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  November 2012

From the President

Dan Peckenpaugh, MD, FACEP

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Thank you for joining us for another edition of the EMPhasis, updating Texas emergency physicians on the recent happenings in TCEP.

The TCEP delegation represented us well at the ACEP Council meeting that preceded the Scientific Assembly in Denver earlier this month. Our TCEP Councilors activity resulted in Council approval of several resolutions sponsored by the Texas chapter. The Alternate Councilors, many of which were attending their first Council meeting, gained valuable experience observing and participating in the methods the ACEP Council uses to conduct business, preparing them for a role as future leaders of our state organization. Dr. Diana Fite, using her experience as a long-standing Councilor and functioning as our Delegation Chair, was invaluable in organizing the proceedings for our chapter.

During the meeting, the ACEP Council approved several resolutions that were sponsored by the TCEP chapter, including:

  1. Support for the development of community non-punitive sobering centers as an alternative for serial inebriates, instead of them being sent to the ED for evaluation and holding
  2. Development of a work group to identify more appropriate practices for the timely evaluation and disposition of ED behavioral health patients
  3. Study of the emergence of free-standing EDs: including the applicable regulatory issues, impact on the EP workforce, fiscal impact on hospital-based EDs and informational resources for ACEP members and state chapters interested in FSEDs


In addition to the approval of resolutions, the Council also elected several new members to the ACEP Board of Directors and a new ACEP President-Elect.

ACEP leadership recognized the TCEP chapter as the winner of the Teamwork Award for the TCEP EM Futures Program, led by Dr. Angela Fisher, as recognition for outstanding contributions and participation in Council activities by a chapter.

TCEP received several personal commendations from other state chapter leaders for our success as a chapter; noting in particular our increased membership, our level of organization, our pro-active approach to Council resolutions, and the resulting influence we have at ACEP. Several of the state chapters have used TCEP as a model for their chapter’s organization and activity.

This kind of recognition, both formal and personal, is a testament to the hard work and dedication of our Board of Directors and the continued active involvement of the past leaders of our chapter.

We will continue to keep you informed on the status of issues important to TCEP. You may contact our chapter office at 800-839-2237 for any question or you may contact me at danpeck@tx.rr.com.

As always, thank you for your continued support.

In This Issue:
Government Relations Report
Congratulations to the New Fellows of ACEP
What Did I Miss at the ACEP Scientific Assembly?
2012 TEXPAC General Election Endorsements
TCEP Free Standing Emergency Department Committee Report
News From the Medical Student Committee
TCEP Calendar of Events
TCEP News
Welcome New TCEP Members
TCEP Leadership and Advocacy Fellowship Program




Government Relations Report

Diana Fite, MD, FACEP
Chair, Government Relations Committee

The TCEP Board of Directors has now approved our legislative priorities for the 2013 legislative session, and the process has been done a bit differently this time.   The Board generally picks three, sometimes four, priorities from a list of suggestions presented by the Government Relations Committee.  The priorities are picked based on relevance to TCEP members and practicality.  For instance, if the priority would be one that the Texas Medical Association (TMA) is already concentrating on and would be very expensive and time-consuming for us to pursue, then it would be better off handled by the TMA, who represents those of us who are members anyway (and by the way, all Texas emergency physicians should be TMA members because clearly it was through the TMA that we obtained our excellent tort laws).  



Of major importance to TCEP members is increasing payments from Medicaid, eliminating the dual eligibility issue (Medicaid no longer picks up the balance that Medicare does not pay), and stopping the practice of Medicaid reducing our payments by 40% if the visit is billed under a procedure code that they deem to not be emergent.  However, the TMA is working on the Medicaid issues, which will be very hard to change when the legislature is looking to cut payments even more, so it is not practical for us to ask our lobbyist to work on that as our priority.  Mignon does work closely with the TMA and will work with them in representing our interests as needed.



In addition to the Medicaid issues, we know in advance that this legislative session we will need to be watching for bills to be introduced that affect free standing emergency departments and will probably need our lobbyist to work on those bills.  We also predict that there will be bills filed once again trying to prohibit us from balance billing.  



So this time the decision was made to pick only two priorities for TCEP because we predict that our lobbyist will have to be involved in the other problems once bills are filed and we see what we are facing.  The two priorities that were picked are:  protecting our tort laws that specifically involve emergency medicine, which is the "willful and wanton" clause; and advocating for the ability to hold and transfer psychiatric patients who are suicidal or homicidal in the ED without having to wait on permission and a warrant from a judge or justice of the peace. For those emergency physicians new to Texas, the following is part of the wording from the statue about the "willful and wanton" clause: "In a suit involving a health care liability claim against a physician or health care provider for injury to or death of a patient arising out of the provision of emergency medical care in a hospital emergency department . . . the claimant  bringing the suit may prove that the treatment or lack of treatment by the physician or health care provider departed from accepted standards of medical care or health care only if the claimant shows by a preponderance of the evidence that the physician or health care provider, with willful and wanton negligence, deviated from the degree of care and skill that is reasonably expected of an ordinarily prudent physician or health care provider in the same or similar circumstances". This statute is separate from the non-economic damages cost limitation tort reform that is protected by the constitutional amendment, and every session since the law was passed in 2003, there has been some attempt made to overturn it.  So TCEP and our lobbyist must remain vigilant in protecting this part of the tort law that directly affects emergency physicians.



Now is the time to be sure to plan on attending at least one of the First Tuesdays sponsored by the TMA.  We would like emergency physicians to have a strong presence at the February 5th First Tuesday.  The TCEP Board of Directors meeting will be held on February 4th so that board members and other attendees can easily stay over.  The TMA has a block of rooms reserved at the Double Tree Suites Hotel in Austin next to the Capitol and across the street from the TMA Building.  Their phone number is 512-478-7000 and you cannot make the reservations on line because it will show as full.  You must call and ask for the "TMA First Tuesday" block.  My experience is that this will fill up quickly, so please go ahead and make reservations as soon as you read this.  Of course, there are other hotels in the area, but this one is the closest.



