Az doc-to-patient ratio below national average

Medical student Nathaniel Rial checks on patient Rachel Trefry at the UA College of Medicine on Tuesday morning. Rial will graduate Friday.

It’s a choice fewer young doctors make.

When they recite the Hippocratic Oath on Friday, University of Arizona College of Medicine graduates Erica Lindsey and Nathaniel Rial will pursue residencies as primary care physicians. Generalists in an industry dominated by specialists, primary care doctors make hundreds of thousands of dollars less than cardiologists or neurosurgeons and work less-than-predictable hours.

Rial will remain in Tucson, beginning a three-year residency in internal medicine that will have him seeing patients at University Medical Center, Tucson Medical Center and the Southern Arizona VA Health Care System.

He spent his last week as a medical student studying for exams and working in a lab at the Arizona Cancer Center.

This summer, Lindsey will begin a three-year residency in primary care at St. Joseph’s Hospital and Medical Center in Phoenix. She spent much of the past two weeks moving into a new place.

The pair will gut out long hours, which, in the end, probably will reduce their salaries to “a little more than minimum wage,” Lindsey joked.

In recent interviews, both of the doctors-to-be said they entered primary care to fill a need.

Nearly half of the 124 students who will graduate from the UA medical school on Friday will remain in Arizona for at least the next three years, as they complete residencies at hospitals throughout the state. More than a third of the class of 2009 will go into primary care.

These are not insignificant numbers given the state’s overall shortage of doctors.

Arizona has 214 physicians per 100,000 patients, a ratio well below the national average of 250 doctors per 100,000 patients. A 2007 study by the Association of American Medical Colleges ranked Arizona 33rd out of 50 states based on that doctor-to-patient ratio.

The state’s ranking drops to 39th when the focus shifts to primary care.

In 2007, the latest data available, Arizona had 4,719 primary care physicians, a ratio of about 77 per 100,000 patients. Nationwide, the number of primary care physicians per 100,000 patients stood at 88 in 2007.

“We have more of a shortage than is found nationally,” said T. Philip Malan Jr., vice dean for academic affairs at the UA medical college. “I like it when our students go into primary care.”

As an area of practice, primary care requires physicians to do a little of everything – pediatrics, family and internal medicine, general surgery and obstetrics and gynecology.

No one can predict how many of the 43 UA medical school graduates will remain in primary care after completing their residencies.

A 2008 report by the Council on Medical Education found that 55 percent of the nation’s internal medicine residents in 2006 chose to enter a subspecialty the following year. Nearly 40 percent of pediatric residents chose to specialize as well.

A residency in primary care or internal medicine constitutes a “gateway” to specialty practices, Rial said.

He has yet to decide whether he will remain in primary care after completing his residency. Because the tuition at UA – around $18,000 a year – remains cheaper than at two-thirds of the nation’s medical schools, Rial said he has the “flexibility” to weigh his options.

“I think another way to look at why so few are going into (primary care), so many are following other pathways, is for lifestyle or quality-of-life issues,” Rial suggested.

The Council on Medical Education report found that nearly three-quarters of medical school graduates “reported that lifestyle had a strong influence on their choice” of specialty.

Mounting debt also factors heavily in medical students’ after-graduation decisions, according to the study. The average U.S. medical student had about $127,000 in debt in 2007, up 43 percent from 2000.

“You have a house in your brain by the time you’re done,” Lindsey said of the cost to complete four years of medical school.

The debt graduates must repay likely forces many of them into more lucrative specialties, she said..

“We don’t compensate (primary care doctors) well,” said Steve Nash, executive director of the Pima County Medical Society.

According to the U.S. Bureau of Labor Statistics, a family or general practitioner in Tucson can earn an average of $148,030 annually. Doctors in other specialties earn on average $52,000 more per year.

“One can live pretty well as a doctor in any specialty,” Malan said. “A student has to have a passion for primary care.”

The 43 UA graduates headed into primary care this year represent 35 percent of the graduating class.

“That’s about average for us,” Malan said.

It’s about twice the average in Pima County.

Of the 2,800 or so physicians practicing in PIma County, about 500 – 18 percent of them – focus on primary care, according to Nash. That’s about 50 primary care doctors per 100,000 patients, or 38 below the national average.

In rural or impoverished areas, like the Navajo reservation where Lindsey grew up, the average can be much worse.

“There’s a big need for primary care doctors,” Lindsey said. “It’s kind of always been the focus for me.”

Because Rial and Lindsey will remain in Arizona for their residencies, they are more likely to stay in the state afterward.

