Central Coast Physicians Spring 2023

CONGRATULATIONS RESIDENTS

I would like to take this opportunity to congratulate all of the graduating residents. You have completed an extraordinary journey of training, dedication, and hard work, and you should be incredibly proud of your accomplishments.

As you embark on your career as a physician, I urge you to be advocates for your patients and for the profession of medicine. This may involve advocating for public health policies, promoting healthcare equity and access, or simply being a voice for those who are vulnerable or marginalized. Your role as a physician extends beyond the exam room, and it is vital that you use your platform to effect positive change.

Furthermore, I encourage you to become involved in organized medicine and to take an active role in shaping the future of healthcare. By working together as a profession, we can address the challenges facing healthcare today and ensure that our patients receive the best possible care.

Once again, congratulations on your achievements, and best wishes for a fulfilling and successful career in medicine.

Sincerely,

Dana Goba Chief Executive Officer Central Coast Medical Association

PRESIDENT Julie Fallon, MD

PRESIDENT ELECT Douglas Murphy, MD

TREASURER Todd Engstrom, MD

SECRETARY Rachel May, MD

IMMEDIATE PAST PRESIDENT Samira Kayumi-Rashti, MD

DIRECTORS Kevin Casey, MD; Michael DiBiase, MD; Priti Gagneja, MD; Jennifer Hone, MD; Bindu Kamal, MD; Christopher Quijano, DO; Rahim Raoufi, MD; Daniel Roshan, MD

CHIEF EXECUTIVE OFFICER Dana Goba, MBA

CMA HOUSE OF DELEGATES REPRESENTATIVES

Sharon Basham, MD; Edward Bentley, MD; Kevin Casey, MD; David Dodson, MD; Julie Fallon, MD; Priti Gagneja, MD; Jennifer Hone, MD; Samira Kayumi-Rashti, MD; Christopher Lumsdaine, MD; Douglas Murphy, MD; Joseph Schwartz, MD

CMA DISTRICT V TRUSTEE Rene’ Bravo, MD

CENTRAL COAST PHYSICIANS MAGAZINE

EDITOR Julie Fallon, MD

MANAGING EDITOR Dana Goba, MBA

CREATIVE DIRECTOR Sherry Lavone Design

CONTRIBUTING WRITERS Richard F. Cahill, JD; California Medical Association; CenCal Health; Marian Regional Medical Center; Santa Barbara Cottage Hospital; and Tenet Health Central Coast

CONTRIBUTING PHOTOGRAPHERS

CenCal Health, Marian Regional Medical Center, Santa Barbara Cottage Hospital, and Tenet Health Central Coast

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 • F 805.364.5431

E magazine@ccmahealth.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 to magazine@ccmahealth.org

DANA GOBA

Get Back

in Motion

New Spine Center for Advanced Spine Care

If your patient has chronic back pain, it might be more than a strained muscle. At Tenet Health Central Coast, we expanded our partnership with nationally ranked UCSF Health to provide a comprehensive resource for back and spine conditions. Our experienced team gives patients access to advanced care from non-invasive therapy to complex treatment options.

The Spine Center can help your patients get back to the life they want to lead.

New artificial intelligence technology is making a real difference for stroke patients

Artificial Intelligence (AI) is revolutionizing healthcare, and Tenet Health Central Coast (THCC) is at the forefront in utilizing this technology to elevate the care of stroke patients in our communities.

Recently, both THCC hospitals – Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton – implemented a diagnosis-to-action technology that features AI, giving THCC care teams the ability to diagnose stroke patients with Large Vessel Occlusion (LVO) within minutes of the CT scan being completed. Subsequently, the hospitals are able to offer faster treatments and interventions, which may have a significant impact on outcomes and mortality.

“In the pre-AI era, which is only a few years ago, stroke patients would undergo complex brain imaging, which were downloaded to our imaging systems and portals. Our stroke team, including neurologists, radiologists, and

Emergency Department physicians, would then review those images and communicate amongst each other by phone to come up with a plan,” said Dr. Moussa Yazbeck, Medical Director of Stroke Programs at Tenet Health Central Coast. “Now, with the recently acquired AI, the AI has the ability to quickly review those images and alert the different providers on the team if an LVO is present. Importantly, the stroke care team utilizes the AI platform to communicate quickly and efficiently. This has already proven to expedite care and improve outcomes in only a short period of time.”

Maria Irthum, Tenet Health Central Coast Neuroscience, Stroke, and Spine Coordinator, gives an example: “We saw the impact during the first week of implementation. We had a neurologist who was out shopping one day when he was alerted via his phone by the AI software, which detected an LVO. This triggered the action for a quicker intervention.”

Just as important as the speed of the results, Dr. Yazbeck speaks of the quality of the images as well.

“The quality of the images is impressive even on a small handheld device such as my phone,” said Dr. Yazbeck. “I can zoom in and zoom out, and utilize 3D technology. The sensitivity and specificity of the AI software in detecting LVO is also very impressive and comforting.”

The tools are HIPAA complaint and available to the THCC stroke care team via cell phones or tablets. THCC works with Viz.ai to implement the AI technology in the coordination of stroke care.

Of course, the reason for the technology is to accelerate diagnosis and care to enhance patient outcomes, which is already happening at THCC – and has been evident in previous, peer-reviewed studies. In stroke care, the saying is “time is brain” because every minute in which a large vessel ischemic stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and seven miles of axonal fibers that carry nerve impulses. A study presented at the 2021 International Stroke Conference and published in the September 2022 issue of AHA Journals showed evidence that there is a 45%, or 102.3-minute, average reduction in doorin door-out time for patients whose care was coordinated through this integrated technology. A reduction in door-in door-out time equates to faster stroke care and more brain tissue saved. In addition, there was an 11.4% improvement in modified Rankin Scale (mRS) scores, which measure stroke outcomes or level of disability.

