of training and retaining more physicians for this area, it is imperative that we expand residency training as well as expand the medical school.

Recently I had the opportunity to address the newest class of WWAMI medical students starting their first year of school here. They exuded that youthful, wide-eyed exuberance and excitement that most of us have long forgotten. I was surprised to find out that I knew two of them from my kids’ soccer years. And there were a few others from small Eastern Washington towns.

There were a number from the West side of the state, and the ones I questioned seemed genuinely happy to be here. One of them had never even been to Spokane before. Their enthusiasm was contagious. You will get a feel for that enthusiasm in this month’s articles.

I hope that many of us will renew our enthusiasm and contribute to the education of the next generation of doctors, and thereby contribute to the solidifying of the future of medical care in the Spokane region.

Gary Knox SCMS President

WWAMI 1st Year Student Orientation with Keith Baldwin and Gary Knox, MD

SCMS is interested in assisting our members to participate more actively in key community leadership roles. If you become aware of an open board, a or advisory committee position please notify Michelle Caird at (509) 325-5010 or my email at michelle@spms.org.

October SCMS Message 1

October SCMS Message 2

SPOKANE COUNTY MEDICAL SOCIETY CONTINUING MEDICAL EDUCATION 2010 Program Schedule Deaconess Health and Education Center 5:30 – 9:15 pm (Three one-hour topics will be presented) OCTOBER Pain Management Update 2010 Wednesday, October 20

DECEMBER Mental Health Update 2010 Thursday, December 9

For more information contact Jennifer Anderson, CME Coordinator at (509) 325-5010 or jennifer@spcms.org.

Currently the U.S. medical school system teaches basic sciences in the first two years followed by clinical work in the last two years of training.

During those last two years of school, after our students have been fire-hosed full of basic science knowledge, we begin to teach clinical reasoning skills. But is this the correct approach? Some Dark Age medical educators think so but others are beginning to see the light. (You can get a hint on which side of this debate I stand.)

Think back to your early years in medical school - the traditional model. Did you feel like a "doctor in training" or did you feel like a sponge soaking up gallons of facts, wondering how all this was going to be relevant? Any clinical experience whatsoever was a welcome relief. It was a link to what would be some day.

Realizing this, for the past two years of WWAMI Spokane, we have offered clinical correlation conferences, grand rounds and case discussions geared to our medical students. The response has been overwhelming. While completely voluntary, we have had virtually 100% attendance by our students at the conferences.

Since UW medical students must take elective courses in their first two years, we thought why not group these sessions into an elective course on clinical reasoning skills? We submitted the proposal and the UW School Medicine Curriculum Committee granted our request.

Why teach clinical reasoning so early in training?

Medical Thinking and Reasoning – It's Never Too Early to Start

UÊ It links basic science to clinical medicine.

UÊ It’s fun.

UÊ It motivates.

Medical students are not blank slates. They come into medicine with a variety of experiences – occupational, personal and familial. They are bright. They can think outside the box. The requirements for a course in clinical reasoning taught early in medical school are actually quite simple. All a first-year student needs is: UÊ A flexible mind UÊ The power to observe UÊ The ability to ask questions UÊ A willingness to learn from colleagues Medical students are competitive. They are puzzle-solvers.

Since they want to succeed, working to solve a dilemma and explaining reasoning openly can be intimidating to beginners.

But when students work in teams (as will be the case for our course), there is little that prevents them from quickly coming up with insightful questions. We will present clinical cases in chunks and as unknowns. After a block of information there will be a pause. Students will work together to decide what highyield questions they now want to ask of the person presenting the case – and why they chose those particular questions. Via this question and answer approach, students will work their way to possible explanations for the clinical cases posed to them. It isn’t important that they know the exact name and etiology of the disease. Coming close counts at this stage. Later in their training, they will need to provide more exact responses.

Becoming a seasoned clinician requires medical knowledge and experience. First year medical students do not have these yet, but, they do have common sense and they do have the capability to reflect on their own thinking. These two skills plus what they will soon find to be a rapidly expanding knowledge base will guide them through exercises that traditionally are the types of teaching sessions used with upper level medical students. The aim of the elective is to give first-year students a head start on their clinical years.

Med S 600-3, Medical Thinking and Reasoning, has been born in Spokane and is underway. We still have 100% attendance – and now the students get credit for having fun.

George Novan, MD Associate Director, WWAMI Medical Education Program WSU Spokane University of Washington School of Medicine

Membership Recognition for October 2010 Thank you to the members listed below. Their contribution of time and talent has helped make the Spokane County Medical Society the strong organization it is today.

60 Years Arch Logan, Jr., MD

10/12/1950

40 Years Larry K. Hatch, MD Peter J. Horn, MD

10/27/1970 10/27/1970

30 Years Jack J. Leonard, MD

10/28/1980

October SCMS Message 3

IT TAKES MORE THAN EXTENSIVE EDUCATION, FELLOWSHIP TRAINING AND YEARS OF EXPERIENCE TO MAKE A GREAT SURGEON. But we think it’s a pretty good place to start.

When your patient needs surgery, you want to refer them to a physician who inspires confidence and trust.

At Surgical Specialists of Spokane, you’ll find our region’s best trained, most talented and experienced surgeons — physicians whose knowledge, informed judgment, compassion and dedication work to produce the best possible outcomes for their patients — every day.

Surgical Specialties » Surgery of the endocrine system » Trauma / acute care surgery » Surgery of the breast » Surgical oncology » Colorectal / anal rectal surgery » Inflammatory bowel disease – ulcerative colitis & Crohn’s disease » General surgeries (including but not limited to) s s s s s s

Acute appendicitis Gallbladder Hernia Spleen Liver Stomach

To refer a patient or consult with one of our surgeons call:

509.747.6194 Or visit us on the web at

www.surgicalspecialistsofspokane.com

October SCMS Message 4

Third-Year Family Medicine Clerkship I decided to become a family physician during my required medical school family medicine clerkship. I’d entered medical school thinking about internal medicine, but had enjoyed most of my clinical rotations and loved OB. Then I got to spend some time with a young woman family physician who had a small child and discovered that not only was family medicine fun in the real world, it was actually possible to do it and have the kind of family life I wanted to have.

Now I am the clerkship director for the required third year family medicine clerkship for University of Washington students who choose to do their clerkship at the residency site in Spokane.

I recognize the importance of this clerkship for the students. For those that are thinking about primary care, it may be a formative experience like mine was. For those who will enter another specialty it is an opportunity to help them understand what family doctors do and how they will interact with primary care doctors in the future.

I enjoyed working with students when I was a resident and knew I wanted to continue to teach after residency. I entered small town practice and arranged to be a clerkship site for my medical school. I welcomed students into my practice the same way my preceptor had welcomed me. They came and spent time in my small town, usually staying in my home, and learned what family medicine was about. I continued to learn from them as well as they brought me news of the latest and greatest ideas from their school.

“Did you just call me Dr. Mackay?”

Well, I’m actually just a medical student. But I’ll admit it does feel pretty good to be a 3rd year. Yes, I now have a broken-in white coat complete with stains; I may even look like I know what I’m doing while wandering the wards; and the occasional patient actually mistakes me for a physician. And even if the stains on my white coat are only from the hospital cafeteria, it feels great to be out of the classroom and learning “on the job”. So what has changed since I completed my first year of medical school in Spokane? Well, let’s talk in terms of numbers, perspective and poetry.

First of all, the numbers… I was lucky enough to be part of the inaugural class of 1st year medical education in Spokane.

