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TCEP Members

Ronnie Barakat
Chad D. Bartel
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Brain E. Dillon
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Stephanie C. Dunlop
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Jakub Furmaga, MD
Herman Gonzalez
Ann C. Hughes Bass
Forrest Linch
Rosalia Mbugua
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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

Riggs_photo_RNF16224P4 (1)_1Leonard Riggs Jr. MD
TCEP President 1975-1976

I attended Medical school in Dallas at UT Southwestern and I first worked full-time in an emergency department at Baylor University Medical Center in Dallas beginning in July 1969 after my one year surgery internship at the John Gaston Hospital in Memphis. Imagine, on July 1st, I was one day out of internship overseeing interns who were just out of medical school. And that was as good as it got! I think that I may have been one of the first full-time practitioners in an ED in Texas. I then went into the Navy and was a Flight Surgeon with the First Marine Air Wing in California and Viet Nam and then I returned to work full time in the Baylor ED in mid-1972.

I attended my first national ACEP meeting at the Scientific Assembly in Dallas in 1973, and met Ben Moore MD who was a second career physician who had been a pediatrician at Methodist Central in Dallas. He started the emergency coverage there around 1970. My first meeting of Texas ACEP was the following spring of 1974. Our meetings were held in conjunction with the TMA at their spring meeting. Ben Moore was President before me and did it for more than one year and I was President for 75-76

There were only about eight or ten of us who had to"pass the presidency around" for the first few years.

I remember that I helped to promote and conduct the first Annual meeting of TCEP at Dallas and held it on a weekend in 1976 when the Cowboys were playing, so that we could attract others from around the state. That had limited success with about 15- 20 attendees and it was several more years before we tried a meeting independent of the TMA timeframe.

Somewhere around 1974, Ben Moore recruited me to help him with another matter which was to represent emergency medicine at the TMA meetings and a TMA EMS committee was formed. Ben was the first chairman and then I became chairman of that for quite a few years. We held our early TCEP meetings in the same city and near the same time as the TMA EMS committee meetings, because there were only eight or ten of us attending each year.

The TMA EMS committee turned out to be our first and most important contact with the house of organized medicine, i.e., the TMA. They were struggling with this new-fangled idea called EMS where EMT's went out and "played Doctor" and were constantly worried that these paramedics, along with nurses, were trying to become "licensed" to practice medicine. There was quite a bit of skepticism and resentment among the non-emergency physicians, and we struggled to explain it to them.

Later this committee took the lead role in promoting the first "anti-dumping" law in the nation which passed in Texas about 1984-85. Ron Anderson from Parkland, Ken Mattox from Ben Taub, and I took this from the EMS committee to the Legislative affairs committee of the TMA, and after much negotiation, they eventually supported it to get it passed through the Texas legislature. This law then became the model for the Federal Law, EMTALA which passed in 1986. Like it or not, this "unfunded mandate" changed the face of medicine in the US and formed the basis for the "safety net" of American Medicine.

Right after finishing my term as Texas ACEP president, I was elected to the national ACEP Board in 1976, and that began to take a lot more time. The early days of TCEP were very rewarding for us even though we were struggling with recognition, reimbursement, recruiting, etc., and special bonds were formed among many of us. It is very gratifying to see the success of our specialty, and to know that our association efforts such as TCEP played some part of that. What an unbelievable story when one hears what it was like "back then," and now we have 33,000 Board certified emergency physicians currently in practice! I know that it must be difficult for the younger physicians in our specialty to even imagine what the conditions were like at that time. The recent film by EMRA does a good job of telling that journey.

CB Compton Borders, MD

TCEP President 1984-1985

I currently practice in the Dallas Fort Worth area. I am the COO of Emergency Medicine Consultants which provides management services for emergency physicians that serve the THR and the Methodist systems and several other hospitals.

My clinical activity is centered around Parkland Hospital and its emergency medicine training program. I am a clinical professor of surgery (EM) at Southwestern.

I remember fondly the time I had when being heavily involved with TCEP. I remember mostly the many friendships that generated across the state that exist to this day.

Our most memorable achievement which occurred when I was very active including when I was President was getting a lobbyist. I remember the struggle to get 60,000 dollars per year to fund that. I also remember how by being present our lobbyist saved Texas EM doctors 3 million dollars by his efforts at a late night Medicaid meeting. Having a lobbyist was definitely worth it.

I also remember during my time of great activity was TCEP's sponsoring an EMS medical directors meetings. Also during that time we had some of the first oral board preparations courses in the nation.

When I was very active including being President--there was maybe only one EM residency in Texas and it was small and in El Paso. Most EM doctors in Texas were from other residencies. We had about 800 members I believe. Many of our members were there because ACEP offered at the time malpractice insurance which funded much "moonlighting".

Over the years TCEP has meant much to me especially in the field of advocacy which has been outstanding. Behind the scenes I am still very supportive and our group is very supportive of TCEP.


R.Lynn Rea, MD
TCEP President 1997 - 1998

Where are you currently practicing?

I am a Director at Large for Emergency Medicine Consultants. Most days I am seeing patients at Hunt Regional Medical Center in Greenville Texas, a 48,000 visit County Hospital. The rest of my time is spread among various other departments in the greater Dallas area.

Tell us about your experiences as TCEP President?

I remember it as a difficult time for the specialty. Emergency Medicine Residency trained physicians were on the increase however there were not enough in the workforce to fill the needs of the emergency medicine community. In those early transition years some Emergency Medicine Residency trained physicians felt threatened if non residency trained doctors were going to continue to cross over in large numbers to the practice of Emergency Medicine

What are some of your most memorable moments in TCEP?

Watching our organization grow and continue to stand on its own as well as learning to stand beside the other physician organizations.

What was your greatest accomplishment as TCEP President?

That perhaps would be best told by someone looking in. I am proud that we made the move to our own building to give us a firm financial footing for the future.

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

We were in the transition from physicians trained in other specialties practicing Emergency Medicine to residency trained Emergency Physicians. There was some concern among non-Emergency Medicine Residency trained doctors that they might lose their jobs. There was concern among the Emergency Medicine Residency trained group that there may not be available jobs or that wages would be lower than expected in the marketplace. These were some uncomfortable times. I am proud that I work with an Emergency Medicine group that has a large number of Legacy Fellows of the American College of Emergency Physicians.

What has TCEP meant to you through the years?

It's my medical organization. It's where I go for support from my friends and colleagues. I am proud of the position that we hold within the Emergency Medicine community at both the state national levels.

Myers_EditJohn H. Myers, MD
TCEP President2006-2007

Where are you currently practicing?

I am the President and CEO of Questcare Medical Services, an integrated multi-specialty group based in Dallas/Fort Worth. My main Emergency Medicine practice site is Medical City Dallas and Medical City Children's Hospital, located in north Dallas.

Tell us about your experiences as TCEP President?

Being the TCEP President was one of the greatest honors of my professional career, the culmination of many years of rewarding service with TCEP. I had served on the TCEP Board for eight years prior to becoming the President. The opportunity to lead TCEP's exceptional Board and membership for a year was, therefore, particularly special for me. I find involvement in TCEP a fulfilling way to give back to the specialty that I believe provides a most critical service to patients in greatest need. Electing the TCEP President is our colleagues' way of saying "We trust you to represent us," and, for me, that trust is a reward in itself.

