November/December 2009 - Travis County Medical Society

TCMS Journal
November • December 2009
Volume 55 • Number 6
Homer R. Goehrs, MD
2009 Physician of the Year
T r a v i s C o u n t y M e d i c a l S o c i e t y

Paris, France. Photo by David Fleeger, MD.
512. 476.7101
www.whitleyco.com
4 November • December 2009 TCMS Journal

TCMS
Journal
Travis County Medical Society
On the Cover
Homer R. Goehrs, MD
Umpire school in Arizona
November • December 2009 VOLUME 55 • NUMBER 6
FEATURES AND ARTICLES
THE PRESIDENT’S MESSAGE
Never Take Away Hope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Charlotte H. Smith, MD
AMA REPORT
Health System Reform and the AMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Bruce Malone, MD
AMA RESOLUTION 203
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
PARTING SHOTS
The Year in Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
TCMS PHYSICIAN OF THE YEAR
Homer R. Goehrs, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Susan Feldkamp
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TCM ALLIANCE
Member Spotlight-Kylan Bunker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Roberta Pazdral
PROJECT ACCESS
Executive Committee Member Spotlight . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
HOLIDAYS REMEMBERED
Papa and the Christmas of ‘33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Harry C. Powell, MD
DEPARTMENTS
In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Classified Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Take 5: Burn Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
EDITORIAL:
Editor, Owen Winsett, MD
Managing Editor, Belinda Clare
Publication Coordinator, Ron Mize
CONTACT: Travis County Medical Society 4300 N Lamar Blvd.; Austin, Texas 78756; Post Office Box 4679; Austin, Texas 78765
Ron Mize (512) 206-1245 or email rmize@tcms.com
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contributors. Advertising in the Travis County Medical Society Journal does not imply approval or endorsement by the Travis County Medical Society.
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TCMS Journal November • December 2009 5

FROM THE PRESIDENT
Never Take Away Hope. . .
Charlotte H. Smith, MD
President, Travis County Medical Society
November 1995:
The case of RS
A 64 year old pastor was
brought to the ED with an
acute onset of difficulty
breathing, numbness, and
weakness of his extremities.
He had woken up that morning, tried to
stand and realized that he was unable to move
his arms and legs. His wife was advised by his
internist to call 911. Upon arrival to the
hospital, he was found to have dense
tetraplegia and respiratory failure. After
emergency intubation, he was evaluated and
underwent multiple diagnostic tests, including a
CSF tap that confirmed a diagnosis of
Guillian-Barre Syndrome. He was admitted to
the Neurological Critical Care Unit where he
was treated with IVIG, plasmapheresis,
mechanical ventilation, and intensive medical
management. He remained ventilator
dependent and tetraplegic with no improvement
in his neurological examination for six months.
A tracheotomy tube and feeding
gastrostomy tube were performed. After
multiple episodes of critical illness, including
pneumonia, ileus, Clostridium difficile, renal
insufficiency, urinary tract infections, and two
cardiac arrests, he was stabilized and began to
tolerate short weans from the ventilator. He
subsequently was transferred to a rehabilitation
hospital, still with no active movement of his
extremities and still requiring the ventilator at
night. After 6 1/2 months of rehabilitation, he
was discharged home to the care of his family.
When RS’s wife called and asked me to
assume the care of her husband, I had
tremendous reservations. He had yet to
spend more than a few days out of the
intensive care unit. Each time he was
transferred to the floor, severe medical
complications would develop, necessitating
his return to the ICU. He was still
completely tetraplegic with no movement
and was ventilator dependent. At that time,
the rehabilitation facility where I worked
did not manage any ventilator dependent
patients. It was standard practice to send
ventilator dependent quadriplegics to a
facility in Houston. His family did not
desire this option, but wanted him
managed in Austin by physicians that they
knew and trusted.
A family conference was held to discuss
options, including transferring him to a
rehabilitation hospital. His attending
physician was blunt, stating that he was still
exceptionally medically fragile with a high
probability of future complications or even
death if he was transferred. I’ll never forget
his family’s response − “being a pastor, he’s
not afraid of death and being with God.
He’s much more afraid of six more months
of being in the ICU. Let’s take a chance.”
Growing up in Austin, I had known
RS as being the highly esteemed pastor of
the biggest church in town. He was
legendary for his visits to hospitals and the
encouragement he would provide to
patients and their families, even visiting
people who did not attend his church. I
came to know him personally when he
visited me in the ICU at Brackenridge
when I was critically ill as a teenager.
Frankly, the idea of taking on his case early
in my professional career was frightening. I
did not want to be the physician
responsible for his demise.
The early weeks of his rehabilitation
were painful for everyone involved. The
combination of his neurological condition
and months of inactivity resulted in
contractures and severe deconditioning.
His autonomic instability made simple
activities such as sitting up difficult. Even
minimal amounts of range of motion
caused excruciating pain. He was
completely dependent for all aspects of his
care, including feeding, toileting, dressing,
and all mobility, resulting in tremendous
frustration. I would observe him in severe
pain, crying in agony from the physical
rehabilitation I prescribed. It was also
difficult for the staff that had to perform
these interventions on a daily basis.
Amazingly, he made slow but continuous
progress. He remained medically stable and
never had to go back to the acute care
hospital. After seven months of inpatient
rehabilitation, he was discharged home, still
requiring an electric wheelchair and
significant amounts of attendant care. He
continued in outpatient rehabilitation after
discharge to slowly improve his
functional abilities.
Today, the pastor is completely
independent and no longer requires a
wheelchair. Despite being retired, he is
exceptionally active. He frequently preaches
as a guest pastor, performs wedding
services, and mentors younger pastors. He’s
maintained a sense of humor throughout
this experience and has even written a book
about his experience entitled Walking Out
of Paralysis − You Can’t Fall Off the Floor.
His book describes his lowest moments
during this episode and how he was able to
maintain hope.
The Reverend Ralph Smith recently
gave me permission to share this story with
my colleagues and asked that I also share
the advice he would give to medical
professionals caring for patients like
himself. In his opinion, three things are
critical for physicians to do:
1)Physicians need to physically touch
their patients every day.
2)Physicians need to emotionally touch
their patients.
3)Physicians should never take away
hope from their patients.
Reverend Smith said that there were
days − and often weeks − when his
physicians would come and see him
without touching or examining him. The
only time he was touched was for nursing
interventions. He feels that more physical
continued on page 9
6 November • December 2009 TCMS Journal

