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Welcome New TCEP Members

Evan Astin
Carrie Aletta Bakunas, MD
Mitchell Bellis
Jeffrey A Conyers
Margaret Daniel, MD
Paige Diamant
Josh Diviney
Courtney Gray, DO
Travis James Guthrie, MD
Quyen T Huynh, MD
Douglas R Johnson, DO
Johnathon S Kerns, DO
Andrew Scott Kirkpatrick, MD
Wan-Ching Lee, MD
Melanie J Lippmann, MD
Santiago Nicolas Lopez
Jeffrey Noel McCreight, MD
Kiel M Melkus, MD
Eric Mozeleski


Ernesto Navarro, MD
Troy M Obregon, MD
Adam Park
Quoc Pham, MD
Andrew James Potter, DO
Adam Rowe, MD
Monique I Sellas, MD, FACEP
Shyam Sivasankar
David Slobodkin, MD, FACEP
Nicolas D Spampinato, MD
Jesse Arthur Standifer, MD
Todd E Stewart, MD
Moriah Thompson
Benjamin Wendell Veronin, MD
Carlo A Villania
Bo Wang, MD
Monica K Wattana, MD
Jodi G Wieters, MD
Anna Yang

Congratulations New ACEP Fellows

Mark R Boyle, MD, FACEP
Peter Andrew Brokish, MD, FACEP
Jacob W Brown, MD, FACEP
Hoi Chan, MD, FACEP
Jennifer Chandler, MD, FACEP
Yvonne C Chow, MD, FACEP
Lara Charles Dean, MD, FACEP
Thomas Ellis, MD, FACEP
John Sigel Garrett, MD, FACEP
Randy J Hartman, MD, FACEP
Danielle Jackson, MD, FACEP
Krista Jahnke Kandel, MD, FACEP
Christopher C Kwon, MD, FACEP
Morgan Kuang-T Li, MD, FACEP
Sean D O'Patry, DO, FACEP


Sohan Parekh, MD, FACEP
Sultana A Qureshi, MD, FACEP
Salim R Rezaie, MD, FACEP
Joseph P Robson, MD, FACEP
Gregory E Rumph, MD, FACEP
Chet D Schrader, MD, FACEP
Edward J Schultz, MD, FACEP
Sara Beth Scott, MD, FACEP
Manish Ishwar Shah, MD, FACEP
Parin Shah, MD, FACEP
Kerri R Sistrunk, MD, FACEP
Richard Spitz, MD, FACEP
Nicholas P Steinour, MD, FACEP
Robert M Vezzetti, MD, FACEP
Noah C White, MD, FACEP
Stanley Longjyi Wu, MD, FACEP



TCEP Turns 40

Fellow TCEP Members - if any of you have current contact information for the following TCEP Past Presidents please forward to Nancy Davis at tcep@aol.com.  We have attempted to contact each of these individuals at the e-mail addresses on file yet have received no reply.  TCEP wishes to include the reflections of these past leaders in a future edition of EMphasis and needs your help to contact them.

Ben E. Moore, MD
N. Peter Plechas, MD
George A. Pruett, Jr., MD
Henry O. Harper, MD
H. Paul Freemyer, MD
Earl E. Smith, III, MD FACEP
James D. Weathers, MD FACEP

Thanks in advance for your assistance in locating these past leaders.

weltge-smallerArlo Weltge, MD, MPH, FACEP
TCEP President 1993-1994

Where are you currently practicing?

Clinical Professor of Emergency Medicine at UTHealth (UT Houston Medical School)
Attending Emergency Physician at Memorial Hermann Hospital-Texas Medical Center and Harris Health Lyndon B. Johnson General Hospital

Tell us about your experiences as TCEP President?

I remember Kathy Dykraaf (Kentz) preparing me as a chapter leader and developing plans for the year as President during the early days and weeks of my "President-Elect" year. 

I vividly remember the hiring process for the current Executive Director, Jim Coles.  I was in a small room with fellow Board Member Ben Zemenick, interviewing a young executive for the builders association.  Leonard Riggs made the comment when we met Jim that "this fellow was on his way up".

I remember traveling with Bill Moore & Jim Coles to "leadership development" training sponsored by the Texas Society of Association Executives and spending a year preparing for the meeting.  I also remember the pleasure of running my first meeting as President and having it go well finishing ahead of schedule.

What are some of your most memorable moments in TCEP?

There are a variety of strong and pleasant memories in TCEP:
I chaired the first Annual Meeting (in Padre Island) after TCEP split from hosting our meetings with ENA. I was scared to death no one would drive that far for the meeting and thrilled when we had a great turn out.  It was Spring Break weekend, it was overcast most of it, my wife was with me in a small hotel room with a very young son and when the partiers next door got too loud she was scared it would wake him so she banged on their door and told them if they didn’t quiet down they would be babysitting a crying baby!

I remember sitting as a guest in my first Board Meeting, invited by David Prentice, and Earl Smith was President.  I remember the discussion to hire Greg Hoosier as the first lobbyist and Compton Broders saying we needed to "go for it" even though it required raising the dues by $100.  I just saw Greg on the floor of the Texas Senate during the last legislative session and he still remembers his years with TCEP.



