The Power of Community

I admit, I’ve been somewhat depressed lately. I find myself glued to the news and social media, obsessed with national and international politics and events, unable to understand the level of animosity and hatred between people. You feel it, too. The national trend toward selfishness and isolation into special interest camps threatens to destroy community. And then I look around Lufkin and refuse to believe all hope is lost.

On May 4, I attended a ribbon cutting for an innovative partnership between Angelina College and Lockheed Martin. Lockheed Martin – a global aerospace and defense company – employs over 500 people in Lufkin, where they manufacture components for several guided missile programs. Working with Angelina College, they created a new manufacturing skills training lab in AC’s Technology and Workforce Center, where students can receive college credit and qualify for an electronics assembler certificate. Certificate graduates will be eligible to follow an accelerated hiring schedule with Lockheed Martin. Those continuing on to get an associate degree have even more options.

The ribbon cutting was a community celebration. Mayor Mark Kicks was there, as well as State Representative Trent Ashby, Chamber CEO Tara Watson-Watkins, AC board members (of which I am one), representatives of the College and Lockheed Martin, and local and regional business development and community leaders. It was a beautiful sight! As Mayor Hicks noted, “Lockheed Martin wins by utilizing the unique training opportunities here at Angelina College to create the best trained employees in all of Lockheed Martin. Angelina College wins by educating workers on the latest in workforce technology.”

What was so heartwarming about the event was that it represented in a concrete way the coming together of community entities and people to accomplish much more than anything anyone could do individually or even as separate institutions. It has been said many times and in many ways that Lufkin is a generous and unique community – one that is full of philanthropic and committed people. We have so much in this county because people get together and make things happen, often with generous support of local foundations. But it is people first and foremost who make it happen.

Take the recent Angelina Benefit Rodeo. According to Chase Luce, President of the Lufkin Host Lions Club, the Rodeo deploys an army of hundreds of volunteers and raises nearly $200,000 to distribute annually for the benefit numerous local organizations, including the Lufkin State Supported Living Center. You can think of many other volunteer-driven arts and civic organizations, museums, churches, the Salvation Army, CISC, the Food Bank, etc., that do great work in our community by helping others and improving our quality of life.

Alexis de Tocqueville, a French aristocrat in the early 1800s, traveled the young United States and collected his observations and reflections in a two-volume tome Democracy in America. In describing what was unique about the United States, he wrote:

Americans of all ages, all conditions, all minds constantly unite. Not only do they have commercial and industrial associations in which all take part, but they also have a thousand other kinds: religious, moral, grave, futile, very general and very particular, immense and very small; Americans use associations to give fêtes, to found seminaries, to build inns, to raise churches, to distribute books, to send missionaries to the antipodes; in this manner they create hospitals, prisons, schools. Finally, if it is a question of bringing to light a truth or developing a sentiment with the support of a great example, they associate. Everywhere that, at the head of a new undertaking, you see the government in France and a great lord in England, count on it that you will perceive an association in the United States.

When it comes to getting something done – especially on the local level – we do not rely on the government when we can take care of it ourselves. Certainly government has a role in society, but so does volunteerism and philanthropy. At a time when we are increasingly depressed about national and world events, it is even more important to focus on what we can accomplish right here at home. Heck, it might just be the key to solving the world’s problems. Attorney and columnist David French modernized and expanded on de Tocqueville’s comments:

“It is here [in community] that we find meaning and purpose. It is here that we build friendships and change lives. … To do the big thing—to heal our land—we have to do the small things. … For those who think and obsess about politics, this shift from big to small is hard. It’s hard to think that how you love your friends [this community] might be more important to our nation [than national political positions, votes, or corporate activism].”

So, what can you do? Find an organization and get involved! Find a place to share your time, talent, and treasure with others. As I often have ended my columns, it boils down to loving God and loving your neighbor. Words are cheap (and meaningless) unless action follows. We cannot “Love Lufkin” – much less our nation and our world – without getting involved right here at home. 

Dental Health is Community Health

We need to return to adding fluoride to our water supply.

The Centers for Disease Control and Prevention (CDC) states that fluoridation of community water supplies is one of the ten great public health achievements of the 20th century in the United States. It ranks up there with vaccinations and control of infectious diseases. According to the CDC, fluoridation of drinking water, which began in 1945 and now reaches three out of four Americans, is both safe and inexpensive. The benefit? Reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%).

Fluoridation of the water supply is race-blind and socioeconomic status-blind. It benefits children and adults regardless of access to dental care. According to dental association reports, on an individual basis, the lifetime cost of fluoridation is less than the cost of one dental filling. For communities, every $1 invested in water fluoridation saves $38 in dental treatment costs. This is a straightforward example of the benefit of public health.

The Texas Department of State Health Services runs the Texas Fluoridation Program (TFP) specifically to improve the health of Texans by preventing tooth decay through community water fluoridation. TFP assists public water systems in the engineering design, installation, and maintenance of water fluoridation systems; monitors the adjusted fluoride level in the drinking water; and maintains the US Centers for Disease Control and Prevention (CDC) fluoridation database for the State of Texas. The Texas DSHS notes that community water fluoridation is recommended by nearly all public health, medical, and dental organizations. The US Department of Health and Human Services’ Community Preventive Services Task Force completed its most recent review of community water fluoridation in April 2013; it recommended water fluoridation based on strong evidence of effectiveness in reducing tooth decay across population groups.

This is also an equity issue. A dental public health publication concluded that water fluoridation is the most effective and practical method for reducing the gap in decay rates between low-income and upper-income Americans. The Hispanic Dental Association has called fluoridation a valuable tool in the reduction of oral health disparities. Another public health paper noted that school performance is indirectly affected by fluoridation because children with poor dental health are nearly three times more likely to miss school and are four times more likely to earn lower grades.

Most water has some fluoride, but usually not enough to prevent cavities. The City of Lufkin 2017 Annual Water Quality Report – the most recent available online – states the fluoride level at the time was 0.722 ppm. The City of Lufkin website, on their FAQ page, continues to state that they add fluoride “at a constant concentration of 1 part per million gallons” and that it is added “as a deterrent to tooth decay.” But according to the CDC, the City of Lufkin’s water system, which supplies a population of more than 42,000 (not just Lufkin, mind you!), now has a fluoride concentration of 0.3, below what is recommended.

I confirmed with our City Manager, Keith Wright, that the City of Lufkin stopped fluoridating water last year. The rationale was that people get fluoride in many ways now, and it seemed unnecessary. In addition, there was concern about conflicting reports of health effects.

Chronic fluoride toxicity is usually caused by excessive fluoride concentrations in drinking water or the use of fluoride supplements. With controlled, measured fluoridation, there is minimal risk with significant public health benefit. A New England Journal of Medicine Journal Watch commentary noted that there may even be an added benefit for older women by increasing bone mineral density with less risk of hip fracture. As for fluoride from other sources, I love the way the Texas Oral Health Coalition, Inc. puts it: “Community water fluoridation and brushing with fluoride toothpaste complement each other, like seat belts and air bags in automobiles. Both work individually, but together they provide even better protection.”

The US Public Health Service’s recommendation for the optimal level of fluoride in community water systems is a ratio of fluoride to water calibrated at 0.7 parts per million. They reached this number after years of scientifically rigorous analysis of the amount of fluoride people receive from all sources, not just fluoridation of the water supply.

What about cost? The Texas Department of State Health Services Fluoridation Program estimates the cost of fluoride additive at $4011/year to the city, based on Lufkin’s average production rate and current average fluorosilicic acid price at $2.00/gallon. I don’t know exactly how accurate those numbers are, but it is obvious we are not talking a lot of money here.

Bottom line? Lufkin needs to return to fluoridating our water supply. And the Texas legislature should consider requiring municipalities to maintain recommended fluoride levels in municipal water supplies. After all, dental health is part of public and community health.

The True Power of Community

I have been reminded lately how wonderful our community of Lufkin is! I use the word community intentionally, for Lufkin is more than a city and more than just voting districts or neighborhoods or individual churches, organizations, or professions. All of these terms tend to identify us in division - as in separateness, not conflict - as opposed to unity.

Not that these markers of identity (such as Rotarian, Church of God in Christ, nurse, Episcopalian, etc.) don’t carry significance or meaning. But community implies (indeed, demands) unity. In fact, the word unity is part of root meaning of community. And unity is our source of strength. When we all – individuals, organizations – have common goals, we can accomplish much.

