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MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies July/August 2001 1

V O L U M E 3 , N O . 4 J U L Y / A U G U S T 2 0 0 1

C O N T E N T SPhysician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Richard J. Morris, M.D.Managing Editor Nancy K. BauerAssistant Editor Doreen M. HinesHMS CEO Jack G. DavisRMS CEO Roger K. JohnsonProduction Manager Sheila A. HatcherAdvertising Representative Betsy PierreCover Design by Susan Reed

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. Periodical postage paid at Minneapolis,Minnesota. Postmaster: Send address changes toMetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761.

To promote their objectives and services, theHennepin and Ramsey Medical Societies printinformation in MetroDoctors regarding activitiesand interests of the societies. Responsibility is notassumed for opinions expressed or implied insigned articles, and because of the freedom givento contributors, opinions may not necessarilyreflect the official position of HMS or RMS.

Send letters and other materials for considerationto MetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. E-mail: [email protected].

For advertising rates and space reservations,contact: Betsy Pierre, 2318 Eastwood Circle,Monticello, MN 55362;phone: (763) 295-5420;fax: (763) 295-2550;e-mail: [email protected].

MetroDoctors reserves the right to reject anyarticle or advertising copy not in accordance witheditorial policy.

Non-members may subscribe to MetroDoctors at acost of $15 per year or $3 per issue, if extra copiesare available.

2Economic Sanctions Affect Health of Iraqi People

4 600 Days — HIPAA Compliance Challenges

6 COLLEAGUE INTERVIEWStuart Lane Arey, M.D.

8 FEATURERace Across America: Team Heart One Year Later

11 Aeromodeling Celebrates All Aspects of Flight

12 Farming “Hobby” Continues to Grow

14 Antartica — This Fragile Environment Remains Relatively Untouched

16 Interest in Model Boat Building Continues

17 Climbing Wyoming’s Devil’s Tower

19 Nepal Provides Unforgettable Experience

20 Apple Trees and Wood Sculptures

21 MN PERSPECTIVEGet Those Shots Before You Go

22 Highlights of the Code of Medical Ethics of the AMA

28 Community Internship — Another Success

RAMSEY MEDICAL SOCIETY

24 President’s Message

25 Resolutions to MMA House of Delegates/Congresswoman Betty McCollum

26 Applicants for Membership/In Memoriam/Don Linder

27 RMS Alliance

HENNEPIN MEDICAL SOCIETY

29 Chair’s Report

30 New Members/In Memoriam

31 Hoban Scholars/Shotwell Awards

32 HMS Alliance

On the cover: This issue focuses onadventurous travel and hobbies.Pictured is William Goodall, M.D.enjoying his flock. Articles begin onpage 8.

MetroDoctorsDoctors

PHYSICIAN’S SOAP BO X

T H E J O U R N A L O F T H E H E N N E P I N A N D R A M S E Y M E D I C A L S O C I E T I E S

2 July/August 2001 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

Economic Sanctions AffectHealth of Iraqi People

I

B Y E U G E N E C . O T T , M . D .

IN 1997 LEON EISENBERG, in an article in theN.E.J.M., concerning the effects of our economicsanctions against Iraq, stated, “Economic sanctionsare, at their core, a war against public health. Ourprofessional ethic demands the defense of publichealth. Thus, as physicians, we have a moral impera-tive to call for the end of sanctions.”

Through reading and listening, I becameincreasingly aware of many public health issues inIraq. Being reported, as direct outcomes of thesesanctions, was malnutrition, increasing infantmortality, outbreaks of preventable diseases, and lackof clean water. This was occurring in spite of a U.N.Oil for Food program that had been implemented toprovide humanitarian aid.

In January 2000 my wife, Mary Lou, and I left for New York tojoin a delegation traveling to Iraq to bring medicines to the people andgive us the opportunity to see for ourselves how the economic sanctionswere inflicting the Iraqi people.

Our trip was arranged by the Iraqi Sanctions Challenge and led byRamsey Clark, the former U.S. Attorney General. After a day oforientation, we flew to Amman Jordan. There, we met members of ourdelegation from other countries, boarded buses, and along with a truckload of medicines and supplies, began the long 20 hour ride toBaghdad. After being greeted by our hosts, The Association of Friend-ship, Peace and Solidarity, we left for our first site visit, a painfulintroduction to the reality of this war. Al Ameriyah, a neighborhoodrecreation building turned Bomb Shelter, was targeted by our “smart”bombs and in a matter of seconds 1,200 people died in the building.Only 14 escaped alive. A woman, who lost her husband and all seven ofher children, lives just outside the building. She gives tours to visitorslike ourselves, taking us through the experience of that terrifying night.

The next morning we visited the Saddam Center for Children.There, physicians and staff met us for a tour of the outpatient clinicsand hospital wards. The clinics were lined with beds occupied bychildren accompanied by mothers and grandmothers. The childrenwere malnourished, suffering from diarrhea, fever, and upper respiratory

infections. Supplies were limited: IV fluids, antibiotics, syringes allinadequate. The doctors talked of how lack of medicines and equip-ment makes adequately treating diseases like dehydration, pneumoniaetc. impossible and causes the death of many children. Leukemia, atreatable disease in the U.S., has 100 percent mortality. Surgicalprocedures are scheduled but frequently cancelled at the last minute dueto being notified of a lack of expected supplies, medicines, or equip-ment. This is a teaching hospital, yet journals and textbooks are notavailable now because of the sanctions. The same is true for medicalinformation via the computer. The only way I could describe thehospital environment is, everything we take for granted in a hospitalsetting, is not readily available, starting with a switch to turn on thelights.

Following our visit to the hospital, we met Dr. Omeed Medhet,the Minister of Health. It was my pleasure to give him 12 c.d.’scontaining updated medical information that had been donated by theFamily Medical Clinic at HCMC. Dr. Medhet gave us an overview ofhow health status indicators have deteriorated over the 10 years sincesanctions had been imposed. Under age five mortality has doubled from50 to 131 deaths per 1,000 live births, and infant mortality from 47 to108 deaths per 1,000 live births. Twenty-five percent of children underage five suffer from chronic malnutrition. When these findings arecontrasted with what had been accomplished in the 10 to 15 yearspreceding the Gulf War, it is estimated that over 500,000 Iraqi childrenhave died because of the sanctions. UNICEF describes these statistics asa “Humanitarian Emergency.”

Dr. Eugene Ott (center) meets with university students in Baghdad.

P H Y S I C I A N ' S S O A P B O X


Our day ended with a tour of Babylon and the Hanging Gardens.This historic site dates back to 6000 BC and our guide, an archeologist,provided us a most informative tour.

The next day we visited the university in Baghdad and met withstudents who were friendly and eager to talk with us, and were askingwhy we came. When we asked about their concerns and hopes theyspoke of a lack of books, materials, computer equipment, as well asnews and information of the outside world. We had similar experienceseverywhere we visited. Labor unions, food distribution centers, a centerfor special needs children, a water treatment plant, clinics, and themarkets. The people were very receptive and directed no anger orhostility toward us personally.

On our last day we traveled to the northern town of Mosel andsaw the Temple of Jonah in Ninevah. We met with the town counciland visited a school that had recently been damaged when a missile, oneof ours, landed near them—a direct consequence of our “No Fly Zone”policy. The school was lacking adequate chairs and desks as well assupplies such as pencils, papers, books, and chalk; all blocked by thesanctions since they are called “non-essential.” The children were eagerto talk with us and had many questions. One young girl, who had beeninjured in the bombing, asked me, “Why are you bombing us?” I didn’thave an answer for her.

On our trip home, the delegation spent time sharing thoughtsabout what might be done to help the people of Iraq. Our first objectivewas to tell others what we saw and experienced. I’ve had the opportu-nity to give presentations to many groups including one at the “GlobalHealth Forum 2000.” As part of these presentations I noted the ACP

Position Paper, Annals of Int. Med., 18 Jan. 2000, K. Morin, LLM, andS.H. Miles MD. The College supports the following:1. Exclude from sanctions humanitarian goods, such as food- and

health- related materials or medical supplies, that are deemed likelyto reduce the morbidity or mortality of civilians;

2. Empowering qualified and neutral agencies to allow humanitarianneeds for exemptions, to conduct and disseminate analyses of thehealth effects and to monitor and report this on an ongoing basis;

3. Provide medical and health-related supplies and services to offsetany increased morbidity caused by sanctions; and

4. Monitor and report the effective delivery of medical and health-related materials. ✦

A memorial to those who died in the Bomb Shelter Al Ameriyah.


I

600 Days —HIPAA Compliance Challenges

B Y T I M O T H Y F. S I G N O R E L L I

“I AM TIRED OF THE insurance games. Ouroffice is inundated with paper work, and I barelyhave time to see all of my patients. I haven’t hadtime to think about it,” sighs the exasperatedphysician. “We are struggling with obtainingand retaining sufficient staffing and dealing withreimbursement challenges and rising costs.When do I have time to read, let alone under-stand and do anything about it?” protests themedical group administrator.

What “It” are they referring to? The HealthInsurance Portability and Accountability Act,now known as HIPAA, replete with its mindnumbing plethora of acronyms such as PHI,AS, CE, ANSIx12, EDI, NRI, NPS.

Numerous journals, publications and pro-fessional association newsletters have publishedarticles over the last few months regardingHIPAA. Some include hyperbolic descriptions(such as comparing it to the Y2K bug, which ofcourse, at times evoked a bit of hyperbole aswell) while others focus on the anesthetizingtechnicalities of the final rules. With this focusof attention, are the medical groups in our com-munity at an appropriate stage of readiness forcompliance? Are physicians aware of and avidlypursuing the various requirements and compli-ance issues raised by the new rules?

These are some of the questions posed to anumber of Twin City medical groups, all ofwhich have sophisticated management infra-structure and leadership. Before getting into howsome medical groups view HIPAA, let’s reviewsome basics.

The Basics of HIPAAThe Health Insurance Portability and Ac-

countability Act was passed and signed into law

in 1997. While the essence of this legislationfocused on lowering the uninsured populationby providing employees the opportunity to re-tain health insurance when leaving employment,another part of the legislation focused on ad-ministrative simplification and privacy. The ini-tial focus (portability) has already beenincorporated throughout the economy, while thelatter focus on administrative simplification andprivacy, awaited a rule-making process that wascompleted this year. And with that rule-mak-ing process complete, the clock begins tickingfor implementation compliance.

HIPAA includes provision for patient pri-vacy, security, medical records, electronic trans-actions and unique identifiers for every healthplan, employer and (eventually) individual.

The entities covered by the rules are healthplans, health care clearinghouses, and thosehealth care providers who conduct certain fi-nancial and administrative transactions elec-tronically. Information protected and coveredby the final regulation includes all medicalrecords and other individually identifiable healthinformation held or disclosed by a covered en-tity in any form, whether communicated elec-tronically, on paper, or orally.

The date for compliance is April 14, 2003.Simply put, by this date, every health care de-livery facility in the nation will need to followone procedure for the electronic transfer of cer-tain specific administrative and financial healthcare records. Highly punitive measures (fines andjail time) are put in place for non-compliancewith these rules.

In addition, other administrative steps arespecified such as physician practices must des-ignate a privacy official responsible for develop-ing and implementing privacy policies andprocedures and designate a contact person to re-ceive complaints about the organization’s privacy

practices. All members of the workforce mustbe trained on privacy policies and procedures.The practice must institute administrative, tech-nical and physical safeguards to protect againstuse or disclosure of PHI in violation of theregulations and apply appropriate sanctions forfailure to comply with privacy policies or regu-lations.1

So how does medical group leadership ap-proach compliance in light of the challenge ofday-to-day concerns? Most medical groups sur-veyed are still in the early stages with 82 percentindicating they have obtained the regulations,reviewed them and begun discussing how to ad-dress. However, 94 percent rank issues such aspayor contracting and reimbursement, opera-tions performance and staffing, budget and fi-nancial controls as a more immediate and higherpriority than HIPAA compliance.

This is very understandable. The rules arecomplex and extensive. To address the compli-ance requirements adequately (upgrading sys-tems, modifying and documenting policies,training staff ) involves spending time andmoney — both of which are under pressure withthe existing payor reimbursement challenges andrising operating costs. Finally, 20 months tillApril 2003 can seem like a long time whenviewed in the context of more immediate con-cerns of meeting patient demand, staffing ad-equately and trying to maximize reimbursementand collections.

