M a r i o n - P o l k C o u n t y M e d i c a l S o c i e t y

April 2010

Chart Notes®

Continued on page 16

When Disaster Strikes...By Nancy Boutin, M.D.

Disasters are things that happen in other places: New York and New Orleans, Phuket and Port-au-Prince.

Right? I mean, what’s the worst thing that could happen in the Willamette Valley? The same question might have been asked in Sioux City, Iowa, 20 years ago. However, within days of an airport disaster drill, held over the objec-tions of those concerned about cost, the city participated in the cornfield equivalent of the “miracle on the Hudson.” A DC-10 with 297 passengers and crew on board crash-landed on Runway 22 one sunny summer afternoon. Ac-cording to airline manuals, the type of malfunction that caused the crash must inevitably result in 100% fatality, but thanks to the skill of the flight deck and the response on the ground, 182 people survived.

As Captain Al Haynes tells the story, a certain num-ber of lucky stars aligned that day—many physicians were on the golf course playing in a medical society golf tournament and were immediately available to help, the National Guard was on site at the airport, and the acci-dent occurred during shift changes at the local trauma center and the burn unit, doubling the number of on-duty staff. Nevertheless, he says he can’t overstate the importance of the disaster drill in preparing airport personnel and responders for a catastrophe that literally dropped out of the clear blue sky.

Something similar could happen here. Airports, freeways, and bridges all pro-vide a potential backdrop for large-scale

trauma. Pacific Northwest Native folklore tells of a mas-sive earthquake some 300 years ago that dwarfs the recent Chilean quake. Experts say a similar rumble along the Cascadia subduction zone waits just around the corner—which means the next 50-100 years in geologic terms. Last March, at a talk for the Marion Polk County Medi-cal Society, Paul K. Carlton, Jr. MD, Homeland Security director at Texas A&M, said Intelligence reports that ter-rorists have begun planning to target rural America, and Oregon has been specifically mentioned. Hype? Maybe. Fear-mongering? Perhaps. Should we be prepared for a jumbo jet to fall on our heads, anyway? Absolutely.

Doug Eliason, DO, Salem Family Practice physician knows a lot about disaster preparedness. A colonel in the Oregon National Guard, Eliason can get pulled from

3 President’s Message

4 Financial Planning

6 Legally Speaking

8 Tax Planning

10 Benefit for MedAssist & Project Access

15 GEM Children’s Foundation Opens Office

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3Chart Notes®

Marion-Polk County Medical Society

Mark Gilbert, M.D.President

Mark Fischl, M.D.President-Elect

William Purnell, Jr., M.D.Immediate Past President

Dean Larsen, M.A., CAE Editor

Executive DirectorCorporate Secretary

Jodilou Berry Assistant Editor

In House Graphics Layout and Design

698 12th St. SE #230Salem, Oregon 97301

(503) 362-9669FAX (503) 362-0109

e-mail: director@mpmedsociety.org website: www.mpmedsociety.org

ChartNotes® is a monthly publication.The purpose of this publication is to

provide information of interest to the local medical community. Unless stated

otherwise, opinions expressed in any article are solely those of the author

and are not necessarily endorsed by the Marion-Polk County Medical Society,

its employees, officers or directors. The editors welcome letters or articles

for publication. Deadline for submission of copy is the 15th of the

month prior to publication. Acceptance of advertising in no way constitutes

professional approval or endorsement of products or services advertised.

The Marion-Polk County Medical Society reserves the right to reject

any advertising.

Advertising rates are available from the Medical Society office.

3145

9

MessageP r E S I D E n t ' S

Continued on page 11

“Ring of Fire” Sends a Warning Claxon Ringing Around the Pacific: Are We Ready?

The “Ring of Fire” is a 25,000 mile long stretch of the most danger-

ously active geologic zone on Planet Earth. It contains ninety percent of the world’s active volcanoes, and eighty percent of the planet’s active earthquake zones. On average, an earthquake or volcano erupts here every hour. Seismologists report that activity on “ the Ring” is three times more active than ever before. Santia-go, Chile is not inexperienced dealing with earthquakes: some of the largest recorded in history occurred in Chile. Building codes and oversight of construction are said to be as vigorously devel-oped and enforced as they are in Japan or California.

The same thing can not be said of much of the building and construction in Oregon. Still, an 8.8 earthquake that shifts a city ten feet, tilts the Earth’s axis and shortens the day, does not happen in every gen-eration. We, the people on the west side of Oregon also have a 700 mile space on this ring, known as the Cas-cadia Subduction Zone. In this past thousand plus years it has triggered magnitude 8 or 9 earthquakes, like the one in Chile, at least four times; the last one was over 300 years ago, which is why experts say we are “over-due” for a big one.