I remember our Executive Directors Ruth Dean, Kathy Dykraaf, and Jim Coles, the decision to move the office to Austin and volunteering to help if needed (which I learned to be cautious about doing, since Jim did call to see if I was still interested…!)  I remember our first "Board Dinner" where Ken Schuricht invited us to a German Beer parlor, a Board dinner with Ken Sherman telling jokes, sitting next to Dighton Packard when he got elected to the ACEP Board on the a run-off ballot.  Watching the then unknown to me, red-haired new Board Member stomp her foot, raise her finger and comment to the Board (when they were whining about some issue) "I say we put a stop to this right now" and thinking that someday she could be ACEP President… and a few years later Angela Gardner was ACEP President. 

What was your greatest accomplishment as TCEP President?

I am not sure I remember any specific issue as president, but I do remember directly being involved with hiring Jim Coles, moving the office to Austin, and hiring a lobbyist.

What was the state of Emergency Medicine during the time of your Presidency?

All I can say is it has come a long way. I had been in practice for about 8-10 years, started a group, watched it quickly grow to a multiple hospital group in Houston, recognized that the groups were consolidating and life was changing, realizing after 10 years in practice I needed some new experiences and joined the faculty of the UT Houston Medical School as their first Board Certified Emergency Physician at the start of forming the second EM Residency in Texas.

What has TCEP meant to you through the years?

Probably the single most important thing I remember is the friendships, the collaboration with colleagues, and building long term relationships with those friends and respected colleagues that I still value today.


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Greg Byrne, MD, FACEP

TCEP President 1996-1997

Where are you currently practicing?

I am a Regional Medical Director for EmCare and reside in Southlake, Texas.

Tell us about your experiences as TCEP President, and what are some of your most memorable moments in TCEP?

I think the funniest thing that happened during my tenure was when we had a very controversial issue arise.  I was the President and the lone voice of dissent about how the rest of the Board wanted it handled.  I argued in vain.  Everyone disagreed with me.  Finally after thirty minutes of heated discussion Dighton Packard came in and sat down.  I believe it was Lynn Rea who asked Dighton what he thought.   I swear he said everything I had been saying almost verbatim.  Everyone agreed wholeheartedly with our illustrious Past President.  I just shook my head, laughed and felt like Rodney Dangerfield.  I got no respect.

What was your greatest accomplishment as TCEP President?

Probably the most important thing we accomplished during my presidency was to work with national ACEP to refine some ethics rules.  There was a conflict between TCEP's lobbying efforts and the interests of an out of state ACEP board member's interest and the interest of that person's employer.  Subsequently a legislative issue we had worked on for years was torpedoed when that person talked with our legislator without our knowledge.  I believe it was not malicious but it created quite a furor.  We subsequently worked with national ACEP to provide guidelines that if an ACEP Board Member talked with an out of state legislator about EM issues they should report that encounter to the State Chapter office.  The other thing that occurred of importance was at some time during my rotation on the Board we started funding the Annual Meeting with exhibitors.  This wasn't while I was President but I was the Board Representative to the Education Committee.  With the increased funding our attendance increased dramatically.  I guess since I am talking about Board experience and not just my presidency, I would have to say the most important thing we did during that time was to hire Jim Coles and Nancy Davis.  What a great team they have been.  None of what has been accomplished would have been done without their attention to the details and long term vision.  Presidents come and go but Jim and Nancy are the institutional memory of TCEP.

What has TCEP meant to you through the years?

I began attending Board meetings in 1988 at the invitation of Dighton Packard.  I had no idea I would run for the Board, I just wanted to learn more about the issues facing Emergency Physicians because I thought it would help me be a better doctor and Medical Director.  After a few years I ran for the Board and eventually was elected to the Officer track.  I was in awe of the wisdom and character of the people that surrounded me.  Dighton Packard, Jim Hayes, Leonard Riggs, Diana Fite, Wayne Schuricht, Ken Sherman, Lynn Rea and many others.  I know I am leaving some out.  I was a sponge soaking up their collective wisdom. Jim Coles and Nancy Davis were so much fun to work with and their ability to advance our cause was unparalleled.  Yes my fondest memories are trite but true—the people.


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Robert Greenberg, MD, FACEP

TCEP President 2000-2001

Where are you currently practicing?

Associate Professor and Vice-Chair
Director, Division of Prehospital Medicine
Department of Emergency Medicine
Texas A&M University System Health Science Center College of Medicine
Scott & White Healthcare
Temple, Texas

Tell us about your experiences as TCEP President?

Ah, TCEP President, the guy that controls the Board, not!  But what an experience to be allowed to try and herd the cats and get to watch the creative minds and energy of some of the most dynamic Emergency Physicians in the state move us forward.  It was great fun.

What are some of your most memorable moments in TCEP?

Some of my most memorable moments have been in the countless hotel bars shared with my TCEP colleagues, but we can't really discuss those here…  Emceeing Medical Jeopardy and participating on the OFT (Old Farts Team) at Annual Meetings has been another highlight relived at many of the aforementioned hotel bar sessions.

Seriously, the most memorable times have been our successes on the ACEP Council floor when we elected many of our own members to national positions and when our members were recognized with national awards.  Additionally, and more importantly to Texas, have been our successes in the legislature highlighted with the passage of our exemplary medical liability law in 2003.

What was your greatest accomplishment as TCEP President?