Arizona ranks 12th in the nation based on the number of its doctors who studied and completed residencies in the state, according to the Association of American Medical Colleges.

The UA medical school hopes to incrementally increase the number of doctors it trains annually, Malan said, by increasing its enrollment to 115 students per year, up from 110. “It’s all about training more physicians,” he said.

It’s long been a rule of thumb in medical circles that a doctor stays where he or she trains.

Lindsey said there’s a simple reason for that: life.

“You’re almost 30, you have a family or are thinking about starting one,” she said. “You’ve got relationships with the doctors you’ve worked with.”

Rial and his wife moved to Tucson 12 years ago.

“We’ll be here at least three more years,” he said.

Source: Association of American Medical College’s “2007 State Physician Workforce Data Book”

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BY THE NUMBERS

The University of Arizona College of Medicine will confer doctor of medicine degrees during a ceremony on Friday. The 2009 class includes:

• 124 graduates

• 66 women

• 58 men

• 17 Hispanics

• 2 Native Americans

• 61 who will remain in Arizona for their residencies

• 43 who will go into primary care

Source: University of Arizona College of Medicine

———

Arizona Doctor Shortage

The University of Arizona produces about 100 medical school graduates per year, according to the Association of American Medical Colleges. Nationwide, about 16,000 graduate from medical school every year, not nearly enough to keep pace with the country’s growing population, most observers say. Compared to national averages, the shortage of doctors in Arizona is more pronounced.

Active physicians per 100,000 patients

U.S.: 250

Arizona: 214

Arizona’s national rank: 33

Active primary care physicians per 100,000 patients

U.S. 88

Arizona: 77

Arizona’s rank: 39

Percent of active physicians in each state who completed undergraduate medical education in the state

U.S. average: 29 percent

Arizona: 10 percent

Arizona’s rank: 41

Percent of active physicians in each state who completed a residency or fellowship in the state

U.S. average: 45 percent

Arizona: 25

Arizona’s rank: 38

Percent of active physicians who graduated medical school and practice in the same state

U.S. average: 39 percent

Arizona: 47 percent

Arizona’s rank: 14

Percent of active physicians who completed graduate medical education and practice in the same state

U.S. average: 47 percent

Arizona: 47 percent

Arizona’s rank: 18

Percent of active physicians who graduated from medical school, completed graduate medical education and practice in the same state

U.S. average: 66 percent

Arizona: 73 percent

Arizona’s rank: 12

———

Convocations and graduation

The University of Arizona’s colleges and schools began holding convocation ceremonies Wednesday. The College of Medicine convocation for candidates for a degree in medicine, will be at 5 p.m. Friday at Centennial Hall.

The campuswide commencement ceremony is 8 a.m. Saturday at McKale Center.

The following are the remaining school and college ceremonies scheduled for this weekend.

Friday:

Eller College of Management, undergraduates, 1 p.m. at McKale Center

College of Nursing, 1 p.m. at Centennial Hall

College of Social and Behavioral Sciences, 2 p.m. at Tucson Convention Center arena

University College, 3 p.m. at Integrated Learning Center

College of Optical Sciences, 5 p.m. at Integrated Learning Center 130

Saturday:

College of Agriculture and Life Sciences, 11 a.m. at Centennial Hall

College of Architecture and Landscape Architecture, 11 a.m. at Crowder Hall

College of Medicine, physiology undergraduates, 11 a.m. at Student Union Memorial Center

College of Law, 2 p.m. at Centennial Hall

Eller College of Management, graduate students, 5 p.m. at Centennial Hall

For more information on each college convocation, visit commencement.arizona.edu/collegeconvocations

Tucson International Airport’s Concourse P is living up to its name with a designated pet area where visiting canines can relieve themselves.

Thanks to an amendment to the Air Carrier Access Act that went into effect Wednesday, the Prickly Paws Pet Stop can be found just outside the terminal building on its east side.

Kececioglu

Someday, genomic sequence testing will help doctors identify whether newborns will develop health problems later in life.

That may seem like science fiction now, but improved technologies and techniques are making genetic sequencing quicker and far less expensive.

Mapping the human genome the first time cost about $3 billion, said John Kececioglu, University of Arizona associate professor of computer science and BIO5 Institute member. Some operations have brought the price down to $5,000.

Kececioglu is conference chair for RECOMB2009, an international conference on computational molecular biology research that will run Sunday through Thursday in Tucson.

Genomic sequencing determines the order of key components in genetic material. Abnormalities such as mutations can mean certain diseases are likely to develop.

