Central Coast Physicians Winter 2018

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New Laws Affecting Physicians Disaster Preparedness for Your Medical Practice Physician of the Year


We travel from BAKERSFIELD TO COTTAGE because we want the best care for Avery. — Alyssa, Avery’s mother

Find TREATMENT for Avery’s 105 degree fevers Make travel from Bakersfield comfortable Get treatment plan for RARE disease Watch our son ENJOY being a kid again

When Avery was one, he had dangerously high fevers. His illness was a mystery, and his parents were desperate for answers. They found them when they met Dr. Miriam Parsa, a specialist at Cottage Children’s Medical Center (CCMC) Grotenhuis Pediatric Clinics. Avery was diagnosed with a rare disease called Familial Mediterranean Fever. They began traveling from Bakersfield to Cottage for treatment. Now four, Avery is enjoying his life as a healthy kid. Meet our pediatric specialists at Cottagechildrens.org

CCMC cares for over 14,000 children a year in our Acute Pediatrics Unit, Neonatal and Pediatric ICU’s, the emergency department, pediatric 2 CENTRAL COAST traumaPHYSICIANS center, and eight specialized outpatient clinics.

Winter 2018

Dreams Made Real.


6 10 20 24 28 30 Winter 2018










Letter from the CEO


The devastating mudslide following the Thomas Fire occurred shortly before we went to print with this issue of our magazine. I am thankful my family and home are safe, but I am feeling the emotional toll of these tragic events. It has been surreal watching the news and not being able to recognize the DANA GOBA streets of our community. Scrolling through social media is like watching a horror movie where I want to look through splayed fingers, worrying what I’ll see next. Sadly, I learned that one of our local physicians, Dr. Mark Montgomery, was one of those who died in the mudslide, along with his daughter, Caroline. The outpouring of compassion for Dr. Montgomery was immediate. Fellow physicians and former patients commented on his professionalism, kindness, and ever-present smile. As they say, the worst brings out the best in us, and I have been moved by the generosity of our community. People are looking for ways to help whether by giving money or their time. Many people emptied their closets to donate to those in need, and others provided refreshments to the hundreds of volunteers. Most striking are those who open their homes to complete strangers. Not surprisingly, physicians are doing their part to help those in need, and two examples are Dr. Brett Wilson and Dr. Chuck Fenzi. Dr. Wilson, Medical Director of Emergency Department Services for Santa Barbara Cottage Hospital, has been leading the efforts for those who come to the hospital in serious condition. Dr. Fenzi, CEO with the Santa Barbara Neighborhood Clinics, is offering free tetanus shots to anyone affected.

PRESIDENT Jennifer Hone, MD PRESIDENT ELECT Douglas Murphy, MD SECRETARY Daniel Berger, MD TREASURER Samira Kayumi-Rashti, MD IMMEDIATE PAST PRESIDENT David Dodson, MD DIRECTORS Kevin Casey, MD; Joseph Freeman, MD; Priti Gagneja, MD; Thomas Hale, MD; Ali Javanbakht, MD; Bindu Kamal, MD; Juan Reynoso, MD; Joseph Schwartz, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sam Ahmad, MD; Sharon Basham, MD; Edward Bentley, MD; Charity Dean, MD, MPH; David Dodson, MD; Priti Gagneja, MD; Jennifer Hone, MD; Christopher Lumsdaine, MD; Douglas Murphy, MD; Jenni Nix, MD; Joseph Schwartz, MD; Steven Yao, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Jennifer Hone, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Julie Brightwell, JD, RN; David Dodson, MD; Sansum Clinic; Elizabeth Schwyzer; Takashi Wada, MD, MPH; Margaret Weiss CONTRIBUTING PHOTOGRAPHERS CenCal Health, Sansum Clinic, Elizabeth Schwyzer, 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:

The Santa Barbara County Public Health Department is keeping everyone abreast of critical health issues, and the local media has been excellent at spreading the current status along with information about resources available. Thank you to everyone who has provided support to those in need. Together, we are stronger. Regards,

Central Coast Physicians 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 • E magazine@sbmed.org ADVERTISING rates and information sent upon request. Acceptance of advertising in Central Coast Physicians in no way constitutes approval or endorsement by CCMA of products or services advertised. CCMA reserves the right to reject any advertising. All advertising inquiries can be sent to magazine@sbmed.org.

Dana Goba Chief Executive Officer Central Coast Medical Association



Winter 2018

Secured over $1 billion annually to improve provider payments and graduate medical education funding.


Defended medical staff independence in “existential threat” lawsuit against the Tulare Regional Medical Center.

ONEMILLION Recouped nearly $1 million from payors on behalf of physician members.

Expanded member insurance program with state-approved workers comp coverage, new cyber liability program and personal insurance products.

CMA executive awarded “CFO of the Year” for fiscal responsibility and innovative strategic investments.

Defeated irresponsible federal legislation that would have harmed patient access to physicians and decreased health care coverage.

Stood in solidarity with California’s “Dreamers” and in support of diversity and inclusion.

Reaffirmed staff commitment to CMA’s mission by developing a credo.

Developed AB 72 and MACRA resource centers to educate members on rights and responsibilities.

Convinced CMS to further reduce 2018 MACRA reporting burdens.

Debuted a Mother’s Room at CMA headquarters for breastfeeding staff and members.

Declared firearm violence “violates the fundamental human right” to “live safely without fear in a free society.”

@cmaphysicians www.cmanet.org

CMA Member Service Center Just one number to call for all your CMA needs! (800) 786-4CMA (4262)



To read detailed performance results, visit CenCal Health’s website at www.cencalhealth.org or call (800) 421-2560.

Commitment to Excellence Stakeholder network helps CenCal Health achieve milestone performance



Winter 2018




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In a time when the future of healthcare coverage may seem uncertain, what is certain is that our community can be proud of the quality of healthcare experienced by CenCal Health’s nearly 180,000 members. CenCal Health was recently rated in the top five percent of Medicaid plans nationally for two important areas of care, and in the top 10 percent for an additional 12 areas of care out of a total of 18, according to the most updated state quality measurement ratings. These exceptional results also placed CenCal Health’s Santa Barbara County managed care product fourth statewide among Medi-Cal health plans. The Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool used by the California Department of Health Care Services, CenCal Health, and more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. These measures allow health plans like CenCal Health to not only assess plan effectiveness internally, but to compare performance against other health plans nationally. This year marks CenCal Health’s best overall performance to date in the 18 years since the State of California began evaluating industry-standard quality indicators. High performance levels were achieved in Santa Barbara and San Luis Obispo counties in diabetes care, prenatal care, and nutritional and physical activity counseling among children and adolescents. Additionally, in Santa Barbara County, excellent results were achieved in asthma treatment. This means healthier pregnancies, healthier children in school, and better management of diseases like diabetes and asthma. That is important for our entire community’s health, and aligns closely with a number of the priority objectives of Santa Barbara County’s Community Health Improvement Plan. CenCal Health would like to thank our healthcare providers, hospitals, our staff and our partners for helping us support the best care possible for our members. This achievement would not be possible without the support of our stakeholders. We take pride in the care our local physicians and hospitals provide to each and every patient.

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Recent fires, hurricanes, and floods nationwide have highlighted the importance of planning for disasters. Wildfires in California forced several physicians to quickly relocate their practices some permanently and to move scheduled procedures to different facilities. Hurricane and flood damage in Texas and Florida left practices without power for days or even weeks. Is your practice prepared for this type of situation? A disaster can overwhelm a medical practice, with damage that can include shattered windows, flood debris, power outages, disrupted telephone systems, computer



and system outages, unsafe drinking water, destroyed medical records, medication exposure to temperature and humidity extremes, contaminated instruments, and building structure failure. Disaster preparedness requires a continuous cycle of planning, organizing, training, equipping, rehearsing, and evaluating. Physicians are critical participants in disaster preparedness, ensuring that patient care and critical services are not interrupted—especially for at-risk individuals who may have special medical needs.

