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Welcome New TCEP Members

Atheer Ja'afar Baldawi, MD, MPH
Bryson Bowman, MD
Patrick V DiCosimo
Katie Gaston
Aditi Ghatak-Roy
Jonathan M Glick, MD
Brian J Kempton, MD

Bridgit Mennite, MD
Marita J Michelin, MD, FACEP
Shani Patel
Jeremy Semeiks
Winnie T Whitaker, MD
Michael P Zimmerman, MD, FACEP

Calendar of Events



2014 Annual Meeting

April 10 - April 14, 2014
Moody Gardens, Galveston

moodygardensThe Annual Meeting Planning Committee, based on feedback from those of you who have attended the meeting the last few years, has planned a great conference for 2014.

We will be presenting lectures on a variety of subjects that have been important to Texas physicians in the past year.
Join our National ACEP Past President, Angela Gardner, MD, FACEP, for an update on current issues facing emergency physicians.  

We will again have the Ultrasound Lab where attendees will learn about ED ultrasound and receive hands on experience by professional ultrasound technicians.

Click Here to Register


TCEP Turns 40

billmoore_copyWilliam Moore, MD, FACEP
TCEP President 1994-1995

Where are you currently practicing?

East Texas Medical Center, Tyler, TX
Regional EMS Medical Director for ETMC-EMS

Tell us about your experiences as TCEP President?

Working with Nancy and Jim was a delight.  The office had just moved from Dallas to Austin to be closer to the legislative events.  Leadership development was one of the key goals, but also lawsuit reform and development of the Out of the Out of Hospital DNR process.  The ACEP office also went through a new computer install that year.

What are some of your most memorable moments in TCEP?

I was able to spend some quality time with Dr. Diana Fite and Jim Coles at a legislative TMA retreat.  Becoming more informed about the legislative process was key to providing leadership to the Chapter.  And, Diana and Jim were great fun.

What was your greatest accomplishment as TCEP President?

The focus during my year was increasing our voice at the State Capitol, expanding our educational offerings, and strengthening our EM residencies.  Improvements were made in each of these areas.

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

Emergency Medicine was growing into a respected member in the  House of Medicine; we had taken on BTLS training for paramedics and the issue of transitioning non-boarded practicing ER physicians was still unresolved.

What has TCEP meant to you through the years?

TCEP has been like a second family, starting with Jim and Nancy, and including all the many new friends I have made through my involvement with TCEP.


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Jerry Grey, MD, FACEP

TCEP President 2002-2003

Where are you currently practicing?

Big Island of Hawaii.  Vice President of Hawaii Emergency Physicians Associated…the largest ER group in the Islands.

Tell us about your experiences as TCEP President?

It was an exciting year during which I learned a lot about legislation at the state level.  As we were seeking legislative support for tort reform, I met with and exchanged views with many politicians, political action groups, and lobbyists.  Will Rogers summed it up best:  It's like a sausage factory…you might like the outcome but not how it's made.  The best moment was when I invited the Immediate Past President of the Texas Trial Lawyers Association to a special meeting we held for tort reform.  After hearing from 150 ED docs, he told me he had agreed to come realizing he would not change any minds…but was wrong, and had changed one--his.   He ended up supporting our efforts.

What are some of your most memorable moments in TCEP?

Attending TCEP meetings, networking and getting new ideas for ongoing challenges.

What was your greatest accomplishment as TCEP President?

Passage of constitutional amendments locking in tort reform and expansion of good Samaritan statues to cover ED physicians were efforts  completed during my watch.  Committee structures were reorganized into their current form during my Presidency.  We reached out to South Texas and East Texas, gaining board members from those regions that year for the first time.  Membership passed 1000 in my year as President.

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

In crisis with most malpractice carriers leaving the state and the amount of insurance we could buy being limited to levels well below our risk exposure.  Specialty surgeons were avoiding the southern portion of the state to avoid litigation risk.

What has TCEP meant to you through the years?

ACEP and TCEP were great assets to me in improving my training and gaining the expertise needed to succeed both as an emergency medicine specialist and a department manager.


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Andrea Green, MD, FACEP

TCEP President 2005-2006

Where are you currently practicing?

Medical Director St Joseph's Hospital ED, Medical Director Redwood Memorial Hospital ED, El Centro Regional Medical Center, Secretary of Medical Staff

Tell us about your experiences as TCEP President?