“We worked diligently to get this technology at Tenet Health Central Coast because we know our patients will benefit from it and we are grateful for the support of our integrated teams” said Dr. Yazbeck. “This is an evolving field, and we’re at the forefront of this technology. We are extremely happy and proud to offer this level of care to patients in our community.”

“The quality of the images is impressive even on a small handheld device such as my phone. I can zoom in and zoom out, and utilize 3D technology. The sensitivity and specificity of the AI software in detecting LVO is also very impressive and comforting.”

- DR. YAZBECK

Medi-Cal Recipients on Central Coast Urged to Reconfirm Eligibility

Community health plan alerts members “to not lose your health coverage”

CenCal Health alerts Central Coast communities to the resumption of the annual “eligibility check” or redetermination of an individual’s Medi-Cal health coverage. During the COVID crisis, the Federal government suspended this annual redetermination process in order to keep health insurance in place for the country’s most vulnerable, especially seniors and children. But as of March 31 of this year, that temporary suspension of eligibility renewals ended nationwide. Beginning in April, California’s Medi-Cal members started receiving communication about the annual redetermination packages and must respond to maintain their benefits.

“We urge our members to update their contact information with their local Department of Social Services or at KeepMediCalCoverage.org to ensure they receive the renewal package in the mail. This is especially important if the member has moved or their mailing address has changed in the last two years,” said CenCal Health Chief Customer Experience & Health Equity Officer Van DoReynoso, MPH, Ph.D. “Access to care is a critical step towards health equity. So please – check, update, and respond to keep yourself and your family covered.”

To maintain healthcare coverage, other life changes also need be reported, including changes to income, disability status and family size. If members are unsure about what to report, they can contact their local California Department of Social Services (DSS) for answers. Account information updates can be done in person, by phone, fax or online. More details on the

redetermination process, including contact information for local DSS offices, can be found in both Spanish and English at cencalhealth.org/keep.

In Santa Barbara and San Luis Obispo counties, all Medi-Cal eligibility and enrollment decisions are made by each county’s

“Health insurance provides peace of mind and enhances access to needed medical care. We encourage all Medi-Cal members to update their account information as soon as possible and respond to communication so that they are able to keep their health coverage. Together, we can build a healthier Central Coast for all residents.”

respective DSS. CenCal Health does not determine Medi-Cal eligibility. The federal government administers Medicaid; MediCal is the name of California’s Medicaid benefits program. The California Department of Health Care Services (DHCS) funds health care services for nearly 15 million Medi-Cal beneficiaries. About one-third of Californians receive health care services financed or organized by DHCS.

“CenCal Health, in cooperation with the DHCS, is committed to making sure enrollees understand the renewal process and how to take action to avoid gaps in coverage,” said Do-Reynoso. “The unprecedented task of resuming renewal operations after the pandemic requires public education, as well as ongoing work with all our Medi-Cal partners and providers.”

Marking its fortieth year as the community health plan on the Central Coast, CenCal Health now partners with over 1,500

local providers – physicians, hospitals, clinics, public health departments, social service agencies, community non-profits and others – to deliver quality care to nearly 232,000 MediCal members. For more information on becoming a Medi-Cal provider in Santa Barbara and San Luis Obispo counties, visit cencalhealth.org/providers/join-our-network.

“It’s a privilege to help improve the health of our communities in San Luis Obispo and Santa Barbara,” said CenCal Health CEO Marina Owen. “Health insurance provides peace of mind and enhances access to needed medical care. We encourage all Medi-Cal members to update their account information as soon as possible and respond to communication so that they are able to keep their health coverage. Together, we can build a healthier Central Coast for all residents.”

More information on CenCal Health is available at cencalhealth.org.

Key Factors in a Deposition What Healthcare Professionals Can Expect

RICHARD F. CAHILL, JD, VICE PRESIDENT AND ASSOCIATE GENERAL COUNSEL, THE DOCTORS COMPANY

A deposition is a discovery tool used in virtually all forms of civil, administrative, and criminal litigation. It provides an opportunity for the defense and prosecution to identify information that is material to a claim, assist in developing strategies for trial, and formally preserve testimony for use at a later time.

Depositions are conducted under oath in a verbal question-and-answer format by counsel for all of the parties to the proceeding. Although the deponent (that is, the person being questioned) is often a participant to the legal action, more commonly the individual has

specific—and possibly unique—knowledge relevant to the case.

The questioning may require several sessions and is frequently conducted over many days, with weeks or sometimes months in between sessions. Depositions are always recorded, traditionally by a certified shorthand reporter, who then transcribes the exchanges into a verbatim document that the deponent is required to sign. With increasing regularity over the past decade, the testimony is now also preserved by separate audio and video technologies.

Most deponents, whether a party to the proceeding or a witness, are represented by an attorney. Legal counsel can protect the interests of the client-deponent. In preparation for a deposition, counsel will meet with a client well in advance to explain the process; offer recommendations on demeanor, dress, and other important considerations; provide valuable suggestions on pitfalls to avoid; and identify probable areas of questioning by the attorneys who will attend the deposition.

Key Factors for Deponents

Contact The Doctors Company immediately for further assistance if you receive notice of a deposition as responses are time sensitive. Deponents must keep several key factors in mind.

Prepare in advance. The deponent must be prepared in advance about the likely scope of the examination and review materials that counsel provides. Advance preparation helps to expedite the process and better ensure the accuracy of the testimony. Opposing counsel is entitled to review any documents that the deponent has examined and to know the names of any individuals the deponent has spoken with about the case. The content of any conversation between the client and lawyer is, however, protected from disclosure as a matter of law by attorney-client privilege.

