Sombrero

Pima County Medical Society

Home Medical Society of the 17th United States Surgeon-General

NOVEMBER 2016

In 1961...
The average cost of a
new car was $2,850;

e
el

g
tin
a
r
b

ars of Dedic
55 Ye
ated

Se
rv

ic
e

The US launched the

first person into space,
Alan Shepard;
Frito corn chips made
their first appearance;
The average income in
the US was $5,315;
The Berlin Wall was
erected;
Bob Hope hosted the
Academy Awards;
...and

Doctors began

seeing patients at

St. Elizabeths

Calling all Supporters, Volunteers

and Former Volunteers:
We are Celebrating Your
Contributions to St. Elizabeths!
Join Us at St. Elizabeths for the Celebration
140 West Speedway Boulevard
Thursday, November 17th, 2016,
4:30 to 7:00 p.m.
Brief Program at 6:00 p.m.

Call 520-670-0907 for more information or to RSVP.

Do You Know Someone Who Has Served at

St. Elizabeths? Friends and Colleagues are Welcome!

Are You A Specialist Who Is

Willing to See Patients in Your
Office for St. Elizabeths?

Wed Love to Talk to You!

Call 520-628-7871 or email info@saintehc.org
and ask about service opportunities.

SOMBRERO November 2016

Sombrero
Pima County Medical
Society Officers
President
Timothy C. Fagan, MD
President-Elect
Michael A. Dean, MD
Vice-President
Susan J. Kalota, MD
Secretary-Treasurer
Unfilled / Appointment
Past-President
Melissa D. Levine, MD

PCMS Board of Directors

David Burgess, MD
Howard Eisenberg, MD
Kelly Ann Favre, MD

Official Publication of the Pima County Medical Society

Jerry Hutchinson, DO
Roy Loewenstein, MD
Kevin Moynahan, MD
Snehal Patel, DO
Wayne Peate, MD
Kenneth Sandock, MD
Sarah Sullivan, DO
Salvatore Tirrito, MD
Debra Townsend, MD
Fred Van Hook, MD
Scott Weiss, MD
Leslie Willingham, MD
Jaren Trost, MD (Resident)
Aditya Paliwal, MD (alt. resident)
Jared Brock (student)

Members at Large

Vol. 49 No. 9

At Large ArMA Board

Charles Krone, MD
Clifford Martin, MD

Robert M. Aaronson, MD
R. Screven Farmer, MD

Board of Mediation

Pima Directors to ArMA

Timothy C. Fagan, MD

Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Sheldon Marks, MD
Mark Mecikalski, MD

Delegates to AMA
Timothy C. Fagan, MD (alternate)
Gary R. Figge, MD
Michael F. Hamant, MD (alternate)
Thomas H. Hicks, MD

Arizona Medical
Association Officers
Michael F. Hamant, MD
Vice President
Thomas C. Rothe, MD
Outgoing Past President

Executive Director
Bill Fearneyhough
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: billf 5199@gmail.com

Editor
Bill Fearneyhough
I welcome your feedback and story ideas.
E-mail: billf 5199@gmail.com

Printing
West Press
Phone: (520) 624-4939
E-mail: andyc@westpress.com

Advertising
Dennis Carey
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: dcarey5199@gmail.com

Art Director
Alene Randklev
Phone: (520) 624-4939
Fax:
(520) 624-2715
E-mail: alener@westpress.com

Publisher
Pima County Medical Society
5199 E. Farness Dr., Suite 151
Tucson, AZ 85712
Phone: (520) 795-7985
Fax: (520) 323-9559
Website: pimamedicalsociety.org

Classic 1928 Spanish Colonial

SOMBRERO (ISSN 0279-909X) is published monthly

except bimonthly June/July and August/September by the
Pima County Medical Society, 5199 E. Farness, Tucson,
Ariz. 85712. Annual subscription price is $30. Periodicals
paid at Tucson, AZ. POSTMASTER: Send address changes
to Pima County Medical Society, 5199 E. Farness Drive,
Ste. 151, Tucson, Arizona 85712-2134. Opinions expressed
are those of the individuals and do not necessarily represent
the opinions or policies of the publisher or the PCMS Board
of Directors, Executive Officers or the members at large,
nor does any product or service advertised carry the
endorsement of the society unless expressly stated. Paid
advertisements are accepted subject to the approval of the
Board of Directors, which retains the right to reject any
advertising submitted. Copyright 2016, Pima County
Medical Society. All rights reserved. Reproduction in whole
or in part without permission is prohibited.

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Inside
5

Dr. Timothy C. Fagan: Our president returns to Austria

for a 50-year reunion.

UA College of Medicine: Dr. Charles Cairns discusses

UA-Banner Healths research in Precision Medicine.

10

Dr. Francisco Garcia: The Pima County Health

Department warns of mercury in face creams.

12

Road Trip: Cochise County is a good place to find

hidden treasures this holiday season.

16

Bike Listening Tour: Dr. Paul Gordon rides cross

country to get feedback on ACA from rural America.

19

End of Life Update: EOLCC continues advanced

planning discussion and sets date for open meeting.

21

Arizona Health-e Connection: Complete health care

information is more important than ever.

22

Walk With A Doc: Physicians help patients get active

with WWAD events.

23

PCMS Alliance: Holiday luncheon tradition continues as

Mobile Meals of Tucson welcomes a new Executive
Director.

25

Mobile Health Program: Providing quality health care to

rural Arizona is still the focus after 40 years.

On the Cover
Mormon homesteaders settled in this valley below the Grand
Teton Mountains in Wyoming. Twenty seven families farmed
irrigated land from 1896 until 1937. Two picturesque barns
remain in what was known as Mormon Row. They were built
by brothers John and T. A. Moulton. Johns barn was built
about 1910 and is said to be the most photographed barn in
America. Image taken in June 2003 on a Arizona Highways
photo workshop. (Photo by Hal Tretbar)

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SOMBRERO November 2016

The pre-meds (and others) reunite

By Dr. Timothy C. Fagan, PCMS President

n September 25,
1966 eighty-some
Stanford undergraduates arrived in
Semmering, Austria for
their six months of study
abroad. Semmering is 60
miles south of Vienna on
the pass between the two
largest cities in Austria,
Vienna and Graz (birthplace of Arnold Schwarzenegger). Semmering is a
resort town, with the ski
area nearest to Vienna. In
1888, a famous Viennese chef named Vinzenz
Panhans built his namesake hotel. In 1965, Stanford
rented half of the Grand Hotel Panhans for its Austrian
Overseas Campus. The hotel had fallen on hard times,
and the Stanford rental kept it solvent. The setting was
gorgeous, the hotel was beautiful, and many students,
including the author, learned to ski there. However, as
a resort town, there were almost no local residents of
an age similar to the Stanford students, and the
cultural resources of Vienna were 60 miles away, by
car, train or hitch hiking. The campus was moved to
Vienna in 1968, and the hotel closed at the beginning
of 1969. It was subsequently purchased and
renovated, maintaining its 19th Century elegance.
This group of students was unusual academically,
even for Stanford. As a group, the students were
purported to have the highest grade point average of
any group that had ever attended any of the five
Stanford overseas campuses. Roughly half of the
group were pre-medical students, and nearly half of
the group became physicians, although not
necessarily the ones who were pre-med when they
arrived at the campus. One
negative aspect of the
studiousness of the group
was that, initially,
opportunities for travel and
cultural or outdoor pursuits
were often foregone, in
favor of study. Fortunately,
this only persisted for one to
two months.
On September 25, 2016, 50
years after they first arrived,
15 of the students returned
with spouses/significant
others. Of the 15 who
returned for the reunion,
SOMBRERO November 2016

Opened in 1888 by legendary Viennese chef Vinzenz Panhas, the

Panhas Hotel features four-star accommodations, including
two bars, a wine cellar, a caf, three Austrian restaurants, spa,
indoor pool, sauna and fitness room.

seven are physicians, four Internists, one Cardiologist,

one Neurologist and one Psychiatrist. Two of the nonphysicians are lawyers, one of which is also an
administrative law judge. One is an Astrophysicist,
who built one of the instruments for the Hubbell space
telescope. Two are retired university professors, one
of music and one of humanities and social sciences.
The latter is most proud of creating a program on
public policy for engineers. The other three include the
former Head of Marketing for Nordstroms, a CPA who
has worked for the Leakey Foundation, and an artist
and teacher. Most of the group are retired, but remain
active with various activities. We were fortunate to be
joined by one of our Professors, Herr Ribisch, who had
taught us German in 1966. He currently lives in
Vienna.

