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JULY / AUGUST 2012  |  Volume 18  |  Number 4


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MCMS Incoming President John Clark, MD, Receives the Gavel From Past President James Ramseur, Jr, MD. JULY / AUGUST 2012 | THE BULLETIN | 3

The Santa Clara County Medical Association Officers President Rives C. Chalmers, MD President-Elect Sameer Awsare, MD Past President William S. Lewis, MD VP-Community Health Cindy Russell, MD VP-External Affairs Howard Sutkin, MD VP-Member Services Eleanor Martinez, MD VP-Professional Conduct Seham El-Diwany, MD Secretary Scott Benninghoven, MD Treasurer James Crotty, MD

Chief Executive Officer


William C. Parrish, Jr.

El Camino Hospital of Los Gatos: Arthur Basham, MD El Camino Hospital: Dan Fox, MD Good Samaritan Hospital: Richard Newell, MD Kaiser Foundation Hospital - San Jose: Seema Sidhu, MD Kaiser Permanente Hospital: Anh Nguyen, MD O’Connor Hospital: Michael Charney, MD Regional Med. Center of San Jose: Richard Kline, MD Saint Louise Regional Hospital: Diane Sanchez, MD Stanford Hospital & Clinics: Peter Koltai, MD Santa Clara Valley Medical Center: Richard Kramer, MD

AMA Trustee - SCCMA James G. Hinsdale, MD

CMA Trustees - SCCMA Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (Past President) Randal Pham, MD (Ethnic Member Organization Societies) Tanya Spirtos, MD (District VII)



Printed in U.S.A.



President John F. Clark, MD President-Elect Kelly O'Keefe, MD Past President James Ramseur, Jr, MD Secretary Patricia Ruckle, MD Treasurer Steven Vetter, MD


Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

Joseph S. Andresen, MD

Managing Editor Pam Jensen

Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/ MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising. Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org © Copyright 2012 by the Santa Clara County Medical Association.



DIRECTORS Paul Anderson, MD

David Holley, MD

E. Valerie Barnes, MD

John Jameson, MD

Jose Chibras, MD

Jeff Keating, MD

Ronald Fuerstner, MD

Eliot Light, MD

James Hlavacek, MD

R. Kurt Lofgren, MD

AMA Trustee - mcms David Holley, MD (Alternate)


Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

700 Empey Way  •  San Jose, CA 95128  •  408/998-8850  •  www.sccma-mcms.org


Feature Articles


12 CMA Responds to United States Supreme Court Ruling

CME Tracking Discounted Insurance Financial Services Health Information Technology Resources House of Delegates

14 You Have A Right to Know: Labeling Genetically Engineered Food 18 MCMS’s Annual Meeting and Installation Dinner 32 SCCMA’s Award Presentations and Installation 40 SCCMA Awards Banquet Photos



Human Resources Services

6 From the Editor’s Desk

Legal Services/On-Call Library

7 Final Message From the Outgoing SCCMA President

Legislative Advocacy/MICRA Membership Directory iAPP for the iPhone

8 Message From the SCCMA President 10 Message From the MCMS President

Physicians’ Confidential Line

20 Santa Clara/Stanford Transformative Experience in Medicine Program (SSTEM)

Practice Management

22 MCMS Residents’ Dinner

Resources and Education

24 Welcome New Members

Professional Development

25 In Memoriam


28 Member Benefit: CME Cruise

Referral Services With

30 CMA Webinars

Membership Directory/Website

31 Member Benefit: Workers Comp Savings

Reimbursement Advocacy/

47 Medical Times From the Past

Coding Services Verizon Discount

48 DocBookMD 52 Classified Ads JULY / AUGUST 2012 | THE BULLETIN | 5


Joseph S. Andresen, MD Editor, The Bulletin

Changing of the Guard By Joseph S. Andresen, MD Editor, The Bulletin Another academic year passes by and we find ourselves in the midst of summer. As in many organizations, and in our own SCCMA, there is the changing of the guard ritual with the past year’s leader handing off the baton to our new president. One year ago, as incoming SCCMA president, Dr. William Lewis wrote: “I am no prophet, and I can make no promises about the future of medicine. But this I know: ours is one of the largest and most influential county medical associations in California, and the CMA is one of the leading state associations in the country. So our opinions have real potential to ripple across the state and beyond, if we overcome our collective apathy. Our awardees are great examples of what passion and participation can achieve. Hopefully, these individuals and their accomplishments will inspire the rider and rally the elephant in the rest of us.” We now welcome Dr. Rives Chalmers as the 77th incoming president of the Santa Clara County Medical Association for 2012-2013.  In his welcoming address, Dr. Chalmers echoed the sentiments of Dr. Lewis:   “Health care in America is in a time of accelerating change, with the engines of this change dating back to the beginning of Medicare in 1965…..We are in a strong position to influence the direction of change both at a local and a state level, by supporting the voice of our physicians.  As Dr. Lewis says, 'SCCMA has the largest number of active physician members in the State of California'……The solution to problems of democracy is more democracy. The base support of any democratic organization is active members, not dues paying bystanders.  With this in mind, I have opened a special email,  rchalmers@sccma.org, for ideas, thoughts, or complaints. Volunteers?  I want member input.” We applaud the contribution of Dr. William Lewis over this past year in working to strengthen SCCMA on our behalf.  We welcome Dr. Chalmers to continue the important work, as our tireless advocate, in meeting the many challenges that lay before us.  Let us not face change with the fear of losing what was, but with renewed efforts to make the best of the opportunities ahead for both our patients and our profession. 6 | THE BULLETIN | JULY / AUGUST 2012

Joseph S. Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area.


william s. lewis, MD Past President, SCCMA

Health Reform and Reflections By William S. Lewis, MD Past President, Santa Clara County Medical Association While the Supreme Court’s recent ruling on the Patient Protection and Affordable Care Act (ACA) will undoubtedly affect all Americans, the impact of this historic decision is particularly significant on physicians across the nation. Throughout the health care debate, the SCCMA and the CMA advocated for an expansion of insurance coverage and improved access to care for uninsured Californians. To this effect, physicians should applaud the court’s decision to uphold the law’s individual mandate provision, which recognizes the responsibility we share for universal affordable health care. Preservation of the mandate also protects two key insurance reforms in the law: the elimination of bans on patients with preexisting conditions and coverage rescissions. Without the mandate, the insurance industry insists these reforms are unachievable. But there is a catch. As beneficial as the ACA is, we know it is flawed. Two flaws are particularly objectionable. First, it is built upon the broken foundation of Medicare and Medicaid. Second, it creates a powerful, unaccountable Independent Medicare Payment Advisory Board. Until the ACA addresses inadequate funding for Medicare and Medi-Cal, it will fail to provide timely access to quality health care. California physicians have called upon Congress for years to eliminate the flawed Medicare Sustainable Growth Rate (SGR) payment formula and adopt a long-term path to an alternative payment system that recognizes the real drivers of cost in health care. Despite these efforts, this issue was not addressed in the ACA, and physicians face a 32% Medicare reduction at the end of this year. Unless the SGR is fixed, Medicare will be the new MediCal. Despite the CMA’s successful fight against cuts to Medi-Cal, current Medi-Cal payments are still so low that most physicians cannot afford to see Medi-Cal patients in their offices. This forces Medi-Cal patients disproportion-

ately into congested and expensive emergency rooms. Expansion of Medi-Cal, without improving physician payments, will only aggravate the problem, and paying primary care doctors Medicare rates will not matter if they are cut to Medi-Cal levels. The Independent Medicare Payment Advisory Board (IPAB) will be appointed by the President and has the power to mandate spending cuts. The IPAB can, and predictably will, reduce physician reimbursement without any accountability or practical reversibility. Eliminating IPAB, at least as it’s currently structured, is imperative. That’s why physician advocacy by the SCCMA and CMA is more relevant now than ever, and I implore you to get involved and stay involved. In that regard, I am happy to leave you with a county medical association in good health. The SCCMA has the largest membership in the state. We enjoy the lowest annual dues of any medium- or large-size county. We

send the largest delegation to the CMA’s annual meeting, giving us the most powerful voting bloc in the state. We have the best staff in the state, and our CEO has invaluable connections county and statewide. It’s been an honor and an education to serve as SCCMA president, for which I am grateful and indebted. If I may paraphrase Winston Churchill: never in the history of this association was so much owed to so many by so few, or actually just one, me. Thank you.

William S. Lewis, MD, was the 2011-2012 president of the Santa Clara County Medical Association. He is a board certified ENT physician and is currently practicing in the Los Gatos area.



Rives C. Chalmers, MD President, Santa Clara County Medical Association

Challenge and Opportunity By Rives C. Chalmers, MD President, Santa Clara County Medical Association The following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 5, 2012. Dr. Lewis, fellow members of the Santa Clara County Medical Association, colleagues, and distinguished guests – It is a tremendous honor and privilege for me to address you as the incoming 77th President of the Santa Clara County Medical Association, the largest medical association in California.