If you are served with notice of a deposition, contact The Doctors Company immediately and our experts will guide you. Contact a claim specialist or patient safety risk manager on our 24hour hotline at 800.421.2368, or contact the Claim Administrative Support Team or a patient safety risk manager by email.

lie will be cross-examined even more rigorously, and the court, arbitrator, or other administrative commissioner will likely allow greater latitude in the scope, tone, and severity of the interrogation. The oath also requires that responses are truthful, accurate, and complete. Embellishments, intentional omissions, and shading the truth are prohibited.

Opposing counsel is entitled to review any documents that the deponent has examined and to know the names of any individuals the deponent has spoken with about the case. The content of any conversation between the client and lawyer is, however, protected from disclosure as a matter of law by attorney-client privilege.

Tell the truth. The oath given at the outset of the proceeding is critically important. Although the swearingin process varies by jurisdiction, all deponents must promise to “tell the truth, the whole truth, and nothing but the truth.” Failure to comply with the oath reasonably and in good faith when responding to questioning may be considered perjury that is punishable, often as a felony, by the prosecuting authorities and may result in fines, sanctions, and even imprisonment. A deponent who is caught in a

Answer the question asked.

Deponents should listen carefully, answer only the question being asked, and then stop talking. Volunteering extraneous information prolongs the proceeding, identifies potential new areas of inquiry that opposing counsel may not have previously considered, and occasionally subjects the deponent to objections by any or all counsel, with corresponding motions to strike the unnecessary portion of the response. One classic tactic is for the attorney to pause, leaving dead air that tends to be uncomfortable and can lead the deponent to resume talking. This opens the possibility of revealing detrimental information not specifically sought by the original inquiry.

Deponents need to be careful of questions that apparently call only for a “yes” or “no” answer. This is a strategy frequently used by counsel to box the deponent into a simple and potentially damning response or admission against interest

Consider yes and no responses. Deponents need to be careful of questions that apparently call only for a “yes” or “no” answer. This is a strategy frequently used by counsel to box the deponent into a simple and potentially damning response or admission against interest. If the question can be truthfully and fully answered with either a yes or no, respond and wait for the next question. If more information is necessary to be accurate, the deponent should state this on the record and wait for the lawyers to offer their opinions. The deponent will be given direction on how to proceed.

Provide accurate information.

Although a transcript can be changed prior to the deponent’s final signature, corrections tend to lessen the individual’s credibility.

Deponents should do their best to provide the most accurate testimony at the time of the deposition. Although a transcript can be changed prior to the deponent’s final signature, corrections tend to lessen the individual’s credibility. If the matter proceeds, a heavily corrected transcript can even increase the probability that the deponent will be vigorously questioned during any subsequent appearance.

Maintain respect. When providing deposition testimony, be well prepared in advance, appear on time and appropriately attired, act professionally and courteously at all times, stay focused, and respond to the questions directly and with respect. Defer when counsel interrupt the proceedings with objections, motions, argument, or requests for clarification.

When providing deposition testimony, be well prepared in advance, appear on time and appropriately attired, act professionally and courteously at all times, stay focused, and respond to the questions directly and with respect.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

To find out more about what differentiates The Doctors Company from other medical malpractice insurance carriers as a physician-first insurer, contact Matt Lawrence at 310.492.4845 or mlawrence@thedoctors.com. CCMA members receive additional savings!

CMA is seeking physician and health care provider stories about the prior authorization process AND access issues in the Medi-Cal system.

You can help CMA explain to lawmakers why change is needed.

MEDI-CAL ACCESS TO CARE

Medi-Cal provides essential health coverage to one in three Californians and is foundational to the state’s health care delivery system and economy. However, much work remains to improve access to care.

How you can help: Share your unique experience as a Medi-Cal patient, physician or health care professional. Your story will help shed light on why the Medi-Cal system is vitally important to every Californian.

Go to cmadocs.org/your-story or scan the QR code.

PRIOR AUTHORIZATION

When insurance company prior authorization gets between patients and physicians, patients get sicker and health care becomes more expensive. It doesn’t have to work this way.

How you can help: Share your unique experience as a patient, physician or health care professional so we can fight back to ensure California policy puts patients first.

Go to cmadocs.org/priorauth or scan the QR code.

Questions? Contact CMA at news@cmadocs.org

Of all the responsibilities of my new role as President of the CCMA, writing an article for this magazine is the most daunting. I am not a writer as I’m sure many physicians would agree. Although I joke with my patients when they ask for unreasonable letters, reports, or work excuses, “I didn’t major in Creative Writing,” I do love reading and have always found a tremendous release in a variety of types of literature! Whether it is listening to an audiobook while driving, exercising, or doing yard work, or finding a stolen moment sitting with an actual book, it is my favorite way to unwind.

Looking for a good book?

When a patient comes in with a book, Kindle, or audiobook it is an easy way to make small talk that puts them at ease. They often give me great suggestions for future reads. Magazines are available again in our office exam and waiting rooms, and it’s interesting to see the ones different patients choose to read. In this profession, it is important to have opportunities to relax and take our minds off the worries and stresses of work.

Reading has led me to join book clubs, which has provided interactions with other interesting like-minded people from other professions, and stimulating conversations ensue. Although I may not always like the monthly book selections, I read them dutifully in an effort to try and expand my focus and

stay open to other ideas. This has also led to supporting the building of two local libraries to help the community with lifelong learning. My three sisters and I spent many happy hours in the cozy Warner Library in Tarrytown, NY, growing up and competing during the summers to win awards for the most books read. I still send my favorite books for birthday and baby gifts, and I have helped many patients deal with insomnia with audiobooks on sleep timers. It reminds me of the Grimms’ Fairy Tales LP record read by Danny Kay my mother played for us at night to put us to sleep.