As we always remind our TCEP members, we would appreciate you working one shift per year to give to EMPACT (the political action committee for the Texas College of Emergency Physicians).  And larger donations are appreciated, of course.  We need to fund EMPACT so that we can give donations to legislators, particularly those in positions of importance to our issues or who have helped us out with our bills or with support of our agenda.  Our reports emphasize the importance of having a strong voice when it comes to legislation that affects us so directly.  We have to help legislators get elected who understand our issues and help us advocate for our patients.  EMPACT needs money to accomplish this. Please send your check to TCEP or call 1-800-TEX-ACEP with your credit card information.  You can donate with credit card deductions monthly or quarterly if that is helpful.  And you have to renew your donation on a yearly basis.  Please call me (713-301-3564) or e-mail me (dianafite@mail.com) or call our executive director, Jim Coles (1-800-TEX-ACEP) or e-mail him (texacep@gmail.com), if you wish to discuss any of the information in this report.


ACEP Council Meeting Report

Diana Fite, MD, FACEP
TCEP Delegation Chair

Each year for the two days before Scientific Assembly begins, the ACEP Council meets.  This year we had about 350 councilors and almost as many alternate councilors attending.  Every state has one councilor as a baseline, then an additional councilor for every 100 members in that state chapter.  Each section of ACEP also has one councilor, then there are a few extra entities that have councilors, such as SAEM and EMRA.  There are only two state chapters with more councilors than Texas.  California and New York have more than Texas. 

Although the ACEP Board of Directors sets policy, the council passes resolutions that go to the board for decision and implementation.  We considered 31 resolutions during this council meeting. Some of the resolutions were memorial resolutions and commendation resolutions. Among this year's memorial resolutions was one honoring Dr. Michael Wainscott of Texas.  Dr. Wainscott was a past president of TCEP, was on the faculty of Texas Tech in El Paso residency program formerly, then more recently had been the beloved residency director of the Parkland residency program in Dallas. 

In this report, I will highlight some of the resolutions that we considered to give you a flavor for what we discuss. For instance, the Pennsylvania chapter is having significant problems with malpractice suits, and they were asking for help to find expert witnesses in emergency medicine and proposed that fellows of the college report annually about their participation as expert witnesses and that ACEP establish a database as a member benefit.  Rather than this resolution being passed or rejected, it was referred to the board so they could come up with a recommendation to help Pennsylvania out but not to the extent of reporting cases on each year’s membership renewal.

Every year for the past few years, the Michigan chapter has proposed that ACEP support the adoption of single-payer health insurance.  Each year their resolution has been defeated, as it was again this year.  However, this year our Texas chapter decided to bring a resolution that opposed a "single payer, federally mandated, uniform health care system that would mandate exclusive and sole participation for all patients, all physicians and all providers", and instead proposed that ACEP:  "support efforts to create a functioning US health care system with universal access to basic primary care services for all citizens; and support the autonomy of physicians to contract with federal, state and local health care systems as well as individual patients and health care plans; and support local and state efforts to create health care services and systems that best meet the needs of individuals and groups; and support a health care system that rewards innovations, allows for competition, free enterprise and creative responses to individual and group needs, and promotes quality, effective and efficient care."  To our surprise, our resolution was also defeated!  The reasoning for defeat seemed to be that since we do not know who will win the presidential election, the council did not want to tie the hands, so to speak, of the board depending upon what health insurance will look like in the future and the ability of ACEP to be at the table for discussions and negotiations. 

However, it was less surprising that our resolution was defeated when a straw vote of the political views of the council was taken during the meeting.  The voting was electronic and anonymous. When asked about political affiliation, 33% of the council members were Democrat, 33% were Republican, and 32% were independent (1% other).  When asked about the election of the president, 166 voted for Romney and 163 voted for Obama, with a few abstaining.

Another resolution that Texas brought involved supporting the development of sobering centers, including exploring the development and identifying medical and professional needs for these centers and promulgating efforts to support their development.  This resolution passed on the consent calendar. 

One resolution that did not pass involved not allowing chronic pain patients to receive patient satisfaction surveys.  Although the sentiment appeared to be in support of the intent that it is not fair that patients who do not get the narcotic drugs they are seeking might fill out a survey in a negative way and therefore makes it harder for physicians to deny the narcotic seeker a prescription for narcotics when administration is demanding good patient satisfaction scores, the resolution was deemed too problematic to pass.  However, we were reassured that ACEP is working with survey groups to try to work through pain management issues and how they reflect on the physician scores.

Texas also brought a resolution about free standing emergency departments to the Council.  Since Texas has the most FSED's in the nation, we wanted to be sure that ACEP is recognizing that many Texas ACEP members work in FSED's and that we need ACEP to develop policies regarding FSED's as being alternative facilities in which to practice emergency medicine and share our legislative rules regarding FSED's being open 24/7 and following EMTALA regulations.  Our resolution was whittled down from five resolves to one, but we accomplished our purpose amidst expected protests from members in states where there are no regulations and places have opened up without emergency physicians running them, and advertising as "emergency departments" but only being open during daytime hours. The final resolution that passed reads: RESOLVED, That ACEP study the emergence and proliferation of free-standing EDs and facilities advertising emergency care including: applicable federal and state regulatory and accreditation issues, the potential impact on the emergency medicine workforce, the potential fiscal impact on hospital-based EDs, and provide informational resources to the membership.

Another function of the council is election of members to the Board of Directors and election of the president-elect.  Elected this year to the board were the two incumbents running:  Jay Kaplan of California and Rebecca Parker of Illinois (formerly of Texas).  Also elected were:  Vidor Friedman of Florida and William Jaquis of Maryland.  We elected Alex Rosenau of Pennsylvania to be the incoming president-elect. 