Just two short years ago we hit the Riverpoint campus running, 20 wide-eyed students who had no idea what we were doing in Spokane or how to successfully survive medical school. What we found out was that med school is super hard, but navigating the choppy waters in a supportive community of educators and clinicians makes medical school much more enjoyable. Seven of us have returned to Spokane for the “Spokane Track” in which we’ll complete the bulk of our 3rd-4th year clinical clerkships in Spokane. Additionally, 6 other students have joined our ranks,

After I moved into a faculty position, I eagerly took on the role of clerkship director. I find working with the 3rd year students to be most rewarding. They have good history and physical skills.

They have a basic fund of medical knowledge. Most of them ask very good questions. They are at a fundamental formative stage of their career when everything is new and everything is important and they want to see and do everything they can. And they LOVE talking to patients. (By letting them talk to my more talkative patients while I see another patient or two, it actually can save time to have a student with me!)

In addition to teaching them the medical content of the clerkship, 3rd year students are eager to learn about medicine as a career. They want to know why we chose the specialty we chose, what we like about it, what we would like to improve and why.

Most of them are still quite idealistic and hope to change at least their part of the world. Helping to steer them to opportunities to make a difference can also be very rewarding.

There are many opportunities for third year clerkship sites in several specialties in Spokane. It does take some effort to set up a clerkship site and to teach each student, but the rewards of working with these future physicians easily outweigh the challenges.

Anne Montgomery, MD, FAAFP, FABM Faculty Physician, Family Medicine Spokane Clinical Professor, University of Washington Department of Family Medicine

making 13 track students total. The most they’ve had in past years is 7, so it seems like the plan to lure us in by placing us in Spokane for our first year of medical education has been quite successful (we couldn’t help but come back!). And what about the 13 students who spent their first year in Spokane but didn’t choose to come back for all of 3rd year? Well, they’re obviously not as savvy as the seven of us who chose to be here full time, but most of them have chosen to do at least one of their required 3rd year rotations in Spokane. In particular, Dr. George Novan has a quasi cult following…all the students want another chance to take in that accent, some quick-witted humor and his superlative teaching skills.

And how has our perspective changed? I think it’s safe to speak for my classmates in saying that we have a greater appreciation for what Spokane has to offer in terms of medical education. Our clerkships boast significant one-on-one time with attendings; coordinators that are willing to schedule our subspecialty exposure by individual preferences; responsive administration and physician leaders; and a tight knit medical community where we have the opportunity to connect with local providers and support staff. It may seem trivial, but one of my classmates just pointed out how nice it is that we only have to learn one EMR system (not the case for the Seattle students rotating through the greater Seattle area). This is just one example of how the medical community in Spokane works together and what makes for a Continued on page 9

October SCMS Message 5

Why choose Spokane?

My decision to become a Spokane track student for my 3rd and 4th years of medical school was one based on traffic.

Time outside of the classroom in medical school is limited and precious, and my wife and I felt we were spending too much of this time in Seattle in the car scuttling here and there at a snail's pace. Having two young children and a tight budget we were looking for ways that we might be able to make getting by just a little bit easier. Becoming a track student in Spokane seemed to fit that bill.

It turns out the there were significant benefits outside of my commute to the hospital being less than 10 minutes. The medical community in Spokane as a whole was welcoming and seemed genuinely excited to have the opportunity to have students. Each of my rotations here provided me with unique and varied learning opportunities. The pathology that one has the opportunity to observe and learn from here has never failed to amaze me. More frequently than I had ever anticipated, I was getting first hand exposure to things that I had read about but which I had written off as something that I would never actually see. The teaching was excellent. Attendings were always willing to take the time to explain things to me and I had many opportunities to spend time learning first hand from the many patients I had the privilege Additionally, Spokane has to meet.

Yes, there were few been a wonderful place for opportunities to get my family. The community grilled by a senior resident or to change offers many things to do just one more wet-to-dry outside of the hospital walls dressing at five thirty in the morning, and I and the affordability adds was always forced to just a bit of ease to the high stand belly up to the table in the OR rather stress lifestyle of medical than watching from the training. corner on my tip toes, but I managed to survive without these more standard training experiences. Additionally, Spokane has been a wonderful place for my family. The community offers many things to do outside of the hospital walls and the affordability adds just a bit of ease to the high stress lifestyle of medical training. My children have had excellent experiences at school and have been able to participate in many extracurricular activities. My wife has been able to make many close friends and has been successfully lured into the local triathlon scene.

I am now just over 2 months out of residency and once again participating in "real life." I have remained here in Spokane because of the opportunities that are available and because of the many relationships within the medical community that I have established and which I continue to make. Had I not had the opportunity to experience Spokane as a track student I am pretty sure I would not be part of this medical community today. I would probably be cursing the car in front of me still, trying to get my kid to swimming lessons.

Now, if I could figure out a way to deal with all of this traffic on Division.

Madeleine Geraghty, MD – SCMS 2009 Citizen/ Physician of the Year Dr. Madeleine Geraghty is board certified in Neurology and Vascular Neurology. She received her medical degree from the University of California, San Francisco in 1999 and did her residency at the University of Wisconsin. In 2005 she completed her Fellowship in Clinical Stroke also at the University of Wisconsin. In 2005 Dr. Geraghty came to Spokane and started with the Rockwood Clinic.

Dr. Geraghty has served as the medical director of the Providence Sacred Heart’s Primary Stroke Center since 2007, is now operating her private practice solely at Sacred Heart. At her Providence Stroke and TIA Clinic in the Sacred Heart Doctors Building, Dr. Geraghty heads up a TIA Clinic that focuses on seeing ER patients who have been discharged after having experienced a transient ischemic attack.

To quote the physician who nominated her for the Citizen/ Physician of the Year Award “Her dedication to cutting edge protocols and advancement of the care of our community stroke patients is unbelievable.”

The Medical Society is proud to award this honor to Dr. Madeleine Geraghty.

Madeleine Geraghty, MD and Stroke Center Staff

Eric Tubbs, MD Group Health Permanente October SCMS Message 6

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October SCMS Message 7

GRADUATE MEDICAL EDUCATION SUMMIT

Take two poems and call me in the morning

Paul Ramsey, MD CEO, UW Medicine Dean, UW School of Medicine Invites medical and community leaders to discuss key issues in expanding GME in the region.

October 15, 2010 – Friday 8:00 a.m. – 4:30 p.m.

Spokane Riverpoint Campus

For information email wwamigme@uw.edu or call (509) 358-7640

This fall the Spokane medical school students may take a humanities and medicine elective named Take Two Poems and Call Me in the Morning.

Recent literature suggests that as medical students and residents progress through training, they become more cynical and are at risk of losing their ability to identify with the suffering of their patients. A hundred years of focusing on science as well as demands by insurance and hospitals have separated the patient from the physician.

This program is an effort to help the medical students recognize those issues and encourage them to develop good communication skills and empathy. We will teach those skills by didactic teaching and role modeling including good listening, repeating back the history and hearing what the patient left out.

Often we will refer to literature written by doctors and patients.

Reflective writing and sharing the writing helps students deal with pressures and frustrations and increases trust in the other students.

The facilitators for the class are Lisa Conger, MS Psychology who teaches reflective writing and William Greene, Pediatrician.

William Greene, MD Group Health Permanente

October SCMS Message 8

Project Access Enrollment Processes Each month, Project Access receives over 100 enrollment applications, most of which are referrals from Spokane’s lowincome Community Clinics. CHAS, the largest Federally Qualified Health Center in the County, accounts for over half of all referrals.

Other major referrers include Spokane Falls Family Clinic, the Christ Clinic, the Native Health Clinic and the House of Charity. Patients who self-refer to Project Access, and have no primary care provider, are directed to one of Spokane’s 12 low-income community clinics to establish care with a primary care medical home.

To qualify for medical services donated by Project Access providers, a patient must be a Spokane County resident for a minimum of 90 days, and have current household income less than 200% of the Federal Poverty Level ($21,000 for an individual and $44,000 for a family of 4). Additionally, all applicants are carefully screened to ensure they do not qualify for public healthcare programs such as Medicaid.