Winter 2018

Plan Ahead Now

Before the next disaster strikes, make sure your practice has a plan in place. A checklist, ordered by priority and customized to specific types of disasters, can provide the framework for a comprehensive plan. The checklist should include these elements:

• A full-circle call tree that outlines who contacts whom. • Instructions for setting up instant messaging technology that enables staff to communicate without a wireless network or cellular data connection • Instructions for securing records of patients undergoing diagnostic testing and a list of outstanding diagnostic studies • Guidelines for maintaining Health Insurance Portability and Accountability Act (HIPAA) compliance. Although the HIPAA Privacy Rule is not suspended during a natural disaster or other emergency, the Secretary of Health and

Human Services may waive certain provisions of the Privacy Rule • A Certificate of Insurance for your medical malpractice coverage, or instructions for contacting your agent or insurer directly to obtain proof of coverage. This document will be necessary if you are forced to temporarily relocate your practice or procedures • Verification that home health agencies caring for your patients have plans in place to provide adequate services in a disaster • Steps to follow upon returning from evacuation

When Disaster Strikes

Planning today makes accomplishing the following tasks more feasible during a disaster:


• Contact staff immediately to determine realistic return-to-work time frames. • Notify external vendors and business associates of your practice interruption and targeted resumption of operation.

replacement costs and losses. • Evaluate applicable warranties and consider an information technology restoration service contract. • Inventory and document hardware and software.

• Implement staff briefings at the beginning and end of each day.

• Document the type and extent of both lost electronic and paper data.

• Create temporary phone, fax, and answering services.

• Ensure data back-up and periodically test compliance.

• Establish patient telephone triage.

• Reestablish filing systems and internal programs.

• Implement temporary controls to ensure HIPAA compliance. Computers and systems

• Contact computer service vendors to ensure integrity and recovery. • Verify insurance coverage for repair or

Medical records

• Determine the extent of damage to, or loss of, patient records and filing systems. • Attempt to restore all damaged charts and document inventory findings.

In addition, create an inventory of all equipment and medications that may have been exposed to water or extremes in temperature. Repair, replace, or discard damaged items appropriately.

Winter 2018

• Notify the state medical board for specific guidance pertaining to lost or damaged records. • Document all efforts to restore and protect existing records. • Reconstruct lost charts at the next patient encounter. • Contact your insurance carrier for restorative services and/or claim procedures. • Reestablish a filing system and temporary storage if necessary. • Obtain legal guidance for patient notification during recovery efforts. • Contemporaneously date and initial all late entries and duplicate information in context of recovery efforts.

Once your plan is in place, regularly reevaluate its steps and update all contact information. Practice and rehearse the plan’s protocols. An effective disaster preparedness plan will help keep your practice focused on delivering care during an emergency.



AB 210


AB 133


NEW LAWS2018 Significant new California laws of interest to physicians The California Legislature had an active year, passing many new laws affecting health care. On the following pages you will find highlights of the most significant health laws of interest to physicians.



Winter 2018

AB 1048


AB 242


AB 841


ALLIED HEALTH PROFESSIONALS AB 89 (LEVINE) Psychologists: suicide prevention tr aining Requires, effective January 1, 2020, an applicant for licensure or license renewal as a psychologist to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention.

Winter 2018

AB 1153 (LOW) Podiatry Authorizes a doctor of podiatric medicine with training or experience in wound care to treat ulcers resulting from local and systemic etiologies on the leg no further proximal than the tibial tubercle.

SB 554 (STONE) Nurse pr actitioners: physician assistants: buprenorphine Prohibits construing the Nursing Practice Act, the Physician Assistant Practice Act, or any provision of state law from prohibiting a nurse practitioner or physician assistant from furnishing or ordering buprenorphine to a patient when done in compliance with the provisions of the federal Comprehensive Addiction Recovery Act.



ANCILLARY SERVICES SB 512 (HERNANDEZ) Health care pr actitioners: stem cell ther apy Requires licensed health care practitioners who perform stem cell therapy that is not approved by the United States Food and Drug Administration (FDA) to communicate to their patients seeking stem cell therapy specified information regarding the provision of stem cell therapies on a specified notice in a prominent display in an area visible to patients in his or her office, posted conspicuously in the entrance of his or her office, and provided in writing to the patient prior to providing the initial stem cell therapy. Does not apply to a health care practitioner who has obtained approval for an investigational new drug or device from the FDA for the use of human cells, tissues, or cellular or tissue-based products.

CONFIDENTIAL INFORMATION AB 210 (SANTIAGO) Homeless multidisciplinary personnel team CMA Position: Support Authorizes counties to establish a homeless adult and family multidisciplinary personnel team, with the goal of facilitating the expedited identification, assessment, and linkage of homeless individuals to housing and supportive services and to allow provider agencies, including those providing health, mental health, and substance abuse services to share confidential information, for the purpose of coordinating housing and supportive services to ensure continuity of care. AB 1119 (LIMÓN) Developmental and mental health services: confidentiality CMA Position: Support Existing law requires all information and records obtained in the course of providing specified developmental and mental services to be confidential and authorizes disclosure only in specified cases. This bill additionally authorizes, during the provision of emergency services and care, the communication of patient information and records between specified individuals, including physicians and surgeons.

SB 241 (MONNING) Medical records: access CMA Position: Support Revises provisions of law governing the right of patients to access and copy their medical records by conforming these requirements to federal Health Information Portability and Accountability Act of 1996 (HIPAA) requirements, including conforming state law regarding charges for clerical costs and requiring health care providers to provide the records in an electronic format if they are maintained electronically and if the patient requests the records in an electronic format. SB 575 (LEYVA) Patient access to health records Expands a provision of law that entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to support an appeal regarding eligibility for certain public benefit programs, by including initial applications in addition to appeals, and by expanding the list of public benefit programs to include In-Home Supportive Services, the California Work Opportunity and Responsibility to Kids program, CalFresh, and certain veterans related benefits.

DRUG PRESCRIBING AND DISPENSING AB 40 (SANTIAGO) CURES database: health information technology system CMA Position: Support Requires the California Department of Justice (DOJ) to make electronic prescription drug records contained in its Controlled Substance Utilization Review and Evaluation System (CURES) accessible through integration with a health information technology system no later than October 1, 2018, if that system meets certain information security and patient privacy requirements.



AB 265 (WOOD) Prescription drugs: prohibition on price discount CMA Position: Support Prohibits, with specified exceptions, a person who manufactures a prescription drug from offering in California any discount, repayment, product voucher, or other reduction in an individual’s out-of-pocket expenses associated with his or her health insurance, health care service plan, or other health coverage, including, but not limited to, a copayment, coinsurance, or deductible, for any prescription drug if a lower cost generic drug is covered under the individual’s health insurance, health care service plan, or other

Winter 2018

health coverage on a lower cost-sharing tier that is designated as therapeutically equivalent to the prescription drug manufactured by that person or if the active ingredients of the drug are contained in products regulated by the federal Food and Drug Administration, are available without prescription at a lower cost, and are not otherwise contraindicated for the condition for which the prescription drug is approved.