Mission Statement To extend medical knowledge and advance medical science, to elevate the standards of medical education and practice, to enlighten and direct public opinion regarding all matters pertaining to public health and welfare, to promote the betterment of the medical profession, to promote excellence in the provision of quality ethical health care, to provide services to its members, to encourage open communication among the physicians of Santa Clara County, to further similar interests in other organizations of like nature, and to unite with similar organizations in other California counties to form the California Medical Association. Notice that Bill (Lewis) is smiling. This has been his job for the past year. This is our mission statement. Notice the many things he had to do. Now, he is on vacation. Looking over the crowd, I have personal acquaintance with presidents dating from 1971, including all those present tonight. I respect each of these individuals immensely for their contributions to our profession, and especially cherish the handful from which I have had the great fortune of receiving mentorship. Health care in America is in a time of

accelerating change, with the engines of this change dating back to the beginning of Medicare in 1965. The member physicians in our association are greatly affected by this change. The next few years, particularly, will bring major changes to their style of practice, income, and lifestyle of physicians in Santa Clara County. Change is accelerating. Issues to be dealt with include: 1. Accountable Care Organizations – These are networks of physicians, hospitals, and secondary providers who share the responsibility of providing care to a patient population of at least 5,000 Medicare beneficiaries for at least three years. 2. State Health Insurance Exchanges – State-regulated marketplaces for buying and selling health insurance, dictated by federal guidelines. Their goal is to give uninsured and underinsured individuals access to health insurance plans at competitive prices. 3. Comparative Effectiveness Research – Choosing treatments based on balancing the benefits with the costs (benefits are measured in quality-adjusted life years – QALYs). 4. Sustainable Growth Rate cuts – 30% Medicare cuts across the board are scheduled for January 2013. 5. Required Electronic Medical Record (EMR) – prescribing and billing. In Medicare and Medi-Cal, funding has reached the limits of the financial resources required to provide the health care that every citizen and every politician wants. Funded by taxes, Medicare and Medi-Cal continue to provide medical care with rapid growth in costs. The Patient Protection and Affordable Care Act, “Obamacare,” will further increase demands to an already underfunded system. The demand for medical services will increase, as many more people, 50 million nationwide, become covered by the medical system. The current health system now spends $2.6 trillion per year; approximately 30% of that money is overhead. This represents 18% of

Rives C. Chalmers, MD, is the 2012-2013 president of the Santa Clara County Medical Association. He is a board certified orthopaedic surgeon and is currently practicing in the Los Gatos area. 8 | THE BULLETIN | JULY / AUGUST 2012

our gross national product. The U.S. government pays approximately 46% of all health care expenditures. Health care reform will include some sort of rationing and it will be decided on a political basis, not by medical leaders. I believe medical payments will continue to decrease. And after the November election, I believe that, in California, both houses will have Democratic super-majorities. If so, the current direction of medical reform will continue, whether or not the federal law is struck down. Locally, California continues to cut reimbursement to Medi-Cal recipients. Governor Brown’s proposed 10% cut in Medi-Cal across the board was disallowed by the courts, but there is simply not enough government funding to pay at current levels. In Santa Clara County, we have approximately 350,000 people on Medi-Cal, receiving their care through a countymanaged valley medical system or through the Family Health Trust with services provided by independent physicians. The population of Santa Clara County is approximately 1.8 million. The majority of these citizens receive care through large groups, such as Kaiser or the Palo Alto Medical Foundation, the academic physicians at Stanford, the V.A. Hospital, and the county-run hospitals, as well as many independent, solo, or small-group physicians. Santa Clara County Medical Association includes members from all these groups of physicians. All of our members are trying to adapt to the challenge of change in a very competitive market. All of our members are worried – they want good information on day-to-day changes, and they want to influence the course of events. What are they to do? Of all of the organizations providing physician input to these changes, the state and county medical societies are the most influential and give the voice of the physician community as a whole. For political advocacy, we have the best seat at the table. We are in a strong position to influence the direction of change, both at a local and a state level, by supporting the voice of our physicians.

As Dr. Lewis says, “SCCMA has the largest number of active physician members in the state of California.” We have the highest percentage of physician membership of any large or medium county medical society. By serving the interests of physicians in our county, we are adding members from Stanford, Valley Medical Center, The Permanente Medical Group, solo, and small group physicians. We have provided clear channels of communication by a revamped website, informational town hall meetings, emailing, and faxing updates from CMA. From our medical association, we have generated the old Santa Clara County Medical Foundation, the Lifeguard Health Plan, the very successful NORCAL Mutual Insurance Company, which began in 1975 in our medical association following the medical malpractice crisis, and the Bureau of Medical Economics. We responded to our local member problems. I looked over the old association Bulletins and the same sort of problems are there since the ‘40s. Remember the smoking ban in public places? – Result of medical society policy at the state level. The point I am making is that the Santa Clara County Medical Association has provided innovative, successful leadership in the medical community at the local and state level. I intend to continue to support innovation in our association with the primary emphasis on the needs of

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our members. Our slogan this year will be to “Think SCCMA.” When a problem arises, call us. We can help and we are listening. SCCMA is a team sport, and needs the input of all the members. We need more diversity – including more of the East Side physicians, especially the Asian community. We always need more young physicians. Governor Alfred Smith said, “The solution to problems of democracy is more democracy.” The base support of any democratic organization is active members, not dues paying bystanders. With this in mind, I have opened a special email, rchalmers@sccma.org for ideas, thoughts, or complaints. Volunteers? I want member input. Special thanks to the association staff, particularly the preeminent CEO in California, William Parrish, Mark Christiansen, Jean Cassetta, Pam Jensen, Sandie Becker, Sharon Jensen, Shannon Landers, Sherin Varghese, Marcy Yarbrough, and Maureen Yrigoyen, the voice of the medical association. Thanks to my office staff, Jeanne and Megan, my sons, Alex and John, his wife Ashley, and especially my wonderful wife of 42 years, Ann. Thank you for this great honor to represent the association as president. I am humbled and excited by this challenge and I pledge to do all I can to move us forward.

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John f. clark, MD President, Monterey County Medical Society

Meet John Clark My Background And Goals For My Tenure As Your President By John F. Clark, MD President, Monterey County Medical Society As the new president of the Monterey County Medical Society, I have been honored to be elected to represent you, the physicians and members of the society, and as your new president, I would like to take this opportunity to tell you a little about myself. I was born and raised in San Jose, CA, and as a child came to Monterey regularly with my father, who was an avid sailor and was fond of racing his 18” lead keel mercury, “Red Fox,” in regattas on the Monterey Bay. When I graduated from UC Davis medical school with the intention of “specializing” in family medicine, the opportunity to complete my training at a top-notch residency in Monterey County proved irresistible. After completing my training, I was fortunate to join a primary care group here managed through Natividad Medical Center, which I directed for eight years. I was equally fortunate to then go on to join the largest primary care group in Monterey County, a group I continue to be a part of as it continues to grow. I am a busy practicing physician, and I think this is valuable perspective to bring to the office. It is from this perspective that I would further like to share with you some ideas I have concerning what I see as the role of the Monterey County Medical Society in the local practice of medicine. It is abundantly evident that we live in a time of mass medicine. Our national health care system is a $3 trillion industry that must meet the needs of over 311 million citizens with a work force of over 660,000 physicians, 83,000 physician assistants, and 106,000 nurse practitioners. Locally, the over 420,000 people of Monterey County depend on more than 600 local physicians for their care. A myriad of large, private national health insurance companies, as well as several enormous state and national public health care programs, facilitate the majority of this care. The recently passed Affordable Care Act attempts to organize this 10 | THE BULLETIN | JULY / AUGUST 2012

system globally on an unprecedented scale and continues to be the subject of ongoing policy debates, political wrangling, and legislative activity. Yet there is a simple fact that can get lost in all the numbingly large numbers and reams of policy papers. Medicine happens most immediately between just two people, a patient and their doctor. It is this relationship, which is at the center of health care, and the actions and policies of any company, organization, or government in regards to health care are ultimately judged by their impact on this relationship. To the practitioner who spends the vast majority of his/her time in these relationships, to contemplate the political, economic, and societal forces that come to bear on the exam room can seem overwhelming. The idea of trying to influence these forces can seem daunting at best and, at worst, impossible. From the position of standing next to the exam table, it is easy to feel helpless. A practitioner could use some help in the face of such titanic forces; help advocating for their patients and themselves within the larger health care system. I believe that the job of the Monterey County Medical Society is to offer such assistance, partnering with physicians as they approach the edifice of organized medicine. MCMS is well positioned being part of District VII. District VII (San Mateo, Santa Clara, Santa Cruz, Monterey, and San Benito counties) enjoys the largest voting block within CMA. That means our collective voice has clout and influence, both at the House of Delegates, CMA’s Board of Trustees, and at the capital. As I begin my tenure, I believe that the Medical Society must use this power to be the collective voice in advocating for the needs of our members and their patients. Since a significant portion of your dues goes to provide legislative access and influence, I would like to try and facilitate increased communication and participation to ensure your voice is heard. To that end, we will be rolling out some new ideas in the next several weeks, designed to increase accessibility and responsiveness to your views

and needs. These enhancements will come in several forms, mostly organized through our website. These ideas include improved access to your local, state, and national legislative representatives, as well as CMA representatives, polling on current/proposed health care policy, consultation to legislators, regular legislative updates, and more. I hope through these changes to increase the value of the service that you have purchased by becoming a member of the society, and I am always open to additional ideas to increase that value. Please feel free to contact me through the MCMS website at www.sccma-mcms.org. The essential role of the physician is as patient advocate, through the practice of medicine and through the maintaining of the quality of that practice. There is no reason that that advocacy needs to stay constrained to the exam room. The MCMS and I look forward to helping further your advocacy in the upcoming year.

John F. Clark, MD, is the 2012-2013 president of the Monterey County Medical Society. He is a board certified family medicine physician and is currently practicing with Salinas Valley PrimeCare Medical Group, Inc.


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By James T. Hay, MD President, California Medical Association Following the U.S. Supreme Court ruling, it is clear that Californians can still expect many changes in health care delivery and insurance coverage. The ruling to uphold the Affordable Care Act (ACA), specifically the 12 | THE BULLETIN | JULY / AUGUST 2012

individual mandate provision, guarantees insurance coverage for most of the uninsured patients in California. It has been the California Medical Association’s goal for decades to achieve universal health insurance coverage. Despite this monumental step forward, there is tremendous work to be done to ensure appropriate implementation here in California. Moreover, there are many problems with the law that need to be fixed to make the ACA work.

CMA has long advocated for affordable access to care for California’s uninsured and for an expansion of health insurance coverage. However, as physicians, we know that insurance coverage alone does not mean access to doctors. Throughout the federal health care reform debate, your CMA advocated for meaningful changes to the health care delivery system that build on what works, while fixing only what is broken. In addition to supporting the individual mandate, CMA has also fought for the protection of the physician-patient relationship from third-party interference, for meaningful reforms to the for-profit health insurance industry, and for sufficient resources to deliver on the promise of improved access to doctors. CMA has also supported eliminating egregious health insurance cancellation practices, pre-existing condition exclusions from coverage, lifetime or annual limits on benefits, and excessive insurer profit and administrative costs. These reforms will ensure that patients are not denied health insurance based on what illnesses they have, but rather will help to guarantee coverage for all. While the individual mandate is essential to making coverage affordable for all, these insurance industry reforms are also critical to making the ACA work. The ACA also made important investments in primary care, primary care training, rural health care, medical homes, public health and prevention, funding research on the effectiveness of different treatments, and increased payment rates, albeit temporary for primary care physicians and related subspecialties in Medicare and Medi-Cal. However, the legislation has left several serious problems unresolved, most specifically the underfunding of Medicare and Medicaid. For a decade, California physicians have been calling on Congress to eliminate the flawed Medicare Sustainable Growth Rate (SGR) fee-for-service payment formula and adopt a long-term path to an alternative payment system that recognizes the real drivers of health care costs. That issue was not addressed in the ACA, and physicians are now facing a 32% cut in payment rates for Medicare patients at the end of this year. The Medicare Advantage rates are being cut as well. Many physicians will not be able to sustain such cuts and remain in the Medicare program, which would have grave negative impacts on Medicare seniors as well as private patients. CMA and our partners in this fight will continue to work with Congress to find a long-term solution that addresses this serious threat.