My first degree of separation to the Chile earthquake was my friend and colleague, Jay. I mentioned him

in one of my columns from last year as the guy who started my training in hiking. Jay was scheduled to be travel-ing through Chile to Argentina when the earthquake struck. He flew into Santiago, Chile and explored a bit of the country, as the airport there is the closest to the area of his three week expedition. I called his girlfriend, and found out that Jay was out of Chile when the earthquake struck. She had been communicating with him by email, and he had already reported

being in the Lake District of the Andes before Chile’s earthquake. He was not yet overdue for his next email exchange, so we both sent out emails and awaited a response. Leslie called sometime the next day to report Jay was fine: the earthquake was “only” registering as a 5.5 on the other side of the Andean mountain range where he was climbing.

Aftershocks above 6 on the Richter scale continue to ripple across Chile and South America in the weeks that

By Mark Gilbert, M.D.

4

Mean & 95th Percentile of Remaining Lifetime Health Care

Costs at Age 65

Mean 95th Percentile

$600,000

$500,000

$400,000

$300,000

$200,000

$100,000

$0 No Nursing Home With Nursing Home

$311,000

$197,000

$260,000

$570,000

ChartNotes® columnist

Ron Kelemen, CFP®

has once again been selected by

Medical Economicsas one of the nation’s...

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By Ron Kelemen, CFP® — The H Group, Inc. Independent Wealth Management Solutions™

Board Member, Medical Foundation of Marion and Polk Counties

PlanningF I n A n C I A L

Out-of-Pocket Medical Costs During Retirement—A True Wild Card

Five years ago I wrote about the cost of

health care during re-tirement. Since then, new sophisticated stud-ies are shedding more light on the topic and the need to plan for health care expenses, regardless of what does or does not happen with health care legislation. It’s a good news, bad news situation.

The good news? Thanks to mod-ern medicine, we are all living longer

after retirement. According to an article in the February 23 Economist and 2006 figures from the CDC, Americans are living 18.7 years past age 65.

This is an average of all races and genders. And just since the last 15

years, life expectancy at age 75 has increased by one full year to an ad-ditional 12 years of retirement. So, if you make it to age 75, you have a 50% chance of being retired for 22 years or more. And the probabilities are even higher if we calculate in a joint life expectancy with your spouse.

By contrast, The Economist report-ed that average retirement for males from 1965 to 1970 lasted just under 10 years. When you think about just the medications that control cholesterol and blood pressure, it is no wonder. Not to mention cancer breakthroughs, use of seat belts, and better diet and exercise.

The bad news? A longer retirement most often equates to higher medical costs, es-pecially if the longer life span is plagued with chronic diseases. We’re living longer, but not always better. Until now, we really didn’t have an accurate way to quantify out-of-pocket medical expenses during retirement because we didn’t have enough data. But a 2010 paper by Webb and Zhivan at the Center for

Retirement Research at Boston Col-lege, gives us some new insights using new data and methodologies. And the numbers are much higher than I first reported in 2005.

The study looks at household out-of-pocket expenses during retire-ment, such as co-pays, deductibles, home health care costs, and Medicare supplement premiums. Using data on many mortality and morbidity factors, they reported the mean and the 95th percentile in today’s dollars. The study contains many variables, assumptions, and footnotes, so if your want to ex-amine all 45 pages in more detail go to: http://crr.bc.edu/images/stories/Working_Papers/wp_2010-1.pdf.

Their findings? A couple retir-ing at age 65 in good health with no chronic conditions can expect to pay on average $197,000 during retirement for out-of-pocket medical

Continued on page 5

Source: Webb & Zhivan (2010)

5Chart Notes®

Three generations of serviceto the Salem area community

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Financial Planning . . . continued from page 4.

expenses, and $311,000 if they fall into the 95th percentile. This doesn’t include nursing home care. When that is included, the mean and 95th percentile costs increase to $260,000 and $570,000 respectively.

The corresponding amounts for couples reaching ages 70 and 75 are very similar. The mean cost at age 70 is $192,000 and the 95th percentile is $317,000. This is because the couple no longer needs to worry about the costs from ages 65 to 70, but faces inflation and higher probabilities of needing care during the remainder of their lifetime.

