october 2015 sombrero

7/21/2019 October 2015 Sombrero

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SOMBREROP i m a C o u n t y M e d i c a l S o c i e t y

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

O C T O B E R 2 0 1 5

Tumamoc Hill: To your health!

Paramedicine: Coming on strong in Rio Rico

The old Presidio: Spanish garrison medicine


http://slidepdf.com/reader/full/october-2015-sombrero 2/242 SOMBRERO – October 2015


http://slidepdf.com/reader/full/october-2015-sombrero 3/24SOMBRERO – October 2015 3

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F O O T

H I L L

S C E N T R A L

Official Publication of the Pima County Medical Society Vol. 48 No. 8

Printing West PressPhone: (520) 624-4939

E-mail: [email protected]

PublisherPima County Medical Society 5199 E. Farness Dr., Tucson, AZ 85712Phone: (520) 795-7985Fax: (520) 323-9559

Website: pimamedicalsociety.org

EditorStuart FaxonE-mail: [email protected]

Please do not submit PDFs as editorial copy.

Art Director

Alene Randklev Phone: (520) 624-4939Fax: (520) 624-2715E-mail: [email protected]

Pima County MedicalSociety Officers

PresidentMelissa Levine, MD

President-Elect Steve Cohen, MD

Vice-President Guruprasad Raju, MD

Secretary-TreasurerMichael Dean, MD

Past-President Timothy Marshall, MD

PCMS Board of DirectorsEric Barrett, MD

David Burgess, MD

Michael Connolly, DO

Jason Fodeman, MD

Howard Eisenberg, MD

Afshin Emami, MDRandall Fehr, MD

G. Mason Garcia, MD

Jerry Hutchinson, DO

Kevin Moynahan, MD

Wayne Peate, MD

Sarah Sullivan, DO

Salvatore Tirrito, MD

Scott Weiss, MD

Leslie Willingham, MD

Gustavo Ortega, MD (Resident)

Snehal Patel, DO (Alt. Resident)

Joanna Holstein, DO (Alt. Resident)

Jeffrey Brown (Student)

Juhyung Sun (Alt. Student)

Members at Large

Richard Dale, MDCharles Krone, MD

Jane Orient, MD

Board of Mediation

Timothy Fagan, MD

Thomas Griffin, MD

Evan Kligman, MD

George Makol, MD

Mark Mecikalski, MD

Arizona MedicalAssociation OfficersThomas Rothe, MD

immediate past-president

Michael F. Hamant, MDsecretary

At Large ArMA Board R. Screven Farmer, MD

Pima Directors to ArMA

Timothy C. Fagan, MD

Timothy Marshall, MD

Delegates to AMAWilliam J. Mangold, MD

Thomas H. Hicks, MD

Gary Figge, MD (alternate)

SOMBRERO (ISSN 0279-909X) is published monthlyexcept bimonthly June/July and August/September by thePima County Medical Society, 5199 E. Farness, Tucson,

Ariz. 85712. Annual subscription price is $30. Periodicalspaid at Tucson, AZ. POSTMASTER: Send address

changes to Pima County Medical Society, 5199 E. FarnessDrive, Tucson, Arizona 85712-2134. Opinions expressedare those of the individuals and do not necessarily repre-sent the opinions or policies of the publisher or the PCMSBoard of Directors, Executive Officers or the members atlarge, nor does any product or service advertised carry theendorsement of the society unless expressly stated. Paidadvertisements are accepted subject to the approval of theBoard of Directors, which retains the right to reject anyadvertising submitted. Copyright © 2015, Pima CountyMedical Society. All rights reserved. Reproduction inwhole or in part without permission is prohibited.

SOMBRERO

Executive DirectorBill FearneyhoughPhone: (520) 795-7985

Fax: (520) 323-9559E-mail: [email protected]

AdvertisingPhone: (520) 795-7985Fax: (520) 323-9559E-mail: [email protected]



5 Dr. Melissa Levine: Somemes we must take

stock of what is most important.

6 Leters: AAPS forecast on Medicare.

8 Milestones: For doctors Clavenna, Goldberg,Schram, and Wong.

10 PCMS News: AHCCCS expansion ruling appeal

heads for Arizona Supreme Court.

12 Public Health: Dr. Ron Spark helps improve

Tumamoc Hill.

14 In Memoriam: Dr. Roland V. Murphy dies at 94.

15 Behind the Lens: Driing along with those

(pesky but hardy) tumbling tumbleweeds.

17 Paramedicine: Rio Rico test case looks good.

20 Time Capsule: Dr. Rudy Byrd has a military

medicine part to play in the Tucson Presidio

Trust for Historic Preservaon’s 18th- and 19th-

century exhibion starng this month.

Brain Trouble

What brain problem is represented when we call one neurology

pracce by the name of another? Seven obituaries in one issue? With

two CNI news items? Whatever the diagnosis, we glaringly erred in

our June-July issue obituary for Dr. Bill Masland, who died in May,

when our editor somehow claimed the nonsense that the former

Neurological Associates of Tucson is now Carondelet Neurological

Instute. In fact, Markeng Manager Alanna Gonzales reminded us,

Neurological Associates of Tucson sll exists, and is doing business asCenter for Neurosciences. Our apologies to her and our member

doctors Norton, Callahan, Rivero, Sanan, Song, and Valdivia. The

mind’s mysteries are endless, and we salute the seekers.

Also, in our August-September Membership prole of Pima

Dermatology, we had some more name confusion. The pracce

administrator is Rachel Chanes. The markeng and cosmec

manager is Sarah Cadrobbi.

On the Cover

This tumbleweed patch was so dense, the tripod could not be placed.

It’s a maturing Russian thistle with a red-and-purple-striped stem, its

leaves becoming tube-like, with pointed ends. The small ower is

2mm across. Shot with Nikon D600, Tamron 70-300mm on macro

seng, ISO 400, f.5.0, 1/1600th second, hand-held (Dr. Hal Tretbarphoto).

Inside


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Our members are our essenceBy Dr. Melissa Levine

PCMS President

Happy New Year!

Rosh Hashana, Sept. 13-15, newyear 5776 on the Hebrewcalendar, marks the the HighHoly Days for Jews around theworld. The New Year is a me totake stock, to atone, and tothink about what’s important.This is also somewhat of a newstart for your medical society.

Last Friday, Sept. 11, I signedthe papers to sell the PCMS building. While this was not my ideaor project, if I were simply a board member, I would have votedfor it. Good or bad, it will likely become my legacy as PCMSpresident. Only me will tell us if it was the right move. It gives a

needed infusion of cash into our coers. It removesfrom us an encumbrance that I consider a growingliability. I hope it will make us more exible andbeer able to meet the needs of our members.