The Travis County Medical Society appreciates the generosity
of the following organizations in underwriting TCMS events.
D I A M O N D L E V E L
Medical Service Bureau
Texas Medical Association Insurance Trust
Texas Medical Liability Trust
P L A T I N U M L E V E L
Austin Radiological Association
Wachovia/Wells Fargo Bank
G O L D L E V E L
Austin Brokerage Company
The Brian Novy Company
Clinical Pathology Laboratories, Inc.
Laura M. Stephens and Associates, PC
S I L V E R L E V E L
Physician’s Resource Services
Stanberry & Associates Realtors

continued from page 6
touch and movement would have facilitated
quicker recovery.
I believe he is correct about this − he is
preaching the gospel according to PMR. As
we’ve become more dependent upon medical
technology, sophisticated diagnostics and
automated processes have replaced human
touch. It is not uncommon for patients to
report to me that physicians they have seen
may have listened to their hearts or looked
at their x-rays but never laid hands on
them. Sadly, this often means that physical
signs are missed or unnoticed secondary
complications are allowed to develop. Even
worse, many patients interpret this lack of
touch as a lack of caring.
Reverend Smith’s second recommendation
required explanation for me to understand fully.
“You prescribed a program that caused me
extreme physical pain and essentially tortured
me for seven months,” he said. “The only
reason I went along with this was because I
could tell that you cared and I trusted you.”
His point was clear – patients don’t care what
you know until they know that you care. A
strong doctor/patient relationship facilitates
trust which then allows optimal treatment
and healing.
I was fortunate to have seven months
to work with the Reverend, with many long
conversations throughout. In our current
health care environment, he would
undoubtedly have had a much shorter
length of stay in the hospital and might
have even ended up in a nursing home. His
daily physician visits would most likely have
been shorter and it is unlikely that he would
see the same physician each day. How much
harder is it to build trusting relationships
with patients these days in light of 10 minute
office visits, physician extenders and a
fragmented medical system?
Reverend Smith’s final recommendation
was his strongest, “There were so many times
I felt that my situation seemed hopeless.
Thank God there were physicians who
believed I could recover and who told me not
to give up.”
I struggle on a daily basis with that
challenging balance between providing
patients with full disclosure about their
medical condition while still maintaining
hope. When I meet a patient with a condition
like Reverend Smith’s, it is critical to give
them honest, objective information about
their condition, including the facts known
about their medical condition. The medical
liability system mandates that we inform
patients fully about the risks associated
with treatment and the probability of bad
outcomes. Unfortunately, there is often
much less said about the possibility of
having a good outcome. How many
patients lose hope because of this imbalance
of information?
I have seen medical miracles occur in
patients who probably shouldn’t have had
hope. This has happened enough times for
me to realize that despite our medical
knowledge, physicians can’t always accurately
predict the future for any single patient.
As we navigate through health system
reform, it may not be possible to be as
hands on or spend as much time with our
patients as we did 15 years ago. That doesn’t
mean we should stop trying to connect
with them physically and emotionally. Just
as we should never take away a patient’s hope
as we care for them, we should also never
lose hope that our health care system can
evolve in a way that allows us be the trusted
physicians our patients need us to be.
Executive Board
Charlotte H. Smith, MD, President
C. Mark Chassay, MD, President Elect
Phillip C. Collins, MD, Immediate Past President
Brian Sayers, MD, Secretary-Treasurer
Robert K. Cowan, MD, Member At Large
R.Y. Declan Fleming, MD, Member At Large
Hillary Miller, MD, Member At Large
Paula S. Oliver, MD, Member At Large
Adam J. Schneider, MD, Member At Large
Sarah I. Smiley, DO, Member At Large
Bruce A. Levy, MD, JD, Chair, Board of Ethics
Michelle A. Berger, MD, Delegation Representative
Stephen S. Clark, MD, BTC Representative
Board of Ethics
William D. Caldwell, MD
Toni Funicello, MD
Bruce A. Levy, MD, JD, Chair
Jeffrey Jekot, MD
Hillary Miller, MD
Clifford K. Moy, MD
Archie Dan Smith, MD
TMA House of Delegates
Clifford K. Moy, MD, Vice Speaker
Delegates to AMA
Charles (Bill) Bailey, MD, JD
David C. Fleeger, MD
C. Bruce Malone, MD
Clifford K. Moy, MD
Alternate Delegates to AMA
Michelle A. Berger, MD
Charlotte H. Smith, MD
AMA Board of Trustees
Joseph P. Annis, MD
AMA Young Physician Section
Governing Council
Dawn Buckingham, MD, Chair
Delegates to TMA
Ira Bell, MD
Michelle A. Berger, MD*
Robert E. Blais, MD
Roberta M. Braun, MD
Dawn C. Buckingham, MD
Edward D. Buckingham, MD
C. Mark Chassay, MD
William J. Deaton, MD
James Eskew, MD**
Lisa C. Ellis, MD
Michael L. Gutierrez, MD
James M. Hicks, MD
Felix Hull, MD
Jeffrey M. Jekot, MD
Thomas D. Kirksey, MD
Greg M. Kronberg, MD
Hillary Miller, MD
Hector E. Morales, MD
Patrick S. Pevoto, MD
Peggy M. Russell, DO
Dora L. Salazar, MD
Catherine L. Scholl, MD
Charlotte H. Smith, MD
Eric S. Tiblier, MD
Emilio M. Torres, MD
Dennis E. Welch, MD
Robert P. Wills, MD
Guadalupe “Pete” Zamora, MD
* Chair
** Vice-Chair
Alternate Delegates to TMA
Sara Austin, MD
Jerald A. Mankovsky, MD
Tony Aventa, MD
Carla F. Ortique, MD
Craig T. Berent, MD Paula S. Oliver, MD
Jane E. Braunstein, MD Jack Pierce, MD
William D. Caldwell, MD Robina N. Poonawala, MD
Nancy T. Foster, MD Melinda Rainey, MD
Leigh A. Fredholm, MD Stephanie D. Roth, MD
Toni Funicella, MD
Aravind B. Sankar, MD
Mary A. Gonzales, MD Halsey M. Settle, III, MD
Juan Guerrero, MD
Adam J. Schneider, MD
Daniel J. Leeman, MD Zoltan Trizna, MD
Bruce A. Levy, MD, JD Belda Zamora, MD
TCMS Journal November • December 2009 9