My two greatest accomplishments were, first and foremost, signing Jim Coles to a 10-year contract (and this will take you back) establishing the TCEP website.

What was the state of Emergency Medicine during the time of your presidency?

Emergency Medicine in Texas in 2000 was during our adolescence.  I believe we had only four civilian EM residencies at the time and we were still finding our way around the house of medicine and establishing ourselves on our hospital medical staffs.  We are now in our young adulthood and growing logarithmically, it seems.  Our practices have outgrown just being part of a hospital and we now have many examples of independent practices.  The credit to our growth precedes my time and in a large part is due to our success with medical liability legislation and the hard work of our members in developing viable business models for EM practice.

What has TCEP meant to you through the years?

Aside from some of the unique, entertaining and unbelievable patient interactions I have encountered as an Emergency Physician, TCEP has been one of the most satisfying professional activities in which I have participated.  The personal and professional friendships and collegiality are unsurpassed.   As I look back at my career, being allowed to serve as TCEP President has been one of the highest honors I have received.


gardner

Angela Gardner, MD, MPH, FACEP
TCEP President 2003-2004

Where are you currently practicing? 

I am currently an Associate Professor, Division of Emergency Medicine, Department of Surgery at the University of Texas Southwestern.  I am also the Chief of Quality and Patient Safety for the Emergency Services Division.  I have been at my current location since May of 2009, having relocated to Dallas from Galveston following Hurricane Ike.

Tell us about your experiences as TCEP President?

I became President of TCEP in the spring of 2003, following the excellent leadership of Jerry Gray.  We were fighting for tort reform in the Texas Legislature, and had pretty much given up hope that our bill would be taken up for a vote.  I remember addressing the Business Meeting as I took office, still trying to sound hopeful in the face of an almost certain defeat.  As a College, we had done our homework.  We had drafted legislative language, found sponsors, and participated in the formation of the Texas Alliance for Patient Access, a group of stakeholders who were also committed to tort reform.  

The professional liability future seemed grim.  One in four Emergency Physicians in Texas had a lawsuit pending.  Of those, one in two had more than one lawsuit pending.  Medical malpractice lawsuits were being filed at the rate of about 36 per month in Dallas County and 43 per month in Harris County against Emergency Physicians.  Malpractice premiums had skyrocketed, and there were only two carriers left in the state.  As an organization, TCEP had gained support from other organizations over the eight years since I first heard Arlo Weltge say the words "egregious testimony" in reference to plaintiff experts, but we still lacked enough public support to pass the bill.

Then Governor Rick Perry came through on a campaign promise he made to us, and in a closed door, last minute session over the Memorial Day weekend, a tort reform bill was born.  The bill had numerous provisions, including a cap on punitive damages, but required passage of a constitutional amendment.  I spent my summer talking to anyone who would listen about tort reform and Proposition 12, the constitutional amendment.  I was recently cleaning out a desk drawer and found a note I had made to myself to change the voice message on my phone.  It said, "You have reached Angela Gardner, but unfortunately, I am unable to answer your call.  Please leave a message....and remember to 'Vote Yes on 12!'"  Of course, my phone message had very little impact compared to that of Rick and Anita Perry, traveling around the state, speaking in a variety of venues about the importance of the legislation.  

After spending $5.2 million (the opposition spent almost $8 million) and three months of intense  campaign time the proponents of Proposition 12 prevailed, and in September 2003 tort law changed in Texas.  It was said at the time that, "history will tell" whether the law was a success.  Both sides of the debate still argue about the exact numbers, but certain facts are indisputable - there are more doctors in Texas, in more places, than ever before; the number of insurance carriers has quadrupled; the cost of malpractice premiums has declined significantly; and Texas Emergency Physicians no longer face daily lawsuits.  In fact, an entire "generation" of Emergency Medicine Residency graduates are practicing in blissful ignorance of the "good old days" before tort reform.

Now, I want to be careful here not to take credit for tort reform in Texas, although I certainly thought I had a plaintiff attorney target on my back for several years afterward and I certainly used it as a platform to campaign for the American College of Emergency Physicians Board of Directors when I ran.  There were MANY people involved in the effort to reform professional liability laws, certainly too many to name here.  The fight for tort reform in Texas was one in which the majority of Emergency Physicians were united, but certainly the opposition was fierce, and it proved to be a valuable training ground for the experience that awaited me when I became President-Elect of ACEP, but that is another "reform" story that only history will judge.

What has TCEP meant to you through the years?

In October 2003, I ran for the Board of Directors of ACEP, and became one of the few sitting Chapter Presidents to ever be elected to the Board. I could not have completed my presidency of TCEP without the TCEP Board and especially the TCEP President-Elect David Morgan.  For that and for my experience-of-a-lifetime with the TCEP Board and the ACEP Board I am eternally grateful. 


Morgan_photoDavid Morgan MD, MS, FACEP
TCEP President 2004-2005

Where are you currently practicing?

I am currently working half-time as the Director of Research in the Department of Emergency Medicine at Scott and White Hospital in Temple.  I am also a Professor in the Department of Emergency Medicine at Texas A&M College of Medicine. 

Tell us about your experiences as TCEP President?

It was a wonderful experience.   To serve as the representative for the Emergency Physicians of Texas was one of the greatest honors of my life.

