Central Coast Physicians Summer 2020

SUMMER 2020

Protecting Physician Practices Yes, I am a Doctor Breaking Barriers Men, Women, and COVID-19

Summer 2020

CENTRAL COAST PHYSICIANS

1

Dr. Marc Zerey, General Surgeon, Chief of Staff, Santa Barbara Cottage Hospital

Open and ready to provide safe care.

We are prepared to protect your health. If you need medical care, don’t delay.

Your health is essential. Seek help if you need it.

cottagehealth.org 2 CENTRAL COAST PHYSICIANS

Summer 2020

VOLUME 5, NUMBER 2 • SUMMER 2020

{FEATURES}

8 10 18 24 40 43 Summer 2020

{DEPARTMENTS} YES, I AM A DOCTOR BREAKING BARRIERS WESTPAC WEALTH PARTNERS COVID-19: PROTECTING PHYSICIAN PRACTICES

6 PRESIDENT’S MESSAGE 20 RISK TIP 22 MEN’S HEALTH 34 CENCAL HEALTH NEWS 38 CLASSIFIEDS 42 2020 CCMS EVENTS 44 NEW MEMBERS

EVERY BREATH YOU TAKE

46 IN MEMORIAM

PPE DISTRIBUTION EVENTS

CENTRAL COAST PHYSICIANS

3

Letter from the CEO

COVID-19 RELIEF RESOURCES PRESIDENT Kevin Casey, MD

These past months have been challenging for everyone, especially physicians. Due to the pandemic, the California Medical Association and Central Coast Medical Association decided to make all of our COVID-19 resources available for free to members and non-members.

We provided PPE resources thanks to a donation

by Direct Relief along with additional supplies provided by the State of California. We have educational resources including telehealth, financial, and employer toolkits along with reopening guidelines and best practices. California physicians, nurses, physician assistants, nurse practitioners, and respiratory therapists who are providing emergency or intensive services to acutely ill COVID-19 patients can receive coaching sessions from trained peer wellness coaches at no cost for up to 30 days. We continue to hold socials virtually so physicians can continue to connect with their colleagues.

DANA GOBA

PRESIDENT ELECT Priti Gagneja, MD TREASURER Samira Kayumi-Rashti, MD SECRETARY Julie Fallon, MD IMMEDIATE PAST PRESIDENT Jennifer Hone, MD DIRECTORS Eric Amador, MD; Daniel Berger, MD; Jeffrey Gauvin, MD; Thomas Hale, MD; Bindu Kamal, MD; Rachel May, MD; Rahim Raoufi, MD; Joseph Schwartz, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sharon Basham, MD; Edward Bentley, MD; Kevin Casey, MD; David Dodson, 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 Kevin Casey, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design

We have devoted marketing resources to let patients know it is safe to visit their doctor’s office and emergency room. We continue focusing resources on advocacy efforts. We have been able to protect access to care in the state budget, and we continue working with government agencies on regulations. We have also strongly supported our local Public Health Officers with a letter to the Board of Supervisors in addition to op eds in local newspapers.

CONTRIBUTING WRITERS California Medical Association; Kevin Casey, MD; CenCal Health; Adri Davies; David Dodson, MD; Jenni Nix, MD; Robert Reid, MD; Tenet Health Central Coast; Nick Welsh; WestPac Wealth Partners; and Todd Zeiter CONTRIBUTING PHOTOGRAPHERS CenCal Health, Daniel Dreifuss, Tenet Health Central Coast, UCSB Library, and WestPac Wealth Partners SUGGESTIONS, story ideas, or completed stories written by

Imagine what we could accomplish if every physician was a member. If you are not a member, we hope our efforts have inspired you to join your colleagues. You can become a member at www.cmadocs.org/join or by calling 800.786.4262.

Together we are stronger.

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

Sincerely,

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

Dana Goba Chief Executive Officer Central Coast Medical Association

products or services advertised. CCMA reserves the right to reject any advertising. All advertising inquiries can be sent to magazine@ccmahealth.org.

A COMPONENT OF THE

4

CENTRAL COAST PHYSICIANS

Summer 2020

WHEN IS THE LAST TIME YOU...

Saved in taxes without having to spend more?

We know that as taxes increase many physicians are looking for a solution that...

• Reduces their tax liability • Is paid for by their practice • Increases their retirement savings OUR SOLUTION:

The Macro Pension for Medical Professionals 1

2

3

PROFIT

PROTECTION

PROSPERITY

Your practice makes profit

Profits are put into tax deferred buckets that are dollar for dollar deductions for the corporation

Your assets continue to grow while the money in the buckets remains protected

THE RESULT:

Your taxes drop up to 120% the first year, and 50% - 70% thereafter

Contact us for more information

J O N AT H A N BARRERA, CFF

512.423.3250 j_barrera@thewp2.com www.jonathanmbarrera.com

R AQ U E L NARANJO, JD

805.448.0640 r_naranjo@thewp2.com www.raquelnaranjo.com

Registered Representatives of Park Avenue Securities LLC (PAS). OSJ: 4275 Executive Square #800 La Jolla, CA 92037 619.684.6400. Securities products offered through PAS, member FINRA, SIPC. Financial Representative of The Guardian Life Insurance Company of America® (Guardian), New York, NY. PAS is an indirect wholly owned subsidiary of Guardian. WestPac Wealth Partners, LLC is not an affiliate or subsidiary of PAS or Guardian. Insurance products offered through WestPac Wealth Partners and Insurance Services, a DBA of WestPac Wealth Partners, LLC. | CA Insurance License # | 0H73984 PAS is a member of FINRA, SIPC not does provide legal or tax advice.

Summer| Guardian 2020 CENTRAL COAST PHYSICIANS

5

CATALYST FOR CHANGE This is not how this year was supposed to go. 2020 was going to be spent with heated debates about the upcoming presidential election. The CMA was gearing up for a fight about MICRA which was undoubtedly going to take up a significant amount of time and resources.

Of course, then COVID happened. As a medical community, physicians and health care providers in Central Coast communities have stepped up and shown great leadership. Our public health officers continue to work tirelessly to inform and protect our communities. Local hospitals have had to make major changes in order to prepare for what still may be an overwhelming surge of coronavirus cases. And, I have yet to talk to a physician who hasn’t had to make overwhelming sacrifices in his or her practice over the past four months.

But is it enough? The death of George Floyd and the events that followed have opened the eyes of the world to institutional racism in our nation. The impact of COVID on communities of color is only one sequela of 200+ years of institutionalized racism in the United States. The health disparities across both

6

CENTRAL COAST PHYSICIANS

Summer 2020

The spark that George Floyd’s death has created must be a catalyst for change in medicine and beyond. racial and economic lines, frequently overlapping, cannot be overstated and are likely to only grow worse. If we do not acknowledge and aggressively work toward fighting racism in all its forms, then we only exacerbate the current discriminatory behaviors that are so blatant in our health care system. A recently published New England Journal of Medicine article documents the prevalence of and the impact of racism in medicine. The authors state that “physiciancitizens must recognize the harm inflicted by discrimination and racism and consider this environmental agent as a vital sign… that provides important information about a patient’s condition.1”

community we step up in this time. Leadership doesn’t have to be grandiose. It doesn’t have to be loud. It starts at home, at work, and in our social circles. Awareness and acknowledgement lead to action. The spark that George Floyd’s death has created must be a catalyst for change in medicine and beyond.

It is easy to get lost in the complex reality that racism continues to plague Black Americans—and even more so, to accept the fact that medicine is guilty of propagating it.

However, I argue that we have an opportunity ahead to lead, not be led. As physicians, our patients and communities look to us for guidance. It is incumbent that as a medical

Kevin Casey, MD President Central Coast Medical Association

Summer 2020

Respectfully,

Evans MK, Rosenbaum L, Malina D, Morrissey S, et al.

Diagnosing and treating systemic racism. NEJM 6/10/2020; pub online nejm.org 1

CENTRAL COAST PHYSICIANS

7

YES

I AM A DOCTOR

BY JENNI NIX , MD

The year is 2020. I just completed the general surgery program at Santa Barbara Cottage Hospital.

I am 32 years old, graduated from Tulane University School of Medicine with a combined MD, MPH&TM, a member of AOA, and I happen to be a woman. The following comments have all been said to me at some point (many with regularity) in the past 5 years – either by patients, fellow residents, or staff. >>

8

CENTRAL COAST PHYSICIANS

Summer 2020

Suggested Readings DiBrito, S.R., Lopez, C.M., Jones, C., and Mathur, A. Reducing implicit bias: Association of Women Surgeons #HeForShe Task Force Best Practice Recommendations. J Am Coll Surg. 2019; 228: 303–309. (Available at:) (Accessed March 13, 2020) www.journalacs.org/article/S10727515(18)32236-1/fulltext Greenberg, C. Association for Academic Surgery Presidential Address: Sticky Floors and Glass Ceilings. (ix–xviii) J Surg Res. 2017; 21.

(Available at:) (Accessed March 13, 2020) www. journalofsurgicalresearch.com/article/S00224804(17)30608-X/fulltext Borrero‐Mejias, C., Starling, A.J., Burch, R., Loder, E. and (2019), Eleven Things Not to Say to Your Female Colleagues. Headache: The Journal of Head and Face Pain, 59: 1846-1854.

(Available at:) (Accessed March 13, 2020) https://headachejournal.onlinelibrary.wiley.com/ doi/10.1111/head.13647 For an extensive list of readings regarding inequality in health systems: (Available at:) (Accessed July 3, 2020) http://sociology.emory.edu/home/documents/ graduate/health-inequality-prelim-reading-list.pdf

Summer 2020

Implicit bias is defined as the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner1. Everyone carries with them experiences and attitudes that shape their interactions with the world and inform or are reinforced by their perceptions of individuals. These are referred to as “implicit biases” because we do not recognize them in ourselves. However, these biases, despite our external declarations and best efforts, frequently result in misunderstanding, miscommunication, discrimination, and a failure to build healthy relationships. Implicit bias may involve gender, sexual orientation, sexual identity, ethnicity, language, age, physical appearance, or many other facets of individuality.