AMA REPORT
Health System Reform
and the AMA
Bruce Malone, MD
TMA Delegate to AMA
Most doctors are puzzled about what is
really happening in Washington with
Health System Reform; they are also
questioning why the American Medical
Association supported the House Bill so
early in the process. The recent interim
meeting of the American Medical
Association in Houston was the most
important meeting I have attended in
about twelve years. Nine of your Travis
County colleagues worked hard to
represent you in the debate about health
care financing reform. The AMA
delegation from Texas includes Travis County
physicians: Bruce Malone, MD, Bill Bailey,
MD, Cliff Moy, MD, David Fleeger, MD,
Charlotte Smith, MD, and Michelle Berger,
MD. Dawn Buckingham, MD is alternate
delegate for the American Academy of
Ophthalmology and Ed Buckingham, MD is
the alternate from the American Academy of
Facial and Plastic Reconstructive Surgeons.
Cathy Scholl, MD is an alternate delegate for
the American Society of Anesthesiologists
and Joe Annis, MD is a member of the AMA
Board of Trustees.
Many of our Texas physicians and
patients think, “What was the AMA
thinking supporting the original House
Resolution 3200?” I can assure you that was
also my first reaction. My friend of 20 years
and the current AMA President, Jim
Rohack, MD has convinced me that
supporting the concept of health care
finance reform was essential in the early
stages. The AMA did not endorse the bill
(but the press often used that word), but
felt they were never going to be able to
influence the outcome of the debate unless
they were participating in the early phases
and supported the bill as it evolved through
the process. The Obama White House, like
many before, thinks that unless you are
with them, you are frozen out of the
planning process. The Republicans have
been essentially frozen out, as well as most
specialty groups.
As in many previous policy debates, the
AMA has prevented many bad things in the
current negotiations with few clear victories
(the SGR fix is still pending). I am now
convinced that the doctors of America
needed to be represented early in the process.
Only the AMA was given that chance.
The public and doctors are fearful of
the proposed measures. Medicare enrollees
get the fact that a $500 billion dollar cut in
Medicare will not be good for them. In all
my years of practice, I have never observed
the current state of fear in the medical
community or the hostility in the Medicare
population. But, the fact is that Medicare
has at least $37 trillion dollars of unfunded
liability and is unsustainable. If not
reformed, Medicare will catastrophically
fail soon. I am worried that the current
“reform proposals” do nothing to control
Medicare costs, except slash doctors’ fees. In
that case “reform,” will not be successful.
Last week, Nancy Pelosi was pushing
HR 3962 and HR 3961 (the SGR fix) was
scheduled for passage later. Thirty-six hours
before we were to arrive in Houston for the
AMA meeting, we had many questions for
our leadership. At noon on Thursday, the
AMA Board of Trustees announced support
for HR 3962. Many of our AMA delegates
were upset about the timing of the
announcement. Our leadership explained
their decisions to the House of Delegates and
convinced most of us that to pull out of the
negotiations now would not be in the best
interest of the doctors of America. The vote
to support the Board at the AMA meeting
was approximately 67% for and 33% against.
The doctors in the AMA House passed
Resolution 203 to define our support for
health care financing reform. I want all of
you to read the details of that support and
tell me if you do not agree with these
principles. The details of Resolution 203
follows this article.
One of my friends is the chief
operating officer of the fourth largest health
insurer in the United States. Five months
ago, I asked him what he feared most of the
proposed health system reform. He
answered that his greatest fear in the end
was that “we would do nothing.” This
statement comes from a good man who
realizes that his government has plans for
the eventual failure of his company. I think
we all need to listen very carefully and be
involved. I have had many frustrations with
the AMA over the years, but the doctors of
America need an umbrella organization to
represent us all. If we divide up into
“specialty tribes,” only the politicians will
win. Our colleagues from England,
Canada, and Australia repeatedly have
warned us about such division when they
had to form a central organization for their
single payer systems. The most successful
strategy for government when radical
change occurs is to divide the doctors. I am
asking all of you to understand that we will
never get the perfect bill. However, we must
be involved in defining the solutions.
Together, we will be stronger in making
those solutions better for our patients and
creating a productive work environment for
the doctors of America who are doing all
the work. In the end, our patients will
realize benefits from a system that gives
them more value for the health care dollar
they spend and, hopefully, we will have
near universal coverage.
10 November • December 2009 TCMS Journal

AMA RESOLUTION 203: HEALTH SYSTEM REFORM LEGISLATION
Adopted by the House of Delegates, November 2009
RESOLVED, That our American Medical Association is
committed to working with Congress, the Administration, and
other stakeholders to achieve enactment of health system
reforms that include the following seven critical components of
AMA policy:
• Health insurance coverage for all Americans;
• Insurance market reforms that expand choice of affordable
coverage and eliminate denials for pre-existing conditions or
due to arbitrary caps;
• Assurance that health care decisions will remain in the
hands of patients and their physicians, not insurance
companies or government officials;
• Investments and incentives for quality improvement and
prevention and wellness initiatives;
• Repeal of the Medicare physician payment formula that
triggers steep cuts and threaten seniors’ access to care;
• Implementation of medical liability reforms to reduce the
cost of defensive medicine; and
• Streamline and standardize insurance claims processing
requirements to eliminate unnecessary costs and administrative
burdens; and be it further
RESOLVED, That our American Medical Association advocate
that elimination of denials due to pre-existing conditions is
understood to include rescission of insurance coverage for reasons
not related to fraudulent representation; and be it further
RESOLVED, That our American Medical Association House of
Delegates supports AMA leadership in their unwavering and
bold efforts to promote AMA policies for health system reform
in the United States; and be it further
RESOLVED, That our American Medical Association support
health system reform alternatives that are consistent with AMA
policies concerning pluralism, freedom of choice, freedom of
practice, and universal access for patients; and be it further
RESOLVED, That it is American Medical Association policy that
insurance coverage options offered in a health insurance exchange
be self-supporting, have uniform solvency requirements; not
receive special advantages from government subsidies; include
payment rates established through meaningful negotiations and
contracts; not require provider participation; and not restrict
enrollees’ access to out-of-network physicians; and be it further
RESOLVED, That our AMA actively and publicly support the
inclusion in health system reform legislation the right of patients
and physicians to privately contract, without penalty to patient
or physician; and be it further
RESOLVED, That our AMA actively and publicly oppose the
Independent Medicare Commission (or other similar construct),
which would take Medicare payment policy out of the hands of
Congress and place it under the control of a group of unelected
individuals; and be it further
RESOLVED, That our AMA actively and publicly oppose, in
accordance with AMA policy, inclusion of the following
provisions in health system reform legislation.
• Reduced payments to physicians for failing to report quality
data when there is evidence that widespread operational
problems still have not been corrected by the Centers for
Medicare and Medicaid Services;
• Medicare payment rate cuts mandated by a commission
that would create a double-jeopardy situation for physicians
who are already subject to an expenditure target and
potential payment reductions under the Medicare physician
payment system;
• Medicare payments cuts for higher utilization with no
operational mechanism to assure that the Centers for
Medicare and Medicaid Services can report accurate
information that is properly attributed and risk-adjusted;
• Redistributed Medicare payments among providers based
on outcomes, quality, and risk-adjustment measurements
that are not scientifically valid, verifiable and accurate;
• Medicare payment cuts for all physician services to partially
offset bonuses from one specialty to another; and;
• Arbitrary restrictions on physicians who refer Medicare
patients to high quality facilities in which they have an
ownership interest; and be it further
RESOLVED, That our American Medical Association continue
to actively engage grassroots physicians and physicians in
training in collaboration with the state medical and national
specialty societies to contact their Members of Congress, and
that the grassroots message communicate our AMA’s position
based on AMA policy; and be it further
RESOLVED, That our American Medical Association use the
most effective media event or campaign to outline what
physicians and patients need from health system reform; and be
it further
RESOLVED, That national health system reform must include
replacing the sustainable growth rate (SGR) with a Medicare
physician payment system that automatically keeps pace with
the cost of running a practice and is backed by a fair, stable
funding formula, and that the AMA initiate a “call to action”
with the Federation to advance this goal; and be it further
RESOLVED, That creation of a new single payer, government-run
health care system is not in the best interest of the country and
must not be part of national health system reform; and be it further
RESOLVED, That effective medical liability reform that will
significantly lower health care costs by reducing defensive medicine
and eliminating unnecessary litigation from the system should be
part of any national health system reform; and be it further
RESOLVED, That our American Medical Association reaffirm
AMA policy H-460.909 Comparative Effectiveness Research.
TCMS Journal November • December 2009 11