What are some of your most memorable moments in TCEP?

The TCEP Board of Directors and many other members were extensively involved in the medical malpractice tort reform in 2002-2003. I have many great memories of many TCEP Board meetings, TCEP meetings, and ACEP Council meetings, and catching up with old friends there.

What was your greatest accomplishment as TCEP President?

I am not sure I accomplished anything "great" during my term.  I am proud that I made some changes to TCEP such as having the Councillors elected by the members rather than appointed. 

What was the state of Emergency Medicine during the time of your Presidency?

There have been many changes in the last nine years:  clinical emergency medicine, hospitalists, scribes, free-standing emergency departments, nurse-practitioners, physician assistants, stroke centers, and many others.  Maybe the biggest change in Texas EM has been the recent addition of five new EM residencies.  I have been practicing EM for almost 30 years and during that time I have always believed that EM is the best specialty (and the most fun.) 

What has TCEP meant to you through the years?

TCEP has always been the best way to help our specialty in Texas. 


jimwilliamspicJim Williams, DO, FACEP
TCEP President 2010-2011

Where are you currently practicing?

Emergency Medicine Attending Physician, Covenant Medical Center, Lubbock
Healthcare consultant to businesses and medical industries.

Tell us about your experiences as TCEP President?

It was a great experience.  I was surrounded by a terrific staff and Board.  We were faced with significant challenges but emerged much stronger both individually and organizationally.

What are some of your most memorable moments in TCEP?

The post-meeting meetings; great friendships and camaraderie.
Working with the Texas and US legislature on behalf of our members and patients.

What was your greatest accomplishment as TCEP President?

Growth and expansion of the organization.  Internally we updated the bylaws, modernized the office, grew the membership in all categories, continued financial growth, and expanded our presence with inclusion of Free Standing EDs into the committee structure.  Externally, we expanded our presence in organizations such as TAPA and TMA.

What was the state of Emergency Medicine during the time of your presidency?

Growth and expansion of the specialty.  Our sphere of influence continued to grow.  Patients, colleagues, hospitals, and government organizations and the legislature recognized us as a significant force in medicine.

What has TCEP meant to you through the years?

TCEP has been my home for Emergency Medicine.


dan_peckenpaugh_color_picDan Peckenpaugh, MD, FACEP
TCEP President 2012-2013

Where are you currently practicing?

I am currently practicing emergency medicine at Harris Methodist HEB in Bedford. I serve as President of HEB Emergicare, P.A., an independent democratic group in Bedford.

Tell us about your experiences as TCEP President?

Too many experiences to count, but I would summarize my overall experience as TCEP President was being afforded the opportunity to navigate the waters of leadership in an organization as diverse as the members of TCEP, solving the series of challenges that regularly presented themselves along the way during my term and then helping the organization meet those challenges as it grew and matured.

What are some of your most memorable moments in TCEP?

My most memorable moment was the day I was installed as President. Standing and addressing a group of my peers who had enough faith and confidence in me to elect me to such an honored position and trusting me to lead TCEP forward. It was a day I could never forget. Most of my other specific memorable moments came during the after-the-meeting-get-togethers on the back patio and are unfit to publish in a respectable document such as the EMphasis.

What was your greatest accomplishment as TCEP President?

Of course, it is rare for one to be able to claim an accomplishment as your own – all "my" accomplishments were those of the team. As an organization, TCEP achieved several milestones during my years as a TCEP officer and as President, including growing to become the third largest state chapter in the nation. I dedicated most of my time working to help re-organize TCEP into an organization that functioned more like the successful business that we have become. As we grew and matured, I strived to maintain a healthy balance and a sense of perspective on the Board of Directors, ensuring that all the various factions of our diverse membership were appropriately represented. A group of us worked to hard-wire certain practices and create incentives in the organization to allow it to function more efficiently and more profitably. We created a program to help identify, nurture and advise emergency physicians with leadership potential into assuming appropriate roles at the local, state and national levels. But the most important accomplishment was to help coordinate the activity of such a strong, talented and dedicated group of emergency physicians into fulfilling their roles as leaders of our specialty.

What was the state of Emergency Medicine during the time of your presidency?

Frankly, I have only been out of office for a few months, so I probably can't comment intelligently on that issue.

What has TCEP meant to you through the years?

What I will always remember is the friends I made, the relationships I built, the challenges I faced, and the opportunity to "return the favor" and give something back to the organization that benefitted me and all Texas emergency physicians in our respective careers.


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November 2013


Dear TCEP Member:

The Texas College of Emergency Physicians was chartered in June 1973. This marks the 40th anniversary of the most active medical specialty society in Texas. TCEP has a rich history of advocacy. Our Members have been on the front lines of medical education, patient advocacy, and healthcare delivery since TCEP was born. That tradition continues today. As part of our year-long celebration TCEP will publish a series of Presidential Reflections intended to provide our Members with a glimpse of the state of Emergency Medicine in Texas over the past forty years. Stories of the friends we made and the battles we fought to ensure a bright future for the next generations of Texas Emergency Physicians will be told. Those of us on the 40th Anniversary Commemorative Committee hope you enjoy reading these articles as much as we enjoy researching and presenting them.