While many of the above statements may seem trivial at face value, over time, with the same message repeated, you begin to question your sense of self, purpose, and belonging. Humans are social beings and a sense of belonging is crucial to our wellness and success. Imposter syndrome – feeling you don’t belong or aren’t good enough, despite objective evidence of success in exams or practical skills – is real and devastating, particularly in the field of surgery. Success in surgery requires clinical acumen, excellent judgment, technical ability, and confidence in the face of adverse outcomes or challenging patient presentations. To have your place in a profession repeatedly questioned is “Are you my nurse?” draining. The first time “I’m waiting to speak with the doctor.” a person assumes you “You look too young to be a doctor.” are not a doctor it is an “You’re not bubbly enough.” annoyance. The 50th “You should be more positive.” makes you angry. I am a “You should smile more.” surgeon, MD behind my “Surgeons don’t wear red lipstick.” name, 4 years of medical “Surgeons don’t wear pearls.”

“You are too timid.” school, 5 years of residency, “You are too authoritative.” and I am tired of justifying “You should apologize for speaking your mind.” my existence in the “ How do you achieve a work-life balance with a family and being a profession. surgery resident?”

Thankfully, Santa “Who is taking care of your child while you are gone?”

Barbara Cottage “Don’t you want your husband to work?”

Hospital and the surgical “ Don’t you want more children? You aren’t getting any younger.” residency are filled with amazing residents, attending physicians, nurses, and staff. This community is blessed with a diverse group of people who support, value, and respect resident contributions and recognize our commitment to patient care – regardless of our ethnicity, gender, sexual orientation, marital status, size of our family, or age. Over the past 5 years, I have received tremendous encouragement, mentorship, and sponsorship that has helped me build upon my successes and learn from my failures. In residency, I have found true allies.

Being an ally is more than saying “I support you.” Being an ally is actively elevating your under-represented colleagues by amplifying their voices, giving them credit for their accomplishments and ideas, recognizing and speaking out against micro- and macroaggressions, acting as mentors and sponsors, nominating your qualified colleagues for speaking engagements, leadership positions, and committees that advance their career goals. Allies recognize the importance of their colleagues’ time and the need to engage in meaningful activities. We need those in positions of power to recognize our value, our contributions, and our place in this profession - for the good of all those affected by implicit bias and the good of our patients.

1 Kirwan Institute for the Study of Race and Ethnicity. Understanding Implicit Bias. (Accessed March 12, 2020) Retrieved from http://kirwaninstitute.osu.edu/research/understanding-implicitbias/

CENTRAL COAST PHYSICIANS

9

G N I K A E BR

S R E I R R A B Before Horace McMillan, Santa Barbara had never had a black doctor. Even now, nearly 20 years after his death, Santa Barbara has never had a doctor — black or white — remotely like Horace McMillan.

10

CENTRAL COAST PHYSICIANS

Summer 2020

Horace McMillan

Remembering Horace McMillan, the Doctor Who Took on Big Banks and Real Estate Lobby Over Civil Rights

BY NICK WELSH AND ADRI DAVIES Reprinted with permission from the Santa Barbara Independent Horace McMillan was properly mystified. He’d just moved to Santa Barbara with his young wife and baby daughter, and they were looking to buy a house. In his early thirties, McMillan was educated and easygoing. He’d served nearly five years in the military. He was a doctor with all the privileges needed to practice in the local hospitals. Yet his agent was showing him nothing but dreck. “This is strange,” McMillan would recall. “All the beautiful homes up for sale and he’s showing me all these dumps.”

McMillan asked the agent, “This is all you have?” The agent’s answer? “This is all we have.” >>

Summer 2020

CENTRAL COAST PHYSICIANS

11

As it turns out, he was lying.

The year was 1953, two years before the bus boycotts of Birmingham, Alabama, helped trigger what would become the Civil Rights movement. And Horace McMillan was a black man.

For black people in Santa Barbara, buying or renting property anywhere outside of a few designated neighborhoods on the city’s lower Eastside was all but impossible. In some places ​— ​l ike Hope Ranch ​— ​deed restrictions specifically barred the sale of property to persons of “African, Japanese, Chinese, or Mongolian descent.” But in most places, such deed restrictions weren’t necessary. Everyone understood; it just wasn’t done. And at that time, that understanding was 100 percent legal.

Eventually, Horace McMillan and his wife, Jessie, would come to buy a house on the Mesa. The woman who sold it happened to be a white member of the National Association for the Advancement of Colored People (NA ACP). Two years later, the McMillans would need new digs. They were shown an exceptionally sweet property in Mission Canyon.

The owner was in a hurry to sell and the price was right. But the owner refused to sell to black people. To get around this, the real estate agent and the McMillans availed themselves to the services of a white “nominee.” That’s someone who would buy properties on behalf of black purchasers who would otherwise be iced out of Santa Barbara’s real estate market. Many “nominees” charged $100 for their help. In the McMillans’ case, there was no fee.

Before Horace McMillan, Santa Barbara had never had a black doctor. Even now, nearly 20 years after his death, Santa Barbara has never had a doctor ​— ​black or white ​— ​ remotely like Horace McMillan. That his name is not better known throughout the South Coast is further evidence that history is far too interesting to be entrusted to the care of historians ​— ​let alone white historians.

Dr. McMillan did not just get mad. He organized.

He lobbied. He agitated. And he moved the needle. For more than 15 years, he assembled a mountain of research documenting how much housing and job discrimination took place in Santa Barbara. As chairman of the NA ACP’s Housing and Labor Committee, McMillan sought to shatter Santa Barbara’s comfortable illusions that discrimination was a problem exclusive to the American South. He took his case to City Hall. He took it to the press. He took it to the churches. He took it to the medical establishment. He took it to the chief of police, and he took it to the most powerful

12

CENTRAL COAST PHYSICIANS

Isaac Garrett “America can declare war on medical diseases, then why not a similar declaration against such social illnesses as deprivation and racism?”

HORACE MCMILLAN

Summer 2020

man in Santa Barbara, News-Press owner and publisher restrictions imposed by Santa Barbara’s exploding Thomas Storke ​— ​a nd eventually he got all their attention. population of medical specialists hoping to protect their But mostly, McMillan took it straight into the teeth of turf. In response, McMillan formed a partnership with Santa Barbara’s then-powerful real estate lobby, relentlessly seven other doctors ​— ​a ll general practitioners ​— ​to start shaming them with facts and figures documenting the a new hospital in Goleta. By 1968, Goleta Valley Hospital extent of discriminatory practices. “They really hated my would open its doors to patients. McMillan would later guts,” McMillan would later say. The feeling was mutual. attempt to start an HMO in 1970. Economically, he was McMillan would call Santa Barbara’s real estate industry about 15 years ahead of his time, and that effort never got at that time “one of the most vicious in the United States,” off the ground. But he had already made a lasting mark. adding, “In the South, at least you knew where you stood.”

McMillan also focused in on income inequality.

In the Heart of Texas In the middle of the 1960s, at a time when one-third One of three kids, McMillan was born in Waco, Texas, of family households brought home $10,000 a year or in 1919, just a few months after bloody race riots erupted more, one-eighth took home less than $3,000. That those in numerous cities throughout the United States, leaving households happened to be located in Santa Barbara’s black hundreds of black people dead and thousands maimed. The neighborhoods, he noted, was hardly coincidental. He family would move to Dallas, where McMillan’s father sold and the NA ACP targeted Bank of America, charging the insurance. His mother died when he was 7. financial giant had never hired a single black person. When McMillan was done, federal regulators were breathing down the necks of Santa Barbara bank managers. Stories started showing up in the News-Press.

Eventually, the Bank of America started hiring black people reportedly.

Along the way, McMillan ​ — ​w ho spent about 72 hours a week tending to his patients ​ — ​a lso changed the culture of Santa Barbara’s medical establishment. Not only was he the first black doctor in town, but he eventually created the most ethnically diverse Isaac Garrett medical practice, boasting one Japanese, one Latino, one black ​ — ​h imself ​— ​a nd one white Isaac Garrett’s been selling real estate in Santa Barbara for 46 years. doctor. As such, they were the He experienced precisely the sort of housing and job discrimination Horace McMillan talked about. McMillan, it turns out, was also medical equivalent of the Mod Garrett’s physician. As a doctor, Garrett said McMillan was thorough Squad. Together, they would and thoughtful. An activist, Garrett worked with McMillan in the build a medical office building NAACP. McMillan, he said, was deliberate in what he said and how he that still stands at the corner of said it. “It took a lot for him to get angry, but when he did, he’d let you know.” Garrett said he was initially concerned whether McMillan was Chapala and Arrellaga. “a family man and a community man” as well as just “a business man.”

As a general practitioner, Garrett would conclude he was all three.

McMillan chafed at the

Summer 2020

CENTRAL COAST PHYSICIANS

13

McMillan would later describe what a Jim Crow childhood looked and felt like. Although his father was college educated and owned his own home, McMillan noted, he could not vote. Instead, he lived “in constant fear of sadistic whites.” As a kid, McMillan grew up riding segregated public transportation in a neighborhood with no library and no playground. The movie theater was segregated with black people restricted to the fifth f loor.

They could go to the zoo only on special days and to the state fair only one day a year.

He wrote all this in an August 1967 letter to Santa Barbara’s police chief at the time, Jack Hawe. The ostensible topic was whether race riots might erupt during Santa Barbara’s annual Fiesta celebration. By then, the nonviolent civil disobedience espoused by Civil Rights leader Dr.

where he would earn the distinction of becoming the first black Pharmacist’s Mate in Coast Guard history. After a few months in Brooklyn, McMillan was dispatched to St. Louis with his young family, where they lived for five years. Baseball diamonds, he would tell reporters later, were segregated when they got there; they weren’t when the family left. Jessie engaged in a lunch counter sit-in as early as 1944 ​— ​about 20 years before such tactics became the staple of the Civil Rights movement. Worried for her safety, he urged her not to go. She ignored his advice.

After getting out of the Coast Guard, McMillan used the GI Bill to enroll at medical school in Tennessee, one with which his uncle ​— ​a doctor who owned a small sanitarium in Texas ​— ​w as affiliated. Upon graduation, McMillan conducted his residency with a hospital in Sacramento. After completing that, the family explored settling down in a “This style of exploitation smells to the number of Southern California towns.