AB 720 (EGGMAN) Inmates: psychiatric medication: informed consent CMA Position: Support Extends to an inmate confined in a county jail the protection from being administered any psychiatric medication without his or her prior informed consent, with certain exceptions. Imposes additional criteria that must be satisfied before a county department of mental health or other designated county department may administer involuntary medication. Requires any court-ordered psychiatric medication to be administered in consultation with a psychiatrist who is not involved in the treatment of the inmate at the jail, if one is available. Requires a county that administers involuntary psychiatric medication to file a report with prescribed information to certain committees of the Legislature. AB 1048 (ARAMBULA) Health care: pain management and Schedule II drug prescriptions CMA Position: Sponsor Beginning July 1, 2018, authorizes a pharmacist to dispense a Schedule II controlled substance as a partial fill if requested by the patient or the prescriber. Requires the pharmacy to retain the original prescription, with a notation of how much of the prescription has been filled, the date and amount of each partial fill, and the initials of the pharmacist dispensing each partial fill, until the prescription has been fully dispensed. Authorizes a pharmacist to charge a professional dispensing fee to cover the actual supply and labor costs associated with dispensing each partial fill associated with the original prescription.

DID YOU KNOW CMA’S ONLINE HEALTH LAW LIBRARY IS FREE TO MEMBERS? CMA On-Call, the California Medical Association (CMA) online health law library contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. 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. CMA members can access

SB 17 (HERNANDEZ) Health care: prescription drug costs. CMA Position: Support Requires health plans and insurers that report rate information through the existing large and small group rate review process to also report specified information related to prescription drug pricing to Department of Managed Health Care (DMHC) and California Department of Insurance (CDI). Requires DMHC and CDI to compile specified information into a consumer-friendly report that demonstrates the overall impact of drug costs on health care premiums. Requires drug manufacturers to notify specified purchasers, in writing at least 90 days prior to the planned effective date, if it is increasing the wholesale acquisition cost (WAC) of a prescription drug by specified amounts. Requires drug manufacturers to notify Office of Statewide Health Planning and Development (OSHPD) three days after federal Food and Drug Administration (FDA) approval when introducing a new drug to market at a WAC that exceeds the Medicare Part D specialty drug threshold. Requires drug manufacturers to provide specified information to OSHPD related to the drug’s price.

Winter 2018

On-Call documents free at www.cmanet.org/cmaon-call. Nonmembers can purchase On-Call documents for $2 per page. CPLH, the complete health law library, is also available for purchase in a multi-volume print set or annual online subscription service. To order a copy, visit www.cplh.org or call (800) 882-1262.



END-OF-LIFE ISSUES AB 242 (ARAMBULA) Certificates of death: veter ans CMA Position: Support Requires a person completing certificate of death to indicate whether the deceased person was ever in the Armed Forces of the United States. Requires the Department of Public Health to access data in the electronic death registration system to compile data on veteran suicides and to provide an annual report to the Legislature and the Department of Veterans Affairs.

HEALTH CARE COVERAGE SB 133 (HERNANDEZ) Health care cover age: continuity of care Requires a health care service plan to include notice of the process to obtain continuity of care in any evidence of coverage issued after January 1, 2018. Requires a health plan to provide a written copy of this information to its contracting providers and provider groups, and a copy to its enrollees upon request. Extends existing continuity of care protections in the Health & Safety Code and Insurance Code to health plan enrollees and insureds whose prior coverage was terminated because the health plan or insurer withdrew from any portion of a market. Requires a health plan or insurer to include notice of the availability of the right to request completion of covered services as part of, to accompany, or to be sent simultaneously with any termination of coverage notice sent under specified circumstances. SB 223 (ATKINS) Health care language assistance services Requires a health care service plan and a health insurer to notify enrollees or insureds upon initial enrollment and in the annual renewal materials of the availability of language assistance services and of certain nondiscrimination protections, and would require this information to be included in the evidence of coverage, on other materials disseminated to enrollees or insureds, and to be posted on the plan or insurer’s website. Requires this written notice to be made available in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California as determined by the State Department of Health Care Services (DHCS). Establishes minimum qualifications for an interpreters providing interpretation services to enrollees and insureds and prohibits the plan or health insurer from requiring an LEP enrollee or insured to provide his or her own interpreter or rely on a staff member who is not a qualified interpreter to communicate directly with the enrollee or insured. Applies to Medi-Cal managed care plans, mental health plans, DHCS in addition to health care service plans and insurers. 14


HEALTH CARE FACILITIES AND FINANCING AB 395 (BOCANEGRA) Substance use treatment providers Adds the use of medication-assisted treatment as an authorized service by narcotic treatment programs licensed by the State Department of Health Care Services. Authorizes methadone, LAAM, buprenorphine, or any other medication approved by the FDA for the purpose of medication-assisted treatment to be used by a licensed narcotic treatment program. Authorizes the department to implement, interpret, or make specific this provision by means of plan or provider bulletins, or similar instructions and require the department to adopt regulations no later than January 1, 2021. Authorizes a physician to treat a number of patients specified under the DEA registration instead of a maximum of 20. Specifies that bills for services under Drug MediCal must be submitted within six months. AB 658 (WALDRON) Clinical labor atories CMA Position: Support Directs the California Department of Public Health to temporarily suspend the annual renewal fee for clinical laboratory licenses until January 1, 2020. AB 1102 (RODRIGUEZ) Health facilities: whistleblower protections Increases the maximum criminal fine, from $20,000 to $75,000, for violations of whistleblower protection laws that apply to patients, employees, and other health care workers of hospitals. SB 54 (DE LEÓN) Law enforcement: sharing data CMA Position: Support Limits the involvement of state and local law enforcement agencies in federal immigration enforcement. States that the Attorney General shall publish model policies limiting assistance with immigration enforcement to the fullest extent possible consistent with federal and state law at public schools, public libraries, health facilities operated by the state or a political subdivision of the state, courthouses, Division of Labor Standards Enforcement facilities, the Division of Workers Compensation, and shelters, and ensuring that they remain safe and accessible to all California residents, regardless of immigration status. Requires all public schools, health facilities operated by the state or a political subdivision of the state, and courthouses to implement the model policy, or an equivalent policy. Encourages other entities that provide services related to physical or mental health to adopt the model policy. SB 219 (WIENER) Long-term care facilities: rights of residents CMA Position: Neutral Enacts the Lesbian, Gay, Bisexual and Transgender (LGBT) LongTerm Care Facility Residents’ Bill of Rights and makes it unlawful Winter 2018

for any long-term care facility to take specified actions on the basis of a person’s actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus status. Prohibited actions include denying admission to a facility, refusing to make room assignments based on a transgender resident’s gender identity, failing to use a resident’s preferred name or pronouns, and denying or restricting appropriate medical or nonmedical care. Requires each facility to post a nondiscrimination notice.

MEDI-CAL AB 205 (WOOD) Medi-Cal: Medi-Cal managed care plans CMA Position: Support Requires Medi-Cal managed care plans (MCMC) to maintain a network of providers that meet specified time and distance standards, specific to county and provider type. Requires plans that cannot meet the standards to submit a request for alternative access standards. Permits the use of clinically appropriate telecommunications technology as a means of determining annual compliance with the time and distance standards or in approving alternative access to care. Sunsets these requirements on January 1, 2022. Implements changes required by the federal Medicaid managed care rule related to state fair hearings involving MCMC beneficiaries as well as to beneficiary grievances and appeals to MCMC plans. AB 340 (ARAMBULA) Childhood tr auma screening CMA Position: Support Requires the State Department of Health Care Services (DHCS), in consultation with the State Department of Social Services and others, to convene, by May 1, 2018, an advisory working group to update, amend, or develop tools and protocols for screening children for trauma within the Early and Periodic Screening, Diagnosis, and Treatment Program benefit. Requires this group to report its findings and recommendations, as well as any appropriations necessary for implementation to DHCS and to the Legislature’s budget subcommittees on health and human services no later than May 1, 2019. Requires review of the protocols for the screening of trauma in children at least once every 5 years, or upon the request of the department. Authorizes DHCS to implement, interpret, or make specific these provisions by means of all-county letters, plan letters, or plan or provider bulletins. SB 171 (HERNANDEZ) Medi-Cal: Medi-Cal managed care plans CMA Position: Support Implements federal Medicaid managed care regulations. Commencing July 1, 2019, requires a Medi-Cal managed care plan to comply with a minimum 85 percent Medical Loss Ratio (MLR) and to report the MLR for each MLR reporting year as specified. Requires, effective for contract rating periods commencing on or after July 1, 2023, a Medi-Cal managed care plan to provide a remittance to the state if the MLR does not meet the minimum ratio of 85 percent for that reporting year, and specifies how any remittance will be transferred. Requires the Department of Health Care Services (DHCS) to ensure that call covered mental health and substance use disorder benefits comply with federal regulations. Directs DHCS to require Medi-Cal managed care plans to increase certain payments to designated public hospitals, as specified, and to establish a program under which such hospitals may earn performance-based quality incentive payments.