Message From the President

Rick Robinson, MD, FACEP

TCEP President

Welcome to another edition of EMphasis – the official publication of the Texas College of Emergency Physicians.  Much has happened in the two months since our September edition.  TCEP members continued their activity on behalf of all Texas Emergency Physicians within both state and national forums.  We celebrated those TCEP members that were presented awards in recognition of their service to Emergency Medicine, our colleagues, and patients.  Several TCEP members were appointed or elected to leadership positions within local, state, and national organizations thereby expanding our voice and influence on issues of importance to our patients and practices.  The official TCEP 40th Anniversary Commemorative Campaign kicked off with the September EMphasis and will continue through Annual Meeting 2014 at Moody Gardens on Galveston Island.  ACEP 13 in Seattle was by all accounts a successful conference highlighted by a productive Council meeting.

Those of you fortunate enough to attend ACEP 13 were provided with quite possibly the finest conference the College has thus far organized.  The educational content was of the highest caliber regarding lecture topics and speakers.  The research forum was well organized, well attended, and showcased many novel approaches to answering the question of how to improve patient outcomes and experiences.  The exhibit hall was expansive and included a mix of established exhibitors demonstrating their latest technology and services as well as some new faces that are targeting existing gaps in emergency medicine support resources.  The ACEP Council Meeting kicked off with our own Carrie de Moor, MD FACEP delivering her rendition of the National Anthem.  The Council then debated and reconciled 49 resolutions and elected or re-elected seven people to represent the College and Council over the coming year.  EMRA sponsored the debut of its documentary film 24/7/365 to rave reviews followed by a reception that included many founders and luminaries of Emergency Medicine.  It is an outstanding historical perspective of the one indispensable medical specialty of the past half century and absolutely sets the stage for our continued position as the leaders in the house of medicine in terms of access to care.  The many receptions hosted by ACEP, several state Chapters, and individual private and academic organizations took full advantage of the sights, sounds, tastes, and hospitality of Seattle.  The Washington Chapter proved itself a gracious host during the weeklong event.

Several weeks prior to distribution of this edition of EMphasis TCEP contacted each of the Texas EM Residency Programs requesting an account of their individual participation in ACEP 13 Research Forum.  Those programs that replied with their data are listed in alphabetical order by program name.

  • Baylor College of Medicine
    • One oral presentation
    • Two poster presentations
  • John Peter Smith Health Network
    • One oral presentation
    • Two poster presentations
  • San Antonio Uniformed Services
    • Two oral presentations
    • Six poster presentations
  • Texas A&M Scott & White
    • One oral presentation
    • Two poster presentations
  • University of Texas at Houston
    • Six poster presentations
  • University of Texas Southwestern
    • One oral presentation
    • One poster presentation

TCEP congratulates those programs that participated in Research Forum and commends their department and program leadership, faculty, residents, medical students, and research support personnel for a job well done.

Speaking of research … the Emergency Medicine Foundation (EMF) enjoyed a successful fundraising effort during ACEP 13.  Texas lead the Council Challenge as our delegates contributed $22,212.50 towards continuing emergency medicine research.  You may recall that the Chapter also donated $2500.00 earlier this year on behalf of all members to help ensure a successful startup for the EMF Endowment which is matched dollar-for-dollar by ACEP.  I encourage those actively engaged in research to apply for EMF Grants to support your research efforts and spread the word regarding the high quality of the studies coming out of Texas.

Several TCEP Members were recognized with awards for their individual significant contributions to emergency medicine during ACEP 13.  A list of those recipients follows.

  • Diana Fite, MD FACEP received the John D. Mills Award for Outstanding Contribution to Emergency Medicine during the President's Award Banquet.
  • Angela Siler Fisher, MD FACEP (BCM) received the Joseph F. Waeckerle Founders Award during the EMRA Fall Awards Reception. 
  • Yashwant Chathampally, MD FACEP (UT-Houston) received the ACEP National Faculty Teaching Award
  • Pratik Doshi, MD FACEP (UT-Houston) received the ACEP National Junior Faculty Teaching Award
  • Emily Turner, MD (UT-Houston) received the ACEP National Medical Student Award

TCEP congratulates those members whose achievements were recognized during ACEP 13.  TCEP attempted to include all members that received awards during ACEP 13.  If other members that received awards are not listed above please contact Nancy Davis at tcep@aol.com and we will note your accomplishments in the next edition of EMphasis.

Three of our young members were elected or transitioned to leadership positions within EMRA.  Anant Patel, DO (JPS PGY2) was elected EMRA Vice Speaker.  Ije Akunyili, MD (BCM Faculty) transitioned from EMRA Vice Speaker to Speaker.  Cameron Decker, MD (BCM PGY3) transitioned from EMRA President to Immediate Past President.  Congratulations to these young leaders.  We look forward to your continued participation in patient advocacy efforts during your careers.

TCEP members continue to impact the TMA as well.  Those of you that are members of TMA may have noted TCEP Member Justin Hensley, MD (Christus Spohn) and his wife Katherine Hensley, MD on the cover of the September TMA publication Texas Medicine reprinted further on in this edition of EMphasis.  The caption refers to the ten year anniversary of tort reform and seems an appropriate subject for which to associate a TCEP Member given the Chapter's involvement in supporting that historic piece of legislation.