Activities during the three-day reunion included getting

reacquainted with Semmering, hiking, riding the
gondola to the top of the
Hirschenkogel, the ski
mountain of Semmering,
and visiting nearby towns
and castles. However, the
primary activity was
reconnecting and catching
up with people, who in
most cases, we had not
seen for nearly 50 years.
One reunion dinner was to
be held in the hotel dining
room, but morphed into
three, three-hour dinners,
with lots of wine. The fact,
The ski mountain Hirschenkogel, offers panoramic views of the that the group chose to
spend nine-plus hours
countryside and resort town of Semmering, Austria.
5

About half of the 1966 reunion group became physicians.

The group also included lawyers, an astrophysicist, professors,
a marketer, artist and teacher.

talking to each other, speaks to the strength of the

friendships and to the interesting lives that we have
led. All of the group took the opportunity to extend the
trip with additional travel. One Internist, who had
retired 30 days before the reunion, planned a seven
week European trip with his wife.
My wife and I travelled with a couple who met at the
campus and subsequently married. Their lives have
been interconnected with ours ever since. We visited
Slovenia, immediately south of Austria, for three days.
Slovenia is one of the more prosperous members of
the European Union. It is modern, clean and orderly.
The people are friendly, and all study English for at
least four years in school. The scenery, particularly in
the Julian Alps, is spectacular. Lake Bled, with its
island chapel, is the most commonly shown scene in

Located in the province of Istria in northwestern Croatia, the

hill town of Motovun features a multitude of wineries.
6

Lake Bled and Castle, Bled Slovenia.

Slovenia and is on the cover of multiple guidebooks.

The castle of Bled sits atop a cliff at the edge of the
lake. Lipica (pronounced Lipizza) is home of one of
the two largest Lipizzaner stud farms and riding
schools in the world. The other riding school is in
Vienna, and the stud farm is in Piber, near Graz,
Austria.

The old harbor and city wall of Dubrovnik.

SOMBRERO November 2016

We then drove south of Slovenia to Croatia, also a

member of the European Union. Croatia was
significantly impacted economically, in lives lost, and
in displaced population, by the 1991-1995 war. They
were attacked by Serbia, Bosnia and Montenegro, who
were seeking to create a Greater Serbia, similar to
the previous Yugoslavia. In the 20 years since the war.
Croatia has made tremendous progress in rebuilding
and progressing economically, but they are still far
behind Austria and Slovenia.
Croatia has beautiful and highly varied scenery,
including mountains, lakes and a long and scenic
seacoast. The province of Istria, in northwestern
Croatia, has multiple hilltop towns and is famous for its
wine. Motovun is one of the best known towns and has
multiple wineries. We visited one winery, and had a
very enjoyable wine tasting. The local cuisine features
seafood and pasta, which pair well with the wine. The
ancient city of Dubrovnik, in the south of the country,
has a history of being a major world trading center,
going back nearly 1,000 years. Dubrovnik was
significantly damaged in the war, but has been rebuilt.
The medieval walls remain intact around the entire
city. The churches, towers and monasteries within
the Old Town are fascinating. After two weeks of
travelling, we flew home, but the sights and memories
will remain.
n

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UA College of Medicine

The Precision Medicine Initiative at the UA

By Charles B. Cairns, MD, Dean, UA College of Medicine Tucson

n July, the UA and

Banner Health were
awarded a mulit-million
dollar research grant from
the National Institutes of
Health (NIH) to participate
in the Precision Medicine
Initiative Cohort
Program, which aims to
enroll 1 million U.S.
participants to improve
prevention and treatment
of disease based on
individual differences in
lifestyle, environment and genetics. The award, which
totals $43.3 million over five years, is the largest NIH
peer-reviewed grant in Arizona history.
What is Precision Medicine?
Precision medicine is a novel health-care platform that
incorporates individual variability in genes,
environment and lifestyle to improve diagnosis and

treatment of disease and to promote disease

prevention. Precision medicine seeks to redefine our
understanding of disease onset and progression,
treatment response and health outcomes through the
more precise measurement of molecular,
environmental and behavioral factors that contribute to
health and disease. Precision medicine approaches
have the promise to deliver:
More accurate diagnoses.
Rational disease prevention strategies.
More accurate prediction of disease risk and
patient stratification.

Development
of targeted therapies for more

effective treatment of disease and minimization of
adverse reactions.

Improvements
in cost effectiveness of health-care

delivery.
Empowerment tools for patient self-management.
Precision Medicine Today
The NIH Human Genome Project (www.genome.gov/

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SOMBRERO November 2016

10001772), completed in 2003, provides the framework

for understanding both the human genome in disease
and the potential for genome-based interventions. The
evolution in information technology now allows for the
practical aggregation and ready analysis of big data,
and electronic health records now are available in 95
percent of U.S. hospitals.
In addition, there has been a personal technology
revolution with high levels of access to mobile phones
and social media. There has also been an explosion in
the number of home-based and consumer-operated
medical technologies such as wearable sensors, blood
pressure devices and automated cardiac defibrillators.
In fact, there are more than 150 FDA-approved drugs
that require genomic information for prescription and/
or monitoring of treatment outcomes. The selective
targeting of genomes currently is used in the
management of cystic fibrosis, HIV, lung cancer,
melanoma and other diseases.
The Precision Medicine Initiative Cohort Program
The Precision Medicine Initiative (PMI) Cohort
Program (www.nih.gov/precision-medicine-initiativecohort-program) was announced by President Barack
Obama in his 2015 State of the Union address and will
enable a new era of medicine through research,
technology and policies that empower patients,
researchers and providers to work together toward
development of individualized care.

not only will share their biological, health, lifestyle and

environmental data, but also will have access to their
study results and be partners in the discovery process.
Safeguards have been developed to ensure the
security and privacy of individual information and data.
The UA Health Sciences and Banner Health will enroll
150,000 participants from the Southwest region,
Alaska and Wyoming over five years and will make a
significant contribution to the diversity of enrolled
participants in the PMI Cohort Program. The inclusion
of American Indian/Alaska Native and Hispanic/Latino
participants, among other populations historically
underrepresented in research, will provide greater
insights to disease prevention and treatment.
The UA-Banner team is part of a network of regional
health-care provider organizations (HPOs)
participating in this effort to understand the factors
contributing to individual health and disease. HPOs
will engage their patients in the PMI Cohort Program,
build research protocols and plans, enroll interested
individuals and collect essential health data and
biological specimens
Academic health-care providers in the initial PMI
Cohort Program
Illinois Precision
Medicine
Consortium:
Northwestern,
University of
Chicago, and
University of Illinois
at Chicago