In light of this, what approach can a medi-cal group use to move more earnestly in bringingthe delivery system into compliance? One placeto start is the mindset used in moving forward.Most view it as onerous, and to be sure, there is alot of rethinking of how the clinic operates thatis required in order to comply sufficiently so asto protect the organization from liability. How-ever, another view focuses on the opportunities


that are imbedded in the compliance process.One of the more onerous aspects of medi-

cal group practice is complying with differingsets of rules, requirements and procedures forpayment by fiscal intermediaries for care deliv-ered to patients. HIPAA, for the first time, putsus at the point of standardizing and simplifyingthese transactions. HHS estimates the savingsfrom administrative simplification and standard-ization at 29.9 billion dollars. HHS also projects17.6 billion dollars in costs relative to the pri-vacy compliance for a net savings of $12.3 bil-lion.2

But even beyond the administrative oppor-tunity is the physician-patient relationship. Phy-sicians have a special covenant with theirpatients. In order for an effective physician-pa-tient relationship, there must be a bond of trustrooted in patient confidence. Confidence bothin the physicians’ expertise and belief that theinformation I (the patient) give will be used tohelp me, will remain private and held in thestrictest confidence. Most physicians feel pas-sionate about the sanctity of that trust relation-ship (witness the umbrage at managed careincursions which are perceived as intruding onthat relationship). The public has demonstrated,through recent polls, that privacy is of higherconcern than crime, taxes, gun control, theeconomy, or global warming.3 While the eco-nomic and efficiency gains on the administra-tive simplification are real and should bemotivators for groups to ready themselves, pri-vacy has the highest level of attention and ex-posure for medical groups. Tommy G.Thompson, Secretary, Department of Healthand Human Services made the following com-ments regarding the patient privacy rule on April12, 2001:

“President Bush wants strong patient pri-vacy protections put in place now. Therefore wewill immediately begin the process of imple-menting the patient privacy rule that will givepatients greater access to their own medicalrecords and more control over how their per-sonal information is used. We have laws in thiscountry to protect the personal informationcontained in bank, credit card and other finan-cial records. Our citizens must not wait anylonger for protection of the most personal of allinformation — their health records…we aregiving patients peace of mind in knowing thattheir medical records are indeed confidential and

their privacy is not vulnerable to intrusion.”However, in the press of organizational re-

quirements to get the job done, some of the sys-tems and procedures designed to support andaugment the care process may inadvertentlycompromise that ideal. HIPAA provides a mo-tivating rationale to work at greater constancybetween clinic systems policies and proceduresand the ideal.

Approaching ComplianceMany of the medical groups surveyed rec-

ognize these opportunities and this is where theapproach begins. After establishing a positivemindset by focusing on the opportunities, hereis a suggested template to achieving benefitsfrom compliance.

First, Prepare by doing the following:• Obtain regulations and read;• Obtain recent articles;• Put together a HIPAA resource book for

the practice;• Raise awareness among physicians and

administrative leadership;• Put together a project team consisting of

at least one physician and key operationspersonnel; and

• Ask the project team to provide a plan iden-tifying all compliance actions needed.Next, the project team should conduct pre-

liminary assessment and design a conformanceplan that includes information on what actionsare needed, who will take actions, by when, andthe resources required.

The assessment begins with a current situ-ation analysis that documents and assesses cur-rent practices, processes and flow, and currentIT standards. Then, the project team describesa future desired state for the organization thatincludes defining HIPAA compliant practicesand processes and IT standards.

The project team is then ready to look forvariances (gap analysis) and plan improvement,which will include:

• Identify where gaps exist and what needsto change in order to achieve the futuredesired state;

• Develop measures for key conformancevariables;

• Develop budget for implementation/im-provement including training and devel-opment activities;

• Assign resources; and

• Sign off on communications within practice.With this foundation, the practice is now

ready to begin making the changes necessary tomeet the compliance challenges. As the projectteam implements changes, measures will needto be monitored and evaluated in order to ad-just as necessary for workable solutions.

With the plethora of public informationavailable, coupled with attentive, diligent andtimely design and implementation of a compli-ance plan, medical groups should be able to con-form to HIPAA standards on health datatransmission and privacy with existing resourcesand capabilities.

If additional assistance is needed, medicalgroups might look to logical business partnerswith whom clinic compliance might be a sharedgoal. For example, the professional liability com-pany the physician uses may have resources avail-able to making sure client risk is low. Forexample, in this community, MMIC has out-standing legal and regulatory resources wellversed on HIPAA and may be a source of help.Professional associations such as the MinnesotaMedical Association, AMA and the various spe-cialty associations are a resource. The Minne-sota Health Data Institute is an excellent sourceof information on HIPAA compliance, espe-cially with respect to data and administrativesimplification. Other potential partners wherecompliance is a shared goal are the health plansand information system vendors.

Obviously, should a medical group needto acquire outside expertise and advice, thereare excellent consulting, management, law, andaccounting firms in this community that willreadily fill that need.

Regardless of how physicians choose toproceed, the time is now to put plans into mo-tion, to avert significant vulnerability 600 daysfrom now. ✦

1. Lincoln JD, Elizabeth S.: HIPAA Minnesota Physician Feb-ruary 20012. Department of Health and Human Services: Protectingthe Privacy of Patients’ Health Information 4/23/01

3. Ingenix: HIPAA and Security 2001

Timothy F. Signorelli is President of METRIAManagement LLC, which is dedicated to provid-ing leadership, enterprise, and market alignmentsolutions to medical and health care organiza-tions.


AQ

Stuart Lane Arey, M.D.Editor’s Note: “Colleague Interview” provides HMS and RMS mem-bers with an opportunity to ask questions of their colleagues who are inunique roles. In this issue, interview questions were asked by Drs. PaulBowlin, Peggy Craig, E. Duane Engstrom, A. Stuart Hanson, and JamesC. Mankey.

Stuart Lane Arey was born in 1908, graduated from the Universityof Minnesota Medical School in 1932, and completed internships atMinneapolis General Hospital and Children’s Memorial Hospital, Chi-cago, Illinois. Dr. Arey assumed the medical practice of his father in1934 following his untimely death. Nine years later, Dr. Arey opened apediatrics clinic in Minneapolis with Drs. F. C. Rodda, E. F. Robb andR. L. Wilder.

In addition to his outstanding career as a pediatrician, Dr. Areywas the recipient of the Harold Diehl Award of the Minnesota MedicalAssociation, the Gold Headed Cane Award from the Department ofPediatrics, University of Minnesota, and received a Citation from theCity of Minneapolis for Community Service in 1984. In addition, he isthe founder of the Hennepin Medical Society Senior Physician Associa-tion and served as its first president.

This issue of MetroDoctors is featuring physicians who have en-joyed adventurous travel and/or unique hobbies. Dr. Arey was chosen asour Colleague Interview because of his stellar career and uniqueness asan individual. He continues to actively enjoy life and all it has to offer,noting he “retired” from winter skiing just this year.

What led you to contribute so much of your time to teachingother physicians while you were in active practice?

Basically, it goes back to the last letter that I had from my hero, Dr. JosephBrennamen. He said, “I would recommend that you spend time out ofyour practice in teaching and continue that even though it might be at theexpense of some of your income. You will thereby be able to keep up withthings; you cannot fool the young students.” I have continued to do thatand really it’s anointed in self-interest. The people I’ve tried to teach havetaught me so much, have kept me current, and have kept me in contactwith young people.

What has been your incentive or underlying values that mo-tivated you to give so much of your time to volunteer activi-ties in our community?

First of all, the example of my father who managed to do volunteer workin the midst of a very demanding private practice. He took care of the BoyScout’s, did the physical exams at the Boy Scout Camp and things like

that. Also, the things I learned in church. It was part of a guilt complex. Irealized that I had been blessed with many advantages simply by the acci-dent of my birth and a loving family who gave me a good education,home, and opportunities. I want to repay some of it.

What advice could you give to physicians at or near retire-ment age to assist them in planning for retirement years fullof enjoyment, intellectual stimulation, and fulfillment?

There is no one route that’s perfect, so the first advice I would have is to beyourself. Keep yourself involved in organizations that will keep you activesuch as the YMCA, Meals on Wheels, garden clubs, book clubs, and soforth. There are many of them. You have to cultivate new friends withvaried interests. One of my favorite mottos came from Lazarus Long, hesaid: everything in excess, to enjoy the flavor of life take big bites, modera-tion is for monks, especiallization for insects. I had a talk I gave on “It’sbetter after 60,” and I had eight “Be- attitudes” if you will, and these arethe advice I can give people: Be yourself; Be lucky; Be challenged; Beventuresome; Be helpful; Be curious; Believe; and Beyond…look forwardto something each day. Perhaps the most succinct advice I ever got wasfrom one of my friends when I was about to retire, and he said “for heav-ens sakes, when you retire, don’t let your day revolve around getting yourhaircut.”

Do you think that we should provide health insurance for allchildren (0-18yrs) in our society? If so, how should we dothis?

Yes I do, but I’m not wise enough to have a great idea. I think that every-one should be covered and it should be paid depending on people’s in-

C O L L E A G U E I N T E R V I E W


come. That is, the lower income should pay nothing, the higher incomeswould have to pay larger and larger co-payments. How you’re going tofinance this, I don’t know. Could we get the lottery or some such moneyas that? I don’t know how we can do it.

Tell us your experiences in piloting airplanes and what moti-vated you to seek a pilot’s license.

I took up flying because at the climax of a bad round of golf when I fourputted four greens, I quit the game of golf in frustration and went to takeflying lessons. Actually, I had been enamored with aviation since my firstflight in an OX5 powered Curtis flying boat in the early 20s. When Istarted flying my children were through college and I figured it wasn’t afoolish risk. I loved flying. The two places on earth where you are nearestGod — one is on a pair of skis by yourself, and the second is a littleairplane boring holes in the sky all by yourself. One of the great thrills waslanding at the old Kansas City airport when they held a DC4 until my172 was cleared to land. I once flew to Jackson Hole for a meeting; com-ing in over the Tetons and looking down on the Snake River was thrilling.Flying became too expensive, so I quit after 300 hours. Incidentally, Ididn’t quit golf permanently.

We would like to know when bow ties entered the pediatricspecialists uniform of the day?

I wear a bow tie because my father always wore one. In looking at the oldpictures, I don’t think bow ties were as popular in the 30s and 40s as theyare now on most pediatricians.

Do you have any suggestions as to how to unravel the ThirdParty intrusion into the patient/doctor relationship?

Again, I don’t have the wisdom of Solomon, but, I think that you have torealize that there can be no medical care unless there are doctors, and thedoctors have to show their authority and stand up to the HMOs and thepeople from the insurance companies, and make sure that the patient/doctor relationship is taken care of — that we are physicians and nothealth care providers.

What do you consider your greatest gift to future generationsof physicians?

I don’t think that I made any huge gift to future generations of physicians;however, if one of the young men I tried to teach someday thinks, “wellthis is how Lane Arey did it,” or “I remember what Lane Arey said,” thenI think I have been a success.

What was the greatest difficulty in maintaining a successfulpractice?

I think my interpersonal relationship with parents. Unfortunately, I wasn’talways the greatest in interpersonal relationships. It got better as I got

older, and I learned better how to handle people. I was always able to getalong with children, but sometimes I was gruff and had the reputation ofbeing difficult. However, I am proud of the fact that most of my patientsstill think the world of me. I wasn’t perfect, but I hoped that I did a goodjob with them.

Is there a “life after medicine” and how did (do) you live it?

Definitely there is a life after medicine. I’ve been busy. I’ve been on lots ofcommittees. I’ve continued to be active in organizations in my church,the Rotary Club, Minnesota Medical Foundation, and I’ve made a lot ofyoung friends outside of medicine. I’ve enjoyed playing a lot of golf, andI’ve skied a lot. But you cannot have your life rotate just around golf — itgets boring.

What is your next career going to be?

I hope to learn more about my computer.

Do you think today’s children are any different than 40 or50 years ago?

No, I don’t think the children are a bit different, but the environmentthey live in is very much different and the temptations that they are facedwith are very different than 50 years ago.

How do you feel about the influence of the media on child-hood development?

I think there is nothing wrong with the media; it’s the content of themedia. There are some wonderful television programs for children; how-ever, they are faced with some poor role models in many of the televisionprograms. I think the greatest problem is that the children spend too manyhours passively watching the television when they should be out playingball or doing some other activities.

What opportunities have you found for volunteer medicalwork for emeritus physicians?

Actually, I did very little because when I retired there was no malpracticeinsurance coverage, so I didn’t do any volunteering. However, I have con-tinued to do programs where I talk to lay groups about advances in medi-cine, and about problems with medicine, etc. I think that has been mygreatest chance to do volunteer medical work. ✦


F E A T U R E S T O R Y

I

R a c e A c ro s s A m e r i c a

Race Across America (RAAM) 2000:

Team Heart One Year Later

B Y D A N I E L H . D U N N , M . D .

IT IS JUNE 21, 2000, two o’clock in the afternoon on a bright,sunny day in Portland, Oregon. Four aging 50-year old Minnesotaphysicians straddle their LeMond bicycles, ready for the greatest physi-cal challenge of their lives. The starting official lines up the five teamsand begins the countdown. Ten, nine, eight – “Phil, can you believeit? We’re really here!” Eight months of training, dieting, trying tostay in the good graces of our wives, and fundraising, seems trivial towhat is ahead of us for the next seven days. Seven, six, five – “Can wemake it? Will anyone get hurt?” Four, three, two – “Nervous, Dan?You’ve got to stay with these guys by yourself for the first 15 miles.”Bob said, “Yeah, but they’re going through town, so I think I canhang on.” One – Team Heart is off on the Race Across America, athree thousand mile, non-stop race from Portland, Oregon toPensacola, Florida. As luck would have it, we’re not the only over50-year-old four man team in the race. Team Alaska is a team offinely tuned endurance athletes who have all competed previously

in significant long distance events. We think they’re over trained. Team Heart has to finishwithin 24 hours of the winning team in our division or we will not get an official time for therace. This is a real race!

In November 1999, eight short months before the race, we decided to throw our hats intothe ring. Phil Murray, Bob Mackie, Tom Pettus and I (Dan Dunn) had been biking together forabout 10 years. We had done some long distance rides, but nothing approaching the RaceAcross America. We recruited Dan Zeman, an exercise physiologist who had experience helpingtrain Greg LeMond during the years he competed in the Tour de France. Dan customized ourexercise programs. Without his help we couldn’t have made it over Mt. Hood. Shortly after westarted training, I sustained a lumbar disc and developed a foot drop that lasted six weeks. Philhad had chronic atrial fibrillation, and an oblation procedure performed two years before andhe was having some problems with arrhythmias, but it didn’t seem to affect his training. Bobwas nursing a chronic back problem, but he never seemed to complain. Tom, being the young-est at just 50, clearly had youth on his side.