TCEP submitted four applications to ACEP for Chapter Grants during October.  ACEP Chapter Grants provide funding to develop and maintain Chapter initiatives.  If approved by ACEP these funds will support:

  • Development of the state mandated EMS Director certification training program
  • Development of a Midlevel Provider emergency medicine certificate of advanced qualifications program
  • Development of a virtual meeting environment designed to reach and educate as many Texas medical students as possible that have an interest in pursuing careers in emergency medicine
  • Development of the Texas Choosing Wisely program in collaboration with TMA and other interested parties

As mentioned in the September EMphasis Annual Meeting 2014 will host the TCEP 40th Anniversary Celebration at Moody Gardens Resort on Galveston.  The planning committee continues its work organizing the venue and events to commemorate this milestone in our history.  We began an important piece of the anniversary celebration in September with the publication of the first installment of the special feature series Presidential Reflections which generated much positive feedback.  The second installment appears in this issue.  These reflections are intended to both honor our Past Presidents and provide insight into our history and growth as a professional organization.  I am pleased to report that to date a number of individuals, groups, and medical devices and services companies have pledged to sponsor the Anniversary Gala.  Any individual, academic, or corporate group wishing to participate in sponsorship of the gala should contact Jim Coles at tcep@aol.com.

The TCEP BOD met September 26-27 at ACEP headquarters in the DFW area.  Standing Committee activities for the prior quarter were reviewed.  We conducted our annual ACEP Council planning meeting and assigned critical actions for the various reference committees.  We also began development on a position statement regarding SB 1191 which mandates all emergency departments provide for a forensic examination in the setting of patients presenting with a report of sexual assault.  The TCEP position statement is expected to be completed in the next several weeks.  It will be available through a link on the TCEP website at that time.  An initiative mentioned in the September EMphasis was deployment of a survey to ascertain TCEP value perception among current members.  Each member should have received a survey from ACEP designed to do just that.  Thanks to those that have submitted their survey to date.  I encourage those of you that have not taken the survey to date to do so at your earliest convenience.  The TCEP BOD will use the results of the survey to (1) determine current value perception and (2) develop strategies to increase that value perception going forward.  Please contact Nancy Davis at tcep@aol.com for assistance accessing the survey.  The BOD is committed to ensuring your membership is meaningful and provides measurable value.  Our next BOD meeting is scheduled for January 23-24, 2014.  We will meet in the Austin area as we focus on the April 11-13 Annual Meeting and 40th Anniversary Gala.  As a reminder TCEP Board meetings are open to all members so join us if your schedules permit.  Those of you that are unable to attend can rest assured that the Board and Committees will use EMphasis as a vehicle to keep you posted regarding the status of the projects adopted for action during the current year.

I want to take an opportunity to recognize someone who has supported TCEP and ACEP for many years.  Marco Coppola, DO FACEP has worn many hats over the years.  He has been a member of the leadership of his primary Chapter – Government Services – to include the office of President.  Dr. Coppola proudly participated in the ACEP Council for many years ultimately serving as Council Vice Speaker (2009-2011) and Speaker (2011-2013).  In spite of the demands of GS-ACEP and ACEP Council Dr. Coppola has remained active in his secondary Chapter TCEP during his professional career.  His LLSA Review at TCEP Annual Meeting is always well attended and received.  TCEP salutes Dr. Coppola for his passion and dedication to emergency medicine education and advocacy.

In closing, I want to once again recognize a TCEP family member.  Jim Coles just celebrated his 21st anniversary as TCEP Executive Director.  It has been a real pleasure to work with Jim during my nine year tenure with TCEP.  Whether organizing sponsorships, interfacing with our lobbyist Mignon McGarry, or coordinating activities at BOD Meetings, Annual Meeting, and Scientific Assembly Jim brings value to each TCEP Member.  I am delighted to announce that Jim was recently selected as a member of the ACEP Chapter Executives Committee.  This clearly demonstrates that his peers – Executive Directors from other ACEP Chapters – recognize Jim as a leader in the College.  During our time together I have come to regard Jim as a trusted colleague and friend.  On behalf of all TCEP Members over the past twenty-one years I want to express our thanks and appreciation to Jim for his commitment to serving TCEP and its mission of advocacy for our members and patients.  Feliz aniversario y muchas gracias amigo.

Wishing you all the very best until we meet again on the pages of EMphasis.

Government Relations Committee Report

Diana Fite, MD, FACEP

Chair, Government Relations Committee

Quite a few years ago while I was serving as ED medical director at a mid-sized community hospital, the chief of staff came to me because he had been asked to investigate a complaint from a patient about treatment from the physician in the ED.  Since the complaint came from a patient I had taken care of, and I was the one to evaluate complaints, the chain of command had elevated the case to him. The complaint was that the physician had barely listened to what he was saying and did not actually examine him. The patient had added that the only person who seemed to care about him was the nurse.  I was a little worried about the accusation because the chief of staff seemed to be drawing out the story a bit, then he laughed, and every female reading this probably knows what was next!  The chief of staff knew me well and thought to ask the patient to describe the doctor, who then described a male with glasses and short hair.  The description of the nurse was that of a female with long blonde hair.  Now I was off the hook!