Winter 2018

MEDICAL CANNABIS AB 133 (COMMITTEE ON BUDGET) Cannabis Regulation Makes changes to the Medicinal and AdultUse Cannabis Regulation and Safety Act and repeals prohibition limiting medicinal cannabis manufacturers to only manufactures medicinal cannabis products for sale by a medicinal cannabis retailer. Provides of an exception to the prohibition by an adult use cannabis licensee from allowing persons under 21 years of age on its premises if the licensee holds a medicinal license, as specified. Allows for the sale of medicinal cannabis products to the primary caregiver of a person who possesses a valid recommendation. SB 94 (COMMITTEE ON BUDGET AND FISCAL REVIEW) Cannabis: medicinal and adult use CMA Position: Support Establishes a single system of administration for cannabis laws in California. Contains changes to the Budget Act of 2017 that are necessary for state licensing entities to implement a regulatory framework pursuant to the Medical Cannabis Regulation and Safety Act (MCRSA) and the Adult Use of Marijuana Act (AUMA) of 2016 (Proposition 64). Conforms MCRSA and AUMA into a single system that prioritizes consumer safety, public safety and tax compliance. Creates agricultural cooperatives, a method for collecting and remitting taxes, a process for testing and packaging, and a process for collecting data related to driving under the influence.

MENTAL HEALTH AB 1315 (MULLIN) Mental health: early psychosis and mood disorder detection and intervention Establishes the Early Psychosis Intervention Competitive Selection Process Plus Program and an advisory committee to the Mental Health Services Oversight and Accountability Commission to expand the provision of high-quality, evidence-based early psychosis



and mood disorder detection and intervention. Establishes the Early Psychosis Detection and Intervention Fund and provides that moneys in the fund shall be available, upon appropriation by the Legislature, to the commission for the purposes of the bill.

SB 565 (PORTANTINO) Mental health: involuntary commitment Requires mental health facilities, upon a patient’s completion of a 14-day period of intensive treatment for mental disorder or impairment by chronic alcoholism, to make reasonable attempts to notify family members or any other person designated by the patient at least 36 hours prior to any certification review hearing for an additional 30 days of treatment.

PROFESSIONAL LICENSING AND DISCIPLINE AB 508 (SANTIAGO) Health care pr actitioners: student loans CMA Position: Support Repeals provisions of law authorizing boards to cite and fine, or deny licensure or licensure renewal, to a health care practitioner if he or she is in default on a United States Department of Health and Human Services education loan. AB 1340 (MAIENSCHEIN) Continuing medical education: mental and physical health care integr ation Requires the Medical Board of California to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment. SB 798 (HILL) Healing arts: boards Extends the operation of the Medical Board of California until 2022 and makes various changes to the Medical Practice Act. Includes, among other provisions, elimination of the medical board’s authority to approve ABMS equivalent boards, establishes a post-graduate training license for physicians, requires additional residency training, makes the Board of Podiatric Medicine independent of the Medical Board of California, changes the adverse event reporting requirements for outpatient surgery settings, changes the requirements for use of an expert witness in disciplinary cases, extends the authorization for the Osteopathic Medical Board of California (OMBC), and makes changes to continuing medical education for OMBC-licensed physicians. 16


PUBLIC HEALTH AB 643 (FRAZIER) Pupil instruction: abusive relationships Amends the California Healthy Youth Act to require school districts to include information about the early warning signs of adolescent relationship abuse and intimate partner violence in its comprehensive sexual health education and HIV prevention education for all pupils in grades 7 to 12. AB 841 (WEBER) Pupil nutrition: food and bever ages: advertising CMA Position: Support Prohibits, except as provided, a school, school district, or charter school from advertising food or beverages during the school day, and from participating in a corporate incentive program that rewards pupils with free or discounted foods or beverages that do not comply with specified nutritional standards when the pupils reach certain academic goals. Provides that it is the intent of the Legislature that the governing board or body of a school district and a charter school annually review their compliance with these provisions. AB 1221 (GONZALEZ FLETCHER) Responsible Bever age Service Tr aining Progr am Act of 2017 CMA Position: Sponsor Establishes the Responsible Beverage Service (RBS) Training Program Act of 2017, and requires the Department of Alcoholic Beverage Control, on or before January 1, 2020, to develop, implement, and administer a curriculum for an RBS training program. Beginning July 1, 2021, requires an alcohol server to successfully complete an RBS training course offered or authorized by the department. Authorizes the department to charge a fee, not to exceed $15, for any RBS training course provided by the department and require the fee to be deposited in the Alcohol Beverage Control Fund. SB 239 (WIENER) HIV and AIDS: criminal penalties CMA Position: Support Modifies criminal penalties related specifically to human immunodeficiency virus (HIV) that imposed stricter criminal penalties to individuals infected with HIV in comparison to other communicable diseases. Repeals provisions making the intentional exposure to another person by a person who has tested positive for HIV a felony. Eliminates criminal penalties specific to HIV-infected individuals and instead makes the intentional transmission of an infectious or communicable disease a misdemeanor if specified circumstances apply. >>

Winter 2018

SB 536 (PAN) Firearm Violence Research Center: gun violence restr aining orders CMA Position: Support Requires the state Department of Justice (DOJ) to make information related to gun-violence restraining orders that is maintained in the California Restraining Order and Protective Order System or any similar database maintained by DOJ available to researchers affiliated with the University of California’s Firearm Violence Research Center, or, at the discretion of DOJ, any other entity that is concerned with the study and prevention of violence, for academic and research purposes.

WORKERS’ COMPENSATION SB 189 (BRADFORD) Workers’ compensation: definition of employee CMA Position: Sponsor Provides clarification to AB 2883 (Insurance Committee, 2016) which allowed shareholder employees with at least a 15 percent ownership stake in a corporation to exempt themselves from workers’ compensation coverage. This bill reduces the ownership threshold for an officer or member of the board of directors who wishes to waive workers’ compensation coverage to 10 percent. Expands the grounds for waiving workers’ compensation coverage to include owners of a professional corporation if the owner is a practitioner of the professional services for which the professional corporation was created and the owner is covered by a health insurance policy or health care service plan. Expands the grounds for waiving workers’ compensation coverage to board members of worker-owned cooperatives and to closely-held family businesses. SB 489 (BRADFORD) Workers’ compensation: change of physician CMA Position: Support Extends the timeline for submitting claims related to emergency medical treatment to the employer, or its insurer or claims administrator in workers’ compensation system 30 days to 180 days from the date the service was provided to the injured worker.