Sometimes our community rallies around a common athletic team such as the Lufkin Panthers or – the last two years – our Little League players. When a sports team is made up of upstanding individual players, such as the Thundering 13 or the Fierce 14, their victories became our victories. Our pride is not only in their outstanding team play and championships, but in their character, which we not so secretly claimed was a reflection of our city’s character. After all, they are “our” kids.

At other times, our community comes together for important work caring for our own. Two shining examples are the annual Thanksgiving Community Food Drive and The Junior League of Lufkin’s Back to School Bonanza (B2SB). Both events are often seen as “one day” events and get great press when they happen. But the events themselves are the tip of their respective icebergs when it comes to the organization and fundraising that precede them. The real testament to community for each of these events, however, is the number of people involved and purpose of each event.

The Thanksgiving Community Food Drive was started by the late Reverend Bettie Kennedy more than 25 years ago, who hand-delivered Thanksgiving meal boxes to needy families in North Lufkin. Bruce Love joined the work in 1999. That year, they delivered 50 boxes. Over the years, as eyes were opened to the even larger need in the community, the volunteer base and money raised grew and grew. Last year, $27,500 was raised - all for food - and 500 volunteers met at Brookshire Brothers’ White’s warehouse to pack and deliver 2,000 boxes of food for families in need. This is a true community event.

The Back to School Bonanza is another great program with broad community support. The junior League of Lufkin headed that effort, providing $60,000 - on top of $20,000 raised in the community - and leadership to over 60 organizations, churches, businesses, and foundations along with more than 500 community volunteers to provide a staggering amount of help for needy school kids to get the school year started off right. This wasn’t just a backpack drive, either! Yes, nearly 2,200 backpacks filled with grade-specific school supplies were handed out (with most of the supplies purchased from Brookshire Brothers). In addition, 1,100 breakfast sandwiches, 1,000 granola bars, and 1,000 bottles of water were handed out, 3,000 health kits were donated, 958 head checks were performed (and 88 lice kits given out). Over 4,200 uniform pieces were collected along with 2,300 pairs of shoes and 2,500 pairs of socks and $5,000 worth of underwear! One hundred forty haircuts were given. Even 1,500 children’s books were given out. Sixteen vendor booths were set up as well. The first person was in line at 1:20 AM!

Want more examples? Impact Lufkin just purchased the old Lufkin Country Club 170-acre tract of land to be used as a “site where the community will sow the seeds of opportunity,” according to Dr. Patricia McKenzie, Vice President of Impact Lufkin’s Board of Directors. “We have been blessed with a unique venue to carry out our mission as a community-driven organization that connects resources with responsible partners, agencies and programs to serve as a catalyst for sustainable community empowerment, revitalization and enrichment.”

Angelina College has also had significant announcements lately, including the launch of the Early College High School program with Lufkin ISD and with support from the TLL Temple Foundation. LISD Superintendent Lynn Torres noted to the Lufkin News that “this partnership allows students to not only take enough classes for an associate degree, but to also have the additional support from college instructors, teachers and counselors.” In addition, Angelina College – also with the help of the TLL Temple Foundation – is expanding staff capacity of the Small Business Development Center to focus on North Lufkin. These efforts are a demonstration of the power of partnership and collaboration – in a word, community.

A healthy community like ours is evidenced by a unifying spirit of cooperation, trust, and respect across party, racial, and religious affiliations. The danger, though, in any living, breathing community is that division in the body can kill. Much like cancer, seeds of complaint and discontent do not benefit the body; they can grow, take over, and destroy it. We can have differences of opinion about how to support our community and provide assistance to our fellow citizens. But we must voice those opinions in constructive ways while seeking the common good.

Our community is not perfect; no community is. But we are pretty darn close! Lufkin is known for being a giving community. That reputation is well-deserved, but we cannot rest on reputation. We each have different gifts and different roles to play. But none of us are unnecessary; we each need to do our part. Only when we all contribute can we truly support our educational institutions, improve community health, combat poverty, and sustain the many wonderful quality of life organizations and events in our area.

The work continues. What can you give? Time? Money? Expertise? Get plugged in, work together, and give! For WE – together, in unity – are the true power of community.

Reflections From the May 5th Election

On May 5, 2018, the citizens of Angelina County had the opportunity to participate in what is arguably the bedrock activity of our democracy: a free and fair election. This election was not, some might argue, as significant as one involving state or national representatives. And voter turnout was certainly less than would be expected for those elections. However, approving a $70 million bond issue and electing leaders of multiple educational institutions – with combined budgets of well over $100M and employing nearly 3,000 people – is not insignificant.

The various independent school districts in Angelina County are quite used to running elections. Angelina College, on the other hand, had not had a contested election for 22 years. They pulled it off admirably. But let’s be honest. This set of elections was not perfect. There are things we can do better next time.

One criticism that was leveled at both the LISD bond and Angelina College elections was a lack of transparency. I suppose this allegation is leveled during every election, especially the national ones. Whether or not voters have not only adequate information but honest information about the issues (or people) involved is always in question. With the LISD bond vote, some voiced there was not enough lead time between the announcement of the bond proposition and the actual vote, and not enough information about how that overall decision-making process came about. However, I strongly feel the LISD board, administration, and others did a great job of educating the voters about the needs. You couldn’t live in Lufkin and not be aware that the bond issue was on the ballot. And you certainly couldn’t have had a child at the Middle School in the last 20 years and not been aware of the critical state of that campus.

The transparency criticism of Angelina College was more vague. I did hear it rumored that Angelina College wanted to become a 4-year university (and the implication was that by doing so the needs of the local population would be ignored). Nothing could be further from the truth! Angelina College has amazingly broad educational offerings for students from all walks of life. That is not about to change. But where rumors exist, there is an opportunity for education. 

One recent example may serve as a model for the future. Angelina College welcomed a number of people who came to one of our board meetings (which are always open to the public) when the board toured the Technology Workforce Building. Board members and visitors alike were very impressed with the quality and number of programs offered. This type of “open house” may be a good way to showcase periodically what Angelina College has to offer to our community. 

Another idea brought up during the election during a town hall meeting in North Lufkin was to have town hall-type meetings from time to time as a way to gather community input and to keep the community informed about what is happening at Angelina College. That is not a bad idea.

Angelina College President Dr. Michael Simon has become well known and quite visible in the community and has made inroads and contacts throughout the county. This visibility and approachability – not just of the AC President, but also of the Board – is key to maintaining strong community relationships as well as a vital way to address questions about the direction of the college.

By far, however, the biggest complaint about the election process this year was about lack of publicity, whether TV or newspaper, especially in the days leading up to the election. It seems everyone was looking for last minute information about where to vote. Examples abound of people who voted early in one election but still needed to vote in another, and where do they go? To the LISD Administration building? Slack? Angelina College? To another school district altogether? And early voting in two different locations with different hours of operation was confusing as well. Voters were counting on the local news media to make sense of a very confusing, complicated election. The news media largely failed. 

Yes, this newspaper provided some voter education about the candidates several weeks prior to the election, but the mechanics of the election itself were largely ignored. One article on Tuesday, April 24, 2018 mentioned that early voting was underway, and discussed where early voting for various races was taking place. Beyond that, and especially close to the election, there was nothing. Television coverage was conspicuously absent as well.

That being said, the number of voters participating – nearly 3,000 voted in the LISD bond election and nearly 2,100 in the Angelina College election – shows that off-year, local elections are important to the citizens of Angelina County. Compare that to the Nacogdoches ISD board election, where one candidate won by a vote of 246 to 104.

Going forward, we must not take our democracy for granted, even in the “less significant” or off-year elections. The voters of Angelina County have every right to expect that a free press in a democracy will beat the drum of voter education and voter turnout as loudly as they can. When the next off-year election happens, the news media must step up to their role to educate the public about the complexity and details of multiple different and simultaneous polling locations. Our democracy is too precious to ignore.

Angelina College: 50 Years and Going Strong

Angelina College opened its doors to students in the fall of 1968, a momentous year in modern history. The Smithsonian called 1968 the Year that Shattered America. North Vietnamese Communists launched the Tet Offensive, deadly college riots were taking place, race relations were at an all-time low, Martin Luther King, Jr. and Robert F. Kennedy were assassinated, and Apollo 8 orbited the moon. 