Reading is not my only pastime, as I believe in the motto, “Mens sana in corpore sano.” Exercise is vital to my work life balance, in particular swimming at lunchtime on work days along with walking or hiking on weekends keeps me healthy. During the Pandemic swimming was not available, so I started doing virtual challenges through an app called

“Cutting for Stone” by Abraham Verghese is my all-time favorite!

The Conqueror. It logs your miles walked, hiked, or swam on virtual courses. I have completed the Camino de Santiago, Ring of Kerry, and Scotland North Coast 500 trails. Currently I am slugging away on the virtual Pacific Crest Trail with only 283 miles remaining of 2485! Although it’s not as “wild” as doing the hike in person it still inspires me to move my avatar along the trail and receive virtual postcards from the key points along the way!

These are just a few of my free time activities as I’m sure you all have found a way to weave pleasurable and rejuvenating pastimes into your lives. We all need to care for ourselves first in order to be able to care for our patients with continued compassion. As so many people in healthcare have been developing “Compassion Fatigue,” I truly believe that our emphasis on self-care will allow us to be able to deliver the best of ourselves to our patients, colleagues, and staff. It reminds me of the flight attendants’ message, telling all passengers to secure their oxygen mask first before helping others. Our recreational activities are what make us capable of being better doctors, as well as enriching every aspect of our lives.

Self-care is the core of great healthcare!

IS IT TIME TO EXAMINE your malpractice insurance?

PRESIDENT’S MESSAGE

By Julie Fallon, MD

With yet another of California’s medical liability insurers selling out to Wall Street, there’s an important question to ask. Do you want an insurer that’s driven by investors? Or do you want an insurer that focuses on you, and has already paid more than $140 million in awards to its members when they retire from the practice of medicine?

Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.

CALIFORNIA MEDICAL ASSOCIATION’S 2023 PRIORITY BILLS

The California Medical Association (CMA) announced its priority bill package for 2023, which includes legislation that would reform prior authorization, expand cultural and linguistic competency, streamline provider credentialing, protect physicians providing reproductive health care and more. Below are summaries of CMA's seven priority bills.

SB 598: PRIOR AUTHORIZATION

Senate Bill 598, authored by Senator Nancy Skinner, takes a wholistic approach to reforming the prior authorization process by requiring plans to create exemption programs that allow physicians who are practicing within the plan's criteria 90% of the time to receive a one-year exemption from the plan's prior authorization requirements. Additionally, the legislation will give a treating physician the right to have an appeal of a prior authorization denial conducted by a physician peer of the same or similar specialty. (Delegated physician groups would be exempt from these requirements, meaning the legislation will only apply to health plans.) SB 598 builds on the momentum CMA had last year with a similar bill (SB 250) championed by then Senator Richard Pan, M.D.

AB 470: EXPANDING CULTURAL MEDICAL EQUITY

Assembly Bill 470, authored by Assemblymember Avelino Valencia, would allow physicians to receive continuing medical education (CME) credits for taking language courses to improve their cultural and linguistic competency. With the ever-increasing diversity of language in our state, allowing physicians to receive CME for taking language courses would increase access to and quality of care with patients being able to communicate more efficiently with their physicians. This bill does not seek to expand requirements for physicians to take these courses, but rather affirms the importance of cultural competency and language fluency as a core tenant of CME and encourages CME providers to make quality foreign language programs available to California physicians.

@reallygreatsite@reallygreatsite

SB 582: EHR VENDOR REGULATION

Recognizing the key role electronic health record (EHR) vendors will play in empowering physicians and other health care providers to comply with California’s Data Exchange Framework (DxF), this bill would require the

state entity regulating physician compliance with data exchange regulations to also regulate EHR vendors. Authored by Senator Josh Becker, SB 582 would authorize the California Health and Human Services agency to create policies and procedures for including EHR vendors in the legal structure of the framework, and incorporate federal standards for the reasonableness

deceived into believing their health care provider is a physician or surgeon by preventing nonphysician health care providers from using terms like “-ologist" or "surgeon" or “medical doctor” or other similar combination of “physicianequivalent” titles.

TO RECEIVE UPDATES ON THESE BILLS AS THEY MAKE THEIR WAY THROUGH THE LEGISLATIVE PROCESS, SUBSCRIBE TO CMA NEWSWIRE AT WWW.CMADOCS.ORG/NEWS/SUBSCRIBE.

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Happy Graduation!

FAMILY MEDICINE

Katrina Ang,

MD MEDICAL SCHOOL: CHICAGO MEDICAL SCHOOL

Hello, I'm Katrina. I studied Biology and Literature at UC San Diego and completed my master's and medical degrees at Chicago Medical School. I chose Family Medicine because I am passionate about preventative medicine, health education, and providing evidence-based care. My career interests include geriatric and academic medicine. My hobbies revolve around dance, books, travel, graphic design, and my two cats. Where to next: Joining a practice

Jennifer

Irvine,

DO

MEDICAL SCHOOL: ROCKY VISTA UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE

Greetings! My name is Jennifer, but most people call me Jen. I grew up in Southern California, went to medical school in Colorado, and am so happy to now call the Central Coast my home. There were many things that drew me to the Family Medicine residency program here at Marian Regional Medical Center but among the most important are: the supportive learning environment, diverse patient population, unique pathology, and family-like atmosphere. We challenge and push each other to grow and learn new things every day. Outside of work I love outdoor activities such as hiking, camping, and going to the beach. Where to next: Joining a practice

Reagan McKendree, MD MEDICAL SCHOOL: UNIVERSITY OF FLORIDA

Hi! I'm Reagan--a transplant to the Central Coast after growing up and attending undergrad and med school in Florida. My passions are integrative medicine, lifestyle, and preventive medicine, providing holistic care for my family medicine patients, and promoting wellness for health care professionals. Along that path, I've also been a yoga teacher and done lifestyle coach training, and I am the first MD resident at Marian to join the Osteopathic Manipulation Track. In my free time, I enjoy hiking, exercising, yoga, water sports, cooking, and music.