All biological processes are governed by the 3 billion lettered segments and their order in human DNA, he said.

“There is a goal to have a $1,000 genome test that a person can actually purchase,” Kececioglu said. “Companies are making use of this data to uncover what disease susceptibilities an individual has.”

Genomics and the environment, including such behaviors as smoking and drinking, contribute to disease, and researchers are trying to offer insights on DNA’s role in the equation, he said.

In addition to identifying the diseases a person is likely to get, markers in a sequenced genome can offer information on which drugs and therapies will best help a person prevail against a specific type of cancer or other disease, he said.

“It’s key to prevention,” Kececioglu said. “It could make health care much more efficient and effective.”

“It’s certainly becoming affordable,” he said. “You do it once in a lifetime. Your genome does not change.”

Continued decreases in price could make use of the tests more commonplace.

If the cost drops to $1,000, it could make economic sense to sequence DNA on all 4 million children born in the United States each year, said Rade Drmanac, chief scientific officer and co-founder of Complete Genomics Inc.

Drmanac will participate in a RECOMB2009 industry panel discussion on personalized genomics.

His Mountain View, Calif., company offers sequencing to research organizations and drug discovery firms for $5,000.

Sequencing efficiencies are expected to increase in the next two to three years, he said, and costs will continue to go down, opening the door for widespread use of the technology.

“The bottom line is we know that having complete and accurate genome sequencing is an absolutely necessary basis for the advance of low-cost health care,” Drmanac said. “We need to do complete genome sequencing to find the genomic basis for disease.”

Pre-diagnosis leading to targeted checkups and early detection can save lives.

Although information from sequencing can benefit health, some fear it could also be used by insurance companies to deny coverage, Kececioglu said.

“The privacy issues are very important. That information is not shared with anyone besides the patient,” he said.

RECOMB2009 will attract 275 top researchers in the computational, mathematical and biological sciences coming from 18 nations, Kececioglu said. It is not open to the public, however.

The BIO5-hosted event, he said, will offer the latest information on how computers help make sense of the huge amount of bioresearch data being produced.

Leslie Boyer, director of the Venom Immunochemistry, Pharmacology and Emergency Response Institute, holds a tube containing a dead bark scorpion at her office at Drachman Hall, 1295 N. Martin Ave.

Dawn Bray worried she might lose a second child to a scorpion’s sting.

A bark scorpion stung her 6-year-old son Morgan last May. As the family rushed him to the hospital in Globe, a wave of fear came over Bray. Six years earlier, in May 2002, she lost her 2-year-old son Dally to a bark scorpion’s sting.

“When Morgan got bit, I was thinking that it was happening again,” Bray recalled this week. “With another son, we would have the same outcome.”

From Globe, doctors flew Morgan to Tucson for treatment. He received a dose of Anascorp, a scorpion antivenin used widely Mexico but not approved for general use by the U.S. Food and Drug Administration.

Morgan made a speedy recovery. Just hours after his treatment, the Brays ate dinner together at a McDonald’s before making the two-hour drive back to their home about 25 miles south of Globe.

Morgan’s survival means that his brother “did not die in vain,” Bray said.

After Dally’s death, the Brays met with Leslie Boyer, director of the University of Arizona’s Venom Immunochemistry, Pharmacology and Emergency Response Institute. Dally received an antivenin but died anyway, his mother said. The family wanted answers.

Of the 60 scorpion species and subspecies in the U.S., only the Arizona bark scorpion is dangerous to humans; consequently, scorpion sting deaths are exceedingly rare in the United States, with fewer than a half-dozen in the past decade. But in equatorial countries more people die of scorpion stings than venomous snake bites. More than 1,000 people a year die from scorpion stings in Mexico, according to an article in eMedicine, an online medical journal.

Two years after Dally’s death, Boyer and a team of UA researchers began studying Anascorp, a drug Mexican doctors used regularly to treat those severely affected by scorpion stings. The UA researchers published their findings in the May 14 issue of The New England Journal of Medicine.

The study focused on 15 children hospitalized for severe reactions to scorpion stings in 2004 and 2005. Eight received Anascorp, which the FDA considers an “investigational drug.” Seven received a placebo.

Symptoms of nerve poisoning disappeared in less than four hours in the children treated with the antivenin. In the placebo group, symptoms lasted for several hours. Children not treated with Anascorp required sedation and longer hospital stays, the study found.

Bark scorpion venom “goes to every nerve of the body and tells them, ‘Fire!’ ” Boyer said.

In the worst cases, the bark scorpion’s venom can cause respiratory failure.