Once a patient has met the above criteria, each application is then reviewed by our Referral Coordinator. Our goal is to get the correct level of care for the patient that is most appropriate for his or her condition. The referral coordinator applies the program’s policies and referral guidelines. For example, Project Access does not offer diagnostic lab and imaging services, OB care, psychiatry, weight loss or substance abuse treatment. Referrals such as those are re-directed to other resources in the community. We then consider physician availability by the specialty requested. Project Access maintains a “physician availability list” and strives to have an initial specialty appointment within 10 weeks of referral. The Referral Coordinator ensures that we have a volunteer provider able to accept and treat the patient in a timely fashion. We will close a specialty to new referrals if we cannot get a patient seen in a reasonable timeframe.

For our high demand specialties such as orthopedics (and several others), Project Access has developed additional case review processes. There are over a dozen physicians who review specialty specific referrals and make treatment suggestions for the primary care referrer to consider. An orthopedic physician may recommend physical therapy prior to considering surgery, which is then communicated to the referring provider.

We our expanding our “case consultation” services to help primary care providers with advice on how to continue care at the primary care level. Along with that, the Therapeutics Committee is developing diagnosis specific work-up and referral guidelines.

We now have several in place and are developing more. Examples include referral guidelines for Uterine Bleeding, Carpel Tunnel Syndrome and Sinusitis. We also offer the primary care clinics inservices by our specialists.

As you can tell, each referral in rigorously evaluated to make sure the patient does not have other means to obtain medical services, and that we have a good working diagnosis and primary care work-up. We re-direct about 50% of all referrals. Those that are enrolled are truly needy, and have no other options to receive the medical care they need. You can be assured that when Project Access schedules a patient in your office that you are seeing a patient truly in need of your services.

John Driscoll Project Access Executive Director

Continued from page 5 supportive training environment, allowing us to focus on patients and our education. As we progress in our medical training, we’re starting to appreciate these advantages, and learning to say thank you to all of you who have made medical training in Spokane a reality.

And finally, the poetry! There’s a great poem by British writer Jenny Joseph called “Warning” (known more for its award as most popular post-war poem) which bears applicability to medical training. The poem speaks of the importance of living in the moment. The author comments that when she’s old she’ll finally indulge—in good food, leisure time and frivolity. She wishes for the day when she can be a crazy old woman, ravished by fleeting desires (whether it’s dressing in purple, walking in her slippers in the rain or eating only sausage). But she ends by saying…

But maybe I ought to practice a little now?

So people who know me are not too shocked and surprised When suddenly I am old, and start to wear purple.

This time I won’t speak for my classmates, but I’ll admit that in returning to Spokane for my 3rd year of medical school, I’ve started wearing purple. I’m sure this poem has a deeper meaning not available to my naïve level of understanding (I’m still just an eager 3rd year), but the opportunity to interact with patients every day was enough to remind me that it’s ok to have little fun while learning to become your future self. It’s a bit harder to remember while buried in the books during 1st & 2nd year, but it’s never too early to start acting like the person you’d like to become (cliché, but true).

The more I think about it, maybe it’s not what’s different that’s so important, but what we’ve known all along. The truth is that we’re thrilled to be involved in medicine, whether as a 1st year medical student, a 3rd year clinical student or a practiced attending. And we’re very lucky to be learning and practicing in Spokane; the facilities, the people, the sense of community and the spirit of improvement all attracted me back for my clinical training – these same attributes will continue to serve medical students for years to come!

Katherine Mackay 3rd Year medical student

James S. Shaw, MD 2010 Sojourns Award Honoree The Sojourns Award recognizes leaders working in Idaho, Oregon, Utah and Washington to advance the availability, quality or understanding of palliative care locally and nationally.

The Regence Foundation created the Sojourns Award to honor exemplary leaders in the field of palliative care, to promote their innovations and to invest in their future work.

On September 9, James S. Shaw, MD was awarded the 2010 Sojourns Award. Dr. Shaw is the Director of Ethics and Medical Director of the Providence Center for Faith and Healing. He founded the palliative care program at Providence Sacred Heart Medical Center in 2007, and has worked to improve the quality of hospice care in the community. His influence spreads far beyond Spokane, however, as he is the driving force behind the creation of an integrated palliative care service across a network of Catholic hospitals and medical facilities from Alaska to California.

October SCMS Message 9

ROCKWOOD IS PLEASED TO WELCOME

DR. SHAUN PETERSON! Shaun Peterson, M.D, orthopedics, joined the Rockwood Bone and Joint Center in August 2010. He received his undergraduate degree from Brigham Young University in Provo, UT, and his medical degree from the University of Texas in Galveston. Dr. Peterson is board certified by the American Board of Orthopedic Surgery, and belongs to the American Academy of Orthopaedic Surgeons, California Orthopaedic Association and the Society of Military Orthopaedic Surgeons.

To refer a patient or schedule a consultative visit, please call (509) 755-5560.

Rockwood Valley Specialty Center 1415 N. Houk Road, Suite D Spokane Valley, WA 99216

www.rockwoodclinic.com

ROCKWOOD IS PLEASED TO WELCOME

DR. ROBERT PFEFFER! Robert Pfeffer, M.D, radiation oncology, joined the Rockwood Radiation Therapy and PET/CT Services Center in September 2010. He received his undergraduate degree from Carroll College in Helena, MT, and his medical degree from the University of Washington School of Medicine in Seattle, WA. Dr. Pfeffer is board certified in radiation oncology, and belongs to the American American Society for Therapeutic Radiology and Oncology, the American Brachytherapy Society the Montana Medical Association, the CyberKnife Society and American Mensa. He was previously with St. Peter’s Hospital in Helena, MT.

To refer a patient or schedule a consultative visit, please call (509) 755-5783.

Rockwood Radiation Therapy & PET/CT Services 12410 E. Sinto Avenue, Suite B Spokane Valley, WA 99216

www.rockwoodclinic.com

October SCMS Message 10

Physician Opportunities PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Family Physicians (no OB) to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs. Contact: April Mayer, April.Mayer@providence. org , (509) 474-6609, www.providence.org/physicianopportunities.

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatricians to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs.

Contact: Pat Isakson, Pat.Isakson@providence.org, (509) 474-6604, www.providence.org/physicianopportunities.

SWEDISH seeks a PRIMARY CARE PHYSICIAN for new Cle Elum Clinic. The ideal candiadate will be a Primary Care Provider, BC/BE in Family Prractice or Internal Medicien. The physicin will lead an innovative care team model in a brand new clinic facility serving communities of Cle Elum, Roslyn, Ronald and Ellensburg.

Autonomy over practice/Generous compensation/Excellent Benefits and retirement/Innovative care models. For more information email your CV to Aaron Bryant, Physician Recruiter for Swedish Physician Division, at aaron.bryant@swedish.org or call 206-320-5925.

Health system reform may help doctors' offices offer coverage Two recently published papers suggest that newly implemented health insurance tax credits and soon-to-be-created exchanges will make it more likely that small businesses -- such as physicians' offices -- will be able to offer employees health insurance and make it less onerous to keep doing so.

These conclusions, reached in separate reports by the Commonwealth Fund and the RAND Corp., run counter to health care reform opponents' contentions that the Patient Protection and Affordable Care Act would hurt small businesses. In its blog, the White House touted the results of both studies.

About 16.6 million people work for small businesses that are eligible for health insurance tax credits, according to "Realizing Health Reform's Potential: Small Businesses and the Affordable Care Act of 2010," released Sept. 2 by the Commonwealth Fund.

Of this number, 3.4 million work in businesses that are projected to take advantage of the health insurance tax credit by 2013.

Experts say the companies most likely to use the tax credits are those that already offer health insurance. However, this also may be enough of an incentive for other companies to start doing so.

