Central Coast Physicians Winter 2022 by Central Coast Physicians

WINTER 2022

2021 LEGISLATIVE LEGISLATIVE

WRAP-UP New Laws for 2022 CMA President and President Elect Remembering Robert A. Reid, MD

“Cottage saved my heart with TAVR” – Patrick, Ojai

Patrick has always led an active life but experienced chest pain while hiking. He was suffering from aortic stenosis and needed TAVR—a minimally invasive heart procedure that does not require open heart surgery. Patrick received TAVR by Dr. Michael Shenoda, an interventional cardiologist affiliated with the Cottage Heart & Vascular Center. “I knew I was going to get better, but I was better immediately,” said Patrick. “I feel like my old self again.” He’s been active ever since.

Cottage is a national leader in interventional cardiology—the only hospital on California’s Central Coast that provides all three minimally invasive treatments.

TAVR Replaces valve for aortic stenosis

MitraClip™ Repairs leaky valve

Watchman™ Reduces stroke risk due to AFib

Ask your physician about these treatment options. 2

CENTRAL COAST PHYSICIANS

Learn more at cottagehealth.org/heart

Winter 2022

CENTRAL COAST PHYSICIANS

2021 YEAR IN REVIEW The California Medical Association (CMA) was once again at the center of key state health care policy decisions and action. With CMA’s help, California helped set an example for the nation in vaccinating residents, even as we coped with the rise of the delta variant. In addition to our work on COVID-19, CMA won key victories for physicians in the state budget, helped increase funding for public health and continues to build our physician workforce to help deal with chronic shortages across the state.

COVID-19 Vaccines: CMA worked closely with the Newsom Administration to ensure all Californians had access to vaccines, providing mapping data and physician feedback to help the state build a distribution network that allowed community-based physicians to obtain vaccines for their patients. CalVaxGrant: CMA helped establish and administer the CalVaxGrant program, which provided $40 million to physician practices to help offset the costs of obtaining, storing and administering COVID vaccines.

Justice, Equality, Diversity and Inclusion: CMA created new Standards for Cultural Linguistic Competency and Implicit Bias in continuing medical education.

Telehealth: CMA sponsored AB 457 (Santiago), which ensures patients can access telehealth services from their selected health care providers, rather than a third-party corporate telehealth provider.

Billing Disputes: CMA’s Center for Economic Services recouped more than $1 million from payors on behalf of physician members.

COVID-19 Payments: CMA sponsored SB 510 (Pan), which requires health insurers to cover the cost of COVID-19 tests and vaccine administration.

Vaping Tax: CMA helped pass an increase in the tax on e-cigarettes and vaping products to more closely mirror the taxes on other tobacco products. The bill also ensures future funding for physician workforce programs, such as the physician loan repayment program.

Physician Workforce: CMA successfully advocated to make permanent a portion of Prop. 56 tobacco funds to pay for physician loan repayment and graduate medical education.

State Budget: In the budget process, CMA helped ensure state policy conformed to federal tax law with regard to Paycheck Protection Program loans for physician practices and made permanent the Prop. 56 supplemental payments for Medi-Cal providers.

Visit cmadocs.org for more information.

CENTRAL COAST PHYSICIANS

Winter 2022

VOLUME 7, NUMBER 1 • WINTER 2022

{FEATURES}

10 12 14 18 20 22 Winter 2022

CCMA LEADERSHIP TCAR NOW IN SLO NEW HEALTH LAWS REMEMBERING DR. REID

{DEPARTMENTS} 8

RISK TIP

CENCAL HEALTH NEWS

38 CLASSIFIEDS 40 NEW MEMBERS 42 IN MEMORIAM

CMA LEADERSHIP LEGISLATIVE WRAP-UP

CENTRAL COAST PHYSICIANS

Membership is affordable and easy to maintain. With our monthly payment plan, you can be a member for less than the price of a daily cup of coffee!

Letter from the CEO

YEAR IN REVIEW Thank you to our members for your support this past year. Without you, we wouldn’t be able to protect your profession and patients. In this issue of our magazine, we are providing a 2021 legislative wrap-up in addition to new laws that are of interest to physicians for 2022. Our major legislative initiative this year will be protecting MICR A, which will be on the November ballot as the Fairness for Injured DANA GOBA Patients Act (FIPA). We included a fact sheet in this issue and will continue providing information throughout the year to educate physicians and their patients. This year we are planning to gather in person, and our first events will be in April to celebrate and honor our 2021 Physicians of the Year, Dr. Thomas Hale in San Luis Obispo and Dr. Alex Koper in Santa Barbara. We were saddened to learn that our 2003 Physician of the Year and 1998 California Medical Association President, Dr. Robert Reid, passed away over the holidays. He was a champion for organized medicine and a wonderful human being. As we continue though the pandemic, please be kind to yourself, and be kind to each other. Together we are stronger.

PRESIDENT Samira Kayumi-Rashti, MD PRESIDENT ELECT Julie Fallon, MD TREASURER Douglas Murphy, MD SECRETARY Todd Engstrom, MD IMMEDIATE PAST PRESIDENT Priti Gagneja, MD DIRECTORS Eric Amador, MD; Kevin Casey, MD; Michael DiBiase, 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; Julie Fallon, 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 Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Samira Kayumi-Rashti, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Sue Boisvert, BSN, MHSA; California Medical Association; CenCal Health; Tenet Health Central Coast CONTRIBUTING PHOTOGRAPHERS California Medical Association, CenCal Health, 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

Sincerely,

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

Dana Goba Chief Executive Officer Central Coast Medical Association

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

CENTRAL COAST PHYSICIANS

Winter 2022

Santa Barbara Vascular Specialists

WELCOMES DR. EDWARD N. LI, MD We are proud to welcome Dr. Li to Santa Barbara Vascular Specialists. Dr. Li joins SBVS, bringing more than 10 years of experience in treating a large variety of vascular problems, including the treatment of peripheral artery disease, carotid artery disease, aortic aneurysms, dialysis access, varicose veins, deep venous thrombosis, and venous insufficiency.

www.sbvascularspecialists.com

Dr. Li strives to treat patients the way he would want to be treated: with respect, honesty, and compassion. Dr. Li is a strong patient advocate, believing that no patient should have to face complex medical decisions alone. To consult Dr. Li, please call 805-456-8890. 2621 De La Vina St. | Santa Barbara, CA 93105 Phone: 805.456.8890 | Fax: 805.456.8894

Helping to Build a Healthy Community

info@sbvascularspecialists.com www.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

Winter 2022

Loans subject to credit approval.

CENTRAL COAST PHYSICIANS

RISK TIP

Strategies for Effective PatientAssisted Telehealth Assessments SUE BOISVERT, BSN, MHSA, PATIENT SAFETY RISK MANAGER II, THE DOCTORS COMPANY

The main differences between telehealth visits and office-based patient visits are the location of the patient (geography), the insertion of technology between the provider and the patient, and the performance of the physical assessment. While much has been written about the challenges of geography and technology in telehealth visits, clinical literature and specialty society journals are beginning to address patient-assisted telehealth assessments.1 The strategies outlined in this article can help physicians perform a successful patient-assisted assessment. Physicians who practice telemedicine must carefully consider the components required to complete an effective remote assessment and plan ahead based on their specialty area and the patient’s presenting complaint. While many patients may purchase a blood pressure cuff or a thermometer, accessing a more complex instrument—such as an otoscope, ophthalmoscope, or digital stethoscope—may be beyond the ability of a typical patient unless the visit occurs in a retail kiosk or pod. Either way, the patient (or caregiver) becomes an essential partner in the assessment process.

CENTRAL COAST PHYSICIANS

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

Winter 2022

The important role that assessment plays in the diagnostic process and the prevention of diagnostic error cannot be understated as illustrated in our recent analysis. The Doctors Company studied 286 primary care malpractice claims that closed between 2014 and 2018. Analysts found that 51 percent of the claims involved assessment failures. The top two contributing factors were failure to establish a differential diagnosis (16.7 percent) and failure to assess and address continued symptoms (14 percent). The standard of care remains the same whether the visit is in person or remote. It is the provider’s responsibility to ensure that information gleaned during a remote assessment is sufficient to determine the patient’s diagnosis and treatment. The following strategies can help providers better prepare patients to assist effectively with the remote assessment: 1. P REVISIT PREPARATION

In addition to offering a technology test session, ensure that the patient telehealth previsit process includes instructions to patients for obtaining the equipment necessary to measure vital signs. Based on diagnosis and provider specialty, the instruction can be patient specific—such as a blood pressure and oxygen saturation monitor—or general, such as a thermometer and scale. Advise the patient to practice using the equipment and to measure and write down the results over the course of several days, including on the morning of the telehealth visit. 2. V ISIT INITIATION

Establish rapport. Smile. Confirm audio and video function, and ask the patient how the sign-in process went. Introduce yourself and confirm the patient’s identity with two identifiers. Evaluate how the patient looks in order to determine if a telehealth visit is appropriate. Evaluate the patient’s mental and physical status to determine if the patient can participate appropriately. In the case of children, frail elderly, and patients with special needs, determine if a caregiver is present and able to assist. Use the opportunity to evaluate the patient’s environment and address any distractions. For additional information on patient distractions in telehealth, read our article, “Telehealth’s Newest Safety Risk: Distracted Patients.” Confirm the patient’s medication list, or if necessary, conduct a virtual “brown bag” medication check. Ask the patient to give you the vital sign information collected. Document the information in the medical record as “patient self-reported.”

Winter 2022

3. P HYSICAL ASSESSMENT

Assessment during a virtual visit is, by necessity, a collaborative effort. The provider observes and directs the patient or caregiver to assist. Patients can be directed to position themselves to facilitate visual inspection of head and neck structures. A willing patient can be guided through palpation of the neck and submandibular areas to examine for “lumps” and, if noted, to describe pain, induration, shape, and size. Patients can be asked to stand and take a few steps to assess balance and gait. Any joint pain can be further evaluated with range of motion and the use of a pain scale. Patients can be asked to palpate pulses, provide a heart rate, and describe what they are feeling. Respiratory function can be assessed by having the patient sit quietly and take deep breaths while the provider and patient listen for any wheezing or coughing. Abdominal assessment can be facilitated by having the patient stand and turn side to side as well as guiding the patient to palpate any areas of concern. Carefully document the portions of the assessment observed by the provider and those that were “patient assisted.” For example, “the patient assisted with lymph node assessment.” Because of the limitations of patient-assisted assessment, carefully consider the clinical conditions that can be evaluated using this approach versus conditions that require an inperson visit. For the comfort and consideration of both the provider and patient, this decision is best made at the time of scheduling as opposed to during the telehealth visit. For staff who schedule appointments, having clear guidelines and ready access to clinical decision makers will increase the chance of making an appropriate determination regarding the type of visit to be scheduled. When used appropriately, a patient-assisted assessment during a telehealth visit is a wonderful opportunity to increase patient engagement in their own healthcare and further enhance the provider-patient relationship. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

CENTRAL COAST PHYSICIANS

2022

CCMA Leadership Thank you to members serving in leadership positions with CCMA and CMA.