It was a progressive and exciting year. On a state level during my term as president, we were on the heels of the recently passed legislation providing medical malpractice caps for the State of Texas. This enabled rate cuts from insurers providing medical malpractice coverage for physicians of Texas as well as a cut in the liability cost for our hospitals. Therefore, we had an influx of much needed primary care and specialist physicians improving healthcare services to the citizens of our state.  Drs. Arlo Weltge, Diana Fite, and Robert Greenberg developed "Every Member a Leader" which was adopted by the ACEP Council as the fresh format for orienting New Councilors and Alternate Councilors for many years onward. The first attempt by John Peter Smith Hospital to bring advanced emergency medical training to Fort Worth was initiated by Dr Taub with an effort to introduce an AAPS Fellowship in Emergency Medicine at that hospital. We had our first Residency Visit to a state ED Residency Program. On a national level, ACEP published the 1st National Report Card of the State of Emergency Care in the United States and we continued in our efforts to address the issue of "ED Crowding".

What are some of your most memorable moments in TCEP?

Laughs with Jim Coles and Nancy Davis, yearly dinner during ACEP Scientific Assembly with Diana Fite and friends, the ED Physician's White Coat march on Washington, DC, the Cigar inauguration (at least that is what Angela Gardner told me it was), seeing the silly and fun side of so many of our members, attending the ACEP BOD meetings in Dallas. Being recognized as one of the Heroes of Emergency Medicine in 2008.

What was your greatest accomplishment as TCEP President?

Getting the first Texas ED Residency Visit off the ground with the creativity of Dr. Angela Fisher.

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

Although Emergency Medicine had made a lot of progress over the years we continued to be challenged with expanding the criteria for membership of the college beyond board eligible and board certified physicians; there remained background issues about who should be allowed eligibility for ABEM certification; ABEM was defining the new criteria that we would all face with the changed requirements for future board certification and recertification, AAEM was beginning to seek ways to work with ACEP, we were struggling with the issue of ED Overcrowding on local, state, and national levels, and questioning how to address the unfunded mandate that overshadows our field.

What has TCEP meant to you through the years?

Having the honor and privilege to count as acquaintances, mentors, and friends men and women who have been superior leaders not just in the state of Texas but on a national level within the field of Emergency Medicine.  These are people whose works created and continue to create the story of Emergency Medicine in this country and internationally.


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January 2014


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.    As we start a new year it is a natural opportunity to take inventory of the events of the past year.  Emergency Medicine and the House of Medicine in general experienced continued opportunity for change – some good and some not.  Through it all TCEP remained focused on surveillance of the changing landscape and swift action on behalf of its Members regarding the issues impacting our patients and our practices.

At the Chapter level we experienced our largest annual conference to date featuring a high caliber speaker roster and outstanding networking opportunities.  We continued our mission to reach out to as many practicing Emergency Physicians as possible with a dialogue that demonstrates the value of TCEP membership and to encourage our colleagues throughout Texas to participate in the TCEP agenda.  Likewise we continued our highly successful Emergency Medicine Residency and Medical School Visit Programs.  We applied for five ACEP Chapter Grants intended to provide funding for new initiatives.  Two of these projects were recently approved by the ACEP National Chapter Relations Committee and are now on the way to the ACEP Board for final approval.  These projects are (1) Exposing Leadership to Medical Students, Texas Chapter Initiative championed by Ronnie Ren and Archana Shah and (2) Choosing Wisely Campaign at the State Level championed by Gerad Troutman, MD.  And you can all rest assured that TCEP worked hard on behalf of our members to establish a great foundation for the 40th Anniversary Gala to coincide with Annual Meeting in April 2014 at Moody Gardens on Galveston.

At the state level we continued our strong partnership with the Texas Medical Association.  TCEP's education track at TexMed was once again received as one of the premier offerings of the entire conference.  TCEP was solicited by a handful of other state and regional organizations to provide recommendation of our Members to fill high profile committee spots in the areas of Pediatric Emergency Medicine, Trauma, and EMS to name a few. We shared in the duties and responsibilities of a focused coalition with other professional organizations in reaching out to the Texas legislature to assist that body in making the decisions that protect patient access to meaningful healthcare through preservation of prior legislative decisions and policy while considering the current legislative agenda and the potential downstream effect of new legislation on our patients' abilities to access the healthcare network.  We developed a position statement in regards to Senate Bill 1191 which addresses expectations of hospital compliance with provision of sexual assault examinations and forensic evidence collection.  The TCEP position statement may be accessed through the TCEP website for individual Member review and use.  TCEP Members successfully lobbied the Texas Medical Disclosure Panel to separate moderate (procedural) sedation consent language from that of monitored anesthesia care on the uniformed consent form.

