Central Coast Physicians Fall 2017

FALL 2017

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Fall 2017

VOLUME 2, NUMBER 4 • FALL 2017

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Fall 2017

{FEATURES} SUMMER SOCIAL PHOTOS

ALZHEIMER’S ASSOCIATION TOOLKIT

{DEPARTMENTS} 6 DINING OUT: LIQUITAS 8 CLASSIFIEDS 12 RISK TIP: MACRA BEST PRACTICES

MIL FAMILIAS

24 MEN’S HEALTH: MISANDRY

PUBLIC HEALTH IMPACTS OF CANNABIS

28 NEW MEMBERS

26 PUBLIC HEALTH: OPIOID EPIDEMIC 30 IN MEMORIAM

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Letter from the CEO

LOOKING BACK AND FORWARD

As the year draws to a close, it’s an opportunity to reflect on what we’ve accomplished and what we plan to achieve next year.

We have been striving to increase communication with local physicians. This year we celebrated the one-year anniversary DANA GOBA of our magazine, we have been active on social media @CCMAHealth for one year, and we launched a new website, CCMAHealth.org. Next year we plan to launch an electronic newsletter to be more responsive in regard to legislation, events, and member benefits. If there are topics you would like to read about, please let me know.

At the state level this past year, we have been working on the Prop 56 budget to increase access to physicians. We are also educating those affected by AB 72, as well as providing resources regarding MACRA changes.

PRESIDENT David Dodson, MD PRESIDENT ELECT Jennifer Hone, MD SECRETARY Daniel Berger, MD TREASURER Joseph Schwartz, MD IMMEDIATE PAST PRESIDENT Charity Dean, MD, MPH DIRECTORS Jonathan Berkowitz, MD, PhD; Philip Delio, MD; Joseph Freeman, MD; Douglas Jacobson, MD; Bindu Kamal, MD; Samira Kayumi-Rashti, MD; Douglas Murphy, MD; and Juan Reynoso, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sam Ahmad, MD; Sharon Basham, MD; Ned Bentley, MD; Charity Dean, MD, MPH; David Dodson, MD; Jennifer Hone, MD; Chris Lumsdaine, MD; Doug Murphy, MD; Jenni Nix, MD; John Sawyer, MD; Joe Schwartz, MD; Steven Yao, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR David Dodson, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Alzheimer’s Association; Penny Borenstein, MD, MPH; David Dodson, MD; Kim Hathaway, MSN, CPHRM; Robert A Reid, MD;

We hope you will celebrate 2017 with us at our Annual Membership Meeting. We will be honoring two great physicians, Saida Hamdani, MD, on November 2 in Santa Barbara, and Rene’ Bravo, MD, on November 3 in San Luis Obispo.

I am looking forward to continuing to work with physicians in 2018. You inspire me every day to work towards our mission. As always, thank you to our members who support our efforts as we would not be able to do this without you. If you would like to learn about membership, contact us at 805.683.5333.

Together, we are stronger.

Regina Ruiz; Elizabeth Schwyzer CONTRIBUTING PHOTOGRAPHERS County of San Luis Obispo, Elizabeth Schwyzer, Beth Torres, William Sansum Diabetes Center SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians 100 N Hope Ave, Ste 14

Regards,

Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 • E magazine@sbmed.org ADVERTISING rates and information sent upon request.

Acceptance of advertising in Central Coast Physicians in no way constitutes approval or endorsement by CCMA of products or services advertised. CCMA reserves the right to

Dana Goba Chief Executive Officer Central Coast Medical Association

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reject any advertising. All advertising inquiries can be sent to magazine@sbmed.org.

Fall 2017

We travel from BAKERSFIELD TO COTTAGE because we want the best care for Avery.

— Alyssa, Avery’s mother

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

When Avery was one, he had dangerously high fevers.

His illness was a mystery, and his parents were desperate for answers. They found them when they met Dr. Miriam Parsa, a specialist at Cottage Children’s Medical Center (CCMC) Grotenhuis Pediatric Clinics. Avery was diagnosed with a rare disease called Familial Mediterranean Fever.

They began traveling from Bakersfield to Cottage for treatment. Now four, Avery is enjoying his life as a healthy kid.

Meet our pediatric specialists at Cottagechildrens.org

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

Dreams Made Real.

Loquitas - A Spanish Restaurant

By Robert A Reid, MD

Dining Out

Friends told us about this new addition to lower State Street approximately across the street from the Santa Barbara Train Station. They couldn’t name most of the foods they enjoyed but said everything was unique and delicious. The proprietors describe their menu as follows: “Loquita showcases the flavors and traditional cooking methods of Spain with hot and cold tapas, wood-fired seafood, grilled meats, and three types of paella.”

With many unrecognizable offerings on the menu, your server is invaluable. Malea guided us with aplomb. The bride started with Red Sangria and I tried a La Ribera Sour. She loved her drink but frankly, I prefer gin on the rocks.

I recognized Gazpacho, which sounded good on a hot night and ordered it. For her it was Aceituna, a small bowl of marinated olives with citrus and rosemary. The servings were very small but powerful and we made short work of them.

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Fall 2017

For the tapas course I ordered Carpaccio de Carne, which featured Spanish touches with Wagyu Beef, Manzanilla, Pickled Mustard Seeds, Jerez Sherry, and Parsley. We decided to try Jurel, which is Japanese Hamachi (Yellowtail) with Blood Orange, Tomato, and Red Onion.

Malea recommended we order Pan con Tomate with this course and it fit perfectly featuring soft but toasted bread with a savory fresh tomato and thyme topping.

The specialty of the House and enough in a single order for 2 or 3 persons is Paella. It is prepared to order so they request 30-40 minutes to serve. Offered are Veduras consisting of Saffron, Black Kale, Royal King Trumpet (mushroom), Sunburst Squash and Asparagus; Mariscos for fish lovers contains Squid Ink, Argentinian Shrimp, Calamari and Venus Clams.

We ordered Chorizo y Pollo, which combined Chorizo, Chicken, Gigante Beans, and Salmorra (the sauce). It was hot off the stove with very sophisticated flavor, rice that was cooked perfectly and more than the two of us could finish though we tried. A glass of Hermanos Rioja Tempranillo was perfect for me and Patti was still nursing her Sangria.

Summer Social 2017

Thank you to everyone who attended our summer social.

Thank you to our venue, The Hangar, and to Windrun Wine for their generous beverage donation.