I would like to thank those who served as councilors this year:  David Arai, Chet Schrader in the place of Shannon Bagwell, Carrie deMoor, Angela Fisher, myself, Juan Fitz, Andrea Green, Shkelzen Hoxhaj, Heidi Knowles, Bruce Moskow, Robert Dickson in the place of Heather Owen, Michael Pawlowski, Dan Peckenpaugh, Rick Robinson, Patty Short, and Jim Williams in the place of Angela Straface.  I would also like to thank the many who came as alternate councilors and a few interested Texas members who attended the council meeting as well.  Please feel free to e-mail me or call/text me (713-301-3564) if you wish to discuss this report.


Summary of 2012 Council Resolutions

Resolutions Not Discussed by the Council
Resolution 28 Study of the Effects of Psychiatric Patient Boarding

Resolutions Not Adopted (NA) or Withdrawn (W)

Resolution 6 Council Officers "Standing" in the ACEP Bylaws – Bylaws Amendment (NA)

Resolution 14 ACEP Principles for the US Health Care System: Individual and Physicians' Rights (NA)

Resolution 15 Choosing Wisely Campaign (NA)

Resolution 16 Development of Guidelines for the Treatment of Chronic Pain (NA)

Resolution 19 Pediatric Emergency Preparedness Recognition (NA)

Resolution 20 Single-Payer Universal Health Insurance (NA)
Resolution 26 Patient Satisfaction Scores and Pain Management (NA)

Referred Resolutions
Resolution 13 Expert Witness Database and Reporting

Resolution 25 Maintenance of Licensure

Non-Bylaws Resolutions
Resolution 1 Commendation for Anita H. Hodson, MD, FACEP

Resolution 2 Commendation for Sandra M. Schneider, MD, FACEP

Resolution 3 In Memory of Michael B. Pipkin, MD

Resolution 4 In Memory of Michael P. Wainscott, MD, FACEP

Resolution 10 Commercial, Political, or Promotional Use of the ACEP Member Directory (as amended)

Resolution 11 Councillor Housing Block at Scientific Assembly

Resolution 12 Criteria for Inclusion of Organizations in the ACEP Council

Resolution 17 Ensuring ED Patient Access to Adequate and Appropriate Pain Treatment (as amended)

Resolution 18 Opposition to Routine Abscess Culturing (as amended)

Resolution 21 Support of Non-Punitive Sobering Centers and Community Recovery Services (as amended)

Resolution 22 Behavioral Health Patients in the Emergency Department (by substitution in lieu of Resolution 28)

Resolution 23 Free Standing Emergency Departments (by substitution)

Resolution 24 Joining Forces Roundtable (by substitution)

Resolution 27 Radiation Exposure in the Emergency Department Patient (by substitution)

Resolution 29 In Memory of Richard A. Midthun, MD, FACEP

Resolution 30 In Memory of John A. Marx, MD, FACEP

Resolution 31 Firearm Injury Prevention (as amended)

Resolution 32 Commendation for Robert C. Solomon, MD, FACEP

Bylaws Resolutions
Resolution 5 Alternate Councillors – Bylaws Amendment (as amended)

Council Standing Rules Resolutions
Does not require action by the Board of Directors

Resolution 7 Alternate Councillors

Resolution 8 Conflict of Interest Disclosure (as amended)

Resolution 9 Council Standing Rules Housekeeping Changes (as amended)


2012 Resolutions Adopted by the Council & Board of Directors

Resolution 1 Commendation for Anita H. Hodson, MD, FACEP

RESOLVED, That ACEP recognizes Anita H. Hodson, MD, FACEP, with a Council commendation for her extensive clinical career, dedication to resident education, and care of and advocacy for patients in the State of Delaware.

Resolution 2 Commendation for Sandra M. Schneider, MD, FACEP
RESOLVED, That the American College of Emergency Physicians commends Sandra M. Schneider, MD, FACEP, for her outstanding service, leadership, and commitment to the specialty of emergency medicine and to the College.

Resolution 3 In Memory of Michael B. Pipkin, MD
RESOLVED, That the American College of Emergency Physicians remembers with gratitude and honor the contributions made by Michael B. Pipkin, MD, as one of the leaders in emergency medicine; and be it further

RESOLVED, That national ACEP and the Maryland Chapter of ACEP extends to his wife, Pam, and his family, friends, and colleagues our deepest sympathy, our sense of loss, and our gratitude for his service to the specialty of emergency medicine.

Resolution 4 In Memory of Michael P. Wainscott, MD, FACEP
RESOLVED, That the American College of Emergency Physicians recognizes the dedication, professionalism, and contributions to emergency medicine, ACEP, the Council, the Texas Chapter, and the educational programs at Texas Tech and the University of Texas Southwestern Medical Schools; and be it further
RESOLVED, That ACEP extends to Dr. Wainscott's family, friends, and colleagues our sympathy, great sense of sadness and loss, and our gratitude for having been able to share a part of his life.

Resolution 5 Alternate Councillors – Bylaws Amendment (as amended)
RESOLVED, That the ACEP Bylaws, Article VIII – Council, Section 1 – Composition of the Council, be amended to read:
"Each chartered chapter shall have a minimum of one councillor as representative of all of the members of such chartered chapter. There shall be allowed one additional councillor for each 100 members of the College in that chapter as shown by the membership rolls of the College on December 31 of the preceding year. However, a member holding memberships simultaneously in multiple chapters may be counted for purposes of councillor allotment in only one chapter.

EMRA shall be entitled to four councillors as representative of all of the members of EMRA, each of whom shall be a candidate or active member of the College.

AACEM shall be entitled to one councillor as representative of all of the members of AACEM, who shall be an active member of the College.
CORD shall be entitled to one councillor, who shall be an active member of the College, as representative of all of the members of CORD.
SAEM shall be entitled to one councillor, who shall be an active member of the College, as representative of all of the members of SAEM.