CCMA Board of Directors OFFICERS Samira Kayumi-Rashti, MD President Pediatrics Santa Barbara Julie Fallon, MD President-Elect Internal Medicine Templeton Douglas Murphy, MD Treasurer Psychiatry San Luis Obispo Todd Engstrom, MD Secretary Internal Medicine Santa Barbara Priti Gagneja, MD Immediate Past President Internal Medicine Santa Barbara DIRECTORS Eric Amador, MD Anesthesiology Santa Barbara

CENTRAL COAST PHYSICIANS

Kevin Casey, MD Vascular Surgery Santa Barbara Michael DiBiase, MD Nephrology San Luis Obispo Jeffrey Gauvin, MD General Surgery Santa Barbara Jennifer Hone, MD Endocrinology Santa Barbara Bindu Kamal, MD Nephrology Santa Barbara

Edward Bentley, MD Gastroenterology Santa Barbara Kevin Casey, MD Vascular Surgery Santa Barbara

Rachel May, MD Emergency Medicine San Luis Obispo

David Dodson, MD Internal Medicine Santa Barbara

Rahim Raoufi, MD Gastroenterology Lompoc

Julie Fallon, MD Internal Medicine Templeton

CMA HOUSE OF DELEGATES

Priti Gagneja, MD Internal Medicine Santa Barbara

Sharon Basham, MD Physical Medicine and Rehabilitation Santa Barbara

Jennifer Hone, MD Endocrinology Santa Barbara

Winter 2022

Grace Park, MD, MPH Internal Medicine Santa Barbara Joseph Schwartz, MD Psychiatry San Luis Obispo CMA BOARD OF TRUSTEES Samira Kayumi-Rashti, MD Pediatrics Santa Barbara Christopher Lumsdaine, MD Family Medicine Lompoc

Rene Bravo, MD Fifth District Ventura, Santa Barbara, and San Luis Obispo Counties Pediatrics San Luis Obispo

Douglas Murphy, MD Psychiatry San Luis Obispo

Winter 2022

CENTRAL COAST PHYSICIANS

Tenet Health Central Coast Now Offers Innovative and Safe Procedure to Treat Carotid Artery Disease and Help Prevent Future Strokes Physicians know, and have been telling patients for years, that blockage of the Carotid artery (Carotid stenosis) is no small matter – it is estimated that up to a third of stroke cases are caused by the buildup of plaque in one or both of the arteries in the neck that supply blood from your heart to your brain. While treatments to lower cholesterol and thin the blood to improve blood flow to the brain are essential first steps, if the degree of narrowing in the artery is severe, surgery may be needed to open the blood vessel and clean the artery. However, as with any surgery, there is a risk of stroke or heart attack from the most common current procedures: Carotid

CENTRAL COAST PHYSICIANS

Endarterectomy (CEA) and Carotid Transfemoral Stenting (TFS). Now, Tenet Health Central Coast will be the first in San Luis Obispo County to offer an innovative surgical alternative, Trans-Carotid Artery Revascularization (TCAR), which reduces greatly the risk of stroke and heart attack from the surgery itself and keeps the brain safe during the procedure. Until this advanced approach, the most common procedures have been surgery through the neck that directly goes to the artery to remove plaque, and TFS, which enters the artery through the groin area. As with any surgery, the risk of stroke or heart attack is serious, and especially due to the location of the Carotid Artery near the brain. However, TCAR actually reverses blood flow, filtering blood in the process, which greatly reduces the risk of traditional Carotid Artery procedures. Dr. Spencer Hansen, who has performed some 50 of these surgeries before providing the procedures at Tenet Health Central Coast, said that the goal is to decrease the risk of stroke

Winter 2022

while minimizing the perioperative risk of heart attack, even in high-risk patients.” “The game-changer for this is the ability to treat people who are at high risk,” said Hansen. “There are criteria that patients have to meet for an intervention. We have an older population in this region and the TCAR procedure is the most up-to date technology for high risk interventions.” With TCAR, the entire procedure is performed through a smaller incision in the neck and in less than half the time of a carotid endarterectomy (CEA) procedure – limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure. This minimally-invasive approach also means less scarring and, potentially, fast healing. Over 20,000 procedures have been performed worldwide, and the clinical data has been excellent. In fact, a study published in 2019 in the Journal of Vascular Surgery found that TCAR carried significantly lower rates of in-hospital stroke (1.9% vs 3.3%) and stroke death (2.2% vs 3.8%), plus data demonstrating less hypotension, lower fluoroscopy (X-Ray imaging) times and contrast volume. It also showed a lower likelihood of a prolonged hospital stay, and increased discharge home in patients treated with TCAR rather than stenting. That study is in line with published clinical trials in 2015, which showed the procedure offers several advantages: TCAR results in a low peri-procedural stroke rate of 1.4% in high surgical risk patients. This compares favorably to a 2.3% stroke rate of CEA and a 4.1% stroke rate of the FTS approach in standard-risk patients. TCAR’s low stroke rate is the lowest reported to date for any prospective, multi-center trial of carotid stenting. “This type of procedure isn’t necessarily going to replace the other carotid surgeries, but it’s an important, safe way to bridge the gap between the risks of other procedures,” said Dr. Hansen. “I can tell you that the early adopters are now doing TCAR up to 80-90 percent of their cases, but we do this on a case-by-case basis. If people qualify, it’s a great option.” Tenet Health Central Coast is already the first certified Thrombectomy Capable Center in San Luis Obispo County and has an exclusive relationship with the University of California, San Francisco and UCSF Health to provide access to a nationally-recognized network of neurological and spine care services here on the Central Coast. Now, Tenet Health Central Coast provides one of the safest and minimally invasive treatments to prevent stroke for those at the highest risk.

Winter 2022

CENTRAL COAST PHYSICIANS

NEW

The second legislative

CALIFORNIA

LAWS OF INTEREST TO PHYSICIANS FOR 2022

session during the COVID-19 pandemic continued to focus on pandemic-related policy issues. While the number of new laws overall is significantly reduced as compared to past years, many new and significant laws were enacted. Below is a list of new laws of interest to physicians. For information about these laws, go to www.cmadocs.org.

ALLIED HEALTH PROFESSIONALS

AB 1533 (Committee on Business and Professions) –

AB 356 (Chen) – Fluoroscopy: temporary permit

AB 407 (Salas) – Optometry: assistants and

AB 1534 (Committee on Business and Professions) –

scope of practice

California State Board of

AB 435 (Mullin) – Hearing aids: locked programming software: notice AB 462 (Carrillo) – Licensed Professional Clinical

Optometry AB 1536 (Committee on Business and Professions) – Board of Vocational Nursing

Counselor Act

and Psychiatric Technicians

AB 691 (Chau) – Optometry: COVID-19

of the State of California:

vaccinations and clinical

vocational nursing and

laboratory tests or examinations AB 815 (Luz) – School nurses: credentialing

psychiatric technicians SB 409 (Caballero) – Pharmacy practice: testing SB 509 (Wilk) – Optometry: COVID-19

AB 1015 (Rubio) – Board of Registered Nursing: workforce planning: nursing

Pharmacy

pandemic: temporary licenses SB 534 (Jones) – Dental hygienists

programs: clinical placements AB 1064 (Fong) – Pharmacy practice: vaccines: independent initiation and administration AB 1407 (Burke) – Nurses: implicit bias courses AB 1532 (Committee on Business and Professions) –

BROADBAND ACCESS AB 41 (Wood) – Broadband infrastructure deployment SB 4 (Gonzalez) – Communications: California Advanced Services Fund

Nursing

CENTRAL COAST PHYSICIANS

Winter 2022

AB 1113 (Medina) – Public postsecondary

BUDGET AB 133 (Committee on Budget) –

education: exemption from

Department of Health Care

tuition and fees: qualifying

Access and Information

survivors of persons providing

SB 171 (Committee on Budget and Fiscal Review) –

medical or emergency services

Health

deceased during COVID-19 California state of emergency SB 242 (Newman) – Health care provider

CANNABIS AB 1305 (Lackey) – The Medicinal and Adult-Use

reimbursements

Cannabis Regulation and

SB 336 (Ochoa Bogh) – Public health: COVID-19

Safety Act: exemptions

SB 510 (Pan) – Health care coverage: COVID-19

SB 311 (Hueso) – Compassionate Access to

cost sharing

Medical Cannabis Act or Ryan’s Law SB 544 (Laird) – Cannabis testing

ELDER AND DEPENDENT ADULTS AB 1243 (Rubio) – Protective orders: elder and dependent adults

CLINICAL LABORATORIES AB 526 (Wood) – Dentists and podiatrists: clinical laboratories and

EMERGENCY SERVICES AB 118 (Kamlager) – Department of Social Services:

vaccines

C.R.I.S.E.S. Grant Pilot Program AB 580 (Rodriguez) – Emergency services: vulnerable populations

PRIVACY AND SECURITY AB 825 (Levine) – Personal information: data

AB 1104 (Grayson) – Air ambulance services

breaches: genetic data AB 1184 (Chiu) – Medical information: confidentiality SB 24 (Caballero) – Domestic violence: protective orders: information pertaining to a child SB 41 (Umberg) – Privacy: genetic testing

END-OF-LIFE AB 439 (Bauer-Kahan) – Certificates of death: gender identity AB 1280 (Irwin) – California Hospice Licensure Act of 1990 SB 380 (Eggman) – End of life

companies HEALTH CARE PLANS, COVERAGE AND INSURANCE COVID-19 PUBLIC HEALTH EMERGENCY AB 80 (Burke) – Taxation: Coronavirus Aid, Relief, and Economic Security

practices: health protection AB 326 (Rivas) – Health care service plans:

Act: Federal Consolidated

Consumer Participation

Appropriations Act 2021

Program

AB 263 (Arambula) – Private detention facilities and public health orders AB 654 (Gómez Reyes) – COVID-19: exposure: notification AB 845 (Rodriguez) – Disability retirement: COVID-19: presumption AB 856 (Maienschein) – Pupil health: COVID-19 Youth Health Information Act

Winter 2022

AB 237 (Gray) – Public employment: unfair

AB 342 (Gipson) – Health care coverage: colorectal cancer: screening and testing AB 347 (Arambula) – Health care coverage: step therapy AB 532 (Wood) – Health care: fair billing policies AB 570 (Santiago) – Dependent parent health care coverage AB 789 (Low) – Health care services

CENTRAL COAST PHYSICIANS

AB 1020 (Friedman) – Health care debt and fair billing

AB 1042 (Jones-Sawyer) – Skilled nursing facilities:

AB 1082 (Waldron) – California Health Benefits

unpaid penalties: related

Review Program: extension AB 1158 (Petrie-Norris) – Alcoholism or drug abuse

parties AB 1422 (Gabriel) – Health facilities: critical care

recovery or treatment facilities:

units: critical care unit program

recovery residences: insurance

flexibility

coverage

AB 1527 (Ting) – Seton Medical Center: seismic

AB 1511 (Committee on Insurance) – Insurance: omnibus SB 221 (Wiener) – Health care coverage: timely access to care

safety AB 1585 (Committee on Health) – Health care SB 541 (Bates) – Substance use disorder

SB 255 (Portantino) – Health care coverage:

treatment facilities and

employer associations

programs: disclosure of license

SB 280 (Limón) – Health insurance: large group health insurance

and certification status SB 564 (Cortese) – Hospitals: seismic compliance:

SB 283 (Gonzalez) – Life and disability income

O’Connor Hospital and Santa

insurance: HIV tests SB 326 (Pan) – Health care coverage: federal health care reforms

Clara Valley Medical Center SB 650 (Stern) – Skilled nursing facilities SB 664 (Allen) – Hospice licensure: moratorium

SB 368 (Limón) – Health care coverage:

on new licenses

deductibles and out-of-pocket expenses SB 428 (Hurtado) – Health care coverage: adverse childhood experiences screenings SB 535 (Limón) – Biomarker testing

MEDI-CAL SB 48 (Limón) – Medi-Cal: annual cognitive health assessment SB 226 (Pan) – Medi-Cal: County of Sacramento

SB 655 (Bradford) – Insurers: diversity SB 718 (Bates) – Health care coverage: small employer groups

MENTAL AND BEHAVIORAL HEALTH AB 134 (Committee on Budget) – Mental Health Services

HEALTH CARE FACILITIES AND FINANCING

Act: county program and

AB 381 (Davies) – Licensed facilities: duties

expenditure plans

AB 450 (Gonzalez) – Paramedic Disciplinary Review Board AB 451 (Arambula) – Health care facilities: treatment of psychiatric emergency medical conditions AB 665 (Garcia, Eduardo) – Care facilities: internet access AB 749 (Nazarian) – Skilled nursing facilities: medical director certification AB 849 (Reyes) – Skilled nursing facilities: intermediate care facilities: liability