CMA worked to eliminate the SGR and increase Medicaid reimbursement rates, but unfortunately nothing was done in the final bill to fix the grossly inadequate Medi-Cal (California’s Medicaid program) payment rates that leave many patients without physicians. This severe underfunding must be addressed, as nearly 3 million new patients will enroll in Medi-Cal under the ACA. California is leading the way for the Medicaid expansion across the country, but in order to succeed, we must look at the reimbursement structure of the program here in our home state. The ACA does increase reimbursement rates for primary care physicians (and related subspecialties) who see Medi-Cal up to Medicare payment levels, but only through 2014. While this is a significant step in the right direction, CMA will be advocating to extend the increase well beyond 2014. CMA was also strongly opposed to the ACA’s creation of an unaccountable Independent Medicare Payment Advisory Board (IPAB), which will mandate arbitrary spending cuts, force more physicians out of the program and limit seniors’ treatment options even further. The IPAB removes Congress’s accountability to voters, including to physicians and seniors, for the Medicare program by simply mandating physician payment cuts if Medicare spending exceeds congressionally set health care spending limits. There have been a number of questions about the Medicaid expansion part of the court’s ruling. The ACA allows an expansion of Medicaid and would make additional Medicaid funds available to states that comply with the expansion. For states that do not comply with the expansion requirement, the ACA in-

tended to impose the penalty of withdrawing all Medicaid matching funds, including funding for current participation levels. The court found that the penalty portion of the Medicaid expansion provision is unconstitutional, but that the provisions of the ACA that expand Medicaid are otherwise valid. Therefore, it is up to the states to decide whether to expand Medicaid – the federal government cannot withhold federal matching funds if states do not comply. This Medicaid ruling will not affect California, because the state has said they will continue to move full steam ahead in implementing the ACA. As your CMA president, I understand that the ACA and the Supreme Court ruling are controversial among California physicians. However, there is deep support among the large majority of you for the individual mandate and universal health insurance coverage. I want to assure you that CMA is firmly committed to advocating for improvements and reforms to the ACA that will ensure everyone can actually see a doctor when they become ill or injured. We will be aggressive in pursuing appropriate payment reforms so that you can sustain your practice. We will continue to be vigilant in fighting to protect us and our patients from any government or private insurance intrusion into the doctor-patient relationship. CMA will keep you updated on ACA implementation issues, such as the state Health Benefit Exchange and health care delivery innovations, and their impact on our practices. Physician involvement in its implementation is crucial to a successful health care system.

CMA releases synopsis of Supreme Court health reform ruling As everyone from legal scholars to television pundits scrambles to wrap their minds around the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act (ACA), the California Medical Association (CMA) is providing its members with a quick, digestible summary of the landmark decision. The document, entitled “Overview of the Supreme Court’s Decision on the ACA,” takes the more than 180 pages of majority, concurring, and dissenting opinions and boils it all down to less than 3 pages of legal summary. Touching upon everything from the Commerce Clause to the Anti-Injunction Act, the summary works through the various legal questions on which the court was asked to rule at a pace designed to allow members to fully understand the implications of the court’s decision. The summary is available free to members in CMA’s online resource library at http://www. cmanet.org. Interested physicians can also watch CMA’s webinar on the ruling, which is now available for on-demand viewing in the resource library. The webinar provides a recap of the ruling from both a legal and policy perspective, with CMA experts providing information on the ACA, in its current form, and discussing what can be done to improve it. JULY / AUGUST 2012 | THE BULLETIN | 13

You Have a Right to Know:

Labeling Genetically Engineered Food By Ken Yew, MD In September 2000, 35-year-old Grace Booth was having a business lunch with coworkers where she ate three chicken enchiladas. She later recalled the food as being very good, but then something went wrong. “I felt my chest getting tight. It was hard to breathe...I thought, Oh my God, what is happening to me? I felt like I was going to die.” Her coworkers called an ambulance and in an emergency room in nearby Oakland she was diagnosed with severe allergic reaction. She later discovered that the tortillas in the enchiladas contained a controversial genetically-modified corn, Starlink, which was only approved for consumption in livestock because of concerns over allergenicity.1 Aventis, the makers of Starlink, had argued with FDA officials for its use in human consumption.2 Had this been approved and an ongoing recall in human food not been in place, Ms. Booth may never have found out about her exposure to Starlink corn. As of this writing, there is no requirement to label products containing genetically engineered (GE) foods. Such concerns lie at the heart of the grassroots movement, currently underway in California, to label such foods.

GE Food Is Everywhere

Before you start to think that you can’t possibly be eating GE foods because you know better, realize that if you eat any kind of processed or convenience food, you probably already are. The main GE products in the United States are corn, soy, cotton, and canola. Fully 89% of soy, 83% of cotton, 75% of canola, and 60% of corn crops in the United States are genetically modified.3 Now think of all the soy, cottonseed oil, canola oil, and corn syrup in the foods you eat.

What Is the Big Deal?

The main uses of genetic engineering are to either make the plant produce its own pesticide, like Bacillus thuringiensis or Bt, or to make it resistant to weed killing chemicals like glyphosate, also known as Roundup®. To do this, scientists take a gene with the desired trait and attach it to a gene promoter, as well as an antibiotic resistance marker gene. They take this spliced DNA Ken Yew, MD, is an and introduce it into plant cells either through active member of the use of bacterial plasmids, or a “gene-gun,” that SCCMA Environmental Health Committee and shoots plant cells with gold particles tagged with has submitted comments the desired gene sequence. As one can imagine, about labeling of GMOs there is an inherent lack of precision in introto the American Medical ducing the desired gene into the organism. The Association. gene sequence can insert itself anywhere on the 14 | THE BULLETIN | JULY / AUGUST 2012

plant chromosomes. They may interrupt normal functioning genes or change the way other genes are expressed. In this way, entirely novel protein sequences can be created through genetic engineering that would not ordinarily occur in nature.4 Products that would never appear in a naturally grown ear of corn would become expressed in high amounts as a result of promoter genes that would code for their production in a constitutive manner. The Cry9 protein found in StarLink corn, that made the Bt pesticide, was implicated in over 40 cases of severe allergic reactions.5 Unlike chemical pesticides, GE crops are living organisms that can self-replicate and contaminate wild and native crops. The Cry9 StarLink corn protein was ultimately found in a native corn variety grown in Iowa. This finding could only have come from contamination of the native corn through GE pollen.6 Numerous animal studies implicate GE corn in hepatorenal toxicity.7,8 Rats fed GE corn for 14 weeks showed a 40% increase in serum triglyceride levels and a decrease in urinary phosphorous and sodium clearance of 30%. These results were consistent and dose-dependent. Ultrastructural and histopathological studies consistently show alterations in liver nuclear structures, as well as glomerular membranes of the kidney in animals fed GE corn and soybeans.9,10 Another concern is that crops resistant to Roundup® encourage farmers to spray herbicide excessively, leading to toxicity from chemical residue. One study in Argentina did, in fact, demonstrate increased levels of glyphosate residues in Roundup® resistant soybeans which were sprayed multiple times.11 In vitro studies in human embryonic and placental cell lines show that very small levels of glyphosate induce apoptosis and act as endocrine disruptors, possibly interfering with reproductive health.12,13

What About the Benefits of Genetic Engineering?

Most claims about the benefits of GE crops fall into two categories: that GE crops will increase yields of planted crops and that certain GE crops can actually incorporate nutrients, such as vitamin A, that will improve people’s health. The claim that GE foods increase crop yields is patently false. A definitive study conducted by the Union of Concerned Scientists, incorporating data from 20 years of research

Continued on page 16 JULY / AUGUST 2012 | THE BULLETIN | 15

You Have A Right to Know, continued from page 15 and 13 years of commercial availability in the U.S. market, concluded “commercial GE crops have made no inroads, so far, into raising the intrinsic or potential yield of any crop. By contrast, traditional breeding has been spectacularly successful in this regard.”14 When considering the impact of Bt corn in areas of insect infestation, the operational yield may have increased by 3% to 4%. There has been no increase in yield of any kind from using Roundup®-resistant crops. There has been considerable controversy surrounding the deployment of “Golden Rice,” to third world countries, which is meant to fight vitamin A deficiency (VAD). VAD has been known to cause blindness, anemia, and even death in areas of severe malnutrition. Golden rice is a GE rice cultivar that contains a provitamin which is converted in healthy humans to vitamin A. The original strains of golden rice contained far too little provitamin A to be useful. A later strain, GR2, was made that produced 23 times more provitamin A. Nonetheless, opposition groups pointed out that no animal testing was done to prove golden rice’s safety, that there was no evidence of the provitamin’s chemical stability in storage and after cooking, and that other dietary deficiencies, particularly fat deficiency, may prevent the dietary absorption of the provitamin. A cheaper, more practical, and ultimately more effective solution would be to ensure more agricultural diversity in impoverished countries. Just two tablespoons of yellow sweet potatoes, half a cup of dark green leafy vegetables, or two-thirds of a mango per day would meet the vitamin A requirement of a preschool child.15

Consumers’ Right to Know

Our economy depends on the idea that consumers are knowledgable about the products they purchase, which ultimately determines through market forces the best price for things. Because of no small effort of industry lobbying, GE ingredients in this country are not labeled as such and they can, therefore, be hidden even in foods advertised as “all-natural.” GE foods are already either banned completely or labeled in 40 other countries. Because of the lack of labeling, there cannot be post-market surveillance of the health effects of GE foods. We, therefore, have no idea how safe GE foods are because their health effects cannot be tracked. This is not an ideological issue. It is a common-sense issue that affects us all. Currently, there is a grassroots movement to label GE foods in California through a ballot initiative. To learn more about the ballot initiative to label GE foods in California, go to www.labelgmos.org.