At the national level TCEP remains the third largest of the ACEP Chapters with almost 2000 Members.  Our influence however can easily be argued to rival the two larger Chapters.  TCEP's presence and influence at ACEP 13 was impressive.  We submitted several key Council resolutions.  We lobbied hard to push through those meaningful and practical resolutions ultimately adopted by Council that now reside in the hands of the ACEP Board for implementation.  We supported and celebrated with our Chapter Members that were recognized as recipients of prestigious awards at the national level.  TCEP supported Emergency Medicine research at a level greater than any other Chapter when considering both funding and output measures – an indication of the commitment of our individual Members, Texas Emergency Medicine Residency Programs, and research hospitals within the state to improving patient outcomes.

In retrospect 2013 was an exceptional year for TCEP and Texas Emergency Medicine.  So where do we go from here?

Although the Texas Legislature will not meet again until 2015 TCEP will monitor the legislative landscape and keep an eye on any posturing by special interest groups leading up to that point in time.  A number of perennial watchdog issues such as preservation of tort reform, fair billing, coding, and reimbursement policies, review of expert testimony with an eye toward discovery of any egregious commentary on the part of expert witnesses, and improvement in GME funding will remain on our list of things to monitor.  We will also keep an eye on the effects of recent legislation and remain committed to assisting our Members and others whose Emergency Medicine practices may be impacted by new requirements for sexual assault forensic examinations and the effects of medical, surgical, and psychiatric boarders in regards to our ability to serve each of our patients efficiently and with the respect and dignity each deserves.  As always TCEP will continue to mentor up the next generation of Emergency Medicine leaders to ensure we maintain a strong, well informed, and well prepared group of colleagues attentive to the needs of our patients and practices as the coming years roll by.

Annual Meeting 2014 is shaping up to be our finest conference to date.  The education program will be one you will not want to miss.  Hot clinical and business topics updates will be delivered up by some of the best lecturers in the field of Emergency Medicine.  And of course the TCEP 40th Anniversary Celebration will highlight the three day event with social and networking venues that will include many past Chapter leaders providing an opportunity for TCEP Members and guests to gather a little historical perspective on what it has meant over the years to be associated with TCEP and its mission to improve the lives of practicing Emergency Physicians and the patients we serve.  Sponsorship opportunities remain available at this time.  Any individual, academic, or corporate group wishing to participate in sponsorship of the gala should contact Jim Coles at tcep@aol.com.

If you have read EMphasis over the past several months you know we are featuring a series called Presidential Reflections leading up to the 40th Anniversary Celebration.  To date EMphasis has included a number of individual Past Presidents' memories of the challenges the Chapter faced and the successes the Members shared during our history.  I trust you are enjoying reading this series as much as we have enjoyed bringing it to the membership.  Sincere thanks to those Past Presidents that have contributed their input to the project thus far.  Any Past Presidents that have not provided their individual reflections to date are encouraged to contact Nancy Davis at tcep@aol.com for assistance in providing your contribution to this historical project.

The TCEP BOD will meet on January 23-24, 2014.  The meeting will take place 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.

In closing I want to recognize each of you for your continued support of TCEP.  Whether you are a new Member or one of the career Members of the Chapter you each bring value to TCEP.  During my ten year tenure with TCEP the Chapter has doubled in size.  Consequently we have been able to add more services to our membership.  Those services can be measured in the political currency brought forth by individuals and groups within TCEP that continue to push your agenda forward.  Advocacy for those issues that provide for a fair and balanced practice environment where each of us can in turn provide the highest quality care and be appropriately compensated for our selfless service to our communities can only be achieved and maintained through the strength we have in our numbers and that common ground we share that focuses on the patient experience.  I invite each of you to commit to an individual New Year's resolution to engage in the process that is TCEP by joining a committee or running for an elected position such as Councillor or Board Member.  TCEP welcomes your energy and input to this process and looks forward to the new heights we will achieve as we all work together to improve our specialty, our work environments, and our patients' outcomes.  Muchas gracias y prospero ano nuevo amigas y amigos.