AB 309 (Gabriel) – Pupil mental health: model referral protocols AB 638 (Quirk-Silva) – Mental Health Services Act: early intervention and prevention programs AB 1443 (McCarty) – Mental health: involuntary treatment AB 1477 (Cervantes) – Maternal mental health SB 14 (Portantino) – Pupil health: school employee and pupil training: excused absences: youth mental and behavioral health

CENTRAL COAST PHYSICIANS

Winter 2022

SB 465 (Eggman) – Mental health

REPORTING REQUIREMENTS

SB 224 (Portantino) – Pupil instruction: mental

AB 1094 (Arambula) – Sexual orientation and gender

health education

identity data collection pilot

SB 434 (Bates) – Substance abuse and mental

project

health services: advertising

AB 1204 (Wicks) – Hospital equity reporting

and marketing

SB 97 (Roth) – Pupil health: type 1 diabetes

SB 507 (Eggman) – Mental health services: assisted

information: parent

outpatient treatment

notification

SB 578 (Jones) – Lanterman-Petris-Short Act: hearings

REPRODUCTIVE HEALTH AB 367 (Garcia, Cristina) –

PRESCRIBING AND DISPENSING

Menstrual products

SB 310 (Rubio) – Unused medications: cancer

AB 556 (Maienschein) – Misuse of sperm, ova, or

medication recycling AB 527 (Wood) –

Controlled substances

embryos: damages AB 1356 (Bauer-Kahan) – Reproductive health care services

PROFESSIONAL LICENSING AND DISCIPLINE

SB 374 (Min) – Protective orders: reproductive

AB 107 (Salas) – Licensure: veterans and

coercion

military spouses AB 359 (Cooper) – Physicians and surgeons: licensure AND CME

TELEHEALTH AB 457 (Santiago) – Protection of Patient Choice in

SB 801 (Archuleta) – Healing arts: Board of

Telehealth Provider Act

Behavioral Sciences: Board of Psychology: licensees SB 806 (Roth) – Healing arts

TESTING SB 306 (Pan) – Sexually transmitted disease: testing

PROFESSIONAL LIABILITY SB 447 (Laird) – Civil actions: decedent’s cause of action

TOBACCO AB 541 (Berman) – Tobacco assessment SB 395 (Caballero) – Excise tax: electronic

PUBLIC HEALTH

cigarettes: Health Careers

AB 45 (Aguiar-Curry) – Industrial hemp products

Opportunity Grant Program:

AB 73 (Rivas) – Health emergencies:

Small and Rural Hospital Relief

employment safety:

Program

agricultural workers: wildfire smoke

WORKFORCE, EMPLOYMENT AND LABOR ISSUES

AB 653 (Waldron) – Medication-Assisted Treatment

AB 615 (Rodriguez) – Higher Education Employer-

Grant Program SB 742 (Pan) – Vaccination sites: unlawful

Employee Relations Act: procedures relating to

activities: obstructing,

employee termination or

intimidating, or harassing

discipline

SB 823 (Committee on Health) – Public health: omnibus bill

SB 331 (Leyva) – Settlement and nondisparagement agreements

Winter 2022

CENTRAL COAST PHYSICIANS

Remembering Robert A. Reid, MD 1939 – 2021

Introduction of 2003 Physician of the Year Robert A. Reid, MD, by Karl J. Sandin, MD Bob Reid was born in Milan, Italy to an American opera singer for medicine is strong and reminds us all of the significance of and his Italian wife, from which partnership one suspects his our vocation. Bob Reid is Santa Barbara medicine, and we are the exuberance has its foundation. He grew up in Denver and better for it. received his undergraduate, medical, and graduate medical While Santa Barbara County has provided the California education at the University of Colorado. My mother the English Medical Association with many leaders, no other local physician teacher would proudly note that his bachelor’s degree is in has achieved more within that organization than Bob Reid. literature. He had been at Vandenberg Air Force Base as a general From trustee, to speaker, to President, he has given so much to medical officer and in 1971 returned to the Central Coast to the House of medicine. He’s knocked on your door asking for begin practice in obstetrics and gynecology. your dues and contributions, reminded you of CMA victories Let’s talk a little about how Bob has protected the public like MICRA, and wheeled and dealed with the best of them to health. As a member of the Board of Directors of Blue Shield of balance the often Byzantine hierarchies of the CMA. Amazingly California he has been brilliantly placed to ensure that insurance he seems to have made no enemies in the process, hardly faint coverage protects Californians. As a medical staff officer and praise as those of us who’ve dabbled in the political sphere know. medical administrator within the Cottage Health System, he I couldn’t let this evening end without some discussion of has assured highest standards of quality for the patients in our Bob’s writing talents. He has edited our county newsletter for 20 community. Many of us know Bob’s important work in the MAP years, serving up controversial columns for our betterment. As process that has highlighted strategic initiatives for the Cottage could only happen in Santa Barbara, the columns that cause the Health System, initiatives that provide us with professional most storm are not his editorials rather his restaurant reviews. benefit and provide the community with a sound medical Just to remind you, Bob the gourmand pays all his own expenses foundation. when he eats out; any dyslipidemic damage he does comes from Can you think of a more visible advocate for the profession his own pocket, not your dues. My wife and I have two kids, and of medicine? Whether on KEYT, speaking to the Kiwanis, usually eating out comes down to the debate between Taco Bell participating with the Economic Forecast group, or in print, Bob and Sushi Teri; we have not the patience for gracious dining. Yet talks glowingly of the importance of physicians in the modern recently, based upon Bob’s recommendation, we went to Casa healthcare arena. He knows the value of capital expenditures to de Sevilla for my wife’s birthday. The kids had a great time, we accommodate modern practice, so he’s led efforts to bring the all dressed up, and it was a fine evening out. Bob really knows equipment and facilities at Cottage to high levels. His enthusiasm what he’s talking about. Don’t send letters, have a dinner at a

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Bob-approved establishment, knowing he’s done the leg work for you. Bob is a kind and good man. He is warm, friendly, confident, hardy, and compassionate. He likes people and they like him. He embodies many noble aspects of humanity and our profession. Tonight, we’re so glad to welcome some members of Bob’s family. I am going to introduce them, asking them to stand as I say their names, knowing you will robustly acknowledge them at the end of these remarks. Many of you know the delightful

Patti Reid, Bob’s high school sweetheart and wife of many years. In her own right, Patti has done so much for our community. They have four children, two of whom are present this evening, sons Bob and Scott, joined by Pamela Reid. Lea Ferguson, Bob’s mother, is here with her husband Art. Thank you all for what you’ve done to bring us this fine man. We have several proclamations for Bob: from the Cottage Health System, from the California Medical Association, from Representative Lois Capps and the Congress of the United States, from Supervisor Naomi Schwartz and the Board of Santa Barbara County, from Mayor Marty Blum and the City of Santa Barbara. Ladies and gentlemen, please stand and welcome Santa Barbara County’s Physician of the Year, Bob Reid.

OB/GYN Private Practice, 1971-1995 Tri-Counties Obstetrics-Gynecology Society President, 1978 California Medical Association Board of Trustees, 1981-1990 Santa Barbara County Medical Society President, 1982 American Medical Association Delegate, 1983-1984 Santa Barbara Cottage Hospital Medical Staff Secretary, 1985-1986 Santa Barbara Cottage Hospital Vice Chief of Staff, 1987-1988 Santa Barbara Cottage Hospital Chief of Staff, 1989-1990 California Medical Association Vice Speaker, 1990-1994 Blue Shield of California Corporate Board Member, 1990-1997 Santa Barbara Cottage Hospital Board of Directors, 1991-1995 Cooperative of American Physicians Board Member, 1992-2000 California Medical Association Speaker of the House, 1994-1997 Cottage Health System Director of Medical Affairs, 1995-2010 California Medical Association President Elect, 1997-1998 California Medical Association President, 1998-1999 Chair of numerous CMA committees, including the Commission on Communications, the Commission on Membership and Member Services, the Committee on Membership Development, the Commission on Health Care Costs, the Committee on Medical Staff Administration, and the Committee on Organizational Planning and Review, and on the Editorial Board of California Physician magazine.

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CENTRAL COAST PHYSICIANS

Santa Cruz internist

Donaldo Hernandez, MD, named CMA president-elect

Santa Cruz internist and hospitalist Donaldo (Don) M. Hernandez MD, FACP, was elected by the California Medical Association (CMA) House of Delegates as the association’s new president elect. He will take office at the close of this year’s meeting and will serve as on the CMA Executive Committee as president-elect for one year. Dr. Hernandez will be installed as president following next year’s House of Delegates. Born in Southern California, he received his undergraduate degree from the University of California, Berkeley, his medical degree from the University of California, San Diego, and completed his Internal Medicine residency at Harbor-UCLA Medical Center in Torrance, California. He also completed two General Internal Medicine Fellowships focused on Inpatient Medicine and Applied Health Services Research, one at Harbor-UCLA and the other at Cedars-Sinai Medical Center in Los Angeles. Raised in a bicultural/bilingual household, Dr. Hernandez came to the Monterey Bay at the conclusion of his fellowships, joining a small practice in order to serve the largely Latin communities in Salinas and the Salinas Valley. He returned to Hospital Medicine at the Santa Cruz Medical Clinic (now merged into the Palo Alto Medical Foundation) when they were inaugurating their Hospital Medicine program, now considered one of the highest quality Hospital Medicine programs in Central and Northern California and is one of longest- serving Hospitalists in the Monterey Bay Area.

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Dr. Hernandez has been a member of the Santa Cruz County Medical Society and the CMA since 2003. He was first named to the CMA House of Delegates from Santa Cruz in 2007. He was elected to two terms as President of SCCMS from 2009 to 2011 during which SCCMS initiated several distinguished community health projects most notably programs to combat childhood obesity, substance use disorder treatment, and behavioral health access issues. Dr. Hernandez has served on the CMA Board of Trustees for District 7 since 2011. He has also served since 2016 as Chair of CMA’s Justice, Equity, Diversity, and Inclusion Committee and is also a member of CMA’s Ethnic Medical Organization Section (EMOS). “What we do, who we are, and what we stand for is far too important to let others dictate their value. It is we who must speak with a resolute voice for the health of our patients and our profession,” said Dr. Hernandez during his campaign. “I have had and will continue to have those tough conversations. My objective will be to position us at the forefront of change and innovation, leading to a deeper understanding of community and the interconnection between us all. Acting with integrity is at the marrow of my leadership style and why I can lead the charge to change.” Dr. Hernandez and his wife, Jessica, reside in Santa Cruz in the home she grew up in (she was born at Dominican Hospital), successfully raising their five vigorous children who have now gone on to their own successful and varied careers.

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San Diego anesthesiologist

Robert E. Wailes, MD, installed as CMA president

On Saturday, October 23, 2021, San Diego physician Robert E. Wailes, MD, was installed as president of the California Medical Association (CMA) at the association’s annual House of Delegates (HOD). This year’s meeting was conducted virtually, due to the ongoing public health emergency. In his address to the delegates, Dr. Wailes—a Southern California pain specialist and board-certified anesthesiologist— recognized the great challenges and great accomplishments the profession of medicine faced over the past year. “Working together our state became an example for others to follow on our pandemic response and vaccine efforts,” said Dr. Wailes. He also noted, however, that our progress went far beyond the pandemic. “In the past year, CMA revised its mission statement to include health equity and justice as core to our mission. That part of the mission statement is more than just words on a page. It is a value proposition that we should all take seriously and work towards. Under my presidency ensuring health equity will be a priority for me and CMA as we move toward changes in both public policy arena and in the house of medicine to make that a reality.”