Having been misinformed that Santa heavens. The lowest economic group is Barbara had 4,000 black people ​— ​t he forced to pay the most. The hospital has been real number was closer to 1,800 ​— ​t he prejudiced so long. A Negro would not dare McMillans decided to check out the central coast. The Medical Society apply for a job unless he is a newcomer to the was less than inviting. He was told community.” he’d “meet with greater success” if he HORACE MCMILLAN moved to Pasadena, where allegedly there were more black patients. “They didn’t want me here; that’s all it was,” Martin Luther King Jr. was increasingly being challenged McMillan recalled as part of an oral history taken in 1989. by more militant younger protestors whom McMillan Undaunted, the McMillans moved to Santa Barbara in dubbed “Patrick Carmichaels,” a mix on the names of 1952 anyway. The same Medical Society that urged him Patrick Henry and Black Power leader Stokely Carmichael. to settle elsewhere gave him a warm welcome. McMillan In the letter, McMillan playfully warned, “I have often said opened an office on the 600 block of Milpas, strategically ‘the young negro of America (the land of plenty) is the close to Santa Barbara’s black population. A year later, he most dangerous non-feathered mammalian bi-ped on this moved to bigger digs on the 700 block. earth.’”

Business was good. McMillan saw a mix of patients: black, Latino, and white. Many were poor. He took his time with patients, explaining things thoroughly. He had Becoming Dr. McMillan presence. One girl with a peanut stuck in her throat ​— ​ That letter was written 25 years after McMillan first now a 70-year-old woman ​— ​recalled being struck at the moved to Santa Barbara with his wife, Jessie, and daughter, immediacy with which the peanut dislodged itself after he Yvonne. Jessie and Horace first met at a mutual friend’s asked, “What seems to be the problem?” He had that effect house in Dallas. He was in college, and she was in high on people in his care. If patients needed special treatment, school. He was smart, good-looking, and ambitious; she McMillan bird-dogged the specialists. According to was smart, beautiful, and formidable. World War II was one press account, he saw as many as 30 patients a day, a raging, and young couples tended to be in a hurry. Horace number that borders on the impossible ​— ​e ven with today’s and Jessie were among them. He joined the Coast Guard,

14

CENTRAL COAST PHYSICIANS

Summer 2020

HMO requirements. ran tests to substantiate their findings, sending in white From the start, there were issues. At St. Francis Hospital, would-be renters to apartments after black prospective McMillan was given a statue of a black saint and told to tenants had been informed they’d just been rented. keep it on his desk at all times. When he sought to admit In 1963, the state legislature passed what was called patients there, he chafed at being asked what their race the Rumford Fair Housing Act, meaning Realtors could was. Black patients, he would discover, were segregated no longer legally refuse to sell based on race. In retaliation, in private rooms. White patients, by contrast, would the real estate lobby teamed up with the John Birch Society share rooms and wards. In his oral history, McMillan to qualify a statewide ballot initiative ​— ​P rop. 14 ​— ​t hat recounted he didn’t want to start “any form of resentment would repeal the Rumford Act. California was engulfed or resistance,” but he bristled nonetheless. He questioned in the controversy. It didn’t pass Santa Barbara by. Things the policy, pointing out to one administrator, “You let got hot. When Episcopal minister Clyde Everton (tinyurl people who are not citizens in this hospital. You put them .com/clydeeverton) announced he would not list his home anywhere. You let Germans who we just got through for sale with any real estate agent who supported Prop. 14, fighting, and you let Mexicans who are not citizens, and yet the industry f looded Everton with angry phone calls from you deny blacks.” people demanding why he insisted on selling “to negroes Although the only.” When policy eventually one real estate “Nobody believed me. And when a changed, he agent, Eric Lyons, remained wary announced he newspaper editor who has lived here all his of St. Francis. supported the life didn’t know what was going on in his When one of Rumford Act community, who thinks it’s a fair city, you his staff nurses, and opposed a black woman, Prop. 14, he was have a hard time.” was forced to kicked off the HORACE MCMILLAN pay the premium board of Realtors. rate for a private Lyons sued for room when giving $100,000 and was birth, he exploded in a letter written in 1969, “This style of eventually readmitted. McMillan engaged in a running exploitation smells to the heavens. The lowest economic war of words with real estate hotshots who insisted on group is forced to pay the most.” In addition, he blistered the primacy of property rights. Prejudice, others argued, St. Francis for its discriminatory hiring practices. “The could not be solved by passing a new law. McMillan, ever hospital has been prejudiced so long. A Negro would outspoken, dismissed such arguments as “a Pandora’s box of not dare apply for a job unless he is a newcomer to the lies, half-truths, and ill-disguised racism.” In 1963, a young community.” black woman named Julie Ann Steven sued a landlord for refusing to rent to her based on her race. She won $250.

Henry Robertson, an active crusader for fair housing, stated Finding Home he was denied a chance to rent many apartments because Mostly, however, McMillan focused on issues of fair of the color of his skin, even though he offered to put up a housing. Often, black people didn’t realize they were being $50,000 cash bond. denied housing based on their race, he stated, because McMillan tried to alert News-Press publisher Thomas landlords and Realtors rarely said as much. Typically, they Storke to the problem but said he got nowhere. “Nobody were told the property in question had already been sold. believed me. And when a newspaper editor who has lived But McMillan used the students of one of his patients ​— ​a here all his life didn’t know what was going on in his UCSB sociology professor ​— ​to conduct endless surveys community, who thinks it’s a fair city, you have a hard designed to plumb the extent of housing discrimination. In time.”

1963, only 30 percent of those polled stated they’d rent or Prop. 14 passed at the polls with Santa Barbara voters sell to black people; the rest said they would not. They also

Summer 2020

CENTRAL COAST PHYSICIANS

15

Managing your practice is no easy feat.

You need to attract new patients, market your services, manage your online reputation, and still run your practice efficiently. There isn’t enough time in the day!

Let our two companies do the heavy lifting for you when you sign up for PatientPop for CMA members and receive

$1,000 off your implementation fee plus additional discounts off your monthly rate.

Attract more patients

Modernize the patient experience

Automate your office

Online review management

Easy, convenient online scheduling

Appointment confirmation and reminders

Web presence and search optimization

Appointment reminders

Integrate PatientPop with your scheduling system

Premium website

Patient satisfaction surveys

Performance dashboard

For more information call 844-487-8399 or email cma@patientpop.com and mention the CMA partnership 16

CENTRAL COAST PHYSICIANS

Summer 2020 PATIENTPOP.COM

weighing in overwhelmingly in favor of it. Ultimately, however, the California Supreme Court ruled the initiative unconstitutional in 1966, thus opening the f loodgates to $22 million in federal housing funds.

Getting a Job

By then, McMillan shifted his focus to employment discrimination and issues of economic inequality. That was easier to prove. McMillan was part of an effort to f lood the Bank of America with 15-20 overly qualified black candidates for bank teller positions. All were told the position had been filled. Then, McMillan had a white woman from Canada ​— ​t he mother of one of the young women who had just been denied ​— ​c all the bank, inquiring about the job, and she was told it was available.

Once exposed, bank officials got really mad, McMillan recounted, complaining they’d been trapped. When McMillan sent his information to federal bank regulators, they showed up in town to talk to him, Storke, and the bank administrators.

McMillan also blew the whistle on the Metropolitan Transit District after it received a large infusion of federal funds. Not one black person worked for the transit agency at that time, he said. “Now it’s just full of them.”

For all the bills passed by Congress and all the rulings issued by various courts, racism, he argued, was still alive and well in Santa Barbara. McMillan described how he and his wife had made reservations at Somerset, an upscale Montecito restaurant. When they showed up, the hostess said she had no such reservations; if the McMillans sat at the bar, she suggested, perhaps something would open up.

McMillan quickly called friends, a white couple named Robert and Marjorie Frost. When the Frosts showed up 15 minutes later, the restaurant staff raised no issue about reservations. The McMillans sued, and the case settled for $1,000.

McMillan served on numerous city commissions designed to promote health, housing, and human rights.

He found himself crossing swords with then-Mayor Don MacGillivray over proposals to create a new city watchdog agency to combat housing discrimination. MacGillivray always had arguments why such plans couldn’t work or went too far.

Shortly after Martin Luther King Jr. was assassinated in 1968, McMillan delivered a 15-page blueprint for what the City Council needed to do to avoid a possible racial

Summer 2020

conf lagration. He called for the construction of a $10 million one-stop-shop social service center ​— ​a hospital of sorts to help victims of discrimination heal. In it, he included dramatic statistics highlighting the great divide between the “richest of the rich” and the “poorest of the poor.” If Cottage Hospital could spend $8 million on new hospital construction, he argued, then certainly the community could find $10 million for such a center. After the Watts riots, he noted, City Hall expanded the number of police officers by 23. The salary of just three officers could go a long way in providing the sort of services such a facility could provide. “If America can declare war on medical diseases, then why not a similar declaration against such social illnesses as deprivation and racism?” he asked.

Ultimately, the council balked at McMillan’s grand plans. It was too expensive. Others recoiled when it was suggested that some of the funds City Hall set aside for lawn bowling might prime the fundraising pump for this enterprise. Although McMillan’s proposal would never be built, it provided the impetus for what would ultimately emerge as the Franklin Community Center located on the Eastside. For McMillan, the gap between his dream and the Franklin Center’s reality was too great. “If no progress is made in this direction, I for one have no hope,” he had warned, “and I will retire from public life.”

McMillan didn’t quite make good on that threat.

Instead, he threw his energies into building the new Goleta hospital, a massive undertaking. He continued to sit on numerous boards and commissions dedicated to public health and affordable housing until he had a serious heart attack in 1978 and finally retired 10 years later.

In 2001, at age 81, Horace McMillan ​— ​t he Coast Guard’s first black Pharmacist’s Mate, the first black doctor in Santa Barbara, and the first black doctor to start a new hospital in Santa Barbara ​— ​w as done in by a fatal stroke. The only record of McMillan’s remarkable life is a photograph on the hallway wall just off Goleta Valley Hospital’s emergency room. He’s one of the hospital’s eight original doctors posing with their shovels during the groundbreaking ceremonies.

Our thanks to the librarians at UC Santa Barbara for access to the Horace James McMillan Papers, CEMA 7, Special Research Collections, UCSB Library; and the Santa Barbara AfroAmerican oral history project collection, CEMA 42, Special Research Collections, UCSB Library.

CENTRAL COAST PHYSICIANS

17

WESTPAC WEALTH & WEALTH STRATEGY P A R T N E R S PROTECT • INVEST • ACHIEVE

CCMA’ S BUSIN E SS PARTN E R WESTPAC WE ALTH PARTNERS WHO WE AR E WestPac Wealth Partners is a local, privately held wealth management firm specializing in tax strategies and solutions for private practices. We have over 18 years of combined experience in tax and financial planning with qualified plans for working professionals. We are known for our expertise in tax reduction strategies for individuals and practice owners. We identify ways to keep your hard-earned money where it belongs while helping to improve financial picture. We are partners to our community and will be with you every step of the way. Our goal is your financial wellness.