What are some of your most memorable moments in TCEP?

I have many great memories from TCEP. The good news is that they keep coming. The achievements that stand out for me include the passage of tort reform, our successful effect on other legislative measures, and our support for the election of national ACEP leaders. Some of the most memorable moments for me have come from the Annual Meetings. My experience as Annual Meeting Chairman and on that committee made clear to me the benefits our members derive from the committee's hard work. I loved seeing Emergency Physicians from around Texas come together for educational opportunities, to collaborate on EM initiatives, and to enjoy some great parties!

What was your greatest accomplishment as TCEP President?

I believe some of the greatest accomplishments TCEP achieved during my year as President revolved around our rapid growth. We set new records for membership, Annual Meeting attendance, First Tuesday participation, and EMPACT donations. We also started the medical school and residency outreach programs that remain in place today.

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

When I finished my EM residency in 1994 and started practicing in Texas, our specialty was in a fledgling state. For one of the biggest states in the country, Texas had few residency programs. Emergency Physicians were still trying to prove themselves as the specialists we are and not merely moonlighters staffing EDs. In the past 20 years, I have seen EM in Texas become a well-respected specialty. In 2006-07, when I was TCEP President, we were still fighting to prove our value. Because of many dedicated leaders, such as Diana Fite, Arlo Weltge, and Bob Suter to name just a few, and the growth of many additional exceptional training programs, EM now is not only respected but is also leading the charge in the Texas house of medicine.

What has TCEP meant to you through the years?

TCEP is essentially a big family to me. Although its members reflect a variety of outlooks and objectives, we all share the goal of promoting EM in Texas. We enjoy the camaraderie of championing the specialty we love. Above all else, I can't say enough about Jim Coles and Nancy Davis, who are like steadfast parents to us. We are blessed by their consistent and effective leadership. Their dedication and guidance over the years have been invaluable to me as TCEP President, Board Member, and proud Texas Emergency Physician. To Jim and Nancy and everyone else involved with TCEP, I say "Thank You!"

Angela_S_PhotoAngela Straface, MD, FACEP

TCEP President 2008-2009

I joined TCEP as a young physician as soon as I moved back to Texas in 1999. Being a part of a professional organization is very important to me as it lends credibility to what we do and allows the individual and the group to grow in unique ways and to accomplish goals as a united front that may otherwise not be possible. For example, in 2009, when the Texas legislation was in session and I was President of the organization, our physicians attended every First Tuesday to lobby the legislators regarding tort reform. The advances we made that year allowed wonderful protection for emergency physicians statewide as well as expanded access to all our state's patients. Seventy eight neurosurgeons came to Texas to build practices, as well as countless OBGYNSs. This protection still exists today and continues to benefit patients everywhere. I cannot encourage participation enough nor reiterate all of the benefits of education and collaboration you will reap when you join a progressive group like this one. I have been honored to be associated with such an amazing group of colleagues.

"Alone we can do so little, together we can do so much."

-Helen Keller


Rick Robinson, MD, FACEP

TCEP President 2013-2014

Where are you currently practicing?

John Peter Smith Health Network
Department of Emergency Medicine
Integrative Emergency Services
Chief Medical Information Officer

Tell us about your experiences as TCEP President?

As President I had the honor of representing the Texas Emergency Medicine community at the local, state, regional, and national levels. Any TCEP Past President is likely to relate that their year as President is the culmination of many years of service to TCEP members and the patients to whom we provide care. Although TCEP's specific agenda may change from year-to-year the fundamental mission of advocacy remains constant. With less than two months remaining in office my year as President can best be summed up as Advocate General and it was one of the highlights of my professional career.

What are some of your most memorable moments in TCEP?

If you have been following the Presidential Reflections thread over the last three months you should have noted a common theme of camaraderie. One of the most enjoyable benefits of TCEP membership is collaboration with Emergency Medicine's finest minds and most passionate advocates. TCEP provides a venue of networking opportunity that opens doors for its individual members to meet and work with the leaders in our specialty and those that shape public health policy. It has been my experience that TCEP offers an appropriate balance between social networking and advocacy work providing for … well … some very interesting memories. Readers are encouraged to refer to Dr. Greenberg's article in the November 2013 EMphasis for further details on the Zen associated with hotel bars.

What was your greatest accomplishment as TCEP President?

The President serves as Chairman of the TCEP Board and is therefore charged with facilitating decisions and actions of the Board on behalf of all TCEP Members. When the Chapter has a good year it is largely due to the success of the Board and its working relationship with the President, the Chapter Executive Director, and headquarters staff. During my year as President the Board successfully (1) continued to grow membership and improve Chapter finances, (2) supported legislation meaningful to our members and patients, (3) influenced appointment of our members to key regulatory and political positions, (4) contributed to historical projects to include the EMRA documentary, the EMF endowment fund, and the TCEP archive, (5) organized and implemented activities for the TCEP 40th Anniversary Commemorative and Gala, and (6) communicated with our membership, other organized medical societies, policy makers, and the public in a timely manner regarding the key issues we faced. These are but a few examples of our body of work for the 2013-2014 annual business year. I believe my greatest accomplishment as President was to facilitate a productive year for the TCEP Board and our Members in an open and transparent forum.

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

Given that my term as President ends in April 2014 the following is more of a summary of relatively recent events than true retrospective. During my tenure as a member of the TCEP Board and Executive Committee Emergency Medicine was being recognized as the indispensable medical specialty of our time. As the Affordable Care Act (ACA) rolled out the House of Medicine experienced a paradigm shift. The concept of the right patient in the right place at the right time became more reality than pipe dream. In the several years leading up to the ACA go live Emergency Medicine was formally recognized as the specialty that most profoundly manages access to care. Hospitals took on the role of center pieces of health care networks development. Emergency Medicine transitioned from simply staffing a single clinical environment to managing multiple areas within the health care network. Those trained in Emergency Medicine moved into network and medical staff leadership positions where their skills in multitasking and service integration were exactly what the doctor ordered and patients needed. Although the jury remains undecided in terms of the overall impact and sustainability of the ACA it is apparent that Emergency Medicine will remain a major partner with regards to the evolution of integrated health care networks.

What has TCEP meant to you through the years?

TCEP has been and will remain the organization I most closely identify with on a professional level. We have a rich history of meaningful advocacy and member support. We have an impressive roster of past and current local, regional, and national leaders. We continue to mentor up the next generation of leaders who will carry our torch forward. Like so many others I am proud to be affiliated with the most effective professional organization in Texas … hands down.






You may not have heard but the Emergency Medicine Interest Group of UNTHSC Texas College of Osteopathic Medicine (TCOM) is one of the most popular clubs to join on our campus and with the extensive opportunities we provide our members it's easy to see why!


CareFlight Landing: Dude where's my car? Over by the helicopter! This year UNTHSC's EMIG was fortunate to have Dallas Ft Worth's premier air ambulance service make a touchdown landing right on the Medical Education & Training building's main field. Students and faculty were offered an opportunity to see the complexity and elegance of these lifesaving helicopters as well as meet the medical director of the program an Emergency physician at UTSW as well as a UNTHSC-TCOM alum Dr. Robert Simonson(81').