Unlike many Americans entering retirement, accumulating the extra $197,000 for retirement is manage-able for most ChartNotes® readers if they plan for it. But what about that 5% probability of ending up in the 95th percentile and need-ing $311,000? I’m sure you have all encountered patients, who for one reason or another, fall into this category. Could it be you? And will you have enough retirement assets to handle it?

And long-term care expenses are an even greater wild card. A 2004 Congressional Budget Office study reported that one-third of individuals turning 65 in 2010 will need at least three months of nursing home care, 24% more than a year, and 9% more

than five years. What does that cost? According to a 2008 survey by Pru-dential, average nursing home costs were $79,000 for a private room. Alternatively, a home health aid for four hours a day, five days a week costs about $22,000 per year. What if you need 24/7 care or more skilled care? Now we’re talking about real numbers. Granted, your travel budget may have decreased completely, but I have seen clients where just the fear of these kinds of expenses keeps them from fully enjoying retirement when they have their health and energy.

You can either self insure or pur-chase long-term care insurance to handle the nursing home risk. But at this time at least, your only options for the out-of-pocket costs are to stay healthy and to self insure through disciplined investing today. The table gives you an idea of what it takes. In an age of long-term financial inse-curity at the personal and national level, all that you can really depend upon in the future is what you send on ahead. Ron Kelemen is an independent CERTIFIED FINANCIAL PLANNER™ with 29 years of experience, and is listed by Medical Economics magazine as one of The 150 Best Fi-nancial Advisors For Doctors. He was also admitted to the MD Preferred Network of Financial Advisors. He offers fee-only investment management and financial planning advice through The H Group, Inc., one of the largest independent registered investment advisory firms in the Northwest. New Address: Waterplace Building • 500 Liberty St. SE, Suite #310 • Salem, OR 97301 • (800) 285-6240 • website: www.PlanningVisionProcess.com

Years to Age 65

$300,000 at 4% inflation

Accumulation Method

Amount at 5%

Amount at 8%

Amount at 10%

5 364,996Annual $66,055 $62,216 $59,785

Lump Sum $285,984 $248,410 $226,634

10 440,073Annual 82,889 75,013 27,612

Lump Sum 270,166 203,839 169,667

15 540,283Annual 25,038 19,898 17,005

Lump Sum 259,885 170,319 129,339

20 657,337Annual 19,879 14,364 11,476

Lump Sum 247,947 141,147 97,790

Annual Investments Required to Accumulate $300,000 Adjusted for 4% Inflation*

*2008 Congressional Budget Office projection of out-of-pocket inflation-adjusted health care cost increases over next decade, based on past three decades.

6

SpeakingL E G A L L y

Planning for the wise transfer of wealth from one generation to the

next is a major focus – and one of the most rewarding areas – of our firm’s estate and legacy planning practice. Virtually all of my clients wish to pass at least a portion of their financial wealth to their children. The ques-tion is how to do so wisely, so that the children not only inherit their wealth, but also inherit their values.

The next two “Legally Speaking” articles will focus on how we use the values-based approach to create uniquely personal family legacies for ourselves and our descendants.

Last January’s column introduced the concept of the Planning Pyramid, and how to plan with the right priori-ties as the foundation of your estate plan. Using a values-based, family-centric approach to planning avoids the typical cookie-cutter form-based planning and incorporates uniquely personal family legacies into a com-prehensive estate plan.

Meet Tom and Sally RayTom and Sally Ray are two

middle-aged professionals who have worked hard to build their medical practice into a successful business. Their net worth, including life insurance, pensions, and retirement plans is approxi-mately $2,000,000 and growing. Their two children, John and Jane, are in their early teens. Both Tom

and Sally expect to receive an inheri-tance from their own parents within the next ten years, which will add to their wealth.

The Rays came to me to assist them in protecting the wealth they had cre-ated and to use that wealth to create their family legacy. They wished to leave their children more than just financial wealth, and they wanted to provide some asset protection in case their children encountered any trouble during their own lifetimes, in-cluding chemical addictions, divorce, or bankruptcy. Their goal was to set up their plan so that the inheritance left to John and Jane would not be a burden or negative influence, but would provide a positive structure with incentives, protection, and in-spiration for the children – and their children’s children – to make the most of their lives.

Sally and Tom, although living at a local country club, had tried

hard to raise their children to be down-to-earth, socially

conscious, and to adhere to basic family values.

For the Rays, these values included

adherence to a family philoso-

phy centered on a spiritual home life,

professional achievement, academic excellence, social contribution, finan-cial responsibility and stewardship,

community involvement and devo-tion to family.