If Paella is not your thing there are many alternate entrees including Scallops, Octopus, Hanger Steak, and Shrimp.

For dessert, you might enjoy Churros with Chocolate, Dulce de Leche and Raspberry, or Torrijas, which is Spanish French Toast, decorated with Peaches and Crema Catalana. There is Pan con Chocolate with Sourdough Ice Cream, Chocolate Crumble and Caramelized Bread and even Fresa, which is Strawberry Ice Cream, Macerated Strawberries, Vanilla Shortbread, and Mint. You might enjoy them but we were too full. Maybe next time.

Try Loquita for a unique and delicious dining experience. Sit on the patio and transport yourself to Spain. Located at 202 State Street in Santa Barbara with dinner served nightly from 5:00 – 10:00 pm, 805.880.3380, www.liquitasb.com. Â

Fall 2017

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CL

Positions Available

ADVANCED DERMATOLOGY & AESTHETICS CENTER in Santa Barbara is seeking a board-certified dermatologist to join our practice, full or part-time. The ideal candidate would have experience in providing quality medical, surgical, and cosmetic dermatological care. Please forward cover letter, resume, and references to our office, attn.: Juliane Fausey, Office Manager, 2936 De La Vina St, Ste 200, Santa Barbara, CA 93105; phone 805.618.1616; fax 805.687.4822; juliane@kimhurvitzmd.com; www.kimhurvitzmd.com.

The COUNTY OF SAN LUIS OBISPO Law Enforcement Medical Care Unit at the County Jail is recruiting for a contract Medical Doctor to perform assessments, establish medical diagnoses, order and evaluate diagnostic tests and medications, and manage follow-up care for a jail population. For more information, go to www.slocounty.ca.gov and click “Career Opportunities�.

The COUNTY OF SANTA BARBARA is looking for a Staff Physician to fill one of our critical roles in our Public Health Primary Care and Family Health Division at our Santa Maria Health Care Center (SMHCC). This position requires board certification or eligibility in Family Practice or Internal Medicine.

Our physicians will collaborate with a team of physicians, nurses and other staff providing clinical services in our expanding Federally Qualified Health Clinics throughout the County. www.sbcountyjobs.com

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DS

F I S IE S A

SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 200 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Physician openings can be found at www.sansumclinic.org/physician-provider-job-opportunities.

Office Space Available

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

Part time office space available to sub-lease. Office, reception area, and exam room near Cottage Hospital, available 2-3 days a week, as of December 1. For more information, call 805.682.6461 or email Karen at kcookand@gmail.com.

Seeking Office Space

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

If you would like to submit a listing to our Classifieds, contact magazine@sbmed.org.

Listings are free for members with reasonable rates for nonmembers.

Fall 2017

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Fall 2017

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ALZHEIMER’S ASSOCIATION LAUNCHES TOOLKIT Information to Aid Providers with New Medicare Code The Alzheimer’s Association has released a Cognitive Impairment Care Planning Toolkit for care providers. This comprehensive resource provides critical information and best practices for physicians, nurse practitioners, and physician assistants to better provide necessary care planning for individuals with cognitive impairment including Alzheimer’s and other dementias — which is now covered by Medicare.

Following a dementia diagnosis, care planning is crucial to improving outcomes and maintaining quality of life for the diagnosed and their caregivers, as well as controlling costs and planning appropriately for the future. The new G0505 Medicare code provides reimbursement for a clinical visit that results in a comprehensive care plan, allowing clinicians to develop a care plan and identify appropriate community support services that

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can contribute to a higher quality of life for those living with cognitive impairment.

The Cognitive Impairment Care Planning Toolkit was developed by the Alzheimer’s Association with input from other experts in the field. The toolkit, available at alz.org/careplanning, serves as a resource for clinicians to understand what the G0505 Medicare code covers, and to provide a wide variety of resources for the clinician to utilize in care planning sessions.

“For far too long, individuals were given a diagnosis and little else. We have worked with thousands of families who have had a better experience living through dementia because they had plans in place”, said Donna Beal, Alzheimer’s Association, California Central Chapter, Vice President Program Services and Advocacy.

Fall 2017

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support, and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s. For more information, visit alz.org.

“Proper care planning results in fewer hospitalizations, fewer emergency room visits, and better management of medication — all of which improves the quality of life for both patients and caregivers, and helps manage overall care costs.”

Through the release of the Toolkit, utilizing our wide chapter network, and engaging medical professionals, the Alzheimer’s Association is working to ensure that eligible care providers are aware not just of the new code, but also of the best way to conduct a proper evaluation and care planning session under the code. Materials in the toolkit include: • Overview of the code; • E asy access to validated tools to assist with diagnosis, such as the Mini-Cog™ and the Dementia Severity Rating Scale; • Safety Assessment Guide; • Caregiver Profile Checklist; • End of Life Checklist; and • Patient and Caregiver Resources.

suggestions on its content and use to CMS. The Alzheimer’s Association Expert Task Force, comprised of a diverse group of experts from across the country that are currently providing care for individuals with Alzheimer’s and other dementias, also provided input on the Toolkit.

Today, an estimated 5.5 million Americans are living with the disease, and that number could rise as high as 16 million by 2050.

Today, an estimated 5.5 million Americans are living with the disease, and that number could rise as high as 16 million by 2050. What’s more, over 85 percent of people with Alzheimer’s and other dementias have one or more other chronic conditions, such as diabetes or heart disease. Care planning is critical for coordinating care and managing chronic conditions.

The Alzheimer’s Association and its sister organization the Alzheimer’s Impact Movement (AIM) played a critical role in the decision by the Centers for Medicare & Medicaid Services (CMS) to pay for cognitive and functional assessments and care planning for patients with Alzheimer’s disease and other cognitive impairments.

The decision, was supported by the Alzheimer’s Association and came following rapidly growing bipartisan support in Congress for the Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act (S. 857, H.R. 1559), legislation conceived by the Alzheimer’s Association.

And, to ensure the success of the new code, the Alzheimer’s Association Expert Task Force provided information and

Fall 2017

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Five Best Practices to Meet MACRA Requirements by the End of the Year

BY KIM HATHAWAY, MSN, CPHRM, HEALTHCARE QUALITY AND RISK CONSULTANT, THE DOCTORS COMPANY

As the end of the third quarter of 2017 approaches, practices that have not yet developed their Medicare Access and CHIP Reauthorization Act (MACRA) plan face great urgency to complete their plan—and those who have started may be feeling overwhelmed.