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WORKFORCE & OFFICE SAFETY ISSUES AB 461 (MURATSUCHI) Personal income taxes: exclusion: forgiven student loan debt CMA Position: Support Excludes from gross income, for taxable years beginning on or after January 1, 2017, and before January 1, 2022, student loan debt, which may include a medical school loan, that is cancelled under specified repayment plans for public service and other employees administered by the United States Secretary of Education. SB 63 (JACKSON) Unlawful employment pr actice: parental leave CMA Position: Support Requires specified employers to allow specified employees to take up to 12 weeks of parental leave within one year of a child’s birth, adoption, or foster care placement. Prohibits an employer from refusing to maintain and pay for coverage under a group health plan for an employee who takes this leave. Does not apply to employees subject to both state and federal laws regarding family and medical leave. SB 179 (ATKINS) Gender identity: female, male, or nonbinary Provides for a third gender option on the state driver’s license, identification card, and birth certificate. Restructures the process for individuals to change their name to conform with their gender identity, and amends procedures for an individual to secure a court-ordered change of gender. The provisions of this bill are effective September 1, 2018. SB 396 (LARA) Employment: gender identity, gender expression, and sexual orientation Requires specified employers to include, as a part of existing required sexual harassment training, training on harassment based on gender identity, gender expression, and sexual orientation. Requires employers to post a poster developed by the Department of Fair Employment and Housing regarding transgender rights in a prominent and accessible location in the workplace.

These are just a sampling of the new laws impacting health care in 2018 and beyond. For a comprehensive list, see “Significant New California Laws of Interest to Physicians for 2018,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.





As luck would have it, my last column on misandry, “The Prejudicial hatred of men as a class”, was published about the time of the shaming of Harvey Weinstein, prompting a colleague to suggest to me that the piece could be construed as in bad taste. But being a Taoist at heart, I took her comment as a very Zen affirmation of what I was trying to say: stereotypes are just that and Harvey Weinstein and Roy Moore and their ilk cannot be thought of as typical or normal men – just sick, pathetic perverts. To tar all men with such a brush is as wrong as any other prejudice. The truth is that many men abhor such people and such behavior and honor their wives, mothers, daughters, and other women in their lives. In popular mythology, testosterone is to blame and this notion forms a “rationale” for misandry. To refute this myth, I offer the example of my cousin (several times removed!) Ulysses S. Grant. Despised as a brutal butcher in the South, he was much loved by Abraham Lincoln because he was fearless, determined, unflappable, and tougher than nails. During the Civil War, he repeated rode up to the front and had bullets fly around him in order to inspire his soldiers with no thoughts for his own safety. Whereas General McClellan and a string of other predecessors refused to fight Robert E. Lee, Grant refused to back down,





and in so doing saved our country. A brilliant strategist and peerless warrior, it is impossible to think of a man who more exemplifies “excess testosterone” than General Grant. Yet Grant was exceedingly humble, gracious to those whom he vanquished, deferential towards women, and an ardent supporter of what we now refer to as civil rights. He even refused to exchange prisoners with General Lee when Lee would not release Blacks captured from the North in exchange for Whites captured from the South. And Grant was deeply and tenderly devoted to his wife and children. It makes no more sense to blame the world’s woes on testosterone than to blame them on estrogen. Testosterone drives so much more than machismo. It drove Grant to save our country and Martin Luther King, Jr. to restore our nation’s conscience and lead the Civil Rights Movement. It drives exploration. John Glenn had his share, as did Sir Edmund Hillary. So did Nelson Mandela and any number of freedom fighters. Cathedrals and other monuments were built by men with drive, ambition, and presumably no lack of testosterone. The difference between a President Grant and a President Trump is not hormones but rather culture and values. The difference is personal integrity or lack thereof. Not gender.

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CMA gives me the sens e that I am not alone in the fight to protect my patients and ensure that they get the best and highest qu ality of care.

C. Freeman, M.D. Psychiatrist, Member Since 2006




Access to practice management experts

Valuable tools and resources

Legislative advocacy

Free CME webinars

Legal support

Free reimbursement helpline

News and updates you need to know

Free access to the most comprehensive health law library




Direct payor intervention

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Passion. Dedication. An unwavering moral compass. Sensitivity to social justice. For over more than four decades as a physician, San Luis Obispo’s Dr. Stephen Hansen brought these traits to his practice. In his retirement, he has turned his focus to a new patient: planet Earth. The disease he battles is climate change. For Hansen, politics and health education have always been central to his medical practice, and indeed, to his life. Longtime San Luis Obispo residents may remember Hansen as the doctor who campaigned hard against smoking in the late 1980s – and won. “I was seeing patients in their 40s die of heart attacks and lung cancer,” he remembered. “I’d see their widows and children grieve. The youngest patient I remember was an 18-year-old chain smoker who came in complaining of left shoulder pain: he had suffered a major heart attack.” >>

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Around the same time, Hansen attended a conference of the American Medical Association where he learned of studies that showed carcinogens in second-hand smoke and discovered that the AMA was preparing to classify the substance as a Class A carcinogen. His determination set, Hansen returned to the Central Coast with a mission to eradicate second-hand smoke wherever possible. Thanks in part to Hansen’s efforts, San Luis Obispo was the first city in the entire world to ban smoking in all public buildings, including bars and restaurants. The law went into effect in 1990, the same years that lung cancer death rates in American men peaked and began their decline. Hundreds of cities and the majority of U.S. states followed. “I got death threats at work,” Hansen remembered of the era. “Executives at tobacco companies were calling me. People thought it would kill business.” Instead, SLO discovered that eateries and even bars could flourish without the ubiquitous presence of tobacco smoke. Hansen had established his passion for championing public health over corporate profit and helped his small Central Coast town lead the way to smoke-free businesses. These years of anti-tobacco advocacy influenced Hansen’s medical practice and his research, and connected him with professionals in settings such as the World Health Organization’s World Conference on Tobacco or Health, held every three years. It was at this conference in 2009 that professor Richard Jackson, then of the U.C. Berkeley School of Public Health, impressed upon him the gravity of another public health risk: climate change. “Jackson explained to me that the pandemics associated with climate change would far exceed those of tobacco,” Hansen said. “We estimate 1 billion lives lost in the past century due to tobacco; it will likely be far more from climate change. Our food, water, and security are all in peril.” For Hansen, who officially retired from his medical practice in 2012, climate change is the new smoking: an urgent health threat that demands his commitment and energy. Instead of spending his golden years in leisure, Hansen is hard at work advocating for changes in policy that will help slow the effects of anthropogenic global warming. When he talks about climate change, Hansen’s tone is serious and insistent. “You have to imagine a globe with shellac painted on it,” he said. That’s our atmosphere. When you pollute it with heattrapping gases, that’s a direct threat to every living thing on the planet. That heating effect is accelerating rapidly now, and it’s an urgent threat to all of us, yet it’s distant from most people’s consciousness. “Humans evolved because we responded well to immediate

threats,” Hansen went on, “but we don’t respond so well to what seems remote. We need to understand that all these storms and fires, this period of political instability, disease, and epidemics – they’re all related.” Put simply, climate change is the phenomenon of average atmospheric temperatures rising over a long period of time. The term has come to be associated with the extreme rise in temperature Earth has undergone in the past century, and particularly in the past 20 years. The vast majority of climate scientists agree that this rise in temperature is due primarily to increased levels of carbon dioxide in the atmosphere produced by the use of fossil fuels. According to data from NASA and the National Oceanic and Atmospheric Administration (NOAA), the planet has warmed roughly 1.7 degrees Fahrenheit since 1880, and the rate of heating is accelerating alarmingly. Climate scientists including James Hansen (no relation) warn that if we don’t heavily reduce emissions of heat-trapping greenhouse gasses like carbon dioxide, global temperatures could rise as much as 9 more degrees by the end of the century, with catastrophic results. For perspective, average global temperatures were approximately 5 to 9 degrees cooler than today at the end of the last ice age. Climatologists estimate a temperature increase of even 3.6 degrees would tip climate change into irreversible and apocalyptic territory. Hansen, too, sees the situation as one of grave peril for all humanity: “It's like we are trapped in a hot car with the windows up and no way out.” Also concerning to Hansen is the fact that most of us accept anthropogenic climate change as a serious problem yet remain ignorant to the true implications for our communities and fail to grasp the very real ways global warming is already threatening our health. In recent years, the medical community has become more active in monitoring the health effects of climate change and sounding the alarm. An October 2017 report titled “Countdown on Health and Climate Change” published in the British medical journal The Lancet and authored by an international team of more than 60 doctors, public health officials, and scientists suggested that "the human symptoms of climate change are unequivocal and potentially irreversible." Likened to a physical check-up, the report offers an alarming prognosis; left unchecked, climate change threatens to render planet earth uninhabitable. Meanwhile, physicians across the United States are organizing to study the public health impacts of climate change, inform the public of their findings, and advocate for public policy to address the crisis. Among the groups Hansen works with is the Medical Society Consortium on Climate and Health or MSCCH: An