Wealth Transfer MethodsDuring our Family Matters work-

shop for new clients, the Rays learned about the primary ways we can trans-fer financial wealth to our heirs: 1) Outright2) Convenience (Demand) Trust3) Step-Distribution Trust and 4) Lifetime (Personal Asset Protec-

tion) Trust1. Outright Distribution: An out-right distribution is just that, mom and dad die and Johnny and Jane receive their inheritance outright, in one lump sum. Such a distribu-tion is simple, clean, but dangerous. Statistics show that an inheritance will be gone within 19 months of a child receiving it. Moreover, it does not matter how old the child or how much the inheritance. If a child gets divorced or goes bankrupt, the in-heritance could be lost. An outright distribution does not allow for legacy planning, nor does it provide any protection at all against predators, creditors, divorce, or lawsuit. 2. Convenience Trust: With this arrangement, the inheritance is dis-tributed to a trust, but the child can withdraw the trust assets at any time and for any reason, just by request-ing it. There may be an independent Trustee managing the trust, or the child may be her own Trustee or co-Trustee. Since no one can force the

6 Continued on page 7

Eden Rose Brown, JD – Attorney and Counsellor at Law Former Board Member of the Medical Foundation of Marion and Polk Counties

A Ferrari for Johnny, A Villa for Jane?A Values-Based Approach to Preserving Family Legacy

Pa r t t w o

Planning with the Right Priorities

Save Taxes & Fees

Expand Wealth

Preserve Wealth

Family/Community

Self/Spouse

7Chart Notes®

child to withdraw the income and principal from the trust, the Con-venience Trust offers some creditor protection, possibly some divorce protection, and perhaps a mental bar-rier to withdrawing the trust’s assets, but not much else. 3. Step-Distribution Trust: This method is the most traditional meth-od of leaving money to your heirs. I call it the “speed-bump” approach. With this type of distribution, the inheritance flows into a trust, usually with an independent Trustee who manages and administers the trust assets for the child. At certain stages in the child’s life, a portion of the trust’s principal is released in a lump sum to the child. A typical scenario has the trust making a distribution of 1/3 when the child turns 25, one half of the principal when the child turns 30 and the final distribution when the

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Legally Speaking . . . continued from page 6.

child turns 35. The child beneficiary still may access the trust assets for income and principal for her needs, but once the distribution is made, the funds lose their protective shield. While this type of trust is still the most commonly drafted inheritor’s trust, we do not promote this old-fashioned strategy in our office. In today’s society, with its litigiousness and high divorce rate, automatically forcing out assets from behind the protective walls of a trust often results in the child losing the asset as quickly as it was distributed. 4. Lifetime Trust: This type of trust (which is also called a Personal Asset Protection Trust or Discretionary Trust) holds and manages the child’s inheritance for the life of the child. An independent Trustee is usu-ally chosen to manage the trust and many times the child can serve as co-

Trustee. The Trustee may distribute trust income and principal to or for the beneficiary’s benefit according to various guidelines and inspirational incentives that the parent drafts into the trust document. For example, popular guidelines include trust dis-tributions for purchasing a home or professional practice, cross cultural travel, higher education, fertility and adoption expenses, funds to allow a child to stay home and raise their children, humanitarian missions, purchasing a car, self-enrichment programs… the guidelines are lim-ited only by what the parents wish to inspire their children to do and experience.

I like to think of the Lifetime Trust as a castle with strong walls, crocodiles in the moat and archers on the rooftops. The inheritance is

Continued on page 9

8

By Douglas C. Parham, CPA — Boldt, Carlisle & Smith, LLC

Planningt A X

What’s in Your Business Plan for 2010

Once per year I try to write an article that brings to real life the

activity or operations of the Internal Revenue Service (IRS). Recently I noticed an article that announced the release of the joint IRS and Treasury priority guidance plan (the Plan). The Plan is issued annually and it is com-monly referred to as the IRS business plan. It was released on November 24, 2009 as most Americans finalized their Thanksgiving Day menus and it covers the fiscal year from July 2009 to June 2010. Interesting that it does not cover the Federal fiscal year which is October to September.

The projects listed in the Plan number 315 and are organized into 15 categories. Three of the categories: Tax Administration, General Tax Is-sues, and Employee Benefits include 171 of the 315 projects. Categories have been established by return/entity type: Consolidate Returns, Corpora-tions and Their Shareholders, Exempt Organizations, Gifts and Estates and Trusts, Partnerships, and Subchapter S Corporations; Industry: Financial Institutions and Products and Insur-ance Companies and Products; and General Topics: Employee Benefits, Excise Tax, International Issues, Tax Accounting, Tax Administration, and Tax-Exempt Bonds.