1. CBS News “Life Threatening Food?”; Feb 11, 2009 http://www. cbsnews.com/2100-18563_162-291992.html. 2. Hansen, Michael Comments on the Assessment of Scientific Information Concerning Starlink Corn (Cry9C Bt Corn Plant Pesticide) EPA Docket Number OPP-00688, Nov 28, 2000. 3. Smith, JM Genetic Roulette: The Documented Health Risks of Genetically Engineered Foods (2007), p 258. 4. Rosati, A et. al. “Characterization of 3’ Transgene Insertion Site and Derived mRNA’s in Mon810 YieldGard Maize,” Plant Mol Biol 2008 June; 67(3): 271-81. 5. Vorman, Julie “44 Claim Illness From Eating Starlink Corn,” Reuters, Nov 29, 2000. 6. Vorman, Julie “More StarLink Corn Contamination Found...,” Reuters, Nov 21, 2000. 7. Seralini, GE et. al. “New Analysis of a Rat Feeding Study With


a Genetically Modified Maize Reveals Signs of Hepatorenal Toxicity,” Arch Environ Contam Toxicol 2007 (52): 596-602. 8. Spiroux, J et. al. “A Comparison of the Effects of Three GM Corn Varieties on Mammalian Health,” Int J Biol Sci (5):706726. 9. Kilic A, Akay MT “A Three Generation Study With Genetically Modified Bt Corn in Rats: Biochemical and Histopathological Investigation” Food Chem Toxicol 2008, (46): 1164-70. 10. Malatesta, M et. al. “Ultrastructural Morphometrical and Immunocytochemical Analyses of Hepatocyte Nuclei From Mice Fed on Genetically Modified Soybean,” Cell Struct Funct 2002, (27):173-80. 11. Arregui, MC et. al. “Monitoring Glyphosate Residues in Transgenic Glyphosate-Resistant Soybean,” Pest Manag Sci 2004, (60):163-166. 12. Benachour, N et. al. “Time and Dose-Dependent Effects of Roundup® on Human Embryonic and Placental Cells,” Arch Environ Contam Toxicol 2007, (53):126-33. 13. Gasnier, C et. al. “Glyphosate Based Herbicides Are Toxic and Endocrine Disruptors in Human Cell Lines,” Toxicology 2009, (262):184-91. 14. Gurian-Sherman, Doug Failure to Yield: Evaluating the Performance of Genetically Engineered Crops, Union of Concerned Scientists, 2009, p.13. 15. Biothai (Thailand), CEDAC (Cambodia), DRCSC (India), GRAIN, MASIPAG (Phillipines), Pan-Indonesia, UBINIG (Bangladesh), Grains of Delusion: Golden Rice Seen from the Ground, 2001.

Spine Symposium 2012

Essentials for the Primary Care Practice A continuing medical education (CME) event providing an overview of the newest evidence-based treatment options for conditions affecting the spine. Presenters include specialists from John Muir Health’s Neurosciences and Orthopedics Services. Friday, October 5, 2012 The Claremont Hotel Berkeley, CA

John Muir Medical Centers, Concord and Walnut Creek, California

Register by September 28: Contact nancy.carol@johnmuirhealth.com or call (925) 947-4466 ext 35426.

johnmuirhealth.com JULY / AUGUST 2012 | THE BULLETIN | 17


MONTEREY COUNTY MEDICAL SOCIETY’S ANNUAL MEETING AND INSTALLATION DINNER The Monterey County Medical Society held its annual meeting and installation dinner on Tuesday evening, June 12, 2012, at the Del Monte Beach House. Over 60 members and special guests attended. Award honoree Allen Radner, MD, received an award for “Physician of the Year.” James Ramseur, Jr., MD, 2011-2012 MCMS president, was honored as the outgoing president, and John Clark, MD, was welcomed as MCMS’s incoming president for 2012-2013. Serving in the current fiscal year with Dr. Clark are: Kelly O’Keefe, MD, as president-elect; James Ramseur, Jr., MD, as past president; Patricia Ruckle, MD, as secretary;

MCMS President John Clark, MD, receives the gavel from MCMS Past President James Ramseur, Jr., MD.

MCMS 2011-2012 President James Ramseur, Jr., MD, receives Presidential Appreciation Plaque.

Luanne Parrish, MCMS CEO William Parrish, Ed Ryu and Julie Ryu (sponsors from Legacy Wealth Advisors, LLC). 18 | THE BULLETIN | JULY / AUGUST 2012

and Steven Vetter, MD, as treasurer. The MCMS board of directors are Paul Anderson, MD; Valerie Barnes, MD; Jose Chibras, MD; Ronald Fuerstner, MD; James Hlavacek, MD; David Holley, MD; John Jameson, MD; Eliot Light, MD; R. Kurt Lofgren, MD; and Jeff Keating, MD. The annual meeting was a great success and a lot of fun! MCMS members, their families, and special guests enjoyed a fantastic meal, a bonfire and roasting marshmallows on the beach, camaraderie, and a great program to wrap up the evening.

Allen Radner, MD, receives award for “Physician of the Year.”

MCMS members, sponsors, guests, and staff enjoy the bonfire and roasting marshmallows on the beach.

Jose Chibras, MD; Mark Christiansen, BME Manager; and William Parrish, MCMS CEO.

Our special thanks to the following sponsors for contributing to the success of this event: PLATINUM

John Clark, MD, MCMS President 2012-13; James Ramseur, Jr., MD, MCMS President 201112; and William Parrish, MCMS CEO, catching some waves.

NORCAL Mutual Insurance Company

GOLD Community Hospital of Monterey Peninsula Salinas Valley Memorial Healthcare System

SILVER Community Health Plan Over 60 members and guests enjoyed the evening’s festivities.

Law Offices of Hinshaw, Marsh, Still & Hinshaw

BRONZE Alvarez Technology Group, Inc Legacy Wealth Advisors, LLC Visiting Nurse Association & Hospice

William Parrish, MCMS CEO, and wife, Luanne, surfing in sync. JULY / AUGUST 2012 | THE BULLETIN | 19

Santa Clara/Stanford Transformative Experience in Medicine (SSTEM) Program Article/Photos by Jean Cassetta In the fall of 2008, two Stanford medical students, Ed Pham and Michael Chiu, met with, SCCMA President Dr. Howard Sutkin. Dr. Sutkin shared that back in Huntington, New York, when he was in junior high or high school, he attended a six-Saturday course, which introduced the idea to students about becoming a physician. Each Saturday, the class focused on a different specialty. Dr. Sutkin said that class was one of the reasons he became a physician. Being that there was shortage of physicians in our county, both Ed and Michael took the idea back to their AMA/CMA/SCCMA student chapter at Stanford, and they, with Dr. Sutkin and the Council’s input, created and titled the first all day program, “Exploring Career Paths in Medicine,” which was held on May 30, 2009. They wanted to reach out to low income or disadvantaged high school students and help them to consider the option/idea of going into the field of medicine. High school participants were selected based upon essays demonstrating their motivation and interest in learning about the medical field, as well as their academics and extracurricular experiences. They had over 30 students attend from Ann Sobrato, Live Oak, Silver Creek, Lincoln, and Andrew Hill high schools. The morning session was comprised of the following speakers: Howard Sutkin, MD, Plastic Surgery; Richard Silberstein, MD, Radiology; Martin Fishman, MD, Ophthalmology; Stephen Harris, MD, Pediatrics; Karen Ketner, NP, Nurse Practitioner; and Sudha Rao, MD, Pathology. The afternoon session consisted of hands-on activities such as learning to use a microscope, learning “Physical Exam Skills,” vital signs, lung/CXR, and how to read an X20 | THE BULLETIN | JULY / AUGUST 2012

ray. At the end of the day, a survey was given and the results showed the program to be a huge success. High school students loved the program and found the physician talks and PowerPoint presentations, of viewing the inside of the eye with retinopathy and seeing a patient’s face before and after plastic surgery, to be fascinating. They also loved the hands-on activities and wanted more days with more activities. So, Ed and Michael presented to Council, again, and proposed a longer program and requested funding. They also wanted to include a hospital tour. Fast forward to this past May 2012. The Stanford medical students have turned into a well-oiled machine. The first year students help with the program for the first session and then lead it the next. The program is now called SCCMA/Stanford Transformative Experience in Medicine (SSTEM). We now host two four-day Saturday programs each year. The medical students visit about 10-12 high schools each year to encourage and educate students about the program. It can often be competitive, as the last program had over 100 applicants/essays with only 35 seats available. There are two physician speakers who review two specialties per day and the rest of the day is devoted to team building and hands-on activities, introducing high school students to skills they may someday use as physicians. The activities are sometimes led by physicians who may have just presented, but usually are led by the medical students and include: sheep heart and cow eye dissections, physical exam and vital signs, CPR, a session on surgical knots and suturing, introduction to obstetrics/gynecology and labor and delivery surgical instruments, sutures, and IUDs. The last day of the program was held on campus at Stanford. High school students were taken to the anatomy lab, where medi-

cal students gave high-schoolers their first introduction to cadaver dissection. Afterwards, students, needing fresh air, embarked on a tour of the beautiful Stanford campus. A panel of medical students shared college and medical school admissions information strategies and gave the high school students and parents plenty of time for Q-and-A. They all shared a wonderful lunch and received certificates of completion given by Dr. William S. Lewis, 2011-2012 SCCMA President. As staff to this wonderful program and liaison to the medical students, I would like to thank the following medical student leaders who have helped make this program so much fun and such a success: Ed Pham, Michael Chiu, Duy Dao, Shawn Lin, Jennifer DeCosteLopez, Cesar Lopez Angel, Grace Kim, Isabel Nga Lai, Allison Truong, Rachel Lee, Nicole Arkin, Joseph Kamil Antonios, Ange Wang, and Michael Henderson. Also a special thank you to the following SCCMA physicians for volunteering to present at the SSTEM programs through the last few years: Drs. Howard Sutkin, Cindy Russell, Annette Chavez, Lynn Smolik, Richard Silberstein, Martin Fishman, Brian Ward, Stephen Harris, Sudha Rao, William Ricks, Felix Lee, Anh-Quan Nguyen, David Hyun, Sameer Awsare, Michael Stein, Jessica Murphy, Madhur Bhatnagar, Randell Camantigue, Donald Mordecai, and Sarala Rao. Going forward with the program, we are hoping to seek hospital funding to expand the program and invite the media to see what things are being done to encourage high school students to think about being a doctor. A special thank you to the SCCMA Council/board for providing funding and support, and to everyone involved for helping to inspire the next generation of doctors!

High school students from the SSTEM program in May 2012. Students get a session on surgical knots and suturing.

Learning about physical exams and vital signs.

Students learn through dissection. JULY / AUGUST 2012 | THE BULLETIN | 21


Thank You for Supporting the Monterey County Medical Society’s Resident Fund Thank you MCMS for the Resident team jackets.