Each chartered section shall be entitled to one councillor as representative of all of the members of such chartered section if the number of section dues-paying and complimentary candidate members meets the minimum number established by the Board of Directors for the charter of that section based on the membership rolls of the College on December 31 of the preceding year.

A councillor representing one component body may not simultaneously represent another component body as a councillor or alternate councillor.

Each component body shall also elect or appoint alternate councillors who will be empowered to assume the rights and obligations of the sponsoring body's councillor at Council meetings at which such councillor is not available to participate. An alternate councillor representing one component body may not simultaneously represent another component body as a councillor or alternate councillor.

Councillors shall be certified by their sponsoring body to the Council secretary on a date no less than 60 days before the annual meeting."

Resolution 10 Commercial, Political, or Promotional Use of the ACEP Member Directory (as amended)
RESOLVED, That the Board of Directors adopt, implement, and present to the 2013 Council a privacy policy regarding the use of the Member Directory.

Resolution 11 Councillor Housing Block at Scientific Assembly
RESOLVED, That ACEP provide a block of rooms to be secured at the Scientific Assembly hotels within ACEP's entire room block, closest to the headquarters hotel, to be made available to councillors up to 60 days prior to the Council meeting.

Resolution 12 Criteria for Inclusion of Organizations in the ACEP Council
RESOLVED, That the ACEP Council, through the Council Steering Committee, develop explicit criteria for the inclusion of additional organizations as component bodies of the ACEP Council; and be it further
RESOLVED, That the Council Steering Committee report these criteria for review and discussion to the 2013 ACEP Council no later than six weeks prior to the deadline for submission of regular resolutions.

Resolution 17 Ensuring ED Patient Access to Adequate and Appropriate Pain Treatment (as amended)
RESOLVED, That ACEP support each state chapter having the autonomy to establish guidelines or protocols for pain management of emergency department patients; and be it further
RESOLVED, That ACEP support the development of evidence-based, coordinated pain treatment guidelines, promoting adequate pain control, health care access, and flexibility for physician clinical judgment; and be it further
RESOLVED, That ACEP oppose non-evidence based public or private limits on prescribing opiates, mandatory opioid related documentation, and mandatory opioid related CME; and be it further
RESOLVED, That ACEP work with government and regulatory bodies on the creation of evidence-supported guidelines for responsible emergency physician prescribing that takes into consideration lack of access while respecting the uniqueness of every individual doctor-patient encounter.

Resolution 18 Opposition to Routine Abscess Culturing (as amended)
RESOLVED, That ACEP recognizes the treating emergency physician as the clinician most appropriate to determine the necessity of antibiotic therapy and/or cultures in the management of abscesses in emergency department patients; and be it further
RESOLVED, That ACEP oppose the recommendation and/or requirement that all abscesses with cellulitis treated with antibiotics be cultured; and be it further
RESOLVED, That ACEP oppose federal or state legislation and/or regulation that require an attending physician to be the person who contacts and notifies patients of positive cultures.

Resolution 21 Support of Non-Punitive Sobering Centers and Community Recovery Services (as amended)
RESOLVED, That ACEP explore the development of sobering centers, identify medical and professional needs for these community centers, and promulgate efforts to appropriately support the development of these entities in our communities.

Resolution 22 Behavioral Health Patients in the Emergency Department (by substitution)
RESOLVED, That ACEP convene  a work group of appropriate stakeholders to explore and identify additional resources, technologies, and best practices that promote quality patient care for timely evaluation and disposition of behavioral health patients.
RESOLVED, That a report from the work group on behavioral health care be delivered to the 2013 ACEP Council.

Resolution 23 Free Standing Emergency Departments (by substitution)
RESOLVED, That ACEP study the emergence and proliferation of free-standing EDs and facilities advertising emergency care including: applicable federal and state regulatory and accreditation issues, the potential impact on the emergency medicine workforce, the potential fiscal impact on hospital-based EDs, and provide informational resources to the membership.

Resolution 24 Joining Forces Roundtable (by substitution)
RESOLVED, That ACEP collaborate with other professional societies, the Department of Veterans Affairs, and the Department of Defense to share educational resources and research opportunities related to the treatment and referral options in the management of patients suffering the acute sequelae of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) that present to the ED.

Resolution 27 Radiation Exposure in the Emergency Department Patient (by substitution)
RESOLVED, That ACEP work with appropriate stakeholders to promulgate techniques to minimize radiation exposure.

Resolution 29 In Memory of Richard A. Midthun, MD, FACEP
RESOLVED, That the American College of Emergency Physicians remembers with gratitude and honor the contributions and service of Richard A Midthun, MD, FACEP; and be it further
RESOLVED, That the American College of Emergency Physicians and CAL/ACEP extend to his wife, Sue Midthun and his daughter, Lauren, his family, friends and colleagues our deepest sympathy, our sense of loss, and our gratitude for his service to the specialty of emergency medicine.

Resolution 30 In Memory of John A. Marx, MD, FACEP
RESOLVED, That the American College of Emergency Physicians recognizes John Andrew Marx, MD, FACEP for his outstanding dedication, professionalism, and contributions to emergency medicine, ACEP, the North Carolina and Colorado Chapters, and the educational programs at Carolinas Medical Center and the Denver Affiliated Residency in Emergency Medicine; and be it further
RESOLVED, That ACEP extends to Dr. Marx's family, friends, and colleagues our sympathy, tremendous sense of sadness and loss, and our gratitude for having been able to share and embrace the life of a man who embodied humility, greatness and a love of humanity.

Resolution 31 Firearm Injury Prevention (as amended)
RESOLVED, That ACEP reaffirm its commitment against gun violence including advocating for public and private funding to study firearm violence prevention.