The final eight pages of this 35-page document is devoted to an Appendix which identifies Regularly Scheduled Publications to be issued on a month to month basis through-out the fiscal year.

Continued on page 9

The Plan was developed using feedback from interested parties including taxpayers, tax practitio-ners, and industry groups. I bet you didn’t know you had the opportunity and were solicited for suggestions. The IRS did this through Notice 2009-43 which was issued on May 4, 2009. The purpose and goals of the Plan are to focus or channel re-sources on guidance items that are most important to taxpayers and tax administration.

Therefore, as a result of the cur-rent experience of processing tax and information returns corresponding with taxpayers concerning their filed or unfiled returns, and auditing for compliance, completeness, and ac-curacy, the IRS has compiled a list of issues which they feel warrant at-tention, further development and/or corrective action.

On March 16, 2010 the IRS is-sued the First Periodic Update of the 2009-10 Priority Guidance Plan. The update adds 31 projects and indicates the publish dates of projects com-pleted to date.

This document, as I mentioned earlier, is the Business Plan for the IRS. It is a very useful tool for op-erating an organization as large as the IRS. There is detail that offers direction or a “to do” list to employ-ees working to fulfill the guidance plan. And there is a list of scheduled publications by calendar month that provides direction and information both internally and externally.

Writing a business plan can be a challenge, but it can also be very rewarding and beneficial to an or-ganization and pave the pathway to success for your business. I would put the challenge out to all of you to write a business plan. To do so here are some helpful hints:

• Identifythetop10servicesyourbusiness delivers to its clients/customers/patients.

• Analyzetheprocessyouusetodeliver these services: who is involved, what tools, equipment, or outside services are used, what are the benchmarks or key steps toward completion, and what procedures are performed along the way.

• Identify10-15ideasforimprov-ing these processes.

• Usinga2010calendar,identify3-5 regularly scheduled items per month that your business must accomplish to function (payroll pay date, accounts payable pay date, annual continuing educa-tion conferences, professional committee meetings).This type of business plan can be

very helpful for goal setting, goal attainment, transition planning, training new members of your or-ganization, and generally giving you and others a sense of confidence about the day to day function of your business.

To view the IRS 2009-10 priority guidance plan, go to the IRS website

9Chart Notes®

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www.IRS.gov, click on “About IRS”, click on “Strategic Plan and Other References”, and click on “Priority Guidance Plan”. Okay, it’s not a best seller and you may not even understand exactly what they are talking about because of the references to code sections, revenue rulings, and various acronyms, but look at it and consider the workings of your own business. How do you know what to do each day? How do your employees know what to do today, tomorrow, next week, next month? In what ways will your business improve internally or externally in the next twelve months? Doug Parham, CPA is a partner with the firm of Boldt, Carlisle & Smith, LLC, Certified Public Accountants, which serves clients throughout the Willamette Valley and around Oregon from offices in Salem, Stayton, and Albany. He can be reached at (503) 585-7751 or at dparham@bcsllc.com. For more information please see www.bcsllc.com.

Tax Planning. . . continued from page 8. Legally Speaking . . . continued from page 7.

safely placed in the castle vault and a Gatekeeper (the Trustee) controls the castle gate. If the child needs money for purposes outlined by the parents, or for his general health, education, mainte-nance, or support, the Gatekeeper may, in its discretion, open the gate – and only then will funds leave the protective walls of the castle. If the child, however, is threatened with divorce, lawsuit, bankruptcy, or if the child is troubled by addiction or disability, the Gatekeeper may close the gate, bring down the portcullis, and protect the inheritance from being taken away or lost.

The Lifetime Trust provides the most flexible vehicle for values-based legacy planning. It also provides the greatest degree of financial stewardship and asset protection, including protections against divorce, bankruptcy, and law-suits such as malpractice or personal in-jury. Once parents learn the benefits of the Lifetime Trust, it quickly becomes

the strategy of choice – perfectly suited for today’s changing world.