Scorpions sting about 8,000 people in Arizona every year. In Mexico, where Anascorp is widely available, scorpions sting 250,000 people a year.

In about 200 cases a year in the U.S., usually involving children, nerve poisoning becomes severe enough to require hospitalization.

Children in Tucson can go to a hospital emergency room for treatment, Boyer said. “But what about the baby in Morenci, the toddler in Globe?”

The UA study has expanded to include 24 Arizona hospitals. About 600 patients have received Anascorp since 2004, Boyer said.

Even in rural areas, severely affected children can receive the treatment within an hour of getting stung, the doctor said.

Whether the study’s findings will lead to FDA approval remains unclear. “We’re the only state in the country where this is important,” Boyer said.

For the Brays, it was a matter of life and death.

“Dr. Boyer was our angel,” Bray said. “If she trusted it, we trusted it.”

Dr. Leslie Boyer holds a tube containing a dead bark scorpion.

Three-digit temperatures have hit Tucson, making it an ideal time for the Salvation Army’s Operation Chill Out to begin.

The summer donation campaign for homeless people starts Wednesday.

“With the heat rising, more displaced and at-risk Tucsonans are going to find themselves needing important resources such as water and basic day-to-day items,” said Salvation Army spokeswoman Tamara McElwee.

To enhance this year’s efforts, the Salvation Army has teamed up with Walgreens and Naughton’s Plumbing, Heating and Cooling.

Walgreens locations throughout the city are hosting summer specials where customers can purchase select, tagged items found near the register that are donated to the Salvation Army.

Walgreens’ Sierra Vista store, which piloted the program, has seen about $100 worth of the tagged bottled water, soup, seasonal items and other goods donated each week.

People can also donate bottled water, hats, sunglasses, sunblock and lip balm by dropping them off at The Hospitality House, 1021 N. 11th Ave., or one of five Naughton’s locations:

• 1140 W. Prince Road

• 3940 W. Costco Drive

• 4226 S. Sixth Ave.

• 6062 E. Speedway Blvd.

• 8190 E. 22nd St.

School may be out soon, but free meals will still be in for Sunnyside Unified School District.

Starting June 1 and running through July 24, free breakfast and lunch will be served to kids 18 and younger who live within the district’s boundaries, according to a district news release.

Breakfast will be from 7:30 to 8:30 a.m. and lunch served from 11 a.m. to 12:30 p.m. at the the following locations:

• Billy Lane Lauffer Middle School, 5385 E. Littletown Road

• Challenger Middle School, 100 E. Elvira Road

• Craycroft Elementary School, 5455 E. Littletown Road

• Gallego Basic Elementary School, 6200 S. Hemisphere Place

• Liberty Elementary School, 5495 S. Liberty Ave.

• Santa Clara Elementary School, 6910 S. Santa Clara Ave.

• Sierra Middle School, 5801 S. Del Moral Blvd.

• Sunnyside High School, 1725 E. Bilby Road

• San Xavier Indian Community Education Center, 1960 Wa:k Lane

The head of Pima County’s health department will join Arizona’s director of health services and others in a public briefing here Wednesday on H1N1, the swine flu virus.

The lecture will be from noon to 1 p.m. at the University of Arizona College of Medicine’s DuVal Auditorium, 1501 N. Campbell Ave.

Among the scientists who will speak are Nafees Ahmad, Ph.D, a professor in the department of immunobiology, on the virology of the disease, and Katie Mathhias, Pharm.D, on therapeutic options for treatment of the virus.

Pima County would be hit with about $13 million more in contributions to the state long-term care program under a House committee proposal in the still-unapproved Arizona budget.

The proposal by the House Appropriations Committee would hit Pima and Maricopa counties for a combined $55 million more in contributions to the state general fund in the coming fiscal year – with Maricopa contributing the majority.

The proposal drew immediate response from Pima County officials, who this fiscal year had to scramble to replace $3.2 million from case reserves taken by the state to balance this year’s state budget.

“We weren’t pleased with the added $3.2 for ALTCS last year, let alone the $13 million more now,” Martin Willett, deputy county administrator, said Friday.

The long-term care program pays for people in nursing homes and health care for the blind and the disabled.

Willett said the $13 million the county could be paying was not included in the recently-released fiscal 2010 county budget of about $1.37 billion. The budget is scheduled to be tentatively approved May 19. The fiscal year begins July 1.

County officials have worked since late last year to eliminate a projected $38 million budget deficit – mostly through across-the-board department cuts of 7.5 percent to 10 percent, a wage and hiring freeze and layoffs, mostly in the Pima County Development Services Department.