18

CENTRAL COAST PHYSICIANS

Summer 2020

WHAT WE DO We provide solutions, not products. Our customized plans are tailored to your situation regardless of where you are in your career. Our planning helps create an incentive-based retirement plan while keeping the lion’s share of the profit in your pocket. The plans we have created for our clients have saved them 100% in taxes the first year alone, plus another 20 percent from 199A (Qualified Business Income Deduction).

Take immediate action to utilize the QBI deduction, which sunsets in 2025. On average, our clients have about 120 percent reduction in taxes the first year and moving forward 50-70 percent every year when following the plan correctly.

Our clients also benefit by creating executive benefits, such as paying off their medical expenses with tax-free dollars.

Please note, we specialize in more than tax planning. We focus on areas such as debt management, personal/investment planning, estate planning, risk management, and exit planning.

OU R PARTN E R S

I S YOU R PORTFOLIO PE R FOR M I N G TO YOU R E XPEC TATION S Don’t panic. We can perform a no cost financial analysis of your current financial planning. We will educate you on any erosion and/or lack of performance, the emotion of investing, timing and the importance of minimizing unnecessary fees and costs, all while analyzing your risk tolerance and investment objectives. The education we provide will also help highlight ways to reduce taxes. Finally, we bring it all together to provide an effective, concise, and transparent solution.

F I NAL THOUG HTS In these times of uncertainty, protecting your financial future is of utmost importance. Understanding and planning for risk is critical. You deserve an advisor who understands how to navigate the complexity of our current environment, including the SECURE, CARES (PPP and EIDL), and HEROES ACTs (currently passed by the house and waiting on senate), and how they affect your practice. We are here to help.

We are proud partners of the Central Coast Medical Association, the Los Angeles County Medical Association, and the Riverside County Medical Association. We also work closely with other associations throughout the central coast. As financial wellness advisors, we are excited to be working with such incredible organizations.

HOW WI LL TH I S B E N E F IT YOU Our clients receive significant reductions in tax liability, a dollar for dollar deduction funded by their businesses, and increased retirement savings. Our clients benefit from a flexible retirement plan within their control and reducing their fees. Whether you are at the beginning of your career or exiting your practice, we customize a plan to reach your goals.

Most importantly, you will have peace of mind knowing your retirement is secure.

Raquel N aranjo, J D FI NAN CIAL P RO FE SS IO NAL WE STPAC WE ALTH PARTN ERS 1114 STATE ST, STE 245 , SANTA BAR BAR A O 8 05 . 8 8 3 . 39 4 4

DO YOU ALR E ADY HAVE A TE AM

C 8 05 . 4 4 8 .0 6 4 0

No problem. We work with you and your team, including your CPA, tax attorney, broker, etc. to find a perfect solution for your retirement goals and help you stay on top of the latest tax laws.

We work closely with experts in all fields, should you need any recommendations to improve your team.

ra q u e l . n a ra n j o @we s t p a c we a l t h . co m

Summer 2020

w w w. l i n ke d i n . co m / i n /ra q u e l n a ra n j o

W W W. R AQ U ELNAR AN J O.CO M

CENTRAL COAST PHYSICIANS

19

RISK TIP

TOP 7 INSURANCE AND LEGAL QUESTIONS

FOR RESUMING MEDICAL PRACTICE DURING COVID-19

BY TODD ZEITER, VICE PRESIDENT OF UNDERWRITING, THE DOCTORS COMPANY

As a company founded and led by physicians, we have unique insight into medical liability and the factors that lead to lawsuits against doctors.

And in these unprecedented times, we are committed to providing information and support so you can focus on practicing medicine.

We’ve heard from physicians that they are concerned about the risks involved in reopening their practices, resuming elective procedures, or otherwise resuming something closer to their usual patient interactions. In response to these concerns, we’re providing answers to common insurance coverage questions to help physicians anticipate issues before they become problems.

First and foremost, we urge physicians to check daily for updates from the Centers for Disease Control and Prevention (CDC), local medical societies, and local health departments. We also urge physicians to have a plan for how to communicate changes to staff and to document that they are doing so—if only by jotting quick notes in an electronic calendar.

The following are answers to the top questions from our members and doctors across the country:

20

CENTRAL COAST PHYSICIANS

Summer 2020

Q: AM I COVERED FOR EMPLOYEE CLAIMS INVOLVING COVID-19?

Q: AM I COVERED IF I PROVIDE SERVICES OUTSIDE THE SCOPE OF MY SPECIALTY?

A: If an employee of yours makes the claim that you failed to provide a safe work environment—for instance, that you did not provide PPE, and they subsequently contracted COVID-19—that claim would fall outside of your medical professional liability coverage. In those instances, your agent can advise you regarding whether the claim is covered by your employment practices liability insurance.

A: Check with your agent or underwriter. If you’re being requested to provide services outside of the scope of your specialty such as assisting with triage in an emergency department (ED), whether being remunerated or not, your coverage with The Doctors Company will not be impacted. We will rely upon your professional judgment. If you have the necessary training and are comfortable performing in that particular capacity, your coverage will follow you.

The same holds true for your non-physician staff when acting under your scope and direction: If they are requested or volunteer to offer services outside of your practice insured with us, coverage under your policy will follow them.

Q: AM I COVERED IF A PATIENT ALLEGES THEY CONTRACTED COVID-19 IN MY OFFICE? A: If you are covered by The Doctors Company, the short answer is yes. The longer answer involves separating what the physician can’t control from what they can: Of course, you cannot guarantee that any given patient will not contract COVID-19. However, you can perform daily reviews of any new CDC guidelines, train your staff, and maintain infection control standards—and document that you are doing those things. In case of a lawsuit, your good-faith effort to maintain the standard of care as it evolves is in your favor.

Q: CAN I CONTINUE MY PRACTICE CONTRARY TO STATE RECOMMENDATIONS? A: We will rely on your professional judgment relative to your practice and your patients’ best interests. That said, as you evaluate your patients’ needs against your local backdrop of infection risks and legal changes, realize that mandates are stronger than recommendations. We encourage you to follow all state mandates, laws, bulletins, and orders.

For example, if a state has opened the door for elective procedures but not cosmetic procedures, and a physician is performing cosmetic procedures, this makes it almost impossible for us to successfully defend that physician in court because they have knowingly violated a state requirement or the law. Therefore, reduce liability by following your local health authority’s recommendations and abiding by the local current standard of care.

Q: IF I CANNOT YET RESUME MY USUAL LEVEL OF PATIENT INTERACTION, CAN I ADJUST MY COVERAGE TO REDUCE MY PREMIUM? A: Many practices have experienced a significant reduction in patient encounters and therefore revenue. Talk to your agent or underwriter about adjusting your service. The Doctors Company offers two types of coverage adjustment: reduction in time (full-time to part-time practice) and/or reduction in the nature of procedures performed (surgical to office-based practice). Either or both would reduce premium. In case of temporary practice closure, we can temporarily suspend coverage.

If, however, a non-physician staff member is stepping outside of your scope and direction, they should seek coverage from the facility or practice with whom they’re offering services.

Q: ASSUMING ELECTIVE SURGERIES OR PROCEDURES ARE ALLOWED, WHAT SPECIAL CONSIDERATIONS APPLY DURING COVID-19?

A: The return to offering procedures will not be like flipping a switch; it will be a gradual process. Use your best judgment to determine whether you have the capability to safely perform the procedure based on your location, patient population, type of procedure, your assessment of the degree of increased risk, and your evaluation of the risks and benefits to the patient.

Have a heart-to-heart with the patient, a true informed consent process that accounts for the increased risks during COVID-19, not just a form for the patient to sign—and document those conversations. No one knows what things will look like in a year or two, so documenting clinical reasoning based on conditions right now is critical.

Q: WHAT IF I HAVE DOCUMENTED MY BEST CLINICAL JUDGMENT, BUT THE INSURER DISAGREES? WILL I STILL BE DEFENDED IN CASE OF A SUIT? A: If you are a member of The Doctors Company, you can count on aggressive, effective defense of your claim. We do not cast doubt on our members’ clinical judgment. However, we strongly recommend that you document your clinical reasoning in case of a suit.

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.

Remember to work with your agent or underwriter to reinstate your customary level of coverage upon reopening or resuming your customary level of patient interaction.

Summer 2020

CENTRAL COAST PHYSICIANS

21

MEN’S HEALTH

MEN, WOMEN, AND

COVID-19

BY DAVID DODSON, MD

The decreased mortality rates are lower in women on the order of 40% which was first observed early on in China and have subsequently been observed around the world.

22

CENTRAL COAST PHYSICIANS

While there is no need for confirmation of the truth I spoke in my first column in the first issue of this magazine that women are biologically superior to men, to anyone looking for further proof, I give you ... COVID-19. It turns out that mortality rates are so much lower in women that estrogen has been studied as a treatment for the disease. The decreased mortality rates are lower in women on the order of 40% which was first observed early on in China and have subsequently been observed around the world. If we had a drug that lowered mortality that much, it would be hailed as an important breakthrough and the manufacturer’s stock would soar. Thus, women have lower mortality rates for 9 of the 10 leading causes of death, and to this we can add COVID-19.

Summer 2020

The risk of acquiring COVID-19 is higher in countries ruled met the challenge posed by COVID-19 with decisive measures by autocrats and strongmen. The countries with the most cases that have worked well to curb their epidemics, save lives, and in include the USA, Brazil, India, Russia, and the UK, all ruled by the long run, undoubtedly protect their economies. men with strong autocratic leanings. In this regard, sadly, the USA is number one with over 25% of all cases in the world. We So in summary, the SARS-CoV-2 virus cannot be talked or have seen the man in our bully pulpit try to bully the virus into bullied into submission. It does not care about your politics, and submission. Naturally this has been spectacularly ineffective. politicizing the pandemic, as we have done in this country for Strangely, as the virus has surged in 27 states, the president said on July 1 that We have all watched our president try to wish away the virus, which the virus was going to fade away. The along with antimalarials, disinfectants, and UV light, has not proved virus did not listen- nationwide the to be an effective strategy to combat the novel coronavirus. incidence has been increasing with well over 50,000 new cases daily. We have all watched our president try to wish away the virus, which along with antimalarials, disinfectants, and UV reasons that escape me, does not work to control the pandemic, light, has not proved to be an effective strategy to combat the as evidenced by our country now seeing more cases than ever. novel coronavirus. The result has been our steep climb on an And to minimize your chances of acquiring COVID-19, be a exponential curve to an upsloping plateau with more than half woman in a country ruled by a woman. of our states currently experiencing increases in the incidence of the disease. This contrasts with countries such as Canada, Germany, and Italy where their incidence curves resemble steep mountain peaks with exponential rises followed by sleep declines.