Many of you have read the me-line in last month’s

Sombrero about the sale of the PCMS building. If so,I am sorry to be repeve, but I think a fewhighlights bear repeang. At our March 2014 boardmeeng, Dr. Jim Klein and a few others presentedideas about ways to save money and renovate thebuilding. The board, and our execuve director,looked into those. In October 2014, Dr. TimothyMarshall wrote his editorial in Sombrero about the

health of the PCMS building. In that discussion henoted that members had received a survey asking ifthey would be willing to contribute to therenovaon, and asking members to vote.Approximately 12 percent of members answeredthat survey, and it was two-to-one against.

My rst Sombrero column talked about relevance.The Execuve Commiee and the Board ofDirectors struggle with that. How do we increasethe society’s relevance? I am sll searching for thatanswer, but one of the ways is to have the funds forlobbying the legislature, or the local city council,about the needs of physicians and our paents.Aer all, I think that despite our dierences, that iswhat we want. We want to take care of ourpaents, and be able to take care of our families.

We invite members to give us ideas, to share in civildiscourse, and to engage in conversaon intendedto enhance understanding. Your board wants toknow what the needs of the members are, andwhat PCMS can do for them.

In the past few weeks I have received some rather

vitriolic leers, based on misinformaon regarding

the sale of the building. I have taken the me to

answer most of them. As your president, I felt that

was my responsibility. It is now me to move forward.

I’ll paraphrase a story my Rabbi recently told. Bob Baert is thetrainer of American Pharaoh, the horse that won the Triple Crownof thoroughbred racing this year, the rst to do so in 37 years.Baert is also from Southern Arizona. What I did not realize isthat Baert came within a nose of a Triple Crown in 1998 with ahorse named Real Quiet . As the photo-nish showed, Victory

Gallop came out of nowhere and won by a nose. As Bob Baertrealized he had lost the race—the Triple Crown and a $5 millionprize—his four-year-old daughter Savannah said, “Daddy, you sllhave me.”

Rabbi Tom implored those present to take stock of what isimportant. I implore you to do the same. The medical societybuilding was not the Washington Monument, and the medicalsociety is not the building. We sll have what is important. Wehave a good sta who work hard for us, we have good peoplewho volunteer their me to serve—and we have our members.

L’Shana Tova Tikatavu. May you all be inscribed for a goodyear. n

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Leers

Medicare unsustainableTo the Editor:

Thanks for Dr. Levine’s interesng history of Medicare, Parts 1 and 2 [May and August-

September Sombrero]. They read rather like the history of the PCMS building. People tried

and tried unl they got it. And now it is a nancial “disaster waing to happen.”

The opmisc predicons about PCMS didn’t happen. The gloomy predicons about

Medicare made by the Associaon of American Physicians and Surgeons, did.

The 2015 Trustees Report on Medicare is full of hopeful speculaons. It uses the word“insolvency” only once, but acknowledges that (1) the number of beneciaries is increasing

faster than the number of workers; (2) Part A expenditures have exceeded income every

year since 2008; and (3) the Trustees’ minimum standards expressed as short-term nancial

adequacy and long-term actuarial balance have not been met for more than a decade.

The trustees also acknowledge that “if [Trust Fund] assets were depleted, Medicare couldpay health plans and providers of Part A services only to the extent allowed by ongoing tax

revenues—and these revenues would be inadequate to fully cover costs. Beneciary access

to health care services would rapidly be curtailed.”

They assume that Congress will somehow “nd” the money [in the future hopes andopportunies of the younger generaon], but as AAPS’s journal editor Dr. LawrenceHuntoon points out, “There is no way to ‘manage’ a wealth transfer Ponzi scheme to make

it nancially sustainable.” He concludes that Medicare at 50 is “terminally ill.” (see hp://

www.jpands.org/vol20no3/huntoon.pdf).Sincerely,

Jane M. Orient, M.D.

Tucson

Dr. Orient is AAPS execuve director and a PCMS past-president.

n

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Milestones

Dr. Clavenna joins Carlson ENTOtolaryngologist and sinus

and allergy specialist Mahew

Clavenna, M.D. recently joined

Carlson ENT.

Aer earning his bachelor’s

degree in biochemistry at

Trinity University in San

Antonio, Texas, he earned his

M.D. in 2009 at Louisiana

State University School of

Medicine, Shreveport, where

he was elected into the Alpha

Omega Alpha Honor Society.

While in med school, he was

introduced to otolaryngology.

He completed a general surgery internship and otolaryngology

surgical residency at Louisiana State University Health,

Shreveport. Dr. Clavenna then completed a Fellowship in sinus,

allergy, and anterior skull base surgery at Vanderbilt University,

Nashville, Tenn. There he trained under internaonally known

surgeons, doctors Rick Chandra, Paul Russell, and Jusn Turner.

In the Fellowship he focused on advanced sinus surgeries,

including management of frontal sinus disease, nasal and skull

base tumors, pituitary surgery approaches, ophthalmological-

related procedures, and treatment of allergies. Many of these

cases were performed in conjuncon with neurosurgeons and

ophthalmologists.

Dr. Clavenna says that one of his fondest memories fromFellowship involved treang a paent transferred to Vanderbilt as

an emergency case for severe sinus disease encroaching on vision

in the paent’s right eye. Using his recently learned endoscopic

sinus surgery techniques with the aid of image guidance, Dr.

Clavenna was able to successfully treat and drain the infecon

and preserve the paent’s vision.

“Dr. Clavenna moves to Tucson with the desire of helping those in

the community with their ear, nose, and throat-related

problems,” the pracce reports. “He is the rst Fellowship-

trained sinus and anterior skull base surgeon to join a private

pracce group in Tucson. Though he has a passion for nasal,

sinus, and allergy related disorders, he also enjoys treang the

full range of ENT related issues, from neck masses to ear surgery.”

In his free me Dr. Clavenna enjoys spending me with his wife

and in the outdoors, and looks forward to taking advantage of our

wonderful Arizona surroundings.

Dr. Goldberg stays on the moveIt’s proven to be an evenul year for Gerald N. Goldberg, M.D.,

owner and medical director of Pima Dermatology in Tucson,

proled in our last issue.

