Central Coast Physicians Summer 2021

SUMMER 2021

AI and the Pandemic • CalVaxGrant Connecting Patients with Vaccine

Thank You FOR DRIVING A LIFE-SAVING SUCCESS

Over the past few months, a team of more than 1,300 caring people – healthcare professionals and volunteers from throughout the community – has worked to provide more than 112,000 doses of vaccine during the COVID-19 Drive-Up Vaccine Clinic at Goleta Valley Cottage Hospital.

Cottage Health thanks all who received vaccines, and those who staffed the clinic to protect our community.

You have helped to save lives.

Cottagehealth.org/covid19

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VOLUME 6, NUMBER 3 • SUMMER 2021

{FEATURES}

11 12 17 18 28 32 Summer 2021

{DEPARTMENTS} RETURN-TO-WORK RESOURCES A POWERFUL INVESTMENT CALVAXGRANT

6 PRESIDENT’S MESSAGE 14 RISK TIP 24 PUBLIC HEALTH UPDATE 26 CENCAL HEALTH NEWS 30 CLASSIFIEDS

STRONGER TOGETHER VACCINE MARKETPLACE

31 NEW MEMBERS 34 IN MEMORIAM

AI DOCTORS

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Letter from the CEO

STRONGER TOGETHER

DANA GOBA

This issue lists our physician members who understand the importance of organized medicine and how we are stronger together.

With our members’ support, we were able to advocate for those administering COVID-19 vaccinations, and physician practices can now apply for CalVaxGrant, which is administered by Physicians for a Healthy California (PHC). This program is offering grant funding, one-on-one myCAvax support, and vaccine administration resources.

PRESIDENT Priti Gagneja, MD PRESIDENT ELECT Samira Kayumi-Rashti, MD TREASURER Julie Fallon, MD SECRETARY Thomas Hale, MD IMMEDIATE PAST PRESIDENT Kevin Casey, MD DIRECTORS Eric Amador, MD; Michael DiBiase, MD; Todd Engstrom, MD; Jeffrey Gauvin, MD; Jennifer Hone, MD; Bindu Kamal, MD; Rachel May, MD; Rahim Raoufi, 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; Grace Park, MD; Joseph Schwartz, MD CMA DISTRICT V TRUSTEE

We’ve also included a list of those who donated to California Medical Association Political Action Committee (CALPAC) this year. With our donors’ support, we were able to elect another physician to the state legislature. Operated by physicians for physicians, CALPAC supports hundreds of candidates for state and federal office who share CMA’s philosophy and vision of the future of health care and medical practice.

Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Priti Gagneja, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Richard E. Anderson, MD, FACP; Penny Borenstein, MD, MPH; California Medical Association; CenCal Health; State of California; Matt Swayne; Tenet Health Central Coast

Members and CALPAC donors are ensuring we have a strong foundation to keep us a dominant force in health care. We will continue working to ensure patients can access doctors to receive high-quality affordable health care. If you are not a member of CCMA/CMA, you can join at www.cmanet.org/join or by calling 800.786.4262. If you want to support candidates and legislators that understand health care, make a donation to CALPAC at www.calpac.org or by calling 800.

CALPAC.9.

We are stronger together.

CONTRIBUTING PHOTOGRAPHERS CenCal Health, Natus Medical Incorporated, Tenet Health Central Coast SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians

Sincerely,

100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 E magazine@ccmahealth.org ADVERTISING rates and information sent upon request.

Dana Goba Chief Executive Officer Central Coast Medical Association

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

A COMPONENT OF THE

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PROTECTING THE PHYSICIANS OF CALIFORNIA A RECORD OF SUCCESS: 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 also gives our members – physicians, residents and medical students – direct access to our state’s and nation’s legislative leaders so they can have a direct impact on the practice of medicine in California.

COVID-19: CMA launched and has maintained an ongoing campaign to support and inform physicians during the COVID-19 pandemic. During this time, CMA has distributed more than $100 million worth of PPE at no cost to physician practices across the state to ensure they are able to safely serve the patients of California. CMA also continues to advocate on all fronts during the COVID-19 pandemic to ensure that the interests of physicians and their patients are considered as local, state and federal governments respond to the pandemic.

PHYSICIAN WORKFORCE: CMA is committed

“Membership in CMA allows me to make a long-lasting difference in the lives of my patients and protect and enhance the practice of medicine in California.”

Bradford Anderson, M.D. Physical Medicine/Rehabilitation Member since 1991

to ensuring California is training enough physicians to meet current and future demand. Expanding funding for graduate medical education to ensure that there are enough residency slots to train physicians in regions where health care services are needed most is one of our top priorities.

PHYSICIAN WELL-BEING: CMA believes physician well-being and professional fulfillment are critical factors in maintaining patient access to quality care, and we must address this challenge at the organizational and systemic level. CMA’s Wellness Program launched Care 4 Caregivers Now in March 2020 to provide physicians with oneon-one emotional support from trained medical professionals in a safe, confidential and nonjudgmental space.

QUESTIONS? CMA’s live-person call center is available Monday through Friday during business hours at (800) 786-4262 or via live chat at cmadocs.org.

Summer 2021

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FIRED

NEED A JOB

!

Unemployment Fever

“To eat, you must sweat first. If you want self-government, you must learn to govern yourself first. If you want to deserve anything, you must learn to serve others first.”

Growing up, I looked at that quote every morning, hanging on the wall above our breakfast nook. My immigrant parents came to this country with nothing but their strive and determination and they made sure I understood that hard work would contribute to a functional and successful society. From a child’s standpoint, they put it in a way I could understand: “You want those jeans? Ok, go learn 50 S.A.T. words and we will get them.”

Or, “You want to sleep over at your friend’s house? Ok, do 50 math questions and I’ll drop you off.” My sister and I knew that we would have to expend intellectual labor to fulfill our social or recreational desires. This quote evolved over the years to mean more.

Today, those teachings are still imprinted upon me, and I set up goals and rewards for myself and my kids all of the time.

When I lived in India from 1996-2003, I saw much social inequity and poverty. When someone on the street asked me for money, locals would advise me not to give it, stating things like - “God gave them arms and legs, a beating heart and brain, give them an opportunity to use it”. Part of that made good sense to me, but another part knew that there was so much more to it than that. Some people are born with so much privilege that they don’t recognize - education, full bellies, generational wealth, and a supportive family.

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PRITI GAGNEJA, MD, PRESIDENT

Summer 2021

I was young, but I still recognized the built-in inequity that helps some and prevents others from thriving economically and emotionally. I didn’t know exactly how to handle it.

So I asked the little boy with a cleft palate who would follow me at the market, “Do you want to help me with these bags up to the auto rickshaw?” Then I’d pay for his meal and give him 50 rupees. He liked this and liked to do work. After two years of knowing this sweet kid, my friend and I arranged a free surgery to repair his cleft palate, with the help of our surgery professor. Surprisingly, his mother declined. I questioned her, but couldn’t get an explanation. Ultimately, she let me know that her family’s income depended on her son’s disability. I was puzzled. Wouldn’t fixing his cleft palate open up more opportunities for him, make him happier and give him a better life? But I had to step back and listen to her. In her experience and perspective, her son’s disability served him better than the surgery could. I could disagree and even judge her for it, but what right did I have? I was born healthy and happy in sunny California with every comfort and privilege.

When I returned to the US, older and more aware of what life could mean in a developing nation, I was in awe of the programs that exist here to help people. Services to help single moms get food, in home support services for family caregivers, laws to protect the rights of disabled people -the list of available government assistance programs seemed endless and amazing.