The PMI Cohort Program is one of the most ambitious

biomedical research projects in history given its size
and scope. The program will launch later this year and
will enroll over 1 million participants, reecting the
broad diversity of the U.S.
The program will be big enough to enable statistically
valid research for a wide range of diseases (both
common and rare) across broad population groups and
a wide variety of health outcomes.
Potential scientific opportunities include:
The development of new ways to measure disease
risk based on environmental exposures, genetic
factors and their interactions.
Identification of the causes of inter-individual
differences in response to therapeutics.
The discovery of biological markers that signal
increased or decreased risk of developing various
diseases.
The use of mobile health (mHealth) technologies
to correlate activity, physiological measures and
environmental exposures with health outcomes.
The creation of new disease classifications and
sub-classifications.
The PMI Cohort Program aims to create a highly
engaged population of active research participants who

SOMBRERO November 2016

Columbia, Cornell,
Harlem Hospital,
and NewYork-
Presbyterian
University of
Pittsburgh

University of
Arizona and
Banner Health

What you can do to help the PMI Cohort Program

By launching a study of this size and scope, we hope
to accelerate our understanding of disease onset and
progression, treatment response and health outcomes,
and we hope you will join us in this landmark project.
Anyone living in the United States will be able to
participate, and when the NIH opens enrollment,
please consider signing up. In addition, you can serve
as a champion when patients or colleagues ask you
about the Precision Medicine Initiative.
You can stay informed of local efforts by emailing
precisonmedicine@email.arizona.edu. Submitting this
form allows us to contact you later to share more
information about the program but does not commit
you to enrolling in the study.
n

Health Risk

Skin cream poses serious health risk

By Francisco Garcia, MD, PCHD Director and Chief Medical Officer

n recent months,
throughout Arizona and
several other states,
health officials discovered
a variety of skin-lightening
creams originating from
Mexico and Asia that
contain high levels of
Mercury, a highly toxic
substance. The companies
that sell these creams
often target older women
with the promise that the
cream will remove dark
spots, lighten the skin, and help them look younger.
While firm skin without signs of aging may make us
more attractive, we shouldnt sacrifice our health to
obtain it. Before using any type of skin products,
consumers must ensure the products contain safe
ingredients. I refuse to believe that anyone would
purposefully use these creams if they knew that theyre
putting themselves and those around them at risk.
Mercury is a toxic substance that easily vaporizes into
the air and gets absorbed by our body when we breath.
The vapor is colorless, odorless and only detected
through special testing. Young children exposed to
mercury may experience extreme fatigue, weakness,
insomnia, irritability, and behavioral issues as well as
headaches, tingling in the hands and feet, tremors,
short-term memory loss, or loss of sense of taste. In
severe cases of mercury poisoning, the kidneys can
become severely damaged and lead to renal failure.
The distribution of these Mercury-containing creams
has become so prevalent that the Federal Drug
Administration recently issued a warning about these
products, explaining that they are usually
manufactured abroad and sold illegally in the United
States. Consumers may have purchased these creams
in shops that cater to the Latino, Asian, African, and
Middle Eastern communities or online on various
websites that use mobile apps and social media to
promote the products. Health officials have also found
that, in some cases, consumers buy the creams in
another country and bring them back to the U.S. for
personal use.
The next time you go to purchase a skin product, read
the list of ingredients and follow these tips provided by
the FDA:
10

This is just one of many brands of mercury-laden face cream

being sold in-store and on the internet.

Dont use a product that has no label. Federal law

requires that the label of any cosmetic or

nonprescription drug contain a list of ingredients.
If it has no label, it probably isnt safe.
Dont use drugs or cosmetics that have no English
label. This may indicate an illegally marketed
product.
Avoid products that include any of these
ingredients: mercurous chloride, calomel,
mercuric, or mercurio. All of these ingredients
contain Mercury.

As important as it is to avoid these Mercury-containing

creams, its equally important to properly dispose of
them. Those who find a cream in their home that
contains Mercury should seal it in a plastic bag or
leak-proof container and bring it to a City of Tucson
Household Hazardous Waste Program drop-off site.
You should not throw these products in the trash or
down the drain because it could lead to further
contamination.
To learn more about the dangers of Mercury and to
obtain more information on how to properly dispose of
such products, visit our website at www.pima.gov/
health.
Remember, no beauty-enhancing product is worth
more than your health and the health of your loved
ones.

SOMBRERO November 2016

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SOMBRERO December 2014

Road Trip

Cochise County:

Crafts, canyons & holiday delights

Tis the season to start exploring places that reveal the regions most unique charms.
By Monica Surfaro-Spigelman Photos by Leigh Spigelman

ochise County is full of colorful character a

natural wonderland of stone canyons and fertile
San Pedro grasslands. Theres also a strong dose
of small-town grandeur here. And the cooler months
beckon us to dally along the Countys back roadsto
visit holiday fairs and catch the scent of sweet pion pine
smoke wafting through often overlooked historic
communities.
Railroad History, Native American Crafts
Just about one hour from Tucson, off Interstate 10, is the
1880s town of Benson, founded when Southern Pacific
Railroad came through to serve then-booming mining
towns and rich ranch country. A stop at the historic
railroad depot will get you to the Visitor Center, and thats
where you may collect maps and details about tours that
reflect the history, nature and ways of life that youd like
to experience.
North of Benson is Dragoon, a good place to start your
Cochise County treasure-hunting excursion. To reach a
Dragoon route laced with scenic drives, holiday craftcollecting and ghost town strolls, head east on I-10 to exit
318, turning onto Dragoon Road. Here youll find the
Amerind Museum since 1937 a beacon for Native
American archaeology, arts, geology and history. At the
Museum you can walk among spectacular rock
formations of Texas Canyon, view exhibits, and also
check the gift shop for fine examples of pueblo jewelry,
pottery, weavings, baskets and books, as well as crafted
ornaments and holiday music. Plan on attending the
November trunk shows for special items (See

Amerind Museum was founded in 1937 and is considered a

prominent resource for Native American archaeology and history.
12

A Cochise County oddity and historic house: The Leonida

Thompson House at Ranch Casa Viejo.

Sombreros shopping suggestions at the end of this

feature).
If theres time, check the historic cemetery at Amerinds
entrance, where many of the areas pioneer settlers are
buried. Next door to Amerind is the Triangle T Guest
ranch, a film location for many movies and the legendary
hangout of movie greats including John Wayne and
Glenn Ford. At the Ranch, good BBQ is served to the
public on the weekends.
Further along Dragoon Road, heading south, youll make
a left onto Johnson Road (before the railroad tracks) to
visit Donnette Adams and her What Not Shoppe,
celebrating its 12th anniversary in November. Donnettes
family has ranched the region for generations, and she

Many of the earliest settlers of the nearby canyons are buried in

the Texas Canyon Pioneer Cemetery, located adjacent to the
Amerind.
SOMBRERO November 2016

Christmas trees, tinsel and assorted holiday decorations embellish

the buildings and grounds.

Cascabel is considered a ghost town, but many interesting items

can be found while browsing the buildings during the Cascabel
Fair.

can direct you to the latest crafts markets in the area. Make
sure to admire the shops locally-made mesquite and
copper items and its mid-century collectibles, or browse
her binders full of local lore and architectural history.
Historic Houses
After visiting the What Not Shoppe, cross over the
railroad track and head east along Dragoon Road,
passing farm shops for local pistachios, salsas, relishes,

The pottery made by local craftspeople is part of the unique

Cascabel Fair holiday shopping experience.
SOMBRERO November 2016

gourds. Theres also the turn off for the local winery, Gold
View Vineyards. At Cochise Stronghold Road, turn right,
where in less than four miles, youll pass a pecan grove
and come upon the Leonida Thompson house, one of the
oldest wooden structures in Cochise County. The leaning
but lovingly conserved homestead is decorated with
historic photos and period furniture. Owners of the
adjoining Rancho Casa Viejo will be happy to share their
research on Thompson family and Cochise ranching with
visitors. The Ranch hosts a craft sale at their barn in
November, so youll have an opportunity to sample
homemade caramel corn, tour the historic house and
purchase ironwork or other family handicrafts if you visit.
Apache Chief Legends
About five miles further south, you can turn right onto
Ironwood Road to visit the Cochise Stronghold National
Monument in the heart of the Dragoon Mountains, where
legendary Apace chief Cochise is said to be buried. The
landscape closes in with tumbles of towering granite,
which surround visitors in a cathedral-like silence. You
can enjoy a picnic lunch here, or meander along an easy
interpretive path.