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organization of more than 500,000 individual physicians and medical groups whose joint mission is to inform the public and policymakers about the health effects of climate change. The MSCCH points out that wellbeing of citizens across the United States and beyond is already impacted by climate change. From drought, wildfires, hurricanes, and flooding to mass migrations, poor air quality, and infections caused by contaminated food and water, our health is suffering. Other health effects of climate change include heat stress caused by extreme temperatures, mosquito and tick-borne diseases, and mental illness. Recent dramatic weather events in the U.S. and elsewhere have demonstrated the ways in which these health threats are interrelated. The spate of hurricanes that ravaged the Caribbean, Puerto Rico, and the southern U.S. states in late summer 2017 led to contaminated water and mosquito-borne disease, while the devastating Northern California fires of October 2017 and the Southern California Thomas Fire of December 2017 created dangerous air quality conditions. The destruction caused by these catastrophic events caused stress and grief for many and in some cases lead to the gravest health impact of all: the loss of human life. These health threats are often interrelated: extreme weather events like the recent spate of hurricanes that ravaged the Caribbean, Puerto Rico, and the southern U.S. states in August and September of 2017 can lead to contaminated water, mosquito-borne disease, and mental health issues. While major wildfires, such as the devastating Northern California fires of October 2017 and the Thomas Fire that scorched Ventura and Santa Barbara counties in December 2017, create dangerous air quality conditions. And too often, extreme weather events such as these lead to the gravest health impact of all: the loss of human lives. One might imagine Hansen as a gloomy character – so long has he placed his focus on dire threats to human health. In fact, he’s something of the opposite. Energetic and engaging, he radiates curiosity and determination. At the same time, he doesn’t sugarcoat his message. He’s also utterly unapologetic about laying the blame where he believes it belongs, and the current political administration doesn’t get off lightly. “When I give talks, I usually start by saying, ‘I’ve got Prozac for everybody; this isn’t going to be easy,’” he joked. “The truth is, we are all complicit. We’re all hypocritical. Yet we mustn’t be focused on that. We must be focused on a world where all of our politicians defend the public interest or are held accountable.” A registered Republican, Hansen repeatedly expressed his disgust with the policies of the Trump administration. “I call them ‘fossil fools,’ he said. “Every country with a scientific academy has endorsed the Paris Agreement. Right now, we’re using far more of the world’s resources than can be justified. More war and strife will come of this.” As for what actions can and should be taken, and by whom, Hansen was unequivocal. “Anyone who doesn’t think about it every day isn’t living in

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FURTHER READING UNDERSTANDING CLIMATE CHANGE climate.nasa.gov noaa.gov/climate climatescienceawarenesssolutions.org CLIMATE CHANGE AND HEALTH medsocietiesforclimatehealth.org usclimateandhealthalliance.org who.int/globalchange/en/ WAYS TO GET INVOLVED citizensclimatelobby.org peoplesclimate.org

the real world,” he said. “Everyone needs to take responsibility. Don’t stay quiet when you hear someone talking as if climate change isn’t real or isn’t a present threat.” Member physicians of the CCMA, Hansen said, should be talking to their patients about climate change and putting pressure on national organizations like the AMA, which left the MSCCH shortly after Trump took office, and the CDC, which canceled its conference on climate change and health shortly before it was to take place in January 2017. Other actions Hansen recommends to local physicians include writing op-eds and letters to the editor regarding the health impacts of climate change, lobbying hospitals, reaching out to legislators, and joining the Citizens Climate Lobby or CCL: an international grassroots nonprofit focused on building the political will for climate solutions. Much of CCL’s current work is focused on encouraging a carbon fee and dividend that would create an economic incentive for carbon pollution reduction. Although his bedside manner is to deliver the bad news straight, Hansen is optimistic about the possibility of recovery, or at least slowing the rate of global warming by changing laws governing carbon emissions. All those years of working to limit the presence of tobacco smoke in his community taught him lessons that apply in this case, too. “Just as restaurants weren’t ultimately hurt by removing tobacco, nobody will be hurt by mandating solar power and this kind of thing except for fossil fuel companies,” he said. Among those who give Hansen hope is Florida Congressman Matt Gaetz, a Republican and the newest member of the congressional Climate Solutions Caucus. “I think history will judge very harshly those who are climate deniers,” Gaetz stated recently. “I want to work…on bipartisan solutions to climate change.” As Hansen sees it, one of the greatest challenges we face is to heighten public awareness of the urgency of climate change for all residents of planet Earth. Physicians, he believes, play a crucial role in informing patients about the massive health threat climate change represents.



Annual Membership Meeting

The 2017 Annual Membership Meetings were a rousing success. Our keynote speaker was Dr. Larry Wolk, Executive Director & Chief Medical Officer for the Colorado Department of Public Health & Environment, who address the myriad issues surrounding medical and retail marijuana. We also thanked outgoing president, David Dodson, MD, and welcomed incoming president Jennifer Hone, MD. 24


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Thank you to our Platinum Sponsor, The Doctors Company

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Annual Membership Meeting



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The Central Coast Medical Association honors physicians who have worked to improve the quality of health care, contri

San Luis Obispo County:

DR. RENE’ BRAVO The 2017 Physician of the Year for San Luis Obispo County was presented to Dr. Rene’ Bravo at Central Coast Medical Association’s Annual Membership Meeting by Dr. Fred Vernacchia. Dr. Bravo was born in Florida to an Ecuadorian father and Cuban mother, and the family relocated to Bell, California, when Dr. Bravo was four years old. Ten years later, Dr. Bravo was diagnosed with Hodgkin’s lymphoma and was treated at Children’s

Hospital in Los Angeles, which inspired him to pursue a career in medicine. Dr. Bravo completed his undergraduate degree in San Diego at Point Loma Nazarene University, which is where he met his wife, Debra. Dr. Bravo continued his education at the University of California, San Francisco School of Medicine and completed his internship and residency in general pediatrics at Stanford University Medical Center. Dr. Bravo then moved to San Luis Obispo, where he has been practicing medicine for more than 30 years. Dr. Bravo has been involved in organized medicine since he moved to San Luis Obispo. He is a past president of the local medical association and has represented his colleagues at the California Medical Association’s House of Delegates. He is politically active and ran for state assembly in 1998. Dr. Bravo also has served as president of the United States Pharmacopeia, which is tasked to ensure drugs conform to specific safety standards. Locally, Dr. Bravo has involved with First 5, the American Cancer Society, The Women’s Shelter, and Boy Scouts. Besides volunteering, his hobbies include gardening, stamp collecting, backpacking, and restoring old cars. Dr. Bravo and his wife, Debra, have five sons and four grandchildren. Photo: Dr. Rene’ Bravo (left) and Dr. Fred Vernacchia (right)



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of the Year

ibuted to the education of other physicians, and engaged in community service and other activities outside of medicine.