You work hard for our health...

Interestingly, it turns out that one way to reduce your risk of acquiring COVID-19 may be to live in a country ruled by a woman. What do Germany, Taiwan, New Zealand, Iceland, Finland, Norway, and Denmark have in common?

You guessed it: effective responses to the pandemic, low incidence rates, and female leadership. While Trump said early on words to the effect that “we have a dozen cases and pretty soon there will be none” and “come spring it will melt away like magic” and “a positive case could be a 15 year old kid with the sniffles who is better in 2 days, big deal”, Angela Merkel warned at the onset that 70% of Germans could wind up being infected, that it was very serious indeed, and needed to be taken seriously. She took it with appropriate seriousness and set the right tone for her country which as a result has done an excellent job of controlling COVID-19 in Germany such that they are now in a good position to reopen their economy safely. The triad of adequate testing, quarantine, and contact tracing recommended by public health experts works if put to the test, which Germany under Merkel did. Similar success stories have occurred in the other countries mentioned where female leaders have

Summer 2020

let us work hard for you...

REPRESENTING BUYERS & SELLERS YOUR TRUSTED REAL ESTATE RESOURCES

KAT HITCHCOCK (805) 705-4485 CalBRE: #01932289

JOANNA KEMP

(805) 335-0158 CalBRE: 01930699

An Independently owned and operated franchisee of BHH Affiliates, LLC

CENTRAL COAST PHYSICIANS

23

Protecting Physician Practices 24

CENTRAL COAST PHYSICIANS

Summer 2020

The California Medical Association (CMA) is closely monitoring the impact COVID-19 is having on physician practices across the state. CMA has been advocating on many fronts for appropriate relief and regulatory flexibility so the physicians of California can provide quality care to patients during and after the COVID-19 pandemic.

CMA has also developed a wide array of resources to help physicians during the public health emergency. These resources are available FREE to physicians, regardless of their membership status.

REOPENING HEALTH CARE RESOURCES PPE RELIEF: The State of California made millions of pieces of medical-grade personal protective equipment (PPE) – including N95 masks, surgical masks, shields, gowns, and gloves – available FREE to physician practices. The California Office of Emergency Services is partnered with CMA and its local medical societies to distribute this equipment to qualifying small and medium sized medical practices.

Summer 2020

CENTRAL COAST PHYSICIANS

25

REOPENING GUIDELINES: CMA convened a taskforce of

EMPLOYER TOOLKIT: New laws have been quickly

practicing physicians from different parts of the state, different sized practices, and various specialties to develop guidelines and recommendations for reopening the health care system.

CMA’s guidelines are heavily referenced by the Newsom Administration and the California Department of Public Health in their own guidelines for resuming deferred and preventive health care.

enacted that have expanded unemployment benefits, sick leave provisions and family medical leave laws to help both employers and employees affected by this public health crisis.

CMA’s toolkit for physician employers addresses these rapidly evolving personnel and other employment-related issues.

BEST PRACTICES FOR REOPENING: CMA’s reopening

COVID-19 NEWS UPDATES: CMA has increased the

taskforce also developed actionable best practices for physicians to consider as they reopen their medical practices for office visits. The document includes steps to take prior to reopening, financial and staffing considerations, and universal safety precautions.

REOPENING WEBINARS: CMA hosts a series of FREE webinars on topics related to reopening medical practices during the public health emergency. These webinars are also available for on-demand viewing for physicians who were unable to participate in the live events.

Learn more about CMA’s reopening resources at cmadocs.org/covid-19.

TOOLKITS FOR MEDICAL PRACTICES CMA understands that things are changing rapidly – sometimes daily – during the COVID-19 pandemic. Our team of experts is distilling the information into easy-to-read toolkits that are updated regularly to keep you informed.

TELEHEALTH TOOLKIT: CMA’s telehealth toolkit includes

EDUCATION frequency of its member communications during this time, to ensure that physicians have the most up-to-date information.

CMA’s COVID-19 Resource Center at cmadocs.org/covid-19 is also updated in real time as new information becomes available.

VIRTUAL GRAND ROUNDS: CMA is partnering with the California Health and Human Services Agency and academic medical centers across the state to host California COVID-19 Clinical Updates, a regular series of virtual grand rounds for the state’s clinicians on the evolving understanding and management of COVID-19 patients.

COVID-19 WEBINAR SERIES: Since the beginning of the public health emergency, CMA has been hosting free COVID-19 webinars to keep the physicians of California informed on critical topics. These webinars are free for all physicians regardless of their membership status. If you are unable to attend a live event, they are also available to play back at your convenience in CMA’s on-demand webinar library.

Frequently Asked Questions: CMA is maintaining a

payor guidance for billing and coding telehealth services, as well as privacy and security concerns and flexibilities, and key considerations for physician practices.

searchable frequently asked questions database to answer the most common questions received from physicians during the COVID-19 outbreak. You can also subscribe to be notified whenever a new answer is published.

FINANCIAL TOOLKIT: Physician practices are confronting

Learn more about CMA’s educational resources at

operational and business challenges as they continue to deliver high quality care to their patients during the COVID-19 pandemic. This toolkit provides an overview of financial assistance available to medical practices so physicians have the information they need to make the right decisions for their businesses.

26

CENTRAL COAST PHYSICIANS

cmadocs.org/covid-19.

Summer 2020

PHYSICIAN FINANCIAL HEALTH: The COVID-19 pandemic has created an unprecedented threat to the viability of physician practices. The fallout from this crisis threatens to fundamentally alter California’s health care delivery system not just during the COVID-19 outbreak, but for years to come. CMA continues to strongly advocate on behalf of physicians, making sure that government agencies understand the immediate and ongoing need for financial assistance for physician practices.

CAREGIVER WELLNESS The emotional stress of responding to patients during the COVID-19 pandemic puts front line health care workers at exceptional risk of emotional burnout. In response, CMA Wellness launched the Care 4 Caregivers Now program, which focuses on the mental and emotional well-being of caregivers while they fight COVID-19. Care 4 Caregivers Now connects physicians, physician assistants, nurses, nurse practitioners and respiratory therapists serving on the front lines of the pandemic with a trained peer coach who will provide remote and confidential coaching sessions at no cost.

Learn more at cmadocs.org/care4caregivers.

PHYSICIAN ADVOCACY Through aggressive political and regulatory advocacy, CMA has positioned itself as one of the most influential stakeholders in the development and implementation of health policy.

CMA’s physician advocates remain engaged on all fronts to ensure that the interests of physicians and their patients are considered as local, state, and federal governments are responding to the rapidly evolving public health emergency.

Summer 2020

BUDGET ADVOCACY: Due in large part to CMA advocacy, the 2020-2021 state budget preserves essential health care safety net programs at a time when the Medi-Cal caseload is expected to grow by more than 2 million cases in the coming year. The budget also protects investments in California’s health care workforce, which will help ensure all Californians, regardless of economic status, will have access to care when they need it.

REGULATORY FLEXIBILITIES: CMA is working to ensure that government agencies understand the regulatory flexibilities necessary so that physicians can continue serving patients during the COVID-19 pandemic. From telehealth flexibility and payment parity, to waivers on privacy and security requirements to expedite the incorporation of telehealth into practice workflows, CMA has been at the table making sure policymakers understand the needs of physicians and their patients.

Learn more about CMA’s COVID-19 advocacy at cmadocs.org/covid-19.

CENTRAL COAST PHYSICIANS

27

COVID-19:

Frequently Asked Questions Prepared by the California Medical Association For more FAQ , including links to resources, go to www.cmadocs.org/covid-19.

Can an employer administer a COVID-19 test before permitting employees to enter the workplace?

The Equal Employment Opportunity Commission (EEOC) recently issued guidance that employers may administer a COVID-19 test (a test to detect the presence of the COVID-19 virus) to employees prior to entering the workplace. In accordance with the Americans with Disabilities Act, the mandatory testing must be “job related” and “consistent with business necessity.” This means that, under the current circumstances of the COVID-19 pandemic, an employer may require employee testing to determine if they have the virus, because an individual with COVID-19 entering the workplace will pose a direct threat to the health of others.

The EEOC further advised that employers who do enact a mandatory testing policy should ensure that the tests are accurate and reliable.

Employers may rely on guidance from the U.S. Food and Drug Administration, Centers for Disease Control and Prevention or other public health authorities to determine what may be considered safe and accurate testing, and should check for updates. Employers should be cognizant of the potential for false-positives or false-negatives associated with a particular test and should understand that accurate testing only reveals if the virus is currently present. >>

28

CENTRAL COAST PHYSICIANS

With regard to hospital medical staffs (many of whom are not hospital employees), in non-pandemic times, the medical staff can (and many do) adopt a policy to require testing for infectious diseases as a condition of medical staff membership and privileging. For example, hospitals may wish to adopt policies to require flu vaccines for medical staff members. While currently there is no state law that requires health care workers to specifically undergo COVID-19 testing prior to patient contact, existing state laws, such as those that require tuberculosis (TB) testing of health care workers as a condition of employment, support the sentiment of mandatory screening of health care workers for infectious diseases before interacting with patients. (See, 22 C.C.R. § 70723(b).)

Furthermore, Governor Newsom’s March 30, 2020, Executive Order suspending the enforcement of hospital licensing, credentialing and privileging requirements due to the declared public health emergency, means that hospitals have increased flexibility to impose these types of requirements. However, as noted by the EEOC, any required testing for COVID-19 must be “job related” and “consistent with business necessity.” Hospitals that plan to implement mandatory COVID-19 testing should consult and work with medical staff leadership to develop policies that can be reviewed and approved by the medical staff.

Can I ask staff to leave the office to selfquarantine if you suspect them to be sick?