I remember feeling so grateful for being born in this great nation, full of opportunities and support for its citizens. Since 2004, when I began practicing medicine in the US, I’ve also seen potential misuse of these same programs. I see WIC services go to parents who aren’t really single and choose to remain unmarried. I see highly questionable disability claims, and I see some massaging the truth to receive a benefit they might not qualify for otherwise. I see young capable working individuals on government insurance get all of their medical needs met, but hard-working blue-collar workers struggling to afford regular insurance and unable to qualify for assistance of any kind. Of course, I see these same programs lift people out of dark situations, change lives favorably, and be such wonderful services. I know there will always be manipulation of the system, and we see this also with billionaires and huge corporations avoiding taxes to accumulate more wealth.

So how do we optimize these amazing programs designed to help those in real need, and avoid abuse and potentially fraudulent use on some? There are systems for screening and red tape in place, but that does not guarantee that the services always get to the right people. Wouldn’t people want freedom from disability, even if that disability is economic capability?

Summer 2021

Does a disadvantage or disability serve some people better than resolving it? I don’t have the answers. These services, as imperfect as they are, are a gift. We can only hope that people have the ethical backbones and integrity to take only what they need, even if the greedy corporate examples don’t teach us the same.

When I returned to the US, older and more aware of what life could mean in a developing nation, I was in awe of the programs that exist here to help people.

Where do ethics and integrity come into play? The home front or within the educational system? Teaching our students about societal and structural inequities and how to overcome them may serve us well. Delving deep into the various social support programs that we have at our disposal, offering educational activities that help students understand where the financial and government support for these programs come from, and well as showing our kids how to critically analyze and respectfully debate so we can improve these systems, might serve them better. Allowing discourse and discussions about how privileged so many of us are here and making room for self-reflection might make for better young citizens.

Over the last 18 months, life in the US has been turned upside down. Not only have we shared in the suffering of a worldwide pandemic and the loss of our loved ones, but we’ve

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also lost jobs, incomes, childcare, and classrooms. After a devastating loss of jobs caused by the impact of the pandemic, the US appears to be bouncing back. In April 2020, the unemployment rate reached levels we haven’t seen since the Great Depression. And while today’s unemployment rate is much lower, it’s still far from pre-pandemic levels. Why? Due to the enormous wealth and resources the US has at its disposal, as well as the current administration’s relatively well-organized vaccine rollout, nearly half of the country has been fully vaccinated. In some states, including California, businesses have full reopened, and face coverings and social distancing restrictions have been removed or drastically reduced. California has one the lowest COVID positivity rates in the nation. Yet, despite all of this positive news, many people remain unemployed. What does it say about us, as a society, when we live in one of the wealthiest nations in the world, to have so many people jobless and income-less?

This is a layered and complex issue. I’ve talked with parents whose home life has changed completely. At least one parent has needed to stay at home to help with home-schooling and

do the majority of the child care. Some families have also learned to scale back and live more simply, prioritizing needs.

Additionally, we are seeing that companies that treated their staff well with competitive pay and health benefits, had less job turnover. Ongoing government assistance can seem more appealing than prevailing wages for some, especially when current wages are not up to par with US inflation.

Are all of these factors contributing to an “unemployment fever”?

It is up to us, the people, to build a society that we are proud of, that reflects our hearts, our consciences, and our love for our brothers and sisters. It can only help for us to live in a country where no child is hungry, no one is without adequate healthcare, and everyone can earn a livable wage. If and when we do get to a sense of normalcy with job opportunities, will we ever get to a place wherein people feel, to eat, you must sweat first? Or rather, should we re-examine our beliefs, and question why anyone in our nation should go hungry? Can we trust that we’ll strive to govern ourselves and serve others?

Will ethics and humanity prevail?

WE’RE HIRING • Medical Director (MD), Mental & Behavioral Health • Program Director, Behavioral Health • Manager, Utilization Management • Health Plan Nurse Coordinator

Apply now! cencalhealth.org/workwithus Why work here • Flexible schedules, telecommuting opportunities • Competitive salaries • CALPERS pension, 457 plan, loan forgiveness, license renewal, professional development • Named Best Place to Work on the Central Coast for the last 3 years

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Summer 2021

SBVS Welcomes Dr. Daniel B. Alfson!

Originally a native of North Central Texas, Dr. Daniel B. Alfson recently moved to California to join Santa Barbara Vascular Specialists after completing his comprehensive surgical education and training - General Surgery residency in Los Angeles followed by Vascular Surgery fellowship in Boston. Thanks to his diverse transcontinental training, he brings with him a breadth of experience and innovation in technology for both open surgical and minimally invasive endovascular therapy. As such, his competencies in Vascular Surgery are broad and include management of aortic aneurysms and dissections, carotid artery disease, peripheral artery disease, vascular trauma, hemodialysis access, treatment of DVT, varicose veins, and chronic venous insufficiency.

Daniel Bruce Alfson, MD

Dr. Alfson is also a certified private pilot with a profound interest in aviation. He enjoys hiking and traveling the world, as well as boating and water skiing as part of his family summer lake trip. Dr. Alfson’s family is his most cherished asset, and he strives for perfection as husband to his wife and father to his newborn baby.

Dr. Alfson is looking forward to meeting and getting to know your patients. To consult Dr. Alfson, or to refer a patient, please call 805.456.8890.

Santa Barbara Vascular Specialists 1919 State St, Suite 204 | Santa Barbara, CA 93101 | O: 805.456.8890 | F: 805.456.8894 www.sbvascularspecialists.com | info@sbvascularspecialists.com

1st Capital Bank Provides SBA Financing for Physicians.

Businesses like yours require ready access to capital in order to grow and remain competitive. Our SBA team will work to understand the needs of your practice and will expedite your application to get your loan funded quickly.

Consider an SBA loan for any of the following situations: • Partnership buy-out

• Purchase new medical equipment

• Purchase a new medical practice

• Purchase or refinance real estate for your medical practice

• Refinance existing medical practice debt

Get a no-cost, no obligation SBA loan evaluation.

Now is the time to take advantage of record low interest rates with an SBA Preferred lender!

Contact SVP, Hillary Olson at 530.220.4613 or email hillary.olson@1stcapitalbank.com to discuss how an SBA loan from 1st Capital Bank will work for you.

Member FDIC | Equal Housing Lender | SBA Preferred Lender

Summer 2021

Loans subject to credit approval.

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Tenet Health Central Coast

Sierra Vista Regional Medical Center

Health

Stronger Together

Your Partners in Neurosurgical Care Together, with the University of California, San Francisco (UCSF), Sierra Vista Regional Medical Center is providing a stronger network of neurosurgical services on the Central Coast. Combining nationally recognized expertise and advanced technology, we can help keep you close to home for specialized neurosurgical care.

Why Choose Sierra Vista Regional Medical Center?

• Integrated care with UCSF Medical Center, which ranks number two in the nation and best in California in neurology and neurosurgery by U.S. News & World Report • Advanced technology for enhanced precision of brain and spine procedures • Advanced Thrombectomy Capable Stroke Center Certification • Blue Distinction Center+ for Spine Surgery • The only designated trauma center in San Luis Obispo County

To meet our specialists, visit TenetHealthCentralCoast.com/UCSF 10 CENTRAL COAST PHYSICIANS

Summer 2021

COVID-19 Return-to-Work Resources for Employers As California businesses begin to transition back the physical workplace, employers understandably have many questions about what is, and is not, allowed as we continue to grapple with the fallout of the COVID-19 public health emergency. Working with employment lawyer Oscar Rivas of Landegger Rivas Verano & Davis, the California Medical Association (CMA) prepared an FAQ and webinar to help employers understand their rights and obligations.

Frequently Asked Questions

Returning to the Physical Workspace: Legal parameters and considerations for employers

Members can request a copy by contacting memberservice@cmadocs.org or 800.786.4262.