“There was no real explanation from legislative staff on the rationale for this,” Willett said.

Rep. John Kavanagh, R-Pleasant Valley, is a proponent of transferring revenue from the counties to the state general fund.

Kavanagh on Friday said that the counties could see the money returned in the form of federal stimulus funding that will come to Arizona.

Kavanagh said the state budget is far from ready for votes by both the House and Senate, and transmittal to Gov. Jan Brewer.

“We still have a lot of talking to do,” he said. “It could be a week; it could be a month,” Kavanagh said.

County governments are experiencing budget crises just like the state, which has a projected $3 billion deficit for next fiscal year, Willett said.

“Are we just supposed to write them a check?” Willett asked.

There is no guarantee that the state would return the money to counties from federal stimulus funds, either, Willett said.

Lambeth in 2005

A medical malpractice lawsuit filed by the mother of a mentally ill man who stabbed his grandparents to death on April 10, 2005, is being heard this week in Pima County Superior Court.

The suit was filed by Lisa Lambeth and her sister, Karen McCollum, daughters of the late Carl Gremmler, 76, and Patricia Gremmler, 72, against a publicly funded behavioral health agency and the psychiatrist who treated Christopher Lambeth for bipolar disorder and schizophrenia.

Filed in March 2007, the suit alleges medical malpractice by the psychiatrist, negligence by the behavioral agency and asks for punitive damages from all defendants for the loss of their parents.

However, COPE Behavioral Services Inc. says in court documents that it “believes” Lambeth, now 24, “was wholly and/or partially at fault in causing” damages to the Gremmler family.

Lambeth pleaded guilty but insane to two counts of first-degree murder in March 2007.

His attorney, Ryan Metcalf, said then that Lambeth was in a psychotic state when he stabbed the couple multiple times in their bed. The bodies were found two days after the stabbings.

Lambeth, who had been living with them, was found lying in his bed at their home.

In April 2007, Lambeth was sentenced to two concurrent life sentences at the Arizona State Hospital in Phoenix.

According to documents in the civil suit, Dr. Virgil Hancock was a contract psychiatric provider for COPE.

He began treating Christopher Lambeth in late 2003 and was his psychiatrist until Lambeth killed his grandparents.

On Sept. 22, 2004, Hancock saw Lambeth “in the presence of his mother” and the youth reported he was taking his medications.

His mother said he wasn’t taking the medication and on Oct. 19, 2004, she called Hancock, asking that her son be admitted to a psychiatric hospital without going to an emergency room, but the psychiatrist refused.

On Oct. 26, 2004, she told Hancock her son “would not be medication compliant in the future and would become violent.”

On Nov. 16, 2004, he was admitted to Sonora Behavioral Health Hospital “after physically menacing his mother and punching holes in the walls at her home.”

“A COPE note prepared at or about this date signed by Dr. Hancock states that Christopher Lambeth was unable to control his anger and was homicidal and had a target and a plan,” the lawsuit states.

“This homicidal ideation was not disclosed to the family before, during or at any time after his hospitalization,” according to the lawsuit.

Lambeth was discharged from Sonora and then spent 24 hours at COPE’s Ocotillo drug treatment facility.

He was discharged on Nov. 19, 2004, and taken to his grandparents’ home.

A COPE case manager had called Lambeth’s mother and sister and asked them to take him into their homes. They refused, saying they feared having him in their homes.

His mother said he was “dangerous and violent” when he didn’t take his medications.

“No day program or other supportive behavioral health services were offered,” the suit states.

“The case manager then persuaded Christopher’s sister to transport Christopher directly from Ocotillo to his aging grandparents’ home.”

According to the suit, Lambeth’s mother repeatedly asked for residential behavioral health services for him in 2004 and was told none was available.

On April 7, 2005, Hancock saw Lambeth for a regularly scheduled appointment, along with his mother and his case manager.

“Lisa again asked COPE to get Christopher out of her parents’ home. No residential or other behavioral services were offered,” the suit states.

“(Lisa) expressed fear and concern about Christopher’s history of violence toward her and his grandparents when he was not taking his medicine.”

Lambeth said he wasn’t happy living in the rural community of Rillito with his grandparents.

Lambeth was incarcerated as a juvenile in 2001 for nearly 10 months in a domestic violence case. His parole in that case ended in October 2002.

In 2003, he was court-ordered to receive services from COPE after he was arrested for marijuana possession.

UA biologist Michael Worobey and 10 other scientists from around the world have posted their research on swine flu on an Internet "wiki" site.