Majority of Natividad Family Medicine Residents and their families enjoying a relaxing dinner at Kula Ranch Island Steakhouse in Marina. 22 | THE BULLETIN | JULY / AUGUST 2012

The Institute for Vascular Testing (IVT) invites both you & your staff to our Open House & Free Screenings on Thursday, August 23 from 5-8pm.



Welcome 57 New Members Santa Clara County Medical Association Name Natalia Abrikosova Al'ai Alvarez Paul Azer Daksha Barot Evan Bloom Derek Browne Patrick Chang Pauline Chang Jamie Cheung Michelle Choi Sarah Conley Emily Corrigan Kelly Derbin Melissa Dunagan Eric Ernster Angela Feng Pradipta Gosh Joseph Hastings Marian K. Kim Marian S. Kim Dhiruj Kirpalani Steven Kramer Lara Kulchycki Elene Lam Ding Ding Lee

City Specialty San Jose *FP San Jose EM Gilroy OM Santa Clara OBG San Jose EM Santa Clara FP Santa Clara PHO Santa Clara OBG Santa Clara AN Santa Clara IM Santa Clara U Santa Clara OBG Mtn View FM Santa Clara PD San Jose EM Santa Clara AN Santa Clara IM Santa Clara RO Santa Clara OBG Santa Clara PD Santa Clara PMR Santa Clara FP San Jose EM Santa Clara GER Santa Clara OBG

Name Li-Fen Lee Chai-Yen Lien Anna Marie Liess Sara Ludlow Jasmine Mahesri Thuy Nguyen Jennifer Nissly Neesheet Parikh David Saito Manpreet Sanghari Samee Shahzada Reed Simons James Soderberg Heather Taher Al Taira Khoi Tran Janet Tsui Robert Venable Priya Venkateshan Jan Vobecky Ann Vosti Laura Webb Nicole Wilcox Li Yu

City Specialty Santa Clara IM Santa Clara IM Mtn View *IM Santa Clara OBG San Jose EM Santa Clara OPH Santa Clara IM San Jose FM Mtn View OTO Mtn View FM Santa Clara P San Jose EM San Jose PD San Jose EM Campbell RO Mtn View GS Santa Clara OPH San Jose FP *EM Santa Clara D San Jose EM Mtn View UC *FP Santa Clara PD Mtn View OBG Santa Clara IM

Monterey County Medical Society Name James DiSario Sean McRoberts Allen Radner Matthew Romans

City Specialty Monterey GE Salinas EM Monterey *ID *IM Salinas *PS

Name Raymond Shaheen Debi Siljander Jeremy Silk John Silva

* - Board Certified   |   US - Unspecified


City Specialty Monterey VS Monterey *FP SM Salinas *PS Salinas FP

In Memoriam Norman Ballin, MD

Richard T. Okumura, MD

*Ophthalmology 2/28/30 – 6/9/12 SCCMA member since 1993

*Orthopaedic Surgery 5/14/28 – 2/4/12 SCCMA member since 1968

Joseph Fischer, MD

Bernard N. Rosenberg, MD

*Internal Medicine Cardiovascular Disease 10/2/22 – 6/19/12 SCCMA member since 1957

*General Surgery 9/12/20 – 2/28/12 SCCMA member since 1958

George D. Griffin, MD *Orthopaedic Surgery Pediatric Orthopaedic Surgery 5/13/31 – 6/1/12 SCCMA member since 1995

Richard K. Johnson, MD Hand Surgery *Orthopaedic Surgery 6/13/32 – 5/27/12 SCCMA member since 1964

Leo A. Strutner, Jr., MD *Internal Medicine Cardiovascular Disease 8/13/25 – 4/22/12 SCCMA member since 1957

Louis Zamvil, MD *Pediatrics 2/21/23 – 5/29/12 SCCMA member since 1953

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CMA Webinars   Please  note  that  this  calendar  does  not  include  CMA’s  ICD-­‐10  training  courses  to  be  offered  in  2012.     Aug.  15:  Program  Integrity  in  Medicare  &  Medi-­‐Cal   Bruce  Tarzy,  M.D.  •  12:15  –  1:15  p.m.   This  session  provides  physicians  with  information  about  the  risks   of  becoming  a  victim  of  fraud  and  how  to  take  preventive  action.   It  also  covers  compliance  with  Medicare  and  Medi-­‐Cal   documentation  requirements.     Aug.  16:  California  Workers'  Comp  eBill  Part  1:     Are  You  Ready?   Jopari  Solutions/CA  Workers’  Comp  •  12:15  –  1:45  p.m.   Part  1  of  an  extended  4-­‐part  California  eBill  Webinar  Educational   Series.  This  webinar  will  provide  you  with  an  overview  of  what   eBill  is,  how  it  works,  and  the  benefits  and  tools  to  help  you   evaluate  your  practice’s  eBill  readiness.  This  webinar  is  free  to  all   attendees.     Aug.  23:  California  Workers'  Comp  eBill  Part  2:  Implementation   Jopari  Solutions/CA  Workers’  Comp  •  12:15  –  1:45  p.m.   Part  2  of  an  extended  4-­‐part  California  eBill  Webinar  Educational   Series.  This  webinar  will  provide  an  overview  of  the  eBill   compliance  requirements.     Aug.  30:  California  Workers'  Comp  eBill  Part  3:  Understanding   Remittance  Advice  Rules   Jopari  Solutions/CA  Workers’  Comp  •  12:15  –  1:45  p.m.   Part  3  of  an  extended  4-­‐part  California  eBill  Webinar  Educational   Series.  This  session  will  provide  an  overview  of  the  eBill  electronic   remittance  advice  rules  and  how  to  use  these  rules  as  a  tool  to   help  automate  your  back  office  work  flow  processes.  This  webinar   is  free  to  all  attendees.     Sept.  5:  A  Guide  to  Reviewing  Payor  Contracts   Kris  Marck  •  12:15  –  1:15  p.m.   Kris  Marck  from  CMA’s  Center  for  Economic  Resources  will  offer   you  tips  to  maximize  success  in  negotiating  with  a  high-­‐level   review  on  contract  terms  and  provisions.  She  will  identify  top   provisions  practices  should  be  aware  of  prior  to  signing  or   renewing  an  agreement,  because  a  contract  is  so  much  more  than   just  reimbursement  rates.     Sept.  6:  California  Workers'  Comp  eBill  Part  4:     First-­‐Time  Submission   Jopari  Solutions/CA  Workers’  Comp  •  12:15  –  1:45  p.m.   Part  4  of  an  extended  4-­‐part  California  eBill  Webinar  Educational   Series.  Learn  how  physician  practices  can  experience  increased   success  in  sending  workers’  compensation  eBills  and  attachments  

correctly the  first  time,  by  understanding  common  reasons  for   eBill  rejections.  This  webinar  is  free  to  all  attendees.     Sept.  19:  Creating  and  Implementing  Financial  and  Office  Policies   Debra  Phairas  •  12:15  –  1:15  p.m.   In  the  medical  office,  office  policies  and  procedures  are  handed   down  verbally  from  one  staff  person  to  another.  Inevitably,   important  elements  of  policies  are  lost  in  translation.  Creating   written  financial  and  office  policies  and  procedures  help  staff   learn  their  jobs  faster,  with  greater  accuracy,  and  relieves   physician  and  manager  frustration!     Oct.  3:  Protect  Your  Practice  From  Payor  Abuse   Mark  Lane  •  12:15  –  1:15  p.m.   CMA  sponsored  legislation  (AB  1455  –  The  Health  Care  Provider   Bill  of  Rights)  includes  many  protections  against  unfair  payment   practices  by  health  plans  and  insurers.  Mark  Lane,  from  CMA’s   Center  for  Economic  Resources,  will  discuss  important  California   laws  that  protect  physicians  and  their  practices  from  payor  abuse.     Oct.  17:  Establishing  Expectations  for  High  Performance  From   Medical  Staff   Debra  Phairas  •  12:15  –  1:15  p.m.   Superstar  staff  members  are  made,  not  born.    Staff  usually  rise  to   the  owner  or  manager’s  level  of  expectations.  This  webinar  will   teach  physicians/managers  how  to  set  high  expectations  for   performance,  create  monitoring  tools  to  evaluate,  and  reward   staff  who  achieve  stellar  performance.     Nov.  7:  Understanding  ARC  and  CARC  Revenue  Codes   David  Ginsberg  •  12:15  –  1:15  p.m.   The  use  of  remark  codes  and  claims  adjustment  reason  codes   became  standardized  under  HIPAA.  The  recent  introduction  of  the   5010  standards  further  emphasizes  use  of  these  codes  on   remittance  advices  and  payments  made  to  medical  offices  by   health  insurers.  Understanding  the  codes  can  assist  medical   practices  in  more  effective  payment  posting  and  follow  up  on   denials  or  payment  reductions.       The  above  webinars  are  being  hosted  by  the  California  Medical   Association.  Please  register  at  www.cmanet.org/events.    Once  your   registration  has  been  appoved,  you  will  be  sent  an  email  confirmation   with  details  on  how  to  join  the  webinar.  Questions?    Call  the  CMA   Member  Help  Line  at  800/786-­‐4262  



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Santa Clara County Medical Association Award Presentations and Installation The Fairmont Hotel’s Club Regent, in San Jose, provided the setting this year for Santa Clara County Medical Association’s Annual Awards Banquet. William Lewis, MD, 2011-2012 SCCMA President, following his outgoing president’s speech, presented Rives Chalmers, MD, with the presidential gavel for 2012-2013. Serving in the current fiscal year with Dr. Chalmers are: Sameer Awsare, MD, as President-Elect; Cindy Russell, MD, as Vice President of Community Health; Howard Sutkin, MD, as Vice President of External Affairs; Eleanor Martinez, MD, as Vice President of Member Services; Seham El-Diwany, MD, as Vice President of Professional Conduct; William Lewis, MD, as Past President; James Crotty, MD, as Treasurer; and Scott Benninghoven, MD, as Secretary. The SCCMA Councilors are: Arthur Basham, MD (El Camino Hospital Los Gatos); Dan Fox, MD (El Camino Hospital); Richard Newell, MD (Good Samaritan Hospital); Seema Sidhu, MD (Kaiser Foundation Hospital – San Jose); Anh Nguyen, MD (Kaiser Permanente Hospital); Michael Charney, MD (O’Connor Hospital); Richard Kline, MD (Regional Medical Center); Diane Sanchez, MD (Saint Louise Regional Hospital); Peter Koltai, MD (Stanford Hospital & Clinics); and Richard Kramer, MD (Santa Clara Valley Medical Center). The evening’s festivities culminated with the recognition of those who have dedicated their lives to furthering the high quality of medical care. Dr. Chalmers made the following presentations:

Assemblymember Jim Beall Citizen’s Award With the Citizen’s Award, the Medical Association recognizes a non-member who has achieved public recognition for a significant contribution in the health field. Tonight, we recognize Assemblymember Jim Beall for this award. Jim Beall represents Assembly District 24, encompassing Campbell, Saratoga, and portions of San Jose – including Willow Glen and Blossom Valley – Santa Clara, and Los Gatos. Born and raised in San Jose, Jim began his career in politics at 28 when he was elected to the San Jose City Council. After 14 years on the 32 | THE BULLETIN | JULY / AUGUST 2012

council, he was elected to the Santa Clara County Board of Supervisors, where he served three terms. Jim has successfully worked with the Board to set policy goals and launch the Children’s Health Initiative (CHI). CHI made Santa Clara County the first county in the nation to make the commitment to provide health coverage for all children in the county. As of August 2006, over 116,339 children have completed applications for Medi-Cal, Healthy Families, or Healthy Kids. Jim has served on the CHI Community Oversight Board since its creation. He has played an essential role in providing direction for the outreach and enrollment activities, providing community education, and gaining community support for the CHI health programs. Jim has served as a member of the Mental Health Board for many years, providing leadership in setting policy goals, promoting client advocacy and empowerment. Jim actively worked to pass Proposition 63 – a statewide initiative to provide increased funding to improve mental health services provided by counties. Since June 2000, Jim has served as a member of the Santa Clara Family Health Foundation, whose charge is to raise funding for the Healthy Kids premium. As a result of Jim’s networking and fundraising efforts, the Foundation has raised over $40,000,000 through the public and private sectors as of August 2006. As both a member and chairperson of the Health and Hospital System from 1995- 2001, Jim oversaw the development of Santa Clara Valley Health & Hospital System Strategic Business and Facilities Plan. Supervisor Beall led the effort to establish a Community Treatment Facility, Starlight, for seriously emotionally disturbed children, ages 1118. CTF consists of interdisciplinary service teams providing case management, mental health services, therapeutic behavior services, nonpublic school, and locked bed facilities for up to 36 youth at a time. CTF has been successful in returning a majority of the children back home and/or to other community settings. Jim is a long-time advocate for the county’s Gay, Lesbian, Bisexual, and Transgender community. He pushed hard, for years, to prioritize expanded HIV testing out in the community. During the FY 2006 budget process, he proposed a major expansion of HIV testing among the most vulnerable populations. Supervisor Blanca Alvarado co-signed this budget augmentation request of $375,000 and it passed the Board on a unanimous vote. Jim assisted the Korean American Community Services (KACS) with acquisition of a favorable long-term lease for a centrally located senior service center. In addition, Jim successfully launched the Children’s Health Initiative (CHI) in the Korean American community, after becoming concerned with an alarmingly low number of Korean American children in Healthy Kids program. This strategy resulted in a 200% in-

crease in enrollment. Jim has a long-time relationship with the county’s Native American community. He successfully lobbied the Board of Supervisors to increase funding for the Indian Health Center ($150,000 on-going) to better meet the medical, dental, counseling, women and children, nutrition, and other community health services to the American Indian population. In 2006, he won the Assembly District 24 race. He has been reinstated twice, and expects to run for the 15th District Senate seat this year. Since arriving at the State Capitol, he has focused on health care, creating more jobs, upgrading our transportation system, improving the foster care system, supporting green technology, and ensuring that those with disabilities are treated equally. As a legislator, he coauthored SB 810, the universal health care bill, supported Feuer’s bill (AB 52) that would allow the State Insurance Commissioner to regulate health plan rates, and introduced AB 12 – a shared partnership between small businesses and the county to provide affordable health insurance coverage to small business employees. AB 12 was passed and signed into law. The following is what a couple of colleagues have to say about Jim and the work that he has done in the field of health: “Jim was one of the county supervisors that initiated the Healthy Kids Program and the Children’s Health Initiative. We were the first county in the United States to make the effort to bring universal health care to all children in our county. At the start of the program, one out of every six children did not have medical, dental, or eye coverage. Due to Jim’s effort, 96% of the children in our county now have coverage.” – Kathleen King, Executive Director of Santa Clara Family Health Foundation, Santa Clara County Medical Association’s 2011 Citizen of the Year “Jim Beall deserves credit for helping make Valley Medical Center one of the finest public hospitals in the United States. His tireless advocacy led to our new outpatient specialty center, our new main hospital, and so much of the quality and excellence associated with VMC. His work at the Board of Supervisors carried over to the Assembly, as he has been looking out for our safety net institutions non-stop since. He is a hero. He is my hero.” – E. Chris Wilder, Executive Director of the VMC Foundation.

Steven Fountain, MD

Jayhawks. After serving in the United States Army for four years, he began orthopaedic residency at the University of California San Francisco, followed by a postgraduate fellowship year in Hong Kong with Dr. Hodgeson, where he learned the pioneering surgery of the spine from the anterior approach, which Dr. Hodgeson had developed to take care of his complex problems including tuberculosis, scoliosis, major deformities, infection, and tumor. On his return to the Santa Clara Valley, he put into practice the advanced techniques of anterior approach spine surgery at Valley Medical Center and Stanford, and began to teach these techniques to other spine surgeons in the local area, including Kaiser and the other valley hospitals. This has represented a major improvement in the treatment of Complex Spinal Surgery, benefiting thousands of patients to the present day. He retains his position as clinical professor of surgery in the Department of Orthpaedics at Stanford University, to the present day. Steve has also been very active in the Santa Clara County Medical Association, joining the medical association in 1978. He began his private practice in orthopaedics in 1981, in Los Gatos. He was chief of staff of Community Hospital of Los Gatos in 1988, followed by the governing board. He was president of SCCMA in 1990–1991, and has been a delegate to the CMA House of Delegates for several years. He joined the administration of the NORCAL Mutual Insurance Company, which was originated by our Medical Association, beginning in 1982. He was elected to their board in 1985 and became chairman of the NORCAL board from 1996–2008. He was chairman of the Physician Insurers of America (PIA) from 1994–1996. He was a founding member of the National Patient Safety Foundation, and chairman of the Professional Liability Committee of the American Association of Orthopaedic Surgery (AAOS) from 1994– 1997. He was the AAOS Representative to the AMA in 1994–1996. He is a member of the JCAHO Sentinel Event Advisory Committee, from 2002–present. Steve received the Outstanding Contribution to the Medical Association Award at this banquet in 1999. Overall, Steve has provided outstanding service to the medical community of Santa Clara County, which has expanded to include service to the state as well as the nation.

Benjamin J. Cory, MD Award

Robert Pearl, MD

This award is given to a physician member of the association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability. Occasionally there arises a physician who is a leader in multiple areas of medicine. Such a man is Steven Fountain. Dr. Fountain has distinguished himself not only as a practicing orthopaedic surgeon, but also as a teacher and, finally, as a national leader in the field of medical liability and patient safety. Dr. Fountain was raised in Kansas and continues to root for the

This award is given to a physician member of the association who has demonstrated extraordinary visionary leadership, tireless effort, selfless longterm commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exalted goals of the medical profession. Robert Pearl, MD, is executive director and CEO of The Permanente

Robert D. Burnett, MD Legacy Award

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SCCMA Award Presentations and Installation, from page 33 Medical Group. As CEO of the largest medical group in the nation, Dr. Pearl is responsible for the health care of more than three million Kaiser Permanente members. The Permanente Medical Group comprises approximately 7,000 physicians and 30,000 staff members and operates 21 medical centers in Northern California. He was selected as executive director and CEO of The Permanente Medical Group in 1998. In addition, he is the president and CEO of the Mid-Atlantic Permanente Medical Group, which serves 500,000 members in Maryland, Virginia, and the District of Columbia. Board certified in plastic and reconstructive surgery, Dr. Pearl received his MD from the Yale University School of Medicine. He completed his residency in plastic and reconstructive surgery at Stanford University and currently serves on the faculty as a clinical professor of plastic surgery. In addition, he is on the faculty of the Stanford Graduate School of Business and teaches courses on strategic thinking and strategic change. Selected by Modern Healthcare as one of the most powerful physician leaders in the nation, Dr. Pearl has published more than 100 articles in various medical journals and has been a contributor to many books. He has made more than 100 presentations at national meetings in the areas of both clinical medicine and medical economics. In the past several years, he served as a visiting professor at Duke University School of Medicine, Haas School of Business, and Harvard School of Public Health. As a frequent lecturer on health care, Dr. Pearl is an advocate for the power of physician-led, integrated medical delivery systems. He believes that organizations like Kaiser Permanente, in which physicians collaborate rather than compete, and in which a multi-specialty medical group works in partnership with a not-for-profit health plan and hospital system, are able to provide superior quality of care over fragmented, insurance-based systems.

Eleanor Levin, MD Outstanding Achievement in Medicine Award The Outstanding Achievement in Medicine Award is given to a physician who, during his/her medical career, has made unique contributions to the betterment of patient care, for which he/she has achieved widespread recognition. It is, in a sense, bestowed upon a physician’s physician. Dr. Eleanor Levin is a clinical professor of Medicine at Stanford University and a cardiologist at Kaiser Santa Clara who is nationally recognized for her work in cardiac disease prevention and population management. Dr. Levin was formerly chief 34 | THE BULLETIN | JULY / AUGUST 2012

of Cardiology at Kaiser Santa Clara, and chair of the Chiefs of Cardiology of Northern California. Following her cardiology fellowship, she joined the faculty at George Washington University as an assistant professor in the Lipid Research Clinic, where she became convinced of the importance of treating hypercholesterolemia and prevention. When she joined Kaiser in 1989, she soon began working to improve cardiac risk factor reduction. She pioneered an integrated, multi-disciplinary approach to disease management, which capitalized on Kaiser’s extensive patient databases and coordinated care among pharmacists, internists, and subspecialists. Her work led to the development of the Cholesterol Management and MultiFit Cardiac Rehab Programs throughout Kaiser Northern California and she remains the regional director of these programs. Cardiovascular disease is the leading cause of death in all parts of the United States, with one exception: among Kaiser Permanente members in Northern California. Under the guidance of Dr. Levin during her term as chief of cardiologists for TPMG, she instituted a population management program that was so successful the mortality rate, due to cardiovascular disease, was decreased dramatically enough to relegate cardiovascular disease to the second cause of death among Northern California Kaiser Permanente patients. By championing a population-based approach to cardiac disease prevention, Dr. Levin has helped improve care for hundreds-of-thousands of patients with or at-risk for heart disease.