Where to next: Joining a practice

Andrea Omonte, MD MEDICAL SCHOOL: VIRGINIA COMMONWEALTH

Hello everyone, my name is Andrea Omonte! I was born in La Paz, Bolivia but grew up just outside of Washington DC in Falls Church, VA. I studied in Southern California for undergrad at Pomona College and attended Virginia Commonwealth University School of Medicine. My interests within family medicine include community/global medicine, maternal-child well-being, improving access to care for underserved populations and mentorship. In my time off, I enjoy spending as much time as possible in the outdoors and you can find me exploring hiking trails with my dog, swimming, going to the beach, and traveling to different places.

Where to next: Joining a practice

Thomas Rehder, DO MEDICAL SCHOOL: PACIFIC NORTHWEST UNIVERSITY

My name is Thomas Rehder and I was born and raised right here in the Central Coast - my hometown being Nipomo and having attended St. Joseph High School in Santa Maria. I went to University of California, Merced for undergraduate education and attended Pacific Northwest University of Health Sciences in Yakima, WA for medical school. My interests include Sports Medicine, diagnostic and procedural ultrasound, and LGBTQ+ health. In my free time, I enjoy playing video games, kayaking, and camping.

Where to next: Fellowship

Anthony Reyes, DO MEDICAL SCHOOL:

TOURO UNIVERSITY

Greetings! My name is Anthony, and I attended medical school at Touro University in Vallejo, California. Although I grew up in the Bay Area, I also spent some time living in the mid-west and in southern California. I am very excited to now call the beautiful Central Coast my home. I am passionate about pediatrics, geriatrics, and preventative medicine. One of my favorite quotes is from a Navy Seal named David Goggins who once said, “It’s not about what you do. It’s about the conditions that you do it in.”

Where to next: Joining a practice

Julia

Veen, DO

MEDICAL SCHOOL: WESTERN UNIVERSITY OF THE HEALTH SCIENCES (WESTERNU)

Good day everyone - I am a California native originally from the SoCal area, but now happily living in SLOcal! I pursued an undergrad education in Neuroscience at UCLA and followed my path to becoming a physician at WesternU. During my time in medical school, I applied and was chosen to complete a Pre-Doctoral Teaching Fellowship in Osteopathic Manipulative Medicine (OMM). The additional year allowed me to take a deep dive into osteopathic care and teach the hands-on medicine I plan to offer my patients. My passion for family medicine stems from the truly holistic nature of the field, the physician's ability to stand side-by-side with a patient through the years, and ultimately develop a relationship that will last a lifetime!

Where to next: Fellowship

FAMILY MEDICINE

OBSTETRICS & GYNECOLOGY

Stephanie Zamora, DO

MEDICAL SCHOOL: WESTERN UNIVERSITY OF HEALTH SCIENCES

Hello! My name is Stephanie! I was born and raised in sunny Los Angeles, California. After spending all of my life in Southern California, I am so excited and beyond grateful to start this next chapter of my life on the Central Coast. During my time rotating at MRMC as a 4th year medical student, I was drawn by the diverse patient population, the dedication of faculty to resident teaching, and the leadership opportunities that exist in joining a new residency program. My interests include high-risk pregnancies, improving access to reproductive health services, and working for health equity. In my free time I enjoy watching sports (Go Lakers!), attending concerts, traveling, and spending time with my family.

Where to next: Pacific Central Coast Health Centers to practice as a generalist OB/GYN

DIAGNOSTIC RADIOLOGY

Arpan Desai, MD, MBA, MS

Hometown: San Jose, CA

MEDICAL SCHOOL: GEORGETOWN UNIVERSITY

Favorite thing about Cottage Health: People, campus, koi pond.

Favorite thing to do in Santa Barbara: Beach.

Fun fact: I have traveled to New Zealand.

Favorite taco in Santa Barbara: East Beach Tacos

Where to next: Fellowship in Abdominal at Stanford University

Robert Maciel, MD

Hometown: Santa Ana, CA

MEDICAL SCHOOL: UNIVERSITY OF CALIFORNIA, LOS ANGELES, GEFFEN SCHOOL OF MEDICINE

Favorite thing about Cottage Health: Steak Day

Favorite thing to do in Santa Barbara: Go to the beach.

Fun fact: I have too many kids.

Favorite taco in Santa Barbara: Lilly’s tacos

Where to next: Fellowship in MSK at RadNet

Nedeljko Uncanin, MD

Hometown: Covina, CA

MEDICAL SCHOOL: UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

Favorite thing about Cottage Health: Co-residents.

Favorite thing to do in Santa Barbara: Hiking Jesusita Trail.

Fun fact: I was a DJ in college.

Favorite taco in Santa Barbara: Norteno Taco from Corazon

Cocina

Where to next: Fellowship in MSK at Duke University

Elyor Vidal, MD

Hometown: Austin, TX

MEDICAL SCHOOL: TULANE UNIVERSITY SCHOOL OF MEDICINE

Favorite thing about Cottage Health: Great looking hospital with happy employees makes coming to work very enjoyable.

Favorite thing to do in Santa Barbara: Hanging out at the beach and hike the mountain trails.

Fun fact: I recently learned that the second, the unity of time, is so named because it is the second division of an hour.

Favorite taco in Santa Barbara: Super Rica Taqueria

Where to next: Fellowship in MSK at RadNet

Brandon

Welbourn, MD

Hometown: Scottsdale, AZ

MEDICAL SCHOOL: UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE-PHOENIX

Favorite thing about Cottage Health: Friendly, laid-back atmosphere.

Favorite thing to do in Santa Barbara: Beach volleyball.

Fun fact: Intramural ping pong champion.