PARTING SHOTS
A year for the record books!
2009 will be remembered as the year of the “swine flu”
pandemic, but closer to home, it’s the year that the Travis
County Medical Society welcomed its 3,000th member!
TCMS continues to grow and be recognized as one of the
most active county medical societies in the state. The Society
continued to offer numerous educational, networking, and
social opportunities sponsored in part by the Friends of the
Society program.
The year started with a bang as members sang along to
the hit movie musical, Mama Mia! at the Alamo Drafthouse 1
and marched to the Texas Capitol for First Tuesdays 2 . Dr.
Phil Collins, 2008 TCMS President, passed the ceremonial
gavel to incoming President, Charlotte Smith 3 . The
Membership Committee 6 chaired by Dr. Dan Leeman,
planned an array of events such as a family picnic, 4 a new
member welcome at The Oasis, 9 and several networking
socials 7 geared to help physicians engage with their colleagues
in fun, relaxed settings.
Interspersed throughout the year were educational
opportunities 10 focused on emerging topics such as health
information technology and FTC red flags rule. We even
found the time to hold a successful Town Hall meeting on
health system reform! 8
The Retired Physicians’ Organization met monthy
offering a variety of progams. Austin police Chief Art
Avecedo 5 was a recent guest speaker.
Society members continued to be active in the community
by donating time to the free athletic physicals for Austin ISD
students and accepting Project Access patients in their practices.
The Public Relations Committee collaborated with a local
magazine, Your Austin Address & Lifestyle, to publish a Society
sponsored health and wellness section called Live Well
providing relevant and credible medical information for a
healthy and active lifestyle.
Adding to member benefits, TCMS introduced
DocBook – an iPhone application that brings the TCMS
Directory to your phone and launched TCMS on Facebook.
As TCMS closes out a record year, the road ahead in
2010 is full of opportunities for its members to remain
actively engaged with their colleagues in this growing and
vibrant medical community
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TCMS Journal November • December 2009 13

CONGRATS
facebook
Become a fan of the Travis County
Medical Society and stay connected.
Capital Medical Clinic recently
celebrated over 75 years of providing
quality health care to Austin and
Central Texas families.
Valli Annamalai, MD was selected as the
UTMB 2009 Austin Educator of the Year
for her outstanding dedication and service
to the medical student program.
William A. Robinson, MD of Austin,
was recognized with the Decade of Service
Award by the Texas Chapter of the
American College of Physicians at its
annual meeting in San Antonio.
The Austin Area Association of
periOperative Registered Nurses (AORN)
recently honored Cathy Scholl, MD as the
2009 Distinguished Anesthesiologist and
Scott Haydon, MD, as the 2009
Distinguished Surgeon.
Milton W. Talbot, MD passed away
on September 24. Dr. Talbot was
born on February 1, 1922 in
Evangeline Parish, LA. He was drum
major of the high school band, enjoyed
the Boy Scouts, and earned Eagle Scout
rank. Dr. Talbot graduated cum laude
from Harvard College in 1943 and
entered Tulane University School of
Medicine. He graduated second in his
class and was elected to Alpha Omega
Alpha, medicine’s national honor society.
He served the Army at the rank of
Captain and was the Wing Flight
Surgeon and Base Hospital Commander
in Itami AFB, Japan.
Upon returning to civilian life, Dr.
Talbot entered the pediatrics residency at
Charity Hospital in New Orleans.
Moving to Austin in 1971, he and Dr.
Maurice Cohn founded Capital Pediatric
Group until retirement in 1998.
Dr. Talbot was president of the
Travis County Medical Society in 1985,
served on the TCMS delegation to the
TMA, and was a delegate from the TMA
to the AMA for many years.
Our condolences to the family and
friends of Dr. Milton Talbot.
IN MEMORY
Life Membership is granted to those
physicians who have been a dues
paying member of organized medicine
for 35 years, of which 25 years must have
been dues paying years in the Texas
Medical Association and its component
county medical societies, and who have
reached a point of comparative inactivity
in the practice of medicine, as determined
by the Society. Upon nomination from
the Board of Ethics, the TCMS
Executive Board elected the following to
Life Membership:
Retired Membership is granted to
those physicians who have retired
from the active practice of medicine.
Upon nomination from the Board of
Ethics, the TCMS Executive Board elected
the following to Retired Membership:
Ernest E. Howerton, MD
Donald R. Mehlisch, MD, DDS
Medical Records and Closing a Practice
To protect patient confidentiality and abide by Texas Medical Board rules, it is
necessary to appropriately manage the disposition of medical records when closing
a practice. Physicians must notify patients and the TMB 30 days prior to closing
their practice. The notices should include the opportunity for patients to receive
copies of their records, arrange the transfer to another physician, and specify
contact information for the custodianship of the records.
TMB record maintenance rules include the following:
• Keep adult records for at least seven years from the date of the last encounter.
• Retain the records of minors (patients under 18) for at least seven years from
the date of the last encounter or to age 21, whichever is longer.
• Keep the records of deceased patients for at least two years.
• Do not destroy medical records that relate to any civil, criminal, or
administrative proceeding until you know the proceeding is fully resolved.
LIFE
RETIRED
J. Tom Connolly, MD
Curtis Lee Hitt, MD
Visit www.tmb.state.tx.us/rules/rules/bdrules.php and search for Chapter 165 for
the full maintenance rules.
The Medical Records Bureau, a TCMS subsidiary, provides records storage for
physicians. Pick-up and delivery services available. For information, contact
Gilbert Guerrero at (512) 467-5193.
14 November • December 2009 TCMS Journal

Umesh Gadaria, MD, FACS
PLASTIC AND H AND SURGERY
Hand Injuries
• Fractures
• Sprains
• Tendon Injuries
• Nerve Injuries
• Partial Amputation of digit(s)
• Laceration
Conditions of the hand
• Carpal Tunnel Syndrome
• Trigger Finger
• de Quervain’s Syndrome
• Dupuytren’s Disease
• Ganglion Cysts
• Tumors
Plaza St. David
(512) 478-0993
1015 E 32nd St, Suite 208 Austin, TX 78705
Workers’s Compensation & Most Insurance Plans Accepted

TCMS Physician of the Year
Homer R. Goehrs, MD
Susan Feldkamp
Freelance Writer
Born in Houston, Dr. Homer R. Goehrs
has spent most of his medical career
practicing in Central Texas. Those who
have witnessed his many years of service
regard his selection as TCMS Physician
of the Year as a fitting capstone to a long
and distinguished career. The TCMS
award, which honors integrity, knowledge,
compassion, and humility, recognizes
qualities that those who know Dr. Goehrs
are quick to acknowledge. His compassion
and care for patients have always been
evident, says Dr. Brian Sayers, a former
partner. “When I lived in another state in
the early 1980s, Homer cared for my
grandmother when she developed
rheumatoid arthritis – she described him
as an extremely compassionate and
knowledgeable physician in whom she
placed great faith,” says Dr. Sayers. “I
had the opportunity to see this in other
patients he treated while we practiced
together at Austin Diagnostic Clinic.”
Dr. Marshall Sack remembers the
care and skill with which Dr. Goehrs
treated his patients: “It was my privilege
to join Dr. Goehrs in the practice of
rheumatology in 1971 and practice with
him for over 20 years. I observed day-in
and day-out the interest and consideration
that Dr. Goehrs showed his patients, the
time he spent with them, and the skill
with which he practiced.”
Early in life, a future in medicine did
not seem likely for Dr. Goehrs. “My
mother was always amazed that I chose a
career in medicine. As a kid, I used to
faint at the sight of blood,” Dr. Goehrs
recalls, smiling at the memory.
In December 1942, he volunteered
to join the Navy. “Because I’d had some
college, the Navy placed me as a medical
corpsman. Then in 1944, the V-12
program sent me back to college,” recalls
Dr. Goehrs. The V-12 Navy college
training program, begun in 1943 to meet
the need for commissioned officers,
accepted men who were already in the
Navy or Marine Corps or high school
seniors who passed a qualifying exam. “I
met Virgil Lawlis at the University of
Texas at Austin. He was my roommate,
and a Navy man, too,” says Dr. Goehrs.
Now retired and living in Bastrop,
Dr. Lawlis has remained a lifelong friend.
Lieutenant Homer R. Goehrs (r) aboard a Navy ship.
Following his Navy service,
Dr. Goehrs completed pre-med studies,
and received his MD degree at Baylor
University in 1950. He then moved to
Baltimore to complete a surgical internship.
Soon, however, military duty called
again. This time, he found himself
stationed aboard a heavy cruiser for two
years during the Korean War. As a
lieutenant in the US Navy Medical Corps,
Dr. Goehrs carried out his medical duties
while simultaneously battling seasickness.
“I was missing during many a dinner at
sea,” he recalls, smiling. “One day, I was
performing an appendectomy as the ship
was rolling from side to side. I asked the
Captain if he could turn the ship into a
trough. He agreed if I’d have coffee with
him afterward. When I joined him later,
the Admiral was there, too. I could
hardly say a word.”
His military service behind him,
Dr. Goehrs completed his residency in
internal medicine at the Mayo Clinic in
Rochester, Minnesota. “So superb!” he
recalls. “When I took my boards, I
discovered that many doctors had not
seen the variety of diseases and disorders
that we had seen at Mayo.” He also
completed an MS degree in Medicine at
the University of Minnesota.
While at the Mayo Clinic,
Dr. Goehrs developed an interest in the
medical specialty that would become his
life’s work. “I studied rheumatology with
Dr. Philip Hench, the first physician to
use cortisone for medical treatments.”
Dr. Hench, the Mayo Clinic’s first
rheumatologist, won the Nobel Prize for
Medicine in 1950 for discovering the
role of cortisone in easing the pain and
inflammation of rheumatoid arthritis.
After completing his residency in the
late 1950s, Dr. Goehrs stayed an
additional year as assistant to the staff at
Mayo; then returned home to Texas and
settled in Austin, becoming only the
third rheumatologist in the state. “I
thought it looked like a growing field.”
Not long after his arrival, Dr. Goehrs
joined Dr. Virgil Lawlis, his former UT
roommate, in practice. Along with
Dr. Leonard Sayers, Dr. Goehrs and
16 November • December 2009 TCMS Journal

