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  January 2013

From the President

Dan Peckenpaugh, MD, FACEP

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

As I am writing this piece, it is mid-December; a time to reflect on the year that was, the year that is ahead of us, and all the things that we are thankful for. By the time you read this, it will be 2013 and a new year will be underway.

I have a lot to be thankful for, starting with my family. Three healthy and successful children and two grandchildren, my four canine companions and of course, my wife, who tolerates me well beyond that of any ordinary human.

I am thankful for the TCEP Board of Directors, a group of volunteers who tirelessly work for the common good of emergency physicians in Texas. Jim Coles and his TCEP staff, who keep our great organization running. And particularly Rick Robinson, our TCEP President-Elect, who keeps me well grounded but always moving forward; sometimes reigning me in to the point of holding me back from doing something I would probably later regret; but always steering me in the right direction.

I am thankful for many others in TCEP leadership positions, namely the Committee Chairs and members, the Fellows and several very involved residents and medical student leaders.

And I am thankful for you, the membership of TCEP, who continue to support your state chapter with your membership dues, your active participation in leadership positions, and your presence at the TCEP meetings.

Looking back, we are now past the halfway point of my term as President. We have made some successful operational transitions during this current term and have had another successful ACEP Council meeting representing the state chapter of Texas. Our membership growth continues to impress ACEP as we anticipate adding another 100 physicians to our membership ranks for the year 2012. Our residency and medical school visit program continues to attract a lot of attention and (in the most sincere sort of flattery) imitators.

Looking ahead, 2013 is a Texas legislative session, where we will begin making our presence known during the First Tuesday events (you will hear more about this from Dr. Fite). And of course, the TCEP annual meeting this spring, where our Education Committee is preparing another exciting agenda, and where we would love to top our record-breaking attendance of 2012.

So here is hoping that you had a good Christmas and a Happy (and safe) New Year.

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

As always, thank you for your continued support.

In This Issue:
Government Relations Committee Report
Oh The Pain!
Register Now for 2013 Annual Meeting!
News From the Medical Student Committee
Welcome New TCEP Members
2013 Calendar of Events

Government Relations Committee Report

Diana Fite, MD, FACEP
Chair, Government Relations Committee

In the last issue of EMphasis, we discussed our priorities for the 2013 legislative session. One priority is advocating the ability to hold and transfer suicidal or homicidal psychiatric patients who are in the ED, without having to wait on a warrant and permission from a judge or justice of the peace. Dr. Bobby Greenberg, a past TCEP president, assistant professor at Scott and White Hospital in Temple, vice-chair of the Department of Emergency Medicine at Scott and White in Temple, and a member of our legislative committee, has been the lead person on this issue. Representative Jose Menendez of San Antonio has filed HB 245, which is the bill that we will be supporting. I would like to extract a portion of the bill for you to read right now:

EMERGENCY ROOM HOLD ON PERSON. (a) A physician who is attending a person at a hospital emergency room or an emergency medical services professional certified in mental health crisis intervention, as described by Section 773.072, who is providing emergency medical services to the person may hold the person at the hospital emergency room if the physician or emergency medical services professional has reason to believe and does believe that the person is mentally ill and that because of that mental illness there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained. The physician or emergency medical services professional may hold the person at the hospital emergency room for a period not to exceed 24 hours pending the arrival of a representative of the local mental health authority or a peace officer able to transport the person to an inpatient mental health facility for a preliminary examination.
(b) If at any time the physician or emergency medical services professional determines that the person being held no longer presents a substantial risk of serious harm to the person or to others, the physician or emergency medical services professional immediately shall release the person.
(c) If the physician or emergency medical services professional holds or releases the person under this section, the physician or emergency medical services professional immediately shall notify the local mental health authority of the circumstances.
(d) Section 573.025 and the rights provided by that section apply to a person held under this section as if holding the person under this section were a detention to which that section applies.
(e) It is an exception to prosecution under Section 20.02, Penal Code, that the restraint of the person was in compliance with this section.

