“This Nation’s Rampant & Reckless Ignorance of Pain,” discussed by Dr. Mark S. Ibsen
Dr. Ibsen prepared a sworn affidavit , on the eve of the Supreme Court argument on March 1, 2022, to consider the nation’s failure to treat pain, preferring to punish what our nation seemingly does not understand.
AFFIDAVIT OF MARK S. IBSEN, MD
State of Montana, County of Lewis and Clark, to-wit:
MARK S. IBSEN, MD, does hereby swear or affirm and state under penalty of perjury, as follows:
1. My name is Mark S Ibsen M.D..
This nation’s rampant and reckless ignorance of pain
2. I have prepared this affidavit to join other physicians and patients who treat and/or suffer acute and/or chronic pain to underscore the fact that the government’s rampant and reckless ignorance of pain and pain management has caused physicians to undertreat patients and, in turn, has caused patients in many cases to commit suicide to escape the unbearable pain they cannot withstand without pain medication.
3. The government insists that anyone who takes pain medication is at high risk for addiction. There are corrals of “experts” who see any medical prescription for pain as an act to addict a patient. They often blunt the terrible consequences of their “expert” opinion by suggesting there are worthy alternative therapies. In some cases, that’s certainly true but not generally. What we are truly talking about when considering pain medication is not addiction, rather it is “dependence” until the pain subsides — if and when it does.
4. We look the other way when the pain is in the final days of a patient in the case of cancer patients. Presumably it’s because we want to make patients comfortable in their final days.
5. But what about a patient who has years to live and who may perhaps suffer unnecessarily without treatment?
6. I am acutely aware that the U. S. Supreme Court of the United States is about to consider two cases, with the oral argument only a few days hence, on March 1, 2022, making it’s final decision by June 2022, and the Supreme Court may determine whether physicians may safely render necessary medical services for pain or risk being prosecuted invoking the Hippocratic oath, by redressing a patient’s pain. See 20–1410, Ruan v. United States, and №21–5261, KAHN v. United States. See also, the Daily Remedy Team, “the Curious Case of Dr. Xiulu Ruan, DAILY REMEDY (February 27, 2022)( https://www.daily-remedy.com/the-curious-case-of-dr-xiulu-ruan/ ).
7. I understand that, among the issues on appeal to the United States Supreme Court are, whether the government may regulate and prosecute a physician acting in “good faith,” meaning the physician is doing nothing worse than an honest but mistaken belief that he is issuing a prescription in the usual course of a professional practice. Id.
How I became an accidental pain physician
8. Let me begin by discussing my background. (Attached is my full CV insofar as it is this experience that prompts and favors my medical opinions on this critical topic for pain patients).
9. My progression from a young physician to an experienced practitioner parallels the careers of others who sooner or later bump up against the question, how to handle a patient’s pain, as it’s a correlative aspect of so many ills that trouble our patients. For a physician to fail to treat pain is to fail patients and to undermine the trust of an aging nation for our medical profession.
10. Having taken the proper boards to do so, I began practicing urgent care in Helena, Montana from 2010, through 2015.
11. I first became aware of the conflict between pain medicine and the intrusion of governmental regulation of the nation’s pain crisis, in the period from 2011 to 2013, while practicing in Montana; the government and medical boards failed to apprehend the chaos that was plain to see.
12. In the early days, in 2005, official documents, medical and otherwise, endorsed the treatment of pain. That made sense given that there was no way to separate pain from the many afflictions a patient may endure. There was, for example, no conclusive imaging device to detect and confirm a back pain was real or faked.
13. These documents and directives, on treating pain, were withdrawn, however, without good reason, by arbitrary notice, sometime in 2013.
14. Thus did medical America become a vast wasteland for pain management? T. S. Eliot wrote: ““The awful daring of a moment’s surrender which an age of prudence can never retract, by this, and only this, we have existed.” It’s a sweet question if our surrender to bad advice, in disregard of medical science, may with prudence be cured. https://helenair.com/opinion/columnists/montana-has-become-a-wasteland-for-pain-management/article_e567f3fa-a8dc-5f69-aa83-16d37394d496.html
15. Pain patients visited my urgent care clinic in 2011 and some of those appeared because they were dropped by other legacy pain management programs.