Dr. Lawlis rented a former fraternity
house to convert to an office. Dr. Henry
Renfert returned to Austin and joined
them. Together the four doctors formed
an internal medicine physician group
that ultimately became the Austin
Diagnostic Clinic (ADC). “We could
provide pretty immediate consultation
for anyone who wanted it,” Goehrs says.
Today, the ADC includes more than 110
doctors representing 23 medical specialties.
The empty house, located across
from Seton Hospital on 26th street,
served as the clinic’s first home. “The
kitchen,” recalls Dr. Goehrs, “became
our lab.”
“Medicine was fun back then! It was
work, but we enjoyed what we did,” he
remembers. “We took care of sick people
regardless of their condition or their
economic status.” Although he specialized
in rheumatology, Dr. Goehrs opted to
keep about twenty percent of his practice
focused on general medicine.
But it was his rheumatoid arthritis
patients who were the most challenging.
“Back then, treatments were limited,”
says Dr. Goehrs. “We used aspirin and
also gold salts injections, which could be
toxic for some patients. We relieved, but
could not cure, many patients.” Dr. Sack
recalls, “In those days, crippling disability
with chronic pain and depression were the
norm, rather than the exception in
rheumatology patients.”
As new drugs were developed,
Dr. Goehrs saw the relief that the
remarkable new pharmaceuticals
provided. Dr. Sack recalls that “in an era
Dr. and Mrs. Goehrs in Sante Fe, New Mexico.
when drug treatment for rheumatic
disease left much to be desired,
Dr. Goehrs understood that the way to
give your patients the best possible
treatment was often through clinical
trials of new drugs. In the 1960s, he
became one of the first physicians in
Austin to conduct clinical trials in his
practice.”
“It was nice to see new drugs coming
down the pike,” Dr. Goehrs says. “If one
of them failed to help a patient, we
would move on to another. Today we
have a good chance of stopping the
disease,” he notes.
Dr. Goehrs was a founding fellow of
the American Rheumatism Association,
served as president of the Texas
Rheumatism Association, and the
secretary of the National Society of
Clinical Rheumatologists. Today, the
Austin Diagnostic Clinic’s Homer R.
Goehrs Rheumatology Center treats
more than 100 types of arthritis.
Throughout his career, Dr. Goehrs
taught and encouraged others. Dr. Sack
notes “one of the things I remember
most fondly was that when we would
encounter a particularly unusual clinical
problem, he would invariably say, “We
need to write that up.” Sack also
remembers, “He served as attending
physician on the staff at Brackenridge
Hospital during the early years of his
practice, and for decades, he ran the
rheumatology clinic and saw in-patient
rheumatology consults there, all
without compensation.”
In addition to his rheumatology
practice, Dr. Goehrs was a Clinical
Assistant Professor of Medicine at the
UT School of Medicine in San Antonio.
He also traveled to Guatemala to help
provide free medical services for
local residents.
Dr. Goehrs was president of the
Travis County Medical Society Blood
Bank in 1965. “The Blood Bank opened
in 1951 after surgeons returned from the
war,” he recalls. “About a hundred
doctors each loaned the Society $200 to
get the blood bank started.” Now known
as the Blood and Tissue Center of
Central Texas, the Center provides
Dr. Goehrs has a fondness for pie.
therapeutic blood and tissue products
and tissue donor recovery services for
more than 30 health care facilities in ten
Central Texas counties.
Dr. Goehrs has been a leader in both
medicine and the community. In
addition to his service as president of the
Blood and Tissue Center, he has served
as president of the Travis County
Medical Society and as executive director
of the Texas Medical Board. He has also
served as president of the Rotary Club of
North Austin and as president of the
Headliner’s Club of Austin, where his
fondness for pecan pie was well-known.
A longtime Austin resident, Dr. Goehrs
met his wife, Glenda, after moving to a
new neighborhood in the 1980s. Shared
interests include baseball and travel. “I
had season tickets to UT baseball. That’s
the major reason she married me!” laughs
Dr. Goehrs.
Snow fun in Colorado!
continued on page 18
TCMS Journal November • December 2009 17