Favorite taco in Santa Barbara: Sandbar

Where to next: Fellowship in Neuro at Barrow Neurological Institute

GENERAL SURGERY

William Ganske, MD

Hometown: Sumner, Iowa

MEDICAL SCHOOL: UNIVERSITY OF IOWA, WITH AN MS FROM UNIVERSITY OF CINCINNATI IN BETWEEN.

Interests (non-medical/medical): Surfing, hiking, backpacking, wine, spending time with my wife and dog.

Favorite thing about Santa Barbara: Having the beach, the mountains, wine country, and on and on- all within a 10-minute drive. Amazing and convenient!

Where to next: Fellowship in Surgical Critical Care at the Medical University of South Carolina in Charleston, SC

Hannah Kornfeld, MD

Hometown: Ross, California

MEDICAL SCHOOL: RUSH MEDICAL COLLEGE

Interests (non-medical/medical): The ocean, music, food, wine, golf, and neuroplasticity. Breast oncology and hernias.

Favorite thing about Santa Barbara: The ocean, proximity to family, access to the outdoors and a great group of colleagues. Where to next: Fellowship with City of Hope in Pasadena

Monica Straatmann, MD

Hometown: Washington, Missouri

MEDICAL SCHOOL: UNIVERSITY OF CALIFORNIA, IRVINE

Interests (non-medical/medical): Climbing, Skiing, Music, exploring the great outdoors.

Favorite thing about Santa Barbara: The natural beauty of the plant life, ocean, and mountains.

Connor Wiles, MD

Hometown: Girdwood, Alaska

MEDICAL SCHOOL: OHSU

Interests (non-medical/medical): Surgical Oncology. Skiing, cycling, climbing, surfing, golfing.

Favorite thing about Santa Barbara: There is access to almost anything you can imagine. Ocean, mountains, great food, fun people.

Where to next: Starting a job as a rural general surgeon in Bishop California

INTERNAL MEDICINE

Douglas Fedder, MD

MEDICAL SCHOOL:

AMERICAN UNIVERSITY OF THE CARIBBEAN, SINT MAARTEN

Natalie Gordon, MD

MEDICAL SCHOOL:

ROSS UNIVERSITY, DOMINICA Yana Gristan, MD

MEDICAL SCHOOL:

ROSS UNIVERSITY, DOMINICA

Mary Henary, MD

MEDICAL SCHOOL:

ROSS UNIVERSITY, DOMINICA Koorush Kabiri, DO

MEDICAL SCHOOL:

ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE, GLENDALE, AZ

Arielle Kanner, DO

MEDICAL SCHOOL:

TOURO COLLEGE OF OSTEOPATHIC MEDICINE, NEW YORK, NY

Sri Mandava, MD

MEDICAL SCHOOL:

N.R.I. MEDICAL

COLLEGE, GUNTUR, INDIA

Neelima Mohan, MD

MEDICAL SCHOOL:

SREE GOKULAM

MEDICAL COLLEGE, INDIA

Prithvi Pande, MD

MEDICAL SCHOOL:

AMERICAN UNIVERSITY OF THE CARIBBEAN, SINT MAARTEN

Lucas Pfeifer, DO

MEDICAL SCHOOL:

PACIFIC NW UNIVERSITY, YAKIMA, WA

CALIFORNIA MEDICAL ASSOCIATION

Data Exchange Explainer Webinar Series

On January 31, 2023, the California Health and Human Services Agency (CHHS) launched the California Data Exchange Framework (DxF). Over the next three years, this framework will require all physician practices in this state to exchange data with other practices, health plans, hospitals, and others. To help physicians prepare for this change, the California Medical Association (CMA) has partnered with CHHS to develop the CMA Data Exchange Explainer Series. This series of webinars will walk practices through the various considerations in implementing robust data exchange.

This webinar series is supported by a grant from CHHS and is free to all physician practices.

#1 - OVERVIEW OF DATA EXCHANGE ON DEMAND

The first webinar in the series will provide a general overview of data exchange - what it is, how it works, and what resources exist to help practices along the way. This webinar will also include an introduction to the Data Exchange Framework (DxF), including some important dates that practices will need to know.

#2 - DATA EXCHANGE POLICY & LEGAL ENVIRONMENT ON DEMAND

In our 2nd webinar we will cover the major policies and requirements of data exchange. This webinar will also include an update on the latest Data Exchange Framework (DxF) developments and important dates practices will need to know.

#3 - DEEP DIVE INTO THE DATA EXCHANGE FRAMEWORK AND DATA SHARING AGREEMENT

JUNE 15, 2023 • 12:15 – 1:15 PM

In this webinar we build on your Webinar 1 and 2 data exchange foundational knowledge and dive into the Data Exchange Framework-requirements, implementation, and technical and funding resources. This webinar will also include an update on the latest DxF developments and important dates practices will need to know.

#4 - HOW TO OPTIMIZE YOUR PRACTICE'S CURRENT EMR FOR DATA EXCHANGE

AUGUST 15, 2023 • 12:15 – 1:15 PM

In this webinar we will review an EMR data exchange inspection checklist to make sure your EMR is tuned-up and ready for a successful DxF implementation journey. This webinar will also include an update on the latest DxF developments and important dates practices will need to know.

#5 - HOW TO OPTIMIZE YOUR PRACTICE'S WORKFLOWS FOR DATA EXCHANGE

OCTOBER 12, 2023 • 12:15 – 1:15 PM

In this webinar we review best practices to ensure secure, timely, and accurate data exchange day-in and day-out. This webinar will also include an update on the latest DxF developments and important dates practices will need to know.

#6 - INCENTIVES AND OTHER FUNDING OPPORTUNITIES FOR DATA

DECEMBER 14, 2023 • 12:15 – 1:15 PM

In this webinar we provide an overview of grant funding opportunities for technical assistance and connecting to a Qualified Health Information Organization to support practices meeting their DSA Requirements.