Next issue, we’ll look at how we designed the Ray’s estate plan to provide a values-based family legacy with the desired incentives, guidance, and protections for their children and grandchildren. For a free copy of sample Lifetime Trust guidelines you can incorporate into your own estate planning, please email us at Office@EdenRoseBrown.com. This article is a publication of the Law Office of Eden Rose Brown. Our purpose in publishing this article is to inform our readers, clients and friends of recent legal developments. It is not intended, nor should it be used, as a substitute for specific legal advice as legal counsel may only be given in response to inquiries regarding particular situationsAttorney Eden Rose Brown is dedicated to providing comprehen-sive, highly personalized, counsel in wealth preservation strategies, asset protection, family legacy design, and estate, tax and chari-table planning. She holds the highest standards of scholarship, client service and lawyer accessibility. Eden has been honored as an Oregon Super Lawyer by her peers, and Worth magazine has twice selected her as one of the Top 100 Attorneys in the United States. Eden is a past director of the Marion-Polk County Medical Society Foundation, Willamette Humane Society, and the Chemeketa Community College Foundation. The Law Office of Eden Rose Brown is located at 1011 Liberty Street SE, near downtown Salem, with additional offices in Bend and Portland. Phone: (503) 581-1800 Email: Eden@EdenRoseBrown.com. Web: www.EdenRoseBrown.com

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11Chart Notes®

President’s Message . . . continued from page 3.

have followed, with seiches (seismic related waves in closed bodies of water)reported as far away as Lake Pontchartrain, Louisiana; tsunami waves from the initial earthquake were reported in New Zealand, Hawaii and many Pacific Islands, as well as around the Pacific Rim. As if these natural phenomena were not enough of a wake up call for disaster prepared-ness, there have been a succession of sizable earthquakes around the “Ring of Fire” since Chile, including here in Oregon(March 28th 2010).

What have we done in Salem to pre-pare for such a natural disaster? The photos and videos of the devastation in Chile, so close on the heels of the destruction from Haiti’s earthquake, made me reprioritize my “to do” list: I moved an update for my personal plans for disaster preparedness to the top. I have increased my water supply, added a capacity to filter water, and stocked up on dry goods to last up to a week. I refreshed and updated my medical and emergency care supplies, as well as made plans for maintain-ing methods of communication with family and friends. I am working on

plans for heating and powering up some devices should those services be disrupted. I have assessed where there are potential “void” spaces (areas next to strong objects which would form gaps if items fell around or on them). These “voids” could act as safe spots inside a home or office, if furnishings or structures begin to shake loose. I hope by now that everyone knows that doorways, and spaces directly under furniture (like a desk or table) are not thought to be the safest places in an earthquake. I also have mapped out primary and alternative paths to turn off utility services to the house if they are damaged in a quake. Do not wait to make your plans for home and office.

Governor Ted Kulongoski has declared the month of April 2010 as Earthquake and Tsunami Awareness month. The Oregon.gov websites include maps of coastline at risk and escape routes for tsunamis, as well as instructions on how to prepare your home, business or office for a disaster. Our Marion Polk County Medical Society Disaster Preparedness Task Force has continued to meet since last year’s conference with national expert, PK Carlton. They are working to de-velop a follow up conference for the medical community in the region to see what “best practices” folks have adopted, which could be modeled for others. Dr. Doug Eliason, DO, family practice in Salem, is also the Disaster Preparedness Task Force leader for the OMA Com-munity Health Committee. He is working with physicians from around Oregon to develop a statewide program for a CME physician training for disaster preparedness, which is not currently available in the Northwest.

Continued on page 12

12

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BRINGING HOPE…Medical Director, Volunteer Position Open

have the right person assist us as we continue to strive for excellence in health care.In addition, volunteers are needed in areas such as: Healthcare Providers, Receptionists, Medical Records Clerks, Interpreters, Administrative Assis-tants, MedAssist and Project Access Assistants and Social Services.

Medical Director Position: This is a Volunteer Position, accountable to and serving on the SFMC Board of Direc-tors to provide expert professional consultation and guidance to the clinic on a wide range of medical topics.

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Some Typical Duties: Provide leadership in the development and monitoring of the scope of medical treatment given at the clinic. Col-laborate with the Medical Trainer to train volunteer medical providers through classes and direct supervi-sion. Oversee FTCA malpractice coverage, ensuring SFMC is 100% compliant. Make personal appear-ances to provide information about SFMC to churches, civic clubs, businesses and other organizations. Attend SFMC Board of Directors’ meetings.

For a full list of qualifications required for this position or if you are inter-ested in this exciting opportunity to make a difference in our community, please contact Todd Gould at (503) 930-1759 or todd@wsfc.org

President’s Message . . . continued from page 11

My awareness of earthquake readi-ness has come a long way since my first experience in 1976. My family had just moved to Southern Califor-nia. It was early in the morning, and everyone was still in bed when a sound like a train echoed through our home, while the furniture began to sway. It

lasted long enough for my younger brother and I, in our “wisdom,” to jump up on our beds and yell “cow-abunga” as we “surfed” the earth’s waves. How little we knew then: we all know better now. Awareness is half the battle, but its time to make more firm preparations for the future.