This FAQ will answer questions such as: what are employer risks of knowing employee’s vaccination status, what are an employer’s legal obligations for employee safety as it relates to COVID-19 (i.e., Cal-OSHA, etc.), can employer require COVID-related safety protocols beyond what is required by federal/state/local law, and if employer requires all employees to return to work in-office, does the employer have to make exceptions or accommodations for employees that request such an accommodation to continue to work from home?

On-Demand Webinar

Return to Work Issues for California Physician Employers www.cmadocs.org/webinars Member Price: Free Non-Member Price: $99

This webinar will answer some of the most common questions employers have about returning to work issues, including whether the employer can inquire if the employee is vaccinated; if vaccination is or can be required for returning employees; whether the employer is required to accommodate employees who want to continue telecommuting; what obligations, if any, will employers have to accommodate employees not vaccinated; and what issues should employers address once employees return to work. This webinar addresses all these issues, as well as provide information on how employers may go about addressing and documenting them.

Summer 2021

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TENET HEALTH CENTRAL COAST’S INNOVATION:

A Powerful Investment in Providers, Community, and Care It is a truism that many great things are accomplished in the face of a formidable foe, such as COVID-19.

This has been exemplified at Tenet Health Central Coast and, while much has happened because of the pandemic, some of the great innovations at Sierra Vista Regional Medical Center and Twin Cities Community Hospital have happened independently of the pandemic.

One obvious example is something you may have seen on the news, or billboards, and that is our relationship with UCSF for neurosurgery that includes technology allowing for real-time consults between Tenet Health Central Coast neurosurgeons and UCSF experts during surgeries. This is a tremendous benefit to our communities and means that the relatively small population of the Central Coast has access to national excellence on a community level.

Innovation is a critical part of Tenet Health Central Coast’s wide-ranging Neuro services that include: •A Neurosurgical scope that fluoresces tumor tissue during surgery, ensuring accurate tumor resection.

•B eing the Central Coast’s accredited Advanced Mechanical Thrombectomy Center as part of an interventional stroke program at both Sierra Vista.

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•T he O-Arm for sub-millimeter precision in spine surgeries that can also help reduce bleeding and risk of nerve damage.

Tenet Heath Central Coast provides advanced technology to other disciplines as well, such as the Savi-SCOUT system at Twin Cities for locating and removing breast tumors: during surgery, the SCOUT guide saves quality tissue by showing the location of the tumor to within one millimeter of accuracy.

Tenet Health Central Coast is the only health care system that offers this technology.

For emergency care innovation, the California Hospital Association has recognized and highlighted Tenet Health’s unique Tele-ER service (www.calhospital.org/tenet-bringsteleer-to-the-central-coast). During the pandemic, this innovation provided a safe space for patients, physicians, and staff because people can call and speak with Emergency Room nurses and doctors to decide if they needed to go to the nearest Emergency Department. Since the height of the pandemic, it has taken on an essential triage and flow role where, in many cases, people do not need to go to ER, and it saves them money and time. In many other cases, they actually do need to go into the nearest Emergency Room and Tele-ER can save lives and

Summer 2021

quality of life.

Another innovation Tenet Health Central Coast has brought to the Emergency Room is the “ER Advisor” app.

This app can be downloaded to the patient’s phone when visiting the ER to help them be informed of the status of their visit, such as how long it might take lab results to come back.

This information can also be shared with family and friends so they may have more peace of mind while a loved one is in the Emergency Department’s care. Even after the visit, the app helps coordinate continuity of care so the healing can continue.

Sierra Vista has the only Level III Neonatal Intensive Care Unit (NICU) in San Luis Obispo County and innovation is helping parents feel connected with their newborn, even when they are physically separate. No parent ever wants to leave the hospital without their baby, and the launch of the NicView webcam system for each baby is one way to keep our families close, whether due to work constraints or the pandemic.

It’s easy to think of innovation as technology-driven, but at Tenet Health Central Coast, innovation can mean advancing quality through programs or approaches to care that help take the fear out of processes and help people feel more comfortable accessing care.

An example of this approach to care is the achievement

Summer 2021

of earning the “LGBTQ+ Health Care Equality Leader” designation from the Human Rights Campaign Foundation (HRC). The designation for both our hospitals confirms Tenet Health Central Coast provides equitable care, in an environment that is welcoming and affirming. It brings a new meaning to “Safe Space” and Tenet Health Central Coast hospitals are the only hospitals in the region with this designation.

Another example of an innovative approach is the care delivery setting. Twin Cities has the only hospital-based Wound Care Clinic in the Central Coast, which not only serves a great public need (over 2,300 visits since February 2020), it promotes continuity of care. By being hospital-based, some necessary aspects of care – such as lab tests, imaging, and diagnostics – can be performed down the hall rather than requiring separate visits to separate facilities that can create an array of challenges, including transportation and delay of treatments.

Ultimately, by combining top technology and quality with meaningful access and community programs, Tenet Health Central Coast is building an infrastructure of quality care in the right place at the right time. Embracing innovation is not only a way to ensure quality of care; it is an investment in our health care providers and, importantly, our community.

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RISK TIP

ARTIFICIAL INTELLIGENCE, COVID-19, AND THE FUTURE OF PANDEMICS RICHARD E. ANDERSON, MD, FACP, CHAIRMAN AND CHIEF EXECUTIVE OFFICER, THE DOCTORS COMPANY AND TDC GROUP

Artificial intelligence (AI) has proven of value in the COVID-19 pandemic and shows promise for mitigating future healthcare crises.

During the pandemic’s first wave in New York, for example, Mount Sinai Health System used an algorithm to help identify patients ready for discharge. Such systems can help overburdened hospitals manage personnel and the flow of supplies in a medical crisis so they can continue to provide superior patient care.

Pandemic applications have demonstrated AI’s potential not only to lift administrative burdens, but also to give physicians back what Eric Topol, MD, founder and director of Scripps Research Translational Institute and author of Deep Medicine, calls “the gift of time.” More time with patients contributes to clear communication and positive relationships, which lower the odds of medical errors, enhance patient safety, and potentially reduce physicians’ risks of certain types of litigation.

However, physicians and health systems will need to approach AI with caution. Many unknowns remain—including potential liability risks and the potential for worsening pre-existing bias. The law will need to evolve to account for AI-related liability scenarios, some of which are yet to be imagined.

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Like any emerging technology, AI brings risk, but its promise of benefit should outweigh the probability of negative consequences— provided we remain aware of and mitigate the potential for AIinduced adverse events.

AI’S PANDEMIC SUCCESS LIMITED DUE TO FRAGMENTED DATA Innovation is the key to success in any crisis, and many healthcare providers have shown their ability to innovate with AI during the pandemic. For example, researchers at the University of California, San Diego (UCSD) health system who were designing an AI program to help doctors spot pneumonia on a chest x-ray retooled their application to assist physicians fighting coronavirus.

Meanwhile, AI has been used to distinguish COVID-19specific symptoms: It was a computer sifting medical records that took anosmia, loss of the sense of smell, from an anecdotal connection to an officially recognized early symptom of the virus.

This information now helps physicians distinguish COVID-19 from influenza.

However, holding back more innovation is the fragmentation of healthcare data in the U.S. Most AI applications for medicine rely on machine learning; that is, they train on historical patient

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CCMA members receive additional savings!

Summer 2021

data to recognize patterns. Therefore, “Everything that we’re doing gets better with a lot more annotated datasets,” Dr. Topol says. Unfortunately, due to our disparate systems, we don’t have centralized data. And even if our data were centralized, researchers lack enough reliable COVID-19 data to perfect algorithms in the short term.

Or, put in bleaker terms by the Washington Post: “One of the biggest challenges has been that much data remains siloed inside incompatible computer systems, hoarded by business interests and tangled in geopolitics.”