We needed a sponsor and we wanted a cause. Four average 50-year old physicians peddlingtheir bikes across the country—there has to be a message! Exercise is important—Age shouldn’tkeep you from exercising. The Minneapolis Health Institute Foundation agreed that this was animportant message. Team Heart was born!

The logistics of the race were formidable. Tom, an Abbott-Northwestern Hospital inter-

Team Heart at the starting line. Fromleft: Drs. Dan Dunn, Phil Murray, BobMackie, and Tom Pettus.


nist, was in charge of transportation. He decided we needed four vehicles. Two vans were usedas chase vehicles to follow the riders at all times as we leap-frogged across the country. TwoWinnebagos were needed for sleeping, eating, showering (oh, sure!), relaxing and socializing forthe 14-crew members, as well as the riders. As it turned out, a fifth vehicle came in handy foremergencies such as taking Meagan, one of our crew, to an ER in Colorado in the middle of thenight when she fell in one of the vans and broke her wrist. Other than a Winnebago breakingdown in Utah and a replacement substituted in Salt Lake City, we had virtually no vehicleproblems.

The race was made possible through the combined efforts of a very committed and enthu-siastic crew numbering 14 at any one time with a four-person exchange in Steamboat Springs.Crew members were largely family and friends of the four riders along with three Abbott-Northwestern physicians appropriately chosen for their specialties. Mark Fallen, urologist andteam physician; Jim Larson, orthopedist, and Frazier Eales, cardiac surgeon, were thankfullythere at critical times.

Bob, a gastroenterologist and a gourmet cook himself, took care of the food. After muchresearch, he concluded that there were as many regimens for food and fluids as there wereteams. We thought we might have an advantage over the other teams, since we were all expertsin human physiology. (Yeah, right!) So, what did we do? We ate everything we could get ourhands on—fried chicken, hamburgers, soups, peanut butter and jelly sandwiches, and tons ofcookies, bananas, and candy bars. Not exactly a scientific approach to the caloric requirementsof long distance bicycling, but it worked, for the most part. Fluids were the same. We each hadour favorites. I drank nothing but XLR-8, a high carbohydrate concoction that is easy to digest.My goal was to urinate before I got on the bike each and every time. Sometimes, that was every20 minutes. We all found out two things—you can’t eat too much and you can’t drink toomuch! Phil, an interventional radiologist andthe only proven long distance athlete, dis-covered that principle and the true mean-ing of the word “Bonk.”

Phil pushed himself too hard, too early,and too long with not enough food or flu-ids. By the second day, he was feeling ter-rible. Phil, at one point, couldn’t get his heartrate below 90 when he was resting or above100 when he was out on the bike. He wasnauseated, so he couldn’t eat, and he had toforce himself to drink. About 60 hours intothe race, Phil was in trouble. Mark Fallen,plugged an IV into Phil and gave him 2 li-ters of Ringer’s lactate. He was rejuvenated—for a while. A Bonk is a Bonk and, unless you’ve been there, it is hard to explain the feeling. Philwas totally depleted of energy. The difficult part of getting past this point is that recovery takesdays or longer. Phil struggled the rest of the race but gave it everything he had and never quit.He was the strongest rider coming into the race and he proved that spirit and determinationsometimes count for more than physical conditioning.

The toughest part of the race was climbing the Rockies. There was over 100,000 feet ofclimbing in the race, 80 percent of which came in the first half. The Tennessee Pass at 10,000-plus feet on the way to Leadville had grades of 7 percent to 10 percent. We climbed this sectionin half-mile stretches. It was all downhill, though, from Leadville. We were very lucky with theweather. The wind was at our backs for the first part of the race, which put us in SteamboatSprings (1,200 miles) in less than three days. The mountain stretch slowed us down some and

Two members of Team Heart prepare tomake the relay switch.

(Continued on page 10)


southern Colorado and New Mexico werepretty hot. Oklahoma has got to be the wid-est and flattest state in the union, other thanTexas. We had a difficult crosswind acrossmost of Oklahoma. After Oklahoma, it waspretty hot and muggy through Arkansas, Mis-sissippi, and Alabama, and our average speedbegan to slow.

We really wanted to finish in Florida onthe 28th of June. Our goal from our earliestplanning sessions was to finish in seven andone-half days. We rode into Pensacola at 15minutes before midnight on June 28—sevendays, nine hours, 45 minutes—14 hours be-hind Team Alaska and good enough to beofficial finishers of the Race Across America.At the award ceremony the next night, TeamHeart received the award for the most inspi-

rational effort of the race. We had made it inone piece, exhausted, seriously sleep deprived,everyone healthy, no serious mishaps, and stillfriends!

It took Phil a couple of weeks to get backto his usual self. I developed a significantmedian nerve palsy in my right hand, whichkept me from some operations for severalweeks. Bob had to have his bicycle seat surgi-cally removed from his derriere. Tom sufferedno ill effects other than the brain damage thatcaused him to decide to do the race all overagain on a two-man team with Ben Popp, ourcrew chief, as an entry in RAAM 2001. Bestof luck to them!

A very important part of this event forTeam Heart was the partnership with the Min-neapolis Heart Institute Foundation andAbbott-Northwestern Hospital. Team Heart’sparticipation in the Race Across America wasa major fund raising effort for the Minneapo-lis Heart Institute Foundation. Ford Bell andhis colleagues at the Minneapolis Heart In-stitute, the Abbott-Northwestern Hospitaland medical staff enthusiastically supportedthis effort. We raised over $120,000 of which$65,000 was donated to the Minnesota De-partment of Health Council on Physical Fit-ness and Sports. This seed money has helpeddevelop a new program—Be Active Minne-sota, which has as its primary goal, to increasepublic awareness of the importance of physi-cal activity in our daily lives. That was themessage of Team Heart.

The Be Active Minnesota Program ismodeled in part on a very successful state-wide program already in place in Michiganand North Carolina. What is unique aboutBe Active Minnesota is that physicians willtake a more active leadership role in promot-ing physical activity.

So what has happened in the year sincewe finished RAAM 2000? People ask us ifwe’re still riding. Yes, but not quite as much(except for Tom). We all remain in the goodgraces of our wives and families. Tom hastrained non-stop since RAAM 2000 to com-pete again this year. Good Luck to Tom andBen! Was it a good experience? Incredible! Willthe rest of us do it again? Never!

So what’s next? Paris-Brest-Paris 2003.Stay tuned! ✦

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Race Across America

(Continued from page 9)


F

Aeromodeling CelebratesAll Aspects of Flight

B Y P A U L G L E I C H , M . D .

FLIGHT HAS ALWAYS fascinated me. As achild I was usually building something that wassupposed to fly. I still build and fly radio con-trolled model airplanes. I recently completed anelectric powered model airplane fashioned afterthe Bleriot XI. The original Bleriot aircraft, withLouis Bleriot at the controls, made the first pow-ered flight from France to England on July 25,1909. This was only six years after the Wrightbrother’s first powered flight on December 17,1903.

Even during the years when I was not ac-tively building model airplanes (career, family,etc.) I kept pace with the hobby. I would peri-odically pay a visit to my favorite hobby shopwhere I could bring myself up-to-date on thelatest kit offerings and modeling trends. Al-though I was usually just looking, the visits werealways satisfying. I also maintained my mem-bership in the Academy of Model Aeronautics(AMA). This non-profit organization promotesmodel aviation and is a source of leadershipwithin the modeling community. Their officialpublication, Model Aviation, is an elegantmonthly tour of the hobby.

Model aviation encompasses an incrediblevariety of enthusiasms. There are models thatreplicate, in stunning detail, full-scale aircraft.Other models are unique miniature aircraft de-signed just for the pleasure of flying. The mod-els are powered by everything from a vigoroustoss into the air (hand launched gliders) to kero-sene fueled jet turbine engines. Made out of ev-erything from cardboard to carbon fiber, thesemodels all have one thing in common: they fly.

I was drawn back to building airplanes bymy fascination with electric powered flight. Al-though electric powered flight remains challeng-

ing (heavy batteries and abbreviated flighttimes) it is a practical method of propul-sion and a rapidly expanding part of thehobby. Virtually any type of airplane,even jets, can be powered with an elec-tric motor. The jets are propelled by thethrust of a powerful electric turbine fan.In addition to being practical, electricpowered flight can be fairly quiet. I’m ableto fly my electric airplane in the calm airof early morning without denying anyone theirsleep. Electric power also lends itself to the rep-lication of historic aircraft. Fragile aircraft, fromthe beginning of aviation history, adapt well tothe minimal vibration and exhaust-free powerof electric motors. The electric motors can evenbe concealed within a replica of the originalaircraft’s engine.

Building and flying model airplanes has be-come a much more accessible hobby in the lastfew years. Radio control airplanes range in sizefrom several ounces to a maximum permissibletakeoff weight (AMA safety code) of 55 pounds.Reliable radio control systems are available forairplanes of all sizes. The large airplanes needpowerful servo motors to convey the pilot’stransmitted control signals to the airplane’s flightcontrol surfaces. These servos weigh five to sixounces and deliver 10 or more pounds of torque.Small airplanes, weighing as little as a fewounces, use servos weighing only several grams.These tiny servos are still able to deliver severalounces of torque. There is a similar spectrum ofpropulsion systems. Piston engine displacementranges from three cubic mm to 10 cubic inches.Electric motors propel airplanes ranging in sizefrom four ounce miniatures to 1/4 scale (1/4the size of the original) giants. Turbine jets(turbo-props are on the way) produce manypounds of thrust to propel some very impres-sive looking jets.

There are many varieties of model airplanesavailable. Classic airplanes, both civilian andmilitary, are the most common modeling sub-jects but virtually any airplane ever built is avail-able either as a kit or a plan. An increasinglylarge selection of model airplane kits require onlya modicum of assembly before the airplane isready to fly. These are known as “almost readyto fly” (ARF) models. Other kits demand a sub-stantial commitment of time and effort. If anairplane is not available in kit form, a set of con-struction drawings may be available. This di-versity of available models strengthens thehobby. There is something for everyone.

Aeromodeling is a fascinating hobby thatcelebrates all aspects of flight from gliders to space-craft. The models are capable of bringing bothjoy and wonder to anyone who has an opportu-nity to see them fly. Visit the model flying fieldof a local aeromodeling club and see them in ac-tion. The AMA web site www.modelaircraft.orgprovides a list of links to AMA chartered flyingclubs. These club web sites usually provide di-rections and even maps to their flying fields. Ahobby shop is also an excellent resource for di-rections to local clubs. While you’re in the hobbyshop take a look around. You might see some-thing that interests you. ✦


I

Farming “Hobby”Continues to Grow

INITIALLY I WAS MILDLY AMUSED andperhaps flattered by the request to write aboutmy hobbies, but as I began thinking about these“hobbies,” it became clearer to me just how im-portant and valuable they are to my family andto me.

Our hobbies include small time farming –sheep, chickens, bees, and more recently, thebeginnings of a tree farm – and last but not least,woodworking.

My wife, Eleanor, and I are city-bred andother than building projects and maintenanceat summer cottages as adolescents, we had noagricultural experience. Our interest began, Ithink, when we moved to rural North Dakotato begin my medical practice. We both grew upin Winnipeg, Manitoba and upon completingmy training, in search of warmer weather, weimmigrated to North Dakota. We didn’t findwarmer weather, but we did find ourselves inan agricultural community. We raised our fam-ily in this environment and that led to horses, afew livestock, and bees!

By the time we moved to the Twin Citiesarea 12 years ago, we decided that we wanted tolive in a rural area and focus on one home, ratherthan living in the city and heading for “the lake”on weekends. The result was that we boughtapproximately 100 acres of land just north ofAnoka.

Over the past decade this has evolved intoa farming project that now includes a flock ofaround 40 Columbia sheep, 11 beehives, whichyield over 800 pounds of honey a year, a smallpoultry operation, outbuildings, farm equip-ment, and my pride and joy, a state of the artwoodworking shop.

Running this operation requires most ofour free time and a lot of hard work – but the

rewards for us are enormous! We havethree daughters, all with families, andto date, a total of six grandchildren. Toour delight, they have all become in-volved in our project, one way or an-other. Three years ago, our eldestdaughter and son-in-law purchased additionalland adjacent to ours, built a home and movedto the “farm.” We now jointly own approxi-mately 130 acres and have really begun to movethe operation forward! Let me walk you througha year of our “hobby” as it stands today.

SpringSpring is a particularly busy time for us. Earlyin March the sheep need to be sheared, wormedand have their hooves trimmed. The actualshearing takes about five minutes per sheep –but it takes a few days to set up pens and pre-pare a shearing floor. The whole family partici-pates in this event – some of us herding, sometrimming the fleece, and some trimming thehooves. We hire a shearer who makes the joblook easy. On our farm, the shearer is a womanwho weighs about 115 pounds and handles 150pound ewes as if they were weightless: great funto watch!

Next come the bees: the hives that win-tered are fed sugar water and new colonies arehived. All the bees are treated with antibioticsbecause of common problems with mites, bac-teria, and fungi. My grandchildren are alwaysinterested in whether I got stung and how manytimes – usually only a few.

By the end of March we’re lambing; thecatch this year was 20 lambs including one setof triplets. We pen the ewes and their lambs inseparate stalls or jugs for the first few days sothat they bond and we can be sure that themother is nursing her lambs. This is the timewhen we ear tag the lambs, dock the tails andcastrate the males. Again, everyone helps and

my grandchildren protest loudly on behalf ofthe lambs.