Before serving as president-elect over the last year, Dr. Wailes served as chair of the CMA Board of Trustees for the three years and as vice chair for three years before that. He has also served as president of the San Diego County Medical Society and represents the American Academy of Pain Medicine at the American Medical Association. Dr. Wailes is the founder, co-owner and medical director of Pacific Pain Medicine Group in Oceanside and Encinitas. He is also an active member of the medical staffs at Scripps Hospital in Encinitas and Tri-City Medical Center in Oceanside and serves as medical director for the Ketamine Research Institute. Dr. Wailes earned his MD from Wake Forest University School of Medicine in North Carolina and holds a bachelor’s degree in public finance and pre-medical sciences from UC Berkeley. He completed an internship at Mercy Hospital and Medical Center in San Diego in 1982 and his residency at UCSD Medical Center in 1984. Dr. Wailes has been providing pain medicine services in Southern California for more than 30 years, and has lived with his family in Carlsbad since starting his practice in 1984.

2021-2022 CMA Executive Committee PRESIDENT: Robert E. Wailes, MD, Oceanside/Encinitas PRESIDENT-ELECT: Donaldo Hernandez, MD, Santa Cruz CHAIR OF THE BOARD: Shannon L. Udovic-Constant, MD, San Francisco VICE-CHAIR OF THE BOARD: Sergio R. Flores, MD, San Diego SPEAKER OF THE HOUSE: Tanya W. Spirtos, MD, Redwood City VICE-SPEAKER OF THE HOUSE: Jack Chou, MD, Baldwin Park Winter 2022

IMMEDIATE PAST PRESIDENT: Peter N. Bretan, Jr, MD, Watsonville CENTRAL COAST PHYSICIANS 21

2021 LEGISLATIVE LEGISLATIVE

WRAP-UP 22

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Entering 2021, hope abounded that the pandemic would dissipate, allowing to life to return to normal. But the collective longing for normalcy would go unmet. The California State Legislature continued to operate under public health protocols that limited in-person contact and relied upon non-traditional approaches to advocacy. As veteran legislators began settling back into their Capitol offices, 18 new elected legislators were sworn into the Legislature: twelve Democrats and six Republicans. With these additions, the Democrats increased their existing supermajorities in both the Senate and the Assembly. Implementing lessons learned from the prior year on how to better navigate the Capitol’s hybrid-working approach and prohibition on in-person meetings, the California Medical Association (CMA) took an aggressive approach to the year. Specifically, CMA sponsored and cosponsored a larger number of bills than standard practice, entered a greater number of partnerships and coalitions, and maintained an aggressive posture throughout the year, despite calls from legislative leadership to decrease the number of bills under consideration.

By the end of the first quarter of 2021, CMA had already provided approximately $250 million in state tax relief to the physicians of California. The aggressive positioning of the association allowed CMA to take advantage of abnormalities in the legislative process. For example, during his presentation of the January 10 budget proposal, Governor Newsom called for the Legislature to take early action on specific items designed to either re-open K-12 public schools or boost the economy. This break from the traditional state budget process allowed CMA to lead a multi-industry coalition effort to enact the largest state tax rebate in the history of California, through CMA-sponsored AB 80 (BURKE). This bill provided full state tax conformity with federal tax rules regarding the deductibility of forgiven Paycheck Protection Program loans for physician practices. Thus, by the end of the first quarter of 2021, CMA had already provided approximately $250 million in state tax relief to the physicians of California.

during the pandemic have not been recovered. Affordable housing, homelessness and school re-opening remained the top overarching policy areas California’s legislative leadership and the Governor sought to address.

CMA was able to utilize the budget process to make significant progress towards achieving interoperability within the health care delivery system. Specifically, the 2021-22 State Budget establishes the California Data Exchange Framework, which puts California on a path toward making all electronic health data available at the point of care for every patient. Although pandemic response was also a top priority, it was not among the highest profile matters at the beginning of traditional budget deliberations. However, the COVID-19 pandemic clearly identified rampant inequalities in health care. Whether it was testing, access to physician practices or availability of hospital beds, the case was clear that too many areas of the state did not have sufficient access to health care. CMA refused to concede the point. Though pandemic response was only a portion of what the state needed to address through budgetary allocations, CMA persisted and worked to achieve many victories including: •

EXTENDING THE TELEHEALTH FLEXIBILITIES and expansions from the COVID-19 public health emergency, including payment parity for telehealth (including audio-only) in Medi-Cal, for an additional year. This will provide $179 million in reimbursements for these services and ensure patients continue to have access to care via telehealth.

•

MAKING PERMANENT THE PROPOSITION 56 TOBACCO TAX FUNDING, ensuring certainty of $1.2 billion in total funds ($413.9 million in general funds) annually to continue the Medi-Cal supplemental payments. This will increase practice stability for Medi-Cal practitioners and access to care for Medi-Cal beneficiaries.

•

EXPANDING ELIGIBILITY FOR FULL-SCOPE COVERAGE to individuals 50 and older, regardless of documentation status;

With an early victory on state tax conformity, CMA was well positioned for the traditional state budget. Despite programs and efforts to mitigate the economic impacts of the pandemic, many Californians still face severe hardships. Over 4 million Californians remain unemployed and approximately half of the jobs lost

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LEGISLATIVE 2021WRAP-UP •

EXTENDING COVERAGE TO ALL CHILDREN UNDER 5, eliminating the risk of these patients sliding into and out of coverage while a physician is managing their care;

•

SECURING $50 MILLION, ONE-TIME IN GME FUNDING to support startup costs for new residency programs.

•

PROVIDING GRANTS OF UP TO $50K TO PHYSICIAN PRACTICES to incentivize participation in the state’s vaccine network for a total of $37 million in one-time support for the community vaccination rollout effort.

•

FIXING THE STATE AND LOCAL TAX (SALT) DEDUCTION CAP. For an individual with a $200k per year total combined (business and wage) income, this change amounts to an estimated $3,900 per year total tax reduction for those who choose to pursue this option.

In addition to these victories, CMA was able to utilize the budget process to make significant progress towards achieving interoperability within the health care delivery system. Specifically, the 2021-22 State Budget establishes the California Data Exchange Framework, which puts California on a path toward making all electronic health data available at the point of care for every patient. Under the framework, the State of California will develop a standard data sharing agreement through which all physicians, hospitals and health plans will exchange health care data. The state will also work with CMA and others to develop a program of technical assistance to support small and safety net practices.

With the main budget bill enacted, CMA turned its attention to the passage of the association’s remaining sponsored bills and priority bills of interest. Below are summaries of outcomes in particular issue areas. SCOPE OF PRACTICE

A primary focus of CMA’s Government Relations team was to ensure that the singular occurrence of the passing of a major scope bill did not turn into a harmful pattern. Despite many attempts, CMA was able to stop bills that sought to further erode important patient protections. Most notably, AB 1328 (IRWIN) if enacted, would have increased pharmacists’ scope by authorizing them to order and interpret all CLIA-approved tests, as opposed to only monitoring and managing the efficacy and toxicity of drug therapies. In partnership with the American College of Obstetricians and Gynecologists, CMA was successful in defeating this legislation. In addition, AB 407 (SALAS) would have allowed optometrists to treat more severe eye diseases with the use of pharmaceutical agents and therapeutic pharmaceutical agents without increased

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education and training. Recognizing the detrimental impact this bill would have, CMA teamed up with the California Academy of Eye Physicians and Surgeons and successfully limited the optometrists’ expansion to include treatable areas, such as the front of the eye, eyelids and adjacent tissue, as well as shortened the list of approved drugs for the conditions they may treat. ADMINISTRATIVE BURDENS CMA-sponsored SB 510, authored by Senator Richard Pan, M.D., requires the health plans and insurers to cover COVID-19 testing and vaccinations during the pandemic without barriers like patient cost-sharing or prior authorizations. At a time when health inequities have been laid bare in the health care system, SB 510 ensures that all Californians, regardless of race, income or geographic region are able to receive vaccination and testing, which will remain necessary until the conclusion of the pandemic. This bill implements valuable lessons learned over the course of the pandemic, setting up a framework in preparation for future public health crises.

Protecting practices from future sudden dramatic cost increases is necessary to increase the resiliency of physician practices during significant public health crises. CMA also sponsored SB 242 by Senator Josh Newman, which requires health care plans and insurers to reimburse provider costs related to the procurement of critical safety supplies, such as personal protective equipment. These increased costs have impacted physician practices of all sizes. Protecting practices from future sudden dramatic cost increases is necessary to increase the resiliency of physician practices during significant public health crises. The passage of SB 242 will ensure health plans meet their obligation to protect provider networks and ensure access to care for all Californians. TELEHEALTH

AB 457 by Miguel Santiago ensures that patients are notified of their rights to have a telehealth visit with their own physician. It would further guarantee that, when patients do access services through a third-party corporate telehealth provider, they receive high quality, integrated care including the sharing of medical records. Essentially, AB 457 stops health insurers from steering patients away from their treating physicians to third-party,

Winter 2022

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LEGISLATIVE 2021WRAP-UP SPONSORED BILLS

AB 32 (AGUIAR-CURRY): TELEHEALTH This bill expands on CMA-sponsored AB 744 (AguiarCurry) from 2019. AB 32 requires that all visits via telehealth, including audio-only, continue to receive payment parity in relation to in-person visits for equivalent services across all plan-provider contracts. This requirement also applies to Medi-Cal managed care to ensure that Medi-Cal patients have the same access to telehealth services as commercially insured patients. CMA co-sponsored this measure with the California Association of Public Hospitals and Health Systems, California Health+ Advocates/California Primary Care Association, Essential Access Health, and Planned Parenthood Affiliates of California. A budget agreement between the legislature and the Newsom Administration, appearing in AB 133, the health omnibus budget trailer bill, extends the Medi-Cal provisions of the telehealth flexibilities, including payment parity for all telehealth including audio-only, implemented by the Governor’s Executive Orders during the COVID-19 public health emergency for an additional year beyond the end of the public health emergency. A stakeholder group has already begun meeting to address the details regarding the parameters of telehealth payment parity in Medi-Cal beyond that time. Status: Implemented in the State Budget.

AB 359 (COOPER): PHYSICIANS AND SURGEONS: LICENSURE: EXAMINATION This cosponsored bill expands the qualifying continuing medical education (CME) courses to include courses dealing with practice management so that physicians can provide better services to patients and maintain their practices. Additionally, this bill allows for out-of-state physicians who have been practicing for at least four years without any disciplinary actions against them to apply for licensure in California as long as they have passed the United States Medical Licensing Examination Step 3 test. CMA worked with the Medical Board of California and the Department of Consumer Affairs (DCA) to ensure any out-of-state applicants demonstrate they meet the high standards of licensure in California. Status: Signed by the Governor (Chapter 612, Statutes of 2021).

AB 457 (SANTIAGO): PROTECTION OF PATIENT CHOICE IN TELEHEALTH PROVIDER ACT This CMA-sponsored bill ensures that patients have the right to access telehealth services from their own selected health care provider, or other networked provider of their

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choosing, rather than having a health plan direct them to a third-party corporate telehealth provider. If a patient does choose to be treated by a third-party corporate telehealth provider, this bill requires that provider to forward patient records from the visit to the patient’s primary care physician or a physician of the patient’s choosing in order to maintain continuity of care for the patient. Status: Signed by the Governor (Chapter 612, Statutes of 2021).

AB 562 (LOW): FRONTLINE COVID-19 PROVIDER MENTAL HEALTH RESILIENCY ACT OF 2021: HEALTH CARE PROVIDERS: MENTAL HEALTH SERVICES This coalition-sponsored bill, led by the United Nurses Association of California/Union of Health Care Professionals, seeks to address the issue of increasing mental burnout being experienced by health care workers due to the strain of providing care during the COVID-19 pandemic. It provides our health care workers with confidential mental health treatment, as well as any other mental or behavioral health services needed. This coalition of associations representing health care professionals is currently working with the Governor’s office to identify funding sources for this program. Status: Held in the Senate Appropriations Committee.