En route to the Cascabel Fair, consider visiting Gammons Gulch, a

recreated 1880s town where the owner recounts tales of movie
filing in the area while he conducts tours.
13

Benson boasts a number of entertaining (and tasty) eateries,

including the landmark Horse Shoe Caf.

St. David Monastery is a birder paradise as well as the site of an

annual holiday crafts fair and family fun event.

When you head back onto Ironwood Road, continue east

about seven miles to get to Route 191 and Sunsites. In
this wee town theres a boardwalk of shops, including a
jewelry artisan, caf and bakery, where a farmers market
is held every Friday. After taking a moment to refresh,
head further south, less than a mile, to a right turn-off to
historic Pearce, the 1895 gold-and-silver-turned-ghost
town still rich in historic architecture and local handmaking treasures.

stop, and the site where civil war rebel soldiers were
ambushed by the Apaches.

Ghost Towns, Goats, Crafts

In Pearce, signs clearly lead you around important sites,
as well as a potter and antiques shop. Also nearby is a
cemetery, where Abraham Lincolns body guard, civil war
soldiers and other colorful mining characters are buried.
Be sure to visit Marcias Garden Goat Milk Soap Shop
(1547 East Pearce Road), where you can say howdy to
the goats and browse an assortment of soaps infused
with local botanicals.
Retrace your route back along Dragoon Road to the
railroad tracks, where, if theres time and your vehicle is
prepared for a very rocky and rutted road, you can take
Old Ranch Road south about two miles, turning left at the
signpost for another mile, to visit the ruins of historic
Dragoon Springs Butterfield Overland mail line stage

Rock formations of Texas Canyon.

14

As you wander through the nooks and crannies of this

County, discovering adventures that mix crafts, collecting,
history and nature, be aware that although most of the
roads are easily traveled by sedans much travel is on
unpaved roads, with spotty cell phone coverage, so it is
wise to stay alert to weather and road conditions.
Along the way, youll find that progress certainly takes its
time in Cochise County. Authenticity is undimmed and far
removed from tourist bustle. Treasures seemed to be
tucked away in unlikely places. Take time to savor an old
timey essence as you find the quaint places to shop and
the hidden trails to loll!
SOMBREROS SHOPPING SIX:
Top Tips on Upcoming Holiday Fairs and Special
Events in Cochise County
If you want to schedule a few jaunts through Cochise
County, try to time your visit to coincide with something
from this list of annual community holiday arts festivals
and special events:
Holy Trinity Monastery Festival of the Arts in
St. David
November 12 & 13
Motor south from Benson center on Route 80 about nine
miles to the shade of mammoth cotton trees and a 70foot celtic cross where youll turn right to Holy Trinity
Monastery. The monasterys 36th Arts Festival will be
hosted November 12 & 13, with more than 100 local
handcrafters, food booths and performers. But, anytime
of the year, you can visit the grounds to follow a birder
trail around a rich riparian area, sit in the chapel, or visit
the shop for some monastery-made breads and arts.
Old Pearce Festival
November 25 and 26
Whats more fun than an outing to a ghost town,
complete with petting zoo, arts and crafts, book sales
and holiday foods? The Old Pearce Festival will be held
SOMBRERO November 2016

when Yultide sights and sounds embellish a fun drive to

the small ghost town called Cascabel. Deep in a
mesquite forest that threads along the San Pedro, this
destination is part-ghost town, part arts community most
of the year. It awakes the first weekend of December to
become an enchanting showcase of quality handicrafts,
live music, food booths and exhibits, and tours of the
1930s post office adobe-turned potter studio. Directions:
Take I-10 through Benson to exit 306. Head north
through Pomerene. Follow the signs for 20 more miles
(the last five of which are unpaved), 520-212-2529;
cascabel.org/fair.html.

Be sure to visit Marcias Garden Soap Shop (and goats) when

you visit Pearce.

November 25 and 26, with historic buildings open for

sightseeing as well as shopping .
Amerind
November Trunk Shows and Specials
On November 26, Amerind will feature Mata Ortiz artist
Oralia Lopez, who will demonstrate her painting methods
as well as sell pottery from a wide variety of Mata Ortiz
artists. On November 25, 26, and 27, Amerind hosts a
collective of Seri artisans, who will be selling many types
of crafts, shell necklaces, ironwood carvings and
beautiful baskets.
Benson Museum Holiday Fair
December 3
A brief walk from the historic Benson Train Depot takes
you to the Benson Museum, where you may attend
brown-bag Saturday lunches about the regions pioneer
history in November, or shop for local crafts and books. If
you attend the Museums December 3 Holiday Fair,
native artisans and local vendors will have additional
regional shopping treats. Theres also a Benson Holiday
Light Parade early in December.
Singing Wind Bookshop Thanksgiving Fest
November 20
For a purposeful bibliophiles, take exit 304 off I-10 and
zig zag two miles up Ocotillo Road, making a right onto
Singing Wind Road to browse a wonderful ranchland
bookshop specializing in southwest reading material. A
Thanksgiving Fiesta, with live music and refreshments, is
set for November 20. Although Singing Wind usually is
open seven days a week, call for events and hours of
operation (700 W Singing Wind Rd, 520- 586-2425).
Cascabel Christmas Fair
December 3 and 4
The 36th Cascabel Community Fair will be held
December 3 and 4 from 10 am to 4 pm, each day. Thats

SOMBRERO November 2016

Resource List
Amerind
2100 N. Amerind Road
520-586-3666
Dragoon What-Not Shoppe
1863 N. Johnson Road
520-586-8635
Rancho Casa Viejo & Leonidas Thompson House
1685 N. Cochise Stronghold Road
520-237-3916
Holy Trinity Monastery
1605 S. St. Marys Way
520-720-4642
Cascabel Christmas Fair
520-212-2529
Cascabel.org/fair.html
Benson Museum
180 S San Pedro Street
BensonMuseum.com/index.html

Benson Visitor Center

Train Depot, 249 E. 4th Street
520-586-4293
(Maps, displays and directions for Benson walking tours
or side trips to Gammons Gulch, Fairbank, Singing Wind
Bookshop, Cochise Stronghold and more are available.)
EXTRAS:
Movies and Memories: Gammons Gulch
If youd like a side adventure in Wild West folktales while
touring Cascabel, turn west off Cascabel Road at
Rockspring Lane for a tour of a recreated 1880s town
that opened in 1995. Jay Gammons dad was a local
deputy who doubled as John Waynes body guard when
the star was in town shooting movies, and western movie
fever inspired Jay to build his town, filled with
memorabilia and many authentic artifacts. For tours
always spiced with Jays storytelling, which he runs with
his wife Joanne, call ahead, as this is still an active movie
set (331 W Rockspring Lane, 520-212-2831,
Gammonsgulch.com).
n

15

Bike Listening Tour

What rural Americans think of Obamacare

By Jane Erickson

orty years ago, as our nation was celebrating its

Bicentennial, Paul Gordon, MD, MPH, promised
himself he would someday bicycle across
America. This summer he made it happen.

arrived back in Tucson on July 18. In between, Gordon

cycled 3,255 miles from D.C. to Seattle to listen to
what small-town Americans have to say about the
Affordable Care Act, widely known as Obamacare.