13Chart Notes®

Photo by Crystal Image Photography

On February12, 2010, Drs. Bud and Selma Pierce were honored at the 60th

Annual First Citizens Awards Banquet as Salem’s First Citizens for 2009. This award, given each year by the Salem Area Chamber of Commerce, recognizes the “‘quiet giants’ throughout the community, many who work behind the scenes taking no credit for their good works” according to the Chamber.

Anyone who knows the Bud and Selma will understand why they have received this distinguished award. Not only is it their significant community service and tireless dedication to members of our community, it is that very special relationship they have, complimenting and supporting each other through all they do.

Salem’s 2009 First Citizens

The hands-on START trainings are designed to help practices:Improve developmental and behavioral screening in accordance with AAP policy statements •and Bright Futures guidelines.

Improve understanding and utilization of standard developmental, behavioral and psychosocial screening tools.•

Learn proper documentation, coding and billing of screening tools.•

At the conclusion of this training, participants will be able to:Recognize the continuum of clinical surveillance, standardized screening and diagnosis•

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Know how to administer and score selected screening tools•

Know more about local community resources and how to make timely referrals•

Implement efficient office procedures for screening and referral•

Code for these services•

This training is for pediatricians, family practice physicians, pediatric nurse practitioners, other mid-level providers, and office staff.

Physicians, nurses, assistants and administrators from the same practice should attend as a team.

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Brought to you with local assistance from:

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15Chart Notes®

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181.004 Chart Notes 14 ad.indd 1 3/18/10 1:39 PM

GEM Children’s Foundation

Opens OfficeThe GEM Children’s Founda-

tion, a legacy of Dr. George E. Miller, has opened a center which is shared with Juntos Podemos and Swindells Resource Center. All three organizations serve families who have children with special health-care needs. The new space, which contains offices, meeting rooms, play area, and a library, is found at 2475 Lancaster Drive, across from Family Building Blocks. The opening recep-tion was held April 1st . The event was hosted by Commissioner Janet Carlson and Randy Franke, Board President of Marion County Chil-dren and Families Commission.

GEM continues to collaborate with existing organizations to

provide help for families. In April there will be a series of classes on nutrition and autism held in the Gehlar Wellness Kitchen in the CHEC at Salem Hospital. GEM and the Autism Society of Oregon sponsor a game night at the center on Lancaster the last Friday night of every month.

GEM will be sponsoring the Oregon Pediatric Society START training (Screening Tools and Re-ferral Techniques) for physicians in the CHEC at Salem Hospital on April 17th. More information on programs and activities may be found at www.gemchildren.org or by calling Ellen Miller, Executive Director, at 503-585-4262.

The Marion County Health Department, in collaboration with Marion County Emergency Management and the City of Salem,

will be hosting an emergency preparedness brainstorming summit in early May. The purpose of the summit is to hear from community mem-bers about what you think a prepared Marion County looks like.

In the wake of H1N1 and all of the earthquakes in Haiti, Chile and Cali-fornia, the Health Department feels that it is critical that Marion County be as prepared as possible. To receive more detailed information about the summit and to sign up, please contact: Jamie Petts at (503) 373-378; or Sara Fillion at sfillion@co.marion.or.us or (503) 584-4844.

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16

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home and practice at a moment’s notice to respond to a crisis anywhere in the country. He says that in order to do his job, he needs to know his own family is safe and secure. To that end, the Eliasons created a personal disaster plan—and they review it ev-ery six months. “If you don’t remind yourselves,” he says, “you forget the details.”

In case of emergency, the family has enough food and water on hand for seven days, they keep car gas tanks at least half full and can use the fuel to run critical circuits in the house, they have an agreed upon rallying point, and know who to call outside the area for a common check in. “If phone lines are scarce,” Eliason says, “you don’t want to have to call all over the place trying to find out where every-body is and how they’re doing.”