Another portion of the bill describes how EMS professionals can be trained and certified in mental health crisis intervention. Dr. Greenberg has worked over the past few years to get key mental health and law enforcement groups to support us regarding this legislation. Passing this legislation would legally protect emergency physicians when preventing suicidal or homicidal patients from leaving the ED. Currently emergency physicians have no legal right to restrain these patients without first obtaining a warrant from a judge or justice of the peace. Obtaining a warrant can be time-consuming and frustrating, especially when our ED's are packed with multiple critical patients. This legislation would enable us to get patients to the appropriate facility, department, or psychiatric unit within our hospital, much quicker. A quicker response in these situations would relieve congestion and allow all patients to get the help they need in a timely fashion. In the future, ED's will continue to see more and more patients, this means that any effort made to improve congestion now will only become increasingly more important in the future.

At some point in this upcoming session, we will be calling on our TCEP members to contact their representatives and senators to support HB 245.

The legislative committee would like to make our members aware that the Texas Medical Board has amended Board Rule 197, which involves EMS medical directors. This is a quote from the Board's press release: "the amendment to 197.3, concerning Off-line Medical Directors, sets out additional requirements to be an off-line medical director including CME, requires off-line medical directors to register with the Board, requires off-line medical directors to have written protocols for those that they supervise, directs off-line medical directors to approve care only for times when employed as an off-line medical director, and sets limits on number of EMS providers a physician may serve as an off-line medical director. The amendment also provides process for waivers of requirements." Of note, the term "EMS providers" used above refers to ambulance services, not individual EMS personnel.

The Texas Medical Association recently held a legislative retreat which was attended by Dr. Arlo Weltge, Dr. Bobby Greenberg, and our lobbyist, Mignon McGarry. Dr. Greenberg was the co-chair for the part of the meeting that involved specialty societies presenting their legislative priorities for the upcoming session. He reported that many of the specialties were concerned about scope of practice issues, and most if not all expressed concern about Medicaid reimbursements, and want the dual eligibility problem corrected (where Medicaid no longer picks up the portion that Medicare does not cover, except for dialysis and for chemotherapy drugs). Most specialties also expressed concerns about GME funding and the need for adequate residency spots to accommodate the number of medical students graduating from Texas medical schools. Certain specialties were particularly concerned about the new federal rules preventing physician ownership of hospitals in which they practice. Many also mentioned protecting our tort reform laws.

I hope many of you who read these legislative reports plan on attending a First Tuesday at the Capitol. The February 5th First Tuesday event will be the one we would particularly like for you to attend, as we want a good showing of emergency physicians. This First Tuesday will be the best time to meet with the representatives and senators before they get bogged down in all the committee hearings that take up so much of their time in the later months. Also, meeting their staff members early on is beneficial to us so we can keep in touch with them as needed. If you will need a hotel room, those reservations need to be made stat because rooms close to the Capitol are hard to come by during the session. 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.

Please let Nancy Davis with TCEP know if you would to get registered for the First Tuesday with the TMA. TCEP will cover the fee for the meeting and Nancy will contact the TMA to get the registration done. Call Nancy at 1-800-TEX-ACEP or email her at

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). Larger donations are also 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 those who have helped us 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 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.

Oh The Pain!

Rob Dickson, MD, FACEP

Dear fellow EM Docs,

This is an invitation to participate in your college's discussion of one of our most difficult topics. As I sit here typing this in my office there are fresh memories of my afternoon shift yesterday in our busy ED. As you may expect a large part of my patient volume had to do with issues surrounding the diagnosis and management of painful conditions. From my own experience and comments from many of my EM colleagues from around the world, issues surrounding pain are some of the most frustrating in EM. Without doubt this frustration can lead to poor outcomes in patient management, job satisfaction and longevity for EM doc's. 

During our annual meeting in Frisco April 12 & 13, 2013 you have the opportunity to help your fellow EM doc's fashion innovative solutions to the daily pain issues we struggle with. TCEP will host a two - hour panel discussion that will include nationally renowned expert on pain management Dr. Knox Todd, ED directors from around the state, representatives from the management suite and the most important experts - YOU!

I encourage you to come and participate in what I'm sure will be a lively discussion about real solutions to real issues surrounding pain management in the ED.  I look forward to seeing you all there.