Santa Barbara County:

DR. SAIDA HAMDANI Dr. Saida Hamdani was honored at the Central Coast Medical Association’s Annual Membership Meeting as the 2017 Physician of the Year for Santa Barbara County. Dr. Priti Gagneja presented the award and shared stories of Dr. Hamdani, who is known by her colleagues, coworkers, and patients for her extreme compassion, patience, grace, and generosity with all. Dr. Gagneja stated, “Not only is Dr. Hamdani a healer and an outstanding doctor, she is the core representation of good citizenship and an example to all.” Dr. Hamdani was born in Pakistan, and her family moved to Nigeria where she was raised. Dr. Hamdani graduated from University of Jos in Nigeria with top honors and then moved to the United States in 1985 to complete her pediatric residency at University of California, Irvine. Dr. Hamdani began practicing at Sansum Clinic in 1991 and has been voted Santa Barbara’s best pediatrician multiple times. Dr. Hamdani is passionate about volunteering and is involved with the Santa Barbara Rescue Mission, Doctors Without Walls, and Camp Wheeze. She

also provides mentorships to premed students and speaks at local schools regarding pediatric issues. In addition, Dr. Hamdani and her husband are active in advocating for universal education and healthcare, and they created the Hamdani Foundation, which promotes world harmony. Dr. Hamdani is married to Jamal Hamdani, a CEO at a local telecommunications company, and they have two daughters. Sasha is a psychiatrist in Kansas, and Saher is a business analyst in New York City.

Photo: Dr. Priti Gagneja (left) and Dr. Saida Hamdani (right)

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Professor O. James Garden has been selected Professor Garden will present a public lecture as the Visiting Professor of Surgery for Surgical on Thursday, March 8 at the Ridley-Tree Cancer Academic Week 2018 (March 5-9). Professor Center at Sansum Clinic in the Lovelace Hall Garden is the seventh recognized Visiting at 540 West Pueblo Street. There will be a Professor of Surgery and the first international reception at 5:30pm and the presentation Visiting Professor. at 6:00pm. The topic will be Edinburgh’s Professor Garden follows six previous Illuminati: Charles Darwin, Sir Arthur Conan Visiting Professors: Dr. John L. Cameron (Johns Doyle, Lord Lister and Grave Rogers (Knox, Hopkins) 2012, Dr. Hiram C. Polk, Jr. (University Burke, and Hare) and how they significantly of Louisville) 2013, Dr. Julie Ann Freischlag contributed to advancements in Medicine (UC Davis School of Medicine) 2014, Dr. Keith and Surgery. Reservations are required; D. Lillemoe (Massachusetts “We have been fortunate to have had outstanding surgeons, General all leaders in their field. The program benefits the surgical Hospital) 2015, residents, surgical staff, and patients. The value to our comDr. Michael munity, to Cottage Health, and to Sansum Clinic is priceless.” G. Sarr (Mayo JAMES T. DUNN, MD, FACS Clinic) 2016, Dr. Barbara Lee Bass (Houston Methodist Hospital). please contact Juli Askew at (805) 681-7762 or Professor Garden is the Regius Professor jaskew@sansumclinic.org. of Clinical Surgery and Honorary Consultant Sansum Clinic’s Visiting Professor of Surgery Surgeon, Hepatobiliary and Pancreatic Surgical program provides expert educational seminars Services, Royal Infirmary of Edinburgh, for practicing Santa Barbara surgeons and University of Edinburgh. He was appointed physicians. More importantly, it allows surgical Surgeon to the Queen in Scotland in 2004 and residents in training at Santa Barbara Cottage was made Commander of the British Empire Hospital the chance to interact with the icons, in the Queen’s New Year’s Honors list in 2014. leaders, and outstanding teachers of the art of He is a graduate of the University of Edinburgh surgery. and undertook his postgraduate training as a This unique educational program advances hepatobiliary, pancreatic and liver transplant the level of surgical care available in our surgeon in Edinburgh, Glasgow, and Paris. community, and is made possible by generous He has written extensively with nearly 270 support from the Title Sponsor, Cottage research and clinical articles to his name and he Health, and grateful patients, medical groups, has authored or edited 13 surgical textbooks. individual community surgeons and physicians, He has a strong interest in surgical training and and corporate donors. education.

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Public Health


The Healthy People Healthy Trails goal is to help physicians to encourage patients who are physically inactive or new to the outdoors. To learn more visit www. healthypeoplehealthytrails. org or contact Steering Committee member Margaret Weiss, mweiss@sansumclinic.org, (805) 737-8754.

Healthy People Healthy Trails By Margaret Weiss, Health Education Director, Sansum Clinic

Encouraged by evidence that spending time in nature improves physical and mental health, local organizations joined together to launch Healthy People Healthy Trails. Its mission is to work collaboratively with land agencies, healthcare providers, and community partners to improve the health and wellbeing of community members through the use and enjoyment of trails, parks, and open spaces. Healthy People Healthy Trails focuses on those with high health needs to help them connect to an active life and connect to the outdoors. Partners actively working on Healthy People Healthy Trails include CenCal Health, City of Santa Barbara Parks and Recreation Department, Coalition for Sustainable Transportation (COAST), Cottage Health, Sansum Clinic, Santa Barbara County Public Health Department, Santa Barbara County Trails Council, and Todos Afuera with additional support provided by the National Park Service and community members.



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Facts of a community health problem of inactivity and chronic illness:

•O nly 3 in 10 teens get the amount of physical activity recommended by the Centers for Disease Control (CDC). •O nly 5 in 10 adults get the amount of physical activity recommended by the CDC. • 4 in 10 people are completely sedentary, with television, computer, phone, and electronic games an increasingly large part of everyone’s day. •L ack of activity contributes to obesity, diabetes, high blood pressure, heart disease and stroke.

Solution: Healthy People Healthy Trails Prescription for Outdoor Activity

•A growing body of literature indicates that nature promotes physical and mental health as well as a sense of belonging and general well being • P eople are more likely to get regular physical activity when they spend time outdoors. Children specifically are 2 to 3 times more likely to be physically active when outdoors.

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• Walking is a suitable prescription because most people are able to walk. It is free of charge, does not require special equipment, can be done indoors or outdoors, alone or with others, and in many easy to access locations. Further, walking is reported as the most popular form of exercise.

Tools for physician offices, free of charge, in English and Spanish

Healthy People Healthy Trails has developed materials for use in physician offices including:

• A sample prescription for outdoor activity which can be adapted to meet provider needs in digital or paper format • A trail guide of easy walks in Santa Barbara County • A n event calendar of community walks

All of the tools are free of charge and available in English and Spanish. Kurt Ransohoff, MD, at Sansum Clinic states, “The trail guide has the best maps available, especially for people who are new to walking for physical activity. At Sansum Clinic we have the Prescription for Outdoor Activity in our electronic medical record, making it easy to give to a patient and it works!”




Positions Available

ADVANCED DERMATOLOGY & AESTHETICS CENTER in Santa Barbara is seeking a board-certified dermatologist to join the practice, full or part-time. The ideal candidate would have experience in providing quality medical, surgical, and cosmetic dermatological care. Please forward cover letter, resume, and references to 2936 De La Vina St, Suite 200, Santa Barbara, CA 93105, attn.: Juliane Fausey, Office Manager (ph: 805.618.1616; fax 805.687.4822; email juliane@kimhurvitzmd.com) The COUNTY OF SAN LUIS OBISPO Law Enforcement Medical Care Unit at the County Jail is recruiting for a contract Medical Doctor to perform assessments, establish medical diagnoses, order and evaluate diagnostic tests and medications, and manage follow-up care for a jail population. For more information, go to www.slocounty.ca.gov and click “Career Opportunities�. The COUNTY OF SANTA BARBARA is looking for a Staff Physician to fill one of our critical roles in our Public Health Primary Care and Family Health Division at our Santa Maria Health Care Center (SMHCC). This position requires board certification or eligibility in Family Practice or Internal Medicine. Our physicians will collaborate with a team of physicians, nurses and other staff providing clinical services in our expanding Federally Qualified Health Clinics throughout the County. www.sbcountyjobs.com





SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 200 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/physician-provider-jobopportunities.