"This is tax relief for small businesses that offer health insurance. It is economic stimulus that will help small businesses get through these rough economic times," said Commonwealth Fund President Karen Davis, PhD, during a Sept. 1 conference call releasing a report on the issue.

Continued on page 14

OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care. We need one or two more doctors to help us. We see the homeless, predominantly, two afternoons each week. Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy. If you are completely retired, the state will pay for your medical license and malpractice. For more information and to sign up, call Dr. Arch Logan, Medical Director, at (509) 325-0255 or Ed McCarron, Director of the House of Charity, at 624-7821.

PHYSICIAN OPPORTUNITIES AT CHAS – At Community Health Association of Spokane (CHAS), we believe doctors should practice what they are passionate about: serving patients and the community. We are looking for physicians to join our great team!

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 April Gleason at 509-710-8046 or agleason@chas.org.

October SCMS Message 11

Medical students learn from physicians who volunteer “Would you like to try?” The physician encourages me to repeat part of a knee exam that has just been demonstrated by a senior medical student. The patient has come to the House of Charity Clinic with increasing pain from an old leg injury, and he kindly allows me to note the absence of the anterior drawer sign.

As a beginning first-year student, I bring an empty space that will someday store clinical knowledge, but currently contains only enthusiasm and a tiny handful of anatomy terms. I am grateful that the doctor has volunteered her morning to serve the community in two ways: supporting patients who have no access to regular care and helping train future physicians.

The Saturday Clinic at House of Charity is run by UW Spokane medical students with support from faculty and staff. Physician preceptors make the clinic possible by ensuring that patients receive good The patient’s story care while providing students with reconnects me with a remarkable learning opportunity. the reasons I chose Many of the patient encounters are straightforward for experienced to go into medicine physicians but they are challenging and and further motivates motivating for new students. When me to do everything I sitting in class, the anterior cruciate can to prepare for the ligament is one of hundreds of structures I get to learn, and concepts like pertinent responsibility. negatives seem deceptively simple. It is very different standing in the clinic with a real patient who is in pain. I find it hard to imagine how I will get to where the senior student is now: interviewing patients, choosing relevant exam techniques and completing them efficiently. I am still trying to figure out where I left my pen.

The physician steps in to continue examination of the patient’s knee while gathering more information about his history. He shares details about a past accident, the surgeries that allowed him to walk again, and the years he has worked to maintain mobility. The patient’s story reconnects me with the reasons I chose to go into medicine and further motivates me to do everything I can to prepare for the responsibility. I will have to find ways to learn faster. How can four years possibly be enough?

When the physician moves on to discussing treatment options, she explains her thinking out loud for my benefit. I get a glimpse into future courses: biochemistry, physiology, pharmacology.

After the patient leaves, the preceptor compliments the senior student on her teaching skills and asks how rotations are going.

They share their appreciation for the many ways that the Spokane community supports medical education. I work on writing up SOAP notes and am impressed with how graciously the physician helps me realize where I have left out important details.

Each preceptor brings a different style, and all have a gift for sharing clinical knowledge while caring for patients. They teach us in many ways, beyond the specific details of the cases we see. We are grateful that Spokane physicians are extending their support and high expectations for us as new members of the medical community. Now I am asking, “Would you like to try?” Your three hours can make a huge difference as we take our first steps from wanting to help to becoming physicians who can.

Navigating the soft patch: is it a dip or a blip?

Recently released economic data confirm that the economy has hit a soft patch. “It’s not surprising to see growth ease following an initial surge in activity as the economy emerges from recession,” notes Mike Ryan, Head of Wealth Management Research– Americas (WMR). “However, the current slowdown is especially troubling since it’s recurring faster than is typically the case, becoming more pronounced in recent weeks, plus the rebound in activity was far shallower than normal.”

In WMR’s Investment Strategy Guide report, “Navigating the soft patch” (August 25, 2010), economists point to several recent measures of regional activity that signal a weakening in manufacturing, while the housing data reflect another potential downdraft in residential real estate as the support from the homebuyer tax credits and the Fed’s mortgage repurchase program begin to wane. Most troubling, however, in WMR’s view, has been the continued sluggish pace of job creation.

Still, although the probability of a “double dip” recession has risen, WMR feels the moderate economic recovery process— albeit sluggish and shallow—will continue. It finds the lowering of bank lending standards to be a bright spot (see chart).

WMR’s analysts reason, “Since small businesses account for a Most troubling, disproportionately large share however, in WMR’s view, of new hires during an economic has been the continued recovery, the easing of lending sluggish pace of job standards can help support more vigorous job growth. This, in creation. turn, should translate into better overall demand growth and a more sustainable economic expansion.”

Another positive sign is the Fed’s recent decision to continue with its exceptionally accommodative policy mix (which includes near zero rates and an explosion in the Fed’s balance sheet) that has thus far helped to drive the economic recovery to a great extent. This decision also suggests that it may even expand these policies if conditions were to deteriorate further which, in WMR’s view, may lessen the impact from the current “soft patch.”

Still searching for a catalyst While they help to ease the threat of a double dip recession, neither looser lending standards nor an extension of the Fed’s current accommodative policy stance represents the sort of catalyst required to shake risk assets (those where the return is uncertain) from their current state of malaise. To find some directional cues for investors, WMR considered the potential impact of a few possible drivers: Corporate profits indicate limited prospects for an earnings inspired stock rally. While second-quarter earnings came in well above consensus expectations, WMR notes that many industry analysts have begun to cut their 2011 earnings estimates amid more sluggish growth prospects. This will likely serve to limit gains within equity markets over the balance of the year, in WMR’s view.

Jennifer Beers 1st year Medical Student October SCMS Message 12

Continued on Page 20

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“I thank everybody at Northwest MedStar, the acute hospital and St. Luke’s. It is a team approach.

Everyone has an integral link.

They are just totally professional, dedicated to helping others, and they do a phenomenal job at it.�

Rob Mildes, Northwest MedStar and St. Luke’s Rehabilitation Institute patient

Northwest MedStar

Inland Northwest Health Services (INHS) is a non-profit corporation in Spokane, Washington providing collaboration in health care services on behalf of its member hospitals Deaconess Medical Center, Providence Holy Family Hospital, Providence Sacred Heart Medical Center & Children’s Hospital, Valley Hospital & Medical Center and the community.

October SCMS Message 13

Continued from page 11 91% of physician practices offered employees health insurance in 2010.

Companies that employ fewer than 25 full-time-equivalents with average salaries of less than $50,000 -- and that pay at least half of individual coverage costs -- can take a tax credit of up to 35% of their share of the premiums paid since the beginning of the year. The credit increases to 50% in 2014. A physician-owner's salary is not worked into these calculations, but the wages of physician employees are.

Helping small businesses offer health insurance is considered particularly important, because these companies are less likely to offer employees health insurance. Higher administrative expenses make per-employee health insurance more costly than plans at larger companies.

Numbers from small-business organizations that oppose the health system reform law question whether many companies will benefit. The National Federation of Independent Business asserted in a July 20 release that a minority of businesses will be eligible for the tax credits and that the reporting requirements are so onerous many will choose not to participate.

The NFIB, a small-business trade group, has joined a federal lawsuit by 20 state attorneys general seeking to overturn the health system reform law.

Another study by RAND Corp. researchers in The New England

Journal of Medicine on Sept. 1 used a simulation model to determine the impact of the insurance exchanges that will be available for small firms within the next year to access health insurance for employees.

Researchers predict that the number of workers offered coverage will increase from 115.1 million, or 84.6% of all workers, to 128.7 million, or 94.6%. The authors suggest that this will be driven by more small businesses being able to offer coverage.

In addition, workers will demand coverage in response to individual penalties for being uninsured. Three out of four workers offered health insurance by a company with fewer than 50 employees most likely will obtain coverage through an insurance exchange.