In mid-March we receive 115 day-oldchicks and turkeys, 100 for broilers and 15 foregg production. They initially reside in broodchambers to keep them warm. The broilers areready for market in 12 weeks and turkeys arekept until fall.

This year on May 9, our golden retriever,Dulce, delivered a litter of 11 pups who are quitespectacular. All of the family were up by 6:00a.m. to watch and occasionally help her withdelivery – one breech and one pup which re-quired resuscitation; all now doing well. Eleanorand I removed their dewclaws on the third daywith the help of our 8-year-old grandson.

Finally, we have all been busy planting andwatering trees. We are starting a tree nurseryand this year planted approximately 400 birch,linden, maple and dogwood.

SummerThe pace slows a little during the summermonths, but there’s still much to do. Livestocklargely look after themselves, but need to bechecked daily to make sure they have adequatewater and pasture. The beehives are examinedon alternate weeks and supers are added as nec-essary for honey production. The new trees allneed regular irrigation; we are currently install-ing another well, trying to automate this work.

This year we are building a new poultrybarn that will allow us to increase productionand will reduce manual labor. We have finishedthe rough-in and are now working on plumb-ing and electrical supply; the project should beB Y W I L L I A M M . G O O D A L L , M.D.


finished by mid-summer. If there is any sparetime we will spend it on fencing and increasingthe length of our woodland walking trails.

FallHarvest time! This year we will extract about1,000 pounds of honey. All our children andgrandchildren will be home for this process – avery busy and sticky event, but one we all like.Eleanor sells much of the honey in bulk form,but saves some for family and charitable events.

The poultry need to be processed and wehave this done in Little Falls. Sobanias Poultrytakes the birds and returns them to us cleaned,shrink-wrapped and ready for the freezer. Wesell some of these free-range birds and the fam-ily uses the rest.

In late fall the lambs are butchered andsold. We process and tan the hides; we salt thehides and dry them on racks – when completelydry we send them to a tanner and then sell thesheepskins. We also send the sheared spring woolto a small mill in Wisconsin where it is washed,carded and spun. We all have “Irish” sweatersfrom our own wool.

Finally, in November, we turn the ram inwith the ewes and the cycle starts again. Thegestation period for sheep is 150 days, so wewill be lambing again in March/April.

WinterWith the exception of feeding stock, the out-door work is done. This is the time of year whenwe repair equipment and my son-in-law and Ispend a good deal of our time in the woodwork-ing shop. We have been buying and seasoningcherry, walnut, and maple hardwoods and arenow building furniture. Our projects have in-cluded bedroom and dining room suites as wellas various tables, chairs and assorted furniturethat Eleanor and my daughters want built. Oflate, I am pleased to report, my grandchildrenare beginning to build things with me in the shop.

Having written this description, I’m not sureif what we’re doing qualifies as a “hobby” or not,but I do know that it provides Eleanor and mewith a great sense of satisfaction. It also allowsboth of us to unwind from the sometimes stress-ful business of emergency medicine and admin-istrative responsibilities. I also know that work-ing with the animals and in the shop is a won-derful experience for my children and grand-children and brings us all closer together. ✦


G

Antartica–This Fragile Environment Remains Relatively Untouched

The ice was here, the ice was there,The ice was all around:It cracked and growled and roared and howled,Like noises in a swound!

Coleridge

GOING TO ANTARCTICA brings to mindvisions of great heroes, fighting against an ex-otic, intolerably cold, windswept and frozenwasteland, deserted by all except a few braveexplorers. The continent, however, is not onlythe cold icy spot of our stories, but at its fringesis a place of great beauty, seasonally full of mys-terious and fascinating animal species. Exceptfor a few research stations, it remains unpopulatedand, until recently, unvisited.

About 25 years ago, the pioneer tour group,led by Sven Lindblad and his small tour ship“Polaris,” began tours to the area. Since then,the fascination and beauty of the Antarctic havecontinued to attract us, and currently, a dozenor so tour groups have ships visiting and enjoy-ing the area during the brief Austral summer,generally from mid-November to mid-March.

Part of the mystery of the area is its re-moteness. On the Pacific side, the Antarcticcontinent lies about two thousand miles fromNew Zealand, the nearest land. South of Chiliand Argentina, however, the Antarctic Penin-sula, really a southern extension of the Andeschain, provides continental seashore available toships only a couple of days sail from civilizationaccessible by air. Most tours fly to either the tipof Patagonia and take a ship from there, or flyto Chili and thence to the Falkland Islands tostart their voyage. Several stops along the wayare valuable—South Georgia Island has enor-mous mountains close to the sea, fascinating bird

nesting, with pen-guins, huge albatross,and a slew of others,literally at your feet. Inaddition, South Geor-gia is the place towhich Shackelton ledhis rescue team, andhe is buried there. Hisstory, and the tradi-tional pouring ofbrandy over his grave,add a bit of romantichistory to the tour.The South Orkneys also are great birding sites,but despite our ship’s bulling its way throughpack ice we couldn’t reach them. To get to theAntarctic mainland, ships must cross the Ant-arctic Convergence, a wild circumpolar windand current system that made all of us thankfulfor scopolamine patches and meclizine. We, asdo most groups, went ashore a couple of timesa day, in little rubber “Zodiac” rafts, each carry-ing a dozen or so passengers. Wading ashorefrom these through seawater and ice chunks inrubber boots definitely adds to the ambience ofthe area.

Antarctica is a fragile environment, andvisitors to the area agree to a rigid set of stan-dards limiting their impact on the physical andbiological structure of the sea and shore. Ships,for example, schedule things so that nobody seesanybody else, only small groups go ashore atany one time or place, and nobody leaves any-thing there nor (hopefully) upsets the variouscritters swimming, flying, or living on the shore.Our tour never saw another ship or tourist. Wevisited one 16-person research station that hadn’t

B Y R I C H A R D C . W O E L L N E R , M . D .

seen anybody since the previous March. I don’tknow if they were happier to see us or the freshveggies that we gave them. We always spreadout our shore visits so that no more than one ortwo zodiacs went into any one spot.

The most obvious part of the Antarctic re-gion is, of course, its geography. The extent ofthe glaciers, shoreline cliffs, and towering snow-covered mountains is really indescribable—thewaters are deep and our ship and zodiacs couldeasily wander next to cliffs and glaciers andamong ice chunks, ice floes, and multistoriedicebergs. Some narrow channels among the is-lands pass close under cliffs and glaciers tower-ing high above the masts. We transited theLeMaire channel, one of the more famous, atabout 1:00 a.m., in fairly bright daylight, withhuge cliffs close by either side.

For most of the year, even the AntarcticPeninsula is glaciers, snow rocky cliffs, and ice.As the weather warms (our highs were in themid-30s) and the days lengthen, (20+ hours ofdaylight), the beaches thaw and seagoing birds,seals, and a few hardy plants occupy the shore-lines and nearby valleys. The animals all feedon the extraordinary volume of fish and plank-

Photo by Meg Woellner


ton in the Antarctic waters.Some of the snow leaves thecliffs and rock outcroppings,and sea birds by the thousandsmate and raise their youngnear the feeding grounds, pro-viding both avid birders andoccasional bird watchers, likeme, with great viewing. Fly-ing, nesting, and feeding birdsof all sorts are constantlyaround, and penguin coloniesharboring thousands of birdsabound in the low areas.

Sailing south from the South Georgia Is-lands down the Antarctic peninsula reveals a va-riety of species of penguins in various phases oftheir courting (very noisy), nesting (very acquisi-tive) and chick-raising (very parental). An houror two spent sitting on a cold rock in the snowwatching penguin behavior is time well spent.It’s easy to humanize these entertaining animalsas they strut about. One of my shipmates and Isat on adjoining rocks watching birds squabbleover nest building. We watched one particularlyacquisitive male gather pebbles (and steal somefrom his neighbors) for building his nest. Helooked like a little Warren Buffet in a tuxedo,and ended up with a huge pebble nest and, pre-sumably, a happy mate. My shipmate com-mented that if her daughter were a penguin,that’s the one she’d want her to marry.

Penguins never had land predators, and sowent about their business totally ignoring us ex-cept for an occasional curious stare or, if we didn’tmove, and occasional hopeful peck at our bootsseeking nesting material. We tried to keep 20or 30 feet away from any wildlife, but the natu-rally curious penguins can’t read the rules, andwe avoided them much more than they avoidedus. I have a great memory of my wife peeringthrough one end of a long telephoto lens andfiddling with her camera while a penguinwaddled up and put a curious eye to the otherend. Each species of penguin, as well as indi-vidual within the species, has its own personal-ity—the dignified King penguins, clowningGentoos, and industrious Chinstraps all goabout their business differently, but all raise theiryoung as couples, with evident parental con-cern about their chicks.

The other summer critters filling thebeaches are seals of various breeds, generally

ashore to mate or loudly enjoy each other’s com-pany. The largest, most vocal, and weird werethe elephant seals, named for their huge noses.The males, weighing a thousand or two pounds,rigidly defended their territory and harems withloud honks, sounding like an industrial-sizeddigestive disturbance. As they were surprisinglyfast on land for an animal with no legs, we kepta very respectful distance, often necessitating along detour around their territory through mud,rocks, ice, and snow. Leopard seals mostly stayout on the ice, and are the Antarctic version ofan eating machine, consuming their share ofpenguins and little seals. In our zodiac, we puttedpast one on an ice floe who looked at us hun-grily. I was glad to be away from him, despiteour naturalist’s reassurance that they never atezodiacs and rarely ate humans.

Even with an increase in tourism, the Ant-arctic remains relatively untouched and is a re-warding trip. Most ships going there are small,with less than a hundred or so passengers, andhave several naturalists aboard. We had four, plusthree German-speaking ones, all of whom gavefrequent excellent lectures and were with us inthe zodiacs, ashore, and aboard the ship. Ourtour group sent us an excellent reading list, andvisiting the land of Amundson, Scott, andShackelton was really enhanced by studying be-forehand. (Most of the books were readily avail-able from the county library systems.)

If you plan to go, the ships and groups givegood clothing advice, and ours issued each ofus a big red parka. High rubber boots and mul-tiple layers of clothes are adequate to keep ev-erybody warm, dry, and comfortable. We had agreat time, and I’d love to go again. ✦

Photo by Meg Woellner

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MMY EARLY MODELING attempts consistedprimarily of balsa and tissue paper airplane kits.At that time (pre WW II) the kits that wereavailable were primarily WW I airplanes suchas the Spad, Fokker, Neuport, and Jenny. I re-member that the kits were either a dime or aquarter. The quarter kits had a wingspan ofabout a foot, and were great for flying from theupstairs bedroom window.

My interest in model building waxed and

Interest in Model BoatBuilding Continues

waned through theyears but was alwayspresent. When myown sons were grow-ing up, I revived myinterest in modelingas an activity that wecould do together.Predictably, their interest ran to airplanes. Ra-dio control had improved to the point that itwas very good and added much to the ability tomake realistic scale models. Unfortunately,model airplanes have a tendency to crash, so

my own interest runs to boats that have a longerlife span. I am especially interested in workingboats such as tugboats, as opposed to yacht typemodels.

The pictures are of MISTER DARBY, ascale model of an ocean going tug, which I builtseveral years ago. The Jackson Marine Corp. ofNew Orleans built the original boat for work inthe Indonesian offshore oil fields. I built mymodel from a kit consisting of a fiberglass hull,a few die cut parts, various types and sizes ofwood, and a set of detailed plans. The finishedmodel is four feet long, weighs 65 pounds andis battery powered. It has twin four bladed propsand is capable of about 20 knots (scale). It isalso equipped with a horn and a diesel soundgenerator whose speed is matched to the pro-peller speed. Overall, I spent about a year incompleting the model. We have had the fun ofoperating the boat in several local lakes, includ-ing Lake Minnetonka. It never fails to attractattention. ✦

B Y C H A R L E S W . F R Y E , M . D .


M

Climbing Wyoming’s Devil’s Tower

MY INTEREST IN TECHNICAL rock climb-ing began with a visit to Wyoming’s Devil’sTower in the early 1990s. I visited with myfamily—a quick stop before continuing a cross-country driving trip to Yellowstone. We wereamazed to see teams of climbers scaling thevertical columns that surrounded the 800-footvolcanic remnant. My daughter, Ingrid, and Idecided that we would learn to rock climb andtarget climbing Devil’s Tower as our goal.

It turns out that for about $200 you canfind a guide to virtually drag you to the top ofthe Tower, but we had the dangerous illusionthat we would spend a couple of years learn-ing the technique and climb it ourselves with-out guided assistance. Boy, were we mistaken!

We enrolled in basic climbing lessons thatwinter at Vertical Endeavors, an indoor climb-ing gym in the East Saint Paul warehouse dis-trict. The gym festooned with synthetic rocksscrewed into forty-foot walls to simulate rockface climbing. We usually climbed Saturday af-ternoons when the gym was heavily infestedwith elementary school children on wall-climb-ing birthday parties. It was an ego booster forme to know that I could climb better than 8-year-old children almost all of the time.

We first learned simple belaying and toprope climbing. Top roping uses a single safetyrope that is attached to the climber, runningover two carabiners attached to the ceiling andthen down to the belayer.

We graduated to real rock that summer,learning to set up top ropes at Taylors Fallsfrom the lead instructor at Vertical Endeavors,Pat Mackin. We would buzz out to the SaintCroix early Saturday morning to stake out ourclaim on a route, and usually poop out bynoon.

before the climb. I didn’t sleep well. At 5:00a.m. Pat woke us up and said it looked like a“go” for the climb, weather-wise. I popped twoLomotil. We dressed and slipped on headlampsto help us scramble to the base of the Tower.

