Central Coast Physicians Spring 2018

TOGETHER WE ARE STRONGER

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CENTRAL COAST PHYSICIANS

Spring 2018

VOLUME 3, NUMBER 2 • SPRING 2018

{FEATURES}

6 10 14 16 20 Spring 2018

TOP 10 REASONS

{DEPARTMENTS} 18 MEN’S HEALTH:

THE VALUE OF ADVOCACY WHAT DOCTORS SHOULD KNOW ABOUT HOSPICE SLO NOOR FOUNDATION CLINICS

VIOLENCE AND THE MAN

28 RISK TIP: ELECTRONIC HEALTH RECORDS 30 PUBLIC HEALTH:

PARTICLE POLLUTION + HEALTH

34 CLASSIFIEDS 36 NEW MEMBERS 38 IN MEMORIAM

CCMA/CMA MEMBERS

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Letter from the CEO

PROTECTING YOUR PROFESSION

This issues features members of the Central Coast Medical Association and California Medical Association who understand the importance of organized medicine. Because of their membership, we are able to work to ensure patients DANA GOBA can access doctors to receive high quality and affordable health care. One bill threatening this right now is Assembly Bill 3087 (Kalra).

PRESIDENT Jennifer Hone, MD PRESIDENT ELECT Douglas Murphy, MD SECRETARY Daniel Berger, MD TREASURER Samira Kayumi-Rashti, MD IMMEDIATE PAST PRESIDENT David Dodson, MD DIRECTORS Kevin Casey, MD; Joseph Freeman, MD; Priti Gagneja, MD; Thomas Hale, MD; Ali Javanbakht, MD; Bindu Kamal, MD; Juan Reynoso, MD; Joseph Schwartz, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sam Ahmad, MD; Sharon Basham, MD; Edward Bentley, MD; Charity Dean, MD, MPH; David Dodson, MD; Priti Gagneja, MD; Jennifer Hone, MD;

AB 3087 should strike fear in the heart of every physician. It proposes a ninemember commission that would set prices for everything from physical exams to cardiac bypass surgery. This price fixing would make practicing medicine unaffordable, decrease patient access to care, and could force many physicians, like yourself, to close their practices.

Christopher Lumsdaine, MD; Douglas Murphy, MD; Jenni Nix, MD; Joseph Schwartz, MD; Steven Yao, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Jennifer Hone, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Penny Borenstein, MD, MPH; David Dodson, MD; Jim Eaton; Tianna Swede, MSW, ASW;

It is only through our collective action that we can stop bad bills like this one. Therefore, we ask you to join us—in emailing or writing your California Assemblymember about this bill, and by joining forces with us at the Central Coast Medical Association and California Medical Association.

Now more than ever, your membership is needed to ensure the health of our communities, and to ensure that physicians can keep serving those communities in the way they deserve.

If you are not a member, help us protect your profession and join us at www.cmanet.org/join or by calling 800.786.4262.

David B Troxel, MD CONTRIBUTING PHOTOGRAPHERS SLO Noor Foundation SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333

Together we are stronger.

Sincerely,

F 805.364.5431 E magazine@sbmed.org ADVERTISING rates and information sent upon request.

Acceptance of advertising in Central Coast Physicians in no way constitutes approval or endorsement by CCMA of products or services advertised. CCMA reserves the right to reject any advertising. All advertising inquiries can be sent

Dana Goba Chief Executive Officer Central Coast Medical Association

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CENTRAL COAST PHYSICIANS

to magazine@sbmed.org.

Spring 2018

2018 2018Physician Physicianofofthe theYear Year Call Callfor forNominations Nominations Deadline: Deadline: August August 31, 31, 2018 2018

TheThe Central Central Coast Coast Medical Medical Association Association (CCMA) (CCMA) is accepting is accepting nominations nominations for for a member a member physician physician to receive to receive thethe Physician Physician of the of the YearYear Award.

Award.

TheThe award award willwill be presented be presented at the at the year-end year-end annual annual membership membership meeting. meeting.

TheThe nominee nominee must must be abemember a member physician physician whowho practices practices in San in San LuisLuis Obispo Obispo or Santa or Santa Barbara Barbara county county andand whowho meets meets some some or all or of allthe of the following following criteria: criteria:  Exemplifies Exemplifies thethe principles principles of CCMA’s of CCMA’s mission mission of promoting of promoting thethe science science andand art art of medicine, of medicine, thethe carecare andand well-being well-being of patients, of patients, thethe protection protection of the of the public public health, health, andand thethe betterment betterment of the of the medical medical profession profession  HasHas practiced practiced for for a reasonable a reasonable period period of time of time in this in this areaarea  HasHas participated participated in organized in organized medicine medicine  HasHas worked worked to improve to improve thethe quality quality of health of health carecare  HasHas contributed contributed to the to the education education of other of other physicians physicians  HasHas engaged engaged in community in community service service andand other other activities activities outside outside of medicine of medicine Include Include in the in the submission: submission:  Nominee’s Nominee’s name name  Reasons Reasons for for nominating nominating  CCMA CCMA member member submitting submitting thethe nomination nomination Send Send nomination nomination to: to: E sbcms@sbmed.org E sbcms@sbmed.org F 805.364.5431 F 805.364.5431 M 100 M 100 N Hope N Hope Ave,Ave, Ste Ste 14, 14, Santa Santa Barbara, Barbara, CA CA 93110 93110

Past Past Honorees Honorees

2017 2017 Rene’ Rene’ Bravo, Bravo, MD,MD, SanSan LuisLuis Obispo Obispo County County 2017 2017 Saida Saida Hamdani, Hamdani, MD,MD, Santa Santa Barbara Barbara County County 2016 2016 Mark Mark Soll,Soll, MD,MD, SanSan LuisLuis Obispo Obispo County County 2016 2016 Ayesha Ayesha Shaikh, Shaikh, MD,MD, Santa Santa Barbara Barbara County County 2015 2015 FredFred S Vernacchia, S Vernacchia, MD,MD, SanSan LuisLuis Obispo Obispo County County 2015 2015 Daniel Daniel Brennan, Brennan, MD,MD, Santa Santa Barbara Barbara County County 2014 2014 KurtKurt Ransohoff, Ransohoff, MD,MD, Santa Santa Barbara Barbara County County 2013 2013 Michael Michael Bordofsky, Bordofsky, MD,MD, Santa Santa Barbara Barbara County County 2012 2012 R Bruce R Bruce McFadden, McFadden, MD, MD, Santa Santa Barbara Barbara County County Spring 2018

2011 2011 Rollin Rollin C Bailey, C Bailey, MD,MD, Santa Santa Barbara Barbara County County 2010 2010 Gilbert Gilbert O Andersen, O Andersen, MD,MD, Santa Santa Barbara Barbara County County 2009 2009 Myron Myron I Liebhaber, I Liebhaber, MD,MD, Santa Santa Barbara Barbara County County 2008 2008 Ralph Ralph Quijano, Quijano, MD,MD, Santa Santa Barbara Barbara County County 2007 2007 Elliot Elliot Schulman, Schulman, MD,MD, Santa Santa Barbara Barbara County County 2006 2006 Edward Edward S Bentley, S Bentley, MD,MD, Santa Santa Barbara Barbara County County 2005 2005 Barry Barry J Coughlin, J Coughlin, MD,MD, Santa Santa Barbara Barbara County County 2004 2004 James James V McNamara, V McNamara, MD,MD, Santa Santa Barbara Barbara County County 2003 2003 Robert Robert A Reid, A Reid, MD, MD, Santa Santa Barbara Barbara County County CENTRAL COAST PHYSICIANS 5

MEMBERSHIP

Top 10 Reasons to Be a Member

When you become a member, you hire a powerful professional staff to protect your profession from legal, legislative and regulatory intrusions. But that’s not all. Let’s count down the top 10 reasons to be a member of the California Medical Association (CMA) and your local county medical society.

10. Protect the Profession Your membership affirms your commitment to the medical profession and ensures physicians remain in control of the practice of medicine.

9. Lead by Example

CMA and its county medical societies provide many opportunities to get involved, including opportunities to volunteer; serve on a committee, council or board; and shape the future of the medical profession.

8. Stay in the Know

CMA and its county medical societies produce publications to keep you up-to-date on the latest health care news

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and information affecting the practice of medicine in California.

7. Get Paid

Members receive one-onone assistance from CMA’s reimbursement experts who have recouped $15.5 million from payors on behalf of CMA physicians in the past nine years.

6. Protect MICRA

CMA staunchly defends the landmark Medical Injury Compensation Reform Act (MICRA) year after year, saving each California physician an average of $75,000 per year in professional liability insurance premiums.