It started on April 21 when Gordon flew to Washington

D.C., where his bike and gear were waiting for him. He

Every day of the trip which Gordon named the Bike

Listening Tour he cycled with friends or family
members or both. They included his
wife, Tucson pediatrician and past
PCMS President Eve Shapiro; their
daughter Miriam, their son Ben, and
UA first-year medical student Laurel
Gray, who caught up with the Bike
Listening Tour in Minnesota, once
summer break began in early June.

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16

It was an amazing trip, said Gordon,

professor of Family and Community
Medicine at the UA College of
Medicine - Tucson. It was everything
I anticipated, and more. We got to
see this beautiful country we live in,
and we learned an enormous amount
about what people think of the
Affordable Care Act.
For Gray, who majored in global
health with a focus on medical
anthropology at ASU, every day of
the trip was truly phenomenal, and a
chance to learn more about barriers to
health care. She is grateful, she said,
to UA College of Medicine Tucson
for covering her travel costs.
The idea for the tour came last year
when Gordon and Shapiro were
backpacking in the Grand Canyon
with their kids; this is no family of
couch potatoes. At one point, their
conversation turned to the Affordable
Care Act. They recognized that the
only opinions most of us hear about
the Act come from politicians and
health-care policy wonks.
The rest of America was not being
heard.
Gordon was due for a sabbatical.
Biking across America to learn what
rural folks think of the Act would fulfill
his long-held dream, and make for an
interesting sabbatical research
project.
SOMBRERO November 2016

According to Gray, Every day of the trip was truly phenomenal.

Paul Gordon at one of his first interviews in western Pennsylvania.

My plan is to arrive in a small town, find that small

caf that I expect many rural towns still have, walk in,
introduce myself to whoever is sitting there, and ask if
they would be willing to talk to me, he said in an
interview before he began the tour.

told Gordon, Yes, we have a responsibility to take

care of people who dont have insurance, and the only
way to do that is to raise taxes. But raising taxes is
equivalent to digging your own grave if youre a
politician. And none of them have the (courage) to
raise taxes.

He would not look for physicians or people enrolled in

the Affordable Care Act, but he would not exclude
them from being interviewed. He would not disclose
what he thinks of the ACA which he considers an
imperfect but possible step toward single-payer health
care, which he advocates and he
would not try to correct any
inaccurate statements about the Act.
He would just listen to and record
The Faces
what people had to say.

In Montana, Gordon listened to a man on a motorcycle,

from Nova Scotia. He said what the president did in
creating the Affordable Care Act was one of the
bravest things a politician has ever done. The man

of Casa are the

The plan worked.

We had more than 115
conversations with people across the
country, Gordon said. There were a
couple of general scenarios. One
was sitting in a caf, and people
would see our jerseys that said Talk
to me about Obamacare, and they
would approach me and start to tell
me what they think. Other times I
would walk up to someone and ask
them if they would be willing to talk.
Quite a few people asked if I was
being paid by the government to go
out and sell Obamacare. I was able to
convince them otherwise.
From a woman in a small town in
South Dakota told Gordon, Well, if
they just didnt call it Obamacare,
maybe people would have liked it
more.
Another woman, in her late 70s,
sitting at a sports bar in Spokane,
SOMBRERO November 2016

James Nicolai, M.D.

Associate Medical Director

As a hospice physician, it is
incredibly satisfying to work with
a team of individuals totally
devoted to easing suffering for
patients and their loved ones.
This is why I became a doctor in
the first place.

520.544.9890 | www.casahospice.com
Hospice services are paid for by Medicare

17

The comments that people made were often

misinformed and some of them actually told me that
they got their information from commercial sound
bites, he said. Nonetheless, the comments they
made were their own impressions and experiences,
and they were legitimate.
I think that we physicians have a lot of work to do to
inform our patients about health-care policy. I think its
important that we educate them about it, just as we
educate them about diabetes and hypertension. I
realize were all stressed for time in the exam room.
Nonetheless, I see it as our responsibility. I know that
many people believe that would be politics, but I dont
agree with that.
In rural America, youll find lifes pace a bit slower, like cows
lazily grazing on ones front yard.

talked about the Canadian health-care system; how

one side feels the system provides incredible health
care for all your medical needs, while the other side
emphatically dislikes having to wait for elective
procedures, he said.
Peoples comments could be categorized as urban or
rural, Gordon said. When we were in Milwaukee and
Madison, and Missoula and Spokane and Seattle,
there were some very positive comments, he said.
But comments in the rural areas were almost
exclusively negative.
For Gordon, the
most important
lesson learned
from the Bike
Listening Tour
was that
physicians could
do more to help
educate patients
about health
insurance
options and
health policy
issues that affect
them directly. He
reported his
impressions in
the October
issue of
Academic
Medicine,
Volume 91, Issue
10: How Can
Physicians
Educate Patients
About Health
Care Policy
Issues?
18

Gordon and Gray had no trouble getting people to talk

to them. We had our purple jerseys that said in bright
yellow Talk to me about Obamacare, and people
really latched on to that, Gray said. Their voices are
not being heard on the national stage, and so when
someone is interested in listening to them, that
generates comfort.
The people Gray listened to were most concerned
about the rising costs of health care. Our follow up
question was, who is to blame for those rising costs,
she said. Some people would say, oh, its the
insurance companies, theyre taking care of the
individual mandate. And others would say its the
politicians fault, they have created too much
regulations, and others would blame the costs on
partisan lines, specifying that President Obama is at
fault for all the wrongs of the Affordable Care Act.
Gray also has co-authored a manuscript with Gordon,
and they are submitting it to various journals. I would
also like to do some reflective writing, but thats going
to have to wait until I find some spare time, she said.
By the numbers, Gordons 3,255-mile Bike Listening
Tour included 79,550 feet of elevation climbing; and
293 hours in the saddle. Grays leg of the tour, from
Minneapolis to Portland, Ore., was about 2,100 miles,
she said.
Our country is magnificent, Gordon said. I would
encourage everyone to get out and see the country.
People were incredibly kind to us. They would always
say, Be safe, be safe. And the truckers always
swayed wide to give us room.
They were long days, and there were probably way
more than half the miles that we rode over where there
were no cell signals. So even if we wanted to listen to
Pandora, we couldnt. There was nothing to listen to
but yourself. It was fantastic.
Read more about the Bike Listening Tour and what
people had to say about the Affordable Care Act at
the blog site bikelisteningtour.wordpress.com.
n

SOMBRERO November 2016

End of Life Care

Coalition promotes End-of-Life

planning and collaboration
Stakeholders gather for country-wide leadership discussion & keynote by Dr. Angelo Volandes;
Open forum, to report back on steps in community-wide collaboration, schedule for Dec. 8.
By Monica Surfaro-Spigelman

broad coalition of stakeholders, led by the Pima

County End of Life Care Coalition (EOLCC) and
sponsored by the Lovell Foundation and
Community Foundation for Southern Arizona, met in
Tucson last month to discuss advance care planning
programs and ways to engage local collaborators
around end of life care conversation, education,
planning and services. To facilitate a community-wide
dialog on this important issue, the EOLCC announced
today that it will host an open forum on Thursday,
Dec. 8, to showcase: 1) areas for action identified at the
September gathering, and 2) anticipated next steps to
advance quality end-of-life care efforts in Pima County,
through enhanced local collaborations and planning
efforts.
On Thursday, September 22, at the
Community Partners Plaza Arboleda
facility, Dr. Angelo Volandes, a national
leader in the end-of-life planning
movement, spoke to more than 100
representatives of community
agencies, nonprofit, religious,
healthcare and business leadership.
Afternoon sessions shared insights,
discussed barriers and opportunities,
and formulated next steps to develop a
plan for end-of-life resources,
education, training and advocacy in
Pima County.
According to EOLCC co-chairs Dr.
Frank Williams and Rev. Karen
MacDonald, the September 22
gathering was a preliminary step,
with the Coalitions December 8
community open forum planned as
another building block in a County
strategy. The Coalition, they say,
intends to be a vehicle to facilitate
collaborations that inspire stronger
end-of-life planning. The December
forum will be held at the YWCA, 525 N.
Bonita Ave., 3-5 p.m.
SOMBRERO November 2016