16. As an “ER Doc,” one first learned, certainly that’s how I was instructed, to treat pain management aggressively but not recklessly. See Julie Baughman, “BIG PAIN IN THE BIG SKY Miscommunication and misinformation: Chronic problems with treating chronic pain” Philadelphia Report (May 18, 2014) (http://b.bsd.dli.mt.gov/license/bsd_boards/pha_board/mpdr/pdf/BigPainInTheBigSkyMay2014.pdf
17. While we physicians are not lawyers, we have learned to pick our way through the Controlled Substances Act (CSA) that makes it unlawful for “any person knowingly or intentionally … to manufacture, distribute or dispense a controlled substance” except in certain cases. See 21 USC Section 841(a)(1).
18. The “exception” for physicians provides any prescription may be made if “issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” See 21 CFR Section 1306.04(a).
19. Some courts have avoided squirrely worded legal tests that sound in the language of medical malpractice, rather than a criminal prosecution, mistakenly treating civil standards as sufficient to find a criminal violation.
20. The corrective for this current institutional error is to test whether the physician lacks “a good faith basis” for making the prescription.
21. Law enforcement and medical boards targeting physicians who are healing, not dealing, make it a risky challenge for every physician to redress a patient’s pain. Unsurprisingly, many physicians now refuse to treat pain.
22. As I make this sworn affidavit, the U.S. Supreme Court is about to consider the questionable standard followed in the 11th Circuit where a doctor may be convicted if the prescription fell outside of “professional norms” — whatever that may mean — no matter if the doctor believed in “good faith” that the prescription he issued served a bona fide medical purpose.
23. The wrong-headed approach sounds in simple negligence, that is, a civil standard of liability, but it is being applied in a criminal prosecution.
24. More than that, negligence is not an intentional offense and the CSA requires the physician have “intent” in order to be criminally responsible.
25. The burden of proof for negligence is a “preponderance of evidence,” not “beyond a reasonable doubt.”
26. How does a fact finder rightly cut the difference? I don’t think they can. That’s why the Supreme Court is being asked to slice and dice the standard of “wrong-doing” going forward.
27. The bias against remedying pain with any opiate is so great that many more patients may suffer this ignorant bias. The fear is that the Supreme Court may prefer a form of criminal Russian roulette for physicians who treat pain and, “oops,” find out afterwards that they got it wrong, and only then, they discover that their “good faith” in their medical practice wasn’t sufficient, if the court allows “good faith” to be relevant when it renders its decision. As a result, a physician’s medical practice, his reputation and freedom may become a memory, gone in this ambiguous changeable law enforcement mist, indifferent to the medical science and the cries of suffering patients.
28. The CSA says a physician must act “knowing or intentionally.” 21 USC Section 841(a)(1). It’s been long established that you must demonstrate “a vicious will” if you hope “to establish a crime.” See Staples v. United States, 511 US 600, 616–617 (1994). In other words, each element of a crime must be knowing or intentional.
29. So, what have I observed as a physician who has treated pain patients?
30. In 2011, Dr. B’s patient came to my medical practice, said Dr. B had retired, and added, “Now Dr. W [a possible successor physician] had refused to write [the patient’s] prescription for hydrocodone.”
31. Dr. W was “unavailable” to discuss the patient’s background, the patient had been receiving medication for 10 years of stable pain management. I helped him wean from opiates slowly and responsibly. No other physician would take his case. Such is the chilling effect of our ambiguous regime of law enforcement by the feds, the state, and medical boards. No prescriptions, no problems. No prescriptions, no peace, no surcease for pain patients.
32. What I found out about the medical profession generally is that patients didn’t care how much I knew until they knew how much I cared.
33. In the current medical pain dragnet, seemingly with little hope for a policy reset, physicians and pain patients have become “opiate refugees,” mostly abandoned, forced by circumstances to fend for themselves, often while they suffer relentless mind-numbing pain.
34. I’m sure I treated some patients that could find no one else to treat their pain.
35. I believe it helped that part of my practice was serving refugees overseas, and necessarily the poor and underserved; I was privileged to serve patients with Mother Teresa in Kolkata, and other patients in the West Indies, Nepal, and Bombay. I have attended upon patients at multiple Indian reservations, inner-city free clinics, and the Dalai Lama’s hospital in Zanskar, India. I believe this wide ranging geographic and social extension of my practice made me a better doctor across the spectrum of the afflicted.