Public Health Update Preventing Overdose on the Central Coast WHAT CLINICIANS CAN DO

BY RICK ROSEN, MD, MPH, DEPUTY HEALTH OFFICER, COUNTY OF SAN LUIS OBISPO

The reality of overdose is something that many physicians and our patients would say we know too well: the opioid epidemic has touched our community members and colleagues personally while also making its mark on the practice of medicine nationwide. San Luis Obispo County currently ranks eighth of 58 California counties with respect to ageadjusted mortality rate (27.88) due to overdose. It’s an area where the bad news can verge on overwhelming. Yet several recent updates in this area highlight steps that physicians – individually and as a group – can take to prevent overdose and protect our community.

Expanded access to naloxone and buprenorphine

In California, pharmacists can dispense naloxone without a prescription if they have completed the required training.

Naloxone nasal spray is widely available in our community, often at no cost and without an individual prescription. Community members can pick up no-cost naloxone at SLO County Behavioral Health clinics and at other local health care clinics or can have it mailed to their home directly; find a full list at www.slocounty.ca.gov/ naloxone.

In California, pharmacists can dispense naloxone without a prescription if they have completed the required training. Pharmacists at most major retail pharmacies across the state (CVS, Rite Aid, Wal-Mart, Walgreens, Vons) are trained to do so, although it is a good idea for patients to call ahead to ensure the licensed pharmacist is available and has naloxone in stock.

That said, your decision to write a prescription can send an important message about the value and validity of this tool for your patients. Co-pay costs vary by insurance when naloxone is dispensed at a pharmacy. It is fully covered (no cost to the patient) by Medi-Cal.

Recently, the U.S. Food and Drug Administration (FDA) also approved Narcan, 4 milligram (mg) naloxone hydrochloride nasal spray for over-thecounter use – the first naloxone product approved for use without a prescription. This decision means that naloxone may become available in places like convenience stores and grocery stores as well as pharmacies, vastly expanding its visibility and access. The timeline for this rollout will be determined by the

manufacturer, with reports indicating it will likely begin later this summer.

The federal government also recently took action to remove the requirement that clinicians complete additional training and obtain an “X-waiver” to prescribe buprenorphine. This decision increases access to life-saving medication and, for many patients, paves a path to long-term recovery. National professional associations and the nonprofit Public Health Institute are providing professional development courses on this expansion.

This decision means that naloxone may become available in places like convenience stores and grocery stores as well as pharmacies, vastly expanding its visibility and access.

Information to those at intentional and unintentional risk

With overdose, as with many issues, individual physicians remain among the most trusted sources of information for Americans. I encourage all of us to connect with the people we encounter in the course of our work who may benefit from information about overdose prevention. This includes not just those who regularly use prescription or illicit opioids but also those who may lack information about the increasing risk of accidental poisoning from, for example, seemingly harmless pills purchased through social media or supplied by friends or family members. Our colleagues in Marin County recently shared an excellent example of this outreach in a message to graduating seniors, highlighting both their bright potential and the risk of accidental overdose they may encounter at college or in their community.

Preparing to respond clinically to xylazine use

While fentanyl remains at the center of overdose prevention conversations, now is the time to prepare for the increasing threat of xylazine in California. Xylazine, an animal tranquilizer known colloquially as “tranq,” has become prevalent on the East Coast; local law enforcement authorities report it is now occasionally found in the Central Coast recreational drug supply, often mixed with opioids.

Xylazine works as a sedative, causing low blood pressure, slow heart rate, reduced breathing, and drowsiness. It is not an opioid and therefore is not responsive to naloxone. Xylazine can cause particularly complex, painful, and serious skin infections like skin ulcers and abscesses. Left untreated, these injuries may eventually lead to additional complications, including amputation. Repeated exposure may also result in dependence and withdrawal.

It’s a good idea to consider potential xylazine exposure if patients presenting with overdose symptoms do not respond to naloxone; when patients have severe, necrotic skin ulcerations; or when patients with withdrawal symptoms do not respond to traditional opioid use disorder treatments, as this may indicate xylazine withdrawal. Xylazine is not identified by a standard drug screening; you must specifically request that labs screen for it.

While best practices for management of xylazine overdose and injury are still emerging, the California Department of Public Health and the Philadelphia Department of Public Health (where xylazine use first took hold in the U.S.) both offer clinical guidance. See bit.ly/xylazine-advisory for a detailed advisory with links to these excellent resources.

Our Public Health Department and our colleagues in Behavioral Health are here to support you in addressing and responding to overdose: please contact us if you have specific questions or would like to share your insight on this challenge we face as a community.

Our Public Health Department and our colleagues in Behavioral Health are here to support you in addressing and responding to overdose: please contact us if you have specific questions or would like to share your insight on this challenge we face as a community.

CLASSIFIEDS

POSITIONS AVAILABLE

Whether you are a seasoned physician or just out of residency, the CALIFORNIA PHYSICIAN CAREER CENTER offers the opportunities and resources you need to advance your career. This benefit includes tips on resume writing, interviews, and networking, as well as hundreds of current job openings in California. Opportunities can be found at https://careers.cmadocs.org

CENCAL HEALTH is a community-accountable health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to more than 200,000 members in Santa Barbara and San Luis Obispo counties. Opportunities can be found at www.cencalhealth. org/workwithus

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST is a nonprofit organization operating federally qualified health centers that provide comprehensive care. Since 1978, CHC has grown to over 30 locations serving over 120,000 unique patients annually across San Luis Obispo and northern Santa Barbara counties. We are always looking for skilled, compassionate providers of all levels. Opportunities can be found at chccares.link/careers.