As it turns out, the recent strain of swine flu has made people sick for far longer than many scientists have thought.

By studying the genes of the virus, University of Arizona biologist Michael Worobey and 10 other scientists from around the world have traced the outbreak’s rather humble beginnings to September, months before the media began reporting on the outbreak in Mexico.

Though new to humans, this strain of swine flu evolved from a variety of influenza viruses already well-known to researchers, Worobey and his colleagues determined this week.

“We’ve kind of shown conclusively that these are pig viruses,” Worobey said Thursday.

The UA professor and other scientists – some from as far away as the United Kingdom and Hong Kong – have published their findings online on a “wiki,” a Web site on which users can post and edit information.

“It’s like being in the same office,” Worobey said. “You’re able to critique and learn from stuff really quickly.”

Typically, scientists might sit on this kind of information and publish it later in an academic journal, the biologist said of the online group’s swine flu research. Worobey and his band of virus hunters thought providing real-time information might help epidemiologists avert a potential catastrophe.

Health officials in Arizona have confirmed 130 cases of swine flu – 22 in Pima County.

Nationwide, the virus has infected nearly 900 people in 41 states, according to the U.S. Centers for Disease Control and Prevention.

Epidemiologists have diagnosed nearly 2,400 people in 24 countries with swine flu, the World Health Organization reported Thursday.

In the event of a pandemic, WHO officials warned that as many as 2 billion could contract the virus.

From his reading of the data, however, Worobey doubts this iteration of swine flu poses such a dire threat.

Worobey, who has taught at UA since 2003, has spent much of his time studying the HIV virus that can cause AIDS. In 2007, he published findings that showed the HIV virus in the U.S. as early as 1969 – more than a decade before scientists had thought.

Worobey draws a common conclusion from his HIV and flu studies: “Epidemics take a long time to build up from the first case.”

Worobey and his colleagues will continue tracking the swine flu, trying to predict how it might evolve in the coming months.

“Everything we’ve seen so far is that it’s evolving the same way as the seasonal flu,” Worobey said.

———

Read the report:

To check out the research conducted by Worobey and his colleagues, go to http://tree.bio.ed.ac.uk/groups/influenza/.

Tucsonan due to complete last leg of 800-mile walk

Tucsonan Sirena Dufault, who has fibromyalgia, plans to complete an 800-mile hike of the Arizona Trail on Tuesday.

When she set out to hike the 800-mile Arizona Trail last spring, Sirena Dufault worried that she might not finish.

The daunting trail stretches from Utah to the U.S.-Mexico border.

Tucsonan Dufault’s concern stemmed from her decade-long battle with fibromyalgia, a little-understood chronic pain disorder.

“I was a little hesitant to publicize it because I didn’t know how far I could go,” Dufault said this week. “Now I can comfortably do a 15-mile day with a big pack, no problem.”

Tuesday – on national Fibromyalgia Awareness Day – the 35-year-old will make a final, eight-mile hike north of Oracle to complete the trail, trudging from the Tiger Mine Trail head to the American Flag Trail head.

Dufault kept an online journal throughout her trek, which she made mostly by herself in one- to five-day trips. Tuesday’s leg will mark the 80th day Dufault has spent on the trail.

Dufault said she hopes her success will inspire the 10 million Americans who suffer from the disorder. “There’s not a whole lot of positive information out there about people getting their lives back after fibromyalgia.”

Fibromyalgia’s symptoms include chronic, widespread body pain, according to the National Fibromyalgia Association. Symptoms can stem from an acute illness or injury, as in Dufault’s case. Her diagnosis came in 1998, a year after she was hit by a car as she crossed a street. For months afterward, even as her initial injuries healed, Dufault’s pain and fatigue worsened.

“I saw her probably at her worst,” said Angi Edge, a nurse and massage therapist who treated Dufault after her diagnosis and became a fast friend. “So many people give up on themselves. They become their disease. She was just not going to give up.”

Dufault’s pain has not flared up in a major way in the past three years, she said. “I attribute that to being very, very active.”

For her next big adventure, Dufault might hike the Tonto Trail in the Grand Canyon. She walked 25 miles of that 90-mile trail last winter.

———

Read about Sirena Dufault’s experiences hiking the Arizona Trail in her online journal: www.aztrail4fms.org.

Fourth-grader gets early birthday party Saturday

Arthur Paz

Family and friends of Arthur Paz gave him an early birthday party Saturday.

The 10-year-old, who had battled cancer since he was an infant, wasn’t going to make it to his 11th birthday.

In fact, “Baby Arthur” as his loved ones call him, died in his mother’s arms a day later.