These days there is far more confusion about who the patient and family members/friends think is a physician.  I think most ED physicians will introduce themselves but the patient may not understand or is not conscious or is in respiratory distress or any number of reasons why he or she might miss hearing who the doctor is.  Many emergency physicians do not wear white coats, but now nurses and nurse practitioners and physician assistants and even social workers and pharmacists in the ED might be wearing white coats!  Name tags, if present, are often turned backwards or are otherwise hard to read.  And all of us know how often patients tell us who their doctor is, we don’t recognize the name and cannot find them listed, only to discover that their "doctor" is a nurse practitioner who does not correct people when they are addressed as "doctor".

In this past Texas legislative session, Senator Jane Nelson, with house sponsor Representative Sarah Davis, successfully passed Senate Bill 945, related to "the identification requirements of certain health care providers associated with a hospital".  The bill specifies that a "photo identification badge" is required.  A "health care provider" is defined in the bill as "a person who provides health care services at a hospital as a physician, as an employee of the hospital, under a contract with the hospital, or in the course of a training or educational program at the hospital".  The bill requires that "a hospital shall adopt a policy requiring a health care provider providing direct patient care at the hospital to wear a photo identification badge during all patient encounters, unless precluded by adopted isolation or sterilization protocols.  The badge must be of sufficient size and worn in a manner to be visible and must clearly state: (1) at minimum the provider's first or last name; (2) the department of the hospital with which the provider is associated; (3) the type of license held by the provider, if the provider holds a license under Title 3, Occupations Code; and (4) if applicable, the provider's status as a student, intern, trainee, or resident."  This law takes effect January 1, 2014.

Now for the twist.  As physicians, we think this law will be helpful, although it will not solve the problem of non-physicians intentionally or unintentionally allowing patients to believe they are physicians.  Senator Jane Nelson and Representative Sarah Davis have been friends to medicine and their intent in bringing this bill was to be helpful to physicians.  However we have just learned that the executive director of the Texas Board of Medical Examiners is interpreting this bill as a directive to make sure physicians are in compliance and are wearing proper photo badges while in the hospital, which clearly affects emergency physicians.  Rather than being used to prevent non-physicians from being thought by others to be physicians, this bill may end up being a burden to physicians and could be actually turned against physicians by our own medical board. 

This would be a perfect example of how legislation can have unintended consequences.  As of January 1st, we assume the hospital will provide the proper badge, as many hospitals have already done, but note that the law does not require the hospital to provide the badge.  The law states that the hospital must adopt a policy requiring the badge be worn.  In some counties, the medical society might be providing photo badges as a member service if the hospital is not.

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 (tcep@aol.com), if you wish to discuss any of the information in this report.

Texas Delegation ACEP13 Highlights

From the Executive Director

jim_coles2James E. Coles, CAE (Certified Association Executive)

With there being numerous activities and achievements over the past twenty one years, I was recently surprised and honored to be chosen to serve once again, at the ACEP Scientific Assembly in Seattle, WA, on the Executive Committee for the Chapter Executives Leadership Forum.  

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Prior achievements include:

  • Being hired as the third Executive Director by Dr. James Hayes, Dr. Arlo Weltge, Dr. Leonard Riggs, Dr. Michael Wainscott, Dr. Dan Weathers, Dr. Diana Fite and Dr. Ben Zemenick.
  • Relocating the Chapter Office to Austin and eventually purchasing a permanent home.  Paid the building off and have received rental income since 1995.
  • Passage of the Prudent Layperson Standard with Dr. William Moore
  • Passage of the 2003 Tort Reform Victories and charter member of TAPA with Dr. Jerry Gray and Dr. Angela Gardner.
  • Awarding of a National Disaster Life Support Grant with the Georgia College of Medicine and Dr. John Myers.
  • Recipient of the ACEP Honorary Membership Award with Dr. Angela Gardner and Dr. Angela Straface.       


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Jim Coles with Past TCEP Presidents Jim Williams, Bobby Greenberg and Lynn Rea


Gerad Ttroutman_1routman, MD
Board o
f Directors – Young Physician
Universi
ty Medical Center – Lubbock, TX

Another year, another win for Emergency Medicine!  With over 6,200 attendees, this was the largest ACEP gathering ever!  Your Texas delegation had strong representation at the Council Meeting under the guidance and leadership of Diana Fite, MD, FACEP.  Multiple resolutions taken to the council on behalf of Texas were passed.    

There are multiple reasons to attend ACEP, from education/lectures, networking, committee/section work, and of course the parties!  This was my fourth year, and I think the parties this year were the best.  ACEP teamed with others to sponsor an opening block party including venues at the Chihuly Garden and Glass, Space Needle, and the Experience Music Project.  The next night was filled with multiple alumni/state specific gatherings followed by an EMRA sponsored late night party.  The meeting was summed up with an ACEP sponsored gathering at the Boeing Museum of Flight where attendees toured a retired Air Force One and Concorde among multiple other aircraft important to aviation history.

ACEP has been and continues to be the largest gathering of Emergency Physicians in the nation.  I always leave invigorated just knowing that our specialty is healthy, growing, and has the potential to be more influential than ever.  Members and money is what gives us the power to influence our elected officials.  If you have a colleague who is not a member of ACEP, suggest they join to aid the quest of preserving, and perpetuating high quality Emergency Medical care.  Now more than ever, we have the opportunity to shape health care.  Take it a step further and donate to the Emergency Medicine Foundation, which funds the literature base that IS Emergency Medicine and donate to the National Emergency Political Action Committee.  NEMPAC is the FOURTH largest specialty PAC in the US, if everyone would "give a shift", we can easily encroach on being the largest specialty PAC and have that much more influence in the political arena!