Resolution 32 Commendation for Robert C. Solomon, MD, FACEP
RESOLVED, That the American College of Emergency Physicians commends Robert C. Solomon, MD, FACEP, for his exemplary service, leadership, and commitment to the specialty of emergency medicine and to the College.

Congratulations to the New Fellows of ACEP

Harbir Singh, MD

TCEP would like to reach out and give a warm congrats to the numerous Texas ER physicians who became Fellows of the American College of Emergency Physicians.  Of note, are TCEP's very own board members: Dr. Heidi Knowles and Dr. Carrie DeMoor.  We look forward to the future accolades and accomplishments by these young physician leaders.

We would like to also congratulate Dr. Angela Siler Fisher & TCEP EM Futures Program for winning the Council Meritorious award for Teamwork!  The award recognizes fisher_awardsmalleroutstanding contributions and participation in Council activities. Dr. Fisher and the TCEP EM Futures program have set a national standard by increasing Texas Membership by greater than 60%.  We as TCEP members set a national example of what it means to be an active state chapter!  Special members of the EM Futures team include: Drs. Carrie deMoor, Heidi Knowles, Arlo Weltge, Shklezen Hoxhaj, Toni Helbling, MS IV; Samantha Shapiro, MS IV; Michael Lara, PGY-1.

Lastly, we would like to congratulate Dr. Raymond Fowler, Professor of Emergency Medicine at UTSouthwestern for winning the national award of Outstanding Contribution in EMS.

Congratulations to the new Fellows of the American College of Emergency Medicine:

Greg Buehler, MD, MBA, FACEP
Jeff J Chambers, MD, FACEP
Christina C M Chiang, MD, FACEP
Jonathan Clarke, MD, FACEP
Christopher Colvin, MD, FACEP
Carrie DeMoor, MD, FACEP
Sean C Denham, MD, FACEP
C Augusto Dias, MD, FACEP
Cory Evan Duncan, MD, FACEP
Jacqueline Frazer, MD, FACEP
Keith S Gates, MD, FACEP
Wesley H Hamilton, MD, FACEP
Alicia Hart, MD, FACEP
Paul R Hinchey, MD, MBA, FACEP
Alexander W Kadin, MD, FACEP
Heidi C Knowles, MD, FACEP
Sunil R Mahbubani, MD, FACEP
Joseph N Martinez, MD, FACEP
David Duane Moyer-Diener, MD, FACEP
Heather S Owen, MD, FACEP
Ajay Arvind Patel, MD, FACEP
Stephen M Paulson, MD, FACEP
Carlos J Roldan, MD, FACEP
Daniel D Smith, MD, FACEP
Kimberly Snyder, MD, FACEP
Micheal Spohn, MD, FACEP
Charles W Todd, MD, FACEP
Scott T Wiesenborn, MD, FACEP
Ira Wood, III, MD, FACEP
Amir Zegar, DO, FACEP

What Did I Miss at the ACEP Scientific Assembly?

Gerad Troutman, MD

If you have never been to ACEP Scientific Assembly (SA) then you are missing out!  SA is the largest gathering of Emergency Physicians each year; this year we gathered in Denver, CO with about 5400 attendees… making it the third largest assembly ever!!  I like to think that every EM Physician is familiar with SA, but I find out there are some that have never been or rarely go.  There are so many incredible opportunities at this conference!  The en masse of leaders of our specialty at this conference is unparalleled.  There are multiple opportunities for networking, exploring state of the art devices, and gaining amazing knowledge.

Networking and professional relationships is an important aspect of our job.  SA allows for the opportunity to do so not only with leaders but also other EM Physicians from throughout the country.  It certainly is the best way to land a position with a top notch group and to share new ideas and concepts with one another.  It is also a great opportunity to meet up with your past colleagues and residents.  There are many dinners, cocktail parties, and gatherings that occur throughout the conference.

The EXPO hall always has many intriguing devices and concepts on display.  Everything from practice management, contract groups, and new devices fill this area.  The cutting edge technology is displayed here and many of these devices are likely to be mainstream to our practice in the future!  This is the opportunity to look for other practice opportunities, ask questions of those representatives from the EHR that you just started using, or even to visit the ACEP Wellness Booth to see how your health is doing!

Last, but certainly not least, is the paramount education that is offered.  When we all signed up to become doctors, we knew that lifelong learning was something we would need to do.  We can all read journals at home and sign up for online CME classes, but there is simply nothing that comes close to the amount of expert education in EM that occurs here.  Just becoming a speaker at SA is a competitive process so you know that only the crème of the crop in our field lectures to you about true state of art Emergency Medicine!

Advancing Emergency Care… The slogan of ACEP is demonstrated well at this conference.  I did not even mention the opportunities where YOU can become involved in making a difference in the future of our specialty.  From committee membership to councilor, the college highly encourages active participation from its members.  Rather a new graduate or a seasoned director/chair, there are opportunities for all.   Next year, Scientific Assembly will be in Seattle, WA on October 14-17.  You can already make your hotel reservations at the following link: http://www.acep.org/seattle2013/   I already have my hotel booked and look forward to meeting new Texas faces next year as we share fresh salmon and take in those west coast breezes!

Gerad Troutman, MD
Associate Medical Director – Lubbock Fire Department
University Medical Center – Lubbock, TX
Gerad.Troutman@umchealthsystem.com


2012 TEXPAC General Election Endorsements

Contested Races Only

Early voting begins Oct. 22 and the Nov. 6 general election date is right around the corner!



Be sure to use this endorsement guide, created just for TEXPAC members, as you head to the polls. Certainly, we understand that individuals will disagree from time to time with TEXPAC decisions, but we are confident in our board-approved slate of candidates. Be sure to download and print off our Voter's Guide.