We climbed the classic Durrance route,rated a modest 5.7, meaning that an experi-enced 9-year-old Vertical Endeavors birthdaypartier could probably climb with ease if notfor the terror. Fortunately for us, I was the onlymember of our party nearly paralyzed with fear.I kept it to myself as we started the first pitch,“Leaning column.” It was only 80 feet high,nothing worse than typical indoor gym height.

Climbing the next pitch, the “Durrancecrack,” was the hardest thing I have ever done.The pitch is essentially a 72-foot tube open toone side. In retrospect, I think there is an easierway to climb it; I did it by jamming my backto one side, scrunching one arm and leg to theother side, and inching my way up (literally—one-inch at a time). When I finished the pitch,pulling myself over the narrow ledge that be-came the next belay station, I could do littlemore than lie on my back gasping for breath.

The next three pitches, “Cussing crack,Flake crack and Chockstone crack,” were easier,but now we were experiencing some seriousheight exposure. Heights give me the creeps,even now after a few years of climbing. Mydaughter kept offering, “Dad, look down! Isn’tthis cool?” I couldn’t pull my eyes away fromthe rock face—in fact, I pressed my whole teth-ered body against the rock away from the abyss.I marveled that I could ever have consideredtrying this adventure unguided.

The sixth pitch is called the “Jumptraverse.” It is a 6-foot open space between twoledges, with a 400-foot shear drop between.Jumping is not recommended. In fact, a Nor-

By the end of the summer, we were feel-ing pretty strong, so we decided to advanceourselves to lead climbing. Lead climbing iswhen a climber carries the top end of the ropeup the wall as he ascends, clipping into placedprotection such as chocks, carabiners, and camsalong the way. There is an opportunity for se-rious injury in lead climbing if you don’t per-form it properly, so lead climbing privileges atVertical Endeavors are not granted easily. Ittook a number of technique lessons and lotsof practice before we felt comfortable.

Our assault on the Tower finally occurredin summer 1998. We still suffered under thedelusion that we could climb the tower un-guided, but at the last minute we chickenedout and hired Pat to guide us. We drove to theBlack Hills to spend two days warming up withtwo-pitch climbs in the Needles area behindthe Rushmore monument. Finally, we drove ahundred miles to the Tower to camp overnight (Continued on page 18)B Y D A V I D L . S W A N S O N , M . D .


wegian nineteen-year-old tried jumping it theyear before without protection and fell to hisdeath. Pat rigged up a piece of webbing to acarabiner that allowed us to swing like Tarzanacross the void. From that point, the rest wasan uneventful 200-foot scramble around boul-ders to the top. The trip down was an exhila-rating three-pitch rappel.

Ingrid has now gone off to college, so mostof my climbing these days is done at the gymor with strangers that I have met on some otherguided climbing trips, but she and I still thinkof each other as climbing partners. This sum-mer, we are doing Devil’s Tower again, con-centrating on technique. For me, the climb willbe all about the Tau of the moment rather thanthe Outward Bound-like focus to achieve a goaland conquer fear. We will be guided again withPat Mackin, of course.

Photos from our first Devil’s Tower tripand another climb I made near Las Vegas canbe seen on our websites: www.angelfire.com/mn2/ingadingo/ingrid/tower.htm; andwww.angelfire.com/mn2/ingadingo/davidsr/redrock.htm. ✦

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Climbing

(Continued from page 17)


N

Nepal ProvidesUnforgettable Experience

NEPAL IS A COUNTRY LOCATED betweenTibet and India, about 500 miles wide and 150miles in the north-south direction. The north-ern most region, of course, includes the Hima-layan range, which has eight of the 10 highestmountains in the world. The lowest portion ofthe country is more or less jungle with elephants,rhinoceroses, and a dwindling number of tigers.The population is over 18 million. The govern-ment is more or less a Hindu monarchy withdemocratic leanings.

Most of the population is Hindu in reli-gious background, especially in the capitol ofKathmandu, which is an interesting city to visit.The Thamel area, especially, is reminiscent ofthe way the city presented itself to tourists 30or 40 years ago. Narrow, irregular streets, are

B Y J A M E S D . F O L E Y, M . D .

filled with locals selling everything fromdifferent types of grains to exotic carvedmasks and Tibetan rugs to used campingand hiking equipment. The largest stupa,or Buddhist monument, that I have everencountered is in the city of Kathmanduand must not be missed. There is also aHindu hospice for the dying next to theriver at which Ghats are located where therecently dead are placed for their funeralpyres, and from which their ashes are sweptinto the river. If you can handle it, this is amost interesting place to visit and givesyou a greater depth of feeling about theHindu culture.

The best part for me, though, is trek-king or flying up into the foothills of theHimalayas where the Sherpa people live.This is, essentially, a Tibetan populace whoare all Buddhists in philosophy and theyare the most peaceful people I have everencountered. Where most of the Sherpaslive at the 9,000-10,000 foot level, themountainsides are covered with Rhodo-dendron plants and in the spring of the yearthere are seen white, pink and red floweringplants carpeting the slopes. The two favorite di-rections for trekking are west out of Pokharainto the Annapurna and Dhaulagiri mountains,which my friends all say are wonderful destina-tions. My preference, however, is taking a planeflight up to the Khumba region in the east, land-ing at the 9,000-foot village of Lukla. Treks be-gin from there up into the Everest region andmost people spend at least a day or two inNamche Bazaar, which is the capitol of theSherpa territory. Nearby is the famous TibetanBuddhist monastery at Tengboche where I havespent a couple of nights camping and fromwhich I saw Everest on my 50th birthday. I doplan on returning in a few years to hike to a

mountain pass at 18,500 feet, which is muchcloser to Everest, from which the entire southface can be seen.

The best time to trek in Nepal is either inthe spring when the Rhododendrons are out orin the fall after the monsoon season is over inmid to late October up until mid November.In addition, for those of you interested in lessstrenuous but still exotic travel, Tiger Tops insouthern Nepal can deliver a good jungle expe-rience and even an occasional viewing of a tigerin the evening. One last thing, for anyone in-terested in going that far I would recommendgetting an around-the-world ticket as they areusually less expensive than round trip tickets.Coming back by way of Paris is always a greatway to finish a wonderful trip. ✦

Thamserku Mountain.

A Buddhist Stupa.


G

Apple Trees andWood Sculptures

GROWING UP ON A FARM near Centuria,Wisconsin, my parents tended a dozen or soapple trees and, every fall, sold apples to theirfriends and neighbors. From that experience, Ideveloped an abiding interest in raising applesand discovering new varieties from self-seededapple trees or with scion grafts from “wild” trees.

In 1975 I purchased an 80-acre farm justsouth of Centuria, and began raising apples forfamily, friends, and roadside customers. Whatbegan as a family project now totals 1,200 treesand includes 12 different varieties of standard

apples (Macintosh, Haralson, Fireside, HoneyCrisp, etc.) as well as several “discovered” vari-eties (Big Ben, Peachy, Southern Bell). My sec-ond oldest, John, has been an enthusiastic part-ner in this project for a number of years. Theother family members and friends have pitchedin to help from time to time, particularly dur-ing harvest season.

I look at the “Baker Orchard” as a greatway to spend my free time, spend time outdoors,and try a different kind of science apart frommy surgical practice. My greatest satisfaction inthe orchard business is producing the “perfect”apples. During the harvest season (late AugustB Y D A N I E L R . B A K E R , M . D .

to early November) the orchard is open everyweekend and is very busy. The orchard is also anatural center for the gathering of family andfriends.

Among my other interests is that of creat-ing wood sculptures and crafts from the pineand hardwood that I harvest from my Wiscon-sin property. Shown here is a rocking horse thatI designed, carved, and constructed for my grand-son.

My busy practice and orchard schedulehave put my wood sculpting at a minimum forthe past several years; however, when, and if, Ido retire, I have plenty of raw materials stackedin my pole barn. ✦

Dr. Daniel Baker (right) with his son, John.

Dr. Daniel Baker with crafted rocking horse.The piece is of solid oak. All of the jointsare glued without nails, screws, or dowels.


T

Get Those Shots Before You Go

M N P E R S P E C T I V E

TRAVEL OPENS OUR MINDS and gives us anew perspective on life. But with more and moretravelers going to exotic destinations today, manypeople are exposing their bodies to deadly diseasesthat are just not present here in Minnesota.Good preventive therapy, including immuniza-tions, preserves health and saves lives. That’s whya visit to the doctor before the trip is so important.

Malaria is probably the biggest risk facedby travelers to exotic locales. We have seen a sig-nificant increase in malaria cases reported inMinnesota. Some of that increase is due to im-migrants returning home to visit their families.The remainder, though, is due both to increas-ing numbers of travelers and increased levels ofmalaria in the endemic countries. Malaria canbe a rapidly evolving and fatal disease — thegreatest risk of complications and death is withthe first attack. So people born in the U.S., in-cluding the children of immigrants, need goodpreventive therapy.

Travelers need to begin prophylaxis one-two weeks before entering a malaria endemicarea. For most, this means starting prior to leav-ing the U.S. Travelers must also understand thatmalaria prophylaxis must continue for a monthafter leaving a malaria endemic country. Withthe rapid spread of drug resistance throughoutthe world, the prophylactic regimen must be tai-lored to the countries that will be visited. Con-sultation on which drugs are appropriate for aparticular locale is best handled through eitherone of many local travel clinics or the Centersfor Disease Control.

A broad variety of vaccines are available toprotect the health of the traveler. The regimenprescribed should be tailored to the locale vis-ited, the duration of the trip, and the antici-pated activities of the traveler.

A consultation for vaccination for travelbegins with an assessment of the routine vacci-nation status. Children over two years and teen-agers should be fully vaccinated with MMR,Polio, DTaP, Hib, Hepatitis B and Varicella.Under two’s should also receive their pneumo-coccal vaccination. Acceleration of the immu-nization schedule may be appropriate for undertwo’s traveling to developing countries wherethe risk of exposure to disease is high. Teenagersand adults should have had a tetanus-diphthe-ria booster in the last 10 years. A second dose ofMMR should be given to persons born after1956. Adults who have received at least threedoses of polio vaccine (either IPV or OPV) andwho are traveling to developing countries shouldbe given a booster dose of inactivated polio vac-cine. Adults over age 65 as well as children andadults with high-risk conditions should receiveinfluenza and pneumococcal vaccines consistentwith the current recommendations of MDH.Pregnant women are at increased risk of compli-cations of influenza and should also be vaccinated.

Additional vaccines are specifically recom-mended for travelers. Yellow fever vaccine isrecommended if traveling to certain parts ofAfrica and South America. Hepatitis B vaccineshould be considered for those who will live sixmonths or more in areas where there are highrates of hepatitis B (Southeast Asia, Africa[Southern, Central, East, West, and North], theMiddle East, the islands of the South and West-ern Pacific, and the Amazon region of SouthAmerica), and who will have frequent close con-tact with the local population. The potential forsexual exposure to hepatitis B during travel is astrong indication for hepatitis B vaccination. Ingeneral, hepatitis A vaccine and/or immuneglobulin (IG) is recommended for travelers toall areas EXCEPT Japan, Australia, NewZealand, Northern and Western Europe and

North America (excluding Mexico). A com-bined Hepatitis A and Hepatitis B vaccine isnow available. Typhoid vaccine is recommendedfor travelers spending time in areas where foodand water sanitation is less than optimal (espe-cially developing countries). Meningococcalvaccine is recommended for travelers to sub-Saharan Africa during the dry season, which isfrom December through June, and especially ifclose contact with the local population is an-ticipated. Japanese encephalitis or tick-borneencephalitis vaccines should be considered forlong-term travelers to areas of risk. There is nocholera vaccine currently available in the U.S.

Immune globulin (IG) may be simulta-neously administered at different body locationswith an inactivated vaccine such as DTaP, IPV,Hib, and hepatitis A and B vaccines. However,IG diminishes the effectiveness of live-virusMMR and varicella vaccines if IG is given si-multaneously. IG does not interfere with yel-low fever vaccine when given simultaneously.

With so many diseases, so many countries,and so many reasons for travel, providing theright protection for each traveler is a complexbusiness. The Minnesota Department of Healthand other physicians with expertise in travelmedicine are available to help you meet theneeds of your patients.

A list of travel clinics in Minnesota andadditional information on travel vaccination canbe found on the Minnesota Department ofHealth website: www.health.state.mn.us/immu-nize. A pamphlet “Tips on advising patientsabout shots for international travel” is availableby calling the MDH travel resources hotline at612/676-5588. ✦

Harry F. Hull, M.D.is the State Epidemiologistand the Director of the Division of Infectious Dis-ease Prevention and Control for the MinnesotaDepartment of Health.B Y H A R R Y F . H U L L , M . D .


Highlights of the Code of Medical Ethics ofthe American Medical Association

Editor’s Note:In the previous issue of MetroDoctors, the cur-rent seven Principles of Medical Ethics and pro-posed amendments to them were published.In this month’s issue, we turn to the first of 10sections of the AMA’s Code of Medical Ethics.The brevity of this first section, which includesonly two Opinions, allows us to provide somebackground on the overall structure of theCode, and its historical evolution, before dis-cussing in more depth Opinions 1.01, “Ter-minology” and 1.02, “The Relation of Law andEthics.”