At year’s start Dr. Goldberg was elected president of the Arizona

Dermatology and Dermatologic

Surgery Society (ADDSS). This

year, ADDSS has been focused

on HB 2493, the bill that

would ban minors (under 18)

from using indoor tanning

devices. “ADDSS and

concerned Arizona medical

providers urge you to take

acon,” Dr. Goldberg said.“You may sign the peon

urging Arizona legislators and

Gov. Doug Ducey to act now to

protect Arizona minors from

tanning beds.” To learn more

or to sign the peon, please

visit: hps://www.change.org/p/arizona-state-house-arizona-

state-senate-arizona-governor-protect-arizona-minors-from-

tanning-beds.

Dr. Goldberg has lectured throughout the U.S. over the past eight

months, including the Orlando Dermatology Aesthec & Clinical

Conference (ODAC) in Orlando, Fla. in January. He presented on

“Challenging Cases From a 30-Year Experience—or, Adventures

and Misadventures in Laser Therapy,” and led the “Fraconal and

Full Ablave CO2 Laser Skin Rejuvenaon Workshop.”

He also lectured at the American Society for Laser Medicine &

Surgery (ASLMS) 2015 Annual Conference in Kissimmee, Fla. in

April. As a faculty member of ASLMS, Dr. Goldberg led a number

of talks for the “Fundamentals in Health Care” course. His talks

included, “Addressing Complicaons of Laser Procedures,”

“Taoos, Pigmented Lesions, Melasma, and Laser Treatment of

Darker Skin Types,” and “Video Demonstraon and Discussion of

Laser Endpoints.” His plenary session talk was “Combinaon

Laser Modalies for the Treatment of Skin Rejuvenaon and

Complex Vascular Lesions.”

Dr. Goldberg spoke at the Noah Worcester Dermatological

Society’s 57th Annual Meeng April 29-May 3 in Asheville, N.C.,

presenng his “challenging cases” talk, and he reviewed laser

treatments for skin over the past 30 years. Work on taoos,

children’s birthmarks, rosacea, skin rejuvenaon, scar revision,

and wrinkles were among the topics. In May, he spoke at the

UofA Dermatology Grand Rounds with his presentaon, “Lasers:

A 30-Year Experience.”

This fall Dr. Goldberg introduces Pima Dermatology’s 17th laser

modality, the Sciton Halo. “The world’s rst hybrid fraconal laser

delivers both ablave and non-ablave wavelengths to the same

or dierent microscopic treatment zones to provide ablave

results, with non-ablave downme,” Dr. Goldberg said. “Pima

Dermatology is the only dermatology physician pracce in Tucson

to oer this new and sophiscated laser.”

Rounding out a year of advancements, Dr. Goldberg and his

associates welcome Sarah E. Schram, M.D. to their team. Board-

cered by the American Board of Dermatology, Dr. Schram

specializes in Mohs skin cancer surgery with a special interest in

cutaneous oncology and cosmec dermatology. She is thoroughly

skilled in surgical dermatology, cosmec dermatology, and lasers.

Dr. Schram earned her M.D. at University of Minnesota Medical



School. She achieved

academic honors with the

Glasgow-Rubin Citaon for

Academic Achievement, and

was elected to the presgious

Alpha Omega Alpha Honor

Medical Society. She completed

her dermatology residency at

University of Minnesota

Medical School in 2011, andreceived extensive training in

Mohs and laser surgery during

a Procedural Dermatology

Fellowship at the University of

Minnesota in 2012.

Prior to joining Pima Dermatology, Dr. Schram was a dermatologic

surgeon and assistant professor at University of Minnesota

Medical School. Dr. Schram began seeing paents on Sept. 1.

Dr. Goldberg is a Clinical Professor of Dermatology at the

University of Arizona where he has been on faculty since 1984

instrucng medical students and residents. He is a preceptor for

dermatology residents for the American Society of DermatologicSurgery (ASDS) as well as the ASLMS. He also lectures throughout

the year at Canyon Ranch, educang guests from all over the

world about the latest trends in dermatology, including an-aging

treatments and products.

Dr. Wong joins Rena CentersRena Centers reports that Ryan K. Wong,

M.D. has joined the pracce, which

includes PCMS members George S. Novalis,

M.D. andMartn A. Worrall, M.D.

Tucson nave Dr. Wong is a vitreorenal

surgeon. He earned his bachelor’s degreein biology with a minor in chemistry at the

University of Pennsylvania, Philadelphia. He

earned his M.D. at Weill Cornell MedicalCollege of Cornell University, New York.

He did his internship at the Hospital of St.

Raphael and his ophthalmology residency

at Yale-New Haven Hospital/Yale University,

both in New Haven, Conn. Dr. Wong thencompleted a two-year vitreorenal

fellowship at the Jules Stein Eye Instute,

University of California at Los Angeles.

Dr. Wong is cered by the American Boardof Ophthalmology. He is a member of theAmerican Society of Rena Specialists,

American Academy of Ophthalmology, the

Associaon for Research in Vision and

Ophthalmology, and AMA. As a naveTucsonan, Dr. Wong says he is excited to

return and serve the community in which

he grew up.

Dr. Wong has extensive training andexperience in management of medical and

surgical diseases of the rena and vitreous,

including severe diabec eye

disease, trauma, and

proliferave vitreorenopathy.

He has also been acve inacademic medicine and

research, having given

numerous oral and posterpresentaons at naonal and

internaonal meengs.

Addionally, he has wrien

book chapters and severalpapers in peer-reviewed

journals.

Rena Centers Northwest,

East, and Southwest say they

are “fully equipped with state-

of-the-art technology for diagnosis and outpaent treatment of

renal disorders. The highly trained sta strives for excellence in

care, and parcipates in providing consultave, diagnosc, and

treatment services within one oce visit when needed, an

important me saver for working and out-of-town paents.

Treatment of renal tears and detachments, as well as diabec

renopathy and age-related macular degeneraon, constute a

major part of the pracce.”

Dr. Wong accepts Medicare Assignment, and is a parcipang

provider for all area health plans, including AHCCCS and TRICARE.

Central Appointments: 520.742.7444 or 800. 535-2484. n



PCMS News

Judge rules AHCCCSexpansion constuonalMaricopa County Superior Court Judge Douglas Gerlach ruledrecently that the simple majority vote that expanded AHCCCS in2013 was constuonal, ArMA’s Medicine This Week reported in

September.

Last December, the weekly reported, the Arizona Supreme Courtruled to allow a lawsuit challenging Gov. Jan Brewer’s AHCCCS(Arizona’s Medicaid program, the Arizona Health Care CostControl System) expansion plan to move forward. The high courtagreed that 36 Republican legislators could sue Gov. Brewer overthe legality of a hospital assessment that funds the expansionplan, which was passed by a bare majority in the legislature.