The Centers for Disease Control & Prevention (CDC) states that employees who become ill with symptoms of COVID-19 should leave the workplace. The Americans with Disabilities Act (ADA) does not prohibit employers from asking staff to leave the workplace to self-quarantine when based on the CDC’s guidance.

What are my obligations around honoring sick leave during this time?

Beginning April 1, 2020, the Emergency Paid Sick Leave provisions of the Families First Coronavirus Response Act (FFCRA) requires covered employers (those with fewer than 500 employees) to provide employees with paid sick leave if they are unable to work or telework because the employee is:

Summer 2020

• Subject to an isolation order •A dvised by a health care provider to quarantine • E xperiencing COVID-19 symptoms (and seeking diagnosis) •C aring for an individual under order or advised to quarantine •C aring for a child under 18 whose school or childcare is unavailable due to COVID-19 • E xperiencing any substantially similar condition as specified by HHS Covered employers are required by the FFCRA to provide employees with 80 hours of paid sick leave. Employees who take leave because they are subject to an isolation order, have been advised to quarantine, or who are experiencing COVID-19 symptoms are eligible for their full wages (up to $511/day) while employees who are caring for another are eligible for 2/3 of their wages (up to $200/day). This leave is in addition to any pre-existing paid leave.

Note that the FFCRA allows employers to exclude health care providers and emergency responders from these provisions. Under the FFCRA, a “health care provider” is broad and includes anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity.

Can I require a worker who is quarantined to exhaust paid sick leave?

No. The California Labor Commissioner has indicated that an employer cannot require that a quarantined worker use state paid sick leave. California Labor Code §246 provides that the employee has the right to decide whether to use paid sick leave.

However, if the employee decides to use paid sick leave, the employer may require the employee take a minimum of two hours of paid sick leave. The determination of how much paid sick leave will be used is once again up to the employee.

If accrued sick leave is exhausted, other leave may be available.

If the employer has a vacation or paid time off policy, an Summer 2020

employee may choose to take such leave and be compensated provided that the terms of the vacation or paid time off policy allows for leave in this circumstance.

How much information may an employer request from an employee who calls in sick, in order to protect the rest of its workforce during the COVID-19 pandemic?

During a pandemic, employers may ask such employees if they are experiencing symptoms of the pandemic virus. For COVID-19, these include symptoms such as fever, chills, cough, shortness of breath, or sore throat. An employer may also ask an employee who has exhibited symptoms of COVID-19 whether that employee has been tested for the disease, and the results of the test. Employers must maintain all information about employee illness as a confidential medical record in compliance with the Americans with Disabilities Act.

Can an employee refuse to come to work because of fear of infection?

Health care workers, to include those over the age of 65, are exempt from self-isolation and shelter-in-place requirements.

Thus, a health care worker who refuses to come to work because of fear of infection would not be able to rely solely on those requirements as justification for their absence.

Generally, employees can refuse to work if they believe they are in imminent danger. Section 13(a) of the Occupational Safety and Health Act (OSHA) defines “imminent danger” to include “any conditions or practices in any place of employment which are such that a danger exists which can reasonably be expected to cause death or serious physical harm immediately or before the imminence of such danger can be eliminated through the enforcement procedures otherwise provided by this Act.” OSHA further clarifies “imminent danger” to exist in situations where “threat of death or serious physical harm,” or “a reasonable expectation that toxic substances or other health hazards are present, and exposure to them will shorten life or cause substantial reduction in physical or mental efficiency.”

Cal/OSHA also provides protection to employees who refuse to work under hazardous conditions. Generally, it is illegal for an employer to retaliate against an employee who refuses to perform hazardous duties, if performing the work would violate a Cal/OSHA health or safety regulation, and the violation would create a “real and apparent hazard.”

CENTRAL COAST PHYSICIANS

29

While neither OSHA nor Cal/OSHA have addressed the existence of “imminent danger” or hazardous duties as they pertain to health care workers’ exposure to COVID-19, OSHA has classified health care workers and support staff as having “very high” to “high” exposure risk to the disease. Thus, an employer’s failure to implement safety control measures, or abide by state and federal standards designed to protect health care workers against transmission of infectious agents (such as failure to provide appropriate PPE), may create a situation that rises to the threshold of an “imminent danger” or “real and apparent hazard.” Because the duties of most health care workers necessarily involve potential exposure to COVID-19, employers should strive to ensure that they adhere to all workplace health and safety regulations and address the concerns of individual employees.

It should be noted that this guidance is general, and employers must continually review the facts and circumstances in their workplace before determining whether it is permissible for employees to refuse to work.

How should I handle reimbursement of reasonable business expenditures (use of cell phone, internet, etc.) while staff is working remotely?

All employees working remotely will need access to computers, telephones, and the means to connect via the internet and cellular service. Generally, the California Labor Code §2802 requires employers to reimburse employees for “all necessary expenditures or losses incurred by the employee in direct consequence of the discharge of his or her duties, or of his or her obedience to the directions of the employer.” The cases interpreting this provision make clear that employees are entitled to be reimbursed for the “actual” expenses.

An employee’s use of a personal cell phone and internet directly related to their employment falls under this provision.

Similarly, the employee may use their personal computer, routers, modems, and other equipment to communicate and work remotely. Thus, employers should reimburse their employees for a reasonable percentage of their cell phone, internet service bills, and wear and tear for any equipment for work-related expenses. Because it is difficult to determine actual expenses, employers generally determine (with the agreement of the employee, if possible) to reimburse a

30

CENTRAL COAST PHYSICIANS

reasonable flat rate for those expenses. Notably, California courts have said that employers may be required to reimburse employees for expenses, such as a portion of a personal cell phone bill, even if the employee was already planning to pay for those services for their personal use.

Should practices disclose to the local health authority the identities of their employees who have tested positive for COVID-19?

Physician employers should disclose the identities of staff they know who have tested positive for COVID-19 to the local health authority. Health & Safety Code § 120250 broadly requires physicians to report the name and location of a person with any infectious, contagious, or communicable disease to the local health authority, along with the nature of the disease.

COVID-19 is listed as a reportable disease under the highest risk category under applicable state law, and therefore must be reported immediately by telephone in each instance.

Physicians should not disclose the identities of any staff known to have tested positive for COVID-19 to the general public. The CMIA and HIPAA contain explicit exceptions for disclosures required by law, including for the purposes of containing communicable diseases. However, no California or federal law requires or permits a disclosure of an individual’s health information to the public at large.

Related to this issue, the CDC has advised that if an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (e.g., not disclosing the name of the infected employee(s) to coworkers).

What types of financial assistance are available to physicians during COVID-19?

CMA has created a comprehensive COVID-10 Financial Toolkit for Physician Practices. This toolkit provides an overview of financial assistance available to medical practices during this difficult time so that physicians have the information they need to make decisions for their businesses and families. The toolkit covers a range of subjects including suggestions for preparation and practice organization, and information on payments, financial assistance programs, unemployment, sick and medical leave, childcare and tax relief.

Summer 2020

Additional State-Level Resources: • Th e Governor’s Office of Business and Economic Development (GO-Biz) has compiled a list of assistance programs, including resource lists and loans.

•C onnect with GO-Biz through this portal or calling their service line: (877) 345-4633 • Th e State Treasurers office has created a resource database, updated regularly any cities, counties and community banks are offering M assistance so we encourage members to research what your locality may be offering.

For additional information about federal financial assistance, AMA has created a Physician Practice Financial Relief guide.

Does practice insurance cover loss of practice revenue and paying staff during state or national declared emergency?

It might. There are many different insurance products, policies, and ways to customize insurance standard policies with insurance “riders.” Accordingly, practices will need to review their individual policy to determine whether it covers lost revenue or staff wages during state or national declared emergencies and call their insurance broker to discuss their specific insurance policy terms and the exclusions that apply.

I am due for Medicare revalidation soon. Do I have to respond to the request?

The Centers for Medicare and Medicaid Services (CMS) has temporarily suspended revalidations. Until further notice, no provider will be deactivated or have their payments pended for not responding to a previously sent revalidation request.

Additionally, no new requests will be mailed to physicians who are due to revalidate. CMS has also established toll-free hotlines for physicians and non-physician practitioners to enroll and receive temporary Medicare billing privileges.

Have the Physician Self-Referral/Stark laws been waived during the current COVID-19 Epidemic?

Yes. On March 13, 2020, U.S. Department of Health and

Summer 2020

Health Law Library

The California Medical Association’s online health law library contains over 5,400 pages of up-to-date information on a variety of subjects of everyday importance to physicians, including current laws, regulations and court decisions that affect the practice of medicine. One of CMA’s most valuable member benefits, the searchable online library contains all the information available in the California Physician’s Legal Handbook (CPLH), an annual publication from CMA’s Center for Legal Affairs. This resource can provide helpful guidance to physicians as they consider their options for changing their practice models to ensure financial viability after the COVID-19 pandemic.

Examples of content that may be relevant at this time include:

• Medical Practice Option Overview • Retaining a practice consultant • Covering Physicians (Locum Tenums) • Retirement Notice • Termination of the Physician-Patient Relationship

CMA members can access the library documents free at cmadocs.org/health-law-library. Nonmembers can purchase documents for $2 per page.

Human Services Secretary Alex Azar issued a statement waiving and/or modifying the requirements under section 1135 of the Social Security Act. Afterwards, on March 30, 2020 CMS issued blanket waivers to permit certain financial relationships and referrals related to the COVID-19 pandemic that would otherwise be sanctioned by the Physician SelfReferral Law. These blanket waivers were given a retroactive effective date of March 1, 2020, and thus protect those referrals and financial relationships since that date. These blanket waivers temporarily permit payments and referrals between physicians and entities if the relationship falls into one of CMS’ stated categories during the COVID-19 pandemic, even if such an arrangement would not meet a Stark law exception.

These blanket waivers are intended to give physicians more freedom and flexibility as the COVID-19 pandemic continues.

CENTRAL COAST PHYSICIANS

31

Similar to other Section 1135 waivers issued in response to the COVID-19 public health emergency, these blanket waivers will terminate at the end of the public health emergency.

Do volunteer physicians have any protection from liability for providing care during a state of emergency? What about physicians practicing outside their usual specialty?