While Arthur’s last days were filled with pain and he was in and out of consciousness, there was joy for him as well, his mother, Tammy Robles, said.

One of his teachers at Santa Clara Elementary, where he was a fourth-grader, videotaped his classmates saying they missed him and wanted him to come back.

“He really enjoyed that,” his mom said.

He came home for the last time from the hospital on Thursday.

The following day was the annual Cinco de Mayo festival at Santa Clara, where Arthur loved being part of the folklorico group.

His fellow members danced without him, dedicating their performance to their friend. The school parent-teacher organization is donating about $1,600 from food sales at the event to his family to help cover funeral costs, but members know it won’t be nearly enough.

It also has set up a fund where donations can be sent: Santa Clara PTO (for Arthur Paz), 6910 S. Santa Clara Ave.; Tucson, AZ 85756. For more information, call Sylvia Tautimer at 545-3791.

Viewing will be from 5 to 10 p.m. Friday at Carrillo’s Tucson Mortuary, 204 S. Stone Ave. A funeral Mass will be at 2 p.m. Saturday at Santa Monica Catholic Church, 212 W. Medina Road.

Arthur’s mother said he was mostly asleep Saturday when relatives and friends brought him presents, which his 8-year-old sister, Anisia, opened for him.

They weren’t sure he was aware of what was going on.

But early the next day, when he was awake, his mom and sister asked him if he remembered the presents and he acknowledged that he did.

“He was a wonderful, very courageous, little boy, said his great aunt, Patricia Paz – Tía Pat. “Although his whole life he was back and forth to hospital and doing chemo, he was a very happy little boy.”

His mom said she could see he had little time on Sunday, but he was fighting to stay alive.

“It was hard, but I said, ‘OK baby, I give you all my permission that you can go with God. It’s OK and everybody is going to be fine because when you get to heaven you’re going to be our little angel up there.’ ”

On Arizona Skin Cancer Institute’s Web site

A new tool to detect skin cancer has been made public by the Arizona Cancer Center’s Skin Cancer Institute.

“Skin Cancer: Learn to Spot it Early” is a 12-minute video that shows how to do skin self-exams to find growths that could be or lead to cancers, said Lois Loescher, the institute’s director of education and behavior research.

The video may be found at www.azskincancerinstitute.org/SCVideos.aspx.

“The whole purpose of doing the video is getting people to do skin self-exams,” she said. “Everyone should know how to examine his or her skin regardless of risk factor.

“Early detection really plays a role in survival from skin cancer,” Loescher said. “It’s very important to protect yourself from the sun, but if you don’t catch it early, you increase your chances of having the disease be much more serious.”

A study proved the video’s effectiveness, she said.

“We found a highly significant change – more people were doing skin self-exams after viewing the video,” Loescher said. “We also found a very significant change in knowledge; they had more knowledge about melanoma.”

The video stresses the importance of early detection of skin cancers. Melanoma survival rates are 98 percent if detected early, she said.

The video recommends that people carefully examine their skin each month for changes in moles and spots.

Hand-held and full-length mirrors are needed for an effective self-exam.

Things to look for in moles and spots include asymmetry, border irregularities, color variation, diameter larger than a pencil eraser and changing appearance and feel.

People finding anything suspicious should contact their primary care physician or dermatologist.

Producing the video and testing its effectiveness were funded with a $25,000 Laurence B. Emmons Endowment, said Loescher, principal investigator of the project.

The video was released on the institute’s Web site Friday and shown at a Living in Harmony with the Sun event Saturday and Sunday at the Arizona-Sonora Desert Museum. The event was to promote sun safety, awareness and skin cancer prevention.

A follow-up video on skin cancer prevention tactics is planned, Loescher said.

The video won the American Academy of Dermatology’s Gold Triangle Award, said Jennifer L. Allyn, spokeswomen for the Schaumburg, Ill., organization.

The award recognizes efforts that further understanding of dermatologic issues and encourage healthy behaviors in the care of skin, hair and nails, Allyn said.

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RELATED

Arizona Cancer Center Skin Cancer Institutes video site: www.azskincancerinstitute.org/SCVideos.aspx

The University of Arizona has rescheduled for next month a lecture about genetic and environmental causes of asthma and allergies.

Asthma expert Fernando Martinez had been scheduled to give a public lecture on the subject this week. Instead, he will make his presentation – “Genes and Environment at the Onset of Asthma and Allergies” – from noon to 1 p.m. June 30 at the Kiewit Auditorium at the Arizona Cancer Center, 1515 N. Campbell Ave.