September 22 Keynote by Dr. Angelo Volandes

Physician and author of the book, The Conversation: A
Revolutionary Plan for End-of-Life Care, Dr. Volandes
gave context to the September 22 discussions. Dr.
Volandes, researcher at Harvard Medical School, is
also the co-founder and president of Advance Care
Planning (ACP) Decisions, a nonprofit foundation that
creates and distributes advance care planning videos.
September 22 Keynote Highlights:

Message to the Tucson gathering: There is no better

time in the history of health care to be a decision
maker. Tucson has a gathering of the right
stakeholders. With nurses, doctors, social workers,

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19

insurers, nonprofits in the same room theres the

opportunity to work together, to get it right.

Setting
perspective: The majority of Americans die

in health care institutions, rather than at home,

often after undergoing intense medical
interventions which were performed because
doctors are trained to save. Advance care wishes
of the patient generally are not identified and family
members may not know advance wishes.

Although
medical teams must be involved in end
of-life decisions, doctors often are not prepared to
talk with patients about end of life. The
conversation must be initiated before critical endof-life medical intervention is required. Patients,
family members and the patients extended
community including social workers and faith
leadership must feel comfortable in talking about
end of life.

Earlier
this year, Medicare began allowing the end
of-life conversation to be a chargeable item in
health care billing, but providers must be properly
trained, according to Dr. Volandes.

Dr.
Volandes organization, as well as others

nationally, is calling for more ways to educate the

public in thoughtful end-of-life conversations that
facilitate the individuals right to choose care
through advance plan directives.

Dr.
Volandes organization has developed a suite of

videos on end-of-life care to support individual

rights in end-of-life decision-making and to support
the doctor-patient relationship. According to a
report published in the Journal of General Internal
Medicine (published in September 2016), building
awareness in individuals resulted in increased
documentation of end-of-life wishes, increased
rates of discharge from hospital to hospice at the
end of life, and decreased average insurance cost
for the last month of life.

Tucson
healthcare leadership needs to help build

awareness and create programs that facilitate

conversations that allow individuals to be in charge
of their doctor-patient relationships and end-of-life
care.

September 22 Leadership Discussions

At the September meeting, small groups identified
challenges faced in local end-of-life care planning
efforts, and discussed best practices that empower
individuals, health care providers, businesses, faith
leadership and others to plan effectively for their
personal end-of-life care as well as the overall quality of
end-of-life care in the community. In particular, the
group discussed how there was a need for a Countywide hub to bring together community resources,
education, training and advocacy, and provide a vehicle
to engage everyone in the community from provider to
volunteer in quality end of life and advance care
planning.

20

About the EOLCC:

The End of Life Care Coalition (EOLCC) is an Action
Team of the Elder Alliance of Pima County, a
collaboration of over 60 diverse organizations dedicated
to ensuring older adults thrive and enjoy quality of life.
The EOLCC began in 2014 as an initiative of Pima
Council on Aging (the designated Agency on Aging for
Pima County), University of Arizona Center on Aging,
and Passages Consulting Group. Funding was provided
by the Community Foundation for Southern Arizona,
Sharon Kent Endowment Fund. The goal was to
provide tools, training and resources to help Pima
County residents discuss and prepare for the end of life.
In June 2015, the Mayors Task Force for Livable
Communities for All Ages, the End of Life Coalition and
the Elder Alliance joined forces. Pima Council on Aging
and the United Way of Tucson and Southern Arizona
provide organizational support, and the Community
Foundation for Southern Arizona and The Lovell
Foundation provide generous funding. The EOLCC now
serves as a resource for end-of-life care planning and
awareness throughout the County, as well as being a
change network to support collaborators and service
providers involved in end-of-life planning. Through
presentations, workshops, and ongoing partnerships,
the Coalition provides education and resources to adults
in Pima County, AZ to increase conversation, planning
and documentation of end of life care wishes.
n
End of Life Care Coalition
Open Forum
Thursday, December 8, 3-5 p.m.
Hosted by YWCA Southern Arizona
YWCA Frances McClelland Community Center
525 N. Bonita Ave, Tucson
EOLCC Open Forum
The Pima County End of Life Care Coalition (EOLCC)
will hold an open forum to invite the community to the
next step in end of life conversation, education,
planning and services. A recent convening session
brought together a diverse group to explore EOL
needs and opportunities in Pima County, and the
results have been compiled to focus Coalition work.
To share results, the Coalition welcomes
representatives from healthcare, non-profit, service
agencies, businesses, faith communities and
community-at- large to learn more about the Coalition,
and to join in a community conversation, collaboration
and commitment to develop key areas identified for
action. This is an opportunity to learn more about
these identified areas of action, share & network in
your area of interest, and become actively engaged
through membership. Watch for additional
information on the upcoming open forum. For more
information on the Coalition, visit Pimaendoflifecare.
com or contact: Susan Kasle, MPH, Planner, Pima
Council on Aging, skasle@pcoa.org 520-546-2006.

SOMBRERO November 2016

AZ Health-e Connecon

Integrating physical and behavioral

health information for better patient care
By Melissa A. Kotrys, Chief Executive Officer, Arizona Health-e Connection

octors and nurses have always been able to

provide better care when they have more
complete information on their patients. Never
has more complete information been more important
than today when health care providers face a future of
value-based health care where payment is based on
value and outcomes rather than the amount or type of
services delivered. Whats more, where more complete
information is especially critical is in managing the
health of the one in five adults with co-morbid physical
and behavioral health conditions.
Arizona Health-e Connection (AzHeC) has taken a
major step toward providing more complete patient
information with the AzHeC Boards recent adoption of
an approach and strategy for integrating physical and
behavioral health data in the statewide health
information exchange. This approach not only includes
addressing state and federal laws regarding the
exchange of physical and behavioral health data, but
also the development of a unified communications and
messaging strategy and a unified fee structure for both
physical and behavioral health providers. The AzHeC
Board eliminated Network participation fees for
physical health providers as of October 2015, and now
the elimination of participation fees has been extended
to include community behavioral health providers.
The value of more complete patient information and
the importance of securely sharing information among
physical and behavioral health providers can be
readily seen in a look at patients with the highest
needs and costs. According to The Synthesis Report
from the Robert Woods Johnson Foundation, about 5
percent of the adult population accounts for half of all
health care spending nationally. A significant part of
this high-need population are the 34 million adults or
17 percent of the adult population that have co-morbid
mental and medical conditions. In fact, numerous
studies have found that co-morbidity between medical
and mental conditions is the rule rather than the
exception. For example, people with diabetes or
chronic asthma self-report depression at two to three
times the rate of the general population, and persons
with cardiovascular disease are at an elevated risk of
having a lifetime anxiety disorder.
SOMBRERO November 2016