A multitude of challenges lay ahead for medicine, but now more than ever is an exciting time to be part of our amazing specialty.  Help protect medicine and make things better for our patients!  I hope you make plans now to attend ACEP14 in Chicago next year!

News From the Practice Enhancement Committee
Zachary Goldman, MD

ABSCESS REVIEW

In this installment of the bulletin we will focus on a very common ED procedure I&D of an abscess.  While Emergency Physicians perform this procedure many times a day, many are not aware of the finer nuances that differentiate a simple I&D from a complex I&D and the reimbursement differences between the two.

A simple I&D/abscess: usually falls into the category of: furuncle, paronychia, single
A complex I&D/abscess: usually falls into: multiple simple, a reference in the procedure to probing, breaking of loculations, or packing

The difference between these two entities in regards to reimbursement is significant:
A simple abscess and single abscess have the code 10060: 2.86 RVUs
A single complex or multiple simple abscesses have the code 10061: 5.33 RVUs

2.47 RVU difference or 86%

This difference helps emphasize the importance of strong documentation to ensure that your billing entity is capturing the difference between simple and complex.  To make sure you are recording all the proper documentation all abscess I&Ds need to have a procedure note, and in that there needs to be mention of consent, location, anesthesia type and how administered along with appropriate preparation of the area. These are the basics for all procedures, however,  specific to an abscess key words to help emphasis a complex abscess include: I&D, blade type, amount of pus expressed and most importantly cavity irrigated, or loculations probed and broken up, or packing placed.  The later three terms of irrigation of cavity or cavity probed with loculation broken up, or packing placed are key indicators of a complex abscess.  These small documentation nuances can make sure you are getting credit for work you are doing and reimbursed correctly.

News From the Medical Student Committee

Lubbock's EM Preceptorship Pilot Program


Bryan Juan, MSIII
Archana Shah, MSIII
TTUHSC School of Medicine

Bryan (BJEMphasisTCEP MSC Liaison): When I started medical school three years ago, I had a small idea of what Emergency Medicine entailed.  I had joined my institution's EMIG as a means to explore the realm of Emergency Medicine, and as time went on, I found myself more and more attracted to this growing field.  As my second year commenced, I heard about an excellent opportunity to work seven shifts in our affiliated hospital's EC; initially, I thought this would just be a shadowing opportunity where I would stay on the heels of an attending physician for 12 hours, bug him/her with a multitude of questions, and go home later, read about those cases, and do it all over again. 

Later on, I discovered that this was not the case - these doctors expected us to be able to take a full history and physical, communicate effectively with a healthcare team, and be able to come up with a basic appropriate treatment plan.  I got anxious.  I panicked in my head.  However, I realized that this would be an excellent opportunity to be able to experience patient communication and interaction at an early point in my education; I realized (and hoped) that this experience would be able to help me in my clinical years, which were approaching quickly.  Finally, I hoped that this experience would be able to open my eyes to the realm of Emergency Medicine and therefore help me decide if it was a pathway that I wanted to pursue. 

I applied, and I think that decision was one of the best decisions I have made in my quest to become a successful physician.  I genuinely feel that the EM Preceptorship currently offered at my institution has helped me progress into a more robust medical student.  Without this preceptorship, I would have been going into my clerkship years feeling lost and very behind in my patient interaction skills.  I am very thankful to those who decided to put this program together and oversee its fruition along with the staff at University Medical Center's Emergency Department who have guided and counseled me throughout my shifts, and for allowing me to actively participate in patient care at an early level of my professional pursuits. 

as_photoArchana (TCEP MSC Chair):  My first real exposure to Emergency Medicine began as a clinical information manager for TeamHealth, a fancy name for the scribe who documents physician care and helps coordinate patient care with the various team players and departments to facilitate the most effective door-to-discharge process.  I fell in love with the diversity of patients we saw, how effectively our department worked as a team, and how focused we were on providing the highest quality of care while continuing to evaluate and improve on our metrics. 

As EMIG president, this experience shaped the way I organized the summer preceptorship for our EMIG and later expanded the preceptorship into an academic year project based on the popularity of a 2-week commitment and the competitive applications we received.  This opportunity was available to any second or third year medical student prior to the EM clerkship and many of our participating students had completed the EM elective our club ran prior to the preceptorship.  During each of the 7 twelve-hour shifts, instead of following one physician, each student would go see a patient as soon as a chart was racked, and come and present to any one of the three physicians on shift after completing a H&P and a tentative differential, participate in patient care from suturing lacerations to pelvic exams to spinal taps and central lines under physician supervision, and then document the entire interaction in PowerChart.  We were able to coordinate this unique experience through the generous support of our wonderful Emergency Medicine Department as well as SOM's Office of Student Affairs at the Texas Tech University Health Sciences Center, who allowed our participating students access to Cerner web applications during their preceptorship.

Special Recognition

Kudos to Justin Hensley for being featured on the September cover of Texas
 Medicine

0913TM.cover

photo credit: Matt Rainwaters
reprinted with permission from Texas Medicine

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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@gmail.com

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