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

2014 Call for TCEP Board of Director's Nominations
The Texas College of Emergency Physicians depends upon its fourteen members Board of Directors for its vision and action.  Eleven Regular Board Members serve staggered three year terms, plus one year terms for a Candidate Member, a Young Physician Member and a Medical Student Member. There are two Regular Board positions on the 2014 ballot.  Candidate, Young Physician, and Medical Student positions are also on the 2014 ballot.  Elections will take place at the TCEP Annual Meeting on Saturday, April 12, 2014 at Moody Gardens Resort in Galveston, Texas.

To nominate yourself or another member, please submit the nomination in writing by email to tcep@aol.com, Attention: TCEP Nominating Committee by February 7, 2014.

The TCEP Nominating Committee will present a slate of candidates to the TCEP Board of Directors for approval no later than February 11, 2014.  The candidates will be sent a candidate survey form for publication in the March 2014 issue of EMphasis.  The deadline for submission of the candidate survey form for publication in the March issue is February 18, 2014.

Government Relations Committee Report

Diana Fite, MD, FACEP

Chair, Government Relations Committee

Do you barely read these Government Relation committee articles because the subject matter seems boring?

Then this first article of 2014 is for you!  It will be short and to the point. 

We are going to be busier than ever in the ED beginning now.  Even with multiple freestanding ED's nearby, the hospital ED census will be increasing and overall the patients will be as sick as ever or getting worse.  This flu season is producing some seriously ill patients, and people are panicking about it.  That has already increased the census in Texas ED's. 

The Affordable Care Act, aka Obamacare, is now officially operational to some degree, and none of us, physicians or patients, know how that will go.  But we do know that it will increase ED visits as more patients think they are covered than before but there is no room for them to get into a private practice office, or that office tells them to go to the ED so that immediate testing can be done. 

Also increasing our census are these issues:  the elderly population is growing; the population of Texas is growing more than any state in the nation; and people are staying alive in higher percentages with multiple disease processes, including the fact that many of these patients are also on chronic narcotic pain medications. 

ACEP will be releasing the 2014 state report cards on January 16, and these report cards may help give us ammunition to use with legislators depending upon the legislative issues TCEP takes up for the 2015 session.  Texas will rank well above other states regarding our tort laws, but we will not rank well regarding many other issues, such as public health issues and percentages of physicians per population base. 

We need our members to be acutely aware of these trends and think of ways we can advocate for our patients and ourselves legislatively to make improvements or catch problems before they become worse.  Our committee will be meeting during the annual meeting in April to discuss priorities for the next session and we welcome the input of any and all members.

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.

Special Recognition

Diana Fite, MD, FACEP was presented with the James D. Mills Outstanding Contribution to Emergency Medicine Award. Congratulations Dr. Fite!

dianaawardgroup Pictured from left to right Dean Wilkerson, CAE Executive Director ACEP, Angela Gardner, MD, FACEP Past ACEP Board President, Diana Fite, MD, FACEP, Arlo Weltge, MD, FACEP Past ACEP Council Speaker

News From the Practice Enhancement Committee

Zachary Goldman, MD

Scribe Attestation

As more and more providers are utilizing scribes to aid in patient flow and documentation, it is important we are compliant with CMS regulations. It is imperative to have a scribe attestation which states who the scribe is scribing for and to capture some specific language (see below).  It is also important that the scribe has a mechanism to sign and date the chart themselves.  With our current CMS carrier Novitas, they suggest certain requirements for a physician attestation in regards to using a scribe along with a specific provider attestation.

CMS criteria for scribe Documentation:

  1. Scribed services must clearly indicate
  2. Who performed the service
  3. Who recorded the service
  4. Qualifications of each person (i.e., professional degree, medical title)
  5. Signed and dated by both the provider and scribe

Please note that ideally there are two components.  One from the scribe stating who they scribe for and one from the provider verifying what has been done. Please see the below examples given by Novitas for such a purpose:

Example:  "I, ______, am scribing for, and in the presence of, Dr. ______"     (Scribe attestation)


Example: "I, Dr. _______, personally performed the services described in this documentation, as scribed by _________in my presence, and it is both accurate and complete."   (Provider attestation)

This is a hot area of conversation regarding utilizing scribes and the required and correct documentation.  To date I am unaware of claims being denied by carries because of improper scribe documentation but this is going to come under increasing scrutiny so it is best to be ahead of the game.  Please note that along with to two above attestations (one from the scribe and one from the provider) the scribe needs to have the ability to sign and date their documentation apart from the provider.  