William Jensen, MD Outstanding Contribution in Medical Education This award is given to a physician member of the association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large. Dr. Jensen, “Bill,” distinguished himself in undergraduate and medical school training. His efforts were acknowledged by appointment to a residency, chief resident, and pulmonary fellowship at the New England Deaconess Hospital. Following a research year with the American Lung Association, Bill took an appointment as the associate chief of Pulmonary Medicine at Santa Clara Valley Medical Center. With this position, Bill became a clinical assistant professor with the Stanford School of Medicine in 1988. Based on his advocacy for the residents and awards for clinical teaching of students and residents, Bill accepted the position as program director of the Internal Medicine Residency. Bill engaged residents in critical thinking, encouraged participation in the medical association, added fellows from Stanford to the training program in Pulmonary, organized monthly CME

programs for the community pulmonologists, and continually stressed the importance of lifelong education. Bill involved residents, fellows, and faculty alike in scholarly writings through publication of observations and participation in research, scholarly textbooks, and clinical vignettes at the meetings of his professional organizations. Bill served as program director and chairman of the Department of Medicine for 21 years. As chairman of the Department of Medicine, Bill provided the leadership needed to continue attracting medical students to the field of internal medicine and the subspecialty of pulmonary-critical care. He did this through his faculty development and selection of key individuals to serve as his co-directors for the various residencies under his direction. These residencies helped train not only internists and primary care physicians, but dermatologists, anesthesiologists, radiologists, and other specialties as well. The characteristics Bill sought from his key faculty included a firm commitment to excellence in teaching, stressing the fundamentals of humanism, and the primacy of the patient, achieved through thorough history taking and the hands-on physical examination. He was honored by the American College of Physicians, receiving the 2011 Distinguished Teacher and Mentor Award. Throughout his careers, Bill exemplifies leadership by example. He has placed teaching and mentorship at the top of his priorities and built the Department of Medicine on a foundation of life-long learning, serving as the foundation for providing the best of medical care. Bill has shown that teaching others motivates them to strive for excellence in delivering the highest quality of care, regardless of an individual’s ability to pay. William Jensen is an individual deserving of recognition by his students, peers, colleagues, and patients for outstanding contributions to the training of physicians in our community.

has worked as a pathologist at Kaiser in San Jose, since 1981. In 1989, he became president of the San Francisco-Bay Area Chapter of Physicians for Social Responsibility (PSR) and, in 2003, was president of the National PSR. Since 1986, Dr. Gould has been a leading member of the Peace Caucus of the American Public Health Association, for which he is currently chairperson, and in 2009, the American Public Health Association (APHA) awarded Dr. Gould the prestigious Sidel-Levy Award for Peace in New York. He has published many articles, authored many chapters in books, and spoken on a range of subjects including health effects of nuclear and biological weapons, prevention of nuclear terrorism, war and public health, U.S. chemical policy, climate change, and the greening of hospital practices. This wealth of knowledge, experience, and networking has propelled our Environmental Health Committee, and indeed the medical association, to new heights in public health action. Since 1992, he has been a leading member of our Environmental Health Committee. In addition, through this work as a CMA delegate for over a decade, he has authored and submitted numerous resolutions adopted by CMA as policy, including resolutions calling for preventing dioxin waste from medical facilities, preventing human exposure to mercury, reducing the use of pesticides, protecting farm workers from toxic pesticide exposures, reducing air pollution for binding reductions in global climate change, for the abolition of all weapons of mass destruction, and for avoiding accidental nuclear war. For his work within CMA, Dr. Gould received the Santa Clara County Medical Association’s (SCCMA) “Outstanding Contribution in Community Service” award in 2001. Dr. Gould’s contributions have been invaluable to our association. We so appreciate his time, input, and service to the SCCMA. His passion to make our world a healthier and safer place is an inspiration to us all.

Robert Gould, MD

David Quincy, MD

Outstanding Contribution to the Medical Association

Outstanding Contribution in Community Service

This award is given to a physician member of the association who has exhibited sustained interest and participation in one or more activities of the association over and beyond that expected of the membership atlarge. Dr. Gould is presented with the “Outstanding Contribution to the Medical Association.” He has made a unique and distinguished contribution to public health both locally and globally. Over the last 20 years, Dr. Gould has not only been active in our Santa Clara County Medical Association, but in many other organizations that focus on nuclear issues, global health, and human rights. I will only be able to mention a portion of these endeavors. Dr. Gould graduated from Albert Einstein College of Medicine in New York, and

This award is given to a physician member of the association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large. Dr. Quincy has been the volunteer medical director of RotaCare, the free medical clinic at El Camino Hospital, for 15 years, since 1996. During the day, he is a family practice physician with Camino Medical Group. His initial attraction to RotaCare was based on his strong personal philosophy of giving back to the community. Dr. Quincy says,“It’s curious to me how I can get there after a full day in the regular clinic, and no matter how tired I am, I leave RotaCare with more energy than when I started.” “I and many of my colleagues feel that if we’re privileged enough

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SCCMA Award Presentations and Installation, from page 35 to have received such a great education and training, we owe it to the community to give back,” he says. He adds that the other volunteers at RotaCare have the same attitude — from physicians to pharmacists to nurse practitioners. His tradition of giving back started after he completed his residency, when he worked in a small underserved community in Arizona, near the Mexican border. Dr. Quincy has seen many changes at RotaCare, but the biggest change has been the huge increase in volume. Last year, they had 6,000 patient visits. “We’re seeing a wide diversity of patients,” he adds. “Around the time of the dot-com bubble burst, in 2001, we started seeing high-level professionals who had lost their jobs and, with that, their health insurance.” The other change has been in the move from treating acute care cases to managing chronic conditions, such as diabetes and heart disease. Because of this, they have expanded their pharmacy services and have added several clinical volunteers with specialties, such as pulmonology and cardiology. Aside from physicians, pharmacists, and nurses, a number of other clerical and support staff—from interpreters to high-school students — keep the clinic going. In addition to the volunteers who staff the clinic, he credits the success of RotaCare Clinic to El Camino Hospital’s investments in radiology, pharmacy, and other services. But it is the volunteers who are the heart and soul of RotaCare. “The energy, I think, comes from the fact that everyone who works there wants to be there. We all feel like we’re a part of something really important for the community.”

Donna Spagna Dedicated County Alliance Member of the Year The Santa Clara County Medical Association Alliance has selected its member Donna Spagna to be the recipient of Dedicated County Alliance Member. Donna was selected for the following reasons: Donna Spagna epitomizes the belief that in all phases of service, one person can make a difference. Donna has made a difference to hundreds of cancer survivors. A breast cancer survivor who, herself, experienced hair loss, Donna had the belief that other survivors should have access to free wigs, scarves, hair styling, and personal beauty strategies in support of the American Cancer Society belief and program: “Look Good, Feel Better.” Donna is a trained volunteer in that program and reorganized the entire ACS Silicon Coast Regional Wig Bank. She took it a step further. She improved the physical and emotional environment at the Stan36 | THE BULLETIN | JULY / AUGUST 2012

ford Cancer Center, the Breast Cancer Center (BCC) in Palo Alto, and the ACS facility in Campbell. For the Wig Bank project, Donna obtained an SCCMA Alliance grant and donations to create a room with full-width mirrors and cabinets to organize and display the donated wigs, hats, and scarves. Every month, she works at the Stanford Cancer Clinic with the ACS, and has enlisted other volunteers and wig professionals to fit wigs for patients and educate them on their use. At BCC, she works as an on-site help line advisor and also organizes workshops (including a “Mad Hatter’s Tea Party”) for cancer survivors. Her creativity, commitment, and kindness made her the unanimous award choice by the Santa Clara County Medical Association Alliance. Achievements: • “Not Even for a Minute – Never Leave Children Unattended in a Car” county campaign: Prepared and distributed materials to hospitals, offices, and clinics. • CMAA conferences: Prepared materials in support of local and state conferences. • Wig Bank coordinator for the Silicon Coastal Region Office of the American Cancer Society and the Stanford Cancer Center. (2010 – Present) • Volunteer for ACS “Look Good, Feel Better” program. (2010 – Present) • “Wig Buddy” for Breast Cancer Connections in Palo Alto. (2007 – Present) • Facilitator of workshops for BCC, including wig-cutting clinics, and workshops for hat and scarf alternatives for women undergoing treatment for cancer. (2007 – Present) • On-site help line advisor at BCC for women and family members needing support. (2007 - Present)

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Y O U !

Our special thanks to the following sponsors for contributing to the success of SCCM A’s Awards Banquet:

PLATINUM The Permanente Medical Group, South Bay and Kaiser Permanente


The Permanente Medical Group, South Bay and Kaiser Permanente



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Facebook.com/bvphotos JULY / AUGUST 2012 | THE BULLETIN | 39

SCCMA Equals Extraordinary Le

SCCMA Past Presidents, President, and CEO pose for a memorable photo at the 2012 Award Left to Right: CEO William Parrish; SCCMA Past Presidents Steve Fountain, MD (also an MD; William Lewis, MD (outgoing president); Rives Chalmers, MD (incoming president); Mar kin, MD; James Hinsdale, MD (also CMA Past President); and Thomas Dailey, MD. 40 | THE BULLETIN | JULY / AUGUST 2012


ds Banquet. n award honoree); Steve Jackson, rtin Fishman, MD; Howard SutJULY / AUGUST 2012 | THE BULLETIN | 41

2012 Annual 1

Outgoing-president William Lewis, MD, passes the gavel to incomingpresident Rives Chalmers, MD.

Awards Banquet June 5, 2012


Silver sponsor attendees from Kaiser San Jose/TPMG celebrate the special evening with award honoree Robert Gould, MD.


L to R: Award Honorees Steve Fountain, MD; Donna Spagna; Robert Gould, MD; Robert Pearl, MD; Eleanor Levin, MD; and William Jensen, MD. Award Honorees David Quincy, MD, and Assemblymember Jim Beall are not in picture.



William Parrish (SCCMA CEO) presents a thank you gift to outgoing president William Lewis, MD.


Platinum sponsor Kaiser Santa Clara/TPMG attendees celebrate with award honorees Robert Pearl, MD, and Eleanor Levin, MD.