CENTRAL COAST PHYSICIANS

Spring 2018

MEMBERSHIP

Through CMA we give important public health “concerns a strong voice and keep elected representatives in tune with changing practice paradigms. – Brandon Woodward, MD

”

5. Collaborate with Colleagues

4. Promote Public Health

CMA and its county medical societies bring together physicians from all regions, specialties and modes of practice through leadership, collaboration, social and educational events, and community service.

From tobacco use and obesity to prescription drug abuse and vaccinations, your membership dollars support forward-thinking public health advocacy to improve the health of Californians.

Continued on page 9 >>

NEW! Membership is easier than ever with new

monthly payment plan

Membership in the California Medical Association (CMA) and your local county medical society is easy to maintain and hassle-free with automatically recurring monthly payments at an affordable monthly price. If you’re not already a member, enroll today at www.cmanet.org/monthly to start receiving your benefits! If you’re a current member, keep an eye out for your renewal invoices this fall and choose the monthly payment plan.

QUESTIONS? Contact CMA’s Member Resource Center at 800.786.4262 or memberservice@cmanet.org.

Spring 2018

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HOW WE HEAL:

Trauma and Anxiety Support

FREE Cottage Health Support Groups, Post-Disaster Relief Unless noted, groups are held at: Santa Barbara Cottage Hospital 400 W. Pueblo Street Santa Barbara, CA 93105 Programs are FREE and open to all Santa Barbara area residents.

We have licensed clinicians who will assist your recovery with personal attention to your unique situation.

For more information or to register, please contact program staff:

805-569-7501 or howweheal@sbch.org

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You may register anytime throughout the program.

HOW WE HEAL: Intensive Outpatient Program Skill Building/Seeking Safety Group: Mondays 6-7:30p.m.

Gibraltar #1 | Tinka Sloss, LMFT This group will be skill specific and will be taught in a psychoeducational fashion. The goals will be skill acquisition, meditation and mindfullness practice.

En Español Process Group: Lunes 6-7p.m.

Gaviota Conference Room | Gonzalo Gonzalez, AMFT Este grupo permitirá a los participantes procesar una experiencia traumática en un espacio seguro. Este grupo estará abierto para adultos jóvenes y mayores.

School Age/Teen Group: Tuesdays 427 W Pueblo Street, Suite B, Santa Barbara | Stephanie Molina, LMFT Group 1: child (ages 7-12) 3:30-4:30 p.m.

Group 2: adolescent (ages 13-17) 4:30-5:30 p.m.

Groups will involve hands-on expressive therapeutic activities such as art therapy. Process oriented group discussions will take place to address current trauma and real-time situations. Skill-based tools to be taught to aid in dealing with current stressors and emotions.

Survivor Group: Tuesdays 6-7p.m.

Gaviota Conference Room | Layla Farinpour, LMFT and Peter McGoey, LMFT This group will be specific to those survivors who directly experienced the disaster. Please call 806-569-7501 before attending to determine eligibility or this group.

Spiritual Care Group: Wednesdays 6-7p.m.

Sacred Space | Chaplain Pam Washburn and the Cottage Spiritual Care Team A non-denominational spiritually-based support group.

Process Group/Inspiring Hope: Fridays 6-7:30p.m.

Gaviota Conference Room | Peter McGoey, LMFT This group will allow individuals to witness how others have healed, and provide a place to start their own healing.

Spring 2018

MEMBERSHIP

Ask yourself who will have the most impact on the way you practice “medicine–the government, or physicians in organized medicine through CMA? Be involved or be left behind. ” – J. Brennan Cassidy, MD

3. Head Seat at the Policy Table

Through aggressive political and regulatory advocacy, CMA and its county medical societies are positioned among the most influential stakeholders in the development and implementation of health policy.

2. Shape the Future of Medicine

Members receive direct access to our state and national

legislative leaders to influence how medical care is provided today and in the future.

1. Together We Are Stronger

Together, we stand taller and stronger as we fight to protect patients and improve the health of our communities. We are a dominant force in health care – but all the great work we do wouldn’t be possible without the support of members like you.

Join or renew your membership today! www.cmanet.org/join

QUESTIONS? Contact our Member Resource Center at 800.786.4262 or memberservice@cmanet.org.

Our Promise: To care for anyone experiencing the impact of serious illness or grieving the death of a loved one.

Patient Care Services - HSB provides support to those impacted by life-threatening illness and their families. We provide comprehensive patient care management, emotional and spiritual counseling, medical navigation, and guidance from initial diagnosis through the disease process.

Adult Bereavement Services - HSB provides individual and support group counseling for adults and seniors grieving the death of a loved one and navigating that loss.

Child Bereavement Services - HSB provides compassionate and caring support to children, teens, and their families through one-on-one and group counseling.

All services are available in English and Spanish, and are free to our community.

For more information visit www.hospiceofsantabarbara.org or call (805) 563-8820.

Spring 2018

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The Value

of

ADVOCACY Dear Health Care Professional,

This report details the California Medical Association’s (CMA) efforts, on your behalf, to increase practice profitability and save physician practices from bad bills. This year CMA has successfully:

PREVENTED RAISES IN YOUR OPERATIONAL COSTS DECREASED YOUR PROFESSIONAL LIABILITY BLOCKED ATTEMPTS TO SADDLE YOU WITH MORE ADMINISTRATIVE BURDENS INCREASED ACCESS TO CARE FOR YOUR PATIENTS

CMA is one of the most influential stakeholders in the development and implementation of health policy. Our past, present and future success is rooted in one principle: California’s physicians are stronger when we stand together.

With over 80 years of combined experience in Sacramento politics, our team is constantly monitoring legislative threats to the practice of medicine, and working to ensure that bad bills don’t become bad medicine.

The bills in this report were introduced last year, the first of a two-year legislative session. This means they could possibly move forward or get re-introduced this year. CMA will continue to keep you engaged and informed on these important matters that could have a profound impact on your practice.

To join this fight and stay informed on issues critical to the practice of medicine, please contact us at 800.786.4262 You can also receive regular updates by subscribing to our free biweekly Newswire at www.cmanet.org/newsletters.

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ADVOCACY

Prevented Administrative Burdens, Lowered Operational Costs and Increased Profitability

Recent studies have suggested that physicians spend twice as much time completing administrative tasks as they do seeing patients. This is unacceptable and negatively affects delivery of care. CMA aims to

lessen or streamline the administrative requirements placed on physicians so they can spend more time with patients, which improves health outcomes, increases access and increases practice profitability.

AB 40 (Santiago): CURES database: health information technology system Obtained amendments to remove the Department of Justice’s ability to influence the electronic health record (EHR) vendor market by establishing a narrow vendor list of EHRs allowed to interface with the Controlled Substance Utilization Review and Evaluation System (CURES), and unilaterality dictating the terms of being able to interface.

AB 120 (Ting): Proposition 56 tobacco tax funds Appropriates Proposition 56 funds to the Department of Health Care Services (DHCS) and contains language allocating over $700 million ($325 million plus the federal match) in funding to physicians. Additional provisional language states that provider payments may be adjusted up to $800 million in the 2018-19 fiscal year. The bill was signed by the Governor in June as part of the Budget Act of 2017.

AB 221 (Gray): Workers’ compensation Defeated this workers’ compensation legislation that would have broadly limited payments to physicians for treatment provided to workers suffering from occupational cumulative trauma injuries.

AB 387 (Thurmond): Minimum wage: health professionals: interns For the purposes of paying minimum wage, AB 387 expanded the definition of employer. CMA obtained amendments to mitigate the impact of the bill on physician practices by excluding all practices. The bill was ultimately defeated in the Assembly.

AB 700 (Jones-Sawyer): Public health: alcoholism or drug abuse recovery Stopped this measure that would have required physicians

Spring 2018

who provide substance use disorder services to get certified by DHCS, in addition to their medical license, to provide these services in programs authorized by DHCS.

AB 715 (Wood): Workgroup review of opioid pain reliever use and abuse Worked with the author to avoid the creation of duplicative opioid prescribing guidelines, which could have created further confusion and complication around prescribing for chronic pain, narrowing the bill to create a guideline focused exclusively on acute prescribing.

AB 1250 (Jones-Sawyer): Counties: contracts for personal services Obtained amendments that exempt physician services from newly proposed stringent requirements for a county and a third party to enter into a contract to provide government services. AB 1250 was defeated in the Senate.

AB 1312 (Gonzalez Fletcher): Sexual assault victims: rights Obtained amendments to remove a requirement that physicians provide sexual assault victims information about the investigation process, evidentiary process and the rights of victims under criminal laws.

AB 1316 (Quirk): Public health: childhood lead poisoning: prevention Obtained amendments to remove mandatory universal lead screening for all young children.