A key to providing integrated exchange of physical and

behavioral health data is the ability to manage the
state and federal laws that govern these two types of
data. There are three basic sets of laws that apply: the
Health Insurance Portability and Accountability Act
(HIPAA), the federal substance abuse treatment
privacy laws (42 CFR Part 2 in the Code of Federal
Regulations), and Arizonas health information
organization (HIO) law. AzHeCs integrated HIE
strategy employs a hybrid approach that meets all
state and federal legal requirements for patient
notification and consent while affording all patient
rights under the laws.
The Network currently manages physical health data
according to Arizonas HIO law which provides patients
notice of their right to opt-out of having their
information shared. If patients do not opt out,
authorized providers are able to access the physical
health information of their patients. Under the
integrated plan, behavioral health data is under
restricted access which means that in order to
comply with 42 CFR Part 2, a provider can request
patient consent to access restricted data and then
access the data with affirmative patient consent. In
addition, as long as a patient has not opted-out of
having their information shared, emergency access to
restricted data is available by a provider electronically
affirming that an emergency is taking place. The
Networks current technology vendor has the capability
to restrict access to certain types of information, so no
new technology will be required to operate this new
strategy.
Closely related to the roll-out of AzHeCs statewide
integrated HIE strategy, AzHeC has recently
collaborated with Mercy Maricopa Integrated Care, the
regional behavioral health authority (RBHA) for
Maricopa County, to implement a Network crisis portal
to support the behavioral health crisis countywide. It is
anticipated that this crisis portal will be extended to
RBHAs in the northern and southern areas of the state
later this year.
The elimination of participation fees for community
providers has resulted in strong growth in Network
participation, and adding community behavioral health
21

providers to the list of those with no participation fees

will spur even stronger growth. Since launching its new
technology platform in April of 2015, The Network has
grown from 33 participants to more than 100
participants by the second quarter of 2016, and many
of the newest participants are behavioral health
organizations that have recently joined The Network.
As with other initiatives throughout our history, AzHeC
relied on broad community outreach and engagement
to develop a statewide strategy. Much of the
information gathered over a period of several months
helped to inform and design the plan and its
implementation. In the end, not only was there broad
community support for one statewide integrated health
information exchange for physical and behavioral
health information, there was also a consensus in the
community that one system would provide the best
care and the best outcomes for Arizona patients.
Mental disorders and comorbidity, Goodell, S, Druss BG, Walker,
ER, The Synthesis Project (Policy Brief No. 21), Robert Woods
Johnson Foundation, February 2011.
n
1

Patients improve their

health through
PCMS Walk-With-A-Doc

Statement of Ownership, Management, and Circulation

(All Periodicals Publications Except Requester Publications)

1. Publication Title

2. Publication Number

0 2

Sombrero

4. Issue Frequency

3. Filing Date

5. Number of Issues Published Annually

Events take place at Rillito River Park near Camp

Lowell and Swan Road. Walkers sign in at the
ramada east of Swan Bridge on the south bank.
Physician leaders give a short presentation on a
subject in their range of expertise. The event
continues with a walk and talk session covering
an easy 1.2- or 2.4-mile hike along the parks trail
or paved path beginning at 8 a.m. Walkers are
encouraged to ask questions and interact with the
physician leader.
Remaining 2016 walks are scheduled for
November 12 and December 10. In 2017 events
are planned for January 14, February 11, March
11 and April 8.
If you are interested in serving as one of our
physician leaders, contact Dennis Carey at 7957985 or dcarey5199@gmail.com.

9-23-2016

6. Annual Subscription Price

0Monthly except bimonthly June/July &aug. Sept.

$30

7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 )

Contact Person

Dennis Carey

Telephone (Include area code)

5199 E. Farness Dr, Ste 151, Tucson, AZ 85712-2134

(520)-795-7985

8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer)

5199 E. Farness Dr. Ste. 151, Tucson, AZ 85712-2134

9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank)
Publisher (Name and complete mailing address)

Pima County Medical Society, 5199 E. Farness Dr. Ste 151, Tucson AZ 86712-2134

Editor (Name and complete mailing address)

Bill Fearneyhough, 5199 E. Farness Dr. Ste 151, Tucson AZ 85712-2134

Managing Editor (Name and complete mailing address)

Dennis Carey, 5199 E. Farness Dr. Ste 151, Tucson AZ 85712-2134

10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the
names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the
names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of
each individual owner. If the publication is published by a nonprofit organization, give its name and address.)
Full Name
Complete Mailing Address

Pima County Medical Society

5199 E. Farness Dr. Ste. 161, Tucson, AZ 85712-2134

11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or
None
Other Securities. If none, check box
Full Name

Complete Mailing Address

12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one)
The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes:
Has Not Changed During Preceding 12 Months
Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement)
13.
Publication
PS Form
3526,Title
July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931

14. IssueSee
Dateour
forprivacy
Circulation
Below
PRIVACY NOTICE:
policyData
on www.usps.com.

Sombrero

Aug-Sept. 2016

15. Extent and Nature of Circulation

No. Copies of Single

Average No. Copies
Issue Published
Each Issue During
Preceding 12 Months Nearest to Filing Date

a. Total Number of Copies (Net press run)

900

(1) Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid
distribution above nominal rate, advertisers proof copies, and exchange copies)

Walk-With-A- Doc is a national organization

founded 10 years ago to familiarize people of all
ages to the benefits of regular exercise. PCMS
has sponsored the walks since 2011. Physicians
are encouraged to urge patients to participate in
the program.

b. Paid
Circulation
(By Mail
and
Outside
the Mail)

(2)

Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid

distribution above nominal rate, advertisers proof copies, and exchange copies)

(3)

Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers,
Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS

(4)

Paid Distribution by Other Classes of Mail Through the USPS

(e.g., First-Class Mail)

c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)]
d. Free or
(1) Free or Nominal Rate Outside-County Copies included on PS Form 3541
Nominal
Rate
Distribution (2) Free or Nominal Rate In-County Copies Included on PS Form 3541
(By Mail
and
Free or Nominal Rate Copies Mailed at Other Classes Through the USPS
Outside
(3)
(e.g., First-Class Mail)
the Mail)
(4)

900

15

14

626

580

641

594

Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)

e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))

f. Total Distribution (Sum of 15c and 15e)

g. Copies not Distributed (See Instructions to Publishers #4 (page #3))

h. Total (Sum of 15f and g)

i. Percent Paid
(15c divided by 15f times 100)

42

38

48

43

689

637

211

263

900

900

Statement of Ownership, Management, and Circulation

(All Periodicals Publications Except Requester
Publications)
93%
93.25%

Electronic
Copyelectronic
Circulation
* 16.
If you
are claiming
copies, go to line 16 on page 3. If you are not claiming electronic copies, skipAverage
to line 17No.
on Copies
page 3.
Each Issue During
Preceding 12 Months
a. Paid Electronic Copies

b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a)
c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a)
d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c 100)

No. Copies of Single

Issue Published
Nearest to Filing Date

0
641

594

689

637

93%

93.25%.

I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price.
17. Publication of Statement of Ownership

XIf3526,
the publication
is (Page
a general
publication of this statement is required. Will be printed
PS Form
July 2014
2 ofpublication,
4)

Publication not required.

November 2016
in the ________________________
issue of this publication.
18. Signature and Title of Editor, Publisher, Business Manager, or Owner

Date

I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form
or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions
(including civil penalties).