According to the Texas State Historical Association’s Handbook of Texas Online, Angelina College began as a project of the Angelina County Chamber of Commerce. In the early 1960s the chamber appointed a steering committee whose purpose was to gain support from area individuals, business, and industry for the construction of a two-year public community college. The efforts of this committee resulted in the Angelina County Junior College District, the sale of bonds for building purposes, a maintenance tax, and a seven-member board of trustees. In its first semester the college enrolled 660 students in both credit and noncredit programs. Dr. Jack Hudgins was the first president of Angelina College. He served until 1991 and was followed by Dr. Larry Phillips, who served until 2015. Current president Dr. Michael Simon is only the third president in the college’s 50 year existence. 

Angelina College, accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC), has grown over the last 50 years to have an operating budget of nearly $23 million and more than 250 faculty on a campus of 230 acres with more than 20 buildings. Angelina College is not only one of the major employers in the county, its influence is widespread and long lasting. More than 5,300 students, including many high school dual-credit students, attend classes either on site or online at any given time, obtaining the education and skills necessary to join or advance in the workforce in Angelina County and beyond. 

President Simon notes on the AC website that AC offers associate degrees and certificates in Business, Fine Arts, Science and Mathematics, Liberal Arts, Technology and Workforce, and Health Careers academic divisions. AC also offers customized workforce training, adult basic education, police and fire academies, and personal enrichment courses through our Community Services division. 

As you can see, Angelina College is so much more than just high school graduates taking college courses on the Lufkin campus, although that remains a core component of what AC provides. AC’s college transfer core curriculum and associate degrees prepare students to transition to four-year universities and beyond. 

Angelina College has an impressively broad catalog of course offerings. Both visual and performing arts classes and opportunities are available at AC, and the availability of the Temple Theater (and AC’s close collaboration with Angelina Arts Alliance to bring world-class performances to Lufkin) is a huge benefit to both AC and the deep East Texas region. 

Sports programs are an important component of the AC experience, with basketball, baseball, softball, and now soccer available.  In 2014, the Lady Roadrunner softball team captured the NJCAA Division I national championship after winning the World Series in St. George, Utah, becoming the first Texas team to earn the title since the Series' inception in 1977. 

The Division of Health Careers is an especially strong part of Angelina College, offering programs in Nursing, Pharmacy Tech, Radiography and Ultrasonography, EMS, and Surgical Tech, among others. Texas A&M’s College of Nursing provides a seamless track for students in Lufkin to get their nursing degree, with AC being one of A&M’s off-site locations for training. 

The Division of Technology and Workforce offers more than thirty certificate and licensure programs in areas from Automotive Technology and Fluid Power Technology to Criminal Justice, HVAC and Welding. 

Want to start a new business? The Angelina College Small Business Development Center assists new business owners and existing businesses raise capital to start and expand businesses with expertise in financial analysis of business ideas, bank presentations, business plans, accounting and marketing. 

Angelina College is not just about Lufkin. Distance learning opportunities are available throughout our 12-county deep East Texas region, and online options are an increasingly important offering for many students, both traditional college students and those seeking adult workforce education. Very soon, we will see international students coming to Lufkin for a valuable education in the United States. 

Angelina County has always been a very generous county, supporting many non-profit and educational initiatives. That is seen in how we help our AC students as well. Government Pell Grants are certainly an important part of educational funding at AC and are given to over 2,700 students a year. But nearly 600 students receive academic scholarships, and with the Angelina Challenge Award, all public high school graduates in Angelina County who do not qualify for more than $1,000 in any other financial aid may receive up to $1,000 for tuition for one year. The total amount of financial aid awarded at AC is over $13 million annually. 

For a half century now, Angelina College has provided a solid educational foundation for the citizens of deep East Texas. Keep an eye out this year for special events related to Angelina College’s 50th Anniversary. It is a great time to be a Roadrunner and a great time to support Angelina College! 

Palliative Care: Something We All Want

As a hospice physician – in addition to my role as a doctor who treats cancer – much of my focus is on comfort care. Part of my motivation to study medicine stems from my childhood concept of who a physician was and should be: a healer and comforter. The physician of yesteryear came to the bedside to care for and comfort the sick (and yes, the dying). I love that the Latin root for comforter is confortare, meaning, “to strengthen much.” In Christianity, the Holy Spirit is also called the Comforter.

Frankly, all physicians should practice comfort care. We know we aren’t to harm our patients. That obligation not to inflict harm intentionally is the ethical principle of nonmaleficence. It is summed up in the Latin phrase Primum non nocere – First, do no harm. The Hippocratic Oath states, in part, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.” That oath – to help the sick – expresses our obligation to do good (the ethical principle of beneficence). Though the actual oath used in various medical schools has changed over time, the overarching mandate to help the sick – and, at a minimum, not to harm them – is universal.

What does it mean to help the sick? That seems, on the surface, like an obvious question. “To cure, of course!” we would say in the 21st century. But curing disease is a quite modern concept. For most of medical history, comfort care was the primary goal. Modern technology and the emphasis on cure got us advanced cardiac care, open heart surgery, amazing innovations in cancer treatment, and so much more. But by 1980, most people died in the hospital. This was rare just a generation or two prior to that, when nearly everyone died at home (or on the battlefield). 

Since 1980, the number of people dying in the hospital has declined somewhat, thanks in part to better end of life care (including hospice care). However, 7 out of 10 Americans still die in a hospital, nursing home or long-term care facility when 7 out of 10 of us say we want to die at home (only 25% of Americans actually do die at home). Utilization of hospice care at the end of life is still woefully low.

But, what about those in the hospital who aren’t expected to die, who want a better, more “comfortable” hospital care experience overall? “Cure sometimes, treat often, comfort always,” is a wonderful mantra attributed to the 19th century tuberculosis physician Dr. Edward Trudeau. This phrase sums up a newer movement in medicine called palliative care. 

Palliative care focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing any serious illness. To palliate means to relieve – literally, to cloak – with the focus being on symptoms. Symptom management obviously should not be limited to end of life care.

As an example, for an ICU patient suffering from an acute exacerbation of lung disease, probably on a ventilator for a short period of time (but expected to recover), the physician historically has been paying attention to oxygen and carbon dioxide measurements, volumes of air going in and out, the acidity of the blood, and other “numbers” that paint a picture of how the patient is doing. But not how the patient or family is feeling. Shortness of breath? Anxiety? Nausea? Pain? Dealing with prognosis and potential end-of-life decision-making? Social and spiritual support? These are issues that might benefit from a palliative care consult.

Every hospitalization (whether ICU or not) has the potential for needing some degree of palliative, or comfort, care in addition to and alongside the acute medical needs that precipitated the admission in the first place. Often, the treating physician can and should address these needs. Quality metrics such as patient satisfaction, length of stay, and even cost of hospitalization are improved with good symptom management.

And, believe it or not, sometimes patients live longer with good comfort care! In my field of oncology, randomized trials have shown improved quality of life and even improved survival with early use of palliative care. The American Society of Clinical Oncology (ASCO) recommends the integration of palliative care with conventional oncology treatment, and the American Society for Radiation Oncology (ASTRO) has urged early palliative care referral when cure is not expected, even if death is not imminent and treatment still is ongoing.

CHI St. Luke’s Health Memorial in Lufkin will be starting a new palliative care consult service later this fall. A team consisting of a physician, nurse, and social worker all certified in palliative care will be available to consult with and advise physicians on any patient with difficult to manage symptoms, regardless of whether or not the patient has a terminal prognosis.

As we learn more about palliative care, we remember the Golden Rule: “So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets (Matthew 7:12, NIV).” 

Comfort always.

The Crockett Hospital’s Painful Demise

June 30, 2017 was a sad day for Crockett, Texas, our neighbor just 47 miles to the west. Little River Healthcare ended its management affiliation with the Houston County Hospital District that Friday, effectively shuttering the Crockett hospital. Nearly 200 employees are affected by the closure.

The simple sign taped on the front door said, “HOSPITAL CLOSED” and directed people to either call 911 in an emergency or to go to Palestine Regional Medical Center, the closest hospital 39 miles away.*

Though this seemed like a sudden event, in many ways it was a slow death over many years. The 49-bed Crockett hospital – most recently known as Timberlands Healthcare, under the management of Little River Healthcare since April 18, 2016 – had danced with several management partners over the last several years. Little River Healthcare didn’t even last 15 months. 