SB 43 (Hill): Antimicrobial-resistant infection: reporting Obtained amendments to remove a proposed new requirement to list antimicrobial-resistant infections as a cause of death on a person’s death certificate.

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SB 189 (Bradford): Workers’ compensation fix Effective July 1, 2018, all owners of medical corporations will be able to exempt themselves from workers’ compensation coverage, regardless of percentage ownership, as long as they submit a waiver and have health insurance coverage. This will result in thousands of dollars in premium savings for physician practices.

SB 199 (Hernandez): The California Health Care Cost, Quality and Equity Atlas Defeated this measure that would have created additional administrative reporting requirements on physician practices.

SB 419 (Portantino): Medical practice: pain management Defeated this measure that would have legislated the practice of medicine by preventing physicians’ ability to appropriately prescribe pain relief medications.

SB 636 (Bradford): Addiction treatment: advertising: payment Stopped this measure that would have created an additional disciplinary process for physicians providing substance use disorder treatment in DHCS-certified programs.

SB 640 (Hertzberg): Sales tax on services Obtained an exemption for health care services in this proposed services tax legislation.

SB 790 (McGuire): Health care providers: gifts and benefits Defeated this measure that would have unfairly curtailed what expenses a pharmaceutical company could provide a physician, including all those expenses connected to educational seminars, research and events.

Decreased Liability Allowing physicians to practice without worrying about the threat of a frivolous lawsuit is one of CMA’s core tenets. We work to ensure that the trial lawyers’ efforts to increase malpractice liability are beaten back, and we oppose any effort to increase malpractice premiums. Additionally, we advocate to protect physicians from exposure to new areas of liability.

AB 334 (Cooper): Sexual assault/forensic medical exams Obtained amendments to remove provisions that would have increased physician liability by allowing forensic medical exams on unconscious patients without the patient’s consent.

AB 859 (Eggman): Elders and dependent adults: abuse or neglect Obtained amendments that exempt physicians from a proposed lowering of the standard of review in elder abuse cases from “clear and convincing” to a “preponderance of the evidence” if the court found that a defendant intentionally destroyed evidence. The bill was vetoed by the Governor.

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AB 889 (Stone): Secrecy agreements Defeated this measure that would have prevented certain confidentiality agreements from being enforced if keeping the information secret presented a “public health hazard” or “environmental danger.” CMA was concerned about how this law would affect medical malpractice settlement agreements.

AB 1422 (Daly): Workers’ compensation insurance: fraud Obtained amendments to ensure due process protections for workers’ compensation physicians facing certain types of fraud accusations.

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ADVOCACY

SB 33 (Dodd): Arbitration agreements Obtained amendments to exempt physician arbitration agreements from a new consumer protection that invalidates arbitration clauses in contracts upon a showing of fraud.

SB 349 (Lara): Chronic dialysis clinics: staffing requirements Obtained amendments to remove liability for medical directors of chronic dialysis clinics related to the proposed staffing requirements.

SB 219 (Wiener): Long-term care facilities: right of residents Obtained amendments to ensure that physician liability would not be increased for those practicing in long-term care facility settings acting in the best medical interests of their patients.

SB 617 (Bradford): Workers’ compensation Stopped workers’ compensation legislation that would have required outreach reports to physicians without sufficient privacy protections.

Access to Care and the Physician-Patient Relationship

CMA defends and advocates to improve physicians’ ability to negotiate fair contracts with payors.

Protecting the economic viability of physician practices ensures that physicians are financially

capable of providing service for patients and protects access to care. Additionally, CMA advocates to protect patient privacy, recognizing that it is an essential component of quality medical care and the patient-physician relationship.

AB 595 (Wood): Health care service plans: mergers and acquisitions Obtained amendments to ensure that the Department of Managed Health Care and the Department of Insurance, for any health care service plan merger, consider the impact on physicians’ ability to secure competitive contracts and patient access to care prior to approving the mergers.

SB 350 (Galgiani): Incarcerated persons: health records Obtained amendments ensuring consistency in medical information privacy laws to limit confusion on when medical information and records can be disclosed. The bill was ultimately defeated in the Senate.

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SB 538 (Monning): Hospital contracts Defeated this measure that allowed health plans and health insurers to eliminate the Provider’s Bill of Rights, which helps guard a physician’s ability to negotiate fair and reasonable contracts and break up integrated health care systems.

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For more information about Hospice of Santa Barbara, visit www.hospiceofsantabarbara.org or call 805.563.8820.

What Doctors Should Know about Hospice of Santa Barbara

By Tianna Swede, MSW, ASW, Patient Care Services Manager, Hospice of Santa Barbara

When doctors hear the name “Hospice of Santa Barbara,� (HSB) they often assume it refers to a medical model hospice, where patients are given a life expectancy of six months or less and are often no longer receiving treatment for their illness.

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The reality is that HSB is different. They operate using a volunteer based model. This means that they are able to work with anyone impacted by life-threatening illness regardless of prognosis or life expectancy. This also means that they do not charge fees or bill insurance for any of their services.

HSB is committed to caring for anyone experiencing the impact of serious illness or grieving the death of a loved one. Their support services include patient care management, bereavement counseling, group counseling, mentorship and compassionate care to children, teens, families, seniors, and adults. Additionally, all of HSB’s services are offered in Spanish.

For the last several decades, Dr. Stephen Hosea has been a strong proponent of Hospice of Santa Barbara’s many invaluable services and has been a proud ambassador for the organization.

“I first learned about Hospice in the early days of the AIDS epidemic in the early 80s,” Dr. Hosea remembers. “I went to a workshop on Death and Dying with Gail Rink (former HSB Executive Director responsible for much of the growth of the organization) and found myself sitting on the floor listening to Willie Nelson sing Angels flying too close to the Ground and Blue Eyes Crying in the Rain,” In the midst of that, I realized I was crying too. Gail would say that tears are an important part of what life is all about.”

Since then, Dr. Hosea has recommended HSB services to patients and their families, friends, neighbors, and loved ones.

“The folks at Hospice have a wealth of experience walking the road at the end-of-life with patients, family, and friends. The journey is not so lonely or frightening when traveling with those who have walked there before,” Dr. Hosea said.

The HSB service most “The folks at Hospice have a wealth of experience recommended by local doctors is their Patient walking the road at the end-of-life with patients, Care Services. The goals of family, and friends. The journey is not so lonely or their Patient Care Services program are to: 1) provide frightening when traveling with those who have comprehensive continuum walked there before.” - Dr. Hosea of care to patients at any stage of a life threatening illness, including the newly diagnosed; 2) increase patient comfort while they are living with the illness; 3) increase end-of-life discussions; 4) provide better long-term caregiver outcomes; 5) decrease hospital re-admissions and emergency department visits; 6) build stronger patient-physician relationships; 7) decrease the drain on our community’s medical resources; 8) provide emotional support and respite for family members and caregivers.

When an individual is placed in HSB’s Patient Care Services program, their care managers are in regular contact with the patient’s physician and health care team. This includes efforts to attend medical appointments and face-to-face contact with the physicians. It also includes regular phone contact with the physicians and health care team to ensure safe short and longterm care plans for clients and their families.

HSB does not require a doctor’s order for care management or counseling services; they only ask that the doctors provide information to patients/clients about these services. Doctors are HSB’s best advocates because they understand the significance of the services they provide and work in close collaboration with HSB’s care managers to provide seamless care.

What advice does Dr. Hosea have for those needing HSB service?

“Give it a try because you do not want to lose a precious opportunity for heart opening healing and love as well as their other extremely useful services.”

Spring 2018

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If you interested in learning about volunteering, or know of someone who might be interested, contact Jim Eaton, Volunteer Coordinator, at 805.550.8970 or jeaton@slonoorfoundation.org.

The SLO Noor Foundation is a 501(c)(3) that provides free non-emergency medical, dental, and vision care for uninsured adults regardless of race, ethnicity, religion, immigration, or socioeconomic status.

SLO Noor Foundation Clinics: FREE HEALTHCARE FOR THE UNINSURED

By Jim Eaton, Volunteer Coordinator, SLO Noor Foundation Clinics A 29-year-old female recently came into the clinic. Ten days earlier she visited an ER and was sent home, as they thought she had the flu. After a bit more investigation, one of the NP’s diagnosed the patient with Lupus. As her condition was very poor, the clinic manager offered to drive her to the ER. With the diagnosis as a guide, the ER doctor rapidly decided to place the patient in ICU. The hospital performed a miracle on a patient they deemed to be in a life-threatening situation. Her health continues to improve daily.