Statewide Offices

Texas Supreme Court, Place 2
Don Willett (R)

Texas Supreme Court, Place 3
Nathan Hecht (R)

Texas Congressional Delegation

CD 1   Louie Gohmert (R-Tyler)
CD 2   Ted Poe (R-Humble)
CD 4   Ralph Hall (R-Rockwall)
CD 5   Jeb Hensarling (R-Dallas)
CD 6   Joe Barton (R-Ennis)
CD 7   John Culberson (R-Houston)
CD 8   Kevin Brady (R-The Woodlands)
CD 9   Al Green (D-Houston)
CD 10 Michael McCaul (R-Austin)
CD 11 Mike Conaway (R-Midland)
CD 12 Kay Granger (R-Fort Worth)
CD 14 Randy Weber (R-Pearland)
CD 15 Ruben Hinojosa (D-Mercedes)
CD 16 Beto O'Rourke (D-El Paso)
CD 18 Sheila Jackson Lee (D-Houston)
CD 20 Joaquin Castro (D-San Antonio)
CD 21 Lamar Smith (R-San Antonio)
CD 22 Pete Olson (R-Sugar Land)
CD 23 Francisco "Quico" Canseco (R-San Antonio)
CD 24 Kenny Marchant (R-Coppell)
CD 25 Roger Williams (R-Weatherford)
CD 26 Michael Burgess, MD (R-Flower Mound)
CD 27 Blake Farenthold (R-Corpus Christi)
CD 28 Henry Cuellar (D-Laredo)
CD 30 Eddie Bernice Johnson (D-Dallas )
CD 31 John Carter (R-Round Rock)
CD 32 Pete Sessions (R-Dallas)
CD 33 Marc Veasey (D-Fort Worth)
CD 34 Filemon Vela (D-Brownsville)
CD 35 Lloyd Doggett (D-Austin)

Texas Senate

SD 1   Kevin Eltife (R-Tyler)
SD 6 Mario Gallegos, Jr. (D-Houston)
SD 7 Dan Patrick (R-Houston)
SD 8 Ken Paxton (R-McKinney)
SD 10 Mark Shelton, MD (R-Fort Worth)
SD 11 Larry Taylor (R-Friendswood)
SD 15 John Whitmire (D-Houston)
SD 19 Carlos Uresti (D-San Antonio)
SD 20 Juan "Chuy" Hinojosa (D-Edinburg)
SD 21 Judith Zaffirini (D-Laredo)
SD 23 Royce West (D-Duncanville)
SD 25 Donna Campbell, MD (R-New Braunfels)
SD 29 Jose Rodriguez (D-El Paso)

Texas House of Representatives

HD 8 Byron Cook (R-Corsicana)
HD 12 Kyle Kacal (R-Bryan)
HD 14 John Raney (R-Bryan)
HD 17 Tim Kleinschmidt (R-Lexington)
HD 23 Craig Eiland (D-Galveston)
HD 24 Greg Bonnen, MD (R-Friendswood)
HD 26 Rick Miller (R-Sugar Land)
HD 27 Ron Reynolds (D-Missouri City)
HD 29 Ed Thompson (R-Pearland)
HD 30 Geanie Morrison (R-Victoria)
HD 31 Ryan Guillen (D-Rio Grande City)
HD 34 Connie Scott (R-Corpus Christi)
HD 39 Mando Martinez (D-Weslaco)
HD 41 Bobby Guerra (D-Edinburg)
HD 43 J.M. Lozano (R-Falfurrias)
HD 45 Jason Isaac (R-Dripping Springs)
HD 47 Paul Workman (R-Austin)
HD 48 Donna Howard (D-Austin)
HD 54 Jimmie Don Aycock (R-Killeen)
HD 59 J.D. Sheffield, DO (R-Gatesville)
HD 62 Larry Phillips (R-Sherman)
HD 64 Myra Crownover (R-Denton)
HD 65 Ron Simmons (R-Lewisville)
HD 74 Pancho Nevarez (D-Eagle Pass)
HD 78 Dee Margo (R-El Paso)
HD 87 Four Price (R-Amarillo)
HD 99 Charlie Geren (R-Fort Worth)
HD 102 Stefani Carter (R-Lewisville)
HD 105 Linda Harper Brown (R-Irving)
HD 107 Kenneth Sheets (R-Dallas)
HD 114 Jason Villalba (R-Dallas)
HD 115 Bennett Ratliff (R-Coppell)
HD 118 Joe Farias (D-San Antonio)
HD 119 Roland Gutierrez (D-San Antonio)
HD 125 Justin Rodriguez (D-San Antonio)
HD 127 Dan Huberty (R-Houston)
HD 134 Sarah Davis (R-Houston)
HD 136 Tony Dale (R-Cedar Park)
HD 137 Gene Wu (D-Houston)
HD 139 Sylvester Turner (D-Houston)
HD 141 Senfronia Thompson (D-Houston)
HD 143 Ana Hernandez Luna (D-Houston)
HD 144 Mary Ann Perez (D-Pasadena)
HD 149 Herbert Vo (D-Houston)
HD 150 Debbie Riddle (R-Tomball)


Judicial Offices

1st Court of Appeals – Houston
Jane Bland (R), Harvey Brown (R), Rebecca Huddle (R), Terry Jennings (R), and Michael Massengale (R)

3rd Court of Appeals – Austin
Diane Henson (D), Robert Pemberton (R), David Puryear (R), and Jeff Rose (R)


4th Court of Appeals – San Antonio
Karen Angelini (R), Marialyn Barnard (R), Steve Hilbig (R), Rebecca Simmons (R), and Phylis J. Speedlin (R)


5th Court of Appeals - Dallas
Robert Fillmore (R), Douglas Lang (R), and James Moseley (R)


6th Court of Appeals – Texarkana
Bailey Moseley (R)


8th Court of Appeals – El Paso
Christopher Antcliff (R)


13th Court of Appeals – Corpus Christi and Edinburg
Tom Greenwell (R), Gina M. Benavides (D), Nelda Vidaurri Rodriguez (D)


14th Court of Appeals – Houston
John Donovan (R), Jeffrey Brown (R), Brett Busby (R), Martha Hill Jamison (R)


TCEP Free Standing Emergency Department Committee Report

Joe Ybarra, MD

Dr. Peckenpaugh has asked me to chair the TCEP Free Standing Emergency Department (FSED) Committee. We both want to see increased collaboration between TCEP and the many emerging FSEDs in Texas. We would like share news about our recent efforts and invite your collaboration.