Regardless of the reporting stage, these steps can help guide practices to succeed: 1. R eview past performance in quality measures such as the Physician Quality Reporting System (PQRS) or specialty measures that your practice has reported. These are strong indicators of how your practice will do in the future. Align activities and quality measures with what you are already doing in your practice and determine how to make capturing the needed data part of your team’s workflow. Ask for input from the frontline of your practice about the most efficient ways to collect the necessary data elements.

2. S tudy the specifications for measures you are reporting to better understand its value. For claims or registry reporting, go to Quality Payment Program website (https://qpp.cms.gov/about/resourcelibrary) and choose the appropriate file under “Documents and Downloads.” If you are reporting through your electronic health record (EHR), the vendor can be very helpful in choosing your measures.

3. M onitor your data on a weekly or bi-weekly basis. Compare the reports that you run in your office to those generated by your EHR or registry. Investigate any discrepancy so that it can be corrected now by coaching the team on documentation or timeliness of reporting.

4. Understand that the scoring process for the quality measures is very different than it was in PQRS. Under PQRS, if you reported the measure enough times, you received credit. And if you reported on one patient, you would get a pass. Under MIPS it is your performance rate that will be most important.

On top of the change in how much you report versus the performance rate, the scores will be determined based on national benchmarks, with the highest performing deciles receiving a greater point value.

5. Review the Quality Resource Utilization Report (QRUR) to fully understand how the practice performs in quality and cost.

Use the 2015 or 2016 QRUR (publishing fall 2017) to identify potential weaknesses and address them before cost returns as a scored category in 2019—because cost will carry a weight of 30 percent toward the MIPS composite score. There are no reporting requirements for the cost category in 2017. CMS will provide feedback on cost for the 2017 performance period, but it will not be counted in the final composite score for 2017 or 2018.

For help with interpreting the information on your QRUR, consult the CMS website regarding QRUR analysis and payment. You will find additional resources and links to the EIDM System and what to do if you believe your QRUR is not accurate.

MIPS Assessment & Action Plan Toolkit Did you know MIPS eligible clinicians who don’t send any data in 2017 will receive an automatic 4% penalty in 2019?

Toolkit Goals  

Ensure that eligible clinicians avoid a negative payment adjustment Offer an opportunity to receive a modest positive adjustment

The toolkit has been designed as a benefit for CCMA members only.

Contact us for your FREE copy.

About MACRA

About MIPS

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a payment reform law that establishes new ways to pay physicians for the healthcare services of Medicare beneficiaries. It repeals the Medicare Part B SGR (Sustainable Growth Rate) reimbursement formula, replacing it with a new value-based system called QPP (Quality Payment Program).

The Merit-Based Incentive Payment Program, (MIPS) has a series of goals (measures) to ensure that providers are moving towards patient centered care and improved outcomes.

The QPP consists of two major tracks:  The Merit-based Incentive Payment System (MIPS)  Alternative Payment Models (APMS) QPP combines the previous incentive programs (PQRS: Physician Quality Reporting System, VBM: Value Based Modifier, and MU: Meaningful Use also known as Medicare Electronic Health Record) into the program called MIPS: Merit-Based Incentive Payment System.

Most clinicians will participate in MIPS, as it is effectively the “new default” for Part B, where few are exempt from MIPS except under a few conditions. Basically, Medicare reimbursement is evolving from volume billing to value billing.

MIPS defines four categories of eligible clinician performance, weighted by percentage, which contributes to an annual MIPS final score. (2017 scores determine 2019 payment adjustments):  Quality  Advancing Care Information (ACI, renamed from Meaningful Use)  Improvement Activities (IA)  Cost MIPS offers more flexibility than past plans, making it easier for clinicians to evaluate the measures and select only the ones relevant to each practice, creating a higher likelihood of favorable adjustments.

Central Coast Medical Association Summer 2017

805.683.5333 sbcms@sbmed.org www.CCMAHealth.org

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Diabetes Rates Soar among Latino Families Research Begins to Understand Causes and Solutions

BY REGINA RUIZ, MARKETING AND COMMUNICATIONS MANAGER, WILLIAM SANSUM DIABETES CENTER

As diabetes takes aim at the Latino community, the William Sansum Diabetes Center (WSDC) just launched Mil Familias, an initiative to find out why Latinos are at a much greater risk for type 2 diabetes and what can be done to reverse the alarming trend. Santa Barbara residents will play a key role in landmark research that could have a global impact on the Latino diabetes epidemic. This fall, the first participant was enrolled in Mil Familias. The program will ultimately recruit 1000 local families, who have at least one family member with type 2 diabetes.

Latinos make up 43% of the population in Santa Barbara County and have nearly double the rate of diabetes compared to the rest of the population. Mil Familias will research previously For more information in English/Spanish: Arianna Larez, MilFamilias@sansum.org 805-335-0124 Promotora Martha Meza after enrolling first participant and Promotoras learning how to screen for diabetes

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unrecognized factors including: stress, poverty, culture, crime, education, and pollution. This ground-breaking research will help us understand and reduce the high rate of diabetes among Latinos. It could also help other vulnerable populations across the globe.

Mil Familias is also providing specialized diabetes education, professional skills, and employment opportunities to local Latinas who historically served as volunteer diabetes educators (called Promotoras) for William Sansum Diabetes Center.

The Mil Familias Promotoras are also being trained in clinical research and have been hired by the Center. They call the new opportunity, “a dream come true and a priceless benefit� for their families.

Mil Familias is the result of a collaboration between WSDC and Eli Lilly and Company to improve the lives of Latino people impacted by diabetes through research, education, and care.

Right now, WSDC is reaching out to physicians to help refer participants. The organization is also bringing more partners on board for the 10-year initiative. WSDC is strengthening the local Latino advisory committee who will oversee and advise Mil Familias research. Mil Familias major local partners include Santa Barbara Neighborhood Clinics, UCSB, Cottage Health, and Westmont Downtown.

Fall 2017

The Central Coast Medical Association cordially invites physicians to our

Annual Membership Meeting Thursday, November 2, 2017

Friday, November 3, 2017

6:00 pm Reception 7:00 pm Dinner & Program

6:00 pm Reception 7:00 pm Dinner & Program

The Fess Parker 633 E Cabrillo Blvd, Santa Barbara

Madonna Inn 100 Madonna Rd, San Luis Obispo

Physicians of the Year

Saida Hamdani, MD

Rene’ Bravo, MD

Santa Barbara County

San Luis Obispo County

Keynote Speaker Larry Wolk, MD, MSPH Executive Director & Chief Medical Officer Colorado Department of Public Health & Environment Addressing the myriad issues surrounding medical and retail marijuana

Cost

Complimentary for CCMA active members and The Doctors Company insured physicians.