The SLO Noor Foundation, with non-emergency medical clinics in San Luis Obispo and Paso Robles, and vision and dental clinics in San Luis Obispo, provides FREE healthcare to uninsured residents of San Luis

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Obispo County and northern Santa Barbara County. Dr. Ahmad Nooristani founded the Foundation in 2009 and treated the first patients in 2011, with the clinic initially being open just one afternoon a week. Today the clinics have a cadre of over 60 volunteer medical professionals. Now open five days a week in San Luis Obispo, the clinics have recently added 2 exam rooms, thereby doubling their capacity for care. Also, the Paso Robles medical clinic recently expanded from one day a week to three days a week.

Another patient, with a history of syphilis, TB and HIV, was recently diagnosed with a blood clot in his leg. While the syphilis and TB were not active, he was just days away from running out of his HIV meds. A SLO Noor social worker doggedly pursued other options and obtained for him a year’s worth of medicines totaling $26,512 for the blood clot and the HIV meds.

Even though there is a huge demand for increased services (4,300 patient visits in 2017, a 2018 goal for 6,000 visits), the volunteers providing care are encouraged to do it the oldfashioned way - they decide how much time they want to spend with patients. An ER volunteer doctor prefers to see three to four patients an hour during his three-hour shift, while a recently retired Family Practitioner who likes to talk requests 45 minutes per patient. They also handwrite their notes, and volunteer medical scribes input patients’ info into our EMR system. The goal is to help those who need services, while accommodating the Doctors, NP’s and PA’s as they share their precious time.

Additionally, a strong referral base of numerous specialists throughout the area provides free or reduced charges for appointments for several patients a month.

Spring 2018

The SLO Noor Foundation medical clinics also partner with Cal State Monterey Bay and their BSN (Public Health Nurse Certificate) program. Marian Regional Medical Center provides residents on Mondays, and they have several NP preceptees throughout the week. With so many bright and eager minds in the clinic, it often feels like a teaching facility.

“We love what we do” is a phrase often heard from both the medical and non-medical volunteers.

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MEN’S HEALTH

Violence and The Man

BY DAVID DODSON, MD

Another mass shooter, another angry young man, usually a white man. White supremacists marching with tiki torches.

Shortened life expectancy in Middle America. The opioid crisis. Is it just me, or is there a theme underlying these pressing problems in contemporary America?

As I see it, there is a void in the soul of our Country that underlies these ills. As we “progress” from a manufacturing based economy to a tech and service based economy, those who benefited from the old order feel left behind, abandoned, and forsaken. Gone are the days when a high school diploma could lead predictably to a good-paying factory job and a ticket to the American dream: an income sufficient to support a family in a house with a white picket fence. These societal changes have not been accompanied by programs and policies to help legions of people who have seen a way of life disappear before their eyes, and they are angry.

The mid twentieth century African American writer James Baldwin blamed “The Man”, referring to the nameless, faceless “they” as in “they aren’t hiring” or “they are closing the factory” or “they foreclosed on my house” or “they repossessed

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my car”. Because The Man is nameless and faceless, those left behind by the tide of history and angry about it are left to seek targets of their ire. The most convenient target is oneself, hence the scourges of despair, depression, and self-medication with drugs and alcohol. This sadly, helps explain why after rising inexorably over the past century, life expectancy has declined for the demographic left behind in our modern economy.

Another target is of course “them”. Those who look different, speak another language, worship differently, or at the Pulse nightclub, love differently. Clearly, acts of violence are not acts of people happy with their lot in life.

While generalizing is risky, I would hazard to say that mass killers are likely to be angry at lacking prospects in life, and they are likely to be people who are not connected to their communities. For reasons not well defined, it is well documented that churchgoers have superior life expectancy relative to non-churchgoers. It is also well known that being socially connected and having a purpose in life promote health, just as not smoking, eating well, and exercising do.

Bill Maher does a shtick entitled “I Can’t Prove It, I Just Know Its True”. While I can’t prove it, I just know it’s true that church-goers who are active in their community and volunteer for good causes do not commit mass murders.

What is the way forward? Society needs to provide channels and outlets for those who would otherwise feel oppressed

by The Man. Many countries in Europe, where mass killings are not common events, have mandatory service for 18 year olds following high school. Typically, it’s military service.

This has many advantages, although those advantages could be achieved with other forms of service. A year of service provides young people an opportunity to mature and to develop connections that could serve them well in their futures, certainly better than joining hate and white supremacist groups, which sadly have proliferated in the void left by the crumbling of our manufacturing sector.

A year of service in an organization such as AmeriCorps would be an excellent alternative to college for many young people who either aren’t ready for college or don’t plan to go to college. During the Great Depression, the federal government had the Works Projects Administration, which helped build many public buildings, roads, parks, and hiking trails. Perhaps a similar program could be started to help with the depression or malaise in the soul of America alluded to above.

I know that this is not a time to look to the federal government for any kind of leadership. But, the great

Spring 2018

Speaker of the House Tip O’Neill famously said “all politics is local” and perhaps local solutions tailored to each community are the best way forward. A thousand points of light, as George HW Bush put it. I had the great pleasure of hearing one of my intellectual heroes, James Fallows, speak at the Lobero Theatre a year ago. He has been touring the country looking at small cities doing well, as well as those in decay, and will write a book on the basis of his travels.

He commented that he has lost interest in national politics because it is so dysfunctional, but he remains optimistic about the country because local governments are much more functional and creative out of necessity: if they don’t fix potholes and keep the libraries open and fire and police departments and schools open, they get voted out and lose their jobs, and people who can get these jobs done replace them. And, as the students at Marjorie Stoneman Douglas School have taught us, what begins locally can quickly become an important, national movement. It is up to each of us to light our candles and not curse the darkness.

As always, I welcome your thoughts, comments, criticisms, and suggestions.

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CENTRAL COAST PHYSICIANS

19

TOGETHER WE ARE STRONGER 20

CENTRAL COAST PHYSICIANS

Spring 2018

THANK YOU The Central Coast Medical Association and California Medical Association thank the following physicians for membership and support to protect physicians’ profession and patients.

Membership list as of March 31, 2018.

MORE THAN 60 YEARS

50 TO 59 YEARS

Stanley J Kirk, MD

John Ackerman, MD

Edward R Wallace, MD

40 TO 49 YEARS Walter Anderson, MD

Maria I Barrows, MD

Rollin C Bailey, MD

William H Coulter, MD

Robert K Baum, MD

William H Gausman, Jr, MD

Christel Bejenke, MD David A Bernhardt, MD

Robert A Harway, MD

Andrew Binder, MD

Bruce Howard, MD

Allan Bosko, MD

W Blake Jamison, MD

Charles Bradley, III, MD Joel H Brandt, MD

Guenther Mayer-Harnisch, MD

Blaine Braniff, MD

David Medina, MD

James Cavins, MD

James Wells, MD

John G Chapple, MD Dugald D Chisholm, MD Ramona Clark, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. Spring 2018

CENTRAL COAST PHYSICIANS

21

Barry Coughlin, MD

H Douglas Roberts, MD

Robert I Fishburn, MD

David Doner, Jr, MD

Timothy Leigh Rodgers, MD

Richard Fulton, MD

Robert Mayo Failing, MD

Joaquin Roses, MD

John Gainor, MD

Donald Omar Fareed, MD

Lewis Rubin, MD

Frank R Gamberdella, MD

Michael Fisher, MD

James Scheib, MD

William James Gealy, Jr, MD

P Joseph Frawley, MD

Louis M Tedone, MD

Michael Gill, MD

Jeffrey Charles Fried, MD

Barry Williams, MD

Robert Lawrence Gong, MD

Donald Gillies, MD

Carl Williams, MD

Cory Gusland, MD

David S Gillon, MD

Michael L Wyatt, MD

Thomas Walter Hale, MD

Richard E Hammond, MD

Steven H Young, MD

Jeffrey Hankoff, MD

Stephen L Hansen, MD Lawrence Phillip Harter, MD

Robert Harbaugh, MD Marvin Harrah, MD

Douglas R Jackson, MD

30 TO 39 YEARS

Robert Jacoby, MD

Thomas Allyn, MD

Richard Allen

Karl Kassity, MD

Andrew Martin Anthony, MD

Hendricks, MD, FAAO

C Seybert Kinsell, MD

Dennis Baker, MD

William J Heringer, MD

Garry R Kolb, MD

David L Bearman, MD

David Hernandez, MD

Stephen Lemon, MD

Edward Bentley, MD

Jeff Herten, MD

Myron Israel Liebhaber, MD

Ernest Blakey, MD

Stephen Hosea, MD

Donald Lindblad, MD

Stuart Braverman, MD

Randall Howard, MD

Thomas S Lossing, MD

Rene Henry Bravo, MD

Eric Jahnke, MD

Edward J McGinn, MD

William K Brokken, MD

David Oscar Javitz, MD

James McNamara, MD

Mary P M Cederberg, MD

Thomas Jones, MD

Randall G Michel, MD

Cary Conyers, MD

Darol D Joseff, MD

Richard Miller, MD

P Kent Cullen, Jr, MD

Roger Kohn, MD

Arthur Morel, MD

David Michael Cumes, MD

Robert A Kolarczyk, MD

Peter Morris, MD

David d’Ablaing, MD

Karen S Kolba, MD

James J Murray, Jr, MD

Olga Daiber, MD

Ernest Kolendrianos, MD

Thomas Ochsner, MD

Gustavo Dascanio, MD

Alex Koper, II, MD

Robert W Olson, MD

Mark Keith Eckert, MD

Bradley Shawn Kurgis, DO

Theodore Polos, MD

Patricia Erbe, MD

Ronald Latimer, MD

George Primbs, MD

Douglas Etsell, MD

Arthur Lee, MD

William Rack, MD

Todd Fearer, MD

Morgan Lloyd, MD

Robert Alfred Reid, MD

Mary Elina Ferris, MD

Laurence Hamilton Lotz, MD

David Hirt, MD

Steven Hartzman, MD Robert Hawkins, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. 22