AB 864 (LOW): CONTROLLED SUBSTANCES: CURES DATABASE This sponsored bill seeks to relocate the Controlled Substance Utilization Review and Evaluation System (CURES) database from its current jurisdiction under the Department of Justice to the Department of Public Health (CDPH). AB 864 was strategically made a two-year bill to allow for discussions with the new Attorney General and new CDPH director. Status: Held in the Assembly Business and Professions Committee.

AB 1156 (WEBER, AKILAH): HEALING ARTS: MEDICAL SCHOOL GRADUATES: POSTGRADUATE TRAINING LICENSE CMA, in coalition with other provider organizations, co-sponsored this bill to address issues related to the postgraduate training license. The bill sought to return to the state of the law pre-January 2020, whereby authorizing a resident to obtain their physician’s and surgeon’s license after 12 months of postgraduate training if the resident is a U.S. or Canadian medical school graduate, or 24 months if the resident is a graduate of a foreign medical school. AB 1156 did not move through the legislative process, as a nearly identical solution was placed in SB 806.

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Status: Held in the Senate Business, Professions and Economic Development Committee.

SB 242 (NEWMAN): HEALTH CARE PROVIDER REIMBURSEMENTS This bill provides physician practices with increased reimbursements to cover cost increases for personal protective equipment (PPE) due to any future public health emergency. While CMA was able to partner with the State of California to provide PPE during the current pandemic, relying on such a strategy for future public health emergencies is not prudent. CMA worked with numerous community organizations to impress upon the legislature the need for these reimbursements and how practices should not have to solely absorb such unanticipated costs. Status: Signed by the Governor (Chapter 538, Statutes of 2021).

SB 250 (PAN): PRIOR AUTHORIZATION AND COLLECTION OF PATIENT SHARE OF COST This is CMA’s sponsored bill to address administrative burdens, specifically prior authorization and the collection of patient cost-sharing. SB 250 would require health plans and insurers to create a program that would allow physicians to practice medicine free from prior authorization requirements if they met certain criteria and are subject to a review of their utilization every two years. The bill also requires health plans to collect the patient share of cost from the patient directly if the service was provided by an in-network physician in a hospital setting. Additionally, when the patient cost-sharing amount is collected from the health plan, the health plan must reimburse the physician the full contracted rate. CMA will continue to push for a solution to these growing problems and ensure that physicians, regardless of their mode of practice, remain viable and are able to practice medicine with minimal intervention from the outside entities. Status: Held in the Assembly Health Committee.

SB 371 (CABALLERO): HEALTH INFORMATION TECHNOLOGY CMA embarked upon an effort to establish a framework for the utilization of health information exchanges (HIE) in California and to provide the means for small practices to connect. The budget package on HIE includes many of the key components of CMA-sponsored SB 371 and garnered the support of the legislature, the Newsom Administration and key health care stakeholders. By including the language in the budget, rather than waiting for passage of the bill, CMA has jump-started state action on this issue, with a required stakeholder advisory group already having been selected and started meeting. Critically, the budget language requires the Health and Human Services Agency to work with stakeholders to

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establish the California Health and Human Services Data Exchange Framework. The Framework must include the establishment of a single data-sharing agreement and a common set of policies and procedures that will govern the exchange of health information among health care entities and government agencies in California but, critically, unlike AB 1131 (Wood), will not require entities to submit data to a single-source, central repository system. Status: Implemented in the State Budget.

SB 395 (CABALLERO): EXCISE TAX: ELECTRONIC CIGARETTES: HEALTH CAREERS OPPORTUNITY GRANT PROGRAM: SMALL AND RURAL HOSPITAL RELIEF PROGRAM This bill increased the tax on electronic cigarettes, establishing tax parity with traditional cigarettes, to a 12.5% tax at point of sale. The tax proceeds will be distributed to various public health, workforce development and early education programs. Most significantly, nearly 50% of the revenue will be dedicated to the Proposition 56 Medi-Cal Physician and Dentist Loan Repayment Program. The tax will go into effect on July 1, 2022. Status: Signed by the Governor (Chapter 489, Statutes of 2021).

SB 428 (HURTADO): HEALTH CARE COVERAGE: ADVERSE CHILDHOOD EXPERIENCES SCREENINGS CMA, in partnership with Children Now, worked to expand the effort to mitigate the effects of adverse childhood experiences (ACEs) by mandating that commercial health plans reimburse physicians for ACEs screenings. Such a mandate already exists in the Medi-Cal program. By expanding to all state-regulated plans and insurers, more physicians and patients will have access to ACEs screenings. Status: Signed by the Governor (Chapter 641, Statutes of 2021).

SB 510 (PAN): HEALTH CARE COVERAGE: COVID-19 COST SHARING This is CMA’s sponsored bill to ensure that patients have access to COVID-19 testing and vaccinations without unnecessary hurdles like prior authorizations and patient cost-sharing. SB 510 requires health plans and insurers to cover COVID-19 testing and vaccinations provided to patients. Additionally, SB 510 implements valuable lessons that the state has learned over the course of the current pandemic and sets up this framework for future public health emergencies so the state can be prepared for the next outbreak. Status: Signed by the Governor (Chapter 729, Statutes of 2021)

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LEGISLATIVE 2021WRAP-UP

PRIORITY SUPPORT AB 263 (ARAMBULA): PRIVATE DETENTION FACILITIES This bill requires private detention facilities to abide by all local and state public health orders in order to ensure that these private prisons are following state guidance on how to mitigate and prevent the spread of COVID-19. Status: Signed by the Governor (Chapter 294, Statutes of 2021).

AB 347 (ARAMBULA): HEALTH CARE COVERAGE: STEP THERAPY This bill will streamline the step therapy process by creating an exemption process physicians and patients can use to get the medications and treatments they need and that work for them. The bill also sets forth requirements for the use of a step therapy exemption and the timeframes for a response from health plans and insurers. Additionally, the bill collects information about the number of step therapy exemption requests and their outcomes, which would be collected from the health plans. This effort ensures that patients can receive the medications and treatments they need and that work for them, without having to navigate the step therapy process. Status: Signed by the Governor (Chapter 742, Statutes of 2021).

AB 451 (ARAMBULA): HEALTH CARE FACILITIES: TREATMENT OF PSYCHIATRIC EMERGENCY MEDICAL CONDITIONS This bill will require psychiatric hospitals or facilities with more than 16 beds to accept patients suffering psychiatric medical emergencies and provide appropriate services regardless of whether the facility operates an emergency department. Facilities are required to accept transfers if the sending facility ensures the patient is medically stable, the receiving facility has available beds, and the receiving facility has qualified personnel to provide appropriate care. Status: Signed by the Governor (Chapter 438, Statutes of 2021).

AB 705/SB 642 (KAMLAGER): HEALTH CARE: FACILITIES: MEDICAL PRIVILEGES AB 705 would have modernized existing state law to ensure that patients’ needs are at the center of care decisions and are free from interference from nonmedical lay entities such as private equity firms and health care facilities. Finally, the bill would have required the Attorney General to consider an additional criterion while

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evaluating and weighing in on proposed mergers and acquisitions they already have authority over. Status: Held in the Assembly Health Committee/ Held in the Senate Appropriations Committee.

SB 4 (GONZALEZ): COMMUNICATIONS: CALIFORNIA ADVANCED SERVICES FUND By authorizing the collection of up to $100 million per year through 2032 utilizing a surcharge on voice over internet protocol calls, SB 4 seeks to improve access to broadband for those who are unserved. SB 4 requires the Governor’s Office of Business and Economic Development to coordinate with other relevant state and local agencies and national organizations to assist in facilitation and streamlining of local land use approvals and construction permit processes for projects related to broadband infrastructure. This aids communities struggling with connectivity as well as providing funding for appropriate projects. SB 4 focuses state resources on expanding broadband, specifically to unserved communities, helping increase access to, and quality of, health care in these communities by expanding the reach of telehealth and health information exchange. Status: Signed by the Governor (Chapter 671, Statutes of 2021).

SB 65 (SKINNER): MATERNAL CARE AND SERVICES This bill will establish the California PregnancyAssociated Review Committee, with the purpose of identifying and reviewing all pregnancy-related deaths. The committee will be authorized to request specific information from government sources, including death records, medical records and autopsy reports. All committee proceedings, activities and opinions shall be confidential, with the purpose of identifying potential factors affecting pregnancy-related deaths and improving pregnancy-related outcomes. Status: Signed by the Governor (Chapter 449, Statutes of 2021).

SB 310 (RUBIO): UNUSED MEDICATIONS: CANCER MEDICATION RECYCLING This bill, also known as the Cancer Medication Recycling Act, will create a program for the collection and redistribution of unused cancer medications. All medication to be eligible for redistribution must meet stringent criteria to ensure patient safety. Status: Signed by the Governor (Chapter 541, Statutes of 2021).

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SB 378 (GONZALEZ): LOCAL GOVERNMENT: BROADBAND INFRASTRUCTURE DEVELOPMENT PROJECT PERMIT PROCESSING: MICROTRENCHING PERMIT PROCESSING ORDINANCE By authorizing a provider of broadband fiber facilities to determine the method of the installation of fiber and preventing a local agency from prohibiting or otherwise discriminating in favor of or against the use of, aerial installations, open trenching or boring or microtrenching, SB 378 helps remove barriers to broadband deployment. CMA supports increased funding and planning for telehealth infrastructure, including the costs of broadband and internet-connected devices for both physician practices and patients, especially in rural and/or disadvantaged communities. This bill ensures that the onus of the planning component is reduced for those entities wishing to expand broadband development. Reducing barriers to and incentivizing deployment of broadband through commercial enterprise reduces the need for the state to expend its own resources in ensuring broadband access for all Californians. Status: Signed by the Governor (Chapter 677, Statutes of 2021).

SB 402 (HURTADO): MULTIPAYER PAYMENT REFORM COLLABORATIVE This bill would have required the Secretary of the Health and Human Services Agency to convene a stakeholder group to propose pilot programs that could transition fee-for-service physicians into value-based payment arrangements in regions that have been hardest hit by COVID-19. The bill would also require the collaborative and the pilots to develop a common set of core quality metrics to measure performance. This bill was sponsored by the California Academy of Family Physicians. Status: Held in the Assembly Appropriations Committee.

SB 507 (EGGMAN): MENTAL HEALTH SERVICES: ASSISTED OUTPATIENT TREATMENT This bill clarified the eligibility for assisted outpatient treatment (AOT) to include a clinical determination that a person is unlikely to receive services in the community due to a deteriorating condition without AOT. This bill was sponsored by the Psychiatric Physicians Alliance of California. Status: Signed by the Governor (Chapter 426, Statutes of 2021).

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SB 742 (PAN): VACCINATION SITES: UNLAWFUL ACTIVITIES: OBSTRUCTING, INTIMIDATING, OR HARASSING This bill makes it a crime, punishable by a misdemeanor and/or up to a $1,000 fine, to knowingly approach within 30 feet of any person or vehicle entering or exiting a vaccination site with the intent of obstructing, injuring, harassing, intimidating or interfering with the person or the vehicle. This bill is in response to anti-vaccine protesters harassing and intimidating people seeking a vaccine at Dodger Stadium in early 2020. As an urgency measure, the bill went into effect immediately upon Governor Newsom’s signature. Status: Signed by the Governor (Chapter 737, Statutes of 2021).

SUCCESSFULLY NEGOTIATED BILLS AB 13 (CHAU): PUBLIC CONTRACTS: AUTOMATED DECISION SYSTEMS This bill would have originally required all businesses in California that used any type of automated decision system (ADS) to analyze them and assess them for any form of bias. These systems are ubiquitous across industries because they can vary from automatic notifications being sent out to members of an organization to systems that decide or recommend treatment options for a patient. CMA reached out to the author early on in the legislative session to explain to him that this would create a new regulatory structure within the health care industry and that we need to have stakeholder involvement in crafting said structure prior to this bill moving through the legislative process. The bill was soon amended to focus on the ADS used by the state, which allowed CMA to remove our opposition. Status: Failed in the Assembly Appropriations Committee.