In addition to a personal disaster plan, Eliason pays attention to the plans developed by organizations. In his role as Deputy Surgeon in the United States Northern Command (Northcom), he has had the opportu-nity to review and critique prepared-ness plans generated by both military and civilian organizations. When the Marion Polk County Medical Society Board began discussing the role of the Society in organizing a disaster response, Eliason had a lot of advice to offer. “We started exploring some issues and realized everybody was do-ing their own thing,” he says. “Every-body was planning, but do the plan-ners ever talk together? The hospital was thinking about preparing the building, making sure the generators would work, and getting staff there. The city was preparing from the

standpoint of how EMS would work. The County was thinking about how to provided that level of governance needed even in a disaster—how to provide services. But medically, we weren’t really getting together to talk about what was going on. We started at the hospital, but realized this wasn’t really a hospital project. This is a community responsibility and that’s why, after some discussion, we moved to the medical society. Whatever we planned for the hospital only ad-dressed physicians who were on the hospital staff. The medical society allowed us to broaden our view. Now we have ways to work with and assist anybody in the community who’s medical, whether or not they have medical staff privileges and looking at roles they might have in a disaster, things they might do to be relevant

When disaster Strikes . . . continued from page 1.

Continued on page 17

17Chart Notes®

When disaster Strikes . . . continued from page 16.

to their community. We can also be a force for bringing different groups together.

“There’s a saying in the business,” he says, “that when disaster strikes, it’s not the time to start exchanging business cards.”

Eliason wasn’t the only one con-cerned about the silo effect of organi-zations planning in isolation. Several members of the new task force had their own stories about the impor-tance of coordinating efforts. In Sri Lanka, six months after the tsunami hit, Jim Lace had seen first-hand what happens when NGOs and govern-ments don’t talk to each other. Among other examples of inefficiency, Lace and his colleagues from North-west Medical Teams found them-selves “dumpster diving”--searching through enormous containers full of medications and supplies abandoned by previous responders who had no mechanism to share resources. Continued on page 18

we faced the real world prospect of maintaining services, medical and otherwise, with up to 40% of the workforce incapacitated. Fortunately, we dodged that bullet with only a fraction of the flu cases we might have seen. Whether we were spared because of immunization and educa-tion, or kismet, we may never know. We do know planning and prepara-tion are never wasted and the task force is ready to get rolling again. Airplanes are flying, plotters are plot-ting, and tectonic plates are grinding. And if that’s not motivating enough, JCAHO has put itself in the middle of the mix.

The organization’s involvement should come as no surprise. In a May, 2008 Time magazine article about the psychology of disaster response, Amanda Ripley cited a fatal 1977 restaurant fire in Cincinnati, Ohio. “But even among the guests,” she

Christine Clarke served on a di-saster planning group as a military surgeon. In addition to their existing hospital, the team identified another building on base that would serve very well as a auxiliary, or alternate, care space if the need arose. But the doctors discovered later that their security colleagues had selected the same building for a different purpose and placed it inside a defense perim-eter inaccessible to medical personnel. She laughs when she reports that she was told by a fellow officer, “If you’d have crossed that line, ma’am, I would have had to shoot you.” Although it makes a funny story now, Clarke says it highlights the need for the various plans to mesh and for the planners to sit around the same table to better understand each other’s visions.

Over the last year, the task force’s natural and/or man-made disaster-planning momentum got diverted to preparing for H1N1. Suddenly,

18

writes, “identity shaped behavior. The doctors who had been dining at the club acted as doctors, admin-istering CPR and dressing wounds like battlefield medics. Nurses did the same thing. There was even one hospital administrator there who — naturally — began to organize the doctors and nurses.”

And JCAHO is doing what it does. According to standard EM.01.01.01, an accredited hospital “together with its community partners, prioritizes the potential emergencies identified in its hazard vulnerability analysis and documents these priorities.” A number of other standards address the hospitals’ responsibilities for preparedness and communication. Physicians get involved in standard EM.02.02.07 with the requirement that “the hospital communicates,

When disaster Strikes . . . continued from page 17.

in writing, with each of its licensed independent practitioners regarding his or her roles in emergency response and to whom he or she reports during an emergency. There is also a medical staff bylaws requirement for grant-ing disaster privileges to volunteer a licensed, independent practitioners.

If you would like to become in-volved with the disaster task force at the Marion Polk County Medi-cal Society, please contact Board president Mark Gilbert or any of the other above-mentioned physicians or Medical Society staff. If you would like to get involved at your hospital, contact your hospital safety officer or medical staff secretary. If you would like to know more about developing a family disaster plan or constructing a 72-hour survival kit, go to www.ready.gov.

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19Chart Notes®

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Editor’s Note: We tip our hat to members of the Medical Society who have recently earned an award, been recognized by their specialty societies for their contributions or have been recognized for some outstanding accomplishment within the community. We welcome any information you may have on yourself or your colleagues and will try to publish the acknowledgment in this section.

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Chart Notes®