CENTRAL COAST PHYSICIANS

Spring 2018

Lawrence Luan, MD

Christian J Voge, MD

Kevin Francis Colton, MD

Tomas Manuel Machin, MD

Martin Walker, MD

Daniel F Craviotto, Jr, MD

Laurence Mamlet, MD

Thomas Weisenburger, MD

Daniel Edward Culhane, MD

Lowell McLellan, MD

Stuart Robert Winthrop, MD

Daniel Curhan, MD

Monica Micon, MD

Edmund M Wroblewski, MD

Thomas Daughters, Jr, MD

James F Mitchell, Jr, MD

James Zmolek, MD

Kamlesh M Desai, MD

Ted B Newman, MD Charles H Nicholson, MD

Robert Dichmann, MD C Christopher Donner, MD

Kevin C Osburn, MD

20 TO 29 YEARS

Stanley Ostern, MD

Mark Abate, MD

Yvonne Ferguson, MD

Steven Pearson, MD

Rushdi Abdul-Cader, MD

Gregory John Frye, MD

Terry J Perkins, MD

Shields Brewster Abernathy, MD

J Gregory Gaitan, MD

Timothy J Perrin, MD

Mitchell Adler, MD

Andrew Scott Gersoff, MD

Richard Ponce, MD

Gilbert O Andersen, MD

Gregory Greaney, MD

Robert Poulin, MD

Robert L Avery, MD

Howard Gregersen, MD

Elliot Prager, MD

Vida Baron, MD

Howard Gross, MD

Ralph Quijano, MD

H Richard Barthel, MD

William Hahn, MD

Thomas Reaper, MD

Sharon L Basham, MD

Laurel Hansch, MD

Brian Michael Roberts, MD

Thomas Beamer, MD

Bilal Harake, MD

Philip Scheinberg, MD

Michael J Behrman, MD

Patrick Joseph Haran, MD

Carl Schlosser, MD

Jeoffrey P Benson, MD

Stephen A Hilty, MD

Ayesha Shaikh, MD

Lurleen Benzian, MD

John Hans Hirschberg, MD

Michael D Silvas, MD

David L Birken, MD

Barbara A Hrach, MD

Timothy M Spiegel, MD

Cindy Blifeld, MD

Farooq Husayn, MD

Donald Larry Stanton, MD

Jeffrey Martin Bloom, MD

Steven Craig Johnson, MD

Robert G Stewart, MD

Lindsay Blount, MD

Richard Kahmann, MD

Mark Wayne Surrey, MD

Gary M Blum, MD

Frederic Kass, MD

Paul John Swedberg, MD

Michael Bordofsky, MD

Phillip Kissel, MD

Victor A Tacconelli, MD

Gary Bradley, MD

Robin P Knauss, MD

Julie Taguchi, MD

Rabindra Braganza, MD

Mark Gerald Kowall, MD

Peter Alan Thom, MD

Jessica Brown, MD

James L Kwako, MD

Ronald G Ungerer, MD

Roman Platon Bukachevsky, MD

Francis P Lagattuta, MD

Thomas Van Meter, MD

David Alan Canvasser, MD

Roger I Lane, MD

Fred Steve Vernacchia, MD

Thomas Albert Caruso, MD

Vikki Lane, MD

Pierre Nizet, MD

James Egan, MD John Elder, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. Spring 2018

CENTRAL COAST PHYSICIANS

23

David LaPatka, MD

Stuart Segal, MD

Steven Colin Barkley, MD

Randolph Schuyler

William A Shapiro, MD

Richard A Belkin, MD

Lawrence, MD, FACS

William Sheehan, MD

Steven Niels Benaron, MD

Suresh C Lodha, MD

Anthony W Sheplay, MD

James Benzian, MD

Mark Logan, MD

Alex Soffici, MD

Daniel Berger, MD

George Philip Lum, MD

Mark Ian Soll, MD

Michael Bernstein, MD

Bryant Jay Lum, MD

Marta Sovilj, MD

Scott Edward Bisheff, MD

Christopher George

Owen Stormo, MD

Jerold Black, MD

Lumsdaine, MD

Gerald Svedlow, MD

Mark C Bocchicchio, MD

Douglas J Mackenzie, MD

Michael Trambert, MD

Claudio Bonometti, MD

David L McAninch, III, MD

Vincent C Tubiolo, MD

Penny Borenstein, MD, MPH

Arnold Medved, MD

Gary Van Deventer, MD

Jason Boyatt, MD

Alan P Moelleken, MD

John Vander Heide, MD

Daniel Brennan, MD

Mark Francis Mooney, MD

Thomas D Watson, MD

James Brewer, MD

Karen Moyes, MD

Marc W Weise, MD

William E Buys, DO

Mark Musicant, MD

Richard Wikholm, MD

Alessandro A Castellarin, MD

Robert M Nagy, MD

Judith Willis, MD

Julie Adele Chacko, MD

Ma’an Nasir, MD

Paul Willis, MD

Rosa Choi, MD

Michael Jon Omlid, MD

John Dean Wrench, MD

Bernard Chow, MD

Michael Paveloff, MD

Robert Simpson Wright, MD

Nicole Christiano, MD

Kim L Peters, MD

Wilson Wu, MD

Richard Y Chung, MD

David Phreaner, MD

Steven Zelko, MD

Eduardo Enrique Clark, MD

Dennis Plesons, MD Kathleen Pojunas, MD

Stephen Couvillion, MD Kenneth Daughters, MD

Christopher S Proctor, MD

10 TO 19 YEARS

Kurt Ransohoff, MD

David Abbott, MD

Philip Delio, MD

Donald Rhodes, MD

Thomas Aguirre, MD

Margaret L Echt, MD

Margot Roseman, MD

Eric Michael Alltucker, MD

Bryan Christian Emmerson, MD

Barry J Ross, MD

Eric Rey Amador, MD

Duard Enoch, III, MD

Lynn A Rudman, MD

Seth Eli Anderson, Jr, MD

Julie Cecilia Fallon, MD

Paul Ryack, MD, MPH

Thomas G Anderson, MD

Kevin L Ferguson, MD

Karl Sandin, MD, MPH

Joseph Aragon, Jr, MD

David Fisk, MD

John Michael Sawyer, MD

Bruce R Bailey, MD

Cary J Fitchmun, MD

Joseph Alan Schwartz, MD

Polly Baldwin, MD

Christopher Flynn, MD

Mark Ford Pomerantz, MD

Bret Davis, MD Julia Delgado, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. 24