The COUNTY OF SAN LUIS OBISPO is committed to serving the community with pride to enhance the economic, environmental, and social quality of life in San Luis Obispo County. Opportunities can be found at www.slocounty.ca.gov

The COUNTY OF SANTA BARBARA delivers exceptional services so Santa Barbara County’s communities can enjoy a safe, healthy, and prosperous life. Opportunities can be found at www.sbcountyjobs.com.

DIGNITY HEALTH is a mission-driven, not-for-profit organization of more than 40 hospitals and care centers across California, Arizona, and Nevada. Opportunities can be found at www.dignityphysiciancareers.org.

PLANNED PARENTHOOD CALIFORNIA CENTRAL COAST is a dynamic and fulfilling place to work. Our staff is caring, knowledgeable, dedicated and we are committed to a diverse workplace and encourage you to apply. Opportunities can be found at https://jobs.lever.co/ppcentralcoast

SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 180 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Opportunities can be found at www.sansumclinic.org/ physician-provider-job-opportunities

Whether you are interested in employment, relocating your practice or joining the staff of one of our urgent care centers, TENET HEALTH most likely has an opportunity that’s right for you. Opportunities can be found at www.tenethealth.com/ for-physicians/physician-careers.

If you would like to submit a listing to our Classifieds, contact ccma@ccmahealth.org. Listings are free for members with reasonable rates for nonmembers.

MEET CENTRAL COAST

United States House of Representatives

Salud Carbajal

CONGRESSIONAL DISTRICT 24

Represents the entirety of Santa Barbara County, as well as portions of San Luis Obispo and Ventura counties.

202.225.3601

https://carbajal.house.gov

California State Senate

John Laird

SENATE DISTRICT 17

Represents the entirety of San Luis Obispo and Santa Cruz counties, as well as portions of Monterey and Santa Clara counties.

916.651.4017

http://sd17.senate.ca.gov

California State Senate

Monique Limón

SENATE DISTRICT 19

Represents the entirety of Santa Barbara County, as well as over half of Ventura County.

916.651.4019

http://sd19.senate.ca.gov

YOUR COAST LEGISLATORS

In Memoriam

WALTER L HOGAN, JR, MD

1930-2022

Walter Hogan, Jr. beloved husband, father, grandfather, and brother, passed away peacefully on November 13, 2022, at the age of 92, in Solvang, California. Walter, known as Walt to his many friends, was born February 15, 1930, in West Hartford, Connecticut to Walter L. Hogan, MD, and Marion Campbell Hogan. He grew up in West Hartford and spent summers fishing for Bass, Pike, and Walleyes at the family’s cottage on Lake Champlain in Burlington, Vermont. He cherished his childhood summers in Vermont and traveled there often in his later years.

Walter loved the view of Lake Champlain from their dining room window. He enjoyed drinking his morning coffee there, while eating maple and apple cider doughnuts with his sisters Marion Hogan and Ellen Kallfelz and brother John Hogan, and “debating” politics and current events.

He attended Canterbury School in New Milford, Connecticut and received his undergraduate degree from

Holy Cross College in Worcester, Massachusetts. He received his medical doctorate degree from the University of Vermont Medical School in Burlington, Vermont. After graduating from medical school, he completed his residency in ophthalmology at the New York Ear and Eye Infirmary.

He married Viola Britton, a nurse, in 1957 in Hartford, Connecticut. They met at St. Francis Hospital where they both worked. They had six children, Lynn Wasylina, Donna Vingo, Colleen Meynet, Michael Hogan, Patricia Hogan, and Brendan Hogan. Walter served in the Air Force as a flight surgeon for several years, and his kids were born in many different states because of their military moves.

He started an ophthalmology practice in Santa Barbara California in the 1970’s and devoted himself to his many patients, whom he treated as extended family. He showed his compassion by caring for many who could not afford medical care, both in the United States and other countries. He pioneered the use of lasers in eye surgery.

He was a founding member of SEE, International and led many of their surgical eye expeditions in other countries, including China, Mexico & Latin America where he trained local doctors to perform innovative cataract eye surgery. China later named the eye wing of a hospital in Dalian after Walter.

Walter had a wicked sense of humor and loved telling hilarious stories. His stories became funnier every year, and no one laughed harder at his stories than he did. Tall tales were his specialty! He will be deeply missed by so many.

Adapted from the Santa Barbara Independent

4 New & Rejoining

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

George Chen-Hsi Cheng, MD, PhD

Radiation Oncology

Santa Barbara

805.879.0650

Ridley-Tree Cancer Center

Melissa Drake, MD

Obstetrics and Gynecology

Santa Barbara 877.832.5440

Laura Traube, MD, MPH

Pueblo Radiology Medical Group

Santa Barbara

805.682.7744

Pueblo Radiology Medical Group

RETIRED

Steven Colin Barkley, MD

Neonatal-Perinatal Medicine

Santa Barbara

Edward Bentley, MD

Gastroenterology

Santa Barbara

Garrett Edwin Foulke, MD

Internal Medicine

Arroyo Grande

Jeffrey Charles Fried, MD

Critical Care Medicine

Santa Barbara

Don Harold Gaede, MD

Vascular Medicine

San Luis Obispo

RESIDENTS

Maya Sampath, MD

Obstetrics and Gynecology

Marian Regional Medical Center

William H Gausman, Jr., MD

Family Medicine

Lompoc

Kenneth Dale Krone, MD

Radiology

Santa Barbara

CHANGE SERVICE REQUESTED

MARK YOUR CALENDAR

ANNUAL MEMBERSHIP CELEBRATION

The Central Coast Medical Association warmly welcomes physicians and their guests to our Annual Membership Celebration in Santa Barbara and San Luis Obispo, where we will honor our 2023 Physicians of the Year. Join us in celebrating medical excellence with your peers.