Generally, yes. California and federal law currently provide a broad base of liability protection for physicians and other health care providers during a state of emergency. Under California law, physicians are generally immune from liability for injuries stemming from medical care and treatment rendered during a state of emergency. This immunity applies both to California-licensed physicians and physicians licensed in another state as well as to certain other health providers, including respiratory care practitioners and nurses. Note that this immunity does not apply in the event of a willful act or omission. (Government Code ยง8659; see also Business & Professions Code ยง900(e).) The U.S. Department of Health

32

CENTRAL COAST PHYSICIANS

and Human Services (HHS) also issued a declaration which provides immunity from suit and liability under state and federal law for certain actions in relation to COVID-19. While these laws provide broad immunity for health care providers during a state of emergency, each situation would need to be analyzed based on facts specific to a particular provider.

What are physicians supposed to do once they have a patient that does test positive for COVID-19?

Per Title17 Section 2500 of the California Code of Regulations, cases of Coronavirus Disease 2019 (COVID-19), must be reported immediately by telephone to the local health officer for the jurisdiction where the patient resides. For questions about COVID-19 reporting or other communicable disease reporting requirements, please contact your local health department. The specific COVID-19 reporting form can be found on the CDPH website.

Summer 2020

On-Demand Webinars

As part of our COVID-19 support to all physician practices, the California Medical Association is providing on-demand webinars free for members and non-members.

Below are some of the webinars currently available, and a complete list is at www.cmadocs.org/webinars.

Employment Law Issues for Reopening Practices This webinar focuses on employment issues as physicians begin to reopen their practices during the COVID-19 public health emergency. Attorney Oscar Rivas, Partner at Landegger Baron Law Group, will discuss a range of topics, including the current status of state and federal financial support for employees and employers, bringing employees back from furlough, continuing remote work policies, and safety precautions to prevent COVID-19 in the workplace.

SBA Webinar for Physicians: COVID-19 Economic Relief Representatives from the U.S. Small Business Administration (SBA) join the California Medical Association to present a webinar on the economic relief available to physicians under the Coronavirus Aid, Relief, and Economic Security Act, also known as the CARES Act. Several key provisions of the CARES Act are discussed, including to the Paycheck Protection Program and the Debt Relief Program, which are both administered by the SBA. The webinar also includes a discussion of the Employee Retention Credit.

Summer 2020

COVID-19 Flexibilities for Medical Staffs and Hospital-Based Physicians During the COVID-19 pandemic, the federal and state government have waived laws and regulations to increase flexibility for hospitals and other health facilities faced with significant uncertainty regarding workforce and patient flow. Medical staffs and physicians have been impacted by changes ranging from broad suspension of hospital licensing requirements to changes in how they may manage credentialing and telehealth. This webinar presents an overview of the most significant federal and state law waivers and provides insight from medical staff leadership on how these changes have impacted care delivery in the field. The webinar also provides an overview of new CMA resources available to assist medical staffs in navigating these waivers.

Strategies for Redefining Wellness and Resilience During and After COVID What does physician wellness look like in light of the COVID-19 pandemic? Webinar participants will hear from experts in the field of physician wellness.

Attendees will also learn how peer coaching has been demonstrated to provide several benefits, including relief from emotional exhaustion and reduced levels of self-reported burnout.

CENTRAL COAST PHYSICIANS

33

CenCal Health NEWS HUB: Fresh Perspective

CenCal Health: We welcome you to our Board of Directors. Why did you agree to the appointment, and what do you hope to contribute and achieve?

CenCal Health has a remarkable history on the Central Coast as a model for local administration of the Medi-Cal program. As a provider in Santa Barbara since 1986, I have appreciated the great service CenCal Health provides to physicians and patients in our community and therefore have a vested interest in seeing the organization continue to thrive.

I hope to provide the perspective of an experienced provider advocating for high-quality patient care.

CenCal Health: How have you seen Medi-Cal evolve and change here on the Central Coast over the past four decades of your career?

Q&A WITH 2020/21 BOARD PHYSICIAN MEMBER EDWARD S BENTLEY, MD Heading into 2020 and a brand-new decade–before the arrival of a worldwide public health crisis–CenCal Health welcomed Edward S. Bentley, M.D. to its Board of Directors as a physician member representing Santa Barbara County.

We are taking this opportunity to glean Dr. Bentley’s unique perspective on the past, present and future of healthcare and Medi-Cal on the Central Coast.

Bentley is senior partner of Santa Barbara Gastroenterology Consultants Medical Group, a division of InSite Digestive Health Care. He has been an active member of the Santa Barbara medical community and a CenCal Health provider since 1986. He is Board-certified in Internal Medicine and Gastroenterology by the American Board of Internal Medicine. He continues to be involved in education through his clinical associate professorship of medicine at USC’s Keck School of Medicine.

34

CENTRAL COAST PHYSICIANS

CenCal Health has always provided great local management of the Med-Cal program during my years of practice. The Medi-Cal program has expanded since the passage of the Affordable Care Act to include many who were previously uninsured. In addition, there have been significant reductions in payments to providers across the state because of budgetary difficulties, placing a significant strain on the program. CenCal Health’s management has been successful in insulating the Central Coast providers and patients from these challenges. In addition, over the years, the program has evolved from one that administers payment to providers to one that coordinates care and measures the quality of its services.

CenCal Health: What do you think are the biggest health challenges for Medi-Cal members on the Central Coast?

Obesity is one of the biggest health challenges nationwide and our area is no exception. A health needs assessment performed by Cottage Health reported that about one third of low-income individuals are overweight and almost another

Summer 2020

third are obese in Santa Barbara County. Obese patients were more likely to report poor health and a higher incidence of diabetes, heart disease and stroke. Historically, as providers we have focused on managing the outcomes of poor health. Now we are focusing on the drivers.

CenCal Health: What do you think are the biggest challenges for Medi-Cal providers and partners on the Central Coast?

The single biggest challenge for providers is to continue to provide the high-quality care our community is accustomed to in the setting of shrinking resources and increasing regulatory burden. In other words, they will be expected to do more with less. Providers will need to develop efficiencies in how they provide care without negatively affecting the quality of care.

They will also need to develop efficiencies in how they report their care to regulatory agencies. Such demands are currently leading to significant levels of provider burnout. Providers will be challenged to meet these demands while maintaining their personal well-being.

CenCal Health: Now let’s address the “elephant in the room�. COVID-19 has certainly changed the delivery of healthcare in our area. What will the long-term changes be to healthcare, do you think, as a result of this public health crisis?

The pandemic exposed vulnerabilities in our healthcare system and way of life which hopefully will lead to long term improvements. I expect there will be greater funding and attention towards pandemic preparedness, public health,

Summer 2020

infection control and management of respiratory viruses in the future. I expect plans will be developed from lessons learned that will address the shortages of resources, the inconsistencies of response, the economic toll, and the disparities in outcomes, access, and support of those affected. I expect changes will be made in specific settings such as skilled nursing facilities, meat packing plants and prisons to protect workers and inhabitants.

To the degree possible, I expect social distancing will become incorporated in the healthcare environment using telehealth, improved scheduling, and avoidance of crowding in office settings.

CenCal Health: How do you foresee Covid-19 impacting the financial aspect of the health care industry?

Like most other industries, the financial aspect of the health care industry has been negatively affected. During the shutdown, all elective services (visits, surgeries, procedures, admissions) were postponed. Productivity was significantly reduced to align resources for the anticipated surge. Since our system relies heavily on employment for insurance coverage and many became unemployed, those needing care could not afford it. Consequently, health provider revenues fell far below governmental support provided through the CARES Act. In addition, expenses increased through the purchase of additional supplies at inflated prices because of large demands. Providers were required to mobilize reserves or borrow money to meet cash flow requirements. It will take time to recover from those losses. When recovery occurs, providers can expect significant cuts in governmental payments as the government attempts to make the same recovery. In the long term, however, the industry will recover and continue to be strong.

CENTRAL COAST PHYSICIANS

35

Supporting Health Care Workers Serving on the COVID-19 Front Lines The emotional stress of responding to patients during the COVID-19 pandemic puts the personal and emotional health of front line health care workers at exceptional risk. To provide relief and help alleviate burnout, the California Medical Association (CMA) Wellness Program (CMA Wellness) has launched the Care 4 Caregivers Now program, connecting front line caregivers with a trained peer coach offering remote and confidential sessions at no cost.

SIGN UP TO RECEIVE COACHING If you are a health care worker in constant worry of COVID-19 infection, currently separated from your family, or facing any other emotional difficulty at this time, we invite you to schedule a confidential peer coaching session at no cost. +

Eligible caregivers include, physicians, physician assistants, nurses, nurse practitioners and respiratory therapists

+

There is no cost, and you may receive coaching for up to 30 days

+

Coaching sessions are confidential and conducted remotely via videoconference; access to a computer or smart phone is necessary

While not a substitute for therapy or medical care, your peer coach understands the rigors of the profession and can offer guidance, mentorship and emotional support. Coaches hold space to listen to your concerns. Their goal is to help you feel heard, understood and become more aware of your options.

VOLUNTEER TO BECOME A COACH Care 4 Caregivers Now provides physicians (M.D. and D.O.) and nurses, including those who are recently retired, the opportunity to lend their unique expertise during these unprecedented times. Coaching services are conducted remotely and not considered practicing medicine. All interested volunteers should have: +

Four hours for training, which includes on-demand videos and 90-minute live/small group training session

+

Access to computer audio/video and sufficient broadband (CMA Wellness supplies a Zoom account)

+

At least 4 hours/week for remote coaching and mastermind sessions to share best practices and receive ongoing support

+

Passion for supporting fellow health care providers

+

Compassion, empathy, patience and strong listening skills.

Sign up to receive coaching, or to volunteer as a coach at: Care4CaregiversNow.org.

cmadocs.org/care4caregivers z

CMAwellness@cmadocs.org (800) 241-2466

Emergencies can’t wait.

Your Safe Care is our #1 Priority In an emergency, there’s no reason to delay your care. We go above and beyond to ensure safety for you and your loved ones.

We want to make your visit with us convenient and comfortable.

Walk-ins welcome at Sierra Vista Regional Medical Center and Twin Cities Community Hospital Check in online to reserve your spot ahead of time and wait from the comfort of your own home.

TenetHealthCentralCoast.com

For more information, visit TenetHealthCentralCoast.com For life-threatening emergencies, call 911.

Summer 2020

Kevin Casey, MD CENTRAL COAST PHYSICIANS

37

CL

DS

F I S IE S A

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. Physician openings 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. Physician openings can be found at www.sbcountyjobs.com.