CENTRAL COAST PHYSICIANS

Spring 2018

Peter Ford, MD

Cedric Kwon, MD

Laura Polito, MD

Daniel Fox, MD

Christopher V Lambert, MD

Liza Presser Belkin, MD

Rebecca D Golgert, MD

Wonuk Lee, MD

Bruce Dudley Ragsdale, MD

William Golgert, MD

Kyle Lemon, MD

Susanne L Ramos, MD

Frank D Gonzales, MD

Hollanda Leon, MD

Rahim Ali Raoufi, MD

Daniel Reif Greenwald, MD

Lawrence Bon Yen Li, MD

David Raphael, MD

Mukul Gupta, MD

Anne E Little, MD

Cinnamon Hampikian Redd, MD

Gloria Hadsall, MD

Keith Llewellyn, MD

Jason M Redd, MD

Jeffrey Hadsall, MD

Adam D Lowenstein, MD

Mark G Richmond, MD

Saida Hamdani, MD

Gary Michael Lucchesi, MD

Joseph Andrew Robinson, MD

George Robert Hansen, MD

Theresa Lueck, MD

Vance Douglas Rodgers, MD

Peter Lee Hasler, MD

David Mandel, MD

Anthony Rogers, MD

Alan Hersh, MD

Kari Mathison, MD

Anthony C Romero, MD

Glenn Hollingshead, MD

Rachel May, MD

Thomas George Ronay, MD

Stephen Raymond

John McCaffery, MD

Andria Ruth, MD

Holtzman, MD

Stanley McLain, Jr, MD

Robert M Ruth, MD

Jennifer Hone, MD, FACE

Anthony Mendesh, MD

Mary-Louise Scully, MD

Bradley E Hope, MD

Andrew Mester, MD

Eric F Shepherd, MD

Robert Michael Hullander, MD

Toni Meyers, MD

Julia Shuleshko, DO

Graham R Hurvitz, MD

Kelli Miller, MD

Virginia Ann Siegfried, MD

Kimberly Hurvitz, MD

James Moghtader, MD

Mark Silverberg, MD

James Ingersoll, MD

Ralph Mozingo, DO

John Sim, MD

Ali Javanbakht, MD

Douglas P Murphy, MD

Armando Frank Siqueiros, MD

Karen Johnson, MD

Ian Blair Murton, MD

Sean Snodgress, MD

Bindu Kamal, MD

Gregg Newman, MD

Mareeni T Stanislaus, MD, FACOG

Douglas Katsev, MD

Diane Nguyen, MD

Gary Strachan, MD

Kathleen April Kennedy, MD

David Nomeland, MD

David Strumpf, MD

Rachel Kernoff, MD

Joseph A Nunez, MD

Sasha Lynn Szytel, MD

Brian Koch, MD

Cecilia O’Dowd, MD

Brian Taber, MD

Kenneth S Kosik, MD

Richard Onishi, MD

Stefan Robert Teitge, MD

Brent Kovacs, MD

Andrew Osburn, MD

Heather Terbell, MD

Kenneth Dale Krone, MD

Edwin Pai, MD

David S Thoman, MD

Sanjay Kumar, MD

Nancy A Pawlik, MD

Rachel Trautwein, MD

Christopher Kuzminski, MD

Dante Pieramici, MD

Jon R Uyesaka, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. Spring 2018

CENTRAL COAST PHYSICIANS

25

Rafael Sollesa Victoria, Jr, MD

Charity Dean, MD, MPH

Derek Brian Lauritzen, MD

David J Vierra, MD

Vincent DeRosa, MD

Susan Lemon, DO

John Vowels, MD

Benjamin Diener, MD

Winifred K Leung, MD

J Patrick Wheelock, MD

David Charles Dodson, MD

Edward Ned Li, MD

Avery Wilmanns, MD

Steven E Dosch, MD

Robin Elizabeth Malone, MD

Mark Wilson, MD

William H Dunbar, V, MD

Steven Douglas McMurtry, MD

Jay Winner, MD

Raul Benjamin

Christopher Allan Miller, MD

Steven Yao, MD, MS

Easton-Carr, MD, MPH

Alexander Eduard Morf, MD

Jeffrey Yim, MD

Todd Michael Erickson, MD

Joann Ng, MD

Hsien Young, MD

Edwin Feliciano, MD

Arbi George Ohanian, MD

Alois Zauner, MD

Charles C Fenzi, MD

William Michael Pace, MD

Marc Zerey, MD

Joseph Dreyfuss Freeman, MD

David Paul, MD, PhD

Priti Gagneja, MD

Jordan Eliot Pinsker, MD

5 TO 9 YEARS

Bryan Leigh Gammon, MD

Michael Polo, MD

Karina Marie Garcia, MD

Christian Harrington Powell, MD

Sam Hosam Ahmad, MD

Jeffrey M Gauvin, MD

Juan Reynoso, MD

Anthony Alexander

Brett A Gidney, MD

Sang-Gyou Rho, MD

Anagnostou, MD

Vishal Goyal, MD

Jonathan Lee Riegler, MD

Thomas Robert Anderson, MD

Khawar Gul, MD

Anne O`Meara Rodriguez, MD

John Onssy Anis, MD

Sawyer Bailey Haig, DO

Jeffrey Seymour Sager, MD, MSc

Benton Turner Ashlock, MD

Muhammad Salman Ul Haq, MD

Wesley G Schooler, MD

Matthew Wayne Backer, MD

Kathryn C Haran, DO

Roberta Sengelmann, MD

J Kevin Beckmen, DO

Noah Francis Hawthorne, MD

Michael Mourad Shenoda, MD

Jonathan L Berkowitz, MD, PhD

Bryce Richard Holderness, MD

William Svend Sogaard, MD

Julia Billington, MD

Douglas W Jacobson, MD

Kenneth Glenn Starr, MD

Laurel Bliss, MD

Lauren Elaine Jacobson, MD

Nathan C Steinle, MD

Sushila L Braganza, MD

Daniel L Jurewitz, MD

Cathy Straits, MD

Leanne Renee Buckner, MD

Robert Jeffrey Kershaw, MD

Alan Mark Sugar, MD

Kristin Nicole Castorino, DO

Tamir H Keshen, MD

Reyna Maria Talanian, MD

Linda Sian Chen, MD

Case H Ketting, MD

Sara Taroumian, MD

Dugald Donald Chisholm, MD

Sylvia Kim, MD

Caleb Daniel Thompson, MD

Gregory Alexander Cogert, MD

Bradley C Knox, MD

Casey Toole, DO

Carin Craig, MD

Li-Sheng Kong, MD

Mandana A Toole, DO

Karen B DaSilva, MD

Erica J Lambert, MD

Stephen J Vara, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. 26

CENTRAL COAST PHYSICIANS

Spring 2018

Takashi Michael Wada, MD

Ryan James Fante, MD

Hoang Nguyen, MD

Anne White, DO

Elizabeth A Finken, DO

Jenni Lynne Nix, MD

Brett Wilson, II, MD

Robert W Fry, MD

William Kiernan O’Callaghan, MD

John Yoon, MD

Liana Gonzalez, MD

Michael John Paisley, MD

David Zisman, MD

Rachel M Greatwood, DO

Grace Eunmi Park, MD

Paul Guarino, MD, FACP

Meredith Ann Perrin, MD

LESS THAN 5 YEARS

Alicia Amelia Guevara, MD

Scott Patrick Piazza, DO

Blake E Hansen, DO

Matthew Alan Pifer, MD

Paul Dietrich Hennig, MD

Spencer Eugene Price, MD

Natalie Achamallah, MD, MA, MS

Stephen Cameron Herrick, DO

Beverly Joy Sanson Ramos, MD

Allison E Akers, DO

Taylor James Holve, MD

Pedram Rashti, MD

Dela Amoussou, MD

Camille Marie Hunter, MD

Alexandra E Rogers, MD

Sean Charles Andrews, DO

Matti Rose Jansen, MD

Isaiah J Roggow, MD

Nicholas Cane Becketti, DO

Helen Anita John-Kelly, MD

Brian David Santacrose, MD

Peggy Carnation Wu

Lindsay Blake Katona, DO, MPH

Matthew Bennett Scales, MD

Becketti, DO

Samira Kayumi-Rashti, MD

Heather Melanie Schultz, MD

Guy Richard Bennallack, DO

Sharon Min Joo Kim, MD

Cameron James Selent, MD

Alan Barry Bernstein, MD

Oma Christine Knox, MD

Colin David Shafer, MD

Julie Michelle Brodfuehrer, DO

Tatyana Kopilova, MD

Laura Sices, MD

Brittany Alice Bryan, MD

Jennifer Backer Kosek, MD

Margaux Kelly Snider, MD

Hugh Randolph Byers, MD,PhD

Sarah Elizabeth Langdon, MD

Cameron St Hilaire, MD

Joye Maureen Carter, MD

Daisy Shabnam Lankarani, MD

Nicole Gaye Stern, MD

Kevin Michael Casey, MD

Jeremy William Lash, MD

Noah Stites-Hallett, MD

Jinny Ei Chang, MD

Ann Miehyung Lee, MD

Christopher John Thrash, MD

Emily Chen, DO

Darryl Chuck Ngin

Burgundy R Tyrrel, MD

Sean David Christiansen, DO

Leong, MD, FAAP, MPH

Nicolas A Walton, DO

Katherine Chung, MD

Alice Wen Lin, DO

Sharon Evelyn Watson, MD

Nathaniel Collins, MD

Caitlin Rae Loseth, MD

Sara Pennington Wilson, MD

Kathleen A Coquia, DO

Miguel Angel Loya, DO

Michelle Withee, MD, MBA

Chelsea Dean, MD

Catherine Aline Martin, DO

Andrea Isabela Zambrano

Carol Del Ciello, MD

Samantha Kate Mathews, MD

Sequera, MD

Benjamin N Dirkx, DO

Yuri Petrovich Matusov, MD

Xi Zhai, DO

Barbara Joan

Aklecia Violet Mcvoy, MD

Rachel Lee Zonca, DO

Donnelly, MD, FAAP

Jamil Suheil Muasher, MD

IF YOUR NAME IS NOT ON THIS LIST, CONTACT CCMA AS SOON AS POSSIBLE REGARDING MEMBERSHIP BENEFITS AND RESOURCES AT 805.683.5333 OR SBCMS@SBMED.ORG. Spring 2018

CENTRAL COAST PHYSICIANS

27

EHRs CAN ADVANCE GOOD MEDICINE IF DOCTORS ARE AWARE OF THE RISKS

by David B Troxel, MD, Medical Director, The Doctors Company Historically, the doctor-patient relationship has been at the heart of medical practice, with administrative tasks and record-keeping at the border.