Casting Call - ER Docs wanted! What better way to make an impression as a first year student rotating through the ER than with your immobilization skills. UNTHSC EMIG held a hands-on splinting workshop for its members with Orthoglass splints donated graciously by 3M Unitek - Just add water! UNTHSC EMIG members learned to evaluate and immobilize several bone and joint injuries and everyone was given a custom splint to take as a souvenir!


Show, Stitches, and Shadowing. At the end of last semester UNTHSC EMIG provided a showing of the documentary 24/7/365 which was an eye opening experience of the evolution of emergency medicine and an opportunity to eat free popcorn, of course! The viewing was marked with an auditorium rented out, popcorn popping, and a huge big screen showing; it was truly a remarkable event inspiring an even deeper appreciation and connection to the founders of our fabulous field. Many of our members had no idea just how young the field of EM actually is. With speeches and live interviews given by some of Emergency Medicine's founding fathers - it gave many the opportunity to feel like emergency medicine was much more tangible and open to new leaders, opportunities, and growth!

UNTHSC EMIG also provided a suture workshop sponsored by Ethicon, giving EMIG members a leg up for future rotations during their 3rd year of medical school. Members learned basic suture skills including different interrupted and continuous techniques and knot tying. The skills our EMIG members acquired through these past Fall's workshops have already been put to the test in our EM shadowing program at a local area hospital here in Fort Worth. The opportunity to shadow emergency room physicians allows our members to see first-hand what being an emergency physician truly entails.

Greetings from California.This past fall we sent five students to the ACOEP Fall Conference October 6-9 on the coast of sunny San Diego, CA. We enjoyed three days packed full with an intubation workshop, ultrasound clinic, EM lectures, and a residency fair! Each night was capped off with an evening cocktail hour, providing ample networking opportunities with some of the nation's leading names in Emergency Medicine.

You Don't Have to Be A Physician to Work in EM!

This year our EMIG made a groundbreaking change and was approved to accept student members from UNTHSC's Physician Assistant (PA) and Medical Science (MedSci) Master's Program for membership into our EMIG. This has increased our membership tremendously, including 27 PA students and 8 Media students. We have enjoyed seeing an interest of Emergency Medicine in these future professionals and we hope to continue expanding their participation in our interest group. After all, with medicine increasingly proving to be a team based approach to care, what better way could there be to promote camaraderie and teamwork than from the very beginning. This change has also given us insight into the training and capabilities of other professional around us.

Recent Projects and Looking Ahead. . .
Just this past week UNTHSC's EMIG held an EM Procedures workshop in the anatomy lab and with the help of unembalmed donor bodies our procedures were as close to the real experience as we could get! Our members were able to learn crucial and lifesaving interventions of the ED. Officers taught members how to intubate, perform basic and advance airway maneuvers, suture, perform a cricothyrotomy, and insert chest tubes! How much cooler could it get?

We are also planning on making an appearance for the 40th Anniversary of TCEP at the Annual Meeting held this year at Moody Gardens Galveston; Caravan Style! Stay tuned for more exciting events and adventures with UNT Health Science Center's Emergency Medicine Interest Group. We are always looking forward to new opportunities and exciting collaborations, so if you're ever in our neck of the woods stop by and say hi.


[Top] Faroukh Mehkri (1st yr. rep); Sam Davis (1st yr. rep); Brian James (Treasurer); Joseph Godwin (Vice-President)
[Bottom] Tiffany Allison (1st yr. rep); Courtney Janick (Secretary); Kayla Smith (1st yr. rep); Briana Tully (President); Hannah Rios (2nd year Liaison) [Not Pictured] Andrew Bui (3/4th year liaison); Katrina Sullivan (PA Rep); Ashley Drewett (Med Sci Rep).






March 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 find ourselves about midway through the first quarter of the calendar year this is typically a time when the Chapter is gearing up for Annual Meeting and 2014 is no different … except that we will celebrate our 40th Anniversary this year. Over the last six months we marked this milestone with our series of Presidential Reflections. The last installment in the series appears in this edition of EMphasis. I personally enjoyed working with the rest of the committee on this project and hope you all are enjoying the virtual time travel offered through the recollections of many of our Past Presidents. More on the 40th Anniversary Gala appears later in this article and throughout this edition of EMphasis.

In the January 2014 EMphasis I wrote that 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. That remains true however on January 16 ACEP released the National Report Card on Emergency Medicine. As you are likely aware Texas received an overall grade of D+ which is down from an overall grade of C in 2009. The details of the Texas report card can be viewed at http://www.emreportcard.org/Texas/. The Chapter sent blast e-mails to our Members and included several ACEP leaders and other medical specialty societies in that distribution on the day the report card was released and then again in mid-February. Those e-mails provided additional information regarding the report card along with links to other sources for individual review. The central message of those notices encouraged each of us to reach out to our friends, families, and legislators to begin the dialogue necessary to allocate resources that will provide us the means to close the gaps in those areas where Texas received failing grades:

1. Access to Emergency Care

2. Quality / Patient Safety

3. Public Health / Injury Prevention

I trust many of you are already delivering this message to and soliciting assistance from those you see every day. The next Texas Legislative Session will open on January 13, 2015. Now is the time to engage in dialogue with your state representatives and senators. Take the opportunity to educate them and their staffs regarding the report card and what it means to Texans. Encourage your families and friends to contact legislators as well and deliver the message that they are dissatisfied with a grade of D+ and that they expect and deserve the best emergency medical services available … period.

The TCEP BOD met on January 23-24, 2014 in Austin. Much of the meeting focused on a discussion of the National Report Card, the grade Texas received, and strategies to communicate the message in a way that best promotes action dedicated to improving emergency medical services in Texas. We also continued planning for the April 11-13 Annual Meeting and 40th Anniversary Gala. The education program for Annual Meeting is once again set to provide hot topics presented by outstanding lecturers. The Annual Business Meeting on Saturday April 12 will include elections for Board of Directors and Councillor positions. We will elect two Regular Board Members to serve three year terms along with the Young Physician, Candidate Physician, and Medical Student Members of the Board to serve one year terms this year. We will also elect ten Councillors to serve during ACEP Council for two year terms. The Annual Business Meeting is open to all Members.

The incoming Board will then meet on Sunday April 13 to review the past year and begin the work of the coming business year under the direction of the new Officers. 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 upcoming year.

The TCEP 40th Anniversary Celebration will highlight Annual Meeting 2014 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. We have a few surprises planned that you will not want to miss. The planning committee led by Carrie de Moor, MD FACEP, Heidi Knowles, MD FACEP, and Heather Owen, MD FACEP has designed what is certain to be an elegant evening of reflection and celebration commemorating the most effective medical specialty society in Texas. 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.

This is my last President's Message for EMphasis. At the close of the Board Meeting on Sunday April 13 I will transfer the duties of the presidency into the capable hands of my colleague Bruce Moskow, MD FACEP. Having had the pleasure of working closely with Dr. Moskow over our many years on the Board together I am confident that the Chapter will continue to grow and prosper under his leadership. I look forward to supporting Dr. Moskow and the rest of the Board during the coming year as Immediate Past President as we continue our service to our Members and the patients for whom we provide care. As I close this article I want to express my sincere appreciation to several people. First to my mentors Diana Fite, MD FACEP and Arlo Weltge, MD FACEP for their encouragement and counsel that continues to this day. Second to all of the Board Members and Officers I have collaborated with throughout my tenure with TCEP. The list is long and the memories fond. Third to the TCEP headquarters staff especially Jim Coles and Nancy Davis for their support over the years starting with my tenure as Chairman of the Education Committee followed by my two terms as a Board Member and right on through my year as President. Most importantly I want to recognize my family for their unwavering support of my involvement with TCEP and their understanding of the time spent working with so many other Emergency Physicians dedicated to building a better practice environment. Muchas gracias amigas y amigos.