Just a few topics:

  • Use of standardized pain protocols in the ED (reducing provider variability)
  • Safe observation times/driver present for patients who receive narcotics/sedating medications
  • Management of chronic pain patients in the ED
  • Use of frequent flier (non-PC) lists
  • Role of drug screen in the ED
  • Opiate protocols/prescribing and patient satisfaction scores


2013 TCEP Annual Meeting


Annual Meeting Registration Fees
Member Type
By March 11, 2013
After March 11, 2013
TCEP/ACEP Member $425 $450
Other Physicians $450 $475
EMS Professional/Nurse/PA $125 $150
One-Day Registration $150 $200
Resident / Fellows Member $50 $75
Resident / Fellows Non-Member $75 $100
Student Member $30
Student Non-Member $85 $110
Golf Tournament Registration $125
Ultrasound Workshop $150 $150

>>Click Here to Register

>>Click Here to Download form


News From the Medical Student Committee

Reed Flora, MS-III, Paul L. Foster School of Medicine Liaison

Yana Gelman, MS-II, Paul L. Foster School of Medicine At-Large Member

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

Reed_Flora_copyJanuary is a busy month for the Medical Student Committee as we finalize plans for the Medical Student Track at the upcoming TCEP Annual Meeting 2013 in April. We have a great team of medical students, faculty, and administrators working out the details so that we can provide the best possible Track for you. All you need to do is show up and reap the rewards!

This month, the liaison and at-large members of the Paul L. Foster School of Medicine in El Paso, update us on the Emergency Medicine Interest Group (EMIG) progress at their medical school. In this edition, Reed Flora (MS-III) and Yana Gelman (MS-II) explain the opportunities that EMIG at Paul L. Foster has to offer its members.

yana_gelmanBeing a new school, Paul L. Foster has worked hard to cultivate emerging interest groups on its campus. The Emergency Medicine Interest Group has thrived and is currently one of the largest interest groups at our medical school. EMIG's shadowing program for MS-Is and MS-IIs is extremely popular and successful, and allows the organization to promote emergency medicine to interested, as well as undecided students. There are many advantages in shadowing at the Emergency Department of University Medical Center (UMC). For example, it is the only Level 1 Trauma Center in a 250 mile radius of El Paso. Additionally, UMC sees many patients from Juarez, Mexico, providing a great opportunity for students to witness uncommon disease presentations, first hand. In a typical shadowing shift, a student may see a patient with blunt trauma, followed by an automobile accident, and end his night by treating an individual with Tuberculosis. Furthermore, due to the poor healthcare access in Juarez, it is not uncommon to see the worst presentations of illnesses which in the United States are usually benign and easily treated.

melanie_stanzerPaul L. Foster places a great emphasis on Emergency Medicine education. Students conclude their first year of medical school with a comprehensive ER unit which integrates previously learned material into emergency medicine clinical scenarios  The ER unit is designed to encourage students to apply the knowledge they gained throughout their MS-I year into real emergency situations. Students are split into medical teams and placed into a simulated environment with programmed mannequin patients, and are required to "save" their patients through teamwork, and by utilizing the knowledge and decision making skills they gained throughout the year.

Next semester, EMIG's faculty advisor, Dr. Robert Stump, is going to be teaching a course in Tactical Combat Casualty Care that will focus on extraction using low friction dragging techniques, hemorrhage control, needle chest decompression, surgical airway management, and treatment of casualties under challenging hostile conditions. This course is designed for medical professionals, such as nurses, technicians, and paramedics, to improve their emergency treatment skills. However, several EMIG members are attending the course in February, to advance their knowledge of emergency medicine, and to gain experience that can be used outside of a hospital setting.

In October, Paul L. Foster sent four MS-IIIs and one MS-IV to the ACEP conference in Denver. This was the first time our school had participated in an emergency medicine conference, and it was an excellent opportunity for students to engage in the EM community. As a new school, it is paramount for us to attend conferences at both the state-wide and national level. It was a great networking opportunity that yielded several residency interviews for our MS-IV, and information regarding away rotations for our MS-IIIs. We look forward to increasing the number of students that attend next year.


Welcome New TCEP Members

Wenhua Chen

Michael Chiang, MD

Bryan Darger

Adam Dunstone

Lael Hubbard

Alfredo Maldonado, MD

Jupin Malhi

Kelly Murray, MD

Sarah Rodrigeuz

Hannah Tran, MD

Thomas Vo, MD


2013 Calendar of Events




Texas College of Emergency Physicians
2525 Wallingwood Drive, Bldg. 13A | Austin, Texas 78746

Phone: 512.306.0605 | Toll Free: 800.TEX.ACEP | Fax: 512.329.8943

texacep.org | texacep@gmail.com

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