The Goldwater Instute, suing on behalf of the legislators, arguedthat the assessment meets the criteria of a tax, and thereforerequires a two-thirds majority in the legislature. State aorneyscountered that the assessment was not a tax because it iscollected from hospitals rather than the broad populaon.

Without the assessment, Arizona would not have the matchingfunds needed to pay its share of the expansion that is nowcovering about 255,000 low-income Arizonans.

In his ruling, Judge Gerlach stated that since hospitals directlybenet from the assessment, it is actually a fee rather than a tax.As the judge himself pointed out during the court hearing, hisruling meant lile at that point because appeals would be ledregardless of his decision. The case will ulmately be decided bythe Arizona Supreme Court.

The Arizona Medical Associaon fully endorsed and acvely

supported Gov. Brewer’s work to expand the AHCCCS program,and said it will connue to closely monitor the lawsuit’s progress.

Are you feeling narrower?The majority of Arizona medical marketplace plans arecompromised of narrow networks, reports a new study by theUniversity of Pennsylvania’s Leonard Davis Instute of HealthEconomics, noted by ArMA’s Medicine This Week .

The study found that the prevalence of narrow physician networksin the federally dened Health Insurance Marketplaces varieswidely by state. It considers networks narrow if 25 percent orfewer physicians in a rang area parcipate. According to thestudy, 73 percent of qualied health plans oered on theMarketplace in Arizona in 2014 were comprised of these narrow

networks, making Arizona the h highest state in terms of narrownetwork prevalence. (Source: AzHHA Connecon, Aug. 28, 2015)

Doc compensaon surveyedThe American Medical Associaon recently released results of areport on its 2014 Physician Pracce Survey detailing how

physicians outside of solo pracce are paid. The survey, completedby 3,500 physicians around the country, idened six trends:

• Slightly more than half of physicians (51 percent) reportedbeing paid by mulple methods.

• Salary and producvity-based payment were the mostcommon payment methods.

• On average, half of physicians’ total compensaon wasearned from salary.

• Being employed didn’t necessarily mean a salary. • Outside of group pracce, salary was more oen a key facto

than inside group pracce. • Physician payment methods vary widely across speciales.

The study found that while the structure of physician payments

has changed lile since 2012, the use of producvity-based payand bonuses both increased by about three percent. For moreinformaon, and to access the AMA survey report, read AMAWire for Aug. 25, 2015. [This story noted by ArMA’s MedicineThis Week.] n

Members’ Classifieds

ATTENTION CARDIOLOGISTS – Very busy central Tucsoncardiology office is seeking an experienced cardiologist to join itspractice. Interested candidates contact Denise at [email protected] resume or any questions about the position.



Public Health

Friends make a healthier Tumamoc HillBy Ronald P. Spark, M.D.

The 7,000 or so walkers per

week on Tumamoc Hill will

now nd refrigerated, lteredwater from a refurbished fountain

at the hill’s halfway point. How

that happened is a labyrinthine,

but delighul and ulmatelyvictorious tale of persistence.

The incredibly popular Tucson

recreaonal site is accessed by

Anklam Road, just south of the

Carondelet St. Mary’s Hospitalcampus. While UofA sciensts

work there during the day,

walkers can enjoy the one-and-

a-half-mile road anyme except 7:30 a.m. to 5:30 p.m. Mondaythrough Friday.

Set aside from open cale grazing in 1903, Tumamoc Hill is the

world’s oldest desert ecology site, as ranked by scienc papers

from its reclamaon work. The volcanic outcropping and

surrounding area have been inhabited for more than 4,000 years,and their archaeology is prime.

The hill’s period basalc rock Tumamoc Desert Laboratory

buildings are part of its Naonal Historic Place registry. In addion

to hundreds of Sonoran plant varies, it has resident deer and

javelina herds. Bobcat and snake sighngs are occasional. Walkers

have rarely reported fox or wolf.

Tumamoc Hill is controlled by the UofA Department of Science.

Monthly science lectures and docent programs are designed toengage public support. The hill’s proximity to downtown allows

Tucsonans easy access to enjoy a prisne desert environment.

Since 2012 Friends of Tumamoc (FOT), of which I am the founding

member, has placed a bike rack at the entry point, and six benches

along the path. Once the bench actually helped in a medicalemergency—certainly a good thing—but the benches have a

spiritual use as well. They encourage walkers to pause and see

what’s around them, a natural respite in the midst of a metro area.

The bike racks help bikers feel secure as they walk up the three-mile round-trip to the top and back. Now we have added a water

fountain and also hope it will save the hill from plasc water bolelierers. Several FOT members pick up boles on their walk,

looking forward to the day when there will be none.

I started Friends of Tumamoc to fund such improvements. Ourcollaborator, Owen Davis, Ph.D., UofA scienst based on the hill,

searched for aordable items and supervised installaon. FOT is an

informal organizaon made up mostly of morning walkers (contact

me at [email protected] for more informaon). Owen runs theTumamocWalkers homepage. Next me you e up your bike, rest

at a bench stop, or taste the delicious refrigerated water, consider

joining the Friends!

Our latest improvement’s genesis dates to when the annual blast

The unassuming but victorious watercooler fountain onTumamoc Hill (Bill Rauch photo).

furnace of a Tucson May had descended upon Tumamoc Hill. Even

then, thousands of Tucsonans come to Tumamoc Desert Preserve

to enjoy the narrow, paved asphalt path elevang 752 feet over amile-and-a-half of Sonoran landscape. It’s quite a physical

challenge to negoate even in more temperate temps. But in the

summer months, it can be a potenal public health hazard,

especially without any available water.

This was the case two summers ago when on that very hot Maymorning, already past 90 degrees at 7 a.m., I resolved to confront

the water issue as a public health threat. And so it was that I spoke

to Owen Davis, pitching the idea of a water fountain midway up

the hill’s path.

“Owen,” I said, “I can ask the hill walkers for donaons for a waterfountain, just as we did for the paths’ six benches, and the bike

racks at the Anklam Road entrance.”

“Great idea,” he said. “I’ll look for a vintage surplus water fountain

in the UofA storage, one that’s appropriate for the Tumamoc Hill’shistoric designaon.”



Weeks pass, and sucient money is raised.

“I found an anque porcelain water bubbler,” Owen said. “It’s

gorgeous, but it needs parts. Even ‘Bonnets and Stems’ doesn’t

have parts going back to the 1930s. I’ve had a watch on theTucson recycling stores, too. No luck. The ones on EBay are way

out of our range. But I’ll keep looking.”