Guests and retired members $30.

RSVP

www.CCMAHealth.org/events prior to October 25

Questions

805.683.5333 or sbcms@sbmed.org

Sponsored by Fall 2017

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Fall 2017

CENTRAL COAST PROFESSIONALS PREPARE

BY ELIZABETH SCHWYZER

On November 8, 2016, the world held its breath as news of the American election results came rolling in.

For some, the unexpected outcome of the presidential race overshadowed the other issues on the ballot. But not for all.

In California, the passage of State Proposition 64, also known as the Adult Use of Marijuana Act, legalized the recreational use of cannabis by those aged 21 and over, and set in motion a cascade of reactions. State legislators went straight to work to reconcile Prop. 64 with existing medical marijuana laws. Local officials across California scrambled to address a host of regulatory issues, from licensing to zoning, manufacturing, and security. The National Academy of Sciences rushed to publish a study on the health effects of cannabis, while drug counselors, youth workers, and public health officials, long hampered in their efforts by pot’s illegal status, set to work devising a whole new approach to their work.

Among those who spent election night closely following the fate of Prop. 64 was Dr. Charity Dean, Public Health Officer for Santa Barbara County. >>

Fall 2017

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“As I was watching to results come in on November 8th, I knew I had a lot of work ahead of me,” Dean said.

“It was pretty clear to those of us in public health when Prop. 64 passed that this was going to be one of the most important emerging public health issues in the next few years.”

Dean has spent the 12 months since then brainstorming ideas with other county government officials and spearheading a collaborative effort between the county’s Public Health and Behavioral Wellness departments. Her approach, she says, is three-fold: to devise a new approach to cannabis surveillance, education, and prevention.

“The best analogy I have for this is that I’m making stone soup,” Dean said. “There’s no budget yet. We’re having to get really creative.”

What exactly these programs will look like is yet to be determined, but Dean described the need to collect data, share information, and prevent cases of marijuana dependency, particularly among vulnerable members of the population.

“Public health is big on epidemiology and surveillance, by which I mean monitoring and

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measuring so we get a sense of health trends in our community,” she explained. “Next comes education: How can we educate our community so that they are empowered to make good choices? The third part is prevention. We are discussing how can we partner with community organizations to reach those who need help.”

The truth, Dean acknowledged, is that nobody knows just what kinds of public health impacts we may see. Some effects may emerge fairly quickly; others will take decades to reveal themselves. In the meantime, the race is on to establish public health programs so that come January 1, 2018, when businesses can begin legally selling marijuana to recreational users, providers are ready to address the consequences.

A LONG, STRANGE TRIP; A HAZY DESTINATION Legally speaking, the journey to this moment has been far from straightforward, even though to many it has long seemed inevitable. How did we get here?

In order to understand the Central Coast’s approach to addressing the potential public health impacts of cannabis, it’s helpful to know how the legal landscape

Fall 2017

around marijuana has shifted over the past half century.

In 1970, U.S. Congress passed the Controlled Substances Act, establishing five schedules or classifications for narcotics.

Marijuana was included in Schedule 1, along with heroin and LSD: drugs deemed to lack any accepted medical use and to have a high potential for abuse. In 1996, California became the first state to legalize medical marijuana with the Compassionate Use Act. Although 29 states have since passed legislation allowing for medical marijuana cultivation and use, federal law still considers cannabis an illegal, Schedule 1 drug.

For the past two decades, California’s medical marijuana industry has been the Wild West—a burgeoning, unregulated, and increasingly unruly patchwork of growers bound by local regulations and those operating outside the law entirely.

More than 15 years after the passage of the Compassionate Care Act, voters across the nation began to legalize marijuana for recreational use. Washington and Colorado were the first states to pass such laws in 2012, followed by Washington, D.C. in 2014, Alaska and Oregon in 2015, and Nevada, Maine, and Massachusetts – along with California – in 2016.

Just one year before the passage of Prop. 64, the State of California passed the Medical Marijuana Regulation and Safety Act (MMRSA) in an attempt to regulate the licensing, cultivation, manufacturing, distribution, and sales of medical marijuana. Then, following the passage of Prop. 64 in June of this year, Governor Jerry Brown signed into law a trailer bill, MAUCRSA, or the Medical and Adult Use of Cannabis Regulation and Safety Act, in an attempt to align MMRSA with Prop. 64.

It’s been challenging just keeping tabs on the rapidly changing legal terrain surrounding marijuana. Now, local government officials across California have to scramble to figure out how to bring their counties in line with the new state law by the New Year.

For healthcare providers, one of the greatest roadblocks to research and treatment has been the ongoing discrepancy between federal, state, and local laws governing marijuana. But physicians and mental health professionals are only part of the much larger framework that suddenly finds itself forced to adapt to the new law – and quickly.

Because of the widespread implications of Prop. 64 and the many ways public health may be impacted, the Santa Barbara County Board of Supervisors in February of this year created an ad-hoc committee: a think-tank representing members of ten local government departments, from agriculture to planning and development to the sheriff and district attorney. Dean sits on the committee, as do First District Supervisor Das Williams and Fifth District Supervisor Steve Lavagnino. Their task is to figure out whether the county should focus on regulating the cultivation of marijuana for commercial recreational use, or prohibiting it entirely. In either case, there will be challenges associated with enforcing the new laws.

Dennis Bozanich, Deputy CEO for Santa Barbara County, described the committee’s work as a rare experience in local

Fall 2017

“Given the potential for harm associated with high dosing or first-time use of cannabis, education and prevention for youth is a priority.”

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Preparing for Recreational Cannabis An Educational Workshop for Professionals in Health, Mental Health, Substance Use Disorders, and Youth/ Children’s Services • Lessons from Colorado where recreational cannabis has been legal since 2014 •C annabis use on neurocognitive function in the developing brain •L ocal panel discussing potential impacts on our communities When: Friday, November 3, 2017, 8:30 am – 12:30 pm Where: Santa Ynez Marriott, Buellton Who: Health/mental health providers, therapists, counselors, educators Cost: No cost to providers and community service agency staff To secure your seat, please register at pfrctickets.eventbrite.com

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government, and an experiment whose outcome is unknown.