The good news is that machine learning and data science platform Kaggle is hosting the COVID-19 Open Research Dataset, or CORD-19, which contains well over 100,000 scholarly articles on COVID-19, SARS, and other relevant infections. In lieu of a true central repository of anonymized health data, such large datasets can help train new AI applications in search of new diagnostic tools and therapies.

AI INTRODUCES NEW QUESTIONS AROUND LIABILITY While AI may eventually be assigned legal personhood, it is not, in fact, a person: It is a tool wielded by individual clinicians, by teams, by health systems, even multiple systems collaborating. Our current liability laws are not ready for the era of digital medicine.

AI algorithms are not perfect. Because we know that diagnostic error is already a major allegation in malpractice claims, we must ask: What happens when a patient alleges that diagnostic error occurred because a physician or physicians leaned too heavily on AI? In the U.S., testing delays have threatened the safety of patients, physicians, and the public by delaying diagnosis of COVID-19.

But again, healthcare providers have applied real innovation— generating novel and useful ideas and applying those ideas—to this problem. For example, researchers at Mount Sinai became the first in the country to combine AI with imaging and clinical data to produce an algorithm that can detect COVID-19 based on computed tomography (CT) scans of the chest, in combination with patient information and exposure history.

AI IN HEALTHCARE CAN HELP MITIGATE BIAS—OR WORSEN IT Machine learning is only as good as the information provided to train the machine. Models trained on partial datasets can skew toward demographics that turned up more often in the data—for example, Caucasians or men over 60. There is concern that “analyses based on faulty or biased algorithms could exacerbate existing racial gaps and other disparities in health care.” Already during the pandemic’s first waves, multiple AI systems used to classify

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x-rays have been found to show racial, gender, and socioeconomic biases.

Such bias could create high potential for poor recommendations, including false positives and false negatives.

It’s critical that system builders are able to explain and qualify their training data and that those who best understand AI-related system risks are the ones who influence healthcare systems or alter applications to mitigate AI-related harms.

AI CAN HELP SPOT THE NEXT OUTBREAK More than a week before the World Health Organization (WHO) released its first warning about a novel coronavirus, the AI platform BlueDot, created in Toronto, Canada, spotted an unusual cluster of pneumonia cases in Wuhan, China.

Meanwhile, at Boston Children’s Hospital, the AI application Healthmap was scanning social media and news sites for signs of disease cluster, and it, too, flagged the first signs of what would become the COVID-19 outbreak—days before the WHO’s first formal alert.

These innovative applications of AI in healthcare demonstrate real promise in detecting future outbreaks of new viruses early. This will allow healthcare providers and public health officials get information out sooner, reducing the load on health systems, and ultimately, saving lives.

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California’s Physician Practice Vaccine Support Grants Program

As California continues its efforts to vaccinate all eligible residents against COVID-19, the state is creating new support for communitybased physicians to help our state reach its vaccination goals.

The CalVaxGrant is a new program administered by Physicians for a Healthy California (PHC) that will offer grant funding, oneon-one myCAvax support and vaccine administration resources for physician practices. To be eligible, practices must complete section A of the myCAVax application process.

Funded by the California Department of Public Health (CDPH), the practice support grants will help physicians and medical practices (with 200 or fewer physicians) administer COVID-19 vaccines in their community, as well as reimburse

for related expenses incurred since November 2020. Allowable expenses include staffing, training, technology, infrastructure, supplies/equipment, and administrative overhead.

The CalVaxGrant application cycle runs July 12 through August 13, 2021.

Small practice providers can apply to receive $10,000 for up to five vaccination sites for a total of $50,000. Additionally, small practice providers can receive an additional $1,000 per site (up to five sites for an additional $5,000) if their vaccination sites match high priority areas as noted by the CDPH.

For more information www.phcdocs.org/Programs/CalVaxGrant calvaxgrant@phcdocs.org 916.551.2565

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TOGETHER WE ARE STRONGER The Central Coast Medical Association and California Medical Association thank the following physicians for membership and support to protect physicians’ profession and patients.

If your name is not on this list, join your colleagues at www.cmadocs.org/join or by contacting us at memberservice@cmadocs.org or 800.786.4262.

Membership list as of July 15, 2021. Every attempt was made to ensure accuracy. If your information is incorrect, please contact us at 805.683.5333 or ccma@ccmahealth.org.

Mark Steven Abate David Abbott Stephen Lee Abbott Rushdi Abdul-Cader Shields Brewster Abernathy Mitchell Adler Thomas Aguirre Hosam Ahmad Bina Ahmed Michael Edward Aldridge Hamid Alipour Bashir Allahdadi Eric Michael Alltucker

Summer 2021

Richard Ira Altesman Eric Rey Amador Gilbert O Andersen Seth Eli Anderson, Jr Thomas Gerald Anderson Thomas Robert Anderson John Onssy Anis Henning Ansorg Andrew Martin Anthony Joseph Raymond Aragon, Jr Hiwot Hagos Araya Felipe De Jesus Arce Benton Turner Ashlock Michelle Renee Auran

Timothy Leonard Auran Robert Logan Avery Keith Alan Ayrons Wei Bai Bruce R Bailey Rollin C Bailey Summer Baird Dennis Baker Claudia Balderrama Polly Baldwin Julian Xander Valentin Bandura Steven Colin Barkley Vida Baron

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Maria Irmgard Barrows Charish Leann Barry H Richard Barthel Sharon L Basham Robert K Baum Thomas L Beamer David L Bearman Andrew Duane Beckler J Kevin Beckmen Michael Jamison Behrman Christel Bejenke Richard A Belkin Jeremy Stephen Bennett Jeoffrey P Benson Edward Bentley James Benzian Daniel Nathan Berger Alex Glenn Bergman Mica Bergman David A Bernhardt Michael Lewis Bernstein Ryan Scott Berry Tamara Marie Berry Julia Ann Billington Andrew Binder David L Birken Scott Edward Bisheff Jerold Adrian Black Cindy Blifeld Laurel Athena Bliss Jeffrey Martin Bloom Gary M Blum Mark C Bocchicchio Michael Bordofsky Penny Borenstein Jason Edward Boyatt Rabindra Alfred Braganza Sushila Linda Braganza Joel Hershel Brandt Blaine Braniff Stuart Braverman Rene Henry Bravo Daniel Russell Brennan James Gerard Brewer William K Brokken Brittany Alice Bryan Roy Gordon Bryan, II Leanne Renee Buckner Daryl Burgess

Chadler Ryan Burgoyne Mark E Burnett William E Buys David Alan Canvasser Kevin Michael Casey Alessandro Attilio Castellarin Kristin Nicole Castorino Thomas Clarence Caves James Cavins Gayle Susan Cekada Julie Adele Chacko Jinny Ei Chang Linda Sian Chen Rosa Sung Eun Choi Bernard Chow Nicole Marie Christiano Katherine Chung Richard Yung Chung Wendy Anne Ciovacco Eduardo Enrique Clark Steve Russell Clarke Michael G Cline Gregory Alexander Cogert Jessica Ann Cohen-Brown Kevin Francis Colton William Charles Conway II Cary Conyers Barry Coughlin Stephen S Couvillion Carin Lynn Craig Daniel F Craviotto, Jr P Kent Cullen, Jr David Michael Cumes Daniel Jay Curhan David d’Ablaing Olga Daiber Gustavo Dascanio Karen B Dasilva Kenneth Daughters Thomas Daughters, Jr Bret E Davis Julian Reed Davis Charity Anne Dean Julia Delgado Philip Delio Vincent Pope DeRosa Arpan Jitendra Desai Kamlesh M Desai Scott Michael Dewhirst

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Thank you to CCMA members who have donated to the California Medical Association Political Action Committee (CALPAC) Eric Michael Alltucker Eric Rey Amador Andrew Martin Anthony Steven Colin Barkley Sharon L Basham Edward Bentley Jeffrey Martin Bloom Rene Henry Bravo James Gerard Brewer Kevin Michael Casey Kevin Francis Colton David Charles Dodson Douglas Barrie Duncan Douglas Etsell Julie Cecilia Fallon P Joseph Frawley Jeffrey Charles Fried Priti Gagneja Stephen Raymond Holtzman Jennifer Hone Douglas R Jackson Samira Kayumi-Rashti Robert A Kolarczyk Garry Richard Kolb Karen S Kolba Roger I Lane Christopher George Lumsdaine Douglas P Murphy Grace Eunmi Park Robert Poulin John Michael Sawyer Joseph Alan Schwartz Thomas Van Meter Fred Steve Vernacchia Steven Zelko

More than ever, health care in California is highly regulated and legislated, with constant threats to your clinical autonomy.