Prior to Little River Healthcare, CHC (Community Hospital Corporation) was brought in June 1, 2015 to run the Crockett hospital for an interim period after the hospital’s messy divorce from East Texas Medical Center (ETMC) in Tyler. ETMC ran the hospital for 10 years. ETMC claimed to have invested $27 million in facility and technology upgrades in Crockett, but for a hospital in the 21st century, that was a paltry amount when spread out over 10 years. 

So why didn’t Little River Healthcare succeed?

According to published news reports, Little River Healthcare blamed Blue Cross and Blue Shield for not paying $32 million it was owed; BCBS would not comment. Little River stated that when it took over the Crockett hospital, the hospital had been “cash flow negative for a long time,” but that they thought they could turn it around.

It was a helluva lot to turn around. Payroll alone was $1.5 million per month. To keep the hospital running in its current state would have cost $2.7 million per month. The Houston County Hospital District board had already increased property taxes to the max amount and even borrowed money in an attempt to keep the hospital afloat. 

LRH Co-Owner Ryan Downton was quoted as saying, “We came to the conclusion the patient volume just isn’t there in the town anymore.” The problem was not volume; it was reimbursement. You can double or triple the number of patients you see, but if you don’t get paid adequately, you are just digging a deeper hole.

Crockett is a dying town. According to the Census Bureau, its population is around 6,500 and shrinking. 39% of the population is living in poverty. Only half of those 16 years of age and older are employed. A mere 17.2% of the population 25 years and older has a bachelor’s degree or higher (and 22.4% don’t even have a high school diploma). 27.4% of the population under the age of 65 has no health insurance. In today’s medical climate, no hospital can survive with this demographic. No hospital district can squeeze enough taxes and reimbursement out of an uneducated, poverty-stricken, unemployed, and under- or un-insured demographic to keep a hospital afloat.

What happened in Crockett is, unfortunately, not unusual. At least 15 rural hospitals have closed across Texas over the last several years. Dozens of counties in Texas have just a single physician – or none at all.

I grieve for Crockett. My brother and his wife live there. I have had the privilege of treating many dear patients from Crockett over the years. We share a compassionate state representative, Trent Ashby, whose rural upbringing cannot be far from his mind in a situation like this. Trent has said he is “committed to working with all of the involved stakeholders to mitigate the loss of existing jobs and help move forward with a plan to increase access to healthcare in our area of the state.” I don’t doubt it one bit. But to be honest, there’s not much he can do. CHI St. Luke’s Health Memorial Lufkin leadership was over in Crockett even before the closing to assist some with employment, but even they can’t come close to softening the impact of nearly 200 jobs lost.

Ultimately, this falls far too heavily on the shoulders of the local Houston County Hospital District board to find a solution. They can’t pull money out of thin air or tax property any higher. And they certainly can’t get paid for healthcare when no insurance coverage or safety net exists. I hope the hospital district board can reassess and reallocate resources to focus on providing comprehensive primary care and prevention services to the citizens of Houston County, at a minimum. They also need to strengthen relationships with surrounding regional hospitals to provide higher level of care services where needed. 

Those of us outside Houston County need to open our eyes. Without a much deeper, systemic and national change in how we allocate and pay for healthcare in this country, what just happened in Crockett is going to be replicated in more and more communities around the country. Let’s help Crockett, but don’t think it can’t happen to us.

*Will Johnson, Senior Reporter for the Messenger News in Grapeland, and Caleb Beames with KTRE-TV have done an excellent job reporting on the hospital closure, and I am indebted to them for some of the details and quotes in this column.

The Grass is Greener in Lufkin!

Sometimes our medical community gets a bad rap. In any community, there can be a tendency to think the grass is always greener somewhere else. This is true whether we talk about education, retail, quality of life, or in my case, medical care.

I have been accused of being critical of our local healthcare community. Perhaps my commentaries on healthcare in general, and the very real problems we all face, have been taken by some to mean I am not supportive of our local healthcare. Nothing could be further from the truth! 

Those who work with me know that I strive for excellence in all I do, and I expect the same from those who work with me. I have considered it an honor and a privilege to be part of this medical community for almost 25 years now, and had I not found this community to be welcoming, supportive, and high quality, I would not have stayed.

Think about it. We are a town of barely 35,000 people, and we have access to everything from neonatal intensive care to neurosurgery and open heart surgery. (Oh, and excellent cancer treatment as well!) These services are rarely seen in a town our size, and it happened for a number of reasons.

First of all, we are a destination for healthcare for patients coming from many surrounding counties. That give us an effective population of several hundred thousand - enough to support sophisticated specialties. Second, we have had visionary leadership from key physicians over the years. I won't try to mention all who have made a difference - there are many - but I do want to highlight just a few for what I see as having provided a significant and long lasting contribution to local healthcare.

Anyone's list would include Dr. Ravinder Bachireddy, a world-class cardiologist whose incessant focus on quality brought credibility and excellence to local cardiac care at a time when everyone in the state (indeed, the nation and the world) was headed to Houston. Along the same lines, Dr. Bill Shelton and Dr. Kavitha Pinnamaneni, in their respective radiation and medical oncology fields, made it possible for cancer patients to stay at home for outstanding cancer care, unifying many different physicians and surgeons involved in cancer treatment into a nationally accredited cancer program.

Dr. George Fidone's energy, intensity, vision, and incredible skill has brought pediatric care to virtually every child in the area. Our kids are healthier for it. Neurosurgery, neurology and stroke care are as good here as can be found in big cities, thanks not only to local medical leadership but also to philanthropic support. Robotic surgery has been embraced and mastered by our local surgeons and gynecologists to a far greater extent than our neighbor to the north or, frankly, most communities.

An early family practice pioneer, Dr. Anna Beth Connell led the way early on for women physicians to be not only allowed into the good ole boy network but also respected as colleagues. Women now make up the majority of medical school graduates and are coming to Lufkin in record numbers and in all specialties.

Finally, I cannot even begin to talk about healthcare without considering the incredible support of local foundations, especially the TLL Temple Foundation and the Kurth Foundation. Their contributions can hardly be totaled or their impact measured. We struggle at a national level to figure out how to care for all people, but that burden has been significantly lowered at the local level by the incredible generosity of our foundations. For that, I am eternally grateful.

Sometimes we all need a reminder of how green the grass is right here in Lufkin and Angelina County, and what a privilege it is to have the healthcare community and resources we have. Next time you see a local doctor, nurse, or other healthcare professional, thank them for living and working here!

What I Would Like to See in Healthcare Reform (Part 2)

Last month, I wrote about the bloated, incredibly inefficient federal bureaucracy that eats up hundreds of billions of dollars annually in administrative costs. I mentioned that Obamacare was not, in my opinion, true healthcare reform and did not address these inefficiencies; rather, it simply added people to the rolls of a broken system.

In this column, I am not intending to argue for or against Obamacare or whether we “repeal and replace” or go with “Obamacare Lite”, whatever that might be. I am simply pointing out areas where I see daily a burden for both patients and providers. My dream would be for simplification of much of the process of valuing, coding, and billing for healthcare services. Whether any of these thoughts are achievable or affordable, I don’t know.

Let’s start with that dreaded hospital bill. Medical billing is indecipherable. Even patients with advanced degrees can spend hours trying to interpret the bill they receive for a hospital stay. And that bill is obscenely higher than what either the hospital or the providers are going to get paid. What’s ironic is that bill often has no correlation with the actual cost of the care received or the value that the federal government (or the insurance company) places on that care. We must simplify how we charge for medical care and how hospitals and providers get paid. Unfortunately, the only patients who get stuck with the full, inflated bill are those without insurance – the ones who can least afford to pay it. That is unethical.

The overall cost of care (and your bill) is determined by coding every aspect of care, from the Kleenex and bedpan to the heart valve. For every cancer patient I treat, there are dozens of separate codes submitted for reimbursement covering all different aspects of planning, designing, QA’ing, and delivering treatment. I have no doubt that much of that could be combined into, say, a fixed reimbursement for treating prostate cancer. The problem is, when the government wants to bundle procedures together, they do it to cut overall reimbursement immensely. We still do the work; we deserve to get paid. Why can’t we work out a way to simplify, cut administrative costs, and make it a win-win both for the providers and the payors?