Last Fall arrives with good news from Owen. “I found a campus

excess water cooler, but I’m sll looking for parts to hook it up.”

It’s now December and quite cold, which arguably explains thenear-glacial pace of parts installaon.

A new year, and the cooler is nally funconing! Appropriatelyand coincidentally, a sign poinng to the water fountain in

Spanish and English manages to pass three UofA commiees.

Quixocally, it’s posted above most walkers’ line of vision and

requires binoculars to see it!

Then, disaster. Vandalism, in which the perpetrators jammed arod down the water egress, wrecking the cooler ’s guts.

Undaunted, the walkers sll had money for another try. But now

UofA facilies management decides to put in a “modern” cooler.

But when the plumbers assess the hill’s lines, they nd them so“vintage” that a major upgrade becomes mandatory.

It’s confounding. Then, with each line modicaon, another

deciency becomes apparent. Weeks pass.

Finally, they declared compleon! But wait! The water tests

posive for E. coli pathogen overgrowth! Shutdown.Decontaminaon.

It’s almost April, and nally it’s all clear!

Hmm... Well, the water bole spout worked ne, but the bubbler

just dribbled. More parts and line surgery are needed. Finally, we

aain a stream that even an experienced urologist would be

proud of!

It’s now late May, and brother, it’s warm. Then the vandals strikeagain, snapping the water feeder liner. Facilies Management is

undaunted. They recongure the plumbing as armed to meet the

21st century.

So now Tumamoc Hill is nally blessed with a funconing watercooler posioned midway up the hill. The parched can now have

their thirsts slaked. It is also an ecological and environmental

remediaon success, as the number of plasc water boles

discarded along the path drops signicantly.

We are smug in our public health threat abatement! Yet MotherNature has a way with such human hubris. Mother’s bees not

only are enjoying the water cooler, but have usurped our ulity

into their realm! Mother has reclaimed Tumamoc Hill! But we

know it’s a natural preserve, so it’s really more hers than ours.

The public health moral here would seem to be: Every sweet plus

has a snging minus!

Pathologist Ron Spark has been a PCMS member since 1975. In

his busy semi-rerement he is a clinical associate professor at the

UofA College of Medicine—Tucson, and lab director for the UofA

Campus Health Service, New Pueblo Medicine, and Wickenburg

Community Hospital. He is a community volunteer for Tucson

Mayor Jonathan Rothschild. For more Tumamoc informaon,

please visit Tumamoc.org . n

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In Memoriam

By Stuart Faxon

Roland V. Murphy, M.D.1920-2015

Roland V. Murphy, M.D., internal

medicine physician who pracced

for 35 years in Tucson, and PCMS

member 1954-2002, died Aug.

23 in Tucson. He was 94.

Roland Virgil Murphy was born

Nov. 28, 1920 in Toledo, Ohio. By

the me he graduated from the

University of Toledo in 1942, the

naon was at war. In 1945, the

year of the war’s end, he

graduated from the University of

Cincinna College of Medicine.

Dr. Murphy interned at HarperHospital in Detroit.

He served as a U.S. Army medical

ocer 1946-48. In 1951-52 he

was a sta physician at the Veterans Administraon Hospital in

Dearborn, Mich., and 1952-54 at the VA hospital in Tucson before

entering private pracce, from which he rered in 1988.

Dr. Murphy working on his fshing gear in an undated PCMS photo

Dr. Roland V. Murphyin 1984.

In the early 1970s Dr. Murphy served on our Board of Censors,

antecedent to the Board of Mediaon. He was also quite the

angler, and in 1964 the Tucson Cizen published a photo of him

displaying a string of trout he caught on River Lake at Greer,

including an 18-incher.

Dr. Murphy is survived by his daughters Maureen and Kathleen,

two grandsons, and one great-grandson. His wife, Mary,

predeceased him, as did his son John Bell Murphy, 43, in 1995.

Services were Sept. 4 at Adair Funeral Home’s Dodge Chapel,

Tucson. n

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Drift along with thisBy Hal Tretbar, M.D.

Behind the Lens

T

umbleweed, or Russian

thistle, is a common plant

in the West, known sciencally

as Salsola tragus. Your mental

image of it depends on which

name you give it.

Call it Russian thistle, and you

think of the large dry weed that

stacks up against fences or

houses and causes trac

problems when it blows across

your lane, geng stuck in your

car grille.

But when you call it tumbleweed, your thoughts turn to an iconic

image of the Old West. Here a cowboy slouches on his horse as a

tumbleweed bounces across the barren landscape. Your brain

probably starts playing Tumbling Tumbleweeds, wrien by Bob

Nolan in 1933 for the Sons of the Pioneers:

I’m a roaming cowboy riding all day long

Tumbleweeds around me sing their lonely song.

Nights underneath the prairie moon,

I ride along and sing this tune.

See them tumbling down

Pledging their love to the ground…

David B. Williams writes on the website www.desertusa.com/

owers/tumbleweed:

“Although tumbleweed is nave to the arid steppes of the Ural

Mountains in Russia, it is now ubiquitous throughout the Western

states, growing in disturbed soils such as agricultural elds,

irrigaon canals, and roadside shoulders and ditches. These

plants thrive in salty and alkaline soils...

“Tumbleweeds were rst reported in the United States around

1877 in Bon Homme County, South Dakota, apparently

transported in ax seed imported by Ukrainian farmers. Within

two decades the plant had tumbled into a dozen states, and by

1900, tumbleweeds had reached the Pacic Coast.

“Virtually everyone recognizes a mature Russian thistle, which

looks like the skeleton of a normal shrub. Plants may be as small

as a soccer ball, or as large as a Volkswagen beetle. Most people,

however, would fail to recognize the seedling and juvenile plant’s

bright green, succulent, grass-like shoots, which are usually red or

purple striped. Inconspicuous owers grow at axils (where leaf

branches o of the stem) of the upper leaves, each one

accompanied by a pair of spiny bracts…

“As it rolls down a desert road, Russian thistle plants do what

they do best—disperse seeds, which typically number 250,000

per plant. Seeds are unusual in they lack any protecve coat or

stored food reserves. Instead each seed is a coiled embryonic

plant wrapped in a thin membrane. To survive winter without a

warm coat, the plant does not germinate unl warm weather

arrives.

“When moisture falls, the plant is ready to uncoil and germinate.

All that is required are temperatures between 28 and 110

degrees F. It then quickly sends up two needle-like leaves and

begins to shoot skyward. By autumn the plant has reached

maximum size, owered and begun to dry out. A specialized layer

of cells in the stem facilitates the easy break between the plant

and the root, and the journey begins anew.”