Successful advocacy depends upon an integrated approach utilizing lobbying, grassroots activism and political action through CALPAC. If you want to support candidates and legislators who understand health care, make a donation at www.calpac.org.

Summer 2021

Michael Joseph DiBiase Robert Dichmann Benjamin Godfrey Diener David Charles Dodson Barbara Joan Donnelly Charles Christopher Donner Steven Eric Dosch K Charmian Dresel-Velasquez Aroma Dulku William Henry Dunbar, V Douglas Barrie Duncan James Timothy Dunn Margaret L Echt James V Egan John Glen Elder Todd William Engstrom Duard Enoch, III Patricia L Erbe Douglas Etsell Julie Cecilia Fallon Ryan James Fante Donald Omar Fareed Todd Fearer Charles C Fenzi Kevin L Ferguson Mary Elina Ferris Robert I Fishburn Michael Fisher David Thomas Fisk Cary J Fitchmun Lynn Nisbet Fitzgibbons Christopher Flynn Kristin Elizabeth Fontes Peter G Ford Adam James Forrest Garrett Edwin Foulke P Joseph Frawley Joseph Dreyfuss Freeman Jeffrey Charles Fried Gregory John Frye Richard Fulton Priti Gagneja John W Gainor John Gregory Gaitan William Louis Ganske Bryan Joshua Garber William H Gausman, Jr Jeffrey M Gauvin Eric Michael Gavarre

Summer 2021

William James Gealy, Jr Andrew Scott Gersoff Brett A Gidney Donald Gillies David S Gillon Rebecca D Golgert William Alan Golgert Robert Lawrence Gong Liana Gonzalez Vishal Goyal Gregory Clay Greaney Justin Lee Greene Daniel Reif Greenwald Howard Gross Elizabeth Myers Grossman Alicia Guevara Page Maryam Guiahi Khawar Gul Mukul Gupta Cory Gusland Gloria Hadsall Jeffrey Matthew Hadsall William Victor Hahn Sawyer Bailey Haig Thomas Walter Hale Saida Hamdani Richard E Hammond Jeffrey Hankoff Laurel Hansch Stephen L Hansen Muhammad Salman Ul Haq Bilal Harake Kathryn Claire Haran Robert D Harbaugh Marvin Harrah Anna Harter Jacob L Harter Lawrence Phillip Harter Steven Hartzman Robert A Harway Peter Lee Hasler Farid Hassanpour Robert Hawkins Paul Dietrich Hennig William J Heringer David Hernandez Jeff Herten Stephen A Hilty John Hans Hirschberg

David Hirt Bryce Richard Holderness Glenn William Hollingshead Stephen Raymond Holtzman Taylor James Holve Jennifer Hone Bradley E Hope Stephen Hosea Benjamin Michael Howard Bruce Howard Randall Hugh Howard Barbara A Hrach Angela Ai-Chieh Hsu Charles Michael Hubeny Pierre-Alain Hueber Robert Michael Hullander Graham R Hurvitz James P Ingersoll Douglas R Jackson Douglas W Jacobson Lauren Elaine Jacobson Robert Jacoby W Blake Jamison Matti Rose Jansen Karen Jensen Johnson Thomas Harlow Jones Darol D Joseff Mark Christopher Juretic Richard Kahmann Bindu Kamal Karl Kassity Samira Kayumi-Rashti Kyle Richard Kelson Ryan Francis Kendle Rachel Kernoff Robert Jeffrey Kershaw Tamir H Keshen Case H Ketting John Khan-Variba Sylvia Kim C Seybert Kinsell Phillip Kissel Robin P Knauss Bradley C Knox Oma Christine Knox Brian Koch Roger Kohn Robert A Kolarczyk Garry Richard Kolb

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Karen S Kolba Ernest Thomas Kolendrianos Li-Sheng Kong Alex Koper, II Tatyana Kopilova Hannah Wilks Kornfeld Jennifer B Kosek Kenneth S Kosik Brent Kovacs Elizabeth Ingrid Krenz Kenneth Dale Krone Sanjay Kumar Bradley Shawn Kurgis Alicia Mikolaycik Kurtz Christopher Kuzminski James Lawrence Kwako Francis Peter Lagattuta Anh Tuan Lam Christopher V Lambert Erica J Lambert Roger I Lane Sarah Elizabeth Langdon David LaPatka Jeremy William Lash Ronald Latimer Baochuong Quy Le Ann Miehyung Lee Arthur Lee Wonuk Lee Kyle Worthington Lemon Stephen Lemon Susan Lemon Hollanda Leon Winifred K Leung Edward Ned Li Danny Leroy Lickness Myron Israel Liebhaber Donald E Lindblad Steven Seth Lipman Anne E Little Keith Llewellyn Morgan Lloyd Mark E Logan Caitlin Rae Loseth Thomas S Lossing Laurence Hamilton Lotz Adam D Lowenstein Miguel Angel Loya Gary Michael Lucchesi

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Bryant Jay Lum George Philip Lum Christopher George Lumsdaine Kurt Franklin Lundquist Christopher Vaughn Lutman Thuthiri Thandar Lwin Tomas Manuel Machin Richard Joseph Macias Robert Christian Maciel Cory Anderson Malone Robin Elizabeth Malone-Cunnison Laurence Mamlet David Adam Mandel Kateryna Markova Kari K Mathison Rachel May David L McAninch, III John McCaffery Edward J McGinn Stanley Eugene McLain, Jr Lowell McLellan Steven Douglas McMurtry James McNamara David Medina Arnold Medved Anthony Mendesh Marilyn Mendoza Andrew Francis Mester Toni Takiko Meyers Sherif Michael Randall G Michel Monica Micon Kelli Jean Miller Richard Miller James F Mitchell, Jr James Allen Moghtader Arthur Morel Alexander Eduard Morf Peter Morris Karen Moyes Ralph Mozingo Jamil Suheil Muasher Douglas P Murphy Robert M Nagy Ma’an Aziz Nasir Gregg Charles Newman Ted B Newman Joann Ng Dung-Hoa Thi Nguyen

Charles H Nicholson Sara Taylor Nimmons Pierre Nizet David L Nomeland Joseph A Nunez David Ernest Nunnelly William Kiernan O’Callaghan Thomas Ochsner Arbi George Ohanian Robert W Olson Michael Jon Omlid Kevin C Osburn Stanley Ostern William Michael Pace Grace Eunmi Park David Paul Michael Paveloff Nancy A Pawlik Steven Pearson Meredith Ann Perrin Timothy J Perrin Monica Renee Phillips David Lockard Phreaner Dante Joseph Pieramici Jordan Eliot Pinsker David C Pires Michael Isidro Polo Theodore Polos Mark Ford Pomerantz Richard S Ponce Robert Poulin Christian Harrington Powell Elliot Prager Liza Presser Belkin Spencer Eugene Price George Primbs Jason J Prystowsky Ralph Quijano William Rack Bruce Dudley Ragsdale Anita Rai Beverly Joy Sanson Ramos Susanne Lucille Ramos Kurt N Ransohoff Rahim Ali Raoufi David Aaron Raphael Karim Rasheed Thomas Reaper Cinnamon Hampikian Redd