SECTION E-1.00: INTRODUCTION

Historical evolution of thestructure of the AMA’s Codeof Medical EthicsThe first and possibly most important – al-though often under-appreciated – fact about thisdocument is its historical origin. At the time ofthe foundation of the American Medical Asso-ciation in 1847, there were two principle itemsof business: the establishment of minimum re-quirements for medical education and the adop-tion of a code of conduct.

The impetus behind both actions, at leastin part, was a response to an environment wheremedical services were rendered by both medi-cally-trained physicians and a multitude of ir-regular practitioners. Physicians who had un-dergone formal training wanted due recogni-tion for their skills. Establishing uniform train-ing requirements would help in this regard, buta public commitment to high standards of con-

duct also would help gain the esteem and trustof the public.

The original Code of Ethics, as it wasknown, expressed the physician’s commitmentto uphold certain ethical duties toward their pa-tients, toward each other and the profession atlarge, and toward the public. Therefore, theCode was organized according to three chap-ters, each including several provisions.

More than a century later, in 1957, theentire document — now referred to as the Prin-ciples of Medical Ethics — underwent a profoundtransformation. From all of the provisions wereextracted 10 basic statements, which retainedthe name “Principles of Medical Ethics,” andwhich were accompanied by a preface. All otherpronouncements were now considered an in-terpretation of these basic ethical principles andbecame known as Opinions. The Code was noworganized in 11 parts, and specific provisionsfell under the preamble and each of the 10 Prin-ciples.

The 1977 edition of the Code brought yetanother change. It was found that an Opiniondid not always correspond closely with the par-ticular Principle under which it was listed orthat it embraced more than one Principle. So,the structure of the Code became based on sixbroad subject matters, which included “Hospi-tal Relations,” “Office Practices,” “Patient Re-lations and Medical Responsibilities,” and “Pub-lic Responsibilities.” There are now 10 sections,the newest being the one devoted to Opinionsthat focus on the patient-physician relationship.

Generally, to reflect that an Opinion flowsfrom an interpretation of the Principles, it is fol-lowed by one or more roman numerals in brack-

ets to reflect the Principle(s) from which it isderived.

The Code’s IntroductionThe two Opinions that appear in this section,Opinions 1.01, “Terminology” and 1.02, “TheRelation of Law and Ethics” are central to therole and function of the AMA’s Code of Medi-cal Ethics, yet often overlooked.

Opinion 1.01 speaks of the very terms“ethical” and “unethical” and makes clear that aphysician, as a member of the medical profes-sion, engages in a moral activity. Moreover, theduties and obligations are, at least in part, de-termined by the profession itself and a viola-tion of these may result in disciplinary action.Self-regulation according to standards estab-lished in a code of conduct is at the heart of thedefinition of a profession.

It is worth noting that the Council on Ethi-cal and Judicial Affairs (CEJA), which developsethics policies that constitute the Code of Medi-cal Ethics, also serves in a judicial capacity. Uponnotice that an applicant to the AMA has a dis-ciplinary record or that an AMA member hasengaged in conduct that resulted in a disciplin-ary action by a medical society or a licensingboard, CEJA will review the matter to deter-mine whether these actions are indication ofconduct that violated the Code.

The other Opinion addresses the complexrelationship between a profession’s self-regula-tory function and the primacy of law in oursociety. It is stated that ethical obligations “typi-cally exceed legal duties.” Thus, in the practiceof medicine, when laws are found to be unjust,physicians should work to change such laws. Insome exceptional circumstances, legal disobe-dience may even be necessary. A clearer call forcivil activism could be found only in a politicalmanifesto. It is also made explicit that conduct

B Y H E R B E R T R A K A T A N S K Y, M . D .A N D K A R I N E M O R I N , L . L . M .


that is not illegal may still be unethical.Executions illustrate this interaction be-

tween law and medical ethics. The criminal sys-tem has sanctioned executions as an appropri-ate sentence for certain crimes. Execution bylethal injection makes this act one that requirespharmacological knowledge or other skills thatphysicians may possess. Therefore, physicianshave been considered by the state as appropri-ate participants in executions. However, theparticipation of a physician fundamentally vio-lates medicine’s commitment to preserve life andto serve the best interests of patients. Therefore,a physician’s participation is prohibited by theCode (Opinion 2.06, “Capital Punishment.”)Similar reasoning applies to the prohibitionagainst participation in torture (Opinion 2.07,“Torture”) or against the performance of cer-tain court-mandated treatments (Opinion2.065, “Court-Initiated Medical Treatments inCriminal Cases”).

Together, the two Opinions found in thissection echo language found in the Preamble tothe Principles of Medical Ethics, where it isstated the principles are not laws but standardsof conduct, “which define the essentials of hon-orable behavior for the physician.”

That being said, the Code of Medical Eth-ics does play a part in the judicial adjudicationof physicians’ conduct. This is made evident inthe annotated edition of the Code, which foreach Opinion lists court cases that have madereference to the Opinion. This is not to say thateach time a court takes notice of an Opinion, itnecessarily relies on it to determine whether aconduct was illegal or below a set standard. It issimply one element of evidence that courts mayconsider among others.

The more important relation between theCode and regulatory authorities exists at the levelof licensing boards. Their oversight of licensuredoes include ensuring that physicians behave ina manner that is consistent with professional-ism. States’ Medical Practice Act generally de-fine unprofessional or dishonorable conduct inbroad terms, some listing a non-exclusive set ofbehaviors that represent grounds for disciplin-ary actions. In this context, some licensingboards have statutorily incorporated the Prin-ciples of Medical Ethics, and a handful of stateshave incorporated the entire Code.

The relationship between ethics and law,self-regulation and judicial oversight, are dy-

namic ones that continue to evolve. The medi-cal profession’s conversation with the law willbenefit from a commitment to high standardsof conduct and a commitment to promote andprotect patients’ health and welfare. Many ofthese matters will be visited in more details whenwe turn to our review of the Opinions relatedto social policy issues in the next installment ofthis series.

The content of the entire AMA’s Code ofMedical Ethics is accessible online at www.ama-assn.org/ceja. ✦

Herbert Rakatansky, M.D. is Chair, Councilon Ethical and Judicial Affairs. Karine Morin,L.L.M. serves as Secretary, Council on Ethicaland Judicial Affairs.

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PRESIDENT ’S MESS A GER O B E R T C . M O R A V E C , M . D .

RMS-Officers

President Robert C. Moravec, M.D.

President-Elect Peter H. Kelly, M.D.

Past President John R. Gates, M.D.

Secretary Jamie D. Santilli, M.D.

Treasurer Peter J. Daly, M.D.

RMS-Board Members

Kimberly A. Anderson, M.D., Specialty Director

Victor S. Cox, M.D., Specialty Director

Charles E. Crutchfield, III, M.D., At-Large Director

Kelley C. du Ford, Medical Student

Thomas B. Dunkel, M.D., MMA Trustee

Michael Gonzalez-Campoy, M.D., At-Large Director

James J. Jordan, M.D., Specialty Director

Kathryn M. Klingberg, M.D., Resident Physician

Charlene E. McEvoy, M.D., At-Large Director

Ragnvald Mjanger, M.D., Specialty Director

Kenneth E. Nollet, M.D., Ph.D., At-Large Director

Thomas F. Rolewicz, M.D., Specialty Director

Paul M. Spilseth, M.D., At-Large Director

Lyle J. Swenson, M.D., MMA Trustee

Charles G. Terzian, M.D., Specialty Director

Jon V. Thomas, M.D., At-Large Director

David C. Thorson, M.D., Specialty Director

Russell C. Welch, M.D., At-Large Director

RMS-Ex-Officio Board Members &Council Chairs

Brent R. Asplin, M.D., AMA Young Physician SectionBlanton Bessinger, M.D., MMA PresidentKenneth W. Crabb, M.D., AMA Alternate DelegatePaul J. Dyrdal, M.D., Sr. Physicians Assoc. PresidentStephen P. England, M.D., Community Health

Council Chair*Michael Gonzalez-Campoy, M.D., Education

Resource Council ChairEleanor Goodall, Alliance PresidentFrank J. Indihar, M.D., AMA DelegateWilliam E. Jacott, M.D., U of MN RepresentativeMatthew D. Layman, M.D., AMA Delegate for

American Society of AnesthesiologistsMelanie Sullivan, Clinic Administrator*Lyle J. Swenson, M.D., Public Policy Council Chair*Russell C. Welch, M.D., Communications

Council Chair

*Also elected RMS Board Member

RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive OfficerDoreen M. Hines, Membership & Web Site CoordinatorSue Schettle, Director of Marketing & Member Services


RFrom Where I Sit…“Let’s Talk”

RARELY HAVE I attended such an importantconference as the one held in St. Paul May 16-18, entitled “Let’s Talk – Communicating Riskand Safety in Health Care.”

The focus of this national conference wasto bring experts in communication and patientsafety to help achieve high quality in safe pa-tient care in the United States. Although mosthealth care in the United States is delivered safely,a small number of patients are seriously harmedin the course of their care. Even though indi-vidual clinicians might account for some of themistakes, most of the harm is the result of com-plex interactions among individuals, products,technology, and organizational systems.

The key to improvement in patient safetyis to better understand the complex mix andorganizational factors and to make enhance-ments to staff-to-staff and staff-to-patient com-munications.

I walked away from the conference with anumber of significant learnings. Drs. Hicksonand Prichert have identified that the most sig-nificant factor associated with the disproportion-ate share of malpractice claims is the physician’sdegree of difficulty in “connecting” with pa-tients. Their study showed that good physician/patient communication was a key factor for re-ducing risk of malpractice claims. They wereable to show that practicing in a high-risk spe-cialty, attracting a medically high-risk patientpopulation, or technical incompetence are notall that important factors in the number of mal-practice suits a physician will experience.1

They then were able to develop a “reportcard” for a group of physicians based on a com-plaint index from various sources and assist thosephysicians with a high complaint index in re-ducing their risk through increased awareness,peer-to-peer discussion, and promotion of ac-countability.

While single complaints delivered one at atime provide no comparative feedback and maybe easily dismissed, a compilation of patientcomplaints can offer a rich and importantdataset about a group or medical center and avalid means to reduce risk and improve deliv-

ery of care and satisfaction with caregivers.I was also struck by the presentation by

Dr. Don Berwick from the Institute forHealthCare Improvement. Dr. Berwick dis-cussed the need to change the focus of our ef-forts from a reduction of “errors”— based in-terventions to a basis of “prevention of harm.”Dr. Berwick said, “If we frame the patient safetyeffort on errors, we will lose. Error has the wrongfocus on people and hindsight bias. The real ques-tion is how can we keep people from being harmed?”

He also went on to note that, as much ef-fort needs to be made in what happens afterpatients get hurt as preventing the hurt in thefirst place. We all need to focus on the healingthat results from harm. We need to communi-cate and converse about it rather than applyingmore technology or tighter rules. In fact, Dr.Berwick noted that it may be rule violation andadapted behavior (“migration” from rules) thatcan account for the next level of improvement.

And finally, he noted that while much com-parison has been made between medical careand the airline industry in the need to improvesafety, we are not the airline industry!! We haveour own issues and traditions, we lack integra-tion between the various components and wevalue (perhaps over-value) our guild-like au-tonomy, probably to the detriment of care.

And remember, we all do eventually die.Other industries do not need to accept death asan outcome, or have a process to make death ascomfortable as possible one minute and applymaximum effort to stave off death the next.

All in all, the work product of this confer-ence will continue to be evaluated and the spon-sors of the conference will discuss a format fordistribution. Keep your eyes and ears peeled forfollow-up to this important event in patientsafety. ✦1 Hickson, et al “Obstetricians’ Prior Malpractice Experienceand Patients’ Satisfaction With Care;” JAMA, November23/30, 1994-Vol 272, No., 20.


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RMS to Sponsor Eight Resolutionsin MMA House of Delegates

THE 28 RMS DELEGATES representing theEast Metro area will be carrying eight resolu-tions to the MMA House of Delegates Septem-ber 19, 20, and 21 in St. Cloud. The resolu-tions cover a wide variety of medical issues rang-ing from Global Risk Sharing Contracts andReimbursement for the Treatment of Obesityto Appropriate Mental Health Evaluation ofChildren and Health Screening of MinnesotaOffenders.

The subjects of the resolutions are as fol-lows:• Global Risk Sharing Contracts Between

Health Plans and Physicians;

• MMA to Co-sponsor a Community Con-ference to Discuss the Next Generation ofHealth Care Delivery and Financing Sys-tems;

• Reimbursement for Treatment of Obesity;• Uniform Bar Coding of Pharmaceuticals;• Standards to Protect the Quality and Pri-

vacy of Patient Care in Contracts BetweenHealth Plans and Physicians;

• Health Screening of Minnesota Offend-ers;

• Task Force to Study Appropriate MentalHealth Evaluation of Children; and

• AMA Federation Unity Project.

These resolutions, and many others, fromcounty medical societies, specialty societies, andMMA committees will be considered by the 233MMA Delegates meeting as the MMA Houseof Delegates in St. Cloud in September. Dr. JohnGates, RMS Past President, will chair the RMSdelegation. Dr. Blanton Bessinger will concludehis term as MMA President at this year’s meet-ing. Dr. Michael Gonzalez-Campoy, RMSBoard member, will be a candidate for electionto the position of MMA Vice Speaker. ✦

ON APRIL 17 newly elected Fourth DistrictCongresswoman Betty McCollum observed thesurgical skills of Dr. Thomas Von Rueden, Car-diac Surgical Associates, and the surgical teamat the John Nassef Heart Hospital at UnitedHospital in St. Paul. Joining RepresentativeMcCollum was her Administrative Assistant, BillHarper. Opportunities for Members of Congressand for other elected state and local officials topersonally observe the delivery of medical careare important educational experiences for gov-ernment leaders who make health care policydecisions. The joint HMS/RMS CommunityIntern Program is another excellent program thatprovides a two-day exposure to medical caredelivery. ✦

Congresswoman Betty McCollumin Surgery

Representative Betty McCollum (right) with Administrative Assistant Bill Harper (left) andOR Supervising Nurse Sue Pitman (center) are scrubbed and ready to head into surgery.