The widely traveled plant now grows in every state except



Florida, and in most countries worldwide. Aempts to control

large areas of tumbleweeds with herbicides have proven very

dicult. Recent research has concentrated on a biologic

approach to control Russian thistle. According to an arcle in

Popular Science posted Sept. 24, 2014, two fungi found onS.

tragis in Hungary may hold the answer to control. Extensive

tesng by the U.S. Agriculture Research Service has found the

fungi have lile eect on other closely related species. The fungi

work against the tumbleweeds when they are saplings so they

don’t have a chance to grow into bushes, dry out, and roll away.

The research service has made applicaons for commercial use,

but approval is sll pending. It will be easy to use. A half-kilogram

of rice infected with the fungus would be dumped every 5,000

meters for those who want it. Rain and tumbleweeds tumbling

will do the rest.

Since government approval for biologicals is notoriously slow, I

think we can keep on singing:

I know when night is gone

There’s a new world at dawn

I’ll keep on rolling alongDeep in my heart is a song

Here on the range where I belong

Driing along with the tumbling tumbleweed

Tumbleweeds will grow in the most inhospitable places. They

were the rst plants to appear at the Trinity site in New Mexico

aer the rst atomic bomb test was done there.

The 2013 tumbleweed Christmas tree in Chandler, Ariz. (Gina Sowell photo).

The Chandler eectIf Russian thistle is a nuisance without purpose, the Phoenix

suburb of Chandler thinks otherwise. For the last 59 years the city

has put tumbleweeds to an invenve use.

In 1957 resident Earl Barnum had an idea to make a tumbleweed

Christmas tree. Each year since, such a tree has been fashioned

by the city parks department. A center pole is bolted to the

ground, and 30 cables are strung from a ring at the top to a

boom anchor ring.

Chicken wire is placed over the cables to provide a framework for

the tumbleweeds. But not just any tumbleweed will do” It must

be well-rounded, three feet in diameter, and just beginning to

turn brown. To nd the just right tumbler, parks personnel mayhave to go to the Gila River Indian Reservaon.

The tumbleweeds are then ed to the chicken-wire and shaped.

First the tree is sprayed with re retardant, then given two coats

of latex paint and 50 pounds of glier. Once it is dry, the workers

add 1,100 lights.

Chandler’s unique holiday tradion starts Saturday, Dec. 5.

Downtown street vendors are open at 4:30 p.m. The Tumble-

weed Tree Lighng and Parade of Lights starts at 7 p.m. n



Rio Rico paramedicine projectindications strongBy Steve Nash

Paramedicine

Y ou have never seen a Paramedicine department inSombrero

because this is the rst one.

Aer years of preliminary work, the rst Southern Arizona

“community healthcare paramedicine program,” begun in

January 2014, now has lessons learned from its rst 15 months.

“This is called the Rio Rico Fire and Medical District Community

Integrated Paramedicine Program,” Rio Rico Fire and Medical

Chief Les Caid said. “The term comes from ‘Community

Paramedic,’ which is trademarked, so when I rst became

interested in this concept in 2010, I wanted to use a term that

was close enough, but did not infringe on the trademark.“Since then the concept has gained tracon throughout Arizona.

In 2014 Arizona Department of Health Services put together a

steering group under the term Community Integrated

Paramedicine (CIP). This is a term I support, because this program

truly must be integrated into the overall healthcare resources of

each community if it is to be successful.”

Five condions qualify paents to enter the program: congesve

heart failure, heart aack, pneumonia, diabetes, and chronic

obstrucve pulmonary disease (COPD). The Rio Rico CIP provides

in-home healthcare services to residents with these chronic

illnesses.

The inial project focuses on helping parcipants manage their

medical condions so that they don’t have to return to the

hospital or call 911 so oen. They idened 911 high-use paents

from their system, “specically individuals who suer from

chronic disease,” Caid said. “Once idened, we scheduled

appointments in an aempt to help them manage their disease.

It is cheaper for us to send two reghter/paramedics at 2 p.m.

than four to six reghters for an emergency 911 call at 2 a.m.

“Our CIP teams consist of a reghter, an emergency paramedic,

and a reghter EMT,” Caid said. “While at the home, the CIP

team gets a baseline set of vitals and conducts a health survey.

Working with the Arizona Poison and Drug Informaon Center,

we do a medicaon reconciliaon, to ensure they are taking their

meds properly, that they are not duplicang medicaon, or have

medicaons that are counteracng each other. We also conduct a

home environmental and safety survey to idenfy and migate

trip-fall hazards, mold, or other environmental issues that can

adversely impact health. If we suspect mold, for example, we can

work with community resources to make the home safe.”

Caid says these services are to help engage and guide parcipants

in understanding their health and disease processes. “We also

want to try to idenfy the core reason that drives the need for

frequent 911 calls, and help the individual idenfy other

Rio Rico Fire and Medical Chief Les Caid says, ‘I truly believethat working pro-actively in the health of our communities, toimprove outcomes, is the logical evolution of the re service(Photo courtesy Les Caid).

healthcare resources that exist, but which they may not have

known about, or known how to access.”

Caid brings a wealth of experience to the job. He began his re

service career in 1979, and served 25 years with the Tucson Fire

Department. While with TFD he worked in all areas of the

department, including many years as a paramedic and EMS

supervisor, baalion chief of technical rescue; hazmat; and

support services. He rered as the deputy chief of emergency

management. While with Tucson Fire, Caid was recognized at the

naonal level for his work in building the Tucson Metropolitan

Medical Response System (MMRS). He worked four years with

Rural Metro Fire as regional re chief, running operaons inArizona and Oregon.

Caid has an A.A. in re science, a bachelor’s degree in public

administraon, and an MS in execuve leadership. He is

president of the Medical Reserve Corps of Southern Arizona. He

sits on the IAFC Exercise and Response Subcommiee, is EMS

Representave for the Arizona Fire Chiefs Associaon, and is a

long-standing member of the AFCA Mutual Aid Commiee. He is

currently co-chairman of the USEPA Border 20/20 Emergency

Preparedness Task Force, chairs the Santa Cruz County LEPC, and

chairs the Pima Community College—FSC-EMT Advisory Board.

He has served on numerous boards, including the Board of



Directors of the American Red Cross, Greater Tucson Leadership,

the Arizona School Counselors Associaon, and World Care.

Caid calls the CIP program ideal for follow-up home visits of post-

hospital-discharge paents, “which I know will prove to be very

benecial in reducing re-admissions,” he said. “ With the PPACA

there are penales for hospitals that have paents re-admied

within 30 days. Working with a re-based CIP team can help the

boom-line nancials of hospitals. If we do this right, we can help

the paent and the hospital, and that is a win-win that you have

to love!”