Summer 2021

Jason M Redd Jana Kokkonen Reed Ashton Donnelle Regalado-Magdos Robert Alfred Reid Juan Reynoso Donald Rhodes Mark G Richmond Jonathan Lee Riegler Sylvia Cristina Rivera Brian Michael Roberts H Douglas Roberts Joseph Andrew Robinson Timothy Leigh Rodgers Anne O’meara Rodriguez Alexandra E Rogers Anthony Rogers Anthony C Romero Thomas George Ronay Margot Roseman Frederick Semenov Rosen Joaquin Roses Daniel Roshan Andrew Gregory Ross Barry J Ross Shane Dee Rostermundt, I Stephanie Joy Rothman Lewis Rubin Sergio Rafael Rubio Lynn A Rudman Rebecca Lynn Ruebsamen Andria Ruth Robert Merrill Ruth Paul Ryack Jeffrey Seymour Sager Dustin Gabriel Sanchez Karl Sandin Brian David Santacrose River Liuyuan Saul John Michael Sawyer Matthew Bennett Scales Philip Scheinberg Carl Schlosser Wesley G Schooler Joseph Alan Schwartz Mary-Louise Scully Stuart Douglas Segal Roberta D Sengelmann Laleh Shaban Colin David Shafer

Summer 2021

Ayesha Shaikh William A Shapiro William Sheehan Michael Mourad Shenoda Eric F Shepherd Anthony W Sheplay Virginia Ann Siegfried Mark Lewis Silverberg John Sim Eric Matthew Sincoff Manu Kush Singh Clinton Andrew Slaughter Margaux Kelly Snider Sean Snodgress Alex Soffici Mark Ian Soll Marta Sovilj Timothy M Spiegel Cameron James St Hilaire Mareeni T Stanislaus Donald Larry Stanton Nathan Christopher Steinle Nicole G Stern Dustin Erin Stevenson Noah Stites-Hallett Monica Leigh Straatmann Gary Strachan Cathy Anne Straits David Strumpf Rachel Subramanian Mark Wayne Surrey Gerald Svedlow Paul John Swedberg Sasha Lynn Szytel Brian Taber Victor Andrew Tacconelli Reyna Maria Talanian Sara Taroumian Dominic John Tedesco Stefan Robert Teitge Heather Irene Terbell Christopher John Thrash Scott Baringer Tobis Casey John Toole Mandana A Toole Michael Trambert Rachel Elisabeth Trautwein Pansy Tsang Kenyon Tsao

Vincent C Tubiolo Nedeljko Jakov Uncanin, Jr Ronald G Ungerer Jon R Uyesaka Gary Van Deventer Thomas Van Meter Fred Steve Vernacchia Rafael Sollesa Victoria, Jr David J Vierra Christian J Voge John Vowels Martin Walker Edward R Wallace Sharon Evelyn Watson Alex J Weinstein Marc W Weise Thomas Weisenburger Brandon Marshall Welbourn J Patrick Wheelock Anne White Richard Wikholm Barry Williams Carl Williams Matthew Akira Williams Judith Willis Paul Willis Avery May Kenyon Wilmanns Brett Wilson, II Jay Michael Winner Stuart Robert Winthrop Michelle Withee John D Wrench Robert Simpson Wright Edmund M Wroblewski Michael L Wyatt Steven Yao Jeffrey Bernard Yim John Yoon Mira Han Yoon Hsien Cheng Young Steven H Young Stephanie Patricia Zamora Steven Zelko Marc Zerey David Abram Zisman James Conard Zmolek

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Public Health

Update

Connecting Patients with Vaccine

Physicians’ Role in Ending the Pandemic

BY PENNY BORENSTEIN, MD, MPH, HEALTH OFFICER/PUBLIC HEALTH DIRECTOR, COUNTY OF SAN LUIS OBISPO

As a physician in a community where vaccines are plentiful, you play a critical role in helping to end the COVID-19 pandemic.

Patients consistently rank physicians as their most trusted source of vaccine information. You can help your patients and their family members understand the importance of vaccination, provide your strong recommendation, and build confidence in vaccines.

Strong vaccine confidence leads to more people getting vaccinated, which leads to fewer COVID-19 I hope you will consider some of these ways you can be a part of vaccination efforts in your community: •C ounsel patients during visits. A January study of vaccine hesitancy by the Kaiser Family Foundation found that 8 in 10 people will turn to doctors, nurses, and other health care providers as trusted sources of information when making decisions about whether to get vaccinated, but only a quarter of respondents had asked a healthcare professional for information about the vaccine.

CDC has resources to help with these conversations, available at www.RecoverSLO.org/HealthCare.

• P rovide educational materials to patients and staff. Sharing a simple handout and talking about any questions or concerns may help those who

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illnesses, hospitalizations, and deaths.

I am asking all local healthcare providers to actively play a role in ending this pandemic. Your level of involvement depends on you. It can be as simple as making information available to your patients and staff, taking a moment to talk with all your patients about COVID-19 vaccination, or offering COVID-19 vaccine in your practice. The County of San Luis Obispo Public Health Department has dedicated resources to support you. are willing but just need more information to move ahead with vaccination. Both CDC and CDPH have a good selection of informative resources.

For links to these resources, see RecoverSLO.org/ HealthCare.

• E ducate staff and encourage them to get vaccinated. Talk to your staff about the importance of COVID-19 vaccination. Their decision to get vaccinated can protect more than just their own health. It can also help protect their colleagues, patients, families, and community. CDC has training materials and other resources, available at RecoverSLO.org/HealthCare, to help with these conversations. Our team can also meet with your staff or host a staff vaccine clinic.

• Host a pop-up clinic for your patients.

Summer 2021

Our mobile vaccine unit can come directly to you to administer vaccines for your patients. For more information and to request a visit from the mobile team, visit www.RecoverSLO.org/MobileVaccine.

• A dminister the COVID-19 vaccine. We encourage health care providers in SLO County to enroll in the California Vaccination Program to receive COVID-19 vaccine for eligible patients. For an overview of the process, visit the enrollment portal at mycavax.cdph.ca.gov. SLO Public Health can assist with enrollment and equipment costs.

• S hare vaccine information through your practice’s website, newsletters, or social media.

Include one of our video PSAs about the benefits of COVID-19 vaccines or what to expect at your vaccine appointment in your next newsletter. Offer to answer questions about the vaccines, or direct patients to our

FAQ page at www.RecoverSLO.org/VaccineFAQs. Share our ready-made social media posts from www.

TheSocialPressKit.com/SLO-County, or let us know what tailored content we can make for your messaging channels.

• I nform the broader community. Sharing your own personal thoughts and experience with the COVID-19 vaccine is impactful for the people in your care and the community as a whole. Speak at community events or engage the local media and encourage other physicians to do so as well. If you’re interested in serving as a spokesperson through our Public Health outreach, please let me know.

The work we do together as a medical and public health community to vaccinate our community in the months ahead will have a profound impact on the course of this pandemic. Thank you for taking on this challenge together, for individual patients and for our community as a whole.

I encourage you to complete the brief survey from us and the Central Coast Medical Association, available online at https://bit.ly/ Physician-Survey-SLOCounty. The survey asks you what role you and your practice are able to play and what support you’ll need from us in the way of staff expertise, equipment, technical assistance, outreach and education materials, and other resources.

Summer 2021

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CenCal Health NEWS HUB:

CENCAL HEALTH SALUTES ALL CARE WORKERS

Nurses, Social Workers, Case Managers Recognized by Local Health Plan

Every year in May, the country celebrates National Nurses Week. For 2021, CenCal Health took that opportunity to publicly recognize all workers who improve the lives of others through “giving care.”