Today, that critical balance is at risk. Nearly all hospitals and 80 percent of medical practices use electronic health records (EHRs), presumably to help improve access to health information and increase productivity. The problem is that none of these digital tools were designed specifically to advance the practice of good medicine.

Consider these stark statistics: Every hour doctors spend with patients, they dedicate nearly two more hours to maintaining

28

CENTRAL COAST PHYSICIANS

EHRs and clerical work. Yet even when physicians are with patients, they’re spending approximately 37 percent of their time interacting with EHRs or other desk work.

We are now witnessing the highest levels of physician burnout on record. Indeed, the rise of documentation demands and decrease of meaningful patient interactions has led to major physician frustrations—while making it harder for physicians to deliver quality care.

For these reasons and more, the EHR has introduced patient safety risks and unanticipated medical liability risks. According to a new study from The Doctors Company, the nation’s

Spring 2018

largest physician-owned medical malpractice insurer, the number of EHR-related medical malpractice claims has risen over the past 10 years.

FACTORS BEHIND EHR ERRORS For the most part, the EHR is a contributing factor in an EHRrelated claim and not the primary cause. This and their low frequency (0.9 percent of all claims) suggest that EHRs infrequently result in adverse events of sufficient severity to develop into a malpractice claim.

When EHRs are a factor in a claim, the study showed that user factors (such as data entry errors, copy-and-paste issues, alert fatigue, and EHR conversion issues) contributed to nearly 60 percent of claims. As computer users, we all copy and paste. Therefore, it’s no surprise that time-pressured physicians embrace the same habits when using EHRs. In fact, the University of California San Francisco Medical Center—today considered a top five medical center in the United States—reviewed more than 23,000 of their own progress notes over an eight-month period and found that, on average, clinicians manually entered just 18 percent of the text in each note, while 46 percent was copied and 36 percent was imported.

System factors (such as data routing problems, EHR fragmentation, and inappropriate drop-down menu responses) contributed to 50 percent of claims. EHR fragmentation was among the most prominent system factors, contributing to 12 percent of errors. This factor means that different components of a single patient encounter might not be located together in the EHR. Consequently, doctors must check in different places to find laboratory and x-ray results, histories and physicals, etc.—resulting in important information being overlooked or unidentified.

RE-CLAIMING THE DOCTOR-PATIENT RELATIONSHIP One overwhelming response to adjust to burdens introduced by EHRs has been the rapid growth of medical scribes. Nearly 20 percent of medical practices are using scribes to help untether

Spring 2018

physicians from the EHR, with many doctors citing improved efficiency and satisfaction. Yet while scribes can offer great advantages, they can be a double-edged sword. According to a survey of hundreds of physicians from The Doctors Company, the lack of standardized training and variability in experience among scribes poses risks to data accuracy and delivery of care— which could increase liability for the patient and physician alike.

With or without scribes, lowering risk begins with each patient visit. At the beginning of each new session, doctors should inform patients of the purpose of the EHR and emphasize they are listening closely even though they might be typing during the appointment. Practices can set up treatment rooms so the patient can watch the screen and see what is being typed. It is also helpful to summarize or read the note to the patient to demonstrate that you have listened, and ask, “Do I have it right?” If the doctor is using a medical scribe to untether them from their EHR, the same principle applies.

Patients must also become their own advocates. They can ask their doctor to read back the EHR notes or review what has been written. Patients can interact with their health record online through patient portals and review their medical record as well as disease-specific educational materials and drug safety information. It is important that they communicate any errors they find as well as personal information updates to the physician.

WHAT THE FUTURE HOLDS As with any challenge of major proportions, progress will take time. But I’m optimistic that the EHR will evolve over the next 5 to 10 years and improve both the quality of medical care and patient safety.

Optimizing the EHR will involve: • Redesigning EHR workflows to reflect clinical practice workflows in hospital, clinic, and office environments. It is essential that physicians and other healthcare providers be involved in this endeavor.

• Developing standardized diagnostic and treatment protocols.

• Researching medical artificial intelligence (AI). This is underway and will doubtless play a significant role in future medical practice.

• Making EHR interoperability a high priority.

• Applying “big data” techniques to healthcare. This is underway and, like AI, will lead to new knowledge insights that will change the practice of medicine.

Today, what I hear from The Doctors Company’s 80,000 member physicians is encouraging. Doctors are eager to “reclaim” their profession and refocus patient relationships amidst the new demands of today’s digital age. Into the future, new protocols, policies, and training programs must take these small successes to a large scale.

CENTRAL COAST PHYSICIANS

29

Public Health

Update

“[W]e do experience real and occasionally prolonged episodes of pollution from particulate matter, also called PM or particle pollution.”

Particle Pollution + Health Making the Connection

by Penny Borenstein, MD, MPH, Health Officer/Public Health Director, County of San Luis Obispo

We know that our patients’ health—for better or worse—is shaped by more than meets the eye. Environmental and social factors can damage well-being over time or trigger a health emergency. As the seasons change and we experience increasingly variable weather patterns here on the Central Coast, I’d like to remind us all to consider one of those invisible factors that can have a profound effect on health: particle pollution.

The U.S. Environmental Protection Agency sets measurable standards for common air pollutants: ground-level ozone, particulate matter (at two sizes), carbon monoxide, lead, sulfur dioxide, hydrogen sulfide, sulfates, vinyl chloride, and nitrogen dioxide. While our region generally enjoys a reputation for clean air and we are fortunate to avoid the heavy daily pollution

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our colleagues in other cities face, we do experience real and occasionally prolonged episodes of pollution from particulate matter, also called PM or particle pollution. PM can range in size and contain different chemicals; it can be emitted directly from sources such as construction sites, unpaved roads or smokestacks, can take the form of a plume of windblown dust, or can be created in the atmosphere through chemical reactions of other pollutants, such as sulfur or nitrogen dioxide.

National and state PM standards are set for particles less than 10 micrometers in size (called PM10 or respirable particulate matter) and particles less than 2.5 micrometers in size (called PM2.5 or fine particulate matter). Breathing particles of this size can trigger a variety of health problems, including asthma exacerbation, heart attack, arrhythmia, or stroke, particularly in the elderly and those with existing lung or heart disease. Its effects on lung function range from coughing or difficulty breathing to permanent damage to the cells that line the lungs. Very small airborne particles (PM2.5) found in haze, smoke and dust are especially harmful because they can become trapped in the smallest airways, alveoli, or enter the blood stream.

Like our County’s microclimates, our pockets of pollution can vary from mile to mile and hour to hour. As the wind picks up in the spring, parts of the Nipomo Mesa have registered particulate pollution levels that are among the highest in the nation for some hours. On cold winter days in North County, particulates from wood-burning stoves can trigger advisories from the Air Pollution Control District (APCD).

Any commuter from San Luis Obispo to South County on the

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101 during rush hour knows we do in fact experience pollution from idling vehicles, no matter how much we enjoy the idea of a region with no traffic. When smoke is in the air during wildfire season, we continually discuss the severity of the air quality risk.

Air pollution is exceptionally difficult to address in a medical or public health setting because it’s often invisible.

The numerous scientific studies that quantify the effects of particle pollution on human health were done with very large populations in order to reveal causal effects. These assessments determine increasing likelihood of effect with increasing “dose.” Such results do not mean everyone will be affected in the same way, or at all: the same episode of pollution in a community may trigger an asthma attack in one person and a heart attack in another, for example, while many do not experience any noticeable harm. Despite studies clearly showing particulate pollution as a cause of heart and lung damage, it is impossible to definitively ascribe a specific heart attack to an episode of pollution exposure, as many factors could cause the same problem. No human lab test is available to quantify PM exposure in individuals (unlike, say, lead or carbon monoxide).