“This is probably a once-in-a-lifetime opportunity to take an industry from barely regulated to regulated locally,” he said. “The state of California is engaging in this experiment. We have Colorado and Washington ahead of us, but not far enough ahead that we can tell things with much certainty. So we’re engaged in a bit of a social experiment, and we’re unclear what the results will be.”

THE GOOD, THE BAD, AND THE UNCERTAIN Despite the fact that cannabis has long been the most widely used illegal drug nationwide, when it comes to the public health impacts of cannabis, there’s still much we don’t know.

There are, however, some facts that are clearly established in medical literature.

“We know that there are adverse health effects for specific, vulnerable populations,” explained Dr. Dean. “These include youth up to age 25, pregnant women and breastfeeding infants, and those with specific mental health issues such as schizophrenia.” Other threats to public health include an increased risk of motor vehicle crashes, chronic bronchitis in those who smoke the drug, and low birth weight in babies of regular cannabis users. Unlike alcohol, which passes through the bloodstream of the pregnant or breastfeeding mother, THC -- the psychoactive found in cannabis -- is stored in the fat, which means that the “pump and dump” approach doesn’t work.

At the same time, Dean noted, cannabis has been clearly shown to have positive outcomes for certain medical conditions, particularly chemotherapy-induced nausea and chronic pain.

According to the recent National Academy of Sciences study, titled, “The Health Effects of Cannabis and Cannabinoids,” adults with multiple sclerosis-related spasticity reported improved symptoms after using oral cannabinoids. The same study notes that in the case of the three aforementioned conditions, “the effects of cannabinoids are modest; for all other conditions evaluated, there is inadequate information to assess their effects.”

Of course, thorough scientific research into the health impacts of marijuana use has been limited due to its federal status as a Schedule I drug; much of the National Academy’s study is devoted to recommending areas for further research.

That dearth of reliable medical research represents a serious challenge when it comes to preparing for what lies ahead, Dean explained.

“We recognized early on that there needed to be a plan in place to mitigate potential health impacts. Yet we had to ask ourselves, ‘How do we devise our plan knowing that the research on cannabis is so limited?’ We doctors like to see randomized, double-blind, placebocontrolled trials. We’re just not going to get that in this case.”

And so, as public health officials so often must, Dean is making do with what she has and what she knows.

Thus far, Santa Barbara County is keeping a close watch of the California Department of Public Health, which is developing its own surveillance tool to be released in November. “At the same time, we are asking ourselves how we can conduct surveillance here, so we get a sense of health trends in our community,” Dean said.

In terms of informing the public, she added, the goal is “to educate our community about the health effects of cannabis.”

“One of the lessons coming out of Colorado and Washington states is that demonizing cannabis does not work,” she noted. “The voters have chosen to legalize it. There are some positive health effects of the drug, especially for certain conditions. So our education needs to have a positive message, and to focus on vulnerable groups.”

When it comes to public outreach, Dean is considering hosting town hall meetings where parents and youth can ask questions, learn more about the health effects of cannabis, and discuss their concerns openly.

Like Dean, San Luis Obispo County Public Health Officer Dr. Penny Borenstein sits on a committee comprised of county officials focused on addressing cannabis-related issues. And like Dean, she faces a great deal of uncertainty when it comes to predicting the public health impacts of recreational marijuana legalization in her region.

Fall 2017

For now, Borenstein said, the county’s public health and behavioral health departments are in discussions about three primary areas of concern: environmental health, maternal and child health, and community education and outreach.

“Environmental health comes under the auspices of the Public Health Department,” she explained. “In terms of manufacturing processes, we’re keeping a close eye on whether or not we might become engaged by virtue of permitted entities using potentially hazardous materials.

“We’re also paying close attention to maternal and child health, especially based on Colorado’s experience,” she went on.

“That state has seen a huge increase in the use of poison control centers and emergency department use, both by those who were knowingly using cannabis products and for accidental ingestion of the drug by young children.”

A third area of focus in San Luis Obispo County, Borenstein said, is community education outreach and prevention messaging, especially that aimed at youth.

“Marijuana has been normalized as a harmless drug, and yet the potency in some forms and the THC activity on the developing brain of adolescents can in many cases be quite significant,” she noted. “Given the potential for harm associated with high dosing or first-time use of cannabis, education and prevention for youth is a priority.”

Fall 2017

“How do we devise our plan knowing that the research on cannabis is so limited?”

At the same time, Borenstein acknowledged, there are legitimate uses for medical marijuana and potential benefits to the drug’s increased availability.

“It has long been thought that cannabis is a gateway drug to worse drugs, particularly heroin; this has been citied over decades,” she explained. “And yet, there’s an emerging body of research that suggests marijuana could actually be a substitute drug that causes less harm than the alternatives.” She pointed to a Science Magazine article published the same month Prop. 64 passed, titled, “Could Pot Help Solve the U.S. Opioid Epidemic?”

In terms of other positive outcomes of the change in law, Borenstein noted, the legalization of cannabis may allow “those with legitimate medical needs to come out from the shadows and

CENTRAL COAST PHYSICIANS

21

not feel quite as uncomfortable about using medical marijuana.”

And the change in law may help prevent other undesirable consequences, she noted. In cases where marijuana possession or transportation may have led to a serious criminal record, which in turn dampens job prospects, “Legalization may prevent the loss of future opportunities,” Borenstein pointed out. “In other words, it may be time we stop imprisoning folks for engaging in cannabis use and turn our attention to education and prevention, especially in youth.”

As part of the effort to inform Central Coast professionals about the health impacts of marijuana, Dean, Borenstein, and their colleagues in both Santa Barbara and San Luis Obispo counties are teaming up to put on a cannabis education workshop for those who work in medicine, mental health, substance use disorders, and youth services. The conference will take place on Friday, November 3rd, at the Santa Ynez Valley Marriott in Buellton. Keynote speakers include Dr. Larry Wolk, chief medical officer for the public health department of Colorado, and J. Cobb Scott, PhD, a leading neuropsychology researcher on the effects of cannabis on cognitive functioning and mental health.

The hope, Dean said, is that healthcare providers and other professionals from across the Central Coast will leave the workshop better informed and prepared to educate their patients and clients.

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CENTRAL COAST PHYSICIANS

A SOBER PERSPECTIVE, AND A CALL TO ACTION It’s a delicate balance: acknowledging the potential benefits of cannabis use and legalization while working to educate the public about the drug’s very real health risks. John Doyel has been working to achieve that balance for more than thirty years.