Wishing you all the very best until we meet again at Annual Meeting and the 40th Anniversary Gala.

Choosing Wisely – Were We Wise to Choose?

Gerad Troutman, MD
Young Physician Member Board of Directors
University Medical Center - Lubbock, TX

Regardless of your opinion of the ACA, there is one thing we all agree upon – medical care in our country needs some fixin’.  Medical costs have risen; often fueled by malpractice concerns and excessive defensive medicine leading to increased admissions and testing.  Fortunately we practice in Texas where medical liability is a more minor concern and we practice Emergency Medicine which accounts for just 2% of all medical costs.  Choosing Wisely is a public campaign developed by the American Board of Internal Medicine that is simply intended to spur conversations about what is appropriate and necessary treatment… something I think most of us do anyway.

The American College of Emergency Physicians was one of the last large specialty societies to develop five items for the campaign.  There was hesitancy from a liability standpoint and against creating restrictive ‘standards of care’ or even guidelines which could cause legal issues for our emergency physicians.  Choosing Wisely does neither of these; it is an awareness campaign on issues that most of us have been practicing all along.  The Texas College of Emergency Physicians has decided to mirror our Choosing Wisely list with ACEP:

  • Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules.
  • Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience.
  • Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.
  • Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up.
  • Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children.

If you are like me, when you see this list, you probably realize you are already doing most of these.  Some of us may have become lax due to time restraints and other factors; those physicians can utilize this tool for a rejuvenation.  Every one of us have spent hours in our careers talking patients out of CT scans, suggesting antibiotics are not actually needed for a simple abscess or even a URI, and that fluids and the IV stick are not really needed when you can drink a sports drink without issue.  How many times has nursing staff asked you to place a urinary catheter for convenience; and we all should agree that end of life/hospice care can be greatly impacted during an emergency visit.  The primary focus for CW is not just to Physicians but to the PUBLIC aka our patients.  I view Choosing Wisely as a simple tool that I can bring to the bedside of my patients where together we can have open discussions and calm concerns they may have.

I believe we can impact healthcare costs if we all practice stewardship of every healthcare dollar.  Much like the ACEP Saving Millions campaign suggests we can still promote evidence based, high quality care that does not impact patient care by reducing unnecessary testing and admissions.  In Texas, with liability reform in place, we have the perfect stance to do this and to urge for similar protection to our colleagues at the national level.

TCEP has joined forces with the Texas Medical Association to promote Choosing Wisely; we want all of our Texas emergency physicians to be well acquainted with Choosing Wisely.  I intend to embrace our list, not so much to change my practice, but to rejuvenate discussions with patients and other staff and as an adjunct to help my patients make choices in their care.  Join me at the TCEP Annual Meeting as we look at the science behind our Choosing Wisely list.

Government Relations Committee Report

Diana Fite, MD, FACEP

Chair, Government Relations Committee

If you are reading this report before March 4, please be sure to vote in the primary election.  The Texas Medical Association (TMA) and Texas physicians have worked for years to get judges elected to the Texas Supreme Court who would be fair to physicians and not favor the plaintiff attorneys over the general public.  Finally that was achieved and it is thanks to the makeup of the Texas Supreme Court that we have kept our tort laws that passed in 2003, particularly the willful and wanton standard for emergency care that was not included in the constitutional amendment that has helped the Supreme Court judges to uphold the tort laws.  However, the opposing side has gotten tricky, and the trial attorneys (and some Democrat major donors) are funding candidate judges to oppose the current judges in the primary election rather than in the general election.  So if you vote in the Republican primary, the political action committee of the TMA (TEXPAC) is strongly encouraging us to vote for Hecht, Brown, Boyd, and Johnson in the Supreme Court races. 

Our Government Relations Committee members and all other interested TCEP members (and their guests) are welcome to meet with us Friday night, April 11, during the TCEP annual meeting in Galveston at Moody Gardens Hotel.  We will meet in the restaurant after the exhibitors’ reception and enjoy a dutch treat dinner.  We will be discussing our recommendations for legislative priorities for the next legislative session which will begin in January of 2015.  Among the items we will be considering to be our priorities will be:  protecting the tort laws, especially for emergency care when willful and wanton negligence has to be proven against physicians caring for emergency patients; the psychiatric hold issue; the sexual assault survivor bill SB1191 from the last session; the identification requirements of health care providers bill SB945 from last session; and many other potential priorities.

We will also be discussing the 2014 ACEP state report card and how we can use that information and our grades to help with our legislative issues.  We want to make sure the legislators do not jump to the conclusion that the report card is grading actual emergency care in the state, but rather is grading how emergency medicine/physicians perceive the environment in Texas for their patients.  As you know by now, Texas went from a grade of “C” in 2009 to a grade of D+ for 2014.  Please go to “emreportcard.org” to read all about the report card and the grading and to see the breakdown of our grade and how we compare to the other states.  Also look at this video done by Dr. Rick Robinson and myself discussing the grades and how we will use them in talking to legislators: 

Password: tcep

(This was filmed on the one day in Austin when it actually snowed, so we look a bit bundled up for south Texas!)

We will also be asking at our annual business meeting on Saturday, April 12, that everyone in attendance update their TCEP political action committee (EMPACT) pledge cards, since we have to get that done on a yearly basis. 

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.

2014 Board Candidates

Regular Board Position - 3 Year Term


Ije Akunyili, MD

1.Please provide us with your Medical School and Residency Program information inculding graduation dates. Also include your current positions held with a brief description of your duties.

Graduate school MPA, Harvard University 2002
Medical School, University of Maryland 2010
Residency, University ot Texas Health Science Center at Houston 2013

Current Position:

Emergency Physician, Memorial Hermann Southwest Hospital Houston.
Staff physician at a Level II Trauma facility and second busiest emergency department in Houston.

Assistant Professor, Baylor College of Medicine.
Attending physician at one of the two level I trauma centers in Houston. Responsible for staffing ED and involved in resident teaching and education.

2.Tell us about your involvement in TCEP.

I have been involved in TCEP and Emergency Medicine leadership for the past several years since I moved to Texas to start my residency at UT Houston. I have been present at almost every single TCEP board retreat and meeting since I made Texas my home.As a Speaker of the Council, for the Emergency Medicine Residents' Association (EMRA), I have continued to advocate for all of Texas physicians by participating in the TCEP residency visits, writing updates for the TCEP Emphasis and being a member of the TCEP Government Affairs Committee.I am also a graduate of the TCEP Advocacy and Leadership Fellowship which has prepared me tremendously to take on the challenges of leadership in our state.