Award Honoree Assemblymember Jim Beall presents the audience with his acceptance speech for the Citizen’s Award.


SCCMA Award Honoree William Jensen, MD, enjoys the special evening with his family.


SCCMA Award Honoree David Quincy, MD, celebrates his honor with wife Jane Varner, MD.

Photos: Brandon Vaccaro Photography 42 | THE BULLETIN | JULY / AUGUST 2012











SCCMA physician members, guests, and sponsors enjoying good food, wine, and good company.


SCCMA Award Honoree Eleanor Levin, MD, enjoys the evening with family and friends.


SCCMA Award Honoree Steve Fountain, MD, enjoys the dinner and special celebration with family and friends.


L to R: Jo Matheson (Comerica Bank), Helen Wang, RN, John Longwell, MD (Past President), Robert Burnett, MD (Past President), Fred Armstrong, MD (Past President), Gladys Armstrong, Olga Nespole, and Tony Nespole, MD (Past President).



SCCMA Alliance Award Honoree Donna Spagna poses with friends Jean Cassetta, Suzanne Jackson (Alliance Chair), and Kathleen Miller.


Rives Chalmers, MD (2012-13 President), celebrates his installation and special evening with family and friends.


SCCMA Award Honoree Steve Fountain, MD, and family appreciated the elegant atmosphere of the Fairmont Hotel.


Award Honoree Eleanor Levin, MD, poses with Joanne Silberstein and Jane Hiatt Pearl.


SCCMA Treasurer James Crotty, MD, enjoys the evening with fellow colleagues, Robert Levan, MD and Christine Levan, MD.

Photos: Brandon Vaccaro Photography 44 | THE BULLETIN | JULY / AUGUST 2012










SCCMA Past President and CMA Trustee Martin Fishman, MD, and CMA President (2012-2013) Paul Phinney, MD, enjoy the camaraderie.


William Parrish (SCCMA CEO) presents an iPad 3 gift to the winner of the door prize drawing, Seham El-Diwany, MD.


SCCMA President Rives Chalmers, MD; SCCMA Past President (2010-11) Thomas Dailey, MD; and Rosemary Kamei enjoy the evening.


SCCMA Award Honoree Robert Pearl, MD, and his wife Jane.

Photos: Brandon Vaccaro Photography 46 | THE BULLETIN | JULY / AUGUST 2012






HIPPOCRATES By Michael A. Shea, MD Leon P. Fox Medical History Committee Many of us remember the Hippocratic oath in medical school. What we may not recall is the story about Hippocrates, from whom much of the oath was derived. Known as the father of medicine, Hippocrates was born in 460 B.C. on the island of Cos (Kos), in the southeastern Aegean Sea, about 200 miles southeast of Athens, Greece. After receiving a good general education, he served an apprenticeship in medicine under his father, Herakleidas, and another physician, Herodikos. Shortly after, he left Cos for the land of the Thessalians, just north of Athens. Hippocrates stressed observation and a scientific approach to the diagnosis and treatment of disease. He is credited with separating medicine from philosophy, mythology, and religion. Under his teachings, medicine became an independent science; a body of knowledge unto itself. He proposed dietetics, exercise, cleanliness, and nutrition as the basis for prevention and treatment of illness. An idea that is espoused even today. His dietary advice included honey and water, barley soup, pomegranate juice, plus a balanced diet of meat, fish, vegetables, and fruit. He was also the first to suspect some diseases might be transported by air or water. He suspected epidemics to occur due to contaminated winds coming in contact with large masses of people. The most famous work of medical writings for these times was the Hippocratic Corpus. It was a large volume of 70 works that described all aspects of medical and surgical disorders and their treatment. Most scholars attribute this collection to a number of physicians, including Hippocrates. The works contain the conservative approach to treatment, as well as more active methods. It is interesting to list some of the active treatments in the Corpus because they were still a significant part of medical practice into the middle of the nineteenth century. 1. Venesection or bloodletting (based on the four humor theory of blood, phlegm, yellow bile, and black bile). 2. Purgatives (emetics and laxatives

for gastrointestinal disease). 3. Poultices (topical concoctions used to treat visible tumors). 4. Trephination (placing holes in the skull to treat such conditions as “water on the brain”). 5. Surgical procedures involving the kidney – the draining of abscesses or removal of stones. 6. Treatment of fractures and dislocations with splinting and manipulation. 7. Vasectomy – recorded as a surgical procedure for permanent birth control. Some of Hippocrates other accomplishments include: 1. Treating the king of Macedonia, who was suffering from consumption. 2. Predicting the spread of epidemics based on wind patterns. 3. Founding a medical school in Cos in 400 B.C. 4. Being listed by Plato as the master of his art. 5. Although not the sole author, he contributed to one of history’s most famous documents, the Hippocratic oath. This is printed below in its complete form.


I swear by Apollo the healer, by Aesculapius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this oath and promise to the best of my ability and judgment. I will pay the same respect to my master in the Science as to my parents and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract. I will hand on precepts, and all other learning to my sons, to those of my master, and to those pupils duly apprenticed and sworn, and to none other.

I will use my power to help the sick to the best of my ability and judgment; I will abstain from harming any man by it. I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing. Neither will I give a woman means to procure an abortion. I will be chaste and religious in my life and in my practice. I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft. Whenever I go into a house, I will go to help the sick and never with the intention of doing harm or injury. I will not abuse my position to indulge in sexual contacts with the bodies of women or of men, whether they be free men or slaves. Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one. If, therefore, I observe this oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for all time. If I transgress and forswear this oath, may my lot be otherwise. Hippocrates died in 377 B.C. He left behind two sons, Thessalos and Dracon, who apprenticed under their father and carried on his tradition.


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DocBookMD.com JULY / AUGUST 2012 | THE BULLETIN | 49

sccma alliance news

Santa Clara County Medical Association’s Alliance Shines With Its Dedicated Member, Member of the Year, and Information Booth at the Silicon Valley Duck Race May and June were busy months for Alliance recognition and volunteerism. On May 5, Donna Spagna was honored in Sacramento at the California Medical Association’s Alliance Annual Session. Donna Spagna was chosen as the Santa Clara County Dedicated Alliance Member for her work with the Coastal Region American Cancer Society (ACS) in designing and coordinating the wig bank and hair covering rooms for cancer patients, both at the Campbell and Stanford facilities. Donna was also honored at the SCCMA’s Awards Banquet, held in San Jose, on June 5. At the ACS annual awards dinner in June, Donna was the recipient of the “Quality of Life Award.” Donna’s dedication and caring for cancer survivors, along with her energy and positive attitude, were recognized to improve the quality of life for these survivors. The Silicon Valley Duck Race was held at Vasona Lake County Park

on Sunday, June 10. The SCCMA Alliance set up a display informing participants about one of the potential perils of summer: running into a store for a quick errand and leaving a child in a car – just for a minute. (When temperatures inside a vehicle exceed 88 degrees, potential lethal temperatures can be reached in less than 20 minutes.) The SCCMA Alliance is involved in a statewide awareness campaign to inform people about the dangers of leaving a child or pet in an enclosed car. At the Duck Race, Alliance volunteers distributed over 1,400 static window stickers, posters, and bookmarks to parents, police officers, local firefighters, and hospital personnel. These reminders can be placed in windows of vehicles and offices. 2012-2013 Alliance Membership Renewal Forms can be located at the SCCMA Alliance website at www.sccmaa.org. Please visit the website to learn more about opportunities and events in the organization.

Alliance members Donna Spagna, Suzanne Jackson, Kathleen Miller, and Mary Hayashi, plus official mascot, at the Silicon Valley Duck Race held at Vasona Park on June 10.

Mary Hayashi, Donna Spagna, and Kathleen Miller at the Alliance information booth at the Silicon Valley Duck Race.

Donna Spagna, Fulvio Spagna, and Kathleen Miller at the SCCMA Awards Banquet.

At the SCCMA Awards Banquet, Suzanne Jackson presents Donna Spagna with the award for Alliance Member of the Year.


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available from 1,000 to 2,500+ sq. ft. Timeshare also available. Call Betty at 408/8482525. DOWNTOWN MONTEREY OFFICE FOR SUBLEASE Spacious, recently remodeled, excellent parking, flexible terms. Call Molly at 831/6449800. MEDICAL/PROFESSIONAL OFFICE FOR LEASE Medical/Professional office 2,600 sq. ft, ground floor near Santana Row. $2.00 sq. ft. Available now. Email at sksiddiqui@yahoo. com. PRIME MEDICAL OFFICE FOR LEASE • SAN JOSE Excellent location. Westgate area. 1,584 sq. ft. West Valley Professional Center, 5150 Graves Ave. Suite 2/stand-alone unit. Private office, reception area, exam rooms with sinks. Available 2/1/11. Call owner at 408/8671815 or 408/221-7821. SANTA CLARA OFFICE • HOMESTEAD AND JACKSON Plumbed for Dental/Medical, or other use. 1,200 sq. ft. Downtown across from post office and weekly farmers market. Excellent Location! Dentist on site, please do not disturb. Don’t miss! Come see! Call 408/838-8191 or 408/741-1956.

PRIVATE PRACTICE/OFFICE for sale PRIVATE PRACTICE FOR SALE IM/FP/GP. Primary care practice for sale, including inventory and equipment. Close to O’Connor Hospital. If interested, please call Stacy at 408/297-2910.

EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@allianceoccmed.com for additional information. INTERNIST WANTED San Jose Medical Group has an immediate opening for a Board Certified, experienced Internist. One of our busy Internists relocated to Southern California recently, creating an

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Address service requested

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

700 Empey Way, San Jose, CA 95128-4705

NUMBERS Callers assisted in 2011

is all it takes

24/7 phone access to live experts




AS YOU DO credentialing letters issued




What is great service? For NORCAL Mutual insureds, just 1 phone call is all it takes for great service. That means calling during business hours and immediately reaching a live, knowledgeable, friendly expert. After hours, it means promptly receiving a call back from a professional qualified to help with your issue. No automated telephone tango. Questions are answered and issues resolved—quickly. We’re on call 24 hours a day, every day of the year. Great service brings you peace of mind. Great service 24/7. Hard-working numbers you can count on.

Call 1-800-652-1051 or visit norCalmutual.Com Proud to be endorsed by the Monterey County Medical Society and the Santa Clara County Medical Association.

Our passion protects your practice

Profile for SCCMA

2012 July/August  

2012 July/August  

Profile for 18621