According to the Kaiser Family Foundation, 98% of companies with more than 200 workers offered health insurance in 2009, but this was true for only 46% of businesses with three to nine employees. In 2000, 99% of large companies offered health insurance, but only 57% of small ones did. These numbers are not broken down by type of business.

A 2010 Salary Survey by the Professional Assn. of Health Care Office Management found that 91% of physician practices provided employees with health insurance. Practices participating in the survey had an average of 23.2 employees, not including physicians.

Victoria Stagg Elliott amednews staff

In Memoriam

Michael A. Negretti, MD Born on December 18, 1919, Dr. Michael Negretti passed away on August 10, 2010, seven months after his wife of 59 years, Shirley Claire Negretti had passed away.

Dr. Negretti graduated from San Diego State University and Hahnemann Medical School in Philadelphia.

He did his residency at Deaconess Hospital. He served in the Air Force as a Captain during the Korean War. As a member of the Spokane County Medical Society, Dr. Negretti was very involved with the Senior Physicians

Golf Tournament. His dedication to the medical community is greatly appreciated.

He is survived by his daughter, Nancy Nordstrom and her son Vic and a son, Nicholas Michael Negretti and his wife Rita Louise and their children, Nicholas Michael Negretti and Christina Louise Negretti. He will be missed by his family and many friends.

October SCMS Message 14

Safe and Effective Analgesia and Anesthesia Administration in OfficeBased Surgical Settings Almost 10 years ago the Washington State Medical Association (WSMA) House of Delegates approved Guidelines for Office Based Surgery and Anesthesia. Many of those guidelines are now law for physicians who use their offices for procedures requiring more than minimal sedation. Our state joins 26 other states with similar oversight of office-based surgery.

The new rule, adopted by our state’s Medical Quality Assurance Commission (MQAC), is titled “Safe and Effective Analgesia and Anesthesia Administration in Office-Based Surgical Settings” (WAC 246-919-601). It is the result of a trip down a winding and sometimes bumpy road beginning in 2000 with the initial publication of “Guidelines for Office Based Anesthesia” by the Washington State Society of Anesthesiologists (WSSA).

How those guidelines became law is instructive for anyone considering a career in government. The WSSA guidelines became the WSMA guidelines. Since the WSMA lacked the resources to implement the guidelines, MQAC was encouraged to engage the effort, and in the summer of 2003 held its first public hearings on Office Based Surgery (OBS). The state’s anesthesiologists supported MQAC approval of the WSMA guidelines, but the WSMA had second thoughts on its own rendition and actually opposed MQAC adoption.

Unfazed, MQAC, led by its chair, Spokane physician Dr. Hampton Irwin, continued to hold public hearings throughout the state. When MQAC’s legal standing “to adopt rules governing the administration of sedation and anesthesia in the offices of physicians” was challenged, the state legislature responded quickly with appropriate authorizing language (RCW 18.71.017(2)).

In 2005, MQAC issued comprehensive guidelines for OBS. At about this time, the Tacoma News Tribune ran a story on “Risks and dangers of surgery and anesthesia in offices in Washington State.” It was inevitable that the guidelines would be transformed into law with MQAC taking the lead.

However, the process was accelerated when national publicity of out-of-state office-based surgical and anesthetic catastrophes caught the attention of our state legislators, who adopted legislation in 2009 (RCW 70.41 and 70.230) which stated in part, “Facilities where physicians do procedures involving general anesthesia are to be regulated by the same rules related to licensed hospitals, hospital-associated surgical centers, and ambulatory surgical facilities.” This was an important step for several reasons.

First, this marked the first time that OBS/OBA was regulated by state law, but importantly only for offices utilizing general anesthesia. Second, the state legislature had essentially left to the MQAC the responsibility for promulgating rules for medical offices utilizing all other forms of anesthesia (i.e., moderate sedation, deep sedation, major conduction anesthesia such as spinal, epidural, plexus blocks and intravenous regional anesthesia.

Now after an additional 3 years of public hearings, full support from the WSMA, written comments, compromises and input from nearly every state medical specialty society, the MQAC has approved rules for the use of anesthesia in physician offices.

Note that these rules apply to offices that utilize any form of anesthesia except for: “minimal sedation”, defined as a drug-induced state during which patients respond normally to verbal commands and which is limited to oral or intramuscular medications, or both and; infiltration of local anesthetics around peripheral nerves in an amount that does not exceed the manufacturer’s published recommendations.

The basics of the new law are as follows: The physician must: 1. be competent and qualified to perform the operative procedure and to oversee the administration of the intravenous sedation and analgesia.

2. ensure that at least one licensed health care practitioner currently certified in advanced resuscitative techniques appropriate for the patient age group (e.g., ACLS, PALS or APLS) is present or immediately available.

3. be able to “rescue” a patient who enters a deeper level of sedation than intended.

4. not administer the intravenous sedation or monitor the patient. The licensed healthcare practitioner who does administer intravenous medications and monitors a patient under moderate sedation may assist the operating physician with minor, interruptible tasks of short duration, but cannot assist with the procedure with patients under deep sedation.

5. ensure that in the event of a complication or emergency, there exists a formal transfer plan to a hospital.

6. maintain a legible, complete, comprehensive and accurate medical record for each patient.

7. obtain by September 2011 accreditation or certification from either the Joint Commission; the Accreditation Association for Ambulatory Health Care; the American Association for Accreditation of Ambulatory Surgery Facilities; or the Centers for Medicare and Medicaid Services. Reporting of untoward results from surgery or anesthesia shall be made to the appropriate accrediting organization.

Physicians are advised to contact the WSMA, their specialty society or MQAC for additional details and advice on meeting the new requirements.

Eric S. Johnson, MD Past President, Washington State Society of Anesthesiologists Chair, WSSA ad hoc Committee on Office Based Anesthesia https://fortress. wa.gov/doh/ policyreview/Docume nts/0924109safeanalg esiaadminstrationoffic ebase102final.pdf

October SCMS Message 15

Meetings and Events CATEGORY I CME SEMINARS

OTHER MEETINGS AND CONFERENCES

UÊ Pain Management Update 2010: 3.0 Hours of Category I CME

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.

credit, sponsored by the Spokane County Medical Society.

Conference held on October 20, 2010 at the Deaconess Health and Education Center. Contact Jennifer Anderson at (509) 3255010 or email jennifer@spcms.org for more information.

UÊ 2010 Diabetes Professional Symposium: 6.0 Hours of Category I CME credit. Jointly sponsored by the Spokane County Medical Society. Conference held on November 12, 2010 at the Davenport Hotel. Contact Emily Fleury at (509) 2328139 or email FleuryE@cherspokane.org for more information.

UÊ Columbia Basin Medical Conference: 14 Hours of Category I CME credit. Conference held on Nov 12 and 13, 2010 at Big Bend Community College's ATEC center in Moses Lake. For more information see the programs full brochure at www. russocme.com or by phone (509) 431-0718 or email russocme@ gmail.com UÊ Hospice Enrollment Criteria and End-of-Life Pain Management Update: Hours of Category I CME credit held on Wednesday, October 13, 2010 at Providence Auditorium, Providence Sacred Heart Medical Center Campus, Noon – 1:00 pm. Dr. Bob Bray, Medical Director, Hospice of Spokane will be presenting. Lunch is provided. There is no cost to attend.

Rural providers can attend via videoconference (same day, same time) at Providence Mt. Carmel Hospital, Providence St. Joseph’s Hospital, Ferry County Memorial Hospital and Newport Community Hospital. RSVP to Andrea Flanigan at (509) 456-0438 or aflanigan@hospiceofspokane.org.

UÊ Medical Response to Infectious Disease Outbreaks and

Caduceus Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p.m. – 7:15 p.m., at 626 N. Mullan Rd, Spokane. Contact (509) 928-4102 for more information. Non-smoking meeting for Healthcare Providers in recovery.