It is perhaps human nature to underestimate risks that do not pose a visible and universal threat. That makes it all the more critical for us to educate our patients about this connection and advise them on ways to minimize their risk.

This conversation poses a dilemma in that air pollution is both “unsafe at any level” and ubiquitous in modern life. For me, it helps to keep three goals in mind:

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Present guidance that protects the majority of people the majority of the time.

This means being aware of air quality ourselves, and reminding all patients of common-sense measures to reduce their exposure to air pollution. For example, it is wise for everyone to avoid exercising outdoors when haze or wildfire smoke is visible in the air, and to set the car vent to recirculate in idling traffic. We can all receive mobile alerts when our local air quality is affected by blowing dust, wildfires and more: Visit SLOCleanAir.org to sign up.

Provide special recommendations for vulnerable populations.

The potential health impacts of particle pollution are especially significant for very young children and pregnant women and their fetuses (for whom development of lungs and other systems can be inhibited), as well as for the elderly and those with underlying cardiopulmonary conditions. Patients in these groups can benefit from clear advice to avoid polluted air as much as possible by staying indoors, setting their HVAC system to recirculate, and even temporarily leaving town if their area is heavily affected. I’d strongly encourage vulnerable patients and their families to follow daily air quality reports. It is also important for people in these groups to be aware of the warning signs of health emergencies that can be triggered by particle pollution–such as heart attack and stroke—so they can seek immediate medical attention if needed.

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Do our part to keep SLO County’s air clean and healthy.

I encourage us all to be part of the effort to keep our community’s air healthy. That may mean using energyefficient technology, offering bike parking at your practice, shopping locally at farmers’ markets, or setting up incentives for your colleagues and staff to do the same. We are uniquely positioned to see the connection between our local environment and our community’s health; I hope this provides us all with motivation to protect both.

In 2012, the Public Health Department and the APCD first launched an educational campaign highlighting the connection between air quality and health, with a special emphasis on cardiac health, asthma, and outdoor exercise.

This year, we’re re-launching this campaign. While particulate exposure for residents on the Nipomo Mesa has received the most attention in recent public dialogue, due to the unique and challenging situation related to off-highway vehicle use, the information in the brochures has universal applicability.

In the months ahead, representatives from the Public Health Department and APCD will connect with medical offices across SLO County to offer brochures for display, and will launch the updated campaign online.

If you would like to offer these brochures in your office or use them to support your conversations with patients about air quality and health, please let me know. As always, I welcome your input and additional discussion of this issue.

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Save The Date 86 6

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Join us for the inaugural Southern California Women in Medicine Conference! The Southern California Medical Societies are proud to present an inspiring day dedicated to the education and empowerment of our female physicians. Topics will include; creating balance, the business of medicine, and importance of advocacy and legislative involvement, and finding and creating opportunity for more female leadership in the profession.

Friday, November 9, 2018 | Hotel Irvine | Irvine, CA for details: Katie Tomarchio, OCMA | ktomarchio@ocma.org

PLACE YOUR AD HERE magazine@sbmed.org 805.683.5333 Spring 2018

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Positions Available The COUNTY OF SAN LUIS OBISPO is seeking physicians to fill the roles of Deputy Health Officer, Staff Psychiatrist, Staff Physician - County Jail, and Medical Doctor at the County Jail - Contract. For more information, go to www.slocounty.ca.gov.

The COUNTY OF SANTA BARBARA Behavioral Wellness Department is seeking physicians to fill the roles of Psychiatrist and Psychiatrist (Child-Adolescent Specialty).

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San Luis Obispo

Thursday, October 25, 2018

Friday, October 26, 2018

Spring 2018

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9 New

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

Armando Siqueiros, MD Internal Medicine PCCHC - Pacific Coast Health Center San Luis Obispo 805.597.6715

Sharon Watson, MD Pediatrics Bravo Pediatrics San Luis Obispo 805.544.4460

Mareeni Stanislaus, MD Obstetrics & Gynecology PCCHC - Templeton Women’s Health Center Templeton 805.434.3000

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RESIDENTS

RETIRED

Tatyana Kopilova, MD General Surgery Santa Barbara Cottage Hospital

Karen Kolba, MD Rheumatology Santa Maria

Caitlin Loseth, MD General Surgery Santa Barbara Cottage Hospital

Ayesha Shaikh, MD Obstetrics & Gynecology Santa Barbara

Heather Schultz, MD Diagnostic Radiology Santa Barbara Cottage Hospital

Steven Young, MD Internal Medicine Santa Barbara

CENTRAL COAST PHYSICIANS

Spring 2018

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Spring 2018 CENTRAL COAST PHYSICIANS 37 Call (800) 786-4262 or email economicservices@cmanet.org.

In Memoriam

In Memoriam

Harris Meisel, MD 1932 – 2018 Dr. Harris Meisel, known as “Bubs” to his family and friends has passed away at age 85. Physician, Artist, Poet, Musician, NCAA Champion Fencer, Founder of Rehabilitation Medicine on the Central Coast of California, Medical Director of the Memorial Rehabilitation Hospital (later called the Rehabilitation Institute of Santa Barbara and what is today Cottage Rehabilitation Hospital), beloved father, husband to Fredda, and dear friend to many. A true renaissance man whose motto was “You can never go wrong doing the right thing.”

Dr. Meisel was surrounded by his family and the remarkable caregivers of Senior Planning Services, Assisted Hospice, and Valle Verde Community following a 15-year challenging dance with Parkinson’s disease and Lewy Body Dementia. He bestowed a final gift to his life love, Fredda, by giving peace in his passing on her birthday, February 23, after 60 years of wedded bliss, and a 70-year friendship.

His many contributions to medicine are inscribed in the Archives of The American Academy of Physical Medicine and Rehabilitation in Chicago which describe his work as “… exemplary sensitivity and awareness given to the needs, worth, and employability of disabled persons lending significant contributions to the growth of Rehabilitation Medicine in the United States”.

Dr. Meisel pursued art and sculpture at the Tyler School of Fine Arts in Philadelphia before attaining his Medical Degree at the University of Pennsylvania. While serving with the Public Health Service in the Four Corners of the Navajo Reservation, (1960 – 1962) he began a monthly air flights’ program between Craig Rehabilitation Hospital in Denver, Colorado and the Navajo Reservation hospital in Shiprock, New Mexico.

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After serving as Chief Resident in Rehabilitation Medicine at Stanford University’s Hospital, Dr. Meisel was invited to Santa Barbara to develop a Physical Medicine and Rehabilitation hospital on the grounds of the, then, Santa Barbara County Hospital. The vacant former County’s tuberculosis ward was transformed as Dr. Meisel incorporated Art and Music into rehabilitation medical care.

His practice of doing artwork with patients and hanging their paintings over the General Hospital’s marred walls …began what is now Santa Barbara’s tradition of bringing art into the hospital….now described as “Art as Healing”.

In 1985, Dr. Meisel was named Physician of the Year by the California Governor’s Committee for Employment of the Handicapped, and shortly thereafter, honored with the Santa Barbara New Press’ Lifetime Achievement Award, for his contributions to his community. He touched many lives in Santa Barbara, and enlisted forces under the Americans with Disability Act to outfit and revamp Santa Barbara’s public buildings, streets, and sidewalks appropriately for universal use, inclusive of people with disabilities.

Outside of his professional life, Bubs embraced family and found wonder in all living things. He could make whistles out of branches from willow and elderberry trees and would joyfully carve fruit into whimsical animal characters. Along with Gary Chafe and Armin “Arnie” Mueller, he was one of the “Three Artist Musketeers” who founded Santa Barbara’s Annual Holiday “YES Store”.

Bubs illustrated music album covers, including those of KiD’n Together (music by his children and inspired by his grandson Matthew). He loved singing with his friends and his son Alex in the Santa Barbara Barbershop Chorus. He whistled, hummed, and sang constantly. He fought passionately and successfully in order to preserve the San Marcos Foothills.

Dr. Meisel is survived by his best buddy and wife, Fredda, brother Paul (Joni), sister-in-law Judy, children Melody (Steve), Alex (Jacqui), and Ben (Laura), grandchildren Matthew, Joshua, Lea, and Sophia.

He was predeceased by his father Alex, mother Sophie, and brother Fred.

There will be a celebration of Dr. Meisel’s life at the Alpha Resource Center over Memorial Day Weekend for those who wish to bring a long-stem flower, have a chance to share about Dr. Meisel’s life, and be together in community. Should you wish to connect prior to the May celebration, please request to join our Facebook Group Page entitled “Love View – Celebrating Dr. Harris “Bubs” Meisel”.

Originally published in the Santa Barbara Independent.

Spring 2018

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