3.Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

In the next three years, we will face increasing pressures especially surrounding tort reform. Emergency Physicians in Texas will also have to deal increasingly with longer boarding times, overcrowding and the need to continue to achieve preset matrices without commensurate re-imbursement . Also our academic programs face the looming threats of GME funding an issue that has been addressed by our State Legislature but requires our continued vigilance. Texas is going to have access to care issues with a growing population and the advent of the ACA act. I see my role as a board member of TCEP as multifaceted:

1)Increase membership especially among young physicians and new entrants into the Texas EM community. Without an active and informed membership our advocacy efforts will fail.
2)Work with the government affairs committee on on legislative advocacy efforts
3)Expand the already vibrant residency visit program and the mentorship of young leaders in Texas
4)Increase awareness of workplace diversity among Emergency Departments across the state.

4.Please provide a brief description of family, community and professional activities, and hobbies.

When I am not working clinically or involved in a myriad of Emergency Medicine advocacy and leadership issues, I spend time with my husband of ten years and two children ages 9 and 6. Everyone loves an EM doc as field trip and cafeteria mum! I can also be found weightlifting, reading memoirs, travelling and practicing yoga. I am very involved in my local community and volunteer on the cultural arts board for the city of Bellaire.


Harbir Singh, MD

1. Please provide us with your Medical School and Residency Program information including graduation dates. Also include your current positions held with a brief description of your duties.

Medical School: Pennsylvania State University 2010-2013
Residency: UTSW/Parkland 2010 - 2013
Employer: Emergency Services Partners 2013, Staff EM Physician

Current Positions in Organized Medicine:

2014-Present (3 yr term): Legislative Committee, Travis County Medical Society
2014-Present: TMA Alternate Delegate Travis County Medical Society
2011-Present: ACEP Alternate Councilor
2012-Present: Assisted TCEP Membership Committee; Residency Visit Program
2013-Present: TMA YPS Member
2014-Present: TCEP Government Affairs Committee
2010-Present: Dallas EM Foundation; Alumni Foundation of UTSW/Parkland EM Residency
President (2010-2013); Immediate Past President (2013-Present)

2. Tell us about your involvement in TCEP.
I've been very active with TCEP over the past few years, including a two year term as a Candidate Board Member and newsletter editor. During my term as a board member, I focused on improving the TCEP Monthly Newsletter as well as increasing resident involvement in TCEP.

2011-2012 TCEP Leadership and Advocacy Fellow
2011-2013 Candidate Board Member
2011-2013 TCEP EMPhasis Newsletter Editor

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

As a Director, I'd like to help the TCEP Board understand and respond to the implications of healthcare reform on Emergency Medicine. The future of healthcare is nebulous and rather than reacting to changes, we should be proactive. We must mobilize to influence legislators and protect the interests of both EM physicians as well as our patients. Living in Austin additionally allows me to be of unique service to TCEP by being readily available for any urgent meeting and lobbying.

4. Please provide a brief description of family, community and professional activities, and hobbies.

While I'm not a native Texan, I've embraced the traditional values of independence, self reliance, and achievement. Having come from a middle class background, these values helped me get to where I am now. Family remains a priority in my life and when I'm not working on activities with TCEP or TMA, I spend as much time with them as possible. They still live in Pennsylvania, but I'm slowly convincing to them come down to Texas. The first convert may actually be my younger brother who will hopefully match for residency here!
In my free time I enjoy hiking, kayaking, playing tennis and volunteering within the community.


Gerad Troutman, MD

1. Please provide us with your Medical School and graduation date. Also include your current positions held with a brief description of your duties.

Texas Tech University Health Sciences Center School of Medicine - 2007


⦁ TCEP Young Physician Board of Director 2013-2014
⦁ TCEP Physician Liaison to the Medical Student Committee - Assist and aid in the direction of the committee as it carries out goals set forth by the TCEP Board. I worked closely with the students to establish the first Medical Student Track in 2012, and helped grow its success in 2013 and 2014.
⦁ TCEP Residency Visit Program - Attended four site visits in 2013 and was a speaker at two visits.
⦁ TCEP Liaison to TMA for the Choosing Wisely Campaign - Helping TCEP and TMA promote Choosing Wisely through lectures and posters.
⦁ TCEP EMS Committee
⦁ TCEP Leadership and Advocacy Fellow 2011-2012


⦁ ACEP Emergency Medicine Practice Committee Member - Directed by the ACEP board to review, edit, and provide feedback on various ACEP policies, white papers, and other duties as needed.
⦁ ACEP YPS Steering Committee
⦁ ACEP Alternate Councilor 2012, 2013 - Promoted to Councilor in 2012 and 2013.


⦁ TMA House of Delegates Member for YPS - Represent the Young Physicians Section at the House of Delegates to vote and assist in establishing TMA policy.
⦁ TMA Leadership College 2012-2013 - A year long program sponsored by the TMA to provide skills and mentorship to future leaders.
⦁ TMA Committee on EMS and Trauma Member - Directed by the TMA to provide comment on issues important to EMS and Trauma services.
⦁ GETAC EMS Medical Directors Committee Member - Advises GETAC on issues important to EMS Medical Directors.


⦁ Emergency Medicine Physician - University Medical Center / Texas Tech University Health Sciences Center - Lubbock, TX - Level 1 Trauma Center, Tertiary Care Center with 80K/year volume
⦁ Texas Tech School of Medicine Lubbock - Emergency Medicine Student Clerkship Director & Emergency Medicine Interest Group Advisor - Provide direct mentorship to students in Lubbock interested in EM as a career, establish all logistics for student and outside resident rotations in our department, and oversee the EM Interest Groups direction.
⦁ UMC EMS Medical Director - 911 Transport Provider for the city and county of Lubbock, TX with 41,000 call volume; approximately 140 ALS Providers.
⦁ Lubbock Fire Rescue Medical Director - 911 ALS First Responder Organization for Lubbock, TX. Over 350 EMT providers and 50 ALS providers.

2. Tell us about your involvement in TCEP.

My original involvement with TCEP began with my participation as a Leadership and Advocacy Fellow. This experience taught me how to navigate organized medicine and develop leadership skills. I really enjoy showing medical students how awesome our specialty is. I helped develop the Medical Student Track three years ago at the annual meeting which has continued to be a huge success with over 100 students each year representing all medical schools in Texas. I was recently asked by the TCEP Board to be the TCEP Liaison to TMA for the Choosing Wisely Campaign. I applied for and received a grant from ACEP for $4,500 to help TCEP advertise Choosing Wisely. I have went to several TCEP Residency Visits and was either a speaker or panel participant.

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

As a director, I wish to continue to work with our Medical Student Committee to ensure our new generation of leadership stays strong. I want to continue to develop our Medical Student Track and bolster attendance of future emergency physicians at the annual meeting. I believe this helps secure future membership by instilling the importance of organized medicine in young physicians. I also want to make certain that independent practice of our specialty is protected in our state and continues to be developed at the national level. With all the changes in healthcare, I believe now is an exciting and important time to be involved with Emergency Medicine Advocacy. I have made visits to Austin to advocate for medicine; I have been to Washington DC the last four consecutive years to advocate with ACEP at LAC for issues facing Emergency Physicians. I believe it is very important to make certain not only medicine, but Emergency Medicine, is at the table as legislation is developed and I hope to continue to be part of that as one of your TCEP Board of Directors.

