Cedars-sinai originated with 3 orthopedic surgeons and myself providing physiatric care to acute and chronic pain patients. It was part of a comprehensive 20 member orthopedic group in Albuquerque. The focus of NMS was entering the care network through physiatry to select the care pathway of either conservative or surgical intervention. The was achieved by utilizing medical assessment/patient care, interventional injections, physical therapy and modalities, with supportive consultation of other care givers to decrease chronic pain or eliminate acute pain. Through weekly meetings of the orthopedic surgeons, therapists, and myself (physiatrist) discussing proposed surgical patients the past care plans were reviewed. After a team discussion of each proposed surgical patient surgery was approved or an alternative care plan. The physiatrist would sign off on the proposed plan of care after the team discussion.

I was the treating physiatrist participating with Anesthesiology, Nursing, P.T. and Psychology in directing a non-operative program for spine care primarily focusing on acute and chronic pain. Through a weekly team driven program adults were given care to maximize functional abilities while decreasing pain. This included clinic visits with myself and a nurse practicioner for medication and functional assessment. Anesthesiologist provided interventional spinal injections. During this time I was the team lead for the development of Low Back Care Map and Stroke Care Map. The LowBack Care map was presented at a national conference for back pain in Saint Louis. The Back Care Program was later summarized in the publication The Spine Journal, authored by Dr.Ben Klein attending psychologist of theLovelace Spine Clinic. The results demonstrated by behavioral cognitive intervention, with directed resource utilization, functional improvement was demonstrated statistically with significant decrease surgical intervention in the Lovelace Healthcare System.

I directed the rehabilitative services at Carrie Tingley Hospital for children and young adult to the age of 21 years. Carrie Tingley Hospital was a free standing orthopedic directed facility. The hospital provided inpatient and outpatient services to cerebral palsy, spina bifida, anoxic and traumatic brain injury with comprehensive orthopedic, neurologic, pediatric coverage. Consultation with other medical services and dental was available. The new pediatric physiatry program expanded the traditional coverage but added spinal cord injury, severe burns, and catastrophic injuries allowing for transfer from the acute care burn trauma and ICU services directly to the inpatient program. The transdisciplinary program included educating students in each rehabilitative discipline as well as pediatric and orthopedic residents. I made rounds on a daily basis with the adult/child burn trauma level 1 program and attended weekly adult trauma outpatient clinics for assessment of physiatric/rehabilitative adult needs. Educational foundation in pediatric physiatry with a transdisciplinary approach was begun by weekly grand rounds supported by the team members presenting from local and national conferences as well as evidence based literature. The program furthered this by supporting attendance at national conferences specific to the needs of the program. A program director was hired to assist with goal direction of the team interacting on a continuous basis. The goal of the program was a family oriented team approach maximizing the function and development of the child young adult inclusive of the schools and vocational needs.

I was medical director and physiatrist for the inpatient and outpatient pediatric rehabilitation program with P.T., S.W., O.T., Psychology, Nursing, Therapeutic Recreation, Neuropsychology, and Case Management. This included spinal cord injury ( venitlation program with peds ICU), TBI and anoxic injury, cerebral palsy, spina bifida, cerebral vascular injury, limb deficiency, and multi-trauma injury.

I established and provided care to 2 traveling clinics while working at WRI. The first was to IdahoFalls, Idaho at the district 7 health clinic. This was a comprehensive rehabilitation program with Nursing, P.T., O.T., Case Manager, Speech, Family and many teachers from the schools participating on a monthly visit to address ongoing physiatric/rehabilitative needs. IEP discussion with the schools occurred as well as outlining the rehabilitation service needs of the child in the community. This included positioning assistive devices, augmentative speech needs, feeding difficulties, and wheel chair ordering in addition to other individual needs.The second clinic was in Las Vegas at The University Hospital Medical Center. I had a similar outpatient clinic as in Idaho Falls but also provided consultation services to the neonatal and pediatric ICU regarding physiatric/rehabilitative needs.

My inpatient care was evaluation and consultation of children and young adult's medical needs as well as rehabilitative. This included pre-operative assessments and post-operative consultations.In addition to the inpatient care I directed the limb deficient clinic and a pediatric physiatric clinic during these years in the outpatient setting.