Along the same lines, consider a simple office visit to the doctor. The complexity required to determine whether I get paid a level 2 or level 3 office visit – which reimburse only $25 and $50 – is outrageous. These so-called Evaluation and Management (E&M) codes – and there are many of them – are based on four different possible levels of complexity of three aspects of the patient encounter: history, examination, and medical decision-making. Take history, for example. The proper level of complexity is determined by the presence or absence of documentation for four sub-elements: chief complaint, history of present illness, review of systems, and past, family, and/or social history. Do you see where I am going with this? Documentation of these encounters (consultations, follow up office visits) often takes longer than the encounter itself! And, any "error" in billing is considered fraud and abuse. It is common to hear patients complain that their doctor never looked at them, but was always looking at the computer screen. We need to simplify coding and put physicians back face-to-face with their patients.

Then there is the ever-increasing burden of deductibles and co-pays. We have such a mishmash of healthcare plans, each with their own deductibles and co-pays, that it is virtually impossible to keep it all straight. At the beginning of every year, doctors’ offices and hospitals cringe. Did a patient change insurance plans, or did their insurance lapse? What about the deductible for the new year? What about co-pays? More than half of Americans have less than $1,000 in savings. Deductibles for individuals enrolled in the lowest-priced Obamacare health plans will average more than $6,000 in 2017. Can the majority of Americans afford that? Certainly not! This is an unfair burden both on patients and on providers, who end up providing that care for free. Why? Most of it gets written off, but only after we spend a lot of personnel time and effort proving we try to bill for what we can’t collect in order to avoid the appearance of fraud and abuse. Those patients who are forced to pay may rack up credit card debt, get sent to a collection agency, and/or go bankrupt. Some go without the care they need rather than add to their debt. I truly believe co-pays and deductibles are a vestige of a bygone era. I would like to see the dollars saved by decreasing the administrative burden of healthcare go to actually paying hospitals and providers what they deserve and earn, and do away with co-pays and deductibles. There should be one price for a procedure or encounter, and that cost should be paid 100% by insurance.

What about insurance companies? In the best of circumstances, they pay fairly and quickly. But too often they can and do delay patient care and prevent patients from getting the care they need in a timely manner, if at all. They do this through a process called precertification or prior authorization (read: denial). And sometimes when they do give prior authorization, they still deny payment. This ought to be illegal. But it happens without recourse because the state insurance regulations are written in favor of the insurance companies. We need to loosen the precertification grip on the practice of medicine, and we need to be able to hold insurance companies accountable to their agreements. A preauthorization is a contract to pay.

The two hospitals in Lufkin (Woodland Heights Medical Center and CHI St. Luke’s Health Memorial) have spent tens of millions of dollars on electronic health records, not to mention what individual and group physician practices have spent, all mandated by the federal government. To what end? This was supposed to be about “quality”, but that emperor had no clothes. There is precious little improvement in communication between providers and hospitals than before electronic health records. The various doctor’s offices use a number of different vendors, and each hospital uses their own separate vendor. None of them share information with each other. I dream of a truly universal electronic health record language with seamless interconnectivity between offices and hospitals, but I sure don’t want to live through the incredible expense, time and effort it would take to get there. But I do dream.

Finally, let’s talk about rights. I have never felt that free or universal healthcare was a “right”. Hear me out. No one has a "right" to healthcare without some responsibility. That responsibility may be in purchasing insurance, but that is not the only way to contribute. The most glaring, but not the only, example is smoking. Half of long-term smokers will die of a smoking-related illness. If you smoke, the rest of us are burdened with some (or all) of your healthcare costs. On average, a pack of cigarettes in the US costs a smoker $5.51, while the combined medical costs and productivity losses attributable to each pack are approximately $18.05, according to researchers. This is where consumption taxes are attractive, but only if the tax truly goes to help offset the cost of healthcare. How we balance rights and responsibilities in healthcare is a good subject for a doctoral dissertation.

As well all hear about and read about proposed healthcare changes over the next year or two, look for what they are really trying to change, and ask yourself, are they really improving the system, or are they just trying to squeeze more people under a broken umbrella? Can they do both? Let’s hope they try.

Support Raising the Smoking Age to 21

The 85th Texas Legislative Session is in full swing. On Wednesday, February 15, a bill was filed in the House by Representative (and physician) John Zerwas (R) to raise the smoking age in Texas to 21 (so-called Tobacco 21, or T21 for short). A companion bill has been filed in the Senate. This is truly a bipartisan effort and is a great idea. For decades now, the legal drinking age has been 21. Tobacco kills far more people than alcohol, and almost all long-term smokers start smoking before they reach the age of 21.

Deep East Texas contains the lowest ranked counties in Texas for health outcomes, and part of that is due to our higher smoking rates. Nearly 90 percent of adults who smoke started smoking before the age of 18 and nearly 100 percent started by age 26. 18- and 19-year-old smokers are a major supplier of cigarettes for younger kids, who rely on friends and classmates to buy them. Raising the smoking age to 21 can help decrease our smoking rates as well as save tax dollars on future healthcare spending related to tobacco use.

Speaking of tax dollars, annual Texas health care expenditures directly caused by tobacco use amount to a whopping $8.85 billion, and we taxpayers bear part of that cost. The State Medicaid program’s total health spend as a result of tobacco use is $1.96 billion. No, we can’t save all of that, unfortunately, unless no one smokes. However, Jeffrey Fellows, PhD, in a Center for Health research report wrote, “Increasing the smoking age to 21 [in Texas] would result in 30,500 fewer smokers after three years, and lead to $185 million in reduced healthcare expenditures and productivity costs over five years. Lower cigarette excise tax revenue of $3.4 million would reduce the 5-year net savings; however the state would still generate a net financial savings of just under $182 million.”

It isn’t just about dollars; it’s about lives, too.

The Institute of Medicine predicts that smoking prevalence would decline by 12 percent if the national minimum age of sale was raised to 21. One of their models also predicted that raising the national minimum age of sale to 21 would result in approximately 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost for those individuals born between 2000 and 2019. Smoking kills.

In case you wonder if the tobacco companies think this will work, here’s a quote from a 1986 Philip Morris report (one of the largest suppliers of tobacco products worldwide): “Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market (17-20) where we sell about 25 billion cigarettes and enjoy a 70 percent market share.” To the tobacco industry, it is always and only about market share and profit.

Raising the smoking age to 21 isn’t the only answer to our smoking and poor health epidemic. Many cities and even entire states have gone smoke-free. Texas needs to. Dietary and exercise components of good health also need to be emphasized. But if we can lessen the number of the next generation who start to smoke simply by increasing the smoking age of to 21, why wouldn’t we? That’s right… there is no good answer. For a healthier Texas and Angelina County, support Tobacco 21.

Resolve to Improve the Health of our Region

January is a time of resolution, and often our New Year resolutions focus on diet and exercise. My friends, we need a city, county, and region resolution to lose weight!

In July, 2016, Sabrina Perry wrote an article for HealthGrove.com – a health data analysis and visualization site – titled, The County with the Highest Obesity Rate in Every State. She repeated the American Medical Association’s contention that obesity is a disease and noted that the World Health Organization considers obesity a global epidemic. I perused the article with interest, looking for the county in Texas that got the dubious honor of being the fattest. Unfortunately, it was our very own Angelina County.

Look around and it is evident. Angelina County has the highest obesity rate in Texas, coming in at 37.5%. That means nearly 4 out of 10 of us aren’t just overweight; we are downright fat. To achieve the dubious distinction of being fat, you have to get to a body mass index (BMI) of over 30. To give you an idea what it takes to qualify as obese, consider a 5’11” male such as myself. My appropriate weight is less than 180 pounds (and probably more like 160 pounds). Any more than that and I am considered overweight. But to be considered obese – which is what 37.5% of Angelina County residents are – I would need to weigh 215 pounds or more. For me, that would be at least 35 pounds overweight, if not more. I routinely see patients with a BMI of 40 or more, which is considered extreme (or morbid) obesity. That would be a whopping 100 pounds overweight for me.

What can we do?

Dan Buettner, author and founder of bluezones.com, has been writing for years about particular geographic pockets around the world where people live longer. According to the website, “Residents of the Blue Zones live in very different parts of the world. Yet they have nine commonalities that lead to longer, healthier, happier lives.” So much of this is what has been preached to us for decades: don’t smoke, eat your vegetables and legumes, exercise, don’t overeat, and drink wine in moderation. On top of this are stress-related factors, having strong family and friend relationships, and spirituality.

It’s not just that we are obese. Our overall health is terrible. The Robert Wood Johnson Foundation ranks population health by county. In Texas, many of the lowest ranked counties are in deep East Texas. Wouldn’t it be great if Lufkin could be known not just for pump jacks and forests, but also for the health of our citizens? This can only work for communities if each of us individually works at it. We have family, friends, and lots of churches. Strengthen those relationships. And, let’s stop smoking, exercise, and eat right!