4. Please provide a brief description of family, community and professional activities, and hobbies.

I am married to Ashley Troutman who is a Chemical Engineer with BP. We have two sons, Cash and Colt Troutman, who are almost 3 years and 6 months respectively. We have been involved with a service organization, Lions Club International for over 10 years and are currently members of Hub City Lions Club. Our family hobby is traveling and exploring new places. We have visited almost every major city in the US and soon wish to start making more International travel. We also enjoy fine dining and "tasting menus" at the best restaurants in America. I enjoy interacting with medical students, especially those interested in Emergency Medicine, and assisting them with their goals to become an Emergency Physician


Hemant Vankawala, MD

1.Please provide us with your Medical School and Residency Program information including graduation dates. Also include your current positions held with a brief description of your duties.

⦁Doctorate of Medicine: (2001)
University of Texas Health Science Center, San Antonio TX
⦁Emergency Medicine Residency: (2001-2004)
Texas Tech Health Science Center, El Paso TX
⦁Emergency Physician & Partner: (2006 - Present)
Emerus Hospital Group, The Woodland TX and McKinney TX
⦁Assistant Clinical Professor: (2012 - Present)
Texas Tech Health Science Center, Department of Emergency Medicine, El Paso TX
⦁Chief Medical Information Officer: (2012 - Present)
Emerus Hospital Group, The Woodlands TX
⦁Volunteer EMS Medical Director, Terlingua Fire & EMS: (2004 - Present)
⦁Volunteer EMS Medical Director, Big Bend National Park: (2004 - Present)

2.Tell us about your involvement in TCEP.

⦁In 2011, after acquiring several years of clinical experience in emergency medicine, I decided to become more involved in TCEP. I have spent the last few years attending board meetings and participating in a variety of TCEP activities, and have found our organization to be incredibly approachable.
⦁TCEP has a fantastic EM residency outreach program and I have been able visit several programs on behalf of TCEP as a lecturer and expert panel member.
⦁In 2013, I participated in the TCEP Leadership and Advocacy Fellowship. The L&A Fellowship is yet another outstanding example of TCEP's commitment to open itself to its membership and allow them to engage and participate. I spent the year learning the key issues that face emergency medicine physicians as well as building relationships with leaders in our field.
⦁I represented TCEP on Capitol Hill as an ACEP Leadership and Advocacy attendee in 2013.
⦁At our 2013 national ACEP meeting, I represented TCEP as an Alternative Delegate.

3.Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

⦁Texas is one of the best places in the country to practice emergency medicine. Tort reform and our business friendly state environment continue to fuel our expansion in EM jobs and residency slots. TCEP must continue to work with leaders from across practice environments and political arenas so that Texas is able to keep the advances it has made and continue to grow.
⦁Health care reform has given a whole new meaning to the phrase "think locally act globally". TCEP has helped to drive local changes to our emergency medicine practice and many other states continue to take notice. TCEP's participation and leadership on the national stage should continue to be a focus for our college.
⦁TCEP has done an excellent job of building its membership by engaging practicing EM physicians and EM residents as well as medical students interested in our field. Our membership is our greatest strength and will continue to be our compass as we grow.

4.Please provide a brief description of family, community and professional activities, and hobbies.

⦁I have enjoyed working with the TCEP and ACEP leadership at state and national meetings discussing the critical role that EM continues to play. EM remains the front door to the American health care system and we provide a critical service unmatched by any other group. After ten years of private practice, I find myself lucky enough to give back to the specialty that has done so much for me.
⦁I spend the majority of my clinical time in solo coverage private practice. But I immensely enjoy the balance that my academic time out on the border working with the EM residents at Texas Tech in El Paso affords me.
⦁In addition to EMS, I have experience in disaster medicine having served as a TX-4 DMAT physician who was deployed to New Orleans during Hurricane Katrina.
⦁I love to travel and am fortunate that my wife, Ketaki, and our 5-year-old daughter, Nidhi, share my passion. We especially enjoy our trips out to the Big Bend area where we can combine our love for the outdoors with my passion for EMS education.

Young Physician - 1 Year Term


Julie Sullivan, MD

1. Please provide us with your Medical School and Residency Program information inculding graduation dates. Also include your current positions held with a brief description of your duties.


2003-2007: Medical College of Virginia at VCU- Doctor of Medicine
2007-2010: Christiana Care Health System- Emergency Medicine Residency


2010-present: Staff Physician, Guadalupe Regional Medical Center
25 bed emergency department
34,000 patient annual volume- Level IV trauma center
2013-present: Director of Leadership & Advocacy Education
UTSW- Austin Emergency Medicine Residency Program
Advocacy Education, Leadership Training, TMA White Coat
Days, Accompany Residents to ACEP, SAEM, L&A in DC, etc.
2013-present: Physician Mentor
Mentor for an Emergency Medicine Resident
Attend regular meetings for resident and faculty development


2010-Present: EMRA Awards Committee Member -
Read, evaluate and select award winners for EMRA's fall and spring
awards ceremonies
2013-present: Young Physician Delegate (Texas Medical Association)-
Attend TMA meetings, rank award applicants, act as young physician
liason to the TMA
2013-present: ACEP- Medical Legal Committee Member -
Monitor medical-legal arena and provide information to ACEP and its
members as needed
2013-present: Emergency Department Practice Management Association-
Board Member

2. Tell us about your involvement in TCEP.

2013: TCEP Leadership & Advocacy Fellow
2013: TCEP Alternate Councillor

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

Goals - Represent young physician interest to the TCEP BOD
Network resident physicians and medical students to the TCEP general body
Educate and encourage young/new physician involvement in TCEP, policy,
lobbying efforts in the state and on a national level

Issues- SGR repeal, GME funding, Texas Medicaid non-Expansion
Lack of physician education and involvement in EM Practice Issues
Inadequate influence/representation of the Emergency Medicine specialty
Liability/Tort Reform protection

4. Please provide a brief description of family, community and professional activities, and hobbies.

My husband and I live downton in Austin, TX with our 1 year-old son. We like to hike state parks, work on our golf swings, and try new restaurants but spend most of our time on potty training, naptime, and reading Cat in the Hat innumerable times each day!!

Candidate Member - 1 Year Term


Jessica Best, MD

1. Please provide us with your Medical School and Residency Program information inculding graduation dates. Also include your current positions held with a brief description of your duties.

2012-present University of Texas Southwestern--Austin Austin, TX
⦁ 2nd Year Emergency Medicine Resident
⦁ Emergency Medicine Residency Association:
Vice-Chair of the Education Committee
Fellowship Project Committee Member
Awards Committee Member
SAEM Quiz Show Project Committee Member
Survey of Chairs Project Committee Member
International Region Representative
2008-2012 St. George's University School of Medicine Grenada, West Indies
⦁ Doctor of Medicine
⦁ Student Government Association
⦁ Women in Medicine Member

2005-2007 University of Colorado at Boulder Boulder, CO
⦁ Master of Sciences in Chemistry

2001-2005 University of Colorado at Boulder Boulder, CO
⦁ Bachelor of Arts in Biochemistry

2. Tell us about your involvement in TCEP.

⦁ Lobbying during the 2013 session
⦁ participant in TMA White Coat Days
⦁ Involved in starting a resident TCEP committee
⦁ UTSW Austin program representative

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

⦁ Continued GME funding
⦁ Exploring alternatives to aid in the expansion of Medicaid and ACA coverage to unfunded patients
⦁ Continued tort reform for EM physicians

4. Please provide a brief description of family, community and professional activities, and hobbies.

⦁ My hobbies include traveling, tennis, running, skiing
⦁ Community projects include the aware, awake, alive program- I have worked to promote alcohol education for teens and college individuals, and promote a safe environment in the hospital for teens to get help for themselves or friends.
⦁ Currently I am working on a global health elective for my residency program. I am passionate about working abroad and plan to spend part of my career working in the public health sector in TX and abroad.