Physician Family Fitness Meeting – Physician Family Fitness is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life. The meetings are on Tuesdays from 6:30 p.m. – 8 p.m. at the Sacred Heart Providence Center for Faith and Healing Building, due east of the traffic circle near the main entrance of SHMC. Enter, turn right, go down the stairs, Room 14 is on your right. Format: 12-Step principles, confidential and anonymous personal sharing; No dues or fees. Guided by Drs. Bob and Carol Sexton. The contact phone number is (509) 624-7320.

Free CME Course for Rural Physicians on Opioids – Project ROAM: On October 30, 2010 Washington State University and the University of Washington – supported by a grant from the Life Sciences Discovery Fund - will present a free CME course in Seattle that will teach rural physicians and a member of their practice staff how to use Suboxone for addiction. This course will allow physicians to receive legal permission to prescribe the medication. Questions e-mail Roger A Rosenblatt MD, MPH at rosenb@u.washington.edu, or call 206-685-1361.

Public Health Emergencies: 7.5 Hour(s) of Category I CME credit, sponsored by the University of Washington. Conference held on November 5, 2010 at the DoubleTree Hotel Portland in Portland, Oregon. Contact Kathryn Koelemay at 206-263-8188 or email Kathryn.Koelemay@kingcounty.gov for more information.

In Memoriam

Edward W. Abrams, MD Three weeks from his 101st birthday, Edward W. Abrams passed away on September 11, 2010. He was born on September 30, 1909. He graduated from WSU and the University of Oregon Medical School in 1937. He set up private practice in Spokane in 1946 in Internal Medicine. Due to heart problems he retired from active practice in 1959, but continued to dedicate himself to the medical community as the first director of Medical Education in the Northwest at Sacred Heart Hospital in 1960. The medical library at Sacred Heart Hospital is named after Dr. Abrams.

He was a member of the AMA, the American Board of Internal Medicine, WSMA, the North Pacific Society of Internal Medicine, the Spokane Society of Internal Medicine and the Spokane County Medical Society.

He was predeceased by his wife of 55 years, Dorothy M. Dixon, one daughter, Peggy and two grandsons. He is survived by two daughters, Patricia Caldwell and Dorothy Brown, his fiancée Marge Gattavara, seven grandchildren and 20 great-grandchildren. He will be missed by all who knew him.

October SCMS Message 16

An interview with Dean Martz, MD – Incoming WSMA President #1: Dr. Martz, please give us some background on your current activities (e.g. your specialty, practice setting, SCMS/WSMA service over the years).

I am a neurosurgeon. I have been in Spokane since 1990 and during that time have been a member of Inland Neurosurgery and Spine. I was on the Spokane County Medical Society board of trustees in the early part of the 1990s and as a result of that was involved during the early phases of the formation of the Preferred Health Care Options (PHCO), where I worked as an associate medical director for a number of years. I joined the board of the State Medical Association in 2004 and subsequently was nominated to the executive committee a couple of years later. #2: Can you describe for us in a little more detail what it will mean to be the WSMA president, what is involved in serving in this position, how you got to this point in your WSMA service, and what’s next?

My first and foremost duty will be to represent our physician members throughout the state. I will be the official spokesperson for the Association. Meaning I will represent the WSMA to the media, at various speaking events, and before other organizations, including government officials. I will testify before the legislature in Olympia on bills of interest to our membership, and also represent our interest to state regulatory agencies, the business community, insurers and other organizations. I’ll also meet with the state’s congressional delegation as appropriate. As President, I will also have the opportunity to visit with the county medical associations and some of the state specialty societies throughout the year. This is probably the most important part of the job, as it adds to the communication between the state organization and the county and specialty societies. Finally I will preside over the WSMA Board of Trustees’ meetings. #3: Please tell us what issues or activities you believe will be the most important to address in your presidency and why.

The Medical Association is in the midst of creating and implementing a five-year strategic plan. The plan was developed based on a resolution passed at last year’s House of Delegates.

The plan attempts to prepare the Association for the large changes that are occurring in medicine. At this point, the plan has been drafted and will be heard at this year’s House of Delegates. As President, one of my primary jobs will be to work with other members of the executive committee, the board and the professional staff of the organization in the implementation of the plan.

#5: Finally, congratulations on being a role model for professional service to your colleagues. Do you have any comments for the profession that might help prepare other physicians for leadership roles as the profession begins to address the challenges of the future, especially with the passage of healthcare reform?

Our Medical Association provides a great opportunity for physicians to have a voice in things that impact the medical profession in our state. The policy is set by the House of Delegates, which is a very democratic body where all voices are equally heard. The policies, once set, are implemented by the executive committee and board of trustees. In addition, our lobbying staff in Olympia has great credibility with the legislature.

But it’s important to point out that the WSMA is involved in much more than just representing our interest in Olympia. The WSMA represents physicians in all aspects of their professional lives, regardless of their practice setting – legally, economically and professionally. In my time on the Executive Committee I have seen the power of WSMA. When a member calls, the WSMA is able to react. The Association has been able to assist members in various ways including recouping money from an insurer, stopping an egregious audit, representing a member in a legal dispute and the list goes on. This means that one’s time and energy put into participating in the organization is time well spent.

Keith Baldwin SCMS CEO

Spokane VA Medical Center launches health information exchange The department of Veterans Affairs (VA) announced a new pilot in the Spokane region that will improve the portability of health information to Veterans and active duty Service members. The Spokane VA Medical Center and Fairchild Air Force Base will partner with Inland Northwest Health Services (INHS) to securely exchange electronic health record (EHR) information using the Nationwide Health Information Network as a next step towards the implementation of the historic Virtual Lifetime Electronic Record.

Since more than half of America’s Veterans and active duty Servicemembers receive some portion of their healthcare outside of VA or Department of Defense (DoD) facilities, interoperability between federal agencies and the private sector is essential to provide the best care for Veterans, Servicmembers and their dependents.

#4: What advice has the current president given you to help you as you begin to serve as the president this year?

I have had the privilege to be on the executive committee with our current President, Dr. Deborah Harper, for four years. This has been a great opportunity to see how she has handled herself in various situations, both on the executive committee and in interactions with the board. All of this has provided great lessons for me and hopefully has helped me adequately prepare for the challenges of the coming year.

October SCMS Message 17

The following physicians/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 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS Espinosa, Randall A., MD Orthopedic Surgery/ Hand Surgery Med School: U of Colorado (1987) Internship/Residency: William Beaumont Army Medical Center (1993) Fellowship: Walter Reed Army Medical Center (1997) Practicing with Rockwood Clinic, PS beginning 11/2010 Han, Ying, MD Ophthalmology Med School: Nanjing Medical U, China Internship: Oakland Kaiser Medical Center (2006) Residency: U of California Medical Center (2009) Fellowship: U of California Medical Center (2010) Practicing with Spokane Eye Clinic beginning 1/2011

PHYSICIANS PRESENTED A SECOND TIME Grawe, Glenda H., MD Pediatrics/Pediatric Emergency Medicine Med School: U of Utah (1996) Practicing with Spokane Emergency Physicians since 9/2010 Halaby, Mohsen, MD Internal Medicine Med School: U of Assiut, Egypt (2002) Practicing with Sound Physicians beginning 10/2010 Harvey, John P., MD Pediatrics/Neonatal-Perinatal Medicine Med School: Uniformed Services U Health Science (1997) Practicing with Pediatrix Medical Group beginning 10/2010 Mallo, Rebecca D., MD Internal Medicine Med School: U of Washington (2006) Practicing with Hospital Specialists, LLC beginning 11/2010 Wagner, Mary Kay, MD Pediatrics Med School: U of Texas Medical Branch, Galveston (1984) Practicing with Valley Young People’s Clinic since 8/2010