AB 407 (SALAS): OPTOMETRY: ASSISTANTS AND SCOPE OF PRACTICE This bill expands the scope of practice of optometrists by allowing them to treat a number of diseases and conditions of the eye and adnexa that they were previously prohibited from, and allows ophthalmologists to practice subjective refraction in their offices. Negotiated by California Academy of Eye Physicians and Surgeons and California Optometric Association, AB 407 ensures advanced procedures currently reserved for physicians are not included in the optometric scope of practice. Status: Signed by the Governor (Chapter 652, Statutes of 2021).

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LEGISLATIVE 2021WRAP-UP

AB 443 (CARRILLO): PHYSICIANS AND SURGEONS: FELLOWSHIP PROGRAMS: SPECIAL FACULTY PERMITS This bill sought to create a streamlined pathway for foreign-trained physicians to participate in a fellowship program at a federally qualified health center (FQHC) if the physician spoke a language matching the FQHC’s population and was sufficiently competent to practice medicine. The goal of the legislation was to fill the gaps of the physician and surgeon shortage in California, particularly in rural and underserved communities, by creating a pathway to temporarily practice and provide care. CMA assisted in crafting language to improve a previously unworkable proposal. Status: Failed in the Senate Business, Profession and Economic Development Committee.

AB 646 (LOW): DEPARTMENT OF CONSUMER AFFAIRS: BOARDS: EXPUNGED CONVICTIONS This bill would have required physicians, as well as any other professional licensed by DCA, to pay a $50 fee to cover the cost of expunging offenses that have been published from a licensing board’s website. Status: Failed in the Assembly Appropriations Committee.

AB 695 (ARAMBULA): ELDER AND DEPENDENT ADULTS CMA was successful in getting amendments to this bill, which would have lowered the age of an “elder adult” to 60 from 65 for purposes of expanding a useful protective services program for the elderly. However, due to the way the bill was originally drafted, AB 695 would have also changed the age threshold for purposes of elder abuse. By expanding the definition of “elder,” this bill would have invited more litigation under California’s elder abuse statute, leaving physicians without the protection of the Medical Injury Compensation Reform Act (MICRA) and exposing them to greater liability. Amendments that CMA was able to negotiate limit the age change solely for the purposes of inclusion in the program so they do not apply to other sections of California law. Status: Failed in the Senate Appropriations Committee.

AB 789 (LOW): HEALTH CARE SERVICES This bill requires that all adult patients seen in primary care settings are offered hepatitis B and hepatitis C screening tests if indicated by the latest screening recommendations by the U.S. Preventive Services Task Force and the tests are covered by the patient’s health insurance. CMA secured amendments ensuring health

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care providers that fail to comply with the statute shall not be subject to any disciplinary action or civil or criminal liability because of their failure to comply. Status: Signed by the Governor (Chapter 470, Statutes of 2021).

AB 814 (LEVINE): PERSONAL INFORMATION: CONTACT TRACING AB 814 would have prohibited data collected for purposes of contact tracing from being used for any purpose other than facilitating contact tracing efforts. The measure also prohibited certain individuals, such as law enforcement, from engaging in contact tracing. The original version of the measure required that all data collected for purposes of contact tracing be deleted within 60 days, except if that data is in possession of a state or local health department. Prior to the bill being held in Senate Appropriations Committee, CMA successfully negotiated amendments that exempted health care providers their business associates from the data deletion requirement, so long as they followed certain levels of privacy and security regarding how the health data were maintained. Status: Failed in the Senate Appropriations Committee.

AB 849 (REYES): SKILLED NURSING FACILITIES: INTERMEDIATE CARE FACILITIES: LIABILITY AB 849 would have greatly increased the liability exposure of skilled nursing facilities and intermediate care facilities by raising the fines and fees associated with an alleged violation of a patient’s rights in those facilities. Currently, the amount of the fee is set at $500 per lawsuit filed, which could contain numerous alleged violations. The bill would change it to $500 per alleged violation. CMA and a collation of health care organizations were successful in getting amendments that would set guardrails around the award increase and certain factors the court must consider when deciding on the award amount to the plaintiffs. Status: Signed by the Governor (Chapter 471, Statutes of 2021).

AB 852 (WOOD): NURSE PRACTITIONERS: SCOPE OF PRACTICE: PRACTICE WITHOUT STANDARDIZED PROCEDURES This bill sought to make clarifying changes to AB 890 (2020), including allowing physical therapists to refer to nurse practitioners, and redefining the circumstances in which a nurse practitioner is required to refer to a physician, adding that the decompensation of the patient must be acute and unexpected. CMA was able to remove the provisions enabling nurse practitioners to refer to physical therapists and requiring patient decompensation

Winter 2022

be unexpected to trigger referral to a physician. CMA also defined practice protocol as a written document detailing manner of communication with and availability of the consulting physician; established that consultation with a nurse practitioner does not create a physicianpatient relationship, ensuring responsibility for services remain with the nurse practitioner; and prohibited nurse practitioners from referring to themselves as doctors. Status: Failed in the Senate Business, Professions and Economic Development Committee.

AB 858 (JONES-SAWYER): EMPLOYMENT: HEALTH INFORMATION TECHNOLOGY: CLINICAL PRACTICE GUIDELINES: WORKER RIGHTS This bill would have allowed all workers who provide direct patient care to override health information technology and/or clinical guidelines. CMA secured amendments explicitly requiring approval of the patient’s physician to do so. Status: Failed on the Senate Floor.

AB 1204 (WICKS): HOSPITAL EQUITY REPORTING This bill would have created significant administrative burdens in the form of duplicative reporting requirements for physician practices by having them report individual patient demographic information, as well as employee demographic and salary information. Additionally, this information would have to be published on their public website. CMA worked with the author to educate her on the duplicitous nature of the requirements and successfully had physician practices removed from the reporting requirements. Status: Signed by the Governor (Chapter 751, Statutes of 2021).

AB 1217 (RODRIGUEZ): PERSONAL PROTECTIVE EQUIPMENT: STOCKPILE This bill was aimed at ensuring that the State did not experience another PPE shortage by having CDPH establish a stockpile and provide them to organizations and health care providers. CMA successfully worked with the author to make sure the bill did not impede on physicians’ ability to procure necessary PPE. Status: Failed in the Assembly Appropriations Committee.

AB 1236 (TING): HEALING ARTS: LICENSEES: DATA COLLECTION This bill would have required all healing arts boards to acquire workforce data from their respective licensees

Winter 2022

when they apply for a license or license renewal. The data would have been shared with the Office of Statewide Health Planning and Development (OSHPD) for inclusion in an annual workforce report. CMA sought and received amendments making it optional for licensees to provide the workforce data and ensure any data provided is aggregated to protect licensees’ privacy. The bill eventually did not proceed through the legislative process as it was enacted in the budget. Status: Failed on the Assembly Floor.

SB 53 (LEYVA): UNSOLICITED IMAGES This bill would have criminalized the act of knowingly sending unsolicited images by electronic means of any persons engaged in sexual acts, sodomy, oral copulation, sexual penetration, masturbation, or the exposed genitals or anus of any person. CMA secured amendments exempting health care providers transmitting images for legitimate medical purposes. Status: Failed on the Senate Floor.

SB 306 (PAN): SEXUALLY TRANSMITTED DISEASE: TESTING This bill will require health plans to cover home health test kits for sexually transmitted diseases (STD) and their laboratory costs if ordered by a physician. The bill will also allow HIV counselors to test for other STDs if they have sufficient education and training in the disease they are testing for and authorize pharmacists to dispense expedited partner therapy prescriptions without the individual’s name as long as the prescription includes “expedited patient therapy” or “EPT.” CMA was successful in restoring the autonomy of pregnant women by removing an early provision of the bill that would have required blood draw of all pregnant women for the purpose of testing for syphilis. Status: Signed by the Governor (Chapter 486, Statutes of 2021).

SB 336 (OCHOA BOGH): PUBLIC HEALTH: COVID-19 CMA prevented an undue mandate on the CDPH and local health officers (LHO), which would have required them to publish any measures taken in response to the COVID-19 pandemic 72 hours in advance of implementation. Additionally, it would have required business groups and community organizations to opine before CDPH or LHOs could move forward with imperative preventative measures. Status: Signed by the Governor (Chapter 487, Statutes of 2021).

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LEGISLATIVE 2021WRAP-UP

SB 380 (EGGMAN): END OF LIFE This bill amends the End-of-Life Option Act by shortening the time period a patient must wait between their two required oral requests for aid-in-dying medication from 15 days to 48 hours; requiring physicians who choose not to participate in the act to still document a patient’s request for aid-indying medication; and prohibiting health care providers and facilities from using deceptive practices regarding their willingness or ability to participate in the act. CMA secured amendments to ensure physicians continue to have the option to decline to participate in the act. Status: Signed by the Governor (Chapter 542, Statutes of 2021).

SB 409 (CABALLERO): PHARMACY PRACTICE: TESTING This bill expands the scope of practice for pharmacists by allowing them to perform CLIA-waived tests used to detect 12 conditions negotiated by CMA, the American College of Obstetricians and Gynecologists and the California Society of Pathologists. CMA also secured amendments to require pharmacists to have sufficient education and training on the conditions they are testing for, and prohibit the administration of tests that require the use of specimens collected by vaginal swab, venipuncture or the collection of seminal fluid. Status: Signed by the Governor (Chapter 604, Statutes of 2021).

SB 492 (HURTADO): MATERNAL HEALTH This bill would have required CDPH tracking of data on pregnancy-related deaths to include deaths in which the attending physician was found to have been negligent in the death. As the ambiguity around determining negligence and the inappropriate comingling of human error and medically indicated outcomes in a single data set were equally troubling, amendments were taken to ensure the data collected regarding pregnancy-related deaths is solely demographic. Status: Failed on the Senate Floor.

SB 652 (BATES): DENTISTRY: USE OF SEDATION: TRAINING This bill would have legislated the number of health care professionals required to be present during procedures in which patients of 13 years or younger are under sedation. It also would have allowed the Dental Board of California (DBC) to approve training standards for general anesthesia and deep sedation in lieu of Advanced Cardiac Life Support (ACLS) certification. CMA and other stakeholders were able to remove the provision authorizing DBC to approve training standards in lieu of ACLS certification. Status: Failed on the Senate Floor.

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SB 744 (GLAZER): COMMUNICABLE DISEASES: RESPIRATORY DISEASE INFORMATION CMA stopped an attempt to needlessly increase the administrative burden on physicians by requiring a weekly summary of viral respiratory diseases by county on top of the current Confidential Morbidity Report requirements. CMA worked with the author and a coalition of public health officers and advocacy organizations to remove the onerous weekly reporting requirements. Status: Failed in the Assembly Appropriations Committee.

OPPOSED BILLS AB 510 (WOOD): OUT-OF-NETWORK HEALTH CARE BENEFITS CMA was successful in stopping this bill, which would have made it more complex and virtually impossible for a physician to get patient consent to be billed for outof-network services. AB 510 would have undermined agreed-upon policy decisions during the negotiations on AB 72 from 2015. Specifically, physicians would have had to get patient consent 72 hours before the service could be provided (currently it is 24 hours), would have required that the consent form include a list of in-network providers at the facility that are able to perform the service and would have required it to be available in the 15 most commonly used languages in the region. It also would have excluded anesthesiology, pathology, radiology, neonatology and others from the ability to receive the required patient consent to bill for out-of-network services. Status: Failed in the Assembly Health Committee

AB 650 (MURATSUCHI): EMPLOYERPROVIDED BENEFITS: HEALTH CARE WORKERS: COVID-19: HAZARD PAY RETENTION BONUSES This bill was touted as a “hero pay” bill to honor the sacrifices of our frontline workers during the pandemic. However, it would have mandated physician groups to pay all employees a $10,000 bonus without providing any funds from the state for those bonuses. It also failed to take into account the financial situation of a practice or any compensation the group may have already provided these employees. CMA worked with a broad coalition of health care and business groups to defeat this bill and prevent these overly onerous mandates from going into effect and decimating practices that have already been hammered by the effects of the pandemic. Through our collective efforts, CMA and the coalition spoke with every member of the California Assembly to inform them of the far-reaching

Winter 2022

effects of such a mandate and how it would force practices to close or be sold. Status: Failed on the Assembly Floor.