I recently participated in a set of strategic planning sessions hosted by the Texas Forest Country Partnership called Stronger Economies Together, or SET. The purpose was to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Our SET healthcare workgroup noted that we have significant work to do if we are going to impact the poor healthcare factors and outcomes the Robert Wood Johnson Foundation identified in the deep East Texas region. We set an ambitious goal simply to raise our overall health ranking from the lowest 20% to the next lowest; in other words, from poor to still below average. But we have to start somewhere.

This will require a multi-year effort working with all aspects of the healthcare and social service community to start to move the dial toward a healthier region. We can do it, but we all need to make – and keep – that that resolution for better health!

History and Medicine in Angelina County

I recently came into possession of Angelina County Medical Society meeting minutes dating back 80 years, from 1936 to 1954. These archives were kept by Dr. W. D. Thames. A walk down medical memory lane with these records is remarkable. Some facts are simply mundane. For example, dues in 1936 were $10.50 per member - $488 in today’s dollar. That makes our current County Medical Society dues of $100 seem like a bargain.

More fascinating to me is that even though the practice of medicine has changed profoundly over the last 80 years, little of the economics and politics of being a physician has changed. For example, charity care issues were documented back in 1937. We struggle with that today. The physician-patient relationship – what today would be assessed by patient satisfaction scores – was the topic of lectures in 1938.

The broad legislative issues on the table today are hardly different than those in 1938 when a Legislative Committee was appointed. Scope of practice issues with optometrists and chiropractors were discussed way back in 1941. In 1953, Dr. Arnett “encouraged members of our society to join the American Association of Physicians and surgeons, which is a political organization of doctors. Its purpose is to stop socialized medicine.” (What would they say now?)

Some issues from the past seem frankly quaint today. In 1952, Dr. Arnett was to appoint a committee to investigate a physician who took out an ad in the Lufkin Daily News, apparently quite the no-no at the time. The next month’s minutes document how that physician “apologized and said it wouldn’t happen again”. The Society even had a secret ballot to vote whether he was guilty or not guilty of advertising. He was acquitted on a 9 to 2 vote.

Admirably, the Angelina County Medical Society minutes also contain notable evidence of community involvement and civic leadership. In January, 1940, the Society was holding joint meetings with city and county officials and the Chamber of Commerce directors to discuss a federal aid program for the building of a county hospital. It was these very discussions that spurred local industry leaders to join together to build a new hospital. The legend we pass down is that in 1941, Arthur Temple, Sr., President of Southern Pine Lumber Company, W.C. Trout, President of Lufkin Foundry & Machine Company, E.L. Kurth, President of Southland Paper Mills, and Col. Cal C. Chambers, President of Texas Foundries, along with ten other businesses and industries, joined resources, refused federal funds, and raised one million dollars to build the non-profit Memorial Hospital (now CHI St. Luke’s Health Memorial). But we have forgotten the groundwork was laid the previous year by the healthcare community, the city and county leaders, and the Chamber of Commerce, all working together. Such cooperation and leadership can still take place today.

Another more poignant event occurred in February, 1954. Then President Dr. Gail Medford “read a letter from the Negro Chamber of Commerce wanting help from the Angelina County Medical Society in their plan to improve sanitary conditions in the colored community. Drs. Taylor and Spivey, City and County health officers, were appointed to work with the colored organization.” We cringe now, thinking about Jim Crow segregation and disparities in neighborhood services and conditions. But do we recognize similar disparities in healthcare today? Are we addressing the needs of the indigent, uninsured and underserved populations among us? Is the medical community as approachable today as it apparently was in the segregated 1950s?

Technology has revolutionized healthcare over the last eighty years. But technology cannot replace the heart. Let us not forget our calling, our oath, and our love for the patient. The practice of medicine should never be just a job. It is a profession.

I invite everyone to the Salute to Healthcare banquet on Thursday, November 10, 2016. Help us recognize and honor those in our community who set the standard in healthcare and who are true to the calling – the profession – of medicine. Call the Chamber at 634-6644 for ticket information.

Empowered – and Inundated – by Pink

There is a minor malady that comes around every season. It is characterized by a drop in energy, glazed eyes, and a strong desire just to sit and do nothing. This condition usually strikes around mid-October and peaks about the end of the month. Luckily, it doesn’t long. After a week or two of wearing dark clothes and drinking Standpipe coffee, it resolves completely with no lasting effects. I call it pink fatigue.

October has barely begun and I have already been interviewed both for the City Hall Update about the upcoming Power of Pink! celebrations in Lufkin and Livingston and by KICKS 105 about breast cancer for their website. I have an on-air interview with Danny Merrell this morning. October 18th is the 5^th annual Power of Pink! event in Livingston, and October 20th is 24^th annual Power of Pink! in Lufkin. Nearly 500 women are expected in Livingston, and an incredible 800 women in Lufkin. And even though it is not a breast cancer-specific event, the American Cancer Society’s amazing Cattle Baron’s Gala is October 15th. October is a busy – and very pink – month!

I jest about getting pink fatigue, but I hope it never, ever happens. We cannot tire of fighting this disease. Breast cancer is the most common cancer in women (246,660 new cases in the US anticipated this year) and the second most common cause of cancer death in women (40, 450 deaths predicted in 2016). Only lung cancer kills more women. The good news is that the cure rate for breast cancer that is caught early is really quite high. Today, most cases (61%) are diagnosed at a localized stage (no spread to lymph nodes, nearby structures, or other locations outside the breast), for which the 5-year survival is a stunning 99%.

The American Cancer Society reports that from 2003 to 2012, breast cancer death rates decreased by 1.9% per year in white women and by 1.4% per year in black women. Overall, breast cancer death rates declined by 36% from 1989 to 2012 due to improvements in early detection and treatment, translating to the avoidance of approximately 249,000 breast cancer deaths. That is truly remarkable!

But we must not succumb to pink fatigue until ALL women who need mammograms are getting them. Our minority communities, for example, still fall behind when it comes to getting mammograms and other screening tests.

The American Cancer Society recommends that women at average risk of developing breast cancer should have the choice to start annual breast cancer screening with mammograms beginning age 40 to 44. Women age 45 to 54 should get mammograms every year. Women age 55 and older should switch to mammograms every 2 years, or have the choice to continue yearly screening. Always, the risks of screening as well as the potential benefits should be considered.

These guidelines are for women at average risk for breast cancer. Women with a personal history of breast cancer, a family history of breast cancer, a genetic mutation known to increase risk of breast cancer (such as BRCA), and women who had radiation therapy to the chest before the age of 30 are at higher risk for breast cancer, not average-risk, and should talk to their doctor about appropriate screening. If in doubt, or you just can’t remember, get a mammogram every year. It is just easier that way.

Please don’t get pink fatigue! Support cancer research for prevention, early detection, and curative treatment for all by participating in something pink this month. Contact Lindsey Mott at 639-7613 for tickets to Power of Pink! Contact the American Cancer Society at 634-2940 for tickets to Cattle Baron’s Gala! Or go online to www.CHIStLukesHealthMemorial.org and click the link to purchase a pink flamingo for $15. Put it in your yard or at your office to show support for breast cancer awareness. All flamingo proceeds go to support patients in need right here at the Temple Cancer Center. Go pink! #BC4TheBirds

Lung Cancer Screening Saves Lives

For more than 50 years now, we have known the dangers of smoking. That smoking causes heart disease, emphysema, and lung and other cancers is not in dispute. For fifty years, we did not have an effective screening tool for lung cancer.

Now we do.

Medical imaging has improved so much that we are now able to do computerized tomography (CT) scans with significantly lower dose to the patient and at a low enough cost to warrant widespread use as a screening tool. Not everyone needs a scan, of course. But smokers who are at high risk of developing lung cancer now have an option for screening, much like mammography for early detection of breast cancer.

In 2011, the results of the National Lung Screening Trial (NLST) were published in the New England Journal of Medicine, arguably the foremost medical journal in the world. This trial screened current or former heavy smokers aged 55 to 74 with low-dose CT scanning of the chest and compared it to standard chest x-ray. The NLST primary trial results show 20 percent fewer lung cancer deaths among trial participants screened with CT compared to those who got screened with chest x-rays. This is huge news, because we haven’t cured a lot of lung cancer over the last 50 years! Based on these results, the Centers for Medicare & Medicaid Services (CMS) decided in 2015 to start paying for the procedure on January 1, 2016.