As the Alcohol and Drug Program Manager for Santa Barbara County, Doyel oversees youth and family treatment programs in Santa Maria, Lompoc, and Santa Barbara, including a program specifically targeted to cannabis use.

Get Doyel talking about cannabis, and his enthusiasm for the subject is immediately evident.

“Marijuana is the most fascinating drug out there,” he said. “It’s completely idiosyncratic. It’s classified as a psychedelic, yet it can also be stimulating, depressing, and have hallucinatory effects.

People who use the drug can be paranoid, energized, or relaxed and calm. It tends to polarize the American people; pot is either demonized or celebrated.”

In other words, Doyel said, “It seems like no one has a sober view of marijuana. People take extreme positions, and it’s entertaining as hell, but it’s not helpful.”

Few Central Coast professionals are more familiar with the negative health impacts of cannabis use, and yet Doyel is careful to stress the drug’s mildness when compared to some of the alternatives.

“It’s relatively harmless compared to other drugs of abuse,” he acknowledged. “At the same time, we have conclusive evidence that marijuana affects adolescent brain development. We can predict that adolescents who use on a regular basis are four times as likely to become drug addicted as adults. It affects motivation and lowers IQ. Adolescents who use cannabis tend to have more negative life outcomes. The research is absolutely conclusive about that.”

On the other hand, he continued, “Facts like this have led to demonization of marijuana, which is unhelpful. The fact that 40 million people at least in this country use cannabis regularly is an indication that it’s not nearly as harmful as other drugs. I’ve always said: ‘Marijuana is neither god nor the antichrist.’ It’s not going to solve all your problems or relieve all your anxiety, but it’s also not as dangerous as people have made it out to be.”

In a 2016 Gallup poll, one in eight Americans reported current marijuana use, and 43 percent said they had tried the drug.

Although marijuana use is common in both adolescent and adult clients, Doyel said, “You don’t find marijuana alone bringing a lot of adults into our treatment programs.” While alcohol, opioids, and painkillers are more common culprits for adults, he said, “Kids are smoking a lot of pot.”

Doyel sees plenty of problems arising from marijuana use in adolescents. Often, by the time teens reach show up in county drug and alcohol programs, they’ve been in trouble with the law. Many of the County’s Drug and Alcohol Program clients are referred to the programs from the court system, Doyel said, though referrals from family, friends, employers, social services, and primary care doctors are on the rise.

When it comes to developing educational programs and

Fall 2017

anticipating the changes ahead, Doyel emphasized the range of severity in the cases he sees, and the need to distinguish between a casual user tangled up in the court system and those with more serious, chronic dependencies.

“Do most of these kids who end up in court for possession have a disorder characterized by craving, increased tolerance, preoccupation, and an inability to stop using?” he asked. “Probably not. Let’s say a kid buys a few grams of marijuana from some adult who bought it from the dispensary. He starts smoking a joint, and the cops show up. We don’t want to throw that kid in with a population of people who have more serious problems. It’s like putting a shoplifter in prison. So we’re looking at developing programs that are very specific and low-key.”

Over the decades, he noted, his approach to young cannabis users has shifted. “We tend not to pathologize adolescents as much as we used to,” he explained. “We used to put them in treatment programs, but we realized that we weren’t seeing as much need for treatment as for prevention.”

How can we intervene earlier, and who is best poised to do so?

Doyel believes it’s primary care providers, more than drug and alcohol counselors, who are in an ideal position to catch cannabis dependency and refer patients to treatment that can make a difference.

“A lot of people come in to the doctor’s office with problems that are actually drug and alcohol related, or at least exacerbated by it,” he said. “People have no problem going to a doctor. They have a big problem going to a psychiatrist or drug counselor.”

Thanks to the Affordable Care Act, he continued, all new medical patients must answer a questionnaire about alcohol use patterns.

“If one flag goes up for alcohol, usually other flags will go up, and even though doctors are not required to screen for other drugs, they often do. It’s the primary care doctor who is going to be able to recognize a drug and alcohol problem and face the least amount of denial and resistance.”

At the same time, Doyel acknowledged the many pressures on primary care physicians and the need for agencies to work together to tackle the challenge of early intervention.

“More and more, primary care doctors will be pressured to look at these situations, to look at the whole person – the overall gestalt of a person – and start dealing with substance use disorders and mild to moderate mental health issues. That means they’re going to need education and support. Addiction and mental health isn’t often what they signed up for. It’s up to us in behavioral health to collaborate and provide that support.”

There’s no predicting exactly what kind of public health impacts the South Coast will see as a result of the passage of Prop. 64. For some, such a lack of clarity might be daunting. But physicians like Dean and Borenstein have spent their careers reacting to unpredictable and emerging public health threats, and in this sense, the legalization of cannabis is no different. What’s clear is that in this new era, educating citizens and combatting the negative health impacts of marijuana use will require fair-mindedness, flexibility, and a joint effort.

Fall 2017

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CENTRAL COAST PHYSICIANS

23

MEN’S HEALTH

Misandry

One of my great heroes is Billie Jean King, winner of The Battle of the Sexes, the 1973 tennis match now the subject of a movie in which she is played by Emma Stone and her self-proclaimed male chauvinist pig opponent Bobby Riggs, played by Steve Carrell.

I was thrilled to meet King when she spoke at the annual meeting of the Massachusetts Medical Society before I moved here in 2010. What does this have to do with the subject of misandry, the counterpart of misogyny, i.e. despising men simply because they are men? Because Billie Jean King, despite her battle with the obnoxious Bobby Riggs, has spent a life devoted to leveling the playing field in both tennis and life in general for both men and women.

Even at age 12, she noticed that in tennis, the balls were white, the clothes were white, and all the players were white. As a successful tennis professional, she set about trying to change that. She told us at Mass Medical, “that’s the way I want the world to work: men and women working together, championing each other, promoting each other – we’re all in this world together”.

Ultimately, her efforts to bring this about led to her receiving the Presidential Medal of Honor in 2009.

In contrast, men today as a group are perhaps the last socially sanctioned targets of ridicule and derision. TV ads typically portray men as stupid boors interested only in trucks, beer, and sports. Men are often stereotyped as faithless, thrill seeking, and irresponsible: the husband and father who trades in his 40-yearold wife for two 20-year-olds.

Suicide is the 9th leading cause of death in men with rates several times that of women. Could misandry be a factor?