RMS UPD ATE

Applicants forMembership

We welcome these new applicants forRamsey Medical Society membership.

ActiveAnneMarie McMorrow Tuohy, M.D.Medical College of GeorgiaPediatricsPACE

AssociatePaul V. Shapiro, M.D.Sackler School of MedicineFamily PracticeMinnesota Institute of Neurology

In Memoriam

Medical Student(University of Minnesota)

Peter AasJennifer E. DickDavid A. KaisakiBecky L. KoshnickNathan D. McParlanGail M. NicholsTheresa A. PersonDavid P. PondBeau G. ReinerKatie L. VogtNorma T. Walks

Transfer into RMS — ActiveRichard G. Karlen, M.D.University of MinnesotaOtolaryngologyOtolaryngology & Head and Neck Surgery, P.A.

Heather L. Rocheford, M.D.University of MinnesotaPlastic Surgery/Hand SurgerySt. Croix Orthopaedics, P.A.

DWIGHT L. MARTIN, M.D. died June 6at the age of 89. He graduated from theUniversity of Minnesota Medical School andcompleted his internship and residency atAncker Hospital. Dr. Martin specialized ininternal medicine. He joined RMS in 1942,and served as its President in 1972. Dr.Martin served on the RMS Constitution andBylaws Committee and the Ethics Commit-tee. He also served as the RMS representativeon the Distribution Committee of the St.Paul Foundation. Dr. Martin retired in 1985.

DONALD M. “TONY” PETERSON, M.D.,a radiologist, died in May. He was 87. Hegraduated from the University of MinnesotaMedical School, completed an internship atBethesda Hospital, and his residency at theUniversity of Minnesota. Dr. Peterson joinedRMS in 1949. ✦

MANY OF YOU RECALL Sue Linder whowas the Executive Director of the RamseyCounty Medical Society from 1968-1985.Many of you also had the privilege ofknowing Sue’s husband, Don Linder. Donwas an executive with the Minnesota MedicalAssociation for many years.

On April 23 Don passed away in Mesa,Arizona. A memorial service was held atSalem Covenant Church in New Brighton onMay 2.

Sue requested memorials to the RamseyMedical Society Foundation and expresses herappreciation to the Ramsey Medical Societyfor their donations to the Foundation. Sheremembers well getting the Foundationstarted and is so pleased that it is viable.

Memorials for Don Linder

Elisabeth A. Slattery, M.D.University of MinnesotaInternal Medicine/GeriatricsHealthEast Downtown St. Paul

Transfer into RMS — 1st YearPracticeMelissa A. Schimnowski, M.D.University of MinnesotaFamily PracticeStillwater Medical Group

Transfer into RMS — ResidentRobyn M. Casey, M.D.University of MinnesotaFamily PracticeSt. Joseph’s Hospital

A. Nadine F. Maurer, M.D.University of WisconsinPhysical Medicine & RehabilitationPark Nicollet Clinic

Transfer into RMS — EmeritusPatrick F. Hergott, M.D.University of MinnesotaFamily PracticePhysicians Neck & Back Clinic ✦

Thank you to the following membersfor their memorium gifts:Dr. Richard and Darlene CarrollDr. Barclay CramDr. Robert S. and Ruth FlomDr. Robert W. and Rosemary GeistDr. William and Eleanor GoodallDr. Barnard HallDoreen Hines, RMS staffRoger Johnson, RMS staffDr. James JordanDr. Roger and Ellen LillemoenDr. Thomas W. O’KaneDr. Kent S. and Missy Wilson

Anyone wishing to make a donationcan still do so. Please send to: RamseyMedical Society Foundation, P.O. Box131690, St. Paul, MN 55113. Note that it isfor the Don Linder Memorial. ✦


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AAS BRENDA ANDREWSON AND I begin ouryear as co-presidents of the Ramsey MedicalSociety Alliance, I feel compelled to reflect onthe significance of our leadership role. What doI bring to the role that will perhaps enhance theAlliance? And when that question proves toodaunting and I feel overwhelmed by its impli-cations, I fall back on my professional role ofthe past 30 years as keen observer of the changeswithin the healthcare scene as a clinical socialworker mainly in three newborn intensive careunits. I have had the good fortune of workingalongside physicians, nurses, chaplains and so-cial workers, for whom I have the deepest respect.And, unfortunately, on a more personal level,as a family member aiding loved ones as theygrapple with the final stages of terminal illness.

I have, therefore, emerged as someonedeeply respectful of the demands made on phy-sicians: the increase in the numbers of patientsseen; the continued assimilation of the ever-in-

creasing knowledge base; and the importanceof the doctor-patient relationship — the essen-tial trust that the doctor cares for and about thepatient.

In Jane Brody’s article on May 15, she re-counted a story told by a colleague about a phy-sician who failed to diagnose his father’s cancer.The father subsequently died and the physicianattended the funeral/memorial service and inspeaking to the family members expressed hisprofound regret and sadness over the misseddiagnosis. He relates to the family that afterknowing that the patient had cancer he reviewedthe X-rays and still could not detect it on thefilm. “The family was relieved and grateful, bothfor the doctor’s visit and for the assurance thatnothing more could have been done. Thedoctor’s conversation helped them resolve theirgrief.”

In my professional capacity, I was privy tohearing unexpurgated comments by family

members. Overwhelmingly, they commentedabout the caring of the staff and about how de-spite the fast pace of the units, that the physi-cian was most appreciated because he/she caredso clearly about the patients and their families.

Recently, I met a woman whose son haddied at age nine after waging a lengthy battlewith leukemia. She recounted in arduous detailhis bone marrow transplants, chemotherapy,lengthy hospitalizations and extensive supportfrom family, school, church, and friends. Shetold me how touched she was when his class-mates all shaved their heads in an effort to offerhim support. And how she had breathed a sighof relief that she could relax her vigilance, fi-nally writing a thank you that was printed inthe local newspaper. Two weeks later, he re-lapsed, requiring a second transplant and sub-sequently died.

What struck this mother so profoundly wasthe caring she received from the healthcare team.She marveled at the power of the compassionshown them and the capacity that the physi-cians had to care for her dying son and his fam-ily. She felt that despite her son’s death, shewould be eternally grateful to those who trav-eled this painful road with her and truly caredso much for them all.

“The capacity to care is the quality thatgives life its deepest meaning and significance.”(Author unknown)

I stand in awe of the power and responsi-bility to care for patients that is inherent in therole of the physician. As co-president of theRamsey Medical Society Alliance, I hope to con-tinue to work with this very dedicated organi-zation of volunteers to “promote educational andcharitable endeavors which improve health andquality of life within our community.” It willbe an honor to aid in this system of compassionand caring. ✦

RMS ALLIANCE NEWS

SAVE THE DATE

Jean LondonCo-President

Royal Caribbean Cruise LineExplorer of the Seas

The Annual RMS/HMS 2002 Winter Medical Conference

Saturday, March 9 —Saturday, March 15, 2002


A

Community Internship— Another Success

ANOTHER SUCCESSFUL Community In-ternship Program, jointly sponsored by HMSand RMS, was held May 14-17. Each of thenine “interns” observed four unique medical/surgical experiences throughout the program,and shared experiences ranging from seeing anactual bullet on an X-ray to the care and com-passion exhibited when decisions about life anddeath are made. They also noted the vast differ-ences in the way medicine can be practiced fromserving the uninsured/underinsured to the high-est level of technology and specialized care.

The enthusiasm for the program is cap-tured in the following letter received from oneof the participants following her experience:

“I can’t thank you enough for the opportu-nity I have had over the past few days. The varietyand scope of the medical procedures I witnessedwas wonderful, and the experience is one that Iwill long remember.

First and foremost, I was blown away by theefforts the physicians made to accommodate me, toinvolve me and to explain everything to me in de-tail. They are all so busy and their responsibilitiesare so enormous, yet they took the time to make myexperience an unforgettable one, talking me through

every X-ray, CAT scanand surgical procedurestep-by-step.

I was also gladyou reminded us totake the time to absorbmore than just the actual patient treatment. It wasenlightening to observe the teamwork that goes intopatient treatment, and it was heartening to see thecare and respect each physician showed each pa-tient (and their colleagues, from tech to nurse tosecretary to PA). Even one physician who was quitecynical about the state of medicine in the physician’slounge was still a very caring physician when face-to-face with a patient and was absolutely dedi-cated to doing everything he could for his patients.Also interesting was the time needed and the meth-ods used for documentation — dictating patientcharts into a voice mailbox and recording suppliesused on a computer for billing purposes.

I don’t have time to go into more detail at themoment, but please know that this is one of themost stimulating experiences I’ve had in a long timeand that I am most grateful for it.— Julie

P.S. On a side-note, I am happy

to report that I did not pass out in surgery — noteven a cold sweat or lightheadedness. : ) I had beena little nervous about it, but found that I was ab-solutely engrossed in examining every tissue, or-gan, incision and suture. It’s truly fascinating work.

The Community Internship Program is of-fered three times per year to members of thecommunity who direct, affect, and/or purchasehealth care. Policy analysts, members of the me-dia, legislators, clergy, and others are also in-vited. Physician faculty are always being sought.If you are interested in participating in the up-coming program, November 12-15, and/or havenames of potential candidates to serve as interns,please contact Nancy Bauer at HMS (612) 623-2893 [email protected] or Doreen Hines atRMS (612) 362-3705 [email protected]. ✦

Peter Alden, M.D.Steven Anderson, M.D.R. M. Bolman, M.D.Peter Bornstein, M.D.Kenneth Casey, M.D.Y. Ralph Chu, M.D.Karl Chun, M.D.Raul Cifuentes, M.D.Kenneth Crabb, M.D.Peter Daly, M.D.William S. David, M.D.Lyn dosSantos, M.D.

William Remington, M.D.Frank Rhame, M.D.David Schmeling, M.D.William Simonet, M.D.Steven Sterner, M.D.David Swanson, M.D.Charles Terzian, M.D.Brett Teten, M.D.Steven Tredal, M.D.Stephen Wagner, M.D.Peter Wilton, M.D.Robert J. Wood, M.D.

Thanks to the following physiciansfor their participation:

Interns Included:Julie Crews Barger – Director of Alumni Relations and Special

Events, Minnesota Medical FoundationCarol Bender – Deputy Director for Constituent Advocacy

for Senator Paul WellstoneNancy Cusick – Information Technology Specialist, Health

Technology Advisory CommitteeDavid W. Johnson – Vice President of Programs, Minnesota

Medical FoundationThomas B. Major – Public Program and Policy Supervisor,

Minnesota Department of Health, Health Economics ProgramDiane M. Marty – State Program Administrator, State of Min-

nesota Health Economics ProgramRichard H. Nicholson – Portfolio Manager, Nicholson Family

FoundationDiane Rydrych – Health Policy Analyst, Minnesota Depart-

ment of HealthSue Schettle – Director of Marketing and Member Services,

Ramsey Medical Society

David Dvorak, M.D.Michael England, M.D.Sandra Engwall, M.D.J. T. Finnell, M.D.Kevin Graham, M.D.James Hart, M.D.Richard Lamon, M.D.Bonnie Landrum, M.D.Theodore Lillehei, M.D.Catherine McKegney, M.D.Phillip Murray, M.D.Kathy Neacy, M.D.

Back row: David Dvorak, M.D., Y. Ralph Chu, M.D., CarolBender, Thomas Major, Diane Marty, David Johnson, JamesHart, M.D., and Peter Bornstein, M.D. Front row: Karl Chun,M.D., Sue Schettle, Diane Rydrych, Nancy Cusick, Julie CrewsBarger, and Richard Nicholson.


IHMS-Officers

Chair Virginia R. Lupo, M.D.

President David L. Swanson, M.D.

President-Elect T. Michael Tedford, M.D.

Secretary Richard M. Gebhart, M.D.

Treasurer Michael B. Ainslie, M.D.

Immediate Past Chair David L. Estrin, M.D.

HMS-Board Members

Ben Baechler, Medical Student

Michael Belzer, M.D.

Carl E. Burkland, M.D.

Jeffrey Christensen, M.D.

William Conroy, M.D.

Dianne Fenyk, Alliance Co-PresidentPaul A. Kettler, M.D.

James P. LaRoy, M.D.

Ronald D. Osborn, D.O.

Joseph F. Rinowski, M.D.

David F. Ruebeck, M.D.

Richard D. Schmidt, M.D.

Marc F. Swiontkowski M.D.

D. Clark Tungseth, M.D.

Trish Vaurio, Alliance Co-PresidentJoan M. Williams, M.D.

HMS-Ex-Officio Board Members

Barbara H. Subak M.D., Senior Physicians AssociationLee H. Beecher, M.D., MMA-TrusteeKaren K. Dickson, M.D., MMA-TrusteeJohn W. Larsen, M.D., MMA-TrusteeRobert K. Meiches, M.D., MMA-TrusteeHenry T. Smith, M.D., MMA-TrusteeDavid W. Allen, Jr., MMGMA Rep.