Sterling Overstreet, MD

1. Please provide us with your Medical School and Residency Program information including graduation dates. Also include your current positions held with a brief description of your duties.

I graduated medical school from Texas Tech University Health Science Center in Lubbock, Texas in 2012. I am currently a second year emergency medicine resident at John Peter Smith Health Network in Fort Worth, Texas on schedule to graduate in 2015.

As a Junior Academic Chief I have been able to work with senior medical students to expose them to the emergency department as well as teach on subject matters crucial to working in the ED. During this time I held procedure labs, taught bedside ultrasound, and mentored emergency medicine applicants.

I currently serve on the Sepsis committee at John Peter Smith which works to develop treatment protocols and their implementation for patients presenting to the emergency department. In addition, I am actively involved in ongoing research at JPS which has led to poster presentations and publication.

2. Tell us about your involvement in TCEP.

Currently I am member of TCEP and attend annual conferences. As I approach my third year of residency I would like to take a more active role in organized medicine and work with the TCEP Board of Directors as they continue to create policy for Texas emergency physicians, residents, and medical students.

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

I first learned of organized medicine as a senior medical student. I was fortunate to have a mentor that was actively involved in TCEP and taught me the importance of being involved and being at the table when decisions were made. In residency I have worked closely with emergency physicians who are active in organized medicine and have continued to foster my interest in TCEP. There are innumerable challenges facing today's emergency physicians from patient flow, changing laws regarding narcotic prescribing, overcrowding, and reimbursement to name a few. This year in particular provides a new challenge as we all adjust to the changes arising from the implementation of the Affordable Care Act. As a Director, I would hope to provide the board with a resident's perspective regarding these issues while advocating for all Texas EM residents.

4. Please provide a brief description of family, community and professional activities, and hobbies.

I was born and raised in the Dallas-Fort Worth area and have remained in Texas for my education. I am the only person in my family to pursue a career in medicine. My father was a police officer with the Dallas Police Department and taught me the importance of a strong work ethic. My wife is a business owner actively involved in the North Texas area with petroleum and natural gas. I will graduate from residency in a little over one year and fully expect to stay and practice medicine in Texas. In my spare time I enjoy being outdoors, fly fishing, and mountain biking.


Rob E. Schmitt, MD

1. Please provide us with your Medical School and Residency Program information including graduation dates. Also include your current positions held with a brief description of your duties.

University of Utah School of Medicine Class of 2013

Scott and White Memorial Hospital Texas A&M Emergency Medicine Residency 2013-Present

2. Tell us about your involvement in TCEP.

As a new resident in both Emergency Medicine and Texas I am new to TCEP. I take time to read the monthly EMphasis and look forward to continuing my involvement as a resident. I attended and assisted at the TCEP sponsored Texas EMS Conference in November.

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

We live in a period of time where the patients, or now customers, perspective on the quality of their care is becoming more and more important. For some the words Press Ganey are becoming an expletive more than a motivation. Some reimbursements are becoming tied to surveys of the few. I see in the next three years patient satisfaction becoming more and more at the forefront.

Merging job satisfaction with patient satisfaction will be a process we must harness rather than hurdle as we jump from patient to patient. Having spent 6 years as a bill collector for a large credit card company it was essential to have the difficult encounters while still maintaining a loyal customer. This is the crux of the Press Ganey initiative.

Like most residents I speak with, we selected our respective programs based more on the people we met than the location or curriculum. A rough shift in the emergency department is made so much better when there are those working with you who can laugh or cry with you and support your resilience. I think it is essential to harness resilience not only within individual Emergency Medicine residencies of Texas, but among the Emergency Medicine residencies of Texas.

Finally, we entered medicine to make a difference. However, a stable foundation must be present in order to support a home. For us to be able to support our home we need a strong economic foundation for our families. This way when we are at work caring for the sick, the scary, and the psychotic, we can know our home is on a sure financial foundation. No one wants to take care of the homeless while fearing for the loss of their own home.

There are three components to these problems that will be essential to understand and initiate for us to have both the job and the patient satisfaction while fostering interpersonal and residency resilience and supporting a solid fiscal foundation.

My goals therefore are to:
⦁ Increase awareness and involvement in critical political and legislative matters among emergency medicine residents,
⦁ Help support the legislative processes that will take into account the fiscal changes being presented to new resident physicians,
⦁ Create new ways for inter-residency communication and collaboration in advancing Emergency Medicine

4. Please provide a brief description of family, community and professional activities, and hobbies.

I grew up in Salt Lake City, Utah. I am the husband to one wife, Angie, and the father of two (almost three) beautiful daughters; Lauren, Claire and soon to be Leah. My oldest daughter, Lauren, is beginning to enjoy the things that I do. For her fourth birthday she asked for a bow so she could shoot archery with me. Now at almost six she looks for opportunities to join me at the shooting range. My ultimate goal in life is to be a father that is looked up to by his children. Service is a foundation of my faith and I seek to provide it as often as possible. During medical school I was the race director for a triathlon in its 11th year of inception, which supported a free medical clinic. I was a class president during medical school and through collaboration with my class and the deans helped develop and mold the curriculum now being taught. Working with the wonderful members of TCEP at the Texas EMS conference solidified my desire to serve and represent the Emergency Medicine residents of Texas as a member of the TCEP board. Through collaboration and service we can support TCEP in building up the Emergency Medicine residents of Texas.

Medical Student - 1 Year Term


Daryn Donathan

1. Please provide us with your Medical School and Residency Program information including graduation dates. Also include your current positions held with a brief description of your duties.

⦁ University of Texas Medical School at Houston, Anticipated Graduation May 2015
⦁ UTH Student Society of Emergency Medicine, MS1 Representative Officer - Assisted EMIG president and vice presidents with various tasks, including executing lunch meeting logistics and visits to undergraduate premed meetings.
⦁ UTH Student Society of Emergency Medicine, EMIG President - Coordinated and delegated tasks to current EMIG officers to ensure optimal benefits to current members
⦁ TCEP Medical Student Committee, Liaison - Provided two-way communication between my school's EMIG and the TCEP Medical Student Committee
⦁ TCEP Medical Student Committee, Chair - Coordinated and delegated tasks to committee members to maximize communication between medical students from all 9 Texas medical schools and ensure optimal resources for medical students interested in Emergency Medicine. Reported project statuses and prospective projects to the TCEP Board of Directors at quarterly meetings.
⦁ ACEP Membership Committee member - Participate in regular conference calls, assisting with projects aimed at increasing student membership in ACEP based on programs piloted through the TCEP medical student commitee.