36. Physicians have been well aware, even before the pandemic, that our nation is in the midst of a public health crisis, of dramatic proportions, but if you call public health officials in the state of Montana, or any other state, they have very little to say about what to do to remedy this crisis.
37. It doesn’t help that the current fear pain treatment protocol doesn’t just involve physicians. Pharmacies have taken it upon themselves to refuse to fill a physician’s prescriptions.
38. In addition, physician’s themselves, bar the door to pain patients. I’ve had patients inform our practice that they were not only refused pain management, but were refused to be treated at all by a primary care doctor for other primary care issues; the rule for some physicians has become: “We don’t see patients who are on chronic opiate therapy.” Some Patients therefore couldn’t get medications for blood pressure, diabetes, cholesterol, or any other primary care needs, because they had earlier been prescribed an opiate for their pain.
39. Thus, patients got sicker and went without treatment.
40. Having pain yourself will make you question your assumptions about pain medication.
41. Jennifer A. was a police officer who injured her back in the line of duty. She had numerous epidural steroid injections and difficulty managing her pain.
42. Jennifer’s CYP 450 genetic profile demonstrated ultra rapid metabolizer genetic pleomorphism.
43. Cytochrome P450 (CYP450) tests help determine how a patient processes (metabolizes) a drug. The human body uses cytochrome P450 enzymes to process medications. Because of inherited (genetic) traits that cause variations in these enzymes, medications may affect each person differently.
44. In Jennifer’s case, it appeared that she required as much as 50 times the doses of the average patient.
45. This genetic pleomorphism research was done over 20 years ago and is established science is unappreciated and ignored by law enforcement and boards of medical examiners.
46. Pharmacies refused her medication. This proud law enforcement officer, Jennifer A., was frustrated.
47. Before her pain, she might have shunned other patients, thought badly of someone, who required large doses of pain medication.
48. By the way, as a matter of statistics, there’s a 100% chance that 5% of the population will be two standard deviations from the mean (average) of what is, in fact, an “average dose.” In other words, there is greater variation than may safely be assumed.
49. It can be disastrous when a patient runs out of alternatives. When Jennifer A. could not get her medication, she shot and killed herself.
50. Her suicide came at a high cost for her most important survivor. She left behind her 12-year-old son.
51. Law enforcement targeted her physician. His medical records were seized in a search. His practice was suspended. This physician was never charged with any offense. Jennifer A’s physician had spoken up about how law enforcement was compromising the medical profession and the patients they need to treat for acute and chronic pain.
52. Given there was no prosecution of the doctor, the investigation was plainly reckless, and, you might say, that it was not conducted in “good faith.”
53. Perhaps it was truly calculated not to enforce the law but to chill a critical voice — Jennifer’s physician. Certainly, that was the effect of the government putting her doctor in law enforcement’s cross-hairs.
54. The agent who filed for the search warrant had had 13 weeks of training in detecting drug trafficking. Before that, the agent had been a dog walker.
55. The physician had been practicing for 50 YEARS. Perhaps a FOIA request might unearth the whole truth, about how reckless and indifferent the government was to this physician; in the end, the “investigation” of the physician resulted in no charges, and was never litigated in any other criminal or civil forum.
56. Unfortunately, I have had to experience this hostile regulatory environment in the form of the Montana Board of Medical Examiners (BOME)
57. It has been said that, to a hammer, everything is a nail. That metaphor rings true in my experience with the Montana Board of Medical Examiners.
58. It started in 2013 with the filing of a baseless BOME complaint. The merits of this complaint I could not fully overcome until 2020. I was trying to get my day in court on the merits of slander, court fees and the like until 2021. I never got my day in court to attack the delays and expense I suffered because of the BOME’s misconduct.
59. In 2015, after extensive discovery and expense in the BOME’s one-sided administrative “process,” the BOME Hearing Examiner concluded that there was nothing irregular about my pain prescriptions. In other words, the Examiner found I acted in “good faith.”
60. Members of the Board did not prefer that outcome, a clean bill of health, and they decided to dictate a different outcome, took into account matters ex parte never considered by the hearing examiner, it was a procedural railroad, concerning information, shared among the BOME, but not provided to my counsel or myself.
61. The Board didn’t just add highly questionable and slanderous material to the record, they zeroed out all of the Examiner’s favorable findings, the hundreds of factual findings and conclusions about the law. Finally, they suspended my medical license.
62. We appealed the decision to the Court in 2016. We got a stay on my medical license suspension shortly after filing our appeal.