continued from page 17
Retirement brought many additional
opportunities, including plenty of tennis,
travel, and baseball. Once a sandlot catcher,
he attended a weeklong umpire school in
Arizona at the age of 66, then spent five
years as a qualified baseball umpire.
Together, Dr. and Mrs. Goehrs have
enjoyed a photo safari to Kenya and
travel to Alaska, Canada, and Europe. In
England, they lived and studied in
Cambridge during a University of Texas
summer session.
An avid Texas history buff, Dr.
Goehrs was a member of the first group
of docents at the Bob Bullock Texas State
History Museum. He continues to
pursue his passionate interest in the role
of the Texas Navy during the early days
of the Republic of Texas.
Although a long time supporter of
the Blood and Tissue Center of Central
Texas, Dr. Goehrs has a new and
unexpected role to play: that of patient.
Diagnosed with myelodysplasia, a
disorder in which the bone marrow fails
to make sufficient numbers of blood
cells, Dr. Goehrs regularly receives blood
transfusions. His illness has given him a
renewed appreciation for the importance
of blood donation. See sidebar this page.
As he looks back on his long career,
Homer Goehrs is grateful for the years
spent amongst the camaraderie of his
fellow TCMS doctors: “It’s been a real
pleasure just to be a part of such an
outstanding medical community.”
Not Just Professional – It’s Personal
Homer R. Goehrs, MD
TCMS Member
As some of you know, I had the pleasure many years ago of serving as
President of the Board for The Blood and Tissue Center of Central Texas, a
non-profit affiliate of the Travis County Medical Society.
As a physician, my patients utilized its valuable services over the years.
Now, as a myelodysplasia patient myself, I have become a blood recipient
and my appreciation for this life-sustaining organization is no longer just
professional, it’s personal.
This is why I recently volunteered to help the Center when one
of its generous supporters pledged to make a $10,000 contribution
if we could raise an additional $40,000 to seed the establishment of
an endowment fund.
Once a minimum of $40,000 is raised, the Center’s endowment fund
will then receive the $10,000 in challenge funds. The endowment will then
grow from year to year through earnings and continued donations. Since its
principle cannot be distributed, it will provide perpetual support to The
Blood and Tissue Center.
I’m sure you know what a vital asset The Blood and Tissue Center is to
our community and to the thousands of individual lives it touches every
year. But you should also know that it started out in 1951 as the Travis
County Medical Society Blood Bank. It’s part of your legacy as a Central
Texas physician.
Today, The Blood and Tissue Center carries on its non-profit service
mission as the guardian of our blood supply and the exclusive provider of blood
products to more than thirty health care facilities in our ten-county region of
Central Texas.
As a physician and a Central Texas resident, you can do your part to help
assure that an adequate supply of blood is always there when the unexpected
need arises – there for your patients; there for you.
My hope, both professionally and personally, is that you will join me in
making a founding contribution to the Endowment Fund of The Blood and
Tissue Center of Central Texas. Please do it today. You’ll be glad you did.
Please direct contributions to:
The Blood and Tissue Center of Central Texas Endowment Fund
c/o Austin Community Foundation
PO Box 5159 • Austin, TX 78763
or call (512) 206-1210
18 November • December 2009 TCMS Journal

Travis County Medical Alliance
Roberta Pazdral
President-Elect, Travis County Medical Alliance
The Alliance kicked off the 2009/2010 year with a general
meeting at the home of Kathy and Kevin Shelly on
September 15. Approximately 40 members attended to listen
to a presentation by David Reynolds, TEXPAC Director of
Political Education, who explained some of the nuances of
health system reform legislation winding its way through
Congress. The featured speakers at the meeting were Stacey and
Sue Auler, interior designers and owners of Savvy Vodka and Fall
Creek Vineyards. They shared their insights about interior
design and provided helpful decorating hints with the group.
American Medical Association Alliance
Leadership Conference
The AMAA held its annual Leadership Conference in
Chicago from October 3-6. Roberta Pazdral, President-Elect
represented Travis County and Patty Loose, a past president
of the TCMA, represented the TMAA. The focus of the
meeting was to train county and state Alliance leaders to
recruit, motivate, and retain members as well as how to
identify members with leadership potential and manage them
effectively. Roberta attended a Train the Trainer workshop on
21st Century Medical Families: Engaged, Enlightened, and
Empowered. She is now certified to deliver this workshop to
physicians, other health care providers, Alliance members,
and prospective Alliance members for CME credit.
Alliance Member Spotlight - Kylan Bunker
Kylan Bunker joined the Alliance two years ago.
She notes that, “I originally joined the Alliance to
participate with the Capital Watch Committee and
legislative advocacy efforts, but have found that the Alliance
has much more to offer those who are new to Austin.” To
emphasize her dedication to medicine’s legislative efforts,
she participated in all of the First Tuesdays at the Capitol
during the recent legislative session.
The Bunkers, who met at Baylor University are quite an
accomplished couple. Noah is an anesthesiologist with an
undergraduate degree in cello performance and Kylan holds
a Master’s degree in psychology. While Noah completed his
residency in Birmingham, Alabama, Kylan was Research
Project Manager for an NIH grant studying anger and stress
management in children and has worked as a counselor for
abused children and victims of crime in San Antonio. Kylan
has also had a career in her family’s oil and gas exploration
and production business. Noah recently acquired his private
pilot’s license and the Bunkers look forward to more travel
as a result.
As chair of the TCMA Outreach Committee, the
Alliance is fortunate indeed to have such an effective and
dedicated professional on its board.
Dr. Noah and Mrs. Kylan Bunker
l to r: Roberta Pazdral, Pres-Elect, Travis County; Doris Johnson,
Pres-Elect, TMAA; Hema Viswanathan, Pres-Elect, Bexar County; and
Verlaine MacClements, Pres-Elect, Smith County.
20 November • December 2009 TCMS Journal

Westlake Medical Space
THE SCHOOLYARD
4201 Bee Caves Road
Join our prestigious Medical/Dental Tenants:
• Austin Family Institute
• Audiology Diagnostic Clinic
• MEI - Medical Equations, Inc.
• Ted L. Edwards, Jr., MD
The Hills Medical Group
• Dr. Steven Perkins / Dr. Vincent Cavaretta
Hill Country Oral Surgery
• Dr. J. Kavin Kelp
General Dentistry
• Dr. Randall Kunik
Orthodontics
• Dr. Stanley LaCroix
Family Dentistry
• Dr. Holly Phillip
General and Cosmetic Dentistry
• Dr. David Baker
Family Dentistry
• Dr. Betsy Reidy
Schoolhouse Pediatrics
• Dr. Michou Shell / Dr. Jeff Shell
Westlake Endodontics
• Dr. Mark Sanders / Dr. Derik Sanders
Family Chiropractic Center
• Dr. David Yu / Dr. Nicole Litizzette
Austin Periodontics & Implantology
• Dr. J. Kevin Irons
Irons Advisory Group
KURTS IMONS
COMPANY
Call for available listings or to view office space.
327-7070
Bee Caves Rd
The Schoolyard
4201 Bee Caves Rd
Buckeye Trl
Westlake Dr
S Capital of Texas Hwy
MoPac Epwy

PROJECT ACCESS
Project Access was created by the
TCMS Foundation to assist individuals
who have no access to health coverage.
Patients often earn too much to qualify
for government assistance, but not
enough to afford proper health care or
insurance. In some instances they have
been laid off by their employer and need
health care assistance during the job
transition period. The Project Access
Executive Committee oversees the
program’s operations which are funded
primarily by grants from the Travis
County Healthcare District and local
foundations. No TCMS dues dollars are
allocated for Project Access. We would
like to thank Drs. Al Lindsey and Kevin
Kriesel as they end their service on the
Executive Committee and welcome three
new members, Drs. Matthew M. Meigs,
F. Javier Otero, and Theresa J. Pugh.
If you are not a participating
physician and want more information on
Project Access, complete the form below
or contact project director Cliff Ames at
206-1165.
Project Access
Executive Committee
Tom S. McHorse, MD - Chair
Manuel J. Martin, MD
Matthew Meigs, MD
F. Javier Otero, MD
Theresa Pugh, MD
Richard D. Tallman, MD
Guadalupe ‘Pete’ Zamora, MD
New Committee Members Spotlight
I wanted to get involved
because I believe in the
Project Access mission
and want to help those in
the community who are
in need and who aren't
supported by existing social programs.
Matthew M. Meigs, MD (OTO)
Austin Regional Clinic
I do appreciate the
opportunity to work
within the community to
reach out to those in
more need.
Project Access Physician Participation
A physician participating in Project Access agrees to either see
patients in their office or volunteer at a community clinic.
I will volunteer to see Project Access patients in my office:
Primary Care Physician
Over a 12 month period I pledge to accept up to the following number of patients:
10 Other ____________
Or
Specialty Care Physician
Over a 12 month period I pledge to accept up to the following number of patients:
10 Other ____________
I will volunteer at a Community Clinic
Over a 12 month period I pledge to volunteer the following number of hours:
24 hours Other ____________
Please contact me. I have additional questions regarding my role in Project Access.
I am not interested in volunteering for Project Access at this time.
F. Javier Otero, MD (CD)
Texas Cardiovascular Consultants
I have enjoyed participating
in Project Access since I
moved to Austin and I am
thrilled to serve on the
Executive Committee. I
hope we can find ways to
expand the program by including
more physicians and increasing our
patient enrollment.
Theresa J. Pugh, MD (FM)
Jefferson Street Family Practice
Office Contact Name (please print):
__________________________________________
Physician name: __________________________________ Specialty: ____________
Fax this card to 206-1135 or mail to PO Box 4679, Austin, TX 78765
For more information, contact Cliff Ames at 206-1165.
22 November • December 2009 TCMS Journal