HMS-Executive Staff

Jack G. Davis, Chief Executive OfficerNancy K. Bauer, Associate Director

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CHAIR ’S REPORTV I R G I N I A R . L U P O , M . D .

I RECENTLY HAD THE unexpected goodfortune of hearing one of my literary heroesspeak.

During my recent year-long sabbatical, Iwas exposed to the author/poet David Whyteby the Bush Foundation. I encountered him inhis book The Heart Aroused, a reflection on find-ing meaning in one’s work, whether corporateor academic or medical. To my great surprise, Ifound that he was the dinner speaker at this year’sAllina Annual Board Meeting, which I wasscheduled to attend. The Shotwell Award wasbeing presented to both Gordon Sprenger andPaul Quie, M.D. A committee of the HennepinMedical Society determined the annual winners,and several HMS board and staff members werepresent at the meeting for the award presenta-tion.

Whyte was just as inspirational in personas he is in print. He suggested that each of usidentify a “place of revelation in our lives” thatwe can visit daily. Much of our daily lives is notrevelation, but frustration. Often I feel that oneof the best survival skills a physician can havetoday is an adult attention deficit disorder, sinceconcentrating too long in any one area, or re-garding any one patient or problem, is detri-mental to keeping a hectic office schedulemoving. Every surgeon knows that the act ofscrubbing in can offer an escape from the fran-tic pace of a day and provide a chance to con-centrate and complete something. And we allknow there’s often not much to show for all oursitting at the end of a beeper and a telephoneand putting out fires, not of our own making.

Whyte also suggested that we need to “havea place in our lives where we can hear anothervoice.” I sometimes reflect upon the differencesbetween medical students and residents. I thinkthat internship is the watershed time, and thatpeople who have completed it have crossed somedivide that they can’t go back across. We arehard-wired by our internship and are rarely thesame as before we started. Whether we stop us-

ing a part of our brains and start to de-learnother ways of thinking or other voices to hear,we’re different people. Whyte would urge us tokeep in touch with whatever motivated us ini-tially to go into medicine, to find where ourpassion lies, and to try to weave that into ourdaily lives at work, or at least touch base with iton some kind of a regular basis.

I sometimes think about what my relationto medicine will be after I’ve retired. Some phy-sicians leave their office, finish signing everymedical record their hospitals’ incomplete roomscan find, sign off on their malpractice tail, neverrenew their journal subscriptions and societymemberships and leave the profession behind.Some physicians don’t retire. When I look atthe advances in my field in the 20+ years since Ibegan residency, I’d argue that large parts ofcurrent obstetrics are unrecognizable from whenI began, and that I’d be reportable to the Boardof Medical Practice within about 15 minutes ifI spent a morning practicing ob/gyn that way. Ican’t help but think that the field will continueto change at least at a comparable rate, and thatsometime when I’m about 84, there will be tre-mendous advances in my field and I’ll envy prac-ticing physicians who have tools I could onlydream of.

I also wonder about what’s to come afterwe stop practicing, remembering that HIV andcrack addiction didn’t exist when many of uswere in medical school, and looking at how theyhave both dramatically changed the way wework every day.

So, reflect on what it is we do each day,and try to find what anchors or centers us andtrack towards that when you can. Pick upWhyte’s book before your next plane trip for athoughtful read and some help from anothervoice to help you do this. ✦


In Memoriam

HMS NEWS

New MembersHMS welcomes these new members to the Soci-

ety. Schools listed indicate the institution where

the medical degree was received.

ActiveDavid A. Asinger, M.D.University of Minnesota Medical School, DuluthDiagnostic RadiologySuburban Radiologic

Krasimir Georges Bojanov, M.D.Varna Higher Institute of Medicine, VarnaAnesthesiologyTwin Cities Anesthesia Associates, P.A.

Terrence D. Brayboy, M.D.University of North Carolina School of MedicineEmergency MedicineUnity Hospital

Evan D. Friese, M.D.University of South Dakota School of MedicineObstetrics & GynecologyCoon Rapid’s Women’s Health

Sean S. Gupton, M.D.University of Manitoba Faculty of MedicineEmergency Medicine

Eric G. Heegaard, M.D.University of Washington School of MedicineObstetrics & GynecologyAssociates in Women’s Health

Mark A. Heller M.D.University of Minnesota Medical SchoolOrthopedic SurgeryMinnesota Orthopaedic Spec., P.A.

Concepcion A. Laqui M.D.Faculty of Medicine and Surgery University ofSanto Tomas, ManilaAnesthesiologyHennepin County Medical Center

Alejandro Mendez M.D.Universidade Catolica de Chile, Faculdade deMedicina y Ciencias Biologicas, SantiagoNeurological SurgeryUniversity of Minnesota Physicians

Owen R. O’Neill M.D.Mayo Medical SchoolOrthopedic SurgeryMinnesota Orthopaedic Spec., P.A.

Michael T. Philbin, M.D.University of Wisconsin Medical SchoolPlastic SurgeryEdina Plastic Surgery, Ltd.

Suzanne Ruth Proudfoot, D.O.UDMHS-Des MoinesPhy. Medicine & RehabilitationFairview Pain Management

Manuel Roman, M.D.University of Wisconsin Medical SchoolEmergency Medicine

J. Richard Sheely, M.D.University of Tennesee Center for Health SciencesFamily PracticeQuello Clinic, Ltd., Mall of America

Kevin David Sipprell, M.D.University of Minnesota Medical SchoolEmergency MedicineRidgeview Medical Center

Julie Ann Switzer, M.D.Stanford UniversityOrthopedic SurgeryOrthopaedic Consultants, P.A.-AdministrativeOffice

Mallikarjun R Thatipelli, M.D.Kakatiya Medical College, Osmania University,Warangal, Andhra PradeshFamily PracticeSouthern Metro Medical Center

Peter J. Thill M.D.University of Michigan Medical SchoolPediatric Critical CareChildren’s Respiratory & Critical CareSpecialists, P.A.

ResidentsMichael D. Alter, M.D.Medical College of Ohio at ToledoPulmonary DiseaseMinnesota Lung Center

Eric J. Anderson, M.D.University of Minnesota Medical SchoolPediatricsFairview-University Medical Center

Gary D. Cravens, M.D.Indiana University School of MedicineGeneral SurgeryIngenix Health Intelligence

Students(University of Minnesota)Sharone Kamran AskariElias P BazakosMichelle A. BochertJonathan B. GullyMonica C. KoplasJoshua R. KovachJennifer C. KoziolNicholas W. KrawezykMichael M. LukomaRosemarie B. RamirezMichael Jay RemucalKelly L. RoodMara B. RosenthalTseganesh SelameabThao P. TranRochus K. Voeller ✦

EVERETT C. PERLMAN, M.D. died inJune at the age of 95. He graduated from theUniversity of Minnesota Medical School. Dr.Perlman, a pediatrician, retired at the age of80. He joined HMS in 1994.

JAMES ROBERT SHANKS, M.D., diedApril 25. He was 60. He graduated from theUniversity of Minnesota Medical School. Anendocrinologist, Dr. Shanks practiced atAbbott Northwestern for many years. Hejoined HMS in 1995. ✦


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THE MINNEAPOLIS CLUB was the venue forthe Allina Annual Meeting and the annual pre-sentation of the Shotwell Award. This year twoawards were given out to noteworthy recipientsfor their exceptional contributions in health care.

The award was established in 1971 by (theformer) Metropolitan Medical Center in rec-ognition of the support and dedication of theShotwell Family. The Hennepin Medical Soci-ety has served as the repository for this awardwith funding provided by the Allina Founda-tion since 1991.

Robert Van Tassel, M.D. presented the firstaward to Gordon Sprenger, former CEO ofAbbott-Northwestern Hospital, and currentlythe CEO of Allina. Among his many accom-plishments, Mr. Sprenger was recognized for his35 years as a leader in health care, both locallyand nationally, and for his inspirational leader-ship, superior integrity and communication skills.

Two Shotwell Awards PresentedThe second recipient, Paul Quie, M.D.,

was recognized by Judith Shank, M.D. Dr. Quie,a University of Minnesota pediatrician with spe-cialization in infectious diseases, has achievedgreat fame in areas of research, both locally as

well as nationally. His other interests includeinternational medical education, and improvingthe lives of refugees. He is described as humble,yet very accomplished, warm, kind, a truegentleman, and an extraordinary role model. ✦

Robert Van Tassel, M.D. with GordonSprenger.

Judith Shank, M.D. presents award to PaulQuie, M.D.

Hoban Scholars PresentEducational Research ProjectsTHOMAS AND MARY KAY Hoban were theguests of honor as five “Hoban Scholars” deliv-ered presentations on their educational researchprojects. Topics such as “Characteristics of Union-ized Minnesota Nursing Homes: An Analysis Atthe Nursing Assistant Level;” “Six Sigma;” “Fac-tors Contributing to Abstaining or Engaging inSexual Intercourse Among Minnesota Adolescents;”“Technological Initiatives;” and “Open Access”were made by the scholars. In addition, TimSignorelli, President of METRIA Management,LLC, shared his insight on “Physicians andAdministrators as Partners.” The highlight, how-ever, was the opportunity for Thomas and MaryKay Hoban to meet in person the scholarshiprecipients and Tom’s recollection of his success-ful partnership with physicians as the CEO ofthe Hennepin Medical Society for 25 years.

Members of the Scholarship Selection Commit-tee include: Roger Becklund, M.D., PaulBowlin, M.D., Peggy Craig, M.D., Paul

Hamann, M.D., Richard Frey, M.D., WilliamPetersen, M.D., and Bonnie Sauerer. Dr. H.Thomas Blum chairs the Committee. ✦

Back row: John Jendro, Eric Nielsen, H. Thomas Blum, M.D., Brian Cooper, Jon Rauen. Frontrow: Thomas & Mary Kay Hoban, Janiece Gray, Jessica Levine.


I

President’s Note: As the recently installed presi-dent of the HMSA for 2001-2002, it is my plea-sure to introduce fellow member, Peggy Johnson,as our guest columnist for this edition. She andher family have had the stimulating experiencesof world-wide travel.

Kathy Larson, HMSA President

IN 1996, OUR DAUGHTER, Lara, traveled toTanzania, East Africa, to study abroad for a se-mester. The experience included a home staywith a Masaii family where she worked with thefamily on several projects such as general healthcare and disease prevention utilizing simple mea-sures such as water sanitation and solar energy.During her stay, Lara noticed the declininghealth of one of the young daughters. AlthoughNema was quite sick, she was allowed to helpwith family chores and attend school, as she feltable. Her ailment had never been diagnosed ortreated and her condition was simply accepted,even as her health steadily deteriorated andsimple tasks became increasingly difficult.

Several months later, after Lara returnedhome, we received a letter from Nema’s father,Zablon, informing us that Nema had becomeweaker, developed shortness of breath, and wasnow unable to attend school. An American phy-

sician in Arusha, Tanzania had diagnosed Nemawith Tetralogy of Fallot, a congenital heart prob-lem, and advised corrective heart surgery. At thistime no heart surgery was performed in Tanza-nia. Remembering that Lara’s father was a phy-sician, Zablon was now seeking our help.

Coincidentally, just a few days after receiv-ing the letter, a medical team from Nairobi,Kenya, was planning a trip to Minneapolis fortraining in diagnostic procedures and treatmentof cardiac patients. The group was sponsoredby Children’s Heartlink, an international medi-cal charity dedicated to the treatment and pre-vention of heart disease in needy children indeveloping countries. Our family had volun-teered with Children’s Heartlink over the years,and a few of the physicians and nurses were stay-ing with us during this visit. We presentedNema’s problem to the team at a welcome re-ception. They agreed to see the patient.

Nema’s family was astonished when theKenyan team notified them that Nema couldbe brought to Kenya for a cardiac workup andsurgery. The family was apprehensive and fear-ful at first, having been approached by a foreignmedical team with promises of helping theirdaughter get well. They did make the six hourbus ride to Nairobi and met with several physi-

HMS ALLIANCE NEWS

cians. After seeking several opinions, the family’sconfusion increased once again as the promisesof Western medicine clashed with those of themore traditional local medicine men. We re-ceived another letter from Nema’s family ex-plaining their anxiety and hesitations regardingthe surgery.

Eventually, my husband, Dr. BruceJohnson, a cardiologist with CardiovascularConsultants, located at North Memorial Medi-cal Center, had an opportunity to journey toNairobi as a member of Children’s Heartlinkvolunteer medical team. The Minneapolis teamwould work alongside the Kenyan physicians,assisting their international counterparts withseveral cardiac cases, teaching new techniques,while learning a bit about traditional medicineas well. Once again we contacted the family, butreceived no reply. A few days after the team’sarrival, Nema and her family unexpectedly ar-rived at Nairobi Hospital. They were ready togo ahead with the surgery. During the team’sstay, the necessary pre-op was completed; Nemahad surgery and was recovering by the time theyleft. The experience marked an emotional andrewarding week for these two fathers from dif-ferent cultures.

Our family has maintained our connec-tion to Nema’s father and Africa. A year laterour family visited Nema and her family in theirTanzanian village. Nema gave our family a tourof her school and introduced us to her new babybrother. She has completely recovered and canenjoy all the activities of her siblings and friends.Today, Lara lives in Tarangire National Park inTanzania where she and her husband, CharlesFoley, head an elephant research and conserva-tion project. This September, our second daugh-ter, Anthea, leaves for a semester abroad in SouthAfrica. ✦

Peggy Johnson

Nema’s father, Zablon, Dr. Bruce Johnson, and Nema’s mother with Nema as sherecovers from surgery.

2001julyaug

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