Both the College and FSEDs have a lot to gain by working together. We both recognize that FSEDs have become a rapidly emerging model for the delivery of emergency care within the overall healthcare system. Additionally, FSEDs represent an evolution in the practice of emergency medicine. We can now practice independently, without a hospital, if we choose.

Over the past two years, FSEDs have taken a huge leap forward within Texas. In September 2010, House Bill 1357 went into effect, allowing the independent licensing of ED facilities. Currently, there are 46 independently licensed FSEDs in operation within Texas and another 13 license applications in process. We expect this number to continue to grow rapidly. Some of us have even entered into the private practice of Emergency Medicine—turning what initially seemed a distant personal dream into a reality.

As FSED physicians, we want to support TCEP in the effort to enhance this relationship and would appreciate the support and collaboration of the College to advance the practice of emergency medicine in the FSED setting. Therefore, the TCEP board and I collaborated with other physicians to draft a Council resolution which will guide the ACEPs approach to FSEDs now and in the years to come. We will present this resolution to the ACEP Council at the Scientific Assembly this October.

The proposed national resolution recognizes that many members of the college now own and/or work within FSEDs, and it calls upon ACEP to:

  • Develop informational resources and policies to support the delivery of care within FSEDs;
  • Develop informational resources and policies to advise regulators on standards of care
  • Study the impact of the rapid proliferation of FSEDs on the workforce; and
  • Develop a white paper around issues of due-process for physicians who work within FSEDs.

Innovation has always been a guiding principle for the delivery of Emergency Medicine, and FSEDs are another part of this journey. We believe that the values and principles of TCEP should always be maintained—whether we practice in a hospital ED, an FSED, or even in the back of an ambulance. Our committee’s goal will be to educate and improve the opportunities for emergency physicians in our field.

If you currently work in an FSED, we want your voice to be heard. We are currently inviting TCEP members who work in FSEDs to join our College's FSED committee, and we are also developing a national ACEP committee. Please contact TCEP or Dr. Ybarra (
joe.ybarra@concierteam.com) so we can represent your needs and ensure that you can participate in this dialogue.

News From the Medical Student Committee

Melanie Stanzer, MSIV, Secretary-Editor, Medical Student Committee

Danielle Meals, MS II, UT-Southwestern At-Large Member

resized__135x202_melanie_stanzerExcitement for emergency medicine among Texas students is soaring right now, as many of us had the opportunity to attend the ACEP Scientific Assembly in Denver last month. It was a weekend of networking with physicians and students from across the country, gaining first hand advice from resident panels, and attending a great series of lectures (which our proud Texas students kicked off with a "Gangnam Style" wake-up call ). All in attendance (over 50 Texas medical students) returned with an increased appreciation for the field and great new ideas to implement in our MSC and respective EMIGs. We hope to see you at next year's Scientific Assembly in Seattle!

Danielle_MealsThis month, Danielle Meals, MSII from UT Southwestern Medical shares how their Emergency Medical Student Association (EMSA) helps students learn more about EM through their shadowing program:

The UT Southwestern Emergency Medical Student Association (EMSA) is open to and free of cost for all Southwestern medical students, especially those with a possible interest in emergency medicine. The goal of our group is to expose all medical students to the field of emergency medicine early in their education. We facilitate this by hosting lunch talks on various areas of Emergency Medicine, ultrasound and intubation clinics, and we also offer shadowing opportunities for all interested medical students. Shadowing is integral to choosing any specialty and in my personal journey to this specialty and to medicine in general, it was essential.

Stepping into the emergency department for the first time in 2008, I was completely unsure of what to expect. Imagining the hustle and bustle of award-winning television drama and afraid of what I might be expected to clean up as a volunteer, I swallowed my fears for my first shift.

There were many ways my time as a volunteer could have affected my path toward becoming a physician.  Each weekend, I was only expected to clean rooms and make beds in Saint Louis University Hospital's ED.  I could have simply done my volunteer tasks and no more or I could have been completely ignored by the staff. Had either of these occurred, I'm confident that I would have been completely turned off to the field of emergency medicine.

Fortunately, as you might have suspected, that was not the case.

Even though I might have just been another transient volunteer in the ED, the staff took an interest in me and why I was there. They gave me the opportunity to observe procedures, ask questions, and learn more about the field of emergency medicine as well as medicine in general.  I found the ED to be exciting and full of surprises – a patient could have only a few scratches after rolling his motorcycle down a 40 foot incline but a lively patient who was forced to the ED by his wife would need emergent cardiac catheterization.  Experiences like these in my time as a volunteer were essential in fostering my interest in emergency medicine and I will always be indebted to the physicians there.

Shadowing in the emergency department as a medical student continues to provide me invaluable experiences. To ensure that opportunities like these are available to all students, our EMSA created a shadowing program to allow any Southwestern medical student to shadow in the Parkland or Children's Emergency Departments on Thursday through Sunday evenings. Right away, our shift sign-ups filled as quickly as we sent them out. In fact, we've had to expand the program twice this year to accommodate the perpetually increasing demand!