According to the American Cancer Society, in 2016 an estimated 224,390 people in the U.S. (117,920 men and 106,470 women) will be diagnosed with, and 158,080 men and women will die of, cancer of the lung and bronchus, the leading single cancer killer in the U.S. If everyone who was eligible got screened, more than 30,000 deaths from lung cancer could be averted every year.

There are more than 94 million current and former smokers in the U.S. at high risk for lung cancer. In 2014, an estimated 18.1 percent, or 40 million U.S. adults, were current cigarette smokers. Unfortunately, smoking rates in East Texas are higher than state and national averages. That means a lot of East Texans are eligible to be screened.

Starting last fall, CHI St. Luke’s Health Memorial began offering low-dose CT lung cancer screening to eligible patients. Medicare covers ages 55-77 (commercial insurance 55-80, but Aetna 55-79). Even within those age ranges, an eligible patient must be a current smoker (or quit no more than 15 years) with at least a 30 pack-year history of smoking (for example, smoking 1 pack per day for 30 years, or 2 packs per day for 15 years). And, eligible patients must have no symptoms of lung cancer (such as coughing up blood or unexplained weight loss of more than 15 pounds in the last year). If lung cancer is suspected, a standard CT chest should be done.

Finally,  Medicare requires “shared decision making” on the risks and benefits of lung cancer screening, which means you must meet face to face with your primary care provider to get an order for screening.

Since we started screening at CHI St. Luke’s Health Memorial, more than 70 patients have been screened. Six abnormalities have been found (including an incidental kidney mass), and two lung cancers have been diagnosed. Those two cancer patients’ lives may have been saved by screening; only time will tell.

Of course, the best way to prevent lung cancer is by not smoking. Ever. Quit if you do smoke. And if you meet the criteria listed above, talk to your doctor about getting screened for lung cancer. If you have questions, feel free to contact the Temple Cancer Center at (936) 639-7466 for more information.

Doctors Must Reinstill Sense of Duty

This article was originally published at Houston Chronicle http://www.houstonchronicle.com/opinion/outlook/article/Doctors-must-reinstill-sense-of-duty-6733668.php?t=d4a64f80cb&cmpid=email-premium and is reprinted here with permission from the author (me).

I am a physician. Being a doctor defines me. Whether I am seeing patients in my Cancer Center or dining at a restaurant, I am Dr. Roberts. I have expectations of myself in my role of physician, certainly. But the broader community has expectations of me, as well - expectations of competence, compassion and especially availability. Surveys and patient satisfaction scores, however, show that physicians are not meeting those expectations.

I see two broad reasons for this disconnect. One is related to how we practice medicine in the 21st century (in front of a computer rather than in front of our patients). The other has to do with what we see our role to be as physicians.

As a member of my hospital's Performance Improvement Committee, patient safety is our primary concern. Too often, though, we get bogged down in an ever-increasing slough of statistics. Some data we need to track (mortality rates, infection rates, etc.) but other data (such as whether patients think the bathroom is clean enough) are, to put it mildly, distracting.

Chasing data has become the focus of American medicine, and the individual patient has been lost in the process. On top of this is the stress and frustration of working with a bloated and perversely incentivized health-care bureaucracy that views every failure to dot an "i" or cross a "t" as fraud and abuse. Not surprisingly, not only has patient satisfaction declined, but physician satisfaction with the practice of medicine has tanked as well.

It isn't simply about computers and bureaucracy. Since I started practice in 1991, the percentage of physicians in private practice has dropped dramatically. "The New England Journal of Medicine's" CareerCenter website posted that physicians coming out of residency are increasingly gravitating toward contracted rather than private practice positions. Anecdotal reports put the desire to be employed as high as 80 percent. Various reasons are given, including the uncertain direction of health-care reform, declining reimbursement and rising overhead costs. Increasingly, physicians just want to show up at work, practice medicine (without having to deal with administrative and insurance issues), and then go home. They believe that employed positions offer a more predictable work schedule than private practice.

This growing employment model, not just among millennials, coincides with a major shift in attitude among physicians about their role - dare I say duty? - when it comes to patient care. "Becker's Hospital Review," an industry magazine, noted that physicians increasingly expect their affiliated hospitals to provide compensation for on-call coverage, which used to be an expectation of all physicians who had hospital privileges. By 2001, nearly two-thirds of health care organizations provided call pay to at least some physicians.

In our hospital committee meetings, we - the self-selected 10-percenters who are involved in medical staff leadership - bemoan the loss of a sense of citizenship among physicians. We opine on the privilege of being on a medical staff, and that there are responsibilities that come with those staff privileges. Ultimately, we just want our fellow physicians to "do what is right." That simple ethical imperative is the heart and soul of the practice of medicine. Not just doing what is expedient. Certainly not just doing what you hope (or demand) to get paid for.

I fear this is where we are in medicine today. Being a physician is no longer a profession - a calling, a responsibility - it is simply a job. The art and practice of medicine has been reduced to a series of individual transactions, each separately identified in an ever-complex system of billing codes, rather than an ongoing relationship not just between doctor and patient, but between doctor and community.

How can we recover the profession? How do we reinstill a sense of duty? Of moral obligation?

Medical schools have the initial obligation to provide a strong ethical foundation for the practice of medicine. But organizations that provide ongoing training and continuing medical education are responsible as well. The Texas Medical Board requires two ethics and/or professional responsibility CME credits every 24 months as part of a total of 48 credits required.

The Texas Medical Association, which has more than 48,000 physician and medical student members, offers 62 ethics-related CME courses ranging from communication skills and dealing with difficult patients to stress and burnout and HIPAA compliance. However, there is not a single course on basic ethical principles, which have guided the practice of medicine in Western civilization for centuries. Maybe that is because an ethical imperative to "do what is right" presupposes we know (and are willing to agree on) what "right" is.

The United States Conference of Catholic Bishops produced a document - Ethical and Religious Directives for Catholic Health Care Services - which guides all Catholic healthcare institutions, including CHI St. Luke's Health hospitals. Physicians of all faiths would be well served to read and abide by these directives, which first and foremost stem from a sacred view of human dignity. If nothing else, physicians should re-read the Hippocratic Oath, which for centuries has united physicians in a common, patient-centered cause.

Finally, we should look to physician role models around us. The Lufkin/Angelina County Chamber of Commerce hosts an annual Salute to Healthcare banquet where they honor a Healthcare Professional of the Year, Nurse of the Year, Individual of Merit, and a Lifetime Achievement Award winner. In November, I had the honor again of emceeing the event. As I announced the Lifetime Achievement award recipient, I emphasized the award is not just about showing up at work for 40 years and then retiring. That's just doing your job. What we honor each year is the extra - the above and beyond - that exemplifies a career marked by service not just to patients but to society. I hope that by honoring those who set a great example of leadership, compassion, and generosity over and above medical skill, younger physicians will be inspired to follow these examples of care beyond the dollar.

I challenge my physician colleagues, young and old alike, to "do what is right" by all patients. This is your profession, if you will still claim it.

Feeding the Hungry this Holiday Season

Our series of articles titled Business is Everyone’s Business has focused so far on various employers, both large and small, and their economic or employment impact in the region. In this season of Thanksgiving and Christmas, we must also remember that our local non-profits are everyone’s business as well.

The Thanksgiving holidays saw a great outpouring of giving through the Community Food Drive, originally started by our own “saint” Rev. Bettie Kennedy and now ably overseen by Bruce Love. On November 21, 2015, two thousand boxes of food were quickly packed and distributed throughout the community. Hundreds of volunteers, young and old, black and white, rich and poor came together for a common purpose and in one accord. That singular, annual event has great impact. Do you ever wonder how that need is met throughout the year?

The Christian Information & Service Center is an amazing organization that provides food for our hungry day in and day out. CISC, a 501 (c)(3) organization led by the indomitable Yulonda Richard, has a mission to be a Christian witness and minister to those in need specifically by feeding the hungry within Angelina County. It is a volunteer-supported organization that exists because of donations given in love by individuals and local churches. These donations allow CISC to operate locally in Lufkin to provide food out of the East Texas Food Bank in Tyler.