63. Two years later, in 2018, it took that long, the Court found the Board had violated my constitutional due process rights by their misconduct and sent it back to the Board, remanded it for further more appropriate review, hoping that this time, the Board would render a fair inquiry.
64. Think again!
65. The Board appointed a 2nd Hearing Examiner, rather than return to the 1st Examiner.
66. Nothing happened for the next two years after his appointment. The 2nd Examiner was inert. He did nothing at all.
67. In 2020, I retained John P. Flannery, II, Esq., as counsel, and he filed in court a mandamus, ordering and demanding that the Board and the 2nd Hearing Examiner perform the legal duty that the Court directed be done by its order in 2018. Simply put, the mandamus charged that the Board and the 2nd Hearing Examiner had done nothing at all, and it was high time that they did what the court ordered.
68. Within a few weeks following the filing of the Mandamus, the 2nd Examiner finally acted. He reinstated the 1st Examiner’s finding, that my prescriptions for pain were appropriate, told the Board that they should adopt the 1st Hearing Examiner’s findings, rejected the Board’s factually unsupported findings that there were any prescription irregularities. The 2nd Hearing Examiner said to forego any suspension of my medical license, but required that I demonstrate that my medical record-keeping was in order.
69. We demanded a hearing on the merits but the trial court refused us one; on appeal two members of the Montana Supreme Court found that we had a right to our day in court on the merits, but the other members of the panel disagreed in a 5–2 decision.
70. Years ago, I stopped prescribing any opiates. You can understand why. My practice suffered because of this lingering case from 2013 to my Montana Supreme Court appeal in 2021. I barely avoided bankruptcy in this period.
71. The worst result of the hostile regulatory environment is that chronic pain patients who can obtain no relief, improvise on a deathly off ramp, by suicide, by gun, by alcohol, by overdosing amytryptylline.
72. True, there are clearly folks who really do need palliative opiate treatment. They are easily identified. They need pain relief and do better on pain medication — this despite the self-appointed lay critics who say otherwise including Andrew Kolodny and Roger Chou.
73. I never treated addicts. They may need treatment. But I have not done so. It is too complicated. I have only treated patients who had been treated previously by other physicians.
74. Not everyone appreciates the distinction between acute and chronic pain. I have a personal story, in fact two stories.
75. I once ruptured my Achilles tending while training for the “Race to the Sky” dog sled race. I finished a 350 mile dog sled race wearing a rear entry ski boot. The agony of spasms and pain kept me alert during the race. This was acute pain but what I feared, as should everyone, was the possibility of chronic pain, of relentless, ceaseless pain and suffering, a dreaded future of agony that leads from suffering and possibly to suicide, a momentary solution for a life long with suffering.
76. The unstated question may be, “how much medication does one need?” It depends on the patient, what he needs to have anything approximating a normal life. We must investigate the condition prompting the acute or chronic pain, and what might work instead of opiates. True, we naturally produce an opiate effect ourselves but that only goes so far.
77. In recent days, I’ve had to consider the expression, “heal thyself.” If you can.
78. This is my second story.
79. I had coronary artery quadruple bypass surgery weeks ago. Among other things, your chest bone, the sternum, is cut wide open. Ribs can be sprained. The surgeon must get at the heart to do what’s required. The good news obviously is that I survived. But then there was the pain. Upon discharge I was given a prescription for oxycodone 5 mg Q6 (every 6) hours, total number of pills, 28.
80. That’s one week’s worth of pain and medication. That was the legal limit in Ohio where I had the procedure.
81. I made the prescription last two weeks. So I had pain.
82. Upon returning to Montana, my cardiologist refused any further oxycodone prescriptions. He said to give Ibuprofen a try. (Suffice it to say it failed.).
Some concluding observations
83. Permit me to re-visit how we have changed the law.
84. The controlled substance act defines who is a drug dealer: It’s a person who distributes drugs who does not have a medical license.
85. The CSA protected doctors from drug interdiction when it was first written in 1970.
86. However, around 2004 the statutory language was interpreted differently — turning against the physician who was practicing medicine and compromising patients who needed a physician to practice medicine, rather than fear the loss of his or her license.
87. DEA Agents won’t tell you what is prohibited or permitted. If you even stumble upon misconduct and report it, the law enforcement engine turns on you and your practice, not the objects of your complaint. It’s like an excuse to rummage around your patients’ confidential HIPPA materials.