Hariharan, Jayaram, MD Family Medicine Med School: U of Bombay, India (1988) Internship/Residency: U of California (2010) OB Fellowship with Family Medicine Spokane beginning 10/2010 Leone Jr., Richard J., MD, PhD Surgery/Thoracic Surgery Med School: Rutgers Medical School (1994) Internship: UMDNJ-Robert Wood Johnson Medical School (1995) Residency: UMDNJ-Robert Wood Johnson Medical School (2000) Fellowship: New York Presbyterian Hospital (2002) Matei, Cristina I., MD Neurology Med School: U of Medicine and Pharmacy, Romania (1991) Internship: New York Hospital & Medical Center (1999) Residency: Upstate Medical U (2002) Fellowship: Upstate Medical U (2003) Practicing with Providence Stroke & TIA Center beginning 11/2010 Pedersen, Jeffrey R., DO Family Medicine Med School: Des Moines U (1996) Internship: Metropolitan Hospital (1997) Residency: Meridia South Point Hospital (1999) Practicing with Associated Family Physicians since 7/2010 Wheeler, Elizabeth G., MD Internal Medicine Med School: U of Alabama (1997) Internship: U of Alabama Medical Center (2002) Internship/Residency: U of Alabama Medical Center (2005) Practicing with Providence Physician Services since 8/2010

PHYSICIAN ASSISTANT Steinbock, Kari L., PA Physician Assistant Med School: U of Washington, Medex Northwest (2010) Practicing with Spokane Urology beginning 10/2010

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME Adams, Jessica A., PA Physician Assistant Med School: U of Washington, Medex Northwest (2010) Practicing with Rockwood Kidney and Hypertension Center beginning 9/2010

SPECIAL THANKS TO OUR PARTICIPATING ADVERTISERS.

YOUR SUPPORT OF THEM IS GREATLY APPRECIATED!

October SCMS Message 18

Riverpoint Pharmacy’s veterinary services can help even the furriest members of your family.

Humans and their animals often have variations of the same diseases including skin rashes, heart conditions, eye and ear infections, cancer and diabetes. Pet medications, though, present unique problems that are often best dealt with through specialized compounding.

We prepare alternate dosage forms, flavored treats with medicines, anti-inflammatories for joint discomfort, allergy medications, and medicines for animals less than eager to take their medications.

Riverpoint Pharmacy will take care of all of your pharmacy compounding needs.

R iverpoint

Your treatment. Custom designed.

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www.riverpointrx.com ww

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(509) 343-6252 | 528 E. Spokane Falls Blvd. #110 (50

ROCKWOOD IS PLEASED TO WELCOME

DR. STEPHEN REESE & DR. DAMON SHENEMAN! Stephen Reese, M.D., general surgery, joined the Rockwood Surgical Group in September 2010. He received his undergraduate degrees from Bob Jones University in Greenville, SC, and the University of Alabama at Birmingham.

He received his graduate and medical degrees from the Saba University School of Medicine in NetherlandsAntilles. Dr. Reese completed an internship and residency in general surgery at Virginia Mason Medical Center in Seattle. He is board eligible by the American Board of Surgery. Dr. Reese is a member of the American College of Surgeons, the American Society of Gastrointestinal and Endoscopic Surgeons and the American Medical Association. He was previously in general surgery private practice in Russellville, KY. Damon Sheneman, D.O., general surgery, joined the Rockwood Surgical Group in August 2010. Dr. Sheneman received his undergraduate degree from the University of Utah in Salt Lake City, and his medical degree from the Arizona College of Osteopathic Medicine at Midwestern University in Glendale, AZ. He is board eligible by the American Board of Surgery.

To refer a patient or schedule a consultative visit, please call (509) 755-5551.

Rockwood Vercler Clinic 1512 N. Vercler, Suite 103 Spokane Valley, WA 99216

www.rockwoodclinic.com

October SCMS Message 19

Continued from page 12 Absolute and relative asset valuation has admittedly become more attractive as stocks have moved back toward the lower half of the broad trading range that has been in place since March and yields on Treasury debt have fallen to their lowest levels since the depths of the global financial crisis. According to WMR’s dividend discount model, equity markets currently stand about 14% below fair value. But while stocks may look relatively inexpensive, they are hardly compellingly cheap. The current moderately attractive valuation level on equities alone is not enough to trump the more downbeat macro backdrop.

U.S. corporate cash balances are in their best shape in decades.

Aggressive cost-cutting measures, coupled with a decade-long deleveraging process and a sharp rebound in corporate profits have left company CFOs awash in cash.

What will they do with it all? There are two shareholder friendly possibilities—increase dividends and engage in share buybacks— but WMR analysts note there is little to suggest that this cash will be directed exclusively to those options, predicting instead that many corporations will likely retain larger-than-normal cash balances to guard against a downturn in business conditions.

Fiscal policy surprises are a possibility, in regard to the “Bush tax cuts� that are set to expire at the end of this year, when tax rates will revert to those in place during the Clinton Administration. This would mean increases in marginal, capital gains and dividend tax rates, and the return of a punitive estate tax burden, in WMR’s view.

Ryan and his team set forth three possibilities: the tax cuts expire (“the worst case for the real economy and financial markets, as it would impose a ‘fiscal shock’ that could come to as much as 2% of GDP); the tax cuts are extended for a year in an effort to further bolster the recovery process (the best scenario

for growth and could well be the catalyst behind a surge in risk assets heading into next year�); and, finally, a compromise where the administration and Congress agree to extend some tax cuts and have only modest tax rate increases. “This is the most likely option and has already largely been discounted into current market prices,� says Ryan.

Maintain status quo Against this decidedly mixed macro backdrop, WMR continues to recommend that investors retain a neutral allocation across each of the major asset classes. Despite a still solid earnings outlook, generally supportive policy backdrop and increasingly attractive relative valuation, equity markets are apt to remain rangebound in the absence of a near-term catalyst, in WMR’s view.

Therefore, it continues to recommend a moderate defensive tilt to its sector strategy (with overweights in consumer staples, technology and utilities) and a focus on large-cap growth stocks within the U.S., while favoring emerging markets over the developed world. As low yield levels suggest that the absolute return prospects for both fixed income and cash positions remain modest, WMR retains a below-average duration weighting in bonds and overweights investment grade and highyield credit, in order to benefit from strong corporate balance sheets. And despite vigorous raw materials demand across emerging markets, WMR analysts feel the growth slowdown in developed nations will temper any near-term price increases in commodities.

Based on WMR’s Investment Strategy Guide: “Navigating the soft patch� (August 25, 2010). To obtain a copy of the report or discuss how its research insights might bear on your portfolio, please contact J. Travis Prewitt or Brad Desoreaumo at UBS – The Prewitt Group - a Circle of Friends member. (509) 744-3314.

Physician Health is Important.