Obviously, there is no need to tell medical students about the importance of shadowing or the importance of being engaged and asking questions. Instead, I want to use this opportunity to thank the physicians of the UT Southwestern Department of Emergency Medicine, particularly Dr. Van Dermark, who make each shadowing experience so fantastic.  Dr. Van Dermark has been instrumental in encouraging student interest in EM and EMSA is incredibly fortunate to have his assistance. The emergency department can be hectic and I'm sure it would be all too easy to disregard a bumbling first or second year medical student who is only there for a few hours. However, our residents and attending physicians always make the time to teach and advise us throughout the shift. In my personal experience, great emergency physicians are also talented teachers to both patients and students.  TCEP has taken teaching a step further by creating the Medical Student Committee to help students get more engaged with organized EM and learn from even more great teachers.  We cherish this chance to tackle our own projects and give back what we can as you, our mentors, continually guide us in our journeys to becoming emergency physicians.


TCEP Calendar of Events

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Register Now for the EMS Medical Director's Seminar

New changes this year!

The EMS Medical Director's Seminar will be a track within the State EMS Conference.

Simply click on the link below to register for the State EMS Conference and you are automatically registered for the EMS Medical Director's Seminar.  CME will be provided through TCEP/ACEP.

>>Click here to register

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Austin Convention Center
November 11-14
Austin, Texas

Exhibit Hours

Sunday 2pm - 7pm
Monday 11am - 6pm
Tuesday 8am - 11am



 2013 TCEP Annual Meeting

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TCEP Board Meeting

The next TCEP Board Meeting is Monday, February 4, 2013, at the Doubletree Hotel, 303 West 15th Street, Austin, TX  78701.  If you plan to attend the meeting and stay over for First Tuesday at the Capitol, I encourage you to make your room reservations now.  We have a room block for 5 rooms on Sunday and 10 rooms for Monday, these rooms are usually reserved well in advanced, so please call 800-222-8733 mention you are with TCEP or TMA for the $189 rate.  You can also go to austinsuites.doubletree.com and after choosing the dates on the main webpage, click on the "have a special code?" link on the left side of the screen.  Type in group code TEP or TMA in order to pull up the discounted rate.  Be sure to choose the Texas College of Emergency Physicians rate beneath the room type.  The cutoff date for the discounted rate is January 14th but again these rooms book fast during the Legislative session so please make them as soon as possible.  I would also suggest, if you plan to attend other First Tuesday's you make your reservations at the same time.

The Board meeting will be from 10:00 am - 4:00 pm.  We will have a happy hour/dinner on Monday with the location TBA.


Mark your calendars for the 2013 First Tuesdays at the Capitol.

  • February 5
  • March 5
  • April 2
  • May 7 
>>Click here for more information


TCEP News

UT Southwestern at Austin Pediatric Emergency Medicine Fellowship Received ACGME Accreditation!

The UT Southwestern at Austin Pediatric Emergency Medicine Fellowship has just received ACGME accreditation to begin training 4 fellows/year beginning in July of 2013. We are actively interviewing and still accepting applications from pediatric and emergency medicine residency trained candidates.

Please go to the website below for more information and application instructions:
www.austingme.com/fellowships/pediatric-emergency-medicine

Coburn Allen, MD, FAAP, FACEP
Program Director


Kay Ghahremani is Named New Medicaid and Chip Director

Texas Health and Human Services Commisioner Kyle Janek has announced that Kay Ghahremani is the new successor to Billy Millwee who retired in August.  Ghahremani succeeds Billy Millwee as the chief of the Medicaid program.

"Kay knows Medicaid policy inside and out," said Janek in a statement. "She's already been working on initiatives to help our Medicaid program increase the quality of services and be even more accountable with tax dollars."

Ghahremani has worked for 17 years at HHS, with much of her experience in Medicaid and CHIP policy. She also earned a master's degree from the LBJ School of Public Affairs.


Please visit TCEP's Facebook and Twitter pages.

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Welcome New TCEP Members


Foyeke Adeyemo, MD
Aldo Andino
Kristin Breden
Lewis Bui, DO
Scott Burdette, MD
Lance Burns, MD
Raymond Cheng
Travis Cosban
Aneta Costa, MD
Stephanie Crenwelge
Cordell Cunningham
Erin DeLong
Vikas Gandhi
Randal Hale
Sara Jackson-Vance, MD
Kenneth Kleckner, MD
Auna Leatham, MD
Fred Levy, MD, JD
Eric Lopez, MD
Ling-chun Lu
Jeremy Maggin, MD
Mark Maynard, DO
Danielle Meals
Adrian Mo, MD
Brian Moss, MD
Aneel Naeem, MD
Catherine Neal, MD
Jessica Nelson, MD
Simone Neuwelt, MD
Nkeiruka Onyenekwu, MD
Linda Paniagua, MD
Adam Parsons
Sonali Patel, MD
Sarah Rapp, MD
Matthew Reddoch
Seth Rehrer, DO
Robert Risch, MD, FACEP
Samir Shahani, MD
Kevin Tavangarian
Hannah Tran, MD
Jose Vasconcellos, MD

TCEP Leadership and Advocacy Fellowship Program

The TCEP Leadership and Advocacy Fellowship was developed to groom future emergency physician leaders.  The fellowship combines elements of mentoring, organizational education and advocacy skills training in addition to guided experiences to selected fellows.


Roles and Responsibilities:

  • Fellows are appointed as ex-officio members of the TCEP Board of Directors and will receive all information and opportunity for participation in the business of the College.
  • Fellows are appointed as ACEP Alternate Councillors.
  • Fellows are expected to seek appointment and participate on TCEP Committees.
  • Fellows are required to contribute articles for publication in the TCEP Emphasis.
  • Fellows will identify and complete a project of interest
  • Attendance is strongly encouraged for all seven meetings outlined below in which Fellows will serve as TCEP Ambassadors.
  • The TCEP Leadership and Advocacy Fellowship program will serve as the foundation for ACEP Fellowship designation.



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Texas College of Emergency Physicians
2525 Wallingwood Drive, Bldg. 13A | Austin, Texas 78746
Phone: 512.306.0605 | Toll Free: 800.839.2237 | Fax: 512.329.8943
texacep@gmail.com

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