EMRA Updates

Ije Akunyili, MD, MPA
Speaker of the Council
Emergency Medicine Residents' Association (EMRA)
Memorial Hermann Southwest
Baylor College of Medicine

Scientific Assembly 2013 was one of the most exciting and ground–breaking meetings for the EMRA Board.  We had a very successful conference with attendance from several residency programs at our EMRA events and representative council meeting.  The highlight of our meeting was the world premiere of 24/7/365: The Evolution of Emergency Medicine.   EMRA has produced a full length documentary chronicling the history of our specialty that has generated great interest and renewed the passion for our specialty for years to come.   The EMRA board is grateful for all the support from individual donors and the TCEP Board during the production of this movie.

EMRA elected new board members at its meeting.  I am thrilled to announce that Dr. Anant Patel, from the JPS Health Network, was elected as our new EMRA Vice-Speaker.  With Dr. Patel's election and with the transition of Dr. Cameron Decker of Baylor College of Medicine to Immediate Past President position we now have three Texans on the EMRA board.   This representation of young Texan leaders on the EMRA board is a direct result of the vibrancy of the TCEP Board and the mentorship provided to young leaders here in Texas.

The EMRA Rep council also adopted a unanimous resolution to support ultrasound as an ACGME subspecialty.  With several of our graduating residents choosing Emergency Ultrasonography as a sub-specialty we believe that the time is right for EM Ultrasound programs to get ACGME accreditation.  Also, two of the resolutions that garnered great debate on the ACEP Council floor initially originated from the EMRA Council.  They include the support for keeping current GME funding levels and clarifying that only MD's or DO's should be addressed as "doctor" in the Emergency Department setting.  I must highlight the hard work of our Medical Student Council on the now famously defeated Resolution X that aimed to eliminate medical student numbers from the Council vote.  EMRA and ACEP value our medical students and understand that they are the future of our specialty. Texas should be proud of its medical student leaders who worked very hard on this resolution and even addressed the reference committee.

Finally, I would like to say how rewarding it has been to meet so many of you as I travel around the state for residency visits. I am constantly reminded of the wealth of talent and diversity of residents in our great state.  Thank you for opening the doors of your residency programs to all of us. 

News From the Medical Student Committee

The Emergency Medicine Interest Group at The University of Texas Medical Branch - 2013


Cordell Cunningham and Alaina Brinley


The EMIG at UTMB had an exciting year in 2013. Our second annual TCEP Medical Student Leadership Initiative was held in the spring, which created a lot of enthusiasm among UTMB students to learn more about Emergency Medicine. Over the summer, several of our members elected to participate in a new Emergency Medicine preceptorship in Galveston, a course which had previously only been offered in Austin. Many students at UTMB are interested in Emergency Medicine and we are very excited to have this opportunity available on our campus.


In the Fall, we welcomed many new members from the School of Medicine, School of Nursing, and the School of Health Professionals to our EMIG. We were inspired to expand our offerings beyond the School of Medicine by a program at UTMB called Synergy which promotes interprofessional activities among students.  Learning to communicate and cooperate interprofessionally is a valuable skill we can encourage through student organization interest groups; therefore, one area of focus this year has been offering lectures and activities that are relevant to a wide variety of students interested in Emergency Medicine. Our EMIG members have found it very rewarding to learn basic procedures, such as intubation, alongside other health professional students who will be our colleagues in the future.   In addition to learning about the diverse spectrum of healthcare positions through our experiences, we have also made new friends. 


For our first meeting, our faculty sponsor, Dr. Robert Kaale, gave the group a general overview of the specialty and what it is like to work in an Emergency Department. We next held our second annual "Sunglasses At Night" Fundraiser at Yaga's Cafe in Galveston followed by our annual intubation workshop.


We were also fortunate to host a talk by ACEP Executive Director Dean Wilkerson. Mr. Wilkerson spoke to us about the imminent changes to the healthcare system through the Patient Protection and Affordable Care Act and discussed how these changes may affect us as future healthcare workers. At a later meeting, Dr. James Vincent, spoke to us about his experiences in Pediatric Emergency Medicine, EMS, and International Medicine. Both speakers were informative and gave enjoyable lectures. We are grateful that they made the trip to Galveston to visit with us, and we are looking forward to hearing from other emergency medicine leaders in the spring.


As the New Year begins, the UTMB EMIG looks forward to TCEP's 2014 Annual Meeting in Galveston. The medical student track at the meeting last year provided invaluable advice and information for medical students pursuing Emergency Medicine. We are excited to see Texas Emergency Medicine students and physicians at Moody Gardens in the spring!


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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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