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

SANSUM CLINIC is the largest and oldest multispecialty 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. Physician openings can be found at www.sansumclinic.org/physicianprovider-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.

Physician openings can be found at www.tenethealth.com/for-physicians/physiciancareers.

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.

38

CENTRAL COAST PHYSICIANS

Summer 2020

Summer 2020

CENTRAL COAST PHYSICIANS

39

Every Breath You Take, Tenet Will Be Here for You Tenet Health Central Coast Provides Complete Pulmonary Testing with Plethysmography – The Most Accurate Pulmonary Function Testing in San Luis Obispo County While it may seem that the information regarding COVID-19 changes frequently, one constant is that those with other, underlying health issues are the most vulnerable for adverse outcomes should they come in contact with the virus. Indeed, often, people with diabetes and cancer are cautioned to be extra careful.

with lung or pulmonary conditions have not been able to access outpatient pulmonary function testing (PFT) due to the COVID-19 restrictions and the planned closure of independent pulmonary practices could be a cause for concern among doctors who need to refer patients for testing.

However, people with pulmonary conditions – such as asthma, bronchitis, pneumonia, emphysema, Chronic Obstructive Pulmonary Disease (COPD) and lung cancer – are also particularly at risk because COVID-19 attacks the lungs, which makes this test so important as part of managing their conditions.

Fortunately, patients who have had to delay tests due to COVID-19 closures, and/or are worried about their lung health, can receive complete Pulmonary Function Testing that includes Plethysmography testing – considered the most accurate technique – at Tenet Health Central Coast, which is the only provider of the plethysmography test in San Luis Obispo County. These tests are available as part of outpatient services at both the Sierra Vista Regional Medical Center campus in San Luis Obispo and the Twin Cities Community Hospital campus in Templeton.

To make matters more precarious, many high-risk people

Complete Pulmonary Function Testing is an important

40

CENTRAL COAST PHYSICIANS

Summer 2020

and critical component of diagnosis and management of respiratory conditions, as well as for determining disability in work-related lung disease. The test is simple and provides a wealth of information to help doctors prescribe the best course of action and/or therapy.

Although common office-setting tests use spirometry to assess how well lungs work by measuring how much air is inhaled and exhaled as a component in diagnosing asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing – it does not measure the total amount of air in the lungs at maximal inspiration. No matter how new the equipment, spirometry alone does not measure the amount of air left in the lungs after maximal expiration, or the volume of the lungs (known as functional residual capacity). Further, although many laboratories report functional residual capacity, experts such as the Mayo Clinic report that it has too much of a variable to provide a diagnostic value.

disease, neuromuscular weakness (when the nerves that control the body do not exchange information with muscles in a normal way), or chest wall limitations, as can happen with obesity.

Physicians with patients that can benefit from a complete PFT are encouraged to contact Tenet Health Central Coast to set up an appointment the location most convenient to the patient. For more information regarding Cardiopulmonary / Respiratory Services, contact Stephen Szabo, RCP, Director of Cardiopulmonary / Respiratory Services for Tenet Health Central Coast, at stephen.szabo@tenethealth.com.

That is why the plethysmography testing available at Tenet Health Central Coast is so important for patients whose spirometry results suggest that there is restriction or a restrictive disorder. These restrictive disorders include lung

Summer 2020

CENTRAL COAST PHYSICIANS

41

PHYSICIANS SAVE LIVES CMA URGES CONGRESS TO SAVE PHYSICIAN PRACTICES The COVID-19 pandemic has created a health care crisis and an economic crisis for providers that jeopardizes access to care.

The fallout from this crisis threatens to fundamentally alter our nation’s health care system—not just during the COVID-19 outbreak, but for years to come.

GDP 4.8% first quarter of 2020

50% of GDP losses from health care sector

Physician Practice Viability Threatened The pandemic has created an unprecedented threat to the financial viability of physician practices because of skyrocketing costs for protective equipment and public health orders to stay-at-home and delay non-urgent surgeries, procedures and care.

The results of CMA’s COVID-19 survey highlight the immediate need for financial assistance to sustain physician practices.

95% of practices fear for their financial future.

64%

average revenue decline for practices since March 1.

49% of practices have furloughed physicians and staff. 11% have already closed. Others report closures by June 1 and will not reopen. They will be forced to consolidate, which increases health care costs.

34% of Californians Lose Access to Care 13 million patients are at risk of losing access to their physician. Losing physicians puts more stress on an already overburdened health care system and it will be impossible to meet the needs of patients now, during the COVID-19 surge, and after to address delayed care.

$8.5 billion in revenue losses experienced by California physician groups March 1-June 1, 2020.

Physicians Practices Are Important to the Economy Physicians contribute to the health and economic well-being of their communities by: + Supporting more than 1.2 MILLION JOBS + Contributing $135 MILLION IN WAGES + Paying $11.2 MILLION IN STATE AND LOCAL TAXES

How Congress Can Help + Increase funding to the Provider Relief Fund, more equitably allocate it and clarify that it’s not taxable. + Reform the Medicare Advance Payment Program. + Increase Medicaid funding and aid to the states. + Safeguard providers from lawsuits.

Rev. 7.21.2020

42

CENTRAL COAST PHYSICIANS

Summer 2020

PPE DRIVE-THROUGH DISTRIBUTION In an effort to ensure California physicians can continue to provide care to patients during the COVID-19 outbreak, the California Medical Association (CMA) is partnering with State of California and Altais to provide free medical-grade personal protective equipment (PPE) – including N95 and surgical masks, gowns, gloves and face shields – to small and medium sized medical practices across the state. Distribution events were held on the Central Coast in early August.

Thank you to all of the volunteers who helped make the events a success!

Summer 2020

CENTRAL COAST PHYSICIANS

43

23 New & Rejoining The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

44

Bina Ahmed, MD Interventional Cardiology Santa Barbara Cardiovascular Medical Group Santa Barbara 805.682.7707

Thomas Clarence Caves, MD Gastroenterology Sansum Clinic Santa Barbara 805.898.3120

Hiwot Hagos Araya, MD Hospitalist Sansum Clinic Santa Barbara 805.898.3077

William Charles Conway II, MD General Surgery Sansum Clinic Santa Barbara 805.879.0670

Michelle Renee Auran, MD Pediatrics Bravo Pediatrics San Luis Obispo 805.544.4460

Elizabeth Myers Grossman, MD,MBA Dermatology Cal Dermatology Santa Barbara 805.869.6544

Charish Leann Barry, MD Pediatrics Petite Pediatrics Santa Barbara 805.845.1221

Christian Andre Guier, MD Orthopaedic Surgery Santa Barbara Orthopedic Associates Santa Barbara 805.220.6020

Tamara Marie Berry, MD Dermatology Sansum Clinic Santa Barbara 805.898.3050

Matthew James Harrison, MD Orthopaedic Surgery The Santa Barbara Orthopaedic Foot & Ankle Center Santa Barbara 805.964.2300

CENTRAL COAST PHYSICIANS

Summer 2020

Anna Harter, MD Anesthesiology Anesthesia Medical Group of Santa Barbara Santa Barbara 805.682.7751

Travis James Mellon, DO Emergency Medicine Solvang 805.686.3989

Farid Hassanpour, DO,MBA Pediatrics CenCal Health Santa Barbara 805.685.9525

Monica Renee Phillips, MD Anatomic Pathology Mission Pathology Consultants Santa Barbara 805.569.7367

Benjamin Michael Howard, MD General Surgery Sansum Clinic Santa Barbara 805.681.7500

Anita Rai, MD Internal Medicine Sansum Clinic Santa Barbara 805.681.6510

Elizabeth Ingrid Krenz, MD Anesthesiology Sansum Clinic Santa Barbara 805.681.6550

Daniel Roshan, MD Pain Medicine Pacific Pain Physicians Santa Barbara 805.563.0363

Anh Tuan Lam, MD Hospitalist Sansum Clinic Santa Barbara 805.681.7500

Manu Kush Singh, MD Interventional Radiology and Diagnostic Radiology Santa Barbara Radiology Medical Group Santa Barbara 805.569.7279

Eunice Suejin Lee, MD Anesthesiology Anesthesia Medical Group of Santa Barbara Santa Barbara 805.682.7751 Christopher Vaughn Lutman, MD Gynecologic Oncology Mission Hope Cancer Center Pismo Beach 805.416.0600 Richard Joseph Macias, MD Pediatrics Central Coast Pediatrics San Luis Obispo 805.549.0888

Summer 2020

RETIRED Virginia Siegfried, MD Obstetrics and Gynecology Santa Barbara

Victor Tacconelli, MD Orthopaedic Surgery Santa Barbara

CENTRAL COAST PHYSICIANS

45

In Memoriam

In Memoriam CHARLES A (FRITZ) BRADLEY 1930 – 2020

Fritz was born in Elizabeth, New Jersey on March 25, 1930. He attended Bowdoin College followed by the University of Pittsburg Medical School 1950-54. His internship was in the Navy where he served as a flight surgeon.

Obstetrical and Gynecologic specialty training followed and was in Buffalo, New York from 1958 to 1962.

That year he opened his medical practice in Solvang, California. He and his wife, Donna had four children. After 4 years in that small town, the pair moved to Santa Barbara where he had a private practice for 20 years.

Always a champion of reproductive freedom for women, he became the medical director of Santa Barbara Planned Parenthood retiring in 2000.

When he wasn’t working, his favorite physical activities included running and tennis. Inspired by his time in Solvang, and later marrying his second wife Annie who is Danish, Fritz picked up the Danish language and was about 80% fluent. They had been married 32 years at the time of his death, they traveled to Denmark several times.

Besides Annie, Fritz is survived by his 4 children, 6 grandchildren, 1 great grandchild, 1 stepdaughter, and 1 step grandson.

46

CENTRAL COAST PHYSICIANS

Summer 2020

Summer 2020

CENTRAL COAST PHYSICIANS

47

Central Coast Medical Association 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 CHANGE SERVICE REQUESTED

Advancing the practice of good medicine.

NOW AND FOREVER. We’re taking the mal out of malpractice insurance.

However you practice in today’s ever-changing healthcare environment, we’ll be there for you with expert guidance, resources, and coverage.

It’s not lip service. It’s in our DNA to continually evolve and support the practice of good medicine in every way. That’s malpractice insurance without the mal. Join us at thedoctors.com

Presorted Standard U.S. Postage

PAID San Dimas, CA Permit No. 410