The concept of using cered emergency paramedics (CEPs) for

prevenve healthcare is not new, and has been around for maybe

20 years, but the concept started internaonally and slowly

gained tracon in the U.S., Caid said. “Last October, I spoke in

Reno at the 10th Annual Internaonal Roundtable on Community

Paramedics. The project we started in Rio Rico is the rst in

Arizona, and from my understanding, at the me it was one of

only a handful of re-based programs—that is, care provided by a

re department or re district.”

Caid said he became involved because he knew that pung out

res is far from the only thing such department do, and that the

public may not realize that. “Most people do not know what the

U.S. Fire Service is all about,” he said. “They see the term ‘re’and think that is all we do. We must always be trained and know

how to put out res, but in actuality, re is only a small

percentage of what we do. If you look at the stascs, Emergency

Medical Services (EMS) is really the bulk of

what our jobs entail. In addion, ‘community

risk reducon’ is a term we have used in the

re service for years. We have been involved

for decades in re prevenon, drowning

prevenon, and in advocang seatbelt use

and bike safety.

“Aer almost 35 years in the re service,

I can aest that you can teach an old doga new trick. I had a FF/CEP Captain Alex

Green come to me and talk about the CIP

program. Aer some badgering by Capt.

Green, and a lile research, I became

convinced that this was an opportunity for

for re-based EMS here.

“Rio Rico is a beauful place to live and

work. It is, however, considered a rural

seng and we are under-resourced as far as

healthcare is concerned. We we lack public

transportaon. We have no buses, or

services to help our aging populaon get todoctors’ appointments. I truly believe that

working pro-acvely in the health of our

communies to improve outcomes is the

logical evoluon of the re service. To me,

since we are the gateway into the U.S.

healthcare system, we should embrace that,

and work to make others aware of the

potenal to improve paent outcomes by

forming partnerships to coordinate care.”

Caid said his department is sll looking at

surveys and total data for 2014, but even

now he can tell from some indicaons “We

have one parcipant who, in the rst six

months of 2014, reduced her 911 calls and

visits to the ED by 50 percent. We had

another for whom we found local PT

resources aer she was told in Tucson that

she could only drive back to Tucson for PT.

This saved her hours of driving me,

reducing her stress and risk of driving

accidents. We had one parcipant whom,

we found out during our medicaon

reconciliaon, had ve dierent physicians

who had prescribed her an-depressants.

Dr. Clavenna was born in Texas butspent most of his childhood in

Baton Rouge, Louisiana. Heattended Trinity University in SanAntonio for his undergraduate work,receiving a B.S. in Biochemistry. Dr.Clavenna’s desire to personallyhelp those with ailments, led himinto the field of medicine. He earned his medical degree fromLouisiana State University Medical School in Shreveport in 2009,where he was elected into Alpha Omega Alpha Honor Society.While in medical school, he was introduced to Otolaryngology(ear, nose, & throat), a wonderful field of complex anatomy,requiring surgical and medical expertise to treat those withproblems of the head and neck. Dr. Clavenna completed a generalsurgery internship and otolaryngology surgical residency atLouisiana State University Health in Shreveport.

Following residency, Dr. Clavenna completed a Fellowship in sinus,

allergy, and anterior skull base surgery at Vanderbilt University inNashville, Tennessee. There he trained under internationallyknown surgeons, Drs. Rick Chandra, Paul Russell, and JustinTurner. During fellowship he focused on advanced sinus surgeries,including management of frontal sinus disease, nasal and skullbase tumors, pituitary surgery approaches, ophthalmologicalrelated procedures and treatment of allergies. Many of thesecases were performed in conjunction with neurosurgeons andophthalmologists. One of his most fond memories from fellowshipinvolved treating a patient emergently transferred to Vanderbiltfor severe sinus disease encroaching on the vision of his right eye.Using his recently learned endoscopic sinus surgery techniqueswith the aid of image guidance, he was able to successfully treatand drain the infection and preserve the patient’s vision.

Dr. Clavenna moves to Tucson with the desire of helping those inthe community with their ear, nose and throat related problems.He is the first fellowship trained sinus and anterior skull basesurgeon to join a private practice group in Tucson. Though he hasa passion for nasal, sinus, and allergy related disorders, he alsoenjoys treating the full gamut of ENT related issues, from neckmasses to ear surgery.

Dr. Clavenna in his free time enjoys spending time with his wife,the outdoors, and looks forward to taking advantage of thewonderful surroundings Tucson and Arizona have to offer.

Dr. Matthew Clavenna,

MD

www.CarlsonENT.com



This is the kind of thing that would never have been caught

without someone actually going into the home and being the

eyes and ears of the primary care provider to ensure that the

reconciliaon was done.”

Another gap paramedicine can ll is called “stove piping,” Caid

said. “I rst heard the term years ago when I was doing some

work with the CDC in Washington. D.C. ‘Stove piping’ was used

inside the capital beltway to refer to agencies not familiar with

anything outside their own sphere of inuence. I guess you can

say healthcare, with its lack of shared informaon and/orresources, is stove piped. This lack creates barriers to good health

outcomes. If you don’t know about a resource, it is not really a

resource. So when we see individuals who need help while we

are on a CIP visit, the team has to be the

connecon to healthcare resources.”

So far, the EMTs and reghters have seen

posive outcomes. “They have established

good solid relaonships with these individuals

in our program,” Caid said. “It is so much

easier for everyone involved to interact

because this is a scheduled visit, which is a

calm seng, way outside the normal stress ofan emergency call.”

In the early evaluaon stage, Caid said, they

idened that they would spend 10 hours per

week on the CIP. “We want to collect good

solid data to validate our premise that this

produces beer outcomes. Aer seeing the

posive eects and outcomes, we will

connue this program unl we nd funding,

but there will be no cost to the parcipants. I

guess you can say this is the eld-of-dreams

model: build it and they will come.” The Rio

Rico Fire & Medical District has applied forseveral grants to help fund the program.

CEPs have a strong training foundaon in

acute care, Caid emphasized. “Their inial

courses are between 1,200 to 1,800 hours of

lectures, hands-on skills training, and clinical

me. Once working in the eld every day, FF/

CEP’s are seeing people in emergencies.