Eastern Washington Physician Health Committee We are available to assist you in the following areas: t t t t t t t t t

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ɨJT DPNNJUUFF B GVTJPO PG UIF GPSNFS 4$.4 DPNNJUUFF BOE POF JODMVEJOH NFNCFST PG NFEJDBM TUBĊT PG $PNNVOJUZ )FBMUI 4FSWJDFT BOE 1SPWJEFODF )FBMUI $BSF )PTQJUBMT NFFUT RVBSUFSMZ UP FEVDBUF PVSTFMWFT BCPVU QIZTJDJBO IFBMUI JTTVFT SFWJFX VUJMJ[BUJPO BOE TBUJTGBDUJPO XJUI UIF 8FMMTQSJOH &BSMZ "TTJTUBODF 1SPHSBN &"1 BOE QMBO BDUJWJUJFT QSPHSBNT BOE SFTPVSDFT UP BEESFTT OFFET JO UIFTF BSFBT 4PNF PG UIF HVJEJOH QSJODJQMFT PG UIJT DPNNJUUFF BSF The medical profession and healthcare community should foster physician well-being A sense of community with one’s peers is vital to personal well-being Changes in the healthcare environment and contributing to personal and professional challenges and new stressors for physicians Physicians should have resources available to them to anticipate and manage episodic personal issues

COMMITTEE MEMBERS Jim Shaw, MD, $IBJS Steve Brisbois Michael Metcalf Paul Russell Phil Delich Michael Moore

Robert Sexton Jim Frazier Mira Narkiewicz Patrick Shannon Deb Harper October SCMS Message 20

Sam Palpant Alexandra Wardzala Mike Henneberry Tad Patterson Hershel Zellman

Group Heath named to lead two Accountable Care Organization (ACO) pilots Last month the Message referenced a variety of medical practices and accountable care organizations (ACOs) in our community. The term ACO is still a concept in our changing Spokane market. An ACO is an approach to care and coverage where a variety of provider groups take joint responsibility for the care and wellbeing of patients, including the cost and quality of their care.

ACOs are a shift away from “payment per procedure” and toward integrated care across the continuum. Many federal and state health reform advocates believe they will slow down rising costs by doing a better job of caring for each patient and avoiding unnecessary tests and treatments, emergency room visits, and hospitalizations caused by lack of communication and coordination.

In September the Washington State Health Care Authority named Group Health Cooperative to lead two ACO pilot projects in our state. The pilots will bring several health care providers into an organized group that’s collectively responsible for the health of each patient—ranging from primary care doctors and physical therapists to surgeons and hospitals. This principle of integrated care has guided Group Health since we began in 1947.

The pilots will be developed by January 2012, without using state funding. At this point it is too early to know if Spokane providers will be involved. We may seek other public and private sources of funding, and the pilots will be evaluated by the Group Health Research Institute and the University of Washington.

At Group Health, we’re clear about some of the key characteristics of ACOs. They require: 1: Aligned financing of care and coverage so payment structures are in place to drive a shared care approach 2: An advanced primary care or medical home model to serve as a foundation for care coordination 3: Technology that supports integration such as shared patient clinical records 4: A patient-centered focus, including tools and patient education for patients to manage their own care 5: An evidence-based approach to patient care that supports continuous improvement.

6: Community partners who are aligned on a common care model.

Many hospitals and medical groups are exploring whether to join an ACO. If this includes yours, be sure to keep this checklist in mind.

Brad Pope, MD, is medical director for Group Health Cooperative’s Eastern Washington/North Idaho District, based in Spokane. Dr. Pope started as a family physician with Group Health in Spokane in 1983.

He still practices part-time as an urgent care provider each week.

For more information contact: Diane M. Davis, CCRC Medical Oncology Associates, P.S. Research Department Phone: 509-462-2273 Fax: 509-462-2275 davisd@nwrm.com

MAGRIT Clinical Reseach Study in Lung Cancer

NOW ENROLLING MAGE-A3 ADJUVANT NSCLC TRIAL 2270 Patients The MAGRIT study is a worldwide, double-blind, randomized, placebo-controlled Phase III trial of MAGE-A3* Antigen-Specific Cancer Immunotherapeutic (ASCI)** as adjuvant therapy in Non-Small Cell Lung Cancer (NSCLC).

MAIN INCLUSION CRITERIA Patients with NSCLC may be considered for participation in the MAGRIT Clinical Research Study if the following conditions are met: t Pathological proven stage IB, II or IIA NSCLC t Completely resected t MAGE-A3 positive primary tumor (to be tested) t With or without adjuvant chemotherapy t ECOG performance status of 0,1, or 2 t Adequate bone-marrow reserve, adequate rental function and adequate hepatic function Resected NSCLC Decision for chemo

No chemo

Chemo Up to 4 cycles of chemo

Randomization MAGE-A3 ASCI

Randomization

Placebo

MAGE-A3 ASCI

Placebo

13 administrations over 27 months * MAGE-A3 is a tumor-specific anitgen present on 35-50% of NSCLC tumors ** ASCIs are Investigational Compounds

MAGRIT October SCMS Message 21

CLASSIFIED ADS RE AL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, secure and quiet. Newly remodeled with full appliances, including full-sized washer and dryer. Wired for cable and phone.

For Rent $850/month. For Sale: Seller Financing Available. Rentto-Own Option Available: $400 monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.

For Sale with Lease Option. MUST SEE!!! Beautiful custom-built Lake home with attached “daughter house.” Main home has two bedrooms, two baths and complete office. Rock Garden, private driveway with security gate, two car garage, AC, wood floors, central VAC, fireplace, washer & dryer. “Daughter” house includes 2 bedrooms, 1 bath, office and separate carport. Lease option $1,200 for main house; $800 for in-law suite or $2,000 for both.

Country living but close to Cheney and Spokane. Contact Jerry Krause, jerrykrause3@aol.com or krausej@athletics.gonzaga.edu or cell #, 509-280-8179.

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, upscale-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 wash/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone.

Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth College. Please call 954-8339 for details.

Also willing to rent "unfurnished.”

MEDICAL OFFICES/BUILDINGS Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820.

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community. If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full service lease. Starting lease length 5 years includes an $8 sq/ft tenant improvement allowance. Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 - 1560 sq/ft *Suite 302 2190 sq/ft

For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available December 2009. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $24 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Shared suite ready for occupancy with all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/ sq ft; will negotiate lower rate. Excellent location in a fullservice medical building with lab and full radiology services. For information, call (509) 981-9298.

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.

Indian Trail Professional Building has medical space available for lease. A 11,243 sf professional medical / office building located in the growing Indian Trail Community directly across from the new Sundance Shopping Center. Address is 5011 W. Lowell Ave or the SWC of Indian Trail and Lowell Avenue, Spokane, WA. The main floor space located off of the main floor entrance consists of 4,389 sf of Class “A” General Medical Practice or Urgent Care Center space. A Tenant Improvement Allowance is Available, subject to terms of lease. Floorplans and marketing materials can be emailed upon request. Please contact Patrick O’Rourke, CCIM with O’Rourke Realty, Inc. at (509) 6246522 or cell (509) 999-2720. Email: psrourke@comcast.net.

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, north of Holy Family Hospital at the NWC of Lidgerwood and Central.

Various spaces available for lease from 635 to 6,306 usable sq ft. Extensive remodeling, including two elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include pediatricians, dermatology, dentistry, pathology and pharmacy. Floorplans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

OTHER Quinton Q4500 Stress Testing Combination, including treadmill, recording paper, electrodes, two solo owners, light use. Excellent condition, maintained by SHMC Engineering.

Original $22,000, listed at $12,495 on E-Bay. Asking $8,000 or best offer. Cast saw $125, two antique wooden exam tables $200 each. Contact Melissa Sousley, MD at (509) 953-4299 or email onedocmom8@aol.com.

October SCMS Message 22

October SCMS Message 23

For orthopedic care that makes you feel this good, we’ve got you covered.

Getting you back to an active lifestyle is the reason The Joint Restoration Center at Valley Hospital offers a wide range of advanced orthopedic services from experienced physicians.

Knee and hip joint replacements, as well as spinal and neck implants Cartilage restoration Fracture and tissue repair Orthopedic surgeon available 24/7 to treat emergencies Make Valley Hospital and Medical Center your choice for orthopedic care. Call (509) 473-5477 for more information or visit www.spokanevalleyhospital.com/physicians to find an orthopedic specialist.

12606 East Mission Spokane Valley

A d va n c e d O r t h o p e d i c C a r e . R i g h t H e r e .

October SCMS 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. 512

ADDRESS SERVICE REQUESTED

Printed on DOMTAR EarthChoice速 Paper: High Quality Paper with a conscience. Please recycle.

October SCMS Message 25