Office Space Available

We are currently seeking a physician to join our team! Looking for a physician that is interested in sharing a fully staffed office near Santa Barbara Cottage Hospital. We will assist in providing quality office support. Please contact Cynthia Hancock at 805.879.4011 for details.

Seeking Office Space

Established Santa Barbara surgeon looking for physician(s) with existing office space to share. If interested, please call 805.452.1899.

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

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Reception & Presentation Professor O. James Garden

Speaking on

Hepatobiliary and Pancreatic Surgical Services, Royal Infirmary of Edinburgh

Charles Darwin, Sir Arthur Conan Doyle, Lord Lister and Grave Robbers (Knox, Burke and Hare) significantly contributed to advancements in Medicine and Surgery.

Regius Professor of Clinical Surgery and Honorary Consultant Surgeon

University of Edinburgh

Edinburgh’s Illuminati:

Professor O. James Garden, Surgeon to the Queen in Scotland, will bring these historic events to life with his presentation about “Edinburgh’s Medical Enlightenment”.

Please Join Us When Thursday, March 8, 2018 5:30 pm to 7:00 pm

Reception 5:30 pm Presentation 6:00 pm

Where Ridley-Tree Cancer Center at Sansum Clinic

Lovelace Conference Hall, 540 West Pueblo St. Free valet parking available

Title Sponsor

RSVP Please RSVP to Juli Askew by March 5

(805) 681-7762 or jaskew@sansumclinic.org Reservations required

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



31 New

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.


Hugh Byers, MD, PhD Pathology

Sawyer Haig, DO Internal Medicine



Santa Barbara 548.1550

Santa Barbara 898.3100

Joye Carter, MD Forensic Pathology

Paul Hennig, MD Family Medicine



San Luis Obispo 781.4513

Santa Barbara 681.7144

Barbara Donnelly, MD Neonatal-Perinatal Medicine Santa Barbara 569.7522

Robert Kershaw, MD Internal Medicine

Alicia Guevara, MD Urgent Care

Meredith Perrin, MD Dermatology



Lompoc 563.6110

Santa Barbara 898.3050



Santa Barbara 681.7634

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San Luis Obispo 548.1550

Sara Taroumian, MD Rheumatology SANSUM CLINIC

Santa Barbara 681.7850

Pedram Rashti, MD Obstetrics & Gynecology RASHTI WOMEN’S CARE

Rafael Victoria, MD Pediatrics

Santa Barbara


RESIDENTS Dignity Health – Marian Family Medicine Residency Program

Allison Akers, DO

Elizabeth Finken, DO

Isaiah Roggow, MD

Nicholas Becketti, DO

Rachel Greatwood, DO

Nicolas A Walton, DO

Peggy Becketti, DO

Blake Hansen, DO

Xi Zhai, DO

Guy Bennallack, DO

Stephen Herrick, DO

Rachel Zonca, DO

Julie Brodfuehrer, DO

Catherine Martin, DO Santa Barbara Cottage Hospital Internal Medicine Residency Program

Sean Christiansen, DO

Aklecia Mcvoy, MD Hoang Nguyen, MD

Kathleen Coquia, DO

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Scott Piazza, DO



In Memoriam John Albert Michal, III, MD December 3, 1947 – August 31, 2017 Local social justice activist and long-time Santa Barbara resident John Michal passed away on August 31, 2017 at the age of 69 surrounded by his loving family. John was born on December 3, 1947, in Chicago, Illinois, where he became a lifelong (i.e., longsuffering) Cubs fan. The son of a florist and a nurse, John grew up a competitive diver with an affinity for model trains and classical music. He attended Cornell University in Ithaca, NY and received his M.D. from Cornell Medical School. A graceful and enthusiastic skier, John lived in Salt Lake City for three years before making Santa Barbara his home in 1979. He practiced as a radiologist at Cottage Hospital for his entire 25-year medical career; patients and colleagues remember Dr. Michal as a dedicated physician with a caring bedside manner. After John’s retirement from medicine, his life’s true work began. He became a scholar of religion, love, peace, and forgiveness and an advocate for equality and social justice. His work with Trinity Episcopal Church and local groups Clergy and Laity United for Economic Justice, Interfaith Initiative, and Showing Up for Racial Justice effected meaningful change for people in the community of Santa Barbara and beyond. John was the kind of person who didn’t speak unless it was something worth saying, and his presence brought an energy of peace and serenity to the room. He was a gentle and generous man with the mind of a philosopher and a limitless heart who will be greatly missed by those he left here on earth. John is survived by daughters Natalie and Carey, son-in-law Stephen, stepgrandchildren Schorr and Will, sister Elizabeth, brotherin-law Jack, and his extended Midwestern family. Originally published in the Santa Barbara Independent.



Fr ancis G Preston, MD June 11, 1920 – March 6, 2017 Francis G Preston, MD was born on June 11, 1920 in Visalia, CA and passed peacefully in his sleep on March 6, 2017. He was born to Dr. and Mrs. Addison Preston, his father being a physician in general practice there. He began premedical training at UC Berkeley obtaining his B.S. in 1941 and then on to UC-San Francisco medical school, graduating in 1943 with a MD. He interned at UC Hospital in Obstetrics and Gynecology in 1943-44. He then served his country for two years during World War II as a captain in the Army Medical Corps, serving in the US, France and Germany. He did his residency in surgery at Santa Barbara Cottage Hospital 1946-49 and in Obstetrics and Gynecology at Bellevue Hospital, New York University, NY in 1949-50. He was a Diplomat of the American College of Obstetrics and Gynecology and a fellow of the American College of Surgeons. He settled with his family in Santa Barbara in 1951 where he practiced Obstetrics and Gynecology for 31 years and was purported to have delivered close to 5,000 babies. While still in college he met the love of his life, Maxine Miller and they were married in 1942. They were dedicated members of the First Presbyterian Church of Santa Barbara and faithfully served it through their lifetimes. Francis was also a member of Rotary, Santa Barbara Club, and La Cumbre Country Club. He was a 75-year Mason and served as Master of La Cumbre #192 of the F&AM. Maxine died a sudden and untimely death in 1995, ending a wonderful 52 years of marriage. Putting his grief behind him as best he could, he moved to Valle Verde Retirement home where many of his professional and recreational friends were already residents. With their support, he resumed his interest in travel, photography, and golf. He resided there until his death. He was preceded in death by his son, David, in 2015. He leaves three sons and three daughters-in-law: William (Pamela), Kenneth (Beth) and Robert (Patty). Also eleven grandchildren and six great grandchildren survive him. Originally published in the Santa Barbara Independent.

Winter 2018

Dear friends and colleagues, It is with great sadness that we share the loss of Mark Montgomery, MD – an orthopedic surgeon who was a business partner at Associated Hand Surgeons, as well as a long-time member of the Central Coast Medical Association (CCMA) and the California Medical Association (CMA). Dr. Montgomery tragically perished in the devastating mudslides, along with his beloved daughter, Caroline. He is survived by his wife, Catherine, and children, Duffy and Kate. He was a consummate professional, and his passing is a huge loss to the community. Colleagues and friends describe Dr. Montgomery as selfless and committed to his patients – often accepting patients irrespective of their ability to pay. His kindness and genuine care for patients, along with the permanent smile on his face, will be greatly missed by all who


knew him. We want to extend our deepest condolences to his loved ones and colleagues, and we reaffirm our support to everyone affected by the recent Thomas Fire and subsequent mudslides on their recovery ahead. CCMA and CMA’s support remains true today and tomorrow – until the last home and medical practice are rebuilt and our community is thriving once again. Sincerely,

Jennifer Hone, MD, FACE President, Central Coast Medical Association

Theodore Mazer, MD President, California Medical Association

Winter 2018



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