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CENTRAL COAST PHYSICIANS

BY DAVID DODSON, MD

I don’t believe that good and evil are inherent qualities of either men or women: there good men and bad men just as there are good women and bad women. Neither gender has a lock on virtue.

There are plenty of quintessential male qualities to celebrate.

And I do not mean women lack these qualities, just that they are considered typically male in the best sense. I speak of qualities such as courage, loyalty, and industriousness.

Over the years, I have had the great pleasure of occasionally meeting women still head over heels in love with their husbands of several decades. What an inspiration. These women had nary a trace of misandry about them.

The very model of devotion, faithfulness, and every good quality except perhaps self-preservation is embodied by my patient, JF, a perfectly delightful 86-year-old gentleman married for 63 years to his wife, CPF. He kept a vigil at her bedside for months after she suffered multiple complications following elective surgery. Sadly, during this difficult time I diagnosed him with prostate cancer with widespread bone metastases and I urged him to consult an oncologist. He told me “Doc, I’ve had a long and wonderful life with every blessing thanks to my wife and I can’t imagine going on without her. She’s my priority now, not me”. So far, I have yet to get him to seek care for himself many months later.

When was the last time you saw a man of that caliber celebrated in the media?

As always, your thoughts, comments, and criticisms are welcome.

Fall 2017

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25

Public Health

Update

Opioid Epidemic on the Central Coast How Physicians Can Be Part of the Solution at the Clinical and Community Levels

By Penny Borenstein, MD, MPH, Health Officer/Public Health Director, County of San Luis Obispo

As many of us know too well, SLO County has not been spared from our nation’s opioid epidemic. In the medical community, we’re familiar with the multi-faceted challenges and questions opioids can present in the clinical setting. In public health, we are working intensely to understand and address this epidemic on a community level, including the ways opioid use intersects with and can exacerbate other health challenges.

As physicians, how can we play a meaningful role in addressing the opioid epidemic and its consequences on the Central Coast?

As we all grapple with these challenges, I’d like to encourage physicians in our community to avail ourselves of opportunities to be part of the solution at both the clinical and community levels.

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CENTRAL COAST PHYSICIANS

Where to Get Naloxone in SLO County Reference for physicians | September 2017

Naloxone is available at no cost or low cost at locations across San Luis Obispo County, including confidential or anonymous settings. Naloxone is available for patients as an injection or a nasal spray. Medi-Cal now offers $0 co-pay access to Narcan Nasal Spray. Many insurance plans also cover naloxone; some require an opioid use diagnosis while others do not.

Clinicians can write a prescription for naloxone, alone or co-prescribed with opioids. The prescription can be filled at any CVS or Rite Aid Pharmacy in SLO County.

County of San Luis Obispo Drug and Alcohol Services prescribes naloxone and provides education sessions on when and how to use it. For details: 805.781.4756.

SLO Bangers Syringe Exchange Program provides naloxone without a prescription, at no cost and in a confidential setting to people who use opioids or concerned family and friends. For details: 805.458.0123, or stop by Wednesdays from 5:30-7:30 at 2191 Johnson Avenue in San Luis Obispo.

Certain pharmacies provide naloxone from the pharmacist without a prescription.

Note that patients must ask for the pharmacist, as only the pharmacist – not front-line staff – will be able to furnish naloxone.

CVS SLO – 11990 Los Osos Valley Road CVS Downtown SLO – 717 Marsh Street CVS Arroyo Grande – 1435 E Grand Avenue CVS Nipomo – 610 W Tefft Street CVS Paso Robles – 187 Niblick Road Cayucos Pharmacy – 72 S Ocean Avenue En Soleil Pharmacy in Atascadero – 5735 El Camino Real For updates, visit naloxone.opioidsafetySLO.org

Fall 2017

Clinical Opportunities: Naloxone and LongTerm Treatment

In recent years, research has repeatedly demonstrated the effectiveness of community-administered naloxone in reducing opioid overdose deaths, reducing overdose-related emergency department visits, and improving outcomes in cases when patients subsequently arrive in the emergency department.

(One good collection of recent research is available at prescribetoprevent.org/research-legal/research.)

The Public Health Department is working to increase access to naloxone at the community level on multiple fronts, including support of the syringe exchange program in San Luis Obispo.

I have provided a signed standing order for naloxone to be distributed at the syringe exchange to people at risk of opioid overdose and people who have regular close contact with those at risk. Our office provided administrative support for a California Department of Public Health grant that provides this naloxone at the syringe exchange. The program is run in our office space after hours by volunteers, who provide training on overdose prevention and response with every naloxone rescue kit they distribute.

The SLO County EMS Division is also currently developing a policy to allow local law enforcement agencies to administer naloxone for known and suspected opioid overdoses, with the goal of law enforcement teams in San Luis Obispo County carrying the medication by early 2018. Law enforcement agencies in Santa Barbara County are already approved to carry and administer naloxone.

• Inform yourself about other options in our community for patients and their family or friends to get naloxone. The resource card accompanying this story provides more detail. I encourage you to keep it handy and share the information with your colleagues and patients.

While naloxone has an important role in reducing overdose deaths, it is of course a short-term solution. Many patients require long-term intervention, treatment, and recovery options. The accompanying resource card includes an overview of public and private options in our community for medication assisted treatment and ongoing psychological and social support for those in recovery.

Community Opportunity: SLO Opioid Safety Coalition

I am proud to work alongside a diverse coalition of community members, including physicians, law enforcement, pharmacists, treatment professionals, educators, community members, and people in recovery as part of the SLO Opioid Safety Coalition.

Since January 2016, this group has worked collaboratively on practical steps to address the opioid epidemic on the

As a provider, you can: • Prescribe naloxone to patients you treat for opioid overdose. Research shows the availability of naloxone does not affect rates of relapse for those seeking recovery.

• Co-prescribe naloxone with opioid prescriptions.

Clinicians report that co-prescribing has the added benefit of communicating the seriousness of opioid risk. Patients consistently underestimate their own risk of overdose and this conversation sends a powerful message about safety.

• Frame the conversation in non-stigmatizing language focused on risky drugs rather than risky patients. An excellent example from our naloxone education team: “I want to talk to you about the safety of your opioid medications. The medications you take are potentially fatal, and because I care about your safety, I want you to know about naloxone in case an emergency ever arises.” This increases patient acceptance of naloxone and has the added benefit of increasing trust and openness between patients and providers.