At the largest health plan on the Central Coast, there are over 60 employees whose job description contains the word “care”. These employees are experienced nurses, licensed social workers and dedicated case managers in various departments at CenCal Health, including Health Services, Quality Management, Medical Management, Utilization Management, and Provider Services. Although they may not work in a doctor’s office, clinic, or hospital, they play an integral part in managing the health of hundreds of thousands of Medi-Cal members in Santa Barbara and San Luis Obispo counties. Three are highlighted here: Laci Crouch is a former hospital emergency room nurse with a Texas accent. After 15 years of nursing in her home state, Crouch moved to California and went to work

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for CenCal Health, which was just starting a specialized pediatric unit to support Medi-Cal members who are also eligible for California Children’s Services. These special health services are for children and teens who have chronic medical conditions such as cystic fibrosis, cerebral palsy, cancer, and traumatic injuries. As a Health Plan Nurse Coordinator, Crouch is a senior member of the team that manages the treatments and care of these vulnerable children. “Every day and many times a day, I get to help children and families improve their lives,” said Crouch. “It might be approving a request for a wheel chair repair for a young boy. That might not seem like a big deal to most people but for a low-income family – whose fragile child has grown too big to pick up and carry – a functioning wheel

Summer 2021

If you are interested in a career at CenCal Health, visit the organization’s website at www.cencalhealth.org/explore-cencal-health/careers.

chair means the world.”

CenCal Health employee Rose Vazquez, LCSW serves members in the Pediatric Case Management department. As a pediatrics social worker, Vazquez provides “psycho-social” support to at-risk children who require highly complex medical services, often including physical and occupational therapy. Frequently, these children are in families that have no or low income, so they also need to access vital resources such as housing and food. “One family I worked with was struggling with transportation to medical appointments, and the child member needed an important follow-up appointment after a recent surgery,” recounted Vazquez about the single-parent family who was also struggling with homelessness. Vazquez moved quickly to connect the family to a social service agency that could help with transportation.

“Over the phone I assisted this overwhelmed parent, simultaneously using my computer to fill out her application for a gas card and submitting it just in time so that the family could drive a friend’s car to see that physician.”

Growing up in a family that also needed social service programs, Vazquez has, in her words, “been doing this work my whole life.” As a young child, she was the interpreter between her Spanish-speaking mother and the social workers and agency employees that aided her family in need. This experience led Vazquez – with her obvious resilience and caring heart – to go on to college at UCSB and graduate school at USC, successfully achieving her career goal of becoming a licensed clinical social worker.

Both Crouch and Vazquez emphasized the importance of “the team” at CenCal Health. They each mentioned the admirable work of the “CSAs” or Clinical Support Associates, who assist with member health management. For the past six years, Angelica Laurel-Castro has served as a CSA at the health plan. When she describes her day-to-day job responsibilities, it appears she is a combination of detective

Summer 2021

and educator. Tracking down medical records for a patient who recently moved from another county and had mixed up her medications, or finding local services that will help a member and their family with food scarcity, are just two examples. “I love my job because I love helping people,” said Laurel-Castro. “Maybe because I had a mother who always helped others in our neighborhood – early on I followed her lead.” Before coming to CenCal Health, Laurel-Castro worked 20 years in public health for Santa Barbara County.

Laurel-Castro summed it up, “to have a member patient call you ‘an angel’, to feel the gratitude of a lonely senior after you’ve taken extra time to schedule their medical appointments, to be able to give individualized attention to someone in need – that is the greatest reward of a care career.”

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COVID-19 Vaccine Marketplace

Need Vaccine? Have Too Much Vaccine?

Check out the Vaccine Marketplace Now Available in myCAvax!

In order to accelerate the use of vaccine before it expires, providers are now able to share or post interest in stateallocated doses in the myCAvax Vaccine Marketplace!

This new feature is open to all providers in the COVID19 Vaccination Program who are approved in myCAvax, including newly enrolled providers and all other providers, regardless of TPA network enrollment or if they have never received doses.

Requesting or Sharing Vaccine is Easy.

All you need to do is log in to myCAvax, find “Vaccine Marketplace” in the menu and complete the required information.

• P roviders who need vaccine can request vaccine doses if they are able to use the doses before expiration.

• P roviders with short-dated or excess vaccine can report

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doses that they will not be able to use. Make sure to report the Beyond Use Date (BUD) which is the last date that a product can be safely used based on vaccine storage or preparation conditions.

•L ocal Health Departments (LHDs), CDPH, and the TPA will match up providers who have extra vaccine with those who want vaccine based on proximity, product needed, and ability to properly transport and receive vaccine. Providers do not need to contact each other.

• P roviders who are not allocated doses by the TPA or LHDs may continue to request doses in the Marketplace as long as vaccine is available in their area.

Note: The Marketplace is not a substitute for reporting of emergency transfers or redistribution of vaccine in myCAvax or vaccine requests. Additionally, a match is not guaranteed.

Summer 2021

Tips for Posting in the Marketplace If you are posting requests for short-dated/excess doses available: • I f you are willing to take any brand, just add a note in your post.

•A lso note if you are willing to pick up vaccines, following proper packaging and transport guidance.

•O nce you received doses from a post, make sure to 1) close your post, and 2) enter the transferred doses in myCAvax.

If you are posting short-dated/excess doses available: •M ake sure to include product brand, lot number, expiration date, and beyond use date (BUD).

•D o not include vaccine that has been exposed to temperature excursions.

•N ote where vaccines are stored now, and if you are willing to transport vaccines.

•Y ou should close excess vaccine post once vaccines have been transferred out.

• I f only part of the doses reported are transferred, close the original post and enter a new post with new available amount.

Summer 2021

Reminders for Transporting Vaccines • F ollow proper vaccine transport guidance in the Transferring Vaccines job aid.

•R eport transferred doses in myCAvax.

Do Not Donate Vaccines Many of us are asking the question if we can donate vaccines outside the US to support international COVID vaccination efforts. We have asked, and only the federal government can export vaccines abroad and provide the necessary proof that the cold chain has been maintained. COVID-19 vaccines were purchased using federal funds; any decision to export vaccines must come from the federal government.

Need Help?

For questions regarding the COVID-19 Vaccination Program, please contact the COVID-19 Call Center: Phone: 833.502.1245 (Monday – Friday, 8AM–8PM) Email: covidcallcenter@cdph.ca.gov

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CL

DS

F I S IE S A

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

CENTRAL COAST HOME HEALTH AND HOSPICE is a fast-growing freestanding company with the energy, flexibility, and commitment to do more than other corporate based home health agencies. Opportunities can be found at www.centralcoasthomehealth.com.

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

The COUNTY OF SANTA BARBARA delivers exceptional

services so Santa Barbara County’s communities can enjoy a safe, healthy, and prosperous life. Opportunities can be found at www.sbcountyjobs.com.

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

SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 180 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine.

Opportunities can be found at www.sansumclinic.org/ physician-provider-job-opportunities.

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

If you would like to submit a listing to our Classifieds, contact ccma@ccmahealth.org.

Listings are free for members with reasonable rates for nonmembers.

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Summer 2021

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

...and even more on the way.