88. DEA Agents and other law enforcement officers won’t say what a physician may do, but are fast to “enforce” if they think that the quantity of opiate prescriptions seem “high” and this is further complicated by the fact that enforcement believes that any prescription leads to addiction, rather than an acceptable dependence that ends when the pain recedes.
89. The Agents will confess, “we are not doctors, we cannot tell you what to do,” but in experience that is only a pose.
90. By the nature of what we physicians do, we seek the trust of patients, believe, while we scrutinize what we’re told by a patient. We are by nature curious, healing, empathetic. We are not an arm of the state, serving as an agent, a de facto attorney general, charged with finding out wrongdoers. We don’t have complete knowledge of who each patient is, what they’ve done, and the science of imaging, for example, doesn’t tell us much about how or where pain may inhabit a patient’s misery.
91. We are more sensitive to the consideration that to deny a patient treatment for chronic pain is in fact and truth a restraint on the freedom a well man or woman enjoys, control of their own being, an impermissible form of custody for the patient caused by failure to treat another’s illness; it is a denial of the medical science that can release a patient from this badge of slavery and violates a patient’s constitutional rights in a variety of ways.
92. Going back to “how it was,” in 1999 pain was considered a fifth vital sign that had to be treated. There was a righteous concern about how inadequate was our management of pain. Physicians and the general public were encouraged to treat pain more aggressively, and patients were asked about the results of their pain treatment regularly.
93. As I’ve suggested, our current governmental regimen recoils from treatment for pain, and has a variety of adverse effects on our patients.
94. In a nation that permits its citizens to abuse their health in so many ways, it is a shame and a disgrace that our government and medical boards effectively bar pain treatment that almost uniformly sustains a person’s health.
95. It is not lost on me that so many believe that any pain medication is dangerous because the government at every level, in ever election and legislative session, and every press release, has been piping this lie for so long it has become a predicate belief that pain medicine hurts and kills, when the government is supposed to promote the general welfare, to tell the truth, rather than compromise the well being of our citizens suffering in pain.
96. Of course, I am available to respond to any questions as may be required. My contact info is found in my CV (following).
97. In this brief affidavit, I have tried to give attention to some few of the salient points that have made pain care in America a nightmare from which we cannot awake.
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 John P. Flannery, II, is the author of a book, “Pain in America — and How Our Government Makes it Worse,” and what he originally wrote, about the state of enforcement and its disastrous impact on pain management, now years ago, remains as true today; what I suffered is just one more example of what he earlier found in his research.
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Mark S. Ibsen, MD, FACEP, FAAFP
6425 Head Lane
Helena, MT 59602
Diplomat, American Board of Emergency Medicine 1988, 1999, 2009
Diplomat, American Board of Family Practice, 1984, Recertified 1992
Residency: Family Practice
University of Utah Family and Community Medicine
Salt Lake City, UT
Medical School: Washington University School of Medicine, St. Louis, MO
Doctor of Medicine: 1980
Recipient, Cowan Pulmonary Medicine Award 1980
Undergraduate: Williams College
Dean’s List 1973–1976
2458 Hwy 93s,
Kalispell MT 59901
2015- present ( providing consultations for cannabis patients throughout Montana)
Owner/Operator Urgent Care Plus
39 Neill Avenue
1/1/2010 — January 2016
Marias Medical Center
Emergency Room Physician
July 7, 2014 — July 14, 2014
Staff Emergency Room Physician
Great Falls, Montana
6/2008 — Present
Staff Emergency Room Physician
St. James Hospital
Consultant: State of Montana
Department of Disability Services
Staff Emergency Room Physician
St. Peter’s Hospital
Staff Physician, The Medicine Tree Clinic
St. Ignatius, MT
Staff Emergency Room Physician
Kalispell Regional Hospital
Interim Medical Director
Emergency Department/A.L.E.R.T. Helicopter
Kalispell Regional Hospital
Staff Emergency Room Physician
Mercy Medical Center
Assistant Director Emergency Department
Director AIR MED TEAM Helicopter Program
Director EMS programs
Redding Medical Center
Staff Emergency Physician
St. John’s Hospital
Staff Emergency Physician
Mercy Medical Center
Redding, CA 6/88–8/91
Staff Emergency Physician
Pioneer Valley Hospital
West Valley City, UT
Staff Emergency Physician
Wasatch Emergency Physicians
Salt Lake City, UT
Director, Emergency Department
Tooele Valley Hospital
Mother Teresa’s Missionaries of Charity
SYDA Foundation PRASAD Project
St. Jude’s Hospital, Sisters of the Sorrowful Mother
St. Lucia, West Indies
Mescalero Apache Reservation
National Health Service Corps
Health Manpower Shortage Area Service Payback
Utah State Medical Association Pre-trial Arbitration Board
Board of Trustees, Lewis and Clark county Cooperative Clinic, 2004–2007
Board of Trustees, Helena Center of Creative Living, 1998–2003, 2004–2006, 2009–2014
Mentor, Landmark Education Wisdom Course 2008–2012.