The need is significant. One in seven Americans will visit a food bank this year. 465,000 East Texans are at risk of hunger. Every year, CISC hands out over 2M pounds of food to around 200,000 people on a budget of $347,000. Though the primary assistance to the community is free food for low-income residents within Angelina County, CISC also offers various programs throughout the year, such as the "BackPack Buddies" after-school feeding program, the "Senior Food Box" senior citizen program which feeds over 2,600 seniors per year, and the "21-Day Meal Program," which aims at feeding children who are on summer vacation. There is also an avenue for assistance with gas vouchers, sleeping bags, bus tickets or utility assistance.

According to Yulonda Richard, the recent layoffs in Angelina County have led to an increase in the number of clients seeking help at CISC. Previous statistics showed that forty-nine percent of the households served have at least one employed adult, and the rest are mostly children and seniors on fixed incomes. It is, to a large extent, the working poor who really need a helping hand.

If you have ever driven by CISC in the morning, you know there are people there at 6:30 AM waiting, even though the doors don’t open until 9:30 AM. Fresh fruits, vegetables, meats, dairy, bread, everything you find in the grocery store CISC delivers. The majority of the donations come from right here in Angelina County: money, food, church support.

How can you help? Come to the Believe in Christmas! musical this Sunday, December 6, 2015 at 6 PM at Lufkin’s First Baptist Church. First Baptist and New Beginnings Baptist are uniting for the second year to celebrate unity, worship together, and support CISC. Admission is free, but bring canned goods or even a monetary donation for CISC when you come. As Yulonda Richard says, “It doesn’t matter what we give, God always expands it. As long as you are giving from the heart, God will increase it.”

CISC may not be the most glamorous non-profit in town, but they just might be the most impactful. As we move through this holiday season, remember that supporting local non-profits like CISC is everyone’s business.

PineCrest has Far-reaching Economic Impact

Mayor Bob Brown, City Manager Keith Wright, Chamber CEO Jim Johnson and other local government and business leaders recently launched a series titled Business is Everyone’s Business. The purpose of this initiative is to highlight local businesses and remind us not only of their economic impact but also the importance of our community support.

I recently asked the Texas Comptroller of Public Accounts office to provide me with updated statistics on the contribution of the healthcare sector to our local economy, and I was startled at the findings. Employment in the healthcare industry in Angelina County grew from 7,091 FTEs in 2005 to 8,411 in 2014. In 2014, 23 percent of all jobs in Angelina County were in the healthcare industry (up from 20 percent in 2013). In 2013, the healthcare industry accounted for $401,447,145 or 13 percent of the gross regional product in Angelina County. Angelina County truly is the healthcare hub of our deep East Texas region.

Within the healthcare industry, there are the major employers we all know about, like CHI St. Luke’s Health Memorial (1200 employees), Woodland Heights Medical Center (580 employees) and the Burke Center (400 employees throughout East Texas). There are myriad small businesses providing pharmacy, home health, hospice, and various diagnostic and therapeutic services to our region. We also have a number of nursing, rehabilitation and long term care facilities, one of which I want to feature today.

PineCrest, part of Methodist Retirement Communities, is a not-for-profit continuing care retirement community offering independent living, assisted living, memory support, skilled nursing and home health. Open since 1992 and located on 55 acres, PineCrest employs 220 people with an annual payroll of $6 million (mostly to Angelina County residents) and an additional spend of $3 million going to physical plant operations, utilities, contractors, and others.

Much more than a nursing home, PineCrest has 82 residential apartments, 36 patio homes, 21 assisted living apartments, 40 memory care units, and 51 skilled nursing units with 19 of those dedicated to transitional rehab. PineCrest also has on-site banking, full-service dining, a bistro, grocery store, library, chapel, beauty salons, a wellness center, and even a large auditorium to hold banquets, seminars, or private parties.

According to Amy Thomas, Executive Director at PineCrest, they currently serve around 237 residents, which include those with spouses. PineCrest is constantly reinvesting in our local community with ongoing renovations. PineCrest residents also contribute to the local economy as any of our county residents would, whether dining out, going to the grocery store, shopping, buying gas, attending Angelina Arts Alliance and Pines Theater shows, as well as with expected healthcare-related visits (hospitals, doctors, pharmacies, etc.).

PineCrest supports our broader economy in other, unexpected ways. For example, they partner with SFA as an intern site for social workers and as a clinical site for nursing students in SFA’s Bachelors nursing program. In addition, PineCrest is an intern site for SFA’s hospitality program. PineCrest also partners with Angelina College with AC’s LVN, RN, and CNA programs. These affiliations have led to numerous full time healthcare positions not only at PineCrest but at other facilities in our community.

PineCrest residents serve as volunteers at CHI St. Luke’s Health Memorial and at AC’s Adult Learning Center. And local high school students are working with PineCrest residents in a program called Wisdom for Youth with Senior Expertise (WYSE), which promotes inter-generational learning through shared experiences. An Alzheimer’s support group is also facilitated at PineCrest. Though these programs may not have a direct economic impact, their quality of life impact is significant.

PineCrest is a true community within our community, and one that is far from insular or isolated. I’m grateful for PineCrest’s economic impact as well as their influence far beyond simple employment statistics. PineCrest demonstrates that Business is Everyone’s Business!

Cattle Baron's Gala Supports Local Cancer Patients

I always look forward to the Pineywoods Cattle Baron's Gala. Not only do I have a good time, I know the money raised is going to a great cause - the American Cancer Society. Unfortunately, there has been recurrent grumbling - from what I hope is an unenlightened minority - that the money raised doesn't stay local. I understand this "local first" mindset and agree that we should expect local return on our charitable giving. The American Cancer Society delivers that in spades.

Yes, the American Cancer Society is a national organization. But did you know that the American Cancer Society has a regional office building right here in Lufkin? This office was built thanks to generous local foundation, business, and individual support. Did you know this office houses eight employees and serves a 12-15 county region? Annual payroll, benefits and overhead is about $450,000 per year. These are good local jobs that feed back into the local economy at a time when all local jobs are significant.

But it isn't just about the jobs. Every dollar raised has local impact in many more ways. Since I started practice in Lufkin nearly 23 years ago, the overall cure rate for cancer has increased from 50% to over 70%. That translates to local lives saved, not in small part due to the incredible research funded by the American Cancer Society. Statistically, an additional 120 people who come through the Temple Cancer Center every year are cured! Now, that is local impact!

Did you know that the American Cancer Society National Cancer Information Center in Austin handles close to 1 million requests for cancer information annually, including calls from Lufkin and deep East Texas? Those calls, emails and online chats provide direct, one-on-one support and information about local services for local patients, including navigation and information on how to access insurance coverage when possible. (By the way, some of these services, like rides for patients to appointments, require local drivers. You can volunteer to help!)

Did you know that every new cancer patient seen in the Temple Cancer receives accurate, specific educational material provided by the American Cancer Society? And local cancer patients have access to wigs, supplies, and support services whether they receive treatment locally or not.

Did you know that the American Cancer Society funds efforts to increase screening rates for cancer? More than 4.6 million women in need have been helped since 1991 through the national breast and cervical cancer early detection program. The latest project is to screen 80% of the eligible population for colorectal cancer by 2018. Colorectal cancer screening can find and remove polyps before they become cancerous, and that prevents colorectal cancer. And what about the incredible American Cancer Society work in the area of tobacco control? Locally, the American Cancer Society Cancer Action Network was instrumental in the passage of smoking ordinances in both Lufkin and Nacogdoches.

What about local patients who choose to travel to the Texas Medical Center for treatment? Soon they will have access to free lodging at Hope Lodge Houston provided by - guess who? - the American Cancer Society. The TLL Temple Foundation generously provided the lead gift for the Hope Lodge Houston. 

What about the various treatments we recommend for cancer patients? Those treatments very well may have been developed from research supported by none other than the American Cancer Society. The American Cancer Society has funded an incredible $4 billion in research grants since 1946. In Texas alone, this year nearly $36 million is currently invested in research.

Website presence? The American Cancer Society's website, cancer.org, is the most trusted website available when it comes to cancer information, with 61 million hits logged in 2014.

The suggestion that funds raised by American Cancer Society events don’t stay local (or don’t benefit our local community) simply can't be supported by facts. Not only that, it misses the point that we can accomplish so much more together than what we can by ourselves. Isn't that our community spirit anyway?

Join me this Saturday night, October 10th, at the Moore Farm for the 2015 Pineywoods Cattle Baron's Gala in support of the American Cancer Society’s lifesaving cancer research, education, and truly local services. Call (936) 634-2940 for ticket information.