The Center for Wound Care and Hyperbaric Medicine
We specialize in the management
of all wounds,
lymphedema care and
hyperbaric medicine.
We have the solution!
HYPERBARIC OXYGEN THERAPY
• Diabetic wounds of the lower extremities
• Soft tissue radioecrosis
• Osteorradionecrosis
• Chronic refractory osteomyelitis
WOUND MANAGEMENT:
• Acute Wounds
• Non-healing Wounds
• Leg Ulcers
• Preparation and preservation of compromised
skin grafts, excluding artificial skin graft
• Including other diagnoses
• Post Surgical Wounds
• Diabetic Foot Ulcers
• Decubitis Ulcers
Cecilia Cervantes,
M.D., C.W.S., C.L.T.
Medical Director
LYMPHEDEMA TREATMENT:
• Post Operative Lymphedema
* Breast Cancer – Lymph Node Dissection
* Cosmetic Surgery
* Knee and Hip Replacement
HEALTH SOUTH
REHABILITATION
HOSPITAL
1215 Red River
(next to Brackenridge Hospital)
• Post Traumatic Lymphedema
• Lympho-Venous Insufficiency
• Pregnancy – Swelling and Leg Pain
(512) 479-3846
fax (512) 479-3770
www.woundandlymphedemacare.com
MEDICARE AND MOST MANAGED CARE PLANS ACCEPTED.

HOLIDAYS REMEMBERED
Papa and the
Christmas of ‘33
Comparing “Papa” and “Santa Claus”
was really not too ridiculous in 1933, in
the mind of an eight-year-old boy
growing up in Mobile. Papa came just
before Christmas – usually by two days.
Papa was not my Father but my
grandfather on Mother’s side of the
family. He would arrive at the train
station alone – looking gaunt and tired
in a rumpled, old gray suit. (His wife
had died when I was two years old).
Dark-haired and about six feet one inch
tall, he looked like a giant – albeit a
friendly one.
The wind and sun had left telltale
marks on his face, a tribute to a poor dirt
farmer who plowed against the elements
in the red clay of north Alabama trying
to scratch out a living. The six-hour train
ride (with a two hour layover in
Montgomery) had wearied him but not
enough to stop the bear hug and big
smile he gave Mother and me. A Baby
Ruth candy bar quickly followed from
his right coat pocket as we walked
toward the luggage area to wait for the
old beat-up brown leather suitcase.
Everybody always perked up when Papa
came on the scene with his funny jokes
and contagious enthusiasm. Mother
always said he prefers to be called Papa
and never Grandpa. My brother and I
always obliged.
To me, at eight, Santa Claus was still
real. Perhaps I knew the secret of his
identity but never wanted to accept it.
Papa’s coming meant more to us with
each Christmas and brought merriment
and good times the whole three days he
stayed. Christmas night meant dreaming
of gifts though Mom and Dad had told
us this year – things would be slim. That
meant apples, oranges, walnuts in the
stockings and a few clothes.
Christmas Eve was very anxious and
we went to bed early. I slept with Papa in
the only spare bedroom and tried hard to
sleep. Papa snored promptly but must
have been irritated by my waking him up
every hour on the hour saying, “Do you
think he’s come yet?” His reply was a
short, “Go back to sleep, boy.” That
didn’t daunt me, however. Soon, he gave
up and at about 4:30 am, he went with
me to the living room, and there it was!
A small, “almost new,” two wheeled
bike with blue body, silver wheels and a
smart “American Flyer” on the front
beneath the handlebars. A small tag
“Little Harry” graced the seat. (Dad was
called “Big Harry”). That was “heaven
on earth” and confirmed my belief in
good St. Nick. That shiny bike gave me
endless hours of pleasure after I
conquered the initial fear of letting go.
Papa must have pushed me six hours in a
row later that morning and I hit the
ground with increasing frequency. That
old bike lasted till 1940 when it was a
victim of a “hit and run” accident in our
own driveway. A younger brother Billy,
age three years, somehow got our car in
gear after Mother left him in the car
(with the motor running) while she took
groceries to the kitchen. She saw the car
moving with his head under the steering
wheel as it went past the kitchen. She ran
out, hopped on the running board and
tried to stop it but was brushed off by the
garage door as the car went into the
garage. A 2 x 4 jammed the wheels and
stopped the car – though the back of the
garage came off. My bike was a pile of
metal when I came in from high school.
Old Billy was dying laughing and
unhurt. He later went on to drive buses
and 18-wheelers, so I guess he had cars in
the blood.
Papa went back home on the train
promising to return again next year. He
did return for eleven more years before a
heart attack felled him in 1945. We lost
a fine man and a special “Papa” then. A
train whistle brings back that spirit and
eternal optimism he had when I think of
that Depression Christmas so long ago.
Harry C. Powell, MD
TCMS Member, Retired
24 November • December 2009 TCMS Journal

Classifieds. Call 206-1245.
OPPORTUNITIES
Physician Opportunity: Existing North
Austin FP/IM practice searching for an
experienced physician to join our growing
practice. Fax CV to (512) 997-9092, email to
officemanager@austinprimarycare.com, or call
(512) 694-3203.
Physician Opportunity: Well established
private practice in Westlake seeking PT/FT
board certified pediatrician. We offer flexible
schedule, pleasant environment, and
no hospital responsibilities. Email to
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(512) 306-8658.
Encounter intriguing cases: Be paid to
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knowledge. No fee to join PHYSICIANS FOR
QUALITY, an organization of physicians
committed to fairness in medical malpractice
cases. Practicing physicians only. Now accepting
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or call (800) 284-3627, email kim@PFQ.com.
Physician Opportunity: People’s
Community Clinic invites physician to join
our dedicated and mission-driven staff to care
for adult patients with acute and chronic care
needs. The position is 20-25 hours/week,
including some evening hours (5:30-10:00).
Board certified in internal medicine or family
medicine, an ability to communicate in
Spanish, and at least one year’s experience in
practice are preferred. The patients are
uninsured, Medicaid, and Medicare. Email CV
to Lindas@austinpcc.org or contact Linda Smith,
HR Manager, (512) 708-3188.ww.austinpcc.org
for information.
Mid-level Provider: Busy internal
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weekends or call, competitive salary + benefits.
Call (512) 694-3203.
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Dr. Gupta is a board-certified neurologist and pain specialist, and former
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Complete Solution to Your Sleep Problems
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Vani Vallabhaneni, MD
Board Certified in Sleep Medicine
Board Certified in Internal Medicine
Ph: 810-0360 Fax: 918-0361
www.sleep360md.com
Our new 6 bed sleep center will be
opening soon at 10601 Pecan Park
Professional Plaza, #203, Austin 78750.
Comprehensive management of sleep disorders
including medical evaluation, sleep studies, CPAP
management with continuity of care.
26 November • December 2009 TCMS Journal