Fall 2017

Central Coast in ways that are relevant and appropriate to our community. Each sector’s unique perspective is key to this work’s success. The coalition works in five action teams: • Safe Prescribing and Health Care • Naloxone: Overdose Antidote • Medication Assisted Treatment • Data Collection and Monitoring • Community Prevention and First Responders There is much work ahead, and many opportunities to contribute to this collaboration at different levels based on your availability.

I encourage you to learn more and express your interest at opioidsafetyslo.org.

As always, I welcome your input and discussion as our community takes on this complex medical and public health challenge.

CENTRAL COAST PHYSICIANS

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7 New

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

Brittany Bryan, MD Internal Medicine Santa Barbara 682.3771

Troy Mounts, MD, MA Orthopedic Surgery Templeton 544.2500

Hugh Byers, MD, PhD Pathology Western Diagnostic Laboratory Services Santa Maria 548.1550

Bruce Ragsdale, MD Pathology Western Diagnostic Laboratory Services Santa Maria 548.1550

Donald Fareed, MD Orthopedic Surgery Santa Barbara 969.0988

Beverly Ramos, MD Psychiatry Templeton 237.2609

RESIDENTS Sarah Langdon General Surgery Santa Barbara Cottage Hospital

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CENTRAL COAST PHYSICIANS

Fall 2017

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CENTRAL COAST PHYSICIANS 29

In Memoriam Charles Baring Farmer, MD December 8, 1931 – June 27, 2017 Charles Baring Farmer, MD passed into eternal rest on Tuesday, June 27, 2017, surrounded by his 4 children and devoted caretaker, Karla.

He was born December 8, 1931, to Agnes and Tudor Farmer in Miami, Florida. As a youngster, he enjoyed adventures at Key Biscayne Beach and listening to the many stories told by his pharmacist father and nurse mother. With an eagerness to learn and grand dreams, he skipped two grades in school and entered the University of Notre Dame as a young Freshman. After attaining his undergraduate degree, Baring enlisted in the US Navy Officer Candidate School during the Korean Conflict. He graduated Lieutenant Junior Grade and became a Gunnery Officer on the USS James Dyess and Saufley destroyers.

Upon discharge from the Navy, he attended University of Miami Medical School and then had an internship at the LA County Hospital where he met and married Elizabeth “Betty” Ann Sitter. He then worked a year at the VA completing a surgical residency. Next, Baring moved his young family to Miami, where he completed a 3-year orthopedic residency. Then to University of Iowa for a 6-month hand surgery fellowship under the renowned hand surgeon and dear friend, Dr. Adrian E Flatt, MD. Longing to be back in California, in 1965, he moved the family to San Luis Obispo to set up his orthopedic practice. He was the third orthopedic doctor in town and serviced all hospitals from Santa Maria to Paso Robles.

Keeping current in his field was very important to him and he enjoyed traveling all over the world to meetings for the American Society for Surgery of the Hand.

After 38 years of medical service, Baring retired and enjoyed spending time in his beloved Avila Beach. His hobbies included traveling, visiting family and friends, gardening, walking, reading, and greatly supporting education and the arts. He was preceded in death by his brother, James Tudor Farmer. Baring is survived by his sister Dean Sheridan; his 4 children: Bing, Matthew, Andrew and Katherine; and his 8 lovely grandchildren. He will be dearly missed!

Originally published in the San Luis Obispo Tribune.

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CENTRAL COAST PHYSICIANS

Fall 2017

In Memoriam Jerome Thomas Kay, MD March 21, 1939 – September 15, 2017 Surrounded by his adoring family, Jerome Thomas Kay passed away peacefully on September 15, 2017. Jerry was a loving husband, a devoted father and grandfather, a healer and a dear friend.

Jerry was born on March 21, 1939 in Chicago, Illinois, one of four brothers born to Henry and Mary Kay. As a child, Jerry developed a quick wit, a love of sports, and a deep respect for hard work and scholarship. This last quality in particular served him well. He earned his undergraduate degree from Marquette University and completed his MD at Northwestern School of Medicine in 1965.

Jerry moved to Oahu, Hawaii to complete his internship. It was there that he met the love of his life, a Canadian nurse by the name of Gail Curry. During their courtship, Jerry joined the United States Navy, where, with a desire to aid sick and wounded countrymen, he served as a naval physician in the Vietnam War. After his service, Jerry returned to practice in Hawaii and shortly he and Gail were married in Oshawa, Ontario, Canada in 1967. In 1970, the couple moved to Santa Barbara with their firstborn son John. Brothers Christopher and Matthew were born shortly thereafter.

Jerry went into private practice upon arriving in Santa Barbara, where he served the community practicing family medicine for 47 years. He was deeply respected by his colleagues and beloved by generations of patients for his skill, genuine compassion, and profound humility.

After working solo for many years, Jerry went into practice with two separate partners. The first was Dr. Henry Holderman and then Dr. Kirk Gilbert, with whom he practiced for 23 years. Jerry developed a close relationship with St. Francis Hospital, where he served as Chief of Staff from 1983 - 1985. He also worked closely with Santa Barbara County Public Health and served as president of the Santa Barbara County Medical Society in 1994. In response to the emergence of Health Maintenance Organizations, and in an effort to preserve independent family doctors and their practices, Jerry founded a physicians group named Central Coast Independent Physicians Association in 1982. This group later changed its name to Santa Barbara Select I.P.A., where Jerry served as Board President until his death. Jerry retired from private practice on July 1, 2015, but continued to guide health care at Val Verde Retirement Community and make meaningful contributions to the community at large.

Jerry’s talents and his commitment to health care and community were matched by the way he approached his personal life. Above all, he devoted himself to his family and friends. He enjoyed playing tennis at Knowlwood Tennis Club, playing golf and bridge with close friends at The Valley Club, and fly fishing with his sons. He and Gail traveled the globe together and with friends, collecting knowledge, perspective, and memories. Throughout his life, Jerry treated those he encountered with respect and kindness. He was beloved by his family and friends, who loved his intellect, honesty, constant kindness, and ever-present sense of humor. Jerry was a man in full, who lived a rich, dignified, and meaningful life, always in service to others. He was a true gentleman. Jerry will be profoundly missed.

Jerome Kay is survived in death by Gail, his wife of 50 years; son John and his wife Page and grandsons Jackson and David; son Christopher and son Matthew and his wife Clara.

Originally published in the Santa Barbara News-Press.

Fall 2017

CENTRAL COAST PHYSICIANS

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