However, we have to have our FF/CEP learn to

focus on a 30-day healthcare picture as

opposed to a 30-minute focus and short-term

emphasis. With the help of our supporng

partners, we have brought classes that focus

on care of chronic diseases such as diabetes,

MI, asthma and COPD. We have been very

fortunate to have great partners like Southeast

Arizona Area Health Educaon Center

(SEAHEC), the University of Arizona, and the

Arizona Poison and Drug Informaon Center

who have helped idenfy and provide

training.”

Caid said he does not see it as necessary to

change the CEP “scope of pracce.” “We have

found that you do not have to change the

scope of pracce for CIP; we just need to change the role of the

CEP. We have to work within the current scope of pracce and if

we do, we can have posive outcomes right away, and we have

proven that.

“First and foremost CIP has to prove it will provide beer

outcomes for the individuals and can reduce healthcare costs.

Once the data are in, we have to look for payers like the insurance

companies and hospitals to share in the savings that are gained

from this. We don’t need to make money providing this extra

service, but we must cover our costs of providing it.”

Steve Nash is execuve director of Tucson Osteopathic Medical

Foundaon and former PCMS execuve director. n



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An 18th-century military barber-surgeon’s instruments went onthe job in his canvas haversack. A bone saw has not changedmuch, though this one was made for the smaller hands ofsmaller practitioners. Two sizes of brass bleeding bowls werealways included.

populace alike. Indeed, some military doctors

moonlighted on o-duty hours seng up

outside pracces to treat local residents as a

supplement to their rather meager army pay.”

Abraham Ruddell Byrd III, M.D. of Sonora Family

Pracce, a.k.a. Dr. Rudy Byrd, PCMS member

since 1983, has in his 72 years gone—if there is

such a declension—from history fan, to bu, to

expert. Part of the Presidio historic trust, Dr.

Byrd plays a Presidio soldier and member of the

Spanish garrison, and in this instance the

barber-surgeon. He has oen spoken on “Blood

and Guts Medicine in the 18th Century.”

It’s the nature of science that those called

physicians in the exhibit’s me-frame would not

even merit the name today. Yet there were sll

benecial things they did, and they saved many

baleeld lives, even if they knew lile or

nothing about infecons that would kill the

paent anyway.

Essenally “you’re bleeding people all the

me,” Dr. Byrd said, “because that’s [thought to

be] good for everything. If bleeding doesn’t

work at rst, try bleeding again. Dr. Benjamin Rush, a friend of

Washington, Adams, and Jeerson believed you could remove

three-fourths of the blood in the human body—though he

thought we had an extra quart.”

Usually bleeding was from an arm, but was considered so

essenal that it was done from any vein, even underneath the Dr. Rudy Byrd and his historical bullet-puller. Merely jam it painfully into the wound, pressin farther to ensure a hard bone backup, thenscrew the auger into the soft-lead bullet tograb and extract. Anesthetic? Bite another bullet.



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tongue, or from the penis. “Inially, it was believed that bleeding

needed to be done as close as possible to the source of the

problem,” Dr. Byrd said, “and some areas did not lend themselves

to use of the tourniquet.”

They also used many catharcs and emecs, Dr. Byrd said, all

based on the Hippocrac “four humors” theory of achieving

balance of the four disnct uids in the body, so as to directly

inuence temperament and health. According to this theory,

which was prevalent in Europe and which the Spanish brought

when conquering Mexico, it was believed that each paent hadhis own humoral composion of black bile, yellow bile, phlegm,

and blood, and that each corresponded to one of the tradional

four temperaments. This sounds crazy today, but it existed for

centuries unl the advent of medical research in the 19th century.

The barber-surgeon bled the paent from the arm using a

tourniquet, Dr. Byrd said. Even bleeding injuries were treated

with more bleeding. For amputaons, they used an “extreme”

tourniquet to cut o arterial circulaon, then sliced around

through the skin and into the so ssues using a large curved

knife such as seen on the le in our haversack photo. Then the

“sawbones” was ready to saw bone. Again, “anesthec” was to

bite the bullet, or take on a good amount of alcohol, usuallybrandy or rum. “They had opiates,” Dr. Byrd said, “but they did

not know they could be used for pain.”

They did not know germ theory but they knew a wound had to be

clean, Dr. Byrd noted, so they dressed it up, and “they would look

for pus as a sign that the body was throwing o the foreign debris

and material. It was always a good sign when they got what they

called ‘laudable pus.’”

The Tucson Presidio Trust for Historic Preservaon operates the

Presidio San Agusn del Tucson Museum, a re-creaon of the

original Spanish fort from which metropolitan Tucson sprang. The

museum funcons as a monument to Hispanic history in Tucson

and the region.

The Presidio’s goal is to educate the public about the many layers

of Tucson history, including an archaic pit house, the northeastcorner of the Presidio, a Territorial Pao, and in the future, exhibit

space to honor the Mexican-American veteran and a visitor

center for the Juan Bausta de Anza Naonal Historic Trail.

The humanies content of the Trust’s mission is history,

anthropology, and archeology, providing the general public and

students with an appreciaon of the mixture of cultures that

made up early Tucson and their success in building a culture of

cooperaon that sll permeates the lives of the residents of

region.

The all-volunteer sta includes two PCMS members, the afore-

menoned Dr. Rudy Byrd, and Robert Hunter, D.O. The Trust has

designed and constructed rotang exhibits and related programsthat honor those cultures and aspects of life that make Tucson

unique. The Trust also conducts Living History Days, and a hands-

on school program known as Friday at the Fort. The hands-on

acvies promote crical thinking, study of history, and further

exploraon of this period and its cultural diversity. n

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ROC #278632



Radiology Ltd. proudly offers3D Mammography. The physicians of Radiology Ltd. believe in personalized

and comprehensive service for all patients and are pleased

to announce a customized approach to breast screening.

Radiology Ltd.’s personalized breast screening service

includes individual breast cancer risk assessment, alongwith access to our Patient Education Specialists to answer

any questions you may have. We have seven locations to

serve you.

Please call and requestyour 3D Mammo today!

(520) 733-7226

For more informationabout this and other

screening exams providedby Radiology Ltd., please

visit our website atwww.radltd.com.

A TUCSON TRADITION FOR MORE THAN 80 YEARS



Did you know?

Since 2014, MICA has set up

a risk retention group and

a protected cell captiveto meet the changing needs

of medical practices.

The policyholder benefits presented here are illustrative and are not intended to create or alter any insurance coverage. They shouldnot be relied on and may differ from actual MICA policy language. Coverage provided by MICA is always subject to the terms andconditions of your policy and MICA strongly encourages you to read your policy in its entirety

Medical Professional

Liability Insurance

(602) 956-5276(800) 352-0402

www.mica-insurance.com

october 2015 sombrero

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