2. Tell us about your involvement in TCEP.

My involvement with TCEP began when I was president of my school's Emergency Medicine Interest Group. The TCEP Medical Student Committee (MSC) was newly formed/approved when I was asked to be Liaison for our school to the committee. The following year I was chosen as a Chair of the committee. As a committee, we were very successful in engaging medical students from across the state to be involved in the committee and organized medicine. My responsibilities as Chair included creating, delegating, coordinating, and overseeing various tasks designed to accomplish charges from the TCEP Board of Directors, as well as our own set objectives. Some of these objectives included: 1.) recruiting volunteer members to serve on the committee from each of the 9 medical schools in Texas; 2.) Creating and/or improving resources for medical students in Texas pursuing Emergency Medicine, such as a Mentor's Database and an Away Elective Database; 3.) Ensuring each school's publication in TCEP's bi-monthly newsletter, EMphasis; 4.) Organizing and ensuring delivery of TCEP's annual Outstanding Medical Student Award to one student from each medical school in Texas; 5.) Creating and maintaining a web page on TCEP's website for MSC updates and resources for students. 6..) Planning the second annual Medical Student Track at TCEP's Annual Meeting. As a TCEP Committee, we were required to update the Board of Directors at quarterly meetings, as well as present new ideas for the Board's consideration/approval. As Chair Emeritus, I have served an advisory role to the succeeding Medical Student Committee leadership, as well as attending each quarterly Board of Director's meeting this past year, maintaining my relationship with the current Board.

3. Convey to us your goals as a Director and what you see as the pressing issues facing Emergency Physicians in the next three years.

As the Medical Student Board of Director my goals will be aimed primarily at issues affecting medical students pursuing Emergency Medicine. As an example, at the past ACEP Scientific Assembly some ACEP state chapters proposed a resolution that would decrease medical student representation in the Council. While this was not initially approved, it is likely that it will be presented again for future votes. TCEP has set multiple precedents in empowering and enabling medical students in the state. As a Director I plan to continue campaigning to the Board on behalf of medical students in Texas in order to garner official support from the Board on issues that will increase opportunities, positions, and representation to medical students on both state and national levels.

4. Please provide a brief description of family, community and professional activities, and hobbies.

I was born and raised in the small town of Henryetta, OK, and have been in Houston since 5th grade, completing high school and undergraduate studies here. I have been married to my "high school sweetheart" of 12 years for almost 6 years. We have two dogs and are expecting our first child in early April. In addition to spending time with family and friends, I enjoy cars and playing sports, especially tennis and softball. I have also recently begun playing the guitar in my ample (...) free time.

Having worked as an EMT before medical school, I continue to have a great interest in topics concerning trauma and pre-hospital care.

News From the Practice Enhancement Committee

Zachary Goldman, MD

This month we will look at the definition of critical care and components necessary to bill for critical care.

Definition of Critical Care:

The 99291, is described as "… the direct delivery by a physician(s) of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition. Critical care involves high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration of the patient's condition. Providing medical care to a critically ill, injured, or postoperative patient qualifies as a critical care service only if both the illness or injury and the treatment being provided meet the above requirements."

The time component requirement of critical care is greater than 30 minutes excluding separately billable procedures (see below). There is nothing wrong with documenting less than 30 minutes of critical care time but to bill for a 99291 you must exceed the 30 minute threshold. Please be aware that this time is exclusive to the care of the patient in question. While the time does not need to be contiguous it cannot be in conjunction with care of another patient. For example if you have 6 patients in your Emergency Department and one comes in in respiratory distress and you place that patient on bipap and start a nitro drip and order labs and talk with consultants to get that patient admitted all that time can count toward critical care. As soon as you turn your attention to another patient or another endeavor the clock stops but can restart once you return to the critical patient. The total time spent treating that patient while critical can be summed together.

In general about 6-8% of Medicare patients are thought to be Critical Care and about 3-6% of all comers to the Emergency Department should fall into this category. This number can vary significantly depending on acuity of the patient population, admission rate and age of the patient population at each facility. Every few months it would be a good practice for individual physicians to review their levels of all EM charts (level 1-5 and CC) and see where they fall in comparison to their group and national averages.

Before documenting CC, ask yourself two questions

1. Was patient admitted to ICU or immediate dispo to OR?

  • If yes: strongly consider CC
  • If no: is it really CC?
  • If no (and you think it is CC): document a Medical Necessity note

2. Will the patient die or deteriorate (soon) if you don't do something (quickly)?

  • If yes: document CC time
  • If no: is it really CC?
  • If no (and you think it is CC) : document a Medical Necessity note

Medical necessity note:Specific documentation that lays out the reason you feel a patients meets criteria for critical care. Most auditors do not have a problem with the intubated head bleed going to the ICU meeting criteria for critical care. However, an asthmatic that goes home might be a different story. For the asthmatic a note that states the patient came in in severe respiratory distress with tachycardia, tachypnea, significantly decreased breath sounds and diaphoretic that was treated immediately with Bipap and with steroids and multiple rounds of bronchodilators and required 2 grams of magnesium and one dose of terbutaline and was watched closely in the ED weaned to NC then off all supplemental oxygen and then at time of DC was asymptomatic with strong vitals would allow for the billing to critical care. While this example is extreme and would most likely still be admitted it is this type of documentation that is needed to demonstrate the two elements of critical care both the critical illness and the critical interventions.

Below are examples of things that count toward critical care time

  • Chest x-ray interpretation
  • Pulse oximetry
  • ABG interpretation /managing acidosis
  • NG tubes,
  • Temporary pacing
  • Initial vent management
  • Peripheral IV access
  • Managing drips

Separately billable procedures which are subtracted out of critical care time

  • Intubation
  • Central lines
  • Chest tubes
  • Orthopedic procedures /lacerations
  • FAST/other bedside US exams
  • CPR*

News From the Medical Student Committee
Update by David Xu, UTSW - Dalls

The EMIG at UT Southwestern has closed off an amazing year in 2013 and transitioned quickly into 2014.  We were fortunate to welcome a new mentor Dr. Scott Goldberg who brings experience not only from in the ED, but also from his post as a Medical Director for Emergency Medical Services in the greater Dallas area. Finishing his residency in Mt. Sinai relatively recently in 2012, he has been instrumental in keeping our talks and events full of energy and well geared toward the average medical student.

In one of our first meetings of the year, Dr. Kurt Kleinschmidt spoke about the many routes that follow a residency in Emergency Medicine. Though many of us undoubtedly knew the work of EM physicians in the ED, Dr. Kleinschmidt discussed opportunities in sports medicine, toxicology, hospital administration, ultrasound, and EMS. Many students, including myself, were interested in Emergency Medicine because of the appeal of working in the ED – but the various other possibilities that Dr. Kleinschmidt discussed only highlighted the diverse work an EM physician could pursue.

One of the goals we set for our EMIG was to continue and improve our hands-on events. In the Fall, we hosted an emergency airway management clinic. Using intubation models and laryngoscopes lent to us by the Emergency Department, several residents and faculty members graciously donated time to explain the basic technique and assist students trying out the procedures.

In addition to airway intubation, our mentor, Dr. Goldberg, put together some makeshift cricothyrotomy models out of plaster, ventilator circuit tubing, tape, and non-rebreather masks. The simplicity of the models mirrored the simplicity of the procedure – he said. He explained that the concept and practice of performing a cricothyrotomy was not exceptionally difficult, but the challenge was doing it amidst the chaos of a rapidly deteriorating patient.

We are grateful to be able to host these events giving students the opportunity to try techniques first hand.  As an EMIG, we strive to be a resource for our medical students, encouraging them to learn and be exposed to as much Emergency Medicine as possible. Lastly, we want to wish our MS4s the best of luck as match day approaches!


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


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