Volunteer and medical Director Hands on Global 2015-present.
Trips to Zanskar 2015,2017.
Lesbos Greece 2018
Standing Rock 2017.
Medical Director R.I.V.E.R. , a service and teaching organization for veterans with PTSD. 2016-present
ACLS Instructor Trainer
Utah Heart Association
ACLS Certified, ACLS Instructor
1995 — Present
1983 — Present (Recertification 1/95)
Montana 1991 — Present
North Dakota 2020
Awards and Honors
Fellow, American College of Emergency Physicians
Fellow, American Academy of Family Physicians
Physician of the Year, 1985, Utah EMT Association
Cowan Pulmonary Medicine Award, Washington U. 1980
National Merit Scholarship Finalist, 1973
MVP and Special Mention All-State Football, 1973
University of Utah Clinical Faculty 1986–88
U.C. Davis Clinical Faculty 1990–93
Chairman, Emergency Medicine Section 8/94–8/95
Quality Assurance 12/93–9/94
Ethics and Pharmacy/Therapeutics at Mercy 1988–91 and 1992–93
Secretary-Treasurer Flathead County Medical Society 1995
Trauma Committee 12/94–9/95
Ethics Committee — St. Peter’s Hospital 1998–2003; 2006–2007
Utah Governor’s EMS Committee
Tooele County EMS Director
EMS and Air Medical Director
Redding Medical Center
Instructor, Bigfork QRU EMT Course, Glacier Park EMT Course
Medical Director, Bigfork quick Response Unit
Medical Director, Kalispell Fire Department Ambulance
Representative, MT Regional Trauma Advisory Committee
Medical Director, Flathead Valley Community College Paramedic Course
Member, Wilderness Medical Society 1983–1995
Member Flathead Nordic Ski Patrol
Instructor Wilderness Emergency Care Course 1993–1996
Wasatch Mountain Club 1983–1988
Medical director Great Divide Ski Patrol
ACEP, AFFP, WMS, Montana Medical Society
Flathead Medical Society
American Academy of Emergency Physicians
Board of Trustees, Great Basin Nature Conservancy
Institute of Noetic Sciences
Lewis and Clark County Medical society(president 2003–2005)
Personal Growth and Development Landmark WorldWideParticipation Landmark Forum 7/13/07 & 09/16/11 Advanced Course 8/24/07 Self Expression and Leadership Program 10/6/2007 Communication Access to Power 1/14/14 Communication Power to Create 5/10/14 Wisdom Unlimited 3/298/08 Landmark Assisting Program 2008 — Present Partnership Unlimited 6/26/09 Power and Contribution 3/24/10 Discourse Program 1/1/10 — Present Conference for Global Transformation: Conference Presenter May 2014 and Poster Presenter May 2013 and 2015
Professional Conferences: PainWeek 2015 9/7/15–9/13/15
Born: May 12, 1955, Grand Rapids, Michigan
Raised: Geneva, Illinois (1960–1973)
Interests: Kayaking, Skiing (alpine, telemark), Biking, Hiking
Transformational personal growth work
Ski-joring, Public Speaking, running
Dog mushing (2005 2006 Beargrease race-380 miles, Race to the Sky finisher 2008, 2010,-2014)
Bicycle racing, marathon running ( St. Louis marathon, Deseret news marathon, St. George marathon, montana Governors cup)
Ski marathons ( Yellowstone Rendezvous )
In my practice of medicine, I provide top-notch patient-centered medical care. I strive to serve my patients in an efficient, cost-effective and compassionate manner. I aim to be present to whatever is needed. My values include: quality, teamwork, and service to patients, community, medical staff, and hospital.