AB 757 (DAVIES): PRIVATE EMPLOYMENT: COVID-19: POSITIVE TEST OR DIAGNOSIS: DOCUMENTATION This bill would have allowed employers to request documentation of a positive COVID-19 test from employees if they reported they were unable to work. CMA had concerns that this policy would potentially violate HIPAA and undermine patient privacy protections. CMA was successful in making this a two-year bill. Status: Failed in the Assembly Labor and Employment Committee.

AB 835 (NAZARIAN): HOSPITAL EMERGENCY DEPARTMENTS: HIV TESTING This bill would have required physicians in emergency departments (ED) to administer HIV tests to every patient 12 years old and up who had their blood drawn, regardless of the reason they were in the ED. It would have forced physicians to unnecessarily administer these tests, and taken crucial time away from physicians being able to provide immediately imperative care to patients. It would also have forced physicians to counsel every patient on the results without providing any additional resources to fulfill this mandate without taking time away from other emergencies. CMA worked with the California chapter of American College of Emergency Physicians to defeat this bill. Status: Failed in the Senate Appropriations Committee.

AB 882 (GRAY): PROPOSITION 56 MEDICAL PHYSICIANS AND DENTISTS LOAN REPAYMENT ACT PROGRAM This bill sought to limit access to the Proposition 56 Physician and Dentist Loan Repayment Program by requiring providers to work in health professional shortage areas, as determined by the Health Resources and Services Administration, and maintain a patient workload of at least 30% Medi-Cal patients. Unfortunately, the author’s language would have unintendedly harmed underserved communities and reduced providers in these needy communities. CMA worked with the Assembly Appropriations Committee to stop this solution in search of a problem. Status: Failed in the Assembly Appropriations Committee.

AB 1034 (BLOOM): CANNABIS: RETAIL PREPARATION, SALE, OR CONSUMPTION OF NONCANNABIS FOOD AND BEVERAGE PRODUCTS This bill would have allowed cannabis lounges to serve food and non-alcoholic beverages on-site while people are consuming cannabis. This would have put patrons and employees at a significant health risk due to the secondhand smoke being inhaled. Status: Failed in the Senate Business, Professions and Economic Development Committee.

AB 1105 (RODRIGUEZ): HOSPITAL WORKERS: COVID-19 TESTING This bill would have enacted new PPE provision and reporting requirements for employers of health care workers. Additionally, general acute care hospitals would have been required to maintain weekly COVID-19 testing programs for health care personnel, and ensure every patient is tested for COVID-19 prior to admission. Status: Failed in the Senate Appropriations Committee.

AB 1130 (WOOD): CALIFORNIA HEALTH CARE QUALITY AND AFFORDABILITY ACT CMA and a group of other stakeholders were successful in stalling this bill, which would have statutorily provided expansive new powers and authorities to “control the rising cost of care” to the Office of Health Care Affordability (OCHA) under OSHPD. AB 1130 would have given OCHA the authority to set cost-growth targets for the state as a whole and for each sector of the health care delivery system, collect any data it deemed necessary to set those targets and penalize entities that do not meet the cost targets. AB 1130 failed to account for the nuances and trends of the current health care landscape, was not targeted at entities that have been shown to be responsible for the most significant cost increases, and would have fortified the imbalances and inequities that exist within our health care delivery system and further drive consolidation. This issue will continue to be of importance in the coming years and CMA continues to work to craft policies that will truly lead to cost savings without creating a new governmental entity with inexhaustible authority to regulate the health care delivery system. Status: Failed in the Senate Health Committee.

AB 1131 (WOOD): HEALTH INFORMATION NETWORK This bill was an effort on HIE that went a different direction than CMA-sponsored SB 371 (Caballero). Instead of capitalizing on existing HIE infrastructure, AB 1131

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CENTRAL COAST PHYSICIANS

LEGISLATIVE 2021WRAP-UP

would have mandated that all health plans, hospitals, medical groups, testing laboratories, and nursing facilities exchange data (both in and out) through a state-operated, central data repository-based, HIE by January 1, 2023, in order to receive reimbursement from any state health program, including Medi-Cal, Covered California and CalPERS. The bill failed to provide any resources, technical assistance, or direction to seek federal funding to aid physician practices or those entities facing broadband inequities or other challenges in connecting to a stateoperated, central data repository HIE.

This bill is a reoccurring measure designed to make providing comprehensive sexual education more onerous. It would have created more barriers to providing this education by requiring notices to parents of the materials and information used to educated students. This bill was killed before it was able to move to the Senate floor.

Status: Failed in the Assembly Appropriations Committee.

Status: Failed in the Senate Appropriations Committee.

AB 1278 (NAZARIAN): PHYSICIANS AND SURGEONS: PAYMENTS: DISCLOSURE: NOTICE

SB 225 (WIENER): MEDICAL PROCEDURES: INDIVIDUALS BORN WITH VARIATIONS IN THEIR PHYSICAL SEX CHARACTERISTICS

This bill would have required physicians to disclose to all patients any and all payments received from a drug and/ or device manufacturer, both orally and in writing, on an annual basis. CMA secured amendments to remove the oral disclosure requirement and require that physicians notify patients of the existence of the federal Open Payments Database rather than individually received payments.

CMA was successful in holding SB 225 in the Senate Business, Professions, and Economic Development Committee. This bill would have prohibited a physician from performing certain procedures specific to those people born with differences in their sexual development until the patient has reached the age of 12, unless the surgery is required to address an immediate risk of physical harm.

Status: Failed in the Senate Appropriations Committee.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

AB 1328 (IRWIN): CLINICAL LABORATORY TECHNOLOGY AND PHARMACISTS

SB 377 (ARCHULETA): RADIOLOGIST ASSISTANTS

This bill would have expanded the scope of practice of pharmacists by allowing them to order, administer and interpret all CLIA-waived tests, as well as perform patient assessments not limited to temperature, pulse, and respiration. Status: Failed in the Senate Appropriations Committee.

AB 1400 (KALRA): GUARANTEED HEALTH CARE FOR ALL This bill, the California Guaranteed Health Care for All Act, would create the CalCare program and board to administer and provide comprehensive universal singlepayer health care coverage and a health care cost control system in the state. Due to the incomplete nature and vagueness of AB 1400, the bill was never referred out of the Assembly Rules Committee. Status: Failed in the Assembly Rules Committee.

SB 217 (DAHLE): COMPREHENSIVE SEXUAL HEALTH EDUCATION AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION EDUCATION

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This bill would have disallowed radiologist techs from performing procedures they are already allowed to perform absent a supervising physician, by requiring radiology assistants meet set requirements before occupying the position, ultimately increasing physician workload and affecting patient access to care. Status: Failed in the Senate Public Safety Committee.

SB 379 (WIENER): UNIVERSITY OF CALIFORNIA: CONTRACTS: HEALTH FACILITIES This bill would prohibit the University of California (UC) from entering into a contract with a health facility in which a health care practitioner employed by UC or a UC trainee providing care in the health facility would be limited in the practitioner’s or trainee’s ability to provide patients with medical information or medical services due to policy-based restrictions on care in the health facility. While CMA is generally supportive of efforts such as this, SB 379 would have severely impacted access to care, particularly in underserved areas. CMA’s opposition is to protect that access to care and prevent UC system facilities

Winter 2022

from becoming overwhelmed once they have lost referral resources. CMA also supported legislation that would have addressed the issue via alternative means. Status: Failed in the Senate Appropriations Committee.

SB 447 (LAIRD): CIVIL ACTIONS: DECEDENT’S CAUSE OF ACTION SB 447 allows for successors of people who have passed away in cases regarding pain and suffering to be entitled to the pain and suffering damages the person that died before adjudication of their lawsuit would have been entitled to. The bill applies to all cases filed between January 1, 2022, and January 1, 2026. While this bill would undermine the protections of MICRA, the bill is broader than medical malpractice suits and applies to all liability cases. CMA and a coalition of other health care providers were opposed to the bill and helped force the author to take amendments, but remained opposed to the bill due to the change in precedent to pain and suffering damages. Status: Signed by the Governor (Chapter 448, Statutes of 2021).

SB 806 (ROTH): HEALING ARTS SB 806 is the bill extending the administration authority of various healing arts boards, including the Medical Board of California. While the bill amends various provisions of the Medical Practice Act, there are four priority issues: fee increases, postgraduate training licenses, enforcement monitor appointment and cost recovery. CMA successfully reduced the proposed fee increase, a $367 fee increase (nearly 50%), to a $80 fee increase (approximately 10%) biannually for an initial and renewed physician’s and surgeon’s license. Additionally, the bill requires the appointment of an unbiased, independent enforcement monitor to review the board’s enforcement program, which incurs 80% of the board’s expenditures. The review of the enforcement program will likely inform some of the future conversations relating to fee increases. SB 806 also authorizes a resident to obtain their physician’s and surgeon’s license after 12 months of postgraduate training if the resident is a U.S. or Canadian medical school graduate, or after 24 months if the resident is a graduate of a foreign medical school. The bill authorizes the medical board to deny renewal of a physician’s and surgeon’s license if the postgraduate trainee does not All-in-one practice growth training platform show 36 months of postgraduate upon initial renewal. Finally, the board is regaining its authority to PatientPop a holistic approach improving seek costtakes recovery from a physician andtosurgeon who is found in violation of thealong Medical Practice Act, which is the every digital touchpoint the patient journey for maintaining opposition. SB withrationale the leading all-in-oneCMA’s practice growthFinally, solution. 806 extends the sunset for the medical board for two years, PatientPop helps you promote your practice online, until January 1, 2024.

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Winter 2022

CENTRAL COAST PHYSICIANS

CenCal Health NEWS HUB: CLOSING GAP IN CARE DURING COVID-19:

HEALTHY MOTHERS CAMPAIGN IN SLO GETS RESULTS

CenCal Health Improves Performance in Timely Postpartum Visits for Member Moms Early in the pandemic, CenCal Health, the Medi-Cal health plan with over 200,000 members on California’s central coast, launched an innovative program for San Luis Obispo County named Healthy Mothers Healthy Families. The purpose of the program is to increase the rate of timely postpartum appointments for CenCal Health members who have recently delivered babies in SLO County. These medical appointments are vital in the early detection of serious, often life-threatening health complications like postpartum hypertension, infections, blood clots,

CENTRAL COAST PHYSICIANS

hemorrhage and depression. According to the Centers for Medicare and Medicaid Services, an estimated 40% of women enrolled in Medi-Cal do not get timely postpartum care after having a baby. The Healthy Mothers Healthy Families program works like this: each week, CenCal Health personnel reaches out to SLO County members who delivered a baby in the last 10 days, to enroll them in the program. Case managers contact the enrollees to screen them for depression and help set up their medical appointments and any other services (like transportation) deemed necessary for an optimal health outcome. After connecting with the new moms, an eye-catching “Baby Cal” direct mail piece is sent to them with postpartum health information in both English and Spanish. Following up on the appointment date and ensuring the appointment was kept, CenCal Health then sends the new mom a gift basket of products that are useful in caring for herself and her newborn. This program has resulted in the successful contact of 68% of the targeted members, with postpartum checkups subsequently scheduled. Of those new moms, over 95% of the women contacted went to their post-partum appointment,

Winter 2022

improving health equity for this at-risk population. “Healthy Mothers Healthy Families supported health equity for new mothers during a public health emergency through comprehensive case management,” said Dr. Karen L. Hord, CenCal Health Deputy Chief Medical Officer. “We focused on perinatal and postpartum mood and anxiety disorders in our outreach due to the extra mental health strain the pandemic has put on new moms.” As the Medi-Cal health plan for both Santa Barbara and San Luis Obispo counties, CenCal Health is required by California’s Department of Health Care Services to improve performance by designing programs that boost members’ access to care. In December 2019, CenCal Health identified a geographic disparity between SLO County and SB County. For health plan members in SLO County who had recently delivered babies, the rate of timely postpartum appointments was lower than those of members who recently delivered in

Winter 2022

SB County. To address this gap in care, CenCal Health developed Healthy Mothers Healthy Families, rolling out the program in August 2020. For the last two consecutive years, in both counties, CenCal Health has rated in the top 5% of Medicaid plans nationwide for timely postpartum care. “Through our case management efforts, we worked to ensure our new moms in San Luis Obispo County knew that getting postpartum care was still safe and recommended during the COVID-19 crisis,” said CenCal Health CEO Marina Owen. “CenCal Health is gratified that our Healthy Mothers Healthy Families program is an ongoing success.” Providers interested in learning more about this program may contact populationhealth@cencalhealth.org.