Martinez, who serves as the interim director of UA’s Bio5 Institute and heads the Arizona Respiratory Center, researches the natural history of childhood asthma and the genetic, physiological and environmental factors behind it.

The lecture is open to the public at no cost. A reception will follow at 1:30 p.m.

University Physicians Healthcare Hospital at Kino will lose an estimated $184 million over the next five years, according to a consultant hired by Pima County.

The anticipated losses, mostly for providing indigent care, are driving the hospital’s request for $31 million in taxpayer support for fiscal 2010, which begins July 1, and nearly $30 million a year in county money in the years to come.

The county in March agreed to pay HFS Consultants $30,000 to review expenses at Kino. The group’s report, released Friday, paints a bleak picture of the hospital’s finances and managers’ actions to curb spiraling costs.

In a letter accompanying the report, County Administrator Chuck Huckelberry cautioned the Board of Supervisors against “drawing specific conclusions regarding the snapshot analysis conducted by HFS Consultants.”

UPH officials said the report offers county leaders at best an incomplete picture of operations at Kino.

“We were somewhat stunned,” UPH CEO/President Larry Aldrich said Monday. “It’s flat-out wrong in so many areas.”

Consultants criticize UPH’s methods for writing off bad debts, saying that the hospital is too quick to refer late payers to collection agencies. The hospital should wait longer to find out if those patients qualify for the state equivalent of Medicaid, the report said.

“UPH does not give patients adequate time to pay prior to referral to a collections agency, which hurts the patient’s credit rating and causes bad public relations in an already disadvantaged population,” the report said.

Providing care to those without insurance will cost the hospital about $12 million in fiscal 2010 and up to $17 million by fiscal 2014. Anticipating the increase, UPH management should work harder to find ways to reduce the cost of providing such care, the report said.

Instead, consultants “didn’t find evidence of (hospital financial counselors) aggressively working with the patients to obtain charity care.”

“There’s a fixed amount of indigent care that won’t go away,” said William Crist, vice president for health affairs at the Arizona Health Sciences Center at the University of Arizona. “I understand the county has needs, and one of them is poor, sick patients.”

The university has begun, under Crist’s leadership, to forge a better working relationship between Kino Hospital and University Medical Center. Doing so might lower some of Kino’s operating costs, Crist said.

But providing care to those who can’t afford it gets expensive, Crist said, and much of those expenses fall to Kino, the only hospital south of Broadway.

The HFS report noted that “the county has very little control over hospital operations, which makes the subsidy request tantamount to allowing UPH to operate the hospital as they see fit while shifting the financial risk to the county.”

Supervisor Ray Carroll, for one, can’t stomach spending another $31 million to keep Kino running.

“I won’t support that,” Carroll said Monday. “We have to get the issue out in the community. I think we need to have some stakeholder meetings.”

Under the terms of a 2004 contract, the county in fiscal 2010 would pay UPH $10 million to operate the hospital.

That’s all Carroll plans to support paying UPH.

“This hospital cannot be run for $10 million,” Aldrich said. “That cannot happen.”

Shutting it down would thrust an estimated 42,000 emergency room patients, including psychiatric patients, into other hospitals in the region, documents show.

“That’s not a very well thought-out position,” board Chairman Richard Elías said. “I think there are some things we can do to improve the patient mix that, if it doesn’t reduce costs, puts a hedge on them.”

In its response to the consultants’ report, UPH said no amount of effort on its part would reduce the cost to the county of caring for uninsured patients.

County hospitals across the country require significant taxpayer subsidies to cover such costs, Crist said.

In 2003, the last year the county ran Kino, it lost an estimated $33 million, officials said. The hospital that year had relatively few patients, most of them in the psychiatric ward.

“Yes, we’re still spending $31 million, but we’re spending it a lot better,” Crist said.

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Finances at UPH

A county-commissioned report on the operations at University Physicians Hospital at Kino outlined several reasons for ongoing financial losses, including:

• Writing off too many accounts to bad debt.

• Being too quick to send accounts to collection agencies, rather than waiting to see if those patients qualify for Arizona’s version of Medicaid.

• Not identifying enough ways for patients to qualify for charity care.

• Poor overall financial management.

All told, the Kino center will spend an estimated $12 million providing uncompensated care in fiscal 2010, said the report by HFS Consultants. By 2014, the amount likely will increase to $17 million, the report said.

UPH officials, who had one week to respond to the report, said the consultants miscalculated certain losses and that the conclusions don’t fit the facts, namely that the hospital aggressively seeks to reduce its level of uncompensated care.