Andrew Beckler, MD Facial Plastic and Reconstructive Surgery Santa Barbara Sansum Clinic (805) 681-7844 Jeremy Bennett, MD Family Medicine Santa Barbara Sansum Clinic (805) 563-6110 Mica Bergman, MD Ophthalmology Santa Barbara Sansum Clinic (805) 681-7500 Wendy Ciovacco, MD Emergency Medicine Santa Maria Vituity (805) 739-3000 Scott Dewhirst, MD Psychiatry Santa Barbara Sansum Clinic (805) 681-7517

Summer 2021

Bryan Garber, MD,MS Pulmonary Critical Care Medicine Santa Barbara Sansum Clinic (805) 898-3400 Alicia Kurtz, MD Emergency Medicine Santa Maria Vituity (805) 739-3000 Sara Nimmons, MD Pediatrics Santa Barbara Sansum Clinic (805) 563-6211 Jana Reed, MD Emergency Medicine Arroyo Grande Vituity (805) 489-4261 Kenyon Tsao, MD Emergency Medicine San Luis Obispo Vituity (805) 739-3114

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PATIENTS MAY NOT TAKE ADVICE FROM AI DOCTORS WHO KNOW THEIR NAMES

BY MATT SWAYNE

As the use of artificial intelligence (AI) in health applications grows, health providers are looking for ways to improve patients’ experience with their machine doctors.

Researchers from Penn State and University of California, Santa Barbara (UCSB) found that people may be less likely to take health advice from an AI doctor when the robot knows their name and medical history. On the other hand, patients want to be on a first-name basis with their human doctors.

When the AI doctor used the first name of the patients and referred to their medical history in the conversation, study participants were more likely to consider an AI health

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chatbot intrusive and also less likely to heed the AI’s medical advice, the researchers added. However, while chatting online with human doctors they expected the doctors to differentiate them from other patients and were less likely to comply when a human doctor failed to remember their information.

The findings offer further evidence that machines walk a fine line in serving as doctors, said S. Shyam Sundar, James P. Jimirro Professor of Media Effects in the Donald P. Bellisario College of Communications and co-director of the Media Effects Research Laboratory at Penn State.

“Machines don’t have the ability to feel and experience, so

Summer 2021

when they ask patients how they are feeling, it’s really the paper. just data to them,” said Sundar, who is also an affiliate “We chose to focus this on COVID-19 because it of Penn State’s Institute for Computational and Data was a salient health issue during the study period,” Sciences (ICDS). “It’s possibly a reason why people in said Jin Chen. the past have been resistant to medical AI.” Accepting AI Doctors Machines do have advantages as medical providers, As medical providers look for cost-effective ways to said Joseph B. Walther, distinguished professor in provide better care, AI medical services may provide communication and the Mark and Susan Bertelsen one alternative. However, AI doctors must provide Presidential Chair in Technology and Society at care and advice that patients are willing to accept, UCSB. He said that, like a family doctor who has according to Cheng Chen, doctoral student in mass treated a patient for a long time, computer systems communications at Penn State. could — hypothetically — know a patient’s complete “One of the reasons we conducted this study was medical history. In comparison, seeing a new doctor that we read in the literature a lot of accounts of how or a specialist who knows only your latest lab tests people are reluctant to accept AI as a doctor,” said might be a more common experience, said Walther, Chen. “They just don’t feel comfortable with the who is also technology and director of The team designed five chatbots for the two-phase study, they don’t feel that the Center for recruiting a total of 295 participants for the first phase, 223 of the AI recognizes Information whom returned for the second phase. In the first part of the their uniqueness Technology study, participants were randomly assigned to interact with as a patient. So, we and Society at either a human doctor, an AI doctor, or an AI-assisted doctor thought that because UCSB. machines can retain “This struck through the chat function. so much information us with the about a person, they question: ‘Who really knows us better: a machine that can provide individuation, and solve this uniqueness can store all this information, or a human who has problem.” never met us before or hasn’t developed a relationship The findings suggest that this strategy can with us, and what do we value in a relationship with a backfire. “When an AI system recognizes a person’s medical expert?’” said Walther. “So this research asks, uniqueness, it comes across as intrusive, echoing who knows us better — and who do we like more?” larger concerns with AI in society,” said Sundar.

The team designed five chatbots for the two-phase In a perplexing finding, about 78% of the study, recruiting a total of 295 participants for the first participants in the experimental condition that phase, 223 of whom returned for the second phase. In featured a human doctor believed that they were the first part of the study, participants were randomly interacting with an AI doctor, said the researchers. assigned to interact with either a human doctor, an Sundar added a tentative explanation for this finding AI doctor, or an AI-assisted doctor through the chat is that people may have become more accustomed function. to online health platforms during the pandemic, and In the second phase of the study, the participants may have expected a richer interaction. were assigned to interact with the same doctor again.

In the future, the researchers expect more However, when the doctor initiated the conversation investigations into the roles that authenticity and in this phase, they either identified the participant the ability for machines to engage in back-and-forth by the first name and recalled information from the questions may play in developing better rapport with last interaction or they asked again how the patient patients. preferred to be addressed and repeated questions The researchers presented their findings at the about their medical history. virtual 2021 ACM CHI Conference on Human In both phases, the chatbots were programmed Factors in Computing Systems — the premier to ask eight questions concerning COVID-19 international conference for research on Humansymptoms and behaviors, and offer diagnosis and Computer Interaction. recommendations, said Jin Chen, doctoral student in Originally published in Penn State News mass communications, Penn State and first author of

Summer 2021

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In Memoriam

In Memoriam DAVID W. DONER, JR., MD 1939-2020 David W. Doner, Jr., MD died unexpectedly in the early hours of October 13, 2020, at the age of 81. David was born in Jackson Michigan to Dorothy Williams Doner and David W. Doner, Sr. He attended Ohio State University College of Medicine where he graduated cum laude. David completed his residency in internal medicine at Strong Memorial Hospital at the University of Rochester in New York, and a fellowship in Nephrology at Boston University before joining the staff at Boston VA Hospital.

After his time at Boston VA, he spent 10 months traveling the world and meditating in Switzerland before moving to Santa Barbara in 1978. He, along with his nephrology colleagues, started the Santa Barbara Artificial Kidney Center first at Cottage Hospital, then on upper State Street, and finely opened the Lompoc Artificial Kidney Center in Lompoc where he was clinical director.

While in private practice, David would reserve the largest picnic site at Tucker’s Grove each year, to throw a patient appreciation party and invite all of his patients and staff.

David held dear many friends and patients over the years and considered most of them like family.

David retired in 2010, and he enjoyed traveling, music, dancing, walking, and meditation. He had been affected by frontal lobe dementia for his last years, which was challenging for someone who had always been active and loved to be around people.

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Preceding David in death are his mother, father, and sister Gaye Diana Doner Tudanger. David is survived by his sister Joy Doner Mazzeo; his children Ivy Elizabeth Doner and David “Austin” Doner, and their mom Lilli Ayers Doner; companion and travel partner Margaret Kenney and her daughter April.

Adapted from the Santa Barbara Independent

JAMES J. MURRAY, MD

1934-2021 Dr. James J. Murray passed away peacefully on May 3rd, 2021.

Jim was born in Salem, Massachusetts, the son of the late Genevieve and James Murray, and the youngest of the three siblings.

Jim attended Harvard University, New York University Medical School and did his residency at the Mayo Clinic in Rochester, Minnesota. In the 1960s, he served as a Captain in the Army Medical Corps and was stationed in Hawaii. After his discharge, he moved to Los Angeles with his family for his internships in Cardiology and Nephrology. He settled in Santa Barbara, CA and was a beloved local physician practicing for over 50 years with patients across the globe.

He is survived by his wife, Patricia Murray; his sister Genevieve Matanoski; his children and step-children Kristina Thomas (Brad), Dawn Murray, James Mark Murray (Makayla), Shannon Murray, Melissa Jasberg (Jeff), and AJ Comito (Skylar). His legacy also continues with his grandchildren Patrick and Charlotte Thomas, Xander and Elliot Murray Osborn, Archer and Marigold Murray, Aidan Murray, Elleanor and Walter Jasberg, and Ashton Comito.

Adapted from the Santa Barbara News Press

Summer 2021

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Summer 2021

Loans subject to credit approval.

CENTRAL COAST PHYSICIANS

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