CENTRAL COAST PHYSICIANS

POSITIONS AVAILABLE Whether you are a seasoned physician or just out of residency, the CALIFORNIA PHYSICIAN CAREER CENTER offers the opportunities and resources you need to advance your career. This benefit includes tips on resume writing, interviews, and networking, as well as hundreds of current job openings in California. Opportunities can be found at https://careers.cmadocs.org. CENCAL HEALTH is a community-accountable health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to more than 200,000 members in Santa Barbara and San Luis Obispo counties. Opportunities can be found at www.cencalhealth.org/workwithus. 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.

F I S IE S A

DIGNITY HEALTH is a mission-driven, not-for-profit organization of more than 40 hospitals and care centers across California, Arizona, and Nevada. Opportunities can be found at www.dignityphysiciancareers.org. PLANNED PARENTHOOD CALIFORNIA CENTRAL COAST is a dynamic and fulfilling place to work. Our staff is caring, knowledgeable, dedicated and we are committed to a diverse workplace and encourage you to apply. Opportunities can be found at https://jobs.lever. co/ppcentralcoast. SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 180 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Opportunities can be found at www.sansumclinic.org/physician-provider-jobopportunities. 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. 38

CENTRAL COAST PHYSICIANS

Winter 2022

MICRA: Fact Sheet Here’s why a broad coalition of physicians, dentists, nurses, hospitals, safety net clinics, and other health care providers is committed to vigorously fighting this initiative. + Effectively eliminates MICRA’s cap on non-economic damages Proponents of this measure say it will simply index for inflation the state’s current cap on non-economic damages. However, the lawyer who drafted this measure has included deceptive and cynical language that creates a new category of lawsuits not subject to the cap on non-economic damages, while effectively eliminating the cap on non-economic damages for any medical malpractice case.

+ Costly for consumers and taxpayers According to the California independent Legislative Analyst’s Office (LAO), this measure would lead to “annual government costs likely ranging from the low tens of millions of dollars to the high hundreds of millions of dollars,” placing the burden of this additional cost on all of us, while reducing access for those who need it most, including those who use Medi-Cal, county programs, safety net providers and schoolbased health centers. This measure will vastly increase the number of lawsuits filed in California, and further divert resources for patient care to the legal system.

+ A misleading measure intended to fool the voters This measure was written by an out-of-state trial attorney who is looking to cash in with California cases. Our health laws should protect access to care and control costs for everyone, not increase lawsuits and payouts for lawyers. This is not an adjustment of the MICRA cap; it is a virtual elimination. It would also eliminate the state’s current cap on attorney’s fees in medical malpractice cases, allowing lawyers to take up to 50% of a patient’s jury award in malpractice cases.

+ Jeopardizes patient access to quality health care This measure would have a particularly adverse impact on community health clinics. This measure will raise insurance costs, causing physicians in high-risk specialties like OB/GYNs to reduce or eliminate patient services. There are, regrettably, individual tragic cases of medical negligence. However, under current law, patients can already receive unlimited awards for past and future health care costs, for lost wages and in cases of gross negligence. This ballot measure is simply a cynical effort by a single trial lawyer looking to increase lawyers’ share of medical malpractice awards and line his own pockets while driving up health care costs for all Californians.

Find out how you can help stop the deceptive MICRA measure: cmadocs.org/micra. Ad paid for by Californians to Protect Patients and Contain Health Care Costs, a Coalition of Physicians, Dentists and Health Care Providers. Committee Major Funding from: The Doctors Company California Medical Association Medical Insurance Exchange of California Revised: 3-9-20 Funding details at www.fppc.ca.gov Winter 2022

CENTRAL COAST PHYSICIANS

21 New & Rejoining

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way. Daniel Alfson, MD Vascular Surgery Santa Barbara Santa Barbara Vascular Specialists 805.456.8890

Graham Reimer, MD Pain Medicine Santa Barbara Sansum Clinic 805.681.8901

Stephanie Culver, MD Otolaryngology Santa Barbara Riviera ENT 805.327.6673

Casey Rives, MD Hospitalist Santa Barbara Sansum Clinic 805.898.3077

Cristina Harnsberger, MD General Surgery Santa Barbara Sansum Clinic 805.681.6550

Mananya Satayaprasert, MD Neurology Santa Barbara Sansum Clinic 805.898.3240

Laura Hutchison, MD Pediatrics Atascadero Patterson and Tedford Pediatrics 805.466.6622 Grace Lim, MD, MPH Pediatrics San Luis Obispo 805.668.4148 Laura Polito, MD Urgent Care Santa Barbara Sansum Clinic 805.563.6110 Arashdeep Poonia, MD Nephrology Santa Maria Santa Maria Nephrology Medical Group 805.287.9711 40

CENTRAL COAST PHYSICIANS

Ken Starr, MD Addiction Medicine Arroyo Grande 805.242.1360 W Warren Suh, MD, MPH Radiation Oncology Santa Barbara Ridley-Tree Cancer Center 805.879.0650 Julie Taguchi, MD Hematology Santa Barbara 805.869.2612 Ashley Thorsell, MD Endocrinology, Diabetes and Metabolism Santa Barbara Sansum Clinic 805.681.7820 Winter 2022

Dale Tylor, MD, MPH Otolaryngology Santa Barbara Riviera ENT 805.327.6673

Connor Gemmell, MD Diagnostic Radiology Santa Barbara Cottage Hospital Dina Obed, MD General Surgery Santa Barbara Cottage Hospital

RESIDENTS

Elyor Vidal, MD Diagnostic Radiology Santa Barbara Cottage Hospital

Aria Ashir, MD Diagnostic Radiology Santa Barbara Cottage Hospital

Eddy Yu, MD Internal Medicine Santa Barbara Cottage Hospital

Robert Dionisio, MD Diagnostic Radiology Santa Barbara Cottage Hospital

Congratulations to our members who have retired Jeoffrey Benson, MD

David Hernandez, MD

Robert Gong, MD

Garry Kolb, MD

WHOSE INTERESTS does your malpractice insurer have at heart?

Gerald Svedlow, MD

Yet another of California’s medical liability insurers has transitioned from focusing on doctors to focusing on Wall Street. This leaves you with an important question to ask: Do you want an insurer that’s driven by investors? Or do you want an insurer that’s driven to serve you—one that’s already paid $120 million in awards to its members when they retire from the practice of medicine? Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.

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8276_CA_CentralCoast_EKG_Winter2022_v1.indd Winter 2022

2/3/22 1:35 PM CENTRAL COAST PHYSICIANS 41

In Memoriam

In Memoriam EDWARD REILLY WALLACE, MD

1929-2021 Edward Wallace, 91, died August 7 at Serenity House in Santa Barbara, weakened by Parkinson’s Disease and illness. In spite of COVID restrictions, his family was able to be with him during his last days. Ed was born in Niagara Falls, NY, to Edward Thomas Wallace and Helen Reilly Wallace, the first of seven children in a traditional Irish Catholic family. Breaking with family tradition, Ed moved to the West Coast in 1955 where he completed his Internship at the Sacramento County Hospital and met and married DaNell Stringham. To finance his education, he joined the Navy and was sent to Hawaii, serving as Battalion Surgeon and then Commanding Medical Officer of the 1st Marine Brigade until 1957. Ed finished his Family Practice Residency at Sacramento Hospital. Since childhood, Ed had dreamed of being a physician in a small town. Driving south along coastal California, he selected Lompoc to begin his family practice, raise his family, and surf. In 1958 he joined a small group of doctors in the newly established Valley Medical Group. A longtime member of the Santa Barbara County Medical Society, Ed served on the SBCMS board and was president in 1992. During his tenure as SBCMS president and delegate to the California Medical Association, he espoused humane and progressive causes such as the Affordable Basic Care Initiative,

CENTRAL COAST PHYSICIANS

equality in the work place for women physicians, healthcare reform to prevent cuts to Medicare and Medicaid, guaranteed care for AIDS patients, healing the impaired physician, and more. Ed practiced medicine full time until he and his second wife, Pat, bought and remodeled a house in Santa Barbara, relocating there in 2000. Not ready to give up medicine completely, he continued to commute to Lompoc once a week to work a 24-hour shift. Finally, nearing age 84, as he and Pat were preparing to move into Valle Verde Retirement Community, he decided it was time to retire. All his life Ed was intensely interested in sports of all kinds, especially team sports, which engaged his competitive nature. In recent years, he played senior softball with the ‘’Ancient Mariners’’. Even with Parkinson’s Disease, he played pickleball and billiards at Valle Verde as long as he could. As an avid reader from childhood and a lifelong seeker of knowledge, Ed read philosophy, history, sociology, science, politics, music, poetry, etc., but always with a detective novel in reserve. Another favorite activity was flying. One time, combining flying with his love of military history, he and sonin-law Peter fought a mock WWI battle in antique biplanes over Palm Springs. Before turning fifty he determined ‘’to journey to the most inaccessible place I could reach which would require the greatest amount of physical endeavor of which I was capable’’. That place was the Baltoro Glacier in Pakistan, at the foot of the five highest peaks in the Karakoram Range, including K-2. The trek was arduous and life threatening. He returned skeletal and exhausted, but triumphant in having achieved his goal. He is survived by his second wife of 41 years, Patricia (Weiss) Wallace; Ed’s son Kevin (Maureen) Wallace; daughter Shauna Lotz; daughter Terri Wallace (James Garnett); stepson, Karl (Irene) Weiss; stepdaughter Karen (AJ) Miller; stepdaughter Frieda Weiss (Dale White); along with many grandchildren and great-grandchildren.

Winter 2022

Offering the only Level III NICU in San Luis Obispo County. When you want confidence and peace of mind for delivering your bundle of joy, we’re here for you. Our services include: The only Level III NICU in San Luis Obispo County, providing intensive care for critically ill and premature babies born at 23 or more weeks gestation The only OB hospitalist program in San Luis Obispo County, allowing for immediate obstetric emergency care 24/7 Trial of Labor after Cesarean (TOLAC) capability for those who had a prior c-section and desire a natural childbirth Our dedicated team of neonatal experts offer families advanced care close to home. We are a community built on care.

Learn more at TenetHealthCentralCoast.com/OBGYN Winter 2022

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

APRIL 4, 2022 | 6 PM Hilton Beachfront Resort

APRIL 7, 2022 | 6 PM Madonna Inn

Presorted Presorted Standard Standard U.S. Postage Postage U.S. PAID PAID San Dimas, CA Permit #500 Permit No. 410 Claremont, CA