Classifieds. Call 206-1245.
OFFICE SPACE
OFFICE SPACE
SERVICES
For information on the following
properties below contact Brian Novy at (512)
327-7613 or visit www.briannovy.com.
For Lease: Anderson Mill Medical Center
located on Hymeadow and 183 near 620 and
Lakeline Mall. Five finished out medical spaces
836, 1528, 1837, 2089, and 2394 sq/ft. Great
rates, flexible terms, generous finish out, and
free rent.
For Lease: Round Rock Professional Building.
Great location 2000 South Mays and I35 / I45
near Dell. 2000-9000 sq/ft available. Recently
renovated with Round Rock Surgery Center and
Advanced Pain Care.
For Lease: 8105 Shoal Creek. Free standing
building with great signage, 3388 sq/ft.
For Lease: Austin Medical Plaza 3705
Medical Parkway across the street from Seton.
Suite 450 is 992 sq/ft and suite 455 is 1498
sq/ft that can be leased together or separately.
For Sale: 13552 Research Blvd. 4020 sq/ft free
standing building with great visibility and
parking. 2040 sq/ft available for owner/occupant
with rental income.
For Lease: Westlake Medical at The
Schoolyard. 4201 Bee Caves Road next to
Eanes Elementary. 1,500 to 6,000 sq/ft.
Contact Ronnie Brooks at (512) 327-7070. See
ad on page 21.
EQUIPMENT
For Sale: Burdick Medic-5 defibrillator, WA
Temp Plus II Model 2080A and BD sharps
wall container units (6). Contact Doris
Robitaille at (512) 413-1903.
Office Space Available: Approximately
2000 sq/ft in Taylor, TX. Easily accommodate 2
physicians; adjoining established ophthalmology
practice and optical shop. Available immediately.
Call (512) 365-1968 ext. 11.
Medical Facility Available in
Lakeway: Fully equipped medical offices for
lease near Lakeway Reg Medical Center site.
2400 sq/ft free standing bldg. w / parking. Great
visibility w / signage on RR 620. 6 fully equipped
exam rooms + 2 offices. X-Ray and lab. 1411 RR
620 South, Lakeway. Call (512) 413-1903.
For Lease: Northfield Professional
Building, 101 W Koenig. 4000 or 8500 sq/ft
of shell space. Free parking. Contact Joel
Haro, joelharo@pmgmt.com for rates.
Beautiful class A office space to
sub-lease/share with specialist. Flexible
lease terms and days. Up to 2650 sq/ft.
available in prime NW Austin location, near
2222 and FM 620 – built-out, furnished, state
of the art. Contact (512) 478-3376.
MD Revenue
Medical Billing
• Let Us Increase Your Revenue
• We Use Your Software
• Ask About Our Guarantee
Joe Kasson Painting: Residential
specialist in quick, neat, clean professional
interior/exterior painting. References available.
(512) 312-1035.
Thaddeus Jones Custom Remodeling:
Construction, remodeling, siding replacement.
Decks/Patios, gutters and gutter shield.
Visa/MC accepted. Free estimates. Call
(512) 291-0606.
Medical Billing: Cost effective,
experienced, reliable, and punctual. There is a
difference. (512) 970-1139.
Beauty & Wellness: Physician operated
beauty and wellness clinic. Laser hair
reduction, microderma abrasion, and
chemical peels. Discounts for TCMS
members. Call (512) 836-5665.
Medical Billing: Reevaluate your current
billing process. You can potentially increase
your net revenues. Discover the difference.
(512) 970-1139.
(512) 288-0101 www.MDRevenue.com
The University of Texas at Austin-University Health Services
is currently seeking qualified applicants for the following position:
Physician
Sports Medicine
Job # 090611010501
Go to
http://utdirect.utexas.edu/pnjobs/
For complete job descriptions and to apply for the job numbers listed.
Security Sensitive – conviction verification conducted on applicant selected.
Equal Opportunity / Affirmative Action Employer
28 November • December 2009 TCMS Journal

BURN INJURIES
TAKE FIVE
for your
HEALTH
Burns, most commonly caused by fire, can also result from chemicals, electricity, and other
heat accidents, such as scalding hot water or steam. More than 300,000 persons die each year
worldwide because of fire-related burn injuries. Many more are seriously injured, disabled, or
disfigured because of all types of burns. Risk factors for burns include cooking with an open
flame, open cooking facilities on the ground floor of a building or residence, wearing loose
clothing while cooking, smoking, alcohol use, water heaters that are set too hot, poor electrical
safety, and unsupervised children. Occupational injuries involving burns can also occur, especially
at job sites with open flames, chemicals, or superheated materials.
BURN INJURIES
TYPES OF BURNS
Burns are classified based on how much of the skin’s thickness is involved. First-degree (or
superficial) burns involve only the top layer of the skin and are the least serious burn injuries.
Second-degree (or partial-thickness) burns injure deeper into the skin and cause blistering.
Third-degree (or full-thickness) burns involve all the layers of the skin, including the nerves
that supply the skin, and are extremely serious injuries. Fourth-degree burns extend into the
muscle below the skin.
Healthy
tissue
Types (Degrees) of Burns
First
Second
Third
Fourth
BURN TREATMENT
Testing for serious causes of cognitive difficulties begins with a medical history, including a
careful description of the type of problem and when it began. Physical examination looks for
signs of illnesses with treatable causes that may be associated with cognitive impairment. Other
testing to help pinpoint causes of cognitive impairment may include computed tomography
(CT) scan, magnetic resonance imaging (MRI), blood tests, and lumbar puncture (spinal tap).
Neuropsychological testing is a specialized paper-and-pencil examination that evaluates
changes in cognition and memory.
Atreries, veins, and nerves
Epidermis
Dermis
Fat
Muscle
PREVENTION
• Do not smoke. If you do smoke, never smoke in bed. Avoid smoking while consuming
alcoholic beverages.
• Never throw a lighted cigarette or a match anywhere. Dispose of those hazards in
proper ashtrays.
• Be very cautious around any type of open flames.
• Supervise children carefully.
• Follow electrical safety rules. Never put electrical appliances or cords in or near water.
• Do not touch downed power lines.
FIRST AID FOR BURNS
• Call emergency services (911 in North America) immediately for large burns, third- or
fourth-degree burns, burns with other injuries, or for a person who loses consciousness.
Any person with an electrical burn should also have immediate emergency care, since there
may be unseen internal electrical injuries as well.
• Seek medical attention rapidly if the burn is on the face, hands, feet, genital area, or
buttocks, or if it involves a joint (such as the elbow or the knee).
• For minor burns, run cool (not cold) water over the burned area. Do not rub it or put ice,
butter, or oil on a burn.
• Cover the burn with a clean gauze dressing. Do not break a blister if it forms. Antibiotic
ointment may be gently applied.
FOR MORE INFORMATION
World Health Organization
www.who.int
American College of
Emergency Physicians
www.acep.org
American Burn Association
www.ameriburn.org
Make copies of this article
to share with your patients
30 November • December 2009
TCMS Journal