22

SOMBRERO November 2016

PCMS Alliance

Alliance and McKinney keep

Mobile Meals rolling
By Dennis Carey Photos Courtesy Mobile Meals of Tucson

n December 7, the Pima County Medical Society

Alliance (PCMSA) hosts its Annual Holiday
Luncheon to benefit Mobile Meals of Tucson. It
will be the first one with Tamara McKinney as Executive
Director of an organization founded by PCMSA in 1971.
The PCMSA Holiday Luncheon is expected to raise
$13,500. It will provide 225 meals per day for 60 days.
McKinney officially became Executive Director in June
following the retirement of Priscilla Altuna, who served
in the position for nearly 12 years. McKinney was
Mobile Meals Director of Development a year prior to
her promotion. She takes over a program that has
seen a lot of growth and change since that first year.
Before joining Mobile Meals, McKinney spent four years
with Reading Seed, a childrens literacy program in
Tucson. She has also served as co-chair of the Tucson
Festival of Books, which helps when organizing large
fund-raisers.
Mobile Meals now has more than 20 financial partners,
10 health care partners, five staff members and 350
volunteers who serve 33 routes, five days a week,
delivering meals to homebound adults.
It is the volunteers that are the heart and soul of Mobile
Meals, said McKinney. They arent just delivering
meals, but providing a community connection. For many
of our clients we provide an important social and safety

Mobile Meals of Tucson is celebrating its 45th year of providing

meals to home-bound adults. Staff members are (L-R) Executive
Director Tamara McKinney, Program Coordinator Jessica
ODonnell and Program Manager Stephanie Swift.

need as well as a healthy meal. Many of our volunteers

are retired and are looking to give back to the
community. Others have flexible work schedules.
Referrals come from physicians, care givers and other
health professionals, or directly by a potential client. An
interview is scheduled to see if they are suitable for the
program. To qualify for Mobile Meals, clients cannot
prepare adequate meals regularly, but are able to eat
without assistance. Approximately 94 percent of Mobile
Meals clients have special dietary needs. Special meals
offered include diabetic, low-sodium, cardiac, renal, soft
and pureed. The meals are prepared at health care
centers such as hospitals and long-term care centers
under the guidance of dieticians.
Mobile Meals is not part of the Meals on Wheels
program and does not receive any federal funding. It
relies on direct donations and fund-raising events like
the PCMSA Annual Holiday Luncheon and Stars on the
Avenue events. Mobile Meals also holds an annual Fall
Fare at St. Philips Plaza with many local restaurants
donating food and funds. This years Fall Fare wrapped
up on October 30.

Volunteers like Randy Van Hulle work the 33 Mobile Meals of

Tucson routes. Van Hulle has been a volunteer since 2011.
SOMBRERO November 2016

The future of Mobile Meals is in experienced hands.

McKinney spent four years with Reading Seed, a
childrens literacy program in Tucson. She has also
served as co-chair of the Tucson Festival of Books,
which helps when organizing large fund-raisers.
23

T he 45t h Annual
Pima County Medical Society Alliance
Holiday Luncheon
is scheduled for

December 7
at

Fleming's Steakhouse and Wine Bar

6360 N. Campbell Avenue.
Nutritional food trays such as this are delivered to more than 200
clients each day.

The association with the PCMS Alliance continues to

be an important part of our organization, McKinney
said. We hope to expand our services in Pima County
and will certainly need the continued help of the
Alliance to reach our goals. I look forward to working
with them.
n

24

Tickets are $45

and include choice of

petite filet, salmon or vegan entre.

There will be a
silent auction, raffle and
Mrs. As Apples and Holiday Logs
will be on sale.

SOMBRERO November 2016

Mobile Health Program

Forty years of health care on wheels

By UA HS Public Affairs

n October 1976, what was then the UA Rural Health

Office launched the Mobile Health Program with
Augusto Ortiz, MD, a UA family physician, as
medical director.
Dr. Ortiz and his wife, Martha Ortiz, who managed
clinic details, took their clinic on wheels an RV
donated by a Tucson missionary and outfitted with two
small exam rooms to such tiny communities as the
Yaqui Pueblo and Picture Rocks northwest of Tucson;
Continental and Amado, south of Green Valley; and
later into Cochise County.
Some families were so poor that their homes lacked
electricity and running water. But the Mobile Health
Programs payment policy was then what it is today:
Pay if you can, and if you cant, you still will get care.
In addition to providing medical care, the Ortizes, with
their staff and volunteers including medical students,
physician residents, and trained community health
workers known as promotoras encouraged
communities to establish their own clinics. As proof
their encouragement paid off, clinics thrive today in
Picture Rocks, Continental and Amado.
Dr. Ortiz died in 2006, but Martha, now 92, continues
to serve on the advisory board that advocates and
raises funds for
the program.
How much of a
difference does
the program
make? Martha
Ortiz recalls the
experience of a
young woman
who had four
miscarriages,
before becoming
pregnant a fifth
time. A friend told
her about the
Mobile Health
Program, through
which she
received

SOMBRERO November 2016

Myra Muramoto, MD

appropriate
prenatal care for
the first time. She
carried her fetus
full-term, then
gave birth to a
perfectly healthy
baby boy.
For many
individuals and
families, the
Mobile Health
Program is the
only place where
they can get
Martha Ortiz
health care that
they trust, said Ravi Grivois-Shah, MD, the programs
medical director and associate professor in the UA
College of Medicine Tucsons Department of Family
and Community Medicine, which now oversees the
program.
There always will be the need for this kind of
program, he said, so our goal is to make our program
sustainable into the future.
Since its grass-roots beginnings, the UA Mobile Health
Program has received financial support from a variety
of funders, including Banner Health, the UA, Pima
County, non-government organizations and private
donors. Recent grants from Delta Dental of Arizona
Foundation, Arizonas First Things First childdevelopment program and the March of Dimes support
prenatal care, well baby check-ups and preventive
dental care for children and adolescents in Tucson and
surrounding communities.
Family and Community Medicine is extremely proud
of the Mobile Health Programs service to our
communities over the past 40 years, said department
head Myra Muramoto, MD, MPH. It also has enabled
generations of medical students and other health
professions students to experience the satisfaction of
providing care to rural and underserved people. The
Mobile Health Program truly brings together our
departments missions of service, teaching and
community outreach.
25

Forty for Forty to Celebrate Four Decades

of the Mobile Health Program
On Sunday, Nov. 13, the Mobile Health
Program will celebrate its 40 years with an
afternoon party open to the community, with
refreshments, a raffle, and entertainment by
Mel Rivers, formerly with the rock and soul
group The Drifters, of Stand by Me fame.
Suggested donation is $40 per person, or $4
for students.
n

Forty for Forty

Sunday, Nov. 13
3 to 5 p.m.
St. Marks
Presbyterian Church
3809 E. Third Streetm Tucson
RSVP to Lupita Loftus at
loftusm@email.arizona.edu,
or
(520) 626-0442

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Contact Dr. George Makol at Alvernon Allergy, phone
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One NovaSure Endometrial Ablation RF Controller
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26

SOMBRERO November 2016

The RadVision Mobile App has arrived!

Introducing our new
iOS Mobile App!
Our
Mobile App allows you to access patient reports
quickly and easily from your hand-held device. This app is also
HIPAA-compliant, which ensures safety for you and your patients
personal health information.
Directions:
Go to the iOS App Store.
Search for our mobile app partner Royal Solutions Group.
Download Royal Solutions Group app.
Enter access code Tucson.
Enter username and password to begin reviewing reports.
If you do not have a username and password, please call
the RadVision Hotline at (520) 901-6747.

Benefits Include
Alerts for finalized
patient reports
Customizable notifications
Alert preferences
User friendly interface
Compatible with
iPhone and iPads
(Android app coming soon)
Free download from
the iOS App Store

For more information, contact RadVision Technology Services at (520) 901-6747 or radvision@radltd.com.
A TUCSON TRADITION FOR MORE THAN 80 YEARS

radltd.com | (520) 901-6747 |

SOMBRERO November 2016

27

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28

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SOMBRERO November 2016